JP2017023571A - Medical appliance - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical appliance that enables an operation of traction of a tip of a support part of an implant to the inside or outside of the sclera to be more easily performed than ever by effectively utilizing a bent part formed at the tip of the support part.SOLUTION: An appliance 1 has a hook part 3 provided near an end of a rod-like part 2. For example, a folded part 52 formed at the tip of a haptic 51 of an intraocular lens 5 is hooked by the hook part 3, and pulled to the outside or inside of sclera. The hook part 3 has rigidity high enough to prevent deformation of a hook shape when the folded part 52 is pulled to the outside of an eye.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a medical instrument.

  As is well known, surgery for inserting an intraocular lens (IOL) into the eye after the patient's clouded lens has been removed as a treatment for cataract of the eye is widely performed. In the following Patent Document 1, the present inventor proposed an intraocular lens having a folded portion at the tip of a support portion (for example, haptic). By inserting the tip of the support part into the intrascleral tunnel or pulling it out of the sclera, the folded part is hooked on the sclera, and the intraocular lens is stably supported.

Japanese Patent No. 5398092

  In Patent Document 1, as a procedure for implanting an intraocular lens having a folded portion at the tip of a haptic into the eye, after inserting the intraocular lens into the eye, the tip of the haptic is placed in the sclera with an instrument such as forceps. It is pulled out of the tunnel or outside the sclera. Although it is possible to pull out the haptic tip with existing instruments such as forceps and levers, there is still room for improvement. In particular, if an instrument that can pull out the haptic tip in a way that effectively utilizes the presence of the folded portion, it may be possible to perform implantation of a scleral-fixed intraocular lens more easily. . This problem is not limited to intraocular lenses, but is a problem for all implants having a bent portion in the support portion.

  Therefore, in view of the above, the problem to be solved by the present invention is that the operation of pulling the tip of the support portion of the implant to the inside or outside of the sclera effectively uses the bent portion formed at the tip of the support portion. Thus, it is an object of the present invention to provide a medical instrument that can be performed more easily than before.

  In order to solve the above-mentioned problems, a medical instrument according to the present invention is inserted into a grasping part grasped by a practitioner and an incision formed on an end of the grasping part and formed in the sclera of the eye. A hook portion having a hook shape that hooks a bent portion at a tip of a support portion of a predetermined implant disposed in the eye and pulls the bent portion to the inside or outside of the sclera through the incision. It is characterized by that. According to the present invention, the implanting operation of the implant supported inside or outside of the sclera can be performed more easily than before by a simple operation of pulling the bent portion of the support portion of the implant.

  Further, the hook portion may have such a rigidity that the hook shape is not deformed when the bent portion is pulled to the inside or the outside of the sclera. According to the present invention, since the hook portion has sufficient rigidity, there is no possibility that the bent portion may drop off during the pulling of the bent portion to the inside or outside of the sclera, thereby causing a trouble in the operation, and the transplantation can be reliably performed. Work can be done.

  In addition, when the grip portion is located in a region outside the ciliary flat portion in the sclera, the hook portion is positioned in the inner space of the ciliary heel portion from the grip portion to the hook portion. It is good also as providing the extended part extended. According to the present invention, an incision can be formed so as to pass through the ciliary flat part, and the work of pulling the bent part of the support part of the implant can be reliably performed so that the implant is positioned at the ciliary flat part. The form which supports is possible.

  The predetermined implant may be an intraocular lens. According to the present invention, by effectively using the bent portion of the support portion of the intraocular lens, the implantation operation of the intraocular lens supported using the inside or the outside of the sclera can be performed more easily than before.

The perspective view which shows Example 1 of the medical instrument of this invention. The elements on larger scale of FIG. The figure which shows the example of an intraocular lens. The figure which shows the example of a mode that pulls an intraocular lens with a medical instrument. The figure which shows the 1st example of the state in the middle of the transplant operation of an intraocular lens. The figure which shows the 2nd example of the state in the middle of the transplant operation of an intraocular lens. The figure which shows the example of the state after the implantation of an intraocular lens. The perspective view which shows Example 2 of the medical instrument of this invention. The perspective view which shows Example 3 of the medical instrument of this invention. The figure which shows the 3rd example of the state in the middle of the transplant operation of an intraocular lens. The figure which shows the 4th example of the state in the middle of the transplant operation of an intraocular lens.

  Embodiments of the present invention will be described below with reference to the drawings. First, FIG. 1 and FIG. 2 are a perspective view and a partially enlarged view of a medical instrument 1 (hereinafter, instrument) in Example 1 of the present invention.

  The instrument 1 is an instrument for hooking a folded portion of a predetermined implant (for example, an intraocular lens described later) inserted into the eye and pulling it inside or outside the sclera. The instrument 1 includes a rod-shaped part 2, a hook part 3, and a stopper 4. The rod-shaped part 2 is a part that the practitioner grips with a finger or a lever or the like. The length and thickness of the rod-like portion 2 may be values suitable for transplantation surgery described later.

  The hook portion 3 is a portion that is disposed at an end portion in the axial direction of the rod-like portion 2 and hooks and pulls a folded portion formed on a haptic of an intraocular lens, for example, as will be described later. As shown in FIG. 2, the hook portion 3 has a hook shape having a curved portion 30 and an end portion 31 that are curved. The hook portion 3 may be formed separately from the rod-shaped portion 2 and may be joined to the rod-shaped portion 2 later, or may be formed integrally with the rod-shaped portion 3. The hook portion 3 may be formed of a material having rigidity suitable for the treatment content described later, such as metal or rigid resin. The stopper 4 is a part formed in some solid shape near the center of the entire instrument 1. The stopper 4 is provided to hold the position of the instrument 1. Note that the stopper 4 may not be provided.

  FIG. 3 is a view showing an intraocular lens as an example of the above-described predetermined implant which is a target to which the instrument 1 is used. The intraocular lens 5 of FIG. 3 includes a lens 50 and two haptics 51 as main components. The lens 50 may have a disk shape when viewed from the front, and may be a convex lens having a large central portion or a concave lens having a small central portion. The haptic 51 is a part that supports the lens 50 in the eye. The haptic 51 is extended from two places on the side edge of the lens 50 in a pair of loop shapes symmetrical with respect to the visual axis (the central axis of the lens 50). Each of the two haptics 51 is formed with a folded portion 52 that is folded in the opposite direction on the tip side.

  In a state where the lens 50 is placed in the eye, the haptic 51 is formed by, for example, the tip being pulled out from an incision formed in the sclera and the folded portion 52 being hooked on the outer surface of the sclera. 50 is supported in the eye. Alternatively, the haptic 51 is inserted into the scleral tunnel formed in the sclera in a state where the folded portion 52 is folded, and the folded portion 51 is hooked on the inner wall of the tunnel so that the lens 50 is intraocularly. To support.

  The haptic 51 may be formed of, for example, an elastic resin. As a result, the folded portion 52 is strongly hooked to the outer surface of the sclera or the inner wall of the intrascleral tunnel due to the bent portion of the folded portion 52 or the elastic restoring force of the haptic 51, so that the lens 50 is stable. Supported by

  FIG. 4 is a diagram illustrating an example of a state in which the haptic 51 (or the folded portion 52) of the intraocular lens 5 is pulled by the instrument 1 and is viewed from the visual axis direction with the ocular tissue omitted. As shown in the figure, the hooks 3 of the instrument 1 are hung on both folded-back parts 52 and each instrument 1 is pulled in the direction of the rod-shaped part 2. As a result, a symmetrical force is exerted with respect to the visual axis, so that the position of the lens 50 is not moved (but rotated around the visual axis), and the folded portion 52 and the haptic 51 are pulled in opposite directions.

  5 and 6 are cross-sectional views of an example of a state in which the haptic 51 (or the folded portion 52) of the intraocular lens 5 is pulled by the instrument 1 as seen from the lateral direction together with the eye tissue, and FIG. It is sectional drawing which shows the example of a mode. In this example, the folded portion 52 is pulled out of the sclera.

  As a procedure up to FIG. 5, for example, the intraocular lens 5 is inserted from the incision formed in the cornea 100 into a rod-like state and inserted behind the iris 102 in the eye by a predetermined injector or the like. Then, two incisions are formed at positions symmetric with respect to the visual axis in the sclera 101. The position of the incision in the eye may be the position of the ciliary groove 104 in front of the ciliary body part 103 as shown in FIG. The instrument 1 is inserted from these incisions with the hook portion 3 at the top.

  Then, as shown in FIG. 5, the folded portion 52 is hooked by each hook portion 3. In this state, the stopper 4 comes into contact with the outer surface of the sclera 101, so that the treatment can be appropriately performed while the position of the instrument 1 is maintained.

  Then, as shown in FIG. 4 described above, the rod-like portions 2 of both instruments 1 are pulled in the direction of being simultaneously pulled out from the incision. As shown in FIG. 6, when the entire folded portion 52 is brought out of the sclera 101, the hook portion 3 is removed from the folded portion 52. Accordingly, the state shown in FIG. 7 is obtained, and the folded portion 51 is pressed against the outer surface of the sclera 101 by the elastic restoring force of the haptic 51. Further, when a force that pulls the haptic 51 toward the base side is generated, the folded portion 52 is hooked on the outer surface of the sclera 101. With these actions, the haptic 51 stably supports the intraocular lens 5 in the eye.

  When inserting the haptic 51 into the intrascleral tunnel, for example, a scleral half-layer valve is formed at two symmetrical points with respect to the visual axis in the sclera 101, and the strong layer 51, for example, moves toward the center of the eyeball. Make a membrane incision. Furthermore, in the side wall of the portion where the scleral half-layer valve is cut out, the entrance is a point at a depth half the thickness of the sclera from the sclera surface, for example, in a direction substantially parallel to the edge, that is, the visual axis. The intrascleral tunnel is formed in the circumferential direction. The intrascleral tunnel may be formed with an appropriate length (for example, 2 mm to 3 mm) so as to penetrate the sclera surface as an outlet.

  Then, the two instruments 1 are inserted into the eye through the intrascleral tunnel, and the hook parts 3 of the two instruments 1 are hooked on the folded-back part 52 and pulled as described above. As a result, the folded portion 52 is folded and inserted into the intrascleral tunnel. When the entire folded portion 52 is inserted into the intrascleral tunnel, the hook portion 3 is removed from the folded portion 52. As a result, the folded portion 52 presses the inner wall of the tunnel with an elastic restoring force, and even if a force for pulling out the haptic 51 to the root side is generated, the intraocular lens 5 is reliably supported by resisting it. It becomes.

  What is necessary is just to form the hook part 3 so that it may have the rigidity suitable for the above treatment contents. That is, the hook portion 3 may have such a rigidity that the hook shape is not deformed when the folded portion 52 is pulled to the inside or outside of the sclera. This avoids the possibility that the folded portion 52 may drop off during the pulling of the folded portion 52 to the inside or outside of the sclera and hinder the treatment. In addition, in the conventional literature (for example, Japanese Patent Application Laid-Open No. 07-194443, Utility Model Registration No. 3115747), an instrument having a hook shape that pulls the iris is disclosed. Not only differs from the present application in that it does not pull to the inside or outside of the sclera, but also differs in terms of rigidity. That is, in these instruments, the hook-shaped portion has flexibility, and the hook shape is deformed into a straight shape when being pulled out of the eye after surgery.

  The present invention is not limited to the form of the first embodiment. FIG. 8 and FIG. 9 show another embodiment. The instruments 1a and 1b in FIGS. 8 and 9 are instruments used when the haptic 51 of the intraocular lens 5 is pulled out of the eye from the ciliary flat part.

  In the instrument 1a of the second embodiment shown in FIG. 8, the curved extension portion 6 extending from the stopper 4 to the hook portion 3 in a curved bar shape is used. In the instrument 1b of Example 3 shown in FIG. 9, the stopper 4 and the hook portion 3 are bent and extended portions 7 extended in a bar shape bent at one location. The length of the curved extending portion 6 and the bent extending portion 7 (that is, the length from the hook portion 3 to the stopper 4) may be set so as to be suitable for the treatment described later. In addition, in the example of FIG. 9, although the bending extension part 7 is bent in one place, it is not limited to this, You may bend in how many places.

  10 and 11 are cross-sectional views showing an example of a state in which the haptic 51 (or the folded portion 52) of the intraocular lens 5 is pulled to the outside of the sclera 101 through the ciliary flat portion 105 using the instrument 1a or 1b. FIG. FIG. 10 shows an example of a state during transplantation, and FIG. 11 shows an example of a state after transplantation. In this example, incisions are formed at two locations symmetrical with respect to the visual axis in a region of the sclera 101 that is outside the ciliary flat portion 105. Then, the two instruments 1a (or 1b) are inserted into the eye through the incision with the hook portion 3 side at the head.

  The intraocular lens 5 is also inserted into the eye through an incision formed in the cornea 100 as in the above example. Thus, when the intraocular lens 5 and the hook part 3 of the two instruments 1a (or 1b) are inserted into the eye, the folded parts 52 of the two haptics 51 of the intraocular lens 5 are respectively inserted into the two hook parts 3. Hook. At that time, as shown in FIG. 10, the intraocular lens 5 is placed in a position relatively close to the iris 102, for example, in a space (inside space) surrounded by the ciliary body collar 103 from the circumferential direction, and the ciliary flat portion The hook part 3 of the instrument 1a (or 1b) inserted from 105 may be made to reach the folded part 52.

  Thereby, the process which hooks the hook part 3 on the folding | returning part 52 in the position near a practitioner can be performed. In the state shown in FIG. 10, the stopper 4 comes into contact with the outer surface of the sclera 101. In addition, the curved extending portion 6 and the bent extending portion 7 are located in the inner space of the ciliary collar portion 105 when the stopper 4 is positioned outside the ciliary flat portion in the sclera. Thus, it extends to the hook portion 3. Further, the bending extension portion 6 and the bending extension portion 7 are made rigid (for example, by using a rigid resin or metal as a material), and the bending extension portion 6 and the bending extension portion during the operation from FIG. 10 to FIG. If the rigidity is such that the shape of 7 does not change, it is preferable in that the operation of hooking the hook portion 3 to the folded portion 52 can be performed in a place close to the practitioner.

  In the state of FIG. 10, the two instruments 1a (or 1b) are pulled in the extraocular direction. When the entire folded portion 52 is pulled out of the eye as a result of pulling, the hook portion 3 is removed from the folded portion 52. Thus, the state shown in FIG. 11 is obtained, and the folded portion 51 is pressed against the outer surface of the sclera 101 by the elastic restoring force of the haptic 51, and the folded portion 52 is hooked on the outer surface of the sclera 101. The lens 5 is supported in the eye.

  As described above, the present invention can also be applied to a treatment in which the folded portion 52 is brought out from the ciliary flat portion 105. In Examples 2 and 3, the length of the haptic 51 of the intraocular lens 5 may be set to a length suitable for the state of FIG. Although FIG. 11 shows a configuration in which the folded portion 52 is pulled out to the outer surface of the sclera 101, this may be changed to a configuration in which it is pulled into the sclera 101 (inner tunnel) as described above.

  The above embodiments may be modified within the scope of the spirit described in the claims. For example, the target using the instrument 1 is not limited to the intraocular lens 5, and may be any implant that has a leg-shaped portion and is implanted into the eye and has a bent portion at the tip of the leg shape. .

1 device (medical device)
2 Bar-shaped part (gripping part)
3 hook part 5 intraocular lens 6 curved extension part (extension part)
7 Bending extension (extension part)
51 Haptic (supporting part)
52 Folding part (bending part)

In order to solve the above-mentioned problem, a medical instrument according to the present invention is a medical instrument that hooks and pulls a bent portion at a tip of a support part of a predetermined implant , and a gripping part that a practitioner grips, disposed at the end of the grip portion, the interior of which is inserted from the incision formed in the sclera of the eye, hooking the bent portion disposed in the eye, the sclera of the bent portion through the incision Or a hook portion having a hook shape to be pulled to the outside. According to the present invention, the implanting operation of the implant supported inside or outside of the sclera can be performed more easily than before by a simple operation of pulling the bent portion of the support portion of the implant.

Claims (4)

A grasping part grasped by the practitioner;
The incision wound is placed at the end of the gripping part, inserted from an incision formed in the sclera of the eye, and hooked at the bent portion at the tip of the support part of a predetermined implant disposed in the eye. A hook portion having a hook shape that pulls the bent portion to the inside or outside of the sclera,
A medical instrument characterized by comprising:   The medical device according to claim 1, wherein the hook portion has a rigidity that does not deform the hook shape when the bent portion is pulled to the inside or the outside of the sclera.   When the gripping part is located in a region outside the ciliary flat part in the sclera, the hook part extends from the gripping part to the hook part so that the hook part is located in the inner space of the ciliary heel part. The medical instrument according to claim 1, further comprising an extended portion provided.   The medical device according to any one of claims 1 to 3, wherein the predetermined implant is an intraocular lens.

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