This document describes devices, systems, and methods related to devices, systems and methods for replacing an intraocular lens.
Intraocular lens (IOL) is a lens implanted in the eye as part of a treatment for cataracts, myopia, or other illnesses. Some example IOLs includes a pseudophakic IOL. The pseudophakic IOL is implanted during cataract surgery after the natural lens (e.g., a cataract) has been removed from the eye. The IOL may provide the same light focusing function as the natural crystalline lens. Other example IOLs include a phakic intraocular lens (PIOL). The PIOL is a lens that is placed over the existing natural lens and is used in refractive surgery to change the eye's optical power as a treatment for myopia. The implanted IOL may carry several risks associated with eye surgeries. For example, the IOL can be dislocated after surgery.
A technique described herein provides a solution to replace a dislocated intraocular lens (IOL), such as a dislocated single-piece IOL. Some implementations of the technique employs an intraocular optic capture device (IOCD) configured to reposition the dislocated IOL in an eye. The IOCD can include an opening for capturing the dislocated IOL. In some implementations, the IOCD can be configured as a ring with the opening. The IOCD can be made of a flexible material, such as acrylic, which allows optic capture of the dislocated IOL.
In some implementations, the IOCD can be used to reposition the dislocated IOL in the posterior chamber without need to create a large corneal or scleral incision. Some example procedures can include enabling access to the posterior segment in the eye, and injecting the IOCD in the anterior chamber of the eye, repositioning the dislocated IOL in the anterior chamber, capturing the dislocated IOL with the opening of the IOCD, and fixing the IOCD to a structure within the eye. For example, a surgical method, such as vitrectomy, can be used to remove some or all of the vitreous humor from the system to allow access to the dislocated lens in the posterior segment of the eye. Alternatively, pars plana vitrectomy (PPV) can be used for such a surgical method. PPV is a technique in vitreoretinal surgery that enables access to the posterior segment for treating conditions such as retinal detachments, vitreous hemorrhage, endophthalmitis, and macular holes in a controlled, closed system.
In some implementations, the IOCD includes one or more fixing arms (e.g., haptics), and the IOCD that captures the dislocated IOL can be scleral-fixated using sutures that are fed through the fixing arms of the IOCD. The fixing arms can be configured in various configurations. In some implementations, the IOCD can include one or more suture holes as the fixing arms, which are arranged around the ring of the IOCD and configured to receive sutures therethrough. For example, the IOCD can include four suture holes, two of which are arranged at one side of the ring of the IOCD and the other two of which are arranged at the opposite side of the ring of the IOCD. In alternative implementations, the IOCD can include two extended arms or haptics configured as strands, one of which extends from one side of the ring of the IOCD and the other of which extends from the opposite side of the ring of the IOCD. For example, the extended arms or haptics may then be scleral-fixated through a tunneled incision in the sclera 180 degrees apart.
The IOCD may be used to fixate a dislocated lens, instead of removing the dislocated lens from the eye. For example, dislocated lenses that offer astigmatic (refractive error in certain axis) correction or presbyopia (age-related loss of near-sightedness) correction are typically extracted from the eye and not reused. Instead, the IOCD described herein can be used to fixate such a dislocated lens so that the lens can be positioned in a certain axis and will not rotate. Thus, ophthalmologists can use the IOCD to fixate astigmatic correction lenses (known as “Toric lenses”) and presbyopia correction lenses (known as “premium lenses” or “extended depth-of-focus lenses”), without having to remove them from the eye.
Particular embodiments described herein include an intraocular optic capture device for repositioning an implanted intraocular lens in an eye. The device may include a body and one or more fixing arms. The body may define an opening configured to receive and hold at least a portion of the intraocular lens. The fixing arms may extend from the body and be configured to fix the body to a structure of the eye.
In some implementations, the system can optionally include one or more of the following features. The opening may be sized to be identical a lens portion of the intraocular lens. Alternatively, the opening may be sized to be smaller than a size of a lens portion of the intraocular lens. The opening may be configured to interference fit with a lens portion of the intraocular lens. The opening may be circular. Each of the fixing arms may define a suture opening configured to receive a suture for fixing the body to the structure of the eye. The structure of the eye may include an eye wall or a sclera. The fixing arms may be symmetrically arranged relative to a center of the opening. The fixing arms may be arranged in a same plane as a plane in which the body is placed. The fixing arms may be arranged in a different plane from a plane in which the body is placed. The fixing arms may include one or more strands. The strands of the fixing arms may include hooked portions. The strands may be made of polyvinylidene fluoride (PVDF) monofilament. The body may be made of a flexible material. The body may be made of acrylic. The intraocular lens may be an astigmatic correction lens or a presbyopia correction lens. The intraocular optic capture device may be configured to position the intraocular lens in a predetermined axis and prevent rotation of the intraocular lens.
Particular embodiments described herein include a method for repositioning an intraocular lens dislocated in an eye. The method may include inserting an intraocular optic capture device in an eye chamber; moving the intraocular optic capture device onto the intraocular lens; capturing a lens portion of the intraocular lens with the intraocular optic capture device; and fixing the intraocular optic capture device to a structure of the eye.
In some implementations, the system can optionally include one or more of the following features. The capturing the lens portion may include placing an opening of the intraocular optic capture device onto the lens portion of the intraocular lens. The lens portion of the intraocular lens may be at least partially inserted through the opening of the intraocular optic capture device. The capturing the lens portion may include interference-fitting the opening of the intraocular optic capture device with the lens portion of the intraocular lens. The fixing the intraocular optic capture device may include routing one or more sutures through one or more suture holes of the intraocular optic capture device; and stitching the one or more sutures with the structure of the eye. The one or more suture holes may be arranged symmetrically relative to a center of the intraocular optic capture device. The intraocular lens may be an astigmatic correction lens or a presbyopia correction lens. The intraocular optic capture device may be configured to position the intraocular lens in a predetermined axis and prevent rotation of the intraocular lens.
The details of one or more implementations are set forth in the accompanying drawings and the description below. Other features and advantages will be apparent from the description and drawings, and from the claims.
Referring to
The IOL 102 can be made of various materials. In some implementations, the IOL 102 can be made of an inflexible material, such as polymethylmethacrylate (PMMA). Alternatively, the IOL 102 can be made of flexible materials, such as silicone, acrylic glass, hydrophobic acrylate, hydrophilic acrylate, collamer, and other suitable materials. The IOL 102 can include soft foldable inert materials, such as silicone, acrylic glass, etc. Such materials can allow the lens to be folded and inserted into the eye through a smaller incision. For example, acrylic lenses can be used for patients who have a history of uveitis or are likely to have to undergo retinal surgery requiring vitrectomy with replacement by silicone oil, such as persons with proliferative diabetic retinopathy or who are at high risk of retinal detachment, such as persons with high myopia.
The lens portion 112 of the IOL 102 can include a monofocal lenses matched to distance vision. Alternatively, the lens portion 112 can be a multifocal lens to provide the patient with multiple-focused vision at far and reading distance. Alternatively, the lens portion 112 can be an adaptive lens provides the patient with limited visual accommodation.
In some implementations, the IOL 102 can be implanted under local anesthesia with the patient awake throughout the operation. A flexible IOL enables the lens to be rolled for insertion into the capsule through a very small incision, thus avoiding the need for stitches. This procedure can be completed in a short period of time, such as less than 30 minutes. The recovery period is about 2-3 weeks.
The IOL 102 can be implanted in the posterior chamber of the eye 104. Alternatively, the IOL 102 can be implanted in the anterior chamber. Various forms of surgery may be used to remove natural crystalline lenses (e.g., cataracts), such as extracapsular cataract extraction, intracapsular extraction, etc. For example, after a natural crystalline lens (e.g., a cataractous lens) is extracted, an intraocular lens (IOL) can be implanted in either the anterior or the posterior chamber of the eye. In an anterior chamber implant, the IOL can be situated forward of, or mounted to the iris. In a posterior chamber implant, the IOL can be situated behind the iris and may be mounted within the cleft or fornix of the capsule which remains in place after extracapsular surgery.
In either anterior or posterior chamber implant, the IOL may be centered and fixed in position by one or more supporting strands or haptic members (e.g., the haptics 114). The haptic members of an IOL can have various geometric shapes and configurations. The haptic members can be flexible strands of non-biodegradable material which is fixed to the lens body. The haptic members can have spring-like memory qualities so that the haptic members can be compressed or offset from the normal rest position and thereafter returned to the fully extended condition when pressure is removed.
Referring to
In some implementations, when the IOL 102 is implanted in the posterior chamber of the eye, the haptics 114 can support the lens portion 112 by engaging the cleft or fornix portion 146C, thereby fixing the lens portion 112 in the eye 104. For example, as depicted in
In other implementations, the IOL 102 can be adapted to be implanted in an anterior chamber 154 of the eye 104, which is anterior to the iris 144 of the eye 104. For example, the IOL 120 may be a special version of intraocular lens that is referred to as an anterior chamber IOL (ACIOL).
The implanted IOL 102 can carry several risks associated with eye surgeries, such as infection, dislocation of the lens (e.g., loosening of the lens, lens rotation, etc.), inflammation, or nighttime halos.
Referring to
The fixing arms 126, which may also referred to herein as haptics, are configured and used to fix the body 122 of the IOCD 120 to a suitable structure in the eye 104 when the body 122 captures the lens portion 112 of the dislocated IOL 102. For example, the fixing arms 126 extend from the body 122 of the IOCD 120 and provide features to fix the body 122 of the IOCD 120 to an eye structure. In the illustrated example, the fixing arms 126 include suture holes 128 configured to receive sutures which are fastened to a suitable eye structure adjacent to the IOL 102 and/or the IOCD 120. Various implementations of the IOCD 120 are described in more detail herein, for example with reference to
The process 200 can include performing posterior vitrectomy to free the dislocated intraocular lens (203). Vitrectomy or other suitable surgical methods can be used to remove some or all of the vitreous humor to allow access to the dislocated lens in the posterior segment of the eye.
The process 200 can include inserting an IOCD in an eye chamber (204). For example, a tiny incision can be created to gain access to an eye chamber, and the IOCD is inserted through the incision into the eye chamber. In some implementations, the IOCD is repositioned and fixated in the eye chamber.
The process 200 can include repositioning the dislocated IOL in the eye chamber (206). For example, the dislocated IOL is moved and located to a desired location in the eye chamber (e.g., the anterior chamber). By way of example, the practitioner (e.g., the ophthalmologist) can use an instrument to engage with or grab a portion of the IOL and reposition the IOL in the eye chamber.
The process 200 can include capturing the IOL with the IOCD (208). For example, the IOCD can be placed onto the IOL that has been repositioned to a desired location, such that an opening of the IOCD (e.g., the opening 124 of the IOCD 120) captures at least part of a lens portion of the IOL (e.g., the lens portion 112). Thus, the lens portion of the IOL can be fitted into the opening of the IOCD, so that the IOL is held in place by the IOCD.
The process 200 can include fixing the IOCD to a suitable structure in the eye (210). The IOCD that captures the IOL can be fixedly placed within the eye, and thus replace the IOL in a desired location (or the original location of the IOL) within the eye. Various methods can be used to fix the IOCD to an eye structure. In some implementations, the IOCD can be fastened to the eye structure using sutures, strands, wires, or other stitching elements. For example, sutures can be routed through one or more holes included in the IOCD and stitched to a desired eye structure to fix the IOCD to the eye structure. In other implementations, the IOCD can include one or more hooked or bendable arms that can be hooked or inserted in, or otherwise held by, a suitable eye structure.
Referring to
The fixing arms 126 of the IOCD 120 can be engaged with a structure of the eye to fixedly support the IOCD 120 holding the IOL 102 within the eye. In the illustrated example, the fixing arms 126 of the IOCD 120 include the suture holes 128 through which sutures 130 are routed. The sutures 130 can be stitched to a structure of the eye, such as the eye wall 148 and/or the sclera 149 in
Referring to
The body 122 of the IOCD 120 can be made of a flexible material. Examples of such a flexible material include silicone, acrylic glass, hydrophobic acrylate, hydrophilic acrylate, collamer, and other suitable flexible materials. In some implementations, the body 122 of the IOCD 120 can be made of the same material as the lens portion 112 of the IOL 102. In other implementations, the body 122 of the IOCD 120 can be made of a different material from the lens portion 112 of the IOL 102. In addition, the body 122 of the IOCD 120 can be made of a sterile material.
Referring to
The fixing arm 126 includes a neck portion 132 and a distal portion 134. The neck portion 132 extends between the body 122 and the distal portion 134. The distal portion 134 includes a suture hole 128. The neck portion 132 can have a width WN smaller than an outer width or diameter WD of the distal portion 134. In other implementations, the width WN of the neck portion 132 can be identical to or larger than the outer width or diameter WD of the distal portion 134.
The fixing arms 126 includes the suture holes 128 at distal ends (e.g., in the distal portions 134). The suture holes 128 can be arranged symmetrically about the center C of the opening 124 to provide balance of the IOCD 120 when fixed using sutures routing through the suture holes 128. The suture holes 128 can be arranged at an angle (ANG1, ANG2, ANG3, and ANG4) relative to the first body axis AV (or a second (e.g. horizontal) body axis AH extending through the center C and perpendicular the first body axis AV). In some implementations, the suture holes 128 can be arranged at the same angle relative to the first body axis AV, which can range between 10 degrees and 80 degrees. In other implementations, at least one of the suture holes 128 can be arranged at a different angle relative to the first body axis AV.
The fixing arms 126 can be made of the same material as the body 122. Alternatively, the fixing arms 126 can be made of a different material from the body 122. The fixing arms 126 can be made to be a single piece with the body 122. Alternatively, the fixing arms 126 can be made separately from the body 122 and connected to the body 122 in various ways, such as using adhesive and/or fasteners of various types. The fixing arms 126 can have the same thickness as the thickness DT of the body 122. Alternatively, the fixing arms 126 can have a smaller or larger thickness than the thickness DT of the body 122.
The body 122 has opposite main surfaces 170, 172 that are connected to a lateral surface 174. The fixing arm 126 can be connected to one of the main surfaces 170, 172 of the body 122 and extend out in a direction perpendicular to the lateral surface 174 of the body 122. In some implementations, all of the fixing arms 126 can be arranged in the same plane (e.g., the second plane P2) while the body 122 is arranged in another plane (e.g., the first plane P1). In other implementations, at least one of the fixing arms 126 can be arranged in a plane different than the other fixing arms. For example, at least one of the fixing arms 126 can be arranged in the same plane (e.g., the first plane P1) as the body 122. Alternatively or in addition, at least one of the fixing arms 126 can be arranged in a plane (e.g., a third plane P3) opposite to the second plane P2 relative to the first plane P3. Alternatively or in addition, at least one of the fixing arms 126 can be arranged in a plane (e.g., a fourth plane P4) at the same side of the body 122 but further away from the second plane P2.
The strands 180 can be made to be flexible. The strands 180 can have spring-like memory qualities so that the haptic members can be compressed or offset from the normal rest position and thereafter returned to the fully extended condition when pressure is removed. For example, the strands 180 can have hooked portions 182 configured to hook in a structure of the eye (e.g., the eye wall 148 and/or the sclera 149 in
In the illustrated example of
The strands 180 can have a circular cross section. Alternatively, other geometric shapes can be used for the strands 180, such as rectangular, square, or oval. In some implementations, the strands 180 can be made of polyvinylidene fluoride (PVDF) monofilament. Other materials are also possible for the strands 180.
While this specification contains many specific implementation details, these should not be construed as limitations on the scope of any inventions or of what may be claimed, but rather as descriptions of features specific to particular implementations of particular inventions. Certain features that are described in this specification in the context of separate implementations can also be implemented in combination in a single implementation. Conversely, various features that are described in the context of a single implementation can also be implemented in multiple implementations separately or in any suitable sub-combination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a sub-combination or variation of a sub-combination.
Similarly, while operations are depicted in the drawings in a particular order, this should not be understood as requiring that such operations be performed in the particular order shown or in sequential order, or that all illustrated operations be performed, to achieve desirable results. In certain circumstances, multitasking and parallel processing may be advantageous. Moreover, the separation of various system components in the implementations described above should not be understood as requiring such separation in all implementations, and it should be understood that the described program components and systems can generally be integrated together in a single software product or packaged into multiple software products.
Thus, particular implementations of the subject matter have been described. Other implementations are within the scope of the following claims. In some cases, the actions recited in the claims can be performed in a different order and still achieve desirable results. In addition, the processes depicted in the accompanying figures do not necessarily require the particular order shown, or sequential order, to achieve desirable results. In certain implementations, multitasking and parallel processing may be advantageous.
This application claims priority to U.S. Provisional Patent Application No. 62/994,450, filed on Mar. 25, 2020. The content of this application is incorporated by reference in its entirety.
Filing Document | Filing Date | Country | Kind |
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PCT/US2021/023931 | 3/25/2021 | WO |
Number | Date | Country | |
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62994450 | Mar 2020 | US |