The Difference in Post-operative Refractive Error between In-the-bag and Sulcus Intraocular Lens Implantation

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.