Comparison of Nd:YAG Laser Capsulotomy Rates after implantation of 2 IOLs: One Hydrophilic Acrylic and the other Silicone with sharp posterior optic edge Dr. Ramesh Dorairajan Dr. Devi Radhakrishnan Sundar Eye Hospital, Chennai, India.

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Comparison of NdYAG Laser Capsulotomy Rates
after implantation of 2 IOLs One Hydrophilic
Acrylic and the other Silicone with sharp
posterior optic edgeDr. Ramesh DorairajanDr.
Devi RadhakrishnanSundar Eye Hospital, Chennai,
India.

• We have no financial interest in this presentation

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Purpose of the study

• To compare the PCO and YAG Capsulotomy rates of
• Akreos (Adapt AO) IOLs and Clariflex IOLs.

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Methods

• Retrospective case sheet review of PCO and YAG
  rates.
• Single Surgeon series of 201 cases of IOL
  implantations done from May 2006 to June 2008.
  the follow up was between 1 and 3 years.
• Inclusion criteria
• group 1 with Akreos Adapt / Akreos
  AO IOLs
• group 2 with Clariflex IOLs
• All implantations were in the bag and the
  surgical technique has remained constant
  throughout the study period with same post
  operative treatment.

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Exclusion criteria

• 1) Patients with previous ocular surgery or
  trauma ,
• 2) Patients who needed additional ocular
  procedures,
• 3) Patients who were noted to have a plaque on
  the posterior capsule
• Patients who were lost to follow up.

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The data collected were

• Date of surgery
• BCVA at 6, 12 and 24 and 36 months
• Complaints at each review
• Presence of PCO within the undilated pupillary
  area
• Whether a Yag capsulotomy was needed or not

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Results of our study
IOL Number of Patients Patients with PCO PCO Rate Patients who required YAG YAG Rate
AKREOS ADAPT/AO 95 38 40 28 29.5
CLARIFLEX 106 4 3.77 4 3.77
Our PCO rate for Akreos IOLs was 40 with a
follow up between 12 months and 36 months . 30
of patients in this series needed a Yag
capsulotomy to improve vision or to reduce glare.
This is in variance with other published
studies.(1) Our PCO rate did not show a
difference between the adapt and AO series of
Akreos IOLs. Reported YAG Rates from other
studies.

Ref 1 The PCO Rate with Akreos Adapt was
8.8 at 30 months follow up. Ref 2. The YAG
Rate with clariflex was 1.93 at 3 years follow
up.

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Discussion Conclusion

• Literature review suggests that PCO preventing
  effect of sharp optic edge is independent of the
  IOL material.
• Reference 3 4
• Our result shows a gross difference in
  the PCO rates between the 2 IOLs with sharp
  posterior edges. Is it possible that the Akreos
  edge is not sharp enough to block growing lens
  epithelium? The background of this slide shows
  cells growing freely all around an Akreos IOL.

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Flattened aggressive LECs behind an Akreos IOL.
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• Our initial experience with the Akreos AO /
  Adapt IOLs were excellent. Crisp vision,
  negligible amount of glare, a comfortable post
  operative period and highly satisfied
  patients.the lenses were easy to implant and
  were refreshingly clear on slit lamp exam unlike
  other acrylic IOLs.
• The Akreos became our favorite IOL. I have
  implanted the Akreos AO IOL in my parents eye,
  teachers and good friends eyes. The initial
  trickle of PCOs made me shift from the Adapt to
  the AO series. Over the next two years the
  number of patients coming with complaints with
  the Akreos IOLs increased dramatically . So much
  so that my optometrist would precede these
  patients with a sorrowful
  look and say PCO .
• Its our clinics policy not charge
  our patients for Yag Capsulotomies, where we
  had done the initial cataract surgery .
  Our Yag rates for the
  last decade has been around 3 until we started
  using the Akreos lenses.
• Are our results unique? Is this high rate of PCO
  due to an inappropriate surgical technique? We
  would like to know if other surgeon are having a
  similar experience with Akreos IOLs after the
  first one or two years. The other foldable
  lenses that we had used during this period were
  the AMO Tecnis, Alcon 3 piece and the Alcon IQ
  series . The other foldable lens PCO rates were
  comparable to Clariflex.
• It is our intention to share this surprising
  result. We look forward to suggestions to modify
  our surgical technique to reduce our PCO rates
  or to improvement s in the lens itself so that we
  can go back to using this otherwise superb intra
  ocular lens.

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Conclusion

• . There is a 10 fold increase in PCO and a 7 fold
  increase in Yag capsulotomy rates with the
  Acrylic Akreos IOLs as compared to Silicone
  Clariflex IOLs.
• 
  Thank you

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References..

• Ref 1.Rate of Posterior Capsule Opacification
  in eyes with the Akreos IOL..JSCRS Aug 2007
  Mona A. Khandwala, FRCS, Branka Marjanovic,
  MRCOphth, Ajay K. Kotagiri, MRCOphth,
  Masoud Teimory, FRCOphth. The PCO Rate with
  Akreos Adapt was 8.8 at 30 months follow up.
• Ref 2. Long term effect of optic edge design
  in a silicone IOL on posterior capsule
  opacification..AJO,June 2007
• Wolf Beuhl,Rupert menapace,Oliver
  Findl,Thomas Neumayer,Mathias Bolz,Ana Prunz
• The YAG Rate with clariflex was 1.93 at 3
  years follow up.
• Ref 3.Cochrane Database Syst Review..2010 feb
  
• Interventions for preventing posterior
  capsule opacification Findl O,Beuhl W,Bauer
  P,Sycha T.

• Ref 4Effect of Intra Ocular Lenses on
  preventing Posterior Capsule OpacificationDesign
  versus material JSCRS OCT 2004..
  Okihiro Nishi MD,Kayonishi MD,Yashuribo osakabeMD
• Ref 5.Evaluating and defining the sharpness of
  Intraocular lensesMicroedge structure of
  commercially available square edged hydrophilic
  intraocular lenses..JSCRS March 2009
• Liliana Werner,Manfred
  Tetz,Ines Feldman,Michael Bucker
• Ref 6..Posterior capsule opacification and
  YAG rates with round edged silicone and a sharp
  edged hydrophobic acrylic intraocular
  lens 10 years after surgery .JSCRS March 2009
• Lorenz Vock,Rupert
  Menapace,Eva Stiffer.Michael Georgopaulos,Stephen
  Sacu.