JP2000166957A - Cornea operation instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To improve and facilitate incision by fixing a suction ring to a patient eye, sucking air in a clearance between with an eye and incising a projecting cornea with a blade drive-controlled based on air pressure in the clearance. SOLUTION: The center of a suction ring opening hole is positioned with a pupil in a center by confirming the tilting state of a suction ring main body 1 and the center position of the pupil based on a mark fitted to a patient's cornea in advance. Next, a pump 41 is driven to suck air between the suction ring and the patient's eye to lower air pressure. A control part 40 keeps a fixed air pressure to suck-fix the suction ring to the patient's eye. At the time of operating a fit switch 42, the part 40 rotate-drive-controls a sending motor 11 and a vibrating motor 12 based on the air pressure detected by a detector 33, to incise the cornea with a cutting part 2. Thus, driving is easily controlled to improve incision.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a corneal surgery apparatus for incising a cornea of a patient's eye in layers during a corneal refractive surgery or the like.

[0002]

2. Description of the Related Art In recent years, for the treatment of corneal refraction, the thickness of the corneal epithelium from the corneal epithelium to the parenchyma except for one end (hinge) of the cornea is 1
A flap is formed by incising a portion of about 50 μm into a layer, and then the material is cut off by the amount of corrective refraction by excimer laser light, and the flap is returned again.
ASIK surgery (Laser in Situ Keratomileusis) has attracted attention. In this LASIK operation, a microkeratome (Microkeratome) is used to cut the cornea in layers.
A corneal surgery device called ome) is used.

[0003] As a microkeratome, a suction ring is fixed by suction from the limbus of the cornea to the surface of the conjunctiva, the cornea is pressed flat by a corneal pressing member, and the blade (blade) is horizontally moved or rotated in the hinge direction while laterally vibrating. It is known that the cornea is cut in a layered manner with a substantially uniform thickness by moving the cornea. At the time of corneal incision, a certain degree of corneal rigidity is required in order for the cornea to escape with respect to the movement of the blade. As this method, there is a method in which the suction pressure applied in the suction ring is increased to increase the intraocular pressure of the patient's eye to obtain corneal rigidity.

[0004]

However, if the suction ring is not sufficiently fixed by suction, or if a tube or the like to be sucked is clogged with foreign matter, the air pressure in the space between the patient's eye and the suction ring is insufficient. Pressure may not be achieved or air pressure may increase during surgery (toward positive pressure). As a result, there is a problem that the corneal rigidity of the patient's eye is not sufficiently increased, and the incision cannot be made, or the cut surface becomes uneven even if the incision can be made.

[0005] In view of the above problems, an object of the present invention is to provide a corneal surgery apparatus that can easily and satisfactorily dissect a cornea.

[0006]

Means for Solving the Problems In order to solve the above problems, the present invention is characterized by having the following configuration.

(1) In a corneal surgery apparatus for incising the cornea of a patient's eye in layers, a suction ring to be brought into contact with the patient's eye and a suction ring formed between the suction ring and the patient's eye to fix the suction ring to the patient's eye. Suction means for sucking the air in the gap to be cut, a blade for incising the cornea protruding from the suction ring, a driving means for driving the blade, and a pressure for detecting the air pressure of the gap which is changed by suction of the suction means. It has a detecting means and a drive control means for controlling the driving means based on the pressure information detected by the pressure detecting means.

(2) In the corneal surgery apparatus of (1),
The driving unit includes a vibration unit that laterally vibrates the blade and a moving unit that moves the blade straight or rotationally.The drive control unit is configured to control the vibration unit and the vibration unit based on pressure information detected by the pressure detection unit. It is characterized in that at least one of the moving means is controlled.

(3) In the corneal surgery apparatus of (2),
The drive control means linearly adjusts at least one of the frequency of the vibration means and the moving speed of the moving means based on the air pressure detected by the pressure detecting means.

(4) In the corneal surgery apparatus of (2),
The drive control unit divides the air pressure detected by the pressure detection unit into a plurality of stages, and adjusts at least one of the frequency of the vibrating unit and the moving speed of the moving unit for each of the divided air pressure stages. It is characterized by.

(5) The corneal surgery apparatus of (1) further includes upper limit value setting means for setting an upper limit value for the detected air pressure, wherein the drive control means is detected by the pressure detection means. When the value of the air pressure is higher than the upper limit, the operation of the driving unit is stopped.

(6) The corneal surgery apparatus according to (5) further has a notifying means for notifying an operator that the value of the air pressure detected by the pressure detecting means is a negative pressure which is lower than the upper limit. It is characterized by the following.

(7) The corneal surgery apparatus according to (1) or (5) further has a lower limit value setting means for setting a lower limit value for the detected air pressure, and the drive control means includes the lower pressure detecting means. When the value of the air pressure detected by the means is lower than the lower limit, the operation of the driving means is stopped.

(8) The corneal surgery apparatus according to (1) further includes upper limit value setting means for setting an upper limit value for the detected air pressure, and the drive control means is detected by the pressure detection means. When the value of the air pressure is lower than the upper limit, the operation of the driving unit is started.

(9) The corneal surgery apparatus according to (1) further comprises suction control means for controlling the suction means based on pressure information detected by the pressure detection means.

[0016]

DESCRIPTION OF THE PREFERRED EMBODIMENTS One embodiment of the present invention will be described below with reference to the drawings. FIG. 1A is a top view of a corneal surgery apparatus according to the present invention, and FIG. 1B is a diagram showing a cross-sectional view taken along line AA of FIG. 1A and a schematic diagram of a control system.

1 is a microkeratome main body, and 1a
Is a gripping part that the operator grips during the operation. On the front side (left side in the figure) of the main body 1, a suction part 3 for fixing to the patient's eye and a cutting part 2 having a blade 20 (described later) for incising the cornea and moving straight on the suction part 3.
Are provided.

In the main body 1, a feed motor 11 for moving the cutting portion 2 straight in the incision direction and a vibration motor 12 for giving lateral vibration to the blade 20 are fixedly provided. The feed shaft 13 of the feed motor 11 is connected to a feed screw 13 having a screw portion for moving the cutting unit 2 straight. A mounting member 14 is screwed into the feed screw 13, and the rotation motor 1 is mounted on the mounting member 14.
2 and a connecting member 17 to which the rotating motor 12 and the cutting section 2 are connected are fixed. Feeding motor 1
1 causes the feed screw 13 and the mounting member 14 to rotate.
, The rotation motor 12 and the connecting member 17 move back and forth, whereby the cutting unit 2 moves back and forth. Further, the rotating shaft 15 is rotatably held by the connecting member 17. An eccentric shaft 16 is implanted at the tip of the rotating shaft 15 at a position deviated from the center of rotation, and the eccentric shaft 16 gives lateral vibration to the blade 20 (described later).

Next, the configurations of the cutting section 2 and the suction section 3 will be described with reference to FIGS. FIG.
(A) and (b) are the cutting part 2 and the suction part 3
FIG. 2 is an enlarged view of FIG. FIG. 3 shows C- in FIG.
It is C sectional drawing.

The cutting section 2 includes a blade 20 for incising the cornea, a blade holder 21a and a holder block 21b for holding the blade 20 so as to be capable of lateral vibration.
And a vibration transmitting member 22 for transmitting the lateral vibration generated by the eccentric shaft 16 to the blade 20, and a corneal pressing portion 23 fixed to the holder block 21b by an attaching member 23c. A rotation hole into which the rotation shaft 15 is inserted is provided inside the holder block 21b, and a distal end portion of the connecting member 17 is fixed.

As the blade 20, a metal blade using stainless steel, steel or the like as a cutting edge or a mineral blade using a mineral such as diamond or sapphire as a cutting edge is used, and the blade holder 21 is formed at an appropriate angle with respect to a horizontal plane.
a and the holder block 21b so as to be capable of lateral vibration. On the blade holder 21a side, a shallow concave portion 210a is formed at a portion where the blade 20 is placed, and the lateral width of the concave portion 210a is larger than the vibration width of the blade 20 due to lateral vibration.

The vibration transmitting member 22 is fixed to the blade 20, and is movable in a lateral direction within a receiving groove 210b formed in the holder block 21b. The vibration transmitting member 22 is formed with a vertical groove 22a that engages with the eccentric shaft 16. When the rotating shaft 15 is rotated by rotation of the vibration motor 12, the eccentric shaft 16 attached to the tip of the vertical shaft 22a is rotated. And a lateral driving force acts. As a result, the blade 20 together with the vibration transmitting member 22
Vibrates laterally.

The corneal pressing portion 23 is provided on the front side (left side in the figure) of the blade 20, and presses the patient's eye cornea flat as the cutting portion 2 advances, prior to the incision by the blade 20. When the blade 20 incises the cornea pressed flat by the cornea holding portion 23, a uniform layered flap is formed.

The interval between the cutting edge of the blade 20 attached to the blade holder 21a and the lower surface of the corneal holding portion 23 is set to about 150 microns so that the corneal epithelium can be incised in layers of this thickness.

The suction part 3 is composed of a fixed member 30, a suction ring 31, and a suction pipe 32. The suction ring 31 is fixed to the main body 1 by the fixed member 30. The suction ring 31 has a substantially U-shaped cross section and is formed with a circular concave portion 31a for making contact with the patient's eye, and an opening 31b concentric with the concave portion 31a. During the operation, when the suction ring 31 is placed on the patient's eye, the patient's eye cornea projects upward from the opening 31b, and the lower end of the suction ring 31 and the opening end of the opening 31b abut on the patient's eye, A space S for suction is secured by the contact.

The suction pipe 32 is implanted in the suction ring 31 and is connected to a vacuum tube (not shown). The vacuum tube extends to the pump 41. The suction passage 32a provided inside the suction pipe 32 communicates with the recess 31a, and the suction ring 31 is adsorbed to the patient's eye by sucking and discharging air in the space S via the suction passage 32a by the pump 41. Fix it. At the time of this fixation, the operator can easily determine the position of the opening 31b by holding the grip portion 1a of the main body 1 and stably hold the device.

Further, a pipe 33a for pressure detection is implanted in the suction ring 31, and the pipe 33a is connected to the pressure detector 33 by a tube (not shown). The pressure detector 33 is connected to a pump 41 via a pipe 33a.
Then, the air pressure in the space S sucked is detected. The control unit 40 controls the operation of the device based on the air pressure detected by the pressure detector 33. If there is a gap between the suction ring 31 and the patient's eye, or if a foreign substance is clogged in the suction passage 32a or the like, and the air pressure in the space S is not a sufficient negative pressure, the corneal rigidity cannot be properly secured. there is a possibility.
For this reason, a predetermined value of the upper limit of the air pressure required to secure the corneal rigidity to some extent is provided, and when the pressure is more positive than the predetermined value of the upper limit, the operation of the apparatus (feeding or vibration of the blade 20) is stopped (operation Lock the start of the device before, and interrupt the operation of the device during the operation). In this case, the surgeon stops inputting the drive instruction signal by the foot switch 42, and checks the contact state of the suction ring 31, the clogged state of the suction passage 32a, and the like. When the detected air pressure becomes lower than the upper limit predetermined value and the operator re-inputs the drive instruction signal by the foot switch 42, the device can start or restart the operation. In addition, it is convenient to notify the operator that the detected air pressure has become a negative pressure higher than the upper limit predetermined value by a notifying device 46 such as a lamp or a sound. For example, the buzzer sounds while the detected air pressure is more positive than the upper limit predetermined value, and the buzzer is stopped when the detected air pressure becomes lower than the upper limit predetermined value. May be sounded). Further, at the start of the incision, the device may be started when the detected air pressure becomes a negative pressure higher than a predetermined upper limit value.

Conversely, if the air pressure in the space S becomes too negative because the suction time is too long, the intraocular pressure of the patient's eye becomes too high, which is not preferable. Therefore, in order to prevent this, a predetermined value of the lower limit of the air pressure is provided, and when the detected air pressure becomes a negative pressure lower than the lower limit of the predetermined value, the operation of the device is stopped, so that the burden on the patient's eyes is reduced. Surgery can be performed without the need for surgery.

Further, the blade is driven at a predetermined feed speed and frequency, but these may be changed according to the detected air pressure. For example, with respect to the feed rate, the feed rate is increased if the corneal stiffness is increased due to a decrease in the air pressure (toward the negative pressure), and the feed rate is decreased if the corneal stiffness is decreased due to the increase in the air pressure (toward the positive pressure). . This change can be made linearly as shown in FIG. 4 (a) or stepwise as shown in FIG. 4 (b). In this way, the operation can be performed more efficiently and accurately.

The predetermined upper and lower limits of the air pressure may be set in advance as predetermined values, or may be variably set by a surgeon using a switch (not shown). .

The control unit 40 is connected to the pressure detector 33, the foot switch 42 and the like. The control unit 40 also controls the motor 1
1, 12, the operation of the pump 41 is controlled.

In the apparatus having the above configuration,
The operation will be described below. The surgeon confirms the inclination state of the suction ring 31 (main body 1), the position of the center of the pupil, and the like based on a mark previously applied to the patient's cornea with an instrument such as a marker, while checking the center of the opening 31b with respect to the center of the pupil. And position the suction ring 31 on the patient's eye.

After the suction ring 31 is installed, the surgeon operates the pump 41 while holding the position and posture of the main body 1 to suck air in the space S between the suction ring 31 and the patient's eye. Reduce air pressure (towards negative pressure). The operation of the pump 41 is controlled by the control unit 40 to maintain the air pressure when the air pressure in the space S decreases to a certain value (when the pressure becomes sufficient negative pressure). This allows
The suction ring 31 is suction-fixed to the patient's eye.

When the fixing of the device is completed, the operator operates the foot switch 42 to rotate the feed motor 11 and the vibration motor 12, and at this time, the control unit 40 detects the pressure by the pressure detector 33 as described above. The drive is controlled based on the air pressure. Since the frequency of the blade 20 vibrates once for one rotation of the rotating shaft 15, the frequency can be easily controlled by the frequency of the vibration motor 12.
When the vibration motor 12 is driven, the cutting unit 2 moves straight in the hinge direction. At this time, the rotating shaft 1
5 slides in the advancing direction integrally with the cutting unit 2 while performing a rotating operation for imparting lateral vibration to the blade 20.

While controlling each of the feed motor 11 and the vibration motor 12 in this way, the patient's eye cornea sequentially and flatly pressed by the corneal presser 23 is incised by the blade 20 and the operation proceeds. .

When the tip of the blade 20 is cut open leaving a hinge portion and flap formation is completed, the feed motor 11
Is rotated in the reverse direction to return the cutting unit 2 to the initial position. At this time, by controlling each motor separately such as stopping the rotation of the vibration motor 12, unnecessary vibration of the blade 20 can be avoided and the blade 2 can be removed from the flap.
Pull out 0. Thereby, the possibility that the formed flap is cut off in the middle can be reduced.

After returning the cutting section 2 to the initial position,
Air is introduced into the space S to release the suction, and the device is removed. After that, the laser beam is used to perform substantial resection for the amount of corrective refraction, and the flap is returned to the original state, thereby completing the operation.

In this embodiment, the blade feed mechanism is described in which the corneal epithelium is dissected by moving the blade straight in the incision direction, but may be dissected by rotating the blade to dissect the corneal epithelium. . For rotating the blade, refer to Japanese Patent Application No. 10-157127 filed by the present applicant.

Further, the blade feed and lateral vibration may be performed by one motor, or only the blade lateral vibration may be performed by a motor, and the blade feed may be manually performed by a rotating gear or the like. In the latter case, only the lateral vibration of the blade is controlled by the detected air pressure.

[0040]

As described above, according to the present invention, the corneal rigidity of the patient's eye can be sufficiently increased, and a good flap can be easily formed.

[Brief description of the drawings]

FIG. 1 is a top view, an AA sectional view, and a schematic diagram of a control system of an apparatus of the present invention.

FIG. 2 is an enlarged explanatory view of a cutting section and a suction section.

FIG. 3 is a sectional view taken along the line CC for explaining a cutting unit.

FIG. 4 is an explanatory diagram relating to control of a blade feed speed with respect to a detected air pressure.

[Explanation of symbols]

 Reference Signs List 11 feed motor 12 vibration motor 15 rotation shaft 16 eccentric shaft 20 blade 31 suction ring 33 pressure detector 40 control unit 41 pump

Claims (9)

[Claims] 1. A corneal surgery device for incising a cornea of a patient's eye in layers, a suction ring abutting on a patient's eye,
Suction means for sucking air in a gap formed between the suction ring and the patient's eye in order to fix the suction ring to the patient's eye, a blade for incising a cornea protruding from the suction ring, and driving the blade Driving means, pressure detecting means for detecting the air pressure of the gap which changes due to suction of the suction means, and drive control means for controlling the driving means based on pressure information detected by the pressure detecting means, A corneal surgery device, comprising: 2. The corneal surgery apparatus according to claim 1, wherein the driving unit includes a vibrating unit for laterally vibrating the blade and a moving unit for moving the blade straight or rotationally, and the driving control unit includes the pressure detecting unit. Controlling at least one of the vibration means and the movement means based on the pressure information detected by the corneal surgery apparatus. 3. The corneal surgery apparatus according to claim 2, wherein the drive control means linearly changes at least one of the frequency of the vibration means and the moving speed of the moving means based on the air pressure detected by the pressure detecting means. A corneal surgery device characterized by adjustment. 4. The corneal surgery apparatus according to claim 2, wherein the drive control unit divides the air pressure detected by the pressure detection unit into a plurality of stages, and the vibration frequency of the vibration unit is changed for each of the divided air pressure stages. And at least one of a moving speed of the moving means is adjusted. 5. The corneal surgery apparatus according to claim 1, further comprising upper limit value setting means for setting an upper limit value for the detected air pressure, wherein said drive control means is detected by said pressure detection means. The corneal surgery apparatus, wherein the operation of the driving unit is stopped when the value of the air pressure is more positive than the upper limit value. 6. The corneal surgery apparatus according to claim 5, further comprising a notifying unit for notifying an operator that the value of the air pressure detected by the pressure detecting unit is a negative pressure that is lower than the upper limit. A corneal surgery apparatus characterized by the above-mentioned. 7. The corneal surgery apparatus according to claim 1, further comprising a lower limit value setting unit for setting a lower limit value for the detected air pressure, wherein the drive control unit detects the lower limit value by the pressure detection unit. The corneal surgery apparatus, wherein the operation of the driving unit is stopped when the value of the detected air pressure is lower than the lower limit value. 8. The corneal surgery apparatus according to claim 1, further comprising upper limit value setting means for setting an upper limit value for the detected air pressure, wherein said drive control means is detected by said pressure detection means. The corneal surgery apparatus, wherein the operation of the driving means is started when the value of the air pressure is lower than the upper limit value. 9. The corneal surgery apparatus according to claim 1, further comprising suction control means for controlling said suction means based on pressure information detected by said pressure detection means.