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Pathologic comparison of asymmetric or sulcus fixation of three-piece intraocular lenses with square versus round anterior optic edges

Poster Details

First Author: L.Werner USA

Co Author(s):    A. Ollerton   S. Strenk   L. Strenk   N. Mamalis     

Abstract Details


Previous studies have described complications with 3-piece intraocular lenses (IOLs) having a square optic edge on the anterior surface, when implanted in the sulcus. The aim of this study was to evaluate pathological findings with 3-piece sulcus fixated IOLs in pseudophakic cadaver eyes, comparing IOLs with square and round anterior optic edges.


John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.


Out of 661 pseudophakic cadaver eyes obtained from eye banks within the United States, 12 had 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges, and 14 had 3-piece lenses with anterior round edges (13 silicone lenses, and 1 hydrophobic acrylic lens) without symmetric in-the-bag fixation. We employed anterior segment scanning of whole eyes with a high-frequency ultrasound system, or with a high-resolution magnetic resonance imaging, followed by gross examination. These 26 selected eyes were then processed for complete histopathologic analysis.


Gross findings in both groups were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, and iris transillumination defects. Histopathology of the 14 eyes with 3-piece IOLs with round anterior optic edges showed mild focal disruption of the iris pigmented layer, and loop protrusion/erosion in the ciliary sulcus. Additional changes observed in the 12 eyes with square anterior optic edge IOLs included iris changes such as vacuolization, disruption and loss of the pigmented epithelial layers, iris thinning and atrophy, synechiae, and pigmentary dispersion within the trabecular meshwork. One eye also exhibited initial signs of optic nerve disc cupping.


In this series, pathologic findings were more severe in eyes implanted with 3-piece IOLs with square anterior optic edges, suggesting that IOLs with round anterior edges are more suitable for sulcus fixation.

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