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Pathological assessment of complications with asymmetric or sulcus fixation of square-edged hydrophobic acrylic intraocular lenses

Poster Details

First Author: L.Werner USA

Co Author(s):    K. Kirk   R. Jaber   S. Strenk   L. Strenk   N. Mamalis  

Abstract Details


One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation. Complications may also be observed with 3-piece lenses having a square optic edge on the anterior surface. We provide pathological evidences of complications concerning out-of-the-bag 1 and 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges.


John A. Moran Eye Center, University of Utah.


661 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs underwent anterior segment scanning of whole eyes with a high-frequency ultrasound system, or a high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathological analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses. Findings from imaging, gross, and histopathological evaluation that could be related to out-of-the-bag fixation of the lenses were tabulated and compared to control eyes.


256 eyes were implanted with hydrophobic acrylic IOLs; 18 with asymmetric or sulcus IOL fixation (six 1-piece, and twelve 3-piece IOLs) were compared to contralateral eyes with symmetric in-the-bag fixation. Pathological findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, thinning, and atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the contralateral eyes. The majority of eyes with 3-piece lenses showed signs of complicated surgery.


We provide pathological correlation of complications clinically reported in the peer-reviewed literature in relation to sulcus fixation of 1-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidences of complicated surgery; therefore all pathological findings in those cases may not be strictly attributed to the out-of-the-bag IOL fixation. FINANCIAL DISCLOSURE?: No

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