Practice Profiles in Pre-Loaded IOL Delivery

Practice Profiles in Pre-Loaded IOL Delivery

This activity is produced by SLACK Incorporated and sponsored by Alcon Laboratories, Inc. Participating physicians are paid consultants of Alcon Laboratories, Inc.

Surgical Efficiency and Technical Pearls in the Operating Room

Edward J. Holland, MD
Director of Cornea Services
Cincinnati Eye Institute
Professor of Ophthalmology
University of Cincinnati
Cincinnati, OH

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The UltraSert™ pre-loaded IOL delivery system (Alcon) has helped me improve efficiency in the operating room with consistent folding and delivery1 of the IOL implant. While I follow the directions for using the UltraSert to deliver the AcrySof® IQ® aspheric IOL (Alcon), to help ensure a perfect fold every time, I make sure to include a 2- to 3-second pause while advancing the IOL for implant just as the leading haptic begins to move. This helps me stop my normal tendency to press too hard on the plunger which can cause the leading haptic to exit on a vertical versus in a folded position.

Additional Insights

Edward J. Holland, MD discusses his clinical experience with the UltraSert pre-loaded IOL delivery system.

Improved surgical efficiency

My operative times improve with a pre-loaded device such as the UltraSert because very little time is required for the surgeon, nurse or technician to load the IOL. The device also lessens the need for a scrub nurse to fold the IOL, which adds a step and time to the procedure. In my experience, proper loading and folding of a IOL into a manual delivery system can be a challenging task with a steep learning curve for nurses and techs, particularly those who do not handle a high volume of IOL implantations.

Surgical Pearls: My technique for consistent IOL folding and delivery

The UltraSert’s plunger tip is designed for smooth advancement2 and to ensure that the trailing haptic remains tucked throughout IOL insertion.1 When fully advanced, the tip extends 6.5 mm past the nozzle, and is designed so that the IOL will not adhere to the tip. In my experience, this results in consistent and reliable placement into the capsular bag.1

Over the time that I have been using the UltraSert, I have developed a surgical technique that enables me to achieve perfect folding more than 90% of the time. First, I follow the directions in the DFU for loading the OVD into the cartridge and advancing the IOL to the “first position” for inspection to ensure that the IOL is folded.3 When ready for implantation, I slowly move the plunger advancing the IOL until the trailing haptic touches the optic, then I watch the leading haptic for initial movement. As soon as the leading haptic moves, I pause for approximately 2 to 3 seconds. This pause allows some viscoelastic to exit the opening at the top of the cartridge, which provides space to allow the leading haptic to fold properly.3 Compressing the optic too rapidly (pushing down on the plunger too hard or too fast) may cause viscoelastic to move forward too quickly because the cartridge is filled, pushing the leading haptic forward before a proper fold has been achieved, and possibly even damaging the lens.3 In my view, understanding the dynamics of the viscoelastic within the cartridge is key to ensuring a proper fold.

I most effectively use my “pausing technique” under the microscope so I can pay close attention to the leading haptic as opposed to relying on a surgical technician to achieve the fold. In my opinion, it is the surgeon who best understands the dynamics of the IOL and the viscoelastic within the cartridge, and the small amount of time needed upfront who will save time later in the eye by ensuring a perfect fold nearly every time.

Surgical Pearl – A two-handed technique

I prefer a two-handed surgical technique with the UltraSert. I engage the UltraSert into the wound, then use a cyclodialysis spatula through the paracentesis while slowly inserting the IOL to ensure delivery into the capsular bag. The second instrument is usually not needed but in my view, it offers me added security in case the IOL moves slightly anteriorly or is displaced sideways and needs guiding. On that rare occasion, I rotate my hand to the right about 20° to 30°, then touch the optic slightly or move the leading haptic with the cyclodialysis spatula as it exits, allowing the haptic to move away from the posterior capsule and leading it more parallel with the capsular bag and into the proper position.

If other surgeons are like me, they will adapt quickly to using the UltraSert and will not want to return to using any other delivery system for the AcrySof IQ aspheric IOLs.


UltraSert™ Pre-loaded IOL Delivery System with the AcrySof® IQ aspheric IOL
Model # AU00T0


Federal (USA) law restricts this device to the sale by or on the order of a physician.


The AcrySof® IQ aspheric intraocular lens (“AcrySof IQ”) is intended for the replacement of the human lens to achieve visual correction of aphakia in adult patients following cataract surgery. This lens is intended for placement in the capsular bag.


Use the UltraSert® Pre-loaded Delivery System (“UltraSert”) at temperatures between 18°C (64°F) and 23°C (73°F). Use only Alcon viscoelastic qualified for this device. Do not use the UltraSert if the nozzle appears damaged or deformed. Follow the Directions for Use for correct order and sequence of steps to avoid damage to the IOL or the UltraSert.

Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use. Caution should be used prior to lens encapsulation to avoid lens decentrations or dislocations.

Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45°C.


Reference the Directions for Use for Model AU00T0 for a complete listing of indications, warnings and precautions.

  1. Alcon Laboratories, Data on File. Comparative in vitro assessment of IOL delivery systems (May, 2015).
  2. Alcon Laboratories, Data on File. UltraSert delivery system human factor testing (February, 2015).
  3. AcrySof IQ aspheric IOL with the UltraSert pre-loaded delivery system Directions for Use.

® 2016 Novartis    6/16   US-ULS-16-E-0598o

Surgical Efficiency and Technical Pearls in the Operating Room

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