Effect of four different intraocular lenses on posterior
capsule opacification
Naim Ismail ImunuKepaniteraan Klinik Ilmu Kesehatan Mata
RSUD R. Soedjati Purwodadi
Introduction
Cataract Surgery
Posterior Capsule Opasification Surgery Method
Laser Nd:YAG
Material of IOLs
Subject and Methods• Study Population
– Data was collected retrospectively for 4970 consecutive eyes of 4013 patients
• Inclusion– patients with senile cataract who underwent uncomplicated
phacoemulsification surgery and IOL implantation performed by one surgeon (Karel F) at the Ankara University Faculty of Medicine, Department of Ophthalmology between January 2000 and January 2008.
• Exclusion– concomitant ocular pathologies (uveitis or history of uveitis high myopia
(>S-6D )– previous trauma or had suffered any intra operative complication
(capsulorhexis rim tear, zonular rupture, posterior capsule rupture with or without vitreous loss or the usage of the capsule tension ring)
Devided into 4 groups based on 4 different IOLs
• Group 1 :AcrySof SN60AT (Alcon Laboratories, Inc., Fort Worth, TX, USA), 1-piece acrylic hydrophobic IOL with a 6.0 mm optic diameter, a 13.0 mm overall diameter and acrylic haptics angled at 0°, was implanted in 1399 eyes of 1014 patients.
• Group 2 : AcrySof MA30BA (Alcon Laboratories, Inc., Fort Worth, TX, USA), a 3-piece acrylic hydrophobic IOL with a 5.5 mm optic diameter, a 12.5 mm overall diameter and poly methyl metahacrylate (PMMA) haptics angled at 5°, was implanted in 1509 eyes of 1242 patients.
• Group 3 : AcrySof MA60BM (Alcon Laboratories, Inc., Fort Worth, TX, USA), a 3-piece acrylic hydrophobic IOL with a 6.0 mm optic diameter, a 13.0 mm overall diameter and PMMA haptics angled at 10°, was implanted in 1501 eyes of 1324 patients.
• Group 4 : Aqua-SenseTM III (Aaren Scientific Inc.,Ontario, USA) a 3-piece acrylic hydrophilic IOL with a 6.0 mm optic diameter, a 12.5 mm overall diameter and acrylic haptics angled at 5°, was implanted in 561 eyes of 433patients.
Surgeon
• (Karel F)• Ankara University Faculty of Medicine,
Department of Ophthalmology between January 2000 and January 2008
Post operative treatment
• Dexamethason topical 0,1%• Ciprofloxasin topical• 5 time daily for 1mo
Statistical analysis• PCO development associated with each IOLMajor outcome
• Were compared using a Z testThe differences between groups
• assessed using the Chi-square test. A value P less than 0.05 was considered statisticallysignificant.
statistical significance ofdifferences in frequencies
• SPSS 13.0 software SPSS Inc., Chicago, USA)Analysis
RESULT
Mean of age
PCO requiring Nd:YAG laser/% Sign. Mean time PCO
developement Sig.
Group 1 67.90±9.55 41 eyes/2.93% 0,74 13.21±10.02mo 0,001
Group 2 66.90±10.73 41 eyes/2.72% 0,71 33.11±25.06mo
Group 3 69.33±8.44 45 eyes/3.00% 0,71 22.25±16.02mo
Group 4 70.03±9.56 26 eyes4.63% 0,015 39.91±15.52mo 0,001
DISCUSSION
• The incidence of PCO is affected by many factors. • The development of modern foldable IOLs with square-edged optics has greatly
reduced the incidence of PCO following cataract surgery.
recent studies
• The sharp optic edge, now known to be a major inhibitory factor for PCO development
Camparasion of IOLs
material
• The clinical introduction of 1-piece acrylic hydrophobic IOLs with some differences in optic and haptic design was expected to be associated with a different rate of PCO development compared with 3-piece acrylic hydrophobic IOLs.
• 1y after surgery, 1-piece acrylic IOLs are associated with slightly more regeneratory PCO than 3-piece acrylic IOLs made from the same material.
• the modification of an IOL from a 3-piece to a 1-piece haptic design caused no significant change in the development of PCO.
• hydrophilic acrylic lenses provide a suitable environment for lens epithelial cells migration because of the hydrophilic surface properties.
• Previous studies have reported that hydrophobic IOLs are associated with lower rates of PCO than hydrophilic IOLs
IOLs causing
PCO
• According to our results, eyes with acrylic hydrophobic optic IOLs were more likely to require Nd:YAG laser capsulotomy than eyes with acrylic hydropholic optic IOLs.
The needed
of Nd:YAG
laser
Conclusion
• A higher percentage of eyes with hydrophilic acrylic IOLs developed PCO than eyes with acrylic hydrophobic IOLs.
• no significant difference in the long-term PCO rate of a1- or 3-piece hapticlens design.
• Eyes with acrylic hydrophilic IOLs did not require an Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs.
summary
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Apakah penelitian ini penting ?
Penting bagi praktisi
kesehatan mata untuk mengetahui
perkembangan tentang pengaruh
jenis IOLs terhadap
insidensi PCO
Apakah hasil penelitian tersebut
mungkin untuk diterapkan pada
pasien kita ?
Tidak bisa, mengingat
sebagian besar pasien kita BPJS
sehingga opsi untuk jenis lensa
yang spesifik terbatas