CN1691925A - Sarfarazi elliptical accommodative intraocular lens for small incision surgery - Google Patents

Abstract

An elliptical accommodating intraocular lens assembly is positionable in an evacuated capsular bag of the posterior chamber of an eye following a small incision capsulorhexis, the capsular bag being pulled and relaxed by ciliary muscles, and the lenses being approximated and separated from one another to provide focusing.

Description

SARFARAZI elliptical accommodative intraocular lens for small incision surgery

Field of Invention

The present invention relates to intraocular lenses implanted in the capsular bag of the posterior chamber of the eye after anterior capsulorhexis. After implantation the lens utilizes the ciliary muscle to accommodate the refractive power of the lens.

Background of the Invention

Cataract extraction is the most common eye surgery performed in the United States. Extracapsular cataract extraction involves removal of part of the anterior capsule (anterior capsulorhexis), followed by removal of the nucleus. Alternatively, a probe can be inserted through the anterior capsule and vibrated with ultrasound, followed by perfusion and aspiration from the capsular bag to transfer lens material into the milk (phacoemulsification). After the natural lens is removed, the image is no longer focused on the retina, and a replacement lens must be provided for clear images. Replacement lenses can be glasses, contact lenses, or intraocular lenses. Of these, the intraocular lens is the most convenient and undistorts the image, however, for lens placement, the size of the incision is controlled by the size of the implant without removing the natural lens. However, replacement lenses lack the natural lens' ability to accommodate near and far objects.

When a person looks at an object, light reflects from the object, passes through the cornea, aqueous humor, and enters the lens through the pupil, and the lens focuses the light through the vitreous body onto the retina. To bring close objects into sharp focus, the light must be bent more. To achieve this, the lens becomes more curved and thicker. Much of this change comes from pulling and relaxing the capsular bag at its equator. The equator of the capsular bag is connected to the ciliary muscle by filaments called the zonules of Zion, which in turn are connected to the ciliary muscle. When looking at distant objects, the ciliary muscle relaxes and stretches, thus pulling on the zonules, flattening the capsule and lens. When looking at near objects, the ciliary muscle tenses and contracts slightly inward moving the muscle and relaxing pulling the zonules, making the capsular bag more curved and thicker from front to back. The lens itself is made up of intertwined fibers that affect the elastic movement of the lens, the lens changes shape and the fibers change curvature. As a person ages, the ability of the lens to accommodate decreases as the eye changes. Ocular changes associated with aging include thickening of the lens, increased amount of insoluble protein within the lens, movement of junctions at the zonules away from the equator of the capsule, and partial liquefaction of the vitreous.

The lens consists of a transparent substance that has the shape of a rotationally symmetrical body, such as a sphere. The degree of curvature of a surface is inversely proportional to the radius of curvature and focal length. Parallel rays converge after being refracted by convex surfaces and scatter after being refracted by concave surfaces. The refractive power of the lens depends on the refractive index of the lens material and the curvature of the lens. A simple lens has two sides, each with a curvature. Two lenses separated by a specific distance can be thought of as one thick lens with two focal lengths and two principal planes. The focal lengths of the systems are obtained by dividing their focal lengths (f1, f2) by the sum of their focal lengths and subtracting the distance (d) between them, ie

F=(f1f2)/(f1=f2-d)

When the inter-lens space is not a vacuum but contains material, the value subtracted from the sum of the focal lengths is divided by the refractive index of the material.

F＝(f1f2)/(f1+f2-d/n)

The refractive power of the lens system is expressed by the reciprocal of the focal length. By using two fixed lenses and varying the distance between them, a variable focal length system can be constructed. If the flexion of one or both lens surfaces increases with increasing inter-lens distance and decreases with decreasing inter-lens distance, the change in focal length increases.

Attempts have been made to provide focus adjustment for the eye. The most common of these are bifocal or multifocal lenses. These are used in spectacles, contact lenses and intraocular lenses, but have the disadvantage that focus accommodation depends on the direction of focus.

US Patent No. 4,254,509 discloses a lens that utilizes the ciliary muscle. However, the lens is placed in the anterior chamber of the eye. This implant is sometimes associated with complications such as damage to the vascular iris.

US Patent No. 4,253,199 discloses a lens attached directly to the ciliary body. The lens is in a more natural position, but requires sutures to the ciliary body, with the risk of massive rupture during surgery and bleeding from the sutures.

US Patent No. 4,685,922, incorporated herein by reference, discloses a capsular lens system in which the refractive power can be altered. This change is permanent with rupture of the chamber.

US Patent No. 4,790,847 provides a single lens implanted using a posteriorly deflected haptic capsular bag that engages the capsular bag at the equator and moves the lens anteriorly and posteriorly as the ciliary muscle contracts and relaxes.

US Patent No. 4,842,601, incorporated herein by reference, discloses a two-part deformable lens assembly for implantation in the capsular bag. The lens allows dividing the refractive power and utilizing the action of the ciliary body and the zonules of the capsular bag. The lens system fits after insertion.

US Patent No. 4,892,543 discloses another two lens combination placed in the posterior chamber, possibly in a bag where the capsular bag is not removed. This lens allows to divide the refractive power between the two lenses and to introduce a variable focal length in one of the lenses by pressing the retractable walls of one lens against the convex surface of the second fixed lens. This requires that the first and second lenses be located substantially close together.

US Patent No. 4,932,966, incorporated herein by reference, provides an accommodating lens in which two lenses are peripherally connected around a fluid-filled capsule, accommodation being achieved by selectively varying the fluid pressure within the capsule. One lens is rigid-based and the other is membranous, with the equatorial diameter of the lens complex fitting approximately to the diameter of the dilated pupil and supported by a capsule or haptic.

Summary of Invention

The present invention provides a dual and thick optical lens capable of accommodating focus over a range of distances in a simple monolithic structure. It uses the natural shaping of the eye capsule by the ciliary body to adjust focus. Embodiments provide small incision insertion of components, natural centering and enhanced focusing.

Description of attached drawings

Figure 1 is a cross-sectional view of an eye with an accommodative lens of the present invention.

Fig. 2 is a longitudinal sectional view of the eye.

Figure 3 is a partial cross-sectional view of the intraocular lens of the present invention when the eye is focused on a near object.

Fig. 4 is a partial cross-sectional view of the intraocular lens of Fig. 3 when the eye is focused on a distant object.

Figure 5 is a partial sectional view showing an alternative embodiment.

Figure 6 is a schematic side view of a natural lens.

Figure 7 is a side view of a thick lens embodiment of the lens composition.

FIG. 8 is a perspective cutaway view of the embodiment of FIG. 3 .

9A and 9B are side and top views of selected whole lens assemblies.

Figure 10 is a side view of a concave whole lens.

Figure 10A is a side view of a concave bicomponent lens.

Figure 11 is a side view of a cylindrical whole lens with a shoulder.

Figure 12 is a side view of a cylindrical whole lens.

13A and 13B are side and top views of a shouldered unit lens.

Figure 14 is a side view of a lens inserted into the capsular bag with the lens removed through the side opening.

Figure 15 is a side view of a cylindrical lens in the capsular bag.

Figure 16 is a cross-sectional view of a hollow cell lens.

17A and 17B are perspective views of an accommodative lens with and without haptic and helical lens connections.

Figure 17C is a perspective view of an accommodating lens with a third lens component.

Figure 17D is a perspective view of an accommodative lens with anterior and medial lens components.

18A and 18B are perspective and side views of a haptic cylindrical lens.

Figures 19A and 19B are top views of an accommodative lens fabricated from a lamellar substance prior to bending.

Figures 19C and 19B are top views of an accommodative lens fabricated from a lamellar substance after bending.

Figures 20A, 20B and 20C are a top view and two side views of an accommodating lens made of sheet material.

Figure 21 is a plan front view of an embodiment of an accommodative lens.

FIG. 22 is a side cross-sectional view of FIG. 21 .

FIG. 23 is a planar rear view of FIG. 22 .

Figure 24 is an alternate lens element of the accommodative lens of Figures 21-23.

Figure 25 is a side cross-sectional view of another embodiment of an accommodating lens of the present invention.

Figure 26 is a side cross-sectional view of another embodiment of an accommodating lens of the present invention.

Figure 27 is a side cross-sectional view of another embodiment of an accommodating lens of the present invention.

Figure 28 is a reduced scale plan front view of an alternative embodiment of an accommodative lens of the present invention.

Figure 29 is a side cross-sectional view of another embodiment of an accommodating lens of the present invention.

FIG. 29A is a planar rear view of FIG. 29 .

Figure 30 is a side cross-sectional view of a cylindrical lens of the present invention.

FIG. 31 is a plan front view of FIG. 30 .

Figure 32 is an alternative embodiment of a cylindrical lens of the present invention.

FIG. 33 is a plan front view of FIG. 32 .

Figure 34 is a side cross-sectional view of another embodiment of an anterior element of an accommodating lens of the present invention.

Figure 35 is a side cross-sectional view of another embodiment of the anterior element of the accommodating lens of the present invention.

Figure 36 is a side cross-sectional view of another embodiment of the anterior element of the accommodating lens of the present invention.

Figure 37 is a cross-sectional view of the lens capsule (capsular bag) of a human eye showing an accommodative lens of the present invention with the anterior lens element against the front of the lens capsule and the posterior lens element against the posterior wall of the capsule.

Figure 38 is a cross-sectional view of the lens capsule (capsular bag) of a human eye with an accommodative lens of the present invention with its anterior lens element located in the equatorial plane region of the capsule and the posterior lens element located against the posterior wall of the capsule.

Figure 39 is a cross-sectional view of an accommodating lens of the present invention with the longest radial length of the haptic located midway between the anterior and posterior elements.

Figure 40 is a cross-sectional view of an accommodative lens of the present invention showing two embodiments of simultaneous haptics.

Description of preferred implementation

Figure 2 shows a cross-section of the eye. When light enters the eye, it passes through the cornea 1; through the aqueous humor 2 in the anterior chamber; through the pupil 3 in the center of the iris; through the front wall of the capsular bag 6a; 9 reaches the fovea 11 of the retina 10 . The shape of the lens capsule is controlled by the ciliary muscle 4 with filaments called zonules attached to the capsule.

Figure 6 shows a natural lens having a central biconvex core portion 26 surrounded by concave-convex menisci 27a and b. The biconvex lens focuses light. Concave and convex lenses have a scatter effect on light. The meniscus of the natural lens thus moderates the converging nucleus. The anterior-posterior or pole of the lens is approximately 5 mm in diameter. The diameter at the equator is about 9mm.

When the natural lens 8 is removed by capsulorhexis 25, the intraocular implant shown in Figures 3 and 4 restores focusing. The implant has an anterior lens 12 with an anterior surface 14 and a posterior lens 13 with a posterior surface 15 . Extending from and connecting the equatorial perimeters of the anterior and posterior lenses is a retractable chamber wall 16 which forms a discoid chamber 17 having approximately the same equatorial diameter as capsule 6 . The chamber 17 formed by the two lenses 12 and 13 is filled with a fluid (gas or liquid) such as air after implantation. Pressure around the equator of the atria supports the lens complex in place.

Figure 8 shows the same lens assembly with an atrial equatorial diameter De, an atrial polar diameter Dp, and a polar axis PaPp. The equatorial circumference 24 of the anterior lens 12 is approximately the size of the pupil (4-5 mm).

Although lenses can be rigid or retractable, retractable lenses provide greater accommodation. In the anterior and posterior lenses, rigid substances can be made of biocompatible, transparent substances such as PMMA (polymethyl methacrylate), HEMA (hydroxyethyl methacrylate), polysulfone, polycarbonate, or silicone polymer (polydimethylsiloxane). Soft lens materials include gel-forming polymers such as silica hydrogels, polysaccharides such as hyaluronic acid, or clear lens-shaped capsules of polyvinyl alcohol. The equatorial diameter of the anterior lens is approximately the size of the dilated pupil or 5mm. The thickness of the posterior lens and the anterior lens is 1 to 1.5 mm. For a typical eye, the anterior lens has an anterior radius of curvature between 8 and 14 mm, and the posterior lens has a curvature with a posterior radius between 4 and 7 mm. The curvature of the two sides of each lens can be changed to correct for differences in eye shape (ie, nearsightedness). Since the two lenses are converging lenses with a space in between, the focal length and refractive power are split between them, however, the refractive power can be in one lens if desired. The wall 16 has a thickness of 0.1 mm and can be made of methacrylate, silicon polymer or other biocompatible, stretchable materials. When full, the disk shape is preferably an ellipsoid having a polar diameter of about 5 mm and an equatorial diameter of about 9 mm. When the ciliary muscle 4 relaxes and expands, the zonules 5 pull on the equator of the capsule 6, and the lens assembly flattens increasing its equatorial diameter and decreasing its polar diameter, thereby reducing the distance between the two lenses and altering the lens assembly's diameter. refraction. If the lens is made of a soft material, such as a lens-shaped capsule filled with polyvinyl alcohol, they are also pulled into a flattened form to increase optical force variation. To facilitate insertion of the lens assembly through the incision, the soft lens can be made of a gel-forming polymer and dehydrated (caused to shrink) leaving the chamber unfilled until after insertion. Fluid from the surrounding tissue after insertion allows the lens to rebuild and fill the chamber. The chamber can also be filled with microtubes or hypodermic injections.

Figure 5 shows another alternative form of the invention. In the capsular bag 6 is a lens combination having an anterior lens 19 with an anterior curved surface 20 and a posterior lens with a posterior curved surface 22 . Extending from and connecting the equatorial perimeter of the anterior and posterior lenses is a retractable, elastic chamber wall 23 having approximately the same diameter as lenses 19 and 21 . The resulting substantially parabolic chamber 24 may be filled with a fluid (gas or liquid) such as air. Two or more elastic haptics can replace the walls to seat and deflect the lens against the capsular pole. The spring-like action of the haptic or atrial walls causes the lens to lean against the surface of the capsular pole to support the lens assembly in place. As the capsular bag is stretched and relaxed by the ciliary muscles, the lenses approach and withdraw from each other to provide focal accommodation. If a soft lens is used, a support ring is provided around the equator of the lens.

FIG. 7 shows an embodiment of the invention comprising a thick lens with an anterior surface 29 and a posterior surface 30 . The shape of the lens 28 is substantially parabolic. Paraboloids for the purposes of the present invention include cylinders, hyperboloids and paraboloids. The lens is made of elastic material with the anterior and posterior surfaces leaning against the cystopole. This spring-like action supports the lens in place so that when the capsular bag is pulled or relaxed, the anterior and posterior surface bodies approach and withdraw from each other to provide focus adjustment.

The lens assembly shown in Figures 5 and 7 can be inserted through an incision about the width of the lens, then rotated or compressed for insertion.

The unit lens assembly of FIGS. 9A and 9B has anterior 100 and posterior 102 lens surfaces and a convex pocket connecting the central portion 104 . The lens assembly is molded in one piece from compressible optically clear materials such as hydrogels, silicone rubber, and soft acrylates. The lens of Figure 10 has a circular central portion 106 between the anterior 108 and posterior 110 concave lens surfaces. The lens of Figure 10A has a cylindrical central portion 105 between the anterior 108 and posterior 110 concave lens surfaces. The lens of Figure 11 has annular ridges 112A and 112B to connect the capsular bags 6A, 6B. Figure 12 shows a lens with a cylinder 114 and is preferably used when the lens is inserted through a lateral capsular incision. The lens of Figures 13A and 13b has a single shoulder 116 and a body forming a continuously curved surface 118 including the posterior lens surface.

Figure 14 shows a detail of the lens of Figure 12 placed in the capsular bag. To insert the lens, the lens 120 is compressed laterally and placed in a tube 122 similar to US Patent 5,123,905 (herein incorporated by reference), or using special forceps as shown in US Patent 4,950,289 (herein incorporated by reference). The tube 122 is placed in the pocket 6A, 6b and the lens 120 is gently pressed from the needle into the pocket. In order to fully compress, it is necessary to use a material with high compressibility and memory, or to be able to dehydrate the material. Ordinary hydrogels offer this possibility, but may lack sufficient refractive index necessary for proper amplification, however, there are methods of modifying the refractive index such as incorporation of solute groups into hydrogels, and such hydrogels are available . Alternatively, a very compressible colorless silicone compound may be suitable. To increase the refractive index and further reduce distortion of the lens surface, the surface can be thinly coated with a harder material such as quartz or PMMA, as is done in eyeglasses today. The lens shown in Figure 15 has a cylindrical body 120 and a set of C-shaped haptics 140, 142 to provide greater positional stability.

The lens of Figures 16A and 16B is similar to the lens of Figure 12, except that the center 124 is hollow. This makes inserts more compressible.

The lens of FIGS. 17A and 17B has anterior 126 and posterior 128 lenses connected by compressible helices 130 . The lens of 17B has a pocket connecting the haptics 132A and 132B. The accommodative lens of FIG. 17C has an intermediate lens 127 between the anterior lens 126 and the posterior lens 128 . The three lenses are on a common optical axis. The haptics 132C are mounted on the helical support of the intermediate lens which tends to place the intermediate lens in the equatorial region of the lens capsule or capsular bag. The accommodative lens of Figure 17D does not have the posterior lens of the accommodative lens of Figures 17A-17C, but has a support ring 131 at the posterior end of the compressible helix and is attached to the helix. The accommodative lens of FIG. 17D also has an intermediate lens 127 between the anterior lens 126 and the posterior support ring 131 . The three lenses share a common optical axis. The haptics 132C are mounted on the helical support of the intermediate lens which tends to place the intermediate lens in the equatorial region of the lens capsule or capsular bag. The compressible helix of the accommodative lens of Figs. 17A to 17D leans the anterior lens against the anterior side of the capsular bag and the posterior lens or posterior ring (Fig. 17D) against the posterior side of the bag. The lenses 126, 127 and 128 may be fixed at their periphery to the compressible helix 130 or they may be fixed at their periphery to the helix by a lens support ring. The accommodative lens of Figures 17A-17D can be molded in one piece or can be assembled from separate components, such as a compressible helix, lens support ring (if used), and lens.

The lens of Figures 18A and 18B is similar to the lens of Figure 12, but has been shown to have haptics 134A, 134b to stabilize the lens. Figure 18B shows an alternative haptic 150 extending from and connecting the anterior 100 and posterior 102 lenses.

The haptics can be attached to the front or back surface, but should be flexible enough to compress into the tube.

Macular degeneration requires the use of a very strong lens. A single lens can provide about 30 diopters of change in vision, and two lenses can provide up to 60 diopters of change in vision. However, the greater the magnification, the smaller the field of view. Now, it is treated by a lens (glasses) placed in front of the eye. However, by moving the posterior surface of the magnifying lens toward the retina, the field of view can be increased, so the lens combination with two lens surfaces according to the present invention can be used to treat macular degeneration. Similarly, severe myopia (nearsightedness) can be treated by using convex surfaces on the posterior and/or anterior lens surfaces.

Figures 19A, B, C, D show lenses that can be made from some flexible sheet material such as thin acrylic. The anterior 152 and posterior 162 lenses are Fresnal type lenses. These lenses may provide a sense of touch 164A, 164B. The central ring 158 has an opening 160 to maintain vision between the anterior and posterior lenses 152,162. A bridge 154 connects the lenses with a central portion. Bridge 154 is provided with creases 156 for ease of bending, as shown in FIG. 19 . Figure 19B shows a similar lens without the sense of touch.

To provide more flexibility, the lens of FIG. 19D is equipped with a second central ring 158 . Several such parts are possible. If only the anterior lens is a Fresnal lens, the lens also works because it can move towards and away from the retina.

Figures 20A, B and C show alternative lenses made of sheet material. Lenses 100 , 102 are connected by ring 180 . To position the anterior 100 and posterior lenses when flexed so that the optical axes line up, the ring 180 acts as a connecting pocket. The two halves of the loop can bend in the same direction as shown in Figure 20B or in opposite directions as shown in Figure 20C.

The principle of this lens can be adapted to children's toys to learn about the lens and accommodation by making a pillow with the same properties of the lens. The material of the pillow is a particularly transparent compressible material. Shanks located on the largest circumference can be introduced into the design. Pull the handle outward to decrease the magnification. Relax or push the handle inward to increase magnification, making it an educational toy.

Referring to Figures 21-23, accommodative lens assembly A has an anterior lens element 206A and a posterior lens element 208A. The anterior lens element 206A has an annular support element or shelf-like projection or disc 208A. The center of the shelf is open in which the anterior lens 100A is seated and supported on the shelf by the support element 200A. Posterior lens element 208A has an annular support member, shelf-like projection or disk 204A, which is open in the center to accommodate and support posterior lens 102A. The anterior lens element and the posterior lens element may be constructed in a similar fashion to the anterior lens element 206A or to the posterior lens element 208A. In other words, each lens element may have a ring-like shelf with the lens element positioned in the center opening of the ring-like shelf and supported by two or more support elements or a shelf with a center opening supported by the lens. Fully occupies and supports the lens. Although illustrated with only two support members, the lens can be supported by three, four, or more support members if desired.

Referring to FIG. 24 , an alternative embodiment of an anterior lens element 206AA is illustrated that is similar in structure to the posterior lens element 208A shown in FIG. 23 . Anterior lens element 206AA of FIG. 24 has an annular shelf-like protrusion 104B whose central opening is fully occupied by anterior lens element 100A. The haptics 202 are attached to the back side of the shelf-like protrusion 104B.

Referring to FIG. 25, an alternative embodiment of the accommodative lens assembly B of the present invention is illustrated, wherein the anterior lens element 206B and the posterior lens element 208B have similar structures, i.e. they all have annular ring-like frame-like projections 104B and 204B and large center opening. Anterior and posterior lenses B and 200b are located in the center of the opening and are supported by shelf-like projections via support elements 200B and 200BB. In the illustrated embodiment, alternative tactile designs 202B and 202BB are illustrated.

Referring to FIG. 26, another embodiment of the accommodative lens assembly C of the present invention is illustrated, wherein the anterior lens element 206C has a similar structure to the anterior lens element 206A shown in FIG. The posterior lens element 208A has a similar structure. In this embodiment of the invention, the anterior portions of the haptics 202C and 202CC are affixed to the support element 200c rather than to the shelf protrusion 104C of the anterior lens element. As in many of the other figures, two embodiments of haptics 202C and 202CC are shown separately in this figure to illustrate side view cross-sections of various haptics that may be used with the accommodative lens of the present invention. Haptic 202CC may be inverted so that the arched portion of the haptic is positioned closer to the anterior lens element 206C and the horizontal portion is positioned closer to the posterior lens element 208C.

Referring now to FIG. 27, another side cross-sectional view of another embodiment of an accommodating lens of the present invention (see also FIGS. 29 and 29A for another embodiment). An accommodative lens assembly D of the present invention is illustrated wherein the lens assembly has an anterior lens element 206D supporting an anterior lens 100D and a posterior lens 102D, but does not have a posterior lens element with a posterior rack (posterior lens element 204 is shown in FIG. 21-23 and 26 et al.). The haptics 202D are directly attached to the periphery of the posterior lens 102d and connect the posterior lens to the anterior lens element 206D.

The housing lens arrangement of the accommodative lens D can be reversed (not shown); the anterior lens 100D can be fixed directly on the haptic 202d like the posterior lens 102d of FIG. The haptics 202D of the posterior lens element are supported in the anterior lens element.

Referring now to FIG. 29, a side cross-sectional view of another embodiment of an accommodating lens assembly E of the present invention. In this embodiment of the invention, the posterior lens element 208 is absent. There is only the anterior lens element 206E comprising the shelf 104E and the anterior lens 100E. The assembly has at least one haptic 202E. The end of the haptic is attached to the upper end of the shelf 104E, and the other end of the haptic ring loops behind the anterior lens element attached to the bottom of the shelf. Preferably, the combination has two haptics, the haptic being offset from the next haptic by 90 degrees of circumference to support positioning of the combination in the lens capsule (capsular bag). Figure 29A illustrates how haptics 202E and 202EE are connected to the periphery of shelf-like protrusion 104E. In the cross-sectional view, the transparent disc 210 of the rear connection - haptics 202E and 202EE is illustrated. The disc 210 is visually clear, but may have optical properties such as an aspherical surface with little or no visual power, or may be a lens (see also Fig. 27 for an alternative embodiment). The haptic tip can be integrally molded with the disc or can be attached to the disc by heat welding, adhesive, or the like. The assembly of Figure 29 has an annular ridge 212 along the periphery in front of the shelf-like protrusion 104E. This ridge can support the positioning of the anterior lens element against the anterior wall or anterior side of lens capsule 6A. But this crest is optional.

Referring to Figures 30 and 31, a cylindrical or tubular lens 114A is illustrated having an anterior end 100F and a posterior end 102F. This type of lens is useful for the telescoping effect that magnifies the image. The overall lens assembly 120A may have two or more haptics. In the embodiment shown in Figure 30, two different types of haptics 202F and 202FF are illustrated.

In FIG. 31 , an assembly 120A is illustrated having three haptics 202FF spaced 120 degrees around the periphery of the cylindrical lens 114a. The haptics can be integrally molded with the lens element, or they can be secured to the lens element later by heat welding or using a medically acceptable adhesive.

Referring to Figures 32 and 33, another embodiment of a cylindrical lens assembly 120B is illustrated. The lens assembly 120B includes a cylindrical lens 114B and a haptic assembly 222 that includes a sleeve that fits and secures around the periphery of the cylindrical lens assembly 114B and extends radially from two or more haptics 202G. 220. Although most lens assemblies described in this invention show only two haptics for ease of illustration, it is recognized that two or more haptics may be used and that usually three is the optimal number as it enables the present invention The described lens assembly is centralized within the capsular bag or lens capsule. Haptic 202G need not be attached to lens 114B with cannula 220 . The haptics can be affixed to the lens by welding or using adhesives or can be molded with the lens. Similarly, haptics 202F, 202FF may be secured to lens 114a using sleeves (not shown) in a manner similar to haptic 202G.

Referring to Figures 34, 35 and 36, the front and rear shelf-like projections 104 and 204 may have other shapes than flat disks. For example, FIG. 34 shows a cross-section of a convex-concave shelf-like protrusion 104F of an anterior lens 100F. The shelf supports the lens 100F. Figure 35 shows a cross-section of a front shelf-like protrusion 104G having a concave front surface and a flat rear surface. The shelf supports the lens 100G. Figure 36 illustrates a cross-section of a ring-shaped shelf, such as the shelf shown in Figure 21, wherein the shelf has convex surfaces on the front and rear sides. In this embodiment, the anterior lens element 206H has an outer annular shelf 104H and the lens 100H is held at the center of the shelf by the support element 202H. The anterior lens elements 206F, 206G, and 206H illustrated in FIGS. 34-36 are for illustration purposes only and are not the only shapes that can be used to make the anterior and posterior lens elements. The posterior lens element 208 may take any shape that the anterior lens element 206 takes.

Referring to Figures 37 and 38, the bladder is illustrated on the front side 6A and back side 6B. The accommodative lens assembly is implanted into the capsular bag by conventional methods as explained herein. In Fig. 37, the accommodative lens combination provides an anterior lens located on the anterior side against capsular bag 6A and a posterior lens located on the posterior side adjacent to capsular bag 6B. In Fig. 38, the accommodative lens assembly is designed so that the anterior lens 100II is located in the region near the equatorial plane of the capsular bag, and the posterior lens 102II is located against the posterior side of the capsular bag 6B. The accommodative lens assembly may be designed to place the anterior lens element 206 anywhere from adjacent to the posterior lens element 208 all the way out to the anterior side of the capsular bag 6a.

Figures 39 and 40 illustrate a tactile accommodative lens assembly with the anterior and posterior lenses at specific locations within the capsular bag. For example, the accommodative lens of FIG. 39 positions the anterior lens element and the posterior lens element in a manner similar to that illustrated in FIG. 37 . In Fig. 40, an accommodative lens assembly is illustrated with two distinct haptics 202K and 202L. The lens assembly with haptics 202K positions the anterior lens element 206A in a similar manner as illustrated in FIG. 38 . Whereas the lens assembly with haptics 202L positions the lens in such a way that the anterior lens element 206 is located on the anterior side of the capsular bag 6A and the posterior lens element can be near, if not in, the equatorial plane of the capsular bag.

Referring to Figure 28, the anterior lens element and the posterior lens element in plan view can have various shapes, including circular as shown in Figures 21, 24 and 23, square, hexagonal and triangular (not shown) as shown in Figure 28. It is believed that in plan view, the anterior lens element and the posterior lens element are generally annular. However, it is advantageous to have other shapes. In Fig. 28, the shelf 104L is a square ring structure with a large opening in which the lens 101L is seated and held by four support elements. Posterior lens element 208 may be similar to the posterior lens element shown in FIGS. 23 or 25, or it may have a plan view similar to that shown in FIG. 28 as anterior lens element 206L. The support elements are shown away from the long sides of the shelf-like protrusions 104L. The support elements may also extend inwardly from the corners to the periphery of the lens. The lens can be supported by two or more support elements. The shelf of FIG. 28 may have a solid construction such that the central opening is fully occupied by the lens 100L, just as the opening of the shelf 104B of FIG. 24 is fully occupied by the lens 100. Haptics (not shown) extending posteriorly and upwardly from the anterior lens element 206L may extend from the posterior side of the shelf protrusion 104L or from the periphery of the 104L. Additionally, the haptic and lens and support elements 200L can be molded as a single piece at one time or secured together by adhesive or spot welding.

In the embodiments described above, the haptics are flexible and move radially outward when placed in the capsular bag, causing the haptics to connect to the equatorial region of the capsular bag, ie, the portion of the capsular bag with the largest circumference that engages the ciliary muscle. In a preferred embodiment of the invention, the haptics extend upwardly and outwardly to engage the inner walls of the bladder.

In the illustrated embodiment, the axis marked with the letter O is the optical axis of the lens assembly.

Claims (14)

1. crystalline lens assembly comprises:

Preceding crystalline lens element, described preceding crystalline lens element has front surface, periphery and optic axis are supported in the equator;

Back crystalline lens element, described back crystalline lens element have the rear surface, periphery and the optic axis parallel substantially with the described optic axis in described preceding crystalline lens zone are supported in the equator; With

Two or more deformable senses of touch of periphery are supported in the described equator of supporting periphery to extend to described rear surface from the equator of described front surface.

2. the described crystalline lens assembly of claim 1 is characterized in that preceding crystalline lens element and tactile combination are whole.

3. the described crystalline lens assembly of claim 1 is characterized in that described assembly is whole.

4. the described crystalline lens assembly of claim 1, its optical change＞30 diopters.

5. the described crystalline lens assembly of claim 1 has at least one spill lens surface.

6. the described crystalline lens assembly of claim 1, it is characterized in that described before and the rear surface coating is arranged.

7. the described crystalline lens assembly of claim 1 is characterized in that assembly has three senses of touch.

8. the described crystalline lens assembly of claim 1 is characterized in that described assembly can be dehydrated.

9. the described crystalline lens assembly of claim 1, it is peripheral that it has hard relatively optics to support periphery and relative soft equator to support.

10. the described crystalline lens assembly of claim 1 is characterized in that described assembly is injectable.

11. the described crystalline lens assembly of claim 3, it has at least one ledge.

12. the described crystalline lens assembly of claim 3 is characterized in that described at least one ledge is cyclic.

13. the described crystalline lens assembly of claim 1 is characterized in that described crystalline lens assembly made by sheeting.

14. the described crystalline lens assembly of claim 13 is characterized in that described assembly is folding.

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