If HPMC is used, a standby IOL should be ready at the time of implantation. These small peripheral cracks have no ill-effects on the visual outcome and stability of the IOL in the short term. These factors could induce stress at the optic-haptic-junction leading to the crack. The UNFOLDER Silver handpiece with the One Series cartridge implantation system is used to fold and assist in inserting TECNIS 1-Piece intraocular lenses into the capsular bag. During culture, PB-MNCs formed multiple cell clusters, and EPC-like attaching cells with endothelial cell lineage markers (CD31, vascular endothelial cadherin, and kinase insert domain receptor) sprouted from clusters. This may lead to movement of optic followed by movement of trailing haptic after a time lag, due to inherent design of the injector. patients with acute myocardial infarction, more cell clusters and EPCs developed from cultured PB-MNCs obtained on day 7 than those on day 1. 6 With HPMC, the force required to dislodge optic and haptic from the cartridge at initiation of injection is higher. Hydroxylpropylemethyl cellulose has lower pseudo-plasticity 6 than other viscoelastics, hence it is more difficult to begin and maintain injection through the cannula. In our case, proper technique for injection was followed, with use of HPMC. This was the first complication of IOL damage. The 2 flaps of the Silver or Sapphire Series cartridge are closed. Though manufacturers instruct to avoid use of Healon TM with Unfolder TM, its use without any lens damage has been reported. We describe the use of the Unfolder Silver/Sapphire Series implantation system (Advanced Medical Optics, Inc.), designed to implant the SI40 or Sensar intraocular lens (IOL), to insert a CTR into the capsular bag. We have been using HPMC for insertion of Phacoflex-II using Unfolder TM for the past three years without any damage to the IOL. Among silicone IOLs this complication has only been reported once with Clariflex but has never been reported with Phacoflex-II. There are reports 1, 2, 3 of IOL damage during implantation. Intraoperative photograph showing cracked Phacoflex-II IOL in the capsular bagĪfter six weeks, the IOL remained stable and well centered, without compromising BCVA. On the first post surgical day, the patient had BCVA of 20/20. In spite of the crack, the IOL was well centered in the bag. The IOL optic had opened and it was impossible to withdraw. Leading haptic was implanted successfully, while crack was noted at the trailing haptic-optic junction. Phacoflex-II was loaded into Unfolder TM using HPMC according to the manufacturer′s instructions. Phacoemulsification was performed in the right eye. 4Ī 56-year-old male presented with bilateral immature senile cataract with best corrected visual acuity (BCVA) of 20/80 in right eye and 20/40 in left eye. 2 We report cracking of Phacoflex-II during insertion, using hydroxylpropylemethyl cellulose (HPMC) with Unfolder TM system. Damage to acrylic 1, 2 and Clariflex 3 IOLs during implantation has been reported most of them do not affect visual outcome but may need explantation. Silicone and acrylic intraocular lenses (IOLs) are commonly used after phacoemulsification.
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