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Is Nd: YAG capsulotomy incidence influenced by IOL biomaterial? Real-word evidence from Spain at 3 & 5 years after cataract surgery

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First Author: J.Belda SPAIN

Co Author(s):    J. Placeres   J. Elvira   D. O'boyle   X. Puig   C. Perez Vives   M. Zou     

Abstract Details


Posterior Capsule Opacification (PCO) is the most common complication after cataract surgery and can result in reduced visual acuity, impaired contrast sensitivity and glare disability. Nd:YAG laser capsulotomies are performed to treat PCO, and can result in additional burden to patients and health care systems. Published evidence suggests that hydrophobic AcrySof intraocular lenses (IOLs) have a demonstrated lower incidence of Nd:YAG capsulotomy compared to other hydrophobic and hydrophilic IOLs. However, there is a paucity of comparative evidence versus IOLs with a hydrophilic-with-hydrophobic surface. The aim of this research was therefore to generate robust real-world evidence to fill this gap.


This study is a retrospective analysis of anonymised electronic medical records of cataract patients from two large Spanish University hospitals of the Ribera Salud group in the Torrevieja-Vinalopó healthcare area who are main providers of ophthalmic procedures in the Alicante region.


De-identified electronic healthcare records for patients aged 65+ years who underwent cataract surgery during the period Jan 2007 – Dec 2017 were extracted from the two large Spanish regional hospitals, and analysed with SAS 9.4. Nd:YAG laser capsulotomy incidence proportions and 95% confidence intervals (CI) were reported for hydrophobic acrylic AcrySof IOLs and non-AcrySof IOLs (hydrophilic-with-hydrophobic surface Zeiss Asphina IOLs; hydrophilic acrylic AJL, IOL Tech, and Medicontur IOLs ) at 3 years (n=8,478) and 5 years (n=4,011).


At 3 and 5 years post-surgery, Nd:YAG incidence was significantly lower for AcrySof compared to the other models. At 3-years the incidence of Nd:YAG capsulotomy for each IOL studied was as follows: 5.0% (CI 3.9%-6.1%) for AcrySof, 21.2% (CI 19.9%-22.5%) for Zeiss Asphina, 23.1% (CI 21.0%-25.2%) for Medicontur IOLs, 23.2% (CI 14.7%-31.6%) for IOL Tech, and 31.1% (CI 28.6%-33.5%) for the AJL IOL. While at 5-years, the following Nd:YAG rates were observed: 8.8% (CI 6.0 %-11.6%) for AcrySof, 44.3% (CI 42.4 %-46.2%) for Zeiss Asphina, 44.0% (CI 33.4 %-54.7%) for IOL Tech and 47.4% (CI 44.1 %-50.6%) for AJL.


This study generated robust real-world evidence on the relationship between IOL biomaterial and the incidence of Nd:YAG capsulotomy to treat PCO. The results indicate AcrySof single-piece IOLs are protective against PCO and therefore reduce the requirement for Nd:YAG treatment compared to other single-piece hydrophilic-with-hydrophobic surface and hydrophilic acrylic IOLs 3 years after cataract surgery. For each comparison, the protective effect of AcrySof IOLs with respect to PCO development became more pronounced when the follow-up period was extended to 5 years. Future research may be warranted to investigate consequence of lens choice for patient quality of life and overall healthcare costs.

Financial Disclosure:

... is employed by a for-profit company with an interest in the subject of the presentation

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