Preloaded IOL injection system found unsafe, unpredictable

This prospective study found that the AcrySof SN60WS/AcrySert preloaded IOL injection system does not appear to provide a predictable means of IOL delivery.

The authors observed the delivery characteristics of one of the first preloaded injectable IOL delivery systems to be sold, the AcrySert (Alcon Laboratories, Inc.), for the single-piece AcrySof IQ Aspheric IOL SN60WS (Alcon).

Subjects were all patients undergoing routine phacoemulsification procedures with implantation of the SN60WS via the preloaded Acrysert system over five consecutive months at a single center.

In 47 of the 85 eyes (55 percent), additional rotational manipulation of the IOL was required. Other problems recorded were trapped trailing haptic, haptic-optic adhesion, overriding of the plunger over the optic, and trauma to optic edge. In the rest of the eyes, correct IOL delivery behavior was achieved with the leading haptic orientating to the left of the surgeon.

The average time to achieve satisfactory IOL position was 47 seconds. IOL power and the experience of the operating surgeon did not appear to influence the occurrence of a misdirected leading haptic.

The authors conclude that a preloaded injectable IOL system should ideally provide the operating surgeon with a predictable and safe means of IOL delivery. This is also of particular importance for surgeons in training. The combined preloaded AcrySof IQ SN60WS/AcrySert system does not appear to meet these expectations, especially in the predictability of IOL insertion. In order to benefit from the potential advantages of a preloaded IOL system, further refinement is necessary to improve its delivery characteristics.