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Meta-Analysis
. 2010 Feb 17;2010(2):CD003738.
doi: 10.1002/14651858.CD003738.pub3.

Interventions for preventing posterior capsule opacification

Oliver Findl  1 , Wolf Buehl, Peter Bauer, Thomas Sycha
Affiliations
Meta-Analysis

Interventions for preventing posterior capsule opacification

Oliver Findl et al. Cochrane Database Syst Rev. .

Abstract

Background: Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. It can be treated by Nd:YAG laser capsulotomy, however this may lead to other complications and laser treatment is not available in large parts of the developing world. Therefore, many studies try to find factors influencing the development of PCO.

Objectives: To summarise the effects of different interventions to inhibit PCO. These include modifications of surgical technique and intraocular lens (IOL) design, implantation of additional devices and pharmacological interventions.

Search strategy: We searched CENTRAL, MEDLINE, EMBASE, LILACS in March 2009 and reference lists of identified trial reports.

Selection criteria: We included only prospective, randomised and controlled trials with a follow-up time of at least 12 months. Interventions included modifications in surgical technique explicitly to inhibit PCO, modifications in IOL design (material and geometry), implantation of additional devices and pharmacological therapy compared to each other, placebo or standard treatment.

Data collection and analysis: We extracted data and entered it into RevMan. We compared visual acuity data, PCO scores and YAG capsulotomy rates and performed a meta-analysis when possible.

Main results: Sixty six studies were included in the review. The review was divided into three parts. 1. Influence of IOL optic material on the development of PCO. There was no significant difference in PCO development between the different IOL materials (PMMA, hydrogel, hydrophobic acrylic, silicone) although hydrogel IOLs tend to have higher PCO scores and silicone IOLs lower PCO scores than the other materials. 2. Influence of IOL optic design on the development of PCO. There was a significantly lower PCO score (-8.65 (-10.72 to -6.59), scale 0 to 100) and YAG rate (0.19 (0.11 to 0.35)) in sharp edged than in round edged IOLs, however not between 1-piece and 3-piece IOLs. 3. Influence of surgical technique and drugs on the development of PCO. There was no significant difference between different types of intraoperative/postoperative anti-inflammatory treatment except for treatment with an immunotoxin (MDX-A) which led to a significantly lower PCO rate.

Authors' conclusions: Due to the highly significant difference between round and sharp edged IOL optics, IOLs with sharp (posterior) optic edges should be preferred. There is no clear difference between optic materials. The choice of postoperative anti-inflammatory treatment does not seem to influence PCO development.

PubMed Disclaimer

Conflict of interest statement

Oliver Findl and Wolf Buehl are authors on some of the studies that have been included in the review. However, neither author has any financial or proprietary interests in any of the studies included.

Figures

1.1
1.1. Analysis
Comparison 1 PMMA versus Silicone, Outcome 1 PCO score 0‐100 (ALL).
1.2
1.2. Analysis
Comparison 1 PMMA versus Silicone, Outcome 2 YAG rate.
2.1
2.1. Analysis
Comparison 2 PMMA versus Hydrogel, Outcome 1 PCO score 0‐100 (ALL).
3.1
3.1. Analysis
Comparison 3 PMMA versus Acrylic (edge), Outcome 1 PCO score 0‐100 (ALL).
3.2
3.2. Analysis
Comparison 3 PMMA versus Acrylic (edge), Outcome 2 YAG rate.
4.1
4.1. Analysis
Comparison 4 Acrylic versus Silicone, Outcome 1 BCDVA.
4.2
4.2. Analysis
Comparison 4 Acrylic versus Silicone, Outcome 2 PCO score 0‐100 (ALL).
4.3
4.3. Analysis
Comparison 4 Acrylic versus Silicone, Outcome 3 YAG rate.
4.4
4.4. Analysis
Comparison 4 Acrylic versus Silicone, Outcome 4 YAG rate (only sharp edge IOLs).
5.1
5.1. Analysis
Comparison 5 Acrylic versus Hydrogel, Outcome 1 BCDVA.
5.2
5.2. Analysis
Comparison 5 Acrylic versus Hydrogel, Outcome 2 PCO score 0‐100 (ALL).
5.3
5.3. Analysis
Comparison 5 Acrylic versus Hydrogel, Outcome 3 YAG rate.
7.1
7.1. Analysis
Comparison 7 Hydrogel versus other materials, Outcome 1 BCDVA.
7.2
7.2. Analysis
Comparison 7 Hydrogel versus other materials, Outcome 2 PCO score 0‐100 (ALL).
7.3
7.3. Analysis
Comparison 7 Hydrogel versus other materials, Outcome 3 YAG rate.
9.1
9.1. Analysis
Comparison 9 Sharp versus round optic edges (PMMA), Outcome 1 BCDVA (2 years).
9.2
9.2. Analysis
Comparison 9 Sharp versus round optic edges (PMMA), Outcome 2 PCO score 0‐100.
9.3
9.3. Analysis
Comparison 9 Sharp versus round optic edges (PMMA), Outcome 3 YAG rate.
10.1
10.1. Analysis
Comparison 10 Sharp versus round optic edges (Acrylic), Outcome 1 BCDVA (2 years).
10.2
10.2. Analysis
Comparison 10 Sharp versus round optic edges (Acrylic), Outcome 2 PCO score 0‐100 (ALL).
10.3
10.3. Analysis
Comparison 10 Sharp versus round optic edges (Acrylic), Outcome 3 YAG rate.
11.1
11.1. Analysis
Comparison 11 Sharp versus round optic edges (Silicone), Outcome 1 BCDVA.
11.2
11.2. Analysis
Comparison 11 Sharp versus round optic edges (Silicone), Outcome 2 PCO score 0‐100 (ALL).
11.3
11.3. Analysis
Comparison 11 Sharp versus round optic edges (Silicone), Outcome 3 YAG rate.
12.1
12.1. Analysis
Comparison 12 Sharp versus round optic edges (all materials), Outcome 1 BCDVA (ALL).
12.2
12.2. Analysis
Comparison 12 Sharp versus round optic edges (all materials), Outcome 2 PCO score 0‐100 (ALL).
12.3
12.3. Analysis
Comparison 12 Sharp versus round optic edges (all materials), Outcome 3 YAG rate (ALL).
13.1
13.1. Analysis
Comparison 13 1‐piece versus 3‐piece design (Acrylic), Outcome 1 BCDVA (2 years).
13.2
13.2. Analysis
Comparison 13 1‐piece versus 3‐piece design (Acrylic), Outcome 2 PCO score 0‐100 (ALL).
13.3
13.3. Analysis
Comparison 13 1‐piece versus 3‐piece design (Acrylic), Outcome 3 YAG rate.
16.1
16.1. Analysis
Comparison 16 Ridge versus no ridge in PMMA IOLs, Outcome 1 YAG rate.
18.1
18.1. Analysis
Comparison 18 Rhexis on versus rhexis off, Outcome 1 PCO score 0‐100 (ALL).
20.1
20.1. Analysis
Comparison 20 Anterior capsule polishing versus non‐polished, Outcome 1 PCO score 0‐100 (FIBROSIS).
21.1
21.1. Analysis
Comparison 21 Capsular bending ring versus no ring, Outcome 1 BCDVA (3 years).
21.2
21.2. Analysis
Comparison 21 Capsular bending ring versus no ring, Outcome 2 PCO score 0‐100.
21.3
21.3. Analysis
Comparison 21 Capsular bending ring versus no ring, Outcome 3 YAG rate.
22.1
22.1. Analysis
Comparison 22 Sealed capsule irrigation versus none, Outcome 1 PCO score 0‐100.
22.2
22.2. Analysis
Comparison 22 Sealed capsule irrigation versus none, Outcome 2 YAG rate.
23.1
23.1. Analysis
Comparison 23 Dexamethasone versus placebo, Outcome 1 YAG rate (2 years).
24.1
24.1. Analysis
Comparison 24 Diclofenac versus placebo, Outcome 1 YAG rate (2 years).
25.1
25.1. Analysis
Comparison 25 Dexamethasone versus Diclofenac, Outcome 1 PCO score 0‐100.
25.2
25.2. Analysis
Comparison 25 Dexamethasone versus Diclofenac, Outcome 2 YAG rate.
27.1
27.1. Analysis
Comparison 27 Immunotoxin MDX‐A versus placebo, Outcome 1 PCO score 0‐100.
See this image and copyright information in PMC

Update of

References

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    1. Yoshida S, Senoo T, Fujikake F, Obara Y. Clinical evaluation of posterior capsule opacification in eyes with different small‐incision intraocular lenses. Ophthalmic Surgery & Lasers 2002;33(6):450‐5. - PubMed
Zaczek 2004 {published data only}
    1. Zaczek A, Laurell CG, Zetterstrom C. Posterior capsule opacification after phacoemulsification in patients with postoperative steroidal and nonsteroidal treatment. Journal of Cataract & Refractive Surgery 2004;30(2):316‐20. - PubMed
Zemaitiene 2004 {published data only}
    1. Zemaitiene R, Jasinskas V, Barzdziukas V, Auffarth GU. Prevention of posterior capsule opacification using different intraocular lenses (results of one‐year clinical study). Medicina (Kaunas, Lithuania) 2004;40(8):721‐30. - PubMed
Zemaitiene 2007 {published data only}
    1. Zemaitiene R, Jasinskas V, Auffarth GU. Influence of three‐piece and single‐piece designs of two sharp‐edge optic hydrophobic acrylic intraocular lenses on the prevention of posterior capsule opacification: a prospective, randomised, long‐term clinical trial. British Journal of Ophthalmology 2007;91(5):644‐8. - PMC - PubMed

References to studies excluded from this review

Aasuri 2002 {published data only}
    1. Aasuri M, Shah U, Veenashree MP, Deshpande P. Performance of a truncated‐edged silicone foldable intraocular lens in Indian eyes. Journal of Cataract & Refractive Surgery 2002;28(7):1135‐40. - PubMed
Abela‐Formanek 2002 {published data only}
    1. Abela‐Formanek C, Amon M, Schild G, Schauersberger J, Heinze G, Kruger A. Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses. Journal of Cataract & Refractive Surgery 2002;28(1):50‐61. - PubMed
Abhilakh 2003 {published data only}
    1. Abhilakh Missier KA, Nuijts RM, Tjia KF. Posterior capsule opacification: silicone plate‐haptic versus AcrySof intraocular lenses. Journal of Cataract & Refractive Surgery 2003;29(8):1569‐74. - PubMed
Afsar 1999 {published data only}
    1. Afsar AJ, Patel S, Woods RL, Wykes W. A comparison of visual performance between a rigid PMMA and a foldable acrylic intraocular lens. Eye 1999;13(3A):329‐35. - PubMed
Aktan 1992 {published data only}
    1. Aktan SG, Laws DE, Taylor RH, Pearce JL. Posterior capsule polishing and postoperative opacification in intercapsular cataract surgery. European Journal of Implant & Refractive Surgery 1992;4(3):161‐3.
Alio 2002 {published data only}
    1. Alio JL, Chipont E, BenEzra D, Fakhry MA, Foster CS, Baarsma GS, et al. Comparative performance of intraocular lenses in eyes with cataract and uveitis. Journal of Cataract & Refractive Surgery 2002;28(12):2096‐108. - PubMed
Auffarth 2003 {published data only}
    1. Auffarth GU, Golescu A, Becker KA, Völcker HE. Quantification of posterior capsule opacification with round and sharp edge intraocular lenses. Ophthalmology 2003;110(4):772‐80. - PubMed
Cumming 2001 {published data only}
    1. Cumming JS, Slade SG, Chayet A. Clinical evaluation of the model AT‐45 silicone accommodating intraocular lens: Results of feasibility and the initial phase of a food and drug administration clinical trial. Ophthalmology 2001;108(11):2005‐9. - PubMed
D'Eliseo 2003 {published data only}
    1. D'Eliseo D, Pastena B, Longanesi L, Grisanti F, Negrini V. Prevention of posterior capsule opacification using capsular tension ring for zonular defects in cataract surgery. European Journal of Ophthalmology 2003;13(2):151‐4. - PubMed
Dada 1999 {published data only}
    1. Dada T, Sharma N, Dada VK, Vajpayee RB. Comparative evaluation of plate haptic lenses with smaller and larger positioning holes. Australian and New Zealand Journal of Ophthalmology 1999;27(6):417‐9. - PubMed
Davison 2002 {published data only}
    1. Davison JA. Clinical performance of Alcon SA30AL and SA60AT single‐piece acrylic intraocular lenses. Journal of Cataract & Refractive Surgery 2002;28(7):1112‐23. - PubMed
Georgopoulos 2001 {published data only}
    1. Georgopoulos M, Menapace R, Findl O, Rainer G, Petternel V, Kiss B. Posterior continuous capsulorhexis with hydrogel and silicone intraocular lens implantation: Development of capsulorhexis size and capsule opacification. Journal of Cataract & Refractive Surgery 2001;27(6):825‐32. - PubMed
Georgopoulos 2003 {published data only}
    1. Georgopoulos M, Menapace R, Findl O, Petternel V, Kiss B, Rainer G. After‐cataract in adults with primary posterior capsulorhexis: comparison of hydrogel and silicone intraocular lenses with round edges after 2 years. Journal of Cataract & Refractive Surgery 2003;29(5):955‐60. - PubMed
Hayashi 2008 {published data only}
    1. Hayashi K, Yoshida M, Hayashi H. Comparison of posterior capsule opacification between fellow eyes with two types of acrylic intraocular lens. Eye 2008;22(1):35‐41. - PubMed
Khalifa 1992 {published data only}
    1. Khalifa M. Polishing the posterior capsule after extracapsular extraction of senile cataract. Journal of Cataract & Refractive Surgery 1992;18(2):170‐3. - PubMed
Kruger 2000 {published data only}
    1. Kruger A, Schauersberger J, Abela C, Schild G, Amon M. Two year results: Sharp versus rounded optic edges on silicone lenses. Journal of Cataract & Refractive Surgery 2000;26:566‐70. - PubMed
Li 2008 {published data only}
    1. Li JG, Wang ML, Chen GP, Gao HM, Zhao CY, Zhang QY. Analysis of related factors of posterior capsular opacification. International Journal of Ophthalmology 2008;8(3):593‐4.
Meacock 2001b {published data only}
    1. Meacock WR, Spalton DJ, Hollick EJ, Barman S, Boyce JF. The effect of polymethylmethacrylate and AcrySof intraocular lenses on the posterior capsule in patients with a large capsulorrhexis. Japanese Journal of Ophthalmology 2001;45(4):348‐54. - PubMed
Miyata 2007 {published data only}
    1. Miyata K, Kato S, Nejima R, Miyai T, Honbo M, Ohtani S. Influences of optic edge design on posterior capsule opacification and anterior capsule contraction. Acta Ophthalmologica Scandinavica 2007;85(1):99‐102. - PubMed
Mootha 2004 {published data only}
    1. Mootha VV, Tesser R, Qualls C. Incidence of and risk factors for residual posterior capsule opacification after cataract surgery. Journal of Cataract & Refractive Surgery 2004;30(11):2354‐8. - PubMed
Nekolová 2008 {published data only}
    1. Nekolová J, Pozlerová J, Jirásková N, Rozsíval P, Kadlecová J. Comparison of posterior capsule opacification after two different surgical methods of cataract extraction. American Journal of Ophthalmology 2008;145(3):493‐8. - PubMed
Nirmalan 2002 {published data only}
    1. Nirmalan PK, Thulasiraj RD, Maneksha V, Rahmathullah R, Ramakrishnan R, Padmavathi A, et al. A population based eye survey of older adults in Tirunelveli district of south India: blindness, cataract surgery, and visual outcomes. British Journal of Ophthalmology 2002;86(5):505‐12. - PMC - PubMed
Nishi 1998 {published data only}
    1. Nishi O, Nishi K, Menapace R. Capsule‐bending ring for the prevention of capsular opacification: A preliminary report. Ophthalmic Surgery & Lasers 1998;29(9):749‐53. - PubMed
    1. Nishi O, Nishi K, Menapace R, Akura J. Capsular bending ring to prevent posterior capsule opacification: 2 year follow‐up. Journal of Cataract & Refractive Surgery 2001;27(9):1359‐65. - PubMed
Nishi 2007 {published data only}
    1. Nishi Y, Rabsilber TM, Limberger IJ, Reuland AJ, Auffarth GU. Influence of 360‐degree enhanced optic edge design of a hydrophilic acrylic intraocular lens on posterior capsule opacification. Journal of Cataract & Refractive Surgery 2007;33(2):227‐31. - PubMed
Oharazawa 2007 {published data only}
    1. Oharazawa H, Suzuki H, Shibata K, Yamada Y, Matsui H, Shiwa T, et al. Quantitative analysis of posterior capsule opacification of hydrophobic acrylic intraocular lenses. Journal of Nippon Medical School 2007;74(1):45‐9. - PubMed
Ozdemir 2007 {published data only}
    1. Ozdemir HG. A long‐term follow‐up study of different irrigation/aspiration techniques on formation of posterior capsule opacification. Canadian Journal of Ophthalmology 2007;42(6):849‐51. - PubMed
Ram 2001 {published data only}
    1. Ram J, Pandey S, Apple D, Werner L, Brar G, Singh R, et al. Effect of in‐the‐bag intraocular lens fixation on the prevention of posterior capsule opacification. Journal of Cataract & Refractive Surgery 2001;27:1039‐46. - PubMed
Sacu 2005b {published data only}
    1. Sacu S, Findl O, Menapace R, Buehl W. Influence of optic edge design, optic material, and haptic design on capsular bend configuration. Journal of Cataract & Refractive Surgery 2005;31(10):1888‐94. - PubMed
Strobel 2002 {published data only}
    1. Strobel J, Hunold W, Kohnen T, Mester U, Hessemer V, Hutz W, Jacobi K, Hoyer H. Highly refractive silicone lens with sharp optic edge (CeeOn Edge, Model 911): one year results of a multicenter clinical trial on performance and efficacy [Hochrefraktive Silikonlinse mit scharfer Hinterkante (CeeOn Edge, Modell 911): 1‐Jahres‐Ergebnisse einer multizentrischen klinischen Studie zur Handhabung und Effizienz]. Klinische Monatsblätter der Augenheilkunde 2002;219(5):358‐64. - PubMed
Tassignon 2002 {published data only}
    1. Tassignon MJ, De‐Groot V, Vrensen GF. Bag‐in‐the‐lens implantation of intraocular lenses. Journal of Cataract & Refractive Surgery 2002;28(7):1182‐8. - PubMed
Thompson 2004 {published data only}
    1. Thompson AM, Sachdev N, Wong T, Riley AF, Grupcheva CN, McGhee CN. The Auckland Cataract Study: 2 year postoperative assessment of aspects of clinical, visual, corneal topographic and satisfaction outcomes. British Journal of Ophthalmology 2004;88(8):1042‐8. - PMC - PubMed
Tobari 1999 {published data only}
    1. Tobari I, Iwaki Y, Miyake K. Effect of tranilast eyedrops in preventing posterior capsule opacification: preliminary report. Journal of Cataract & Refractive Surgery 1999;25(10):1394‐9. - PubMed
Vock 2007 {published data only}
    1. Vock L, Menapace R, Stifter E, Bühl W, Georgopoulos M. Effect of primary posterior continuous curvilinear capsulorhexis on clinical performance of ACR6D SE single‐piece hydrophilic acrylic intraocular lenses. Journal of Cataract & Refractive Surgery 2007;33(4):628‐34. - PubMed
Wren 2005 {published data only}
    1. Wren SM, Spalton DJ, Jose R, Boyce J, Heatley CJ. Factors that influence the development of posterior capsule opacification with a polyacrylic intraocular lens. American Journal of Ophthalmology 2005;139(4):691‐5. - PubMed

Additional references

Apple 1992
    1. Apple DJ, Solomon KD, Tetz MR, Assia EI, Holland EY, Legler UFC, et al. Posterior capsule opacification. Survey of Ophthalmology 1992;37(2):73‐116. - PubMed
Buehl 2005b
    1. Buehl W, Sacu S, Findl O. Association between intensity of posterior capsule opacification and visual acuity. Journal of Cataract & Refractive Surgery 2005;31(3):543‐7. - PubMed
Buehl 2005c
    1. Buehl W, Sacu S, Findl O. Association between intensity of posterior capsule opacification and contrast sensitivity. American Journal of Ophthalmology 2005;140(5):927‐30. - PubMed
Findl 2003
    1. Findl O, Buehl W, Menapace R, Georgopoulos M, Rainer G, Siegl H, et al. Comparison of 4 methods for quantifying posterior capsule opacification. Journal of Cataract & Refractive Surgery 2003;29(1):106‐11. - PubMed
Glanville 2006
    1. Glanville JM, Lefebvre C, Miles JN, Camosso‐Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006;94(2):130‐6. - PMC - PubMed
Hayashi 2003
    1. Hayashi K, Hayashi H, Nakao F, Hayashi F. Correlation between posterior capsule opacification and visual function before and after Neodymium: YAG laser posterior capsulotomy. American Journal of Ophthalmology 2003;136(4):720‐6. - PubMed
Higgins 2008
    1. Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.
Javitt 1992
    1. Javitt JC, Tielsch JM, Canner JK, Kolb MM, Sommer A, Steinberg EP, et al. National outcomes of cataract extraction: Increased risk of retinal complications associated with Nd:YAG laser capsulotomy. Ophthalmology 1992;99(10):1487‐98. - PubMed
Meacock 2003
    1. Meacock WR, Spalton DJ, Boyce J, Marshall J. The effect of posterior capsule opacification on visual function. Investigative Ophthalmology and Visual Science 2003;44(11):4665‐9. - PubMed
Riaz 2006
    1. Riaz Y, Mehta JS, Wormald R, Evans JR, Foster A, Ravilla T, et al. Surgical interventions for age‐related cataract. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD001323.pub2] - DOI - PMC - PubMed
Schaumberg 1998
    1. Schaumberg DA, Dana MR, Christen WG, Glynn RJ. A systematic overview of the incidence of posterior capsule opacification. Ophthalmology 1998;105(7):1213‐21. - PubMed

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