Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial

Abstract

Purpose To compare the outcomes of phacoemulsification with either a 2.5-mm clear corneal incision and a foldable intraocular lens (IOL) or a 5-mm sclerocorneal tunnel incision and a rigid polymethyl methacrylate (PMMA) IOL. Methods In a prospective, randomised clinical trial of phacoemulsification cataract surgery, 1200 patients received either a foldable hydrophilic acrylic IOL through a 2.5-mm corneal incision or an inexpensive rigid PMMA IOL via a 5-mm sclerocorneal tunnel. Intra-and post-operative data and visual acuity at discharge, 6 weeks, and 1 year follow-up were analysed.Results At 1 year after surgery, 996 (83.0%) patients were followed up with an uncorrected visual acuity of 6/18 or better in 90.3% of the foldable and 94.3% in the rigid IOL group (risk ratio (RR) 0.96, 95% confidence intervals (CI) 0.92-0.99). Poor outcome (best-corrected acuity 6/60 or worse) occurred in 1.0% and 0.4%, respectively (RR 4.28,). The surgical cost of consumables and overall surgical time were similar in both groups; however, the cost of the foldable IOL was eight times higher than the PMMA IOL. Posterior capsule opacification was more common in the rigid IOL group at 12 months (36.1% vs 23.3%); however, this did not affect postoperative vision. Conclusion In the hands of experienced cataract surgeons, phacoemulsification with implantation of a foldable or a rigid IOL gives excellent results. Using an inexpensive rigid PMMA IOL will make phacoemulsification more affordable for poor patients in low-and middle-income countries.

Incidence of Posterior Capsular Opacification With Foldable Acrylic and Pmma Intraocular Lens Implantation

“…7 In another study by Hennig et al, PCO rate was 23.3% in acrylic and 36.1% in PMMA groups at the end of one year. 8 Hazra et al found that there was no difference in PCO formation between the rigid and foldable lens designs. 9 According to Takkar et al, significant PCO is associated with PMMA IOLs.…”

Phacoemulsification outcomes in Boston terriers as compared to non‐Boston terriers: a retrospective study (2002–2015)

“…While dogs have an amplified uveal inflammatory response to surgery compared to that seen in humans, one would otherwise expect dogs to have a similarly improved outcome with a small incision and foldable lenses. On the other hand, a recent randomized clinical trial comparing foldable vs. rigid IOLs in people found an excellent visual outcome in both groups (>90% with uncorrected visual acuity of 6/18 or better), although PCO was more common in the PMMA group as compared to the foldable IOL group (36.1% vs. 23.3%) . One recent veterinary study found that the PCO score via direct slit lamp was significantly lower for acrylic foldable IOLs when compared to PMMA IOLs in a group of dogs .…”

A Comparative Study of Clear Corneal Phacoemulsification with Rigid IOL Versus SICS; the Preferred Surgical Technique in Low Socio-economic group Patients of Rural Areas

“…A study conducted in Nepal by Hennig A et al, [14] compared the results of phacoemulsification done using foldable versus rigid IOL's, in which the foldable lens was inserted using a 2.5mm clear corneal incision, while the rigid lens was inserted using a 5mm sclerocorneal incision. They found no significant difference in the visual outcome of phacoemulisfication using either a rigid intraocular lens (PMMA PC IOL) or a foldable PC IOL (hydrophilic acrylic).…”