Eradication of posterior capsule opacification - Documentation. of a marked decrease in Nd : YAG laser posterior capsulotomy rates noted in an analysis of 5416 pseudophakic human eyes obtained postmortem

Objective: (1) To report the neodymium:yttrium-aluminum-garnet (Nd:YAG) las er posterior capsulotomy rate (%) of eight rigid and foldable intraocular l ens (IOL) designs in a series of 5416 pseudophakic human eyes obtained post mortem, accessioned in our center between January 1988 and January 2000. (2 ) To identify factors that are instrumental in reducing the incidence of po sterior capsule opacification, (PCO, secondary cataract) and hence the need for Nd:YAG laser posterior capsulotomy. Design: Comparative autopsy tissue analysis. Participants: A total of 5416 globes with posterior chamber intraocular len s (PC-IOLs) obtained postmortem received from Lions Eye Banks between 1988 and 2000. Methods: Miyake-Apple posterior photographic technique. Special reference w as given to the presence or absence of Nd:YAG laser posterior capsulotomy o rifice on the posterior capsule of each eye. Main Outcome Measures: The Nd:YAG laser posterior capsulotomy rate (%) as o f January 2000 was documented. In addition, the Nd:YAG laser posterior caps ulotomy rate for each lens was plotted on a monthly basis for the same peri od, creating a computerized trend or "timeline" for each IOL style. Results: Relatively high Nd:YAG laser posterior capsulotomy rates ranging f rom 20.3% to 33.4% were noted with four relatively older designs (high inci dence of implantation between 1988 and the early 1990s). Four modern foldab le IOLs manufactured from silicone and acrylic materials had significantly lower Nd:YAG laser posterior capsulotomy rates ranging from 0.9% (Alcon Acr ysof) to 17.1%. The difference in Nd:YAG rates among the eight IOL designs was found to be significant (P ( 0.0001, chi-square test). Comparing foldab le versus rigid designs, the foldable IOLs were associated with a much lowe r Nd:YAG laser posterior capsulotomy rate (14.1% vs. 31.1%). Conclusions: By use of the six factors regarding surgical technique and IOL choice described in this article, we strongly believe that the overall inc idence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing from rates as high as 50% in the 1980s to early 1990s. Surgical tools and IOLs are now available to bring these rates down to single digits. Careful application and use of these tools by surgeons ca n genuinely lead in the direction of virtual eradication of secondary catar act, the second most common cause of visual loss worldwide. (C) 2001 by the American Academy of Ophthalmology.