A laboratory evaluation of nozzle tip damage in four generations of intraocular lens injector systems using a self-developed damage scale

Hui Fang,Lu Zhang,Weijia Yan,Patrick R Merz,Mélanie Leroux,Gerd U Auffarth,Sonja Schickhardt

doi:10.1038/s41598-022-06696-5

Hui Fang, Lu Zhang + Show 5 more

Open Access

https://doi.org/10.1038/s41598-022-06696-5

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Abstract

During intraocular lens (IOL) implantation it is not uncommon for the injector’s nozzle-tip to get damaged. However, the damage has not been systematically described or evaluated using an objective scale. In this study we developed our own system—the Heidelberg Score for IOL Injector Damage (“HeiScore”), which was used to grade 60 injectors from four generations of injector models (Monarch III D, AcrySert C, UltraSert, AutonoMe) made by the same manufacturer. (Alcon Laboratories Inc.) HeiScore has six grades of nozzle-tip damage: no damage (which was graded 0); slight scratches (1), deep scratches (2), extensions (3), cracks (4) and bursts (graded number 5). The score for each injector model was the sum of all grades (total number), and we could compare the four injector models. The injectors showed varying damage profiles, from “no damage” to “crack”. A tendency of a lower damage score in the newer generations of IOL injectors was noted. However, a statistically significant difference was observed only between Monarch III D and AutonoMe. The “Heidelberg Score for IOL Injector Damage” could efficiently and effectively evaluate the damage to IOL injector systems, which might help manufacturers optimize the positioning of the IOL in the injector during pre-loading.

Highlights

During intraocular lens (IOL) implantation it is not uncommon for the injector’s nozzle-tip to get damaged
Plastic parts of an injector might be retained in the anterior chamber as a foreign body[6], which could be a causative agent for toxic anterior segment syndrome (TASS), an acute postoperative sterile inflammatory reaction of the anterior segment tissues to a toxic substance[7,8]
Injector Monarch III D Cartridge resulted in the highest value of damage score of 2 (1–2)

Summary

Introduction

During intraocular lens (IOL) implantation it is not uncommon for the injector’s nozzle-tip to get damaged. In this study we developed our own system—the Heidelberg Score for IOL Injector Damage (“HeiScore”), which was used to grade 60 injectors from four generations of injector models (Monarch III D, AcrySert C, UltraSert, AutonoMe) made by the same manufacturer. A statistically significant difference was observed only between Monarch III D and AutonoMe. The “Heidelberg Score for IOL Injector Damage” could efficiently and effectively evaluate the damage to IOL injector systems, which might help manufacturers optimize the positioning of the IOL in the injector during pre-loading. A few s tudies[10,11] have evaluated damage to the IOL injectors after implantation None of these studies measured the damage to injectors in a systematic manner. We developed a scale—Heidelberg Score for IOL Injector Damage (HeiScore), by which the damage to IOL injectors of four generations from the same manufacturer was examined systematically

Objectives

Results

Conclusion