Cartridge cracks during foldable intraocular lens insertion

J Cataract Refract Surg. 1998 Sep;24(9):1220-2. doi: 10.1016/s0886-3350(98)80015-1.


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.

MeSH terms

  • Chondroitin Sulfates
  • Humans
  • Hyaluronic Acid
  • Incidence
  • Intraoperative Complications*
  • Lens Implantation, Intraocular / adverse effects*
  • Lens Implantation, Intraocular / instrumentation*
  • Lenses, Intraocular*
  • Phacoemulsification
  • Silicone Elastomers*


  • Silicone Elastomers
  • Hyaluronic Acid
  • Chondroitin Sulfates