Characterisation of Intraocular Lens Injectors

Abstract

In modern ophthalmic surgery, an intraocular lens (IOL) is commonly implanted into the patientʼs eye with an IOL injector. Many injectors are available, showing various technological differences, from the early manually loaded injector systems to the modern preloaded injectors. This review aims to give a concise overview of the defining characteristics of injector models and draws attention to complications that may occur during IOL implantation. One can differentiate injectors according to their preoperative preparation (manually loaded or preloaded), their implantation mechanism (push-type or screw-type or combined or automated), the size of the nozzle tip, the presence of an insertion depth control feature, and the injectorʼs reusability. Potential complications are IOL misconfigurations such as a haptic-optic adhesion, adherence of the IOL to the injector plunger, an overriding plunger, uncontrolled IOL rotation, a trapped trailing haptic, or damage to the IOL. Additionally, during IOL implantation, the nozzle can become damaged with scratches, extensions, cracks, or bursts to the tip. While these complications rarely produce long-term consequences, manufacturers should try to prevent them by further improving their devices. Similarly, surgeons should evaluate new injectors carefully to ensure the highest possible surgical safety.

Zusammenfassung

In der modernen Augenchirurgie wird eine Intraokularlinse (IOL) i. d. R. mithilfe eines IOL-Injektors in das Auge implantiert. Es gibt eine Vielzahl von Injektoren, die sich technologisch unterscheiden, von den frühen manuell zu ladenden Injektorsystemen bis hin zu den moderneren vorgeladenen IOL-Injektoren. Dieser Übersichtsartikel soll einen prägnanten Überblick über die charakteristischen Merkmale der unterschiedlichen Injektormodelle geben und auf Komplikationen aufmerksam machen, die während der IOL-Implantation auftreten können. Die Injektoren lassen sich nach ihrer präoperativen Vorbereitung (manuell geladen oder vorgeladen), ihrem Implantationsmechanismus (Druck- oder Schraubmechanismus, eine Kombination von beidem oder ein Automatismus), der Größe der Injektorspitze, dem Vorhandensein einer Funktion zur Kontrolle der Einführtiefe und der Wiederverwendbarkeit des Injektors unterscheiden. Zu den potenziellen Komplikationen gehören Fehlkonfigurationen der IOL, wie z. B. eine Haptik-Optik-Adhäsion, ein Anhaften der IOL am Kolben des Injektors, ein vorbeischiebender Injektorkolben, eine unkontrollierte IOL-Rotation, eine eingeklemmte Haptik oder eine Beschädigung der IOL. Darüber hinaus kann die Injektorspitze während der IOL-Implantation durch Kratzer, Ausdehnungen, Risse oder Aufplatzen der Spitze beschädigt werden. Obwohl diese Komplikationen selten langfristige Folgen haben, sollten die Hersteller versuchen, das Auftreten von Komplikationen durch weitere Verbesserungen der Injektoren zu verhindern. In der Zwischenzeit sollten Chirurgen vor der IOL-Implantation die IOL-Injektor-Systeme genaustens begutachten, um eine größtmögliche chirurgische Sicherheit zu gewährleisten.

Keywords

intraocular lens injector - cataract surgery - complications - injector damage - microscopy

Schlüsselwörter

Intraokularlinsen-Injektor - Kataraktoperation - Komplikationen - Injektorschaden - Mikroskop

Publication History

Received: 24 October 2023

Accepted: 19 June 2024

Article published online:
15 August 2024

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