The inferior haptic would be inserted, and eventually fibrose, between a leaflet of remaining anterior capsule and the posterior capsule. The lenses designed for this technique had a small platinum or plastic rod attached to the superior optic that could be clipped to the superior posterior haptic through a superior peripheral iridectomy ( Fig. Iridocapsular fixation was the next step. The structural diaphragm of the posterior capsule after ECCE was rediscovered and appreciated because it contained the vitreous and created compartmentalization and stabilization of the AC, iris, and posterior chamber. Even when done well, the procedure left an eye not able to support an IOL in stable fashion. ICCE was difficult and time-consuming and carried a high risk. Aside from partial dislocation, this type of lens performed very well, but eye movement after ICCE still generated substantial iridopseudophakodonesis. Then, when the IOL fell into position, we would reposition the patient and administer a topical miotic to capture the appropriate part of the IOL with the pupil. Because surgical manipulation was expensive and carried the risk of infection, we would spend hours positioning patient’s heads and bodies after pharmacologic weak dilation so that gravity would reposition the IOL. This would still allow the posterior haptics to dislocate anteriorly (embarrassingly, many times after engaging in sexual activity) or create a partial pupillary capture, but at least it prevented total dislocation. The suture was tied loosely so that the optic was secured to the superior iris. Because iris suture had to be preplaced, it always seemed to become entangled with the haptics during insertion, making it difficult to place smoothly under air after ICCE, which featured a 180-degree corneal incision and an unprotected anterior hyaloid membrane. A Prolene suture was passed horizontally through the superior iris and then threaded between through two small holes in the superior optic. In the mid-1970s, the Worst medallion IOL also featured an anterior optic with two horizontally oriented horseshoe-shaped looped posterior haptics similar to the Binkhorst structure. Introduced in 1967, Stanislav Fyodorov’s “Sputnik” IOL design achieved stabilization without larger anterior haptics ( Fig. On May 25, 2001, at the age of 94 years, Sir Harold died in Salisbury, England, after a cerebral hemorrhage. In recognition of his unique efforts in IOL development and implantation, Ridley was knighted on February 9, 2000, by Queen Elizabeth II. In 1990, he was guest of honor at the Annual Meeting of the American Academy of Ophthalmology. The same year, the American Society of Cataract and Refractive Surgery (ASCRS) honored him as one of the 10 most influential ophthalmologists of the 20th century. In the Flight Room, with airplanes suspended overhead, Ridley was honored by fellow pioneers and colleagues from around the world, as well as by the Rayner Corporation and government representatives from the United Kingdom and United States. He received another honor at the Science Museum in London on November 29, 1999, the 50th anniversary of the first part of the first IOL implantation. Apple presented him his first University Doctorate at the Medical University of South Carolina in 1988.
His first and perhaps most-prized honor was his election to the Royal Society in 1986. Ridley’s achievements were finally and belatedly celebrated in numerous tributes.
The process continues as microincision phacoemulsification procedures gain sophistication in search of an IOL to be inserted through a sub–2.0-mm incision. As with any evolutionary process, this has been and still is a leapfrogging phenomenon, so that at any one point in time several cataract surgery strategies and IOL implantation techniques can be considered good science and good medicine. For IOL fixation, the evolution has been posterior chamber, anterior chamber (AC), pupil and iris, iridocapsular, ciliary sulcus, asymmetric placement, and capsular bag. Cataract surgery evolved through extracapsular cataract extraction (ECCE), intracapsular extraction (ICCE), machine-assisted ECCE, phacoemulsification by external nuclear attack, and phacoemulsification-assisted internal nuclear disassembly. It involves a reciprocating but overlapping evolutionary relationship of cataract removal technology with IOL design. It is a classic example of the improvement of medicine with the active cooperation of science and industry. The history of the IOL is interesting and colorful.