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Comparison of Posterior Capsular Opacification with 9 different IOL Designs

Comparison of Posterior Capsular Opacification with 9 different IOL Designs. Dr. Devaki Senthilkumar Dr. Prasanna Kumar. S RNH Eye Hospital Trichy. Electronic Poster No.   FP1450. E-Poster Serial No.       : 5. (No financial interests in any of the IOLs). Introduction.

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Comparison of Posterior Capsular Opacification with 9 different IOL Designs

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  1. Comparison of Posterior Capsular Opacification with 9 different IOL Designs Dr. Devaki Senthilkumar Dr. Prasanna Kumar. S RNH Eye Hospital Trichy Electronic Poster No.  FP1450 E-Poster Serial No.      : 5 (No financial interests in any of the IOLs)

  2. Introduction Incidence of PCO: 1980 s – 50 % Currently < 10 % Reasons – improvement in techniques, instrumentations and intra ocular designs Aim To compare posterior capsular opacification after phaco emulsification with foldable IOL implants with 9 different types of IOLs of different materials and design at the end of 1, 2, 3 and 4 years

  3. Materials and Methods Retrospective analysis of incidence of PCO in 356 eyes of 336 patients ( Males - 150; Females - 186 ) with senile cataract who underwent phacoemulsification with 9 different types of foldable IOLs by a single surgeon Pts were aged between 50 – 80 years Exclusion Criteria Posterior capsular rupture & Vitreous loss IOL not fixated in bag, Congenital & developmental cataract H/O trauma, H/O pre existing uveitis

  4. Materials and Methods All cases underwent uneventful Phacoemulsification with a clear corneal temporal incision 2.8 mm * Foldable IOL implanted within the bag * Post op steroids ( Pred acetate ) tapered over 1 month * Antibiotics – 1 month ( Gatifloxacin ) * NSAIDs – 1 ½ months ( Acular LS ) 1st day, 7th day, 1st month, 3rd month, 6th month & yearly visits for 4 years. At each visit: 1. BCVA 2. IOP 3. Fundoscopy 4. S/L exmn Followup

  5. Materials and Methods * PCO evaluation in - all patients with significant drop in VA of 1 or more lines after ruling out associated pathology * PCO graded based on S/L appearance according to Sellman & Lindstrom protocol • Correlated with distant direct ophthalmoscopy – PCO graded as • 0 – nil PCO • 1 – visible PCO but none reaching IOL edge • 2 – at IOL edge • 3 – well inside IOL edge – visual axis clear • 4 – across visual axis (Grade 4 PCO by S/L and Gr 1-2 PCO with 90 D lens – advised Nd yag cap)

  6. Materials and Methods Results

  7. Incidence of PCO P C O % - Maximum incidence of PCO at 1-2 years - Nil PCO with Acrysof IOLs

  8. Results – PCO incidence 2.6 % Hydrophilic acrylic without Sq edge Hydrophilic acrylic with Sq edge Hydrophobic acrylic with Sq edge Silicone Clariflex

  9. Time interval between Cataract surgery and PCO 4.2% 30%

  10. Discussion • Surgery related factors to reduce PCO remained constant • as surgery was done by a single surgeon using the same techniques • Hydrodissection enhanced cortical cleanup • In the bag capsular fixation • Capsulorhexis edge overlap on the anterior surface • 4. Posterior capsular and anterior capsular polishing

  11. Discussion • IOL related factors to reduce PCO: • IOL biocompatibility – reduces epithelial cellular proliferation • Maximal IOL optic - posterior capsule contact : • Relative stickiness of hydrophobic acrylic IOL enhances capsular adhesion • Barrier effect of IOL optic - • Truncated square edged optic rim – complete blockage of migration of mitotically active LECs at the optic edge

  12. Conclusion Our results show that the incidence of PCO in Hydrophobic Acrylic IOL is < Hydrophilic Acrylic IOL Square Edge < Rounded or Sharp edge IOL Our maximum incidence of PCO was at 1 to 2 years

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