Cartridge cracks during foldable intraocular lens insertion

PURPOSE: To assess the incidence of cartridge cracks during foldable intraocular lens (IOL) insertion and to determine factors that play a role in the development of these cracks. SETTING: Leesburg Regional Ambulatory Surgical Care Center, Leesburg, Florida, USA. METHODS: Small incision cataract surgery was performed in 350 consecutive cases. A foldable silicone IOL (Allergan Medical Optics SI-40) was inserted in all cases using the Unfolder cartridge and 3 viscoelastic agents: sodium hyaluronate (Healon, Vitrax) and sodium chondroitin sulfate-sodium hyaluronate (Viscoat). RESULTS: Cartridge cracks occurred in 52 eyes (14.86%). Almost all cracks (98.1%) occurred in cases in which Healon was used to load the IOL. In each case of a cracked cartridge, there was evidence of the plunger overriding the optic edge. CONCLUSIONS: We recommend the use of chondroitin-based viscoelastic agents to load the SI-40 foldable IOL to minimize the risk of cartridge cracks. Modifications in the design of the IOL inserter may eliminate the problem of cartridge cracks.