2. INTRODUCTION
❖ Present method of aphakia correction is IOL implantation
❖ Attempts for IOL implantation started 1795 by Italian
ophthalmologist, Casamata with glass IOL
❖ But the real beginning of IOL implant started in 1949
❖ First successful implantation was done by Dr.Harold
Ridley with PMMA IOL
4. GENERATIONS OF IOL
GENERATIONS IOL DESCRIPTION
FIRST RIDLEY PCIOL
SECOND EARLY ACIOL
THIRD IRIS SUPPORTED IOL
FOURTH INTERMEDIATE ACIOL
FIFTH RIGID PCIOL
SIXTH FOLDABLE PCIOL
SEVENTH MULTIFOCAL IOL
EIGHTH ACCOMODATIVE IOL AND PHAKIC REFRACTIVE LENS
5. PARTS OF IOL
❖ OPTIC - part that focusses the
light on the retina
❖ HAPTIC - small filaments that
hold optic in position
❖ Standard optic size - 5.5 - 6 mm
❖ IOL diameter - 12- 14 mm
7. BASED ON OPTIC SIZE
Large optic - 6-6.5mm
❖ Small optic - 5-5.25mm
Single piece
Multiple piece
BASED ON NUMBER OF PARTS
8. BASED ON HAPTIC STYLE
❖ LOOP
➢ J loop
➢ C loop
➢ Modified J loop
➢ Quadriloop
❖ PLATE
❖ PLATE LOOP
9. BASED ON HAPTIC ANGULATION
❖ Increases pupillary
clearance
❖ Pushes optic into the bag
❖ Increases the barrier effect
for lens epithelial cell
migration
10. BASED ON THE OPTIC EDGE
❖ Square edge
❖ Biconvex
❖ Aspheric optic
11. BASED ON POSITION OF FIXATION
❖ ACIOL
➢ In front of iris
➢ Suspended at the angle of
anterior chamber
➢ After ECCE or ICCE
➢ Increased incidence of bullous
keratopathy
12. BASED ON POSITION OF FIXATION
❖ IRIS CLAW IOL
➢ Fixed on iris with sutures, claws, loops
➢ Types
■ Pre pupillary - increased post op
complications
■ Retro pupillary
● Most cosmetically acceptable
● Similar to PCIOL
● Post pigment epithelium is more
resistant - less iris chafing and IOL
displacement
13. BASED ON POSITION OF FIXATION
❖ Ciliary sulcus IOL
❖ In the capsular bag IOL
15. ❖ GLASS
➢ Heavy and shatters with laser
❖ PMMA
➢ Most widely used
➢ Rigid
➢ Chemically stable
➢ High index of refraction -1.49
➢ Specific gravity - 1.2
➢ Good laser resistance
➢ Large wound size
➢ Not autoclavable
RIGID IOL
16. ❖ SILICONE IOL
Polyorganosiloxane
Lower refractive index - 1.43
Thicker lens is needed
Less CME
❖ HYDROGEL IOL
Made of poly hydroxyethyl methacrylate
Flexible
Can be inserted through small incision
Refractive index - 1.43
Water content - 3.8%
Small when dry, swells when implanted
FOLDABLE IOL
17. ACRYLIC IOL
HYDROPHILIC
❖ Retains water
❖ Not tacky
❖ Easily movable and injectable
❖ Do not easily adhere to
capsule
❖ Higher incidence of PCO
HYDROPHOBIC
❖ Retain minimal water
❖ Tacky
❖ Don't move easily once
implanted
❖ Reduced PCO incidence
18. ❖ AKA ultra thin IOL
❖ Injected through 2mm incision by phaconit procedure
❖ Acri smart
➢ Hydrophilic acrylic
➢ 25% water content
➢ Plate haptic
➢ Square edges
➢ Injected by special injectable system
❖ Medennium smart
➢ Thermoplastic hydrophobic acrylic gel polymer
ROLLABLE IOL
21. BASED ON FOCUSING ABILITY
❖ MONOFOCAL
➢ Unifocal power
❖ MULTIFOCAL
➢ Optic focus for distant and near
vision
➢ AKA simultaneous vision lenses
➢ May be diffractive or refractive
22. BASED ON FOCUSING ABILITY
❖ PSEUDO ACCOMMODATIVE IOL
➢ Diffracted optic for excellent near and distant vision
➢ Additional near power of +2.5 - 4.5 D
❖ ACCOMMODATIVE IOL
➢ Anterior movement of optic to improve near vision
❖ EXTENDED DEPTH OF FOCUS IOL
➢ Extended range of vision due to elongated focus
area
23. PHAKIC REFRACTIVE LENSES
❖ Posterior chamber sulcus fixated PRL
❖ Angle supported PRL
❖ Iris supported PRL
25. TORIC IOL
❖ First toric lens - 1994 - PMMA non
foldable three piece IOL
❖ Indication - Regular astigmatism
without any coexisting ocular
pathology
❖ Currently - foldable IOL used
➢ Acrosof
➢ STAAR
➢ T- flex
26. TORIC IOL
❖ POWER CALCULATION
➢ Accurate keratometry readings
➢ Surgically induced astigmatism
• IOL requires 2.2mm incision
• SIA for 0.2-0.3 D for temporal incision, 0.4 D for
superior incision
➢ 10 deg misalignment causes decreased efficacy of 33%
27. MARKING OF AXIS
❖ PRE OP
➢ Slit lamp - coaxial thin slit
➢ Bubble marker
➢ Gravity marker
❖ INTRA OP
➢ Toric axis marker
➢ Iris fingerprinting technique
➢ wavefront aberrometry
➢ Verion image guided system
28. ROTATIONAL STABILITY
❖ Crucial factor
❖ Depend on
➢ IOL material
hydrophobic - hydrophilic - PMMA - silicone IOL
➢ IOL design - total diameter - 11- 13mm
❖ POST OP ASSESMENT
➢ > 10 deg misalignment - corrected within 2 weeks
29. ASPHERIC IOL
❖ Cornea - positive SA
❖ Young lens - negative SA
❖ In young, compensate each other
❖ In old, increases in refractive
index of lens, causes positive SA
and reduced contrast sensitivity
❖ Aspheric IOL decreases SA
❖ Eg : tecnis, acrosof, bauch and
lomb
30. SPECIAL FUNCTION IOL
❖ ANIRIDIA IOL
➢ Cover defects in iris
➢ In partial or extensive iris damage
❖ SMART YELLOW IOL
➢ Photochromic hydrophobic acrylic
➢ Blocks blue light in photopic vision
31. ❖ BLUE BLOCKING IOL
➢ Human lens becomes yellow - oxidation of tryptophan and
glycosylation of lens proteins
➢ This increases blue wave absorption
➢ This IOL protects RPE, decreases ARMD
➢ May cause decreased scotopic vision
➢ Eg : acrysof SN60AT
32. Improves vision in ARMD
Contains optical cylinder and carrying device
Optical cylinder - ultra precise wide angle micro
lenses - enlarged retinal image 52° - 60°
2 models - 2.2 X / 3X magnification
Carrying device has carrier with 2 modified C-
loops and blue light restrictor
Once implanted, anterior window extends
through the pupil
2-3 mm clearance from corneal endothelium
IMPLANTABLE MINIATURE TELESCOPE
33. PIGGY BACK IOL
❖ Extreme short axial length - strong power - IOL power
more - increased asphericity - decreased image
quality
❖ 2 lenses are used to obtain needed power
❖ Used for longer AL / high corneal curvature for which
single lens is not available
❖ Inserted in 2 stages - one in bag , one in ciliary sulcus
❖ Results depend on
• Post op refraction
• Accuracy of IOL power
• Plane of IOL in correspondence with previous
one
34. FUTURE IOL DESIGNS
❖ INJECTABLE GEL IOL
used in femtosecond laser cataract surgery
❖ ELECTRO OPTIC DIFFRACTABLE IOL
static monofocal IOL
central aspheric - far and intermediate vision
Smart electro active diffractive crystal - near
Microsensors - detect triggers for accommodation
Processors for power control
