LONG-TERM RESULTS OF SULCUS IMPLANTATION OF A SINGLE-PIECE ACRYLIC INTRAOCULAR LENS FOLLOWING POSTERIOR CAPSULE RUPTURE DURING PHACOEMULSIFICATION

Implantation of a single-piece-acrylic intraocular lens (SPA-IOL) in the ciliary sulcus during phacoemulsification (PE) surgery complicated with posterior capsule rupture (PCR) is controversial as it can be related to several complications. This study aims to report the long-term results of sulcus implantation of a SPA-IOL.

The present study evaluates the postoperative outcomes and complications of sulcus implantation of a SPA-IOL at the Ophthalmology Department of Hospital Pedro Hispano, Portugal.

Retrospective study of 54 eyes of 54 patients who underwent PE with PCR and sulcus implantation of a SPA-IOL (Akreos Adapt Advanced Optics®, Bausch&Lomb), that were followed for at least 12 months. Recorded data included demographics, IOL centration and postoperative complications. Best corrected visual acuity (BCVA) in logMAR, subjective refraction and intraocular pressure (IOP) were recorded preoperatively, 1-month postoperatively and at last observation.

The mean age was 71.94 ± 10.31 years and the mean postoperative follow-up period was 35.35 ± 21.41 months. Mean preoperative BCVA was 0.78 ± 0.10 logMAR and it significantly improved to 0.22 ± 0.06 logMAR 1-month postoperatively (p<0.001) and 0.30 ± 0.07 logMAR at last observation (p<0.001), without significant differences between 1-month postoperative and final BCVA (p=0.170). Mean preoperative manifest spherical equivalent was -1.12 ± 0.60 Diopter (D), reaching -0.82 ± 0.15 D 1-month postoperatively and -0.77 ± 0.16 D at last examination, without significant differences (p=0.861). Mean IOP was 16.04 ± 0.55 mmHg preoperatively, 15.63 ± 0.73 mmHg 1-month postoperatively and 15.61 ± 0.50 mmHg at last observation (p=0.831). One patient with history of pseudoexfoliative glaucoma required nonpenetrating deep sclerectomy to control postoperative high IOP, precipitated by retained intracapsular cortical fragments and topical corticosteroids. One patient developed secondary glaucoma due to the inflammation from retained intravitreal lens fragments. Two patients (3.7%) started chronic IOP-lowering medications during long-term follow-up time. Postoperatively, 7 eyes (13.0%) showed IOL decentration or subluxation, but only 3 (5.5%) required IOL repositioning. None of the patients developed IOL-associated iris transillumination defects during the follow-up period. Other postoperative complications included posterior capsule opacification in 3 eyes (5.5%), macular edema in 5 eyes (9.3%) and retinal detachment in 4 eyes (7.4%).

Most postoperative complications were expected for a PE surgery complicated with PCR. Postoperative visual results were good and IOL-related complications were few and manageable. Thus, it can be a reasonable option when there are no available backup IOL designed for sulcus placement.