Long-term comparison of posterior capsular opacification in highly myopic eyes between hydrophilic and hydrophobic intraocular lenses

To compare the long-term outcomes of posterior capsular opacification (PCO) in highly myopic eyes between hydrophilic intraocular lenses (IOLs) and hydrophobic IOLs. 679 highly myopic eyes (axial length ≥ 26 mm) undergoing phacoemulsification with IOL implantation were included in this retrospective study and divided into the hydrophilic IOL and hydrophobic IOL groups. The severity scores of PCO were evaluated using EPCO2000 software system, with both the areas of central 3.0 mm (PCO-3 mm) and of the capsulorhexis (PCO-CCC) analyzed. Clinically significant PCO was defined as eyes with visual-impairing PCO or history of capsulotomy. The mean follow-up time was 34.7 ± 12.3 months. Both PCO-3 mm and PCO-CCC scores were significantly higher in the hydrophilic IOL group compared with those of the hydrophobic IOL group (P < 0.05). The hydrophilic IOL group also had shorter time to clinically significant PCO development (P = 0.029). Multivariate linear regression revealed that higher scores of PCO-3 mm and PCO-CCC in highly myopic eyes were both associated with hydrophilicity of IOL, longer follow-up duration, and worse postoperative best-corrected visual acuity (P < 0.05). Patients with implantation of hydrophilicity IOL and younger age showed higher risk of clinically significant PCO according to the Cox proportional hazards model. In extreme myopia (> 30 mm), hydrophobic IOLs reduced PCO risk by 41% (HR = 0.59, p = 0.003). In highly myopic patients, the hydrophilicity of IOL affects the severity of long-term PCO after cataract surgery, which shall be considered in the selection of IOLs.