JP2765803B2 - Lens nucleus crushing / emulsifying apparatus and method for lens surgery - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to surgical procedures and techniques, and more particularly to apparatuses and techniques used for ophthalmic surgery and the like.

[0002]

BACKGROUND OF THE INVENTION Certain ophthalmic techniques require the removal of the lens nucleus and cortex. Such techniques are particularly needed in the case of cataract surgery.

[0003] At present, the most advanced lens nucleus extraction method is a lens ultrasonic suction method [Banko and Kelman (Banko and Kelman).
man) U.S. Patent Nos. 3,589,363 and 199.
A technique disclosed on pages 1-5 of Devine et al.'S "Phaco-emulsification Surgery" published by Permagon Press in 1 year. In this technique, a probe having a hollow tip (needle) that is vibrated in a vertical direction by a laminated metal plate (magnetostrictive exciter) or a transducer that is a crystal (piezoelectric) or an acoustic vibrator (ultrasonic) is used. A small incision is made in the cornea, and the tip of the lens ultrasonic aspiration device is inserted through the incision into a thin lens capsule supporting the opaque lens. Touch the chip to the lens nucleus,
High audio / super audio frequency of 27-64kHz, 50
Vibrate with an amplitude of ~ 60 microns. The hard nucleus of the lens is broken into fine particles by the chip, and is sucked and sucked through the chip. This technique, which is widely used, is known as `` lenpotomy '' or `` lens surgery, '' in which the lens nucleus and the surrounding cortex are removed and the outer lens, the lens capsule, is removed. In this way, it is possible to insert a plastic material or other substance, ie a substitute for the lens.

[0004]

However, this technique has certain disadvantages. First, because the vibrating tip exerts a longitudinal or vertical hammering effect, the lens nucleus moves away from the tip, and particularly the destroyed lens nucleus particles are pushed away from the very tip. Tend. For this reason, to maintain the lens nucleus close to the hammering tip and to aspirate these particles through the tip, a very strong vacuum (approximately 100
mm or more). Second, there is a risk that the chip itself or particles destroyed by the chip may break through the lens capsule. In such a case, the vitreous body inside the eyeball tends to leak from the resulting opening, and complications occur during the operation.

According to the discovery underlying the present invention, instead of a vertical, vertical hammering motion, a lateral, arcuate or rotational incision / defibrillation motion is performed on the lens nucleus. It has been found that all problems have been resolved and that the requirement for a rather strong vacuum to hold the lens nucleus, rather than merely sucking out the broken lens nucleus fragments, can be relaxed.

Accordingly, it is an object of the present invention to provide for lateral, arcuate or rotational oscillations in phacotomy or "lens" surgery in the destruction of the lens nucleus, rather than the prior art longitudinal hammering motion. Incision and destruction of the lens nucleus using this technique gracefully eliminates the disadvantages and problems associated with current hammering techniques, greatly enhances safety, and, if desired, reduces vacuum requirements. It is an object of the invention to provide new improvements and surgical instruments or devices that can be alleviated.

[0007] Other objects of the present invention are described below, and are particularly pointed out with particularity in the appended claims.

[0008]

According to the present invention, there is provided a lens surgery method for fracturing a lens nucleus and extracting the lens nucleus from the lens capsule, wherein a longitudinal axis probe for rupture having a hollow incision tip is provided on the lens capsule. Inserting into the lens through the incision to bring the chip into contact with the lens nucleus; vibrating the chip laterally across the longitudinal axis at high or super audio frequencies and abutting the lens nucleus Breaking the continuous layer of the lens nucleus while pressing the probe in the longitudinal direction toward the lens nucleus; sucking the shredded fragments through the hollow portion of the tip It provides a surgical method.

The present invention also provides a longitudinal probe having a hollow tubular dissecting tip extending along a longitudinal axis; the tip being super-audible in a longitudinal direction across the longitudinal axis over a small acute angle range. Means for vibrating rotationally at a frequency; means for intermittently controlling the vibration; means for applying a vacuum for suction to the hollow portion of the tip during the rotational vibration; It is intended to provide a nuclear destruction device.

According to one aspect of the invention, rather than a vertical, vertical hammering motion, the needle tip is pivoted at a very small angle in a horizontal plane from front to back or from side to side at high audio frequencies to super audio frequencies. (Hereinafter, this movement is collectively referred to as “rotational vibration”), and a conventional vertical or semi-circular incision is formed in the lens nucleus having a hard needle tip in a lateral or somewhat arcuate shape. Providing an improved lens "emulsifier" (or rupture device) with a built-in oscillating vibrator that performs lateral or shear defibrillation at a super-audio frequency different from the direction of hammering and piercing motion I do. A small circular incision in the longitudinal direction
Although rupture movements are preferred, in some cases more complete rotational vibrations, i.e., helical or helical rotational vibrations, are also conceivable.

[0011] A cutting edge may be provided at the end of the tip, and the cutting edge may be formed into a saw blade for convenience to improve the cutting ability. Regarding the rotational vibration of the tip, it is preferable that the lateral, arc-like or rotational vibration of the tip is performed by lever operation of the ultrasonic crystal, but the present invention is not limited to this. The tip end can be sharpened to increase the destructive force on the hard lens nucleus. Further, as described above, the sharp tip portion may be formed into a saw blade shape to improve the cutting ability.

Further, in the vibration of the chip, a linear vibration component in the vertical direction (a component close to the vertical direction) may be added to the horizontal or rotational operation.

In accordance with another aspect of the present invention, the step of applying a lens "emulsifier" (or defibrillator) to the hard lens nucleus of the eye as described above, and oscillating the chip to rotate the lens nucleus Destroying the eye.

[0014]

DESCRIPTION OF THE PREFERRED EMBODIMENTS Preferred and best modes for carrying out the present invention will be described below with reference to the accompanying drawings.

FIGS. 2 and 3 illustrate a lens "emulsifier" or a lens comprising a tubular elongated body 12 made of "Teflon" (registered trademark) or similar plastic which is dimensioned to be easy to hold and operate by the surgeon. 1 shows a disruption device 10. The tubular body 12 has an outlet neck 14 from which a tubular tip (needle) 16 having an inner diameter of about 1.5 mm and a wall thickness of 0.25 mm extends along the longitudinal axis. The exposed probe is protruding. The tip (not shown) of the tip 16 is sharpened, and preferably has a saw blade shape. The inner end of the tip 16 has a flange 20 for the purpose described below.
And a wide portion 18 having a non-circular, preferably rectangular, recess 21. A cap 24 having a wide portion 18 protruding from a central opening is screwed to the neck portion 14 to hold the flange 20, thereby fixing the distal end portion 16 rotatably on the neck portion.

As shown in FIG. 3, a substantially "Z" shaped core 22 preferably made of titanium is provided in the cylindrical body 12 to support the central shaft 24. As shown in FIG. The central shaft 24 penetrates the bearing 28 at the neck portion 14 as shown in FIG.
Non-circular end 30 that engages with recess 21 to transmit rotational motion
Has a convex end 26 having The inner bearing 32 is the main body 1
Acts on a central pin 34 at the rear end of the two, which also supports the central axis 24.

In FIG. 3, a pair of "Teflon" elongate suspension members 36 extend vertically inside the cylindrical body 12. A pair of ultrasonic crystals 38 contacting the arm end side surface 40 of the core 22 are disposed on the electrode member 36, respectively.
Each arm of the core serves as a ground electrode. In FIG. 3, a crystal body 38 is formed by the electrode.
A conventional foot pedal or other on / off switch, abbreviated as IS, connected to a power source, abbreviated as P, allows the surgeon to intermittently oscillate as needed as the surgeon progressively disrupts the lens. Or synchronized vibration. This vibration is transmitted to the core 22, and the core rotates back and forth at a super audio frequency of about 25 to 55 kHz within a very small acute angle of about 5 degrees in a plane transverse to the longitudinal axis of the probe and the tip. Move.

A well-known envelope (not shown) is placed around the inner end of the chip 16 so that the central chip 16
It is connected to a suction device that applies a suction force of mHg to suck out a substance located at the outer end of the chip 16.

This lens “emulsifier” or defibrillator 1
Numeral 0 is used to remove an opaque part in lens surgery. In such an operation, a small circular incision 4 having a diameter of about 3 mm is provided near the edge of the cornea 46 of the eye 48.
4 (see FIG. 1), a portion of the lens capsule 50 of the lens 52 is removed. From the incision through the opening of the lens capsule 50 to the internal cortex, the probe tip 1 of the device
6 is brought into contact with the hard lens nucleus 52. When the surgeon longitudinally abuts the device against the lens nucleus, rotational or oscillating vibration of the tip 16 causes a lateral incision such that the tip traverses a continuous layer of the hard lens nucleus. A continuous layer of the hard lens nucleus is fragmented or partially destroyed and a vacuum is applied to the tip cavity to be sucked out of the surgical site by the aspirated liquid. After the lens nucleus is destroyed and removed from the lens capsule in this way, a vacuum is applied to the chip, or the cortex around the lens nucleus is suctioned using a separate portable suction device. Thereafter, a lens substitute is inserted into the eye.

The lens "emulsifier" or defibrillator 54 shown in FIGS. 4 and 5 comprises four crystals 3 as shown in FIG.
2 and 3 in that 8 'is mounted on each of the four suspended electrode members 36'. The core portion 22 'has a corresponding cross shape. The tip 16 ′ is housed in a cylindrical envelope 56 as shown in FIG.
There is provided a conduit 58 for injecting the saline solution from I into the anterior chamber of the eye and sucking it out of W through the tip 16 '. The same structure can be adopted in the embodiments of FIGS. An opening 62 is provided at the inner end of the tip 16 ′ that communicates with the expansion chamber 63 near the rear end of the envelope 56.

The cylindrical body 12 'of the lens "emulsifier" 54
The rear end is constituted by a detachable cap 64 screwed to the main body 12 '. The cap is a center pin 34 '
And a conical bearing 66 which bears the rear end of the shaft 24 'is mounted on the center pin.

The method of using the lens "emulsifier" 54 is shown in FIG.
And 3 lens "emulsifier" 10.

The lens emulsifiers 10 and 54 as described above have been found to have a number of advantages. First
In addition, the rotational vibration does not have the "hamming" effect of the prior art linear vibrating lens "emulsifier" which tends to keep the broken lens nucleus or debris away from the chip. As a result, vacuum requirements are relaxed. Furthermore, the likelihood of a broken lens nucleus or a portion thereof being urged through the lens capsule and thus breaking it is greatly reduced, if not completely, reduced. It has been found that the operability of the device when the surgeon brings the chip into contact with the lens nucleus is higher and more reliable than the conventional hammering lens “emulsifier”. The device according to the invention can be operated very precisely and can also be operated intermittently by means of the foot-operated switch IS, as described above, making it easier for the surgeon to use than, for example, when the tip is constantly rotating at high speed. I understood.

When the apparatus shown in FIGS. 2 and 3 was operated at 20 kHz in an initial test conducted first on pig eyes and then on human eyes, it was particularly suitable for slicing, ie, rotationally oscillating. When the incision tip is brought into contact with the lens nucleus by the operator, the operability of the device is higher than in the case of the prior art vertical hammering technique, and the transverse slicing or shearing is more gentle. It was found that no fragments in the form of fragments as would be caused by destruction by the conventional vertical hammer "emulsification method" were found. Regarding the vacuum in the tip, its main purpose is not to keep the lens from moving out of place, as in the case of a longitudinal drilling operation,
It was found that a proper vacuum of the debris was sufficient, and a low vacuum of only 20 mm was sufficient, and that much higher vacuum was not required.

The detailed structure of the present invention is not limited to the above description and the accompanying drawings. For example, a suction device may be connected to a tube around the tip. As described above, linear fine vibration may be applied to the chip. A flat blade may be provided at the tip end. The chip may be vibrated laterally or rotationally by another means. Dimensions, speeds and pressures can be varied as needed. All such modifications are intended to be within the spirit and scope of the invention as set forth in the appended claims.

In summary of the present invention described above, in one important aspect, the present invention is a lens surgery method for rupture of a lens nucleus and excision from a lens capsule, comprising a hollow incision tip. Insert a longitudinal axis probe for defibrillation into the lens through an incision in the lens capsule and bring the chip into contact with the lens nucleus; while pressing the probe against the lens nucleus in the direction of the vertical axis, traverse the longitudinal axis. Vibrating the tip laterally at a high or super audio frequency to break up a continuous layer of the lens nucleus into fragments; and inspiring the fragments through the hollow portion of the tip. Is what you do.

[0027] The present invention provides a method for vibrating the incision needle or tip of a probe so as to traverse back and forth at a super-audible frequency, thereby breaking or "emulsifying" the lens nucleus, while at the same time hollowing the tip. It is applied to the improvement of the lens nucleus destruction technique and apparatus for phacosurgery in which debris is sucked through the part.

[Brief description of the drawings]

FIG. 1 is an enlarged diagram showing a patient's eye treated using the devices and techniques of the present invention.

FIG. 2 is a longitudinal sectional view showing a phacoemulsifier or defibrator according to the present invention.

FIG. 3 is a cross-sectional view of the device of FIG. 2;

FIG. 4 is a longitudinal sectional view of a device obtained by modifying the device of FIG. 2;

5 is a cross-sectional view of the device of FIG.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 10 ... Lens emulsifier 12 ... Body 16 ... Chip 36 ... Suspension part 38 ... Crystal P ... Power supply IS ... On / off switch 46 ... Cornea 48 ... Eye 50 ... Lens cap 52 ... Lens

Claims (7)

(57) [Claims] 1. A lens nucleus crushing apparatus for lens surgery, comprising: a probe extending in a longitudinal direction; a hollow tubular incision tip provided on the probe and extending along a longitudinal axis of the probe; the chip in a high audio frequency or ultra audible frequencies, the
Within a very small acute angle within a plane that crosses the vertical axis
For lens surgery and means for applying a vacuum for sucking in the hollow portion of the chip when rotating dynamic vibration; in time dynamically vibrated means and Ru was back and forth; the vibration intermittently and means for controlling Lens nucleus crushing device. 2. The lens nucleus crushing apparatus according to claim 1 , further comprising means for adding a longitudinal vibration component to the chip. 3. The frequency of the rotational vibration is about 25 to 5
While being adjusted in the range of 5 kHz, lens surgical lens nucleus Yabuhoso apparatus of claim 1 wherein the very small <br/> acute angle is about 5 degrees. 4. The lens nucleus pulposus for lens surgery according to claim 1 , wherein the vacuum is adjusted to about 20 mmHg. 5. The lens nucleus pulposus for lens surgery according to claim 1 , wherein the tip is provided with a saw-shaped cutting blade. 6. A salt solution through the hollow portion of the chip.
2. The lens nucleus crushing device for lens surgery according to claim 1 , further comprising means for injecting and sucking a liquid . 7. The lens nucleus pulposus for lens surgery according to claim 1 , wherein the rotational vibration is a spiral rotational vibration.