# Patent

## Title
Pre-loaded injector for use with intraocular lens

## Abstract

An injector folding and injecting a flexible intraocular lens into the eye of a patient is described. The injector is configured to be loaded with the intraocular lens, and optionally, an aqueous solution, before the injector and lens are sterilized. The injector includes a lens compartment that is configured to prevent leakage of the aqueous fluid from the lens compartment caused by autoclaving/sterilization.

## Background
CROSS-REFERENCES TO RELATED APPLICATIONS
This application claims priority from U.S. Application No. 61/636,512 filed Apr. 20, 2012 incorporated by reference in its entirety.


BACKGROUND
The invention relates to a device and a method of injecting a flexible intraocular lens which is ready to use, that is, ready to be implanted by injections through an incision formed in the wall of a patient's eye.
Flexible intraocular lenses are useful, for example, in a cataract operation in order to restore sight by a surgical procedure, which inserts into the eye such intraocular lens, which replaces the natural lens that has become opaque due to the cataract.
Flexible intraocular lenses are often made of hydrophilic material(s) such as, for example, hydrogel, acrygel or acrylic (the latter term deviating from its normal meaning), which materials are PMMA (polymethylmethacrylate) and/or HEMA (hydroxymethylmethacrylate), hydrated to more than 16%, in particular between 24% and 28%. U.S. Pat. No. 4,787,904 describes various examples of materials that may be used to produce hydrophilic lenses. These lenses need to be kept in a hydrated state for conservation.
Flexible intraocular lenses can also be made from silicone materials, having a higher refractive index than hydrophilic materials, or hydrophobic acrylic materials with low glass transition temperatures. The latter materials are desirable because they typically have a high refractive index and lenses made from them unfold more slowly and more controllably than silicone lenses. U.S. Pat. No. 7,157,538 describes such a high refractive index, acrylic material used for making hydrophobic flexible intraocular lenses.
Flexible intraocular lenses have the advantage of being able to be folded, allowing them to pass through incisions in the eye of small dimensions. However, the problem arising with these flexible lenses is precisely that of folding and manipulating them at the moment of the surgical act. U.S. Pat. No. 4,787,904 proposes to conserve a hydrophilic lens in a folded state in the injection device while being immersed in a conserving solution, the whole assembly being contained in a flexible packaging pocket. However, this method may not be used in practice, since a lens which has remained folded for a long period may retain a shape memory of the folded state and therefore does not regain its unfolded, functional shape after implantation.
As a result, hydrophilic lenses up to now have been conserved flat in sterilized rigid containers of conserving solution. At the moment of the surgical act, the surgeon removes the lens using a pincer, folds it (optionally with the aid of a folding device) or places it in a folding cartridge or in an injector and injects it into the eye. These manipulations are relatively complex and delicate, increasing the risk of contamination and damage to the lens.
U.S. Pat. No. 6,386,357 discloses a soft intraocular lens-folding device comprising a base member with a tapered slide groove portion, and a movable member comprising an elastically bendable pair of legs and a common base connecting the pair of legs. A soft intraocular lens is introduced in the lens-receiving portion of the movable member, the lens being clamped by wall portions. The lens is folded by moving the movable member into the groove portion in the base member, forcing the legs of the movable member to be drawn near to one another. This document does not disclose any means for injecting the folded lens.
U.S. Patent Publication No. 2005182419 discloses an injector for an intraocular lens comprising an injector housing with an intraocular lens disposed in the housing. The injector further comprises a lens carrier, which, in response to an actuator, engages and moves the lens within a narrowing injection nozzle in order to fold the lens. A plunger is then used to advance the folded lens and inject it into a patient's eye. Here, folding and injection of the lens cannot be achieved by a single, continuous movement of a plunger, adding complexity to the surgical procedure.
What has been needed, and heretofore unavailable, is an injector configured to accept an intraocular lens, the injector also configured to allow the lens and injector to be sterilized as one unit. In this manner, the lens is preloaded into the injector, the injector may be filled with a suitable fluid, and then subjected to a sterilization process. The injector should be able to withstand the sterilization process without leaking any fluid from a lens containing portion of the injector, thus ensuring that the lens stays immersed in the fluid once the sterilization process is completed and the injector/lens assembly is packaged and stored. In this way, the injector/lens assembly is ready for use by a surgeon without the need to hydrate or rehydrate the intraocular lens, nor load the lens into the injector, prior to surgery. The present invention fulfills these, and other needs.
SUMMARY OF THE INVENTION
In its broadest aspect, the present invention includes an injector having a lens compartment configured to hold an intraocular lens and to provide for injection of the lens into the eye of a patient. The lens compartment is configured to hold both the lens and an aqueous fluid designed to wet the lens in a sealed condition so that the injector, lens and fluid may be sterilized, preferably by autoclaving.
In another aspect, the present invention includes an injector for folding and injecting a flexible intraocular lens into the eye of a patient, the injector comprising: an assembly of an injection nozzle, a lens compartment that holds an unfolded flexible intraocular lens and is in communication with the injection nozzle, the lens compartment being configured to be filled with a fluid, loaded with an intraocular lens, and then sealed to prevent leakage of the fluid, an injector body communicating with the lens compartment and a plunger that is inserted in the free end of the injector body, and wherein the lens compartment and injector body comprise a mechanism whereby the lens is first folded by forces compressing the lens in a non-axial direction in response to an axial movement of the plunger over a first distance and is subsequently ejected from the injector through the injection nozzle in response to an axial movement of the plunger over a second distance. In still another aspect, the lens compartment is integrated in the injector body.
In another aspect, the lens compartment includes an upper portion and a lower portion, the lower portion having a sealing surface and a plurality of posts extending upwards disposed on the sealing surface, and the upper portion has a sealing surface and a plurality of holes disposed in the sealing surface of the upper portion configured to receive the pins disposed on the sealing surface of the lower portion.
In still another aspect, the sealing surface of the upper portion includes a lip located adjacent thereto, and the sealing surface of the lower portion includes a lip located adjacent thereto, the lips of the upper portion and lower portions configured to be engaged by a clamp configured to hold the upper and lower portions together in a sealed relationship. In an additional aspect, the injector further includes an octagonal finger grip.
In yet another aspect, the invention includes an injector for folding and injecting into the eye of a patient a deformable intraocular lens, the injector comprising: an injection nozzle assembly; an injector body having a space for holding an unfolded deformable intraocular lens, the injector body in communication with the injection nozzle assembly; a flange mounted on the injector body at a position proximal to the space for holding the unfolded deformable intraocular lens and the injection nozzle assembly, the flange having a plurality of seal holes disposed adjacent an outer edge of the flange; a cap configured to be mounted to the flange and having a plurality of seal posts configured to engage the plurality of seal holes in a one-to-one arrangement, the cap having an interior space defining a cavity that, when the cap is mounted to the flange, defines a reservoir for holding a fluid to bath the injection nozzle assembly, the space for holding the unfolded deformable intraocular lens, and an unfolded deformable intraocular space disposed within that space; and a flexible clamp configured to engage the flange and the cap in such a manner as to removably fix the cap to the flange in a fluid tight configuration. In an alternative aspect, the cap has a clear portion through which an intraocular lens contained therein may be viewed.
In another aspect, the invention further comprises an intraocular lens mounted in the space for holding the unfolded deformable intraocular lens of the injector in an undeformed state. In another aspect, an octagonal finger grip is disposed on the injector body. In still another alternative aspect, the space for holding the unfolded deformable intraocular lens is viewable through a window disposed on the injector body.
In a further aspect, the invention includes a method for assembling as injector as described above, comprising: inserting a plunger into the injector body through an end piece of the injector body; inserting a plunger guide within the injector body; disposing an unfolded intraocular lens within an internal support cavity of a lens support within the space for holding the unfolded deformable intraocular lens, and mounting the lens support on the plunger guide; assembling the injector body and the cap by aligning the plurality of seal holes and seal posts in a one to one arrangement; introducing a sufficient volume of an aqueous solution though an opening in the reservoir to keep the lens wetted; fixing a clamp onto the flange and the cap to hold the cap onto the flange in a sealed relationship; packaging the injector in a sealable foil packaging; and sterilizing the packaged injector. In one alternative aspect, the aqueous solution is a saline solution.
Other features and advantages of the invention will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, which illustrate, by way of example, the features of the invention.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective side view of an improved injector having an end cap, an injector body, a plunger, according to an embodiment of the invention.
FIG. 2 is a partial view of the injector of FIG. 1 where the end cap has been removed, showing a support guide.
FIG. 3 is another partial view of the injector where end cap, injector body, and support guide have been removed, showing a lens support, a plunger guide and a plunger.
FIG. 4 depicts an isolated view of a plunger and a lens support.
FIG. 5 is an isolated view of a lens support with wedge plate, a pair of folding members and an injection nozzle.
FIG. 6 is another isolated view of the lens support with the pair of folding members being pivotally mounted.
FIG. 7A is a perspective view of the lens support mounted within the support guide seen from the plunger side, according to an embodiment of the invention.
FIG. 7B is a sectional view taken along the line C-C of FIG. 7A.
FIG. 8 is a sectional view illustrating an intraocular lens disposed within the lens support, according to an embodiment of the invention.
FIG. 9 illustrates the intraocular lens being completely folded within the lens support, according to an embodiment of the invention.
FIG. 10 illustrates a view of the injector of an embodiment of the invention, viewed from its proximal end showing details modifications to the proximal end to enhance retention of fluid within the injector.
FIG. 11 is a side view of an end cap of embodiment of FIG. 10.
FIG. 12 is a top view of an embodiment of a clamp used to hold the end cap of FIG. 11 onto the proximal end of the injector of FIG. 10.
FIG. 13 is a partial view of the clamp of FIG. 12 taken along the line D-D showing the “U shaped” construction of the clamp.
FIG. 14 is a partial view of the clamp of FIG. 12 taken along the line E-E showing the details of a distal end portion of one side of the claim configured to engage a pin of the embodiment of FIG. 11.
FIG. 15 is a top perspective view of an embodiment of an end cap, looking into the end cap from its proximal end.



DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to the drawings in detail, in which like reference numerals indicate like or corresponding elements among the several figures, there is shown in FIG. 1 an embodiment of a preloaded injector. The injector 1 comprises a plunger 2, extending along a longitudinal axis corresponding to the injection axis A, within a hollow cylindrical injector body 3. In the example of FIGS. 1 and 2, the injector body 3 includes an octagonal shaped finger tab 4 which is intended to provide a holding point to facilitate operation of the plunger 2 during usage of the injector to inject a deformable intraocular lens into an eye of a patient. Different configurations of the injector body 3 and finger tab 4 are also possible as long as the injector body 3 is provided with means against which the fingers of a user can bear.
The injector body 3 is closed at its proximal end by an end piece 6 comprising an opening 7 in which the plunger 2 is introduced and guided. The end piece 6 has a sleeve portion 8 arranged to be fixed by snap-fit into the proximal end of the injector body 3. A first toric joint seal 9 (FIG. 3) is accommodated in the end piece 6 in order to fluidly seal the end piece 6 on the injector body 3 and the opening 7 with the plunger 2 passing through it. The 9 may be formed of any flexible elastomeric material.
At its distal end, or at the end opposite to the end piece 6, the injector body 3 comprises an oval-shaped flange portion 10 extending essentially perpendicular to the injection axis A. Flange 10 comprises a collar portion 12 (FIG. 2), extending in the axial direction from part 10. Other configurations of the flange 10 are also possible. For example, flange 10 can have a circular, an elliptical or a rectangular shape and can be supported on the injector body 3 with support elements (not shown).
In one embodiment of the invention, the injector body 3 comprises a first portion 16 having a first internal diameter and extending from the flange 10 to a second portion 17 having a second internal diameter that is smaller than the first internal diameter (FIG. 2). The injector body 3 also comprises a third portion 18, having an internal smaller than the one of the second portion 17, and extending between the second portion 17 and the end piece 6.
In FIG. 1, the injector 1 comprises an end cap 13 configured to fit over the collar portion 12 and engage with flange 10 to hold proximal end of the injector in a sealed arrangement, allowing for fluid to be introduced into a cavity of the end cap 13 to form a fluid reservoir and to maintain the fluid within the reservoir formed by the cooperation of the end cap and flange 10. A second toric joint seal 11 (FIG. 2) placed around the outer wall of the collar portion 12 insures the fluid tightness between the end cap 13 and flange 10.
Referring now to FIGS. 10 and 11, details of an embodiment of the flange 10 and end cap 13 are shown that improve the ability to maintain fluid within the reservoir formed by flange 10 and end cap 13, even when the injector assembly is sterilized using an autoclave. As one skilled in the art will understand, when the injector assembly is steam sterilized, pressure may build up within the reservoir that causes fluid to leak from the reservoir, either during the sterilization process, or afterwards when the injector is stored. The inventors have observed that reservoir integrity and fluid retention may be improved by incorporating seal posts 500 (FIG. 11) disposed around a top edge 505 of the cap 13 configured to be received by and engage with seal holes or indents 502 disposed on the distal side of flange 10 (FIG. 10). Seal holes 502 may extend completely through flange 10, or they may be formed only as indents of partial holes disposed on the distal side of flange 10, having a depth sufficient to receive the seal posts 500 such that the distal side of flange 10 mates with the top edge of cap 13 to form a fluid seal.
Referring now to FIG. 12, there is shown a locking clamp 600 configured to cooperate with flange 10 and the top edge 505 of cap 13. FIG. 13 is a sectional view taken along line D-D of FIG. 12 showing the arrangement of one embodiment of locking clamp 600. Clamp 600 is formed to have an approximate “C” shape that engages edges of flange 10 and top edge 505 of the cap 13. To accomplish this, clamp 600 has an upper lip 615 and a lower lip 620 connected by a web 610, forming a “U” shaped channel. The spacing between upper lip 615 and lower lip 620 is configured to accept an edge of flange 10 and the top edge 505 of cap 13 between the upper and lower lips.
Referring again to FIGS. 11 and 12, cap 13 includes a tab 510 that includes one or more posts or pins 515 configured to engage ends 625 of clamp 600. In one embodiment, each end 625 of clamp 600 is held in place by a post 515 mounted on a top side of the top edge 505 of cap 13. Those skilled in the art will understand that other embodiments are possible, such as an embodiment where the post 515 is replaced by a tab or other structure capable of holding end 625 of clamp 600 in place.
FIG. 14 is a partial view taken along line E-E of FIG. 12 that shows how each of the proximal ends 625 of clamp 600 are configured to engage pins 515 of cap 13. As shown, proximal ends 625 are formed in a tab shape that is defined by partially cutting away lower edge 620 and a portion of web 610. This construction provides a relief that allows the end 625 to pass over the top side of flange 10 and engage pin 515. When both ends 625 engage both pins 515, the clamp is securely held in place, and securely holds flange 10 and cap 13 together. In this manner, the joint between the injector and the cap is made secure and is capable of withstanding pressure changes within the cap during sterilization that could lead to fluid loss from the reservoir within the cap.
Clamp 600 may be made of any material that is suitable for use with the injector system such that it is able to withstand autoclaving or methods of sterilization. Clamp 600 must also be sufficiently flexible to allow placement of clamp 600 around the flange and cap without breakage. In the embodiment shown in FIG. 12, clamp 600 includes hinge 605 formed between the two arms of the clamp. Hinge 605 allows the arms of the clamp to be opened for placement about the edges of the flange and cap. Hinge 605 may be an actual hinge arrangement, or the clamp may be formed from a material that can be repeatedly articulated, with hinge 605 being formed from a shape that facilitates such articulation in a “living hinge” arrangement well known in the art.
Referring again the FIGS. 1-3, the injector 1 also comprises a lens compartment consisting of a support guide 100 and a lens support 200 (FIG. 3). FIG. 2 shows the injector 1 where the end cap 13 has been removed from the injector body 3, showing the support guide 100 fixed on the flange 10. The support guide 100 is an open hollow structure having side walls defining a tapered internal shape, a narrower, truncated support guide distal end 101, and a wider proximal end 102 having an oval section, or any section conformal with the internal periphery of the collar portion 12. The support guide 100 can be mounted and fixed on the flange 10 by press-fitting its proximal end 102 within the internal periphery of the 5 collar portion 12.
As shown in FIG. 2, the support guide 100 contains a guiding pin 103 fitted in a corresponding indentation 15 in the collar portion 12, insuring a better positioning and fixation of the support guide 100 on the flange 10. Holes 107 are provided in the support guide 100 in order to allow for the introduction of a viscoelastic solution within the lens support 200 as will be 10 explained below. Holes 107 are accessible through indentations 15 let into the collar portion 12.
Support guide 100 also includes an inspection window 108 disposed on a surface of support guide 100. Inspection window 108 provides for viewing the positioning and state of an intraocular lens 400 disposed within an internal support cavity 208 (FIG. 8) when the intraocular lens is loaded into the injector.
In one embodiment of the invention, the injector body 3 is fabricated in one piece with an injection plastic molding process. The material used for the injector body and cap 13 should be sterilizable using various processes, include steam sterilization. The material used for cap 13 may be opaque or clear. Alternatively, cap 13 may be formed in such a manner that a portion of the cap is opaque and a portion of the cap is clear, forming a window, allowing visualization of the portion of the injector and the lens mounted in the injector, as well as the level of any fluid within the reservoir formed by flange 10 and cap 13, that is placed within cap 13.
FIG. 3 depicts another partial view of the injector 1 from which the injector body 3, the end cap 13, and the support guide 100, have been removed. In this view, the plunger 2 extending between the end piece 6, with its toric joint seal 9, and the lens support 200, placed underneath the support guide 100. Also visible in FIG. 3 is a plunger guide 300, disposed 20 within the injector body 3 and extending between the internal wall of the injector body 3 and the plunger 2. The plunger guide 300 comprises a pair of flexible legs 301 of hollow semi-oval shape, the legs 301 being connected on the distal side of the plunger guide 300, or on the side of the lens support 200, by a connecting portion 302 integrally formed with the legs 301. The legs 301 each 25 comprise a protruding stop piece 303 at their respective free ends.
In FIG. 3, the legs 301 are shown in an unstressed open position allowing the plunger 2 to move axially within the plunger guide 300. The plunger guide 300 also comprises two opposite ribs 304, extending along its whole length. The ribs 304 are guided in corresponding grooves (not shown) provided 30 in the internal wall of the injector body 3, when the plunger guide 300 is inserted within the injector body 3, and used to orient radially and guide axially the plunger guide 300 within the injector body 3.
FIG. 4 shows a view of the plunger 2 with the lens support 200 disposed at the distal end 22 of the plunger 2. The plunger 2 preferably has an elliptical or ovoid section but can have any other suitable section shape such as a circular, square or rectangular section. The plunger 2 also comprises clipping means. In the embodiment shown in FIG. 4, the clipping means are two snap hooks 19 that are oppositely disposed on the plunger 2, each at a position corresponding to that one of a stop piece 303 of the plunger guide 300.
The lens support 200 according to one embodiment of the invention is represented in the perspective views of FIGS. 5 and 6. The lens support 200 comprises a pair of parallel wedge plates 201 of tapered shape and connected, at their narrow extremity, to an injection nozzle 202. The injection nozzle 202 is 15 terminated by a nozzle distal end 203 destined to be introduced in an incision formed in the wall of a patient's eye during lens replacement surgery. The interior of the injection nozzle 202 forms a nozzle canal 204. The lens support 200 also comprises a folding device for folding the lens 400 in a direction essentially perpendicular to the injector axis in response to axial movement of the plunger 2, as exemplified by the depictions of FIGS. 8 and 9. In the example of FIGS. 5 and 6, the folding device is a pair of folding members 205 being fixed by their distal extremity, which is the extremity on the side of the injection nozzle 202, to the external wall of the injection nozzle 202 with a flexible link 206. The folding members 205 comprise a notch 207 at their distal 25 extremity. The pair of folding members 205 can be pivotally mounted by abutting their respective notches 207 against edges of the injection nozzle 202, as shown in FIG. 6. The spacing between the two wedge plates 201 allows the folding members 205 to pivot within the two plates 201 while being guided laterally by the plates 201. When the two folding members 205 are in an open position as shown in FIG. 6, the two wedge plates 201 and the folding members 205 delimit an internal support cavity 208.
The wedges plates 201 also comprise a tail-shaped part 209, extending along the plunger 2 and within the plunger guide 300 as shown in FIG. 3. The internal surface of the tail-shaped part 209 forms a groove 210 extending along the injection axis A on the internal surface of the wedge plates 201, 5 forming an injection canal that extends the nozzle canal 204 of the injection nozzle 202. Two ribs 211 extend along the injection axis A, on the tail-shaped part 209 and the two opposite external surfaces of the wedge plates 201 of the lens support 200.
FIGS. 7A and 7B depict a view of the support guide 100 according to an embodiment of the invention. In FIG. 7A, the support guide 100 is seen from the plunger side, and a section view along the line C-C of FIG. 7A is represented in FIG. 7B. In FIG. 7B, the lens support 200 is also shown with pivoted folding members 205.
The support guide 100 comprises two internal lateral sloped ridges 106, formed within the internal surface of the support guide 100 and sloping toward one another from the support guide proximal end 102 to the support guide distal end 101 of the support guide 100. These sloped ridges 106 are destined to cooperate with the folding members 205 as will be explained below.
In the example of FIGS. 7A and 7B, the internal surface of the support guide 100 also comprises two guiding slots 104 extending along both sides of the support guide 100, and adapted to guide laterally the movement of the lens support 200 within the support guide 100 along the injection axis A. The two ribs 211 press against two parallel guiding faces 105, extending along the injection axis A and oppositely disposed on the internal upper and lower surfaces of the support guide 100, in order to laterally guide the lens support 200 advancing within the support guide 100. Alternatively, the two ribs 211 can also press against two parallel guide ribs (not shown), extending along the injection axis A and oppositely disposed on the internal upper and lower surfaces of the support guide 100.
Other configurations of the support guide 100 are also possible. For example, the guiding slots 104 can be replaced by a pair of ribs in order to guide laterally the movement of the lens support 200 within the support guide 100 along the injection axis A.
The lens injectors of the present invention and their various parts may fabricated from different types of plastic materials. For example, the injector body may be produced from polycarbonate (PC), polyetherimide (PEI) or polysulfone (PSU), the end cap from PC, PEI or polyamide (PA), the plunger from PC, PEI or PSU, the support guide from PP, PC, polybutylene-terephtalate (PBT) or polyoxymethylene (PaM), the lens support from PaM, PP, BC, PA, PEI or polyethylene-terephtalate (PET), the plunger guide from PA, PBT or polypropylene, the plug from silicone or a vulcanized thermoplastic material, and the toric joints from silicone.
When assembling the injector 1, the end piece 6 and the toric joint seal 9 are first disposed on the proximal end of the plunger 2. Here, the plunger 2 is inserted into the end piece 6 through the opening 7. The plunger 2 is then inserted into the injector body 3. The two snap hooks 19 of the plunger 2 are arranged such as to be able to pass through the third portion 18 of the injector body 3, and abut against the distal end of portion 18 once the hooks 19 have passed this portion 18, preventing the plunger 2 from moving backward. Preferably, the end piece 6 is not yet clipped on the proximal end of the injector body 3.
In a preferred embodiment of the injector of the invention, a flexible 25 plug 20 is subsequently mounted on the distal end of plunger 22. The plug 20 is preferably made from a soft and flexible material, in order to avoid scratching of the lens 400 during the injection operation. Here, the distal end of the plunger 2 can comprise a forked distal end 22, as shown in FIG. 4, allowing the flexible plug 20 to extend at least partially in between the two teeth of the distal end 22. Other configurations of the distal end 22, that abuts the plug 20, are also possible. It is noted that plug 20 may be added to the plunger end 22 at a later stage, but prior to the mounting of the lens support 200 on the plunger guide 300.
The plunger guide 300 is next mounted within the injector body 3. The two opposite ribs 304 of the plunger guide 300 are guided within the corresponding grooves of the injector body 3 allowing the plunger guide 300 to be introduced into the desired angular position within the injector body 3. When the plunger guide 300 reaches its full rear position, it is forced into its closed position, the clipping means of the plunger 2, here the two snap hooks 19, are able to engage on the distal edge of the stop pieces 303, reversibly connecting the plunger guide 300 and the plunger 2.
The respective internal diameters of the portions 16, 17, 18 are such as to allow the plunger guide 300 to be introduced within the first and second portions but not within the third portion 18. The plunger guide 300 introduced within the injector body 3 from the flange 10 side thus abuts against the end of 15 the second portion 17, adjacent to the third portion 18. In this initial position, the plunger guide 300 extends along the first and second portions 16, 17. The internal diameter of the second portion 17 is such as to force the two opposite stop pieces 303 of the legs 301 to come in contact with the two snap hooks 19, the plunger guide 300 being thus in a closed position. When, in response to a forward movement of the plunger, the plunger guide is advanced out of the second portion 17 and into the first portion 16, the plunger guide 300 is able to regain its unstressed open position.
Other configurations of the injector body 3 are also possible, as long as they provide a configuration that enables the plunger guide 300 to be either in a closed position or in an unstressed open position, depending on the axial position of the plunger guide 300 within the injector body 3. For example, the injector body 3 can have a uniform internal diameter along its whole length but comprise internal ribs distributed around its internal wall, the ribs having a height that varies between sections along the injector body 3.
An intraocular lens 400 is then disposed unfolded between the two wedge plates 201, within the internal support cavity 208 (FIGS. 6 and 8). Preferably, the lens 400 is disposed within the internal support cavity 208 with the two haptics 401 of the lens being oriented along the injection axis A, as shown in FIG. 8.
The lens support 200 containing the lens 400 is then mounted on the plunger guide 300 by inserting the tail-shaped part 209 within the connecting portion 302 of the plunger guide 300 (FIGS. 3 and 6). In this position, the two folding members 205 are prevented from pivoting on the intraocular lens 400 by abutting against two protrusions 23 located on the flange 10 of the injector body 3 (FIG. 8). Also shown in FIG. 8 are two protruding members 21 arranged to maintain the unfolded lens 400 within the lens support 200 in its unfolded orientation as described above, until the lens 400 is folded and ejected. The protruding members 21 do not prevent the pivoting of the two folding members 205.
The support guide 100 is then fixed on flange 10 of the injector body 3 and the end cap 13 is placed over the injector, aligning seal holes 502 (FIG. 10) with seal posts or pins 500 (FIG. 11) and fastened to flange 10 using clamp 600 (FIG. 12) after placing the second toric joint seal 11 around the external periphery of the collar portion 12 (FIGS. 1 and 2). The second toric joint seal 11 could also be placed at any other injector assembly steps, before the step of mating end cap 13 with the flange 10, described below.
In the case of a flexible hydrophilic intraocular lens, the end cap 13 and the injector body 3 are filled with an aqueous solution or fluid such as a saline solution, distilled water, or any other aqueous solution adequate for keeping the intraocular lens 400 wet. The aqueous solution may be introduced through filling openings, in the proximal end of the injector body 3 by means of a syringe.
The aqueous solution fills at least partly the volume enclosed by the end cap 13, lens support 200 and injector body 3. In the case a flexible hydrophobic intraocular lens is used, there is no need for a bathing solution or fluid such as saline and the step of filling the injector body 3 and the end cap 13 with an aqueous 30 solution may be omitted.
When the end cap 13 is fixed on the injector body 3, the lens support 200 abuts against the end cap 13 and the plunger 2 cannot be depressed.
In a preferred embodiment of the invention shown in see FIG. 15, end cap 13 comprises a central hollow tube 24 extending along the injection axis A toward the injector body 3. When the end cap 13 is fixed on the injector body 3, the distal end 215 of both opposite support ribs 211 of the lens support 200 abuts against the proximal end 25 of the central tube 24. In this configuration, the plunger 2 cannot be moved backward due to the snap hooks 19 abutting against the distal end of portion 18, as described above. Consequently, any false manipulation of the plunger 2 prior to the injection operation is avoided.
After fixing the end cap 13, the toric joint seal 9 is placed on a groove 26 on the proximal end of the injector body 3 (FIG. 9) and the end piece 6 is clipped on said proximal end, making the interior of the injector body sealed. The injector 1 is then ready to be packaged into a sealable flexible packaging (not)) such as a sleeve, pouch or blister, or any other packaging. After the packaging is sealed, the packaged injector 1 is subjected to sterilization. A preferred method of sterilization is steam sterilization (autoclaving). In one alternative embodiment, the sleeve or pouch may be formed from a suitable foil material.
Prior to the injection operation, the injector is separated from its packaging, clamp 600 is removed and the end cap 13 is separated and removed from the flange 10, causing the aqueous solution to drain from the injector body 3 and the lens support 200. In order to keep the lens 400 and lens support 200 lubricated during the injection operation, a viscoelastic solution such as a solution containing hyaluronic acid, chondroitin sulfate or a cellulose derivative such as hydroxypropylmethylcellulose (HPMC) can be introduced within the internal support cavity 208 through holes 212 provided in the wedge plates 205 and the corresponding holes 107 of the support guide 100, for example, by using a syringe. Alternatively or in addition, the viscoelastic solution can also be introduced through the nozzle distal end 203 of the injection nozzle 202. The holes 107 and 212, and the nozzle distal end 203 also increase the fluidic communication within the end cap 13, facilitating the penetration of aqueous wetting solution into the lens support 200.
During an injection operation, the plunger 2 is depressed causing the plunger guide 300 to move forward over a first distance, advancing the lens support 200 within the support guide 100 along the injection axis A. During the advance of the lens support 200, the sloped ridges 106 of the support guide 100 force the pair of folding members 205 to pivot toward the injection axis A, drawing them near to one another until they become essentially parallel to the injection axis A, transforming the internal support cavity 208 into an injection canal 213 that extends along the folded folding members 205 and into the nozzle canal 204 of the injection nozzle 202. The lens support 200 advances in the support guide 100 until it abuts against the support guide 100 and cannot advance further.
Alternatively, the advance of the lens support 200 within the support guide 100, the folding members 205 of the lens support 200 may interact with the internal tapered side walls, forcing the folding members 205 to pivot inward and fold the intraocular lens in a direction essentially perpendicular to the injection axis A.
The above operation causes the intraocular lens 400 to fold, the lens 400 being folded or rolled in a direction essentially perpendicular to the injection axis A as shown in FIG. 7B, when completely folded. Consequently, the folded lens 400 is ready to be advanced axially into the nozzle canal 204.
In one embodiment of the invention, each folding member 205 comprises a protruding element 214. When the lens support 200 advances within the support guide 100, the sloped ridges 106 press against the protruding elements 214, and pivots the pair of folding members 205 toward the injection axis A, as described above. The protruding elements 214 can advantageously enhance the angular distance the folding members 205 will travel within the lens support 200 during the forward motion of the lens support within the support guide 100. Moreover, the use of protruding elements 214 can also reduce the friction during the advancement of the lens support 200 within the support guide 100, compared to a contact made along the whole folding member 205.
When the plunger 2 has moved over the first distance and the lens support 200 reached its abutting position within the support guide 100, the plunger guide 300 has moved completely outside the second portion 17 and extends only within the first portion 16 of the injector body 3 and within the support guide 100. It is noted that once plunger guide 300 has moved outside of second portion 17, it cannot be returned to its initial position within portion 17, thereby preventing an unfolding of the folded lens as a consequence of an accidental retraction of plunger 2. The diameter of the first portion 16 is large enough to allow the two legs 301 of the plunger guide 300 to regain their unstressed position, in which the two legs 301 are slightly bent apart, enabling the plunger guide 300 to be detached from the plunger 2, allowing the plunger 2 to move freely within the plunger guide 300 and advance within it.
When operator pressure continues to be applied, the plunger 2 and plug 20 advance over a second distance and propel the folded lens 400 along the injection canal 213, and outside the nozzle distal end 203, enabling the lens 400 to be injected into the patient's eye (FIG. 9). The flexible plug 20 is able to follow conformably the varying dimensions of the internal support cavity 208 formed by the two folding members 205 and the nozzle canal 204, avoiding the necessity of requiring accurate dimensions for the different parts forming the compressed support cavity 208 and the nozzle canal 204.
In an exemplary embodiment of the invention, the lens support 200 is able to advance in the support guide 100 over a distance of about 15 mm, this distance corresponding to the length of the second portion 17 of the injector body 3. Here, the total length formed by the first and second portions 16, 17 corresponds essentially to the length of the plunger guide 300.
In one embodiment of the invention, the lens support 200, comprising the two wedge plates 201, the injection nozzle 202, the two folding, members 205 and links 206, is fabricated in one piece by an injection plastic molding process.
While several particular forms of the invention have been illustrated and described, it will be apparent that various modifications can be made without departing from the spirit and scope of the invention.

## Claims

1. An injector for folding and injecting into the eye of a patient a deformable intraocular lens, the injector comprising:
an injection nozzle assembly;
an injector body having a space for holding an unfolded deformable intraocular lens, the injector body in communication with the injection nozzle assembly;
a flange mounted on the injector body at a position proximal to the space for holding the unfolded deformable intraocular lens and the injection nozzle assembly, the flange having a plurality of seal holes disposed adjacent an outer edge of the flange;
a cap configured to be mounted to the flange and having a plurality of seal posts configured to engage the plurality of seal holes in a one-to-one arrangement, the cap having an interior space defining a cavity that, when the cap is mounted to the flange, defines a reservoir for holding a fluid to bath the injection nozzle assembly, the space for holding the unfolded deformable intraocular lens, and an unfolded deformable intraocular space disposed within that space; and
a flexible clamp having an upper lip and a lower lip connected by a web to form a U-shaped channel, the flexible clamp configured to circumferentially engage an edge of the flange and a top edge of the cap in such a manner as to removably fix the cap to the flange in a fluid tight configuration.

2. The injector of claim 1, wherein the cap has a clear portion through which an intraocular lens contained therein may be viewed.

3. The injector of claim 1, further comprising an intraocular lens mounted in the space for holding the unfolded deformable intraocular lens of the injector in an undeformed state.

4. The injector of claim 1, further including an octagonal finger grip disposed on the injector body.

5. The injector of claim 1, wherein the space for holding the unfolded deformable intraocular lens is viewable through a window disposed on the injector body.

6. The injector of claim 1, wherein the flexible clamp has two arms, the two arms each having a first end and a second end, the first ends of the two arms being joined by a hinge.

7. The injector of claim 6, wherein the cap includes two pins disposed on one side of the cap at a top side of a top edge of the cap, configured to engage each of the second ends of the two arms of the flexible clamp to hold the second ends in a locked state.