Intraoperative Event Mechanisms During the Early Adoption of Yamane Flanged Intrascleral Intraocular Lens (IOL)...

Introduction To identify intraoperative events during early Yamane adoption using structured surgical video review, linking each event to procedural stage, plausible mechanism, and recovery action. Methods This retrospective study included 24 eyes undergoing Yamane flanged intrascleral intraocular lens (IOL) fixation between November 2024 and February 2025, representing early adoption by a single vitreoretinal surgeon. All procedures were video-recorded and reviewed postoperatively by a non-operating co-author experienced in Yamane fixation using a structured micro-step checklist to time-stamp events, assign plausible mechanisms, and record recovery actions. Secondary outcomes included operative timing and postoperative safety and visual outcomes. Results Intraoperative events occurred in eight eyes (33.3%): haptic slippage/disengagement (five), haptic breakage (one), mild vitreous hemorrhage (one), and suprachoroidal hemorrhage (one). Slippage most commonly involved the leading haptic and clustered around the "let-go" phase (M7) and subsequent trailing-haptic manipulation, with recurrent contributors including inadequate threading length and optic torque during nondominant-hand docking. Most events were recovered intraoperatively through repositioning, re-threading, or scleral re-tunneling; IOL exchange was required in one case of haptic fracture. Mean corrected distance visual acuity improved from logarithm of the minimum angle of resolution (logMAR) 0.96 ± 0.79 preoperatively to 0.47 ± 0.55 postoperatively. Conclusion Structured video review with micro-step classification standardizes linking events to stage, mechanism, and recovery, providing a practical framework for mentors to deliver targeted feedback and recommend technical refinements during training. Although based on a single-surgeon early series, this work introduces the checklist and warrants validation in broader cohorts.