Artificial crystalline lens

An artificial crystalline lens shaped as a lens provided with supporting and fastening elements. The fastening element is essentially a wire angle held at its ends to the lens lateral surface, while the supporting element is arranged on a diametrically opposite side of the lens. The vertex of the fastening wire angle lies on a line passing through the midpoint of the supporting element and the center of the lens. The supporting element is made of an elastic wire so as to make it possible to adjust the distance from the center of the lens to the supporting wire element. A novel method of implanting the artificial crystalline lens is also the subject of the present invention.

The present invention relates to medicine and more specifically to 
ophthalmology, having particular reference to an artificial crystalline 
lens and a method of implanting same. 
One of the most important problems in ophthalmological practice is one of 
correcting the vision after cataract extraction. There exist a number of 
methods of such correction, e.g., spectacles or contact lenses. However, 
in the case of correction with the aid of spectacles the patient fails to 
obtain an optimum vision, while correction with the help of contact lenses 
is far from being tolerated adequately well by any patient, especially by 
advanced-age ones, wherein the incidence of cataract is as high as 80 to 
85 percent. 
That is why the scientists of many countries were engaged in search for new 
ways of solving the abovediscussed problem; one of such ways was an 
intraocular correction or implantation of an artificial crystalline lens. 
Known in the present state of the art are various constructions of 
artificial crystalline lenses adapted to suit various operational 
procedures and techniques. 
Thus, for instance, one prior-art artificial crystalline lens is known to 
comprise a lens provided with fastening and supporting elements, both of 
said elements being substantially similar and being essentially 
loop-shaped lugs of a stiff material held to the lens lateral surface, the 
only difference between said elements residing in that the fastening 
element has two projections adapted for guiding and retaining the suture 
material (cf. USSR Inventor's Certificate No. 563,174). 
The crystalline lens of the character set forth hereinbefore is intended 
for being implanted in the crystalline capsule of the eye. However, when 
implanting such an artificial lens the centre and optical axis of the 
latter may prove to be offset with respect to the centre of the pupil and 
the optical axis of the eye due to the fact that crystalline capsule 
differs in size in various persons and may therefore frequently disagree 
with the linear dimensions of an artificial crystalline lens. It must be 
borne in mind that such a construction needs a pin-point production 
accuracy of structural components thereof, in particular, mutual 
arrangement of the lugs of the fastening element, as any displacement of 
these will result in mispositioning of the lens and, hence, in an 
inaccurate orientation thereof with respect to the vertical meridian of 
the eye. 
The afore-discussed artificial crystalline lens is fitted in position as 
follows. 
After having slit open the anterior chamber of the eye one must make an 
incision at the root of the iris, whereupon the anterior capsule of the 
crystalline lens is incised through an opening formed in the iris 
beforehand; next the nucleus of the lens and the lenticular masses are 
removed, after which an opening is made in the anterior chamber of the 
lens, and an artificial crystalline lens is implanted in the crystalline 
capsule, whereupon the lugs of the fastening element are stitched to the 
margins of the incision in the iris. 
The aforesaid operation is disadvantageous in that the anterior capsule may 
be ruptured if the supporting element interferes with the edges of the 
capsule opening, and that no provision is made for an individual matching 
of an artificial crystalline lens to suit the size of the patient's 
crystalline capsule. 
It is a general and essential object of the present invention to provide 
such fastening and supporting elements of an artificial crystalline lens 
as to make possible a reliable orientation thereof with respect to the 
vertical meridian of the eye. 
It is another object of the present invention to reduce the production 
accuracy tolerance of the supporting element and make its mounting in 
position simpler and easier. 
One more important object of the present invention is to provide a 
possibility of attaining a complete fitness of the overall size of an 
artificial crystalline lens and the size of the patient's crystalline 
capsule. 
One of the other objects of the present invention is to render possible a 
visual control over orientation of the lens axis relative to the vertical 
meridian of the eye. 
And still another object of the present invention is to provide an optimum 
procedure for implanting the artificial crystalline lens of the character 
set forth hereinbefore. 
Said and other objects are accomplished due to the fact that in an 
artificial crystalline lens, comprising a lens, fastening and supporting 
elements held thereto on the diametrically opposite sides thereof, said 
elements being adapted for setting said lens in the crystalline capsule of 
the patient's eye, according to the present invention the fastening 
element is a wire angle held to the lens lateral surface in such a manner 
that the vertex thereof lies on a line passing through the centre of the 
lens circumference and the midpoint of the supporting wire element also 
held to the lens lateral surface, said wire element being spread along the 
lens periphery and made of an elastic material so as to be radially 
displaceable in order to adjust the distance from the lens centre to the 
supporting wire element to suit the size of the crystalline capsule of the 
patient's eye. 
An advantageous feature of the afore-discussed construction consists in 
that the mutual arrangement of the vertex of the fastening element, viz., 
wire angle, the supporting element and the centre of the lens at all times 
provides for a correct orientation relative to the vertical meridian of 
the eye, this being due to the fact that any cocking inherent in the 
prior-art construction is ruled out. In addition, radial displaceability 
of the supporting element on the one hand makes it possible to reduce 
production accuracy tolerance of said element and simplify its mounting in 
position, and on the other hand provides for a possibility of attaining a 
complete fitness of the overall size of an artificial crystalline lens and 
the size of the patient's crystalline capsule. 
It is expedient that the wire angle be curved, nearby its vertex, in a 
direction perpendicular with the legs or sides thereof so that the vertex 
of the wire angle lies in a plane passing through the apex of the lens 
spherical surface, which enables one to avoid cocking of the lens in its 
vertical plane. 
It is most expedient that the wire angle be curved so as to define an elbow 
bend one of whose arms being normal to the sides of the wire angle, while 
the other arm thereof is normal to the former arm of the elbow bend and 
lies in a plane passing through the apex of the lens. 
An eyelet may be provided at the vertex of the wire angle for the suture 
material to pass through. 
With a view to appropriately positioning the lens with respect to the 
vertical meridian of the eye, marks must be made on the lens, said marks 
lying on an imaginary line passing through the vertex of the wire angle 
and the midpoint of the supporting element and being spaced one-third the 
lens radius apart from the edge of the lens. 
A method of implanting an artificial crystalline lens incorporates a basal 
iridotomy to form an opening in the iris, a preequatorial incision of the 
anterior crystalline capsule through said opening in the iris, removal of 
the contents of the crystalline capsule followed by cleaning the posterior 
capsule, measurement of the distance from the equator of the crystalline 
capsule to the centre of the pupil followed by a corresponding radial 
displacement of the supporting element of the artificial crystalline lens 
until the distance from the centre of the lens thereof gets substantially 
equal to said measured distance, bringing the artificial lens with its 
supporting element into the crystalline capsule making way through the 
opening resulting from said basal iridotomy and through said preequatorial 
incision in the anterior crystalline capsule, stitching the fastening 
element to the margins of the central portion of the basal iridotomy, 
making an incision in the central zone of the anterior capsule opposite to 
the pupil, whereupon the axis of the artificial crystalline lens is 
oriented against the vertical meridian of the patient's eye using the 
marks provided on the lens. 
Such a method of implanting an artificial lens prevents the crystalline 
capsule from rupture and provides for matching of optimum overall size of 
said lens immediately during the operation.

Now referring to FIG. 1 an artificial crystalline lens indicated as a whole 
at Ref. No. 1 comprises a lens 2 of any known construction, such as a 
planoconvex one as shown in FIG. 2, a fastening element 3 and a supporting 
element 4. The fastening element 3 is essentially an angle made of a wire 
5 and built-in with its ends 7 into a peripheral lateral surface 6 of the 
lens 2 by any known method. Situated on a diametrically opposite side of 
the lens is the supporting element 4 which is in effect a loop-shaped lug 
made of an elastic wire, say, one of a platinum-iridium alloy, said 
element being built-in with its ends 8 into the lateral lens surface 
similarly to the ends 7 of the fastening element. 
The fastening element made as the wire angle 3 and the lug-shaped 
supporting element 4 are so arranged that a vertex 9 of the wire angle 
lies on a line passing through the centre of the lens 2 and the midpoint 
of the supporting element 4. 
The top portion of the wire angle is curved transversely towards the apex 
of the lens 2, with the result that an elbow bend 10 is formed, as can be 
seen distinctly from FIG. 2, said elbow bend having two arms of which one 
is normal to the sides of the wire angle, while the other arm is normal to 
the former arm and lies in a plane passing through the apex of the lens 
spherical surface. 
In addition one can see from FIGS. 1 and 2 point-marks 11 are made on the 
lens spaced one-third its radius from the edge thereof and lying on a line 
passing through the vertex of the wire angle 3 and the midpoint of the lug 
4. 
FIG. 3 illustrates an artificial crystalline lens substantially similar to 
that shown in FIGS. 1 and 2 and therefore having the same reference 
numerals, the sole difference between said lenses residing in that an 
eyelet 12 is provided at the vertex of the wire angle for the suture 
material to pass through. 
Now let us consider the operational procedure involved in fitting such an 
artificial crystalline lens in position. 
The implanting of an artificial crystalline lens in the crystalline capsule 
of a patient is carried out as follows. Once an extracapsular extraction 
of the cataract has been performed a special calibrated spatula 15 is 
brought into the empty crystalline capsula through a basal iridotomy 13 
(FIG. 4) and a preequatorial incision 14 of the anterior capsule. Then the 
end of the spatula 15 is let go as far as an equator 16 in the eye bottom 
portion (at six o'clock), and the distance to the centre 17 of the pupil. 
The supporting element of the artificial crystalline lens, made as the 
loop-shaped lug 4 (FIG. 5) is either bent out or bent in so as to obtain a 
distance to a centre 18 of the lens, corresponding to the distance from 
the equator of the crystalline capsule to the centre of the pupil. 
After matching the lens of a required size it is introduced into the 
crystalline capsule through the basal iridotomy 13 (FIG. 6) and the 
preequatorial incision 14 in the anterior capsule so that the loop-shaped 
lug 4 should reach the equator 16 of the crystalline capsule in the bottom 
eye portion, and the wire angle 3 with an elbow bend is stitched up to the 
margins of the basal iridotomy. Then an opening is made in an anterior 
capsule 20 of the crystalline capsule within the zone of the pupil, using 
a diamond blade or Vannas's scissors. 
An axis 19 of the artificial crystalline lens is oriented to the vertical 
meridian of the eye along the line passing through the vertex of the wire 
angle and the point-marks 11 on the lens 2 depending upon whether said 
axis deviates from the normal (vertical) position, whereby the centre 18 
of the lens is brought in alignment with the centre 17 of the pupil. 
The implantation terminates in hermetically sealing the operative incision 
and restoration of the anterior chamber with a balanced solution. Then the 
eyeball is irrigated with an atropine solution, whereas some antibiotics 
and corticosteroids are medicated under the bulbar conjunctiva. 
For the sake of example given below are two case histories. 
Patient A., male, aged 22. a car driver. Admitted to the eye clinic on June 
27, 1978 with a diagnosis of a traumatic cataract of the right eye. The 
affected eye shows a scar of the cornea; the left eye is sound and 
emmetropic. 
Status on admission was as follows. 
Right eye: acuity of vision at the level of photoreception with a correct 
projection, autoophthalmoscopy and cobalt test are positive, P.sub.o =13 
mm Hg. 
The adnexa oculi remain unchanged, the conjunctiva is quiet. The cornea 
shows a small scar passing throughout all layers. The anterior chamber is 
not as deep as that of the left eye. The iris exhibits no changes. The 
pupil is round, of a medium width, reacts to light vividly. The 
crystalline lens is opalescent throughout all layers and shows the 
symptoms of intumescence. The angle of the anterior chamber is open, of a 
medium width, the trabecula is not pigmented. Electronic tonography 
evidence: P.sub.o =13; C=0.34; F=0.595; P.sub.o /C=38.2. Findings of 
echobiometry; the length of the antero-posterios axis of the eye is 23.32 
mm; the refraction of the cornea is 44 diopters. An artificial crystalline 
lens was made, having an optical refractive power of 61.9 dioptres (as 
measured in the air). 
Left eye: no pathological changes. The acuity of vision equals 1.0. 
The operation of the right eye performed on June 28, 1978 was one of an 
intracapsular implantation of an artificial crystalline lens by the 
afore-described procedure. During the operation a 1-percent atropine 
solution was several times introduced into the eye operated upon. 
The clinical coursing of the postoperative period was as follows. 
In the day of operation the patient was permitted to walk and take food 
normally; the following treatment was instituted: eye drops three times a 
day, viz., a one-percent atropine solution, corticosteroids and some 
disinfectants; Butadion and Dimedrol were administered perorally in a dose 
of one tablet of each drug three times a day. 
The state of the eye operated upon: 
in the day of the operation--hyperemia of the conjunctiva, the corneal 
incision is well adapted with a continuous supramid suture (ten noughts); 
an inconsiderable descemetitis is observed; the anterior chamber is deep, 
the aqueous humour is transparent. The iris is quiet, the pupil is 3 mm 
wide, round in shape; iridotomy is seen at the upper edge of the limbus 
corneae at 12 o'clock, the supporting element of the implanted artificial 
crystalline lens being stitched up to the margin of the incised iris at 
the midpoint thereof; the artificial crystalline lens is seen to assume a 
normal position in the crystalline capsule, the position of its axis with 
respect to the vertical meridian of the eye is right. 
Within the following days after the operation (from the 1st to the 5th) the 
hyperemia of the conjunction nearly disappeared, the pupil dilated to 6.5 
mm in diameter, round in shape; there is seen against the reflex of the 
fundus oculi the entire artificial lens and the ends of the supporting and 
fastening elements built-in into its edge; there are also seen the 
point-marks on the lens a dia. 3.5 mm opening in the anterior capsule, 
showing irregular margins. The posterior capsule is spaced somewhat apart 
from the posterior lens surface. The vitreous body is transparent. The 
fundus oculi shows the optic disk, the yellow spot and the periphery 
without any pathological changes. 
Status on dismissal on July 3, 1978 was as follows. The acuity of vision 
equals 0.4 with correction (-cyl 2.0.sup.D), 0.8. 
On Sept. 13, 1978 the corneal suture was removed. The accuity of vision 
equals 0.9 with correction (+0.5.sup.D), 1.0. 
The right eye is quiet, the scar on the cornea is scarcely seen. The 
anterior chamber is deep, the aqueous humor is transparent. The pupil is 
round at the centre, 2.5 mm in diameter, reacts to light normally. The 
margins of the opening in the anterior capsule are not seen. An incision 
in the iris is seen at 12 o'clock in the limbus cornease, with the 
fastening element stitched up to the margins thereof. No iridodonesis is 
observed. 
The artificial lens is seen within the zone of the pupil, the anterior and 
posterior surfaces of the lens are clean. The posterior capsule and the 
vitreous body are transparent. The optic disk, the yellow spot and the 
periphery of the fundus oculi show no changes. 
Gonioscopy findings: the anterior chamber angle is wide, the trabecula is 
not pigmented, no adhesions at the corner are observed. 
Electronic tonography findings: P.sub.o =15; C=0.4; F=1.5; P.sub.o /C=37.5. 
The field of vision is normal. A binocular vision takes place. 
The patient keeps working as a car driver and leads an ordinary mode of 
living without any restrictions as to physical work, or the attitude of 
the head and trunk. The observation period lasts 9 months. 
Patient P., male, aged 78, a writer. Admitted to the eye clinic on Dec. 15, 
1976 with a diagnosis of an immature scyphoid cataract on the right eye 
and a primary cataract on the left eye. 
Status on admission: 
The acuity of vision: of the right eye, at the level of photoreception with 
a correct projection; of the left eye, 0.6, the visual acuity fails to be 
improved by correction. 
Right eye--the adnexa oculi remain unchanged, the conjunctiva is quiet; the 
cornea is lustrous and transparent; the anterior chamber is of a medium 
depth, the aqueous humor is transparent; the iris is subatrophic; the 
pupil is round, 2 mm in diameter; opalescence in the lens is mostly 
localized under the posterior capsule. The fundus oculi is not amenable to 
ophthalmoscopic examination. P.sub.o =14; C=0.15; F=0.41; P.sub.o /C=93. 
Autoophthalmoscopy and cobalt test are positive. Gonioscopic examination 
shows the angle of the anterior chamber to be of a medium width. The 
trabecula is moderately pigmented. The refraction of the cornea is 44.5 
dioptres. Echobiometry shows the length of the anteroposterior axis of the 
eye to be 24.1 mm. An artificial crystalline lens with an optical 
refractive power of 61 dioptres (in the air) was custom-made. The left eye 
exhibits but inconsiderable changes in the lens under the posterior 
capsule. 
The operation of the right eye carried out on Dec. 16, 1976 was one of an 
intracapsular implantation of an artificial crystalline lens by the 
aforedescribed procedure. 
Both the operation and the postoperative period were uneventful. 
The clinical coursing of the postoperative period was as follows. 
In the day of operation the patient was allowed to walk and take food 
normally. The treatment instituted: eye drops three times a day, 
corticosteroids, disinfectant and vitamin drops. Administered perorally 
were Butadion (0.15 g). and Dimedrol (0.05 g) in tablet form in a dose of 
one tablet of each drug three times a day. 
Forasmuch as a hypertensive syndrome was observed in the patient in the 
first day after the operation, he was administered Diacarb in a dose of 
0.25 g twice a day for two days, whereupon the intraocular pressure 
returned to normal and has remained normal since then. 
The state of the eye operated upon; 
in the day of the operation--the conjunctiva is hyperemic, the corneal 
epithelium is edematous, descemetities is observed. The edema of the 
corneal epithelium disappeared on the 3rd day, descemetitis on the 4th day 
(the day of dismissal) after the operation. The corneal incision is 
adapted well by a continuous supramid suture (ten noughts). The anterior 
chamber is deep; a gradually attenuated tyndallization was noted in said 
chamber for four days. The pupil is 3.5 mm wide, the incision of the iris 
is seen at the upper edge of the limbus corneae at 12 o'clock, showing the 
fastening element stitched up thereto. The implanted artificial lens is 
seen in the optical section within the zone of the pupil, its surfaces 
being clean. 
Within the following days after the operation (from the 1st till the 4st) 
the hyperemia of the conjunctiva nearly disappeared, as well as the edema 
of the corneal epithelium, while the symptoms of descemetitis almost 
subsided. The pupil is round at the centre, 3.5 mm in diameter; no 
iridodonesis is observed; the margins of the opening in the anterior 
capsule are shown at the very edge of the pupil in some individual spots. 
The posterior capsule is transparent, as well as the vitreous body. The 
optic disk, the yellow spot and the periphery of the fundus oculi exhibit 
no changes. 
Status on dismissal on Dec. 20, 1976: the visual acuity of the right eye 
equals 0.4 with correction -cyl 5.0.sup.D ax 180.degree.. 
Results of a repeated examination on Feb. 14, 1977: 
The visual acuity of the right eye equals 0.2 with correction -3.0.sup.D 
=0.9; on Aug. 1, 1977 the visual acuity of the right eye was found to be 
0.5 with correction -0.75.sup.D cyl-2.0.sup.D ax 95.degree.=1.25. 
Upon an examination carried on Aug. 1, 1977 the following data were 
obtained. 
Right eye is quiet, the scar in the corneal portion of the limbus cornea is 
barely seen. The cornea is lustrous and transparent. The anterior chamber 
is deep, the aqueous humor is transparent. The iris is subatrophic. The 
pupil is round at the centre, 2 mm in diameter. An incision of the iris is 
seen in the limbus corneae at 12 o'clock (only with the upper lid raised), 
showing the fastening element stitched up thereto. The implanted 
artificial lens is seen in the zone of the pupil, its surfaces being 
clean. The posterior capsule is transparent and is spaced somewhat apart 
from the posterior lens surface. The vitreous body is transparent. The 
fundus oculi exhibits the optic disk, the yellow spot and the periphery 
without any pathological changes. 
Gonioscopy findings: the angle of the anterior chamber is wide, the 
trabecula is moderately pigmented, no adhesions at the corner are 
observed. 
Electronic tonography findings: P.sub.o =16; C=0.3; F=1.42; P.sub.o /C=53. 
The field of vision is normal. 
Left eye: the visual acuity decreased to 0.2 and fails to be corrected due 
to an intensified opalescence of the lens. 
The patient continues to work as a writer, goes skiing, visits regularly 
the swimming pool. The observation period 2 years and 3 months.