Snare-assisted flapless closed-loop scleral refixation of dislocated Akreos Adapt intraocular lenses

To describe a flapless, single-pass, snare-assisted technique for four-point scleral refixation of dislocated Akreos Adapt intraocular lenses (IOLs) using an 8 - 0 polypropylene suture in a closed-loop configuration.

An 8 - 0 polypropylene suture was passed through the four fenestrated haptics of the IOL using a non-sliding snare constructed from a 30-gauge thin-walled needle mounted on a 1 mL syringe. The extraocular portions of the suture were routed within the intrascleral plane between two fixation points on the same side (nasal or temporal), which are 2 mm away from the limbus, with a distance of 7 mm between the two fixation points, without conjunctival dissection or scleral flap creation. The external suture knot was buried within the scleral stroma.

This retrospective case series included five eyes with Akreos Adapt IOLs that were completely dislocated into the vitreous cavity. All lenses were successfully fixated without intraoperative complications. At a mean follow-up of 8.4 months, all IOLs remained well-centered and stable. Best-corrected visual acuity improved in all cases. The preoperative and postoperative spherical equivalent values ranged from - 5.00 D to 11.00 D preoperatively, and from - 2.50 D to -0.50 D postoperatively. No hypotony, suture erosion, knot exposure, or IOL redislocation were observed.

This technique offers a minimally invasive and reproducible method for four-point scleral fixation of dislocated Akreos Adapt IOLs, eliminating the need for conjunctival or scleral dissection and requiring no specialized instrumentation.