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A.C. Cirino, R.S. Feder, P.J. Bryar, D. Gupta; Evaluation of an Intraocular Lens Inserter as a Source of Intracameral Intorductions of Surface Epithelium . Invest. Ophthalmol. Vis. Sci. 2005;46(13):778.
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Purpose: The increasing use of small incision cataract surgery has prompted the need for intraocular lens (IOL) delivery devices such as the foldable IOL inserters available from a number of manufacturers. With the use of IOL inserters there may be an increased risk of introducing surface epithelium into the eye. We have identified a small subset of patients following clear corneal phacoemulsification cataract extraction that have developed a thin sheet–like layer of tissue on the anterior surface of the IOL. This presently unidentifiable layer of material is distinct from the lens capsule. This material may be surface epithelial cells that have been introduced into the eye by an IOL inserter. The purpose of our study was to analyze the IOL inserter tips for the presence of surface epithelial cells and to determine if a relationship exits between the number of cells recovered and the incision site and size, inserter tip design, and IOL design. Methods: This study was a prospective case series involving 50 consecutive phacoemulsification cataract surgeries from a single cataract surgeon. Patients were enrolled after meeting inclusion and exclusion criteria. Either an empty Advanced Medical Optics (AMO) Inc, or Alcon Labs Inc. IOL inserter tip was placed through the surgical incision. This was followed by a second inserter tip with the folded IOL that was then inserted into the capsular bag as routinely done. The tips were sent for analysis. Material from the interior was thoroughly scraped onto slides, fixed and stained with hematoxylin and eosin. When present, epithelial cells were counted for each specimen. Scanning electron microscopy was performed on the inserter tips and / or IOL’s that had been partially inserted in the eye and then removed. Results: Epithelial cells were found in over 90% of the empty inserter tips with clear corneal incisions and over 78% of the second tips inserted. Scleral tunnel incision often resulted in fewer samples with epithelial cells. There was a trend toward fewer cells retrieved from the Alcon Sensar inserter tip. Conclusions: With the use of IOL inserters there may be an increased risk of introducing surface epithelium into the eye. We found that over 90% of initial inserter tips contained epithelial cells. We have observed coating of the leading edge of the IOL optic after lens implantation; which has been shown to be epithelial cells. The use of a foldable IOL inserter may result in intracameral implantation of epithelial cells. Debris injected with the IOL implantation should be aspirated from the eye following insertion.
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