---
title: What Is a Sulcus Supplementary (Sulcoflex) Lens?
description: "A sulcus supplementary lens is a second intraocular lens (IOL) placed in front of an existing primary IOL, sitting in the ciliary sulcus rather than inside the capsular bag. The best-known example is the Rayner Sulcoflex family, designed specifically for…"
url: "https://bluefinvision.com/knowledge-base/topics/treatments-procedures/what-is-a-sulcus-supplementary-sulcoflex-lens/"
updated: "2026-02-25"
category: "Treatments & Procedures"
---

# What Is a Sulcus Supplementary (Sulcoflex) Lens?

A sulcus supplementary lens is a second intraocular lens (IOL) placed in front of an existing primary IOL, sitting in the ciliary sulcus rather than inside the capsular bag. The best-known example is the Rayner Sulcoflex family, designed specifically for sulcus placement.

After posterior capsule rupture (PCR), the safest option is often a three-piece monofocal IOL (typically in the sulcus or supported by remaining capsule). If a premium outcome was originally planned (toric or multifocal/EDOF), a supplementary sulcus lens can later provide:

- Astigmatic correction (toric)
- Extended depth of focus or multifocal effect
- Refractive adjustment

This staged approach separates priorities:

- Stage 1: Stabilise the eye (secure with a stable primary IOL)
- Stage 2: Optimise vision (upgrade or fine-tune once the eye is quiet)

Supplementary lenses are specifically designed for sulcus implantation, with rounded edges and appropriate haptic configuration to minimise iris chafing or interlenticular interaction ¹ ². The main risks relate to sulcus anatomy and iris contact: pigment dispersion, elevated IOP, inflammation, or decentration. These risks are reduced by using lenses designed for the sulcus and by careful sizing and follow-up ³.

When appropriately selected and positioned, supplementary sulcus lenses achieve excellent refractive accuracy ¹.

PCR may delay premium correction. It does not necessarily end premium visual ambition.

**References**

1. Gerten G, Kermani O, Schmiedt K, et al. Dual intraocular lens implantation: supplementary sulcus-fixated multifocal lens. J Cataract Refract Surg. 2009;35(2):213-220.
2. Rayner G, Hollick EJ. Supplementary sulcus-fixated intraocular lens implantation for correction of residual refractive error. J Cataract Refract Surg. 2011;37(2):231-239.
3. Kahraman G, Amon M. Secondary piggyback intraocular lens implantation. J Cataract Refract Surg. 2006;32(11):1909-1913.

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