The Yamane technique of IOL fixation to the scleral works better with certain three-piece IOLs because of the differences in haptic material. The Canabrava technique can be applied to other IOLs such as those with eyelets or in this case, by creating a small hole at the haptic-optic junction of a single-piece acrylic IOL. Our guest surgeon is Dr Hassan Khaled from Saudi Arabia is he demonstrates this technique very well.
A 5-0 or 6-0 polypropylene suture is used to pierce the IOL at the haptic-optic junction and then hot-tip cautery is used to melt the end to create a flange and prevent the suture from slipping through the hole. These long ends are then brought into the anterior segment and coupled into the hollow tip of 30g needles where they are guided out via scleral tunnels. These ends can then be cut and cauterized to achieve successful fixation of the IOL.
If you are going to try this technique, let us offer some important pearls. A complete anterior vitrectomy must be performed so that vitreous does not become entangled with the IOL which could lead to a retinal detachment. The scleral tunnels made with the 30g needles should be 180 degrees apart to give the best centration of the IOL optic. IOL calculations will be more challenging, so plan for calculations for in-the-bag placement and err on the side of mild myopia. There can be a hammock effect where the optic can tilt since there are just two points of fixation and this can induce aberrations like astigmatism and coma. Finally, push the flanged ends into the scleral tunnels so that they are not simply sitting under the conjunctiva where they may cause erosion with time.
click below to learn this technique of double flange IOL fixation: