Vitreous management in Yamane’s technique for crystalline lens dislocation: anterior vitrectomy or PPV?

Objective: To study the postoperative visual outcomes and surgical complications of anterior/pars plana vitrectomy and concurrent Yamane’s IOL fixation for crystalline lens dislocation. Methods 53 patients (56 eyes) with crystalline lens subluxation/dislocation were enrolled in this retrospective interventional study. Patients received anterior/pars plana vitrectomy and concurrent Yamane’s IOL fixation. Main outcome measures were postoperative BCVA and surgical complications. Proportion of spontaneous PVD and preoperative undetected retinal holes/degeneration (PURH/D) were recorded. Results 24 eyes were treated with anterior vitrectomy (Group AnV) and 32 eyes with pars plana vitrectomy (Group PPV). Overall incidence of PURH/D was 10.7% (6/56). Spontaneous PVD occurred in 68.8% (24/32) in Group PPV. During six months follow-up, one case of postoperative RRD and one case of choroidal detachment occurred in Group AnV. There was no significant difference between anterior vitrectomy and PPV in the final BCVA and postoperative complications. Conclusion Anterior or pars plana vitrectomy, which are both applicable in YAMANE technique for crystalline lens dislocation, exhibit similar surgical outcomes. Patient’s age, PVD status and PURH helps to determine the route of vitrectomy. Pediatric patients might be potential candidates for transcorneal vitreolensectomy. For adult, PURH managed with total vitrectomy and intraoperative lase retinopexy might be beneficial to decrease the incidence of postoperative RRD.