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

Table 3 The Yamane technique: Advantages, limitations, and key technical challenges of the Yamane scleral-fixated intraocular lens technique

Category	Details
Advantages	Sutureless - eliminates suture degradation, erosion, and late dislocation
	Minimal conjunctival manipulation preserves tissue
	Shorter operative time vs sutured fixation
	Small incision (30-gauge needles), self-sealing sclerotomies
	Good IOL centration and axial stability
	Posterior chamber positioning maintains normal anatomy
	Comparable or superior outcomes vs sutured fixation
	Cost-effective (no sutures, fewer reoperations)
	Mechanical stability via intrascleral friction + flanges
	Reproducible with standardized steps
Limitations	Significant learning curve requiring precise coordination
	Refractive predictability less precise than in-the-bag IOL
	Requires specific three-piece IOLs with appropriate haptic material (e.g., PMMA or PVDF)
	Limited options for premium IOLs
	Risk of tilt/decentration with asymmetric placement
	Haptic deformation risk during externalization
	Not ideal for very thin sclera (high myopia, Marfan)
	Higher CME rates than sutured techniques
	Potential late haptic exposure if inadequately buried
	Limited long-term data beyond 5 years
	Often benefits from a complete vitrectomy
Key technical challenges	Symmetric and precise scleral tunnel creation
	Controlled haptic capture within the needle lumen
	Symmetric beveled entry to prevent lens tilt
	Uniform flange and haptic formation to promote lens centration
	Adequate burial of flanged ends to prevent erosion or migration
	Assessment of lens centration intraoperatively with irregular pupils

IOL: Intraocular lens; PMMA: Polymethyl methacrylate; PVDF: Polyvinylidene fluoride; CME: Cystoid macular edema.