The Yamane technique of securing a three-piece IOL to the scleral wall is ingenious. It can work very well but there are some important caveats. The IOL haptics must be placed so that the optic stays centered in the pupil and the haptic flange should be buried so that it does not erode through the conjunctiva. But the most important pearl is to ensure that there is no entangled vitreous with the IOL haptics. Watch this video and you will see two cases where the IOL is in the mid-vitreous as the haptics are externalized through the sclera. This is typical and if you only do a limited anterior vitrectomy, you are likely to entangle vitreous with these haptics. This will lead to macular traction, chronic macular edema, and other complications. The solution is to perform a full pars plana vitrectomy and both of these surgeons do just that.
By the way, our first surgeon is Dr Rishi Gupta who has published my favorite book in ophthalmology which you can find here.
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