Comparative Two-Year Outcomes of Three Different Three-Piece Intraocular Lenses in Flanged Intrascleral Fixation

Description This retrospective cohort study compared the 24-month outcomes of three different three-piece intraocular lenses (IOLs)—Eyecryl (polypropylene haptics, 5° angulation), Sensar OptiBlue AR40e (PMMA haptics, 5° angulation), and AcrySof MA60AC (PMMA haptics, 10° angulation)—implanted using the flanged intrascleral (Yamane) technique in eyes without capsular or zonular support. Of 192 consecutive patients who received the assigned IOL, 145 (75.5%) completed the 24-month follow-up. Endothelial cell density (ECD) loss, IOL decentration, tilt, and anatomical anterior chamber depth (ACD) were assessed using inverse probability of treatment weighting (IPTW) and mixed-effects models with cluster-robust standard errors. All three platforms provided equivalent visual acuity gains within the prespecified equivalence margin. However, significant differences were observed across platforms. The MA60AC group exhibited longer operative time (24.1 vs. 12.9 minutes for Eyecryl), greater decentration (0.75 vs. 0.56 mm), shallower ACD (3.42 vs. 3.61 mm), and higher unadjusted 24-month ECD loss (7.45% vs. 4.92%) compared to the Eyecryl group. The Sensar group showed intermediate results. After adjusting for operative duration, ACD, and decentration, the MA60AC coefficient for ECD loss attenuated by 81.4% and became non-significant, suggesting that the observed differences are largely attributable to surgical workflow and final optic position rather than to the implant material alone. Since haptic material and angulation co-vary across the three platforms, these comparisons apply to whole IOL platforms rather than to individual design attributes.