Long-term Effect of Sharp Optic Edges of a Polymethyl Methacrylate Intraocular Lens on Posterior Capsule Opacification A Randomized Trial Oliver Findl, MD, Wolf Buehl, MD, Rupert Menapace, MD, Stefan Sacu, MD, Michael Georgopoulos, MD, Georg Rainer, MD Purpose: To compare the posterior capsule opacification (PCO) inhibiting effect of a 3-piece polymethyl methacrylate (PMMA) intraocular lens (IOL) with a sharp optic edge design with that of the round-edged version of the same IOL during a 5-year period. Design: Randomized patient- and examiner-masked clinical trial with intraindividual comparison. Participants: Thirty-two patients with bilateral age-related cataract (64 eyes). Methods: Each study patient had phacoemulsification cataract surgery in both eyes and received a sharp optic edge PMMA IOL in one eye and a round optic edge PMMA IOL in the fellow eye (both by Dr Schmidt in Germany). Follow-up examinations were at 1 week, 1 month, 1 year, 3 years, and 5 years. Digital retroillumination images were taken from each eye. The amount of posterior capsule opacification was assessed objectively by means of automated image analysis software (Automated Quantification of After-Cataract) at 1 year, 3 years, and 5 years after surgery. Main Outcome Measure: Posterior capsule opacification score: 0 –10. Results: The sharp optic edge IOL showed significantly less regeneratory and fibrotic PCO at 1 year, 3 years, and 5 years after surgery. The mean AQUA PCO score was 5.12 for the round-edge and 2.49 for the sharp-edge IOL (scale, 0 –10; P0.001) at 5 years. The mean difference among patients for the PCO score in the eye implanted with the sharp optic edge versus the score in the eye with the round optic edge was 2.83 at 5 years (95% confidence interval, 1.66 – 4.00). Due to the large number of neodymium:yttrium–aluminum– garnet laser capsulotomies that were performed (12 in the round-edge group and 4 in the sharp-edge group), there was no significant difference in visual acuity between both groups at any time point. Conclusions: Compared with the round-edge version, the sharp optic edge design of a 3-piece PMMA IOL led to significantly less PCO at 1 year, 3 years, and 5 years after surgery. However, the sharp optic edge did not lead to complete PCO prevention during this follow-up period. This finding has implications for the design of PMMA IOLs used for cataract surgery, especially in the developing world. Ophthalmology 2005;112:2004 –2008 © 2005 by the American Academy of Ophthalmology. Posterior capsule opacification (PCO), or after-cataract, re- mains the most frequent long-term complication after cata- ract surgery with implantation of an intraocular lens (IOL). 1,2 Clinically, 2 different components of PCO can be differentiated—namely, a regeneratory and a fibrotic com- ponent. Regeneratory PCO is more common; it is caused by residual lens epithelium cells from the lens equator region that migrate and proliferate in the space between the pos- terior capsule and the IOL. Fibrotic PCO is caused by transdifferentiated lens epithelium cells from the anterior capsule that gain access to the posterior capsule and cause whitening and wrinkling of the capsule. 1 Both components lead to a decrease in visual function when they affect the central region around the visual axis. Treatment of PCO by neodymium:yttrium–aluminum– garnet (Nd:YAG) laser capsulotomy is effective, but it can lead to other complications, including an increase in intraoc- ular pressure, ocular inflammation, cystoid macular edema, and retinal detachment. 3 Besides, Nd:YAG laser capsulot- omy does not improve visualization of the peripheral retina Originally received: January 9, 2005. Accepted: June 7, 2005. Manuscript no. 2005-26. From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Presented in part at: Congress of the European Society of Cataract and Refractive Surgery, September, 2002; Nice, France. The authors have no financial or proprietary interest in any of the materials or equipment mentioned in the artice. No financial support was received for this study. Correspondence to Oliver Findl, MD, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18 –20, Wien, 1090 Austria. E-mail: oliver.findl@meduniwien.ac.at. 2004 © 2005 by the American Academy of Ophthalmology ISSN 0161-6420/05/$–see front matter Published by Elsevier Inc. doi:10.1016/j.ophtha.2005.06.021