Novel Surgical Technique Provides Efficient Solution to Rescue Dislocated IOL

The use of a novel surgical technique to rescue a dislocated Akreos AO60 intraocular lens (IOL) is a safe and efficient surgical solution and results in acceptable visual outcomes and no postoperative complications. This is according to research published in Retina. 

Although techniques for the implantation of IOLs absent capsular support have evolved, some IOL styles are “not amenable” to the most commonly used techniques. One such lens, the Akreos AO60 (Bausch + Lomb), is a foldable acrylic lens with 4 points of haptic fixation. In recent years, the Akreos has been used with increasing frequency due to its clinical and refractive stability for both “in-the-bag” placement and secondary insertion utilizing scleral fixation. But because this lens does not have the classic 3-piece IOL haptic structure, the use of traditional techniques — such as 2-point intrascleral fixation, iris fixation, and sutureless techniques — are not possible. 

Researchers utilized a novel surgical technique in 4 eyes from 3 patients to rescue and reaffix the Akeros AO60 lens. The technique requires a localized conjunctival peritomy at 2 and 8 o’clock, followed by Wetfield cautery for hemostatsis. Two partial thickness, wedge-shaped scleral flaps were then created, in addition to 2 partial-thickness slit incisions. 

A pars plana vitrectomry was then performed. Surgeons then inserted a 27-gauge needle with a 9-0 polypropylene suture, passed through the superior slit incision and through the superior haptic hole of the Akreos lens from the posterior plane. A 23 g forceps was inserted from the left side to retrieve the suture from the needle. The suture needle was passed anticlockwise through the partial thickness sclera from the slit incision to the bed of the scleral flap, at which point the suture was tied. The procedure was repeated contralaterally, and the final position of the lens was confirmed. 

Among the 4 patients who underwent this novel surgical technique, preoperative best-corrected visual acuity (BCVA) ranged from 20/100 to 20/250; postoperative BCVA ranged from 20/20 to 20/800. 

Patient 1, a 79-year-old woman, underwent surgery due to a spontaneous, uncomplicated dislocation of both intraocular lenses 6 years after cataract surgery. The patient experienced 20/25 BCVA in the left eye and 20/20 BCVA in the right eye at 3 and 4 months postoperatively, respectively, with no complications. 

Patient 2, an 86-year-old woman, had a dislocated Akreos AO60 following complicated cataract surgery, Descemet’s stripping automated endothelial keratoplasty (DSAEK), and a separate insertion of a glaucoma drainage device. Preoperative BCVA was 20/150, while postoperative BCVA was 20/70 at 7 months with no further improvement at a 15-month follow-up. 

Patient 3, a 68-year-old man, required surgery after the previous scleral fixation of Akreos AO60 and previous complicated cataract surgery with retained lens fragments. DSAEK had also been performed, but evidence of moderate pseudophakic bullous keratopathy remained. The patient’s intraocular lens dislocated following a break of one of the scleral sutures. Preoperative BCVA was 20/250, and postoperative BCVA was 20/350, limited, per the researchers, due to corneal edema. 

No other intra- or postoperative complications occurred, including vitreous hemorrhage, hypotony, retinal detachment, or infection. The intraocular lens remained centered in all eyes. 

“This report is the first to describe [intraocular lens] rescue of a dislocated Akreos [intraocular lens] with its unique 4 eyelet haptics,” the researchers wrote. “Through several of the cases described herin, it is evident that this technique can be performed in surgically complicated eyes, including those with previous DSAEK or glaucoma surgery.” 

“We believe this technique offers an efficient solution for rescue of a dislocated Akreos AO60 lens with acceptable visual outcomes and no postoperative complications,” they concluded.

Reference

Fan KC, Smiddy WE. Rescuing an Akreos 4-point haptic intraocular lens: A novel surgical technique. Published online March 3, 2021. Retina. doi:10.1097/IAE.0000000000003159