Long-term outcomes of sutured and sutureless (Yamane) scleral-fixated intraocular lens implantation for lens subluxation in Marfan syndrome: a retrospective case series.

PURPOSE: To describe scleral-fixation surgical approaches in patients with Marfan syndrome and lens subluxation and to evaluate postoperative visual outcomes and complications.

DESIGN

Retrospective case series.

METHODS

Medical records of 9 patients (15 eyes) with Marfan syndrome who underwent surgery for lens subluxation between January 2015 and March 2023 were retrospectively reviewed. Surgical techniques included sutured scleral fixation, sutureless intrascleral fixation (Yamane technique), and vitrectomy-assisted procedures when indicated. Preoperative and postoperative best-corrected visual acuity (BCVA), postoperative complications, secondary interventions, and intraocular lens (IOL) position were analyzed. Outcomes according to fixation technique were assessed descriptively due to small and unbalanced subgroup sizes.

RESULTS

Sutured scleral fixation was performed in 13 eyes, while sutureless intrascleral fixation using the Yamane technique was applied in 2 eyes. The mean patient age was 15.46 ± 15.88 years (range, 5-70 years), and the mean follow-up duration was 30.66 months (range, 7-120 months). BCVA improved significantly from 1.28 ± 0.76 logMAR preoperatively to 0.69 ± 0.80 logMAR postoperatively (p = 0.01). Postoperative complications occurred in 4 eyes (26.7%), including retinal detachment in one eye (6.7%) and intraocular lens subluxation or pupillary capture in three eyes (20%). All complications were successfully managed with secondary surgical interventions. Visual improvement was limited in two eyes due to pre-existing amblyopia.

CONCLUSION

Scleral-fixated intraocular lens implantation is an effective option for visual rehabilitation in patients with Marfan syndrome and lens subluxation. However, observed complication patterns highlight the importance of individualized surgical planning and long-term postoperative surveillance. Comparisons between fixation techniques should be interpreted as descriptive.