Pathologic assessment of complications with asymmetric or sulcus fixation of square-edged hydrophobic acrylic intraocular lenses

Ophthalmology. 2012 May;119(5):907-13. doi: 10.1016/j.ophtha.2011.10.022. Epub 2012 Mar 15.


Objective: One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation because of complications, such as uveitis-glaucoma-hyphema syndrome. Similar complications may also be observed with 3-piece lenses that have a square optic edge on the anterior surface. The objective of this study was to provide pathologic evidence of complications related to out-of-the-bag fixation of 1- or 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges.

Design: Comparative case series with pathology.

Participants: A total of 661 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs.

Methods: Anterior segment scanning of whole eyes with a high-frequency ultrasound system or high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathologic analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses.

Main outcome measures: Findings from imaging, gross, and histopathologic evaluation that could be related to out-of-the-bag fixation of the lenses.

Results: A total of 256 eyes were implanted with hydrophobic acrylic IOLs with anterior and posterior square optic edges; 18 of them exhibiting asymmetric or sulcus IOL fixation (six 1-piece and twelve 3-piece IOLs) underwent complete histopathologic evaluation and were compared with the contralateral eyes with symmetric in-the-bag IOL implantation. Pathologic findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, iris thinning, and iris atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the control contralateral eyes and were particularly evident in relation to the sulcus-fixated haptic in the case of 1-piece lenses. The majority of the eyes with 3-piece lenses showed signs of complicated surgery.

Conclusions: This study provides pathologic correlation of complications that were clinically reported in the peer-reviewed literature in relation to sulcus fixation of 1-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidence of complicated surgery; therefore, all pathologic findings in those cases may not be strictly attributed to the out-of-the-bag fixation.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acrylic Resins*
  • Aged
  • Aged, 80 and over
  • Anterior Eye Segment / diagnostic imaging
  • Artificial Lens Implant Migration / diagnosis*
  • Ciliary Body / surgery
  • Humans
  • Intraoperative Complications*
  • Lens Implantation, Intraocular / methods*
  • Lenses, Intraocular*
  • Magnetic Resonance Imaging
  • Postoperative Complications*
  • Prosthesis Design
  • Pseudophakia / etiology
  • Tissue Donors
  • Ultrasonography


  • Acrylic Resins