JP2008307394A - Insertion instrument for lens for intraocular insertion, and lens-built in type insertion instrument for intraocular insertion - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an insertion instrument for a lens for intraocular insertion which is especially suitable for being used when a liquid such as a physiological salt solution is used as a lubricant. <P>SOLUTION: This insertion instrument 10 has a main body 12 which has a nozzle 12c on the distal end, and an extrusion shaft 16 which pushes out the lens 1 for intraocular insertion being arranged in the main body into the eye through the nozzle. The extrusion shaft has an injection section 24 for injecting a liquid and a flow passage 16d which makes the liquid being injected from the injection section flow into the main body. The injection section 24 is installed on the proximal end section on the opposite side from the distal end section 16c which comes into contact with the lens for intraocular insertion on the extrusion shaft. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to an insertion instrument for inserting an intraocular lens that is inserted in the eye for the purpose of correcting a refractive error or the like, after being inserted in place of the lens after removing the lens due to cataract It is about.

  In current cataract surgery, the central part of the anterior capsule of the eyeball is excised, the clouded lens is removed with an ultrasonic suction device, and then an artificial intraocular lens is placed there. When a lens is placed in the eye, the mainstream is a technique of using the flexibility of the lens and folding it into a small incision and inserting it into the eye through a small incision. This prevents postoperative astigmatism.

  In surgery, the lens loaded in the instrument body is deformed to a small extent while being moved in the instrument body by the push-out shaft, and the lens is pushed into the eye from the distal end opening of the insertion tube (nozzle) inserted into the incision. Many insertion tools are used. Such an insertion device is used not only in cataract surgery but also in insertion surgery of an intraocular lens for vision correction treatment or the like.

  When inserting a lens into the eye using these insertion devices, a viscoelastic substance such as sodium hyaluronate is a lubricant in the insertion device so that the lens moves smoothly and deforms in the insertion device. As injected. The viscoelastic material also has a role of expanding (expanding) the space of the anterior chamber of the eye into which the lens is inserted.

Conventionally, a viscoelastic substance is injected from the distal end opening of the insertion tube using a syringe, or a viscoelastic substance is injected from an injection port provided in the insertion instrument body (see Patent Document 1).
JP 2004-351196 A

  However, the use of viscoelastic materials causes the following problems.

  1. The viscoelastic substance that has entered the eye together with the lens is difficult or troublesome to remove from the eye due to its viscosity. Therefore, the operation time becomes longer.

  2. Since the space for inserting the lens in the eye is narrow, if the viscoelastic material enters the eye before the lens, the space is blocked by the viscoelastic material, making it difficult to insert the lens into the space.

  3. Many viscoelastic materials such as sodium hyaluronate are expensive.

  As described above, the viscoelastic material is effective as a lubricant, but has a drawback. For this reason, it is desired to use physiological saline that is low in viscosity and inexpensive and is generally used in surgery instead of a viscoelastic substance.

  An object of the present invention is to provide an insertion device for an intraocular lens particularly suitable for using a liquid such as physiological saline as a lubricant.

An insertion device according to one aspect of the present invention includes a main body having a nozzle at a tip, and an extrusion shaft that pushes an intraocular insertion lens disposed inside the main body into the eye through the nozzle. The extrusion shaft has an injection part for injecting a liquid and a flow path for allowing the liquid injected from the injection part to flow into the main body. The injection portion is provided at a proximal end portion opposite to the distal end portion that contacts the intraocular insertion lens on the extrusion shaft.

According to the present invention, a liquid such as saline, can be introduced into the body through the injection portion provided at a base end portion of the pushing shaft. Liquid that has flowed into the inside of the body, flows through the space (including the nozzle) of the lens is moved in the interior of the body and flows out from the tip opening of the nozzle. For this reason, even without using a viscoelastic substance, by properly setting the flow rate of the liquid, it is possible to perform the lubrication function within the lens body and the function of inflating the space of the anterior chamber of the eye. it can.

  Hereinafter, preferred embodiments of the present invention will be described with reference to the drawings.

  FIG. 1 shows an insertion system for an intraocular lens which is Embodiment 1 of the present invention. 1 is a top view, and the lower view is a side view.

  Reference numeral 10 denotes an insertion instrument for an intraocular lens (hereinafter simply referred to as a lens) according to the present embodiment, and reference numeral 15 denotes a supply device for supplying a liquid 14 such as physiological saline to the insertion instrument 10.

  The insertion instrument 10 includes a main body 12 and an extrusion shaft 16. The main body 12 includes a cylindrical portion 12a, a lens holding portion 12b provided at the distal end of the cylindrical portion 12a, a nozzle portion 12c provided at the distal end of the lens holding portion 12b, and a proximal side of the cylindrical portion 12a ( It is formed as an integral part having a handle portion 12e provided on the side opposite to the nozzle portion 12c. The cylindrical portion 12a and the handle portion 12e have a hollow structure, and an extrusion shaft 16 is inserted therein.

  The lens holding portion 12b has a hollow flat plate shape, and the lens 1 is housed and held in a state where the optical portion (a portion replacing the crystalline lens in the eye) 1a is not substantially stressed. The state where substantially no stress is applied here refers to a state where stress or deformation that affects the optical function of the optical unit 1a does not occur even when stored for a long period of time. The lens 1 includes an optical unit 1a and a support unit 1b that is formed of a wire or the like and supports the optical unit 1a in the eye. In order to allow the lens 1 to be loaded into the lens holding part 12b, the lens holding part 12b has a structure that is divided into two parts in the vertical direction and a structure that opens and closes the lid.

  The form of the lens 1 is not limited to these, and the lens 1 may have an optical part and a flat support part. In this embodiment, the so-called preload type (in other words, an intraocular insertion lens interior type) in which the lens 1 is loaded in the lens holding portion 12b in advance before delivery to the hospital, such as when the insertion instrument is shipped from the factory. However, the present invention can also be applied to other insertion devices. For example, the present invention can be applied to a type in which the insertion instrument and the lens are stored separately and the lens is loaded into the insertion instrument immediately before surgery.

  Furthermore, although a present Example demonstrates the case where it has the main body 12 which integrally molded from the handle part 12e-the nozzle part 12c, the insertion instrument of this invention is not restricted to this. For example, the nozzle may be used by being attached to a main body integrally formed from the handle portion to the lens holding portion. Further, a part having a nozzle part and a lens holding part may be used by being mounted on a main body having a cylinder part and a handle part. In any of these cases, after assembling (in use), since the handle portion to the nozzle portion are integrated and function as a main body, it is included in the insertion instrument of the present invention as in this embodiment.

  The push-out shaft 16 is provided at the first shaft portion 16a exposed from the main body 12 in a state before the lens 1 is inserted into the eye, and at the tip of the first shaft portion 16a. And a second shaft portion 16b extending in the direction. A lens contact portion 16c that contacts the lens 1 held by the lens holding portion 12b when the lens 1 is inserted into the eye and pushes it into the eye through the nozzle portion 12c is formed at the tip of the second shaft portion 16b. Has been.

An injection portion 24 is formed at the proximal end portion of the extrusion shaft 16 (first shaft portion 16a) , that is, the end portion on the opposite side to the distal end portion where the lens contact portion 16c is provided . A tube 13 extending from the supply device 15 is connected to the injection unit 24.

An injection port 24 a for taking in physiological saline from the tube 13 is formed inside the injection unit 24. Furthermore, a flow path 16d extending in the distal direction (axial direction) from the injection port 24a is formed in the first shaft portion 16a. The distal end of the flow path 16d is opened to the space in the main body 12 at the distal end portion of the first shaft portion 16a, in other words, at a portion (intermediate portion) on the proximal end side of the lens contact portion 16c in the extrusion shaft 16. Yes. The opening (opening) serves as an outlet 16e for allowing physiological saline to flow out of the flow path 16d and to flow into the main body 12 .

  As the supply device 15, a device that supplies the insertion device 10 using a pressure difference generated by putting the liquid 14 in a bottle and making the liquid level higher than that of the insertion device 10 can be used. In addition, an irrigation unit of an ultrasonic emulsification and suction device generally used in cataract surgery may be used as the supply device 15.

  In the insertion system configured as described above, when the liquid 14 such as physiological saline is supplied from the supply device 15 to the injection part 24 (injection port 24a) of the insertion instrument 10, the liquid 14 flows in the extrusion shaft 16. It passes through the passage 16d and flows into the internal space of the handle 12e of the main body 12 from the outlet 16e. Then, the liquid 14 flows through the internal space of the cylindrical portion 12a to the lens holding portion 12b and further to the nozzle portion 12c, and is discharged to the outside from the tip opening 12d of the nozzle portion 12c.

  FIG. 2 shows a flow path of the liquid 14 communicating from the supply device 15 to the tip opening 12d of the nozzle portion 12c by hatching. By appropriately setting the flow rate of the liquid 14 from the supply device 15, the liquid 14 can always flow through the main body 12 in the direction of the nozzle portion 12c and can be discharged from the tip opening 12d of the nozzle portion 12c.

  By the way, in the insertion instrument 10 shown in FIG. 1, the opening part 20 is formed in the base end side rather than the handle part 12e in the main body 12 as an opening part of the internal space of the main body 12 other than the front end opening 12d of the nozzle part 12c. ing. Specifically, a cylindrical member 22 having a screw portion for advancing the pushing shaft 16 in the pushing direction by a screw action when the lens is inserted is inserted into the base end portion of the main body 12. An opening 20 is formed between the main body 12 as a gap or a groove-shaped passage. This is because the liquid 14 in the main body 12 leaks from the gap between the lens holding portion 12b and the handle portion 12e when the lens holding portion 12b has a vertically divided structure or a lid that can be opened and closed. This is particularly to prevent the portion held by the hand from getting wet. That is, by discharging excess liquid 14 from the opening 20 provided on the base end side with respect to the handle portion 12e, the liquid 14 is prevented from leaking from the lens holding portion 12b, and the insertion instrument 10 is easily held. To prevent it from falling.

  It should be noted that the number, size, and location of the water drain openings are not limited as long as they do not directly affect the flow of the liquid 14 to be supplied to the nozzle portion 12c. Further, a water drainage passage having a small diameter that does not affect the flow in the flow path is connected to the flow path (hatched portion in FIG. 2) from the injection section 24 to the nozzle section 12c. Also good.

  A cylindrical intermediate member 25 extending from the proximal end portion of the main body 12 to the vicinity of the distal end of the cylindrical portion 12a is press-fitted inside the cylindrical member 22 described above. An O-ring 23 for sealing is attached to a portion of the first shaft portion 16a on the inner surface of the intermediate member 25 that is slightly proximal to the outlet 16e. For this reason, the liquid 14 is prevented from leaking from the inside of the cylindrical member 22.

  As described above, when the outflow port 16e is disposed slightly on the nozzle portion 12c side from the seal portion formed by the O-ring 23, when the liquid flows into the main body 12 from the outflow port 16e, a part of the liquid is on the side opposite to the nozzle portion 12c side. The liquid 14 flows immediately toward the nozzle portion 12c because the proximal end side thereof is sealed by the O-ring 23.

  And by such a backflow prevention structure, the flow of the liquid 14 to the opening part 20 for draining water can be suppressed, and the water leak from this opening part 20 can be made into the minimum. That is, unnecessary liquid leakage can be prevented.

  In many cases, the use of only one O-ring 23 cannot completely prevent water leakage. For this reason, in this embodiment, a plurality of O-rings 23 are used. However, when a plurality of O-rings 23 are used, the frictional resistance between the O-rings 23 and the intermediate member 25 increases, and it becomes difficult to perform smooth and delicate operation of the extrusion shaft 16. For this reason, if one O-ring 23 is designed to increase the diameter with an emphasis on the function of blocking water leakage, the other O-ring 23 is designed to have a diameter that is small enough to avoid the leakage of slightly leaked water. Good. That is, by providing a plurality of O-rings 23 having different sizes, it is possible to achieve both prevention of water leakage and an appropriate operational feeling of the extrusion shaft 16.

  3A and 3B show a cross-sectional shape of the nozzle portion 12c. The right side of these figures is a cross section obtained by cutting the nozzle portion 12c along the lens pushing direction, and the left side drawing is a cross section perpendicular to the lens pushing direction of the nozzle portion 12c.

  When the lens 1 passes through the nozzle portion 12c, the space through which the liquid 14 passes in the nozzle portion 12c becomes very narrow due to the presence of the lens 1. For this reason, the flow rate of the liquid 14 flowing out from the nozzle part 12c decreases, and there is a possibility that the anterior chamber of the eye cannot be sufficiently inflated.

  For this reason, in this embodiment, as shown in FIGS. 3A and 3B, the flow area of the liquid 14 is ensured inside the peripheral wall of the nozzle portion 12c (that is, within the thickness of the peripheral wall) or on the inner surface (inner peripheral surface). A hole (flow channel) 28 and a groove 29 are formed. These holes 28 and grooves 29 open at the base end portion of the nozzle portion 12c and extend in the longitudinal direction from here to the distal end opening 12d.

  As shown in FIG. 3C, a plurality of rails 30 extending in the longitudinal direction from the base end portion of the nozzle portion 12c to the distal end opening 12d may be formed on the inner surface of the peripheral wall of the nozzle portion 12c. As the lens 1 moves in the nozzle portion 12 c while in contact with the rail 30, a groove 29 ′ serving as a flow path for the liquid 14 is formed on the outer periphery of the lens 1.

  According to these, even if the lens 1 is present inside the nozzle portion 12c, it is possible to sufficiently secure the flow rate of the liquid 14 that flows into the eye from the main body 12 (cylinder portion 12a) through the nozzle portion 12c. it can. Therefore, the lens 1 can be inserted smoothly by fully inflating the anterior chamber.

  Further, as shown in FIG. 3D, a hole (flow channel) 31 extending in the longitudinal direction is formed inside the peripheral wall of the nozzle portion 12c to the vicinity of the tip portion inserted into the eye of the nozzle portion 12c, and the nozzle portion 12c. The liquid 14 may be discharged by opening the hole 31 on the outer peripheral wall surface of the portion inserted into the eye. By forming the hole 31 having the opening 31a on the outer surface of the peripheral wall, when the swelling of the anterior chamber of the eye is insufficient, the nozzle portion 12c including the opening 31a is inserted into the anterior chamber. The liquid 14 can flow into the anterior chamber and the anterior chamber can be fully inflated. On the other hand, when the bulge of the anterior chamber of the eye is sufficient, only the portion of the nozzle portion 12c ahead of the opening 31a is inserted into the anterior chamber, and the opening 31a is exposed to the outside of the eye. Can be prevented from flowing further into the anterior chamber, and the bulge (pressure) of the anterior chamber can be prevented from becoming excessive. That is, the flow rate of the liquid 14 into the eye can be controlled simply by adjusting the insertion amount of the nozzle portion 12c into the anterior chamber, and the pressure in the anterior chamber can be optimized for lens insertion. .

  The hole 31 shown in FIG. 3D and the holes 28 and grooves 29 and 29 ′ shown in FIGS. 3A to 3C may be formed in the same nozzle portion 12c.

  As described above, in this embodiment, the injection portion 24 for connecting the tube 13 is provided at the proximal end portion of the extrusion shaft 16. However, if the injection portion 24 and the tube 13 are left exposed, Difficult to perform push-in operation and rotation operation. Further, there is a possibility that the tube 13 is deformed by the hand operating the extrusion shaft 16 and the supply of the liquid 14 to the insertion instrument 10 is hindered.

  For this reason, in this embodiment, as shown in FIG. 1, a cover 32 that covers the vicinity of the injection portion 24 and the end portion of the tube 13 connected thereto is attached to the extrusion shaft 16. When the push shaft 16 is operated, the cover 32 is provided so that the operation can be easily performed without deforming the tube 13.

  There are various sizes of the diameter of the tube 13 connected to the injection part 24. For example, the size of the connector of the irrigation part of the ultrasonic emulsification and suction device varies depending on the manufacturer of the device, and the size of the tube 13 varies accordingly. Further, it is convenient if the flow rate of the liquid 14 can be adjusted by the size of the tube 13.

  For this reason, as shown in FIG. 4, a plurality of injection portions 24 having different sizes (sizes of connectable tubes 13) may be provided at the proximal end portion of the extrusion shaft 16. In this case, the injection part 24 not connected to the tube 13 may be provided with a stopper or a lid.

  Further, in this system, since the liquid 14 such as physiological saline having a low viscosity is used, the operation of the extrusion shaft 16 becomes lighter than the case where a viscoelastic member is used, and the extrusion shaft 16 may be pushed strongly. Conceivable. Increasing the diameter of the O-ring 23 can avoid such an inappropriate operation to some extent, but it is not perfect.

  For this reason, in this embodiment, the spring 35 is disposed on the base end portion of the main body 12 (the outer periphery of the extrusion shaft 16). Thereby, resistance is given to pushing operation of the pushing shaft 16, and it is surely avoided that pushing operation with improper momentum is performed.

  In the present system capable of discharging the lens 1 and the liquid 14 such as physiological saline, the usability is improved if the amount of the liquid 14 flowing into the eye can be controlled. This is because various situations can occur during the operation, so that it is possible to cope with the case where it is desired to set the intraocular pressure lower when the lens 1 is inserted.

  Therefore, the hole 31 as shown in FIG. 3D may be formed in the peripheral wall of the nozzle portion 12c. However, as shown in FIGS. 5A and 5B, the nozzle portion is located near the tip opening 12d of the nozzle portion 12c. You may form the slit 36 and the nozzle hole 37 which penetrate the surrounding wall of 12c to radial direction. The slit 36 is a groove-shaped opening connected to the tip opening 12d. The nozzle hole 37 is a hole formed separately from the tip opening 12d.

  Further, as shown in FIG. 5C, the tip opening 12d ′ of the nozzle portion 12c may be formed to be inclined with respect to the lens push-out direction.

  When the bulge of the anterior chamber is insufficient, the slit 36 and the nozzle hole 37 are inserted into the anterior chamber together with the distal end opening 12d, or the entire oblique distal end opening 12d 'is inserted into the anterior chamber. .

  On the other hand, when the swelling of the anterior chamber of the eye is sufficient, the liquid 14 that has flowed into the nozzle portion 12c is exposed by exposing at least a part of the slit 36, the nozzle hole 37, and the tip opening 12d ′ to the outside of the anterior chamber. A part of can be discharged out of the eye. Thereby, the amount of the liquid 14 flowing into the eye from the tip openings 12d and 12d ′ of the nozzle portion 12c can be controlled.

  Further, since it is not necessary for the liquid 14 to always flow during the operation, it is easy to use if the flow of the liquid 14 can be stopped if necessary. For this reason, in this embodiment, as shown in FIG. 1, a clip 38 is provided on the tube 13, and the clip 14 can be detached and flowed or stopped as necessary. Thereby, the usage-amount of the liquid 14 decreases and the operation room water-wetting by discharge | emission of the unnecessary liquid 14 is prevented.

FIG. 6 shows a top view and a side view of an insertion instrument 10C that is Embodiment 2 of the present invention. This insertion instrument 10C has a main body 12 having a cylindrical portion 12a, a lens holding portion 12b, and a handle portion 12e, and a nozzle 12c attached to the tip of the lens holding portion 12b.

  The lens holding portion 12b is provided with a deformation mechanism 18 that pushes into the space below the inside of the lens holding portion 12b while deforming the lens 1 from a state in which the lens 1 is held without applying any stress. By pushing the lens 1 down to the space, the push-out shaft 16 can be pushed into the eye.

  The injection shaft 16 of the insertion device 10C is also formed with an injection portion 24 and a flow path 16d, as in the insertion device 10 of FIG. 1, and liquid is not shown inside the main body in the middle portion of the extrusion shaft 16. An outlet is formed.

  In addition, in the insertion device 10C of the present embodiment, as in the second and third embodiments, an injection portion is provided in the cylindrical portion 12a, and a liquid is injected by connecting a tube or piercing the needle of a syringe. May be.

Also in this embodiment, as shown in FIG. 3A~ view 3D or FIG 5A~ Figure 5C, the peripheral wall of the nozzle (parts) 12c, holes serving as a flow path or the discharge port of the liquid 14, a groove or opening You may form.

  Thus, the present invention can be applied to various types of insertion instruments. The liquid used in the present invention is not limited to physiological saline.

BRIEF DESCRIPTION OF THE DRAWINGS The upper side figure and side view which show the insertion system of the lens for intraocular insertion which is Example 1 of this invention. FIG. 2 is a top cross-sectional view of FIG. 1, and shows a flow path by hatching. FIG. 3 is a cross-sectional view illustrating a configuration example of a nozzle portion in the first embodiment. FIG. 3 is a cross-sectional view illustrating a configuration example of a nozzle portion in the first embodiment. FIG. 3 is a cross-sectional view illustrating a configuration example of a nozzle portion in the first embodiment. FIG. 3 is a cross-sectional view illustrating a configuration example of a nozzle portion in the first embodiment. The figure which shows the modification of the insertion system of Example 1. FIG. FIG. 3 is a perspective view illustrating a configuration example of a nozzle portion according to the first embodiment. FIG. 3 is a perspective view illustrating a configuration example of a nozzle portion according to the first embodiment. FIG. 3 is a perspective view illustrating a configuration example of a nozzle portion according to the first embodiment. The top view and side view of the insertion system of the lens for intraocular insertion which are Example 2 of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Lens for intraocular insertion 12 Main body 12a Tube part 12b Lens holding part 12c Nozzle part 13 Tube 14 Liquid 15 Supply device 16 Extrusion shaft 16d Flow path 16e Outlet 23 O-ring 24, 24 ', 24 "Injection part 28, 31 hole 29, 29 'groove 36 slit 37 nozzle hole 35 spring

Claims (4)

A body having a nozzle at the tip;
An extrusion shaft that pushes an intraocular lens disposed inside the main body into the eye through the nozzle;
The extrusion shaft has an injection part for injecting a liquid, and a flow path for allowing the liquid injected from the injection part to flow into the main body.
The injection device for an intraocular lens, wherein the injection portion is provided at a proximal end portion of the push-out shaft that is opposite to a distal end portion that contacts the intraocular insertion lens. 2. The intraocular device according to claim 1, wherein an opening for allowing liquid to flow into the main body from the flow path is provided at a position closer to the proximal end portion than the distal end portion of the extrusion shaft. Insertion device for insertion lens. An insertion instrument according to claim 1 or 2,
An intraocular lens-incorporating insertion device including an intraocular lens housed in the main body. An insertion device according to any one of claims 1 to 3,
An insertion system for an intraocular lens, comprising a supply device for supplying a liquid to the injection part.