Improved Refractive Outcome for Ciliary Sulcus-Implanted Intraocular Lenses

Abstract

To investigate the ideal correction of intraocular lens (IOL) power for sulcus implantation. Retrospective, comparative case series. The records of 679 patients undergoing cataract surgery from June 2007 to June 2008 were reviewed. Eyes in this series underwent phacoemulsification and IOL implantation with local anesthesia. Patients in our study population had their IOL power reduced by 0.5 or 1 diopter (D) from that calculated by the SRK-T formula for in-the-bag implantation. The IOL implanted was the foldable 3-piece acrylic Acrysof MA60AC (Alcon Laboratories Inc., Fort Worth, TX). In each case, the difference between actual spherical equivalent (SE) refraction and that predicted by biometry using the SRK-T formula was calculated. Posterior capsule tears requiring implantation of IOL in the ciliary sulcus occurred in 36 eyes. When comparing eyes in which the power was reduced by 0.5 D with those in which the reduction was 1.0 D, those with a power reduction of 1.0 D had significantly less unexpected error (0.49 vs. 1.01 D SE). After stratifying eyes by axial length (AL), we found higher unexpected refractive error in short eyes (<22 mm AL). Likewise, eyes with a predicted IOL power >25 D had a greater postoperative refractive error. This is the first comparative clinical review examining adjustment of power of the sulcus-implanted IOL. We found that the IOL power should be adjusted according to the measured AL and predicted IOL power. For patients with a predicted IOL power from 18 to 25 D, power should be reduced by at least 1 D; for lenses >25 D, power should be reduced by 1.5 to 2 D.