Outcomes of the flanged intrascleral haptic fixation with double-needle technique in patients with Marfan syndrome

Abstract

Purpose: To investigate the clinical outcomes and complications associated with the flanged intrascleral haptic fixation with double-needle technique (a.k.a. the Yamane technique/FIHFT) in patients with Marfan syndrome (MFS) with subluxated or dislocated lenses. Methods: Eighteen eyes of 11 patients with MFS with subluxated or dislocated lenses who had undergone intraocular lens implantation using the FIHFT from March 2019 to October 2020 were evaluated. All patient data were retrospectively collected from medical records, including a complete ophthalmologic examination at baseline and follow-up examinations of uncorrected visual acuity (UCVA, logMAR), best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP), and slit-lamp examination. Results: The median follow-up period was 6 ± 3 (range, 3–12) months. The average patient age at the time of surgery was 13 ± 9 (range, 4–34) years. The mean preoperative BCVA was 0.49 ± 0.20 logMAR (Snellen equivalent visual acuity, 20/60), while the mean postoperative BCVA at the end of follow-up was 0.21 ± 0.14 logMAR (20/30), indicating an improvement of 0.28 ± 0.20 logMAR (20/40) postoperatively ( p < 0.001). Postoperative iris capture occurred in six eyes (38.9%). No cases of hypotony, IOP elevation, or vitreous hemorrhage were noted, and no patients developed intraocular lens dislocation, retinal detachment, or endophthalmitis. Conclusions: To our knowledge, the present study is the first to report outcomes of the FIHFT in patients with MFS. Our findings suggested that scleral lens fixation is safe and effective for improving visual acuity in patients with MFS who have subluxated or dislocated lenses.

Risk Factors for Pupillary Optic Capture Following Sutureless Flanged Intraocular Lens Fixation for Intraocular Lens Dislocation

“…Pupillary optic capture after flanged IOL scleral fixation is a relatively common postoper-ative complication, and its incidence in this study was similar to that of previous studies. 4,9,10 Although the mechanism of pupillary optic capture is not fully understood, axial length, ACD, and IOL tilt have been suggested as possible causes of the complication after sutured scleral IOL fixation. [12][13][14] For flanged IOL fixation, construction of the nasal and temporal scleral tunnels is a critical step because both haptics are directly fixed to the sclera instead of the suture thread.…”

“…8 Recent studies have reported that pupillary optic capture is also a complication of flanged IOL fixation, with complication rates ranging from 8% to 38.9%. 4,9,10 However, the risk factors for this complication have not been fully elucidated for flanged IOL fixation, a relatively new technique. The aim of this study is to determine the risk factors for pupillary optic capture following flanged IOL fixation in patients with IOL dislocation.…”

Case report: Management of recurrent pupillary optic capture with sutureless surgical technique using 7–0 polypropylene flange

“…Pupillary optic capture of IOL is a common complication of sutured scleral fixation of IOL implantation, with an incidence rate ranging from 7.9% to 23.0% ( 4 , 5 ). Similarly, in cases with flanged IOL fixation, incidence rates of pupillary optic capture have ranged from 8% to 38.9% ( 2 , 6 , 7 ). Pupillary optic capture of IOL leads to blurred vision and photophobia and can cause chronic uveitis, macular edema, and secondary glaucoma.…”