This document discusses intraocular lenses (IOLs) used in cataract surgery. It begins by introducing IOL implantation and its history starting in 1795. It then describes the generations of IOLs from the first successful implantation in 1949 to modern multifocal and accommodative IOLs. The rest of the document details the different types of IOLs based on characteristics like material, size, haptic style, optic design, and intended vision correction. It also discusses considerations for special IOLs and potential future IOL designs.

1. IOL IN CATARACT
SURGERY
PRESENTOR - DR.VIMALA.M

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

3. HAROLD RIDLEY

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

6. TYPES OF IOL

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

14. BASED ON THE MATERIAL

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

19. ROLLABLE IOL
❖ Ultra choice 1.0 rollable thin lens
➢ 1.45mm incision
➢ Hydrophilic acrylic
➢ 18% water content
➢ Biconvex
➢ Meniscus shaped
➢ 5 optical zones 50 micrometre apart -
reduce aberrations

20. ROLLABLE IOL
❖ Slimflex lens
➢ 26% hydrophilic
➢ Square edge
➢ 4 haptics with 5 degree angulation
❖ Acriflex MICS
❖ Careflex
❖ Tetraflex

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

24. BASED ON TORICITY AND
SPHERICITY

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

36. THANK YOU