The Yamane technique fixes a three-piece IOL in the sclera without sutures. Both haptics pass through short intrascleral tunnels made with two thin-wall 30G needles, and their tips are melted into small flanges that anchor the lens. This guide covers the six key steps, the right IOL, the pitfalls behind tilt and iris capture, and how to rehearse every step before your first live case.
This overview is for surgeons in training and is not a substitute for supervised surgical education. Parameters vary between surgeons and cases.
Background
What is the Yamane technique?
Shin Yamane and colleagues described it in 2017 as flanged intrascleral IOL fixation with a double-needle technique. It is used for secondary IOL implantation when the capsule cannot support a lens: aphakia, complicated cataract surgery or a dislocated IOL.
Its appeal is a sutureless fixation with few steps and stable results. Its challenge is that every step demands symmetry and fine motor control.
Procedure
The Yamane technique in 6 steps
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Prepare the eye
Perform an adequate anterior or pars plana vitrectomy and keep the globe firm with an infusion or anterior chamber maintainer. Mark two sclerotomy sites exactly 180° apart, typically 2 to 2.5 mm posterior to the limbus.
Schematic, not to scale: both tunnels run parallel to the limbus at the same distance. 
Mounted in a head, the eye sits at a realistic orientation with the medial side marked. -
Insert the three-piece IOL
Inject the lens into the anterior chamber with the leading haptic inside the eye and the trailing haptic kept at the main incision.
-
First needle pass and docking
Enter the sclera with a 30G thin-wall needle at a shallow angle to create an intrascleral tunnel of about 1.5 to 2 mm. Thread the leading haptic into the needle lumen with microforceps.
-
Second needle pass and docking
Repeat the pass exactly opposite, with the same distance and tunnel length, and thread the trailing haptic. This is usually the hardest manoeuvre, so some surgeons dock the trailing haptic first.
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Externalise and check
Withdraw both needles to bring the haptics outside the sclera. Check centration and tilt now, before any cautery.
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Create the flanges and bury them
Melt each haptic tip with a low-temperature cautery into a small bulb, then push it back into the tunnel so it sits fully under the conjunctiva. Many surgeons add a peripheral iridotomy to prevent iris capture.
Practising the flange with the eyecre.at soldering pen on the training eye. 
The Soldering Pen for Yamane Technique gives you a controlled, low-temperature tip for the flange step.
Which IOL works best?
A three-piece IOL with PVDF haptics is widely preferred: PVDF resists kinking and forms a clean, mushroom-shaped flange. Lenses with PMMA haptics can be used but bend more easily, and lenses with curved haptic tips are less suitable. Many surgeons aim for a slightly myopic target of about -0.50 to -1.00 D to avoid a hyperopic surprise.
Troubleshooting
Common pitfalls and how to avoid them
| Problem | Typical cause | Prevention |
|---|---|---|
| IOL tilt or decentration | Sites not 180° apart, unequal distance to the limbus, unequal tunnels | Precise marking, identical needle angles, check before cautery |
| Iris capture, reverse pupillary block | Entry too close to the limbus | Entry about 2.5 mm posterior, peripheral iridotomy |
| Dropped or kinked haptic | Rough handling, unsuitable haptic material | PVDF haptics, gentle microforceps technique |
| Flange slips out or extrudes | Flange too small or too large | Measure the melt length, controlled low-temperature cautery |
| Exposed flange | Flange not buried in the tunnel | Push the bulb fully into the sclera |
| Soft eye, bleeding | No pressure control during needle passes | Infusion or anterior chamber maintainer |
Options
Yamane compared with other secondary IOL options
| Option | Sutures | Main advantage | Main limitation |
|---|---|---|---|
| Yamane flanged intrascleral fixation | None | Sutureless, few steps | Steep learning curve, needs a suitable three-piece IOL |
| Sutured scleral fixation | Yes | Long track record | Suture erosion or breakage over time |
| Iris-claw IOL (retropupillary or anterior) | None | Quick to learn | Requires a healthy iris |
| Anterior chamber IOL | None | Simple implantation | Risk to corneal endothelium and angle |
Wetlab
How to practise each step
The critical moments are tactile: symmetric needle docking, threading a springy haptic into a thin needle and judging the heat for a flange. Videos explain them, but only repetition builds the hand skill. We built the Eye 4 Yamane for exactly this: a stable sclera for intrascleral tunnelling, a working anterior segment and room to manoeuvre a three-piece IOL.
- Needle passesTwo 30G passes exactly 180° apart with equal tunnels
- Haptic dockingThreading leading and trailing haptics into the needle lumen
- Flange creationMelting flanges with the soldering pen at a controlled temperature
- CentrationChecking tilt and decentration before and after flanging
- Full sequenceRunning the complete procedure for speed and consistency
Eye 4 Yamane
Artificial eye for sutureless flanged IOL fixation. Pack of 6.
EUR 99 per eye · EUR 594 per pack View in store
Soldering Pen for Yamane Technique
Low-temperature tip for forming haptic flanges in the wetlab.
View in storeFor broader secondary IOL training, combine it with the Eye 4 Aphakia or the Eye 4 Compromised Capsule Bag. Planning a course or a department wetlab? Our wetlab setup guide lists everything you need.
FAQ
Frequently asked questions
What is the Yamane technique?
A sutureless method to fix a three-piece IOL in the sclera: both haptics are passed through intrascleral tunnels with 30G needles and anchored with melted flanges.
Which needle is used?
Thin-wall 30G needles. Standard 30G needles have too narrow a lumen for the haptic, and larger needles create larger tunnels.
Which IOL is best for the Yamane technique?
A three-piece IOL, preferably with PVDF haptics, which resist kinking and form reliable flanges.
What causes IOL tilt after Yamane?
Mostly asymmetry: needle sites not exactly opposite, different distances to the limbus or unequal tunnel lengths.
How can I learn the Yamane technique safely?
Watch annotated surgical videos, then rehearse every step on an artificial eye, ideally under supervision, before your first live case.
What does the Eye 4 Yamane cost?
EUR 99 per eye, sold in packs of 6. Institutions can request a quote.
Ready to practise the Yamane technique?
We help you plan the right setup for your wetlab or course.
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- Yamane S, et al. Flanged intrascleral intraocular lens fixation with double-needle technique. Ophthalmology. 2017.
- Pearls for the Yamane Technique, CRST
- Yamane Tips and Tricks, CRST
