Successful Visual Rehabilitation After Penetrating Ocular Trauma via Yamane Scleral Fixation: A Case Report
DOI:
https://doi.org/10.35790/ecl.v14i2.65520Keywords:
penetrating ocular trauma; traumatic cataract; zonular dialysis; scleral fixation; Yamane techniqueAbstract
Abstract: Penetrating ocular trauma frequently leads to traumatic cataract with capsular and zonular disruption, complicating standard in-the-bag intraocular lens (IOL) implantation. Sutureless intrascleral fixation (Yamane technique) offers a minimally invasive posterior chamber IOL option that avoids long-term suture-related complications. We reported a 68-year-old woman presented one day after penetrating needle injury to the right eye with uncorrected visual acuity (UCVA) 1/300, full-thickness corneal laceration (positive Seidel), anterior capsule tear, and zonular dialysis from 7 to 1 o’clock with lens fragments in the anterior chamber. Under retrobulbar anesthesia, corneal wound closure was performed with interrupted 10-0 nylon, followed by cataract extraction and anterior vitrectomy. In the same operation, two transconjunctival sclerotomies were created 2.0 mm posterior to the limbus (superonasal and superotemporal) using 27-gauge thin-walled needles at ~20°. A three-piece foldable IOL was implanted by the Yamane flanged-haptic technique; haptics were externalized, cauterized to 0.3–0.5 mm flanges, and tucked into scleral tunnels. The IOL centered well without tilt; no conjunctival peritomy was required. Postoperatively, UCVA improved to 1/60 on day 1, 6/60 at 2 weeks (after suture removal), and 6/15 at 1 month (6/6 with pinhole). In three-month follow-up, the retina remained attached, intraocular pressure was stable, no cystoid macular edema, and the IOL remained well positioned. In conclusion, in complex open-globe injury with inadequate capsular support, single-session repair with immediate Yamane sutureless scleral fixation of a three-piece IOL can achieve rapid, stable visual recovery and anatomic stability in geriatric eyes. Careful wound closure, symmetric needle entry, and precise flange creation are key to IOL centration and complication avoidance; continued follow-up is advised to monitor long-term flange stability.
Keywords: penetrating ocular trauma; traumatic cataract; zonular dialysis; scleral fixation; Yamane technique
References
1. Bhandari A, Jorvekar S, Singh P, Bangal S. Outcome after cataract surgery in patients with traumatic cataract. Delta Journal of Ophthalmology. 2016;17(2):56-8. Doi: 10.4103/1110-9173.189074
2. Gurnani GSOB. Traumatic Cataract: StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm. nih.gov/books/NBK594251/
3. Yuksel H, Turkcu FM, Cinar Y, Cingu AK, Sahin A, Sahin M, et al. Etiology and prognosis of penetrating eye injuries in geriatric patients in the Southeastern region of Anatolia Turkey. Ulus Travma Acil Cerrahi Derg. 2014;20(4):253-7. Doi: https://doi.org/10.5505/tjtes.2014.71597
4. Shen JF, Deng S, Hammersmith KM, Kuo AN, Li JY, Weikert MP, et al. Intraocular lens implantation in the absence of zonular support: an outcomes and safety update: A report by the American Academy of Ophthalmology. Ophthalmology. 2020;127(9):1234-58. Doi: https://doi.org/10.1016/j.ophtha.2020.03.005
5. Wang X, Su M, Li Y, Xie H, Sun X, Jiang F. Application of modified Yamane technique in intrascleral intraocular lens fixation combined with or without iris reconstruction. BMC Ophthalmol. 2024;24(1):235. Doi: https://doi.org/10.1186/s12886-024-03493-8
6. Li X, Ni S, Li S, Zheng Q, Wu J, Liang G, et al. Comparison of three intraocular lens implantation procedures for aphakic eyes with insufficient capsular support: a network meta-analysis. Am J Ophthalmol. 2018;192:10-19. Doi: https://doi.org/10.1016/j.ajo.2018.04.023
7. Zhang C, Palka C, Zhu D, Lai D, Winokur J, Shwani T, et al. Clinical outcomes in scleral fixation secondary intraocular lens with Yamane versus suture techniques: a systematic review and meta-analysis. Journal of Clinical Medicine. 2024;13(11):3071. Doi: https://doi.org/10.3390/jcm13113071
8. Do JR, Park SJ, Mukai R, Kim HK, Shin JP, Park DH. A 1-year prospective comparative study of sutureless flanged intraocular lens fixation and conventional sutured scleral fixation in intraocular lens dislocation. Ophthalmologica. 2020;244(1):68-75. Available from: https://sci-hub.st/10.1159/000507713
9. Chang Y-M, Weng T-H, Tai M-C, Chen Y-H, Lee C-H, Chang W-C, et al. A meta-analysis of sutureless scleral-fixated intraocular lens versus retropupillary iris claw intraocular lens for the management of aphakia. Scientific Reports. 2024;14(1):2044. Available from: https://homepage.ntu.edu.tw
10. Gajula S, Manayath GJ, Verghese S, Saravanan V, Narendran K, Narendran V. Real world outcomes of sutureless and glueless sclerally fixated intraocular lens implantation. Eye. 2022;36(12):2334-40. Doi: https://doi.org/10.1038/s41433-021-01880-9
11. Shahid SM, Flores-Sanchez BC, Chan EW, Anguita R, Ahmed SN, Wickham L, et al. Scleral-fixated intraocular lens implants-evolution of surgical techniques and future developments. Eye (Lond). 2021;35(11):2930-6110. Doi: https://doi.org/1038/s41433-021-01571-5
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ade J. Nursalim, Ardelia Emily
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
COPYRIGHT
Authors who publish with this journal agree to the following terms:
Authors hold their copyright and grant this journal the privilege of first publication, with the work simultaneously licensed under a Creative Commons Attribution License that permits others to impart the work with an acknowledgment of the work's origin and initial publication by this journal.
Authors can enter into separate or additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (for example, post it to an institutional repository or publish it in a book), with an acknowledgment of its underlying publication in this journal.
Authors are permitted and encouraged to post their work online (for example, in institutional repositories or on their website) as it can lead to productive exchanges, as well as earlier and greater citation of the published work (See The Effect of Open Access).
