The influence of different types of intraocular lenses on the development of posterior capsular opacification: a systematic review

Currently, posterior capsule opacification (PCO) remains one of the most common complications after cataract surgery. It can be treated with neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy, but this may lead to other complications. Therefore, many studies have attempted to identify the best intraocular lens (IOL) design that influences the development of PCO. The purpose of this study is to compare the effects of different intraocular lenses (IOLs) on PCO development after cataract surgery. These IOLs include comparisons of IOL materials, IOL edge designs, one-piece versus three-piece IOLs, and spherical versus aspheric IOLs. We searched the CENTRAL, PubMed, MEDLINE, EMBASE,China National Knowledge Infrastructure (CNKI),China Wanfang Database and China VIP Database in March 2025. This study included a total of 5,957 unique records. After screening and applying eligibility criteria, 59 randomized controlled trials or cohort studies were included. The effect of the intervention on PCO was assessed by measuring(subjective or objective) PCO score and the number of performed Nd:YAG laser capsulotomies. Funnel plots assessed publication bias. The results of the review were divided into four parts. In part one (effect of IOLs materials on PCO), the meta-analysis found that, when excluding the effects of optical edges and other differences, the rate of PCO for hydrophobic acrylic IOLs was significantly lower than that for hydrophilic acrylic IOLs. In addition, the PCO rate for silicone IOLs was significantly lower than that for hydrophobic acrylic and polymethyl methacrylate (PMMA) IOLs. In part two (effect of IOL edge design on PCO), the meta-analysis showed significantly lower PCO rates in IOLs with sharp posterior optic edges than in IOLs with round optic edges. In part three (effect of one-piece and three-piece IOLs on PCO), there was no difference between one-piece and three-piece IOLs. In part four (influence of spherical and aspherical IOLs on PCO), there was no difference between spherical and aspherical IOLs. In summary, primarily the choice of the IOL edge design and IOL materials seem to have a significant influence on the development of PCO. Therefore, IOLs with sharp optic edges should be preferred, and silicone IOLs seem to be a better choice. INPLASY2025120024. The DOI number is 10.37766/inplasy2025.12.0024. Not applicable.