Postoperative Flange Stability Following Intrascleral Iol Fixation: A Prospective Randomized Comparison
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT208 | Type: Free paper | DOI: 10.82333/zamp-vw85
Authors: Prof. Dr Markus Schranz* 1 , Dr Marcus Lisy 1 , Dr Klaudia Birner 1 , Dr Nikolaus Mahnert 1 , Dr Victor Danzinger 1 , Prof. Dr Daniel Schartmüller 1 , Prof. Dr Claudette Abela-Formanek 1
1Ophthalmology and Optometry,Medical University of Vienna,Vienna,Austria
Purpose
To prospectively compare postoperative flange stability and clinical outcomes between the two most commonly used techniques for intrascleral intraocular lens (IOL) fixation: the Yamane technique and the 4-flanged technique.
Setting
Single-center prospective randomized comparative study at a tertiary referral center
Methods
Patients with subluxated IOLs or absent capsular support were randomized 1:1 to either the Yamane group (YG) or the 4-flanged group (4G).
Follow-up visits were conducted at 1, 4, 12, and 52 weeks postoperatively. Flange position relative to the sclera was assessed by slit-lamp examination using a standardized grading scale:
0 = intrascleral and not visible;
1 = intrascleral and visible;
2 = flush with sclera;
3 = subconjunctival;
4 = conjunctival erosion with exposed flange.
Higher scores indicated more superficial flange positioning.
Intergroup comparisons and longitudinal changes were analyzed using generalized estimating equations and mixed-effects models.
Results
Fifty-four eyes were evaluated (YG: 28; 4G: 26).
In the YG, a significant increase in haptic visibility over time was observed, reaching a plateau at 12 weeks (p < 0.01). In contrast, the 4G demonstrated a continuous and significant decrease in haptic visibility from week 1 to week 52 (p < 0.01), indicating progressive internalization.
Between-group differences were significant at week 1 (p < 0.01) and week 4 (p < 0.01).
Conclusions
Over time, the Yamane technique demonstrated significantly more stable flange positioning compared with the 4-flanged technique. Although no cases of complete flange internalization or recurrent IOL subluxation were observed in this cohort, the findings suggest a higher potential risk of flange displacement with the 4-flanged technique. Long-term monitoring of flange position appears essential to ensure sustained fixation stability.