AAO 2019 Video Program
    Cataract/Anterior Segment

    Scleral fixation of IOL (SF-IOL) in penetrating keratoplasty (PK) prolongs the open-sky time, increasing the risk of expulsive hemorrhage. Low scleral rigidity during open-sky also makes SF-IOL difficult and less predictable. In this video, we demonstrate the use of a closed chamber for SF-IOL using the Yamane technique followed by PK. This technique brings extra control and stability. The patient was a 66-year-old man with high myopia (axial length: 27.52 mm) and a postvitrectomized eye. There was an inferiorly subluxed one-piece PMMA IOL in sulcus with one haptic protruding into the anterior chamber, causing bullous keratopathy with significant stromal scarring. One month postoperatively, the cornea graft was clear, IOP was normal and the flanged IOL well in place, with no obvious tilting on anterior segment OCT.