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Related Experiment Video

Updated: Mar 1, 2026

Author Spotlight: Enhancing Visual Outcomes in Cataract Surgery: A Novel Technique to Prevent Posterior Capsular Opacification Through IOL Rotation
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Advances and Challenges in Sulcus-Implanted Intraocular Lenses: A Comprehensive Narrative Review.

Mario R Romano1,2, Alfonso Savastano3,4, David Keegan5

  • 1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. mario.romano.md@gmail.com.

Ophthalmology and Therapy
|February 27, 2026
PubMed
Summary

Sulcus intraocular lens (IOL) implantation is effective for inadequate capsular support. Lens design significantly impacts safety and outcomes, with three-piece and add-on lenses offering favorable profiles.

Keywords:
Aphakia managementCiliary sulcus fixationIntraocular lens complicationsSecondary IOLSulcus intraocular lens implantation

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Area of Science:

  • Ophthalmology
  • Intraocular Lens Implantation
  • Ophthalmic Surgery

Background:

  • Sulcus implantation of intraocular lenses (IOLs) is crucial for cases with inadequate capsular support or when refractive correction is needed.
  • Existing evidence on safety, design, and outcomes is extensive but varied.

Purpose of the Study:

  • To review current evidence on indications, visual outcomes, and complications of sulcus-implanted IOLs.
  • To identify design-specific factors influencing predictability and safety.

Main Methods:

  • A narrative review of studies on sulcus-positioned IOLs (three-piece, supplementary/add-on, primary) was conducted.
  • PubMed and manual reference screening were utilized.

Main Results:

  • Fifty studies were included; visual acuity generally improved post-implantation.
  • Complications varied by IOL design; three-piece and purpose-designed sulcus lenses showed better safety profiles than single-piece acrylics.
  • Endothelial safety was comparable to standard cataract surgery with appropriate designs.

Conclusions:

  • Sulcus implantation is a reliable option for compromised capsular bags or supplementary correction.
  • Outcomes and safety are highly design-dependent, favoring three-piece and sulcus-specific add-on lenses.
  • Further research is needed for long-term risk assessment and design recommendations.