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Secondary intraocular lens implantation with the Yamane intrascleral fixation technique in paediatric aphakia

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First Author: S.Basti USA

Co Author(s):    S. Basith   A. Sternfeld                 

Abstract Details

Purpose:

Purpose: Surgical correction of paediatric aphakia with insufficient capsular support has traditionally involved suture fixation of secondary intraocular lens (IOL). Previous techniques that do not involve sutures require opening conjunctiva and dissecting a scleral flap. We used an approach (Yamane technique) of intrascleral fixation that obviates many downsides of both the above approaches. We present a series of twelve consecutive pediatric aphakia cases operated by a single surgeon with modifications as necessary and with good initial outcomes.

Setting:

Setting: Tertiary care pediatric hospital: Ann and Robert Lurie Children's Hospital- Northwestern University, Chicago, Illinois

Methods:

Methods: Retrospective chart review of patients from May 2018 to January 2020 who underwent secondary IOL implantation by a single surgeon (SB) was performed. Best corrected visual acuity (BCVA) preop, intraop and postoperative events if any, were documented. Any modifications to surgical technique were noted.

Results:

Results: Twelve eyes (10 patients; mean age 9.8±6.4 years) were included. Indications were ectopia lentis secondary to Marfan syndrome (n=3) idiopathic (n=1) and Weill-Marchesani syndrome (n=2), prior lensectomy with insufficient capsule (n=5) and traumatic aphakia (n=1). Mean followup was 8.2±4.7 months. Some modifications to technique were necessary. First haptic retraction during second haptic placement occurred (n=1) but was recognized and rectified. Early postoperative events were haptic slippage requiring surgical correction(n=1) and superficial haptic without signs of erosion during 10 months followup(n=1). All haptic related events occurred in Marfan syndrome.. At last followup, all patients had a stable IOL and improved BCVA.

Conclusions:

Conclusions: Intrascleral fixation provides an option for controlled insertion and stable placement of the IOL without violation of the conjunctiva or creation of scleral flaps. While true in all eyes, proper depth of the needle track is particularly critical for safe and stable placement of the IOL in paediatric eyes with Marfan syndrome. Yamane technique is an advantageous and effective option for management of paediatric aphakia.

Financial Disclosure:

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