JP7181544B2 - ophthalmic surgical instrument - Google Patents

Description

The present invention relates to an ophthalmic surgical instrument and the like used for intraocular lens surgery.

A lens reconstruction operation using an intraocular lens (IOL: Intraocular lens) is widely performed as a cataract operation. In phacoemulsification, an intraocular lens is fixed in the lens capsule that has been aspirated and made void by phacoemulsification.

However, in some patients, the intraocular lens cannot be fixed in the lens capsule due to breakage or loss of the lens capsule. Intraocular lens intrascleral fixation is known as a surgical method for such cases. However, this surgical method requires a highly difficult operation such as inserting the haptic of the intraocular lens into the needle hole in the eyeball, and requires a high level of surgical skill.

Patent Literature 1 describes a medical instrument used for intraocular lens intrascleral fixation. This medical instrument is an instrument for hooking and pulling a folded portion formed on a haptic of an intraocular lens. A hook portion of the medical instrument is hooked on the folded portion of the haptic.

Japanese Patent No. 6045659

By the way, an intraocular lens in which a haptic is provided with a folded portion is not generally used. A conventional ophthalmic surgical instrument (medical instrument described in Patent Document 1) is intended for a special intraocular lens. Therefore, conventionally, intraocular lens intrascleral fixation using a general-purpose intraocular lens still required a high level of surgical technique.

The present invention has been made in view of such circumstances, and provides an ophthalmic surgical instrument that can reduce the difficulty of intraocular lens intrascleral fixation using a general-purpose intraocular lens. The purpose is to

In order to solve the above-mentioned problems, a first invention is an ophthalmic surgical instrument used for intraocular lens surgery having a haptic, comprising a guide member to be passed through a needle hole formed in the eyeball, and a guide member. and a flexible tube connected to and pulled by the guide member to be passed through the needle hole, the flexible tube being capable of inserting a haptic inside and holding the haptic inserted inside.

In a second invention based on the first invention, the dimension of the inner space of the flexible tube is larger than the dimension of the distal end portion of the haptic.

A third invention is the first or second invention, wherein a silicon tube is used as the flexible tube.

According to a fourth invention, in any one of the first to third inventions, the guide member is inserted inside the flexible tube at a connecting portion between the guide member and the flexible tube.

In a fifth invention, in any one of the first to third inventions, the flexible tube is sandwiched between clamping portions provided at the ends of the guide member at the connection point between the guide member and the flexible tube. is

In a sixth invention, in any one of the first to fifth inventions, an end surface of the flexible tube on the side connected to the guide member is formed obliquely with respect to the width direction.

In the present invention, the flexible tube can be passed through the needle hole formed in the eyeball using the guide member. Here, if the intraocular lens is not a special intraocular lens, the haptic can be inserted inside the flexible tube by preparing a flexible tube according to the thickness of the haptic. In the present invention, a haptic is inserted into the end of a flexible tube extending inward and outward of the eyeball through a needle hole in the eyeball. A flexible tube holds the haptics inserted inside. By pulling out the flexible tube to the outside, the haptic is pulled by the flexible tube, and the tip side of the haptic can be guided through the needle hole and pulled out of the eyeball through the needle hole. This allows fixation of the intraocular lens in intraocular lens intrascleral fixation.

In addition, in the present invention, for example, by securing a certain length of the flexible tube passed through the needle hole of the eyeball, the flexible tube can be passed through the needle hole and the eyeball through an incision formed in the eyeball. The inwardly extending portion can be pulled out of the eyeball. This allows the operation of inserting the haptic inside the flexible tube to be performed outside the eyeball. According to the present invention, the degree of difficulty of intraocular lens intrascleral fixation can be reduced.

FIG. 1 is a schematic configuration diagram of an ophthalmic surgical instrument according to an embodiment. FIG. 2 is a schematic diagram for explaining a state in which a haptic is inserted into a flexible tube of an ophthalmic surgical instrument. FIG. 3 is a diagram for explaining the tube insertion work in the method of using the ophthalmic surgical instrument, and is a schematic diagram of the eyeball in a cross-sectional view. FIG. 4 is a diagram for explaining the tube cutting work in the method of using the ophthalmic surgical instrument, and is a schematic diagram of an eyeball in a cross-sectional view. FIG. 5 is a diagram for explaining the lens connection work in the method of using the ophthalmic surgical instrument, and is a schematic diagram of the eyeball in a cross-sectional view. FIG. 6 is a diagram for explaining the lens fixing work in the method of using the ophthalmic surgical instrument, and is a schematic diagram of the eyeball in a front view. FIG. 7 is an enlarged view of the main part for explaining the funnel-shaped member attached to the flexible tube in the ophthalmic surgical instrument according to the embodiment. FIG. 8 is an enlarged view of a main part for explaining another form of the connecting portion between the guide member and the flexible tube in the ophthalmic surgical instrument according to the embodiment.

Hereinafter, embodiments of the present invention will be described in detail with reference to FIGS. 1 to 8. FIG. The following embodiments are examples of the present invention, and are not intended to limit the scope of the present invention, its applications, or its uses.

The ophthalmic surgical instrument 10 is a surgical instrument used for surgery on an intraocular lens 20 (see FIG. 2). For example, the ophthalmic surgical instrument 10 is used when the lens capsule is damaged or lost during lens reconstruction, or when the intraocular lens 20 falls into the eyeball 30 (in the case of intraocular lens dislocation). It is used when performing internal fixation. The ophthalmic surgical instrument 10 is a surgical instrument for pulling out the distal end side of the haptic 22 of the intraocular lens 20 to the outside of the eyeball 30 in intraocular lens intrascleral fixation.

Before describing the ophthalmic surgical instrument 10, the intraocular lens 20 will be briefly described. The intraocular lens 20 includes a lens portion 21 and a plurality of haptics 22 (for example, two haptics 22) projecting outward from the outer peripheral surface of the lens portion 21 (see FIG. 2). The plurality of haptics 22 are provided point-symmetrically with respect to the center of the lens portion 21 . Each haptic 22 has an elongated shape and gently curves inward. The outer diameter (thickness) of the tip of each haptic 22 is, for example, about 0.14 mm.

[Configuration of Ophthalmic Surgical Instruments]
Next, the ophthalmic surgical instrument 10 will be described with reference to the drawings. As shown in FIG. 1, the ophthalmic surgical instrument 10 includes a guide member 12 passed through needle holes 41 and 42 (see FIG. 3) formed in the eyeball 30, and a guide member 12 connected to the guide member 12. and a flexible tube 14 that is pulled and passed through the needle holes 41 and 42 .

The guide member 12 is, for example, a needle-like member. Metal such as stainless steel is used as the material of the guide member 12 . A material other than metal, such as hard resin, may be used for the guide member 12 . Further, although the shape of the guide member 12 is formed in a straight needle shape, it may have another shape. For example, the guide member 12 may be curved or shaped like a bar with a blunt tip.

The guide member 12 is formed to have a length that does not hinder handling within the eyeball 30, and is formed to have a thickness that does not cause a large damage even if it is inserted through the sclera 31 of the eyeball 30. - 特許庁For example, the guide member 12 has a total length of 15 mm and a thickness (outer diameter) of 0.14 mm. Note that the dimensions of the guide member 12 are not limited to the values described in this paragraph.

The flexible tube 14 is a very thin tubular member made of flexible material. The flexible tube 14 can be bent arbitrarily. A silicon tube, for example, can be used for the flexible tube 14 . A material other than silicon may be used for the flexible tube 14 .

The flexible tube 14 has circular outer and inner circumferences when viewed in cross section. In addition, the cross-sectional shape of the flexible tube 14 is not limited to this shape. For example, at least one of the outer circumference and the inner circumference may be polygonal when viewed in cross section.

One end portion 15 of the flexible tube 14 is fixed to the needle head portion 13 of the guide member 12 (the portion opposite to the needle tip side). Specifically, as shown in the enlarged view within the dotted line in FIG. 1, the needle head 13 of the guide member 12 is inserted inside one end 15 of the flexible tube 14 . In this state, the needle head 13 of the guide member 12 and the one end 15 of the flexible tube 14 are fixed to each other with an adhesive or the like.

The length of the flexible tube 14 is 200 mm or more as a length that can be divided into two and used in the method of use described later. The inner diameter (inner dimension) of the flexible tube 14 is set so that the haptic 22 can be inserted inside the flexible tube 14 and the haptic 22 inserted inside can be held by friction. The inner diameter of the flexible tube 14 is, for example, 0.2 mm. The dimension (inner diameter) of the inner space of the flexible tube 14 is slightly larger than the dimension (outer diameter or thickness) of the tip side of the haptic 22 (the tip side from the center of the length). When the thickness of the haptic 22 changes, the dimension of the tip side of the haptic 22 refers to the thickness of the thickest part on the tip side.

Even if the dimensional relationship is set in this way, the haptics 22 are bent. Therefore, when the haptics 22 are inserted into the flexible tube 14 for a certain length, the inner surface of the flexible tube 14 is bent as shown in FIG. The haptics 22 abut on at least two points. Therefore, even if the flexible tube 14 pulls the haptic 22 lightly, the haptic 22 is held. Further, by making the inner diameter of the flexible tube 14 larger than the outer diameter of the haptic 22, the work of inserting the haptic 22 into the flexible tube 14 becomes easier.

In addition, the outer diameter (outer dimension) of the flexible tube 14 is set to a dimension that makes it difficult for the flexible tube 14 pulled by the guide member 12 to get caught in the needle holes 41 and 42 when it enters the needle holes 41 and 42 . be. It is preferable that the outer diameter of the flexible tube 14 is set so that, for example, the difference in thickness from that of the guide member 12 is small. The outer diameter of the flexible tube 14 is, for example, 0.3 mm.

In addition, in this embodiment, one end of the flexible tube 14 is provided as shown in the enlarged view of FIG. The end surface of the portion 15 (the side connected to the guide member 12) is formed obliquely with respect to the width direction. The angle .theta. between the end surface and the transverse line in the width direction is, for example, 15 to 75 degrees.

[How to use ophthalmic surgical instruments]
A method of using the ophthalmic surgical instrument 10 in intraocular lens intrascleral fusion will now be described with reference to FIGS. In addition, below, the case where the intraocular lens 20 falls into the eyeball 30 (intraocular lens dislocation) will be described as an example.

First, in intraocular lens intrascleral fixation, the operator performs a tube inserting operation of inserting the flexible tube 14 through the needle holes 41 and 42 formed in the eyeball 30 . In the tube insertion operation, the operator pierces the guide member 12 and the picking needle 18 from the outside to the inside of the eyeball 30, as shown in FIG. 3(a). The picking needle 18 has a hollow structure and a hole is formed at the tip. A needle hole 41 is formed by piercing the eyeball 30 with the picking needle 18 . Further, a needle hole 42 is formed in advance by another needle at the place where the guide member 12 is to be inserted.

These needle holes 41 and 42 eventually become holes through which the haptic 22 is passed and fixed. These needle holes 41 and 42 are formed at positions slightly outside the cornea of the sclera 31 of the eyeball 30 and substantially symmetrical with respect to the center of the eyeball 30 when viewed from the front of the eyeball 30 . Hereinafter, the needle hole 41 through which the picking needle 18 is inserted may be referred to as the "first needle hole", and the needle hole 42 through which the guide member 12 is inserted may be referred to as the "second needle hole".

Subsequently, in the tube insertion operation, the tip of the guide member 12 is inserted into the hole at the tip of the picking needle 18, and the picking needle 18 is pulled out together with the guide member 12, as shown in FIG. 3(b). By this face-to-face threading method, the guide member 12 can be easily passed from the inside to the outside of the eyeball 30 at a predetermined position.

Then, by pulling the guide member 12 further outward, the flexible tube 14 is guided through the first needle hole 41 and passed through the first needle hole 41, and as shown in FIG. 14 is pulled out of the eyeball 30. At this time, since the end surface of the one end portion 15 of the flexible tube 14 is cut obliquely with respect to the width direction, the flexible tube 14 is less likely to get caught in the first needle hole 41 . As described above, the tube insertion operation is completed, and the flexible tube 14 is inserted through the two needle holes 41 and 42 .

Next, a tube dividing operation for dividing the flexible tube 14 into two is performed. In the tube cutting operation, as shown in FIG. 4(a), an operator pulls a rod-shaped hook 36 having a hook at the tip from an incision 35 formed in the cornea of the eyeball 30 to the outside of the eyeball 30. , and the flexible tube 14 is hooked on the hook. Then, the flexible tube 14 is pulled out together with the hook 36 from the incision 35 to the outside of the eyeball 30 . Note that tweezers can be used instead of the hook 36 for pulling out the flexible tube 14 to the outside of the eyeball 30 . As shown in FIG. 4(b), by cutting the flexible tube 14 outside the eyeball 30 with the scissors 37, the flexible tube 14 is cut into a first flexible tube that has been passed through the first needle hole 41. The tube 14a and the second flexible tube 14b passed through the second needle hole 42 are divided. The above completes the tube cutting work.

Next, a lens connection operation is performed to connect each haptic 22 of the intraocular lens 20 to each flexible tube 14a, 14b. In the lens connecting operation, the operator picks up the intraocular lens 20 with tweezers inserted into the eyeball 30 and pulls out one first haptic 22 a from the incision 35 . Then, as shown in FIG. 5A, the first haptic 22a is inserted outside the eyeball 30 and inside the end of the first flexible tube 14a.

Further, the operator returns the first haptic 22a into the eyeball 30 with tweezers, then pulls out the second haptic 22b from the incision 35 to the outside of the eyeball 30, as shown in FIG. 5(b). , the second haptic 22b is inserted inside the end of the second flexible tube 14b. In the lens connecting operation, each haptic 22a, 22b is inserted into the flexible tube 14a, 14b for a certain length so that each haptic 22a, 22b does not easily come off from the flexible tube 14a, 14b. Then, the operator returns the second haptic 22b into the eyeball 30 with tweezers, and moves the entire intraocular lens 20 behind the iris 32 as shown in FIG. 5(c). With the above, the lens connection work is completed.

In addition, in intraocular lens intrascleral fixation when the lens capsule is damaged or lost in lens reconstruction, each haptic 22a, 22b is flexible while the entire intraocular lens 20 exists outside the eyeball 30. It is inserted inside the sex tubes 14a, 14b. The intraocular lens 20 is then introduced into the eyeball 30 .

Next, the haptics 22a and 22b are passed through the needle holes 41 and 42 to fix the haptics 22a and 22b to the sclera 31, thereby performing a lens fixing operation. In the lens fixing operation, the operator pulls each flexible tube 14a, 14b outward. As a result, the haptics 22a and 22b held in the flexible tubes 14a and 14b are pulled outward, guided to the needle holes 41 and 42, and enter the needle holes 41 and 42, respectively. Each flexible tube 14a, 14b is pulled until the distal end side of each haptic 22a, 22b is drawn outside the eyeball 30, as shown in FIG. 6(a). In addition, in FIG. 6, a portion inside the eyeball 30 is indicated by a dotted line.

Then, the flexible tubes 14a and 14b are removed from the haptics 22a and 22b, the haptics 22a and 22b are cut outside the eyeball 30 as shown in FIG. 6(b), and then the haptics 22a and 22b are heated. Each of the haptics 22 a and 22 b is fixed to the sclera 31 by performing end processing to form the fastening portion 23 . The lens fixation work and the intraocular lens intrascleral fixation are thus completed.

[Effects of the embodiment, etc.]
In this embodiment, a certain length is secured for the flexible tube 14 passed through the needle holes 41 and 42 of the eyeball 30. A portion extending inward of the eyeball 30 can be pulled out from the needle holes 41 and 42 . This allows the operation of inserting the haptic 22 inside the flexible tube 14 to be performed outside the eyeball 30 . According to this embodiment, the degree of difficulty of intraocular lens intrascleral fixation can be reduced.

In addition, in the present embodiment, since the guide member 12 is inserted inside the flexible tube 14 at the connection point between the guide member 12 and the flexible tube 14, the connection during the manufacture of the ophthalmic surgical instrument 10 can be prevented. Easy to work with. However, since the flexible tube 14 covers the outside of the guide member 12 , the flexible tube 14 may be caught in the needle holes 41 and 42 and fall off the guide member 12 . In particular, the flexible tube 14 is likely to get caught in the needle hole 42 through which the flexible tube 14 is passed without using the pick-up needle 18 .

Therefore, in order to prevent the flexible tube 14 from falling off, the guide member 12 and the flexible tube 14 may be introduced through the corneal incision. In this case, two ophthalmic surgical instruments 10 are used instead of dividing the flexible tube 14 into two for one intraocular lens 10 . For each ophthalmic surgical instrument 10 , the guide member 12 introduced into the eyeball 30 through the incision 35 is pulled out of the eyeball 30 together with the pick-up needle 18 , and the flexible tube 14 is passed through the needle hole formed by the pick-up needle 18 . In this case, in order to facilitate the insertion of the haptic 22, a funnel-shaped member 17 is attached to the end 16 of the flexible tube 14 opposite to the guide member 12, as shown in FIG. can be The funnel-shaped member 17 may be formed by rolling a sheet into a funnel shape so that it can be removed after the haptic 22 is inserted, or may be cut to make a cut so that it can be easily removed. may be provided.

Also, in order to prevent the flexible tube 14 from falling off, as shown in FIG. , the guide member 12 and the flexible tube 14 may be connected. One end 15 of flexible tube 14 may not have a hollow structure.

[Other embodiments]
Although the flexible tube 14 is directly connected to the guide member 12 in the above embodiment, the flexible tube 14 may be connected to the guide member 12 via another member such as a thread member.

In the above-described embodiment, a silicon tube is used as the flexible tube 14. Although the silicon tube is excellent in flexibility, the bonding strength is not so strong due to the adhesive. Therefore, the flexible tube 14 made of resin or the like may be used with priority given to the adhesiveness of the adhesive.

In the above embodiment, the case of using the ophthalmic surgical instrument 10 for a general-purpose intraocular lens 20 has been described as an example. The ophthalmic surgical instrument 10 may be applied to the lens 20 .

INDUSTRIAL APPLICABILITY The present invention is applicable to ophthalmic surgical instruments and the like used in intraocular lens surgery.

REFERENCE SIGNS LIST 10 ophthalmic surgical instrument 12 guide member 14 flexible tube 18 picking needle 20 intraocular lens 21 lens unit 22 haptic

Claims (5)

An ophthalmic surgical instrument for use in intraocular lens surgery with haptics, comprising:
a guide member that passes through a needle hole formed in the eyeball;
a flexible tube connected to the guide member and pulled by the guide member to be passed through the needle hole;
the flexible tube is capable of inserting the haptic inside and holding the haptic inserted inside ;
An ophthalmic surgical instrument , wherein the end surface of the flexible tube connected to the guide member is formed obliquely with respect to the width direction. The ophthalmic surgical instrument according to claim 1, wherein the dimensions of the inner space of the flexible tube are greater than the dimensions of the tip of the haptic. The ophthalmic surgical instrument according to claim 1 or 2, wherein a silicon tube is used as said flexible tube. The ophthalmic surgery according to claim 1 , wherein the end surface of the flexible tube connected to the guide member forms an angle of 15 to 75 degrees with a transverse line in the width direction of the flexible tube. instrument. An ophthalmic surgical instrument for use in intraocular lens surgery with haptics, comprising:
a needle-like member that is passed through a needle hole formed in the eyeball;
a flexible tube connected to the needle-like member and pulled by the needle-like member to be passed through the needle hole;
the flexible tube is capable of inserting the haptic inside and holding the haptic inserted inside;
The needle-like member is inserted into the flexible tube at the connection point between the needle-like member and the flexible tube, and the needle-like member and the flexible tube are fixed to each other with an adhesive. ophthalmic surgical instruments.

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