WO1990002536A1

WO1990002536A1 - Device for surgical removal of the nucleus lentis from the capsula lentis of an eye

Info

Publication number: WO1990002536A1
Application number: PCT/DE1989/000577
Authority: WO
Inventors: Leonhard Klein
Original assignee: Storz Instrument Gmbh
Priority date: 1988-09-06
Filing date: 1989-09-06
Publication date: 1990-03-22
Also published as: DE3830226A1

Abstract

The device has an excision implement in the form of a gripper driven back and forth which, in a closing movement of its jaws (24) penetrates into the nucleus lentis and transports material enclosed between the jaws to the opening region of a suction line (14). The opening and closing movement of the gripper is controlled by a low-friction slide mounted on the jaws (24). The slide moves in the suction line (14) between telescopic guide tubes (12) through which perfusion liquid flows at the same time.

Description

description

Device for the operative removal of the lens nucleus from the lens capsule of an eye

The invention relates to a device for the operative removal of the lens core from the lens capsule of an eye with a tool for mechanical removal of lens core material, which has an infusion line for the supply of an infusion liquid and a suction line through which removed lens core material can be sucked off in the liquid flow is.

The removal of the lens nucleus is part of the operative treatment of the cataract (cataracts). The lens core is replaced by an artificial lens (capsule sac lens) inserted into the lens capsule. A known device of the type mentioned has a removal tool in the form of a round body which is bevelled at the tip, which causes high-frequency vibrations by ultrasound and which the surgeon passes through an opening in the cornea and the lens capsule over the one to be removed

Replacement sheet Lentil core is guided. The lens core material is blown open in a scraping motion, whirled up and sucked off through the suction line. The simultaneous feeding of infusion liquid into the lens capsule ensures that there is always enough rinsing liquid available and that the anterior chamber maintains its mechanical configuration, that is, it does not collapse during suction.

When using the known device, one manages with a relatively small surgical opening in the cornea and the lens capsule. It is problematic, however, that ultrasound energy is introduced into the biological tissue, which can lead to damage at an undesired point, for example the retina. There is little certainty about the side effects and late effects of ultrasound treatment. It is also difficult to detect small loose particles (fragments or core residues), since these literally "dance" under the action of ultrasound in front of the tip of the removal tool and are pushed freely floating in front of it. The operator usually tries to detect the particles on a portion of the lens core or lens capsule which serves as an abutment, but this is accompanied by the risk of uncontrolled ultrasound radiation. The alternative is to enter the lens capsule while accepting a larger surgical opening with an auxiliary instrument acting as an abutment. Another surgical technique involves opening the lens capsule with a relatively large incision, expressing the lens nucleus and loosening it e.g. B. with tweezers. Then you drive into the lens capsule with a suction and rinsing device and remove core residues and bark. Disadvantages here are the large surgical opening and the high mechanical stress that is exerted on the suspension apparatus (cilar body with zonula fibers) when the lens core is pressed out. A small operation opening is desirable so that the statics of the anterior chamber with the suspension device are maintained. In addition, a small surgical opening is required for the further development of a new technique for restoring the natural lens, in which, after removal of the lens core, a plastic mass, in particular a silicone polymer, is introduced into the lens capsule and allowed to harden on the spot. The result is a new lens which fully corresponds in shape and size to the natural lens and is located exactly at its position in the natural hanging apparatus.

The object of the invention is to provide a device of the type mentioned, with which simple and effective removal of the lens core, including small fragments, by macromechanical action is possible with a very small operation opening.

Replacement fathers This object is achieved in such a device in that the removal tool is a gripper, which moves in a cyclical path movement away from and back to the mouth area of the suction line and one that preferably takes place in the mouth area of the suction line. Opening movement and a closing movement taking place at a distance from the mouth area of the suction line can be driven.

The gripper according to the invention has a very compact structure. It can be inserted into the lens capsule through a cut opening of approximately 4 mm in length and digs into the material of the lens core, which is quickly and effectively destroyed without problematic ultrasound radiation. Compared to the conventional ultrasound system, the operating time can be shortened. The forces occurring when the gripper closes act against each other and compensate each other so that the loads on the lens capsule and the suspension device are low. Small, freely floating fragments can also be easily gripped with the gripper. The path movement of the gripper brings the material held by it into the immediate mouth area of the suction line, where it is gripped by the suction flow and completely sucked off.

In a preferred design, the gripper is driven in a reciprocating longitudinal movement from which its opening and closing movement is derived. It will be one Gripper working in a confined space with an uncomplicated and robust movement mechanism.

The gripper preferably works with a clock frequency of approximately 1.1 Hz (1 / s). A rapid destruction of the lens core is thus achieved, during which the surgeon can easily follow the gripper's work visually and control it well.

To drive the gripper, an electric motor, in particular a gear motor, an electromagnetic linear drive z. B. in the form of a moving coil drive, etc. serve. However, a pneumatic drive of the gripper is preferred, which enables simple cleaning and sterilization and is completely safe from a safety point of view with simple cable routing.

The gripper preferably has at least a pair of symmetrically arranged jaws which can be moved synchronously with one another when the grief is closed. The jaws of a pair of jaws work against each other when they are closed, so that the forces exerted on the detected material are compensated for and only slight mechanical loads occur on the lens capsule and the suspension device.

The jaws are preferably resilient and biased into one of the gripper positions, in particular the gripper closed position, by their inherent elasticity. The movement mechanics for - υ -

the gripper is therefore inexpensive to set up. The jaws can in particular consist of spring wires, preferably flat wires, curved towards one another.

In a preferred embodiment, the drive for the reciprocating longitudinal movement goes directly onto the jaws. These are acted upon by a slider which is carried along in a friction-inhibited manner and can be adjusted in the longitudinal direction with limited stops and which controls the opening and closing movement of the jaws.

A stop arrangement can be provided with which the stroke of the slide can be predetermined. You can influence the working stroke of the jaws so that they reach more or less far in adaptation to the respective operating conditions. An uncomplicated, user-friendly and sufficiently variable stop arrangement consists of two fixed stops limiting the stroke of the slide at both ends and an adjustment stop which can be brought into the path of the slide in between.

The slide is preferably a tube slide with two parallel slide tubes drawn onto the jaws. This design is characterized by high guidance accuracy.

The jaws can be pulled back into the slide tubes by the force of a spring against which the drive works

Replacement Biatt Position biased. The fine tips of the jaws are thus optimally protected against damage in the rest position.

In a preferred design, the device according to the invention has two parallel guide tubes which form a telescopic guide for the slide tubes accommodated therein. This ensures precise guidance of the tube slide valve, which benefits the good manageability and operational reliability of the device according to the invention.

The gripper outlet end of the guide tubes preferably forms a cutting edge on which the material gripped by the jaws is crushed in the gripper return stroke. The suctioning of relatively large fragments detached with the gripper thus also presents no difficulties.

The guide tubes and possibly also the slide tubes can also serve as an infusion line and thus advantageously perform a double function. The suction line is preferably provided in a parallel arrangement between the guide tubes. A triplet tube arrangement is particularly recommended, in which the guide tubes and the suction line lie directly adjacent to one another in one plane and end on the gripper outlet side at the same height. This treble tube arrangement allows a wide

He "- ^" • l-itsoiaf working liquid-tight on the eye. When using a regulated suction and irrigation system, the collapse of the anterior chamber of the eye is definitely prevented.

The suction line can be slotted on the gripper outlet side or can be designed in such a way that the jaws can enter it. In this way, the material gripped by the gripper is literally drawn into the suction line, being rubbed against the cutting-like edges of the guide tubes and fully entering the suction flow.

The suction line is preferably continuously straight and accessible at its end facing away from the gripper for connection and cleaning purposes. This avoids bends and constrictions in the suction line where blockages could occur, and facilitates cleaning of the device, for which a needle can be pushed through the suction line if necessary.

The invention is explained below with reference to an embodiment shown in the drawing. Show it:

1 shows the schematic longitudinal section through a device according to the invention for the operative removal of the lens core with a gripper, which is shown in two optionally available maximum extension divisions; 2 shows the basic body of the device;

3 shows a claw slide as an individual part of the gripper;

Fig. 4 as a further item of the gripper a pipe slide; and FIGS. 5 to 9 simplified representations of the device in successive stages of operation.

The device shown in the drawings has a basic body with a circular cylindrical closed housing 10 and three tubes 12, 14 protruding from it in a parallel arrangement on the front side, which lie directly adjacent to one another in a plane, have the same diameter (approx. 0.9 mm) and end at the same height. The two outer tubes serve as guide tubes 12 for a gripper and at the same time as an infusion line for feeding an infusion liquid which is supplied via a connection 16 on the rear side 18 of the housing facing away from the triplet tube configuration. The inside of the housing 10 forms a chamber 20 filled with infusion liquid. The guide tubes 12 protrude a little into the housing 10, and they are cut open near the end of the casing, so that infusion liquid can enter the guide tubes 12 laterally from the outside. The middle tube 14 belongs to a continuously straight suction line 14 which passes through the housing 10 in a sealed manner and has a suction connection 22 on the rear side 18 of the housing. The gripper includes a tubular slide valve 30 and a claw slide valve 32, both of which are guided so as to be longitudinally displaceable in the guide tubes 12. The claw slide 32 has a drive plate 26 contained in the housing 10 and drawn onto the suction line 14 with a central bore 34. Two parallel guide pins 36 protrude from this on one end face, at the ends of which jaws 24 made of resilient flat steel, which are thinner than the guide pins 36, attach in axial extension. Guide pins 36 and jaws 24 fit into the guide tubes 12 with play, from which the ends of the jaws 24 facing away from the drive plate 26 can move out. These ends are curved towards one another in a symmetrical arrangement and are biased by the inherent elasticity of the jaws 24 into a closed position in which they touch on the central axis of the suction line 14 before its mouth. The jaws 24 can be moved into the guide tubes 12 with elastic spreading.

On the end face of the drive plate 26 facing away from the jaws 24, there is a lifting rod 38 which extends parallel to the guide pins 36 and is guided out of the housing 10 in a sealed manner with play. A pneumatic working cylinder 28, which is attached to the outside of the housing 10, acts on the lifting rod 38, through which the claw slide 32 moves in a reciprocating linear movement parallel to the longitudinal axis of the - left -

Jaws 24 is driven. A typical work cycle is 1 Hz (1 / s). The lifting rod 38 can be operatively connected to a spring, not shown, which biases the jaws 24 into a rest position in which they are fully retracted into the guide tubes 12.

The tube slide 30 controlling the jaw spreading movement has two parallel, telescopically guided slide tubes 46 which are accommodated in the guide tubes 12 with play. These are penetrated by the jaws 24. The slide tubes 46 have an identical length, which essentially corresponds to that of the straight part of the jaws 24. They are connected in the rear end region by a slide plate 48 which is drawn onto the suction line 14 with a central bore 40 and is seated in the housing 10 between the ends of the guide tubes 12 and the drive plate 26. The slide plate 48 is penetrated by the slide tubes 46. The latter are cut adjacent to the slide plate 48 over a length corresponding to the stroke of the tube slide 30 (not shown in detail in FIG. 1), so that irrespective of the tube slide position, infusion liquid via the jacket opening of the guide tubes 12 laterally from the outside can enter the slide tubes 46 and flow to their front end. The slide tubes 46 and guide tubes 12 thus also serve as infusion lines. The slide plate 48 cooperates with a stop arrangement to which a front fixed end stop 50, a

Replacement sheet include a fixed end stop 52 and an adjustable stop 54 which can be inserted between them. If the latter is not placed in the path of the slide plate 48, the tubular slide 30 moves in the drive direction of the jaws 24 over the stroke predetermined by the end stops 50, 52. If, on the other hand, the adjustment stop 54 is brought into the path of the slide plate 48, the movement of the tube slide 30 is limited to the distance between the rear end stop 52 and the adjustment stop 54. Regardless of where the adjustment stop 54 is located, the stroke of the tube slide 30 is shorter on both sides than the drive stroke of the claw slide 32.

The slide tubes 46 are frictionally mounted on the guide pin 36 of the claw slide 32. The friction ratios are selected so that the tubular slide 30 adheres to the claw slide 32 and is carried along with its frictional movement when it is driven until it is held in place by the stop arrangement. When the tubular slide valve 30 assumes its front stop position at the end stop 50 or the adjustable stop 54, the ends of the jaws 24 curved toward one another extend in the further forward stroke out of the slide tubes 46 and spring towards one another, so that the gripper closes. When the tube slide 30 strikes the rear end stop 52, the further return stroke of the claw slide 32 results in the jaws 24 being deformed elastically

He ^β af and spread into the slide tubes 46, where they assume an approximately extended position.

In the stop position of the slide plate 48 at the front end stop 50, the slide tubes 46 protrude slightly from the guide tubes 12. In the stop position on the adjustment stop 54, however, their ends lie flush with the ends of the guide tube 12 or are sunk a short distance into the guide tubes 12. With the adjustment stop 54, the distance by which the jaws 24 reach forward and dig into the lens core material is varied, namely by the stroke difference of the tubular slide valve between the adjustment stop 54 and the front end stop 50. For a quick and effective destruction _. of the lens core, the tube slider 30 is allowed to work between the end stops 50, 52. The adjustment stop 54 is effective for operational fine work, critical points, etc.

The suction line 14 is provided at the end with two longitudinal slots 56 diametrically opposite one another in the plane of the triplet tube configuration, and corresponding longitudinal slots 58 are also provided in the wall of the guide tubes 12 adjacent to the suction line 14. When moving back, the gripper remains closed until the pipe slide 30 strikes the rear end flange 52. Then the front ends of the slide tubes 46 stand at the inner edge of the slots 56, 58. The jaws

^ rsalzbiatt 24 move in the return stroke with the gripper still closed in the slots 56, 58. Detected lens core material is thus transported into the suction line 14 when the gripper is closed, so that it reaches the suction flow fully, and is thereby ground on the edge of the tubes 12, 14 which acts as a cutting edge.

5 to 9, for the sake of clarity, the adjustment stop 54 is omitted and only the effect of the end stops 50, 52 is illustrated. Fig. 5 shows the rest position which the device assumes when there is no pneumatic operating pressure. The claw slide 32 is retracted to a suitable stop 42 to the maximum. The slide plate 48 bears against the rear end stop 52. The slide tubes 46 are thus retracted as far as possible in the guide tubes 12, and the jaws 24 are completely stretched and sunk completely into the slide tubes 46.

When the working cylinder 28 is pressurized, the forward stroke of the gripper begins (cf. FIG. 6). The claw slide 32 is moved toward the free end of the triplet tube configuration. The tube slider 30, which is friction-locked on the claw slide 32, continues this movement until it reaches the front end stop 50. The slide tubes 46, in which the jaws 24 are still sunk, then protrude slightly from the guide tubes 12.

Ξrsstzbiaft In the further forward stroke of the claw slide 32 (cf. FIG. 7), the tubular slide 30 hangs on the front end stop 50. The ends of the jaws 24 extend from the slide tubes 46 and they spring towards one another due to their pre-curvature, so that the gripper closes. He captures lenticular nucleus

_* Material, thanks to the movement of the jaws 24 towards each other only slight forces are exerted on the lens capsule and the suspension device of the lens. The gripper can literally dig into the soft material of the lens core, but it can also target small, freely floating fragments.

At the end of the forward stroke, the drive plate 26 bears against the slide plate 48, which is intercepted at the front end stop 50. A return stroke then begins when the gripper is closed, during which the pipe slide 30 is carried along by the claw slide 32 until it reaches its rear end stop 52 (cf. FIG. 8). The curved ends of the still closed jaws 24 then lie in the longitudinal slots 56, 58 of the tubes 12, 14, and the detected lens core material is ground at the ends of the tubes 12, 14 and literally drawn into the suction line 14.

In the further return stroke (cf. FIG. 9), the pipe slide 30 remains caught on the rear end stop 52. The claw slide 32 moves back to the starting position (cf. FIG. 5)

Replacement sheet the jaws 24 are pulled into the slide tubes 46 and are straightened with elastic deformation in preparation for the next forward stroke.

In connection with the technique for restoring the natural lens mentioned in the introduction, in which a plastic mass is introduced into the cleared lens capsule and allowed to harden on the spot, a function of the device according to the invention as an injection tool can also be considered. The highly viscous plastic mass can be injected into the lens capsule through the middle tube previously referred to as suction line 14 and the gripper can be used to cut off the strand after the plastic mass has hardened.

ErGd zblatt

Claims

Expectations

1. Device for the operative removal of the lens core from the lens capsule of an eye with a tool for mechanical removal of lens core material, which has an infusion line for the supply of an infusion liquid and a suction line through which removed lens core material can be sucked off in the liquid flow that the removal tool is a gripper that moves in a cyclical path movement back and forth from the mouth area of the suction line (14) and there is an opening movement that preferably takes place in the mouth area of the suction line (14) and a distance from the mouth area of the suction line ( 14) ^• constricting closing movement successes drivable.

Spare baffle

2. Device according to claim 1, characterized gekennzeichet. that the gripper is driven in a reciprocating longitudinal movement and its opening and closing movement is derived from this driven longitudinal movement.

3. Apparatus according to claim 1 or 2, characterized gekennzeich¬ net that the gripper is driven at a clock frequency of about 1 Hz (1 / s).

4. Device according to one of claims 1 to 3, characterized by a pneumatic drive of the gripper.

5. Device according to one of claims 1 to 4, characterized ge indicates that the gripper has at least one pair of symmetrically arranged, when the gripper closes synchronously to each other movable jaws (24).

6. Device according to one of claims 1 to 5, characterized ge indicates that the jaws (24) are resilient and preferably biased into the gripper closed position by their inherent elasticity.

7. Device according to one of claims 1 to 6, characterized in that the jaws (24) consist of wires which are curved towards one another, preferably flat wires.

8. Device according to one of claims 1 to 7, characterized ge indicates that the drive for the reciprocating longitudinal movement on the jaws (24), which are acted upon by a friction-inhibited, stop-limited adjustable in the longitudinal direction adjustable slide, which controls the opening and shooting movement of the jaws (24).

9. Device according to one of claims 1 to 8, characterized by a stop arrangement with which the stroke of the slide can be variably predetermined.

10. Device according to one of claims 1 to 9, characterized ge indicates that the stop arrangement consists of the stroke of the slide at both ends limiting fixed stops (50, 52) and at least one adjustable stop (54) which can be brought into the path of the slide.

11. Device according to one of claims 1 to 10, characterized in that the slide is a tubular slide (30) with two parallel slide tubes (46) mounted on the jaws (24).

12. The device according to one of claims 1 to 11, characterized in that the jaws (24) are biased by the force of a spring against which the drive works, in a retracted position in the slide tubes (46).

Replacement sheet

13. Device according to one of claims 1 to 12, characterized in that it has two parallel guide tubes (12) which form a telescopic guide for the slide tubes (46) accommodated therein.

4

14. Device according to one of claims 1 to 13, characterized in that the gripper outlet end of the guide tubes (12) forms a cutting edge.

15. Device according to one of claims 1 to 14, characterized in that at least one and preferably both guide tubes (12) and optionally also one and preferably both slide tubes (46) serve as an infusion line.

16. Device according to one of claims 1 to 15, characterized in that the suction line (14) is provided in a parallel arrangement between the guide tubes (12), preferably the guide tubes (12) and the suction line have substantially the same diameter, directly against each other lie adjacent to one level and end at the same height on the gripper outlet side.

17. The device according to one of claims 1 to 16, characterized in that the suction line (14) and given if the guide tubes (12) are also slotted (56, 58) on the gripper outlet side or are designed in another way in such a way that the jaws (24) can enter them closed.

18. Device according to one of claims 1 to 17, characterized in that the suction line (14) is continuously straight and accessible at its end facing away from the gripper.

REPLACEMENT LEAF