LABORATORY SCIENCE Variations in intraocular lens injector dimensions and corneal incision architecture after cataract surgery Alejandro Arboleda, MS, Esdras Arrieta, MD, Mariela C. Aguilar, MS, Krystal Sotolongo, MS, Derek Nankivil, PhD, Jean-Marie A. Parel, PhD Purpose: To evaluate the differences in intraocular lens (IOL) in- jectors and to assess the effect of IOL insertion on injector tips and eyes after cataract surgery in a rabbit model. Setting: Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Florida, USA. Design: Experimental study. Methods: A modified optical comparator was used to measure the tips of 13 IOL injector models to determine the perimeter, tip angle, and cone angle of each. Injectors were analyzed before and after IOL insertion. Surgery was performed on rabbits with 71 IOL injectors of 13 models, and custom gauges were used to determine the incision size before and after surgery. Results: The injector dimensions varied by model; tip diameter, tip angle, and cone angle ranged from 1.44 to 2.12 mm, 29.7 to 66.5 degrees and 0.6 to 10.8 degrees, respectively. The incision size through which surgery was successfully performed also varied by injector model; the initial incision sizes ranged from 2.0 to 2.63 mm. For all injectors, there was wound enlargement after IOL insertion that ranged from a 0.1 to 0.65 mm increase in incision length. Conclusions: The dimensions and injection systems varied with each IOL injector. All injectors led to postoperative wound stretch after IOL insertion, with no final incision measuring less than 2.0 mm. These findings suggest that the clear cornea incision should have a width corresponding to the injector diameter. J Cataract Refract Surg 2018; -:-–- Q 2018 ASCRS and ESCRS C ataracts are the leading cause of treatable blindness in the world. Surgery, specifically clear corneal inci- sion (CCI) and phacoemulsification, has become the standard of care for removal of the lens content for refractive surgeons worldwide. 1 Phacoemulsification is then followed by insertion of an artificial intraocular lens (IOL) within the empty capsular bag. In recent years, there have been many refinements to avoid possible issues attributed to the procedure. One such advancement is the use of CCIs, which are safer, have decreased inflammation and pain, and have reduced postoperative recovery time. 2 Furthermore, there has been a trend to minimize the size of the CCI used in cataract sur- gery, leading to mini-incision (2.2 to 2.4 mm) and micro- incision (!2.0 mm) cataract surgery. Benefits of having a smaller incision include accelerated patient recovery, less surgery-induced astigmatism, and a reduced risk for aqueous leakage and inflammation. 3–7 To successfully complete these surgeries, new surgical techniques, including microcoaxial and biaxial approaches, are performed. These techniques require thin phacoemulsi- fication tips, sleeveless needles, and higher vacuum and flow settings. 5 The trend to minimize the corneal incision has also led to the development of new IOLs that can be Submitted: August 21, 2018 | Final revision submitted: October 15, 2018 | Accepted: October 22, 2018 From the Ophthalmic Biophysics Center (Arboleda, Arrieta, Aguilar, Sotolongo, Nankivil, Parel), Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, and Johnson & Johnson Vision Care, Inc. (Nankivil), Research and Development, Jacksonville, Florida, USA; Department of Ophthalmology (Parel), University of Li ege, Sart-Tillman CHU, Belgium. Mr. Arboleda and Dr. Arrieta contributed equally to the study. Presented in part at the XXIX Congress of the European Society of Cataract and Refractive Surgeons, Vienna, Austria, September 2011, and at the annual meeting Association for Research in Vision and Ophthalmology, Ft. Lauderdale, Florida, USA, May 2012. Supported in part by the Florida Lions Eye Bank and Beauty of Sight Foundation, Croma Pharma GmbH, NIH center grant P30 EY14801, Karl R. Olsen, MD and Martha E. Hildebrandt PhD, an unrestricted grant from Research to Prevent Blindness, and the Henri and Flore Lesieur Foundation. William Lee, Cornelis Rowaan, and Eleut Hernandez provided technical support. Corresponding author: Corresponding Author: Jean-Marie Parel, PhD, Ophthalmic Biophysics Center, 1638 NW 10th Avenue, #117A, Miami, Florida, 33136, USA. Email: jmparel@med.miami.edu. Q 2018 ASCRS and ESCRS Published by Elsevier Inc. 0886-3350/$ - see frontmatter https://doi.org/10.1016/j.jcrs.2018.10.047 1