Incidence and factors for pseudoaccommodation after monofocal lens implantation: the Monofocal Extended Range of Vision study.

PURPOSE: To screen patients with a monofocal intraocular lens (IOL) for incidence of unaided 20/40 and 0.3 LogMAR for distance and near (pseudoaccommodation) and to find factors for pseudoaccommodation. SETTINGS: University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom. DESIGN: Prospective study. METHODS: This was a single-eye study ( ClinicalTrials.gov : NCT04011696). At 3 to 9 months, refraction, uncorrected and corrected distance and uncorrected near visual acuity (logMAR), spherical equivalent (SEQ), mesopic pupil size (PS), total eye spherical (Z 40 ), vertical coma (Z 3-1 ) aberrations, reading speed and smallest print size were assessed. Refractive astigmatism (RA) was classified as against-the-rule, with-the-rule, oblique and no astigmatism. Data on preoperative axial length (AL) and anterior chamber depth (ACD) were collected. RESULTS: 29 patients (9.6%, 95% CI, 6.5-13.5) had pseudoaccommodation. In cases vs controls, median SEQ, PS, total Z 40 , Z 3-1 , reading speed, smallest print size, preoperative ACD, preoperative AL were: -0.39 vs 0.0 diopters; 3.62 vs 4.10 mm; 0.01 vs 0.02 µm; 0.018 vs 0.022 µm; 106 vs 133 words per minute; 0.30 vs 0.50 logMAR; 2.94 vs 3.13 mm, 23.4 vs 23.7 mm, respectively. RA was not different between the groups. Univariate analysis revealed preoperative ACD (odds ratio [OR], 0.38, 95% CI, 0.16-0.94, P = .04), SEQ (OR, 0.61, 95% CI, 0.42-0.88, P = .01), total Z 40 (OR, 0.0003, 95% CI, 0.00-0.39, P = .03) and PS (OR, 0.39, 95% CI, 0.22-0.69, P < .041) to be significant. Whereas multivariable logistic regression identified: preoperative AL (OR, 0.62, 95% CI, 0.42-0.91, P = .02), SEQ (OR, 0.49, 95% CI, 0.31-0.78, P = .01), Z 40 (OR, 0.00, 95% CI, 0.0-0.01, P = .01) and PS (OR, 0.41, 95% CI, 0.23-0.75, P = .01) to be significant. CONCLUSIONS: A combination of low myopic SEQ, lower Z 40 , shorter preoperative AL, and smaller PS increases the chances of pseudoaccommodation.

Comparison of Anterior Corneal Aberrometry, Keratometry and Pupil Size with Scheimpflug Tomography and Ray Tracing Aberrometer.

This study aimed to assess the anterior corneal wavefront aberrations, keratometry, astigmatism vectors and pupil size between Pentacam HR® (Oculus Optikgeraete GmbH, Wetzlar, Germany) and iTrace® (Tracey Technologies Corp., Houston, TX, USA). In this observational study, 100 eyes (50 healthy volunteers) were scanned in mesopic light condition with a Pentacam HR® and iTrace®. Anterior corneal aberrations (spherical aberration (Z40), vertical coma (Z3 − 1), horizontal coma (Z3 + 1)), keratometry in the flattest (K1) and steepest meridian (K2), mean astigmatism, astigmatic vectors (J0 and J45), and pupil size were measured. We found a significant difference in Z40 (Pentacam®: +0.30 ± 0.11 µm and iTrace®: −0.03 µm ± 0.05 µm; p < 0.01) with no correlation between the devices (r = −0.12, p = 0.22). The devices were in complete agreement for Z3 − 1 (p = 0.78) and Z3 + 1 (p = 0.39), with significant correlation between the machines (r = −0.38, p < 0.01 and r = −0.6, p < 0.01). There was no difference in K1, K2 and mean astigmatism. J0 was negative with both devices (against-the-rule astigmatism), but there was no correlation. J45 was negative with the Pentacam HR® (more myopic oblique astigmatism) but significantly correlated between the devices. Pupil size was smaller with Pentacam HR® (p < 0.01). In summary, these devices cannot be used interchangeably. Corneal Z40 was significantly different with more negative Z40 with iTrace® compared to Pentacam HR®. iTrace® operates with lower illumination, giving larger pupil size than Pentacam HR®, which uses intense blue light during measurement. No correlation was found for J0. Pentacam HR® had a trend to record more negative J45 (myopic oblique astigmatism).

Use of the double-pass technique to quantify ocular scatter in patients with uveitis: a pilot study.

PURPOSE: to assess whether the double-pass technique can be employed to quantify the amount of light scattering in patients with uveitis. METHODS: 56 eyes of 44 patients with intraocular inflammation were consecutively recruited from the uveitis clinic over 9 months. The degree of intraocular inflammation was recorded according to the Standardization of Uveitis Nomenclature criteria and the eyes were grouped as having anterior, intermediate, posterior or panuveitis. Objective scatter index (OSI) was assessed using a double-pass technique with the Optical Quality Analysis System II. RESULTS: twenty-four eyes had anterior uveitis, 9 eyes had intermediate uveitis, 10 eyes had posterior uveitis and 13 eyes had panuveitis. The OSI was significantly different between all 4 groups (p = 0.0005). The mean OSI was highest in eyes with anterior uveitis (2.6 ± 3.1) and lowest in posterior uveitis (1.9 ± 1.3). Anterior chamber cells significantly correlated with OSI (R(2) = 0.8726, p = 0.007), unlike posterior chamber cells (R(2) = 0.0189, p = 0.588) and flare (R(2) = 0.0048, p = 0.471). CONCLUSION: patients with anterior uveitis have more ocular scatter, and anterior chamber cells scatter more light. This pilot study opens new avenues for research in use of the double-pass technique to assess light scattering in uveitis.

Edge profile of commercially available square-edged intraocular lenses.

PURPOSE: To analyze the sharpness of the posterior optic edge profile and edge thickness of intraocular lenses (IOLs) marketed with a square-edged profile. SETTING: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: Seventeen square-edged 20.0 diopter IOLs of different manufacture, design, and material were selected. After the environmental scanning electron microscopy technique was standardized, repeatability of the technique was tested. Posterior optic edges of all IOLs were scanned at a magnification of x 500. Local radii of curvature of the posterior optic edges were measured by purpose-designed software. Optic edge thickness was also measured from the electron micrographs. RESULTS: The repeatability of the scanning technique was excellent (+/-0.10 microm). The radius of curvature of posterior optic edges ranged from 7.6 to 23.1 microm. Hydrophilic acrylic IOLs (except the HumanOptics MC Microlens 611 MI-B and 1CU) had radii of curvatures more than 10.0 microm of the posterior optic edge compared with hydrophobic acrylic and silicone IOLs (<10.0 microm) except the Hoya AF-1 (19.9 microm). Alcon AcrySof single-piece (SN60WF), HumanOptics 1CU, and AMO Clariflex CLRFLXC IOLs had the thinnest optic edges in the hydrophobic, hydrophilic, and silicone groups, respectively. CONCLUSIONS: Commercially marketed square-edged IOLs differed in the sharpness of the posterior optic edge. Hydrophobic acrylic and silicone IOLs have sharper posterior optic square edge than most hydrophilic acrylic IOLs. This probably reflects difference in manufacturing techniques. Differences in posterior optic edge profile may explain variation in posterior capsule opacification performance with different IOLs and materials.

Commercial Slit Lamp Anterior Segment Photography versus Digital Compact Camera Mounted on a Standard Slit Lamp with an Adapter.

PURPOSE: To compare slit lamp mounted anterior segment cameras (SLCs) versus digital compact camera (DCC) with slit-lamp adaptor when used by an inexperienced technician. METHODS: In this cross sectional study, where posterior capsule opacification (PCO) was used as a comparator, patients were consented for one photograph with SLC and two with DCC (DCC1 and DCC2), with a slit lamp adaptor. An inexperienced clinic technician, who took all the photographs and masked the images, recruited one eye of each patient. Images were graded for PCO using EPCO 2000 software by two independent masked graders. Repeatability between DCC1 and DCC2, and limits-of-agreement between SLC and DCC1 mounted on slit-lamp with an adaptor were assessed. Coefficient-of-repeatability and Bland-Altmann plots were analyzed. RESULTS: Seventy-two patients (eyes) were recruited in the study. First 9 patients (eyes) were excluded due to unsatisfactory image quality from both the systems. Mean evaluation of posterior capsule opacification (EPCO) score for SLC was 2.28 (95% CI: 2.09-2.45), for DCC1 was 2.28 (95% CI: 2.11-2.45), and for the DCC2 was 2.11 (95% CI: 2.11-2.45). There was no significant difference in EPCO scores between SLC vs. DCC1 (p = 0.98) and between DCC1 and DCC2 (p = 0.97). Coefficient of repeatability between DCC images was 0.42, and the coefficient of repeatability between DCC and SLC was 0.58. CONCLUSIONS: DCC on slit lamp with an adaptor is comparable to a SLC. There is an initial learning curve, which is similar for both for an inexperienced person. This opens up the possibility for low cost anterior segment imaging in the clinical, research, and teaching settings.

Effect of square-edged intraocular lenses on neodymium:YAG laser capsulotomy rates in the United States.

PURPOSE: To model the effect of the introduction of square-edged intraocular lenses (IOLs) in the United States on neodymium:YAG (Nd:YAG) laser capsulotomy rates and to compare the model with actual capsulotomy rates. SETTING: Ophthalmology Department, St. Thomas' Hospital, London, United Kingdom, and Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. METHODS: The actual numbers of cataract surgeries and Nd:YAG laser capsulotomies performed in the U.S. were obtained from Medicare claims data for 1993 to 2003. The percentage market share of square-edged IOLs was obtained, and numbers of square-edged and round-edged IOLs implanted were calculated. Predicted laser capsulotomy rates were modeled on published postmortem and clinical data and compared with actual capsulotomy rates. RESULTS: Between 1993 and 2003, the number of cataract surgeries and Nd:YAG laser capsulotomies reimbursed by Medicare rose by 67.4% and 18.9%, respectively. After the introduction of square-edged IOLs in 1995, the market share grew to 48.5% in 2003. The total number of Nd:YAG capsulotomies reimbursed by Medicare in 2003 exceeded the number of capsulotomies predicted by the model by at least 23.9%. The estimated cost generated by the discrepancy between predicted and actual laser capsulotomies in 2003 was at least US $30 million. CONCLUSIONS: After the introduction of square-edged IOLs, Nd:YAG laser capsulotomy rates decreased, but not by as much as predicted. The additional cost to the Medicare system was more than US $30 million higher than the model predicted.

Effect of intraocular lens edge profile on posterior capsule opacification after extracapsular cataract surgery in a developing country.

PURPOSE: To determine whether square-edged polymethyl methacrylate (PMMA) intraocular lenses (IOLs) reduce posterior capsule opacification (PCO) in the context of extracapsular cataract surgery in a developing country. SETTING: A rural hospital in India. METHODS: This was a prospective randomized double-masked fellow-eye controlled study. Over a 4-month period, 118 patients with normal eyes apart from age-related cataract were randomized to receive a square-edged or round-edged PMMA IOL in the first eye. The IOLs were identical apart from the edge profile. The fellow-eye had implantation of the alternative IOL within 1 month. Retroillumination images of the posterior capsule were taken using a dedicated camera system and analyzed to quantify the PCO area using POCO software 1 and 2 years postoperatively and the PCO area and severity using POCOman semiqualitative software at 2 years. Visual acuity was measured using a Gujarati logMAR chart. RESULTS: One hundred fifteen patients were available for examination at 1 year and 107 at 2 years. With POCO software, the PCO area was reduced in the square-edged IOL group at 1 year (median 30% versus 20%, P=.001) and at 2 years (median 45% versus 35%, P=.006). With POCOman, the PCO area and severity were reduced in the square-edged group at 2 years (median 41.5% versus 33.2%, P=.019 and 0.59 versus 0.46, P=.037, respectively). There was no significant difference in visual acuity between the 2 groups at 1 or 2 years. CONCLUSIONS: Sophisticated image analysis techniques can be used in developing countries to quantify PCO. Using extracapsular surgery, square-edged PMMA IOLs reduced the PCO area and severity compared with an identical round-edged IOL; however, the differences were not as marked as those reported with phacoemulsification. This may be due to the difficulty of performing a capsulorhexis that lies on the IOL surface in this situation. Nevertheless, square-edged IOLs offer a potential benefit for extracapsular surgery in the developing world.

Hydrophobic acrylic and plate-haptic silicone intraocular lens implantation in diabetic patients: pilot randomized clinical trial.

PURPOSE: To compare the capsular and uveal reaction after implantation of a plate-haptic silicone intraocular lens (IOL) (C11UB, Chiron) and a hydrophobic acrylic (AcrySof MA60, Alcon) IOL in diabetic patients. SETTING: Moorfields Eye Hospital and St. Thomas' Hospital, London, United Kingdom. METHODS: Thirty-five diabetic patients were recruited consecutively and randomly assigned to have implantation of either of the 2 IOLs. The percentage area of posterior capsule opacification (PCO), anterior capsule contraction (ACC), and postoperative inflammatory indices (flare and cells) were assessed objectively at 2 to 3 weeks, 6 months, and 1 year. Between-group and within-group analyses were conducted using the Student t test or Mann-Whitney test and Friedmann test, respectively. RESULTS: Between-group analysis showed the percentage area of PCO was significantly greater in patients with plate-haptic silicone IOLs at 6 and 12 months (P = .002). At 6 months, ACC was significantly greater in the plate-haptic group (P = .04), but the difference was not significant at 12 months. There was higher flare in the hydrophobic acrylic IOL group than in the plate-haptic silicone IOL group at 2 to 3 weeks (P = .08). Within-group analysis showed that over the follow-up period, the plate-haptic silicone group, but not the hydrophobic acrylic group, had a progressive increase in PCO (P = .003). In the hydrophobic acrylic group, but not the plate-haptic silicone group, there was a significant reduction in the mean anterior chamber flare value (P = .01). There was no significant difference in visual acuity or contrast sensitivity at any postoperative visit. CONCLUSION: In diabetic patients, hydrophobic acrylic IOLs can lead to an increased flare in the early postoperative period but they seem to be more favorable than plate-haptic silicone IOLs because the latter lead to more PCO.

Growth factor restriction impedes progression of wound healing following cataract surgery: identification of VEGF as a putative therapeutic target.

Secondary visual loss occurs in millions of patients due to a wound-healing response, known as posterior capsule opacification (PCO), following cataract surgery. An intraocular lens (IOL) is implanted into residual lens tissue, known as the capsular bag, following cataract removal. Standard IOLs allow the anterior and posterior capsules to become physically connected. This places pressure on the IOL and improves contact with the underlying posterior capsule. New open bag IOL designs separate the anterior capsule and posterior capsules and further reduce PCO incidence. It is hypothesised that this results from reduced cytokine availability due to greater irrigation of the bag. We therefore explored the role of growth factor restriction on PCO using human lens cell and tissue culture models. We demonstrate that cytokine dilution, by increasing medium volume, significantly reduced cell coverage in both closed and open capsular bag models. This coincided with reduced cell density and myofibroblast formation. A screen of 27 cytokines identified nine candidates whose expression profile correlated with growth. In particular, VEGF was found to regulate cell survival, growth and myofibroblast formation. VEGF provides a therapeutic target to further manage PCO development and will yield best results when used in conjunction with open bag IOL designs.

Factors that influence the development of posterior capsule opacification with a polyacrylic intraocular lens.

PURPOSE: To identify factors that contribute to posterior capsule opacification (PCO) after implantation of a 5.5 mm polyacrylic (IOL). DESIGN: A retrospective analysis of a cohort of sequential images taken from the PCO database at St. Thomas' Hospital, London, to include all patients with an AcrySof MA30 lens and a 1-year retroillumination image. METHODS: Records of age, gender, axial length, and PCO measurements using the POCO software system were available. Images were divided into those with greater or less than 10% PCO. The degree of rhexis-IOL contact was recorded in clock hours. RESULTS: Images of 60 eyes were analyzed. Twenty-one eyes had more than 10% PCO. No correlation was found between PCO and age, gender, or axial length. Forty-eight eyes (80%) had some loss of rhexis-IOL contact. These eyes had increased PCO (P < .001) compared with eyes with complete IOL-rhexis contact. More PCO developed when the rhexis was partly on and partly off the IOL. CONCLUSIONS: PCO is reduced when the rhexis is in complete contact with the anterior IOL surface. The failure to achieve this accounts for the majority of increased PCO seen in patients implanted with this IOL model. PCO formation is related to surgical technique as well as IOL design, and comparisons cannot be made between IOLs without taking this into consideration. These results support the trend to the use of larger optic IOLs to prevent PCO and also support the "capsule compression" theory of PCO prevention.

Fellow eye comparison between the 1CU accommodative intraocular lens and the Acrysof MA30 monofocal intraocular lens.

PURPOSE: To examine the near visual clinical performance of an accommodative intraocular lens (IOL) when compared with a standard monofocal IOL in a fellow eye comparison. DESIGN: Prospective, randomized fellow eye comparison. METHODS: Thirty patients (60 eyes) with bilateral cataracts but otherwise normal eyes were recruited from a single university hospital cataract waiting list. Patients were randomized to receive either the 1CU accommodative IOL in their first eye or the Acrysof MA30 monofocal IOL. The alternative lens was then implanted in the second eye 4 to 6 weeks later. At all follow-up visits, a full assessment was made of distance, near and reading visual performance, and accommodative amplitude. RESULTS: Data are available for all patients at 6 months and 20 patients at 1 year. At 6 months, no difference was found in distance-corrected visual acuity between the two IOLs. Of the 1CU eyes, nine patients (30%) could read J6 or better at a reading speed of 80 words/min or better. In these nine patients, the mean difference in the amplitude of accommodation between the two eyes was 0.71 diopters. CONCLUSIONS: No measurable variable distinguished eyes that developed functional reading vision from those that did not. The accommodative IOL appears to produce improved near vision in some eyes, but it does not work in all eyes, and in eyes where there is apparent accommodation, there is a discrepancy between subjective reading performance and the modest measured increase of accommodative amplitude.

Comparison of posterior capsule opacification rates between hydrophilic and hydrophobic single-piece acrylic intraocular lenses.

PURPOSE: To determine the effect of intraocular lens (IOL) material on the development of posterior capsule opacification (PCO) at 1 year. SETTING: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: One hundred six eyes of 53 patients with bilateral cataract and no other ocular comorbidity were prospectively randomized to receive a hydrophobic acrylic or hydrophilic acrylic single-piece IOL in the first eye to have surgery. The alternate IOL was implanted in the fellow eye 4 to 6 weeks later. All surgery was performed by a single surgeon. Postoperative follow-up was 1 day, 1 and 6 months, and 1 year. At each visit, the best corrected high- and low-contrast visual acuities were assessed and a high-intensity digital retroillumination photograph was taken. Posterior capsule opacification was assessed from the digital images by a single operator using a dedicated software program and calculated as the percentage area of opacified capsule. RESULTS: One year postoperatively, the median percentage area of PCO was 50.3% in the hydrophilic IOL group and 4.9% in the hydrophobic IOL group (P<.001). The difference in PCO was not accounted for by loss of contact between the capsulorhexis and IOL surface. Further analysis showed that lens epithelial cells tended to invade the posterior capsule at the haptic-optic junction. This was more marked in the hydrophilic IOL group. CONCLUSIONS: The rate of PCO was significantly higher with the hydrophilic IOL. However, the results cannot be attributed to the IOL material alone as they show the importance of both IOL material and design.

The effect of posterior capsule opacification on visual function.

PURPOSE: To investigate how posterior capsule opacification (PCO) affects visual function in pseudophakic eyes. METHODS: One hundred and six eyes that had undergone uncomplicated phacoemulsification were recruited sequentially. Patients with surgical complications or other ocular disease were excluded. PCO was assessed by a digital retroillumination camera using a software program based on the analysis of texture in the image, and the percentage area within the central 3-mm zone of the posterior capsule was calculated. Visual function assessment included Early Treatment Diabetic Retinopathy Study (ETDRS) high- and low-contrast visual acuity, contrast sensitivity with the Pelli-Robson and CSV-1000 grating charts, and forward light-scatter by the direct-compensation method (van den Berg). RESULTS: The percentage PCO required for decline in high-contrast ETDRS was 78%; for low-contrast acuity and Pelli-Robson, 46%; for CSV-1000 contrast sensitivity, 38% to 51%; and for forward light-scatter, less than 1% PCO. CONCLUSIONS: Central PCO affects psychophysical test results with differing degrees of sensitivity. Forward light-scatter is the most sensitive, followed by contrast sensitivity and visual acuity.

The effect of texturing the intraocular lens edge on postoperative glare symptoms: a randomized, prospective, double-masked study.

OBJECTIVE: To determine whether texturing the optic edge of the intraocular lens reduces photic symptoms in patients with square-edged acrylic intraocular lense implants. METHODS: Sixty patients underwent routine phacoemulsification performed by a single surgeon and were prospectively randomized to receive either the standard AcrySof MA30 intraocular lens (Alcon Laboratories, Ft Worth, Tex) (group 1) or an MA30 intraocular lens with a textured optic edge (group 2). Patients were seen at 1 month by an independent observer who was masked to treatment groups. A questionnaire on photic symptoms was completed, and attempts were made to elicit symptoms under mesopic and photopic conditions. RESULTS: At 1 month postoperatively, 20 (67%) of 30 patients in group 1 noticed symptoms compared with 4 (13%) of 30 patients in group 2 (P<.001). The mean duration of symptoms was 3.5 weeks in group 1 and 1 week in group 2 (P =.01). By provocative testing under photopic conditions, symptoms could be elicited in 26 patients (87%) in group 1 and 6 (20%) in group 2. No patients in either group were symptomatic at 3 months postoperatively. Under mesopic conditions, symptoms could be elicited in 27 patients (90%) in group 1 and 11 (37%) in group 2. There was no relationship between the incidence of symptoms and the degree of intraocular lens-rhexis contact. CONCLUSION: Photic phenomena can be significantly reduced by texturing the edge of a square-edged profile AcrySof intraocular lens.

In vitro model for the study of human posterior capsule opacification.

PURPOSE: To develop and evaluate a model for the organ culture of human lens capsules that reduces problems inherent in preexisting models for the study of in vitro posterior capsule opacification (PCO). METHODS: Human lenses (N = 110) were isolated from donor eyes and supported externally within a lens holder system by medical-grade cyanoacrylate glue, allowing visualization of the entire capsular bag. After capsulorhexis and lens extraction were performed, the capsule specimens were maintained at physiological conditions for up to 4 weeks. The area of lens epithelial cell (LEC) coverage over the posterior capsule surface was determined objectively on a daily basis using a graticule. Lens epithelial cell behavior was correlated with clinical data and other in vitro PCO models. RESULTS: Cyanoacrylate glue did not appear to be toxic to LECs at the concentration used. The amount of viable epithelium after nuclear extraction was dependent on the age and postmortem time of the specimen. Viable LEC cultures were obtained from eyes up to 9 days postmortem. The time from death to culture or from enucleation to culture did not influence LEC viability if it was fewer than 5 days. The LEC proliferation rates and confluence times were age dependent and correlated closely between pairs of eyes. CONCLUSIONS: Results show that the lens holder model is a more physiological method for supporting the capsule and is a robust, reproducible system for the study of LEC migration and proliferation. It allows visualization within the entire capsular bag. Intraocular lenses can be implanted in this system in a way that more closely resembles the in vivo scenario. This model can be used to evaluate therapeutic measures to prevent PCO.

Predicting posterior capsule opacification: value of early retroillumination imaging.

PURPOSE: To investigate the value of early retroillumination imaging of the posterior capsule in predicting the eventual development of posterior capsule opacification (PCO). SETTING: Ophthalmology Department, St. Thomas' Hospital, and Department of Physics, King's College, London, United Kingdom. METHODS: All patients with retroillumination images of the posterior capsule taken 6 months and 2 years after uneventful phacoemulsification with in-the-bag intraocular lens (IOL) implantation were selected. The images were taken using the same hardware and analyzed with the same software to calculate the percentage area of the posterior capsule covered by lens epithelial cells. The percentage area of PCO with all IOL types 6 months postoperatively was correlated with that at 2 years. RESULTS: One hundred forty patients had analyzable images at 6 months and 2 years. Of these, 63 had a poly(methyl methacrylate) (PMMA) IOL (Pharmacia 812A or Storz P497UV), 33 an acrylic (Alcon AcrySof MA30 or SA30), 22 a silicone (Allergan SI-30), and 22 a hydrophilic acrylic (Bausch & Lomb Hydroview H60). The correlation of the percentage area of PCO at 6 months with that at 2 years resulted in an r value of 0.71 (P <.0001) in the entire group. The r value was 0.48 in the PMMA group and 0.86 in the foldable IOL group (P <.0001) (r value: AcrySof, 0.66; silicone, 0.82; Hydroview, 0.75). CONCLUSIONS: Retroillumination imaging of the posterior capsule 6 months after cataract surgery predicted the PCO outcome at 2 years in eyes with foldable IOLs.