1.
EVOLUTION,
TYPES,
MATERIALS OF
IOLB I P I N B I S TA
R E S I D E N T - O P H T H A L M O LO G Y

2.
HISTORICAL PERSPECTIVES
• Before 1949, cataract surgery resulted in
aphakia, and patients were destined were high
hyperopic spectacles.
• Development of IOL began in 1949.
• Harold Ridley, an English ophthalmologist
observed that PMMA fragments from airport
cockpit windshields were well tolerated in the AS
of injured WW II pilots.
• He placed disc-shaped PMMA lens into the PC
of 45 year old woman after ECCE.
• High incidence of post operative complications
such as glaucoma, uveitis, and dislocation .
• Then constructed biconvex designed PMMA
(GENERATION 1 –PC LENS)

3.
GENERATION II (EARLY AC LENSES)
• Consideration with fixation of the lens with angle recess.
• Anterior chamber was chosen because of less chances of dislocation
• Could be implanted after an ICCE or an ECCE.
• UGH syndrome was first described when ocular tissue were damaged by poorly
manufactured lenses.

4.
GENERATION III (IRIS SUPPORTED
LENSES)
• Cornelius Binkhorst was an early
advocate of iris-supported lens
• 4 looped iris-clip IOL
• Iris chafing, pupillary abnormalities,
and dislocation .
• Increased corneal decompensation
occurred d/t long peripheral loops.
• Changed ICCE to ECCE and the
introduction of 2 –looped iridocapsular
IOL in 1965

5.
GENERATION IV (INTERMEDIATE AC
LENSES)
• Major modifications of iris-supported
lenses
• More flexible loops
• 3 or 4 point Kelman IOLs were made
up of with PMMA & Polypropylene.

6.
GENERATION V (IMPROVED
POSTERIOR LENSES)
• John Pearce of England implanted the first
uniplanar Posterior Chamber lens
• Rigid tripod design with the two inferior feet
implanted in front of anterior capsuleand
sutured to the iris.
• Steven Shearing of Las Vegas : Major
breakthrough in early 1977 with his posterior
chamber.
• William Simcoe of Tulsa introduced his C-
looped posterior chamber lens after Shearing
J-loop.
• Remains away from delicate structure of
anterior segment.

7.
GENERATION VI (MODERN CAPSULAR
LENS – RIGID PMMA, SOFT FOLDABLE,
MODERN AC LENS)
• In the bag fixation with advancement IOL design and surgical technique. (after 1980)
• After 1990 with the introduction of Ophthalmic Viscosurgical devices, improvement
towards foldable lens.
• Mazzocco is given credit for developing foldable IOL.

8.
RECENT ADVANCES
• Large fixation holes : fibrous adhesion between
the anterior and posterior capsules, enhances
the stability and fixation
• Use of PMMA, polymide or polyvinyl fluoride
• Square, truncated optic edge : barrier effect
against cell migration on posterior capsule
towards visual axis : reduction in PCO
• New injector system
• Multifocality, toric correction,
pseudoaccomodation, asphericity, image
magnification
• For spectacle freedom : piggy bank IOLs
• Toric IOLs

9.
THANK YOU