Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial

Area of Science:

• Ophthalmology
• Surgical Innovation
• Cataract Surgery

Background:

• Phacoemulsification is a common cataract surgery technique.
• Intraocular lens (IOL) choice impacts surgical outcomes and cost.
• Foldable and rigid IOLs represent distinct material and implantation approaches.

Purpose of the Study:

• To compare the visual outcomes and complications of phacoemulsification using a 2.5-mm clear corneal incision with a foldable IOL versus a 5-mm sclerocorneal tunnel incision with a rigid polymethyl methacrylate (PMMA) IOL.

Main Methods:

• A prospective, randomized clinical trial involving 1200 patients undergoing phacoemulsification.
• Patients received either a foldable hydrophilic acrylic IOL (2.5-mm incision) or a rigid PMMA IOL (5-mm incision).
• Data on intraoperative events, postoperative complications, and visual acuity at multiple time points were analyzed.

Main Results:

• Excellent uncorrected visual acuity (6/18 or better) was achieved in 90.3% of the foldable IOL group and 94.3% of the rigid IOL group at 1 year.
• Poor outcomes (best-corrected acuity 6/60 or worse) were rare in both groups (1.0% vs 0.4%).
• Posterior capsule opacification was more frequent in the rigid IOL group (36.1% vs 23.3%) but did not impact vision; foldable IOLs were significantly more expensive.

Conclusions:

• Phacoemulsification with either foldable or rigid IOLs provides excellent results when performed by experienced surgeons.
• The use of inexpensive rigid PMMA IOLs can enhance the affordability of phacoemulsification for patients in resource-limited settings.