JPH07194643A - Hook for operation to be used when operating on eyes of living organism - Google Patents

Abstract

PURPOSE: To provide an operation hook that does not injure the iris at the time of tension, can be inserted to a cut part of a cornea without using an additional seal, is detachable, and does not need suture, etc., afterwards. CONSTITUTION: This operation hook (an iris retractor) 25 comprises a hook element 10 made of a flexible thermoplastic synthetic resin, and a fixed element 20 mounted regulably on the hook element. The hook element includes at least one hook-shaped hanging part 15 for tensioning an iris 3 at a surgical operation on an eye for a living being. The hook element further comprises a curved part 12. The fixed element 20 has 2 holes, disposed apart from each other, to be penetrated by a filiform hook element and can be deformed. By this deformation, the operation hook, the curved part of which is hanged on a range 3" of the iris 3, is retained at a transition zone 5 from a cornea 2 to a sclera 7, and can be drawn out by a tensile movement Z made relatively to the eye 1.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION The present invention comprises a hook element and a fixing element, the hook element having a hook-like hooking portion and a long guiding portion at at least one end for locally pulling the iris. A slidably mounted on a guide portion and a surgical hook inserted through an incision in the cornea is retained on the outer contour of the eye by a fixation element for use during biological eye surgery Regarding surgical hook.

[0002]

2. Description of the Related Art In the field of ophthalmic surgery, there are often problems that the patient does not respond to the enlargement of the iris caused by a drug or the pupil is not sufficiently enlarged for surgery. Especially in the case of cataract surgery, it is necessary for the surgery of the anterior and posterior parts of the eye to ensure a sufficiently large and unchanging visual field for the operator. To produce this field of view, it is known to grab the iris and pull it outwards for pupil dilation by means of a plurality of spaced-apart surgical hooks (iris retractors). The individual surgical hooks are then each inserted into an incision made in the cornea, positioned visually and then removed again after surgery.

For biological eye surgery, US Pat.
From 037,589, a holding device is known which is formed as a wire frame. The holding device comprises a first surgical hook adjustably mounted in the slider and a second surgical hook which is fixed to pull the iris of the eye separately from the first surgical hook. ing. This second surgical hook has a straight member with bent hook portions at both ends. A disc made of a flexible material is adjustably provided on this member. in this case,
The incision provided for inserting the surgical hook into the cornea is sealed by the disc, which prevents the outflow of aqueous humor. In the case of this known surgical hook, the individual incisions made through the cornea for the insertion of the respective surgical hook have a relatively large size, so that undesired outflow of the quartz station is prevented. To prevent it, the incision must be well sealed with a flexible disc and must be reclosed after removal of the surgical hook by time consuming sutures.

European Patent Application Publication No. 0502258
From the specification, another surgical hook is known for use during surgery on the eye of a living being. The surgical hook includes a guide portion integrally formed with a hook portion and a sandwiching portion formed as a small plate that is slidable on the guide portion. In the case of this surgical hook, the sandwiching portion through which the guide portion is inserted is provided with an arcuate recess at least on the side facing the outer corneal contour. The gripping member is divided into two parts by this recess, thereby optimally matching the outer corneal contour.

[0005]

The problem underlying the present invention is to maintain the handling operability as accurate as possible while avoiding damage to the iris on the one hand on pulling, and on the other hand without the use of additional seals. A surgical hook is improved and shaped so that it can be inserted into the corneal incision and then removed again without the need for subsequent suturing or the like.

[0006]

According to the invention, the object is to provide a hook element made of a flexible thermoplastic synthetic resin in which the hooking part is integrally formed, the hooking part having a limited rigidity at least in the bending range. This rigidity is less than the resistance exerted on the hooked portion by the iris pulled in the hooked state or the resistance exerted on the hooked portion by the cornea in the detached state, thereby pulling out the surgical hook from the eye. This is solved by the fact that the bending range of the hooked portion can be bent and extended in a sufficiently straight state by resistance.

The surgical hook according to the invention has the advantage that a small incision need only be made in the cornea for insertion into the eye. The incision is shaped and dimensioned so that it does not require the additional sealing function of the fixing element which is slidable on the guide member.

Within the scope of the present invention, it has been found that the thread-like guide portion of the surgical hook is self-sealingly surrounded by the corneal wall separated by the incision during surgery. The locally limited rigidity of the hooked portion has the following advantages.
That is, when a suitable pulling load is applied to the guide part in order to remove the surgical hook, the hook-like hooking part automatically opens, whereby the hook element can be pulled out of the eye as a long thread. There are advantages.
Furthermore, it has been found that after the surgical hook is removed, the corneal incision is closed in a self-sealing manner while at the same time preventing undesired outflow of the quartz liquid (aqueous liquid). Therefore, no additional suturing of the incision is needed anymore. The thread-shaped guide portion, which is longer than the hooked portion, has sufficient elasticity so that the operator's abrupt contact does not injure the eyes.

Other features according to the invention will be apparent from the description and other claims associated with the drawings.

[0010]

The present invention will be described below with reference to the drawings. Figure 1
FIG. 6 is an enlarged side view of a surgical hook element. At the time of eye surgery, this surgical hook allows you to grab the iris and pull it outward. As shown in FIG. 2, the surgical hook (iris retractor) substantially includes a hook element 10 and a fixing element 20 slidably and fixedly attached to the hook element.

The hook element 10 is made of a thread (line) having a perfectly smooth surface and, as shown in FIG. 1, a substantially long guide portion 11 and a hook-shaped hooking portion 15.
Is included. This hooking portion is provided at one end of the guide portion 11. The hooking portion 15 is a curved portion 12 and a leg portion 1 provided at a distance 14 from the guide portion 11.
It consists of 3. This leg has an edge 13 'which is at right angles to it. The edge 13 ′ is designed as a particularly smooth and flat surface with respect to the leg 13. The hooking portion 15 that is bent into a hairpin shape and is integrally formed with the guide portion 11 has, for example, a leg portion 13 with a gap 14 therebetween.
It is formed so as to extend in parallel with 1.

FIG. 2 showing the entire surgical hook 25 is shown in FIG.
1 shows a hook element 10 and a fixing element 20 provided on it. The fixing element 20, which is formed, for example, as a disc and is made of a flexible material, has two holes 23, 23 ', which are spaced from each other and through which the fixing element 20 passes, as shown in FIG. I have it. Both holes 23, 23 '
Is provided so that the fixing element 20 can slide on the guide portion 11 of the hook element 10 in the direction of the double-headed arrow X. In this case, the fixing element 20 forms contact parts 22 with a substantially arcuate profile cross section on one side of the guide part 11 and is spaced from each other on the other side of the guide part 11, as shown in FIG. The two parts 21, 21 '
Are formed so as to project. In order to slide the fixing element 20 on the guide part 11, both parts 21, 21 'are compressed towards each other. Thereby, the holes 23, 23 '
The inner edge, not shown, disengages the guide portion 11 (not shown). When the two parts 21, 21 'are separated, the fastening element 20 is self-tightening and the hook element 1
It is fixed on 0.

FIG. 3 is a plan view of the surgical hook 25 seen from the direction of arrow III shown in FIG. In Figure 3,
The hook element 10 formed by the guide part 11 and the hooking part 15 and the fixing element 20 provided on it are shown. The holes 23, 23 ', which are provided on the common axis of symmetry X'of the hook element 10 and the fixing element 20 at a distance from one another, are provided in particular on the guide part 11 with the hook element 20 self-tightening as already described. , Shaped and sized relative to the thread-like hook element 10 so as to be adjustable on the guide portion 11 in the double-headed arrow X (FIG. 2) by compressing the two portions 21, 21 '. By separating the two parts 21, 21 ′, the fastening element 20 is held self-tightening, whereby it can be arranged in any position on the guide part 11.

Thereby, to make the hook element 10, a relatively flexible thread is used, which consists of a thermoplastic synthetic resin having good surface slip properties, for example a polyamide thread. In order to create the shape of the hook element 10 shown in FIGS. 1 and 2, the thread is formed by a suitable heat treatment.

In order to shape the hook element 10, the polyamide thread is attached to a molding (not shown) which is formed in conformity with the guide part 11 and the hook part 15,
It is subjected to heat treatment (temperature control) with the molded body. The heat treatment causes the polyamide yarn to have a hook-like shape in the area of the hooked portion 15, thereby obtaining local rigidity. The guide portion 11, which is longer than the hooked portion 15, is sufficiently flexible even after the heat treatment. The guide portion 11 is straight (FIG. 1) or, as shown diagrammatically in FIG. 2, is arcuate with a relatively large radius.

By the above-mentioned heat treatment of the polyamide yarn, when the resistance is applied by pulling the guide portion 11 in the direction of the arrow Z, the hook-shaped hooking portion 15 bends to sufficiently return to the original state. Local stiffness of the portion 15 is achieved.

The fixing element 20 is made of a flexible synthetic resin having a good sliding property and can slide on the guide portion 11 of the hook element 10 with a sufficiently weak force when the two portions 21 and 21 'are compressed. The fixing element 20 is made of, for example, transparent silicon (silicon rubber).

FIG. 4 is a schematic horizontal cross-sectional view of the eye generally designated by 1. Shown in this figure are the cornea 2, the iris 3 with the areas 3 ', 3 ", the sclera 7, the lens 4, the pupil 4'and the ciliary ligaments 6, 6'.

For the sake of clarity of the invention, FIG. 4 shows a surgical hook 25 with the curved portion 12 of the hooking portion 15 hooked in the area 3 "of the iris 3. The surgical hook 2
5 is a contact part 2 of the fixing element 20 which makes sufficient contact with the transition part 5.
Held by two. The slightly arcuately shaped flexible guide portion 11 of the hook element 10 then substantially conforms to the outer contour of the sclera 7. As a result, even when a plurality of surgical hooks 25 are distributed in a ring shape apart from each other, a surgical range with good access is ensured, and the surgical operator can guide each surgical hook 25 at the guide portion 11 during the surgical operation.
I will never engage. Unintentional contact of the guide part 11 by the operator is compensated by the flexibility of the long guide part 11, so that in the unlikely event of contact, dangerous movements (pulling out the surgical hook 25 or acting on the lens) can be noticed. It never reaches 1.

FIG. 5 is a plan view showing a part of the eye 1 slightly smaller than that of FIG. 4, and in this figure, the surgical hook 25 is shown.
A portion 3 ″ of the iris 3 is shown partially pulled by the surgical hook 25, in this case the surgical hook 25 being held in the transition 5 by a disc-shaped fixing element 20.

FIG. 6 is an enlarged view of the front part of the hook element 10 formed as the hooking part 15. The heat treatment of the polyamide yarn described above locally increases the strength in the area of the hooked portion 15. However, this strength is such that in the first phase the hooking portion 15 pulls the portion 3 "of the iris 3 to the outer edge (Fig. 5), as shown in Fig. 4.

In the second phase, the surgical hook 10 is moved inward, in particular in the direction opposite to the direction of the arrow Z, whereby the portion 3 "of the iris 3 is under tension (the hooking portion 15 is Of the surgical hook 10 is about 70
It is rotatable about its longitudinal axis by ˜90 °. Subsequently, the surgical hook 10 is pulled in the arrow Z direction. The end surface 13 ′ of the leg portion 13 of the hook-shaped hooking portion 15 comes into contact with the not-shown inner transition portion from the cornea 2 to the sclera 7 and is further pulled in the arrow Z direction, so that the hook-shaped hooking portion 15 Is bent and stretched so that the surgical hook 10 can be pulled out as a long thread. As soon as the thread is completely withdrawn, the incision (not shown) formed in the cornea 2 closes in a self-sealing manner.

However, starting from the state shown in FIG.
The surgical hook 10 can be taken out by further pulling the guide portion 11 in the direction of the arrow Z. in this case,
Due to the rigidity of the pulled portion 3 ″, the hooked portion 15 is bent and extended to the original extended position (two-dot chain line portions 12 ′ and 13 ′) and pulled out from the eye, as shown in FIG. Also in this case, immediately after taking out the surgical hook 25, the incision of the cornea 2 is closed in a self-sealing manner.

With respect to the dimensions of the surgical hook 25 according to the present invention, the overall length of the hook element 10 is of the order of about 5-8 mm and the length of the bent hook 15 is 1.
It is on the order of 0 to 1.5 mm. The total width of the curved portion 12 is
It is on the order of 0.4 to 0.5 mm. Polyamide yarn has, for example, a circular profile cross section and is approximately 0.15 to 0.2 m.
It has a diameter of m.

Due to the rigidity of the hooking portion 15 which is limited by the bending range of the hooking portion, the hooking portion 15 in the hooked and pulled states of the iris 3 "(FIG. 4) and the hooked portion 15
In the unhooked state (not shown), the surgical hook 25 according to the present invention, which bends and extends the hooking portion 15 sufficiently, can be pulled out from the eye 1 without any problem. At that time, the incision of the cornea 2 does not undesirably expand due to the dehiscence. The incision in the cornea 2 is closed in a self-sealing manner after the surgical hook 25 is removed.

7-10, eye 1 through surgical hook 2 are shown.
The important phases of different states when pulling out 5 are shown enlarged. The actuation method described below for removing the surgical hook 25 is one preferred variant of the method for removing the surgical hook 25.

FIG. 7 is a horizontal cross-sectional view of the eye 1 according to FIG. 4, showing the cornea 2, the iris 3 with both areas 3 ', 3 ", the sclera 7, the lens 4, the pupil 4'and the ciliary ligament 6. , 6 '. Unlike the operation hook 25 shown in FIG. 4, the leg portion 13 of the hooking portion 15 has a portion 3 "of the iris 3 as shown in FIG.
It is moved in the direction of the arrow Z'to move away from it.

In the next phase, the surgical hook 25 is rotated about its longitudinal axis X'in the direction of arrow D by about 70 to 90 °, as shown in FIG. Then, the surgical hook 25
Is pulled in the direction of arrow Z, as shown in FIG.

As shown in FIG. 9, the hook-shaped hook portion 15 is provided.
By contacting the end face 13 'of the leg 13 with a not-shown inner transition from the cornea 2 to the sclera 7 and pulling further in the direction of the arrow Z, the hook-like hooking portion 15 is shown in FIG.
As shown at 0, the surgical hook 10 is stretched so that it can be pulled out of the eye 1 as a long, almost straight thread.

[0030]

As described above, the surgical hook according to the present invention requires only a small incision to be formed in the cornea for insertion into the eye. In addition, the thread-like guide portion of the surgical hook is self-sealingly surrounded by the corneal wall separated by the incision during surgery. Furthermore, the hook-like hooking portion automatically opens when a suitable pulling load is applied to the guide portion for removing the surgical hook, whereby the hook element can be pulled out of the eye as a long thread. Furthermore, after the surgical hook is removed, the corneal incision is self-sealingly closed and at the same time an unwanted outflow of the quartz crystal is prevented, so that no additional suturing of the incision is necessary anymore. . Further, since the thread-shaped guide portion, which is longer than the hooked portion, has sufficient elasticity, there is an advantage that the eye is not injured by an unexpected contact of the operator.

[Brief description of drawings]

FIG. 1 is an enlarged side view of a hook element for a surgical hook.

FIG. 2 is a side view of a surgical hook including the hook element of FIG. 1 and a fixing element provided on the hook element.

FIG. 3 is a plan view of the surgical hook as seen from the direction of arrow III in FIG.

FIG. 4 is a schematic enlarged horizontal cross-sectional view of a part of the eye showing a state where the surgical hook of FIG. 2 is pulled in the range of the iris.

FIG. 5 is a plan view showing an eye in which the iris is partially pulled, which is smaller than that in FIG.

6 shows a part of the hook element for a surgical hook according to FIG. 2, showing the hook-shaped hooking part fully opened or extended.

FIG. 7 is a schematic enlarged horizontal cross-sectional view showing a part of the eye together with the surgical hook at the time of withdrawal.

FIG. 8 is a schematic enlarged horizontal cross-sectional view showing a portion of the eye with different phases of the surgical hook during withdrawal.

FIG. 9 is a schematic enlarged horizontal cross-sectional view showing a portion of the eye with different phases of the surgical hook during withdrawal.

FIG. 10 is a schematic enlarged horizontal cross-sectional view showing a part of the eye together with different phases of the surgical hook when withdrawn.

[Explanation of symbols]

 1 eye 2 cornea 3 iris 10 hook element 11 guide portion 15 hooking portion 20 fixing element 22 contact portion 23, 23 'hole 25 surgical hook

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Dyson Hicking Botham, North Carolina, United States 27503, Barhama, Colt Drive, 9805 (72) Inventor Yuen Do Jiuyuan Giunia United States, North Carolina, 27503, Durham, Rosswell Center, 2

Claims (8)

[Claims] 1. A hook element (10) and a fastening element (20).
The hook element at least at one end for locally pulling on the iris (3).
5) and a long guide part (11), a fixing element is slidably provided on the guide part (11) and a surgical hook (25) inserted through an incision in the cornea (2) is fixed In a surgical hook for use during surgical operation of a living eye (1), which is held by the element on the outer contour of the eye (1), the hook element (10) integrally molded the hooking portion (15). It is made of a flexible thermoplastic synthetic resin, and the hooking portion (15) has a limited rigidity at least in the bending range, and this rigidity is hooked by the iris (3 ″) pulled in the hooked state. The resistance (1) acting on the portion (15) or the hooking portion (1
It is smaller than the resistance acting on 5), so that when the surgical hook (25) is pulled out from the eye (1), the bending range of the hooking portion (15) can be bent and stretched in a sufficiently straight state by the resistance. A surgical hook characterized by being present. 2. Surgical hook according to claim 1, characterized in that the hook-shaped hooking part (15) is integrally formed with the hook element (10) by heat treatment. 3. Surgical hook according to claim 1, characterized in that the hook element (10) with an integrally formed hooking part (15) is made of polyamide thread. 4. The fixing element (20) is formed as a flexible disc, which disc comprises at least two holes (23, 23 ') spaced apart from each other with respect to the axis of symmetry.
Surgical hook according to claim 1, characterized in that the guide portion (11) of the threadlike hook element (10) is insertable through this hole. 5. The fastening element (20) is a hook element (10).
Characterized in that it has an intrinsic rigidity in the state of being fitted into the guide part, and by this intrinsic rigidity, the longitudinally adjustable fixing element (20) on the guide part (11) can be self-tightened and fixed in any position. The surgical hook according to claim 4. 6. A securing element, in the fitted state, on one side of the guide part (11), spaced apart in two parts, which is compressible for the adjustment of the securing element (20). 21, 21 ') and on the other side an arcuate contact part (22), the fixing element (20) being the contact part (22).
Surgical hook according to claim 4 or 5, characterized in that it is held and supported by the eye (1) by means of. 7. Holes (23, 23 ') in which fixing elements (20) are spaced and oriented transversely to the surface.
5. Surgical device according to claim 4, characterized in that it is formed as a shaped plate and is made of a flexible material, the profile of the plate-shaped fixing element (20) being circular, oval, square or rectangular. hook. 8. The fixing element (20) is made of silicone rubber or the like, as claimed in claim 4.
One of the 7 surgical hooks.