JP2010246573A - Intraocular surgery instrument - Google Patents

Intraocular surgery instrument Download PDF

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Publication number
JP2010246573A
JP2010246573A JP2007209225A JP2007209225A JP2010246573A JP 2010246573 A JP2010246573 A JP 2010246573A JP 2007209225 A JP2007209225 A JP 2007209225A JP 2007209225 A JP2007209225 A JP 2007209225A JP 2010246573 A JP2010246573 A JP 2010246573A
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JP
Japan
Prior art keywords
perfusate
handpiece
intraocular
pressure
suction pump
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
JP2007209225A
Other languages
Japanese (ja)
Inventor
Masato Kishimoto
Go Sugisawa
Makoto Ueno
誠 上野
眞人 岸本
剛 杉澤
Original Assignee
Saver Inc
株式会社セーバー
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Application filed by Saver Inc, 株式会社セーバー filed Critical Saver Inc
Priority to JP2007209225A priority Critical patent/JP2010246573A/en
Publication of JP2010246573A publication Critical patent/JP2010246573A/en
Application status is Pending legal-status Critical

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007Methods or devices for eye surgery
    • A61F9/00736Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
    • A61F9/00745Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments using mechanical vibrations, e.g. ultrasonic
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/0058Suction-irrigation systems
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00Medical syringes, e.g. enemata; Irrigators
    • A61M3/02Enemata; Irrigators
    • A61M3/0204Physical characteristics of the irrigation fluid, e.g. conductivity or turbidity
    • A61M3/0212Physical characteristics of the irrigation fluid, e.g. conductivity or turbidity after use
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00Medical syringes, e.g. enemata; Irrigators
    • A61M3/02Enemata; Irrigators
    • A61M3/0204Physical characteristics of the irrigation fluid, e.g. conductivity or turbidity
    • A61M3/022Volume; Flow rate
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/0023Suction drainage systems
    • A61M1/0031Suction control
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00Medical syringes, e.g. enemata; Irrigators
    • A61M3/02Enemata; Irrigators
    • A61M3/0275Pulsating jets; Vibrating nozzles

Abstract

In an intraocular surgical device, the occurrence of a surge phenomenon is prevented so as not to cause intraoperative complications such as posterior capsule damage.
SOLUTION: A storage bottle 21 for storing perfusate, a handpiece 1 having an inflow port and a discharge port for perfusate, and an ultrasonic tip 11 for crushing an affected part in the eye, and a storage bottle 21 and handpiece 1 are provided. A supply pipe 6 to be connected and a discharge pipe 7 for discharging the crushed intraocular affected part from the handpiece 1 together with the perfusate are provided. Then, the perfusate is caused to flow by the supply pressure from the storage bottle 21. Here, from the viewpoint of further simplifying the apparatus and saving energy, it is preferable to use the water head pressure due to the difference in height between the storage bottle 21 and the handpiece 1 as the supply pressure.
[Selection] Figure 1

Description

  The present invention relates to an intraocular surgical apparatus, and more particularly to an intraocular surgical apparatus that is particularly suitably used for cataract surgery.

  Cataract is a disease in which the lens that acts as a camera lens in the eye becomes cloudy. As cataracts progress, surgery is required to replace the lens in the eye with an intraocular lens (artificial lens). As one of such operations, there is currently an ultrasonic emulsification and aspiration (PEA) in which the lens in the affected area of the eye, particularly the nucleus or / and cortex of the lens, is pulverized, emulsified and aspirated by ultrasonic vibration. It has been adopted. In this operation, the lens is crushed by ultrasonic vibration, and the crushed piece is sucked and removed from the eye with a thin tube.

  FIG. 7 shows a schematic diagram of a conventional intraocular surgical apparatus. In the apparatus of this figure, a storage bottle 21 storing perfusate is suspended at a predetermined height, and the storage bottle 21 and the handpiece 1 are connected by a supply pipe 6. As a result, the perfusate is supplied from the storage bottle 21 to the handpiece 1 by hydraulic head pressure, and flows into the eye from the inlet 13 of the ultrasonic tip 11 attached to the tip of the handpiece 1.

  A suction tube 7 is attached to the handpiece 1. The suction pipe 7 is connected to the waste liquid bag 22 via a peristaltic pump 4 as a suction pump. As a result, the perfusate that has flowed into the eye is sucked from the suction port 14 of the ultrasonic chip 11 and discharged to the waste liquid bag 22.

  When performing an operation in the intraocular surgical apparatus having such a configuration, the distal end portion of the ultrasonic chip 11 is moved by an oscillating means (not shown) while allowing the perfusate to flow into the intraocular affected area from the inlet 13 of the ultrasonic chip 11. The lens P is finely crushed and emulsified by ultrasonic vibration. Then, the peristaltic pump 4 is activated, and the fragment of the pulverized lens P (for example, a lens core fragment, a cortex fragment, etc .; hereinafter referred to as a lens fragment) is mixed with the perfusate in the ultrasonic chip 11. It was sucked from the suction port 14 and discharged to the waste liquid bag 22. At this time, the pressure in the intraocular affected area is kept stable by the balance between the inflow amount (supply pressure) of the perfusate and the suction amount (suction pressure).

  When the lens piece is sucked into the suction port 14 of the ultrasonic chip 11, the discharge port 14 may be temporarily blocked by the lens piece. While the outlet 14 is closed, the perfusate is not discharged. If suction is further continued by the peristaltic pump 4 in this state, the negative pressure in the suction pipe 7 increases. Then, at the moment when the crystalline lens piece is sucked into the suction port 14 at once and the closed state of the suction tube 7 is released, the suction flow rate of the suction tube 7 increases rapidly. On the other hand, since the supply of the perfusate cannot respond instantaneously to this, the anterior chamber is in a reduced pressure state. The reduced pressure state in the anterior chamber continues until the perfusate that has stopped flowing in reaches a constant flow rate and the supply pressure and suction pressure reach an equilibrium state (hereinafter referred to as “surge phenomenon”). When the inside of the anterior chamber is in a reduced pressure state, so-called microcollapses occur in which the inner volume of the eyeball and the anterior chamber decreases, and the posterior capsule damage and corneal endothelial damage in which the posterior capsule S of the lens is sucked into the suction port of the handpiece and destroyed There is an increased risk of causing intraoperative complications.

  Conventionally, the surgeon has dealt with such problems by appropriately changing the amount of ultrasonic waves and the amount of suction based on actual experience and practice, but for inexperienced surgeons, etc. It was not easy.

Therefore, in order to reduce such a surge phenomenon, for example, in Patent Document 1, a suction reverse feed device is provided in the suction pump, and when the suction is interrupted, the suction pump is reversely rotated to reverse the suction, A technique for releasing the negative pressure in the suction path has been proposed. In Patent Document 2, an irrigation reservoir for storing irrigation, a range, an irrigation pressure sensor, and a pressure controller are provided in the middle of the irrigation fluid injection line, and the controller is used when the irrigation pressure exceeds an appropriate range. A technique has been proposed in which the irrigation reservoir is operated so as to forcibly inject irrigation into the irrigation supply passage, thereby preventing the anterior chamber pressure from falling below a reference value.
Japanese Patent Laid-Open No. 7-442 JP 2002-153499 A JP 2005-52389 A

  However, the surge phenomenon occurs within a very short time of about 0.2 seconds after the suction pipe is released from the closed state. In each of the proposed technologies, there is a time difference between the occurrence of the surge phenomenon and the actual control. Inevitably, it was practically difficult to reliably suppress the surge phenomenon.

  The present invention has been made in view of such a conventional problem, and an object thereof is an intraocular surgical apparatus that prevents the occurrence of a surge phenomenon and does not cause intraoperative complications such as posterior capsule damage. Is to provide.

  It is another object of the present invention to provide an intraocular surgical apparatus that can simplify the apparatus and save energy.

  As a result of intensive studies to achieve the above object, the present inventors have supplied the perfusate into the eye at a predetermined supply pressure, so that the fragment of the crushed intraocular affected area can flow out together with the perfusate. The present invention has been achieved by obtaining the idea that the fragment of the affected part of the eye is good and suctioned and removed from the eye together with the perfusate. That is, an intraocular surgical device according to the present invention includes a storage part for storing perfusate, a handpiece having an inlet and a discharge port for perfusate, an ultrasonic chip for crushing an affected part in the eye, and the storage part. A supply path for connecting the handpiece; and a discharge path for discharging the crushed intraocular affected area from the handpiece together with the perfusate, and allowing the perfusion liquid to flow with a supply pressure from the reservoir. And

  Here, from the viewpoint of simplifying the apparatus and saving energy, it is preferable to use a water head pressure due to a difference in height between the storage section and the handpiece as the supply pressure.

  A suction pump that can be moved or stopped by an on / off switch may be further provided in the discharge path in case the intraocular affected area is hard and the intraocular affected area cannot be removed smoothly only by the supply pressure of the perfusate into the eye. . In this case, from the viewpoint of smooth operation, the suction pump on / off switch is preferably provided on the handpiece, or the suction pump on / off switch is a foot switch.

  Further, when a suction pump is provided in the discharge path, the discharge path is branched into two in the middle, the suction pump is provided in one discharge path, and a valve is provided in the other discharge path. It may be possible to prevent the perfusate from flowing back through the discharge path when the is driven.

  Alternatively, when the suction pump is not driven without branching the discharge path, the perfusate is caused to flow with the supply pressure from the reservoir, and when the suction pump is driven, from the reservoir The perfusate may be caused to flow according to the supply pressure and the suction pressure of the suction pump. At this time, as the suction pump, a rotor provided with a roller on the outer peripheral portion is rotatably accommodated in the case, and an elastic discharge pipe constituting at least a part of the discharge path is wound around the rotor, Using a peristaltic pump that forms a constriction portion in the discharge pipe with a peripheral wall and a roller and moves the constriction section by rotating the rotor to transfer perfusate in the discharge pipe, the inner peripheral wall of the case and the rotor The inner peripheral wall of the case and the rotor connect the discharge pipe when the peristaltic pump is not driven, and the position can be relatively moved between a position where the constriction is formed in the discharge pipe and a position where the discharge pipe is opened. The perfusate may be held in the open position so that the perfusate can flow in the discharge pipe.

  From the viewpoint of more surely preventing a surge phenomenon, the affected part is provided with an accommodating part that is connected in the middle of the supply path and forms a chamber that can be closed leaving an opening into which the perfusate supplied to the supply path flows. There may be further provided a decompression compensation device for intraocular surgery that can supply perfusate into the affected area when the inside becomes an excessively decompressed state.

  In the intraocular surgical device according to the present invention, since the perfusate is caused to flow by the supply pressure from the reservoir, unlike the flow due to the suction pressure of the conventional suction pump, the intraocular pressure does not become negative pressure, and the surge phenomenon There is no risk of occurrence of Therefore, the occurrence of intraoperative complications such as posterior capsule breakage can be remarkably suppressed as compared with the conventional case. In addition, the perfusate that has flowed in from the inlet of the handpiece flows greatly while maintaining a positive pressure in the eye, compared to suction from the discharge port by a conventional suction pump, so that the ultrasonic chip is brought closer to the lens piece. Even without it, the lens piece comes close to the ultrasonic chip. Thus, for example, by positioning the ultrasonic chip in the center of the crystalline lens, the crystalline lens piece in the vicinity of the posterior capsule can be removed, and there is no possibility of damaging the posterior capsule or damaging the corneal endothelium.

  Further, when the perfusate is caused to flow by the hydraulic head pressure due to the difference in height between the reservoir and the handpiece, the power of the supply pump or the like is not required, and the apparatus can be simplified and save energy.

  Further, when a suction pump is further provided in the discharge path, it is possible to cope with a case where the crystalline lens is hard and the lens piece cannot be removed smoothly only by the supply pressure of the perfusate into the eye. Here, if the on / off switch of the suction pump is provided on the handpiece or the on / off switch is a foot switch, the smoothness of the operation is enhanced.

  When the inside of the affected part is in an excessively reduced pressure state, the container is connected in the middle of the supply path and includes an accommodating part that forms a chamber that can be closed leaving an opening into which the perfusate supplied to the supply path flows. The surge phenomenon can be more reliably prevented by further providing a decompression compensation device for intraocular surgery that can supply perfusate into the affected area.

  Hereinafter, although the intraocular surgical apparatus which concerns on this invention is demonstrated based on figures, this invention is not limited to these embodiment at all.

  FIG. 1 is a perspective view showing an embodiment of an intraocular surgical apparatus according to the present invention. In the intraocular surgical apparatus of FIG. 1, a storage bottle 21 storing a perfusate suspended at a predetermined height and a handpiece 1 are connected by a supply pipe 6. A decompression compensation tube 5 filled with a perfusate is connected to the supply pipe 6 in the middle. The decompression compensation tube 5 will be described later. Further, the handpiece 1 is provided with a discharge pipe 7 for discharging the perfusate into the waste liquid bag 22. The discharge pipe 7 is branched into a first discharge pipe 71 and a second discharge pipe 72 along the way, the check valve 3 is attached to the first discharge pipe 71, and the second discharge pipe 72 serves as a suction pump. The peristaltic pump 4 is attached. The check valve 3 enables the flow of the perfusate from the handpiece 1 to the waste bag 22 while disabling the flow in the reverse direction. The first discharge pipe 71 and the second discharge pipe 72 are joined again on the downstream side of the check valve 3 and the peristaltic pump 4 to form one discharge pipe and connected to the waste liquid bag 22. Of course, the first discharge pipe 71 and the second discharge pipe 72 may be separately connected to the waste liquid bag 22 without joining.

  The handpiece 1 is provided with a switch 12 for turning on and off the peristaltic pump 4 at a position where it can be operated by the operator's finger. Usually, the peristaltic pump 4 is stopped. When the switch 12 is pressed, the peristaltic pump 4 is driven, and when the switch 12 is released, the peristaltic pump 4 is stopped. Of course, the switch 12 can be attached to the handpiece 1 as well as the foot switch alone. The check valve 3 is for preventing the waste liquid stored in the waste liquid bag 22 from flowing backward through the first discharge pipe 71 toward the handpiece 1 when the peristaltic pump 4 is driven. Conventionally known ones such as on / off valves can be used in addition to check valves. However, when an on-off valve is used instead of the check valve 3, it is necessary to open the on-off valve when the peristaltic pump is stopped and to close the on-off valve when the peristaltic pump 4 is driven. . The opening / closing operation of the opening / closing valve may be interlocked with turning on / off of the switch 12 of the peristaltic pump.

  The handpiece 1 includes a cylindrical handpiece main body 10 including a vibrator (not shown) that generates ultrasonic vibrations and a horn (not shown) that outputs ultrasonic vibrations generated by the vibrators, The ultrasonic chip 11 is detachably attached to the tip of the piece body 10, and the ultrasonic chip 11 is connected to a horn and vibrates ultrasonically. An inlet 13 (shown in FIG. 2) through which the perfusate flows out is formed on the outer periphery of the ultrasonic tip 11, and an inflow path 15 connected to the inlet 13 is formed in the handpiece body 10 in the axial direction of the handpiece body 10. The supply pipe 6 is connected to the rear end of the inflow passage 15. A discharge port 14 (shown in FIG. 2) is formed at the tip of the ultrasonic chip 11, and an outflow path 16 connected to the discharge port 14 extends in the axial direction at the approximate center of the handpiece body 10. A discharge pipe 7 is connected to the rear end.

  The perfusate stored in the storage bottle 21 is supplied from the storage bottle 21 through the supply pipe 6 to the handpiece 1 by water head pressure, and the inlet 13 of the ultrasonic chip 11 attached to the tip of the handpiece 1 (see FIG. 2). And it is normally discharged | emitted from the discharge port 14 (illustrated in FIG. 2) of the ultrasonic chip 11 through the first discharge pipe 71 to the waste liquid bag 22. In addition, as a means for applying the supply pressure to the perfusate, the water head pressure due to the height difference between the handpiece 1 and the storage bottle 21 may be used, or the supply pressure may be applied by a pump. However, from the viewpoint of energy saving and simplification of the apparatus, it is desirable to apply a supply pressure to the perfusate using the hydraulic head pressure. The height difference between the storage bottle 21 and the handpiece 1 may be such that a supply pressure capable of discharging the affected part in the eye together with the perfusate to the waste liquid bag 22 is obtained, and is usually in a range of 20 to 120 cm.

  A method of using the intraocular surgical apparatus having such a configuration will be described by taking a case of cataract surgery as an example. The perfusate supplied from the storage bottle 21 to the handpiece 1 at a predetermined supply pressure flows into the crystalline lens from an inlet 13 (shown in FIG. 2) formed in the ultrasonic chip 11 of the handpiece 1. The state at this time is shown in FIG. As shown in FIG. 5A, in the apparatus of the present invention, the perfusate flows into the posterior capsule S vigorously from the inlet 13 formed in the ultrasonic tip 11 of the handpiece 1, and the inner periphery of the posterior capsule S. And flows out from the outlet 14 of the ultrasonic tip 11. At this time, the fragments of the crystalline lens P are guided to the discharge port 14 at the tip of the ultrasonic chip 11 by the perfusate, and fragments smaller than the diameter of the discharge port 14 are discharged as they are from the discharge port 14. Large fragments are crushed at the tip of the ultrasonic tip 11 that is ultrasonically vibrated by vibration means (not shown) and flow out of the discharge port 14. Therefore, it is not necessary to move the ultrasonic chip 11 greatly, and normally, if the discharge port 14 is positioned at a substantially central portion in the crystalline lens, the crystalline lens pieces gradually flow toward the discharge port 14 one after another. In addition, the vibration output of the ultrasonic chip 11 of the handpiece 1 may be about 20 to 50 kHz, which is the same as the conventional one.

  On the other hand, FIG. 7B schematically shows the flow of the perfusate in the eye in the case of the conventional apparatus using the suction pump shown in FIG. The debris of the crystalline lens P is sucked together with the perfusate by the discharge port 14 formed at the tip of the lens. However, since the range that can be sucked is narrow, the ultrasonic chip 11 has to be moved to each crystalline lens piece and sucked. For this reason, in order to suck the lens piece in the vicinity of the posterior capsule S, it is necessary to bring the discharge port 14 of the ultrasonic chip 11 close to the posterior capsule S, and it is necessary to pay close attention not to suck the posterior capsule S. there were.

  Further, in the conventional suction type device, the balance between the supply pressure of the perfusate and the suction pressure of the suction pump is lost, and when the suction pressure increases, the inside of the posterior capsule S may become negative. Since only the supply pressure is applied to the perfusate in the apparatus of the present invention, the inside of the posterior capsule S does not become a negative pressure. Therefore, even if the discharge port 14 of the ultrasonic chip 11 is moved to the vicinity of the posterior capsule S, the posterior capsule S is not sucked into the discharge port 14.

  In the apparatus of FIG. 1, a peristaltic pump 4 as a suction pump is attached. In general, the crystalline lens P tends to be hardened with aging, and depending on the patient, the crystalline lens P is hard, and it may be considered that it cannot be crushed and removed only by ultrasonic vibration at the tip of the ultrasonic tip 11. Therefore, in such a case, the peristaltic pump 4 is attached in the apparatus of FIG. When the fragment of the crystalline lens P that has flowed to the discharge port 14 of the ultrasonic chip 1 is hard and cannot be poured into the discharge port only by the supply pressure of the perfusate, the switch S provided on the handpiece 1 is pressed. Then, the peristaltic pump 4 is driven and the suction of the perfusate is started from the discharge port 14 of the ultrasonic chip 11. At this time, the backflow of the waste liquid from the waste liquid bag 22 is prevented by the check valve 3. The fragments of the crystalline lens P that have flowed to the discharge port 14 of the ultrasonic chip 11 are sucked into the discharge port 14 by the suction force of the peristaltic pump 4 in addition to the ultrasonic vibration. When the debris of the hard crystalline lens P is discharged and removed, the pressing of the switch 12 is released. Then, the peristaltic pump 4 stops and returns to the normal state in which the perfusate flows only by the supply pressure due to the hydraulic head pressure. Note that if the intraocular affected area can be crushed and removed by ultrasonic vibration by the ultrasonic chip 11 and the supply pressure of the perfusate, the suction pump may not be provided. As the suction pump used in the present invention, a conventionally known pump can be used. For example, a venturi pump or a diaphragm pump can be used in addition to a peristaltic pump.

  When a suction pump is provided, a surge phenomenon inevitably occurs. Therefore, in order to suppress this phenomenon, it is recommended to further attach a decompression compensation tube (decompression compensation device) 5. The decompression compensation tube 5 will be described. The decompression compensation tube 5 is mainly composed of a flexible tube made of, for example, silicon or vinyl chloride, and is connected in the middle of a supply pipe 6 that connects the storage bottle 21 and the handpiece 1. . In order to suppress the surge phenomenon, the supply pipe 6 is preferably connected to a portion as close as possible to the handpiece 1. And the front-end | tip part of the pressure reduction compensation tube 5 is clamped by forceps 51 which is an opening / closing means. As means for closing the distal end portion of the decompression compensation tube 5, conventionally known closing means such as a manual check valve can be used in addition to the forceps 51.

  The tip of the decompression compensation tube 5 is positioned above the operation area of the handpiece 1 and below the deployment height of the storage bottle 21. When the perfusate is allowed to flow down from the storage bottle 21 in this state, the perfusate flows into the decompression compensation tube 5 through the supply pipe 6 to form a replenishment liquid storage part, and at the same time, the perfusion liquid is placed above the replenishment liquid storage part. By receiving the water head pressure of the bottle 21, a gas storage part for storing the compressed gas is formed.

  By connecting the decompression compensation tube 5 to the supply pipe 6, for example, after the crystalline lens P to be sucked and discharged is clogged for a moment in the discharge port 14 of the ultrasonic chip 11, the suction is suddenly greatly sucked into the discharge side. In rare cases, when the pressure inside the posterior capsule S drops abnormally than the pressure during normal treatment, the perfusate is replenished from the decompression compensation tube 5 to the inside of the posterior capsule S in conjunction with this pressure drop, preventing the surge phenomenon. The collapse of the eyeball and anterior chamber is prevented.

  Further, in preparation for the case where the affected part of the eye such as the crystalline lens is hard, a means for changing the height position of the storage bottle 21 or changing the supply pressure of the supply pump is provided together with the installation of the suction pump or May be taken independently.

  In the case of the apparatus illustrated in FIG. 1 including the suction pump 4 and the check valve 3, the suction pump 4 may be always driven in a range where a suction force smaller than that of the conventional device is generated. Thereby, the suction removal capability of the fragment of the crystalline lens P increases.

  The flow rate of the perfusate when the head pressure is used as the supply pressure of the perfusate can be adjusted by the height difference between the storage bottle 21 and the rear ends of the discharge pipes 7 and 71. Table 1 below shows examples of changes in the flow rate (mL / min) of the perfusate when the height from the floor surface of the storage bottle 21 and the height from the floor surface at the rear end of the discharge pipes 7 and 71 are changed. Indicates. From this table, it can be seen that the flow rate of the perfusate increases as the height of the storage bottle 21 is increased and the height of the rear ends of the discharge pipes 7 and 71 is decreased.

  As the perfusate used in the present invention, conventionally known perfusates can be used. For example, “BS Plus (trade name)” or “Opeguard (registered trademark)” configured by setting and diluting an oxyglutathione solution or the like with a diluent. ) Neo Kit ”,“ Opeguard (registered trademark) MA ”and the like.

  Next, another embodiment of the intraocular surgical device according to the present invention will be described. FIG. 3 shows a schematic diagram. The intraocular surgical apparatus of this figure is different from the apparatus of FIG. 1 in that the discharge pipe is not branched and the handpiece 1 and the waste liquid bag 22 are connected by a single elastic tube (discharge pipe) 73. is there. Hereinafter, this difference will be mainly described. In the apparatus shown in FIG. 1, the discharge pipe is branched into two in the middle, and the perfusate is discharged using different discharge pipes when the peristaltic pump 4 is stopped and when it is driven. . On the other hand, in the apparatus shown in FIG. 3, the perfusate can be discharged through the elastic tube 73 even when the peristaltic pump 4 is not driven.

  The peristaltic pump 4 used in this apparatus includes a rotor 41 in which a plurality of rollers 42 are provided at equal intervals on the outer peripheral portion, and a case that rotatably accommodates the rotor 41. The case includes a main body case 43 that rotatably supports the rotor 41, and an upper case 44 that covers substantially half of the outer periphery of the rotor 41 with a predetermined gap therebetween. On the other hand, it is attached to be swingable about a shaft 45. A pin 46 projects from the free end side of the upper case 44. On the other hand, a substantially inverted “h” -shaped cam 8 is mounted so as to be swingable about a shaft 81 (shown in FIG. 4), and an upper case is formed in a slot 82 (shown in FIG. 4) formed on one side thereof. 44 pins 46 are engaged, and the plunger 92 of the solenoid 9 is connected to the other side of the cam 8. The plunger 92 is always urged in a direction in which it protrudes from the solenoid body 91 by a push spring 93 fitted around the plunger 92.

  As shown in FIG. 4A, in the normal state, the plunger 92 of the solenoid 9 is held at a position protruding from the solenoid body 91 by the push spring 93, so that the upper case 44 is opened with respect to the case body 43. The elastic tube 73 is not sandwiched between the inner peripheral wall of the upper case 44 and the roller 42. Therefore, the perfusate flows in the elastic tube 73 from the handpiece 1 to the waste bag 22. On the other hand, when a suction force by the peristaltic pump 4 is required, such as when a fragment of the crystalline lens P is clogged in the discharge port 14 of the ultrasonic chip 11, the switch 12 of the handpiece 1 is pressed. Then, as shown in FIG. 4B, the solenoid 9 is activated and the plunger 92 is drawn into the solenoid main body 91. As a result, the cam 8 rotates counterclockwise about the shaft 81, and the upper case 44 rotates clockwise about the shaft 45 by the pin 46 engaged with the elongated hole 82 of the cam 8. As a result, the elastic tube 73 is sandwiched between the inner peripheral surface of the upper case 44 and the roller 42, and the elastic tube 73 can be constricted. At the same time, since the rotor 41 of the peristaltic pump 4 rotates, the constriction of the elastic tube 73 rotates and the perfusate in the elastic tube 73 is transferred to the waste bag 22. By transferring the perfusate in the elastic tube 73 to the waste liquid bag 22, suction force is generated at the discharge port 14 of the ultrasonic chip 11, and suction of the fragments of the crystalline lens P is promoted.

  Here, when the switch 12 of the handpiece 1 is pressed, the rotor 9 may be rotated at the same time as the solenoid 9 is operated, and the peristaltic pump 4 may transfer the perfusate. There is also a possibility that the negative pressure in the tube 73 becomes large at a stretch and a surge phenomenon occurs. Therefore, the rotor 41 of the peristaltic pump 4 is always rotated, and when the switch 12 of the handpiece 1 is pressed, the solenoid 9 is actuated to rotate the upper case 44 and the inner peripheral surface of the upper case 44 and the roller 42. Therefore, it is recommended that the elastic tube 73 be sandwiched between the two. According to such control, as the upper case 44 rotates and closes, the amount of perfusate transferred by the peristaltic pump 4 gradually increases, and the negative pressure in the elastic tube 73 gradually increases. The occurrence of the surge phenomenon can be effectively suppressed.

  In the peristaltic pump 4 described above, the upper case 44 is rotatably provided and moved to a position where a constriction is formed in the elastic tube 73 and a position where the elastic tube 73 is opened, but the upper case 44 is fixed, The rotor 41 can be moved in the vertical direction in FIG. Alternatively, both the upper case 44 and the rotor 41 may be movable so that the elastic tube 73 is constricted.

  In addition, when the roller 42 is attached to the rotor 41 so as to freely enter and exit and the peristaltic pump 4 is not driven, the perfusate passes through the elastic tube 73 with the roller 42 being housed in the rotor 41. On the other hand, when the peristaltic pump 4 is driven, the roller 42 may protrude from the rotor 41 to form a constriction in the elastic tube 73.

  EXAMPLES Hereinafter, although an Example demonstrates this invention further in detail, this invention is not limited to these examples at all.

(Examples 1-9)
The following experiment was conducted using the intraocular surgical apparatus shown in FIG. 1 with the decompression compensation tube removed. As an experimental device, an ultrasonic cataract surgical device “Series 2000 Legacy” (manufactured by Alcon Surgical) was used, and as a handpiece, “Piezo Electric Small Feco Handpiece” (manufactured by AMO) was used. The ultrasonic chip of “19G” was used, and the vibration output of the ultrasonic chip was set to 35 kHz. As the perfusate, “BSS Plus (registered trademark)” (manufactured by Alcon) was used. Then, without driving the peristaltic pump, the height difference between the storage bottle and the handpiece was changed to 55 to 135 cm, and an experiment was conducted to remove the porcine eye lens. The perfusate volume and time required to remove the lens were measured. The results are shown in Table 2.

(Comparative Examples 1-9)
Using the intraocular surgical device shown in FIG. 7, an experiment was conducted to remove the porcine eye lens by changing the height difference between the storage bottle and the handpiece from 55 to 135 cm, as in Examples 1 to 9. It was. The perfusate volume and time required to remove the lens were measured. The results are shown in Table 2.

  As can be seen from Table 2, in the device of the example, the amount of perfusate required for the operation is smaller than that of the device of the comparative example, except for the case where the height of the storage bottle is low (55 cm). It was almost the same as the apparatus of the comparative example.

(Measurement of intraocular pressure)
(Example 10)
An experiment for removing the lens of the pig eye was performed in the same manner as in Example 1 except that a decompression compensation tube was attached, and the pressure change in the eye was measured. The measurement results are shown in FIG.

(Example 11)
An experiment was conducted to remove the lens of the pig eye in the same manner as in Example 1 except that a decompression compensation tube was attached and the peristaltic pump was driven in a low suction force range, and the pressure change in the eye was measured. The measurement results are shown in FIG.

(Example 12)
Except that the peristaltic pump was driven in a low suction force range, an experiment for removing the lens of the pig eye was performed in the same manner as in Example 6 above, and the pressure change in the eye was measured. The measurement results are shown in FIG.

  FIG. 6 shows changes with time in intraocular pressure when the height of the storage bottle is 55 cm, with the vertical axis representing pressure and the horizontal axis representing time. (A) shows the case where the perfusate was allowed to flow only with the hydraulic head pressure (Example 10), and (b) shows the case where the perfusate was caused to flow with the hydraulic head pressure and a weak suction force by the peristaltic pump ( Example 11) and FIG. 10C show changes in intraocular pressure when the perfusate is caused to flow with a strong suction force by a peristaltic pump (Comparative Example 1).

  FIG. 7 shows changes over time in the intraocular pressure when the height of the storage bottle is 100 cm. FIG. 7A shows the case where the perfusate was caused to flow only by the hydraulic head pressure (Example 6). Fig. (B) shows a case where the perfusate was caused to flow with a hydraulic head pressure and a weak suction force by the peristaltic pump (Example 12). Fig. (C) was a case where the perfusate was caused to flow with a strong suction force by the peristaltic pump. The change in intraocular pressure is shown (Comparative Example 6).

  As can be understood from FIGS. 6 and 7, the fluctuation range of the intraocular pressure is the smallest when the perfusate is flowed only by the hydrocephalic pressure (each figure (a)), and is weak by the hydrocephalic pressure and the peristaltic pump. The case where the perfusate was caused to flow by the suction force was the next smallest (each figure (b)), and the case where the perfusate was caused to flow by the strong suction force by the peristaltic pump was the largest (each figure (c)). It is understood that the device of the present invention is safer than the conventional device because the safety of the surgery is enhanced when the fluctuation range of the intraocular pressure is small.

1 is a schematic view showing an embodiment of an intraocular surgical device according to the present invention. It is explanatory drawing which shows a mode that the lens piece in a capsule is removed with an ultrasonic chip. It is a schematic diagram which shows other embodiment of the intraocular surgery apparatus which concerns on this invention. It is explanatory drawing which shows the state at the time of on / off of the peristaltic pump of FIG. It is a figure which shows a time-dependent change of the intraocular pressure when the height of a storage bottle is 55 cm. It is a figure which shows a time-dependent change of the intraocular pressure when the height of a storage bottle is 100 cm. It is a schematic diagram which shows the conventional intraocular surgery apparatus.

Explanation of symbols

1 Handpiece 3 Check valve 4 Peristaltic pump (suction pump)
5 Depressurized compensation tube (depressurized compensator for intraocular surgery)
6 Supply pipe (supply path)
7 discharge pipe (discharge channel)
12 switch (on / off switch)
13 Inlet 14 Outlet 21 Reservoir (Reservoir)
41 Rotor 42 Roller 72, 73 Elastic tube

Claims (9)

  1. A reservoir for storing perfusate;
    A handpiece having an inlet and outlet for perfusate, an ultrasonic tip for crushing the affected area in the eye, and
    A supply path connecting the reservoir and the handpiece;
    A discharge path for discharging the crushed intraocular affected part from the handpiece together with the perfusate,
    An intraocular surgical apparatus, wherein the perfusate is caused to flow by supply pressure from the reservoir.
  2.   The intraocular surgical apparatus according to claim 1, wherein a hydrocephalic pressure due to a difference in height between the storage unit and the handpiece is used as the supply pressure.
  3.   The intraocular surgery device according to claim 1, further comprising a suction pump in the discharge path.
  4.   The intraocular surgery device according to claim 3, wherein an on / off switch of the suction pump is provided on the handpiece.
  5.   The intraocular surgical apparatus according to claim 3, wherein an on / off switch of the suction pump is a foot switch.
  6. Branching the discharge path into two in the middle, providing the suction pump in one discharge path, providing a valve in the other discharge path,
    The intraocular surgical apparatus according to any one of claims 3 to 5, wherein the valve prevents the perfusate from flowing backward through the discharge path when the suction pump is driven.
  7.   When the suction pump is not driven, the perfusate is allowed to flow with the supply pressure from the reservoir, and when the suction pump is driven, the supply pressure from the reservoir and the suction pressure of the suction pump The intraocular surgery device according to any one of claims 3 to 5, wherein the perfusate is caused to flow by the above.
  8. The suction pump rotatably accommodates a rotor having a roller on the outer periphery thereof, winds an elastic discharge pipe constituting at least a part of the discharge path around the rotor, and the case inner peripheral wall and the roller A peristaltic pump that forms a constriction in the discharge pipe and moves the constriction by rotating a rotor to transfer the perfusate in the discharge pipe,
    The case inner peripheral wall and the rotor are relatively movable to a position where a constriction is formed in the discharge pipe and a position where the discharge pipe is opened,
    The intraocular surgical apparatus according to claim 7, wherein when the peristaltic pump is not driven, the inner peripheral wall of the case and the rotor are held at a position where the discharge pipe is opened, and perfusion fluid can flow in the discharge pipe.
  9.   When the inside of the affected part is in an excessively reduced pressure state, the container is connected in the middle of the supply path and includes an accommodating part that forms a chamber that can be closed leaving an opening into which the perfusate supplied to the supply path flows. The intraocular surgical apparatus according to any one of claims 1 to 8, further comprising a decompression compensation instrument for intraocular surgery capable of supplying a perfusate into the affected area.
JP2007209225A 2007-08-10 2007-08-10 Intraocular surgery instrument Pending JP2010246573A (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP2007209225A JP2010246573A (en) 2007-08-10 2007-08-10 Intraocular surgery instrument

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2007209225A JP2010246573A (en) 2007-08-10 2007-08-10 Intraocular surgery instrument
PCT/JP2008/063147 WO2009022525A1 (en) 2007-08-10 2008-07-23 Intraocular surgery instrument

Publications (1)

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2015504349A (en) * 2011-11-30 2015-02-12 アルコン リサーチ, リミテッド Retinal surgery
JP2015505685A (en) * 2011-12-02 2015-02-26 エルジェーティー プロジェクツ リミテッド Lacrimal flow resistance measurement system
KR20160000231A (en) * 2014-06-24 2016-01-04 김재순 Tip and handpiece for ocular surgery, ocular surgery system using thereof

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5230614A (en) * 1992-06-03 1993-07-27 Allergan, Inc. Reduced pulsation tapered ramp pump head
JP3192340B2 (en) * 1994-10-12 2001-07-23 住友ベークライト株式会社 Ultrasonic surgical device
JP3529311B2 (en) * 1999-12-22 2004-05-24 眞人 岸本 Intraocular surgical apparatus
US6908451B2 (en) * 2002-04-25 2005-06-21 Alcon, Inc. Liquid venting surgical system

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2015504349A (en) * 2011-11-30 2015-02-12 アルコン リサーチ, リミテッド Retinal surgery
US9517162B2 (en) 2011-11-30 2016-12-13 Alcon Research, Ltd. Retinal surgery
JP2015505685A (en) * 2011-12-02 2015-02-26 エルジェーティー プロジェクツ リミテッド Lacrimal flow resistance measurement system
KR20160000231A (en) * 2014-06-24 2016-01-04 김재순 Tip and handpiece for ocular surgery, ocular surgery system using thereof
KR101631749B1 (en) * 2014-06-24 2016-06-17 김재순 Tip and handpiece for ocular surgery, ocular surgery system using thereof

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