Acta Scientific Ophthalmology (ISSN: 2582-3191)

Research Article Volume 5 Issue 3

A Prospective Study on Visual Outcomes of Cataract Surgery after Phacoemulsification with Foldable vs Non Foldable Intraocular Lenses

Shavina Garg1, Harsimran Singh1, Rajinder Khalsa1, Usha Aggarwal2, Anand Aggarwal1*, Indu Khosa1, Kamlinder Kaur1 and Shubham Mittal1

1Department of Ophthalmology, Government Medical College, Patiala, Punjab, India
2Director, Harnam Satsangi Clinic, Civil Lines, Ludhiana, Punjab, India

*Corresponding Author: Anand Aggarwal, Department of Ophthalmology, Government Medical College, Patiala, Punjab, India..

Received: February 10, 2022; Published: February 24, 2022


Purpose: To compare the visual outcomes of cataract surgery with foldable vs non foldable Intraocular lenses after phacoemulsification, at a tertiary Eye centre in Department of Ophthalmology, Government Medical College, Patiala.

Methods: In a prospective, comparative, randomized clinical trial of phacoemulsification cataract surgery, 200 patients received hydrophilic foldable intraocular lenses through 2.8mm clear corneal incision and 100 patients received non foldable Polymethyl Methacrylate (PMMA) intraocular lenses through 5.25mm clear corneal incision. Preoperative and postoperative visual acuity, Pentacam based analysis of astigmatism, dry eye changes and IOP measurements at day 7, 1 month, 3 month and 6 month follow up visits were analysed.

Results: A total of 300 people were enrolled in the trial, 200 were randomly allocated to receive a hydrophilic foldable lens and 100 to receive a non foldable PMMA lens. At 6 months after surgery, 194 out of 200 patients (97%) had best corrected visual acuity of 6/9 or better in foldable group (group I) and 95 out of 100 (95%) in the non foldable group (Group II). Visual acuity of 6/12 - 6/18 was observed in 3% of foldable and 5% of non foldable group (p value - 0.385). None of the cases in both group I and II had best corrected visual acuity worse than 6/18 at the end of 1 month. Vision stabilized in both groups after first month postoperatively. Surgically induced astigmatism was 0.47 0.39 D in group I and 1.03 0.48 D in group 2 at the end of 6 months as compared to baseline. The difference in SIA between both groups was statistically significant (p value < 0.001). Dry eye changes were more in group 2 as compared to group 1 but the difference was not significant. As far as IOP changes were concerned, both the groups didn’t have any significant difference, though the decrease in IOP was significant in each group after 6 months of cataract surgery (p value < 0.05).

Conclusion: Phacoemulsification with implantation of a foldable IOL through a 2.8mm incision leads to less post operative astigmatism as compared to phacoemulsification with implantation of a non foldable IOL through 5.25mm incision. The main concern of patients is final visual outcome, which remains the same with both foldable and non foldable IOLs. Therefore, phacoemulsification with either implantation of a foldable or an inexpensive rigid PMMA IOL gives excellent results in hands of experienced cataract surgeons.

Keywords: Cataract; Phacoemulsification; Intraocular lenses; Visual Acuity; Surgically Induced Astigmatism; Intraocular pressure


  1. Pascolini D and Mariotti SP. “Global estimates of visual impairment: 2010”. British Journal of Ophthalmology 5 (2012): 614-618.
  2. Malhotra S., et al. “Prevalence of blindness in India: A systematic review and meta-analysis”. The National Medical Journal of India 6 (2019): 325.
  3. Petrash JM. “Aging and age-related diseases of the ocular lens and vitreous body”. Investigative Ophthalmology and Visual Science 14 (2013): ORSF54-59.
  4. Lundström M., et al. “The changing pattern of cataract surgery indications: a 5-year study of 2 cataract surgery databases”. Ophthalmology 1 (2015): 31-38.
  5. Lamoureux EL., et al. “The impact of cataract surgery on quality of life”. Current Opinion in Ophthalmology 1 (2011): 19-27.
  6. Kelman CD. “Phaco-emulsification and aspiration: a new technique of cataract removal: a preliminary report”. American Journal of Ophthalmology 1 (1967): 23-35.
  7. El-Maghraby A., et al. “Foldable IOL technology: an overview”. In Foldable Intraocular Lenses (1993): 3-12.
  8. Bachani D., et al. “Visual outcomes after cataract surgery and cataract surgical coverage in India”. International Ophthalmology 1 (1999): 49-56.
  9. Venkatesh R., et al. “Manual small incision cataract surgery in eyes with white cataracts”. Indian Journal of Ophthalmology 3 (2005): 173-176.
  10. Allen HF. “Phacoemulsification and Aspiration: The Kelman Technique of Cataract Removal”. Archives of Ophthalmology 6 (1976): 1053.
  11. Hennig A., et al. “Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial”. Eye5 (2014): 567-575.
  12. Tyagi R., et al. “Comparative Analysis of Phacoemulsification Cataract Surgery with Rigid and Foldable IOLS in Terms of Safety, Efficacy and final Visual outcome-A Retrospective Study at a State Hospital”. Journal of Medical Science And Clinical Research 11 (2018): 663-669.
  13. Prasad RJ and Saroja LP. “Phacoemulsification with PMMA IOL Vs Phacoemulsification with Foldable Acrylic IOL. A Comparative Study”. IOSR Journal of Dental and Medical Sciences 15 (2016): 34-41.
  14. Afsar AJ., et al. “A comparison of visual performance between a rigid PMMA and a foldable acrylic intraocular lens”. Eye 3 (1999): 329-335.
  15. Alam M and Iqbal Z. “Comparison of visual acuity and astigmatic changes in phacoemulsification with posterior chamber foldable vs non foldable intraocular lens implant”. Pakistan Journal of Ophthalmology 2 (2007).
  16. Raiyawa S., et al. “Visual acuity in patients having foldable and non-foldable intra-ocular lens for cataract surgery”. Journal of the Medical Association of Thailand 1 (2008): S102-10.
  17. Nikose AS., et al. “Surgically induced astigmatism after phacoemulsification by temporal clear corneal and superior clear corneal approach: a comparison”. Clinical Ophthalmology 12 (2018): 65.
  18. Gupta M., et al. “Comparative study of dry eye after phacoemulsification in senile cataract”. International Journal of Research in Medical Sciences 12 (2015): 3802-3807.
  19. Sinha M., et al. “Comparative evaluation of dry eye following cataract surgery: a study from North India”. IOSR Journal of Dental and Medical Sciences 6 (2014): 13-18.
  20. Cetinkaya S., et al. “The course of dry eye after phacoemulsification surgery”. BMC Ophthalmology 1 (2015): 1-5.
  21. Kasetsuwan N., et al. “Incidence and pattern of dry eye after cataract surgery”. PLoS One 11 (2013): e78657.
  22. Cho YK and Kim MS. “Dry eye after cataract surgery and associated intraoperative risk factors”. Korean Journal of Ophthalmology 2 (2009): 65-73.
  23. Dhawan M., et al. “Dry eye after phacoemulsification”. The Official Scientific Journal of Delhi Ophthalmological Society 1 (2018): 25-30.
  24. Steuhl KP., et al. “Intraocular pressure and anterior chamber depth before and after extracapsular cataract extraction with posterior chamber lens implantation”. Ophthalmic Surgery 4 (1992): 233-237.
  25. Kerstetter JR., et al. “Prostaglandin F2α1-isopropylester lowers intraocular pressure without decreasing aqueous humor flow”. American Journal of Ophthalmology 1 (1988): 30-34.
  26. Baek SU., et al. “Effect of phacoemulsification on intraocular pressure in healthy subjects and glaucoma patients”. Journal of Korean Medical Science 6 (2019): e47.
  27. Lv H., et al. “Changes of intraocular pressure after cataract surgery in myopic and emmetropic patients”. Medicine 38 (2018): e12023.


Citation: Anand Aggarwal., et al. “A Prospective Study on Visual Outcomes of Cataract Surgery after Phacoemulsification with Foldable vs Non Foldable Intraocular Lenses".Acta Scientific Ophthalmology 5.3 (2022): 48-59.


Copyright: © 2022 Anand Aggarwal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate35%
Acceptance to publication20-30 days
ISI- IF1.042
JCR- IF0.24

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