Operative time trends and clinical outcomes of the Yamane technique during pars plana vitrectomy: a single-surgeon retrospective study

Abstract Purpose To evaluate operative time trends during early independent practice with the Yamane technique for scleral-fixated intraocular lens (SFIOL) implantation with pars plana vitrectomy (PPV), and to assess visual outcomes and postoperative complications. Design Retrospective, single-surgeon case series. Subjects Seventy-five consecutive eyes of 74 patients undergoing Yamane SFIOL implantation with concurrent PPV between November 2023 and October 2025. Methods Medical records were reviewed for surgical indication, prior vitrectomy, operative time, best-corrected visual acuity (BCVA), and postoperative complications. Operative time was evaluated in 37 consecutive lens exchange cases, which were ordered chronologically and divided into early, middle, and late groups. Secondary outcomes included BCVA, complications, and follow-up. Main outcome measures Operative time as a measure of surgical efficiency. Results Mean operative time decreased from 56.4 min (early) to 49.9 min (middle) and 40.7 min (late). One-way analysis of variance (ANOVA) showed a non-significant difference ( p = 0.057) with a downward trend. Linear regression demonstrated a negative association between case number and operative time (y = − 0.60x + 60.12; R² = 0.15; 95% confidence interval [CI], − 1.09 to − 0.11; p = 0.018), corresponding to an estimated 0.6-minute reduction per case; the association persisted after adjustment for prior vitrectomy and indication ( p = 0.040). Mean BCVA improved from 1.26 ± 0.62 to 0.50 ± 0.61 logMAR ( p < 0.0001). Eyes achieving ≥ 20/40 vision increased from 5% to 59%, while those ≤ 20/200 decreased from 64% to 13%. New-onset cystoid macular edema (CME) occurred in 13% of eyes without preoperative CME; the overall postoperative CME/macular edema rate was 25% when recurrent CME and postoperative edema in eyes with pre-existing diabetic macular edema (DME) were included descriptively. Other complications included ocular hypertension (8%), epiretinal membrane (4%), iris capture (3%), and vitreous hemorrhage (3%). No postoperative retinal detachments or retinal tears occurred. Conclusions Yamane SFIOL implantation with PPV during the first two years of independent practice was associated with significant visual improvement and an acceptable early postoperative complication profile during available follow-up. Operative time decreased across sequential lens exchange cases, suggesting a descriptive trend toward improved efficiency rather than definitive evidence of a learning curve. Visual outcomes were largely influenced by baseline optic nerve and macular status.