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CV Albanis, AP Kaplan, JT Ernest, KM Goins; Surgical Outcomes of Complicated Phacoemulsification Requiring Intraocular Lens Implantation in the Sulcus . Invest. Ophthalmol. Vis. Sci. 2002;43(13):367.
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Purpose: During phacoemulsification, certain circumstances require intraocular lens (IOL) placement in the ciliary sulcus. This study evaluates the visual outcomes and complications of phacoemulsification involving IOL implantation in the sulcus. Methods: We retrospectively reviewed 42 patients undergoing phacoemulsification with IOL implantation in the sulcus, between January 1995 and March 2001. Visual acuity outcomes, intraocular pressure (IOP), and intra/post-operative complications were recorded and analyzed. Results: Of the patients studied, 62% (26/42) were hypertensive, 24% (10/42) were diabetic, and 26% (11/42) had pre-existing glaucoma. The mean preoperative best corrected visual acuity (BCVA) was 20/202 (range 20/20 to light perception). At 1-4 months post-operatively, the mean BCVA was 20/45 (range 20/20 to 20/400), with 81% (34/42) having a BCVA of 20/40 or better. The average pre-operative IOP was 16 mmHg (range 9-22), and was equal to the average post-operative IOP of 16 mmHg (range 8-22). Intraoperative complications, necessitating sulcus placement, were noted in 86% (36/42) of patients, including posterior capsular tear in 74% (31/42), and vitreous loss in 33% (14/42). Intraocular lenses used included: Alcon acrylic MA60BM (81%), Alcon PMMA MC20CM (7%), Allergan silicone SI30NB (2%), Allergan PMMA PS60AMB (2%), and Mentor Memory (2%). Post-operative complications occurred in 19% (8/42) of the patients, including iritis in 2 patients, corneal edema in 2 patients, IOL displacement with iris pigment dispersion in 1 patient, and CME in 1 patient. Conclusion: While phacoemulsification remains a highly successful operative procedure with excellent visual outcomes, preexisting pathology and certain intra-operative complications necessitate IOL placement in the ciliary sulcus. Previous studies suggest that IOL placement in the sulcus leads to elevated post-operative IOP secondary to iris pigmentary dispersion, an increased risk of iritis, and an increased risk of IOL dislocation. Our results indicate no difference in post-operative IOP, a 5% incidence of iritis, and a 2% incidence of IOL displacement and iris pigment dispersion.
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