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Zhang L, Schickhardt S, Merz P, Auffarth GU. Evaluation of Parameters and Nozzle Tip Damage after Clinical Use of Three Hydrophilic Intraocular Lens Injector Models. J Ophthalmol 2024; 2024:2360368. [PMID: 38846928 PMCID: PMC11156505 DOI: 10.1155/2024/2360368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose To assess the nozzle tip damage and the parameters of three different hydrophilic intraocular lens (IOL) injector models. Methods After routine cataract surgeries at the University Eye Hospital Heidelberg, all the used IOL injectors were collected from the operating room and sent to our laboratory. Nozzle tip damage was assessed under a microscope and graded as follows: no damage (grade 0), slight scratches (1), deep scratches (2), extensions (3), cracks (4), and bursts (5). Each damage grade was assigned a score from 0 to 5, and the total damage score for each injector system was calculated and compared. Nozzle tip parameters (diameters and areas), plunger tip parameters, and tip angles were also measured in each model. Results The damage scores were (median, Q3-Q1): 1 (1-1) for Accuject, 1 (1-1) for Bluemixs, and 1 (1-1) for RayOne. There was no statistically significant difference in the damage scores between the study groups (P > 0.05). The outer cross-sectional vertical and horizontal diameters were 1.69 and 1.69 mm for Accuject, 1.69 and 1.69 mm for Bluemixs, and 1.70 and 1.71 mm for RayOne. Plunger tip areas were 0.78 mm2 for Accjuect, 0.74 mm2 for Bluemixs, and 0.43 mm2 for RayOne. Plunger tip area/inner cross-sectional area of the nozzle tip (%) was 31.2% for RayOne, 66.7% for Accuject, and 63.8% for Bluemixs. The tip angles for three injector models were 56° (Accuject), 56° (Bluemixs), and 44° (RayOne). Conclusions All the injector models showed mild to moderate damage to the nozzle tip after IOL implantation, even with smaller diameter tips. RayOne resulted in the lowest ratio between plunger tip area and inner cross-sectional area of the nozzle tip and a better distribution of damage categories than the other two groups. All three injector models had relatively small tip parameters. If smaller incisions are required in certain patients, smaller tip parameters should be considered.
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Affiliation(s)
- Lu Zhang
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Sonja Schickhardt
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Patrick Merz
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Gerd Uwe Auffarth
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
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Zhang L, Auffarth G, Schickhardt S, Merz P, Tandogan T. Evaluation of Nozzle Tip Damage in Intraocular Lens Injectors with V-Shaped Notch. Ophthalmic Res 2023; 66:1104-1113. [PMID: 37369191 PMCID: PMC10614508 DOI: 10.1159/000531078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/09/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Damage to the nozzle tips of intraocular lens (IOL) injectors has been associated with various adverse events and even IOL surface abnormalities after IOL implantation. In this study, nozzle tip damage of three different injector models with v-notched nozzle tips was systematically evaluated using our self-developed system - the Heidelberg Score for IOL injector damage. METHODS Nozzle tip damage was categorized into 6 grades: no damage (grade 0), slight scratches (1), deep scratches (2), extensions (3), cracks (4), and bursts (5). Each grade was assigned to a score of 0-5. In each IOL injector group, all IOLs were divided into 2 subgroups based on IOL power: +15 to +21D group and +21 to +26D group. The total scores for each group were the sum of scores for all injectors in this group. Further analysis was performed on the nozzle tip configuration and parameters in each injector model. RESULTS The median (Q1-Q3) for each injector group in group +15 to +21D was 1.5 (1-2) for Avansee, 4 (3-4) for iSert, and 4 (3-4) for multiSert. A statistically significant difference was found between Avansee and iSert (p < 0.001) as well as between Avansee and multiSert (p < 0.01) in terms of median scores. The median (Q1-Q3) for each injector group in group +21 to +26D was 1.5 (1-2) for Avansee, 4 (4-4) for iSert, and 3 (3-3.75) for multiSert. A statistically significant difference was found between Avansee and iSert in terms of median scores (p < 0.001). The outer cross-sectional diameters were 1.80 and 1.78 mm for Avansee, 1.70 and 1.69 mm for iSert, and 1.69 and 1.68 mm for multiSert. The radii of each notch-based circle were 0.21 mm (Avansee), 0.09 (iSert), and 0.06 (multiSert), respectively. The tip angles for three injector models were 48° (Avansee), 46° (iSert), and 37° (multiSert). CONCLUSIONS Avansee showed the least nozzle tip damage of all three groups. Compared with our earlier study using preloaded injectors with intact endpieces, all the injector groups with v-notched nozzle tips had more damage to the nozzle tip. It was found that the closer the notch of the nozzle tip was to the letter "V," the more damaged the nozzle tip was after IOL implantation.
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Affiliation(s)
- Lu Zhang
- Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerd Auffarth
- Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sonja Schickhardt
- Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Merz
- Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Heidelberg, Germany
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Zhang L, Schickhardt S, Merz P, Auffarth G. Nozzle tip damage in three generations of intraocular lens injector models: an experimental laboratory study. BMC Ophthalmol 2023; 23:7. [PMID: 36600209 PMCID: PMC9811761 DOI: 10.1186/s12886-022-02726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To assess the nozzle tip damage of IOL injectors in three generations from the same manufacturer using the self-developed system-the Heidelberg Score for IOL Injector Damage. SETTING David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany DESIGN: Experimental laboratory study METHODS: The nozzle tip damage of three injector models (Emerald, iTec, and Simplicity) was determined using the Heidelberg score for IOL injector damage. Damage to the nozzle tip was examined under a microscope and graded as follows: no damage (score 0), slight scratches (1), deep scratches (2), extensions (3), cracks (4) and bursts (5). The total scores for each injector system were the sum of scores for all injectors in this model. Total scores of the three injector systems were evaluated and compared. The nozzle tip parameters (diameters, tip angles) were also measured in each group. RESULTS The Emerald system achieved the highest total scores, while the other two systems achieved similar total scores. There was no statistically significant difference in the total scores between the study groups (P > 0.05). The outer cross-sectional diameters were 2.10 and 2.10 mm for Emerald, 1.80 and 1.78 mm for iTec, and 1.78 and 1.80 mm for Simplicity. The thickness of the nozzle tips was 0.13 mm (Emerald), 0.17 mm (iTec) and 0.17 mm (Simplicity). The tip angle for three injector models was 35° (Emerald), 45° (iTec), and 45° (Simplicity). CONCLUSIONS Although different injector models exhibited varying degrees of damage to the nozzle tip, all injector models generally showed relatively good results. Newer generations of IOL injector models tend to perform better in terms of nozzle tip damage after IOL implantation.
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Affiliation(s)
- Lu Zhang
- grid.5253.10000 0001 0328 4908Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120 Germany
| | - Sonja Schickhardt
- grid.5253.10000 0001 0328 4908Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120 Germany
| | - Patrick Merz
- grid.5253.10000 0001 0328 4908Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120 Germany
| | - Gerd Auffarth
- grid.5253.10000 0001 0328 4908Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120 Germany
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Anitha V, Ravindran M, Ghorpade A. The momentary deposits behind the phakic intraocular lens: The rationale! TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2023. [DOI: 10.4103/tjosr.tjosr_68_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Cabeza-Gil I, Ríos-Ruiz I, Calvo B. Experimental evaluation of the injection force exerted in intraocular lens delivery with syringe-type injectors. J Mech Behav Biomed Mater 2021; 124:104793. [PMID: 34492403 DOI: 10.1016/j.jmbbm.2021.104793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 01/03/2023]
Abstract
The process of intraocular lens (IOL) delivery within the capsular bag during cataract surgery is crucial, as the integrity of the IOL, the injector and the ocular structures should be preserved at all times. This study aims to obtain the main parameters that affect the injection force exerted in the ejection of an intraocular lens (IOL) through syringe-type injectors. For that purpose, ejection tests were carried out in vitro, measuring the resistance force throughout the entire delivery process. The effect of IOL material, haptic design, IOL thickest area and ophthalmic viscosurgical device (OVD) was studied by ejecting seven IOLs with four syringe-type injectors of different sizes, 3.0, 2.2 and 1.8 mm. In all injectors, plate hydrophilic IOLs present the lowest resistance forces; hydrated C-loop hydrophobic IOLs present higher forces and the C-loop hydrophobic IOL in dry conditions presents the highest resistance forces. All IOLs could be properly delivered with an injector size of 2.2 mm, making injector sizes of 3.0 mm outdated. The injector size of 1.8 mm damaged several IOLs. IOL material and cartridge nozzle size were the most influential parameters in IOL delivery. IOL thickest area was also relevant but in a lesser extent whereas IOL haptic design was not as relevant.
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Affiliation(s)
- I Cabeza-Gil
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Spain
| | - I Ríos-Ruiz
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Spain.
| | - B Calvo
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Spain; Centro de Investigación Biomédica en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Spain
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Thermally Crosslinked Biocompatible Hydrophilic Polyvinylpyrrolidone Coatings on Polypropylene with Enhanced Mechanical and Adhesion Properties. Macromol Res 2018. [DOI: 10.1007/s13233-018-6031-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Optic surface changes in Intraocular lens scaffold: An ex vivo study. Graefes Arch Clin Exp Ophthalmol 2016; 254:1319-24. [PMID: 27236574 DOI: 10.1007/s00417-016-3389-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/21/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE We aimed to assess the micro injuries on the intraocular lens (IOL) optic in the IOL scaffold technique by ex vivo study. SETTING This study was conducted at the Tahira Research Laboratory, Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai. DESIGN This was an experimental study. METHODS IOL scaffold technique was simulated in 12 caprine eyes with moderate lens changes using 12 IOLs (six acrylic hydrophilic and six polymethyl methacrylate IOL) in experimental set up. IOLs (6 mm optic diameter) were explanted from the caprine eyes immediately after the surgery and examined under light microscopy and phase contrast microscopy for anterior and posterior optic changes, and again after 24 hours. Scanning electron microscopy (SEM) was performed in IOLs with abnormalities. Two IOLs placed in caprine eyes that did not undergo scaffold procedure acted as controls. A trocar anterior chamber maintainer was used in four eyes. RESULTS Four out of 12 IOLs showed mark defects on the surface in mid periphery. Linear mark defects measured IOL 1 (190 μm), IOL 6 (18 μm), IOL 2 (2.33 μm, 2.3 μm, 14 μm, 14 μm) and IOL 5 (12 μm). The marks do not change after 24 hours. There were no mark defects (micro abrasions or scratches) seen on any of the IOL's in the central 4 mm of the optic anterior surface. The control IOLs showed no surface changes. The pre-experiment mark defects (n = 0) in study IOLs changed to post-experiment (n = 7), with no statistical significance obtained (p = 0.059). CONCLUSION IOL scaffold technique can cause microscopic optic surface changes seen as linear marks defects in the mid periphery and intraoperative fluid maintenance can reduce its incidence.
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Kleinmann G, Kleinmann I. Intraocular lens injector-induced stress on the corneal incisions during lens implantation. Am J Ophthalmol 2014; 158:185-191.e1. [PMID: 24631476 DOI: 10.1016/j.ajo.2014.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 03/01/2014] [Accepted: 03/03/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a model for calculating induced stress on corneal incisions during intraocular lens implantation, and to compare the nozzles of common injectors using 2 incision sizes. DESIGN Experimental study. METHODS A finite element calculation model was developed and used to compare 7 commercially available injectors in widespread clinical use. The injectors' characteristics were measured and correlated for the stress they induced for 2.4- or 2.2-mm corneal incisions. RESULTS Each injector created a different level of stress on the corneal incision. The stress was highest at the incision margins, and its level correlated with the injector's external circumference. The induced stress on 2.2-mm incision margins was about 9% higher compared to the induced stress on 2.4-mm incision margins. CONCLUSIONS A model for comparing stress induced on corneal incisions during intraocular lens implantation by 7 injectors revealed different levels of induced stress on the incision margins. It is therefore recommended that the choice of injector be matched to the size of the corneal incision.
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Mehta A. Unusual markings on an intraocular lens postoperatively. Indian J Ophthalmol 2012; 60:241-2. [PMID: 22569395 PMCID: PMC3361829 DOI: 10.4103/0301-4738.95887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pereira FA, Werner L, Milverton JE, Coroneo MT. Miyake-Apple posterior video analysis/photographic technique. J Cataract Refract Surg 2009; 35:577-87. [DOI: 10.1016/j.jcrs.2008.11.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/17/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
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Harsum S, Mann S, Clatworthy I, Lewin J, Little B. An investigation of intraocular lens damage and foreign bodies using an injectable hydrophilic acrylic lens implant. Eye (Lond) 2009; 24:152-7. [DOI: 10.1038/eye.2009.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Andresen J, Winther JB. Intraocular plastic foreign bodies, introduced via the Monarch II intraocular lens delivery system. ACTA ACUST UNITED AC 2007; 85:460-1. [PMID: 17559473 DOI: 10.1111/j.1600-0420.2006.00871.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kleinmann G, Apple DJ. Evaluation of a new soft tipped injector for the implantation of foldable intraocular lenses. Br J Ophthalmol 2006; 91:1070-2. [PMID: 17135340 PMCID: PMC1954791 DOI: 10.1136/bjo.2006.103192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the R-INJ-04 soft-tipped injector, a new injector with an integral round nozzle manufactured by Rayner Intraocular Lenses, England. METHODS 16 Rayner C-flex intraocular lenses (IOLs; Rayner Intraocular lenses, England) ranging between +10 and +30 D (2 for each power) were tested. An ophthalmic viscoelastic device (Healon, AMO, Santa Ana, California, USA) was applied to the injectors. The IOLs were loaded according to the company injector's instructions for use and were injected into a Petri dish. After the injection, all the IOLs and nozzles were evaluated by gross (macroscopic) and microscopic analyses and photographed under a light microscope. One lens of each power and the cartridge used for the implantation were then sent for further analysis by scanning electron microscopy (SEM). The rest of the IOLs were tested for power and modulation transfer function (MTF). RESULTS All the injections were successful. No damage to the IOLs or to the injectors was found by gross examination, light microscopy and SEM. No deposits were found on the IOL optical surfaces or haptics. Power and MTF analysis showed a close match with the original measurements. CONCLUSION Our results suggest that the R-INJ-04 soft-tipped injector is safe for the implantation of the C-flex IOL with power range from 10 to 30 D. No structural damage to the IOLs or to the injectors was found, and the lens power and light transmission properties were not damaged in any way by the injection process.
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Affiliation(s)
- Guy Kleinmann
- John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, 50 N Medical Drive, Salt Lake City, UT 84132, USA.
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Marcovich AL, Kleinmann G, Epstein D, Pollack A. The course of surface deposits on a hydrophilic acrylic intraocular lens after implantation through a hexagonal cartridge. Br J Ophthalmol 2006; 90:1249-51. [PMID: 16854825 PMCID: PMC1857429 DOI: 10.1136/bjo.2006.097857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the outcome of surface deposits that occurred during implantation of hydrophylic acrylic intraocular lenses (IOLs) through a hexagonal cartridge. METHODS Surface deposits were observed on the posterior surface of the ACR6D SE IOLs that were injected through a hexagonal cartridge filled with sodium hyaluronate 1%. All the patients were examined 1 day, 1 week, 1 month, 6 months and 1 year postoperatively. The location of the deposits was recorded and photographed. The patients were questioned about blurred vision, glare or halos. RESULTS Linear or curly deposits were detected on the posterior surface of the IOL in six patients. In four patients, the deposits were peripheral and were observed 1 week postoperatively. In two patients, the deposits were noticed immediately after implantation. In one eye, they were misinterpreted as a crack in the IOL's optic and were left in the eye. In the second patient the deposits were removed immediately after implantation with forceps. The deposits that were left after implantation (five eyes) did not resolve during 1 year of follow-up. None of the eyes developed abnormal inflammatory reaction. In three eyes the best-corrected visual acuity (BCVA) was 6/6. In the other three eyes the BCVA was 6/12. None of the patients experienced any visual disturbance. CONCLUSIONS Implantation of the ACR6D SE IOL through a hexagonal cartridge can lead to the formation of deposits on the posterior surface of the lens. The deposits do not resolve and may resemble a crack in the IOL. The deposits left on the IOL had no clinical relevance in our patients.
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Affiliation(s)
- A L Marcovich
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.
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