Purpose: To assess whether preoperative lens status—aphakia, intraocular lens (IOL) subluxation, or complete IOL dislocation—influences retinal and functional outcomes after secondary IOL implantation using the Yamane technique. Methods: This retrospective study included 59 eyes undergoing the Yamane technique: 13 aphakic, 25 with subluxated IOLs, and 21 with dislocated IOLs. All patients completed a 12-month follow-up with spectral-domain OCT at 1, 3, and 12 months. The primary endpoint was cystoid macular edema (CME) or epiretinal membrane (ERM). Secondary endpoints were best-corrected visual acuity (BCVA), subjective refractive astigmatism (SRAST), and endothelial cell density (ECD). A quantile regression model was used to identify predictors of visual improvement. Results: At 3 months, CME was observed in 19 eyes (32.2%). After excluding eyes with pre-existing macular changes, incident postoperative CME occurred in 6 eyes (10.2%). At 12 months, CME was present in 8 eyes (13.6%). Postoperative ERM developed in 5 eyes (8.5%). BCVA improved significantly in all three groups (p < 0.001), and SRAST remained stable (p = 0.819). ECD decreased significantly in subluxated and dislocated eyes but not in aphakic eyes. Baseline BCVA was the only independent predictor of visual improvement at 12 months. Conclusion: Retinal and functional outcomes after Yamane fixation were comparable across aphakia, IOL subluxation, and IOL dislocation. Although a transient peak in CME prevalence was observed at 3 months, the incidence of new postoperative CME was limited and mainly associated with IOL explantation. Visual recovery was primarily determined by preoperative visual acuity. Plain Language Summary: When the natural support of an intraocular lens (IOL) is lost, a secondary procedure may be required to reposition or replace the lens. The Yamane technique allows sutureless fixation of an IOL. We evaluated how this technique performs in three different clinical situations: aphakia (no lens), partial IOL subluxation, and complete IOL dislocation. We assessed the occurrence of retinal complications such as cystoid macular edema (macular swelling) and epiretinal membrane, as well as changes in vision, astigmatism, and corneal endothelial cell density over 12 months. Macular swelling was observed in approximately one third of eyes at 3 months; however, new postoperative cases occurred in about 10% of patients, and the prevalence decreased by the final follow-up. Vision improved significantly in all three groups, and outcomes were comparable across aphakia, IOL subluxation, and IOL dislocation. Visual recovery was primarily determined by preoperative visual acuity. Our findings indicate that the Yamane technique provides consistent anatomical and functional outcomes across different types of lens instability. Keywords: Yamane technique, secondary intraocular lens implantation, aphakia, IOL subluxation, IOL dislocation, cystoid macular edema, epiretinal membrane, endothelial cell density, visual outcomes, scleral fixation
Visioli et al. (Sun,) studied this question.