Cataract surgery is a common procedure; however, complications related to the IOL and capsular bag, such as IOL opacity, subluxation, and dislocation, can occur [11, 12]. Different methods have been introduced to address IOL subluxation and dislocation, and the SF technique using a three-piece IOL is the most commonly used approach [13–15). This study compared two commonly used SF IOL techniques, namely, the traditional sutured SF IOL technique and the sutureless intrascleral haptic fixation technique, known as the Yamane technique, to evaluate their effect on visual outcomes following surgery.
The target refraction changes and iris-optic capture of IOL were considered as important factors for the comparison of two methods. Previous studies have indicated that the sutured SF IOL technique may result in a myopic shift compared with target refraction because of haptic adherence to the ciliary sulcus and IOL optic adherence to the back of iris, resulting in increased axial length [8, 16]. This fixed position close to the iris may increase the risk of iris-optic capture and subsequent complications. In this study, iris-optic capture was found in approximately 17% of patients (4 of 24 eyes) who only underwent sutured SF IOL surgery, which could lead to visual impairments such as intraocular hemorrhage and CME [9].
Contrastingly, patients who underwent sutureless SF IOL surgery demonstrated a different pattern. Despite the longer learning curve of the sutureless technique, a higher risk of trailing haptic damage during surgery, and a higher incidence of IOL tilting [8, 17, 18], removing vitreous and lens remnants to minimize interference with the IOL, maintaining consistent needle entry angles, and positioning the left hand appropriately during the trailing haptic handling could reduce the disadvantages associated with the sutureless technique. Postoperative refraction showed a mild hyperopic shift compared with the target refraction, and anterior OCT image revealed that the IOL optic position was situated further away from the iris plane and below it (Fig. 4). This was attributed to the sutureless fixation technique, which allowed for haptic length adjustment and appropriate optic positioning. Consequently, iris-optic capture did not occur in patients who underwent sutureless SF IOL surgery. Placing the IOL optic far from the pupillary plane may contribute to the reduced risk of iris-optic capture in the sutureless technique.
This study has limitations owing to, its retrospective design and relatively short follow-up period. Longer follow-up would allow for a more comprehensive evaluation of the functional and anatomical outcomes associated with the sutureless SF IOL technique.
In conclusion, the sutureless SF IOL technique allows for positioning the IOL optic away from the back of the iris, resembling the natural position in the presence of the capsular bag. With this technique, the setting of refraction is similar to the target refraction before surgery, and IOL-iris irritation is minimized, reducing iris-optic capture. Overall, the sutureless SF IOL technique is a useful surgical method and mitigates vision-related postoperative complications.