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Meta-Analysis
. 2019 Aug 19;14(8):e0220498.
doi: 10.1371/journal.pone.0220498. eCollection 2019.

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

Howard Thom  1 , Frank Ender  2 , Saisudha Samavedam  3 , Caridad Perez Vivez  4 , Subhajit Gupta  3 , Mukesh Dhariwal  5 , Jan de Haan  6 , Derek O'Boyle  4
Affiliations
Meta-Analysis

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

Howard Thom et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: FE, CPV, JdH and DOB are employees of Alcon Vision LLC; SS and SG are employees of Novartis Healthcare Pvt Ltd, Hyderabad, India the marketing authorization holder of AcrySof IOLs. HT is an employee of University of Bristol, Bristol, United Kingdom and received a consulting fee for his work on the network meta analysis reported in this paper The authors declare no other conflicting interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA flowchart for study selection.
Fig 2
Fig 2. Risk of bias assessment of RCTs included in SLR.
Fig 3
Fig 3. Evidence network for Base-case analysis: AcrySof vs. other hydrophobic acrylic, hydrophilic acrylic, silicone, and PMMA IOLs without optic edge classification*.
* Each node corresponds to an implant and nodes are connected by an edge if those implants have been compared in RCT. The numbers along the edges, and edge thickness, represent the number of RCTs informing that contrast. RCTs with more than two arms can contribute to multiple contrasts.
Fig 4
Fig 4. Evidence network for sensitivity analysis: AcrySof vs. other hydrophobic acrylic, hydrophilic acrylic, silicone, and PMMA IOLs with edge classification into round or sharp edged*.
* Each node corresponds to an implant and nodes are connected by an edge if those implants have been compared in RCT. The numbers along the edges, and edge thickness, represent the number of RCTs informing that contrast. RCTs with more than two arms can contribute to multiple contrasts.
Fig 5
Fig 5. Base-case analysis: Hazard ratios and 95% CrI for Nd:YAG comparing IOL materials vs. AcrySof IOL without optic edge classification*.
* Bars represent the hazard ratio relative to AcrySof IOL. Solid lines represent 95% credible intervals.
Fig 6
Fig 6. Sensitivity analysis: Hazard ratios and 95% CrI for Nd:YAG comparing IOL materials with sharp/round edge classification vs. AcrySof IOL*.
*Bars represent the hazard ratio relative to AcrySof IOL. Solid lines represent 95% credible intervals.
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Publication types

Grants and funding

This study was sponsored by Alcon Laboratories. Alcon is the market authorisation holder of AcrySof® IOLs. The funder provided support in the form of salaries for authors [FE, SS, CPV, SG, JdH, DOB], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. HT received a consulting fee for his work on the network meta analysis reported in this paper.