There are occasions when we will be handed an IOL which has been loaded incorrectly into the injector system. It is important that we recognize this early and then take steps to deal with it appropriately so that we can insert it safely and in the correct orientation. When the IOL is being advanced in the cartridge, look carefully at the configuration of the haptics. The anti-S orientation is the correct one. This means that the first haptic should come out point to the left and the trailing haptic should point to the right. The correct orientation of the haptics should be the Z-configuration.
In this case, the leading haptic is clearly mis-loaded, so I take care to inject it on top of the iris while the IOL is advanced. This allows the optic and trailing haptic to be inserted correctly, then the chopper is used to place the leading haptic into the capsular bag. We ensure that the lens opens up completely and it correctly oriented.
Click below to learn from this mis-loaded IOL surgery:
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