JPH11276513A - Cornea operation device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To facilitate a flap forming without burden on a patient's eye by sucking a gaseous body between a plate for flattening the cornea, of which cornea opposing surface is flat, and the cornea to flatten the cornea, and by moving the plate in a direction for separating from a blade surface. SOLUTION: After advancing a blade holder 21, the cornea is cut by a blade 20. At the same time, a projection 21b formed at both sides of rear upper surface of the blade 20 pushes up a cornea pressing down section 33 from the bottom. In this case, a recess section 31a of a suction base 30 of a suction section and an edge section of an opening section 31b are brought into contact with each other from a cornea corolla section to the conjunctiva, and air in a space S is sucked to determine an absorption fixing position of the suction base 30. Thereby a flap section formed together with a cutting procedure is sucked to the side of the cornea pressing section 33 and is pushed up together with the cornea pressing section 33 to cut the flap at preferable cross-section without tearing the flap. In this way, the flap can smoothly be formed.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a corneal surgery apparatus for cutting a patient's eye cornea into layers during a corneal refractive surgery or the like.

[0002]

2. Description of the Related Art In recent years, a flap is formed by incising a layer having a thickness of about 150 .mu.m from the corneal epithelium to the parenchyma while leaving one end (hinge) of the cornea in a layered manner. LASIK surgery (Laser in Situ Keratomileusis), in which the corneal refraction treatment is performed by removing the flap and returning the flap again, has attracted attention.
In the LASIK operation, a corneal operation device called a microkeratome is used to cut the cornea in layers.

In a microkeratome, a suction ring is fixed by suction from the limbus of the cornea to the surface of the conjunctiva, the cornea is pressed flat by a corneal pressing member, and the blade (blade) is moved in a hinge direction while laterally vibrating. It is known that the cornea is cut into layers with a substantially uniform thickness. At the time of corneal incision, a certain degree of corneal rigidity is required because the cornea tends to escape with respect to the advance of the blade. As this method, there is a method in which a patient's intraocular pressure is increased by increasing suction pressure applied to a suction ring to obtain corneal rigidity.

Further, by increasing the coefficient of friction with the corneal pressing member, or by providing a suction port in the corneal pressing member and adsorbing and pressing the upper surface of the cornea on the flap forming side, the resistance to the advance of the blade is increased. Some have been proposed.

[0005]

However, increasing the intraocular pressure by increasing the suction pressure applied to the inside of the suction ring as in the former method has a concern that the high intraocular pressure may affect the optic nerve.

On the other hand, in the latter method, even if the suction pressure applied to the suction ring is reduced, it is difficult for the cornea to escape from the blade, so that an increase in the intraocular pressure of the patient's eye can be suppressed. However, since this is pressed while the upper surface of the cornea is adsorbed by the corneal pressing member, the frictional force between the flap and the blade increases with the progress of the blade during incision,
There have been problems that the flap is cut off in the middle and the cut surface becomes uneven.

[0007] In view of the above problems, an object of the present invention is to provide a corneal surgery apparatus capable of easily forming a flap without imposing a burden on a patient's eye.

[0008]

Means for Solving the Problems In order to solve the above problems, the present invention is characterized by having the following configuration.

(1) A corneal surgery apparatus for cutting a cornea into layers by using a blade for cutting the cornea of a patient into layers and a blade moving means for moving the blades, wherein a flat plate having a flat side facing the cornea, the flat plate and the cornea Corneal flattening means having suction means for sucking gas in the gap between the corneal and the corneal flattening means, and movement for moving the flat plate away from the surface of the blade as the blade is moved by the blade moving means. Means.

(2) In the corneal surgery apparatus of (1),
The moving means includes a turning means for turning the flat plate vertically about an axis provided at one end of the apparatus.

(3) In the corneal surgery apparatus of (1),
The moving means includes a turning means for turning the flat plate vertically around an axis provided at one end of the apparatus, and a convex portion provided above the blade.

(4) In the corneal surgery apparatus of (1),
The blade is provided with frictional force reducing means for reducing a frictional force with a cornea cut in layers.

(5) The frictional force reducing means of (4) is characterized in that a coating treatment for reducing a frictional force is applied to a surface of the blade which comes into contact with the cornea cut into layers.

[0014]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1A is a top view of a corneal surgery apparatus according to the present invention, and FIG. 1B is a diagram showing a cross-sectional view taken along line AA of FIG. 1A and a schematic diagram of a control system.

1 is a main body of the microkeratome, 1a
Is a gripping part that the operator grips during the operation. On the front side of the main body 1, a cutting section 2 and a suction section 3 are provided.

In the main body 1, there are provided a feed motor 11 for moving the blade 20 of the cutting section 2 straight in the incision direction and a vibration motor 12 for giving a lateral vibration to the blade 20. A feed screw 13 having a thread portion for moving the cutting portion 2 is connected to the rotation shaft of the motor 11. The feed screw 13 is screwed with a tubular connecting member 17 for connecting the cutting section 2 and an attachment member 14 to which the vibration motor 12 is fixed. With the forward and reverse rotation of the motor 11, the mounting member 1
The cutting unit 2 connected to the vibration motor 12 and the connecting member 17 moves forward and backward together with the motor 4. The connecting member 17 includes a rotating shaft 1 connected to a rotating shaft of the vibration motor 12.
5 is inserted, and an eccentric shaft 16 is implanted at the tip of the rotating shaft 15 at a position deviated from the center of rotation.

The structure of the cutting section 2 and the suction section 3 will be described with reference to FIG. 2A and 2B are enlarged views of the cutting unit 2 and the suction unit 3 with respect to FIG.

The cutting section 2 includes a blade 20 for incising the cornea, a blade holder 21 having two L-shaped arms 21a for supporting the blade 20 at the lower end,
A holding member 23 attached to the tip of the connecting member 17 and suspending and holding the blade holder 21 so as to be able to move laterally;
Is provided. The blade holder 21 held by the holding member 23 is formed with a vertical groove 22 that receives and engages with the eccentric shaft 16, and is attached to the tip of the rotation shaft 15 when the rotation shaft 15 is rotated by the rotation of the vibration motor 12. The eccentric shaft 16 engages with the vertical groove 22 to exert a driving force in the lateral direction.
Thereby, the blade 20 oscillates laterally with the blade holder 21.

The blade 20 is a metal blade using stainless steel, steel, or the like as a cutting edge, and a fluororesin coating or the like for reducing friction is applied to the upper surface of the blade that contacts the formed flap. Blade 2
On both sides of the rear upper surface of the 0, convex portions 21b having a radially inclined surface in the traveling direction are formed. As the blade holder 21 is advanced and the corneal incision proceeds by the blade 20, the convex portion 21b enters below a corneal pressing portion 33 described later and pushes up the corneal pressing portion 33. The protrusion 21b
Is so large that it does not come off from the corneal pressing portion 33 due to lateral vibration, and the interval between the two convex portions 21b secures a length through which the cut corneal flap can pass. Convex part 2
In order to reduce the contact between the upper surface of the blade 20 and the incised corneal flap, the height of 1b is set so that the end of the corneal flap is 10 times lower than the initial pressing position when the incision is completed while leaving the hinge.
The height is raised to about a micron. In addition, this convex part 21b may be formed inside the two arm parts 21a. In this case, if a relief that does not interfere with the protrusion 21b is provided on the blade 20 side, the blade 20 can be formed with a sufficient thickness.

The suction section 3 is fixed to the apparatus main body 1 via a suction base 30. The suction base 30 is formed with a circular concave portion 31a for making contact with the limbus of the patient's eye and an opening 31b concentric with the concave portion 31a. The concave portion 31 a is connected to a vacuum tube (not shown) via a suction passage 32 formed in the suction base 30, and the vacuum tube extends to the pump 41. At the time of surgery, the end of the concave portion 31a and the open end of the opening 31b are brought into contact from the limbus of the cornea of the patient's eye to the conjunctiva, and the gap S secured by the contact is made.
By suctioning the air inside the suction base 30
Is adsorbed and fixed to such an extent that the intraocular pressure of the patient's eye is not excessively increased.
At the time of this fixation, the operator can easily determine the position of the opening 31b by holding the grip portion 1a of the apparatus main body 1 and stably hold the apparatus main body.

A connection end 36 for connecting the corneal pressing portion 33 and a suction tube (not shown) is supported on the upper portion of the suction base 30 so as to be rotatable around a support shaft Ra. The corneal pressing part 33 is composed of a transparent part 34 of a central region made of a material such as PMMA (polymethyl methacrylate) and a peripheral part 35 which is a peripheral part thereof. In order to adsorb the corneal surface pressed and deformed by the transparent portion 34 from the lateral direction, a lower portion between the transparent portion 34 and the peripheral portion 35 is shown in FIG. Such a gap Sc is formed in a circular shape. This gap Sc is the connection end 3
6, and communicates with a suction passage 36a formed in the suction passage 36. When the suction base 30 is placed in contact with the limbus of the patient's eye, the gap Sc circumferentially contacts the peripheral portion of the corneal surface. By applying a suction pressure by a pump 42 connected to the suction passage 36a, the corneal pressing portion 33 is fixed to the cornea of the patient's eye. At this time, the gap Sc adsorbs the corneal surface from the lateral direction, so that the deformation caused by the suction at the time of incision by the blade 20 can be made to be the peripheral edge of the flap with little optical influence.

The interval between the upper surface of the blade 20 attached to the blade holder 21 and the transparent portion 34 is set to about 150 μm so that the corneal epithelium can be incised in layers with this thickness.

An outer shell 37 fixed to the upper front end (left side in FIG. 2) of the suction base 30 is disposed on the corneal holder 33.
In the vertical direction. The outer shell 37 is formed with an opening 37a concentric with the opening 31b and the transparent part 34 so that the operator can observe the cornea incised through the opening 37a, the transparent part 34 and the opening 31b. It has become. An elastic member 38 such as a spring is provided between the outer shell portion 37 and the corneal pressing portion 33, and applies a force to push the corneal pressing portion 33 downward.

In FIG. 1B, reference numeral 40 denotes a control unit of the corneal surgery apparatus, which is connected to the foot switch 43 and controls the operations of the motors 11, 12 and the pumps 41, 42.

In the apparatus having the above configuration,
The operation will be described below. The surgeon confirms the inclination state of the suction unit 3 (the apparatus main body 1), the position of the center of the pupil, and the like based on a mark previously put on the patient's cornea with an instrument such as a marker. The suction base 30 is positioned on the patient's cornea with the center of the center 37a positioned (the positioning mark may be attached to the transparent part 34 observed through the opening 37a).

After installing the suction section 3, the surgeon operates the pump 41 while holding the position and posture of the apparatus main body 1 to suck air in the gap S between the suction base 30 and the corneal surface. , Reduce pressure. The operation of the pump 41 is controlled by the control unit 40 so as to maintain the pressure when the pressure in the gap S decreases to a certain value. This allows
The suction base 30 is fixed by suction to the patient's eye. At this time, the suction pressure may be fixed so that the suction unit 3 and the apparatus main body 1 do not move during the operation in a state where the suction unit 3 and the apparatus main body 1 are held by the operator. You don't have to.

When the suction portion 3 is fixed by suction, the corneal pressing portion 33 presses the patient's eye cornea flat. Subsequently, when the pump 42 is driven, the pressure in the gap Sc abutting on the cornea decreases, and the upper surface of the cornea is suction-fixed while being pressed by the corneal pressing portion 33.

When the fixation of the device is completed, the operator operates the foot switch 43 to move the feed motor 11 and the vibration motor 1.
2 is driven to rotate. While the blade 20 is laterally vibrated by the vibration motor 12, the cornea is incised, and the feed motor 11 is moved straight in the direction of forming the hinge to perform the corneal incision so as to form a flap.

The cutting operation at this time will be described with reference to FIG. FIG. 4A shows a state when the incision of the cornea is started. Since the upper surface of the cornea is adsorbed to the corneal pressing portion 33, even if the suction pressure on the suction base 30 side is not high,
Sufficient corneal rigidity against the advancement of the blade 20 is obtained, and a smooth incision is possible.

FIG. 4B shows a state in which the incision has progressed halfway. As the corneal incision proceeds and the blade 20 gradually advances in the hinge direction, the convex portion 21b provided on the blade holder 21 sinks into the lower end of the corneal pressing portion 33, and the corneal pressing portion 33 is pushed down by the elastic member 38. While the force is being applied, it is gradually pushed up by the projection 21b. Since the flap portion formed by the incision is adsorbed on the corneal pressing portion 33 side by the gap Sc,
It is pushed up together with the corneal presser 33. This allows
The portion where the flap formed by the incision comes into contact with the blade 20 is reduced (a gap is secured between the flap and the blade 20), and the frictional force therebetween is reduced. Therefore, generation of flap tears due to the influence of frictional force is prevented, and the cut surface is also improved. Further, since the incision by the blade 20 proceeds while the incised portion of the cornea is widened, the flap is formed smoothly.

In this way, when the tip of the blade 20 is cut open leaving the hinge portion and the flap is formed, air is introduced into the gap S and the gap Sc to release the suction, and the apparatus is removed. After that, the laser beam is used to perform substantial resection for the amount of corrective refraction, and the flap is returned to the original state, thereby completing the operation.

In the above embodiment, the blade 20 is made of a metal such as stainless steel or steel, and the corneal incision is made while vibrating. However, a mineral blade using a mineral such as diamond or sapphire for the cutting edge is also used. can do. When using a sufficiently sharp mineral blade,
The incision can be made without lateral vibration. In addition, in order to reduce the frictional force with the flap, the top surface of the blade that comes into contact with the flap after incision is provided with perforations or fine irregularities, or by making it into a honeycomb shape, the contact area with the flap is reduced. Doing so is also effective.

[0033]

As described above, according to the present invention, a good flap can be easily formed without imposing a burden on the patient's eye.

[Brief description of the drawings]

FIG. 1 is a top view, a side sectional view, and a schematic diagram of a control system of a corneal surgery apparatus according to the present embodiment.

FIG. 2 is an enlarged explanatory view of a cutting section and a suction section of the corneal surgery apparatus according to the present embodiment.

FIG. 3 is an enlarged explanatory view of a corneal suction unit of the corneal surgery apparatus according to the present embodiment.

FIG. 4 is a diagram illustrating a corneal incision of the corneal surgery apparatus according to the present embodiment.

[Explanation of symbols]

 Reference Signs List 11 feed motor 13 feed screw 14 mounting member 17 connecting member 20 blade 21 blade holder 21b convex portion 33 corneal pressing portion 42 pump Ra rotating shaft

Claims (5)

[Claims] 1. A corneal surgery apparatus having a blade for cutting a cornea into a layer of a patient's eye and a blade moving means for moving the blade, and a cornea surgical apparatus for cutting the cornea in a layer. Corneal flattening means having suction means for sucking gas in the gap between them, and a cornea flattening means for flattening the cornea, and moving means for moving the flat plate away from the surface of the blade with movement of the blade by the blade moving means A corneal surgery device comprising: 2. The corneal surgery apparatus according to claim 1, wherein the moving means includes a turning means for turning the flat plate vertically about an axis provided at one end of the apparatus. Surgical equipment. 3. The corneal surgery apparatus according to claim 1, wherein the moving means is provided above the blade with a turning means for turning the flat plate up and down about an axis provided at one end of the apparatus. A corneal surgery device comprising a convex portion. 4. The corneal surgery apparatus according to claim 1, wherein the blade is provided with frictional force reducing means for reducing a frictional force with the cornea cut in layers. 5. The corneal surgery apparatus according to claim 4, wherein the frictional force reducing means is provided with a coating treatment for reducing a frictional force on a surface of the blade in contact with the cornea cut in layers.