Supplementary Material for: Evaluation of nozzle tip damage in intraocular lens injectors with V-shaped notch

Introduction Damage to the nozzle tips of IOL injectors has been associated with various adverse events and even IOL surface abnormalities after IOL implantation. In this study, nozzle tip damage of three different injector models with v-notched nozzle tips were systematically evaluated using our self-developed system - the Heidelberg Score for IOL Injector Damage. Methods Nozzle tip damage was categorized into 6 grades: no damage (grade 0), slight scratches (1), deep scratches (2), extensions (3), cracks (4) and bursts (5). Each grade was assigned to a score from 0-5. In each IOL injector group, all IOLs were divided into 2 subgroups based on IOL power: +15 to +21D group and +21 to +26D group. The total scores for each group were the sum of scores for all injectors in this group. Further analysis was performed on the nozzle tip configuration and parameters in each injector model. Results The median (Q1-Q3) for each injector group in group +15-+21D was: 1.5 (1-2) for Avansee, 4 (3-4) for iSert, and 4 (3-4) for multiSert. A statistically significant difference was found between Avansee and iSert (P < 0.001) as well as between Avansee and multiSert (P < 0.01) in terms of median scores. The median (Q1-Q3) for each injector group in group +21-+26D was: 1.5 (1-2) for Avansee, 4 (4-4) for iSert, and 3 (3-3.75) for multiSert. A statistically significant difference was found between Avansee and iSert in terms of median scores (P < 0.001). The outer cross-sectional diameters were 1.80 and 1.78 mm for Avansee, 1.70 and 1.69 mm for iSert, and 1.69 and 1.68 mm for multiSert. The radii of each notch-based circle were 0.21 mm (Avansee), 0.09 (iSert), and 0.06 (multiSert), respectively. The tip angles for three injector models were: 48° (Avansee), 46° (iSert), and 37° (multiSert). Conclusions Avansee showed the least nozzle tip damage of all three groups. Compared with our earlier study using preloaded injectors with intact endpieces, all the injector groups with v-notch nozzle tips had more damage to the nozzle tip. It was found that the closer the notch of the nozzle tip was to the letter "V", the more damaged the nozzle tip was after IOL implantation.