Sulcus implantation of a 3-piece, 6.0 mm optic, hydrophobic foldable acrylic intraocular lens in phacoemulsification complicated by posterior capsule rupture Periklis D. Brazitikos, MD, Miltiadis O. Balidis, MD, Paris Tranos, MD, Sofia Androudi, MD, Nick T. Papadopoulos, MD, Ioannis T. Tsinopoulos, MD, Vasilios Karabatakis, MD, Nikolaos T. Stangos, MD Purpose: To evaluate the safety of implanting a 3-piece, 6.0 mm optic, foldable acrylic intraocular lens (IOL) in cases of posterior capsule rupture during phacoemulsification. Setting: Department of Ophthalmology, Ahepa Hospital, Aristotle University Medi- cal School, and Interbalkan Medical Center, Thessaloniki, Greece. Methods: This prospective noncomparative case series included 28 eyes (28 pa- tients) having phacoemulsification complicated by extensive posterior capsule rupture with or without vitreous loss. In all eyes, a 3-piece, 6.0 mm optic, foldable acrylic IOL (AcrySof MA60BM, Alcon) was implanted in the sulcus. Postoperative examination included best corrected visual acuity (BCVA), anterior segment biomicroscopy, IOL centration and position, intraocular pressure (IOP), and fun- dus biomicroscopy. The follow-up was 6 months. Results: The most common postoperative complications were transient corneal edema in 12 eyes and increased IOP in 11 eyes. Slight asymptomatic decentra- tion from the center of the pupil (1.0 to 2.0 mm) and pseudophacodonesis were observed in 5 eyes each. Friction of the IOL with the iris occurred in 1 eye. Clini- cally significant cystoid macular edema occurred in 3 eyes. The final BCVA was between 20/15 and 20/25 in 18 patients, 20/30 in 2, between 20/40 and 20/50 in 4, and between 20/60 and 20/200 in 4. Conclusions: AcrySof IOL implantation in the sulcus during phacoemulsification complicated by posterior capsule rupture preserved the advantages of small-inci- sion surgery. The postoperative behavior and centration of the IOLs resembled those of poly(methyl methacrylate) lenses. J Cataract Refract Surg 2002; 28:1618 –1622 © 2002 ASCRS and ESCRS S mall-incision cataract surgery has the advantage of rapid visual rehabilitation because of less surgically induced astigmatism and faster wound healing. 1–3 The implantation of foldable intraocular lenses (IOLs) through a small incision after uneventful phacoemulsi- fication preserves a closed system, providing safer intra- operative conditions. 1–3 In phacoemulsification complicated by posterior capsule rupture and vitreous loss, rigid, large-diameter, posterior chamber poly(methyl methacrylate) (PMMA) IOLs are usually inserted in the sulcus if there is suffi- cient capsular support. 4,5 In cases in which the posterior capsule ruptures, implantation of foldable intraocular IOLs would preserve the closed small-incision system and its advantages. 1–3 However, there are few case re- Accepted for publication November 11, 2001. Reprint requests to P.D. Brazitikos MD, 10 Agias Sophias Street, 54622 Thessaloniki, Greece. E-mail: pbrazitikos@hotmail.com. © 2002 ASCRS and ESCRS 0886-3350/02/$–see front matter Published by Elsevier Science Inc. PII S0886-3350(02)01211-7