The effect of polymethylmethacrylate and AcrySof intraocular lenses on theposterior capsule in patients with a large capsulorrhexis

Purpose: We have previously shown that patients who have a capsulorrhexis l arger than the diameter of a polymethylmethacrylate (PMMA) intraocular lens (IOL) rapidly develop increased posterior capsule opacification (PCO), in effect, producing an example of enhanced PCO. This study focuses on the inf luence of AcrySof IOLs on this process. Methods: Phacoemulsification was performed on two groups of patients. The f irst consisted of 38 patients with a large capsulorrhexis of 6-7 mm who rec eived a 5.5-mm PMMA IOL. The second group of 32 patients had identical surg ery and a 5.5-mm, MA30 AcrySof IOL was implanted. On days 1, 14, 28, 90, 18 0, and 360, high resolution digitized retroillumination images were taken o f the posterior capsule. The PCO area was measured by image analysis at 90, 180, and 360 days. Wrinkling of the posterior capsule was determined at 90 days, and the progression or regression of lens epithelial cell (LEC) prol iferation was established by examination of serial images at 28 and 180 day s. Results. At 90 days, 79% of the patients with PMMA IOLs had moderate to sev ere wrinkling of the posterior capsule, whereas the patients with AcrySof I OLs had none (P < .001). The percentage of PCO area was 69% for the PMMA IO Ls and 24% for the AcrySof IOL group at 360 days (P < .0001). In the PMMA g roup, LEC progression occurred in 77%, LEC growth was stable in 15%, and LE C regression occurred in only 8%, compared to 69% of patients with AcrySof IOLs (P < .0001). Conclusions: In patients with a rhexis larger than the IOL, AcrySof IOLs po tentially can prevent capsular wrinkling and cause less PCO than a PMMA IOL with a similar rhexis size. The LEC regression occurs with AcrySof between 28 and 180 days. The reasons for this are discussed. Jpn J Ophthalmol 2001 ;45:348-354 (C) 2001 Japanese Ophthalmological Society.