26.5 Sulcus Intraocular Lens

A new or repositioned IOL can be placed in the ciliary sulcus if there is adequate capsular support.

1. Complete all Necessary Procedures such as Vitrectomy and Inspection of the Retinal Periphery.

Ensure removal of all anterior vitreous and any vitreous prolapsed above the iris plane. Triamcinolone acetonide can be useful to assist in visualizing vitreous.

2. Ensure Adequate Sulcus Support

Through a paracentesis wound inflate the ciliary sulcus with viscoelastic. Use a Kuglen hook if necessary to displace the iris and visualize the edge of the anterior capsule. Iris retractors can be used as needed to ensure adequate exposure. As a guide, at least 270 degrees of intact capsule is required to place a sulcus IOL.

3. Create a Main Corneal Wound

This wound should be oversized to approximately 3.5mm using a keratome.

4. Insert the Sulcus Intraocular Lens

This should be a three-piece acrylic lens. It can either be injected or folded. Ensure as the lens is inserted that the first haptic is captured in the sulcus and the lens is in the “reverse S” configuration. Leave the trailing haptic outside of the main wound (Figure 26.5.1).

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