INTRA-OCULAR LENS

VISHNU NARAYANAN

What is intraocular lens?

An artificial lens implanted in the
eyes
Replaces the crystalline lens
To correct the optical power of the
eyes following:Lens being
clouded by
cataract

Refractive
surgery

Primary vs secondary
implantation
Primary implantation use of IOLs
during surgery for cataract
Secondary implantation
implantation of IOL to correct
aphakia in a previosly operated eye

Parts of an IOL
OPTIC
Part of the lens that focuses
light on the retina.
HAPTIC
Small filaments connected to
the optic that hold the lens in
place in the eye

HAPTE
N

OPTIC

HISTORY OF IOL
K

THE FIRST IOL!!

PMMA made lens 45
year old female after
performing
extracapsular cataract
extraction
Disc shaped bi-convex
design
Site- posterior
chamber
First generation IOL

EVOLUTION OF IOLs
1. First generation IOLs
. Ridley lenses
. Disadvantages posterior dislocation
poor surgical
technique
2. Second generation IOLs
. Rigid and semi-rigid anterior chamber IOLs
. Advantages reduce posterior dislocation
. Disadvantage corneal decompensation
UGH syndrome

3. Third generation IOLs

Iris supported lens
Advantages- less corneal
decompensation
Disadvantages iris chaffing
pupillary
distortion
c/c inflammation
cystoid macular
edema

4. Fourth generation IOLs

Modern anterior chamber lens
Flexible loops and multiple point
fixation
Advantages more stable, better
design, less complications
Disadvantages anterior chamber is
not the physiological site for IOL

5. Fifth generation IOLs

PMMA lenses
Foldable and small incision lenses

MATERIALS USED FOR INTRAOCULAR LENSES

Optic materials
1.Non-foldable-rigid IOL
Polymethyl
methacrylate(PMMA)

Haptic
materials

2.Foldable IOL
Silicone
Hydrophobic acrylic
Hydrophilic acrylic

Polypropylene
PMMA
Acrylic

3.Rollable/Ultra-thin IOL
hydrogel

POSITIONING OF IOL
1. Posterior chamber
implantation
. Ciliary sulcus fixation
. In the bag fixation
. Scleral fixation
Eg:- modified C loop type
IOL

Ciliary sulcus fixation

In-the-bag fixation

Scleral IOL

2. Anterior chamber
implantation
angle supported
IOLs
Kelman multiflex
type IOL

3. Iris- fixated lens

Fixed on the iris
with claws,loops or
sutures
Eg- Singh and
Worsts iris claw
lens

Different types of haptic angulation

relative to the plane of optic:-

For posterior chamber lens: 100 anterior angulation to keep the

optic part away from the pupil.

For anterior chamber lens: Posteriorly angulated lens to vault

the intraocular lens away from the
pupil

FOCUSSING ABILITY OF IOLs

1. Unifocal intraocular lens
. Lens with unifocal power
. Can have problem with near vision

2.Multifocal IOLs

Simultaneous vision
lenses
Based on either
refractive or
diffractive optics
Psuedoaccomodation
lens

3.Accomodative IOLs

Exhibit anterior movement of

optic to improve near vision

Special function IOLs

TORIC IOLs
Correct any associated
astigmatism
ASPHERIC IOLs
Reduce spherical
aberration

ANIRIDIA IOLs
Cover the defects of aniridia
or partial iris loss as in
trauma
Has a black diaphragm over
the optic
PIGGYBACK IOLs
An IOL piggybacking onto an
existing IOL or simultaneous
implantation of 2 IOLs

BLUE LIGHT FILTERING IOLs

Lenses are yellow colored to screen
out UV Light and blue spectrum
Reduced risk of age related macular
degeneration
PHOTOCHROMATIC IOLs
UV absorbing photo chromes

IMPLANTABLE MINIATURE
TELESCOPE
Miniature implantable Galilean
telescope
Implanted in posterior chamber
Contains number of micro
lenses in the optic which gives
a magnification of about 3 at
the central visual field
Used to treat macular
degeneration

TELESCOPIC IOLs
New generation
miniature telescopes
which uses 2 mirrors
instead of lens to provide
magnification with
minimum loss of
peripheral vision

Phakic IOLs
IOLs used to correct myopia with the
eyes natural lens being untouched
Implantable contact lenses
1. Angle supported lens
2. Iris fixated lens
3. Sulcus supported lens

BIOMETRY
THEORETICAL FORMULAE

Binkhorst formula
Colenbranders formula
Gull strands formula
Hoffers formula

EMPERICAL FORMULAE

Modified Sanders-Retzlaff-Kraff formula

SRK II
SRK III
SRK T
Haigis formula

Binkhorst formula
E= [N/(L-C)] NK/(N-KC)]
E Emmetropic IOL power
L Axial length of the eye
K Corneal dioptric power
C

Psuedophakic length of anterior

chamber

Refractive index of aqueous and vitreous

humor

Modified Sanders-Retzlaff-Kraff
formula

Based on the statistical

correlation between calculated
and observed refractive error
after ocular implantation.

Modified SRK Formula

E=A - 2.5L - 0.9K
Parameters used in the formula are
estimated by
A-scan ultrasonographic
sonometry and keratometry
Instrument - biometer

E=A - 2.5L - 0.9K

E:
Emmetropic power of eye
A:
Predetermined constant of IOL
L:
Axial length in mm
K:
Average of keratometry readings

 Power ( I )required to produce

Required post operative refraction ( R
),
I = E cr R
cr empirical constant
cr = 1 if E < 14
cr = 1.25 if E > 14

Complications of IOL
implantation

Mechanical damage to the IOL

Dislocation
Bullous keratopathy
Posterior capsule rupture
Anterior capsule opacification
Posterior capsule opacification
Calcium deposits within the optic of hydrophilic
intraocular lens
Adherence
UGH syndrome
Sunset syndrome

Sunset syndrome

Lens of the future-liquid injectable

IOLs
A new IOL concept that combines an acrylic
IOL with a liquid, injectable IOL may someday
allow patients to retain accommodation.
Following IOL implantation, liquid IOL is
injected and capsular bag is inflated fully
and IOL kept in place
Mechanism- forward movement and
thickening of lens

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