7 EyeWorld Asia-Pacific | September 2024 FEATURE Highlights from the 36th APACRS - 24th CSCRS Joint Meeting Chengdu, 2024 by Christina Chintanaphol and Michelle Dalton Tales Of The Flanging Technique Shin Yamane, MD (Japan) presented at the Lim Lecture this year, with the promise to “reveal everything about the flanging technique: how the flanging technique was developed; what other techniques exist besides the original flanged intraocular lens (IOL) fixation technique; and problems associated with the flanging technique and how to overcome them.” Although a trained vitreoretinal surgeon, Dr. Yamane won both the ASCRS Film Festival and APACRS Film Festival in 2016. Dr. Yamane was “so honored to be selected as a speaker of the Lim Lecture,” but humbly and professionally noted how his technique was the result of collaboration. He “noticed intrascleral IOL fixation techniques were not perfect,” and so modified them. His first-generation attempt used two 27-gauge needles to insert both haptics. Admittedly, it was not as successful as he’d hoped. Soon, he found that both 31- and 30-gauge needles could insert haptics of 3-piece IOLs, but the haptics may end up under the conjunctiva. “It’s not a big problem,” he explained. Shortly after this discovery, he continued reading about flanging techniques that were first used in glaucoma surgery. “Flanging techniques are not my own idea. I modified it from other applications. My fixated intrascleral IOL fixation with the double-needle technique only takes about 5-6 minutes, but it took many tries to make it successful,” he said. Dr. Yamane offered several steps for mastering his technique. Among these steps included bending the needles to 45 degrees with bevel side up and inserting the haptic into the needle on the table before the first case (and to use non-human eyes as the test case). “The direction of the needle hole is important,” he said. Scleral tunnels should be 2.3-2.5 mm from the limbus to avoid iris capture. Over the years, his flange size has decreased from 1 mm to about 0.25-0.5 mm, but Dr. Yamane noted how he still uses a 30-gauge needle. “If you use a 27-gauge, you’ll need a larger flange,” he added. He also developed a needle stabilizer to ensure the insertion angle is perfect so surgeons have better control of IOL tilt. His first iteration “didn’t work,” and his second idea was to create a spiral groove, “but it was too difficult to make.” After he won the Film Festival in 2016, however, “many companies came to me to develop the instrument.” The device has two wings to hold the loops 20 degrees inward and 10 degrees downward, he said. “This is especially effective for beginner surgeons,” he said. Finally, he commended others for modifying his flanging technique as well. “My take-home message is to learn from the past,” he said. “Ideas don’t come from one person alone.” The Lim Lecture was named after APACRS founder Professor Arthur S.M. Lim, a pioneer who recruited and worked with expert ophthalmic microsurgeons from around the world, to introduce microsurgical techniques and IOL implant technology to the region. Shin Yamane
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