Abstract
Phaco-Ersatz represents a new approach to cataract surgery and the correction of aphakia. The procedure involves the removal of the cataractous cortex and nucleus while preserving the lens capsule and its zonular attachments. The empty lens capsule is then refilled with biocompatible and optically suitable clear gel. A physiologic lens is recreated in situ. Experimental work with human cadaver eyes and rabbit and cat eyes in vivo demonstrates this surgical feasibility. A review of the literature reveals contradicting theories regarding the physical laws and lens properties governing accommodation. The accommodative potential of the ersatz lens has not been tested, but it may be speculated that this recreated lens may, in fact, possess some accommodative properties. Experimental investigations in this area represent the logical extension of intraocular lens implant development.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Agarwal LP, Narsimhan EC, Mohan M (1967a) Experimentals lens filling. Orient Arch Ophthalmol 5:205–212
Agarwal LP, Narsimhan EC, Mohan M (1967b) Experimental lens refilling. II. (In monkeys). Orient Arch Ophthalmol 5:278–280
Arkles BC (1981) New generation silicones for medical devices. Med Dev Diagnost Ind 3: 31–61
Brown N (1973) The change in shape and internal form of the lens of the eye on accommodation. Exp Eye Res 15:441–459
BuPark J (1979) Biomaterials: An introduction. Plenum Press, New York London, pp 1–239
Coleman DJ (1970) Unified model for accommodative mechanism. Am J Ophthalmol 69:1063–1079
Duke-Elder S (1958) System of ophthalmology, vol 1. The eye in evolution. C.V. Mosby, St. Louis, pp 652–655
Duke-Elder S (1970) The mechanism of accommodation. In: System of Ophthalmology, vol V. Ophthalmic optics and refraction. Henry Kimpton, London, pp 161–175
Farnsworth PN, Shyne SE (1979) Anterior zonular shift with age. Exp Eye Res 28: 291–297
Fincham E (1937) The mechanism of accommodation. Br J Ophthalmol 98:1–9
Fisher RF (1977) The force of contraction of the human ciliary muscle during accommodation. J Physiol 270:51–74
Groves B (1925) The response of the lens capsule in the act of accommodation. Trans Am Ophthalmol Soc 23:184–198
Helmholtz H (1962) Southall, JPC (ed) Treatise on physiologic optics, vol 1. Dover Publications, New York, pp 143–172
Holtman HW (1980) Bindehautfistelabdichtung mittels Fibrinkleber. Klin Monatsbl Augenheilkd 177:326–362
Kessler J (1964) Experiments in refilling the lens. Arch Ophthalmol 71:412–417
Kessler J (1966) Refilling the rabbit lens: further experiments. Arch Opthalmol 76: 596–598
Kessler J (1975) Lens refilling and regrowth of lens substance in the rabbit eye. Ann Ophthalmol 7:1059–1062
Koretz JF (1982) The accommodative mechanism: a model for the young anisotropic lens. ARVO Abstracts. Invest Ophthalmol Vis Sci [Suppl] 22:150
Koretz JF, Handelman GH (1981) The effects of anisotropic lens elasticity on the model distribution of forces during accommodation. ARVO Abstracts. Invest Ophthalmol Vis Sci [Suppl] 20:129
Lynch W (1978) Handbook of silicone rubber fabrication. Van Nostrand Reinhold, New York, pp 1–257
Miller D (1981) Intraocular lenses. Ann Ophthalmol 13:541–543
Noll W (1968) Chemistry and technology of silicones. Academic Press, New York London, pp 1–702
Ober M, Rohen JW (1979) Regional differences in the fine structure of the ciliary epithelium related to accommodation. Invest Ophthalmol Vis Sci 18:655–664
O'Neill WD, Doyle JM (1968) A thin shell deformation analysis of the human eye. Vis Res 8:193–206
Patnaik B (1967) A photographic study of accommodative mechanisms: changes in the lens nucleus during accommodation. Invest Ophthalmol 6:601–611
Prince JH, Eglitis I (1964) The crystalline lens. In: The rabbit in eye research. C.C. Thomas, Springfield, Ill., pp 342–371
Prince JH, Diesen CD, Eglitis I, Ruskell GL (1960) Anatomy and history of the eye and orbit in domestic animals. Charles C. Thomas, Springfield, Ill, pp 80, 110, 220, 247, 272
Rohen JW (1979a) Scanning electron microscope studies of the zonular apparatus in human and monkey eyes. Invest Ophthalmol Vis Sci 18:133–144
Rohen JW (1979b) Die funktionellen Systeme des Sehapparates. Nova Acta Leopold 50: 13–22
Rohen JW (1980) Zur funktionellen Morphologie des Akkommodationsapparates. Verh Anat Ges 74:631–632
Van Heyningen R (1975) What happens to the human lens in cataract. Sci Am 283:70–72; 77–81
Wolter JR (1981) The message of a bony lens. Ophthalmol Surg 12:332–335
Author information
Authors and Affiliations
Additional information
This investigation was supported in part by the Florida Lions Eye Bank, Miami; the Veterans Administration Medical Center, Miami; Public Health research grant EY02180 from the National Eye Institute; and Research to Prevent Blindness, Inc., New York, New York
Rights and permissions
About this article
Cite this article
Parel, J.M., Gelender, H., Trefers, W.F. et al. Phaco-Ersatz: Cataract surgery designed to preserve accommodation. Graefe's Arch Clin Exp Ophthalmol 224, 165–173 (1986). https://doi.org/10.1007/BF02141492
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02141492