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Innovator develops visco-free preloaded IOL injector
HANOI, Vietnam — The latest advance in cataract surgery is a new preloaded disposable IOL injector that uses no viscoelastic, according to a speaker here.
Kimiya Shimizu, MD, discussed the development of the preloaded disposable injector, which uses balanced salt solution irrigation in place of viscoelastic, in the Lim Lecture he gave at the Asia-Pacific Association of Cataract and Refractive Surgeons meeting.
Dr. Shimizu said there have been a number of advances in recent years in phacoemulsification surgery that make the procedure safer and more effective than ever before. In particular, the use of a small, temporal clear corneal incision assures that there will be no induced astigmatism.
"The most important advantage of today's surgery is that there is less induced astigmatism because today's incision is small," he said.
"This is why we prefer phacoemulsification surgery. In Japan, almost 1 million cataract surgeries were performed last year, and more than 90% of those were done with phaco and a foldable IOL," he said.
Dr. Shimizu said foldable, injectable IOLs are the reason small incision sizes have been achieved. "In small-incision surgery, we can reduce induced astigmatism and achieve quick visual recovery," he said.
In addition to less induced astigmatism, injectable IOLs also create a cleaner environment, which aids in preventing endophthalmitis, "the most feared and miserable complication after cataract surgery," Dr. Shimizu said.
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Image: Mullin D, OSN |
To help further create the cleanest surgical environment, Dr. Shimizu and colleagues invented a disposable IOL injector in 1993. At the time, there was a problem with IOL damage occurring during the loading process, he said.
"IOLs are damaged in 3% of the insertions. So we hoped to decrease such an undesirable complication when we invented preloaded injectors in 2002," Dr. Shimizu said.
"With this preloaded injector, damage to the IOL decreased dramatically from 3% to 0.14%," he said.
"We had realized an ideal system, [but] we still had the desire to improve surgical devices, instruments and surgical steps," Dr. Shimizu said. This led him to develop a visco-free preloaded disposable injector, he noted.
"Is visco material essential in IOL implantation? The answer is no," he said.
The injector uses saline irrigation instead of viscoelastic to inject the IOL. The main advantage of this is that the capsular bag is formed more deeply and uniformly with saline irrigation, Dr. Shimizu said.
The only additional step required to use the new injector during cataract surgery is that, before the injection, the surgeon needs to connect the irrigation tube to the injector.
"You can make a deep capsular bag with irrigated [saline] and then push the IOL into the bag in almost the same way as with visco material," Dr. Shimizu said. "Without any additional procedure, you can finish the surgery.
"With this visco-free injector, we can prevent the pressure rise in glaucomatous patients after surgery and also we can achieve simple, safe and economical surgery," he said.