 Hi, this is Austin Akatsuka, Kornia Fellow at the University of Utah Moran Eye Center and this is a case of a sclerophyxated IOL with the Yamane technique in a patient with a large iris defect. The patient was a-fake-ik with iris damage following a rupture globe repair. We chose to sit temporarily for this case and markings were made 180 degrees away at 6 and 12 o'clock with markings for the scleral tunnel 2mm away from the limbus and 2mm horizontally for the tunnel itself. Two paracentesis incisions are made nasally. A bent 30 gauge thin walled TSK needle is used to make the scleral tunnel. After the needle has been tunneled for 2mm, make sure that the needle exits as perpendicular to the sclera as possible so that the needle points directly into the vitreous space. Here the needle gets slightly embedded in the remnant iris root so I have to direct it more posteriorly before it comes out nicely. A 3-3.5mm incision is made temporarily and the IOL is inserted. We use a CT Lucia 602 3-piece hydrophobic lens formerly known as the EC3 PAL which is great for Yamane because it has very flexible but durable haptics that do not easily dislodge from the optic. We do IOL calcs with a target between the sulcus and the bag. Unfortunately I did inject it upside down so I identified that and flipped it. Our technique involves docking the trailing haptic first so we externalize the leading haptic through the paracentesis site to stabilize the lens. One technique is to leave the trailing haptic outside of the main wound, then grasp the haptic from outside the wound first before docking it in the eye in one swift movement such as seen here in another case. However, we could not do that due to the large iris defect and pupil that would not completely dilate. Therefore, we first inserted the optic and trailing haptic into the eye and through the pupil. The trailing haptic was then grasped with the MST micrograsper forceps through the iris defect about 1.5mm from the end and then slowly fed into the needle. Ergonomically this is usually the most difficult part of the procedure so take care not to damage the haptic end as you are doing this. Once the haptic has been docked, the needle is kept within the sclerotunnel and the syringe is removed. This effectively secures the haptic. The same thing is done with the leading haptic now. In this case through the iris defect we get a unique view of what the haptic looks like just before it enters the sclerotunnel. Once the haptics have been externalized, they can be grasped to position and center the lens. The haptic ends are trimmed to size and then cauterized with handheld low temp cotteries to form a bulb. The bulbs are then buried under the conjunctiva and ideally within the entrance of the sclerotunnel. After consideration we decided to leave the iris defect for now both because the patient was not cosmetically bothered by it and because we did not want to risk dislodging our IOL. Additionally, when attempting to mobilize the iris tissue there is very little remnant of the iris root. After the IOL is structurally secure we may consider secondary iris repair. The patient is currently doing very well with uncorrected visual acuity of 2025 at post stop week 1 and no issues with glare or dysphotopsias.