Analyzing the Relationship Between IOL Fixation and PCO Prevention

Background: Posterior capsular opacification (PCO) remains the most common long-term complication following cataract surgery. This correspondence investigates whether intraocular lens (IOL) fixation type influences PCO risk by comparing Nd:YAG capsulotomy rates between capsulotomy-fixated (FEMTIS) and conventional in-the-bag IOLs with similar material and edge profiles. Methods: A systematic review was conducted. Eligible studies reporting quantitative YAG rates at ≥3 months of follow-up were included. Results: FEMTIS IOLs demonstrated lower capsulotomy rates (3.1% at 12 months) compared to in-the-bag LENTIS lenses (4.7% at 12 months), despite identical optic designs and identical material. Conclusions: This suggests that capsulotomy fixation may promote closer capsule-optic contact and reduce the potential space for lens epithelial cell migration. While data are limited by study heterogeneity and follow-up duration, early evidence supports anterior fixation as a potential strategy to reduce PCO risk and improve long-term capsular clarity. Further prospective studies are warranted. Limitations include heterogeneous study designs, relatively short follow-up, and reliance on Nd:YAG capsulotomy as the sole endpoint.