How to inject a 3-piece IOL when the haptics twist

3-piece IOL loading title 156

When we inject a three-piece acrylic IOL into the eye, we must be very careful to ensure that the IOL is in the correct orientation. We have previously explained the correct IOL orientation so that the haptics are in the Z-formation and absolutely not in the S-formation. This applies to both singe-piece and three-piece IOLs and regardless of the material type (acrylic, silicone, PMMA, etc).

IOL S config

In the two cases presented here, we are implanting the same IOL: a three-piece acrylic IOL with a power of +1.0 (the very low IOL power is due to both patients having extreme axial myopia).

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In the first case, the IOL is properly placed into the injector cartridge and advanced down the barrel. The leading haptic stays in the straight configuration so that when it is injected into the eye, it comes out in the correct direction.

In the second case, the IOL is also properly placed into the injector cartridge and advanced down the barrel. But when it comes down the tip, the leading haptic twists in the opposite direction. If we implant the IOL into the eye in a normal manner, the haptic will come out in the wrong direction and the IOL will likely be delivered in the S-formation. What’s the solution?

We must flip the injector to re-orient the leading haptic for delivery, then once it has come out of the tip, we flip the injector back to deliver the optic and trailing haptic in the correct formation.

Click below to learn how to properly inject a three-piece IOL, even if the haptic is twisted

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