WO2010047387A1 - Procédé de compensation de la dégradation d'élasticité de la sclère d'un globe oculaire et espaceur utilisé dans ce procédé - Google Patents

Procédé de compensation de la dégradation d'élasticité de la sclère d'un globe oculaire et espaceur utilisé dans ce procédé Download PDF

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Publication number
WO2010047387A1
WO2010047387A1 PCT/JP2009/068270 JP2009068270W WO2010047387A1 WO 2010047387 A1 WO2010047387 A1 WO 2010047387A1 JP 2009068270 W JP2009068270 W JP 2009068270W WO 2010047387 A1 WO2010047387 A1 WO 2010047387A1
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Prior art keywords
eyeball
extensibility
sclera
spacer
corneal
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PCT/JP2009/068270
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English (en)
Japanese (ja)
Inventor
憲次 吉田
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志村 好美
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Publication of WO2010047387A1 publication Critical patent/WO2010047387A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/14—Eye parts, e.g. lenses, corneal implants; Implanting instruments specially adapted therefor; Artificial eyes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
    • A61F9/00827—Refractive correction, e.g. lenticle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
    • A61F9/00838—Correction of presbyopia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00865—Sclera
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea

Definitions

  • the present invention relates to a method for complementing the decrease in extensibility of the sclera located between the eyeball adhering portion and the cornea ring portion of the extraocular muscle, and a spacer used in the method.
  • the eye movement is explained by the internal eye muscle adjustment theory, the so-called Helmholtz theory, proposed by Helmholtz, a physiologist and physicist in the 19th century.
  • Helmholtz theory proposed by Helmholtz, a physiologist and physicist in the 19th century.
  • the eye movement is driven by the elastic movement of the ciliary muscle in the eyeball, and its effector is only the lens. And it is an effector.
  • the focus of the crystalline lens is adjusted by changing its thickness and position.
  • Helmholtz theory is not a complete theory because it cannot often explain the eye movement. This is already a well-known fact, but there is still no new theory that can overturn this theory, and Helmholtz theory has been supported to date.
  • presbyopia age-related accommodation weakness
  • wearing a spectacle or contact lens with a convex lens to adjust the focal position (far point) and near vision It has been generally done to improve.
  • the near vision is improved by these methods, the distance vision will be disturbed. Therefore, at present, a multifocal lens or a progressive focus lens is transplanted into the eye and referred to as presbyopia recovery treatment for convenience.
  • the present inventor in the process of examining and treating patients for many years as an ophthalmologist, said, “Only the ciliary muscles that the eyeball's accommodation movement is actively operated are proposed by Helmholtz theory. In other words, it is done by changing the shape of the whole eyeball flexibly. " In addition to the extraocular muscles directly attached to the eyeball, the shape of the entire eyeball changes due to coordinated movements of the eyelids, eyelid fist muscles, facial muscles such as the ocular muscles and the frontal muscles, and further contains the eyeballs We obtained the knowledge that the soft tissue behind the eyeball in the eye socket and the eye socket is also indispensable for the eye movement.
  • FIG. 15 is a schematic diagram showing the eyeball and its peripheral part when the external eye muscle is in a relaxed state
  • FIG. 16 is a schematic diagram showing the eyeball and its peripheral part when the external eye muscle contracts.
  • the internal pressure of the soft tissue 8 that has been compressed increases, and the eyeball bottom 4 is pushed back evenly with a pressure P1 having the same magnitude as the internal pressure.
  • the drag force P2 generated in the eyeball 1 becomes a force P3 for extending the sclera 5 and the cornea 6 positioned in front of the extraocular muscle adhesion portion 3 of the eyeball 1 toward the front.
  • the eyeball axis extends.
  • the extraocular muscle adhering part 3 works as an action point, and therefore the sclera 5 part from the extraocular muscle adhering part 3 to the corneal ring part 7 is most strongly extended (indicated by an arrow E in FIG. 16).
  • the portion of the sclera 5 to which the extraocular muscles 2 are attached is the thinnest, and is originally a site with excellent extensibility.
  • the present inventor has found that not only the expansion and contraction movement of the ciliary muscle (inner eye muscle) but also the extension of the eyeball axis due to the extension of the sclera 5 has a great influence on the adjustment movement of the eyeball. Therefore, hereinafter, the sclera is also referred to as a regulatory sclera in the present specification.
  • symbol 6 in a figure shows an optic nerve, 9 shows a cornea, respectively.
  • the extensibility of the regulatory sclera 5 depends on its thickness and the moisture content of the collagen tissue constituting it. This decrease in the moisture content of the collagen tissue leads to the hardening of the tissue, leading to a decrease in the extensibility of the regulatory sclera 5.
  • the moisture content of the collagen constituting the regulatory sclera 5 tends to decrease with aging, similar to that of the skin. Therefore, the extensibility of the regulatory sclera 5 decreases with age, and as a result, the ability to adjust the eyeball is reduced.
  • the present inventor has discovered that a decrease in the ability to adjust the eyeball by such a series of mechanisms leads to the development of presbyopia.
  • the present inventor has proposed a constant-depth corneal ring-shaped incision device for the treatment of presbyopia based on the above theory (see Patent Document 1).
  • Patent Document 1 in order to prevent the incision formed in the cornea from being repaired by re-adhesion and adhesion and to maintain the incision, an indwelling ring inserted into the incision was proposed (Patent Document). 2).
  • the desired constant depth annulus incision is formed in the corneal region near the corneal limbus using the constant depth corneal annulus incision instrument, this incision becomes a new extension site to replace the regulatory sclera 5, and as a result
  • the decrease in the extensibility of the regulatory sclera 5 due to aging is complemented.
  • the intracorneal indwelling ring is inserted into the incision, adhesion and adhesion of the incision are prevented, so that the function of the incision is maintained, and the above complementation can be continued. As a result, the ability to adjust the eyeball is restored and presbyopia is healed.
  • the suction ring having the suction means is fixed to the cornea and the adjustment sclera with suction pressure.
  • the patient had discomfort during the procedure.
  • the revolver equipped with the blade is rotated by hand, so that an incision is formed at a predetermined position of the cornea with the blade. Therefore, adjustment of the position and posture of the blade and the amount of protrusion of the blade that determines the depth of the incision Adjustment was cumbersome.
  • the incision was formed with a blade, the cross-sectional shape of the incision was limited to a straight line. For this reason, unless the incision is formed to a very deep part of the cornea, the function of the incision as described above cannot be fully exhibited.
  • the indwelling ring When using the indwelling ring, since the cross-sectional shape of the incision formed by the incision instrument is limited to a straight line as described above, the incision is formed to a considerably deeper position. Otherwise, the intracorneal indwelling ring will be pushed out of the cornea from the incision. However, forming an incision deep in the cornea often involves a risk of excision (separation) of the cornea itself.
  • the Bowman's membrane which is the corneal constituent tissue, is incised, and the function of the Bowman's membrane, particularly the traction force Since the resistance to resistance is impaired, a highly plastic site appears on the cornea along the incision.
  • the shape of the cornea is sharpened more strongly in the periphery of the cornea than in the incision, while the curvature of the cornea does not change in the center of the cornea than in the incision or is flattened and close. In other words, hyperregulation occurs as a result.
  • forming a corneal flap with a laser in LASIK surgery so that it does not cross with the incision formed with the incision instrument means that the center of the incision by the incision instrument (the center of the circle drawn by the incision) and the corneal flap It was actually impossible because it was extremely difficult to match the center without any difference.
  • the present invention provides a method for complementing the decrease in scleral extensibility and a spacer used in the method, which can be performed safely without burdening the patient. It is an object.
  • the method for complementing the decrease in sclera extensibility of the eye according to the invention of claim 1 is characterized by creating a highly flexible region between the corneal periphery and the corneal limbus.
  • An eyeball sclera extensibility reduction complementing method is a method of creating a highly flexible region between the cornea peripheral part and the cornea ring part, thereby providing an eyeball adhering part and a cornea ring part of the extraocular muscle.
  • the sclera extensibility reduction complementing method according to each of the above inventions may further include a step of inserting a spacer into the incision wound surface or the excision layer, respectively.
  • the scleral extensibility reduction complementing method according to the first aspect of the present invention may further include a step of inserting a spacer into the first incision wound surface.
  • the scleral extensibility reduction complementing method according to the invention of claim 2 may further include a step of inserting a spacer into the first ablation layer.
  • the above spacers are preferably ring-shaped or arc-shaped.
  • a material that is harmless to the living body is selected.
  • a synthetic resin that is harmless to a living body such as polymethyl methacrylate (PMMA) used as a material for contact lenses, or gold (Au) or platinum (Pt) is selected.
  • PMMA polymethyl methacrylate
  • Au gold
  • Pt platinum
  • the spacer When the spacer is ring-shaped or arc-shaped, the spacer is inserted not in the incision along the thickness direction of the cornea as in the prior art, but in the first incision surface (or the first excision layer) along the radial direction of the cornea. Even if it tries to move into the second incisional wound surface (or second excision layer) along the thickness direction of the cornea from that position, it is caught at the lower end of the second incisional wound surface (or second excision layer). Therefore, since the spacer always stays in the first incisional wound surface (or the first excision layer) along the radial direction of the cornea, there is no possibility of slipping out of the cornea.
  • a plurality of chip-like spacers having anchor portions that enter the first incision wound surface are further provided in the second incision wound surface.
  • the process of inserting over may be included.
  • chip-like spacers having anchor portions that enter the first ablation layer are further provided in a plurality of locations in the second ablation layer. May include a step of inserting.
  • the number of chip-shaped spacers inserted is arbitrary, but 4 to 8 is preferable.
  • the insertion interval of a spacer becomes equal intervals along a 2nd incisional wound surface or a 2nd excision layer. For example, when the number of inserted spacers is four, the interval is 90 °, and when the number is eight, the interval is 45 °.
  • the chip-shaped spacer includes a flaky main body portion inserted into the second incision wound surface or the second excision layer, and the first spacer protruding from one end or both sides from the lower end of the main body portion. What provided the anchor part which penetrates in an incisional wound surface or a 1st excision layer is preferable.
  • the anchor portion enters the first incision wound surface (first excision layer) and functions as an anchor, so that the spacer remains stably in the second incision wound surface (second excision layer). There is no risk that the spacer will come out of the cornea.
  • a material that is harmless to a living body is selected as in the case of the ring-shaped or arc-shaped spacer.
  • a synthetic resin that is harmless to a living body such as polymethyl methacrylate (PMMA) used as a material for contact lenses, or gold (Au) or platinum (Pt) is selected.
  • the tip-shaped spacer as described above is easier to insert into the incisional wound surface (excision layer) than the above-described ring-shaped or arc-shaped spacer, and the treatment time can be further shortened.
  • a granular material or powder of gold (Au) or platinum (Pt) is also suitable.
  • the corneal opacity can be effectively reduced or suppressed after the operation.
  • the incision wound surface (or excision layer) along the radial direction of the cornea and the incision wound surface (or excision layer) along the thickness direction of the cornea are adjacent to each other in the vicinity of the corneal ring portion. Since it is formed, it is possible to obtain greater extensibility at the formation site than when the conventional incision is formed. That is, it is possible to create a part having higher flexibility than the conventional part between the corneal peripheral part and the corneal ring part.
  • the same femtosecond laser as that used to form the incised wound surface is used in a series of treatments, so there is no risk of both crossing and short-term myopia. And correction of hyperopia.
  • the phrase “parallel to the corneal surface” means a direction along the radial direction of the cornea, and does not mean to be strictly parallel to the corneal surface. Therefore, the first incisional wound surface and the first excision layer each include a case where the inclined surface is slightly inclined with respect to the surface of the cornea.
  • an incisional wound surface having a desired cross-sectional shape can be formed without imposing a burden on the patient, and a region having higher flexibility than the conventional one can be created between the corneal peripheral part and the corneal ring part.
  • the extensibility of the sclera can be complemented, the ability to adjust the eyeball can be restored more effectively. It can also correct myopia and astigmatism.
  • FIG. 2 shows the other example of the positional relationship of a 1st incision wound surface and a 2nd incision wound surface. It is a figure corresponding to FIG. 2 which shows the positional relationship of a 2nd incision wound surface and a corneal flap. It is a figure corresponding to FIG. 2 which shows the state which inserted the spacer in the 1st incision wound surface.
  • FIG. 2 shows a perspective view which shows one Embodiment of a spacer.
  • FIG. 2 shows the front view which shows other embodiment of a spacer.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd incisional wound surface.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd incisional wound surface.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd incisional wound surface.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd incisional wound surface.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd incisional wound surface.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd incisional wound surface.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd incisional wound surface.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd incisional wound surface.
  • FIG. 11 shows the state which inserted the spacer shown in FIG. 7 in the 2nd in
  • FIG. 1 is a schematic view of the cornea as viewed from the front
  • FIG. 2 is a schematic view showing an end surface taken along line II-II in FIG.
  • the method for complementing the decrease in sclera extensibility of the eyeball according to the present invention creates a highly flexible portion between the cornea peripheral part and the corneal ring part 7 to thereby provide the eyeball attachment part 3 and the corneal ring part 7 of the extraocular muscle 2. It is a method of complementing the decrease in the extensibility of the regulatory sclera 5 positioned between the two. That is, in the method according to the present invention, the step of forming a ring-shaped first incisional face 10 parallel to the corneal surface 92 in the corneal substantial layer 91 in the vicinity of the corneal ring portion 7, and the first incisional wound face 10 to the corneal surface 92. Forming the second incisional wound surface 20 that reaches the point, and each of these steps is performed by a femtosecond laser.
  • the laser beam emitted from the laser irradiation means is stored in advance in the memory of the femtosecond laser device, with the spot in the corneal substantial layer 91.
  • the light is guided so as to reach the depth of one incisional wound surface 10, and the laser light spot is scanned by any of the following methods. That is, scanning is performed in a ring shape along the corneal ring portion 7 while performing amplitude scanning with the width of the first incision wound surface 10 stored in advance in the memory of the femtosecond laser apparatus.
  • scanning may be started from the inner peripheral side of the cornea 9 or may be started from the outer peripheral side (corneal ring portion 7 side).
  • scanning is performed in a ring shape and a spiral shape along the corneal ring portion 7 within the range of the width of the first incision wound surface previously stored in the memory.
  • scanning may be started from the inner peripheral side of the cornea 9 or may be started from the outer peripheral side (corneal ring portion 7 side).
  • the depth of the first incision surface 10 is selected from the range of 100 to 900 ⁇ m from the corneal surface 92, and preferably 400 to 600 ⁇ m.
  • the width W of the first incision wound surface 10 is preferably 500 ⁇ m or more for the purpose of correcting myopia and astigmatism, and 1000 ⁇ m or more for the purpose of presbyopia correction, glaucoma, macular degeneration, keratoconus and the like.
  • the first incision wound surface 10 is not limited to the ring shape as described above, but may be an arc shape. Which form is selected, and how long is the arc shape? This may be determined as appropriate in consideration of the entire eyeball and the state of the cornea.
  • a laser beam spot emitted from the laser irradiation means is directed from the first incisional wound surface 10 toward the corneal surface 92 or from the corneal surface. Scan along the first incision wound surface 10 in the direction toward the one incision wound surface. As a result, the second incisional wound surface 20 is connected to the first incisional wound surface 10 at the lower end thereof.
  • the second incision wound surface 20 is connected to the first incision wound surface 10 at a substantially central portion in the width direction, and these two incision wound surfaces 10 and 20 form an “inverted T shape”.
  • the treatment subject when the treatment subject is an elderly person, there may be a white and cloudy part in the periphery of the cornea (specially called the elderly ring). 2
  • the incisional wound surface 20 should be separated from the corneal ring portion 7. Therefore, as shown in FIG. 3, the second incision wound surface 20 is connected to the first incision wound surface 10 at its inner peripheral end (inner peripheral edge on the center side of the cornea 9) or at a position closer to the inner peripheral end. Is good.
  • the distance of the second incision wound surface 20 from the corneal ring portion 7 is preferably 0.1 to 2.0 mm, more preferably 0.5 to 1.0 mm.
  • the 1st incision wound surface 10 and the 2nd incision wound surface 20 are good also as an excision layer instead of these, respectively.
  • a certain region of tissue may be excised along the first incision wound surface 10 and the second incision wound surface 20.
  • the corneal flap 60 is formed in the inner region of the second incision wound surface 20.
  • the corneal flap 60 may be before or after the first incision wound surface 10 and the second incision wound surface 20 are formed.
  • a flat ring-shaped spacer 50 may be inserted into the first incision wound surface 10 as shown in FIG.
  • the material of the spacer 50 is preferably gold or platinum. Further, the thickness can better compensate for the decrease in extensibility of the adjusting sclera 5 as the thickness increases, but a thickness of about 50 ⁇ m is preferable.
  • the spacer may be gold or platinum particles or powder. A metal having a low ionization tendency and low toxicity can also be used as the spacer material.
  • the spacer is not limited to the ring shape as described above, and may be a chip-like spacer 52 as shown in FIGS.
  • the spacer 52 includes a flaky body portion 521 inserted into the second incision wound surface 20 and an anchor portion 522 that protrudes from the lower end of the body portion 521 to both sides and enters the first incision wound surface 10. As shown in FIG. 7, it has an arrow shape facing downward.
  • the anchor portion 522 is formed in a wedge shape so that it can be easily inserted into the second incision wound surface 20.
  • the spacer 52 thus configured is inserted into the second incision wound surface 20 over a plurality of locations as indicated by a circle A in FIG.
  • eight spacers 52 are inserted at intervals of 45 °.
  • the number of spacers 52 is not limited to eight, and may be four to seven. Also in this case, it is preferable that the insertion interval of the spacers 52 is equal.
  • the anchor portion 522 enters the first incision wound surface 10 and functions as an anchor. Therefore, the spacer 52 stays stably in the second incision wound surface 20, and the spacer 52 comes out of the cornea. There is no fear.
  • the second incision wound surface 20 actually intersects the first incision wound surface 10 in relation to the treatment accuracy, and the lower end 22 of the second incision wound surface 20 is slightly slightly in the first incision wound surface 10. It is formed so as to protrude downward.
  • the shape of the anchor portion 522 is a so-called wedge shape as shown in FIG. 7, the tip of the anchor portion 522 bites into the lower end 22 of the second incision wound surface 20 as shown in FIG.
  • the anchor portion 522 is not displaced in the direction along the first incisional wound surface 10, and the spacer 52 is not inclined in the second incisional wound surface 20.
  • the anchor portion 522 does not necessarily protrude from the lower end of the main body portion 521 on both sides, and may protrude only one side from the lower end of the main body portion 521 as shown in FIG.
  • FIG. 14 shows a case where the spacer 52 shown in FIG. 13 is used.
  • a material that is harmless to the living body is selected.
  • a synthetic resin that is harmless to a living body such as polymethyl methacrylate (PMMA) used as a material for contact lenses, or gold (Au) or platinum (Pt) is selected.
  • the insertion work into the incision wound surface is easier than the above-described ring-shaped or arc-shaped spacer 50, and the treatment time is further shortened. be able to.
  • the present invention can be applied not only to the treatment of presbyopia, but also to myopia and astigmatism, and particularly to irregular irregular astigmatism that has not been treated before.
  • the present invention enables myopia and astigmatism correction surgery without impairing the thickness of the cornea, so that it is possible to treat myopia and astigmatism even in an eyeball with a thin cornea thickness.
  • the effect of reducing intraocular pressure is also obtained, it is effective for the treatment of glaucoma.
  • the tension of the extraocular muscles can be released, it is also effective in treating senile macular degeneration, retinitis pigmentosa, keratoconus, and cataract prevention.

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Abstract

Selon ce procédé, on forme une première surface coupée (10) et une seconde surface coupée (20) au moyen d'un laser femtoseconde. La première surface coupée (10) présente une forme de roue ou d'arc, et est parallèle à la surface cornéenne (92) de la couche parenchymateuse cornéenne (91) située près du limbe sclérocornéen (7). La seconde surface coupée (20) s'étend de la première surface coupée (10) à la surface cornéenne (92). Ainsi, l'invention permet d'obtenir une zone présentant une grande souplesse entre la partie périphérique cornéenne et le limbe sclérocornéen (7) et de compenser la dégradation d'élasticité de la sclère (5) située entre le limbe sclérocornéen (7) et la partie de liaison (3) du globe oculaire d'un muscle oculaire extérieur (2).
PCT/JP2009/068270 2008-10-23 2009-10-23 Procédé de compensation de la dégradation d'élasticité de la sclère d'un globe oculaire et espaceur utilisé dans ce procédé WO2010047387A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JPPCT/JP2008/069268 2008-10-23
PCT/JP2008/069268 WO2010046987A1 (fr) 2008-10-23 2008-10-23 Procédé de compensation de la baisse d'extensibilité de la sclérotique, procédé de commande de laser femtoseconde s'utilisant pour ce procédé, et écarteur s'utilisant pour ce procédé

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WO2010047387A1 true WO2010047387A1 (fr) 2010-04-29

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