This was a longitudinal, retrospective cohort study featuring 47,754 (three years) and 20,763 (five years) eyes with age-related (≥65 year) cataract surgeries between 2010-2013 across seven UK ophthalmology clinics. The three- and five-year incidence of posterior capsular opacification (PCO) and Nd: YAG capsulotomy in eyes implanted with single-piece, square-edged acrylic monofocal IOLs were derived from electronic medical record data. IOL models of Alcon AcrySof, AMO Tecnis, Bausch & Lomb (B&L) Akreos, LenStec Softec, and Rayner Flex were analysed. The three-year incidence ranged between 4.7-18.6% for PCO and 2.4-12.6% for capsulotomy. The five-year incidence ranged between 7.1-22.6% for PCO and 5.8-19.3% for capsulotomy. AcrySof demonstrated the lowest five-year incidence of PCO (7.1%, p<0.001) and capsulotomy (5.8%, p<0.001). Adjusted logistic regression correcting for known confounders confirmed that AcrySof had the lowest three- and five-year odds of PCO and capsulotomy. Compared with AcrySof the odds ratios at three years for PCO and capsulotomy were as follows: AMO Technis (1.49, 2.15), B&L (2.95, 4.25), Lenstec (3.65, 5.34), Rayner (4.73, 6.03). These results may be explained by the different fibronectin binding properties of the acrylate material used in AcrySof IOLs compared with other hydrophobic materials. Patients with any postoperative complications were 4.5 and 4.76 times more likely to experience PCO and capsulotomy at five years. Patients with any documented ocular co-pathologies prior to surgery were 1.37 and 1.22 times more likely to experience PCO and capsulotomy at five years. Other covariates that appear to increase risk are younger age, female gender, bilateral surgery, lower IOL power and better visual acuity.
Multicentre PCO rates in different brands of monofocal intraocular lenses
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