ICT Role in 21st Century Education & its Challenges.pptx
IOLCatridge-Injector Systems
1. NETHRADHAM
Super Speciality Eye Hospital
NETHRADHAMA
Super Speciality Eye Hospital
Dr.SMITH SNEHAL SUTE
Fellow- Phaco & Refractive Surgery
2. INTRODUCTION
• Multiple needles, tips, instruments, and devices enter and leave the anterior
chamber during cataract surgery.
• Introduction of the IOL into the capsular bag- an important step
• Each step of cataract surgery has evolved over the decades.
• The place of lens holding and folding forceps is being taken by myriad IOL
insertion systems.
3. • Sir Harold Ridley introduced the first IOL in 1949.
• Charles D. Kelman MD introduced phacoemulsification,
- led to the era of small-incision cataract surgery.
• Thomas R. Mazzocco MD, developed the first foldable IOL in
1980.
- allowed lens insertion without enlargement of the 3-mm
phaco wound
INTRODUCTION
5. • Additional steps to load and prime
the IOL
• More number of errors
• Longer training for the operating
room staff
• Increased time of surgery.
PROBLEMS with Manual Injection Systems
• Contamination
Wang L, Wolfe AP, Paliwal CS. IOL delivery performance of
three IOL preloaded delivery systems XXXIII Congress of the
ESCRS 2015, ESCRS Official Website.
• Foreign-body
introduction
• Inadequate
cleaning
• Postoperative endophthalmitis
6. • Deposits on IOL surface:-
• shape of the cartridge or nozzle
• linear deposits
• hexagonal-shaped cartridges
rather than round.
Kleinmann G, Marcovich AL, Apple DJ, Mamalis N. Linear
deposits on the surfaces of intraocular lenses implanted
through a hexagonal cartridge which mimic
scratches/cracks on the lenses. Br J Ophthalmol 2005;
89:1474–1477
Cartridge Complications
• Cartridge cracking:-
• friction during the transit through
the injector nozzle.
Singh AD, Fang T, Rath R. Cartridge cracks during foldable
intraocular lens insertion. J Cataract Refract Surg. 1998
Sep;24(9):1220-2. doi: 10.1016/s0886-3350(98)80015-1.
PMID: 9768396.
X
7. • Surgically induced astigmatism:-
• Creating an incision necessary for
the removal of cataracts and IOL
implantation
• varying degrees of surgically
induced astigmatism.
• type of injector cartridge or
insertion method used,
Cartridge Complications
Wound stress- greatest
when the IOL passed
through the incision.
8. • Corneal wound is like a slit
• IOL cartridges are like a cylinder
(oval or circular in section).
• Thus, by the law of physics,
insertion of a cylinder through a
slit would always lead to some
stretch or damage to the slit
architecture
Cartridge Complications
• Smaller diameter injector
nozzles
hamper the ease of IOL insertion
• Reducing the thickness of the
nozzle or designing a slit in the
nozzle to buffer the stretch force
would be a good compromise
9.
10. • Manual holding, folding, and insertion techniques have, in recent years,
been largely replaced by the use of novel IOL injection systems.
PRELOADED INJECTORS
Pre-packaged
Ready-to-insert
Preloaded IOL
adopted by many manufacturers.
Simple
Safe
Effective devices
IOL implantation through a
relatively small incision
12. One step, ready to insert
Optimized design for small incision size
Smooth passage of the IOL
No risk of damage to haptic or optic
Smooth folding and unfolding of the haptic
Convenient and cost effective use
CHARACTERISITCS OF AN IDEAL
PRELOADED INJECTOR
13. • Implantation through smaller
incision
• Shorter duration of wound
healing,
faster recovery
• Microbiologic safety
Kokuzawa S, Suemori S, Mochizuki K, Hirose Y, Yaguchi
T. Aspergillus tubingenesis endophthalmitis after cataract
surgery with implantation of preloaded intraocular lens. Semin
Ophthalmol 2014; 29(4): 218-21.
Advantages of Preloaded Injectors
• IOL is already loaded instill
(OVD) ready for insertion.
• Avoids potential mistakes such as
loading the lens incorrectly
• Enhanced surgical outcomes
deployed directly from the
manufacturer to the eye,
minimizing the risk for IOL damage
through handling
• Intraoperative aberrometry
21. UNFOLDER
Platinum series DK 7796
UNFOLDER
Emerald series T/ XL
Injectors
Cartridg
es
1MTEC30 Emerald C
1VIPR30
Tecnis 3 piece
Sensar 3 piece
Tecnis Toric
Tecnis MF Toric
Tecnis 1
Tecnis MF
Tecnis Symfony Tecnis Synergy
22. • Syringe type systems
• 1.8 mm incision
• Large loading chamber
Preloade
d &
Disposabl
e
• 2.0
Injector
• 2.2
Injector
• 2.4
Injector
23. • Blueject2.0
(+4.0 to +24.0 D)
• Blueject2.2
(+24.5 to +30.0 D)
• Blueject2.4
(+30.5 to +34.0 D)
• Large loading chamber
• Unrestricted access for IOL loading
• Safety ontrolled and linear
injection
• For a wide variety of hydrophilic
ZEISS MICS IOLs
Preloade
d
26. Bluemixs® 180
Designed for
AT LARA® 829 MP
AT LISA® Tri 839 MP
AT LISA® 809 MP
909 M
CT ASPHINA
409 MP/ 509 MP
AT Torbi 709 MP
27. Bluemixs® 180
Designed for
AT LARA® 829 MP
AT LISA® Tri 839 MP
AT LISA® 809 MP
909 M
CT ASPHINA
409 MP/ 509 MP
AT Torbi 709 MP
28.
29. Monarch® II
• “C” cartridge
• 2.4 mm incision
• “C” cartridge
• 2.4 mm incision: through the
wound
• “D” cartridge: smaller
• 2.2 mm incision: wound assisted
smaller plunger tip
Monarch ® III
31. Monarch® II
• “C” cartridge
• 2.4 mm
• “D” cartridge:
• 2.2 mm
Monarch ® III
33%
32.
33. B C D
“B” Cartridge
• Incision size :
3mm
• All 3 Piece IOLs
• Special order
Single
pieceIOLs
(+35 to + 40 D)
“C” Cartridge
• Incision size : 2.4mm
• All Single Piece IOLs ( +6 to +34 D)
“D” Cartridge
• Incision size :
2.2mm
• THIN Single
Piece IOLs
(+6 to +26 D)
Big Compact Dimunitive
44. COMPLICATIONS
Trapped trailing haptic
Haptic optic adhesion
Misdirected leading haptic
Twisted haptic
Overriding plunger
Trauma to IOL: damage to IOL haptic/optic:
45. COMPLICATIONS
Damage to IOL haptic/optic:
poor IOL injector design and packaging
Nguyen DQ, Saleh TA, Pandey SK, Bates AK. Irregularities on the surface of single-piece AcrySof SA60ATintraocular lenses.
J Cataract Refract Surg 2006;32(3):495–498
Inappropriate manual handling and loading,
Vrabec MP, Syverud JC, Burgess CJ. Forceps-induced scratching of a foldable acrylic intraocular lens.
Arch Ophthalmol1996;114(6):777
Overriding injector plungers,
Friction during IOL passage through the injector nozzle
- type of viscoelastic medium used for loading and IOL injection
Myers TD, Olson RJ. Comparison of the effects of viscoelastic agents on clinical properties of the unfolder
lens injection system. J Cataract Refract Surg 1999;25(7):953–958
47. • IOL manufacturers are keenly working on the development of better
preloaded IOL delivery systems.
• The focus is on making IOL size, design, and thickness more compatible with
the disposable plunger and cartridge assembly.
• In the near future, all IOL implantations will be performed through preloaded
IOL delivery systems.
• The healthy competition among manufacturers to achieve the best system
will not only provide us with flawless IOL delivery but will also make these
products more cost-effective
48. • Foldable IOLs have helped alter the face of cataract surgery by improving
healing time, limiting complications and making phacoemulsification the
standard procedure over extracapsular surgery, all in the span of 3 decades
• Advancements in cataract surgery have necessitated the availability of
intraocular lens preloaded delivery systems that can safely, effectively and
predictably deliver IOLs in the eye.
• Preloaded delivery systems simplify and reduce procedural variability
during surgery preparation.
Clearly, cataract surgery continues to improve
in all areas, with a bright future for improved
vision and a happy patient.
49. Vision
Leadership in the Eye Care Domain
Mission
Vision Care Par Excellence
smithsnehalsute@yahoo.com
Notes de l'éditeur
A critical step in cataract surgery is the delivery of the intraocular lens (IOL) into the eye, and recent advances in how IOLs are deployed means surgeons now have the option to use both manual IOL injectors and preloaded IOL injectors.
As the demand for cataract surgery grows with the aging population and increased prevalence, improved safety and efficiency in the operating room become more important.
Newer preloaded IOL systems might help satisfy these ever-increasing stringent requirements.
