SimulEYE ISHF Model: Kim Modified Yamane Technique, JnJ Sensar. Gentle on Delicate PMMA Haptics.

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Күн бұрын

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@Eye.Surgeon Жыл бұрын

Thank you for your great explanation and elaboration of each step. You are great! Cataract surgeons like me, who are working in underdeveloped countries benefit very much from your videos.

@DocBrianKimMD Жыл бұрын

Thank you for the kind words. Best wishes.

@dego2899 15 күн бұрын

A real masterclass! Thanks!

@DocBrianKimMD 15 күн бұрын

@@dego2899 thank you. Best wishes and happy holidays.

@ernestoperez7382 Жыл бұрын

Excellent technique. With the scleral incisions at 2.0 mm from limbus, does the IOL remains in its expected optical plane? Or is it necessary to choose an IOL 1 diopter less, to avoid miopization?

@DocBrianKimMD Жыл бұрын

Excellent question. Most updated recommendation is if you place the incision 2.5mm posterior to the limbus, choose -0.50D target. If you go 2mm posterior, it is a Plano target. Shin Yamane did UBM studies when he first introduced the technique in 2016-2017.

@natheerayed9626 5 ай бұрын

Dr . Nice work may i ask if these stiches effect the vision or not thanks alot

@ernestoperez7382 Жыл бұрын

Have you done UBM in these patients to asses the final IOL plane?

@azamqureshi6532 2 жыл бұрын

Great video. I just spent an hour trying to dock the trailing haptic after already externalizing the leading haptic already which definitely made my life way too difficult.

@azamqureshi6532 2 жыл бұрын

Also, thanks for talking to me and my co resident many years ago when we represented GA at the advocacy event. You were a breath of fresh air. Where can we get model eyes like that?

@DocBrianKimMD 2 жыл бұрын

Thank you for the feedback. Yes! This is the very reason why I developed this modification. For me personally it was a game-changer. I know many colleagues including Dr. Yamane himself who perform the original technique and do it without difficulty. I know for myself after having done many of these cases, I could do it the original way as well, but the maneuvers with where and how to hold the instruments and the haptics are much more nuanced and difficult to overcome for the person on the learning curve. My modification takes these challenges out of the equation. Why make it hard on yourself and the patient when there is an easier way, therefore less surgical time, less potential risk and probably safer for the patient.

@DocBrianKimMD 2 жыл бұрын

@@azamqureshi6532 thank you for the kind comments. Yes, I believe you and Morgan Micheletti were there, maybe a few others? Thanks for sharing your time and passion with the legislators. Happy to reconnect at a future meeting. Are you on LinkedIn?

@azamqureshi6532 2 жыл бұрын

D. Brian Kim MD yes, Azam Qureshi. Would love to connect. I agree about your technique here, and this was my first case doing it on a patient. I am a pediatric ophthalmologist now who does a lot of anterior segment trauma stuff in the Bay Area and was working on a trauma case. I think if I had seen your video I could have saved some struggles! Great stuff!

@hattia6 11 ай бұрын

Thank you for your prompt response , much appreciated. I don’t know if our hospital carry JNJ lenses and since you kept emphasizing how delicate the haptics are , it made me concerned, if they are more delicate than the MA60, which I hate, because i ran into trouble couple of time, and one of them was really out of control and I almost lost the eye

@DocBrianKimMD 11 ай бұрын

Both JNJ and Alcon IOLs have PMMA haptics. The issue with Alcon is the curvature. Both are delicate compared to CT Lucia but JNJ is manageable with the proper technique. I would not advise using the Alcon IOLs for this technique to avoid potential problems. Best wishes

@hattia6 11 ай бұрын

@@DocBrianKimMD Thank you very much, I was aware that both have PMMA haptics, but I wasn't sure if the JNJ is more delicate than the MA60, since I don't have experience with the JNJ products , but I can confirm for sure that I didn't like the curvatures on the MA60, when I was trying to externalize them, so certainly what you saying making sense, and thank you very very much for sharing your experience and you prompt response to my questions, much appreciated

@nibeditadas2543 2 жыл бұрын

Great technique,if we don’t externalise the leading haptic ,just keep it over iris at angle what will happen

@DocBrianKimMD 2 жыл бұрын

That is an excellent question. I haven’t done that but Dr. Soon-Phaik Chee does it this way. The only issue is that the leading haptic will flex out and against you when you when attempt to cannulate the trailing haptic, since they are opposing forces. If the haptic is externalized you do not have this opposing force issue and cannulation of the haptic is easier. There is however a theoretical risk of touching the corneal endothelium with my technique but I have never encountered focal edema over the area of haptic externalization so I don’t really think this is a real issue based on the cases I’ve done. Best wishes.

@beatrizbermeo2476 3 жыл бұрын

Excellent Dr Kim

@DocBrianKimMD 3 жыл бұрын

Thank you. Best wishes.

@thomaschia3173 3 жыл бұрын

Excellent technique and modification with the 25g needle. What grasper and AC maintainer are you using? Thank you

@DocBrianKimMD 3 жыл бұрын

Thank you. I use the 23g MST micrograsper but have also used the IOL holders I also use the 20g Lewicky AC maintainer.

@Mitch-MD 2 жыл бұрын

Really enjoy your modifications. Have had trouble with threading haptic into 30G needle. Too tight for MA60. . End up using 27G forceps which risks haptic damage. Haven’t tried 27 G needle. Have you? Curious if 27G not tight enough during canalization exit.

@DocBrianKimMD 2 жыл бұрын

Thank you for the kind comments. I don’t feel comfortable using MA60AC due to the relatively shorter haptics with more acute curve at the tip. I cannot comment on 30g vs 27g needle in this context. If you want to try 30g thin wall/large bore, then I would try cannulating the haptic before placing it into the eye as an initial test. Best wishes.

@Mitch-MD 2 жыл бұрын

@@DocBrianKimMD thanks. I prefer CT Lucia, unfortunately as a retina surgeon, most dislocated IOL rescues are MA60 and I prefer my first attempt keep that IOL.

@mshk0625 3 жыл бұрын

Excellent modification Dr. Kim. Do you still use low temp cautery to create a bulb/mushroom top at the edge of the haptic?

@DocBrianKimMD 3 жыл бұрын

Thank you for the kind words Yes, you need to create a small bulb at the end and push it into the sclera. I did not do it here because I wanted to be able to reuse the IOL for teaching purposes.

@hattia6 11 ай бұрын

Thank you 🙏🏼🙏🏼🙏🏼 … would you use the same 25 G with MA60 ? Are the haptics the same thickness and will they fit and be stable to do these maneuvering ?

@DocBrianKimMD 11 ай бұрын

Hello, I do not advise using MA60AC because the haptic is curved too acutely and the angle is not ideal for this technique. However, I have heard of others scleral fixating MA60AC. I have no experience with it. Best wishes.

@hattia6 11 ай бұрын

@@DocBrianKimMD Thank you 🙏🏼🙏🏼🙏🏼 … would you use the same 25 G with MA60 ? Are the haptics the same thickness and will they fit and be stable to do these maneuvering ?

@DocBrianKimMD 11 ай бұрын

I do NOT use 25 g needle. I use 30g thin wall needle from TSK. I would not advise using 25g needle because the needle will not hold the haptic when you pull it out from the scleral tract. Best wishes.

@hattia6 11 ай бұрын

@@DocBrianKimMD Got it, thank you. when you do 25 PPV all the time, everything become 25G to you 😊... should have paid more attention ... Thank you again 😊

@MiguelRaimundo 3 жыл бұрын

This makes a lot of sense, excellent improvement on the base technique. What’s your experience doing Yamane’s technique with the Alcon MN60AC?

@DocBrianKimMD 3 жыл бұрын

Thank you for the kind words. I do NOT recommend the Alcon 3 piece IOL. The haptic curvature is too acute, I.e. C shape curve instead of L shape curve. Not advise using it.

@markgkoskomd 3 жыл бұрын

Very helpful video Brian! I love the 25g needle trick to externalize the leading haptic and can’t wait to try that. I noticed you did most of the maneuvers through the main incision which seems new compared to some of your previous videos?? Is that your preference now, or just something on the Simuleye? I think I tend to use the forceps through the main incision for the trailing haptic (done first), and then I think I put the microforceps through a para to the right of main incision (from viewpoint of a video) for docking of leading haptic (done second). Lastly, was gonna mention that I do think if one is gonna use a lens with PMMA haptics (a non ct lucia 602 lens) that using something like J&J sensar/ar40 like you did here makes sense cause I believe that lens is non-aspheric, which I think is better cause in theory it would be slightly more forgiving with subtle tilt or subtle decentration, wheres a j/j za9003/tecnis A is aspheric and in theory could be slightly more sensitive to higher order aberrations if there is any of the subtle tilt or decentration that can be encountered even with a perfectly executed yamane. I think both lenses are hydrophobic acrylic? I know both of them have the PMMA haptics. At any rate, great video and thanks for making! I know they take a lot of work!

@DocBrianKimMD 3 жыл бұрын

Hey Mark, agree 100% the non-aspheric Sensar is a better choice in theory because it can tolerate decentration better compared to the sister IOL Tecnis ZA9003 which is aspheric. Actually I have been cannulating the haptics through the main incision for both trailing and leading haptics for some time now. The main limitation with the artificial eye model is that it does not simulate chamber collapse which as you know is a real potential issue when trying to visualize the haptic and needle during cannulation. Nonetheless, I do feel like the externalization of the leading haptic is the best way to tackle the trailing haptic with minimal stress and manipulation of the haptic. And now with the 25 g needle guide to externalize the leading haptic, this is an easy, no-grab, no-risk of damaging the haptic tip which is crucial with the delicate PMMA haptics. Best wishes.