RETRACTION: Heritability of Children's Secure Base Script Knowledge in Middle Childhood: a Twin Study With the Attachment Script Assessment.

The zonular fiber network connects to the ciliary body and the lens equator, forming a 360° ring. Zonular fibers are the most important anatomical structure that stabilizes the lens in phakic eyes and the intraocular lens (IOL) in pseudophakic eyes [, ]. Loss or weakness of zonular fibers can lead to lens subluxation in phakic eyes and IOL subluxation in pseudophakic eyes [, ]. While lens subluxation can result from various etiologies, including trauma, inherited disorders such as Marfan syndrome, or systemic diseases, IOL subluxation may arise from trauma, zonular fiber damage during previous cataract surgery, severe capsular fibrosis, pseudoexfoliation, uveitis, high myopia, or other conditions associated with progressive zonular weakening and capsular contraction [, , ]. In these cases, patients often experience progressive blurred vision, monocular diplopia, or secondary angle-closure glaucoma []. Aphakia following the extraction of a subluxated lens or IOL represents a significant surgical challenge [–]. For the management of aphakia, since the introduction of flanged intrascleral fixation by Yamane et al., various modifications have been developed, each aiming to improve specific aspects of the original technique [–]. This study aims to assess the anatomical and functional outcomes of secondary intraocular lens (IOL) implantation using the Yamane technique in eyes rendered aphakic following either complicated cataract surgery (CCS) or prior IOL extraction (IE). To our knowledge, this study is one of the few to directly compare outcomes of Yamane scleral fixation between eyes undergoing the procedure after complicated cataract surgery and those undergoing it following IE. In addition, the present study provides a standardized comparison by evaluating percentage endothelial cell loss and refractive outcomes under similar surgical conditions, offering clinically relevant insights into the impact of prior surgical status on postoperative outcomes. This retrospective study included 50 eyes from 50 patients who underwent Yamane IOL implantation due to IOL subluxation or lens subluxation between January 2023 and June 2025 at Adana City Training and Research Hospital. Patients were divided into two groups: those who had undergone complicated cataract surgery (CCS) or prior IOL extraction (IE). All surgical procedures were performed by a single surgeon (F.K.). In all cases, a three-piece intraocular lens (Eyecryl, manufactured by Biotech Vision Care) was used. All surgeries were performed under sub-Tenon anesthesia. In all cases, the Yamane technique was applied with transconjunctival sclerotomies created 2 mm posterior to the limbus at the 3 and 9 o’clock positions for symmetric haptic externalization. The 27-gauge needle was introduced at an approximately 20–30° angle relative to the scleral surface to facilitate controlled haptic externalization. The detailed surgical technique is described below. The presence of pseudoexfoliation (PEX), an important predisposing factor, as well as a history of ocular trauma, were recorded from patient files. All patients were routinely examined at postoperative day 1, week 1, month 1, and month 6. In order to present the short-term outcomes of the study, the 6-month results were reported. Keratometric and spherical/cylindrical refractive values were obtained in all cases using an autorefractometer (VISUREF 100, Carl Zeiss, Germany). Optical biometry was performed with the IOLMaster 500 (Carl Zeiss Meditec, La Jolla, CA, USA) for intraocular lens (IOL) power calculation, and IOL power was determined using both the Barrett and SRK/T formulas. Preoperative evaluation included best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP) measured using a fully automated non-contact tonometer (Canon, Japan), endothelial cell density (ECD) assessed with a specular microscope (CEM-530, NIDEK Co., Ltd., Gamagori, Japan), and central macular thickness (CMT) measured by optical coherence tomography (Cirrus HD-OCT Model 5000, Carl Zeiss Meditec, Dublin, CA, USA). The same parameters were reassessed postoperatively at six months. Cystoid macular edema (CME) was defined as the presence of intraretinal cystic changes on optical coherence tomography associated with increased central macular thickness. Changes in central macular thickness (CMT) were expressed as percentage change from preoperative values (ΔCMT%). Similarly, endothelial cell density (ECD) loss was calculated as percentage change from baseline (ΔECD%). Visual acuity change was defined as the difference between preoperative and postoperative logMAR values (ΔlogMAR).