Safety and efficacy of the Yamane technique for intraocular three-piece lens implantation in Egyptian patients diagnosed with Marfan syndrome: a retrospective study

Abstract

Background: This study aimed to investigate the safety and efficacy of the Yamane technique (flanged intrascleral haptic fixation with double-needle technique /FIHFT) for three-piece intraocular lens (IOL) implantation in Egyptian patients diagnosed with Marfan syndrome (MFS) presented with subluxated lenses (ectopia lentis, EL).

Methods: This was a retrospective evaluation of thirty-three patients who were diagnosed with MFS and had subluxated lenses in a total of forty eyes. Seven of these patients had bilateral subluxation. Lensectomy or phacoemulsification was performed with limited anterior vitrectomy, followed by IOL implantation using the FIHFT method. Data was collected from medical records, including preoperative and postoperative corrected distant visual acuity (CDVA) using logarithm of the minimal angle of resolution (log MAR), preoperative and postoperative refractions, intraoperative and postoperative complications, and follow-up periods.

Results: The mean age of patients in the study was 30.79 years, with a mean follow-up of 23.9 months. Post-surgery, the refractive sphere decreased significantly from -9.1 ± 1.4 diopter (D) to -1.4 ± 0.7 D, and cylinder measurements dropped from -4.5 ± 0.8 D to -1.4 ± 0.6 D. The spherical equivalent (SEQ) also declined from -11.4 ± 1.5 D to -2.1 ± 0.8 D. The CDVA improved from 0.80 ± 0.32 to 0.18 ± 0.10 log MAR (P < 0.001). No intraoperative complications were identified. Postoperative complications included IOL decentration (12.5%), vitreous hemorrhage (7.5%), IOL slippage (5%), IOL tilt (5%), and retinal detachment (RD) (5%). Further surgical procedures were necessary for only four cases (10%), all of which had positive outcomes. IOL tilting and slippage occurring at average ages of 18 and 19 years, respectively. No other complications, such as hypotony, elevated intraocular pressure (IOP), corneal edema, iritis, IOL dislocation, cystoid macular edema (CME) or endophthalmitis, were reported.

Conclusions: The Yamane technique has proven effective and safe for treating subluxated lenses in Egyptian patients with Marfan Syndrome, resulting in improved visual acuity with minimal complications, mostly minor and manageable. Comprehensive fundus examinations before and after surgery are essential for promptly identifying retinal breaks and reducing the risk of retinal detachment. IOL tilting and slippage are more common in younger patients.

Keywords: Ectopia lentis; Lenticular astigmatism; Marfan syndrome; Scleral lens fixation; Yamane technique.

Fig. 1

Slit-lamp examination showed crystalline lens subluxation (ectopia lentis) in Egyptian patients diagnosed with Marfan syndrome. a superior temporal subluxation with intact zonules. b inferior temporal subluxation with intact zonules

Fig. 2

The flanged intrascleral haptic fixation technique (FIHFT/Yamani) involves several key steps: (a) visualizing the subluxated lens, (b) performing phacoemulsification and limited vitrectomy (note the trocar with an infusion cannula), (c) bending 30-G needles positioned 7 mm from its tip, (d) employing the Yamane double-needle stabilizer to create 180-degree transconjunctival sclerotomies, (e) simultaneous introduction of 30-G guide needles, (f) injecting the 3- pieces intraocular lens (IOL), (g) threading the haptics through the guide needles, (h) externalizing the haptics onto the conjunctiva, (i) securing the haptic with forceps and creating cauterized plugs, (j) positioning the plugs in the scleral tunnel, (k) washing the anterior chamber after injecting triamcinolone acetate, (l) and achieving a well-centred IOL at the end of the procedure

Fig. 3

Incidence of postoperative complications

Fig. 4

Postoperative complications included (a) intraocular lens (IOL) slippage, visible during intraoperative view, and (b) IOL tilt, detectable through slit lamp examination with pupillary dilatation