title: Complications of sulcus placement of single-piece acrylic intraocular lenses: recommendations for backup IOL implantation following posterior capsule rupture.
abstract: 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.
authors.affiliation: Altos Eye Physicians, Los Altos, California 94024, USA. dceye@earthlink.net
authors.forename: David F
authors.initials: DF
authors.lastname: Chang
authors.forename: Samuel
authors.initials: S
authors.lastname: Masket
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Miller
authors.forename: Rosa
authors.initials: R
authors.lastname: Braga-Mele
authors.forename: Brian C
authors.initials: BC
authors.lastname: Little
authors.forename: Nick
authors.initials: N
authors.lastname: Mamalis
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Oetting
authors.forename: Mark
authors.initials: M
authors.lastname: Packer
mesh_terms: 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
chemical_list: D000180:Acrylic Resins