Effect of manual, preloaded, and automated preloaded injectors on corneal incision architecture after intraocular lens implantation

Purpose To analyze the effects on corneal morphology of manual, preloaded and
automated preloaded IOL injectors in eye bank human corneas by Environmental
Scanning Electron Microscopy (ESEM) and in patients after phacoemulsification using
Anterior Segment Optical Coherence Tomography (AS-OCT)
Settings Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and
Child Health, University of Florence, Italy
Design Retrospective and experimental study
Methods A total of 78 corneal incisions after IOL implantation were examined: 30 in
human corneas mounted on artificial chamber (ex-vivo study); 48 in patients
undergoing phacoemulsification (in vivo analysis). Three different injectors were used:
manual (Monarch III, n=26), manual preloaded (Ultrasert=26) and automated
preloaded system (Autonome, n=26). Thirty IOLs were implanted in ex-vivo study: 5
intermediate and 5 high dioptric powers for Acrysof IQ (Monarch and Ultrasert) and for
Clareon (Autonome) IOLs. In in vivo analysis, 16 corneal wounds for each injector were
evaluated using AS-OCT. In ex vivo study incision width was measured; in patients
Descemet membrane detachment, posterior wound retraction and posterior gape were
analyzed.
Results In the eye bank corneas, the incision width was significantly wider in high
dioptric power IOL manual subgroup (p<0.05), with more Descemet tearing compared
to AutonoMe. In the in vivo study, the incidence of Descemet membrane detachment,
posterior gape and wound retraction was lower in the automated preloaded group at 1
postoperative day.
Conclusions The automated preloaded injector ensures integrity and safety of the
corneal wound also in high-power IOL implantation and in the early postoperative period