Abstract
PURPOSE: To evaluate the safety and efficacy of a combined surgical approach involving intraocular lens (IOL) explantation, flanged intrascleral IOL fixation using the Yamane technique, and gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with dislocated IOLs and pseudoexfoliative glaucoma. DESIGN: Retrospective observational study. METHODS: This single-center study included 15 patients (15 eyes) with dislocated IOLs and pseudoexfoliative glaucoma who underwent combined IOL exchange (Yamane technique) and GATT, with a minimum 3-month follow-up. Inclusion criteria were uncontrolled IOP (>21 mmHg) or progressive glaucomatous damage. Main outcome measures included changes in IOP and antiglaucomatous medications (AGMs), surgical success, and complications. RESULTS: The mean preoperative IOP decreased from 29.40 ± 3.40 mmHg to 14.80 ± 1.52 mmHg (P < 0.001), and the mean number of AGMs reduced from 3.47 ± 0.83 to 1.13 ± 0.83 (P < 0.001) at a mean follow-up of 14.67 ± 6.10 months. The best corrected visual acuity improved significantly (P < 0.001), while ganglion cell layer and retinal nerve fiber layer thicknesses remained stable. Complete surgical success was achieved in 26.7% of eyes, and qualified success in all cases. The overall complication rate was 60%; the most common complications were microhyphema and mild vitreous hemorrhage, occurring in four patients each (26.7%), all of which resolved spontaneously. CONCLUSIONS: Combined flanged intrascleral IOL fixation and GATT is an effective, minimally invasive strategy with an acceptable safety profile for IOP reduction and IOL exchange in patients with dislocated IOLs and pseudoexfoliative glaucoma, with the advantage of preserving the conjunctiva for future interventions.