Eyeworld

34 | EYEWORLD | SEPTEMBER 2023 ATARACT C COMPLICATED CASES by Liz Hillman Editorial Co-Director About the physicians D. Brian Kim, MD Professional Eye Associates Dalton, Georgia Jeff Pettey, MD Clinical Vice Chair Moran Eye Center University of Utah Salt Lake City, Utah Austin Nakatsuka, MD Assistant Professor Glaucoma/Cornea/ Anterior Segment Moran Eye Center University of Utah Salt Lake City, Utah Dr. Kim, Dr. Pettey, and Dr. Nakatsuka provided their thoughts on some of the more common complications that can occur with intrascleral haptic fixation as well as pearls for handling each situation. Choroidal hemorrhage: When passing nee- dles through the sclera, Dr. Nakatsuka said the needles may intersect blood vessels and cause bleeding, which can be more significant in older individuals on anticoagulation medications but can also happen in younger individuals. See Figure 1 for an example. "In our experience, this happens in rough- ly 1–5% of cases," he wrote. "Depending on the severity of the bleeding, it may be treated medically with topical and/or oral steroids and cycloplegics versus surgical drainage." Dr. Pettey and Dr. Nakatsuka's pearl for this situation was to stop anticoagulant use, if possi- ble, in high-risk patients and to cauterize scleral vessels if needed. Uveitis-glaucoma-hyphema (UGH) syndrome: "After placement of the lens, the optic or haptics can come in contact with the posterior face of the iris, leading to the dreaded trifecta of UGH," Dr. Pettey said. "Ironically, the Yamane tech- nique is sometimes used as a surgical treatment for UGH caused by previously implanted IOLs," Dr. Nakatsuka added. "Still, it can cause UGH in Yamane complications and management pearls I n the years since Shin Yamane, MD, PhD, presented on flanged double-needle in- trascleral haptic fixation (2017), 1 many surgeons have adopted the technique, but it's not without complications that require preparation and management. "There are many potential complications from intrascleral haptic fixation techniques, such as the Yamane technique. Herein we discuss some of the most relevant and worst," Austin Nakatsuka, MD, and Jeff Pettey, MD, wrote in an email to EyeWorld. D. Brian Kim, MD, also weighed in on the topic. A literature search, he said, failed to reveal exact incidence of complications with this technique, but "it's safe to say the incidence is higher while on the learning curve, and it tends to be steep," he added. "These technical challenges have led sur- geons to develop various adaptations, such as using a trocar instead of needles while others externalize the right side needle outside of the main incision to more easily cannulate the more challenging trailing haptic," Dr. Kim said. "It's difficult to assess frequency of complications when there are so many variations. With my own modifications, I have been fortunate to reduce the frequency and avoid catastrophic complications thus far, and currently, I do not tend to struggle with problems related to the technique." Figure 2: Lens tilt or decentration can occur due to a variety of reasons during intrascleral haptic fixation, especially asymmetry of the scleral tunnels. Figure 1: If needles intersect blood vessels, hemorrhagic choroid can occur.

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