REFRACTIVE OUTCOME OF CILIARY SULCUS IMPLANTED INTRAOCULAR LENSES

Abstract

BACKGROUND Although cataract surgery is a safe and effective method of restoring sight, unexpected intraoperative events can force cataract surgeons to implant the lens in the ciliary sulcus, which affords long-term stability and safety. As it produces sub- optimal visual outcomes the power of the new IOL must be changed to reflect the new location. In general, surgeons empirically subtract 0.50 to -1.50 diopters (D) from the IOL power calculated before surgery. Thus, we aimed to study to the refractive outcome of sulcus implanted IOL during cataract surgery. OBJECTIVES To determine the difference in the predicted and postoperative spherical equivalent refraction – “Refractive shift” and the IOL power for in the bag and ciliary sulcus IOL implantation. METHODS This prospective interventional study included 77 patients who underwent cataract surgery in the Department of Ophthalmology, R. L. Jalappa Hospital and Research Centre , attached to Sri Devaraj URS Medical College, Tamaka , Kolar from September 2022 to December 2023, after obtaining ethical clearance from Institutional Ethical Committee of Sri Devaraj Urs Medical College and CTRI. Following the written informed consent from the subjects, they were evaluated by detailed history and standard protocol for cataract surgery. Posterior capsular rent cases were identified and PCIOL was placed in ciliary sulcus with IOL power 0.5 D or 1 D less than calculated IOL power for in the bag implantation. The XIV preoperative and postoperative visual acuity, spherical equivalent and complications were noted on day 1, after 1 week and 1 month. RESULTS: Out of 77 patients 20 (26%) were males and 57 (74%) females with mean age of 63.50 + 10.445 years. The right eye was operated in 39 (50.6%) and left eye in 38 (49.4%) patients, the laterality distribution being almost equal. The most common risk factors were hypertension 24 (31.16%), Diabetes mellitus 22 (28.5%), mature cataract 17 (22%) and pseudo exfoliation 15 (19.48%) patients. Maximum number of PCR occurred during the stage of cortical wash 38 (49.4%), nucleus prolapse 18 (23.4%), hydro dissection 13 (16.9%), IOL placement 5 (6.6%) and PC polishing 3 (3.8%) of cataract surgery. The mean preoperative and postoperative VA is 1.039 ± 0.745 and 0.189 ± 0.177 log MAR respectively. [P <0.001] Good visual outcome was observed in 74 (96.1%) and borderline in 3 (3.9%). The mean predicted and postop spherical equivalent was 0.0108 ± 0.00977 and 0.0586 ± 0.17787 (D) respectively. [P <0.001]. A statistically significant difference was also noted while comparing the mean virtual power 21.50 + 1.9596 (D) and actual power of the IOL implanted 22.046 + 1.9377 (D). [P <0.001]. Early postoperative complications noticed were striate keratopathy in 11 (14.5%) followed by iritis 8 (10.5%), IOL pigment dusting 12 (15.8%) and endothelial pigment dusting in 10 (13.2%) eyes. The late complications were Cystoid macular edema 5(6.6%), IOL decentration 2 (2.6%) and iris IOL contact in 2 (2.6%) eyes.