Clinical Ophthalmology (Nov 2020)
Clinical Outcomes and Lens Constant Optimization of the Zeiss CT Lucia 602 Lens Using a Modified Yamane Technique
Abstract
Edward L Randerson,1 Joseph D Bogaard,1 Lisa R Koenig,2 Eileen S Hwang,3 Clinton C Warren,1 Steven B Koenig1 1Department of Ophthalmology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA; 2Weill Cornell Medical College, New York, NY, USA; 3Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USACorrespondence: Steven B Koenig Tel +1 414 228-1653Email [email protected]: To report the clinical and refractive outcomes of a modified Yamane technique for scleral fixation of the CT Lucia 602 lens.Design: Retrospective case series.Patients: One hundred twenty-one eyes with dislocated posterior chamber lens implants, surgical aphakia, subluxed crystalline lenses, capsular tear, anterior chamber, or iris sutured posterior chamber lens intolerance were included.Methods: Secondary implantation of the Zeiss CT Lucia 602 lens was performed by a single surgeon using a modified Yamane technique employing a single needle, rather than the double-needle approach. One hundred twelve eyes underwent simultaneous 3 port pars plana vitrectomy and 9 eyes had previously undergone posterior vitrectomy surgery. Exclusion criteria were age < 18, simultaneous glaucoma or corneal procedures, staged corneal transplantation, and follow-up < 30 days.Main Outcome Measures: A paired t-test was used to compare pre- and post-operative corrected distance visual acuity (CDVA), the mean predictive error, and the mean absolute predictive error between the manufacturer’s and optimized constants for Hoffer Q, Holladay I, and SRK/T. Complication rates were reported.Results: One hundred twenty-one consecutive eyes with a mean follow-up of 237 days were included. The pre-operative CDVA was 0.871 ± 0.785 logMAR (mean ± standard deviation, Snellen equivalent 20/149), which improved to 0.401 ± 0.608 (Snellen equivalent 20/50) post-operatively. In 109 eyes with reliable postoperative refractions, the mean predictive refractive error (D) ± std was +0.74 ± 1.37 for Hoffer Q, +0.66 ± 1.41 for Holladay 1, and +0.47 ± 1.49 for SRK/T (p< 0.05). Refractive outcome analysis yielded a mean optimized personalized anterior chamber depth (pACD) of 5.69, Surgeon Factor of 1.79, and A constant of 118.56. Vision-limiting complications occurred in 11 eyes (9.1%).Conclusion: Scleral fixation of the CT Lucia 602 lens using a single-needle modification of the Yamane technique resulted in very good visual acuity, predictable postoperative refractive errors, but some vision-limiting complications in this heterogeneous group of eyes with significant comorbidities.Keywords: Yamane technique, scleral lens fixation, secondary lens implantation, sutureless IOL fixation
