Sulcus placement of a proprietary three-piece multifocal IOL restores good outcome

Key Points

San Francisco-Sulcus placement of a proprietary three-piece multifocal IOL (ReZoom, Abbott Medical Optics) is a viable option in eyes in which capsular bag support is not adequate to ensure good lens stability. Then, if the lens decenters in the sulcus, scleral suturing is a safe and effective option for recentering the IOL and restoring good vision, said Francis A. D'Ambrosio Jr., MD, at the annual meeting of the American Society of Cataract and Refractive Surgery.

If the multifocal IOL decenters and vision is compromised, however, surgeons who are comfortable with scleral suturing may consider this technique to salvage the case.

Patients who are deemed good candidates for a presbyopia-correcting IOL are likely to be very disappointed if they receive a monofocal implant instead because of an intraoperative complication, he said. "The situation becomes even more problematic if the complication occurs during the second-eye surgery," Dr. D'Ambrosio added.

Sulcus placement is an option with the aforementioned three-piece lens as well as the three-piece version of an apodized diffractive IOL (ReSTOR, Alcon Laboratories), he said. When implanting the three-piece multifocal IOL, Dr. D'Ambrosio added, he calculates IOL power for capsular bag and sulcus placement and has both implants on hand in case sulcus placement becomes necessary.

Technique described

The recentering procedure is performed using peribulbar or retrobulbar anesthesia. After conjunctival dissection, a posterior limbal scleral corneal incision is created temporally and an ophthalmic viscosurgical device of 1.6% sodium hyaluronate (Amvisc Plus, Bausch & Lomb) is instilled both anterior and posterior to the IOL.

The suturing is performed using double-armed, 10-0 polypropylene (Prolene, Ethicon) on a spatula straight needle (Ethicon 171 3G). First, the first arm of the suture is introduced into the anterior chamber from 3 mm posterior to the limbus and then exited through clear cornea. Next, the second arm of the suture is introduced into the eye 1 mm from the first suture and exited through clear cornea.

After cutting the needles, a Sinskey hook is used to pull the cut suture ends out of the anterior chamber through the scleral corneal incision and then to bring the temporal haptic out of the eye for suture fixation. Once the sutures are tied to the haptic, the knot ends are trimmed, and the haptic is replaced in the sulcus. Lastly, the distal end of the suture is cut and a single knot is gently fastened to bring the temporal haptic to the sclera while centering the IOL. Once the IOL is properly positioned, the knot is finished and the ends are trimmed to 1 mm.