JP5514477B2 - Intraocular insertion lens insertion device and intraocular insertion lens insertion device - Google Patents

Description

The present invention relates to an insertion instrument for inserting an intraocular lens that is inserted in place of a lens removed by cataracts or inserted into the eye for the purpose of correcting refractive error. It is.

In general, as a cataract operation, an artificially inserted intraocular lens (hereinafter also simply referred to as a lens) is inserted into the eye after removing a cloudy lens in the eye by ultrasonic emulsification and suction. ing. Lenses to be inserted into the eye mainly use lenses made of soft materials such as silicone elastomers, soft acrylics, and hydrogels. When these optical units use soft lenses, the lenses are rounded or folded. It is possible to insert into the eye from a small incision formed in the eyeball by deforming it, etc., and it is possible to prevent risks such as postoperative corneal astigmatism and infection, so these deformable lenses in recent years Has been used a lot.

As a method of inserting these deformable lenses into the eye, the lens is loaded into an insertion instrument body for inserting the lens into the eye, and the lens is moved and deformed in a small amount while being moved in the insertion instrument body by an extrusion shaft. In many cases, an insertion instrument that pushes the lens into the eye from the tip opening of the nozzle part inserted into a small incision formed in the eyeball is often used. Such an insertion device is used not only in the operation of cataract but also in the operation of inserting an intraocular lens in a vision correction treatment or the like.

More recently, a lens-incorporated insertion device is also used in which the lens is stored in advance in a lens holding portion in the device body, and the lens can be inserted into the eye simply by operating the push shaft during surgery. ing.

  These insertion instruments are designed to prevent the lens loaded during transportation and storage from moving inside the insertion instrument, or to deform the lens into a desired shape when the lens is inserted into the eye. For this purpose, the inner wall of the insertion device is configured in various shapes, and a member that is a separate part from the insertion device is inserted through the insertion device from the outside to be loaded during transportation and storage. A technique is disclosed for preventing a moving lens from moving inside the insertion device, and for deforming the lens into a shape suitable for insertion into the eye when the lens moves inside the insertion device. (Patent Document 1).

JP 2004-351196 A

  However, these insertion devices have the following problems. In conventional insertion instruments, the optical edge of the lens is placed on the inner wall (inside or lumen) of the insertion instrument to prevent the lens loaded during transport and storage from moving within the insertion instrument. A rib for holding the lens, a floor for holding the lens support, and the like are formed, and the lens is held in a state where no stress is applied to the lens. Therefore, when using the insertion tool, when the lens held by the rib or floor is moved in the nozzle direction by pushing the push-out shaft of the surgeon, the lens must be moved over the rib or floor. There is a risk that unexpected rotation of the lens may occur or clogging may occur due to the movement of the lens being blocked by the rib or floor.

  The present invention provides an insertion instrument that stabilizes the behavior of the lens when moving the lens from the lens holding portion to the nozzle side, and enables smooth extrusion of the lens into the eye, thereby improving the accuracy of surgery. .

An insertion instrument according to one aspect of the present invention includes a main body having a lens holding portion that holds an intraocular lens, and an extrusion shaft that pushes the lens held by the lens holding portion into the eye from a distal end opening of the main body. And an insertion device for an intraocular lens, wherein at least a part of the lens holding portion has a structure that can be deformed in the circumferential direction.

  It should be noted that the above-described insertion instrument, which is an intraocular lens-incorporating insertion instrument including an intraocular lens held by a lens holding part, also constitutes another aspect of the present invention. Further, the method for manufacturing an intraocular lens-incorporating insertion device characterized by comprising the step of preparing the insertion device and the step of holding the intraocular lens in the lens holder. Constitutes one aspect.

According to the present invention, at least a part of the lens holding part is deformed in the circumferential direction, so that the lens pushed in the nozzle direction by the extrusion shaft does not move so as to get over a part of the lens holding part, Therefore, when moving the lens from the lens holding portion in the nozzle direction, it is possible to realize an insertion instrument that stabilizes the behavior of the lens and enables smooth extrusion of the lens into the eye, thereby improving the accuracy of surgery. it can.

The lens for intraocular insertion used in the Example of this invention is shown, (a) is a top view, (b) is a side view. The insertion instrument of the lens for intraocular insertion which concerns on Example 1 of this invention is shown, (a) is upper surface sectional drawing, (b) is side surface sectional drawing. The lens holding state in the insertion instrument of Example 1 is shown, (a) is a top fractured view, (b) is a side fractured view. The lens movement start state in the insertion instrument of Example 1 is shown, (a) is a top fractured view, (b) is a side fractured view. The lens advancing state in the insertion instrument of Example 1 is shown, (a) is an upper surface fracture surface view, (b) is a side fracture surface view. The flowchart which shows the manufacturing process of the lens built-in type insertion instrument for intraocular insertion which concerns on the Example of this invention. The lens holding state in the insertion instrument of Example 2 is shown, (a) is a top broken-away view, (b) is an AA broken-away view in (a). The lens movement progress state in the insertion instrument of Example 2 is shown, (a) is an upper surface fracture surface view, (b) is a BB fracture surface view in (a). FIG. 6 is a top cross-sectional view showing a lens holding state in the insertion instrument of Example 3. FIG. 6 is a top cross-sectional view showing a lens movement progress state in the insertion instrument of Example 3.

Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings.

  First, FIG. 1 shows an intraocular lens 1 that is inserted into an eye by an insertion device to which the present invention is applied, wherein (a) is a top view and (b) is a side view. The lens 1 includes an optical unit 1a having a function as a lens and two support units 1b each having a curved shape extending from both ends of the optical unit 1a. Each support portion 1b is a linear portion for elastically supporting the optical portion 1a in the eye after the lens 1 is inserted into the eye, and the tip of each support portion 1b is a free end. Yes. In this description, as shown in FIG. 1A, the length (optical part diameter) in the direction orthogonal to the optical axis of the optical part 1a of the lens 1 is referred to as the lens width. As shown in FIG. The length in the optical axis direction (axial direction) of the portion 1a is defined as the lens thickness or the lens height.

  The lens 1 is formed of a deformable elastic body having memory characteristics. The optical portion 1a is a silicone elastomer, a deformable material such as a collomer or a hydrophilic or hydrophobic acrylic resin, and the support portion 1b is polyimide or PMMA ( (Polymethylmethacrylate) and other materials having flexibility and shape memory. However, since the lens 1 is a medical instrument that is a highly managed medical device, it is needless to say that it is necessary to be a material that is certified or standardized as an implant material in ISO, FDA, or the like.

  In addition, although the lens 1 in this embodiment has shown the example which uses the 3 piece type lens 1 produced by joining the optical part 1a and the support part 1b, an optical part and a support part are a series of plates. Or a one-piece lens in which the optical part and the support part are integrally manufactured from the same material (or chemical bonding of different materials).

  2A and 2B show an insertion instrument 10 for an intraocular lens that is Embodiment 1 of the present invention, wherein FIG. 2A is a top view and FIG. 2B is a side view. In the following description, the nozzle part side is referred to as the front end side, the front end direction, or the front direction, and the opposite side to the nozzle part side is referred to as the rear end side, the base end side, the rear end direction, or the base end direction. A direction extending to the front end side and the rear end side is referred to as an axial direction, and a direction orthogonal to the axial direction is referred to as a vertical direction, a horizontal direction, a circumferential direction, or a radial direction.

This insertion instrument 10 is mainly composed of a main body 20 that passes the lens 1 and guides it into the eye, and an extrusion shaft 30 that is housed in the main body 20 so as to be reciprocally movable and pushes the lens 1 into the eye. Has been.

  The main body 20 includes a cylindrical portion 21, a lens holding portion 22 provided at the distal end of the cylindrical portion 21, a nozzle portion 23 provided at the distal end of the lens holding portion 22, and a proximal end side (nozzle of the cylindrical portion 21). A handle portion 24 provided on the opposite side of the lens portion, and an openable / closable lid portion 25 connected to the lens holding portion 22 with a hinge structure for accommodating the lens 1 inside the main body 20. It is formed as an integral part. A hollow structure is formed from the nozzle part to the handle part, and the extrusion shaft 30 is housed from the base end side so as to be able to reciprocate in the hollow structure (inside the main body).

  Moreover, it is preferable to form the main body 20 of the insertion instrument from a plastic, and in particular, from the viewpoint of transparency, moldability, stability, and cost, it may be formed from an olefin resin such as polypropylene or polyethylene, or a polycarbonate resin. It is not limited to.

  The lens holding part 22 has a flat part 22a in which the lens 1 for receiving and holding the lens 1 in a state in which no stress is applied to the lens 1 so that the lens 1 can be stably held in the main body 20; And a protrusion 22b for limiting unintentional movement (displacement) of the lens 1. In addition, the state which does not apply a stress here means the state which does not produce the stress and the deformation | transformation which affect the optical function of the optical part 1a, even if it stores for a long period of time. Details of the structure of the lens holding portion 22 will be described later in detail.

A lens holding member, which is a member different from the main body for holding the lens in a state where no stress is applied to the lens, is accommodated inside the main body as the lens holding portion 22, and the lens holding member is fixed inside the main body. The lens may be formed so that the lens can be held in the main body.

  The nozzle part 23 can be inserted into a small incision formed in the eyeball, and the lens holding part 22 is inserted so that the lens 1 pushed out by the push-out shaft 30 can pass through and can be inserted into the eye from the tip opening of the nozzle part 23. It is a continuous hollow structure. Further, the tip opening of the nozzle portion 23 may have a shape having a cross section that intersects at right angles to the axial direction, or a shape having a cross section that intersects at an angle other than a right angle to the axial direction (so-called bamboo fluff shape). Further, the nozzle portion 23 may have a shape in which a slit is provided from the front end opening of the nozzle portion 23 toward the proximal direction, or the inner wall of the nozzle portion 23 is subjected to a rough surface treatment.

  As described above, in the present embodiment, the main body is described as being formed by integrally forming the tube portion and the nozzle portion, but the insertion instrument of the present invention is not limited to this, For example, the nozzle may be used by being attached to a main body integrally formed from the handle portion to the lens holding portion. Further, a part having a nozzle part and a lens holding part may be used by being mounted on a main body having a cylinder part and a handle part. In any of these cases, after assembling (in use), the handle portion to the nozzle portion are integrated to function as a main body, and are included in the insertion instrument of the present invention as in the present embodiment.

  The extrusion shaft 30 is provided at the first shaft portion 31 exposed from the main body 20 and the distal end of the first shaft portion in the axial direction in the main body 20 before the lens 1 is inserted into the eye. And a second shaft portion 32 extending. At the distal end of the second shaft portion 32, the lens portion 1 comes into contact with the lens 1 held by the lens holding portion 22 when the lens 1 is inserted into the eye, and the nozzle portion 23 faces the inside of the eye (toward the distal end). A lens contact portion 33 for pushing through is formed. On the other hand, on the proximal end side of the first shaft portion 31, a pressing portion 34 that is suitable for an operator to push the pushing shaft 30 in the distal direction with respect to the main body 20 is formed. The first shaft portion 31 is formed with an outer diameter slightly smaller than the inner diameter of the cylindrical portion 21 of the main body 20, and the second shaft portion 32 is formed with an outer diameter slightly smaller than the inner diameter of the nozzle portion 23 of the main body 20. Although not shown in the figure, the extrusion shaft 30 is provided with at least one O-ring at an appropriate position (desirably near the tip end side of the first shaft portion), so that the inner wall of the main body 20 and the extrusion shaft 30 are connected. It is possible to extrude the lens 1 in a stable state without adjusting the sliding resistance between them and suppressing the push shaft 30 from being greatly displaced in the radial direction with respect to the main body 20. It becomes.

The extrusion shaft 30 is preferably formed of the above-described plastic as in the case of the main body 20. In this embodiment, the case of the extrusion shaft 30 integrally formed from the first shaft portion 31 to the lens contact portion 33 will be described. However, the insertion instrument of the present invention is not limited to this. For example, the first shaft portion is formed of a plastic material, and the second shaft portion is made of a resin material used for a pipe such as a metal or a catheter. You may make it the structure assembled using a tube. Further, when the second shaft portion is formed of a material such as metal, it is necessary to configure the lens contact portion at the tip of the second shaft portion with a material such as resin or elastomer. It will be formed from three parts.

  3A and 3B show details of the vicinity of the lens contact portion 22 provided in the main body 20 in the insertion instrument 10 for an intraocular lens according to the first embodiment. FIG. 3A is a top sectional view, and FIG. It is side surface sectional drawing.

  As shown in FIGS. 3A and 3B, the lens 1 accommodated in the insertion instrument 10 is in a state in which no stress is applied to the lens holding portion 22 provided in the proximal direction from the nozzle portion 23 in the main body 20. Is retained. The structure of the lens holding unit 22 that holds the lens 1 includes a flat portion 22a that is positioned in the lower direction of the lens 1, a protrusion 22b that holds the lens edge in the front end direction of the lens 1, and a lens in the rear end direction. It is formed with a protrusion 22c that holds the edge. Further, the flat portion 22a and the protruding portion 22b are connected by a hinge portion 22d, and are formed so that the protruding portion 22b can be rotated by applying an external force with the hinge portion 22d as a fulcrum. In addition, about the projection part 22c, you may shape | mold integrally with the flat part 22a, and it forms by fixing another member by welding etc.

In FIG. 3B, the surface of the flat portion 22a facing the lens 1 is represented by a straight line in the axial direction, but the surface of the flat portion 22a facing the lens 1 is a spherical surface or an aspheric surface of the lens optical surface. Needless to say, it may be designed in an optimal shape such as a hollow shape along the surface.

The protrusions 22b and 22c that hold the edge of the lens 1 accommodated in the insertion instrument 10 are formed to prevent the lens loaded during transportation and storage from moving inside the insertion instrument. It is only necessary to hold the lens edge portion in the front end direction of the lens 1 to be accommodated, and to hold the lens edge portion in the rear end direction. The positions and the number of the protrusions 22b and 22c are as follows. What is necessary is just to design suitably. However, in the formation position of the projection 22c formed in the rear end direction of the lens 1, it should not be formed on the axis along which the push-out shaft advances.

Furthermore, it is desirable to form the side surface shape facing the lens 1 in the protruding portion 22b with the same curvature as that of the proximal end portion of the nozzle portion 23 located in the distal end direction of the lens holding portion 22 of the insertion instrument 10. Further, the lens holding portion 22 has a recess formed on the inner wall in the distal end direction of the hinge portion 22d that connects the flat portion 22a and the protruding portion 22b.

Ribs, grooves and the like may be appropriately formed on the surface (inner wall surface) facing the lens 1 housed in the insertion instrument 10 of the lid portion 25 of the lens holding portion 22. This is because these structures are useful for deforming the lens into a desired shape when the lens 1 is moved in the direction of the nozzle portion 23 by the extrusion shaft 30. (For example, the lens may be deformed to a downward convex shape without being deformed to an upward convex shape.)

The lens edge described above includes not only the lens side surface parallel to the optical axis, but also the vicinity of the outer periphery of the lens optical surface extending in the circumferential direction from the optical axis.

In the present embodiment, the projections 22b and 22c of the lens holding unit 22 have been described as the projections 22b and 22c projecting from the lower direction of the insertion instrument 10. However, for example, the projection 22b and the recess are formed in the upper direction, that is, the lid 25. Even when 22e is formed, the same effect that the lens 1 is prevented from moving inside the insertion instrument 10 can be obtained. In this case, the lens holding part 22 can be accommodated directly on the inner wall of the lens holding part 22 without providing the flat part 22a, and the space inside the insertion instrument 10 can be saved.

Furthermore, in the present embodiment, the lens holding portion in the insertion instrument has been described as holding the optical portion of the lens, but the present invention is not limited to this, and the lens holding portion is the optical portion of the lens. A structure in which the lens is held only by the support portion without holding the lens, and a structure in which both the optical portion and the support portion of the lens are held are also included.

  Next, an operation of inserting the intraocular lens 1 into the eye using the intraocular lens insertion tool shown in the first embodiment to which the present invention is applied will be described with reference to FIGS.

  FIGS. 3A and 3B show a state (lens holding state) immediately before the lens 1 is loaded into the lens holding portion 22 formed on the main body 20 of the insertion instrument 10 and the operator pushes the pushing shaft 30 in the distal direction. ). The lens 1 is accommodated in the lens holding portion 22 of the main body 20 in a state where the optical portion 1a of the lens 1 is not substantially stressed. The lens holding part 22 includes a flat part 22a for accommodating the lens 1, a protrusion part 22b for holding the edge part of the optical part in the front-rear direction of the optical axis of the lens 1 to be accommodated, and a protrusion part 22c. Yes. Further, in the main body 20, the push shaft 30 is accommodated in a state where the push shaft 30 can reciprocate in the main body 20 behind the lens 1. This is a state in which the lens 1 accommodated therein has not started to be pushed out toward the nozzle portion. Note that the tip opening of the nozzle portion 23 of the main body 20 is located on the extension of the axis of the extrusion shaft 30 in the tip direction.

In this state, the operator does not push out the pushing shaft 30 and the lens contact portion 33 of the pushing shaft 30 is in contact with the rear end direction of the lens edge of the lens 1 held by the lens holding portion 22. Even when there is no contact, the optical part 1a of the lens 1 is in contact with no stress. In the latter case, the lens contact portion 33 of the extrusion shaft 30 is structured so as to hold the lens edge of the lens 1 (for example, a U-shape as shown in FIG. 3B), thereby holding the lens. The lens 1 can be held without providing the protruding portion 22c of the portion 22.

By the way, when the lens 1 is inserted into the eye using the insertion instrument 10 described in this embodiment, a lubricant for deforming or pushing the lens 1 or the lens 1 is inserted into the main body 11 of the insertion instrument 10. As an intraocular injection solution for expanding the space in the eyeball into which the eye is inserted, a viscoelastic substance such as sodium hyaluronate or a liquid such as physiological saline is injected from the tip opening of the nozzle portion 11c. A state (initial state) immediately before the surgeon pushes the push-out shaft 12 of the insertion instrument 10 in the distal direction including this stage.

  4A and 4B, the lens 1 held by the lens holding portion 22 of the main body 20 of the insertion instrument 10 is inserted into the nozzle portion 23 inside the main body 20 when the operator pushes the pushing shaft 30. It shows a state (lens movement initial state) where movement in the direction (tip direction) has started. The lens 1 shown in FIG. 3 is loaded into the lens holding portion 22 formed on the main body 20 of the insertion instrument 10, and the surgeon pushes the pushing shaft 30 from the state immediately before the surgeon pushes the pushing shaft 30 in the distal direction. When the pushing operation is started in the direction, first, the lens contact portion 33 formed at the tip of the push-out shaft 30 comes into contact with the lens edge portion of the optical portion 1a of the lens 1 held by the lens holding portion 22 in the rear end direction. As the operator continues to push out the pushing shaft 30 as it is, the optical portion 1a of the lens 1 is pressed against the lens contact portion 33, and the lens 1 moves in the distal direction, thereby being held by the lens holding portion 22. The lens edge portion in the tip direction of the optical portion 1a of the lens 1 starts to press the protrusion 22b of the lens holding portion 22 in the circumferential direction. The projection 22b receives a pressing force from the optical portion of the lens 1, and the projection 22b is deformed in the circumferential direction with the hinge 22d connected to the flat portion 22a as a fulcrum.

  At this time, accommodation of the side surface in the front end direction of the protrusion 22b into the concave portion 22e formed on the inner wall in the front end direction of the hinge portion 22d of the lens holding portion 22 is started. Therefore, the optical part 1a of the lens 1 starts to move smoothly in the direction of the nozzle toward the nozzle by the protrusion 22b serving as a barrier in the forward direction starting to deform (tilt) in the circumferential direction. Will be able to. At this time, the optical part 1a of the lens 1 also starts to deform along the shape of the contact wall surface of the protrusion 22b of the lens holding part 22.

  The deformation in the circumferential direction referred to here is not only a linear deformation from the axis to the vertical direction, but also a so-called parabolic trajectory that is deformed in the vertical direction while proceeding in the axial direction. It is also included.

Furthermore, in the present embodiment, the protrusion of the lens holding portion has been described as being deformed with the hinge portion connected to the flat portion as a fulcrum (the protrusion is inclined), but the elastic material (the protrusion can be deformed by itself) For example, it may be formed of a rubber material or the like so that it can be deformed in the circumferential direction without using a fulcrum of the hinge portion. In this case, however, it is needless to say that the material needs to have at least strength sufficient to hold the lens.

  FIGS. 5A and 5B show that the lens 1 held by the lens holding portion 22 of the main body 20 of the insertion instrument 10 is obtained by further pushing the pushing shaft 30 from the lens movement initial state described above by the operator. The state in which the inside of the main body 20 is further moved in the direction of the nozzle portion 23 (the lens movement progress state) is shown. When the surgeon shown in FIG. 4 pushes the pushing shaft 30, the lens 1 held by the lens holding portion 22 of the main body 20 starts to move inside the main body 20 in the direction of the nozzle portion 23. Further, when the surgeon continues to push out the push-out shaft 30, from the lens edge in the distal direction of the optical part 1a of the lens 1 to the vicinity of the optical axis facing the protrusion 22b of the optical part 1a of the lens 1 Up to the optical surface, the projection 22b of the lens contact portion 22 is further deformed in the circumferential direction with the hinge portion 22d as a fulcrum. Finally, the protrusion 22b of the lens holding portion 22 is accommodated in the recess 22e and the opposing surfaces collide with each other, so that the deformation in the circumferential direction stops.

When the projecting portion 22b of the lens holding portion 22 is accommodated in the concave portion 22e and the respective opposing surfaces collide with each other and the deformation in the circumferential direction is stopped, the optical portion 1a of the lens 1 in the lens holding state shown in FIG. As shown in FIG. 5, the wall surface of the protrusion 22 b facing the lens edge in the tip direction of the lens holder 22 is deformed in the circumferential direction. It changed so as to face. That is, the wall surface of the protrusion 22b that has been directed rearward in the lens holding state illustrated in FIG. 3 is directed upward in the lens movement progress state illustrated in FIG. Therefore, the aforementioned wall surface of the protrusion 22b becomes a part of the inner wall surface of the lens holding portion 22, and is continuous with the inner wall of the nozzle portion 23 positioned in the distal direction. In addition, the continuous shape here means that it is a straight line when viewed in the axial direction, that is, it means that the inner wall structure that prevents the movement of the lens such as a protrusion or a groove is not formed, and the movement of the lens is not hindered. Concavities and convexities can be included.

As described above, when the projection 22b of the lens holding portion 22 is deformed in the circumferential direction and becomes a part of the inner wall shape of the main body 20, when the lens 1 is pushed out toward the nozzle portion 23 by the pushing shaft 30, There is no barrier portion of the lens holding portion 22 that the lens 1 has to get over, and the lens 1 can move smoothly toward the nozzle portion 23. Finally, the lens 1 that has been deformed to a small extent by the nozzle portion 23 is inserted into the eye from the front end opening of the nozzle portion 23.

In the present embodiment, the lens inserted from the tip of the nozzle portion has been described as being deformed small in the nozzle portion, but the lens holding portion is also provided with a mechanism for deforming the lens separately, and the lens is held in the lens holding portion. It may be modified so that it is deformed in advance and moved to the nozzle portion to be further deformed.

In addition, as shown in this embodiment, a part of the lens holding portion, which is deformed in the circumferential direction by contacting the lens pushed out by the pushing shaft, eliminates the operation of the lens moving over the lens holding portion, thereby saving space. Even when the lens has a large lens thickness and a high power lens or a small lens thickness and a low power lens, when the lens is advanced from the lens holding portion, it is uniform (stable). It becomes possible to push out the extrusion shaft with the force of.

  The insertion instrument 10 of this embodiment is a lens-incorporated insertion instrument for intraocular insertion (preload type) that is shipped from the factory with the lens 1 installed in the lens holding part 22 and stored until surgery at the hospital. Even if the lens is loaded into the insertion device immediately before the operation of inserting the lens into the eye, the same effect of the present invention is exhibited.

This preload type insertion instrument is manufactured by the manufacturing method shown in the flowchart of FIG. 6, for example. The manufacture of the insertion instrument has a step (step S1) of preparing the insertion instrument 10 (main body and extrusion shaft) before the lens 1 is installed. In addition, there is a step (step S2) of loading (installing) the lens 1 into the lens holding portion 22 of the main body 20. The manufacturing process (step S3) is completed by sterilizing and packaging the insertion instrument 10 on which the lens 1 is installed.

  7A and 7B show details of the vicinity of the lens contact portion 222 provided on the main body 220 in the insertion device for an intraocular lens that is Embodiment 2 of the present invention. FIG. ) Is a side sectional view. Although the present embodiment has the same configuration as that of the first embodiment in many respects, the lens holding portion 222 is a deformable protrusion that holds the lens edge in the distal direction of the optical portion 1a of the lens 1. The point which has a structure which hold | maintains the free end of the support part 1b of the lens 1 located in a nozzle direction in the point which does not have is different from Example 1.

  As shown in FIGS. 7A and 7B, the lens holding part 222 provided in the base end direction from the nozzle part 223 in the main body 220 accommodates and holds the lens 1 in a state where no stress is applied. The lens holding part 222 is formed on the inner wall of the lens holding part 222 to hold the flat part 222a for receiving the lens 1 and the vicinity of the free end of the support part 1b positioned in the distal direction of the lens 1 to be received. A protrusion 222 b and a protrusion 222 c that holds the lens edge in the rear end direction of the lens 1 are provided. Further, in the main body 220, the push shaft 230 is accommodated in a state where the push shaft 230 can reciprocate in the main body 220 behind the lens 1, but the lens contact portion 233 at the tip of the push shaft 230 is attached to the lens holding portion 222. This is a state in which the lens 1 accommodated therein has not started to be pushed out toward the nozzle portion. Note that the tip opening of the nozzle portion 223 of the main body 220 is positioned on the extension of the extrusion shaft 230 in the tip direction. The protrusion 222b is connected to the inner wall of the lens holding part 222 by a hinge part 222d, and a concave part 222e is formed on the inner wall of the lens holding part 222 positioned above the protrusion 222b.

Therefore, the lens 1 accommodated in the insertion instrument 210 does not move in the insertion instrument 210 even during transportation and storage, and is accommodated and held in a state where no stress is applied to the optical part 1a of the lens 1. Has been.

As is apparent from FIG. 1, the lens 1 is generally formed of an optical unit 1 a and a support unit 1 b having a certain inclination from a plane orthogonal to the optical axis, and a protrusion 222 b of the lens holding unit 222 is formed. The height to be arranged is preferably set to a height that matches the inclination of the support portion 1b of the lens 1, and the concave portion 222e is preferably provided above the protrusion 222b. In addition, the hinge part 222d for connecting the protrusion 222b to the inner wall of the lens holding part 222 needs to be strong enough to hold the support part 1b of the lens 1 in the holding state.

  Next, the operation of inserting the intraocular lens 1 into the eye using the intraocular lens insertion tool shown in the second embodiment to which the present invention is applied will be described with reference to FIGS. .

  7A and 7B show a state immediately before the lens 1 is loaded into the lens holding part 222 formed on the main body 220 of the insertion instrument and the operator pushes the push-out shaft 230 in the distal direction (lens holding state). Is shown. The lens 1 is held by the lens holding portion 222 positioned in the proximal direction of the nozzle portion 223 in a state where no stress acts on the optical portion 1a of the lens 1 as described above. In this state, the operator does not perform the pushing operation of the pushing shaft 230, and the lens contact portion 233 of the pushing shaft 230 contacts the rear end direction of the lens edge of the lens 1 held by the lens holding portion 222. Even when the lens 1 is not in contact or in contact with the optical portion 1a of the lens 1, the lens 1 is in contact with the optical portion 1a without being stressed, and the lens 1 is directed toward the tip opening of the nozzle portion 223 inside the main body 220. It is assumed that it has not moved. Then, when the surgeon starts the push-out operation of the pushing shaft 230, the lens 1 held by the lens holding part 222 of the main body 220 is moved in the nozzle part 223 direction (tip direction) inside the main body 220. Be started. (Lens movement initial state)

  8A and 8B show that the lens 1 held by the lens holding portion 222 of the main body 220 of the insertion instrument is moved from the initial state of the lens movement by the surgeon pushing the push-out shaft 230. This shows a state in which the inside is moving in the direction of the nozzle portion 223 (lens movement progress state). The lens 1 shown in FIG. 7 is loaded in the lens holding part 222 formed on the main body 220 of the insertion instrument 210, and the surgeon pushes the pushing shaft 230 from the state immediately before the surgeon pushes the pushing shaft 230 in the distal direction. When the pushing operation is started in the direction, the lens contact portion 233 formed at the tip of the push-out shaft 230 first comes into contact with the lens edge portion in the rear end direction of the optical portion 1a of the lens 1 held by the lens holding portion 222. Then, when the surgeon continues to push out the push-out shaft 230, the optical portion 1a of the lens 1 is pressed against the lens contact portion 233, and the lens 1 moves in the distal direction, thereby being held by the lens holding portion 222. The support portion 1b of the lens 1 in the direction of the nozzle portion 223 starts to move with the upper surface of the protrusion 222b of the lens contact portion 222 facing the tip. In the case of the present embodiment, since the lens edge portion in the tip direction of the optical portion 1a of the lens 1 is not held by a projection or the like, the optical portion 1a of the lens 1 is the lens holding portion 222. The flat portion 222a can be smoothly moved toward the nozzle portion 223.

  When the above-described surgeon pushes the pushing shaft 230, the lens 1 held by the lens holding part 222 of the main body 220 is further moved from the state in which the movement of the inside of the main body 220 toward the nozzle part 223 is started. When the operator continues the push-out operation of the pushing shaft 230, the support portion 1b in the direction of the nozzle portion 223 of the lens 1 whose free end is accommodated in the recess 222e formed on the inner wall of the lens holding portion 222 is It begins to enter the nozzle portion 223 located in the distal direction. At this time, the free end of the support portion 1b in the direction of the nozzle portion 223 extends in the proximal direction in the axial direction and is tacked. Also in the optical part 1a of the lens 1, as shown in FIG. 8A, the lens side in the left-right direction of the optical part 1a is brought into contact with the inner wall shape formed by the taper of the nozzle part 223 from the lens holding part 222. The edge portion starts to be deformed along the inner wall shape of the lens holding portion 222 and the nozzle portion 223.

Next, as shown in FIG. 8, when the surgeon advances the pushing operation of the pushing shaft 230 as it is, the protruding portion 222b of the lens holding portion 222 is pressed by the lens edge portion of the optical portion 1a, and the protruding portion 222b is moved to the lens. The hinge part 222d connected to the inner wall of the holding part 222 is deformed in the circumferential direction with the fulcrum as a fulcrum. Then, the protrusion 222b is accommodated in the recess 222e formed on the inner wall of the lens holding part 222. Finally, the protrusion 222b of the lens holding part 222 is accommodated in the recess 222e, and the opposing surfaces collide with each other. Deformation in the circumferential direction stops.

Through the above-described steps, the protrusion 222b of the lens holding part 222 is deformed in the circumferential direction, so that it is accommodated in the recess 222e formed on the inner wall of the lens holding part 222 and becomes a part of the inner wall shape of the main body 220. . When the lens 1 is pushed out in the direction of the nozzle portion 223 by the push-out shaft 230, the lens 1 can smoothly move in the direction of the nozzle portion 223 because there is no portion that becomes a barrier of the lens holding portion 222 that the lens 1 must get over. become able to. Then, the lens 1 that finally passes through the nozzle portion 23 and is deformed to a small extent is inserted into the eye from the front end opening of the nozzle portion 23.

  FIG. 9 shows details of the vicinity of the lens contact portion 322 provided in the main body 320 in the insertion instrument for an intraocular lens that is Embodiment 3 of the present invention, (a) is a top sectional view, (b) ) Is a side sectional view. This embodiment also has the same configuration as that of the first embodiment in many respects, but the lens holding portion 322 is a deformable protrusion that holds the lens edge portion in the distal direction of the optical portion 1a of the lens 1. The first embodiment is greatly different from the first embodiment in that the portion protrudes in the direction perpendicular to the optical axis of the lens 1 accommodated in the insertion instrument 310.

  As shown in FIGS. 9A and 9B, the lens 1 is housed and held in a state in which no stress is applied to the lens holding portion 322 provided in the proximal direction from the nozzle portion 323 in the main body 320. The lens holding part 322 includes a flat part 322a for accommodating the lens 1, and a lens edge part of the optical part 1a of the lens 1 in the tip direction of the lens 1 to be accommodated (forward in the axial direction from the optical axis of the optical part). A projection 322b formed in a state of projecting in a direction perpendicular to the optical axis of the lens 1 held on the inner wall of the lens holding portion 322, and a lens edge in the rear end direction of the lens 1 And a protrusion 322c to be held. Further, in the main body 320, the pushing shaft 330 is housed in a state where it can reciprocate in the main body 320 behind the lens 1, and the lens contact portion 333 at the tip of the pushing shaft 330 is housed in the lens holding portion 322. This is a state where the pushed lens 1 has not started to be pushed out toward the nozzle portion. Note that the tip opening of the nozzle portion 323 of the main body 320 is located in the tip direction on the axial extension of the extrusion shaft 330. The protrusion 322b is connected to the inner wall of the lens holding part 322 by a hinge part 322d, and a recess is formed in the inner wall of the lens holding part 322 in the forward direction of the position where the protrusion 322b is formed on the inner wall of the lens holding part 322. 322e is formed. Needless to say, the hinge portion 322d for connecting the projection 322b to the inner wall of the lens holding portion 322 needs to be strong enough to hold the optical portion 1a of the lens 1 in the lens holding state.

Therefore, the lens 1 accommodated in the insertion instrument 310 is inserted during transportation and storage by holding the front and rear directions with the projection 322b and the projection 322c across the lens optical axis. It can be accommodated and held without moving inside the instrument 310 and in a state where no stress is applied to the optical part 1a of the lens 1.

  Next, the operation of inserting the intraocular lens 1 into the eye using the intraocular lens insertion tool shown in Example 3 to which the present invention is applied will be described with reference to FIGS.

  FIGS. 9A and 9B show a state (lens holding state) immediately before the lens 1 is loaded into the lens holding portion 322 formed on the main body 320 of the insertion instrument and the operator pushes the pushing shaft 330 in the distal direction. Is shown. The lens 1 is held by the lens holding portion 322 positioned in the proximal direction of the nozzle portion 323 in a state where no stress acts on the optical portion 1a of the lens 1 as described above. In this state, the operator does not push out the pushing shaft 330, and the lens contact portion 333 of the pushing shaft 330 is in contact with the rear end direction of the lens edge of the lens 1 held by the lens holding portion 322. Even when the lens 1 is not in contact or in contact with the optical unit 1a of the lens 1, the lens 1 is in contact with the optical unit 1a without being stressed. It is assumed that it has not moved. Then, when the surgeon starts the pushing operation of the push-out shaft 330, the lens 1 held by the lens holding portion 322 of the main body 320 is moved in the direction of the nozzle portion 323 (front end direction) in the main body 320. Be started. (Lens movement initial state)

  FIGS. 10A and 10B show that the lens 1 held by the lens holding portion 322 of the main body 320 of the insertion instrument is moved from the initial state of lens movement by the operator pushing the push-out shaft 330. This shows a state in which the inside is moving in the direction of the nozzle portion 323 (a lens movement progress state). The lens 1 shown in FIG. 9 is loaded into the lens holding portion 322 formed on the main body 320 of the insertion instrument 310, and the surgeon pushes the pushing shaft 330 from the state immediately before the surgeon pushes the pushing shaft 330 in the distal direction. When the push-out operation is started in the direction, first, the lens contact portion 333 formed at the tip of the push-out shaft 330 comes into contact with the lens edge portion in the rear end direction of the optical portion 1a of the lens 1 held by the lens holding portion 322. When the operator continues the push-out operation of the push-out shaft 330 as it is, the optical part 1a of the lens 1 is pressed against the lens contact part 333 and the lens 1 moves in the distal direction. The lens edge portion in the distal direction of the optical unit 1a of the lens 1 held by the holding unit 322 starts to press the protrusion 322b of the lens holding unit 322 in the circumferential direction. . The projection 322b receives a pressing force from the optical part of the lens 1, and the projection 322b deforms in the circumferential direction with the hinge 322d connected to the flat part 322a as a fulcrum.

  When the above-described surgeon pushes the pushing shaft 330, the lens 1 held by the lens holding portion 322 of the main body 320 is further operated from the state in which the inside of the main body 320 is started to move in the direction of the nozzle portion 323. When the operator continues the push-out operation of the push-out shaft 330, the optical surface from the lens edge in the distal direction of the optical part 1a of the lens 1 to the optical surface near the projection 322b of the optical part 1a of the lens 1 is reached. The projection 322b of the lens contact portion 322 is further deformed in the circumferential direction using the hinge portion 322d as a fulcrum. Finally, the protrusion 322b of the lens holding portion 322 is accommodated in the recess 322e and the opposing surfaces collide with each other, so that the deformation in the circumferential direction stops. At this stage, the inner wall shape in which the inner wall of the lens holding portion 322 and the wall surface of the protrusion 322b facing the lens 1 are continuous is formed.

Through the above-described steps, the protrusion 322b of the lens holding portion 322 is deformed in the circumferential direction, so that it is accommodated in the recess 322e formed on the inner wall of the lens holding portion 322, and becomes a part of the inner wall shape of the main body 320. When the lens 1 is pushed out in the direction of the nozzle portion 323 by the push-out shaft 330, the lens 1 can smoothly move in the direction of the nozzle portion 323 because there is no place that becomes a barrier of the lens holding portion 322 that the lens 1 must get over. become able to. Then, the lens 1 finally passing through the nozzle portion 323 and deformed to a small extent is inserted into the eye from the opening of the tip of the nozzle portion 323.

  As mentioned above, although this invention was demonstrated based on some Examples, this invention is not limited to these, It cannot be overemphasized that various deformation | transformation implementation is possible. For example, in the above-described embodiments, the case where the lens is directly loaded in the main body has been described.

DESCRIPTION OF SYMBOLS 1 Lens for intraocular insertion 10 Insertion instrument 20 Main body 22 Lens holding part 22b Projection part 22d Hinge part 30 Extrusion shaft

Claims (3)

A main body having a lens holding portion for holding an intraocular lens;
An insertion device for an intraocular lens having an extrusion shaft that pushes the lens held by the lens holding portion into the eye from the distal end opening of the main body,
When the intraocular insertion lens is pressed and moved by the push-out shaft, the projection of the lens holding portion is pressed by the intraocular insertion lens to move the projection and the inner wall of the lens holding portion. An insertion device for an intraocular insertion lens, wherein the insertion device is configured to be deformed in the circumferential direction with a hinge portion to be connected as a fulcrum, and to smoothly move the intraocular insertion lens in the distal opening direction. .   2. The intraocular insertion according to claim 1, wherein at least a part of the lens holding portion deformed in the circumferential direction becomes a part of the inner wall shape of the main body and has a continuous inner wall shape. Lens insertion device. An insertion instrument according to claim 1 or 2,
An intraocular lens-incorporating insertion device including an intraocular lens held in the lens holding portion.