Findl O, Buehl W, Bauer P, Sycha T
Medical University of Vienna, Department of Ophthalmology, Allgemeines Krankenhaus Wien, Währinger Gürtel 18-20, Vienna, Austria, A-1090.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD003738. doi: 10.1002/14651858.CD003738.pub2.
Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. It can be treated by Nd:YAG laser capsulotomy, however, this may lead to other complications and laser treatment is not available in large parts of the developing world. Therefore, many studies try to find factors influencing the development of PCO.
To summarise the effects of different interventions to inhibit PCO. These include modifications of surgical technique and intraocular lens (IOL) design, implantation of additional devices and pharmacological interventions.
We searched CENTRAL, MEDLINE, EMBASE, LILACS in January 2007 and reference lists of identified trial reports.
We included only prospective, randomised and controlled trials with a follow-up time of at least 12 months. Interventions included modifications in surgical technique explicitly to inhibit PCO, modifications in IOL design (material and geometry), implantation of additional devices, and pharmacological therapy, compared to each other, placebo or standard treatment.
Data were extracted and entered into Review Manager. Visual acuity data, PCO score and YAG capsulotomy rates were compared and a meta-analysis was performed when possible.
Fifty three studies were included in the review. The review was divided into three parts. (1) Influence of IOL optic material on the development of PCO. Compared to other materials, the meta-analysis of the included studies showed a significantly higher PCO score (overall effect: 12.39 (95% confidence interval: 9.82 to 14.95), scale 0 to 100) and YAG rate (odds ratio: 8.37 (3.74 to 20.36)) only in hydrogel IOLs. (2) Influence of IOL optic design on the development of PCO. There was a significantly lower PCO score (-8.65 (-10.72 to -6.59), scale 0 to 100) and YAG rate (0.19 (0.11 to 0.35)) in sharp edged than in round edged IOLs, however, not between 1-piece and 3-piece IOLs. (3) Influence of surgical technique and drugs on the development of PCO. There was no significant difference between different types of intra-/postoperative anti-inflammatory treatment except for treatment with an immunotoxin (MDX-A) leading to a significantly lower PCO rate.
AUTHORS' CONCLUSIONS: Due to the highly significant difference between round and sharp edge IOL optics, IOLs with sharp (posterior) optic edges should be preferred. There is no clear difference between optic materials, except for hydrogel IOLs, that showed more PCO than the other materials. The choice of postoperative anti-inflammatory treatment does not seem to influence PCO development.
后囊膜混浊（PCO）仍然是白内障手术后最常见的长期并发症。它可以通过Nd:YAG激光囊切开术进行治疗，然而，这可能会导致其他并发症，并且在发展中世界的大部分地区无法进行激光治疗。因此，许多研究试图找出影响PCO发生发展的因素。
总结不同干预措施抑制PCO的效果。这些措施包括手术技术的改进、人工晶状体（IOL）设计的改变、额外装置的植入以及药物干预。
我们于2007年1月检索了Cochrane中心对照试验注册库（CENTRAL）、医学文献数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、拉丁美洲及加勒比地区卫生科学数据库（LILACS）以及已识别试验报告的参考文献列表。
我们仅纳入随访时间至少为12个月的前瞻性、随机对照试验。干预措施包括明确为抑制PCO而对手术技术进行的改进、IOL设计（材料和几何形状）的改变、额外装置的植入以及药物治疗，并相互比较，或与安慰剂或标准治疗进行比较。
提取数据并录入Review Manager软件。比较视力数据、PCO评分和YAG囊切开术发生率，并在可能的情况下进行荟萃分析。
本综述纳入了53项研究。该综述分为三个部分。（1）IOL光学部材料对PCO发生发展的影响。与其他材料相比，纳入研究的荟萃分析显示，仅水凝胶IOL的PCO评分显著更高（总体效应：12.39（95%置信区间：9.82至14.95），评分范围0至100），YAG囊切开术发生率也显著更高（比值比：8.37（3.74至20.36））。（2）IOL光学部设计对PCO发生发展的影响。锐边IOL的PCO评分（-8.65（-10.72至-6.59），评分范围0至100）和YAG囊切开术发生率（0.19（0.11至0.35））显著低于圆边IOL，但一体式和三件式IOL之间无显著差异。（3）手术技术和药物对PCO发生发展的影响。除使用免疫毒素（MDX-A）治疗导致PCO发生率显著降低外，不同类型的术中和术后抗炎治疗之间无显著差异。
由于圆边和锐边IOL光学部之间存在高度显著差异，应优先选择（后）光学部边缘锐利的IOL。除水凝胶IOL显示出比其他材料更多的PCO外，光学部材料之间没有明显差异。术后抗炎治疗的选择似乎不影响PCO的发生发展。
