CataractCoach™ 2930: Yamane SFIOL in Marfan Syndrome (ISHF)

Added: 2026-05-15

[00:00:00][music] >> cataractcoach.com Yamane scleral fixated IOL in Marfan syndrome is a temporal approach to fixated IOL with this interesting little device to market.

[00:00:11]Look at this. So, here marking 180 apart. That's very important to get these opposite each other. And here's the new marker. It's basically four points and it's 2 by 2 mm. So, you poke on it right there. And remember haptic orientation, right? So, this one's towards you on that side. Yep, and then the opposite one's going to be away from you. Cuz what's the position of the haptics, right? This haptic on your left side of the screen will be curled towards you.

[00:00:33]On the right side of the screen it's away from you. So, that's correct markings. Looks great. And that again is 2 mm by 2 mm. So, you know how far back to go and how long of a tunnel length.

[00:00:41]That's an interesting technique here. I like it. Now, patient already had the cataract removed as well as the lens. So, this is completely gone. There's no capsular support. So, basically the entire lens and capsule was removed. Now, making a couple of paracenteses here.

[00:00:56]And maybe even another one here.

[00:00:58]And now you're going to put in this three-piece lens for fixation. So, oh, first check. I think that's a smart idea. I put in less triamcinolone.

[00:01:05]That's a That's a lot. You don't need too much. Oh, look at the white reflex now. No more red reflex.

[00:01:10]There's obviously a little bit of vitreous prolapse there. So, you got to clean that up. So, the trick in triamcinolone is don't use the full strength, which is 40 mg per cc. That's too much.

[00:01:20]You want it maximum 10 mg per cc or even dilute it even more to 5 mg per cc. You need very little. You don't want to put a ton of triamcinolone on the eye.

[00:01:28]That's way, way, way too much.

[00:01:30]>> [snorts] >> So, now here comes the infusion, the AC maintainer.

[00:01:34]There we go. That's going to stay in position.

[00:01:36]And that's important to keep this, you know, eye intact from from collapsing here. Now, here comes the incision. I try to open the existing incision. Looks like there's even a suture there.

[00:01:46]So, I don't know if I'd make a new incision, especially one [clears throat] that's avascular. But okay, we'll take it. Ooh, look at the vitreous coming up.

[00:01:52]You may need to do more of a vitrectomy, to be honest.

[00:01:54]You may need to do a little more of a vitrectomy. That vitreous is floating around a little too much. Or viscoelastically something.

[00:02:02]Some viscoelastic in there. Keep that vitreous pushed back.

[00:02:05]And so, it's one of the dangers in in Yamane is that when you're doing it, if you're not careful, you can get the IOL haptic entrapped with vitreous. So, here's the three-piece lens. Get that leading haptic kind of straightened out.

[00:02:16]You don't don't don't break it.

[00:02:19]And now you don't want to put the lens in the eye. The haptic is which what?

[00:02:21]What orientation? 7 L.

[00:02:23]So, here comes the 2 mm back and 2 mm long tunnel length with a 30-gauge thin-wall needle. And then get that inside the eye. There we go.

[00:02:32]And then now let's see what we're going to do here.

[00:02:35]Probably going to have a start to inject and kind of guide it in there.

[00:02:39]So, you can actually do this solo. You can start to inject a little bit and just get the one haptic out. And then you can get it inside there. So, now twist it around. There you go. That's the correct orientation. And then use that move that needle with the other hand. So, now you're not touching the plunger of the injector. You're just getting the direction of it lined up.

[00:02:56]And now once you get it in a little bit, you can let go of the hollow bore needle and keep injecting it injecting it and then kind of wiggle it more. Or you can use the system, too.

[00:03:04]So, be very careful to damage these.

[00:03:06]There's the lens. Get it flipped in the correct orientation. Right, 7 L rule anti-S. That looks good.

[00:03:12]And so, you may want to I get a little bit Yeah, get a little bit more of that one leading haptic inside the hollow bore needle before externalizing it.

[00:03:21]So, I go in here, grab that haptic, and push it in there more. Yep, yep, yep. Or just Yeah, now now you can pull it out.

[00:03:28]Now you're good. You can pull that haptic outside the eye.

[00:03:31]And let's get that first haptic out.

[00:03:34]Good, good, good. Externalizing it here.

[00:03:36]And then you can do your little bit of cautery.

[00:03:39]Interesting technique here. Looks pretty good. There's the end of the haptic.

[00:03:43]Remember, make Don't make too huge of a of a bulbous tip that your flange should be pretty small. Like that's enough.

[00:03:48]That's enough. Enough enough enough enough.

[00:03:50]Because you want to get this inside the tunnel. You don't want that haptic flange to sit under the conjunctiva as a big nubbin.

[00:03:59]Because that's just going to erode through the conjunctiva.

[00:04:02]And so, here you can see this is a uh trailing haptic going in. And these are the very flexible haptics because not all lenses can do this. And some lenses that have more fragile haptics, you can actually fracture the haptic or misbend it. So, now getting this pushed in there. Remember, haptics are actually hand-staked into the optic by humans in a factory. And so, they're not glued in there. You can, if you pull hard enough, pull the haptic out of the optic. And you don't want to do that. So, here we go. Now, little bit of cautery. Little flange. And remember to bury these flanges within the sclera. It's intrascleral haptic fixation.

[00:04:37]And so, you want to get that haptic pushed in more. Good, good, good. And then even just get the nub of the flange here and push it inside that tunnel. Do not leave it just sitting on the conjunctiva.

[00:04:49]I push it in a little bit more, but that's pretty good. And then seal up the incision here at the end. I may even put a suture in this incision cuz this eye's been through a bit. So, I think a suture in that incision It looks like there's already a suture there, by the way. But I'd put another one here.

[00:05:02]And that was pretty good. Double-check.

[00:05:04]Make sure there's no more vitreous coming forward. Get the vitrectomy out if you need to. Put a little tiny bit of triamcinolone. And here at the end, pupil comes down nicely. Looks pretty good. Beautiful job. Submit your video to cataractcoach.com. And remember, check out Retina Realms. That's a sister channel. You know you love it.