JPH0528624B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION Field of the Invention The present invention relates to intraocularly insertable devices and methods for surgically inserting such devices into the retroocular aqueous of the human eye.

BACKGROUND OF THE INVENTION Surgical removal of the opaque lens from the eye of a cataract patient is one of the most common surgical procedures. Postoperatively, contact lens or eyeglass treatment is generally indicated to provide the patient with at least limited vision. Although spectacle lenses and contact lenses have a number of optical deficiencies, they are safe and have the ability to be removed or replaced if they have defects. It is considered an attractive device.

However, for some patients, glasses or contact lenses may not work. Many elderly patients are unable to insert and remove contact lenses or handle thick glasses. The same is true for significantly younger patients. Fortunately, surgical replacement surgery is available for these patients. That is, a prosthetic lens, that is, an artificial lens, can be implanted inside the eye in place of the surgically removed opaque crystalline lens. Although this type of surgery may not be appropriate for all cataract patients at this time, improvements in lenses and techniques such as the present invention may make this type of surgery common in the future. It might be. This surgery is called lens implant insertion, and to this day, it is widely used in the United States.
More than 100,000 such operations have been performed.

The first intraocular lens insertion surgery was performed by Ridley in 1949.
It was performed on the retroorbital aqueous of the eye. Since fixation in the retroocular aqueous was difficult, many subsequent insertions were performed in the anterior aqueous, or by clamping the iris in a certain way. Jaffe,
Galin, Hirschman and Clayman (the latter is the inventor of the invention) (CVMosby Company
The publication Pseudophakos, et al. (1978) summarizes the developments in this field and describes many of the different types of devices that have been inserted in the past.

Although contradictory to earlier efforts, placing the device in the retroocular aqueous has a number of substantial benefits. Therefore, several devices have recently been proposed and developed for placement in this aqueous chamber. The Shearing intraocular lens disclosed in U.S. Pat. ) using a pair of spring-like loops on either side. This shearing lens is a plano-convex lens, and the plane is called the retro-ocular capsule (capsule).
or are designed to contact the surface of the lens, which usually remains intact but can often be perforated (cut) during extracapsular cataract extraction (ECCE). The optical element portion of the shearing lens is circular. This shearing lens is structurally similar to Barraquer's earlier device, but this latter device was designed to be placed in the anterior aqueous. Polar U.S. Patent No. 4,073,014 and
No. 4,080,709 describes another example of a retroaqueous device.

SUMMARY OF THE INVENTION The present invention is directed to a unique insertable intraocular device that has a number of substantial advantages over prior devices, including shearing devices. As in the shearing device, in the present invention two haptic loops are attached to the lens opposite each other. Like a shearing device,
At least one haptic loop is compressible, and preferably both haptic loops are compressible. Although the lens is designed to be fixed in the ciliary sulcus, the different thicknesses of the upper and lower haptic loops are utilized to uniquely compress the haptic loops, making this invention The device is also suitable for insertion into a capsula bag. However, unlike the shearing device, the lower haptic loop is more rigid than the upper haptic loop. Experiments have shown that when the insertable device is moved from its desired position, it tends to move downwards, or alternatively, if the pupil is asymmetrical, the latter tends to move upwards. The greater rigidity of the lower tactile loop ensures that the device remains in place and that the optic occupies all or most of the pupil.

Hereinafter, the vertical direction of the lens refers to the longitudinal direction in which the upper and lower haptic loops are attached to and extend from opposite sides, and the horizontal direction refers to the horizontal direction transverse to the longitudinal direction. Used in the sense of direction.

The lens of the present invention has a vertical dimension larger than a horizontal dimension. Misalignment as described above tends to move in the vertical direction, and increasing the dimensions ensures that the lens remains in its functional position.

The insertion is the primary insertion performed when removing a cataract,
There is a secondary insertion performed during a subsequent secondary surgery. As mentioned above, during ECCE, the retroocular aqueous or natural lens surface usually remains intact, but it is often perforated to prevent the lens from becoming opaque later on. Form. If so, the perforations can cause individual images to be formed on the retina and provide satisfactory visual acuity. This stage of drilling is called cutting. The usual procedure during primary insertion is to make a cut after the inserted lens is properly positioned. After removing the nucleus and cortex of the natural lens, the pressure of the vitreous humor behind the natural lens often forces the posterior surface of the eye forward. In shearing lenses, the membrane presses directly against the flat posterior surface of the lens, making incision a difficult procedure without displacing the lens and/or introducing vitreous fluid into the anterior aqueous. .

However, this problem can be overcome to a large extent by the present invention, which provides a convex rear surface of the lens with a sufficient chamber to allow for easy cutting. In addition,
The optical characteristics of the lens of the present invention include having a convex rear surface,
This can also be improved by making the front surface flat.

According to another aspect of the invention, the front surface of the lens has at least one hole, preferably an upper and a lower hole, extending through the lens at an angle of, for example, 15° to 20° with respect to the vertical direction. Make a square hole on the side. In the past, it was customary to use forceps to insert the device into the eye. However, opening the forceps within the limited space within the anterior aqueous can be an inconvenient procedure for the corneal endothelium. By providing a square hole, the insert can be secured in the upper or lower square hole with either a thin spatula or forceps and manipulated within the location.

According to the gist of the invention, the side edges of the lens are provided with straight sections. These straight sections not only minimize the size of the incision required to insert the insert, but also guide the lens into position during insertion. In the case of circular lenses, such as shearing lenses, there may be a tendency for the lens to be off-centered during insertion as the largest diameter portion of these lenses passes inward through the incision.

To insert the device according to the invention, generally an air bubble (or other substance for forming the preocular aqueous)
is placed in the anterior aqueous of the eye and the device is slipped through the corneal-scleral incision to the posterior side of the bubble in the aqueous. The device is then moved downwards so that the lower haptic loop compresses in the inferior (inferior) ciliary sulcus. The device can then be continued to be moved downwardly while compressing the lower haptic loop until the upper haptic loop passes the pupillary margin.
If the upper haptic loop needs to pass through the pupillary margin, the upper haptic loop can be compressed using a second instrument or the upper iris can be retracted. When the insert is released, the device springs back into place and is held without suturing (although suturing can be done via the upper haptic loop). Preferably, the lens may be provided with a angular hole to allow manipulation of the lens within the eye using a thin spatula or other instrument. The device of the present invention can be inserted with relative ease by either left-handed or right-handed surgeons.

[Example] Other objects of the present invention will become clear from the description of the drawings below.

FIG. 1 and FIG. 2 are front and side views of the present invention, respectively, and will be described with reference to these figures. The device of the present invention consists of an oval lens 20 of a suitable material, an upper haptic loop 22 attached to the lens 20, and a lower haptic loop 24 attached to the lens 20. The two haptic loops may be inserted into drilled holes or may be molded into an optical element.
The haptic loops are fixed in appropriate positions around the lens 20, facing each other. The edge of the lens between the two haptic loops is provided with straight sections 26 and 28 which serve to guide the lens through the small cut into the desired position, as described above. The lower haptic loop 24 acts like a spring during insertion of the device, as will be explained in more detail below. As is clear from the figure, a square hole 30 is formed in the front surface of the lens 20 in a non-penetrating manner.
and 32, which holes allow the device to be secured to a thin spatula or other similar instrument to properly insert and position the lens without traumatizing the corneal endothelium. angle with respect to the vertical direction
A suitable angle is 15° to 20°.

After insertion, to ensure lens alignment,
The lower haptic loop 24 has greater stiffness than the upper haptic loop 22. This difference in stiffness can be provided, for example, by forming the upper tactile loop of 5-0 polypropylene or nylon and the lower tactile loop of 4-0 polypropylene or nylon; The loop may be formed of other bioreceptive materials.
If misalignment occurs after insertion, since this misalignment is usually vertical, the lens should be shaped like an oval with its vertical dimension larger than its horizontal dimension, so that the lens optics can align with the pupil. The optical effect is enhanced by occupying the space. Also, hole 30
Since numerals 32 and 32 are non-through holes, it is possible to reduce the glare phenomenon that occurs when a positional shift occurs and the hole overlaps the pupil, compared to the case where the hole is a through hole.

Preferably, unlike a shearing device,
The upper tactile loop 22 is closed by fixing its ends and is further strengthened by the two-point fixation. Additionally, the closed upper haptic loop 22 can be sutured in place if desired by the surgeon.

To aid in dissection, the posterior optical surface of the lens 20, which contacts the posterior surface of the eye's natural lens, the capsule, is convex rather than flat. The front surface of this optical element is inherently flat, and this plano-convex shape is considered to have excellent optical properties.

Lens 20 is preferably formed from a suitable synthetic resin, such as polymethyl methacrylate, or glass, and may be molded by injection, compression molding, lathe cutting, or other techniques conventional for forming intraocular lenses. (or a combination of these techniques).

3-6 are schematic diagrams illustrating a surgical method for inserting the device of the present invention. As shown in FIG. 3, the device of the invention is slid with suitable forceps through the incision and into the retro-ocular aqueous area, beneath the pre-established bubble.

The insert is then secured with a thin spatula or other similar device into the upper angular hole 30, and the lower tactile loop 24 is placed in the lower ciliary position in the retroocular aqueous, as shown in FIG. Gently move the insert downward until it compresses against the body sulcus. The lower hole allows the surgeon to reverse the insertion position from the preferred position shown if desired. As shown in FIG. 4, the lower haptic loop 24 is compressed until the upper haptic loop 22 passes the pupillary margin. If desired, the upper haptic loop can be compressed by the second instrument to pass through the pupillary margin and/or the iris can be retracted.

The insert is then released, as shown in FIG.
Move this insert by flicking it behind the iris. Next, remove the spatula. After this insert springs back into the desired position behind the iris and into the ciliary sulcus, the pupil can be tightened by suitable means and peripheral iris excision (removal of a portion of the iris) can be performed. can. If desired, the upper haptic loop can be sutured to provide an anchor. At this point,
As shown in FIG. 6, a surgical incision may be performed to avoid later opacity of the retroocular capsule. The wound is sutured and the surgery is completed.

It will be appreciated that many variations and modifications may be made to the above-described embodiments of the invention without departing from the scope of the invention. Accordingly, its scope is limited only by the appended claims.

[Effects of the Invention] As is clear from the above description, according to the present invention, when inserting a lens into the eye, the peripheral edge of the lens is a lens body having at least one hole impenetrably drilled in the lens body, and attached to an opposite side of the lens body at a different position than the hole for positioning the lens in the retroocular aqueous; The flexible upper and lower tactile loops allow for easy manipulation with the instrument during insertion, and even if the lens body is misaligned after insertion. , the glare phenomenon can be reduced compared to through holes.

[Brief explanation of the drawing]

Fig. 1 is a rear view showing the device of the present invention, Fig. 2 is a side sectional view showing the device of the present invention, and Fig. 3 is a book inserted into the anterior aqueous of the eye through an appropriate incision after extracapsular cataract removal. FIG. 4 is a schematic diagram illustrating the device of the invention, in which the lower haptic loop is compressed into the lower ciliary sulcus by means of a spatula or similar device engaged in the upper square hole; A schematic diagram illustrating the present invention; FIG. 5 is a schematic diagram illustrating the present invention with the insert moved downward behind the pupil edge; FIG. FIG. 4 is a schematic diagram showing the invention with the haptic loop springing back into position in the ciliary sulcus and with the incision made on the posterior side of the lens;

Claims (1)

[Scope of Claims] 1. At least one hole made in a non-penetrating manner in the periphery of the lens from one side to the other in order to allow attachment of an instrument when inserting the lens into the eye. and flexible upper and lower tactile loops attached to opposite sides of the lens body at different locations from the hole for positioning the lens in the retroocular aqueous. A retro-aqueous intraocular implant device for insertion into the retro-ocular aqueous of an eye. 2. The retro-aqueous intraocular implant device according to claim 1, wherein the hole has an angle.