title: Effect of posterior chamber intraocular lens design and surgical placement on postoperative outcome.
abstract: Intraocular lens (IOL) design, optical configuration, and placement have potential effects on postoperative outcome. Laboratory studies have suggested that one-piece, biconvex designs may reduce or delay posterior capsular opacification and that in-the-bag fixation of the posterior chamber IOL may reduce inflammation. To document the clinical significance of IOL design and placement, we conducted a randomized, prospective, clinical trial. Six hundred uncomplicated capsulorhexis and phacoemulsification patients were randomized in a three-factor design to receive an IOL that was one-piece or three-piece, had a biconvex, plano-convex, or laser ridge optic, and was bag-or sulcus-fixated. Treatment differences were related to lens placement. Patients with bag-fixated IOLs had less posterior capsular opacification, fewer YAG laser capsulotomies, a higher percentage of centered lenses, less inflammation, and fewer late posterior capsular striae than those with sulcus-fixated IOLs. In the latter group, patients with three-piece IOLs had fewer posterior capsular striae at three months postoperatively. All six occurrences of haptic loop distortion were in patients with three-piece IOLs. Patients with the one-piece design had less late inflammation than those with the three-piece design. Fewer YAG capsulotomies were necessary at one year in patients with the biconvex design than in those with the plano-convex or laser ridge configurations. Operative complications, endothelial cell loss, and postoperative complications were not IOL-related.
authors.affiliation: Medical Care International Teaching and Research Institute, Southern Pines, North Carolina 28387.
authors.forename: R G
authors.initials: RG
authors.lastname: Martin
authors.forename: D R
authors.initials: DR
authors.lastname: Sanders
authors.forename: J
authors.initials: J
authors.lastname: Souchek
authors.forename: M G
authors.initials: MG
authors.lastname: Raanan
authors.forename: M
authors.initials: M
authors.lastname: DeLuca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000009:adverse effects; D002452:Cell Count; D009877:Endophthalmitis / Q000473:pathology; D004728:Endothelium, Corneal / Q000473:pathology; D006801:Humans; D007910:Lenses, Intraocular; D008875:Middle Aged; D055095:Optics and Photonics; D011446:Prospective Studies; D011474:Prosthesis Design; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity