International Ophthalmology

, Volume 39, Issue 2, pp 397–403 | Cite as

Corneal incision architecture after IOL implantation with three different injectors: an environmental scanning electron microscopy study

  • Rita MencucciEmail author
  • Eleonora Favuzza
  • Maria Cristina Salvatici
  • Leopoldo Spadea
  • David Allen
Original Paper



To evaluate by Environmental Scanning Electron Microscopy (ESEM) the corneal incision architecture after intraocular lens (IOL) implantation in pig eyes, using manual, automated injectors or preloaded delivery systems.


Twenty-four pig eyes underwent IOL implantation in the anterior chamber using three different injectors: manual (Monarch III) (n = 8), automated (AutoSert) (n = 8), or a preloaded system (UltraSert) (n = 8). Acrysof IQ IOLs, 21 Dioptres (D) (n = 12) and 27D (n = 12), were implanted through 2.2 mm clear corneal incisions. Incision width was measured using corneal calipers. The endothelial side of the incision was analyzed with ESEM.


In each group, the final size of the corneal wound after IOL implantation, measured by calipers, was 2.3–2.4 mm. The incision architecture resulted more irregular in the Monarch group compared with the other injectors. In every group the 27D IOL-implanted specimens showed more alterations than in 21D IOL-implanted samples, and this was less evident in the UltraSert group. The Descemet tear length was higher in the Monarch group than AutoSert and UltraSert group.


The automated and preloaded delivery systems provided a good corneal incision architecture; after high-power IOL implantation the incisions were more regular and less damaged with the preloaded system than with the other devices.


Corneal incision Environmental scanning electron microscopy Injector Preloaded injector Intraocular lens Cataract 


Compliance with ethical standards

Conflict of interest

David Allen is a paid consultant to Alcon Laboratories. The other authors declare no conflict of interest.

Ethical approval

This ex vivo study was conducted on pig cadaver eyes (whole globes), obtained from the abattoir Italpork S.r.l. (Borgo a Buggiano, Italy), and it did not involve live animal subjects; it followed the tenets of the Helsinki Declaration. All applicable international, national, and institutional guidelines for the care and use of animals were followed.


  1. 1.
    Hayashi K, Yoshida M, Hayashi H (2009) Postoperative corneal shape changes: microincision versus small-incision coaxial cataract surgery. J Cataract Refract Surg 35:233–239CrossRefGoogle Scholar
  2. 2.
    Weikert MP (2006) Update on bimanual microincisional cataract surgery. Curr Opin Ophthalmol 17:62–67Google Scholar
  3. 3.
    Calladine D, Packard R (2007) Clear corneal incision architecture in the immediate postoperative period evaluated using optical coherence tomography. J Cataract Refract Surg 33:1429–1435CrossRefGoogle Scholar
  4. 4.
    ESCRS Endophthalmitis Study Group (2007) Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 33:978–988CrossRefGoogle Scholar
  5. 5.
    Cooper BA, Holekamp NM, Bohigian G, Thompson PA (2003) Case-control study of endophthalmitis after cataract surgery comparing scleral tunnel and clear corneal wounds. Am J Ophthalmol 136:300–305CrossRefGoogle Scholar
  6. 6.
    Wallin T, Parker J, Jin Y, Kefalopoulous G, Olson RJ (2005) Cohort study of 27 cases of endophthalmitis at a single institution. J Cataract Refract Surg 31:735–741CrossRefGoogle Scholar
  7. 7.
    Steinert RF, Deacon J (1996) Enlargement of incision width during phacoemulsification and folded intraocular lens implant surgery. Ophthalmology 103:220–225CrossRefGoogle Scholar
  8. 8.
    Kohnen T, Lambert RJ, Koch DD (1997) Incision sizes for foldable intraocular lenses. Ophthalmology 104:1277–1286CrossRefGoogle Scholar
  9. 9.
    Kohnen T, Kasper T (2005) Incision sizes before and after implantation of 6-mm optic foldable intraocular lenses using Monarch and Unfolder injector systems. Ophthalmology 112:58–66CrossRefGoogle Scholar
  10. 10.
    Berdahl JP, DeStafeno JJ, Kim T (2007) Corneal wound architecture and integrity after phacoemulsification Evaluation of coaxial, microincision coaxial, and microincision bimanual techniques. J Cataract Refract Surg 33:510–515CrossRefGoogle Scholar
  11. 11.
    Jun B, Berdahl JP, Kuo AN, Cummings TJ, Kim T (2010) Corneal wound architecture and integrity after torsional and mixed phacoemulsification: evaluation of standard and microincisional coaxial techniques. Ophthalmic Surg Lasers Imaging 41:128–134CrossRefGoogle Scholar
  12. 12.
    Ouchi M (2012) Effect of intraocular lens insertion speed on surgical wound structure. J Cataract Refract Surg 38:1771–1776CrossRefGoogle Scholar
  13. 13.
    Allen D, Habib M, Steel D (2012) Final incision size after implantation of a hydrophobic acrylic aspheric intraocular lens: new motorized injector versus standard manual injector. J Cataract Refract Surg 38:249–255CrossRefGoogle Scholar
  14. 14.
    Khokhar S, Sharma R, Patil B, Aron N, Gupta S (2014) Comparison of new motorized injector vs manual injector for implantation of foldable intraocular lenses on wound integrity: an ASOCT study. Eye 28:1174–1178CrossRefGoogle Scholar
  15. 15.
    Weikert MP, Wang L, Barrish J, Dimalanta R, Koch DD (2012) Quantitative measurement of wound architecture in microincision cataract surgery. J Cataract Refract Surg 38:1460–1466CrossRefGoogle Scholar
  16. 16.
    Bang JW, Lee JH, Kim JH, Lee DH (2015) Structural analysis of different incision sizes and stromal hydration in cataract surgery using anterior segment optical coherence tomography. Korean J Ophthalmol 29:23–30CrossRefGoogle Scholar
  17. 17.
    Danilatos GD (1993) Environmental scanning electron microscope: some critical issues. Scanning Microsc Suppl 7:57–80Google Scholar
  18. 18.
    Danilatos GD (1985) Design and construction of an atmospheric or environmental SEM (part 3). Scanning 7:26–42CrossRefGoogle Scholar
  19. 19.
    Nanavaty MA, Kubrak-Kisza M (2017) Evaluation of preloaded intraocular lens injection systems: ex vivo study. J Cataract Refract Surg 43(4):558–563CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Eye Clinic, Department of Surgery and Translational MedicineUniversity of FlorenceFlorenceItaly
  2. 2.Electron Microscopy Centre “Laura Bonzi” (Ce.M.E.), ICCOM, CNRSesto Fiorentino, FlorenceItaly
  3. 3.Department of Biotechnology and Medical-Surgical Sciences“Sapienza” University of RomeRomeItaly
  4. 4.Sunderland Eye InfirmarySunderlandUK

Personalised recommendations