In vitro comparison of delivery performance of 4 preloaded intraocular lens injector systems for corneal and sclerocorneal incisions

Purpose To compare preloaded intraocular lens (IOL) injector systems in porcine eyes. Setting Alcon Japan, Tokyo, Japan. Design Experimental study. Methods Freshly-excised porcine eyes were assigned to 11 study groups (10 eyes per group) consisting of UltraSert (system U: corneal incisions 2.2 mm and 2.4 mm), UltraSert long tip (system ULT: corneal incision 2.6 mm; sclerocorneal incisions 2.4 mm and 2.6 mm), iTec (system iT: corneal incisions 2.2 mm and 2.4 mm; sclerocorneal incisions 2.2 mm and 2.4 mm), and Vivinex iSert (system iS: corneal incision 2.0 mm; sclerocorneal incision 1.8 mm). Results There were a few cases with IOL adherence to the plunger tip, delayed trailing haptic, intrawound manipulation, and damage to IOL, although the occurrence was not confined to particular devices. Cartridge tip splitting was observed with system iS. System U 2.4 mm and system ULT 2.6 mm caused the least amount of incision enlargement for corneal and sclerocorneal incisions, respectively. System ULT 2.6 mm resulted in the largest final size for corneal incisions and sclerocorneal incisions. System iS induced the largest amount of incision enlargement for both incisions but had significantly smaller final incision size than all other systems for corneal incisions and sclerocorneal incisions, except for system U 2.2 mm for corneal incisions. Conclusions Intraocular lens implantation through a tighter incision and with cartridge-insertion technique (>wound-assisted technique) caused greater wound enlargement. A smaller preimplantation incision with a preloaded IOL delivery system did not necessarily result in significantly smaller final incision because of wound enlargement.