Comparison of Nd:YAG Capsulotomy Rates between Hydrophobic and Hydrophilic Intraocular Lenses

Mihyun Choi; Sun Young Kim; Mee Yon Lee; Young-Chun Lee; Su-Young Kim

doi:10.3341/jkos.2016.57.7.1063

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Choi, Kim, Lee, Lee, and Kim: Comparison of Nd:YAG Capsulotomy Rates between Hydrophobic and Hydrophilic Intraocular Lenses

Original Article

J Korean Ophthalmol Soc 2016;57(7):1063-1070.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.7.1063

Comparison of Nd:YAG Capsulotomy Rates between Hydrophobic and Hydrophilic Intraocular Lenses

Mihyun Choi, MD, Sun Young Kim, MD, Mee Yon Lee, MD, PhD, Young-Chun Lee, MD, PhD, Su-Young Kim, MD, PhD

Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea

Address reprint requests to Su-Young Kim, MD, PhD Department of Ophthalmology, The Catholic University of Korea Uijeongbu St. Mary's Hospital, #271 Cheonbo-ro, Uijeongbu 11765, Korea Tel: 82-31-820-3110, Fax: 82-31-847-3418 E-mail: cassiopeia-su@hanmail.net

Received 10 March 2016 Accepted 15 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy rates between hydrophobic and hydrophilic intraocular lenses.

Methods

The present retrospective study enrolled patients who received cataract surgery from a single surgeon between July 2006 to December 2009. Patients included in the study were implanted with SA60AT hydrophobic spherical intraocular lenses (Alcon, Fort Worth, TX, USA, 268 eyes) or I-FLEX hydrophilic spheric intraocular lenses (i-Medical^®, Ophthalmic International Heidelberg GmbH, Mannheim, Germany, 331 eyes). The Nd:YAG capsulotomy rates and best-corrected visual acuity (BCVA) were compared between the two groups for 2 years after the operation.

Results

The mean follow-up period was 23.5 months and 22.6 months and the mean age was 68.6 years and 70.3 years in the SA60AT and I-FLEX groups, respectively. Follow-up periods were longer in the SA60AT group (p = 0.035), but ages were not significantly different between the two groups (p = 0.367). Nd:YAG laser capsulotomy rates were 6.3% in the SA60AT group and 11.2% in the I-FLEX group. Nd:YAG laser capsulotomy rates were significantly higher in the I-FLEX group (p = 0.020). BCVA before and after the Nd:YAG laser capsulotomy was not significantly different.

Conclusions

Nd:YAG laser capsulotomy rates were higher in the I-FLEX hydrophilic spheric intraocular lens group than in the SA60AT hydrophilic spheric intraocular lens group. Adhesion between capsular bag and intraocular lens by bioadhesive character of hydrophobic acryl intraocular lens may contribute to the prevention of lens epithelial migration and posterior capsule opacification.

Keywords: Hydrophilic intraocular lens, Hydrophobic intraocular lens, Nd:YAG capsulotomy, Posterior capsule opacification

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Figure 1.

The hydrophobic intraocular lens and hydrophilic intraocular lens used in this study. (A) AcrySof® SA60AT (Alcon Inc., Fort Worth, TX, USA). (B) I-FLEX (i-Medical® Ophthalmic International Heidelberg GmbH, Mannheim, Germany).

Figure 2.

Kaplan-Meier survival plots for eyes not requiring neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. Percentage of eyes without Nd:YAG laser capsulotomy after cataract surgery. Kaplan-Meier survival analysis showed that the rate of capsulotomy was statistically significantly higher in the hydrophilic group than in the hydrophobic group (p=0.02). At postoperative 24 months, Nd:YAG laser capsulotomy rates were 6.3% in eyes with SA60AT and 11.2% in eyes with I-FLEX. IOL = intraocular lens.

Table 1.

Overview of intraocular lens characteristics

	SA60AT	I-FLEX
Type	Ultraviolet absorbing single-piece hyprophobic acrylic IOL	Ultraviolet absorbing single-piece hyprophillic acrylic IOL
Optic material	Copolymer of phenylethyl acrylate and phenylethyl methacrylate	Copolymer of 2-hydroxyethyl methacrylate and methylmethacrylate
Optic type	Biconvex/Spherical	Biconvex/Spherical
Edge type	Sharpedged optic interrupted at the optic-haptic junction	360° squared posterior optic edges
Overall length (mm)	13.0	12.0
Optic diameter (mm)	6.0	6.0
Haptic material	Same as optic	Same as optic
Haptic angulation (degree)	0	0

IOL = intraocular lens.

Table 2.

Patients' demographics

	SA60AT (n = 268)	I-FLEX (n = 331)	p-value
Mean age (years, range)	68.6 ± 12.9 (45–90)	70.3 ± 12.2 (42–92)	0.367^*
Sex (male:female)	95:173	116:215	0.525^†
DM (n, %)	21 (7.8)	29 (8.8)	0.317^†
Right eye/Left eye (n)	145/123	156/175	0.157^†
Mean follow up time (months, range)	23.5 ± 8.8 (6.3–36.2)	22.6 ± 10.1 (6.2–34.5)	0.035^*

Values are presented as mean ± SD unless otherwise indicated.

DM = diabetes mellitus.

^* Independent t-test

^† Chai-square test.

Table 3.

The rate of Nd:YAG laser posterior capsulotomy and visual acuity in 2 intraocular lens groups (pre-laser & post-laser)

	SA60AT	I-FLEX	p-value
Nd:YAG capsulotomy eye/total eye (%)	17/268 (6.3)	37/331 (11.2)	0.020^*
Mean time to Nd:YAG capsulotomy (months, range)	20.1 ± 6.8 (15.8–30.5)	18.3 ± 11.6 (13.5–32.0)	0.045^†
Pre-laser mean BCVA	0.59 ± 0.36	0.61 ± 0.41	0.535^†
post-laser mean BCVA	0.10 ± 0.44	0.13 ± 0.46	0.122^†

Values are presented as mean ± SD unless otherwise indicated.

Nd:YAG = neodymium-doped yttrium aluminum garnet; BCVA = best-corrected visual acuity as tested on the Snellen chart and transformed into the log MAR unit.

^* Chai-square test

^† Independent t-test.

Table 4.

Clinical characteristics of eyes with or without Nd:YAG laser capsulotomy

	Total	Non-capsulotomy	Nd:YAG capsulotomy	p-value
Total No.	599	545	54
Sex
Male	211 (35.2)	191 (90.5)	20 (9.5)	0.165^*
Female	388 (64.8)	354 (91.2)	34 (8.8)
Age (years)	69.0 ± 12.6 (42–92)	69.7 ± 11.9 (45–92)	62.1 ± 16.9 (42–89)	0.002^†
DM	50 (8.3)	44 (88.0)	6 (12.0)	0.472^*
Trauma history	14 (2.3)	10 (71.4)	4 (28.6)	0.312^*
History of refractive surgery	59 (9.8)	45 (76.3)	14 (23.7)	0.121^*
Axial length (mm)
<22	9 (1.5)	9 (100.0)	0 (0)
22–26	384 (64.1)	363 (94.5)	21 (5.5)	<0.001^*
>26	206 (34.4)	173 (84.0)	33 (16.0)
IOL
SA60AT	268 (44.7)	251 (93.7)	17 (6.3)
I-FLEX	331 (55.3)	294 (88.8)	37 (11.2)	0.020^*

Values are presented as n (%) unless otherwise indicated.

Nd:YAG = neodymium-doped yttrium aluminum garnet; DM = diabetes mellitus; IOL = intraocular lens.

^* Chai-square test between Non-capsulotomy group and Nd:YAG capsulotomy group

^† Independent t-test between Non-capsulotomy group and Nd:YAG capsulotomy group.

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