Dr. Neil Friedman provides a preview of the Intrepid Autosert Injector from Alcon.
One of the critical steps in cataract or IOL exchange surgery is properly positioning the intraocular lens implant (IOL) in the capsular bag.
Techniques and instrumentation have improved significantly with advances in IOL technology and smaller incision surgery. Rigid one piece polymethylmethacralate lenses have a number of disadvantages including the need for large incisions of 6 mm or more, contact with the ocular surface during forceps delivery through the wound, and sometimes difficult manipulations of the trailing haptic to place it into the bag. Foldable IOLs allow for easier and gentler bag placement, and injector systems enable lens insertion through smaller incisions than with forceps. They also eliminate IOL contact with the external surface of the eye.
Preloaded IOL implantation systems now exist. These devices, which include the iSert from Hoya, Tecnis iTec from AMO, and AcrySert C from Alcon, further improve sterility and reduce potential damage to the IOL optic surface from manipulation. An automated injection system, the Intrepid AutoSert injector from Alcon, also is available and allows one-handed delivery of the lens.
Recently, I had the opportunity to evaluate the AutoSert system as documented in the video here.
The device is controlled with the foot pedal on the Infiniti and Centurion phaco machines. The plunger initial speed, pause time, and final speed—with default settings of 1.7 mm/sec, 3 seconds, and 1.7 mm/sec, respectively—are completely programmable depending on surgeon preference, and the final speed mode can be set to either fixed or linear control.
The video demonstrates these three phases of the delivery process, and during the final plunger advancement—set for linear foot pedal control—I slow the speed during initial lens entry into the eye by backing off the foot pedal.
I found it offered several advantages over the standard, manual, two-handed lens injectors. It is easier to use, it injects the lens more smoothly, and it allows precise and customizable control of the IOL delivery parameters.