SURGICAL PEARLS

Incorporating Preloaded IOL Injectors Into Practice

Save time and increase OR efficiency with this innovative tool

By Sumit (Sam) Garg, MD

When it comes to operating room (OR) time, every tick of the second hand means money. OR efficiency is more than just the surgeon’s time; it is everybody’s time. One simple way to streamline the surgical process is to utilize innovative tools. Although these tools generally require additional financial outlay, the efficiencies gained in preparation, procedure, and safety largely offset the increased costs. A perfect example is the preloaded intraocular lens (IOL) device, which is designed to streamline setup, IOL insertion, and post-surgical sterilization. A number of manufacturers offer preloaded IOL devices in the United States, including the Tecnis iTec Preloaded Delivery System (AMO), AcrySert C (Alcon), iSert Preloaded IOL System (Hoya), and the Pre-Loaded Injector (Lenstec).

Making the switch to preloaded IOL devices is a practical and simple change to make, yielding multiple safety and time-saving benefits. Here are a few key advantages to incorporating these devices into your OR.

Safety and Accuracy

One of the biggest benefits is safety. With the IOL already loaded, the technician or surgeon simply inserts the ophthalmic viscosurgical device (OVD) and the IOL is ready for insertion. There is no cross-contamination or possibility of damage to the lens while handling, allowing for a safer procedure. Also, a preloaded IOL goes directly from the manufacturer to the eye, dramatically reducing the risk of potential lens damage caused by handling the lens during loading.

Figure 1. Tecnis iTec preloaded delivery system with IOL in “ready position.”

Figure 2. iTec injecting IOL into eye.

Using a preloaded IOL also contributes to my peace of mind during surgery. Since I began using preloaded IOLs, I no longer have concerns about whether the resident, fellow, or technician correctly loaded the lens with the haptic in the right place, and I don’t have to wonder if the lens was compromised during handling. Further, with the lens power printed directly on the device, I can quickly and easily double check that I am inserting the correct lens power just by looking down.

Efficiency

Preloaded IOLs create efficiency for the surgeon, staff, and surgery center. Operating room technicians realize several advantages with the pre-loaded IOL. Most importantly, utilizing the preloaded IOL completely eliminates the step of loading the IOL. With the lens already loaded, the technician simply inserts the OVD and the lens is ready for injection. Secondly, the disposable device means there is one less item to catalog and sterilize. With the imposition of new ASC surgical equipment and sterilization requirements, fewer tools on the tray can save both time and expense. In a high-volume center, a disposable device reduces the need for capital outlay on additional reusable injectors and it helps to avoid disruptions in patient flow by eliminating the need to sterilize and prep for more cases.

For each procedure using a preloaded IOL, I have shaved about 30 seconds off my total time when compared to insertion using the platinum traditional lens inserter. For a surgeon who performs 15 to 20 cases per day, that saves enough time to add one more case per day, further offsetting the cost of adopting this tool.

Minimal Learning Curve

Adapting to the preloaded IOL was an easy process for me. As a user of the Tecnis line of lenses (AMO), I made the transition to the iTec, which feels very similar to the platinum injector I was accustomed to using. Although it is a different process than the traditional injector, after just a few cases, I had the new progression down. The steps are: put the viscoelastic in, take the cap off, advance it to a resting position (and leave it there for 10 seconds); then advance it again until it clicks and is ready for injection.

One major difference between the traditional injector and the iTec is that the iTec is plastic instead of metal. However, I haven’t noticed any difference with respect to insertion through the wound because the tip of the iTec is the same as the platinum cartridge to which I was already accustomed. Also, I do use a little more viscoelastic with the iTec than I did with the platinum injector, so this may result in having to open an additional vial.

Working in a teaching site, I still want my residents and technicians to learn how to load lenses using the traditional method, as this is always the fallback. With the preloaded IOL, they may not have the opportunity to develop or maintain this skill, so I will use the platinum injector when working with beginning residents or inexperienced technicians. This way, if something does happen to the disposable injector, my surgical staff has the training necessary to remove the lens and load it into the platinum injector.

Embracing Change

Adopting this assistive tool into my surgical procedure has proven virtually seamless with respect to my process and outcomes. Although there is a minimal upcharge for the preloaded IOL, I find this cost is offset by having to maintain inventory of fewer cartridges, not requiring a separate injector, not having to sterilize and clean the injector, and by my faster procedure time. In my opinion, this innovation is a responsive action to address OR needs and to streamline the process as much as possible, ultimately saving us time and expense. ■