A high-power IOL is not the same as an IOL with an average power, primarily because the increased power of the optic makes it substantially thicker. These thicker IOLs cannot compress as much as a thin IOL and often a larger injector cartridge is needed to facilitate delivery.
Manufacturers of these IOLs specify the recommended cartridge size for implantation, with a move to a larger bore tip usually at an IOL power of about 26 or 27. In the two cases presented here, we are using Alcon IOLs, one in a power of 29 and the other in a power of 30. In both cases, we use the larger monarch C cartridge (instead of the D cartridge) to allow for more room. Using too small of a cartridge can cause the IOL to crack or become damaged during delivery.
When loading the IOL into the injector, use plenty of viscoelastic as lubrication. When the IOL is being delivered, keep a constant speed to ensure momentum of delivery. Aspheric IOLs are also recommended since the higher optic power can mean more spherical aberration if an older-design lens is used.
Click below to learn about delivery of these high-power IOLs:
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