In vivo and in vitro results of an automated preloaded delivery system for IOL implantation in cataract surgery

Purpose To compare the corneal tissue trauma after the use of an automated preloaded injector and a manual injector and assess scanning electron microscope (SEM) and atomic force microscope (AFM) features of both injector cartridges. Setting Ophthalmology Clinic and Laboratory of Stem Cells and Regenerative Medicine University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy; Design Prospective randomized clinical study Methods Forty eyes of 40 patients for phacoemulsification were divided into two groups: implantation of intraocular lens was performed with AutonoMe automated delivery system (AutonoMe group: 20 eyes) and Monarch III injector system (Monarch group: 20 eyes). In vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) were performed before surgery, at 1 h, 1 day and 1 month post-operatively. In addition, SEM and AFM were performed on cartridges of both injector systems after injection of the IOL. Results A greater increase in central corneal thickness and corneal thickness at the incision site were observed in Monarch group versus AutonoMe group 1 h and 1 day post-operatively ( p < 0.05). Endothelial cell count loss was significantly higher in Monarch group compared with AutonoMe group ( p < 0.05) at 1 and 24 h. AS-OCT showed less endothelial misalignment at 30 days ( p < 0.05), and IVCM showed less tunnel inflammation at all time points ( p < 0.05) in AutonoMe group compared with Monarch group; roughness analysis at AFM of the AutonoMe cartridge was significantly lower compared to Monarch D cartridge ( p < 0.05). Conclusions The AutonoMe injector provided less corneal tissue trauma compared with Monarch III injector. The AutonoMe cartridge showed lower roughness at AFM compared to the Monarch D cartridge.