Acute postoperative complications after scleral fixation of Akreos AO60 intraocular lens

We report three cases of postoperative exogenous endophthalmitis and toxic anterior segment syndrome (TASS) following vitrectomy for dislocated intraocular or crystalline lenses and scleral fixation of an Akreos intraocular lens (IOL) with Gore-Tex sutures. To our knowledge, postoperative exogenous endophthalmitis and TASS have not been previously described with this technique. A 67-, 56-, and 36-year-old underwent pars plana vitrectomy, lens removal or vitreolensectomy, and Akreos IOL scleral fixation. Three days later, cases 1 and 3 required vitreous biopsy and intravitreal Vancomycin/Amikacin for culture-positive endophthalmitis (<i>Staphylococcus epidermidis</i> and <i>Streptococcus pneumoniae</i>). Case 2 underwent removal of a dislocated fluocinolone implant, biopsy, and intravitreal antibiotics; negative cultures supported a diagnosis of TASS. Scleral-fixated IOLs carry risks of endophthalmitis and TASS. Large corneal wounds increase risk; meticulous wound construction is essential. Akreos IOLs do not prevent anterior migration of steroid implants. Immediate management is crucial.