Unique Applications Of Secondary Supplementary Sulcus Intraocular Lenses - Expanding The Surgical Toolbox

Secondary sulcus supplementary intraocular lenses (IOLs) are well established for correction of residual refractive error following cataract surgery. However, their role extends beyond refractive enhancement. This study explores the strategic use of sulcus supplementary IOLs as part of deliberate refractive planning in complex cataract surgery, including situations where primary in-the-bag solutions are limited by refractive unpredictability, IOL power range constraints, or the need for reversibility.

Single-surgeon refractive cataract practice, Sydney, Australia.

This presentation illustrates a series of cases involving implantation of secondary sulcus supplementary intraocular lenses, including 1stQ AddOn (Medicontur Ltd, Zsámbék, Hungary) and Sulcoflex (Rayner, Worthing, United Kingdom).

Applications include correction of residual refractive error, upgrading vision with multifocal or monovision enhancement, management of cases where primary IOL powers fall outside available ranges, particularly when presbyopia-correcting IOLs are desired, staged spproaches in irregular or ectatic corneas with reduced IOL calculation precision, and protective strategies for in-the-bag hydrophilic IOLs when intraocular air may be required in the anterior chamber

Supplementary sulcus implantation enabled predictable refractive refinement while preserving reversibility. Strategic sequencing allowed maintenance of intended refractive targets in cases that would otherwise require compromise, or inability to acieve the desired outcome. Visual and refractive outcomes were consistent across indications, with no significant intraoperative or postoperative complications observed.

Secondary sulcus supplementary IOLs can be used in a range of clinical situations as a strategic extension of refractive cataract surgery rather than solely an enhancement technique. When incorporated deliberately into surgical planning, they expand refractive flexibility, preserve target accuracy, and maintain reversibility in complex eyes. Clinical experience supports their role as a valuable adjunct in contemporary refractive cataract practice.