JP2007021147A - Lens capsule equator retaining appliance - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To develop an appliance for safely operating a surgery for a fragile case or a fracture case of the Zinn's zonule regarded as an intractable case among the cataract operation and the intraocular lens transplant surgery. <P>SOLUTION: This lens capsule equator retaining appliance is used for retaining the lens capsule equator section when a patient's Zinn's zonule is fragile or fractured in the cataract operation or the intraocular lens transplant surgery. This lens capsule equator retaining appliance is characterized in that the appliance is formed of a soft rod-shaped flexible synthetic resin having the thickness of 0.01 mm to 1.0 mm, the distal end is acutely bent, the length of the bend from the bending top to the distal end is 1.5 mm or more, the distal end of the bend is a linear or planar pad, the width of the pad is 1 mm or more in the linear shape or the plane area is 1 mm<SP>2</SP>or more in the planar pad, and the flexible synthetic resin is fixed or mounted on a rigid support rod. This lens capsule equator retaining appliance is used for securing the lens capsule equator part with the pad. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The lens capsule holding device of the present invention is used for holding the lens capsule during ophthalmic surgery, particularly cataract surgery and intraocular lens implantation surgery.

  In cases of cataract patients such as the elderly, cases of mydriasis, and pseudophagocytic syndrome, it is often the case that the chin band is originally weak or partially cut off or detached. In this way, the fragile and ruptured cases of chin ligaments may cause complications such as rupturing or expanding the range of rupture leading to lens dislocation, and the dislocated lens falling into the vitreous cavity. The nature also increases. Therefore, in cataract surgery, it is an important point of this ultrasonic emulsification and intraocular lens transplantation to keep the lens capsule for fixing the intraocular lens in a circular bag shape.

  U.S. Pat. 6,183,480   Japanese Patent Publication No. 2004-337551

  Chin ligament cases and rupture cases are treated as intractable cases in cataract surgery, and it is difficult to remove the nucleus of the lens, dropping the lens, posterior capsule rupture, intraocular lens shift, dropping into the vitreous cavity, etc. Is known as a complication. One of the conditions for safely performing cataract surgery is to maintain a good mydriatic state. Eye drops are usually used for mydriasis, but in patients with a history of glaucoma or uveitis, there are cases where the mydriasis cannot be obtained sufficiently because they do not respond to eye drops. In such a small pupil example, a surgical auxiliary instrument called an iris retractor that can forcibly expand the pupil is conventionally used. When a metallic iris retractor is used for a chin small band fragile / ruptured case, the iris edge (pupil edge) and the anterior capsule after incision are pulled together to pull the lens capsule, but the towing site is incised. A sufficient capsular bag shape cannot be secured only by the posterior anterior capsule edge.

  U.S. Pat. In the lens capsule fixing device disclosed in US Pat. No. 6,183,480, the traction site is only the front capsule edge after the incision, and a sufficient bag shape of the lens capsule cannot be secured, and there is a crack in the front capsule edge after the incision. Cannot be used. In order to secure the equator portion of the lens capsule in a circular shape, there is a lens capsule expansion ring and an intraocular lens support (haptic). The lens capsule expansion ring is used for preventing subsequent cataracts by preventing the growth and extension of the anterior lens capsule epithelial cells to the posterior capsule, and the intraocular lens is used for correcting vision. The lens capsule expansion ring and intraocular lens can fall into the vitreous cavity when the chin ligament ruptures, which can lead to reoperation. Furthermore, if the lens capsule holding device disclosed by the present inventor in Patent Publication No. 2004-337551 is a flexible synthetic resin such as a nylon thread of 0.15 mm, the anterior capsule in the eye because of the flexibility. The operation on the incision edge is difficult and the operation time tends to be long. On the other hand, in the case of a synthetic resin or metal that is hard to enter the eye of the instrument, such as corneal endothelium, anterior lens capsule, iris etc. May damage tissue.

Means to solve the problem

In cataract / intraocular lens transplantation surgery, in order to hold the capsular equator of the patient when the chin ligament is fragile or ruptured, a flexible flexible synthetic resin with a rod shape of 0.01 to 1.0 mm in thickness The tip is bent at an acute angle, the length to the tip of the bend is 1.5 mm or more from the bend apex, and the tip of the bend is a linearly branched pad or a planar pad, and the line has a thickness of 0.01 A flexible synthetic resin and a rigid support in which the root of this rod having a linear pad having a branch pad width of 1 mm or more and a surface pad having a surface area of 1 mm ² or more is fixedly attached to the tip of the support rod. A lens capsule equatorial holding device made of a stick is used.

  The distal end of the capsular equator holding device is a linear pad, the line branches up and down, and the width of the branch is 1 mm or more, and the capsular equator is widened back and forth with the pad to ensure a bag shape . Alternatively, the tip of the bend is a linear pad, the line branches left and right or up and down, and the width of the left and right is set to 1 mm or more, and the capsular equator is widened along this equator with this pad to secure the equator. Alternatively, the capsular equator holding device of the present invention in which the tip of the bend is planar and the capsular equator is secured by using the surface as a spatula pad is used for cataract and intraocular lens implantation surgery.

Furthermore, the tip is bent at an acute angle with a rod-shaped flexible synthetic resin having a thickness of 0.01 to 1.0 mm, the length to the tip of the bend is 1.5 mm or more from the apex, and the tip of the bend is linear. This bar has a linear pad with a thickness of 0.01 to 1 mm and a branched pad width of 1 mm or more, or a planar pad with a surface area of 1 mm ² or more. 2 is inserted into the tip of the cylindrical support rod as shown in FIG. 2, and the tip of the tip pad D is attached to the tip of the support rod Y by pushing out the flexible synthetic resin root that is exposed to the front side P of the support rod. The problem is solved by a lens capsule equatorial part holding instrument comprising a flexible synthetic resin and a rigid support rod.

  The tip of the capsular equator holding device of the present invention is a flexible synthetic resin, a material selected from polypropylene, nylon, silicone, polyvinyl chloride, polyvinyl fluoride, polymethyl methacrylate, shape memory resin, or Other flexible acrylic resins can also be used. The rigid support rod is preferably a stainless steel rod having a diameter of 0.2 to 0.9 mm or a support rod made of a hard synthetic resin such as delrin, polyimide, or plastic.

  As described above, in the instrument of the present invention, securing the lens equator is the most important purpose. The device of the present invention differs from conventional iris retractors, McCool lens capsule fixators, lens capsule expansion rings, and the like in shape, usage, and action.

The invention's effect

  The capsular equator holding device of the present invention can be used as a surgical aid during surgery for a cataract patient with a weak or partially torn chin band. The device of the present invention prevents further rupture of the chin ligament during cataract / intraocular lens implantation surgery, accurately fixes the position of the intraocular lens, and helps the patient recover their visual acuity. In FIG. 1, when the instrument is inserted into the patient's eye, bending and twisting of the instrument is suppressed by the support rod Y, and damage to the intraocular tissue contacting the instrument is minimized, so that the surgeon can operate. It can be made simpler.

  As shown in FIG. 2, the instrument in which the rod-shaped flexible synthetic resin root R and pad portion D of the present invention are placed in the distal end of the support rod Y is easier to insert into the eye than the distal end T. By pushing out the flexible synthetic resin R root at the operator's side P, the pad portion D can be brought out of the support rod Y within the eye.

  With the use of the device of the present invention, the surgeon prevents subluxation or dislocation of the lens and prevents further complications arising from lens or intraocular lens shift or drop into the vitreous cavity.

  If the capsular bag that becomes a bag fluctuates during ultrasonic emulsification and suction, the risk of posterior capsule rupture due to the ultrasonic emulsification and suction needle increases. Can prevent posterior capsule rupture during ultrasonic emulsification and aspiration of cataract patients who have been severely ruptured, and perform safe surgery without further complications.

  The instrument of the present invention can be used, for example, in the direction of the insertion portion of the ultrasonic emulsification suction needle, for example, even in the use of the equator part, and at this time the ultrasonic emulsification of the surgeon even if the chin band is not fragile or ruptured Aspiration and intraocular lens implantation will be facilitated.

  The device of the present invention can secure a three-dimensional structure of the capsular equator which cannot be achieved by an iris retractor or a capsular capsule fixing device, and further facilitates ultrasonic emulsification and intraocular lens transplantation. Even if the vitreous body pressure from the posterior eye is slightly high, at least three-dimensional securing of the capsular equator can be achieved.

  In cases where the chin band is fragile or partially ruptured, the lens is swung with an incision needle at the time of anterior capsulotomy, so this anterior capsulotomy operation is difficult for the operator, and the anterior capsule, Ac in FIG. Often, it cannot be cut well and rounded. However, the device of the present invention is highly effective because it retains the equator portion E of the lens capsule rather than the anterior capsule Ac even when there is a slight disturbance or crack at the incision edge of the lens capsule.

  In ophthalmic surgery, the capsular equator holding device of the present invention is used as a surgical aid for cataract patients, especially during ultrasonic emulsification and intraocular lens implantation. An example of the shape of the instrument of the present invention is as shown in FIG. 1, and the proximal end of the rod-like flexible flexible synthetic resin portion R is fixed in the support rod Y. 1 and 3 is best used by bending the support bar Y in order to avoid eyelids.

  Further, in FIG. 1, the bending from the tip bending portion T of the instrument of the present invention is an acute angle toward the pad D. The length from the bent portion T to the pad D is preferably about 1.5 mm or more, and is about 5 mm at the longest. In FIG. 1 for the example and explanation, the distance from the bent portion T to the pad tip is 2.25 mm. The tip pad D branches to the left and right. The left-right width that becomes the pad D is about 1.25 mm. The pad width is at least 1 mm and not more than 15 mm, and it is preferable to secure the equator with this width. The rod-shaped device of FIG. 1 of the present invention is manufactured with a 5-0 nylon thread having a tip R of 0.15 mm in thickness, and the support rod Y is a cylindrical stainless steel rod having a diameter of 0.16 mm with a tip of a 0.2 mm diameter stainless steel rod. A hole is provided so as to become, and a nylon thread root portion is fitted and fixed with a caulking portion Q. In addition to the stainless steel rod, a method of fixing the nylon thread root to a 28 gauge cannula (chemical solution injection needle) may be used. Caulking can be performed with stainless steel, but if the support rod Y is a synthetic resin, the tip R root fixing with heat fusion or adhesive is selected. The positioning stopper S that slides for positioning on the support bar Y uses soft silicone.

  FIG. 2 is a cross-sectional view in which the tip of the pad D of the instrument of the present invention is inserted into the support rod T, and the wound for insertion into the intraocular eye of the instrument, for example, provided at four locations around the cornea, 1 mm wide, and the instrument is bent. It can be inserted into the eye more smoothly than the part T. As shown in FIG. 3, the distal end of the instrument is inserted into the equator E from the anterior capsule portion A which is inserted through the incision at the K-edge of the cornea and incised. Next, the pad D is pushed out of the support rod Y within the eye. The flexible synthetic resin portion R can be freely operated in the support rod Y.

  FIG. 3 is a view in which the distal end and the pad D are applied to the inner equator portion E of the sac C after the distal end of the flexible synthetic resin portion R of the present invention is inserted into the intraocular lens capsule C. Although the pad D is drawn up and down perpendicular to the equator E for the sake of explanation, it is preferable that the subsequent surgery is more easily performed if the pad D is applied to the sac parallel to the equator E. The left chin band Z is ruptured from the uvea U, and the right chin band Z is not ruptured from the uvea U. The device is inserted and mounted in this manner, and then the lens L is removed by ultrasonic emulsification and intraocular lens implantation is performed as a substitute lens.

  Before inserting the device of the present invention into the eye, the lens having a hard nucleus is separated from the nucleus and cortex by water pressure. After the nuclear separation, when the instrument of the present invention is mounted in the sac, the tip pad comes into contact with the sac equatorial cortex. At this time, the cortex under the pad is also sucked by the ultrasonic emulsification suction needle, but the pad of this instrument is shaken but does not hinder cortical suction. At this time, the support bar has the effect of minimizing the pad shaking.

  An instrument as shown in FIG. 1 was produced. In the pad D of the present invention, the tip length of 0.75 mm of a 5-0 nylon thread having a rod-like diameter of 0.15 mm is vertically divided into half the thickness up to the branch point, and a pad D width of about 1.25 is obtained by branching the tip. confirmed. The equator is secured with this pad width. The shape was thermoformed. A 28-gauge (φ0.2 mm) stainless steel support rod Y with a 0.16 mm hole drilled from the tip end, the root of the nylon thread R inserted into the hole, Yes, soft silicone was mounted on the support bar Y as a positioning stopper S.

  The effect of the instrument was tested using the pig eyes after slaughter. After incision of the anterior lens capsule under a microscope, it was excised near the posterior eye hemisphere, the chin ligament was cut in half, and the action of the device of the present invention in the sac was confirmed from the posterior eye. Punctures are made at 4 corners of the conjunctiva, 1 mm wide at every 90 degrees, and the instrument of the present invention is inserted into the viscous liquid crystalline lens through the anterior capsulotomy edge from these wounds. Differently, it was applied to the sac along the lens equator E. The position was fixed with the positioning stopper S. At this time, the movement of the tip pad D of the device R was observed from the posterior eye part. The tip pad could be fixed along the equator without piercing the sac. In this state, ultrasonic emulsification and intraocular lens transplantation became possible. The support bar Y significantly suppressed vibration and shaking of the device pad D. Although the porcine lens capsule is stronger than the human lens capsule, it has been confirmed that it can maintain a pouch shape and can safely and reliably perform cataract / intraocular lens implantation.

  As described above, the capsular equator holding device of the present invention can hold the capsular sac during cataract surgery and can suppress damage to the proximal tissue at the time of intraocular insertion of the instrument, and is a highly safe cataract.・ Provide intraocular lens transplant surgery.

  The perspective view of the front-end | tip part of the lens capsule equatorial-part holding instrument of this invention which has a pad where the front-end | tip branched to right and left.   Sectional drawing of the cylindrical support bar front-end | tip part by which the front-end | tip pad was included in the support bar front-end | tip.   FIG. 2 is a partial schematic cross-sectional view of an anterior eye part in which the lens capsule equatorial part holding device of FIG. 1 is mounted in the eye.

Explanation of symbols

A Incised anterior capsule part Ac Acral lens capsule C Lens capsule D Rod-shaped flexible synthetic resin R tip pad E Lens equator K Cornea L Lens P Rod-shaped lens capsule Equator holding instrument handle side Q Flexible synthetic resin caulked portion of rigid support rod R Rod-shaped flexible synthetic resin S Positioning stopper T Bent portion of the tip of this instrument U Uvea Y Hard support rod Z Chin small belt

Claims (5)

The tip is bent at an acute angle with a rod-shaped flexible synthetic resin with a thickness of 0.01 to 1.0 mm, the length to the tip of the bend is bent over 1.5 mm from the apex, and the tip of the bend branches in a linear shape The base of this rod having a linear pad with a thickness of 0.01 to 1 mm and a branch pad width of 1 mm or more, or a planar pad with a surface area of 1 mm ² or more. A lens capsule equator holding device comprising a flexible synthetic resin and a rigid support rod, wherein the lens capsule is fixedly attached to the tip of the support rod. The tip is bent at an acute angle with a rod-shaped flexible synthetic resin with a thickness of 0.01 to 1.0 mm, the length to the tip of the bend is bent over 1.5 mm from the apex, and the tip of the bend branches in a linear shape The base of this rod having a linear pad with a thickness of 0.01 to 1 mm and a branch pad width of 1 mm or more, or a planar pad with a surface area of 1 mm ² or more. And the tip pad portion is inserted into the tip of the cylindrical support rod, and the flexible pad is pushed out from the front side of the support rod to push out the tip pad portion from the tip of the support rod. A lens capsule equatorial holding device comprising a synthetic resin and a cylindrical rigid support rod.   The capsular equator holding device according to claim 1 or 2, comprising a flexible synthetic resin and a rigid support rod, each having a positioning stopper provided on the rigid support rod.   3. The capsular equator portion holding according to claim 1, wherein the bent tip pad is linear, the line branches vertically or horizontally, the branch line has a thickness of 0.01 to 1 mm, and the branch pad width is 1 mm or more. Instruments.   Stainless steel whose flexible synthetic resin is selected from polypropylene, nylon, silicone, polyvinyl chloride, polyvinyl fluoride, polymethyl methacrylate, and shape memory resin, and whose thickness of the rigid support rod is 0.2 to 0.9 mm 3. The capsular equator holding device according to claim 1 or 2, wherein the capsular equator holding device is a support rod selected from a rod, a delrin, a polyimide, and a plastic hard synthetic resin.

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