Evaluation of Nd:YAG Laser Capsulotomy Rates in a Real-Life Population

Early Clinical Experience with a New Hydrophobic Acrylic Single-Piece Monofocal Intraocular Lens

Purpose

To evaluate early clinical outcomes and adverse events (AEs) in cataract patients following implantation of a monofocal hydrophobic acrylic IOL with a new optimized non-constant aberration-correcting design (CT LUCIA 621P).

Methods

This retrospective study included patients with visually significant cataracts who underwent implantation of the CT LUCIA 621P IOL. Refraction, corrected (CDVA) and uncorrected (UDVA) visual acuity of the last available visit were used in the analysis. Intraoperative and postoperative AEs of the cohort were reviewed.

Results

A total of 191 eyes of 133 patients with the mean age of 70.2±11.2 years were included in this study. The mean follow-up time of the last available visit was 1.7±1.3 months. The mean postoperative monocular UDVA was 0.09±0.16 logMAR (≈20/25), and 74.9% (143/191) eyes achieved ≥20/25 UDVA. The percentage of eyes with manifest spherical equivalent (MSE) within ±0.50D and ±1.00D of emmetropia was 84.8% (162/191) and 98.4% (188/191), respectively. Linear regression of attempted vs achieved MSE showed a tight relationship, with the coefficient of determination close to 1 (R2=0.99), indicating a very predictable refractive correction. The reported AEs were those typically expected after cataract surgery. There were no AEs related to intraoperative manipulation with the IOL/injector or to postoperative stability of the IOL in the capsular bag. No eye lost ≥2 lines of CDVA.

Conclusion

The implantation of CT LUCIA 621P resulted in good refractive predictability and visual outcomes. No IOL-related adverse events were reported.

Clinical Outcomes of a Monofocal, Optimized, Aspheric, Hydrophobic Acrylic Intraocular Lens Implant

Purpose

To evaluate the refractive and visual outcomes of eyes implanted with monofocal, optimized, aspheric, hydrophobic acrylic intraocular lenses (IOL) following cataract surgery.

Methods

The study assessed 55 eyes implanted with CT LUCIA® 621P IOLs (Carl Zeiss Meditec AG, Jena, Germany) at 3-months postsurgery. The main outcome measures were refractive error, monocular corrected distance visual acuity (CDVA), monocular uncorrected distance visual acuity (UDVA), photopic and mesopic contrast sensitivity, and wavefront aberrations. Patients were asked to complete the Catquest-9SF questionnaire.

Results

At 3 months, the cumulative Snellen visual acuity was 20/20 in 94.55% of eyes and 20/25 or better in 100%. The difference between the UDVA and CDVA was either the same (70.91%) or better (29.09%) in all eyes. The mean Snellen decimal UDVA and DCVA were 1.07 ± 0.15 and 1.13 ± 0.11, respectively. The safety and efficacy indexes were 1.48 and 1.40, respectively. 47.27% of eyes showed a spherical equivalent ±0.13 D, with 92.73% of the eyes were within ±0.50 D and all eyes were within ±1.00 D. The mean spherical equivalent was -0.03 ± 0.30 D and the mean refractive cylinder -0.36 ± 0.34 D. The log photopic and mesopic contrast sensitivity functions were good and similar for all spatial frequencies. All patients reported being either fairly satisfied (score 3) or very satisfied (score 4) with their vision (mean = 3.64 ± 0.49). No intra- and postoperative complications were reported during the 3 months of follow-up.

Conclusion

The current study demonstrates that excellent visual and refractive outcomes, as well as patient satisfaction, can be achieved after cataract surgery with optimized, aspheric CT LUCIA 621P monofocal IOLs.

Incidence of Nd:YAG laser capsulotomy following cataract surgery: a population-based nation-wide study - FreYAG1 study

RATIONALE

Nd:YAG (neodymium:yttrium-aluminum-garnet) capsulotomy (Nd:YAG-caps) is the gold standard for the treatment of PCO (Posterior Capsule Opacification). There is a lack of real-world data about Nd:YAG-caps use.

PURPOSE

This study's objectives were to estimate Nd:YAG-caps incidence in France, to describe the patient characteristics, and to analyze the time between surgeries and capsulotomies.

SETTING

The study was based on data extracted from the EGB database, a 1/97th sample representative of the French population.

DESIGN

observational, retrospective, cohort study using national claims data.

METHODS

French adult patients who underwent Nd:YAG-caps between 2014 and 2017 were selected. Main outcomes were the number of patients and procedures performed and the risk factors associated with early Nd:YAG-caps.

RESULTS

During the study period, Nd:YAG-caps were performed in 8,425 patients accounting for 10,774 procedures. The extrapolation to the French population led to estimate that 253.103 patients had Nd:YAG-caps, representing 312.103 procedures in 2017. The mean age at Nd:YAG-caps was 75.1 (± 10.2) years. About 36% of patients presented at least one ocular comorbidity. Nd:YAG-caps was performed within 2 years after surgery in 33.0% of patients and within one year in 9.8% of patients. Patients with Nd:YAG-caps within the first year (OR CI95 0.721 [0.673-0.772]) or in the first two years (OR CI95 0.721 [0.673-0.772]) were younger than patients with later Nd:YAG-caps and had a more frequent history of treated ocular diseases (OR 1.516 and 1.178, respectively).

CONCLUSIONS

This study brought new real-world and large-scale data regarding Nd:YAG-caps use and gave an updated insight into the patients' characteristics.

"Comparing outcomes of advanced nurse practitioners to ophthalmologists performing posterior YAG capsulotomy, a six-year study of 6308 eyes"

PURPOSE

To primarily report the baseline characteristics and visual acuity (VA) outcomes of advanced nurse practitioners (ANP) compared to ophthalmologists following YAG posterior capsulotomy (YAGPC). We secondarily looked to characterise the risk factors that lead to a repeated YAGPC.

METHOD

Retrospective consecutive case series of 6,308 eyes attending the Birmingham and Midlands Eye Centre.

RESULTS

ANPs performed 33.1% of YAGPC compared to 66.9% ophthalmologists. Compared to ophthalmologists, ANPs performed YAGPC in lower proportion of patients with ocular co-morbidities (p < 0.001) and had lower proportion of patients requiring further YAGPC compared to ophthalmologists (p < 0.001). Median pre, post-operative and LogMAR gain in VA of 0.48 (IQR 0.30-0.78), 0.18 (IQR 0.10-0.40) and 0.30 (0.08-0.48) LogMAR units, respectively. Multivariate regression showed that ANPs had a significantly lower rate of repeat YAGPC compared to ophthalmologists even when adjusting for age, ethnicity, training grade and ocular co-morbidities. No difference in visual outcomes was found between operator grade and ethnicity on multivariate analysis.

CONCLUSION

YAGPC leads to excellent visual outcomes. ANPs can deliver safe and effective YAGPC.

Outcomes of a multicenter U.S. clinical trial of a new monofocal single-piece hydrophobic acrylic IOL

PURPOSE

To evaluate the safety and effectiveness of the CT LUCIA 611P intraocular lens (IOL) in patients with cataracts.

SETTING

23 surgeons at 15 different clinical sites.

DESIGN

Prospective single-arm clinical trial.

METHODS

The study was conducted under an Investigational Device Exemption for premarket approval of a new hydrophobic acrylic IOL in the United States. Patients were followed for 12 months, and the main measured variables included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and adverse events.

RESULTS

In total, 339 eyes of 339 patients were implanted with the study device, of which 310 (91.4%) reached the 12-month visit. The percentage of eyes within ±0.50 diopter (D) and ±1.00 D of emmetropia was 85.8% (266/310) and 96.8% (300/310), respectively. Manifest refraction spherical equivalent (MRSE) remained stable over the first year with the mean 12-month MRSE of -0.03 ± 0.45 D. The mean 12-month UDVA and CDVA were 0.09 ± 0.15 (≈20/25) and -0.02 ± 0.09 (≈20/19) logMAR, respectively. Of all patients, 99.4% (308/310) achieved postoperative CDVA ≥20/40. The incidence of Nd:YAG capsulotomy within the first year was 3.5% (11/310). Only 2 eyes had IOL tilt present at the 12-month postoperative visit with no associated visual symptoms. There were 2 cases of IOL decentration; one required removal of the IOL, whereas the other had no visual side effects related to decentration. There were no findings of glistening at any visit.

CONCLUSIONS

The CT LUCIA 611P IOL demonstrated excellent safety, efficacy, and stability of refractive outcomes. No significant issues related to the biocompatibility of the IOL material were observed.

Refractive and Visual Outcomes of a Monofocal Non-Constant Aberration Aspheric Intraocular Lens

Purpose

To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new monofocal non-constant aberration aspheric intraocular lens (IOL).

Methods

Ninety eyes of 86 patients who underwent implantation the CT LUCIA 621P IOL (Carl Zeiss Meditec AG) were retrospectively analyzed in this study. Main outcome measures were refractive error and monocular corrected distance visual acuity (CDVA) and monocular uncorrected distance visual acuity (UDVA) values. Patients were evaluated at 1-month post-surgery and intra- and post-operative complications were recorded.

Results

Eighty percent of the eyes showed a CDVA of 20/25 or better before surgery. The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.64±0.22 and 0.89±0.13, respectively. All eyes showed the same or better difference between UDVA and CDVA. In relation to the postoperative spherical equivalent, the highest percentage of eyes, 31.11%, was for the range between −0.50 and −0.14D followed by 22.22% for the ±0.13D range. Ninety percent of the eyes were within ±1.00 D and 73.33% of eyes within ±0.50 D. The mean postoperative spherical equivalent was −0.18±0.55D. 37.78% and 76.67% of the eyes showed a value ≤0.50 D and ≤1.00D, respectively, being the mean postoperative refractive cylinder −0.81±0.50D. No adverse events were reported in whole sample intra and postoperatively.

Conclusion

The present study shows that cataract surgery with an monofocal non-constant aberration aspheric IOL implantation resulted in good visual performance and refractive outcomes. This lens may be considered as a valid choice for patients in a standard-routine cataract surgery practice.

Posterior Capsule Opacification after Cataract Surgery via Implantation with Hydrophobic Acrylic Lens Compared with Silicone Intraocular Lens: A Systematic Review and Meta-Analysis

Hydrophobic acrylic intraocular lens (IOL) is the most popular material in cataract surgery. Posterior capsule opacification (PCO) is a long-term complication of cataract surgery. It can impair vision and adversely affect the prognosis of IOL delamination. The objective of this study was to perform a systematic review and meta-analysis to provide an updated evaluation of long-term complications and visual function after implantation with hydrophobic acrylic and silicone intraocular lenses. PubMed, Embase, and Cochrane Library were searched from January 2000 until March 2021. Randomized controlled trials (RCTs) and retrospective studies were finally included. The main outcomes were PCO value and neodymium-doped yttrium aluminum garnet (Nd : YAG) capsulotomy rate. Subgroup analysis was performed to compare hydrophobic acrylic and silicone IOLs during the follow-up period. Sensitivity analysis was also performed. The meta-analysis included a total of 17 studies. When the follow-up period was considered, the results of the analysis revealed higher PCO value (Group 3: standardized mean difference (SMD), −0.59; 95% confidence interval (CI), −0.90 to −0.28) and Nd : YAG capsulotomy rate (Group 3: risk ratio (RR), 0.60; 95% CI, 0.40–0.89) for hydrophobic acrylic IOLs than silicone IOLs during a long-term (≥6 years) follow-up. In conclusion, both the PCO value and the Nd : YAG capsulotomy rates were higher in hydrophobic acrylic IOLs group than the silicone IOLs group at long-term use (more than 6 years) after implantation.

Geometry of Acrylic, Hydrophobic IOLs and Changes in Haptic-Capsular Bag Relationship According to Compression and Different Well Diameters: A Bench Study Using Computed Tomography

Introduction

Characteristics of the haptics and optic–haptic junction (OHJ) of an intraocular lens (IOL) affect IOL position in the capsular bag, positional stability, and the development of posterior capsule opacification. Therefore, the haptics and OHJ have a role in determining initial and long-term visual outcomes after cataract surgery. Understanding differences in the haptics and OHJ of available IOLs and in the relationships between the haptics of each IOL and the capsular bag across a range of capsular bag sizes might inform selection of an IOL model for individuals.

Purpose

To evaluate the geometry of five currently marketed, commonly used one-piece hydrophobic acrylic monofocal IOLs and changes in haptic–capsular bag relationships according to capsular bag size using a range of compression well diameters.

Methods

AcrySof SN60WF, CT LUCIA 621PY, enVista MX60, TECNIS ZCB00, and Vivinex XY1 IOLs were scanned with computed tomography (CT) in a dry, uncompressed state for quantitative analyses of haptic and OHJ dimensions and qualitative assessment of geometry. CT scanning was done after IOL placement into a series of compression wells (11.5, 11.0, 10.0, and 9.0 mm) for analyses of haptic angle of contact (AoC) and capsular bag contact (CBC). IOL axial alignment and haptic–capsular bag relationships were assessed on side-view and 3-dimensional top-view images, respectively.

Results

The qualitative and quantitative evaluations highlighted differences in haptic and OHJ geometry and dimensions across the five IOLs. All haptic dimensions (length, thickness, surface area, volume) and all OHJ dimensions (surface area and volume) were greatest for the CT LUCIA 621PY IOL. Compared to the IOL that had the smallest measurement for each parameter, the value for the CT LUCIA 621PY IOL was 31–91% larger. The lens with the largest OHJ surface area and volume showed values that were 500% and 240% greater than the corresponding values for the lens with the smallest OHJ surface area and OHJ volume. The AoC and CBC values decreased with increasing well size for all IOLs. The CT LUCIA 621PY had the greatest AoC and CBC values for all well sizes and the smallest percentage change in AoC and CBC comparing the values from the 9.0 mm and 11.5 mm wells.

Conclusion

The in vitro evaluations in this study highlight differences in the haptic and OHJ geometric characteristics of the five IOLs studied. The collected evidence refutes opinions that all hydrophobic acrylic one-piece IOLs are the same and supports the idea that individual IOLs can have relative advantages and disadvantages that depend on the individual case. We believe the knowledge of geometry is necessary for the surgeon to have the opportunity to select the best “customized” option in the individual case as a result of anatomical conditions and secondary diagnoses. Our bench study shows how big the differences are in currently available monofocal hydrophobic acrylic lenses.

Long-Term Clinically Significant Posterior Capsular Opacification Development Pattern in Eyes Implanted with an Aspheric Monofocal Intraocular Lens with a Square Optic Edge

Purpose

To analyse the posterior capsular opacification (PCO) development pattern in the long term in eyes implanted with a monofocal intraocular lens (IOL) with a square edge all around the optic.

Methods

Longitudinal retrospective study is data analyzed from a total of 7059 eyes from 4764 patients (mean age: 75.8 years) undergoing cataract surgery with implantation of an aspheric monofocal IOL (Bi-Flex HL 677AB/677P, Medicontur, Budapest, Hungary). These data were retrospectively collected using the electronic medical record of the hospitals involved. Nd : YAG capsulotomy rates were calculated per year during a follow-up of more than 10 years. The Kaplan–Meier analysis was used to establish the transparent capsule survival rate.

Results

The Nd : YAG capsulotomy rate increased from 1.1% at 1 year postoperatively to 17.2% at 5 years after surgery. No significant differences were found between eyes with and without capsulotomy in terms of age (p = 0.202), gender (p = 0.061), type of anaesthesia used (p = 0.128), and presence of conditions such as hard cataract (p = 0.111) or pseudoexfoliation (p = 0.137). IOL power was significantly lower in those eyes of patients requiring Nd : YAG capsulotomy during the follow-up (p < 0.001). Significantly more eyes implanted with the preloaded model of the IOL required capsulotomy (p < 0.001). Mean survival time and rate were 9.38 years and 85.9%, respectively.

Conclusions

Most eyes undergoing cataract with implantation of the Bi-Flex IOL do not develop a clinically significant PCO requiring Nd : YAG capsulotomy in the long term. IOL material and design may be the main factors accounting for this finding.