DE202013009162U1 - Intraocular lens assembly - Google Patents

Abstract

An intraocular lens assembly comprising an intraocular lens structure (IOL) (1) for implantation in a capsular bag (22) of an eye (20), said IOL (1) comprising: - an optical structure (2) comprising a Having circumference (7); At least two rear supports (5, 5 ') connected to and extending from said periphery (7) of said optical structure (2), intended to be located inside the capsular bag (22) when the IOL (1) is implanted in the capsular bag (22), and - at least two front supports (6, 6 ') connected to and extending from said periphery (7) of said optical structure (2) determined to be located outside the capsular bag (22) when the IOL (1) is implanted in the capsular bag (22), the anterior supports (6, 6 ') and the posterior supports (5, 5') facing each other on the arranged to hold between them a front capsular bag tab (23) to hold the optical structure of the IOL (1) aligned with an opening (32) in a front part of the capsular bag (22), said intraocular lens Assembly continues to have a secondary intraocular lens (S-IO L) (30) for attachment to a front side (3) of the IOL (1), said S-IOL (30) comprising: - a secondary optical structure (35) comprising a secondary periphery (36); - at least two fixing parts (37, 37 ') connected to said secondary circumference and each intended to be connected to one of said front supports (6, 6') to form said S-IOL (30) on the said IOL (1), wherein the optical structure (2) and the secondary optical structure (35) are aligned with each other, and - a ring (41) around said secondary optical structure (35), wherein an inner Circumference (44) of said ring is secured to the secondary perimeter (36) and said inner perimeter (44) fits around the perimeter (7) of the optical structure (2) of the IOL (1).

Description

Field of the invention

The invention relates to an intraocular lens assembly comprising an intraocular lens structure (IOL) and a secondary intraocular lens, and a method of inserting such an intraocular lens assembly.

Background of the invention

Modern cataract surgery, also known as extracapsular cataract extraction, cuts a hole in the anterior capsule. This can be done with the help of laser devices. Then the natural lens is removed. In the remaining parts of the capsular bag, an IOL is used in many proposed methods. The IOL stays more or less in position in the empty bag.

Usually, an IOL is supplied with a feel. This haptic extends radially from a lens of an IOL. After implantation of an IOL, this haptic normally engages the inner periphery of the remaining capsular bag portion to hold the optic, such as a lens, more or less centering and positioning the IOL in the capsular bag.

To improve the fixation of the position of an IOL, numerous designs have been proposed. US6027531 describes an intraocular lens for use in extracapsular cataract extraction, which has a haptic part surrounding the optical part of the lens, and further includes a groove of such shape that it covers the anterior and posterior capsules of the lens bag after anterior capsulorhexis, extracapsular cataract extraction, and can absorb posterior capsulorhexis. The lens is preferably used in a calibrated, circular and continuous, combined anterior and posterior capsulorhexis, slightly smaller than the inner circumference of the groove, such that an extension of the edges of the capsular openings is effected. It is believed that this new approach prevents the capsules from fogging, provides a very stable fixation of the intraocular lens and ensures a tight separation between the anterior and posterior segments of the eye. This new insertion principle is referred to as a 'bag-in-the-lens' technique, in contrast to the classic 'lens-in-the-bag' technique. The implantation of this IOL requires skill and the capsular bag may be damaged. If the capsular bag breaks after insertion, the IOL will not stay in place.

In US6881225 An intraocular lens structure for reducing complications is described. The intraocular lens structure consists of an optic, a support and a locking device. The locking device is a groove or "indentation" formed on the side part of the optic of the intraocular lens. The valley is formed by the optics and by a projection that protrudes from the back of the optics. The groove or valley in the optic is designed to engage the posterior capsular opening, generally the entire circumference of the groove or valley, to close the opening of the posterior capsule. Like most current IOL structures, the structure also uses its feel to hold the structure in the capsular bag. The groove holds the back part of the capsular bag.

US5171320 describes an intraocular lens system that is implantable within a generally circular opening in a front wall of the capsular bag that normally contains the crystalline lens of an eye. The intraocular lens system comprises a lens body having an annular groove formed in a peripheral part thereof in a plane substantially perpendicular to an optical axis of the lens body. The lens body has an optically effective portion disposed radially in the annular groove, and a front lens portion and a rear lens portion respectively disposed on the front and rear sides of the annular groove. The intraocular lens system is held in position within the circular opening in such a manner that an annular tab portion of the capsular bag surrounding the circular opening is received in the annular groove in the lens body.

Known IOLs and IOL systems do not usually correct for optical errors in the eye completely. Normally, no normal vision in which light is focused precisely on the retina is achieved. There remains a residual error. Often, the patient continues to need glasses or undergoes a laser treatment to correct for the typically remaining refractive error of +0.5 to +1.5 diopters. The prior art has proposed an additional lens which is clamped onto an implanted IOL. Examples are the following documents.

US4932971 describes a collapsible optic assembly intended to be clamped in situ onto a previously implanted intraocular lens to alter its optical properties without removal from the eye, consisting of a lens body having a plurality of spaced apart elastic clamping members that run away from it, and externally terminated in terminals that grip the peripheral edge of the implanted lens to clamp the assembly thereon. At least one clip is configured as a bent end that is resilient enough to be temporarily straightened and moved over the peripheral edge of the implanted lens to grip the clip thereon, such as the clips. B. have a selected length to hold the lens body concentric with the optical axis or eccentric to the optical axis of the implanted lens, wherein the assembly is clamped when inserted into the eye in such a manner on the implanted lens that last with a clamp bent end is manipulated on said peripheral edge.

US5366502 describes an additional intraocular lens adapted to be attached to a conventional implanted intraocular lens either before or after surgery to form an adjustable or removable multifocal optic or to form a required optic of spherical, cylindrical or combined shape to correct the refractive error in aphakic patients. There is also provided an intraocular lens system including a primary intraocular lens modified to secure a corrective intraocular lens provided in addition to the primary lens. Either the primary or the additional lens could be formed from a suitable multifocal lens, or both lenses could be monofocal. The primary intraocular lens is implanted in the anterior chamber of an eye or in the posterior chamber of an eye between the capsular bag and the iris.

WO2008094518 describes a multi-component intraocular lens implanted in a human eye optical system and having one or more foldable removable components, each component being foldable. One component serves as a base lens and has a flange with an aperture or a slot. Another component serves as the middle lens and a third component serves as the upper lens which receives the middle lens. The upper lens and the middle lens may be assembled or integrated to form an optical assembly. The top lens, the center lens or the optical assembly may include at least one projection that engages the slot of the base lens. A medical adhesive may be applied to an outer peripheral surface of the upper lens to join the upper lens to the center lens, or may be applied to an upper surface of the upper lens opposite to a lower surface of the middle lens. Because the lens components are foldable, they can be inserted into the eye using an incision that is smaller than the diameter of the unfolded lens. The removable components can be used to correct various medical complaints of the eye and to improve and optimize vision, as well as for cosmetic purposes.

Summary of the invention

A drawback of the prior art is that insertion of the IOL, and especially the secondary intraocular lenses, can be very difficult and there is a high risk of damaging the capsular bag during the procedure. This becomes even more problematic when additional manipulations, for example in the capsular bag, are required to correct for remaining refractive errors.

Thus, one aspect of the invention is to provide an alternative intraocular lens assembly which preferably at least partially obviates one or more of the disadvantages described above. In particular, the intraocular lens assembly of the invention allows for proper and easy implantation. Alternatively or additionally, it results in less damage to the capsular bag and allows for secure positioning.

The invention provides an intraocular lens assembly according to claim 1. In particular, said intraocular lens assembly comprises an intraocular lens structure (IOL) for implantation in a capsular bag of an eye, said IOL comprising an optical structure comprising a perimeter and at least two posterior supports connected to said perimeter of said optical structure and extending therefrom, which are intended to be in the capsular bag when the IOL is implanted in the capsular bag, and at least two front posts connected to and from said periphery of said optical structure which, when the IOL is implanted in the capsular bag, are located outside the capsular bag,
wherein the front pillars and the rear pillars are disposed on the said periphery with respect to each other so as to hold therebetween a front capsular bag tab for retaining the optical structure of the IOL in a position aligned with an opening in a front part of the capsular bag.
said intraocular lens assembly further comprising a secondary intraocular lens (S-IOL) for attachment to a forward side of the IOL, said S-IOL having a secondary optical structure comprising a secondary perimeter and at least two attachment portions are connected to said secondary periphery and each intended for connection to one of said front supports, for mounting said S-IOL on said IOL, wherein the optical structure and the secondary optical structure are aligned, and a ring of approximately said secondary optical structure, wherein an inner periphery of said ring is secured to the secondary periphery and said inner circumference approximately fits around the circumference of the optical structure of the IOL.

The IOL can be inserted into the capsular bag. The anterior and posterior supports allow the fixation of the IOL with its optical structure aligned with an aperture, in particular an aperture or aperture, in a capsular bag. It has been found that due to its ability to be stably and accurately positioned with its optical structure aligned with, and in particular aligned with, the opening in the capsular bag, the IOL provides a solid support structure for additional refractive corrections.

The terms "forward" and "behind" refer to an arrangement of features related to the propagation of the light into the eye. Thus, the light enters through the cornea and passes through the pupil through the iris. Cornea and iris are considered as anterior parts of the eye. Subsequently, the light propagates to the retina, which is located in the back of the eye.

The axis of an eye can be the optical axis or the visual axis, the line of sight or the pupil axis. These axes are in shown.

An eye has a capsular bag that normally holds the natural lens. In diseases where this natural lens needs to be removed, an empty capsular bag remains. Usually, to remove the natural lens, an opening is first made in the front part of the capsular bag. Part of the capsular bag membrane is removed. There remains a through hole surrounded by a peripheral edge defining the circumference. Such an opening may be, for example, circular or elliptical. The front membrane of the capsular bag is thus provided with an aperture which provides a diaphragm which allows access to the capsular bag.

The part of the capsular bag closest to the cornea is also referred to herein as the anterior capsular bag portion. The remaining front capsular bag portion surrounding the mentioned opening is referred to herein as the front capsular bag tab. This can also be considered as a ring of capsular bag membrane.

The capsular bag also has a back part. This is the part of the capsular bag closest to the retina. The average capsular bag thickness is 4 to 9 microns for the posterior capsular bag section and 10 to 20 microns for the anterior capsular bag section.

In a method of removing the natural lens, the opening in the anterior capsular bag can be made by means of a laser cutting device. This method of making the opening in the capsular bag is also referred to as capsulotomy. This laser-assisted method allows extremely accurate positioning and shape of the opening in the capsular bag. Further, after the removal of the natural lens, it is possible to subsequently make an opening in the rear part of the capsular bag, the rear opening. These two openings can be aligned exactly. The shape of the openings may be made to fit with a shape of a circumference of the IOL, or more specifically, a circumference of approximately the optical structure of the IOL. Thus, the IOL can fit perfectly in the opening. Finally, the openings can be perfectly matched to an optical axis of the eye. Furthermore, when an optical axis of the IOL is aligned in a predetermined position within the periphery of the IOL, the optical structure of the IOL can be optimally positioned in the eye. In this way, the optics of the optical structure can be aligned in a predetermined manner in the eye. For example, optical axes may be aligned, but another predetermined configuration may be possible, for example taking into account the quality of parts of the retina.

In one embodiment, the assembly is the IOL and the S-IOL. The S-IOL serves as an additional correction to the IOL. With regard to the exact positioning and fixation of the IOL, it has been found that in this embodiment, no further additional correction may be required. In fact, if additional correction is required, the S-IOL can be removed and another S-IOL deployed. Such an S-IOL can be customized or selected from a given set of S-IOLs.

The IOL has a frontal side that is oriented toward a cornea of the eye when the IOL is implanted in an eye and attached to the capsular bag. Furthermore, the IOL has a posterior side that is oriented toward a retina of the eye when the IOL is implanted in an eye and attached to the capsular bag.

In one embodiment, the anterior supports and the posterior supports are disposed with respect to each other on said perimeter such that they clamp a front capsular bag tab therebetween to retain the optical structure of the IOL in an opening in the forward portion of the capsular bag. This clamping prevents the IOL from moving independently in the front and rear directions in the eye. The supports together cause pinching of the optical structure in the opening in the front capsular bag part. In particular, this clamping also prevents the rotation of the optical structure in the opening, for example about an axis extending in the direction of the normal of the opening. In this sense, by using the word clamping, it is meant to hold a sheet-like material in the manner in which a paperclip holds one or more sheets of paper.

For clamping the capsular bag tab, various positions of the front and rear supports may be considered. When the IOL is inserted into the capsular bag, the posterior supports remain inside the capsular bag. The front pillars protrude from the capsular bag The capsular bag flap is clamped between these two pillars. The front and rear supports may be substantially in one plane. In such a configuration, in one embodiment, the pillars are circumferentially offset. For example, when following the circumference, a front post and a rear post alternate. To provide additional clamping force, one or more front supports may be inclined rearwardly, and / or one or more rear supports may be inclined forwardly. This may be limited to less than about 10 degrees, more preferably less than about 5 degrees.

Alternatively or additionally, the front pillars and the rear pillars may be spaced apart from one another.

The front and rear supports extend from the circumference. In particular, the supports extend in the radial direction from the periphery.

The circumference of the optical structure may be a surface that extends in the axial direction around the optical structure. The edge of the opening in the front capsular bag part in such an embodiment can be carried around the circumference of the optical structure. In one embodiment, taking into account the elasticity of the capsular bag, the perimeter of the opening may be smaller than the perimeter of the optical structure. Thus, the capsular bag lanyard fits snugly around the IOL.

The front and rear supports of the IOL in one embodiment include support surfaces. The support surfaces may be limited areas of the front and rear supports, respectively, which receive the capsular bag surface. In one embodiment, at least one front support includes a rearward side that substantially fully receives the front surface of the front capsular bag portion. In one embodiment, at least one rear support includes a front side that substantially fully receives the rear surface of the front capsular bag portion.

• – eine optische Struktur;
• – mindestens zwei hintere Stützen, die dazu bestimmt sind, wenn die IOL in den Kapselsack implantiert ist, sich im Kapselsack zu befinden und sich von der genannten optischen Struktur hinwegzuerstrecken, wobei die genannten hinteren Stützen so ausgestaltet sind, dass sie im Gebrauch Stützflächen für die Aufnahme einer hinteren Fläche einer vorderen Kapselsacklasche bieten, und
• – mindestens zwei vordere Stützen, die dazu bestimmt sind, wenn die IOL in den Kapselsack implantiert ist, sich außerhalb des Kapselsacks zu befinden und sich von der genannten optischen Struktur hinwegzuerstrecken, wobei die genannten vorderen Stützen so ausgestaltet sind, dass sie im Gebrauch Stützflächen für die Aufnahme einer vorderen Fläche einer vorderen Kapselsacklasche bieten, wobei eine hintere Ebene, die definiert wird von den Stützflächen der hinteren Stützen, und eine vordere Ebene, die definiert wird von den Stützflächen der vorderen Stützen, so ausgestaltet sind, dass sie im Gebrauch in einem Abstand voneinander angeordnet sind, der dazu ausgestaltet ist, zwischen ihnen eine vordere Kapselsacklasche zu halten, um die IOL in der genannten Öffnung festzuhalten.

The invention further relates to an intraocular lens structure (IOL) for implantation in the capsular bag which holds the IOL in an opening in a front part of a capsular bag, with a front capsular bag strap surrounding said opening, said IOL having a front side which in the Use when the IOL is implanted in an eye, directed toward a cornea of the eye, and a posterior side which, in use, when the IOL is implanted in an eye, is directed to a retina of the eye, said IOL includes:

• An optical structure;
• At least two rear supports intended, when the IOL is implanted in the capsular bag, to be in the capsular bag and to extend away from said optical structure, said rear supports being adapted to provide support surfaces for use in the capsular bag Provide a posterior surface of a front capsular bag tab, and
• At least two front supports intended, when the IOL is implanted in the capsular bag, to be located outside the capsular bag and to extend away from said optical structure, said front supports being configured to have support surfaces in use provide a front surface of a front capsular bag tab, wherein a rear plane defined by the support surfaces of the rear pillars and a front plane defined by the support surfaces of the front pillars are configured so as to be in use in one Spaced apart, which is adapted to hold between them a front capsular bag tab to hold the IOL in said opening.

In one embodiment, the IOL is formed as one part. In one embodiment, the IOL is made from a polymeric material. In one embodiment, the IOL is foldable. The polymer material makes it possible to roll the IOL into a roll smaller than 2.5 mm in diameter. Thus the front capsular bag part clamped can be, at least the front supports are elastic, whereby the IOL can be inserted into the capsular bag and then the front supports are guided through the opening in the front capsular bag part and can be brought into engagement with the front surface thereof. This actually makes it possible to hold the IOL in place.

In one embodiment, the at least two rear pillars extending from said optical structure are arranged in a functionally opposite direction. In one embodiment, the at least two front pillars extending from said optical structure are arranged in a functionally opposite direction.

In one embodiment, the front plane and said back plane, especially in the application, when they clamp the capsular bag are 5-100 microns apart. In particular, said back and front planes are 5-50 microns apart.

If the support surfaces are approximately parallel, this removal allows clamping of the anterior capsular bag tab.

The rear supports, or at least their support surfaces, may be angled toward the front of the IOL. In this way, after implantation, the posterior supports may press into the capsular bag against the posterior surface of the capsular bag tab. The rear supports can be at an angle of up to 10 °.

Alternatively or in combination, the forward supports, or at least their support surfaces, may be angled toward the rear of the IOL. In this way, after implantation, the anterior supports may press into the capsular bag against the anterior surface of the capsular bag tab. The front supports can be at an angle of up to 10 °.

In one embodiment, the rear supports and the front supports are offset from each other in the perimetric direction or in the azimuthal direction. This allows easier production, in particular by the use of mechanical processing or molding technology.

In one embodiment, the rear supports and the said front supports extend in the perimetric direction or in the azimuthal direction over the optical structure. Thus, a good support of the capsular bag flap can be realized, and even a fixation of the IOL.

In one embodiment, the rear pillars and the front pillars do not overlap. In fact, when viewed from the front side, if the front and rear supports do not overlap, machining can be simplified. Furthermore, it may even be possible to allow a smaller distance between the front and rear planes. In fact, the support surface of the front support can be offset to -70 microns past the support surface of the rear support. In particular, when the back support and the front support are resilient, the back support and the front support may pinch the capsular bag tab therebetween and thereby fix the IOL in the opening. Thus, if the pillars do not overlap, the distance between the front and back planes may be between -70 and 100 microns. The negative values indicate that, when not in use, the front support may be further in the rearward direction, past the rear support. In use, however, when holding the capsular bag, the anterior support will be on the anterior side of the anterior capsular bag portion, while the posterior support will be located on the posterior aspect of the anterior portion of the capsular bag.

In one embodiment, the IOL includes a perimetric surface surrounding said optical structure and said rear support, said front support extending from said perimetric surface. In particular, said perimetric surface describes a radial surface intended to receive, when implanted, a perimetric edge of the anterior capsular bag flap defining the diameter of the opening.

This can allow alignment of the IOL. For example, if the opening is not circular, for example elliptical, and the circumference of the IOL matches the shape of the opening, the azimuthal orientation of the IOL may be fixed. In this way, specific optical structures can be aligned.

In one embodiment, at least a selected one of said rear pillars and said front pillars is a haptic. In particular, the feel has an outer diameter of 8-12 mm.

It has been found that the IOL thus fits into the capsular bag. This can serve as a stopgap if alignment with the opening fails.

In one embodiment, the IOL is formed in one piece, with its thickness and flexibility configured with respect to the onset of the IOL in the eye in a folded manner by way of a micro-implantation.

In one embodiment, the IOL further includes an at least partially peripheral groove behind the rear pillars. In particular, said rearward groove opens in the radial direction to receive at least one edge of a posterior capsule bag flap surrounding a posterior opening in a posterior portion of the capsular bag when said IOL is implanted in an eye. In one embodiment, the rear groove is 0.1 to 0.3 mm deep. In particular, said rear groove is 0.05-0.2 mm wide. In particular, the rear groove is conical.

In one embodiment, said S-IOL comprises a posterior side opposite said anterior side of said IOL, said anterior side of said IOL, in use, facing an iris of an eye, said ring comprising a posterior surface is intended to receive the front surface of the front capsular bag part, in particular said rear surface being arranged axially so that it is at least in a plane with the rear surfaces of the at least two front supports, or arranged in the rearward direction behind the rear surfaces is.

In one embodiment said at least two fixing parts are fixed to said ring, said fixing parts extending in particular from said rear side of said ring.

In one embodiment, said at least two fixing parts are attached to said ring and extend rearwardly beyond the rear surface of said ring, said fixing parts extending rearwardly beyond a rear face of the front support, with the said they are connected.

In one embodiment, said front supports comprise through-holes or openings, while said fixing parts comprise ends provided with holding elements or holding devices designed to pass through said openings.

In one embodiment, said inner circumference of said ring comprises an inner circumferential surface which is conical, said circumference having a conical surface having substantially the same angle as the conical inner peripheral surface, said conical surfaces tapering in a frontward direction.

• – umfassen die mindestens zwei hinteren Stützen geschlossene Schlaufen, die sich von der genannten optischen Struktur hinwegerstrecken, wobei jede Schlaufe mit beiden Enden an dem genannten Umfang befestigt ist, und
• – sind die genannten mindestens zwei vorderen Stützen jeweils innerhalb einer der genannten Schlaufen zwischen den genannten Enden angeordnet.

In one embodiment

• The at least two rear supports comprise closed loops extending from said optical structure, each loop being fixed at both ends to said periphery, and
• - said at least two front supports are each disposed within one of said loops between said ends.

In one embodiment, said rear pillars and said front pillars of the IOL are offset from one another in the azimuthal direction (Az).

In one embodiment, said rear pillars of the IOL provide front support surfaces, and said front pillars of the IOL provide rear support surfaces which are offset in the azimuthal direction (Az), particularly in the azimuthal direction (Az) each time a rear support surface and a front support surface is provided.

In one embodiment, said rear pillars and said front pillars of the IOL extend in the azimuthal direction (Az) above the optical structure.

In one embodiment, a front side of said optical structure and a rear side of said secondary optical structure facing said optical structure have substantially the same radius of curvature, in particular said front side of said optical structure and a rear side of said secondary structure optical structure have a distance.

• – mindestens zwei hintere Stützen, die mit dem genannten Umfang der genannten optischen Struktur verbunden sind und sich von dieser hinwegerstrecken und die dazu bestimmt sind, sich innen im Kapselsack zu befinden, wenn die IOL in den Kapselsack implantiert ist, und
• – mindestens zwei vordere Stützen, die mit dem genannten Umfang der genannten optischen Struktur verbunden sind und sich von dieser hinwegerstrecken und die dazu bestimmt sind, sich außerhalb des Kapselsacks zu befinden, wenn die IOL in den Kapselsack implantiert ist, wobei die vorderen Stützen und die hinteren Stützen zueinander so auf dem genannten Umfang angeordnet sind, dass sie zwischen sich eine vordere Kapselsacklasche klemmen, um die optische Struktur der IOL in einer mit einer Öffnung in einem vorderen Teil des Kapselsacks ausgerichteten Position festzuhalten.

The invention further relates to an intraocular lens structure (IOL) for implantation in the capsular bag, comprising: an optical structure having a circumference;

• At least two rear supports connected to and extending from said periphery of said optical structure and intended to be located inside the capsular bag when the IOL is implanted in the capsular bag, and
• At least two front supports connected to and extending from said periphery of said optical structure and intended to be located outside the capsular bag when the IOL is implanted in the capsular bag, the anterior supports and rear supports are arranged to each other on the said circumference, that they between one clamp the front capsular bag tab to hold the optical structure of the IOL in a position aligned with an opening in a front part of the capsular bag.

• – eine sekundäre optische Struktur;
• – einen Ring, der um die genannte sekundäre optische Struktur befestigt ist, wobei der genannte Ring mindestens zwei axiale Flächen umfasst;
• – mindestens zwei Fixierungsteile, die sich von den genannten axialen Flächen des genannten Rings erstrecken und an ihren Enden Halteelementen in einer Entfernung von den axialen Flächen des Rings aufweisen.

The invention further relates to a secondary intraocular lens (S-IOL), said S-IOL comprising:

• A secondary optical structure;
• A ring fixed about said secondary optical structure, said ring comprising at least two axial surfaces;
• At least two fixing parts extending from said axial surfaces of said ring and having at their ends holding elements at a distance from the axial surfaces of the ring.

• – der Bildung einer Öffnung in einem vorderen Teil eines Kapselsacks eines Auges, insbesondere der Durchführung einer lasergestützten Kapsulotomie, wobei die genannte Öffnung umgeben wird von einer vorderen Kapselsacklasche, die zurückbleibt, nachdem die genannte Öffnung gebildet wurde,
• – der Entfernung einer natürlichen Linse aus dem Kapselsack durch die genannte Öffnung;
• – dem Einsetzen der IOL in den Kapselsack durch die genannte Öffnung;
• – der Herausnahme der vorderen Stützen aus dem Kapselsack, während die hinteren Stützen im Kapselsack verbleiben, wodurch die IOL in einer in der Öffnung des vorderen Teils des Kapselsacks ausgerichteten Position befestigt wird.

The invention further relates to a method for fixing the intraocular assembly according to any of the above claims in an eye, which method is composed of:

• The formation of an opening in a front part of a capsular bag of an eye, in particular the performance of a laser-assisted capsulotomy, said opening being surrounded by a front capsule flap which remains after said opening has been formed,
• The removal of a natural lens from the capsular bag through said opening;
• Inserting the IOL into the capsular bag through said opening;
• Removing the front supports from the capsular bag while leaving the rear supports in the capsular bag, thereby securing the IOL in a position aligned in the opening of the front part of the capsular bag.

In one embodiment, the method comprises coloring the front part of the capsule bag with a light absorbing composition having absorbing properties selected to absorb the energy of the laser beam.

In one embodiment, said opening is disposed in a position aligned with an axis of the eye and / or with the optical structure of the IOL.

In one embodiment, said aperture is disposed in a position aligned with an optical and azimuthal axis of the eye and an optical and azimuthal axis of the optical structure of the IOL.

In one embodiment, said opening is circular with a center aligned with the optical axis of the eye, and the optical structure has an optical axis aligned with the periphery of the IOL.

In one embodiment, said opening is not circular and said perimeter of said optical structure is circular. This makes it possible to give the optical structure an inclination relative to an axis of the eye.

In one embodiment, the method further comprises subsequently inserting an S-IOL into said eye.

In one embodiment, the method further comprises connecting the fixation members to corresponding front supports.

• – der Bildung einer Öffnung innerhalb des vorderen Teils eines Kapselsacks eines Auges, wobei die Öffnung ein Profil hat, das zum Umfang der IOL passt, wobei die genannte Öffnung von einer vorderen Kapselsacklasche umgeben wird, die zurückbleibt, nachdem die genannte Öffnung gebildet wurde;
• – der Implantation der IOL in das Auge, wobei die hinteren Stützen sich in den genannten Kapselsack erstrecken, und
• – der Herausnahme der vorderen Stützen aus dem Kapselsack, wobei die vorderen Stützflächen auf der vorderen Fläche des verbleibenden vorderen Teils des Kapselsacks, der die genannte Öffnung umgibt, ruhen, während die hinteren Stützen im Kapselsack belassen werden und der zurückbleibende Teil des vorderen Teils des Kapselsacks, der die Öffnung umgibt, zwischen den hinteren und vorderen Stützen positioniert ist und dadurch die IOL in der Öffnung des vorderen Teils des Kapselsacks festhält.

The invention further relates to a method for fixing the above-described intraocular structure (IOL) in an eye, the IOL having a circumference approximately of an optical structure, the method consisting of:

• The formation of an opening within the anterior portion of a capsular bag of an eye, the opening having a profile that mates with the periphery of the IOL, said opening being surrounded by a front capsular bag tab remaining after said opening is formed;
• The implantation of the IOL into the eye, the posterior supports extending into said capsular bag, and
• The removal of the front supports from the capsular bag, the front support surfaces resting on the front surface of the remaining front part of the capsular bag surrounding said opening while leaving the rear supports in the capsular bag and the remaining part of the front part of the capsular bag , which is positioned between the rear and front pillars, thereby holding the IOL in the opening of the front part of the capsular bag.

In one embodiment of the method, the aperture is aligned with an axis of the eye and / or with the optical structure of the IOL. If the optical structure is a lens, often an optical axis of that lens is aligned.

In one embodiment of the method, the aperture is aligned with an axis and / or an azimuthal axis of the eye and an optical and / or azimuthal axis of the optical structure of the IOL.

In one embodiment of the method, the opening is circular with a center aligned with an axis of the eye and / or the optical structure has an optical axis aligned with the periphery of the IOL.

• – die Bildung einer hinteren Öffnung im hinteren Teil des Kapselsacks, wobei die genannte hintere Öffnung von einer hinteren Kapselsacklasche umgeben wird, die nach der Bildung der genannten hinteren Öffnung zurückbleibt;
• – die Anwendung einer Kante der hinteren Kapselsacklasche, die die hintere Öffnung in einer hinteren Rille in der IOL umgibt und die die optische Struktur hinter den hinteren Stützen zumindest teilweise umgibt. Dadurch wird die hintere Kapselsacklasche befestigt an der IOL, hinter den hinteren Stützen.

In one embodiment of the method, the circumference is circular. In one embodiment of the method, the capsular bag further includes a rear portion, said method further comprising:

• The formation of a rear opening in the rear part of the capsular bag, said rear opening being surrounded by a rear capsular bag tab remaining after the formation of said rear opening;
• The application of an edge of the posterior capsular bag strap which surrounds the posterior opening in a rear groove in the IOL and which at least partially surrounds the optical structure behind the posterior posts. This secures the rear capsular bag tab to the IOL, behind the rear pillars.

• – eine optische Struktur, die einen Umfang aufweist;
• – mindestens zwei hintere Stützen, die mit dem genannten Umfang der genannten optischen Struktur verbunden sind und sich von dieser hinwegerstrecken und die dazu bestimmt sind, sich innen im Kapselsack zu befinden, wenn die IOL in den Kapselsack implantiert ist, und
• – mindestens zwei vordere Stützen, die mit dem genannten Umfang der genannten optischen Struktur verbunden sind und sich von dieser hinwegerstrecken und die dazu bestimmt sind, sich außerhalb des Kapselsacks zu befinden, wenn die IOL in den Kapselsack implantiert ist, wobei die vorderen Stützen und die hinteren Stützen auf dem genannten Umfang so zueinander angeordnet sind, dass sie zwischen sich eine vordere Kapselsacklasche halten, um die optische Struktur der IOL in einer mit einer Öffnung in einem vorderen Teil des Kapselsacks ausgerichteten Position festzuhalten, wobei die genannte intraokulare Linsen-Baugruppe weiterhin eine sekundäre intraokulare Linse (S-IOL) umfasst zur Befestigung an einer vorderen Seite der IOL, wobei die genannte S-IOL umfasst:
• – eine sekundäre optische Struktur, die einen sekundären Umfang aufweist, und
• – mindestens zwei Fixierungsteile, die mit dem genannten sekundären Umfang verbunden sind und jedes dazu bestimmt ist, mit einer der genannten vorderen Stützen verbunden zu werden, um die genannte S-IOL auf der genannten IOL zu befestigen, wobei die optische Struktur und die sekundäre optische Struktur ausgerichtet sind.

The invention further relates to an intraocular lens assembly comprising an intraocular lens structure (IOL) for implantation in a capsular bag of an eye, said IOL comprising:

• An optical structure having a circumference;
• At least two rear supports connected to and extending from said periphery of said optical structure and intended to be located inside the capsular bag when the IOL is implanted in the capsular bag, and
• At least two front supports connected to and extending from said periphery of said optical structure and intended to be located outside the capsular bag when the IOL is implanted in the capsular bag, the anterior supports and rear pillars on the said periphery are arranged to each other to hold therebetween a front capsular bag tab to hold the optical structure of the IOL in a aligned with an opening in a front part of the capsular bag position, said intraocular lens assembly further comprises a secondary intraocular lens (S-IOL) for attachment to a front side of the IOL, said S-IOL comprising:
• A secondary optical structure having a secondary periphery, and
• At least two fixing parts connected to said secondary periphery and each intended to be connected to one of said front supports in order to fix said S-IOL on said IOL, the optical structure and the secondary optical Structure are aligned.

In one embodiment, the S-IOL further includes positioning members that include radial surfaces for receiving the periphery of the IOL, and axial surfaces in an axial surface plane that is parallel to a plane of rear surfaces of the forward supports, and axially disposed in the plane or offset in the rearward direction, said positioning parts being attached to the S-IOL outside the secondary perimeter.

In an embodiment, the IOL includes a recess in said periphery that provides an axially extending groove in the peripheral surface of said periphery.

In one embodiment, this indentation is provided between a rear pillar and a front pillar. When positioned in the opening of the capsular bag, as explained, the peripheral edge of the capsular bag will rest around the circumference of the IOL. The indentation then provides a passage for liquid.

In one embodiment, the S-IOL includes a passage extending through said S-IOL and connected to said indentation of the IOL. When the S-IOL is located on the IOL, one or more fluid passages remain, allowing fluid to be transferred from the anterior side of the capsular bag to the capsular bag and even to the posterior side of the capsular bag.

In one embodiment, the S-IOL includes a recess in its periphery that provides a radially extending groove connected to said indentation of said IOL. In this embodiment, a passage for liquid is also provided past at least one capsular bag membrane.

The term "substantially" as used herein, for example, "substantially opposite" or "consisting essentially of," will be understood by those skilled in the art. The term "substantially" may also extend to embodiments of "whole", "complete", "all", etc. Thus, the adjective "substantially" in embodiments may also be omitted. Optionally, the term "substantially" may also refer to 90% or higher, such as. B. 95% or higher, in particular 99% or more, more preferably 99.5% or more, including 100%. The term "comprising" also extends to Embodiments in which the term "comprising" means "consists of".

The term "functional" as used herein, such as. B. in "functionally opposite", is understood by the skilled person. For example, it extends in exactly the opposite way, but also extends to deviations from precise positioning, as long as the feature behaves functionally in operation or functionally has the effect of, for example, being substantially opposite. The term "functional" may therefore also extend to embodiments with "whole", "complete", "all", etc. Thus, the term "functional" in embodiments may also be omitted. Optionally, the term "functional" may also refer to 90% or higher, such as. B. 95% or higher, in particular 99% or more, more preferably 99.5% or more, including 100%.

Moreover, the terms first, second, third and similar terms in the specification and claims are used to distinguish between similar elements, and not necessarily to describe a sequential or temporal order. It should be understood that the terms used in this manner are interchangeable under certain conditions and that the embodiments of the invention described herein are operable in other than those described and illustrated herein.

The devices or devices described herein are described inter alia during operation. As will be apparent to those skilled in the art, the invention is not limited to working methods or devices in operation.

It should be understood that the above-mentioned embodiments illustrate rather than limit the invention, and that those skilled in the art will be able to design numerous alternative embodiments without departing from the scope of the appended claims. In the claims, any reference numbers placed in parentheses can not be construed as limiting the claim. The use of the word "include" and its declinations does not preclude the presence of elements or steps other than those specified in a claim. If an article precedes the article "on", this does not exclude the presence of several such elements.

The mere fact that certain measures are mentioned in different sub-claims does not suggest that a combination of these measures can not be applied to advantage. In fact, many of the features of the present IOL, S-IOL or assembly can be combined to further enhance ease of implantation or fixation.

The invention further relates to a device or device comprising one or more of the characterizing features described in the specification and / or shown in the attached drawings. The invention further relates to a method or process comprising one or more of the characterizing features described in the specification and / or shown in the attached drawings.

The various aspects discussed in this patent can be combined to provide additional benefits. In addition, some of the characteristics may form the basis for one or more divisional applications.

Brief description of the drawings

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

The and schematically illustrate a cross section through an eye before and after the removal of the natural lens; and a front view of ,

schematically illustrates an embodiment of an IOL in front view;

shows an embodiment of in lateral view;

shows a detail of as stated;

shows the embodiment of in perspective view, showing the front side;

schematically forms a back side of the IOL of off, with an alternative trailing feature;

shows a cross section of the IOL of with the trailing feature of ;

shows a cross section of the IOL of with the alternative rear feature;

shows a detail of as stated;

shows a detail of as stated;

shows still another embodiment of an IOL in front view;

shows an eyeball with an IOL;

shows a detail of as stated with the IOL of ;

shows a detail of as indicated, but with an IOL with an alternative posterior feature and an intact posterior capsular bag portion,

shows a front view of the IOL the and with a secondary intraocular lens (S-IOL) attached thereto;

The and show a perspective view of in back and front view;

shows a cross section of , as in specified;

shows a detail of as stated;

shows a cross section of as stated;

shows a detail of as stated;

shows the S-IOL of from its front side (front side);

shows the S-IOL of from its rear side (back);

the and show a perspective view of the S-IOL of , respectively in the front and rear view;

shows a cross section of as stated;

shows a detail of as stated;

shows a cross section of as stated;

shows a detail of as stated;

shows a cross-sectional view of the intraocular lens assembly of attached to a front capsular bag part showing the flexible clamp using the front capsular bag part;

shows a front view or front side of the alternative IOL the and with an attached alternative secondary intraocular lens (S-IOL);

shows the rear side of the assembly the ;

the and show a perspective view of the S-IOL the each in front and back view;

shows a cross section of the assembly of as mentioned in the above specified;

shows a detail of as stated;

The and show a perspective view of the alternative S-IOL the each in front and back view;

an eye from above, showing the axes of the eyes, and

the and an alternative embodiment of the IOL of , in front view and in perspective, partly from behind.

The drawings are not necessarily to scale.

Description of the Preferred Embodiments

In this description, first the relevant parts of the eye in the and and described. In the - Some special designs of an intraocular lens structure (IOL) and their position in one eye ( - ), and a method for inserting such an IOL into an eye. In the - Various embodiments of an intraocular lens assembly described in US Pat - based IOL based.

The eye

In the and and is schematically a cross section through an eyeball 20 displayed. In has the eyeball 20 a cornea 21 , Iris 25 , Pupil 26 and capsular bag 22 with a natural lens 31 , The capsular bag 22 has a front part 23 and a back part 24 , In becomes the eyeball 20 shown after the natural lens 31 was removed, after which the empty capsular bag 22 remains behind with an opening 32 , which usually has a circular or elliptical shape. The opening 32 is in the front part 23 of the capsular bag 22 , In many cases, the center of opening is 32 on an axis of the eye. The axes are in Are defined. shows a part of the eyeball in front view and shows the iris 25 , the front part 23 of the capsular bag with the opening 32 and the edge of the opening 52 , This edge 52 is also called 'peripheral edge' 52 designated.

Some patients may be the back part 24 of the capsular bag 22 not clear anymore. In such cases, in addition, an opening in the rear part 24 or in the capsule bag 22 manufactured, which is referred to as the rear opening.

In the previous section, the adjectives 'front (er)' and 'behind (er)' are used. As already explained, the terms "forward" and "rearward" refer to an arrangement of features related to the propagation of the light into the eye. Thus, light enters cornea and iris, which are anterior parts of the eye, and propagates to the retina located in the back of the eye. Thus, for example, the capsular bag 22 has a front part 23 and a back part 24 , The anterior part in turn has an area facing the cornea 21 and the iris 25 is aligned. This surface is called the front surface of the front part 23 of the capsular bag 22 designated. The opposite surface, on the inside of capsular bag 22 , thus becomes the back surface of the front part 23 of the capsular bag 22 designated.

The intraocular lens structure (IOL)

Next, some embodiments of the intraocular lens structure (IOL) will be described. schematically illustrates an embodiment of an intraocular lens structure (IOL) in front view. The front side is the side of the IOL 1 leading to the cornea 21 is oriented towards when the IOL mentioned 1 is implanted in an eye. The side of the IOL 1 , which is directed toward the retina after the IOL has been implanted into an eye, is referred to here as the posterior aspect of IOL 1 designated. If a natural lens 31 must be removed from an eye, usually an opening 32 in the front part 23 from capsule bag 22 produced. Subsequently, the natural lens 31 away. In specific cases, such as in pediatric patients, there may also be a posterior opening in the posterior part 24 of the capsular bag 22 produced, the part of the capsular bag 22 that between the natural lens 31 and the retina is located. The opening 32 and the rear opening are normally aligned. The openings are often circular, but other shapes are also possible, certainly with the use of laser-assisted capsulotomy. Usually, the openings are aligned with an optical axis of the eye, but other positions may be used. Around the openings remains a ring of capsular bag fabric or membrane. This ring is also referred to as a capsular bag flap. This ring or tab has an edge adjacent to the perimeter of the opening 32 or in fact the opening 32 Are defined. The opening 32 has a radial direction and extends from the center of the opening 32 outward to its extent.

The IOL 1 includes an optical structure 2 , The optical structure 2 is in many cases a lens, in fact a front lens and a rear lens. In embodiments such as in embodiment shown has the optical structure 2 a front surface of the lens structure 3 and a rear surface of the lens structure 4 , s. , The optical structure may further be provided with any type of optical structure known for IOLs. Furthermore, in this description, the constitution of the optical structure is not intended to be limited. The optical structure may include a lens or cap. In one embodiment, both the front and rear sides are provided with a curved surface to provide one or more lenses. Examples of lens optics are a monofocal lens, an astigmatic lens, a multifocal lens, an accommodative lens or a bifocal sector lens, which are described in, for example, US Pat PCT / NL2012 / 050115 were disclosed. The optics can be refractive, light-diffractive or a combined form of both forms. Further or in combination, the optical structure may comprise an optical filter and / or a functional layer known to a person skilled in the art. The optical structure may comprise active and / or passive elements. An example of an active element is z. B. a liquid crystal optics.

An IOL 1 is usually essentially a flat structure. Its thickness is about 0.1-1 mm. The diameter of IOL 1 is usually about 7-12 mm. The optical structure usually has a diameter of 4-7 mm. In most embodiments, the optical structure has a diameter of 5-7 mm.

In such a mainly flat structure, an axial direction Ax, which may have a rear and a front direction, can be distinguished. Furthermore, a radial direction Ra can be distinguished. Finally, it is possible to distinguish an azimuthal direction Az, which may have a clockwise or anti-clockwise direction. If it is when the optical structure is a simple circular lens, the axial direction is the optical axis, and the radial direction is the radial direction of the lens. In the and these are specified. In the case of other optical structures, the axial, radial and azimuthal directions will be apparent to one skilled in the art.

In one embodiment, the IOL 1 made of a polymer material. In particular, the IOL 1 from a polymer material that is foldable. In particular, the supports are elastic. The IOL 1 in one embodiment is made in one piece. In particular, the IOL 1 flexible, so that it can be rolled up into a small roll with a diameter smaller than 2.5 mm. In particular, this makes it possible to roll up the IOL to a diameter smaller than 1.8 mm. On the other hand, the IOL is dimensionally stable, in particular so flexible that it can be unfolded from its rolled-up state and returned to its original shape once inserted into the capsular bag.

The embodiment of will be further shown in detail in the - , in which the embodiment of in the side view shows a detail of as in indicated, and the embodiment of in a perspective view from the front shows.

The IOL includes a scope 7 of about the optical structure 2 , The scope 7 has a peripheral surface. The scope 7 may be designed to match the shape of the opening in the capsular bag. For example, if the opening is circular, the circumference may be circular. The size of the perimeter is such that it may be slightly oversized to slightly increase the size of the capsular bag opening or to match the size of the opening. In the embodiment of includes the optical structure 2 a curved surface that forms a lens. The lens in this embodiment is circular and has an optical axis. The peripheral surface extends parallel to the optical axis here. The circumference here forms a cylindrical surface. In the case of a circular circumference 7 is the peripheral surface circular cylindrical, and in the embodiment of even straight cylindrical. A non-circular shape of the opening and the circumference 7 can provide benefits to a rotation of the IOL 1 to prevent the optical axis. For example, the opening may be elliptical and the circumference 7 be elliptical, matching the elliptical shape of the opening. Alternatively, an alignment device, such as a cam, may be on the periphery 7 be attached and a matching device attached to the opening. The rotational fixation may be advantageous, for example, in the context of an astigmatism optic. In one embodiment, shown for example in FIG and , is the diameter of perimeter 7 greater than the circumference 10 the optical structure 2 , For example, the scope 7 0.5-2 mm larger than the circumference 10 the optical structure 2 ,

The IOL 1 includes rear supports 5 . 5 ' , here on opposite sides of the optical structure 2 , The rear supports 5 . 5 ' extend away from the optical structure. In particular, the rear supports extend 5 . 5 ' away in the lateral direction relative to the optical structure 2 , The rear supports 5 . 5 ' have support surfaces 13 . 13 ' on, also referred to as the support surfaces of the rear supports 5 . 5 ' , These support surfaces 13 . 13 ' are here in a plane called the back plane. In the specific embodiment of in which the circumference discussed above is cylindrical, the rear plane is perpendicular to the cylindrical surface of the circumference 7 ,

The rear supports 5 . 5 ' here form loops, with two ends on the circumference 7 are attached.

The optical structure 2 usually has a diameter of 4-7 mm. The scope 7 usually has a diameter of 4-7 mm. In the embodiments shown in the drawings, the front supports 6 . 6 ' and the rear supports 5 . 5 ' at the extent 7 attached.

If the IOL 1 implanted, take the support surfaces 13 . 13 ' the rear supports 5 . 5 ' the back surface of the front part 23 of the capsular bag 22 on. In one embodiment, the rear supports 5 . 5 ' and thus at least a part of the support surfaces are arranged at an angle of 0-10 degrees in the front direction. In one embodiment, when implanted, the surface area decreases in circumference 7 the edge of the opening in the front capsular bag engaged or almost engaged, and the support surface 13 . 13 ' the rear supports 5 . 5 ' actually nestles against the posterior surface of the anterior capsular bag. For this purpose, the support surface 13 . 13 ' be carried out so that it holds the surface of the capsular bag. For example, cams or edges can be attached.

At least one of the surfaces of the rear supports can be roughened, for example sandblasted, to prevent light reflections.

The IOL 1 also includes the front supports 6 . 6 ' , The front supports 6 . 6 ' also extend sideways with respect to the optical structure 2 , The front supports provide the support surfaces 14 . 14 ' the front supports 6 . 6 ' , If the IOL 1 is implanted, these are front supports 6 . 6 ' outside the capsule bag 22 , The support surfaces 14 . 14 ' are then designed and engineered to be when the IOL 1 implanted, pick up the anterior surface of the anterior part of the capsular bag. Again, these support surfaces are 14 . 14 ' in a plane called the front plane. In one embodiment, when implanted, the area of circumference decreases 7 the edge of the opening in the front capsular bag is engaged or almost engaged, and the support surface 14 . 14 ' the front supports 5 . 5 ' can in fact be made to nestle against the anterior surface of the anterior capsular bag. Thus, both surfaces are in almost complete physical contact. For this purpose, the support surface 14 . 14 ' be carried out so that it holds the surface of the capsular bag. In order for the anterior supports to actually extend out of the capsular bag and be able to nestle against the anterior surface of the anterior capsular bag, there are usually some manipulative actions by the person who is the IOL 1 implanted, required.

The front plane is functionally parallel to the back plane. sideview shows this. In particular, these levels are parallel when using the capsular bag 22 between them. The distance between the rear support surfaces 14 . 14 ' the front supports 6 . 6 ' and the front support surfaces 13 . 13 ' the rear supports 5 . 5 ' is designed to fit the front part 23 of the capsular bag 22 between them. The front supports 6 . 6 ' and the rear supports 5 . 5 ' are positioned so that their support surfaces between them a distance 11 include. In fact, the distance between the posterior plane and / or the anterior plane is tuned to that of the anterior capsular bag flap 23 between hold to the IOL 1 to hold in the opening when the IOL 1 is implanted. In fact, the distance between the back plane and the front plane can be tuned to the thickness of the front part of the capsule bag. It was found that the rear supports 5 . 5 ' and the front supports 6 . 6 ' were able to hold the front capsular bag between them when the distance is between 5 and 100 microns. In particular, the distance of the back plane and the front plane from each other is 15-50 microns. The distance forms the distance 11 , If the distance is less than 20 microns, the tab is firmly clamped and possible rotation of the lens is avoided.

In the embodiment of are the back supports 5 . 5 ' and the front supports 6 . 6 ' offset against each other. In fact, the rear pillars are seen from the front 5 . 5 ' and the front supports 6 . 6 ' do not cover up. This can also be referred to as the rear pillars 5 . 5 ' and the front supports 6 . 6 ' in the perimetric direction or in the azimuthal direction (Az, ) are offset. In this sense, 'offset' is used, as in 'a staggered intersection'.

Especially if the rear supports 5 . 5 ' and the front supports 6 . 6 ' are offset, the rear plane and the front plane are parallel or substantially parallel when the front part of the capsular bag is held between them.

In the embodiment of are the back supports 5 . 5 ' from IOL 1 closed loops. In the embodiment of have the back supports 5 . 5 ' from IOL 1 a diameter of about 7-12 mm and a thickness of 0.15-0.4 mm, in particular 0.20-0.35 mm.

Alternatively, the ends of the loops can also be removed, whereby the rear supports 5 . 5 ' in each case be transformed into two rear supports, resulting in four rear supports 5 . 5 ' leads. The radially extending rear supports or loop supports may in fact serve as a safety measure when implanting the IOL 1 in the opening 32 for some reason fails.

The thickness of the front supports 6 . 6 ' may be between 0.04 and 0.25 mm, in particular between 0.05 and 0.20 mm.

In the embodiment of assigns the IOL 1 at or near the perimeter 7 at least one space extending in the perimetric or azimuthal direction 19 between a rear support 5 . 5 ' and a front pillar 6 . 6 ' on. This space facilitates manufacturing and also makes it easier to use the front support 6 . 6 ' through the opening 32 through and out of the capsular bag as it provides the space for insertion of an instrument when inserting and positioning the IOL 1 offers. In the embodiment of is located at each transition from the front pillar 6 . 6 ' to the rear supports 5 . 5 ' an azimuthal space 19 ,

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

It has been found that at least one of the front supports supports the front side of the front part of the capsular bag 6 . 6 ' extends at least about 0.3 mm in the radial direction from the circumference. In particular, the front supports extend 6 . 6 ' at least 0.5 mm in the radial direction.

In the embodiment of the IOL 1 from has the IOL 1 additional front supports 8th . 8th' , These anterior supports are referred to herein as anterior lips 8th . 8th' , In use, these also extend outside of the capsular bag 22 , They complement the other front supports 6 . 6 ' and cause additional clamping of the front capsular bag part 23 , The front lips 8th . 8th' have back surfaces 17 . 17 ' against the outside of the capsular bag 22 rest, against the anterior surface of the anterior capsular bag section 23 , The front lips 8th . 8th' extend here approximately 0.1-2 mm in the circumferential direction (or azimuthal direction). The front lips 8th . 8th' extend in the radial direction, ie away from the optical structure 2 and the scope 7 , about 0.1-1.3 mm, especially about 0.4-1.0 mm. In this embodiment, the front lips extend 8th . 8th' about 0.3 mm.

In becomes an embodiment of an IOL 1 shown in the front pillars 6 . 6 ' have a different shape. In this embodiment, the front supports 6 . 6 ' with a column opening 18 . 18 ' Mistake. Through these pillar openings 18 . 18 ' an instrument can be introduced, the front supports 6 . 6 ' through the opening 32 in the capsular bag after inserting the IOL into the capsular bag. The front supports 6 . 6 ' thus extend out of the capsular bag The diameter of the support hole 18 . 18 ' can be 0.2-1.5 mm.

In the and , two different embodiments of posterior features that affect the posterior portion of the capsular bag are visible.

In the . and , respectively, a perspective view of the rear side, a cross section and a detail of the cross section of As indicated, the back side is the IOL 1 at and near the perimeter with a sharp edge 16 provided to prevent the growth of tissue from the posterior capsular bag portion. Such tissue growth can cause turbidity of the posterior capsule.

In the . . and an alternative embodiment of the rear features is shown. show a side view, shows a detail as indicated, shows a cross-sectional view of the IOL of and shows a detail as indicated in ,

The IOL of this embodiment has a rear circumferential groove 12 which extends behind the rear supports 5 . 5 ' and the front supports 6 . 6 ' , In fact, the rear groove 12 here formed behind the rear surface 15 . 15 ' the rear supports 5 . 5 ' , The rear groove 12 is designed to receive and hold the edge surrounding the rear opening, ie the opening in the rear capsule bag. As explained, such a posterior opening can be made by performing a second capsulotomy on the posterior part 24 of the capsular bag 22 is performed. The edge surrounding the rear opening becomes the rear groove 12 pushed after the IOL 1 in position in the opening in the front capsular bag part. For this purpose, the IOL can be gently pushed backwards until the edge or the edge of the rear opening into the rear groove 12 slides. The rear groove 12 here has a depth of 0.1-0.3 mm. The rear groove 12 is shaped to receive the edge around a rear opening. At the rear groove 12 it can be a rectangular groove. Here it is wedge-shaped. It has walls at an angle of 10-60 degrees, especially about 40-50 degrees. This rear groove 12 closes the rear opening, preventing clouding of the capsule.

The eye-positioned IOL

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

• 1. Die Sehachse 51, die durch den festen Objektpunkt und den Knotenpunkt N des Auges verläuft. Wenn die Funktion der Knotenpunkte berücksichtigt wird, verläuft der Strahl, der die Sehachse 51 verkörpert, durch die Fovea 48 zur Netzhaut.
• 2. Die optische Achse 47, die senkrecht zur Hornhaut-Oberfläche verläuft und die Iris 25 ?durch? die Pupille 26 im Mittelpunkt durchläuft. Da die Fovea 48 nicht zentral zum Augapfel 20 angeordnet ist, unterscheidet sich die optische Achse 47 von der Sehachse 51. Die optische Achse 51 ist die geometrische Symmetrieachse des Augapfelsystems und unterscheidet sich von dem optischen zentralen Strahl, der den Mittelpunkt der Fovea erreicht und schräg durch das Augensystem hindurchtritt.
• 3. Die Gesichtslinie 50 ist die Achse, die durch den Objektpunkt und den Mittelpunkt der Eintrittspupille 26 verläuft. Dies ist der Strahl, der durch den Schwerpunkt des Lichtbündels hindurchtritt und bei dem es sich um die Achse des Strahlenbündels handelt, der in das Auge 20 eintritt. Normalerweise liegt der Winkel zwischen der Sichtlinie und der optischen Achse 47 im Bereich von 3° bis 8°. Der Mittelpunkt der Eintrittspupille 26 wird aufgrund der asymmetrischen Bilderzeugung durch das Hornhautsystem und die außeraxiale Position der Fovea zur nasalen Seite versetzt.
• 4. Die Pupillenachse 49, die durch den Mittelpunkt der Eintrittspupille 26 verläuft und senkrecht zur Vorderfläche der Hornhaut steht.

In , which shows a cross section through the eye from above, will be different axes of the eye 20 Are defined:

• 1. The visual axis 51 passing through the fixed object point and the node N of the eye. When the function of the nodes is taken into account, the ray passing the visual axis passes 51 embodied by the fovea 48 to the retina.
• 2. The optical axis 47 that runs perpendicular to the corneal surface and the iris 25 ?by? the pupil 26 goes through the center. Because the fovea 48 not central to the eyeball 20 is arranged, the optical axis is different 47 from the visual axis 51 , The optical axis 51 is the geometric axis of symmetry of the eyeball system and differs from the optical central ray, which reaches the center of the fovea and passes obliquely through the eye system.
• 3. The facial line 50 is the axis passing through the object point and the center of the entrance pupil 26 runs. This is the beam passing through the center of gravity of the light beam, which is the axis of the beam entering the eye 20 entry. Normally, the angle is between the line of sight and the optical axis 47 in the range of 3 ° to 8 °. The center of the entrance pupil 26 is due to asymmetric imaging the corneal system and the offaxial position of the fovea are displaced to the nasal side.
• 4. The pupil axis 49 passing through the center of the entrance pupil 26 runs and is perpendicular to the front surface of the cornea.

The field of view for the monocular view extends to the entire retina, without the small part of the blind spot. Usually, people tend to turn the eye to the most favorable position in which the image in the fovea 48 is produced. When the eye 20 is moved in this way to a position of optimal orientation, so that the image is at the center of the fovea, the optical system of the eye is not used as a centered system. However, the tilt is small and the spherical aberration and astigmatism are the predominant aberrations of the eye.

In becomes a detail of shown, with the IOL 1 from is used. The IOL 1 In this example, it is equipped with the rear groove already described 12 ,

Here is the posterior capsular bag 24 the already explained rear opening. The edge of the rear opening is positioned in the rear groove 12 , The front capsular bag tab (a ring of capsular bag membrane material) that remains after an opening in the anterior capsular bag portion 23 is maintained between the front support 6 and the rear support 5 , The support surface of the front support 6 and the support surface of the rear support 5 both of them are resting on the front capsule flap and, in fact, although perhaps not shown in this way, may even pin the flap between them.

In will have a similar detail to that of shown, but with an IOL 1 with an alternative trailing feature. In this case, the rear capsule bag part has 24 no opening: the rear capsular bag part 24 is intact and lies on the back surface 4 the IOL 1 on.

In both and have the back supports 5 . 5 ' a big diameter. The IOL 1 but is positioned in opening 32 with the help of the front and rear supports, if necessary, precisely with circumference 7 and the length of the perimeter of the opening 32 , Thus, the radial dimension of the rear supports 5 . 5 ' be reduced.

Insert the IOL into an eye

Below is the insertion of the previously described IOL 1 explained. An example of a method of making the incision and implanting the IOL is described as such, for example US5376115 which is included by this reference as if fully set forth. In particular, this describes:
One surgical technique that has gained in popularity is the phacoemulsification technique, which uses ultrasonic vibrations to fragment the lens nucleus, thereby allowing the lens material to be removed through an approximately 3 mm incision. The benefits of a small incision are faster visual acuity, faster healing, and less astigmatism than traditional, large incisions. A titanium hollow needle approximately 1 mm in diameter is vibrated by a magnetostrictive ultrasonic mechanism. The mechanical vibration converts the lens into an emulsion, which explains the term phacoemulsification.

As the phacoemulsification technique has been refined, the design of the incision has been developed to allow healing of the wound without the need for suturing - "self-healing incisions".

According to the reference, the technique is described, for. In J Cataract Refract Surg 16 (5): 567-577 (1990) Menapace, R. et al , and in Ophthalmology (US) 100 (2) (1993), pp. 159-163 to Ormerod, LD et al ,

US 5376115 further describes an example of establishing an IOL.

This can be combined with the following method. Before inserting the IOL 1 An opening in the front part of the capsular bag is first made in the capsular bag. With the help of z. As a laser device such as the femtolaser, an opening or aperture can be made in the front membrane or front capsule of the capsular bag, which has a precise shape and a precise position. This method is also referred to as 'capsular hexis', although recent literature refers to a laser-based method as 'capsulotomy' and uses this term in contrast to 'capsular hexis', which term is then used to refer to mechanical tearing or cutting of an opening in the To refer to capsular bag. Currently, other laser-based methods are also developing. In these methods, a laser beam is directed through the cornea and into the eye, where its energy is absorbed in an internal structure to cut that structure. In one of these methods, the anterior capsular bag membrane is stained with a light-absorbing agent. The absorption properties of this light absorbing agent are selected so as to absorb the energy of the laser beam.

In many cases, for example in a cataract, in a next step, the clouded natural lens is removed through the opening in the capsular bag. In this step, the natural lens may first be laser treated before it is removed, for example with a phacoemulsification device. The removal of the natural lens as such is known to those skilled in the art.

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

An example of such a classical Kapsularhexis method and the use of a laser device in such a method is described in US8409182 which is included by this reference as if fully set forth herein. For example, column 3 describes an example of the steps in a Kapsularhexis method, or more specifically, a capsulotomy method. The laser-based method allows exact positioning and shaping of the opening. In addition, such a method may leave a relatively strong edge around the created opening in the capsular bag. In particular, the following has been found with respect to a laser-based method.

METHODS: Capsulotomies performed by an OCT-guided femtosecond laser (OCT - optical coherence tomography) in eyes of pigs and human cadavers were subsequently performed in 39 patients in a prospective, randomized study of femtosecond laser-assisted cataract surgery. The accuracy of size, shape and centering of the capsulotomy was quantified and the capsulotomy thickness was assessed on the pig's eye.

RESULTS: Lasered capsulotomies were significantly more accurate in size and shape than hand-made capsulorhexes. For the patient's eyes, the deviation from the intended diameter of the resected capsule disc was 29 μm ± 26 (SD) in the laser technique and 337 ± 258 μm in the manual technique. The mean deviation from the circular shape was 6% and 20%, respectively. The midpoint of the laser capsulotomy was within 77 ± 47 μm from the intended position. All capsulotomies were complete, with no radial nicks or cracks. The severity of laser capsulotomies (pig subgroup) decreased with increasing pulse energy: 152 ± 21 mN at 3 mJ, 121 ± 16 mN at 6 mJ and 113 ± 23 mN at 10 mJ. The strength of the manual capsulorhexen was 65 ± 21 mN.

CONCLUSION: The femtosecond laser produced capsulotomies that were more accurate, precise, reproducible, and stronger than those made using conventional manual techniques.

Source: J. Cataract Refract. Surg. 2011; 37: 1189-98 Q 2011 ASCRS and ESCRS ,

Tests continue to show the following results.

METHODS: Ten fresh porcine eyes were randomized to femtosecond laser-assisted capsulotomy or manual capsulotomy. The capsule was immersed in hyaluronic acid and retractors were mounted in the capsule opening with a tensile force gauge. The force required to break the capsulotomy was measured in millinewtons (mN); In addition, the maximum aspect ratio was evaluated.

RESULTS: The observed mean fracture limit (i.e., the maximum amount of force measured immediately before tissue rupture) was 113 mN ± 12 (SD) laser guided and 73 ± 22 mN manual (P <0.05). The stretch ratios were 1.60 ± 0.10 (femtosecond) and 1.35 ± 0.04 (manual) (P <0.05).

CONCLUSION: In this laboratory study on pig eyes, the femtosecond laser-assisted capsulotomy resulted in significantly greater anterior capsule opening than the manual capsulotomy performed by the standard procedure.

Source: J. Cataract Refract. Surg. 2013; 39: 105-109 Q 2013 ASCRS and ESCRS ,

A very accurate positioning of an opening 32 in a capsule bag 22 and a very accurate shape of the opening 32 allows accurate positioning and alignment of the described IOL 1 and is particularly advantageous when the current IOL or IOL / S-IOL combination is used.

The IOL 1 can be used in the following way. Often the IOL 1 inserted through a micro-incision into the eye in the capsular bag. Via an insertion instrument, the IOL is rolled up outside the eye and advanced through a nozzle that passes through the incision in the eye. The rolled up IOL 1 enters the capsular bag through the opening. The rolled up IOL 1 unfolds within the capsular bag.

Next are the front pillars 6 . 6 ' manipulated with the help of a small tool, that they fold back through the opening 32 in the front capsular bag part 23 , causing them to fall outside the capsular bag 22 extend. With the help of the same or an identical tool, the lips 8th . 8th' be manipulated so that they are also through the opening 32 extend through and out of the capsular bag 22 protrude. The back surfaces 17 and 17 ' the lips 8th . 8th' then lie on the front surface of the front part 23 of the capsular bag 22 on. If the posterior capsule is also open, then in a second act, gently pushing the IOL slightly down, the posterior tab in the posterior groove 12 attached.

The intraocular lens assembly and the secondary intraocular lens (S-IOL)

In the next - For example, some embodiments of the intraocular lens assembly and the secondary intraocular lens (S-IOL) are described. In the - A first embodiment of an intraocular lens assembly described on the IOL 1 based separately in the - is described. In the - A second embodiment of an intraocular lens assembly described on the IOL 1 based separately in is described. It must be noted, as already mentioned, that the rear feature of the rear edge 16 and the rear groove 12 both can be used in these designs, and even combined. The embodiments shown here use the trailing edge 16 ,

In the - Different views are shown by the intraocular lens assembly that houses the IOL 1 and a secondary intraocular lens (S-IOL) 30 includes. shows a view from the front side, the and show a perspective view, respectively from the front side and the rear side, and the - show different cross sections and details. In the - will be some details of the S-IOL 30 of the first embodiment.

The S-IOL 30 has a front surface 33 and a back surface 34 , The back surface 34 the S-IOL 30 is opposite the front surface of the IOL 1 , The S-IOL 30 has a secondary optical structure 35 , With such an optical structure 35 it can be a simple lens that has a spherical positive or negative diopter. Often the spherical diopter is between -8.0 and +8.0. As an alternative or in addition, the optical structure 35 also include a near portion ('reading portion'), an astigmatism optic, a toric optic, and combinations thereof. Moreover, a multifocal optic as described in FIG WO2012 / 118371 to be used. Another known to those skilled, active or passive optics can be used. The secondary optical structure 35 has a secondary scope 36 , Associated with the secondary scope 36 are the fixation parts 37 . 37 ' ,

At the back 38 . 38 ' have the fixation parts 37 . 37 ' lips 39 . 39 ' on. The lips 39 . 39 ' extend in the inward direction relative to the circumference. The lips 39 . 39 ' are thus removed from the rear surface 34 the secondary optical structure 35 , In this embodiment, the fixing parts 37 . 37 ' designed so that they are about the front pillars or front lips 8th . 8th' to reach. In this way are the parts of the lips 39 . 39 ' on the back sides of the front pillars 8th . 8th' , Thus, they are at least partially between the front pillars 8th . 8th' and the capsular bag 22 arranged. Due to the elasticity of the capsular bag, the lips 39 . 39 ' against the front supports 8th . 8th' pressed. This contributes to the fixation. In addition, because the parts are compressed, it is possible to further fix them by cohesion when similar materials are used. The thickness of the lips 39 . 39 ' is between 0.1 and 0.4 mm, in particular between 0.15 and 0.25 mm.

In this embodiment of the module thus hook the fixation parts 37 . 37 ' behind the front pillars, here the front pillars 8th . 8th' which are also called front lips 8th . 8th' be designated. In this embodiment, the fixation parts provide 37 . 37 ' So hook. These hooks have ends that extend on the rear surface of the front pillars, here the front pillars 8th . 8th' , Furthermore, provide in this embodiment, the fixing parts 37 . 37 ' Hooks around radial ends of the front pillars 8th . 8th' hook.

The S-IOL also includes openings 40 . 40 ' outside the scope 36 the secondary optical structure 35 , These openings 40 . 40 ' are still azimuthal at the sites of fixation 37 . 37 ' arranged. Through the openings are the lips 39 . 39 ' the fixation parts 37 . 37 ' visible when the S-IOL is viewed from its front. In the azimuthal direction, the openings extend 40 . 40 ' about the azimuthal width of the lips 39 . 39 ' , This allows the production of the S-IOL, for example, by machining or molding. Furthermore, the visual inspection allows the arrangement of the fixing parts 37 . 37 ' , which are behind the front supports 8th . 8th' hook. The openings 40 . 40 ' can measure about 0.7 × 2.5 mm. The openings 40 . 40 ' continue to allow the exchange of fluids between parts of the eye and / or the fluid between the IOL 1 and the S-IOL 30 ,

In this embodiment, the S-IOL includes 30 continue a ring 41 of about the circumference 36 the secondary optical structure 35 , The ring is attached to the structure here. In fact, the ring becomes 41 here as a part formed together with the secondary optical structure 35 , Here are the fixation parts 37 . 37 ' in turn, on the circumference of the ring 41 attached. If the secondary optical structure 35 is circular, is the ring 41 often also circular.

ring 41 from S-IOL 30 provides (additional) axial and radial positioning of the S-IOL in this embodiment 30 on the IOL 1 , as well as support for the secondary optical structure 35 , ring 41 provides a rear ring surface 42 for receiving the front surface of the capsular bag flap 23 next to the opening 32 in the capsule bag 22 , In fact, the ring can 41 in one embodiment, on the opening 32 in the capsule bag 22 be sized. For example, the inner diameter of the ring 41 at least the diameter of the opening 32 to have. In one embodiment, the inner circumference of ring 41 a diameter at least around the opening 32 around fit. The rear ring surface 42 can be adapted to the surface of the capsular bag. Thus, the rear ring surface is located 42 usually in a plane, especially a flat plane. In particular, the rear ring surface has 42 a height of 0.05-0.5 mm. Thus, the rear ring surface provides 42 an axial positioning.

The inner diameter of ring 41 in another or combined embodiment is tuned to the diameter of the circumference 7 the optical structure of the IOL 1 , The ring 41 fits around the circumference 7 , In one embodiment, ring fits 41 around the perimeter 7 , Thus, the inner peripheral surface provides 44 from ring 41 a radial positioning of the S-IOL 30 on the IOL 1 , In the embodiment shown, the shape of the ring 41 the S-IOL 30 on the scope 7 the IOL 1 Voted. Often the inner peripheral ring surface 44 cylindrical. If the ring 41 is circular, the inner ring surface can be 44 be circular cylindrical. In such an embodiment, the inner annular surface 44 the scope 7 the IOL 1 record what's out of the and becomes apparent. Thus, a radial positioning is provided.

To facilitate mounting, the inner peripheral surface may 44 conical, or conical, while the scope of the IOL 1 can be matching conical or conical. This will cause the application of the S-IOL 30 on the IOL 1 relieved, and once it is inserted, the surface of the perimeter stand 7 and the inner peripheral annular surface engaged.

So that the S-IOL 30 better on the IOL 1 fits, the ring can 41 with notches or cutouts 43 be provided by the front and / or rear supports through the ring 41 can be passed. In one embodiment, the cutouts are 43 shaped so that a cutout 43 fits the shape of the supports that go through this neckline 43 can be passed. Thus, further fixation is possible, and even fixation by means of local cohesion between the IOL 1 and the S-IOL 30 where the surfaces of the IOL 1 and the S-IOL 30 touch. In particular, if the materials of the IOL 1 and the S-IOL 30 have a similar nature, it has been found that parts of the IOL in contact with each other 1 and the S-IOL 30 stick to each other. By similar nature, it should be understood in this regard that, for example, the polymers used belong to the same type. For example, both the IOL 1 as well as the S-IOL 30 prepared from either hydrophilic or hydrophobic polymers selected from acrylate-based polymers, silicon-based polymers or other known materials. The hardness of these materials may vary.

ring 41 can continue a distance between the rear surface 34 the secondary optical structure 35 and the front surface 3 the optical structure 2 gain. The distance can be 0.05-0.2 mm. In particular, the distance can be 0.05-0.15 mm. The distance allows the formation of a liquid film that can act as an additional lens, often adding -2 to +2 dioptres.

The radial ends of the fixation parts 37 . 37 ' are rounded to prevent interference with the iris.

In use, after the IOL 1 used, positioned and fixed in the manner described above, usually some time later the refractive error of the person carrying the IOL 1 has been determined. Based on the measured values, an S-IOL 30 selected from a set of S-IOLs that have an optical structure 35 For example, it will correct as much as possible of any remaining optical errors, or it may, for example, provide a reading part. Alternatively, such an S-IOL can be customized. With the help of the previous incision, which is also used to insert the IOL 1 used, the S-IOL 30 be used in the eye. Thus, no new refractive errors due to cuts are caused. Using the openings 40 . 40 ' can the S-IOL 30 be manipulated and positioned so that its rear surface 34 the front side 3 the IOL 1 is opposite. Subsequently, the fixation parts 37 . 37 ' around the ends of the front supports 8th . 8th' attached. The back surfaces of the fixation parts 37 . 37 ' are printed tightly against the front surface of the capsular bag and deform it. In this is clearly indicated in cross section through a lip 39 and front prop 8th , The elasticity of the capsular bag contributes to the fixation of the intraocular lens assembly. Furthermore, the rear ring surface presses 42 in one embodiment against the capsular bag surface. From inside the capsule bag 22 pushes the rear support against the capsular bag. This provides additional clamping of the capsular bag.

In the - A second embodiment of the intraocular lens assembly is shown. This assembly includes the in shown IOL 1 , In this embodiment, the front supports 6 . 6 ' Support holes or through holes 18 . 18 ' , In this embodiment, the S-IOL includes 30 fixing portions 37 . 37 ' passing through the openings 18 . 18 ' through the front supports 6 . 6 ' through rich. At their ends have the fixation parts 37 . 37 ' each one locking part 46 that faces the rear surface 14 . 14 ' the front supports 6 . 6 ' extends. In The rear side view is visible as are the locking parts 46 to the rear surface 14 . 14 ' the front supports 6 . 6 ' extend. When the intraocular lens assembly is inserted in use and in the opening and on the capsular bag tab 22 is fixed, the relatively elastic tissue of the capsular bag 22 against these two rear surfaces 14 . 14 ' the front supports 6 . 6 ' Press and the locking parts 46 in the front direction against these rear surfaces 14 . 14 ' the front supports 6 . 6 ' Press, causing the fixation parts 37 . 37 ' continue to be prevented from passing through the openings 18 . 1.8 ' to return. Another advantage of the fixation parts 37 . 37 ' passing through the openings 18 . 18 ' in the front supports 6 . 6 ' protrude, is that the rotation of the S-IOL 30 is prevented. The S-IOL 30 is thus fixed at the IOL 1 in axial (Ax), radial (Ra) and azimuthal (Az) directions.

Using the laser-assisted method, it is still possible in the anterior capsular bag portion 23 Through holes at a small distance from the edge of the opening 32 manufacture. In particular, these small through holes (additional capsulotomies) can be made at the locations of the openings 18 . 18 ' in the front supports 6 . 6 ' , The fixation parts 37 . 37 ' in this case can also pass through these through holes in the anterior capsular bag 23 pass through to provide additional clamping and attachment. Alternatively, or in addition, additional fixatives may be provided on the S-IOL through these through-holes in the anterior capsular bag portion 23 protrude.

The S-IOL 30 further comprises a ring in this embodiment 41 of about the circumference 36 the optical structure 35 , This ring 41 has the same features as described above, but in some cases designed differently. The fixation parts 37 . 37 ' are attached in this embodiment to the rear annular surface 42 from ring 41 , In particular, the fixation parts extend here 37 . 37 ' from this area. The ends of the fixation parts 37 . 37 ' are provided with retaining elements 46 , which provide surfaces that are in one plane with the rear ring surface 42 but these surfaces may continue to extend in the rearward / rearward / axial direction. The retaining elements may be sized to fit the openings 18 . 18 ' in the front supports 6 . 6 ' through which they have to pass, who the S-IOL 30 on the IOL 1 is positioned and fixed. There are the fixation parts 37 . 37 ' in excerpts 43 for the front supports 6 . 6 ' arranged. Thus, the further surface of the rear ring 42 in use, as already explained rest on the capsular bag or even press against the capsular bag. Due to the cutouts or recesses 43 is the rear ring surface 42 divided into separate areas. Normally these areas are in one plane so that they are able to engage the capsular bag surface. The depth of the cutouts or recesses 43 is designed so that the area of the recesses or cutouts 43 the front surfaces of the front supports 6 . 6 ' . 8th . 8th' engages in engagement.

The S-IOL 30 still includes cutouts 45 in their scope at the fixation parts 37 . 37 ' , Thus, the ends of the fixation parts 37 . 37 ' , in particular the holding elements 46 Visible when the S-IOL is viewed from the front. Thus, the person using and implanting the S-IOL may have those parts and the relevant part of the IOL 1 during attachment of the S-IOL 30 at the IOL 1 see.

The different parts of the back side of the S-IOL 30 and the front part of the IOL 1 are mutually shaped so that they intermesh over a surface area. If the S-IOL 30 and the IOL 1 are made of the same or identical material, in particular a flexible and foldable polymeric material, and have a smooth surface, it has been found that cohesion occurs. In fact, it was found that after some time the material of the S-IOL 30 and the IOL 1 adheres to each other and must be peeled off each other with a certain force. Thus, the various areas discussed can be designed and arranged such that the IOL 1 and the S-IOL 30 continue to adhere to each other after both elements of the assembly are in position.

In one embodiment, the different parts of the IOL 1 and the S-IOL 30 each other so dimensioned that a distance arises between the front surface 3 the optical structure 2 the IOL 1 and the back surface 34 the secondary optical structure 35 the S-IOL 30 , Thus, the front surface remains 3 the optical structure 2 the IOL 1 free from the back surface 34 the secondary optical structure 35 the S-IOL 30 , The distance can be from 0.03-0.5 mm, in particular 0.05-0.25 mm. Thus, between the IOL 1 and the S-IOL 30 to form a film of anterior chamber fluid. In the optical sense, such a liquid film may have an effect of -2 to +2 diopters, in particular -0.5 to +0.5 diopters (in the case of a spherical film causing a spherical lens). In one embodiment, the front surface of the IOL 1 the optical structure 2 and the back surface of the optical structure of the S-IOL 30 a radius of curvature that is substantially the same, thereby facilitating a design of the assembly in which an IOL can be combined with a selection of S-IOLs because the liquid film will be the same. For both surfaces, the radius of curvature may be 9 to 13 mm, for example. Tuning the radius of curvature may result in a reduction in the number of S-IOLs that need to be stocked.

Implantation of the S-IOL

The implantation of the S-IOL is relatively simple. With the help of the previous incision, which is also used to insert the IOL 1 used, the S-IOL 30 be used in the eye. Thus, no new refractive errors are caused. The S-IOL 30 is in the axial direction between the iris and the IOL 1 introduced into the eye through the already existing micro-incision. About a Einsetzinstrument becomes the S-IOL 30 rolled up outside the eye and advanced through a nozzle that passes through the incision in the eye. The rolled up S-IOL 30 enters the eye through the iris. The rolled up S-IOL 30 unfolds in front of the IOL 1 , Using, for example, the openings 40 . 40 ' can the S-IOL 30 now manipulated and positioned so that its rear surface 34 the front side 3 the IOL 1 opposite. Subsequently, the fixation parts 37 . 37 ' around the ends of the front supports 8th . 8th' attached. As an alternative, the fixation parts 37 . 37 ' through the openings 18 . 18 ' in the front supports 6 . 6 ' be introduced. The back surfaces of the fixation parts 37 . 37 ' are pressed tightly against the front surface of the capsular bag and deform it. The flexibility and elasticity of the capsular bag membrane also serves to hold the S-IOL in place.

In the and becomes an alternative embodiment of the IOL 1 of the shown. In becomes the embodiment of partially shown from behind in a perspective view. Again, the same reference numerals refer to the same elements.

A rare but recognized cause of visual impairment following cataract surgery is the Capsular Bag Distension Syndrome (CBDS). It usually occurs in the immediate postoperative period, with a flattening of the anterior chamber, an unexpected myopic refraction, and an accumulation of liquified substance between the implanted lens and the posterior capsule.

The most likely course of CBDS is the production of collagen from residual epithelial cells or necrotic and / or apoptotic autolysed lens epithelial cells or that the retained viscoelastic material from the surgery accumulates behind the intraocular lens (IOL) as the IOL optics accumulate closes the capsule opening made by the capsulotomy. Creating a small opening in the lens that prevents complete sealing of the bag can prevent this postoperative complication. The opening could be formed in the form of a notch on the edge of the optic or a small hole made in the optic. It is also possible to make small capsulotomies when the capsule opening is made in the anterior or posterior capsular lobes to prevent complete sealing of the capsule opening using the IOL already described.

In the embodiment according to and another approach was chosen. In this embodiment, a recess 53 in the peripheral area 7 created. This indentation 53 provides an axial groove (Ax) in the circumference 7 from about the IOL. This creates a passage between the peripheral surface 7 and the edge of the opening 32 in the front part of the capsular bag 23 after inserting the IOL 1 created. Thus, a passage for liquid is provided when the IOL enters the opening 32 was used in the capsular bag. In fact, this groove can even if the rear groove 12 provided in the IOL, provide a passage for fluid when the rear part of the capsular bag into the rear groove 12 was used. In fact, the radial extent of the indentation can control such a passage.

To provide a slight passage, the indentation 53 provides in the radial direction next to a rear support 5 . 5 ' or one front prop 6 . 6 ' , In the embodiment shown in the drawings, the indentation 53 provided between a rear support 5 . 5 ' and a front pillar 6 . 6 ' , In this embodiment, two indentations 53 . 53 ' provided here opposite each other. Here is the diameter of the indentations 53 . 53 ' selected so that eye fluid can pass through the passage. In this embodiment, the width of the indentations 53 . 53 ' here 0.2-0.6 mm. In particular, the width is 0.25-0.5 mm. The depth of the indentations 53 . 53 ' here is 0.05-0.4 mm. In particular, the depth is 0.1-0.3 mm.

In one embodiment, the S-IOL comprises 30 a passageway or indentation that provides a passageway for fluid and communicates with the indentation. This leaves a passage for liquid when the IOL 1 was inserted into the capsular bag and the S-IOL 30 on the IOL 1 was positioned. The S-IOL may include a through-hole at its outer edge or near its outer edge, which is connected to the indentation when the S-IOL 30 in the IOL 1 is used. The fluid passage may allow the fluid to flow between the anterior side of the capsular bag and the inside of the capsular bag. It can also facilitate fluid exchange to the posterior side of the capsular bag. The hole or channel can pass through the ring 41 the S-IOL 30 be provided. The exact mutual positioning of the IOL 1 and the S-IOL 30 to each other ensures a proper fluid passage and prevents clogging of the fluid passage. The indentation in the IOL and the channel or indentation in the S-IOL may also be used in other embodiments of the assembly, such as the embodiment shown in the other drawings.

It will also be understood that the above description and drawings have been included to illustrate some embodiments of the invention, and not to limit the scope of protection. Starting from this disclosure, many other embodiments will be apparent to one skilled in the art. These embodiments are within the scope and spirit of the invention and are obvious combinations of the prior art
appropriate techniques and the disclosure of this patent.

LIST OF REFERENCE NUMBERS

1

Intraocular lens structure (IOL)

2

Optical structure

3

Front surface of the IOL

4

Rear surface of the IOL

5, 5 '

Rear supports

6, 6 '

Front supports

7

Scope of the IOL

8, 8 '

Additional front lips

9

Outer perimeter of the optical structure

10

Scope of the optical structure

11

Distance between the rear level and the front level

12

Rear groove for the posterior capsular flap

13, 13 '

Support surfaces of the rear support

14, 14 '

Support surfaces of the front support

15 15 '

Rear surfaces of the rear support

16

Back edge

17, 17 '

Areas of additional front lips

18, 18 '

Holes in the front support

19

Azimuthal distance between posterior and anterior supports

20

eyeball

21

cornea

22

capsular bag

23

Front part of the capsular bag

24

Back part of the capsular bag

25

iris

26

pupil

30

Secondary IOL (S-IOL)

31

Natural lens

32

Opening (in the front part of the capsular bag)

33

Front surface of the S-IOL

34

Rear surface of the S-IOL

35

Secondary optical structure / optical structure of S-IOL

36

Scope of the secondary optical structure

37, 37 '

Fixation parts of the S-IOL

38, 38 '

Back surface of the fixation parts of the S-IOL

39, 39 '

Lips of the fixation parts for hooking the fixation parts in the front supports

40, 40 '

Openings in said S-IOL between the perimeter of the secondary optical structure and the fixation parts

41

Ring of about the secondary optical structure

42

Rear annular surface which is formed to lie concentrically around the opening against the anterior capsular bag surface

43

Section in the ring for passing the rear and / or front support

44

Inner ring surface of the ring, which forms a peripheral / perimetric ring area of about the circumference of the optical structure of the S-IOL

45

neckline

46

retaining elements

47

Optical axis

48

fovea

49

Pupillarachse

50

line of sight

51

visual axis

52

Peripheral edge of the capsular bag opening

53

indentation

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• US 6027531 [0004]
• US 6881225 [0005]
• US 5171320 [0006]
• US 4932971 [0008]
• US 5366502 [0009]
• WO 2008094518 [0010]
• NL 2012/050115 [0127]
• US 5376115 [0161, 0164]
• US 8409182 [0168]
• WO 2012/118371 [0183]

Cited non-patent literature

• J Cataract Refract Surg 16 (5) (1990), pp. 567-577 by Menapace, R. et al. [0163]
• Ophthalmology (US) 100 (2) (1993), pp. 159-163 to Ormerod, LD et al [0163]
• J. Cataract Refract. Surg. 2011; 37: 1189-98 Q 2011 ASCRS and ESCRS [0172]
• J. Cataract Refract. Surg. 2013; 39: 105-109 Q 2013 ASCRS and ESCRS [0177]

Claims (18)

An intraocular lens assembly containing an intraocular lens structure (IOL) ( 1 ) for implantation in a capsular bag ( 22 ) of an eye ( 20 ), said IOL ( 1 ) comprises: an optical structure ( 2 ), which have a scope ( 7 ) having; At least two rear supports ( 5 . 5 ' ), which are of the same scope ( 7 ) of said optical structure ( 2 ) and extending therefrom, intended to extend within the capsular bag ( 22 ), when the IOL ( 1 ) in the capsular bag ( 22 ), and - at least two front supports ( 6 . 6 ' ), which are of the same scope ( 7 ) of said optical structure ( 2 ) and extending therefrom, intended to extend outside the capsular bag ( 22 ), when the IOL ( 1 ) in the capsular bag ( 22 ) is implanted, wherein the front supports ( 6 . 6 ' ) and the rear supports ( 5 . 5 ' ) are arranged on each other on the said circumference so that they between them a front capsular bag flap ( 23 ) to determine the optical structure of the IOL ( 1 ) aligned with an opening ( 32 ) in a front part of the capsular bag ( 22 ), said intraocular lens assembly further comprising a secondary intraocular lens (S-IOL) ( 30 ) for attachment to a front side ( 3 ) the IOL ( 1 ), said S-IOL ( 30 ) comprises: a secondary optical structure ( 35 ), which have a secondary scope ( 36 ); - at least two fixation parts ( 37 . 37 ' ) connected to said secondary periphery and each intended to be connected to one of said front supports ( 6 . 6 ' ) to be connected to said S-IOL ( 30 ) on the said IOL ( 1 ), the optical structure ( 2 ) and the secondary optical structure ( 35 ) are aligned with each other, and - a ring ( 41 ) to the said secondary optical structure ( 35 ), with an inner circumference ( 44 ) of said ring at the secondary perimeter ( 36 ) and said inner circumference ( 44 ) around the circumference ( 7 ) of the optical structure ( 2 ) the IOL ( 1 ) fits. The intraocular lens assembly of claim 1, wherein said S-IOL comprises a posterior side facing said anterior side of said IOL, said anterior side of said IOL opposing an iris of an eye in use, said ring ( 41 ) a rear surface ( 42 ), which is intended to cover the front surface of the front capsular bag part ( 23 ), in particular the said rear surface ( 42 ) is arranged axially so that it is at least in one plane with the rear surfaces ( 14 . 14 ' ) of the at least two front supports, or in the rearward direction behind the rear surfaces ( 14 . 14 ' ) is arranged. The intraocular lens assembly according to any one of the preceding claims, wherein said at least two fixation parts ( 37 . 37 ' ) on said ring ( 41 ), and in particular the said fixing parts ( 37 . 37 ' ) from said rear side of said ring ( 41 ). The intraocular lens assembly according to claim 3, wherein said at least two fixation parts ( 37 . 37 ' ) on said ring ( 41 ) and in the rearward direction over the rear surface ( 42 ) of said ring, in particular wherein said fixing parts (( 37 . 37 ' ) in the rearward direction over a rear surface ( 14 . 14 ' ) of the front support ( 6 . 6 ' ) extend, with which it is connected. The intraocular lens assembly according to any one of the preceding claims, wherein said anterior supports ( 6 . 6 ' ) Through-holes or openings ( 18 . 18 ' ), and the said fixing parts ( 37 . 37 ' ) with retaining elements ( 46 ), which are designed to pass through said openings ( 18 . 18 ' ) to be passed. The intraocular lens assembly according to any one of the preceding claims, wherein said inner circumference of said ring ( 41 ) an inner peripheral surface ( 44 ), which has a conical surface, and wherein said circumference has a conical surface which is substantially the same angle as the conical inner circumferential surface (11). 44 ), said conical surfaces tapering in a frontward direction. The intraocular lens assembly according to any one of the preceding claims, wherein - said at least two posterior supports ( 5 . 5 ' ) comprise closed loops extending from said optical structure ( 2 extend), wherein both ends of each loop on the said circumference ( 7 ), and - said at least two front supports ( 6 . 6 ' ) are each positioned within one of said loops between said ends. The intraocular lens assembly according to any one of the preceding claims, wherein said rear supports ( 5 . 5 ' ) and said front supports ( 6 . 6 ' ) the IOL ( 1 ) are offset or staggered relative to one another in the azimuthal direction (Az). The intraocular lens assembly according to any one of the preceding claims, wherein said rear supports ( 5 . 5 ' ) the IOL ( 1 ) front support surfaces ( 13 . 13 ' ) and the said front supports ( 6 . 6 ' ) the IOL ( 1 ) rear support surfaces ( 14 . 14 ' ) which are offset or staggered in the azimuthal direction (Az), in particular each time in the azimuthal direction (Az) a rear support surface (Az) 14 . 14 ' ) and a front support surface ( 13 . 13 ' ) is procured. The intraocular lens assembly according to any one of the preceding claims, wherein said rear supports ( 5 . 5 ' ) and said front supports ( 6 . 6 ' ) the IOL ( 1 ) in the azimuthal direction (Az) above the optical structure (FIG. 2 ). The intraocular lens assembly according to any one of the preceding claims, wherein a front side of said optical structure ( 2 ) and a rear side of said secondary optical structure facing said optical structure have substantially the same radius of curvature, in particular the said front side of said optical structure (FIG. 2 ) and a rear side of said secondary optical structure have a distance. An intraocular lens structure (IOL) for implantation in the capsular bag, comprising: - an optical structure ( 2 ), which have a scope ( 7 ) having; At least two rear supports ( 5 . 5 ' ), which are of the same scope ( 7 ) of said optical structure ( 2 ) and extending therefrom, intended to extend within the capsular bag ( 22 ), when the IOL ( 1 ) in the capsular bag ( 22 ), and - at least two front supports ( 6 . 6 ' ), which are of the same scope ( 7 ) of said optical structure ( 2 ) and extending therefrom, intended to extend outside the capsular bag ( 22 ), when the IOL ( 1 ) in the capsular bag ( 22 ) is implanted, wherein the front supports ( 6 . 6 ' ) and the rear supports ( 5 . 5 ' ) are arranged on each other on the said circumference so that they between them a front capsular bag flap ( 23 ) to check the optical structure of the IOL ( 1 ) aligned with an opening ( 32 ) in a front part of the capsular bag ( 22 ). A secondary intraocular lens (S-IOL), said S-IOL comprising: - a secondary optical structure ( 36 ); - a ring ( 41 ) surrounding the said secondary optical structure ( 36 ), said ring ( 41 ) at least two axial surfaces ( 42 ); - at least two fixation parts ( 37 . 37 ' ) extending from said axial surfaces ( 42 ) of said ring ( 41 ) and at their ends holding elements ( 46 ) at a distance from the axial surfaces ( 42 ) of the ring ( 41 ) exhibit. A set of parts comprising a set of said S-IOLs according to any one of the preceding claims which differ in at least one optical property of the secondary optical structure, in particular differing in diopter. The intraocular lens assembly of any one of the preceding claims, wherein said IOL ( 1 ) a recess ( 53 ) to the extent mentioned ( 7 ) having an axially extending (Ax) groove in the peripheral surface of said circumference ( 7 ). The intraocular lens assembly according to claim 15, wherein said indentation ( 53 ) between a rear support ( 5 . 5 ' ) and a front support ( 6 . 6 ' ) is provided. The intraocular lens assembly according to claim 15, wherein said S-IOL has a passage extending through said S-IOL and having said indentation ( 53 ) connected is. The intraocular lens assembly according to claim 15, wherein said S-IOL has an indentation in its periphery forming a radially extending groove coincident with said indentation ( 53 ) of the said IOL ( 1 ) connected is.

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