JP4834337B2 - Anterior lens capsule cutter - Google Patents

Description

  The present invention relates to a cutter for an anterior lens capsule that is performed in cataract surgery.

  For cataract, a disease in which the lens becomes cloudy and impairs vision, the front part (anterior capsule) of the lens capsule is removed, the lens cortex and nucleus are removed from the lens capsule, and the remaining lens capsule is intraocular. A treatment method in which a lens is fitted (fixation in a sac) is widespread. A general flow of cataract surgery using a phacoemulsification and aspiration (PEA) performed generally is as follows (see Non-Patent Document 1). That is, a part of the anesthetized eyeball is firstly incised by the conjunctiva and keratotomy (entered from the sclera near the corneal limbus, passed through the corneal limbus in parallel with the sclera and cornea, and then the anterior chamber. An incision (opening in) is made. A viscoelastic material is injected from a blunt needle inserted into the anterior chamber through a tunnel formed by this keratotomy, thereby ensuring the depth of the anterior chamber. In this state, the anterior lens capsule exposed in the dilated pupil is incised (anterior capsule incision). The anterior capsulotomy is performed such that the anterior capsule is rounded out while leaving the chin body attachment site on the posterior capsule side and in the vicinity of the equator of the lens capsule. This is not only because the remaining part of the lens capsule is used as a scaffold for fixing the intraocular lens, but also because the vitreous body that is in contact with the back of the lens escapes to the anterior chamber. This is also because it can be prevented by leaving behind. After anterior capsulotomy, ultrasonic lens emulsification (PEA) is applied to the exposed lens cortex and its posterior nucleus while maintaining the depth of the anterior chamber by reinjection of viscoelastic material into the anterior chamber. ) The chip of the device is inserted, grooves are formed by ultrasonic crushing / suction, splitting the nucleus by inserting forceps into this, and further ultrasonic crushing / suction of each part after division is performed, so that the cortex and nucleus of the lens The extraction is completed. Thereafter, the folded intraocular lens is inserted into the remaining capsular bag and extended in the capsular bag. Many intraocular lenses have a main body that performs a lens function and a pair of loops that are legs for supporting the portion in place. These loops are stretched on the inside of the lens capsule. The main body is fixed in place. After fixation of the intraocular lens, the viscoelastic substance is washed away with the intraocular perfusate, and the operation is completed after the conjunctiva is repaired and closed.

  Anterior capsule incision (CCC) is an indispensable procedure in cataract surgery, and its completeness greatly affects nuclear processing and intraocular lens insertion. This is an important step. In addition, it is necessary to change the diameter of the CCC depending on the type of intraocular lens to be inserted, but the anterior chamber depth, chin band weakness, vitreous pressure, mydriatic condition, post-irisal adhesion, etc. Affects. At present, CCC is performed with a chitotome or anterior capsule forceps, but since this is a work requiring skill, the surgeon's stress is high. Specifically, the anterior capsulotomy usually begins with making a cut about 2 mm in length from the center of the anterior capsule, and the direction and speed are adjusted while the edge is hooked with the tip of the cystome or picked with forceps and turned over. Pulling carefully, subtracting, thereby allowing the incision line to grow into a generally circular shape and completing the incision line after one round. When growing the incision line, skill and careful attention are required so that the incision line does not flow radially outward of the lens capsule. When the incision line flows radially outwardly of the capsular bag, a V-shaped notch is likely to remain behind when it is pulled back, which can directly lead to surgical failure. That is, when such a V-shaped notch toward the equator of the lens capsule is present in the lens capsule, the circumferential direction that acts on the lens capsule during ultrasonic crushing / suction of the lens, insertion of the intraocular lens, etc. The tensile stress is concentrated on the tip of the notch, and the lens capsule is torn until it reaches the posterior capsule (posterior capsule breakage). Not only is intraocular fixation of the intraocular lens impossible, but the vitreous body escapes. It is because it may be invited. If posterior capsule breakage and vitrectomy occur during cataract surgery, the patient must immediately move to a completely different type of surgery, anterior vitrectomy, which can be very burdensome and risky to the patient. In addition, the intended intraocular lens cannot be fixed in the capsule.

Thus, in the anterior capsulotomy step, it is extremely important to keep the incision line of the anterior capsule in a substantially circular shape so that a V-shaped notch is not formed. Rather, since it tends to flow in the radial direction of the capsular bag, a practitioner who is not skilled in cataract surgery has a high risk of making such a failure. Various instruments or devices have been proposed for the purpose of reducing the difficulty of anterior capsulotomy, but no practical ones have been found yet (Patent Documents 1 to 6).
WO01 / 56519 WO01 / 60266 Publication GB2247174 Publication EP0165657 Japanese Patent Laid-Open No. 10-213 JP-A-8-275969 Edited by Tetsuro Ooka, “Ultrasonic Cataract Surgery ABC”, 1st Edition, Medical View Inc., April 10, 2002, pages 78-82 and pages 126-129

  In view of the above background, an object of the present invention is to provide a surgical instrument that allows an unskilled practitioner to easily and reliably perform an anterior capsulotomy.

  The present inventor has sought an instrument that can be inserted into the anterior chamber and cut the anterior capsule of the lens into a circular shape, and has an annular frame whose diameter can be expanded and contracted, and a blade that moves along the frame. It has been found that the above object can be achieved if a device provided with the above can be configured. The present invention has been completed as a result of various studies on a specific configuration enabling this.

That is, the present invention provides the following.
(1) An anterior lens capsule cutter for performing an anterior capsule incision of the lens,
A belt-like elastic guide member, a handle piece in which the elastic guide member is slidably passed in the longitudinal direction thereof, and a belt-like shape which is slidably passed along the elastic guide member in the handle piece A first elastic cutter probe of
The elastic guide member protrudes from the tip of the handle piece, extends while forming a loop, and reaches the tip of the handle piece again.
The size of the loop is increased or decreased by sliding the elastic guide member in the longitudinal direction relative to the handle piece and adjusting the length of the elastic guide member extending from the tip of the handle piece. Is something that can be
The first elastic cutter probe has, at its distal end, engagement means engaged with a portion projecting from the distal end of the handle piece of the elastic guide member so as to be slidable in the longitudinal direction, and the width of the elastic guide member With a blade protruding in the direction,
By sliding the first elastic cutter probe with respect to the handle piece in the longitudinal direction, the distal end portion of the first elastic cutter probe can be moved along a loop formed by the elastic guide member. Is possible,
Anterior lens capsule cutter.
(2) The anterior lens capsule capsule according to 1 above, wherein the elastic guide member is fixed at a predetermined angle to a distal end portion of the handle piece at a distal end thereof.
(3) The anterior lens capsule capsule according to 1 above, wherein the elastic guide member is attached to the distal end portion of the handle piece at its distal end so as to be rotatable about an axis in the width direction of the elastic guide member. .
(4) The elastic guide member protrudes from the tip of the handle piece, extends while forming a loop, reaches the tip of the handle piece again, and further extends through the handle piece. The anterior lens capsule cutter according to 1 above, wherein the elastic guide member portion is slidable relative to the handle piece in the longitudinal direction.
(5) It further includes a belt-like second elastic cutter probe that is slidably passed along the further extending elastic guide member portion in the handle piece,
The second elastic cutter probe has, at its distal end, engaging means engaged with a portion projecting from the distal end of the handle piece of the elastic guide member so as to be slidable in the longitudinal direction, and the width of the elastic guide member With a blade protruding in the direction,
By sliding the second elastic cutter probe with respect to the handle piece in the longitudinal direction, the tip of the second elastic cutter probe can be moved along a loop formed by the elastic guide member. Is possible,
4. The anterior lens capsule capsule of 4.
(6) The anterior lens capsule capsule according to any one of 1 to 5 above, comprising stopper means capable of fixing the elastic guide member at a desired position.
(7) The crystalline lens according to any one of 1 to 6 above, wherein the blade has a sharp edge along the front edge thereof and a guide portion including a portion extending forward at the tip of the blade. Anterior capsule cutter.

  According to the anterior lens capsule cutter of the present invention, even a practitioner who is not skilled in cataract surgery can easily and surely perform an anterior capsule incision, thereby improving the success rate and safety of cataract surgery. Can do.

  In the present invention, the “lens” means a lens of a human, dog, cow, horse or other mammal, and particularly preferably a human lens.

  In the present invention, the belt-like elastic guide member and the belt-like first cutter probe are preferably made of metal. The elastic guide member partially protrudes from the tip of the handle piece, and is bent so as to form a substantially circular loop having a variable diameter within an inner diameter range of about 2 to 9 mm, and is allowed to return to the tip of the handle piece. It is necessary to provide sufficient elasticity. The elastic guide member is inserted into the anterior chamber of the eyeball through a tunnel formed by keratotomy, and then forms a loop parallel to the anterior lens capsule in the anterior chamber. The width is preferably about 2 mm or less. The thickness of the band is preferably ¼ or less of the width.

  The handle piece that passes through the elastic guide member is inserted into the anterior chamber at the time of surgery. Therefore, it is preferable that the handle piece has a stick-like shape with the smallest possible diameter. Other than the tip, it may be a stick-like shape with a small diameter, but it is located outside the eyeball, so it may be a thick stick-like shape that is easy to hold and operate. In order to facilitate, a stick-like shape with wings extending to both sides or one side, or a flat shape as a whole may be used. The handle piece is formed with an elongated first passage that allows the elastic guide member to slide in the longitudinal direction. The first passage passes through at least the tip of the handle piece, and the elastic guide member extends forward from the tip of the handle piece by passing through the penetrating portion.

  The elastic guide member that protrudes forward from the handle piece is bent to form a loop so that the tip of the elastic guide member reaches the tip of the handle piece again. For example, this can be achieved by fixing to the part at a predetermined angle. In this case, the fixed angle is such that the elastic guide member protruding outward from the tip of the handle piece forms a substantially circular loop by the balance between the elasticity and the force received from the tip of the handle piece. What is necessary is just to set suitably. Such a setting can be easily made by those skilled in the art by structural calculation based on basic mechanical property data of a material. The fixing is preferably performed such that the extending direction of the elastic guide member at the portion is substantially parallel to or close to the extending direction of the elastic guide member at the projecting portion from the handle piece. By doing so, the elastic guide member protruding from the tip of the handle piece can form a substantially circular loop as a whole. The diameter of this loop depends on the length of the portion of the elastic guide member protruding from the handle piece. Therefore, the diameter of the loop can be adjusted by sliding the elastic guide member along the handle piece and adjusting the length of the portion protruding from the tip of the handle piece. By adopting such a structure, when inserting the tip of the cutter into the anterior chamber through the tunnel formed by keratotomy, the diameter of the loop is kept to a minimum, and after insertion, the diameter is expanded to a desired diameter. After the capsulotomy, it is possible to remove the loop from the anterior sac after reducing the diameter of the loop again. Therefore, it is not necessary to substantially increase the width of the keratotomy.

  In addition, the band-shaped elastic guide member that protrudes and extends forward from the handle piece is fixed to the distal end portion of the handle piece at a predetermined angle at the distal end thereof, but the distal end of the elastic guide member is strip-shaped relative to the distal end portion of the handle piece. It is good also as what was attached rotatably about the axis | shaft parallel to the width | variety of this elastic guide member. When the tip of the elastic guide member is attached to the tip of the handle piece so as to be pivotable, the angle between the tip and the handle piece depends on the length of the elastic guide member protruding from the handle piece. Can change. In this case, the elastic guide member may be configured so that a substantially circular loop is formed without difficulty when the protruding length of the elastic guide member is maximized. In this case, when the protruding length of the elastic guide member is very short, the tip of the elastic guide member rises laterally with respect to the tip of the handle piece, that is, with respect to the longitudinal direction of the elastic guide member in the handle piece. In this case, a substantially vertical direction can be taken, whereby a large bending stress acting on the elastic guide member when a small loop is formed can be reduced. Further, when the elastic guide member is further pulled, the tip end part falls forward, so that the lateral width can be minimized.

  Such a pivotable attachment of the tip of the band-shaped elastic guide member to the tip of the handle piece, for example, allows the tip of the handle piece to support the axial pin and the tip of the elastic guide member. This can be achieved by providing a hole through which a pin can pass and passing a pin through the hole. Alternatively, instead of providing a hole at the tip of the elastic guide member, the same purpose can be achieved by bending the tip of the elastic guide member in a hook shape and hooking the pin on the hook.

  The elastic guide member may also extend further through the handle piece after once protruding from the tip of the handle piece to form a loop and reaching the tip of the handle piece again. In this case, the portion of the elastic guide member (referred to as “second arm”) further extending from the loop is slidable in the longitudinal direction in the second passage provided in the handle piece. Can do. In such a case, by sliding the other part of the elastic guide member (referred to as “first arm”) passing through the handle piece and the second arm back and forth with respect to the handle piece. It is possible to adjust the diameter of the loop.

  The anterior lens capsule cutter of the present invention further includes a belt-shaped first elastic cutter probe that is slidably passed through the handle piece along the elastic guide member. The first elastic cutter probe has a handle piece of the elastic guide member at least at the tip so that at least the tip of the first elastic cutter probe can slide along the loop formed by the elastic guide member along with the slide along the elastic guide member. It is slidably engaged with the part which protrudes from the front-end | tip. As long as it engages slidably, the concrete structure of the engagement means for this may be appropriate. For example, a hook-like protrusion that slidably engages with the edges on both sides of the belt-like elastic guide member may be provided at the tip of the first elastic cutter probe. The tips of the protrusions may be separated from each other on the opposite surface of the elastic guide member, or may be in contact with each other. Alternatively, an annular object (for example, having a rectangular cross section) that surrounds the elastic guide member and is slidably fitted may be joined to the tip of the first elastic cutter probe by welding or other appropriate means.

  In the handle piece, the first elastic cutter probe is passed through the two surfaces of the elastic guide member on the side forming the inner surface of the loop so as to slide along the inner side of the loop formed by the elastic guide member. It is preferred that If so, the first elastic cutter probe is pushed and bent along the inner surface of the loop formed by the elastic guide member as it protrudes from the tip of the handle piece, so that This is because it can slide in close contact with the loop. However, if the first elastic cutter probe is provided with an engaging means that is slidably engaged with the elastic guide member at an appropriate interval, the first elastic cutter probe may be slid along the outer surface of the loop. Therefore, in this case, in the handle piece, the first elastic cutter probe can be passed through the two surfaces of the elastic guide member on the side forming the outer surface of the loop. The form of such engagement means is appropriate, and may be the same as that described above for the engagement means at the tip of the first elastic cutter probe.

  When the elastic guide member forms a loop with the first and second arms slidably passed through the handle piece, the anterior lens capsule cutter of the present invention has the first elastic cutter probe. In addition, a belt-like second elastic cutter probe threaded through the handle piece in a manner slidable along the second arm of the elastic guide member in a manner similar to the first elastic cutter probe. it can. That is, the second elastic cutter probe is slidably passed through the handle piece along the second arm of the elastic guide member, and the tip of the second elastic cutter probe is along the loop formed by the elastic guide member. The elastic guide member is slidably engaged at least at the distal end. The specific structure for this engagement and the method for sliding the second elastic cutter probe in a state where it always overlaps the loop are the same as described above with respect to the first elastic cutter probe. Good. When the second elastic cutter probe is provided, the first elastic cutter probe and the second elastic cutter probe can slide from opposite directions along the loop formed by the elastic guide member, Each of them can be moved by sliding approximately half the circumference of the loop, and the entire length of the loop can be covered by each tip.

  The first elastic cutter probe has a blade at the tip, and the blade protrudes from the first elastic cutter probe in the width direction (transverse direction) of the elastic guide member. When the tip of the anterior lens capsule capsule is inserted into the anterior chamber of the eyeball, the blade moves downward (i.e., the anterior capsule surface) from a loop formed on the anterior capsule by the elastic guide member to a desired diameter in the anterior chamber. Toward the edge) of the elastic guide member.

  The blade is for incising the anterior lens capsule, and the blade has a sharp edge along the longitudinal direction of the first elastic cutter probe (that is, the direction of sliding along the elastic guide member). Provided. The specific configuration of the blade may be appropriate, for example, a circular blade (rotatable or fixed blade), semi-circular, arcuate, wedge-shaped (having a sharp edge in at least one of the sliding directions), etc. Is mentioned. When the first elastic cutter probe is provided with such a blade, when the first elastic cutter probe is slid along the loop formed by the elastic guide member, the anterior lens capsule is cut in a substantially circular shape along the loop. The In order to connect both ends of the incision line, for example, at the start position of the incision, the entire anterior lens capsule cutter is slightly bladed with the first elastic cutter probe stationary relative to the elastic guide member. A slight incision line (length is slightly longer than the distance between both ends of the movable range of the blade at the tip of the first elastic cutter probe on the loop, near the tip of the handle piece) And the incision line can be extended further by sliding the first elastic cutter probe and advancing the tip. By doing so, the end of the incision line formed first and the tip of the incision line that the blade is forming when the blade of the first elastic cutter probe finishes making a round on the loop are joined together to form a substantially circular shape. It becomes possible to complete the clipping. This joining can be easily performed by moving forward from the distal end of the incision line formed first so that the open line is obliquely crossed so as to wrap around somewhat from the outer peripheral side.

  In the case where the anterior lens capsule cutter of the present invention also includes the second elastic cutter probe, the blade is provided in the same manner at the tip of the second elastic cutter probe. In this case, the distal ends of the first and second elastic cutter probes may be slid in the range of about half of the loop, and the ends of the incision line may be joined at the most advanced positions. In addition, the ends of the incision line near the tip of the handle piece are connected to each other with the second or second elastic cutter probe relative to the elastic guide member in the same manner as described above in the case of having a single blade. This can be done by moving the entire anterior lens capsule cutter forward by a small distance and making a slight length of incision line in a stationary state.

  For example, the end of the elastic guide member extending in the handle piece can be protruded from the proximal end of the handle piece so that the elastic guide member can be picked and slid with respect to the handle piece. In order to facilitate the operation of the elastic guide member, a knob portion can be provided at a part of the elastic guide member (for example, the proximal end). The knob may be of any shape as long as it is easy to manipulate the slide of the elastic guide member by picking it with a finger, for example, a hook-shaped part formed by bending sideways, or a ring attached to the end However, it is not limited to these. Moreover, when providing the knob | pick part which can be operated, the proximal end of an elastic guide member does not need to protrude from the proximal end of a handle piece. For example, the elastic guide member may be protruded laterally in the middle of the handle piece to form a knob. Moreover, in order to be able to fix the elastic guide member at the position after adjusting the diameter of the loop by the elastic guide member, a stopper means can be provided in the handle piece. The stopper means can be configured as a mechanism capable of engaging with or compressing the elastic guide member at an arbitrary slide position. As one specific example, a part of the handle piece is formed so that a tooth (for example, a sawtooth shape) is carved on one (for example, the upper side) edge of the elastic guide member, and the nail can be engaged with the tooth. It is only necessary to provide a slit in the arm and to provide an arm provided with a claw so as to be rotatable on the handle piece so that when the arm is tilted, the claw is inserted into the slit and engaged with the tooth.

  The first elastic cutter probe can have its proximal side protruding from the proximal end of the handle piece. Since the first elastic cutter probe slides back and forth within the handle piece along the elastic guide member, in this case, the front end of the first elastic cutter probe is closer to the front side than the front end of the elastic guide member. And when the tip of the first elastic cutter probe is advanced to the maximum along the elastic guide member, the front end of the elastic guide member may be positioned in front of the front end. preferable. Further, in order to facilitate the operation, a knob (for example, a portion bent to the side) may be provided at the front end of the first elastic cutter probe in the same manner as the front end of the elastic guide member. it can. The form of the knob may be the same as that described above for the elastic guide member.

  What is necessary is just to set the protrusion direction of the elastic guide member from the front-end | tip of a handle piece according to the relative position of the loop to form with respect to the front-end | tip of a handle piece. For example, when the loop is formed so as to be in contact with the longitudinal axis of the distal end portion of the handle piece, the elastic guide member protrudes from the distal end of the handle piece toward the front (longitudinal direction of the distal end portion) as it is. That's fine. When the loop is to be formed so that the center is positioned in the longitudinal direction of the distal end portion of the handle piece, for example, the first end of the distal end portion of the elastic guide member projects from the distal end portion of the handle piece. And the elastic guide member may be protruded from the side by bending the passage.

  When the elastic guide member is such that both the first arm and the second arm are slidably passed through the handle piece, the size of the loop is such that each of the first and second arms has a handle piece. Can be adjusted by sliding against. In this case, the first passage and the second passage are bent sideways at the tip of the handle piece so that the first and second arms protrude from the handle piece in the opposite direction. It is preferable to keep.

  Hereinafter, the present invention will be described more specifically with reference to examples. However, the present invention is not intended to be limited to the examples.

  FIG. 1 is a perspective view from above of an embodiment of the anterior lens capsule cutter 1 of the present invention, with the loop enlarged to the diameter required to incise the anterior lens capsule in the anterior chamber. The anterior lens capsule cutter 1 is inserted into the handle piece 2, the belt-like elastic guide member 3 slidably inserted into the handle piece 2, and the handle piece 2 slidably along the elastic guide member 3. An elastic cutter probe (first elastic cutter probe) 4 is included, and each of these components is made of metal. The elastic guide member 3 protrudes from the tip of the handle piece 2, and after forming a substantially circular loop 5, the tip 6 is integrally fixed to the side surface of the tip of the handle piece 2 by welding or other appropriate means. The inner diameter of the loop 6 in the state shown in the figure is about 9 mm. The elastic guide member can be slid with respect to the handle piece from the position shown in the drawing to the hand side, whereby the inner diameter of the loop 6 can be reduced to about 2 mm. The elastic guide member 3 is made of a material having sufficient elasticity to repeatedly increase and decrease such a diameter.

  The elastic guide member 3 is bent sideward on the hand side to form a knob 10. The knob 10 is used when a practitioner who performs cataract surgery slides the elastic guide member 3 with respect to the handle piece 2 and uses the finger to pick or hook the finger. The knob 10 also serves to prevent the proximal end of the elastic guide member 3 from being immersed in the handle piece 2 and becoming inoperable.

  The elastic cutter probe 4 further extends to the proximal side from the elastic guide member 3 on its proximal side, and is bent laterally at the end to constitute a knob portion 11. The purpose and function of the knob 11 are the same as those of the knob 10.

  The elastic guide member 3 and the elastic cutter probe 4 may be passed through separate parallel independent paths in the handle piece 2, or overlapped in a single common path. May be. In the latter case, the contour of the cross section of the passage may be along a cross sectional shape in which the elastic guide member 3 and the elastic cutter probe 4 are overlapped.

  FIG. 2 is a perspective view from below of the anterior lens capsule cutter 1 in the state shown in FIG. 1, and FIG. 3 is a partially enlarged view thereof. As shown in the figure, the engaging means 7 provided at the distal end of the elastic cutter probe 4 is slidably engaged with the elastic guide member 3, and is an abbreviation for incising the anterior lens capsule in the lower surface thereof. A semicircular blade 15 is provided protruding downward.

  4-7 are enlarged views from the same point of view of FIG. 3 of the part including the engaging means 7 and the blade provided thereto for various embodiments of the blade for incising the anterior lens capsule. It is a perspective view. FIG. 4 shows a substantially semi-circular blade 15 with sharp edges on the circumference, and FIG. 5 shows a triangular blade 16 with sharp edges on two adjacent sides. FIG. 6 shows a wedge-shaped blade 17 with sharp edges on the bottom and front and back. FIG. 7 shows a blade 18 particularly suitable for the present invention with a guide 18g for capturing the anterior capsule and reliably guiding it to the edge by inserting it into and submerging under the anterior lens capsule. . The guide portion 18g is composed of a portion extending forward from the tip (lower end) of the blade 18 and has a sharp tip for facilitating insertion into the lens capsule. Further, on the base side of the guide 18g, the blade 18 has a sharp edge along its front edge. A sharp edge is not required between the tip of the guide 18g and its root. Since the blade 18 has such a configuration, when the tip of the guide portion 18g is inserted into the capsular bag and advanced in parallel with the inner surface of the capsular bag, the blade 18 is engaged with the upper side of the guide portion 18g (in FIG. In the gap with the lower surface of the coupling means 7, the capsular bag is captured and inserted. Therefore, when the edge 18e of the blade 18 is advanced, the edge 18e can always catch the lens capsule, so that the incision can be easily and reliably advanced.

  As shown in FIG. 3 and FIGS. 4 to 7, the engaging means 7 provided at the tip of the elastic cutter probe 4 extends in the width direction (vertical direction in the drawing) of the elastic cutter probe 4 to form a band shape. It includes protrusions 8 and 9 having a cross-sectional ridge shape that wraps around the opposite side of the elastic guide member 3 and holds the elastic guide member 3 on both sides of the width.

  FIG. 8 is a partially enlarged view of a preferred embodiment of the anterior lens capsule cutter 1 of the type that can accommodate the engaging means 7 provided at the distal end of the elastic cutter probe 4 in the distal end of the handle piece 2. FIG. In the figure, the tip of the handle piece 2 is provided with a recess 20 having a size sufficient to receive the engaging means 7 and the blade 15 included therein, and when the elastic cutter probe 4 is retracted to the maximum, The engaging means 7 and the blade 15 are completely housed in the recess 20. For this reason, the movable distance of the blade 15 can be increased, and the insertion and withdrawal of the distal end portion of the anterior lens capsule cutter into the anterior chamber can be performed in a state in which the blade 15 is stored, so that safety is high.

  9 and 10 are a partially enlarged perspective view from above and a perspective view in which the upper half near the tip of the handle piece is cut away, according to another embodiment. As shown in these drawings, in this embodiment, the elastic guide member 3 has a bent hook-shaped tip 23 and is in a recess 24 provided on the side of the tip of the handle piece 2. The tip 23 is engaged with the provided pin 25. Since the pin 25 is attached in parallel to the width direction (vertical direction in the drawing) of the elastic guide member 3, the elastic guide member 3 can be rotated around the axis parallel to the width direction at the tip 23 thereof. . For this reason, in this embodiment, since the moment applied to the tip 23 of the elastic guide member 3 is always substantially zero, the tip 23 of the elastic guide member 3 is formed on the handle piece according to the diameter of the loop 5. The most reasonable angle can be taken. Accordingly, the elastic guide member 3 is given a curved shape in its natural state so that the substantially circular loop 5 is formed when the loop diameter is suitable for anterior capsulotomy (inner diameter of about 9 mm). In this case, when the elastic guide member 3 is pulled back to the hand side and the loop 5 is reduced, the distal end portion 23 of the elastic guide member 3 can turn up with respect to the handle piece 2 and rise up accordingly. This reduces the total amount of angular change along the longitudinal direction in the portion of the elastic guide member 3 that protrudes from the tip of the handle piece and forms the loop 5, and as a result, the elastic guide member 3 is moved to the proximal side. In addition to reducing the resistance when pulling back, the diameter of the loop 5 can be easily reduced and the loop can be reduced to a smaller diameter.

  FIG. 11 is an enlarged partial perspective view showing another embodiment of the engaging means 37 of the elastic cutter probe 3 and the blade provided thereon. In the figure, the elastic guide member 3 is omitted. In the drawing, the blade 30 has a circular shape, and is attached to one surface of the engaging means 37 via a pin (not shown) so as to be rotatable around the central axis. In the engaging means 37, the protrusion 39 on the side where the blade 30 is located is a portion near the rear end of the engaging means 7 in order to avoid interference with the blade 30. It is limited to. FIG. 12 is a perspective view showing the engaged state of the engaging means 37 and the elastic guide member 3 from the same viewpoint as FIG.

  FIG. 13 is a partial perspective view from above of a state in which the loop 45 is expanded to the maximum diameter in use (inner diameter of about 9 mm) according to another embodiment of the present invention. As apparent from the figure, in the present embodiment, the loop 45 is formed in plane symmetry with respect to a plane including the central axis of the handle piece 42. Further, in the drawing, the elastic cutter probe 44 extends long from the tip of the handle piece 42 along the loop 45, and the engaging means 47 at the tip reaches the position of about 3/4 of the entire circumference of the loop 45. Shown in state. The elastic cutter probe 44 can be further advanced until the engaging means 47 abuts against the side surface of the handle piece 42.

  FIG. 14 is a perspective view from below of a state in which the loop 55 is expanded to the maximum diameter (inner diameter of about 9 mm) in use according to still another embodiment of the present invention. As is apparent from the drawing, in this embodiment, the loop 55 is formed in plane symmetry with respect to a plane including the central axis of the handle piece 52, as in the embodiment shown in FIG. Further, in this embodiment, a pair of elastic cutter probes 54 protrude from the distal end portion of the handle piece 52 to the sides opposite to each other. For this reason, in this embodiment, the engaging means 57 provided at the tip of each handle piece 54 may be configured to be able to slide only approximately half the circumference of the loop 55. In this case, if the movable range of one engaging means 57 and the movable range of the other engaging means 57 are at least partially overlapped, the farthest point of the loop 55 (that is, at the counter electrode of the handle piece). Also at the point), the ends of the incision lines formed by the respective blades 60 can be connected.

  FIG. 15 is a perspective view from above of the embodiment shown in FIG. 14 with a part near the tip of the handle piece cut away. In the drawing, the elastic guide member 53 protrudes laterally from the distal end portion of the handle piece 52 to form a loop 55, and then reenters the distal end portion of the handle piece 52 from the opposite side. It extends in the longitudinal direction. A pair of (first and second) elastic cutter probes 54 extend through the handle piece 52 through the elastic guide member 53 between the first and second arms extending in parallel. Yes. These portions of the elastic guide member 53 and the elastic cutter probe 54 extending in the handle piece 52 may be passed through separate parallel independent paths in the handle piece 2. They may be passed through a common passage. In the latter case, the outline of the cross section of the passage may be along a cross-sectional shape in which a pair of parallel portions of the elastic guide member 53 and a pair of parallel portions of the elastic cutter probe 54 are overlapped. The embodiment shown in FIG. 13 is different from the present embodiment in that there is only one elastic cutter probe 44 (first elastic cutter probe), but the other points are the same as in the present embodiment. is there.

  FIG. 16 is a perspective view from above of the embodiment shown in FIGS. As is apparent from the drawing, the two portions (first and second arms) of the elastic guide member 53 extending in parallel with the proximal end of the handle piece 52 protrude from the proximal end of the handle piece, Each of them is bent at the end to form a knob portion 65. Also, a pair of elastic cutter probes 54 extending in parallel with the proximal end of the handle piece 52 protrude from the proximal end of the handle piece, and each of them is bent at the distal end to form a knob 66. .

  According to the present invention, even a practitioner who is not skilled in cataract surgery can easily and reliably perform anterior capsulotomy, thereby improving the success rate and safety of cataract surgery. An anterior lens capsule cutter can be provided.

Perspective view from above of one embodiment of anterior capsule capsule cutter 1 is a perspective view from below of the anterior lens capsule capsule of FIG. Partial enlarged view of the anterior lens capsule cutter of FIG. The perspective view which shows one Example of the blade for incising an anterior lens capsule The perspective view which shows another one Example of the blade for incising an anterior lens capsule The perspective view which shows another one Example of the blade for incising an anterior lens capsule The perspective view which shows another one Example of the blade for incising an anterior lens capsule Partially enlarged perspective view from below of one embodiment of an anterior lens capsule cutter Partially enlarged top perspective view of another embodiment of an anterior capsule capsule cutter The perspective view which notched a part near the handle piece front-end | tip of the lens capsule capsule of FIG. An enlarged partial perspective view showing another embodiment of the engaging means and the blade. The perspective view which shows the engagement state of the elastic guide member and engagement means in the Example of FIG. Partial perspective view from above of another embodiment of an anterior lens capsule cutter Partial perspective view from below of yet another embodiment of an anterior lens capsule cutter The perspective view from the upper part which notched a part near the front-end | tip of a handle piece of the Example shown in FIG. A perspective view from above of the embodiment shown in FIGS.

Explanation of symbols

1 = anterior lens capsule cutter, 2 = handle piece, 3 = elastic guide member, 4 = elastic cutter probe, 5 = loop, 6 = tip, 7 = engaging means, 8-9 = protruding portion, 10 = picking portion, 11 = pick part, 15-18 = blade, 18e = edge, 18g = guide part, 20 = recessed part, 23 = recessed tip, 24 = dent, 25 = pin, 30 = blade, 37 = engaging means, 38 ˜39 = projection, 42 = handle piece, 43 = elastic guide member, 44 = elastic cutter probe, 45 = loop, 47 = engaging means, 52 = handle piece, 53 = elastic guide member, 54 = elastic cutter probe, 55 = Loop, 57 = Engagement member, 60 = Blade, 65 = Knob, 66 = Knob

Claims (7)

An anterior lens capsule cutter for performing an anterior capsule incision,
A belt-like elastic guide member, a handle piece in which the elastic guide member is slidably passed in the longitudinal direction thereof, and a belt-like shape which is slidably passed along the elastic guide member in the handle piece A first elastic cutter probe of
The elastic guide member protrudes from the tip of the handle piece, extends while forming a loop, and reaches the tip of the handle piece again.
The size of the loop is increased or decreased by sliding the elastic guide member in the longitudinal direction relative to the handle piece and adjusting the length of the elastic guide member extending from the tip of the handle piece. Is something that can be
The first elastic cutter probe has, at its distal end, engagement means engaged with a portion projecting from the distal end of the handle piece of the elastic guide member so as to be slidable in the longitudinal direction, and the width of the elastic guide member With a blade protruding in the direction,
By sliding the first elastic cutter probe with respect to the handle piece in the longitudinal direction, the distal end portion of the first elastic cutter probe can be moved along a loop formed by the elastic guide member. Is possible,
Anterior lens capsule cutter.   The anterior lens capsule cutter according to claim 1, wherein the elastic guide member is fixed at a distal end thereof to the distal end portion of the handle piece at a predetermined angle.   The anterior lens capsule cutter according to claim 1, wherein the elastic guide member is attached to the distal end portion of the handle piece at its distal end so as to be rotatable about an axis in the width direction of the elastic guide member.   The elastic guide member protrudes from the distal end of the handle piece, extends while forming a loop, reaches the distal end of the handle piece again, and further extends through the handle piece. The anterior lens capsule cutter according to claim 1, wherein the guide member portion is slidable with respect to the handle piece in a longitudinal direction thereof. Further comprising a second elastic cutter probe in the form of a strip that is slidably passed along the further extending elastic guide member portion in the handle piece;
The second elastic cutter probe has, at its distal end, engaging means engaged with a portion projecting from the distal end of the handle piece of the elastic guide member so as to be slidable in the longitudinal direction, and the width of the elastic guide member With a blade protruding in the direction,
By sliding the second elastic cutter probe with respect to the handle piece in the longitudinal direction, the tip of the second elastic cutter probe can be moved along a loop formed by the elastic guide member. Is possible,
The anterior lens capsule capsule of claim 4.   6. An anterior lens capsule cutter according to any one of claims 1 to 5, comprising stopper means capable of fixing the elastic guide member at a desired position. The capsular anterior capsule according to any one of claims 1 to 6, wherein the blade has a sharp edge along its front edge and a guide portion comprising a portion extending forward at the tip of the blade. cutter.

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