Posterior capsule opacification with 3 intraocular lenses: 12-year prospective study

Abstract

Purpose: To compare posterior capsule opacification (PCO) with 3 intraocular lenses (IOLs) 12 years postoperatively.

Setting: St. Erik Eye Hospital, Stockholm, Sweden.

Design: Randomized clinical trial.

Methods: Patients having unilateral standard phacoemulsification were randomized to implantation of a round-edged heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) IOL, a round-edged silicone IOL, or a sharp-edged hydrophobic acrylic IOL. The neodymium:YAG (Nd:YAG) capsulotomy rates and timing from surgery were recorded. Survival analysis was used to compare Nd:YAG rates. Retroillumination images were taken to evaluate PCO.

Results: After 12 years, there was no significant difference in the fraction or severity of PCO between the silicone IOL and acrylic IOL. The HSM PMMA IOL had a significantly higher PCO fraction than the silicone IOL (P<.05), but not more than the acrylic IOL. There was no difference in PCO severity between the HSM PMMA IOL and the other 2 IOLs. The silicone IOL had higher median capsulotomy-free survival (>150 months) than the acrylic IOL (108 months) and the HSM PMMA IOL (53 months). Overall survival without Nd:YAG capsulotomy did not differ between the acrylic and silicone IOLs or between the silicone and HSM PMMA IOLs; however, overall survival was significantly better with the acrylic IOL than with the HSM PMMA IOL (P<.001).

Conclusions: After 12 years, there was no difference in PCO or overall survival without capsulotomy between the acrylic IOL and the silicone IOL. The HSM PMMA IOL had a significantly higher PCO fraction than the silicone IOL and lower overall survival than the acrylic IOL.