Background/Objectives: this study aims to assess the safety of ciliary sulcus-placed hydrophilic acrylic intraocular lenses (IOLs). Methods: In this retrospective cohort study, consecutive patients who underwent phacoemulsification with implantation of IOLs into the ciliary sulcus without suture fixation between 2014 and 2016 at the Meir Medical Center were included. Clinical outcomes were compared between one-piece (1P) hydrophilic acrylic IOLs (Seelens AF, Hanita Lenses, Kibbutz Hanita, Israel) and three-piece hydrophobic acrylic IOLs with PMMA haptics (3P) (MA60AC, Alcon Laboratories, USA). Results: Thirty-eight eyes met the inclusion criteria and had ciliary sulcus IOLs implanted, twenty-three eyes with 1P hydrophilic (60.52%) and fifteen (39.47%) with 3P hydrophobic IOLs. Mean follow-up was 47.36 ± 7.25 months for the 1P group and 46.54 ± 9.82 months for the 3P group (p = 0.87). The mean peak IOP was higher in the 3P group (p = 0.038). No differences in the incidence of anterior uveitis or cystoid macula edema (CME) were detected between the groups (p > 0.05). None of the patients in our study developed uveitis, bleeding episodes, or required treatment for increased intraocular pressure, and no patient was diagnosed with uveitis-glaucoma-hyphema (UGH) syndrome. Post-operative corrected distance visual acuity (CDVA) was similar between the groups (p = 0.66). Conclusions: Hydrophilic IOLs can be safely placed in the ciliary sulcus and are non-inferior to the implantation of three-piece hydrophobic IOLs in the sulcus. In our cohort, with an average follow-up of approximately four years, no UGH was diagnosed, and none of the lenses were explanted.

Introduction: IgG4-related disease (IgG4-RD) is a chronic immune-mediated fibroinflammatory condition that may involve multiple organs but rarely presents as an isolated conjunctival lesion. Ocular surface involvement can mimic benign inflammatory conditions, leading to diagnostic delay. We report a rare case of isolated conjunctival IgG4-RD initially misdiagnosed as recurrent pingueculitis. Case Presentation: A 37-year-old female presented with a gelatinous, cystic mass on the bulbar conjunctiva. Comprehensive ophthalmic examination and anterior segment optical coherence tomography (OCT) revealed a well-demarcated subconjunctival lesion without scleral or intraocular invasion. Differential diagnoses included conjunctival lymphoma, ocular surface squamous neoplasia, and nonspecific orbital inflammation. An excisional biopsy was performed, and histopathological examination confirmed IgG4-RD, demonstrating dense lymphoplasmacytic infiltration with CD138- and IgG4-positive plasma cells, storiform fibrosis, and abundant collagen fibers. Postoperatively, a suspected local recurrence was successfully treated with topical dexamethasone. At 6-month follow-up, complete clinical remission was achieved without additional local or systemic therapy. Conclusion: This case highlights the importance of considering IgG4-RD in the differential diagnosis of atypical conjunctival lesions. Tissue biopsy remains essential for definitive diagnosis, while adjunctive imaging modalities such as anterior-segment OCT may aid in lesion characterization, even in the absence of systemic disease.