JP4616106B2 - Corneal surgery device and head portion used by being attached to main body of corneal surgery device - Google Patents

Description

  The present invention relates to a corneal surgical apparatus that peels a corneal epithelium in a flap shape, and a head unit that is used by being mounted on a main body of the corneal surgical apparatus.

As a corneal refraction surgery, there is a technique called LASIK (laser in-situ keratomileusis) in which a portion from the corneal epithelium (epithelium) to the stroma is incised and a flap is created, and then the parenchyma is irradiated by laser irradiation. In recent years, a new technique called Epi-LASIK has been proposed in which only the corneal epithelium is peeled off to create a flap (hereinafter also referred to as corneal epithelial flap), and then the laser beam is irradiated to remove the substance. Has been. An apparatus for Epi-LASIK for creating a corneal epithelial flap has also been proposed (see, for example, Patent Document 1). In this apparatus, a corneal epithelial flap is created by moving a blade vibrated at high speed in the blade width direction to a predetermined position in the corneal epithelial peeling direction. After creating the corneal epithelial flap, the blade is moved in the direction opposite to the peeling direction and returned to the initial position.
JP 2003-175071 A

  The Epi-LASIK apparatus described above may or may not include a corneal presser that presses the cornea substantially flatly before the blade to be moved. The former has the advantage that the corneal epithelium can be exfoliated uniformly, but there is a possibility that the corneal epithelium flap may be broken or stretched due to friction with the corneal presser when the blade is returned to the initial position after the corneal flap is created. There is a point. On the other hand, the latter has no problem like the former, but has a problem that the corneal epithelium may not be peeled uniformly.

  In view of the above problems, it is an object of the present invention to provide a corneal surgery device capable of creating a good corneal epithelial flap, and a head portion used by being mounted on a main body portion of the corneal surgery device. .

  In order to solve the above problems, the present invention is characterized by having the following configuration.

(1) A blade for peeling the corneal epithelium, a vibration mechanism for vibrating the blade in the blade width direction, and a feed mechanism for moving the blade in the peeling direction of the corneal epithelium. In the corneal surgery device to be created, a corneal presser that is moved in the peeling direction by the feeding mechanism and presses the cornea substantially flatly prior to the blade, and the corneal presser and the blade when moving the blade in the peeling direction. A presser supporting portion that supports the corneal presser so that the distance between the corneal presser and the blade is increased according to the movement when the blade is moved in the direction opposite to the peeling direction. It is characterized by having.
(2) In the corneal surgery apparatus according to (1), the blade has a head portion that is vibrated and is moved linearly in the peeling direction by the feed mechanism, and the presser support portion has a rotation axis perpendicular to the peeling direction. Is supported by the head portion so as to be rotatable around the center.
(3) In the corneal surgery apparatus according to (2), at least one of the presser support part and the head part has a rotation limiting part that limits the rotation of the presser support part in a direction approaching the blade. .
(4) A blade for peeling the corneal epithelium is held so as to be able to vibrate in the width direction of the blade, and is attached to the main body of a corneal surgical apparatus for creating a corneal epithelial flap, and the cornea is fed by a feeding mechanism provided in the main body. In the head part moved in the epithelial peeling direction, a corneal presser that presses the cornea substantially flatly before the blade, and the corneal presser supported by the head part and moving the blade in the peeling direction, Presser support that supports the corneal presser so as to increase the distance between the corneal presser and the blade in accordance with the movement when the blade is moved in the direction opposite to the peeling direction when the distance from the blade is kept constant. And a portion.
(5) The head portion of (4) is linearly moved in the peeling direction by the feed mechanism, and the presser support portion is supported by the head portion so as to be rotatable about a rotation axis perpendicular to the peeling direction. And

  According to the present invention, a good corneal epithelial flap can be created.

  Hereinafter, an embodiment of the present invention will be described with reference to the drawings. FIG. 1 is a schematic configuration diagram of a corneal surgery apparatus according to the present invention.

  Reference numeral 1 denotes a main body portion (handpiece portion) of the corneal surgery apparatus. On the front side of the main body 1 (left side in FIG. 1), a suction section 3 for fixing the main body 1 to the patient's eye and a blade 20 for peeling the corneal epithelium are held so as to be able to vibrate. And a head portion 2 that is moved straight up.

  In the main body 1, a feed motor 11 for moving the head portion 2 straight in the corneal epithelial peeling direction and a vibration motor 12 for vibrating the blade 20 in the blade width direction are incorporated. . A connecting member 14 is screwed to the feed screw 13 fixed to the rotating shaft of the motor 11, and the motor 12 and the connecting member 17 are fixed to the connecting member 14. Then, the motor 12 and the connecting member 17 are linearly moved in the front-rear direction through the screw 13 and the connecting member 14 by the forward / reverse rotation of the motor 11, and thus the head portion 2 is also moved linearly in the front-rear direction. A rotating shaft 15 fixed to the rotating shaft of the motor 12 is rotatably held by the connecting member 17, and an eccentric pin 16 is implanted at the tip of the rotating shaft 15 at a position deviated from the rotation center. Yes.

  FIG. 2 is an enlarged view of FIG. 1 regarding the head unit 2 and the suction unit 3. The head portion 2 includes a blade holder 21 a and a holder block 21 b that hold the blade 20 so as to be able to vibrate, and a first vibration transmission member 22 that converts the circumferential movement of the pin 16 caused by the rotation of the shaft 15 into vibration and transmits the vibration to the blade 20. And the second vibration transmission member 23, the corneal presser 24 that presses the patient's cornea prior to the blade 20, and the presser support portion 25 that supports the cornea presser 24, and the block 21b and the presser support portion 25. And connecting member 26 to be included. The block 21b is provided with a hole into which the shaft 15 is inserted, and the distal end portion of the connecting member 17 is fixed.

  As the blade 20, a metal blade using stainless steel, steel or the like as a cutting edge, a mineral blade using a mineral such as diamond or sapphire as a cutting edge, or the like is used. The blade 20 is held so as to be able to vibrate between the holder 21a and the block 21b at an angle of 25 degrees with respect to the horizontal plane. Further, as shown in FIG. 3, for example, the blade 20 has a shape with a blade tip height H of 1 to 50 μm and a corner radius R of 0.5 to 25 μm (see Japanese Patent Application Laid-Open No. 2003-175071). ).

  The holder 21 a has a shallow recess formed in a portion where the blade 20 is placed, and the width of the recess is larger than the vibration width of the blade 20. The holder 21a is detachably fixed to the block 21b with screws (not shown).

  The 1st transmission member 22 is hold | maintained so that a vibration is possible in the receiving groove formed in the block 21b. The first transmission member 22 is formed with a vertical groove 22 a that engages with the pin 16. When the shaft 15 is rotated by the rotation of the motor 12, the pin 16 that is engaged with the vertical groove 22 a is formed on the first transmission member 22. Motion force in a direction perpendicular to the rotation axis of the shaft 15 (hereinafter also referred to as a lateral direction) is applied. Thereby, the first transmission member 22 vibrates in the lateral direction.

  The second transmission member 23 is held in a receiving groove formed by the holder 21a and the block 21b so as to vibrate. The first transmission member 22 has a convex portion 22b below it, and the second transmission member 23 has a vertical groove 23a that engages with the convex portion 22b. When the first transmission member 22 vibrates in the lateral direction due to the rotation of the shaft 15 (the circumferential movement of the pin 16), the second transmission member 23 further moves in the lateral direction due to the vibration of the convex portion 22b engaged with the vertical groove 23a. Power is added. Thereby, the second transmission member 23 vibrates in the lateral direction, and the blade 20 fixed to the second transmission member 23 further vibrates in the lateral direction.

  The cornea presser 24 is provided on the front side (left side in FIG. 2) of the blade 20 and presses the cornea substantially flatly prior to the blade 20. The presser support portion 25 that supports the corneal presser 24 is supported by a connecting member 26 so as to be rotatable around a rotation pin 27 perpendicular to the peeling direction that is the rotation axis direction of the shaft 15. The connecting member 26 is fixed to the block 21b. This presser support portion 25 has a structure having a center of gravity on the front side of the pin 27 (a weight may be attached), and the corneal presser 24 is positioned on the blade 20 side of the pin 27. 24 is configured to support the corneal presser 24 so that a rotational force in the rear direction (B direction) is easily applied. Then, when the convex portion 25a formed on the block 21b side of the presser support portion 25 comes into contact with the flat surface 50 on the presser support portion 25 side of the block 21b, the presser support portion 25 rotates in the direction approaching the blade 20. The distance between the corneal presser 24 and the blade 20 is kept constant. The rotation restricting portion for restricting the rotation of the presser support portion 25 in the direction approaching the blade 20 may be provided in at least one of the presser support portion 25 and the head portion 2 (block 21b). For example, the corneal presser 24 side A convex portion may be provided on the block 21b.

  In order to separate the corneal epithelium from the Bowman membrane, the position of the blade tip of the blade 20 with respect to the lower surface of the corneal retainer 24 is positioned below the thickness of the corneal epithelium. The distance between the lower surface of the cornea presser 24 and the blade tip of the blade 20 is preferably 300 μm or less.

  The suction unit 3 includes a suction ring 31 and a suction pipe 32. A substantially cylindrical ring 31 that is in contact with the patient's eye is fixed to the main body 1 by a fixing member 30, and an opening 31 a is formed. When the ring 31 is placed on the patient's eye, the cornea protrudes from the opening 31a, and the lower end of the ring 31 and the opening end of the opening 31a are brought into contact with the patient's eye to secure the suction space S. The pipe 32 is fixed to the ring 31, and is connected to the pump 41 via a tube not shown. When the pump 41 is driven, air in the space S is sucked through the suction passage 32a inside the pipe 32, whereby the ring 31 is adsorbed and fixed to the patient's eye.

  The operation of the apparatus having the above configuration will be described. First, the ring 31 is placed on the patient's eye. Next, the pump 41 is operated to suck the air in the space S between the ring 31 and the patient's eye, and the ring 31 is adsorbed and fixed to the patient's eye. Next, the foot switch 42 is operated and the motor 12 and the motor 11 are rotationally driven by the control unit 40.

  The blade 20 is vibrated in the lateral direction by the rotational drive of the motor 12, and is moved in the peeling direction of the corneal epithelium together with the head unit 2 by the rotational drive of the motor 11. Due to the vibration and movement (feed) of the blade 20 and the shape of the blade edge, the corneal epithelium is peeled from the Bowman membrane below it, and a corneal epithelium flap is created.

  The cornea presser 24 is supported by the block 21b via the press support part 25 and the connecting member 26 so as to be rotatable in the peeling direction so as to press the cornea substantially flatly prior to the blade 20. When the head portion 2 moves forward, the reaction force from the cornea and the frictional force with the cornea cause the corneal presser 24 to apply a rotational force in the rear direction (B direction) about the pin 27. The convex portion 25a and the surface 50 of the block 21b limit the backward rotation of the presser support portion 25, and the distance between the corneal presser 24 and the blade 20 is kept constant. Thus, the cornea is pressed by the corneal presser 24, and a corneal epithelial flap having a uniform thickness can be created regardless of the corneal shape.

  When the creation of the corneal epithelium flap is completed (the state shown in FIG. 4A), the motor 11 is rotated in the reverse direction to retract the head unit 2 and return to the initial position. When the head part 2 is retracted, a reaction force from the cornea and a frictional force between the cornea and the corneal presser 24 are applied with a rotational force forward (A direction) around the pin 27, and the corneal presser 24 is in the epithelium. It will be in the state stopped at the position where formation of a flap was completed (state of Drawing 4 (b)). That is, when the blade 20 is moved in the direction opposite to the peeling direction, the presser support portion 25 supports the corneal presser 24 so that the distance between the corneal presser 24 and the blade 20 increases as the blade 20 moves. Thereby, when the head part 2 is returned to the initial position, friction between the corneal epithelium flap and the corneal presser 24 does not occur, so that the corneal epithelial flap can be prevented from being broken or stretched in any direction.

  When the head part 2 returns to the initial position, air is introduced into the space S and the ring 31 is removed from the patient's eye. Next, the portion where the corneal epithelium has been peeled is irradiated with a laser beam, and the refraction correction amount is removed. Finally, replace the corneal epithelial flap. As a result, the corneal refractive surgery is completed.

  Although the above description has been given of the configuration in which the presser support portion 25 that supports the corneal presser 24 is rotated in the peeling direction, that is, the forward / backward direction of the blade 20, it is not limited thereto. For example, a configuration as shown in FIG. 5 can be considered. In FIG. 5, a guide concave portion 36 for sliding the presser support portion 25 in the advancing and retreating direction of the blade 20 is formed in the connecting member 26, and the guide convex portion 37 that engages with the guide concave portion 36 is formed in the presser support portion 25. Is formed. In this case, when the blade 20 moves forward in the peeling direction, the guide convex portion 37 of the presser support portion 25 is moved from the cornea by the reaction force from the cornea and the frictional force between the cornea and the cornea presser 24. As a result, the distance between the cornea presser 24 and the blade 20 is kept constant. Accordingly, the cornea is pressed by the corneal presser 24, and a corneal epithelial flap having a uniform thickness can be created regardless of the corneal shape. On the other hand, when the blade 20 moves backward in the direction opposite to the peeling direction and returns to the initial position, the cornea presser 24 and the presser support portion 25 are caused to react by the reaction force from the cornea and the frictional force between the cornea and the cornea presser 24. It will be in the state stopped at the position where formation of epithelial flap was completed. Thereby, when the head part 2 is returned to the initial position, friction between the corneal epithelium flap and the corneal presser 24 does not occur, so that the corneal epithelial flap can be prevented from being broken or stretched in any direction.

  In the above, the configuration in which the rotational force of the motor is used as the driving force for the vibration of the blade 20 and the linear movement (feed) of the blade 20 (head portion 2) has been described, but the present invention is not limited to this. For example, the blade 20 (head unit 2) may be moved manually in a straight line. Air pressure may be used instead of the rotational force of the motor.

  Moreover, although the above demonstrated the structure by which the main-body part 1 and the head part 2 of the corneal surgery apparatus were connected and fixed, it is good also as a structure which can attach or detach the main-body part 1 and the head part 2. FIG. That is, the present invention can also be applied to a head portion that is used by being attached to a main body portion of a corneal surgery apparatus. That is, the present invention can also be applied to a so-called disposable head unit.

It is a schematic block diagram of the corneal surgery apparatus which concerns on this invention. It is an enlarged view of FIG. 1 regarding a head part and a suction part. It is a figure explaining the shape of the blade edge of a blade. It is a figure explaining operation | movement of a presser support part. It is a figure explaining the apparatus of 2nd Embodiment.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Main-body part 2 Head part 3 Suction part 11 Feeding motor 12 Vibration motor 20 Blade 24 Cornea presser 25 Presser support part 27 Rotating pin 36 Guide recessed part 37 Guide convex part

Claims (5)

A cornea having a blade for peeling the corneal epithelium, a vibration mechanism for vibrating the blade in the blade width direction, and a feeding mechanism for moving the blade in the peeling direction of the corneal epithelium, and creating a corneal epithelium flap In the surgical apparatus, a corneal presser that is moved in the peeling direction by the feed mechanism and presses the cornea substantially flatly before the blade, and a distance between the corneal presser and the blade when the blade is moved in the peeling direction. And holding the corneal presser so as to increase the distance between the corneal presser and the blade according to the movement when the blade is moved in the direction opposite to the peeling direction. A corneal surgery device characterized by the above. The corneal surgery apparatus according to claim 1, further comprising a head unit that holds the blade so as to vibrate and is moved linearly in the peeling direction by the feed mechanism, and the presser support portion is centered on a rotation axis perpendicular to the peeling direction. A corneal surgery apparatus, which is rotatably supported by the head unit. 3. The corneal surgery device according to claim 2, wherein at least one of the presser support portion and the head portion has a rotation restricting portion that restricts rotation of the presser support portion in a direction approaching the blade. . A blade for detaching the corneal epithelium is held so as to be able to vibrate in the width direction of the blade, and is attached to the main body of a corneal surgery device that creates a corneal epithelial flap, and the corneal epithelium is peeled off by a feeding mechanism provided in the main body. A corneal presser that presses the cornea substantially flatly prior to the blade, and the corneal presser and the blade that are supported by the head unit and move the blade in the peeling direction. A presser support portion that supports the corneal presser so as to increase the distance between the corneal presser and the blade according to the movement when the blade is moved in the direction opposite to the peeling direction. A head portion characterized by comprising: 5. The head according to claim 4, wherein the head portion is linearly moved in the peeling direction by the feed mechanism, and the presser support portion is supported by the head portion so as to be rotatable about a rotation axis perpendicular to the peeling direction. Department.