FEATURE EWAP DECEMBER 2023 11 In the years since Shin Yamane, MD, PhD, presented on flanged double-needle intrascleral haptic fixation (2017), 1 many surgeons have adopted the technique, but it’s not without complications that require preparation and management. “There are many potential complications from intrascleral haptic fixation techniques, such as the Yamane technique. Herein we discuss some of the most relevant and worst,” Austin Nakatsuka, MD, and Jeff Pettey, MD, wrote in an email to EyeWorld. D. Brian Kim, MD, also weighed in on the topic. A literature search, he said, failed to reveal exact incidence of complications with this technique, but “it’s safe to say the incidence is higher while on the learning curve, and it tends to be steep,” he added. “These technical challenges have led surgeons to develop various adaptations, such as using a trocar instead of needles while others externalize the right side needle outside of the main incision to more easily cannulate the more challenging trailing haptic,” Dr. Kim said. “It’s difficult to assess frequency of complications when there are so many variations. With my own modifications, I have been fortunate to reduce the frequency and avoid catastrophic complications thus far, and currently, I do not tend to struggle with problems related to the technique.” Dr. Kim, Dr. Pettey, and Dr. Nakatsuka provided their thoughts on some of the more common complications that can occur with intrascleral haptic fixation as well as pearls for handling each situation. Choroidal hemorrhage: When passing needles through the sclera, Dr. Nakatsuka said the needles may intersect blood vessels and cause bleeding, which can be more significant in older individuals on anticoagulation medications but can also happen in younger individuals. See Figure 1 for an example. “In our experience, this happens in roughly 1–5% of cases,” he wrote. “Depending on the severity of the bleeding, it may be treated medically with topical and/or oral steroids and cycloplegics versus surgical drainage.” Dr. Pettey and Dr. Nakatsuka’s pearl for this situation was to stop anticoagulant use, if possible, in high-risk patients and to cauterize scleral vessels if needed. Uveitis - glaucoma - hyphema (UGH) syndrome: “After placement of the lens, the optic or haptics can come in contact with the posterior face of the iris, leading to the dreaded trifecta of UGH,” Dr. Pettey said. “Ironically, the Yamane technique is sometimes used as a surgical treatment for UGH caused by previously implanted IOLs,” Dr. Nakatsuka added. “Still, it can cause UGH in its own right and most often requires a revision to address the negative sequela.” To avoid UGH, Dr. Pettey and Dr. Nakatsuka said to ensure the lens is centered without tilt after viscoelastic removal. “Always place at least one iridotomy, and consider placing haptics further Contact information Kim: docdbk100@gmail.com Pettey: jeff.pettey@hsc.utah.edu Nakatsuka: austin.nakatsuka@hsc.utah.edu Yamane complications and management pearls by Liz Hillman Editorial Co - Director Figure 1. If needles intersect blood vessels, hemorrhagic choroid can occur. This article originally appeared in the September 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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