Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/14—Eye parts, e.g. lenses or corneal implants; Artificial eyes
  • A61F2/16—Intraocular lenses
  • A61F2/1613—Intraocular lenses having special lens configurations, e.g. multipart lenses; having particular optical properties, e.g. pseudo-accommodative lenses, lenses having aberration corrections, diffractive lenses, lenses for variably absorbing electromagnetic radiation, lenses having variable focus
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/14—Eye parts, e.g. lenses or corneal implants; Artificial eyes
  • A61F2/16—Intraocular lenses
  • A61F2/1613—Intraocular lenses having special lens configurations, e.g. multipart lenses; having particular optical properties, e.g. pseudo-accommodative lenses, lenses having aberration corrections, diffractive lenses, lenses for variably absorbing electromagnetic radiation, lenses having variable focus
  • A61F2/1624—Intraocular lenses having special lens configurations, e.g. multipart lenses; having particular optical properties, e.g. pseudo-accommodative lenses, lenses having aberration corrections, diffractive lenses, lenses for variably absorbing electromagnetic radiation, lenses having variable focus having adjustable focus; power activated variable focus means, e.g. mechanically or electrically by the ciliary muscle or from the outside
  • A61F2/1629—Intraocular lenses having special lens configurations, e.g. multipart lenses; having particular optical properties, e.g. pseudo-accommodative lenses, lenses having aberration corrections, diffractive lenses, lenses for variably absorbing electromagnetic radiation, lenses having variable focus having adjustable focus; power activated variable focus means, e.g. mechanically or electrically by the ciliary muscle or from the outside for changing longitudinal position, i.e. along the visual axis when implanted
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/14—Eye parts, e.g. lenses or corneal implants; Artificial eyes
  • A61F2/16—Intraocular lenses
  • A61F2002/1681—Intraocular lenses having supporting structure for lens, e.g. haptics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/14—Eye parts, e.g. lenses or corneal implants; Artificial eyes
  • A61F2/16—Intraocular lenses
  • A61F2002/1681—Intraocular lenses having supporting structure for lens, e.g. haptics
  • A61F2002/16901—Supporting structure conforms to shape of capsular bag
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis

Definitions

• Intraocular accommodative lens Intraocular accommodative lens
• the present invention relates to intraocular lenses, also called intraocular implants, intended to replace the lens affected by cataracts, after its removal and more particularly accommodative intraocular lenses.
• the intact lens allows the individual to see near or far through the mechanism of accommodation.
• Accommodation is linked to the variation in the shape of the lens by the contraction of the ciliary muscle. This mechanism remains poorly understood.
• Helmholtz theory during accommodation, the contraction of the ciliary muscle causes relaxation of the zonular fibers attached to the equator of the capsular bag of the lens. This relaxation allows the lens to bulge, the radius of curvature of the anterior face and the posterior face decreasing, thus increasing the power or vergence of the crystalline lens.
• the anterior surface of the lens moves forward towards the cornea under the vitreous pressure caused by an increase in pressure.
• vitreous opposes the modification of the shape of the posterior surface of the lens during accommodation, but contributes to the advancement of the lens towards the cornea.
• presbyopia decreases the accommodation capacity of the natural lens.
• Several concordant studies show that the contraction of the ciliary muscle is at least partially preserved when an individual suffers from presbyopia.
• the lens is most often removed by a capsulotomy of the anterior leaf or capsule of the capsular bag, followed by phacoemulsification of the lens and cleaning of the site.
• the implant is inserted inside what remains of the capsular bag, namely the posterior capsule as well as the remaining peripheral annular part of the anterior capsule.
• the natural kinetics of accommodation is affected by the capsulotomy, the extraction of the lens and, to a lesser extent, by the implantation of an intraocular lens.
• accommodative intraocular lenses have been designed to take advantage of the remaining forces in a pseudo-phake eye, that is to say after extraction of the lens and implantation of an intraocular lens.
• Such accommodative intraocular lenses were not entirely satisfactory, in particular because of the displacement in the postero-anterior direction was insufficient under the conditions of the neokinetic of the capsular bag of a pseudo-phake eye.
• Document WO 97/43984 describes an intraocular lens with an elastically deformable intermediate region to modify the angle of inclination of this zone with respect to the plane normal to the optical axis of the lens and therefore insufficient accommodation. This is also the case in document WO 01/60286 where an intraocular lens is associated with a sole by means of a hinge.
• the present invention aims to overcome the drawbacks mentioned above. It also relates to a new accommodative intraocular lens capable of making better use of the neokinetics of the capsular bag of a pseudophakic eye, and in particular vitreous hyper-pressure. Indeed, the contraction of the ciliary muscle which is at the origin of the accommodative mechanism induces an increase in vitreous pressure. The vitreous is enveloped by the sclera which is not substantially deformable and by the posterior capsule which deforms under the increase in vitreous pressure. According to the study by Dr. Coleman ("On the hydraulic suspension theory of accommodation" Tr. Am. Opht. Soc. Vol.
• Neo-kinetics also includes the displacement of the apex of the ciliary muscle and of the equator of the crystalline sac both radially towards the optical axis of the eye and previously
• An object of the present invention is to take advantage of this joint and linear displacement of the apex of the ciliary muscle and the equator of the crystalline sac to induce the accommodation of an intraocular lens
• an accommodative intraocular lens for a capsular bag comprising a central optical part and a peripheral haptic part, the optical part having an advanced position of accommodation and a rest position for far vision, characterized in that that the haptic part includes a radial expansion zone allowing the displacement of the optical part towards the advanced position
• This zone is located in practice between the peripheral edge of the optical part and that of the haptic part. It can extend over all or part of the radial extent between the peripheral edge of the optic and the peripheral edge of the haptic. Its circumferential extent will preferably be the same as the circumferential extent of the haptic part where it is located.
• the elongation potential of the radial expansion zone determines between a point on the periphery of the optical part and a point on the periphery of the haptic part on the same radius is between 0.2 mm and 1.6 mm.
• This potential elongation of the radial expansion zone allows an axial displacement of the optical part between 0.8 mm and 2.0 mm to ensure good accommodation for near vision
• the elasticity of the radial expansion zone in the advanced accommodation position ensures the return of the optical part to the rest position for far vision.
• this radial expansion zone comprises a bellows.
• this radial expansion zone has at least one undulation and is substantially annular or circumferential, possibly interrupted by a plurality of radial notches opening at the periphery of the haptic part to favor postero-anterior displacement. or interrupted by intervals between the radial arms constituting as many haptic elements extending between the peripheral edge of the optical part and that of the haptic part
• the bellows comprises at least two undulations, one opening anteriorly and the other posteriorly, preferably the one opening previously being arranged at the periphery of the optical part.
• the peripheral edge of the haptic part has two posterior and anterior square angles.
• the haptic part comprises a peripheral gutter which ensures the spacing parallel to the optical axis between the rest of the anterior capsule and the posterior capsule of a pseudo-phake eye.
• the radial expansion zone is made of a less rigid material, and therefore constitutes a more flexible zone so that the elongation results from the stretching of this more elastic material.
• the bellows can be made at least in part from a material having a higher elasticity, so that the elongation results both from the flattening of the undulations or from the bellows and from the stretching of the part made out of material with higher elasticity.
• the haptic part comprises at least two haptic elements, each with a radial expansion zone comprising a bellows or one or more undulations and / or made of a material having a higher elasticity.
• these haptic elements have a circumferential extent at their periphery greater than their circumferential extent at the junction zone with the optical part.
• FIG. 1 is a sectional view along line l-l of Figure 2 of an accommodative intraocular lens according to a first embodiment of the present invention
• FIG. 2 is a front view of the intraocular lens of Figure 1;
• - Figure 3 is a sectional view along the line III-III of Figure 4, according to a second embodiment;
• - Figure 4 is a front view of the intraocular lens of Figure 3;
• - Figure 5 is a sectional view along line VV of Figure 6 according to a third embodiment;
• Figure 6 is a front view of the intraocular lens of Figure 5;
• FIG. 7 is a sectional view of the accommodative intraocular lens of Figures 1 and 2 to illustrate the elongation of the radial expansion zone of the haptic part in solid line compared to the configuration at rest in broken line;
• FIG. 8 is a sectional view of the accommodative intraocular lens of Figures 3 and 4 to illustrate the elongation of the radial expansion zone of the haptic part in solid line compared to the configuration at rest in broken line;
• FIG. 9 is a sectional view of the accommodative intraocular lens of Figures 5 and 6 to illustrate the elongation of the radial expansion zone, the haptic part in solid line compared to the resting configuration in broken line;
• Figures 10 and 11 show the intraocular lens of Figure 1 implanted in the eye and respectively in the position of rest and accommodation;
• - Figures 12 and 13 show the intraocular lens of Figure 3 implanted in the eye and respectively in the position of rest and accommodation;
• - Figures 14 and 15 show the intraocular lens of Figure 5 implanted in the eye, and respectively in the position of rest and accommodation;
• FIG. 16 is a front view similar to Figure 2 for a variant of the first embodiment where the haptic part comprises a plurality of radial notches;
• - Figure 17 is a view similar to Figure 2 for a second variant of the first embodiment, where the haptic part has a plurality of bosses along the circumference intended to be located opposite the equator of the capsular bag ;
• - Figure 18 is a front view similar to Figure 6 for a variant of the third embodiment where the haptic part comprises two haptic bellows elements;
• - Figure 19 is a view similar to that of Figure 1 for another variant of the accommodative intraocular lens;
• FIG. 20 is a front view of the intraocular lens of Figure 19;
• FIG. 21 is a sectional view along line XXI-XXI of Figure 22 of an accommodative intraocular lens according to a preferred embodiment.
• the accommodative intraocular lens 1 comprises a central optical part 10 having an optical axis AA and a peripheral haptic part 20 extending circumferentially around the optical part.
• the intraocular lens is made entirely or partially from flexible material, such as a hydrophilic acrylic or poly-HEMA.
• the optical part 10 is biconvex. It can have other forms, in particular plano-convex, even concave-convex.
• the posterior face of the optical part will be convex and shaped to conform to the central region of the posterior capsule and thus ensure good transmission of the vitreous hyper-pressure.
• the peripheral edge of the optical part can optionally be provided with a sharp annular edge and projecting posterior to reduce the migration of epithelial cells between the optical part and the posterior capsule.
• the haptic part 20 comprises a radial expansion zone 21.
• the radial expansion zone 21 In this first embodiment, the radial expansion zone
• the 21 consists of a bellows 22 or one or more corrugations, the first corrugation 23 of which opens previously and is located in the immediate proximity of the periphery 11 of the optical part 10.
• This first annular corrugation 23 is surrounded by a second corrugation annular 24 opening posteriorly which is surrounded by a third annular corrugation 25 opening previously.
• the first two corrugations have substantially the same configuration, although extending in opposite directions, while the third corrugation 25 has a reduced radial width compared to the other two corrugations.
• the bellows are substantially the same configuration, although extending in opposite directions, while the third corrugation 25 has a reduced radial width compared to the other two corrugations.
• the bellows 22 has a substantially sinusoidal shape from the periphery 11 of the part optical up to the peripheral edge 26.
• the bellows may have a more sawtooth shape.
• the third corrugation is replaced at least in part by a substantially planar annular zone in continuity with the peripheral edge 26.
• the peripheral edge 26 is preferably annular and continuous. It has a substantially rectangular section, of radial dimension, for example 0.6 mm, larger than its axial dimension, for example 0.3 mm.
• the outer edge of the peripheral edge 26 has an anterior edge or square angle 27 and a posterior edge or square angle 28.
• the radial expansion zone 21 forming the bellows 22 or comprising one or more undulations has a thickness substantially constant from the periphery of the optic 11 to the peripheral edge 26. The depth of the first two undulations of the same depth and approximately between 0.40 and 0.70 mm and the opening angle between approximately 50 and 70 ° .
• the haptic part 20 comprises two haptic elements 20F extending in opposite directions from the peripheral edge 11 F of the optical part 10F.
• Each of these haptic elements 20F has substantially the same radial section as that of the haptic part 20 of the embodiments of FIGS. 1 and 2.
• the corresponding parts are designated by the same reference numerals supplemented by the letter F.
• the circumferential extent of each haptic element 20F is larger at the peripheral edge 26F of the haptic part 20 than the circumferential extent of the haptic element 20F at the junction zone with the optical part 10F so as to facilitate forward deformation.
• each of these haptic elements has an angular extent of 90 °, so that the intervals defined by the opposite lateral edges of the two haptic elements also have an angular extent of 90 °.
• the surgeon can, after implantation, access the site through intervals 29F formed between the haptic elements 20F to clean it beyond the implant in the posterior chamber.
• the haptic part 20F of such an embodiment will be more flexible than the haptic part 20A of the first embodiment since the part haptic is divided into two haptic elements 20F of reduced circumferential extent.
• This increased flexibility, particularly in the radial expansion zone 21 F, increases from the periphery of the haptic part towards the periphery of the optical part thanks to the orientation of the lateral edges of the haptic elements while allowing good retention of the haptic part in the capsular bag thanks to the circumferential extent of these haptic elements at the peripheral edge.
• At least the major part of the lateral edges 29F of these haptic elements 20F is substantially radial. Indeed, as illustrated, the portion of the lateral edges corresponding to the junction zone of each haptic element
• 20F is slightly flared when approaching the optical part 10F.
• one or more of these lateral edges can be provided with a notch as a reference to ensure that the implant is in the right direction.
• the overall diameter of such an intraocular lens is preferably slightly greater than the diameter of the capsular bag at the equator.
• the haptic part comprises three, or even four, haptic elements of the same general shape as the haptic elements of the embodiment of FIGS. 21 and 22 whose circumferential extent and the intervals between the haptic elements will be reduced proportionally.
• the haptic part 20 comprises two haptic elements 20C extending in opposite directions from the peripheral edge 1 1 C of the optical part 10C .
• Each of these haptic elements 20C has the same radial section as that of the haptic part 20 of the embodiment of Figures 1 and 2.
• the corresponding parts are designated by the same reference numerals supplemented by the letter C.
• the haptic part 20 has a plurality of notches 27A arranged symmetrically around the optical axis AA of the implant according to this variant.
• the corresponding parts of the embodiment of Figures 1 and 2 are designated by the same reference numbers supplemented by the letter A.
• the notches partially or completely pass through the annular undulations.
• the haptic part 20 is provided with four notches 27A arranged at 90 ° relative to each other around the optical axis.
• each of these notches 27A has a closed and rounded interior end 28A preferably semi-circular about 1 mm from the edge of the periphery 11A of the optical part 10 and of the opposite rectilinear and parallel edges 29A extending from the rounded end in a more or less radial direction and up to the peripheral edge 26A of the haptic part 20.
• the haptic part 20 comprises a plurality of radial arms and three arms 20D, as illustrated in FIGS. 19 and 20, each of these arms extending in a radial direction between the peripheral edge 11 D of the optical part 10 towards the peripheral edge 26D of the haptic part 20.
• each of the radial arms 20D a the same radial section as the haptic part 20, the corresponding parts of the embodiment of Figures 1 and 2 having the same reference numbers, supplemented by the letter D.
• the haptic arms 20D have a greater circumferential width at the junction with the peripheral edge 26D than with the peripheral edge of the optical part 11 D.
• these radial arms have an angle at the center of 60 ° .
• the intervals between the radial arms have the same angle at the center.
• the angle at the center of the radial arms is preferably between 40 and 80 °.
• the lateral edges of the radial arms can be parallel to one another. In any case, the width of each of the arms should be equal to or greater than 1 mm.
• the surgeon can, after implantation, access the site through the closed contour intervals 29 formed between the radial arms 20D.
• the extent L1 of the haptic part 20 between the periphery 11 of the optical part and the peripheral edge 26 of the radial expansion zone 21 in the rest state is of the order of 2.5 to 3.0 mm and in any case substantially less than the extent L2 of the haptic part 20 between the periphery 11 of the optical part and the peripheral edge 26 of the radial expansion zone 21 in the elongation state which is of the order of 3 to 4 mm after reduction or elimination of ripples. It is the same for the variants of these embodiments. .
• the accommodative intraocular lens 1 of the first embodiment of FIGS. 1 and 2 and of the second embodiment of FIGS. 21 and 22 as well as their variants is represented in FIGS. 10 and 11 implanted in a capsular bag SC after ablation and phacoemulsification of the lens and cleaning of the site. It can be introduced through a small sclerocomeal incision when the optical part and the haptic part are made at least partially of flexible material, such as a hydrophilic poly-HEMA acrylic or silicone. Such an implant can be folded or rolled up to pass through such an incision before being deployed in the posterior chamber of the aphake eye. Any folding or injection device can be used, and in particular an injector.
• the outer edge 20 of the peripheral edge 26 is in contact by its edges or square angles anterior 27 and posterior 28 with the capsular bag.
• the square angles are intended to limit or inhibit the proliferation of epithelial cells, in particular on the posterior capsule and which is responsible for the opacification of this called secondary cataract, requiring intervention by YAG laser.
• the radial expansion zone 21 will normally be prestressed, since the overall diameter of the implant is slightly greater than the diameter of the capsular bag SC at the equator.
• the center of the convex posterior face of the optical part 10 is in contact with and marries the posterior capsule CP, so that the transmission of vitreous pressure is maximum and immediately applied to the optical part during pseudoaccommodation of the eye.
• the combination of vitreous pressure acting in the corresponding central region of the optic part and concomitant with the displacement of the apex of the ciliary muscle and of the equator of the capsular bag both radially towards the center and axially forwards promotes the displacement of the optical part 10 towards the advanced position of accommodation, as illustrated in FIG. 1 1.
• the radial expansion zone 21 is stretched and, therefore, the corrugations 23, 24 and 25 of the bellows 22 are flattened, or even eliminated when the optical part is in the position of maximum accommodation.
• the radial expansion zone 21 adopts a generally frustoconical shape. It goes without saying that if the vitreous hyper-pressure was less than about 200 Pa, there would remain one or more partially flattened undulations.
• the haptic part 20 returns to its rest configuration, by virtue of the return of the radial expansion zone to its initial position, as illustrated in FIG. 10.
• the optical part will preferably be slightly in front of, or possibly in, the plane perpendicular to the optical axis passing through the middle of the contact zone of the peripheral edge of the haptic part with the capsular bag.
• the variants of this embodiment have the same operating mode as that which has just been described.
• Figures 3 and 4 show an accommodative intraocular lens according to the third embodiment. It comprises an optical part 30 and a haptic part 40.
• the optical part 30 illustrated has a biconvex shape but can have other shapes, as already indicated.
• the haptic part 40 has an expansion zone 41 comprising an annular bellows 42 having two annular undulations 43 and 44.
• the first corrugation 43 is located in the immediate vicinity of the periphery 31 of the optical part 30 and opens previously.
• the second corrugation 44 extends circumferentially around the first corrugation and opens posteriorly.
• the bellows 42 is substantially sinusoidal in radial section.
• the second ripple is deeper and wider than the first.
• the depth of the first corrugation is between 0.40 and 0.70 mm and that of the second corrugation is between 0.6 and 1.0 mm.
• the opening angle of the first corrugation 43 is between 50 ° and 70 ° and that of the second corrugation 44 is between 50 and 70 °.
• the thickness of the haptic part 40 in the expansion zone in the form of a bellows is of the order of 0.15 mm and that of the haptic part in the peripheral zone of 0.3 mm.
• the haptic part 40 comprises a peripheral annular gutter 46.
• the thickness of the haptic part 40 in the zone comprising the peripheral gutter is substantially greater than that in the zone comprising the bellows 42 and therefore it is substantially more rigid than the zone d 'radial expansion 41.
• the gutter 46 has a concave anterior surface 48 and a convex posterior surface 49 which are substantially concentric.
• the gutter has an angle at the center of between 90 and 180 °, and more particularly of the order of 150 °.
• the peripheral gutter has a maximum width in the axial direction between 0.5 and 1.5 mm.
• the plane perpendicular to the optical axis AA of the optical part 30 in the area of largest diameter of the gutter passes through the periphery 31 of the optical part 30 or is slightly offset in front of the periphery. Once implanted, the larger diameter area of the gutter is aligned with the equator of the capsular bag SC.
• the extent L3 of the haptic part 40 between the periphery 31 of the optical part and the peripheral edge 46 of the radial expansion zone 41 in the rest state is on the order of 2.4 to 2.8 mm and in any case substantially less than the extent L4 of the haptic part 40 between the periphery 31 of the optical part and the peripheral edge 46 of the radial expansion zone 41 to the state of elongation is of the order of 3 to 4 mm, after reduction or elimination of the undulations.
• the rear surface 47B of the gutter is provided with a plurality of bosses or projections 49B preferably of rounded shape. These bosses or projections cooperate with the capsular bag at the equator. These bosses are such as to avoid the formation of transverse or radial folds, or to decrease them, between the periphery of the optical part 30 and the gutter of the haptic part 40 during the contraction of the periphery of the haptic for vision. near.
• FIGS. 12 and 13 the implant of FIGS. 3 and 4 is shown implanted in a capsular bag SC, respectively in the rest position for far vision and in the position of maximum accommodation.
• the choice of materials will be the same as for the embodiment of Figures 1 and 2 and its implantation process is also the same
• the convex posterior surface 47 of the gutter 46 is in contact with the capsular bag with regard to the equato ⁇ ale zone of the zonules Z.
• the complementarity of this convex posterior surface and that of the corresponding part of the capsular bag constitutes a barrier to the migration of epithelial cells towards the center of the posterior capsule CP and ensures a good spacing between the anterior and posterior sheets of the capsular bag thus restoring the termination fan of the zonule on the equator of the crystalline sac of a phake eye
• this accommodative intraocular lens is moreover substantially the same as that described in relation to the first embodiment. Indeed, during the advancement of the optical part for accommodation, the depth of the undulations decreases, even disappears, the haptic part gradually adopting a substantially frustoconical shape between the periphery of the optical part and the gutter
• Figures 5 and 6 show an accommodative intraocular lens 3 according to the fourth embodiment It comprises an optical part 50 and a haptic part 60
• the optical part 50 illustrated has a biconvex shape
• the haptic part 60 has an annular and substantially planar zone extending between the periphery 51 of the optical part 50 and a peripheral edge 66 with square angles 67, 68
• the radial expansion zone 61 is annular and consists at least in part of the annular zone between the periphery 51 of the optical part and the peripheral edge 66 and is made of a less rigid material and therefore with a higher elasticity It is likely to lengthen from the passage from the rest position to the accommodation position, while ensuring by its inherent elasticity, the return of the optical part to the rest position when the vitreous hyper-pressure and the position of the apex of the ciliary muscle return to their initial position In the rest position, the optical part is preferably slightly forward, or possibly in a plane perpendicular to the optical axis passing through the middle of the contact zone of the peripheral edge of the haptic part with the capsular bag.
• the haptic part 60 can comprise two haptic elements of the type illustrated in FIG. 18 or in FIGS. 21 and 22, arranged like those illustrated in FIG. 18.
• the planar annular zone is replaced partially or entirely by a bellows as illustrated in FIGS. 1 and 2 or in FIGS. 3 and 4. All or part of such a bellows is therefore made of a less rigid and therefore more elastic material than that of the peripheral edge, so that the expansion is obtained in part by reducing the depth or eliminating the undulations, and in part by elongating the zone made of material with superior elasticity.
• a bi-material implant according to this fourth embodiment is preferably produced by modifying the chemical and structural characteristics of the starting material, such as for example that described in the French patent application published under No. 2,779,940. It goes without saying that any other material or combination of materials can be adopted, provided that the geometry and the functionalities of the implant according to the present invention are respected.
• the extent L5 of the haptic part 60 between the periphery 51 of the optical part and the peripheral edge 66 of the radial expansion zone 61 to the rest state is of the order of 2.4 to 2.8 mm and in any case substantially less than the extent L6 of the haptic part 60 between the periphery 51 of the optical part and the peripheral edge 66 of the zone d 'radial expansion 61 in the elongation state is of the order of 3 to 4 mm.
• FIGS. 5 and 6 as well as its variants are shown implanted in a capsular bag, as illustrated in FIGS. 14 and 15, respectively, in the rest position for far vision and in the position of maximum accommodation.
• the actual implantation process will be the same as that already described in connection with the first embodiment.
• edge 66 In the rest position for far vision, represented in FIG. 15, the edge 66 is in contact by its square angles 67, 68, anterior and posterior. of the type already described in connection with the first embodiment and having the same functions
• this accommodative intraocular lens is substantially the same as that described in relation to the other embodiments. Indeed, during the advancement of the optical part for accommodation, the radial expansion zone is stretched so that the distance between the periphery 51 of the optical part 50 and the peripheral edge 66 of the haptic part 60 s 'elongate. If the radial expansion zone comprises, according to the variants of this embodiment, one or more undulations, these undermine gradually, or even disappear, when the optical part reaches its position of maximum accommodation. In this position, the annular part 66 adopts a substantially frustoconical shape between the periphery of the optical part and the peripheral edge. The combination of the bellows on the one hand and a material having a higher elasticity allows a greater axial displacement of accommodation.
• the present invention is not limited to the embodiments described and shown, but encompasses any other variant.
• corrugations in the haptic parts are preferably sinusoidal, but other forms may be suitable.
• the thickness of the radial expansion zone can be uniform or include variations in thickness.
• the optical part can comprise zones of rigid material and others of flexible material, while allowing the optical part to be folded or rolled up to be introduced by a small incision. It is possible to adopt, for the peripheral zone of the haptic part, configurations other than the peripheral edge with square or edge angle and the peripheral edge constituted by a gutter.

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• 2002
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