Addon Sulcus Lenses - Review Of 10 Years’ Clinical Experience

To evaluate safety and efficacy of IOLS`s placed in the sulcus as a secondary refractive procedure (“AddOn IOL`s”) 

Single ophthalmology clinic. 

We performed a retrospective chart analysis of all AddOn IOL`s implanted between 2015 and 2025 at our clinic and identified 311 eyes of 236 subjects which had been treated with secondary sulcus IOLS`s. After chart review and analysis, we were able to include 238 eyes of 188 subjects in this retrospective chart review. 

Main outcome parameters for efficacy were UCVA, BCVA and manifest refraction after AddOn surgery. The safety profile of this type of lens was evaluated by tabulating all intra and postoperative complications after surgery. 

The indication for AddOn implantation was missed refractive target in 85%, secondary presbyopia treatment in 14% and mixed indications in 1% of cases. 

There was overall a statistically significant improvement in UCVA of about 2 lines after surgery (p<0.01), with no change in BCVA (p=0.94). Mean UCVA was 0.05 ± 0.03 logMAR.  Mean BCVA was -0.01 ± 0.03 logMAR (20/20+2). After secondary toric IOL implantation, residual refractive astigmatism was significantly reduced (1.88 ± 0.96 to 0.38 ± 0.28 D). There was no appreciable change in the spherical equivalent refraction among these toric cases. 78% had residual refractive astigmatism ≤0.50D. 

We identified zero case of endopthalmitis and two cases of TASS. We identified 4 cases of IOP > 45mmHg just after surgery. No eye lost more than 2 lines of BCVA. In total, 8 eyes had their AddOn IOL`s explanted. 

After more than 10 years of clinical experience using secondary sulcus IOL`s (AddOn IOL) we observed high efficacy and safety in this study cohort. AddOn IOL`s represent an effective strategy to treat missed refractive target, but also offering the option of secondary presbyopia correction.