One-piece foldable acrylic IOLs implanted in the ciliary sulcus can cause complications

CHICAGO — Implanting one-piece foldable acrylic IOLs in the ciliary sulcus can cause significant complications requiring surgical intervention, a speaker said here.

"Those soft acrylic lenses are meant to be placed in the bag, not in the sulcus," Abdulla Naqi, MD, FRCSC, said at the annual meeting of the American Society of Cataract and Refractive Surgery.

Dr. Naqi and colleagues conducted a retrospective study of 15 patients implanted with IOLs in the ciliary sulcus between 1996 and 2007 who later developed complications. Symptoms consisted of decreased visual acuity, photosensitivity, discomfort and monocular diplopia. Twelve patients had developed uveitis-glaucoma-hyphema (UGH) syndrome, and three had developed IOL decentration alone.

The mean age of the patients was 66.7 years, Dr. Naqi said.

At a mean time of 20.5 months after IOL implantation, 11 of the patients underwent lens exchange, three underwent repositioning of the lens and one underwent lens explantation only.

Adjunct procedures included vitrectomy in seven patients, tube shut implantation in four patients, pupilloplasty in two patients and a nonpenetrating glaucoma procedure in one patient.

After intervention, the mean IOP dropped from 25.66 mm Hg to 14.85 mm Hg, and the mean number of glaucoma medications used was reduced from 2.76 to 0.76.

In terms of vision, the mean visual acuity increased from 20/400 to 20/60.

"There were some patients who have not improved their vision either because they started with a bad cornea that did not allow improvement of vision or they developed complications related to the UGH syndrome that worsened despite correction of the disease," Dr. Naqi said.