Cataract surgery can provide an incredible refractive result, particularly for small eyes which are highly hyperopic. We can correct 10 or more diopters of refractive error by implanting an IOL with the appropriate power. In the USA, the highest power IOL that I have found is the Alcon SA60AT single-piece acrylic IOL which comes in powers up to +40.0 diopters. This IOL is much thicker than the typical 20 D IOL and we must approach the IOL delivery differently.
In this case, the manufacturer calls for the larger B cartridge to deliver the IOL instead of the C or D cartridge. This cartridge will not be able to fit all the way inside our phaco incision, so we need to either enlarge width of the incision or use the wound-assist technique. By abutting the tip of the IOL injector against the phaco incision, we can deliver the IOL through an un-enlarged incision and into the anterior chamber, where we can then dial it into the capsular bag.
Click below to learn about the challenges of high power IOL delivery in these small eyes: