Secondary Iol Implantation: Yamane Technique Vs Posterior Iris Enclavation

Published 2023 - 41st Congress of the ESCRS

Reference: FP29.06 | Type: Free paper | DOI: 10.82333/hsyp-9p77

Authors: Marco Pastore* ¹ , Gian Marco Guerin ¹ , Pier Luigi Guerin ¹ , Stefano Gouigoux ¹ , Daniele Tognetto ¹

¹Department of Medicine, Surgery and Health Sciences,Eye Clinic, University of Trieste,Trieste,Italy

Purpose

To evaluate early and late complication rates, best corrected visual acuity (BCVA), and refractive outcomes of secondary intraocular lens (IOLs) implantation

via Yamane technique or posterior iris enclavation.

Setting

Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste

Methods

Retrospective observational not-randomized study clinical and instrumental data from 105 eyes of 101 patients who underwent secondary IOL implantation were collected including early complications (occurred within the first month) and late complications (occurred later than one month), BCVA and manifest refraction at the last follow-up visit. The mean follow-up was 12.9 ± 5.8 months. Patients were divided into two groups according to the surgical procedure they went through, in the first Artisan Aphakia lenses were implanted, in the latter 3-pieces IOLs, the ZA9003, were used. Indications for surgery were surgical aphakia (20%), IOL subluxation (58%) and IOL dislocation into the vitreous chamber (22%).

Results

No postoperative statistically significant difference in best corrected visual acuity (BCVA) was found between the two groups. Yamane’s technique resulted in a higher rate of early dislocations (p= 0,10) but has shown a lower percentage of early hypertension (p= 0,19) although not statistically significant. Cystoid macular edema was the most frequent complication in both groups. In the refractive analysis both groups produced a hyperopic refractive prediction error (RPE) with posterior iris enclavation having a lower absolute refractive error (MAE) (p= 0,02), indeed a RPE between ± 0,50D was found in 54,3% patients of the posterior iris enclavation group while only 34,6% of the patients in Yamane’s group reached that target.

Conclusions

Both techniques were successful in increasing BCVA in the absence of an adequate capsular support with similar complication rates.

The iris enclavation technique has the advantage of being a more widespread and simpler surgical technique even though a greater risk of endothelial decompensation and dysphotopsias in case of malposition or scotopic pupillary diameters > 6 mm can occurs. The Yamane’s technique is sutureless with smaller corneal incisions, but requires more surgical experience, presents a non-negligible risk of dislocation/tilting and a less predictable postoperative refraction. Therefore, except in case with extensive scleromalacia or iris atrophy the choice of a technique over the other can be based on surgeon’s experience.