IOL Injector UPDATE
New inserter systems are easier to use and are fitting through smaller incisions.
JOHN PARKINSON, ASSOCIATE EDITOR

Technology upgrades are constantly changing the way people go about their daily lives. In the case of ophthalmologists, that includes how they perform surgeries. As recently as 2 years ago, IOL inserters were challenging to use. Loading the lenses into the inserters was labor-intensive, and the overall procedure didn't always result in a consistent success rate. But fast-forward a couple of years, and the use of inserters has become a much more popular way to deliver IOLs. Today's products have adapted to the demand for smaller and easier-to-use technology. Additionally, innovations in existing product lines have found new uses. For example, before the Tecnis and CeeOn lenses came under the Advanced Medical Optics (AMO) name, the lack of a proven inserter was a deterrent to using those lenses for some surgeons. However, AMO's Silver Series Unfolder can implant both.

	AMO's EmeraldEase can deliver IOLs simpler by reducing rotations to only one axis with a single-handed syringe style.
	The Silver T Series can implement IOLs in two steps. Users twist the plunger and then rotate the handpiece to deliver the IOL.

The Latest in IOL Inserters

Advanced Medical Optics (AMO). The company's EmeraldEase Unfolder gives surgeons a choice of inserters for the Sensar acrylic IOL with OptiEdge. In addition to the Emerald T, a traditional threaded inserter, the new EmeraldEase makes insertion easier by reducing rotations to only one axis with a single-handed syringe style, the company says.

Surgeons can insert a three-piece, full 6-mm-optic IOL through an unenlarged phaco incision of 2.6 mm. The Emerald cartridge -- which can be used with either the Emerald T or the EmeraldEase -- won't change wound architecture and facilities smooth haptic release and
control.

The Silver T Series Unfolder is designed to implant IOLs with two easy steps: twist the plunger and then rotate the handpiece, allowing for safe, controlled delivery of AMO's silicone IOLs. The design features include:

► enhanced SofTip Applicator and Sheath, which control the release of the IOL.

► conical tip shape that ensures the integrity of the incision architecture.

The entire Silver Series is designed for use with AMO's Clarifex, Phacoflex and Array IOLs.

For more information about AMO products, contact June Cassell at (714) 247-8302.

Alcon. The company has developed the Monarch II IOL delivery system that allows for one-step, in-the-bag implantation preserving the sterile integrity of the AcrySof Single-Piece foldable IOL. The company says the patented design provides a smooth, controlled delivery, avoiding explosive forces in the capsular bag. Easy to load by surgeons or staff, the system offers ease of use and predictable outcomes. The Monarch II IOL Delivery System also provides visibility of the lens within the cartridge during the implantation process. This creates the advantage of assessing the viability of the lens delivery through loading, advancement, and insertion of the lens. The Monarch II minimizes the need to enlarge the incision for delivery of an AcrySof IOL through one of three cartridge sizes engineered to offer safe wound entry and preserve lens quality.

For more information about Alcon products, contact Mark Jeffers at (800) 862-5266.

Bausch & Lomb. B&L has three different inserter systems. The MPort-SI is the SofPort System inserter. It is a syringe-based three-piece lens placement system. The instrument is single-handed, single-use, and delivers the IOL in a planar manner. According to B&L, the M-fold and tapered tip assures predictable placement and unfolding of the lens. IOLs are delivered into the bag with no lens inversion or haptic sweep. The closed system reduces the risk of external contamination entering the eye during insertion. The SofPort System MPort multipiece lens inserter has been designed for easy loading and insertion of the B&L multipiece silicone IOL line, and the new SofPort Advanced Optics aspheric IOL. The recommended incision size is 2.8 mm to 3.0 mm.

► The Passport II is a second-generation lens placement system for single-piece silicone foldable lenses.The syringe technology allows for single-handed delivery through a small incision. The blue-colored plunger provides excellent visualization and is designed to protect the haptics during insertion. The 55-degree beveled tip facilitates incision entry while minimizing incision stretching and enhancing controlled lens release. The recommended incision size is 2.8 mm to 3.2 mm for this Bausch & Lomb instrument.

► The Microsert II is designed to deliver single-piece silicone foldable lenses through an unenlarged phaco incision. The Microsert is a winged cartridge system. It is a reusable handpiece device that holds the single-use cartridges as follows: IC-2BU winged, beveled, non slit; beveled, slit; IC-5BU rhombus, winged, beveled, non slit. The recommended incision size is 2.8 mm to 3.2 mm. The handpiece inserter material is stainless steel.

(All of the Bausch & Lomb incision sizes listed above are estimates. Actual sizes may vary due to incision construction, location, and any stretching that may have occurred.)

For more information about Bausch & Lomb products, contact Blake Michaels at (909) 971-5151.

The Monarch II provides three cartridge sizes for users.\	The blue plunger of the Passport II gives users a bright contrast to protect the haptics during insertion.	The MPort SI's closed system reduces the risk of external contamination to the eye.

STAAR Surgical. STAAR has recently launched the new Indigo IOL Delivery System designed to deliver the single-piece Collamer IOL through a 2.8-mm incision. The new MicroSTAAR Indigo Injector has been designed in conjunction with the new Indigo Foam Tip Plunger. These two components are combined with the STAAR SFC-25 cartridge to provide an effective small-incision delivery system for the Collamer single-piece IOL.

	The Micro STAAR injector is easily resterilized due to its autoclavable plastic construction.

The MicroSTAAR injector can provide either a micrometer advance (twist style) or a syringe (plunger style) inserter. The MicroSTAAR injector is made of an autoclavable plastic that can be resterilized for multiple uses. The injector accepts only STAAR small-incision cartridges to accommodate 2.8-mm to 3.0-mm incisions. These injectors are sold sterile and 10 per carton.

Whether you prefer micrometer precision or the tactile feel of a syringe, STAAR says this system was designed specifically for easy loading and smooth delivery of its IOLs through small incisions. The injectors are available in the following formats:

► MSI-TM (twist) / MSI-PM (plunger) for the delivery of silicone three-piece IOLs (cartridge: AQ).

► MSI-TR (twist) / MSI-PR (plunger) for the delivery of silicone single-piece IOLs (cartridge: MTC-60c).

► MicroSTAAR Indigo (plunger) for the Collamer single-piece IOL (cartridge: SFC-25).

For more information, about STAAR products contact Alex Phillips at (800) 292-7902.

Looking Ahead

According to the company representatives interviewed for this update, the drive to make inserters easier to load and capable of delivering IOLs through smaller incisions will continue as marketplace forces demand these features. Therefore, doctors can expect even more changes in the future as these instruments evolve.