U.S. patent number RE31,963 [Application Number 06/463,845] was granted by the patent office on 1985-08-06 for intraocular lenses.
Invention is credited to Charles D. Kelman.
United States Patent |
RE31,963 |
Kelman |
August 6, 1985 |
Intraocular lenses
Abstract
A new intraocular lens, suitable for use in artificial lens
implantations and having a light-focusing lens body and two
position fixation means therefor, is disclosed. One position
fixation means extends generally radially from a first region of
the periphery of the lens body and the other position fixation
means comprising a pair of support members extends generally
radially from a second region of the periphery of the lens body
spaced from the first region. At least one of the support members
of said latter position fixation means is resiliently deformable
between a normal undeformed condition, in which the entire lens
will not pass through an incision in the eye of a given length and
a deformed condition, in which the entire lens will pass through
such given incision. During insertion of the lens into the eye,
sufficient force is applied to the deformable position fixation
means to maintain it in the deformed condition thereof. Following
insertion, removal of the applied force results in the deformable
position fixation means tending to spontaneously return to the
normal condition thereof.
Inventors: |
Kelman; Charles D. (Floral
Park, NY) |
Family
ID: |
26863608 |
Appl.
No.: |
06/463,845 |
Filed: |
February 4, 1983 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
Reissue of: |
167923 |
Jul 14, 1980 |
04343050 |
Aug 10, 1982 |
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Current U.S.
Class: |
623/6.45 |
Current CPC
Class: |
A61F
2/16 (20130101); G02C 7/02 (20130101); A61F
2002/1683 (20130101) |
Current International
Class: |
A61F
2/16 (20060101); A61F 001/16 (); A61F 001/24 () |
Field of
Search: |
;3/13,1 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Sternberg; Henry
Claims
I claim:
1. An intraocular lens with flexible support suitable for use as an
artificial lens in the interior of a human eye and insertable
through an incision in said eye, said eye interior having groove
portions extending circumferentially at lower and upper portions of
the eye when viewed in cross-section, said lens comprising a
light-focusing lens body with first and second peripheral sections,
and first and second position fixation means respectively joined to
said first and second peripheral sections of said lens body and
extending generally radially beyond said peripheral sections, said
position fixation means being respectively engageable with the
corresponding one of said groove portions, at least one of said
position fixation means being resiliently deformable, in response
to a force applied thereto, between a first undeformed condition,
and second deformed condition, said deformable position fixation
means being capable of spontaneously returning toward substantially
said first condition thereof upon removal of said applied force
after said lens has been inserted into the eye, and wherein said
deformable position fixation means comprises first and second
support members extending generally outwardly of said lens body and
each having a free end, said free ends being spaced apart a first
distance when in said first undeformed condition, and spaced apart
a second distance less than said first distance when in said second
deformed condition, each of said first and second support members
having at least one portion thereof defining a seating portion
which contacts the adjacent groove portion of the eye, and wherein
said second position fixation means comprises a stabilizing member,
wherein said first and second support members of said deformable
position fixation means are non-overlapping when viewed in the
direction of the optical axis of said lens body in said first
undeformed condition of said deformable position fixation means,
and wherein said first and second support members of said
deformable position fixation means are generally "C"-shaped when
viewed in the direction of the optical axis of said lens body after
said lens is implanted in the eye, the respective concave portions
of the members face each other such that a line joining said free
ends is not superposed within the periphery of said lens body.
2. An intraocular lens according to claim 1, wherein the dimensions
of said deformable position fixation means are such as to preclude
said deformable position fixation means from returning to
substantially said first condition upon removal of said applied
force after said lens has been inserted into the eye.
3. An intraocular lens according to claims 1 or 2, wherein in said
first condition the distance between the circumferentially most
remote edges of said deformable position fixation means precludes
insertion of the lens through a minimum length incision and in said
second condition the lens may be inserted into the eye through a
minimum length incision.
4. An intraocular lens as in claim .[.1.]. .Iadd.3 .Iaddend.wherein
at least one of said first and second support members is
resiliently deformable in a direction toward the other of said
support members for reducing the distance between said
circumferentially most remote edges of said deformable position
fixation means.
5. An intraocular lens as in claim 1, wherein said second position
fixation means comprises a third support member having a portion
thereof defining at least one seating portion.
6. An intraocular lens as in claim 1, wherein said deformable
position fixation means comprises means adapted to receive a force
applied to said deformable position fixation means to deform said
last-mentioned means.
7. An intraocular lens in claim 6, wherein said means for receiving
said deformation force comprises at least one aperture.
8. An introacular lens as in claim 6, wherein said means for
receiving said deformation force comprises at least one notch.
9. An intraocular lens as in claim 6, 7 or 8 further comprising a
suture cooperating with said force receiving means to apply to said
deformable position fixation means a deformation force.
10. An intraocular lens as in claims 6, 7 or 8 further comprising a
suture cooperating with said force receiving means to apply to said
deformable position fixation means a deformation force and wherein
said deformation force applied by said suture is such that the
distance between the most remote edges of said deformable position
fixation means is no greater than would permit insertion of the
lens through a minimum length incision.
11. An intraocular lens as in claim 1, wherein each said first and
second support member is resiliently deformable toward the other of
said support members in a direction generally circumferential with
respect to the lens body. .[.12. An intraocular lens with flexible
support suitable for use as an artificial lens in the interior of a
human eye and insertable through an incision in said eye, said eye
interior having groove portions extending circumferentially at
lower and upper portions of the eye when viewed in cross-section,
said lens comprising a light-focusing lens body with first and
second peripheral sections, and first and second position fixation
means respectively joined to said first and second peripheral
sections of said lens body and extending generally radially beyond
said peripheral sections, said position fixation means being
respectively engageable with the corresponding one of said groove
portions, at least one of said position fixation means being
resiliently deformable, in response to a force applied thereto,
between a first undeformed condition, in which the distance between
the circumferentially most remote edges of said deformable position
fixation means precludes insertion of the lens through an incision
of a given length, and a second deformed condition, in which the
distance between the circumferentially most remote edges of said
deformable position fixation means is such as to permit insertion
of the lens through said incision of given length, said deformable
position fixation means being capable of spontaneously returning
toward substantially said first condition thereof upon removal of
said applied force after said lens has been inserted into the eye,
and wherein said deformable position fixation means comprises first
and second support members extending generally radially outwardly
of said lens body, said first and second support members each
having at least one portion thereof defining a seating portion
which contacts the adjacent groove portion of the eye, and wherein
said second position fixation means comprises a stabilizing member,
and wherein said first and second support members of said
deformable position fixation means in said second condition are
generally "C" shaped, the respective concave portions of the
members face each other and the convex portion of each of the
members comprises a
plurality of noches..]. 13. An intraocular lens suitable for use as
an artificial lens in the interior of a human eye and insertable
through an incision in said eye, said eye interior having groove
portions extending circumferentially at lower and upper portions of
the eye when viewed in cross-section, said lens comprising a
light-focusing lens body with first and second peripheral sections,
said first and second position fixation means respectively joined
to said first and second peripheral sections of said lens body and
extending generally radially beyond said peripheral sections, said
position fixation means being respectively engageable with the
corresponding one of said groove portions, one of said position
fixation means being resiliently deformable, in response to a force
applied thereto, between a first undeformed condition, and a second
deformed condition, said deformable position fixation means being
capable of spontaneously returning toward substantially said first
condition thereof upon removal of said applied force and comprising
first and second support members extending generally outwardly of
said lens body, each of said first and second support members being
resiliently deformable and each having a free end, said free ends
being spaced apart a first distance when in said first undeformed
condition, and spaced apart a second distace less than said first
distance when in said second deformed condition, said first and
second support members being non-overlapping when viewed in the
direction of the optical axis of said lens body in said first
undeformed condition of said deformable position fixation means,
each of said first and second support members being generally
"C"-shaped when viewed in the direction of the optical axis of said
lens body after said lens is implanted in the eye, the concave
portion of each of said last-mentioned members facing each other,
such that a line joining said free ends is not superposed within
the periphery of said lens body, the convex portion of each of said
last-mentioned members comprising a seating portion for contacting
the adjacent groove portion of the eye, the other position fixation
means comprising a stabilizing member, said first, second and
stabilizing members being engageable with said groove portions of
the eye
so as to align the lens body with respect to the pupil of the eye.
14. An intraocular lens with flexible support suitable for use as
an artificial lens in the interior of a human eye and insertable
through an incision in said eye, said eye interior having groove
portions extending circumferentially at lower and upper portions of
the eye when viewed in cross-section, said lens comprising a
light-focusing lens body with first and second peripheral sections,
and first and second position fixation means respectively joined to
said first and second peripheral sections of said lens body and
extending generally radially beyond said peripheral sections, said
position fixation means being respectively engageable with the
corresponding one of said groove portions, one of said position
fixation means comprising first and second support members each
having a free end, one of said first and second support members
being resiliently deformable in response to a predetermined force
applied thereto in a direction toward the other of said support
members for reducing the distance between said free ends a
predetermined amount, said deformable support member being capable
of spontaneously returning toward substantially its undeformed
condition upon removal of said applied force after said lens has
been inserted into the eye, said lens further including a force
applicator means connected to said first and second support members
to establish said predetermined force on said one of said support
members, the other of said support members being substantially
nondeformable in response to said predetermined force. 15. An
intraocular lens according to claim 14 wherein the dimensions of
said first and second support members are such as to preclude said
one of said support members from returning to substantially the
nondeformed condition upon removal of the predetermined force after
said lens has been inserted into the eye.
An intraocular lens according to claims 14 or 15 wherein the normal
distance between the circumferentially most remote edges of said
first and second support members precludes insertion of the lens
through a minimum length incision and the reduced distance between
said circumferentially most remote edges permits insertion of the
lens into the eye through said
minimum length incision. 17. An intraocular lens according to claim
14 wherein said first and second support members extend generally
radially outwardly of said lens body and each has at least one
portion thereof defining a seating portion which contacts the
adjacent groove portion of
the eye. 18. An intraocular lens as in claim 14 wherein said
second
position fixation means comprises a stabilizing member. 19. An
intraocular lens as in claim 14 wherein said second position
fixation means comprises a third support member having a portion
thereof defining at least one
seating portion. 20. An intraocular lens as in claim 19 wherein
said first and second support members and said second position
fixation member each comprise a first portion and a second portion,
each said second portion of a support member comprising said
seating portions and each second portion being offset slightly
posteriorly relative to said lens body and in a plane relative to
the plane of said lens body, and each said first portion
respectively connecting each said second portion and said lens
body. 21. An intraocular lens as in claim 14 wherein said first and
second
support members each include at least one aperture. 22. An
intraocular lens as in claim 14 wherein said first and second
support members each
include at least one notch. 23. An intraocular lens as in claim 14
wherein
said force applicator means comprise a suture. .Iadd.24. An
intraocular lens with flexible support suitable for use as an
artificial lens in the interior of a human eye and insertable
through an incision in said eye, said eye interior having first and
second groove portions extending peripherally at lower and upper
portions of the eye when viewed in cross-section, said lens
comprising a light-focusing lens body, position fixation means and
a stabilizing member joined to said lens body and extending
generally beyond the periphery of said lens body, said position
fixation means being engageable with said first groove portion and
being resiliently deformable in response to a force applied
thereto, between a first undeformed condition, in which the
distance between the peripherally most remote edges of said
position fixation means precludes insertion of the lens through an
incision of a given length, and a second deformed condition, in
which the distance between the peripherally most remote edges of
said position fixation means is such as to permit insertion of the
lens through said incision of given length, said position fixation
means being capable of spontaneously returning toward substantially
said first condition thereof upon removal of said applied force
after said lens has been inserted into the eye, said position
fixation means comprising first and second support portions
disposed generally outwardly of said lens body, said first and
second support portions each having a seating portion which
contacts said first groove portion of the eye, said first and
second support portions of said position fixation means in said
second condition being generally "C" shaped, the respective concave
edges of the support portions facing each other and the outer edge
of each of the
seating portions comprising at least one protrusion. .Iaddend.
.Iadd.25. An intraocular lens as in claim 24 wherein the outer edge
of each of said seating portions of said first and second support
portions of said position fixation means comprises a plurality of
protrusions. .Iaddend.
Description
This invention relates to intraocular lenses suitable for use as
artificial lens implants.
Intraocular lenses generally consist of a medial lens body and a
plurality of lateral lobes or position fixation elements usually
projecting from different sides of the lens body for use in fixing
the lens in position in the eye.
As is well-known to those skilled in this art, even though the
diameter of the lens body of an intraocular lens is only about 4
mm, a corneo-scleral incision considerably longer than the lens
body diameter, and normally from about 8 to 9 mm in length, is
normally required for lens implantation. An incision of this
magnitude is mandated because the incision must be capable of being
spread far enough to accommodate both the thickness and the width
of the lens, i.e., the lens body and the position fixation elements
extending therefrom. In this context, "thickness" means the
dimension of the lens as measured from the anteriormost plane in
which any part of the lens structure (e.g., the apex of the lens
body) is found, to the posterior-most plane (e.g., the plane of the
position fixation elements). "Width" means the minimum length of a
projection of the lens onto a plane parallel to the optical axis of
the lens body, in a direction perpendicular to a projection of the
optical axis on such plane, which can be achieved by rotating the
lens 360.degree. about said optical axis.
Lens implantations are not only extremely difficult and delicate
operations, but the use of certain currently available intraocular
lenses, even by a highly skilled surgeon, entails a number of
disadvantages. One of these is that a relatively long incision,
generally double the diameter of the lens body or more, is required
because of the mechanical, i.e., lens dimension, aspects mentioned
earlier. The problem which ensues here is, of course, that the
longer the incision, the greater the wound and the more difficult
the post-operative recovery and healing period for the patient.
Another disadvantage is that many of the currently available lenses
are somewhat difficult to manipulate, given the relatively cramped
environment of the surgical operation involved. An improper
fixation of the lens relative to the pupil thus can easily occur,
which would make it necessary for the surgeon, despite the possible
traumatic effects on the patient, to go back into the eye after the
initial surgery in order to correct the positioning error.
In my U.S. Pat. No. 4,092,743, issued June 6, 1978, a new
intraocular lens construction, suitable for use in artificial lens
implantations and having a medial light-focusing lens body and two
lateral position fixation elements thereof, is disclosed. By virtue
of the special shape of the position fixation elements, the lens
can be introduced into the eye by being in effect "snaked through"
the corneo-scleral incision. The length of the incision thus can be
considerably less than is required in cases of lens implantations
utilizing previously available intraocular lenses and still provide
a three-point support for the lens in the eye so as to maintain
proper lens positioning relative to the pupil of the eye.
It is an important object of the present invention to provide an
alternate class of novel intraocular lenses which will also both
substantially simplify lens implantation surgery and enable the
disadvantages of the prior art lenses to be minimized if not
avoided altogether.
A more particular object of the present invention is the provision
of intraocular lenses so constructed that they will enable use of a
corneo-scleral incision of considerably less length than had been
required prior to those of my above-described inventions in
implanting lenses having supports spaced apart a distance which
exceeds the diameter of the lens body.
Further objects of the present invention are the provision of an
intraocular lens that may be deformed into a temporary smaller
configuration prior to and during insertion and a final larger
configuration once it is in the eye, and an intraocular lens having
a combined peripheral extent greater than the lens body alone but
insertable through an incision the size of which is the minimum
length required for insertion of just the lens body alone.
Other objects and features will be in part apparent and in part
pointed out hereinafter.
Basically speaking, the objectives of the present invention are
achieved by an intraocular lens construction which is characterized
by a medial lens body and two position fixation means joined to and
projecting from spaced, generally opposite, lateral peripheral
regions of the lens body, at least one of the position fixation
means being deformable and including a first and a second support
member, at least one of which is resiliently deformable toward and
away from the other such support member in a circumferential
direction with respect to the lens body. The other position
fixation means includes a third support or stabilizing member
joined to an opposite peripheral section of the lens body.
In one form of the invention the deformable position fixation means
include means for temporarily deforming at least one of the first
and second support members by an applied force, preferably with a
suture. In such embodiment of the invention, the first and second
support members are integrally joined to a generally circular lens
body and, in the undeformed condition, extend substantially
radially therefrom at a predetermined angle with respect to each
other. When the members are in such undeformed state, the remote
edge portions of these support members are spaced apart a distance
that is greater than the diameter of the lens body. When one or
both of the support members are temporarily deformed during
insertion, the deformation is such that no portion of one of these
members is spaced from a corresponding portion of the other of
these members a distance in excess of the lens body diameter. The
third support member is preferably formed as an integral part of
the lens body and need not be deformable.
In another representative form of the invention, both the first and
second support members are deformable and the third member
functions primarily to stabilize the lens in the eye while
virtually all of the lens support function is performed by the
first and second support members. This form of the invention is
further distinguished from the embodiment of the preceding
paragraph in that the first and second support members need not be
deformable to the extent necessary to permit passage of the lens
through a minimum length incision. Rather the flexibility of the
first and second support members is utilized to permit insertion of
the lens in contracted form through an incision in the eye which,
although not of "minimum length", is still of significantly less
length than would be required in order to accomodate a prior art
lens that would provide equivalent support to the lens body once
the lens is implanted in the eye.
The lens body and associated position fixation means are inserted
in the eye through a corneo-scleral incision with the first
position fixation means in a deformed, i.e., contracted condition.
The contracted condition is achieved by utilizing suitable means to
exert sufficient force to temporarily bring the one or more
resiliently deformable support members of the first position
fixation means more closely together in a plane generally
perpendicular to the optical axis of the lens body. After insertion
into the eye, the intraocular lens is restored to substantially its
original shape by removal of the force imposed on the resiliently
deformable support member(s).
The configurations of the two position fixation means in the
undeformed condition of the deformable support member(s) and their
location with respect to the lens body are such that first, the
minimum length of a projection of the entire lens onto a plane
parallel to the optical axis of the lens body in a direction
perpendicular to a projection of the optical axis on the plane
which can be achieved by rotating the lens 360.degree. about the
optical axis, is greater than the minimum length of a projection of
the lens body alone onto the plane in a direction perpendicular to
a projection of the optical axis on the plane which can be achieved
by rotating the lens body 360.degree. about the optical axis; and
second, the difference between these lengths is such that an
insertion of the lens, through an incision in the eye, by a
movement which is generally radial with respect to the optical axis
would require the length of the incision to be greater than the
minimum possible length of the incision which, as a function of the
thickness and lateral dimensions of the lens body, would
accommodate and permit passage of the lens body alone. However,
when the lens is in the deformed, i.e. contracted, state, the
maximum transverse dimension of each position fixation means at any
part thereof is such that it can be accommodated in and pass
longitudinally through an incision of significantly less length
than would be required for the lens in uncontracted form.
In some embodiments of the invention the lens will pass through a
minimum length incision when the lens is in the contracted state.
As used herein, the expression "minimum length incision" means that
minimum size incision required in the eye to permit passage of the
lens body alone therethrough. The size of the minimum length
incision will vary as a function of the lens body dimensions in two
directions i.e., (1) along the optical axis and (2) perpendicular
to the optical axis.
In an intraocular lens according to one embodiment of the present
invention, which is particularly suited for an implantation in
which the first and second position fixation means are to be seated
behind the iris in the lower and upper regions, respectively, of
the cul-de-sac formed by the anterior and posterior capsules, the
two position fixation means are in substantially coplanar relation
with one another.
In use, when a lens according to the present invention that will
pass through a minimum length incision is being implanted, the
surgeon will first make a corneo-scleral incision in the eye only
slightly longer than the diameter of the lens body, i.e., the
incision will be about 5 mm in length. In order to insert the lens
into the eye, the surgeon will ensure that the first position
fixation means is in contracted form, e.g., via a suture, and then
introduce the lens generally longitudinally into the eye. When the
lens is to be implanted in the anterior chamber, the force holding
the first position fixation means in a contracted state is removed
after insertion and after the lens has assumed its normal
configuration it may then be properly positioned and implanted in
the anterior chamber. On the other hand, when a lens according to
the invention is to be implanted in the posterior chamber, it is
preferred to allow the lens to assume an uncontracted configuration
only after the latter is located in the posterior chamber and
properly oriented so that the expanding deformable fixation means
will automatically enter the cul-de-sac formed by the anterior and
posterior capsules upon removal of the contracting force. It will
be understood that in both cases the two position fixation means,
upon release of the resiliently deformable first position fixation
means, will cooperate to maintain the proper disposition of the
lens body relative to the pupil of the eye.
When a lens of the invention that will not pass through a minimum
length incision is being implanted, the length of the incision will
of course have to be adjusted to the minimum dimension attainable
by contraction of the deformable position fixation means.
The foregoing and other objects, characteristics and advantages of
the present invention will be more clearly understood from the
following detailed description thereof when read in conjunction
with the accompanying drawings, in which:
FIG. 1 is a plan view of an intraocular lens according to one
embodiment of the present invention;
FIG. 1A is a plan view of the intraocular lens of FIG. 1 in
contracted condition ready for insertion into the eye;
FIG. 1B is a sectional view of the intraocular lens of FIG. 1 after
implantation, taken along the line 1B--1B in FIG. 1 and also
including a diagrammatic, substantially vertical section through a
human eye;
FIG. 2 is a plan view of an intraocular lens according to another
embodiment of the invention, in which the lens is in a contracted
condition preparatory to insertion;
FIG. 3 is a plan view of a preferred form of intraocular lens
according to the present invention in normal, i.e., uncontracted,
condition e.g. prior to insertion;
FIG. 4 is a plan view of a FIG. 3 lens in contracted condition
preparatory to insertion; and
FIGS. 5 and 6 are diagrammatic views respectively showing a FIG.
3-type lens in position in a vertical cross-section of the eye and
in a frontal view of the eye with the lens being prevented from
expanding to its uncontracted condition by the interior of the
eye.
Referring now to the drawings in greater detail, an intraocular
lens 10 according to one embodiment of the present invention is
shown in FIGS. 1, 1A and 1B. The lens 10 consists of a
lightfocusing lens body 11 having a convex anterior surface 11a and
a flat posterior surface 11b, first position fixation means
comprising support members 12 and 13 and second position fixation
means comprising support member 14. The intraocular lens 10 of this
embodiment is designed for implantation anteriorly of the iris
20.
The support member 12, which extends generally laterally from one
region of the periphery of the lens body 11, comprises portions 12'
and 12" which are not coplanar with each other or with the lens
body. The first portion 12' is inclined somewhat posteriorly of the
lens body from the region of its connection to the same, and the
second portion 12" is disposed entirely posteriorly of the lens
body and in a plane generally parallel to the plane of the lens
body. Support member 13 is substantially identical to support
member 12 with the angle between support members 12 and 13 being
approximately 60.degree.. Support member 14 extends generally
laterally from a second region of the periphery of the lens body
spaced from and generally opposite the region where first position
fixation means comprising support members 12 and 13 are located. As
with the other support members, the support member 14 has a first
inner portion 14' which is inclined somewhat posteriorly of the
lens body 11 from the region of its connection to the same, and a
second outer portion 14" which is disposed entirely posteriorly of
the lens body and in a plane generally parallel to the plane of the
lens body.
Although by virtue of the foregoing arrangement the three support
members 12, 13 and 14 of the first and second position fixation
means are not coplanar with the lens body, the degree of
inclination of the first portions 12', 13' and 14' of the support
members is such as to dispose the second portions 12", 13" and 14"
of the support members in coplanar relation with each other and
with their posterior surfaces at a perpendicular distance of about
0.25 to 0.75 mm from the posterior surface 11b of lens body 11. By
virtue of this arrangement, therfore, when the lens 10 has been
implanted in a human eye, as shown in FIG. 1B, the lens body 11 and
the proximate portions 12', 13' and 14' of the position fixation
means will be maintained out of contact with the iris 20 in the
region of the pupil, thereby minimizing the possibility of the lens
irritating the iris and interfering with the expansion and
contraction of the pupil 19. Preferably, both position fixation
means are unitary with the lens body, i.e., they are not separately
attached but are formed with the lens body (by molding or
machining, for example) of any suitable physiologically inert and
non-toxic synthetic plastic material such as is well known to the
art, e.g., polymethylmethacrylate, but the position fixation means
may, as long as they have the requisite shapes, orientations and
properties, comprise materials different than used for the lens
body.
It will be noted from FIG. 1, which illustrates an anterior chamber
lens, that the distance between the most remote edge, i.e., the
free ends of portions 12" and 13" of support members 12 and 13
defines a first dimensional side 15 of a rectangle shown in dotted
outline in FIG. 1. The distance from a line joining the free ends
of portions 12" and 13" to the free end of portion 14" of support
member 14 defines a second dimensional side 16 of the rectangle.
The rectangle, which encloses the entire structure of the
intraocular lens 10, does not contact any portion of the periphery
of the lens body 11. In FIG. 1, intraocular lens 10 is shown in its
manufactured shape or configuration, which also corresponds to the
configuration of the lens after it is implanted. In FIG. 1A, the
intraocular lens 10 is shown in the contracted condition i.e. the
condition in which the lens is inserted into the eye preparatory to
implanatation. To permit temporary contraction of support members
12 and 13 during insertion of intraocular lens 10 into the eye,
support members 12 and 13 are both deformable to such extent that a
properly applied force will bring support members 12 and 13 closely
enough together so that the maximum width dimension W between the
most remote edges of said support members 12 and 13 will not exceed
the diameter d of the lens body 11. As a result the intraocular
lens 10 may be inserted through a corneo-scleral incision that is
the minimum size necessary to accommodate lens body 11. Since it is
desired that the lens shape after implantation correspond to the
initial manufactured shape, the materials used in the construction
of support members 12 and 13 are chosen such that the elastic limit
of these support members should not be exceeded when they are
brought into the contracted condition shown in FIG. 1A.
As shown in FIG. 1A, intraocular lens 10 is provided with means
permitting application of the force necessary for contraction of
the support members, namely the apertures 17 and 18, respectively.
A suture 19, threaded through each of the apertures, is shown
sufficiently tightened to draw support members 12 and 13 closely
enough together that the width dimension w between the remote edges
of these support members is nowhere greater than the diameter d of
lens body 11. Of course, the force for contracting the support
members need not be provided by a suture, but could instead be
provided by other means, e.g., by a tool such as a miniature pliers
which the surgeon could use to hold the support members in deformed
condition during insertion.
In use, an incision is made about 5 mm long, i.e. just sufficient
to enable it to spread to the degree required to accommodate both
the diameter and the thickness of the lens body 11. With the
incision properly spread apart, lens 10 in the contracted condition
shown in FIG. 1A, i.e., with the support members 12 and 13
deflected toward one another, is then inserted essentially
"longitudinally" into the eye through the incision, starting, for
example, with the free end of support member 14. The lens body 11
and the first position fixation means comprising support members 12
and 13 are then fed through the incision.
Upon completion of the passage of the lens through the incision
into the eye, the force which is used to retain the support members
17 and 18 in deformed condition is removed, whereupon lens 10
automatically assumes the shape desired for implantation, i.e., in
this embodiment, the original manufactured shape shown in FIG. 1.
The free ends of the two support members 12 and 13 are then guided
into the lower regions 21 of the groove located behind the scleral
spur 23 and the free end of the support member 14 into the upper
region 22 of the same groove. In those cases where a suture 19 is
used to provide the force for deforming, that force is removed by
cutting of the suture after the lens is in the eye.
The ultimate position of the lens 10 is such that the entire lens
is positioned anteriorly of the iris, with the second portions 12"
and 13" of the first position fixation means and the second portion
14" of the second position fixation means seated in the lower and
upper regions 21 and 22, respectively, of the groove behind the
scleral spur 23. The free ends of portions 12", 13" and 14" provide
a three-point support for the lens in the eye so as to maintain the
lens body in proper optical position relative to the pupil of the
eye. One or more of the support members may then be sutured in
place so as to ensure that the lens will maintain its position.
According to the present invention the three supporting ends are in
undeformed final condition spaced apart further than they could be
had they been confined to a distance dictated by the lens body
diameter.
In lieu of the apertures as a means of permitting application of
sufficient force to deform the support members 12 and 13 forming
the first position fixation means, as utilized in the embodiment of
FIGS. 1, 1A and 1B, the aforementioned support members may be
provided with serrations or notches (see FIG. 4), around which a
suture may be looped and tightened to the degree necessary to bring
these support members into the previously described deformed, i.e.,
contracted, condition preparatory to insertion of the lens into the
eye.
The intraocular lens 100 according to the FIG. 2 embodiment is
identical in all respects with the lens 10 of FIGS. 1, 1A and 1B
except that only one of the two support members comprising the
first position fixation means is deformable toward the other of
said support members. Thus lens body 101 and support members 102
and 104 are as described for lens body 11 and support members 12
and 14 respectively, of FIGS. 1, 1A and 1B. Support member 103 of
FIG. 2 need not be deformable but is otherwise the same as support
member 13 of FIGS. 1, 1A and 1B. The FIG. 2 embodiment is shown in
a contracted position achieved via suture 105 being looped through
apertures 106 and 107 and sufficiently tightened to reduce the
maximum distance between the most remote edges of support members
102 and 103 to not more than the maximum dimension of the lens body
101.
FIGS. 3 and 4 respectively show a preferred embodiment of a
posterior chamber lens according to the present invention in
undeformed and in contracted condition. Intraocular lens 120
comprises lens body 121 and the first position fixation means
comprise a pair of resiliently deformable support members 122 and
123 and the second position fixation means comprise stabilizing
member 124. The lens is intended for implantation in the posterior
cavity. As shown in FIG. 4, when the lens is in contracted form the
deformable support members 122 and 123 form a serrated pincer-like
shape. As shown, each of the deformed or contracted support members
122 and 123 has a concave edge and a convex edge forming a
generally "C"-shaped member. The concave edges of the support
members face each other, resulting in the pincer-like shape. A
series of serrations or notches 129 and 130 are provided on the
convex edge of each of the members. In the illustrated embodiment,
the serrations on each support member extend from the free end of
the member to about the mid-point of the "C". Serrations or notches
129 and 130 form at least one, but preferably a plurality of
protrusions which serve to enhance the position-fixation ability of
support members 122 and 123. Holes 125 and 126 located near the
free ends of support members 122 and 123 provide a means of
applying sufficient deformation force via a suture 132 as shown (or
a pliers-like instrument) to the first position fixation means to
bring the lens 120 from the uncontracted state shown in FIG. 3 to
the contracted configuration of FIG. 4 for insertion.
Intraocular lens 120 of the instant embodiment (FIGS. 3 and 4)
comprises first and second position fixation means which are to be
seated behind the iris in the lower and upper regions,
respectively, of the cul-de-sac formed between the anterior and
posterior capsules. As shown in FIG. 5, which is a diagrammatic
view of a vertical cross-section through the eye illustrating the
relative location of the implanted lens, the lens body 121
comprises a convex anterior surface 134 and a flat posterior
surface 136. The posterior surfaces of all three support members
comprising the first and second position fixation means are
coplanar with each other and with posterior surface 136 of the lens
body, as partially shown in FIG. 5. Thus, in this embodiment of the
invention, the position fixation means are coplanar with the lens
body. Although support members 122 and 123 of the first position
fixation means are so designed and used that they tend to re-assume
their original configuration following removal of suture 132, their
lengths and shapes are preferably chosen such that there is not
sufficient room in the cul-de-sac 146 for the original shape to be
re-assumed. Consequently, the remote sides of the free ends of the
support members are met by slight restraining forces arising from
their contact with the afore-mentioned cul-de-sac, as shown in FIG.
6. Notches or serrations 129 and 130 result in the formation of
multiple edges on the remote side of each support member comprising
the first position fixation means, which edges, coupled with the
above-mentioned slight restraining forces, increase the ability of
those support members to fix the position of the lens in the eye.
Stabilizing member 124 serves primarily to maintain the lens in the
proper position with respect to the vertical plane of the lens
body.
FIG. 6, a diagrammatic front view of a human eye, illustrates lens
120 in implanted position with deformable support members 122 and
123 under compression and therefore being gently urged against the
inner peripheral surface of the cul-de-sac 146 formed between the
anterior and posterior capsules. Thus, a lens embodying the
features of the FIG. 4 embodiment may dispense with the need for
suturing the lens in place since the serrated edges of the first
position fixation means, being urged slightly outwardly into
engagement with the inner surface of the cul-de-sac as a result of
the members 122 and 123 being restrained by the cul-de-sac, prevent
the lens from returing to the undeformed condition. The dimensions
of the lens are preferably chosen such that in implanted condition
the deformable support members are not fully sprung to their
undeformed condition and are configurated and manufactured to exert
only that slight degree of pressure against the cul-de-sac which is
known by those skilled in the art to be safely accommodated by the
eye.
The dimensions provided certain of the intraocular lenses according
to this invention will vary according to eyeball measurements for
each patient, although the embodiment illustrated in FIGS. 3 to 6
will adapt itself to various sizes of the eye within a limited
range. Nevertheless, as illustrative only and in order to exemplify
the magnitudes of the dimensions being dealt with, the overall
length of an intraocular lens in final, non-contracted condition
from the free ends of the first position fixation means to the free
end(s) of the second position fixation means is approximately 12-13
mm; the diameter of the lens body is approximately 4 mm; the
thickness of the lens body is approximately 0.4 mm; the angle
between the portions of the first and second support members that
are closest to the periphery of the lens body in embodiments
according to FIGS. 1 and 2 is preferably, but not necessarily,
approximately 60.degree., while in embodiments according to FIG. 3
such angle may approach 180.degree.; the distance between the
remote edges of first and second support members at points of
contact with the eye is typically approximately 7 mm when there is
only one contact point per support member; the cross-sectional
width of typical support members is approximately 1.2 mm; the
cross-sectional thickness of typical support members is
approximately 0.2 mm; and the offset between the main portions and
the seating portions of the support members for implantation
anteriorly of the iris is approximately 0.7 mm.
It is apparent that many variants on the structures described
herein are possible without departing from the nature of the
invention, such as by slight modification of support members and
varying the selection of same for use in a particular lens
embodiment. Thus intraocular lenses according to the invention may
be provided with both the first and second position fixation means
being deformable, resulting in four widely spaced support points
where, for example, both position fixation means are of the sort
illustrated for the first position fixation means of FIG. 1.
Moreover, it should also be apparent from this disclosure that lens
embodiments described in the context of anterior chamber lenses may
be configured for posterior chamber implantation by suitable
modification of the support members from the FIG. 1B to the FIG. 5
configuration.
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