Late Reverse Pupillary Block After Scleral Fixation With Yamane Technique: A Case Report

The Yamane technique is a transconjunctival, sutureless method for scleral fixation of intraocular lenses (IOL) in cases lacking capsular support. While widely adopted because of its efficacy and safety, rare late complications such as IOL subluxation have been reported. We describe a case of late-onset reverse pupillary block with recurrent IOL subluxation following Yamane fixation.

We present a case of a 64-year-old male with a history of cataract surgery and ocular hypertension who underwent Yamane scleral IOL fixation in his left eye. Five years later, he presented with cystoid macular edema, which progressed to a full-thickness macular hole and 360° iris capture of the intraocular lens optic associated with pupillary block. He underwent pars plana vitrectomy, internal limiting membrane peeling, gas tamponade, and IOL repositioning in the sulcus. Despite initial improvement, the patient experienced multiple episodes of IOL subluxation, requiring repeated repositioning and laser iridotomy. Intraoperative findings included IOL tilt and a floppy iris. After the final repositioning, the IOL remained stable at 18-month follow-up, with intraocular pressure controlled and visual acuity partially restored.

Although the Yamane technique is generally safe and effective, this case highlights the potential for late reverse pupillary block and recurrent IOL subluxation. Contributing factors included optic-haptic junction stress, iris instability, and improper scleral tunnel architecture. Proper case selection, careful surgical technique, and close follow-up are essential to minimize the risk of complications.