JP2019033817A - Needle with ultrafine tube for intrascleral fixation of intraocular lens - Google Patents

Abstract

To easily and reliably fix an intraocular lens to a sclera even when a lenticular capsule is damaged.SOLUTION: The needle with an ultrafine tube for intrascleral fixation of an intraocular lens includes an ultrafine tube 2 and a straight needle 1 suited for penetrating through an eyeball, where one end of the ultrafine tube and the needle are joined at a terminal of the straight needle. Preferably, the inside diameter of the ultrafine tube is 0.1 to 0.4 mm, and the diameter of the needle is 0.2 mm to 0.5 mm. The thickness of the ultrafine tube is enlarged at an intermediate portion thereof, and the inside diameter of the intermediate portion can accommodate to a section size of a support part of the intraocular lens.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a needle with an ultrafine tube for intraocular lens intrascleral fixation used for installing an intraocular lens in the eye.

  It is widely practiced to implant an artificial intraocular lens instead of a lens whose function has been impaired by cataracts or the like. In normal cataract surgery, the lens in the eye is removed while leaving the lens capsule that supports the lens, and an intraocular lens is inserted into the lens capsule.

  The intraocular lens used at this time is generally composed of a lens part (optical part) and a support part that positions and supports the lens part in the eye. The optical part is circular and has a diameter of about 5 to 7 mm, and a folding intraocular lens is used to insert the optical part from a small wound. The folding lens, called Foldable IOL, was initially made of silicone, and then a material made of soft acrylic has been developed for the purpose of providing a variety of other functions from a smaller wound area. . The optical part and the support part are made of different materials or the same material. For example, there is an intraocular lens described in Non-Patent Document 1.

  Under such circumstances, the capsular bag remains severely damaged during cataract surgery, and the insertion of the intraocular lens into the capsular bag may not be successful. In this case, it is necessary to perform an operation for embedding the support portion of the intraocular lens into the sclera that becomes the wall of the eyeball, and intraocular lens intrascleral fixation. According to this intrascleral fixation, it is necessary to pull out the support portion of the lens placed in the eye out of the eye.

  As a conventional method, a hole is made in the eyeball, a forceps is inserted through the hole, and the support part is grasped and pulled out. As in Non-Patent Document 2, a sharp needle such as an injection needle having a lumen is applied to the eyeball. There has been a technique of pricking, inserting a support part into the lumen, and pulling out the support part together with a sharp needle. However, in both methods, it is necessary to capture the support portion in the eye, and only a skilled operator can perform the operation.

  Further, as an instrument widely used when the lens capsule is not damaged, an intraocular lens insertion device as disclosed in Non-Patent Document 3, for example, is known.

Attached document "Eternity" Medical device approval number: 21900BZX00947000 Revised in October 2015 (5th edition) Back chamber lens JMDN code: 35658100 [Manufacturer / Seller] Santen Pharmaceutical Co., Ltd. Sutureless 27-Gauge Needle-Guided Intrascleral Intraocular Lens Implantation With Lamellar Scleral Dissection, S Yamane, M Inoue, A Arakawa, and K Kadonosono, Ophthalmology 121 (1), 61-66. 2013 Oct 20. Attached document “Acject” certification number: 223AIBZX00014000 Revised July 1, 2013 JMDN code: 36061002 Single-use intraocular lens inserter [Manufacturer / Seller] Santen Pharmaceutical Co., Ltd.

  The present invention provides a needle with an ultrathin tube for intrascleral fixation of an intraocular lens.

  The needle with an ultrafine tube for intraocular lens intrascleral fixation of the present invention is formed by joining an ultrafine tube and a needle suitable for penetrating the eyeball. One end of the ultrafine tube and the needle are joined at the end of the needle. The inner diameter of the ultrafine tube is preferably 0.1 to 0.4 mm, and the needle diameter is preferably 0.2 mm to 0.5 mm.

  In addition, this ultra-thin tube can be made to correspond to the cross-sectional size of the support part of the intraocular lens by increasing the thickness at the intermediate part. Moreover, the marking for a cutting | disconnection demonstrated below can be provided.

It is a top view of the needle | hook with an ultrafine tube concerning one Embodiment of this invention. It is a top view of the needle | hook with an ultrafine tube concerning another form of this invention. It is a schematic diagram which shows the usage example of the needle | hook with an ultrafine tube of this invention.

  FIG. 1 is a plan view of a needle with an ultrathin tube for intraocular lens intrascleral fixation according to one embodiment of the present invention. According to this embodiment, the ultrathin tube 2 is joined to the straight needle 1. As the ultrathin tube 2, a commercially available ultrathin tube made of a synthetic resin such as silicone or silicon rubber can be used. As the ultrathin tube 2, various materials can be used as long as conditions such as an inner diameter, an outer diameter, flexibility and strength are met. Such extra-fine tubes (also sold as “microtubes”) are sold by, for example, As One Corporation. The inner diameter is 0.1 mm to 0.4 mm, and the outer diameter is preferably 0.2 mm to 0.5 mm corresponding to the inner diameter. However, an appropriate inner diameter can be selected depending on the thickness of the support portion of the intraocular lens to be used. In general, the inner diameter is 0.2 mm and the outer diameter is 0.3 mm. Considering the size of the cornea, the length of this ultrafine tube is at least 30 mm or more, and there is no particular upper limit. For example, 10cm would be enough.

  Various needles for ophthalmic surgery are used, including round needles with round cross-sections, triangular square needles, straight straight needles, curved needles, and needles with silicone surface treatment. However, although any type of needle can be used, a straight needle having a round cross-sectional shape can be preferably used. Stainless steel is generally used and can be made by cutting a stainless steel rod. A needle having a diameter of about 0.2 mm to 0.8 mm can be used, but 0.2 to 0.5 mm is preferable. The length of the needle is generally 12 mm to 20 mm, preferably 14 mm to 18 mm. The joining of the ultrafine tube and the needle can be performed using a conventional technique used for manufacturing a suture with a needle. In other words, a fine hole is made at the end of the needle using a laser or the like along the axis of the needle, the ultrathin tube is pushed into the needle, pressure is applied to the end, and the ultrathin tube is pressed into the collapsed hole. Like that. In FIG. 1, a straight needle having a diameter of 0.3 mm and a length of 1.5 cm is shown.

  As shown in FIG. 2, the ultrathin tube can be thickened at the intermediate portion thereof, and the inner diameter of the intermediate portion can correspond to the cross-sectional size of the support portion of the intraocular lens. Moreover, the marking for cutting | disconnection can be provided to the intermediate part. This can be applied with ink that is familiar to silicone and does not easily fade. By doing in this way, the ultra-thin tube described below can be easily cut at an appropriate position.

  For example, as described in Non-Patent Document 1, in addition to an intraocular lens having a support portion made of a material different from the optical portion, an intraocular lens in which the optical portion and the support portion are made of the same material is also frequently used. ing. Such intraocular lenses are often shaped so that the cross-section of the support is large. In order to cope with such an intraocular lens, as shown in FIG. 2, it is conceivable to increase the inner diameter of the intermediate portion of the ultrathin tube. For example, the inner diameter of the intermediate portion can be 0.2 mm to 0.6 mm. The end portion of the support portion can be folded and housed within this inner diameter. This makes it possible to easily insert and position an integrated intraocular lens having the same material for the optical part and the support part while keeping the degree of invasiveness to the eye to a minimum. Furthermore, by marking the thickened intermediate portion, the position to be cut can be reliably recognized, and the ease and certainty of the surgical procedure can be further improved.

  Next, with reference to FIG. 3, the usage aspect of the needle | hook with an ultrafine tube of this invention is demonstrated. First, as shown in FIG. 3A, the needle 1 is inserted from the side of the sclera of the eye and inserted to the center of the eye. A 27 gauge needle with a lumen from the opposite side of the sclera (27G: outer diameter 0.41 ± 0.02mm, inner diameter) Pierce a needle such as 0.22 ± 0.03mm). The 27 gauge needle and the needle 1 with the ultrafine tube are docked in the eye. When the 27 gauge needle is pulled out together with the needle with the ultrathin tube, only the ultrathin tube 2 remains in the eyeball. FIG. 3A shows a state in which a 27 gauge needle is pulled out from the eye. Then, the ultrathin tube in the eyeball is pulled out of the eye from a direction perpendicular to the penetration direction. This can be easily performed by hooking the ultrafine tube using a micro forceps or using a lens hook or the like for adjusting the lens position in the eye. This operation can be performed by any operator who can perform normal cataract surgery. FIG. 3B shows a state in which the ultrathin tube is dragged out of the eye. If the extra-fine tube is pulled out of the eye, it can be cut at an appropriate position, and the end of the intraocular lens support can be inserted inside the cut end of the extra-fine tube to join the extra-fine tube and the support. it can. This operation is performed outside the eyes for both of the pair of support portions. This means that the bonding can be performed outside the eye, and the operation can be performed with a degree of invasiveness that is incomparably low compared to the degree of invasiveness when trying to secure the end of the support portion in the eye in an exploratory manner. . Unlike (a), in (b), the pupil is outlined so that the state of the fine tube can be easily understood.

  After the joining, the intraocular lens can be gently inserted into the eye and the opposite side of the part where the intraocular lens support is joined can be pulled out of the eye. Finally, an incision is created in the sclera in a pocket shape, and the intraocular lens support is pulled out and embedded in the scleral pocket, so that the intraocular lens can be fixed at a predetermined position in the eye.

  In this way, operations performed in the eye can be minimized, physical damage to the eye can be minimized, and a procedure that does not depend on the skill level of the operator can be performed. The needle with an ultrathin tube of the present invention enables an epoch-making procedure with a low degree of invasiveness compared to the conventional surgical methods.

Claims (3)

  A needle with an ultrafine tube for intraocular lens scleral fixation, comprising an ultrafine tube and a needle, wherein one end of the ultrafine tube and the needle are joined at the terminal end of the needle.   The needle with an ultrafine tube for intraocular lens intrascleral fixation according to claim 1, wherein the inner diameter of the ultrafine tube is 0.1 to 0.4 mm, and the diameter of the needle is 0.2 mm to 0.5 mm.   The needle with an ultrafine tube for intraocular lens sclera fixation according to claim 1, wherein the inner diameter of the ultrathin tube is large at a certain distance from the needle, and there is a marking in the vicinity of the center of the expanded inner diameter portion.

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