Intraocular Lens

Harold Ridley placed first lens in 1949 -PMMA

1950s rigid anterior chamber lenses were used with ECCE and ICCE bullous

keratopathy was common

chronic inflammation led to CME and glaucoma

lens which were too small would decenter and too long would hurt

Later pupil or iris fixation lenses were used to avoid contact with the angle

Some would suture onto the iris and other would clip on

These lenses would frequently dislocate

Closed loop flexible anterior chamber lens were next

These kept corneal transplant surgeons in business for years

Modern open loop flexible anterior chamber lenses have been a great success

The development of viscoelastics to allow safe placement is most important

Posterior chamber lenses are most commonly used today with ECCE-phaco

Most lenses are biconvex - so optically they are equivalent upside down

But most lens have haptics which are angled to push optic posterior

3 basic materials - PMMA, acrylic, silicone

PMMA is the time tested material but requires a large incision

Use the largest optic that can fit incision eg 6.5 or 7 for ECCE

Be careful cheeting down on optic size to allow smaller incision in phaco

Esp. in young light can get around optic w/pupil dilation at night

Acrylic and silicone lenses are very popular

Multifocal lens are now approved by the FDA

Allow for decent uncorrected near and far vision

Increase problems with glare and contrast