Long-Term Assessment of PC-IOL Optic Apposition in Surface-Modified IOL and Its Impact on Nd:YAG Capsulotomy Rate and Visual Quality.

Purpose: To assess apposition of posterior capsule (PC) to intraocular lens (IOL) optic in ultraviolet (UV)/ozone surface modified IOL and its impact on neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy rate and visual quality.

Design: Prospective interventional case series.

Methods: The study enrolled 100 eyes implanted with UV/ozone surface modified hydrophobic acrylic IOL during phacoemulsification. The primary outcome measure was PC-optic apposition on anterior segment optical coherence tomography (ASOCT). Secondary outcomes were Nd:YAG capsulotomy and visual quality (ray-tracing aberrometry). Follow-up was performed on postoperative day (POD) 1, at 1, 3, and 6 months, and 1 and 2 years.

Results: Complete PC-optic apposition was observed in 4% of cases on POD1, which increased to 75% at 2 years. PC configuration in cases with PC-optic non-apposition was smooth (34.4%) or wavy (65.6%) on ASOCT; initial smooth PC was associated with significantly higher incidence of PC-optic apposition at 2 years (p=0.028). At 2 years, visual quality was significantly better in cases with complete PC-optic apposition in terms of Strehl ratio (P = .029), modulation transfer function (MTF) (P = 0.016), root mean square (RMS) aberrations (P = .024) and higher order aberrations (HOAs) (P = 0.043). A significant positive correlation was observed between height of interface fluid and total RMS (Pearson correlation coefficient 0.221; P = .027) and HOAs (Pearson correlation coefficient 0.198; P = .048). PCO developed in 7% of cases (7/100); of these, 6 cases had persistent PC-optic non-apposition. Nd:YAG laser capsulotomy was required in 3% (3/100) cases; all of these cases had persistent PC-optic non-apposition.

Conclusions: Long-term complete PC-optic apposition was observed in 75% of patients implanted with UV/ozone surface-modified IOLs. Complete PC-optic apposition is associated with lower Nd:YAG capsulotomy rate and superior visual quality.