JPWO2010084595A1 - Simulated eye device for practicing cataract surgery - Google Patents

Abstract

The present invention provides a simulated eye device for practicing cataract surgery techniques. This simulated eye apparatus for practicing cataract surgery includes a lower member having a recess opened upward with a circular opening, and an upper member detachably connected to the lower member, the device insertion hole having An upper member having an annular portion formed, a soft simulated lens cortex that is accommodated in a recess and approximates the lens cortex of the human eye, and a front lens body that is disposed between the lower member and the upper member A simulated anterior lens capsule composed of a film having a property similar to that of the anterior lens capsule of a human eye, and a simulated anterior lens capsule 360 in a state where the simulated anterior lens capsule film is in contact with the simulated lens cortex. And tension applying means for applying a tension that is uniform over the angle of the anterior lens capsule of the human eye. This makes it possible to easily and repeatedly practice most cataract surgery techniques such as a continuous circular anterior capsulotomy and a lens nucleus splitting technique, and to perform a surgical simulation with a realistic sensation similar to the human eye.

Description

  The present invention relates to a simulated eye apparatus for practicing cataract surgery that enables simulation training of cataract surgery operations.

  Cataract is a disease in which the lens functioning as a lens becomes turbid in the eye, and this opacity results in a lack of sufficient light in the eye, resulting in visual impairment. The crystalline lens of the human eye is a transparent convex lens having a diameter of about 9 mm and a thickness of 4 to 5 mm, and is located behind the iris. The lens has a structure in which a tissue called the cortex of its contents is wrapped in an anterior lens capsule and a posterior capsule having a thickness of about 10 μm. The cortex is a soft tissue, but a hard tissue called a nucleus is formed in the central part of the lens mainly due to aging. This is the cause of cataracts. The cataract surgery is an operation for recovering visual acuity by taking out such a cloudy lens so that sufficient light can be taken into the eye.

  Various techniques for such cataract surgery have been developed in the past, such as intracapsular excision (total excision) and extracapsular excision. Among these, because the incision is small, ease of postoperative recovery and low astigmatism incidence, etc., the mainstream of current cataract surgery is ultrasonic emulsification, which was created in the cornea or sclera The operation is performed by inserting a surgical instrument through an incision of about 1 mm to 3 mm. In this surgery, the transparent anterior lens capsule with a thickness of about 10 μm surrounding the lens is torn with a needle or tweezers to create a continuous circular incision with no radial tear (this is a continuous circular anterior capsule incision, CCC: Continuous Circular Capsule Hexis), which removes the contents of the turbid lens by suction. At this time, the lens nucleus, which is a hard portion formed in the center of the lens, is finely divided by various techniques, and then each core fragment is crushed with an ultrasonic emulsification suction device and removed by suction. Finally, the turbid cortex between the anterior lens capsule and the posterior capsule is aspirated into a bag made by the transparent lens anterior capsule and posterior capsule. Insert an intraocular lens. Such surgery is performed on more than 1 million patients per year in Japan and more than 3 million patients per year in the United States.

  Here, the above-described CCC will be briefly described. At present, CCC is performed by a chitotome or an anterior capsular insulator. And what is called a tear method and flap inversion method are known as CCC performed using a chitotome. Specifically, CCC by the flap inversion method is usually performed by first forming a 2 mm-long cut from the center of the anterior capsule at the tip of the chitotome and hooking the edge with the tip of the chitotome to flap the flap. Turn it over. Then, while bringing the tip of the chitotome into contact with the flipped flap in the vicinity of the center of gravity position, pulling the flap while carefully adjusting the direction and speed, thereby growing the incision line into a substantially circular shape, and making an incision after one round. The lines are merged to form a continuous circular incision. On the other hand, the CCC by the tearing method is started by first making a cut of about 2 mm in length from the center of the anterior capsule at the tip of the cystome, but then the tip of the cystome is brought into contact with the front side without turning the anterior capsule over. However, it is pulled while carefully adjusting the direction and speed, thereby growing the incision line into a substantially circular shape. In any case, when growing the incision line, skill and great care are required so that the incision line does not flow radially outward of the lens capsule.

  This ultrasonic cataract operation is a delicate operation that requires very delicate techniques, and a considerable number of cases must be accumulated in order to improve. However, due to the frequent occurrence of medical lawsuits and thorough informed consent to patients, it is a time when it is extremely difficult to educate young doctors and other patients through clinical surgery. Therefore, the most frequently used training for cataract surgery is surgical training using freshly-extracted pig eyes. However, in the case of porcine eyes, it must be removed and used early because it is damaged quickly, it is unsanitary for use in the operating room, complicated preparation and clean-up, and surgical consumables are expensive There is a problem. After all, the biggest problems of pig eye practice are that the porcine eye lens capsule is too soft to be suitable for practicing continuous circular anterior capsulotomy, and that the porcine eye lens has only a soft cortex without a nucleus. Because it is configured, it is impossible to practice the lens nucleus division technique. Also, the sclera of pig eyes is hard and is not suitable for practicing the creation of a cataract surgical incision, especially the scleral tunnel incision.

  Thus, several proposals have been made so that simulation training for cataract surgery can be performed with a sense close to that of the human eye.

  For example, simulated eyes developed for use by students and young doctors for practicing cataract surgery include “Marty the Surgical Simulator” disclosed in Patent Documents 1 to 4 (hereinafter referred to as “Marty” simulated eyes). There is something called. This “Marty” simulated eye is brought into the operating room to simulate and train cataract surgery using an ultrasonic cataract surgery device. This “Marty” simulated eye has an eyeball (orb) in which a chamber is formed and an opening that communicates with the outside is provided. The opening has a shelf for sequentially receiving a simulated posterior capsule convex toward the chamber, a simulated crystalline lens encapsulated with a thick film whose front and rear are simulated anterior capsules, and a corneal cap.

  The simulated lens capsule that encloses the "Marty" simulated lens is made of a thick film made of vinyl or vinylidene chloride film and is an indispensable and important step for mainstream ultrasonic cataract surgery as described above. It was almost impossible to make a continuous circular anterior capsulotomy because the film material was too hard and too thick. Furthermore, under this film is a hard simulated lens nucleus, there is no soft part hitting the lens cortex, and the simulated anterior capsule of this film is fixed with the surface wrinkled and tensioned with moderate tension The fact that it was not fixed in the state was also the reason why continuous circular anterior capsulotomy cannot be performed. The simulated lens nucleus that should be divided and crushed by ultrasonic waves is composed of gelatin, alginic acid, guar gum, glycol, or gelactasol, which is difficult to break cleanly and easily collapses during operation. It was very different from cataract surgery. Moreover, the “Marty” simulated eye was used only in some facilities because the product itself was very expensive, and the disposable cornea and the simulated lens were also expensive. No products are supplied. The biggest factor that this “Marty” simulated eye was not used for cataract surgery training was that it was difficult to say that surgery could be simulated with a sense resembling that of the human eye.

  As a practicing device for cataract surgery other than the “Marty” simulated eye, there is “Fukasaku Capsule Trainer” << HS-2868 >> (sold by HANDAYA CO, LTD. TOKYO). This is for practicing the aforementioned continuous circular anterior capsulotomy (CCC), which is said to be the most difficult step in cataract surgery. This “deep-work capsule trainer” includes a flat lower plate and an upper plate, both of which are hinged at one end. An opening is formed in the upper plate, while a cylindrical portion having an outer diameter smaller than the inner diameter of the opening of the upper plate is formed on the lower plate. A relatively hard soft plastic columnar body is disposed in the cylindrical portion of the lower plate. In this instruction manual, a food packaging film such as a brand name “Saran Wrap” (registered trademark) containing polyvinylidene chloride as a main component is used as a simulated anterior lens capsule film and is put on the cylindrical portion of the lower plate, It is described that the upper plate and the lower plate are used in a closed state.

However, this product, as well as the “Marty” simulated eye, is quite different from the human eye, so it has not been used by many doctors. This is because it was very difficult to complete CCC for the following four reasons.
1. The material of the polyvinylidene chloride that is a simulated anterior capsule film is difficult to control as intended for the formation of the incision line of CCC.
2. When performing CCC of the human eye, the anterior lens capsule is colored by red to yellow reflected light from the fundus (transillumination), and the position of the incision line and the shape of the anterior capsule flap can be determined. In CCC, since there is no reflection from the fundus, the position of the incision line and the shape of the anterior capsule flap are very difficult to understand.
3. In the material made of soft plastic used as a simulated cortex, the instrument will not be buried in the lens cortex like the human eye, and the instrument will be caught there,
4). The structure that only closes the upper and lower plates cannot apply tension to the simulated anterior capsule film uniformly over 360 °,
There are four.

  In addition, in the cataract surgery procedure, continuous circular anterior capsulotomy and nuclei segmentation procedures are particularly important steps that are difficult to master, but the creation of an incision is also an important step. The mainstream of current cataract surgical incision is a self-closing wound made in the sclera and cornea in a tunnel shape, which cuts the cornea and sclera half layer after 800 μm in thickness, so that delicate technique is used. This is a necessary step. As a training tool for practicing corneal incision in ophthalmic surgery, there is an “ophthalmic surgical incision training tool” disclosed in Patent Document 5. It has a structure in which the anterior segment of the human eye, such as the sclera and cornea, is replicated locally, and is made of a material containing any of thermoplastic elastomer, silicone rubber, and hydrogel. This is a training tool for practicing human corneal incision. This is a training tool that only practice corneal incision, it can not practice scleral tunnel incision and other cataract surgery techniques, it is expensive to introduce this training tool only for corneal incision practice There is no sales record in Japan. Also in the United States, this training tool is only used for the development of new knives and is not sold for general ophthalmologists to use for incision practice.

U.S. Pat. No. 4,762,495 U.S. Pat. No. 4,762,496 U.S. Pat. No. 4,865,551 US Pat. No. 4,865,552 US Pat. No. 6,589,057

  Cataract surgery is a combination of many steps. Among the many steps, the most important steps are described in 1. 1. continuous circular anterior capsulotomy, 2. lens nucleus division; Incision creation. It is required for an eye model for cataract surgery training that these important surgical steps can be practiced with a sense similar to that of human eye surgery. For this reason, several examples have been proposed for the artificial eye that has been disclosed in the above-mentioned patent documents, and the artificial simulated eye for the above-mentioned patent literature has been proposed so far to make the above-mentioned isolated pig eye close to the human eye. For the reasons mentioned, all these previously reported methods are simulated to simulate cataract surgery techniques such as continuous circular anterior capsulotomy, nucleotomy, and scleral corneal tunnel incision creation, with a sensation similar to that of the human eye. I couldn't.

  In addition, the conventional simulated eyes are very expensive and difficult for trainees and students to use. In particular, simulated anterior capsule film, simulated lens nucleus, simulated cornea / sclera, etc. are used repeatedly and are disposable after practicing surgical techniques, so these can be recycled and reused or are inexpensive There was no such thing that had to be able to supply.

  Therefore, the development of artificial artificial eyes that can perform simulation training for cataract surgery with a sense close to that of the human eye is expected. This simulated eye is intended for the trainee to practice repeatedly and improve the operation, so that it is desired that the simulated eye be simple, inexpensive, and used repeatedly.

  This invention solves these problems of conventional pig eyes and simulated eyes for practicing cataract surgery, and is an important step in cataract surgery techniques, such as continuous circular anterior capsulotomy and lens nucleus division technique, It is an object of the present invention to provide a simulated eye device for practicing cataract surgery, which can practice sclera / corneal tunnel incision individually or continuously with a sense close to that of the human eye.

  In order to achieve the above object, a simulated eye apparatus for practicing cataract surgery according to the first embodiment of the present invention is provided with a lower member having a recess opened upward with a circular opening, and removable to the lower member. An upper member to be connected, which has at least one annular portion in which at least one instrument insertion hole is formed, and a simulated crystalline lens which is accommodated in the recess and has a softness similar to that of the lens cortex of the human eye A simulated anterior lens capsule disposed between the cortex and the lower member and the upper member, and a simulated lens capsule made of a film having properties similar to those of the human eye lens capsule; Tension applying means for applying a uniform tension over the simulated anterior lens capsule film to the simulated anterior lens capsule in a state of 360 ° and similar to the anterior lens capsule of the human eye in a state where the simulated anterior lens capsule film is in contact with the simulated lens cortex. And wherein the door.

  According to the simulated eye device for practicing cataract surgery according to the first embodiment of the present invention, when the lower member and the upper member are connected, the simulated eye device is composed of a film having properties similar to those of the anterior lens capsule of the human eye. The anterior lens capsule of the human eye that is uniform over 360 ° in a state of being in contact with the simulated lens cortex that has a softness similar to that of the lens cortex of the human eye, in the depression by the tension applying means, with respect to the simulated lens capsule The approximate tension is given. Thus, it is necessary to be able to practice continuous circular anterior capsulotomy with the same sensation as surgery performed on the human eye. 1. The simulated anterior lens capsule film is made of a material having properties (thickness, tear strength, and elasticity) similar to those of the human eye lens capsule. 2. The simulated lens cortex on which the simulated anterior capsule film is placed is made of a soft material that fills the tip of the instrument like the human lens cortex; and The requirement that the simulated anterior capsule film is appropriately tensioned uniformly by 360 ° is satisfied, as the anterior lens capsule of the human eye lens is pulled by the chin band uniformly by 360 °. Therefore, by simulating a cystome through at least one instrument insertion hole, it is possible to perform simulation training for continuous circular anterior capsulotomy with a sense close to that of the human eye.

  Here, in the first embodiment, the simulated anterior lens capsule film has a thickness of 4 to 20 μm mainly composed of one of the group consisting of polyethylene terephthalate (PET), orientated polypropylene (OPP), and cellophane. A film is preferred.

  According to this embodiment, since these films have tear strength and elasticity similar to those of the human eye, it is possible to perform simulation training for continuous circular anterior capsulotomy with a sense closer to that of the human eye. .

  The inventor has investigated all the films that are generally produced, and among them, the artificial film that can perform a continuous circular anterior capsulotomy with a sense closest to the human eye is a PET film having a thickness of 4 μm or 9 μm. I found. The 9 μm-thick OPP film and the 20 μm-thick cellophane film have a slightly harder sensation than the human eye, but can perform continuous circular anterior capsulotomy with a sensation close to the human eye next to a 4 μm or 9 μm thick PET film. The thinnest OPP film and cellophane film on the market are 9 μm and 20 μm in thickness, respectively. If a thinner OPP film or a cellophane film is produced, it may be possible to produce a film superior to a PET film having a thickness of 4 μm or 9 μm.

  Further, in the first embodiment, the tension applying means is fitted into the depressed portion with the depressed portion formed at the lower end of the upper member and the simulated anterior lens capsule film interposed therebetween, You may provide the cyclic | annular protrusion formed in the opening part periphery of the said lower side member.

  According to this embodiment, the tension can be uniformly applied over the simulated anterior lens capsule film 360 ° simply by fitting the annular protrusion of the lower member into the recessed portion of the upper member.

  Furthermore, in the first embodiment, it is preferable that the simulated anterior lens capsule film is colored and at least one surface is formed to be a rough surface. The rough surface may be formed by attaching a colorant.

  According to this embodiment, simulation training of continuous circular anterior capsulotomy can be performed with a sense closer to the human eye. In more detail, during the actual surgery of the human eye, as described above, the anterior lens capsule appears colored by red to yellow reflected light (transillumination) from the fundus, so the position of the incision line And the shape of the anterior capsule flap. However, in CCC using a simulated eye, there is no reflection from the fundus, so it is difficult to confirm the position of the incision line and the shape of the anterior capsule flap. The position of the line and the shape of the anterior capsule flap can be easily confirmed. Furthermore, as described above, during CCC, it is necessary to pull the cystome tip in contact with the anterior lens capsule while carefully adjusting the direction and speed, thereby growing the incision line in a substantially circular shape. However, since at least one surface of the simulated anterior lens capsule film is formed into a rough surface, it becomes easy to catch the chitotome as in the case of the human eye.

  In addition, the present inventor has a smooth and slippery property when the PET film, the OPP film, and the cellophane film used as a simulated anterior lens capsule are not colored. It has been found that the surface changes to a rough surface with extremely fine irregularities, that is, a rough surface, like the anterior capsule. Therefore, when the rough surface is formed by attaching a colorant dye by printing or dyeing, the above-described coloring and rough surface can be efficiently formed simultaneously.

  In the first embodiment, the simulated lens cortex is a plastic material having a predetermined softness (hardness), and is made of wheat clay, oil clay, resin clay, agar, jelly, hard methylcellulose, and a superabsorbent resin. May consist of one of these. As this predetermined softness (hardness), it is preferable that the measured value by the Asker rubber hardness meter C type (manufactured by Kobunshi Keiki Co., Ltd.) conforming to Japanese Industrial Standards JIS K 7312 and JIS S 6050 is 5 to 20 points. . According to this embodiment, a soft simulated lens cortex approximate to the lens cortex of the human eye can be easily obtained.

  In order to achieve the above object, a simulated eye apparatus for practicing cataract surgery according to the second embodiment of the present invention is provided with a lower member having a recess opened with a circular opening on the upper side, and removable to the lower member. An upper member connected to the upper member having at least an annular portion in which at least one instrument insertion hole is formed; and at least a simulated lens nucleus accommodated in the recess; In at least one of the resin clays heated at different times under a predetermined temperature environment and formed at 2 degrees, 3 degrees, 4 degrees or 5 degrees of the emery nuclear hardness classification of human eye It is characterized by being.

  According to the simulated eye apparatus for practicing cataract surgery according to the second aspect of the present invention, resin clay (polymer clay) is heated under a predetermined temperature environment at different times to classify nuclear hardness of human eye emery. At least one simulated lens nucleus formed at 2 degrees, 3 degrees, 4 degrees or 5 degrees is housed in the recess. And, by inserting a simulated ultrasonic oscillator, simulated nucleus split hook or pre-chopper into this simulated lens nucleus through at least one instrument insertion hole, it feels very similar to the nuclear split operation of the human eye. Split operation can be performed, and it is possible to practice nuclear splitting techniques repeatedly on a desk at home without using an ultrasonic cataract surgery device in the operating room. Therefore, it is most suitable for the practice of the phaco-chop method or the pre-chop method, which is a nuclear division technique for dividing the nucleus before emulsifying and sucking the lens nucleus with an ultrasonic oscillator. In addition, the plastic lens-made simulated lens core is economical because it can be reused after being divided and kneaded in its own hand to reshape it. The original purpose of this simulated eye for practicing cataract surgery is to be able to practice repeatedly on a desk at home, but the simulated lens nucleus made of plastic clay is emulsified and sucked using an ultrasonic cataract surgical device. Therefore, it is also possible to bring a simulated eye apparatus for practicing cataract surgery equipped with this into the operating room and practice the division and emulsification of the simulated lens nucleus using an ultrasonic surgical apparatus under a microscope.

  In order to achieve the above object, a simulated eye apparatus for practicing cataract surgery according to a third embodiment of the present invention is provided with a lower member having an indentation opened upward with a circular opening, and removable to the lower member. An upper member to be connected, which has at least one annular portion in which at least one instrument insertion hole is formed, a cup member accommodated in the recess, and a simulated crystalline lens held in the cup member Each of the simulated lens nuclei is formed with a pattern corresponding to an operation procedure of the lens nucleus splitting technique, and has at least one of the previously split structures. Features.

  According to the simulated eye apparatus for practicing cataract surgery according to the third embodiment of the present invention, a simulated lens having a structure in which a pattern corresponding to the operation procedure of the lens nucleus dividing technique is formed on each of them and the structure is divided in advance. One of the nuclei is held in the cup member and received in the recess. Then, by inserting a simulated ultrasonic oscillator tool or the like into the simulated lens nucleus from at least one instrument insertion hole and moving the instrument according to the pattern, the correct instrument operation can be naturally acquired naturally. it can. As this pattern, for example, corresponding to the nuclear division techniques of the Divide & Conquer method, the Stop & Chop method, and the Phaco-chop method, which are three typical techniques among the existing lens nucleus division techniques, respectively. Grooves, side holes, and tunnels are appropriately combined. After the practice of splitting and rotating the nucleus, and other nuclear manipulations, the simulated lens nucleus with the previously split structure will naturally fit in the original position in the cup member. Can practice.

  In order to achieve the above object, a simulated eye apparatus for practicing cataract surgery according to a fourth aspect of the present invention is attached to at least an annular portion of the upper member in addition to any of the first to third aspects of the present invention. Further, the present invention further includes a simulated sclera or a simulated cornea made of a soft, planar material having a predetermined thickness with elasticity and resistance similar to those of the human sclera and cornea.

  According to the simulated eye apparatus for practicing cataract surgery according to the fourth embodiment of the present invention, it is made of a soft and predetermined planar material having elasticity and resistance similar to the sclera or cornea of the human eye. A simulated sclera or a simulated cornea is attached to at least the annular portion of the upper member. Thus, the creation of an incision in the sclera and cornea for cataract surgery and practice for suturing can be easily performed using a simulated sclera or simulated cornea made of a flat (sheet or tape) material. Can do. After practice, the practice can be repeated by peeling off and discarding the used simulated sclera and simulated cornea and reapplying a new simulated sclera and simulated cornea. The practice of incision and suturing is repeated and improved many times. Since these simulated sclera and simulated cornea are disposable after the incision practice, they must be supplied in large quantities at low cost. The simulated sclera and simulated cornea of the present invention do not use a simulated sclera or simulated cornea that is created for that purpose, one by one, like the practice instrument for incision and suture that has been in the past. A flat material can be cut into an appropriate size and used. Therefore, since the simulated sclera and cornea for one incision practice are supplied at low cost, the incision and suture practice can be repeated as many times as necessary without worrying about the cost.

  Here, in the fourth embodiment, the simulated sclera or simulated cornea is soft and has a planar material having a predetermined thickness, such as polyethylene foam, acrylic foam, polyurethane foam, foamed butyl rubber, ethyl vinyl acetate resin, soft vinyl chloride. Any one of the group consisting of resin, silicon resin, urethane resin, fluororesin, styrene-butadiene-styrene resin, elastomer, and synthetic rubber may be used.

  In order to achieve the above object, a simulated eye apparatus for practicing cataract surgery according to the fifth aspect of the present invention, in addition to any one of the first to fourth aspects of the present invention, the direction of the magnetic lines of force substantially coincides with the direction of the line of sight The magnet further includes a magnet incorporated in the lower member, and a magnetic body having at least a surface abutting against the magnet formed into a convex curved surface and fixed to a pedestal.

  According to the simulated eye apparatus for practicing cataract surgery according to the fifth aspect of the present invention, the magnet incorporated in the lower member and the magnetic body fixed to the pedestal are adsorbed by magnetic force. At this time, since the magnet is incorporated in the lower member so that the direction of the magnetic field line thereof substantially coincides with the direction of the line of sight, the simulated eye composed of the lower member and the upper member connected thereto The direction of is always opposite to the center of curvature of the curved surface of the magnetic body. When an external force acts on the simulated eye, the simulated eye can be moved so as to slide on the curved surface of the magnetic body with the center of curvature of the curved surface of the magnetic body as the center of rotation. The simulated eye can point in any direction within the turning range regulated by the amount of exposure from the pedestal above the magnetic body and the radius of curvature, and is fixed in that arbitrary direction. Therefore, by using the simulated eye device for practicing cataract surgery according to this embodiment, you will learn how to move the human eye by moving the instrument, and how to move the instrument that does not rotate the eyeball in a bad direction. Useful for. In order to match the behavior of the human eye during surgery, the magnet is preferably incorporated in the lower member so that the point contact position between the magnet and the curved surface of the magnetic body is at the center of the human eye.

  Here, in a 5th form, it is preferable to provide further the restoring force provision means which is provided between the said lower side member and the said base, and provides a restoring force to the said lower side member.

  According to this embodiment, when the simulated eye is turned by applying an external force, the same resistance as when the human eye is turned during surgery is obtained, and when the external force is released, the eyeball is naturally Restore the original position. The sense of resistance and behavior of the simulated eye when turning are very well reproduced when operating on the human eye, and a realistic surgical simulation can be experienced, which is very effective in practicing surgical techniques.

  In order to achieve the above object, a simulated eye apparatus kit for practicing cataract surgery according to the sixth aspect of the present invention is formed with a recess capable of accommodating a simulated lens cortex, a simulated lens core, and a cup member holding the simulated lens core. A lower member having a circular opening at the top of the recess and an annular protrusion formed at the periphery of the opening, and is detachably connected to the lower member. An upper member having at least an annular portion in which at least one instrument insertion hole is formed; a recessed portion formed at a lower end into which the annular protrusion is press-fitted; the lower member; A simulated anterior lens capsule disposed between the upper member and the lens that has a property similar to that of a human eye lens capsule, and is mainly composed of one of the group consisting of PET, OPP, and cellophane Mock made up of film Predetermined softness composed of a crystalline anterior capsule film and one of the group consisting of wheat clay, oil clay, resin clay, agar, jelly, hard methylcellulose, and superabsorbent resin as the simulated lens cortex (Hardness) plastic material and the simulated lens nucleus, heated at a predetermined temperature environment for different times, 2 degrees, 3 degrees, 4 degrees or 5 degrees of Emery's nuclear hardness classification of human eye A resin clay that can be formed into a plurality of types and a plastic member having a structure in which a pattern is formed in advance and corresponding to the operation procedure of the lens nucleus division technique. .

  Here, in the sixth embodiment, as the simulated sclera or the simulated cornea, it is affixed to at least the annular portion of the upper member, and is soft and predetermined having elasticity and resistance similar to the sclera or cornea of the human eye. It is preferable to further comprise a planar material having a thickness of.

  In the sixth embodiment, the magnet incorporated in the lower member and at least the surface in contact with the magnet are formed in a convex curved surface so that the direction of the lines of magnetic force substantially coincides with the direction of the line of sight. And a magnetic body fixed to the pedestal, and a restoring force applying means provided between the lower member and the pedestal for applying a restoring force to the lower member.

  The simulated anterior lens capsule film, simulated lens nucleus, simulated cornea / sclera, etc. of the present invention are disposable or recyclable parts that can be reused as they are or are commercially available products. It can also be used after processing raw materials. Therefore, it can be provided at a low price that can be easily purchased by a trainee or a student.

FIG. 1 is a perspective view showing the overall appearance of an embodiment of a simulated eye apparatus according to the present invention. FIG. 2 is an exploded perspective view showing an embodiment of a simulated eye device according to the present invention. FIG. 3 is a cross-sectional view showing an embodiment of a simulated eye device according to the present invention, and is an explanatory view of practice of continuous circular anterior capsulotomy. FIG. 4 is a cross-sectional view showing an embodiment of a simulated eye device according to the present invention, and is an explanatory view of practice of the lens nucleus division technique. FIG. 5A is a cross-sectional view showing an embodiment of a simulated eye device according to the present invention, and is also an explanatory diagram of practice of creating a sclera / corneal incision. FIG. 5B is a cross-sectional view showing an embodiment of a simulated eye device according to the present invention, and is an explanatory view of sclera / corneal incision creation and suture practice. FIG. 5C is a partially enlarged view of FIG. 5A, and is an explanatory view of practice of creating a sclera / corneal incision. FIG. 6 is a diagram for illustrating simulated lens nuclei in which a pattern corresponding to the operation procedure of the lens nucleus division technique in one embodiment of the simulated eye device according to the present invention is illustrated, and each of columns A to C is illustrated. Corresponding to the Divide & Conquer method, Stop & Chop method, and Phaco-chop method, and 1 to 4 rows, perspective view, plan view, and side view along the 3-3 dividing line of each simulated lens nucleus , And side views along the 4-4 dividing line are shown in sequence. FIG. 7A is an exploded perspective view showing another embodiment of the simulated eye device according to the present invention. FIG. 7B is a cross-sectional view showing a normal state of another embodiment of the simulated eye device according to the present invention. FIG. 7C is a cross-sectional view showing a state after turning of another embodiment of the simulated eye apparatus according to the present invention. FIG. 8A is an exploded perspective view showing still another embodiment of the simulated eye device according to the present invention. FIG. 8B is a cross-sectional view showing a normal state of still another embodiment of the simulated eye device according to the present invention. FIG. 8C is a cross-sectional view showing a state after turning of still another embodiment of the simulated eye device according to the present invention. FIG. 9A is a cross-sectional view showing a normal state of still another embodiment of the simulated eye device according to the present invention. FIG. 9B is a cross-sectional view showing a state after turning of still another embodiment of the simulated eye apparatus according to the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Simulated eye 20 Upper member 22 Toroidal part 24 Depression recessed part 25, 26, 27 Hole 30 Lower member 32 Indentation 35 Annular projection 40 Simulated lens cortex 50 Simulated lens nucleus 60 Cup member 70 Simulated anterior lens capsule film 80 Magnet 90 Simulated strength Membrane / cornea 200 Eyeball movable device 210 Iron ball 220 Pedestal 230 Elastic member

I. Structure and material of the simulated eye device of the present invention

  FIG. 1 is a perspective view showing an entire simulated eye 10 according to an embodiment of the present invention, and FIG. 2 is an exploded perspective view of the simulated eye 10.

  The simulated eye 10 according to an embodiment of the present invention includes an upper member 20 that partially corresponds to the cornea / iris portion of the human eye and a lower member 30 that partially corresponds to the sclera / posterior lens capsule. Yes.

  The upper member 20 includes a base portion 21 having a convex curved surface and a flat lower end surface at a peripheral portion, an annular portion 22 corresponding to the lower portion of the transparent dome-shaped cornea connected to the base portion 21, and the human eye And a donut-shaped simulated iris portion 23 corresponding to the iris, and a circular recessed portion 24 formed below the simulated iris portion 23. In the present embodiment, the annular portion 22 is subjected to a relatively large hole 25 into which an ultrasonic oscillator tool and other instruments are inserted, and anterior lens capsule incision and nucleus division operation are performed on both sides of the hole 25. Small first and second holes 26 and 27 are provided for receiving the instrument. Furthermore, in the present embodiment, an opening 28 surrounded by the annular portion 22 is provided, and ears 29 are formed on both sides of the base portion 21.

  The lower member 30 corresponds to a substantially hemispherical shell-shaped main body portion 31 having a flat upper end surface on the upper side, a simulated lens cortex 40, a simulated lens core 50, and a simulated lens core described later. A bottom wall 33 that forms a recess 32 that can accommodate the cup member 60 that holds the cup. An upper portion of the recess 32 is opened by a circular opening 34, and an annular protrusion 35 protruding from a flat upper end surface is formed on the periphery of the opening 34.

  The outer diameter of the annular protrusion 35 and the inner diameter of the recessed portion 24 of the upper member 20 are designed to function as tension applying means for uniformly applying tension to a simulated anterior lens capsule film 70 to be described later over 360 °. In the state where the sac film 70 is interposed, both are set to have an interference fit relationship. The annular protrusion 35 does not need to be completely continuous, and may be divided in the circumferential direction as long as it can apply a uniform tension and can be fitted into the recessed portion 24 of the upper member 20.

  Further, the lower member 30 is integrally formed with a support portion 36 that hangs down from the bottom wall portion 33 toward the center of the sphere, and a magnet is provided so that the magnetic pole surface is exposed at the lower end portion of the support portion 36. 80 is embedded (see FIG. 3).

  In this embodiment, the material of the upper member 20 and the lower member 30 is a cured plastic in consideration of cost and durability. However, the material is not particularly limited, and silicon resin, fluororesin, synthetic rubber, etc. A relatively soft material may be used. Moreover, the part of the bottom wall part 33 which forms the hollow 32 of the lower side member 30 may be a thin film sheet made of polyester or polypropylene.

  Here, the 1st form when the simulated eye 10 of this embodiment is assembled and used is demonstrated with reference to FIG.

  FIG. 3 is a cross-sectional view of the simulated eye 10 in a state in which the upper member 20 and the lower member 30 are detachably connected, and the cystome 100 is inserted through the first or second hole 26 or 27 and continuously. It shows when a circular anterior capsulotomy (CCC) is about to take place. The assembly procedure is as follows. First, the cup member 60 holding the simulated lens nucleus 50 and the simulated lens cortex 40 are accommodated in the recess 32 of the lower member 30, and the simulated lens cortex 40 and the annular projection 35 are brought into contact with each other. The upper lens 20 is pressed toward the lower member 30 so as to cover the simulated anterior lens capsule film 70 and so that the annular protrusion 35 of the lower member 30 fits into the circular recess 24 of the upper member 20. is there. In this manner, the simulated anterior lens capsule film 70 that is in contact with the annular protrusion 35 is uniformly tensioned over 360 ° by the inner surface of the circular recess 24, and the upper member 20 and the lower member 30. Are removably connected. Since the simulated lens cortex 40 is made of a soft material such as wheat clay, as will be described later, the simulated lens cortex 40 existing under the simulated anterior lens capsule film 70 is also the simulated anterior lens capsule. It plays a role in giving moderate tension to the film 70.

  Here, the simulated anterior lens capsule film 70 used in the simulated eye 10 of the present embodiment will be described. The simulated anterior lens capsule film 70 has a thickness of 4 to 20 μm mainly composed of any one of polyethylene terephthalate (PET), orientated polypropylene (OPP), and cellophane having tear strength and elasticity similar to those of the human eye. It is a film. The inventor has investigated all films that are generally produced or marketed. Among them, an artificial film that can perform a continuous circular anterior capsulotomy with a sense closest to the human eye is a PET film having a thickness of 4 μm or 9 μm. I found out. Also, the 9μm thick OPP film and the 20μm thick cellophane film are somewhat harder than the human eye, but the continuous circular anterior capsulotomy is similar to the human eye next to the 4μm and 9μm thick PET films. I also confirmed that I can do it. The thinnest OPP film and cellophane film on the market are 9 μm and 20 μm in thickness, respectively. If a thinner OPP film or a cellophane film is produced, it may be possible to produce a film superior to a PET film having a thickness of 4 μm or 9 μm.

The simulated anterior lens capsule film 70 is colored by attaching a coloring agent dye by printing or dyeing, and the colored surface is roughened. As the coloring method, it has been confirmed that the following method may be used.
(A) When dyeing (1) HOYA PMMA Intraocular Lens Yellow colorant is dissolved in methyl alcohol (or ethyl alcohol). The PET film or OPP film is submerged and left overnight, then removed and washed with water. To do. In addition, if it is an oil-based dye soluble in methanol, it can be colored by the same method.
(2) A PET film is immersed in a polyester-specific hot die P-100 red (Katsura Fine Goods Co., Ltd.) or polyester COLOR red or yellow (Seiwa Co., Ltd.) and heated at 90 ° C. for 30 minutes. The OPP film is not dyed.
(B) In the case of printing (1) It is applied to one side of a PET film or an OPP film with an oily or aqueous felt pen (for example, Himackey Care Red or Himackey Green (manufactured by ZEBRA)).
(2) Commercially available fax ink ribbon (for example, Speaks genuine ink film cartridge SP-FA430 (manufactured by NEC Access Technica), personal fax refill ribbon PC-400RF (manufactured by Brother Industries, Ltd.), facsimile ink Ribbon SHARP UX-NR8G (manufactured by Sharp), ink ribbon SANYO FXP-A41R40 (manufactured by Sanyo), and ink film KX-FAN190 for personal fax (manufactured by Panasonic) are used as they are.

  The simulated lens cortex 40 used in the simulated eye 10 of the present embodiment is preferably measured by an Asker rubber hardness meter C type (manufactured by Kobunshi Keiki Co., Ltd.) in accordance with Japanese Industrial Standards JIS K 7312 and JIS S 6050. A soft (hardness) wheat clay with a value of 5 to 20 points. However, it may be any soft and soft material that fills the tip of the instrument (Chistome 100), such as the lens cortex of the human eye, such as oil clay, other clays, agar, jelly, hard methylcellulose, and a superabsorbent resin. Even so long as the softness (hardness) of the predetermined 5 to 20 points is satisfied.

  An example of a method for measuring the softness (hardness) when wheat clay is used as the simulated lens cortex 40 is as follows. That is, a sample of wheat clay is filled in a 32 × 32 × 10 mm styrene cup, and the surface is pressed against a plastic plate to make it flat. The sample is placed in a bag to prevent drying, and left in an environment of a temperature of 20 ° and a relative humidity of 60% for 24 hours. Thereafter, an Asker rubber hardness meter C-type pusher needle (indenter) is pressed against the sample surface in a room at a temperature of 20 ° and a relative humidity of 60%, and the maximum value is taken as the measurement value. And it measures in three places of a different position of a sample, and makes the average value the last measured value.

In addition, the Asker rubber hardness meter C type used here is based on JIS K 7312 and JIS S 6050 and has the following specifications.
Measurement scale: 0 to 100 points, Minimum scale: 1 point, Needle shape: Height 2.54 mm, hemisphere with a diameter of 5.08 mm, Spring load: 539 mN at 0 point, 8379 mN at 100 point, Center hole diameter on the pressing surface: 5.5 mm, pressing surface dimension: 44 × 18 (rectangular), outer dimensions: width 57 mm × depth 30 mm × height 76 mm, weight: 200 g.

  Another material of the simulated lens core 50 is plastic. However, it is not limited to this as long as it has an appropriate strength. There are four types of plastic cores depending on the structure. One is an undivided simulated lens nucleus 50D used for the purpose of placing the simulated lens cortex 40 thereon when performing a continuous circular anterior capsulotomy, similar to the simulated lens nuclei 50S and 50H described above. It has the shape of The remaining three are the ideal positions corresponding to each technique in advance in order to practice the three typical division techniques, Divide & Conquer method, Stop & Chop method, and Phaco-Chop method. The simulated lens cores 50A, 50B, and 50C are of the type in which grooves and tunnel patterns are formed and divided into four. FIG. 6 shows the positions and shapes of grooves, tunnels, and side holes formed in the simulated lens nuclei 50A, 50B, and 50C for the respective division techniques.

  In FIG. 6, column A is the Divide & Conquer method, column B is the Stop & Chop method, and column C is a simulated lens nucleus for practice of the Phaco-Chop method. The first row is a perspective view and the second row is a plane. In the figure, the third row shows a side view along the 3-3 dividing line, and the fourth row shows a side view along the 4-4 dividing line. In the simulated lens nucleus 50A for practice of the Divide & Conquer method, a cross-shaped groove Gc intersecting at the center of the nucleus is formed, and the nucleus is vertically divided into four by a line passing through the center of each groove Gc. Further, in the simulated lens nucleus 50B for practice of the Stop & Chop method, one groove Gs passing through the center of the nucleus, and two grooves obliquely downward from the center of the groove Gs in a direction orthogonal to the groove Gs. The side hole Sp is made, and the nucleus is vertically divided into four along a line passing through the center of the groove Gs and the side hole Sp. Further, in the simulated lens nucleus 50C for the practice of the Phaco-Chop method, one tunnel T heading obliquely downward from a position slightly closer to the periphery of the upper surface of the nucleus, and the direction of the tunnel T in a direction perpendicular to the tunnel T Two side holes Sp are formed obliquely downward from the center, and the nucleus is divided into four by a line passing through the center of the tunnel T and a line perpendicular thereto.

  These pre-divided simulated lens cores 50A, 50B, and 50C are accommodated in a cup member 60 having a substantially concave spherical surface corresponding to the lens outer core of the human eye. The plastic simulated lens nuclei 50A, 50B, and 50C are made of a relatively hard material and cannot actually crush or emulsify the nucleus using an ultrasonic surgical device. You can practice nuclear division, rotation, and other nuclear operations. And after practice of division | segmentation, since it will naturally fit in the original position in the cup member 60 which has a concave spherical surface, practice of nuclear operation can be performed repeatedly many times. Therefore, the correct instrument operation can be naturally acquired by moving the instrument according to a groove, tunnel, or dividing line that has been created in an ideal position in advance.

  Next, the simulated sclera or simulated cornea used with the simulated eye 10 of the present embodiment will be described with reference to FIGS. 5A to 5C. In FIG. 5A, a simulated sclera / cornea 90 made of a planar material is pasted from the base portion 21 to the annular portion 22 of the upper member 20.

  The simulated sclera / cornea 90 is not limited as long as it is a soft and flat material having a predetermined thickness with elasticity and resistance similar to those of the human sclera and cornea. , Polyethylene foam, acrylic foam, polyurethane foam, foamed butyl rubber, ethyl vinyl acetate resin, soft vinyl chloride resin, silicon resin, urethane resin, fluororesin, styrene-butadiene-styrene resin, elastomer, synthetic rubber It may be a thing.

  As this simulated sclera / cornea 90, a sheet-like or tape-like planar material is cut into an appropriate size and pasted on a place where the incision practice of the wall surface of the simulated eye 10 is desired using a thin double-sided tape. Alternatively, incision creation and suture practice may be performed, and after practice, they may be peeled off and discarded. Another method is to use a double-sided tape made of a soft material having a thickness similar to the thickness of the human sclera or cornea. It may be affixed to a wall, used for practicing incision and suturing, and disposable after use.

  Among the above, for practice of sclera and corneal incision, those that are superior in terms of cost, simplicity, and sensory similarity to human eye incision are polyethylene foam as a base material and release paper It was confirmed to be a commercially available double-sided tape (trade name: double-sided tape can be re-applied, product number T3630, Nitoms Co., Ltd.) using thin paper and having a thickness of 1.0 mm. In this case, only the release paper on one surface is peeled off, and then pasted from the base portion 21 to the annular portion 22 of the upper member 20, and the simulated sclera / cornea 90 is left with the release paper on the other surface left. Use as For the sense of incision, a thin release paper corresponds to the relatively dense connective tissue of the upper sclera of the human eye, and the polyethylene foam of the base material corresponds to a relatively rough connective tissue of the sclera below the upper sclera Therefore, it is possible to practice the creation of a scleral incision with a feeling that resembles the sense of making an incision in the sclera of a human eye.

  In addition, the simulated sclera / cornea 90 extends from the base portion 21 to the annular portion 22 of the upper member 20, and in particular, is used by being attached so as to close a relatively large hole 25 for inserting a simulated surgical instrument. The material is a commercially available double-sided tape with a thickness of 1.0 mm using acrylic foam as the base material (trade name: Scotch (registered trademark) super-strength double-sided tape for vinyl chloride, in terms of cost, simplicity, and durability. Alternatively, for transparent materials, product number CAT.No. PV-2, Sumitomo 3M Co., Ltd.), and a commercially available double-sided tape having a thickness of 0.75 mm using foamed butyl rubber as a base material (trade name: foamed butyl rubber sheet) It was confirmed that the strong double-sided tape, product number No. 541, Nitoms Corporation) was excellent. In this case, peel off the release paper on one side and stick it in place, remove the release paper on the other side, and then apply a thin (4 μm or 9 μm) PET film or OPP film on the surface of the tape. Paste and use. After making an incision at the position where the hole 25 of the simulated sclera / cornea 90 thus installed is closed, if the instrument is inserted and the instrument is operated for a cataract surgery technique, the instrument is restrained to the incision. Therefore, it is possible to obtain a sense similar to that performed by the human eye and practice effective surgical techniques.

  Furthermore, the method for creating a sclera or corneal incision wound and suture practice for cataract surgery according to the present invention can also be applied to a method for creating a sclera valve and suture practice for glaucoma surgery.

  The method of practicing scleral or corneal incision creation by cutting a soft sheet-like or tape-like material according to the present invention into an appropriate size and affixing it to the eyeball wall is described later in II. . This will be further described in the usage of the simulated eye device of the present invention.

  Next, a second embodiment of the simulated eye 10 of the present invention will be described with reference to FIGS. In the second embodiment, an eyeball movable device 200 is added to the first embodiment described above. FIG. 7A is an exploded perspective view of the second embodiment to which the eyeball movable device 200 is added. The eyeball movable device 200 includes a magnet 80 incorporated in the simulated eye 10, an iron ball 210 as a magnetic body, and a pedestal 220. It is shown that it is configured by. The magnet 80 is fixed to the lower member 30 of the simulated eye 10 as described above, and the upper part of the iron ball 210 is exposed and the lower part is embedded and fixed in the pedestal 220.

  In order for the simulated eye 10 to perform an eyeball swivel movement with a rotation radius similar to that of the human eye, the simulated eye 10 as shown in FIG. 7A is preferably hemispherical only for the front half of the eyeball. It may be a simple sphere. The size and shape of the magnet 80 and the pedestal 220 are not particularly limited. Even if the magnetic body is not a perfect sphere, it is sufficient that the surface in contact with the magnet 80 has a smooth convex curved surface. However, a spherical body is preferable from the viewpoint of ease of manufacture.

  The turning range of the simulated eye 10 is affected by the shape of the pedestal 220 and the simulated eye 10 and the way the magnet 80 is attached, but the largest influence is the size of the iron ball 210 and the exposure from the pedestal 220. In proportion, the movable range of the simulated eye 10 increases as the radius of the iron ball increases and the ratio of the portion exposed from the pedestal increases. In order to realize a movable range similar to the human eye and a turning radius, the size of the iron ball and the ratio of the exposed part are naturally determined.

  7B and 7C are cross-sectional views showing a state in which the magnet 80 fixed to the simulated eye 10 and the iron ball 210 fixed to the pedestal 220 are attracted by magnetic force. In the simulated eye 10 according to the second embodiment, the lower surface of the hemispherical shell-shaped main body 31 of the lower member 30 is closed by the bottom wall 37, and the magnet 80 is formed on the bottom wall 37 of the hemispherical simulated eye 10. It is fixed in the center. And this magnet 80 is installed in the bottom wall 37 so that the direction Z of a magnetic force line may correspond with the direction of a line of sight, in other words, it may face the direction of the virtual cornea vertex 10p. Since the direction Z of the magnetic field lines is always directed toward the center of the spherical iron ball 210, the simulated eye 10 turns around the center of the iron ball 210 while moving so as to slide on the surface of the iron ball 210 when an external force is applied. It will be. When the external force is removed, the simulated eye 10 is maintained at that position, so that the direction of the simulated eye 10 can be fixed in a predetermined direction. Further, if the pedestal 220 is fixed, the simulated eye 10 can be detached from the pedestal 220 by pulling the simulated eye in the direction of the lines of magnetic force with an external force that exceeds the magnetic force.

  Furthermore, a third embodiment of the simulated eye 10 of the present invention will be described with reference to FIGS. In the third embodiment, an elastic member 230 as a restoring force applying unit is added to the eyeball movable device 200 in the second embodiment described above. FIG. 8A is an exploded perspective view of a simulated eye device including the eyeball movable device 200 to which an elastic member 230 is added. The elastic member 230 has a cylindrical shape, and is provided in a compressed state so as to surround the iron ball 210 between the lower member 30 and the pedestal 220. The elastic member 230 is made of a sponge-like substance that is deformed by an external force and is restored when the external force is released. The material, shape, and thickness of the sponge-like substance are not particularly limited, but the material, thickness, and inner diameter of the sponge-like substance are the same as those felt when the eyeball is swung during human eye surgery. Is adjusted. The material for the sponge material is preferably urethane foam, but a spongy material such as melamine foam, a fibrous hair material such as polyester or cotton, or the like may be used.

  FIG. 8B is a cross-sectional view of the simulated eye device in a normal state in which no external force is applied, while FIG. 8C is a cross-sectional view in a state in which the simulated eye 10 is turned by applying an external force. In this state, when the external force is released, the simulated eye 10 is restored to the state shown in FIG. 8B by the restoring force of the elastic member 230. When the simulated eye 10 is turned by an external force, the same resistance as when the human eye is turned by the restoring force of the elastic member 230 is obtained, and the simulated eye 10 returns to its original state when the force is removed. And more realistic surgical simulation.

  9A and 9B show an embodiment in which the simulated eye 10 is not a hemisphere but a sphere. 9A is a cross-sectional view in a normal state, and FIG. 9B is a cross-sectional view after turning. In this case, a magnet 80 is installed on the bottom wall 38 of the lower member 30 formed in a spherical shape opposite to the corneal apex 10p so that the direction of the magnetic force line Z passes through the corneal apex 1p. If the member 230 is disposed around the iron ball 210 between the spherical bottom wall 38 and the pedestal 220, the same effect as in the case of the hemispherical simulated eye 10 can be obtained. However, at this time, the turning radius of the spherical simulated eye 10 is slightly increased.

II. How to Use the Simulated Eye Device of the Present Invention II-1. Practice of continuous circular anterior capsulotomy (CCC) using simulated anterior lens capsule film 70 CCC practice of making a continuous incision in the anterior lens capsule and opening a round window, which is particularly difficult to learn among cataract surgery techniques A method will be described with reference to FIG. First, the magnet 80 of the lower member 30 is attracted to the iron ball 210 of the pedestal 220. Then, the cup member 60 of the simulated lens outer core containing the plastic lens core 50D that is not divided is placed in the recess 32 of the lower member 30. Then, an appropriate amount of simulated lens cortex 40 made of, for example, wheat clay is attached on the simulated lens core 50D. The appropriate amount is such that when the simulated anterior lens capsule film 70 is covered from above, the entire lower surface of the film contacts the simulated lens cortex 40 and the center of the film is slightly raised. Next, the simulated anterior lens capsule film 70 cut to an appropriate size is placed on the simulated lens cortex 40 while being stretched with fingers so that the film cannot be wrinkled.

  At this time, when only one surface of the simulated anterior lens capsule film 70 is roughened, the direction of the rough surface is determined according to which method is practiced as CCC. In the practice of the so-called tearing method, the rough surface is placed on top, and in the practice of the flap inversion method, the rough surface is placed on the bottom.

  Next, the recessed portion 24 on the bottom surface of the upper member 20 is fitted into the annular projection 35 of the lower member 30 from above the simulated anterior lens capsule film 70, and the simulated anterior lens capsule film 70 is sandwiched and fixed therebetween. Then, after applying a small amount of a viscoelastic material such as hydroxyethyl cellulose or sodium hyaluronate to the center of the fixed simulated anterior lens capsule film 70, the chitotome 100, which is a hook-like needle from the small hole 26 or 27 of the upper member 20. Or an anterior lens capsule through a large hole 25 to practice CCC. When one CCC practice is completed, the upper member 20 is removed from the lower member 30 using the ear portion 29, and the position of the simulated anterior lens capsule film 70 is shifted. Then, the uncut film surface is covered on the simulated lens cortex 40, the surface of the simulated lens cortex 40 is smoothed by stroking the finger from above the film, and the upper member 20 is again applied to the lower member 30 as a film. Insert and fix. Then, in the same manner as described above, a small amount of viscoelastic material is applied to the film surface, and CCC is practiced in the same manner with the cystome 100 or insulator. In this way, it is possible to practice CCC repeatedly several tens of times in a short time.

II-2. Practice of lens nucleus division procedure using simulated lens nucleus 50S or 50H made of polymer clay An example of how to practice lens nucleus division procedure, which is an important step that is difficult to learn after CCC in cataract surgery procedure This will be described with reference to FIG. First, the magnet 80 of the lower member 30 of the simulated eye 10 is attracted to the iron ball 210 of the pedestal 220.

  When it is desired to practice a relatively soft nucleus, a simulated lens nucleus 50S made of polymer clay is selected, and when a relatively hard nucleus is desired to be practiced, a simulated lens nucleus 50H is selected. The cup member 60 containing the selected polymer clay core is placed in the recess 32 of the lower member 30. The simulated anterior lens capsule film 70 in which the CCC is completed is placed on the lower member 30 with care so that the CCC comes to the center of the opening 34. The upper member 20 from above is fitted and fixed to the annular protrusion 35 of the lower member 30 with the simulated anterior lens capsule capsule 70 interposed therebetween. Then, a pre-chopper (not shown) is inserted from the large hole 25 of the upper member 20 and pierced into the simulated lens nucleus 50S or 50H made of polymer clay. When pierced to a sufficient depth, the tip of the pre chopper is opened to divide the simulated lens nucleus 50S or 50H into two. Further, after rotating the simulated lens nucleus 50S or 50H by 90 ° using Pre chopper, the nucleus is divided into four in the same manner. In this way, it is possible to practice the nuclear division technique of the pre chop method.

  When practicing the Phaco-Chop method, the simulated ultrasonic oscillator 110 is inserted from the large hole 25 of the upper member 20, the simulated nuclear split hook 120 is inserted from the small hole 26, and the simulated ultrasonic oscillator 110 is polymerized. After inserting the simulated lens nucleus 50S or 50H made of clay and inserting the simulated nucleus split hook 120 into the equator of the simulated lens nucleus 50S or 50H made of polymer clay through the CCC already created in the simulated lens capsule 70, The simulated lens nucleus 50S or 50H made of polymer clay is torn into two by the simulated nucleus split hook 120. Thereafter, the same operation is repeated to divide the nucleus into four.

  In this way, after the splitting of the simulated lens nucleus 50S or 50H made of polymer clay by the practice of the nuclear splitting technique by the Phaco-Chop method or the PreChop method is taken out of the simulated eye 10 and kneaded in the hand. Once again, it can be shaped into a nuclear shape and reused. In this way, the nuclear division technique can be practiced easily and repeatedly on the desk at home.

  Although different from the original usage, the simulated eye 10 of the present invention in which the simulated lens nucleus 50S or 50H made of polymer clay is installed is brought into the operating room, and an ultrasonic cataract surgical device is used under a microscope. You can also practice nucleation and emulsification. However, care should be taken because the simulated lens core made of polymer clay tends to clog the ultrasonic chip.

II-3. Practice of lens nucleus splitting procedure using pre-split plastic simulated lens nucleus 50A, 50B or 50C Select split plastic simulated lens core 50A, 50B or 50C for the lens splitting technique you want to learn To do. The simulated eye apparatus of the present invention can select simulated lens nuclei for three typical techniques: Divide & Conquer method, Stop & Chop method, and Phaco-Chop method.

  Here, the case where the Stop & Chop method is selected will be described with reference to FIG. Similarly to the practice of other techniques, the magnet 80 of the lower member 30 is attracted to the iron ball 210 of the base 220. The cup member 60 containing the simulated lens nucleus 50B for the Stop & Chop method is put into the recess 32 of the lower member 30. The simulated anterior lens capsule film 70 in which the CCC is completed is placed on the lower member 30 with care so that the CCC comes to the center of the opening 34. The upper member 20 from above is fitted and fixed to the annular protrusion 35 of the lower member 30 with the simulated anterior lens capsule capsule 70 interposed therebetween. Then, the simulated ultrasonic oscillator 110 is inserted from the large hole 25 of the upper member 20, and the simulated ultrasonic oscillator 110 is inserted into the groove Gs formed in the simulated lens nucleus 50B for the Stop & Chop method in the image of ultrasonic oscillation. Move along and practice digging a ditch. The simulated nucleus split hook 120 is inserted from the small hole 26 of the upper member 20, and further inserted under the simulated anterior lens capsule film 70 via the CCC, and the simulated lens nucleus 50B is rotated by 90 ° to simulate the ultrasonic oscillator. 110 is inserted into the side hole Sp formed in the simulated lens nucleus 50B. Then, the simulated nucleus dividing hook 120 is brought to the equator of the simulated lens nucleus 50B, and the simulated nucleus dividing hook 120 is moved along the dividing line divided in advance to divide the simulated lens nucleus 50B into two. Thereafter, the simulated lens nucleus 50B is rotated 180 ° with the simulated nucleus split hook 120, and the simulated nucleus is divided into four by the same operation. Although the simulated lens nucleus 50B is divided into four parts, the four-divided pieces naturally gather in the center in the cup member 60 and return to the state of one block in contact with each other. In this way, it is possible to practice the nuclear splitting technique of the Stop & Chop method any number of times. The simulated lens nucleus to be used is changed to the simulated lens nucleus 50A for practice of the Divide & Conquer method or the simulated lens nucleus 50C for practice of the Phaco-Chop method. You can also practice the Chop method.

II-4. Practice of incision creation using simulated sclera / cornea 90 An example of how to practice sclera or corneal incision creation will be described with reference to FIG. 5A. As the simulated sclera / cornea 90, (1) when the base material is acrylic foam and a double-sided tape having a thickness of 1.0 mm is cut to an appropriate size, this double-sided tape is used as the upper member 20 of the simulated eye 10. The large hole 25 is pasted from the base portion 21 of the upper member 20 to the annular portion 22 so as to cover from the outside. And after peeling release paper, a thin PET film or OPP film is stuck on the surface of a double-sided tape. As another method, (2) after attaching a thin double-sided tape to the same site and peeling off the release paper on the surface, a sheet made of a soft material such as soft vinyl chloride resin or urethane resin is placed on it. It may be cut and pasted into a simulated sclera / cornea 90. Then, the magnet 80 of the lower member 30 of the simulated eye 10 is attracted to the iron ball 210 of the pedestal 220, and the sclera or corneal incision is practiced using a sclera or keratotomy surgical knife such as a keratome or a crescent knife. I do.

  As one of the sclera or corneal incision, an example of how to practice scleral / corneal tunnel incision will be described with reference to FIG. 5C in which FIG. 5A is enlarged. The simulated sclera / cornea 90 is the same member, but in the following description, it is referred to as the simulated sclera 90 or the simulated cornea 90 corresponding to the part to which it is attached. In this scleral / corneal tunnel incision practice, an external incision X1 is first created with a keratome for the simulated sclera 90 located at the base 21, and then an interlayer incision X2 is created with a crescent knife. Then, the inner incision X3 is created in the simulated cornea 90 positioned in the large hole 25 by drilling inward again using a keratome, and the sclera / corneal tunnel incision X is completed. This scleral / corneal tunnel incision is a self-closing wound and does not require suturing, so it is the mainstream surgical technique at present.

  In the above sclera or corneal incision practice, surgery can be performed in which the turning behavior and resistance of the simulated eye 10 can be remarkably experienced when an external force is applied to the simulated eye 10 with a surgical knife for sclera or corneal incision. It is very effective for practicing procedures.

  Furthermore, if the instrument is inserted through the sclera / corneal tunnel incision X created in the simulated cornea 90 and practiced for the above-mentioned continuous circular anterior capsulotomy and nuclear splitting technique, the sclera / cornea is moved when the instrument is moved. The resistance experienced by the tunnel incision X allows the user to experience a resistance that approximates the operation with the human eye, and allows more realistic and effective surgical practice.

  It should be noted that the above-described practice of creating a scleral / corneal tunnel incision can also be performed by applying a simulated sclera / cornea 90 as shown in FIG. 5B. The right side of FIG. 5B shows the method (1) above, and the left side of FIG. 5B shows the method (2) above. The simulated sclera / cornea 90 is attached to the lower member 30 of the simulated eye 10. Affixed to the outer wall. At this time, the upper member 20 of the simulated eye 10 may be attached or removed. If removed, the portion can be used as the simulated cornea 90 if it is pasted so that there is a portion protruding from the lower member 30 above the simulated sclera / cornea 90. That is, when practicing the creation of scleral / corneal tunnel incision, this protruding portion is regarded as a simulated cornea 90, and an internal incision X3 is created following the interlayer incision X2, or simply a corneal incision practice using a keratome or the like. May be performed.

Claims (14)

A lower member having an indentation that is open at the top with a circular opening;
An upper member detachably coupled to the lower member, the upper member having at least an annular portion in which at least one instrument insertion hole is formed;
A soft simulated lens cortex that is contained in the indentation and approximates the lens cortex of the human eye;
A simulated anterior lens capsule disposed between the lower member and the upper member, the simulated anterior lens capsule made of a film having properties similar to those of the human lens capsule,
Tension applying means for applying a tension that is uniform over 360 ° to the simulated anterior lens capsule in a state that the simulated anterior lens capsule film is in contact with the simulated lens cortex;
A simulated eye apparatus for practicing cataract surgery, comprising:
2. The cataract surgery practice according to claim 1, wherein the simulated anterior lens capsule film is a film having a thickness of 4 to 20 μm mainly composed of one of the group consisting of PET, OPP, and cellophane. Simulated eye device.
The tension applying means is formed on a peripheral edge of the opening of the lower member, which is fitted into the concave portion formed in the lower end of the upper member and the simulated anterior lens capsule film. The simulated eye apparatus for practicing cataract surgery according to claim 1, further comprising an annular protrusion formed.
The simulated eye apparatus for practicing cataract surgery according to any one of claims 1 to 3, wherein the simulated anterior lens capsule film is formed so that at least one surface thereof is a rough surface.
The simulated lens cortex is made of a plastic material and is composed of one of the group consisting of wheat clay, oil clay, resin clay, agar, jelly, hard methylcellulose, and a superabsorbent resin. 5. A simulated eye apparatus for practicing cataract surgery according to any one of 1 to 4.
A lower member having an indentation that is open at the top with a circular opening;
An upper member detachably coupled to the lower member, the upper member having at least an annular portion in which at least one instrument insertion hole is formed;
At least a simulated lens nucleus contained in the recess;
With
The simulated lens nucleus is formed of resin clay heated at different times under a predetermined temperature environment for 2 degrees, 3 degrees, 4 degrees or 5 degrees of Emery's nuclear hardness classification of human eyes. A simulated eye apparatus for practicing cataract surgery, characterized by being at least one of the following.
A lower member having an indentation that is open at the top with a circular opening;
An upper member detachably coupled to the lower member, the upper member having at least an annular portion in which at least one instrument insertion hole is formed;
A cup member accommodated in the recess;
A simulated lens nucleus held in the cup member;
With
Cataract surgery practice characterized in that the simulated lens nucleus is formed with a pattern corresponding to the operation procedure of the lens nucleus splitting technique and has at least one of a previously split structure Simulated eye device.
A simulated sclera or a simulated cornea, which is affixed to at least the annular portion of the upper member and is made of a flat material having a predetermined thickness with elasticity and resistance similar to the sclera and cornea of the human eye, The simulated eye device for practicing cataract surgery according to any one of claims 1, 6, and 7, further comprising:
The above-mentioned simulated sclera or simulated cornea is soft and has a planar material having a predetermined thickness, such as polyethylene foam, acrylic foam, polyurethane foam, foamed butyl rubber, ethyl vinyl resin, soft vinyl chloride resin, silicon resin, urethane resin, and fluorine resin. The simulated eye device for practicing cataract surgery according to claim 8, wherein the simulated eye device is any one selected from the group consisting of styrene-butadiene-styrene resin, elastomer, and synthetic rubber.
A magnet incorporated in the lower member so that the direction of the magnetic lines of force substantially coincides with the direction of the line of sight;
At least a surface that contacts the magnet is formed as a convex curved surface, and a magnetic body fixed to the pedestal;
The simulated eye apparatus for practicing cataract surgery according to claim 1, further comprising:
The simulated eye apparatus for practicing cataract surgery according to claim 10, further comprising restoring force applying means provided between the lower member and the pedestal and applying a restoring force to the lower member.
A lower member formed with a recess capable of accommodating a simulated lens cortex, a simulated lens core, and a cup member that holds the simulated lens nucleus, wherein the opening is opened by a circular opening above the recess. A lower member having an annular protrusion formed on the periphery;
An upper member that is detachably connected to the lower member, and has at least an annular portion in which at least one instrument insertion hole is formed, and a recessed portion that is formed in the lower end and into which the annular protrusion is press-fitted. An upper member having,
A simulated anterior lens capsule disposed between the lower member and the upper member, which has properties similar to those of the human lens capsule, and is one of the group consisting of PET, OPP and cellophane A simulated anterior lens capsule film composed of a film composed mainly of two,
A plastic material having a predetermined softness (hardness) composed of one of the group consisting of wheat clay, oil clay, resin clay, agar, jelly, hard methylcellulose and superabsorbent resin as the simulated lens cortex When,
Resin clay that can be formed at 2 degrees, 3 degrees, 4 degrees, or 5 degrees of the nuclear hardness classification of human eye emery as it is heated under varying temperature under a predetermined temperature environment as the simulated lens nucleus, A plurality of types of plastic members having a structure in which a pattern is formed and pre-divided, corresponding to the operation procedure of the lens nucleus dividing technique,
A simulated eye apparatus kit for practicing cataract surgery.
As a simulated sclera or a simulated cornea, it is affixed to at least the annular portion of the upper member, and is a soft and flat material having a predetermined thickness with elasticity and resistance similar to the sclera and cornea of the human eye,
The simulated eye apparatus kit for practicing cataract surgery according to claim 12, further comprising:
A magnet incorporated in the lower member so that the direction of the magnetic lines of force substantially coincides with the direction of the line of sight;
At least a surface that contacts the magnet is formed as a convex curved surface, and a magnetic body fixed to the pedestal;
A restoring force applying means provided between the lower member and the pedestal to apply a restoring force to the lower member;
The simulated eye apparatus kit for practicing cataract surgery according to claim 13, further comprising:

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