https://doi.org/10.46889/JOAR.2023.4301 https://athenaeumpub.com/journal-of-ophthalmology-and-advance-research/ Case Report Case Report: Yamane Fixation of a Light Adjustable Lens in a Patient with Marfan Syndrome Kyle Margulies 1* , Kerrick Chinen 2 , Neda Nikpoor 3 1 Medical Student, Department of Ophthalmology/Visual Sciences, AT Still University of Health Sciences, USA 2 Medical Student, Department of Ophthalmology/Visual Sciences, University of Hawaii John A. Burns School of Medicine, USA 3 Aloha Laser Vision, University of Miami Palmer, USA *Correspondence author: Kyle Margulies, Medical Student, Department of Ophthalmology/Visual Sciences, AT Still University of Health Sciences, USA; Email: kyle.margulies@gmail.com Abstract This paper aims to discuss a case of a Light Adjustable Lens (LAL) implanted with the Yamane technique in a Marfan patient undergoing complex cataract surgery. A 60-year-old female with a history of Marfan syndrome presented in May 2020 with complaint of worsening vision due to bilateral subluxed cataracts. Bilateral LALs were planned to be implanted in the capsular bag with scleral fixated Ahmed segments using 5-0 prolene due to zonular instability. The procedure was complicated by an anterior capsular tear at 6 O’clock due to a very friable capsular bag. This tear extended posteriorly with no vitreous loss. Given inadequate capsular support, the decision was then made to scleral fixate the LAL using a Yamane technique. The first attempt at scleral fixation resulted in the LAL haptic breaking off into the 27G needle during the scleral pass. The LAL with remaining haptic was cut in half and explanted. A new LAL was successfully fixated with the Yamane technique. A scleral fixated Ahmed segments using 5-0 prolene was done successfully for the right eye. Final adjustment and locking occurred 10 weeks after right eye procedure. The final refraction of the right eye was measured to be plano, + 0.5 cyl, 85 axis with uncorrected distance visual acuity of 20/20 and corrected distance visual acuity of 20/20. The final refraction of the left eye was measured to be -2.75 D, 0 cyl, 0 axis with uncorrected distance visual acuity of 20/200, uncorrected near visual acuity of J1+ and corrected distance visual acuity of 20/20. When choosing a lens to Yamane, LALs are uniquely capable of correcting a residual refractive error without an additional surgery. LALs are an excellent option for patients that desire a refractive outcome with limited or no capsular support. Keywords: Refraction; Intraocular Lens; needles; Extended Depth-of-Focus Introduction Sutureless intrascleral Intraocular Lens (IOL) fixation has become an increasingly popular technique in patients with compromised capsular or zonular support. These techniques offer an alternative to angle-supported or iris-fixated anterior chamber IOLs. One sutureless technique commonly used is the double-needle flanged haptic technique also known as the Yamane technique. This technique involves inserting a pair of 30G needles through the sclera, 2 mm posterior to the limbus. The surgeon then feeds the haptics of the IOL, already in-situ, into the lumen of the needles. The needles containing the haptics are drawn out of the scleral tunnels, resulting in the fixation of the haptics within the tunnels. Finally, the protruding ends of each haptic are cauterized into flanges that prevent the haptic from slipping into the eye and dislocating the IOL [1]. Indications for scleral fixation via Yamane technique include subluxation of the lens and inadequate capsular support. The most common causes of zonular insufficiency are pseudoexfoliation syndrome, trauma, previous ocular surgery, hyper-mature Citation: Margulies K, et al. Case Report: Yamane Fixation of a Light Adjustable Lens in a Patient with Marfan Syndrome. J Ophthalmol Adv Res. 2023;4(3):1-4. https://doi.org/10.46889/JOAR.2023. 4301 Received Date: 04-09-2023 Accepted Date: 24-09-2023 Published Date: 30-09-2023 Copyright: © 2023 by the authors. Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CCBY) license (https://creativecommons.org/li censes/by/4.0/).