Yamane Technique for The Management of Cataract in Children with Insufficient Capsular Support: A Prospective Study

Abstract

PURPOSE: To report the results of Yamane technique for scleral fixation of intraocular lenses (IOL) in children with lens subluxation or insufficient capsular support. METHODS: A prospective observational study was conducted on 56 eyes of 38 children <18 years with insufficient capsular support. A Sensar AR40e or a Tecnis ZA9003 IOL was used for scleral fixation. Haptics were externalized using Yamane technique. Postoperative refractive error, visual acuity, and intraocular pressure were recorded for 6 months after surgery. Degree of IOL tilt and decentration were measured using ultrasound biomicroscopy. RESULTS: Mean age was 6.5 ± 3.6 years. Intraoperative haptic breakage occurred in 4 cases. Postoperative haptic slippage occurred in 2 eyes. Revision for IOL decentration was needed in 2 patients. Mean improvement in logMAR lines at 6 months after surgery was 5.2 ± 4.8 lines. Mean angle of vertical and horizontal tilts were 5.4 ± 4.4° (range, 0-18°) and 4.4 ± 4.7° (range, 0-18.6°), respectively. Mean absolute amounts of vertical and horizontal decentration were 0.58 ± 0.42 mm and 0.58 ± 0.41 mm, respectively. Significant IOL tilt >7 degrees and decentration > 1 mm occurred in 10 and 5 cases, respectively. Haptic complications and IOL tilt/decentration were associated with ocular comorbidities and early parts of the learning curve. IOL tilt and decentration were not associated with significant effect on BCVA, spherical equivalent, or cylindrical error. CONCLUSIONS: While Yamane technique is an option for the management of children with insufficient capsular support, it requires a steep learning curve and is still associated with a relatively high rate of complications.