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Single-piece acrylic IOLs do not belong in the sulcus
In the U.S. market, the most popular IOLs are single-piece acrylic monofocal lenses. These types of IOLs are available from multiple manufacturers including Abbott Medical Optics (Tecnis one-piece), Alcon (AcrySof one-piece) and Bausch & Lomb (Akreos). They all share some common characteristics: single-piece design for simplicity and durability, acrylic material (hydrophobic for the Tecnis and the AcrySof; hydrophilic for the Akreos), a square edge to help prevent posterior capsule opacification. In addition, they are all meant to be placed in the capsular bag.
 A single-piece acrylic IOL in the ciliary sulcus is causing iris chafing, chronic inflammation and pigment loss, as seen in retroillumination. |
When placed in the ciliary sulcus, the single-piece acrylic IOLs can cause issues. Because of their bulky square-edged haptics, these IOLs can rub the posterior surface of the iris and cause pigment dispersion, iris atrophy and chronic inflammation. In addition, the size of the single-piece acrylic IOLs makes them too short for secure sulcus placement and centration in the visual axis.
Three-piece IOLs, with their thin and long haptics, are a better match for sulcus placement. Even better is placing the haptics of the three-piece IOLs in the sulcus while capturing the optic behind the capsulorrhexis. This secures the lens into position and helps to ensure its centration and long-term stability. The next time there is an issue with in-the-bag placement, remember that single-piece acrylic IOLs are not suitable for ciliary sulcus placement.