Retrospective evaluation of complicated cataract surgeries with sulcus implantation of single-piece foldable intraocular lenses Original research study

Main Article Content

Daniel Czyżewski
Joanna Sempińska-Szewczyk
Ewa Filipiak
Radosław Kaźmierczak
Grzegorz Róg


Objectives: To evaluate the results of treatment in a group of patients undergoing cataract phacoemulsification with sulcus implantation of single-piece foldable intraocular lenses.

Material and methods: A total of 24 eyes of 24 patients, who underwent cataract phacoemulsification in the Department of Ophthalmology at the Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw in 2008–2015 was included. As a result of intraoperative rupture of the posterior lens capsule, single-piece foldable intraocular lens was implanted into the ciliary sulcus. Visual acuity, intraocular pressure, anterior and posterior segment of the eyes were assessed before the surgery, on days 1 and 7 after the surgery and in the period of 6 to 84 months after the surgery.

Results: During the follow-up period from 6 months to 7 years, an improvement in BCVA was shown by an average of 0.2 on the Snellen chart. Complication included: pigment dispersion (42%), increased intraocular pressure or the need to modify antiglaucoma treatment (25%), iris transillumination defect (17%).

Conclusions: In the case of cataract phacoemulsification complicated by rupture of the posterior lens capsule, sulcus implantation of a single-piece foldable intraocular lens improves visual acuity, but poses a risk of developing secondary glaucoma. If we choose such a solution, we should provide patients with the possibility of regular checkups. Due to relatively frequent complications, in cases of cataract surgery with posterior capsule rupture, the authors recommend choosing other fixation methods.


Download data is not yet available.

Article Details

How to Cite
Czyżewski D, Sempińska-Szewczyk J, Filipiak E, Kaźmierczak R, Róg G. Retrospective evaluation of complicated cataract surgeries with sulcus implantation of single-piece foldable intraocular lenses. Ophthatherapy [Internet]. 2020Dec.29 [cited 2022Aug.16];8(1):50-5. Available from:
Surgery and laser therapy


1. Ng DT, Rowe NA, Francis IC et al. Intraoperative complications of 1000 phacoemulsification procedures: a prospective study. J Cataract Refract Surg. 1998; 24(10): 1390-5.
2. Bhagat N, Nissirios N, Potdevin L et al. Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School. Br J Ophthalmol. 2007; 91(10): 1315-7.
3. Rutar T, Porco TC, Naseri A. Risk factors for intraoperative complications in resident-performed phacoemulsification surgery. Ophthalmology. 2009; 116(3): 431-6.
4. Chang DF. Siepser slipknot for McCannel iris-suture fixation of subluxated intraocular lenses. J Cataract Refract Surg. 2004; 30(6): 1170-6.
5. Ferguson AW, Malik TY. Pseudophakic posterior iris chafing syndrome. Eye (Lond). 2003; 17(3): 451-2.
6. Uy HS, Chan PS. Pigment release and secondary glaucoma after implantation of single-piece acrylic intraocular lenses in the ciliary sulcus. Am J Ophthalmol. 2006; 142(2): 330-2.
7. Toma HS, Dibernardo C, Schein OD et al. Recurrent vitreous hemorrhage secondary to haptic-induced chafing. Can J Ophthalmol. 2007; 42(2): 312-3.
8. Wintle R, Austin M. Pigment dispersion with elevated intraocular pressure after AcrySof intraocular lens implantation in the ciliary sulcus. J Cataract Refract Surg. 2001; 27(4): 642-4.
9. Rabie HM, Esfandiari H, Rikhtegar MH et al. Management of sulcus-fixated single-piece intraocular lens-induced pigmentary glaucoma with 3-piece IOL exchange. Int Ophthalmol. 2018; 38(1): 145-50.
10. Bar-Sela SM, Fleissig E. Intermediate term follow-up after a single-piece-acrylic intraocular lens implantation in the ciliary sulcus – a cross-sectional study. BMC Ophthalmol. 2013; 13: 76.
11. Ganesh S, Brar S. Swivel haptics anterior capsule-fixated intraocular lens. Indian J Ophthalmol. 2018; 66(9): 1307-9.
12. Suto C, Hori S, Fukuyama E et al. Adjusting intraocular lens power for sulcus fixation. J Cataract Refract Surg. 2003; 29(10): 1913-7.
13. Carifi G, Zuberbuhler B, Teggihalli BC et al. Ciliary sulcus lens power. Ophthalmology. 2012; 119(11): 2416-7; author reply 7.
14. Vajpayee RB, Sharma N, Dada T et al. Management of posterior capsule tears. Surv Ophthalmol. 2001; 45(6): 473-88.
15. Arbisser LB, Charles S, Howcroft M et al. Management of vitreous loss and dropped nucleus during cataract surgery. Ophthalmol Clin North Am. 2006; 19(4): 495-506.
16. Oh J, Shin HH, Kim JH et al. Direct measurement of the ciliary sulcus diameter by 35-megahertz ultrasound biomicroscopy. Ophthalmology. 2007; 114(9): 1685-8.
17. Sugiura T, Kaji Y, Tanaka Y. Anatomy of the ciliary sulcus and the optimum site of needle passage for intraocular lens suture fixation in the living eye. J Cataract Refract Surg. 2018; 44(10): 1247-53.
18. Mehta R, Aref AA. Intraocular Lens Implantation In The Ciliary Sulcus: Challenges And Risks. Clin Ophthalmol. 2019; 13: 2317-23.
19. Gimbel HV, DeBroff BM. Intraocular lens optic capture. J Cataract Refract Surg. 2004; 30(1): 200-6.
20. Millar ER, Allen D, Steel DH. Effect of anterior capsulorhexis optic capture of a sulcus-fixated intraocular lens on refractive outcomes. J Cataract Refract Surg. 2013; 39(6): 841-4.
21. Bourke RD, Gray PJ, Rosen PH et al. Retinal detachment complicating scleral-sutured posterior chamber intraocular lens surgery. Eye (Lond). 1996; 10(4): 501-8.
22. Price MO, Price FW Jr., Werner L et al. Late dislocation of scleral-sutured posterior chamber intraocular lenses. J Cataract Refract Surg. 2005; 31(7): 1320-6.
23. Schallenberg M, Dekowski D, Hahn A et al. Aphakia correction with retropupillary fixated iris-claw lens (Artisan) – long-term results. Clin Ophthalmol. 2014; 8: 137-41.
24. Lett KS, Chaudhuri PR. Visual outcomes following Artisan aphakia iris claw lens implantation. Eye (Lond). 2011; 25(1): 73-6.
25. Rao R, Sasidharan A. Iris claw intraocular lens: a viable option in monocular surgical aphakia. Indian J Ophthalmol. 2013; 61(2): 74-5.