Effect of intraocular lens optic edge design and material on fibrotic capsule opacification and capsulorhexis contraction Stefan Sacu, MD, Rupert Menapace, MD, Wolf Buehl, MD, Georg Rainer, MD, Oliver Findl, MD Purpose: To examine the influence of intraocular lens (IOL) optic edge design and optic material on fibrosis of the anterior and peripheral posterior capsules and on capsulorhexis contraction. Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods: This randomized controlled patient- and examiner-masked study com- prised 210 eyes of 105 patients with bilateral age-related cataract. In Group 1 (n = 53), the Sensar OptiEdge AR40e hydrophobic acrylic IOL with a sharp pos- terior optic edge was compared with the AR40 acrylic IOL with a round edge. In Group 2 (n = 52), the ClariFlex OptiEdge silicone IOL with a sharp posterior op- tic edge was compared with the PhacoFlex SI-40 silicone IOL with a round edge All IOLs were manufactured by Advanced Medical Optics, Inc. Standardized digi- tal slitlamp images of anterior capsule opacification (ACO) and fibrotic posterior capsule opacification (PCO) were taken 1 year postoperatively, and digital retroillu- mination images were taken at 1 week and 1 year. The intensity of fibrotic PCO was graded subjectively (score 0 to 4), ACO was graded objectively (score 0% to 100%), and the capsulorhexis area (mm 2 ) was determined objectively. Results: One year after surgery, the mean ACO score was 32% in eyes with the sharp-edged acrylic IOL and 29% in eyes with the round-edged acrylic IOL (P.05). In the silicone group, the mean was 31% and 26%, respectively (P.05). The mean fibrotic PCO score was lower in eyes with a sharp-edged acrylic IOL than in eyes with a round-edged acrylic IOL (0.26 and 0.93, respectively; P.05) and in eyes with a sharp-edged silicone IOL than in eyes with a round-edged sili- cone IOL (0.24 and 0.82, respectively; P.001). At 1 year, the mean capsulo- rhexis area was statistically significantly smaller in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (P.05). Conclusions: Acrylic and silicone IOLs with the sharp OptiEdge design led to sig- nificantly less fibrotic PCO but more ACO than round-edged acrylic and silicone IOLs. The sharp-edged silicone IOL caused significantly more capsulorhexis con- traction than the round-edged silicone IOL and both acrylic IOLs. J Cataract Refract Surg 2004; 30:1875–1882  2004 ASCRS and ESCRS A fter-cataract, or capsule opacification, remains the the posterior capsule. The incidence of posterior capsule opacification (PCO) during the first 5 postoperative major complication of cataract surgery. The opaci- years ranges between 3% and 50%. 1–4 fication may form on the anterior capsule as well as on Capsule opacification is caused by lens epithelial cells (LECs) that remain in the evacuated capsular Accepted for publication January 22, 2004. bag. 5–10 These cells form 2 subpopulations with distinct Reprint requests to Rupert Menapace, MD, Department of Ophthalmol- properties. The equatorial LEC population resides in ogy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail: rupert.menapace@univie.ac.at. the equatorial region of the capsular bag. After capsular  2004 ASCRS and ESCRS 0886-3350/04/$–see front matter Published by Elsevier Inc. doi:10.1016/j.jcrs.2004.01.042