Laboratory Analysis of Causative Factors for the Final Incision Size due to Intraocular Lens Injector Insertion

Maximilian Friedrich; Isabella D. Baur, MD; Timur M. Yildirim, MD; Victor A. Augustin, MD; Ramin Khoramnia, MD; Gerd U. Auffarth, MD, PhD

Ophthalmology Science (Jan 2024)

Laboratory Analysis of Causative Factors for the Final Incision Size due to Intraocular Lens Injector Insertion

Maximilian Friedrich,
Isabella D. Baur, MD,
Timur M. Yildirim, MD,
Victor A. Augustin, MD,
Ramin Khoramnia, MD,
Gerd U. Auffarth, MD, PhD

Affiliations

Maximilian Friedrich: Department of Ophthalmology, The David J Apple International Laboratory for Ocular Pathology, University Hospital Heidelberg, Heidelberg, Germany
Isabella D. Baur, MD: Department of Ophthalmology, The David J Apple International Laboratory for Ocular Pathology, University Hospital Heidelberg, Heidelberg, Germany
Timur M. Yildirim, MD: Department of Ophthalmology, The David J Apple International Laboratory for Ocular Pathology, University Hospital Heidelberg, Heidelberg, Germany
Victor A. Augustin, MD: Department of Ophthalmology, The David J Apple International Laboratory for Ocular Pathology, University Hospital Heidelberg, Heidelberg, Germany
Ramin Khoramnia, MD: Department of Ophthalmology, The David J Apple International Laboratory for Ocular Pathology, University Hospital Heidelberg, Heidelberg, Germany
Gerd U. Auffarth, MD, PhD: Correspondence: Gerd U. Auffarth, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.; Department of Ophthalmology, The David J Apple International Laboratory for Ocular Pathology, University Hospital Heidelberg, Heidelberg, Germany

Journal volume & issue: Vol. 4, no. 1
p. 100356

Abstract

Read online

Purpose: In intraocular lens (IOL) implantation, insertion of the IOL injector enlarges the clear corneal incision. A larger incision size (IS) is associated with a higher risk for surgically induced astigmatism and endophthalmitis. The goal of this study was to determine which parameters most influence the final IS. Design: Experimental study. Subjects: A total of 126 cadaver porcine eyes were included in this study. Methods: We analyzed 409 clear corneal incisions made with 126 injectors from 13 injector models. We noted the vertical diameter and the tip angulation for every model. The corneal thickness of each incision location was measured using Scheimpflug tomography. The IS was measured before and after injector insertion and described as preoperative and final ISs, respectively. During surgery, the insertion depth and incision length were documented. A mixed effects model was applied to analyze the influence of the parameters on the final IS. Main Outcome Measures: Influence on the final IS. Results: Increases in the vertical diameter of the injector tip, the preoperative IS and the insertion depth, and a reduction of incision length were all significantly associated with increased final IS (P 0.05). Conclusions: The IOL injector’s vertical diameter should be as small as possible to ensure a minimal final IS. The injector’s insertion depth may be minimized, and the incision length should be long enough to reduce the final IS. Further studies are needed to confirm the findings in human autopsy eyes and in clinical practice. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article..

Published in Ophthalmology Science

ISSN: 2666-9145 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Ophthalmology
Website: https://www.journals.elsevier.com/ophthalmology-science/

About the journal

Abstract

Keywords