RU2720822C1 - Method for destruction and removal of crystalline lens by lever-force cutting - vectopotential lensectomy - vplec and device for implementation thereof - lever-power cutter of lens - vector-potential disposable lensotom - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. Method for destruction and removal of pathologically changed and/or localized lens of eye, consisting in priority mechanical destruction by sharp end of movable internal cutting-aspirating tube of tip, driven by drive, located outside or in handle of device, indirectly connected with ophthalmic surgical apparatus, and accompanying vacuum removal of destructed substance through it by apparatus aspiration system with parallel filling of volumes of eye chambers and a capsular sac of a lens with a physiologically balanced solution supplied through a second external tube of the tip with an irrigation system of the apparatus, with required parameters of pressure levels, flow rates of liquids and vacuum in irrigation and aspiration systems, direction, speed and amplitude of impact of sharp end of inner tube of tip, pre-installed processor unit of apparatus, activated and variable during operation pedal remote control panel. Mechanical lens destruction is performed by lever-force cutting - vectopotential lensectomy - VPLEC sharpened and molded sharp edge of distal end of inner tube-cutter tip with force, amplitude, speed and direction, created by lever under rod action, driven by the drive, which are topologically successively and functionally integrated by a design of a device - a lever force cutter of a lens - a vectopotential disposable lensotom. Device comprises a tip cutter, a cutter lever, a lever of the lever and a con-rod drive. In the device, force and amplitude of cutting are set by lever formed by short arm from cutting tip of inner tip-cutter tip to support point and long arm from support point to plane of rod contact with central aspiration tube of handle. Support point is the point of connection of these tubes and is located in the distal end of the handle. Cutting speed depends on the speed of the con-rod movement, which is set by the force acting on the con-rod of the drive. Cutting direction is set by direction of con rod movement, shape and position of guide through slot of distal end face of the handle directly, in version - front end plug of the handle, through which tip cutter passes.

EFFECT: using the group of inventions enables higher speed, accuracy, technological and biological safety while reducing the cost of eye lens operations.

7 cl, 2 dwg

Description

The invention relates to medicine, namely to ophthalmology, the section of eye microsurgery, and can be used to destroy and remove a pathologically altered and / or localized crystalline lens of any density through self-sealing microcuts of the fibrous membrane of the eyeball.

There is a method in which a small self-sealing incision of the fibrous membrane of the eyeball is made, the tip of the device is introduced and activated, the lens is destroyed, in parallel through the same device, the sterile balanced solution is supplied by the irrigation system of the apparatus to the eyeball and the lens fragments are vacuum removed by the aspiration system of the apparatus. The device consists of two tubes inserted into each other with a gap, motionlessly fixed detachably to the handle, through which they are connected to hoses leading from the outer tube to the irrigation system, and from the inner tube to the aspiration system. The outer tube of the tip is made resiliently elastic and serves to feed the solution, and the inner tube is a metal straight or with a curved distal end and a perpendicular or beveled blunt end, and serves to destroy and remove the lens. Moreover, to bring into oscillatory motion, the inner tube of the tip is connected by the proximal end to a piezocrystalline vibrator located in the handle, under the influence of electric pulses excited with a frequency of from 20 to 50 KHz.

Destruction and removal of the lens by the so-called ultrasonic phacoemulsification is carried out by a combined action - the mass of the lens is pulled into the lumen of the inner tube of the tip of the phacoemulsifier by vacuum and the tube is drilled into the crystalline lens, the fragments are detached and shaken inside the tube to facilitate passage through the suction channel.

The technology of lens destruction by low-frequency ultrasound was first proposed and implemented by the American ophthalmic surgeon Charles Kelman (American Jornal of Ophthalmology, 1967; US Patent No. 3589363, 1971).

This technical solution is still used by most surgeons in the world and is constantly being improved in almost all modern devices for cataract surgery, for example, in the Centurion Vision System phacoemulsifier (Alcon, Novartis, USA) (https://www.myalconestore.com/cataract-surgery / centurion-phacoemulsifi cati-on system ), or Stellaris Elite Vision Enhancement System (Bausch & Lomb, USA) (https://www.stellariselite.com, https://www.bausch.ru) and others.

Despite the fifty-year period of existence, the method and the device have a number of irreparable technologically caused sequentially dependent disadvantages:

1. without vacuum, the vibrating inner tube of the tip, because of the blunt end, repels the lens and does not cut it, therefore, in this technology, vacuum is the main factor and the vibration of the tube is secondary;

2. high-frequency vibration of the inner tube of the tip arising from collisions with a piezocrystalline vibrator leads to deformations of the metal tube and causes ultrasound - remotely damaging the surrogate factor, which can destroy the lens only by cavitation arising at high power of collisions, which leads to damage to the cornea, iris, ciliary body and retina, which is why ultrasound of such power is not used to destroy the lens, but rather try to level it in every possible way with a short exposure and / or decrease in the power of collisions to reduce the degree of tube deformation, thus the initial idea of the author of technology K. Kelman to destroy the lens with ultrasound did not find application in practice, only vacuum aspiration and tube vibration remained from it, but the wrong name stuck - ultrasonic phacoemulsification, although ultrasonic destruction of the lens to the state of the emulsion does not occur; another way to eliminate the pathological effect of ultrasound was to create a technology for femtosecond laser fragmentation of the nucleus - an effective, but technologically complicating and very expensive operation!

3. vibrational deformations of the inner tube of the tip lead to its heating, which is transmitted to the surrounding tissues in the area of the surgical wound, which requires cooling of the tube and tissue protection fit the outer tube with a gap around the entire perimeter of the inner tube and, therefore, does not allow to reduce the outer diameter of the tip and therefore the width of the surgical incision.

4. reducing the degree of deformation of the tip does not allow to destroy more dense structures, such as the lens nucleus in case of brown cataract, and for less dense, the tip is clogged with fragments, which requires more than 300 mm RT to move the obturating tube through the aspiration channel of the inner tube of the high vacuum tip. Art., in addition, a high vacuum is required to overcome the repulsion of the lens by the blunted end of the vibrating tube;

5. high vacuum in the aspiration system leads to two traumatic moments: idle flow of irrigation solution in an alarming volume of more than 100 cm3 at a critical flow rate of more than 30 cm3 / min, which can lead to irrigation injury - destruction of corneal epithelial cells and the anterior choroid ; to a sharp drop in pressure in the anterior chamber of the eye during a breakthrough of occlusion, which can lead to a barotrauma - a sharp deflection of the cornea with damage to the endothelium, as well as to a hydrodynamic burst of the vitreous body, which negatively affects the retina;

6. The fight against the effect of breaking the occlusion of the tip is carried out by improving the irrigation and aspiration systems of cataract surgery devices, mainly their programmatic interaction and cassettes, but at the same time their design is complicated, which ultimately leads to an increase in the cost of the apparatus and cassette, and, therefore, the cost of operations;

7. The design of the device does not allow the handle to be made disposable because of the electric drive piezocrystals placed in it, which requires re-sterilization and does not exclude the biological and / or infectious complication of the operation.

The closest in essence to the claimed inventions are a method of destroying and removing the lens of the eye and a device for implementing the method, in which the leading destructive factor is the mechanical impact of the end of the inner suction tube of the tip, made in the form of a movable cutter with a pointed and beveled cutting end capable of rotary and / or longitudinal reciprocating movements in a given direction and at a given speed, while the tip and handle are paired and made of several tubes inserted one into the other, and the accompanying vacuum removal of the destroyed lens material (RF Patent No. 2238710, publication date 2004.10.27).

The advantages of this method and device are the high cutting properties of the cutter, which allows the lenses of any density to be destroyed at high speed, while ultrasound radiation does not occur, and the device can be made disposable. The main disadvantages are: the need for shielding of the cutter, which does not allow to reduce the outer diameter of the tip and, therefore, reduce the surgical incision; the position of the tip relative to the handle can only be longitudinally coaxial, which is not always convenient for performing operations on eye blocks deeply immersed in orbit; rather complicated design of the tip and handle, which does not allow to reduce production costs and, therefore, the cost of the operation.

To eliminate the above listed disadvantages, a method and device for the destruction and removal of a pathologically altered and / or localized crystalline lens of any hardness through self-sealing microcuts of the fibrous membrane of the eyeball, the purposes of which are:

- reducing trauma by eliminating remotely hazardous ultrasound, heating the tip and the effects of breakthrough occlusion of the aspiration system, reducing the outer diameter of the tip and the amount of irrigation solution consumed while slowing the flow rate;

- shortening the period of the operation by increasing the cutting properties of the tip and its more powerful impact with ordered movements with predetermined and dynamically changing speed and direction;

- ensuring complete biological and infectious safety due to the implementation of the device for single use;

- improving the usability of the device in front of eyes, especially deeply immersed in orbit;

- reducing the cost of the operation due to the simplification of the device.

The goals are achieved in that:

A method of destroying and removing a pathologically altered and / or localized lens of the eye consists in priority mechanical action, in which the lens is destroyed by lever-force cutting of a specifically sharpened and shaped sharp edge of the distal end of the inner cutting-aspirating tube of the tip - torch - vectopotential lensectomy, with effort, the amplitude, speed and direction created by the lever under the action of the connecting rod driven by the drive, which are combined by the design of the device — a lever-power lens cutter — a one-time potential lensotome containing a tip cutter, a torch lever, a lever connecting rod and a connecting rod drive, where: the cutting force and amplitude are specified by the lever formed by a short shoulder from the cutting edge of the inner tube of the tip to the fulcrum and a long shoulder from the fulcrum to the contact plane of the connecting rod with the central aspiration tube of the handle, and the fulcrum is the junction of the tubes and laid at the distal end of the handle; cutting speed depends on the speed of the connecting rod, which is set by the force acting on the connecting rod of the drive; the direction of cutting is set by the direction of movement of the connecting rod, the shape and position of the guide through groove of the distal end of the handle through which the inner tube of the tip passes. In this case, the cutting is performed by movements: with a given amplitude of 10 to 1 thousand microns, optimally 50 to 500 microns, and a speed of 1 thousand to 1 million cuts per minute, optimally 3 thousand to 300 thousand cuts per minute, under the action of the central tube of the handle of the movable element - the connecting rod driven by compressed air or electromagnetic, or electromechanical effects; cuts in the direction you choose: circular clockwise or counterclockwise; linearly semicircular with deviations downward vertically or diagonally; linear reciprocating vertical or horizontal, or diagonal; all types of movements can be supplemented by movements that are abrupt to the eye and can be performed in the mode of acceleration - braking; with the amplitude of deviations and the impact force of the cutting edge, which are set by the decentralization of the connecting rod bore and the ratio of the lever arm lengths, and are changed by lengthening or shortening the long arm by the longitudinal displacements of the connecting rod in the range from 10 to 1 thousand μm, optimally from 50 to 500 μm.

A device for implementing the method - a lever-power lens cutter - a single-use vectopotential lensotome connected via hoses to the irrigation and aspiration systems of the apparatus, consists of sequentially conjugated and interacting components, combined by a handle - a tip cutter, a torch lever, a lever connecting rod and a connecting rod drive. In this case, the tip consists of an external irrigation stationary and an internal cutting-aspirating movable tube, where the outer tube is made of inert elastic polymers, including silicone, lavsan, polypropylene, polyamide, polyurethane, polyethylene; with a clearance around the entire perimeter of the inner tube or only laterally horizontally; with a cross-sectional shape - oval, diamond-shaped or hexagonal with the direction of the oval peaks or acute angles to the corners of the eye section; with a preferably wedge-shaped or oval vertically cut end with a symmetrical or asymmetric horizontal arrangement of the upper and lower lips relative to each other; and the inner tube is made of: rigid inert materials resistant to deformation; with an outer diameter from 0.6 mm to 1.2 mm, and an inner diameter from 0.4 mm to 1.0 mm; with the area of entry into the tube equal to or less by 5 - 50%, optimally - 30% in terms of the size of the lumen of the tube; along the profile - straight or curved in an arc and / or angle with the bend of the distal end down and / or with the bend of the proximal end up, while it is made curved only down from the longitudinal axis of the tube by an angle of 10 to 50 degrees, optimally 30 degrees or down to the left or down to the right from the vertical by an angle of lateral deviation from 5 to 85 degrees, optimally 45 degrees, and the bending of the proximal end up is made at an angle from 120 to 160, optimally 140 degrees; the shape of the cross section is round, oval, equal or unequal and has four to eight angles, optimally six, and it is possible to combine these forms with each other with a transition along the length of the tube of one form to another; in the angle and direction of the cut of the end - at an angle to the longitudinal axis of the tube from 90 to 45 degrees down or up and / or sideways; with a sharp cutting edge in combination options: for sharpening the edge - external and / or internal smooth and / or serrated and sharpening angles from 30 to 70 degrees; by the shape of the edge - continuous or in the form of protruding sectoral wedge-shaped or arched knives in an amount of from one to eight; along the edge profile - without and / or with a bend or its knives to the center of the lumen of the tube along the arc and / or at an angle of one or more equal or unequally remote; in the form of edge bends - sectoral-planar and / or wedge-shaped; the shape of the perimeter of the edge - round or oval, star-shaped or polygonal from four to eight angles; with the position of the longitudinal axis of the inner tube of the tip to the longitudinal axis of the central tube of the handle at an angle of 180 to 100 degrees, optimally 140 degrees; along the path of movements of the cutting edge of the straightened tube specified in the direction - circular clockwise or counterclockwise, linearly semicircular with a deviation downward vertically or diagonally, or linear reciprocating vertical or horizontal, or diagonal movements, and bent in different versions of the tube - combined movements for which purpose, at the transition point of the inner tube of the tip into the central aspiration tube of the handle, a rigid or elastic connecting support is made, the center of which is the fulcrum of the lever relative to which the tubes are displaced. The handle is made of four tubes: external support, middle feed, internal regulating and central aspiration, three of which - external, middle and internal are interfaced with each other, the first two fixed, and the second two movable - internal longitudinally displaced and central displaceable transversely and longitudinally; in this case: the outer tube of the handle is equipped with a front end cap, the distal end of which can be located along the longitudinal axis of the handle or be dorsally deflected from it by an angle ranging from 170 to 100 degrees, optimally 135-140 degrees; the middle tube of the handle is pressed into the outer tube, serves to supply irrigation solution to the tip and air to the connecting rod through channels formed by grooves of the outer surface of the tube when paired with the outer tube of the handle, which are connected to the air and irrigation hoses from the proximal end; the inner tube of the handle is used to adjust the amplitude of deviations of the cutting edge of the inner tube of the tip by longitudinal displacements of the connecting rod and lengthening or shortening the long arm of the lever, is installed in the middle tube with the possibility of longitudinal movement, for which its outer surface is freely mated with the inner surface of the middle tube and is shaped - round, oval or polygonal, optimally six or octagonal; the central aspiration tube of the handle is made of inert metals or their alloys, or rigid or flexible polymers with the ability to make amplitude circular deviations and, by means of support, set in motion the inner tube of the tip for lever-force action on the lens, and performs movements under the action of the crank of the handle or due to deflection of its central part along the fusiform path, for which its ends are clamped in the handle by the front and rear supports, or due to deviations of the proximal end along the cone-shaped path, for which the distal end is clamped in the handle by the front support, and the proximal end is freely movable, passes through the hole of the polymer elastic elastic absorbing noise and vibration of the ring pressed into the rear end of the inner tube of the handle; in addition, all types of tube movements can be supplemented with reciprocating abrupt movements in the direction of the eye and be performed in the acceleration-braking mode; to give the inner tube of the tip ordered movements, the distal end of the handle is equipped with a guide through groove through which the inner tube of the tip passes; either on the front end of the handle or its end cap, it is externally mounted detachably, but with a 180-degree turn around the longitudinal axis on both sides, the coupling is equipped with a choice of through-shape grooves of the same shape, the rotation of which the movements of the cutting edge of the inner tube of the tip are directed to the one necessary for surgery the plane, in this embodiment, the outer tube of the tip is mounted on a guide sleeve; and the guide groove to give the cutting edge of the inner tube the tip of the movements has three shapes to choose from: a cone with a vertex facing the support for circular motions; a cone truncated dorsally through the apex to the chord or diameter of the base for linearly semicircular movements; a longitudinal slit, optionally located in horizontal or vertical or one of the diagonal planes for reciprocating linear movements; the distal end of the handle or its front end plug can be made either coaxially relative to the longitudinal axis of the handle, or with a deviation to the side of the lens at an angle in the range from 180 to 100 degrees, optimally 140 degrees and correspond to the angle of deviation of the tip and central tube of the handle or shoulders lever; in this case, the internal suction tubes of the tip and the handle can be made in the form of a single monolithic tube and conditionally divided at the position of the support mounted on the whole tube in an interference fit. The drive is either pneumatic or electromagnetic, and transmits movement through a connecting rod, which is located transversely and around the central tube of the handle; in the pneumatic drive, the role of the connecting rod is played by a turbine equipped with a through longitudinal decentered hole through which the central tube of the handle passes, the turbine can be made in versions with blades for front or side air supply, an air supply channel is connected to the turbine, the channel is connected to the air hose coming from the compressor either directly or through the pneumatic control unit of the apparatus, from the side of the connecting rod-turbine handle facing the distal end of the handle, by means of a rigid metal or polymer smooth movable pressure washer with a central hole, it is pressed by a coil spring located around the central tube of the handle, and from the opposite side it is pressed to the distal end of the inner handle tubes by means of a rubber ring-shaped gasket serving to brake the connecting rod-turbine when the air supply is cut off; the rotation speed of the connecting rod-turbine is regulated by the force of the compressed air from 1 thousand to 1 million rpm, optimally from 3 thousand to 300 thousand rpm; and in the electromagnetic drive, the role of the connecting rod is played by the rotor, which is equipped with a disk with a longitudinal decentered hole and placed in a stator concentrically located in the handle cavity, and the rotation speed of the connecting rod rotor is set from 1 thousand to 100 thousand rpm; the connecting rod in both versions to give impulse reciprocating movements of the support in the direction of the lens can be equipped with one or two opposite end wedge-shaped or arched radial protrusions, and the surface of the clamping washer facing the connecting rod is provided with similar protrusions, and the washer is fixedly mounted on the central tube handles; a combination of materials of rubbing pairs — a metal connecting rod with a polymer clamping plate and a central handle tube and vice versa a polymer connecting rod with a metal washer and pipe — is used. In addition, the device is made with the possibility of: changing the degree of deviation and, therefore, the impact force of the cutting edge of the inner tube of the tip, for which the inner tube of the handle is made with the possibility of longitudinal displacements with the displacement of the connecting rod so that the ratio of the lever arms is shortened or lengthened by a long shoulder; manufacturing of all components of the device disposable for surgery on only one eye, and in the embodiment with an electromagnetic connecting rod, the handle with the stator can be made reusable and longitudinally detachable, and all other elements of the device disposable and inserted into them as a single insert for the duration of the operation on one eye, then replaced.

The invention is illustrated by drawings, where figure 1 shows a General diagram of the interaction of the device with the apparatus; figure 2 is a device in longitudinal section, a pneumatic drive option.

In the figures, the numbers denote: 1 - the lens, 2 - the eye, 3 - the inner tube of the tip, 4 - the tip, 5 - drive, 6 - the handle, 7 - the device-lensot, 8 - the device, 9 - the outer tube of the tip, 10 - pedal remote control, 11 - sharp cutting edge of the inner handpiece tube, 12 - lever, 13 - connecting rod, 14 - support, lever rotation point, 15 - central suction tube of the handle, 16 - guide groove, 17 - front end cap of the handle, 18 - irrigation hose, 19 - suction hose, 20 - channels and grooves, 21 - cylindrical groove, 22 - cylindrical groove hole, 23 - external handle tube, 24 - middle handle tube, 25 - internal handle tube, 26 - guide sleeve, 27 - pneumatic air hose or electric cable, 28 - rear support, 29 - absorbing ring, 30 - connecting rod hole, 31 - clamping washer, 32 - clamping spring, 33 - rubber gasket, 34 - concentric holder.

In the drawings, arrows indicate the directions of movement of compressed air, irrigation and aspiration flows, and counter movements of the inner tube (3) of the tip (4) and the central aspiration tube (15) of the handle.

1. A method of destroying and removing a pathologically altered and / or localized crystalline lens (1) of the eye (2) consisting in the priority mechanical action of the pointed end of the movable internal suction tube (3) of the tip (4) with a movable drive (5) placed outside or in / on the handle (6) device (7) indirectly connected to the apparatus (8) and the accompanying vacuum removal through it of the destroyed substance by the aspiration system of the apparatus (8) with parallel replenishment of the volumes of the eye chambers (2) and the capsular bag of the lens (1) with a balanced solution supplied through the second external the tube (9) of the tip (4) with the irrigation system of the apparatus (8), with the necessary parameters of pressure levels, flow rates of liquids and vacuum in the irrigation and aspiration systems, the direction, speed and amplitude of the sharp end of the inner (3) tube of the tip (4) previously installed by the processor unit of the apparatus (8), activated and changed during the opera pedal remote control (10) is characterized by the fact that the mechanical destruction of the lens (1) is performed by lever-force cutting - vectopotential lensectomy - VPLEK - specifically sharpened and molded by a sharp edge (11) of the distal end of the inner cutting-aspirating tube-cutter (3) tip (4) with the force, amplitude, speed and direction created by the lever (12) under the action of a connecting rod (13) driven by the drive (5), which are topologically sequentially and functionally combined by the design of the device (7) - a cutter of the lever-power lens - a single-use vectopotential lensotome comprising a cutter (3), a lever (12) of a cutter (3), a connecting rod (13) of a lever (12), and a drive (5) of a connecting rod (13) where: the cutting force and amplitude are defined by a lever (12) formed by a short shoulder from the cutting edge (11) the inner tube (3) of the tip to the fulcrum (14) and a long shoulder from the fulcrum (14) to the plane of contact of the connecting rod (13) with the central suction tube oh (15) handles (6); the fulcrum (14) is the junction of the tubes (3, 15) and is located at the distal end of the handle (6); cutting speed depends on the speed of the connecting rod (13), which is set by the force acting on the connecting rod (13) of the drive (5); the cutting direction is set by the direction of movement of the connecting rod (13), the shape and position of the through guide groove (16) of the distal end of the handle (6) or the front end cap (17) of the handle (6), through which the inner tube (3) of the tip (4) passes.

In this case, the cutting is performed by movements:

- with predetermined amplitudes from 10 to 1 thousand μm, optimally from 50 to 500 μm, and a speed from 1 thousand to 1 million cuts / min, optimally from 3 thousand to 300 thousand cuts / min, under the action of a transversely swinging central aspiration tube (15 ) the handle (6) of the movable element - the connecting rod (13), located transversely to the tube (15), and driven by means of variants — compressed air or an electromagnetic field, or an electromechanical pusher;

- in the direction specified by choice: circular clockwise or counterclockwise; linearly semicircular with deviations downward vertically or diagonally; linear reciprocating vertical or horizontal, or diagonal; all types of movements can be supplemented by spasmodic reciprocating movements towards the eye (2) of the support (14) along the longitudinal axis of the handle (6), and in the acceleration mode — braking;

- with the amplitude of deviations and the force of influence set at choice, which are set by two points - the decentration of the through longitudinal hole of the connecting rod (13) through which the central aspiration tube (15) of the handle (6) passes, and the ratio of the lengths of the short and long arm arms (12 ), which can be changed by lengthening or shortening the long arm by longitudinal translational-reciprocal displacements of the connecting rod (13) and changing the amplitude of deviations of the cutting edge (11) of the inner tube (3) of the tip (4) by 10 to 1 thousand μm, optimally from 50 to 500 microns, and change the force of impact.

A device (7) for destroying and removing a pathologically altered and / or localized crystalline lens (1) eyes (2) - a disposable force-lens lens cutter - a vectopotential lensot connected through hoses (18, 19) to the irrigation and aspiration systems of the apparatus (8) and consisting of a tip (4) connected to a handle (6), in which the tip (4) is made of two hollow tubes (3, 9) inserted with a gap into each other: an external irrigation fixed tube (9), which supplies the solution into the eye an apple made of resiliently elastic polymers, equipped with a detachable connection to the distal end of the handle (6), through the irrigation channel (20) of which (6) and the irrigation hose (18) communicating with the irrigation system of the apparatus (8); an internal rigid movable tube (3) that destroys and removes the lens (1), made of inert metals or their alloys, connected to the central aspiration tube (15) of the handle (6), through which (6) and the suction hose (19) communicates with apparatus aspiration system (8); and the handle (6) is multilayer and contains: an irrigation channel (20), the lumen of which communicates from the distal end with a lumen between the outer (9) and inner (3) tubes of the tip (4), and from the proximal end with the lumen of the irrigation hose (18) ) by means of a fitting; a central aspiration tube (15) of the handle (6), the lumen of which communicates from the distal end with the lumen of the inner tube (3) of the tip (4), and from the proximal end with the lumen of the suction hose (19) by means of a fitting; the connecting rod drive (5) (13), which is located outside or in / on the handle (6) and indirectly connected to the device (8), which consists in the fact that it contains sequentially conjugated and interacting components combined by the handle (6) - a cutter (3 ) of the tip (4), the torch lever (12) (3), the connecting rod (13) of the lever (12), and the connecting rod drive (5) (13).

In this case, the outer tube (9) of the tip (4) is made:

- from inert elastic polymers, including silicone, lavsan, polypropylene, polyamide, polyurethane, polyethylene;

- with a clearance around the entire perimeter of the inner tube (3) or only horizontally from the sides;

- with a cross-sectional shape - oval, rhomboid or hexagonal with the direction of the oval peaks or acute angles to the corners of the surgical incision;

- with the shape of the distal end - wedge-shaped or oval vertically cut with a symmetrical or asymmetric arrangement of the upper and lower lips relative to each other without lateral outlet windows, or cut perpendicular to the longitudinal axis of the tube (9) with lateral oval or slit-like windows located closer to the distal end of the tube ( 9) diametrically opposite horizontally or with a slight displacement lower to the lens (1).

The inner tube (3) of the tip (4) is made:

- from rigid inert materials - metals or their alloys, or polymers resistant to deformation;

- with an outer diameter of 0.6 to 1.2 and an inner diameter of 0.4 to 1.0 mm;

- with the area of entry into the tube (3) equal to or less by 5 - 50%, optimally - 30% in terms of the size of the lumen of the tube (3);

- along the profile — straight or curved in an arc and / or angle with the bend of the distal end downward in the direction of the lens (1) and / or with the bend of the proximal end upward in the direction from the lens (1), while the tube is curved only downward from the longitudinal axis of the tube (3) at an angle of 10 to 50 degrees, optimally 30 degrees or down-to-left or down-to-right from a vertical angle of an additional lateral deviation of 5 to 85 degrees, optimally 45 degrees, and the bending of the proximal end upward is made at an angle of 120 to 160, optimally 140 degrees;

- according to the shape of the cross-section - round, oval, polygonal, equal to or unequal, equal to or unequal and have from four to eight angles, optimally six, and it is possible to combine these shapes with each other, i.e. with the transition along the length of the tube (3) of one form to another;

- in the angle and direction of the cut of the end - at an angle to the longitudinal axis of the tube (3) from 90 to 45 degrees down or up and / or sideways;

- cutting, for which, from the distal end, it is equipped with a specifically sharpened and molded sharp edge (11) in combinations:

* for sharpening the cutting edge (11) - external and / or internal smooth and / or serrated and sharpening angles from 30 to 70 degrees;

* according to the shape of the cutting edge (11) - in the form of a solid edge or sectorally protruding wedge-shaped or arched knives in an amount of from one to eight, in the variant - horizontally or vertically opposed;

* along the profile of the cutting edge (11) - without and / or with a bend to the center of the lumen of the tube (3) along the arc and / or at an angle in one or two or more adjacent or opposite meridians is equally or unequally remote;

* the shape of the bends of the cutting edge (11) - sectoral-planar and / or wedge-shaped;

* according to the shape of the perimeter of the cutting edge (11) - round or oval, star-shaped or polygonal from four to eight angles, optimally - six angles;

- with the position of the longitudinal axis of the inner tube (3) of the tip (4) to the longitudinal axis of the central suction tube (15) of the handle (6) at an angle of 180 to 100 degrees, optimally 140 degrees;

- movable with the ability to make the cutting edge (11) of the distal end of the straight tube (3) set in the direction of circular clockwise or counterclockwise, linearly semicircular with a downward deviation vertically or diagonally, or linear reciprocating vertical or horizontal, or diagonal movements, and bent in different versions of the tube (3) - combined movements, for which a rigid or elastic connecting support (14) is preferably made in the form of a transition from the inner tube (3) of the tip (4) to the central aspiration tube (15) of the handle (6) ball or cylinder, the center of which is the fulcrum of the lever (12), relative to which the displacement of the tubes (3, 15);

- with the entry of the tube (3) into the support (14) - from the distal end or from the side it is dorsal, for which the support (14) is equipped with a connecting channel into which the opposite ends of the tubes (3, 15) are inserted, and placed in a cylindrical groove ( 21) located from the distal end of the handle (6) with its bottom toward its proximal end and having an inner diameter equal to the outer diameter of the support (14), a through coaxial hole (22) is made in the bottom of the groove (21) with a diameter smaller than the outer diameter of the support (14), where passes the central suction tube (15) of the handle (6).

The device contains a multilayer handle (6) which consists of four tubes: external (23) support, middle (24) feed, internal (25) regulating and central (15) suction, three of which are external (23), middle (24) and the inner (25) are conjugated with each other, the first two (23, 24) motionless, and the second two (25, 15) movable - the inner (25) longitudinally displaced and the central (15) transversely displaced. Wherein:

- the external support tube (23) of the handle (6) is used for grip and is made of rigid or elastic polymer with a round inner cross-sectional shape and can be coated with a longitudinally or transversely ribbed or tuberous silicone wafer, equipped with a distal front end cap (17) the end of which can be located along the longitudinal axis of the handle (6) or be dorsally angled from it at an angle in the range from 170 to 100 degrees, optimally 135-140 degrees, on the outer surface of its (17) distal end, either a thread or wedge-shaped concentric alternating ridges and grooves for attaching either the outer (9) tube of the tip (4) or the guide sleeve (26), or the guide sleeve (26) can be pressed into the front end of the middle tube (24) of the handle (6) as a plug;

- the middle feeding tube (24) of the handle (6) is made of a rigid or elastic polymer with an external surface coinciding with the inner surface of the external tube (23) and installed in it (23) motionless in interference, oval or polygonal in shape of the outer surface, optimally six or octagonal in shape, and serves to supply irrigation solution to the tip (4) and air to the connecting rod (13), for which longitudinal parallel grooves (20) are made on its outer surface to form the outer (23) and middle (24) mates ) tubes of channels for supplying air from the pneumatic drive to the connecting rod-turbine (13) and the solution from the irrigation system of the apparatus (8) into the gap between the tip tubes (3, 9), while one or two transverse grooves (20) for air starting from proximal end of the middle tube (24), and not reaching the distal end pass into the through holes or coaxial longitudinal slots, which also do not reach the distal end of the middle tube (24), and about the bottom or two transversally connected grooves (20) for the solution extend from the proximal to the distal ends of the middle tube (24), fittings for connecting with the air (27) and irrigation (18) hoses are inserted into the channels from the side of the proximal end;

- the inner control tube (25) of the handle (6) serves for the handle serves to adjust the amplitude of the deviations of the cutting edge (11) of the inner tube (3) of the handle (6) by longitudinal displacements of the connecting rod (13) and by lengthening or shortening the long arm of the lever (12) the stop of the connecting rod (13), and made of hard or elastic polymer, is installed in the middle tube (24) with the possibility of translational-longitudinal longitudinal movements, for which its (25) outer surface is freely mated to the inner surface of the middle tube (24) and corresponds to shape - oval or polygonal, optimally six or octagonal in shape, and the inner surface in the cross section is round;

- the central aspiration tube (15) of the handle (6) is made of inert metals or their alloys, or rigid or flexible polymers with the ability to make amplitude circular deviations clockwise or counterclockwise and, using the support (14), set the internal cutting-aspiration tube ( 3) a tip (4) for lever-force impact on the lens (1), and performs movements under the action of the connecting rod (13) of the handle (6) or due to the deflection of its central part along a fusiform path, for which its (15) ends are clamped in handle (6) through the front (14) and rear (28) supports, or due to deviations of the proximal end along a cone-shaped path, for which the distal end is clamped in the handle (6) by means of a support (14), and the proximal end is freely movable, passes through the hole of the polymer elastic-elastic noise and vibration absorbing ring (29) pressed into the rear end of the inner tube (25) of the handle (6), the diameter of which corresponds to or larger narrower than the diameter of the circle described when moving by the proximal end of the tube (15); in addition, all kinds of tube movements (3, 15) can be supplemented with reciprocating, spasmodic movements of the support (14) along the longitudinal axis of the handle (6) in the direction of the eye (2) and be performed in the acceleration-braking mode.

To give the tip (4) an inner tube (3) of ordered movements, either the front monolithic blind blind end of the handle (6) itself or the plug (17) installed in the distal end of the handle are equipped with a guide through groove (16) through which the inner tube of the tip (3) passes ); either on the front end of the handle (6) or its end cap (17) is installed externally detachably with an interference fit, but with the possibility of a 180 degree turn around the longitudinal axis in both directions, the coupling (26) made of a rigid or elastic polymer and equipped with a choice of similar shape through grooves (16), the rotation of which (26) the movement of the cutting edge (11) of the inner tube (3) of the tip (4) are directed to the desired plane, in this embodiment, the outer tube (9) of the tip (4) is mounted on the sleeve (26);

- the guide groove (16) to give the cutting edge (11) the distal end of the inner tube (3) of the tip (4) of the movements has three shapes to choose from: a cone with a vertex facing the support (14) for circular movements; a cone truncated dorsally through the apex to the chord or diameter of the base for linearly semicircular movements; a longitudinal slit located in a horizontal or vertical or necessary diagonal plane for linear movements; in this case, the distal end of the handle (6) or its front end cap (17) can be made either coaxially relative to the longitudinal axis of the handle (6), or with a deviation to the dorsal side, i.e. from the lens (1) at an angle in the range from 180 to 100 degrees, optimally 140 degrees, respectively, the angle of connection of the arms of the lever (12) or the inner tube (3) of the tip (4) and the central tube (15) of the handle (6);

- internal suction tubes (3, 15) of the tip (4) and handles (6) can be made in the form of a single monolithic tube and conditionally divided at the position of the support (14) mounted on the whole tube in an interference fit.

The device (7) contains a drive (5) for imparting movement to the inner tube (3) of the tip (4), which is made in the variants pneumatic or electromagnetic, or electromechanical, and transmits the movement by means of a connecting rod (13), which is located transverse to the central aspiration tube ( 15) handles (6), while:

- in the pneumatic actuator (5) the role of the connecting rod (13) is played by a turbine rotating laterally and around the central tube (15) of the handle (6) equipped with a through longitudinal hole (30) through which the central tube (15) of the handle (6) passes, the hole (30) ) is made with a diameter slightly larger than the outer diameter of the tube (15) and is offset relative to the central longitudinal axis of the connecting rod-turbine (13), and the turbine (13) can be made in versions with blades for front or side air supply, and is located in the corresponding groove of the handle ( 6) to which the air supply channel is connected, the channel is detachably or indivisibly connected to the air hose (27) coming from the compressor either directly or through the pneumatic control unit of the device (8), the connecting rod-turbine facing the distal end of the handle (6) (13) by means of a rigid metal or polymer smooth movable clamping washer (31) with a central hole preloaded by a coil spring (32) placed around a central ac a piration tube (15) of the handle (6), and on the opposite side is pressed to the distal end of the inner tube (25) of the handle (6) by means of a rubber ring-shaped gasket (33) serving to brake the connecting rod-turbine (13) when the air supply is cut off; the rotation speed of the connecting rod-turbine (13) is regulated by the force of the compressed air from 1 thousand to 1 million rpm, optimally from 3 thousand to 300 thousand rpm;

- in the electromagnetic drive (5), the role of the connecting rod (13) is played by the rotor, which is equipped with a disk with a longitudinal decentered hole and placed in a stator concentrically located in the cavity of the handle (6), while the drive (5) is made by an electromagnetic programmable rotational reversible in synchronous versions or asynchronous direct or alternating current with a rotor in hollow or rod versions as a “squirrel cage”, and the rotation speed of the connecting rod rotor is set from 1 thousand to 100 thousand rpm;

- the connecting rod (13) in rotary versions of the actuator (5) for impulse reciprocating movements of the support (14) in the direction of the lens (1) can be equipped with one or two opposite end wedge-shaped or arched radial protrusions, and the surface is provided with similar protrusions a pressure washer (31) facing the connecting rod (13), and the washer (31) is fixedly mounted on the central tube (15) of the handle (6); in this case, a combination of materials of rubbing pairs is used - a metal connecting rod (13) with a polymer clamping washer (31) and a central aspiration tube (15) of the handle (6) and vice versa a polymer connecting rod (13) with a metal washer (31) and a pipe (15 )

The device is also configured to:

- changes in the degree of deviation and, consequently, the impact force of the cutting edge (11) of the distal end of the inner cutting-aspirating tube (3) of the tip (4), for which the inner tube (25) of the handle (6) is supported by a rubber gasket (33) connecting rod ( 13) from its proximal end, and is made with the possibility of longitudinal displacements with the displacement of the connecting rod (6) in such a way that allows you to change the length of the lever (12) - to shorten or lengthen the distance from the support (14) to the plane of contact of the connecting rod (13) with the central aspiration tube (15) of the handle (6), for which the inner tube (25) of the handle (6) extends beyond the proximal end of the outer (23) and middle (24) tubes of the handle (6) and is provided with a marking on the outside - an indicator of the displacement length, and concentric holder (34) for manual movement back and forth longitudinally to the handle (6);

- operation of the inner tube (3) of the tip (4) without using the outer tube (9) of the tip and feeding the solution into the eyeball (2) through the cannula or irrigation channel of the optional chopper or spatula, which are separately introduced through paracentesis of the fibrous membrane;

- manufacture of all components of the device (7) disposable for surgery on only one eye (2);

- manufacture of a connecting rod (13) in a variant with an electromagnetic drive (5) of a connecting rod (6) with a stator can be made reusable and longitudinally detachable, and all other elements of the device (7) are made disposable and inserted into them as a single insert for the duration of the operation on one eye (2), then replaced.

The method and device are used as follows.

The processor unit of the device is pre-installed and the pedal remote control is activated during the operation and the levels of pressure and flow rates of the liquids, vacuum in the irrigation and aspiration systems, the direction and speed of the connecting rod rotation, the amplitude with the force and the cutting direction of the lens with the sharp edge of the inner distal end are changed by the surgeon cutting-suction tube tip.

After appropriate processing of the surgical field and adequate anesthesia with a pricking cutting tool, a micro-section (s) of the fibrous membrane of the eye is made in proportion to the outer diameter of the outer tube of the tip, and without it, it is proportional to the outer diameter of the inner tube of the tip. An anesthetic, mydriatic and viscoelastic keratoprotectors are injected into the anterior chamber of the eye. Capsulorexis and hydrodissection of the lens capsule are performed. The tip of the device is introduced, the pedal remote control includes the irrigation system of the apparatus and a sterile balanced solution is supplied to replenish the volumes of the chambers of the eye, capsular bag and replace the removed lens. Turn on the vacuum system of the suction apparatus to remove the soft bark of the lens. In this case, a sterile balanced solution from the container through the hose, the handle channel, the gap between the outer and inner tubes of the tip enters the eye, and the solution is removed together with the destroyed masses of the lens through the lumen of the inner cutting and aspirating tube of the tip, the central aspiration tube of the handle, aspiration hose, cassette into the receiver of the suction system. To destroy a denser lens core, a pneumatic or electromagnetic drive is activated, a connecting rod is set in motion, by which the central aspiration tube of the handle is rocked in a predetermined direction and speed, which in turn transmits the lever movement to the inner cutting-aspirating tube of the tip, which in turn the queue deviates in a given direction with a given force and speed by cutting the substance with a sharp edge of the distal end only in the contact area. After the destruction and removal of the nucleus is completed, the drive is turned off, and in the irrigation – aspiration mode, the remnants of the posterior cortex of the lens are removed either by the device itself or by two cannulas separately connected to the hoses of the irrigation and aspiration systems of the apparatus. Next, turn off the irrigation and aspiration systems, remove the tip of the device or cannula from the anterior chamber of the eye. A flexible intraocular lens is implanted, preferably in a capsular bag. The cannulas are again introduced and the keratoprotector residues are removed by irrigation-aspiration, the cannulas are removed, the systems are turned off. The microcuts (s) of the fibrous membrane of the eye are sealed with active hydration of the stroma or they are self-sealed. The operation is completed.

The positive aspects of the method and device are:

1) mechanical lever-force action with a sharp, specifically sharpened and molded edge of the distal end of the inner rigid cutting and aspirating tube of the tip allows you to destroy lenses of any density at low parameters of irrigation and aspiration flow and vacuum;

2) the use of a mechanical factor that does not emit remotely damaging ultrasound and a destructive medium in direct contact with the lens makes the device remotely safe;

3) a different combination of options for the middle and inner tubes of the tip expands the choice at different densities of the lens and facilitates the adaptation of the surgeon to the method and device;

4) the ability to operate the device without an outer tube of the tip allows you to reduce the incision of the fibrous membrane to the technologically minimum possible;

5) the ability to make the device disposable to perform surgery on one eye to one patient makes the operation biologically and infectious safe.

Thus, as a result of the combination of all the above particular positive effects, a common technical result is achieved - the destruction and removal of a pathologically altered and / or localized lens of the eye of any density through a self-sealing micro-section of the fibrous membrane with increasing technological and biological safety, and reducing the morbidity, time and cost of the operation .

Claims (7)

1. The method of destruction and removal of a pathologically altered and / or localized lens of the eye, which consists in priority mechanical destruction by the pointed end of the movable internal cutting-aspirating tube of the handpiece, driven by a drive located outside or in the handle of the device indirectly connected to the ophthalmic surgical device, and the accompanying vacuum removal through it of a destroyed substance by an aspiration system of the apparatus with parallel replenishment of the volumes of the chambers of the eye and the capsule bag of the lens with a physiologically balanced solution supplied through the second outer tube of the tip by the irrigation system of the apparatus, with the necessary parameters of pressure levels, flow rates of liquids and vacuum in irrigation and aspiration systems, direction, the speed and amplitude of the impact of the sharp end of the inner tube of the handpiece, pre-installed by the processor unit of the device, activated and changed during the operation by the pedal remote control m control, characterized in that the mechanical destruction of the lens is carried out by lever-force cutting - vectopotential lensectomy - VPLEK sharpened and molded by the sharp edge of the distal end of the inner tube-cutting tip with force, amplitude, speed and direction created by the lever under the influence of the connecting rod driven by the drive, which are topologically sequentially and functionally combined by the design of the device — a lever-power lens cutter — a single-use vectopotential lensotome containing a tip cutter, a cutter lever, a lever connecting rod and a connecting rod drive, where the cutting force and amplitude are specified by the lever formed by the short shoulder from the cutting edge of the inner cutting tube the tip to the fulcrum and a long shoulder from the fulcrum to the plane of contact of the connecting rod with the central suction tube of the handle; the fulcrum is the junction of these tubes and is located at the distal end of the handle; the cutting speed depends on the speed of the connecting rod, which is set by the force acting on the connecting rod of the drive; the direction of cutting is determined by the direction of movement of the connecting rod, the shape and position of the guide through groove of the distal end of the handle itself, in the embodiment, the front end cap of the handle through which the tip cutting tube passes. 2. The method of destruction and removal of a pathologically altered and / or localized lens of the eye according to claim 1, characterized in that the cutting is performed by movements in the following variants: with a given amplitude from 10 to 1 thousand microns, optimally from 50 to 500 microns, and a speed of 1 thousands to 1 million cuts / min, optimally from 3 thousand to 300 thousand cuts / min, under the action of the arm of the movable element — the connecting rod, which is transverse to the tube and is driven by compressed air or electromagnetic radiation — swinging the transverse central aspiration tube; in a given direction - circular clockwise, counterclockwise, linearly semicircular with deviations downward-vertically or diagonally, linear reciprocating vertical, horizontal or diagonal; all types of movements can be supplemented by spasmodic movements in the direction of the eyeball and occur in acceleration-inhibition mode; with the amplitude of the deviations and the force of action, which are set by two points - the decentralization of the through longitudinal hole of the connecting rod through which the central suction tube of the handle passes, and the ratio of the lengths of the short and long arms of the lever, which can be changed by lengthening-shortening the long arm by longitudinal translational-reciprocal displacements connecting rod and change the required amplitude of the deviations of the cutting edge of the inner tube-cutting torch tip in the range from 10 to 1 thousand microns, optimally from 50 to 500 microns, and accordingly the impact force. 3. A device for destroying and removing a pathologically altered and / or localized lens of the eye - a lever-force lens cutter - a single-use vectopotential lensotome connected via hoses to the irrigation and aspiration systems of the ophthalmic surgical apparatus and consisting of a tip connected to a handle in which the tip is made of two hollow tubes inserted with a gap into each other: an external fixed tube supplying the solution into the eyeball made of resiliently elastic polymers, provided with a detachable connection to the distal end of the handle, through an irrigation channel and an irrigation hose that communicates with the irrigation system of the device; an internal rigid movable tube that destroys and removes the lens made of inert metals or their alloys, connected to the central suction tube of the handle, through which the suction hose communicates with the aspiration system of the apparatus; and the handle is multi-layered and contains: an irrigation channel, the lumen of which communicates from the distal end with a lumen between the outer and inner tubes of the tip, and from the proximal end with the lumen of the irrigation hose through a fitting; a central suction tube of the handle, the lumen of which communicates from the distal end with the lumen of the inner tube of the handpiece, and from the proximal end with the lumen of the suction hose by means of a fitting; a drive that is located outside or in the handle and indirectly connected to the device, characterized in that it contains sequentially conjugated and functionally interacting elements combined by a handle - a cutter, a torch lever, a connecting rod of a lever and a connecting rod drive. 4. A device for destroying and removing a pathologically altered and / or localized lens of the eye, containing a tip, which consists of two tubes inserted into each other - an external stationary and internal mobile, according to claim 3, characterized in that the external irrigation tube of the tip is made in options: from inert elastic polymers, including silicone, lavsan, polypropylene, polyamide, polyurethane, polyethylene; with a clearance - around the entire perimeter of the inner tube, only horizontally from the sides; with a cross-sectional shape - oval, diamond-shaped, hexagonal with the direction of the oval peaks, acute angles to the corners of the surgical incision; with the shape of the distal end - cut wedge-shaped or oval vertically with a symmetrical or asymmetric arrangement of the upper and lower lips relative to each other and without side outlet windows, cut off perpendicular to the longitudinal axis of the tube with side windows located diametrically opposite horizontally opposite to the tube or offset below horizontal plane to the lens; and the inner tube-cutter of the tip is made in the following variants: from hard inert materials resistant to deformation - metals, their alloys, polymers; with an outer diameter from 0.6 mm to 1.2 mm, and an inner diameter from 0.4 mm to 1.0 mm; with an entrance area into the tube equal to 5-50% less, optimally 30% in terms of the size of the tube lumen area; along the profile — a straight line, curved in an arc and / or angle with the bend of the distal end downward in the direction of the lens and / or with the bend of the proximal end upward in the direction from the crystalline lens, while it is made curved only downward from the longitudinal axis of the tube by an angle of 10 to 50 degrees , optimally 30 degrees, additionally - down-to-left, down-to-right from a vertical angle of lateral deviation from 5 to 85 degrees, optimally 45 degrees, and the bending of the proximal end upward is made at an angle from 120 to 160, optimally 140 degrees; according to the shape of the cross-section - round, oval, polygonal, equal to or unequal, equal to or unequal, and have from four to eight angles, optimally six, it is possible to combine these forms with each other, i.e. with the transition along the length of the tube of one form to another; in the angle and direction of the cut of the end - at an angle to the longitudinal axis of the tube from 90 to 45 degrees down, up, sideways, up and side, down and side; with a sharp cutting edge in combination options: for sharpening the edge - external, internal, external and internal, smooth, serrated, with sharpening angles from 30 to 70 degrees; the shape of the edge is continuous, in the form of protruding sectoral wedge-shaped or arched knives in an amount from one to eight, optimally two knives horizontally or vertically opposed; along the edge profile - without bending, with bending to the center of the tube’s lumen along the arc or at an angle in one or two or more adjacent or opposite meridians equal or unequally remote; in the form of edge bends - sectoral-planar, wedge-shaped; the shape of the perimeter of the edge - round or oval, star-shaped or polygonal from four to eight angles, optimally six angles; with the position of the longitudinal axis of the cutting tube to the longitudinal axis of the central suction tube of the handle at an angle of 180 to 100 degrees, optimally 140 degrees; movable with the ability to make the cutting edge the movements specified in the direction in the variants of the straightened cutting tube circular, counterclockwise, linearly semicircular with a downward-vertical deflection, downward-diagonal, linear reciprocating vertical, horizontal or diagonal, and curved in different versions of the torch tube, combined movements, for which purpose a rigid or elastic connecting support in the form of a ball is made at the place of transition of the internal tip cutting torch into the central aspiration tube of the handle, the center of which is the fulcrum of the lever relative to which the tubes are displaced; with the cutter tube entering the support, opposite the distal end of the central aspiration tube of the handle or dorsally from the side, for which the support is equipped with a connecting channel into which the opposite ends of the cutting tube and the central aspiration tube of the handle are inserted, and placed in a cylindrical groove located with the distal end of the handle with the bottom facing its proximal end and an inner diameter equal to the outer diameter of the support, a through coaxial hole is made in the bottom of the groove with a diameter smaller than the outer diameter of the support, where the central aspiration tube of the handle passes. 5. A device for destroying and removing a pathologically altered and / or localized lens of the eye, comprising a multilayer handle, according to claim 3. characterized in that the handle is made of four tubes: an external support, an average supply, an internal regulatory and central aspiration, three of which - the outer, middle and inner are made of polymers and are conjugated with each other, the first two stationary, and the second two movable, the inner longitudinally displaceable and the central displaceable transversely and longitudinally; at the same time: the outer tube of the handle serves to grip and is made with a round inner cross-sectional shape and can be coated with a silicone rough cachet, equipped with a front end cap, the distal end of which in options is located along the longitudinal axis of the handle or angled dorsally from it within from 170 to 100 degrees, optimally 135-140 degrees, thread or wedge-shaped concentric alternating ridges and grooves are made on the outer surface of its distal end for fastening the outer tube of the tip or guide sleeve, which can be pressed into the front end of the middle tube of the handle; the middle tube of the handle is made with an outer surface that coincides with the inner surface of the outer tube and is mounted motionlessly in an interference fit, in the shape of the outer surface in versions - oval, polygonal, optimally hexagonal or octagonal, and serves to supply irrigation solution to the tip and air to the connecting rod for this purpose, longitudinal parallel grooves are made on its outer surface to form channels for supplying air from the pneumatic drive to the connecting rod-turbine and solution from the irrigation system of the apparatus into the lumen between the tip tubes when pairing the outer and middle tubes, while the two air grooves are connected between each other with a transverse groove and starting from the proximal end of the middle tube, not reaching the distal end, pass into the through holes or coaxial longitudinal slots, which also do not reach the distal end of the middle tube, and the grooves for the solution in the amount of one or two connected by a transverse groove pass from pr nipples to the distal ends of the middle tube, fittings are inserted into the channels from the side of the proximal end for connection with air and irrigation hoses; the inner tube of the handle is used to adjust the amplitude of deviations of the cutting edge of the inner tube of the tip cutter by means of longitudinal displacements of the connecting rod and lengthening and shortening of the long arm of the lever; it is installed in the middle tube with the possibility of translational-reciprocal longitudinal displacements, for which its outer surface is freely associated with the inner surface of the middle the tube and corresponds in shape to the options - oval, polygonal, optimally hexagonal or octagonal, and the inner surface in the cross section is round; the central suction tube of the handle is made in the variants of inert metals, their alloys or polymers, rigid or flexible with the ability to make amplitude circular deviations in a clockwise, counterclockwise direction and, by means of a support, set in motion the inner tube-cutter of the tip for lever-force destruction of the lens and carries out movements under the action of the crank of the handle in the variants - due to the deflection of its central part along the fusiform path, for which its ends are clamped in the handle by the front and rear supports, due to deviations of the proximal end along the conical path, for which its distal end is clamped in the handle by supports, and the proximal end is freely movable, passes through the hole of the polymer elastic-elastic absorbing noise and vibration rings pressed into the rear end of the handle’s inner tube, the diameter of which is larger than the diameter of the circle described when the proximal end of the tube moves; in addition, all types of tube movements can be supplemented by reciprocating abrupt movements of the support along the longitudinal axis of the handle in the direction of the eye and be performed in the acceleration-braking mode; in order to give ordered movements to the inner tube-cutter of the variants, the front monolithic blind end face of the handle or plug installed in the distal end of the handle is provided with a guide through groove through which the inner tube of the tip cutter passes; in the variant - on the front end of the handle or its end plug is installed externally detachably, but with the possibility of a 180 degree turn around the longitudinal axis in both directions, a coupling made of polymer and equipped with similar through-shape grooves, the rotation of which the movement of the cutting edge of the inner tube - tip torches are sent to the plane necessary for surgery, while the tip outer tube is attached to the guide sleeve; and the guide groove for giving the sharp tip of the inner tube-cutter to the direction of motion direction has the form - for circular motions - of a cone with a vertex facing the support, for linear semicircular motions - of a cone truncated dorsally through the apex to the chord or diameter of the base, for reciprocating linear movements - a longitudinal slit located horizontally, vertically or diagonally; the distal end of the handle or its front end plug can be made in the following versions - coaxially to the longitudinal axis of the handle, with a deviation to the dorsal side of the lens at an angle in the range from 180 to 100 degrees, optimally 140 degrees, respectively, of the angle of connection of the arm shoulders - the inner tube of the torch tip and central suction tube of the handle; while the inner tube-cutting torch and the central suction tube of the handle can be made in the form of a monolithic tube and conditionally divided at the position of the support mounted on the whole tube in interference. 6. A device for destroying and removing a pathologically altered and / or localized lens of the eye, comprising a drive according to claim 3. characterized in that the drive is made in pneumatic, electromagnetic, and transmits motion through a connecting rod, which is located transversely and around the central aspiration handle tubes; in this case, in the pneumatic version, the role of the connecting rod is played by a turbine equipped with a through longitudinal hole through which the central aspiration tube of the handle passes, the hole is made with a diameter larger than the outer diameter of the tube, and is offset from the central longitudinal axis of the connecting rod-turbine, the turbine is made with blades for supplying air to options from the end, on the side and located in the corresponding groove of the handle, to which the channel for supplying air is connected, the channel is detachably connected to the air hose coming from the compressor in the options - directly or through the pneumatic control unit of the device, from the side facing the distal end of the handle, the connecting rod-turbine by means of a rigid smooth movable clamping washer with a central hole is preloaded by a coil spring placed around the central suction tube of the handle, and from the opposite side is pressed to the distal end of the inner tube of the handle by means of a rubber ring-shaped gasket used for torus the capabilities of the connecting rod-turbine when the air supply is cut off; the rotation speed of the connecting rod-turbine is regulated by the force of the compressed air from 1 thousand to 1 million rpm, optimally from 3 thousand to 300 thousand rpm; and in the electromagnetic drive, the role of the connecting rod is played by the rotor, which is equipped with a disk with a longitudinal decentered hole and placed in a stator concentrically located in the handle cavity, while the drive is made of electromagnetic, software-controlled, rotational, reversible, in versions synchronous or asynchronous, direct or alternating current , with a hollow or rod rotor, and the rotation speed of the connecting rod rotor is set from 1 thousand to 100 thousand rpm; the connecting rod for impulse reciprocating movements of the support in the direction of the lens can be equipped with one or two opposite end wedge-shaped or arched radial protrusions, and the surface of the pressure washer facing the connecting rod is provided with similar protrusions, and the washer is fixedly mounted on the central aspiration tube of the handle; a combination of materials of rubbing pairs is used - a metal connecting rod with a polymer clamping plate and a central suction tube of the handle or a polymer connecting rod with a metal washer and pipe. 7. A device for the destruction and removal of a pathologically altered and / or localized lens of the eye according to paragraphs. 3 and 6, characterized in that it is made with the possibility of changing the degree of deviation and, consequently, the impact force of the cutting edge of the inner tube-cutting torch, for which the inner tube of the handle is supported by a rubber gasket connecting rod from its proximal end and is made with the possibility of longitudinal displacements with displacement the connecting rod in such a way that the ratio of the lever shoulders changes - the long arm is shortened-lengthened, for which the inner tube of the handle extends beyond the proximal end of the outer and middle tubes of the handle and is provided with a marking on the outside - an indicator of the displacement length, and a concentric holder for manually moving back and forth longitudinally handle; work with the inner tube-cutter of the tip without using the outer tube of the tip and supplying the solution into the eyeball through the cannula, the irrigation channel of the optional chopper, which are separately introduced through the paracentesis of the fibrous membrane; the manufacture of all components of the device is disposable, and in the embodiment with an electromagnetic connecting rod, the handle with the stator can be made reusable and longitudinally detachable, and all other elements of the device are disposable and inserted into them as a single insert for the duration of the operation, then replaced.

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