In a patient with Marfan syndrome who is completely aphakic and lacks any capsular support, the Yamane intrascleral haptic fixation (ISHF) technique provides an elegant solution for secondary IOL placement. Because the crystalline lens and the entire capsular bag have been removed, there is no scaffold to support a traditional lens. The Yamane technique bypasses the need for a bag or sulcus by securing the haptics directly within the scleral walls.
The procedure begins with precise marking 180 degrees apart to ensure centration. Using thin-walled needles, usually 30-gauge, the surgeon creates two angled scleral tunnels starting approximately 2 mm posterior to the limbus. A three-piece IOL is then injected into the anterior chamber. The leading haptic is docked into the first needle lumen, followed by the trailing haptic into the second needle.
Once both haptics are externalized, the surgeon uses low-temperature cautery to bulb the tips of the haptics. These expanded ends are then recessed into the scleral tunnels, acting as a bolster to prevent the lens from decentering or falling back into the vitreous. For a Marfan patient with typically thinned sclera, ensuring the tunnels are of adequate length and depth is vital to maintain long-term stability and prevent haptic exposure.
In yamane iol slight back, may get tilt also, need to confirm on UBM, in 4F XNit no issues at all,