Patent Abstract:
Intraocular devices for use in and attached to the natural lens capsule of an eye are provided. The lens capsule may be maintained in a configuration to avoid post-operative changes that are deleterious to vision. Single or dual optic systems are provided, which may be accommodating. Combinations of devices to obtain dual optic systems are disclosed.

Full Description:
This is a divisional application of U.S. patent application Ser. No. 10/927,743 filed on Aug. 27, 2004. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention pertains to apparatus and method for supplying an intra-ocular lens (IOL) to an eye, which may be an accommodating lens, and providing other benefits in treatment of the natural lens of an eye. More particularly, a structure adapted to be placed in a human lens capsule along with one or two lens optics is supplied, along with methods of using. 
     2. Description of Related Art 
     A young human eye has a natural “accommodation” ability, which is the ability to focus on both near and far objects. Contraction and relaxation of the ciliary muscle provides the eye with this ability. Ciliary muscle action shapes the natural crystalline lens in the eye to the appropriate optical configuration for focusing light rays entering the eye on the retina. Because of physiological changes with age, the human eye often loses this natural accommodation ability and develops a condition called “presbyopia.” Furthermore, the natural crystalline lens often develops a cataract, which is an opaque region of the lens. This condition leads to widespread application of techniques to remove the natural crystalline lens. Often a conventional intra-ocular lens (IOL) is then placed in the eye. The conventional (monofocal) IOL has very limited, if any, accommodating ability. The wearer or user of the conventional IOL then may use corrective spectacles as a useful aid in vision. Multi-focal IOL&#39;s without accommodating movement have been used to provide near and far vision correction. 
     A variety of attempts have been made to provide IOL&#39;s with accommodating movement in the eye. One such device is the CRYSTALENS, which was approved for use in the United States in November, 2003. (Another accommodating lens has been approved for use in Europe.) The CRYSTALENS has a single optic attached to hinged haptics. The optic is vaulted in the posterior position against the posterior capsule. Operation of the ciliary muscle increases the pressure in the vitreous humor, moving the optic in an anterior direction, thereby increasing the power of the optic. Relaxation of the ciliary muscle allows the lens to move backward. The forward and backward motion simulates natural lens accommodation. The amount of accommodation is limited, however. The CRYSTALENS normally includes a relatively small optic zone to enhance optic movement, but thereby this increases the chances of nighttime glare and halos. 
     Another approach to obtaining accommodation is disclosed in U.S. Pat. No. 6,645,246 B1. An accommodating IOL employs an optic made of two different materials to enhance the accommodation achievable in the eye in response to normal accommodative stimuli. The optic includes a first lens portion surrounding a second lens portion that is less deformable than the first portion. The optic can be sized and configured to fit within the capsular bag. 
     Researchers have envisioned a soft, elastic polymer gel that may someday be used to replace the clouded natural lens that is removed during cataract surgery. This approach is considered by some researchers also as a possible mechanism to correct presbyopia. The gel would be injected into the capsular bag after the eye&#39;s natural lens is removed. The material may be a modified hydrogel, similar to that used for extended wear contact lenses. Its injectability could eliminate the need for the larger incision that is normally required to insert a replacement IOL. One of the limitations of this approach is that the gel must have a high refractive index. Also, a method for re-sealing the lens capsule will be required. 
     When IOLs are placed in the capsule of an eye, tissue growth around the haptics or other position fixation apparatus occurs, particularly when the lens has been implanted for an extended period of time. Also, adhesion of tissue to the lens or its haptics occurs. This, in most cases, eliminates the possibility of removing or adjusting an existing implanted lens and replacing it with a more efficacious optic. Also, when greater accommodation is needed using accommodating IOLs, keeping the lens capsule open would be beneficial. Pressure change in the vitreous humor because of muscle contraction will have greater effect on movement of an accommodating lens apparatus if volume of the capsule is maintained at a higher value. Holding the lens capsule open will also prevent the fusion of the anterior and posterior capsules and allow greater ease of accommodation and flexibility of the complex. Apparatus and method that would allow these further procedures in a pseudophakic eye are needed. 
     Surgical procedures to form an opening (capsulorhexis) in both the anterior capsule and the posterior capsule are sometimes necessary. Particularly in the eyes of younger patients, the capsule opening is closed by growth of tissue in a relatively short time. Particularly in pediatric ophthalmology, there is a need for surgical apparatus and method to avoid the rapid closure of such openings. In adults, pseudoexfoliation syndrome is also complicated by contraction of the capsule (phimosis) with resultant visual disturbance and damage to supporting zonules. 
     Contraction of the anterior capsule also occurs in eyes where the CRYSTALENS has been implanted. The capsular contraction can cause posterior displacement of the CRYSTALENS, resulting in hyperopia, or extreme contraction of the capsule results in asymmetric compression of the CRYSTALENS with significant power changes including myopia and astigmatism, e.g., “Z Compression.” 
     What is needed is apparatus and method for providing accommodating lenses that allow greater range of accommodation, allowing a user to obtain near and distant vision without eyeglasses. When openings are surgically formed in the capsule to implant IOLs or perform other surgical procedures, there is a need to provide apparatus and procedure to maintain the form of the lens capsule and to maintain the diameter of a capsulotomy opening. 
     SUMMARY OF INVENTION 
     In one embodiment of the present invention, a lens optic having haptics attached is implanted within the capsular bag. The haptics extend from the lens, placed in contact with the posterior capsule, so as to maintain the volume of the lens capsule and prevent fibrosis or collapse and fusion of the anterior and posterior capsule. The haptics may have a spiral structure or other forms, which are radially displaced around the optic and have dimension&#39;s allowing the haptic to extend around the interior of the capsule past the fornix. The optic may be a light-adjustable lens. In another embodiment, a capsulotomy ring is placed and fitted within the capsulorhexis, and the ring may include haptics that extend posteriorly toward the posterior capsule. The ring may also include a membrane or an optic. The optic may be attached to the ring after the ring is implanted. In another embodiment, an artificial capsule is implanted within the natural lens capsule. The artificial capsule may contain liquid, gel or other deformable medium, such that it is deformed in response to the action of ciliary muscle, changing the power of the lens. An external conduit that is removable and reattachable to a valve in the implantable capsule may be used for adjusting the volume of the capsule. In other embodiments, an artificial anterior capsule is provided. The artificial anterior capsule, including a membrane, may be used to prevent extrusion of the artificial capsule from the natural capsule. Further, the artificial anterior capsule may include an optic. The membrane may be deformable, so as to respond to pressure changes in the capsule and provide an accommodating lens system. The optic may be a light-adjustable lens. The artificial anterior capsule may be provided by a membrane affixed around the periphery of an opening in the natural anterior capsule by a collar or a pinched segment of the natural anterior capsule. Combinations of the disclosed devices may provide dual optic devices. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The same numerals in different drawings indicate the same parts of an eye and the same parts of a disclosed apparatus. 
         FIG. 1  shows a cross-sectional view of the anterior portion of a human eye. 
         FIG. 2 a    shows a plan view and  FIG. 2 b    a side view of an optic having haptics formed from coiled members;  FIG. 2 c    shows a plan view of an optic having haptics that form a spiral;  FIG. 2 d    shows a plan view of an optic having haptics formed from strips having flexible hinges;  FIG. 2 e    is a plan view and  FIG. 2 f    is a side view of an optic having haptics formed from continuous loops;  FIG. 2 g    is a plan view and  FIG. 2 h    is a side view of an optic having haptics formed from plates having distal support members. 
         FIG. 3 a    shows a cross-sectional view of a human eye in which the device of  FIG. 2 a - b    has been placed in the lens capsule;  FIG. 3 b    shows a cross-sectional view of a human eye in which the device of  FIG. 2 d    has been placed in the lens capsule.  FIG. 3 c    shows a cross-sectional view of a human eye in which the device of  FIG. 2 h    has been placed in the lens capsule. 
         FIGS. 4 a  and 4 b    show a plan view and side view of an intracapsulotomy ring to be placed in a capsule opening.  FIG. 4 c    shows a plan view of the ring of  FIG. 4 a    with an optic attached to the top of the ring.  FIG. 4 d    is an isometric view of a coupling on the optic attached to a pin on the ring.  FIG. 4 e    shows a plan view of the ring of  FIG. 4 a    with an optic attached to the bottom of the ring. 
         FIGS. 5 a  and 5 b    show a plan view and side view of an alternate embodiment of an intracapsulotomy ring to be placed in the capsule opening.  FIG. 5 c    shows a plan view of the ring of  FIG. 5 a    with an optic attached to the top of the ring. 
         FIG. 6  shows a cross-sectional view of an eye having an intracapsulotomy ring with haptics attached placed in the capsule opening. 
         FIG. 7  shows a cross-sectional view of an eye with an intracapsulotomy ring in the capsule opening, the ring having within a membrane and/or optic, with haptics attached to the ring. 
         FIG. 8  shows a cross-sectional view of an eye having an artificial capsule placed within the lens capsule, the artificial capsule being attached to apparatus for inflating the capsule and having an optic within. 
         FIG. 9  shows a ring and membrane apparatus attached to a natural anterior capsule to form an artificial anterior capsule, the ring being attached by a collar. 
         FIG. 10  shows a cross-sectional view of a ring and membrane forming an artificial anterior capsule, the ring being attached to the natural lens capsule by a pinching mechanism, the membrane including an optic and membrane. 
         FIG. 11  shows a cross-sectional view of the human eye in which an artificial capsule has been implanted, the capsule including an optic, and an artificial anterior capsule has also been implanted, the artificial anterior capsule including a ring attached by a pinch seal to the anterior capsule and including a second optic. 
     
    
    
     DETAILED DESCRIPTION 
     Referring to  FIG. 1 , a cross-sectional view of the anterior portion on an eye, which may be a human eye, is shown. Eye  10  includes cornea  12 , sclera  13 , iris  14 , zonules  15 , conjunctiva  16 , ciliary body  17 , lens capsule  18 , anterior capsule  19 , posterior capsule  20  and capsule equator or fornix  22 . The development of presbyopia and cataracts in the human eye are associated with changes in natural lens capsule  18  and its contents. Surgical procedures to remove cataracts from lens capsule  18  or to implant intraocular lenses, either accommodating or fixed, involve making an incision through cornea  12  or sclera  13  and forming an opening in capsule  19  (a capsulorhexis). The size of the external incision is minimized to limit trauma to the patient&#39;s eye and allow faster healing. Common sizes of the incision are 2.5 to 3 millimeters, however there is a trend to make smaller incisions, such as 1.5 millimeter. 
       FIG. 2 a    shows a plan view of an optic and attached haptics according to one embodiment of the present disclosure. Optic  23  may be a rigid lens or may be adaptable to folding for insertion in the eye through a smaller incision. Such foldable lenses are widely used in the art. Optic  23  may be a light-adjustable lens, such as is available from Calhoun Vision, Inc., Pasadena, Calif., disclosed in U.S. Patent Application Publication No. 2003/0174375, published Sep. 18, 2003, which is incorporated by reference herein. In one embodiment, haptics  24  are in a spiral configuration of a deformable material suitable for biomedical use, such as materials disclosed in U.S. Patent Application 2002/0175846, for example, which is incorporated by reference herein. Such materials for lenses and haptics are well known in the art and may be selected based on available material modulus and other physical properties. Haptics  24  may be integrally formed with lens  23  or may be attached by various known mechanical attachment methods. The spiral configuration may be formed from strands of polymeric material. Alternatively, the strands may be used to form haptics without formation of the spiral configuration.  FIG. 2 b    shows a side view of the device of  FIG. 2 a   . Haptics may be linearly extended in the absence of a force on the haptic, or haptics  24  may be formed to a preset position, such as conforming to the interior of a natural lens capsule in the absence of a bending force on the haptic, before insertion in an eye. Haptics may also be curved in a plane parallel to the lens plane, such as shown in  FIG. 2 c   , where haptics  24   a  attached to lens  23  are illustrated. Preferably, haptics  24  or  24   a  are deformable and foldable such that they may be folded into a position near lens  23  while the device is placed in an eye. The modulus of the material used to form a spiral haptic or the cross-sectional area of the material along the length of the haptic may be varied in a selected manner so as to provide variable resistance force to bending along the haptic. For example, a lowered cross-section area or lowered elastic modulus material may be placed one-third the distance from the proximate end of the haptic (where it is joined to optic  23 ) and one-third the distance from the distal end of the haptic. The spacing of such more deformable segments along a haptic may be selected to allow the haptic to conform more closely to posterior capsule  20 , capsule fornix  22  and the inner aspect of the anterior capsule ( FIG. 1 ). Experiments with haptics having different initial shapes and placing variations of resistance to bending of haptics in different locations and observing configurations of the lens-haptic assembly in simulated lens capsules, plus what is well known to those of ordinary skill in the art, may be used to select optimum properties and configurations of haptics. 
       FIG. 2 d    shows another embodiment of haptics  25 . Haptics in this embodiment are strips of biocompatible elastomeric material. Such strips may include areas of weakness  26  placed at selected locations along each haptic, where resistance to bending force is decreased. The bending force on each haptic is selected to hold open a capsule when disposed within, and, preferably, to allow the haptic to conform more closely to posterior capsule  20  and capsule equator or fornix  22  plus the inner aspect of the anterior capsule  19  ( FIG. 1 ). Again, experiments using variations of initial shape and placing resistance to bending of haptics in different locations and observing configurations of the lens-haptic assembly in simulated lens capsules, plus what is known to those of ordinary skill in the art, may be used to select optimum properties and configurations of haptics. 
       FIGS. 2 e  and 2 f    illustrate another embodiment of haptics  27 . Plan view  2   e  illustrates haptics forming an elongated loop from lens  23 .  FIG. 2 f    illustrates that the haptics may be formed in a shape conforming to the inside of a capsule when no bending force is applied. Haptics  27  preferably fold to near lens  23  for insertion into an eye. 
       FIGS. 2 g  and 2 h    illustrate yet another embodiment of haptics  28  and  29 . Haptic  28  may be in the form of a plate. Haptics  29  extend from plate  28  and may be formed to conform to the inside of a capsule while extending past the fornix but not to a normal capsulorhexis. 
       FIG. 3 a    illustrates by cross-sectional view placement of the device of  FIGS. 2 a -2 c    in natural lens capsule  18 . Lens  23  and haptics  24  are illustrated in  FIG. 3 a   . Forceps or an injector or other device well known to surgeons may be used for placement. Capsulorhexis  21  has been formed in lens capsule  18 , or, specifically, in anterior capsule  19  of  FIG. 1 . Capsulorhexis  21  may also be referred to herein by the term “capsulotomy” or “anterior capsule opening” or “lens capsule opening.” In  FIG. 3 a    and other figures disclosed herein, it should be understood that an optic or lens should be designed according to well known methods for each patient, and although only bi-convex lens are shown, the lens may also be planar, concave or suitable combinations thereof. A lens may also be a light-adjustable lens, such as disclosed above.  FIG. 3 b    illustrates by cross-sectional view placement of the device of  FIG. 2 d    in natural lens capsule  18 .  FIG. 3 c    illustrates by cross-sectional view placement of the device of  FIG. 2 g - h    in natural lens capsule  18 . Preferably, an optic having haptics attached as disclosed herein is placed in lens capsule  18  by the surgeon such that the optic is disposed in contact with posterior capsule  20 . Haptics are preferably formed so as to maintain the optic in contact with posterior capsule  20  as it moves in response to ciliary muscle action, which will then produce an accommodating lens system. 
       FIG. 4 a    shows a plan view of device  40  which is adapted for placement in a capsulorhexis such as capsulorhexis  21  of  FIG. 3 a   , in either an anterior or posterior capsule. Ring  42  is a thin, flexible ring adapted to fit inside capsule opening  21 , comprising body  42  and groove  41 . The ring is normally made from an elastomeric material such as a silane material or other such materials normally used in devices for placement in an eye, and may be referred to herein as an “intracapsulotomy ring.”. The ring may be continuous or may be split, as shown in  FIG. 4 a   . Groove  41  is adapted for placement in a lens opening with retention of the anterior  19  or posterior capsule  20  material at the edge of the capsulorhexis within groove  41 . The split ring may be placed in the capsule opening with a linear injector similar to the injector used for the Morcher ring, which is well known in the art. After the split ring is placed in the opening, it may be latched to form a continuous structure having an appropriate diameter, using latch  43  and socket  44 . Other forms of a latch may be used to join ring body  42  when it is split into a structure having a dimension suitable for the lens opening. One or more eyelets  48  may be placed on ring body  42  or the exterior of groove  41  for suturing device  40  to an iris or other eye tissue. Cleats  44   a  and  44   b  may be integral with ring  42  and groove  41 . Cleats  44   a  and  44   b  may be used to attach a replaceable lens to ring  42  body, as will be further described below 
     In another embodiment, ring body  42  has a hollow core that can be inflated with fluid through sealing valve  46 . A cannula (not shown) may be inserted into valve  46  for inflation of ring body  42  to a selected pressure and rigidity after the device is placed in the lens opening. The cannula may then be withdrawn, leaving ring body  42  within the eye. In this embodiment, the ring may not be split, in which case latch  43  and socket  44  are not needed, as ring body  42  is continuous. 
     Membrane  45  may be present within ring body  42  of  FIG. 4 a   . Membrane  45  may be integrally formed with ring body  42 , may be inserted in ring body  42  separately and latched in place, such as in a groove around the periphery of the ring (not shown). Membrane  45  may be elastic or have elastic segments to provide for operation of a latch when a split ring, such as illustrated in  FIG. 4 a    is used. In another embodiment, membrane  45  may have sufficient rigidity and strength to confine an artificial capsule, as described below, within the natural lens capsule. Membrane  45  may include an optic, such as illustrated by the membrane  56  and  57  of  FIG. 5 a   .  FIG. 4 b    shows a side view of the ring body  42  and groove  41  of  FIG. 4   a.    
       FIG. 4 c    illustrates the device  40  of  FIG. 4 a    with lens  47  attached on cleats  44   a  and  44   b . Such detachable lens is described, for example, in U.S. Patent Application No. 2002/0175846, published Nov. 21, 2002, which is hereby incorporated by reference herein. Lens  47  includes openings  47   a  and  47   b , which the surgeon may place over cleats  44   a  and  44   b  to hold the lens in place. Lens  47 , which may be folded and implanted by normal means, may then be explanted if such procedure is needed for any reason. 
       FIG. 4 d    is a detailed isometric view of the placement of one embodiment of opening  47   a  of lens  47  on cleat  44   a  outside a lens capsule. Elastic properties of ring  42  allow the surgeon to place openings  47   a  and  47   b  on the cleats. Ring  42  then provides a radial force outward to maintain the lens in place on the cleats and outside the capsule. 
       FIG. 4 e    is a detailed isometric view of the placement of openings  47   a  and  47   b  of lens  47  on cleats  44   a  and  44   b  inside a lens capsule. Elastic properties of ring  42  allow the surgeon to place openings  47   a  and  47   b  on the cleats when the cleats are disposed inside a lens capsule, using the ability of lens  47  to fold. Ring  42  then provides a radial force outward to maintain the lens in place on the cleats inside the capsule. 
     An alternate embodiment of an intracapulotomy ring for a capsule opening is shown in  FIGS. 5 a  and 5 b   .  FIG. 5 a    shows a plan view of ring  51  having tabs  52  disposed around the ring, the tabs being spaced apart a distance selected to receive and retain the periphery of a capsulorhexis in the anterior or posterior capsule of an eye within the tabs. Ring  51  may be latched into an approximately circular configuration by latch pin  54  and latch receptor  55 . Other forms of latch mechanisms may be used to bring ring  51  together. The ring may also be inserted by a tool similar to that used to insert a Morcher ring. Within ring  51  membrane  56  may be present, and lens  57  may be included in membrane  56 . Such parts may be formed integrally with ring  51  or may be separately installed in ring  51  before or after ring  51  is placed in an eye, as disclosed in regards to  FIG. 4 . Eyelets  58  may be present at selected positions to provide for suturing to eye tissue. Cleats  51   a  and  52   b  may be present to provide a mechanism to attach a replaceable lens to device  50 , as more particularly described below.  FIG. 5 b    shows a side view cross-section of the device also shown in  FIG. 5   a.    
       FIG. 5 c    illustrates the device  50  of  FIG. 5 a    (without membrane  56  and lens  57 ) but with lens  59  attached on cleats  51   a  and  51   b . Such detachable lens is described, for example, in U.S. Patent Application No. 2002/0175846, published Nov. 21, 2002, discussed above. Lens  59  includes openings  59   a  and  59   b , which the surgeon may place over cleats  51   a  and  51   b  to hold the lens in place. Lens  59 , which may be folded and implanted by otherwise normal means, may then be explanted if such procedure is needed. 
       FIG. 6  depicts in cross-section in an eye the device  40  of  FIG. 4  or the device  50  of  FIG. 5 , further having attached to the device haptic  62 . Haptic  62  may have the form such as shown in  FIG. 2 , for example. Such ring and haptic combination may be used to hold open capsule  18  after a surgical procedure. Device  40  or  50  ( FIG. 4 or 5 ) may, alternatively, be placed in an opening in posterior capsule  20  ( FIG. 1 ), not shown. Such device may be employed for preventing fibrosis or growth of a capsule opening toward closure after surgery. Such devices may be particularly useful in pediatric ophthalmic surgery, where closure of capsule openings by tissue growth is more rapid, as well as in treating a condition such as pseudo-exfoliation syndrome. 
       FIG. 7  illustrates the device of  FIG. 6  after placement of membrane  71  and optic  72  within the ring  40  or  50  of  FIGS. 4 and 5 . Haptic  62  of  FIG. 6  is also shown. Haptic  62  may not be used in some cases. Alternatively, a haptic such as shown in  FIGS. 2 c  through 2 h    or other forms of haptics may be employed. Membrane  71  may be used without optic  72 . Also, optic  72  may extend throughout a ring without the presence of membrane  71 . The device including ring  40  or  50 , membrane  71 , optic  72 , and haptic  62  may be formed integrally or may be formed by joining of separate component parts. Materials may be materials known in the art to be useful in optical devices for implantation in a human or animal eye. In another embodiment, a lens such as illustrated in  FIG. 4 c - e    or  FIG. 5 c    may be employed with the lens and haptics of  FIG. 2 a - h   . The length of haptics may be adjusted to accommodate both anterior and posterior lens. 
     Referring to  FIG. 8 , another embodiment of the device to hold apart anterior and posterior capsules and maintain the natural capsule shape is shown at  80 . Artificial capsule  80  may be constructed of plastic material suitable for biomedical use, such as a silane material. The wall thickness or elastic constants of the material of the wall of capsule  80  may vary to cause artificial capsule  80  to conform more closely to the shape of a natural lens capsule. Optimum variations may be determined by experiment in a simulated lens capsule. as explained above relative to the use of haptics. Optic  81  may be formed within artificial capsule  80 . Valve  82  may be present in capsule  80  to allow the capsule to be inflated with a selected liquid or gel after placement through capsulorhexis  21  ( FIG. 3 ). Cannula  83  may be inserted in valve  82  and pump or syringe  84  may be used for injection of a selected fluid into artificial capsule  80 . The fluid used may be selected for refractive index and biomedical properties. Artificial capsule  80  may be folded and placed in the natural capsule through capsulorhexis  21  (such as shown in  FIG. 3 ) and then inflated to a desired volume. The location of optic  81 , if present, may be adjusted prior to inflation and during inflation of artificial capsule  80 . Valve  82  preferably seals after removal of cannula  83 . 
     Referring to  FIG. 9 , apparatus  90  for forming an artificial anterior capsule is illustrated by a cross-sectional view. Ring  91  includes membrane  92 . Membrane  92  may be deformable to accommodate movement of any contents of capsule  18  in response to ciliary muscle action. Ring  91  has attached thereto collar  94 , which is adapted for receiving natural anterior capsule  19  at the periphery of capsulotomy  21 . Similar apparatus is disclosed in U.S. patent application Ser. No. 10/888,298, titled “Apparatus and Methods for Isolating Lens Capsule Fluids,” filed Jul. 9, 2004, which is hereby incorporated by reference herein. The referenced patent application discloses use of a device such as disclosed in  FIG. 9  (and  FIG. 10 ) during surgery, except that the device includes a port for injecting or aspirating fluids to or from capsule  18 . This procedure may be used to “polish” the capsule to remove cells that may later cause fibrosis or PCO. Such procedure is preferably used before implantation of the devices disclosed herein. Device  90  may be implanted in an eye for various reasons after surgery. Membrane  92  may include an optic, as illustrated in  FIG. 10 . Apparatus  90  will normally be made of an elastomeric biomedically approved material, such as a silane material, or combinations of such materials. Ring  91  may include colorant  95 . Such colorant may be used by a surgeon in locating ring  91  with respect to a capsulorhexis during a surgical procedure. Tissue adhesive may be placed within collar  94  for forming a bond with anterior capsule  19 . Such tissue adhesives are well known in the art. The dimensions of capsulorhexis  21 , as illustrated in  FIG. 3 , determines the preferred dimensions of ring  91  and membrane  92 . Preferably, different sizes of ring  91  and membrane  92  are available to the surgeon for application in different cases. Oval or other non-rounded shapes may be formed and applied in cases when a capsulorhexis is not round. Although membrane  92  is shown inside capsular lens  18  in  FIG. 9 , it should be understood that collar  94  may be placed so that membrane  92  is disposed outside capsular lens  18 . 
     Referring to  FIG. 10 , an alternative embodiment for placing a membrane and ring within the lens capsule to form an artificial anterior capsule is illustrated by a cross-sectional view. Ring  101  includes flow channel  104 . Contacting flow channel  104  is port  105 . A cannula (not shown) may be inserted into port  105  and reduced pressure applied within channel  104 . Ring  101  is adapted to contact the posterior surface of anterior capsule  19  before the reduced pressure is applied in channel  104 . When the reduced pressure is applied, anterior capsule  19  is pulled into channel  104 . The structure of ring  101  is designed to pinch and permanently hold anterior capsule  19  within channel  104 . Similar apparatus and method are disclosed in U.S. application Ser. No. 10/888,298, filed Jul. 9, 2004, which is incorporated by reference herein. The procedure that may be used to cause anterior capsule  19  to be attached to ring  101  is disclosed in Paragraph 25 of the subject application. A segment of anterior capsule  19  in the form of a ring is shown folded to enter a portion of flow channel  104  within ring  101 . Ring  101  is constructed to receive the segment of anterior capsule  19  in contact with ring  101  when a sufficiently reduced pressure is applied to the sealing area between ring  101  and the posterior surface of anterior capsule  19 . The reduced pressure in flow channel  104  pulls anterior capsule  19  into flow channel  104 . Further, ring  101  is constructed to pinch anterior capsule  19  with sufficient force to keep the segment of anterior capsule in place within ring  101  and form a permanent seal of device  100  to anterior capsule  19 , thus sealing and isolating volume  18  of the capsule. This pinching arrangement may be supplied by elasticity properties in ring  101  or by other mechanical spring force applied radially in ring  101 . A ridge running along within flow channel  104  may be used to decrease the width of flow channel  104  before it is intersected by port  105 , so as to keep flow channel  104  open throughout ring  101 . Alternatively, a perforated partition may be placed in flow channel  104  so as to limit movement of a ring of anterior capsule  19  into flow channel  104 . 
     Membrane  102 , included within ring  101 , may include optic  103 . Membrane  102  may be deformable to accommodate movement of any contents of capsule  18  in response to ciliary muscle action. The dimensions of capsulorhexis  21 , as illustrated in  FIG. 3 , determines the preferred dimensions of ring  101  and membrane  102 . Preferably, different sizes of ring  101  and membrane  102  are available to the surgeon for application in different cases. Oval or other non-rounded shapes may be formed and applied for cases when the capsulorhexis is not round. Although membrane  102  is shown inside capsular lens  18 , it should be understood that collar  104  may be placed so that membrane  92  is disposed outside capsular lens  18 . 
       FIG. 11  illustrates in a cross-sectional view one combination of apparatus described in previous drawings. Artificial capsule  80  of  FIG. 8  is shown implanted within natural capsule  18 , where it has been implanted through a capsule opening. It has normally been inflated through valve  82 , and may contain optic  81 . After artificial capsule  80  is in place and inflated, device  100 , illustrated in  FIG. 10 , may be implanted. Device  100  may contain lens  103 , as shown in  FIG. 10 . In this application, two optics,  81  and  103 , are placed in the eye. Dual optics are known in the art for forming an accommodating lens. Techniques for designing the configuration of each lens are well known in the art, using dimensions separating the lenses. Movement of optic  81  in an anterior or posterior direction, caused by ciliary muscle  17  ( FIG. 1 ), would provide accommodation for such compound lens apparatus. Other combinations of the devices disclosed herein may be used to obtain dual optic systems, adjusting haptics to allow placement of the devices in the capsular lens. 
     Although the disclosures herein have been primarily described with respect to application in human eyes, it should be understood that the apparatus and methods may be used in all animals and reference to “eye” or “human eye” herein includes an eye of any animal. 
     Although the present invention has been described with reference to specific details, it is not intended that such details should be regarded as limitations on the scope of the invention, except as and to the extent they are included in the accompanying claims.

Technology Classification (CPC): 0