Офтальмохирургия (Oct 2015)
AN EXPERIMENTAL STUDY OF THE FOLDABLE PUPIL-FIXATED INTRAOCULAR LENS IMPLANTATION THROUGH THE SMALL INCISION
Abstract
Purpose. To study features in implantation of the pupilfixated intraocular lens (IOL RSP-3) through a small incision in the experiment.Material and methods. Fifty pupil-fixated IOLs (RSP-3, manufactured by the NEP Eye Microsurgery Ltd., Russia) with a 26.0D refractive power previously dyed with trypan blue were included into this experimental study. We compared various IOL delivery systems including the Monarch II with B cartridge (Alcon, USA), the Monarch II with C cartridge (Alcon, USA), Viscoject-eco (Medicel, Switzerland), the Softject 2.2P (Hanita, Israel) and the Viscoject 1.8 (Medicel, Switzerland). Ten attempts of IOL delivery using each of injector systems were made. In all cases the IOL was loaded into the cartridge filled with viscoelastic (1% HPMC) and then delivered onto the surgical wipe. We carefully watched how the IOL passed through the cartridge and checked its interaction with the plunger. After that overall integrity of the IOL was visually evaluated using the surgical microscope (29.1x magnification). Finally a comparative analysis of each delivery system was performed to determine possible causes of IOL damage.Results. Group 1, which was characterized with the majority of unsuccessful IOL delivery attempts and included the Monarch II with B and C cartridges. Group 2 comprised of the Viscoject-eco and Softject 2.2P delivery systems. All attempts of IOL delivery using these systems were successful. The Viscoject 1.8 injector system was included into the group 3 where the amounts of successful and unsuccessful attempts were almost equal. Comparative analysis of the delivery systems revealed a number of features that are characteristic to the studied groups. Firstly, significant differences were noticed in the design of plungers. The group 1 delivery systems had flattened, metallic plungers with the tip bent downward. The groups 2 and 3 delivery systems had soft cylindrical plungers filling the entire lumen of the cartridge. Secondly, we found the difference between diameters of the outlets correlated with those recommended for the use during surgical procedure. Thirdly, we observed a difference in the cartridge tips design. Cartridges in the group 1 had sharp edges, while the cartridge edges in the groups 2 and 3 were slightly rounded.Conclusion. The experimental study revealed that the Viscoject-eco and Softject 2.2P delivery systems allow introducing the RSP-3 IOL through a 2.2mm incision. Main requirements for the RSP-3 delivery system were defined as follows: plunger should be soft and occlude the lumen of cartridge, also the cartridge should have a sufficient lumen diameter at the outlet.
