Complications of sulcus placement of single-piece acrylic intraocular lenses Recommendations for backup IOL implantation following posterior capsule rupture SPECIAL REPORT

for the ASCRS Cataract Clinical Committee PURPOSE: To describe complications arising from sulcus placement of single-piece acrylic (SPA) intraocular lenses (IOLs), evaluate IOL options for eyes that lack adequate capsule support, and examine the appropriateness of various IOL designs for sulcus placement. SETTING: University and private anterior segment surgery practices. METHODS: RESULTS: Complications of sulcus SPA IOLs included pigment dispersion, iris transillumination defects, dysphotopsia, elevated intraocular pressure, intraocular hemorrhage, and cystoid macular edema. Two patients in the series of 30 patients experienced 1 complication; 8 experienced 2 complications; 13 experienced 3 complications; 4 experienced 4 complications; and 2 experienced 5 complications. Twenty-eight eyes (93%) required surgical intervention; IOL exchange was performed in 25 (83%). Postoperatively, the mean CDVA improved, with most eyes attaining 20/20. CONCLUSIONS: Intraocular lenses designed solely for the capsular bag should not be placed in the ciliary sulcus. Backup IOLs in appropriate powers, sizes, and designs should be available for every cataract procedure. The development, investigation, and supply of IOLs specifically designed for placement in eyes that lack adequate capsule support represent clinically important endeavors for ophthalmology and the ophthalmic industry. J Cataract Refract Surg 2009; 35:1445-1458 Q 2009 ASCRS and ESCRS Single-piece acrylic (SPA) intraocular lenses (IOLs) currently account for approximately one half of the IOLs implanted concurrent with cataract surgery in the United States (Alcon, Inc.; data on file). Given the large annual volume of cataract surgery performed worldwide, a significant number of SPA IOLs may be inadvertently or intentionally placed in the ciliary sulcus; eg, following posterior capsule rupture. This raises the question of whether this strategy is appropriate and the larger issues of which IOL designs are suitable as backup IOLs in the absence of secure capsular bag support. The growing popularity of accommodating, multifocal, toric, and aspheric monofocal IOLs raises additional concerns about whether these IOLs are appropriate for placement in the ciliary sulcus. Finally, the debate continues over whether an anterior chamber IOL (AC IOL) or a sutured posterior chamber IOL (PC IOL) is the best long-term option in the absence of adequate capsule support. To help answer these questions, members of the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Clinical Committee conducted a retrospective survey of patients referred for complications associated with SPA IOLs implanted in the ciliary sulcus. We also reviewed the literature with respect to recommendations for backup IOL design and placement

Multiple Cranial Neuropathies and Pachymeningitis in a Patient With a Pathogenic Nucleotide-Binding Oligomerization Domain 2 Polymorphism

An 11-year-old boy presented with 2 weeks of intermittent headache, right orbital pain, and constant diplopia. Brain MRI showed dural thickening and enhancement of the right lateral cavernous sinus, right orbital apex, and tentorium. Initial cerebral spinal fluid analysis showed only mild pleocytosis, and serum diagnostics were unrevealing