Quality and complications after cataract surgery

Abstract: Research about IOL parameters` influence on posterior capsule opacification (PCO) and lens glistenings may be rapidly applied in clinical practice and may help the industry to manufacture intraocular lenses (IOLs) with higher quality, which will be of benefit to the patients. In paper I we compared the influence on PCO of 3 different IOLs; a sharp-edged hydrophobic acrylic, a round-edged silicone and a round-edged heparin-surfacemodified polymethylmethacrylate (HSM-PMMA) IOL in a 5 year randomized prospective study with 180 patients. The PCO fraction and severity did not differ significantly between the hydrophobic acrylic and the silicone IOL 5 years after surgery. The capsulotomy rate was significantly higher in the silicone (29%) than in the acrylic IOL group (8%). The HSM-PMMA IOL had significantly higher PCO fraction and severity and capsulotomy rate (54 %) than the arylic and the silicone IOLs. In paper 2 PCO and anterior capsule opacification (ACO) were assessed 12 years after surgery in the same patients as in paper I. The PCO fraction and severity did not differ between the hydrophobic acrylic and the silicone IOL 12 years after surgery. The PCO fraction was significantly higher in the HSM-PMMA IOL than in the silicone IOL, but not higher than in the acrylic IOL. The PCO severity did not differ between the HSM-PMMA and the hydrophobic acrylic and the silicone IOLs. There was no significant difference in overall survival without capsulotomy between the acrylic and the silicone or the silicone and the HSM-PMMA IOLs. The acrylic had significantly better overall capsulotomy free survival than the HSM- PMMA IOL. The median capsulotomy free survival time was higher in the silicone IOL (>150 months) than the acrylic (108 months) and the HSM-PMMA (53 months) IOLs. In paper III we compared lens glistenings in the same 3 IOLs as in paper I in 46 eyes; and investigated the influence of dioptric power on lens glistenings 12 years after cataract surgery. There was significantly more glistenings in the hydrophobic acrylic than in the silicone and the HSM-PMMA IOL, and significantly more glistenings in the silicone than in the HSM-PMMA IOL. The IOL dioptric power did not influence the amount of lens glistenings in the acrylic IOL. The other two IOLs had too little glistenings to be evaluated for this purpose. In paper IV we studied factors influencing patient-reported visual function after cataract surgery in 14 817 patients, using data from the Swedish National Cataract Register. We found that the improvement in subjective visual function, the postoperative visual function and the satisfaction with vision were influenced by age, preoperative and postoperative corrected visual acuity, ocular comorbidity, a first- or second-eye surgery, gender, and achieved postoperative refraction.