Should We Abandon Hydrophilic Intraocular Lenses?

PURPOSE:To characterize the features of hydrophilic intraocular lenses (IOLs) important in the clinical context of expected prolonged duration time of the IOL within the eye. DESIGN:Perspective. METHODS:Discussion includes possible factors and mechanisms associated with hydrophilic IOLs' susceptibility to calcification and posterior capsule opacification (PCO) formation. RESULTS:Results of recently reported studies show that particular surgeries, such as pars plana vitrectomy, Descemet stripping (automated) endothelial keratoplasty, and Descemet membrane endothelial keratoplasty with intraocular gas or air injection, might predispose the calcification process of hydrophilic IOLs, leading to a significant decrease in visual quality and possibly explantation of the IOL. Hydrophilic IOLs are more susceptible than hydrophobic IOLs to PCO formation, which is the most common of late postoperative complications that are associated with significant side effects. CONCLUSIONS:We believe that all patients should be informed about the higher risk of calcification and PCO associated with hydrophilic IOLs. We also recommend limiting the use of hydrophilic acrylic IOLs during cataract surgery, especially when it is combined with pars plana vitrectomy or endothelial keratoplasty, and in patients with endothelial diseases who will probably require operation on it in the future.