Eyeworld

119 EW RESIDENTS March 2017 a white paper published in JCRS in 2009, Chang et al. outlined the American Society of Cataract and Refractive Surgery (ASCRS) cataract placed in the bag, it remains unclear which type of IOL to use in the sulcus. This study addressed nei- ther IOL selection nor the incision size required to place the IOL. In acuities, were not aphakic, and had fewer comorbid conditions. Even if most ophthalmologists accept that sulcus placement is the best option when a lens cannot be formed a linear regression analysis to determine which factors predicted final CDVA. They identified four statistically significant parameters that predicted better postoperative CDVA: (1) good preoperative CDVA, (2) the absence of comorbid condi- tions, (3) final IOL position in the sulcus with optic capture, and (4) the absence of early postoperative complications. Refractive outcome data was analyzed for a subset of 114 patients with CDVA 20/40 or better. There was no statistically significant dif- ference in refractive prediction error (RPE) between study groups. Overall, approximately 80% of patients were within 1 diopter of predicted error, and 55% were within 0.5 diopters. Patients who underwent concurrent anterior vitrectomy trended toward more myopic error, although this finding was not statistically signifi- cant. In the discussion section, the authors affirmed that secondary IOLs are best placed in the sulcus with optic capture. They concluded that there was no difference in the final visual acuity between the TSSI- OL, IFIOL, and ACIOL groups, and that all three groups had excellent refractive outcomes (i.e., a small RPE). Despite the potential compli- cations of ACIOL placement, the ACIOL group had lower complica- tion rates than IFIOL or SFIOL and a statistically significant improvement in CDVA from pre- to post-op. Over- all, the findings from this JCRS study are remarkably similar to those from Wagoner et al.'s 2003 review paper. Comment Several prior studies have found that sulcus IOL placement is best when in-the-bag placement is no longer an option. 2,3 This study found similar results: better visual outcomes and lower complication rates with sulcus IOL placement. However, direct comparison to the other techniques for secondary IOL implantation is inherently problematic due to selection bias. In this study, patients who had enough capsular support to undergo sulcus placement (and optic capture through the anterior capsulotomy) represented a vastly different population than those who did not. Furthermore, patients who were able to undergo sulcus place- ment had better preoperative visual continued on page 120

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