Fewer Nd:YAG Capsulotomies Necessary for Patients Implanted With Entirely Hydrophobic IOLs

Lenses with only hydrophobic surface materials are not as effective in preventing posterior capsule opacification, a study shows.

Depending on the type of intraocular lens implanted after cataract removal, some patients may be less likely to require follow-up Nd:YAG capsulotomy than others. As a result, lens choice may play a critical role in patients’ quality of life after surgery and may reduce future healthcare risks and costs, according to the findings published in Eye.

Cataract surgery can lead to posterior capsule opacification (PCO) in up to 43% of patients within the first year after surgery, according to investigators. While Nd:YAG is generally considered a safe procedure, the treatment may be complications and increased healthcare costs. Therefore, reducing patients’ risk of PCO is an important step in improving outcomes.

Researchers conducted a longitudinal retrospective cohort study to investigate the incidence of Nd:YAG capsulotomy 3 years after cataract surgery in 14,519 patients (mean age of 75±5.9 years, 53% women) who received 1 of 5 different types of single-piece monofocal IOLs. Devices reviewed included AcrySof (Alcon, 2968 participants, LLASY60 (AJL Ophthalmic, 1776 participants), Bi-flex (Medicontur, 5176 participants), Asphina (Zeiss, 4478 participants), and Stabibag (IOLTECH, 121 participants). Of the eyes studied, 8293 were followed until their 3-year follow-up.

The overall incidence of Nd:YAG capsulotomy 3 years after cataract surgery was approximately 14%. The rates were significantly lower in only 1 group: the patients fitted with AcrySof IOLs (5%). The other groups demonstrated YAG rates of 31.1% for LLASY60, 23.2% for Stabibag, 23.1% for Bi-flex, and 21.2% for Asphina; (P <.0001 for each comparison).

Further, researchers found that the incidence of Nd:YAG capsulotomy increased between year 1 and year 3 post-surgery, but the incidence was consistently an approximate 80% lower for AcrySof patients than the other groups. 

“Our results indicate that the hydrophobic surface material is not as effective in preventing PCO as an entirely hydrophobic lens,” researchers suggest.

The study’s limitations include that the data used may over-represent more severe PCO cases and potential biases that may arise from between-eye correlation and other variables that also may play a role in PCO’s development. 

Disclosure: Multiple authors declared affiliations with biotech, pharmaceutical, and/or device companies. This research was supported by Alcon. Please see the original reference for a full list of authors’ disclosures.  


Belda JI, Dabán JP, Elvira JC, et al. Nd:YAG capsulotomy incidence associated with five different single-piece monofocal intraocular lenses: a 3-year Spanish real-world evidence study of 8293 eyes. Eye. Published online November 11, 2021. doi:10.1038/s41433-021-01828-z