Automatic IOL inserters

Preloaded motorised devices may stretch incisions less than manual inserters

Howard Larkin

Posted: Thursday, December 3, 2020

Thomas Kohnen MD,PhD

Preloaded automatic intraocular lens (IOL) inserters appear to stretch corneal incisions less than manual inserters, presenters said at the ASCRS Virtual Annual Meeting 2020.
In a comparison of a preloaded automatic IOL inserter with three manual inserters, Thomas Kohnen MD, PhD, of Goethe University, Frankfurt, Germany, found that the AutonoMe (Alcon, Fort Worth, Texas, USA) automated delivery system provided the smallest incision enlargement of the four when inserted through a 2.2mm incision (Comparative assessment of the corneal incision enlargement of 4 preloaded IOL delivery systems. Liu, Jingbo; Wolfe, Patricia; Hernandez, Victor; More; Journal of Cataract & Refractive Surgery. 46(7):1041-1046, July 2020.).
The mean 0.29±0.03mm stretch observed with AutonoMe matched that of the preloaded manual UltraSert (Alcon) was slightly less than the 0.31±0.03mm seen with the preloaded manual Tecnis iTec (Johnson & Johnson Vision, Rochester, New York, USA), and was significantly less than the 0.36±0.08 of the preloaded manual Vivinex iSert (Hoya Surgical Optics, Chromos, Singapore), Dr Kohnen reported. The in-vitro model involved 15 of each device and subtracted pre-insertion incision size from post-insertion incision size as measured by Asico incision gauges.
“The automated delivery system design and depth-guard tip may facilitate IOL implantations through smaller incisions with less incision enlargement,” Dr Kohnen said.
Further clinical studies are needed to confirm the effect of incision enlargement on wound healing and post-operative cornea morphology, he added.
Corneal healing
Motorised injectors caused less wound damage than a manual injector, particularly at smaller incision sizes, but no difference in wound healing was noted one month after surgery, according to a clinical study by Eiichi Nishimura MD, PhD, of Showa University Fujigaoka Hospital, Yokohama, Japan. The study involved 193 eyes in 124 patients and compared wound characteristics from cataract surgeries using two automated IOL injectors, AutonoMe and AutoSert (Alcon), and the manual UltraSert injector.
Anterior segment OCT revealed significantly more wound damage, as measured by Descemet’s detachment, bulge and endothelial gaps, with the manual inserter at 2.2mm and 2.4mm incisions one day and one week after surgery. No significant difference was seen among the groups one month after surgery, Dr Nishimura reported. Wound expansion was also significantly more for the manual injector at a 2.0mm incision, but not at larger incisions up to 2.6mm.
“As concluded in previous reports, IOL insertion using motorised injectors can reduce damage to incisions,” Dr Nishimura said (Allen et al. J Cataract Refract Surg 2012; 38: 249-255. Yokahama Y, Nishimura E et al. IOL&RS 2015 (Japanese); 29:224-229). However, wound healing significantly improved in all groups after one month, and there was no significant difference among the groups at that point, he concluded.