Intraocular lens structure.

© Patent holder (s):

Oculentis Holding BV in Eerbeek.

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Inventor (s):

Bernardus Franciscus Maria Wanders in Angerlo.

© Patent issued:

11.02.2015 © Authorized representative:

PA van Essen et al. in Wageningen.

© Intraocular lens structure.

© The invention provides an intra ocular lens structure (IOL) for placement in the capsular bag and securing the IOL in an opening in an anterior part of a capsular bag, with an anterior capsular bag flap surrounding said opening, said IOL having an anterior side which in use when the IOL is implanted in an eye is directed towards a cornea of ​​the eye, and a posterior side which in use when the IOL is implanted in an eye is directed towards a retina of the eye, said IOL comprising an optical structure, at least two posterior supports forwhen the IOL is implanted in the capsular bag residing in the capsular bag extending away from said optical structure, said posterior supports adapted for in use providing support surfaces for a posterior surface of an anterior capsular bag flap, and at least two anterior supports for when the IOL is implanted in the capsular bag residing outside the capsular bag extending away from said optical structure, said anterior supports adapted for in use providing support surfaces for an anterior surface of an anterior capsular bag flap, wherein a posterior plane defined by the support surfaces of the posterior supports and an anterior plane defined by the support surfaces of the anterior supports are spaced apart at a distance adapted for holding an anterior capsular bag flap between them for securing the IOL in said opening.

LC 2011235

This patent has been granted regardless of the enclosed result of the prior art research and written opinion. The patent corresponds to the documents originally filed.

P100130NL00

Intraocular lens structure

Field of the invention

The invention relates to an intraocular lens structure (IOL), and a method for inserting such an IOL.

Background of the invention

In modern cataract procedures, also called extracapsular cataract extraction, a hole is cut in the anterior capsular bag. This may be done using laser devices. Subsequently, the natural lens is removed. In the remaining parts of the capsular bag, in many suggested procedures an IOL is placed. The IOL more or less maintains its position.

Usually, an IOL is provided with haptics. These haptics extend radially from a lens of an IOL. After implanting an IOL, these haptics usually engage the inside circumference of the remaining capsular bag part in order to more or less keep the optics, for instance a lens, of the IOL centered an positioned in the capsular bag.

Lor improving fixation of the position of a IOL, many designs were proposed. US6027531 describes “An intraocular lens for use in extracapsular cataract extraction has a haptic pa [r] t that surrounds the optical pa [r] t of the lens and further contains a groove of such shape to accommodate the anterior and posterior capsules of the lens bag after anterior capsulorhexis, extracapsular cataract extraction and posterior capsulorhexis. The lens is preferably inserted in a calibrated, circular and continuous combined anterior and posterior capsulorhexis, slightly smaller than the inner circumference of the groove as to induce a stretching of the rims of the capsular openings. This new approach is believed to prevent the appearance of secondary opacification of the capsules, allows a very stable fixation of the intraocular lens and ensures a tight separation between the anterior and posterior segment of the eye. This new principle of insertion is called the bag-in-the-lens technique, in contrast with the classical lens in-the-bag technique. ”. Placement of this IOL requires skills and the capsular bag may get damaged. If after insertion the capsular bag ruptures, the IOL will not maintain its position.

In US6881225, an intraocular lens structure for reducing complications is described. The intraocular lens structure comprises an optic, a support and a closing fixture. The closing fixture is a groove or a valley formed on the side portion of the optic of the intraocular lens. The valley is formed by the optic and a protrusion projecting posteriorly from the optic. The groove or the valley in the optic is made engaged with the posterior capsular opening generally over the entire circumference of the groove or the valley to close the opening of the posterior capsule. Like most of the current IOL structures, the structure also uses its haptics for keeping the structure in the capsular bag. The groove holds the posterior part of the capsular bag.

US5171320 describes an intraocular lens system adapted to be implanted within a generally circular opening in an anterior wall of the capsular bag which normally contains the crystalline lens of an eye. The intraocular lens system includes a lens body having an annular groove which is formed in a peripheral portion thereof in a plane substantially perpendicular to an optical axis of the lens body. The lens body includes an optically effective portion located radially inside the annular groove, and an anterior lens portion and a posterior lens portion located on respective anterior and posterior sides of the annular groove. The intraocular lens system is secured in position within the circular opening such that an annular flap portion of the capsular bag which surrounds the circular opening is accommodated within the annular grove in the lens body.

Summary of the invention

A disadvantage of prior art is that placement of the IOL may be very difficult, with a high chance of damaging the capsular bag during the medical procedure, or may get damaged after the IOL is placed, or that there remains room for improvement.

Hence, it is an aspect of the invention to provide an alternative IOL, which preferably further at least partly obviates one or more of above-described drawbacks. In particular, the IOL of the invention allows proper and straightforward placement. Alternatively of additionally, it induces less damage to the capsular bag and allows secure positioning.

The invention in an embodiment provides a an intra ocular lens structure (IOL) for placement in the capsular bag and securing the IOL in an opening in an anterior part of a capsular bag, with an anterior capsular bag flap surrounding said opening, said IOL having an anterior side which in use when the IOL is implanted in an eye is directed towards a cornea of ​​the eye, and a posterior side which in use when the IOL is implanted in an eye is directed towards a retina of the eye. The IOL comprises an optical structure. Furthermore, the IOL comprises at least two posterior supports for when the IOL is implanted in the capsular bag residing in the capsular bag and extending away from said optical structure. The posterior supports are adapted for in use providing support surfaces for a posterior surface of an anterior capsular bag flap. The IOL further comprises at least two anterior supports for when the IOL is implanted in the capsular bag residing outside the capsular bag, and extending away from said optical structure. The anterior supports are adapted for in use providing support surfaces for an anterior surface of an anterior capsular bag flap. The IOL further has a posterior plane defined by the support surfaces of the posterior supports and an anterior plane defined by the support surfaces of the anterior supports. These planes are adapted to be spaced apart at a distance adapted for holding an anterior capsular bag flap between them for securing the IOL in said opening.

It was found that due to the geometry and limited depth (approx. 0.2mm) of prior art circumferential groove in known IOL's, the anterior capsular bag flap could easily escape from that groove resulting in IOL dislocation. Furthermore, the rotation stability of the lens structure may not optimal due to the prior art groove's geometry

The terms “anterior” and “posterior” relate to an arrangement of features relative to the propagation of the light into the eye. Thus, light enters cornea and iris, which are anterior parts of the eye, and propagates to the retina that is located in the posterior part of the eye.

An eye has a capsular bag that usually holds the lens. In conditions where the natural lens needs to be removed, an empty capsular bag remains. Usually, for removal of the natural lens, an opening is made in the anterior part of the capsular bag. This anterior bag part is the part o f the capsular bag that is closest to the cornea. The remaining anterior capsular bag part is referred to as the anterior capsular bag flap. It can also be seen as a ring of capsular bag membrane.

The capsular bag also had a posterior part. That is the part of the capsular bag that is closest to the retina. The average capsular bag thickness is between 4 and 9 microns for the posterior capsular bag part and 10 to 20 microns for the anterior capsular bag part.

In a procedure for removal of the natural lens, the opening can be made using a laser cutting device. This allows a very accurate positioning and shape of the opening in the capsular bag. Furthermore, after removal of the natural lens, it is possible to subsequently make an opening in the posterior part of the capsular bag, the posterior opening. These two openings can be accurately aligned. The shape of the openings can be matched with a shape of a perimeter of the IOL or, more exactly stated, a perimeter about the optical structure of thelOL. Thus, the IOL can fit in the opening perfectly. Finally, the openings can be matched perfectly with an optical axis of the eye. Furthermore, if an optical axis of the IOL is aligned in a predetermined position within the circumference of the IOL, the optics can be positioned in an optimal manner in the eye. Thus, the optics of the optical structure can be aligned in a predefined manner in the eye. For instance, optical axes may be aligned, but also other predefined configuration may be possible, for instance taking into account the quality of parts of the retina.

The support surfaces can be bounded areas on the anterior respectively the posterior supports that engage the capsular bag surface. In an embodiment, at least one anterior supports comprise a posterior side that substantially completely engages the anterior surface of the anterior capsular bag part. In an embodiment, at least one posterior supports comprise an anterior side that substantially completely engages the posterior surface of the anterior capsular bag part.

In an embodiment, the IOL is formed as one part. In an embodiment, the IOL is made from a polymer material. In order to allow clamping of the anterior capsular bag part, at least the anterior supports are resilient, allowing the IOL to be inserted in the capsular bag and subsequently bringing the anterior supports through the opening in the anterior capsular bag part and in engagement with the anterior surface thereof. In fact, this allows holding the IOL in place.

In an embodiment, the at least two posterior supports extending away from said optical structure in a functionally opposite direction with respect to one another. In an embodiment, the at least two anterior supports extending away from said optical structure in a functionally opposite direction with respect to one another.

In an embodiment, the anterior plane and said posterior plane are spaced apart 570 microns. In particular, said posterior and anterior planes are spaced apart 5-50 microns.

In case the support surfaces run about parallel, this distance allows a clamping of the anterior capsular bag flap.

The posterior supports, or at least their support surfaces, may be angled towards the anterior side of the IOL. In that way, after implantation in the capsular bag, the posterior supports can urge against the posterior surface of the capsular bag flap. The posterior supports can be at an angle of up to 10 °.

Alternatively of in combination, the anterior supports, or at least their support surfaces, may be angled towards the posterior side of the IOL. In that way, after implantation in the capsular bag, the anterior supports can urge against the anterior surface of the capsular bag flap. The anterior supports can be at an angle of up to 10 °.

In an embodiment, the posterior supports and the anterior supports are in perimetrical sense or azimuthal direction shifted with respect to one another. This allows an easier manufacturing, in particular using for instance tooling.

In an embodiment, the posterior supports and said anterior supports extend in perimetrical direction or in azimuthal direction about the optical structure. Thus, a good support of the capsular bag flap can be provided, and even a fixation of the IOL.

In an embodiment, the posterior supports and the anterior supports do not overlap. In fact, when viewed from the anterior side, if the anterior and posterior supports do not overlap, tooling can be simplified. Furthermore, in may even be possible to allow a smaller distance between the anterior and posterior planes. In fact, the support surface of the anterior support may be shifted to -70 micron past the support surface of the posterior support. In particular when the posterior support and the anterior support are resilient, the posterior support and the anterior support may clamp the capsular bag flap between them, thus fixing the IOL in the opening. Thus, when the supports do not overlap, the distance between the anterior and posterior plane can be between -70 and 70 microns.

In an embodiment, the IOL comprises a perimetrical surface surrounding said optical structure and said posterior support and said anterior support extending from said perimetrical surface. In particular, said perimetrical surface defines a radial surface for when implanted engaging a perimetrical edge of the anterior capsular bag flap which defines the perimeter of the opening.

This can provide alignment of the IOL. For instance, if the opening is noncircular, for instance elliptic, and the perimeter of the IOL matches the shape of the opening, the azimuthal orientation of the IOL can be fixed. Thus, specific optical structures can be aligned.

In an embodiment, at least one selected from said posterior supports and said anterior supports is a haptic, In particular, the haptic has an outer diameter of 8-12 mm.

It was found that the IOL thus fits in the capsular bag.

In an embodiment, the IOL is formed in one piece, its thickness and flexibility adapted for insertion of the IOL into the eye in a folded manner via a micro insertion.

In an embodiment, the IOL further comprises an at least partially peripheral groove posterior to the posterior supports. In particular, said posterior groove opens in radial direction for receiving, when said IOL is implanted in an eye, at least an edge of a posterior capsular bag flap surrounding a posterior opening in a posterior part of the capsular bag. In an embodiment, the posterior groove is between 0.1 and 0.3 mm deep. In particular said posterior groove is between 0.05-0.2 mm wide. More in particular, the posterior groove is tapered.

The invention further pertains to a method for fixing the intra ocular structure (IOL) described above into an eye, where the IOL has a perimeter about an optical structure, the method comprising the steps of:

- forming an opening within the anterior part of a capsular bag of an eye, the opening having a profile matching the perimeter of the IOL, said opening surrounded by an anterior capsular bag flap remaining after forming said opening;

- inserting the IOL in the eye with the posterior supports extending in said capsular bag, and

- taking the anterior supports out the capsular bag with the anterior support surfaces resting on the anterior surface of the remaining anterior part of the capsular bag surrounding said opening and while leaving the posterior supports inside the capsular bag, the remaining part of the anterior part of the capsular bag surrounding the opening positioned between the posterior and anterior supports, thereby securing the IOL in the opening of anterior part of the capsular bag.

In an embodiment of the method, the opening is aligned with an optical axis of the eye and an optical axis of the optical structure of the IOL.

In an embodiment of the method, the opening is aligned with an optical and azimuthal axis of the eye and an optical and azimuthal axis of the optical structure of the IOL.

In an embodiment of the method, the opening is circular with a centre aligned with the optical axis of the eye, and the optical structure comprises an optical axis that is aligned with the perimeter of the IOL.

In an embodiment of the method, perimeter is circular.

In an embodiment of the method, the capsular bag further comprises a posterior part, said method further comprise the steps of:

- forming a posterior opening in the posterior part of the capsular bag, said posterior opening surrounded by an posterior capsular bag flap remaining after forming said posterior opening;

- urging the IOL when secured in the opening in the anterior part of the capsular bag in posterior direction in a direction of a retina of the eye, until an inner perimeter of the posterior capsular bag flap that defines the posterior opening surrounds a posterior groove in the IOL and which at least partially surrounds the optical structure posterior of the posterior supports, thereby securing the posterior capsular bag flap to the IOL posterior to the posterior supports.

The term “substantially” herein, such as in “substantially opposite” or in “substantially consists”, will be understood by the person skilled in the art. The term “substantially” may also include embodiments with “entirely”, “completely”, “all”, etc. Hence, in embodiments the adjective substantially may also be removed. Where applicable, the term “substantially” may also relate to 90% or higher, such as 95% or higher, especially 99% or higher, even more especially 99.5% or higher, including 100%. The term “comprise” includes also embodiments wherein the term “comprises” means “consists of’.

The term “functionally” herein, such as in “functionally opposite”, will be understood by the person skilled in the art. It includes for instance exactly opposite, but deviations from exact positioning are also included, as long as in operation, the feature functionally behaves or has the effect of being for instance substantially opposite. The term “functionally” may therefore also include embodiments with “entirely”, “completely”, “all”, etc. Hence, in embodiments the adjective functionally may also be removed. Where applicable, the term “functionally” may also relate to 90% or higher, such as 95% or higher, especially 99% or higher, even more especially 99.5% or higher, including 100%.

Furthermore, the terms first, second, third and the like in the description and in the claims, are used for distinguishing between similar elements and not necessarily for describing a sequential or chronological order. It is to be understood that the terms so used are interchangeable under appropriate circumstances and that the embodiments of the invention described herein are capable of operation in other sequences than described or illustrated herein.

The devices or apparatus herein are amongst others described during operation. As will be clear to the person skilled in the art, the invention is not limited to methods of operation or devices in operation.

It should be noted that the above-mentioned embodiments illustrate rather than limit the invention, and that those skilled in the art will be able to design many alternative embodiments without departing from the scope of the appended claims. In the claims, any reference signs placed between parentheses shall not be construed as limiting the claim. Use of the verb to comprise and its conjugations does not exclude the presence of elements or steps other than those stated in a claim. The article a or an preceding an element does not exclude the presence of a plurality of such elements. The invention may be implemented by means of hardware comprising several distinct elements, and by means of a suitably programmed computer. In the device or apparatus claims enumerating several means, several of these means may be embodied by one and the same item of hardware.

The mere fact that certain measures are recited in mutually different dependent claims does not indicate that a combination of these measures cannot be used to advantage. In fact, many of the feature of the current IOL can be combined to further improve easy implantation, or fixation.

The invention further applies to an apparatus or device comprising one or more of the characterising features described in the description and/or shown in the attached drawings. The invention further pertains to a method or process comprising one or more of the characterising features described in the description and/or shown in the attached drawings.

The various aspects discussed in this patent can be combined in order to provide additional advantages. Furthermore, some of the features can form the basis for one or more divisional applications.

Brief description of the drawings

Embodiments of the invention will now be described, by way of example only, with reference to the accompanying schematic drawings in which corresponding reference symbols indicate corresponding parts, and in which:

Figure 1 schematically depicts an embodiment of an IOL in anterior view;

Figure 2 shows the embodiment of figure 1 in side view;

Figure 3 shows a detail of figure 2 as indicated;

Figure 4 shows the embodiment of figure 1 in perspective view showing the anterior side;

Figure 5 schematically depicts a posterior side of the IOE of figure 1, with an alternative posterior feature;

Figure 6A shows a cross section of the IOE of figure 1 with the posterior feature of figure 1;

Figure 6B shows a cross section of the IOE of figure 5 with the alternative posterior feature;

Figure 7A shows a detail of figure 6A as indicated;

Figure 7B shows a detail of figure 6B as indicated;

Figure 8 shows yet another alternative embodiment of an IOE in anterior view; figure 9 shows an eyeball with an IOE;

Figure 10 shows a detail of figure 9 as indicated with the IOE of figure 1, and

Figure 11 shows a detail of figure 9 as indicated, but with an IOE with an alternative posterior feature and a posterior capsular bag part that is intact.

The drawings are not necessarily on scale.

Description of preferred embodiments

Figure 1 schematically depicts an embodiment of an intra ocular lens structure (IOE) 1 in anterior view. The anterior side is the side of the IOE 1 that is directed towards the cornea when said IOE is placed in an eye. The side of the IOE that is directed towards the retina after the IOE is implanted in an eye is here referred to as the posterior side of the IOE 1. When a natural lens has to be removed from an eye, usually an opening is made in the anterior part of the capsular bag. Subsequently, the natural lens is removed. In specific cases, such as paediatric patients, there may also be a posterior opening made in the posterior part of the capsular bag, the part of the capsular bag that is positioned between the natural lens and the retina. The opening and the posterior opening are usually aligned. The openings are often circular, but other shapes may be possible, certainly when using for instance laser equipment. The openings are usually aligned with an optical axis of the eye, but other positions maybe used. Around the openings, a ring of capsular bag tissue or membrane remains. This ring is also referred to as a capsular bag flap. The ring or flap has an edge bounding the perimeter of the opening, or in fact defining the opening. The opening has a radial direction, running from the centre of the opening outwards to the perimeter.

The IOL 1 comprises an optical structure 2. The optical structure 2 in many cases is a lens, in fact an anterior lens and a posterior lens. In embodiments like the one shown in figure 1, the optical structure 2 has an anterior lens structure surface 3 and a posterior lens structure surface 4, see figure 2. The optical structure can further be provided with any type of optical structure known in IOL. In this description, the nature of the optical structure should further not be considered limited. The optical structure can comprise a lens or a closure cap. In an embodiment, both the anterior and posterior sides are provided with a curved surface to provide one or more lenses. Examples of lens optics are a mono focal lens, an astigmatic lens, a multifocal lens a accommodative lens or a sector bifocal such as for instance disclosed in PCT/NL2012/050115.

In an embodiment, the IOL is from a polymer material. In particular, the supports are resilient, in particular said anterior

The embodiment of figure 1 is further also shown in detail in figures 2-4, in which figure 2 shows the embodiment of figure 1 in side view, figure 3 shows a detail of figure 2 as indicated in figure 2, and figure 4 shows the embodiment of figure 1 in perspective view, from the anterior side.

The IOL comprises a perimeter 7 about the optical structure 2. The perimeter 7 has a perimetrical surface. The perimeter 7 can match the shape of the opening in the capsular bag. If for instance the opening is circular, the perimeter can be circular. The size of the perimeter is such that it may be a little oversized to stretch the size of the capsular opening a little or matches the size of the opening. In the embodiment of figure 1, the optical structure 2 comprises a curved surface providing a lens. The lens in this embodiment is circular and has an optical axis. The perimetrical surface here extends parallel to the optical axis. The perimeter provides here a cylindrical surface.

In case of a circular perimeter 7, the perimetrical surface is circle cylindrical, in the embodiment of figure 1 even right circle cylindrical. A non-circular shape of the opening and the perimeter 7 can have advantages for preventing rotation of the IOL 1 about the optical axis. For instance, the opening can be elliptical, and the perimeter 7 can be elliptical, matching the elliptical shape of the opening. Alternatively, an alignment feature, for instance a cam, can be provided at the perimeter 7, and a matching feature can be provided to the opening. The rotational fixation can for instance be advantageous in case of astigmatic optics.

The IOL 1 comprises posterior supports 5, 5’ here at opposite sides of the optical structure 2. The posterior supports 5, 5’ extend away from the optical structure. In particular, the posterior supports 5, 5’ extend away in sideward direction with respect to the optical structure 2. The posterior supports 5, 5’ have support surfaces 13, 13’, also referred to as the support surfaces of the posterior supports 5, 5’. These support surfaces 13, 13’ are here in a plane, referred to as the posterior plane. In the specific embodiment of figure 1, where the perimeter discussed above is cylindrical, the posterior plane is perpendicular to the cylindrical surface of the perimeter 7. The optical structure 2 usually has a diameter of between 4-7 mm. The perimeter 7 usually has a diameter of between 4-7 mm.

When the IOL 1 is implanted, the support surfaces 13, 13’ of the posterior supports 5, 5’engage the posterior surface of the anterior part of the capsular bag. In an embodiment, the haptics and thus at least part of the support surfaces can be e angulated between 0-10 degree in anterior direction. In an embodiment, when implanted, the surface of perimeter 7 engages or almost engages the edge of the opening in the anterior capsular bag, and the support surface 13, 13’ of the posterior supports 5, 5’ in fact nestles against the posterior surface of the anterior capsular bag. To that end, the support surface 13, 13’ can be adapted to hold the surface of the capsular bag. For instance, cams or rims may be provided.

In the embodiment of figure 1, the posterior supports 5, 5’ are also haptics that can engage the inner surface of the remaining part of the capsular bag. Haptics as such are known in the art. Here, haptics are included as a safety measure to provide additional positioning and stabilisation of the IOL with respect to the capsular bag.

The IOL 1 further comprises anterior supports 6, 6’. The anterior supports 6, 6’ also extend sideward with respect to the optical structure 2. The anterior supports provide the support surfaces 14, 14’ of the anterior supports 6, 6’. The support surfaces 14, 14’ are designed and adapted for, when the IOL 1 is implanted, engaging the anterior surface of the anterior part of the capsular bag. Again, these support surfaces 14, 14’ are in a plane, referred to as the anterior plane. In an embodiment, when implanted, the surface of perimeter 7 engages or almost engages the edge of the opening in the anterior capsular bag, and the support surface 14, 14’ of the anterior supports 5, 5’ in fact can be made to nestles against the anterior surface of the anterior capsular bag. To that end, the support surface 14, 14’ can be adapted to hold the surface of the capsular bag. For the anterior supports to actually reach outside the capsular bag and be able to nestle against the anterior surface of the anterior capsular bag, usually requires some manipulation of the surgeon implanting the IOL 1.

The anterior plane is functionally parallel to the posterior plane. Side view figure 2 shows this. The distance between the support surfaces of the anterior support and the support surfaces of the posterior support are such that they can hold the anterior part of the capsular bag between them. The anterior supports 6, 6’ and the posterior supports 5, 5, are positioned such that their support surfaces comprise a spacing 11 between then. In fact, the distance between the posterior plane and of anterior plane is adapted for holding the anterior capsular bag flap between them for securing the IOL in the opening when the IOL is implanted. In fact, the distance between the posterior plane and the anterior plane can be adapted to the thickness of the anterior part of the capsular bag. It was found that the posterior supports 5, 5’ and the anterior supports 6, 6’ were able to hold the anterior capsular bag flap between them if the distance is between -70 and 70 micron. In particular, the posterior plane and the anterior plane are spaced apart 15-50 micron. The distance provides the spacing 11. In case the distance is less than 10 Micron the flap will be securely clamped and possible rotation of the lens prevented.

In the embodiment of figure 1, the posterior supports 5, 5’ and the anterior supports 6, 6’ are staggered. In fact, when viewed from the anterior direction, the posterior supports 5, 5’ and the anterior supports 6, 6’ do not overlap. This may also be referred to as that the posterior supports 5, 5’ and the anterior supports 6, 6’ are staggered in a perimetrical sense. In this sense, staggered is used as in a ‘staggered junction’.

In the embodiment of figure 1, the posterior supports 5, 5’ of IOL 1 are also closed haptics. Usually, a function of the haptics is stabilising a position of an IOL in a capsular bag. In the embodiment of figure 1, the haptics have a diameter of about 8-12 mm, and a thickness of between 0.2-0.4 mm, in particular between 0.25-0.35 mm. The thickness of the anterior support 6, 6’ are between 0.04 and 0.20 mm, in particular between 0.05 and 0.10 mm.

In the embodiment of figure 1, the IOL 1 at or near the perimeter 7 has at least one in perimeter or azimuthal direction extending space 19 between a posterior support

5, 5’ and an anterior support 6, 6’. This space facilitates manufacturing, and also facilitates getting the anterior support 6, 6’ through the opening and out of the capsular bag as it provides room for insertion of an instrument when inserting and positioning the IOL 1. In the embodiment of figure 1, at each transition from anterior support 6, 6’ to posterior supports 5, 5’ there is a azimuthal space 19.

It was found that in order to support the posterior side of the anterior part of the capsular bag, the posterior supports 5, 5’ extend at least about 0.5 mm away from the perimeter, in radial direction. In particular, the posterior supports 5, 5’ extend at least 1.0 mm in radial direction.

It was found that in order to support the anterior side of the anterior part of the capsular bag, at least one of the anterior supports 6, 6’ extend at least about 0.3 mm away from the perimeter, in radial direction. In particular, the anterior supports 6, 6’ extend at least 0.4 mm in radial direction.

In the embodiment of the IOL 1 of figure 1, the IOL 1 has additional, anterior lips 8, 8’. These anterior lips 8, 8’ complement the anterior supports 6, 6’ and provide additional clamping of the anterior capsular bag part. The anterior lips 8, 8’ have posterior surfaces 17, 17’ that rest against the anterior surface of the anterior part of the capsular bag. The anterior lips 8, 8’ here extend in perimeter direction about 0.1-2 mm. The anterior lips 8, 8’ extend in radial direction, i.e. away from the optical structure 2 and the perimeter 7, about 0.1-1.3 mm, in particular about 0.4-0.6 mm. In this embodiment, the anterior lips 8, 8’ extend about 0.3 mm.

In figure 8, an embodiment of an IOL 1 is shown in which the anterior supports

6, 6’have an alternative shape. In this embodiment, the anterior supports 6, 6’ are provided with a support opening 18, 18’. Through these support openings, an instrument can be inserted for pulling the anterior supports 6, 6’ back through the opening in the capsular bag. The diameter of the support opening can be 0.2-1.0 mm.

In figures 2-7B, two different embodiments of posterior features that influence the posterior part of the capsular bag can be seen.

In figures 5, 6B and 7B, showing respectively a perspective view from the posterior side, a cross section and a detail of the cross section of figure 6B as indicated, the posterior side of the IOL 1 at and near the perimeter is provided with a sharp rim to prevent growth of tissue from the posterior capsular bag part.

In figures 2, 3, 6A and 7A, an alternative embodiment is shown. Figure 2 shows a side view, figure 3 shows a detail as indicated, figure 6A shows a cross sectional view of the IOL of figure 1, and figure 7A shows a detail as indicated in figure 6A.

The IOL of this embodiment has a circumferential posterior groove 12, extending posterior to the posterior supports 5, 5’. In fact, the posterior groove 12 is here provided posterior to the posterior surface 15, 15’ of the posterior supports 5, 5’. The posterior groove 12 is provided to receive and hold the edge of the posterior capsular bag flap. The edge around the posterior opening is slipped into posterior groove 12 after the IOL 1 is positioned in the opening in the anterior capsular bag part. To that end, the IOL is gently urged backward until the edge or rim of the posterior opening slips into the posterior groove 12. The posterior groove 12 here has a depth of 0.1-0.3 mm. The posterior groove 12 can be a rectangular groove. Here it is wedgeshaped. It has an angle of between 30 and 60 degrees, in particular about 40-50 degrees. This posterior groove will seal the posterior flap, and since no posterior capsule is left posterior capsule opacification will not happen.

figure 9 shows in cross sectional view an eyeball with an IOL 1 in inserted position. The eyeball 20 has a cornea 21, a capsular bag 22, an iris 25 and a pupil 26.

In figure 10, a detail of figure 9 is shown with the IOL 1 of figure 1 inserted. Here, a posterior opening is made in the posterior part of the capsular bag 24. The rim of the posterior opening is positioned in the posterior groove 12. The anterior capsular bag flap (a ring of capsular bag membrane) which remains after an opening is made in the anterior capsular bag part 23 is held between the anterior support 6 and the posterior support 5. The support surface of the anterior support 6 and the support surface of the posterior support 5 both rest against the anterior capsular bag flap, and in fact, although perhaps not indicated that way, may even clamp that flap between them.

In figure 11, a detail of figure 9 is shown with an IOL 1 with alternative posterior feature. In this case, the posterior capsular bag part 24 does not have an opening.

Before inserting the IOL 1 into the capsular bag, first an opening is made in the anterior part of the capsular bag. Using for instance a laser device like the Lemto laser, an opening can be made in the anterior membrane or anterior capsule of the capsular bag. This procedure is also referred to as ‘Capsularhexis’.

In many cases, for instance in case of a cataract, in a next step the natural lens is removed through the opening in the capsular bag.

In an optional next step, a posterior opening can be made in the posterior part of the capsular bag, in the posterior membrane or posterior capsule of the capsular bag.

The IOL 1 can be used in the following way. Often, the IOL 1 is inserted in the capsular bag via a micro incision in the eye. Via an insertion device, the IOL outside the eye is rolled up and urged forward through a nozzle that fits through and matches the incision in the eye. Via the incision, the rolled-up IOL 1 enters the capsular bag via the opening. In the capsular bag, the rolled-up IOL unfolds. Next, using a small curved tool, the anterior supports 6, 6’ are manipulated to fold back through the opening to extend outside the capsular bag. If the IOL 1 also has the lips 8, 8’, using the same or an identical tool, also these lips may be manipulated to extend through the opening and outside the capsular bar. The posterior surfaces 17 and 17’ of the lips 8, 8’ will then rest on the anterior surface of the anterior part of the capsular bag. If the posterior capsule is opened as well then in a second manoeuvre by gently pushing the IOL a little bit downward the posterior flap will be secured in the posterior groove 12.

It will also be clear that the above description and drawings are included to illustrate some embodiments of the invention, and not to limit the scope of protection. Starting from this disclosure, many more embodiments will be evident to a skilled person. These embodiments are within the scope of protection and the essence of this invention and are obvious combinations of prior art techniques and the disclosure of this patent.

List of reference numbers

Intra ocular lens structure (IOL)

Optical structure

Anterior surface of the IOL

Posterior surface of the IOL

5, 5’ Posterior supports

6, 6’ Anterior supports perimeter of the IOL

8, 8’ Additional anterior lips

Outer perimeter of the optical structure

Perimeter of the optical structure

Space between the posterior plane and anterior plane

Posterior groove for the posterior capsular bag flap

13, 13’ Support surfaces of the posterior support

14, 14’ Support surfaces of the anterior support

15’ Posterior surfaces of the posterior support

Posterior rim

17, 17’ Sur faces of the additional anterior lips

18, 18 'holes in the anterior support azimuthal space between posterior and anterior supports eyeball

Cornea

Capsular bag

Anterior part of the capsular bag

Posterior part of the capsular bag

Iris pupil

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