ABSTRACT
Purpose: To study the use of sulcus placement of a 3?piece intraocular lens (IOL) with optic capture in patients with exfoliation with zonular weakness. Methods: Data on all exfoliation patients who had direct or indirect evidence of zonular weakness and had a 3?piece IOL implanted in the sulcus with optic capture over a 5?year period between January 2017 and January 2022 were included in this retrospective case series. Results: The study comprised of 35 eyes of 35 patients. The mean age at surgery of the 20 male and 13 female patients was 75.21 years ± 5.74 (standard deviation (SD)). The mean pupillary diameter was 5.77 ± 2.23 mm (range: 10 to 3 mm). A capsular tension ring (CTR) was used in 17 cases and iris hooks as a pupil?expanding device were used in 15 cases. No patients had an increase in inflammation after surgery and there were no late subluxation or dislocation of “in the bag” posterior chamber IOL or major complications. There was a significant improvement in visual acuity. Conclusion: The sulcus placement of 3?piece IOL with optic capture is the ideal technique in patients with clinical or intraoperative evidence of mild to moderate zonular weakness. It may also be more appropriate in relatively younger patients (in the fifties or sixties) with exfoliation with no overt zonulopathy to prevent late subluxation or dislocation of “in the bag” IOL
ABSTRACT
PURPOSE: During the cataract surgery, a need to insert IOL into the ciliary sulcus sometimes arises by many intraoperative events. In such case, a change of postoperative refractive error may result due to the change in IOL insertion site. So we evaluated the difference between preoperative expected refractive error and postoperative refractive error in IOL in-the-bag insertion group and in IOL sulcus implantation group and, compared the result in each group. METHOD: We compared the postoperative refractive states between in-the-bag and sulcus IOL implantation group by retrospective review of the 83 patients (96 eyes) who underwent cataract surgery with AcrySof(R) IOL implantation. RESULTS: The mean age of the patients was 58.6 (21~87) years and average follow-up was 9.2 (2~49) months. Seventy three eyes of in-the-bag IOL insertion (Group 1) and 23 eyes of sulcus implantation (Group 2) were studied. The preoperative expected refractive error was -0.31+/-0.43 D, and -0.14+/-0.33 D, and the postoperative manifest refractive error was -0.40+/-0.58 D, and -1.09+/-0.56 D in Group 1 and Group 2, respectively. The difference between this preoperative and postoperative refractory error was not significant in group 1 (p=0.091), but significant myopic shift by -0.95+/-0.46 D was found in Group 2 (p=0.000). There was no difference in postoperative best corrected visual acuity (p=0.106) and incidence of complications between the two groups. CONCLUSION: In case suboptimal posterior capsular or zonular support was noted during cataract surgery, implantation of IOL in the sulcus may be a safe and effective substitution of in-the-bag implantation of IOL. In this case, we should adjust the power of implanting AcrySof(R) IOL to cover the myopic shift of about 1 diopter.