Performing the Yamane intrascleral haptic fixation (ISHF) technique without intraocular forceps is possible using externalization methods and careful instrument handling. Begin by creating two transconjunctival scleral tunnels 180 degrees apart using a 30-gauge thin-walled needle, angled 2 to 2.5 mm posterior to the limbus. Prepare a three-piece IOL and inject it into the anterior chamber. To externalize the leading haptic, dock it directly into the first needle inside the eye by guiding the haptic into the needle lumen. Withdraw the needle with the haptic secured inside. Repeat the process with the trailing haptic. Once both haptics are externalized, use low-temperature cautery to create flanges at each tip and gently push them into the scleral tunnels for secure fixation. With good visualization and careful coordination, the Yamane technique can be performed safely without intraocular forceps.
