BLOG: One-piece acrylic IOL in the sulcus: Just don’t do it
Infrequently, cataract surgeons may face a scenario in which the posterior capsule is compromised at the time of planned IOL implantation. This unplanned scenario requires thoughtful consideration of IOL choice and positioning.
Although a one-piece acrylic IOL may have been the preferred option, this is not a suitable choice when implantation will no longer be in the capsular bag but rather in the ciliary sulcus. Surprisingly, despite long-standing evidence pointing to the risks of one-piece acrylic IOL implantation in the ciliary sulcus, this does still occur. In fact, I personally manage the sequelae of these cases at least one to two times annually.
One-piece acrylic IOLs are not suitable for implantation in the ciliary sulcus because their relatively thick and bulky haptics may rub against the posterior iris pigment epithelium and lead to iris chafing and the liberation of pigment particles into the anterior chamber (Figure). Anterior chamber pigment particles tend to settle at the trabecular meshwork and lead to increased aqueous outflow resistance, increased IOP, and risk for glaucomatous optic neuropathy and associated irreversible vision loss.
Suitable options for IOL implantation under the circumstances of a compromised posterior capsule and intended implantation in the ciliary sulcus include three-piece acrylic IOLs (with thinner haptics composed of PMMA or polyvinylidene fluoride), three-piece silicone IOLs or one-piece PMMA lenses. Surgeons should become familiar with these IOL options in case of unplanned intraoperative events and the need to change course from the original plan.
- Reference:
- Chang DF, et al. J Cataract Refract Surg. 2009;doi:10.1016/j.jcrs.2009.04.027.
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