WO2015163006A1 - 眼内手術システム - Google Patents
眼内手術システム Download PDFInfo
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- WO2015163006A1 WO2015163006A1 PCT/JP2015/056003 JP2015056003W WO2015163006A1 WO 2015163006 A1 WO2015163006 A1 WO 2015163006A1 JP 2015056003 W JP2015056003 W JP 2015056003W WO 2015163006 A1 WO2015163006 A1 WO 2015163006A1
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- WIPO (PCT)
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- suction
- perfusate
- tube
- internal space
- suction tube
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Classifications
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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
- A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
- A61F9/00745—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments using mechanical vibrations, e.g. ultrasonic
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/60—Containers for suction drainage, adapted to be used with an external suction source
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/71—Suction drainage systems
- A61M1/74—Suction control
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/71—Suction drainage systems
- A61M1/79—Filters for solid matter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/80—Suction pumps
- A61M1/804—Suction pumps using Laval or Venturi jet pumps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/007—Aspiration
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/84—Drainage tubes; Aspiration tips
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/75—General characteristics of the apparatus with filters
- A61M2205/7536—General characteristics of the apparatus with filters allowing gas passage, but preventing liquid passage, e.g. liquophobic, hydrophobic, water-repellent membranes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2206/00—Characteristics of a physical parameter; associated device therefor
- A61M2206/10—Flow characteristics
- A61M2206/16—Rotating swirling helical flow, e.g. by tangential inflows
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/06—Head
- A61M2210/0612—Eyes
Definitions
- the present invention relates to an intraocular surgery system and a separation device used therefor.
- an operation in which an intraocular lens is replaced with an intraocular lens has been often employed.
- an ultrasonic emulsification suction operation (PEA) in which the affected lens is crushed by ultrasonic vibration and the emulsified lens is sucked is widely used.
- an ultrasonic handpiece (hereinafter, also simply referred to as “handpiece”) that is an ultrasonic emulsification and suction device is used.
- the handpiece has a rod-like main body supported by the surgeon's hand, and the main body includes a vibrator that generates ultrasonic vibration and a horn that amplifies the ultrasonic vibration generated by the vibrator.
- a crushing tip for crushing and emulsifying the crystalline lens is attached to the tip of the main body.
- the tubular crushing tip is connected to a horn, and can apply ultrasonic vibration to the lens to be operated.
- the lens is crushed by ultrasonic vibration while supplying the perfusate into the anterior chamber of the eye.
- the lens is emulsified by ultrasonic vibration and discharged with the perfusate to the outside through the suction channel provided in the handpiece.
- part of the nucleus of the lens becomes a fragment (nuclear fragment) and is perfused. It is discharged with the liquid.
- a peristaltic pump or a venturi pump is generally used to suck the perfusate discharged from the handpiece.
- the peristaltic pump has an advantage that the suction pressure and the suction flow rate of the perfusate can be controlled independently, there is a problem that it is expensive.
- the venturi pump has a simple structure and is inexpensive, but there is a problem that the suction pressure and the suction flow rate cannot be controlled independently. That is, the suction pressure and the suction flow rate are set to be proportional. Therefore, for example, if the suction pressure is set to a value that can reliably suck the nucleus of the crystalline lens, there is a problem that the suction flow rate becomes excessive.
- the present invention has been made to solve the above-described problems, and is an intraocular surgery system capable of preventing clogging of a nuclear fragment even when the suction flow rate is reduced, while being a simple system using a venturi pump, and the same
- An object of the present invention is to provide a separation apparatus used for the above.
- An intraocular surgery system includes an air pressure feeding means, a venturi tube to which air is supplied from the air pressure feeding means, a drainage tank connected to a throttle portion of the venturi tube, and an intraocular by ultrasonic vibration.
- An intraocular surgical device that crushes the nucleus of the eye and discharges the nucleus together with the perfusate, a first suction tube through which the perfusate discharged from the intraocular surgical device flows, and the first suction tube are connected, A separation device that separates nuclei from the perfusate that has flowed in from the first suction tube, and a second suction tube that has an inner diameter smaller than that of the first suction tube and supplies the perfusion fluid discharged from the separation device to the drainage tank.
- the separation device includes a main body portion having an internal space, a discharge portion connected to the upper end portion of the internal space and connected to the second suction pipe, and the internal portion below the discharge portion. Communicate with space, said 1 the suction pipe is provided with a suction unit connected.
- the perfusate is sucked from the intraocular surgical device to the drainage tank by a so-called venturi pump having a pneumatic feeding means and a venturi tube. Therefore, the perfusate can be sucked easily.
- the first suction tube, the separation device, and the second suction tube are disposed between the intraocular surgical device and the drainage tank.
- the inner diameter of the second suction tube is larger than the inner diameter of the first suction tube. Since it is small, the suction flow rate of the perfusate can be reduced.
- the inner diameter of the first suction tube is large, it is possible to suck from the intraocular surgical device to the separating device so that the core piece of the crystalline lens is not clogged.
- the separation device communicates with the main body portion having the internal space, the upper end portion of the internal space, the discharge portion to which the second suction pipe is connected, and the internal space below the discharge portion. And a suction part to which a suction pipe is connected.
- the discharge part can be attached to the upper end part of the main body part. Thereby, it is possible to more reliably prevent the core piece of the crystalline lens sucked from the suction part from being discharged from the discharge part.
- the suction unit can be configured to extend downward at an angle of less than 90 degrees with respect to the vertical direction.
- the internal space may be formed in a cylindrical shape having an axis in the vertical direction, and the suction portion may be provided along the tangential direction of the outer peripheral surface of the internal space.
- the inner diameter of the first suction tube can be set to 0.9 to 3.0 mm.
- the above intraocular surgery system may further include an adjustment mechanism capable of adjusting the inner diameter of the second suction tube. Thereby, the suction flow rate of the perfusate can be freely adjusted.
- the separation device includes a pneumatic feeding means, a venturi pipe to which air is supplied from the pneumatic feeding means, a drainage tank connected to a throttle portion of the venturi pipe, and an intraocular nucleus by ultrasonic vibration.
- An intraocular surgical device that discharges the nucleus together with the perfusate, a first suction tube through which the perfusate discharged from the intraocular surgical device flows, an inner diameter smaller than the first suction tube,
- the separation device is connected between the first suction tube and the second suction tube, and has an internal space A main body, a discharge portion that communicates with the internal space and to which the second suction pipe is connected, and a suction portion that communicates with the internal space below the discharge port and to which the first suction pipe is connected; It is equipped with.
- the present invention although it is a simple system using a venturi pump, it is a simple system using a venturi pump, and even if the suction flow rate is reduced, clogging of nuclear fragments can be prevented.
- FIG. 2 is a side view of a handpiece in the system of FIG. 1. It is a schematic block diagram of the venturi pump in the system of FIG. It is a front view which shows the separation apparatus in the system of FIG. It is a front view which shows the other form of a separation apparatus. It is a partial schematic diagram which shows the other example of the system of FIG. It is a graph which shows the change of the pressure in the system of FIG. It is a photograph which shows attraction
- this system includes a handpiece 1 that crushes the crystalline lens, and uses a venturi pump 2 to suck perfusate from the handpiece 1.
- Two suction pipes 31 and 32 and a separation device 4 are arranged between the handpiece 1 and the venturi pump 2.
- the configuration of this intraocular surgery system will be described in detail.
- FIG. 2 is a side view of the handpiece.
- the handpiece 1 according to the present embodiment is formed in a cylindrical shape and includes a main body portion 11 held by a surgeon's hand, and generates ultrasonic vibrations in the main body portion 11.
- a vibrator (not shown) and a horn (not shown) for amplifying ultrasonic vibration generated by the vibrator are incorporated.
- a tubular crushing tip 12 for crushing and emulsifying the crystalline lens is attached to the tip of the main body 11, and a cylindrical sleeve 15 formed of a flexible material such as silicon is attached to the crushing tip 12. It is arranged to cover the surroundings.
- the sleeve 15 is provided to prevent a portion other than the tip of the crushing tip 12 from contacting the affected part, and the crushing tip 12 protrudes slightly from the tip of the sleeve 15. Further, the crushing tip 12 is connected to a horn in the main body 11 and can apply ultrasonic vibration to the crystalline lens to be operated.
- the vibration is applied to the crushing tip 12 so as to reciprocate around the axis of the tube (around an axis X described later).
- the vibration can be applied so as to perform 30,000 to 40,000 reciprocating rotations per minute at a rotation angle of 2 to 4 degrees.
- the outer peripheral surface of the main body 11 is provided with a perfusate supply channel 112 extending to the distal end side so that the perfusate can be supplied from the vicinity of the crushing tip 12 to the anterior chamber in the eye. .
- the crushing tip 12 is formed in a tubular shape, the crushed crystalline lens can be sucked together with the perfusate.
- the sucked crystalline lens passes through the suction flow path built in the main body 11 together with the perfusate, and is discharged to the outside from the port 111 at the rear end of the main body 11.
- the first suction tube 31 is connected to the port 111, and the crystalline lens and perfusate are discharged.
- the form of the crushing chip is not particularly limited, and the crushing chip may be crushed by moving back and forth as well as crushing the lens by rotation as described above.
- FIG. 3 is a schematic configuration diagram of the venturi pump.
- the venturi pump 2 according to the present embodiment includes a positive pressure tank 21, a venturi pipe 22, and a connection pipe 23 connecting them, and the positive pressure is supplied via the connection pipe 23. Air flows from the tank 21 to the venturi tube 22. An air pump 24 and a relief valve 25 are connected to the connection pipe 23 from the upstream side. A silencer 26 is attached to the downstream end of the venturi tube 22.
- a connecting pipe 27 is attached to the throttle portion 221 of the venturi pipe 22, and this connecting pipe 27 is connected to a drainage tank 28.
- the drainage tank 28 is a tank that stores the perfusate discharged from the handpiece 1 described above. As described above, when the air pump 24 is driven, air flows through the venturi tube 22. As a result, the drainage tank 28 communicating with the throttle portion 221 of the venturi tube 22 has a negative pressure. As a result, the perfusate discharged from the handpiece 1 is sucked and flows into the drainage tank 28.
- a pressure gauge 29 is attached to the connecting pipe 27, and the pressure of the connecting pipe 27 is measured. Thereby, the suction pressure of the perfusate can be measured.
- the venturi pump 2 is provided with a controller, and the output of the air pump 24 can be adjusted. Thereby, for example, according to the pressure measured by the pressure gauge 29, the output of the air pump 24 can be adjusted and the suction pressure can be adjusted.
- the space between the drainage tank 28 and the handpiece 1 is configured as follows. That is, the first suction pipe 31 connected to the handpiece 1 is connected to a separation device 4 described later, and the second suction pipe 32 connected to the separation device 4 is connected to the drainage tank 28. .
- the inner diameter of the first suction pipe 31 is preferably 0.9 to 3.0 mm, for example, so that the core sucked by the handpiece 1 can pass through, and 1.0 to It is more preferably 2.0 mm, and particularly preferably 1.0 to 1.75 mm.
- the inner diameter of the second suction pipe 32 is smaller than the inner diameter of the first suction pipe 31, for example, preferably 0.05 to 2.0 mm, and more preferably 0.1 to 2.0 mm. .
- FIG. 4 is a front view of the separation device.
- the separation device 4 includes a cylindrical main body portion 41, a discharge portion 42 provided at the upper end of the main body portion 41, and a suction portion 43 provided on a side surface of the main body portion 41. These are formed integrally.
- the main body 41 has a flat bottom surface at the lower end, and is formed in a hemispherical shape with the upper end convex upward, and has a closed internal space 40 except for the discharge part 42 and the suction part 43 described above. Yes.
- the discharge part 42 is formed in a tubular shape that protrudes upward from the upper end of the main body part 41, and communicates with the internal space 40 of the main body part 41 and the outside.
- the suction portion 43 is formed in a tubular shape that is connected obliquely downward to the outer peripheral surface of the main body portion 41 at an angle ⁇ , and communicates with the internal space 40 of the main body portion 41 and the outside.
- the separation device 4 can be formed of a material such as glass or plastic.
- the color of the separation device 4 is not particularly limited, but is preferably transparent so that the internal space 40 can be visually recognized from the outside.
- Step (1) the anterior capsule is incised while maintaining the shape of the anterior chamber with a viscoelastic substance or the like.
- step (2) an incision layer is formed in the cornea or sclera, the crushing tip 12 is inserted into the anterior chamber, and the lens is crushed and emulsified by the vibration of the crushing tip 12.
- the emulsified lens is sucked from the tip opening of the crushing tip 12 together with the perfusate, and discharged from the port 111 to the outside through the discharge channel in the handpiece. At this time, the anterior chamber is kept stable by the balance between the inflow amount of the perfusate and the suction amount.
- the air pump 24 Prior to the operation, the air pump 24 is driven and air is pumped toward the venturi tube 22. As a result, air is sucked from the inside of the drainage tank 28 toward the venturi pipe 22 through the connecting pipe 27 connected to the throttle portion 221 of the venturi pipe 22, so that the inside of the drainage tank 28 has a negative pressure. It becomes. Thereby, the perfusate discharged from the port 111 of the handpiece 1 flows into the drainage tank 28 through the first suction pipe 31, the separation device 4, and the second suction pipe 32.
- nuclear pieces a part of the nucleus of the crystalline lens crushed by the crushing chip 12 is broken into pieces (hereinafter referred to as “nuclear pieces”) and discharged from the port 111 together with the perfusate.
- the nuclear piece passes through the first suction tube 31 toward the separation device 4, but the inner diameter of the first suction tube 31 is substantially larger than that of the nuclear piece, so the nuclear piece is blocked by the first suction tube 31. Without flowing into the separation device 4.
- the core piece flows into the internal space 40 of the separation device 4 from the suction part 43 of the separation device 4 together with the perfusate.
- the suction part 43 is connected to the surface of the main body part 41 of the separation device 4 while being inclined downward, the core piece flows downward of the main body part 41. Since the specific gravity of the core piece is larger than that of the perfusate, the core piece sinks below the internal space 40 of the main body 41 and accumulates at the bottom of the internal space 40.
- the perfusate is discharged from the discharge portion 42 connected to the upper portion of the main body portion 41 and flows into the drainage tank 28 through the second suction pipe 32. In this way, the nuclear fragments crushed by the handpiece 1 are stored in the separation device 4 and no longer flow to the downstream side, that is, the second suction pipe 32.
- a first suction pipe 31, a separation device 4, and a second suction pipe 32 are arranged between the handpiece 1 and the drainage tank 28, and the inner diameter of the second suction pipe 32 is set to the first suction pipe. Since it is smaller than the inner diameter of 31, the suction flow rate of the perfusate can be reduced.
- the handpiece 1 to the separation device 4 can perform suction so as not to clog the core piece of the crystalline lens.
- the separation device 4 by providing the discharge portion 42 above the suction portion 43, the nuclear pieces sucked from the suction portion 43 to the internal space 40 are not discharged from the discharge portion 42 to the second suction pipe 32. Can be. Therefore, it is possible to prevent the core piece from flowing into the second suction pipe 32 having a small inner diameter.
- the suction flow rate of the perfusate can be reduced while using the venturi pump, and the lens core can be prevented from being clogged. Further, since the configuration of the venturi pump is simple, the entire system can be reduced in size. Therefore, the intraocular surgery system can be easily carried and cataract surgery can be performed at various locations.
- the form of the separation device 4 is not limited to that described above, and various aspects are possible.
- the discharge portion 42 is disposed at the upper end portion of the main body portion 41 or in the vicinity thereof, but at least the discharge portion 42 may be disposed above the suction portion 43. Therefore, an embodiment as shown in FIG. 5 is possible.
- the suction part should just be connected toward the horizontal or the downward direction with respect to the outer peripheral surface of a main-body part (FIG. 5 (a)).
- the suction part is connected in a tangential direction with respect to the outer peripheral surface of the main body part, the core piece spirals downward in the internal space of the main body part by centrifugal force (FIG. 5B).
- the form of the main body is not particularly limited, and can be various shapes such as a cylindrical shape, a polygonal column shape, a frontal view triangular shape, a frontal view circular shape, a frontal view elliptical shape, and a frontal view inverted triangular shape. (FIGS. 5 (e) to (h)).
- the inner diameter of the second suction pipe 32 is constant.
- the inner diameter of the second suction pipe 32 can be changed by sandwiching the second suction pipe 32 with a pinch cock or a pinch valve. .
- the suction flow rate can be adjusted.
- it may be other than a pinch cock or a pinch valve, and if it is an adjustment mechanism which can change an internal diameter by pressing the 2nd suction pipe 32 from the outside. Good.
- the pressure sensor closer to the venturi pump than the adjustment mechanism 8 is referred to as a first pressure sensor 71
- the pressure sensor closer to the separation device 4 than the adjustment mechanism 8 is referred to as a second pressure sensor 72.
- the pressure detected by the first pressure sensor 71 is before the crushing tip 12 is closed, as shown in FIG. 7. high.
- the crushing tip 12 is a core piece and the overall pressure is high, the pressure detected by the second pressure sensor 72 is lowered, and the pressure detected by both the pressure sensors 71 and 72 is the same. Thereby, it is possible to detect that the crushing chip 12 is closed by the nuclear fragment.
- venturi pump is not particularly limited, and is not particularly limited as long as the venturi pipe is provided and the drainage tank can be made negative pressure by connecting the throttle part and the drainage tank. Moreover, in the said venturi pump, although air is pumped with a positive pressure tank and an air pump, if it can pump air, it will not specifically limit.
- the perfusate was aspirated by an intraocular surgical system as shown in FIGS.
- the system settings are as follows. ⁇ Venturi pump suction pressure 300mmHg (negative pressure) ⁇ Inner diameter of first suction tube 1.75mm ⁇ Inner diameter of second suction tube 0.1mm ⁇ Inner diameter of separation device 10mm ⁇ Height of separation device 80mm -Position of the discharge unit in the separation device Upper end of the main unit-Position of the suction unit in the separation device ⁇ An angle ⁇ 60 degrees of the suction part in the separation device
- the suction flow rate is 40 ml / min because the inner diameter of the second suction pipe on the venturi pump side is smaller than that of the separation device (the first suction pipe in FIG. 1). 31). Accordingly, the suction flow rate can be reduced while maintaining the suction pressure even when the venturi pump is used.
Abstract
Description
図2は、ハンドピースの側面図である。同図に示すように、本実施形態に係るハンドピース1は、円筒状に形成され、手術者の手で持たれる本体部11を備えており、この本体部11に、超音波振動を発生する振動子(図示省略)と、この振動子によって発生した超音波振動を増幅するホーン(図示省略)とが内蔵されている。そして、本体部11の先端には、水晶体を破砕して乳化するための管状の破砕チップ12が装着されるとともに、シリコンなどの柔軟な材料で形成された筒状のスリーブ15が破砕チップ12の周囲を覆うように配置されている。スリーブ15は、破砕チップ12の先端以外の部分が患部に接触するのを防止するために設けられるものであり、スリーブ15の先端からは、破砕チップ12がわずかに突出するようになっている。また、破砕チップ12は本体部11内のホーンと連結されており、手術対象となる水晶体に超音波振動を付与することができる。
図3はベンチュリーポンプの概略構成図である。同図に示すように、本実施形態に係るベンチュリーポンプ2は、陽圧タンク21と、ベンチュリー管22と、これらを接続する接続管23と、を備えおり、接続管23を介して、陽圧タンク21からベンチュリー管22へ空気が流れるようになっている。また、接続管23には、上流側からエアーポンプ24、及びリリーフバルブ25が連結されている。そして、ベンチュリー管22の下流側の端部には、サイレンサー26が取り付けられている。
図4は分離装置の正面図である。同図に示すように、分離装置4は、円筒状の本体部41と、この本体部41の上端に設けられた排出部42と、本体部41の側面に設けられた吸引部43と、を備え、これらが一体的に形成されている。本体部41は、下端部が平坦な底面で構成され、上端部が上に凸の半球状に形成されており、上述した排出部42と吸引部43以外は閉じた内部空間40を有している。排出部42は、本体部41の上端から上方に突出する管状に形成されており、本体部41の内部空間40と外部と連通している。一方、吸引部43は本体部41の外周面に対して斜め下方に角度αで接続される管状に形成されており、本体部41の内部空間40と外部と連通している。
次に、上記のように構成された眼内手術システムを用いた白内障の手術方法について説明する。白内障手術は主として次の4つの工程からなる。すなわち、(1)前嚢切開、(2)水晶体乳化吸引、(3)皮質吸引および(4)眼内レンズ挿入の工程であるが、ここでは主として、工程(1)(2)について説明する。まず、工程(1)においては、粘弾性物質などで前房の形状を維持しながら前嚢を切開する。そして、工程(2)において、角膜や強膜に切開層をつくり前房内に破砕チップ12を挿入し、破砕チップ12の振動によって水晶体を破砕して乳化する。乳化された水晶体は、灌流液とともに破砕チップ12の先端開口から吸引され、ハンドピース内の排出流路を経てポート111から外部へ排出される。そして、このときの灌流液の流入量と吸引量とのバランスにより前房が安定に保たれる。
以上のように、本実施形態によれば、いわゆるベンチュリーポンプによりハンドピース1から排液タンク28へ灌流液を吸引しているため、灌流液の吸引を簡易に行うことができる。したがって、システムの低コスト化が可能になる。また、ハンドピース1と排液タンク28との間には、第1吸引管31、分離装置4、及び第2吸引管32が配置されており、第2吸引管32の内径を第1吸引管31の内径よりも小さくしているので、灌流液の吸引流量を小さくすることができる。その一方で、第1吸引管31の内径を大きくしているので、ハンドピース1から分離装置4までは、水晶体の核片を詰まらないように吸引することができる。そして、分離装置4においては、排出部42を吸引部43よりも上方に設けることで、吸引部43から内部空間40へ吸引された核片が、排出部42から第2吸引管32へ排出されないようにすることができる。したがって、核片が内径の小さい第2吸引管32へ流れるのを防止することができる。
以上、本発明の実施形態について説明したが、本発明は上記各実施形態に限定されるものではなく、その趣旨を逸脱しない限りにおいて、種々の変更が可能である。
(1) 吸引部は、本体部の外周面に対して水平または下方に向かって連結されていればよい(図5(a))。
(2) 吸引部が、本体部の外周面に対して接線方向に連結されていれば、核片は遠心力によって本体部の内部空間を螺旋状に下方に向かって進行する(図5(b):断面図)。したがって、本体部の下方に確実に沈んでいく。
(3) 本体部の外周面の径が下方に行くにしたがって小さくなるように形成され、その下端部に径が大きい貯留部を設けることができる(図5(c))。これにより、一旦下方に沈んだ核片が貯留部に入ると、貯留部の上部開口の径が小さいため、上昇しにくくなる。同様の形態として、図5(d)に示すような鼓型でもよい。
(4) 本体の形態は特には限定されず、円筒状のほか、多角柱状、正面視三角形状、正面視円形、正面視楕円形、正面視逆三角形状など、種々の形態にすることができる(図5(e)~(h))。
ここでは、図1~図4に示すような眼内手術システムによる灌流液の吸引を行った。システムの設定は以下の通りである。
・ベンチュリーポンプの吸引圧 300mmHg(陰圧)
・第1吸引管の内径 1.75mm
・第2吸引管の内径 0.1mm
・分離装置の内径 10mm
・分離装置の高さ 80mm
・分離装置における排出部の位置 本体部の上端
・分離装置における吸引部の位置 本体部の底面から40mm
・分離装置における吸引部の角度α 60度
21 陽圧タンク(空気圧送手段)
22 ベンチュリー管
221 絞り部
24 エアーポンプ(空気圧送手段)
28 排液タンク
31 第1吸引管
32 第2吸引管
4 分離装置
41 本体部
42 排出部
43 吸引部
Claims (7)
- 空気圧送手段と、
前記空気圧送手段から空気が供給されるベンチュリー管と、
前記ベンチュリー管の絞り部に接続される排液タンクと、
超音波振動により眼内の核を破砕するとともに、当該核を灌流液とともに排出する眼内手術装置と、
前記眼内手術装置から排出される灌流液が流れる第1吸引管と、
前記第1吸引管が接続され、当該第1吸引管から流入した灌流液から核を分離する分離装置と、
前記第1吸引管よりも内径が小さく、前記分離装置から排出される灌流液を前記排液タンクに供給する第2吸引管と、
を備え、
前記分離装置は、
内部空間を有する本体部と、
前記内部空間と連通し、前記第2吸引管が接続される排出部と、
前記排出部よりも下方において前記内部空間と連通し、前記第1吸引管が接続される吸引部と、
を備えている、眼内手術システム。 - 前記排出部は、前記本体部の上端部に設けられている、請求項1に記載の眼内手術システム。
- 前記吸引部は、鉛直方向に対して90度より小さい角度をなして下方に向って延びている、請求項1に記載の眼内手術システム。
- 前記内部空間は、鉛直方向に軸線を有する筒状に形成され、
前記吸引部は、前記内部空間の外周面の接線方向に沿うように設けられている、請求項1から3のいずれかに記載の眼内手術システム。 - 前記第1吸引管の内径が、0.9~3.0mmである、請求項1から4のいずれかに記載の眼内手術システム。
- 前記第2吸引管の内径を調整可能な調整機構をさらに備えている、請求項1から5のいずれかに記載の眼内手術システム。
- 空気圧送手段と、前記空気圧送手段から空気が供給されるベンチュリー管と、前記ベンチュリー管の絞り部に接続される排液タンクと、超音波振動により眼内の核を破砕するとともに、当該核を灌流液とともに排出する眼内手術装置と、前記眼内手術装置から排出される灌流液が流れる第1吸引管と、前記第1吸引管よりも内径が小さく、前記排液タンクに接続される第2吸引管と、を備えた眼内手術システムにおいて、前記第1吸引管と前記第2吸引管との間に連結される分離装置であって、
内部空間を有する本体部と、
前記内部空間と連通し、前記第2吸引管が接続される排出部と、
前記排出口よりも下方において前記内部空間と連通し、前記第1吸引管が接続される吸引部と、
を備えている、分離装置。
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