Comparison Of The Incidence Of Posterior Capsular Opacification Post Pciol Implant With Two Aspheric Posterior Chamber Intraocular Lenses

To study the quality of vision and incidence of posterior capsular opacity(PCO) or secondary cataract in two monofocal aspheric posterior chamber intra-ocular lenses (PCIOLs) : Alcon Acrysof SN60WF and Hoya Vivinex iSert model XY1.

Objectives-

PRIMARY:

To compare incidence of PCO between two monofocal aspheric PCIOLs: Alcon Acrysof SN60WF and Hoya Vivinex iSert model XY1.

SECONDARY:

To compare subjective and objective methods of PCO scoring To correlate visual impairment with the extent of PCO.

A retrospective+prospective study including one or both eyes of patients with senile cataract, who underwent cataract surgery by single surgeon under cataract and refractive surgery clinic of Advanced Eye Centre, PGIMER, Chandigarh between 01/09/2017-31/08/2018 and were willing to follow up for evaluation of PCO. Patients were selected using pre- existing Medical Records Department data where either or both eyes had one of the IOLs of interest:

AcrySof SN60WF or

Hoya Vivinex iSert model XY1

Enrollment: 72 eyes (37 vivinex +35 AcrySof)

Allocation : Convenience sampling

Study start date:01/09/2017

Completion date:30/06/2022

Patients operated during 01/09/2017-31/08/2018

Period of enrolment-01/10/2021-30/06/2022

Ages Eligible to study: 50-70 years

Following parameters were assessed on follow up:

1.Visual acuity(VA) for distance using Snellen’s chart

2.Intraocular pressure-non-contact tonometry

3.Anterior segment(AS) photo, iTRACE, functional acuity contrast testing- 3.5-4.5 folow-up post surgery

4.Analysis of the PCO on AS photo using ImageJ software and iTRACE(MAP score)

5.Analysis of visual impairment, Modulation transfer function(MTF)-iTRACE and functional acuity contrast testing(FACT)

6.Subjective Questionnaire-vision quality assessment

• PCO area (divided into grades) was analysed using ImageJ score, intensity, zone, VA, MTF, opacity map score, Contrast (FACT) and subjective symptoms.
• Incidence of PCO in Group 1(SN60WF) was 74.3% whereas it was only 32.4% in Group 2(Vivinex), (p<0.05).
• Subjective symptoms of PCO like Glare, Halos, Distortion and Haze were significantly more in SN60WF group(p<0.05). Ghosting was not reported by any patient. Clarity of vision scored higher in Vivinex group.
• VA in SN60WF group showed a decline with more severe PCO, it could not be compared to vivinex group due to lack of moderate and severe PCO in Vivinex group. Difference in best corrected VA in mild PCOs were presumably skewed due to larger pool of patients in Vivinex group.

1. Hoya Vivinex XY1 with sharper posterior optic edge and ultraviolet-ozone irradiation of posterior surface was found to be superior to AcrySof SN60WF which lacks the above. Rest of the properties of the 2 lenses are similar. 
2. Manual evaluation of grade of PCO using AS photo and imageJ software which is free and easily available provides results parallel to the softwares available for PCO evaluation which are expensive and not readily available.
3. Subjective methods of grading a PCO are useful in assessing severity of PCO.
4. Subjective symptoms and the effect of PCO on involvement of visual axis was also evaluated and found to be significantly better with Hoya Vivinex XY1.