Retrospective Study
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World J Ophthalmol. Aug 12, 2014; 4(3): 87-91
Published online Aug 12, 2014. doi: 10.5318/wjo.v4.i3.87
Considerations in the management of single-piece intraocular lenses outside the capsular bag
Anna K Junk
Anna K Junk, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Anna K Junk, Miami Veterans Affairs Medical Center, Miami, FL 33125, United States
Author contributions: Junk AK solely contributed to this paper.
Supported by NIH Center Core, No. P30EY014801; Research to Prevent Blindness Unrestricted Grant, Department of Defense, No. DOD- Grant #W81XWH-09-1-0675
Correspondence to: Anna K Junk, MD, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136, United States. ajunk@med.miami.edu
Telephone: +1-305-3266000 Fax: +1-305-4824568
Received: February 9, 2014
Revised: May 23, 2014
Accepted: June 10, 2014
Published online: August 12, 2014
Processing time: 253 Days and 3.3 Hours
Abstract

AIM: To investigate the outcomes of off label single-piece acrylic intraocular lenses (SPA-IOL) ciliary sulcus placement compared to three-piece IOL (3P-IOL).

METHODS: The charts of eight consecutive eyes of patients who received sulcus-placed SPA-IOLs between 2006 and 2009 were reviewed. None of the patients underwent IOL exchange. Charts of six age-matched patients who received sulcus placed 3P-IOLs were reviewed as a control group.

RESULTS: Mean follow up was 16 mo for SPA-IOL and 23 mo for 3P-IOL. Five of 8 patients in the SPA-IOL group required chronic use of IOP lowering medications at final follow up. Of these, one patient needed glaucoma implant surgery for uncontrolled IOP. One patient in the 3P-IOL group used chronic aqueous suppression pre- and postoperatively. Four of eight eyes with SPA-IOL were treated with chronic topical steroids and or non-steroidal anti-inflammatory drugs for cystoid macula edema, chronic uveitis, pigment dispersion syndrome or a combination of the above, compared to none in the control group. Mean best-corrected visual acuity was 20/35 in the SPA-IOL group and 20/47 in the 3P-IOL group.

CONCLUSION: Sulcus placed SPA-IOLs are associated with increased ocular morbidity. In select cases good visual acuity may be achieved. Due to postoperative rotation of sulcus placed toric SPA-IOLs stable astigmatism correction cannot be achieved. Alternative intraocular lenses should be considered when in-the-bag placement of SPA-IOL is not possible.

Keywords: Cataract surgery; Sulcus intraocular lens implant; Single piece intraocular lenses; Three piece intraocular lenses; Posterior capsule tear; Cataract surgery complication; Pigment dispersion; Cystoid macula edema; Posterior capsule tear; Anterior vitrectomy

Core tip: Single-piece acrylic intraocular lenses implants are FDA approved for placement into the capsular bag. Their off label placement into the ciliary sulcus is not recommended by the manufacturer and has been the subject of controversy in ophthalmology. This retrospective case series is unique in that patients were followed for 16 mo (range 1.2-37 mo) without intervention and visual outcomes and comorbidities were evaluated and compared with eyes receiving standard of care sulcus placed three-piece intraocular lenses implants.