Haripriya Aravind, Chandrashekharan Shivkumar, Schehlein Emily M, Shekhar Madhu, Venkatesh Rengaraj, Narendran Kalpana, Uduman Mohammed Sithiq, Ravindran Ravilla D, Robin Alan L
From the Aravind Eye Hospital, Chennai, India (A.H., M.S.U.).
Aravind Eye Hospital, Thirunelveli, India (S.C.).
Am J Ophthalmol. 2025 Oct;278:337-345. doi: 10.1016/j.ajo.2025.06.043. Epub 2025 Jun 30.
To compare long-term (10-year) best-corrected visual acuity (BCVA) and complication rates of intraocular lens (IOL) decentration and neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy for posterior capsule opacification (PCO) in eyes with and without pseudoexfoliation (PEX) after undergoing cataract surgery.
Clinical cohort study using randomized control trial data.
A total of 930 eyes with cataract and PEX without phacodonesis, clinically shallow anterior chambers, or pupil size <4 mm and 476 controls with cataract but without PEX.
We randomized both groups separately to receive either a single-piece acrylic IOL or a 3-piece acrylic IOL. We further randomized the PEX group to receive or not receive capsular tension rings (CTRs). Experienced surgeons performed phacoemulsification with the insertion of an IOL in all eyes, and we followed all patients at 1 day, 1 month, 3 months, 1 year, and yearly thereafter for 10 years.
The association of PEX with IOL decentration, posterior capsular opacification requiring capsulotomy, and BCVA.
The 10-year follow-up was 82.2% for the PEX group and 85.6% for the control group excluding those who died in the interim; 24.1% and 16.8%, respectively, died before completion. IOL decentration rates (2.4% vs 1.7%, respectively, P = .4) and Nd:YAG capsulotomy rates (5.7% vs 5.67%, respectively, P = .98) were similar in the PEX and control groups. Capsular phimosis (P = .001) and capsulorhexis that did not overlap the edge of the IOL optic (P < .001) were risk factors for IOL decentration and Nd:YAG capsulotomy. At 10 years, logarithm of the minimum angle of resolution BCVA was better in the control group than in the PEX group (0.08 vs 0.12, respectively; P = .035). Capsular phimosis (P = .001) and a capsulorhexis that did not overlap the IOL optic (P < .001) were each independently associated with decentration and need for a capsulotomy.
This is the only long-term, large-scale prospective comparative study using experienced surgeons evaluating both CTRs and IOL types in eyes with PEX without preoperative and intraoperative zonular weakness and small pupils. At 10 years postoperatively (most of a life expectancy), we found no differences between eyes with and without uncomplicated PEX and having a 1- or 3-piece IOL or CTRs.
比较白内障手术后有和没有假性剥脱（PEX）的眼睛中，人工晶状体（IOL）偏位以及钕掺杂钇铝石榴石（Nd:YAG）后囊切开术治疗后囊膜混浊（PCO）的长期（10年）最佳矫正视力（BCVA）和并发症发生率。
使用随机对照试验数据的临床队列研究。
共有930例患有白内障和PEX且无晶状体震颤、临床前房浅或瞳孔直径<4 mm的眼睛，以及476例患有白内障但无PEX的对照组。
我们将两组分别随机分为接受单片丙烯酸IOL或三片丙烯酸IOL。我们进一步将PEX组随机分为接受或不接受囊袋张力环（CTR）。经验丰富的外科医生对所有眼睛进行超声乳化并植入IOL，我们在术后1天、1个月、3个月、1年以及此后每年对所有患者进行随访，持续10年。
PEX与IOL偏位、需要进行囊切开术的后囊膜混浊以及BCVA之间的关联。
PEX组的10年随访率为82.2%，对照组为85.6%（不包括在此期间死亡的患者）；分别有24.1%和16.8%的患者在随访结束前死亡。PEX组和对照组的IOL偏位率（分别为2.4%和1.7%，P = 0.4）以及Nd:YAG囊切开术率（分别为5.7%和5.67%，P = 0.98）相似。囊膜挛缩（P = 0.001）和撕囊未与IOL光学部边缘重叠（P < 0.001）是IOL偏位和Nd:YAG囊切开术的危险因素。在10年时，对照组的最小分辨角对数视力（logMAR BCVA）优于PEX组（分别为0.08和0.12；P = 0.035）。囊膜挛缩（P = 0.001）和撕囊未与IOL光学部重叠（P < 0.001）均分别与偏位和囊切开术需求独立相关。
这是唯一一项长期、大规模的前瞻性比较研究，由经验丰富的外科医生对无术前和术中悬韧带薄弱及小瞳孔的PEX眼睛评估CTR和IOL类型。术后10年（接近预期寿命），我们发现无并发症的PEX眼和非PEX眼在植入一片式或三片式IOL或使用CTR方面没有差异。
