WO2004082535A2

WO2004082535A2 - Intra-ocular, accommodatively movable implant

Info

Publication number: WO2004082535A2
Application number: PCT/EP2004/002889
Authority: WO
Inventors: Klaus Müller
Original assignee: Mueller Klaus
Priority date: 2003-03-21
Filing date: 2004-03-19
Publication date: 2004-09-30
Also published as: WO2004082535A3; DE10312551A1; EP1608296A2

Abstract

The invention relates to an intra-ocular, accommodatively movable implant (1) for insertion in the capsular bag (11) of any eye. Said implant comprises a lens (2) and at least one first (3) and one second (4) transmission element that have a terminal zone (10) each. The implant preferably has loop haptics that directly contact the capsular bag and that facilitate an axial mobility of the implant. The invention also relates to implants that work according to the focus-shift principle.

Description

Intraocular, accommodatively movable implant

The present invention relates to an intraocular, accommodatively movable implant which can be inserted into at least one optically active part, in particular a lens, in a capsular bag of an eye and has at least a first and a second transmission element, each of which has an end region.

The implantation of plastic lenses in the human eye is one of the most common interventions today, especially in the context of modern cataract surgery, and is now considered the most frequently performed operation on humans.

A simultaneous restoration of the accommodation capacity - defined as the ability of the dioptric system of the eye caused by a change in refractive power or a shift in focus - to sharply depict different distance areas on the retina - would come considerably closer to the goal of complete visual rehabilitation. To this end, very different paths have been and are being followed.

One of the basic possibilities is based on the change in focus caused by axial displacement of the lens in the eye, the so-called “focus shift” or “optics shift” principle, which results in different refractive power ratios within the overall eye system depending on the position of the lens.

Several registrations are already known for this.

For example, an intraocular plate haptic lens is known from WO 00/66040, which is arranged movably in a capsular bag. The lens is fully bordered along its edge. This frame is movable relative to the lens and in contact with the capsular bag. If pressure is applied to the frame via the capsular bag, the frame bends and the lens is moved in the anterior direction. If the capsular bag is relaxed, the frame remains in a shape that kinks relative to the lens. EP 0 793 460 B1 in turn shows an implant that has two haptics that are fastened in a ring that is arranged in the capsular bag.

The object of the present invention is to improve or restore the ability to accommodate by means of an implant. This object is achieved with an intraocular, accommodatively movable implant with the features of claim 1, with an intraocular, accommodatively movable implant with the features of claim 2 and with an intraocular, accommodatively movable implant with the features of claim 3. Furthermore, a method for changing the beam path in the eye by means of an intraocular implant is provided with the features of claim 20. Further advantageous refinements and developments are specified in the respective subclaims.

In contrast to the artificial lenses that are already on the market and are based on the optic shift principle, the “shift effect” in the present invention is not achieved by a direct external compression effect of the ciliary muscle and / or vitreous body on the implant, but by means of the due to the largely intact accommodation structures of the eye (ciliary body, zonular fibers, capsular bag), the spring forces present in the implant itself are released according to need.

In the following, the term “implant” is to be understood to mean a structure which comprises at least one optical lens and transmission elements. The lens can, for example, additionally sit on a holder, be enclosed in a holder or even have an edge region similar to a holder, in particular with The lens and the holder can each have a flexible material individually or together, in particular consist of a flexible material. The material is preferably foldable.

According to a first embodiment of the invention, an intraocular, accommodatively movable implant that can be inserted into a capsular bag of an eye is provided with at least one optical lens and with at least one first and a second transmission element, each of which has an end region. The transmission elements designed for the self-centering of the lens in the capsular bag each have an end region designed for direct contacting of the capsular bag and for direct absorption of force from the capsular bag. The end region is completely offset in a rest position outside the eye in the posterior direction to the lens, an angle of attack being defined between a lens plane and an action plane running through a transmission element and its end regions. The special design of this implant enables good centering in the capsular bag, on the one hand, through the uniform endocapsular tensioning of its two flexible transmission elements, in particular in the form of loop haptics. On the other hand, the angled back of the haptics is intended to keep the optical part of the implant within the eye in a middle rest position - in a kind of floating state between the forces of the spring action of the implant and the tension state of the capsular bag. It is only when the zonular capsule apparatus is slackened by contraction of the ciliary muscle that the overall effect of the entire implant increases in thickness, with a simultaneous axial displacement of the optical lens, due to the predominance of the spring action. This results in a close accommodation.

On the other hand, when the zonular capsule apparatus is tightened, when the ciliary muscle relaxes, the capsular bag is pulled out equatorially, while the front capsule leaf exerts pressure on the middle part, and the implant is flattened with an axial displacement of the optics towards the retina. This results in remote accommodation or disaccommodation.

The functionality of this first embodiment of the invention will be exposed to a fibrosis or glueing of the two capsule sheets which always occurs postoperatively, based on the problem of the so-called "internal wound healing of the capsular bag". One solution here is an additional filling of the capsular bag with a biogel , which in addition to a "spacer function" of the two capsule leaves also contributes to the inner support of the shifting effect.

According to a second embodiment of the invention, which takes advantage of the fact that the ciliary sulcus is anatomically predetermined somewhat further anteriorly than the capsular bag, in particular after the two capsular leaves have been glued, in the human eye, an intraocular, accommodatively movable implant with a optical lens and provided with at least a first and a second transmission element. In which the haptics of the implant, which were originally not at all or only slightly angled posteriorly, are placed intraoperatively in the suicus ciliaris of the eye and the middle part carrying the optical lens through the previously applied capsulorhexis of the front capsule leaf If the capsular bag is tied in, there is a forced angling of the haptics anteriorly with respect to the optics or the central part with a permanent spring effect of the optics to the front and the result of an axial displacement of the entire optic structure depending on the respective ciliary muscle-controlled tension state of the zonular capsule structures. Capsule diaphragm ("optic shift principle").

The pretension can be varied as desired, depending on the material properties and the primary angle of the haptics, especially in the rest position outside the eye. Likewise, tying the middle section through an additional capsulorhexis of the posterior capsule leaf significantly increases the pulling effect posteriorly.

The flexible, in particular elastic transmission elements, in particular loop haptics, which are designed for independent centering of the lens and for generating a restoring force, are angled from the lens in the anterior direction in the inserted state and at least partially run outside the capsular bag, the transmission elements end regions for contacting , in particular fixation, in the suicus ciliaris, while the lens has a holder, in particular the lens is enclosed, preferably the lens is seated on the holder. According to a further development, the holder at least partially forms a support surface for a front and / or rear capsular bag leaf.

A widened edge design of the holder surrounding the lens, which serves to support the front capsule sheet, also prevents the optics from sliding back out of the capsular bag, provided the capsulorhexis edge is intact and the diameter of the capsulorhexis is smaller than the total diameter of the middle part of the lens. In particular, the middle part has a material that is elastic enough on the one hand to be inserted into the capsular bag when folded. On the other hand, the material has a strength that prevents it from at least partially folding and slipping out after insertion of the implant solely due to the forces acting in conjunction with the eye. A major advantage of this configuration lies in the postoperative fibrosis and tendency of the capsule sheets to no longer interfere. Quite the contrary: with increasing fibrosis or gluing of the capsular bag, the influence of the ciliary muscle on accommodation or against the spring force of the lens and any pressure from the vitreous cavity increases.

According to a further embodiment of the invention, an intraocular, accommodatively movable implant that can be inserted into a capsular bag of an eye is provided with at least one optical lens and with at least a first and a second transmission element, the transmission elements being resilient, especially in the rest position outside the eye -Elastic angulation posterior to the lens. At least on one of the flexible transmission elements, a clamping means is provided for fastening the implant to the capsular bag and for transmitting force from the capsular bag to the lens.

This implant is fixed in the plane of the intraoperative circular opening of the front capsule leaf, ie on the edge of the so-called "capsulorhexis".

The forces used here for the axial displacement of the optical lens are, on the one hand, the spring effect of the implant resulting from the elastic bending of the haptics. For this purpose, the haptics preferably do not reach all the way to the equator. On the other hand, it is the tension of the existing capsule structures that counteracts this spring pressure, depending on the respective contraction state of the ciliary muscle.

With increasing tension of the ciliary muscle, and thus relaxation of the capsule structures - possibly additionally supported by a more or less pressure exerted from behind from the vitreous area of the eye to the front - the haptics are completely or further realized at the same time axial shift of the optical lens forward towards the cornea. This creates a near accommodation. When the ciliary muscle relaxes and the capsule structures become tense, on the other hand, the balance of forces is reversed: Tensioning the capsular sac gradually abolishes the haptic deflection while at the same time taking the optics back towards the retina. This creates long-distance or desac accommodation.

A postoperative fibrosis or gluing of the capsule leaves can also be advantageous with this implant. In addition to the described, a variety of different attachment options for the implant on the capsulorhexis edge are conceivable.

Rhexisfixation can be performed in particular on the front capsule leaf. However, if the front capsule sheet is too weak, in particular torn, there is still the possibility of carrying out the implant on the edge of an additional “rear capsulorhexis” of the rear capsule sheet.

It is preferably provided that the implant has clamping means for clamping a capsulorhexis edge of an anterior and / or posterior capsular bag leaf. It is preferably provided that the transmission element itself is designed as a clamping means. This allows a direct power transmission from the capsular bag leaf to the lens.

According to a further development it is provided that the clamping means has a plurality of flexible clamping sections. In particular, it is provided that at least one clamping section has a hollow inner area. This allows the weight to be reduced and improved gluing to the capsular bag leaf.

The plurality of bendable clamping sections make it possible, for example, for them to be arranged such that they can move relative to one another. A part of the capsular bag leaf can be clamped in between by this counter movement.

A further embodiment consists of moving the central optical part of the implant as far as possible behind the plane of the front capsular bag leaf in order to largely avoid direct contact between the front surface of the lens and the back surface of the iris (in the course of near accommodation). The implant can have one or more lenses and a different number of clamping sections. According to one embodiment, the implant has an addition of the diopters by connecting optically acting components of the implant in series. These can be multiple lenses or combinations of at least one lens with a gel (“lens refilling systems”). In the sense of the invention, this combination is also to be understood as an implant.

According to a further idea of the invention, the intraocular implant that can be moved in an accommodative manner is used. In addition, a gel is placed in the capsular bag. The capsular bag is then closed. This prevents the capsule leaves from sticking and at the same time supports the axial displacement of the optical lens. In the context of this disclosure, reference is made in this regard in particular to WO 01/85067 as well as to US 2002/0107567 A1, in particular with regard to the materials used, the procedure, desired values and also a closure of the capsular bag, the description of which in this regard belongs to the scope of this disclosure , According to a further development, the clamping means of the flexible transmission elements is used in particular to close the capsular bag.

Calculations using the optics shift principle show that the accommodative efficiency achieved through the focus shift has a positive correlation with the strength of the refractive power of the optics to be shifted. However, since the required total refractive power of the eye is always predetermined over the respective length of the eyeball, an additional improvement in the accommodative efficiency of the “optic shift” by means of a conscious increase in the lens refractive power with simultaneous or subsequent compensatory weakening of the corneal refractive power (to maintain the total refractive power) is by a contact lens, or even better, by laser surgery (PRK, LASIK etc.) on the cornea.

Another possibility of increasing the refractive power of the artificial lens in a targeted manner is to implant an additional optical lens with a diverging effect behind the front optically collecting lens (“dual optics”). The present invention is particularly suitable for this purpose, since it is independent of one another Fixation in the front capsular bag area even without a mechanical connection to the second optically diverging lens located in the rear capsular bag area, enables an opposite “shift”. In particular with regard to the refractive index to be set, the refractive index, the diopter of the implant, its dimensions and partial geometries such as lens, holder and haptics, the materials that can be used, as well as coatings and properties of materials and coatings, with regard to insertion aids and usable methods for implantation, reference is made to DE 103 12 551, the relevant content of which is part of the disclosure content of this invention.

Further advantageous refinements and developments are explained in more detail with reference to the following drawings. However, the designs and features described there are not limited to the individual exemplary embodiments. Rather, these features, modes of action and advantages can also be combined with the implants described above and their respective further developments. Show it:

Fig A first implant in a top view, Fig The first implant from Figure 1 in a side view, Fig The first implant implanted in a capsular bag, Fig A second implant in a top view, Fig The second implant in a side view, Fig The second implant from Figure 4 implanted in a capsular bag with the optical lens in the capsular bag and a support of end regions of the transmission elements in the suicus ciliaris,

7: a section through an eye, an implant corresponding to that from FIG. 4 being inserted into the eye,

Fig. 8: A third implant in a top view, Fig. 9: The third implant in a side view, Fig. 10 The third implant implanted in a capsular bag, Fig. 11 A fourth implant in a top view, Fig. 12 The fourth implant in a side view, Fig. 13 The fourth implant implanted in a capsular bag, FIG. 14 A fifth implant in a top view FIG. 15 The fifth implant in a side view, FIG. 16 The fifth implant implanted in a capsular bag, FIG. 17 A schematic representation of one of the implants shown in FIGS a state suspended in a capsulorhexis margin with maximum near accommodation, 18: the same implant as shown in FIG. 17 with medium accommodation,

19: The same implant as shown in FIGS. 17 and 18 with maximum femoral accommodation, FIG. 20: A section through the eye, an implant corresponding to that from FIG. 1 being inserted into the eye,

Fig. 21, Fig. 22 and Fig. 23: Different flexible implants, which are inserted folded with tweezers.

FIG. 1 shows a first implant 1 which has a lens 2 and a first transmission element 3 and a second transmission element 4. The lens 2 is arranged on a holder 5 for the lens 2. The holder 5, which is centered in particular by means of the first and the second transmission element 3 and 4 on account of their elastic properties, has recesses 6 which form joints. In this way, the first transmission element 3 and the second transmission element 4 bring about a special radial, flexible force transmission with respect to the holder 5.

FIG. 2 shows the first implant 1 from FIG. 1 in a side view. The first implant 1 has an angle of attack 7 which is formed via an active plane 8 and a lens plane 9. The lens plane 9 is displaced in parallel in FIG. 2 and runs through the respective outer edge of the holder 5. This is indicated by the dash-dotted line. The transmission elements 3, 4 have end regions 10. In particular, these end regions 10 are in direct contact with a capsular bag.

3 shows the first implant 1 arranged in a capsular bag 11. The implant lies against the anterior capsular bag sheet 13 with a support surface 12 in the holder 5. The bearing surface 12 is indicated by hatching. The transfer elements 3, 4 are designed as arcuate, opposing haptics that enable direct power transmission from the capsular bag to the lens 2. A centering of the implant in the capsular bag 11 is ensured in particular by uniform, endocapsular tensioning of the two flexible loop haptics. The development of the haptics of the implant in the eye, which points in the posterior direction, allows the inserted first implant 1 to be held in a middle rest position there, in a kind of floating state between the forces of the achieved spring action of the lens and the tension state of the capsular bag becomes. The function of the first implant is then as follows: With an additional slackening of the zonular capsule apparatus a contraction of the ciliary muscle leads to a predominance of the spring action of the implant and thus to an increase in its thickness with simultaneous axial displacement of the optical lens in the anterior direction. In this way, sewing accommodation is achieved. On the other hand, when the zonular fibers become tense due to relaxation of the ciliary muscle, an equatorial extension of the capsular bag with simultaneous pressure from the front capsule leaf on the support surface 12 of the holder 5 leads to a flattening of the implant with an axial displacement of the lens in the posterior direction. A distance or disaccommodation is thereby achieved.

As shown in FIGS. 2 and 3, the holder 5 has a specific shape, which at least partially includes a rounded surface. The rounded surface at least partially forms the contact surface 12. This flatness enables the probability of an undesired so-called "capsule capture phenomenon" to be avoided. This phenomenon would result in the intraoperatively circular anterior capsule sheet 13 being pinched under one another Edge section of the holder 5 or the lens 2 come.

4 to 7 show a second implant 15. The second implant 15 is shown in FIG. 4 and in FIG. 5 in a rest position outside the eye, in which no force acts on the implant from the outside. Fig. 6 and Fig. 7 show the second implant 15, however, in the ^"eye 28 inserted state. The second implant 15 includes at least two transfer elements as haptic loops 29. The haptic loops 29 are formed such that they allow support in Suicus ciliaris 32 The haptic loops 29 therefore have a dimensioning which enables the optical lens 2 to be guided past when it is implanted in the capsular bag 13. The haptic loops 29 preferably have a first section which runs at least predominantly radially, in a section adjoining this The haptic loops 29 preferably run predominantly in the circumferential direction of the lens 2. The at least partially flexible and / or rigid holder 5 of the second implant 15 has a contact surface 12 for contacting the anterior capsular bag leaf 13. The contact surface 12 runs in particular along the entire lens 2 around, preferably only interrupted for a passage area 31 for the loop haptics 29. For this purpose, the holder 5 preferably has joint-forming recesses in which the loop haptics 29 are connected to the holder 5, in particular with a material fit. 7 shows an eye 28 into which the second implant 15 is inserted. The haptics 29 are placed intraoperatively in the suicus ciliaris 32 of the eye and the lens 2 has been specifically linked into the capsulorhexis of the anterior capsular sac sheet in the capsular sac 11. The forced angling of the haptics with respect to the lens 2 or the holder 5 results in a permanent spring effect of the lens 2 in the anterior direction. Depending on the respective tension state of the zonular capsule apparatus controlled by the ciliary muscle, there is an axial displacement of the optical lens. By means of the specific contact surface design of the holder 5, the lens is prevented from sliding back out of the capsular bag, provided the capsulorhexis rim 22 is intact and the diameter of the capsule hexis is smaller than the overall diameter of the holder 5.

In order to achieve a stronger spring action, the implant can have an angled position of the loop haptics in the posterior direction to the lens in the rest position outside the eye. In this way, the pretension increases due to the greater distance to the rest position outside the eye for the end regions of the loop haptics.

8 to 10 show a third implant 16, which has four transmission elements in the form of clamping profiles 17 angled in the posterior direction as clamping means. The clamping profiles 17 have a first longitudinal web 18 and a second longitudinal web 19, which are connected to one another via a connecting web 20. An opening, in particular a passage 21, is arranged between the webs. The connecting webs can in particular be at least partially flat and / or curved. Furthermore, this allows a particularly flexible construction of the webs. The third implant 16 can be attached to the capsulorhexis edge 22 by means of the clamping profiles 17. For this purpose, the hollow clamping profiles 17 are arranged alternately on the anterior and posterior surface of the capsular bag leaf and can thereby develop a clamping effect.

In addition, the number of clamping profiles shown can also deviate upwards as well as downwards.

11 to 13 show a fourth implant 23, in which the clamping profiles 17 can be partially bent open in a hinge-like manner before they are inserted. The fourth implant 23 is also suitable for being attached to the capsulorhexis edge 22. For this purpose, the fourth implant 23 has the holder for the lens 2 constructed in such a way that the clamping profiles 17 forming the transmission elements each have a counter surface 24. arranges. A counter surface 24 and a region of the clamping profiles 17 each form a clamping opening 25 as clamping means 26. A section of the capsulorhexis edge 22 is introduced into the clamping opening 25.

14 to 16 show a fifth implant 41 with only two clamping profiles 17 which form two clamping openings 25 for the capsulorhexis edge 22 with the two respectively assigned counter surfaces 24.

The spring-elastic bend 7 of the respective transmission elements (haptics) of approximately 10 ° in the rest position outside the eye is decisive for the function of the implants shown in FIGS. 8 to 16. However, the bend can also preferably move in a range between 5 ° and 15 ° in the rest position.

17 to 19 schematically show the basic mode of operation of the “rhexis-fixed” implants shown in FIGS. 8 to 16. Starting from a middle rest position, see FIG. 18, the implant suspended in the capsulorhexis rim 22 of a front and / or rear capsule leaf , with increasing tension of the ciliary muscle 33, relaxation of the capsule structures 13 leads to complete or further realization of the primary angling of the haptics 17 with simultaneous axial displacement of the optical lens 2. This produces the near accommodation, see FIG. 17. With relaxation The force relationships of the ciliary muscle 33, see FIG. 19, are reversed: by tightening the capsule apparatus 13, the haptic angulation is gradually eliminated and the optics 2 are taken backwards towards the retina. This produces distant or unaccomodation.

The transmission elements are preferably designed to be flexible and form-fitting in one piece over their entire area. A further embodiment provides that the material in the area of the clamping means has a different modulus of elasticity than the material in the immediate vicinity of the lens 2. A further embodiment provides that at least the holder 5 together with the clamping profiles 17 and the counter surfaces 24 are integrally cohesive. A further embodiment provides that the lens 2 is made of the same material as the holder 5, in particular the holder 5 and the lens 2 are connected to one another in a form-fitting manner. A development of the implants shown in FIGS. 1 to 16 provides that the capsular bag 11 is additionally filled with a gel 37 in addition to the lens 2 (ens refilling).

FIG. 20 shows the first implant 1 shown in FIG. 1, which is implanted in an eye 28. Via the ciliary muscles 33 and the zonular fibers 34, for example, a tensile force can be exerted on the capsular bag 11 and the first implant 1 can thus provide accommodative focusing on the retina 35. The desired focusing or accommodation ability is achieved by the spring action of the first implant 1 in conjunction with the remaining capsular bag dynamics while maintaining the contractility of the ciliary muscle. A supportive effect is achieved by additionally filling the capsular bag with a gel 37.

21 to 23 show different types of implants as described above. All of them, provided the optical lens is made of flexible material, can be inserted into the eye with tweezers in the usual way through a 3-4mm wide access. FIG. 21 indicates how, for example, the first implant 1 from FIG. 1 can be inserted into the eye. 22 shows, for example, how the second implant 15 from FIG. 5 is inserted into the capsular bag 11. FIG. 23 indicates how, for example, the third implant 16 from FIG. 8 can be used folded.

The invention can be used in particular in the eyes of mammals, preferably in human eyes. It can be carried out on one or both sides of a mammal. In addition to use in humans, the invention is used in particular in horses, dogs, cats, cattle, camels and other living beings. The invention can be used not only in the context of cataract surgery, but also in refractive surgery, for example as a replacement or supplement to glasses, in particular for presbyopia correction.

Claims

claims

1. Intraocular, accommodatively movable implant (1) which can be inserted into a capsular bag (11) of an eye (28) with at least one lens (2) and with at least a first (3) and a second (4) transmission element, each having an end region (10), characterized in that the flexible transmission elements (3, 4), in particular loop haptics, designed to independently center the lens in the capsular bag, in each case one for direct contacting of the capsular bag (11) and for direct absorption of force from the capsular bag (11 ) designed end area (10), which is completely offset in the rest position of the implant (1) in the posterior direction to the lens (2), an angle of attack (7) between a lens plane (9) and one through a transmission element (3, 4 ) and its end region (10) running action level (8) is defined.

2. intraocular, accommodatively movable implant (15) which can be inserted into a capsular bag (11) of an eye (28) and has at least one optical lens (2) and at least one first and one second transmission element, each of which has an end region (30), characterized in that, in the inserted state, the transmission elements designed to independently center the lens, in particular loop haptics, have an angled-on anterior direction, extend outside the capsular bag and have end regions (30) for support in the suicus ciliaris (32), while the lens (2) inserted into the capsular bag has a holder (5) which forms a contact surface for an anterior and / or posterior capsular bag sheet (13).

3. Intraocular, accommodatively movable implant (16; 23; 41) that can be inserted into a capsular bag (11) of an eye with at least one lens (2) and with at least one first and one second transmission element, each having an end region, characterized in that that at least one of the transmission elements has a small tel for attaching the implant (16; 23; 41) to the capsular bag (11) and for power transmission from the capsular bag (11) to the lens (2) is provided.

4. Implant according to one of the preceding claims, characterized in that the modulus of elasticity of the material of the transmission element (3; 4; 5; 17; 29) has a different value than the modulus of elasticity of the lens material.

5. Implant (1; 15) according to one of the preceding claims, characterized in that the transmission elements are haptics which extend in an arc from the lens (2) with a radial and axial spring effect.

6. Implant (15) according to one of the preceding claims, characterized in that the transmission elements (29) in the rest position outside the eye have no angling or a slight angling posterior to the lens (2).

7. implant (1; 15; 16; 23; 41) according to any one of the preceding claims, characterized in that the lens (2) is arranged in a holder (5) which is integrally integrally connected to the transmission elements.

8. implant (1; 15; 16; 23; 41) according to one of the preceding claims, characterized in that the holder (5) has joint-forming recesses, each of which a haptic extends.

9. Implant (15; 16; 23; 41) according to one of the preceding claims, characterized in that at least one contact surface is provided for an anterior and / or posterior capsular bag leaf (13).

10. The implant (1; 15; 16; 23; 41;) according to claim 8, characterized in that an at least partially convex contact surface (12) adjoins the lens (2).

11. The implant (1; 15; 16; 23; 41) according to claim 8, characterized in that an at least partially flat contact surface (12) adjoins the lens (2).

12. Implant (15; 16; 23; 41) according to one of the preceding claims, characterized in that a plurality of clamping openings (25) are provided, into which a part of the capsular bag (11) or capsulorhexis rim (22) can be inserted.

13. Implant (15; 16; 23; 41) according to one of the preceding claims, characterized in that clamping means (26) are provided for clamping a capsulorhexis edge (22) of an anterior and / or posterior capsular bag leaf.

14. The implant (15; 16; 23; 41;) according to claim 13, characterized in that the transmission element has clamping means (26).

15. implant (15, 16; 23; 41;) according to claim 13 and 14, characterized in that the clamping means (26) a plurality of bendable

Has clamping sections.

16. The implant (15, 16; 23; 41) according to claim 13, characterized in that at least one clamping section has a hollow inner area.

17. The implant (1; 15; 16; 23; 41;) according to one of the preceding claims, characterized in that the implant (1; 15; 16; 23; 41;) is designed as a closure of a capsulorhexis edge (22).

18. Implant (1; 15; 16; 23; 41) according to one of the preceding claims, characterized in that the lens (2) forms an optic with a gel which can be inserted into the capsular bag (11).

19. Implant (15; 16; 23; 41) according to one of the preceding claims, characterized in that the lens (2) forms an optical system with at least one further lens introduced into the capsular bag (11).

20. Method for realizing the accommodative optics shift principle in the eye by means of an intraocular implant, in which it is carried out by means of endocapsular spring action (1) and / or a capsular bag implantation (15) and / or rhexis fixation (16; 23.) Supported in the suicus ciliaris ; 41) comes to a force change induced by the ciliary muscle, transmitted by the respective state of tension of the zonular capsule apparatus and acting on the implant with simultaneous axial movement anteriorly or posteriorly at least of the optically active lens of the implant.