JP3779819B2 - Lens insertion device for intraocular insertion - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention is capable of deforming a deformable intraocular lens that is inserted in place of the crystalline lens after a lens is removed due to cataracts, a deformable visual acuity correction lens that is inserted into the eye only for the purpose of correcting visual acuity, etc. The present invention relates to an insertion device for inserting a lens for insertion into the eye into the eye.
[0002]
[Prior art]
In 1949, Ridley transplanted an artificial lens, i.e. an intraocular lens, into a human eye for the first time instead of a clouded lens during a cataract surgery, and then implanted an intraocular lens as a treatment for cataracts. Things have been done widely.
This first intraocular lens is an intraocular lens that uses polymethylmethacrylate (PMMA) as the material for the optical part. Many ophthalmologists are concerned about complications associated with intraocular lens implantation after cataract surgery. Although showing interest and addressing these issues, many of which have been resolved, the incision for implanting this intraocular lens is optical due to the inherent problem of using hard materials in the optics. Since a size somewhat larger than the diameter of the part is required, the incision made in the eyeball becomes large, and the problem of increased astigmatism after surgery cannot be solved.
[0003]
In addition, a surgical method was cited as one of the causes of the aforementioned problems. That is, the original cataract lens excision is performed by the cataract extracapsular excision (ECCE) in which the lens is removed as it is, and this surgical method requires an incision of about 10 mm. There was a problem of increasing astigmatism. In recent years, ultrasonic lens emulsification and suction (PEA) using an ultrasonic lens emulsification and suction device has emerged as a surgical method that causes astigmatism after surgery. This is a method of extracting a crystalline lens by pulverizing and emulsifying and sucking the lens that has become cloudy with an ultrasonic wave using a cylindrical ultrasonic chip. The retraction is a size only for inserting a cylindrical ultrasonic tip, and the incision can be removed with a lens of about 3 mm to 4 mm.
[0004]
Therefore, surgery to remove the cloudy lens during cataracts is possible with a small incision that reduces astigmatism after surgery, but transplants an intraocular lens that replaces the human eye lens. In intraocular lens insertion, due to the inherent problem that the optical part of the intraocular lens is made of a hard material, the insertion of the intraocular lens is somewhat less than the optical part diameter. Since an incision with a large incision size and a standard optical part diameter of 6.0 mm requires an incision of approximately 6.5 mm or more, a cloudy lens is removed from the small incision by ultrasonic phacoemulsification. However, in order to insert an intraocular lens, a small incision must be widened, and the problem of astigmatism after surgery caused by a large incision cannot be solved.
[0005]
For such a situation, for the purpose of reducing astigmatism after surgery, the improvement of an intraocular lens for reducing the incision, that is, the elliptical optical part for inserting the minor axis in the direction of the incision Intraocular lenses and small-diameter optical lenses with a smaller optical diameter have appeared, but the essential problem remains that the optical part is rigid. Only about 5.5mm and only 1mm were made small.
[0006]
However, further improvements have been made, and new intraocular lenses corresponding to the above-mentioned essential problems have recently been used. As shown in Japanese Patent Application Laid-Open No. 58-146346, a deformable elastic body that can be inserted from a small incision made in an eyeball and at least an optical part has predetermined memory characteristics is used. Appearance of an intraocular lens, or a deformable intraocular lens having a support portion made of a heterogeneous member that supports the optical portion in the eye, using an elastic body or the like in which at least the optical portion has a predetermined memory characteristic; JP-A-58-146346, JP-A-4-212350, JP-A-5-103803, JP-A-5-103808, JP-A-5-103809, JP-A-7-23990 In this way, the optical part of the deformable intraocular lens is compressed, rolled, bent, stretched, folded, and deformed to reduce the large shape before deformation to a small shape. The emergence of an insertion device that enables insertion through a small incision made in the eyeball. . With these deformable intraocular lenses and their insertion instruments, intraocular lens insertion is also possible with a small incision, and cataract surgery with a small incision that reduces astigmatism after surgery can be performed after the lens is removed. It has become possible to insert lenses for internal insertion.
[0007]
At least the optical part has a predetermined memory characteristic and the deformable intraocular lens is folded and deformed, for example, folded from a large shape to a small shape, and then passed through an insertion tube formed in a cylindrical shape into the eyeball. the prepared incision or al intraocular lens to be inserted into the eye, for example, using a insertion instrument shown in Japanese Patent 7-23990 discloses.
[0008]
To insert a deformable intraocular lens from a small incision using the insertion device, open the opening / closing mechanism of the holding member of the insertion device, insert the intraocular lens into the lens installation part, and open / close By closing the mechanism, the intraocular lens placed in the lens installation part is deformed from a large shape before deformation to a small shape, and the locking member attached to the instrument body is moved to the lens installation part side to open and close the opening / closing mechanism. By locking in the closed state, the intraocular lens is installed in the installation part. Thereafter, by operating the push-out mechanism of the insertion instrument, the push-out shaft is advanced, the intraocular insertion lens in the installation portion is pushed out, and the distal end of the insertion tube inserted into the incision through the insertion tube connected to the distal end side of the installation portion An intraocular lens is inserted into the eye. The shape of the insertion tube is a tapered taper so that an intraocular lens can be inserted from a smaller wound.
[0009]
In addition, inventions relating to the shape of the tip of the push-out shaft that is actually pushed out to insert the lens into the eye are also disclosed in Japanese Patent Laid-Open Nos. 8-19558 and 8-24282 by the applicant of the present invention. The shape disclosed here has such a shape that the optical part of the intraocular lens is scooped up and can be safely extruded without damaging the lens.
[0010]
[Problems to be solved by the invention]
However, as shown in the prior art, a deformable intraocular lens using a deformable elastic body having at least an optical part having a predetermined memory characteristic, or at least an optical part has a predetermined memory characteristic. Using a deformable elastic body, the deformable intraocular lens composed of different members that support the optical part within the eye is deformed from a large shape before deformation into a small shape to form a nozzle (cylindrical) tip The above-described insertion instrument for inserting an intraocular lens that can be deformed from a small incision made in the eyeball through the section has the following problems.
[0011]
When inserting an intraocular lens into the eye from the inside of the insertion tube using the push-out shaft, the shape of the tip of the push-up shaft scoops up the intraocular lens, or an intraocular lens for insertion more securely. It is desirable to have a shape that sandwiches the optical part. In addition, in order to insert an intraocular lens from a smaller wound opening, it is necessary to make the insertion tube into a tapered shape that narrows toward the distal end. If the tip of the tube is sized so as to conform to the inner diameter of the insertion tube, the insertion tube is inflated when moved to the tip of the insertion tube, and the meaning of taper is lost. On the other hand, when the size of the distal end portion of the extrusion shaft is determined in accordance with the inner diameter of the distal end portion of the insertion tube, the inner wall of the insertion tube is formed at the proximal end portion of the insertion tube where the distal end portion of the extrusion shaft contacts the intraocular lens. There is a disadvantage that a gap is formed between the lens and the lens for intraocular insertion, which cannot be reliably picked up or pinched. Furthermore, even if the diameter of the insertion tube is made constant to ensure the above-described function, the tip of the push-out shaft enters the lens due to the friction between the intraocular lens and the inner surface of the insertion tube. Therefore, there was a possibility that the original purpose could not be achieved.
[0012]
The present invention solves the above-described problems and provides a biasing means for biasing the distal end portion of the push-out shaft against the inner wall of the intraocular lens insertion cylinder so that the lens contact portion provided at the distal end portion is an eye. The main object is to provide an insertion device that prevents the lens from getting over the edge of the lens for internal insertion, prevents the lens from being damaged, and allows the lens to be inserted into the eye more reliably.
[0013]
[Means for Solving the Problems]
In order to achieve the above object, the present invention provides an intraocular lens having an insertion tube for inserting an intraocular lens into the eye and a push-out shaft that pushes the intraocular lens into the eye through the insertion tube. In the insertion instrument of the present invention, there is provided an urging means for urging the distal end portion having the lens contact portion provided at the distal end of the push-out shaft in a direction to press against the inner wall of the insertion cylinder, and the urging means includes a lens contact portion and It is characterized that you have provided in different portions.
In the present invention, the lens contact portion and the urging means may be provided in separate members coupled to the extrusion shaft. Further, the lens contact portion and the urging means may be provided integrally with the extrusion shaft. Further, the urging means may be a curved portion formed on the base end side with respect to the lens contact portion on the extrusion shaft. The urging means may be made of polypropylene.
[0019]
DETAILED DESCRIPTION OF THE INVENTION
FIG. 1 is a longitudinal sectional view of a deformable intraocular lens insertion instrument according to a first embodiment of the present invention, and the applicant of this patent application previously proposed except for the distal end side of an extrusion shaft 3 to be described later. This is the same as that disclosed by JP-A-7-23991. A male screw 1a is formed on the outer periphery of the base end portion of the cylindrical instrument body 1, and the male screw 1a is screw-fitted with a female screw 2a formed on the inner peripheral portion of the operation tube 2, thereby constituting an extrusion mechanism. It is.
[0020]
The push-out shaft 3 is inserted into the operation cylinder 2 substantially coaxially so as to be rotatable with respect to each other, and the push-out shaft 3 is not rotated by a rotation suppression mechanism (not shown) regardless of the rotation of the operation cylinder 2. 1 is movable in the longitudinal direction.
A holding member 4 is fixed to the distal end of the instrument body 1. The holding member 4 is formed by integrating a lens installation portion 4a and an insertion tube 5 having a tapered shape whose diameter decreases toward the tip, and is described in JP-A-7-23991. As described above, the deformable intraocular lens 8 is installed, folded and held. A slide stopper 6 for holding and holding the intraocular lens 8 is fitted and fixed to the main body 1. The intraocular lens 8 is formed of a deformable elastic body having predetermined memory characteristics, and is formed of a material different from the optical section 8a to support the optical section 8a in the eye. Although it consists of the support part 8b, what consists of the said optical part and the support part of the same material as this can also be used as a lens for intraocular insertion.
[0021]
The extrusion shaft 3 is formed of, for example, a synthetic resin having a sufficient strength. As shown in FIG. 2 which is an enlarged view, the extrusion shaft 3 has a spring property such as polypropylene and is made of a soft material. The tip tip 7 is a separate member from the extrusion shaft 3 and fixed by a method such as press-fitting or bonding. The tip 7 is provided in a portion different from the lens contact portion 7a, which is in contact with the intraocular insertion lens 8 and moves the intraocular insertion lens 8 as the push shaft 3 moves . It is composed of a biasing portion 7b as a biasing means for pressing the tip 7 against the inner wall of the holding member 4 or the insertion tube 5 by utilizing the spring property of the material, and is substantially horizontal V-shaped with the tip side expanding in the longitudinal section. It is in the shape.
As shown in FIG. 2, the urging portion 7 b has a hemispherical projection 7 c protruding above the distal end portion, and the force of the holding member 4 (insertion tube 5) by the force of spreading in the outer diameter direction by its own spring property. The protrusion 7c is in contact with the upper portion (one portion in the radial direction) of the inner wall, and is elastically deformed so that a force is applied downward in FIG. Then, even if the operation cylinder 2 is rotated and the pushing shaft 3 is moved leftward in FIGS. 1 and 2, the lower edge of the lens contact portion 7a (that is, the distal tip 7) is always held in the holding member 4 ( It is in contact with the lower part (the other part in the radial direction) of the inner wall of the insertion cylinder 5).
[0022]
FIG. 3 is a cross-sectional view taken along the line AA when the state of FIG. 2 is viewed from the left side of the drawing, and the lens contact portion 7a seems to have cut out the upper part of a circle having the same diameter as the thinnest portion at the tip of the insertion tube 5. It has a simple shape. By adopting such a shape, even if the insertion tube 5 is moved to the distal end portion, the insertion tube 5 is not inflated by the distal tip 7, so that the insertion tube 5 is not broken due to expansion.
[0023]
The operation tube 2 is rotated to move the pushing shaft 3 to the distal end side, and the intraocular lens 8 is moved to the distal end portion of the insertion tube 5 to obtain the state shown in FIG. FIG. As can be seen from these drawings, the urging portion 7 b is shaped to be elastically deformed and crushed along the insertion tube 5, and presses the lens contact portion 7 a against the inner wall of the insertion tube 5.
[0024]
As shown in FIG. 3, the shape of the lens contact portion 7a according to the first embodiment has a planar shape that is very close to the inner diameter of the holding member 4 and the insertion tube 5, so that the side of the deformable intraocular lens 8 can be obtained. It has a structure that pushes out the edges over a wide area. With such a structure, the contact area between the intraocular lens 8 and the lens contact portion 7a is increased, the pressure applied to the intraocular lens 8 is dispersed, and the distal tip 7 has a spring property as described above. Combined with a certain soft material, the lens for intraocular insertion can be prevented from being damaged or damaged, and the lens contact portion 7a can be secured to the holding member 4 by the urging portion 7b. Since the inner wall is brought into contact with the inner wall with a pressing force, it is possible to prevent the distal tip 7 from being encased in the intraocular lens 8 and damage the intraocular lens 8 at the corner of the distal tip 7.
[0025]
In addition, since the insertion cylinder 5 has a shape that decreases in diameter toward the distal end portion as described above, a larger force is required toward the distal end portion to move the intraocular insertion lens 8. Although the lens contact portion 7a as described above gets over the lens edge, there is an increased possibility of causing damage or damage to the intraocular lens. However, as in this embodiment, the biasing portion 7b is elastically deformed. If the structure is such that the lens contact portion 7a is pressed against the inner wall of the insertion tube 5, the pressing force becomes stronger as the inner diameter becomes smaller, and this can be prevented.
[0026]
In the first embodiment, the edge of the intraocular lens is pushed by a plane. However, as disclosed in, for example, JP-A-8-19558, the deformable intraocular lens is inserted. If the lens support part is composed of a separate member in the optical part of the lens, the optical part is supported by a deformable intraocular lens in which the optical part and the support part are made of the same material. Even if it has a tip shape that pushes out the intraocular lens by sandwiching each part by providing a protruding part, as disclosed in JP-A-8-24282, an optical part or a support part Even in the case of having a tip shape that scoops up, the function can be realized more reliably by providing the biasing means and pressing the tip portion against the inner wall of the insertion cylinder to move.
[0027]
In the first embodiment shown in FIGS. 1 to 5, another member called a tip is provided at the tip of the extrusion shaft, and an urging means is provided on this member. However, the second embodiment shown in FIGS. In order to make the structure simpler, the extrusion shaft 3 itself is made of a material having a spring property, and a distal end portion having a lens contact portion 3a and an urging portion 3b is integrally formed at the distal end of the extrusion shaft 3. It is.
[0028]
The insertion device for the intraocular lens of the second embodiment is constituted by a main body 1, an operation tube 2, an extrusion shaft 3, a holding member 4, an insertion tube 5, and a slide stopper 6, as in FIGS. is there. Said extrusion axis 3 is formed from a material having a spring property and softness due to elastic deformation as polypropylene, the shape of the tip portion of the extrusion shaft 3 as shown in FIGS. 6 and 7, the lens contact portion 3a and the lens contact the parts 3a are constituted by two parts that biasing portion 3b provided in the different parts. And also in the insertion instrument of 2nd Embodiment, the urging | biasing part 3b is elastically deformed as it moves to the front-end | tip part of the insertion cylinder 5, The force which always presses the contact part 3a side among the front-end | tip parts to the inner wall of the insertion cylinder 5 is provided. It can be generated.
[0029]
Although not shown in the drawing, the second embodiment has the same configuration as that of the second embodiment, and has a tip shape that sandwiches and pushes a deformable intraocular lens or a tip shape that scoops and pushes the intraocular lens. It is possible to have the same effect as that of the form.
[0030]
FIG. 8 is a partially enlarged longitudinal sectional view of the distal end portion of the pushing shaft of the insertion device for the intraocular lens according to the third embodiment of the present invention.
In this embodiment, as in the second embodiment, the lens contact portion 3 a is provided at the tip of the extrusion shaft 3. The lens contact portion 3a is shaped so as to be pushed up and pushed out at the edge of the lens for intraocular insertion as disclosed in Japanese Patent Application Laid-Open No. H8-24282 previously proposed by the applicant of this patent.
The intermediate portion of the push-out shaft 3 (a portion different from the lens contact portion 3a) is opposed to the direction in which the tip portion provided with the lens contact portion 3a is always pressed against the inner wall of the insertion tube 5 by 180 degrees. A bent portion 3c deformed into a shape bent or curved in the direction is provided to form a substantial biasing means.
[0031]
Unlike the first and second embodiments, in the third embodiment, since the distance between the lens contact portion 3a and the curved portion 3c is large, the friction between the intraocular lens 8 and the inner wall of the insertion tube 5 is large. Even in such a case, since the intraocular lens 8 is not elastically deformed and does not come into contact with the curved portion 3c, the possibility of damaging the intraocular lens 8 can be further reduced. In addition to the direction perpendicular to the inner wall of the insertion tube 5, the bending portion 3 c, which is the urging means, urges the lens contact portion 3 a toward the inner wall surface of the insertion tube 5. Since force is also applied in the traveling direction of the lens, it also has an effect of pushing the intraocular lens.
[0032]
Furthermore, in the third embodiment, since only the lens contact portion 3a is formed at the tip end portion of the extrusion shaft, the shape of the tip portion of the extrusion shaft can be simplified.
Of course, like the first and second embodiments, in the third embodiment, a tip shape that sandwiches and pushes the intraocular lens is inserted, and a tip shape that pushes the marginal portion of the intraocular lens in contact with a wide area. However, the effect of the third embodiment is not lost. Rather, since the curved portion 3c, which is the urging means, is separated from the lens contact portion 3a as described above, the shape of the lens contact portion 3a can be made more freely than in the first and second embodiments.
[0033]
【The invention's effect】
As described above, according to the present invention, since the lens contact part does not ride over the edge of the intraocular lens, prevents scratches or damage occurs in intraocular lens, to ensure the lens eye Can be inserted in.
[0035]
In addition, by the extruding axis, and a lens contact portion contact and biasing means to another member, it is possible to maintain strong strength of the extrusion axis.
[0036]
Further, if a biasing means and the extrusion axis and the lens contact portion integrally, the insertion device of the present invention can be realized with a simpler configuration.
[0037]
In addition, by providing a curved portion such as a bent or curved portion on the proximal end side of the lens contact portion on the push-out shaft , a substantial biasing means is formed, so that the insertion instrument of the present invention can be realized with a simple configuration. At the same time, it is possible to prevent the intraocular lens from being damaged by the contact between the intraocular lens and the biasing means.
[0038]
Furthermore, if the material of the biasing means and polypropylene, since the material has elasticity, and soft, without impacting the lens contact portion, it is possible to push the intraocular lens, damage of the lens Can be prevented more reliably.
[Brief description of the drawings]
FIG. 1 is a longitudinal sectional view showing an insertion device for an intraocular lens according to a first embodiment of the present invention.
FIG. 2 is a partially enlarged vertical sectional view of the insertion instrument shown in FIG.
3 is a cross-sectional view taken along line AA in FIG. 2;
4 is a longitudinal sectional view showing a state in which the push-out shaft of the insertion instrument shown in FIG. 1 is moved to the tip side. FIG.
FIG. 5 is a partially enlarged longitudinal sectional view of the insertion instrument shown in FIG.
FIG. 6 is a longitudinal sectional view showing an insertion device for an intraocular lens according to a second embodiment of the present invention.
FIG. 7 is a partially enlarged longitudinal sectional view of the insertion instrument shown in FIG.
FIG. 8 is a partially enlarged longitudinal sectional view of an insertion device for an intraocular lens according to a third embodiment of the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 The instrument main body 1a of the lens for intraocular insertion The male thread part 2 provided in the instrument main body 2 The operation cylinder 2a The internal thread part provided in the inner cylinder part of the operation cylinder 3 Extrusion shaft 3a Lens contact part 3b provided in the front-end | tip part of an extrusion axis | shaft Energizing portion 3c provided at the distal end of the extrusion shaft Extrusion shaft bending portion 4 provided behind the lens contact portion 4 Holding member 5 Inserting cylinder 6 Slide stopper 7 Tip tip 7a Lens contact portion 7b provided on the tip tip Provided biasing part 7c Hemispherical protrusion provided at the tip of the biasing part

Claims (5)

In an insertion device for an intraocular lens having an insertion tube for inserting an intraocular lens into the eye, and a push-out shaft that pushes the intraocular lens into the eye through the insertion tube,
Biasing means for biasing a tip portion having a lens contact portion provided at a tip of the push-out shaft in a direction of pressing the inner wall of the insertion tube ;
The urging means is provided in a portion different from the lens contact portion, and an insertion device for an intraocular lens.   2. The intraocular lens insertion device according to claim 1, wherein the lens contact portion and the urging means are provided in separate members coupled to the push-out shaft.   The insertion device for an intraocular lens according to claim 1, wherein the lens contact portion and the urging means are provided integrally with the push-out shaft.   The insertion device for an intraocular lens according to claim 3, wherein the biasing means is a curved portion formed on the proximal end side with respect to the lens contact portion on the push-out shaft.   The insertion device for an intraocular lens according to claim 1, wherein the biasing means is made of polypropylene.

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