Abstract
PurposeThis meta-analysis aims to evaluate the differences in performance of posterior capsular opacification (PCO) between hydrophobic acrylic intraocular lens (IOLs) and hydrophilic acrylic IOLs.SettingTianjin Medical University, Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China.DesignSystematic review of randomized controlled trials (RCTs) or meta-analysis.MethodsAn electronic literature search was performed using the PubMed, EMBASE and Cochrane Library database before May in 2013 to identify prospective RCTs comparing hydrophobic acrylic IOLs and hydrophilic acrylic IOLs in patients after phacoemulsification with IOL implantation with a follow-up time of at least 1 year. Pertinent studies were selected by meeting predefined criteria and reviewed systematically by meta-analysis. The PCO scores and YAG capsulotomy rate, as indicator of PCO, were measured and discussed in a meta-analysis. Standardized mean differences (SMD), relative risk ratio (RR), and the pooled estimates were computed according to a random effect model or fixed effect model.ResultsNine prospective RCTs involving 861 eyes were included in the current meta-analysis. The hydrophobic acrylic IOLs were favored and the pooled SMD of PCO severity was1.72 (95% confidence interval (CI), 0.20 to 1.23, P = 0.0002) and 1.79 (95% CI, 0.95 to 2.64, P<0.0001) with 1-year follow-up and 2-year follow-up respectively. The pooled RR of Nd:YAG laser capsulotomy rates at postoperative 2-year follow-up was 6.96 (95% CI, 3.69 to 13.11, P<0.00001) comparing hydrophilic acrylic IOLs with hydrophobic acrylic IOLs.ConclusionsCompared with hydrophilic acrylic IOLs, the hydrophobic acrylic IOLs showed superior reduction in rates of PCO and laser capsulotomy in 2-year follow-up. More RCTs with standard methods for longer follow-up are needed to validate the association.
Highlights
With the development of surgical techniques and biomaterial science, cataract surgery with intraocular lens (IOL) implantation has brought great benefits for patients
Nine prospective randomized controlled trials (RCTs) involving 861 eyes were included in the current meta-analysis
The hydrophobic acrylic IOLs were favored and the pooled Standardized mean differences (SMD) of posterior capsule opacification (PCO) severity was1.72 (95% confidence interval (CI), 0.20 to 1.23, P = 0.0002) and 1.79 with 1-year follow-up and 2-year follow-up respectively
Summary
With the development of surgical techniques and biomaterial science, cataract surgery with intraocular lens (IOL) implantation has brought great benefits for patients. Posterior capsule opacification (PCO), remains the most frequent long-term complication [1], decreasing the visual performance in 1 or 2 years after cataract surgery. Two areas of concern are the biomaterials and the edge design of IOLs. Studies have shown that the rate of PCO with sharp edge designed IOLs was lower due to the inhibition of lens epithelial cells (LECs) migration [3,4]. Acrylic IOLs with hydrophilic or hydrophobic surfaces, as two types of biocompatibility materials, safe for intraocular implantation, have a long history of clinical practice and have shown significantly lower rates of PCO and less Nd:YAG laser capsulotomy [5,6,7,8]. Whether the hydrophilic or hydrophobic IOLs are better for PCO prevention remains controversial
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