JP5467665B2 - Open device - Google Patents

Description

  The present invention relates to an opener used to open upper and lower eyelids during ophthalmic surgery or when administering a drug into the eye.

  When performing intraocular surgery such as cataract surgery, retinal vitreous surgery, glaucoma surgery, or extraocular surgery such as pterygium resection, disinfect and drape the keratoconjunctiva and its surroundings, and then open the eyelid using a cleaver Take action in the same condition. In recent years, in the developed countries, intravitreal local administration of angiogenesis inhibitors has been effective as a treatment method for age-related macular degeneration, the leading cause of blindness. Has increased. Vitreous injections of this angiogenesis inhibitor are carried out every month to every other month, and each time, after this, the eyelid anesthesia device is opened and ophthalmic anesthesia is applied, and then injection treatment is performed. . Thus, recently, the use of eyelids has increased greatly.

  Conventional openers are made of metal, and examples thereof are shown in FIGS. 3 and 4.

  The opener 60 shown in FIG. 3 has a bar holder 62 formed of two curved plates that are respectively hooked on an upper barb and a lower barb at both ends of an arm 64 formed by bending a metal wire having a spring property into a U shape. Are joined by brazing or the like, and the open state is maintained by the spring repulsive force of the arm 64.

  Each scissor pressing portion 62 is formed in a U-shaped cross section having an inner insertion piece 62a inserted inside the scissors and an outer presser piece 62b that presses the outer side of the scissors. The length Lb of the presser piece 62b is set substantially equal. For example, since the inner insertion piece 62a must be smoothly inserted without imposing a large burden on the heel and the strong conjunctiva, the inner insertion piece 62a is usually designed to have a size of about a corneal diameter (about 11 mm) to about 14 mm. . Moreover, the wire which has a high bending elastic modulus is used for the arm 64 so that it may not lose to the patient's own closing force.

  Further, the opener 70 shown in FIG. 4 is provided with two hook presser portions 72 that are hooked on the upper hook and the lower hook, respectively, at both ends of an arm 74 that is bent in a U shape so as to have a spring property. Thus, all parts are made by bending one metal wire, and the open state is maintained by the spring repulsive force of the arm 74.

  Each heel presser 72 is curved by a wire so as to have an inner insertion portion 72a to be inserted inside the heel and an outer presser portion 72b to hold the outer side of the heel. The length La and the outer side of the inner insertion portion 72a are The length Lb of the presser portion 72b is set to be approximately equal. Also in this case, in order to prevent the spring force of the arm 74 from losing the patient's own closing force, a metal wire having a high bending elastic modulus is used.

  As shown in FIG. 5 in which an example of using the opener 60 of FIG. 3 is used, these openers are provided with the eyelid presser portions 62 provided at both ends of the arm 64 with the upper eyelid 102 and the lower eyelid 103 of the eye 101. By hooking on the upper hook 102, the upper hook 102 and the lower hook 103 can be opened by the spring repulsive force of the arm 64.

  Examples of these metal opening devices are disclosed in Patent Document 1 and the like.

  In addition, as a non-metal opener, a opener made of synthetic resin or silicon rubber is also proposed in Patent Document 2. The eyelid device proposed in Patent Document 2 is a flexible molded frame configured to be inserted into the eye socket and cover a part of the eyeball, and to the eyeball for ophthalmic surgery or examination. It has an opening to access. The patent document also shows that a handle is attached to the forming frame.

Utility Model Registration No. 3105573 Japanese translation of PCT publication No. 2005-512661

Incidentally, as described above, but scene speculum is used more recently has been very increased, metallic eyelid speculum, since both costly, can not be disposable, sterilized I had to use it many times. Such a disposable request for the eyelid device has not yet been realized from the viewpoint of preventing infectious diseases.

  Further, in the case of a metal opening device, the bending elastic modulus of the arm is inevitably large, and the portion that directly contacts the heel is made of a hard material, which may cause the following problems.

  In other words, in general, the wider the surgical field, the easier it is to perform the surgery, so to secure a sufficient surgical field, a hard metal wire with a high flexural modulus will be used for the arm. In the case of a patient who cannot, the spring force is too strong, so it is easy to feel pain, and troubles such as increased vitreous pressure may be induced.

  In addition, the conventional resin or silicon rubber opening device described in Patent Document 2 is not a type having an arm that exerts a spring action, so it is inconvenient and has a complicated structure and high cost. As with the metal opener, it is impossible to dispose of it, and there is a problem that it is difficult to meet the demand for quantitative use.

  In consideration of the above circumstances, the present invention can perform the necessary function of opening the upper and lower eyelids easily and sufficiently, and is a type having an arm that exerts a spring action, while being flexible and soft. Can be produced in large quantities at a low cost with a simple structure, and can therefore be disposable, eliminating the hassle of sterilization, and requiring a large amount of use. The purpose is to provide a retractor that can meet the requirements.

The first aspect of the present invention is:
It has one arm that is bent in a U shape so as to have a spring property, and two heel pressers that are respectively connected to both ends of the arm and hooked on the upper heel and the lower heel, respectively. It is configured as an integrally molded product, and keeps the open state by the spring repulsive force of the arm,
The scissor pressing part is formed of a curved plate having a U-shaped cross section having an inner insertion piece inserted into the inner side of the scissors and an outer presser piece for pressing the outer side of the scissors. And at least the distal end portion on the inner insertion piece side becomes thinner than the U-shaped curved portion where the outer presser piece is connected, and the change in the thickness is continuous from the curved portion toward the distal end portion. It is a changer that is characterized by a thinning.

The second aspect of the present invention is:
The thickness of the curved plate is changed from the U-shaped curved portion where the inner insertion piece and the outer presser piece are connected so as to continuously become thinner toward both tip portions. The eyelid opening device according to the embodiment.

According to the present invention, each scissor presser portion is constituted by a curved plate having a U-shaped cross section having an inner insertion piece inserted into the inner side of the scissors and an outer presser piece for pressing the outer side of the scissors, and the thickness of the curved plate is increased. Since the inner insertion piece and the outer holding piece are connected to each other so that at least the tip of the inner insertion piece is thinner than the U-shaped curved portion where the inner holding piece and the outer holding piece are connected, the strength of the presser holding portion made of resin is maintained. The patient's feeling of burden when inserting the inner insertion piece inside the bag can be reduced.

  That is, in the case of a metal opening device, it is very difficult to change the thickness of the presser foot part, whether the presser foot part is formed of a metal plate or a wire rod. However, in the case of a plastic opener, it is easy to change the thickness of the curved plate that constitutes the presser foot by simply adding a dimension according to the thickness change to the mold during molding. Can be given to. Therefore, by reducing the thickness of at least the distal end portion of the inner insertion piece, it is possible to reduce the burden on the patient when inserting the inner insertion piece into the heel. In addition, although the thickness of the tip of the inner insertion piece is reduced, the thickness of the U-shaped curved portion on the base side is set to be thick, so that the strength of the connecting portion between the inner insertion piece and the outer pressing piece is sufficient. It can be kept large and can have durability against cracking and breakage.

Further, according to the present invention, the thickness of the curved plate constituting the heel presser is changed so that the thickness gradually decreases from the U-shaped curved part where the inner insertion piece and the outer presser piece are connected toward both tip parts. Therefore, the effect of the invention of claim 2 can be exhibited more remarkably. In addition, since the thickness gradually decreases from the U-shaped curved portion toward both tip portions, the resin can be molded from the U-shaped curved portion on the base side toward both tip portions. The flow of the resin can be made smooth, and the mold can be easily removed from the mold.

The structure of the eyelid opening device of embodiment of this invention is shown, (a) is a perspective view, (b) is a top view, (c) is a side view, (d) is a front view, (e) is (d). It is an enlarged view of Ie part. It is a figure which shows the use condition of the same opener. It is a perspective view which shows an example of the conventional metal opening device. It is a perspective view which shows another example of the conventional metal opening device. It is a figure which shows the use condition of the conventional opening device.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 shows the configuration of the eyelid opening device of the embodiment, (a) is a perspective view, (b) is a plan view, (c) is a side view, (d) is a front view, and (e) is a diagram of (d). It is an enlarged view of Ie part. Moreover, FIG. 2 is a figure which shows the use condition.

  The eyelid opening 10 is composed of a single wire-like arm 14 that is curved in a U shape so as to have a spring property, and an upper eyelid 102 and a lower eyelid 102 that are coupled to both ends 14 a of the arm 14. And two hook presser portions 12 that are respectively hooked on the 103. The opener 10 is configured as an integral molded product of polymethylmethacrylate, which is a thermoplastic resin, and keeps the open state by the spring repulsive force of the arm 14.

  The upper and lower heel presser portions 12 are configured by a U-shaped curved plate having an inner insertion piece 12a inserted inside the heel and an outer presser piece 12b that presses the outer side of the heel. FIG. As shown in FIG. 4, the length Lb in the direction along the edge of the outer pressing piece 12b is set larger than the length La in the direction along the edge of the inner insertion piece 12a.

  Further, as shown in FIG. 1 (e), the thickness of the curved plate constituting the heel pressing portion 12 is gradually increased from the U-shaped curved portion where the inner insertion piece 12a and the outer pressing piece 12b are connected toward both tip portions. It has changed to become thinner. That is, the dimensions t2 and t3 are smaller than the dimension t1 in the figure (t1> t2 = t3). In this case, for example, t1 = about 0.6 mm and t2 = t3 = about 0.4 mm. The allowable width of the dimension of t1 is preferably in the range of 0.5 to 0.7 mm, for example, and the allowable width of the dimension of t2 and t3 is preferably in the range of, for example, 0.3 to 0.5 mm. . If the minimum thickness portion is made too thin, it becomes easy to break, so it is necessary to secure a thickness that is unlikely to crack at least.

  In addition, although it is preferable that the change of the thickness of the curved plate which comprises the collar holding part 12 is provided continuously, you may provide in steps.

  Further, the upper and lower heel pressing portions 12 having a U-shaped cross section are formed so as to open slightly by an angle θ (about 20 °) on the side opposite to the side where the arm 14 is located. In addition, the back portions (portions corresponding to the bottom of the U shape) of the upper and lower heel pressing portions 12 having a U-shaped cross section are curved in a concave shape with a curvature of a radius R.

  Further, the arm 14 is formed in a wire shape having a circular section of about 2 mm in diameter. The inventor has performed a bending test using arms of several diameters and found that a diameter of at least 1.5 mm is required to achieve the required stiffness and elasticity.

  In addition, as a result of actually making and testing a model, the lateral width of the outer pressing portion 12b (the length in the direction along the edge of the heel) should be set to 16 mm or more, preferably about 17 mm or more. It has been found that the lateral width of 12a (the length in the direction along the edge of the ridge) should be set to about 15 mm or less, desirably 14 mm or less.

  As described above, the eyelid opening device 10 has a very simple configuration that includes only the U-shaped arm 14 and the two hook pressing portions 12 at both ends 14 a of the arm 14. Since the whole is formed by integral molding of the thermoplastic resin, it can be easily mass-produced at low cost. Therefore, it can be used disposable, and sterilization is not required, and a large amount of usage requirements can be met.

  In addition, since the two hook presser portions 12 are provided at both ends 14a of the arm 14 having a spring property, the necessary function of mounting and opening the upper and lower hooks 102 and 103 as shown in FIG. It is easy to use and can perform well. And as shown in FIG. 2, although it is resin, sufficient operative field can be ensured. In addition, since the arm is opened by the spring repulsive force of the resin arm 14 that exhibits more supple elasticity than metal, there is no pain in the case of a patient who cannot open the arm greatly, and the vitreous body pressure rises. There is no risk of inducing trouble.

  Moreover, by using as a disposable type, the possibility of breakage due to repeated fatigue of the resin can be eliminated, so safety can be improved. In addition, since the portion that directly touches the heels 102 and 103 (the heel pressing portion 12) is made of a resin having a hardness lower than that of the metal, a soft contact feeling can be given to the patient, and the burden on the patient can be reduced. Can be reduced.

  Further, each scissor presser portion 12 is constituted by a curved plate having a U-shaped cross section having an inner insertion piece 12a inserted inside the scissors 102 and 103 and an outer presser piece 12b that presses the outer sides of the scissors 102 and 103. Since the thickness of the bending plate is changed so that at least the distal end portion on the inner insertion piece 12a side is thinner than the U-shaped bending portion where the inner insertion piece 12a and the outer pressing piece 12b are connected, It is possible to reduce the patient's burden when inserting the inner insertion piece 12a inside the heel while maintaining the strength of the heel holding portion 12 that is present.

  For example, in a conventional metal opening device, it is extremely difficult to change the thickness of the presser foot part, whether the presser foot part is formed of a metal plate or a wire rod. However, in the case of the resin opening device 10 as in the present embodiment, the heel presser 12 can be simply configured by adding a dimension setting corresponding to the thickness change to the mold during molding. The thickness change can be freely given to the curved plate. Therefore, by reducing the thickness of at least the distal end portion of the inner insertion piece 12a, it is possible to reduce the patient's burden when inserting the inner insertion piece 12a into the inner side of the heel. In addition, although the thickness of the distal end portion of the inner insertion piece 12a is reduced, the thickness of the U-shaped curved portion on the base side is set to be thicker, so that the connecting portion between the inner insertion piece 12a and the outer pressing piece 12b The strength can be kept sufficiently large and durability against cracking and breakage can be imparted.

  Further, since the length in the direction along the edge of the collar of the outer pressing piece 12b is set larger than the inner insertion piece 12a, the inner insertion piece 12a can be smoothly inserted into the back side of the collars 102 and 103. As shown in FIG. 2, it is possible to cover many of the eyelashes 105 and the roots of the upper and lower eyelids 102 and 103 by the large outer presser piece 12b.

  For example, when a vitreous injection of an angiogenesis inhibitor is performed, a sterilized eyelid device is directly attached to the eye 101 that is not draped. Since the size of the eyelashes is set larger, as shown in FIG. 2 than the conventional example shown in FIG. , So that the risk of developing endophthalmitis can be reduced by inserting the injection needle in contact with the eyelashes 105 into the eye. Further, since the size of the outer pressing piece 12b is increased, the upper and lower eyelids 102 and 103 can be pressed on a wide surface, so that the patient is less likely to complain of pain and induces an increase in vitreous body pressure. It becomes difficult.

  In particular, since the length of the outer presser piece 12b is set to 16 mm or more and the length of the inner insert piece 12a is set to 15 mm or less, the feeling of burden on the patient when inserting the inner insert piece 12a into the back side of the collars 102 and 103 is reduced. However, a safe treatment can be performed by pressing the eyelashes 105 on the front side of the eyelids 102 and 103.

Further, as shown in FIG. 1 (d), the dimension Wa to be inserted inside the eyelid of the inner pressing pieces 12a, by setting smaller than the same dimension W b of the outer pressing pieces 12b, to the patient Can be further reduced, and the operability when attaching and detaching can be improved.

  Further, since the arm 14 is formed in a wire shape having a thickness of 1.5 mm or more, a spring force sufficient to open the arm 14 can be applied to the resin arm 14, and the arm 14 can be easily formed. it can.

  In the above embodiment, the case where polymethyl methacrylate is used as the resin material has been described. However, as other materials, polyolefins such as polyethylene and polypropylene, polysulfone, polyphenylsulfone, polyether polyetheretherketone, polycarbonate, It is also possible to use polyphenylsulfone or the like. However, when it is used as a disposable type, it is preferable to use polymethyl methacrylate which can be injection-molded from the viewpoint of cost and the results as a medical device.

  Further, the technical idea described above, that is, the size of the outer presser piece 12b is made larger than the size of the inner insert piece 12a of the presser foot part 12, can also be applied to the metal opener shown in FIG. In this respect, the same effect can be obtained even in a metal opening device.

DESCRIPTION OF SYMBOLS 10 ... Opening device 12 ... Reed clamp part 12a ... Inner insertion piece 12b ... Outer hold piece 14 ... Arm 14a ... Both ends 102 ... Upper collar 103 ... Lower collar

Claims (2)

It has one arm that is bent in a U shape so as to have a spring property, and two heel pressers that are respectively connected to both ends of the arm and hooked on the upper heel and the lower heel, respectively. It is configured as an integrally molded product, and keeps the open state by the spring repulsive force of the arm,
The scissor pressing portion is formed of a curved plate having a U-shaped cross section having an inner insertion piece inserted into the inner side of the scissors and an outer presser piece for pressing the outer side of the scissors, and the thickness of the curved plate is determined by the inner insertion piece. And at least the distal end portion on the inner insertion piece side becomes thinner than the U-shaped curved portion where the outer presser piece is connected, and the change in the thickness is continuous from the curved portion toward the distal end portion. An opening device characterized by a thinning change . 2. The thickness of the curved plate changes from a U-shaped curved portion where the inner insertion piece and the outer presser piece are connected so as to continuously become thinner toward both tip portions. Opening device described in 1.

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