6th Annual Global Video Contest
    Retina/Vitreous, Trauma

    In this video, the resistance to dislocate an intrascleral fixated (Yamane) flanged haptic is demonstrated in vivo. A 61-year-old male with advanced glaucoma and a previous trabeculectomy surgery was referred for management of a dislocated IOL. Pars plana vitrectomy ports were placed, and the eye was marked in preparation for a Yamane procedure. At this gentleman’s previous surgery, a Yamane technique was attempted, however, the nasal haptic of the Alcon MA60 lens fractured and the surgery was abandoned. You can see that the temporal haptic is firmly held in place and resists efforts to disinsert it from its intrascleral position. At this stage we were prepared to leave this haptic in place and attempt to fixate the nasal fractured haptic if necessary.  However, one more attempt was made with max-grip forceps and eventually the haptic was freed up, fortunately without complications.   The flange can be appreciated at the tip of the haptic. The Alcon MA60 3-piece lens was removed and thereafter replaced with a Zeiss Lucia 602 IOL. Using two 25g max-grip forceps, and a handshake technique, the haptic is positioned for docking into the TSK ultrathin walled 30g needle. The needle was tunneled for 2mm and then directed into the eye at a 20 degree angle. After carefully docking the trailing haptic into the needle, it was externalized as can be seen here. Curved Macpherson forceps are used to ensure that the haptic does not slip back into the eye. A flange was created using a low-temperature cautery. Thereafter, the same process was repeated for the leading haptic. After docking the needle, it was externalized, and again, a flange created by threatening the haptic with low-temperature cautery. Both haptics were then rotated and flanges buried intrascleral in order to prevent future conjunctival erosion.