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A multicentre, retrospective cohort study comparing the real-world incidence of Nd:YAG laser capsulotomy procedure to treat posterior capsular opacification in the first 3 years after cataract surgery among hydrophobic and hydrophilic acrylic IOLs

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Session Details

Session Title: Cataract Surgery Practice Styles/PCO

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:00

Paper Time: 15:02

Venue: Room 4.4

First Author: : P.Ursell UK

Co Author(s): :    M. Dhariwal   M. Keith   K. Majirska   F. Ender   C. Miglio   S. Rabhi     

Abstract Details


PCO is the commonest complication after cataract surgery. It causes significant visual impairment and often requires treatment with neodymium-doped yttrium aluminium garnet laser capsulotomy (Nd:YAG), with associated risks and costs. The aim of this study is to generate real-world evidence on the incidence of Nd:YAG and PCO over 3 years following age-related cataract surgery, comparing outcomes for hydrophobic monofocal AcrySof IOLs versus a basket of non-AcrySof monofocal acrylic IOLs (hydrophilic and hydrophobic) in a large, multicentre, retrospective cohort.


This study is a retrospective analysis of anonymised electronic medical records of cataract patients from a selected sample of 7 NHS (National Health Service) ophthalmology clinics across the UK.


Eyes from patients (≥65 years) undergoing cataract surgery with in-the-bag implantation of acrylic monofocal IOLs during 2010-2013 and with ≥3-year follow-up were analysed. At 3 years, Nd:YAG incidence proportions and 95% confidence intervals (CI) were reported for AcrySof IOLs and non-AcrySof IOLs, overall and by hydrophobic and hydrophilic properties. A sensitivity analysis in the sub-group of single-piece IOLs was also performed. Unadjusted/adjusted odds ratios (95% CI) were calculated through multivariate logistic regression for AcrySof versus non AcrySof lenses. Time to Nd:YAG in the two groups was modelled over the 3 years using Kaplan-Meier curves.


The AcrySof and non-AcrySof groups included 13,330 and 38,832 (hydrophobic: 19,025; hydrophilic: 19,807) eyes, respectively. The 3-year Nd:YAG incidence for AcrySof IOLs (2.4%, CI: 2.2-2.7%) was 2-times lower than for hydrophobic (4.4%, CI: 4.1-4.7%) and 4-time lower than for hydrophilic (10.9%, CI: 10.5-11.3%) non-AcrySof IOLs. Similar trend was found when restricting to single-piece IOLs (2.4% vs 5.1% vs 10.9%, respectively). Overall, AcrySof recorded 70% lower risk of Nd:YAG (adjusted OR 0.29, CI: 0.26-0.33) compared to other non-AcrySof IOLs. The difference in proportions of eyes not undergoing Nd:YAG became apparent after 1.5 years and continued to progress for the non-AcrySof group.


This study generated robust real-world evidence on the association between IOL materials and post-cataract Nd:YAG capsulotomy procedure to treat PCO. The results indicate that AcrySof single-piece IOLs are protective against PCO and subsequent Nd:YAG treatment compared to other single-piece hydrophobic and hydrophilic acrylic IOLs in the 3 years after cataract surgery. Future studies will confirm these findings over longer follow-up durations and investigate the consequences of lens choice for patient quality of life and overall healthcare costs.

Financial Disclosure:

is employed by a forNONEprofit company with an interest in the subject of the presentation, research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, receives consulting fees, retainer, or contract payments from a competing company

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