Sulcus placement of single-piece acrylic intraocular lenses.

Single-piece acrylic (SPA) intraocular lenses (IOLs) have proven to be excellent posterior chamber IOLs (PC IOLs) for placement in the lens capsular bag. However, surgical complications such as posterior capsule tear or rupture may preclude placement of an IOL in the capsular bag. When capsular bag fixation is not possible, placement of a SPA IOL in the ciliary sulcus is problematic. This raises the larger issue of which IOLs are appropriate for ciliary sulcus fixation. Several case reports describe complications of SPA IOLs that have been placed in the ciliary sulcus; the complications include iris chafing with pigment dispersion, the uveitis–glaucoma–hyphema (UGH) syndrome, and recurrent vitreous hemorrhage. The issue of SPA IOLs placed in the sulcus was raised during the Spotlight on Cataract Complications Symposium at the 2008 American Academy of Ophthalmology annual meeting. In an audience survey, more than 40% of the respondents said a SPA IOL could be placed in the sulcus if capsule support was adequate. These findings prompted members of the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Clinical Committee to compile their patients who had complications related to SPA IOL implantation in the ciliary sulcus. The results were incorporated into an extensive report about the complications of sulcus placement of SPA IOLs that appears in this issue (pages 1445–1458). The 6 members of the Cataract Clinical Committee contributed 30 patients to the report. In 29 patients, a single-piece AcrySof IOL (Alcon, Inc.) had been placed in the ciliary sulcus; approximately two-thirds of the cases showed signs of posterior capsule rupture at the time of the surgery. The most common complication noted was pigment dispersion with associated IOL transillumination defects. In addition, elevated intraocular pressure (IOP) and symptoms caused by the IOL edge, secondary to decentration of the IOL, were noted in many patients. Other findings such as intraocular hemorrhage and cystoid macular edema were seen much less frequently. Surgical intervention was necessary in 28 of the 30 eyes, with IOL repositioning or amputation of the offending haptic performed in 2 eyes. An IOL