This patient had cataract surgery years ago and then progressive zonulopathy, such as from pseudo-exfoliation, caused the entire capsular bag to dislocate. The capsular bag contains the CTR (capsular tension ring) as well as the IOL and it is very mobile with minimal support. The surgeon carefully brings up the capsular bag into the anterior chamber and then extracts the CTR. The IOL is then removed using the twist and out technique that we have featured here previously. For the new IOL, a Yamane technique is used but with a somewhat better approach. Instead of having the optic go back into the vitreous cavity during externalization of the haptics, the surgeon keeps the optic on top of the iris. This works beautifully and is probably the better method of doing Yamane ISHF. Great job with this tough case.
A Peripheral Iridotomy MUST be done in every Yamane case to avoid reverse pupillary block and risk of pigment dispersion, glaucoma, optic capture, iris damage etc.. If it is a myopic eye prone to RPB you may need 2 or even 3. You also should do a complete pars plana vitrectomy and have an infusion line in place for Yamane. An anterior vitrectomy is not adequate. An infusion line is critical for Yamane…. you should not pass needles into a soft eye without an infusion line in place or you run the risk of choroidal detachment, bleeding etc. You also need the infusion line to form the globe at physiologic pressure to determine the position of the IOL. A lot of issues here.
By the way the previous comment was from Steven G. Safran MD