Incidence and associated factors of Nd:YAG posterior capsulotomy after premium IOL implantation surgery: a systematic review and meta-analysis

AIMS: Although premium intraocular lenses (IOLs) have become a prominent choice in modern cataract surgery, they may be more prone to posterior capsule opacification (PCO) and subsequent neodymium-doped yttrium aluminum garnet (Nd:YAG) posterior capsulotomy. This study aims to systematically evaluate the incidence of Nd:YAG capsulotomy after premium IOLs implantation and identify associated factors. METHODS: An exhaustive literature search was performed on PubMed, Embase, and Cochrane Library databases up to 12 June 2024, for studies reporting Nd:YAG posterior capsulotomy incidence after premium IOLs implantation. This review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS: A total of 129 studies with 14 048 eyes met the inclusion criteria. The incidence of Nd:YAG posterior capsulotomy was 0.5% (95% CI: 0.1-1.2%) at 6 months postoperatively, 3.7% (95% CI: 2.1-5.6%) at 12 months, and 18.1% (95% CI: 10.0-27.8%) at 24 months. Subgroup analyses identified significantly higher incidence among silicone, plate-loop or four-haptic, round-edge, and accommodative IOLs. Meta-regression revealed that longer follow-up and plate-loop/four-haptic design were significant risk factors for Nd:YAG capsulotomy; additionally, incidence appeared to decrease in studies published in more recent years. CONCLUSIONS: This systematic review and meta-analysis revealed that silicone, plate-loop or four-haptic, round-edge, and accommodative IOLs were associated with a higher incidence of Nd:YAG posterior capsulotomy. Clinicians should be aware that, for patients at higher risk of PCO, such as those with high myopia, younger age, diabetes, or grade III-V nuclear hardness, these IOLs should be avoided to reduce the risk of PCO and the need for Nd:YAG capsulotomy.