Sterile Anterior Segment Inflammation Associated With Sulcus-Supported Phakic IOL Surgery

Purpose: To investigate the incidence, presentation, and outcomes of sterile anterior segment inflammation following sulcus-supported phakic IOL implantation (SASI-pIOL). Methods: The retrospective case series included consecutive patients diagnosed as having SASI-pIOL (early-onset: ⩽ 7 days; late-onset: > 7 days postoperatively) between July 2023 and July 2024 at two tertiary centers in China. All patients were followed up for at least 6 months after diagnosis. Results: SASI-pIOL occurred in 39 eyes (0.26%) out of 15,209 pIOL surgeries. Early-onset cases accounted for 26 eyes (66.7%), and late-onset for 13 eyes (33.3%). Anterior chamber inflammation and pIOL surface white deposits resolved completely with topical steroids. No eye lost one or more Snellen lines in corrected distance visual acuity. No significant changes were observed in intraocular pressure or endothelial cell density compared to baseline. Recurrence of white deposits on the pIOL occurred in 11 eyes (42.3%) in the early-onset group and 6 eyes (54.5%) in the late-onset group. A significant difference was observed in the proportion of early-onset versus late-onset SASI-pIOL cases relative to ophthalmic viscosurgical device use ( P < .001, Fisher's exact test). Conclusions: SASI-pIOL is uncommon, responds well to topical corticosteroids, and is associated with favorable visual outcomes, yet requires long-term monitoring due to a notable recurrence rate.