1. Comparison of Nd:YAG Laser Capsulotomy Rates after implantation of 2 IOLs: One Hydrophilic Acrylic and the other Silicone with sharp posterior optic edge Dr. Ramesh Dorairajan Dr. Devi Radhakrishnan Sundar Eye Hospital, Chennai, India. We have no financial interest in this presentation

2. Purpose of the study To compare the PCO and YAG Capsulotomy rates of Akreos (Adapt & AO) IOLs and Clariflex IOLs.

3. Methods Retrospective case sheet review of PCO and YAG rates. Single Surgeon series of 201 cases of IOL implantations done from May 2006 to June 2008. the follow up was between 1 and 3 years. Inclusion criteria: group 1: with Akreos Adapt / Akreos AO IOLs group 2: with Clariflex IOLs All implantations were in the bag and the surgical technique has remained constant throughout the study period with same post operative treatment.

4. Exclusion criteria: 1) Patients with previous ocular surgery or trauma, 2) Patients who needed additional ocular procedures, 3) Patients who were noted to have a plaque on the posterior capsule Patients who were lost to follow up.

5. The data collected were: Date of surgery BCVA at 6, 12 and 24 and 36 months Complaints at each review Presence of PCO within the undilated pupillary area Whether a Yag capsulotomy was needed or not

6. Results of our study IOL IOL Number of Patients Patients with PCO PCO Rate Patients who required YAG YAG Rate AKREOS ADAPT/AO 95 95 38 38*40% 28 2829.5% CLARIFLEX 106 106 43.77% 4**3.77% Our PCO rate for Akreos IOLs was 40 % with a follow up between 12 months and 36 months. 30% of patients in this series needed a Yag capsulotomy to improve vision or to reduce glare. This is in variance with other published studies.(1) Our PCO rate did not show a difference between the adapt and AO series of Akreos IOLs. Reported YAG Rates from other studies…. Ref 1… The PCO Rate with Akreos Adapt was 8.8% at 30 months follow up. Ref 2…. T he YAG Rate with clariflex was 1.93% at 3 years follow up.

7. Discussion & Conclusion 1.Literature review suggests that PCO preventing effect of sharp optic edge is independent of the IOL material. Reference 3 &4… Our result shows a gross difference in the PCO rates between the 2 IOLs with sharp posterior edges. Is it possible that the Akreos edge is not sharp enough to block growing lens epithelium? The background of this slide shows cells growing freely all around an Akreos IOL.

8. Flattened aggressive LECs behind an Akreos IOL.

9. Our initial experience with the Akreos AO / Adapt IOLs were excellent. Crisp vision, negligible amount of glare, a comfortable post operative period and highly satisfied patients….the lenses were easy to implant and were refreshingly clear on slit lamp exam unlike other acrylic IOLs. The Akreos became our favorite IOL. I have implanted the Akreos AO IOL in my parent’s eye, teachers and good friend’s eyes. The initial trickle of PCOs made me shift from the Adapt to the AO series. Over the next two years the number of patients coming with complaints with the Akreos IOLs increased dramatically. So much so that my optometrist would precede these patients with a sorrowful look and say’ PCO’. Its our clinic’s policy not charge our patients for Yag Capsulotomies, where we had done the initial cataract surgery. Our Yag rates for the last decade has been around 3% until we started using the Akreos lenses. Are our results unique? Is this high rate of PCO due to an inappropriate surgical technique? We would like to know if other surgeon are having a similar experience with Akreos IOLs after the first one or two years. The other foldable lenses that we had used during this period were the AMO Tecnis, Alcon 3 piece and the Alcon IQ series. The other foldable lens PCO rates were comparable to Clariflex. It is our intention to share this surprising result. We look forward to suggestions to modify our surgical technique to reduce our PCO rates or to improvement s in the lens itself so that we can go back to using this otherwise superb intra ocular lens.

10. Conclusion. There is a 10 fold increase in PCO and a 7 fold increase in Yag capsulotomy rates with the Acrylic Akreos IOLs as compared to Silicone Clariflex IOLs. Thank you

11. References….. Ref 1….Rate of Posterior Capsule Opacification in eyes with the Akreos IOL..JSCRS Aug 2007 Mona A. Khandwala, FRCS, Branka Marjanovic, MRCOphth, Ajay K. Kotagiri, MRCOphth, Masoud Teimory, FRCOphth. The PCO Rate with Akreos Adapt was 8.8% at 30 months follow up.Mona A. KhandwalaBranka MarjanovicAjay K. KotagiriMasoud Teimory Ref 2…. Long term effect of optic edge design in a silicone IOL on posterior capsule opacification..AJO,June 2007 Wolf Beuhl,Rupert menapace,Oliver Findl,Thomas Neumayer,Mathias Bolz,Ana Prunz The YAG Rate with clariflex was 1.93% at 3 years follow up. Ref 3….Cochrane Database Syst Review..2010 feb Interventions for preventing posterior capsule opacification Findl O,Beuhl W,Bauer P,Sycha T. Ref 4…Effect of Intra Ocular Lenses on preventing Posterior Capsule Opacification:Design versus material… JSCRS OCT 2004.. Okihiro Nishi MD,Kayonishi MD,Yashuribo osakabeMD Ref 5….Evaluating and defining the sharpness of Intraocular lenses:Microedge structure of commercially available square edged hydrophilic intraocular lenses..JSCRS March 2009 Liliana Werner,Manfred Tetz,Ines Feldman,Michael Bucker Ref 6…..Posterior capsule opacification and YAG rates with round edged silicone and a sharp edged hydrophobic acrylic intraocular lens 10 years after surgery.JSCRS March 2009 Lorenz Vock,Rupert Menapace,Eva Stiffer.Michael Georgopaulos,Stephen Sacu.