Refractive Outcomes of Four Point Scleral Fixation of Akreos A060 Intraocular Lens Using Gore-tex Suture

Abstract

Purpose : To describe refractive outcomes post secondary intraocular lens implantation with 4 point scleral fixated Akreos A060 intraocular lens (IOL) using Gore-tex suture.

Methods : This was a single center, retrospective, consecutive case series. Cases were found using CPT codes for the Akreos intraocular lens from 8/2014 to 12/2018. Exclusion criteria were ocular pathology that precluded an accurate refraction. Baseline preoperative patient data was collected including age, sex, visual acuity (VA), spherical equivalent (SE) and corneal astigmatism. Intraoperative data collected incorporated refractive target, distance from limbus to sclerotomy site, and surgeon’s choice of clear cornea wound or scleral tunnel. Postoperative data were composed of VA, refraction, and complications. Primary outcome measures were post operative SE, astigmatism and deviation from spherical target in diopters. The secondary outcome was variance between SRK and Holladay formula calculations.

Results : There were 95 eyes of 94 cases that met the inclusion criteria from a total of 158. Median age was 61.0 +/- 15.7, range 12-93 years old. Mean follow up was 206 days (range 8-883 days). Pre-operative average best corrected visual acuity (BCVA) LogMAR was 0.56 +/- 0.53, Snellen 20/73. Average refractive target was -0.436 diopters on SRK and -0.461 diopters on Holladay. The average pre-op corneal astigmatism was 1.53 (range 0 to 7.71 D) diopters using IOL master K values. Average BCVA post operatively was 0.21 +/- 0.20, Snellen 20/30. The average post-operative SE was -0.671 diopters. The average post-operative astigmatism was 1.24 diopters (range 0 to 5.75 D) and was 0.29 diopters less than average pre-operative astigmatism. There was no significant difference in refractive outcomes in clear corneal versus scleral tunnel or location of sclerotomy between 2.0 mm and 3.0 mm posterior to the limbus.

Conclusions : This study is the largest series to date to examine data for the 4 point fixation of secondary IOLs using Akreos A060 lens and Gore-tex suture. Refractive outcomes for this technique in patients with good visual potential were excellent and closely approximated the target. There was statistically no difference between SRK and Holladay formulas, clear cornea versus scleral tunnel, and location of the sclerotomy site. Complications of the procedure were rare and largely transient.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.