Incision sizes before and after implantation of 6-mm optic foldable intraocular lenses using Monarch and Unfolder injector systems.

Purpose: To determine incision sizes for 6-mm optic foldable intraocular lenses (IOLs) implanted with injector systems.

Design: Nonrandomized, prospective clinical study.

Participants: One hundred fifty eyes of 150 patients with cataract and without other anterior segment pathological features or previous eye surgeries.

Intervention: We performed implantation of foldable IOLs with sharp optic edges and 6-mm total optic diameter with their recommended injector systems and cartridges: (1) Alcon MA60BM with Monarch II/cartridge A, (2) Alcon SA60AT with Monarch II/cartridge B, (3) Alcon SA60AT with Monarch II/cartridge C, (4) AMO AR40e with Unfolder Sapphire, (5) AMO AR40e with Unfolder Emerald, and (6) AMO Clariflex with Unfolder Silver. With every combination, 25 IOLs were implanted.

Main Outcome Measures: We measured incision width before and after phacoemulsification as well as before and after IOL implantation using a Kohnen caliper.

Results: The tunnel width (in millimeters; +/- standard deviation) for each combination before and after IOL implantation, respectively, was (1) 3.61 (+/-0.12) and 3.74 (+/-0.15), (2) 3.31 (+/-0.12) and 3.44 (+/-0.16), (3) 2.88 (+/-0.11) and 2.96 (+/-0.11), (4) 3.37 (+/-0.12) and 3.52 (+/-0.09), (5) 2.99 (+/-0.16) and 3.11 (+/-0.14), and (6) 3.06 (+/-0.12) and 3.15 (+/-0.11). The incision sizes before and after implantation for (3) were significantly smaller than all other combinations. Combinations (2) and (4) were not statistically significantly different, but were statistically significantly smaller in preimplantation and postimplantation incision size compared with combination (1) and were larger compared with combinations (5) and (6). However, the relationship of incision size and effective IOL optical zone differed: AR40e (Unfolder Sapphire) < MA60BM < Clariflex < AR40e (Unfolder Emerald) < SA60AT with both Monarch II B and C cartridge (greater means better relationship).

Conclusions: Postimplantation incisions sizes of 2.96 to 3.74 mm were determined with 6-mm total optic foldable IOLs using Monarch and Unfolder injector systems. Because the effective optical zone size is different for some of these IOLs, the incision size alone may not be the only relevant factor for optical outcome.