Complicated IOL Rescue - Yamane Lessons Learned with ZA9003 Lens, Small Eye, Floppy Iris, Glaucoma
A patient’s intraocular lens is dislocated inferiorly. She has a small eye, a history of narrow angle glaucoma with acute angle closure, a history of pars plana vitrectomy, a pterygium, and floppy iris syndrome. I want to help her but it will be a challenge. To the non-surgeons out there, I have a secret to tell you. Not all cases go as planned. And I think it’s good to share videos when things get challenging. We learn the most from such cases. In this video, I will show you a difficult case, in which I attempt to rescue a dislocated IOL. But things don’t go exactly as planned. During my attempt to perform the Kim-Modified Yamane technique to rescue this lens, i kink the haptics. Both of them!
For the Yamane procedure, it’s helpful to have good exposure of your sclera. As you’ll see, I’ll have to rotate her eye to properly mark. I considered sitting superiorly to give myself better scleral exposure, but she has a pterygium on one side, and if that were to ever be removed, there would be a higher chance of haptic exposure. For you who do pterygium surgery, the epithelium that grows over the nasal sclera is super thin. Another challenge in this case is that the IOL I’m going to rescue, is not ideal for the Yamane procedure. It’s the J&J ZA9003. I’ve never yamane’d this lens before, the haptics are very delicate and kink easily. Also, this patient has a history of acute narrow angle glaucoma with pressure in the 50’s. Despite having LPI’s already, An ACIOL is contraindicated, and so that’s why I will attempt the Yamane. An Iris fixated IOL would be possible and technically much easier, but I believe fixating the IOL to then sclera would be a better end goal. Can I save the lens, or will it need to be replaced?
If you have any questions, feel free to leave them in the comment section below!
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