Postoperative inflammation and optical quality after AQBH intraocular lens implantation: a retrospective comparative study

Objective To evaluate the association of implantation of the AQBH heparin-modified intraocular lens (IOL) with postoperative blood-aqueous barrier disruption and objective optical quality after age-related cataract surgery. Methods In this retrospective, non-randomized comparative study, 62 patients (82 eyes) undergoing phacoemulsification and IOL implantation at Weifang Eye Hospital between July 2021 and September 2022 were grouped by the implanted IOL: AQBH (heparin-modified), iSert 250/251 (unmodified hydrophobic acrylic), or CT LUCIA 601P/601PY (heparin-coated hydrophobic acrylic). Aqueous flare and objective scatter index (OSI) were measured at 1 day, 3 days, 1 week, 1 month, and 3 months after surgery. Flare-AUC, threshold achievement, CDVA, refractive outcomes, OSI-AUC, and within-eye OSI variability were evaluated as exploratory, unadjusted eye-level outcomes. Results Patient-clustered GEE showed a significant group×time interaction for aqueous flare (Wald χ²=69.95, P < 0.001). At month 3, aqueous flare was higher in the iSert group (mean difference, 1.82 pc/ms; 95% CI, 1.47–2.17; P < 0.001) and LUCIA group (mean difference, 0.93 pc/ms; 95% CI, 0.65–1.21; P < 0.001) than in the AQBH group; the one-eye-per-patient analysis yielded consistent findings. Unadjusted exploratory eye-level analyses suggested between-group differences in flare-AUC and early inflammatory peak (both P < 0.001), but these derived findings did not account for inter-eye correlation. For OSI, the GEE group×time interaction was not significant ( P = 0.768), and evidence of a month-3 group difference was inconsistent between the patient-clustered GEE ( P = 0.040) and one-eye-per-patient analysis ( P = 0.064). Exploratory unadjusted OSI-AUC and within-eye variability comparisons should therefore be interpreted cautiously. CDVA and refractive findings were also exploratory and unadjusted. Conclusion AQBH implantation was associated with lower postoperative aqueous flare levels after age-related cataract surgery. Associations with optical-quality stability were less definitive. Larger prospective studies are required to confirm the visual and clinical relevance of these findings.