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

Table 4 Stepwise procedural checklist for the Yamane flanged intrascleral haptic fixation technique

Step	Stage	Action
1	IOL selection	Confirm three-piece IOL with PMMA haptics compatible with 30-gauge needle lumen
2	Scleral marking	Mark symmetric scleral entry points 180° apart, 2.0-2.5 mm posterior to the limbus
3	Needle insertion	Insert 30-gauge needles with bevel orientation optimized for haptic capture (bevel-up preferred); maintain entry angle of 20° relative to the limbus and 5° relative to the iris surface
4	Tunnel adequacy	Confirm intrascleral tunnel length ≥ 2.0 mm to ensure adequate haptic retention
5	Haptic externalization	Externalize haptics through needle lumen with controlled, minimal force to avoid deformation
6	Flange formation	Form flanges using low-temperature cautery; target flange diameter 0.3-0.5 mm; avoid excess heat to prevent haptic brittleness
7	Haptic retraction	Retract flanges into scleral tunnels and confirm fully seated position
8	IOL verification	Verify IOL centration and tilt under the operating microscope before wound closure

PMMA: Polymethylmethacrylate; IOL: Intraocular lens.