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Surgeons tout better injectors, as well as preloaded injectors, for their role in making cataract surgery safer, faster and more sterile.
The advent of foldable IOLs propelled phacoemulsification into the mainstream of cataract surgery, allowing small incisions and minimizing complications. However, since the first injection device for a foldable IOL emerged in the mid-1980s, injection technology has lagged as incisions have shrunk.
Ultrasound, vacuum and fluidics provide fast, safe and efficient lens extraction, and increasingly small incisions have become the norm for both crystalline lens removal and IOL insertion.
Current IOL injection systems include the Unfolder Series (Advanced Medical Optics), Monarch III IOL delivery system (Alcon), SofPort Advanced Optics Lens Insertion System with Easy-Load inserter (Bausch & Lomb), MicroSTAAR and Canon-STAAR (STAAR Surgical), and others.
Some of the injectors may be used with incisions smaller than 2 mm. Most injectors must be loaded, but the paradigm is gradually shifting toward preloaded cartridges.
In telephone interviews with OCULAR SURGERY NEWS, OSN Cataract Surgery Section Member Louis D. "Skip" Nichamin, MD, surgeon Mark Packer, MD, and OSN Refractive Surgery Section Member Kerry D. Solomon, MD, discussed their preferred IOL injection systems and techniques.
"I'm really looking for something that will allow me to place a lens through as small an incision as possible," Dr. Solomon said. "Preloaded is always a plus, if possible, but if not, then it needs to be easy to load and easy to use. The biggest preference for me is ease of use and size of the incision."
Currently, the smallest incision that can offer optimal outcomes is about 2 mm, Dr. Solomon said.
"At the end of the day, quality of vision is going to rule," he said. "That's one area that we can't compromise."
Small incisions minimize endophthalmitis, a common complication of cataract surgery, Dr. Solomon said.
"The smaller our incision and the more square our incision, the better the integrity of the incision and the less the likelihood that it will leak short term or long term," Dr. Solomon said.
Dr. Packer emphasized the need to avoid stretching a small incision to inject an IOL.
"The thing is that you don't really want...