Management Of Pigment Dispersion: Explantation Of A Sulcoflex® Supplementary Intraocular Lens (Rayner, Uk) – A Case Report
Published 2026 - 44th Congress of the ESCRS
Reference: CC02.14 | Type: Case Report | DOI: 10.82333/bgxa-kv51
Authors: Dr Francisca Teixeira da Costa Maia* 1 , Dr Marta Vaz Pereira 1 , Dr Ana Margarida Sampaio 1 , Dr Ana Mendes da Silva 1 , Dr Rui Silva 1 , Dr Christophe Pinto 1 , Prof. Dr Tiago Monteiro 2
1Ophthalmology,Hospital de Braga,Braga,Portugal, 2Ophthalmology,Unidade Local de Saúde São João,Porto,Portugal;Faculdade de Medicina da Universidade do Porto,Porto,Portugal
Purpose
The Sulcoflex® (Rayner,Uk) is a supplementary intraocular lens (IOL) designed for sulcus implantation, complementing a standard monofocal in-the-bag IOL. It is primarily indicated to correct refractive surprises after cataract surgery or to address pseudophakic presbyopia. This lens can be implanted either during the initial surgery or as a secondary intervention. Compared to conventional in-the-bag IOLs, it offers the advantage of easier removal or exchange. However, long-term data on its refractive stability and safety profile remain limited. We present a case requiring bilateral explantation of a Sulcoflex lens due to secondary pigment dispersion conditioning uncontrolled intraocular pressure (IOP).
Setting
A tertiary referral hospital in Braga, Portugal
Report of case
A 40-year-old woman with a history of bilateral cataract surgery at the age of 37 (records unavailable) presented for routine ophthalmic evaluation. She had ocular hypertension under maximal topical therapy. Uncorrected distance visual acuity was 20/30 in both eyes. IOP was 18 mmHg in the right eye (RE) and 19 mmHg in the left eye (LE) by Goldmann applanation tonometry. Slit-lamp examination revealed decentered multifocal Sulcoflex IOL with pigment deposition in both eyes, together with a well-centered monofocal IOL in the capsular bag. Gonioscopy showed open angles with pigmentation. Fundus examination was unremarkable. Given the suspicion of secondary pigment dispersion, simultaneous bilateral explantation of the supplementary IOLs was indicated. After a 6-month follow-up, intraocular pressure was 22 mmHg in both eyes just on topical medication; the corneal remained clear and CDVA improved to 20/20.
Conclusion/Take home message
In the situation of a sulcus-implanted IOL for a piggyback indication, if the IOL diameter is excessively smaller than the sulcus-sulcus diameter, the decentration and continuous movement of the IOL with iris chaffing can lead to pigment dispersion and uncontrolled elevated intraocular pressure. Explantation of a decentered Sulcoflex IOL is a safe and effective approach to manage and stop the progression of secondary pigment dispersion.