Modular intraocular lenses and bases for modular intraocular lenses

Abstract

To provide modular IOL removal systems and methods.SOLUTION: Modular IOL removal systems and methods cut an optic portion of an intraocular lens in a single motion so as to facilitate removal of the optic portion from an eye through an incision, for example a corneal incision, without increasing the size of the corneal incision. Various cutting tools having one or more blades may be utilized. The cut intraocular lens may have one continuous cut or be cut into multiple smaller pieces. The single cutting step may apply balanced force and torque to avoid damaging the surrounding eye anatomy, reducing the risk of trauma.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The present disclosure relates generally to intraocular lenses (IOLs). More specifically, the present disclosure relates to modular IOL designs, methods and associated instrumentation embodiments. [Background technology]

[0002] The human eye functions to provide vision by transmitting light through a clear outer portion called the cornea and focusing an image onto the retina by means of the lens. The quality of the focused image depends on many factors, including the size and shape of the eye and the transparency of the cornea and lens.

[0003] When the lens becomes less transparent (e.g., clouded) due to age or disease, vision decreases due to the reduced light that can be transmitted to the retina. This defect in the eye's lens is medically known as a cataract. The accepted treatment for this condition is the surgical removal of the lens from the capsular bag and the placement of an artificial intraocular lens (IOL) within the bag. In the United States, the majority of cataractous lenses are removed by a surgical procedure called phacoemulsification. During this procedure, an opening (capsulorhexis) is made in the front of the lens capsule and a thin phacoemulsification cutting tip is inserted into the diseased lens and vibrated ultrasonically. The vibrated cutting tip liquefies or emulsifies the lens so that it can be aspirated from the capsule. Once removed, the diseased lens is replaced with an IOL.

[0004] After cataract surgery to implant an IOL, the optical result may be suboptimal or may require adjustment over time. For example, shortly after the procedure, it may be determined that the refractive correction is incorrect, resulting in what is sometimes called a "refractive surprise." Also, for example, some time after the procedure, it may be determined that the patient needs or desires a different correction, such as a stronger refractive correction, an astigmatism correction, or a multifocal correction.

[0005] In each of these cases, the surgeon may be reluctant to attempt removal of a suboptimal IOL from the capsule and replacement with a new IOL. Generally, manipulation of the capsule to remove the IOL risks inflicting damage to the capsule, including posterior rupture. This risk increases over time as the capsule collapses around the IOL and tissue ingrowth surrounds the haptics of the IOL. Thus, it would be desirable to be able to correct or modify the optical outcome without having to remove the IOL or manipulate the capsule.

[0006] To address the aforementioned disadvantages, various secondary lenses have been proposed. For example, one solution includes a secondary lens that resides anterior to the capsular bag with haptics that engage the ciliary sulcus. While this design has the advantage of avoiding manipulation of the capsular bag, its main disadvantage is engaging the ciliary sulcus. The ciliary sulcus is composed of soft vascular tissue that is easily damaged upon engagement by haptics or other materials. Such damage can result in complications such as bleeding, inflammation, and hyphema. Thus, it is generally desirable to avoid placing a secondary lens in the ciliary sulcus to avoid the risk of complications.

[0007] Another possible solution may include a lens system that avoids the potential problems associated with the ciliary sulcus. The lens system may include a primary lens and a secondary lens, the secondary lens attached to the primary lens, both of which may be located within the capsular bag. The primary lens may have a recess into which the edge of the secondary lens is inserted. The recess is preferably located radially outside the opening of the capsular bag (capsulorhexis) so as not to interfere with the transmission of light. To attach the secondary lens in situ, the capsule must be manipulated around the capsulorhexis to gain access to the recess in the primary lens. As mentioned above, manipulation of the capsule may be undesirable given the risks associated therewith. Thus, although such lens systems may avoid the possibility of damaging the ciliary sulcus by implanting both the primary and secondary lenses within the capsule, these systems do not avoid manipulation of the capsule to attach the secondary lens. Summary of the Invention [Problem to be solved by the invention]

[0008] Thus, there is a need for an IOL system and method that allows for correction or modification of the optical result using a lens that can be attached to a base or primary lens, without the need to manipulate the capsular bag. [Means for solving the problem]

[0009] An embodiment of the present disclosure provides a modular IOL system including an intraocular primary element and a secondary element that, when combined, form an intraocular optical correction device. The primary element may comprise an intraocular base, and the secondary element may comprise an intraocular lens. The base is configured to releasably receive the intraocular lens. In some embodiments, the base may be configured as a lens, in which case the modular IOL system may be described as comprising a primary lens and a secondary lens. The primary element (e.g., base or primary lens) may be placed in the capsular bag using conventional cataract surgery techniques. The primary element may have a diameter larger than the diameter of the capsular incision to hold the primary element in the capsular bag. The secondary element (e.g., secondary lens) may have a diameter smaller than the diameter of the capsular incision such that the secondary element may be attached to the primary element without manipulating the capsular bag. The secondary element may also be manipulated intraoperatively or postoperatively to correct or modify the optical result without the need to remove the primary element and without the need to manipulate the capsular bag. For example, the secondary element may be removed, repositioned, and / or replaced to correct, modify, and / or fine-tune the optical result.

[0010] Common indications for replacing the secondary element may be residual refractive error (e.g. for monofocal lenses), dispersion disorder due to post-operative healing (e.g. for multifocal lenses), surgically induced astigmatism disorder (e.g. for toric lenses), changes in optical correction requirements due to progressive disease, changes in optical correction needs due to lifestyle changes, injury, age, etc.

[0011] The primary element may have haptics (e.g., protrusions) extending therefrom for centration within the capsular bag, while the secondary element may not have haptics, relying instead on attachment to the primary element for stability. The secondary element may be radially inward of the periphery of the capsular incision, thereby eliminating the need to disturb the capsular bag to manipulate or replace the secondary element. The attachment between the primary and secondary elements may be radially inward of the periphery of the capsular incision and radially outward of the field of view, so as not to interfere with light transmission. Alternatively or additionally, the attachment may include a small portion (e.g., less than 20%) of the periphery of the secondary element, so as to minimize the possibility of interfering with light transmission.

[0012] The primary element may have a front surface in intimate contact with the rear surface of the secondary element to prevent fluid ingress, tissue ingrowth, and / or optical interference. For example, the secondary element may be removably secured to the primary element by mechanical attachment and / or chemical attraction. Mechanical attachment may be facilitated by mating or interlocking geometries corresponding to each of the primary and secondary elements. Such geometries may be preformed, for example, by molding or cutting, or may be formed in situ, for example, by laser etching. Chemical attraction may be facilitated, for example, by using similar materials with smooth surface finishes activated by surface treatments. In some cases, it may be desirable to reduce chemical attraction and rely more on mechanical attachment for stabilization. In this case, the primary and secondary elements may be formed from dissimilar materials or may otherwise have adjacent surfaces that do not have chemical attraction.

[0013] In general, the primary element (base or primary lens) can be delivered in a rolled form into the lens capsule through a capsulorhexis with a delivery tube inserted through a corneal or scleral incision. The primary element can be released from the delivery tube and expanded inside the lens capsule. The secondary element (lens) can also be delivered in a rolled form by release from the delivery tube and expanded in front of the primary element. With gentle manipulation, the secondary element can be centered relative to the primary element and attached to the primary element by an attachment mechanism.

[0014] The secondary element may be removed and replaced with a replacement secondary element, such as a replacement lens, having a different optical correction. First, the secondary element may be separated from the primary element so that it is in front of the primary element. The secondary element may be removed from the eye through the same corneal incision used to implant the modular IOL without increasing the size of the incision. This may be done by folding the secondary element before removing it through the incision, or by cutting the secondary element so that it has a width smaller than the incision. A cannula or delivery tube may be used to facilitate this removal. The IOL may be removed as a single piece or in multiple pieces.

[0015] The cutting and removing method may use one continuous cutting path or multiple cutting paths. A surgical cutting instrument may be used to create a variety of cutting patterns. The cutting path may be linear or non-linear. The cutting step may be simultaneous with the removing step. For example, the secondary element may be cut as it is extracted through the cannula.

[0016] The surgical cutting instrument and removal method may apply a balanced force and / or torque on the secondary lens to minimize movement of the secondary lens during cutting. This minimizes or avoids anterior-posterior forces on the lens capsule, preventing capsule rupture. The removal method may prevent bending of the secondary lens in the posterior-posterior direction ("tenting") and / or rotation of the secondary lens to further avoid trauma to the lens capsule. The cut may be a "clean cut" to avoid creating small fragments, foreign bodies, or serrated edges.

[0017] In one embodiment, a cutting tool may be used to cut the secondary lens into two or more pieces. The cutting pattern may be, for example, a horseshoe shape. The cutting tool may be a scissor-like punch. Alternatively, the cutting tool may comprise a retractable cutting base configured to extend either above or below the secondary lens. The cutting tool may also comprise a dual-edge blade having two cutting surfaces configured to sandwich the secondary lens against the retractable cutting base. As the cutting base retracts into the cutting tool, the dual-edge blade may cut the secondary lens along a side of the secondary lens opposite the cutting base. Alternatively, the dual-edge blade may extend toward the cutting base, cutting the secondary lens as the blade extends.

[0018] In a related embodiment, an extendable gripper may replace the cutting base such that the secondary lens is fixed along the length of the cutting path during the cutting process, during which the dual edge blade extends towards the gripper to cut the secondary lens.

[0019] In another embodiment, a cutting instrument may be used to cut a curved "spiral" or "J-shaped" cut pattern in the secondary lens. The cutting instrument may be scissor-like with curved blades. The cut secondary lens may rotate or "spiral" as the lens is pulled through the corneal incision or cannula.

[0020] In another embodiment, the secondary lens may be cut as it is removed from the anterior chamber. A cannula having a distal cutting surface may be inserted into the anterior chamber through a corneal incision. Forceps or other suitable grasping instrument may be extended through the cannula to grasp an edge of the secondary lens and pull the secondary lens into the cannula. As the secondary lens is pulled into the cannula, it passes the cutting surface and is cut or "peeled." The secondary lens rotates as it is pulled into the cannula and may be removed from the anterior chamber through the corneal incision.

[0021] Modular IOL systems, instruments, and methods according to embodiments of the present disclosure may be applied to a variety of IOL types, including fixed monofocal, multifocal, toric, accommodative, and combinations thereof. In addition, modular IOL systems, instruments, and methods according to embodiments of the present disclosure may be used to treat large optical errors, ectopia lentis, aphakia, pseudophakia, and nuclear sclerosis, for example, in cataract, myopic (near-sighted), hyperopic (far-sighted), and astigmatic eyes.

[0022] Various other aspects of the embodiments of the present disclosure are set forth in the following detailed description and the drawings. The drawings illustrate examples of embodiments of the present disclosure, the drawings are not necessarily to scale, may include similar elements numbered identically, and may include, by way of example, but not necessarily by way of limitation, dimensions (in millimeters) and angles (in degrees). [Brief description of the drawings]

[0023] [Figure 1]Schematic diagram of the human eye shown in cross section. [Figure 2A] 1A and 1B are front and side cross-sectional views, respectively, of a modular IOL positioned within a capsular bag in accordance with an embodiment of the present disclosure. [Figure 2B] 1A and 1B are front and side cross-sectional views, respectively, of a modular IOL positioned within a capsular bag in accordance with an embodiment of the present disclosure. [Figure 3A] 1A and 1B are front and side cross-sectional views, respectively, that are schematic illustrations of a method of implanting a modular IOL according to an embodiment of the present disclosure. [Figure 3B] 1A and 1B are front and side cross-sectional views, respectively, that are schematic illustrations of a method of implanting a modular IOL according to an embodiment of the present disclosure. [Figure 3C] 1A and 1B are front and side cross-sectional views, respectively, that are schematic illustrations of a method of implanting a modular IOL according to an embodiment of the present disclosure. [Figure 3D] 1A and 1B are front and side cross-sectional views, respectively, that are schematic illustrations of a method of implanting a modular IOL according to an embodiment of the present disclosure. [Figure 4A] 1A and 1B are front and side cross-sectional views, respectively, that are schematic illustrations of a method of implanting a modular IOL according to an embodiment of the present disclosure. [Figure 4B] 1A and 1B are front and side cross-sectional views, respectively, that are schematic illustrations of a method of implanting a modular IOL according to an embodiment of the present disclosure. [Figure 4C] 1A and 1B are front and side cross-sectional views, respectively, that are schematic illustrations of a method of implanting a modular IOL according to an embodiment of the present disclosure. [Figure 4D] 1A and 1B are front and side cross-sectional views, respectively, that are schematic illustrations of a method of implanting a modular IOL according to an embodiment of the present disclosure. [Diagram 5] FIG. 2 is a front view of a modular IOL according to an embodiment of the present disclosure in which a subsurface attachment mechanism is provided for connection between the primary lens and the secondary lens. [Figure 6A] 6 is a cross-sectional view taken along line 6-6 of FIG. 5 showing two embodiments of a subsurface attachment mechanism. [Figure 6B] 6 is a cross-sectional view taken along line 6-6 of FIG. 5 showing two embodiments of a subsurface attachment mechanism. [Figure 7] FIG. 2 is a front view of a modular IOL according to an embodiment of the present disclosure in which an extension attachment mechanism is provided to connect the primary lens and the secondary lens. [Figure 8A] 8A-8C are cross-sectional views taken along line 8-8 of FIG. 7 showing three embodiments of extension attachment mechanisms. [Figure 8B] 8A-8C are cross-sectional views taken along line 8-8 of FIG. 7 showing three embodiments of extension attachment mechanisms. [Figure 8C] 8A-8C are cross-sectional views taken along line 8-8 of FIG. 7 showing three embodiments of extension attachment mechanisms. [Figure 9A] 11A-11C are front views showing various positions of a mounting mechanism for adjusting the position of the secondary lens relative to the primary lens. [Figure 9B] 11A-11C are front views showing various positions of a mounting mechanism for adjusting the position of the secondary lens relative to the primary lens. [Figure 9C] 11A-11C are front views showing various positions of a mounting mechanism for adjusting the position of the secondary lens relative to the primary lens. [Figure 9D] 11A-11C are front views showing various positions of a mounting mechanism for adjusting the position of the secondary lens relative to the primary lens. [Figure 10] FIG. 2 is a front view of a modular IOL according to an embodiment of the present disclosure, in which an etched subsurface attachment feature is provided for connection between the primary and secondary lenses. [Figure 11A] 11A-11C are cross-sectional views of the modular IOL shown in FIG. 10 illustrating various embodiments of etched subsurface attachment features. [Figure 11B] 11A-11C are cross-sectional views of the modular IOL shown in FIG. 10 illustrating various embodiments of etched subsurface attachment features. [Figure 11C] 11A-11C are cross-sectional views of the modular IOL shown in FIG. 10 illustrating various embodiments of etched subsurface attachment features. [Figure 11D] 11A-11C are cross-sectional views of the modular IOL shown in FIG. 10 illustrating various embodiments of etched subsurface attachment features. [Figure 11E]11A-11C are cross-sectional views of the modular IOL shown in FIG. 10 illustrating various embodiments of etched subsurface attachment features. [Figure 11F] 11A-11C are cross-sectional views of the modular IOL shown in FIG. 10 illustrating various embodiments of etched subsurface attachment features. [Figure 12A] 1A-1D are front, cross-sectional and detailed views, respectively, of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 12B] 1A-1D are front, cross-sectional and detailed views, respectively, of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 12C] 1A-1D are front, cross-sectional and detailed views, respectively, of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 13A] Representative photomicrographs at 4x and 40x magnification, respectively, of grooves formed by laser etching (see arrows). [Figure 13B] Representative photomicrographs at 4x and 40x magnification, respectively, of grooves formed by laser etching (see arrows). [Figure 14] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 14A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 14B] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 14C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 15] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 15A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 15B] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 15C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 15D] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 16]1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 16A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 16B] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 16C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 16D] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 17] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 17A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 17B] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 17C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 18] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 18A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 18B] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 18C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 19] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 19A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 19B] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 19C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 19D] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20]1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20B] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20D] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20E] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20F] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20G] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20H] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 20I] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 21] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 21A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 21B] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 21C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 21D] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 21E] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 22] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 22A] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 22B]1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 22C] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 22D] 1A-1D are various views of another modular IOL in accordance with an embodiment of the present disclosure. [Figure 23A] 1 is a schematic diagram of a lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 23B] 1 is a schematic diagram of a lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 23C] 1 is a schematic diagram of a lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 23D] 1 is a schematic diagram of a lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 23E] Schematic diagram of another embodiment of a lens removal system for a modular IOL. [Figure 23F] Schematic diagram of another embodiment of a lens removal system for a modular IOL. [Figure 23G] Schematic diagram of another embodiment of a lens removal system for a modular IOL. [Figure 23H] Schematic diagram of another embodiment of a lens removal system for a modular IOL. [Figure 24] 1 is a schematic flow chart of a method for using a modular IOL according to an embodiment of the present disclosure, where secondary lens exchange is motivated by suboptimal optical results detected intraoperatively. [Diagram 25] 1 is a schematic flow chart of a method for using a modular IOL according to an embodiment of the present disclosure, where secondary lens exchange is motivated by suboptimal optical results detected postoperatively. [Figure 26] 1 is a schematic flow chart of a method for using a modular IOL according to an embodiment of the present disclosure, in which a secondary lens is attached to a primary lens by forming an attachment means in situ. [Figure 27]11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 27A] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 27B] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 27C] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 27D] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 28A] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 28B] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 28C] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 28D] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 28E] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 28F] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 28G] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29A] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29B] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29C] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29D] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29E] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29F]11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29A2] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29B2] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29C2] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29D2] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29E2] 11A-11D are various views of yet another embodiment of a modular IOL according to the present disclosure. [Figure 29G] Anatomy showing the insertion and removal of a modular IOL into the eye. [Figure 29H] Anatomy showing the insertion and removal of a modular IOL into the eye. [Figure 29I] Anatomy showing the insertion and removal of a modular IOL into the eye. [Figure 29J] Anatomy showing the insertion and removal of a modular IOL into the eye. [Figure 29K] Anatomy showing the insertion and removal of a modular IOL into the eye. [Figure 29L] Anatomy showing the insertion and removal of a modular IOL into the eye. [Figure 29M] Anatomy showing the insertion and removal of a modular IOL into the eye. [Diagram 30] 1A and 1B are various views of a further embodiment of a modular IOL according to the present disclosure. [Figure 31A] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31B] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31C] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31D]Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31E] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Fig. 31F] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31G] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Fig. 31H] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Fig. 31I] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31J] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31K] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31L] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31M] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 31N] Schematic diagram of another lens removal system for a modular IOL according to an embodiment of the present disclosure. [Figure 32A] 1 is a schematic diagram of an embodiment of a modular IOL removal system and method. [Figure 32B] 1 is a schematic diagram of an embodiment of a modular IOL removal system and method. [Figure 32C] 1 is a schematic diagram of an embodiment of a modular IOL removal system and method. [Fig. 32D] 1 is a schematic diagram of an embodiment of a modular IOL removal system and method. [Figure 33A] 1 is a schematic diagram of an embodiment of a modular IOL removal system and method. [Figure 33B]1 is a schematic diagram of an embodiment of a modular IOL removal system and method. [Figure 33C] 1 is a schematic diagram of an embodiment of a modular IOL removal system and method. [Figure 33D] 1 is a schematic diagram of an embodiment of a modular IOL removal system and method. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0024] Referring to FIG. 1, a human eye 10 is shown in cross-section. The eye 10 is referred to as a light-responsive organ for several purposes. As a conscious sensory organ, the eye enables vision. The rod and cone cells of the retina 24 enable conscious light perception and vision, including color discrimination and depth perception. In addition, the non-image-forming photosensitive ganglion cells of the human eye within the retina 24 receive light signals that affect the regulation of pupil size, the regulation and inhibition of the hormone melatonin, and the entrainment of the body clock.

[0025] The eye 10 is not exactly a sphere, but rather a fused two-part unit. A smaller, more curved anterior unit called the cornea 12 is associated with a larger unit called the sclera 14. The corneal portion 12 typically has a radius of about 8 mm (0.3 inches). The sclera 14 makes up the remaining 5 / 6ths, and its radius is typically about 12 mm. The cornea 12 and sclera 14 are connected by a ring called the limbus. The cornea 12 is transparent, so instead of the cornea 12, one sees the iris 16, i.e., the color of the eye, and its black central part, the pupil. To see inside the eye 10, an ophthalmoscope is required, as light is not reflected. The fundus (area opposite the pupil), including the macula 28, shows the characteristic pale optic disc (papilla), where the blood vessels entering the eye pass and where the optic nerve fibers 18 exit the eye.

[0026] Thus, the eye 10 is composed of three coatings that encase three transparent structures. The outermost layer is made up of the cornea 12 and the sclera 14. The middle layer is made up of the choroid 20, the ciliary body 22, and the iris 16. The innermost layer is the retina 24. The retina 24 receives its circulation from the blood vessels of the choroid 20 as well as from the blood vessels of the retina, which can be seen in an ophthalmoscope. Within these coatings are the aqueous humor, the vitreous body 26, and the flexible crystalline lens 30. The aqueous humor is a transparent fluid contained in two regions: the anterior chamber, between the cornea 12 and the exposed areas of the iris 16 and crystalline lens 30, and the posterior chamber, between the iris 16 and crystalline lens 30. The crystalline lens 30 is suspended from the ciliary body 22 by the ciliary zonules 32 (zonules of Zinn), which are made up of minute transparent fibers. The vitreous body 26 is a transparent, jelly-like substance that is much larger than the aqueous humor.

[0027] The crystalline lens 30 is a transparent, biconvex structure within the eye that, together with the cornea 12, helps refract light so that it is imaged onto the retina 24. By changing its shape, the crystalline lens 30 functions to change the focal length of the eye so that objects at different distances can be focused on, thereby allowing a sharp, real image of the object of interest to be formed on the retina 24. This adjustment of the crystalline lens 30 is known as accommodation, and is similar to a photographic camera changing focus by moving its lens.

[0028] The lens has three main parts: the lens capsule, the lens epithelium, and the lens fibers. The lens capsule forms the outermost layer of the lens, and the lens fibers form most of the interior of the lens. The cells of the lens epithelium, located between the lens capsule and the outermost layer of lens fibers, are found primarily on the anterior side of the lens, but also extend posteriorly a little past the equator.

[0029] The lens capsule is a smooth, transparent basement membrane that completely surrounds the lens. It is elastic and composed of collagen. It is synthesized by the lens epithelium and its main components are type IV collagen and sulfated glycosaminoglycans (GAGs). It is very elastic and causes the lens to assume a more spherical shape in the absence of tension from the zonular fibers that connect it to the ciliary body 22. The capsule varies in thickness between approximately 2 and 28 micrometers, being thickest near the equator and thinnest near the posterior pole. The capsule may be involved in a higher anterior curvature of the lens than posteriorly.

[0030] Various diseases and disorders of the lens 30 may be treated by the IOL. By way of example, and not necessarily by way of limitation, a modular IOL system according to embodiments of the present disclosure may be used to treat cataracts, myopic (near-sighted), hyperopic (far-sighted), and large optical errors in astigmatic eyes, ectopia lentis, aphakia, pseudophakia, and nuclear sclerosis. For purposes of illustration, however, the modular IOL embodiments of the present disclosure will be described with respect to cataracts.

[0031] The following detailed description describes various embodiments of a modular IOL system comprising an intraocular base configured to releasably receive a primary intraocular element and a secondary intraocular element, i.e., an intraocular lens. In some embodiments, the base may be configured to provide optical correction, in which case the modular IOL system may be said to comprise a primary lens and a secondary lens. Principles and features described with respect to embodiments in which the base is configured for optical correction may be applied to embodiments in which the base is not configured for optical correction, and vice versa. More broadly, features described with respect to any one embodiment may be applied to and incorporated into other embodiments.

[0032] 2A and 2B, the modular IOL system 50 / 60 is shown implanted within the capsular bag 34 of the lens 30 having a capsular incision 36 formed therein. The modular IOL system may include a primary lens 50 and a secondary lens 60. The primary lens 50 may include a body portion 52, a pair of haptics 54 for anchoring and centering the primary lens 50 in the capsular bag 34, and means for attachment to the secondary lens 60 (not shown here, but described below). The secondary lens 60 may include an optic body portion 62, no haptics, and corresponding means for attachment to the primary lens 50 (not shown here, but described below). The anterior surface of the body portion 52 of the primary lens 50 may be in intimate contact with the posterior surface of the body portion 62 of the secondary lens 60 without any intervening material (e.g., adhesive, aqueous humor, tissue ingrowth, etc.) therebetween. For example, the anterior surface of the body portion 52 may be in direct contact with the posterior surface of the body portion 62. To facilitate replacement of the secondary lens 60, the secondary lens 60 may be acutely and chronically releasably attached to the primary lens 50 while the primary lens 50 remains within the capsular bag 34 of the lens 30.

[0033] The body portion 52 of the primary lens 50 may provide some, but less than necessary, refractive correction for an optimal optical result. The optimal optical result may be provided by a combination of the corrections provided by the optical body portion 52 of the primary lens 50 together with the optical body portion 62 of the secondary lens 60. For example, the optical body portion 62 of the secondary lens 60 may modify (e.g., add or subtract) the refractive power (for a single vision correction), toric features (for an astigmatism correction), and / or diffractive features (for a multifocal correction).

[0034] The secondary lens 60 has an outer diameter d1, the capsulotomy 36 has an inner diameter d2, and the body 52 of the primary lens 50 may have an outer diameter d3, in which case d1 < d2 < d3. This configuration provides a gap between the secondary lens 60 and the perimeter of the capsulotomy 36 so that the secondary lens 60 can be attached to and detached from the primary lens 50 without contacting or otherwise disturbing any part of the crystalline lens capsule 34. As an example, and not by way of limitation, assuming the capsulotomy has a diameter of about 5-6 mm, the body of the primary lens (i.e., excluding the haptics) may have a diameter of about 5-8 mm, and the secondary lens may have a diameter of less than about 3-5 mm, thereby providing a radial gap of up to about 1.5 mm between the secondary lens and the perimeter of the capsulotomy. Regardless of this example, any suitable dimensions may be selected to provide a gap between the secondary lens and the perimeter of the capsulotomy to reduce the need to manipulate the crystalline lens capsule in order to attach the secondary lens to the primary lens.

[0035] Referring to FIGS. 3A-3D (front views) and FIGS. 4A-4D (side cross-sectional views), a method for implanting the modular IOL system 50 / 60 is schematically shown. As seen in FIGS. 3A and 4A, the crystalline lens 30 having a cataract includes an opaque or cloudy central portion 38 inside the crystalline lens capsule 34. Access to the crystalline lens 30 for cataract surgery can be provided by one or more lateral incisions in the cornea. For purposes of illustration, the term corneal incision is used throughout this text, but it is to be understood that this includes any suitable incision for providing access to the crystalline lens capsule, including a scleral incision.

[0036] A capsulorhexis (circular hole) 36 may be formed in the anterior lens capsule 34 using manual instruments or a femtosecond laser. As seen in Figures 3B and 4B, the opaque central portion 38 is removed by phacoemulsification and / or aspiration through the capsulorhexis 36. The primary lens 50 is delivered in a rolled-up form into the capsular bag 34 using a tube inserted through the capsulorhexis 36. The primary lens 50 is released from the delivery tube and unfolds. Gently, the haptics 54 of the primary lens engage the interior equator of the capsular bag 34 and center the lens body 52 relative to the capsulorhexis 36, as seen in Figures 3C and 4C. The secondary lens 60 is delivered in a rolled-up form using a tube placed with its distal tip in close proximity to the primary lens 50. The secondary lens 60 is released from the delivery tube and unfolds. Gently, the secondary lens 60 is centered relative to the capsulorhexis 36. Next, without manipulating the capsular bag 34 or the primary lens 50, the secondary lens 60 is attached to the primary lens 50, as seen in Figures 3D and 4D. If necessary, the secondary lens 60 may be removed and / or replaced in a similar manner, with the steps reversed if appropriate. Alternatively, the primary lens 50 and secondary lens 60 may be implanted as a single unit, thereby eliminating the delivery step.

[0037] Since it may be difficult to ascertain which side of the secondary lens 60 should face the primary lens 50, the secondary lens may include indicia to indicate the appropriate position. For example, a clockwise arrow may be placed around the periphery of the front surface of the secondary lens 60 that appears as a clockwise arrow when placed right side up and a counterclockwise arrow when placed wrong side up. Alternatively, a two layer color indicia may be placed around the periphery of the front surface of the secondary lens 60 that appears as a first color when placed right side up and a second color when placed wrong side up. Other indicia to indicate position may be used on the secondary lens 60, and a similar indicia scheme may be applied to the primary lens 50.

[0038] With reference to FIG. 5, a subsurface attachment mechanism 70 may be used to releasably secure the secondary lens 60 to the primary lens 50. The attachment mechanism 70 may be located radially inward of the circumference of the capsulotomy 36 and radially outward of the field of view to avoid interfering with light transmission. Alternatively or additionally, the attachment mechanism 70 may be limited in radial and lateral extent to a small portion (e.g., less than 10-20%) of the circumference of the secondary lens 50 to minimize potential interference with light transmission. Although two diametrically opposed attachment mechanisms 70 are shown, any suitable number may be used, evenly or non-uniformly distributed around the secondary lens 60.

[0039] In the event that the primary lens 50 and secondary lens 60 are delivered simultaneously, it may be desirable to align the attachment mechanism 70 with the roll axis 80, about which the lenses 50, 60 may be rolled for insertion by a delivery instrument. By providing the attachment mechanism 70 along the roll axis 80, stress on the attachment mechanism 70 is minimized, since the secondary lens 60 may shift relative to the primary lens 50 when rolled about the axis 80. To this end, the attachment mechanism 70 may be configured to be coaxially aligned with the roll axis 80 and to extend a limited distance from the axis 80 (e.g., less than 10-20% of the circumference of the secondary lens 60).

[0040] The attachment mechanism 70 may be configured to have mating or interlocking shapes as shown in Figures 6A and 6B. In general, the shapes include male and female portions that are releasably connectable. The female portion is configured to receive the male portion and limit relative motion between the primary lens 50 and the secondary lens 60 in at least two dimensions (e.g., up-down and left-right). The female and male portions may be configured to have interlocking shapes to limit relative motion between the primary lens 50 and the secondary lens 60 in three dimensions (e.g., up-down, right-left, front-back). The attachment mechanism 70 may be engaged and disengaged by application of orthogonal forces in the rearward (push) and forward (pull) directions, respectively. For example, the attachment mechanism 70 may be preformed by molding, cutting, etching, or a combination thereof.

[0041] In the example shown, each attachment mechanism 70 includes an interlocking cylindrical projection 72 and a cylindrical recess or groove 74. Other mating or interlocking shapes may be used as well. The cylindrical shape shown has the advantage of allowing some rotation of the secondary lens 60 relative to the primary lens 50 when rolled for delivery, thus further reducing stress thereon. As shown in FIG. 6A, the cylindrical projection 72 may extend forward from the front surface of the body 52 of the primary lens 50, and the cylindrical recess 74 may extend forward through the rear surface of the body 62 of the secondary lens 60 adjacent the radial peripheral area of ​​the secondary lens 60. Alternatively, as shown in FIG. 6B, the cylindrical projection 72 may extend rearward from the rear surface of the body 62 of the secondary lens 60 adjacent the radial peripheral area of ​​the secondary lens 60, and the cylindrical recess 74 may extend rearward through the front surface of the body 52 of the primary lens 50. The configuration shown in FIG. 6B may be particularly suitable where the primary lens 50 is an existing implanted IOL into which a recess 74 can be etched in situ, for example by a laser.

[0042] Referring to FIG. 7, an extended attachment mechanism 90 may be used to releasably connect the primary lens 50 and the secondary lens 60. The extended attachment mechanism 90 may be similar to the subsurface attachment mechanism 70 except as shown and described. The extended attachment mechanism 90 extends radially from the circumference of the secondary lens 60 and may each have mating or interlocking shapes. Examples of these shapes are shown in FIGS. 8A-8C. In FIG. 8A, a cylindrical portion 92 extends from the outer edge of the secondary lens 60 and a cylindrical recess 94 extends from the outer edge of the primary lens 50. In FIG. 8B, a system is shown having a cylindrical portion 92 extending from the outer edge of the primary lens 50 and a cylindrical recess 94 extending from the outer edge of the secondary lens 60. In both the embodiments shown in FIGS. 8A and 8B, the attachment mechanism 90 may be engaged and disengaged by applying normal forces in the forward (push) and rearward (pull) directions, respectively. Alternatively, in the embodiment shown in Figure 8C, the attachment mechanisms 90 may be engaged or disengaged by application of a rotational force in a clockwise or counterclockwise direction, depending on which lens 50 / 60 is attached to the cylindrical portion 92 and cylindrical recess 94, respectively. Additionally, while the embodiment of Figure 7 only illustrates the use of two attachment mechanisms 90, any suitable number of attachment mechanisms 90 may be used within the principles of the present disclosure.

[0043] 9A-9D, the portion of the attachment mechanism 90 associated with the secondary lens 60 may be positioned such that the center of the secondary lens 60 is aligned with the center of the primary lens 50. Alternatively, to accommodate misalignment of the primary lens 50 due to, for example, uneven post-surgical healing, the portion of the attachment mechanism 90 associated with the secondary lens 60 may be biased as shown in FIGS. 9B-9D. In FIG. 9B, the portion of the attachment mechanism 90 associated with the secondary lens 60 is rotationally biased. In FIG. 9C, the portion of the attachment mechanism 90 associated with the secondary lens 60 is upwardly biased. In FIG. 9D, the portion of the attachment mechanism 90 associated with the secondary lens 60 is laterally biased. Anterior-posterior biasing may also be used, as described in more detail in connection with FIGS. 11C and 11F. Each of the embodiments shown in Figures 9B, 9C, 9D, 11C, and 11F are provided as examples, and the bias may be in any direction (forward, backward, up, down, right, left, clockwise, counterclockwise), or combinations thereof, to vary in magnitude in response to misalignment of the primary lens 50. Additionally, while attachment mechanism 90 is shown as an example, the same principles may be applied to other attachment means described herein.

[0044] With reference to FIG. 10, another subsurface attachment mechanism 100 may be used to releasably connect the secondary lens 50 to the primary lens 60. The subsurface attachment mechanism 100 may be similar to the subsurface attachment mechanism 70, except as shown and described. The subsurface attachment mechanism 100 may include a mating or interlocking shape that extends along an arcuate path proximate the periphery of the secondary lens 60. The subsurface attachment mechanism 100 may include a protrusion 102 and a corresponding recess or groove 104 in which the protrusion 102 may be received. As shown in FIG. 11A (separated) and FIG. 11D (attached), the protrusion 102 may extend from the rear surface of the secondary lens 60 and the corresponding recess or groove 104 may extend into the front surface of the primary lens 50. Alternatively, the protrusion 102 may extend from the front surface of the primary lens 50 and the corresponding recess or groove 104 may extend into the rear surface of the secondary lens 60, as shown in FIG. 11B (separated) and FIG. 11E (attached). In either embodiment, the anterior-posterior dimension of the protrusion 102 may match the same dimension as the recess or groove 104 to provide a tight fit between the anterior surface of the primary lens 50 and the posterior surface of the secondary lens 60. Alternatively, the anterior-posterior dimension of the protrusion 102 may exceed the same dimension of the recess or groove 104 to provide anterior-posterior bias, as shown in Figures 11C (separated) and 11F (attached). Moreover, one of ordinary skill in the art will readily appreciate that any suitable number of attachment mechanisms 100 may be used within the principles of the present disclosure.

[0045] Referring to FIG. 12A, another subsurface attachment mechanism 105 may be used to connect the secondary lens 60 to the primary lens 50. The subsurface attachment mechanism 105 may be similar to the subsurface attachment mechanism 100 except as shown and described. As seen in FIG. 12B, a cross-sectional view taken along line BB in FIG. 12A, the subsurface attachment mechanism 105 may comprise a mating or interlocking shape including a protrusion 107 and a series of holes 109 within which the protrusion 107 may be received. The holes 109 may be distributed in a pattern as seen in FIG. 12C, which shows another detailed view of some of box C in FIG. 12A. In FIG. 12C, the protrusions 107 reside in the holes 109 shown as solid circles, while the remaining holes 109 shown as open circles remain open. In this configuration, the protrusions 107 may be placed in a corresponding pair of holes 109 to achieve a desired alignment between the primary lens 50 and the secondary lens 60. For example, with continued reference to FIGURE 12C, protrusions 107 may be positioned in a corresponding pair of holes 109 for centered (reference), shifted right, shifted left, shifted up, shifted down, rotated clockwise, or rotated counterclockwise (labeled C1-C7, respectively) alignment between primary lens 50 and secondary lens 60. This configuration provides a wide range of adjustment as described with respect to FIGURES 9A-9D. Additionally, any suitable number of attachment mechanisms 105 may be evenly or non-uniformly spaced around the circumference of lenses 50, 60.

[0046] All or a portion of the various subsurface attachment means described herein may be formed by molding, cutting, milling, etching, or a combination thereof. For example, with particular reference to FIG. 11A, the groove 104 may be formed by in situ laser etching of an existing implanted primary lens 50, and the protrusions may be pre-formed by molding, milling, or cutting the secondary lens 60.

[0047] Examples of lasers that can be used for in situ etching include femtosecond lasers, titanium / sapphire (ti / saph) lasers, diode lasers, YAG lasers, argon lasers, and other lasers in the visible, infrared, and ultraviolet ranges. Such lasers can be controlled with respect to energy output, spatial control, and temporal control to obtain the desired etching shape and pattern. In situ etching may be performed, for example, by transmitting laser light from an external laser source through the cornea and through the pupil. Alternatively, in situ etching may be performed by transmitting laser light from a flexible fiber optic probe inserted into the eye.

[0048] 13A and 13B, photomicrographs at 4x and 40x magnification, respectively, show how a groove (see arrow) was tentatively etched into the primary lens by laser etching. A femtosecond laser set in the following ranges may be used to etch the groove: power from 1 nJ to 100 uJ, pulse duration from 20 fs to picosecond range, and frequency from 1 to 250 kHz.

[0049] The primary and secondary elements of the modular IOL systems disclosed herein may be formed from the same, similar, or dissimilar materials. Suitable materials include, for example, acrylic materials, silicone materials, hydrophobic or hydrophilic polymers, and such materials may have shape memory properties. For example, the material that makes up the optic portion of the modular lens system may be silicone, PMMA, hydrogel, hydrophobic acrylic, hydrophilic acrylic, or other transparent materials commonly used in intraocular lenses. The non-optical elements of the modular IOL may contain nitinol, polyethylene sulfone, and / or polyimide.

[0050] Materials can be selected to aid in the performance of certain features of the modular lens system, particularly the attachment and separation features required for the primary and secondary lenses as discussed above. Other features of the modular lens that can be improved by the selection of specific materials include manufacturability, intraoperative and postoperative handling, fixation (both intraoperative and postoperative revision), accessibility to small incision sizes (<2.4 mm) and interchangeability (minimal trauma upon lens extraction).

[0051] For example, in one embodiment, the primary and secondary lenses are made from a hydrophobic acrylic material having a glass transition temperature of about 5-300° C. and a refractive index of about 1.41-1.60. In another embodiment, the primary and secondary lenses can be made from different materials having different glass transition temperatures and mechanical properties to aid in the fixation and separation characteristics of the modular system. In another embodiment, both or either of the modular lens systems are made from a material that allows for compression to an outer diameter of about 2.4 mm or less.

[0052] Generally desirable material properties in modular IOL systems include minimal or no glistening, minimal pitting when exposed to YAG laser, and passing standard MEMs elution tests and other industry standard biocompatibility tests. The material may contain various chromophores that enhance the UV blocking ability of the base material. Generally, wavelengths below 400 nm are blocked by standard chromophores at concentrations of 1% or less. Alternatively or in addition, the material may contain blue light blocking chromophores, such as yellow dyes that block the desired region of the blue light spectrum. Suitable materials are generally resistant to damage, such as surface abrasion, cracking, or hazing caused by mechanical trauma during standard implantation procedures.

[0053] The elements of the modular IOL may be formed by conventional techniques such as molding, cutting, milling, etching, or a combination thereof. As an alternative to mechanical attachment, chemical attraction between the primary and secondary elements may be used. Chemical attraction may be promoted by using similar materials with smooth surface finishes. Chemical attraction may be enhanced by surface activation techniques such as plasma or chemical activation. In some cases, it may be desirable to reduce chemical attraction to avoid adhesion between materials and rely more on mechanical attachment for stabilization. In this case, the primary and secondary elements may be formed from dissimilar materials or may otherwise have adjacent surfaces that do not have chemical attraction.

[0054] 14-14C, another modular IOL 140 is shown in front view, cross section, and detailed view, respectively. FIG. 14A shows a cross section taken along line AA in FIG. 14, FIG. 14B shows a cross section taken along line BB in FIG. 14, and FIG. 14C shows a detailed view of circle C in FIG. 14B. The modular IOL 140 may include a primary lens 50 with haptics 54 and a secondary lens 60. The interfacing surfaces of the primary lens 50 (anterior surface) and the interfacing surfaces of the secondary lens 60 (posterior surface) may be in close contact as best shown in FIG. 14A and FIG. 14B. Maintaining close contact (i.e., avoiding gaps) or maintaining a constant gap between the interfacing surfaces of the primary lens 50 and the secondary lens 60 may reduce the possibility of induced astigmatism. However, in some embodiments, a substance (e.g., adhesive) may be disposed between the surfaces of the lenses 50, 60. To form an interference fit between the primary lens 50 and the secondary lens 60, and thus securely connect the two elements, the secondary lens 60 may be formed with an annular extension and the primary lens 50 may be formed with a correspondingly sized and shaped circular recess. The depth of the recess in the primary lens 50 may be a portion of the thickness of the secondary lens 60, and the annular extension of the secondary lens 60 may extend over a portion of the primary lens 50, thereby forming an overlapping connection 142 as best shown in FIG. 14C. The overlapping connection 142 may extend 360 degrees around the secondary lens 60 as shown, or a portion thereof. The annular extension of the secondary lens 60 may rise above the front surface of the primary lens 50 to form a ridge. In some embodiments, the ridge may have a radially tapered configuration. The ridge may be radially compressed with forceps to facilitate connection and separation of the primary lens 50 and the secondary lens 60. Using radial compression to insert the secondary lens 60 into the primary lens 50 reduces the anterior-posterior forces applied to the capsular bag during insertion, thereby reducing the risk of capsule rupture.

[0055] 15-15D, another modular IOL 150 is shown in front view, cross section, and detailed view, respectively. FIG. 15A shows a cross section taken along line AA in FIG. 15, FIG. 15B shows a cross section taken along line BB in FIG. 15, and FIG. 15C shows a detailed view of circle C in FIG. 15B. FIG. 15D shows another detailed view of circle C in FIG. 15B. The modular IOL 150 may include a primary lens 50 with haptics 54 and a secondary lens 60. The interface (anterior surface) of the primary lens 50 and the interface (posterior surface) of the secondary lens 60 may be in close contact as best shown in FIG. 15A and FIG. 15B. The primary lens 50 may include a recess defining a wall within which a correspondingly sized and shaped circular secondary lens 60 may be placed. The wall defined by the recess in the primary lens 50 may extend around the entire circumference of the primary lens except for two diametrically opposed cavities 152. Thus, the void 152 exposes the periphery of the secondary lens 60 as seen in FIG. 15A to facilitate insertion and removal by radial compression of the secondary lens 60, for example, with forceps. The remainder of the wall defined by the recess in the primary lens provides a flush joint where the front surface of the secondary lens 60 may lie flush with the front surface of the primary lens 50, as seen in FIG. 15B and FIG. 15C. As seen in FIG. 15C, the contacting edges of the wall defined by the recess in the primary lens 50 and the secondary lens 60 may be inwardly angled to provide a joint 154 having a positive mechanical capture and secure connection therebetween. Alternatively, as seen in FIG. 15D, the contacting edges of the wall defined by the recess in the primary lens 50 and the secondary lens 60 may be "S" shaped to provide a joint 156 having a positive mechanical capture and secure connection therebetween. Other interlocking shapes may be used.

[0056] 16-16D, another modular IOL 160 is shown in front view, cross section, and detailed view, respectively. FIG. 16A shows a cross section taken along line AA in FIG. 16, FIG. 16B shows a cross section taken along line BB in FIG. 16, and FIG. 16C shows a detailed view of circle C in FIG. 16B. FIG. 16D shows a detailed view of circle D in FIG. 16A. The modular IOL 160 may be constructed similarly to the modular IOL 150 shown in FIGS. 15-15D, having a primary lens 50 with a recess defining a wall within which a correspondingly sized and shaped circular secondary lens 60 may be placed. However, in this embodiment, an angular cavity 162 (rather than cavity 152) is provided along a portion of the circumference of the secondary lens 60. The wall defined by the peripheral portion of the periphery of the secondary lens 60 may have the same geometric shape as the wall defined by the recess in the primary lens 50 to provide a flush connection 154, as best shown in FIG. 16C. The wall defined by another (e.g., remaining) peripheral portion of the periphery of the secondary lens 60 may have a more inwardly sloping geometry to provide an angular cavity 162, as best shown in Figure 16D. The cavity 162 thus exposes the peripheral edge of the secondary lens 60, as seen in Figure 16D, where forceps may be placed to facilitate insertion and removal by radial compression of the secondary lens 60. Other cavity shapes may be used.

[0057] 17-17C, another modular IOL 170 is shown in front, cross-sectional, detailed, and isometric views, respectively. FIG. 17A shows a cross-sectional view taken along line AA in FIG. 17, FIG. 17B shows a detailed view of circle B in FIG. 17A, and FIG. 17C shows an isometric view of the assembled elements. The modular IOL 170 may be constructed similarly to the modular IOL 150 shown in FIGS. 15-15D, which has a primary lens 50 with a recess defining a wall within which a correspondingly sized and shaped circular secondary lens 60 may be placed. However, in this embodiment, the wall defining the recess in the primary lens 50 includes a portion thereof that is milled down to define two diametrically opposed tabs 172. The inner peripheral wall of the tabs 172 provides a flush connection 174 as seen in FIG. 17B, such that the front surface of the secondary lens 60 is flush with the front surface of the primary lens 50. The interface of connection 174 along tab 172 may be, for example, angled, "S" shaped, or "C" shaped as shown. Elsewhere along the periphery, away from tab 172 in the area where the wall is milled, the periphery of secondary lens 60 is exposed as seen in FIG. 17C to facilitate insertion and removal of secondary lens 60 by radial compression of said periphery, for example with forceps.

[0058] 18-18C, another modular IOL 180 is shown in front, cross-sectional, detailed, and isometric views, respectively. FIG. 18A shows a cross-sectional view taken along line AA in FIG. 18, FIG. 18B shows a detailed view of circle B in FIG. 18A, and FIG. 18C shows an isometric view of the assembled elements. The modular IOL 180 may be constructed similarly to the modular IOL 170 shown in FIGS. 17-17C, having a primary lens 50 with a recess defining a partial wall within which a correspondingly sized and shaped circular secondary lens 60 may be placed and interlocked by a flush connection 174 in tabs 172. However, in this embodiment, a gripping recess or hole 182 is provided in each of the tabs 172 and adjacent portions of the secondary lens 60. In one embodiment, the gripping recess or hole 182 may not extend through the entire thickness of the primary lens 50 and the secondary lens 60. For example, gripping holes 182 in secondary lens 60 facilitate insertion and removal by radial compression of secondary lens 60, for example with forceps. Adjacent gripping holes 182 in tab portion 172 and secondary lens 60 can be radially drawn or pushed apart, for example with forceps, to facilitate connection and disconnection, respectively, of connection portion 174.

[0059] By using a radial force applied by the gripping holes 182 to connect and separate (or lock and unlock) the connection 174 between the primary lens 50 and the secondary lens 60, the anterior-posterior force applied to the capsule is reduced, thereby reducing the risk of capsule rupture. The gripping holes 182 may also be used to facilitate connection and separation of different interlocking shapes while minimizing anterior-posterior forces. For example, a recess in the primary lens 50 may include female threads that engage corresponding male threads on the periphery of the secondary lens 60. In this embodiment, forceps inserted into the gripping holes 182 may be used to facilitate rotation of the secondary lens 60 relative to the primary lens 50 to screw or loosen the primary lens 50 and secondary lens 60. In other embodiments, a keyed extension of the secondary lens 60 is inserted into a keyed opening of the primary lens 50 and rotated with forceps inserted into the gripping holes 182 to lock and unlock the primary lens 50 and secondary lens 60. In another alternative embodiment, forceps or the like may be inserted rearwardly through holes in the secondary lens 60 to grasp an anterior protrusion on the primary lens 50, such as a handle (not shown), and then posterior pressure is applied to the secondary lens 60 while the primary lens 50 remains stationary. The grasping holes 182 may also be used to rotate the secondary lens 60 relative to the primary lens 50, for example, for rotational adjustment in toric applications.

[0060] 19-19D, another modular IOL 190 is shown in front view, cross section, detail view, exploded isometric view, and assembled isometric view, respectively. FIG. 19A shows a cross section taken along line AA in FIG. 19, FIG. 19B shows a detail view of circle B in FIG. 19A, FIG. 19C shows an exploded isometric view of the elements, and FIG. 19D shows an assembled isometric view of the elements. The modular IOL 190 differs from some of the previously described embodiments in that the primary element functions as the base 55 but does not necessarily provide optical correction, whereas the secondary element functions as the lens 65 and provides optical correction. The base 55 may be configured in the shape of an annulus or ring with a central opening 57 extending therethrough in the anterior-posterior direction. In some embodiments, the base 55 may not define a complete ring or annulus. The base 55 may also include haptics 59 similar in function to the previously described haptics 54 but with a different geometric configuration. Generally, haptics 54 / 59 function to center base 55 within the capsular bag. Such haptics may also be configured to apply outward tension to the inner equatorial surface of the capsular bag, similar to capsular tension rings, to aid in symmetric healing and maintain centering of the base. Haptics 59 may include one or more apertures therein.

[0061] The base 55 includes a central opening 57 so that the posterior optical surface of the lens 65 does not contact the base 55. The lens 65 may include an annular extension and a correspondingly sized and shaped circular recess in the base 55 to form a shelf on the base 55 and an overlapping connection 192 having an interference and / or friction fit between the annular extension and the shelf, thereby securely connecting the two elements. Alternatively, the shape of the overlapping connection 192 may form a canted angle or an "S" shape as previously described to form an interlock therebetween. The connection or joint 192 may include a modified surface to reduce light scattering caused by the joint 192. For example, one or both of the interface surfaces of the connection 192 may be partially or completely opaque or matte (i.e., rough) to reduce light scattering due to the joint 192.

[0062] The depth of the recess in the base 55 may be the same as the thickness of the annular extension of the lens 65 such that the front surface of the lens 65 and the front surface of the base 55 are coplanar, as best seen in FIG. 19B. With this configuration, the rear surface of the lens 65 extends rearwardly from the front surface of the base 55. However, in some embodiments, the front surface of the lens 65 may be positioned relatively higher or lower than the front surface of the base 55. The dimensions of the recess and corresponding shelf in the base 55 may be selected in relation to the thickness of the lens 65 such that at least a portion of the rearmost surface of the lens 65 is coplanar with the rearmost surface of the base 55 or such that at least a portion of the rearmost surface of the lens 65 is rearwardly of the rearmost surface of the base 55.

[0063] As with the previous embodiment, the lens may be replaced intraoperatively or postoperatively with a different lens. This may be desirable, for example, if the first lens does not provide the desired refractive correction, in which case the first lens may be replaced with a second lens having a different refractive correction without disturbing the capsular bag. If the lens 65 does not have the desired optical alignment, for example due to base movement or misalignment, it may be replaced with a different lens with an optic portion manufactured to be biased relative to the base 55. For example, the optic portion of the second lens may be rotationally, laterally, and / or axially biased, similar to the embodiment described with respect to Figures 9A-9D. This general concept may be applied to other embodiments of the present application in which the secondary element (e.g., lens) has limited positional adjustability relative to the primary element (e.g., base).

[0064] There are numerous advantages associated with the general configuration of this embodiment, some of which are described below. For example, the posterior optical surface of the lens 65 is not in contact with the base 55, eliminating the possibility of entrapment of foreign bodies therebetween. Also, by way of example, because the base 55 includes a central opening 57 that is completely free of material, the base 55 may be rolled to a smaller diameter than the primary lens 50, as previously described, to facilitate delivery through a smaller incision in the cornea. Alternatively, the base 55 may have a larger outer diameter and be rolled to a similar diameter to the primary lens 50. For example, the base lens 55 may have an outer diameter of approximately 8 mm (excluding haptics) and be rolled to the same diameter as the primary lens 50, which includes an outer diameter of 6 mm. This may allow at least a portion of the interface between the base 55 and the lens 65 to be moved radially outward from the circumferential perimeter of the capsulorhexis, which typically has a diameter of 5-6 mm. By moving at least a portion of the interface between base 55 and lens 65 radially outward from the periphery of the capsulorhexis, one may reduce the amount of interface located in the field of view, thereby reducing the likelihood of light scattering or optical aberrations (e.g., dysphotopsia) caused by said interface. Of course, notwithstanding this example, any suitable dimensions may be selected to provide a gap between lens 65 and the periphery of the capsulorhexis to alleviate the need to manipulate the lens capsule to remove lens 65 from base 55.

[0065] Referring to Figures 20-20D, another modular IOL 200 is shown in a front view, a cross-section view, a detailed view, an exploded isometric view, and an assembled isometric view, respectively. Figure 20A shows a cross-section view taken along line AA in Figure 20, Figure 20B shows a detailed view of circle B in Figure 20A, Figure 20C shows an exploded isometric view of the elements, and Figure 20D shows an assembled isometric view of the elements. The modular IOL 200 comprises a base 55 with associated haptics 59, and a lens 65. The base 55 comprises a central hole 57 such that the posterior optical surface of the lens 65 does not contact the base 55. The lens 65 comprises an annular extension sized and shaped to fit into an annular recess formed in the base 55 to form a shelf on the base 55 to form an overlapping connection 202. The overlapping connection 202 may be configured by an "S" shaped interface to securely connect the two elements. Thus, modular IOL 200 is similar to modular IOL 190, except that interface 202 between base 55 and lens 65 may include a peg-and-hole configuration in which a pair of diametrically opposed pegs 204 extend rearwardly from the posterior periphery of lens 65 to fit within a selected pair of holes 206 from a series of holes 206 formed in a ledge of interface 202 of base 55.

[0066] 20E-20I show further details of the modular IOL 200. FIG. 20E shows a side view of the lens 65, FIG. 20F shows a rear view of the rear surface of the lens 65, FIG. 20G is a detail of circle G of FIG. 20E, FIG. 20H is a front elevational view of the front surface of the base 55, and FIG. 20I is a detail of circle I of FIG. 20H. As seen in FIG. 20E-20F, a pair of diametrically opposed pegs 204 may extend rearwardly from the posterior periphery of the lens 65. As seen in FIG. 20H-20I, the inner diameter of the base 55 along with the ledge of the connection portion 202 includes a series of holes 206 into which a pair of pegs 204 may be inserted. With this configuration, the lens 65 may be selectively rotated relative to the base 55, for example, for rotational adjustment in toric applications.

[0067] 21-21E, another modular IOL 210 is shown in a front view, a cross-sectional view, a detailed view, and an isometric view, respectively. FIGS. 21A and 21B show cross-sectional views taken along lines AA and BB, respectively, of FIG. 21. FIGS. 21C and 21D show detailed views of circle C of FIG. 21A and circle D of FIG. 21B, respectively. FIG. 21E shows an isometric view of assembled elements of the modular IOL 210. The modular IOL 210 may be configured similarly to a combination of the modular IOL 190 shown in FIGS. 19-19D and the modular IOL 170 shown in FIGS. 17-17C. Like the modular IOL 190, the modular IOL 210 comprises a base 55 configured in the shape of an annulus or ring having a central opening and a recess defining a wall in which a correspondingly sized and shaped circular lens 65 may be placed. As with modular IOL 170, the wall defining the recess extends along the inner periphery of base 55, a portion of which is milled down to define two diametrically opposed tabs 212. The inner peripheral wall of tab 212 provides a flush connection 214, as seen in FIG. 21C, such that the front surface of lens 65 lies flush with the front surface of base 55. The interface of connection 214 along tab 212 may be, for example, angled, "S" shaped, or "C" shaped as shown. Elsewhere along the periphery away from tab 212 in the area where the wall is milled down, the periphery of lens 65 is exposed, as seen in FIG. 21D, to facilitate insertion and removal of lens 65 by radial compression, for example, with forceps.

[0068] 22-22D, another modular IOL 220 is shown in front view, cross section, and detailed view, respectively. FIG. 22A shows a cross section taken along line AA in FIG. 22, FIG. 22B shows a cross section taken along line BB in FIG. 22, FIG. 22C shows a detailed view of circle C in FIG. 22A, and FIG. 22D shows a detailed view of circle D in FIG. 22B. The modular IOL 220 comprises a base 55 with associated haptics 59 and a lens 65. The base 55 comprises a central hole such that the posterior optical surface of the lens 65 does not contact the base 55. The periphery of the lens 65 is sized and shaped to fit into an annular recess formed in the base 55 to form a shelf and a flush connection 222 on the base 55. The flush connection 222 may be configured by an "S" shaped interface to securely connect the two elements. A pair of pegs 224 extend forwardly from the base 55 adjacent its inner circumference and through a pair of arcuate slots 226 adjacent the circumference of the lens 65. The arcuate slots may extend along a portion of the circumference of the lens 65, as shown in FIG. 22. This configuration allows the lens 65 to be selectively rotated relative to the base 55, for example, for rotational adjustment in toric applications.

[0069] Peg 224 may be sized and configured to protrude above the anterior surface of lens 65, as shown in FIG. 22C. Forceps or the like may be inserted rearwardly through arcuate slot 226 in lens 65 to grasp peg 224 like a handle, and then posterior pressure is applied to lens 65 while holding peg 224 stationary. By holding peg 224 while connecting lens 65 to base 55, thereby stabilizing base 55, the anterior-posterior forces applied to the capsule are reduced, thereby reducing the risk of capsule rupture.

[0070] As described herein, the lens removal system and method for the modular IOL lens 60 / 65 is shown in the drawings by way of example, and it should be understood to embody other modular IOL embodiments. The lens 60 / 65 may have the dimensions shown in the drawings by way of example, but are not necessarily limited to these.

[0071] 23A-23D, a lens removal system for a modular IOL according to an embodiment of the present disclosure is shown diagrammatically. FIGS. 23A and 23B are side and top views, respectively, of the lens removal system. FIGS. 23C and 23D are top views illustrating how the lens removal system may be used to remove a lens 60 / 65. The lens removal or extractor system may include a cannula 230 and a pair of forceps 235. The cannula 230 may include a lumen sized to slidably receive the forceps 235. The cannula 230 may include a tubular shaft portion 232 and a contoured distal opening 234. The cannula 230 may be formed and configured similarly to, for example, a conventional IOL insertion device. The forceps 235 include a pair of atraumatic grasping tips 237 and a tubular shaft 239. The tubular shaft 239 can be advanced to compress the tip 237 and grasp the lens 60 / 65. The forceps 235 can be formed and configured similarly to, for example, conventional ophthalmic forceps, except that the tip 237 can be formed or coated with a relatively flexible polymeric material to avoid damaging the lens 60 / 65. In general, any device used to manipulate the modular IOL elements described herein can be formed from or coated with a relatively flexible polymeric material to avoid damaging those elements.

[0072] 23C and 23D, the cannula 230 may be inserted through the corneal incision until its distal end (tip) is proximate the capsulotomy. The forceps 235 may be inserted into and through the cannula 230 until the distal tip 237 extends distally beyond the distal end of the cannula 230. The lens 60 / 65 to be extracted may be grasped by the forceps 235 as shown in FIG. 23C. With the lens 60 / 65 securely held by the forceps 235, the forceps 235 may be retracted proximally into the cannula 230. As the forceps 235 are retracted into the cannula 230, the lens 60 / 65 enters the contoured opening 234. The contoured opening 234 causes the edges of the lens 60 / 65 to roll and fold, as seen in FIG. 23D. Thus, full retraction of the forceps 235 into the cannula 230 safely captures the lens 60 / 65 within the lumen of the cannula 230, which may then be removed from the eye. A similar approach may be used to insert the lens 60 / 65, with the relevant steps reversed.

[0073] In a related embodiment, the surgical instrument may cut the lens 60 / 65 by a "peeling" mechanism. FIGS. 23E-23F show a lens removal system that may be used to remove the lens 60 / 65. The lens removal system may include the lens 60 / 65 of the modular IOL 290, a cannula 230, forceps 235, and a blade 650. The cannula 230 may be substantially similar to the cannula 230 described above and may be configured for insertion through a corneal incision 13 having an outer diameter of, for example, less than 2.2 mm. The cannula 230 may have an elliptical or rectangular cross-section to facilitate extraction of the lens 60 / 65 while minimizing the size of the corneal incision. A cutting path 610 is shown on the lens 60 / 65 of the modular IOL 290. The cutting path 610 may extend from the fixed tab 295 into the optic portion 297 and spiral inward without reaching the actuable tab 296.

[0074] 23G is a detailed view of blade 650. Blade 650 may be a sharp cutting surface of a single cannula 230 (as shown) or may be a separate unit (not shown). As shown, forceps 235 extend distally from cannula 230 in an open configuration.

[0075] In use, the lens 60 / 65 may be extracted from the capsular bag 34 into the anterior chamber 15 using the methods described herein. The cannula 230 may be inserted into the anterior chamber 15 of the eye 10 via the corneal incision 13. The forceps 235 may be inserted into and through the cannula 230 until the distal tip 237 extends distally beyond the distal end of the cannula 230. The forceps 235 may securely grasp the lens 60 / 65. With the lens 60 / 65 securely held by the forceps 235, the forceps 235 may be retracted proximally into the cannula 230. As the forceps 235 is retracted into the cannula 230, the lens 60 / 65 may pass the blade 650 which simultaneously cuts the lens 60 / 65 along the cutting path 610. The lens 60 / 65 may rotate as it is severed by the blade 650 and drawn into the lumen of the cannula 230. Thus, retraction of the forceps 235 into the cannula 230 safely captures the lens 60 / 65 within the lumen of the cannula 230, which may then be removed from the eye by pulling the cannula 230 out of the corneal incision 13. Because the cannula 230 has a smaller maximum width than the corneal incision 13, the severed lens 60 / 65 also has a smaller maximum width than the corneal incision 13. This lens extraction system and method may avoid harmful forces on the eye 10, such as anterior-posterior forces that may damage the eye 10 and / or cause posterior tears.

[0076] 23H illustrates another embodiment of a lens removal system that may be used to remove the lens 60 / 65. The lens removal system may include the lens 60 / 65 of a modular IOL 290, a cannula 230, a blade 650, and a curved grasper 240 having a curved upper arm 242 and a curved lower arm (not shown). The cannula 230 may be substantially similar to the cannula 230 described above and may be configured for insertion through a corneal incision 13 having an outer diameter of, for example, less than 2.2 mm. A cutting path 610 is shown on the lens 60 / 65. The cutting path 610 may extend from the fixed tab 295 into the optic portion 297 and spiral inward without reaching the actuable tab 296.

[0077] The upper surface of the upper curved arm 242 and the lower surface of the lower curved arm (not shown) can both be generally smooth. The lower surface of the upper curved arm 242 and the upper surface of the lower curved arm (not shown) can both have a surface configured to facilitate gripping, such as a serrated surface. The serrated surface can have a plurality of teeth 246. The angle of the teeth 246 can be configured with a proximal bias to further facilitate gripping the lens 60 / 65 during the cutting process and / or retraction.

[0078] The curved gripper 240 may be extendable and retractable relative to the cannula 230 and the blade 650. In the retracted configuration, the curved gripper 240 may fit within the lumen of the cannula 230. Upon extension from the cannula 230, the curved gripper 240 may bend to form a "hook" configuration, as shown in FIG. 23H. Additionally, the upper curved arm 242 and the lower curved arm may have a bias for the open configuration such that as the curved gripper 240 extends from the cannula 230, the curved arms separate to the open configuration while bending to the "hook" configuration. Thus, as the curved gripper 240 retracts into the cannula 230, the upper curved arm 242 and the lower curved arm may return to the closed or gripping configuration. The curved grippers 240 may be formed from a suitable material to produce this biased configuration of the curved grippers 240 when the device is outside the cannula 230, such as a shape memory polymer, a non-shape memory polymer, a metal, a metal alloy, stainless steel, heat set nitinol, an elastic material, or a superelastic material.

[0079] In use, this embodiment of the lens removal system functions similarly to the other disclosed embodiments. During gripping, the curved gripper 240 may extend distally from the cannula 230. A bias on the curved gripper 240 causes it to form a curved "hook" configuration and an open configuration upon extension. The upper curved arm 242 and the lower curved arm (not shown) may encircle the lens 60 / 65. The curved gripper 240 may be positioned to facilitate cutting along the cutting path 610. To initiate gripping, the cannula 230 may extend forward slightly or the curved gripper 240 may retract slightly so that the proximal teeth 246 begin to encircle the lens 60 / 65 and the blade 650 approaches the lens 60 / 65. The curved gripper 240 may be further retracted such that the lens 60 / 65 is drawn into the blade 650 , which simultaneously cuts the lens 60 / 65 along the cutting path 610 .

[0080] As the curved gripper 240 retracts into the cannula 230, the teeth 246 are forced into contact with the lens 60 / 65. This may distribute the gripping force along the length of the curved gripper 240. This may increase the grip and prevent perforation and tearing of the lens. During the cut, the portion of the lens 60 / 65 being cut at any one time will always be proximate to the portion of the lens 60 / 65 held by the gripper 240. Gripping the lens 60 / 65 proximate to the cut may provide a more stable cut and prevent tearing, bending, curving, or crimping of the lens 60 / 65.

[0081] The lens 60 / 65 may rotate as it is cut by the blade 650 and drawn into the lumen of the cannula 230. This embodiment allows the entire lens 60 / 65 to be retracted into the cannula 230 in one cutting step. Thus, retraction of the grasper 240 into the cannula 230 safely captures the lens 60 / 65 within the lumen of the cannula 230, which may then be removed from the eye by pulling the cannula 230 out of the corneal incision 13 using the disclosed methods.

[0082] 24-26 describe methods of using modular IOLs according to embodiments of the present disclosure. By way of example, and not necessarily by way of limitation, described with respect to a primary lens and a secondary lens, the same or similar methods may be applied to other modular IOL embodiments, including the modular IOL embodiments described herein that include a base and a lens.

[0083] Referring to FIG. 24, a schematic flow chart illustrates a method of using a modular IOL according to an embodiment of the present disclosure. In this example, the secondary lens may be replaced if a suboptimal optical result is detected intraoperatively. An IOL implantation procedure, such as cataract surgery, begins conventionally (110). The natural lens may then be prepared to receive the modular IOL using conventional steps such as forming a corneal access incision, cutting a capsulorhexis in the anterior lens capsule, and removing the cataractous lens by phacoemulsification (112). A base lens (i.e., primary lens 50) is then placed within the capsular bag (114). A secondary lens (i.e., secondary lens 60) is then placed over the base lens within the periphery of the capsulorhexis without touching or otherwise disturbing the capsule (116). An attachment means is then engaged (118) to releasably connect the secondary lens to the base lens. Alternatively, the secondary lens may be attached to the base lens before placement in the capsular bag, such that the base lens and secondary lens are inserted together as a unit. With both the base lens and the secondary lens in place, the optical result may be measured (120), for example by intraoperative aberrometry. The optical result may take into account refractive correction, centrality, toric correction, etc. A determination is then made as to whether the optical result is optimal or suboptimal (122). If the optical result is optimal or otherwise satisfactory, the IOL procedure is complete (124). However, if the optical result is suboptimal, unsatisfactory, and / or the patient is otherwise dissatisfied, the attachment means may be released (126) and the secondary lens removed (128). A different secondary lens is then placed over the base lens (116), following the same subsequent steps shown. The different secondary lenses may have, for example, different refractive powers to treat refractive errors, different offsets to correct for dispersion, or different toric powers to correct for toric errors.

[0084] Referring to FIG. 25, another method for using a modular IOL according to an embodiment of the present disclosure is shown in a schematic flow chart. In this example, the secondary lens may be replaced if a suboptimal optical result is detected postoperatively. The same steps 110-118, 124 may be performed as described above, except that the patient is allowed to acclimate to the modular IOL (130), for example, over a period of 1-4 weeks. At the follow-up visit, the optical result is measured (120) and a determination is made as to whether the optical result is optimal or suboptimal (122). If the optical result is optimal or otherwise satisfactory, the IOL procedure is discontinued (132). If the optical result is suboptimal, unsatisfactory, and / or the patient is otherwise dissatisfied, a revision procedure may be initiated (134) and the secondary lens may be replaced according to steps 126, 128, 116, 118 as described above.

[0085] This method allows the capsule to heal before determining whether the optical result is satisfactory. This may be advantageous if the healing process changes the position of the primary and / or secondary lens. This method may also be applied chronically, where the patient's optical needs and desires change over a longer period of time (e.g., >1 year). In this example, the patient may need or desire different corrections, such as stronger refractive correction, toric correction, or multifocal correction, each of which may be addressed by a different secondary lens.

[0086] Referring to FIG. 26, yet another method for using a modular IOL according to an embodiment of the present disclosure is shown in a schematic flow chart. In this example, a secondary lens may be implanted in a patient 138 with an existing IOL that is optically suboptimal or otherwise does not meet the patient's needs and desires. After the procedure begins (110), an attachment mechanism may be formed in situ in the existing (base) IOL (step 140), for example, using laser etching to form a groove as described above. The formation of the groove may be performed within the periphery of a previously cut capsulotomy to avoid touching or otherwise disturbing the lens capsule. The secondary lens may then be placed over the base lens within the periphery of the capsulotomy (116), an attachment means may be engaged to connect the secondary lens to the base lens (118), and the procedure may be completed as described above (124).

[0087] 27-27D, another modular IOL 270 is shown in front view, cross section, and detailed view, respectively. FIGS. 27A and 27B show cross sections taken along lines AA and BB, respectively, of FIG. 27B. FIGS. 27C and 27D show detailed views of circle C of FIG. 27A and circle D of FIG. 27B, respectively. The modular IOL 270 may be constructed similarly to the modular IOL 210 shown in FIGS. 21-21D. Like the modular IOL 210, the modular IOL 270 includes a base 55 configured in the shape of an annulus or ring with a central opening and a recess defining a wall within which a correspondingly sized and shaped circular lens 65 may be placed. Also like the modular IOL 210, the wall defining the recess extends along the inner circumference of the base 55, a portion of which is milled to define two diametrically opposed tabs 272. The inner peripheral wall of tab 272 provides a flush connection 274 as seen in FIG. 27C such that the front surface of lens 65 lies flush with the front surface of base 55. The interface of connection 274 along tab 272 may be, for example, angled, "S" shaped, or "C" shaped as shown. Elsewhere along the periphery away from tab 272 in the area where the wall is milled, the periphery of lens 65 is exposed as seen in FIG. 27D to facilitate insertion and removal of lens 65 by radial compression, for example, with forceps.

[0088] Because the base 55 has a central opening that is completely free of material, the base 55 can have a larger outside optic diameter (excluding haptics), for example, of about 8 mm, and still be rounded to a delivery profile small enough to pass through a corneal incision, for example, less than about 2.4 mm. This can allow at least a portion of the interface between the base 55 and the lens 65 to be moved radially outward from the circumferential boundary of the capsulorhexis, which typically has a diameter of 5-6 mm. Moving at least a portion of the interface between the base 55 and the lens 65 radially outward from the periphery of the capsulorhexis can reduce the amount of interface located in the field of view, and thus reduce the possibility of light scattering or optical aberrations (e.g., dysphotopsia) caused by the interface.

[0089] To further illustrate this advantage, consider a standard (single element) IOL with a conventional lens optic diameter, which is typically 6 mm. An IOL with a 6 mm diameter optic can be rolled and delivered through a 2.2 mm corneal incision. To secure a standard IOL within the capsular bag, the capsular incision is typically made sized to allow the capsular bag to completely capture the standard IOL after the capsule collapses and heals. This forces the surgeon to make a capsular incision with a diameter of approximately 4.5 mm to 5.5 mm.

[0090] Now consider IOL270 by way of comparison. The modular (two-piece) nature of IOL270 and the hole in base 55 allows both elements (base 55 and lens) to be rolled and delivered through a small corneal incision (e.g., 2.2 mm), but does not require a 4.5 mm to 5.5 mm capsulotomy. Rather, since the base has a diameter of 8 mm (excluding haptics), the capsulotomy diameter may be larger (e.g., 6.0 mm to 6.5 mm). This allows lens 65 to fit comfortably inside the periphery of the capsulotomy, and also allows the junction 274 to be more peripherally located, further minimizing light scattering. Of course, notwithstanding these examples, any suitable dimensions may be selected to provide a gap between lens 65 and the periphery of the capsulotomy to alleviate the need to manipulate the capsular bag to remove lens 65 from base 55.

[0091] 28A-28G, another modular IOL 280 is shown. The modular IOL 280 may have dimensions as shown in the drawings by way of example, but not necessarily by way of limitation. The modular IOL 280 may be the same or similar in function and benefits to other modular IOL embodiments described herein. The modular IOL 280 provides another interlocking feature that is used to connect the base and lens, as described in more detail below.

[0092] Figures 28A-D show base portion 55 of modular IOL 280, and Figures 28E-G show lens portion 65 of modular IOL 280. Specifically, Figure 28A shows a front view of base 55, Figure 28B shows a cross-sectional view taken along line BB in Figure 28A, Figure 28C shows a cross-sectional view taken along line AA in Figure 28A, and Figure 28D shows a perspective view of base 55. Figure 28E shows a front view of lens 65, Figure 28F shows a cross-sectional view taken along line FF in Figure 28E, and Figure 28G shows a perspective view of lens 65.

[0093] 28A-28D , a portion of the base 55 of the modular IOL 280 includes a pair of haptics 54 and a central hole 57 such that when the lens 65 is attached to the base 55, all or a majority of the posterior optical surface of the lens 65 does not contact the base 55. A recessed ledge 282 sized and configured to receive the lens 65 defines a periphery of the hole 57. The ledge 282 may include one or more keying portions 284 sized and configured to receive tabs 286 on the lens 65.

[0094] 28E-28G, the lens 65 includes an optical portion 287 and one or more tabs 286, each of which includes a through hole 288. The tabs 286 are sized to fit within a keyed portion 284 in the base. More specifically, the tabs 286 may be aligned with an opening in the keyed portion 284 (the discontinuity in the ledge 282) and moved rearwardly to rest on a lower portion 283 of the ledge 282 within the keyed portion 284. A probe or similar device may be used to engage the hole 288 in the tab 286 and rotate the tab 286 (e.g., clockwise as shown) to slide within the keyed portion 284 until the tab 286 is partially below an upper portion 285 of the ledge 282 within the keyed portion 284, thereby connecting the lens 65 to the base 55. The reverse process may be followed to separate the lens 65 from the base 55.

[0095] 29A-29F, another modular IOL 290 is shown. The modular IOL 290 may have dimensions as shown in the drawings, by way of example, but not necessarily by way of limitation. The modular IOL 290 may be the same or similar in function and benefits to other modular IOL embodiments described herein. The modular IOL 290 provides another interlocking feature that is used to connect the base and lens, as described in more detail below.

[0096] 29A-29C show a base portion 55 of a modular IOL 290, and FIGs. 29D-29F show a lens portion 65 of the modular IOL 290. Specifically, FIG. 29A shows a front view of the base 55 with a body portion, FIG. 29B shows a cross-sectional view taken along line BB in FIG. 29A, and FIG. 29C shows a perspective view of the base 55. FIG. 29D shows a front view of the lens 65, FIG. 29E shows a cross-sectional view taken along line EE in FIG. 29D, and FIG. 29F shows a perspective view of the lens 65. The base portion 55 does not have an optic portion, allowing the lens 65 to be the only optic portion of the modular IOL 290.

[0097] 29A-29C, a portion of the base 55 of the modular IOL 290 includes a pair of haptics 54 and a central hole 57 such that when the lens 65 is attached to the base 55, the posterior optical surface of the lens 65 does not contact the base 55 except at its outermost portions. A recessed groove 292 sized and configured to receive tab portions 295, 296 of the lens 65 defines a periphery of the hole 57.

[0098] The recessed groove 292 includes a lower rim 291 and an upper rim 293. The upper rim 293 may have an inner diameter larger than the outer diameter of the lens 65 so that the lens 65 can remain inside the hole 57 of the base 55. All or a portion of the lower rim 291 may have an inner diameter smaller than the outer diameter of the lens 65 so that the lower rim 291 acts as a backstop for the lens 65 when placed within the hole 57 of the base 55. By way of example, and not necessarily by way of limitation, as shown in FIG. 29D, the upper rim 293 may have an inner diameter of approximately 6.0 mm, the lower rim 291 may have an inner diameter of approximately 5.5 mm, and the lens 65 may have a diameter or longitudinal dimension (including tabs 295, 296) of approximately 7.125 mm from the top of tab 295 to the top of tab 296. Additionally, the optic body portion 297 may have an outer diameter of approximately 5.8 mm, also as shown in FIG. 29D. 29B, the base may have a thickness of about 0.615 mm, and the upper rim 293 may have a length of about 0.45 mm. The lower rim 291 may have a front surface having a length of about 0.55 mm and a rear surface having a length of about 0.75 mm.

[0099] The lower rim 291 and upper rim 293 defining the groove 292 may extend continuously around all or a portion of the circumference of the hole 57. Alternatively, the lower rim 291 and upper rim 293 defining the groove 292 may extend discontinuously around all or a portion of the circumference of the hole 57. One example of a discontinuous configuration alternates portions of the lower rim 291 and upper rim 293, which may be well suited for cryo-machining the base 55 into a single piece. As shown, the base 55 may be cryo-machined into two pieces including a lower or rear portion 55A and an upper or front portion 55B that are subsequently bonded (e.g., adhesively or solvent bonded). This may be well suited for defining a continuous groove 292. To maintain compatibility of chemical and mechanical properties, the adhesive and the parts 55A / 55B of the base 55 may contain the same monomer or polymer formulation. For example, the adhesive may be formulated from the same acrylic monomers used to manufacture the hydrophobic acrylic parts 55A / 55B of base 55. Other manufacturing methods well known in the art may also be used.

[0100] Optionally, the posterior portion 55A of the base may be a solid disk rather than an annular ring with holes 57, thereby defining a posterior surface against which the posterior side of the lens 65 contacts. The posterior surface may be flat or curved to match the posterior contour of the lens 65. This may have the advantage of making delivery and placement of the lens 65 in the base 55 easier by providing a backstop for the lens 65. This may also provide the advantage of reducing the rate of posterior capsule opacification.

[0101] With particular reference to FIGS. 29D-29F, lens 65 of modular IOL 290 includes optic body portion 297 (also referred to herein as "optical portion") and one or more tabs 295, 296. As shown in FIG. 29E, tab 296 may include a thickness of approximately 0.25 mm and optic portion 297 may include a maximum thickness of approximately 0.78 mm. The thickness of optic portion 297 may taper toward tabs 295, 296. As shown, tab 295 is fixed, but tab 296 may be movable. Alternatively, fixed tab 295 may be replaced with a movable tab (such as tab 296). Fixed tab 295 may include a through hole 298 such that tab 295 may be manipulated using a probe or similar device to engage hole 298. Hole 298 may have a diameter of approximately 0.231 mm. The movable tab 296 can be moved between a compressed position for delivery into the hole 57 of the base 55 and an uncompressed, expanded position (as shown) for deployment into the groove 292 of the base 55, thereby forming an interlocking connection between the base 55 and the lens 65.

[0102] The outer curvature of fixed tab 295 may have a radius that matches the inner radius of groove 292. Similarly, the outer curvature of movable tab 296 may have a radius that matches the inner radius of groove 292 when movable tab 296 is in its unstressed, extended position. This configuration limits relative motion between base 55 and lens 65 once connected.

[0103] Optionally, the lens 65 may be oval or elliptical rather than circular, with the tabs 295, 296 located proximate the major axis. This configuration would thus define a gap between the edge of the lens 65 along its minor axis and the inner circumference of the upper rim 293 of the groove 292 in the base 55. The gap may have the advantage of providing access for a probe or similar device to remove the lens 65 from the base 55, should separation become necessary.

[0104] The movable tab 296 may, as shown, be attached to the lens 65 and extend away from the lens at two ends with a middle portion spaced apart from the lens 65 (like a leaf spring). Alternatively, the movable tab 296 may be attached to the lens 65 and extend away from the lens at one end with the other end free (like a cantilever spring). Other spring configurations may be used as known in the mechanical arts.

[0105] The movable tab 296 may be elastically deformed (e.g., by application of a lateral inward force) into its compressed position. To facilitate compression with small forces, a recess 299 may be provided on the outer (and / or inner) curvature of the tab to form a hinge for the spring.

[0106] Figures 29A2-29E2 show an alternative base portion 55 of a modular IOL 290. Specifically, Figure 29A2 shows a front view of base 55, Figure 29B2 shows a cross-sectional view taken along line BB of Figure 29A2, Figure 29C2 shows a perspective view of base 55, Figure 29D2 shows a detailed view of circle D of Figure 29B2, and Figure 29E2 shows a detailed view of circle E of Figure 29A2. In this alternative embodiment, all aspects of base 55 of modular IOL 290 are substantially identical except that it includes a pair of notches 291A, a pair of indentations 293A, and a sharp edge 291B.

[0107] By way of example, and not necessarily by way of limitation, the following dimensions are provided: In FIG. 29A2, diameter A1 may be 13.00±0.02 mm, diameter A2 may be 8.50±0.10 mm, diameter A3 may be 7.00±0.051 mm, diameter A4 may be 6.30±0.051 mm, diameter A5 may be 5.50+0.15 / -0.05 mm, and diameter A6 may be 7.92 mm. In FIG. 29B2, dimension B1 may be 0.615±0.020 mm. In FIG. 29D2, dimension D1 may be 0.15 mm, dimension D2 may be 0.17 mm, dimension D3 may be 0.75 mm, dimension D4 may be 0.35 mm, dimension D5 may be 0.08 mm, and dimension D6 may be 0.30±0.02 mm. In FIG. 29E2, dimension E1 (width of notch 291A) can be 1.48 mm, dimension E2 (diameter at the outer edge of notch 293A) can be 6.62 mm, dimension E3 (inner diameter of upper rim 293) can be 6.25 mm, and dimension E4 (radians of notch 291A) can be approximately 30 degrees.

[0108] As in the previous embodiment, a portion of the base 55 of the modular IOL 290 of this alternative embodiment includes a pair of haptics 54 and a central hole 57 such that when the lens 65 is attached to the base 55, the posterior optical surface of the lens 65 does not contact the base 55 except at its outermost portion. A recessed groove 292 that is sized and configured to receive tab portions 295, 296 of the lens 65 defines a periphery of the hole 57. The recessed groove 292 includes a lower rim 291 and an upper rim 293.

[0109] In this alternative embodiment of the base 55 of the modular IOL 290, the lower rim 291 may include one or more notches 291A to aid in the removal of visco-elastic during surgery. Also, in this alternative embodiment, the upper rim 293 may include one or more notches 293A to provide access for a Sinskey hook during surgery, allowing the base 55 to be more easily manipulated. Additionally, in this embodiment, the lower rim 291 (or the posterior side of the base 55) may include at least one corner edge 291B along its posterior circumference to reduce the tendency for posterior capsule opacification. The corner edge 291B may be in addition to the corner edges formed along the anterior circumference and periphery of the base 55. For example, in the illustrated embodiment, the base 55 includes two edges along the periphery, one anterior edge and one posterior edge 291B. In cross section, the corner edge 291B may be defined by a square angle, an acute angle, or an obtuse angle. The corner edge 291B may be flush with the rear face as shown, or may protrude rearward. The base 55 may be machined without subsequent tumbling to better form the edge 291B.

[0110] 29B, 29B2, and 29E, it is noted that the lower rim 291 and the upper rim 293 may define an anterior-posterior (AP) dimension around the circumference of the base 55 that is greater than a corresponding AP dimension of the optic 65 proximate the tabs 295, 296 that fit into the grooves 292. For example, as shown in FIGS. 29B and 29B2, the AP dimension around the circumference of the base 55 may be 0.615 mm, and the corresponding AP dimension of the optic 65 proximate the tabs 295, 296 may be 0.25 mm, as shown in FIG. 29E. When the modular IOL 290 is implanted within the capsular bag, these relative dimensions provide standoff between the posterior capsule and the posterior side of the optic 65, as well as standoff between the anterior capsule (sometimes referred to as the anterior apex) proximate the capsulorhexis and the anterior side of the optic. This isolation reduces the possibility of cellular proliferation that may otherwise prevent post-operative replacement of the optic, as well as opacification of the optic 65 and / or tissue attachment to the optic 65. Because such cellular proliferation typically grows radially inward, the isolation may be provided proximate the periphery of the optic 55 proximate the inner circumference of the lower and upper rims 291, 293. In contrast, the center of the optic, which may or may not have isolation, has an AP dimension that is smaller, the same as, or larger than the AP dimension around the circumference of the base 55. For example, the center of the optic may have an AP dimension of 0.78 mm (by diopter) as shown in FIG. 29E, which is larger than the AP dimension around the circumference of the base 55 of 0.615 mm as shown in FIG. 29B and FIG. 29B2. Additionally, recognizing that there is a greater likelihood of cell proliferation on the posterior side than the anterior side due to the presence of a capsulotomy on the anterior side and a correspondingly smaller area of ​​tissue contact on the anterior side, the inferior (posterior) rim 291 may have a larger AP dimension than the superior (anterior) rim 293. Those skilled in the art will appreciate the importance of relative dimensions to achieve this effect, rather than the specific dimensions, which are provided by way of example and not necessarily limitation.

[0111] With particular reference to Figures 29G-29J, implantation of a modular IOL 290 is illustrated. As shown in Figure 29G, the modular IOL 290 may be implanted by first delivering the base 55 in a rolled up configuration into the capsular bag 34 with a delivery tube inserted through the corneal incision 13 and through the capsulotomy 36 into the capsular bag 34. As shown in Figure 29H, the base 55 may be released from the delivery tube and allowed to unfold. With gentle manipulation, the haptics 54 of the base 55 may engage the inner equator of the capsular bag 34 and center the hole 57 of the base 55 relative to the capsulotomy 36.

[0112] The lens 65 is also delivered in a rolled form using a delivery tube that positions the distal tip of the lens 65 proximate to the base 55. The lens 65 is released from the delivery tube and allowed to unfold. Through gentle manipulation, the lens 65 is centered relative to the capsulotomy 36. Once the base 55 is delivered and unfolded within the capsular bag, the lens 65 may be connected to the base 55 by the attachment mechanism 70. The modular IOL 290 provides an interlocking connection between the base 55 and the lens 65 including the attachment mechanism 70 using tabs 295 / 296 and grooves 292.

[0113] 29I-29J, the lens 65 may be connected to the base 55 by first inserting the movable tab 296 into the groove 292. The movable tab 296 is then compressed by application of a lateral force with a probe or similar device inserted into the hole 298 of the fixed tab 295, allowing the lens 65 to be advanced into the hole 57 of the base 55 such that the lens 65 and base 55 are flush with each other.

[0114] The compressive force is then released from the movable tab 296, allowing the fixed tab 295 to slide into the groove 292 in the base 55, thus connecting the lens 65 to the base 55. By using a lateral force rather than an anterior-posterior force to compress the interlocking feature, the risk of posterior tearing of the lens capsule is reduced. The probe may be removed from the hole 298. The reverse process may be followed to separate the lens 65 from the base 55.

[0115] The movable tab 296 and groove 292 may be referred to as interlocking members that provide an interlocking connection between the base 55 and the lens 65. At least one of the pair of interlocking members is movable to lock or unlock the connection therebetween. More generally, one or more interlocking connections may be provided between the base and the lens. Each interlocking connection may comprise a pair of interlocking members, one or both of which are movable. The movable interlocking members may be associated with the lens as described with respect to the modular IOL 290 of FIGS. 29A-F. Alternatively, the movable interlocking members may be associated with the base 55 as described with respect to the modular IOL 300 shown in FIGS. 30A-B.

[0116] Removal of lenses, such as lens 60 / 65, can present challenges. Lens 60 / 65 may be detached from a primary element or base as described herein, and removal through the corneal incision may risk increasing the width of the corneal incision if the diameter of the expanded lens 60 / 65 is greater than the width of the corneal incision. This may increase the risk of damaging the cornea (or the sclera if a scleral incision is used) and the likelihood of a negative postoperative outcome. On the other hand, reducing the width of the lens 60 / 65, for example by rewrapping, also requires substantial manipulation and generally risks damaging the capsule or eye. Disclosed herein are lens removal methods and instruments that allow removal of lens 60 / 65 without increasing the width of the corneal incision and without damaging the eye or capsule. The lens removal methods and instruments may be configured to minimize anterior-posterior forces and torques on the lens to prevent damage or trauma to the eye. The methods and instruments may also avoid the creation of fragments, foreign bodies, or serrated edges.

[0117] Releasing the lens 60 / 65 from the base 50 / 55 initiates removal of the lens. As shown in FIG. 29K, a probe or similar device may pass through the corneal incision 13, the capsulotomy 36, and into the capsular bag 34 housing the modular IOL, e.g., modular IOL 290. As shown in FIG. 29L, the probe or similar device may engage the hole 298 in the fixation tab 295 and compress the movable tab 296 with the application of a lateral force. The compression may cause the fixation tab 295 to separate from the groove 292 in the base 50 / 55. With gentle manipulation, the lens 60 / 65 may be lifted such that the lens 60 / 65 and the base 50 / 55 are no longer flush. Once released, the compression force is released and the movable tab 296 may resiliently expand and separate from the groove 292 in the base 50 / 55.

[0118] 29M, a probe or similar device may be used to pass the lens 60 / 65 from the capsular bag 34 into the anterior chamber 15. This process does not damage the eye or expand the size of the capsular incision 36 because the width of the lens 60 / 65 is less than the width of the capsular incision 36. The probe or similar device may also rotate the lens 60 / 65 to an orientation where the fixed tab 295 is proximal to the corneal incision 13 and the movable tab 296 is distal to the corneal incision 13.

[0119] A typical corneal incision 13 may have a width of approximately 2.2 mm, which is less than the outer diameter of the lens 60 / 65. Thus, mechanical manipulation of the lens 60 / 65 may be required to remove the lens 60 / 65 from the anterior chamber 15 through the corneal incision 13. The lens 60 / 65 may be manipulated, e.g., cut, so that it can be pulled through the corneal incision as a single piece, or in multiple pieces. A cannula or delivery tube may facilitate this removal.

[0120] 30A-30B show another modular IOL 300 with a base 55 and a lens 65. FIG. 30A shows a front view of the base 55, and FIG. 30B shows a perspective view of the lens 65. The base 55 may include a central hole 57 and a pair of haptics 54, as previously described. The base 55 may also include one or more movable tabs 302 that are sized and configured to fit within a groove 304 in the lens 65. As shown, the base 55 includes a pair of movable tabs 302, although one of the tabs may be fixed (i.e., non-movable). The lens 65 includes an optic portion 307 and one or more grooves 304 defined by a lower rim 303 and an upper rim 305. Because the lens 65 is relatively thin around the circumference where the grooves 304 exist, the grooves 304 may be defined by extending the lower rim 303 and the upper rim 305 as shown. As will be appreciated by those skilled in the art, the movable tab 302 and groove 304 of this embodiment may be the same as or similar to the movable tab 296 and groove 292 described in the previous embodiment, including the same or similar functions, uses, alternatives and advantages.

[0121] 31A-31B, a lens removal or extractor system 310 for a modular IOL in accordance with an embodiment of the present disclosure is shown generally. FIG. 31A shows a perspective view of the extractor system 310 with a captured lens 60 / 65, and FIG. 31B shows a perspective view of the extractor system 310 with a detached lens 60 / 65. The extractor system 310 is shown in a shortened view for illustrative purposes only. The length and diameter of the extractor system 310 may be selected for conventional manual manipulation through a corneal incision, e.g., for the dimensions of a conventional lens cartridge.

[0122] The extractor system includes a handle 314 and a sleeve 312 extending distally therefrom. The sleeve 312 is hollow internally and includes a tongue-like extension 313 for supporting the lens 60 / 65.

[0123] A grabber 316 can be extended distally from and retracted back into the sleeve 312 by an actuation member (not shown) that extends proximally through the handle 314. The grabber 316 can include a distal hook, forceps, or other mechanism for engaging and pulling the lens 60 / 65. In this example, the grabber 316 engages the distal (opposite) edge of the lens 60 / 65. Alternatively, a microforceps can be used to grasp the proximal end of the lens 60 / 65, or a sharp instrument can be used to puncture the anterior surface of the lens 60 / 65 near the proximal end. This can be done safely because the sharp tip is introduced through the sleeve 312 and the extended tongue 313 protects the ocular anatomy.

[0124] A pair of blades 318 may extend slightly beyond the distal end of the sleeve 312 on either side of the proximal end of the tongue extension 313, as shown. Using a blade actuator 319, the blades 318 may be advanced for cutting, as shown in FIG. 31A, or retracted within the sleeve 312 for no cutting, as shown in FIG. 31B.

[0125] In use, with the lens 60 / 65 removed from the base and residing in the anterior chamber in the capsular bag (not shown), the sleeve 312 can be inserted through the corneal incision and the tongue extension 313 can be placed under the lens 60 / 65 to be extracted. The gripper 316 can then be advanced over the lens 60 / 65. With the blade 318 extended for cutting, the gripper 316 can be retracted into the sleeve 312 to form an incision in the lens 60 / 65 that divides the lens into a central portion and two lateral portions. The gripper 316 can be retracted until the incision extends partially (e.g., 80%) across the diameter of the lens, thus maintaining the connection between the central portion and the two lateral portions. At this point, the blade 318 can be retracted using the actuator 319. The grasper 316 is then further retracted to cause the central portion of the lens 60 / 65 to be pulled into the sleeve 312 and the lateral portions of the lens 60 / 65 may be inverted or rotated. Further retraction of the grasper 316 causes the lateral portions of the lens 60 / 65 to overlap and follow the central portion into the sleeve 312. The extractor system 310 is then removed from the corneal incision, thereby extracting the lens 60 / 65 from the eye. The extractor system 310 may also be used to extract other optics, including optics with haptics, where the haptics follow the lateral portions into the sleeve.

[0126] 31C-31F, a related embodiment of a lens removal or extractor system 310 for modular IOLs is shown in schematic form. FIG. 31C shows a detailed perspective view of the extractor system 310 with the lens 60 / 65 captured. FIG. 31D shows a detailed perspective view of the extractor system 310 with the extendable tongue 313 partially retracted and the lens 60 / 65 partially cut by a pair of blades 318. FIG. 31E shows a perspective view of the extractor system 310 with a central portion of the lens 60 / 65 extracted into the lumen of the hollow sleeve 312, and the remaining "horseshoe-shaped" lens 60 / 65 is gripped between the sleeve 312 and the extendable tongue 313. FIG. 31F shows a schematic view of the lens 60 / 65 after the central portion has been cut off and extracted. The length and diameter of the extractor system 310 may be selected for manual manipulation through a conventional corneal incision, for example, relative to the dimensions of a conventional lens cartridge.

[0127] The extractor system 310 may include a hollow cannula 312 having a pair of distally directed blades 318. The hollow cannula 312 may be sized and configured to extend through the corneal incision without increasing the size of the corneal incision. The hollow cannula 312 may have an oval or rectangular cross-section to facilitate extraction of the lens 60 / 65 while minimizing the size of the corneal incision. The hollow cannula 312 may be formed from a hard material, and the blades 318 may be formed by sharpening the distal lateral edges of the cannula 312, with cutting edges formed on the inside of the cannula wall to avoid cutting ocular tissue as it passes through the corneal incision. The extractor system 310 may also include an extendable tongue 313 disposed at and extendable beyond the distal end of the hollow cannula 312. The distal tip of the extendable tongue 313 may form a grasper 316, such as a distal hook, forceps, or other mechanism that engages the lens 60 / 65.

[0128] The extendable tongue 313 may be configured to extend beyond the distal end of the cannula 312 to engage the distal end of the lens 60 / 65 in the extended position and to be fully retracted into the sleeve 312 in the retracted position. In the retracted position, a gripper 316 on the distal tip of the extendable tongue 313 may protrude slightly from the sleeve 312. In the extended configuration (as shown), the extendable tongue 313 may provide a support surface for the lens 60 / 65 while it is being cut. The gripper 316 may engage the lens 60 / 65 through a hole formed between the optic portion 297 and the movable tab 296 of the modular IOL 290.

[0129] Tongue 313 moves relative to hollow cannula 312 and pair of blades 318 such that retraction of tongue 313 toward blade 318 may be functionally equivalent to extension of blade 318 toward tongue 313. Although this embodiment discloses cutting by retraction of tongue 313, it should be understood to include extension of blade 318.

[0130] In use, the lens 60 / 65 may be removed from the base in the capsular bag (not shown) and placed in the anterior chamber using the methods described herein. The sleeve 312 may be inserted through the corneal incision 13 with the extendable tongue 313 in a retracted position. The extendable tongue 313 may be extended below (back) the lens 60 / 65 and the grasper 316 may engage the lens 60 / 65 through a hole formed between the optic portion 297 and the movable tab 296 of the modular IOL 290. For purposes of viewing, the extendable tongue 313 is shown below (back) the lens 60 / 65, but the extendable tongue 313 may also be extended above the lens 60 / 65 or both above and below the lens 60 / 65.

[0131] As the extendable tongue 313 is retracted into the cannula 312, the lens 60 / 65 is pulled along the pair of blades 318, which cut the lens along parallel cutting paths 330. The cut may extend from the fixed tab 295 on the proximal side of the lens 60 / 65, through the optic portion 297, and into the space between the optic portion 297 and the movable tab 296. Thus, the lens 60 / 65 is cut into two or more pieces. For example, as shown in Figures 31E-31F, the lens 60 / 65 may be cut into two pieces, with the central piece retracted into the hollow sleeve 312 and the remaining two "lobes" remaining in the anterior chamber. Thus, after cutting, the movable tab 296 may act as a connection for the two remaining "lobes" of the lens 60 / 65. This may facilitate removal from the eye, since only a single connected fragment remains in the anterior chamber after cutting. Additionally, the notches 299 on the movable tab 296 may act as flexible pivot points so that the two "pieces" may bend and rotate relative to one another, for example, during subsequent extraction from the eye. If the cutting path 330 were instead rotated 90 degrees relative to the lens 60 / 65, the lens 60 / 65 would be cut into three pieces.

[0132] The blades 318 may be spaced apart to cut approximately 1 / 3 of the diameter of the lens 60 / 65 to define three portions of approximately equal width less than the width of the corneal incision. For example, the portions may have a width of less than 2.0 mm to be removed through a corneal incision of 2.2 mm. The width between the blades 318 may be defined by the width of the cannula 312, which is sized to be inserted through the corneal incision without increasing the size of the corneal incision. Thus, each of the three portions is also sized to be removed through the corneal incision without increasing the size of the incision. The portions may be removed sequentially in individual pieces or in interconnected pieces with the uncut portions of the lens 60 / 65 connecting each piece. As shown, generally, a rectangular central portion is cut (first portion) leaving a horseshoe shaped portion 340 (second and third portions or "lobes" connected by movable tabs 296). The following dimensions are provided by way of example, but are not necessarily limiting: In FIG. 31F, dimension F1 can be 1.950 mm and dimension F2 can be 1.900 mm.

[0133] Notches or other features in the lens 60 / 65 may aid in locating the extendable pair of blades 318 over the center of the lens. For example, the space between the optic portion 297 and the movable tab 296 may be sized to limit lateral movement of the gripper 316, centering the extractor system 310 relative to the lens 60 / 65.

[0134] The cutting process may apply substantially balanced forces (minimal or no net force) to the lens 60 / 65. The blade 318 may apply forces to the lens 60 / 65 as it cuts. These forces may be countered by bracing forces applied by the extendable tongue 313 and the gripper 316. This minimizes or avoids net forces on the lens 60 / 65 to prevent trauma and damage to the lens capsule. Alternative cutting mechanisms are possible. A pair of circular blades ("pizza cutters") attached to an extendable arm and configured to rotate along a cutting path 330 may replace the blade 318. In another embodiment, the pair of blades 318 may cut the lens 60 / 65 by applying a downward compressive force ("cookie cutter") balanced by an upward compressive force from the extendable tongue 313.

[0135] After cutting the lens 60 / 65, the extendable tongue 313 may retract into the sleeve 312 to extract the central portion therein. The extractor system 310 may then grasp the horseshoe portion 340 between the gripper 316 between the blades 318 and the upper or lower edge of the cannula, as shown in FIG. 31E. The extractor system 310 may be pulled out of the eye through the corneal incision 13, thereby removing the lens 60 / 65. Alternatively, forceps or other suitable surgical tool may grasp the horseshoe portion 340 and extract it from the anterior chamber 15 of the eye through the corneal incision 13. The horseshoe portion 340 may bend as it is extracted, similar to the extraction shown in FIG. 32D. The extractor system 310 may also be used to extract other optics, including optics with haptics, where the haptics follow the lateral portions into the sleeve.

[0136] 31G-31N, another embodiment of a lens removal or extractor system 310 for a modular IOL is shown in schematic form. FIG. 31G shows a detailed perspective view of the extractor system 310 with a lens 60 / 65 captured by a retractable grasper 320. FIG. 31H shows a detailed perspective view of the extractor system 310 with an extendable / retractable hollow cannula 312 fully extended with the grasper 320 grasping the lens 60 / 65 cut by a pair of blades 318. FIG. 31I shows a perspective view of the extractor system 310. FIG. 31J shows a zoom-in view of the extendable / retractable grasper 320 with the lens 60 / 65 captured. FIG. 31K shows a zoom-in view of the grasper 320 fully retracted into the hollow cannula 312 in a closed configuration. Figure 31L shows a close-up view of the grasper 320 in a fully extended, open configuration outside of the hollow cannula 312. Figure 31M shows a related embodiment of the grasper 320 having a rectangular cross-section. Figure 31N shows a related embodiment of the grasper 320 having four prongs. The length and diameter of the extractor system 310 can be selected for manual manipulation through a conventional corneal incision, e.g., relative to the dimensions of a conventional lens cartridge.

[0137] As shown in FIGS. 31G-31H, the extractor system 310 has an extendable / retractable hollow cannula 312 having a pair of distally facing blades 318 at a distal end and a circular base 360 ​​at a proximal end. The hollow cannula 312 may have an oval or rectangular cross-section to minimize the size of the corneal incision and facilitate extraction of the lens 60 / 65. The extractor system 310 has an extendable / retractable grasper 320 that can be extended or retracted relative to the hollow cannula. The grasper 320 is connected to a "T-shaped" handle 350 such that as the handle 350 slides distally or proximally, the grasper 320 extends distally or proximally, respectively. As shown in FIG. 31I, a spring 370 facilitates the extension / retraction of the cannula 312 relative to the grasper 320. A spring 370 is located proximal to handle 350 and distal to circular base 360 ​​and is configured to bias grasper 320 in the extended configuration and to bias cannula 312 in the retracted configuration.

[0138] As shown in FIG 31J, the gripper 320 has an upper arm 322 and a lower arm 324. The upper surface of the upper arm 322 and the lower surface of the lower arm 324 are both generally smooth. The lower surface of the upper arm 322 and the upper surface of the lower arm 324 may both have a surface configured to facilitate gripping, such as a serrated surface. The serrated surface may have a plurality of teeth 326. The angle of the teeth 326 may be configured to be proximally biased to further facilitate gripping of the lens 60 / 65 during cutting and / or retraction.

[0139] The grasper 320 may be coupled between an open configuration and a closed grasping configuration. As shown in FIGURE 31K, when the grasper 320 is fully retracted into the cannula 312, the grasper 320 is in a closed configuration with the upper arm 322 angled slightly downward such that the distal end of the upper arm 322 contacts the distal end of the lower arm 324. This tapered tip may facilitate entry into the cornea.

[0140] As shown in FIG. 31L, when the gripper 320 is fully extended from the cannula 312, the gripper 320 is in an open configuration. In the open configuration, the upper arm 322 has two inflection points 328 that bias the upper arm 322 into the open configuration when the cannula 312 is retracted. The lower arm 324 remains flat and parallel to the cannula 312. In this open configuration, the distal portion of the upper arm 322 is parallel to the lower arm 324 and the opening is wide enough to accommodate the lens 60 / 65. This parallel arm open configuration allows the maximum number of serrations 326 to contact the lens 60 / 65 simultaneously as the cannula 312 and blade 318 extend to close the gripper 320. This also minimizes the opening distance that keeps the upper arm 322 and lower arm 324 from touching the cornea while still allowing the lens 60 / 65 to slide into the opening. Gripping portion 320 may be formed from a suitable material to produce this biased configuration of upper arm 322 when gripping portion 320 is outside cannula 312, such as a shape memory polymer, a non-shape memory polymer, a metal, a metal alloy, stainless steel, heat set nitinol, an elastic material, or a superelastic material.

[0141] As shown in Figure 31M, gripper 320 can have a rectangular cross section. As shown in Figure 31N, gripper 320 can have four protrusions, two upper protrusions 322 and two lower protrusions 324. These gripper 320 embodiments function much the same as gripper 320 previously disclosed.

[0142] In use, the lens 60 / 65 may be removed from the base in a capsular bag (not shown) and placed in the anterior chamber using the methods described herein. The cannula 312 may be inserted through the corneal incision 13 with the "T-shaped" handle 350 in a proximal configuration, such that the grasper 320 is retracted into the cannula 312 as shown in FIG. 31K. The handle 350 may be slowly released and the spring 370 may extend the grasper 320 from the distal end of the cannula 312. The upper and lower arms 322, 324 may open to a parallel configuration. The grasper 320 may encircle the lens 60 / 65, as shown in FIG. 31L.

[0143] During the cutting process, extending the cannula 312 and blade 318 distally toward the lens may be desirable as opposed to pulling the gripper 320 proximally toward the blade 318, as this prevents the lens 60 / 65 from striking the angle of the eye and keeps the lens 60 / 65 centered in the user's field of vision. The gripper 320 is stationary while the spring 370 is compressed by the handle 350, allowing the cannula 312 and blade 318 to extend toward the lens 60 / 65. As the cannula 312 extends distally, it surrounds the gripper 320, causing the upper and lower arms 322, 324 to close around the lens 60 / 65. As the gripper 320 closes, a maximum number of the serrations 326 contact the lens 60 / 65 simultaneously, increasing the gripping force. As the blade 318 cuts into the lens 60 / 65, the gripper 320 is in direct proximity to the blade 318. Gripping the lens 60 / 65 in direct proximity to the blade 318 as it cuts provides stability by preventing tearing, twisting, bending, or crimping of the lens 60 / 65.

[0144] The cannula 312 and blade 318 may continue to extend along the cutting path 330 toward the distal end of the lens 60 / 65. As shown in FIG. 31F, the cutting path 330 may extend from the fixed tab 295 on the proximal side of the lens 60 / 65, through the optic portion 297, and into the space between the optic portion 297 and the movable tab 296. As previously mentioned, after cutting, the movable tab 296 may act as a connection for the two remaining "segments" of the lens 60 / 65. This may facilitate removal from the eye, since only a single piece remains in the anterior chamber. Additionally, the notch 299 on the movable tab 296 may act as a flexible pivot point so that the two "segments" may bend and rotate relative to each other, for example, during extraction from the eye.

[0145] As shown in Figure 31I, after the cut is completed, the handle 350 compresses the spring 370 and the grasper 320 is retracted into the cannula 312 along with the central portion of the lens 60 / 65. The extractor system 310 is removed from the anterior chamber and the eye, simultaneously removing the central cut portion of the lens 60 / 65. The remaining portion or portions of the lens 340 may be removed from the eye using the disclosed methods.

[0146] In another embodiment, the IOL lens 60 / 65 may be removed from the eye 10 in multiple pieces using a surgical punch 430 cutting tool. As shown in FIG. 32A, the surgical punch 430 may be scissor-like having a proximal spring 475 that normally biases the punch to an open position, a proximal handle region 480, a distal hinge 470, and a distal narrow punch 440. The distal narrow punch 440 may be configured to fit within the corneal incision, for example having a tapered shape with a cross-sectional width of less than about 2.2 mm. This may facilitate insertion of the distal narrow punch 440 into the anterior chamber 15 through the corneal incision 13.

[0147] The distal narrow punch portion 440 may have an inner blade 450 and an outer blade 460 joined at a distal hinge 470. The inner blade 450 and the outer blade 460 may be configured separate from one another in a "jaw-like" configuration. The inner blade 450 may be configured to fit inside the outer blade 460 such that when the surgical punch is compressed, any material caught between the inner blade 450 and the outer blade 460, such as a central portion of a lens 60 / 65, is cut through. The shape of the cut in the material may be approximately similar to the shape of the inner blade 450 overlapping the material when cut. The inner blade shaft 455 may extend proximally from the inner blade 450. The outer blade shaft 465 may extend proximally from the outer blade 460. The inner blade shaft 455 and the outer blade shaft 465 may each have a gripping region 485 and may connect at a proximal hinge 475.

[0148] As shown in FIG. 32B, the distal narrow punch 440 of the surgical punch 430 may enter the anterior chamber 15 through the corneal incision 13 and grasp the lens 60 / 65 of the IOL 290. The distal narrow punch 440 may enter the anterior chamber 15 in a compressed or closed configuration. Once inside the anterior chamber 15, the surgical punch may expand to an "open jaw" configuration in which the inner blade 450 and the outer blade 460 may be configured to surround a central portion of the lens 60 / 65. The surgical punch 430 may be compressed to close the "jaws" of the narrow punch portion 440 and return the inner blade 450 and the outer blade 460 to the closed configuration. This compression may cut the central portion of the lens 60 / 65. The compression of the surgical punch 430 may apply a counter force against the lens 60 / 65 such that the forces applied to the lens 60 / 65 are balanced (i.e., there is no net force against the lens 60 / 65). Thus, compression does not apply substantial force in the anterior or posterior direction and does not damage the capsular bag.

[0149] The surgical punch 430 may be removed from the anterior chamber 15 through the corneal incision 13. A central portion of the lens 60 / 65, having approximately the same shape as a portion of the inner blade 450, may also pass through the corneal incision 13. Thus, as the surgical punch 430 is removed, the central portion may be simultaneously extracted from the anterior chamber 15 through the corneal incision 13. Alternatively, the central portion may be extracted from the anterior chamber 15 through the corneal incision 13 by another suitable surgical instrument, such as forceps 235 having a pair of atraumatic grasping tips 237 and a tubular shaft 239, as previously described.

[0150] With particular reference to FIG. 32C, a modular IOL 290 is shown with a central portion of the lens 60 / 65 removed, leaving behind a concave horseshoe portion 420. Both the central portion of the lens 60 / 65 and the remaining horseshoe portion 420 may be sufficiently narrow at all points to fit through a corneal incision, e.g., may have a width of less than 2.0 mm at all points. The central portion may include the fixation tab 295, the hole 298, and a portion of the optic portion 297. It may be desirable for the central portion to include a portion of the fixation tab 295, but not a portion of the movable tab 296. Cutting the movable tab 296 with a surgical punch 430 may result in a small third fragment that includes a fragment of the movable tab 296 that may include the recess 299. Such a fragment may be difficult to find or extract. Thus, in this embodiment, the central portion extends beyond the midpoint of the optic portion 297, but does not extend to the movable tab 296. The following dimensions are provided by way of example, but are not necessarily limiting. Dimension C1 in FIG. 32C may be 5.8 mm, dimension C2 may be 0.75 mm, dimension C3 may be 1.69 mm, and dimension C4 may be 6.92 mm.

[0151] As shown in FIG. 32D, the horseshoe portion 420 of the lens 60 / 65 can be removed through the corneal incision 13. The width of the horseshoe portion 420 at any point can be less than the width of the corneal incision, for example 2.0 mm. This may be referred to as the maximum width of 2.0 mm. Thus, the horseshoe portion 420 can be narrow enough at all points to pass through the corneal incision (typically 2.2 mm) without increasing its size. Forceps 235 can be inserted into the anterior chamber 15 through the corneal incision and used to grasp the horseshoe portion 420 of the lens 60 / 65. With gentle manipulation, the forceps 235 can rotate the horseshoe portion 420 of the lens 60 / 65 and pull it out of the anterior chamber 15 through the corneal incision 13. Special care can be taken so that the extraction of the horseshoe portion 420 of the lens 60 / 65 does not enlarge the corneal incision 13. After extraction, the base 50 / 55 of the modular IOL 290 may remain within the capsular bag 34.

[0152] In another embodiment, a cutting tool may be used to create a curved cut 510 (a "spiral cut") in the lens 60 / 65, which remains unitary and is not cut into multiple pieces. With particular reference to FIG. 33A, a modular IOL 290 is shown having a curved cut 510. As shown, the curved cut 510 may extend from the fixation tab 295 into the optic portion 297 beyond the midpoint of the optic portion 297, but may not extend all the way to the movable tab 296. The curved cut 510 may bisect the hole 298 in the fixation tab 295 of the lens 60 / 65.

[0153] The curved notch 510 may be configured on the lens 60 / 65 such that the distance from any point on the curved notch 510 to the closest point on the circumference of the lens 60 / 65 is less than the width of the corneal incision 13, for example, less than 2.0 mm. This may be referred to as a maximum width of 2.0 mm. This may facilitate extraction of the lens 60 / 65 with the curved notch 510 from the anterior chamber 15 through the corneal incision 13 (typically 2.2 mm).

[0154] The curved incision 510 may be formed using any suitable cutting instrument, such as a curved microscissors 530 having a distal cutting portion 540 as shown in FIG. 33B, which is a detailed schematic diagram of the distal cutting portion 540. The distal cutting portion 540 of the curved microscissors 530 may have an inner blade 550 and an outer blade 560 attached at a distal hinge 570. The distal cutting portion 540 may be configured to fit within a corneal incision 13 having a cross-sectional width of, for example, less than about 2.0 mm. This may facilitate insertion of the distal cutting portion 540 through the corneal incision 13 and into the anterior chamber 15. Proximal to the distal cutting portion 540 is a body portion (not shown) that may be generally similar to the proximal handle region 480 of the surgical punch 430, including the distal hinge.

[0155] The inner blade 550 and the outer blade 560 can be configured to open and close in a "jaw-like" manner. Similar to the blades of regular scissors, the inner blade 550 and the outer blade 560 can be configured to cut any material caught between the blades when the curved microscissors 530 are squeezed or closed. As shown in FIG. 33C, the curved microscissors 530 can form a curved cut 510 in the lens 60 / 65 whose cutting path is approximately similar to the shape between the inner blade 550 and the outer blade 560.

[0156] The compression of the curved microscissors 530 may apply a counter force to the lens 60 / 65 such that the forces applied to the lens 60 / 65 are balanced (i.e., the net force on the lens 60 / 65 is approximately zero). In addition, the curvature of the curved microscissors 530 also avoids unwanted torque or rotation of the lens 60 / 65. While straight scissors may apply torque to the lens as they cut, causing lens rotation, any torque on the lens 60 / 65 from the inner blade 550 and outer blade 560 is countered by an equal and opposite torque on the lens 60 / 65 at another contact point on the curved blade. Thus, cutting the lens 60 / 65 does not apply substantial force or torque in the anterior or posterior direction and does not damage the lens capsule.

[0157] Referring again to FIG. 33C, curved microscissors 530 are shown gripping lens 60 / 65 of IOL 290. This configuration is possible in the anterior chamber 15 of eye 10 having corneal incision 13. Using the methods described above with respect to surgical punch 430, distal cutting portion 540 of curved microscissors 530 can be inserted partially into anterior chamber 15 through corneal incision 13. Because the cross-sectional width of distal curved blade 540 is less than the width of corneal incision 13, the size of corneal incision 13 remains unchanged.

[0158] The distal cut 540 may enter the anterior chamber 15 in a closed configuration. Once inside the anterior chamber 15, the inner blade 550 and outer blade 560 may open to an expanded configuration to cut the lens 60 / 65 along a curved cut path 510. The distal cut 540 may press and close against the lens 60 / 65 to create a curved cut 510 that begins by cutting the fixation tab 295, extends past the midpoint into the optic portion 297, and curves back toward the fixation tab 295 without reaching the movable tab 296. The curved cut 510 may bisect the hole 298 in the fixation tab 295.

[0159] After cutting the lens 60 / 65, the curved microscissors 530 may be removed from the anterior chamber 15 through the corneal incision 13. The lens 60 / 65 with the curved cut 510 may be extracted from the anterior chamber 15 through the corneal incision 13 by a suitable surgical instrument, such as forceps 235 having a pair of atraumatic grasping tips 237 and a tubular shaft 239, as previously described.

[0160] As the lens 60 / 65 is extracted, it may elongate into a spiral configuration. Similar to the elongated horseshoe configuration of Fig. 32D, Fig. 33D shows the lens 60 / 65 with curved slits 510 in an elongated spiral configuration. The lens 60 / 65 may elongate in a spiral manner during extraction from the anterior chamber 15 through the corneal incision 13. The lens 60 / 65 assumes this spiral configuration when a pulling force is applied to either the proximal gripping point 515 or the distal gripping point 520.

[0161] The forceps 235 may be inserted into the anterior chamber 15 through the corneal incision 13 and used to grasp the lens 60 / 65, for example, at the proximal grasping point 515 or the distal grasping point 520. With gentle manipulation, the forceps 235 may rotate the lens 60 / 65 with the curved incision 510 and pull it out of the anterior chamber 15 through the corneal incision 13. Special care may be taken to ensure that the extraction of the lens 60 / 65 does not enlarge the corneal incision 13. As mentioned above, the lens 60 / 65 with the curved incision 510 may be narrow enough at all points to fit through the corneal incision. The distance from any point on the curved incision 510 to the closest circumferential point of the lens 60 / 65 may be less than the width of the corneal incision 13, for example, less than 2.0 mm. This may be referred to as a maximum width of less than 2.0 mm.

[0162] The above discussion of the present invention is presented for purposes of illustration and description. The above is not intended to limit the present invention to the form disclosed herein. Although the description of the present invention includes one or more embodiments and descriptions of certain alternatives and modifications, other alternatives and modifications, such as may be within the skill and knowledge of a person skilled in the art after understanding the present disclosure, are within the scope of the present invention. The present disclosure is intended to entitle to include, to the extent permitted, alternative embodiments including alternative, interchangeable and / or equivalent structures, functions, ranges, or steps to those claimed, whether or not such alternative, interchangeable and / or equivalent structures, functions, ranges, or steps are disclosed herein, and is not intended to make patentable subject matter publicly available.

Claims

1. A modular intraocular lens comprising a base and a lens, The base is a front rim having a first opening; a rear rim having a second opening and a protruding portion protruding radially outwardly of the forward rim; a recessed groove defining a periphery of a central bore communicating with the first opening and the second opening, the recessed groove being defined by the forward rim and the rearward rim; The lens is an optical portion and at least one tab portion including a movable tab; the recess of the base is configured to receive the at least one tab portion of the lens. Modular intraocular lenses.

2. The modular intraocular lens of claim 1 , wherein the posterior rim and the anterior rim define an anterior-posterior dimension around the circumference of the base that is greater than an anterior-posterior dimension of the optic portion proximate the at least one tab portion.

3. The dimension of the base in the front-rear direction around the circumference is 0.615 mm; The anterior-posterior dimension of the optical portion adjacent to the at least one tab portion is 0.25 mm. The modular intraocular lens of claim 2 .

4. The modular intraocular lens of claim 1 , wherein the posterior rim and the anterior rim define an anterior-posterior dimension around the circumference of the base that is less than an anterior-posterior dimension of a central portion of the optic portion.

5. The dimension of the base in the front-rear direction around the circumference is 0.615 mm; The anterior-posterior dimension of the center of the optical portion is 0.78 mm. The modular intraocular lens of claim 4.

6. The modular intraocular lens of claim 1 , wherein a posterior surface of the optic portion of the lens does not contact the base when the at least one tab portion of the lens is received in the recessed groove of the base.

7. The modular intraocular lens of claim 1 , wherein the base further comprises a pair of haptics projecting radially outwardly.

8. The modular intraocular lens of claim 7 , wherein the distance between the tips of the pair of haptics is between about 12.98 mm and about 13.02 mm.

9. The modular intraocular lens of claim 1 , wherein the posterior rim includes one or more notches.

10. The modular intraocular lens of claim 9 , wherein each of the one or more notches has a width of 1.48 mm.

11. The modular intraocular lens of claim 1 , wherein the thickness of the optic portion tapers toward the at least one tab portion.

12. The modular intraocular lens of claim 1 , wherein the movable tab is attached to the optic portion at two ends with a middle portion spaced from the optic portion.

13. The modular intraocular lens of claim 1 , wherein the movable tab is actuable between (i) a radially compressed position and (ii) a non-compressed, expanded position to form an interlocking connection between the lens and the base.

14. 1. A modular intraocular lens comprising: a base; and a lens configured to be inserted into the base, The base is a front rim having a first opening; a rear rim having a second opening and a protruding portion protruding radially outwardly of the forward rim; a recessed groove defining a periphery of a central bore communicating with the first opening and the second opening, the recessed groove being defined by the forward rim and the rearward rim; a pair of haptics protruding radially outward from the protruding portion; the lens includes an optical portion and two tabs protruding from the optical portion, at least one of the two tabs being movable; A modular intraocular lens, wherein the two tabs are received in the recessed grooves of the base when the lens is inserted into the base.

15. The modular intraocular lens of claim 14 , wherein each of the two tabs is movable.

16. The modular intraocular lens of claim 14 , wherein one of the two tabs is fixed.

17. The modular intraocular lens of claim 14 , wherein a width of each haptic of the pair of haptics increases as it approaches the protruding portion of the base.

18. The modular intraocular lens of claim 14 , wherein the posterior rim includes one or more notches.

19. 20. The modular intraocular lens of claim 18, wherein each of the one or more notches has a radian of about 30 degrees.

20. 15. The modular intraocular lens of claim 14, wherein at least one tab is attached to the optic portion at two ends with a middle portion spaced from the optic portion.

21. The modular intraocular lens of claim 14, wherein a movable one of the two tabs is actuable between (i) a radially compressed position and (ii) a non-compressed, expanded position to form an interlocking connection between the lens and the base.

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