Experimental Study on Delivery Performance of an Automated Preloaded Intraocular Lens Injector System for Corneal and Sclerocorneal Incisions

In vitro analysis of clinically relevant aspects of a polymer-coated phacoemulsification tip vs a traditional tip

PURPOSE

To compare the in vitro incisional temperature, acoustic energy, transient cavitation, and turbulence of the polymer-coated hybrid phacoemulsification tip with the balanced tip.

SETTING

Pasteur Ophthalmology Clinic, Vitacura, Santiago, Chile.

DESIGN

Laboratory study.

METHODS

The Centurion Vision System with Active Sentry handpiece was used with tips operated in torsional mode, and stroke was normalized. For thermal measurements, controlled loads were applied over the tip sleeve simulating the pressure applied at the expected level of the corneal incision. Heat generated was recorded on a blackbody filmstrip using infrared imaging. A directional hydrophone provided 360° mapping of acoustic pressure. Cavitation patterns with increasing ultrasound power were imaged with high-speed video recording. Particle image velocimetry was used to evaluate turbulence, streaming, and bubble formation.

RESULTS

The temperature rise for the hybrid and balanced tips was lower than with the control mini-flared Kelman tip ( P ≤ .0001). The hybrid tip generated reduced acoustic output compared with the balanced tip. Ultrasound threshold for cavitation was higher for the hybrid vs balanced tip (55% vs 25%). Fluid turbulence was more evident with the balanced tip compared with the hybrid tip at all flow conditions when normalized for stroke at 60% and 80% power for balanced and hybrid tip, respectively.

CONCLUSIONS

The polymer-coated hybrid tip showed reduced heat generation compared with the control mini-flared Kelman tip and had lower acoustic output, lower cavitation, and lower turbulence compared with the balanced tip, suggesting potential for improved clinical safety.

Preferred cataract surgery practices in Malaysia: a survey based study

BACKGROUND

To describe the preferred cataract surgery practices among Malaysian ophthalmologists and medical officers in comparison with the recommended practices.

METHODS

An online questionnaire was sent out in April 2021, to Malaysian Ophthalmologists and medical officers who perform cataract surgeries. The questions were focused on the preferred cataract surgery practices of the participants. All data obtained were collected, tabulated and analysed.

RESULTS

A total of 173 participants responded to the online questionnaire. 55% of the participants were within 31-40 years of age. 56.1% preferred peristaltic pump over venturi system. 91.3% of participants practised povidone iodine instillation to the conjunctival sac. With regards to the main wound incision, more than half of the surgeons (50.3%) preferred fixed superior incision and 72.3% of them preferred 2.75 mm microkeratome blade. Most of the participants (63%) were inclined towards C-Loop clear intraocular lens (IOL) with a single-handed push preloaded system. 78.6% of the surgeons routinely use carbachol in their cataract surgery.

CONCLUSIONS

This survey provides some insight into the current practices among Malaysian ophthalmologists. Most of the practices are in line with international guidelines for preventing postoperative endophthalmitis. This article could help trainees and ophthalmologists benchmark and observe the common cataract surgery practices among their seniors and peers in Malaysia.

Twelve-Months Follow-Up Postmarket Study of a Hydrophobic Intraocular Lens Using a Preloaded Automated Injector in an Indian Population

Purpose

To assess real-world clinical outcomes and safety of the Clareon^® intraocular lens (IOL) and AutonoMe^® automated preloaded delivery system in an Indian population.

Patients and methods

This was a prospective, single-arm, multicenter, 12-month clinical study in patients aged ≥20 years with unilateral or bilateral cataracts. Surgery was performed by phacoemulsification followed by implantation of the Clareon monofocal IOL (CNA0T0). Monocular best-corrected distance visual acuity (BCDVA) and uncorrected distance visual acuity (UCDVA) were assessed at 1 week and 1, 6, and 12 months after implantation. Posterior capsular opacification (PCO), surface haze, and glistenings were evaluated at all visits. Surgeons' satisfaction with automated injector system was also evaluated using a questionnaire. Safety was assessed by monitoring adverse events (AEs).

Results

A total of 151 eyes received the CNA0T0 IOL. Mean ± SD monocular BCDVA improved from 0.53±0.44 logMAR preoperatively to 0.00±0.08 logMAR at week 1 and -0.03±0.08 logMAR at 12 months after implantation. At 12 months, 137/137 (100%) of eyes achieved BCDVA of 0.3 logMAR or better. Mean ± SD monocular UCDVA was 0.78±0.40 logMAR preoperatively, 0.11±0.15 logMAR at week 1, and 0.08±0.13 logMAR at 12 months after implantation. At 12 months, 132/137 (96%) eyes achieved UCDVA of 0.3 logMAR or better. Serious intraoperative AEs were posterior capsule rupture (n=1) and ciliary zonular dehiscence (n=1). Surgeons reported that the automated preloaded device was more intuitive compared with other push- or screw-style preloaded injector systems. None of the eyes in this study presented surface haze; all were graded as 0 glistenings at all visits. No clinically significant PCO or neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomies were reported.

Conclusion

The hydrophobic IOL preloaded in an automated injector system provided good visual and refractive outcomes, as well as no surface haze and grade 0 glistenings. None of the patients required Nd:YAG capsulotomy.

One-year multicenter evaluation of a new hydrophobic acrylic intraocular lens with hydroxyethyl methacrylate in an automated preloaded delivery system

PURPOSE

To assess a single-piece monofocal hydrophobic acrylic intraocular lens (IOL) with hydroxyethyl methacrylate (HEMA) (Clareon) contained in automated preloaded delivery system (AutonoMe).

SETTING

18 surgical sites in Japan.

DESIGN

Observational study.

METHODS

In patients undergoing phacoemulsification and IOL implantation of a new hydrophobic acrylic IOL using an automated injector, clinical data were collected preoperatively and at 1 day, 1 week, and 1 month, 6 months, and 12 months postoperatively. The degree of glistenings was graded on a 4-point scale. The surgeons rated usability and performance of the IOL delivery system on a 5-point scale.

RESULTS

The study enrolled 384 eyes of 384 patients, ranging in age from 41 to 93 (73.8 ± 8.2, mean ± SD) years. The percentage of eyes with corrected distance visual acuity of 20/25 or better at 1 day, 1 week, and 1 month, 6 months, and 12 months postoperatively was 82.6%, 91.9%, 92.8%, 96.6%, and 95.2%, respectively. Refractive error was within 1.0 diopter in approximately 90% of cases. No glistenings were found in all cases throughout the study period. The rate of Nd:YAG laser posterior capsulotomy was 0.9% at 1 year. The IOL delivery system received high ratings on its usability and performance by the surgeons.

CONCLUSIONS

The new hydrophobic acrylic IOL with HEMA showed excellent visual and refractive outcomes without developing glistenings throughout the 1-year study period. The surgeons gave high marks for usability and performance of the automated preloaded delivery system.