Accommodating intraocular lens

Intraocular lens that fits

Technical field

This invention relates generally to intraocular lenses and more particularly to new intraocular lenses that are accommodated to implant within the capsular bag of a human eye from which the natural lens matrix has been removed by an extraction procedure that leaves intact within the eye the posterior capsule and a remnant of the anterior capsule of the natural lens. The invention also relates to a new method of using intraocular lenses in a human eye to provide the patient with an accommodation capacity sensitive to the action of the normal ciliary muscle.

Prior art

The human eye has an anterior chamber between the cornea and the iris, a posterior chamber behind the iris that contains a crystalline lens, a vitreous chamber behind the lens that contains vitreous humor, and a retina at the back of the vitreous chamber. The crystalline lens of a normal human eye has a lens capsule attached around its periphery to the ciliary muscle of the eye by zonules and contains a crystalline lens matrix. This lens capsule has walls similar to optically transparent anterior and posterior membranes commonly referred to by the anterior and posterior capsule ophthalmologists, respectively. Between the iris and the ciliary muscle there is a space similar to an annular fissure called the ciliary groove.

The human eye has a capacity for natural accommodation. Natural accommodation involves relaxation and strangulation of the ciliary muscle by the brain to provide the eye with near and far vision. This action of the ciliary muscle is automatic and forms the natural crystalline lens in the appropriate optical configuration to focus on the retina the rays of light entering the eye from the scene being viewed.

The human eye is subject to a variety of disorders that completely degrade or destroy the eye's ability to function properly. One of the most common of these disorders involves the progressive clouding of the natural crystalline lens producing the formation of what is called a cataract. It is currently a common practice to cure a cataract by surgically removing the human crystalline lens with cataracts and implanting an artificial intraocular lens in the eye to replace the natural lens. The prior art is replete with a wide assortment of intraocular lenses for this purpose.

Intraocular lenses differ widely in their physical appearance and disposition. The invention relates to intraocular lenses of the type that have a central or optical optical region and haptics that extend outwardly from the optician and that engage inside the eye in such a way as to support the optician on the axis of the eye. US Patent No. 5,047,051 describes an intraocular lens that has a haptic anchor plate, an optic in the longitudinal center of the plate, and elastic haptic loops placed at the ends of the plate.

Until the late 1980s, cataracts were surgically removed by intracapsular extraction that involved the removal of the entire human lens including both its matrix of the outer lens capsule and the inner lens capsule, or by extracapsular extraction that involved removal of the anterior capsule of the lens and the matrix of the inner crystalline lens but leaving the posterior capsule of the lens intact. Such intracapsular and extracapsular procedures are prone to certain post-operative complications that introduce undesirable risks in their use. Among the most serious of these complications are opacification of the capsule after removal of the capsular lens, offset from the intraocular lens, cystoid macular edema, retinal detachment and astigmatism.

An improved surgical procedure called anterior capsulotomy was developed to relieve the previous and other complications and post-operative risks involved in extracting the intracapsular and extracapsular cataract. Expressed simply, the anterior capsulotomy involves forming an opening in the anterior capsule of the natural lens, leaving intact within the eye a capsular bag that has an elastic posterior capsule, and a remnant or anterior capsular border around the opening of the anterior capsule, and an annular groove, referred to herein as the groove of the capsular bag, between the remnant of the anterior capsule and the outer circumference of the posterior capsule. This capsular bag is held around the periphery of the surrounding ciliary muscle of the eye by the eye zones. The natural lens matrix with cataracts is removed from the capsular bag through the opening of the anterior capsule by phacoemulsification and aspiration or in some other way after which an intraocular lens is implanted into the bag through the opening .

A relatively recent and improved form of the anterior capsulotomy known as capsulorhexis is essentially a circular or round continuous tear capsulotomy. A capsulorhexis is performed by tearing the anterior capsule of the natural lens capsule along a generally circular tear line substantially coaxial with the lens axis and eliminating the generally circular portion of the anterior capsule surrounded by the tear line. A continuous tear capsulotomy or circular capsulorhexis, if properly performed, provides a generally circular aperture through the anterior capsule of the substantially coaxial natural lens capsule with the eye axis surrounded at its circumference by a continuous annular remnant or annular edge of the anterior capsule which has a relatively smooth and continuous inner margin surrounding the opening. When a continuous tear circular capsulorhexis is performed, however, the leading edge is often accidentally torn or cut or otherwise broken, or the inner margin is nicked or cut in a manner that makes the tear prone edge when the Edge is stressed, as during fibrosis as discussed below.

Another anterior capsulotomy procedure, called wrap capsulotomy, involves cutting a horizontal incision in the anterior capsule of the natural lens capsule, then cutting two vertical incisions in the anterior capsule that intersect and rise from the horizontal incision, and finally tearing the anterior capsule along the tear line that has an upper ascending arcuate portion that begins at the upper extremity of the vertical incision and continues in a descending vertical portion parallel to the vertical incision that extends down and then through the second vertical incision. This procedure produces an opening in the anterior capsule generally with an arc shape centered on the axis of the eye. The opening is surrounded in its lower part by the horizontal incision, on a vertical side by the vertical incision, on its vertical side opposed by the second vertical incision of the anterior capsule, and on its upper side by the upper arcuate portion of the capsular tear. . The vertical incision and the adjacent end of the horizontal incision form a flexible flap on one side of the opening. The vertical tear edge and the adjacent end of the horizontal incision form a second flap on the opposite side of the opening.

A third capsulotomy procedure, called beer can or can opener capsulotomy, involves perforating the anterior capsule of the natural lens in a multiplicity of positions along a substantially coaxial circular line with the eye axis and then removing the generally circular portion of the capsule surrounded in its circumference by the line. This procedure produces an opening in the anterior capsule generally circular substantially coaxial with the axis of the eye and surrounded in its circumference by a remnant or annular edge of the anterior capsule. The inner margin of this edge has a multiplicity of recesses formed by the edges of the holes drilled in the anterior capsule that make the remnant or annular edge prone to tear radially when the edge is tensioned, as during fibrosis as discussed below.

Intraocular lenses also differ with respect to their ability to accommodate, and their placement in the eye. Accommodation is the ability of an intraocular lens to accommodate, that is, to focus the eye for near and far vision. U.S. Patent No. 5,326,347 and certain prior patents describe accommodating intraocular lenses. Other prior United States patents describe intraocular lenses that do not fit. Most lenses that do not fit have single-focus optics that focus the eye only at a certain fixed distance and require glasses to change the focus. Other lenses that do not fit have bifocal optics that form the image of both near and distant objects on the retina of the eye. The brain selects the appropriate image and suppresses the other image, so that a bifocal intraocular lens provides both near vision and distant vision without glasses. Bifocal intraocular lenses, however, suffer from the disadvantage that each bifocal image represents only about 40% of the available light and the remaining 20% ​​of the light is lost by scattering.

There are four possible locations of an intraocular lens inside the eye. These are (a) in the previous chamber,

(b) in the posterior chamber, (c) in the capsular bag, and (d) in the vitreous chamber.

WO 95/06446 describes an intraocular lens that fits.

Description of the invention

According to one of its aspects, this invention provides improved accommodating intraocular lenses according to claim 1 for implanting within the capsular bag of a human eye that is maintained in the eye after removal of the natural matrix of the Human lens capsule through an opening in the anterior capsule created by an anterior capsulotomy and preferably by a capsulorhexis. An improved intraocular lens according to the invention has an optical and central haptics that extend outward from diametrically opposite sides of the optic and can be moved anteriorly and posteriorly in relation to the optic. In some embodiments of the described lenses, the haptics are joined at their inner ends to the optic by hinge-like joints referred to herein as hinges, and the anterior / posterior movement of the haptics implies a fundamental movement of the haptics in these hinges. In other described embodiments, the haptics are elastically flexible, and the anterior / posterior movement of the haptics in relation to the optic involves elastic flexing or bending of the haptics. In this regard, it is important to indicate at the outset that the terms "flex", "flex", "flexible" and the like are used in this document in a broad sense to encompass both hinge and elastically foldable haptics.

Certain of the lens embodiments of the invention described herein are called single plate haptic lenses. These single-plate haptic lenses are intended for use when the capsulotomy procedure used in eye surgery is performed properly and provides a remnant or edge of the anterior capsule that is not only completely intact and free of cracks, tears and the like at the time. of the lens implant but also probably remains intact during subsequent fibrosis. Other lens embodiments described are called plate haptic spring lens. The latter lenses are intended for use in those situations in which the capsulotomy produces an anterior capsular remnant that is not intact or is not likely to remain intact during fibrosis. Both types of lenses are designed to implant inside a capsular eye bag in a position where the lens optic is aligned on the axis of the eye with the opening of the anterior capsule in the bag, and the lens haptics they are placed inside the groove of the capsular bag in contact with the groove wall. The normally posterior side of the lens is then opposite the elastic posterior capsule of the bag.

The presently preferred lens embodiments of the invention according to claim 1 have round optics and haptics attached at their inner ends to the opposite edges of the optician by relatively narrow junctions. These junctions occupy only relatively small diametrically opposite edge portions of the optics and leave the remaining main circular edge portions of the optic between the junctions unobstructed. In the preferred lenses described herein, these joints are hinge joints around which the haptics can move anteriorly and posteriorly in relation to the optic. These flexible or hinge joints form a bridge between the optic and the haptic plate that is fixed in position within the anterior and posterior capsules by fibrosis. The bridges are tapered, the widest end being adjacent to the optic. This allows the bridge to slide in and out of the pocket formed by the fibrosed anterior capsular edge and the posterior capsule, and allows the optician to move anteriorly when the plate haptics are subjected to end-to-end compression.

During a post-operative healing period of the order of three weeks, active endodermal cells on the posterior side of the anterior capsular border cause fusion of the border with the elastic posterior capsule due to fibrosis. Fibrosis occurs around the haptics in such a way that the haptics "pack" with the capsular bag and form radial pockets between the leading edge and the posterior capsule. These pockets contain the haptics and act to place and center the lens in the eye. The anterior capsular border shrinks during fibrosis. This shrinkage combined with the packaging of the haptics causes compression at the ends of the lens in a way that has to deflect the center of the lens along the axis of the eye in relation to the fixed outer haptic ends. The intact fibrous capsular edge prevents forward deflection of the lens, so that the fibrosis-induced lens deflection occurs backward in a position where the lens presses against the elastic posterior capsule and stretches this capsule backwards.

The relaxation of the ciliary muscle during normal use of the eye after the conclusion of the fibrosis stretches the capsular bag and the fibrous anterior capsular border. The edge is stretched to a stretchy trampoline state in which the edge deflects the lens back and keeps the lens in a rear position. In this position of the lens, which is its far vision position, the lens optician presses back against the elastic posterior capsule and stretches it. The stretched posterior capsule then exerts a force of forward pressure on the lens.

The accommodating lenses of the invention according to claim 1 are constructed and disposed only to use the fibrous anterior capsular rim, the elastic posterior capsule, the vitreous cavity pressure, and the action of the ciliary muscle of the eye controlled by the brain to provide postoperative accommodation for near vision. Therefore, when looking at a nearby object, the brain strangles the ciliary muscle. This relaxes the anterior fibrosed edge, increases the pressure of the vitreous cavity and compresses the ends of the lens in such a way as to make forward deviation, that is, accommodating movement, of the lens optic along the axis of the eye. to a close viewing position. Depending on the amount of accommodation, the lens deviation of accommodation is initially caused by the increase in the vitreous pressure and the force of forward pressure of the stretched posterior capsule and finally by the forward buckling of the lens in response to the compression at the ends of the lens. The subsequent relaxation of the ciliary muscle activated by the brain stretches the capsular bag and the fibrous anterior capsular border causing the lens to return back to its distant vision position.

Preferred lens embodiments of the invention according to claim 1 have round optics that fit in size to a diameter that passes through the anterior capsular opening. These preferred lenses are constructed and arranged for anterior accommodating movement of their opticians to positions where the opticians project through the opening of the anterior capsule to maximize the range of lens accommodation.

In accordance with another important aspect of the invention, the ciliary muscle is paralyzed in its relaxed state at the beginning of the surgery and is kept in this relaxed state during both the surgery and the post-operative fusion of the remnant or anterior capsular border with the capsule. posterior fibrosis. The ciliary muscle is therefore relaxed by introducing a ciliary muscle relaxant (that is, a ciploplegic) into the eye. While various cycloplegics can be used, the preferred cycloplegic is atropine due to its relatively long effective period compared to other cycloplegics. The cycloplegic is initially introduced into the eye at the beginning of surgery to dilate the pupil and paralyze the ciliary muscle in its relaxed state. After surgery, the patient periodically introduces cycloplegic drops into the eye during a postoperative healing period of sufficient duration (usually about two to three weeks) to keep the ciliary muscle in its relaxed state until fibrosis is complete. This drug-induced ciliary muscle relaxation prevents muscle contraction and immobilizes the capsular bag during fibrosis. By this means, the lens is fixed in position within the eye in relation to the retina for distant vision. When the cycloplegic effect is passed and the ciliary muscle can contract again, the contraction causes end-to-end compression of the plates thereby moving the optic anteriorly for close vision. If the ciliary muscle is not maintained in its relaxed state, the muscle would essentially undergo normal contraction and relaxation for vision accommodation induced by the brain during fibrosis. This action of the ciliary muscle during fibrosis would not only produce improper formation of the haptic stakes in the fibrous tissue, but also the contraction of the ciliary muscle during fibrosis would compress the capsular bag radially and the lens ends in such a way as to displace most likely the lens of its proper position in the bag.

A lens that fits in accordance with the invention according to claim 1 may have a normal unstressed configuration, so that when it deviates from its normal unstressed configuration, the lens develops elastic tension energy forces that deflect the lens towards its normal unstressed configuration in a way that helps accommodation. The lens can be generally flat, arcuate anteriorly, or arcuate posteriorly in its normal unstressed configuration. A described embodiment of the lens includes auxiliary springs to aid in the accommodation of the lens. Some described lens embodiments have integral fixation means at the haptic ends around which fibrosis of the anterior edge of the capsular bag occurs to fix the lens against displacement in the eye. Other embodiments described have fasteners from which the lens itself can be separated to allow later removal of the lens for repair or correction and return the lens to its exact original position within the eye.

As indicated above, the single plate haptic lens of the invention is designed for use when the anterior capsulotomy performed on the eye provides a remnant or anterior capsular edge that remains intact and continuous in its circumference throughout the fibrosis. The plate haptic spring lens is designed to be used when the remnant or anterior capsular edge of the capsular bag is broken, that is, cut or torn, or is prone to it during fibrosis. A broken capsular edge can be produced in different ways. For example, improperly performing a continuous tear circular capsulotomy, or capsulorhexis may cause accidental cutting or tearing of the anterior edge. A beer can capsulotomy or can opener, on the other hand, produces an anterior capsular border that is not intact and has an internal margin with recesses that have regions that induce tension that make the edge very prone to tearing during surgery or fibrosis later. An envelope capsulotomy inherently produces an anterior capsular remnant that is broken and not intact.

A broken anterior capsular border or remnant may prevent the use of a single plate haptic lens of the invention for the following reasons. A broken edge cannot firmly retain the lens haptics in the groove of the capsular bag during fibrosis, thus making the lens sensitive to off-center and / or posterior or anterior displacement. A broken capsular edge may be unable to adopt the state similar to a trampoline bed of an unbroken edge. If so, a broken capsular rim is unable to perform the complete posterior deviation of a haptic plaque lens to a distant viewing position against the posterior capsule during and after fibrosis. In fact, a broken capsular edge may allow anterior deviation of the lens. In any case, since the power of the lens is selected for each individual patient and depends on their power of glasses, and since good vision without glasses requires that the optical lens be precisely at the correct distance from the retina, a Single plate haptic lens of the invention may not be acceptable for use with a remnant or anterior capsular edge.

The plate haptic spring lenses of the invention are designed to be used when the anterior capsular remnant or cap of the capsular bag is broken. These plate haptic spring lenses are similar to single plate haptic lenses but have elastic springs, such as spring loops, at the ends of plate haptics. When a plate haptic spring lens is implanted in a capsular bag, the haptic springs press out against the groove wall of the capsular bag to fix the lens in the bag during fibrosis. Fibrosis occurs around the springs in such a way as to effect the fusion of the broken anterior remnant with the posterior capsule, firm fixation of the springs and therefore of the haptics in the bag, and subsequent deflection of the lenses against the posterior capsule. Elastic during fibrosis. Strangulation and relaxation of the ciliary muscle induced by the brain after fibrosis with a broken capsular edge makes the accommodation of the plate haptic spring lens much as in the same way as with the simple plate haptic lens and a capsular edge Not broken intact.

While the plate haptic spring lens of the invention is designed for use with a ruptured anterior or remnant capsular edge, these lenses can also be used with an intact edge. A plate haptic spring lens also compensates for improper placement of a lens in the eye with one end of the lens located in the capsular bag and the other end of the lens located in the ciliary groove of the eye. In this regard, an advantage of the plate haptic spring lens of the invention over single plate haptic lenses lies in the fact that the spring lenses eliminate the need to have both a haptic lens in the operating room Single plate for use with an intact capsular edge such as a plate haptic spring lens as a substitute for the plate haptic lens in case the edge is broken during surgery.

Another advantage of the plate haptic spring lenses over the single plate haptic lenses of the invention resides in the fact that the haptic spring lenses allow a larger diameter optic than those of single plate haptic lenses whose optical diameters will be normally restricted to the range of 4–7 mm. Therefore, haptic spring lenses depend on haptic springs instead of the remnant or capsular edge to keep the lenses in position during fibrosis. As a consequence, these lenses can be used with a remnant or capsular edge of reduced radial width or a capsular edge that is cleft or torn, both types of edge providing an opening of the anterior capsule of effective size larger than possible with a haptic lens single plate. An opening in the larger anterior capsule, in turn, allows a larger optical diameter which offers certain ophthalmological benefits. In accordance with one aspect of this invention, such a larger opening is provided after the fibrosis is completed using a laser to open the anterior capsular edge radially or cut the edge in its circumference to widen the opening.

A further aspect of the invention relates to a lens that is accommodated according to claim 1 to provide accommodation in a human eye whose natural lens matrix has been removed from the lens capsule by a procedure involving anterior capsulotomy of the lens. natural lens The lens that fits can be used to replace a natural lens from which a cataract has been removed and correct a refractive error in the eye of a patient who previously wore glasses to enable the patient to see well without glasses. For example, the invention can be used to correct refractive errors and restore accommodation in 40-year-old people who need reading glasses or bifocals for near vision by replacing the matrix of the crystalline lens without transparent cataracts of their eyes with an intraocular lens that It is accommodated according to the invention. According to the method of using a plate haptic spring lens of the invention, the anterior capsular remnant or cap of the capsular bag is opened radially or cut to widen the opening of the anterior capsule after the fibrosis is completed. to allow the use of a lens with an optical of relatively larger diameter of 6 or 7 mm.

Brief description of the drawings

Figure 1 is a section through a human eye from which the natural lens matrix has been removed by a surgical procedure involving anterior capsulotomy, such as capsulorhexis, of the natural lens, and illustrating a lens that fits haptically. single plaque implanted inside the eye's capsular bag;

Figure 1A is a section through a normal human eye;

Figure 2 is a view of the anterior side of the intraocular lens of Figure 1;

Figure 3 is a section taken on line 3–3 in Figure 2;

Figure 4 is a section taken on line 4–4 in Figure 1;

Figures 5–8 illustrate the manner in which the intraocular lens of Figures 1–4 is used in the eye of Figure 1 to provide accommodation:

Figures 9–12 are sections, similar to Figure 3, through modified accommodating intraocular lenses that have alternative optical forms;

Figure 13 is a section similar to Figure 3 through an intraocular lens that fits modified according to the invention illustrating the lens in its normal non-tensioned configuration ;

Figure 14 is a section similar to Figure 16, illustrating the lens in its far vision position;

Figure 15 is a section through an intraocular lens that is fitted modified in accordance with the invention having an optic displaced in the foregoing manner;

Figure 16 is a view of the anterior side of a modified accommodating intraocular lens having integral fixation means for fixing the lens in the eye's capsular bag;

Figure 17 is a section taken on line 17–17 in Figure 16;

Figures 18–21 are views of the anterior sides of modified accommodating intraocular lenses that have integral fixation means for fixing the lenses in the eye capsular bag;

Figure 22 is a view of the anterior side of a modified accommodating intraocular lens having springs to aid in accommodation;

Figure 23 illustrates the lens of Figure 22 implanted within the capsular bag of a human eye as that of Figure 1, and showing the lens in the position occupied by the lens immediately after the surgery as well as after a certain degree of accommodation;

Figure 24 is a view similar to Figure 23 showing the lens in its far vision position

later; Figures 25–30 are views of the anterior sides of modified intraocular lenses that fit which have separate fixing means to fix the lenses in the capsular bag of a human eye like the of figure 1;

Figures 31–34 illustrate modified accommodating intraocular lenses that have fixation means.

integral; Figures 35–37 illustrate the capsulotomy produced by a circular tear capsulotomy. (capsulorhexis), a beer can capsulotomy, and a shell capsulotomy, respectively;

Figure 38 is a view of the front face of a plate haptic spring lens;

Figure 39 is a view similar to Figure 4 showing the plate haptic spring lens of Figure 38 implanted in the eye; Figure 40 is an enlarged section taken on line 40–40 in Figure 39; Figures 41 and 42 illustrate two ways of enlarging the capsulotomy of a capsular bag after

Fibrosis conclusion to allow anterior movement of a relatively large lens optic; Figure 43 is a view of the front side of a modified plate haptic lens; Figures 44–46 illustrate modified plate haptic spring lenses; Figure 47 is a plan view of the front side of a lens that is presently preferred; Figure 48 is a section taken on line 48–48 in Figure 47; Figure 49 illustrates the lens of Figure 47 implanted within the capsular bag of one eye and shows the

lens in its rear view position;

Figure 50 is a view similar to Figure 49 showing the lens at the front limit of its accommodation or near it; Figure 51 is a section similar to Figure 48 through a modified fitting lens; Figure 52 is a view similar to Figure 47 of an additional modified fitting lens; Figure 53 is a view similar to Figure 47 of a lens that is further modified further accommodated; Figure 54 is a view showing an intraocular lens that accommodates anteriorly offset

in its position of distant posterior vision inside the eye after the conclusion of fibrosis after surgery;

Figure 55 is an enlargement of the area surrounded by arrow 55-55 in Figure 54; Figure 56 is an additional enlarged view of an intraocular lens and a natural capsular bag, which shows incoming rays of light focused on the retina of the eye;

Figures 57 and 58 are sectional views showing an intraocular lens that is accommodated in a previously deviated manner preferred, which provides increased accommodation amplitude and increased accommodation diopters, Figure 58 showing the preferred intraocular lens in continuous lines at a position of average range of accommodation, in dashed lines in their rearward view accommodation position, and in dashed lines in their anterior near vision accommodation position;

Figure 59 is a view of the edge of the lens of Figure 58; Figure 60 is a perspective view of the fragmentary exploded view of an intraocular lens that is accommodates modified according to the invention which has essentially hinge haptics;

Figure 61 is a view similar to Figure 60 but showing a modified haptic hinge arrangement that includes reinforcement hinge inserts, and a modified hinge arrangement;

Figures 62 and 63 are views similar to the anterior portion of Figure 56 but illustrating two intraocular lenses that are accommodated in a previously deviated manner modified in accordance with the invention in their posterior distant viewing positions within the capsular bag of the eye;

Figure 64 is a plan view of an improved intraocular lens according to the invention having extended haptic portions in the form of elastically foldable fingers defined by haptic inlays;

Figure 65 illustrates an embodiment similar to that of Figure 64 and includes a pocket sunk in a haptic to accommodate a drug;

Figure 65A is a sectional view taken on line 65A-65A in Figure 65;

Figure 66 is a plan view in which pairs of haptics extend opposite from an optician, a loop extends outward between each pair of haptics, and one arm generally extends transversely of each loop with a protrusion final defining an opening;

Figure 66A is a sectional view taken on line 66A-66A in Figure 66; and

Figure 67 shows another embodiment in which the haptics extend in radially separated relationship from an optician, and two loops extend outward between the respective pairs of haptics, one arm generally extending transversely with respect to the loops and having protrusions with openings at its outer ends.

Best way to realize the invention

Turning now to these drawings and first to Figures 1 and 1A, a human eye 10 is illustrated from which the natural crystalline lens matrix was previously removed by a surgical procedure involving an anterior capsulotomy, in this case a circular rupture capsulotomy. of continuous tearing, or capsulorhexis. The natural lens comprises a lens capsule having elastic anterior and posterior walls A and P, respectively, which are referred to by the ophthalmologists and in this document anterior and posterior capsules, respectively. The natural lens capsule (Figure 1A) contains a matrix M of normally optically transparent crystalline lens. In many individuals, this lens matrix is ​​clouded advancing in age and forms what is called a cataract. It is now a common practice to restore the patient's vision with cataracts by removing the cataract from the natural lens and replacing the lens matrix with an artificial intraocular lens.

As mentioned above, the circular continuous tear capsulotomy, or capsulorhexis, involves tearing the anterior capsule A along a generally circular tear line in such a way as to form a circular opening with a relatively smooth edge in the center of the anterior capsule The cataract is removed from the natural lens capsule through this opening. After the conclusion of this surgical procedure, the eye includes an optically transparent anterior cornea 12, an opaque sclera 14 on the inner side of which is the eye's retina 16, an iris 18, a capsular bag 20 behind the iris, and a vitreous cavity 21 behind the capsular bag filled with the vitreous humor similar to a gel. The capsular bag 20 is the structure of the natural lens of the eye that remains intact within the eye after the continuous tear circular rupture capsulorhexis has been performed and the natural lens matrix has been removed from the natural lens.

The capsular bag 20 includes an annular anterior capsular remnant or edge 22 and an elastic posterior capsule 24 which is joined along the perimeter of the bag to form a groove 25 of the capsular bag similar to an annular shout between the edge and the capsule later. The capsular edge 22 is the remnant of the anterior capsule of the natural lens that is maintained after the capsulorhexis has been performed on the natural lens. This edge surrounds in the circumference a generally round, central anterior opening 26 (capsulotomy) in the capsular bag through which the natural lens matrix was previously removed from the natural lens. The capsular bag 20 is secured around its perimeter to the ciliary muscle of the eye by zones 30.

Natural accommodation in a normal human eye that has a normal human crystalline lens implies contraction

or strangulation and relaxation of the ciliary muscle of the eye by the brain in response to the observation of objects at different distances. The relaxation of the ciliary muscle, which is the normal state of the muscle, forms the human crystalline lens for distant vision. The contraction of the ciliary muscle forms the human crystalline lens for near vision. The change induced by the brain from far vision to near vision is called accommodation.

Implanted within the capsular bag 20 of the eye 10 is an intraocular lens 32 that accommodates that replaces and performs the function of accommodating the removed human crystalline lens. Lens 32 is instead called a single plate haptic lens to distinguish it from the last described plate haptic spring lens of the invention.

As mentioned above and will be readily understood as the description continues, the accommodating intraocular lens can be used to replace a natural lens that is virtually completely defective, such as a natural lens with cataracts, or a natural lens that provides vision. satisfactory at a distance without wearing glasses but provides satisfactory vision at another distance only when wearing glasses. For example, the intraocular lens that accommodates the invention can be used to correct refractive errors and restore accommodation for people 40 and older who require reading glasses or bifocals for near vision.

The intraocular lens 32 comprises a body 33 that can be formed of relatively hard material, relatively soft flexible semi-rigid material, or a combination of both hard and soft materials. Examples of relatively hard materials that are suitable for the lens body are methyl methacrylate, polysulfones and other relatively hard biologically inert optical materials. Examples of relatively soft materials suitable for the lens body are silicone, hydrogels, thermolabile materials and other biologically inert semi-rigid flexible optical materials.

The lens body 33 has a generally rectangular shape and includes a central or optical optical zone 34 and haptic 36 of the plate extending from diametrically opposite edges of the optic. The haptics have inner edges attached to the optic and opposite free outer ends. The haptics 36 can be moved anteriorly and posteriorly in relation to the optic 34, that is, the outer ends of the haptics can be moved anteriorly and posteriorly in relation to the optic. The embodiment of the particular lens illustrated is constructed of an elastic semi-rigid material and has flexible hinges 38 that connect the inner ends of the haptics to the optic. The haptics are relatively rigid and are flexible around the hinges anteriorly and posteriorly in relation to the optic. These hinges are formed by grooves 40 that enter the front side of the lens body and extend along the inner ends of the haptics. The haptics 36 are flexible around the hinges 38 in the anterior and posterior directions of the optician. The lens has a relatively flat non-tensioned configuration, illustrated in Figures 2 and 3, in which the haptics 36 and their hinges 38 are arranged in a common plane transverse to the optical axis of the optic 34. The deformation of the lens from its configuration not stressed by anterior or posterior deviation of the haptics around its hinges 38 creates in the hinges forces of elastic tension energy that divert the lens to its unstressed configuration. If the lens is constructed of a relatively hard optical material, it may be necessary to replace flexible hinges 38 with central hinges of some kind. In a lens embodiment of the invention described later, the haptic hinges are removed, and the haptics are manufactured flexible throughout their length.

The accommodating intraocular lens 32 is implanted within the capsular bag 20 of the eye 10 in the position shown in Figures 1 and 5. When the lens is implanted in the bag, the ciliary muscle 28 of the eye is kept in its relaxed state. in which the muscle stretches the capsular bag 20 to its maximum diameter. The lens is inserted into the bag through the opening 26 of the anterior capsule and placed in the position shown in Figures 1 and 4. In this position, the optic 34 of the lens is aligned on the axis of the eye with the opening 26, the rear side of the lens is in front of the elastic rear capsule 24 of the bag, and the outer ends of the haptics 36 of The lens is located inside groove 25 in the radially outer perimeter of the bag. The overall length of the lens substantially equals the internal diameter (10–11 mm) of the stretched capsular bag so that the lens fits well within the stretched capsule bag with the outer ends of the haptics in contact with the inner perimeter of The bag, as shown. This prevents the lens from being offset and therefore allows the optician 34 to be smaller so that it can move forward within the capsular edge during the last described accommodation.

During a post-operative healing period of the order of two to three weeks after the surgical implantation of the lens 32 in the capsular bag 20, the epithelial cells below the anterior capsular edge 22 of the bag cause fusion of the edge with the capsule 24 posterior fibrosis. This fibrosis occurs around the haptics 36 of the lens so that the haptics are "packed" by the capsular bag 20, and the haptics form pockets 42 in the fibrous material F (Figures 4 and 6–8). These pockets cooperate with the lens haptics to place and center the lens in the eye. To ensure proper formation of the haptic pockets 42 and prevent displacement of the lens by contraction of the ciliary muscle during fibrosis, sufficient time should be allowed for the conclusion of the fibrosis without contraction of the ciliary muscle 28 from its relaxed state. In accordance with an important aspect of this invention, this is achieved by introducing a ciliary muscle relaxant (cycloplegic) into the eye before surgery to dilate the pupil and paralyze the ciliary muscle in its relaxed state and having the patient to periodically administer drops cycloplegics in the eye for a post-operative period of sufficient duration (two to three weeks) to allow fibrosis to continue until completion without contraction of the ciliary muscle. The cycloplegic keeps the ciliary muscle 28 in its relaxed state in which the capsular bag 20 is stretched to its maximum diameter and is immobilized, and the anterior capsular edge 22 is stretched to a state or position similar to a pull-up trampoline. The edge is fibrous from this tight state. The cycloplegic passes through the cornea of ​​the eye to the fluid inside the eye and enters the ciliary muscle from this fluid. While other cycloplegics may be used, atropine is the preferred cycloplegic due to its prolonged paralyzing effect compared to other cycloplegics. A drop of atropine, for example, can last two weeks. However, to be on the safe side, patients are advised to take a drop of atropine in the eye every day during the period of fibrosis.

The capsular edge 22 shrinks during fibrosis and therefore shrinks the capsular bag 20 slightly in its radial direction. This shrinkage combined with the packaging of the lens haptics 36 produces some compression at the opposite ends of the lens that tends to bend or flex the lens at its hinges 38 and therefore moves the lens optic 34 of the lens to along the axis of the eye. Unless limited, this lens flexion could occur forward or backward. The anterior capsular leading edge 22 pushes back and therefore prevents forward flexion of the lens. This compression of the lens induced by fibrosis is not sufficient to interfere with the proper formation of the haptic pockets in the fibrous tissue or cause displacement of the lens. Accordingly, compression at the ends of the lens by fibrosis aided by the backward thrust of the tether capsule against haptics 36 of the lens causes backward flexion of the lens from its initial position of Figures 1 and 5 to its position. of Figure 6. The lens haptics 36 are manufactured rigid enough so that they will not be arched by the forces of fibrosis. At the conclusion of the fibrosis, the lens occupies its posterior position of Figure 6 in which the lens presses back against the elastic posterior capsule 24 and stretches this capsule backwards. The posterior capsule then exerts a force of elastic pressure forward on the lens. This posterior position of the lens is its far vision position.

The flexion of the lens 32 induced by the ciliary muscle during fibrosis can be resisted or prevented by placing sutures within the grooves 40 of the hinge. The removal of these sutures after the conclusion of the fibrosis can be achieved using sutures that are absorbable in the fluid inside the eye or using sutures made of a material, such as nylon, which can be removed with a laser.

Natural accommodation in a normal human eye involves shaping the natural crystalline lens by automatic contraction and relaxation of the ciliary muscle of the eye by the brain to focus the eye at different distances. The relaxation of the ciliary muscle forms the natural lens for distant vision. The contraction of the ciliary muscle forms the natural lens for close vision.

The intraocular lens 32 that is accommodated is constructed solely to use this same action of the ciliary muscle, the fibrous capsular edge 22, the elastic posterior capsule 24, and the vitreous pressure within the vitreous cavity 21 to effect the accommodation movement of the optic 34 of the lens along the optical axis of the eye between its far vision position of Figure 6 to its near vision position of Figure 8. Therefore, when looking at a distant scene, the brain relaxes the ciliary muscle 28. The relaxation of the ciliary muscle stretches the capsular bag 20 to its maximum diameter and its anterior fibrous edge 22 to the state or position similar to a distant trampoline analyzed above. The pulling edge deflects the lens backwards to its rear view position in Figure 6, in which the elastic posterior capsule 24 is stretched backward by the lens and therefore exerts a force of forward pressure on the lens. When you look at a nearby scene, such as when you read a book, the brain strangles or contracts the ciliary muscle. This contraction of the ciliary muscle has the effect of increasing the pressure of the vitreous cavity three times, relaxing the capsular bag 20 and particularly its fibrous capsular edge 22, and exerting compression forces on the ends that oppose the ends of the haptics 36 of the lens with compression at the resulting ends of the lens. The relaxation of the capsular edge allows the edge to flex forward and therefore enables the combined forward pressure force exerted on the lens by the posterior capsule stretched forward and the increased vitreous cavity pressure push the lens forward in a initial accommodation movement from the position of figure 6 to the intermediate accommodation position of figure 7.

In this intermediate accommodation position, the lens is substantially flat, and the ends of the lens haptics and their hinges 38 are arranged substantially in a common plane normal to the axis of the eye. During the initial accommodation, the lens arches backward so that compression at the ends of the lens by contraction of the ciliary muscle produces a buckling force backward on the lens that resists the initial accommodation. However, the increased pressure of the vitreous cavity and the forward pressure force of the stretched anterior capsule are sufficient to overcome this opposing buckling force and effect the forward movement of the lens up to and at least just slightly beyond the intermediate position of figure 7. At this point, compression at the ends of the lens by the contracted ciliary muscle produces a forward buckling force on the lens that effects the final accommodation of the lens beyond the intermediate position of Figure 7 to the viewing position. close to figure 8. The posterior relaxation induced by the ciliary muscle brain 28 in response to the observation of a distant scene reduces the pressure of the vitreous cavity, stretches the capsular bag 20 to its maximum diameter, and restores the anterior capsular edge 22 to its state similar to a trampoline trampoline to effect the return of the lens to its far vision position of figure 6. During accommodation, the optic 34 of the lens moves along the axis of the eye towards the retina 16 and away from it. The power of the optician is selected by the brain to clearly focus incoming light rays on the retina throughout the interval of this accommodation movement.

The haptics 36 of the lens flex at their hinges 38 with respect to the optical 34 of the lens during the accommodation. Any force of elastic tension energy developed in the hinges during this flex produces additional anterior and / or subsequent forces on the lens. For example, it is assumed that the lens is relatively flat, that is, that the lens haptics 36 are located in a common plane as shown in Figure 1, in the normal unstressed state of the lens. In this case, the rear deviation of the lens from its position in Figure 1 to its distant viewing position of Figure 6 creates forces of elastic tension energy at the hinges 38 that propel the lens forward back to its non-position. tension of Figure 1 and therefore helps the initial accommodation of the lens discussed above in response to the contraction of the ciliary muscle. The final accommodation flexion of the lens from its intermediate position of Figure 7 to its near viewing position of Figure 8 creates forces of elastic tension energy at the hinges 38 that propel the lens back into its unstressed position and therefore it helps in the initial return of the lens from its near vision position to its far vision position in response to the relaxation of the ciliary muscle. The lens can be designed to adopt another normal unstressed position, of course, in which case any elastic tension energy force created in the lenses during haptic flexion will help, resist, or both help and resist the lens accommodation. to its near vision position and the return of the lens to its far vision position depending on the unstressed position of the lens.

During accommodation, the lens haptics 36 slide along the ends in their pockets 42 of fibrous tissue. As best shown in Figures 2 and 3, haptics have tapered ends in width and thickness to enable haptics to move freely in pockets. The lens optic 34 moves toward the anterior capsular edge 22 and away from it. The diameter of the optician is made as large as possible to maximize its optical rendering efficiency. The optic is preferably manufactured but not necessarily smaller than the diameter of the opening 26 of the anterior capsule to allow the optic's accommodation movement in and from the opening without interference from the capsular edge 22 to maximize the accommodation range. The actual dimensions of the lens are determined by the ocular dimensions of each patient. The dimensions of a single plate haptic intraocular lens according to the invention will generally be within the following ranges:

Optical diameter: 3.0 mm - 7.0 mm Overall lens length: 9.0 mm - 11.5 mm Haptic thickness: 0.25 mm - 0.35 mm

We now refer to Figures 9–15 that illustrate several possible alternative forms of the intraocular lens that fits. The modified lens 50 illustrated in Figure 9 is identical to the lens 32 of Figures 1–8 except that the haptic hinges 38 of the lens 32 are removed in the lens 50, and the haptics 52 of the lens 50 are flexible throughout its length, as illustrated by the broken lines in Figure 9. The modified lens 54 in Figure 10 has an unstressed arcuate shape anteriorly and includes a bi-convex optic 56, flexible hinges 58 and haptics 60 anteriorly domed with convex anterior surfaces 62. The convex anterior face 64 of the optic 56 and the convex anterior haptic surfaces 62 are rounded into a common radius. The modified intraocular lens 66 in Figure 11 is relatively flat and includes an optic 68 that has a flat front 70 Fresnel face and a convex rear face 72, haptics 73, and flexible haptic hinge 74. The modified lens 76 in Figure 12 has an unstressed arc posteriorly and includes an optic 78 that has a flat front face 80 and a convex front face 82, haptics 84 having convex rear surfaces 86 and haptic hinges 88. The rear face 82 of the optic 78 and the rear surfaces 86 of the haptics 84 are rounded into a common radius. The modified lens 90 illustrated in Figures 13 and 14 includes an optical 92 and flexible haptics 94 and has a non-tensioned near vision configuration shown in Figure 13. The haptics are flexed to allow the rear deviation of the lens to its configuration of distant view of figure 14. The optic 92 is subsequently compensated in relation to the inner ends of the haptics to allow greater anterior displacement of the optic during accommodation without contacting the anterior capsular edge 22 of the capsular bag 20. The modified intraocular lens 100 of the Figure 15 includes haptics 102 and an optic 104 that is previously compensated in relation to the inner ends of the haptics. The haptics are joined to diametrically opposite sides of the optic by flexible hinges 106.

The modified intraocular lenses of Figures 9–15 are implanted within the capsular bag 20 of the eye 10 and use the posterior deviation of the fibrous capsular edge 22, the posterior capsule 24, changes in the vitreous cavity pressure and muscle action ciliary of the patient to make the accommodation in the same manner as described in connection with the intraocular lens 32 of Figures 1-8. In the case of the lens 100 in Figure 15, the outer ends of its haptics 102 are implanted within the capsular bag 20 essentially in the same way as the lens haptics 32 so that the edge fibrosis 22 occurs around the haptics in the same way as described in connection with figures 1–8. The optic 104 of the previously compensated lens 100, on the contrary, protrudes through the anterior opening 26 in the capsular bag 20 and is positioned anteriorly with respect to the edge and between the edge and the iris 18 of the eye. There is enough space between the edge and the iris to accommodate the lens of a properly sized lens without the lens coming in contact with the iris.

Figures 16–20 illustrate modified accommodating intraocular lenses that have means to fix or anchor the lens haptics in the capsular bag 20 to prevent the lens from entering the vitreous cavity 21 of the eye in the event that the posterior capsule 24 a posterior capsulotomy should be torn or should be performed on the posterior capsule due to cloudiness. Except as indicated below, the modified intraocular lenses of Figures 16–20 are identical to the lens 32 of Figures 1–8 and are implanted in the capsular bag 20 of eye 10 in the same manner as described in connection with figures 1–8. The intraocular lens 110 of Figures 16 and 17 is identical to the lens 32 except that the outer ends of the lens haptics 112 have raised shoulders 114. The fibrosis of the capsular edge 22 around the haptics 112 and their shoulders 114 anchors or fixes the lens 110 in the capsular bag 20. The intraocular lens 116 of Figure 18 is identical to the lens 32 except that protrusions 118 similar to trunks extend diagonally from the outer ends of the haptics 120 of the lens plate. The distance between the outer ends of the diametrically opposed protrusions 118 is slightly larger than the distance between the outer ends of the lens haptics and slightly larger than the diameter of the capsular bag 20. The protrusions fit wider than the lens body width. These two features help to center the intraocular lens inside the capsular bag so that the lens optic is centered immediately behind the circular capsulotomy 26 in the bag. The fibrosis of the capsular edge 22 around the haptics 120 and their protuberances 118 fixes the lens 116 in the capsular bag 20. The intraocular lens 122 of Figure 19 is identical to the lens 32 except that the outer ends of the haptics 124 of the Lens have openings 126. The fibrosis of the capsular edge 22 occurs around the haptics 124 and through its openings 126 to fix the lens 122 in the capsular bag 20. The intraocular lens 128 of Figure 20 is similar to the lens 122 in that the lens 128 has apertures 130 at the outer ends of its haptics 132 through which fibrosis of the capsular edge 22 occurs to fix the lens in the capsular bag 20. Unlike the lens 122, however, the haptic openings 130 are surrounded along the outer ends of the haptics by spring loops 134. The overall length of the lens 120, measured between the centers of the spring loops 134 becomes slightly larger than the maximum diameter of the capsular bag. The spring loops 134 press and deform inward slightly by the outer circumference of the capsular bag to center the lens in the eye during fibrosis.

The modified intraocular lens 140 of Figure 21 is identical to the lens 32 of Figures 1–8 except that the lens 140 has centering nozzles 142 projecting at the ends from the outer ends of the lens haptics 144 to compensate slight differences, from one patient to another, in the diameter of the human capsular bag 20. Therefore, the diameter of the capsular bag varies from approximately 11 mm in acute myopia to approximately 9.5 mm in acute hypermetropics. Centering nozzles 142 prevent differences in the degree of flexion of haptics 144 in capsular bags of different diameters. For example, in a hypermetropic eye with a small capsular bag, the lens haptics would flex more with marked posterior vaulting of the lens by the fibrous capsular edge compared to the minimum vaping of the haptics that would occur in acute myopia with relatively capsular bags. big. The nozzles leave marks by themselves on the outer circumference of the capsular bag to compensate for such a diameter of bag that differ and therefore centering the lens on the bag.

The modified intraocular lens 150 illustrated in Figures 22–24 comprises a body 152 of the appropriate lens identical to that of Figures 1–8 and U-shaped springs 154 constructed with biologically inert spring material. The ends of these springs are fixed to the anterior sides of the lens haptics 156 adjacent to the haptic hinges 158 such that the arched ends of the springs extend a small distance beyond the outer ends of the haptics. The springs are tensioned to normally be relatively close to the anterior sides of the haptics. The body 152 of the lens is implanted within the capsular bag 20 of the eye 10 in the same manner as described in connection with the lens 32 of Figures 1–8, and with the arched outer ends of the springs 154 of the lens housed within groove 19 of the eye between iris 18 and cornea 12. When the lens is in the position of Figure 23 it occupies immediately after surgery as well as after some degree of accommodation, the springs 154 are located relatively close to the front sides of the lens haptics 156. During the subsequent displacement of the lens to its far vision position of Figure 24 by the posterior deviation of the fibrous capsular edge 22, the springs deviate anteriorly from the lens haptics, as shown, thus creating in the springs forces of elastic tension energy that helps the posterior capsule 24 stretched and the pressure of the vitreous cavity to move the lens anteriorly during the accommodation in response to the contraction of the ciliary muscle 28. The figures 25–32 illustrate modified intraocular lenses that have a separate lens body and lens fasteners for placing the lenses in the capsular bag 20. Fibrosis of the capsular edge 22 occurs around these fasteners in a manner that securely fixes the elements within the bag. In some figures, the lens body can be separated from the fasteners to allow removal of the lens and return the lens to its original position in the eye. In other figures, the lens body and the fixing elements are secured against the separation to prevent the entry of the lens body into the vitreous chamber in the event that a tear develops in the posterior capsule 24 of the bag or a posterior capsulotomy is performed in the capsule.

The modified lens 160 of Figure 25 includes a body 162 of the lens that is identical, except as indicated below, to that of the lens 32 in Figures 1–8 and separate fastener elements 164 at the outer ends of the haptics 166 of the lens. The fixation and haptic elements are interconnected in such a way that the elements and haptics are capable of a relative movement in length of the haptics when the haptics are flexed during the lens accommodation. The fasteners 164 in Figure 25 are generally U-shaped loops of biologically inert material having legs 166 that slide into longitudinal sockets 170 that enter through the outer ends of the haptics 166. The haptics 166 are somewhat shorter in length than those of the lens 32, and the overall length of the lens, measured between the outer arched ends of the fixing loops 164, when its legs 168 are assembled with the lower parts of its sockets 170, is smaller than the maximum diameter of the capsular bag 20 when the ciliary muscle 28 is relaxed and larger than the diameter of the bag when the ciliary muscle is fully contracted for accommodation. The lens 160 is implanted within the capsular bag 20 of the eye 10 with the fixing loops 164 and the outer ends of the haptics 166 disposed between the leading edge 22 and the posterior capsule 24 of the capsular bag 20. The outer arched ends of the loops are located on the outer circumference of the bag.

The fibrosis of the capsular edge 22 occurs around the outer ends of the haptics 166 of the lens and the exposed outer ends of the fixing loops 164 and through the spaces between the haptics and the loops such that the loops are firmly fixed. in the capsular bag, and the haptics form pockets 42 in the fibrous F tissue. The posterior deviation of the fibrous capsular edge 22 drives the lens posteriorly to its far vision position when the ciliary muscle 28 is relaxed, thereby stretching the posterior capsule 24 backwards in the same manner as explained in connection with the Figures 1–8. When the ciliary muscle contracts during accommodation, the vitreous cavity pressure increases and the capsular edge 22 relaxes, thus allowing the stretched posterior capsule and the vitreous cavity pressure to push the lens body 162 forward towards its near vision position, again in the same way as explained in connection with figures 1–8. The contraction of the capsular bag in response to the contraction of the ciliary muscle during the displacement of accommodation exerts inward forces on the fixing loops 164. These inward forces propel the loops inwards and their haptic sockets 170 until the Loops are assembled with the bottom parts of the sockets. The inward forces exerted on the loops then produce a moment of anterior buckling on the body 162 of the lens that aids in the accommodation of the lens by the posterior capsule. During this accommodation, the haptics 166 of the lens flex later in relation to the optic 172 of the lens and slide inward in their fibrous pockets 42 and along the legs 168 of the fixing loops 164, being helped the movement by the hinges 38.

The fixing loops have holes 174 at their outer arcuate ends through which a suture 176 can be passed and tied to hold the loops and the lens body in assembled relationship during implantation of the lens in the capsular bag. This suture is removed at the end of the surgery. Holes 174 may also be used to place the lens in the capsular bag during surgery. The haptics 166 of the lens can be separated and re-coupled with the fixing loops 164. This allows the body 162 of the lens to withdraw from the eye at any time after surgery to correct or replace the optic 172 of the lens and replace it. in its original position in the eye.

The modified intraocular lens 180 of Figure 26 is similar to that of Figure 25 except for the following differences. First, the haptics 182 of the lens 180 are substantially the same length as the haptics of the lens 32 and have cutouts 184 at their outer ends. The legs 188 of the fastening loops 188 slide in sockets 190 that enter through the lower edges of the cuts 184. When the lens is implanted within the capsular bag 20, the tongue-like haptic portions on opposite sides of the haptic cuts 184 and the outer arcuate ends of the fixing loops 186 are located within the outer circumference of the bag. As with the lens of Figure 25, fibrosis of the capsular rim 22 occurs around the haptics 182 and the fixation loops 186 and through the spaces between the haptics and loops to firmly fix the loops in the capsular bag and form pockets inside. of which the haptics slide when they flex during lens accommodation. Second, the legs 188 of the fastening loops 186 and their sockets 190 in the lens haptics 182 are tapered to facilitate the relative free movement of the loops and haptics when the haptics flex during accommodation. Third, the fixing loops have fixing nozzles 192 at their outer arcuate ends that leave marks on the outer circumference of the capsular bag 20 to retain the lens against movement in relation to the bag during fibrosis.

Figure 27 illustrates a modified intraocular lens 196 similar to lens 180 illustrated in Figure 26 except that the legs 198 of the fixing loops 200 and the haptic sockets 202 that receive these legs have shoulder 204, 206 that co-act. These shoulders allow limited relative movement of the lens body 208 and the loops when the haptics 210 flex during the lens accommodation, but secure the lens body and the loops against complete separation to prevent the lens body enter the vitreous chamber 21 if a tear occurs or a capsulotomy is performed on the posterior capsule 24. Another difference between the lens 196 and the lens 180 lies in the fact that the hinges 212 connecting the inner ends of the haptics 210 with the optic 214 of the lens extend through only an intermediate portion of the haptic width. The remaining lateral portions of the inner haptic ends beyond the ends of the hinges are separated from the optic by arched notches 216 centered on the axis of the optic. These separations of the haptics with respect to the optic allow the optician to move freely in and from the anterior opening 26 in the capsular bag 20 without interference with the capsular edge 22 during lens accommodation. The generally triangular haptic portions adjacent to the notches 216 prevent the edge 22 of the capsular bag 20 from fibrousing between the optic 214 of the lens and the inner ends of the haptics 210 of the lens thereby limiting movement at the ends of the haptics in their fibrous pockets 42.

The modified lens 220 of Figure 28 includes a lens body 222 and separate fastener elements 224 at the outer ends of the lens haptics 226. The inner ends of the haptics are convexly curved and generally arranged in tangential relationship with diametrically opposite sides of the lens optic 228 to provide relatively large removal spaces 230 between the optic and the inner haptic ends. The haptics and optics are joined along their tangential portions by flexible hinges 232. The fasteners 224 are generally cruciform-shaped screws having internal joints 234 that slide into support perforations 236 that enter through the lower edges of the cuts 238 at the outer ends of the haptics 226. These fixing screws have holes 240 between their ends, outer cross arms 242, and nozzles 244 at their outer ends. The length of the lens 220 measured between the outer ends of its haptics 226 and fixing screws 224 approximates the maximum inner diameter of the capsular bag 20 when the ciliary muscle is relaxed. The joints 234 of the fixing screws and their perforations 236 have shoulder cores 246, 248 that allow limited relative movement of the lens body and the fixing screws when the haptics flex during accommodation but secure the body and screws of fixation against complete separation, for the same reasons as explained above in connection with figure 27. If desired, shoulders 246, 248 can be removed to allow separation of the fixing screws and the lens body for the same reasons as explained in connection with the figure.

26. If the shoulders are removed, a removable suture can be threaded through the holes 240 of the fixing screws and tied to hold the fixing screws and the lens body in relation assembled during the implantation of the lens, such as It has been explained in connection with Figure 25. The holes can also be used to place the lens in the capsular bag during lens implantation.

When the lens 220 is implanted within the capsular bag 20 of the eye 10, the outer ends of the haptics 226 of the lens and the fixing screws 224 are disposed between the capsular edge 22 and the rear capsule 24 of the bag as much of the same way as described in connection with figures 25-27. The nozzles 224 leave marks on the outer circumference of the bag to fix the lens against the circumferential rotation around the bag and center the lens on the eye during edge fibrosis 22. The fibrosis of the capsular edge occurs around the outer ends of the haptics and the fixing screws to firmly fix the screws in the bag and form pockets in the fibrous tissue that receives the haptics. The lens body 222 is propelled posteriorly to its far vision position by the posterior deviation of the capsular edge 22 when the ciliary muscle 28 relaxes and anteriorly towards its near vision position during accommodation by the posterior capsule 24 stretched and the vitreous cavity pressure increases when the ciliary muscle contracts, all in essentially the same way as explained above in connection with Figures 25–27. During the anterior accommodation of the lens, the contraction of the capsular bag 20 in response to the contraction of the ciliary muscle exerts inward forces on the outer ends of the haptics 226 that produce a moment of anterior buckling on the body 222 of the lens It helps to accommodate the lens through the posterior capsule. The cross arms 242 of the fixing screws 224 are wrapped with the fibrous tissue F during the fibrosis of the edge 22 to provide pivots around which the screws can rotate during the buckling of the lens body in the course of the accommodation of the lens The spaces 230 between the inner ends of the haptics 226 and the optic 228 accommodate the movement of the optician inside and from the opening 26 in the capsular bag without interference with the surrounding capsular edge 22.

The modified intraocular lenses 260, 262 in Figures 29 and 30 are identical to lenses 180, 196, respectively, in Figures 26 and 27 except that the fixing loops of the last lenses are replaced, in Figures 29 and 30, by fixing screws 264, 266 similar to those in figure 28.

The modified intraocular lenses 270, 272 in Figures 31 and 32 are identical to the lenses 32 of Figures 1–8 except that the lens 270 has lateral spring arms 274 extending from the haptic hinges 276 and the lens 272 has arms Side spring 278s extending from the edges of the lens haptics 280. The arms 274, 278 extend laterally from and longitudinally towards the outer ends of the lens haptics such that in their normal non-tensioned position, the arms are arranged at acute angles in relation to the longitudinal axes of the lenses. The arms are adjusted in size in length so that when the lenses are implanted within the capsular bag 20 of the eye, the outer ends of the arms press against the outer circumference of the bag and thereby roll or compress to the positions illustrated by broken lines. The winding or compression in the arms decreases when the capsular bag expands in response to the relaxation of the ciliary muscle during the distant vision accommodation of the lens and increases when the bag contracts in response to the contraction of the ciliary muscle during the accommodation of close view of the lens. The coupling of the arms with the circumference of the capsular bag acts to center the lens in the bag in a position where the optics 282, 284 of the lens align coaxially with the opening 26 of the anterior bag. The fibrosis of the capsular edge 22 occurs around the spring arms to fix the lenses inside the capsular bag and around the lens haptics to form pockets in which the haptics slide when they flex during the lens accommodation.

Referring to Figure 32 and Figures 4 to 8, projections such as those indicated in 286 in Figure 32 can preferably be provided in various embodiments of the invention to separate the capsulorhexis from the optic when the capsulorhexis is strangled from its configuration shown in Figures 5 to 8. This separation prevents the anterior capsular edge 22, with a relatively small capsular opening 26, from invading the optic during fibrosis of the capsular edge 22. As shown in Figure 32, such projections 286 extend outwardly anteriorly from the Haptic surface of the plate, and are arranged around and separated from the optical. The projections extend outwardly not beyond the outer limit of the optician, typically at a height of approximately 1 - 1.5 mm. The projections may be in the form of continuous arcs (not shown) and may lean outward in relation to the optical.

The modified accommodating intraocular lens 290 of Fig. 33 comprises a circular optic 292 and two pairs 294, 296 of curved and flexible haptics 298, 300 extending from opposite edges of the optic. These haptics have the form of relatively thin arms. At the outer ends of the haptics there are enlarged bumps 302. The two haptics 298 of each pair of haptics 294, 296 extend outwardly from the optic 292 in mutually divergent relationship and curl away from each other towards their outer ends, as shown. The four haptics are arranged symmetrically in relation to a plane of symmetry that contains the axis of the optician and that passes halfway between the two haptics of each haptic pair. The two haptics 298 are diametrically opposed to each other, and the two haptics 300 are diametrically opposed to each other. The measured diametral distance between the outer ends of the diametrically opposed haptics 298, 300 becomes slightly larger than the maximum diameter of the capsular bag 20. The lens 290 is implanted within the bag at most in the same manner as the previous embodiments and with the outer ends of the haptics 298, 300 of the lens disposed between the anterior capsular edge 22 and the posterior capsule 24 of the bag. The outer ends of the haptics press elastically against the outer circumference of the bag and flex or bend in such a way to both accommodate bags of different diameter and to center the optic 292 behind the anterior capsulotomy in the bag. The anterior capsular edge 22 of the bag is fibrous around the haptics to fix the lens in the bag. After the fibrosis is completed, relaxation and strangulation of the ciliary muscle 28 of the eye initiated by the brain is effective in causing the lens to fit between the near and far vision positions essentially in the same manner as described above. During this accommodation, the lens is buckled and the haptics flex anteriorly and posteriorly in relation to the optic 292 at most in the same manner as described above. The fibrosis of the capsular border around the haptic protrusions 302 fixes the lens in the capsular bag and against displacement in the event that a tear or a capsulotomy is formed in the posterior capsule 24 of the bag.

The modified accommodating intraocular lens 310 of Figure 34 is similar to lens 290 of Figure 33 and differs from lens 290 only in the following aspects. The four haptics 312, 314 of the lens 310, instead of being thin curved arms similar to those of the lens 290, are symmetrically tapered from relatively wide inner ends that join the lens optic 316 to the relatively narrow outer ends. On the outer ends of the haptics 312, 314 there are elongated protrusions 318. On the inner ends of the haptics there are grooves 320 that form flexible hinges 322 around which the haptics are flexible anteriorly and posteriorly with respect to the optical. The diametral distance between the outer ends of the diametrically opposed haptics 312, 314 approximates or slightly exceeds the maximum diameter of the capsular bag 20. The lens 310 is implanted inside the bag and the fibrosis of the anterior capsular edge 22 of the bag occurs around the lens haptics in the same manner as described in connection with the lens 290. After the fibrosis is completed. , relaxation and strangulation of the ciliary muscle 28 of the eye initiated by the brain causes lens accommodation in the same manner as described in connection with the lens 290. The fibrosis of the capsular border around the haptic protuberances 318 fixes the lens in the capsular bag and against displacement in the event that a tear or a capsulotomy is formed in the posterior capsule 24 of the bag.

The accommodating plate haptic lens described herein is referred to herein as a single plate haptic lens. These lenses are intended for use when the anterior capsulotomy procedure performed on the eye provides a remnant or anterior annular capsular rim that remains intact and continuous in its circumference throughout the fibrosis and has sufficient radial width to retain the lens in position. appropriate inside the capsular bag during and / or after fibrosis. According to another of its aspects, modified accommodating intraocular lenses are provided which are illustrated in Figures 38–40 and 43–46 and are referred to as plate haptic spring lenses, for use when the remnant or anterior capsular edge of The capsular bag is broken, that is, cut or torn, or has a radial width too small to firmly hold the lens in proper position during and / or after fibrosis.

As indicated above, a rupture of the remnant or capsular edge of different shapes can occur. For example, a circular continuous tear capsulotomy, or capsulorhexis, (Figure 35) involves tearing the anterior capsule of the natural lens along a circular tear line to form in the anterior capsule a circular opening or capsulotomy 400 surrounded in its circumference by a remnant or annular edge 22 of the anterior capsule. Improper performance of this capsulorhexis can easily create slits or tears 404 at the capsular edge. A beer can capsulotomy or can opener (Figure 36) involves perforating the anterior capsule of the natural lens in a multiplicity of positions near 404 along a circular line and eliminating the circular portion of the anterior capsular edge within the line. perforated to form an opening 406 of the anterior capsule surrounded at its circumference by an annular edge 408. While this edge may initially be intact and continuous in its circumference, it has a margin 410 with internal recesses that have tension inducing regions that make the edge very prone to tear radially, as shown in 411, during subsequent surgery or fibrosis. A shell capsulotomy (Figure 37) involves opening the anterior capsule of the natural lens along a horizontal line 412, then along vertical lines 414 that extend upward and cross the horizontal slit, and then tear the capsule anterior along a tear line 416 that arches upwardly from the upper end of the vertical slit and then extends vertically downward to join with the second vertical cut. This capsulorhexis produces an opening 418 of the anterior capsule surrounded by a capsular remnant 420 that opens at 412 and is therefore inherently broken.

A broken anterior capsular border or remnant may prevent the use of a single plate haptic lens of the invention for the following reasons. A broken edge cannot firmly retain the lens haptics in the groove of the capsular bag during fibrosis. This makes the lens prone to off-centering and / or displacement, such as displacement in the vitreous cavity if the posterior capsule is torn or clouded over a period of time and cut with a laser to provide a capsulotomy in the posterior capsule. A broken capsular edge may be unable to adopt the state similar to an elastic trampoline bed of an intact capsular edge. As a consequence, a broken capsular edge may be unable to effect the complete posterior deviation of a plaque haptic lens to a distant viewing position against the posterior capsule during and after fibrosis. A broken capsular edge may also allow anterior deviation of the lens during fibrosis. In any case, since the power of an intraocular lens is selected for each individual patient and may depend on its power of glasses, and since good vision without glasses requires that the lens optic be precisely at the correct distance from of the retina during the entire accommodation interval, a single plate haptic lens of the invention may not be acceptable for use with a broken anterior capsular border or remnant.

Figures 38–40 illustrate an intraocular lens 420 of a haptic plate spring that is accommodated for use with a remnant or broken anterior capsular edge, such as any of those illustrated in Figures 35–37. This plate haptic spring lens has an appropriate lens body 422 similar to that of plate haptic lens 32 in Figures 1-8 and springs 424 at the ends of the body. The lens body 422 includes a central optic 426 and flexible plate haptics 428 extending outward from diametrically opposite sides of the optic. These haptics are attached to the optic by hinges 429 formed by grooves on the front side of the lens. The springs 424 are elastic loops placed at one end to the ends of the haptics 428 on opposite sides of the longitudinal centerline of the body. These spring loops are folded outward in the length of the lens body from their bent ends to their centers and then rotated back toward the lens body from their centers to their free ends. The ends of the haptics 428 have recesses 430 over which the spring loops extend so that the loops and the edges of the recesses form openings 432 between them. The ends of the spring loops have holes 433 to receive instruments to position the lens in the eye.

The haptic plate lens 420 is implanted inside the eye capsule bag 20 in the same manner as described above in connection with the single plate haptic lenses of the invention. That is, the lens 420 is implanted into the eye while its ciliary muscle 28 is paralyzed in its relaxed state, and the capsular bag is therefore stretched to its maximum diameter (9-11 mm). The overall length of the lens body 422 measured between the ends of the haptics 428 of the lens on either side of the haptic gaps 439 substantially equals the inside diameter of the stretched capsular bag. The overall length of the lens measured between the outer edges of the spring loops 424 at their centers when the loops are in their normal unstressed state is slightly greater than this inner diameter of the stretched capsular bag. For example, if the inside diameter of the stretched capsular bag is in the range of 10–10.6 mm, the lens body 422 will have an overall length of 10–10.6 mm measured between the outer ends of the haptics of the lens, and the overall length of the lens measured between the centers of the non-tensioned spring loops will be in the range of 11-12.5 mm.

Figures 39 and 40 illustrate the haptic spring plate lens 420 implanted in a capsular bag 20 that is stretched by relaxation of the ciliary muscle 28 and has a torn anterior capsular edge 22 such as could result from a circular continuous capsulorhexis of continuous tear made of inappropriate way. Because the edge is torn, the lens body 422 will not fit as well in the stretched bag as it would if the capsular edge were an intact edge without tears. The loops 424 of haptic springs, however, press out against the groove wall of the capsular bag around the edge of the bag to fix the lens in the bag during post-surgery fibrosis. The fibrosis of the torn capsular edge 22 occurs around the outer ends of the haptics 428 of the plate, around the spring loops 424, and through the openings 432 between the loops and the ends of the haptics in such a way to effect fusion of the torn edge, or more precisely the remnants of the torn edge, with the posterior capsule 24 of the capsular bag. The outer ends of the haptics and the spring loops are therefore packaged by fibrosis somewhat in the same manner as explained above in connection with the single plate haptic lenses of the invention. Even though the torn capsular edge 22 may be unable to stretch to the stretchy trampoline state discussed above when the ciliary muscle is relaxed, this packing of the lens during fibrosis of the torn edge will firmly fix the lens in the capsular bag and should cause some posterior deviation of the lens against the elastic posterior capsule 24. Therefore, strangulation and relaxation of the ciliary muscle 28 induced by the brain after the fibrosis of the torn capsular rim is completed should accommodate the accommodation of the plate haptic spring lens as much in the same way, but possibly not with the same amount of accommodation, as the single plate haptic lens with an intact unbroken capsular edge.

While the plate haptic spring lens 420 is designed for use with a remnant or broken anterior capsular edge, it can also be used with an intact edge. A plate haptic spring lens also compensates for improper placement of the lens in the eye with one end of the lens located in the capsular bag and the other end of the lens located in the ciliary groove of the eye since the spring loops they will expand outward to fit both the inner edge of the bag and the cylindrical wall. In this regard, an advantage of the plate haptic spring lenses of the invention over single plate haptic lenses lies in the fact that the spring lenses eliminate the need to have both a haptic lens in the operating room Single plate for use with an intact capsular edge such as a plate haptic spring lens as a support for the plate haptic lens in case the edge is broken during surgery.

Another advantage of the haptic spring lens 420 lies in the fact that it allows the lens to have a larger optic than a single plate haptic lens whose optical diameters will normally be within the range of 4–7 mm. Therefore, since the haptic spring lens depends on the spring loops 424 instead of on the remnant or capsular edge 22 to retain the lens in position during fibrosis, the lens can be used with a remnant or capsular edge of radial width smaller and therefore an opening of the anterior capsule of larger diameter than those required for the use of lenses that accommodate single plate haptics. The opening of the larger-sized anterior capsule, of course, allows a larger optical diameter in the range of 7–9 mm that offers certain ophthalmological benefits.

The opening of the large-diameter anterior capsule necessary to accommodate a lens that accommodates large optical spring can be formed during the original surgery by a planned large continuous circular tear capsulorhexis, a beer can capsulotomy of the desired large diameter, a capsulotomy of planned wrapping or cutting radial grooves in the anterior capsular edge during surgery after implanting the spring-fitting lens in the capsular bag. According to another of its aspects, the invention provides a method by which the opening of the desired large anterior capsule can be formed after the original surgery after the conclusion of the fibrosis. This method involves opening a radially annular capsular edge with a laser after fibrosis is completed in several remnants similar to flaps 434 (Figure 41) that easily move with the lens during accommodation to allow the lens optician to pass through of the opening of the anterior capsule. Alternatively, the opening of the anterior capsule can be enlarged by cutting the capsular edge with a laser at its circumference along a circular line 406 (Figure 42) concentric with and radially outward from the original edge of the opening to extend the latter.

The modified plate haptic spring lens 500 of Figure 43 is identical to the lens 420 just described except that the haptics 502 of the modified lens, instead of being crimped with the lens 504 of the lens, are elastically flexible throughout length like those of the plate haptic lens in figure 9. Figure 44 illustrates an additional modified plate haptic spring lens 600 according to the invention that is identical to lens 420 except that the spring loops 602 of the modified lens are integrally formed with the lens haptics 604. The modified lens 700 and 800 of Figures 45 and 46 are identical to the lens 600 except that the modified lens has a pair of spring loops at each end. The lens loops 702 of the lens 700 have common base portions 704 integrally attached to the ends of the lens haptics 706 along the longitudinal centerline of the lens and free ends curving outwardly from the portions of base both at the ends and laterally with respect to the lens. The lens loops 802 of the lens 800 have base portions 804 integrally bonded to the ends of the haptics 806 of the lens along the longitudinal edges of the opposite haptics and free ends curving inward toward another side of the lens. lens.

Figures 47–50 illustrate an intraocular lens that fits. The lens 900 illustrated is a plate haptic spring lens having a body 902 that includes a round 904 bi-convex optic and plate haptics 906 joined to diametrically opposite sides of the optic by hinge junctions 908.

The haptics 906 have relatively wide outer end portions 910, tapered inner portions 912, and relatively narrow tapered inner end portions 914. The inner end portions 914 are joined to diametrically opposite edge portions of the round optic 904. The width of the outer end portions 910 of the haptics measured transverse to the length of the lens approximates the diameter of the optic. The width of the inner haptic end portions 914 measured transverse to the length of the lens is substantially smaller than the diameter of the optic. The outer end portions 910 and the tapered central portions 912 of the haptics occupy the main length of the haptics measured in the direction of the lens length. The tapered inner end portions 914 of the haptics narrow inwardly to a progressively narrower width toward the outer ends of the haptics. These inner end portions effectively form bridges between the optic and the wide outer main portions 910 of the haptics. The inner haptic end portions contain V-grooves 916 that extend through the front sides of these end portions transverse to the length of the near lens and preferably in virtually tangential relationship with the edge of the optic 904.

The outer end portions 910 of the haptics 906 contain relatively large openings 918 in the form of cutouts that open through the outer ends of the haptics. Attached at one end of the outer ends of the haptics, on one side of the open ends of the haptic cuts 918, there are spring arms 920. These arms extend laterally through the outer haptic ends and are elastically flexible at the ends of the lens.

As shown in Figure 48, the optic 904 is previously compensated in relation to the haptics 906 of the plate. That is, a plane (middle plane) containing the edge of the circumference of the lens is compensated earlier along the axis of the lens in relation to a plane (middle plane) that passes through the parallels of the haptics already halfway between its anterior and posterior sides. This anterior compensation of the optician provides recesses 924 similar to grooves on the rear side of the lens along the optic junctions and the inner ends 914 of the haptics. The relatively thin band-like portions of the lens body between the anterior grooves 916 and the posterior recesses 924 are elastically flexible and form the hinge joints 908 around which the lens haptics are flexible anteriorly and posteriorly in relation to with the lens optic.

Referring to Figure 49, the lens 900 is implanted in the capsular bag 20 of a patient's eye, and after the conclusion of the fibrosis, experiences accommodation in response to the contraction and relaxation of the ciliary muscle 28 at most in the same way. which has been described in connection with embodiments of lenses of the invention described above. Lens spring arms 920 press outwardly against the outer perimeter of the bag to place the lens in the bag even though the previous remnant 22 of the bag may be creased, torn or otherwise intact, in the same way which has been described in connection with figures 38–40. During fibrosis of the anterior capsular edge 22 of the bag 20 with the elastic posterior capsule 24 after surgery, fibrosis occurs around the haptics 906 of the lens and through the haptic openings 918 to fix the lens in the capsular bag. The ciliary muscle 28 remains in its relaxed state until the fibrosis is completed by introducing a cycloplegic into the eye, as explained above.

The previous compensation of the optical 904 in the preferred lens 900 provides two advantages. One of these advantages lies in the fact that the arrangement of the hinge joints 908 resulting from the anterior compensation of the optic 904 helps the anterior buckling of the lens and thus the optic accommodation movement in relation to the outer ends of haptics 906 in response to compression at the ends of the lens by contraction of the ciliary muscle 28. The other advantage lies in the fact that the hinge joints 908 that connect the haptics 906 to the diametrically opposite edge portions of the optic 904 are relatively narrow compared to the diameter of the optic and are preferably narrower than the radius of the bag, as shown. The hinge joints therefore occupy only relatively small portions of the edge of the circumference of the optic. The portions of the edge of the circumference of the optician remaining between the joints are free edge portions that are completely unobstructed by the haptics and taken together constitute a major portion of the circumference of the optician. The diameter of the optician is made to approximate or be slightly smaller than the opening 26 of the anterior capsule in the capsular bag in which the lens is implanted. These characteristics of the lens allow the lens to experience increased anterior movement of movement from its posterior distant viewing position of Figure 49 to its front accommodation limit of Figure 50, in which the optic is projected through the aperture 26 of the anterior capsule, in response to contraction of the ciliary muscle 28. The narrowing inward of the inner or end bridge portions 914 of the haptics allows these haptic portions to slide in and out of the haptic pockets of the capsular bag during lens accommodation.

Actual dimensions of preferred lenses may vary depending on the patient's ocular dimensions. The following are typical lens dimensions:

Overall lens length: 10.5 mm Overall lens length including springs: 11.5 mm Optical diameter: 4.50mm Width of the haptic outer end: 4.50 mm Narrowing angle of the haptic edge: 30 degrees Length of the inner haptic end portion: 0.75 mm Haptic thickness: 0.25–0.4 mm Hinge joint width: 1.50 mm Lens material: silicone

In the lens 900 of Figures 48–50, the optic 904 is previously compensated in relation to the haptics 906 within the thickness of the haptics such that both the edge of the optic circumference and the hinge junctions 908 are they place within the thickness of the haptics and between their anterior and posterior surfaces. Figure 51 is a longitudinal cross-section similar to Figure 48 through a modified intraocular lens 900a of the invention that is identical to lens 900 except that the optic 904a of lens 900a is compensated earlier in relation to the haptics 906a out of the thickness of the haptics. That is, in the lens 900a, both the edge of the circumference of the optic 904a and the hinge joints 908 between the optic and the haptics are positioned forward of the anterior surfaces of the haptics 906a. This modified lens configuration provides the same advantages as that of Figures 48–50.

The modified intraocular lens 900b of Figure 52 is essentially identical to lens 900 except for the following differences. Integrally joined at its ends and extending through the outer ends of the lens haptics 906b are relatively thin bridges or arches 922b that surround and close the adjacent sides or ends of the haptic openings 918b. These arcs are typically 0.20 mm wide and bend in a radius of 5.25 mm around the optical axis of the lens optic 904b. The arches can be elastically flexible or relatively flexible or relatively rigid. The spring arms 922b of the lens 900b extend laterally through the outer ends of the haptics opposite the open ends or sides of the haptic openings 918b and are flexible at the ends of the lens.

The modified fitting lens 900c of Figure 53 is similar in many ways to the lens 900b of Figure 52 and differs from the last lens in the following. The spring arms 920b of the lens 900b are omitted in the lens 900c. The inner end or bridge portions 914c of the lens haptics 906c are quite short in the direction of the lens ends. In fact, the length of the inner haptic end portions 914c approximates or is just slightly greater than the width of the open sides of the haptic grooves 916c forming the junctions 908c of haptic hinges with the optical lens 904c around which The haptics are flexible anteriorly and posteriorly in relation to the optic. As a consequence, these hinge joints occupy or constitute almost the entire length of the inner haptic end portions 914c. Haptic end arches 922c can be elastically flexible or relatively rigid.

The lenses 900a, 900b, 900c of Figures 51–53 are implanted in the capsular bag of a patient's eye and provide vision accommodation in response to contraction and relaxation of the ciliary muscle essentially in the same manner as the lens 900 of Figures 47–50. In the case of lenses 900b, 900c, however, fibrosis occurs through the closed openings 918b, 918c in the lens haptics and around the end arches 922b, 922c haptic to fix the lens in the patient's eye. The lens 900c can be adjusted in size in length between the outer sides of its arches 922c to be closely fixed in the capsular bag when the ciliary muscle is relaxed, and these arcs can be made elastically flexible to enable the arcs to serve as springs that press against the perimeter of the bag to place the lens in the bag in the same manner as the haptic springs of the plate haptic spring lenses described above even though the previous remnant of the bag may be split, torn or not an intact remnant otherwise.

The less inert materials used for intraocular lens components are preferably selected to provide optimal fixation of the lens portions in the peripheral portions of the capsular bags, and to provide optimum lens centering. Less fibrosis forms around components formed by inert materials than around less inert materials. Less inert materials produce greater fibrosis, occurring around the components. Such materials include PMMA, acrylic, prolene (a nylon) and polyimide.

Fibrosis forms more firmly around those materials that are less inert, for the reason that the body treats such materials as foreign objects. The lens elements, such as bumps, arms and loops, are preferably formed by less inert material, and the elements intended for a relative sliding movement in a pocket of the fibrosis capsular bag, are formed by more inert materials, such as silicone, polyhema (hydroxymethyl methacrylate) or HEMA.

Referring now to Figs. 54–56, as well as Figs. 62 and 63, an intraocular lens 1000 that is accommodated anteriorly deviated in accordance with the invention in its posterior distant viewing position within the capsular bag 20 is illustrated. of a patient's eye. Lens 1000 is like the lens described above except in the following aspects. The anterior surfaces 1002 of the thickened or haptic extended portions of the lens plate 1000 are at the same level as the anterior surface of the lens 1006 of the lens. The rear haptic surfaces 1008 are tilted back away from the anterior haptic surfaces 1002 from the outer haptic tips towards their inner joints with the optic 1006 and then forward towards the previous haptic surfaces to define, with the peripheral edge of the optic, notches with V-shaped backs that form flexible 1010 hinges thinned at the inner haptic ends. Optic 1006 has a convex rounded rear surface 1012.

The lens 1000 is implanted in the capsular bag 20 in the same manner as the lenses described above and is subjected to the same contraction and relaxation of the ciliary muscle as the lenses described above during normal vision accommodation after the conclusion of the fibrosis. The lens 1000 is sized and shaped so that the rear surfaces 1008 of its haptics 1004 and the rear surface 1012 of its optic 1006 are brought into contact with the posterior capsule 24 of the bag 20. When the lens 1000 occupies its rear view configuration of Figures 54–56 which it adopts in its rear view position shown in the last figures, its hinges 1010 are located a short distance forward from the plane P of the haptic tip of the lens, that is, a plane that passes through the outer tips of the haptics 1004 and the groove that receives the annular haptic tip of the capsular bag 20 normal to the axis of the lens and the eye. Therefore, during contraction of the ciliary muscle in the course of normal accommodation, end-to-end or radial compression of the lens 1000 and the vitreous pressure exert both anterior accommodation forces on the lens 1006 of the lens throughout its entire range complete accommodation This combined action of the two forces increases the amplitude of accommodation and therefore the diopter of accommodation of the lens.

Figures 62 and 63 illustrate two intraocular lenses 1000a and 1000b that accommodate modified anterior deviations according to the invention implanted within a capsular bag 20 of a patient's eye. These modified anterior deviated lenses are identical and experience accommodation at most in the same manner as the anterior deviated lens of Figures 54–56 with the following exceptions. In the lens 1000a, only the posterior surfaces 1004a of the extended or haptic portions 1002a of the lens plate are brought into contact with the posterior capsule 24 of the capsular bag. Therefore, the vitreous pressure acts only on these haptics during accommodation, and the lens optic is immune to laser damage during the laser capsulotomy of the posterior capsule. The posterior surface 1012a of the lens optic 1006 is separated from the posterior capsule. In the lens 1000b, only the rear surface 1012b of the lens optic 1006b contacts the rear capsule 24 of the capsular bag. The posterior surfaces 1004b of the lens plate haptics 1002b are separated from the posterior capsule. Therefore, during accommodation, the vitreous pressure acts only on the rear surface of the optic.

Most intraocular lenses that accommodate the embodiments described so far have extended portions of the hinge in the form of haptics with elastically flexible haptic hinges. Figures 60–61 illustrate modified lenses that have extended portions in the form of essentially hinge haptics. The lens 1100a of Figure 60 includes a central optic 1102a and plate haptics 1104a (only one shown) that extend opposite from the optician and are joined by central hinges 1106a to the edge of the optic. Each haptic hinge comprises portions 1108a, 1110a of binding hinges on the respective haptic and optics, which fundamentally interconnect and connect the haptics with the optic for the anterior and posterior movement of the haptics in relation to the optic.

The intraocular lenses 1100a and 1100c that accommodate figures 60 and 61 are made of materials that are not firm or hard enough to form hinge portions, and their hinge portions are manufactured separately with suitably hard or firm materials to reinforce Hinge inserts or inlays, which are molded into the optics and lens haptic plates. The parts of the lenses 1100a and 1100b are designated by the same reference numbers as the corresponding parts, with subscripts a and b for the respective lenses.

The optic and each haptic plate may be molded or otherwise manufactured from any suitable intraocular lens material including the materials mentioned above. These materials have optics and other qualities suitable for an intraocular lens. Some of the materials are hard or firm enough to allow the components of the haptic hinge to be molded or otherwise formed integrally with the haptic plates, and each haptic hinge groove is molded or otherwise formed in the material of the lens optic, as shown. Each hinge portion of such an embodiment would have a hinge groove or channel along the edge of the optician that opens laterally outward toward the optic, each hinge groove being cylindrically curved, cut in a biased manner or adjusted in size in cross section to receive essentially the pearl of the adjacent haptic tongue, whereby the pearl is captivated in the groove and the respective haptic moves primarily within certain angles anteriorly and posteriorly in relation to the optic.

The lens 1100a of Figure 60 comprises an elongated hinge plate 1120a that is encapsulated and extends along the edge through, forming a reinforcement insert or insert, within a respective haptic plate 1114a. At the inner end of this hinge plate there is a cross bar 1122a that extends along the edge beyond the inner end of the haptic plate 1114a to form the tongue 1112a on the hinge portion 1108a. On the outer end of each hinge plate 1120a there are flexible fingers 1124a. Each haptic hinge portion 1110a comprises a rod that is encapsulated within and forms a reinforcement insert or reinforcement at the edge of the lens 1102a of the lens. Along the outer edge of the bar is the groove or hinge channel 1118a which essentially receives the cylindrical bead 116a along the adjacent hinge tongue 1112a.

The modified lens 1100b of Figure 61 is like the lens 1100a except that the inner end of each haptic plate 1114b extends along the edge beyond the inner crossbar 1122b of the reinforcing hinge plate forming the portion 1108b of respective haptic hinge of the lens 1100b. This inner end extending from each haptic plate 1114b has a rounded cylindrical surface and a central notch 1126b. Each haptic hinge portion comprises a hinge bar 1128b encapsulated at the edge of the lens 1102b of the lens and having a projection 1130b of central rounded hinge. This hinge projection is rotatably adjusted within the notch 1126b of the hinge portion 1108b, thus forming the respective haptic hinge 1106b with the hinge screw 1132b, which extends through holes aligned in the hinge portion Haptic in optical hinge projection.

Figures 57–59 illustrate an intraocular lens 1050 that is accommodated implanted within a capsular bag 20 of a patient's eye. This lens is an anteriorly deflected lens with flexibly extended haptic portions of hinge, which achieves an increased range of accommodation and increased diopter of accommodation by the combined action of (a) its anteriorly offset configuration that increases the amplitude of accommodation and increased accommodation diopters, and (b) increased power of its optician that increases the amount of accommodation produced by any given amount of accommodation movement of the lens optic or, conversely, reduces the accommodation movement of the optician required to produce any given amount of accommodation .

The lens 1050 comprises a one-piece lens structure having a central optic 1052 and flexibly extended hinge portions 1054 in the form of plate haptics that generally extend radially from the optic. Each plate haptic 1054 narrows longitudinally in width and thickness to widen in width and increase in thickness towards its inner end. Each plate haptic includes an inner plate portion 1056 that is integrally attached to an edge of the optic 1052 and inclines anteriorly relative to the optic towards its outer end, an outer plate portion 1058 attached to the outer end of the portion of inner plate, and a V-groove 1060 that enters through the union of these plate portions to form in this joint a flexible hinge 1062. The outer plate portion 1058 moves fundamentally in its hinge anteriorly and posteriorly in relation to the inner plate portion 1056 and the optical 1052. The lens structure including its optic and portions 1056, 1058 of the haptic plate is molded or it is otherwise formed as a unit lens structure from a lens material mentioned above and has inserts 1054 fixed at the outer ends of the outer haptic plate portions 1058. These inserts provide the lens with extended portions or haptics 1054 and can be used to reinforce portions 1058 of outer haptic plate if necessary.

The lens 1050 is implanted in the capsular bag 20 of the eye with the ciliary muscle of the paralyzed eye in its relaxed state and maintained in this paralyzed state until the conclusion of the fibrosis, all in the same manner as explained above. During this fibrosis, the optic 1052 of the lens is propelled posteriorly to its far vision position shown in solid lines in Figure 57 and in dashed lines in Figure 58 in which the rear surface of the optician presses back against the posterior capsule 24 of the tilt bag and pulls this posterior capsule backwards. The configuration that the lens 1050 adopts or occupies in this posterior far vision position is its posterior far vision configuration. The contraction of the ciliary muscle during normal vision accommodation after the conclusion of the fibrosis increases the vitreous pressure and compresses the lens radially or at the ends to effect the anterior accommodation movement of the lens optic 1052 in the same way as He has explained above.

As mentioned above, lens 1050 is a lens deflected earlier. In this aspect, it will be seen in Figures 57 and 58 that when the lens occupies its position of far posterior vision, its haptic hinges 1062 are placed forward of a pointed PT plane passing through the outer tips of the haptics 1054 from the normal lens to the 1052 optical axis of the lens and the eye. Accordingly, compression of the lens by contraction of the ciliary muscle during normal vision accommodation is effective in producing an anterior accommodation force over the optic during its entire range of complete accommodation from its posterior distant vision through its position of medium interval (solid lines in figure 58) to its previous near vision position (dashed lines in figure 58). The compression of the lens by the contraction of the ciliary muscle therefore helps the anterior vitreous pressure force on the optic during its entire accommodation range and therefore increases the amplitude of accommodation and the diopter of lens accommodation, as explained above.

An important feature of the lens 1050 is that its optic 1052 has increased optical or dioptic power that aids the anterior deflected configuration of the lens to further increase the amplitude of accommodation and the diopter of accommodation. For this purpose, the front face 1066 of the optician is relatively flat or just slightly convex while the rear face 1068 of the optician has a relatively pronounced convex curvature so that the optician has a generally planar convex shape. This optical form places the majority

or all the optical power of the optician on the rear side of the optician. Increasing the power of the lens optic in this way decreases the distance through which the optician must move to produce any given amount of vision accommodation and, conversely, increases the amount of vision accommodation produced by any given optical movement of the optician and thereby increases the amplitude of maximum accommodation and the diopters of lens accommodation.

Increasing the power of an optic of an intraocular lens on the back side of the optician, as in Figures 57–58, changes the optic plane of the optician (that is, the plane from which the optic focal point originates) towards back towards the retina 16 of the eye. For example, the optical plane PO of the lens optic 1052 is located at the approximate position shown in Figure 58 which is backwards from the position of the optical plane (not shown) of a symmetric biconvex optic of the same thickness at the measured center along the axis of the optician but which has anterior and posterior surfaces of equal curvature. This backward shift of the optical plane of the optician towards the retina must be compensated by increasing the optic power of the optician to clearly focus incoming light rays on the retina. The required increase in the power of the optic 1052 is achieved by appropriately shaping the pronounced convex curvature of the rear surface 1068 of the optic.

Figure 64 illustrates an embodiment of the invention comprising a central optic 1202 and extended or haptic portions 1204 extending from opposite edge portions of the optic. The optic, in side view, (not shown) is preferably of the configuration shown in Figures 58 and 59 to provide the operation and advantages described above in relation to the embodiment of those figures.

The haptics or extended portions include plates 1206 having inner ends attached to the optic and with free outer ends, and flexible locking fingers 1208 extending laterally at the outer ends. The openings 1209 are defined at the outer ends of each fixing finger for improved fibrosis fixation.

The haptic plates 1206 narrow longitudinally to reduce in width in the outward direction, and have a width in its entire length less than the diameter of the optic. The haptics and their outer ends can be moved anteriorly and posteriorly in relation to the optic. The hinges 1210 are defined by grooves in the haptics that enter the front or rear sides and extend through the inner end portions of the haptic plates 1206.

The lens has a relatively flat non-tensioned configuration in which the haptics 1204 and their hinges are arranged in a generally common plane. The outer edges of the haptic plates and fingers 1208 may preferably be circularly curved generally around the axis of the optic 1202. In their normal unstressed state, the fingers extend laterally outward from opposite longitudinal edges of the respective haptic plates . When not tensioned, fingers 1208 preferably arch with a slight curvature inwards.

The deformation of the lens from the normal non-tensioned configuration by the anterior or posterior deviation of the haptics produces elastic tension energy forces in the hinges that drive the lens to its normal non-tensioned configuration.

Figure 65A shows a modification of the embodiment of Figure 65 in which a pocket 1214 with gaps is defined in a haptic portion to accommodate a drug, such as atropine or a related drug, to paralyze the ciliary muscle for a period of time , or another drug for some other purpose. Such a pocket can be provided in both haptics, although Figure 65 shows only a partial view with only one haptic.

The embodiments of Figures 64 and 65 have flexible fingers 1208 and 1206 on inserts formed of a material different from that of the haptic plates, and preferably of a material that is not particularly inert, to thereby effect a better fibrosis formation around fingers and bumps 1209. Inert and relatively less inert materials have been discussed earlier in this document. Haptic plates 1206 are preferably constructed of elastic semi-rigid material.

Figures 66 and 67 illustrate somewhat related embodiments.

The intraocular lens 1300 of Figure 66 has an optical 1302, preferably configured, in side view, as shown in Figures 58 and 59 to provide the advantages and operation described above of the embodiment of Figure 59 of the invention. A plurality of portions of relatively small extensions or haptic plates 1304 having hinges 1306 to facilitate posterior and anterior movement of the optic in response to the action of the ciliary muscle. The hinges 1306 are defined by grooves in the haptic plates and / or grooves 1306a in the loops. The hinge action of the plates can be provided as an alternative forming haptics of a flexible material.

Two pairs of haptics extend opposite from the optician, and a loop 1310 extends between each pair of haptics, and is secured to the haptics. An arm 1312 extends from an arcuate transverse portion of each loop 1310 at an acute angle from the transverse portion. Each arm 1312 has a final protrusion defining an opening 1314 for improved fixation and centering.

Figure 67 illustrates a related embodiment 1350 having an optical 1352, and loops 1354 extending outward between pairs of haptics or portions 1356 of small, radially extending, spaced apart extensions. As with the embodiment of Figure 66, the hinge action can be provided with grooves 1357 in the haptics

or with grooves 1357a in the loops. An arm 1358 extends from each loop at an acute angle with it, and has a protuberance 1360 defining a fairly large opening at its end, as shown. Enhanced fibrosis-centered and securement is provided with or without the opening in there, by the bulge. The protrusions 1314 of Figure 66 and 1360 of Figure 67, preferably with the openings therein are important features in that they provide retention and centering substantially enhanced by fibrosis. The arms 1358 and their protuberances 1360, as well as the loops 1354, are preferably formed of a relatively non-inert material for improved fibrosis thereon.

Therefore, a new intraocular lens that accommodates all the objectives and advantages sought therefore has been shown and described. Many changes, modifications, variations and other uses and applications of the subject of the invention will, however, become apparent to those skilled in the art after considering this specification together with the accompanying drawings and claims. All such changes, modifications, variations and other uses and applications that do not depart from the scope of the invention are considered to be covered by the invention which is limited only by the claims that follow.