EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1538634
FALL 2025 | EYEWORLD | 31 C YES CONNECT: BEYOND THE ROUTINE by Ellen Stodola Editorial Co-Director About the physicians David Crandall, MD Henry Ford Hospital Detroit, Michigan John Hart Jr., MD Associates in Ophthalmology Farmington Hills, Michigan me aphakic, most often from trauma or from a surgery that did not go well," Dr. Crandall said. "These techniques are also valuable during cataract surgery and lens exchange if there is inadequate capsule support for in-the-bag or in- the-sulcus lens placement. Many patients who are aphakic, especially if it's in one eye, can do well with contact lens correction but over time become intolerant to this approach and desire lens implantation. Some patients know from the get-go that they will not be able to do contacts." Techniques Dr. Crandall said the main secondary IOL fixation techniques that he utilizes are Yamane intrascleral haptic fixation and directly suturing a lens with polytetrafluoroethylene (Gore-Tex) sutures. For most patients, either technique will work fine, he said. "For patients who have conjunctival scarring, I generally prefer the Ya- mane technique since that does not require me Secondary IOL fixation is a hot topic and likely will be for as long as we are continuing to do traditional IOL surgery. It requires skill, patience, steady hands, an innovative mind, and experience to accomplish these effectively. But most of all, it requires a persistent dedication to doing these types of procedures and doing them well. This is because these procedures are at the pinnacle of difficulty in the field of anterior segment surgery. For anyone who has consistently done them, they know what kinds of complications can occur both intraoperatively and postoperatively. A surgeon who does secondary IOLs must be prepared to do multiple surgeries to get the lens just right. They must have a stout heart to prepare themselves for the numerous complications that occur, including ones like retinal detachments or choroidal hem- orrhages that can cause a patient to lose vision or even lose the eye. The surgeon must be brilliant enough to figure out a solution to a problem that can occur within a few seconds during surgery and to be able to safely navigate their way out of it and produce an outstanding outcome despite the challenges. And finally, there's a whole refrac- tive outcome aspect that is equally challenging, and the surgeon must have the clinical acumen and empathy to walk the patient through the proper expectations for this type of surgery. I have requested that these outstanding sur- geons describe their techniques for how and when to successfully fixate a secondary lens when the capsule is either not present or not secure enough for traditional IOL implantation. –Austin Nakatsuka, MD, YES Connect Guest Editor S econdary IOL fixation can be used when the IOL is not in the right posi- tion, when there isn't an IOL, or when there isn't anything to fixate the IOL to in an ordinary way, said John Hart Jr., MD. When to proceed with this option depends on how the patient is functioning and any visual complaints. Dr. Hart and David Crandall, MD, discussed techniques and lens considerations when choos- ing to do secondary IOL fixation. "The most obvious situation for secondary lens implantation is when a patient is sent to Secondary IOL fixation: when to use, techniques, and other considerations continued on page 32 Single-piece IOL dislocation within the bag due to dead bag syndrome Source: John Hart Jr., MD