The aim of this study is to investigate the effect of the intraocular lens (IOL) loading methods on the incidence of the adhesion phenomenon.

439 patients (439 eyes) who underwent phacomulsification for cataract extraction combined with IOL implantation at the Ophthalmology Department of Peking University Third Hospital from July 2021 to July 2022 were included. Among them, there were 214 males (214 eyes) and 225 females (225 eyes) with the averge age of (68.7±9.5) years (ranged from 59 to 79 years). According to the types of hydrophobic acrylic IOLs, they were divided into Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV group. According to the methods of loading for IOL, they were divided into conventional loading method, composite electrolyte loading method, viscoelastic agent loading method, double loop interval loading method, pre loading method, composite electrolyte+ viscoelastic agent loading method, and composite electrolyte+ viscoelasticagent+ double loop interval loading method. The differences in the incidence of adhesion phenomena, adhesion types, and the need for additional instrument assistance were compared. The age were in accordance with normal distribution, which was expressed as ±s, and compared with one-way ANOVA. The incidence of adhesion, loading method, adhesion type and additional instruments methods, were described by the number of cases and percentage, and chi-square test was used for comparison between groups.

There were 45 cases (45 eyes), 29 cases (29 eyes), 28 cases (28 eyes), and 87 cases (87 eyes) implanted with Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV, respectively. There was no statistically significant difference in age (F=1.536, P>0.05) and gender (χ²=5.327, P>0.05) between the groups. The incidence of adhesion during IOL implantation in the Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV groups was 15.6%, 3.4%, 14.3%, and 34.5%, respectively. The differences between the groups were statistically significant (χ²=15.658, P<0.05). The incidence of adhesion in the A1UV group was higher than that of other groups, and the differences were statistically significant (χ²=5.267, 10.698, 4.149; P<0.05). The rates of additional instrument assistance during the four IOL surgeries were 2.2%, 0, 7.1%, and 24.1%, respectively, with a statistically significant difference (χ²=19.723, P<0.05). The A1UV group had the highest rate of requiring additional equipment assistance, which was higher than other groups, and the difference between them was statistically significant (χ²=10.257, 8.547, 5.231; P<0.05). The conventional loading method, composite electrolyte loading method, viscoelastic agent loading method, double loop interval loading method, pre loading method, composite electrolyte+ viscoelastic agent loading method, and composite electrolyte+ viscoelastic agent+ double loop interval loading method groups of 250 cases (250 eyes) of A1UV IOL were included with 20 cases (20 eyes), 17 cases (17 eyes), 30 cases (30 eyes), 56 cases (50 eyes), 61 cases (61 eyes), 15 cases (15 eyes), and 51 cases (51 eyes), respectively. There was no statistically significant difference between the groups in the average age (F=0.267, P>0.05) and gender (χ²=4.229, P>0.05) between them. The different loading method groups had additional instrument assistance rates of 55.0%, 5.9%, 10.0%, 8.9%, 31.1%, 40.0%, and 31.4%, respectively with a statistically significant (χ²=28.780, P<0.05). There was a statistical significance in comparing the types of adhesive adhesion between different loading methods (χ²=31.490, P<0.05). Different loading methods had statistically significant differences in the comparison of single loop adhesive optical department, double loop adhesive optical department, double loop embracing and non adhesive (χ²=10.976, 12.928, 10.793, 10.400; P<0.05).

Among Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV IOLs, the rate of adhesion phenomenon between the haptic and optical part of A1UV is the highest. Among the conventional, composite electrolyte, viscoelastic agent, double loop interval, pre loading method, composite electrolyte+ viscoelastic agent, and composite electrolyte+ viscoelastic agent+ double loop interval loading method, compound electrolyte eye rinse solution is the most effective for installation, and the rate of adhesion phenomenon is lowest.