Duet Procedure

Sometimes it takes two. Two lenses in one eye.

As a refractive surgeon, achieving perfect visual results for your patients is paramount. Even with the best patient selection and most accurate work, results can change.

Wouldn’t it be great to have a lens system that gives you more than one shot? An option that is adjustable?

Introducing to the Sulcoflex DUET procedure.

The Sulcoflex DUET procedure involves the sequential implantation of a primary capsular bag IOL and a supplementary Sulcoflex sulcus IOL. This is done as a planned DUET procedure during the initial cataract surgery.

The DUET is an easy procedure, adding little time to the overall cataract surgery, and yet offers an elegant adjustable solution.


How do I DUET?

The DUET procedure is centred on Rayner’s Sulcoflex lenses. These IOLs have been specifically designed for sulcus implantation and as such, the problems associated with the practice of “piggybacking” – two biconvex lenses in the capsular bag – are now a thing of the past.

The special design of the lens optic and haptics underlies this unique concept. In order to avoid interlenticular opacification, the Sulcoflex IOLs have a concave/convex optic design, which ensures an average distance between lenses of ~ 500 microns.

Sulcoflex is a proven supplementary platform with over 10 years’ clinical data and is also available in Aspheric and Toric variants.


  1. Amon MI. Correcting refractive surprises following cataract surgery. Cataract Refract Surg Today Europe. 2009:56-9.
  2. Khan, M.I. & Muhtaseb, M. Piggybacking with the Sulcoflex. J Cataract Refract Surg. 2010;36:14-6.


The Sulcoflex Trifocal is specifically for pseudophakic patients following the implantation of a primary monofocal or monofocal toric capsular bag IOL.

During the DUET procedure the capsular bag IOL is implanted first and treats the sphere — and where required cylinder — correction power for distance vision.

Then a plano Sulcoflex Trifocal is implanted which features the patented Rayner trifocal optics with a +3.50 D add for near and +1.75 D add for intermediate vision.

Combining the two lenses provides the patient with an opportunity for a spectacle free solution.


When would I DUET?

The DUET procedure using Sulcoflex Trifocal could become your solution of choice for all patients who demand an opportunity for being spectacle free.

The simple step of implanting a second lens can easily be incorporated into any existing cataract surgery procedure.

A wider patient selection using Sulcoflex Trifocal DUET procedure:
There are several reasons why a patient may not be suitable for a capsular bag multifocal IOL. Through the option of reversibility, the Sulcoflex Trifocal DUET procedure may offer a solution for these patients.

  • Works with any monofocal or toric primary capsular bag IOL
  • Available in 0.25 dioptre increments from -3.0 to +3.0

Implantation of the Sulcoflex Trifocal within a DUET procedure is made easy with the Medicel Accuject 1.8P-1 (LP604540) – recommended and provided by Rayner.



Exploiting the benefits of reversibility and adjustability

Challenging patients may expect more, and demand a chance of being spectacle free.

The Sulcoflex Trifocal supplementary IOL is an adjustable option which allows you to treat an even wider range of patients for presbyopia, to meet both their visual and lifestyle needs.

Unlike capsular bag multifocal IOLs or refractive laser treatments, the Sulcoflex Trifocal DUET procedure is easily reversed. Refractive change or surprise cannot be predicted, and nor can a failure to neuroadapt. Through the DUET procedure, the optic system can be easily adjusted with a different Sulcoflex Trifocal or converted back to monofocality in a straightforward procedure.

  • Plan for excellence with a simultaneous implantation
  • Treat ametropia after cataract surgery
  • Reversible – more flexibility for you and your patient

It may seem counter-intuitive to implant a lens in anticipation of its removal, but for Premium Channel cataract and refractive surgeons, the ability to offer patients the benefits of a specialist lens knowing that the procedure can be reversed at a later date, is highly reassuring.

The Sulcoflex DUET procedure empowers surgeons with the ability to offer refractive treatments to their patients without needing to invest in expensive laser equipment. This cost-efficient treatment option can easily be incorporated into any existing cataract surgery environment.


Not only as DUET procedure, but for ‘Top-Up’ as well

Sulcoflex offers an even wider opportunity.

Through a secondary procedure for those historic cataract patients who require further visual enhancements, you can correct pseudophakic presbyopia, residual corneal astigmatism or refractive surprise with the Sulcoflex range of IOLs. Ask your Rayner sales representative for further information.

Michael-Amon-MD surgeon

“Supplementary IOLs offer a safer, less traumatic option for pseudophakic ametropia for enhancing post refractive results compared with IOL exchange.”

Michael Amon MD, Correcting refractive surprises following cataract surgery. CRST Europe, March 2009.