Background: To evaluate refractive outcomes and intraocular lens (IOL) tilt following secondary implantation using the Yamane technique and to assess the relationship between tilt and refractive predictability compared with standard phacoemulsification.
Methods: This retrospective comparative study included 19 eyes (16 patients) treated with the Yamane technique and 18 eyes (16 patients) undergoing uncomplicated phacoemulsification between 2022 and 2024. Pre- and postoperative best-corrected visual acuity (BCVA) were recorded. Refractive prediction error (RPE), mean absolute error (MAE), and median absolute error (MedAE) were analyzed. IOL tilt was assessed using anterior segment optical coherence tomography (AS-OCT) at least six weeks postoperatively.
Results: The mean best-corrected visual acuity (BCVA, logMAR) improved significantly in both groups-from 0.61 ± 0.39 to 0.10 ± 0.10 in the Yamane group (p < 0.0001) and from 0.81 ± 0.91 to 0.13 ± 0.32 in the control group. The mean refractive prediction error (RPE) was 0.81 ± 0.97 D in the Yamane group and 0.01 ± 1.08 D in the control group. Corresponding mean absolute error (MAE) values were 1.05 ± 0.69 D and 0.69 ± 0.82 D, with median absolute errors (MedAE) of 0.86 D and 0.56 D, respectively. The average intraocular lens (IOL) tilt was greater in the Yamane group (3.79°) than in the control group (0.69°). In the Yamane group, the highest tilt was observed at the 60° meridian (4.70°), and the lowest at the horizontal meridian (2.36°). In contrast, in the control group, the greatest tilt occurred at the 90° meridian (0.81°) and the smallest at the horizontal meridian (0.62°). A significant positive correlation was found between vertical IOL tilt (90°) and RPE in the Yamane group (ρ = 0.41, p < 0.05). No significant correlations were observed between tilt at other meridians and BCVA, MAE, or RPE.
Conclusion: The Yamane technique provides excellent postoperative visual outcomes despite greater IOL tilt compared with standard pseudophakia. Only vertical tilt correlated with refractive prediction error, suggesting a mild hyperopic trend. The method represents a safe and effective alternative for posterior chamber IOL fixation in eyes lacking capsular support.
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