Perspectives of anterior segment surgeons vs vitreoretinal surgeons on modified Yamane technique: Anterior or Total vitrectomy?

Abstract

Purpose

To compare the clinical and refractive outcomes of anterior vitrectomy (AnV) and pars plana vitrectomy (PPV) in patients undergoing modified Yamane intrascleral fixation for secondary intraocular lens (IOL) implantation.

Methods

In this retrospective, comparative study, 74 eyes of 74 patients who underwent modified Yamane intrascleral fixation between January 2021 and August 2024 were included. Patients were categorized into two groups: AnV (n = 45) for subluxated IOLs and PPV (n = 29) for nucleus drop or IOL luxation. Postoperative visual acuity (uncorrected [UDVA] and corrected distance [CDVA]), refractive stability, IOL tilt, endothelial cell count (ECC), lenticular astigmatism, and complications were assessed. IOL tilt was measured by using swept-source optical coherence tomography.

Results

Postoperative UDVA and CDVA were significantly higher in the AnV group (p < 0.001). IOL tilt was similar between groups (p = 0.591). Corneal astigmatism was lower in the AnV group (−1.00 D vs. −1.75 D, p < 0.001), while ECC was significantly better preserved compared to the PPV group (1784 ± 520 vs. 1234 ± 652 cells/mm², p < 0.001). The median tilt angle was 1.87° (range: 0.15°–10°) in the AnV group and 1.85° (range: 0.47°–8.50°) in the PPV group (p = 0.591). Postoperative lenticular astigmatism values were similar between the groups (p = 0.124). Lenticular astigmatism correlated with IOL tilt (r = 0.794, p < 0.001). Complication rates, including cystoid macular edema and epiretinal membrane formation, were similar between groups (p = 0.383, p = 0.780).

Conclusions

Both AnV and PPV yielded comparable refractive and IOL positioning outcomes in modified Yamane intrascleral fixation. However, AnV demonstrated superior endothelial preservation, lower corneal astigmatism, and better visual acuity, suggesting an advantage.