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34 | EYEWORLD | OCTOBER 2019 ATARACT C WEBINAR SPOTLIGHT by Liz Hillman EyeWorld Senior Staff Writer Three-piece IOLs should be used. Dr. Weikert said they have used different kinds, but the CT LUCIA 602 (Carl Zeiss Meditec) is his favorite due to its stronger, shape-maintaining PVDF haptics. "Meticulous measurement and practice in wet labs." "Needle and paracentesis placement …" Dr. Weikert noted the 20-degree needle angu- lation needed for proper haptic orientation. One way to ensure this is to make three marks on each side. Mark the eye 180 degrees across the limbus, then 2 mm away from the limbus on that same plane. See Figure A and B to view these marks and where the third mark should be made in relation. Dr. Ayres said despite being experienced with Yamane, he takes a long time to measure. "It's all about measuring five times for good centration," he said. Dr. Weikert advocated practicing this technique in the lab, specifically mentioning SimulEYE (InsEYEt). Dr. Fram said using the SimulEYE gives you the confidence to practice incision placement, marking, and techniques to grab the distal haptic. "Symmetry is key to IOL centra- tion." "Critical for symmetrical tunnels to ensure centering." "Avoiding decentration." Once the lens is in the eye and the haptics externalized, you might notice the lens pivoting when you start to embed the haptics. Decentra- tion is related to asymmetrical scleral tunnels, Dr. Weikert noted. "In general, if you've got one side that positions a little better than the other, you can always trim the haptics or melt one a little more than the other," he said. Dr. Safran said he doesn't like shortening one of the haptics to achieve centration and would rather make a new scleral tunnel to achieve centration. Making one haptic shorter than the other could cause tilt, he cautioned. T he ASCRS Cataract Clinical Commit- tee hosted a webinar covering the in- creasingly popular flanged, double-nee- dle intrascleral IOL fixation technique pioneered by Shin Yamane, MD, PhD. This technique was first showcased at the 2016 ASCRS Film Festival where it won the grand prize. After the webinar, attendees shared the most valuable tips they learned. EyeWorld com- piled some of that feedback and augmented it with additional insights from the webinar's expert panelists Mitchell Weikert, MD, Brandon Ayres, MD, and Steve Safran, MD, who were led by moderator Nicole Fram, MD. "Type of IOL, the type of needle, and the choice of anterior or pos- terior infusion." "Materials need- ed for the case." "Needle gauges and loops materials." Dr. Weikert said he uses the TSK aesthetic 30-gauge needle with 13 mm bore (PRC- 3000131), but you could use a larger needle, such as a 27-gauge. MicroSurgical Technology (MST) is developing a needle set for the Yamane technique, Dr. Weikert said. Both Drs. Weikert and Safran noted the importance of inspecting/ testing the needle before starting the case to make sure the lumen is adequate to receive the haptic. The needles should be angled about 5 degrees from the surface of the eye, but "you want to come in pretty flat along the iris plane" so you enter in the sulcus, Dr. Weikert said, ex- plaining that approaching too steeply can result in suboptimal externalized haptics. Dr. Weikert said it's important to have balanced salt solution in the syringe loose on the needle. This solution should be pushed through the tip of the needle to prevent air bubbles when you are inserting it. The syringe is removed after needle insertion. Dr. Weikert uses 25-gauge MAXGRIP forceps (Alcon) through the paracentesis. An AC maintainer or a trocar can be helpful in these cases as well, Dr. Weikert said. What the audience valued most from the Yamane technique webinar About the doctors Brandon Ayres, MD Instructor Sidney Kimmel Medical College, Thomas Jefferson University Philadelphia Nicole Fram, MD Clinical instructor of ophthalmology Stein Eye Institute, University of California, Los Angeles Steve Safran, MD Solo practice Lawrenceville, New Jersey Mitchell Weikert, MD Associate professor Cullen Eye Institute, Baylor College of Medicine Houston Relevant financial interests Ayres: MicroSurgical Technology Fram: None Safran: None Weikert: None

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