The Effect of Sulcus Intraocular Lens Implantation with Optic Capture on Refractive Outcomes in Cataract Patients with Pseudoexfoliation Syndrome: A Prospective Randomized Study

Purpose To compare the refractive outcomes of sulcus intraocular lens (IOL) implantation with optic capture following capsular tension ring (CTR) implantation versus standard in-the-bag IOL implantation in cataract patients with pseudoexfoliation syndrome (PES). Methods Senile cataract patients diagnosed with PES were prospectively enrolled in the study and divided into two groups using closed-envelope randomization: Group 1: Following CTR implantation, a 3-piece IOL was implanted in the ciliary sulcus with optic capture. Group 2: A 3-piece IOL was implanted in-the-bag in a standard manner. Best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), refraction, and corneal topography measurements were performed preoperatively and at 1 month postoperatively. The difference between calculated and actual spherical equivalent was defined as the refractive shift (RS). Results 56 eyes of 56 patients meeting the study criteria were evaluated. The mean RS was -0.38±0.72 D in Group 1 and +0.14±0.60 D in Group 2, and the difference was statistically significant (p=0.015). Postoperative ACD increase was significantly lower in Group 1 (0.87±0.38 mm vs. 1.07±0.29 mm; p=0.038). Best corrected visual acuity and IOP were similar in both groups. Postoperative capsular bag distension syndrome (CBDS) developed in two patients in Group 1. Conclusions In patients with PES, using CTR combined with sulcus implantation of the IOL with optic capture may result in a more anterior IOL position compared to in-the-bag implantation, leading to myopic RS. Therefore, the possibility of a more anterior effective lens position (ELP) should be considered in IOL power calculations. In patients undergoing optic capture technique, careful viscoelastic clearance is important to minimize the risk of CBDS.