The long-term effect of vitreous presentation during extracapsular cataract surgery on postoperative visual acuity

To compare at two, three, and four years after surgery the effect on best-corrected visual acuity (BCVA) of anterior chamber (AC) intraocular lenses (IOLs) and posterior chamber (PC) IOLs implanted after vitreous presentation (VP) during extracapsular cataract extraction in patients having sufficient capsular support for a nonsutured PC IOL.

The study was a randomized prospective, long-term, clinical trial.

Patients at 19 Department of Veterans Affairs Medical Centers having VP during cataract surgery with sufficient capsular support were randomized to receive either a PC IOL (230 patients) or an AC IOL (208 patients). Patients having insufficient capsular support (ICS; 143 patients) and a 5% random sample of nonvitreous presentation patients (NVP; 521 patients) were prospectively followed in the same fashion.

There was no significant difference on the major outcome measure of BCVA of 20/40 or better between the PC IOL and AC IOL groups at two (88.7% vs 82.2%; P = .23), three (82.5% vs 91.8%; P = .18), and four (88.6% vs 92.6%; P = .69) years of follow-up. The ICS patients had significantly worse (P < .0083) or a trend to be worse (P < .05) BCVA of 20/40 or better than the other three groups at two and four years.

The significant difference that the PC IOL was better than the AC IOL on the major outcome measure at one year reported previously was not maintained in later years. The poor results for ICS patients reported previously at one year continue at two and four years.