Surgical Roundtable Case 2: Managing a Dislocated Scleral-Fixated IOL

Nimesh A. Patel, MD, demonstrates management of a dislocated Akreos AO60 intraocular lens (IOL; Bausch + Lomb) that had been previously fixated with Prolene sutures, and a panel of experienced vitreoretinal surgeons discusses secondary IOL fixation, lens repositioning, suture management, and long-term considerations in complex aphakia cases.

By
Christina Y. Weng, MD, MBA
Nimesh A. Patel, MD
Frank Brodie, MD, MBA
Mrinali Gupta, MD, FASRS
July 1, 2026
18 min

Retinal Physician

Background

Dislocated intraocular lenses (IOLs) present a challenge in ophthalmic surgery, particularly as the use of secondary IOLs increases. The Akreos AO60 lens, known for its four-point fixation, is commonly used but can dislocate due to factors such as suture material degradation over time.

Data Highlights

No numerical data or trial data presented in the source material.

Key Findings

The dislocated Akreos AO60 lens was previously fixated with Prolene sutures, which may have contributed to its dislocation after 10 years.
Vitrectomy was performed to assess and manage the lens dislocation effectively.
The lens was successfully retrieved and repositioned using a technique that involved threading the eyelets outside the eye.
Meticulous planning and organization were emphasized as critical for managing the multiple suture ends during the procedure.
The technique allows for a hang-back approach to avoid excessive tension on the sutures, aiding in proper lens positioning.

Clinical Implications

Surgeons should consider the choice of suture material and the potential for long-term complications when performing scleral fixation of IOLs. Effective planning and organization are essential to navigate complex surgical scenarios involving dislocated lenses.

Conclusion

The management of dislocated scleral-fixated IOLs requires careful technique and planning. The case presented demonstrates a successful approach to repositioning a dislocated Akreos AO60 lens.