Comparison of Refractive Prediction Error by Axial Length in Flanged Intrascleral Intraocular Lens Fixation.

This study aims to investigate the postoperative refractive outcomes in eyes that underwent the flanged intrascleral intraocular lens (IOL) fixation combined with vitrectomy with or without gas/air tamponade. The eyes were divided into two groups (Group A; eyes that underwent flanged intrascleral IOL fixation with gas/air tamponade, and Group B; eyes that underwent flanged intrascleral IOL fixation without gas/air tamponade). The predicted spherical equivalent (SE) refraction values were calculated using the Sander-Retzlaff-Kraff Theoretical formula. Then, the prediction error was calculated by subtracting the predicted SE refraction from the postoperative objective SE refraction and the absolute prediction error was calculated as the absolute value of the prediction error for each eye. A total of 68 eyes were included in the current study. There was a significant correlation between the predicted and postoperative SE refraction in both groups (Group A, r = 0.968, P < 0.0001, Group B, r = 0.943, P < 0.0001, linear regression analysis). The prediction error demonstrated a mild myopic shift after the flanged intrascleral IOL fixation in both groups (Group A, -0.40 ± 0.96 diopter, Group B, -0.59 ± 0.95 diopter). There was no significant difference in prediction error and absolute prediction error between the two groups ( P = 0.44, P = 0.70, Wilcoxon rank sum test). The postoperative SE refraction after flanged intrascleral IOL fixation was not influenced by gas/air tamponade.

To restore vision in complex eyes with coexisting anterior and posterior segment problems, combined corneal transplantation (penetrating keratoplasty [PK] or Descemet-stripping automated endothelial keratoplasty [DSAEK]), pars plana vitrectomy (PPV), and/or flanged intrascleral intraocular lens (IOL) fixation, designated vitreocorneal surgery are performed. In this study, we evaluated the usefulness of vitreocorneal surgery for eyes with complex comorbidities. Thirteen consecutive eyes in 13 patients with coexisting corneal pathology (ie, corneal scarring, bullous keratoplasty, corneal laceration) and posterior segment pathology (ie, aphakia without capsular support, retinal detachment, intravitreal foreign body) underwent vitreocorneal surgery. Visual outcomes, intraoperative and postoperative complications, and additional surgery were retrospectively evaluated. Vitreocorneal surgery included PK + PPV + intrascleral IOL fixation (n = 5), PK + PPV (n = 3), PK + intrascleral IOL fixation (n = 1), DSAEK + intrascleral IOL fixation (n = 1), and DSAEK + PPV + intrascleral IOL fixation (n = 3). An intraoperative Eckardt temporary keratoprosthesis use enabled safe PPV. No vitreoretinal/IOL complications occurred. One eye required repeat DSAEK to repair endothelial graft detachment and inversion. In 3 eyes, secondary glaucoma was subsequently treated by glaucoma drainage device implantation through the pars plana. Mean best spectacle-corrected visual acuity (logMAR) improved from 1.8 ± 0.9 preoperatively to 1.1 ± 0.6 at 11.2 ± 14.6 months postoperatively (P = 0.002). Postoperative refraction was -0.68 ± 2.56 D (spherical equivalent). PK or DSAEK with PPV and/or flanged intrascleral IOL fixation is useful for complex eyes with coexisting anterior and posterior segment problems.

Purpose: To compare the anatomical and clinical outcomes based on the distance from the corneal limbus to the scleral tunnel in flanged intrascleral intraocular lens (IOL) fixation.Methods: We retrospectively analyzed the medical records of patients who underwent scleral fixation of flanged IOLs. Group 1 (54 eyes) had a distance of 2.1 mm from the corneal limbus to the scleral tunnel, and Group 2 (48 eyes) had a distance of 2.8 mm. We evaluated the best corrected visual acuity (BCVA), postoperative complications, IOL tilt and decentration, refractive prediction error (RPE), effective lens position, and iris-IOL distance.Results: The BCVA, postoperative complications, IOL tilt, and IOL decentration did not differ between the two groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). The RPE showed a hyperopic shift in Group 1 and a myopic shift in Group 2 (Group 1: +0.24 ± 0.68 D, Group 2: -0.03 ± 0.43 D, &lt;i&gt;p&lt;/i&gt; = 0.03). The iris-IOL distance was statistically longer in Group 1 compared to Group 2 (Group 1: 1.02 ± 0.40 mm, Group 2: 0.57 ± 0.32 mm, &lt;i&gt;p&lt;/i&gt; = 0.02). The incidence of pupillary optic capture was significantly higher in Group 2 compared to Group 1 (Group 1; 0%, Group 2; 8.3%, &lt;i&gt;p&lt;/i&gt; = 0.03).Conclusions: It should be considered that a shorter distance from the corneal limbus to the scleral tunnel results in a postoperative hyperopic shift and reduces the incidence of pupillary optic capture when performing flanged intrascleral IOLs fixation.

We compared our early experience of visual outcomes, operation time, and complications for two techniques of intrascleral intraocular lens (IOL) fixation: T-fixation and flanged IOL fixation. Data from patients who underwent scleral fixation of an IOL between October 2017 and December 2018 were analyzed retrospectively. Intraoperative time for fixation steps, corneal endothelial cell density (ECD) rate reduction, and intraoperative/postoperative complications were compared between T-fixation (Group T, n = 4) and flanged IOL fixation (Group F, n = 6). Mean patient age was 73.7 ± 13.0 years. Intraoperative time was significantly longer for Group T (27.5 ± 9.7 min) than for Group F (13.0 ± 3.8 min; P=0.03, Mann-Whitney U-test). Intraoperative complications included iris damage from the 30-G needle in 2 eyes in Group F. Postoperative complications included iris capture by the IOL in 1 eye in Group F. No incidents of postoperative retinal detachment or IOL dislocation were identified. The ECD reduction rate did not significantly differ between groups. Both techniques yielded favorable surgical outcomes. Flanged IOL fixation might be superior because of its shorter intraoperative time but could initially be technically difficult because of the need to perform angled sclerotomy with a 30-G needle to avoid iris injury.

Purpose: We compared the surgical outcomes and complications of conventional, sutured scleral fixation and flanged intrascleral intraocular lens (IOL) fixation.Methods: We retrospectively analyzed the medical records of patients who underwent conventional, sutured scleral fixation or flanged intrascleral IOL fixation and who were then observed for more than 6 months. The best-corrected visual acuity (BCVA), operation time, spherical equivalent (SEQ), astigmatism, and postoperative complications were recorded up to 6 months after surgery.Results: Of sixty-nine enrolled eyes, 39 underwent conventional, sutured scleral fixation (“sutured” group) and 30 flanged intrascleral IOL fixation (“sutureless” group). The operation time was significantly shorter in the sutureless group than in the sutured group (56.3 ± 11.8 vs. 77.7 ± 17.9 minutes, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). In both groups, the BCVA and SEQ improved significantly at all visits after surgery compared to the baseline values &lt;i&gt;p&lt;/i&gt; &lt; 0.05). There was no between-group difference in BCVA, SEQ, astigmatism, or complications.Conclusions: Compared to conventional, sutured scleral fixation, flanged intrascleral IOL fixation afforded equivalent improvements in visual acuity but with a shorter surgical duration. Therefore, flanged intrascleral IOL fixation is a useful alternative to conventional, sutured scleral fixation.

PurposeIn this study, we aimed to report on the early results of intrascleral intraocular lens (IOL) fixation using a hook-shaped haptic IOL (hsh-IOL).Patients and MethodsWe enrolled 27 consecutive eyes of 27 patients (mean age, 74±11.4 years) who underwent intrascleral IOL fixation with an hsh-IOL and were followed-up for 3 months postoperatively. The reasons for surgery included insufficient capsular support, including IOL dislocation, aphakia, or dislocated crystalline lens. The haptic of the hsh-IOL was externalized from the eye using forceps, and the hook was buried in the scleral tunnel. We investigated the preoperative and 3-month postoperative corrected visual acuity (VA), intraocular pressure (IOP), corneal endothelial cell density, refractive prediction error, postoperative intraocular astigmatism, surgically induced astigmatism, and intraoperative and postoperative complications.ResultsThe mean postoperative corrected VA (logMAR, 0.083±0.18) was significantly better than the mean preoperative value (0.42±0.60, p=0.0007). The 3-month postoperative mean absolute prediction error was 1.00±0.96 D. The mean IOL-induced astigmatism was 0.95±0.70 D. Further, the mean postoperative corneal endothelial cell count (2036±644 cells/mm2) was significantly lower than the preoperative value (2316±527 cells/mm2) (p=0.009). No patient had a 1-month postoperative IOP <5 mmHg or >25 mmHg. There were no intraoperative or vision-threatening complications, such as retinal detachment, endophthalmitis, or IOL dislocation, due to postoperative haptics misalignment.ConclusionIntrascleral IOL fixation using hsh-IOL is an effective option for eyes with insufficient capsular support.

Combined flanged intrascleral intraocular lens fixation with corneal transplant

To evaluate the refractive prediction error (RPE) of intraocular lens (IOL) calculation formulas in eyes that have undergone the Yamane technique for scleral fixation of IOLs. Alkek Eye Center, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. Retrospective case series from electronic chart review. Patients who had undergone scleral fixation of secondary IOLs were selected. The IOL RPEs for 4 IOL prediction formulas-Barrett Universal II, Holladay 1, Hoffer Q, and SRK/T formulas-were obtained by subtracting the predicted spherical equivalent from the postoperative spherical equivalent. The arithmetic mean RPE, mean absolute error (MAE), and percentages of eyes with prediction error of 0.50 diopter (D) or lesser and 1.00 D or lesser were calculated and compared. Forty eyes of 40 patients met inclusion criteria. All formulas produced hyperopic mean arithmetic RPE. MAE values were 0.73 D for Holladay 1, 0.76 D for Barrett Universal II, 0.80 D for SRK/T, and 0.86 D for Hoffer Q formulas. The percentage of eyes with prediction error of 0.50 D or lesser and 1.00 D or lesser with these formulas were 45% (18 eyes) and 75% (30 eyes) for Holladay 1, 38.5% (15 eyes) and 77% (30 eyes) for Barrett Universal II, 32.5% (13 eyes) and 67.5% (27 eyes) for SRK/T, and 27.5% (11 eyes) and 62.5% (25 eyes) for Hoffer Q formulas. There were no statistically significant differences in prediction errors between the 4 formulas. Refractive outcomes of the Yamane technique were less predictable than those of standard cataract surgery. Arithmetic RPE ranged from hyperopic to predicted values for all formulas tested.

To evaluate the refractive prediction accuracy of intraocular lens (IOL) power calculation formulas after flanged intrascleral IOL fixation(SF-IOL; Yamane technique) in long axial length (AL) eyes. The University of Osaka Hospital, Osaka, Japan. Retrospective observational cohort study. Eyes undergoing SF-IOL between January 2023 and April 2024 were classified into normal (N, <26.0 mm) and long (L, ≥26.0 mm) AL groups. Barrett Universal II, Hoffer Q, Holladay 1, and SRK/T were evaluated. Prediction error (PE) was defined as 3-month postoperative spherical equivalent minus predicted value. Prediction accuracy was assessed using root mean square absolute error (RMSAE) and the Formula Performance Index (FPI). Fifty-three eyes from 50 patients were analyzed (N=35; L=18). Mean AL was 24.6±0.8 mm (N) and 27.1±1.0 mm (L). Mean PE (N and L) was -0.55±0.72 D and -0.64±0.62 D with Barrett Universal II (P=0.52), -0.68±0.77 D and -0.45±0.62 D with Hoffer Q (P=0.32), -0.78±0.74 D and -0.31±0.72 D with Holladay 1 (P=0.043), and -0.74±0.72 D and -0.62±0.72 D with SRK/T (P=0.60). In L group, Holladay 1 showed PE nearest zero; however, demonstrated steep AL-PE regression slope and low FPI. Barrett Universal II yielded the lowest RMSAE and the highest FPI. Barrett Universal II demonstrated the highest overall predictive accuracy in long AL eyes undergoing SF-IOL. Although Holladay 1 produced a smaller PE in long AL, this reflected systematic offset rather than superior accuracy, as indicated by its lower FPI.

BackgroundPupillary capture can cause complications after intrascleral intraocular lens (IOL) fixation; however, no method has been established to definitively prevent pupillary capture. Therefore, we aimed to examine the differences in the incidence of pupillary capture in patients who underwent intrascleral IOL fixation and had intraoperative lens capsule preservation or lens capsule loss.MethodsThis single-center, retrospective study, conducted at a University Hospital, included 83 eyes from 83 patients. The eyes were allocated to the capsule and no-capsule groups based on the presence or absence of capsule, respectively. Patient demographics, causative diseases, incidence of pupillary capture at 1 year postoperatively, anterior chamber depths (ACDs), IOL tilts, and decentrations of the two groups were analyzed and compared.ResultsThe capsule and no-capsule groups comprised 26 and 57 eyes, respectively. The indications for intrascleral IOL fixation were: IOL dislocation in 6 (23.1%) and 41 (71.9%), artificial aphakia in 4 (15.4%) and 2 (3.5%), conversion during cataract surgery due to complications (zonular dialysis or posterior capsule rupture) in 14 (53.9%) and 3 (5.3%), lens dislocation in 0 and 11 (19.3%), and IOL opacification in 2 (7.7%) and 0 eyes in the capsule and no-capsule groups, respectively (P < 0.05). The postoperative outcomes including ACD, magnitude of tilt, or decentration of the fixed IOL did not differ between the two groups (P > 0.05). Pupillary capture was observed in eight eyes, all in the no-capsule group (P < 0.05).ConclusionsWhen performing intrascleral fixation in cases where the lens capsule remains, preserving the capsule and fixing the IOL under the capsule may prevent postoperative pupillary capture.

AimsTo 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 designThe 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 materialThe 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.ResultsTwelve 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.ConclusionsThe 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.

Peripheral Iridectomy in Intrascleral Intraocular Lens Fixation: Preventing Reverse Pupillary Block

We describe three cases of pseudoexfoliation syndrome (PEX) in which good outcomes were achieved after secondary intrascleral intraocular lens (IOL) fixation with capsule preservation for aphakic eyes. Three Japanese patients with PEX underwent phacoemulsification and aspiration (PEA) owing to challenges in IOL intracapsular fixation caused by zonular weakness. Case 1 involved an 83-year-old man with PEX. Six weeks post-PEA, 30-gauge needles were inserted to exit between the capsule and the iris. The IOL was fixed intrasclerally using the double-needle technique. Case 2 involved a 90-year-old man with PEX. The same abovementioned double-needle intrascleral IOL fixation procedure was performed eight weeks post-PEA. Intraoperative vitreous prolapse into the anterior chamber was observed, and anterior vitrectomy was performed. Case 3 involved an 80-year-old man with PEX. Seven weeks post-PEA, the patient underwent the same double-needle intrascleral IOL fixation procedure. Good IOL fixation was achieved in all patients without postoperative iris capture. No serious complications, including retinal detachment and vitreous hemorrhage, were observed. Preserving the capsule during secondary IOL scleral fixation for aphakic eyes can effectively reduce intraoperative vitreous prolapse, minimize surgical invasiveness, suppress iris flutter, and prevent capture of the pupillary IOL, making it a meaningful and acceptable approach, although the long-term risks, such as potential lens capsule drop, should be studied further.

Purpose To assess the visual and refractive outcome of immediate intraoperative vitrectomy and intrascleral intraocular lens implantation using a “standardized” sutureless Yamane technique during cataract luxation in the vitreous chamber as a complication of phacoemulsification. Design A prospective, interventional, consecutive case series. Materials and Methods Twelve patients underwent vitrectomy and intrascleral intraocular lens fixation using a standardized Yamane technique as the primary procedure during complicated phacoemulsification. Patients were evaluated preoperatively and 6 months postoperatively for best-corrected distance visual acuity, correspondence to the preoperative refractive target in the spherical equivalent, endothelial cell count, and complications. Results Mean preoperative best-corrected visual acuity was 1.16 ± 0.3 logarithm of the minimum angle of resolution (logMAR), the endothelial cell count was 1910.5 ± 297.64, and target refraction at baseline was −0.197 ± 0.087. Postoperatively, best-corrected visual acuity was significantly improved; the mean value was 0.05 logMAR ± 0.06. Mean baseline target refraction in the spherical equivalent was −0.20 ± −0.09 (range: −0.08 to −0.37), and mean final refraction was −0.44 ± −0.14 (range: −0.25 to −0.75) with no significant difference (p=0.87). No complication was registered intra- and postoperatively. Conclusion Standardization of the Yamane technique seemed a valuable option for patients who had complicated phacoemulsification to achieve a predictable refractive outcome. Synopsis. The predictable refractive outcome could be achieved with the immediate standardized Yamane technique in patients with intraoperative cataract luxation in the vitreous chamber during phacoemulsification.

To evaluate which secondary intraocular lens (IOL) implantation technique was more successful in achieving the best postoperative results and refractive outcomes between retropupillary iris-claw IOL (ICIOL) and flanged intrascleral IOL (FIIOL) fixation with the Yamane technique. Eye Clinic of the University of Trieste, Trieste, Italy. Retrospective observational study. 116 eyes of 110 patients who underwent ICIOL or FIIOL were analyzed. Patients with follow-up shorter than 6 months or with incomplete clinical data were excluded. Collected data included demographics, ocular comorbidity, indication of surgery, intraocular pressure, early (≤1 month) and late (>1 month) postoperative complications, corrected distance visual acuity (CDVA), and manifest refraction at the last follow-up visit. 50% (n = 58) of eyes underwent FIIOL and 50% (n = 58) ICIOL implantation for aphakia (n = 44, 38%) and IOL dislocation (n = 72, 62%). No statistically significant differences in demographics, comorbidity, follow-up duration, postoperative complications, and surgical indications were found. The refractive prediction error (RPE) was 0.69 ± 0.94 diopter (D) in the FIIOL group and 0.21 ± 0.75 D in the ICIOL group ( P = .03), indicating residual hyperopia after both techniques. RPE, mean absolute error, and median absolute error were higher in the FIIOL group ( P = .003). ICIOL implantation was more successful in obtaining a RPE between -0.50 D and +0.50 D (52% of ICIOL, n = 30, and 31% of FIIOL, n = 18). Both techniques were effective in increasing preoperative CDVA with no statistical difference between them. Although complication rates did not significantly differ, the FIIOL group exhibited less predictable refractive outcomes. Adjusting the dioptric power of the 3-piece IOL, as performed in ciliary sulcus implantation, to prevent myopic shift, is not recommended.