JPH0732791B2 - Intraocular lens implanter - Google Patents

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an implanting instrument for implanting an artificial intraocular lens in the eye instead of the crystalline lens extracted by cataract surgery.

[0002]

2. Description of the Related Art Heretofore, it has been widely practiced to implant an artificial intraocular lens in place of the lens extracted during cataract surgery. Many eye surgeons have expressed interest in the complications associated with intraocular lens implantation of cataract surgery since Ridley first implanted polymethylmethacrylate (PMMA) intraocular lenses in the human eye in 1949.
Although the problem has been dealt with, it is considered that there are four major categories of the above-mentioned complications under the present circumstances.

Postoperative inflammation, posterior capsule opacification, intraocular lens deviation, and postoperative astigmatism. For these complications, post-operative inflammation is treated by the use of chemicals or intraocular lens surface treatment / improvement of biocompatibility, posterior capsule opacity is treated by YAG laser, intraocular lens displacement is intraocular. This can be dealt with by improving the bearing capacity by improving the lens.

However, post-operative astigmatism is very harmful for the purpose of obtaining better visual acuity without post-operative eyeglasses. Post-operative astigmatism has not been fully resolved although the use of an intraoperative keratometer and ingenuity of suturing and incision have been made. This is considered to be related to the size of the incision, and is a small incision. It is considered that the change in postoperative astigmatism is small.

It is the advent of a surgical technique called ultrasonic phacoemulsification (KPE) using an ultrasonic emulsification suction device that has made it possible to perform surgery with a small incision. According to this procedure, the cloudy cloudy lens is crushed with an ultrasonic tip, emulsified and sucked by using the above-mentioned device, whereby the lens can be removed with an incision of about 4 mm, and conventional cataract extracapsular surgery (ECCE) is performed. ) About 10 incisions at the time of lens extraction
Compared with mm, small incision surgery is possible.

[0006] Similar to the above-mentioned surgical incision, an intraocular lens that can be inserted from a small incision has appeared. The conventional intraocular lens has an optical part made of a hard material such as glass or plastic, and the incision at the time of implantation is 6.5 mm or more in size larger than the diameter of the optical part. Even if the lens was removed, the incision had to be expanded when inserting a hard intraocular lens.

On the other hand, the optical part as invented in Japanese Patent Application No. 58-18005 (Japanese Patent Application Laid-Open No. 58-146346) has an eye having a deformable optical part using an elastic body having a predetermined memory characteristic. An intraocular lens having an inner lens or an optical part made of a foldable hard material, and by compressing, rolling, bending, stretching, or folding the intraocular lens, an intraocular lens can be obtained from a small incision. With the advent of implantable devices, an incision of about 4 mm
Therefore, the intraocular lens is becoming implantable, and the possibility of small incision surgery has been found from both sides of the surgical method and the intraocular lens to be implanted.

[0008]

However, in the above-mentioned conventional intraocular lens implanting device, the entire or optical part is made of a deformable elastic body having a predetermined memory characteristic or a foldable hard intraocular lens. The intraocular lens with the optical part of the material is compressed, rolled, bent, stretched, or folded to change from a large shape to a small shape, and a cylindrical shape of the tip of the implanting instrument or similar. Insert a shaped insertion tube into the eye through a small incision in the eye, operate it to push the intraocular lens out of the insertion tube, and implant the intraocular lens into the eye. was there.

That is, the intraocular lens is composed of an optical part and a support part for supporting the optical part in the eye. However, since the support part of many intraocular lenses is flexible, it has a thread-like shape to some extent. It has hardness and a spring function. However, since the above-mentioned support portion is easily deformed by an external force, when the intraocular lens is implanted, the support portion is deformed by applying an external force, which is an original function of supporting the optical portion at an appropriate position in the eye. There is a risk of loss of function.

The conventional intraocular lens implanting device is
By compressing, rolling, bending, stretching, or folding an intraocular lens made of a deformable elastic body with memory characteristics or an intraocular lens having a foldable hard material optical part, Since the intraocular lens is pushed out from the insertion tube having a cylindrical shape at the distal end portion of the transplantation device or a shape similar to this, an external force is applied to the optical portion and the support portion.

Therefore, at the time of implantation of the intraocular lens, an external force is applied to the supporting part, and the supporting part is deformed by this external force, so that the function as the intraocular lens cannot be achieved in the eye. only could not be compatible to a particular said intraocular lens having a supporting portion made of not causing the deformable material. Therefore, the intraocular lens support
An attempt to push out the intraocular lens without applying force
As disclosed in Japanese Patent Laid-Open No. 2-156943,
In addition to being cumbersome to operate, these transplantation devices lack reliability.
However, there is a problem that the supporting portion of the intraocular lens may be deformed . The present invention solves the above-mentioned problems, and when implanting an intraocular lens in which the support portion is easily deformed by an external force, the operation is simple and the deformation of the support portion can be reliably prevented. An object of the present invention is to provide an intraocular lens implanting device that can support the optical part at an appropriate position by the support part, does not impair the function of the intraocular lens during transplantation, and can be widely used for various intraocular lenses. .

[0012]

The invention according to claim 1 is
Deformable elastic or fold with predetermined memory characteristics
Optics made of rigid hard material, and integrated with the optics
Intraocular with flexible material support that supports optics in the eye
It is a lens transplant device, and has a holder mounting groove on the tip side.
The formed tubular instrument body and the axial direction inside the instrument body
Insert so that it can move linearly and push the intraocular lens out of the instrument
A main shaft and a drive unit that is provided in the instrument body to move the main shaft back and forth.
And the insertion tube that projects from the tip of the instrument body.
The other half of the insert tube that is formed integrally with the base end of the insert tube.
Connect the two half-split tubes so that they can be opened and closed, and press them on both half-split tubes.
Position each ply board by projecting it into a small shape
Hold the intraocular lens, and then close the two half-cylinders.
Removably fit into the fixture body from the holder mounting groove,
Keep the two presser plates that are closed and fitted together in the retainer mounting groove.
And a holder for holding the tip of the main shaft.
It has a small diameter with the inner diameter of the barrel and is the optical part of the intraocular lens.
It is formed in a shape that pushes only the chisel .

[0013]

A device for implanting an intraocular lens according to the invention of claim 1
Is one half of the holder and the holding plate to the other half.
Open the half tube and the holding plate and
After placing and positioning the lenses, the other half cylinder and
By closing the holding plate, the intraocular lens can be
Can be made into a small shape and can be positioned and held in both halves.
Both presser plates are put together, and in this state, the instrument body
From the holder mounting groove formed on the
Insert and project the insertion tube from the tip of the instrument body,
Is engaged and held in the holder mounting groove to keep it closed . This
In this state, operate the drive mechanism to move the spindle forward,
Pushes the optical part of the intraocular lens with the tip, and the small shape
Insert the intraocular lens as it is from the inside of the half-split tube
Insert it into the eye from the tip of the insertion tube, and return to the large shape before deformation
To be implanted in the eye .

Therefore, the intraocular lens is positioned and held on the holder.
Hold it into a small size, attach the holder to the instrument body, and
A series of operations for pushing out the lens can be easily performed . And the Lord
The tip of the shaft has a small shape that has a gap with the inner diameter of the insertion tube.
Since I tried to push only the optical part of the intraocular lens,
Make sure that the tip of the main shaft does not interfere with the support of the intraocular lens.
Ensure that external force is applied to the support and the support is deformed.
Can be prevented, and the optical part can be positioned at the proper position in the eye by the support part.
Can be supported . Therefore, the function of the intraocular lens is not impaired at the time of transplantation, and the intraocular lens returns to a large size due to the memory characteristic when it is inserted into the eye through a small incision
Further, it can be widely used for various intraocular lenses.

[0015]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An implanting device according to a first embodiment of the present invention will be described below with reference to FIGS. 1 and 2
And 3, 1 is a substantially tubular instrument body, to form a Ne Flip 2 fit into the distal large diameter portion 1a the peripheral surface of the equipment main body 1, the tip end small diameter portion 1b the upper surface of the tip portion 3a A holder mounting groove 3 having a narrow width is formed along the axial direction.

A screw cylinder 4 is screw-fitted to a screw 2 for forming the instrument main body 1, and these are used as main members for a drive mechanism 5.
The operating portion 6 is formed at the end of the male screw cylinder 4. At the end of the male screw cylinder 4, the end of the main shaft 7 is rotatably fitted and supported while restraining its axial movement. Main shaft 7 extends distally arranged tool body 1 concentrically to the instrument body 1, to form a cutout portion 7a formed by cutting a flat along the bottom in the axial direction, the notch 7a instrument By fixing the lower end of the main body 1 and engaging the tip of the anti-rotation pin 8 protruding into the instrument body 1, the main shaft 7 is restrained from rotating with respect to the instrument body 1 and supported movably in the axial direction. is there.

A large-diameter guide portion 7b is formed on the tip side of the main shaft 7, and a tip portion 9 on the tip side of the guide portion 7b has a
As shown in FIG. 4, the extruded portion 9b is inserted through the small outer diameter portion 9a.
Are integrally formed. The push-out portion 9b is formed in an oval shape by notching the upper and lower surfaces facing each other , has a gap with the inner diameter of an insertion cylinder 11 of a holder 10 described later, and has an outer diameter shape considerably smaller than this .

As shown in FIG. 5, the holder 10 has a pair of holding plates 12 and 13, and the lower edge of one holding plate 12 is provided at the base end of the insertion tube main body 17 and one half-split tube. 14 and the lower edge of the other holding plate 13 is formed integrally with the other half-split tube 1
5 is a molded product made of a flexible synthetic resin, which is formed integrally with 5, and the lower edges of the half-split cylinders 14 and 15 are connected by a hinge portion 16. Then, with respect to the one pressing plate 12 and the half-split cylinder 14, the other pressing plate 13 and the half-split cylinder 15 are opened and closed from the hinge portion 16, and when closed, the half-split cylinders 14 and 15 are concentric with the insertion cylinder main body 17, It becomes the radius, and the insertion cylinder main body 17 and the half-divided cylinders 14, 1
5 and 5 form the insertion tube 11. In addition, the insertion tube main body 17 has a large diameter portion 17a formed on the outer periphery of the base portion and a tapered taper portion 17b formed on the distal end portion.

FIGS. 6 and 7 show a general intraocular lens to be implanted by the implanting device of the first embodiment. 6 and 7, 18 is an optical portion made of a deformable elastic body having a predetermined memory characteristic, and 19 is a thread shape in which a base end portion is fixed to the outer peripheral portion of the optical portion 18, and a spring function having a certain hardness. However, the intraocular lens 20 is composed of a pair of supporting parts made of a flexible material that is easily deformed by an external force. The intraocular lens 20 is composed of the optical part 18 and the supporting part 19.

The supporting portion 19 extends symmetrically on both sides of the diameter d of the optical portion 18 from the outer circumference of the optical portion 18, and in the supporting portion 19 shown in FIG. 6 and the supporting portion 19 shown in FIG. The length differs in the direction orthogonal to the diameter d, and the latter has a longer length in the same direction, which results in different shapes. Further, specifically, the optical portion 18 is made of polyurethane elastomer, silicone elastomer, hydrogel polymer, collagen compound or the like, and the supporting portion 19 is made of polyimide or the like.

In order to implant the intraocular lens 20 shown in FIG. 6 by using the implanting device of the first embodiment, first, the holding plate 13 and the half tube 15 of the holder 10 are opened to open the intraocular lens 20 .
Pair supporting portion 19 in front of one side of this, the rear of each is positioned on the other side is placed between the half cylinder 14, 15, the presser plate 12 and the half to close the presser plate 13 and the half tube 15 The optical part 18 is bent into a half shape in the half-split cylinders 14 and 15 in accordance with the split cylinder 14 to have a small shape, and is positioned and held.

In this holding state, from the base side of the holder mounting groove 3 of the instrument body 1, the half-split tubes 14 and 15 and the insertion tube main body 1
The insertion cylinder 11 constituted by 7 is fitted into the instrument main body 1,
Holding the pressing plates 12 and 13 projecting out of the device body 1 in the hand while keeping them closed and advancing to the tip side of the device body 1, the pressing plates 12 and 13 are attached to the narrow tip part 3a of the mounting groove 3. While being engaged and supported, the distal end portion of the insertion tube main body 17 is projected from the distal end of the instrument body 1.

Next, by holding the operating portion 6 of the drive mechanism 5 and rotating the male screw cylinder 4 in the forward direction, the male screw cylinder 4 and the screw 2 for forming the instrument body 1 are screw-fitted. So
The main shaft 7 moves forward together with the male screw cylinder 4 in the retracted position.
At this time, since the main shaft 7 is engaged with the detent pin 8 having the notch 7a fixed to the instrument body 1, the main shaft 7 goes straight without rotating around the shaft.

[0024] By advancing of the spindle 7, it abuts the tip of the intraocular lens 20, pushes the intraocular lens 20 from the insertion tube 11 outside the vessel <br/> tool. At this time, the main shaft 7 is guided by the guide portion 7b to move straight in the insertion cylinder 11, and the push-out portion 9b provided at the tip end portion 9 of the main shaft 7 is notched at the upper and lower surfaces facing each other, and is half- cut.
It has an outer diameter smaller than the inner diameter of the insertion tube 11 composed of the split tubes 14 and 15 and the insertion tube main body 17 , and the intraocular lens 20 has an optical portion 18 curved in two and supporting portions on both front and rear sides. Since 19 is positioned and held in the half-divided cylinders 14 and 15 , the pushing portion 9a of the main shaft 7 does not come into contact with the support portion 19 of the intraocular lens 20 and only the optical portion 18 is provided, as shown in FIG. press this contact, Ku such that deformation of the support portion 19, the intraocular lens 20 is half cylinder 14, 15 and
It advances in the insertion tube main body 17 and comes out from the tip of the insertion tube 11 and enters the eye.

Since the insertion tube 11 of the intraocular lens 20 is inserted into the crystalline lens through the incision, the deformation of the optical portion 18 when it comes out of the insertion tube 11 is large before bending due to the elastic restoring force based on the memory characteristic. After returning to a predetermined shape, it is transplanted in the crystalline lens while being supported by the support portion 19. In order to facilitate the forward movement of the intraocular lens 20 in the insertion tube 11, an appropriate viscoelastic substance is put in the insertion tube 11,
It is preferable to push out the intraocular lens 20 together with this lubricating liquid.

After the implantation of the intraocular lens 20, the driving mechanism 5 is operated to retreat the spindle 7 and the holder 10 is removed from the instrument body 1. Although the above description is for implanting the intraocular lens 20 shown in FIG. 6, the intraocular lens 20 shown in FIG. 7 can be similarly implanted. 9 and 10 respectively show the guide portion 7b and the tip portion 9 of the main shaft 7 of the implanting device according to the second and third embodiments of the present invention. In the second embodiment shown in FIG. 9, the tip portion 9 of the main shaft 7 is shown. The tip is formed in a small-diameter columnar shape having a hemispherical shape, and in the third embodiment shown in FIG. 10, the tip end portion 9 of the main shaft 7 is formed in a small-diameter columnar shape having a tip surface orthogonal to the axial direction. Even when the main shaft 7 according to the third embodiment is used, the intraocular lens can be implanted without deforming the supporting portion by pushing only the optical portion by the tip portion 9 of the main shaft 7 as in the case of the first embodiment described above.

[0027] In this invention, the optical portion of the intraocular lens may be formed by stiff folding material, the shape of the support portion may be changed as appropriate, the intraocular lens is not folded curvature of the embodiment, the folding Even if it is made small by bending or folding, it can be appropriately changed as long as the optical unit has at least a memory characteristic of increasing to a predetermined shape after being extruded from the insertion tube.

Further, in the present invention, the drive mechanism may be variously modified as long as it linearly reciprocates the main shaft in the axial direction in the instrument body, such as a piston type drive mechanism, and the tip end of the main shaft is smaller than the inner diameter of the insertion tube. As long as it can press only the optical part of the intraocular lens, it can be variously modified without being limited to the shape of the above-mentioned embodiment, and the shape of the distal end portion of the insertion tube of the holder is also limited to the shape of the embodiment. Instead, the lower part can be appropriately changed such as being cut out diagonally.

[0029]

As described above, according to the invention of claim 1.
According to the intraocular lens implantation device, one half of the holder is used.
Open the other half tube and the holding plate to the holding plate.
Position the intraocular lens between the two halves.
And then close the other half tube and presser plate to
The intraocular lens is made into a small shape by the half-split cylinder
It can be positioned and held in the cylinder, and when both presser plates are
In this state, the holder mounting groove formed on the instrument body
Put both halves into the instrument body, and
Extend the insertion tube and hold both presser plates in the holder mounting groove
And keep it closed . Operate the drive mechanism in this state
And move the main shaft forward, and the tip of the main shaft moves the intraocular lens.
Press the optical part of the lens and split the intraocular lens
From the inside of the insertion tube, through the insertion tube, and from the tip of the insertion tube into the eye.
It returns to its original large shape and is implanted in the eye.
There is .

Therefore, the intraocular lens is positioned and held on the holder.
Hold it into a small size, attach the holder to the instrument body, and
A series of operations for pushing out the lens can be easily performed . And the Lord
The tip of the shaft has a small shape that has a gap with the inner diameter of the insertion tube.
Since I tried to push only the optical part of the intraocular lens,
Make sure that the tip of the main shaft does not interfere with the support of the intraocular lens.
Ensure that external force is applied to the support and the support is deformed.
Can be prevented, and the optical part can be positioned at the proper position in the eye by the support part.
Can be supported. Therefore, the function of the intraocular lens is not impaired at the time of transplantation, and the intraocular lens returns to a large size due to the memory characteristic when it is inserted into the eye through a small incision.
Further, it can be widely used for various intraocular lenses.

[Brief description of drawings]

FIG. 1 is a plan view showing an intraocular lens implanting device according to a first embodiment of the present invention.

FIG. 2 is a sectional view taken along the line AA of FIG.

FIG. 3 is a perspective view in which a part of FIG. 1 is cut away.

4 is an enlarged perspective view showing a guide portion and a tip portion of the main shaft of FIG.

5 is an enlarged perspective view of the holder shown in FIG. 1 in an open state.

FIG. 6 is a front view showing an example of an intraocular lens.

FIG. 7 is a front view showing another example of the intraocular lens.

FIG. 8 is a partially cutaway perspective view showing the insertion tube of the holder of FIG. 1 in use.

FIG. 9 is an enlarged perspective view showing a guide portion and a tip portion of a spindle according to a second embodiment of the present invention.

FIG. 10 is an enlarged perspective view showing a guide portion and a tip portion of a spindle according to a third embodiment of the present invention.

[Explanation of reference numerals] 1 instrument main body 3 retainer mounting groove 4 male screw cylinder 5 drive mechanism 6 operation part 7 main shaft 8 anti-rotation pin 9 main shaft tip 10 holder 11 insertion cylinder 18 optical part 19 support part 20 intraocular lens

Claims (1)

[Claims] 1. An optical part made of a deformable elastic body or a foldable hard material having a predetermined memory characteristic, and a support part made of a flexible material provided integrally with the optical part to support the optical part in the eye. A device for implanting an intraocular lens that
A substantially tubular instrument body with a holder attachment groove formed therein, a main shaft that is inserted into the instrument body so as to be linearly movable in the axial direction, and pushes the intraocular lens out of the instrument, and a main body provided on the instrument body to advance and retract the main axis. One having a drive mechanism and an insertion tube protruding from the tip of the instrument body at the tip end and formed integrally with the base end of the insertion tube
The other half-split cylinder is connected to the half-split cylinder so that it can be opened and closed.
Make the small shape by protruding the holding plate to each half cylinder.
Position and position to hold the intraocular lens, before closing
Both half halves can be attached to and detached from the fixture body through the holder mounting groove.
Holding the two presser plates that are fitted together and closed together
A holder for engaging and holding the attachment groove , wherein the tip of the main shaft is small with an inner diameter of the insertion tube and a gap, and is formed in a shape that pushes only the optical portion of the intraocular lens. Intraocular lens implanter.