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Incidence, Timing, and Management of Postoperative Tilt with the Yamane Technique for Secondary Intraocular Lens
Hueyjong Shih1, Pooja P Patel2, Celine Chaaya1
1Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA.
Purpose:
To evaluate the incidence, timing, and management of postoperative intraocular lens (IOLs) tilt after secondary IOL implantation or repositioning using the Yamane flanged intrascleral haptic fixation (FISHF) technique.
Design:
Retrospective consecutive case series.
Subjects:
A total of 182 eyes undergoing secondary IOL implantation or repositioning using the Yamane FISHF technique at a single tertiary referral center over a 4-year period were included in this study.
Methods:
Medical records were reviewed to identify cases of postoperative IOL tilt. Patient demographics, surgical approach, and postoperative outcomes were collected and analyzed.
Main Outcome Measures:
Incidence of postoperative IOL tilt, time from implantation to tilt detection, and change in best-corrected visual acuity (BCVA) after postoperative tilt intervention.
Results:
Among 182 consecutive cases, 21 eyes (11%) developed postoperative IOL tilt. Techniques for haptic externalization included 30-g needles (57%), 27-g needles (14%), and 27-g pars plana vitrectomy ports (29%). Immediate postoperative complications included Uveitis-Glaucoma-Hyphema Syndrome (14%), hypotony (14%), cystoid macular edema (5%), and ocular hypertension (5%). In 20 of 21 eyes (95%), tilt occurred spontaneously. The median interval between IOL implantation and detection of tilt was 10 days (range, 1-1086 days; interquartile range, 1-74 days), and the median interval between tilt detection and corrective intervention was 75 days (range, 6-946 days; interquartile range, 21-197 days). Lens exchange was pursued to address the tilt in 10 (48%) eyes. Of these, 4 received an anterior chamber IOL, 5 underwent repeat FISHF implantation, and 1 received a scleral-sutured IOL. Of the remaining cases, 7 (33%) were repositioned, 3 (14%) were observed without intervention, and 1 (5%) underwent lens removal and was left aphakic. The mean BCVA before and after any procedure to correct lens tilt was 1.10 logarithm of the minimum angle of resolution and 0.55 logarithm of the minimum angle of resolution, respectively (P = 0.03). White-to-white corneal diameter did not significantly differ between eyes with and without tilt (P = 0.69).
Conclusions:
Spontaneous IOL tilt after Yamane FISHF occurred in 11% of cases, most frequently within the first 2 postoperative weeks. Lens tilt was observed across multiple haptic externalization techniques and IOL types, and the majority of affected eyes (86%) required subsequent surgical management, including IOL exchange, repositioning, or removal.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
