Comparative Outcomes of Transscleral Four-Point Fixation with Closed Continuous-Loop Suture and Yamane Technique for Intraocular Lens Fixation

PURPOSE: To compare the outcomes of transscleral four-point fixation using a closed continuous-loop suture and transconjunctival intrascleral haptic fixation (Yamane technique) for intraocular lens (IOL) fixation. METHODS: Patients who underwent scleral fixation of IOL using four-point fixation with a closed continuous-loop suture and the Yamane technique were reviewed. Demographics, pre- and postoperative data, including operation time, complications, and reoperation rates, were reviewed. The cumulative probability of remaining free from IOL redislocation was analyzed using Kaplan-Meier curves, and the factors associated with IOL redislocation were assessed using a Cox proportional hazards model. RESULTS: A total of 179 eyes of 175 patients were included, comprising 120 eyes in the four-point fixation group and 59 eyes in the Yamane group. Visual and refractive outcomes were comparable 6 months postoperatively. Operative time was significantly shorter in the Yamane group (35.6 ± 10.9 vs. 49.5 ± 14.7 min; p < 0.001). Postoperative complication rates, including corneal decompensation, hypotony, and endophthalmitis, did not differ significantly between groups. Cox proportional hazards model showed that the Yamane technique was associated with a significantly higher hazard of IOL redislocation (hazard ratio, 8.68; 95% confidence interval, 1.38-54.46; p = 0.021). CONCLUSION: Both four-point fixation and the Yamane technique yielded comparable visual outcomes and safety profiles. The Yamane technique offered shorter operative time, whereas the four-point fixation was associated with a lower risk of IOL redislocation. These findings highlight the importance of preoperative structural assessments in guiding the selection of fixation methods.