Troubleshooting Yamane

Top tips for intrascleral haptic fixation – and its application in complicated cornea cases

By Karolinne Rocha

July 2018

At a Glance

  • Since its introduction in 2014, the Yamane technique of two needle intrascleral haptic fixation has been increasing in popularity
  • Possible complications associated with the technique include IOL tilt and decentration, conjunctival erosion, iris capture, vitreous hemorrhage, cystoid macular edema, vitreous traction and retinal tear
  • I overview top tips to master the Yamane technique – including some of my own modifications
  • Complicated cornea cases in which the technique has helped achieve good outcomes for my patients are presented.

The Yamane technique (sutureless needle-guided intrasceral IOL implantation with lamellar scleral dissection) was first published in 2014 by Shin Yamane of Yokohama University Hospital, Yokohama, Japan (1). Two years later at the ASCRS 2016 annual meeting, Yamane was awarded the Grand Prize for his video on the technique (available here). But in the years since Yamane’s technique was introduced, there have been several reports of complications – such as IOL tilt and decentration, and haptic erosion through the conjunctiva and sclera. Turnbull and Lash reported that there was an ‘ultrathin line’ between success and failure; the line turned out to be the need for an ultrathin wall 30G needle instead of a regular 30G needle (2). Here, I share my own experiences to help other surgeons when performing the technique.

  1. S Yamane et al., “Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection”, Ophthalmol, 121, 61–66 (2014). PMID: 24148655.
  2. AM Turnbull and SC Lash. “Transconjunctival intrascleral intraocular lens fixation with double-needle and flanged-haptic technique: Ultrathin line between success and failure”, J Cataract Refract Surg, 42, 1843–1844 (2016). PMID: 28007120.

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