Our guest surgeon has developed a novel technique for simplifying the Yamane IOL scleral fixation procedure. Typically with the Yamane technique as the haptic is inserted into the lumen of the hollow bore needle, the optic of the IOL can move and twist in the anterior and mid-vitreous. If a full pars plana vitrectomy has not been performed then the optic and haptics can become entangled with vitreous and this can lead to traction which causes macular edema and other retinal pathology. In the X-NIT method the hollow bore needle is brought outside the main incision and then the haptic is inserted inside. The same is done for the second haptic and this allows the IOL optic to stay planar and just behind the iris. This minimizes the risk of vitreous entrapment and potential falling of the IOL into the vitreous cavity. In this video the patient has a large scleral incision for MSICS nucleus extraction but I anticipate being able to perform this through a smaller 3.5 mm incision with folding forceps being used to insert the IOL optic after the first haptic is secured. Lots of great pearls in this video including using a collar to hold the first haptic while securing the other one. This X-NIT modification is a welcome addition and it will simplify the Yamane technique for beginners and experienced surgeons alike.
