2025 - 4 Issue

Review

The Frequency of Postoperative Complications in Current Types of Hydrophobic and Hydrophilic Intraocular Lenses. A Systematic Review

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Summary

Objective: To compare the incidence of postoperative complications after cataract surgery in current types of acrylic intraocular lenses (IOLs) in relation to the material used to manufacture the implant, published in the scientific literature.

Methodology: Search for publications in the Pubmed database, published in 2015–2024 (inclusive), without language restrictions, featuring the keywords Hydrophobic, Hydrophilic, Intraocular lens. Reviewing all abstracts and excluding publications that do not match the specified topic.

Results: A total of 220 works were published in the last 10 years that met the specified keywords. Of these, 92 publications were dedicated to the comparison of both types of IOLs. These were 4 meta-analyses, 10 reviews and 47 clinical studies, 21 laboratory and experimental studies and 10 studies of a different nature (editorials, considerations, chapters in textbooks).

Conclusion: Current types of soft acrylic intraocular lenses achieve excellent refractive results and high subjective patient satisfaction. This applies to lenses made of both hydrophilic and hydrophobic materials. The main disadvantage of hydrophilic implants is the higher risk of opacification of the posterior capsule of the lens, as well as the risk of opacification of the implant itself. Especially in patients who are expected to undergo subsequent surgery (corneal endothelial dystrophy, retinal pathology), as well as in patients with a higher risk of complications after Nd:YAG laser capsulotomy (patients with myopia, chronic uveitis or glaucoma), the use of hydrophobic material should be considered as a priority.

References

  1. Schaumberg DA, Dana MR, Christen WG, Glynn RJ. A systematic overview of the incidence of posterior capsule opacification. Ophthalmology. 1998 Jul;105(7):1213-1221.
  2. Thom H, Ender F, Samavedam S, et al. Effect of AcrySof versus other intraocular lens properties on the risk of Nd:YAG capsulotomy after cataract surgery: A systematic literature review and network meta-analysis. PLoS One. 2019 Aug 19;14(8):e0220498.
  3. Buehl W, Findl O. Effect of intraocular lens design on posterior capsule opacification. J Cataract Refract Surg. 2008 Nov;34(11):1976-1985.
  4. Findl O, Buehl W, Bauer P, Sycha T. Interventions for preventing posterior capsule opacification. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003738. Update in: Cochrane Database Syst Rev. 2010 Feb 17;(2):CD003738.
  5. Findl O, Menapace R, Sacu S, Buehl W, Rainer G. Effect of optic material on posterior capsule opacification in intraocular lenses with sharp-edge optics: randomized clinical trial. Ophthalmology. 2005 Jan;112(1):67-72.
  6. Hollick EJ, Spalton DJ, Ursell PG, et al. The effect of polymethyl- methacrylate, silicone, and polyacrylic intraocular lenses on posterior capsular opacification 3 years after cataract surgery. Ophthalmology. 1999 Jan;106(1):49-54; discussion 54-55.
  7. Koch CR, Santhiago MR, Jorge PA, Sena P, Kara-Júnior N. Posterior Capsule Opacification after Cataract Surgery in Children Over Five Years of Age with Square-edge Hydrophobic versus Hydrophilic Acrylic Intraocular Lenses: A Prospective Randomized Study. Clinics (Sao Paulo). 2020;75:e1604.
  8. Sen P, Kshetrapal M, Shah C, Mohan A, Jain E, Sen A. Posterior capsule opacification rate after phacoemulsification in pediatric cataract: Hydrophilic versus hydrophobic intraocular lenses. J Cataract Refract Surg. 2019 Oct;45(10):1380-1385.
  9. Zhao Y, Yang K, Li J, Huang Y, Zhu S. Comparison of hydrophobic and hydrophilic intraocular lens in preventing posterior capsule opacification after cataract surgery: An updated meta-analysis. Medicine (Baltimore). 2017 Nov;96(44).
  10. Wu Q, Li Y, Wu L, Wang CY. Hydrophobic versus hydrophilic acrylic intraocular lens on posterior capsule opacification: a Meta-analysis. Int J Ophthalmol. 2022 Jun 18;15(6):997-1004.
  11. Chen L, Zhong Y, Yao K, Fu Q. Effect of intraocular lens material and haptic design on anterior capsule contraction after cataract surgery: A systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2024 May;262(5):1421-1432.
  12. Grzybowski A, Markeviciute A, Zemaitiene R. A narrative review of intraocular lens opacifications: update 2020. Ann Transl Med. 2020 Nov;8(22):1547.
  13. Grzybowski A, Auffarth GU, LaHood BR. How do intraocular lens materials influence the outcome of cataract surgery? Curr Opin Ophthalmol. 2025 Jan 1;36(1):18-24.
  14. Fizia-Orlicz A, Misiuk-Hojło M. Soczewki wewnątrzgałkowe w chirurgii zaćmy - wykorzystanie polimeró. Polim Med. 2015 Jul- Dec;45(2):95-102. Polish.
  15. Özyol P, Özyol E, Karel F. Biocompatibility of Intraocular Lenses. Turk J Ophthalmol. 2017 Aug;47(4):221-225.
  16. Łabuz G, Reus NJ, van den Berg TJ. Comparison of ocular straylight after implantation of multifocal intraocular lenses. J Cataract Refract Surg. 2016 Apr;42(4):618-625.
  17. Khoramnia R, Yildirim TM, Łabuz G, Mayer CS, Auffarth GU. Eintrübung von Intraokularlinsen: Erkenntnisse aus dem Labor und der Klinik. Ophthalmologe. 2021 Jul;118(7):633-642.
  18. Khoramnia R. Eintrübung von Intraokularlinsen. Klin Monbl Augenheilkd. 2021 Jul;238(7):831-842.
  19. Kanclerz P, Yildirim TM, Khoramnia R. A review of late intraocular lens opacifications. Curr Opin Ophthalmol. 2021 Jan;32(1):31-44.
  20. Kanclerz P, Yildirim TM, Khoramnia R. Microscopic Characteristics of Late Intraocular Lens Opacifications. Arch Pathol Lab Med. 2021 Jun 1;145(6):759-767.
  21. Tetz M, Jorgensen MR. New Hydrophobic IOL Materials and Understanding the Science of Glistenings. Curr Eye Res. 2015;40(10):969-
  22. Borkenstein AF, Borkenstein EM. Clinical Performance of New Enhanced Monofocal Intraocular Lenses: Comparison of Hydrophobic C-loop and Hydrophilic Plate-Haptic Platform. Adv Ther. 2023 Oct;40(10):4561-4573.
  23. Nagy ZZ, Popper-Sachetti A, Kiss HJ. Comparison of visual and refractive outcomes between hydrophilic and hydrophobic trifocal intraocular lenses sharing the same optical design. J Cataract Refract Surg. 2019 May;45(5):553-561.
  24. Garzón N, Poyales F, García-Montero M, Vega F, Millán MS, Albarrán-Diego C. Impact of Lens Material on Objective Refraction in Eyes with Trifocal Diffractive Intraocular Lenses. Curr Eye Res. 2022 Jan;47(1):51-61.
  25. Khoramnia R, Kretz FTA, Gerl M, Breyer D, Auffarth GU. Long-term Clinical Outcomes After Bilateral Implantation of Two Trifocal Diffractive IOLs. J Refract Surg. 2023 Dec;39(12):798-807.
  26. Poyales F, Pérez R, López-Brea I, Zhou Y, Rico L, Garzón N. Comparison of Visual Performance and Patient Satisfaction Outcomes with Two Trifocal IOLs with Similar Optical Design but Different Materials. Clin Ophthalmol. 2020 Oct 13;14:3237-3247.
  27. Poyales F, Pérez R, López-Brea I, Zhou Y, Garzón N. First Results after Implantation of Hydrophilic and Hydrophobic Trifocal Intraocular Lenses: Visual and Optical Performance. J Ophthalmol. 2021 Dec 18;2021:3514577.
  28. Ang RET. Long Term Clinical Outcomes of Hydrophilic and Hydrophobic Versions of a Trifocal IOL with the Same Optical Design. Clin Ophthalmol. 2023 Feb 21;17:623-632.
  29. Chang A, Kugelberg M. Posterior capsule opacification 9 years after phacoemulsification with a hydrophobic and a hydrophilic intraocular lens. Eur J Ophthalmol. 2017 Mar 10;27(2):164-168.
  30. Chang A, Kugelberg M. Glistenings 9 years after phacoemulsification in hydrophobic and hydrophilic acrylic intraocular lenses. J Cataract Refract Surg. 2015 Jun;41(6):1199-1204.
  31. Ursell PG, Dhariwal M, Majirska K, et al. Three-year incidence of Nd:YAG capsulotomy and posterior capsule opacification and its relationship to monofocal acrylic IOL biomaterial: a UK Real World Evidence study. Eye (Lond). 2018 Oct;32(10):1579-1589.
  32. Ursell PG, Dhariwal M, O‘Boyle D, Khan J, Venerus A. 5 year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes. Eye (Lond). 2020 May;34(5):960-968.
  33. Iliescu IM, Constantin MA, Cozma C, Moraru OM, Moraru CM. Posterior Capsule Opacification and Nd-YAG rates evaluation in a large series of pseudophakic cases. Rom J Ophthalmol. 2017 Oct- Dec;61(4):267-274.
  34. Eggermont RL, Witteman AM, van Erkelens JA, Vermeulen K, Vunderink L, Reus NJ. Nd:YAG laser capsulotomy rates in the Netherlands: practice variation and association with physician practice styles. J Cataract Refract Surg. 2023 Apr 1;49(4):373-377.
  35. Lee Y, Kim JS, Kim BG, Hwang JH, Kang MJ, Lee JH. Comparison of the Incidence of Nd:YAG Laser Capsulotomy Based on the Type of Intraocular Lens. Medicina (Kaunas). 2023 Dec 14;59(12):2173.
  36. Dvali M, Tsertsvadze O, Mekvabishvili G. Comparison of posterior capsule opacification after implantation of same design single-piece hydrophilic and hydrophobic acrylic intraocular lenses. Georgian Med News. 2020 Apr;(301):59-62.
  37. Sharon Y, Livny E, Mimouni M, Weinberger D, Bahar I. Laser capsulotomy following cataract surgery: Comparing time to capsulotomy with implantation of two broadly used intraocular lenses. Indian J Ophthalmol. 2017 Feb;65(2):144-147.
  38. Duman R, Karel F, Özyol P, Ateş C. Effect of four different intraocular lenses on posterior capsule opacification. Int J Ophthalmol. 2015 Feb 18;8(1):118-121.
  39. Kossack N, Schindler C, Weinhold I, et al. German claims data analysis to assess impact of different intraocular lenses on posterior capsule opacification and related healthcare costs. Z Gesundh Wiss. 2018;26(1):81-90.
  40. Tokko HA, Hussain F, Al-Awadi A, et al. Factors Associated with the Development of Posterior Capsule Opacification Requiring Yttrium Aluminum Garnet Capsulotomy. Optom Vis Sci. 2019 Jul;96(7):492-499.
  41. Koshy J, Hirnschall N, Vyas AKV, et al. Comparing capsular bag performance of a hydrophilic and a hydrophobic intraocular lens: A randomised two-centre study. Eur J Ophthalmol. 2018 Nov;28(6):639-644.
  42. Bai L, Zhang J, Chen L, Ma T, Liang HC. Comparison of posterior capsule opacification at 360-degree square edge hydrophilic and sharp edge hydrophobic acrylic intraocular lens in diabetic patients. Int J Ophthalmol. 2015 Aug 18;8(4):725-729.
  43. Joshi RS. Incidence of primary peripheral posterior capsular opacification after cataract surgery and posterior capsular opacification in the patients implanted with foldable intraocular lenses. Nepal J Ophthalmol. 2017 Jul;9(18):149-155.
  44. Schriefl SM, Menapace R, Stifter E, Zaruba D, Leydolt C. Posterior capsule opacification and neodymium:YAG laser capsulotomy rates with 2 microincision intraocular lenses: Four-year results. J Cataract Refract Surg. 2015 May;41(5):956-963.
  45. Schriefl SM, Leydolt C, Stifter E, Menapace R. Posterior capsular opacification and Nd:YAG capsulotomy rates with the iMics Y-60H and Micro AY intra-ocular lenses: 3-year results of a randomized clinical trial. Acta Ophthalmol. 2015 Jun;93(4):342-347.
  46. Joshi RS. Postoperative posterior capsular striae and the posterior capsular opacification in patients implanted with two types of intraocular lens material. Indian J Ophthalmol. 2017 Jun;65(6):466-
  47. Rajesh SJ. Study on buckling of intraocular lens haptic in 2 types of intraocular lens material and its effect on vision. Rom J Ophthalmol. 2020 Oct-Dec;64(4):387-395.
  48. Özdamar Erol Y, Özdemir Yalçınsoy K, Özdal P. The outcomes of cataract surgery in eyes with Fuchs uveitis. J Ophthalmic Inflamm Infect. 2023 Feb 13;13(1):4.
  49. Wang Y, Wang W, Zhu Y, Xu J, Luo C, Yao K. Comparison Study of Anterior Capsule Contraction of Hydrophilic and Hydrophobic Intraocular Lenses Under the Same Size Capsulotomy. Transl Vis Sci Technol. 2022 Jan 3;11(1):24.
  50. Sharma P, Kalia S, Chouhan JK. Incidence and causes of negative dysphotopsia after uncomplicated cataract surgery - A randomized clinical trial. Indian J Ophthalmol. 2021 Jul;69(7):1786-1791.
  51. Bhogal-Bhamra GK, Aujla M, Kolli S, Sheppard AL, Wolffsohn JS. Glare prediction and mechanism of adaptation following implantation of hydrophilic and hydrophobic intraocular lenses. Front Ophthalmol (Lausanne). 2024 Apr 25;4:1310468.
  52. Sezgin Asena B. Visual and refractive outcomes, spectacle independence, and visual disturbances after cataract or refractive lens exchange surgery: Comparison of 2 trifocal intraocular lenses. J Cataract Refract Surg. 2019 Nov;45(11):1539-1546.
  53. Serdiuk V, Ustymenko S, Fokina S, Ivantsov I. Comparison of three different presbyopia-correcting intraocular lenses. Rom J Ophthalmol. 2020 Oct-Dec;64(4):364-379.
  54. Tang Y, Song H, Chen J, Tang X. Comparison of pseudophakic retinal straylight in spherical/aspherical and hydrophobic/hydrophilic intraocular lens. Int J Ophthalmol. 2015 Dec 18;8(6):1146-1150.
  55. Lapid-Gortzak R, Labuz G, van der Meulen IJ, van der Linden JW, Mourits MP, van den Berg TJ. Straylight Measurements in Two Different Apodized Diffractive Multifocal Intraocular Lenses. J Refract Surg. 2015 Nov;31(11):746-751.
  56. Jafarzadehpur E, Hashemi H, Abdolahinia T, Yekta AA, Khabazkhoob M. Comparison of Ocular Aberrations in Two Hydrophobic and Hydrophilic Intraocular Lenses. Eye Contact Lens. 2015 Sep;41(5):287-290.
  57. Vinas M, Dorronsoro C, Garzón N, Poyales F, Marcos S. In vivo subjective and objective longitudinal chromatic aberration after bilateral implantation of the same design of hydrophobic and hydrophilic intraocular lenses. J Cataract Refract Surg. 2015 Oct;41(10):2115-2124.
  58. Haripriya A, Gk S, Mani I, Chang DF. Comparison of surgical repositioning rates and outcomes for hydrophilic vs hydrophobic single-piece acrylic toric IOLs. J Cataract Refract Surg. 2021 Feb 1;47(2):178-183.
  59. Draschl P, Hirnschall N, Luft N, et al. Rotational stability of 2 intraocular lenses with an identical design and different materials. J Cataract Refract Surg. 2017 Feb;43(2):234-238.
  60. Dvali M, Tsertsvadze O, Skhirtladze S. Incidence of CME after hydrophilic and acrylic IOL implantation – OCT results. Georgian Med News. 2019 Jun;(291):42-45.
  61. Wang X, Wu X, Dai Y, Huang Y. Intraoperative and Postoperative Intraocular Lens Opacifications: Analysis of 42545 Cases. J Ophthalmol. 2021 Dec 6;2021:1285947.
  62. Neuhann T, Yildirim TM, Son HS, Merz PR, Khoramnia R, Auffarth GU. Reasons for explantation, demographics, and material analysis of 200 intraocular lens explants. J Cataract Refract Surg. 2020 Jan;46(1):20-26.
  63. Lorenzana-Blanco N, Velarde-Rodríguez G, Corte-Alonso S, et al. Risk of Intraocular Lens Opacification After Endothelial Keratoplasty for Different Intraocular Lens Models: A Retrospective Single-Center Cohort Study. Cornea. 2023 Jul 1;42(7):797-804.
  64. Moura-Coelho N, Papa-Vettorazzi R, Reyes A, et al. Intraocular Lens Opacification After Descemet‘s Membrane Endothelial Keratoplasty-Risk Factors and Outcomes After Intraocular Lens Exchange. Cornea. 2024 Jul 30. Epub ahead of print. doi: 10.1097/ ICO.0000000000003649
  65. Schrittenlocher S, Penier M, Schaub F, Bock F, Cursiefen C, Bachmann B. Intraocular Lens Calcifications After (Triple-) Descemet Membrane Endothelial Keratoplasty. Am J Ophthalmol. 2017 Jul;179:129-136.
  66. Cabeza-Gil I, Ríos-Ruiz I, Calvo B. Experimental evaluation of the injection force exerted in intraocular lens delivery with syringe-type injectors. J Mech Behav Biomed Mater. 2021 Dec;124:104793.
  67. Rateb MF, Eldaly ZH, Ibrahim WSE, Eldoghaimy AH. Scanning electron microscopic characteristics of manually loaded and preloaded foldable acrylic intraocular lenses. Eur J Ophthalmol. 2019 Jan;29(1):28-32.
  68. Borkenstein AF, Borkenstein EM. Analysis of YAG Laser-Induced Damage in Intraocular Lenses: Characterization of Optical and Surface Properties of YAG Shots. Ophthalmic Res. 2021;64(3):417-431.
  69. Borkenstein AF, Mikitisin A, Schwedt A, Borkenstein EM, Mayer J. A Novel 3D High Resolution Imaging Method Using Correlative X-Ray and Electron Microscopy to Study Neodymium-Doped Yttrium Aluminum Garnet Laser-Induced Defects in Intraocular Lenses. Ophthalmic Res. 2024;67(1):292-300.
  70. Eppig T, Rawer A, Hoffmann P, Langenbucher A, Schröder S. On the Chromatic Dispersion of Hydrophobic and Hydrophilic Intraocular Lenses. Optom Vis Sci. 2020 Apr;97(4):305-313.
  71. Wang GQ, Dang YL, Huang Q, et al. In Vitro Evaluation of the Effects of Intraocular Lens Material on Lens Epithelial Cell Proliferation, Migration, and Transformation. Curr Eye Res. 2017 Jan;42(1):72-78.
  72. Liu H, Liu X, Chen Y, et al. Effect of Nd:YAG laser capsulotomy on the risk for retinal detachment after cataract surgery: systematic review and meta-analysis. J Cataract Refract Surg. 2022 Feb 1;48(2):238-244.
  73. Dot C, Schweitzer C, Labbé A, et al. Incidence of Retinal Detachment, Macular Edema, and Ocular Hypertension after Neodymium:Yttrium-Aluminum-Garnet Capsulotomy: A Population-Based Nationwide Study-The French YAG 2 Study. Ophthalmology. 2023 May;130(5):478-487.
  74. Huang Q, Cheng GP, Chiu K, Wang GQ. Surface Modification of Intraocular Lenses. Chin Med J (Engl). 2016 Jan 20;129(2):206-214.
  75. Donachie PHJ, Barnes BL, Olaitan M, Sparrow JM, Buchan JC. The Royal College of Ophthalmologists‘ National Ophthalmology Database study of cataract surgery: Report 9, Risk factors for posterior capsule opacification. Eye (Lond). 2023 Jun;37(8):1633-1639.
  76. Bompastor-Ramos P, Póvoa J, Lobo C, et al. Late postoperative opacification of a hydrophilic-hydrophobic acrylic intraocular lens. J Cataract Refract Surg. 2016 Sep;42(9):1324-1331.
  77. Amon T, Goldblum D, Meyer P, et al. 674 Cases of Late Postoperative Intraocular Lens Opacification of a Hydrophilic-Hydrophobic Acryl Intraocular Lens in Switzerland and Retrospective Opacification Risk Factor Assessment of 212 Cases. Klin Monbl Augenheilkd. 2023 Apr;240(4):440-445.
  78. Gartaganis SP, Prahs P, Lazari ED, Gartaganis PS, Helbig H, Koutsoukos PG. Calcification of Hydrophilic Acrylic Intraocular Lenses With a Hydrophobic Surface: Laboratory Analysis of 6 Cases. Am J Ophthalmol. 2016 Aug;168:68-77.
  79. Scherer NCD, Müller K, Prahs PM, Radeck V, Helbig H, Märker DA. Serial opacification of a hydrophilic-hydrophobic acrylic intraocular lens: analysis of potential risk factors. J Cataract Refract Surg. 2020 Dec;46(12):1624-1629.
  80. Buhl R, Yildirim TM, Schickhardt SK, Britz L, Lieberwirth I, Auffarth GU, Khoramnia R. Higher phosphate concentrations as in aqueous humor of diabetic patients increase intraocular lens calcification. BMC Ophthalmol. 2024 Aug 23;24(1):363
  81. Mackert M, Muth DR, Vounotrypidis E, et al. Analysis of opacification patterns in intraocular lenses (IOL). BMJ Open Ophthalmol. 2021 Feb 11;6(1):e000589.
  82. Werner L, Wallace JK, Balendiran V, Shumway C, Ellis N, Mamalis N. Surface deposits mimicking calcification on a hydrophobic acrylic intraocular lens. J Cataract Refract Surg. 2019 Jul;45(7):1036-1039.
  83. Otrošinová M, Novák J, Kvasnička J, Žídek O. Late postoperative opacification of a hydrophobic acrylic intraocular lens AcryNovaT- MPC 610Y. Cesk Slov Oftalmol. 2019;75(4):172-179.
  84. Bopp S, Özdemir HB, Aktaş Z, et al. Clinical Characteristics of Patients with Intraocular Lens Calcification after Pars Plana Vitrectomy. Diagnostics (Basel). 2023 Jun 1;13(11):1943.
  85. Marcovich AL, Tandogan T, Bareket M, et al. Opacification of hydrophilic intraocular lenses associated with vitrectomy and injection of intraocular gas. BMJ Open Ophthalmol. 2018 Dec 15;3(1):e000157.
  86. Werner L, Wilbanks G, Nieuwendaal CP, et al. Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas. J Cataract Refract Surg. 2015 Jan;41(1):199-207.
  87. Yildirim TM, Schickhardt SK, Wang Q, Friedmann E, Khoramnia R, Auffarth GU. Quantitative evaluation of microvacuole formation in five intraocular lens models made of different hydrophobic materials. PLoS One. 2021 Apr 30;16(4):e0250860.
  88. Ting DSJ, Tatham AJ, Donachie PHJ, Buchan JC. The Royal College of Ophthalmologists‘ National Ophthalmology Database study of cataract surgery: report 16, influence of remuneration model on choice of intraocular lens in the UK. Eye (Lond). 2023 Dec;37(18):3854-3860.
  89. Vacalebre M, Frison R, Corsaro C, et al. Current State of the Art and Next Generation of Materials for a Customized IntraOcular Lens according to a Patient-Specific Eye Power. Polymers (Basel). 2023 Mar 22;15(6):1590.