Complications of sulcus placement of single-piece acrylic intraocular lenses: recommendations for backup IOL implantation following posterior capsule rupture.
OBJECTIVE
To describe complications arising from sulcus placement of single-piece acrylic (SPA) intraocular lenses (IOLs), evaluate IOL options for eyes that lack adequate capsule support, and examine the appropriateness of various IOL designs for sulcus placement.


METHODS
University and private anterior segment surgery practices.


METHODS
Patients referred for complications of SPA IOLs in the ciliary sulcus from 2006 and 2008 were identified. Demographic information, examination findings, and complications of the initial surgery were recorded. Details of surgical interventions and the most recent corrected distance visual acuity (CDVA) were noted. A thorough review of the literature was undertaken to analyze options for IOL placement.


RESULTS
Complications of sulcus SPA IOLs included pigment dispersion, iris transillumination defects, dysphotopsia, elevated intraocular pressure, intraocular hemorrhage, and cystoid macular edema. Two patients in the series of 30 patients experienced 1 complication; 8 experienced 2 complications; 13 experienced 3 complications; 4 experienced 4 complications; and 2 experienced 5 complications. Twenty-eight eyes (93%) required surgical intervention; IOL exchange was performed in 25 (83%). Postoperatively, the mean CDVA improved, with most eyes attaining 20/20.


CONCLUSIONS
Intraocular lenses designed solely for the capsular bag should not be placed in the ciliary sulcus. Backup IOLs in appropriate powers, sizes, and designs should be available for every cataract procedure. The development, investigation, and supply of IOLs specifically designed for placement in eyes that lack adequate capsule support represent clinically important endeavors for ophthalmology and the ophthalmic industry.
Chang
David F
DF
Altos Eye Physicians, Los Altos, California 94024, USA. dceye@earthlink.net
Masket
Samuel
S
Miller
Kevin M
KM
Braga-Mele
Rosa
R
Little
Brian C
BC
Mamalis
Nick
N
Oetting
Thomas A
TA
Packer
Mark
M
D000180:Acrylic Resins; D000368:Aged; D000369:Aged, 80 and over; D002924:Ciliary Body / Q000601:surgery*; D017889:Exfoliation Syndrome / Q000209:etiology*; D005260:Female; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000473:pathology / Q000601:surgery; D019654:Lens Implantation, Intraocular / Q000009:adverse effects* / Q000379:methods; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D013536:Suture Techniques
D000180:Acrylic Resins