spotlight on technology & technique
Performing Visian ICL Implantation
New and modified instruments make this procedure easier, better and safer.
By Leslie Goldberg, Assistant Editor

Using the proper instruments for implanting the Visian ICL is crucial for optimal surgical outcomes, according to Charles Williamson, M.D., of the Williamson Nelson Eye Center in Baton Rouge, La. "As more and more doctors begin to perform this procedure, training and experience will become diluted. Doctors may not have expertise in this area, so adding a margin of safety is important."

"Most instruments associated with this surgery are modifications to existing instruments," says Dr. Williamson, who served as one of STAAR Surgical's core investigators in the clinical trials for this delicate procedure. "Those [instruments] that are specific to the procedure aid in creating a better surgical outcome and increased patient safety."

Dr. Williamson has worked with Diamatrix, Ltd. (The Woodlands, Texas) to design a range of instruments specific to the Visian ICL surgery.

The Williamson Vacuum Cannula, the Diamatrix ICL Trapezoid, angled, the Diamatrix ICL Paracentesis, angled, and the Diamatrix Batlle Manipulator

Three Important Aspects of the Surgery

Dr. Williamson explains that there are three significant aspects of the Visian ICL procedure: loading the lens properly, making the incisions in the cornea and putting the lens safely underneath the iris behind the pupil.

■ Loading the lens. "If the lens is not loaded properly, the surgery doesn't come out properly," says Dr. Williamson. He recommends using the Duet lens-loading forceps. "These are tremendous forceps. They load the lens perfectly almost every time. Prior to the Duet, we used long ICL-loading forceps. We still use these to manipulate the lens but no longer use them to pull the lens down the barrel. We use the Duet forceps. The long ICL-loading forceps load the lens in the cartridge and the Duet pulls the lens into position in the cartridge."

■ Incisions to the cornea. "The problem with using cataract knives in this procedure is that they are longer than those designed specifically for the Visian ICL surgery and were designed to go further inside the eye," says Dr. Williamson. "You have to be careful when using the existing cataract knives, so that you stay away from the crystalline lens. You need to be careful how far you penetrate."

Dr. Williamson says that Diamatrix recognized this problem and designed diamond knives that did not penetrate too far — just far enough to go through the cornea and enter the anterior chamber. Diamatrix's diamond knives have a guarded entry and are specifically designed for the ICL surgery. 

Ron Dykes, president of Diamatrix, worked for STAAR for many years and has an extensive background in instrumentation. Dr. Williamson believes that Dykes' experience provides Diamatrix with unique insight into creating instruments for the Visian ICL procedure.

■ Placing the ICL. "Placing the ICL into the sulcus beneath the iris is tricky," says Dr. Williamson. "You want to do this in a very atraumatic way. There are multiple possible problems; the pupil can start to come down or constrict, the anterior chamber can start to shallow, additional viscoelastic fluid may need to be added."

There are two ways to maneuver the implantable lens. The first, which is used most often, involves using an ICL manipulator. This is a flat spatula with a rounded end and is used to position the lens under the iris. Dr. Williamson prefers the Batlle manipulator, created by Juan F. Batlle, M.D., Santo Domingo. He says the tackier surface has more of a grip on the lens. An alternate method uses a vacuum cannula. Dr. Williamson says that this can be significantly helpful in a difficult procedure.

"Attaching a hollow cannula to suck onto the lens and lift the lens up, then slipping it underneath where you need it and releasing it is very important," says Dr. Williamson. "The vacuum cannula can be attached to a syringe or a phaco unit on I&A and be used to adhere to the anterior peripheral haptic of the ICL through suction. The lens can be easily positioned beneath the iris atraumatically and released. With a spatula, there is a possibility that a metal instrument will poke through the lens or that you push downward too hard it can also slip off lens and hit the crystalline lens.

"By creating new instruments such as Diamatrix's shortened diamond knives, the vacuum cannula and the Duet forceps and making modifications to existing instrumentation, we can make the Visian ICL procedure easier, safer and better," concludes Dr. Williamson.

For more information on Diamatrix's ICL instrumentation call (800) 867-8081 or visit their Web site at www.diamatrix.com.