Important Lesson from a Misloaded IOL

I had a case recently, where the surgical assistant told me that he was having difficulty loading the IOL into the injector cartridge. He passed it to me and I examined it under the surgical microscope. With the high degree of magnification, it was easy to see that the optic was arched upwards to the roof of the cartridge. It needed to be in more of a taco-form with a U-shaped profile, so I pulled it out and re-inserted it appropriately. I was then able to inject it into the eye and within the capsular bag without further issues. 

The take home message here is two-fold:

  1. You must load the lens as per the manufacturer’s instructions and protocol, which has been validated for safe delivery of the IOL. Doing alternative methods may work, but they may also increase the risk of IOL damage such as a cracked optic or broken haptic.
  2. Cataract surgery is teamwork and if the surgical assistant is having difficulty, then I am so happy that he feels comfortable enough to ask for help. As the surgeon, we have the benefit of years of surgical judgment and also the use of the surgical microscope. 

Click below to see this video of how I re-loaded the IOL: