Introduction: The Evolution of Intraocular Lenses
Pp. 3-20 (18)
Brain Zaugg, Guy Kleinmann and David J. Apple
The development of foldable lenses, and perhaps more importantly, the
small-incision capsular surgical techniques that accompany them, have been
instrumental in achieving a vast reduction in cataract surgery complications. The
excellent optical and visual rehabilitory benefits of small incision phacoemulsificationfoldable
intraocular lens (IOL) surgery, including reduced astigmatism, quick recovery,
and many other advantages, are well known. This modern procedure has achieved a
state of vision restoration as well as vision rehabilitation. Modern cataract surgery is
now a genuine form of refractive surgery.
The history of cataract surgery with IOLs is one of the extensive trial and errors, with
many dead ends. By far, the most important and basic element required for success with
IOLs is fixation. Indeed, the generations of IOLs are named according to the type of
fixation used during each era.
The six generations that we identify signify the continuous movement forward, as
surgeons attempted to improve IOL fixation. The move from Ridley's initial lens
(Generation I) to the early anterior chamber lenses and iris-fixated lenses (Generations
II and III) were basically attempts to overcome decentration issues (recall that Ridley’s
IOL had no haptics). In addition, the move toward a second generation of anterior
chamber lenses (Generation IV), usually implanted after intracapsular cataract
extraction (ICCE), was in part caused by a desire to avoid the posterior capsule
opacification (PCO) or secondary cataract that often occurred after early methods of
extracapsular cataract extraction (ECCE). The last generation includes “specialized”
IOLs, which are the focus of this book.
Intraocular Lenses, History, Evolution.
Ophthalmology Department Kaplan Medical Center, POB 1, Rehovot, 76100, Israel.