Yamane IOL Fixation with Large Iris Defect

In this video, Drs. Austin Nakatsuka and Mark Mifflin perform the Yamane scleral-fixated IOL technique in a patient with a large traumatic iris defect. First described by Dr. Shin Yamane, the Yamane technique is a method of direct haptic-scleral fixation of an IOL without the use of sutures. The surgeons used a Zeiss CT Lucia 602 3-piece hydrophobic lens (formerly EC-3 PAL) because polyvinylidene fluoride (PVDF) haptics have excellent flexibility and durability.

In this case, the haptic was grasped through the iris defect to perform the handshake maneuver with a 30-gauge thin-walled TSK docking needle. The trailing haptic was fixated first, with the leading haptic externalized through a paracentesis incision to provide stability. After externalizing the haptic ends, the iris defect provides a unique view of the inferior haptic as it enters into the scleral tunnel. Low-temperature cautery of the haptic end forms a bulb that secures the haptic within the scleral tunnel. Attempts were made to close the iris defect but this was abandoned due to lack of remnant iris tissue and no preoperative cosmetic concerns. The patient has done well postoperatively and is not complaining of dysphotopsia.

Acknowledgments: The authors thank Craig Chaya, MD, for his advice and guidance on this case. 

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