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Challenging cases may necessitate placement of IOL in ciliary sulcus

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For routine cataract cases, we like to insert our new IOL into the same place as the original human crystalline lens — into the capsular bag. In most eyes, the capsular bag provides a secure positioning of the IOL with good long-term stability. But in some cases with a compromise of the posterior capsule or weakness of the zonules, placement of an IOL in the ciliary sulcus is preferred.

The ciliary sulcus, as the name implies, is a small space between the posterior surface of the iris base and the anterior surface of the ciliary body. The diameter of the sulcus depends on the eye, but it is typically about 12 mm wide. The sulcus can effectively fixate an appropriately designed IOL with good long-term stability and safety. The most common conditions in which a sulcus IOL is preferred include rupture of the posterior capsule, zonular laxity and piggyback placement.

Uday Devgan

Click here to read the full publication exclusive, Back to Basics, by Uday Devgan, MD.