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Jonathan B. Kahn, Jack M. Dodick; High-Powered Acrylic Intraocular Lens Surface Damage From Small Cartridge Injection May Be Reduced By Lens Warming. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1379.
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Cartridge injector systems are frequently used to implant foldable intraocular lenses (IOLs) in small-incision cataract surgery. Previous reports have described the vulnerability of acrylic IOLs to damage from cartridge injector systems. We recently observed surface abnormalities on the optics of high-powered IOLs that had been inserted via cartridge injector systems. The purpose of our study is to evaluate IOL optic surface damage in high-powered acrylic IOLs injected through small cartridge injector systems, and to determine whether warming the IOLs prior to injection could decrease surface damage.
AcrySof Restor (Alcon Laboratories) one-piece acrylic IOLs of powers 26.0 to 29.5 diopters (D) were received as samples from the manufacturer for inclusion in the study. Eight IOLs were paired by dioptric power and then randomized to warming or control arms. Warmed lenses were placed in a water bath at 45ºC for ten minutes, while control lenses were stored at 23ºC. Each set of paired IOLs were then injected through a D-cartridge using a Monarch III handpiece (Alcon Laboratories). All cartridges were filled with ample ophthalmic viscoelastic material prior to IOL loading. After injection, IOLs were rinsed thoroughly with balanced salt solution. Optic surfaces were inspected using a high powered microscope and photomicrographs were taken with a x10 objective.
Of the eight high powered acrylic IOLs studied, four (50%) demonstrated optic surface abnormalities consisting of debris, microscratches, or microcracks (see figure 1, upper images control lenses, lower images dioptric-matched warmed lenses). The control group was observed to have a higher percentage of optic surface abnormalities as compared to the warmed group (75% vs. 25%), although the data did not reach statistical significance.
We found that the use of a pre-injection warming technique may reduce optic surface abnormalities involving high-powered acrylic IOLs injected through small cartridge injector systems. This small study could be expanded to include a greater sample size, including evaluation of high-powered monofocal IOLs.
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