Murtaza K. Adam, MD, on pearls for the Yamane scleral-fixated IOL technique

Docking the trailing haptic is the step where surgeons most often struggle with the Yamane technique, according to Murtaza K. Adam, MD, a retina specialist and partner physician at Colorado Retina Associates in Lakewood, Colorado. At the American Academy of Ophthalmology (AAO) 2026 Annual Meeting in New Orleans, Louisiana, Adam spoke with Ophthalmology Times about technique pearls, patient selection, complications, and advice for surgeons who are new to secondary IOL fixation.

>>> Prefer to read? Here is the Q&A with Murtaza K. Adam, MD, on pearls for the Yamane technique.

The leading haptic is relatively easy to guide into the first needle through a paracentesis, Adam said, but the trailing haptic can present a difficult angle for docking into the right-sided needle. To avoid this, he recommends placing the corneal incision slightly to the left of the superior cornea, and perhaps a little wider, and working with both hands at the same time. “Kind of work with both hands together to get them to meet and shake, so that you can dock it and then externalize it,” he told Ophthalmology Times.

When is another fixation method a better fit?

Flange fixation with the double-needle technique works for about 95% of his patients, Adam said, and it minimizes trauma to the conjunctiva, so surgeons can usually find untouched conjunctiva for fixation in eyes with a tube shunt or a history of scleral buckle. Some cases call for other approaches. In a patient with a rigid one-piece polymethyl methacrylate (PMMA) IOL, glaucoma, and a prior corneal transplant, Adam avoided the roughly 6-mm incision needed for explantation to minimize endothelial damage and graft failure risk, instead securing the existing lens to the iris with Prolene sutures. For a CZ70 IOL with eyelets, which is also PMMA and difficult to explant through a small incision, he uses a lasso technique with a Gore-Tex suture and then sutures it to the sclera.

How can complications be prevented?

Tilt and decentration were the most common complications early in his career, Adam said. With only 2 points of fixation, surgeons must center the haptics on the visual axis and create even scleral tunnels on each side, a skill that takes time to develop. In eyes with uveitis or a glaucoma drainage device, hypotony is common, so he sutures all incisions, leaves the pressure slightly high, and uses aggressive postoperative corticosteroids. To reduce haptic exposure, he places all haptics horizontally, because eyelids rub against haptics fixated at 12 and 6 o’clock. “We know that 90% of erosions occur when they’re superior placed,” he said.

For surgeons learning the technique, Adam recommends in-person mentorship when possible, studying videos from proficient surgeons, and scheduling about 1 hour and 15 minutes for a first case. Good corneal wound construction is a fundamental, and thorough planning matters as much as surgical skill, including evaluating the conjunctiva and choosing a refractive target with the patient rather than defaulting to plano. “These things, if you plan ahead, can avoid unnecessary second surgeries,” he said.