An intraocular lens and method for implanting the same in the posterior chamber of an eye having a posterior capsule. The lens has a lens support system including anterior supports which allows it to be placed in the anterior chamber of the eye against the iris and posterior supports which extend down into the posterior chamber and capsule for capsular fixation. After capsular fixation has occurred the pupil and iris of the eye is dilated, so that the anterior supports do not engage the iris. Upon reconstriction of the pupil the iris rides back over the anterior supports and over the face of the lens, positioning the lens in the posterior chamber with the lens being mounted in the chamber by the support system.

FIELD OF THE INVENTION 
This invention relates to a method for implanting an artificial intraocular 
lens in the posterior chamber of the eye and a novel lens construction 
including retaining means which allows seating of the lens in the 
posterior chamber. 
DESCRIPTION OF THE PRIOR ART 
When no lens is present in the eye, which is known as the aphakic condition 
of aphakia and is usually the result of intracapsular or extracapsular 
lens extraction, the eye does not have the ability to focus rays of light. 
Therefore, the eye receives a blurred image and vision is impaired. 
The most common solution for providing a focusing mechanism to obviate the 
aphakic condition is to interpose contact lenses or spectacles or a 
combination thereof between the eye and the light entering therein. 
However, both contact lenses and spectacles have drawbacks when used in 
the treatment of aphakia. Neither spectacles nor contact lenses can 
duplicate the natural optical system because they are positioned outside 
of the eye, which results in a shift of the optical center from the vivo 
state. Because the optical center has been shifted, the image received by 
the eye is changed in size. Many aphakic patients who have had their 
cataracts removed are fitted with glasses or spectacles. These extremely 
thick lenses present many more problems than they solve. Immediately upon 
receiving cataract spectacles a patient is confronted with the problem of 
a remarkable increase in the size of familiar objects. Cataract spectacles 
magnify objects by up to 35 percent, so that all objects appear much 
larger than actual size, which may take many weeks for patient adjustment 
to the condition. If only one cataract is removed from a patient, the 
patient must thereafter wear a combination of a one cataract spectacle for 
the operated eye and a regular spectacle for the unoperated eye. Thus the 
patient will find it impossible to fuse the different size images seen by 
each eye into one picture, resulting in double vision. Even when both eyes 
have been operated on and spectacles are provided for both eyes, the 
patient still experiences a partial element of false orientation in that 
everything seems closer than it previously appeared. 
Another problem faced by the wearer of spectacles is that the all straight 
lines of the outside world are transformed into curves, and whenever a 
patient moves his or her eyes the curves seem to squirm, which requires 
the wearer to hold the eyes still and look only through the optical center 
of the cataract lens glass. Thus the wearer must turn his or her head and 
not move the eyes in order to see anything not directly in front of them. 
Furthermore, the wearer is confronted with a ring-like zone within which 
no image appears causing what is called the "jack-in-the-box phenomena" 
where people and objects pop in and out of view as they pop in and out of 
the blind area, thus causing the wearer to have collisions with anything 
interjecting itself into the blind area. In addition to the aforementioned 
problems, spectacles must be taken off for activities such as washing a 
person's face, swimming or sleeping, causing the wearer to fumble in the 
morning until he or she can find their glasses. Another common problem is 
that the wearer often misplaces the spectacles and must resort to 
obtaining a new pair or pairs of spectacles which can be extremely 
expensive and disturbing to cataract patients. Still another problem is 
that cataract spectacles must be accurately centered and adjusted in order 
to see clearly and well. This means that the optical formulation must also 
be available to the wearer so that new glasses can be made. 
Contact lenses are superior to thick cataract spectacles since the wearer 
enjoys good peripheral side vision. The magnification problem does not 
bother contact lens wearers as much as it does cataract spectacle wearers, 
because the contact lenses only magnify in the range of 7 to 10 percent. 
Furthermore, hand to eye coordination of contact lens wearers is better 
than in spectacle wearers, as objects are seen in more normal spatial 
orientation and straight lines are not seen as curves. However, contact 
lenses are very small and fragile, and it is difficult to insert and 
remove them daily, particularly for elderly users or individuals with 
arthritis or coordination problems. In addition allergies and dry eye 
conditions also interfere with contact lens wearing. Furthermore, patients 
who have had a cataract removed only from one eye may have a problem of 
adjusting to two different sized images, as seen by the two eyes causing 
double vision. 
Intraocular lens provide a significant improvement over the previously used 
artificial ocular aids in that once the implantation has been implemented 
patients regain a close approximation of their former visual function. The 
wearers of intraocular lens implants regain full side to side vision and 
problems of magnification and depth perception are practically 
non-existent. Since the intraocular lens are permanently implanted within 
the eye, problems of daily cleaning, insertion and removal, and loss and 
replacement are eliminated. Furthermore, the wearer can enjoy sports such 
as swimming as the lenses remain in the eye and cosmetically there is no 
difference between persons who have intraocular lenses and those persons 
who have had no history of cataracts or eye surgery. 
The most common reason for removal of a lens is the condition of lenticular 
opacity known as a cataract, which occurs primarily in aged persons. 
Cataracts are the leading cause of blindness, and more than 400,000 persons 
in the United States undergo surgery for the removal of diseased lenses in 
their eyes each year. 
The most promising method of sight restoration for cataract patients is the 
intraocular lens. An intraocular lens (hereinafter referred to as an IOL) 
in various parts of the specification is one which is placed inside the 
eye. When the IOL is implanted in substantially the same location formerly 
occupied by the natural lens, relatively normal vision may be restored to 
the patient. Generally lens implantation and cataract surgery takes around 
45 minutes to an hour and with the lens implant the person usually has 
improved vision within a couple of days, and continued improvement over 
several more weeks until the eye is completely healed. 
The desirability of implanting an artificial lens within the eye to obviate 
the condition of aphakia was first proposed by Tardini in 1764. The first 
actual lens implant was carried out by Dr. Harold Ridley in 1949. 
Ridley originally placed this lens in the posterior chamber of the eye 
behind the iris, resting against the ciliary body between the ciliary 
processes and the base of the iris. However, positioning of this lens in 
the posterior chamber was abandoned because of instances of dislocation 
after implantation and failures from glaucoma and the like. 
One of the problems encountered with the early lens implants was the 
tendency for some lens to partially or totally dislocate from the original 
position of insertion. This stimulated many alternate designs to keep the 
IOL centered along the optic axis with positions varying from (1) in front 
of the pupilary space (anterior chamber); (2) within the pupilary space 
(iris plane) or (3) just posterior to the pupilary space (posterior 
chamber). 
Ridley's failure with posterior chamber artificial lenses led him and 
others, such as D. P. Choyce, to turn their attention to IOL's implanted 
in the anterior chamber of the eye between the iris and the cornea. The 
particular lens used had radially protruding feet which accomplished 
positioning of the lens in front of the pupil. These efforts met with 
limited success, primarily because of the problems of irritation of the 
eye by the supporting feet. 
It should be noted that placement of the lens in the anterior chamber is an 
unnatural position. Also, an anterior chamber lens is not positioned 
adjacent to the hyaloid membrane supporting the vitreous humor, and 
instances of forward displacement of the vitreous humor and retinal 
detachment are more likely to occur when anterior chamber lenses are used. 
Binkhorst has developed an iris-clip (four-loop) lens and an irido-capsular 
(two or three-loop) lens. Both lenses comprise a lens of larger diameter 
than the pupil and are placed so that the periphery of the lens engages 
the front of the iris. The iris-clip (four loop) lens is held by two pairs 
of loops which flank the iris and support the lens in front of the pupil. 
In some instances, the iris is sutured to the clips to secure the 
positioning of the lens. The irido capsular (two or three-loop) lens has 
two or three loops which protrude from the back of the lens and extend 
posteriorly behind the iris to engage the capsula of the crystal lens that 
is left inside the eye after extracapsular cataract extraction. Both 
designs of lenses being in the perpupiliary position and having supports 
that extend posteriorly behind the iris, are unsatisfactory because, by 
necessity, it interferes with constriction of the pupil and fixes the size 
of the pupil. 
Lenses which are placed in the anterior chamber come in various 
configurations, and are secured to the iris by various methods are shown 
in U.S. Pat. Nos.: 3,673,616; 3,906,551; 3,922,728; 3,925,825; 3,971,073; 
3,975,779; 3,979,780; 3,986,214; 3,996,627; 4,010,496; 4,056,855; 
4,073,015; 4,077,071; 4,079,470 and 4,087,866. 
Artificial lenses designed for positioning in the posterior chamber are 
described in U.S. Pat. No. 3,711,870 to Deitrick. Deitrick's lens 
comprises a central optical position surrounded by a resilient silicone 
flange shaped to receive and nest against the ciliary body. The lens is 
held in place by suturing the resilient flange to the ciliary body. 
Another lens shown by U.S. Pat. Nos. 3,925,825 and 4,014,049 to Richards 
et al. is designed for implantation in either the anterior or posterior 
chamber of the eye, with the lens supporting (haptic) section of the IOL 
comprising a plurality of flexible spring like members designed to follow 
the margin of the dynamic pupil, while providing longitudinal fixation and 
centration of the lens. The U.S. Pat. Nos. 4,053,953 and 3,866,249 to Flom 
disclose a posterior lens held in place by an insertion necklace in the 
former and a holding ring in the latter. In U.S. Pat. No. 4,041,552 to 
Ganis the lens element is placed in the posterior chamber and supported by 
support on the anterior side of the iris, while a lower arm is sutured to 
the ciliary body and sclera at one side of the iris with another arm 
extending to the opposite side. 
U.S. Pat. No. 3,913,148 to Potthast discloses a lens apparatus inserted in 
the posterior chamber, with a plurality of cantilevered clips, each of 
which is mounted to a central portion which extends outward from the face 
of the lens towards the periphery. The clips are used to secure the iris 
to the front face of the lens when the lens is positioned within the 
posterior chamber of the eye behind the iris. 
Several of the prior art lenses are discussed in an article by D. P. Choyce 
entitled "History of Intraocular Implants" which is printed in Annals of 
Opthalmology, October, 1973. The article also includes a list of 
references from which further information concerning prior art intraocular 
lenses can be obtained. 
SUMMARY OF THE INVENTION 
The present invention pertains to a novel lens design and method for 
implanting an IOL that encompasses the advantages of capsular support and 
fixation, together with the advantages of the posterior chamber position 
of the optical portion of the lens thus including the advantages of 
excellent centration of the lens by having the optic portion of the IOL 
temporarily occupy a pre-pupilary or anterior chamber position allowing 
pupilary constriction to center the entire lens structure. A capsular 
support is where the posterior capsule of the crystalline lens which was 
left in place after extra-capsular surgery supports the support system of 
the lens. Thus the lens is implanted into the eye so that the design 
incorporates the characteristic of centration by pupilary constriction 
while the optic portion of the lens rests in the anterior chamber in the 
pre-pupilary position. After the capsular fixation occurs between the 
posterior loops of the support system in the posterior capsule (usually 
within 4 to 5 days) the pupil is dilated and the optic portion of the IOL 
moves into the posterior chamber as the pupil is reconstricted. 
The optical portion of the IOL is of normal lenticular design with 
posterior loops attached to the design to go into the capsular bag. 
Anteriorly there are attached loops or extension members that hold the 
optic portion of the lens within the anterior chamber for pupilary 
centration until capsular fixation has occured. These anterior loops or 
extensions extend outward and posteriorly so that after capsular fixation 
of the eyewell and pupilar dilation is completed, the pupil and iris 
dilates and moves away from the optical portion by slipping out from under 
the anterior loops or extensions. When the pupil is reconstricted again 
the iris slides up and over the anterior extensions and front surface of 
the IOL moving it to a permanent location within the posterior chamber. 
The invention thus provides a posterior chamber lens which has advantages 
as previously discussed over anterior chamber lenses. The underlying 
principle of the anterior-posterior chamber lens uses the sphinter muscles 
for centration avoiding surgical manipulation such as iris sutures and 
avoiding the ciliary sulcus which has a potential danger for late 
complications. The iris sphinter muscle is used for centration only for a 
short period until capsular fixation is accomplished. The sphinter muscle 
is dismissed from its duty as the lens and the supports are constructed 
with short anterior extensions which extend posteriorly, so as to allow 
the lens to slip from the anterior chamber to the posterior chamber 
through dilation and subsequent constriction of the pupil fixing the lens 
in its final position. The lens is an initial anterior chamber lens and 
its final position is that of a posterior chamber lens. Its two plane 
design prevents contact of the lens with the posterior capsule, and 
creates room for spontaneous absorption of critical cortical material and 
aspiration of cortical material and for incision of a capsular membrane if 
later necessary. Thus it does not force the surgeon to do a primary 
needling because of lack of adequate room for discission. The transition 
of the lens from the anterior chamber to the posterior chamber is achieved 
through a novel design of extension loops or haptics which allow seating 
of the lens through pupilary dilation. The lens is a capsular bag fixated 
lens situated finally in the posterior chamber without iris involvement. 
It supports the iris as the crystalline lens does, avoiding iridodonesis 
and its long term consequences of pigmentary dispersion and corneal 
endotheliel cell loss. 
Thus the anterior-posterior chamber IOL provides normal pupilary mobility, 
lack of pupilary erosion, no pseudo-phakodonesis, very little or no 
iridodonesis, less glare from lens edges and loops and is closer to the 
optical center. The novel lens also provides less aniseikoma with less 
residual refractive error and eliminates iris sutures while combining the 
advantages of capsular fixation and the advantages of anterior chamber or 
prepupilary centration. Esthetically the lens is also much more similar to 
the normal crystaline lens in appearance, so that cosmetic benefits are 
also derived along with the medical benefits. 
The above-mentioned purposes and operations of the invention are more 
readily apparent when read in conjunction with the following description 
of the drawings and the detailed description of the preferred embodiment 
of the present invention.

DETAILED DESCRIPTION OF THE DRAWINGS 
The present invention and more particularly the preferred mode of the 
invention is shown in FIGS. 2 through 8, 18 and 19 and is directed towards 
an IOL 10 and a method for implanting the IOL in an eye 12. 
An eye 12 which has undergone extracapsular surgery is shown in FIGS. 2 and 
18 through 21. The eye 12 shown with an illustrated cornea 14, sclera 16, 
iris 18, pupil 20, ciliary muscle 22, ciliary processes 24 and posterior 
capsule 26 which was left in place after extracapsular surgery. 
The eye 12 is divided into two chambers; an anterior chamber 28 located in 
front of the iris and a posterior chamber 30 located behind the iris. The 
lens 32 is a capsular bag fixated lens and while the preferred embodiment 
discloses the lens 32 as plano-convex in structure, it can under desired 
circumstances be double convex and be provided with spherical, toric or 
aspherical curvatures. The lens is made of a material which is 
biologically inert and is not susceptible to being absorbed by the human 
fluids and capable of being tolerated by the human body when implanted. 
Such materials which can be used are quartz, ophthalmic glass, 
methylmethacrylate resins such as those available under the trade names 
"perspex", "lucite" and "plexi-glass" along with biologically natural, 
chemically pure polymethacrylates or biologically inert polymerised 
materials. Examples of lens glasses which can be used which are chemically 
durable, free of toxicity, harmful radioactivity with low density and 
lightness of weight with a transmission for simulating the optical 
absorption of the human crystal lenses are the various glasses set forth 
in U.S. Pat. No. 3,996,627 which patent is incorporated by reference into 
this application. 
In the preferred embodiment and best mode of the invention posterior loops 
34 are attached to the lens 32 and designed to extend into the capsular 
bag. Positioned anteriorly on the lens and orientated 90.degree. to the 
posterior loops 34 are loops or extension members 36. These loops hold the 
optical portion of the lens within the anterior chamber of the eye for 
pupilary centration until the capsular fixation of the posterior loops 34 
has occurred. These anterior loops or extension members 36 extend outward 
and posteriorly in such a manner as to end in the same general plane as 
the outward extension of the posterior loops. After capsular fixation of 
the eyewell and pupilary dilation is completed the pupil 20 and iris 18 
dilates and moves away from the optical portion of the lens slipping out 
from under the anterior loops 36. When the pupil 20 is constricted again 
the iris 18 slides up and over the anterior loops 36 and the front surface 
of the lens 32 moving it into a permanent location within the posterior 
chamber. The supporting system haptics or loops may be described as being 
formed of "wire" it being understood that the term "wire" used in this 
specification is intended to include resilient strands, strips, or rods of 
biologically inert material, whether such material is metallic or plastic 
and/or whether one or the other is used exclusively throughout the system. 
Acceptable materials which avoid irritation in the body and rejection such 
as platinum, titanium, and extruded polyamide such as nylon or a 
polyolefin such as polypropolene may be used. 
Thus the embodiment of FIGS. 12 through 14 is similarly constructed to the 
preferred embodiment excepting that it uses three anterior loops 136 and 
three posterior loops 134 equidistantly spaced as compared to the two 
pairs of opposing loops of the preferred embodiment. 
In the embodiment shown by FIGS. 9 through 11 the anterior loops are 
replaced by extending rod like members 38 with smoothly rounded termini 
39. If desired the termini may be spherically shaped. These extending 
anterior members 38 extend posteriorly away from the lens 32 toward the 
posterior capsule. 
Yet another embodiment is disclosed in FIGS. 15 through 17 in which a lens 
40 having a convex surface 42 and concave surface 44 is disclosed. The 
lens surface itself takes the place of the anterior clips or loops of the 
preferred embodiment. It should be noted in this embodiment that the 
central midpoint 41 of the lens is positioned so that its rounded 
peripheral edges 43 extend posteriorly away from the central midpoint. 
This lens is provided with a pair of posterior loops 46 which extend 
outward posteriorly in the same manner as the preferred embodiment and 
which serve in the same function as the posterior loops of the preferred 
embodiment. 
In the implantation of the anterior-posterior chamber lens the posterior 
loops 34 and 46 attached to the lens are designed to go into the capsular 
bag 26 with the anterior loops or extensions 36 holding the optical 
portion of the lens within the anterior chamber with pupilary centration 
until capsular fixation has occurred. The feet of the posterior loops dig 
into the capsular bag and are held in place in the bag. Capsular fixation 
occurs between the posterior loops 34 or support system and the capsular 
bag usually within four or five days. The anterior loops or extensions 
extend outward and posteriorly in such a fashion as to end in the same 
general plane or level of the posterior loop, so that after capsular 
fixation of the eyewell the pupil is dilated. Upon pupilary dilation the 
iris dilates and moves away from the optical portion slipping out from 
under the anterior loops. When the pupil is constricted again the iris 18 
now slides up and over the anterior loops 36 and the front surface of the 
intraocular lens, thus moving it to its permanent position within the 
posterior chamber. Thus the anterior and posterior loops act as a spring 
mechanism locking the lens in a fixed position. 
The present invention is used after extracapsular surgery in connection 
with the posterior capsule 26 of the crystalline lens. The new lens 
embodiment encompasses the advantages of capsular support and fixation, 
together with the advantages of posterior chamber positioning of the 
optical portion of the lens 32. After extracapsular surgery the lens is 
placed in the eye for centration by having the optic portion of the IOL 
temporarily occupy a prepupilary or anterior chamber position allowing 
pupilary constriction to center the entire IOL structure. The optic 
portion of the lens is held in the anterior chamber by the anterior loops 
36 which extend out over the iris as shown in FIG. 18. The anterior loops 
36 or extension members 38 extend outward from the lens a shorter distance 
than the posterior loops 34 and are directed posteriorly so that after 
pupilary dilation is accomplished the pupil and iris move away from the 
optical lens portion slipping out from under the anterior loops 36 or 
extension members 38. When the pupil is reconstricted the iris slides up 
and over the anterior loops 36 or extension members 38 and the front 
surface of the lens 32 supporting the iris and moving the lens to a 
permanent location within the posterior chamber as shown in FIG. 19. The 
lens is in effect spring loaded in the eye. 
It will be appreciated that the embodiment shown in FIGS. 15 through 17 
that the curved lens body 42 with its rounded periphery 43 acts in the 
same manner as the anterior loops 36 or extension members 38 of the other 
embodiments. 
While the preferred embodiment of the invention has been disclosed, it is 
understood that the invention is not limited to such an embodiment since 
it may be otherwise embodied in the scope of the appended claims.