Comparative Two-Year Outcomes of Three Different Three-Piece Intraocular Lenses in Flanged Intrascleral Fixation

Background and Objectives: To compare 2-year positional stability, endothelial preservation, and visual outcomes of three three-piece intraocular lenses (IOLs) implanted by the Yamane technique: Eyecryl (polypropylene haptics, 5° haptic angulation), Sensar OptiBlue AR40e (polymethyl methacrylate [PMMA] haptics, 5° haptic angulation), and AcrySof MA60AC (PMMA haptics, 10° haptic angulation). Materials and Methods: Records of 192 consecutive patients (one eye per patient; no bilateral implantation) receiving a study IOL were reviewed; 145 patients (75.5%) completed 24 months of follow-up (Eyecryl 48 eyes, Sensar 48 eyes, MA60AC 49 eyes). Endothelial cell density (ECD) loss and anterior segment OCT measures of decentration, tilt, and anatomical anterior chamber depth (ACD) were modelled with mixed-effects models weighted by stabilised inverse probability of treatment weights, using cluster-robust standard errors. Results: Visual acuity gain was equivalent within the prespecified ±0.15 logMAR margin (two one-sided tests, p = 0.009). Operative time differed (Eyecryl 12.9 ± 3.4 versus MA60AC 24.1 ± 7.6 min; p < 0.001), as did the proportion of eyes requiring repeat cautery of at least one haptic (Eyecryl 4.2%, Sensar 22.9%, MA60AC 42.9%; p < 0.001). MA60AC showed greater decentration (0.75 ± 0.21 versus 0.56 ± 0.20 mm) and shallower ACD (3.42 ± 0.38 versus 3.61 ± 0.35 mm); tilt did not differ (omnibus p = 0.312). Unadjusted 24-month ECD loss, expressed as a percentage of baseline ECD, was 4.92 ± 1.52% (Eyecryl), 6.18 ± 1.87% (Sensar), and 7.45 ± 2.01% (MA60AC) (all pairwise p < 0.0167). After operative duration, ACD, and decentration were entered, the MA60AC-versus-Eyecryl difference in ECD loss fell by 81.4%, from 2.1 to a non-significant 0.4 percentage points; this attenuation is descriptive, not causal mediation. Conclusions: All three platforms gave equivalent 2-year visual outcomes. Eyecryl showed better positional stability and lower unadjusted endothelial loss than MA60AC, with shorter surgery and a less anterior optic. Because haptic material and angulation vary together here, comparisons concern whole platforms, not individual attributes.