Effect of AcrySof versus other intraocular lens properties on the risk of Nd:YAG capsulotomy after cataract surgery: A systematic literature review and network meta-analysis

OBJECTIVE: The purpose of this study was to evaluate the impact of different intraocular lens materials (IOL) and optic edge designs on the incidence of Nd:YAG laser capsulotomy. METHODS: Randomized controlled trials (RCTs) reporting incidence of Nd:YAG capsulotomy in patients with monofocal IOLs were identified for systematic literature review (SLR) using Cochrane methodology. A network meta-analysis was conducted under a Bayesian framework. Mean hazard ratios (HRs), 95% credible intervals, and one-sided p-values were estimated for Nd:YAG capsulotomy incidence by comparing AcrySof IOLs with a group of non-AcrySof hydrophobic acrylic, hydrophilic acrylic, silicone, and PMMA IOLs. Sensitivity analysis was conducted comparing the risk of Nd:YAG capsulotomy between sharp- and round-edged designs of the above IOLs. RESULTS: AcrySof IOLs had a lower risk of Nd:YAG capsulotomy compared to hydrophobic acrylic (HR: 2.68; 95% CrI: 1.41, 4.77; p < 0.01), hydrophilic acrylic (HR: 7.54; 95% CrI: 4.24, 14.06; p < 0.001), PMMA (HR: 3.64, 95% CrI: 1.87, 6.33; p < 0.001), and silicone (HR: 1.13; 95% CrI: 0.59, 1.91; p <0.1) IOLs. The risk for Nd:YAG was highest among sharp-edged IOLs for hydrophilic acrylic IOLs (HR: 9.32; 95% CrI: 4.32, 19.29; p < 0.01), followed by other hydrophobic acrylic (HR: 2.91; 95% CrI: 1.27, 5.88; p < 0.01), silicone (HR: 0.838; 95% CrI: 0.328, 1.74; p = 0.69), and PMMA (HR: 0.39; 95% CrI: 0.042, 1.49; p = 0.93) IOLs, compared to AcrySof. Acrysof IOLs had a lower risk of Nd:YAG compared to PMMA (HR: 3.25; 95% CrI: 1.21, 7.37; p < 0.01) and silicone, round edge IOLs (HR: 3.84; 95% CrI: 1.08, 10.64; p = 0.015). CONCLUSION: The risk of Nd:YAG capsulotomy is lower in eyes implanted with AcrySof IOLs compared to non-AcrySof hydrophobic or hydrophilic acrylic IOLs. Sharp-edged AcrySof, PMMA, and silicone IOLs are comparable in terms of reducing the risk of Nd:YAG laser capsulotomy.