Long-term outcomes of modified glued versus flanged intrascleral haptic fixation techniques for secondary intraocular lenses

Yuan, Amy; Mustafi, Debarshi; Banitt, Michael R.; Rezaei, Kasra A.

doi:10.1007/s00417-022-05647-0

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Among the 11 patients who received combined IOL fixation and other procedures, such as PPV and iris reconstruction, there were no significant intraoperative or postoperative complications reported over the longterm follow-up. Moreover, the incidence of complications was far lower than those reported in earlier studies [4,5,[10][11][12][13]. The mean postoperative BCVA was significantly improved compared with that before surgery (0.39 ± 0.56 logMAR vs. 0.89 ± 0.72 logMAR, p < 0.05).…”

Section: Discussioncontrasting

confidence: 53%

“…The precise calculation of preoperative IOL power is critical, yet prior research indicates that postoperative refractive outcomes often bear a degree of unpredictability, with postoperative refractive states ranging from mild hyperopia to mild myopia. Retrospective analyses of sutureless intrascleral IOL fixation have yielded varied results; some studies report a myopic shift, while others indicate a hyperopic shift [4,5,10,[12][13][14][19][20][21]. In our study, the mean refractive difference from predicted value showed mild myopic shift (− 0.13 ± 0.42 D), aligning with the findings of Yamane et al Within our patient cohort, 63.6% exhibited a myopic shift, 36.4% a hyperopic shift, and notably, 63.6% achieved a target refractive error within 0.5 D.…”

Section: Discussionmentioning

confidence: 99%

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Application of modified Yamane technique in intrascleral intraocular lens fixation combined with or without iris reconstruction

Wang,

Su,

et al. 2024

BMC Ophthalmol

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Aims To explore the application and long-term clinical effects of modified Yamane technique in intrascleral intraocular lens (IOL) fixation combined with or without iris reconstruction. Settings and design The data of patients receiving IOL fixation with modified Yamane technique in an ophthalmology department between December 2021 and August 2023 were analyzed retrospectively. The longest follow-up duration was > 12 months. Methods and material The trailing haptic was fixed with the needle before the leading haptic. The silicone haptic stoppers were used to stabilize the IOL when iris reconstruction was combined. Preoperative and postoperative best-corrected visual acuity (BCVA), corneal endothelial cells (CECs), postoperative intraocular pressure (IOP), surgical indications and methods, and postoperative complications were recorded. Anterior segment optical coherence tomography (OCT) was used to evaluate IOL decentration and tilt. The paired sample t-test or Wilcoxon rank sum test were used to compare the results of the same index before and after the operation. Results Twelve patients (12 eyes) were included in this cohort. There were 1 case of IOL dislocation, eight cases of lens dislocation or subluxation, and three cases of aphakia. Traumatic lens dislocation was the main cause of aphakia. Primary lens extraction was performed in previous surgeries, and all three were combined with pars plana vitrectomy (PPV). Four of 12 patients underwent IOL fixation and iris reconstruction. The mean age of participants was 63 ± 10.61 years. The mean BCVA increased from 0.89 ± 0.72 logMAR to 0.39 ± 0.56 logMAR at the last visit (p < 0.05). The postoperative relative refractive error was − 0.13 ± 0.42 D (–0.60 D to + 0.57 D). The OCT showed that the IOLs were well centered, with a mean decentration of 0.20 ± 0.13 mm and a mean tilt of 2.31°±0.93°. Ten patients did not experience any complications. Conclusions The modified Yamane technique in IOL fixation surgery, especially combined with iris reconstruction, reduces operation difficulty, increases operational stability and safety, and improves postoperative visual acuity without serious intra- or postoperative complications. The long-term improvement effect was remarkable.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Application of modified Yamane technique in intrascleral intraocular lens fixation combined with or without iris reconstruction

Wang,

Su,

et al. 2024

BMC Ophthalmol

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“…Without prospective randomized controlled trials, direct comparison of outcomes between various SFIOL techniques is challenging. Outcomes for FH SFIOL have been reported from Kakisu et al, 12 Patel et al, 16 Yuan et al, 22 and Ucar. 15 Where reported, our data were in keeping with decreased rate of IOL dislocation among FH cases.…”

Section: Discussionmentioning

confidence: 98%

“…15 Where reported, our data were in keeping with decreased rate of IOL dislocation among FH cases. 16,22 A SFIOL technique using 24-g peripheral intravascular catheter was recently described, with no reported IOL dislocations in 6-month follow-up in 13 eyes. 23 Our practice of haptic flanging of PMMA or polyvinylidene fluoride-based haptics represents off-label use of three-piece IOLs.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of sutureless intrascleral IOL fixation in children and adults: single surgeon case series with and without haptic flanging with up to 11 years of follow-up

Moore,

Bullock,

Walsh

2023

Retina

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Purpose: Report and compare long-term outcomes and complications of sutureless scleral tunnel (SST) and flanged haptic (FH) scleral fixated IOLs (SFIOL), with spontaneous IOL dislocation as primary outcome measure. Methods: Retrospective single-surgeon case series of 95 SST and 458 FH eyes from 2011-2022 (553 total eyes). Demographics, surgical indications, ocular history, visual acuity and complication rates were collected. Results: Reoperation-requiring spontaneous IOL dislocation rate was significantly different (P=0.0167) between FH (3.7%) and SST (10.5%). Mean follow-up was 3.31±0.30 vs. 1.58±0.07 years for SST and FH, respectively. There was no significant difference between preoperative (20/305 vs. 20/300) or final postoperative (20/77 vs. 20/62) visual acuity. Other complications included any cystoid macular edema (20.0% vs. 25.3%), elevated IOP (16.8 vs. 9.6%), IOL tilt requiring re-operation (5.3 vs. 0%), haptic exposure (2.1 vs. 3.3%), and reverse pupillary block (4.2 vs. 1.1%). Conclusions: Haptic flanging resulted in fewer eyes meeting the primary endpoint of IOL dislocation. We report the longest-to-date follow-up of both non-flanged SST IOL fixation and our FH modified Yamane technique. Our FH modified Yamane technique represents a safe, durable, and potentially superior option for SFIOL.

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“…17,19 Although long-term studies are missing, the 5.0 polypropylene sutures, being ten times thicker than the 10.0's, might provide better longevity and higher tensile strength. 16,20…”

Section: Discussionmentioning

confidence: 99%

Double-flanged knotless technique for iris prosthesis and IOL implantation associated with keratoplasty

Lupardi

Moramarco

Iannetta

et al. 2023

European Journal of Ophthalmology

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Introduction Anterior segment reconstruction and penetrating keratoplasty combined with iris prosthesis (IP) and intraocular lens (IOL) scleral fixation require prolonged open-sky surgery and complex suturing. Herein we present a novel double-flanged knotless surgical technique that minimizes the open sky duration and facilitates the fixation of the IP and IOL complex to the sclera. Methods After corneal trephination and removal, a temporary keratoprosthesis is fixated. Three 5.0 polypropylene suture segments are introduced in the anterior chamber transconjunctivally and then externalized through keratoprosthesis. Each suture is threaded through the eyelets of the IP and then flanged. The temporary keratoprosthesis is removed, and the IP and IOL complex is positioned in the sulcus. A donor cornea button is sutured in place and the IP is centred on the optical axis by adjusting the polypropylene sutures. Finally, the suture ends are shortened, flanged, and buried under the conjunctiva. Results Surgery was performed on three eyes of three patients. No intraoperative complications occurred, while cystoid macular edema and ocular hypertension occurred in two patients during the follow-up period. The best corrected visual acuity was 6/20, 8/20, and 13/20. So far the IPs remained stable in the three eyes with a maximum follow-up of 18 months. Conclusion This novel technique of penetrating keratoplasty combined with an intraocular lens (IOL) and iris prosthesis implantation makes it possible to reduce open sky surgery time, avoid complex suturing, and ensure optimal IOL visual axis alignment by adjusting suture tension.

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Long-term outcomes of modified glued versus flanged intrascleral haptic fixation techniques for secondary intraocular lenses

Cited by 9 publications

References 29 publications

Application of modified Yamane technique in intrascleral intraocular lens fixation combined with or without iris reconstruction

Application of modified Yamane technique in intrascleral intraocular lens fixation combined with or without iris reconstruction

Long-term outcomes of sutureless intrascleral IOL fixation in children and adults: single surgeon case series with and without haptic flanging with up to 11 years of follow-up

Double-flanged knotless technique for iris prosthesis and IOL implantation associated with keratoplasty

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