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
- 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.
- 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.
- Kahraman G, Amon M. Secondary piggyback intraocular lens implantation. J Cataract Refract Surg. 2006;32(11):1909-1913.
Related Topics
- What is Posterior Capsule Rupture?
- Why is my risk of retinal detachment increased after PCR?
- Why is there increased cystoid macular oedema (CMO) after PCR?
- Why might my eye pressure rise after PCR?
- When will I be seen again after PCR?
- What does PCR mean for my bilateral surgery?
- Will my vision be ok after posterior capsule rupture?
- Will my vision be ok after dropped nucleus surgery following PCR?
- How long will the operation take if PCR occurs?
- Can I go to Moorfields for a second opinion instead?
- If I seek a second opinion, can I still have my corrective surgery at Blue Fin Vision®?
- What happens to my fees if I cancel the second eye after PCR?
- Is my risk higher for the second eye if I had PCR in the first?
- What is anterior vitrectomy and why is it performed after PCR?
- What is a three-piece monofocal lens and why is it used after PCR?
- What is a sulcus supplementary (Sulcoflex) lens?
- What is dropped nucleus and why does it happen after PCR?
- What is expulsive suprachoroidal haemorrhage and why is it mentioned with PCR?
- Why does pseudoexfoliation increase the risk of PCR?
- Why do very dense cataracts increase the risk of PCR?
- Is posterior capsule rupture negligence?
