JPH03139347A - Device for ultrasonic operation for ophthalmologist - Google Patents

Abstract

PURPOSE:To make a perfusing fluid unnecessary during an extraction is performed and to make a out opening small in extraction of divided lens by making an apex of a chip transmitting an ultrasonic mechanical vibration a flat knife shape for vibrating and cutting the lens. CONSTITUTION:A flat knife part 22b for vibrating and cutting the lens is provided on an apex of a chip 22 transmitting an ultrasonic mechanical vibration. By giving an ultrasonic vibration to this flat knife, the lens can be cut and the lens thus divided into two or more can be extracted out from a relatively small cut opening. Therefore, a perfusing fluid is not necessary even during the extraction is performed and the cut opening can be made relatively small when the divided lenses are extracted.

Description

DETAILED DESCRIPTION OF THE INVENTION [Field of Industrial Application] The present invention relates to an ultrasonic surgical instrument for ophthalmology, and particularly to improvements in an ultrasonic vibrating tip for cutting the crystalline lens.

[Prior Art] When vision is lost due to cataract or the like, a surgery is performed to remove the cloudy crystalline lens and insert a human glass lens into the capsule in its place.

Conventionally, in order to remove the crystalline lens, basically two steps have been taken:
There are two laws of the species, the first one is t! i-meter wave emulsification aspiration (
PEA), and the second method is extra-osseous lens extraction (E
CCE).

In the former PEA technique, a tip that transmits ultrasonic vibrations is inserted into the capsule to crush the crystalline lens using ultrasonic waves, and at this time, the crushed crystalline lens is suctioned out of the bone along with the fluid using the irrigation fluid injected into the capsule. , the lens is fragmented and removed within the capsule.

According to this PEA technique, the above-mentioned ultrasonic fragmentation is carried out in the capsule by simply guiding a thin tip into the capsule, so the incision of the eyeball membrane can be kept relatively small and the incision can be made smaller. There is.

On the other hand, in the ECCE technique, a relatively large incision is made in the membrane of the eyeball, and the crystalline lens is removed from the incision using a hook, and the removal surgery can be completed in a relatively short time.

In both methods, after the crystalline lens is removed, an artificial lens is inserted and fixed into the capsule.

[Problems to be Solved by the Invention] However, each of the above-mentioned methods has its own problems, and has the disadvantage that the crystalline lens cannot be removed safely and reliably.

In other words, in PEA surgery, in order to perform ultrasonic fragmentation of the crystalline lens within the capsule, a perfusate is always injected into the eye and this perfusate is removed by suction to the outside along with minute pieces of the shattered crystalline lens. In the normal case, this irrigation fluid is supplied from around the ultrasound chip by an irrigation fluid tube, and the irrigation fluid along with the microscopic particles is removed by suction from a suction conduit provided in the tip.

Therefore, the tips used in such PEA procedures usually consist of a cylindrical tip with a central conduit.

When supplying irrigation fluid into the eye, it is difficult to control the pressure of irrigation fluid, and when the irrigation water pressure is high, it may cause damage to the cornea.
There was a drawback that the fE liquid penetrated and mixed 1 yen:J was generated.

On the other hand, when the suction pressure becomes high, the cornea is likely to dent inside and come into contact with the ultrasound tip, causing damage to the corneal endothelium.

Furthermore, the irrigation fluid supply causes turbulence within the eye and tends to escape from the lens or chip, resulting in the ultrasonic vibrations not being used to fracture the lens and damaging surrounding tissues. There was a risk.

Therefore, there is a trend to avoid PEA procedures that require such irrigation fluids.

On the other hand, the ECCE technique, which does not involve intraocular fragmentation of the crystalline lens, does not have the drawbacks of the PEA technique mentioned above, but on the other hand, since the crystalline lens, which has a relatively large outer diameter, is removed as is, the incision formed in the ocular membrane is large. There was a problem in that post-operative recovery was likely to be delayed.

Normally, the incision for removing the crystalline lens in ECCE is around 9 mm, whereas in PEA, only a cylindrical tip needs to be inserted, so in principle, an incision of about 3 m is sufficient.

However, in general, it goes without saying that the PEA procedure requires an incision of about 6 mm not only for the insertion of an ultrasound chip but also for the insertion of an artificial lens after removal of the crystalline lens.

The present invention has been made in view of the above-mentioned conventional problems, and
An object of the present invention is to provide an ultrasonic surgical instrument equipped with an ultrasonic chip for realizing a new method that combines both EA technique and ECCE technique.

[Means for Solving the Problems] In order to achieve the above object, the ultrasonic tip according to the present invention has a flat knife at the tip of a solid tip that does not require a conventional irrigation fluid supply or suction conduit. It is characterized by giving it a shape.

[Function] Therefore, according to the present invention, although the ultrasonic chip without irrigating fluid cannot completely fracture the crystalline lens as in the conventional method,
The crystalline lens can be cut by applying ultrasonic vibration to the flat knife, and the crystalline lens thus divided into two or more parts can be extracted to the outside through a relatively small incision.

Therefore, according to the present invention, there is an advantage that no irrigation fluid is required even during the extraction operation, and that the incision can be made relatively small when extracting the split crystalline lens.

[Embodiment] Hereinafter, a preferred embodiment of the present invention will be described based on FIG. 1.

FIG. 1 shows a cross section of the essential parts of an ultrasonic surgical instrument according to the present invention.

An ultrasonic vibrating body is built in the main body case 10, and the ultrasonic vibrating body in the embodiment is composed of a plurality of electrostrictive vibrators 12-1.12-2.12-3°12-4 arranged in a stacked manner and this vibration. It includes a horn 14 that transmits ultrasonic vibrations of the child 12.

The horn 14 is provided with a flange 14a,
Inside the main body case 10, the flange 14a is firmly screwed through an O-ring 16 and a fixing nut 18.

The laminated electrostrictive vibrators are made of ceramic such as PZT, and are fixed to one end of the flange 14a, and each vibrator 12 is connected to an electric wire 820-1.20-2.
．． A high frequency voltage is supplied from 20-3 and 20-4, and this ultrasonic vibration is transmitted to the horn 14.

As is well known, a high frequency voltage is supplied to each electrode 20 from a controller not shown in detail.

The horn 14 is made of a metal cylinder whose diameter gradually decreases, and a tip 22 is screwed to the tip thereof.

and a horn 1 which protects the horn] 4 and the chip 22.
A horn case 24 is screwed onto the front 3 nut 181, and a chip case 2 is also attached to this horn case 24.
6 is fixed with screws.

In the surgical instrument according to the present invention, it is not necessary to supply the liquid to the tip of the tip 22, but the ultrasonic vibrator generates heat during vibration, and in the embodiment, in order to prevent this heat generation, Cooling water is guided to the horn 14 of the vibrating body.

For this purpose, a cooling water conduit 28 is connected to the side surface of the chip case 26, while a conduit is provided in the center of the chip 22 and the horn 14. conduits are connected.

Therefore, the cooling water sent into the cooling water conduit 28 from the outside passes through the chip 22, the horn 14, and the inside of the vibrator 12, and is discharged to the outside from the drainage conduit 30 as shown by the arrow, thereby effectively reducing the heat generated in the vibrating body. It's cooling down.

In order to form this cooling water conduit, a flexible sealing ring 3 made of rubber or the like is installed between the tip of the chip case 26 and the chip 22.
2 is provided to prevent cooling water from leaking from the chip 22 to the outside.
4 is also provided with a circle 34.

An opening 22a is provided in the tightening nut portion of the tip 22.
is provided, and the cooling water is supplied to the horn 1 from this opening 22a.
It is led to a conduit within 4.

A characteristic feature of the present invention is that the tip 22 has a flat knife portion 22b at its tip, and in the embodiment, this tip 22 is made of substantially solid stainless steel or titanium alloy, etc. Knife part 22
b allows cutting of the crystalline lens during ophthalmic surgery.

FIG. 2A shows the state of the chip 22 in this embodiment as viewed from the direction of the arrow in FIG. 1, and a flat knife portion 22b whose side surface is cut flat is provided at the tip thereof.

Therefore, according to the present invention, the distal end surface 22c of the flat knife portion 22b is used for cutting the crystalline lens.

FIG. 2B shows a perspective view of the flat knife portion 22b of the tip 22, and the distal end surface 22c is ultrasonically vibrated to cut the crystalline lens.

FIG. 3 shows another shape of the tip according to the present invention, in which a wide flat knife portion 122b is provided at the tip of the tip 122.

FIG. 4 shows another embodiment of the present invention, in which the tip 222 has a tapered flat knife portion 222b.

In both Figures 3 and 4, these flat knives 1
22b and 222b perform vibration cutting of the crystalline lens by 1 tft.

5 and 6 show a surgical process for cutting a crystalline lens using the chip according to the present invention.

In FIG. 5A, an incision indicated by a in the figure is provided in the ocular membrane connected to the cornea, and in the example, a 6 mm wide incision is made.

In this state, a viscoelastic agent is inserted into the space between gc, which surrounds the crystalline lens, and cornea d, to form a surgical space.

Next, the anterior capsule of capsule C is removed, as shown in FIG. 5B, and the lens is then moved to a position where it can be easily cut, as shown in FIG. 5C.

FIG. 5D shows the tip 22 according to the present invention from the incision a.
is shown inserted, and the flat knife portion 22b and tip surface 22c are cut into the crystalline lens d.

FIG. 5E shows the progress of cutting the crystalline lens while applying vibration to the tip 22 in the eye, and according to the embodiment, the crystalline lens is thereby divided into two parts.

When the crystalline lens is completely divided into two parts, as shown in Fig. 5F, a hook e is inserted into the eye, and one of the two halves of the crystalline lens piece b1 is extracted to the outside through the incision a. . In Fig. 5F, the remaining crystalline lens piece b divided into two
2 remains in the eye, or the remaining crystalline lens piece b2 is easily removed to the outside like the other crystalline lens piece b1.

FIG. 6 shows the extracted state of the crystalline lens piece b1 from another direction, where a wire-like hook e is inserted into the eye through the incision a and the two-divided crystalline lens piece b2 is taken out.

In this way, according to the present invention, the crystalline lens is vibrated and cut by the biased knife part of the chip, and the cutting part at this time produces only a very small amount of fragmentation compared to conventional fragmentation. It is possible to easily divide the crystalline lens within the eye without supplying /Iu fluid.

Figure 5G shows both lens pieces b1. The state after b 2 has been removed is shown, and a cavity will be formed within the sac C.

Therefore, as shown in Fig. 5H, an artificial lens f is inserted into this cavity, and the incision is then tied with sutures.
The surgery can be completed.

As described above, according to the chip of the present invention, it becomes possible to easily perform lens extraction surgery without introducing perfusion fluid.

[Effects of the Invention] As explained above, according to the present invention, the tip through which ultrasonic vibrations are transmitted does not require an irrigation fluid conduit inside, and can be made into a small-diameter tip that can be inserted into the eye. It has the advantage that there is no risk of damaging the cornea or the like in some cases.

Further, according to the present invention, lens extraction surgery can be performed without requiring an irrigation fluid, there is no need to adjust the pressure of the irrigation fluid, and there are advantages in that no TI scars on the cornea occur due to the introduction of the irrigation fluid.

Further, according to the present invention, since the crystalline lens is divided or divided into a plurality of parts, it is possible to reduce the size of the incision required for its removal.

[Brief explanation of the drawing]

FIG. 1 is a cross-sectional view of essential parts showing a preferred embodiment of the ultrasonic surgical instrument according to the present invention, FIG. 2A is an explanatory diagram of the vibrating tip in this embodiment as seen from the direction A in FIG. 1, and FIG. 2B 3.4 is a perspective view showing the flat knife portion provided at the tip end of the tip according to the present invention, and FIG. FIG. 6 is an explanatory diagram for performing lens extraction using the ultrasonic surgical instrument according to the present invention. FIG. 6 is a perspective view showing the main parts at the time of crystalline lens extraction. ] 2... Electrician vibrator 14... Horn 22... Chip 22b... Flat knife portion a... Incision wound b... Crystalline lens b l, b 2... Crystalline lens piece C... Capsule . Figure 2A

Claims (1)

[Claims] 1. An ophthalmic ultrasonic surgical instrument comprising a tip through which ultrasonic mechanical vibrations are transmitted, the tip of which has a flat knife shape for vibrationally cutting a crystalline lens.