الفهرس 
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Abstract
Insufficient capsular support for placing an in-the-bag intraocular lens (IOL) can be addressed in different ways. Surgical options include angle-supported anterior chamber intraocular lenses (ACIOLs), iris-fixated anterior or posterior chamber intraocular lenses (PCIOLs), and scleral-fixated intraocular lenses (SFIOLs). SFIOLs have emerged as the preferred option for surgical management of aphakia in the absence of capsular support. SFIOLs have the advantage of placement in a better physiological position, torque anti torque balance, better centration, and feasibility of surgical refixation in case of dislocation. Many different techniques have been described for sutured SFIOL that involve – four-point fixation with scleral grooves, use of scleral flaps or Lasso technique. Sutureless SFIOL was first described by Gabor and Pavlidis, 2007 which involved the tucking of the Poly Methyl Methacrylate (PMMA) haptics in partial thickness scleral tunnels. Many modifications of sutureless technique of fixation have emerged including use of glue, flanged intrascleral fixation and the X-NIT technique to exteriorize haptics. The novel flanged IOL fixation technique, reported by Yamane et al, 2017 comprises transconjunctival intrascleral IOL fixation with a double-needle technique using flanged haptics. This technique is not reliant on scleral flaps, tunnels, sutures, fibrin glue, or exposure of the sclera by conjunctival incision. Safety and efficacy of SFIOL is well established in adults and is fast gaining acceptance in pediatric population. Concerns have been raised about the centration of the scleral-fixated IOLs and their long-term stability. The aim of our study was to compare between intrascleral (Yamane Technique) versus trans-scleral (ab externo technique) intraocular lens implantation in cases of pediatric aphakia, described their outcomes on the visual acuity and reported any developed postoperative complications. 20 aphakic eyes were included in the study, divided into two groups (each=10): ⮚group (1): Tunnel fixated IOL (Yamane technique): included 8 males and 2 females with mean age of 12.3 ± 4.4 years. ⮚group (2): Suture-fixated IOL (ab externo technique): included 7 males and 3 females with mean age of 11.3 ± 3.1 years. The following data were fulfilled from the Mansoura Ophthalmic Center, Mansoura University: 1.Detailed history taking and clinical assessment: including age, sex. 2.Preoperative evaluation: Complete ophthalmic examinations including: anterior segment examination using slit-lamp, retinal evaluation using either slit lamp biomicroscopy with +90D lens or indirect ophthalmoscopy and (IOP) measurement. 3.Surgical Technique: For group A: scleral tunnel fixated IOL (Yamane Technique) and for group B: scleral suture fixated IOL (ab externo technique). 4.Postoperative: Follow up for 6 monthes including visual Acuity (uncorrected and best corrected), refraction, centralization, stability of IOL, intraocular pressure and post-operative complication. Results of this study showed that: ●There was no statistically significant difference between the two groups for baseline characteristics including age, sex, operated eye, ocular history, type of aphakia and axial length (P>0.05). Age of cases among group (1) and group (2) was (12.3 and 11.3, respectively). ●There was no statistically significant difference in studied IOL parameters between the two groups. ●Of clinical concern, one case in group (2) (10%) had posteriorly dislocated IOL and tilted IOL occurred in 50% of group (1) cases vs. only 10% of group (2) cases. Corneal astigmatism occurred in 50% of group (2) cases vs. only 10% of group (1) cases. ●There was no statistically significant interaction effect of group and time on uncorrected visual acuity (UCVA) and there was no statistically significant main effect of group on UCVA. ●Clinically, UCVA at the 1st month was different between the two groups. It was better in the group (1) than group (2). But, statistically it was insignificant due to the small group number. ●There was a statistically significant main effect of time on UCVA. Pairwise comparisons revealed a statistically significantly higher UCVA preoperatively vs. all three post-operative values (1, 3 and 6 months), and a statistically significantly higher post-operative UCVA at 1-month vs. 6-months. ●There was no statistically significant interaction effect of group and time on best corrected visual acuity (BCVA) and there was no statistically significant main effect of group on BCVA. ●There was a statistically significant main effect of time on BCVA. Pairwise comparisons revealed a statistically significantly higher BCVA one-month post-operatively vs. 3-, and 6-months post-operatively. ●There was a statistically significant interaction effect of group and time on spherical equivalent (P=0.004). ●There was a statistically significant simple effect of group on spherical equivalent. Pairwise comparisons revealed a statistically significantly higher pre-operative spherical equivalent vs. all three post-operative values in each group. ●There was a statistically significant difference in spherical equivalent between the two groups pre-operatively only, but no statistically significant difference was detected in all three post-operative spherical equivalent values between the two groups. ●There was a statistically significantly higher adjusted post-operative K2-reading in group (2) vs. group (1) (P=0.005). For adjusted post-operative K1-reading, there was no statistically significant difference between the two groups (P=0.59). •There was statistically significant strong association (P = 0.010, point biserial correlation coefficient [rpb] = 0.558). That signified that postoperative K2 is higher in the presence of preoperative corneal wound.