Clinical Outcomes of Yamane and Gore-Tex Sutured Scleral Fixation IOL Techniques

Authors: Amar Khaira, Romeo Apostol, David Ta Kim, Steve Levasseur, Robert Gizicki.
Author Disclosure Block: A. Khaira: None. R. Apostol: None. D. Ta Kim: None. S. Levasseur: None. R. Gizicki: None.


Purpose: To compare the clinical outcomes between patients undergoing Yamane vs Gore-Tex sutured scleral fixation intraocular lens (IOL) techniques for secondary IOL implantation. 
Study Design: Retrospective review of patients at a single retina practice. Methods: Clinical data of all patients who underwent sclera-fixated IOL implantation using either Yamane or Gore-Tex sutured techniques. All surgeries were performed by one of three experienced vitreoretinal surgeons between January 01, 2019 and August 31, 2021, at Surrey Memorial Hospital in British Columbia. Baseline demographics and relevant pre-operative, intraoperative, and post-operative outcomes and complications were collected with 3-months of follow-up data. Mann Whitney U, chi-square, Z-test, and Friedman tests were employed to analyze data using SPSS version 28.0. P < 0.05 was considered statistically significant. 
Results: 155 procedures met the inclusion criteria; 81 Yamane technique cases and 74 Gore-Tex sutured cases. The demographic profile of both groups was similar, with no significant differences in age (p=0.65), sex (p=0.38), eye laterality (p=0.21), ocular history (p values > 0.5), and pre-operation indication (p≥0.5). The median lens power used was 19.5 dioptres in both groups. No significant differences in complications were observed between the two groups when analyzing the presence of vitreous hemorrhages (p=0.16), IOL opacification (p=0.07), cystoid macular edema (p=0.23), retinal detachment (p=0.58), suture/haptic exposure (p=0.30), and the need for a subsequent procedure either related to the IOL correction/removal (p=0.47) or for another indication (p=0.65). However, there was a significant difference between Yamane technique and Gore-Tex sutured groups on rates of post-operative endophthalmitis (p=0.035) and IOL dislocation/subluxation (p=0.014). The Gore-Tex sutured group had a higher number of eyes with post-operative endophthalmitis (0% vs 5%) while IOL dislocation was more common in the Yamane technique group (1% vs 11%). Between the groups, there was no difference in visual acuity at baseline (p=0.57) and 3-months (p=0.86). For both groups, there was a significant increase in visual acuity from baseline vision to the final observation vision. Average visual acuity in the Yamane technique group improved from 2.0 LogMAR (20/200 Snellen) to 0.6 (20/80 Snellen) (p<0.0001) . In the Gore-Tex sutured group, the average visual acuity improved from 2.0 LogMAR (20/200 Snellen) to 0.5 (20/65 Snellen) (p<0.0001). 
Conclusions: Despite differences in the type of treatment performed, both the Yamane technique and Gore-Tex sutured scleral fixation groups had similar clinical outcomes with regards to vitreous hemorrhages, opacification, cystoid macular edema, retinal detachment, suture/haptic exposure, visual acuity, and the need for subsequent procedures. However, there was an increased rate of postoperative endophthalmitis in the Gore-Tex sutured group and increased rate of IOL dislocation in the Yamane technique group.