Recovering from misloaded IOLs

We count on our surgical techs and assistants to help with certain parts of the cataract surgery. One of these is loading the IOL prior to the surgeon delivering it into the capsular bag. In this video we have a new scrub tech who insisted that she was an expert at loading IOLs, but that certainly was not the case. The surgeon still has the responsibility for ensuring the success of the surgery and any complication is likely going to be deemed the surgeon’s fault.

The idea of a pre-loaded IOL is to help standardize the technique and minimize any manipulation of the lens implant. In both cases shown here, in fact we were using a pre-loaded IOL but this still requires that the technician do a competent job in injecting the viscoelastic and preparing the device. As a surgeon, the key is to watch as the IOL comes out of the injector tip and to notice anything unusual such as increased resistance to injection. As the leading haptic comes out, we must keep the orientation correct — this means that the leading haptic will look like the number 7 and the trailing haptic will look like the letter L.

The 7L rule — now you will never forget!

The final surgical pearl is to deliver the IOL into the anterior chamber if it is coming out of the injector incorrectly. This will give you much more room for manipulation or even flipping of the optic if needed. Avoid delivering the IOL incorrectly into the capsular bag because the haptics can tear the delicate posterior capsule if they catch it during repositioning maneuvers. Instead, open the IOL fully in the anterior chamber and then dial the IOL haptics and optic into the capsular bag.

Click to learn how to deal with misloaded IOLs from this video:


  1. What a great surgical pearl the 7-L rule! And never forget it ain’t over till it’s over!

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