DEC 02, 2020
Cataract/Anterior Segment, Refractive Mgmt/Intervention, Retina/Vitreous
The authors detailed refractive outcomes for patients who underwent scleral fixation of a posterior chamber IOL using the flanged intrascleral haptic fixation technique first described by Shin Yamane, MD.
This single-center, retrospective case series included 115 eyes that underwent flanged intrascleral haptic fixation by vitreoretinal surgeons in Melbourne, Australia, between February and December 2018. Controls included 54 eyes that underwent anterior chamber IOL (ACIOL) placement, and 100 eyes that had standard cataract surgery with an IOL placed in the capsular bag. Patients were followed for a minimum of 1 month. Data collected included visual acuity, postop manifest refraction (performed 2 weeks of suture removal) and slit-lamp exam. The Johnson & Johnson/AMO Tecnis ZA9003 lens was used in all patients who underwent the Yamane technique. Prediction error, which was calculated by subtracting predicted postop refraction from the actual postop spherical equivalent, was compared across all groups.
The prediction error for the Yamane technique group was +0.04 D, which was not significantly different from the IOL-in-the-bag group (-0.10 D). The prediction error for ACIOL patients was significantly more myopic than predicted (-0.76 D) compared with the Yamane group. The IOL-in-the-bag group had a significantly greater proportion of patients with a prediction error within 0.50 D (72%) compared with the Yamane group (50%) and the ACIOL group (34%).
The study was limited by its retrospective and nonrandomized design. There was relatively short follow-up (mean 4.7 months for the Yamane group, 12.4 months for the ACIOL group, 1.2 months for the IOL-in-the-bag group). Finally, there was no testing performed to assess for IOL tilt.
This study helps support the growing body of literature indicating that the Yamane technique for intrascleral haptic fixation offers both a good safety profile and reasonably good refractive predictability. Of course, the eyes undergoing the Yamane technique for intrascleral haptic fixation are inherently complex and it is important for surgeons to inform patients that refractive predictability is not as good as in-the-bag IOL placement.