Cost-effectiveness analysis of PMMA, silicone, or acrylic intra-ocular lenses in cataract surgery in four European countries.

PURPOSE: To compare the cost-effectiveness of different intra-ocular lens (IOL) materials (Hydrophobic acrylic, Polymethylmethacrylate (PMMA), Hydrophilic acrylic and Silicone) implanted after cataract surgery with reference to Nd:YAG laser capsulotomy and Nd:YAG-related complications in four European countries (France, Italy, Germany and Spain). SETTING: A retrospective review of 1,525 patients (eyes), aged 50 to 80 years, operated with phacoemulsification for cataract in 1996 or 1997 in 16 surgical centres (4 per country). METHODS: The study was conducted using a cost-effectiveness approach. Medical charts were reviewed to collect retrospective information during the 3-year period following cataract surgery in order to identify patients who underwent Nd:YAG laser capsulotomy post-operatively. Clinical data were combined with unit costs assessed by experts for Nd:YAG laser capsulotomy and their complications. A cost-effectiveness ratio (cost per patient without Nd:YAG laser capsulotomy intervention) was estimated in relation to each IOL material used in each of the four European countries. RESULTS: Hydrophobic acrylic, specifically Acrysof, was the most cost-effective IOL material in all the countries except Germany where it was second. PMMA had the best ratio in Germany, was second in Spain and only third in Italy and France. Silicone was second in France and ranked third in the other countries, while hydrophilic acrylic had the worst ratio overall in all countries. CONCLUSIONS: Cost-effectiveness ratios of hydrophobic acrylic (Acrysof) were better than those of other types of IOL materials used in most of the countries. Sensitivity analyses were performed to vary the base case analysis to demonstrate the economic importance of the assumptions. In all cases, hydrophobic acrylic IOL material was shown to be a highly cost-effective option.

Preliminary results of cataract extraction with implantation of a single-piece AcrySof intraocular lens.

PURPOSE: To evaluate the intraoperative and postoperative performance of the single-piece AcrySof SA30AL intraocular lens (IOL) in a series of patients after cataract surgery and IOL implantation. SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: In this prospective study, 20 patients who had phacoemulsification and implantation of a single-piece AcrySof SA30AL lens from March to April 2000 were evaluated. Assessed were control of IOL folding, ease of IOL implantation, IOL centration, intraoperative and postoperative complications, visual acuity, and anterior (ACO) and posterior (PCO) capsule opacification. RESULTS: In all cases, the IOL was easily folded, inserted, and unfolded. It remained well centered in the capsular bag, and there were no intraoperative or postoperative complications. The best corrected visual acuity after surgery was 20/40 or better in all patients. No eye developed ACO or phimosis. One eye had a well-demarcated, oval area of lens epithelial cell proliferation on the posterior capsule that did not impair visual acuity. CONCLUSIONS: Initial results indicate that the single-piece AcrySof SA30AL IOL has good biocompatibility, haptic flexibility and resistance, and stability in the capsular bag. The incidence of PCO in 1 eye could have been the result of several factors and requires further evaluation. An area of future study is the wide haptic of the lens, which may create a path for cells to proliferate as they travel from the equatorial capsule.

Comparison of AcrySof MA30BA and Sensar AR40 acrylic intraocular lenses.

PURPOSE: To compare differences in anterior (ACO) and posterior (PCO) capsule opacification and subjective glare between 2 acrylic intraocular lenses (IOLs): AcrySof MA30BA (Alcon) and Sensar AR40 (Allergan). SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: This retrospective study comprised 100 cataract patients who had phacoemulsification and IOL implantation. Fifty eyes of 50 patients received an MA30BA and 50 eyes of 50 patients, an AR40. The mean postoperative follow-up was 25 months (range 20 to 31 months) and 22 months (range 19 to 29 months), respectively. Examiners subjectively evaluated ACO, and a photographic image-analysis system was used to assess PCO. All patients received a questionnaire to evaluate the incidence of subjective photic phenomena. RESULTS: In the MA30BA group, 60% had no ACO, 19% had mild ACO, and 21% had anterior capsule fibrosis. In the AR40 group, 55% had no ACO, 27% had mild ACO, and 18% had anterior capsule fibrosis. In the MA30BA group, the mean PCO score measured by image-analysis was 0.043 (range 0.000 to 0.084) at 1 year and 0.125 (range 0.000 to 0.197) at 2 years and in the AR40 group, 0.071 (range 0.000 to 0.157) and 0.230 (range 0.091 to 0.628), respectively. Although the ACO percentages and the PCO scores at 1 year were not statistically different between the 2 groups (P >.05), the MA30BA group had statistically less PCO at 2 years (P <.05). In the MA30BA group, 36 patients had trouble reading in a dim environment, 25 had difficulty driving at night, 25 were mildly bothered by the lights of other vehicles, and 17 saw halos when looking at the lights of other vehicles and 17, when looking at lights at night. In the AR40 group, 7 patients had trouble reading in a dim environment and 11 had difficulty driving at night. At 6 months, the AR40 group had a statistically significantly lower incidence of photic phenomena than the MA30BA group (P <.05). In the MA30BA group 1 year after surgery, 13 patients had trouble reading in a dim environment and 12 had difficulty driving at night. In the AR40 group, 5 patients had trouble reading in a dim environment and 8 had difficulty driving at night. One year after surgery, the difference between the 2 groups in photic phenomena was not statistically significant (P >.05). CONCLUSIONS: The findings indicate that the AcrySof MA30BA has a lower incidence of PCO than the Sensar AR40. The AR40 IOL induced less glare; however, the glare phenomena did not disturb those with an MA30BA lens and the symptoms decreased by 1 year after surgery. These results suggest that both optic design and haptic material influence postoperative clinical results.

Comparison of Nd : YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, or acrylic intra-ocular lenses in four European countries.

PURPOSE: The aim of this study was to compare the incidence of Nd : YAG laser capsulotomy after cataract surgery according to the type of intra-ocular lens material (PMMA, silicone, hydrophilic acrylic, hydrophobic acrylic) implanted in four European countries (France, Italy, Germany, Spain). DESIGN: A retrospective record review. PARTICIPANTS: A review of 1525 patients (first operated eye), aged 50 to 80 years, operated on for cataract in 1996 or 1997 in 16 surgical centers (4 per country). METHODS: The study employed a retrospective cohort design. Charts were reviewed to collect information during at least a three-year period following cataract surgery to identify patients who underwent Nd : YAG laser capsulotomy postoperatively. MAIN OUTCOME MEASURES: Data on the type of intra-ocular lens implanted was extracted from the patient notes, as was the date and outcome of the Nd : YAG laser intervention. Kaplan-Meier survival curve analysis with the time to Nd : YAG laser was performed on the data. RESULTS A total of 1525 patients (first operated eye) were available for the study (n = 294 for hydrophilic acrylic, n = 384 for PMMA, n = 421 for hydrophobic acrylic, n = 426 for silicone). There was a highly statistically significant difference between the IOL groups for the incidence of posterior capsule opacification (p < 0.001) and for Nd : YAG laser treatment (p < 0.001). The mean delay of Nd : YAG laser treatment from the date of cataract operation was 2.48 years (+/-1.70, ranging from 0 to 5.88 years). The rate of Nd : YAG laser capsulotomy over the follow-up period was lowest in the hydrophobic acrylic group (7.1%), followed by silicone (16.2%), PMMA (19.3%) and hydrophilic acrylic (31.1%), respectively. CONCLUSIONS: A low incidence of posterior capsular opacification (PCO) and Nd : YAG laser treatment was detected in hydrophobic acrylic IOLs in comparison to three other types of IOLs implanted in a large cohort of persons with age-related cataract. Choice of IOL type may reduce the need for Nd : YAG laser treatment, although further research on the reasons for this is needed.

Histopathology of explanted AlphaCor due to keratoprosthesis extrusion.

AlphaCor keratoprosthesis (KPro) is a new-concept poly (2-hydroxyethyl methacrylate) one-piece KPro that makes possible a two-step implantation technique easy to perform with a short learning curve. In literature an 18% incidence of AlphaCor removal due to melting complications is reported. The histopathology of corneal tissue removed during a re-operation while bearing an AlphaCor KPro has previously been described in the literature only in one report. Herein, the first histological features of an AlphaCor-corneal complex explanted because of KPro extrusion is described. The histopathology of the AlphaCor-corneal complex is characterized by mild inflammation in the corneal tissues, limited to the region surrounding the anteriorized and extruded part of the KPro. It is not possible to fully understand the mechanisms that trigger the device extrusion. One possible explanation could be a dislocation of the prosthesis in the corneal pocket due to the untied fixation stitch. Another explanation could be a foreign body reaction induced by KPro.

Glare disability and spherical aberration with five foldable intraocular lenses: a prospective randomized study.

PURPOSE: To compare differences in subjective glare and spherical aberration between five foldable intraocular lenses (IOLs) made of different materials and to different designs. METHODS: This prospective study comprised 175 cataract patients who underwent phacoemulsification and were randomized to receive one of five types of foldable IOL (AcrySof MA30BA, Alcon; Sensar AR40, AMO; AcrySof SA30AL, Alcon; Sensar AR40e, AMO, and Tecnis Z9000, Pharmacia & Upjohn). All patients received a questionnaire investigating the incidence of subjective photic phenomena. Two months postoperatively, we collected data regarding subjective glare and evaluated pupil size, visual acuity and wavefront aberration of the cornea and eye. RESULTS: With regard to difficulty in performing ordinary activities under different light conditions and light and dark adaptation, the difference between the groups was not significant (p > 0.05, chi-squared test). With respect to difficulty in driving at night, the MA30BA group had a significant higher incidence of photic phenomena than the SA30AL, AR40e and Z9000 groups (p < 0.05, chi-squared test). Wavefront measurements revealed a significant difference between the Z9000, AR40e and SA30AL groups, which showed the lowest values, and the MA30BA group, which showed the highest value (p < 0.05, anova with Tamhane posthoc test). CONCLUSIONS: New generation IOLs such as the Pharmacia Z9000, AMO AR40e and AcrySof SA30AL have a lower incidence of glare and spherical aberrations; however, their impact on future IOL design should be conditioned by further data, especially regarding posterior capsule opacification.