Infection risk after intrascleral IOL fixation: how to minimize?

Abstract

Aim. To evaluate the incidence and causes of endophthalmitis following intrascleral intraocular lens (IOL) fixation and to identify strategies for minimizing postoperative infectious complications. Material and methods. A retrospective analysis was performed on 130 patients (130 eyes) who underwent intrascleral IOL fixation at the Adult Ophthalmology Department of the Moscow Regional Research and Clinical Institute (MONIKI) between 2025 and 2026. Both the sutureless Yamane technique and Lewis scleral-sutured fixation were used. All patients received the same perioperative antiseptic protocol and intracameral cefuroxime (1 mg). The incidence, timing, risk factors, microbiological findings, and treatment outcomes of postoperative endophthalmitis were analyzed. Results. Delayed-onset endophthalmitis occurred in 2 of 130 eyes (1.54%) at 4 and 7 months after surgery. In both cases, conjunctival erosion with exposure of a polypropylene flange or suture knot was identified as the source of infection. Microbiological examination revealed Staphylococcus epidermidis with biofilm formation on the explanted fixation material. Conservative topical and systemic antibiotic therapy was unsuccessful, requiring pars plana vitrectomy, removal of the exposed fixation elements, and repeat IOL fixation. No infectious complications were observed in the remaining patients during the one-year follow-up period. Conclusions. Exposure of scleral fixation elements represents the major risk factor for delayed postoperative endophthalmitis after intrascleral IOL fixation. Complete intrascleral burial of haptics or sutures, secure conjunctival-tenon's coverage, routine intracameral antibiotic prophylaxis, and early surgical management of conjunctival erosion are effective measures for minimizing the risk of severe infectious complications.