Repositioning Ocular Lenses and Optimizing Vision Outcomes, With Mark Breazzano, MD

At the 2025 New York State Ophthalmological Society (NYSOS) Annual Meeting, Mark P. Breazzano, MD, associate professor of ophthalmology at the Flaum Eye Institute at the University of Rochester Medical Center, presented a surgical video demonstrating the repositioning of a scleral-sutured lens.

Repositioning intraocular lenses (IOLs) presents a technical challenge, as it requires precision, planning, and familiarity with lens-specific features. Breazzano’s video presentation specifically highlighted a flipped lens, the positioning of which was determined based on comparison to optimal haptic placement behind the iris for the Bausch & Lomb Akreos adaptive optic 60 (AO60) lens. The operation aimed to correct the lens’s positioning between the anterior chamber and the vitreous cavity.

“The Akreos lens is a pretty commonly performed surgery, primarily out of necessity,” Breazzano told HCPLive. “There are other techniques that have been quite popular; however, due to production constraints and materials involved, issues with haptic integrity and extrusion of the haptics through conjunctiva make options like Akreos a much more attractive option.”

Still, however, the need for repositioning is uncommon. Breazzano notes that outright removal of the lens is a much larger and more extensive surgery, given the size of the lens in question and the opening required to remove it. Repositioning the lens instead reduces surgical trauma in select cases.

Breazzano also noted the complexity of the repositioning, advising clinicians facing similar operations to prepare as much as possible for the operation. Maintaining vision while also properly orienting the lens so that the patient’s eye generates healthy tissue and exhibits fresh conjunctiva. Additionally, Breazzano suggested postoperative confirmation of lens orientation via direct visualization to further ensure success.

“I usually inform my trainees, residents, and fellows, measure three times and cut once,” Breazzano told HCPLive. “That was certainly the case here; normally, just out of convention, we usually have the lens oriented in the horizontal plane if the patient were to be sitting or standing up.”

Relevant disclosures for Breazzano include Eyepoint, Ophtea, Ocuterra, and others.

Referencs

1. Breazzano, MP. Repositioning of flipped and backward scleral-sutured intraocular lens. Presented at the 2025 New York State Ophthalmological Society Annual Meeting, May 16, 2025. New York, NY.