JP3639963B2 - Laser surgery equipment - Google Patents

Description

[0001]
[Industrial application fields]
The present invention relates to a laser surgical apparatus having a handpiece provided with a probe to be inserted into an irradiated portion, and is particularly suitable for an intraocular surgical apparatus such as cataract and glaucoma, and a distal end portion to which laser light is emitted is provided. The present invention relates to a laser surgical apparatus configured so that the fiber part and the intraocular tissue do not come into contact with each other even when broken by laser energy or the like, and the connection part of the fiber part is not easily damaged by the laser energy.
[0002]
[Prior art]
For cataract patients whose lens has become cloudy, there is currently no effective treatment to clear the lens, and surgery to remove the cloudy lens is necessary to recover the loss of vision. It must be made.
[0003]
In recent years, an ultrasonic emulsification and aspiration technique has been widely practiced as a surgical method for cataracts. Although this ultrasonic emulsification and aspiration technique is limited to a soft lens nucleus, a lens nucleus splitting method has been proposed, and an ultrasonic emulsification and aspiration technique is also performed on a hard lens nucleus.
[0004]
In other words, the lens nucleus splitting method is designed to inject a certain amount of perfusate between the layers of the lens cores that are laminated before the ultrasonic emulsification aspiration operation, to separate the layers and soften the lens nucleus. is there. Ultrasonic emulsification and aspiration is performed by applying ultrasonic waves of about 27 to 55 KHz while injecting a perfusate to generate cavitation, and the mechanical destruction action destroys the cataractous lens tissue, which is emulsified. The lens nucleus tissue and perfusate are aspirated.
[0005]
For a relatively soft lens nucleus, first, the anterior lens capsule is incised, and the cataractous lens tissue is destructively sucked by ultrasonic emulsification and suction. And the operation which inserts an artificial lens in the remaining lens capsule is performed. As a method for incising the anterior lens capsule, a circular incision method is widely used. This is because the opening is symmetrical, the anterior capsule margin is hard to crack, and there are few obstacles to the eye tissue. In addition, since the inserted artificial lens is kept stable, it is said that there is little decrease in visual acuity after surgery due to the axis deviation of the artificial lens.
[0006]
In addition, for phasic nuclei with advanced cataracts, capsulotomy (total pneumonectomy) has been performed in which the capsular capsule is completely removed without incision of the anterior lens capsule or ultrasonic emulsification. Has been implemented. However, the capsulotomy has a problem that the crystalline lens capsule does not remain, so that the artificial lens cannot be fixed in the eye in a stable state. For this reason, a hydrodynamic separation method (HYDRODELATIONATION) is performed in which the tip of a thin wire is vibrated with ultrasonic waves, a perfusion solution BSS (BALANCED SALT SOLUTION) is injected from the tip, and the layers of the lens nucleus are separated.
[0007]
In order to remove the cataract lens tissue in the eye, a handpiece using a laser beam has been developed. The handpiece includes a handpiece body, a means for transmitting laser light having a wavelength corresponding to the absorption peak of water, a perfusion means for perfusing perfusate, and aspiration of tissue evaporated by the laser light. Suction means.
[0008]
A probe for a laser knife is attached to the handpiece, and there is a probe that uses a crystal body such as ZnSe as a fiber support member to protect the emission end face of the fiber.
[0009]
In addition, a fiber with an outer diameter equal to or larger than the laser power transmission fiber is attached to the tip of the probe to protect the end face of the power transmission fiber and to focus or diverge the emitted laser light. There was also a fiber to let it go.
[0010]
[Problems to be solved by the invention]
However, the probe used in the above-mentioned conventional handpiece has a complicated fiber tip protection member attached to the probe tip, and the fiber tip protection member is processed with high precision in order to increase the sealing effect of the fiber tip. There is a problem that it is difficult to reduce the diameter of the flow.
[0011]
That is, in order to perform precise intraocular surgery using a laser probe, it is necessary to reduce the beam diameter of the laser beam to be irradiated by making the core diameter of the tip portion as small as possible. However, the laser light emitted from the tip of the optical fiber spreads from the entire surface of the core at an angle defined by the numerical aperture of the fiber, so even if the tip of the fiber is processed into a convex lens shape or a convex lens is provided at the tip This is because it is difficult to focus the laser beam to be irradiated smaller than the fiber core diameter.
[0012]
Moreover, although the above-mentioned fiber support member is made of a crystal such as ZnSe, it is not harmless to the human body, and there is a problem that it is not suitable as a fiber end probe to be inserted into the human body. .
[0013]
In addition, handpieces using laser light can use infrared laser light with a wavelength of about 2.9 μm, but infrared laser light with a wavelength of about 2.9 μm has a sharp absorption spectrum of —OH groups. Therefore, there is a problem that transmission using, for example, quartz fiber containing —OH group as a component is impossible.
[0014]
And 2J / cm, which is enough energy to act on the living body as a laser knife.²As a fiber capable of transmitting more than about (energy of working surface in infrared laser light having a wavelength of about 2.9 μm) or more, a fiber mainly composed of zirconium fluoride glass is said to be optimal at present. However, since the zirconium-based fluoride glass fiber slightly dissolves in water and produces fluoride, there is a problem that it cannot be inserted into the human body without being coated.
[0015]
Furthermore, when a zirconium-based fluoride glass fiber is used for the fiber part in order to guide infrared laser light having a wavelength of about 2.9 μm to the irradiated part, the connection part between the fiber part and the tip part is a laser beam. There is a problem that not only the tip part may be destroyed by the thermal energy but also the fiber part may come into contact with the living tissue when it is destroyed, which is not harmful to the human body.
[0016]
And, the dehydrated epoxy adhesive used for laser scalpels has a molecular weight of 200,000 to 300,000 as the main agent, a molecular weight of 20,000 to 30,000 as the curing agent, and an initial viscosity of mixing. It has a characteristic of 5 to 7 Pa · S (5000 to 7000 cP), and is, for example, Devcon 2-Ton Epoxy 2 hour curing type. Normal epoxies are mainly composed of amines and epoxies with large molecular weights, but they also contain many amines and epoxies with small molecular weights. If this epoxy is used as it is for bonding zirconium-based fluoride glass fibers, the low molecular weight amine, epoxy, and zirconium-based fluoride glass fibers cause a chemical reaction until the epoxy is cured, and the zirconium-based fluoride glass fibers. There has been a problem that the durability against laser energy of the chemical glass fiber is remarkably lowered.
[0017]
In addition, when these epoxies are used as adhesives, the connection portion of the first fiber portion may be destroyed before the second fiber portion formed at the tip portion by the thermal energy of the laser beam. For this reason, there is a problem that an expensive zirconium-based fluoride glass fiber must be frequently replaced.
[0018]
Recently, infection due to viruses and the like has become a problem, and it has become common sense that probes to be inserted into a living body are disposable. However, with conventional methods, it is not possible to make only the tip of a probe disposable. There was a problem that it was possible.
[0019]
Therefore, the core of the first fiber portion having a core diameter of 260 μm or less and the core of the second fiber portion at the tip can be accurately and easily aligned, and suitable for a disposable method of using the tip, The emergence of a connection technique between the first fiber portion and the second fiber portion that is excellent in durability has been strongly desired.
[0019]
[Means for Solving the Problems]
  The present invention has been devised in view of the above problems, and in a laser surgical apparatus having a handpiece provided with a probe to be inserted into an irradiated portion, the light from a laser light source having a wavelength corresponding to an absorption peak of water is A first fiber portion composed of a zirconium-based fluoride glass fiber for guiding to the handpiece, and connected to the first fiber portion at a connection surface, irradiated with light from the first fiber portion A second fiber portion for leading to the first portion, a first opening in which a small opening is formed near the end of the first fiber portion, and a large opening is formed at a position away from the end, and the first terminal A small opening is formed in the vicinity of the end of the fiber portion 2 and a second terminal having a large opening is formed at a position away from the end, and the first terminal and the second terminal are connected to each other. A split sleeve, a pair of cylindrical connecting portions having a large opening at one end and a small opening at the other end, and the first terminal and the first fiber portion are separated from the connection surface. A first fixing means for fixing with a dehydrated epoxy-based adhesive at a predetermined position, and the second terminal and the second fiber portion for fixing at a position away from the connection surface. It is comprised from the 2nd adhering means, The alignment with the said 1st fiber part and the said 2nd fiber part was made easy, It is characterized by the above-mentioned.
[0020]
  In the present invention, the laser light source may be an infrared laser light source having a wavelength of about 2.9 μm, and the second fiber portion may be made of anhydrous silica fiber.
[0021]
Furthermore, in the present invention, the first fiber portion has a core diameter of 40 μm to 260 μm, and the core diameter of the second fiber portion is the same as or larger than the core diameter of the first fiber portion. It can also be configured.
[0022]
In the present invention, the handpiece is configured to be separable into a tip portion and a main body portion, and a first fiber portion to which a first terminal to which a split sleeve is fixed is attached is attached to the main body portion. And a second fiber to which a second terminal is attached is provided at the distal end portion. When the distal end portion and the main body portion are separated from each other, the split sleeve is It can also comprise so that the protection function of the end surface of a fiber part may be fulfilled.
[0023]
In the present invention, the irradiated portion may be in the eye, and the laser surgical apparatus may be an intraocular surgical apparatus.
[0024]
DETAILED DESCRIPTION OF THE INVENTION
  In the present invention configured as described above, the first fiber portion composed of a zirconium-based fluoride glass fiber guides light from a laser light source having a wavelength corresponding to the absorption peak of water to the handpiece, The second fiber part connected to the first fiber part at the connection surface guides the light from the first fiber part to the irradiated part, and the first terminal is near the end of the first fiber part. A small opening is formed at a position away from the end, and a small opening is formed near the end of the second fiber part at the second terminal, and the position away from the end. Has a large opening, and the split sleeve connects the first terminal and the second terminal, and the pair of cylindrical connecting portions has a large opening at one end and a small opening at the other end. And the first fixing means has the first terminal and the first The fiber part is fixed with an epoxy adhesive dehydrated at a position away from the connection surface, and the second fixing means is a position at which the second terminal and the second fiber part are separated from the connection surface. The first fiber portion and the second fiber portion are easily aligned with each other.
[0025]
  In the present invention, the laser light source is an infrared laser light source having a wavelength of about 2.9 μm, and the second fiber portion is made of anhydrous silica fiber.
[0026]
In the present invention, the first fiber portion may have a core diameter of 40 μm to 260 μm, and the core diameter of the second fiber portion may be the same as or larger than the core diameter of the first fiber portion.
[0027]
According to the present invention, the handpiece is configured so that the tip portion and the main body portion can be separated from each other, and the main body portion is provided with a first fiber portion to which a first terminal to which a split sleeve is fixed is attached. The part is provided with a second fiber to which a second terminal is attached, and when the tip part and the main body part are separated, the split sleeve serves to protect the end face of the first fiber part. ing.
[0028]
In the present invention, the irradiated portion is in the eye, and the laser surgical apparatus can be an intraocular surgical apparatus.
[0029]
【Example】
[0030]
Embodiments of the present invention will be described with reference to the drawings.
[0031]
As shown in FIG. 1, the intraocular surgical apparatus 1 of this embodiment includes a handpiece 2, an intraocular probe 3, a distal end fiber 4 inserted through the intraocular probe 3, and the distal end fiber 4. It is comprised from the fiber 5 for connecting with the infrared laser light source 1000. FIG. And the intraocular surgery apparatus 1 is comprised so that the main-body part in which the fiber 5 was provided, and the front-end | tip part in which the front-end | tip part fiber 4 was provided are separable.
[0032]
An intraocular probe 3 is formed on the handpiece 2, and a distal end fiber 4 is inserted into the intraocular probe 3. The distal end fiber 4 is connected to the infrared laser light source 1000 through the fiber 5, and guides the infrared laser light generated by the infrared laser light source to the most distal portion of the intraocular probe 3. Incision of the intraocular tissue can be performed by the laser light emitted from the most distal portion of the intraocular probe 3. The inside of the eye corresponds to the irradiated part.
[0033]
The infrared laser light source generates an infrared laser having a wavelength of about 2.9 μm. In this embodiment, an Er / YAG (erbium yttrium aluminum garnet) laser light source is employed, but other laser light sources can be used.
[0034]
Here, the infrared laser beam for the living tissue will be described in detail.
[0035]
Laser light has different effects on a living body due to differences in wavelength, energy and power intensity, whether it is a continuous wave or a pulse wave, and the like. From these characteristics of action, the THEMAL region is classified into four regions, PHOTOCHEMICAL, THERMAL, PHOTOABLATIVE, and ELECTRO-MECHANIC, and used as a laser knife.
[0036]
The reason why the temperature of the biological tissue irradiated with the laser rises is that the temperature of the molecule rapidly rises when the rotational vibration band of the molecule that has absorbed the photon and is in a low excited state does not spontaneously emit. The combination of laser light wavelength, irradiation time, and irradiation area determines the depth of energy and the temperature of the tissue, and controls everything from cell activity suppression to protein melting, coagulation, carbonization, and transpiration. be able to.
[0037]
For example, an Ar laser can be solidified by raising the temperature of the retinal choroid to 60 to 70 ° C. with irradiation of several tens of milliseconds, and a continuous wave carbon dioxide laser raises the temperature of a living tissue to 100 ° C. or higher. Since the tissue is evaporated while creating a carbonized layer around it, it is used for open surgery where a hemostatic effect is expected.
[0038]
Furthermore, when a laser with a wavelength that matches the absorption peak of water, which is the main component of living tissue, is applied with high peak power and ultrashort pulse width, it can remove living tissue with little thermal damage. it can. Water has a strong absorption peak in the vicinity of a wavelength of 2.9 μm, and an HF laser (multispectrum 2.74 to 2.96 μm) that oscillates in the vicinity of this wavelength or an Er / YAG laser (wavelength 2.93). If 6 μm) is used, the living tissue can be excised with almost no thermal damage.
[0039]
As a condition that allows only the target biological tissue to evaporate without causing significant thermal damage such as protein denaturation or coagulation to the tissue adjacent to the excision, an infrared wavelength of about 2.9 μm is used. In laser light, it is known that EXPOSURE DULATION TIME is 1.7 μSEC or less.
[0040]
Therefore, when an infrared laser beam having a wavelength of about 2.9 μm and a pulse width of 1.7 μSEC or less is used, an incision process similar to that performed by a conventional metal knife can be performed under no pressure. In particular, in the intraocular surgical apparatus 1 as in the present embodiment, it is possible to cope with precise surgery by making the emission diameter of the infrared laser emitted from the most distal portion of the intraocular probe 3 as small as possible.
[0041]
Next, the handpiece 2 will be described in detail with reference to FIG. FIG. 2 is a cross-sectional view of the handpiece 2, and an intraocular probe 3 is disposed inside the handpiece 2.
[0042]
A distal end fiber 4 is inserted into the intraocular probe 3, and the distal end fiber 4 and the fiber 5 are connected by a connecting means 6. The fiber 5 corresponds to the first fiber portion, and the tip end fiber 4 corresponds to the second fiber portion. The connection surface that is the end surface of the tip end fiber 4 and the connection surface that is the end surface of the fiber 5 are connected by the connecting means 6.
[0043]
The connecting means 6 includes ferrules 61 a and 61 b, a split sleeve 62, and a coil spring 63.
[0044]
The ferrules 61a and 61b are connectors for holding the fiber. The ferrule 61a holds the distal end fiber 4 in the intraocular probe 3, and the ferrule 61b holds the fiber 5. The ferrule 61a The ferrule 61 b is connected by a split sleeve 62. As a result, the tip end fiber 4 and the fiber 5 are connected.
[0045]
Furthermore, the handpiece 2 includes a handpiece main body 21 and a cap member 22 for attaching to the handpiece main body 21. The handpiece main body 21 and the cap member 22 are screwed together by screw means 23. It is configured. Then, the coil spring 63 is inserted into the ferrule 61b from the direction of the fiber 5, and the cap member 22 is screwed into the handpiece main body 21, whereby the ferrule 61b is guided through the coil spring 63 and the ferrule 61a is guided using the split sleeve 62 as a guide. It comes to adhere to.
[0046]
The packing 64 and the filling adhesive 65 are for preventing moisture in the living body from entering the inside of the handpiece 2 from the gap 67 between the intraocular probe 3 and the handpiece body 21 at the time of surgery.
[0047]
Next, FIG. 3 is an enlarged cross-sectional view of the connecting portion between the tip end fiber 4 and the fiber 5 connected by the connecting means 6.
[0048]
One end of the ferrule 61a is open, and a small hole 611a is formed in the other end, and the distal end fiber 4 is inserted into the small hole 611a. Furthermore, a guide 68a is inserted into the opened one end so as to hold the tip end fiber 4.
[0049]
Similarly, the ferrule 61b has one end opened, and a small hole 611b is formed at the other end, and the fiber 5 is inserted into the small hole 611b. Further, a guide 68b is inserted into the opened one end so as to hold the fiber 5. The split sleeve 62 positions and connects the ferrule 61a and the ferrule 61b. The split sleeve 62 is fixed to the ferrule 61b by means such as an adhesive or a pin.
[0050]
The outer diameter of the ferrule 61a is usually φ = 2.499 ± 0.001 mm, and the eccentricity between the outer diameter of the ferrule 61a and the center of the small hole 611a is usually 0.0009 mm or less. The accuracy of the hole diameter is usually φ target value ± 0.001 mm.
[0051]
The fiber 5 used in the present embodiment is composed of a zirconium-based fluoride glass fiber having a core portion 501 of φ200 ± 5 μm and a clad portion of φ250 ± 5 μm. The ferrule is inserted through the guide 68b. It is inserted into the small hole 611b of 61b. The fiber 5 is fixed inside the ferrule with a filling adhesive 612b. Then, after peeling off the buffer layer 503 and polishing the end surface portion 504, the end surface portion 504 is inserted into the fiber 5. The buffer layer 503 is a protective layer formed for fiber protection.
[0052]
That is, the fiber 5 is fixed to the ferrule 61b corresponding to the first terminal by the filling adhesive 612b at a position away from the end surface portion 504 that is the connection surface. The filling adhesive 612b corresponds to the first fixing means. The fiber 5 provided with the ferrule 61b that is in contact with the ferrule 61a corresponding to the second terminal and to which the filling adhesive 612b is not applied has the buffer layer 503 peeled off and the end surface portion 504 is polished. It is configured.
[0053]
As the adhesive used here, for example, a two-component mixed Devcon 2-Ton Epoxy 2 hour curing type is adopted, and before mixing, for example, a dehydrating treatment such as Molecular Sieves 4A 1/16 is performed. This adhesive is characterized by a molecular weight of 200,000 to 300,000 of epoxy as a main agent, a molecular weight of 20,000 to 30,000 of an amine as a curing agent, and an initial mixed viscosity of 5 to 7 Pa · S (5000 to 7000 cP). In addition, the adhesive strength is high, and there is little cure shrinkage and a complete cure rate is excellent. This dehydration process almost completely removes amines, epoxies and moisture having a small molecular weight. If the dehydrated main agent and curing agent are accurately weighed to the unit of 0.1 mg using an analytical balance and mixed for use in adhesion, the complete cure rate is further improved, and zirconium-based fluoride Can be bonded to ferrules without chemically damaging the glass fiber.
[0054]
Further, the tip end fiber 4 of this embodiment has a core portion 401 of φ200 ± 5 μm and a clad portion 402 made of anhydrous silica fiber of φ240 ± 5 μm, and the end surface portion 404 is polished by peeling the buffer layer 430. After that, the guide 68a is inserted into the small hole 611a of the ferrule 61a. The tip end fiber 4 is inserted into the stainless steel tube 410 up to the ferrule inside 612a, and the tip end fiber 4 and the stainless steel tube 410 are fixed by a filling adhesive 420. The tip fiber 4 is fixed together with the stainless steel tube 410 by the filling adhesive 420 inside the ferrule.
[0055]
That is, the distal end fiber 4 is fixed to the ferrule 61a corresponding to the second terminal by the filling adhesive 420 at a position away from the end surface portion 404 that is a connection surface. The filling adhesive 420 corresponds to the second fixing means. Further, the tip end fiber 4 provided with the ferrule 61a that is in contact with the ferrule 61b corresponding to the first terminal and is not coated with the filling adhesive 420 has the buffer layer 430 peeled off and the end face portion 404 is polished. Configured.
[0056]
Since the fiber 5 and the tip fiber 4 made of anhydrous silica fiber are not filled with an adhesive that absorbs infrared energy having a wavelength of 2.9 μm and generates heat, the fiber 5 is heated by heat. The effect is that there is very little risk of damage.
[0057]
As described above, after the front ends of the ferrule 61a and the ferrule 61b are polished, they are brought into contact with each other, and the ferrule 61a and the ferrule 61b are brought into close contact with each other by the split sleeve 62. Connection with the fiber 4 can be performed.
[0058]
The fiber 5 of the present embodiment may be a zirconium-based fluoride glass fiber having a core diameter of 40 μm to 250 μm, and the anhydrous quartz fiber of the tip end fiber 4 may have a core diameter larger than the diameter of the fiber part. The end surface portion 404 and the end surface portion 504 correspond to connection surfaces.
[0059]
As shown in FIG. 4, the connecting means 6 configured as described above has the core of the fiber 5 as shown in FIG. 4 even if the errors on the ferrule 61a side and the ferrule 61b side are all added in the opposite directions and the maximum error occurs. The amount of the part 501 coming off from the core part 401 of the distal end fiber 4 is extremely small. Even if it is removed, the connecting portion between the fiber 5 and the tip fiber 4 is not filled with an adhesive that absorbs infrared energy having a wavelength of 2.9 μm and generates heat. There is an effect that the risk of the fiber 5 being damaged is extremely small.
[0060]
The tip fiber 4 is made of anhydrous silica fiber having a relatively good transmittance of infrared laser light in the vicinity of a wavelength of 2.9 μm, and the fiber 5 made of zirconium fluoride glass fiber is made of a hand. It is connected inside the piece 2. This is because the zirconium-based fluoride glass fiber has a very good transmittance of infrared laser light with a wavelength of about 2.9 μm, but it is not harmless to the human body. This is because touching the living tissue must be avoided, and for this reason, the distal end fiber 4 needs to have a sufficient length in the axial direction. The zirconium-based fluoride glass fiber 5 is composed of a core portion 501 and a clad portion 502.
[0061]
By configuring as described above, it is possible to make disposable from the intraocular probe 3 including the handpiece 2 to the ferrule 61a on the distal end fiber 4 side. Connections can always be made precisely.
[0062]
Here, from the intraocular probe 3 to the ferrule 61a on the distal end fiber 4 side corresponds to the distal end portion, from the ferrule 61b to the fiber 5 corresponds to the main body portion, and the ferrule 61b corresponds to the first terminal, The ferrule 61a corresponds to the second terminal. When the distal end portion and the main body portion are separated, the split sleeve 62 is fixed to the ferrule 61b, so that the end face of the fiber 5 is protected.
[0063]
In order to minimize the influence of shock waves on the corneal endothelium, when the infrared laser light having a wavelength of about 2.9 μm is irradiated in a pulsed manner, the energy irradiated by one pulse is: It is desirable to minimize. However, the energy density required to evaporate living tissue with infrared laser light having a wavelength of about 2.9 μm is 2 J / cm.²  The incision cannot be performed below this energy density. Therefore, in order to evaporate the living tissue and minimize the influence of the shock wave, it is necessary to minimize the irradiation area of the infrared laser light.
[0064]
In the present embodiment, since the diameter of the distal end fiber 4 is about 80 μm to 250 μm, the thermal effect on the eyeball due to laser irradiation in this case is theoretically considered.
[0065]
The cross-sectional area Ar of the sapphire rod 221a is
[0066]
π * (80/2 * 10^-Four)²≦ Ar ≦ π * (250/2 * 10^-Four)²
5 * 10^-Five ≦ Ar ≦ 4.9 * 10^-Four   (Cm² )
[0067]
It becomes.
[0068]
Therefore, the energy required to evaporate living tissue is 2 J / cm²The applied energy E is 2 J / cm² * Because it is Ar,
[0069]
0.1 mJ ≦ E ≦ 1.0 mJ
[0070]
It becomes.
[0071]
Furthermore, if the eyeball diameter is 24 mm, the eyeball volume is 7.2 cm.^Three If a circular incision with a diameter of 5 mm is made to the anterior lens capsule, the incision length S is
[0072]
S = 5 * π = 15.7 mm
[0073]
And the number of pulses required for this circular incision is
[0074]
(15.7 / (80 * 10^-3)) = 196 (when the diameter of the tip end fiber 4 is 80 μm)
[0075]
(15.7 / (250 * 10^-3)) = 63 (when the diameter of the tip fiber 4 is 250 μm)
[0076]
It becomes. And the temperature rise of the whole eyeball in this case is
[0077]
((0.1 * 10^-3* 4.2) cal * 196) /7.2 = 0.011 ° C
(When the tip fiber 4 has a diameter of 80 μm)
[0078]
((1.0 * 10^-3* 4.2) cal * 63) /7.2 = 0.037 ° C
(When the diameter of the tip fiber 4 is 250 μm)
[0079]
Thus, in the circular incision of the anterior lens capsule by the intraocular surgical apparatus 1 of the present embodiment, the adverse effect of heat on the eyeball can be almost ignored.
[0080]
Although described as an intraocular surgical device as described above, the present invention can also be applied to fields requiring precise tissue incision such as dentistry and plastic surgery.
[0081]
Furthermore, the present invention can also be applied to trabeculotomy, which is one effective treatment method for glaucoma.
[0082]
Further, the adhesive of this example is subjected to a dehydration treatment with a dehydrating agent, the molecular weight of the epoxy resin as the main agent is 200,000 to 300,000, the molecular weight of the amine as the curing agent is 20,000 to 30,000, and the initial mixed viscosity is 5 It has a characteristic of ˜7 Pa · S (5000 to 7000 cP). For example, a two-component mixed Devcon 2-Ton Epoxy 2 hour curing type is accurately weighed to a unit of 0.1 mg using an analytical balance and mixed. Since the material is used for bonding, the complete curing rate is further improved, and the zirconium-based fluoride glass fiber can be bonded to the ferrule without causing chemical damage.
[0083]
【effect】
  The present invention configured as described above is a first fiber portion including a zirconium-based fluoride glass fiber for guiding light from a laser light source having a wavelength corresponding to a water absorption peak to the handpiece. And a second fiber part connected to the first fiber part at the connection surface, for guiding the light from the first fiber part to the irradiated part, and the vicinity of the end of the first fiber part are A small opening is formed, and a small opening is formed in the vicinity of the end of the second terminal and the first terminal in which a large opening is formed at a position away from the end, and at a position away from the end. A second terminal having a large opening, a split sleeve for connecting the first terminal and the second terminal, a pair of cylindrical shapes having a large opening at one end and a small opening at the other end A connecting portion of A first fixing means for fixing the first terminal and the first fiber portion with an epoxy adhesive dehydrated at a position away from the connection surface; the second terminal; and the second terminal. Since the first fiber portion and the second fiber portion can be easily aligned with each other, the first fiber portion and the second fiber portion can be easily aligned.
[0084]
In addition, even when the tip portion made of the second fiber portion or the like is destroyed by the energy of the laser beam due to a failure accident or the like, the first fiber portion and the intraocular tissue that is the irradiated portion are not in contact with each other. effective. Therefore, there is an effect that a safe and precise incision operation can be performed on the eyeball tissue or the like.
[0085]
The laser light source may be an infrared laser light source having a wavelength of about 2.9 μm, and the first fiber portion is made of a zirconium-based fluoride glass fiber, and the second fiber portion is made of an anhydrous silica fiber. You can also
[0086]
Furthermore, the core diameter of the first fiber portion may be 40 μm to 260 μm, and the core diameter of the second fiber portion may be larger than the core diameter of the first fiber portion.
[0087]
The hand piece is configured to be separable from the tip and the main body, the first fiber portion to which the first terminal to which the split sleeve is fixed is attached is formed in the main body, and the second terminal is attached. Further, when the second fiber is formed at the tip portion and the tip portion and the main body portion are separated, there is an effect that the split sleeve can perform the protective function of the end face of the first fiber portion. And it becomes possible to use only a front-end | tip part disposablely, and has the outstanding effect that prevention of infection, such as a virus, can be aimed at.
[0088]
The first fiber portion is fixed to the first terminal with an adhesive at a position away from the connection surface, and the first terminal of the portion that is in contact with the second terminal and is not coated with the adhesive Can be constituted by previously peeling the buffer layer for protecting the fiber and polishing the end face. Further, the second fiber portion is fixed to the second terminal by an adhesive at a position away from the connection surface, and the second terminal of the portion that is in contact with the first terminal and is not coated with the adhesive is Alternatively, the fiber protection buffer layer may be peeled off in advance, and the end face may be polished. Therefore, the connecting portion between the first fiber portion and the second fiber portion is not filled with an adhesive that absorbs infrared energy having a wavelength of 2.9 μm and generates heat, and the fiber is heated by heat. Has the outstanding effect that there is very little risk of damage.
[0089]
If the irradiated portion is in the eye and the laser surgical device is an intraocular surgical device, there is an effect that it is optimal for ophthalmic surgery.
[0090]
[Brief description of the drawings]
FIG. 1 is a diagram illustrating an intraocular surgical apparatus 1 that is an embodiment of the present invention.
FIG. 2 is a cross-sectional view of the handpiece 2 of the present embodiment.
FIG. 3 is a cross-sectional view illustrating connecting means 6 of the present embodiment.
FIG. 4 is a cross-sectional view illustrating a connecting portion of fibers according to the present embodiment.
[Explanation of symbols]
1 Intraocular surgery device
2 Handpiece
21 Handpiece body 21
22 Cap members
23 Screw means
3 Intraocular probe
4 End fiber
401 Core part
402 Clad part
404 End face
420 Filling adhesive
430 Buffer layer
5 Fiber
501 Core part
502 Clad part
503 Buffer layer
504 End face
6 connection means
61a Ferrule
61b Ferrule
611a Small hole
611b Small hole
612b Filling adhesive
62% sleeve
63 Coil spring
64, 65 Filling adhesive
68a guide
68b guide
1000 Infrared laser light source

Claims (5)

In a laser surgical apparatus having a handpiece provided with a probe to be inserted into an irradiated part, from a zirconium-based fluoride glass fiber for guiding light from a laser light source having a wavelength corresponding to a water absorption peak to the handpiece A first fiber portion that is configured , a second fiber portion that is connected to the first fiber portion at a connection surface and guides light from the first fiber portion to an irradiated portion; and near the end of the first fiber portion is small opening is formed, at a position remote from the end portion and the first terminal a large opening is formed, near the edge of the second fiber portion is small opening is formed , a second terminal large opening is formed at a position remote from said end portion, and a split sleeve for connecting the said first terminal and the second terminal, while a large opening in the end And a connecting portion of the pair of cylindrical shape having a small opening at the other end, and said a first terminal a first fiber portion, by epoxy adhesive that has been dehydrated at a position apart from the connection surface First fixing means for fixing, and second fixing means for fixing the second terminal and the second fiber portion at a position away from the connection surface, A laser surgical apparatus characterized by facilitating alignment between the first fiber portion and the second fiber portion. The laser light source is an infrared laser light source having a wavelength of about 2.9 μm . The laser surgical apparatus according to claim 1 , wherein the second fiber portion is made of anhydrous quartz fiber .   The core diameter of the first fiber portion is 40 μm to 260 μm, and the core diameter of the second fiber portion is the same as or larger than the core diameter of the first fiber portion. 3. A laser surgical apparatus according to item 2.   The handpiece is configured to be separable into a distal end portion and a main body portion, and the main body portion is provided with a first fiber portion to which a first terminal to which a split sleeve is fixed is attached, The distal end portion is provided with a second fiber to which a second terminal is attached. When the distal end portion and the main body portion are separated, the split sleeve is formed on the end surface of the first fiber portion. The laser surgical apparatus according to claim 1, which is configured to perform a protective function. The laser surgical apparatus according to any one of claims 1 to 4 , wherein the irradiated portion is in the eye and the laser surgical apparatus is an intraocular surgical apparatus.

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