Eyeworld Supplements

Innovative IOL technologies for the cataract surgeon in the bag. I found that I would rotate the globe incredibly nasally and have to move the injector verti- cally to make the lens go into the bag. Adopting a one-hand technique makes a huge difference in terms of the control, the globe position, and patient com- fort. Rather than pushing the plunger toward the hub of the injector with my thumb, I keep the cartridge chamber in the lip, but I am trying to pull the plung- er flange back toward my thumb with the tip staying in the wound. That way, I don't put any pressure nasally toward the wound, and that seems to work well. Dr. Lane: That's similar to my technique. The distal end of the cartridge has a depth guard nozzle on it. I find that small flange proximal to the nozzle end so valuable in being able to insert the distal end of the cartridge in through the wound and have it stop there so that I can't advance it anymore and potential- ly expand the size of the incision. With the UltraSert, I have less concerns about stretching my initial incision because the depth guard is an automatic "stop" as I am inserting the lens. Dr. Cibik: We haven't seen any cracking in the tip with the UltraSert. It is a very consistent system, and that makes the techs a lot more comfortable. Also, with the UltraSert system, the IOL is delivered a little bit more vertically than it is with the Monarch or the AutoSert system. as the initial engagement of the IOL by the plunger is performed in a very slow and controlled manner, the leading haptic and IOL fold nicely every time to allow consistent delivery in the capsular bag. Dr. Lane: One of our col- leagues actually does the whole thing himself. The surgical tech puts the OVD in and then hands it to him. He made the observation that as he advances the lens down the cartridge, when he sees the leading haptic start to straighten out, he stops, waits just a second, and then advanc- es again slowly. In other words, he stops, waits for the viscoelastic to come around, and then he goes. I haven't done that my- self, but it certainly makes sense. Dr. Woodard: For the first 100 or so cases, sometimes when the technician would load it, it would be perfect. Other times, the haptic was straight. Finally, I just start- ed preparing all of them on my own under the mi- croscope, and I visualized exactly that. Then I edu- cated our technicians on that, and they now realize that they need to watch the leading haptic very closely. I don't load it myself much anymore. Dr. Tipperman: We have used the Monarch injection system at our center. I real- ly like it and think it works extremely well. When I first began using UltraSert to deliver the AcrySof IQ aspheric IOL, I put two hands on the UltraSert cartridge, pretty much just like a Monarch injector, and tried to inject the lens AutoSert (Alcon) and UltraSert to Monarch in terms of smoothness? Dr. Cibik: I think it's more similar to the Monarch than the AutoSert system as far as how it feels. There is a very smooth, comfortable, controlled delivery. I feel like I am in command of the situation. In my experience, the delivery is very repro- ducible, and I haven't found any problems with the hap- tic being stuck to the IOL optic or in the plunger. Dr. Woodard: The UltraSert is a very consistent delivery system. When preparing the cartridge, it is very im- portant for the technician to advance the plunger very slowly, especially the first couple of millimeters. If not, that leading haptic tends to straighten instead of folding along with the IOL. I have found that as long lens power when using an AcrySof IQ monofocal lens, so we will have to open a different lens. The time it takes to do that is certainly much shorter with a pre- loaded system. When you change the lens, the scrub nurse is usually in panic mode because the lens is not available when the measurements are being performed. In my experi- ence, this system allows for an easier flow and greater efficiency when using tech- nology like the ORA System. Please describe any chang- es you made to your tech- nique for delivery of the IOL with UltraSert. Dr. Cibik: I stabilize the globe with my left hand through a lateral portal opening, while I deliver the lens with my right hand using UltraSert. Dr. Lane: How would you compare UltraSert to " The experienced technicians appreciate the UltraSer t system because they don't have to worry about folding the lens. Surgeons can be confident that the lens is well-loaded, even with a less-seasoned tech. " –Lisa Cibik, MD Please refer to page 8 for impor tant product information about the Alcon products described in this supplement.

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