1 Year Surgical Outcomes And Safety Of Secondary Fixated Intraocular Lenses Using Yamane Technique

To describe the characteristics and 1-year postoperative surgical outcomes of modified yamane technique scleral fixated intraocular lens (SFIOL) with for subluxated cataracts and intraocular lenses (IOLs) by a single surgeon and demonstrate the learning curve and improvement in outcomes after the first 10 cases.

2 tertiary referral centres where a single anterior segment surgeon performed the technique with 3 different vitreo retinal surgeons. 

Consecutive cases of significantly subluxated or dislocated cataracts and IOLs from July 2022 to  July 2023 were included in this retrospective case series. In all cases, the anterior segment surgeon performed the SFIOL. In cases where the original IOL require explantation, the IOL was often anteriorized and removed by the anterior segment surgeon as well before the VR surgeon performed trans pars planar vitrectomy(TPPV) an cases with a completely dislocated IOL, the VR surgeon would anteriorize the IOL but it would be removed by the anterior segment surgeon.  

A total of 65 eyes of 62 patients were included. Median age was 67.4 (interquartile range [IQR] 27-89) years. 52(80%) underwent combined trans pars planar vitrectomy(TPPV), explant of IOL and SFIOL,  9(13.8%) underwent TPPV with IOL explant with SFIOL at a later date, 4(1.07%) underwent TPPV, lensectomy, SFIOL. Overall median preoperative logMAR BCVA was 0.9 (IQR 0-2.5). Median logMAR BCVA improved to 0.3 (0-1.9). 78.5% of eyes achieved logMAR ≤ 0.3, and 96.9% achieved IOL stability at month 12.The most commone complication of cystoid macula oedema occurred in 9.23%. Endothelial cell loss was significantly pronounced in eyes that required lensectomy compared to those requiring explant of IOL. 3 patients had IOL capture in front of iris. 

Modified yamane technique SFIOL is a good surgical option for subluxated IOL or cataract without sufficient capsular support, with at least 78.5% of eyes achieved logMAR ≤ 0.3, and 96.9% achieved IOL stability at month 12. While the learning curve is initially steep and complications can occur, outcomes after the first five cases rapidly stablilised and became predictable