Evaluation of the Effectiveness of Preloaded IOL Injectors in Surgical Time

Background: The implantation of the intraocular lens (IOL) is still subject to error and complication, as it can result in traumatic opening of the IOL leading to rupture of the posterior capsule and zonular dialysis, it takes time to train paramedic teams to assemble such IOLs with the manual injectors. Moreover, there is a potential risk of comtamination and endophthalmitis as there is manipulation of the IOL and cartridge. The preloaded IOLs tend to reduce those unwanted results and may optimize the surgical time. Purpose: The aim of this study is to compare the effectiveness and implantation time between three injectors and three intraocular lenses, two pre-loaded and one conventional. Methodology: Videos of thirty patients undergoing cataract surgery from December 2019 to December 2020 at the Hospital Oftalmológico de Brasília (HOB), Brasília, Brazil were included in this observational, analytical retrospective study, non randomized. All patients had their surgeries recorded, from which the time of injection and opening of the intraocular lens (IOL) was extracted, 20 eyes were implanted with preloaded intraocular lens, and 10 eyes with conventional IOL implant. The patients were divided into three groups with similar eye characteristics. The first received the AutonoMeTM (CE) injector with the Clareon® IOL, the second the IsertTM injector (I) with the Hoya® IOL, and the third was injected with Johnson & Johnson Platinum 1 Series injector used to deliver Sensar® One AAB00 lens. The Welch test and Tukey’s Post Hoc test were used in the statistical analysis. Results: It was observed that there was a statistical significance regarding the presence of a haptic stuck (5 Clareon vs 0 Sensar and Hoya), between the mean opening time of the IOL optics Sensar One, Hoya and Clareon (25.00 vs 31.40 vs 11.70 s, p < 0.001) and between the total time (the injection time more the opening time of the IOL) in relation to Hoya and Clareon lenses (39.50 s vs 19.60 s, p < 0.001); the total time of the Sensar IOL was 31.30 s. The opening time of the IOL optics was significantly longer for the Sensar One and Hoya groups compared to Clareon group, and the total time of Hoya group was significantly longer compared to the total time of the Clareon group. Conclusion: The study demonstrated that the choice of injector and IOL set can significantly affect the total time of IOL implantation. However, there was no difference regarding complications and collateral damage depending on the set chosen for the implant.