Recommendations for sulcus-implanted IOL power adjustment

Investigators reviewed the charts of 679 cataract surgery patients to identify the ideal power correction for sulcus IOL implantation. They found that the IOL power should be adjusted according to the axial length and predicted IOL power.

We should be aware of this study’s recommendations for IOL power reduction in case we are ever unfortunate enough to not be able to optic-capture a sulcus lens.

The authors performed a literature search for subjects who underwent phacoemulsification and IOL implantation with local anesthesia. All patients had their IOL power reduced by 0.5 or 1.0 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).

Posterior capsule tears requiring ciliary sulcus IOL implantation occurred in 36 eyes. Eyes with a 1.0 D power reduction had significantly less unexpected error than those with a 0.5 D power reduction (SE, 0.49 vs. 1.01 D). After stratifying eyes by axial length, there was a higher unexpected refractive error in short eyes (axial length less than 22 mm). Likewise, eyes with a predicted IOL power of greater than 25 D had a greater postoperative refractive error.

Based on these results, the authors recommend the following: Patients with a predicted IOL power of less than 18 D should have power reduced by 0.5 D; those with a planned IOL power of 18 to 25 D should have it reduced by at least 1 D; and for lenses greater than 25 D, power should be reduced by 1.5 to 2 D.