Multifocal Single-Piece Intraocular Lens In A Patient With Posterior Capsular Rupture

To present a case of a single piece multifocal intraocular lens (IOL) implanted in the ciliary sulcus following posterior capsule rupture during cataract surgery with good visual outcome.

A fit 79 year old woman presented with cataracts requesting multifocal lens implantation. She had no relevant past medical or ophthalmic history and was assessed to have good visual potential from surgery.

The patient has had bilateral sequential cataract surgery complicated by posterior capsule rupture in the left eye with an anterior vitrectomy. The eye was left aphakic and a secondary sulcus Liberty 677 PMY IOL (Medicontur, Zsámbék - Hungary) multifocal lens was implanted the next week. This is a multifocal hydrophilic IOL with a +3.50 D (near); +1.75 D (intermediate) addition, an overall length 13.0 mm and 0° haptic angulation, making it a suitable haptic design for sulcus implantation in our case. At 2 days postoperatively, the left uncorrected visual acuity (UCVA) was recorded as 6/5 distance, and N5 near (refraction -0.25 sph / -0.50 cyl x 149°) with a well-centred IOL. At 2 years, the lens was stable with UCVA 6/5 distance and N4.5 near (refraction -0.50 sph / -0.50 cyl x 35°), representing a good visual outcome.

Cataract surgery is a generally safe and successful procedure, but capsule rupture occurs in around 0.87% of cases, often requiring a secondary sulcus fixated IOL either as a primary or secondary procedure. This is usually a 3-piece monofocal IOL for reasons of lens size and stability in the ciliary sulcus. In cases where the surgical plan was for a multifocal IOL implant, a monofocal lens can cause patient dissatisfaction, but there are no readily available 3-piece multifocal IOLs. This case shows an example of a good visual outcome using a suitably sized multifocal single piece IOL for secondary sulcus fixation in a patient with posterior capsular rupture.