Ophthalmic device for drug delivery

Abstract

To provide an ophthalmic device for drug delivery.SOLUTION: An ophthalmic implant for drug delivery is provided. The implant includes a primary intracapsular device coupled to a secondary device. When implanted in a patient's eye, the primary intracapsular device is held in place by the patient's capsular bag, and the secondary device is held in place by the primary intracapsular device. The implant may be inserted in the eye by injecting the primary intracapsular device into the eye either before or after attaching the secondary device to the primary intracapsular device, and subsequently positions the joined secondary device and primary intracapsular device with the primary intracapsular device held in place by the patient's capsular bag and with the secondary device held in place by the primary intracapsular device. The secondary device may be designed to hold a tertiary device that can be implanted and attached at the time of surgery or anytime postoperatively.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] FIELD OF THE INVENTION The present invention relates to ophthalmic devices for drug delivery. [Background technology]

[0002] Ophthalmic devices can be implanted in a patient's eye to treat, diagnose, monitor, or otherwise benefit ocular or systemic diseases or conditions. For example, an intraocular device may be implanted in the eye to deliver steroids, NSAIDs, or antibiotics after cataract removal or other intraocular surgery. An intraocular device may also be implanted in the eye for long-term drug delivery, such as in the treatment of glaucoma. Alternatively, an intraocular device may mechanically alter light transmission to a patient's eye, for example, in the treatment of astigmatism or to improve vision, or the intraocular device may act as an artificial iris in certain cases.

[0003] There are drawbacks associated with the existing ophthalmic devices described above, including trauma to the eye tissue related to device movement, which can lead to anterior capsule opacification, loss of capsular integrity, deformation of the capsular bag shape, capsular narrowing over time, lens tilt and decentration, and other undesirable effects if the ophthalmic device is not properly stabilized. Summary of the Invention [Problem to be solved by the invention]

[0004] There is a need or desire for an intraocular device that can be implanted in a patient's eye that minimizes collateral tissue damage. Additionally, there is a further need or desire for an intraocular device that can be implanted in a patient's eye that provides lens stabilization. [Means for solving the problem]

[0005] As described herein, the ocular implant includes a primary intracapsular device coupled to a secondary device, and when implanted in a patient's eye, the primary intracapsular device is held in place by the patient's capsular bag, and the secondary device is held in place by the primary intracapsular device. Both the primary intracapsular device and the secondary device may be positioned within the capsular bag of the patient's eye. Alternatively, the primary intracapsular device may be positioned within the capsular bag, while the secondary device may be positioned extracapsularly within the patient's eye, with the patient's anterior capsule or a portion of the patient's anterior capsule positioned between the primary intracapsular device and the secondary extracapsular device. The secondary device may be designed to hold a tertiary device that can be implanted either during the initial surgery or at any time thereafter. Insertion of the ocular implant into a patient's eye results in partial or total compression of the anterior capsule against the primary intracapsular device, thereby achieving essential lens stability.

[0006] The primary intracapsular device may be an intraocular lens, a capsular tensioning ring, or a lens scaffold to hold the secondary device in place. The secondary device may be in the form of, for example, a ring, one or more partial rings, or a protrusion. The secondary device may be secured to one or more extensions extending from the primary device. Alternatively, the primary device may be secured to one or more extensions extending from the secondary device.

[0007] The secondary device may be a drug delivery device that delivers one or more active pharmaceutical ingredients capable of treating an eye condition. The secondary device may include a housing that houses one or more drug delivery devices and one or more drugs. Additionally or alternatively, the secondary device may be an optical mask that can control the amount of light entering the patient's eye.

[0008] The tertiary device may be in the form of, for example, a ring or one or more partial rings and may include a housing housing one or more drug delivery devices and one or more drugs. The tertiary device may deliver drugs, function as an artificial iris, or resolve dysphotopsia. Additionally or alternatively, the tertiary device may be an optical mask capable of controlling the amount of light entering the patient's eye.

[0009] As described herein, methods for treating eye conditions using ocular implants include introducing a primary intracapsular device and a secondary device into the eye either before or after attaching a secondary device to the primary intracapsular device. As described above, both the combined primary intracapsular device and the secondary device may be positioned within the capsular bag of the patient's eye, with the secondary intracapsular device being positioned between the patient's anterior capsule and the primary intracapsular device. Alternatively, the primary intracapsular device may be positioned within the capsular bag, while the secondary device may be positioned extracapsularly within the patient's eye, with the patient's anterior capsule or a portion of the patient's anterior capsule being positioned between the primary intracapsular device and the secondary extracapsular device. Furthermore, tertiary devices may be implanted and attached at any time during or after surgery.

[0010] To explain how the above-mentioned advantages and features, as well as other advantages and features, are obtained, a more particular description will be given, and reference will be made to specific examples which are illustrated in the accompanying drawings. Embodiments will be described and explained with additional specificity and detail through the use of the accompanying drawings, with the understanding that such drawings illustrate typical examples only and are not therefore to be considered limiting of the scope thereof. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 is a perspective view of an intraocular lens having a supracascular extension. [Figure 2] FIG. 2 is a perspective view of a secondary device that can be secured to the suprapascular extension of FIG. 1. [Figure 3] 1 is a perspective view of one embodiment of an intraocular device attached to the capsular bag. [Figure 4] 10 is a perspective view of another embodiment of an intraocular device attached to the capsular bag. [Figure 5] FIG. 10 is a perspective view of yet another embodiment of an intraocular device attached to the capsular bag. [Figure 6] 6 is another perspective view of the intraocular device of FIG. 5. [Figure 7] FIG. 7 is a side view of the intraocular device of FIGS. 5 and 6. [Figure 8] FIG. 10 is a perspective view of another embodiment of an intraocular lens having an extension portion. [Figure 9] 10 is a cross-sectional view of yet another embodiment of an intraocular lens having an extension portion. [Figure 10] FIG. 1 is a plan view of a ring-shaped secondary device. [Figure 11] FIG. 10 is a plan view of a partial ring configuration secondary device. [Figure 12] FIG. 12 is a cross-sectional view of either FIG. 10 or FIG. 11. [Figure 13] FIG. 1 is a perspective view of another embodiment of an intraocular device. [Figure 14] FIG. 14 is a cross-sectional view of FIG. 13. [Figure 15] 15A-15C illustrate various embodiments of the intraocular device of FIG. 14. [Figure 16] 15A-15C illustrate various embodiments of the intraocular device of FIG. 14. [Figure 17] 15A-15C illustrate various embodiments of the intraocular device of FIG. 14. [Figure 18] 15A-15C illustrate various embodiments of the intraocular device of FIG. 14. [Figure 19] 15A-15C illustrate various embodiments of the intraocular device of FIG. 14. [Figure 20] 15A-15C illustrate various embodiments of the intraocular device of FIG. 14. [Figure 21] 15A-15C illustrate various embodiments of the intraocular device of FIG. 14. [Figure 22] 15A-15C illustrate various embodiments of the intraocular device of FIG. 14. [Figure 23] 1A and 1B show perspective views of embodiments of intraocular devices having non-circular inner periphery shapes. [Figure 24] 1A and 1B show perspective views of embodiments of intraocular devices having non-circular inner periphery shapes. [Figure 25] 1A and 1B show perspective views of embodiments of intraocular devices having non-circular inner periphery shapes. [Figure 26] 1A and 1B show perspective views of embodiments of intraocular devices having non-circular inner periphery shapes. [Figure 27] FIG. 1 is a perspective view of another embodiment of an intraocular device. [Figure 28] FIG. 28 is a perspective view of the intraocular device of FIG. 27 with a tertiary device. [Figure 29] FIG. 29 is a perspective view of the intraocular device of FIG. 28 with an additional tertiary device. [Figure 30] FIG. 1 is a perspective view of another embodiment of an intraocular device. [Figure 31] FIG. 10 is a perspective view of yet another embodiment of an intraocular device. [Figure 32] FIG. 10 is a perspective view of another embodiment of a primary intracapsular device. [Figure 33] FIG. 10 is an implantation diagram of another embodiment of an intraocular device. [Figure 34] FIG. 34 is a plan view of the secondary device of FIG. 33. [Figure 35] FIG. 1 is a plan view of one embodiment of interlocking components of an intraocular device. [Figure 36] FIG. 1 is a plan view of one embodiment of interlocking components of an intraocular device. [Figure 37] FIG. 10 is a plan view of another embodiment of an intraocular device. [Figure 38] FIG. 1 is a perspective view of another embodiment of an intraocular device. [Figure 39] FIG. 10 is a perspective view of yet another embodiment of an intraocular device. [Figure 40] FIG. 1 is a perspective view of another embodiment of an intraocular device. [Figure 41] FIG. 1 is a plan view of an intraocular scaffold. [Figure 42] FIG. 10 is a plan view of another embodiment of an intraocular device. [Figure 43] FIG. 43 is a side view of the intraocular device of FIG. 42. [Figure 44] FIG. 10 is a perspective view of yet another embodiment of an intraocular device. [Figure 45] FIG. 45 is another perspective view of the intraocular device of FIG. 44. DETAILED DESCRIPTION OF THE INVENTION

[0012] The above drawings are not necessarily drawn to scale. Similarly, some components and / or operations may be separated into different blocks or combined into a single block for purposes of illustrating some embodiments of the present technology. Moreover, while the present technology is susceptible to various modifications and alterations, specific embodiments are shown in the drawings for purposes of illustration and will be described in detail below. However, the intention is not to limit the present technology to the specific embodiments described. On the contrary, the present technology is intended to cover all modifications, equivalents, and alternatives falling within the scope of the present technology as defined by the appended claims.

[0013] As described herein, an ophthalmic device is implantable in a patient's eye to treat, diagnose, monitor, or otherwise benefit an ocular or systemic disease or condition. The ophthalmic device includes a primary device coupled to a secondary device. In each of the embodiments, the primary device is implanted within the patient's capsular bag. The primary intracapsular device is held in place by the capsular bag, while the secondary capsular device is held in place at least in part by the primary intracapsular device. A tertiary device may be held in place by a secondary device and can reside entirely within the capsular bag, partially inside and partially outside the capsular bag, or entirely above the capsular bag.

[0014] According to one embodiment, the primary intracapsular device is positioned inside the patient's lens capsule, and the secondary device is a secondary extracapsular device positioned outside the patient's lens capsule in the patient's eye. The primary intracapsular device may be tethered to the secondary extracapsular device, with the secondary extracapsular device moving from the intracapsular attachment to the superior surface of the capsule. When implanted in the patient's eye, the primary intracapsular device is held in place by the patient's lens capsule, the secondary extracapsular device is held in place by the primary intracapsular device, and the patient's anterior capsule, or a portion thereof, is positioned between the primary intracapsular device and the secondary extracapsular device. The secondary extracapsular device may be at least partially held in place by the anterior capsule. Placement of the ocular implant in the patient's eye can result in partial or total compression of the anterior capsule, or a portion thereof, against the primary intracapsular device, thereby achieving essential lens stability.

[0015] By holding the secondary extracapsular device in place on the anterior lens capsule in the patient's eye, the ophthalmic device may also create space between the secondary extracapsular device and the iris, ciliary sulcus tissue, and / or zonules. This placement of the secondary extracapsular device prevents abrasions or other discomfort caused by friction between the secondary extracapsular device and ocular tissue. The placement of the secondary extracapsular device may also reduce or prevent positive and negative dysphotopsias associated with the edge of the intraocular lens by stabilizing the incision capsular bag, thereby eliminating optical effects from the incision capsular bag or the edge of the intraocular lens. The extension portion associated with the secondary extracapsular device may also serve as a reservoir to hold a drug in place, with or without controlled elution rates.

[0016] According to another embodiment, the primary intracapsular device is placed within the patient's capsular bag, and the secondary device is a secondary intracapsular device coupled to the primary intracapsular device and similarly placed within the patient's capsular bag within the patient's eye. The tertiary device may be held in place by the secondary intracapsular device and can reside entirely within the capsular bag, partially inside and partially outside the capsular bag, or entirely above the capsular bag. In particular, the secondary intracapsular device is positioned between the primary intracapsular device and the anterior capsule of the patient's eye within the capsular bag. In this way, the intraocular device is positioned to receive the tertiary device without the need to manipulate the primary or secondary intracapsular device. Unless otherwise specified, the secondary devices described in the following embodiments may be either intracapsular or extracapsular secondary devices.

[0017] As shown in FIG. 1, according to certain embodiments, an intraocular device 20 includes a primary intracapsular device 23 in the form of an intraocular lens (IOL) 22 or optic. As will be described in more detail below, according to one embodiment, the primary intracapsular device 23 may be comprised of an intraocular lens (IOL) and other devices. For example, the primary intracapsular device 23 may be a capsular tension ring or a capsular scaffold. Various configurations may be used to couple the secondary device to the primary intracapsular device 23. As shown in the embodiment of FIG. 1, the primary intracapsular device 23 may include one or more extensions 26 extending from the anterior capsule side 24 of the intraocular lens 22. These extensions 26 may be used to couple the secondary device to the primary intracapsular device 23.

[0018] The intraocular lens 22 may be held in place in the capsular bag of the patient's eye using intraocular lens haptics 28 or other suitable attachment devices. When the intraocular lens 22 is implanted in the patient's eye, one or more extensions 26 extending from the anterior capsule side 24 of the intraocular lens 22 may each be at least partially intracapsular and terminate either below or above the anterior capsule position of the lens capsule in the patient's eye. In embodiments in which one or more extensions 26 terminate above the anterior capsule position of the lens capsule, each of the one or more extensions 26 may similarly be partially epicapsular.

[0019] One or more extensions may extend from the primary intracapsular device to engage the secondary extracapsular device, thereby sandwiching the anterior capsule between the primary intracapsular device and the secondary extracapsular device. If the anterior capsule is not sandwiched in this manner, it may deform at the supracapsular pressure point, causing anterior capsule opacification, loss of capsular integrity, deformation of the capsular shape, narrowing of the capsular bag over time, tilt and decentration of the lens, and other potential undesirable side effects. Furthermore, the placement of the primary intracapsular device and the secondary extracapsular device, when combined, may stabilize the capsular bag. In particular, applying pressure to the capsular bag edge between the primary intracapsular device and the secondary extracapsular device can stabilize the capsular bag edge while preventing narrowing, while also acting as a barrier to cellular growth from the anterior capsule to the anterior surface of the optical device.

[0020] One or more extensions may extend from the primary intracapsular device to engage the secondary intracapsular device, thereby coupling the primary intracapsular device to the secondary intracapsular device and positioning the secondary intracapsular device between the primary intracapsular device and the anterior capsular bag. The tertiary device may be held in place by the secondary device and can reside entirely within the capsular bag between the secondary intracapsular device and the anterior capsular bag, partially inside and partially outside the capsular bag, or entirely above the capsular bag.

[0021] As an alternative to the above-described embodiment, rather than extensions 26 extending from intraocular lens 22, one or more extensions 26 may extend from secondary device 30 for engaging primary intracapsular device 23.

[0022] The extensions 26 may be in the form of tabs, hooks, wedges, rings, flats with indentations, pins, polygons, or other configurations adapted to receive a secondary extracapsular or intracapsular device, or, when extending from a secondary device, may be adapted to receive a primary intracapsular device. As shown in FIG. 1 , the extensions 26 may be tabs, in this case diametrically opposed and facing away from the center of the intraocular lens 22. Alternatively, the extensions 26 may be tabs or indentations facing toward the center of the intraocular lens 22 (not shown). According to certain embodiments, the extensions 26 are deformable to facilitate manipulation during attachment of a secondary extracapsular or intracapsular device. In certain embodiments, flexibility in the extensions 26 may further be beneficial during insertion of the intraocular device 20 into a patient's eye, such that the primary intracapsular device 23 can be bent and the extensions 26 can hold the primary intracapsular device 23 in a bent position to facilitate insertion.

[0023] As shown in FIG. 2 , the secondary device 30 may be secured to the primary intracapsular device 23. As described above, the secondary device 30 may be positioned over the anterior capsule of the lens capsule within the patient's eye, such that the secondary extracapsular device 30 and extension 26 are positioned over the lens capsule. The secondary extracapsular device 30 may be positioned in contact with or directly over the anterior capsule without contacting any structure other than the extension 26. Any other structure in this case refers to the iris, ciliary sulcus tissue, and / or zonules. In particular, the secondary device 30 may be secured to one or more tabs positioned outside the visual axis of the intraocular lens 22. The secondary extracapsular or intracapsular device 30 may be non-permanently attached to the extension 26 so that the secondary device 30 can be replaced as desired or required. According to certain embodiments, the secondary device 30 may be biodegradable.

[0024] The secondary extracapsular or intracapsular device 30 may be virtually any device secured anteriorly or posteriorly to the lens capsule to treat, diagnose, monitor, or otherwise benefit an ocular or systemic disease or condition. The secondary device 30 may perform optical device functions, including refractive correction and presbyopia correction, such as providing extended depth of focus. For example, the secondary device 30 may be a drug delivery device, an optical mask, a pinhole mask, a refractive mask, a toric mask, a multifocal mask, a trifocal mask, an opaque occluding surface, a partial occluding surface, and / or an dysphotopsia ring. In certain cases, the secondary device 30 may act as an artificial iris, for example, in cases of trauma to the iris or in cases of congenital albinism or aniridia. The secondary device 30 may be any suitable shape, such as a ring, partial ring, ring segment, multi-ring segment, or polygon.

[0025] In one embodiment, the secondary device 30 may be inserted into the eye and positioned above the anterior capsule 36, with one or more extensions 26 positioned below the anterior capsule 36 to stabilize the secondary device 30 in place before introducing the primary intracapsular device 23 directly into the capsular bag through an opening in the secondary device 30. In this embodiment, the primary intracapsular device 23 may further secure the secondary device 30 within the supracavular space by one or more supracavular or intracapsular extensions 26.

[0026] As another technique to aid in the placement of the secondary device 30 on the intraocular lens 22 or scaffold, the extension 26 and secondary device 30 may be color-coded to aid in proper placement. In particular, if the extension 26 and secondary device 30 are color-coded, the secondary device 30 may be positioned on the extension 26 to reveal or hide a particular color that indicates proper placement of the secondary device 30 in the supracausal region of the extension 26. According to certain embodiments, other portions of the primary intracapsular device 23 may be color-coded along with the secondary device 30 instead of, or in addition to, the extension 26 to aid in proper visualization and placement of the secondary device 30 relative to the primary intracapsular device 23.

[0027] 3 shows the secondary extracapsular device 30 with the intraocular lens 22 and haptics 28 residing within the capsular bag 32 and secured to the extension 26 over the anterior capsule of the capsular bag 32. After the intraocular lens 22 is implanted and the extension 26 is positioned within the anterior capsule 36, the attached secondary extracapsular device 30 may reside along the remaining anterior capsule 36 of the capsular bag 32 after a 4.5 mm to 7 mm capsulotomy. Attachment of the secondary extracapsular device 30 to the intraocular lens 22 presses the secondary extracapsular device 30 against the anterior capsule 36, which may be pressurized between the secondary extracapsular device 30 and the intraocular lens 22, thereby creating an improved barrier to anterior capsule opacification (ACO).

[0028] Additionally, the primary intracapsular device 23 and / or the secondary extracapsular or intracapsular device 30 may include fenestrations or openings to allow evacuation of viscoelastic from the capsular bag 32 immediately after surgery. Without such fenestrations or openings, the viscoelastic may displace the lens and cause refractive errors. In addition to providing an evacuation route for viscoelastic to exit the capsular bag 32 immediately after surgery, the fenestrations or openings may also serve to increase the surface area of ​​the secondary device 30 for regulating drug elution if the secondary device 30 is a drug delivery device.

[0029] In FIG. 4 , the secondary extracapsular device 30 is a pinhole mask. According to certain embodiments, the pinhole can be turned on or off to provide partial or 0% transmittance to reduce the effects of astigmatism. Also, according to certain embodiments, when the pinhole mask is placed on the implanted intraocular lens 22, the mask may be movable in the xy plane to optimally position the pinhole relative to the center of the pupil. In the case of retinal surgery, if the pinhole obstructs the view, the mask may be removed. The pinhole may also be constructed of a material that is transparent to non-visible light (e.g., infrared light), so that scanning imaging devices commonly used in ophthalmology, such as optical coherence tomography (OCT) devices, can still image the posterior pole through the mask. According to some embodiments, the materials used for the primary intracapsular device 23 and / or the secondary device 30, respectively, may include materials that are partially or entirely opaque to OCT imaging to assist in image-guided docking.

[0030] 5, 6, and 7 show various views of one embodiment of an intraocular device 20 implanted in a capsular bag 32. In this embodiment, the primary intracapsular device 23 is a one-piece mechanism that forms an intracapsular scaffold 34 with an extracapsular extension 26. The scaffold 34 may be formed in one piece, as shown, or in multiple pieces. As shown in the figures, the intraocular lens may be omitted, and the intracapsular scaffold 34 and its extracapsular extension 26 may secure the secondary device 30 in place. According to certain embodiments, the scaffold 34 may reside entirely within the ciliary sulcus. In another embodiment, a capsular tension ring may also serve as the intracapsular scaffold 34 from which the extracapsular extension 26 may extend. In yet another embodiment, the secondary device 30, which may be a drug delivery device, may be attached to a sulcus anchoring ring, sulcus anchoring optic, or similar device, such that the entire device resides in the plane of the ciliary sulcus without extending into the capsular bag 32.

[0031] In the side view of Figure 7, the anterior capsule 36 of the lens capsule 32 is clearly shown, with the supracalloral extension 26 extending above the anterior capsule 36 and holding the secondary device 30 in place above the anterior capsule 36, while the intraocular scaffold 34 is positioned within the lens capsule 32.

[0032] A secondary extracapsular or intracapsular device 30, such as one in the form of a ring or partial ring, may include one or more ridges 38 on its inner or outer surface or micropattern that help secure the secondary device 30 in place on the extension 26. For example, the micropattern on the secondary device 30 may be attached to a corresponding micropattern on the extension 26. Additionally or alternatively, the extension 26 may include one or more step features 40, as shown in FIG. 8, that help secure the extension 26 to the secondary device 30. The embodiment shown in FIG. 8 is identical to the embodiment shown in FIG. 1, but with the addition of an additional step feature 40 on the extension 26. In particular, the additional step feature 40 in FIG. 8 helps maintain the secondary device 30 away from the anterior capsule 36 of the capsular bag 32. The anterior capsule 36 may be positioned below the step feature 40, as shown in FIG. 9. Alternatively, the step feature 40 may be positioned below the anterior capsule 36. This step feature 40 may be present only under the extension 26, or may be continuous 360° or partially around the circumference of the intraocular device 20. According to certain embodiments, ridges and / or micropatterns may be present on any surface of the extension 26 and / or secondary device 30 to help secure the extension 26 to the secondary device 30.

[0033] 9 is a cross-sectional view of the intraocular device 20 attached to the lens capsule 32. In this embodiment, the intraocular scaffold 34 aligns with the anterior capsule 36 attached within the capsulorhexis or capsulorhexis. The intraocular scaffold 34 is open midsection and lacks a lens. As mentioned above, the step feature 40 on the anterior capsule helps the secondary device 30 maintain contact with the anterior capsule 36, thereby eliminating the possibility of adhesion.

[0034] According to certain embodiments, a micropatterned surface may be present on the secondary device 30 and / or the intraocular lens 22 and / or the intraocular scaffold 34 to reduce the surface area available for contact with the anterior capsule 36. The micropattern on the secondary device 30 may also allow for an increased surface area for eluting a drug. In particular, the use of a micropattern on the secondary device 30 is a way to modulate the release rate of a drug when the secondary device 30 is a drug delivery device.

[0035] In one embodiment, the anterior extension 26 from the intraocular lens 22 or scaffold 34 to the anterior capsule 36 positions the secondary device 30 between the anterior capsule 36 and the iris without contacting anything other than the anterior extension 26 from the intraocular lens 22 or scaffold 34.

[0036] The secondary device 30 may be in the form of a ring, as shown in Figure 10, a partial ring, as shown in Figure 11, or one or more ring segments. A cross-sectional view of one embodiment of the secondary device 30 taken along line AA in either Figure 10 or Figure 11 is shown in Figure 12, not necessarily to scale.

[0037] One advantage of using a partial ring or ring segment rather than a full ring as the secondary device 30 is that the partial ring can be more easily manipulated both during installation and removal of the secondary device 30. In particular, the partial ring can be wrapped in place around the extension 26 without the need to stretch over or apply pressure under the extension 26, as would be necessary if a full ring were used. Also, when a partial ring or ring segment rather than a full ring is used as the secondary device 30, the partial ring can be removed from the extension 26 by grasping one free end and unwinding the device in a direction that moves the ring away from the extension 26, essentially freeing the device from the extension 26 without the need to stretch or apply pressure to deflect the device. This is believed to be less traumatic than removing a full ring and reduces movement of the optical device during the ring exchange process when a new ring needs to be installed due to completion of drug elution.

[0038] The ring or partial ring may include nitinol wire or Prolane suture material, which allows the ring to be securely wrapped in place. In particular, the nitinol wire or Prolane suture material can guide the folding and unfolding of the ring to improve connection with the primary intraocular device. This allows the ring to assume a configuration that biases it to bend in one direction when compressed or stretched. The nitinol wire or Prolane suture material thereby improves placement of the secondary device 30 in the supracascular extension 26.

[0039] According to certain embodiments, secondary device 30 may have one or more indentations or other pre-formed regions that aid in bending or folding and unfolding of secondary device 30 in a controlled manner at specific points along the body of secondary device 30 in connection with positioning secondary device 30 relative to extension 26 and / or primary intracapsular device 23.

[0040] As another technique for controlling the bending or folding and deployment of the intraocular device 20 during insertion, the primary intracapsular device 23 and the secondary device 30 may be formed from different materials that deploy at different rates. This difference in material facilitates placement of the primary intracapsular device 23 within the capsule and the secondary extracapsular device 30 outside the capsule. Suitable materials include essentially any polymeric material suitable for implantation in the eye, including, but not limited to, acrylic and non-acrylic polymers, silicone materials, and hydrogels. These materials may be hybrid hydrophobic, hydrophilic, or various polymers in various ratios to achieve the appropriate modulus required for a particular application.

[0041] The thickness of the secondary device 30 gradually decreases toward the inner diameter 50 of the ring or partial ring, as shown in FIG. 12. Similarly, the thickness of the secondary device 30 gradually decreases toward the outer diameter 52 of the ring or partial ring, as shown in FIG. 12, to avoid iris tissue overlying this area during normal iris movement. As shown in FIG. 12, the thickness of the ring or partial ring gradually decreases from the central portion of the body to both the inner diameter 50 and the outer diameter 52, with the thickness of the secondary device 30 being smallest along the inner diameter 50 and the outer diameter 52 and the thickness of the secondary device 30 being largest between the inner diameter 50 and the outer diameter 52 of the ring or partial ring. This wedge shape allows the secondary device 30 to slide toward the optic fixation point of the primary intracapsular device 23 or extension portion. This is because the narrowest portion of the inner diameter 50 or outer diameter 52 of the ring or partial ring fits into the widest opening of the wedge of the extension portion 26, as shown in FIGS. 13-21, depending on whether the corresponding wedge of the extension portion is facing inward or outward. These complementary wedge shapes also secure the anterior capsule 36 to the primary intracapsular device 23 or optic more securely than certain non-wedge configurations.

[0042] Figure 13 shows an intraocular device 20 with a secondary device 30 in place on the primary intracapsular device 23 and secured by the supracavular extension 26. Figure 14 is a cross-sectional view of the intraocular device 20 of Figure 13 taken along line BB. Figures 15-21 are cross-sectional views of various embodiments of the intraocular device 20 of Figure 13 taken along line BB. In each of these embodiments, the secondary device 30 may be a ring or partial ring.

[0043] 14 and 15 each illustrate an embodiment in which the thickness of the secondary device 30 tapers in a wedge shape toward the inner diameter 50 of the ring, with the corresponding wedge shape of the suprapascular extension 26 facing outward. The complementary wedge shapes of the secondary device 30 and suprapascular extension 26 sandwich the anterior capsule 36 between the primary intracapsular device 23 and the secondary device 30, achieving a stable configuration in which the primary intracapsular device 23 is bonded to the secondary device 30.

[0044] The intraocular device 20 of FIG. 16 is very similar to the embodiment shown in FIG. 15, except that in FIG. 16 the secondary device 30 decreases in thickness toward the inner ring diameter 50 and decreases in thickness toward the outer ring diameter 52, forming wedges along each edge, with the thickness of the secondary device 30 being greatest between the inner ring diameter 50 and the outer ring diameter 52.

[0045] In FIG. 17 , secondary device 30 has a corrugated surface configuration along the body of the ring. This corrugation can coordinate with a corresponding shape on suprapascular extension 26. This particular corrugation is only one embodiment of a corrugation. Other corrugations may also be used. For example, suprapascular extension 26 in FIG. 17 has inwardly facing wedges, and the corrugated surface configuration of secondary device 30 has wedges that mate with the wedges on the suprapascular extension. Alternatively, suprapascular extension 26 may have outwardly facing wedges, and the corrugated surface configuration of secondary device 30 may have wedges that mate with the wedges on the suprapascular extension, e.g., in the opposite configuration from FIG. 17 .

[0046] The intraocular device 20 of Figure 18 is very similar to the embodiment shown in Figure 15, except that in Figure 18 the primary intracapsular device 23 includes a step feature 40 similar to the step feature 40 shown in Figures 8 and 9. However, unlike the embodiment shown in Figure 9, the step feature 40 in Figure 18 is positioned within the capsular bag 32, below the anterior capsule 36. This step feature 40 may help secure the extension 26 relative to the secondary device 30.

[0047] The intraocular device 20 of Figure 19 is very similar to the embodiment shown in Figure 15, except that in Figure 19 the secondary device 30 includes a nitinol or plastic ring 54 that can be used as a drug delivery device, as described in more detail below.

[0048] The intraocular device 20 of Figure 20 is also very similar to the embodiment shown in Figure 15, except that in Figure 20, the secondary device 30 includes a micropattern 56 on its bottom surface. The micropattern 56 may reduce the surface area available for contacting the anterior capsule 36, while at the same time helping to secure the secondary device 30 in place.

[0049] When multiple secondary devices 30 are connected to the suprapascular extension 26, the secondary devices 30 may be stacked either radially, as shown in FIG. 21, or vertically, as shown in FIG. 22. According to some embodiments, the first innermost or bottommost ring may contact the extension 26, while subsequent rings may either be stacked against the first ring or similarly connect directly to the extension 26. This configuration allows for the delivery of different therapeutic agents using multiple rings, as needed. In some embodiments, the rings may have gaps between them when stacked, allowing each ring to be easily accessed with a surgical tool, such as a Sinskey hook, to remove each ring from its docked position without undue manipulation.

[0050] According to certain embodiments, secondary device 30 may have a non-circular inner periphery and / or a non-circular outer periphery. Alternative inner periphery shapes allow the ring to be placed over extensions 26 without stretching the ring by aligning the ring's largest or larger inner diameter 50 with extensions 26 and then rotating the ring relative to extensions 26 until the ring's smaller inner diameter 50 is aligned with extensions 26, thereby securing the ring in place with applied pressure. Similarly, alternative outer periphery shapes allow the ring to be placed between inward extensions 26 without applying pressure to the ring by aligning the ring's smallest or smaller outer diameter 52 between extensions 26 and then rotating the ring relative to extensions 26 until the ring's larger diameter 50 is aligned between extensions 26, thereby securing the ring in place with applied pressure.

[0051] The secondary device 30 may be elliptical, thereby securing to one or more tabs or other features of the extension 26 when rotated clockwise or counterclockwise after placement on the already implanted intraocular lens 22. For example, the long side of the elliptical ring may form wings that can be pulled up onto the capsular bag, and the short side of the elliptical ring may include fenestrations that can be secured to the extension 26. This configuration facilitates introducing the intraocular device into the capsular bag after pulling the wings up onto the anterior capsule with a Sinskey hook or similar device. Alternatively, the short side of the elliptical ring may be coaxial with the haptics 28, allowing the haptics 28 to be open and visible and easily enter the capsular bag because the ring does not obstruct the view of the open haptics 28 in the capsular bag.

[0052] For example, as shown in Figures 23 and 24, the inner diameter 50 of the secondary device 30 may be elliptical in combination with the outwardly facing extensions 26. In Figure 23, the largest inner diameter 50 of the elliptical ring is aligned with the extensions 26. In Figure 24, the ring has been rotated so that the smaller inner diameter 50 of the ring is aligned with and held in place by the extensions 26. If the outer diameter 52 of the secondary device 30 is elliptical with the extensions 26 facing inward, the smallest outer diameter 52 of the elliptical ring can be aligned between the extensions 26, and then the ring is rotated to align the larger outer diameter 52 between the extensions 26 in a stable and secure interlocking configuration.

[0053] As another example, Figures 25 and 26 show the inner diameter 50 of a secondary device 30 having a hexagonal shape in conjunction with outwardly facing extensions 26. In Figure 25, the largest inner diameter 50 of the hexagonal ring is aligned with the extensions 26. In Figure 26, the ring has been rotated so that the smaller inner diameter 50 of the ring is aligned with and held in place by the extensions 26. As in the embodiment above, if the extensions 26 are inwardly facing and the outer diameter 52 of the secondary device 30 is hexagonal, the smallest outer diameter 52 of the hexagonal ring can be aligned between the extensions 26, and then the ring is rotated to align the larger outer diameter 52 between the extensions 26 in a stable and secure interlocking configuration.

[0054] The intraocular device 20 may include one or more of the features described above designed to secure the secondary device 30 and extension 26. For example, in the embodiment shown in Figures 23-26, the inner diameter 50 of the ring may include a micropattern to improve fixation after rotation into place.

[0055] Rather than using extensions 26 to secure secondary device 30 to primary intracapsular device 23, according to certain embodiments, secondary device 30 can be directly coupled to primary intracapsular device 23 by snap-fitting and / or adhesive. In such embodiments, primary intracapsular device 23 can essentially be a conventional intraocular lens 22, with secondary device 30 being separately formed and then attached to intraocular lens 22. In the embodiment shown in FIG. 27, secondary device 30 is in the form of two part rings or ring segments. Each of the ring segments may have a snap fit or other mechanical fit to primary intracapsular device 23, or the ring segments may be secured to primary intracapsular device 23 using an adhesive.

[0056] The secondary device 30 may be designed to hold a tertiary device 39 that can be implanted either during the initial surgery or at any time after surgery. The tertiary device 39 may be in the form of a ring or one or more partial rings, for example, and may include a sheath that houses one or more drug delivery devices and one or more drugs. Ideally, the intraocular device 20 is positioned to receive the tertiary device 39 without the need to manipulate the primary intracapsular device 23 or the secondary intracapsular device 30.

[0057] As described above, the secondary device 30 may be a drug delivery device. For example, the secondary device 30 of FIG. 27 may contain one or more drugs, such as in a drug pad integrated with the secondary device 30, and release the one or more drugs over time after the intraocular device 20 is fully implanted in the lens capsule. After the initial drug in the secondary device 30 is fully released, a new drug supplement in the form of a tertiary device 39, which may be in the form of a ring or other suitable shape, can be implanted to fit into the recesses in the two opposing parts of the secondary device 30. If the tertiary device 39 is a drug contained within a ring, as shown in FIG. 28, the tertiary device 39 can be held in place by elastic forces within the recess in the secondary device 30. The tertiary device 39 may be a conventional circular ring, or it may be formed in other shapes that can extend beyond the outer diameter of the optic to utilize some of the space not present in the secondary device 30.

[0058] Tertiary device 39 may be essentially any device secured to secondary device 30 to treat, diagnose, monitor, or otherwise benefit an ocular or systemic disease or condition. Like secondary device 30, tertiary device 39, if present, may perform optical device functions, including refractive and presbyopic correction, such as extending depth of focus and resolving dysphotopsia. For example, tertiary device 39 may be a drug, drug delivery device, optical mask, pinhole mask, refractive mask, toric mask, multifocal mask, trifocal mask, opaque occluding surface, partial occluding surface, and / or dysphotopsia ring. In certain cases, tertiary device 39 may serve as an artificial iris, for example, in cases of trauma to the iris or in cases of congenital albinism or aniridia. Tertiary device 39 may have any suitable shape, such as a ring, partial ring or ring segment, multiple ring segments, or polygonal.

[0059] Figure 29 shows the intraocular device 20 of Figure 28 with a tertiary device 39 attached on top of the secondary device 30. In this particular embodiment, the tertiary device 39 is in the form of a drug pad. The drug pad of the tertiary device 39 can be placed over a ring segment of the secondary device 30, as shown. Alternatively, the tertiary device 39 can be placed over part or all of the secondary device 30.

[0060] As shown in Figures 27-29, when secondary device 30 is a secondary intracapsular device, tertiary device 39, held in place by the secondary intracapsular device, can be positioned either within the lens capsule below the anterior capsule of the patient's eye, or outside the lens capsule with the anterior capsule of the patient's eye positioned between the tertiary device and the secondary intracapsular device, or partially within the lens capsule and partially above the anterior capsule of the patient's eye.

[0061] The secondary device 30 itself can extend both below and above the primary intracapsular device 23 as a means of coupling the secondary device 30 to the primary intracapsular device 23, as shown in FIG. 30 . Such attachment can be used with the secondary device 30 in the form of one or more ring segments, as well as in the form of a full ring, as shown in FIG. 30 . FIG. 31 shows another embodiment in which the secondary device 30 extends both below and above the primary intracapsular device 23, but in this embodiment, the secondary device 30 is in the form of a full ring on the anterior side of the primary intracapsular device 23, with ring segments extending around the posterior side of the primary intracapsular device 23. According to certain embodiments, the primary intracapsular device 23 may be integrally molded, cut, printed, or otherwise fabricated with the secondary device 30, and optionally with a tertiary device 39. For example, the primary intracapsular device 23 and the secondary intracapsular device 30 may be formed together in a single structure, or the primary intracapsular device 23 and the secondary extracapsular device 30 may be formed together in a single structure. Additionally or alternatively, the secondary device 30 may be coupled to the primary intracapsular device 23 by one or more extensions 26 or haptics 28 extending from the primary intracapsular device 23 through one or more holes in the secondary device 30.

[0062] Figure 32 shows one embodiment of a primary intracapsular device 23 that can be coupled to a secondary device 30. In Figure 32, the intraocular device 20 includes a flare 27 at the optic device haptics coupling on each of opposite sides of the primary intracapsular device 23 that act as supracavular extensions. Any of the above-described embodiments of secondary device 30 can be held in place by the flare 27.

[0063] FIG. 33 shows one embodiment of a secondary device 30 coupled to a primary intracapsular device 23 implanted in a patient's eye. The secondary device 30 is shown in more detail in FIG. 34. As shown in FIG. 34, the pad 33 on the secondary device 30 can be reinforced or more rigid than the rest of the secondary device 30, thereby providing a proper location when secured to the extension 26. For example, the pad 33 can be formed from an impermeable material while the rest of the secondary device 30 is permeable. However, the pad may include some surface areas that are permeable or impermeable. Alternatively, the entire pad 33 may be permeable. The degree of permeability is controlled by the surface area, the mix of permeable and impermeable areas, and the permeability of the particular material forming the outer structure of the pad 33.

[0064] 35 and 36 both show another embodiment for coupling a secondary device 30 to a primary intracapsular device 23. In FIG. 35, the primary intracapsular device 23 includes extensions 26 each having an aperture 25. In FIG. 36, the secondary device 30 includes protrusions 31. The secondary device 30 can be coupled to the primary intracapsular device 23 by aligning the ring of the secondary device 30 over the primary intracapsular device 23 and rotating the ring counterclockwise to fit the protrusions 31 into the corresponding apertures 25 for improved attachment. This embodiment may be modified to accommodate clockwise rotation as well. This embodiment may also be modified with corresponding protrusions 31 extending from the apertures and extensions 26 on the secondary device 30.

[0065] The primary intracapsular device 23 of FIG. 35 can also be used in combination with a ring-shaped secondary device 30. In particular, if holes 25 extend entirely through each extension 26, a ring can be secured to the extension 26 through the holes 25, thereby forming a full circle connected by glue or other adhesive, and cannot be removed from the suprapascular extension 26 without cutting the ring in one or more areas. Similarly, as shown in FIG. 37, the ring can be held in place under the extension 26. Alternatively, just as the ring can be fed through the holes 25 of the extension 26 of FIG. 35, the ring can be fed through the loops of the extension 26 of FIG. 37. To be able to feed the ring through the loops or holes, the ring must be opened or cut for assembly, and then the ends must be reattached by adhesive, hooks, an interference fit, or any other suitable form of reconnecting the ends of the ring to one another.

[0066] Additionally, secondary device 30 can be coupled to primary intracapsular device 23 using magnetic forces. For example, one or more magnets can be provided on extension 26, which can be aligned with a corresponding one or more magnets on secondary device 30. The magnetic forces can secure secondary device 30 in place on primary intracapsular device 23.

[0067] As described above, the secondary device 30, and optionally the tertiary device 39, may be configured to administer a therapeutic agent selected from the group consisting of beta-blockers, alpha-agonists, prostaglandin analogs, pilocarpine, rock inhibitors, ethacrynic acid, CNP / BNP / ANP, carbonic anhydrase inhibitors, steroids, NSAIDs, antibiotics, biological therapeutic agents, tetrahydrocannabinol (THC), cannabinol (CBD), cannabinoids, or other molecules derived from cannabis plants, small or large molecule active ingredients, antifibrotic agents, miotics, mydriatics, antineoplastic agents, 11-epi-PGF, 2αThe secondary device 30 may also serve as a drug delivery device for holding and releasing active pharmaceutical ingredients for treating the eye, such as ophthalmic solutions, and / or other active ingredients capable of treating eye diseases. For example, the secondary device 30 may provide long-term drug delivery, such as for treating glaucoma or macular degeneration, or short-term delivery of steroids, NSAIDs, or antibiotics after intraocular surgery. The secondary device 30 and tertiary device 39 may also be used to deliver biological or non-biological molecules for the treatment of any disease or disorder. If a patient requires multiple types of treatment, the secondary device 30 and tertiary device 39 may contain multiple drugs.

[0068] According to some embodiments, the secondary device 30 may include a sheath that may contain a tertiary device 39 in the form of a drug delivery device, as shown in FIGS. 38 and 39. FIG. 38 illustrates the sheath, and FIG. 39 illustrates the drug delivery device contained within the sheath. In particular, the drug delivery device embedded in the silicone shell of the secondary device 30 may be designed to enhance pressure or attachment to the supracavular or intracapsular extension from the primary intracapsular device 23 to enhance lens stability by the coefficient of the drug delivery sheath. After the initial drug contained within the sheath is depleted, a new drug delivery device can be implanted in the sheath. Furthermore, the sheath may contain drug delivery devices capable of containing multiple drugs. Optionally, the sheath may contain multiple drug delivery devices.

[0069] In some embodiments, the ring sheath may have a surface area that is impermeable to water or drugs, thereby allowing more surface area to be used to improve attachment of the sheath to the extension, but not as much surface area for elution.

[0070] According to certain embodiments, the secondary device 30 may include a refillable reservoir. This reservoir can be refilled with a fluid or solid. For example, the reservoir may be refilled every 6 to 12 months after the drug in the reservoir diffuses through the reservoir wall, either by Fickian or non-Fickian diffusion, through micropores, a "wetting balloon" mechanism, or any other suitable method for eluting the drug. As another example, the reservoir may receive a solid pellet, such as a sustained-release biodegradable implant, and hold the pellet in place while it degrades. In this case, the reservoir does not need to be flow-regulated. The entire reservoir may be formed from a nitinol mesh or prolene suture material, which may allow for pellet placement and maintaining the pellet in place during elution. Holding the pellet in place may prevent the pellet from damaging intraocular tissue, such as the lining of the cornea.

[0071] FIG. 40 illustrates a secondary device 30 in the form of a refillable reservoir. In particular, this secondary device 30 includes a drug-delivery bleb reservoir 42. The reservoir 42 may include a docking port 44 for refilling the reservoir 42. The reservoir 42 may be formed of a polymer or other suitable material. The docking port 44 is an entry point for refilling the reservoir 42 with either a fluid or a solid. The docking port 44 may be a one-way valve or a flexible door, depending on the drug and its intended release. For example, the docking port 44 may resemble a Hickman catheter port. A ring portion of the secondary device 30 may or may not be included in combination with the drug-delivery bleb reservoir 42.

[0072] Another embodiment of a primary device in the form of an intraocular scaffold 34 is shown in FIG. 41. In this embodiment, the intraocular scaffold 34 resides entirely in the supracavular space. In particular, after the scaffold 34 is implanted on the anterior capsule 36, the secondary device 30 attaches to one or more support features 46, which may take the form of tabs, hooks, wedges, rings, or flats with indentations, pins, polygonal, or other configurations adapted to receive the secondary device 30. The one or more stabilizing features 48 that provide stability in the ciliary sulcus may take the form of haptics, as shown in FIG. 41, or any other suitable attachment feature that couples with surrounding tissue other than the ciliary sulcus. In one form, the device shown in FIG. 41 may attach to the anterior capsule 36 using a clip, and portions of the clip may extend both above and below the anterior capsule 36.

[0073] Methods for implanting and using the intraocular device 20 described herein can be performed using currently known surgical procedures. According to one embodiment, a primary intracapsular device 23, such as the device shown in FIGS. 42 and 43, can be introduced into a patient's eye. The primary intracapsular device 23 can be held in place and stabilized by haptics 28 extending from the primary intracapsular device 23 or any other suitable device for securing the primary intracapsular device 23 within the lens capsule. A secondary device 30 can then be implanted in the patient's eye and attached to the primary intracapsular device 23, such as using an extension 26 extending from the anterior side of the primary intracapsular device 23. Alternatively, the secondary device 30 can include retention features that can penetrate beyond the anterior capsule surface into the lens capsule and attach to an already implanted primary intracapsular device 23, which itself has complementary attachment features. The combined secondary device and primary intracapsular device 23 can then be placed inside the patient's eye, with the extension 26 terminating above the location of the anterior capsule 36 of the lens capsule 32 in the patient's eye as an suprapascular extension 26, with the primary intracapsular device 23 being held in place by the lens capsule of the patient's eye and the secondary device being held in place by the primary intracapsular device 23.

[0074] According to another embodiment, the secondary device 30 can be attached to the primary intracapsular device 23, such as using the extension 26. The combined secondary device 30 and primary intracapsular device 23 can then be introduced into the patient's eye, with the primary intracapsular device 23 held in place by the patient's eye's lens capsule and the secondary device 30 held in place over the anterior capsule 36 by the primary intracapsular device 23. According to certain embodiments, the secondary device 30 may be positioned between the anterior capsule 36 and the iris, without the secondary device contacting either the anterior capsule 36 or the iris. Alternatively, the combined secondary device 30 and primary intracapsular device 23 can be introduced into the patient's eye, with both the primary intracapsular device 23 and the secondary device 30 positioned entirely within the patient's lens capsule.

[0075] As shown in Figure 44, haptics 28 from primary intracapsular device 23 can be placed in the gap between primary intracapsular device 23 and secondary device 30 and introduced as a single assembly. When introduced into the patient's eye, secondary device 30 is supported by the anterior capsule, and then surgical manual displacement of haptics 28 causes haptics 28 to slide out of the slots and open in the capsular bag, as shown in Figure 45. One or more gaps between primary intracapsular device 23 and secondary device 30 can be formed by textures or micropatterns on the bottom surface of secondary device 30 facing primary intracapsular device 23.

[0076] The tertiary device 39 can be attached to the secondary device 30 either before or after the intraocular device 20 is implanted in the patient's eye. Because the tertiary device 39 can be easily attached to the secondary device 30, if the intraocular device 20 is already implanted, the tertiary device 39 can be attached to the secondary device 30 without having to manipulate the primary intracapsular device 23 or the secondary device 30.

[0077] Implantation of intraocular device 20 can be performed during or after intraocular surgery, such as cataract surgery. In particular, after a cataract lens has been removed, primary intracapsular device 23 can be implanted with haptics, allowing extension 26 to extend from primary intracapsular device 23 through the opening where the cataract was removed.

[0078] As described above, the secondary device 30 can be used to treat, diagnose, or monitor ocular or systemic diseases or conditions. For example, the secondary device 30 can be used for long-term drug delivery, short-term drug delivery, and / or delivery of biological or non-biological molecules to the eye. In certain embodiments, the secondary device can include a refillable reservoir that can be filled with a fluid or solid. Additionally, the secondary device 30 can be used as an artificial iris. If necessary or advantageous, the secondary device 30 can be removed. Also, if necessary or advantageous, after removal, the secondary device 30 can be replaced with another secondary device 30 of the same type or another secondary device 30 deemed more effective under similar conditions. Similarly, the tertiary device 39 can be used to treat, diagnose, or monitor ocular or systemic diseases or conditions.

[0079] Advantages of the intraocular device 20 described herein include the ability to treat, diagnose, monitor, or otherwise benefit an ocular or systemic disease or condition with minimal residual discomfort in the patient's eye, while providing essential lens stability. The description and figures contained herein depict specific embodiments to teach those skilled in the art how to best select and use them. For the purpose of teaching the principles of the invention, some conventional aspects have been simplified or omitted. Those skilled in the art will appreciate variations from the above-described embodiments that fall within the scope of the invention. Those skilled in the art will also appreciate that the above-described features can be combined in various ways to form multiple embodiments. Consequently, the present invention is not limited to the specific embodiments described above, but is limited only by the claims and their equivalents.

Claims

1. 1. An ophthalmic implant comprising: a primary intracapsular device coupled to a secondary device, wherein, when implanted in a patient's eye, the primary intracapsular device is held in place by the lens capsule of the patient's eye and the secondary device is held in place by the primary intracapsular device.

2. 10. The ocular implant of claim 1, wherein the primary intracapsular device includes one or more extensions, each at least partially intracapsular, that couple the secondary device to the primary intracapsular device.

3. The ocular implant of claim 1 , wherein when implanted in the patient's eye, both the primary intracapsular device and the secondary device are positioned within the capsular bag of the patient's eye.

4. The ocular implant of claim 1 further comprising a tertiary device held in place by the secondary intracapsular device.

5. 10. The ophthalmic implant of claim 1, wherein, when implanted in a patient's eye, the primary intracapsular device is positioned within the lens capsule and the secondary device is a secondary extracapsular device positioned outside the lens capsule within the patient's eye.

6. 10. The ocular implant of claim 1, wherein the secondary device is coupled to the primary intracapsular device by one or more extensions or haptics extending from the primary intracapsular device through one or more holes in the secondary device.

7. 10. The ocular implant of claim 1, wherein the secondary device is coupled to the primary intracapsular device by one or more extensions or haptics extending from the primary intracapsular device through one or more holes in each of the one or more extensions or haptics.

8. 10. The ocular implant of claim 1, wherein the secondary device is coupled to the primary intracapsular device with a protrusion extending from the secondary device that fits into a hole in the one or more extensions of the primary device.

9. The ocular implant of claim 1 , wherein the primary intracapsular device (1) is selected from the group consisting of an intraocular lens, a capsular tension ring, and a capsular scaffold.

10. The ocular implant of claim 1 , wherein the secondary device is selected from the group consisting of a ring, a partial ring, and multiple partial rings.

11. 10. The ocular implant of claim 1, further comprising a tertiary device coupled to the secondary intracapsular device, the tertiary device being selected from the group consisting of a ring, a partial ring, and a plurality of partial rings.

12. 10. The ophthalmic implant of claim 1, further comprising a tertiary device coupled to the secondary device, the tertiary device comprising at least one device selected from the group consisting of a drug, a drug delivery device, a polygon, an optical mask, a pinhole mask, a refractive mask, a toric mask, a multifocal mask, a trifocal mask, an opaque shading surface, a partial shading surface, and a dysphotopsia limiting ring.

13. 10. The ocular implant of claim 1, wherein the secondary device comprises at least one device selected from the group consisting of a drug delivery device, a polygon, an optical mask, a pinhole mask, a refractive mask, a toric mask, a multifocal mask, a trifocal mask, an opaque shading surface, a partial shading surface, and a dysphotopsia limiting ring.

14. 10. The ocular implant of claim 1, wherein the secondary device is a pinhole mask, the pinhole in the mask being capable of being turned on and off.

15. 10. The ocular implant of claim 1, further comprising a tertiary device coupled to the secondary device, the tertiary device being a pinhole mask, the pinhole in the mask being capable of being turned on and off.

16. The ocular implant of claim 1, wherein the secondary device and / or the tertiary device held in place by the secondary device includes a sheath containing a drug delivery device, and a new drug delivery device can be embedded in the sheath after the initial drug contained in the sheath is depleted.

17. 1. A method of implanting and using an ocular implant, comprising: introducing a primary intracapsular device into the patient's eye; introducing a secondary device into the patient's eye; attaching the secondary device to the primary intracapsular device; placing the combined secondary device and primary intracapsular device in the patient's eye with the primary intracapsular device held in place by the lens capsule of the patient's eye and the secondary device held in place by the primary intracapsular device; and a method comprising:

18. 20. The method of claim 17, comprising attaching the secondary device to the primary intracapsular device prior to introducing the primary intracapsular device and the secondary device into the patient's eye, and introducing the combined secondary device and primary intracapsular device into the patient's eye.

19. 20. The method of claim 17, comprising the steps of separately introducing the primary intracapsular device and the secondary device into the patient's eye, and attaching the secondary device to the primary intracapsular device while both the secondary device and the primary intracapsular device are in the patient's eye.

20. 20. The method of claim 17, comprising placing the primary intracapsular device inside the capsular bag and the secondary device outside the capsular bag in the patient's eye.

21. 20. The method of claim 17, comprising placing both the primary intracapsular device and the secondary device inside the capsular bag of the patient's eye.

22. 20. The method of claim 17, further comprising attaching a tertiary device to the secondary device.

23. 20. The method of claim 17, comprising using the secondary device and / or a tertiary device attached to the secondary device to treat, diagnose, or monitor an ocular or systemic disease or condition.

24. 18. The method of claim 17, comprising using the secondary device and / or a tertiary device attached to the secondary device for drug delivery.

25. 20. The method of claim 17, comprising using the secondary device and / or a tertiary device attached to the secondary device to deliver a biomolecule to the eye.

26. 18. The method of claim 17, comprising using the secondary device and / or a tertiary device attached to the secondary device as an artificial iris.

27. 20. The method of claim 17, comprising using the secondary device and / or a tertiary device attached to the secondary device to provide a pinhole of partial or 0% light transmission.

28. 20. The method of claim 17, wherein the secondary device and / or a tertiary device attached to the secondary device includes a refillable reservoir, the method including filling the refillable reservoir with a fluid or solid.

29. 20. The method of claim 17, comprising removing and replacing the secondary device and / or a tertiary device attached to the secondary device.

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