Clinical Outcomes in Scleral Fixation Secondary Intraocular Lens with Yamane versus Suture Techniques: A Systematic Review and Meta-Analysis

Abstract

Background: The purpose of the study is to compare the visual outcomes and complications of sutured scleral fixation (SSF), a traditional and conservative surgical approach, and the newer and faster Yamane technique for secondary intraocular lens placement. Methods: A literature search was performed on PubMed, Embase, and Scopus on studies published between 1 July 2017 to 29 September 2023. Outcomes analyzed included the final best corrected visual acuity (BCVA) between 3 and 12 months to assess the effectiveness of the procedure, post-operative month (POM) 1 BCVA to assess the speed of visual recovery, endothelial cell count (ECC), absolute refractive error, surgical duration, and complication rates. Additional subgroup analyses were performed based on surgeon experience with the technique. Single-surgeon studies had an average of 26 procedures performed, whereas multiple-surgeon studies averaged only 9 procedures performed; these were then used to delineate surgeon experience. A sample-size weighted mean difference (MD) meta-analysis was performed across all variables using RevMan 5.4.1; p < 0.05 was considered statistically significant. Results: Thirteen studies with 737 eyes were included: 406 eyes were included in the SSF group, and 331 eyes were included in the Yamane group. There was no significant difference in the final BCVA between groups in both the single-surgeon versus multiple-surgeon studies (MD = -0.01, 95% CI: [-0.06, 0.04], p = 0.73). In the single-surgeon studies, the BCVA at POM1 was significantly improved in the Yamane group compared to SSF (MD = -0.10, 95% CI: [-0.16, -0.04], p = 0.002). In the multiple-surgeon studies, there was no significant difference in BCVA at POM1 (MD = -0.06, 95% CI: [-0.16, 0.04], p = 0.23). The Yamane group had a shorter surgical duration than SSF in both single-surgeon and multiple-surgeon studies (MD = -24.68, 95% CI: [-35.90, -13.46], p < 0.0001). The ECC, refractive error, and complication rates did not significantly differ amongst all groups. Conclusions: The Yamane technique demonstrated similar long-term visual outcomes and complication rates to the traditional SSF. Visual recovery was significantly faster in the Yamane group in the single-surgeon studies. The operative times were shorter across all Yamane groups. Based on these findings, it is advisable to consider the Yamane technique as a viable, and perhaps preferable, option for patients requiring secondary IOL placement, alongside traditional SSF methods.

Keywords: Yamane; flanged haptic; scleral fixation; secondary IOL; sutureless fixation.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart.

Figure 2

(a) Forest plot meta-analysis comparing the best corrected visual acuities (BCVAs) at last follow-up between Yamane versus sutured scleral fixation. Each study is shown by the last name of the first author and the mean difference (MD) with 95% confidence interval (CI) [5,20,21,22,23,24,25,26,27,28,29,30,31]. The summary mean difference and 95% CI are also shown (according to random-effect estimations). For subgroup analysis, studies are separated by single surgeon, multiple surgeons, or unspecified number of surgeons. (b) Funnel plot of the studies included in the meta-analysis. IV = inverse variance; SD = standard deviation.

Figure 2

(a) Forest plot meta-analysis comparing the best corrected visual acuities (BCVAs) at last follow-up between Yamane versus sutured scleral fixation. Each study is shown by the last name of the first author and the mean difference (MD) with 95% confidence interval (CI) [5,20,21,22,23,24,25,26,27,28,29,30,31]. The summary mean difference and 95% CI are also shown (according to random-effect estimations). For subgroup analysis, studies are separated by single surgeon, multiple surgeons, or unspecified number of surgeons. (b) Funnel plot of the studies included in the meta-analysis. IV = inverse variance; SD = standard deviation.

Figure 3

Forest plot meta-analysis comparing the best corrected visual acuities (BCVAs) at 1 month between Yamane versus sutured scleral fixation. Each study is shown by the last name of the first author and the mean difference (MD) with 95% confidence interval (CI) [20,22,23,24,25,26,27,28,29,31]. The summary mean difference and 95% CI are also shown (according to random-effect estimations). For subgroup analysis, studies are separated by single surgeon, multiple surgeons, or unspecified number of surgeons. IV = inverse variance; SD = standard deviation.

Figure 4

Forest plot meta-analysis comparing the absolute difference between the intended and final spherical equivalent between Yamane versus sutured scleral fixation. Each study is shown by the last name of the first author and the mean difference (MD) with 95% confidence interval (CI) [21,25,26] The summary mean difference and 95% CI are also shown (according to random-effect estimations). IV = inverse variance; SD = standard deviation.

Figure 5

Forest plot meta-analysis comparing the mean surgical durations between Yamane versus sutured scleral fixation. Each study is shown by the last name of the first author and the mean difference (MD) with 95% confidence interval (CI) [5,22,23,24,26]. The summary mean difference and 95% CI are also shown (according to random-effect estimations). For subgroup analysis, studies are separated by single surgeon, multiple surgeons, or unspecified number of surgeons. IV = inverse variance; SD = standard deviation.

Figure 6

Forest plot meta-analysis comparing the post-operative endothelial cell count (ECC) between Yamane versus sutured scleral fixation. Each study is shown by the last name of the first author and the mean difference (MD) with 95% confidence interval (CI) [21,22,25,26]. The summary mean difference and 95% CI are also shown (according to random-effect estimations). IV = inverse variance; SD = standard deviation.

Figure 7

Forest plot of the risk ratio (RR) meta-analysis comparing rates of cystoid macular edema (CME) between Yamane versus sutured scleral fixation. Each study is shown by the last name of the first author and the RR with 95% confidence interval (CI) [5,20,22,23,24,25,26,30,31]. The combined effect and 95% CI are also shown (according to random-effect estimations). IV = inverse variance.

Figure 8

Forest plot of the risk ratio (RR) meta-analysis comparing rates of secondary surgical intervention between Yamane versus sutured scleral fixation. Each study is shown by the last name of the first author and the RR with 95% confidence interval (CI) [23,24,28,30,31]. The combined effect and 95% CI are also shown (according to random-effect estimations). IV = inverse variance.