JP5980218B2 - Intraocular lens insertion device - Google Patents

Description

  The present invention relates to an intraocular lens insertion device that is provided with a built-in intraocular lens and is used to insert the built-in intraocular lens into the eye.

  Conventionally, in surgery such as cataract, after removing the lens in the capsule through the incision provided in the eye tissue such as cornea (capsular) and anterior lens capsule part, removing the intraocular lens to replace the lens, A technique is adopted in which the incision is inserted into the eye and placed in the sac.

  Particularly in recent years, a technique using an intraocular lens insertion tool as described in Patent Document 1 has been widely adopted. In general, a push-out member that is inserted into the eye through the incision through the incision at the distal end of the insertion tube provided at the distal end of the tubular instrument body, The intraocular lens is inserted into the eye by deforming the intraocular lens housed in the mounting portion into a small shape and pushing it out from the distal end opening of the insertion tube portion. With such an insertion device, it is possible to insert an intraocular lens without expanding the incision formed for the removal of the crystalline lens, so that the labor required for the operation can be reduced, as well as the occurrence of postoperative astigmatism and infection. Risk can also be reduced.

  By the way, as such an intraocular lens insertion device, an intraocular lens that is provided separately from the intraocular lens and is used by setting an intraocular lens that is separately packed at the time of treatment to the insertion device is used. Some are provided with built-in. In a so-called preset type intraocular lens insertion device provided with a built-in intraocular lens, the intraocular lens is sterilized and packed and stored until use.

  Therefore, various mechanisms have been proposed for stably holding the intraocular lens so that the intraocular lens stored for a long time in the insertion device is not deformed or damaged. For example, the applicant of the present application previously disclosed in Japanese Patent Application Laid-Open No. 2009-160140 (Patent Document 1), which protrudes from the placement portion of the intraocular lens and positions and holds the peripheral portion of the intraocular lens on the placement portion. A structure was proposed in which the holding members were assembled in a removable manner. According to such an insertion instrument, it is avoided that the optical part of the intraocular lens is in close contact with the inner surface of the instrument main body such as the placement part over a wide range, thereby advantageously preventing the occurrence of deformation over time. be able to. In addition, at the time of surgery, the intraocular lens can be positioned and placed on the placement portion by removing the holding member from the placement portion, so that the intraocular lens can be deformed into a desired shape and inserted into the patient's sac. It is.

  However, even when the intraocular lens is held by the holding member to prevent the occurrence of deformation at the time, it is difficult to completely stabilize the behavior of the intraocular lens when the intraocular lens is inserted into the patient's sac. was there. That is, in the so-called one-piece type intraocular lens in which the optical part and a pair of support parts extending on both sides of the optical part are integrally formed of a soft synthetic resin material, the support part is hard due to the influence of room temperature or the like. Is easy to change. Then, when the intraocular lens is deformed small toward the insertion tube part by the pushing member, the posture of the support part is not stable, and when the intraocular lens is released from the insertion tube part into the capsule, the intraocular lens There was a possibility that the behavior of the garment would change.

  In order to cope with such a problem, the applicant of the present application previously described in International Patent Publication No. WO2010 / 064275 (Patent Document 2), provided with a protruding portion at an appropriate position of the insertion tube portion, the optical portion of the intraocular lens is located upward. A structure has been proposed in which a so-called tacking state is developed in which a front support portion located in front of the extrusion direction is inserted into the optical portion so as to be deformed into a mountain-fold shape that is convex on the lens front surface. As a result, the posture of the support portion on the front end side of the intraocular lens can be stabilized, and the behavior of the intraocular lens in the sac can be stabilized with high accuracy.

  In addition, it is possible to further stabilize the behavior of the intraocular lens in the sac by stabilizing the posture at the time of being pushed out by the pushing member with respect to the posterior support part located behind the pushing direction of the intraocular lens. Conceivable. However, since the rear support part extends on the path of the pushing member on the rear side of the optical part, there is a problem that it is difficult to provide a projection or the like for regulating the posture of the rear support part at such a part. there were. In addition to the holding member that holds the intraocular lens, it may be possible to provide a detachable protrusion that regulates the posture of the rear support part of the intraocular lens. However, due to the increase in the number of parts that need to be removed, Since the operation of the insertion tool becomes complicated and complicated, it was not practical. Further, when the holding member is removed and the fixation of the intraocular lens is released, and the pushing member pushes the rear support part forward, the contact position between the pushing member and the rear support part changes as the lens moves or rotates. There is a problem that the posture of the rear support portion cannot be controlled to be constant.

JP 2009-160140 A International Patent Publication No. WO2010 / 064275

  The present invention has been made in the background as described above, and the problem to be solved is to maintain the stability of the intraocular lens for a long period of time and to control the posture of the rear support part of the intraocular lens. An object of the present invention is to provide an intraocular lens insertion device having a novel structure that can be realized with a simple structure and simple operation.

  As a result of intensive studies in order to solve the above-described problems, the present inventors have superimposed the rear support portion of the intraocular lens on the front surface side (the upper surface side on the mounting surface) of the optical portion. It is possible to smoothly push out the intraocular lens from the insertion tube part and to quickly release the close contact between the optical part and the support part and to stabilize the behavior of the intraocular lens in the sac. I found something to do. In addition, the rear support part of the intraocular lens is deformed so as to overlap the rear surface side (the lower surface side on the mounting surface) of the optical part, so that the rear support part is inserted between the optical parts deformed in a mountain shape. This makes it possible to stabilize the posture of the rear support part during movement in the instrument body, prevent the occurrence of damage such as cracks in the rear support part, and when pushed into the sac It has also been found that the behavior of the intraocular lens is stable. Since these two patterns have their respective characteristics, a method for controlling one of them with good reproducibility is required. Thus, the present inventors have completed the present invention based on such new knowledge.

  That is, the first aspect of the present invention is a cylindrical instrument body provided with a placement portion on which an intraocular lens having an optical portion and a pair of support portions extending from both sides of the optical portion is placed; A holding member that is inserted from the rear end of the instrument body and pushes out the intraocular lens to an insertion tube part provided at the distal end of the instrument body, while protruding and assembled to the mounting part. Intraocular provided by the member in a state where the intraocular lens is positioned and held on the mounting portion so that the pair of support portions of the intraocular lens extend to the front end side and the rear end side of the instrument body. In the lens insertion device, the holding member is provided with a movable portion that is slidable from the rear end side to the front end side of the holding member in a state of being engaged with the push-out member, and the movable portion slides. When positioned on the rear end side of the direction, the holding member is While the movable body cannot be detached from the tool body, the support portion positioned behind the intraocular lens by the distal end portion of the pushing member is moved to the optical portion side by moving the movable portion to the distal end side in the sliding direction. And the holding member including the movable part is detachable from the instrument body, and the rear support part is moved to the optical part side when the rear support part is deformed to the optical part side. It is an object of the present invention to provide an insertion device for an intraocular lens, characterized in that a guide portion for guiding the front side or the rear side is provided.

  In the intraocular lens insertion device structured according to this aspect, the movable member is provided on the mounting member for positioning and holding the intraocular lens, and the movable unit is positioned on the rear end side. In this case, a locking action that makes the holding member unremovable from the instrument main body is exhibited. Thereby, it is possible to prevent a problem that the holding member is detached from the main body of the instrument and the stable holding of the intraocular lens is hindered during the transportation of the insertion instrument before the operation.

  When performing the treatment, the movable part is moved to the distal end side to release the locking action and the holding member is detached from the instrument body. By performing this separation operation, the movable part is engaged. By the extruded member, the rear support portion of the intraocular lens is bent or curved to the optical portion side, and the rear support portion is guided to a desired position on the upper surface side or the lower surface side of the optical portion by the guide portion. it can. Accordingly, when the intraocular lens is actually inserted from the instrument body into the patient's sac by extruding the pushing member, the deformation posture of the posterior support part can be controlled to a desired shape, and the intraocular lens in the patient's sac The behavior of the intraocular lens when releasing the lens can be controlled with high accuracy.

  Thus, according to this aspect, the holding member is detached from the instrument body by providing the movable member that slides in a state in which the intraocular lens is stably held for a long time while being engaged with the pushing member. Only by performing a series of operations, desired deformation of the rear support part toward the optical part side can be made manifest at the same time. Therefore, stable holding of the intraocular lens and control of the rear support portion can be realized with a simple structure and simple operation.

  The guide part may be any structure as long as it can guide the rear support part approaching the optical part to the front side or the rear side of the lens. For example, the curved surface provided on the front end surface of the push-out member may constitute a guide unit that guides the front support side or the rear side as the rear support unit approaches the optical unit, or the upper or lower side provided on the instrument body The guide portion may be configured by a protruding portion that protrudes toward the optical portion, and a rear support portion approaching the optical portion may be brought into contact with the protruding portion and guided to the front side or the rear side of the optical portion.

  According to a second aspect of the present invention, in the intraocular lens insertion device according to the first aspect, a gripping protrusion protrudes from the movable part, and the sliding operation of the movable part is performed by the gripping protrusion. The holding member can be detached from the instrument body.

  According to this aspect, the sliding operation of the movable part and the detaching operation of the holding member can be performed in a series of operations while holding the gripping protrusion, and the operability can be improved.

  According to the intraocular lens insertion device of the present invention, the holding member is provided by providing the movable member that slides in a state in which the intraocular lens is engaged with the pushing member with respect to the holding member that stably holds the intraocular lens for a long period of time. Only by performing a series of operations for detachment from the main body, a desired deformation of the rear support portion toward the optical portion side can be simultaneously exhibited. That is, stable holding of the intraocular lens and control of the rear support portion can be realized with a simple structure and simple operation.

The top view of the insertion instrument of the intraocular lens as 1st embodiment of this invention. The side view of the insertion instrument shown in FIG. The principal part enlarged top view of the mounting part which comprises the insertion instrument shown in FIG. The top view of the holding member which comprises the insertion instrument shown in FIG. The side view of the holding member shown in FIG. The upper surface explanatory drawing which expands and shows the principal part of the insertion instrument shown in FIG. VII-VII longitudinal cross-sectional enlarged view of FIG. The principal part enlarged top view of the mounting part of the insertion instrument of the intraocular lens as 2nd embodiment of this invention. The top view of the holding member which comprises the insertion instrument shown in FIG.

  Hereinafter, in order to clarify the present invention more specifically, embodiments of the present invention will be described in detail with reference to the drawings.

  First, FIG. 1 and FIG. 2 show an intraocular lens insertion device 10 as one embodiment of the present invention. The intraocular lens insertion instrument 10 is made of a synthetic resin, and is inserted from a cylindrical instrument body 16 having a placement portion 14 on which the intraocular lens 12 is placed, and a rear end portion 18 of the instrument body 16. The push-out member 22 that pushes the intraocular lens 12 to the insertion tube portion 20 provided at the distal end portion of the instrument main body 16 is provided, and the intraocular lens 12 is provided in advance. In the following description, “front” refers to the pushing direction of the pushing member 22 (left direction in FIG. 1), and “upward” refers to the up direction in FIG. The left-right direction refers to the left-right direction in the top view of the intraocular lens insertion device 10 (upper is right and lower is left in FIG. 1).

  More specifically, the instrument main body 16 has a main body cylinder portion 24 having a substantially cylindrical shape. A through-hole 26 that penetrates in the axial direction with a substantially rectangular cross-sectional shape is formed inside the main body cylinder portion 24. Further, a plate-like portion 28 that extends in a direction orthogonal to the extending direction of the main body cylinder portion 24 is integrally formed at a position slightly forward from the rear end portion of the main body cylinder portion 24.

  Further, a mounting portion 14 is formed in front of the main body cylinder portion 24 in the instrument main body 16. FIG. 3 shows the placement unit 14. The mounting portion 14 is formed with a concave groove 32 extending in the axial direction with a width that is slightly larger than the diameter of the optical portion 30 of the intraocular lens 12 shown in FIG. The concave groove 32 is formed with an axial length dimension that is slightly larger than the maximum width dimension (the horizontal dimension in FIG. 1) including the pair of support portions 34, 35 of the intraocular lens 12.

  Here, the concave groove 32 has an opening 36 opened upward, and a mounting surface 38 is formed on the bottom surface thereof. The placement surface 38 has a width dimension slightly larger than the minimum width dimension (the vertical dimension in FIG. 1) of the intraocular lens 12, and is larger than the maximum width dimension (the horizontal dimension in FIG. 1) of the intraocular lens 12. Is also a flat surface having a large axial length dimension. In addition, the height position of the mounting surface 38 is located higher than the height position of the bottom surface of the through hole 26 in the main body cylinder portion 24, and the front edge of the through hole 26 in the main body cylinder portion 24 is A wall portion 40 (see FIG. 2) that extends upward from the bottom surface of the through hole 26 and is connected to the rear end edge portion of the placement surface 38 is formed. Thus, the concave groove 32 communicates with the through hole 26, and the width dimension of the concave groove 32 is substantially equal to the width dimension of the through hole 26.

  A cover member 42 as a lid is integrally formed with the instrument body 16 at the side of the concave groove 32 (right side in the present embodiment). The cover member 42 has an axial dimension substantially equal to the axial dimension of the concave groove 32 and is formed with a width dimension slightly larger than the width dimension of the concave groove 32. Further, the cover member 42 is connected to the instrument main body 16 by a substantially thin plate-like connecting portion 44 formed by extending the upper end edge of the mounting portion 14 to the side (in the present embodiment, the right side). . The connecting portion 44 is thinnest at a bent portion 46 extending in the axial direction of the instrument body 16 at a substantially central portion in the width direction, and can be bent at the bent portion 46. Thus, the cover member 42 is configured to be able to cover the opening 36 by bending the connecting portion 44 and overlapping the concave groove 32.

  An engagement piece 48 is formed to project from the edge of the cover member 42 opposite to the connecting portion 44, while the end of the mounting portion 14 opposite to the cover member 42 projects outward. A protruding edge 50 is formed, and an engagement notch 52 is formed at a position corresponding to the engagement piece 48 in the protruding edge 50.

  A holding member 54 is detachably provided in a state where the intraocular lens 12 is positioned and held below the placement surface 38 of the placement portion 14 having such a structure. As shown in FIGS. 4 and 5, the holding member 54 is configured as a separate body from the instrument body 16, and a pair of side wall portions 56, 56 are connected by a connecting plate portion 58 formed integrally between the opposing surfaces. It is structured. Here, the separation distance of the outer surface of the side wall portion 56 is substantially equal to the radial dimension of the optical portion 30 of the intraocular lens 12. Further, a thin flat plate-like leg plate portion 60 is integrally formed at the lower end portion of the connecting plate portion 58 in a direction perpendicular to the pushing direction of the pushing member 22.

  The first holding projections 62 and 62 projecting upward in a substantially arc shape when viewed from above are integrally formed on the upper end portions of the respective side wall portions 56 and 56. Further, a peripheral wall 64 is integrally formed on the outer side of the upper end surface of the first holding projection 62 on the inner side of the holding member 54. Here, the separation distance of the peripheral wall 64 is slightly larger than the diameter of the optical part 30 of the intraocular lens 12.

  In addition, a pair of second holding projections 66 and 66 projecting upward in a rectangular shape in a top view are mutually opposite in the longitudinal direction of the holding member 54 (left and right direction in FIG. 4). Are integrally formed so as to be opposed to each other. Here, the height position of the upper end surface of the second holding projection 66 is equal to the height position of the upper end surface of the first holding projection 62. Each of the second holding projections 66 includes a projection main body 68 projecting from the connecting plate portion 58, a peripheral wall 70 projecting from the upper end surface of the projection main body 68, and the second main body projection 68 in the opposing direction of the second holding projection 66. It is comprised from the engaging part 71 which protruded and provided in the outward end side. The separation distance in the facing direction of the peripheral walls 70 and 70 is slightly larger than the diameter of the optical part 30 of the intraocular lens 12. Further, each peripheral wall 70 and each engagement portion 71 have a width dimension substantially equal to the width dimension of the projection main body 68.

  Furthermore, the opening part 72 of the rectangular shape is formed in planar view at both axial ends of the connecting plate part 58, and the distance between the opposing side wall parts 74, 74 in the axial vertical direction of the opening part 72 is the side wall. The distance between the portions 56 and 56 is shorter. A movable portion 78 is formed in the opening 72 separately from the holding member 54 and has a rectangular flat plate-like portion 76 that is slightly narrower than the distance between the side wall portions 74 and 74 in plan view. It is slidably assembled to the holding member 54 from the rear end side toward the front end side.

  More specifically, the movable portion 78 is formed with engagement protrusions 80 protruding from the side edge portions on both sides in the width direction over a predetermined length at the center portion in the length direction. On the other hand, both side wall portions 74, 74 that define the opening 72 extend on both side walls 74, 74 forward in the axial direction of the holding member 54, and on the rear end side of the opening 72 and the holding member 54. Long grooves 82 and 82 that are open rails are formed, respectively. The movable portion 78 is inserted into the long groove 82 from the rear end side of the holding member 54, so that the movable portion 78 can move by sliding forward in the axial direction. The long groove 82 is formed with an internal dimension slightly larger than the external dimension of the engaging projection 80 in the direction perpendicular to the axis (vertical direction in FIG. 4) so that the movable portion 78 can slide smoothly and does not wobble. In the axial direction, it is formed with a length dimension that can ensure a predetermined slide length.

  As shown in FIG. 3 and FIG. 4A, first, the movable portion 78 is inserted into the long groove 82 from the rear end side of the holding member 54. Next, the holding member 54 having such a structure is assembled from below the placement surface 38 of the instrument body 16. Specifically, the mounting surface 38 of the instrument body 16 is formed with through holes 84 and 86 that penetrate in the thickness direction (see FIG. 3). The through holes 84 and 86 are formed to have a substantially similar shape that is slightly larger than the top view of the first holding projection 62 and the second holding projection 66 of the holding member 54. Then, the first holding projection 62 and the second holding projection 66 of the holding member 54 are inserted into the through holes 84 and 86 from the lower side of the mounting surface 38 and protruded on the mounting surface 38. As a result, the engaging portion 71 provided on the second holding projection 66 is protruded on the mounting surface 38 and is locked to the upper surface of the mounting surface 38, so that the holding member 54 is attached to the instrument body 16. The state where the first holding protrusion 62 and the second holding protrusion 66 are protruded from the mounting surface 38 is held from the outside.

  Further, a through hole 85 penetrating in the thickness direction is formed in the mounting surface 38 of the instrument body 16 (see FIG. 3). The through-hole 85 is opened to a predetermined size so that the columnar protrusion 88 protruding upward (perpendicular to the paper surface) from the rectangular flat plate portion 76 constituting the movable portion 78 can perform a sliding operation described later. Yes.

  Then, the movable portion 78 assembled to the holding member 54 is slid rearward in the axial direction of the instrument main body 16, thereby being guided to the groove 92 formed in the front portion 90 of the main body cylinder portion 24 in the instrument main body 16. The locking claw 94 provided in the rectangular flat plate portion 76 constituting the movable portion 78 is fitted into the locking hole 96 provided in the groove portion 92. That is, at the slide start end where the movable portion 78 is located on the rear end side in the sliding direction, the holding member 54 is moved to the instrument main body 16 by the engagement of the rectangular flat plate portion 76 constituting the movable portion 78 with the main body cylinder portion 24. It is engaged so that it cannot be detached. Further, in a state where the movable portion 78 is positioned at the slide start end, as shown in FIG. 6A, a columnar protrusion 88 that protrudes upward (in the direction perpendicular to the paper surface) from the rectangular flat plate portion 76 constituting the movable portion 78. Further, an engagement notch 100 formed at the tip of the rod-like portion 98 of the push member 22 is fitted. In addition, at the slide end end where the movable portion 78 is moved to the front end side in the sliding direction and the rectangular flat plate portion 76 constituting the movable portion 78 comes out from the groove portion 92 formed in the front portion 90 of the main body cylinder portion 24, The holding member 54 including the movable portion 78 can be detached from the placement portion 14.

  Next, as shown in FIGS. 3 (b) and 4 (b), the movable portion 78 assembled to the holding member 54 is slid toward the distal end side in the axial forward sliding direction of the instrument body 16, thereby moving the movable portion 78. Can be removed from the groove 92 formed in the instrument main body 16, and the locking claw 102 provided in the axially forward direction of the rectangular flat plate portion 76 constituting the movable portion 78 is provided on the leg plate portion 60 of the holding member 54. It is fitted into the provided locking hole 104 and engaged with the holding member 54. That is, the holding member 54 including the movable portion 78 can be detached from the placement portion 14 at the slide end end. As shown in FIG. 5, the rectangular flat plate portion 76 constituting the movable portion 78 is housed in the lower portion of the placement surface 38. At this time, it is desirable that the engagement protrusion 80 is in contact with the end portion on the front end side of the long groove 82.

  An insertion tube portion 20 that extends toward the front in the axial direction of the instrument body 16 is integrally formed in front of the placement portion 14. The insertion tube portion 20 has a tapered shape that gradually tapers from the placement portion 14 side toward the distal end portion in the extending direction as a whole, and has a tapered shape penetrating the entire length in the extending direction. A through hole 106 is formed.

  The through hole 106 communicates with the placement unit 14 by connecting a base end opening 108 opened to the placement unit 14 side to the placement surface 38. The base end opening 108 as a whole has a flat, substantially elliptical cross section in which the bottom surface 110 is a flat surface and the top surface is a substantially arc shape. The tip opening 112 provided at the tip of the through-hole 106 has an oblique opening shape in a side view with the upper surface extending forward from the bottom.

  The bottom surface 110 is formed with an introduction protrusion 114 extending in the axial direction of the instrument body 16 with the widthwise center portion of the bottom surface 110 interposed therebetween. The introduction protrusions 114 have a linear shape that protrudes slightly upward from the bottom surface 110 and extends parallel to each other. The protrusion height of the introduction protrusion 114 is gradually increased as it goes forward in the axial direction of the instrument body 16, and is flush with the bottom surface 110 at the rear end portion of the proximal end opening 108. .

  Furthermore, the introduction protrusions 114 are disposed substantially in parallel with each other at a predetermined distance in the direction perpendicular to the axis of the instrument body 16 with the center in the width direction of the bottom surface 110 interposed therebetween. Is preferably slightly larger than the width of the distal end portion of the extrusion member 22, and in this embodiment, it is slightly larger than the width of the rod-shaped portion 98 of the extrusion member 22.

  As described above, the instrument main body 16 in the present embodiment is configured as a single member in which the main body cylinder part 24, the placement part 14, the cover member 42, and the insertion cylinder part 20 are integrally molded. A holding member 54 including a movable portion 78 configured separately from the main body 16 is assembled from below the placement surface 38.

  And the extrusion member 22 is inserted in the through-hole 26 from the back of the instrument main body 16 made into such a structure. The pushing member 22 has a substantially rod shape having an axial length dimension slightly larger than the axial length dimension of the instrument main body 16, and has a substantially cylindrical action portion 116 and a substantially rectangular rod shape. The insertion portion 118 is integrally formed.

  In the intraocular lens insertion device 10 having such a structure, first, the distal end portion of the pushing member 22 is inserted into the main body cylinder portion 24 of the device main body 16 from the rear side, and the pushing member 22 as shown in FIG. The claw portion 120 is set at an initial position locked in a locking hole 124 penetrating the instrument body 16. At the same time, the holding member 54 is attached to the instrument body 16 from below the placement surface 38 as described above, and the movable portion 78 is set at the slide start end. Accordingly, the holding member 54 including the movable portion 78 is assembled to the instrument body 16 so as not to be detached, and the first holding projection 62 and the second holding projection 66 of the holding member 54 are held in a state of protruding on the placement surface 38. Is done.

  As shown in FIGS. 6 and 7, the optical unit 30 of the intraocular lens 12 is placed and held on the upper end surfaces of the first holding projection 62 and the second holding projection 66 of the holding member 54. In FIG. 6, only a necessary portion of the instrument main body 16 and a distal end portion of the pushing member 22 facing the intraocular lens 12, the holding member 54, and the placement portion 14 are shown for easy understanding. In such a mounted state, the intraocular lens 12 has the outer peripheral portion of the optical unit 30 in contact with the first and second holding projections 62 and 66, and the central portion has the first and second holding projections 62 and 66. 66 in a non-contact state.

  Furthermore, the peripheral walls 64 and 70 formed on the first holding protrusion 62 and the second holding protrusion 66 are outside the optical unit 30 in the intraocular lens 12, and in particular in the present embodiment, formed on the first holding protrusion 62. The peripheral wall 64 sandwiches the intraocular lens 12 on both sides in an oblique direction with respect to the axial direction of the instrument main body 16, and the peripheral wall 70 formed on the second holding projection 66 connects the intraocular lens 12 to the axis of the instrument main body 16. It is provided so as to sandwich both sides of the direction. Thereby, the amount of displacement of the intraocular lens 12 with respect to the instrument body 16 in the axial direction and the axial direction is limited, and the intraocular lens 12 can be stably held.

  The pair of support portions 34 and 35 of the intraocular lens 12 extend from the first and second holding projections 62 and 66 of the holding member 54 to the front side and the rear side of the instrument body 16. Is placed on top.

  Then, the bent portion 46 is bent, and the opening 36 of the placement portion 14 is covered with the cover member 42, whereby the intraocular lens 12 is set in the instrument main body 16 in the accommodated state. The cover member 42 is maintained in the closed state by the engagement piece 48 being engaged with the engagement notch 52.

  As described above, the intraocular lens 12 is accommodated in the insertion instrument 10. And the insertion instrument 10 in this embodiment is packaged and delivered after sterilization etc. are made in the state which accommodated the intraocular lens 12. FIG.

  As described above, the insertion instrument 10 according to the present embodiment provided with the intraocular lens 12 is used in the following manner during an operation such as a cataract.

  After taking out from a package, it is desirable to inject | pour into the inside of the mounting part 14 or the insertion cylinder part 20 the lubricant which has viscoelastic substances, such as sodium hyaluronate, as a main component first. Particularly in this embodiment, an injection hole 126 penetrating in the thickness direction is formed in the cover member 42, and the lubricant can be injected through the injection hole 126 with the cover member 42 being closed. However, the lubricant may be injected from, for example, the distal end opening 112 of the insertion tube portion 20, or the cover member 42 is opened once and then injected from the opening 36 of the mounting portion 14, or once the extrusion member. 22 may be pulled out from the instrument body 16 and injected from the rear end 18 of the rear end of the through hole 26.

  Next, in a state where the optical part 30 of the intraocular lens 12 is placed and held on the upper end surfaces of the first holding protrusion 62 and the second holding protrusion 66 of the holding member 54, the movable part 78 of the holding member 54 is moved to the instrument. From the slide start end fitted in the groove portion 92 provided in the front portion 90 of the main body cylinder portion 24 of the main body 16, toward the slide end end positioned at the lower portion of the placement surface 38 of the holding member 54. And slide forward in the axial direction. At the time of sliding, the first and second holding projections 62 and 66 constituting the holding member 54 are not displaced, and only the distal end portion of the rod-like portion 98 of the pushing member 22 engaged with the movable portion 78 is slid forward in the axial direction. Therefore, the rear support part 35 of the intraocular lens 12 can be deformed to the optical part 30 side. At the time of this deformation, for example, as shown in FIG. 7, by providing a guide portion 128 that increases in height toward the front in the axial direction on the mounting surface 38, the rear support portion 35 is guided to the front side of the optical portion 30. can do. Similarly, the rear support portion 35 is guided to the rear surface side of the optical portion 30 by providing the guide portion 128 in a symmetrical shape with respect to the paper surface (not shown) on the surface of the cover member 42 facing the placement surface 38. You can also Alternatively, the rear support portion 35 is guided to the front surface side or the rear surface side of the optical unit 30 by providing a taper of a right shoulder downward or a right shoulder upward at the front end portion 129 of the rod-shaped portion 98 of the pushing member 22. Can do. In this way, the rear support portion 35 can be deformed into a desired shape, and the stability of the intraocular lens 12 within the sac can be improved. In addition, the installation location of the guide part 128 is not limited to the illustrated example, and can be installed on the holding member 54 or the movable part 78.

  The intraocular lens 12 can be placed on the placement surface 38 in a state of being wrapped in the above-described lubricant by pulling the holding member 54 below the instrument body 16 and removing it from the instrument body 16. It becomes. In addition, since the mounting surface 38 in this embodiment is a flat surface, the intraocular lens 12 can be stably mounted, and the width dimension of the concave groove 32 is the optical part of the intraocular lens 12. Since the diameter is slightly larger than 30, the rotation of the intraocular lens 12 in the circumferential direction on the placement surface 38 is also prevented. A gripping protrusion 130 bent outward is integrally formed at the lower central part of the rectangular flat plate portion 76 constituting the movable part 78, and the sliding operation of the movable part 78 and the movable part are formed by the gripping protrusion 130. The holding member 54 engaged with 78 can be detached from the instrument main body 16. Accordingly, the sliding operation of the movable portion 78 and the detaching operation of the holding member 54 can be performed by a series of operations while the gripping protrusion 130 is gripped, and operability can be improved.

  Subsequently, the pressing plate portion 132 of the pushing member 22 is pushed into the instrument body 16 side in a state where the distal end portion of the insertion tube portion 20 is inserted into the incision provided in the eye tissue. Thereby, the rod-like portion 98 at the tip of the pushing member 22 is brought into contact with the outer peripheral edge portion of the optical portion 30 of the intraocular lens 12 placed on the placing surface 38, and the intraocular lens 12 is inserted into the insertion tube portion by the pushing member 22. The intraocular lens 12 is fed out from the distal end portion of the insertion tube portion 20 into the sac. Note that the maximum pushing amount of the pushing member 22 into the instrument main body 16 is limited by the distal end surface of the insertion portion 118 being locked by the wall portion 40 of the through hole 26, and the maximum pushing position is as follows. Thus, the distal end portion of the pushing member 22 is protruded from the distal end opening portion 112 to an appropriate length, for example, 5 to 10 mm.

  In the intraocular lens insertion device 10 configured according to this embodiment, since the movable member 78 is provided in the holding member 54, when inserting the intraocular lens 12 into the patient's sac, With the intraocular lens 12 positioned and held by the holding member 54, the pushing member 22 can be brought close to the intraocular lens 12. Thus, with the intraocular lens 12 positioned and held by the holding member 54, the rear support part 35 of the intraocular lens 12 is guided to either the front surface or the rear surface of the optical part 30 of the intraocular lens 12 with good reproducibility. can do. Therefore, the rear support portion 35 is deformed into a desired shape, and the behavior of the intraocular lens 12 after being inserted or inserted into the sac can be controlled and the stability in the sac can be improved. Therefore, as in the conventional structure, after the intraocular lens 12 is removed from the holding member 54, it is possible to prevent problems such as lens movement and rotation caused by pushing out the rear support portion 35 with the pushing member 22, and stable. It is possible to insert an intraocular lens.

  Further, in this embodiment, since the intraocular lens 12 is built in the instrument body 16 in a state of being positioned and placed on the holding projections 62 and 66 of the holding member 54, stable holding during transportation and storage is possible. It becomes possible. Further, after the movable portion 78 is slid, the intraocular lens 12 can be stably placed on the placement surface 38 by withdrawing the holding member 54 from the placement portion 14. As described above, the holding member 54 can exhibit a stable support function during transportation and storage of the intraocular lens 12.

  Further, at the slide start end of the movable portion 78, the rear portion of the rectangular flat plate-like portion 76 of the movable portion 78 is fitted into the groove portion 92 provided in the front portion 90 of the main body cylinder portion 24 of the instrument main body 16, and cannot be detached. Therefore, it is possible to prevent the holding member 54 including the movable portion 78 from being unexpectedly detached from the placement portion 14. In addition, after the movable portion 78 is moved to the slide end, the holding member 54 can be quickly removed from the through holes 84 and 86, and the insertion operation by the pushing member 22 of the intraocular lens 12 can be performed with the holding member 54. Interference can be avoided and stable operation can be performed.

  Further, in this embodiment, since the movable portion 78 is provided with the gripping protrusion 130, the sliding operation of the movable portion 78 by the gripping protrusion 130 and the holding member 54 engaged with the movable portion 78 from the instrument main body 16. The withdrawal operation is possible. Accordingly, the sliding operation of the movable portion 78 and the detaching operation of the holding member 54 can be performed by a series of operations while the gripping protrusion 130 is gripped, and the operability can be improved.

  Since the intraocular lens 12 can be placed while maintaining the state in which the opening 36 of the placement portion 14 is covered by the cover member 42, the ocular lens can be prevented from falling off from the insertion device 10. At the same time, the chance of contact of the intraocular lens 12 with the outside world is reduced, and an excellent effect on hygiene can be obtained.

  Next, the principal part of the intraocular lens insertion device 134 according to the second embodiment of the present invention will be described with reference to FIGS. 8 and 9. In the second embodiment, when the intraocular lens 12 is pushed out by the pushing member 22 with respect to the intraocular lens insertion device 10 of the first embodiment, the support holding protrusion 136 that abuts the front support 34. Is provided so that the deformed shape of the front support portion 34 can be controlled. In the following description, members and parts that are substantially the same as those of the above-described embodiment are denoted by the same reference numerals as those of the above-described embodiment, and detailed description thereof is omitted.

  More specifically, as shown in FIG. 9, in the intraocular lens insertion device 134 of the present embodiment, a thin strip-like connecting portion in which the support holding projection 136 can be easily curved and deformed with respect to the holding member 54. It is integrally connected to the side wall part 56 via 138. As shown in FIG. 9A, in the initial state in which the separation distance between the holding member 54 and the support holding protrusion 136 is maximum, the connecting portion 138 extends straight in the longitudinal direction of the holding member 54, and the support holding portion is held. The protrusion 136 is disposed at substantially the same position as the front edge of the holding member 54. Further, as shown in FIG. 9B, after the connecting portion 138 is curved and deformed, the separation distance between the holding member 54 and the supporting portion holding projection 136 is minimized, and the supporting portion holding projection 136 is positioned in front of the holding member 54. It is located in the rear side of the side edge portion.

  On the other hand, as shown in FIG. 8, an accommodation hole 140 for the support portion holding projection 136 is provided through the bottom surface of the concave groove 32 of the device body 16, and the support portion holding projection 136 is passed through the accommodation hole 140. It protrudes on the mounting surface 38 in front of the intraocular lens 12 on the distal end side of the main body 16. In addition, although not shown, an accommodation groove that opens on the back side of the bottom surface of the recessed groove 32 may be provided so that the connecting portion 138 can be accommodated in a state where it can be bent and deformed.

  In the intraocular lens insertion device 134 of this embodiment, first, the initial state shown in FIG. 8A, that is, the intraocular lens 12 is positioned and placed on the holding protrusions 62 and 66 of the holding member 54. From this state, the rear support portion 35 of the intraocular lens 12 can be deformed to the optical portion 30 side by sliding the movable portion 78 provided on the holding member 54 forward in the axial direction with respect to the instrument body 16. Thus, the desired deformed shape of the rear support portion 35 can be advantageously produced. Further, in the present embodiment, the through holes 142 and 144 for projecting the holding projections 62 and 66 that hold the intraocular lens 12 have a long hole shape extending in a predetermined length in the axial direction of the instrument body 16. . Accordingly, the movable portion 78 engaged with the holding member 54 can be further slid from FIG. 8B to FIG. 8C together with the holding member 54, and the rear support portion 35 is deformed. The intraocular lens 12 can be slid while maintaining the above. At the time of this slide, the support portion holding projection 136 that protrudes on the placement surface 38 through the accommodation hole 140 is immovable with respect to the instrument main body 16, so that the connecting portion 138 is curved to cause the eye to bend. The inner lens 12 can be brought close to the support holding projection 136. In other words, the movement of the front support portion 34 of the intraocular lens 12 can be restricted by the support portion holding protrusion 136 by sliding the holding member 54 axially forward with respect to the instrument body 16. As described above, after the front and rear support portions 34 and 35 are deformed to the optical portion 30 side, the holding member 54 including the support portion holding projection 136 is collectively pulled out from the device main body 16, and the device main body is pulled out downward. 16 can be removed. Here, the connection portion 138 has been described with a thin-walled and strip-like structure. However, a chain-like structure or a telescopic structure may be used, or the connection portion 138 may be omitted and formed separately.

  In this way, the front support part 34 is deformed so that the front end part of the front support part 34 is deformed to the optical part 30 side, and the front end part of the rear support part 35 is placed on the front surface of the optical part 30. The pushing member 22 pushes out the intraocular lens 12 from the instrument body 16. Then, a so-called tacking state in which the front support portion 34 is sandwiched between the optical portions 30 deformed so as to be convex upward can be advantageously produced, and the intraocular lens 12 is released into the sac. The behavior of the front support part 34 and the optical part 30 is stabilized, and the stability of the intraocular lens 12 within the capsule can be improved. On the other hand, since the rear support portion 35 is deformed so as to be placed on the front surface of the optical portion 30, the cross-sectional area of the intraocular lens 12 pushed out from the insertion tube portion 20 is reduced, and the intraocular lens 12 is pushed out. Can be performed smoothly and with less resistance. As described above, the front and rear support portions 34 and 35 can be deformed to the optical portion 30 side simply by sliding the movable portion 78 forward in the axial direction. The postures of the front and rear support portions 34 and 35 can be controlled to a desired state.

  As mentioned above, although several embodiment of this invention has been explained in full detail, this is an illustration to the last, Comprising: This invention is not limited at all by the specific description in this embodiment. For example, also in the intraocular lens insertion device 134 according to the second embodiment, the rear support part 35 can be deformed so as to enter the lower surface side of the optical part 30 as in the first embodiment. This can advantageously prevent the rear support portion 35 from being damaged when the intraocular lens 12 is pushed out. In addition, the engagement structure between the movable portion 78 and the pushing member 22 may be a known engagement structure as long as the engagement is released when the holding member 54 is detached from the instrument body 16. .

  Further, the introduction protrusion 114 provided on the bottom surface 110 of the proximal end opening 108 may be provided to extend to a portion on the placement surface 38 where the optical part 30 of the intraocular lens 12 is placed. Then, the optical unit 30 may be placed and supported also on the projecting tip of the introduction projection 114 in the state of being placed on the first and second holding projections 62 and 66.

10: insertion instrument, 12: intraocular lens, 14: placement part, 16: instrument body, 18: rear end part, 20: insertion cylinder part, 22: pushing member, 24: body cylinder part, 30: optical part, 32: concave groove, 34: front support part, 35: rear support part, 38: mounting surface, 42: cover member, 54: holding member, 62: first holding protrusion, 66: second holding protrusion, 76: rectangular Flat plate portion, 78: movable portion, 88: columnar protrusion, 90: front portion, 92: groove portion, 94: locking claw, 96: locking hole, 98: rod-shaped portion, 100: engagement notch, 128: guide portion , 130: gripping protrusion

Claims (2)

A cylindrical instrument body provided with a placement part on which an intraocular lens having an optical part and a pair of support parts extending from both sides of the optical part is placed, and inserted from the rear end part of the instrument body A push-out member that pushes the intraocular lens to an insertion tube provided at the distal end of the instrument body, and the pair of intraocular lenses by the holding member that protrudes and is assembled to the mounting portion. In the intraocular lens insertion device provided in a state where the intraocular lens is positioned and held on the mounting portion so that the support portion extends to the front end side and the rear end side of the device main body,
The holding member is provided with a movable portion that is slidable from the rear end side to the front end side of the holding member in a state of being engaged with the pushing member,
When the movable part is located on the rear end side in the sliding direction, the holding member is not removable from the instrument body,
When the movable part is moved to the front end side in the sliding direction, the support part located behind the intraocular lens is deformed to the optical part side by the front end part of the push-out member, and includes the movable part. The holding member is removable from the instrument body;
A guide part is provided for guiding the rear support part to the front side or the rear side of the optical part when the rear support part is deformed to the optical part side.
An intraocular lens insertion device.   The eye according to claim 1, wherein a gripping protrusion protrudes from the movable part, and the sliding operation of the movable part and the detachment operation of the holding member from the instrument main body are enabled by the gripping protrusion. Inner lens insertion device.

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