JP5080961B2 - Ophthalmic ultrasound treatment equipment - Google Patents

Description

  The present invention relates to an ophthalmic ultrasonic treatment apparatus having an annular ultrasonic oscillating element that irradiates a target portion of an eyeball with an ultrasonic wave and having an ultrasonic probe that can observe the inside of the eyeball while irradiating the ultrasonic wave.

An ultrasonic treatment apparatus using ultrasonic waves has been proposed for eye treatment. For example, a tubular ultrasonic tip is inserted into the surgical eye, the lens is emulsified at the tip of the ultrasonic tip, sucked into the ultrasonic tip and discharged out of the surgical eye, and the irrigation supply passage is opened from the irrigation tank. Cataract surgery device (Patent Documents 1 and 2) that supplies irrigation into the surgical eye via the eye, ultrasonic probe (Patent Document 3) used to treat glaucoma, or eye strain by ultrasonic vibration For example, an eye treatment device (Patent Document 4) has been proposed in which tension and fatigue of the ciliary muscle in the eyeball, which is the cause of the above, is alleviated.
JP 2005-052389 A JP 2002-153499 A Japanese National Patent Publication No. 11-502436 JP-A-11-206836

  Conventional ultrasonic devices for eye treatment are mainly used for physical applications such as cataract surgery devices. In addition, treatment of the retina with a laser has come to be done on a daily basis. On the other hand, a surgical instrument may be directly inserted into the eyeball from the outside, and the operator may operate inside the eyeball while observing the inside of the eyeball through the pupil. There is also a technique for observing the state directly under the cornea using an image obtained by an ultrasonic diagnostic apparatus, but it has no therapeutic effect in itself. Ophthalmologists in clinical settings often encounter patients in cases where thrombus grows rapidly, stops blood flow, and loses eyesight under fundoscopic examination.

  From the viewpoint of the ideal of ultrasonic therapy, it is necessary to precisely irradiate the target site with the necessary ultrasound and to send the required drug to the target site at the required time. However, there are no devices in the field of ultrasonic chemotherapy, particularly drug therapy using ultrasound for treatment of the fundus such as a fundus thrombus, or an ultrasound treatment apparatus using ultrasound irradiation while observing the inside of the eyeball. The same applies to the brain, nerves, blood vessels, neoplasms, etc. behind and around the fundus. In the case of treatment with high-intensity ultrasound, the cornea and iris located in front of the eyeball are injured, so it has not been applied clinically for safety reasons.

  Therefore, the present invention provides an ophthalmic ultrasonic treatment apparatus capable of irradiating a target site of an eyeball with ultrasound while observing the inside of the eyeball.

  The present invention is an ultrasonic therapy apparatus capable of irradiating ultrasonic waves to a target site in the eyeball, the fundus, and the surroundings while observing the inside of the eyeball.

  The ultrasonic probe has an annular ultrasonic oscillation element having an observation hole for observing the inside of the eyeball in the center. Since the operator can directly view the target treatment site from the observation hole, it can be treated while observing in real time. When using the cooling liquid, a transparent material such as silicon is embedded in the observation hole so that the cooling liquid does not leak. Further, as the transparent material, an ultrasonic absorbing material such as silicon that easily absorbs vibration energy is used because the ultrasonic wave tends to concentrate at the center of the annular ultrasonic oscillator.

  The ultrasonic oscillator is attached to the upper part of a goggle-shaped holder made of a cylindrical body that surrounds the eyes. The ultrasonic oscillating element is formed by annularly arranging a plurality of small ultrasonic oscillating elements in a ring shape. The ultrasonic element may be enclosed in a bag or a bag together with oils such as vegetable oil, liquid paraffin, petroleum jelly and silicone.

  By sealing the oil, it is electrically insulated and the ultrasonic oscillation element is cooled. Further, the oil is a safety device for preventing the oscillator from coming into direct contact with the subject and causing damage.

  Further, a transparent elastic resin sheet that is in close contact with the ridge or the conjunctiva via an ultrasonic paste may be integrally provided at the bottom of the holder. Moreover, a corneal damage etc. are protected by sticking a hollow ultrasonic shielding circular sheet | seat on the center part of the bottom membrane of a probe. It is also possible to make an ultrasonic focus at a specific part by providing an inclination angle on the surface of the ultrasonic probe.

  In addition, by forming a surgical instrument insertion opening for inserting a surgical instrument such as a catheter, injection needle, or light into the eyeball, a part of the outer sclera of the ultrasound probe is irradiated with ultrasound while observing the inside of the eyeball. Surgery can be performed.

  In the ophthalmic ultrasonic treatment apparatus of the present invention, ultrasonic treatment is performed by irradiating a target site around the eyeball, fundus, and eyeball with an ultrasonic probe, and simultaneously with the treatment, ultrasonic treatment is performed from the observation hole of the donut-shaped ultrasonic oscillator. The site can be observed with a fundus or microscope.

  In addition, when a surgical instrument is inserted directly into the eyeball and ultrasonic therapy is used at the time of excision of a lesioned part or drug injection, it can be directly viewed through the observation hole, so that optical observation can be performed simultaneously.

  When chemotherapy (pharmacotherapy) and ultrasonic therapy are used in combination, two methods are conceivable, in which the drug is administered from a blood vessel, or the drug is administered by directly inserting an injection needle or catheter into the eyeball to the lesion site. In the latter case, since the drug can be administered directly from the insertion port of the surgical probe of the ultrasonic probe with a catheter, the treatment can be efficiently performed. In addition, it is possible to simultaneously irradiate ultrasonic waves and laser beams from the surgical instrument insertion port and the observation hole, and it is considered that the treatment efficiency is remarkably increased. In this way, it is possible to apply physical chemotherapy using drugs containing ultrasound and bubbles to treat the eyeball and its surroundings while observing the inside of the eyeball, and safely treat it without damaging the cornea or iris in front. it can. Also, in shallow places, application of prevention of neovascularization and hemostasis at the time of corneal transplantation can be considered.

  By changing the position of the ultrasonic probe, the ultrasonic intensity and timing of each ultrasonic element, the focal position of the ultrasonic wave can be freely moved, so that the lesion site can be treated accurately.

  In addition, safety is increased by smoothing the surface with a soft resin material so that air does not enter the contact portion between the ultrasonic probe and the eyeball. In addition, an ultrasonic absorbing material that easily absorbs vibration energy is used in the center of the ring-shaped ultrasonic oscillator, and the surface on the opposite side where the probe is in close contact with the eyeball is air-cooled or water-cooled. It can be treated more safely by preventing the rise.

The ophthalmic ultrasonic treatment apparatus of the present invention will be described with reference to the drawings.

  FIG. 1A is a plan view of an ultrasound probe used in the ophthalmic ultrasound treatment apparatus of the present invention, FIG. 1B is a sectional view on the long axis side, and FIG. 1C is a sectional view on the short axis side. FIG. 2 is a cross-sectional view of an ultrasonic shielding catheter used in the ophthalmic ultrasonic treatment apparatus of the present invention, and FIG. 3 is an explanatory diagram of a usage state of the ophthalmic ultrasonic treatment apparatus according to the present invention.

  In FIG. 1, an ultrasonic probe 1 is formed by fitting an ultrasonic oscillation element 3 on an upper part of a goggle-shaped holder 2 made of an ellipse that surrounds an eye like a swimming goggle that is slightly smaller.

  The goggle-shaped holder 2 has a shape that can be in close contact with the front of the eyeball and filled with the solution. As the solution, a saline solution that does not irritate even in an open state is used, so that the ultrasonic wave can easily enter the eyeball or be cooled. Further, when air enters the goggles or when heat is generated, a solution injection / discharge port 4 is provided for refluxing and cooling the liquid inside.

  By forming the holder to have an elliptical cross section, it is possible to make a wide space for easy insertion of a car tail or a surgical instrument by incising the sclera. A plurality of ultrasonic probes are prepared for each size according to the eyeballs from adults to children.

  As the ultrasonic oscillator 3, an annular ultrasonic oscillator having an observation hole 5 in the center is used. The annular ultrasonic oscillator 3 has, for example, a diameter of about 20 mm and a central hole of about 13 mm. The ultrasonic oscillating element 3 is wrapped with a transparent seal 22 through oil 23 for insulation and cooling. Electric power is supplied to the ultrasonic oscillator 3 from an external power source through a lead wire. The probe is preferably a disposable type to maintain cleanliness.

  It is possible to observe the fundus using a fundus mirror through the central observation hole 5. The ultrasonic oscillator 3 is covered with a transparent sheet 6 so that the liquid inside does not leak. Alternatively, the observation hole 5 is filled with a transparent material so that the solution does not leak.

The ophthalmic ultrasonic treatment apparatus of the present invention is applied to chemotherapy using ultrasonic waves and drugs. Therefore, in addition to the ultrasonic probe, as shown in FIG. A medical solution 9 containing fine bubbles 8 is injected into the eyeball using the sound wave shielding catheter 7. For example, 0.1 to 100 μm bubbles (for example, air) and urokinase or TPA are used as a drug in the case of a fundus thrombus. In addition, various uses such as anticancer agents, photosensitivity, ultrasonic sensitivity, and gene recombination drugs (hematoporphyrin, titanium oxide, bleomycin, etc.) are possible. The frequency of the ultrasonic wave 20KHz～10MHz, output is adjusted within a range of ^{0.1W / cm 2 ~1000W / cm 2} .

  The reason for using the chemical 9 containing the bubbles 8 is as follows. Cavitation occurs when the ultrasonic vibration from the ultrasonic oscillator 3 is applied to the drug solution 9 containing the bubbles 8, and the drug diffuses, penetrates into the target site or instantaneously enters the cell membrane with the vibration energy generated by the cavitation. Gene therapy is possible by opening holes.

  Bubbles become the core for cavitation generation, making cavitation easy to occur, weak energy can obtain the necessary ultrasonic energy at the target part, and prevent inconvenience such as burns and heat generation outside the target part it can.

  The reason for using the ultrasonic shielding catheter 7 is as follows. A thin catheter is inserted through the surgical instrument insertion port 24 from the sclera of the eyeball into the eyeball (vitreous body) and injected while viewing the tip with a retinoscope, and is introduced near the target site. However, when a drug solution containing bubbles is introduced via a normal catheter, the bubbles cannot be used because the bubbles are destroyed by irradiation with ultrasonic waves when passing through the catheter and cannot reach the injection target part. In normal experiments, this phenomenon cannot be avoided by alternately shifting the injection and irradiation with the catheter, but the limit of the repetition speed at which the solution can be injected intermittently through a thin catheter is low. Yes. Therefore, in the present invention, the ultrasonic wave is shielded to prevent the bubble from being destroyed until the bubble in the catheter is released from the catheter tip opening when passing through the catheter, thereby preventing the bubble from being destroyed.

  In FIG. 2, an ultrasonic shielding catheter 7 forms a gas layer 11 of a foamed material containing bubbles 10 such as air for preventing ultrasonic waves from passing through the outer wall of the catheter. The gas layer 11 uses a foamed synthetic resin material, and can be appropriately selected from hard or soft materials according to the purpose of use.

  In FIG. 3, the eyelid 13 is opened, the goggle-shaped ultrasonic probe 1 is covered and covered, and the saline solution is filled from the solution injection / discharge port 4. Reference numeral 14 denotes a cornea, 15 an iris, 16 a lens, 17 a vitreous body, 18 a retina, 19 an optic disc, and 20 an optic nerve.

  Next, the ultrasonic shielding catheter 7 is inserted into the vitreous body 17 from the sclera portion between the outer side of the goggles and the inner side surface of the eyelid, injected while viewing the tip with a fundus scope, and introduced to near the target site. While irradiating with sound waves, a chemical containing bubbles is injected.

  Since the ultrasonic shielding catheter 7 is made of a foamed wall that does not allow ultrasonic waves to pass therethrough, even if ultrasonic irradiation is performed from the outside, the ultrasonic irradiation is shielded inside, and bubbles in the drug solution that is sent through the catheter are bubbled. Is not destroyed, and ultrasonic waves are only exposed to irradiation after release from the catheter tip opening, and the effect of bubbles can be produced by cavitation.

  In this embodiment, an ultrasonic probe in which goggles are integrated by attaching a transparent resin sheet to the bottom of the goggles of the ultrasonic probe shown in FIG. In use, the ultrasonic shielding catheter 7 is inserted into the vitreous body 17 from the sclera of the eyeball and injected while looking at the tip with a fundus scope, and then brought into close contact with the eyelid with ultrasonic paste. The probe of the present embodiment can be brought into close contact with the eyeball with a transparent resin sheet, and can efficiently irradiate the fundus with ultrasonic waves.

  4A and 4B are plan views showing another embodiment of the ultrasonic probe of the present invention, and FIG. 4C is a sectional view.

  In the example shown in FIG. 4A, the ultrasonic oscillation element 3 of the present embodiment forms the observation hole 5 by arranging small ultrasonic oscillation elements 21 having a disk shape or a square shape in an annular shape. In the example shown in FIG. 4B, the observation hole 5 is formed by arranging the small ultrasonic oscillation elements 21 in the form of a ring in a ring shape. The ultrasonic oscillation element formed in an annular shape is sealed in a bag 22 made of silicon or the like in the form of an eyeband, and the air is removed and replaced with oil 23. Vegetable oil, liquid paraffin, petroleum jelly and silicon are used as oils for electrical insulation and cooling.

  The ultrasonic probe of this embodiment irradiates ultrasonic waves from above the eyeball. During irradiation, the eyes are closed, and an ultrasonic paste is filled between the eyelid and the probe.

  Since the ultrasonic probe of this embodiment is combined with several small ultrasonic oscillators 21, the flexibility of the ultrasonic probe is improved, the compatibility with the skin is good, and a thin probe can be produced. Moreover, it is suitable for the type that is left for a long time. When irradiating from the eyelid with the eyes closed for a long time, it is preferable for safety to attach a hollow contact lens to the front of the cornea because there is a possibility that the eyeball may move.

  FIG. 5 is a diagram showing another embodiment of the present invention.

  The ultrasonic oscillating element of the present embodiment is formed by annularly forming a disk-shaped small ultrasonic oscillating element 21 and having a curved shape in accordance with the curvature of the eyeball, and enclosing it in a bag 22 such as silicon. Remove air and replace with oil 23.

  In this embodiment, since the ultrasonic probe is curved, it can be placed in the eyelid and brought into close contact with the roundness of the eyeball, so that it is possible to efficiently irradiate the fundus with the ultrasonic wave.

  FIG. 6 is a diagram showing another embodiment of the present invention.

  In the ultrasonic probe of this embodiment, a surgical instrument insertion port 24 for inserting a surgical instrument such as a catheter or an injection needle is formed in a part of the eyeball. The surgical instrument insertion port 24 is formed continuously to the observation hole 5 as shown in FIG. 6 (a), or is formed on both sides with the observation hole 5 interposed therebetween as shown in FIG. 6 (b). Or you may. The surgical instrument insertion port 24 may be opened and closed by a cover (not shown).

  In this embodiment, a surgical instrument can be inserted through the surgical instrument insertion port 24 and an operation can be performed while observing the inside of the eyeball through the observation hole 5.

  FIG. 7 is a diagram showing another embodiment of the present invention.

  The ultrasonic probe of the present embodiment is a disc-like shape and has a large observation hole so that not only treatment of the fundus but also the back of the fundus and the surrounding brain can be targeted for irradiation.

  In FIG. 7, the ultrasonic oscillating element 3 is formed in a thin annular shape having a large observation hole 5 having an outer diameter and an inner diameter that can be irradiated into the brain through a gap around the eyeball.

  The eyeball is surrounded by a collection of occipital bones, but this bone is thin like paper and can easily pass through the bone if it has a certain level of ultrasound intensity, so it can be used as a window for ultrasound treatment in the brain. Conventionally, the idea of injecting ultrasound into the brain from a thin part of the skull has been the mainstream, and eye contact has been avoided because of eye safety issues. In the experiment of this example, it was possible to reduce damage to the eye, which has been a problem in the past, by using a thin annular oscillator and irradiating the brain from the gap around the eyeball.

(A) is a top view of the ultrasonic probe used for the ophthalmic ultrasonic therapy apparatus of this invention, (b) is the same sectional drawing. It is sectional drawing of the ultrasonic shielding catheter used for the ophthalmic ultrasonic treatment apparatus of this invention. It is explanatory drawing of the use condition of the ophthalmic ultrasonic treatment apparatus of this invention. It is a figure which shows another Example of the ultrasonic probe of this invention. It is a figure which shows another Example of this invention. It is a figure which shows another Example of this invention. It is a figure which shows another Example of this invention.

Explanation of symbols

1: Ultrasonic probe 2: Holder 3: Ultrasonic oscillation element 4: Solution injection / discharge port 5: Observation hole 6: Transparent sheet
7: Ultrasonic shielding catheter 8: Bubble 9: Chemical solution 10: Bubble 11: Gas layer 12: Eye 13: Eyelid 14: Cornea 15: Iris 16: Lens 17: Vitreous body 18: Retina 19: Optic nerve head 20: Optic nerve 21: Small ultrasonic oscillator 22: Bag 23: Oil 24: Surgical instrument insertion port

Claims (7)

In an ophthalmic ultrasonic treatment apparatus including an ultrasonic probe having an ultrasonic oscillation element that irradiates an ultrasonic wave toward a target portion of an eyeball,
An ophthalmic ultrasonic treatment apparatus, wherein the ultrasonic oscillation element is an annular ultrasonic oscillation element having an observation hole through which an inside of an eyeball can be observed.   The ophthalmic ultrasonic treatment apparatus according to claim 1, wherein a transparent material is embedded in the observation hole.   The ophthalmic ultrasonic treatment apparatus according to claim 2, wherein the transparent material is an ultrasonic absorption material.   The ophthalmic ultrasonic therapy according to any one of claims 1 to 3, wherein the annular ultrasonic oscillating element is attached to an upper part of a goggle-shaped holder made of a cylinder surrounding the eye. apparatus.   The ophthalmic ultrasonic treatment apparatus according to claim 1, wherein the annular ultrasonic oscillation element is formed by arranging a plurality of small ultrasonic oscillation elements.   The ophthalmic ultrasonic treatment apparatus according to claim 1, wherein a surgical instrument insertion port for inserting a surgical instrument into an eyeball is formed in a part of the ultrasonic probe.   The ophthalmic ultrasonic therapy apparatus according to any one of claims 1 to 6, wherein a resin sheet that is in close contact with the eyeball via an ultrasonic paste is integrally provided at a bottom portion of the holder.

Images