When generally making the excising operation of cataract eyeglass, (in-cision) is littler for the otch that cuts on the eyeball, and it is littler that scattered-light probability takes place in the operation back.
For this reason, be developed out a kind of so-called ultrasonic crystal emulsifying suction (KPE) of using ultrasound emulsifying suction device.Skill is to utilize above-mentioned ultrasound emulsifying suction device according to this, the crystal of nebulousurineization is smashed and emulsifying after with its sucking-off.So only can be with lens extraction to the otch of the about 4mm of eyeball incision.This compares with the traditional ECCE (ECCE) that need cut the otch of about 10mm when the extracting lens, and is obviously progressive.
For cooperating above-mentioned little cutting operation method, the intraocular lens that existing a kind of at present otch from childhood inserts ophthalmic is developed.Traditional intraocular lens is to have the optic of being made by hard materials such as glass or plastic cement (optical part), and the otch size when therefore transplanting must be greater than the diameter of this optic.Multiple occasion, the otch size is at 6.5mm or bigger.Because this kind relation, even if, when inserting the intraocular lens of hard, otch need be cut expansion once again according to the KPE otch extracting lens from childhood of performing the operation.
In the clear 58-18005 of Japanese Patent Application, have and disclose a kind of deformable eyes buitin lens that can insert from the little otch of eyeball.These lens 1 are the optic 2 that form of the deformable elastomer by the memory characteristic fixed to have and the support sector 3 that 2 of this optic are held in ophthalmic are constituted as shown in Figure 6.Support sector 3 and optic 2 are to form with different types of pliability material, base portion 3a are imbedded the peripheral part of optic 2 and are fixed, with first end 3b bending and the 3 symmetric configurations of two support sectors.Another kind is as shown in Figure 7, has the optic 2 identical with optic shown in Figure 6, and in the outwards outstanding laminar support sector 4 of the formation of the periphery subtend of this optic 2 and one to support the structure of optic 2.
As for deformable apparatus for inserting lens into eyes, then have for example to be disclosed in the flat 3-14206 person of Japanese Patent Application.This inserts utensil, as shown in Figure 8, have: leading section is provided with the roughly tubular apparatus body 5 of the formerly distolateral assembling ditch 5a in its narrow wide position, by the release axle 6 that is intercalated in vessel 5 and for making these push-off pin 6 advance and retreat be screwed into the ejecting mechanism 8 that the cylindrical shell 7 in the apparatus body constitutes, reach and insert the distolateral retaining member 12 of elder generation that tube (insertion mouth) 11 protrudes in the lens maintaining part 10 that has switching mechanism 9.
Said lens maintaining part 10 lies in being provided with of rear end one of inserting tube 11 and fixes half 13, simultaneously subtend is set freely in fixing half 13 movable half 14 in opening and closing near the rear end of inserting tube 11, borrow hinge to link and fix half 13 and movable half 14 lower edge, but and in fixing half 13 and movable half 14 prominent upward respectively fixation clip 15 and the dynamic pressure plate 16 established of upper limb.
In addition, but constitute switching mechanism by movable half 14, hinge and dynamic pressure plate 16.When closing this switching mechanism 9, movable half 14 is touched and fixes half 13 but dynamic pressure plate 16 touches fixation clip 15, it is formed and inserts tube 11 co-axial tubulars.The internal diameter of base end side that inserts tube 11 is for fixing, and it is and fix, engages the cylindrical portion internal diameter that forms with the footpath for movable half 13,14, only the gradually thin frustum-like shape (taper) of end 11a formation tip formerly.
When utilizing this kind insertion utensil that deformable eyes buitin lens 1 is substituted eyeglass insertion ophthalmic, in switching mechanism 9 open states, intraocular lens 1 is arranged at the lens maintaining part 10 that unloads from the retaining member 12 of apparatus body 5, closing switching mechanism 9 subsequently can make intraocular lens be deformed into less shape, keep under this shape, but the major part beyond the fixing dynamic pressure plate 15,16 of retaining member 12 is flush-mounted in the first end of apparatus body 5 by assembling ditch 5a, and makes above-mentioned pressing plate 15,16 protrude in the top of assembling ditch 5a.
Under this state, retaining member 12 is advanced, pressing plate 15,16 is pressed into the narrow wide portion of assembling ditch 5a, and switching mechanism 9 dresses are taken off assembling freely, insertion tube 11 is given prominence to from the tip of apparatus body 5, can finish inserting the utensil assembling.
According to after above-mentioned assembling finishes, the operation tube 7a of cylindrical shell 7 rearward end of utensil is inserted in turn, make push-off pin 6 shift-in forward that is in going-back position, then can borrow the first end of push-off pin 6 with intraocular lens, the lens maintaining part 10 of self-sustaining member 12 is released via inserting tube 11, and the otch via the about 4mm that is formed at eyeball that continues inserts intraocular lens in the eyeball, this moment, the optic 2 of intraocular lens 1 was to return to the preceding former big shape of distortion by being deformed into little shape attitude by shape memory characteristic.
The apparatus body 5 of above-mentioned insertion utensil, push-off pin 6 and cylindrical shell 7 are the integrally formed product of the flexual synthetic resin of tool for 12 of metal silks system retaining members.
Yet, because inserting with utensil system, above-mentioned traditional intraocular lens will make optic be out of shape the intraocular lens of less shape in the lens maintaining part of retaining member, borrow the push-off pin of ejecting mechanism to go in the eyeball via inserting the tube interpolation, so lens end in the first end of arriving at the insertion tube, system is keeping the shape of being out of shape in the lens maintaining part, can't make optic be deformed into littler shape sharp in the first end of inserting tube, so following problem is arranged.
Promptly, for making intraocular lens otch insertion from childhood ophthalmic, the first end of inserting tube must be made tinyly, must make optic be deformed into littler shape in the lens maintaining part for this reason, be difficulty very but make big shape before the distortion in the lens maintaining part optic is deformed into little shape maturely.Make distortion easily then the size after the distortion than desired size for big, the result inserts the first end gesture of tube must be thicker, this will make lens be difficult to from childhood otch inserts in the eyeball.Therefore, the distortion easiness of lens maintaining part and through little otch inserts intraocular easiness the two can't get both.
Now illustrate that with reference to Fig. 1-Fig. 4 one embodiment of the invention are in following.
Among Fig. 1 and Fig. 2,21 is retaining member.This retaining member 21 comprises rear side cylindrical shell 22, be formed at the lens maintaining part 24 that has switching mechanism 23 of the front of this rear side cylindrical shell 22, be equipped on the front side cylindrical shell 25 of these lens maintaining part 24 front sides, by the insertion letter (insertion mouth) of the side-prominent tip segmentation convergent of the tip of this front side cylindrical shell 25.These each several part systems are by co-axial configuration.
Said lens maintaining part 24 be by one be equipped between rear side cylindrical shell 22 and the front side cylindrical shell 25 and be integrally formed therewith fix half 27 and one and this fix half 27 and be movable half 28 that subtend is equipped between rear side cylindrical shell 22 and the front side cylindrical shell 25 and constitute.This movable half 28 lower edge system borrows hinge 29 to open and close to be linked to freely and fixes half 27 lower edge.
But fix half 27 and movable half 28 upper limb respectively standing shape be provided with fixation clip 30 and dynamic pressure plate 31, and above fixation clip 30, be formed with jut 30a.In addition, be formed with the 28a of incised notch portion at movable half 28 back upper lateral part.But dynamic pressure plate 31 is because of only being formed at the zone, front side near the 28a of incised notch portion, thereby forms and prevent that intraocular lens 1 support sector 3 and 36 interference of disturbing of push-off pin described later from preventing portion 32.
When but the switching mechanism 23 that is made of movable half 28, hinge 29 and dynamic pressure plate 31 is closed, but dynamic pressure plate 31 promptly touches fixation clip 30, is concentric tubular so can form with rear side cylindrical shell 22 and front side cylindrical shell 25.
The base portion 26a system that inserts tube 26 forms cylindrical shape, and the internal diameter of its internal diameter and the cylindrical shell of fixing half 27 and movable half 28 formation and the internal diameter of front side cylindrical shell 25 are identical.Be shown in Fig. 3 and Fig. 4 as amplification, insert the formation par 26d of pars intermedia 26b system on the top of tube 26, make and dwindle basal area, the while also extends this par 26a to first end 26c in the truncated cone portion that the first end 26c that inserts tube 26 forms the tip convergent.So, the inner section of borrowing the truncated cone portion of this par 26d and first end 26c will insert tube 26 amasss dwindling of two-stage nitration, intraocular lens 1 is out of shape gradually dwindle and is sent to first end opening 26e.Design according to this, first end opening 26e can make than the first end opening of above-mentioned traditional insertion tube that more light section is long-pending.
The rear side cylindrical shell 22 of above-mentioned retaining member 21 is to borrow such as being pressed into the co-axial front side portion 33a that are fixed in apparatus body 33 described later of means such as chimeric.Apparatus body 33 is by front side portion 33a and the cylindrical body more integrally formed than its larger-diameter rear lateral portion 33b.
The rear lateral portion 33b outer peripheral face of apparatus body 33 is formed with a bit of male thread 33c, screws togather the box thread 35a of operation tube 35 inner peripheral surfaces that are formed at ejecting mechanism 34 on this male thread 33c.Ejecting mechanism 34 has co-axial be inserted in the operation tube 35 in end thereafter and by the push-off pins 36 of these operation tube 35 supports.So 36 pairs of operation tubes 35 of this push-off pin can rotate around the axle but it is restrained moving axially of operation tube 35.The leading section of push-off pin 36 is co-axial being inserted in the apparatus body 33, and extends to the front end of this body 33.Push-off pin 36 is to borrow one of not shown suitable means to stop tool to apparatus body 33 rotations.In addition, the rear end that has 36 mouthfuls of operation tubes 35 of release portion in big footpath in the first end of push-off pin 36 then utilizes suitable means to be sealed.
The front side portion 33a of apparatus body 33 and the rear side cylindrical shell 22 of retaining member 21 have same central shaft and form a successive urceolus face.These partly 33a and 22 be inserted into slidably that tubular is transparent to be agreed with in the part 37, but these partly 33a and 22 restrained with this relative rotating part that agrees with between the part 37.Be formed with vertically on the front top of agreeing with part 37 and agree with ditch 37a.When this agrees with part 37 and advances to progressive position, but this agree with ditch and promptly agree with mutually for 37 mouthfuls with the fixation clip 30 and the dynamic pressure plate 31 of retaining member 21, it is contacted with each other, thereby switching mechanism 23 is remained in closure state.When agreeing with part 37 and retreating, agree with ditch and promptly separate for 37 mouthfuls, but make switching mechanism be open mode with pressing plate 30,31.
Retaining member 21 is integrally formed by the flexual synthetic resin of tool, apparatus body 33, operation tube 35, push-off pin 36 and agree with part 37 then each is made by synthetic resin.
Use the insertion device of this embodiment, when inserting deformable intraocular lens shown in Figure 61 in the eyeball, at first the push-off pin 36 of ejecting mechanism 34 and tubular being agreed with part 37 retreats, the switching mechanism 23 that makes retaining member 21 in opened condition, promptly as shown in Figure 2, but make dynamic pressure plate 31 with movable half 28, and fixation clip plate 30 with fix half 27 subtend face, with hinge 29 as the summit, but dynamic pressure plate 31 and movable half 28 are opened open state in obtuse angle.Under this state, intraocular lens 1 is placed in the lens maintaining part 24,2 of optic that make lens 1 and make its support sector 3 on one side near fixing half 27 and forwards outstanding on hinge 29, and the support sector 3 of another side is near movable half 28 and rearward outstanding.
According to aforesaid way with lens 1 location adorn appropriate after, Closing Switch mechanism 23 is so but dynamic pressure plate 31 and movable half 28 are right after at fixation clip 30 respectively and fix on half 27.So, lens 1 promptly by movable, fix half 28,27 and remain in the lens maintaining part 24, make the optic 2 of lens be deformed into less change curved shape, promptly become and have the tubular of central axes in hinge 29.
Keep under this state, make and agree with part 37 and advance, force to be embedded in fixing dynamic pressure plate 30,31 but order agrees with ditch 37a, to keep this equipressuring plate 30,31 in closure state.Continue it, borrow hands that the operation tube 35 of ejecting mechanism 34 is just being changeed, so the box thread 35a of operation tube 35 and the male thread of apparatus body 33 are screwed, along with operation tube 35, push-off pin 36 is to move forward.
By advancing of push-off pin 36, the 36a of release portion of its first end promptly contacts with the optic 2 of lens 1, and lens 1 just entered via front cylindrical shell 25 and insert in the tube 26 when it was pushed.Continue to make push-off pin 36 to advance, lens 1 promptly are pushed to the pars intermedia 26b that inserts tube 26.This moment is owing to be provided with par 26d to dwindle basal area at this pars intermedia 26b, the optic 2 of lens 1 is become than it by fixing, movable half 27,28 cylindrical portion that forms the time, be littler shape, be pushed into then and insert a first end 26c of tins 26.When push-off pin 36 moves on, because inserting the first end 26c of tube 26 is the frustum-like shape that forms the tip convergent, so can make optic 2 ratios pars intermedia 26b distortion person, further diminish, be pushed out to via first end opening 26e at last and insert outside the tube 26, the fine incision that is inserted into subsequently after crystal picked-off is inserted in the eyeball.
Because of the first end opening 26e that inserts tube 26 is inserted in the eyeball by otch, so the lens 1 that first thus end opening 26e releases will be borrowed the shape before elastic restoring force be recovered its distortion because of its memory characteristic, and transplanted in eyeball with the state of its support sector's 3 supports.
For making lens 1 be able to slick and sly advancing in inserting tube 26, preferably these lens 1 are released with lubricating fluid.
As mentioned above, during according to the insertion utensil of the foregoing description, lens 1 inserted eyeball via little otch before, its optic 2 formed less shape through several sections distortion.Promptly, lens 1 initial system is kept by the lens maintaining part 24 of retaining member 21, borrow fixing, movable half 27,28 cylindrical portion that formed to make the optic 2 of lens be deformed into less shape, borrowing push strut 36 to advance before subsequently pushes these lens 1 in the insertion tube 26, borrow and be located at the par 26d that inserts tube 26, optic 2 is further dwindled, and it is littler to borrow the convergent truncated cone portion that inserts tube 26 leading section 26c that optic 2 is become again more subsequently.So can borrow fixing, movable half 27,28 deflection that reduces optic 2, also can when the first end opening 26 that inserts tube 26 is released, increase the deflection of optic 2 simultaneously, maybe can with above-mentioned both and close enforcement.
Therefore, when of the present invention, optic 2 be deformed into more than traditional person be little shape, it is inserted in the eyeball via for example less otch below the 4mm easily.
In the present embodiment, agree with part 37, so when being placed in lens 1 in the lens maintaining part 24, can agreeing with part 37 through this and see switching mechanism 23 etc. because of making tubulars with lucite 37.So, can confirm the arrangement state of lens 1 in lens maintaining part 24, thereby promote its safety.
Constitute the retaining member 21 of the insertion utensil of present embodiment, apparatus body 33, operation tube 35, push-off pin 36 and agree with part 37 and be synthetic resin system, so can make by low cost, with after can also abandon.
Even, make the optic 2 and the support sector 3 thereof of intraocular lens with different types of pliability material, and when the tip of this support sector 3 is bending, the first end of the support sector 3 of the rear projection of optic 2 is positioned over the interference that is formed at switching mechanism 23 prevents in the portion 32, can avoid the 36a of release portion of push-off pin 36 that the end 3a of this elder generation is disturbed.
The deformable ophthalmic of present embodiment inserts and does not limit to the intraocular lens that is applicable to as shown in Figure 6 with utensil, also the deformable intraocular lens of being given prominence to by optic 2 periphery one applicable to its support sector 4 as shown in Figure 7.When using the lens of form shown in Figure 7, the portion 32 that prevents that disturbs can be set in retaining member 21 again.
Agree with part and also needn't one be decided to be tubular again.Total length in the cylindrical shell bottom is provided with agreeing with part and also can using of ditch.When using this kind to agree with part, will agree with the elastic distortion of part and its front end sidepiece that is installed in apparatus body will be got final product.In this occasion, but the shaping of apparatus body and retaining member one.
Fig. 5 is another embodiment in order to the insertion tube 26 that deformable intraocular lens is inserted intraocular insertion utensil.This inserts tube 26 is the base portion 26a that links to each other with the tip of the front cylindrical shell of retaining member by, link to each other but the 1st 26f of truncated cone portion that its tip dwindles suddenly with this base portion 26a is smooth-going, with smooth-going the linking to each other and the 2nd 26g of truncated cone portion that attenuates that its tip blows slowly of the 1st 26f of truncated cone portion, and constitute with the smooth-going flat part 26h with tiny diameter of first end opening 22e who links to each other of the 2nd 26g of truncated cone portion.It is cylindric that the transverse section of above-mentioned each one all is.Stating partly on shown in Figure 5, other structures partly all embodiment with Fig. 1-shown in Figure 4 are identical.
When the intraocular lens that has been out of shape little shape when the optic 2 of borrowing push-off pin will remain in the lens maintaining part of retaining member forwards pushes and inserts in the tube 26, this optic 2 at first is out of shape less shape because of the effect of the 1st 26f of truncated cone portion, and that continues further dwindles because of the effect of the 2nd 26g of truncated cone portion again.After these two sections distortion are dwindled, by flat part 26h in first end opening 26e inserts eyeball.So when using the insertion tube of present embodiment, still can obtain described same effect with above-mentioned Fig. 1-Fig. 4 embodiment.
In the embodiment of Fig. 1-Fig. 4, retaining member 21 is the leading section that is fixed on apparatus body 33.But this retaining member 21 is not fixed on the apparatus body 33 and also can uses.That is,, transform into retaining member shown in Figure 2 21 into loading and unloading shown in Figure 8 retaining member 12 freely, it is installed in the first end of apparatus body 5 along assembling ditch 5a in this occasion.At this moment, the rear side cylindrical shell 22 of the retaining member in the previous examples 21 can omit.