3-Piece Intraocular Lens In The Sulcus With Optic Capture: Is It Better To Adjust The Lens Power Or Not?

Implanting an intraocular lens (IOL) in the sulcus is associated with anterior effective lens position (ELP) leading to a myopic refractive shift and intraoperative adjustment of the IOL power is recommended for higher accuracy. However, when optic capture is achieved, the optic of the IOL is positioned behind the anterior capsule (similarly to in-the-bag configuration), and only the haptics are in the sulcus. We evaluated whether adjusting the IOL power improves accuracy of refractive outcomes compared to using the original power calculation in the biometry.

A single-centre retrospective cohort study was conducted across Moorfields Eye Hospital NHS Foundation Trust sites.

Consecutive eyes undergoing complicated cataract surgery and optic capture with Alcon MA60AC IOLs were included in the study. The eyes were stratified according to whether intraoperative IOL power adjustment was performed. The conversion rule was as follows: 0.5 D was subtracted when IOL power was within 10-17 D, 1.0 D with IOL power within 17.5-28 D, and 1.5 D with IOL power over 28.5 D. We calculated mean prediction error (PE), mean absolute prediction error (APE), median absolute error (MedAE), and proportions within ±0.25 D, ±0.50 D, and ±1.00 D of target. Multivariable mixed-effects models adjusted for axial length, corneal astigmatism, IOL formula, surgeon grade, and site.

A total of 99 eyes with successful optic capture were included in the analysis (55 non-adjusted and 44 adjusted). The adjusted eyes demonstrated a lower mean PE (-0.02±0.76 vs −0.41±0.69 D; p=0.012), lower mean APE (0.52±0.55 vs 0.67±0.43 D; p=0.026), and lower MedAE (0.34 vs 0.65 D; p=0.026). A higher proportion of eyes achieved a refractive outcome of ±0.50 D of the target (66.7% vs 37.0%; p=0.007). The postoperative spherical equivalent was less myopic and closer to plano in the adjusted eyes (-0.24±0.78 vs -0.54±0.68 D; p=0.008). Multivariable analysis revealed that IOL power adjustment was independently associated with a 0.30 D reduction in MAE (b = -0.30; p=0.024) and a +0.53 D shift in mean error (p=0.006).

In complicated cataract surgery cases with IOL in the sulcus with optic capture, IOL power adjustment is associated with more precise refractive outcomes, closer to emmetropia. In eyes without IOL power adjustment, the approximately 0.5 D refractive myopic shift observed, suggests that optic capture alone, may not fully compensate for the changes in the effective lens position. Ongoing expansion of the cohort will further refine these estimates.