Patent Publication Number: US-2017360556-A1

Title: Intraocular lens inserter

Description:
RELATED APPLICATIONS 
     Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57. 
     The present application is a divisional of application Ser. No. 14/402,778, filed Jun. 4, 2013, and claims the benefit of U.S. Provisional Patent Application No. 61/655,255, filed Jun. 4, 2012, the entire contents of both being hereby incorporated by reference. 
    
    
     TECHNICAL FIELD 
     The inventions disclosed herein generally relate to devices and methods for inserting intraocular lens into an eye of an animal. 
     BACKGROUND 
     A cataract is a clouding that develops in the crystalline lens of the eye or m its envelope (lens capsule), varying in degree from slight to complete opacity and obstructing the passage of light. Early in the development of age-related cataract, the power of the lens may be increased, causing near-sightedness (myopia), and the gradual yellowing and opacification of the lens may reduce the perception of blue colors. Cataracts typically progress slowly to cause vision loss, and are potentially blinding if untreated. The condition usually affects both eyes, but almost always one eye is affected earlier than the other. The following is a list of different types of cataracts: 
     Senile cataract—Characterized by an initial opacity in the lens, subsequent swelling of the lens, and final shrinkage with complete loss of transparency occurring in the elderly. 
     Morgagnian cataract—Liquefied cataract cortex forming a milky white fluid, which can cause severe inflammation if the lens capsule ruptures and leaks, occurring as a progression of the cataract. Untreated, the advanced cataract can cause phacomorphic glaucoma. Very advanced cataracts with weak zonules are liable to dislocation anteriorly or posteriorly. 
     Cataract resulting from trauma—A cataract resulting from trauma to the eye in an otherwise healthy individual. Blunt trauma or penetrating trauma resulting from accidental injury to the eye can result in crystalline lens opacification. Retinal surgery involving a para plana vitrectomy will result in a post-operative cataract in six to nine months after the surgery. Infrequently, an adverse event can occur where by the otherwise healthy crystalline lens is touched by a surgical instrument during Retinal surgery. The crystalline lens clouds and a cataract forms within minutes of the contact. 
     Congenital cataract—A cataract developed in a child before or just after birth. 
     In the United States, age-related lenticular changes have been reported in 42% of those between the ages of 52 and 64, 60% of those between the ages 65 and 74, and 91% of those between the ages of 75 and 85. 
     Age-related cataract is responsible for 48% of world blindness, which represents about 18 million people, according to the World Health Organization. Continued population growth with the shift of the average age will result in increased numbers of patients with cataracts. The increase in ultraviolet radiation resulting from depletion of the ozone layer is expected to further increase the incidence of cataracts. 
     In many countries, surgical services are inadequate, and cataracts remain the leading cause of blindness. Cataracts are a large cause of low vision in both developed and developing countries. Even where surgical services are available, low vision associated with cataracts can remain prevalent, as a result of long waits for operations and barriers to surgical uptake, such as cost, lack of information and patient transportation problems. 
     Several factors can promote the formation of cataracts, including long-term exposure to ultraviolet light, exposure to ionizing radiation, secondary effects of diseases such as diabetes, hypertension and advanced age, or trauma (possibly much earlier); they are usually a result of denaturation of lens protein. Genetic factors are often a cause of congenital cataracts, and positive family history may also play a role in predisposing someone to cataracts at an earlier age, a phenomenon of “anticipation” in presenile cataracts. Cataracts may also be produced by eye injury or physical trauma. 
     A study among Icelandair pilots showed commercial airline pilots are three times more likely to develop cataracts than people with nonflying jobs. This is thought to be caused by excessive exposure at high altitudes to radiation coming from outer space, which becomes attenuated by atmospheric absorption at ground level. Supporting this theory is the report that 33 of the 36 Apollo astronauts involved in the nine Apollo missions to leave Earth orbit have developed early stage cataracts that have been shown to be caused by exposure to cosmic rays during their trips. At least 39 former astronauts have developed cataracts, of whom  36  were involved in high-radiation missions such as the Apollo missions. 
     Cataracts are also unusually common in persons exposed to infrared radiation, such as glassblowers, who suffer from exfoliation syndrome. Exposure to microwave radiation can cause cataracts. Atopic or allergic conditions are also known to quicken the progression of cataracts, especially in children. Cataracts can also be caused by iodine deficiency. Cataracts may be partial or complete, stationary or progressive, or hard or soft. Some drugs can induce cataract development, such as corticosteroids and the antipsychotic drug quetiapine (sold as Seroquel, Ketipinor, or Quepin). 
     The operation to remove cataracts can be performed at any stage of their development. There is no longer a reason to wait until a cataract is “ripe” before removing it. However, since all surgery involves some level of risk, it is usually worth waiting until there is some change in vision before removing the cataract. 
     The most effective and common treatment is to make an incision (capsulotomy) into the capsule of the cloudy lens to surgically remove it. Two types of eye surgery can be used to remove cataracts: extra-capsular cataract extraction (ECCE) and intra-capsular cataract extraction (ICCE). ECCE surgery consists of removing the lens, but leaving the majority of the lens capsule intact. High frequency sound waves (phacoemulsification) are sometimes used to break up the lens before extraction. ICCE surgery involves removing the lens and lens capsule, but it is rarely performed in modem practice. In either extra-capsular surgery or intra-capsular surgery, the cataractous lens is removed and replaced with an intraocular plastic lens (an intraocular lens implant) which stays in the eye permanently. The intraocular lens is placed into a cartridge and inserted through the small surgical incision. The inserter folds the intraocular lens and pushed it through a small needle. The end of the needle is positioned within the capsular bag. When the folded intraocular lens exits the end of the needle, it slowly unfolds as the surgeon manipulated the lens into its final position. Cataract operations are usually performed using a local anesthetic, and the patient is allowed to go home the same day. Until the early twenty-first century intraocular lenses were always monofocal; since then improvements in intraocular technology allow implanting a multifocal lens to create a visual environment in which patients are less dependent on glasses. Such multifocal lenses are mechanically flexible and can be controlled using the eye muscles used to control the natural lens. 
     Complications are possible after cataract surgery, including endophthalmitis, posterior capsular opacification and retinal detachment. 
     Laser surgery involves cutting away a small circle-shaped area of the lens capsule, enough to allow light to pass directly through the eye to the retina. There are, as always, some risks, but serious side effects are very rare. As of 2012 research into the use of extremely-short-pulse (femtosecond) lasers for cataract surgery was being carried out. High frequency ultrasound is currently the most common means to extract the cataract lens. 
     Cataract surgeries are conducted in an operating room under sterile conditions to prevent the risk of infection, particularly endophthalmitis; a rapid devastating infection that can cause blindness in a few days. The patient&#39;s eye is cleaned with an antiseptic, and then isolated with a sterile drape that fully covers the patient with only the eye exposed. A sterile field is established around the patient such that any personnel or instrumentation must be suitably scrubbed, draped or sterilized following standard aseptic procedures. 
     With reference to  FIGS. 1 and 2 , such a prior art type of cataract surgery includes using a surgical microscope to view the interior of the eye through a patient&#39;s cornea and iris. The surgeon typically makes two incisions  10 ,  12  in the patient&#39;s cornea, close to the limbus, to enable surgical instruments to gain access to the interior segment of the eye and to implant an intraocular lens after the cataract crystalline lens has been removed. For example, an intraocular lens inserter  14  can be inserted through the incision  10  and a positioning device  16  can be inserted through the incision  12 . 
     The surgery typically includes creating a full-circle tear in the center of the capsular bag on the interior side, called a “capsulorhexis,” and remove the tom circle of the capsule. Then, the cataract crystalline lens is removed using a phacoemulsifier, an ultrasonic infusing and aspirating instrument that breaks up the cataract and aspirates the fragments, removing the cataract. 
     The lingering cortical material that is attached to the inner surface of the capsular bag is then aspirated using an infusion/aspirating instrument. The intraocular lens  18  is then inserted using the lens inserter  14  and positioned within the capsular bag using the positioning device  16  or other devices. 
     The lens inserter  14  transfers the flat intraocular lens  18  through the small clear corneal incision  10  into the capsular opening (capsulorhexis) and to its final position within the capsular bag. The inserter  14  pushes the flat lens  18  through a cartridge which causes the lens to fold and pass through a tubular portion of the cartridge which is placed into the small incision  10 . As the lens  18  emerges out of the tubular end of the cartridge  14 , it slowly unfolds and returns to its original flat shape. 
     Recent advances in femtosecond laser instrumentation has automated the process of making entry incisions and the capsulorhexis as well as pre-cutting the cataract making the cataract surgical procedure more precise, safer, and easier for the surgeon to execute. 
     The majority of current lens inserters are manually operated re-usable instruments with primarily one of two means to push the lens: a lead screw or plunger. The lead screw approach provides consistent and smooth delivery of the lens, however slowly, and requires the surgeon or an assistant to turn the manual lead screw as the surgeon positions the tip of the instrument 
     The plunger approach does not require an assistant, as the surgeon uses their thumb to drive the lens forward, much like injecting a drug from a syringe. Additionally, the surgeon can more readily control the speed of delivery, swiftly moving though the less critical portions and slowing for the more delicate segments. A draw back of the plunger approach can emerge when the lens becomes stuck resulting in a more forceful push by the surgeon where upon clearance of the hang-up, the lens can over-shoot its exit and injure the patient. 
     Re-usable instrumentation requires re-processing (cleaning and sterilization) resulting in additional instrumentation overhead and increased risk of Toxic Anterior Segment Syndrome (TASS) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5625a2.htm. 
     Recently, efforts have been made to perform such lens replacement surgeries using smaller corneal incisions. For example, as shown schematically in the illustration of  FIG. 3 , typically, the distal end of an intraocular lens inserter  14  is inserted completely through the incision  10 , during a procedure of inserting an intraocular lens  18 . However, with reference to  FIG. 4 , recently surgeons have been adopting a “wound-assist” technique, wherein only a small portion of the tip  20  of the intraocular lens inserter  14  is inserted into the incision  10 , wherein the incision  10  is smaller than the incisions previously made, such as during the procedure illustrated in  FIG. 3 . As such, the intraocular lens  18 , in its folded state, is pushed through and slides along interior surfaces of the incision  10 . This allows the incision  10  to be smaller and the wound itself (incision  10 ) becomes a lumen for inserting the lens  18  into the eye. 
     During such a procedure, the surgeon can use the distal end  20  of the tip of the intraocular inserter  14  to help hold the incision  10  open. For example, the surgeon might apply a lateral force in the direction of arrow  22  in order to hold the incision  10  open such that the lens  18  can be pushed therethrough. 
     SUMMARY OF THE INVENTION 
     An aspect of at least one of the inventions disclosed herein includes the realization that an intraocular lens inserter design can allow a surgeon to actuate and thus discharge a lens from an inserter device with one hand can provide a surgeon and can also reduce the manual force that must be applied by the surgeon. For example, in some known conventional devices, such as plunger devices, a surgeon must use significant manual force against the proximal end of the plunger to push the lens through the end of the inserter device. This makes it more difficult for the surgeon to hold the device in the desired orientation and location during insertion. This problem is more significant in the surgical procedures more recently adopted such as that described above with reference to  FIG. 4 . Thus, an intraocular lens insertion device that provides assisted discharge force can help a surgeon perform the surgical procedure as desired. 
     Another aspect of at least one of the inventions disclosed herein includes the realization that significant costs for such devices can be reduced by the use of an inserted device having an incorporated mechanism for storing energy for providing a discharge force, which is not connected by a tether, for example, to a separate console. For example, some known types of surgical devices include electrical motors or pneumatic systems that are operated by standalone consoles that provide either electrical power to an electric motor or compressed air to a compressed air motor inside a handpiece of a surgical device. Such systems require the surgeons to purchase or rent the console devices for use with such specialized surgical tools. 
     Thus, by providing an intraocular lens inserter with energy storage for providing a discharge force, the intraocular lens inserter is more portable and avoids the requirement for a surgeon to purchase or rent a separate standalone console. 
     Another aspect of at least one of the inventions disclosed herein includes the realization that compressible energy storage devices, such as springs, or compressed air, can provide convenient and portable means for storage of energy which can be output as forces. However, such energy storage devices are more difficult to control for providing, for example, constant velocity output. Thus, an aspect of at least one of the inventions disclosed herein includes the realization that providing an actuating circuit operating with a substantially incompressible fluid, such as a liquid, accommodates the use of mechanisms that can provide more fine control over the velocity of downstream components, even where energy is supplied by a compressible storage device, such as springs or compressed air. 
     Another aspect of at least one of the inventions disclosed herein includes the realization that a hand-held intraocular lens inserter can be made with an incorporated energy storage device and a movement control actuator, with sufficient simplicity that the resulting device can be designed as a single use device and thus disposable, thereby avoiding the costs of resterilization and the potential for cross-contamination. Thus, for example, an intraocular lens inserter device can include a compressible energy storage device and an actuator configured to operate with a substantially incompressible fluid for controlling the release of the energy stored by the energy storage device and the movement of downstream components, such as a lens insertion rod. 
     This summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       A more complete understanding of the subject matter may be derived by referring to the Detailed Description and claims when considered in conjunction with the following figures, wherein like reference numerals refer to similar elements throughout the figures. 
         FIG. 1  is an enlarged sectional view of a human eye with an intraocular lens inserter inserted through an incision in the cornea and a positioning device inserted through a second incision, with an intraocular replacement lens shown as being partially ejected from the intraocular lens inserter. 
         FIG. 2  is a front plan view of the procedure illustrated in  FIG. 1 . 
         FIG. 3  is a schematic diagram of a portion of the arrangement shown in  FIG. 1 , with the distal tip of an intraocular lens inserter inserted completely through an incision and discharging a replacement lens. 
         FIG. 4  is a schematic illustration of a different procedure than that illustrated in  FIG. 3 , in which the distal tip of the intraocular lens inserter is inserted only partially into the incision. 
         FIG. 5  is a schematic illustration of an embodiment of an intraocular lens inserter. 
         FIG. 6  is a perspective view of a further embodiment of an intraocular lens inserter. 
         FIG. 7  is a side elevational and cross-sectional view of the intraocular lens inserter of  FIG. 6 . 
         FIG. 8  is a side elevational and cross-sectional view of a portion of a housing member of the intraocular lens inserter of  FIG. 7 . 
         FIG. 9  is an enlarged sectional view of an energy storage portion of the lens inserter of  FIG. 6  and in a partially exploded view; 
         FIG. 10  is also a cross-sectional view of lens inserter of  FIG. 6  showing an energy storage device being pierced by a piercing device and within end caps screwed down over the energy storage device. 
         FIG. 11  is a cross-sectional view of the inserter of  FIG. 6  showing movement of a piston after an expanding gas has been discharged from the energy storage device. 
         FIG. 12  is an enlarged sectional view of an actuator portion of the inserter of  FIG. 6 . 
         FIG. 13  is an exploded view of a lens cartridge holder portion of the inserter of  FIG. 6 . 
         FIG. 14  is an enlarged perspective and exploded view of the inserter shown in  FIG. 13 . 
         FIG. 15  is an enlarged side elevational view of a lens cartridge removed from the lens cartridge holding portion. 
         FIG. 16  is a view of the inserter of  FIG. 15  with the lens cartridge inserted into the lens cartridge holder portion. 
         FIG. 17  is a partial cross-sectional view of the inserter of  FIG. 16  prior to the lens cartridge being engaged with a plunger. 
         FIG. 18  is a cross-sectional view of the inserter shown after the lens holder portion has been moved axially to engage the plunger with the lens cartridge. 
         FIG. 19  is an illustration of a further embodiment of the inserter in  FIG. 6 , in which the energy storage device is in the form of a spring. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     The following detailed description is merely illustrative in nature and is not intended to limit the embodiments of the subject matter or the application and uses of such embodiments. As used herein, the word “exemplary” means “serving as an example, instance, or illustration.” Any implementation described herein as exemplary is not necessarily to be construed as preferred or advantageous over other implementations. Furthermore, there is no intention to be bound by any expressed or implied theory presented in the proceeding technical field, background, brief summary, or the following detailed description. 
     Certain terminology may be used in the following description for the purpose of reference only, and thus are not intended to be limiting. For example, terms such as “upper”, “lower”, “above”, and “below” refer to directions in the drawings to which reference is made. Terms such as “proximal”, “distal”, “front”, “back”, “rear”, and “side” describe the orientation and/or location of portions of the component within a consistent but arbitrary frame of reference which is made clear by reference to the text and the associated drawings describing the component under discussion. Such terminology may include the words specifically mentioned above, derivatives thereof, and words of similar import. Similarly, the terms “first”, “second”, and other such numerical terms referring to structures do not imply a sequence or order unless clearly indicated by the context. 
     The inventions disclosed herein are described in the context of intraocular lens inserters for the treatment of cataracts. However, the inventions disclosed herein can be used in other context as well with regard to surgical devices that are required to discharge devices, for example, into or beyond the tissues of an animal, such as a human. 
     With reference to  FIG. 5 , an intraocular lens inserter  100  can include an energy storage device  102 , an actuator device  104 , and a lens discharge portion  106 . The energy storage portion  102  can be in the form of any type of energy storage device. In some embodiments, the energy storage portion  102  is in the form of a device for storing a compressible fluid, mechanical springs, or other compressible types of energy storage devices. Other types of energy storage devices can also be used. 
     In some embodiments, the energy storage portion  102  can be configured to discharge mechanical energy from the energy stored therein. For example, where the energy storage device  102  is in the form of a compressed gas container, the energy storage device  102  can discharge such compressed gas which therefore provides an output of mechanical energy. Similarly, where the storage device  102  is in the form of a mechanical spring, such a spring can output linear or torsional movement, which is also a form of mechanical energy. 
     The actuator portion  104  can be any type of actuator configured to provide controllable actuation of the output of mechanical energy from the energy storage portion  102 . For example, in some embodiments, the actuator portion  104  can be in the form of a mechanical or electronic button or lever for providing a user with means for controlling the output of mechanical energy from the energy storage portion  102 . For example, the actuator  104  can be in the form of a button or other electronic devices configured to provide variable resistance or movement associated with a mechanical member used for outputting the energy from˜the energy storage portion  102 . The actuator portion  104  can also provide for the control of an output member configured for interaction with the intraocular lens portion  106 . For example, the actuator portion  104  can include an output plunger or other device for interacting with the intraocular lens portion. 
     The intraocular lens portion  106  can be configured to interact with or retain an intraocular lens cartridge which is widely commercially available from several different sources. For example, the intraocular lens portion  106  can be configured to releasably engage with an intraocular lens cartridge commercially available as a Monarch available from Alcon. The intraocular lens portion  106  can also be configured to move between an open position configured for allowing an intraocular lens cartridge to be engaged with the lens portion  106  and a closed portion in which the lens portion  106  engages with the lens cartridge. 
     As such, in operation, the actuator portion  104  can be manipulated by a user, such as a surgeon, to control the output of mechanical energy from the energy storage portion  102 , to thereby control the discharge of a lens from a lens cartridge retained by the lens portion  106 . Further, the inserter  100  can be configured to be hand-held, and in some embodiments, disposable. 
     With reference to  FIGS. 6-18 , a further embodiment of the lens inserter  100  is illustrated there and identified by the reference number  100 A. The features and components of the lens inserter  100 A that can be the same or similar to corresponding components of the lens inserter  100  have been identified with the same reference numeral, except that the letter “A” has been added thereto. 
     With reference to  FIGS. 6-8 , the intraocular lens inserter  100 A also includes an energy storage portion  102 A, an actuator portion  104 A, and a lens portion  106 A. 
     In the illustrated embodiment, with reference to  FIG. 8 , the inserter  100 A includes a main body portion  200  which includes various cavities, recesses, and conduits, and, in the present embodiment, provides for communication between the energy storage portion  102 A and the actuator portion  104 A.  FIG. 8  illustrates the body portion  200  with all other components removed therefrom. In some embodiments, optionally, the body portion  200  can be made from a single piece of material forming a monolithic body. However, other configurations can also be used. 
     In some embodiments, the body portion  200  includes an energy storage receiving portion  202 . In some embodiments, the receiving portion  202  is configured as a recess within the body  200 , sized and configured to receive a container of compressed gas. In some embodiments, the recess  202  can be sized to receive a canister of compressed carbon dioxide  204 . Such containers of compressed gas and, in particular, carbon dioxide, are widely commercially available. 
     The housing  200  can also include a piston chamber  206  configured to receive gas discharged from the container  204 . The piston chamber  206  can include devices for interacting with the gas from the container  204  for providing usable mechanical energy. For example, as shown in  FIG. 7 , a piston  208  can be disposed in the piston chamber portion  206 . In some embodiments, the piston  208  subdivides the piston chamber portion  206  into a gas-receiving portion and a liquid-receiving portion  210 . 
     The housing  200  can also include a conduit  212  connecting the energy storage portion  102 A with the actuator portion  104 A. For example, the conduit  212  can provide a flow path between the liquid receiving portion  210 , along the direction of arrow  216 , into the actuator portion  104 A. 
     The conduit  212  can include an aperture in a portion of the liquid receiving portion  210 , that leads into an actuator control portion  214 , then to a lateral connector portion  218 , into a further liquid-receiving portion  220  of the actuator portion  104 A. 
     The actuator receiving portion  214  can be configured to receive an actuator for controlling the flow of fluid along the conduit  212 . Additionally, the chamber  220  can be configured to receive a piston  222 , described in greater detail below. 
     With continued reference to  FIG. 8 , the body  200  can also include an actuator mounting portion  230 . The actuator mounting portion  230  can be in the form of a projection  232  extending radially outwardly from the longitudinal axis L of the body  200 . The projection  232  can include an aperture  234  and could be configured to receive an actuator rod  236  ( FIG. 7 ). 
     The body  200  can also include various other outer surfaces and devices for engagement with a sliding cartridge engagement member  240  ( FIG. 6 ), described in greater detail below. For example, the outer surface  242  of the actuator portion  104 A of the body  200  can include various engagement devices  246 ,  248 , and/or other ridges for providing alignment and engagement with the engagement device  240 . Such features are described in greater detail below with reference to  FIG. 14 . 
     With reference to  FIGS. 9-11 , the storage portion  102 A is illustrated in further detail, including various components that can be included within the body member  200 . The distal end  250  of the body member  200  can include internal threads  252  configured for engagement with external threads  254  disposed on a removable end cap  256 . Additionally, the energy storage portion  102 A can include a bulkhead member  260 . The bulkhead member  260  can be configured to provide for secure engagement with a chosen energy storage device used with the energy storage portion  102 A. As noted above, the illustrated embodiment is designed for use with a cartridge of compressed carbon dioxide  204 . Thus, in the illustrated embodiment, the bulkhead member  260  includes an upstream end  262  configured for abutting engagement with a distal end  205  of the cartridge  204 . The bulkhead member  260  can also include a sealing device, such as an O-ring  264 , for providing a sealing engagement with an inner surface of the piston chamber  206 . In the illustrated embodiment, the bulkhead member  260  remains stationary during operation. Thus, the inserter  100 A also includes a set screw  266  which extends through the body portion  200  for secure engagement with the bulkhead member  260 . Other designs can also be used. 
     The energy storage portion  102 A can also include an accumulator piston  280 . In the illustrated embodiment, the accumulator piston  280  is slidably engaged with two surfaces. Firstly, the accumulator piston  280  includes a first portion  282  engaged with an inner surface of the bulkhead member  260  and a downstream portion  284  engaged with an inner surface of the piston chamber  206 . Additionally, in the illustrated embodiment, the piston  280  includes a piercing needle  286  which is configured to pierce a seal that is commonly used on compressed gas cartridges, such as the carbon dioxide compressed gas cartridge  204 . 
     The piston  280  is configured to move slidably along the longitudinal axis L of the inserter  100 A. As such, the piston  280  includes an O-ring  288  for sealing against the inner surface of the bulkhead  260  and a second O-ring  290  for providing a sliding seal with the inner surface of the piston chamber  206 . 
     In some embodiments, the O-ring seal  288  can be configured to maintain all of the gas discharged from the cartridge  204  in the area  292  disposed between the piston  280  and the cartridge  204 . Additionally, the piston chamber  206  can be configured to receive a substantially incompressible fluid, such as a liquid, including but not limited to, silicone oil, propylene glycol, glycerin, saline, water, or other substantially incompressible fluids. For purposes of illustration, the piston  280  and the downstream or distal portion of the piston chamber  206  can be considered as a substantially incompressible fluid-receiving chamber  300 . Thus, in some embodiments, the O-ring  290  is configured to maintain any liquid or fluid in the chamber  300  in the distal portion of the chamber  206 . 
     During operation, when the cap  256  is screwed into the threads  252 , the cartridge  204  is thereby pushed into the piercing needle  286 , thereby opening the cartridge  204  and releasing the compressed gas therein into the space between the cartridge  204  and the bulkhead  260  and the distal proximal end portion  282  of the piston  280 . 
     With reference to  FIG. 11 , when the actuator portion  104 A is operated appropriately, the pressurized gas from the cartridge  204  continues to expand into the gas receiving portion  292 , thereby pressurizing any fluid or liquid in the substantially incompressible fluid receiving portion  301 . Actuation of the actuator portion  104 A allows the pressurized fluid in the chamber  301  to flow outwardly therefrom and into the chamber  220  to thereby drive the piston  222  longitudinally in the direction of arrow R ( FIG. 11 ), described in greater detail below. 
     With continued reference to  FIG. 12 , the actuator portion  104 A can include an actuator member  300  mounted relative to the housing member  200  so as to be movable between an unactuated position (illustrated in  FIG. 12 ) and an actuated position (not shown). For example, the lever member  300  can be attached to the housing  200  with the hinge member (not shown), such that the actuator member can be pivotable along the arc  302 . The actuator member  300  can also be engaged with the rod  236  which can be configured to provide a flow control function for controlling the flow of substantially noncompressible fluid from the chamber  300  toward the chamber  220  for moving the piston  222 . For example, the piston rod  236  can include a distal end  240  which extends through the aperture  234  of the projection  232  and a proximal end  320  configured to provide a flow control function. 
     The distal end  240  of the rod  236  can include a slot for engagement with a screwdriver to provide adjustment of the positioning of the rod  236 . For example, the lever member  300  can also include an engagement member  310  pivotally mounted to the lever member  300 . The engagement member  310  can include a threaded portion  312  configured for engagement with external threads on the distal portion  240  of the rod  236 . Additionally, a spring  314  can provide a bias of the lever member  300  to the unactuated position. Connected as such, when the lever mover  300  is moved through the arc  302 , and more particularly, when the lever member  300  is moved downwardly from the position illustrated in  FIG. 12 , the engagement member pulls the rod  236  in a distal direction D, thereby moving the flow control portion  320  in the direction of arrow D. The spring  314  provides a bias return action for returning the lever member  300  to the position illustrated in  FIG. 12 , when released by a user. 
     With continued reference to  FIG. 12 , the proximal portion  320  of the rod  236  can include a piston member  322  and seal, in the form of an O-ring  324 . The proximal portion  320  can also include a needle portion  326  configured to cooperate with a throat portion  328 . Using well known techniques, the engagement and cooperation of the needle portion  326  with the throat portion  328  can be used to control a flow of substantially incompressible fluid along the conduit  212 . For example, when the lever  300  is moved downwardly from the position illustrated in  FIG. 12 , the piston rod is moved distally in the direction D, thereby moving the needle portion  326  also in the direction of arrow D, thereby forming or increasing a gap between the needle portion  326  and the throat portion  328 . As such, fluid flows through the conduit  212 , for example, a substantially incompressible fluid pressurized by the piston  208  due to interaction with gas discharged from the cartridge  204  can thereby flow through the conduit  212  toward the piston  222 . 
     When the substantially incompressible fluid presses against the piston  222 , the piston  222  also moves in the direction of arrow D. This movement of the piston  222  can be used to discharge a lens from the cartridge  400 . More specifically, as illustrated in  FIGS. 12 and 13 , a plunger  402  can be attached to a distal end of the piston  222 . Thus, as the piston  222  is moved by the flow of fluid through the conduit  212 , the plunger  402  is also moved in the direction of arrow D. This movement of the plunger  402  can be used to discharge a lens disposed within the cartridge  400 , in a technique that is well known in the art. 
     With reference to  FIGS. 13 and 14 , the cartridge engagement member  240  can include a cartridge receiving portion  430 . For example, the cartridge receiving portion  430  can include a distal wing engagement portion  432  and a body receiving portion  434 . The wing receiving portion  432  and the body receiving portion  434  can be sized in accordance with the outer dimensions of commercially available lens cartridges  400 , which are well known in the art. 
     The distal wing receiving portion  432  can include a recess designed to engage the wings  436  of the lens cartridge  400 . Thus, when the cartridge  400  is engaged with the cartridge receiving portion  430 , as shown in  FIG. 6 , the cartridge  400  is generally aligned with the plunger  402 . 
     With continued reference to  FIGS. 15 and 16 , the cartridge receiving portion  430  can optionally include a proximal engaging portion  440  configured to engage with a proximal portion of the cartridge  400 . For example, in some commercial embodiments of the cartridge  400 , the cartridge  400  includes rearward wings  442  or other rearward surfaces. The cartridge engagement portion  430 , therefore, can include an additional proximal recess  444  and an engagement device  446 , for a positive engagement with the wings  442 . Thus, as shown in  FIG. 16 , when the cartridge  400  is engaged both with the forward engagement portion  432  and the rearward engagement portion  444 , with the projection  446  extending over the rearward wings  442 , the cartridge  400  is more securely seated within the cartridge receiving portion  430 . 
     This can provide a substantial benefit to a surgeon using the inserter  100 A. For example, with the projection  446  extending over the rearward wing  442 , if the surgeon applies a force to the inserter  100 A, in the direction of arrow F ( FIG. 16 ), a torque T can be created or imparted onto the cartridge  400 , thereby tending to cause the cartridge to pivot about the distal receiving portion  432 , which can thereby tend to cause the proximal end of the cartridge  400  to lift upwardly in the direction of arrow U. However, the engagement portion  446  can help retain the proximal portion of the cartridge  400  within the receiving portion  430 . This type of force can be created during execution of surgical procedures that are becoming more common, such as that described above with reference to  FIG. 4 , known as the “wound-assist” technique. 
     With continued reference to  FIGS. 14-18 , the member  240  can also be slidably engaged with the body  200 . Thus, the member  240  can include various internal surfaces configured to cooperate with outer surfaces of the body  200 . Thus, the member  240  can be slid longitudinally along the body  200 , parallel to the longitudinal axis L of the inserter  100 A. 
     For example, with reference to  FIGS. 17 and 18 , the portion  240  can be moved to a distal position, show in  FIG. 17 . In this position, the lens receiving portion  430  is spaced apart from the plunger  402 . As such, the cartridge  400  can be inserted into the cartridge receiving portion  430  without interference of the plunger  402 . Thus, after the cartridge is received as such, as shown in  FIG. 18 , the portion  240  can be slid backwards relative to the body  200  until the plunger  402  engages or presses against a lens within the cartridge  400 . 
     As noted above, the body  200  can include various detents or ramps or other portions  246 ,  248  which can engage with a portion of the member  240  for providing positive engagement into various positions. For example, the portion  240  can include a ramp and hook portion  460  configured to engage with the portion  246  and portion  248  of the housing member  200 . Thus, the member  240  can be positively engaged in the position illustrated in  FIG. 17  with the body member  200 , and then when pulled in the proximal direction, so as to move the plunger  402  into the cartridge  400 , the portion  460  can engage with the proximal portion of the housing  200  to thereby engage into a retracted position. Other designs can also be used to provide for the convenient insertion and removal of the cartridge  400 . 
     With reference to  FIG. 19 , a further embodiment of the inserter  100 A is illustrated therein and identified generally by the reference numeral  100 B. The components of the inserter  100 B that can be the same or similar to the inserter  100 A are identified with the same reference numerals, except that a letter “B” has been added thereto. 
     With continued reference to  FIG. 19 , the energy storage portion  102 B can be configured to use a compressive energy storage function of a coiled spring  500 . The coiled spring can include a distal end  502  engaged with a piston  504  and a proximal end  506  held in place with a removable cap  256 B. The piston  504  can be configured to form a seal, for example, with an O-ring  506 , so as to operatively contain a substantially incompressible fluid in the chamber  202 B. The remaining portions of the inserter  100 B can be constructed in accordance with the description of the inserter  100 A above. 
     While at least one exemplary embodiment has been presented in the foregoing detailed description, it should be appreciated that a vast number of variations exist. It should also be appreciated that the exemplary embodiment or embodiments described herein are not intended to limit the scope, applicability, or configuration of the claimed subject matter in any way. Rather, the foregoing detailed description will provide those skilled in the art with a convenient road map for implementing the described embodiment or embodiments. It should be understood that various changes can be made in the function and arrangement of elements without departing from the scope defined by the claims, which includes known equivalents and foreseeable equivalents at the time of filing this patent application.