Long term clinical outcome of a randomised controlled trial of anterior chamber lenses after high volume intracapsular cataract surgery

Background-Age related cataract remains the major cause of blindness throug hout the world. In many countries, the majority of cataract surgery continu es to be done by the intracapsular cataract extraction (ICCE) method. The r esults of a large randomised controlled trial of multiflex open loop anteri or chamber intraocular lenses (ACIOL) were reported from a busy eye hospita l in Nepal. Methods-There was a randomised controlled trial of 2000 people with bilater al cataract reducing vision to less than 6/36. Interventions were ICCE with an ACIOL compared with ICCE with aphakic spectacles (+11 dioptres). Partic ipants were followed at discharge, 6 weeks, 1 year, and 1 1/2-5 years after surgery. Visual acuity and clinical outcome were measured. A poor outcome was defined as vision <6/60. Results-Visual outcome was comparable in the two groups. More of the contro l group experienced functional blindness due to loss of aphakic spectacles at 1 year. The majority of cases of poor outcome occurred in the first year after surgery. There was no indication of any lens related problems after 1 year. Conclusion-Multiflex open loop anterior chamber lenses are safe for up to 1 year of follow up when used by experienced surgeons, and the available evi dence of 2-5 years of follow up suggests that the complication rate is reas onably low. An ACIOL at the time of cataract surgery offers benefits over r outine ICCE surgery with aphakic spectacle correction as it avoids the prob lem of replacing lost and broken spectacles.