Consistent haptic insertion using a blunt-needle guide for intrascleral IOL fixation

Trailing haptic insertion is one of the most technically challenging steps of flanged intrascleral intraocular lens (IOL) fixation using the Yamane technique. This study evaluated a blunt-needle guide technique designed to facilitate trailing haptic insertion and compared it with the conventional technique. This retrospective comparative study included 80 eyes of 74 patients who underwent flanged intrascleral IOL fixation between April 2017 and March 2025. Eyes were divided into a blunt-needle guide group (36 eyes), in which the trailing haptic was docked into a 27-gauge blunt needle outside the eye and guided into the anterior chamber before docking into the fixation needle, and a conventional group (44 eyes). Primary outcome measures were assessed by retrospective review of recorded surgical videos. The number of grasping attempts was analyzed using Poisson regression adjusted for chronological case sequence. Postoperative IOL tilt and decentration were evaluated using anterior segment optical coherence tomography. The number of grasping attempts during trailing haptic insertion was significantly lower in the blunt-needle guide group than in the conventional group (1.7 ± 1.1 vs. 4.5 ± 3.1, P < 0.001). This association remained significant after adjustment for chronological case sequence. Mean insertion time did not differ significantly between groups (50.6 ± 17.8 s vs. 66.9 ± 50.2 s, P = 0.18). However, variability of insertion time was significantly lower in the blunt-needle guide group ( P = 0.01). Postoperative IOL tilt (6.9 ± 3.1° vs. 5.8 ± 3.2°, P = 0.09) and decentration (0.4 ± 0.2 mm vs. 0.4 ± 0.3 mm, P = 0.18) were comparable between groups. No complication specifically attributable to the blunt-needle guide technique was identified. The blunt-needle guide technique reduced the number of grasping attempts required for trailing haptic insertion and improved consistency during trailing haptic insertion without adversely affecting postoperative IOL positioning. This simple adjunctive maneuver for intraocular transfer of the trailing haptic from the blunt guide to the fixation needle may improve the reproducibility of trailing haptic insertion.