Effect of AcrySof versus other intraocular lens properties on the risk of Nd:YAG capsulotomy after cataract surgery: A systematic literature review and network meta-analysis

Objective
The purpose of this study was to evaluate the impact of different intraocular lens materials (IOL) and optic edge designs on the incidence of Nd:YAG laser capsulotomy.
Methods
Randomized controlled trials (RCTs) reporting incidence of Nd:YAG capsulotomy in patients with monofocal IOLs were identified for systematic literature review (SLR) using Cochrane methodology. A network meta-analysis was conducted under a Bayesian framework. Mean hazard ratios (HRs), 95% credible intervals, and one-sided p-values were estimated for Nd:YAG capsulotomy incidence by comparing AcrySof IOLs with a group of non-AcrySof hydrophobic acrylic, hydrophilic acrylic, silicone, and PMMA IOLs. Sensitivity analysis was conducted comparing the risk of Nd:YAG capsulotomy between sharp- and round-edged designs of the above IOLs.
Results
AcrySof IOLs had a lower risk of Nd:YAG capsulotomy compared to hydrophobic acrylic (HR: 2.68; 95% CrI: 1.41, 4.77; p < 0.01), hydrophilic acrylic (HR: 7.54; 95% CrI: 4.24, 14.06; p < 0.001), PMMA (HR: 3.64, 95% CrI: 1.87, 6.33; p < 0.001), and silicone (HR: 1.13; 95% CrI: 0.59, 1.91; p <0.1) IOLs. The risk for Nd:YAG was highest among sharp-edged IOLs for hydrophilic acrylic IOLs (HR: 9.32; 95% CrI: 4.32, 19.29; p < 0.01), followed by other hydrophobic acrylic (HR: 2.91; 95% CrI: 1.27, 5.88; p < 0.01), silicone (HR: 0.838; 95% CrI: 0.328, 1.74; p = 0.69), and PMMA (HR: 0.39; 95% CrI: 0.042, 1.49; p = 0.93) IOLs, compared to AcrySof. Acrysof IOLs had a lower risk of Nd:YAG compared to PMMA (HR: 3.25; 95% CrI: 1.21, 7.37; p < 0.01) and silicone, round edge IOLs (HR: 3.84; 95% CrI: 1.08, 10.64; p = 0.015).
Conclusion
The risk of Nd:YAG capsulotomy is lower in eyes implanted with AcrySof IOLs compared to non-AcrySof hydrophobic or hydrophilic acrylic IOLs. Sharp-edged AcrySof, PMMA, and silicone IOLs are comparable in terms of reducing the risk of Nd:YAG laser capsulotomy.

研究目的
本研究旨在评估不同人工晶状体（intraocular lens, IOL）材料及光学边缘设计对Nd:YAG激光晶状体后囊膜切开术发生率的影响。

研究方法
本研究采用Cochrane系统评价方法，检索报道单焦点人工晶状体患者Nd:YAG激光后囊膜切开术发生率的随机对照试验（randomized controlled trial, RCT）以开展系统文献综述（systematic literature review, SLR）；并基于贝叶斯框架开展网络Meta分析。通过将AcrySof人工晶状体与非AcrySof疏水丙烯酸酯、亲水丙烯酸酯、硅胶及聚甲基丙烯酸甲酯（PMMA）人工晶状体进行对比，估算Nd:YAG激光后囊膜切开术发生率的平均风险比（hazard ratio, HR）、95%可信区间（credible interval, CrI）及单侧p值。此外开展敏感性分析，对比上述人工晶状体锐边与圆边设计的Nd:YAG激光后囊膜切开术发生风险。

研究结果
与非AcrySof疏水丙烯酸酯人工晶状体（HR=2.68；95% CrI：1.41~4.77；p<0.01）、亲水丙烯酸酯人工晶状体（HR=7.54；95% CrI：4.24~14.06；p<0.001）、聚甲基丙烯酸甲酯（PMMA）人工晶状体（HR=3.64；95% CrI：1.87~6.33；p<0.001）及硅胶人工晶状体（HR=1.13；95% CrI：0.59~1.91；p<0.1）相比，AcrySof人工晶状体的Nd:YAG激光后囊膜切开术发生风险更低。
其中，亲水丙烯酸酯锐边人工晶状体的Nd:YAG激光后囊膜切开术发生风险最高（HR=9.32；95% CrI：4.32~19.29；p<0.01），其次分别为非AcrySof疏水丙烯酸酯人工晶状体（HR=2.91；95% CrI：1.27~5.88；p<0.01）、硅胶人工晶状体（HR=0.838；95% CrI：0.328~1.74；p=0.69）及聚甲基丙烯酸甲酯（PMMA）人工晶状体（HR=0.39；95% CrI：0.042~1.49；p=0.93），以上均以AcrySof人工晶状体为参照。
进一步对比边缘设计发现，与AcrySof人工晶状体相比，聚甲基丙烯酸甲酯（PMMA）圆边人工晶状体（HR=3.25；95% CrI：1.21~7.37；p<0.01）及硅胶圆边人工晶状体（HR=3.84；95% CrI：1.08~10.64；p=0.015）的Nd:YAG激光后囊膜切开术发生风险更高。

研究结论
与非AcrySof疏水或亲水丙烯酸酯人工晶状体相比，植入AcrySof人工晶状体的患眼发生Nd:YAG激光后囊膜切开术的风险更低。锐边AcrySof、聚甲基丙烯酸甲酯（PMMA）及硅胶人工晶状体在降低Nd:YAG激光后囊膜切开术风险方面效果相当。