Scleral-fixation of the Akreos^® AO60 lens in vitrectomized eyes: a retrospective analysis of outcomes and complications with emphasis on intraocular lens opacification

Background: The Akreos^® AO60 intraocular lens (IOL) has been employed for scleral fixation in eyes without capsular support, although surgical complications, including IOL opacification, have been reported. This study aims to evaluate the outcomes and complications associated with scleral fixation of the Akreos^® AO60 IOL in vitrectomized eyes, with a particular focus on IOL opacification. Methods: Electronic medical records of consecutive eyes that underwent scleral-fixation of the Akreos^® AO60 lens using Gore-tex^® sutures from 2017 to 2022 were reviewed. The following parameters were collected: age, sex, laterality, past ocular/medical history, surgical indication, pre-operative visual acuity (VA) and intraocular pressure (IOP), surgical procedure, and post-operative VA and IOP. The types of complications, onset, management, and outcomes were also documented. Descriptive statistics, Wilcoxon signed-rank test, and Fisher’s exact test were employed for statistical analysis. Results: Eighty-nine eyes of 86 patients aged 31–100 years were included. The most common surgical indication was non-traumatic IOL displacement. Retinal tears and localized choroidal hemorrhage were found intraoperatively in 7.9% and 1.1%, respectively. The most common post-operative complications were vitreous hemorrhage (13.5%), corneal edema (12.4%), ocular hypotony (11.2%), and IOL opacification (11.2%). IOL opacification was associated with intra-/post-operative exposure to air/gas [odds ratio (OR): 12.24; 95% confidence interval (CI), 1.46–103.0; P=0.006]. Mean logarithm of the minimum angle of resolution (logMAR) best-reported VA (BRVA) improved from 1.22±0.77 pre-operatively to 0.56±0.67 on latest follow-up (P<0.001). Conclusions: The majority of the complications from scleral-fixation of the Akreos^® AO60 lens in vitrectomized eyes were mild and transient; however, a proportion required surgical intervention. A significant risk for opacification was found in IOLs exposed to air/gas, although VA was often maintained.