Variations in intraocular lens injector dimensions and corneal incision architecture after cataract surgery

Arboleda, Alejandro; Arrieta, Esdras; Aguilar, M.; Sotolongo, Krystal; Nankivil, Derek; Parel, Jean-Marie A.

doi:10.1016/j.jcrs.2018.10.047

Cited by 15 publications

(11 citation statements)

References 21 publications

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“…Previous studies have shown that a smaller preoperative incision leads to more intraoperative incision enlargement. For example, Oshika et al, Arboleda et al and Zhang et al showed that a smaller preoperative incision size leads to a larger intraoperative incision enlargement and is not always associated with a smaller postoperative incision size 10 , 20 , 21 . In accordance with these results, Yildirim et al found a larger preoperative incision size to have less intraoperative incision enlargement 22 .…”

Section: Discussionmentioning

confidence: 99%

“…This issue is further complicated as new IOL implantation techniques have been developed, such as the Into-the-bag-, the Into-the-wound- or the Wound-assisted-technique, which differ regarding the depth of IOL injector insertion. They involve new IOL injector systems which have a cone angle that enlarges the effective cross diameter of the injector on the CCI as the injector is inserted further into the incision 10 . A larger effective nozzle diameter of an IOL injector would induce more stress on the incision margins and is associated with a higher intraoperative incision enlargement 11 .…”

Section: Introductionmentioning

confidence: 99%

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Experimental analysis of recommended corneal incision sizes in cataract surgery using 13 intraocular lens injector systems

Friedrich

Merz

2023

Sci Rep

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Smaller corneal incisions in cataract surgery are linked with a better visual outcome and less frequent postoperative endophthalmitis. The insertion of intraocular lens (IOL) injector systems into the anterior chamber of the eye to implant an IOL is associated with incision enlargement (IE) impeding these positive effects. The aim of this study was to compare manufacturers’ recommended incision sizes (IS) of 13 different intraocular lens injector systems in regard of intraoperative IE and postoperative IS. In total, 499 corneal incisions in ex vivo porcine eyes were analyzed. The preoperative ISs depended on the recommended IS of the examined injector system. The IS was measured right before and after IOL injector insertion with an incision gauge set. There was intraoperative IE in 87% of the incisions with a mean IE of 0.26 ± 0.18 mm. IE was often significantly larger in small IS compared to larger IS concerning an injector system (P < 0.05). Five injector systems needed to have a significantly larger IS than the manufacturers’ recommended IS with an average difference of 0.3 mm when applying study criteria (P < 0.05). Thus, the present study shows that IS recommendations require to be critically analyzed by ophthalmic surgeons to enable evidence-based practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experimental analysis of recommended corneal incision sizes in cataract surgery using 13 intraocular lens injector systems

Friedrich

Merz

2023

Sci Rep

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“…None of the injectors used in their study could implant a lens through a 1.8 mm incision, so they recommended that the surgeon chooses an initial incision size according to the injector tip diameter to avoid excessive wound stretch. 16 The injectors we used had a diameter of 2.05 mm for the AutonoMe and 1.70 mm for the Multisert, according to each manufacturer. 10 It seems plausible that the larger nozzle tip diameter of the AutonoMe causes greater incision enlargement than the Multisert with a smaller diameter.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Enlargement of main corneal incision: clinical intraindividual comparison of two preloaded intraocular lens injectors

Khoramnia

Baur

Łabuz

et al. 2022

J Cataract Refract Surg

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“…Even though these are rare complications, further refinement is needed to sophisticate IOL preloaded delivery systems. Some extent of incision enlargement and stretch pertain to intraocular surgery, especially when IOL injector systems are used [6,7,13,[15][16][17]. Wound enlargement can occur at various steps of cataract surgery, but mostly during lens insertion procedures [18].…”

Section: Discussionmentioning

confidence: 99%

Experimental Study on Delivery Performance of an Automated Preloaded Intraocular Lens Injector System for Corneal and Sclerocorneal Incisions

Oshika

Sasaki

2021

Journal of Ophthalmology

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Purpose. To evaluate delivery performance of an automated preloaded intraocular lens (IOL) injector systems (AutonoMe) in the porcine eyes. Methods. In the freshly excised porcine eyes, lens removal and IOL implantation were performed. There were 4 groups (10 eyes per group) with different incision site and size: 2.2-mm and 2.4-mm corneal incisions and 2.2-mm and 2.4-mm sclerocorneal incisions. Delivery performance and wound enlargement of AutonoMe were analyzed and compared with those of iTec and iSert from a previous study. Results. There were a few minor troubles associated with AutonoMe, such as overriding plunger within cartridge and trapped trailing haptic during IOL insertion, but the incidence was low. Other interactions were not observed, such as IOL adherence to plunger, sudden ejection of IOL, intrawound lens manipulation, IOL behavior, and gross damage to IOL. AutonoMe caused significantly less wound enlargement for both corneal and sclerocorneal incisions than other injector devices. Wound enlargement by using AutonoMe was significantly smaller with 2.4-mm corneal incision than with 2.2-mm corneal incision, but the final incision size was still smaller with 2.2-mm corneal incision. For sclerocorneal incisions, the amount of wound stretch was not different between 2.2 and 2.4 mm incisions. Conclusion. The wound enlargement caused by the automated preloaded insertion system, AutonoMe, was smaller than that of other preloaded injectors for both corneal and sclerocorneal incisions. There were a few minor technical events during IOL insertion, but the overall incidence was low.

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Variations in intraocular lens injector dimensions and corneal incision architecture after cataract surgery

Cited by 15 publications

References 21 publications

Experimental analysis of recommended corneal incision sizes in cataract surgery using 13 intraocular lens injector systems

Experimental analysis of recommended corneal incision sizes in cataract surgery using 13 intraocular lens injector systems

Enlargement of main corneal incision: clinical intraindividual comparison of two preloaded intraocular lens injectors

Experimental Study on Delivery Performance of an Automated Preloaded Intraocular Lens Injector System for Corneal and Sclerocorneal Incisions

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