Artificial Iris– Intraocular Lens Complex Implantation Using Combined Yamane And Canabrava Fixation Techniques: A Case Series

The management of traumatic aniridia and aphakia after penetrating ocular injuries remains a significant surgical challenge. Our cases describe a novel sutureless surgical technique for artificial iris intraocular lens (AI-IOL) complex implantation using combined Yamane and Canabrava four-flanged technique.

Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, Kaunas Clinics.

Two male patients aged 36 and 54 presented with aniridia and aphakia secondary to penetrating eye trauma in 2024 and 2023, respectively. Both patients underwent primary surgical repair of penetrating open-globe injuries followed by pars plana vitrectomy with endolaser photocoagulation. Postoperatively, uncorrected distance visual acuity (UDVA) was hand motion in the first patient and 20/800 in the second, improving to 20/25 with a +10.00 spherical dioptres, and to 20/40 with a +15.0 spherical dioptres, respectively. A combined Yamane–Canabrava technique was used to implant a scleral-fixated AI-IOL complex in both patients. The IOL was positioned posterior to the artificial iris (AI), with haptics passed at 0° and 180°, 0.5 mm away from the AI edge. At 90° and 270°, a 5/0 polypropylene suture was passed 1.5 mm away from the outer AI rim, thus, two flanges using cautery were created on the anterior surface of the AI. AI-IOL  complex was stabilized with four scleral flanges: two flanges at 3 and 9 o’clock for the IOL, and two flanges at 6 and 12 o’clock for the AI. The four scleral fixation points create four balanced vectors of tension, improving stability and centration of the AI–IOL complex while minimizing the risk of postoperative IOL tilt.  Postoperative UDVA improved to 20/32 in both patients. The first patient achieved best-corrected distance visual acuity 20/22 with a refractive cylinder of -1.5 D at 171°. Postoperative 1-year follow-up visits showed no complications. 

Combined Yamane and Canabrava fixation of AI-IOL provides four-point stability, centration, and significant visual rehabilitation. By distributing fixation forces symmetrically across four quadrants, the technique promotes stable axial alignment of the AI–IOL complex and decreases the likelihood of AI-IOL decentration or tilt. Aniridia and aphakia are corrected in a single surgical session to minimize overall trauma to the eye. This technique is minimally invasive and technically straightforward, aiming to avoid sutures and their associated risks of long-term complications. Long-term follow-ups of this and similar cases are necessary to confirm stability and low complication rates.