Hydrophilic and Hydrophobic Acrylic Intraocular Lens Implantation with the Monarch II Injector

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Hydrophilic and Hydrophobic Acrylic Intraocular
Lens Implantation with the Monarch II Injector

• Aysel Pelit, Yonca A. Akova
• Baskent University, Faculty of Medicine, Adana,
  Turkey

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No author has a financial or proprietary interest
in any material or method mentioned
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Introduction-I

• The Monarch II injector system is designed for
  hydrophobic acrylic IOLs (AcrySof IOL).
• The benefits of the Monarch II injector system
  are well recognized however, no study has
  evaluated the complication rates of a single
  surgeons use in a series of hydrophilic and
  hydrophobic acrylic IOLs.

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Introduction-II

• We aimed to evaluate the clinical experience and
  complication rates in using the Monarch II
  injector system with hydrophilic and hydrophobic
  acrylic IOLs.

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Materials and Methods-I

• The patients were prospectively randomized to
  have implantation of a hydrophilic acrylic IOL or
  a hydrophobic acrylic IOL.
• One surgeon (AP) implanted a hydrophilic acrylic
  IOL (AIALA IOL, AJL Ophthalmic SA, Minano-Alava,
  Spain) in 100 eyes of 82 patients and a
  hydrophobic acrylic IOL (AcrySof IOL, model
  SA60AT, Alcon Laboratories Inc, Fort Worth, TX,
  USA) in 100 eyes of 76 patients during
  phacoemulsification surgery.

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Table 1. Baseline demographics
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Materials and Methods-II

• IOL implantation using a Monarch II injector was
  performed through a 3.0 mm corneal incision in
  all patients.
• During the surgery, an IOL was placed in a
  Monarch II B cartridge. The cartridge was
  inserted into the handpiece, and the trailing
  loop was positioned so that the plunger was in
  contact with the optic during initial
  advancement.

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Materials and Methods-III

• During implantation, the cartridge tip was
  pressed against the wall of the corneal incision
  so that the front portion of the tip was in the
  incision but did not enter the anterior chamber.
  Then, the screw was turned so that the leading
  haptic was inserted into the left side of the
  capsular bag. Once the optic came out of the
  cartridge, it was placed in the capsular bag by
  downward manipulation. The cartridge inserter was
  rotated clockwise to ensure that the trailing
  haptic was in the capsular bag.
• Surgical technique and complications were
  prospectively evaluated.

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Results-I

• We experienced difficulty in loading of the
  hydrophilic acrylic IOLs in the cartridge.
• During the unfolding, 30 (30) hydrophilic
  acrylic IOLs turned up side down. Because of the
  zero angulations between the optic and haptic, we
  did not need to correct the IOL position.
• The trailing loop became captured in the
  cartridge tunnel in 3 instances (3). The
  cartridge inserter was rotated counterclockwise
  to release the trailing loop.

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Results-II

• One (1) hydrophobic acrylic IOL reversed front
  side back during the implantation. The leading
  loop stuck to the back of the optic surface in 1
  instance (1). The leading loop that had been
  stuck was released with sinskey under
  viscoelastic material.
• A small crack occurred in the optic of 1
  hydrophobic acrylic IOL (1) but caused no
  problems.
• No posterior capsule perforation during
  implantation occurred with either of the IOLs.

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Table 2. Intraoperative complications
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Conclusion

• IOL implantation using the Monarch II injector
  is easy and requires a minimal learning curve. We
  recorded fewer complications related to Monarch
  II delivery system in hydrophobic acrylic IOLs
  than in hydrophilic acrylic IOLs. However, none
  of the complications led to an unwanted outcome.
• Our results indicate that the Monarch II
  delivery system can be used to effectively and
  safely to insert hydrophilic IOLs through
  relatively small incisions.