Flanged Fixation: New Technique to Keep IOLs in Place

A new minimally invasive technique for fixation of an intraocular lens (IOL) was presented at two recent retina conferences.

At the Retina World Congress in February, Shin Yamane, MD, of Japan, presented his technique of flanged fixation. At the 5th Annual Vit-Buckle Society Meeting in April, Mark Walsh, MD, of Tucson, AZ, presented his method that adapts Dr. Yamane’s technique.

The difference in this technique from previous methods is an alteration of the haptics, the two-side structures that hold the IOL in place. Prior to this technique the haptics would sometimes slip, even if they had been sutured into the sclera, causing the IOL to dislocate. Dr. Yamane’s method uses a flange to hold them much more securely.

The procedure involves vitrectomy with a 27-gauge or 25-gauge needle and injection of a three-piece IOL into the anterior chamber.

Dr. Yamane then inserts a 30-gauge needle through the sclera and places the end of the leading haptic of the IOL into the lumen of the needle. A second 30-gauge needle is then inserted, and the end of the trailing haptic is placed into the lumen of that needle. The needles are used to externalize the haptics, and the lens is adjusted into place.

Dr. Walsh’s modification incorporates a trocar–cannulas to create scleral tunnels, and externalizes the haptics, instead of utilizing Dr. Yamane’s needle method. Dr. Walsh believes this provides greater stability without needing an extra set of hands, and simplifies working with the haptics.

With both techniques, once the haptics are externalized, the end of each haptic is cauterized to form a bulb-shaped flange. The heating element should not touch the end of the haptic; it should just be held close enough to create the cauterization. The resulting bulb is then pushed into the scleral tunnel where it is held securely.

Says Dr. Yamane, “I just push the flange back into the scleral tunnel. If the flange is too large and difficult to push into the scleral tunnel, I enlarge the entry site of the scleral tunnel. It will never come out if the flange is completely inside the sclera.”

Dr. Walsh creates a big bulb so it doesn’t slip all the way through the tunnel. “I tuck it just so it’s in the mouth of the tunnel, so it’s covered by a little bit of sclera,” he explains.

The new technique and accompanying modification are a testament to the continuing evolution in instrumentation and techniques in retina and other ophthalmic specialties. Better and smaller instruments allow less invasive procedures with more successful outcomes and new concepts in patient care.