LONG TERM FUNCTIONAL OUTCOME BETWEEN YAMANE TECHNIQUE AND RETROPUPILLARY IRIS-CLAW TECHNIQUE IN A LARGE STUDY COHORT

Abstract

Purpose: to evaluate which secondary IOL implantation technique is more successful in achieving the best postoperative results and refractive outcomes between retropupillary iris-claw (ICIOL) and flanged intrascleral IOL fixation with Yamane technique (FIIOL). Setting: Eye Clinic of the University of Trieste, Italy. Design: retrospective observational study. Methods: 116 eyes of 110 patients who underwent ICIOL or FIIOL were analysed. 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 (IOP), early (≤1 month) and late (>1 month) postoperative complications, BCVA and manifest refraction at the last follow-up visit. Results: 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 ± 0.94D in the FIIOL group and 0.21 ± 0.75D in the ICIOL group (P = 0.03), indicating residual hyperopia after both techniques. RPE, mean absolute error (MAE) and median absolute error (MedAE) were higher in the FIIOL group (P = 0.003). ICIOL implantation was more successful in obtaining a RPE between -0.50D and +0.50D (52% of ICIOL, n=30, and 31% of FIIOL, n=18). Conclusions: both techniques were effective in increasing preoperative BCVA with no statistical difference between them. Although complication rates did not significantly differ, FIIOL group exhibited less predictable refractive outcomes. Adjusting the dioptric power of the 3-pieces IOL, as done in ciliary sulcus implantation, to prevent myopic shift, is not recommended.