Transcript Comparison of Nd:YAG Laser Capsulotomy Rates after

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.
We have no financial interest in this presentation
Purpose of the study
To compare the PCO and YAG Capsulotomy rates of
Akreos (Adapt & AO) IOLs and Clariflex IOLs.
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.
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.
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
Results of our study
IOL
Number
of
Patients
AKREOS
ADAPT/AO
95
CLARIFLEX
106
Patients PCO
with PCO Rate
38
4
Patients who YAG Rate
required YAG
*40%
28
3.77%
4
29.5%
**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.
Discussion & Conclusion
1. 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.
Flattened aggressive
LECs behind an Akreos IOL.
•
•
•
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 parent’s eye, teachers
and good friend’s 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 clinic’s 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.
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
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 4…Effect of Intra Ocular Lenses on preventing Posterior Capsule Opacification:Design versus
material…
JSCRS OCT 2004..
Okihiro Nishi MD,Kayonishi MD,Yashuribo osakabeMD
Ref 5….Evaluating and defining the sharpness of Intraocular lenses:Microedge 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.