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Subspecialties Cataract, Refractive, Education and Training

Yamane: Revisited

What inspired your original double-needle technique?

Gabor Scharioth was my main influence. I took his method and tried to make it as minimally invasive as possible by creating small wounds using 27 gauge needles. I focused on preserving the conjunctiva through cutting and suturing – something I’ve altered slightly in my new technique, whereby a square knot secures the suture to the haptic.

What is different about the flange IOL fixation technique?

I now recommend grabbing the trailing haptic from outside the eye first, then pushing it into the eye via the main incision. It is less invasive than the previous technique, yet the fixation of the haptics is strengthened.

Why have you decided to change your technique?

Doctors said my original insertion technique was too difficult to master – requiring the surgeon to stabilize the needle using only their hands. I found it easy, but only because I had performed more than 200 surgeries using this technique – not everyone has that level of experience.

How have you made it easier?

I worked with Geuder to create a stabilizer. The device has a toothed ring for fixating the globe during needle insertion, and two integral “landmarks” for orientation and identification of the sclerotomy sites. Geuder is known for its excellent instrumentation, and this piece is no different – it is even better than I imagined. 

Why?

Control is essential to this surgery, but it is difficult to make a controlled incision using only the microscope – particularly for beginners. The stabilizer makes the whole process easier by giving surgeons standardized insertion angles for every scleral tunnel. I also hope it will make the learning curve less daunting for trainees, and improve the consistency of surgical outcomes. For anyone wary about using the stabilizer, I would recommend practicing on a model eye first.

When do you use the stabilizer?

Now, I always use the stabiliser for IOL fixation, but I’d say it is especially important in difficult cases where the patient has small or deep-set eyes. Although I can technically do it without, I have much more control with the stabilizer than if I were to just use my hands.

What’s next?

There is nothing planned for now, but there may be more improvements coming. I simply want to continue making surgery easier for all.

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About the Author

Phoebe Harkin

Associate Editor of The Ophthalmologist

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