Single-Piece Foldable Intraocular Lenses versus Three-Piece Intraocular Lenses in the Sulcus following Posterior Capsular Rupture

Abstract Purpose: Successful intraocular lens (IOL) placement in cataract surgery is synonymous with the IOL being placed in the capsular bag. When the bag is violated, the ciliary sulcus becomes an option to be able to place an intraocular lens in a near in-the-bag position. Studies report that single-piece foldable acrylic (SPA) IOLs are a poor choice for the sulcus. This study aimed to compare the visual outcomes and complications between sulcus placement of single-piece intraocular lenses and three-piece intraocular lenses. Methods: The medical records of patients were retrospectively reviewed in a single center. Results: A total of 245 patients were included in the study with mean age of 61 with male predominance. Majority of sulcus implantation occurred during phacoemulsification (87%). Around 82% (n=202) were implanted with SPA IOLs and 18% (n=43) were three-piece IOLs. Best corrected distance visual acuity (BCDVA) was 20/20 after 6 months for both groups. Comparison between two groups showed no superiority with each other. Complications notable were elevated IOP, corneal edema, loss of IOL centration and pigment dispersion. Results showed more proportions of complications with SPA IOLs than three-piece IOL. Smaller optic diameter and overall length predispose to increase in decentrations. Conclusions: We found no significant difference between the visual outcomes of three-piece IOLs with SPA IOLs. Complications were found to be more significant in SPA IOLs. Knowledge on the outcomes and complications of SPA IOLs would help ophthalmologists in their decision making and help set realistic expectations for both doctors and patients.