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Akreos Capsular Issues

I had implanted ~40 B & L Akreos AO60 IOLs over the past 4-5 months.
I had been very pleased with the lens until two patients showed up for their 4 month postop visit.

In 3 eyes there was a significant tilting of the IOL with the induction of astigmatism and a variable amount of spherical error compared to their 3 week refraction. The fourth eye which also had the AO60 did not have any issues.

One eye had significant phimosis reducing the anterior capsular opening to 2.5 x 2.8 mm. This patient had a low grade iritis as well. The other two eyes (one patient) did not have phimosis

None of the patients had any preoperative conditions or operative complications that would predispose to weak zonules.

I did anterior capsular relaxing incisions with the YAG laser in the phimosis case and this gave a nice optical opening, but no change in the IOL position.

I did an IOL exchange on one of the other eyes and found it very difficult to dissect one of the haptics out of the bag. I am concluding that this IOL has loops and/or a look haptic-junction that is too flexible for cases that have capsular contraction.

Two articles have some relevance:
JCRS 2010; 36:161-163
JCRS 2010; 36:1605-1609 (this one deals with other hydrophilic acrylic lenses, not the Akreos)

I did contact my B & L rep and did fill out the form that they requested on the one lens that I exchanged. Unfortunately I did not save the IOL, an oversight while in the midst of doing this challenging case.

I spoke to Joel Pynson, MD while at the ASCRS meeting in San Diego. He is a French ophthalmologist and has the title of Director Research Surgical R & D at B & L. I think they said that he designed the lens. No one had anything specific to say, but acknowledged that there have been a few reported cases like mine.

I also sent this information to Liliana Werner and Stephen Tuft, the authors of the above papers. (See “Letters of Opinion”)

Also, of interest, I think is another patient who I saw just recently. Here is a summary:

Gus T, AO60 lenses
Right eye

  • Surgery on 2/14/11, uncomplicated insertion of a 20.5 D lens
  • 2/14/11—no refraction, but VA was 20/20 without correction
  • 7/7/11— spherical equivalent +1.12 D. IOL is definitely more posterior than expected, no obvious tilt and no phimosis of anterior capsulotomy

Left eye

  • Surgery on 1/11/11, uncomplicated insertion of a 20.5 D lens
  • 1/12/11—no refraction, but VA was 20/25 without correction
  • 2/10/11—spherical equivalent is +0.50 D
  • 3/3/11— spherical equivalent is +0.75 D
  • 7/7/11— spherical equivalent +1.00 D. IOL is definitely more posterior than expected, no obvious tilt and no phimosis of anterior capsulotomy

The IOLs did not show any significant crimping of the haptics. There appeared to be a posterior vault, but I may have been reading into it.

I feel that this patient’s experience demonstrates that capsular bag contraction compressed the IOLs, causing a posterior vault and a hyperopic shift.

I would certainly appreciate feedback from anyone.

S Jerome Holtz
108 Broughton Avenue
Bloomfield, NJ 07079
United States
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