Background Of The BIL

Modern intraocular lens implantation was introduced by Sir Harold Ridley in 1948.

"The use of cataracts was established within perhaps one and one-half hours in Cavendish Square in 1948." (Harold Ridley, 1952, BJO)

From that very same moment, research in the field of cataract aimed at finding the solution for two major complications which were already described by H. Ridley:

"Two surgery-related problems triggered criticism for decades after Harold's initial implant. The discussion of decentration and posterior capsule opacification (PCO) ... Harold himself noted these complications of extracapsular cataract extraction with IOL implantation in his earliest patients."
(David Apple, 2006)

The bag-in-the-lens was initially designed and patented as "intraocular lens and method for preventing secondary opacification".

US Patent Number: 6,027,531
EP Patent Number: 0916320A2


The first case operated using the BIL technique was in December 1999, a few months after having met H. Ridley in Stockholm at the SOE meeting where he was invited guest and before he was knighted by the Queen Elisabeth II in 2000.

Harold Ridley with his wife Elisabeth at SOE 1999 in Stockholm

The clinical study on the bag-in-the-lens started in 2000 after approval by the ethical committee of the Antwerp University Hospital (1/47/136) and got the approval of the Belgian Social Security in 2004.

In 2006, David Apple wrote the following dedication in his book "Sir Harold Ridley and his fight for sight" edited by Slack and published in 2006.

"I know that he (H. Ridley) would be fascinated by your work and would have an absolute ball (enjoyed) working with your lens."
David Apple

The postoperative follow-up of the bag-in-the-lens implantation has reached ten years now and no PCO, or in absence of capsular bag, we should rather speak about visual axis reproliferation (VAR), did occur.  It is, as a consequence, very likely that PCO is under control (De Groot V. et al., 2005; Tassignon M.J. et al., 2006; De Groot V. et al., 2006; Leysen I. et al. 2006).

The centration stability of this new approach was also studied and turned out to be very stable over time (Verbruggen K. et al., 2007; Rozema J. et al., 2009).

PCO and centration are indeed two prerequisites before starting the implantation of more complex optics like toric and multifocal IOLs.

Implementation of toricity in the bag-in-the-lens is now finalized. The new challenge is to introduce a new approach for the alignment of diffractive IOL.