Abstract
AimCataract extraction is one of the most frequent surgeries in Germany. In most cases, the clouded natural lens is replaced by a hydrophobic or hydrophilic acrylic intraocular lens (IOL) implant. The most common long-term complication after cataract surgery is the development of a posterior capsule opacification (PCO). Although no precise real world data are available, published evidence suggests a lower risk for PCO development for hydrophobic acrylic IOLs compared to hydrophilic acrylic IOLs. Therefore, in the present study we assessed real world data on the impact of different IOL material types on the incidence of post-operative PCO treatment.Subject and methodsIn this retrospective study, we included 3,025 patients who underwent cataract extraction and implantation of either an acrylic hydrophobic or hydrophilic IOL in 2010. We assessed clinical outcomes and direct costs in a 4-year follow-up period after cataract surgery from a statutory health insurance (SHI) perspective in Germany.ResultsPCO that required capsulotomies occurred significantly (p < 0.0001) less frequent in patients who had received a hydrophobic IOL (31.57% of 2,078 patients) compared to the group with hydrophilic IOL implants (56.6% of 947 patients) and costs per patient for postoperative treatment in a 4-year follow-up were 50.03 € vs. 87.81 € (i.e. 75% higher in the latter group, p < 0.0001).ConclusionConsidering the high prevalence of cataract, the economic burden associated with adverse effects of cataract extraction is of great relevance for the German SHI. Hydrophobic lenses seem to be superior regarding both medical and economic results.
Highlights
Cataract, the clouding or loss of transparency of the eye’s natural lens is the leading cause for blindness worldwide (Abraham et al 2006)
Since a contralateral intraocular lens (IOL)-implantation increases the risk for a posterior capsule opacification (PCO) treatment, the average costs for patients with hydrophobic IOL implants are overestimated by around 2.6%5 and should be decreased by this factor compared to hydrophilic IOL.6. This would result in average costs of 48.72 € for population A. This retrospective analysis was performed to compare the incidence of PCO measured by Neodymium-doped yttrium-aluminum-garnet (Nd):YAG laser capsulotomy or surgical intervention after implantation of either hydrophobic or hydrophilic IOLs following cataract extraction
Hydrophobic acrylic lens material was found to be related to a lower risk of PCO development measured by the rate of Nd:YAG laser capsulotomy compared to hydrophilic acrylic IOL material (34% vs. 49%, p = 0.04; Schriefl et al 2015)
Summary
The clouding or loss of transparency of the eye’s natural lens is the leading cause for blindness worldwide (Abraham et al 2006). Prevalence rates of age-related cataract as the most common form considerably increases from about 30% for the 60–69-year-old population up to more than 60% for those older than 70 years (Prokofyeva et al 2013). Surgical cataract extraction is the sole effective treatment to restore visual function and prevent blindness (Prokofyeva et al 2013). With about 850,000 up to 1,000,000 yearly cases, cataract extraction is one of the most frequently performed surgeries in Germany, representing a high economic burden to the healthcare system (AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH 2010). The affected lens is extracted and replaced by an IOL implant. IOLs are available in four optic materials, i.e. polymethylmethacrylate (PMMA), high water content hydrophilic acrylic, low water content
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