I agree that many steps of the Yamane procedure are easier with a PPV and posterior viewing system. However, easier is not always better. Dr. Yamane uses 30G thin-walled needles for a reason: the needle track is a tighter fit to the haptic and the terminal bulb is more reliably larger than the scleral pass. Using a 27G trocar is not as tight a fit and slipped haptics have been reported. If the dislocated IOL is posterior on the retina it makes the most sense for a retinal surgeon to do the surgery provided they are familiar with it. And I would advocate for needle pass over trocar.
Absolutely- great point about the tighter fit! I do 30g thin-walled needles as well, but each technique has its pros and cons. Using the trocars puts a lot less stress on the haptics. So just have to pick your poison with these cases. Good to be comfortable with a wide variety of approaches and tailor it to each patient. This technique is more approachable and a good one to have in your arsenal.
This is an AR40. I’ve done this with MA60s. This technique is very gentle on the haptics. I’ve never kinked the haptics with this technique. Wish I could say the same for the traditional TSK needle. I think the Brian Kim modification definitely helps not kink it, but still more stress on the haptics with the tsk needles due to the angles you have to move and feed them.
Excellent Technique as a VR Surgeon this technique is much easier than using the needle.
Thank you so much for sharing.
I agree that many steps of the Yamane procedure are easier with a PPV and posterior viewing system. However, easier is not always better. Dr. Yamane uses 30G thin-walled needles for a reason: the needle track is a tighter fit to the haptic and the terminal bulb is more reliably larger than the scleral pass. Using a 27G trocar is not as tight a fit and slipped haptics have been reported. If the dislocated IOL is posterior on the retina it makes the most sense for a retinal surgeon to do the surgery provided they are familiar with it. And I would advocate for needle pass over trocar.
Absolutely- great point about the tighter fit! I do 30g thin-walled needles as well, but each technique has its pros and cons. Using the trocars puts a lot less stress on the haptics. So just have to pick your poison with these cases. Good to be comfortable with a wide variety of approaches and tailor it to each patient. This technique is more approachable and a good one to have in your arsenal.
wow THATs a cool technique! I appreciate phacomd comment as well. thx for sharing!
An interesting approach
Great technique! Is this a CT Lucia? With PMMA haptic-lenses such as ARe40 the trailing haptic will likely get damaged with this technique.
This is an AR40. I’ve done this with MA60s. This technique is very gentle on the haptics. I’ve never kinked the haptics with this technique. Wish I could say the same for the traditional TSK needle. I think the Brian Kim modification definitely helps not kink it, but still more stress on the haptics with the tsk needles due to the angles you have to move and feed them.
@@asgharh1 Thank you for responding Dr Haidar! Beautiful surgery!
Not a procedure for the faint hearted cataract surgeon!