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~his inventlon relate~ to lntraocular len~es suitable for u3e as artlflcial len~ implants. l~
Lens implantatlon i8 a surglcal teohnlque which ln recent . . years, ba~ed to a large e~tent on the work and experiences Or Drs. C. D. Binkhorst and J.~.F. Wor~t in Hollahd, ha~ come lnto increasing u~e ror the correction o~ aphakia resul~ing ~rom t~'e surgical extrac~lon teither extracap~ular or intracap~ular) o~
the natural len~ rrom the pa~lent's eye becau3e of a blinaness-causlng conditlon ~uch as catara¢t. In general tor~atp an intra-o¢ular len~ ~onslsts o~ a medlal len~ body about 4 mm in dlameter and a plurallty Or lateral lobe~ u~ually pro~ecting ~rcm ~r-erent sides Or the lens bo~y for use in risin~ the len~ ln posltion ln the eye. Within thls basic ~ormat, however, ~everal . dlf~erent deslgns o~ lntrao¢ular len~es are currently available.
-;` In most Or these, the lobes or po~itlon Pixation elements are in - the ~orm o~ two or ~ore metallic loops, wlth each loop belng oonstituted by a ~hort length o~ wire o~ a metal ~uch aa plati-num-iridlum, ~nd with each wire being anchored at lt8 two end~
on the poeterlor sur~ace o~ the lens body. In ~ome lense~, ~; ~ . nnteriorly as well ae po~teriorly mounted loops are pro~i~ed.
:` Bach ~UGh loop e~tend~ generally radlally o~ the lens body D an~
-. - the ~arious loops are space~ ~rom one another peripherally or the l~n~ body and ~re dioposed in a co~mon plane ~paced ~rom the posterior ~urface Or the lens bo~y tor the anterlor ~urface in the case of anterlor loop~. Another type of intraocular len~
.~ whlch has recently been de~eloped u~llizes ~our lobes or posl~ion .~ ~isatlon elements ~hich are lntegral part0 of the len~ an~ ar-~; 30 r~nged ln ~ "malt~e cross" conrlguration about the lens bo~y.
- ( 1086(~
In thl~ type o~ len~, the lobes are di~posed ln generallg the same plane as the lens body.
AB iB well-known to t~ose ~kl~led in khi~ art~ even though the dlameter o~ the len~ body Or an intraocul~r len~ 1 only about 4 mm~ ~or the purpo~e Or a lens implan~ation, a corneo-scleral ~nci~ion conslderably longer than the lens body diameter, and normally ~rom sbou~ 8 to 9 mm ln length, i~ re-qulred. An lncislon o~ thls magnitude 18 mandated becau~e the lnclslon must be capable o~ ~elng spread rar enough to accom-modate both t~e thiekne~s and the wldth o~ the lens. In this context, "thlckness" means the d~menslon o~ ~he lens a~ measured rrom the anterlormo~t plane ln whlch any part of the lens 3truc-ture (e.g. the apex of the lens body) is ~ound, to the po~terior-mo~t plane (e.~. the plane Or the po31tlon fl~atlon element~).
"Wldth" means the m~nimum len~th Or a pro~ectlon of the lens onto a plane parallel to the optlcal axl~ o~ the len~ body, ln a dlrectlon perpendlcular ~o a pro~ectlon o~ the optlcal a~ls on such plane, ~hich can be achieved by rotating the lens 360 about ~aid optical a~is.
Lens lmplantation~ are not only e~tremely dir~icult and delicate operattons, but th~ use o~ the currently available intraooular lense~, even by a hl~hly hkllled surgeon, entall~ a ~- number o~ di~aAvantagcs. One o~ the~e 18 that a relatlvely long inclsion, eenerally double the diamet~r o~ ~he l~ns body or ~5 more, i8 required because o~ the mechanical, i.e. lens dimen~lon, aspects mentioned oarlier. The problem whlch ensue~ here i~, o~
course, that the long~r ~he lnci3ion3 ~he greater the wound and the more dl~lcult the pu~t-operative recov~ry and healing perlod for the patlent. Ano~her dlsadvanta~e iB that the lenseR are somewhat dirflcult to manipulate, given the rela~ively ~ramped envlronment Or the ~urgical op~ratlon lnvolved. An lmproper ~ixation Or the l~ns relatlve to the pupil thua can ~a~ily oc~ur 6 ~
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.: whlch will make lt nece~ary ~or the sur~eon~ desplte the po~s~ble traumatlc e~fects on the patient, to go back lnto the eye withln a ~ew days a~ter the initlal ~urgery in order to correct the po~ltioning error.
It iB an important obJect o~ the present ~nventlon, thererore, to provlde a class o~ novel and highly 1mproved lntraocular lense~ whlch will both aubstan~ially ~mpli~y len~
.~ implantation ~urgery and enable ~he a~ore~ald d~sadvantaee~ to - be minlmlzed 1~ not avoided al~oget~er.
A more particular ob~e¢t o~ the present inventton 15 the provlslon o~ lntraocular len~e~ ~o constructed that they wlll be easler to insert properlg in po61tlon than here~orore ~nown lenses and that they wlll enable u~e Or a corneo-~cleral inci~ion o~ oonslderably less length than ha~ heretofore been required in lmplanting the known lense~.
Baslcally speakln~9 the obJe~tives o~ the present lnven-tion are achieved by an lntraooular lens con~truction which i~
character~ed by a medial len~ body and only two po~itlon rlsa-tlon elements pro~ectlng rrom spaced, generally oppo~ite lateral reæions Or the len~ body. One of the~e elements ha~ a rirst portion extendlng generally laterally ~rom the lens body and a : s~oond portlon ex~ending rrom the ~nd o~ the ~irst portion gena- .
rally trannversely thereto and at lQast partly perlpherally o~
the len~ body, while the other ~l~ment oxtend~ ~enerally lateral-~5 ly ~rom the len3 body. ~he maximum width Or any portion of ~ either position ~ixation element ~or a glven thiokne~ thereo~
:' ~8 BU¢h that ~t ~an be accommodated ~n and pass through th~ minl-mum length incislon ~hlch i3 requlred to accommodate Qnd permit ~ passage Or ~he 12ns body. Pr~ferably9 bo~h elements are unitary .. `j 30 wlth the lens body, i.e. they are n~t ~parately at~achea ele-`
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ments but ~re formed with the lens body (by molding or machining, . for example) ~f a single block of any suitable physiologically -- inert and non-toxic synthetic plastic material such as are well known to the art, e.g. polymethylmethacrylate, but the position fixation elements may, as long as they have the requisite shapes and orientations, be constituted by platinum-iridium or equiva-lent metal wire loops such as hereinbefore mentioned.
The first portion or leg of the first position fixation element which is contiguous to the lens body, extends (as stated above) generally laterally of the lens body, while the transverse second portion of the element extends from the leg or first por-tion at lease partly peripherally of the lens body. The said second portion must, however, be at a spacing from the periphery of the lens body sufficient easily to accommodate the thickness 15 ` of the cornea an~ sclera of the eye, and preferably its length will be su~ficient for it to extend through an arc of between . about 40 and about 60 along the periphery of the lens body, wikh the opposite and extremities of the second portion of the - , first position fixation element as viewed peripherally of the~4 lens body being, respectively, located on two imaginary lines which are tangent to the lens body at opposite sides thereof and intersect at a point spaced from the lens body on the side thereof where the second position fixatlon element is located.
The lens construction can also be stated in somewhat different words: first, the configurations of the two position fixation elements and their location with respect to the lens body are such that the minimum length of a projection of the entire lens onto a plan parallel to the optical axis of the lens body in a direction perpendicular to a projection of the optical ; 30 axis on that plan which can be achieved by rotating the lens 360~ about the optical axis, is greater than the minimum length :; l 6~5 ~;
of a pro;ection ~f the lens body alone onto that plane in a direc-tion perpendicular to a projection of the optical axis on the Il plane which can be achieved by rotating the lens body 360 about 1 the optical axis; second, the difference between these lengths ~v; 5 1 is sufficient that an insertion of the lens, through an incision ¦l in the eye, by a movement-which is generally radial with respect - I to the optical axis would require the length of the incision to be greater than the minimum possible length of the incision Il which, as a function of the thickness and lateral dimensions of I the lens body, would accomm~date and permit passage of the lens body alone; and third, the maximum width of each position fixatio~
el.ement at any part thereof for a given thickness thereof is such that the element can be accommodated in and pass longitu-dinally through the said minimum length incision.
l~ In anintr.a~ r lens according to one embodiment of ¦ the present invention, which is particularly suited for an im-plantation in which the first and second position fixation ele-~¦ ments are to be seated behind the iris in the lower and upper regions, respectively, o~ the cul-de-sac of the anterior and " posteriQr capsules, the two position fixation elements are in pre~lRely ~oplanar relation wlth one another both anteriorly and : 1~
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- posteriorly. The two po itlon fixatlon element~ thus are also _ _ ln substantlally coplanar relatlon wlth the lens body~ and the .. term "substantlally coplanar" wherever ~t appears in the spe-cl~ication and clalms ln thls regard shou~d be so lnterpreted even though the convex anterior surface Or the len~ ~ody may well e~tend ~lightly beyond the anterior sur~ace planes o~ the - po~ltlon ~ixation elements. As a modi~ication o~ thi~ embodiment . o~ the present in~entlon, lt 1~ contemplated that the second posltlon rlxation element may be of~set slightly anteriorly with respect to the first posltlon fixation element, ~o that lt would ~eat agalnst the front or anterlor surface o~ the irls rather - than behlnd it. As a ~tlll further modl~icatlon o~ th~s embodi- ment o~ the present inventlon, lt 1~ ¢ontemplated that the second position flxation element may be a combination of the ~o~egoing, l.e. it would be composed ot two parallel, spaced members one of - which would be in the same plane as the ~lrst positlon rixation: element while the other would be sllghtly offset anteriorly relative thereto, leaving therebetween a narrow space Or at most . about 1 mm ln wldth lnto which the lris could be ~itted ~o as to ; 20 proYide a mean~ ~or immobllizing ~he tab-like position flxation element relatlve to the iric that would not requlre suturing. In both o~ the two ~ust-described modl~ications, however, the re-; spective second po~ltion ~lxation elements are deemed to be in ; substantially coplanar relatlon wl~h the len~ body, and the ~erm .~ 25 "sub~tantially coplanar" wherever lt sppear~ ln the ~peci~ica-~ tlon and claims ln thls regard 1~ to be lnterpreted accordingly.
The ~econd po~itlon fixatlon element, when made o~ plastlc . ` and located ~o as to sea~ either behlnd or ~n ~ront Or the lri l ; in the upper re~lon o~ t~e cu~-de-sac Or the anterlor and poste- ' , i~ ~ ~ rior capsules, normally wlll al~o be proYlded wlth means ~or ~'' 11 , _ , . I ., ,, ", c . ~
6~al5 ..~,3 .; ( ~ -6-~, ' enblin~ it to be sutured tG the lris to achieve complete lm- ;
mobllizatlon. Such means wlll pre~erably consist Or an aperture provlded withln the con~lnes o~ the element, buk a~ an alterna-tive a palr o~ notches c~ould be pro~lded on opposite alde edg~s of the element.
In use, when a lens according to the above embodlment o~
the pre ent lnvention is beln~ implanted3 the surgeon will ~lrst make a corneo-~cleral incislon in the eye only sllghtly longer than the diameter Or the lens body, iOe. the lncislon wlll be about 5 mm ln length. In order to insert the léns lnto the eye, the surgeon will then lntroduce ~he lens essentially "longltudi-nally" lnto the eye, l.e. he will ln e~rect snake the lens ln - through the lnolslon, ~tarting wlth the rree-end extremity Or the transver~e ~econd portion of the rirst posltlon ~ixation elemènt and endlng with the tip o~ the second element, until the lens is properly positloned in the eye. This means that the second portlon o~ the ~irst positlon flxation element is seàted behin~
the iri~ in the lower region o~ the cul-de-sac of the anterior and posterlor cap~ules, that the len~ body is properly centered in the re~ion o~ the pupil, and that the second posltlon fixatlon element ~sutured to the irls, if neces~ary~ 1~ seated behind the iris in the upper reglon or the capsular cul-de-sac (or in ~ron~
Or the lrls or embracing it, as the case may be, if one or the other o~ the modified form~ Or the lens is used). It will be understood tha~ the two po~ition ~lxation element~ upon implanta tion o~ the lens, w~ll cooperate to maintaln the proper dlspo~i-tlon of the lens body relative to the pupll o~ the eye.
By way of contra~t to the ~oregoing construction, ln an lntraocular len~ accordlng to another embodiment o~ the present inventlon, whlch i~ partlcularly sulked ~or an ~mplantation in ~: ~
l . I
60~5 , .. --7---whic~ vhe ~lrs~ and second position ~ixation element3 are to be _ seated'in f~ont o~ the iris in the lower and upper region3 3 re3pectively, of the groove located behind the sclerol spur, the two posltion flxation elements, althou~h o~ respective configura-tlon generally. lmllar to those o~ the flrst-described embodl~
: ment, are not entlrely coplanar with each other. In thls lens '~ constructlon,'both the ~lrst portlon or leg-of the flr t posi- ' tlon fixation element and an lnner first sectlon of the second position flxatlon element, whlle extendlng generally laterally from the lens body, also are i~clined somewhat poste~iorly of the lens body, and the transverse second portion o~ ~he ~irst ~ixa-tion element and the outèr~or second sectlon'o~ the second'posl-tion fixatlon element`are.generally coplanar with each other, in a plane parallel to the posterior sur~ace plane Or the len3'.body' .
It is contemplated that the degree of the said'ln~lination o~ the - first portion o~ the ~lrst posltion rlxation element and the ~irst section .o~ the second po~ltion flxatibn.eIement ~hOUld be such that the perpendicular di~tance from the common po~terior plane o~ the second portion o~ the flr~t po~ition~ixation element
2~ and the ~econd section o~ the second'posi'tion ~ixatlon element to the posterior sur~ace plane Or the lens body 1~ ~etween about 0.25 and 0.75 mm and pre~erably abouk 0.5 mm. Additionally, the seoond or transverse portion o~ the ~lrst po~ltlon ~i'xation element pre~erably will have a slight degree'o~ eoncavity, wi~h a 2S radius o~ curvature o~ about 180 mm9 in that edge ~hereo~ which aces away ~rom the lens body, so that at the oppo~lte ends o~
~'. ' the said second portion there will be de~ined respective down-' wardly.dlrected lobes or tlp reglons whlch~ upon implantation o~
the lens (by me~ns'o~ a !'snakihg ln".pro.cedure as previously ' .' 30 ; descrlbed), will ~oact wlth the tlp end''region of the ~econd ., 11 ... . .
086~5 section o~ the second positlon ~ation elemen~, ~hen the ~ame are all recelved in the groove behlnd the scleral spur9 to ef~ect an es3entially three-polnt positlon ~lxat~on o~ the len3 in the eye. The arrangemen~ thu~ uch ~hat a small gap wlll be malntained between the region oP the anterior ~urrace o~ the lrls bounding the pupll and the posterlor surraces Or the rirst portion and ~lrst sectlon Or the rlrst and second po~ltisn flxatlon elementB~ 80 a3 to avold po~sible irrltatlon o~ the lrls in that reglon.
The ~oregoing and other ob~ects~ characterlstio~ and advantages Or the present lnventlon will be more clearly under-atood rrom the ~ollowing deta~led descrlption thereo~ when read ln con~un¢tlon wlth the accompanylng drawings, in whioh:
Fig. 1 1~ a per~pectlve vlew o~ an ~ntraocular lens accordlng to one embodlment o~ the present inventlon;
Flg~ 2 1B a plan vlew o~ the len~ shown ln Flg. l;
Fig. 3 19 a seotional vlew taken alon~ the llne 3-3 ln -` Fi~. 2;
Fi~s. 3A and 3B are ~ragmentary sectlonal views, ~lmilar ao to Flg. 3, which lllustrate, r2spectlvely, t~o modl~lcations Or the lens acoordlng to thls embodlment Or the pr~ent lnvention;
Fig. 4 i~ 8 diagrammatlc vertical aection through a human ey~ and ~how~ a lens accordln~ to the ~mbodiment of Fig8. 1 to 3 implanted in the eye;
Flgs. 5 and 6 are ~lagrammatic rron~ vlew~ o~ a human eye and, respectively, illustrake ~he len3 position3 at the start and completlon o~ the lens implantQ~lon procedure;
Fig. 7 iB a plan vlew o~ an lntraoGular len~ accor~lng to another em~odiment o~ th~ pre~ent invention;
C 1 ~861~5 g-' .
Fig. 8 i8 a ~ide vlew o~ the lens ~hown in Fig. 7; and Flg. 9 is a dlagrammatlc vertical section through a human eye and ~hows a len~ according to the embodiment o~
Figs. 7 and 8 impl~nted ln the eye, the lens being ~hown in a ~ectlon taken along the line 9-9 in Fig. 7.
Referrlng now to the drawlngs in ~reater detall, an lntraocular lens lC according to one ~mbodlment o~ the present .
lnvention 1~ shown ln Fig . 1 to 3. ~he len~ 10 con8i8t8 0~ a llght-focuslng lens body 11 havlng a conYex an~erlor ~ur~ace lla and a flat posterlor sur~ace llb, a fir~t position ~i~ation element 12 which has rlat anterior and po~terlor sur~ces 12a and 12b, and a second posltlon rlxation element 13 whlch ha~ flat anterior and posterlor Rurraces 13a and 13b and a medial suturlng aperture 13c. The thicknesse~ o~ the l~n~ body 11 and the two po~ltion rlxatlon elements 12 and 13 are denoted by rererence characters T and t9 respectlvely, in Flg. 3. A~ ~urther clearly -; shown ln Fig. 3, the po~terior surra¢e~ 12b and 13b o~ the po~i-tlon ~lxatlon elements 12 and 13 are ¢ontinuous with the poste-rior surrace llb o~ the lens body 11. Wlthln the contemplatlon Or the present invention, there~ore, the posltlon ~ixation elements are subutantially coplanar wlth the lens body even though the convex anterlor sur~ace lla Or the latter protrude~
; som~what anteriorly beyond the plane Or the anterlor ~urraces 12a and 13a o~ the po~itlon rixatlon elements.
l 25 The posltion ~ixation element 12 inolu~es a rir~t or ; leg portion 12' which 1~ contlguous wlth and e~ends g2nerally .
laterally from the len~ body 119 and a second portlon 12n, which i8 elther imperrorate as ohown or may have a large opening ~not ~hown) de~ined w~thln ~ts expan~e to permit ante-~ 30 rlor and posterlor ¢ap~ulary adhesion to take plaee through : the op~ning a~ter ~mplantation o~ the lens, and which e2tend~
generally tran~er~ely ~rom the ~r~t portlon 12' to one - ~ ~L[)8i~5 ~ l -lo-I
slde thereof along and ~pace~ ~rom the perlphery o~ the lens body 11. The len~th o~ the second portion 12" i~ ~u~Plcient to cover an arc of between about 40 and about 60 relative to the center of the lens body, and overall the ~onstruct~on 1~ such that the opposltely lateral extremitie~ (denoted by the rererence characters U and V ln Fig. 2) o~ the ~lrst po~ltion ~l~ation element 12 a~ viewed peripherally o~ the len~ body 11 are . located on two lmaglnary linss, denoted by the re~erence ~har :~ acters X and Y, whlch are tangen~ ~o ~he len~ body at opposite sides thereor and lntersect at a polnt (not ~hown be¢au~e of space llmltations) spaced ~rom the len~ body on the side thereo~
where the 3econd positlon ~ixatlon element 13 i~ located.
. The positlon flxatlon element 13 also extend~ generally :. laterally from the lens body 11 but ~rom a reglon o~ the perlph-ery o~ the latter generally opposlte that where the portion 12' . o~ the ~ir~t po~ltlon rlxatlon element 12 ~ B located. Like the element 12, the element 13 is ar¢uately con~lgured, l.e. lt 1~
devold Or sharp corner~ and edge~, ~or obYiou~ reasons. As shown : in Fig. 2, the element 13 has in lts outermos~ region a allght inclination to one side, here in a dlrection opposite to that Or the portlon 12" Or tho element 12, but it should be understood that such conflguration Or the element 13 iB not an es~ential . characterl~tic and the ~lement may in~tead have a sllght lncllna-tion in the other direction or ~ctually be truly s~raight. It t- 25 in n~verth~less oontemplated that ln Gase a ~erlection or in-cllnRtion Orr the truly radlal orlentation 1~ provlded, it ~111 1 not be more than about 15 to about 20.~
; It will be understoo~, o~ cour~e, that except in~o~ar ~8 the maxlmum width~ o~ the two posltion ~isatlon el~ments5 ~enoted E and F ln Flg. 2, mu~t~ ~or a ~ven thtckness t thereo~ be ~uch ~ s ~ .~!r ~ l -- ~ ~136~)~5 i~
-.' . ,, that each element ¢an be accommo~ated ~n and pa~s longltudinally through the minlmum length inc~slon whlch i~ requlred to accom-modate the len3 body because o~ itB diameter and thickness Tg ~ the precise dimensions o~ the len~ lO are ln ~nd o~ themsel~e~
,~ 5 not crltical aspects Or the present inventlon~ slnce the physio-logical make-up of the eye~ o~ di~erent human belng~ may well dictate the choice o~ lense~ o~ htly ~ erent dimen~ional characterlst$cs. Merely by way o~ example, howe~er, the ~ollow-ing dlmen~lon~, denoted A to H ln Fig. 2, mlght be present in a representative lens lO accordlng to the pre~ent invention. The lens body ~iameter A may be 4 mm, lts maximum thloknes~ ~ 0.4 mm;
and the overall lens length B g mm~ with the distance C rrom the oenter of the lens body to the en~ edge o~ the posltion ~l~atlon element 13 being 4 mm~ and the dlstance D rrom the center Or the lS lens body to the en~ ~dge Or the poslklon rixatlon element 12 belng 5 mm. ~he maxlmum wldth~ E and F o~ the two position i~ation elements may be 2.1 mm, thelr thicknes~ t may be 0.2 mm, thc diameter G Or the suturing hole may be 0.75 mm, and the ;; minimum width H o~ the space between the periphery o~ the lens ' 20 body ll and the pro~imate e~ge o~ the aecond por~lon 12" o~ the ~irst poRltlon rixation element 12 may be about 1 mm. With rerer .
enoe to a dlametral line Or the len~ body parallel to the ~imen-~lon linc B, the arc length Or the second portion 12" o~ the element 12 may be 45, and the angle between that ~ia~etral line :, and a line conne¢ting the center~ o~ the len~ body and the ~utur-lng hole may be 12. ~he angle Or lncllnation o~ the outwardmo~t sectlon o~ the ~econd posltlon ~ixation element 13 rel~tiv~ to the radial dlrectlon o~ the ~ectlon o~ that element contlguou3 to the len~ body may be 15.
~he manner o~ u~e o~ an intrao~ular lens lO a¢cording to this ambodiment o~ the pre~ent inventlon~ ~hen the ~ame i~ to be .1 11-I ~L~19160~5i ,... -., ~. .~
lmplanted ~n ~he eye Or a human beingJ ~111 ~o~ be ~escrlb~d wlth reference to ~ig~. 4, 5 and 6. It i8 noted at this point, how-ever, that the ln~tant appllcatlon i not intended to ~er~e as a technlcally and medlcally eomplete pr~mer for len~ lmplantatlon ~urgery. Rather, the des¢ription and illustrat~on Or ~ome o~ the sur~lcal aspects o~ 3uch an operation that are presented hereln are purely dlagrammatic, and they are lntended only to provide baslc slgnposts to those sklllea ln the art a~ ~o how ~uch an intraocular len~ 18 to be implanted.
~urning now to the operatlon itselr, a~sumlng the pa~lent has been properly prepared and anesthesized, the surgeon ~ill ~lrst make a corneo-s¢leral lnel~lon 14 ln the eyeball of the patlent near the upper rront region ~hereof, a~ ~hown ln Flgs. 5 and 6. For the sake Or slmpllcity, in tho3e vie~s a part of the cornea 15 1B lllu~trated broken away, and the internal element~
o~ the eye, such Q8 the lri~ the posterlor ¢ap~ule~ and the zonules, ha~e been omitted entirely. The lncl~ion l~ made about 5 mm long, l~e. ~ust s~rlclent to enable it to be ~pread to the ; degree requlred to accommodate both the dlam~ter and ~he thlck-nes~ Or the lens body ll.
Wlth the lncision properly ~prea~ apart, the lens lO iB
then lnserted essentlally "longltudlnally" lnto the eye throu~h the lncision, i.e. startin~ ~lth the ~ree end o~ the second portion 12" Or the ~irst position ~ixation ~lement 12 (Fig~ 5).
At the initlal stage Or the in~ertion, there~ore, a~ shown ln Fig. 5, the lan~ body ll will be located 80mewhat o~ to one slde of the lnclslon. On¢e the l~adlng end re~ion o~ the ~ortlon 12" Or the po~ltion rlsatlon ~lement 12 i~ dlspo~ed ln the anterlor chamber Or the ~yeball, ho~ev2r~ the lens la ~n ef~ect rotated counterclockwlse, as ln~lcated by the broken line arrow . ~ 3L~860(~5 ,:, :. 16, unt~l the rlr~ portion 12' Or the posltion ri~atlon element12 an~ the lens body ll ar~ loGated immedtat~ly ln front Or ~e . lnclslon 14. ~he remainlng part~ o~ the len~ lO, 1.~. the lens .. body ll and the second position ~ixation element 13, are then ~ed through the lncision~ Durlng this stage, the portion 12"
of the po~ltion ~i~a~ion element l~ i~ guided (Flg~. 4 and 6) : lnto the lower reglon o~ the cul-de-~ac 17 o~ the a~terior and posterlor capsules 18 and 19 behind the lower region o~ the lris 20, where the element ~lts in properly by ~irtue o~ lts arcuate end edge, and the posit~on ~i~atlon element 13 i~ ln-serted lnto the upper region Or the cul-de-~ac o~ the anterior and posterior capsules behlnd the upper reglon o~ the irl~ 20 .. ~ and 18 sutured to the iris a~ that location by mean~ o~ appro-prlate ~utures 21. Wlth the lmplantatlon ~o completed, the - 15 lens 10 wlll be securely aeated in the eye, and the len3 body ll .. , wlll be maintalned ln lts proper po8ition with respect to the pupll 22 o~ the eye by the cooperatlon o~ the two position ~i~atlon elements in provldlng a three-point ~lxation o~ the len~. Flnally, Or cour~e, the incislon 14 ia sutured to clo~e the wound.
.. In the lens accordlng to the present invention B0 ~ar desoribedl the po~itlon rlxation element 13 lc adapted to eeat i~ behind the iris~ as shown in Flg. 4. Shoul~ it be de~lred, howeverg to ~uture tho po3itlon ~l~atlon oleme~t 13 to the ~ri~
at the rront thereor snd not to have lt ~eated ln ~he upper re~lon Or the cul-~e-sa~ o~ the anterior and p~sterior cap~ules 18 and l9, an modlfied intraocular lens 23 a~¢or~lng to the ~` invention, a~ shown ln Flg. 3, would be u~ed. In the len~ 23 3 .: the rlr~t po~ltlon ~ixatlon element 12 (not ~hown ln thi~ vlew) ~ 30 18 the same as shown in Flgs. 1 and 2, but the ~econd posltion ~ 6~
fi~atlon element 24 18 orr~e~ ghtly~ ~o the extent o~ about 1 mm, anterlorly wlth respect to ~he plane of the rirst po~ition flxation element.
In ~ccordance wlth the present invent~on also~ especlally lr suturing o~ the second po~ition rlxation element to the iri~
i8 to be avoided, the lmmoblliæation o~ ~hat element relatl~e to the lris may be e~fected by means Or a ~urther modified lens 25 such aQ shown in Fig. 3B. In the lens 25, where agaln the ~lr~t position ~lxatlon element 12 (not shown~ 18 the same as ~n Figs. 1 ~nd 2, the eecond position ~atlon element 26 i8 in e~
sence a combinatlon o~ the element~ 13 and 24 shown ln Figs. 3 and 3A, ln that it consists o~ a po~terlor member 26~ coplanar with the rirst position ~ixatlon element 12 and an anterior member 26" ~llghtly O~r et an~erlorly wi~h re~pect to the member 26'. There i~, accordlngly, de~lned bet~een the two members a : narrow space 27, approximately 1 mm wlde9 lnto whlch the Juxta-posed portion o~ the upper region o~ the lris ¢an be inserted 80 as to be con~lned between the member~ 26' and 26"~ whi¢h would adhere to the ir~ su~iciently to ~mmobilize the po~ltion rixa-tion element 26 relatl~e thereto. It will be apparent, o~ ¢ourse that the overall thlcknes~ of the position fixatlon element 26 in the lens 25 ~ill be only about 1.4 mm, l.e. still le~ than the ma~imum thlckne~s ~ o~ the l~n~ body ll, ~o tha~ ther~ ~lll be no inter~erence with the pas~ag~ o~ this position ~ixatlon ~l~ment through the lncl~ion 14. AB will ~urther be elear to ~hoae ~kllled in the art~ l~ deslred one or both o~ the member~ 26' an~
26" o~ the po~ition ~l~atlon ~le~ent 26 ln the len~ 25 may be provlded wlth means, ~uch as a suturing hole, ~o permlt ~uturlng ther~or to the lris. A~ pr2vlou~1y in~lGa~d9 Or cour~e, the s~cond po~lt~on ~i~ation element ln any o~ the lens ~orms ~o ~ar ~ . ~ ~ff .~f~ r~;~ 57,'~",~ ~
'' ~ 5 . -15-'.
descrlbed may9 in lleu o~ a ~uturing hole~ be provl~ed ~t lts opposlte ~lde edges wlth a palr o~ approprlately arranged notches to recelv~ the ~uture6.
Re~errlng now to Figs. 7r 8 and 9~ lk i~ also contem-plated, ln accordance wlth another embodiment o~ the present :.- lnvention, to provlde an lntraocular len~ 28 de~lgned ~or implantatlon anterlorly Or ~he iri~. AB 8hOWn in F1g~. 7 and B, the lens 28 (llke the len~e~ shown in Flg~. 1 to 6~ lncludes a .~ medl~l llght-rocuslng lens body 29 ha~lng a convex anterlor surface 29a and a flat posterior ~ur~ace 29b9 a first posltlon . rixation element 30 and a ~econd posltion ~lxation element 31.
~he posltlon ~l~ation element 30, like the element 12, has a rlrst portlon 30' extendln~ generally laterally ~rom one reglon o~ the perlphery o~ the lens body 2g ana a ~econd por~
tlon 30" extendlng generally transver~ely ~rom the end o~ the portlon 30' and at leaBt partly perlpherally oP the lens body.
- Unll~e the ~irst and second portions o~ the element 12 9 however, the portlons 30' and 30" Or the posltlon ~lxation element 30 are not ooplanar with ~ach oth~r or the lena body. Rather, a~ shown ln ~i~. 8, the ~lr~t portlon 30' i~ incllned ~omewhat posteriorly of the lena body from the reglon of lta ~onn~cblon to the same, and the aecond portlon 30" i~ dlcpose~ entirely posterlorly o~
- the lens body and in ~ plane generally parallel to the pla~e o~
the lens body. Also, ~he tran~verse second portion 30~ o~ the s~ond ~osltlon ~ix~tlon olement 30 i~ somewhat conc~ely ourved on itB out~ardly ~aclng ~d~e 30a, as sho~n in Flg. 7, ~or e~
ample at a radius o~ ~urv~ture Or about 180 mm, thereby to de~ine at its oppoaite ~nds re~pective flown~ardly dlreoted lobes or ~lp re~lon~ 30b and-30c.
,- ~ I
- ~l ~ ~6 Corre~pondlngly, the aeco~ po~itlon rlxation el~ment 31, llke the element 13, e~tend~ generally laterally ~rom a aecond region of the perlphery of the lens body ~paeed rrom and gen-erally opposlte the reglon where ~he flrst por~ion 30' o~ the rlrst positlon ri~ation element 30 i~ located. Unllke the : element 13, however~ the element 31 i8 not ~oplanar ~ikh the len~
body. Rather, as al~o ahown ~n Fig. 8, the po~ition fisation element 31 has a ~lr~t inner ~ectlon 31' whlch is incllned ~ome-what posterlorly o~ the lens body 29 ~rom the region o~ it8 connectlon to the same, and a ~econd ou~er aectlon 31" which ls disposed entlrely posteriorly o~ the lens body and in a plane generally parallel to the plane Or the len~ body.
Although by virtue Or the ~oregoing arrangement ~he two po~ltlon ~ixation elements 30 and 31 ~re not coplanar wlth the len~ body, the degree Or lnclination of the rlrst portlon 30' Or the rirst position ri~atlon element 30 and the degree of in-cllnatlon Or the rir~t ~ection 317 Or the ~econd po~itlon ~i~a-tion olement are, respectiv~ly, such a~ to di~po3e the second portion 30" o~ the rlr~t po~ltion rixatlon element and the ~e¢ond ~ection 31" Or the ~econd po~itlon rixation element in ooplanar relation wlth each other and wlth their po~terior surraces at a psrpendicular distan¢e J o~ about 0.25 to 0~75 mm from the po~terlor sur~ace 29b o~ the lens body 29. By ~irtue o~ thls arr~ngement, ther~ore, when the l~ns 28 ha~ been lmplanted in a ~S hum~n eye, ~B shown in ~igo 9~ the len3 bo~y 29 and the pro~l-mste portion 30~ ~nd sect~on 31' o~ the two po~ltlon ~l~ation ~lements ~ill be maintalned out Or ~onta~t ~lth the lri~ 20 ln the region Or the pupllS thereby to minimlz@ the pos~ibiliky o~
; the len~ lrritating the lrl2 and lnterrering ~lth the e~panslon and ¢ontraction Or the pupil 220 .-. -16-- `
, . ' C '! ~
3LV~36~5 , ~;~
: -17-Referring again to Fig. 7, it wlll be ~een that the _ _second section 31" of the position ~l~ation element 31 is pro-~ided ad~acent lts outer extremity with a small aperture 32, generally about 0.15 mm ln d~ameter. In this case, however, the aperture is not a suturing hole but rather 1~ pro~ided only to facllitate manlpulation o~ the lens during the insertlon thereo~
into the eye.
It will be apparent from the ~oregoing that the insertlon of the lens 28 through the ~orneo-scleral lncision ln the eye wlll be effected ln the same manner, i.e. by a "~naklng in" pro-? cedure, as i~ described herelnbe~ore in connection wlth Figs. 5 - and 6 for the lens 10, and the details of that descriptlon thus need not be repeated at this point. The ultlmate position of the lens 29 will be different, however, ln that the entire lens i~
positloned anteriorly o~ the lrls~ with the second portion 30"
~ o~ the ~irst position ~ixation element 30 and the second section - 31~ o~ the ~econd posltlon ~ixation element 31 se ted in the lower and upper regions 33 and 34, respectively, o~ the groove behind the 3clerol spur 350 It can also be ~een that by virtue o~ the provi~on o~ the lobes 30b and 30c on the portion 30" o~
- the position flxation element 30, the same will coact with the lobe or tlp end 31a o~ the second section 31" o~ the position ~lxatlon element 31 to provide a three-polnt suppor~ rOr the lens ln the eye 80 as to maintain the lens body ln proper posltion 2S relatlve to the pupil o~ the eye.
Yet another advantage o~ a len3 28 accordlng ~o khl~
- embodlment o~ the present lnven~ion ls that ~or any given lm-plantatlon operatlon, the ffelec~ion Or a len~ having a vertical -~ dimen~ion whlch 1~ p~ecisely equal to, or ln any event not greater than, the avallable space between the top and bo~tom lobe-seatlng . ~
!l . .
~a ;, ,, . -17a-reglons o~ the groove behind the sclerol spur of the patient's eye is not a matter o~ critical concern ~or ~he surgeon. In thls context, by "vertical dlmenslon" i3 meant the perpendicu-lar d~stance between a plane tangent to the downwardly convex ed~e reglons of the lobes or tips 30b and 30c o~ the second portion 30" of the ~irst pôsltion fixation element 30 and a p~rallel plane tangent to the upwardly convex edge region o~ the lobe or tip 31a of the ~econd section 31" o~ the second posi-tlon ~lxatlon element 31. Thus, in the lens 28 the medlal ~ 10 transverse width Or the second portlon.30" of the position flxatlon element 30 can be ~u~iciently reduced, ~or example by a sultable choice of the degree o~ concavity of the edge 30a, that lf the surgeon happens to have used a lens which i~
sllghtly overslzed by, ~ay, a hal~ milllmeter or 80 with re-spect to the aforesaid available spa¢e in the eye, the portlon 30" will be able to ~lex upwardly a little ~o as to adapt ltself to the eye without placlng undue ~tresse3 on, and perhaps even damaglng, the tlssue~ in the groove The same type o~ upward ~lexure may also be accommodated by a suitable choice of the transverse wldth o~ the end region Or the ~irst portion 30' of the position ~ixation element 30 where that ; portlon Joln~ the second portlon 30". If de~ired~ o~ course, the con~emplated upward ~lexure capabillty may be achleved by an approprlate conJoint utilization o~ both these approache~.
.~ ~ . ., ,', .