JP2014113406A - Plug, reflux device, and crystalline lens epithelial cell killing system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To kill crystalline lens epithelial cells remaining in a crystalline capsule at a surgery for cataract.SOLUTION: A plug 1 seals an incision opening formed at anterior capsulotomy from the inside of a crystalline capsule. The plug 1 comprises: a convex part 2 which protrudes to a hydatoid side rather than to the incision opening when sealing is made; and a flange part 3 made to be larger than the incision opening. The plug further comprises: a conduit line 4 for infusion to infuse a hypotonic solution or an isotonic solution into the crystalline capsule from the outside in order to kill crystalline lens epithelial cells remaining in an anterior capsule by infusing the hypotonic solution or the isotonic solution into the crystalline capsule; and a conduit line 5 for suction to suck, to the outside of the crystalline capsule, the hypotonic solution or the isotonic solution infused into the crystalline capsule. This ensures that the crystalline lens epithelial cells do not grow after the surgery for cataract, preventing cataract from appearing later. When an adjustment-type intraocular lens is used, the focus adjustment function is preserved in a good condition.

Description

  The present invention relates to an ophthalmic surgical instrument, apparatus, and system used, for example, during cataract surgery.

  More specifically, the present invention relates to a plug for sealing an incision formed by anterior capsule incision from the inside of the anterior capsule, and a hypotonic or isotonic solution in the lens capsule with the incision sealed with the plug. The present invention relates to a reflux device for reflux, and a system for killing lens epithelial cells remaining in a lens capsule, for example, during cataract surgery using the plug and the reflux device.

  As shown in FIG. 8A, the human eye has a cornea 101 in the forefront of the eyeball, and the back of the cornea 101 is filled with an aqueous humor 102. Behind the iris 103 that forms the pupil, there is a crystalline lens 104 that is a tissue that plays a role corresponding to a lens in terms of a camera. The lens 104 includes a lens nucleus 104 a and a lens cortex 104 b, and the lens cortex 104 b is surrounded by a lens capsule 105. The crystalline lens 104 and the crystalline lens capsule 105 are suspended in the eye by a chin band 106.

  Of the lens capsule 105, the front portion is called the anterior capsule 105a, and the rear portion is called the posterior capsule 105b. The back of the posterior capsule 105b is filled with a vitreous body 107, and a retina (not shown) is present behind the vitreous body 107.

  Cataracts occur due to aging, diabetes, drugs, trauma, etc., and the lens 104 becomes white and cloudy, causing a strong haze in the field of vision, or the light that enters the eye cannot be focused correctly on the retina. That means. Recently, this cataract treatment is mainly performed by removing the lens 104 that has become cloudy due to the cataract from the lens capsule 105 and implanting an artificial intraocular lens instead of the lens 104.

  When an intraocular lens is implanted as a treatment for cataract, prior to the implantation, as shown in FIG. 8 (b), the cornea 101 is incised, for example, at a position of reference numeral 101a by about 3 mm, and then shown in FIG. 8 (c). Thus, for example, a circular incision 105c having a diameter of about 6 mm is provided in the anterior capsule 105a, and the lens 104 that has become cloudy due to a cataract is extracted.

  Extraction of the lens 104 may be performed by extracapsular extraction (ECCE) in which the lens 104 is removed as it is, but in recent years, ultrasonic emulsification and suction (PEA) using ultrasonic waves may be used. . Ultrasonic emulsification and aspiration (PEA) is performed by inserting a cylindrical ultrasonic chip through the incision 105c provided in the anterior capsule 105a, crushing the clouded crystalline lens 104 with ultrasonic waves, emulsifying and sucking, This is a method of removing the crystalline lens 104 while leaving the crystalline lens capsule 105, and has an advantage that the incision 105c can be made smaller compared to the extracapsular extraction (ECCE). As shown in FIG. 8D, at present, many intraocular lenses 108 are placed in the lens capsule 105 after the lens 104 is extracted by extracapsular extraction (ECCE) or ultrasonic emulsification (PEA). Transplanted.

  As shown in FIG. 9, the intraocular lens 108 includes a lens body 108a having a diameter of about 6 mm and a support portion 108b. When the intraocular lens 108 is folded and inserted into the lens capsule 105 after the operation, the support portion 108b naturally expands. It is fixed in the lens capsule 105. There are two types of intraocular lenses: a single-focus type with a single focus distance and a multi-focus type with multiple focus distances, depending on the patient's eye characteristics, occupation, lifestyle, etc. A more appropriate type is selected.

  As described above, in cataract surgery, the lens nucleus 104a and the lens cortex 104b are removed from the incision 105c provided in the anterior capsule 105a. Even if it is mechanically removed, it remains on the inner surface side of the anterior capsule 105a at the cell level.

  In particular, as shown in FIG. 10, since the portions 105aa at both ends of the anterior capsule 105a are located on the back side of the iris 103 and are difficult to operate, the lens epithelial cells remaining in the portions 105aa at both ends are removed. Complete removal by mechanical operation is almost impossible.

  However, if the lens epithelial cells 109 remaining in the anterior capsule 105a continue to grow as shown in FIGS. 11 (a) and 11 (b), as shown in FIG. 11 (c), the anterior capsule 105a and the posterior capsule 105b. It is known that this type of adhesion occurs and causes post-cataract, which is one of the problems in current cataract surgery.

  Recently, as an intraocular lens of a new type different from the above-described single focus type and multifocal type, an adjustable type intraocular lens having a function of automatically adjusting the focus and moving closer to the crystalline lens has been proposed. In the accommodation type intraocular lens, when the chin band around the lens contracts, the movement is transmitted to the lens, and the lens moves in the direction of the cornea, so that the focusing can be made close to the lens.

  However, when the lens epithelial cells 109 remaining at the time of cataract surgery proliferate as shown in FIG. 11C and the anterior capsule 105a and the posterior capsule 105b are fused, the lens capsule 105 becomes fibrotic and loses elasticity. As a result, the movement of the adjustable intraocular lens also deteriorates, and there is a problem that the above-mentioned focus adjustment function is lost.

  Thus, lens epithelial cells that cannot be completely removed during cataract surgery cause various problems such as causing secondary cataract and making it difficult to apply an adjustable intraocular lens.

  However, in the past, for the problem of residual lens epithelial cells, for example, after the surface modification treatment of the intraocular lens material, contact with a polar medium improves the adhesion between the intraocular lens and the posterior capsule. However, there is only a proposal for an intraocular lens (for example, Patent Document 1) that suppresses turbidity of the posterior capsule accompanying the proliferation of lens epithelial cells, and there is no fundamental countermeasure at present.

JP 2009-45329 A

  The problem to be solved by the present invention is that, conventionally, it has been impossible to completely remove lens epithelial cells during cataract surgery.

  An object of the present invention is to solve various problems caused by proliferation of lens epithelial cells after surgery by killing lens epithelial cells remaining in the lens capsule during cataract surgery.

  The present invention provides an ophthalmic surgical instrument (plug), apparatus, and system for achieving the above object.

Specifically, the plug of the present invention is
A plug that seals the incision formed in the anterior capsulotomy from the inside of the lens capsule,
A convex portion that protrudes toward the anterior aqueous humor from the incision at the time of sealing, and a flange portion that is larger in size than the incision, and
An infusion line for injecting hypotonic or isotonic solution into the lens capsule from the outside in order to kill the lens epithelial cells remaining in the anterior capsule by refluxing the hypotonic or isotonic solution in the lens capsule; The main feature is that it comprises a suction conduit for sucking hypotonic or isotonic fluid injected into the lens capsule out of the lens capsule.

Further, the reflux device of the present invention comprises:
In order to kill lens epithelial cells remaining in the anterior capsule, a reflux device for refluxing hypotonic or isotonic fluid into the lens capsule via the plug,
An isotonic solution bottle containing an isotonic solution; a hypotonic solution bottle containing a hypotonic solution; an injection side tube connected to the isotonic solution bottle and the hypotonic solution bottle via a three-way stopcock; A pinch valve that opens and closes the flow path by pressing the injection side tube, a foot pedal that controls the opening and closing of the pinch valve, and a suction pump that sucks hypotonic or isotonic liquid injected into the lens capsule This is the main feature.

In addition, the system of the present invention
The incision formed by the anterior capsulotomy can be sealed from the inside of the capsular bag, and an infusion line for injecting hypotonic or isotonic solution into the capsular bag from the outside, and a low injected into the capsular bag A plug having a suction line for sucking the isotonic solution or isotonic solution to the outside of the lens capsule;
A reflux device comprising injection means for injecting hypotonic or isotonic liquid at a required speed and suction means for sucking hypotonic or isotonic liquid injected into the lens capsule at a required speed And consists of
A system that kills lens epithelial cells remaining in the anterior capsule during cataract surgery,
In the state where the incision is sealed from the inside of the lens capsule with the plug, the injection means and the injection conduit, and the suction means and the suction conduit are connected directly or indirectly, respectively. The most important feature is that a hypotonic solution or an isotonic solution is refluxed into the capsular bag using a device.

  According to the present invention, the lens epithelial cells remaining in the anterior capsule are expanded and ruptured by the action of the osmotic pressure of the hypotonic solution that is refluxed into the lens capsule through the injection line and the suction line of the plug. Can be killed.

  Since the lens epithelial cells remaining at the time of surgery for cataract can be completely killed, the present invention can prevent secondary cataract. In addition, when the present invention is applied, the lens epithelial cells do not proliferate and the lens capsule does not become fibrotic. Therefore, when the accommodation type intraocular lens is used, the focus adjustment function is favorably sustained.

It is a figure which shows the plug of this invention, (a) is the figure seen from the direction of the side, (b) is the figure seen from the direction of a plane, (c) is the figure seen from the direction of the bottom face. It is a figure which shows the other structure of the plug of this invention. It is a figure which shows the structure of the reflux apparatus of this invention. It is a figure which shows the structure of the lens epithelial cell killing system of this invention. It is a figure explaining a mode that an injection side tube is opened and closed with a pinch valve, (a) is an open state, (b) is a figure which shows a closed state. It is a figure explaining a mode that a hypotonic solution or an isotonic solution is recirculated in a lens capsule using a reflux device in the state where an incision of an anterior capsule is sealed with a plug. It is an enlarged view of the state which sealed the incision of the anterior capsule with the plug. It is a figure explaining an example of the procedure of the operation | movement of a cataract, (a) is the state before an operation, (b) is the state which opened the cornea, (c) is about half which provided the incision in the anterior capsule. (D) is a diagram showing a state in which the crystalline lens is completely removed and the intraocular lens is implanted. It is a figure explaining the structure of a general intraocular lens, (a) is the figure seen from the direction of the side surface, (b) is the figure seen from the direction of the plane. It is an enlarged view of the both ends of an anterior capsule, and the back side of an iris is a figure explaining that mechanical operation is difficult. It is a figure explaining a mode that the lens epithelial cells which remain | survived in the front capsule proliferate, and adhesion with a back capsule advances in order of (a), (b), (c).

  Hereinafter, embodiments for carrying out the present invention will be described in detail with reference to FIGS.

  In FIG. 1, reference numeral 1 denotes the plug of the present embodiment that seals the incision provided in the anterior capsule from the inside of the lens capsule. In this embodiment, a femtosecond laser is used as means for providing an incision in the anterior capsule during cataract surgery. If a femtosecond laser is used, the anterior capsule can be accurately excised, for example, into a perfect circle having a diameter of 5 mm.

  In the present embodiment, ultrasonic emulsification and aspiration (PEA) is used as means for extracting the lens. If ultrasonic emulsification and aspiration (PEA) is used, the lens that has become cloudy can be excised with ultrasonic waves, emulsified and sucked, and the lens can be removed with the lens capsule remaining.

  As shown in FIG. 1 (a), the plug 1 is a cylindrical convex portion that protrudes toward the anterior aqueous humor from the incision when the incision provided in the anterior capsule is sealed from the inside of the lens capsule. 2 and a cylindrical flange portion 3 having a diameter (for example, 7 mm) larger than the diameter of the incision (for example, 5 mm). The diameter of the convex part 2 is the same size (for example, 5 mm) as the incision.

  Further, the plug 1 is used for injecting a hypotonic solution or an isotonic solution from the outside into the lens capsule so as to circulate the hypotonic solution or isotonic solution in the lens capsule and kill the lens epithelial cells remaining in the anterior capsule. An injection conduit 4 and a suction conduit 5 for aspirating hypotonic or isotonic fluid injected into the lens capsule out of the lens capsule are provided. As shown in FIGS. 1A and 1C, the injection conduit 4 and the suction conduit 5 are circular holes penetrating the convex portion 2 and the flange portion 3 in the vertical direction.

  As shown in FIG. 1B, the plug 1 of the present embodiment further includes an injecting connection tube 4a connected to the injecting conduit 4 and a suction connecting tube 5a connected to the aspirating conduit 5. Prepare. The injection connection tube 4 a and the suction connection tube 5 a are attached to the upper surface of the convex portion 2.

  In the present invention, the injection connecting tube 4a and the suction connecting tube 5a are not indispensable structures, but in order to facilitate connection with a reflux device described later, it is more preferable to provide such a connecting tube. desirable.

  The plug 1 is made of a material that can be inserted into the anterior capsule while being folded from the incision of the anterior capsule. Specifically, for example, by using silicon and resin-molding into a shape as shown in FIG. 1, the plug 1 that can be flexibly deformed can be produced.

  The plug 1 inserted in a state of being folded inside the anterior capsule spreads to its original shape inside the anterior capsule. In the state where the plug 1 is expanded to the original shape shown in FIG. 1, the cut portion is sealed from the inside if the convex portion 2 is fitted into the cut portion and the flange portion 3 is in contact with the periphery of the cut portion. be able to.

  FIG. 2 is a diagram showing another configuration of the plug of the present invention. In FIG. 1, although the Example in which the bottom face of the flange part 3 was made into the flat plane was disclosed, the shape of the plug 1 of this invention is not restricted to this. For example, as shown in FIG. 2, on the bottom surface side of the flange portion 3, an injection nozzle portion 4 b connected to the injection conduit 4 and a suction nozzle portion 5 b connected to the suction conduit 5 are provided. You may comprise.

  FIG. 3 is a diagram showing the configuration of the reflux device of the present invention. The reflux device 11 of the present invention is a device used for refluxing a hypotonic solution or an isotonic solution into the lens capsule via the plug 1 to kill the lens epithelial cells remaining in the anterior capsule.

  As shown in FIG. 3, the reflux device 11 includes an isotonic solution bottle 12 containing an isotonic solution 12a (for example, physiological saline) having an osmotic pressure substantially equal to that of lens epithelial cells, and an osmotic pressure lower than that of lens epithelial cells. A hypotonic solution bottle 13 containing a hypotonic solution 13a (for example, distilled water).

  The isotonic solution bottle 12 and the hypotonic solution bottle 13 are installed at a position 10 to 60 cm higher than the position of the eye of the patient undergoing surgery while checking the intraocular condition. The patient is usually lying on the surgical bed and the eye position of the patient is, for example, about 70 cm from the floor of the operating room. In that case, the isotonic bottle 12 and the hypotonic solution What is necessary is just to install the bottle 13 in the position of 80-130 cm from the floor of an operating room, for example.

  The isotonic liquid bottle 12 and the hypotonic liquid bottle 13 are connected to the injection side tube 15 via a three-way cock 14. Therefore, the ratio of the isotonic liquid 12a and the hypotonic liquid 13a flowing in the injection side tube 15 is adjusted by opening and closing the valve of the three-way cock 14 and adjusting the flow rate on the isotonic liquid bottle 12 side and the hypotonic liquid bottle 13 side. Can be adjusted to a desired ratio. In addition, the injection side tube 15 is extended outside the reflux apparatus 11, and the code | symbol 15a has shown the extended part.

  Reference numeral 16 denotes a pinch valve that opens and closes the flow path in the injection side tube 15 by pressing the injection side tube 15 in a direction crossing the longitudinal direction thereof. The pinch valve 16 is connected to the foot pedal 17 via the cable 20 and the control unit 21, and the opening and closing of the pinch valve 16 is controlled by the depression angle of the foot pedal 17.

  That is, when the foot pedal 17 is not depressed, as shown in FIG. 5A, the same distance as the diameter of the injection side tube 15 is secured between the pressing portions 16a and 16a. The hypotonic solution 13a is in a state of freely flowing in the injection side tube 15. On the other hand, when the foot pedal 17 is gradually depressed, the distance between the pressing portions 16a and 16a is gradually reduced accordingly, so that the speed at which the isotonic solution 12a or the hypotonic solution 13a flows through the injection side tube 15 is decreased. Can do. FIG. 5B shows a state where the injection side tube 15 is sandwiched between the pressing portions 16a and 16a and the flow path is completely closed.

  In the reflux device 11 of FIG. 3, the above-described configuration (isotonic solution bottle 12, hypotonic solution bottle 13, three-way cock 14, injection side tube 15, pinch valve 16, foot pedal 17) is a hypotonic solution or isotonic. It functions as an injection means for injecting the liquid at a required speed.

  In addition, the reflux device 11 includes a suction pump 18 that sucks a hypotonic solution or an isotonic solution injected into the lens capsule at a required speed. The suction pump 18 is connected to the suction side tube 19. The suction side tube 19 is extended to the outside of the reflux device 11, and a reference numeral 19a indicates an extended portion.

  In the reflux device 11 of FIG. 3, the above-described configuration (suction pump 18 and suction side tube 19) functions as a suction means for sucking the hypotonic solution or isotonic solution injected into the lens capsule at a required speed. Is.

  Next, the configuration of the lens epithelial cell killing system of the present invention will be described with reference to FIG. The lens epithelial cell killing system of the present invention comprises, for example, the plug 1 shown in FIG. 1 or 2 and the reflux device 11 shown in FIG. 3, and kills the lens epithelial cells remaining in the anterior capsule during cataract surgery. System.

  In other words, the lens epithelial cell killing system of the present invention can seal the incision formed by the anterior capsule incision from the inside of the lens capsule and inject hypotonic solution or isotonic solution from the outside into the lens capsule. A plug 1 having an infusion line 4, a hypotonic or isotonic liquid injected into the capsular bag, and a suction line 5 for sucking out the capsular bag, and a hypotonic or isotonic solution The recirculation device 11 includes an injection means for injecting the liquid at a required speed and a suction means for sucking the hypotonic or isotonic liquid injected into the lens capsule at the required speed. .

  When using the lens epithelial cell killing system of the present invention, first, the connection tube 4a for injection of the plug 1 is returned to the extended portion 15a of the injection side tube 15 of the reflux device 11, and the connection tube 5a for suction of the plug 1 is returned to the outlet. Each is connected to the extended portion 19 a of the suction side tube 19 of the device 11. By connecting these tubes, the injection means of the reflux device 11 and the injection pipe 4 of the plug 1 and the suction means of the reflux apparatus 11 and the suction pipe 5 of the plug 1 are connected indirectly. It becomes.

  Next, an accurate circular incision with a diameter of 5 mm is formed in the anterior capsule of the lens capsule using a femtosecond laser, and the lens is removed using ultrasonic emulsification and aspiration (PEA), and then an intraocular lens is implanted. Before doing so, the plug 1 of the present invention is folded and placed in the lens capsule, and the convex portion 2 is fitted into the incision from the inside of the lens capsule.

  As described above, when the isotonic solution is started to be injected into the capsular bag from the injection means of the reflux device 11 through the injection line 4 of the plug 1 while the incision is sealed using the plug 1, The pressure is increased, and the incision is sealed from the inside by the plug 1.

  The completion of sealing of the incision with the plug 1 can be confirmed by a doctor or an assistant with a surgical microscope, but if the pressure in the lens capsule gradually increases, the isotonic fluid injection speed will also decrease accordingly. . Therefore, when the monitoring means for monitoring the injection rate of the isotonic liquid is provided, it is possible to detect that the sealing of the incision is completed also in the system of the present invention.

  FIG. 6 is a diagram for explaining a state in which a hypotonic solution or an isotonic solution is refluxed into the lens capsule using the reflux device 11 with the incision of the anterior capsule sealed with the plug 1. It is an enlarged view of the state which sealed the incision of the sac with the plug.

  After the injection of the isotonic solution 12a is started and the incision is sealed with the plug 1, the valve of the three-way cock 14 is switched, and the liquid injected into the lens capsule is changed from the isotonic solution 12a to the hypotonic solution 13a. Subsequently, the suction pump 18 is operated to suck the isotonic solution 12a or hypotonic solution 13a injected into the lens capsule at a suction speed of 10 to 30 cc per minute, for example.

  The liquid sucked into the reflux device 11 is in a state where the isotonic liquid 12a and the hypotonic liquid 13a are mixed when the suction pump 18 starts to operate, but the three-way cock 14 is switched to the hypotonic liquid 13a side. Thus, the ratio of the hypotonic solution 13a gradually increases, and eventually only the hypotonic solution 13a is aspirated, so that it can be confirmed that the inside of the lens capsule is filled with the hypotonic solution 13a.

  The confirmation of switching to the hypotonic solution 13a may be performed by, for example, coloring the hypotonic solution 13a in advance with a staining agent so that a doctor or an assistant can visually confirm with a surgical microscope. When monitoring means for monitoring the concentration of the liquid flowing in the side tube 19 is provided, the completion of switching to the hypotonic solution 13a can be detected also in the system of the present invention.

  Even after the inside of the capsular bag is filled with the hypotonic solution 13a, the hypotonic solution 13a is refluxed into the capsular bag for 1 to 5 minutes. By doing so, the lens epithelial cells remaining in the anterior capsule can be ruptured by the osmotic pressure of the low preparation 13a and completely killed.

  Thereafter, the three-way cock 14 is switched again to the isotonic solution 12a side, and after confirming that the inside of the lens capsule is filled with the isotonic solution 12a, the plug 1 is taken out from the lens capsule. Thereafter, an intraocular lens is transplanted in the same manner as in normal cataract surgery.

  As described above, according to the present invention, lens epithelial cells remaining at the time of cataract surgery can be completely killed, so that secondary cataract can be prevented. Further, when the present invention is applied, adhesion between the anterior capsule and the posterior capsule can be prevented, so that the accommodation type intraocular lens can continue to move well in the lens capsule, and the focus adjustment function is maintained semipermanently.

  The present invention is not limited to the above examples, and it is needless to say that the embodiments may be changed as appropriate within the scope of the technical idea described in each claim.

DESCRIPTION OF SYMBOLS 1 Plug 2 Convex part 3 Flange part 4 Injection pipe line 5 Suction pipe line 11 Reflux device 12 Isotonic liquid bottle 12a Isotonic liquid 13 Hypotonic liquid bottle 13a Hypotonic liquid 14 Three-way cock 15 Injection side tube 16 Pinch valve 17 Foot pedal 18 Suction pump

Claims (4)

A plug that seals the incision formed in the anterior capsulotomy from the inside of the lens capsule,
The plug is
A convex portion that protrudes toward the anterior aqueous humor from the incision at the time of sealing, and a flange portion that is larger in size than the incision, and
An infusion line for injecting hypotonic or isotonic solution into the lens capsule from the outside in order to kill the lens epithelial cells remaining in the anterior capsule by refluxing the hypotonic or isotonic solution in the lens capsule; A plug comprising: a suction conduit for sucking a hypotonic solution or an isotonic solution injected into the lens capsule out of the lens capsule.   An injection connecting tube connected to the injection conduit; and a suction connecting tube connected to the suction conduit; and the injection connecting tube and the suction connecting tube are attached to the convex portion. The plug according to claim 1. In order to kill lens epithelial cells remaining in the anterior capsule, a reflux device for refluxing a hypotonic or isotonic solution into the lens capsule via the plug according to claim 1 or 2,
An isotonic solution bottle containing an isotonic solution; a hypotonic solution bottle containing a hypotonic solution; an injection side tube connected to the isotonic solution bottle and the hypotonic solution bottle via a three-way stopcock; A pinch valve that opens and closes the flow path by pressing the injection side tube, a foot pedal that controls the opening and closing of the pinch valve, and a suction pump that sucks hypotonic or isotonic liquid injected into the lens capsule A reflux apparatus characterized by that. The incision formed by the anterior capsulotomy can be sealed from the inside of the capsular bag, and an infusion line for injecting hypotonic or isotonic solution into the capsular bag from the outside, and a low injected into the capsular bag A plug having a suction line for sucking the isotonic solution or isotonic solution to the outside of the lens capsule;
A reflux device comprising injection means for injecting hypotonic or isotonic liquid at a required speed and suction means for sucking hypotonic or isotonic liquid injected into the lens capsule at a required speed And consists of
A system that kills lens epithelial cells remaining in the anterior capsule during cataract surgery,
In the state where the incision is sealed from the inside of the lens capsule with the plug, the injection means and the injection conduit, and the suction means and the suction conduit are connected directly or indirectly, respectively. A lens epithelial cell killing system, wherein a hypotonic solution or an isotonic solution is refluxed into a lens capsule using an apparatus.

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