Does the design of replacement lenses used in cataract surge | Figure 1

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Does the design of replacement lenses used in cataract surgery help stop clouding of the new lens?

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Key messages

In cataract surgery, replacement lenses that have a sharp edge design may be less likely to develop clouding on their surface than lenses with a round edge. People given new lenses with sharp edges may have clearer eyesight, and may be less likely to need laser surgery, than people given lenses with rounded edges.

How are cataracts treated?

The lens is a small, clear disc inside the eye that focuses light rays to make clear images of objects seen. A cataract starts when cloudy patches develop on the lens. As the cloudy patches get bigger over time, sight becomes misty and blurred.

Surgery is the only way to improve your eyesight if you have cataracts. In cataract surgery, a tiny cut is made in your eye; the old, cloudy lens is removed and a new, plastic lens is put in its place.

After cataract surgery

A common problem after cataract surgery is that the back of the new lens develops cloudy patches on the surface, causing blurred or misty sight again. The problem is treated by using a laser to create a small opening in the back of the lens, to allow light through. However, this procedure could cause further problems, such as raising pressure inside the eye, or could damage other parts of the eye.

Different styles of plastic lenses have been designed to try to stop or reduce clouding once they are in the eye. Changes include making the edges of the lens round or sharp. We wanted to find out if differently shaped edges on the lens would make it less likely to cloud.

We searched for studies that tested different designs of plastic lenses used in cataract surgery. We wanted to know how differently shaped edges on the lens affected the need for laser eye treatment one year after cataract surgery.

We found 10 studies involving 1065 people with age‐related cataracts who had surgery to replace the lens in 1834 eyes. The studies took place in Austria, Germany, India, Japan, Sweden and the UK. The studies lasted for at least one year. Some studies followed participants for up to 12 years after their surgery.

The studies compared replacement lenses with rounded edges against replacement lenses with sharp edges.

What are the main results of our review?

In all 10 studies, eyes given a sharp‐edged lens showed less clouding on the lens, compared with eyes given a round‐edged lens.

Read the full results, and further details, here:

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\ \ Key messages\ We did not find enough good‐quality evidence about the best way to deliver medicines directly to the eye during cataract surgery. We found only one study that had enrolled a large enough number of people to give reliable results.\ Larger, well‐designed studies are needed to give better estimates of the benefits and potential harms of the different ways of delivering these medicines.\ Before and during cataract surgery, doctors use medicines to widen (dilate) the pupil, the dark part in the center of the eye that lets in light. For surgery, the pupil should be as wide as possible to help doctors see and work inside the eye; wide pupils also reduce the chance of problems during surgery.\ We found 14 studies in 1652 people (aged 57 to 78 years) who had cataract surgery in 1670 eyes.\ The studies compared eye drops against injections (7 studies) or depot devices (6 studies); one study compared all three delivery types. Unfortunately, there were too many differences between the study designs and results reported to allow us to make overall estimates of how well each method worked.\ The results of the 14 studies comparing eye drops against injections or depot devices did not show sufficiently clear differences between different methods.\ We do not know whether one method worked better than either of the others to:\ · widen the pupil (measured during surgery, and at the beginning and end of surgery);\ · reduce how much time the surgery lasted; or\ · reduce how much time it took to replace the lens during surgery.\ Not all studies reported on unwanted effects. One study showed that eye discomfort was probably greater with eye drops than with an injection, when measured at one week (555 people) and one month (543 people) after surgery. Another study reported problems with the iris (the colored disc that surrounds the pupil) in 11 people who had an injection, compared with none in the group who had a depot device, although our confidence in these results is limited.\ No studies reported on cost‐effectiveness of any of the delivery methods.\ Our confidence is limited because the results from the studies varied widely, and the studies involved only small numbers of people.](https://app.figure1.com/case-detail/2db422ad-9371-4590-bed3-a0b96577773a)

\ \ Ab interno trabecular bypass surgery with Schlemm's canal Hydrus microstent for open angle glaucoma\ What was the aim of the review?\ The aim of this Cochrane Review was to find out if ab interno trabecular bypass surgery with the Hydrus microstent lowers the pressure in the eye (intraocular pressure) for people with open angle glaucoma (OAG). The Cochrane Review authors collected and analysed all relevant studies to answer this question, and found three completed studies.\ Key messages\ In people with cataracts and glaucoma, having combined treatment of cataract surgery and a Hydrus implant may increase the number of people who do not need intraocular pressure (IOP) lowering medication (drugs), and may further reduce IOP compared with cataract surgery alone in the short‐ and medium‐term. Where the Hydrus microstent was compared to iStent, the microstent was probably more effective in people with OAG. This evidence was from studies on people in whom IOP was often well‐controlled with medication, and their OAG was mainly mild or moderate.\ What was studied in the review?\ Glaucoma is a common eye condition and can cause blindness if left untreated. In glaucoma, the optic nerve (which connects the eye to the brain) is damaged, often due to increased pressure in the eye as a result of build‐up of fluid. Ab interno trabecular bypass surgery with a Hydrus microstent is a type of surgery in which doctors implant the Hydrus (a small device that opens up a channel in the main fluid canal called Schlemm's) and improves the flow of fluid through this canal. This may lead to lower eye pressure and a lower chance of damage to the optic nerve. This type of surgery is less invasive, and may lead to fewer complications and faster healing times than other types of surgery for glaucoma.\ What were the main results of the review?\ Two studies (653 participants with cataracts and open angle glaucoma) found that the proportion of people not using IOP lowering medication at two years was about half for those who received cataract surgery alone, and was more than three‐quarters if the Hydrus microstent was also implanted during cataract surgery; this evidence was of moderate‐certainty because of problems with study quality. About one in 30 or 50 participants needed further glaucoma surgery after cataract surgery alone, compared with one in 100 or less when the Hydrus microstent was added; this evidence was of low‐certainty, because of problems with study quality and the small number of glaucoma surgeries.\ Another study (152 participants with open angle glaucoma) compared a Hydrus implant with an iStent implant (a small tube implanted into the eye's drainage system, known as the trabecular meshwork, allowing fluid to flow in the Schlemm's canal) at one year. The study found that the Hydrus microstent nearly doubled the number of people not using IOP lowering medication at one year, from about a quarter to almost a half; this evidence was of low‐certainty, because of problems with study quality and the small number of participants. Further glaucoma surgery was very rarely needed in either group.\ All included studies were sponsored by the Hydrus manufacturer Ivantis Inc.\ The use of the Hydrus implant was probably safe in these studies, but larger studies and a longer follow‐up may be needed to investigate very rare or long‐term adverse events. This evidence was from studies on people in whom IOP was often well‐controlled with medication, and further trials are needed for participants with uncontrolled glaucoma.\ How up‐to‐date is the review?\ The Cochrane Review authors searched for studies published up to 7 May 2019.](https://app.figure1.com/case-detail/5e06848b-3caa-4578-9bd0-63ea31979287)

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