JP2000237228A - Sleeve for ophthalmic operation, and ophthalmic operation device equipped with the same - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent an anterior chamber collapse and a lenticular capsule collapse from occurring, and properly perform an operation by providing a plurality of flow-out ports while making the distances from the tip end different, on a sleeve in order to feed a perfusion liquid into an eye. SOLUTION: A forward section 23a which is in the tubular section of a sleeve and is inserted in a part of a lenticular capsule and an anterior chamber, is made thinner than a conventional one, and is formed into a size of a diameter of approx. 1 mm so that the forward section 23a may be inserted from a small incision ccc, and also, is made thin in a manner to ensure a gap with a chip. A rear section 23b which is not inserted in the capsule is made thicker than the forward section 23a so that a large amount of a fed perfusion liquid can be ensured. A flow-out port 24 is constituted of a plurality of flow-out ports 24a-24d which are formed by making the distances in the axial direction different. For example, the flow-out ports 24a and 24b are formed at a section having a length L1 located in the capsule, and the flow-out ports 24c and 24d are formed at a section having a length L2 located in the anterior chamber. By this constitution, the perfusion liquid is fed into the lenticular capsule, and a lenticular capsule collapse can be prevented from occurring.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ophthalmic surgery sleeve for covering an intraocular insertion tip attached to a distal end of a surgical handpiece, and an ophthalmic surgery apparatus including the sleeve.

[0002]

2. Description of the Related Art In conventional cataract surgery, an opaque lens nucleus is removed while leaving the lens capsule, and an intraocular lens formed of a biocompatible material such as PMMA (polymethyl methacrylate) is inserted instead. In recent years, the capsular bag is filled with a gel-like injectable substance such as silicon, collagen, HEMA (hydroxyethyl methacrylate), or PVA (polyvinyl alcohol) instead of these intraocular lenses, thereby restoring the accommodation function of the patient's eye. A cataract surgery technique called lens refilling has been attempted.

In cataract surgery, the lens nucleus is removed by inserting a surgical handpiece having a crushing tip at the distal end from an incision made in the eyeball, and applying ultrasonic vibration to the crushing tip to remove the crushed and emulsified lens nucleus. This is performed by sucking and discharging outside the body from the suction hole at the tip of the crushing tip. In the case of crushing emulsification, in order to supply the perfusate from the perfusion bottle into the eye, a flexible soft body that has an inner wall larger than the outer diameter of the crushing tip and is flexible and easily deformed, such as silicone resin The sleeve formed by the above is covered with a crushing tip and attached to a handpiece. The sleeve serves as an inlet for the perfusate, and the perfusate guided from the perfusion bottle into the handpiece via the perfusion tube passes through the gap secured between the crushing tip and the sleeve, near the tip. It is supplied into the eye from the provided outlet.

[0004] In the case of cataract surgery by inserting an intraocular lens, an opening having a diameter of about 6 mm is provided in the anterior capsule of the lens, and a crushing tip covered with a sleeve is inserted through the opening to emulsify and aspirate the lens nucleus. Later, the intraocular lens is inserted into the capsular bag. At this time, the perfusate supplied from the outflow hole at the distal end of the sleeve is supplied not only to the inside of the lens capsule but also to the anterior chamber through the opening.

In capsular bag filling by lens refilling, a small circular opening (CCC: CoC) having a diameter of up to about 1 mm is formed in the anterior capsular portion in order to prevent leakage of the injected substance.
ntinuous Curvilinear Capsulorhexis or Continuous
Circular Capsulorhexis) is provided, and a crushing tip is inserted into the capsule through the opening to remove the lens nucleus.

[0006]

As described above, in both the case of inserting an intraocular lens and the case of lens refilling, a crushing tip and a sleeve attached to a handpiece are used for emulsifying suction of a lens nucleus. Surgery is performed by inserting it into the lens capsule. However, in lens refilling, since the CCC is as small as about 1 mm in diameter, the CCC is blocked by the outer edge of the sleeve, and the perfusate supplied from the outlet hole at the tip of the sleeve is limited only to the inside of the capsular bag. It is hard to be supplied to the side. For this reason, the perfusate for supplementing the aqueous humor flowing out of the incision provided in the eyeball is not replenished, and the anterior chamber collapse may occur in which the anterior chamber is collapsed.

In the conventional sleeve diameter, a small incision C
Inserting the sleeve into the capsular bag from the CC was sometimes difficult. If the operation is performed while the sleeve cannot be inserted into the capsular bag, only the suction is performed in the capsular bag, and the capsular bag may collapse, which causes the capsular bag to collapse. When CCC is formed according to the sleeve diameter,
The likelihood of leakage of the infused material in the capsule after lens nucleus removal increases, and the effective optical area of the lens is reduced if a large sealing plug is used to prevent leakage.

In view of the above-mentioned problems of the prior art, the present invention prevents the collapse of the anterior chamber and the collapse of the capsular bag even when the opening formed in the anterior capsule is small, such as lens refilling. It is an object of the present invention to provide an ophthalmic surgery sleeve capable of performing the above and an ophthalmologic surgery apparatus provided with the sleeve.

[0009]

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

(1) In an ophthalmic surgical sleeve for covering an intraocular insertion tip attached to the tip of a surgical handpiece, for supplying a perfusate guided through the surgical handpiece into the eye. A plurality of outflow holes are provided at positions at different distances from the tip.

(2) In the sleeve for ophthalmic surgery according to (1), the outflow hole is provided at a position near the distal end and at a position at least remaining in the anterior chamber when inserted into the lens capsule. And

(3) In the ophthalmic surgery sleeve of (1), of the tubular portion inserted into the eye during the operation, the portion inserted into the lens capsule relative to the outer diameter of the portion located in the anterior chamber. Are formed thin.

(4) In the sleeve for ophthalmic surgery according to any one of (1) and (3), a diameter of a portion to be inserted into the capsular bag during the operation is approximately 1 mm or less.

(5) In the sleeve for ophthalmologic surgery according to (1), the size of the outflow hole increases as it approaches the tip.

(6) The sleeve for ophthalmic surgery of (1)
It is characterized in that it is used for cataract surgery performed for lens refilling in which an injected substance is filled in a capsular bag.

(7) An ophthalmic surgery apparatus including the ophthalmic surgery sleeve according to any one of (1) to (6), wherein a perfusion solution supply means for supplying a perfusion solution into the eye via the ophthalmic surgery sleeve. And suction means for sucking waste liquid in the eye.

[0017]

DESCRIPTION OF THE PREFERRED EMBODIMENTS An ultrasonic cataract surgery apparatus used for cataract surgery according to the present invention will be described below as an embodiment with reference to the drawings. FIG. 1 is a schematic configuration diagram of an ultrasonic cataract surgery apparatus according to an embodiment, and FIG. 2 is a schematic diagram of a main part of an ultrasonic crushing handpiece (US handpiece).

In FIG. 1, reference numeral 1 denotes a perfusion bottle filled with a perfusion solution, which is used by being suspended from a perfusion pole 2. The perfusion pole 2 is moved up and down by a vertical drive unit 12 according to the pole height set by the input unit 11. The height of the perfusion bottle 1 is changed by the vertical movement of the perfusion pole 2, and the perfusion pressure is adjusted.

The perfusate from the perfusion bottle 1 is supplied to the perfusion tube 3
And is irrigated into the patient's eye E via a surgical handpiece gripped by the operator. A control valve 4 is provided in the middle of the perfusion tube 3, and opening and closing of the control valve 4 controls outflow of the perfusate. The surgical handpiece is replaced with various ones as the operation progresses. In this embodiment, a US handpiece for crushing and emulsifying the lens nucleus will be described.

As shown in FIG. 2, the handpiece 5 has a vibrator 20 for generating ultrasonic vibration therein, and the vibrator 20 is driven by energy supplied via a power cable 13. The horn 21 for amplifying the ultrasonic vibration generated by the vibrator 20 is connected to the vibrator 20 by bolts,
The crushing tip 26 is integrally fixed by a nut or the like, and the tip thereof is fixed by screwing.

The suction passage provided in the crushing tip 26 includes a suction passage 22 formed in the horn 21 and the vibrator 20.
The rear end of the suction passage 22 is connected to the suction tube 6.
Connected to. A suction pressure is applied to the suction tube 6 by a suction pump 7, and the crushed and emulsified lens nucleus is sucked and discharged into a waste liquid bag 8 together with a perfusate.

The crushing tip 26 is covered with a sleeve 23 for supplying a perfusate into the eyeball. Sleeve 23
Is formed of metal, and its tip is formed thin as described later. The handpiece 5 to which the sleeve 23 is attached is provided with a perfusion passage 25 for guiding the perfusate into the gap between the sleeve 23 and the crushing tip 26, and the rear end of the perfusion passage 25 is connected to the perfusion tube 3. . The perfusate is delivered from the perfusion bottle 1, guided into the sleeve 23 via the perfusion tube 3 and the perfusion passage 25, and supplied into the eye through the outflow hole 24 shown in FIG.

A flexible suction tube 6 is connected to the handpiece 5, and a connection portion 16 connected to the pressure sensor 15 and a peristaltic suction pump 7 are provided in the middle of the suction tube 6.
The suction tube 6 communicates with the perfusion tube 3 via the bypass tube 17.
Is controlled by the control valve 18. Pressure sensor 1
5, the suction pressure is constantly detected, and when the suction pressure rises above the set value, the control valve 18 is opened by the control of the control unit 10 as necessary, and the perfusate is transferred from the perfusion tube 3 through the bypass tube 17. It is made to flow into the suction tube 6 to lower the suction pressure. The upper limit of the suction pressure is set by operating a switch of the input unit 11.

The control unit 10 controls the operation of the control valve 4 and the suction pump 7 based on the set value of the input unit 11 and the operation signal transmitted from the foot switch 14 via the cable 9.
In addition, drive control of the ultrasonic vibration of the crushing tip 26 is performed.

FIG. 3 is a diagram showing a cross section of the sleeve 23 in the axial direction. In FIG. 3, at the time of normal surgery (when crushing and emulsifying the lens nucleus in the center of the capsule), the length of the distal side indicated by L1 is mainly located in the capsule, and the posterior side indicated by L2 is located in the anterior chamber. . The anterior portion 23a inserted into a part of the tubular portion of the sleeve 23, in the capsular bag and in the anterior chamber is thinner than the conventional sleeve diameter of 1.8 mm, and has a small incision CCC.
It has a diameter of 1 mm so that it can be inserted from above, and is formed so as to be thin so as to secure a gap with the chip 26. On the other hand, the rear portion 23b that is not inserted into the sac has a larger diameter than the front portion 23a (the same as the conventional 1.8 m diameter).
m), so that a large amount of perfusate to be supplied into the eyeball can be secured. A plurality of outflow holes 24 are provided at different axial positions of the front portion 23a. In the present embodiment, two outflow holes 24a, 24b, and two outflows are provided at two locations at the front end side L1. Hole 2
4c and 24d are formed on one side (the same applies to the side opposite to the drawing).
Outflow holes 24 are formed). Note that the rearmost outflow hole 24d is formed at a position where at least at least the remaining outflow hole 24d remains in the anterior chamber even when the chip 26 is inserted deeply into the lens capsule.

As described above, of the tubular portions of the sleeve 23,
Since the anterior portion 23a has a shape that can be inserted from the CCC of the small incision, it is possible to supply a perfusate into the capsular bag and prevent collapse of the capsular bag. In addition, since the outflow hole 24 is also provided at a position extending over the anterior chamber, it is possible to supply the perfusate to the anterior chamber.

In the apparatus having the above-described configuration,
The operation during lens nucleus removal surgery for performing lens refilling will be described. FIG. 4 is a view schematically showing a state in the eye during this operation.

After making an incision by sclerocorneal incision, the surgeon uses a cystotome or a perfusion needle or the like to perform lens refilling on the lens capsule with a small C of about 1 mm in diameter.
A CC is formed. After incision and CCC formation,
The tip of the handpiece 5 is inserted into the eyeball from the incision, and the tips of the crushing tip 26 and the sleeve 23 are inserted into the capsular bag from the CCC.

The surgeon inputs a signal for operating each device by the foot switch 14. Foot switch 14
Is input to the control unit 10, and the control unit 10 controls the supply of the perfusate by the control valve 4, the suction by the suction pump 7, and the ultrasonic vibration by the driving of the vibrator 20 according to the type of the signal. By doing so, emulsified suction of the lens nucleus is gradually performed.

When the supply of the perfusate is controlled by the control unit 10, the perfusate passes through the perfusion tube 3, the perfusion channel 25, the gap between the sleeve 23 and the crushing tip 26, and from each outflow hole 24 into the eye. Supplied to At this time, as shown in FIG. 4, the two outflow holes 24a and 24b on the distal end side are located in the capsular bag, and the outflow holes 24c and 24d on the rear side are located in the anterior chamber. Outflow hole 24 located in the capsular bag
a and 24b are supplied to the crushing tip 26.
Since the inside of the capsular bag is filled with a substantially constant amount of perfusate, the pressure in the capsular bag is maintained.
Further, the perfusate supplied into the anterior chamber from the outlet holes 24c, 24d on the rear side supplements the aqueous humor flowing out from the incision wound, maintains the anterior chamber volume, maintains the anterior chamber pressure, and collapses the anterior chamber. Can be prevented.

In the embodiment described above, the size of the plurality of outflow holes 24 is the same, but it may be gradually increased toward the front end. In this way, even when the number of the outflow holes 24 located in the lens capsule decreases when emulsifying and sucking the lens nucleus in the vicinity of the CCC, it is possible to suppress the insufficient supply of the perfusate into the lens capsule.

Although the sleeve has been described as being made of metal, it is also possible to form only the finest part of the tip to be inserted into the capsular bag with metal, and to make the other part a flexible soft body such as silicon. Further, the entire sleeve including the finest portion at the tip may be formed only of the flexible soft body.

[0033]

As described above, according to the present invention,
The sleeve attached to the handpiece is inserted through the small-diameter opening formed in the anterior capsule and the perfusion solution is sufficiently supplied into both the capsule and the anterior chamber to perform the operation. Collapse can be prevented.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of an ultrasonic cataract surgery apparatus according to an embodiment.

FIG. 2 is a schematic view of a main part of a US handpiece.

FIG. 3 is a sectional view of a sleeve.

FIG. 4 is a schematic relation diagram of a handpiece and a patient's eye during surgery.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Perfusion bottle 3 Perfusion tube 5 Handpiece 7 Suction pump 23 Sleeve 24 Outflow hole 25 Perfusion channel 26 Crushing tip

Claims (7)

[Claims] 1. An ophthalmic surgery sleeve for covering an intraocular insertion tip attached to a distal end of a surgical handpiece, for supplying a perfusate guided through the surgical handpiece into the eye. An ophthalmic sleeve, wherein a plurality of outflow holes are provided at different positions from the tip. 2. The ophthalmic surgery sleeve according to claim 1, wherein the outflow hole is provided at a position near the distal end and at a position at least remaining in the anterior chamber when inserted into the capsular bag. Ophthalmic surgery sleeve. 3. The ophthalmic surgical sleeve according to claim 1, wherein, of the tubular portions inserted into the eye during the operation, a portion inserted into the capsular bag with respect to an outer diameter of a portion located in the anterior chamber. An ophthalmic surgery sleeve, which is formed to be thin. 4. The sleeve for ophthalmic surgery according to claim 1, wherein a diameter of a portion to be inserted into the capsular bag during the operation is approximately 1 mm or less. 5. The sleeve for ophthalmic surgery according to claim 1, wherein the size of the outflow hole increases as approaching the distal end. 6. The ophthalmic surgical sleeve according to claim 1, wherein the ophthalmic surgical sleeve is used for cataract surgery performed for lens refilling for filling an injectable substance into a capsular bag. 7. An ophthalmic surgery apparatus comprising the ophthalmic surgery sleeve according to any one of claims 1 to 6, wherein a perfusion solution supply means for supplying a perfusion solution into the eye via the ophthalmic surgery sleeve. And an aspirating means for aspirating waste fluid in the eye.