JP2007130334A - Constant depth cornea loop incision apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To obtain a constant depth cornea loop incision apparatus which surgically achieves the recovery of ocular modulation ability and enables the treatment of presbyopia. <P>SOLUTION: The constant depth cornea loop incision apparatus, which creates incised wound of one round time with the shape of a ring and fixed depth in the cornea near the cornea ring section, is provided with a strong cornea fixing ring (a suction ring) 20 which has a cornea circular aperture 24 for passing the cornea and a suction pressure means 37 to suck the strong cornea, and fixes the strong cornea, a revolution body (a revolver) 40 which has an inner wall face (an inclined plane 43) of a reverse truncated cone shape around the cornea circular aperture 24 and can rotate only in one direction in relation to the strong cornea fixing ring, and an incision means (a blade fixing mechanism 60 and a blade 61) installed on the inner wall face (the inclined plane 43) of the revolution body 40 so that it can project into the inside of the cornea circular aperture 24, improves the extensibility of the sclera 5 located outside of the incised wound through the constant depth cornea loop incision near the cornea ring section by this, and enables the treatment of the presbyopia. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a surgical instrument for incising the cornea in a certain pattern, and restores the ability of adjustment lost by aging, developed based on the new theory of eyeball adjustment proposed by the present inventor (presbyopia treatment). The present invention relates to a constant-depth corneal ring-shaped incision instrument.

  The principle of accommodation in the eye movement has been supported by Helm Holtz in the 19th century, with many contradictions. The Helm-Holtz theory can be briefly explained as follows. That is, the adjustment movement of the eyeball uses the expansion and contraction movement of the ciliary muscle existing in the eyeball as its sole driving force, and the only effector is the lens. The crystalline lens, which is an effector, adjusts the focal point by changing its thickness and position.

As a result of the decline in the ability to stretch and contract the internal muscles due to aging, if the lens, which is the effector, cannot be sufficiently affected, the accommodation function of the eye deteriorates, and the focal position (far When the point is adjusted, a phenomenon (generally called presbyopia, technically referred to as age-related accommodation weakness) that makes it difficult to see the near area occurs.
When such age-related accommodation weakness (hereinafter referred to as presbyopia) occurs, until now, wearing a spectacle or contact lens with a convex lens to adjust the focal position (far point) and near vision It has been generally done to improve. However, if the near vision is improved by these methods, the distance vision will be disturbed.

  The recovery of presbyopia in the essential sense is to restore the eye's ability to adjust. As a fundamental solution for this, a method to restore the function of the weakened ciliary muscle (inner eye muscle) is required. However, the function recovery of the ciliary muscle that appears as part of the aging phenomenon and the eye It has been considered impossible to restore the ability to adjust.

With the recent development of laser technology, as shown in Patent Document 1, a bifocal lens is directly placed on the patient's eyeball so that the patient's eye can be selected with a near or far focus. A presbyopia treatment system that processes the surface has been proposed.
This system is a surgical presbyopia treatment system using a laser irradiation system, and has laser irradiation means and laser control means. An annular excision part (annular transpiration part) centered on the visual axis is provided in the central region of the cornea (the pupil cornea, and thereafter the pupil cornea is unified) by desired laser irradiation.

The treatment with the presbyopia treatment system is shown in FIGS. 12 (a) and 12 (b), and is specifically performed in the following procedure.
(1) The cornea surface layer portion of the eyeball 600 is cut into a disc shape with a thickness of 100 to 200 μm to form a corneal flap 610, which is then lifted to expose the corneal substantial portion 620 (FIG. 12 (a)).
(2) Laser irradiation 630 is performed on the corneal stroma 620 of the pupillary cornea to evaporate the corneal stroma so as to form a desired annular recess 640 (FIG. 12B).
(3) Return the corneal flap 610 to its original position on the corneal stroma, and finish the treatment.

  In this presbyopia treatment system, as shown in FIGS. 13 (a) and 13 (b), an annular recess 640 is created with a size that does not exceed an outer diameter of 3.5 mm with the visual axis as the center. This modifies the curvature in the pupillary cornea, thereby producing a multifocal effect on the cornea.

In the recent refractive surgery field, LASIK surgery (hereinafter referred to as LASIK surgery), which corrects myopia, astigmatism, and hyperopia by changing the curvature of the pupillary cornea by evaporating the corneal parenchyma in a certain pattern, is a long leg. Progress has been made. The above-mentioned presbyopia treatment system has the same principle as LASIK surgery in that it modifies the curvature of the pupil cornea, and is considered to be an extension of LASIK surgery.
Patent No. 3020049

  The purpose of the above-mentioned presbyopia treatment system was merely to acquire the multifocal lens effect on the cornea, and the eye movements lost due to aging could not be recovered from the root.

  The present invention has been made in view of the above circumstances. An object of the present invention is to obtain a structure of a constant depth corneal ring incision device that surgically realizes fundamental treatment of presbyopia, more specifically, restoration of eye accommodation ability.

  The present inventor stated that "only the ciliary muscle shown in Helm-Holtz theory is actively operated, and not the adjustment movement of the eyeball, but the adjustment movement is performed by flexibly changing the shape of the entire eyeball. Is advocated. This new theory is behind the development of a constant depth keratotomy device for the treatment of presbyopia.

This will be described in more detail as follows.
That is, in the eyeball 1 shown in FIG. 1 and FIG. 2, when the near eye is viewed (at the time of near vision adjustment), not only the internal muscles contract and perform adjustment movement, but also all the external eyes attached to the eyeball 1. The muscle 2 contracts while maintaining balance. At this time, the eyeball 1 is pulled toward the rear of the orbit with the eyeball attachment part 3 of the external eye muscle as an action point. (The other end of the extraocular muscle 2 is attached to the bone forming the orbit via a tendon.) The optic nerve and soft tissue existing in the rear of the orbit in contact with the eyeball 1 Apply pressure to the bottom 4. This drag force is a force that causes the sclera 5 and cornea 6 positioned in front of the extraocular muscle adhesion part 3 of the eyeball 1 to extend forward. At this time, since the extraocular muscle adhesion part 3 works as an action point, the sclera 5 part from the extraocular muscle adhesion part 3 to the corneal ring part 7 is most strongly extended. By the way, anatomically, the sclera portion to which the extraocular muscles 2 are attached is the thinnest, and is originally a site with excellent extensibility. The present inventor has found that not only the expansion and contraction movement of the inner eye muscle, but also the extension of the eyeball axis due to this scleral extension has a great influence on the adjustment.

  The extensibility of the sclera 5 is affected by its thickness and the moisture content of the collagenous tissue constituting it. This decrease in the moisture content of the collagen tissue leads to the hardening of the tissue, leading to a decrease in the extensibility of the sclera 5. The moisture content of the collagen constituting the sclera 5 tends to decrease with aging, similar to that of the skin. Therefore, the extensibility of the sclera 5 decreases with aging, and as a result, the ability to adjust decreases. The present inventor has discovered that such a series of mechanisms causes a decrease in regulation ability, leading to the development of presbyopia.

  According to the above-described theory, if a treatment that restores the extensibility of the regulatory sclera that has decreased due to aging is performed, the ability to adjust the eyeball is restored, and presbyopia can be cured. Accordingly, the present inventor has completed a constant-depth corneal ring-shaped incision device aimed at presbyopia treatment against the background of the above theory.

In order to achieve the above object, the constant depth corneal ring-shaped incision instrument 10 according to claim 1 is a surgical instrument for incising a cornea in the vicinity of a desired corneal ring portion into a ring shape with a certain depth (creating a round incision). The following features are provided.
(1) Strong cornea fixing ring (suction ring 20). The suction ring 20 has a cylindrical shape having a corneal circular hole 24 through which the cornea passes, and has suction means to fix the cornea and sclera with suction pressure.
(2) Rotating body (revolver 40). The revolver 40 has a conical inner wall (inclined surface 43) and is rotatably mounted on the suction ring 20.
(3) Incision means. The incision means (blade fixing mechanism 60 and blade 61) is installed on the inner wall (inclined surface 43) of the revolver 40 so that it can protrude into the corneal circular hole 24.
Note that the number of incision means (blade fixing mechanism 60 and blade 61) installed in the revolver 40 may be one or plural.

  In the constant depth corneal ring-shaped incision instrument 10 according to claim 2, the incision means includes a blade 61 movable toward the center of the revolver 40, and a desired incision in an incision created in the cornea. In order to obtain the depth, the blade 61 is configured to be detachable and replaceable.

  According to a third aspect of the present invention, in the constant depth corneal ring-shaped incision instrument 10 of the second aspect, the blade (blade 61) is a blade with a guide, which is provided with a guide surface at the tip thereof and protrudes a predetermined length from the guide surface. It is a feature.

A fourth aspect of the constant depth corneal incision instrument 10 according to the first or second aspect is as follows:
The incision means (blade fixing mechanism 60 and blade 61) is arranged on the conical inner wall surface (inclined surface 43) of the revolver 40 so that the incision is created perpendicular to the corneal surface of the incision part. It is characterized by being installed in parallel toward. As a result, the blade 61 can be inserted perpendicularly to the incised corneal surface.

  According to a fifth aspect of the present invention, in the constant depth corneal ring-shaped incision instrument 10 according to the first or second aspect, a reverse rotation prevention mechanism is provided between the suction ring 20 and the revolver 40.

  According to the constant depth corneal ring dissection instrument of the present invention, this is mounted on the cornea and the cornea is fixed by applying suction pressure, and then a revolver equipped with dissection means (blade fixing mechanism 60 and blade 61). The ring-shaped incision 11 can be formed at a desired constant depth in the corneal region near the corneal limbus by a simple operation of manually rotating 40 (FIG. 2).

  Due to the presence of the constant-depth corneal incision 11 created in the vicinity of the corneal ring portion 7 in this manner (in the schematic diagram shown in FIG. 1), as described in paragraph 0012, the extraocular muscles during near-field adjustment When 2 contracts, the extensibility of the sclera 5 region from the eyeball adhesion part 3 to the corneal ring part 7 of the extraocular muscle 2 can be recovered.

  Restoring the ability to adjust the eyeball by improving the extensibility of the sclera 5 thus lowered is essentially restoring the ability to adjust lost by aging.

The annular incision 11 formed in the cornea is preferably formed in the corneal region 0.1 to 2.0 mm inside from the corneal ring portion 7. The position from the corneal ring portion, that is, the diameter of the ring-shaped incision is determined by the size of the corneal circular hole 24 provided in the suction ring 20. Therefore, the diameter of the corneal ring must be selected according to the desired annulus incision diameter. The diameter of the corneal ring is not variable and several types are prepared depending on the desired diameter of the ring-shaped incision.
By the way, in order to impart greater extensibility to the sclera 5, it is more effective to incise the sclera 5 itself outside the corneal ring portion 7, but incision to the sclera is extremely effective in wound healing. It is likely to occur and causes re-adhesion and adhesion after incision, and warps and reduces the extensibility of the sclera 5. Therefore, it is not appropriate to select the sclera as the incision position by the constant depth corneal ring-shaped incision instrument 10 of the present invention.

On the other hand, when an annular incision is provided in the cornea using the constant-depth corneal annular incision instrument 10, wound healing is extremely unlikely and the extensibility of the sclera 5 is maintained semipermanently.
However, it has been empirically and theoretically found that the extensibility of the sclera 5 is hardly improved when the annular incision is greatly separated from the corneal limbus. Therefore, it is necessary to create a ring-shaped incision on the cornea as close to the cornea ring as possible.

  In other words, the position where the ring-shaped incision 11 is formed should be close to the corneal ring portion 7 for the purpose of improving the extensibility of the sclera 5, and from the viewpoint of preventing natural healing of the ring-shaped incision. Good location. Therefore, in harmony with each other, the corneal region 0.1 to 2.0 mm inside from the corneal ring portion 7, more preferably the corneal region 0.3 to 0.5 mm inside is selected as the constant depth annulus incision position.

  Further, the depth of the constant-depth annular incision 11 is empirically selected so that the extensibility in the sclera 5 can be reliably recovered. The depth is 75 to 95% of the corneal thickness of the ring-shaped incision. A guide is provided on the side of the blade to create a selected constant depth incision. The distance from the tip of the blade to the tip of the guide determines the incision depth. Therefore, the position of the guide must be selected according to the desired incision depth. The position of the guide may be variable or fixed with respect to the blade. In the case of a fixed guide, since the guide is fixed to the blade, a desired blade needs to be selected according to a desired incision depth.

One example of an embodiment of the constant depth corneal ring-shaped incision device of the present invention will be described with reference to FIGS.
The constant-depth corneal ring-shaped incision device 10 is a device that cuts the cornea in the vicinity of the corneal ring portion into a ring shape at a certain depth, and includes a suction ring 20, a revolver 40 that can rotate with respect to this, and Incision means (blade fixing mechanism 60 and blade 61) attached to the head.

  The suction ring 20 is placed on the sclera and has a cylindrical sclera fixing portion having two circular holes, a scleral circular hole 22 for fixing the sclera and a corneal circular hole 24 for fixing the cornea. 21 and a support 31 that supports the revolver 40 and is fixed thereon.

  When the cornea fixing portion 21 is fixed to the cornea, a space portion 23 is formed between the cornea fixing portion 21 and the cornea. When a suction pressure is applied from the outside through the suction hole S, the suction pressure is stored in the space 23, and the cornea fixing portion 21 is adsorbed and fixed to the cornea. More specifically, it is as follows.

A suction hole S communicating with the space portion 23 in the cornea fixing portion 21 is provided on the inner wall surface of the revolver support portion 31, and a suction pressure passage 35 following the suction hole S is sucked into the space portion 23 from the outside. It functions as a passage for transmitting pressure. The other end of the suction pressure passage 35 is connected to a hollow handle 37 for a surgeon to hold a constant depth keratotomy device, and the other end of the handle 37 is a suction tube for transmitting suction pressure from the outside. (Not shown).
Therefore, when suction pressure is applied to the handle 37 from the outside via the suction tube, the suction pressure is stored in the handle hollow portion 38, the suction pressure passage 35, and the space portion 23 and is disposed in the cornea fixing portion 21. It becomes possible to adsorb sclera and cornea.

  The installation position of the ring-shaped incision on the cornea is determined by the size (diameter) of the corneal circular hole 24. Therefore, a plurality of suction rings 20 having different diameters of the corneal circular holes 24 are provided so that an optimal installation position of the ring-shaped incision 11 is required in accordance with the eyeball to be treated (the corneal diameter varies greatly among individuals). It is preferable to prepare.

The inner surface (inclined surface 34) of the revolver support portion 31 has a conical shape, and forms a continuity with the conical shape of the inner wall surface (inclined surface 43) of the revolver 40 installed thereon. . The revolver 40 can be rotated endlessly only in one direction (for example, clockwise direction) with respect to the suction ring 20 and is provided with a mechanism that prevents reverse rotation.
Since the revolver 40 can rotate endlessly only in one direction, the scale M is placed at appropriate positions on the inclined surface 43 of the revolver 40 and the inclined surface 34 of the revolver support 31 so that it can be seen that it has made one rotation (360 ° rotation). It is preferable to display it.

  The incision means includes a blade fixing mechanism 60 installed on an inclined surface 43 serving as an inner wall surface of the revolver 40, a blade mounted on the blade fixing mechanism 60, and a blade 61. The blade fixing mechanism 60 is fixed in a state where the tip of the blade 61 protrudes into the corneal circular hole 24 by pushing the upper end of the blade 61 or screwing it with a screw 68 provided at the upper end (a dotted line position in FIG. 4). It has a structure having a lock mechanism that can be used.

  Further, the blade 61 is installed on the inclined surface 43 of the revolver 40 in parallel with the cutting edge facing the center of the cone. The angle of the inclined surface 43 is set so that the extended line of the inclined surface 43 is perpendicular to the cornea fixed to the suction ring 20. Therefore, since the blade 61 is installed in parallel on the inclined surface 43, the blade 61 can be inserted perpendicularly to the incision portion corneal surface.

As shown in FIG. 5, the blade 61 is composed of a blade with a guide having a protruding blade 61b having a fixed protruding length L from the guide surface 61a at the tip thereof.
That is, when the blade tip is pressed against the cornea and the incision is performed, the guide surface 61a abuts against the cornea surface to prevent further incision, whereby the corneal incision depth can be kept constant. The corneal incision depth at this time is determined by the constant protrusion length L of the protrusion blade 61b.
The blade 61 has a structure that can be attached and detached from the blade fixing mechanism 60. Therefore, the corneal incision depth can be changed by selecting a blade 61 having a constant protrusion length L from the guide surface 61a and mounting it on the blade fixing mechanism 60.

(Example of treatment)
Next, a procedure for performing presbyopia treatment using the constant depth corneal ring lancing device 10 having the above-described structure will be described.
First, in the eyeball to be treated, the corneal thickness at the site where the constant depth corneal incision is to be performed is measured with an ultrasonic measuring device (pachymeter) or the like to determine a desired incision depth. The incision depth is selected between 75-95% of the corneal thickness at the incision site. The greater the incision depth, the higher the effect. When the incision depth is determined, a blade to be attached to the constant depth corneal annular incision instrument 10 is selected and attached to the blade fixing mechanism 60.

  After sterilization and eye drop anesthesia, a cleaver is attached, and the constant-depth keratotomy device 10 is placed on the cornea of the eyeball 1 to be treated so that the cornea is centered in the corneal circular hole 24. When the placement is completed, suction pressure is applied while pressing the corneal ring-shaped dissection instrument 10 against the eyeball. At this time, a suction pressure is applied to the inside of the space surrounded by the space portion 23 and the cornea, resulting in a negative pressure. With this pressure, the cornea is fixed to the corneal ring-shaped incision instrument 10.

  Next, the desired blade 6 arranged in the blade fixing mechanism 60 is pushed toward the cornea appearing in the corneal circular hole 24 while sliding in the blade fixing mechanism 60. At this time, the tip of the blade 61 protrudes into the corneal circular hole 24 (FIG. 6), and the position of the blade 61 is fixed and maintained by the lock mechanism in a state where a desired depth of cut is made at the desired position of the cornea. Is done.

With the tip of the blade 63 positioned at a desired depth of the cornea, the outer surface of the revolver 40 is gripped with respect to the revolver support 31 and rotated once in one direction (for example, clockwise). A ring-shaped incision 11 having a desired constant depth is created on the top (FIG. 2). At this time, the reverse rotation preventing mechanism prevents the revolver 40 from rotating in the reverse direction.
The constant depth corneal ring incision 11 created in this way is preferably a corneal region 0.1 to 2.0 mm inside from the corneal ring portion 7 and having a depth of 450 to 700 μm. This depth corresponds to 70 to 95% of the incised corneal thickness.

After the revolver 40 is rotated once to create a constant depth corneal incision, the suction pressure is released. The constant-depth corneal ring-shaped dissection instrument from which the suction pressure has been released can be easily removed from the eyeball.
Finally, the inside of the incision is thoroughly washed with a solution such as BSS (trade name) using a Healon needle (27G needle) or the like to complete the treatment of presbyopia.

A more specific configuration of the constant-depth corneal annular incision device will be described with reference to FIGS.
7 to 11 includes a suction ring 20 and a revolver 40 as in the case of the device of FIGS. 3 to 6, but a pair of incision means on the revolver 40. (Blade fixing mechanism 60 and blade 61) are mounted. In the figure, parts having the same configurations as those in FIGS. 3 to 6 are denoted by the same reference numerals.
The following description will focus on the detailed structure of the blade fixing mechanism 60 constituting the cutting means, the locking mechanism of the blade 61 in the blade fixing mechanism 60, and the reverse rotation prevention mechanism formed between the suction ring 20 and the revolver 40. .

  In the constant depth corneal ring-shaped incision instrument 10 in this example, blade fixing mechanisms 60 are respectively mounted at positions facing each other on the inclined surface 43 of the revolver 40. Since each blade fixing mechanism 60 is equipped with a blade 61 and has a pair of incision means, it is possible to form an annular incision in the cornea by rotating the revolver 40 by 180 degrees with respect to the suction ring 20.

Each blade fixing mechanism 60 includes a guide body 62, a blade 61, a leaf spring 64, and a holder portion 65 that are mounted on the inclined surface 43.
The guide body 62 is composed of a rectangular L-shaped piece, and is mounted on the inclined surface 43 of the revolver 40 so as to be slidable within the holder portion 65 in the center direction. The guide body 62 is mounted so that the bent portion 62a is positioned on the lower side, and a cylindrical knob portion 66 used when the guide body 62 is pushed and slid is formed on the bent portion 62a. .
The blade 61 is fixed on the guide body 62 with screws 63. The holder portion 65 is fixed to the inclined surface 43 so as to accommodate the plate spring 64, and is configured to press and fix the blade 61 and the guide body 62 from above by the plate spring 64.

The blade 61 slides on the inclined surface 43 together with the guide body 62 so that the tip of the blade 61 protrudes into the corneal circular hole 24. The blade 61 is provided with a linear groove 61c. A flat bow spring 67 is mounted between the holder spring 65 and the leaf spring 64. When the blade 61 slides, the tip of the bow spring 67 fits into the groove 61c of the blade 61. Thus, a lock mechanism is configured, and sliding movement in the center direction is restricted (FIG. 10A).
Further, when the guide body 62 and the blade 61 are slid in the reverse direction by pulling up the knob 66 from the state where the blade 61 is locked by the locking mechanism, the tip of the arcuate spring 67 comes off from the groove 61c. The blade 61 can be returned to a state in which the tip of the blade 61 does not protrude from the corneal circular hole 24.

The constant depth corneal ring-shaped incision instrument 10 includes a revolver 40 and a support portion 31.
The revolver 40 is composed of a cylindrical body having a lower inner diameter 41 having the same diameter as the upper inner diameter 33 of the support portion 31 and an inclined surface 43 on the inner wall between the upper inner diameter 42 having a larger diameter. Since the inclined surface 34 of the revolver support 31 and the inclined surface 43 of the revolver 40 have the same inclination angle, the inclined surfaces are continuous with each other so that the inner walls of both of them form a conical shape.
Around the lower surface side of the revolver 40, an annular plate 44 for allowing the revolver 40 to be rotatably mounted on the revolver support 31 is disposed. That is, the revolver support 31 is disposed in a hole 45 provided in the center of the annular plate 44 and fixed with the screw 46 in a state where the annular plate 44 is pressed around the lower surface of the revolver 40. The revolver 40 is rotatably attached to.

A reverse rotation prevention mechanism is formed between the suction ring 20 and the revolver 40 so that the revolver 40 can rotate only in one direction (for example, clockwise direction) with respect to the support portion 31. .
That is, a gear 50 is formed inside the support portion 31 along the inner periphery. The gear 50 is inclined to the rotation direction side with respect to the right-angled portion 51a along the radial direction of the support portion 31 and this surface. In addition, a large number of grooves 51 having a constant pitch, each having an inclined portion 51b, are provided. And the front-end | tip of the latching bar 53 with which the axial part 52 in the support part 31 was mounted | worn with this groove | channel 51 fits. The locking bar 53 has a tip protruding from a hole 31a formed on the side surface of the support portion 31, and a cylindrical release operation portion 54 is formed at the tip (FIG. 8).

A spring support screw 55 is fixed at a position near the locking bar 53 on the lower surface of the annular plate 44. The spring support screw 55 is fitted with a linear member 56 wound once around the screw, and one end thereof is fitted into a hole 57 drilled in the lower surface of the annular plate, and the other end is attached to the side surface of the locking bar 53. It is made to fit in the recessed part 58 in which the position was formed (FIG.10 (b)).
With this structure, the linear body 56 always exerts a force that urges the locking bar 53 outward, so that the tip of the locking bar 53 inside the support portion 31 is fitted in the groove 51 of the gear 50. ing.
Accordingly, the revolver 40 can move in the rotational direction indicated by the arrow in FIG. 8 by moving over the gentle inclined portion 51b, but in the opposite direction, the revolver 40 moves by contacting the right-angled portion 51a of the groove 51 of the gear 50. A regulated reverse rotation prevention mechanism is configured.

  Further, when the release operation portion 54 of the locking bar 53 is moved in the direction approaching the revolver 40 and the annular plate 44 against the urging force of the linear body 56, the distal end portion of the locking bar 53 moves from the groove 51 of the gear 50. As a result, the locking bar 53 is released so as not to interfere with the gear 50, and the revolver 40 can be rotated in the reverse direction while maintaining this state.

  Further, as shown in FIG. 11, a columnar grip 39 is fixed to the side surface of the support 31 at a position θ1 (90 degrees) with respect to the suction pipe (suction pressure means 37). On the lower surface of the annular plate 44, a protruding portion 47 is formed at a position away from the suction pressure means 37 by θ 2 (an angle smaller than 90 degrees) on the side opposite to the grip portion 39. When the protrusion 47 comes into contact with the grip 39 by the rotation of the revolver 40 (the state shown in FIG. 11B), the rotation of the revolver 40 is restricted, so that the protrusion 47 serves as a stopper with respect to the grip 39. Works.

  That is, according to the above structure, when the revolver 40 is rotated at a certain angle with respect to the suction ring 20 while the position of the grip portion 39 is supported from the state of FIG. The rotation is regulated by contacting with 39 (state shown in FIG. 11B). At this time, since the rotation angle from the beginning of rotation of the revolver 40 to its stop is slightly over 180 degrees, a ring-shaped incision can be formed in the cornea by the tips of the pair of blades 61.

  In the above example, when the revolver 40 is rotated relative to the suction ring 20, if the revolver 40 is rotated by a certain angle, the protrusion 47 acts as a stopper on the grip portion 39 to restrict the rotation, and the release operation portion 54. Although the revolver 40 is rotated in reverse by using, a structure that rotates endlessly only in one direction may be used. In this case, the stopper (protrusion 47) and the release operation unit 54 are not necessary.

  The blade 61 locking mechanism described in the above example and the reverse rotation prevention mechanism formed between the suction ring 20 and the revolver 40 are examples. Therefore, the lock mechanism and the reverse rotation prevention mechanism can be used as long as the effect of temporarily fixing the position of the blade 61 and the effect of allowing the revolver 40 to rotate in only one direction with respect to the suction ring 20 are obtained. The mechanism may be adopted and is not limited to these configurations.

  In each of the above examples, the number of incision means (blade fixing mechanism 60 and blade 61) in the constant depth corneal ring incision instrument 10 is one or two, but the number of incision means installed is limited. is not. As the number increases, the angle required to rotate the revolver 40 can be reduced and the time required for the incision can be reduced. In order to obtain this, the number of incision means (blade fixing mechanism 60 and blade 61) is preferably one or two.

  In each of the above examples, the revolver 40 is configured to manually rotate with respect to the revolver support 31 of the suction ring 20 when creating the constant-depth corneal annular incision 11, but the motor driving means is included. Alternatively, a structure in which the revolver 40 is rotated by driving a motor may be used.

It is a model figure which shows the structure of an eyeball. It is front explanatory drawing of an eyeball. It is sectional explanatory drawing of the constant depth corneal ring-shaped incision instrument of an example of embodiment of this invention. It is plane explanatory drawing of the constant depth corneal ring-shaped incision instrument same as the above. It is an isometric view explanatory drawing of the braid | blade mounted | worn with a constant depth corneal ring-shaped incision instrument. It is sectional explanatory drawing which shows the state which mounted | wore the eyeball with the constant depth corneal ring-shaped incision instrument same as the above. It is sectional explanatory drawing of the constant depth corneal ring-shaped incision instrument which shows the other examples of embodiment. It is plane explanatory drawing of the constant depth corneal ring-shaped incision instrument same as the above. FIG. 4 is an exploded cross-sectional explanatory diagram for explaining a combined state of a suction ring, a revolver, and a suction pressure means that constitute the constant depth corneal ring-shaped incision instrument. It shows a part of the above-mentioned constant depth corneal ring-shaped incision device, (a) is a structural explanatory diagram of the locking mechanism of the locking bar portion constituting the reverse rotation prevention mechanism, (b) is a structural explanatory diagram of the blade fixing mechanism It is. (A) And (b) is back surface explanatory drawing of the constant depth corneal ring-shaped incision instrument same as the above. (A) And (b) is treatment explanatory drawing in the case of performing the eyeball treatment using the conventional presbyopia treatment system. (A) And (b) is the top view and cross-sectional explanatory drawing of the eyeball treated with the system of FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Eyeball 2 Extraocular muscle 3 Extraocular muscle adhesion part 4 Eyeball bottom 5 Sclera 6 Cornea 7 Cornea ring part 8 Pupil area 10 Constant depth corneal ring incision instrument 11 Annulotomy 20 Suction ring (corneal fixation ring)
21 sclera fixing part 22 sclera circular hole 24 cornea circular hole 31 revolver support 34 inclined surface 37 handle (suction pressure means)
40 Revolver (Rotating body)
43 Inclined surface 44 Annular plate 50 Gear 51 Groove 51a Right angle 51b Inclined portion 53 Locking bar 56 Linear body 60 Blade fixing mechanism 61 Blade 61a Guide surface 61b Projecting blade 61c Groove 64 Plate spring 67 Arc spring

Claims (5)

In the cornea near the corneal limbus, a surgical instrument for creating a circular incision with an annular shape and a constant depth,
A cornea-fixing ring having a corneal circular hole for passing the cornea and being fixed with suction pressure on the cornea;
A rotating body having a circular hole coinciding with the circular corneal hole and having a conical inner wall rotatable on the cornea fixing ring;
A constant-depth corneal ring-shaped incision device, characterized in that it comprises an incision means capable of projecting inside the cornea circular hole of the cornea fixing ring and mounted on the inner wall of the rotating body. The incision means is
With a blade movable toward the center of the rotating body,
2. The constant depth corneal ring-shaped incision device according to claim 1, wherein the blade is configured to be detachable and replaceable in order to obtain a desired incision depth in an incision created in the cornea. 3. The constant depth corneal ring-shaped incision device according to claim 2, wherein the blade is a blade with a guide provided with a guide surface at a tip thereof and protruding from the guide surface by a predetermined length. The constant-depth corneal ring-shaped incision device according to claim 1 or 2, wherein the incision means is mounted in parallel on the inner wall of the rotating body in order to obtain an incision perpendicular to the corneal surface of the incision portion. The constant depth corneal ring-shaped incision device according to claim 1 or 2, wherein a reverse rotation prevention mechanism is provided between the cornea fixing ring and the rotating body.

Images