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Evolution, types, materials of iol

prepared during lens session

reference :
1) Ophthalmology : Yanoff & Duker : 4th edition.
2) AAO : Section 11 : 2014-2015

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Evolution, types, materials of iol

  1. 1. EVOLUTION, TYPES, MATERIALS OF IOLB I P I N B I S TA R E S I D E N T - O P H T H A L M O LO G Y
  2. 2. HISTORICAL PERSPECTIVES • Before 1949, cataract surgery resulted in aphakia, and patients were destined were high hyperopic spectacles. • Development of IOL began in 1949. • Harold Ridley, an English ophthalmologist observed that PMMA fragments from airport cockpit windshields were well tolerated in the AS of injured WW II pilots. • He placed disc-shaped PMMA lens into the PC of 45 year old woman after ECCE. • High incidence of post operative complications such as glaucoma, uveitis, and dislocation . • Then constructed biconvex designed PMMA (GENERATION 1 –PC LENS)
  3. 3. GENERATION II (EARLY AC LENSES) • Consideration with fixation of the lens with angle recess. • Anterior chamber was chosen because of less chances of dislocation • Could be implanted after an ICCE or an ECCE. • UGH syndrome was first described when ocular tissue were damaged by poorly manufactured lenses.
  4. 4. GENERATION III (IRIS SUPPORTED LENSES) • Cornelius Binkhorst was an early advocate of iris-supported lens • 4 looped iris-clip IOL • Iris chafing, pupillary abnormalities, and dislocation . • Increased corneal decompensation occurred d/t long peripheral loops. • Changed ICCE to ECCE and the introduction of 2 –looped iridocapsular IOL in 1965
  5. 5. GENERATION IV (INTERMEDIATE AC LENSES) • Major modifications of iris-supported lenses • More flexible loops • 3 or 4 point Kelman IOLs were made up of with PMMA & Polypropylene.
  6. 6. GENERATION V (IMPROVED POSTERIOR LENSES) • John Pearce of England implanted the first uniplanar Posterior Chamber lens • Rigid tripod design with the two inferior feet implanted in front of anterior capsuleand sutured to the iris. • Steven Shearing of Las Vegas : Major breakthrough in early 1977 with his posterior chamber. • William Simcoe of Tulsa introduced his C- looped posterior chamber lens after Shearing J-loop. • Remains away from delicate structure of anterior segment.
  7. 7. GENERATION VI (MODERN CAPSULAR LENS – RIGID PMMA, SOFT FOLDABLE, MODERN AC LENS) • In the bag fixation with advancement IOL design and surgical technique. (after 1980) • After 1990 with the introduction of Ophthalmic Viscosurgical devices, improvement towards foldable lens. • Mazzocco is given credit for developing foldable IOL.
  8. 8. RECENT ADVANCES • Large fixation holes : fibrous adhesion between the anterior and posterior capsules, enhances the stability and fixation • Use of PMMA, polymide or polyvinyl fluoride • Square, truncated optic edge : barrier effect against cell migration on posterior capsule towards visual axis : reduction in PCO • New injector system • Multifocality, toric correction, pseudoaccomodation, asphericity, image magnification • For spectacle freedom : piggy bank IOLs • Toric IOLs
  9. 9. THANK YOU

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