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Self-rescue technique and Yamane's technique in situ: Management of intraoperative haptic slippage.

ABSTRACT: Haptic slippage is a frequently encountered and technically demanding complication in Yamane's surgery. The slipped haptic could be regained when bimanual operations are workable. Management of haptic slippage is difficult when the right hand is occupied by the puncture needle, which could be solved easily with the self-rescue technique, which uses the needle tip as an intraocular instrument for better exposure and easier engagement of the slipped haptic. With the aid of bimanual operations and self-rescue technique, Yamane's technique in situ is applicable when the haptic of dislocated intraocular lens suits for flange-making.

SUBMITTER: Tang Y

PROVIDER: S-EPMC10228947 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Self-rescue technique and Yamane's technique <i>in situ</i>: Management of intraoperative haptic slippage.

Tang Yong Y Li Weiwei W Chu Yanhua Y Han Quanhong Q

Indian journal of ophthalmology 20230201 2

Haptic slippage is a frequently encountered and technically demanding complication in Yamane's surgery. The slipped haptic could be regained when bimanual operations are workable. Management of haptic slippage is difficult when the right hand is occupied by the puncture needle, which could be solved easily with the self-rescue technique, which uses the needle tip as an intraocular instrument for better exposure and easier engagement of the slipped haptic. With the aid of bimanual operations and ...[more]

PMID: 36727380

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Project description:PurposeTo report two patients with a complication of Yamane intrascleral haptic fixation surgery (ISHF) with the Zeiss CT Lucia 602 lens: severely tilted intraocular lens (IOL) leading to significantly decreased vision in the early post-operative period.ObservationsWe report two patients presenting with severely tilted IOL implants one day and one month following Yamane ISHF. The first patient is a monocular 81-year-old woman referred for treatment of cornea edema. Initial surgery involved replacement of an anterior chamber lens with a CT Lucia 602 posterior chamber lens using Yamane technique and Descemet's stripping endothelial keratoplasty. The patient returned at one month follow-up with poor vision and IOL tilt observable at the slit lamp through a peripheral iridectomy site. Explanation of the Zeiss lens revealed haptic distortion at the optic-haptic insertion point such that each haptic was about 45° off axis to the plane of the optic in approximately equal and opposite directions. The second patient, a 75-year-old woman, was referred with a completely dislocated lens-bag complex in the right eye. The initial operative treatment for this patient included pars plana vitrectomy, retrieval and removal of the dislocated lens-bag complex, and placement of a Zeiss 602 lens via Yamane ISHF technique. On the first postoperative day, the patient was count fingers in the right eye with an intraocular pressure of 5 mm Hg and obvious IOL tilt on slit lamp examination. Explanation of the lens revealed severely distorted haptics relative to the optic by more than a 60-degree angle on both sides. In both cases, initial surgery was performed with an IOL inspected prior to implantation and found to have normal appearing haptics. At the end of each case, there was adequate centration and no tilt of the IOL. Management in both patients included removal of the defective lens and placement of a new, same power CT Lucia 602 lens via the Yamane technique. Visual acuity improved from CF to 20/30 best corrected after reoperation in both cases.Conclusions and importanceIn summary, we describe a complication of Yamane ISHF with the CT Lucia 602 lens in which there is lens tilting associated with distortion at the optic-haptic fastening zone in the early postoperative period. In the event of a titled lens following Yamane ISHF, awareness of this complication may help surgeons consider lens replacement, as the haptics may be permanently distorted or damaged.

Project description:BackgroundDislocated IOL exchange conventionally involves manipulation within the anterior chamber which risks secondary injury to anterior chamber structures. We describe and evaluate a 4-haptic IOL rescue technique that avoids entering the anterior chamber and thus minimizes post operative inflammation, astigmatism and recovery time relative to conventional IOL explantation and replacement techniques.MethodsRetrospective, non-randomized, interventional study of all patients undergoing 4-haptic IOL rescue performed by two independent vitreoretinal surgeons at a single UK centre over two years.Surgical techniqueA limited peritomy is performed with four 25-gauge scleral ports placed to enable use of two forceps, an infusion and a chandelier. A further four 27-gauge sclerotomies are symmetrically placed on the nasal and temporal sclera at 3 mm from the limbus with a 5 mm vertical separation on either side. A pars plana vitrectomy is performed followed by chandelier illuminated, bimanual cleaning of the dislocated IOL using 27-gauge serrated forceps. Gore-tex sutures are threaded through the IOL islets within the vitreous cavity and externalized through the sclerotomies for scleral re-fixation followed by conjunctival closure.ResultsSeven patients underwent IOL recycling with Gore-Tex suture scleral re-fixation. All procedures were successful in repositioning the IOLs, with all patients satisfied with post-operative outcome. Mean (standard deviation) time to IOL dislocation was 13 (3) years. Median visual acuity significantly improved post-operatively from 0.85 logMAR (Interquartile Range [IQR]: 0.2-2.1) to 0.07 (0.02-0.60) logMAR (p = 0.02). No significant post-operative complications were noted apart from persistent cystoid macular oedema in one patient non-compliant with post-operative treatment.ConclusionsTransscleral refixation using Gore-Tex suture is an effective, safe and practical approach in the management of dislocated 4-piece IOLs.

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Self-rescue technique and Yamane's technique in situ: Management of intraoperative haptic slippage.

Publications

Self-rescue technique and Yamane's technique <i>in situ</i>: Management of intraoperative haptic slippage.

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