Preloaded IOLs ease surgical workflow

Reviewed by Damien Goldberg, MD

Preloaded IOL systems can save almost 30 seconds of operating time in cataract surgery, according to Damien Goldberg, MD, who participated in a trial with a preloaded delivery system (AcrySof IQ IOL Model AU00TO with UltraSert, Alcon Laboratories).

“This is the direction to go,” said Dr. Goldberg, who practices in Torrance, CA. “It’s more and more critical to be efficient in the operating room.

“Most of us in surgery centers have very good techs who are comfortable loading these lenses, but not everybody does, and having these lenses preloaded would make it easier for people,” he added.

To see whether preloaded IOL delivery can save time, Dr. Goldberg and colleagues in Belleville, IL, Durham, NC, and Stillwater, MN, used video cameras to record implantation of 84 AcrySof IQ IOLs preloaded in the UltraSert cartridge and 84 AcrySof IQ IOLs in the Monarch D Cartridge (Alcon) in adult patients undergoing cataract surgery.

The two lenses are identical except the UltraSert comes from the manufacturer already loaded in its injector, whereas the Monarch must be loaded, typically by a surgical technician. The lenses were all basic monofocal IOLs.

Researchers clocked three surgical stages:

1. Device preparation time from the moment the nurse or assistant signaled the initiation of the device preparation until the device touched the eye.

The mean time was 43.0 seconds with the Monarch versus 21.6 seconds with the UltraSert. The difference was statistically significant (p < 0.25). The median time was 38.0 seconds for the Monarch and 10.0 seconds for the UltraSert.

“Obviously, the tech preparing the lens is a lot faster . . . just to put the viscoelastic in the cartridge and get the implant all ready,” Dr. Goldberg said.

2. Lens delivery time

2. Lens delivery time from the moment the device touched the eye until time the trailing haptic left the plunger.

The mean time was 12.1 seconds with the Monarch versus 14.4 seconds with the UltraSert. The difference was not statistically significant (p = 0.9833). The median time was 38.0 seconds for the Monarch and 10.0 seconds for the UltraSert.

3. Lens positioning/unfolding time from the moment the trailing haptic left the plunger to the complete unfolding.

The mean time was 51.3 seconds with the Monarch and 47.7 seconds with the UltraSert. This was also not statistically significant (p > 0.05). The median time was 37.5 seconds for the Monarch and 40.5 seconds for the Ultrasert.

Combining these stages, the mean total surgical case time was 106.4 seconds for the Monarch and 83.7 seconds for the UltraSert, which was statistically significant (p < 0.05). The median total surgical case time was 94.0 seconds for the Monarch and 77.0 for the UltraSert.

The UltraSert can make a difference in the era of wavefront aberrometry (ORA System, Alcon), which allows precise intraoperative measurement of the eye’s refractive properties. For example, a surgeon might be prepared to implant a 25-D IOL and suddenly find the system recommends a 23.5-D IOL.

“To have these implants preloaded so someone can just open the box and grab the injector, that’s going to be extremely helpful and reduce patients’ surgical time,” he said.

Damien Goldberg, MD

P: 310/543-2611

This article was adapted from Dr. Goldberg’s presentation at the 2017 meeting of the American Society of Cataract and Refractive Surgery. The study was funded by a research grant from Alcon Laboratories. Dr. Goldberg is a speaker for Alcon/Novartis.