INTRAOCULAR LENSES

INTRAOCULAR LENSESDr. Neeraj Agarwal

History:-Sir Harold Ridley was the first to successfully implant an intraocular lens on November 29, 1949, at St Thomas' Hospital , London.

That first intraocular lens was manufactured from Polymethylmethacrylate (PMMA.).

INSPIRATIONInertness of intraocular plexiglass shardsA medical student, Steve Perry questioned him why was he not replacing the lens after removal

Approximately 1000 Ridley IOLs implanted in the next 12 years

ComplicationsDisclocation : approx 20%Glaucoma : 10 %Uveitis

Went into disreputeStrongly opposed by Sir Duke-Elders

First IOL

StructureofIOLACIOLPCIOL

The Evolution of Intraocular Lenses

EVOLUTION OF IOLsFirst generation IOLsRidley lensesDisadvantages posterior dislocation poor surgical technique2. Second generation IOLsRigid and semi-rigid anterior chamber IOLsAdvantages reduce posterior dislocationDisadvantage corneal decompensation UGH syndrome

3. Third generation IOLs

Iris supported lensAdvantages- less corneal decompensationDisadvantages iris chaffing pupillary distortion inflammation

4. Fourth generation IOLs

Modern anterior chamber lensFlexible loops and multiple point fixationAdvantages more stable, better design, less complicationsDisadvantages anterior chamber is not the physiological site for IOL

5. Fifth generation IOLsPMMA lensesRigid posterior chamber iol

6. Sixth generation IOLs Foldable IOL

7. Seventh generation IOLs Multifocal IOL

8. Eighth generation Accomodative IOL Phakic refractive IOL

POSITIONING OF IOL

Posterior chamber implantation

Ciliary sulcus fixation

In the bag fixation

Eg:- modified C loop type IOL

Ciliary sulcus fixation

In-the-bag fixation

2. Anterior chamber implantation

angle supported IOLs

3. Iris- fixated lens

Fixed on the iris with claws,loops or sutures

Eg- Singh and Worsts iris claw lens

ADVANTAGES OF IN-THE-BAG PLACEMENTProper anatomical site

Symmetrical loop placement

Intraoperative stretching or tearing of zonules is avoided

Minimimal magnification (