Issue 3 - July 2026
From Threading to Grasping: A More Controlled Approach to Intrascleral IOL Fixation
Secondary IOL fixation is often one of the most demanding steps in anterior segment surgery. When capsular support is absent or compromised, the surgeon is not simply placing an IOL; they are creating a stable, centred, long-term fixation strategy in an already complex eye.
Flanged intrascleral haptic fixation, including Yamane-style techniques, has become an important option in these cases. The approach is elegant: externalize the haptics of a 3-piece IOL, create flanges with cautery, and secure them within scleral tunnels.
The challenge is execution.
One of the most delicate steps is docking the haptic into a fine needle and externalizing it through the sclera without slippage, distortion, or repeated manipulation. In complex eyes, small variations in angle, visualization, haptic position, or tissue resistance can make this step unpredictable.
That is where the Amon Forceps Needle offers a meaningful shift: moving from threading to grasping.
A different way to externalize the haptic
In traditional double-needle flanged fixation, the surgeon must guide the haptic into the lumen of a hollow needle before externalizing it. When alignment is ideal, the technique can work very well. But when the haptic is difficult to dock, the surgeon may need repeated attempts, increasing surgical stress and intraocular manipulation.
The Amon Forceps Needle was designed to address this challenge. It combines a needle-shaped tip with integrated micro-forceps, allowing the surgeon to create the scleral passage, grasp the haptic or suture material, and externalize it through the same access point.
Instead of asking, “Can I thread the haptic into the needle?” the surgeon can directly capture and control the structure that needs to be externalized.
That difference matters.
Why controlled capture can improve confidence
Threading depends on precise alignment between the haptic and the needle lumen. Grasping gives the surgeon a more direct form of control.
This can be especially useful when the haptic is difficult to align, the anterior chamber is crowded, visualization is limited, tissue resistance is high, or the case involves complex iris-lens anatomy. It may also be helpful when externalizing suture material for flanged fixation or managing artificial iris–IOL constructs.
The procedure remains advanced and technique-sensitive. But by reducing reliance on perfect docking, the instrument may help make one of the most variable steps more controlled.
Useful beyond standard secondary IOL fixation
The forceps-needle concept has been described not only for intrascleral IOL fixation, but also for complex secondary IOL and artificial iris cases. These include posterior IOL placement behind an artificial iris, fixation of iris-IOL constructs, and knotless recentering of decentered artificial iris implants.
Across these applications, the surgical need is similar: capture, control, and externalize a haptic or suture through a precise scleral pathway.
The Amon Forceps Needle has also been described for broader fixation work, including scleral fixation of different IOL designs, iris fixation of IOLs, fixation of capsular tension rings or segments, and handling of Gore-Tex or Prolene sutures.
For surgeons managing complex anterior segment reconstruction, that flexibility can be valuable.
Supporting reproducibility
The Amon Forceps Needle can also be paired with the Yamane Double Needle Stabilizer, which helps stabilize the eye and support consistent sclerotomy placement and tunnel orientation.
Together, these instruments reflect a broader principle in modern ophthalmic surgery: reproducibility comes from technique, but it is supported by instrumentation that reduces unnecessary variability.
One instrument helps with stability and alignment. The other helps with capture and externalization.
The takeaway
Flanged intrascleral IOL fixation has changed the way surgeons manage eyes without adequate capsular support. But even strong techniques have pressure points, and haptic docking remains one of the most delicate steps.
The Amon Forceps Needle addresses that challenge by combining scleral access with controlled micro-grasping. In doing so, it gives surgeons another way to approach complex fixation: less reliance on perfect docking, more emphasis on secure capture.
In complex secondary IOL surgery, that kind of control matters.
References:
Amon M, Bernhart C, Geitzenauer W, Kahraman G. The forceps-needle: Combining needle and grasping functions in a single instrument. J Cataract Refract Surg. 2021 Jan 1;47(1):123-126. doi: 10.1097/j.jcrs.0000000000000302. PMID: 32675649.
https://theophthalmologist.com/issues/2022/articles/dec/iol-fixation-made-simple
https://crstoday.com/crst-issues/may-2026/troubleshooting-flanged-fixation-in-complex-secondary-iol-and-artificial-iris-surgery/60829/
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