Refractive Outcomes Of A Supplementary Sulcus-Fixated Intraocular Lens For Residual Refractive Error After Cataract Surgery In Eyes With Prior Laser Vision Correction

Achieving accurate refractive outcomes after cataract surgery in eyes with prior laser vision correction (LVC) remains challenging due to altered corneal parameters and limitations in intraocular lens (IOL) power calculation. Residual refractive error may compromise visual outcomes and patient satisfaction. Supplementary sulcus-fixated intraocular lenses provide a reversible option for correcting postoperative refractive surprises. This study aimed to evaluate the refractive outcomes and safety of supplementary sulcus-fixated IOL implantation for the management of residual refractive error after cataract surgery in eyes with previous LVC.

Retrospective case series conducted at a tertiary referral center for cataract and refractive surgery in Barcelona, Spain.

Seven eyes with prior laser vision correction underwent implantation of a supplementary sulcus-fixated intraocular lens (Rayner Sulcoflex) to correct residual refractive error following cataract surgery. Pre- and postoperative data included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (spherical equivalent [SE] and cylinder), and endothelial cell density (ECD) when available. Refractive predictability was assessed as the proportion of eyes within ±0.50 D and ±1.00 D of the intended refractive target. Safety outcomes included changes in CDVA and ECD.

Mean SE improved from −2.16 D preoperatively to −0.48 D postoperatively. Refractive accuracy was high, with 86% (6/7) of eyes within ±0.50 D and 100% (7/7) within ±1.00 D of target. Mean UDVA improved from 0.48 to 0.76, while CDVA remained stable (0.90 vs 0.91), with no loss of lines. Mean follow-up was 10 months (range 2–24). In eyes with ECD data (n=3), mean ECD changed from 2479 to 2204 cells/mm².

Sulcus implantation of the Rayner Sulcoflex supplementary IOL appears to be a safe and effective option for correcting residual refractive error after cataract surgery in eyes with prior laser vision correction. The technique demonstrated good refractive predictability and improvement in uncorrected visual acuity without loss of corrected vision. No intraoperative or postoperative complications were observed, and endothelial cell counts remained stable in eyes with available measurements. Sulcoflex implantation represents a valuable strategy for managing postoperative refractive surprises in this challenging patient population.