Standardizing the Yamane flanged intrascleral haptic fixation: A framework for efficacy, complication mitigation, and reproducible training

Abstract

The Yamane technique for flanged intrascleral haptic fixation has emerged as a pivotal sutureless method for scleral fixation of a posterior chamber intraocular lens (IOL) in the absence of capsular support. This methodological review provides a technically oriented, stepwise description of the Yamane technique, emphasizing critical procedural nuances and evidence-based refinements that influence surgical control to achieve proper, long-term lens fixation. Key steps are consolidated from the original descriptions and subsequent mechanical studies evaluating haptic behavior, needle-haptic compatibility, tunnel geometry, and IOL centration. Surgical parameters—including needle gauge selection, bevel orientation, entry angle relative to the limbus, symmetric scleral tunnel creation, tunnel length, controlled haptic externalization, and flange formation—are reviewed in relation to postoperative lens position and stability. Comparative studies of the Yamane technique and those utilizing suture-based fixation techniques suggest broadly comparable refractive stability and a potentially favorable mechanical complication profile. However, variability across studies and the absence of long-term randomized controlled trial data warrant cautious interpretation. The methodological framework presented consolidates current evidence and technical refinements of the Yamane technique. Standardizing the key procedural steps of this technique is essential to enhance reproducibility, minimize avoidable complications, and improve the ability to compare outcomes across clinical studies.

Keywords: Yamane technique; Scleral fixation; Intrascleral fixation; Secondary intraocular lens implantation; Cataract surgery methods; Surgical efficiency; Surgical training; Cost-effectiveness

Core Tip: The Yamane technique is a sutureless approach for scleral fixation of secondary intraocular lenses based on symmetric intrascleral haptic fixation anchored by terminal flange formation. This review addresses technical factors that directly influence fixation stability, including needle gauge selection, bevel orientation, scleral tunnel length and angulation, haptic externalization, and flange sizing. By linking mechanical principles with clinical experience, a practical methodological framework is proposed to reduce tilt, promote centration, and avoid postoperative slippage, while improving reproducibility in both surgical training and clinical research.