The Yamane technique for fixation of a three-piece IOL to the sclera is a good option for a posterior chamber IOL in the absence of capsular support. When performing this technique the two most important pearls are: (1) achieve accurate centering of the IOL and (2) avoid entangling vitreous in the haptics.
Accurate marking is important to ensure that the scleral entry sites are exactly 180 degrees apart and the IOL stays centered in the pupil. Remember that care must be taken when handling the haptics since they may become dislodge from their insertion point into the optic. An interesting fact: most three-piece IOLs have the haptics hand-staked into the optic by technicians using a microscope during the manufacturing process. The haptics can also break or fracture if too much force is placed on them.
When you watch a video of Yamane fixation such as this recent one, you may notice that the optic and haptics extend well into the anterior vitreous cavity when performing the haptic externalization step. If an insufficient anterior vitrectomy was done, then vitreous strands can become entangled in the haptics resulting in chronic vitreous traction which can lead to development of cystoid macular edema and even a retinal detachment. Fortunately, in today’s video a full pars plana vitrectomy was previously completed and this is why an anterior chamber maintainer is used during the surgery.
In this video our guest surgeon shows us how to accurately re-center the IOL and then perform a cerclage suture to restore a more normal pupil. The ideal pupil size is about 4 mm since that will still allow a good view of the retina. If the final pupil is 3 mm or smaller then the retinal view will be limited because this suture will prevent pharmacologic dilation.
click to learn how to re-center a Yamane IOL (and learn to do it right the first time):