Visual outcomes and short-term complication profile following Yamane scleral fixation of intraocular lenses across different surgical indications.

Abstract

Purpose: To evaluate visual and safety outcomes of double-flanged (Yamane) intrascleral intraocular lens fixation across different clinical scenarios of capsular support loss.

Methods: This retrospective cohort study included 55 eyes undergoing Yamane scleral fixation. Eyes were stratified by surgical indication into aphakia (10), dislocated intraocular lens (12), complicated phacoemulsification (15), and dropped intraocular lens managed with pars plana vitrectomy (18). Best-corrected visual acuity, intraocular pressure, and postoperative complications were assessed preoperatively and at 1-week, 1-month, and 3-month follow-up. Multivariable regression analysis was performed to evaluate associations between clinical factors and final visual acuity.

Results: Best-corrected visual acuity improved significantly in all groups (p < 0.001), with no intergroup differences at any postoperative time point (all p > 0.05). Postoperative intraocular pressure remained comparable across groups (p > 0.05). Early postoperative complications were more frequent in the phacoemulsification with scleral fixation group (p = 0.01), primarily transient corneal edema (93.3%) and transient intraocular pressure elevation (53.3%). Lens-related complications, including iris optic capture, intraocular lens tilt, and intraocular lens dislocation, each occurred in 6.7% and required surgical repositioning. Later postoperative complication rates at 1 and 3 months were comparable among groups. Postoperative refractive outcomes, including spherical equivalent and prediction error, were comparable across all surgical indications, with no significant intergroup differences (all p > 0.05).

Conclusions: Yamane scleral fixation was associated with consistent short-term visual improvement and an acceptable short-term complication profile across a broad range of clinical indications in eyes without capsular support. Combined cataract extraction with scleral fixation was associated with visual outcomes comparable to isolated secondary intraocular lens fixation but was associated with a higher incidence of early postoperative complications.