Scleral Fixation of Intraocular Lenses Clinical Experience and Case Analysis with Yamane and Canabrava Techniques at the Clinic Albanian Eyes Centre

Tonuzi A and Dine L

Published on: 2025-12-29

Abstract

The successful placement of Intraocular Lenses (IOLs) during cataract surgery has become synonymous with their precise positioning in the capsular bag. In these cases, the Intraocular Lens is positioned within the lens capsule, well-aligned on the pupillary axis, and its capsular complex is supported by the zonules. This approach maximizes surgical and refractive outcomes. In the absence of sufficient posterior capsular support, such as in cases of complicated cataract surgery with capsular damage, it is possible to place an Intraocular Lens in the ciliary sulcus and achieve good visual outcomes. Surgical options for eyes without sufficient capsular support include:

  1. a) Intraocular Lens fixed in the anterior chamber
  2. b) Intraocular Lens fixed in the Iris
  3. c) Intraocular Lens fixed in the Sclera
  4. d) Intraocular Lens fixed in the Sclera, including sutured and non-suture fixation.

Our scientific research aims to present the clinical experience in the use of Intraocular Scleral Fixation of Lenses (IOSFL) techniques in patients without sufficient capsular support, analysing the causes of the intervention, the surgical techniques applied, additional interventions and post-operative complications. Our study included 36 patients treated with IOSFL during two years, February 2022-March 2024, at the ophthalmological clinic “Albanian Eyes Centre”, Tirana, Albania. The Yamane and Canabrava techniques were applied with and without modifications, and additional combined interventions such as Phaco, Pupiloplasty, and Lensectomy were documented. From the analysis of statistical data, it results that the most common cause for IOSFL in patients was Luxation and Subluxation of the lens (43.8%), which was followed by Subluxation of the crystalline lens and traumatic cataracts. In 87.5% of cases, patients underwent lens replacement, while in 12.5% of cases, re-implantation of the same lens was performed. Only 6 patients (18.75%) developed cystoid macular oedema after the intervention, which was treated with intravitreal injections. In all cases, we achieved clinical stabilization and visual improvement. The IOSFL represents a safe and reliable technique for the management of Aphakia and Lens Subluxation in the absence of capsular support. The techniques used by us, Yamane and Canabrava, provide stable visual results, especially when applied with modifications adapted to each specific case. Additional interventions are necessary in most cases and contribute to the overall success of the procedure. The low incidence of complications testifies to the safety of the methods in contemporary surgical practice. The 4 clinical case studies presented in the article emphasize the importance of adapting surgical techniques individually, as well as the possibility of applying small innovations with a large impact on clinical results. The study material is valuable for reporting in the international literature and contributes to the improvement of existing practices.