Combined Pars Plana Vitrectomy and Novel Scleral Fixation of the Light Adjustable Lens

Purpose: The light adjustable lens (LAL) (RxSight, Aliso Viejo, CA) is a premium intraocular lens that allows for correction of residual refractive error and astigmatism following implantation. Herein, we describe the surgical approach and evaluate the visual outcomes of patients following scleral fixation of the LAL. Methods: Retrospective, single-surgeon surgical case series of 3 patients (3 eyes) with intraocular lens complications, who underwent combined pars plana vitrectomy and sutureless needle assisted intrascleral haptic fixation of the LAL between April 2022, to August 2023. Results: A total of 3 patients (73.3 ± 4.4 years) underwent off-label application of sutureless intrascleral haptic fixation of the LAL. Indications for surgery included pseudophacodonesis (N=1), dislocated subluxed IOL with secondary vitreous hemorrhage (N=1), and multifocal IOL intolerance (N=1). Preoperative average visual acuity of 0.2 ± 0.1 (20/30) LogMAR improved to 0.03 ± 0.03 LogMAR (20/20) at 1 month follow-up after LAL ultraviolet light treatments. Preoperative sphere of +0.25 ± 0.9 improved to +0.0 ± 0.0 and preoperative cylinder of +0.4 ± 0.4 improved to +0.0 ± 0.0 postoperatively. No surgical complications were noted. Conclusion: Scleral fixation of the LAL is a viable option for eyes without capsular support to maximize postoperative uncorrected visual acuity outcomes.