EyeWorld Asia-Pacific March 2011 Issue

28 EW CATARACT/IOL March 2011 Figure 3 Figure 2 Sulcoflex IOLs offer future options for refractive enhancements by Richard S. Hoffman, MD IOLs designed specifically for piggyback implantation O ne of the most potentially useful IOL technologies available outside of the US is the Rayner Sulcoflex Pseudophakic Supplementay IOL. The Sulcoflex lens is currently the only IOL to have been specifically designed to be placed in the ciliary sulcus as a piggyback IOL to correct residual refractive errors following primary IOL implantation. The IOL is made from a biocompatible hydrophilic acrylic material and has special design features to reduce complications that might develop from sulcus placement. The lens has large 14-mm undulating round-edged haptics with a 10-degree angulation that reduces the risk of contact with the posterior iris pigmented epithelium and subsequent pigment dispersion. The lens has a round- edged 6.5-mm optic to prevent optic-iris capture and reduce the likelihood of edge glare and dysphotopsias. In addition, the optic has a concave posterior surface to prevent contact between the IOL in the bag and the Sulcoflex IOL in the sulcus (figure 1). The lens comes in three varieties including an aspheric, toric, and multifocal IOL. The Sulcoflex Aspheric IOL comes in a standard dioptric range of –5 D to +5 D in half-diopter steps. If needed, these lenses can be special ordered up to –10 D or +10 D. The Sulcoflex Toric IOL (figure 2) comes in a standard range of –3.0 D to +3.0 D in half-diopter steps and cylindrical powers of +1 D to +3 D in 1 D steps. The toric lenses can also be special ordered in powers up to –6 D and +6 D with up to 6 D of cylindrical correction in half-diopter steps. The round- edged undulating haptic design has been found to give excellent rotational stability making this lens a useful option for treating residual spherocylindrical errors following primary cataract surgery. If the corneal toricity meridian changes with aging, the IOL could theoretically be rotated surgically to neutralize the change in axis many years following the piggyback implantation. Post-keratoplasty patients could also be well-served with this lens by treating transplant induced myopia and astigmatism in pseudophakic eyes that have undergone subsequent corneal transplantation. Perhaps the most exciting lens is the multifocal variety. The Sulcoflex Multifocal (figure 3) is a Figure 1 refractive multifocal IOL available in powers between –3 D to +3 D in half-diopter steps. These lenses have a +3.5 D add that yields a +3 D add at the spectacle plane. Refractive multifocal IOLs are less susceptible to the effects of decentration and IOL tilt compared to diffractive multifocal IOLs, making them ideal for sulcus piggyback implantation. The availability of a piggyback multifocal IOL opens up a whole group of potential patients who might wish to enhance their original surgery with multifocality and a spherical refractive refinement to achieve emmetropia if needed. In addition, sulcus placement allows for easy removal if patients are unhappy with any optical aberrations from the multifocal optics. All of the Sulcoflex lenses can be easily injected into the eye through a sub-3-mm incision utilizing the Rayner Soft-Tipped Injector System. Unfortunately, these lenses are currently not available in the US; however, the company promises US Food and Drug Administration clinical trials in the near future. Eventual availability of these IOLs in the US will provide our patients with multiple options for improving their surgical results. EW C urrent options for treating refractive surprises following cataract surgery include corneal refractive surgery and piggyback IOLs. Piggyback IOLs are a quick and safe method of adjusting post-op refractive errors but currently accepted models for piggybacking do not correct for astigmatism. There are different IOLs that have been used for piggybacking; however, these lenses are not specifically designed for ciliary sulcus placement, and although they have functioned well as sulcus lenses, they are not ideal. The Rayner Sulcoflex series of IOLs are specifically designed for sulcus placement over an existing in-the-bag IOL. These lenses were fashioned to reduce pigment dispersion, IOL-to-IOL touch, optic edge glare, and maximize rotational stability. The three versions of this lens now give surgeons the option of adjusting spherical and spherocylindrical refractive errors in addition to offering patients the option of safely trying multifocal optics with an easily reversible procedure. Surgeons outside of the US can now utilize this exciting technology, but surgeons within the US will have to wait. Richard Hoffman, MD, Column Editor