RCOphth Annual Congress 2026

Delayed Spontaneous On-axis Lens Rotation and Accelerated Endothelial Failure Following Yamane Intrascleral Haptic Lens Fixation (ISHF): A Case Report

Highlights and Summary

Delayed (7-week) 90° on-axis IOL rotation after Yamane ISHF

Rapid corneal decompensation and endothelial cell loss (>50%) without lens–cornea touch

Vision preserved with timely intervention

Sudden vision loss post ISHF requires urgent evaluation.

Introduction

•Sutureless Intrascleral haptic fixation (ISHF) is widely used for secondary IOL implantation

•Early IOL rotation has been reported within 1 month

•However, late rotation and endothelial decompensation remain poorly characterised

Aim

We report a case of delayed spontaneous IOL rotation with rapid endothelial failure, despite absence of lens-cornea touch

Case Vignette

•69M

•Left traumatic cataract (2015) --> Sulcus IOL + 2x Capsular Tension Rings (CTR)

•9 years later: monocular diplopia + blurred vision à subluxed IOL

•Underwent pars plana vitrectomy (PPV) with Yamane ISHF of existing Sensar AR40 IOL. CTRs left in situ.

•Good visual recovery 3 weeks post-op

Baseline Status

•BCVA 6/6, refraction -0.50 / -1.25 x 125

•Corneal CCT: 621µm, Endothelium 2653 cells/mm², CV 46%, Hex 37%

The Complication

•7 weeks post-op, developed sudden BOV

•Examination revealed corneal decompensation

The Findings

•90-degree on-axis rotation of IOL optic

•Haptics remained securely attached to sclera

•AS-OCT: no direct contact between IOL and cornea

•Specular: marked deterioration of ECC to ~1138/mm²

•No AC inflammation or lens mobility

The Management

•Urgent vitrectomy + IOL removal

•Haptics (found to be secure intrasclerally) removed together with 2x CTRs

•Left aphakic

•2 weeks post-removal, CCT was 702µm with persistent bullae

The Rehabilitation

•Given steroid drops

•3 months post-removal, cornea had cleared

The Next Move

•Secondary lens implanted with sclerostomies and Gore-Tex Sutures

•Developed Irvine-Gass syndrome --> treated successfully with Nevanec

•Sutures and IOL remained intact, no further issues

The Outcome

•Corneal oedema continued to clear

•Avoided corneal transplant

•Latest review: VA 6/20 Unaided, 6/8.5 Pinhole

•Steroids continue to be downtitrated

•ECC Trend: 2653 (pre) > 1138 (post) > 1105 (stable)

•Patient satisfied

Discussion

•The “Rotisserie effect” of ISHF lenses can occur spontaneously even beyond 1 month

•Such rotation can precipitate rapid corneal decompensation without direct lens-corneal touch

•Possible Causes:

•Torsional instability of haptic despite fixation

•Altered aqueous dynamics

•Interaction with retained CTRs

•Micro-movement causing endothelial shear stress

Conclusion

IOL rotation can occur late in ISHF

Sudden visual changes require urgent review

Endothelial failure can occur without direct lens-cornea contact.

Early intervention may limit endothelial damage

Caution in complex eyes (trauma, retained CTRs)

RCOphth Annual Congress 2026

Delayed Spontaneous On-axis Lens Rotation and Accelerated Endothelial Failure Following Yamane Intrascleral Haptic Lens Fixation (ISHF): A Case Report

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