[Sulcus fixation of a foldable acrylic intraocular lens]

To describe a surgical technique for sulcus fixation of a foldable single-piece acrylic intraocular lens (IOL) through a 3.0 mm clear cornea incision.

Between 2003 and 2004, this technique was used in 10 eyes at Sestre Milosrdnice University Hospital. Seven eyes were aphakic secondary to a capsule defect during phacoemulsification, one eye had a perforating injury with lens destruction, and two eyes were aphakic after congenital cataract extraction in childhood. In all eyes an AcrySof Natural SN60AT foldable single-piece acrylic IOL (Alcon, Forth Worth, TX, USA) was implanted.

The median age of patients at surgery was 41 (range 31-68) years, and the median follow up was 11 (range 4-18) months. In all cases, the intraocular lens was placed and fixed in the anatomic sulcus without complications. Slight IOL decentration (up to 1.0 mm) was seen in 2 eyes, and transient hypotonia and transient cystoid macular edema in 1 eye each.

In the absence of adequate posterior capsule support, scleral sutured posterior chamber intraocular lens implantation has become a popular technique. The reduction in incision, from 7 mm for the implantation of poly(methyl methacrylate) (PMMA) IOL to 3 mm for foldable IOL, represents an improvement in the technique, allowing for good postoperative vision recovery. Small incision helps maintain adequate intraoperative intraocular pressure in the anterior chamber. The design of single-piece AcrySof Natural lens allows for easy and safe fixation of the Prolene suture to the IOL. Also, this technique with scleral flaps that protects the exposed suture helps reduce the risk of endophthalmitis. Longer follow up is needed to ascertain the stability of this suture fixed IOL.

Sulcus fixation of a foldable IOL offers an acceptable alternative for rehabilitation of vision function. The unique design characteristics of the single-piece AcrySof Natural IOL make possible the suture fixation through a small clear corneal incision.