Hydrophilic vs hydrophobic: which is the better option?

Key Points

"Hydrophilic IOLs tend to be easier for the surgeon to implant, and are therefore, particularly in the case of very small incisions, probably a more suitable surgical option than hydrophobic IOLs," said Christophe Chassain, MD, an anterior segment surgeon at the Clinique Beau-Soleil, Montpellier, France. "Postoperatively, though, hydrophilic lenses have a worse reputation for prevention of posterior capsule opacification (PCO), which traditionally has been a prime metric used to determine the success of IOL implantation."

PCO: investigating hydrophilic IOLs

The SlimFlex is a 26% hydrophilic monobloc IOL with a 6 mm optic, and a 360° posterior square edge. It has an overall diameter of 10.5 mm, with four haptics at a 5° angle. The lens can be injected through a 2.4 mm incision. MicroSLIM - the microincision version of the lens, which can be injected through a 1.8 mm incision - is made from 25% hydrophilic material.

Dr Chassain implanted 344 SlimFlex lenses into 191 female and 153 male subjects with a mean age of 77 years (range: 46–94 years) and a mean dioptric power of +20.5 D (range: 9–28 D). Topical anaesthesia was used and, during the coaxial surgery, the posterior capsule was cleaned; FlexiRing intracapsular rings (IOLTECH Laboratories) were implanted into 34 eyes. A rhexis of 5.5 mm was achieved in 66% of cases; the rhexis IN position was 76% with an optic overlap.

Similar PCO rates with both lens types

"Of the 344 subjects implanted with the SlimFlex lens, 3.2% required further treatment with Nd:YAG posterior capsulotomy to combat PCO. Of these, four YAGs were performed in the 180 eyes with an IN rhexis; six in the 57 eyes with an IN/OUT rhexis; one in the four eyes with posterior fibrosis, and two in the 34 eyes implanted with a FlexiRing," reported Dr Chassain.

The mean follow-up period was 20.6 months (range: 11–28 months). At this stage, 68.6% of subjects had achieved a clear central posterior capsule.