Journal club   Irina Cozma On behalf of David H Hughes’ team Royal Gwent Hospital
Vasavada  AR,  Raj  SM.     Anterior capsule relationship of the AcrySof intraocular lens optic and posterior capsule opac...
PCO <ul><li>Common complication of cataract surgery with IOL implantation </li></ul><ul><li>Meta-analysis 1998 </li></ul><...
Incidence of PCO with AcrySof IOL  <ul><li>Is very low </li></ul><ul><li>Hydrophobic acrylic AcrySof®  leads to the lowest...
<ul><li>Sharp truncated optic edge combined with total cover of the optic by the anterior capsule is crucial to blocking t...
<ul><li>It also seems that overall IOL size is important in preventing PCO, with a 6.0 mm optic leading to less PCO than a...
Incidence of PCO <ul><li>11.8% - 1 year </li></ul><ul><li>20.75% – 2 years </li></ul><ul><li>28.55% - 3 years  </li></ul>
What is the study about? <ul><li>Means and approaches to prevent or delay PCO </li></ul><ul><li>Not looking at : </li></ul...
Clinical approaches to PCO prevention <ul><li>Non IOL related </li></ul><ul><li>Surgical </li></ul><ul><li>Anterior CCC si...
The study <ul><li>Prospective randomised controlled </li></ul><ul><li>Primary end point: </li></ul><ul><li>To evaluate the...
Inclusion criteria <ul><li>202  consecutive patients with senile cataracts over 50 yr old operated on over 6/12 in India  ...
Exclusion criteria <ul><li>Co-morbidity or previous intraocular surgery </li></ul><ul><li>Black </li></ul><ul><li>On topic...
Method <ul><li>Same surgical technique </li></ul><ul><li>Topical anesthetic </li></ul><ul><li>Temporal clear corneal incis...
Randomization groups <ul><li>1. Anterior capsule covering completely the edge of IOL  </li></ul><ul><li>2.Anterior capsule...
Assessment <ul><li>1/52 </li></ul><ul><li>1/12 </li></ul><ul><li>6/12 </li></ul><ul><li>12/12. </li></ul><ul><li>18 patien...
 
 
 
 
Does this research add to literature in any way? <ul><li>Will the result add information to a meta-analysis? </li></ul><ul...
.  Incidence of Posterior Capsule Opacification in the  Peripheral Zone of the Posterior Capsule                          ...
Incidence of PCOn in the  Midperipheral Zone of Posterior Capsule                                                         ...
Incidence of PCO in the  Central Zone of the Posterior Capsule                                                            ...
Conclusion <ul><li>When using Acrysoft mode  MA30 the relationship of the AC and the IOL is not a factor that relates to t...
Power and limitations <ul><li>Power close to 80%. </li></ul><ul><li>Degree of PCO has not been assessed, only presence or ...
Take home message <ul><li>A total cover of the optic when using AcrySof MA30 does not seem to be compulsory. </li></ul>
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Journal Club

  1. 1. Journal club Irina Cozma On behalf of David H Hughes’ team Royal Gwent Hospital
  2. 2. Vasavada AR, Raj SM. Anterior capsule relationship of the AcrySof intraocular lens optic and posterior capsule opacification: a prospective randomized clinical trial. . Ophthalmology. 2004 May;111(5):886-94
  3. 3. PCO <ul><li>Common complication of cataract surgery with IOL implantation </li></ul><ul><li>Meta-analysis 1998 </li></ul><ul><li>Schaumberg DA et al A systematic overview of the incidence of PCO. Ophthalmology. 1998 Jul;105(7):1213-21. </li></ul>
  4. 4. Incidence of PCO with AcrySof IOL <ul><li>Is very low </li></ul><ul><li>Hydrophobic acrylic AcrySof® leads to the lowest incidence of PCO. 3 A study with a 3-year follow-up showed that hydrophobic acrylic IOLs yielded the lowest percentage of PCO (10%) followed by silicone (40%) and poly(methyl methacrylate) (PMMA) (56%) lenses. 2 </li></ul>
  5. 5. <ul><li>Sharp truncated optic edge combined with total cover of the optic by the anterior capsule is crucial to blocking the migration of lens epithelial cells. </li></ul><ul><li>There are 2 conflicting theories on the mechanism. Nishi and coauthors 22 postulate that cell contact inhibition is responsible for reduced PCO with square-edged IOLs, while Boyce and coauthors 23 suggest the phenomenon may be caused by a mechanical pressure barrier effect at the sharp optic edge. </li></ul>
  6. 6. <ul><li>It also seems that overall IOL size is important in preventing PCO, with a 6.0 mm optic leading to less PCO than a 5.5 mm optic 2 years after surgery. 24 The above factors undoubtedly influenced the low incidence and severity of PCO with both IOLs in our study. </li></ul>
  7. 7. Incidence of PCO <ul><li>11.8% - 1 year </li></ul><ul><li>20.75% – 2 years </li></ul><ul><li>28.55% - 3 years </li></ul>
  8. 8. What is the study about? <ul><li>Means and approaches to prevent or delay PCO </li></ul><ul><li>Not looking at : </li></ul><ul><li>How to quantify PCO most common used POCOMAN </li></ul><ul><li>http:// www.ph.kcl.ac.uk/POCOMAN .html </li></ul><ul><li>Ocular or systemic factors </li></ul>
  9. 9. Clinical approaches to PCO prevention <ul><li>Non IOL related </li></ul><ul><li>Surgical </li></ul><ul><li>Anterior CCC size </li></ul><ul><li>Posterior CCC </li></ul><ul><li>Capsule polishing </li></ul><ul><li>Cortical clean up </li></ul><ul><li>Mechanical </li></ul><ul><li>Capsular tension ring </li></ul><ul><li>Chemical </li></ul><ul><li>Heparin </li></ul><ul><li>IOL related </li></ul><ul><li>Surgical </li></ul><ul><li>Placement site of IOL </li></ul><ul><li>Mechanical </li></ul><ul><li>IOL optic edge </li></ul><ul><li>Chemical </li></ul><ul><li>Surface coating </li></ul>
  10. 10. The study <ul><li>Prospective randomised controlled </li></ul><ul><li>Primary end point: </li></ul><ul><li>To evaluate the relationship of the anterior capsule and AcrySof MA 30 IOL and its impact on the development of central PCO </li></ul><ul><li>Secondary end point: </li></ul><ul><li>Incidence of PCO in the 3 zones of the capsule </li></ul>
  11. 11. Inclusion criteria <ul><li>202 consecutive patients with senile cataracts over 50 yr old operated on over 6/12 in India </li></ul><ul><li>One surgeon </li></ul><ul><li>Same cataract technique </li></ul><ul><li>Ethics committee approved </li></ul><ul><li>Informed consent </li></ul><ul><li>Pupil dilatation more than 7mm </li></ul><ul><li>Hypertensive included </li></ul>
  12. 12. Exclusion criteria <ul><li>Co-morbidity or previous intraocular surgery </li></ul><ul><li>Black </li></ul><ul><li>On topical or systemic NSAIDS or steroids </li></ul>
  13. 13. Method <ul><li>Same surgical technique </li></ul><ul><li>Topical anesthetic </li></ul><ul><li>Temporal clear corneal incision </li></ul><ul><li>Acrysoft MA30 5.5mm optic and 12.5mm diameter in the bag </li></ul><ul><li>After IOL implanted and before viscoelastic removed </li></ul><ul><li>Randomization: envelope </li></ul>
  14. 14. Randomization groups <ul><li>1. Anterior capsule covering completely the edge of IOL </li></ul><ul><li>2.Anterior capsule totally off the IOL edge </li></ul><ul><li>3. Anterior capsule partially covered the edge of IOL </li></ul>
  15. 15. Assessment <ul><li>1/52 </li></ul><ul><li>1/12 </li></ul><ul><li>6/12 </li></ul><ul><li>12/12. </li></ul><ul><li>18 patients excluded as no f/u(6,4,6). </li></ul><ul><li>Single observer. </li></ul><ul><li>No eye required Yag laser at 3 years. </li></ul>
  16. 20. Does this research add to literature in any way? <ul><li>Will the result add information to a meta-analysis? </li></ul><ul><li>Is there sufficient doubt in the mind of the reader to make new evidence desirable even when not scientifically necessary? </li></ul>
  17. 21. . Incidence of Posterior Capsule Opacification in the Peripheral Zone of the Posterior Capsule                                                                                                                        .
  18. 22. Incidence of PCOn in the Midperipheral Zone of Posterior Capsule                                                                                                                                                                                                                                                                                                                                                                          
  19. 23. Incidence of PCO in the Central Zone of the Posterior Capsule                                                                                                                       
  20. 24. Conclusion <ul><li>When using Acrysoft mode MA30 the relationship of the AC and the IOL is not a factor that relates to the development of central PCO at 3 years. </li></ul><ul><li>Confirms suggestion of retrospective study that at 3 years overlap of the anterior capsule is more critical with SI40 than with AcrySof 3-piece. </li></ul><ul><li>Peripheral opacification was slow and similar between the groups. </li></ul><ul><li>Midperipheral opacification was present in 24.2% in group 1, 16% in group 2 and 20.65 9n group 3. </li></ul>
  21. 25. Power and limitations <ul><li>Power close to 80%. </li></ul><ul><li>Degree of PCO has not been assessed, only presence or absence. </li></ul>
  22. 26. Take home message <ul><li>A total cover of the optic when using AcrySof MA30 does not seem to be compulsory. </li></ul>
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