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

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

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Objective:

To demonstrate the management of a dislocated Akreos AO60 intraocular lens (IOL) that had been previously fixated with Prolene sutures.

Approach:
  • Surgical Technique: The procedure involved vitrectomy, cutting remaining Prolene sutures, and using a soft-tip cannula to manipulate the dislocated lens. The lens was threaded through a keratome wound and re-fixated using a 4-point fixation technique.
  • Suture Management: Meticulous planning and organization were emphasized to avoid tangling of sutures during the procedure.
  • Lens Positioning: The lens was positioned approximately 3-3.5 mm back from the limbus to avoid iris chafing and ensure proper centration.
Key Findings:
  • Four-point fixation provides excellent IOL stability and minimizes tilt.
  • Avoiding overtightening of fixation sutures can improve lens positioning.
  • A small amount of 'hang-back' in sutures may enhance lens stability.
Interpretation:

Limitations:
  • The discussion noted a 14% redislocation rate in secondary lens techniques, indicating potential challenges in these procedures.
Conclusion:

Original Source(s)

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

  • by Christina Y. Weng, MD, MBA, Nimesh A. Patel, MD, Frank Brodie, MD, MBA, Mrinali Gupta, MD, FASRS

  • July 1, 2026

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