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.