US2480737A - Cutting instrument particularly useful in connection with corneal grafting - Google Patents

Description

Filed March 8, 1948 CUTTING INSTRUMENT PARTICULARLY 'USEFUL. IN

Aug. 30,1 949- .GJE AN-EDWARb JAYLE 7 CONNECTION WITH CORNEAL GRAFTING ZShets-Sheet 1 INVENTOR.

C BJyEAU-EOUARD JAYLE ATTORNEIT G..JEAN-EDWARD JAYLE CUTTING INSTRUMENT PARTICULARLYUSEFUL IN Aug. 30, 1949.

CONNECTION WITH CORNEAL GRAFTING 2 sheets sheet 2 Filed March 8, 1948 IIIVVENTORJ- 6.- Jeml- EooAzo J M:

Patented Aug. 30, 1949 CUTTING INSTRUMENT PARTICULARLY.v USEFUL IN CONNECTION WITH COR NEAL GRAFTING Gatan J can-Edward Jayle, New York, N. Y.-

Application March s, 1948, Serial No. 13,624

This invention relates to a cutting instrument particularly useful in connection with corneal grafting, and to apparatus for the treatment of ocular and other conditions generally.

The principal object of this invention is the provision of a cutting instrument of the character described which is adapted to cut the cornea obliquely in such manner that the anterior end of the cornea aperture is smaller than the posterior end. Conventional cutting instruments used in corneal grafting are provided with cylindrical cutting heads and they are, therefore, adapted to remove a cylindrically shaped portion of the cornea preparatory to the grafting operation. The instrument herein claimed, however, is adapted to cut obliquely into the tissue to remove a section thereof which has the shape of a truncated cone. The advantages inherent in such oblique cutting are very substantial. Since the corneal graft or transplant will be of the same shape as the aperture which is cut in the cornea, and since the anterior ends both of the hole and of the graft are smaller than their respective posterior ends, once the graft is properly inserted into'the hole, it will resist outward displacement therefrom'. This is especially important when the anterior chamber refills with fluid and the fluid pressure against the graft tends to push it out of the corneal hole. Another substantial advantage in cutting the cornea obliquely is the provision of a larger contact area or surface between the graft and the wall of the corneal hole. The greater this contact area, the more surely will the transplant become nourished by and united with the corneal tissue remaining in the eye, thereby insuring positive adhesion and growth.

Another object of this invention is the provision of a pressure chamber usable in connection with the cutting instrument herein claimed to prevent collapse of the eye during the course of and by reason of the surgical operation and to enable the cutting instrument to cut completely through the cornea without injury to the iris or lens many other tissue which lies immediately adjacent the cornea or the anterior chamber. In corneal grafting and other similar surgical operations, a trepan or trephine is used to cut partly through the cornea and another cutting instrument such as a pair of scissors must be used to complete the cutting operation. These two steps are generally found necessary to avoid injury to the tissue behind the cornea when the eye collapses.

In the present invention, .however, a pressure 10 Claims. (Cl. 128'305) chamber is provided to prevent escape of the fiuid from' the corneal chamber durin the process of cutting and removing the diseased portion of the cornea. It is, therefore, possible, using this pressure chamber, to out completely through the cornea without injury to other tissue of the eye since the cornea remains spaced from the iris and the lens at all times during the cutting operation.

The pressure chamber may also be used for post-operative Work as for treating of the eye or eyes to promote healing, etc. In such case, the implement is removed from the pressure chamber and the opening is closed by a screw plug, not shown. Pressure may then be applied to maintain the graft in place until knitting of the tissue has occurred. Also, if desired, liquid or gas may be introduced for stimulating healing and fo-rantibiotic andantiseptic purposes.

It will be understood that although the invention is herein described in connection with corneal graftingoperations, it is also suitable for use in connection with surgical operations of other types, especially relating to the eye, but not necessarily, so. I It will further be understood that although the invention is herein described relative to surgical operations and to living tissue, it

may be adapted to other cutting operations and in connection with matter and material other than living tissue.

It will also be understood that the mask or pressure chamber may be used for other medical and physiological purposes where it is desired to use pressure with gas or liquid heating or nutritive strument, showing the means by which its effective or operative height may be adjusted.

Fig. 3 is an enlarged fragmentary view of the cutting head of the instrument, showing it in vertical section.

Fig. 4 is a horizontal section therethrough, on the line 4-4 of Fig. 3. I

Fig. 5 is a fragmentary detailed view in verticalsection of the blade or knife holder and of sired to'prevent relative movement between said member and the housing A-cam-shaped lever I6 'pivoted'on I1 and having a handle I8 is provided in housing 22 to engage theloweriend of piston-like member 01 to move said member upwardly against the action of spring 68 -or to release said member for downward movement in response to the action-of said spring. -It has been indicated that rod 63is adapted to rotate within bearing 66 of piston-like member 61, but it will be understood that axial, movement ofsaid rod relative to said piston-like member will be prevented by reason of the clamping action which exists between shoulder'I9 and nut 80 at the upper end of rod 63 on'the one hand, and the inner rows of bearing 66 on the other hand. Hence, vertical movement of the piston-like member 61 will be productive of corresponding vertical movement of rod 63.

It has been stated that rod 03 is provided with gear teeth at its lower end and that it therefore constitutes the rack gear which engages pinion 62. Since the pinion also engages rack gear teeth of cutter 3|; a downward movement of rod 63 will c'ausean upward movement of the cutter andan upward movement of the rod will-cause a downward movement of the cutter. -A leaf spring BI is provided to hold the rack gear teeth of the cutter in engagement with the teeth of pinion 62.

' When it is desired therefore to move the cutter downwardly along its longitudinal axis,'handle' I8 should be depressed, thereby causing cam lever IE to force the piston-like member 6'! to move upwardly against the action of spring 60 and to carry rod 63 upwardly simultaneously therewith. The upwardmovement of said rod 63 will, therefore, cause the cutter to move downwardly. When it'is desired to raise the cutter, handle 16 should be released to the desired extent, thereby permitting spring 68 to lower piston-like member 61 and rod 63. The downward movement of the rod will of course produce an upward movement of the cutting member. It will be understood that no conflict arises'between the vertical movement of rod 63 and the axial movement of cutter 31 on the one hand, and the rotary movement of driveshaft 29 and cutter holder 30 on the other hand. Rod 63 rotates integrally with the drive shaft and with the cutter holder 30, and hence it remains in uninterrupted engagement with pinion 82, and said pinion remains in uninterrupted engagement with the teeth of the cutting member SI. Angular movement of the cutter about the axis of the drive shaft may, therefore, be had simultaneously with axial movement either upwardly or downwardly of said cutter. It should be understood at this point that spring 53 is supplied to provide a smoother axial movement of the cutter in response to the actuation of cam lever 16 and to prevent back lash in the rack and pinion connection above described.

The cutting angle of the cutter is substantially fixed in the form of invention shown in Fig. 3. If it be desired to vary the cutting angle within the limitations imposed by the construction of the cutting head as shown in Fig. 3jof the drawing, then a plurality of cutters such as cutter 90 should be provided in place of or inaddition to cutter 3 I. C-utters 90 diffe from cutter 3I solely in the width of the shank where rack gear teeth 9| are provided. Cutters 90 are provided with varying shank thicknesses to increase or lessen the distance between the longitudinal axis of the cutter and the central axis of the pinion which therack gear teeth of the cutter engage. Since cutter 90 is pivotally mounted in its holder, these varying distances between the longitudinal axis of the cutter and the central axis of the pinion will make for correspondingly difierent cutting angles which the cutter will present to the tissue, and also allow for varying the diameter of the hole which can be cut.

It will be noted in Figs. 3 and 5 that the cutting member 3I extends diagonally across the longitudinal axis of drive shaft 29. It is this arrangement that. enables the'cutter to cut a cone-shaped or truncated cone-shaped hole, the smaller diameter of the hole being at its outer end and its larger diameter being at its inner end. Should it be desired to produce a hole of cone or truncated cone shape whose larger diameter is at its outer end and whose smaller diameter is at its inner end, the cutter should :be so positioned in its hole 60 that its cutting blade does not extend across the longitudinal axis of drive shaft 29. The cutter would still remain positioned an acute angle removed from longitudinal'axis of drive shaft 29.

The pressure chamber above referred to is shown in Fig. '7 and'in slightly modified form in Fig. 8. In Fig. 7, it will be seen that a transparent tubular member I09 is screwed to the lower'end of housing IOI which corresponds to housing 22 above described. A suction ring I03 or a sealing ring of any suitable material is fastened to the lower end of tubular member' I00, and it will be noted that said ring is adapted for engagement with the eyeball I 04 to provide an airand liquidtight closure therewith. Contained in said tubular member'IGEl is a'suitable liquid I05 which is non-injurious to the tissue of the eye. Suitable means are employed to provide a greater pressure in fluid I05 than normally exists in the fluid in the anterior chamber I040. of the eye. Hence, it is possible, using; this device, to out completely through the cornea I04b and yet to prevent escape of the fluid from the anterior chamber I04a. It is clear, therefore, that the use of this device prevents collapse of the eye during the course of the operation and permits of cutting completely through the cornea without danger of injuring the tissue behind it.

It hasbe'en'stated that tubular member I00 is made of transparent material, the reason being that it must serve as a window in addition to serving as a pressure chamber to enable the surgeon to see what he is doing. To prevent or at least reduce refraction, a conical portion I05 is' provided in the wall of member I00. The radial lines'of said conical 'wall portion I06 extend substantially at right angles across the line of vision from the eye of the surgeon to the eye of the patient, thereby enabling the surgeon to see the cutting operation very clearly and to enable him to control it as well as is humanly possible. i

In Fig. 8 the cup-shaped member IIO corresponds to the tubular member I09 of Fig. 7. It is much larger, however, and its suction ring III is scriptive solely of a preferred form or preferred 1 terms or this-inventions dthatmodifications and var-iationsmay be incorporated therein within the broad principles of the invention,

Having thus described my invention, what I claim new and: desire tic-secure by Letters Pate out, is:

1, A cutting instrument of the character de scribed, comprising a motor: driven "drive shaft and a cutting member connected to said drive shaft for rotation therewith, said. cutting. member being mounted at an: acute angle relative to the longitudinal axis of said drive shaft and extending across. said longitudinal axis,

22 A cutting device or the character described, comprising a rotatable drive shaft, means con:- n'ectedto-said drive shaftcausi-ng said drive shaft torotate, and a cutter mounted on said drive shaft and. movable integrally'therewith, said cut ter being mounted at an acute angle relative: to the longitudinal axis of the drive shaft and ex tending across said: longitudinal axis.

3. cutting device-of the character described, comprising 'a. motor-driven, rotatabiy mounted drive shaft, acuttcr mounted: on said drive shaft at its free endandapositioned thereon at an acute angle relative to the longitudinal axis of said drive shaftiandextending across said longitudinal axis, said cutter being, rotatable with said drive shaft and being also movable longitudinally 'of itself and across the longitudinal axis of the drlveishaft; and con'trolmeans for controlling said longitudinal movement of the cutter.

ii; A: cutting device of the character described; comprisinga rotatably mounted motor-driven drive shaft, a cutter holder mounted at the free end of said: drive shaft and rotatable integrally therewith, a cutter mounted in said holder and extending across the longitudinal axis ofsaid drive shaft, said cutter being movable longituidinally of itself, and control means geared to said cutter for causing longitudinal movement thereof at-the same time-that saidcutter rotates with the drive shaft 7 V V A cutting device of the character described, comprising a :rotatably mounted motor-driven hollow drive shaft, aicutter holder mounted at the free end of said drive shaft, a cutter mounted in said holder at an acute angle relativetmthalom gitudinal axis of the drive shaft and extending across said longitudinal axis, said cutter being movable longitudinally of itself, gear teeth pro:- vided on saidcutter, a pinion provided in said holder in. engagement with-the cutter gear teeth, a rack gear extending through the hollow drive shaft, and-control-means for-controllingsaidr-ack gear being fixed against angular. movement. relative to said drive shaft but. being free to move longitudinally thereof, and control means for controlling the longitudinal movement of said rack gear to effect longitudinal movement of the cutter through thepinion connection therewith.

6.. A cutting device of thecharacter described, comprising a rotatably mounted motor-driven hollow. drive shaft having a. cutter holder at its free end, said cutter holder having a. cutter mountedtherein atanaculie angle relative to the longitudinal axis of the drive shaft, said-cute ter being movable longitudinally of, itself across said longitudinal aidsof' the drive shaft, rack and pinion means in the holder and connected to the cutter for causing longitudinalmovement or said edited. and' a control. member connected dee -rev to said-rack and pinion means throughthehollow drive shaft, said controlmembcrloeing movable longitudinallyof said drive shaft to control the rack and pinion means and thereby to control the longitudinal movement of the cutter, said control l'nember being integrally rotatable with the drive shaft, tension means urging the control member to'move'in one direction longitudinal thereot and lever means connected to said control member for causing said control member to movein the opposite longitudinal direction against the action ofthe tension means.

'7'.v A cutting device of the character described; comprising a rotatably mounted motor driven hollowshai-hxa cutter holder mounted at the-free endof said shai t, a cutter mounted in said holder for-integral rotary movement therewith; said cut terbeing also adapted for movement longitudi nally of itself relative to said holder, said cutter being: positioned at an acute angle relative to the" longitudinal axis of the drive shaftand eX tending across said longitudinal axis, rack gear teeth provided'at the'non cutting end or the cut-- ter, a pinion engaging said teeth mounted in said holder, anda rack gear engaging said pinion to control the longitudinal movement of said out"- ter, said rack gear extending through the hollow shaft and rotatable integrally therewith, said rack gear being also movable longitudinally of itself in said hollow drive shaft and being pro vided with tension means tending to urge it to move longitudinally of itself in one direction, and lever control means operativelyconnected tosaid rack gear for causing its movement in the opposite longitudinal direction against the action of the tension means.

8. A cutting device in accordancewithclaim'l', inwhic-h'the angular distance separating the cut tenfrom the longitudinal axis 'ofthe drive-shaft is determined by the width of the cutter at its rack teeth end, said cutter being pivotally mounted in said holder on an axis which intersects its own longitudinal axis. at right angles .open-tothe eye of the patient and being provided with a suction ring to provide a liquid-tightand air-tight closure therewith, and means maintainingthe liquid in said member underpress-ure, said member being provided with a transparent wall'through which the surgeon may witness and control. the cutting operation.

10. In. a cutting device of the character described, a cutting element, a fluid-containing member surrounding said cutting element and open to the eye or the patient, a suction ring provided on said liquid-containing member to provide a liquid-tight and airtight closure between said member and the area surrounding the operative region or the .patients eye, and means maintaining the liquid in said member under pressure greater than the pressure of the fluid No references cited.

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