The new scrub technician was working with us for the first time. She had previously assisted with ophthalmology surgeries in the past and was familiar with certain IOL injectors. However, in this case we are using a pre-loaded IOL and she thought that it was similar enough to other models so she did not ask for guidance. Remember our previous case where a different scrub technician was smart to ask for help.
The injector was not loaded with enough viscoelastic which is necessary to provide the lubrication for controlled delivery of the IOL. As a result the IOL shoots of the injector quite rapidly. Quick reflexes ensured that the IOL was still delivered carefully. But then we noted two opacities: a roundish mark at the periphery and then a linear mark centrally.
It turns out that the roundish opacity was a piece of lens cortex and the linear mark was a small fracture in the acrylic material of the IOL.
Click below to see the video of this misloaded IOL shooting out of the injector: