Influence of Posterior Capsulotomy Size on Visual Quality and Patient Satisfaction with Extended Depth-of-Focus IOLs

Area of Science:

• Ophthalmology
• Optical Engineering
• Biomedical Optics

Background:

• Prior studies on monofocal intraocular lenses (IOLs) suggest larger Nd:YAG posterior capsulotomies reduce straylight.
• Generalizability of these findings to extended depth-of-focus (EDOF) IOLs remains uncertain.
• Posterior capsule opacification (PCO) is a common complication affecting visual quality after cataract surgery.

Purpose of the Study:

• To evaluate the effect of capsulotomy size on optical quality, higher-order aberrations (HOAs), and patient-reported outcomes in eyes with EDOF IOLs.
• To compare outcomes between small (≈1.6-1.8 mm) and large (≈4 mm) Nd:YAG posterior capsulotomies in EDOF IOLs.

Main Methods:

• Prospective single-center study involving 106 pseudophakic eyes with PCO and EDOF IOLs undergoing Nd:YAG laser posterior capsulotomy.
• Eyes were assigned to small (S group, n=47) or large (L group, n=59) capsulotomy sizes.
• Assessment included visual acuity, HOAs, defocus curves, optical quality metrics, and subjective outcomes via APPLES and Catquest-9SF-CN questionnaires at 1-month post-treatment.

Main Results:

• Both groups showed improved visual acuity; the L group had a greater corrected distance visual acuity (CDVA) gain (-0.15 vs -0.06 logMAR; P=0.024).
• Trefoil aberration increased more in the S group (+0.15 vs +0.02; P=0.021), while spherical aberration decreased more in the S group (-0.20 vs -0.09; P=0.024).
• The L group reported a greater reduction in starburst severity and frequency (Δ -0.43 vs +0.07; P=0.010).

Conclusions:

• Capsulotomy size significantly influences optical quality and patient satisfaction in EDOF IOLs.
• Larger openings enhance CDVA and reduce photic symptoms, whereas smaller openings may better reduce spherical aberration but increase trefoil.
• Personalizing capsulotomy size holds potential for optimizing patient outcomes after Nd:YAG laser posterior capsulotomy.