Acrylic intraocular lens damage after folding using a forceps insertion technique

Purpose: To analyze intraocular lens (IOL) surface abnormalities seen after folding using a forceps insertion technique. Setting: Mayo Clinic, Rochester, Minnesota, USA. Methods: Acrylic AcrySof MA60AC IOLs were examined using an Axio Imager microscope before and after they were folded using a forceps insertion technique. Differential interference contrast, brightfield reflected light, and darkfield reflected light imaging techniques were used as necessary. The effects of temperature, time, and ophthalmic viscosurgical device (OVD) on optic surface abnormalities after folding were studied. Results: All 17 IOLs examined had smooth, defect-free optic surfaces before folding. After folding, anterior optic surface depressions were observed in all IOLs; the depressions corresponded to the contact area of the titanium insertion forceps. Surface depressions were present up to 72 hours after folding, were more pronounced when an insertion forceps with a high degree of wear was used, and were greater when the IOL was warmed to 98°F before folding. Coating the IOL surface with OVD before grasping it with the insertion forceps prevented formation of depressions. Conclusions: The anterior optic surface of the acrylic IOL was vulnerable to forceps-induced surface depressions. Surface abnormalities were prevented by coating the anterior optic surface with OVD before grasping it with a metal insertion forceps. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.