Combined double-needle flanged-haptic intrascleral fixation of an intraocular lens and Descemet-stripping endothelial keratoplasty.

A slight modification to the Yamane transconjunctival double-needle flanged-haptic technique of intrascleral fixation of an intraocular lens (IOL) shows the technique's usefulness when combined with Descemet-stripping endothelial keratoplasty (DSEK). The modification uses bipolar cautery to create flanges at the tip of the IOL haptics and delays tucking the haptics into the scleral tunnels until DSEK has been completed. Bipolar cautery enables the technique to be used in situations in which disposable low- or high-temperature cautery, as originally described, might not be possible. Delaying the haptic tuck until after the complete air fill of DSEK means the surgeon can be confident of the IOL position at all times. This combined technique can be a viable option for patients with aphakia and endothelial cell dysfunction.