Study shows why sulcus implantation of a 1-piece AcrySof IOL is not recommended

Researchers used ultrasound biomicroscopy to examine 10 consecutive patients who underwent primary sulcus implantation of a one-piece acrylic IOL after posterior capsule rupture during phacoemulsification. Both haptics were in the sulcus in seven of the 10 eyes. The optic edge was close to the posterior iris surface in all eyes. Two eyes had one haptic abutting the iris and the other in the sulcus, and one eye had both haptics embedded in the ciliary body. No eye had optic tilt or ciliary body edema. Glaucoma occurred in one eye at seven years postop.

The authors concluded that fastidious surgery plus sulcus implantation of the one-piece acrylic IOL over broad circumferential anterior capsule support to the haptic, optic-haptic junction, and optic edge were crucial in reducing trauma to anterior segment tissue in these cases. The study confirms the clinical notion that when a one-piece acrylic IOL is implanted in the sulcus, its edge and haptics come in close proximity to the posterior iris surface, opening the potential for mechanical rubbing of the iris against the sharp surfaces of the IOL. These eyes should be closely monitored for signs of chronic inflammation and glaucoma, even long after surgery. Determining the haptic location using UBM could provide a guideline for further management. 

The authors currently implant a multipiece foldable IOL in cases of posterior capsule rupture.