Diagonal haptic capture of an acrylic intraocular lens - Longterm safety and efficacy

PURPOSE: To evaluate the long-term safety, stability, and visual outcomes of diagonal haptic capture (DHC) of a 4-haptic hydrophilic acrylic intraocular lens (Akreos adapt, Bausch&Lomb) in eyes with posterior capsule deficiency and an intact anterior capsulorhexis. SETTING: Single tertiary referral center. DESIGN: Retrospective interventional case series. METHODS: Medical records were reviewed for patients who underwent cataract surgery complicated by posterior capsule rupture and in whom DHC was used for IOL fixation between 2015 and 2023. Twenty eyes of 20 patients were identified. Fellow eyes with uneventful in-the-bag implantation of the same IOL model served as controls. RESULTS: Median follow-up was 2 years (mean 2.6±2.1 years; range 0-6 years) based on data from referring ophthalmologists, and 8 years (mean 6.0±2.8 years; range 2-9 years) for patients examined at the study center. Mean postoperative corrected distance visual acuity did not differ significantly between DHC eyes and fellow eyes (p>0.4). Refractive predictability and intraocular pressure were comparable between groups. All IOLs remained well centered with normal tilt throughout follow-up. No cases of pigment dispersion glaucoma, uveitis-glaucoma-hyphema syndrome, pseudophacodonesis, or late IOL dislocation were observed. In a subset of eyes, anterior segment optical coherence tomography demonstrated adequate clearance between the IOL and posterior iris without evidence of iris chafing. CONCLUSIONS: Diagonal haptic capture of a 4-haptic hydrophilic acrylic IOL provided stable long-term fixation, satisfactory visual and refractive outcomes, and a low incidence of complications. However, these results may be IOL-specific.