The Yamane technique of IOL fixation to the sclera has become very popular in the last few years but increasingly we are seeing potential pitfalls such as exposed flanges and, in this video, severe optic tilt due to loose haptic insertions which allow rotation. Many surgeons have reported that their previous choice for Yamane fixation, the Zeiss CT Lucia 602 IOL, now seems to have issues with the haptic insertion being too loose. Our guest surgeon presents a case where he demonstrates this defect as he explants the Zeiss IOL and then replaces it with a Johnson & Johnson Sensar AR40 IOL which has more rigid PMMA haptics which are more securely attached to the optic thereby preventing this rotisserie rotation.
Just for the record I’ve removed and replaced J&J lenses, AR40 and za9003 for severe tilt after Yamane done by other surgeons. There have been reports of “Rotisserie” phenomenon with J&J lenses as well but it’s less common and that may be due to the fact that the same forces applied to PMMA haptics will damage those haptics before they will damage the haptic optic junction so that is the weak point in the chain for those IOLs. There is no question that the “rotisserie” phenomenon is real and happening now more commonly with Zeiss 602 lenses but this is not the only reason that an IOL may be tilted after Yamane. The Hallmark of true “Rotisserie” is that the patient had a completely normal non tilted IOL at the end of surgery but the next day it was tilted on exam at the slit lamp and when the IOL is removed you can see rotation of the haptic relative to the optic. Many of the tilted Yamane IOLs I remove and replace have kinked haptics (PMMA) or the haptics were inserted improperly with shallow tunnels and what is called the “Flagpole” sign where the haptic is at an acute angle to the surface of the sclera. It is not clear that the optic haptic junction is stronger with PMMA haptis vs PVDF and in fact Zeiss has tested this in the lab and found the opposite to be true. This study is consistent with that finding….dislocation forces for the PVDF haptics on the Zeiss lens were greater than Za9003 and other PMMA haptic lenses: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479968/
This is an article on this topic of haptic rotation my son Jordan and I published in AJO. In it we have cited the article I provided a link to as our second reference. BTW the reviewers insisted that we change the wording from “rotation” to “distortion” but it was clearly rotation of the haptic relative to the optic that ocurred and from discussing this with other surgeons the problem is always discovered on day one.
If things are good on day one they will remain that way.
https://www.sciencedirect.com/science/article/pii/S2451993623000531?via%3Dihub