Intermediate Term Follow-Up after a Single-Piece-Acrylic Intraocular Lens Implantation in the Ciliary Sulcus- A Cross-sectional Study

Abstract

 

Purpose

 

To report the efficacy and safety of sulcus implantation of a single-piece-acrylic intraocular lens (SPA-IOL), designed for both in-the-bag and sulcus positioning.

 

Methods

 

A prospective cross-sectional study including 12 patients, who underwent phacoemulsification with posterior capsule tear (PCT) and sulcus implantation of SPA-IOL designed for both in-the-bag and sulcus positioning (Seelens AF, Hanita, Israel; figures 1&2) between January 2009 and March 2012 (follow-up 12-37 months). Preoperatively corrected distance visual acuity (CDVA), subjective refraction and intraocular pressure (IOP) were recorded. Postoperative evaluation included anamnesis for IOL edge symptoms and transient visual obscurations (TVO) along with CDVA, subjective refraction IOP, anterior segment biomicroscopy, gonioscopy, assessment of IOL centration, fundus biomicroscopy and spectral-domain optical coherence tomography of the macula.

 

Results

 

Preoperatively, mean CDVA was 0.84±0.60 LogMAR (Counting Finger-20/33) improving to 0.18±0.13 LogMAR (20/40-20/20) at last examination (p=0.004), as all the patients gained better CDVA. Mean preoperative spherical equivalent was -0.2±2.5 Diopter (D) (-4.0D to +5.4D) reaching -1.9±0.9 (-4.0D to -0.6D) at last examination (p=0.12). Mean preoperative refractive astigmatism magnitude was 1.0±0.6D (0.3D to 2.3D) changing to 1.1±1.0D (0.0D to 3.0D) at last examination (p=0.88). Mean preoperative IOP was 14.7±3.2 mmHg (11-23 mmHg) without medications reaching 15.9±3.3 mmHg (10-21 mmHg) at last follow up (p=0.21). Postoperatively one patient required two medications for IOP control in his study and contralateral eyes. None of the patients had symptoms of IOL edge or TVO. There were no intraocular hemorrhages, inflammatory reactions, or pigment dispersion and the IOLs were well centered in all cases. Central macular thickness was 280±33 μm (193-310 μm).

 

Conclusions

 

Appropriately designed SPA-IOL may be implanted in the ciliary sulcus during phacoemulsification with PCT rather than switching to another backup IOL demanding wound enlargement.

 

 

A diagram of the single-piece-acrylic intraocular lens used in this study.

 

 

A slit lamp photograph of our SPA-IOL, which was implanted during phacoemulsification complicated with large posterior capsule tear and vitreous loss.

 

Keywords: 445 cataract • 567 intraocular lens