Intraocular lens inserter

An intraocular lens inserter can include a drive device with controllable advance motion. The drive device may include an actuator device and an energy device. The actuator device may include a piston rod that uses the advance motion to push an intraocular lens from a cartridge for insertion into an eye of an animal. The energy device may act upon the actuator device to generate the advance motion. The actuator device may include a dampening medium to control the advance motion, such as by controllably dampening the advance motion.

RELATED APPLICATIONS

TECHNICAL FIELD

The inventions disclosed herein generally relate to devices and methods for inserting an intraocular lens into an eye of an animal.

BACKGROUND

A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope (lens capsule), varying in degree from slight to complete opacity and obstructing the passage of light. Early in the development of age-related cataract, the power of the lens may be increased, causing near-sightedness (myopia), and the gradual yellowing and opacification of the lens may reduce the perception of blue colors. Cataracts typically progress slowly to cause vision loss, and are potentially blinding if untreated. The condition usually affects both eyes, but almost always one eye is affected earlier than the other. The following is a list of different types of cataracts:

Senile cataract—Characterized by an initial opacity in the lens, subsequent swelling of the lens, and final shrinkage with complete loss of transparency occurring in the elderly.

Morgagnian cataract—Liquefied cataract cortex forming a milky white fluid, which can cause severe inflammation if the lens capsule ruptures and leaks, occurring as a progression of the cataract. Untreated, the advanced cataract can cause phacomorphic glaucoma. Very advanced cataracts with weak zonules are liable to dislocation anteriorly or posteriorly.

Cataract resulting from trauma—A cataract resulting from trauma to the eye in an otherwise healthy individual. Blunt trauma or penetrating trauma resulting from accidental injury to the eye can result in crystalline lens opacification. Retinal surgery involving a para plana vitrectomy will result in a post-operative cataract in six to nine months after the surgery. Infrequently, an adverse event can occur where the otherwise healthy crystalline lens is touched by a surgical instrument during retinal surgery. The crystalline lens clouds and a cataract forms within minutes of contact.

Congenital cataract—A cataract developed in a child before or just after birth.

In many countries surgical services are inadequate, and cataracts remain the leading cause of blindness. Cataracts are a large cause of low vision in both developed and developing countries. Even where surgical services are available, low vision associated with cataracts can remain prevalent, as a result of long waits for operations and barriers to surgical uptake, such as cost, lack of information, and patient transportation problems.

Several factors can promote the formation of cataracts, including long-term exposure to ultraviolet light, exposure to ionizing radiation, secondary effects of diseases such as diabetes, hypertension, and advanced age, or trauma. Genetic factors are often a cause of congenital cataracts, and positive family history may also play a role in predisposing someone to cataracts at an early age, a phenomenon of “anticipation” in presenile cataracts. Cataracts may also be produced by eye injury or physical trauma.

Cataracts are also unusually common in persons exposed to infrared radiation, such as glassblowers, who suffer from exfoliation syndrome. Exposure to microwave radiation can cause cataracts. Atopic or allergic conditions are also known to quicken the progression of cataracts, especially in children. Cataracts can also be caused by iodine deficiency. Cataracts may be partial or complete, stationary or progressive, or hard or soft. Some drugs can induce cataract development, such as corticosteroids and the antipsychotic drug quetiapine (sold as Seroquel®, Ketipinor, or Quepin).

The operation to remove cataracts can be performed at any stage of their development. There is no longer a reason to wait until a cataract is “ripe” before removing it. However, since all surgeries involve some level of risk, it is usually worth waiting until there is some change in vision before removing the cataract.

The most effective and common treatment is to make an incision (capsulotomy) into the capsule of the cloudy lens to surgically remove it. Two types of eye surgery can be used to remove cataracts: extra-capsular cataract extraction (ECCE) and intra-capsular cataract extraction (ICCE). ECCE surgery consists of removing the lens, but leaving the majority of the lens capsule intact. High frequency sound waves (phacoemulsification) are sometimes used to break up the lens before extraction. ICCE surgery involves removing the lens and lens capsule, but it is rarely performed in modern practice. In either extra-capsular surgery or intra-capsular surgery, the cataractous lens is removed and replaced with an intraocular plastic lens (an intraocular lens implant) which stays in the eye permanently. The intraocular lens is placed into a cartridge and inserted through the small surgical incision. The inserter folds the intraocular lens and pushes it through a small needle. The end of the needle is positioned within the capsular bag. When the folded intraocular lens exits the end of the needle, it slowly unfolds as the surgeon manipulates the lens into its final position. Cataract operations are usually performed using a local anesthetic, and the patient is allowed to go home the same day. Until the early twenty-first century intraocular lenses were always monofocal; since then improvements in intraocular technology allow implanting a multifocal lens to create a visual environment in which patients are less dependent upon glasses. Such multifocal lenses are mechanically flexible and can be controlled using the eye muscles used to control the natural lens.

Complications are possible after cataract surgery, including endophthalmitis, posterior capsular opacification, and retinal detachment.

Laser surgery involves cutting away a small circle-shaped area of the lens capsule, enough to allow light to pass directly through the eye to the retina. There are, as always, some risks, but serious side effects are very rare. High frequency ultrasound is currently the most common means to extract the cataract lens.

Cataract surgeries are conducted in an operating room under sterile conditions to prevent the risk of infection, particularly endophthalmitis, a rapid devastating infection that can cause blindness in a few days. The patient's eye is cleaned with an antiseptic and then isolated with a sterile drape that fully covers the patient with only the eye exposed. A sterile field is established around the patient such that any personnel or instrumentation must be suitably scrubbed, draped, or sterilized following standard aseptic procedures.

With reference toFIGS. 1 and 2, such a prior art type of cataract surgery includes using a surgical microscope to view the interior of the eye through a patient's cornea and iris. The surgeon typically makes two incisions10,12in the patient's cornea, close to the limbus, to enable surgical instruments to gain access to the interior segment of the eye and to implant an intraocular lens after the cataract crystalline lens has been removed. For example, an intraocular lens inserter14can be inserted through the incision10and a positioning device16can be inserted through the incision12.

The surgery typically includes creating a full-circle tear in the center of the capsular bag on the interior side, called a “capsulorhexis,” and removing the torn circle of the capsule. Then the cataract crystalline lens is removed using a phacoemulsifier, an ultrasonic infusing and aspirating instrument that breaks up the cataract and aspirates the fragments, removing the cataract.

The lingering cortical material that is attached to the inner surface of the capsular bag is then aspirated using an infusion/aspirating instrument. The intraocular lens18is then inserted using the lens inserter14and positioned within the capsular bag using the positioning device16or other devices.

The lens inserter14transfers the flat intraocular lens18through the small clear corneal incision10into the capsular opening (capsulorhexis) and to its final position within the capsular bag. The inserter14pushes the flat lens18through a cartridge which causes the lens to fold and pass through a tubular portion of the cartridge which is placed into the small incision10. As the lens18emerges out of the tubular end of the cartridge14, it slowly unfolds and returns to its original flat shape.

Recent advances in femtosecond laser instrumentation has automated the process of making entry incisions and the capsulorhexis as well as pre-cutting the cataract making the cataract surgical procedure more precise, safer, and easier for the surgeon to execute.

The majority of current lens inserters are manually operated re-usable instruments with primarily one of two means to push the lens: a lead screw or plunger. The lead screw approach provides consistent and smooth delivery of the lens, however slowly, and requires the surgeon or an assistant to turn the manual lead screw as the surgeon positions the tip of the instrument

The plunger approach does not require an assistant, as the surgeon uses a thumb to drive the lens forward, much like injecting a drug from a syringe. Additionally, the surgeon can more readily control the speed of delivery, swiftly moving through the less critical portions and slowing for the more delicate segments. A drawback of the plunger approach is that when the lens becomes stuck, resulting in a more forceful push by the surgeon to clear the hang-up, the lens can overshoot its exit and injure the patient.

Reusable instrumentation requires reprocessing (cleaning and sterilization) resulting in additional instrumentation overhead and increased risk of Toxic Anterior Segment Syndrome (TASS) www.cdc.gov/mmwr/preview/mmwrhtml/mm5625a2.htm.

Recently, efforts have been made to perform such lens replacement surgeries using smaller corneal incisions. For example, as shown schematically in the illustration ofFIG. 3, typically the distal end of an intraocular lens inserter14is inserted completely through the incision10during a procedure of inserting an intraocular lens18.

However, with reference toFIG. 4, surgeons recently have been adopting a “wound-assist” technique, wherein only a small portion of the tip20of the intraocular lens inserter14is inserted into the incision10, wherein the incision10is smaller than the incisions previously made, such as during the procedure illustrated inFIG. 3. As such, the intraocular lens18, in its folded state, is pushed through and slides along interior surfaces of the incision10. This allows the incision10to be smaller and the wound itself (incision10) becomes a lumen for inserting the lens18into the eye.

During such a procedure the surgeon can use the distal end20of the tip of the intraocular inserter14to help hold the incision10open. For example, the surgeon might apply a lateral force in the direction of arrow22in order to hold the incision10open such that the lens18can be pushed therethrough.

There are a number of intraocular devices for implanting an intraocular lens described in the prior art. For example, WO 96/37152 describes a pushrod in a housing, which can be moved by the pressure of a thumb. During the axial advance of the pushrod, the intraocular lens may be removed from the housing and implanted in the eye. A spring and/or a dampening element made from an elastic rubber or plastic material acts opposite the direction of advance of the pushrod to adjust the force of the pushrod. Also, EP 0477466 A1 describes a rotary drive which may be embodied as an electric engine, which acts upon a pushrod via a rod and a transmission. Thereby, the rotary motion is converted to a forward motion. The intraocular lens, which particularly comprises a foldable intraocular lens comprising a rubber-elastic material, for example silicon, is located in an implanting tool which can be placed upon the implanting device. The pushrod motion in the axial direction of advance is transferred during the implanting process upon the intraocular lens in the implanting tool.

SUMMARY

An aspect of at least one of the inventions disclosed herein includes the realization that an intraocular lens inserter can allow a surgeon to actuate and thus discharge a lens from an inserter device with one hand and can also reduce the manual force that must be applied by the surgeon. For example, in some known conventional devices, such as plunger devices, a surgeon must use significant manual force against the proximal end of the plunger to push the lens through the end of the inserter device. This makes it more difficult for the surgeon to hold the device in the desired orientation and position during insertion. This problem is more significant in the surgical procedures more recently adopted such as that described above with reference toFIG. 4. Thus, an intraocular lens insertion device that provides assisted discharge force can help a surgeon perform the surgical procedure as desired.

Another aspect of at least one of the inventions disclosed herein includes the realization that significant costs for such devices can be reduced by the use of an inserted device having an incorporated mechanism for storing energy for providing a discharge force.

Thus, by providing an intraocular lens inserter with an energy device that stores energy for providing a discharge force, the intraocular lens inserter is more portable and avoids the requirement for a surgeon to purchase or rent a separate standalone console.

Another aspect of at least one of the inventions disclosed herein includes the realization that a hand-held intraocular lens inserter can be made with an incorporated energy device and a movement control actuator, with sufficient simplicity that the resulting device can be designed as a single use device and thus is disposable, thereby avoiding the cost of resterilization and the potential for cross-contamination. Thus, for example, an intraocular lens inserter device can include a compressible energy device and an actuator configured to operate with a substantially incompressible fluid for controlling the release of the energy stored by the energy device and the movement of downstream components, such as a lens insertion rod/plunger.

Another aspect of at least one of the inventions disclosed herein includes the realization that compressible energy devices, such as springs or compressed air, can provide convenient and portable means for storage of energy which can be output as forces. However, such energy devices are more difficult to control for providing, for example, constant velocity output.

Thus, an aspect of at least one of the inventions disclosed herein includes the realization that providing a dampening medium with a substantially incompressible fluid, such as a liquid, accommodates the use of mechanisms that can provide more fine control over the velocity of downstream components, even where energy is supplied by a compressible storage device, such as springs or compressed air.

DETAILED DESCRIPTION

The inventions disclosed herein are described in the context of intraocular lens inserters for the treatment of cataracts. However, the inventions disclosed herein can be used in other context as well with regard to surgical devices that are required to discharge devices, for example, into or beyond the tissues of an animal, such as a human.

Generally described, aspects of the present disclosure relate to intraocular lens inserters that include a drive device with controllable advance motion. The drive device may include an actuator device and an energy device. The actuator device may include a piston rod that uses the advance motion to push an intraocular lens from a cartridge for insertion into an eye of an animal. The energy device may act upon the actuator device to generate the advance motion. The actuator device may include a dampening medium to control the advance motion, such as by controllably dampening the advance motion.

In some embodiments, the piston rod may include a plunger part, a piston part, and a pushrod part. The pushrod part may be impinged in the direction to advance by a pressurized gas provided by the energy device. The pressurized gas may be a single phase gas or a multi-phase gas such as a liquefied dual phase gas. In some embodiments, such as that involving the use of a liquefied dual phase gas, the pressurized gas component can act as a substantially constant force storage means. In some embodiments, the pressurized gas is stored wholly within the intraocular lens inserter. In some embodiments, the pressurized gas is stored remotely from the intraocular lens inserter. When the pressurized gas is stored remotely, the intraocular lens inserter may be fed the pressurized gas from a tube in fluid communication with the intraocular lens inserter.

Opposite the direction of advance, a dampening means applies dampening pressure upon the piston part. The dampening means may be a dampening medium capable of flow. For example, the dampening medium may be a hydraulic fluid. In some embodiments, the dampening medium may be an ophthalmologic tolerated liquid. During the implanting process, the dampening pressure applied to the piston part counteracts the pressurized gas pressure applied to the pushrod part. Thereby, the movement control of the plunger part may be controlled by controlling the dampening pressure applied to the piston part.

For example, the energy device may release pressurized gas pressure upon the pushrod part to move the piston rod in the advance direction (by applying the pressurized gas pressure upon the pushrod part in the advance direction). However, the piston part of the piston rod may be in contact with a dampening medium in a pressure chamber to apply dampening pressure that counteracts the pressurized gas pressure (by applying the dampening pressure upon the piston part in a direction opposite to the advance direction). Thereby, control of the dampening medium may be used to control the motion of the intraocular lens inserter (by controlling a reduction of the dampening pressure, such as by draining the dampening medium from the pressure chamber).

In certain embodiments, a channel may be used to drain the dampening medium from the pressure chamber. Thereby, varying the cross section of the channel may be used to control the dampening medium. Also, a valve may be used to allow the dampening medium to drain from the pressure chamber via the channel. Thereby, varying the cross section of the valve (such as by opening and/or closing the valve) may be used to control the dampening medium. In some embodiments, a slider may be used to control the cross sections of the channel and/or the valve may be controlled (such as by applying the pressure of a finger upon the slider) such that the pressurized gas is converted into a relaxing stroke for implanting the lens.

With reference toFIG. 5, an intraocular lens inserter100can include an energy device102, an actuator device104, and a lens discharge device106. The energy device102can be in the form of any type of energy device. In some embodiments, the energy device102is in the form of a device for storing energy, such as compressible fluids, mechanical springs, or other compressible types of energy storage devices. Other types of energy storage devices can also be used. In some embodiments, the energy device102may receive and/or convert energy from an external source, such as by being fed pressurized gas from a tube in fluid communication with the energy device.

In some embodiments, the energy device102can be configured to discharge mechanical energy from the energy therein. For example, where the energy device102is in the form of a compressed gas container, the energy device102can discharge such compressed gas which therefore provides an output of mechanical energy. Furthermore, where the energy device102is an interface (such as a valve or connector) for a tube that is fed pressurized gas from an energy source, the energy device102can discharge such pressurized gas which provides an output of mechanical energy.

The actuator device104can be any type of actuator configured to provide controllable actuation of the output of mechanical energy from the energy device102. For example, in some embodiments, the actuator device104includes user interface (such as a mechanical or electronic button, lever, or slide) for providing a user with means for controlling the output of mechanical energy from the energy portion102. For example, the actuator device104can include a slide, lever, or button configured to control variable resistance or movement dampening of the pressurized gas pressure applied to the piston rod from the energy device102. The actuator device104may also control the piston rod's interaction with the lens discharge device106. For example, the actuator device104may include an output plunger part or other device for interacting with the lens discharge device106.

The lens discharge device106may be configured to interact with or retain an intraocular lens cartridge which is widely commercially available from several different sources. For example, the lens discharge device106can be configured to releasably engage with an intraocular lens cartridge commercially available as a Monarch® available from Alcon®. The lens discharge device106may also be configured to move between an open position configured for allowing an intraocular lens cartridge to be engaged with the lens discharge device106and a closed portion in which the lens discharge device106engages with the lens cartridge.

As such, in operation, the actuator device104can be manipulated by a user, such as a surgeon, to control the output of mechanical energy from the energy device102, to thereby control the discharge of a lens from a lens cartridge retained by the lens discharge device106. Further, the intraocular lens inserter100can be configured to be hand-held, disposable, and/or reusable in different embodiments.

In some embodiments, the actuator device104and the energy device102may be referred to, in combination, as a drive device200. With reference toFIG. 6, the intraocular lens inserter100may comprise a further embodiment of the drive device200A, which comprises the actuator device104A and the energy device102A. The features and components of the drive device200A, which comprises the actuator device104A and the energy device102A, can be the same or similar to corresponding components of the drive device200, which comprises the actuator device104and the energy device102, that have been identified with the same reference numeral, except that the letter “A” has been added thereto.

FIG. 6is a cross-sectional illustration of an embodiment of the drive device200A, by which the plunger part600of the piston rod615in a housing602can be moved in the direction of advance604. A pressurized gas606, such as a liquefied dual phase gas having a liquid component606A and a gas component606B is stored wholly within the housing602.

In some embodiments, the pressurized gas606can serve as a constant energy storage means of the energy device102A. The pressurized gas606acts at one side upon the pushrod part608supported in a displaceable fashion in the housing602in a pressure-tight or generally pressure-tight fashion via an O-ring610.

The piston part612is guided in a piston chamber632of the housing602, and also in a pressure-tight or generally pressure-tight fashion, preferably liquid tight, for example via an O-ring614. The piston chamber632may include a pressure chamber616and a drainage chamber628separated by the piston part612. Thereby, the pushrod part608and the piston part612act upon the plunger part600in the axial direction, particularly in the direction of advance604.

At the other side of the piston612, the pressure chamber616includes a dampening medium618. The dampening medium618may be capable of flow and may be in the form of a hydraulic fluid. In an idle state, a valve620, for example located at a sealing plug622, is closed. When the valve620is closed, the pressure chamber616is sealed pressure-tight or generally pressure-tight towards the outside of the pressure chamber616. For this purpose, a seal, for example in the form of another O-ring624, is provided at the sealing plug622. Also, the piston rod615is also guided in a pressure-tight or generally pressure-tight fashion in the sealing plug622. This occurs with the help of another seal, which may also be embodied as an O-ring625.

In the exemplary embodiment, a channel626may be connected with the valve620. The channel626may terminate at the drainage chamber628. Thereby, the dampening medium618can be drained out of the pressure chamber616through the channel626. However, in other embodiments, the channel626may drain the dampening medium to another collection vessel (not illustrated) in lieu of the drainage chamber628or along with the drainage chamber628.

In the idle state (while the valve620is closed) the gas component606B of the pressurized gas606acts upon the piston rod615via the pushrod part608. However, the piston part612is hindered from moving in the direction of advance by the dampening medium (which may be an incompressible or substantially incompressible fluid, such as a liquid including for example, saline).

Opening the valve620allows the dampening medium618to flow through the channel626into the drainage chamber628. This allows the gas component606A of the pressurized gas606to drive the piston rod615in the direction of advance604. This causes the dampening medium618in the pressure chamber616to be displaced through the open valve620and the channel626into the drainage chamber628. In order to limit the advance motion of piston612, a stop630may be located in the pressure chamber616.

Pressure may be applied to the plunger part600for retracting the piston part612opposite the direction of advance604. By applying pressure opposite the direction of advance604to the plunger part600, the dampening medium may be deposited into the pressure chamber616by way of suction and the pressurized gas606may be re-compressed. When the piston part612is retracted, a vacuum develops in the pressure chamber616so that the dampening medium618can be suctioned through the open valve620. The pushrod part608also decreases the volume of the liquefied dual phase gas. After retracting the piston part612and closing the valve620, the drive device200A may be returned to a ready-to-use condition.

In certain embodiments, the piston chamber632and the channel626may be filled with the dampening medium618such that movement of the piston614is equivalent to displacement of the dampening medium618between the pressure chamber616and the drainage chamber628. In other embodiments, the pressure chamber616may be filled with the dampening medium618while the drainage chamber628and/or the channel626and/or the collection vessel may include another medium different than the dampening medium618(for example, a vacuum, a different dampening medium, or the ambient environment of the drive device200A).

The rate of displacement of the dampening medium618(and thereby the movement of the piston612and the plunger600) can be controlled by regulating the cross-section of the valve620, the cross-section of the channel626, and/or the viscosity of the dampening medium618. For example, a user interface (such as a slider discussed further below) may be utilized to control the rate of displacement of the dampening medium. Thereby, the speed of the advance of the piston rod615can be controlled to smoothly push an intraocular lens from a cartridge for insertion into an eye.

FIG. 7is a cross-sectional illustration of an exemplary embodiment of the drive device200B. With reference toFIG. 7, the drive device200B may be a further embodiment of the drive device200A. The features and components of the drive device200B can be the same or similar to corresponding components of the drive device200A, except that the letter “B” has been added thereto. As illustrated inFIG. 7, the drive device200B includes a channel626B and a slider700. The channel626B may be formed of a flexible material such that the cross section of the channel626B may be reduced and expanded by applying pressure to the surface of the channel626B (such as from the pressure of a finger). The slider700may be positioned on the channel626B such that the pressure of a finger on the slider700may control the cross section of the channel. For example, the slider may include a plate that is mobile or deformable perpendicular in reference to the channel626B.

Furthermore, in certain embodiments, the cross section of the valve620B may be controlled by the slider700. For example, the cross section of the valve620B may be controlled such that the valve620B is either completely open, completely closed, or in any position between being completely open or completely closed (such as by incrementally controlling the cross section of the valve620B). For example, a rod member (not shown) can connect the slider700to the valve620B to control the opening of the valve620B, the valve620B optionally being biased to a closed state with the slider700in a neutral state, and the valve620B being opened with movement of the slider700away from the neutral state. In other embodiments, a separate user interface (such as an additional slider (not illustrated)) may control the cross sectional aperture of the valve620B.

Also, in certain embodiments, the viscosity of the dampening medium618B may be selected and/or controlled to influence the rate of advance of the piston rod615B. For example, different dampening mediums may have different viscosities such that movement of the piston part612B is a factor of the viscosity of the particular dampening medium618B used in the drive device200B. Also, the viscosity may be controlled, such as by controlling the temperature or another characteristic of the dampening medium618B, to influence the rate of advance of the piston612B.

FIG. 8is a cross-sectional illustration of an exemplary embodiment of the drive device200C. With reference toFIG. 8, the drive device200C may be a further embodiment of the drive device200B. The features and components of the drive device200C can be the same or similar to corresponding components of the drive device200B, except that the letter “C” has been added thereto. As illustrated inFIG. 8, the pressurized gas606(which is a liquefied dual phase gas having a liquid component606A and a gas component606B) is replaced with pressurized gas800having a single phase.

FIG. 9is a cross-sectional illustration of an exemplary embodiment of the drive device200D. With reference toFIG. 9, the drive device200D may be a further embodiment of the drive device200B. The features and components of the drive device200C can be the same or similar to corresponding components of the drive device200B, except that the letter “D” has been added thereto. As illustrated inFIG. 9, the pressurized gas606(which is a liquefied dual phase gas having a liquid component606A and a gas component606B) is replaced with pressurized gas (not illustrated) that is stored remote from the drive device200C. The remote pressurized gas source may be delivered to the drive device200C via a tube902in fluid communication between the interface900(such as a valve or connector) of the energy device102D of the drive device200D.

With reference toFIGS. 10-17, a further embodiment of the intraocular lens inserter100is illustrated and identified by the reference number100E. The features and components of the lens inserter100E that can be the same or similar to corresponding components of the lens inserter100have been identified with the same reference numeral, except that the letter “E” has been added thereto.

FIG. 10is a perspective view of a further embodiment of the intraocular lens inserter100ofFIG. 5. As illustrated inFIG. 10, the intraocular lens inserter100E also includes an energy device102E, an actuator device104E, and a lens device106E. The intraocular lens inserter100E may include a main body portion201which includes various cavities, recesses, and conduits, and, in the present embodiment, provides for communication between the energy storage portion102A and the actuator portion104A and the lens device106E. In some embodiments, optionally, the main body portion201can be made from a single piece of material forming a monolithic body. However, other configurations can also be used.

As illustrated, the lens device106E may include a cartridge receiving portion430configured to receive a lens cartridge400. The lens device106E may also include a cartridge engagement member240configured to connect the lens device106E and the actuator device104E. The actuator device104E may include the slider700E. Also, the energy device102E may include a removable cap256.

FIG. 11is a side elevation and cross-sectional view of the intraocular lens inserter ofFIG. 10. As illustrated inFIG. 11, the removable cap256may be removed to insert a container of compressed gas into a receiving portion202. The receiving portion may be configured as a recess within the main body portion201, sized and configured to receive the container of compressed gas. In some embodiments, the recess202can be sized to receive a canister of compressed carbon dioxide204. Such containers of compressed gas, and in particular carbon dioxide, are widely commercially available.

With reference toFIGS. 12 and 13, the cartridge engagement member240can include the cartridge receiving portion430. For example, the cartridge receiving portion430can include a distal wing engagement portion432and a body receiving portion434. The wing receiving portion432and the body receiving portion434can be sized in accordance with the outer dimensions of a commercially available lens cartridge400, which are well known in the art.

The distal wing receiving portion432can include a recess designed to engage the wings436of the lens cartridge400. Thus, when the cartridge400is engaged with the cartridge receiving portion430, as shown inFIG. 10, the cartridge400is generally aligned with the plunger600E.

With continued reference toFIGS. 14 and 15, the cartridge receiving portion430can optionally include a proximal engaging portion440configured to engage with a proximal portion of the cartridge400. For example, in some commercial embodiments of the cartridge400, the cartridge400includes rearward wings442or other rearward surfaces. The cartridge engagement portion430, therefore, can include an additional proximal recess444and an engagement device446, for a positive engagement with the wings442. Thus, as shown inFIG. 15, when the cartridge400is engaged both with the forward engagement portion432and the rearward engagement portion444, with the projection446extending over the rearward wings442, the cartridge400is more securely seated within the cartridge receiving portion430.

This can provide a substantial benefit to a surgeon using the inserter100E. For example, with the projection446extending over the rearward wing442, if the surgeon applies a force to the inserter100E in the direction of arrow F (FIG. 15), a torque T can be created or imparted onto the cartridge400, thereby tending to cause the cartridge to pivot about the distal receiving portion432, which can thereby tend to cause the proximal end of the cartridge400to lift upward in the direction of arrow U. However, the engagement portion446can help retain the proximal portion of the cartridge400within the receiving portion430. This type of force can be created during execution of surgical procedures that are becoming more common, such as that described above with reference toFIG. 4, known as the “wound-assist” technique.

With continued reference toFIGS. 13-15, the cartridge engagement member240can also be slidably engaged with the main body portion201. Thus, the cartridge engagement member240can include various internal surfaces configured to cooperate with outer surfaces of the main body portion201. Thus, the cartridge engagement member240can be slid longitudinally along the main body portion201, parallel to the longitudinal axis L of the intraocular lens inserter100E.

For example, with reference toFIGS. 16 and 17, the portion240can be moved to a distal position, show inFIG. 16. In this position, the lens receiving portion430is spaced apart from the plunger600E. As such, the cartridge400can be inserted into the cartridge receiving portion430without interference of the plunger600E. Thus, after the cartridge is received as such, as shown inFIG. 17, the cartridge engagement member240can be slid backwards relative to the main body portion201until the plunger600E engages or presses against a lens within the cartridge400.

As noted above, the main body portion201can include various detents or ramps or other portions246,248which can engage with a portion of the cartridge engagement member240for providing positive engagement into various positions. For example, the cartridge engagement member240can include a ramp and hook portion460configured to engage with the portion246and portion248of the main body portion201. Thus, the cartridge engagement member240can be positively engaged in the position illustrated inFIG. 17with the main body portion201, and then when pulled in the proximal direction, so as to move the plunger600E into the cartridge400, the portion460can engage with the proximal portion of the housing201to thereby engage into a retracted position. Other designs can also be used to provide for the convenient insertion and removal of the cartridge400.