JPH0520102B2 - - Google Patents

Description

[Detailed Description of the Invention] Industrial Application Field This invention relates to an irrigator used in ocular vitrectomy surgery, and particularly to an illuminated irrigator that has an intraocular illumination function in addition to the irrigating function. It is.

Conventional technology Vitreous surgery is performed as shown in Figures 8 and 9.
For example, by removing the cloudy part of the jelly-like vitreous body 3 between the crystalline lens 1 and the retina 2 and replacing it with a clear liquid, light can pass through the crystalline lens 1 and reach the retina 2, allowing visual acuity. This is done to aid in recovery.

It is also performed to remove the proliferative membrane that forms in front of the retina, allowing light to reach the retina, and to eliminate retinal damage caused by contraction of this membrane.

To perform vitrectomy surgery, the following functions are essential: perfusion of irrigation fluid into the eyeball, removal of cloudy vitreous body, suction of the resected material, and illumination of the inside of the eyeball.

Conventional vitrectomy involves making three holes in the sclera 7 of the eyeball and inserting each instrument, as shown in Figure 8, and inserting each instrument into two holes in the sclera 7, as shown in Figure 9. There is a way to open it and insert each device.

In the method shown in FIG. 8, three instruments perform the functions of irrigation, illumination, and ablation and aspiration. The cutter 4 has vitrectomy and suction functions. The perfusion tube 5 has the function of perfusing the perfusion solution into the eyeball. The plug 5a of the irrigation tube 5 is fixed to the eyeball with a thread. The light guide 8 has a function of illuminating the inside of the eyeball. As shown in FIG. 8a when viewed in cross section and FIG. 8b when viewed from the front, the irrigation tube 5, cutter 4, and light guide 8 are inserted into the eyeball at a distance of approximately 4 mm from the cornea 6.

During the surgery, while illuminating with the light guide 8, the cloudy vitreous body 3 is excised with the cutter 4, irrigation fluid is irrigated through the irrigation tube 5, and the excised material is discharged from the eyeball by suction. The vitreous cavity is then filled with irrigation fluid to restore intraocular pressure.

On the other hand, in the method shown in FIG. 9, a cutter 4 with a suction function and an instrument 9 are used. Both have cornea 6
It is inserted into the sclera 7 at a position approximately 4 mm away from the

As shown in FIG. 10, the device 9 has an optical fiber bundle 11 for illumination arranged around an irrigation tube 10 that guides irrigation fluid into the eyeball. This instrument 9 is
During surgery, the surgeon holds it and performs the surgery.

Problems to be Solved by the Invention In the former method, the surgeon generally performs the surgery using the light guide 8 and the cutter 4.
However, it is not enough for the operator to operate only the cutter 4, and the operator may want to use forceps to pinch the proliferative membrane or the like. However, the operator's hands are occupied by the cutter 4 and light guide 8.
Using forceps is difficult. Furthermore, since three pipes or cables are routed, handling becomes complicated.

In the latter method, since the optical fiber bundle 11 is placed around the perfusion tube 10, it is somewhat easier to handle, but the diameter of the instrument 9 increases. Therefore, the size (area) of the hole made in the eyeball must be increased, and if the instrument 9 is removed after the surgery, the eyeball is likely to collapse.

Furthermore, since it is necessary to apply a coating to protect the optical fiber bundle 11, the weight and size of the instrument 9 increase, making it impossible to sew the instrument 9 to the eyeball, and the operator must support the instrument 9 by hand during the surgery. It won't happen. Therefore, the operator's hands are occupied by the cutter 4 and the instrument 9, making it difficult to use forceps as in the former case.

This invention was made to solve the above-mentioned problems, and in cases such as vitreous surgery that require perfusion and intraocular illumination, the present invention provides a method for supporting the eyeball so that the operator does not have to support it with his/her hands. The purpose of the present invention is to provide an illuminated irrigation device that can be sewn together.

Means for Solving the Problems To achieve this object, the present invention provides an irrigation part having an insertion end inserted into the eyeball for perfusing irrigation fluid into the eyeball, and a light source for intraocular illumination. and a light transmitting section having one end connected to the light source unit and transmitting light from the light source, at least a portion of the light irradiation side of the light transmitting section being covered by the perfusion section. The object of the present invention is to provide an illuminated perfusion device characterized in that it is configured to be protected by being exposed to water.

Embodiment FIG. 1 is a schematic diagram showing a surgical operation using a vitrectomy apparatus equipped with an illuminated perfusion device according to the present invention.

The vitrectomy apparatus has an external device 12, an illuminated irrigator 13 of the present invention, and a cutter 14.

The external device 12 is composed of a drive unit 17 and a suction unit 18.

The cutter 14 has a built-in motor (not shown), and rotates the inner blade (not shown) to remove the vitreous body 3.
can now be removed. A suction path is provided in the cutter 14, and the suction path is connected to the suction pipe 1.
9 to the suction unit 18.
The motor is also connected to the drive unit 17 via a power cable 20.

The illuminated perfusion device 13 is composed of a light source unit 15 having a built-in light source, a perfusion section 21, and first and second public transmission sections 25 and 28, as shown in FIGS. 1 and 2. The perfusion section 21 includes the first member 2
2, a tubular second member 23, a tubular insertion member 24, and a perfusion unit 16.

From the first member 22 to the insertion member 24, the first
A light transmission section 25 is inserted. The first light transmitting section 25 can preferably be made of a plastic optical fiber or a glass optical fiber with excellent flexibility. Further, the second member 23 is also made of a material with good flexibility. If the second member 23 and the first light transmission section 25 are made to be easily bent, even if the perfusion section 21 is fixed to the eyeball during surgery,
Since there is no springiness, there is no extra burden on the eyeballs.

The first member 22 is branched in three directions. The light receiving end 2 of the first light transmitting part 25 is connected to the small diameter connecting part 22a.
6 is interpolated. Connection portion 22b is connected to perfusion unit 16. The connecting portion 22c is the second
It is fitted into one end of the member 23.

The connecting portion 22a can be connected to a connector 27. A light emitting end 29 of the second light transmitting section 28 is fitted into the connector 27 .
The second light transmitting section 28 can preferably be made of plastic or glass optical fiber, and its diameter is larger than the diameter of the first light transmitting section 25 . The reason for this is that connector 27
When connecting to the connecting portion 22a, both transmitting portions 28,
This is to ensure that even if the connection position of 25 deviates to some extent, there will be no problem in transmitting light. The second light transmitting section 28 is connected to the light source unit 15.

An insertion member 24 is fitted into the other end of the second member 23 . The insertion end 24a of the insertion member 24 is formed obliquely so that it can be easily inserted into the eyeball 90. Although the inner diameter of the insertion end 24a is smaller than the inner diameter of the second member 23,
It is larger than the diameter of First light transmission section 2
The light irradiation end 30 of No. 5 is connected to the first member 22 and the second member 23.
The insertion member 24 is disposed through the inside. 1st
The light transmitting portion 25 is configured such that its light emitting end 30 side can be fixed to the insertion member 24 . That is, the first light transmission section 25 is fixed to the inner wall of the insertion member 24 by the fixing bolt 31 attached to the insertion member 24 . (See FIG. 3) The irrigation path 32 for the irrigation fluid extends from the inside of the first member 22 through the inside of the second member 23 to the inside of the insertion member 24. Therefore, the first light transmission section 25
, at least the light irradiation end 30 side is connected to the perfusion channel 32
located within. Preferably, the majority of the perfusion channel 32 is located within the perfusion channel 32, as shown in FIG.

The insertion member 24 has extensions 33, 3 on its outer periphery.
4 is formed to protrude. Extensions 33, 34
Notches 35 are formed at four locations in total.
These notches 35 are parts for threading when sewing the perfusion part 21 to the sclera 7 of the eyeball 90.

During the surgery, two incisions are made on the sclera 7 for the cutter 14 and the irrigation part 21, and another for forceps if necessary, and the cutter 14 is inserted into one of the incisions. Irrigation part 1 on the other incision
Insert the insertion end 26 of 9. and extension part 33,
34 is sewn and fixed to the sclera 7 with a thread.

The light source of the light source unit 15 is turned on, and the light from the light source is irradiated into the eyeball 90 via the first and second light transmitting parts 25 and 28. Using the cutter 14, the operator cuts out the clouded part of the vitreous body 3. and,
The perfusion unit 16 is operated to supply the perfusion fluid to the perfusion path 32.
The eyeball 90 is irrigated from the insertion end 24 through the irrigating fluid, and the suction unit 18 is operated to suction the resected material together with the irrigation fluid.

After the excision and aspiration are completed, the vitreous cavity is filled with irrigation fluid to restore intraocular pressure.

After the surgery is completed, the insertion member 24, cutter 14, etc. are removed and the incision is sutured.

In this way, at least the light irradiation end 30 portion of the first light transmission section 25 is disposed within the perfusion path 32, and the insertion member 24 forming the perfusion path 32 also serves as protection for the first light transmission section 25. , first light transmission section 2
5 does not require a dedicated protective coating. Therefore, the cross-sectional area of the insertion end 24a is the same as that of the conventional example (see FIG. 10).
Since the insertion end 24a can be made smaller than the above, collapse of the eyeball is less likely to occur even if the insertion end 24a is removed from the eyeball at the end of the surgery. Furthermore, since the insertion member 24 can be made small and lightweight, it can be directly sewn and fixed to the eyeball, and there is no need for the operator to support the irrigation section 21 with his hands.

Furthermore, while the perfusate is flowing through the perfusion path 32,
Even if strong light is incident on the first light transmitting section 25 from the light source, the irrigation fluid acts as cooling water to prevent problems such as deformation of the first light transmitting section 25.

Figures 4 to 7 show another embodiment.

The embodiment shown in FIG. 4 and the embodiment shown in FIG. 1 differ in the structure of the perfusion section 51. Other parts are the same as those in FIG. 1, so the same reference numerals are given.

In the embodiment shown in FIG. 2, light transmission is performed by first and second light transmission sections 25 and 28. In the embodiment shown in FIG.

On the other hand, in another embodiment shown in FIG. 5, light is transmitted through one seamless light transmitting section 55. The light transmission section 55 is an optical fiber made of plastic or glass.

The perfusion section 51 includes a first member 52, a second member 53, and an insertion member 54. The first member 52 is T-shaped, and the connecting portion 52a is inserted into the side wall of the light source unit 15. A light receiving end 56 of the light transmitting section 55 is fitted into the connecting section 52a. The light receiving end 56 is connected to the light source 7 in the light source unit 15.
0, and a relay lens 80 is set between the light source 70 and the light receiving end 56. The relay lens 80 allows the image of the light source 70 to be projected onto the light receiving end 56.

The connecting portion 52b of the first member 52 is connected to the perfusion unit 16 via a connecting tube 65. 1st
The connecting portion 52c of the member 52 is fitted into one end of the second member 53.

The insertion member 54 is fitted into the other end of the second member 53. The insertion end 54a of the insertion member 54 is formed obliquely so that it can be inserted inside the sclera 7. The inner circumferential surface of the insertion member 54 is subjected to a mirror finish, for example, to increase the reflectance of light. Light transmission section 5
The light irradiation end 57 of No. 5 is arranged inside the insertion member 54. The light emitting end 57 is fixed to the insertion member 54 as shown in FIG. The inner diameter of the insertion member 54 is smaller than the inner diameter of the second member 53, as also shown in FIG. The extensions 63 and 64 of the insertion member 54 have cutouts 65.

First member 52, second member 53 and insertion member 5
4 is made of synthetic resin or the like. Second member 53
should be transparent and have excellent flexibility.

The irrigation channel 62 has a length that reaches the first member 52, the second member 53, and the insertion member 54. Most of the light transmission section 55 is disposed within the perfusion channel 62 .

By the way, the present invention is not limited to the embodiments described above.

Effects of the Invention Since at least the light irradiation end of the light transmission section is disposed within the perfusion path, and the perfusion section forming the perfusion path can protect the light transmission section, there is no particular need for a protective coating exclusively for the light transmission section. Therefore, the cross-sectional area of the insertion end can be made smaller than that of the conventional example, and therefore, even if the insertion end is removed during surgery, the eyeball will not collapse.

Furthermore, the insertion member can be made smaller and lighter in weight, and can be fixed by directly sewing the insertion end to the eyeball, so there is no need for the operator to support the irrigation part with his hands.

By arranging most of the light transmission part within the perfusion channel, there is no need to handle the light transmission part and the perfusion tube separately, and only one tube-shaped perfusion part can be handled, making it easier to perform surgery. It's convenient.

By using a plastic optical fiber as the light transmission part, flexibility is achieved and no extra burden is placed on the eyeballs.

A seamless plastic optical fiber is used as the light transmission section, and the majority of it is placed inside the perfusion section, so even if strong light is incident on the plastic optical fiber, which has a low softening temperature,
The irrigation fluid flowing through the irrigation channel acts as cooling water, and the optical fiber does not become hot and suffer from deformation or other problems.

[Brief explanation of the drawing]

FIG. 1 is a schematic diagram showing an example of a surgical state using a vitrectomy apparatus equipped with an embodiment of the illuminated perfusion device according to the present invention, and FIG. 2 is an enlarged sectional view showing the perfusion section.
Figure 3 is a sectional view taken along line A-A in Figure 2;
The figure is a schematic diagram showing a surgical state using a vitrectomy apparatus equipped with another embodiment of the illuminated perfusion device of the present invention;
Figure 5 is a cross-sectional view showing the structure of part of the perfusion section and light source unit shown in Figure 4, Figure 6 is a cross-sectional view taken along line B-B in Figure 5, and Figure 7 is an insert of Figure 5. The bottom view of the member, FIGS. 8a, b, and 9 are schematic diagrams showing the surgical state of the conventional example, and FIG. 10 is a sectional view of the instrument of FIG. 9. 3... Vitreous body, 7... Sclera, 13... Illuminated perfusion device, 15... Light source unit, 21... Perfusion section,
25...first light transmission section, 28...second light transmission section,
24a...insertion end, 32...perfusion path, 55...light transmission section, 70...light source.

Claims (1)

[Scope of Claims] 1. An irrigation unit having an insertion end inserted into the eyeball for perfusing irrigation fluid into the eyeball, a light source unit having a light source for intraocular illumination, and one end connected to the light source unit. and a light transmission section configured to transmit light from the light source, and at least a portion of the light transmission section on the light irradiation side is configured to be covered and protected by the perfusion section. An illuminated perfusion device featuring: 2. The illuminated perfusion device according to claim 1, wherein the light transmission section is arranged within the irrigation path from at least near the insertion end of the irrigation section to near the light source unit. 3. The illuminated perfusion device according to claim 2, wherein the light transmission section is constructed of a plastic optical fiber. 4. The plastic optical fiber is seamless, and the light source unit guides the light from the light source to the plastic optical fiber through a relay lens. Illuminated irrigator.