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Abstract
The injector is a method of implantation of foldable intraocular lenses. Although it has been officially registered in 1982; it is gaining popularity throughout the last few years when it has been combined with acrylic IOL’s rather than silicone ones that were responsible for most of the frustrating performance of the early designs of the injectors.
Injectors must be used exactly according to the manufacturer’s instructions in order to harvest its advantageous performance which can be summarized in its ability to implant foldable IOL’s through small incisions that are continuously decreasing with technological advances in the field of cataract and IOL’s. Such implantation can be accomplished with minor incision disturbance in comparison to the forceps technique. Other advantages include easier, accurate, smooth implantation, in the capsular bag even in some difficult situations as small pupil, small rhexis or rupture posterior capsule.
This study evaluates the role of injectors in small incision cataract surgery. Sixty eyes of fifty nine patients. All of them underwent phacoemulsification and implantation of three piece 6 mm optic hyDROPhobic acrylic IOL’s. They were divided into two groups:
Group I: Included thirty eyes implanted by the injector technique.
Group II: Included thirty eyes implanted by the forceps technique.
All cases were followed up postoperatively for three months. The follow up data included postoperative astigmatism using refraction and keratometry at the first week, the first month and the third month. The follow up data also included centration of the IOL and presence of complications either to the ocular structures or to the IOL.
Average preoperative astigmatism in the injector group was 0.406 D by refraction and 0.46 D by keratometry, While in the forceps group; it was 0.321 D and 0.357D respectively.
The results showed lesser postoperative astigmatism in the eyes implanted by the injector than those implanted by the forceps throughout the whole follow up period using two methods of assessment. Using refraction, average postoperative astigmatism in the injector cases was 0.938, 0.667 and 0.625 Diopters at one week, one month and three months respectively, while in the forceps cases it was2.738, 1.881 and 1.321 Diopters at one week, one month and three months respectively. Using keratometry confirms the previous results. In the injector cases, postoperative astigmatism was 1. 125, 0.833 and 0.833 Diopters at one week, one month and three months respectively, while in the forceps cases, it was 3.071, 2.119 and 1.524 Diopters at one week, one month and three months respectively.
Moreover, the change in the average postoperative astigmatism from the first week to the first month postoperatively in the injector group was lesser than that in the forceps group, as it was 0.313 Diopters by refraction and 0.292 Diopters by keratometry in the injector group, while it was 1.417 Diopters by refraction and 1.548 Diopters by keratometry in the forceps cases.This means that the postoperative astigmatism is more stable in the injector group even at this early postoperative period.
Change in the average astigmatism from one month postoperatively to three months postoperatively was lesser in the injector group than that in the forceps group. In the injector group it was 0.042 Diopters by refraction and 0.0 Diopters by keratometry, while in the forceps group it was 0.56 and 0.595 Diopters respectively. This result clarifies that the injector is a technique for foldable IOL implantation that gives a relatively earlier stability of the postoperative astigmatism by the first month so that final spectacle prescription can be given with better accuracy.