Ophthalmologic surgery instrument, intraocular resection member and manufacturing method thereof

Abstract

To provide an ophthalmologic surgery instrument or intraocular resection member capable of constituting an instrument suitable for trabeculectomy and including a grip part used for both of first ophthalmologic surgery such as the trabeculectomy and second ophthalmologic surgery different from the first ophthalmologic surgery.SOLUTION: An ophthalmologic surgery instrument 1 comprises a grip part 2, a distal member 3, and a sleeve 4. The grip part 2 includes a first passage 7 and a second passage 8 for sucking or supplying a perfusion liquid, formed inside thereof. The grip part 2 includes a female screw part 9 formed at the tip thereof. The distal member 3 is a member for resecting an intraocular site in the first ophthalmologic surgery. The distal member 3 includes a single passage 13 in the inside, a bent-shaped blade part 16 and an opening 14 of the passage 13 at a distal side, and a male screw part 17 on a proximal side. The male screw part 17 is screwed into the female screw part 9. A distal member for treating inside the eye in the second ophthalmologic surgery can be screwed into the female screw portion 9 instead of the distal member 3.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The present disclosure relates to ophthalmic surgical instruments. [Background technology]

[0002] The following Patent Document 1 discloses an ophthalmic surgical instrument used in trabecular meshwork resection as a glaucoma surgery. The instrument in Patent Document 1 has a rod-shaped portion with a single passage formed inside. The rod-shaped portion has a bent portion and a passage opening at the tip. The bent portion is used to resect the intraocular site to be resected (trabecular meshwork). It also describes that liquid is caused to flow out of the opening in the rod-shaped portion, or the resected site is sucked into the passage from the opening. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] Patent No. 6934685 Summary of the Invention [Problem to be solved by the invention]

[0004] The instrument in Patent Document 1 has a bent portion (blade portion) at the tip, and is intended for use in surgery in which the bent portion is used to remove trabecular meshwork, etc., and is therefore difficult to apply to other ophthalmic surgeries that do not use the bent portion.

[0005] The present disclosure has been made in consideration of the above circumstances, and has an objective of providing an ophthalmic surgical instrument or an intraocular resection component that can be used to configure an instrument suitable for resecting trabecular meshwork, and that has a gripping portion that can be used in both a first ophthalmic surgery, such as a trabecular meshwork resection, and a second ophthalmic surgery different from the first ophthalmic surgery. [Means for solving the problem]

[0006] The ophthalmic surgical instrument of the present disclosure comprises: a combined gripping portion having a first passage and a second passage formed separately on the inside for supplying a suction or irrigation fluid, a first opening which is an opening of the first passage, and a second opening which is an opening of the second passage formed at the tip, the combined gripping portion being used for both the first ophthalmic surgery and the second ophthalmic surgery; an excision member for excising an intraocular site in the first ophthalmic surgery, the excision member being detachably provided at a tip of the combined grip portion, the excision member having a single passage formed therein that is conductive to the first passage, and a bent blade portion and an opening of the single passage at a tip of the excision member; the dual-purpose gripper has a screw portion at a tip to which the excision member is attached, The screw portion is formed so as to be capable of being screwed onto a distal end member for performing intraocular treatment in the second ophthalmic surgery in place of the resection member.

[0007] According to this, the resection member is detachable from the combined grip part, and the screw part of the combined grip part can be screwed with a tip member for treating the inside of the eye in the second ophthalmic surgery, instead of the resection member, so that the grip part can be used for both the first ophthalmic surgery and the second ophthalmic surgery, and the convenience of using the grip part for both purposes can be improved. In addition, since the resection member has a blade part with a curved shape, the blade part can resect the trabecular meshwork. In this case, the first ophthalmic surgery is a glaucoma surgery (specifically, a resection of the trabecular meshwork). When the resection member is attached to the combined grip part, the first passage of the combined grip part and the single passage of the resection member are electrically connected, so that, for example, the resected intraocular site (e.g., the trabecular meshwork) can be aspirated or an irrigation fluid can be supplied into the eye through the first passage and the single passage. In addition, since the resection member has a single passage, the structure of the resection member can be simplified. Furthermore, since the dual-purpose grip can be screwed with a tip member for treating inside the eye in a second ophthalmic surgery (e.g., cataract surgery) instead of the resection member, an instrument for use in the second ophthalmic surgery can be configured by attaching the tip member to the dual-purpose grip. Also, an instrument for the first ophthalmic surgery can be configured by attaching a resection member for the first ophthalmic surgery to the dual-purpose grip instead of the tip member for the second ophthalmic surgery. In this way, an ophthalmic surgical instrument that can be used for both the first and second ophthalmic surgeries can be configured by providing the dual-purpose grip, the resection member, and the tip member.

[0008] The intraocular resection member of the present disclosure comprises: A resection member for resecting an intraocular site in a first ophthalmic surgery, the resection member having a single passage formed therein, a threaded portion at a base end, and a blade portion having a bent shape at a tip end and an opening of the passage, the resection member comprising: The screw portion is detachably attached to a grip portion that is held by a user, the gripping part is a dual-purpose gripping part that is used for both the first ophthalmic surgery and the second ophthalmic surgery, the gripping part having a first passage and a second passage formed therein for supplying a suction or irrigation fluid, and a first opening that is an opening of the first passage and a second opening that is an opening of the second passage formed at a tip thereof, The gripping portion has a threaded portion to which the threaded portion is attached, The screw portion of the gripping portion is formed to be capable of being screwed onto a tip member for treating an inside of an eye in the second ophthalmic surgery, instead of the resection member; The passage of the cutting member communicates with the first passage when the cutting member is attached to the gripper.

[0009] This allows the intraocular resection component of the present disclosure used in the first ophthalmic surgery to be attached to a dual-purpose holding part that can also be used for the second ophthalmic surgery, thereby making it possible to construct an instrument suitable for resecting the trabecular meshwork and improving convenience by using the holding part for both purposes. [Brief description of the drawings]

[0010] [Figure 1] 1 is a cross section of an ophthalmic surgical instrument cut so as to include its central axis within the plane. [Diagram 2] 2 is a top view of the tip member as viewed from above the plane of the paper in FIG. 1. [Diagram 3] 2 is a bottom view of the bent portion of the tip member as viewed from below the plane of FIG. 1. [Figure 4] FIG. 2 is a perspective view of the distal end side of the gripping portion, a first distal end member for ophthalmic surgery attached thereto, a second distal end member for ophthalmic surgery, and a sleeve. [Diagram 5] FIG. 13 is a cross-sectional view showing a state in which a tip member and a sleeve for the second ophthalmic surgery are attached to a gripping portion, and is a cross-sectional view of the tip side of the instrument for the second ophthalmic surgery. [Figure 6] 1 is a diagram illustrating the tip side of a needle member that is a material for a tip member. FIG. [Figure 7] FIG. 13 is a diagram showing a first modified example of a tip member (intraocular resection member). [Figure 8] FIG. 13 is a diagram showing a second modified example of a tip member (intraocular resection member). DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0011] Hereinafter, an embodiment of the present disclosure will be described with reference to the drawings. An ophthalmic surgical instrument 1 shown in Fig. 1 is used in a surgery (first ophthalmic surgery) for removing trabecular meshwork as a treatment for glaucoma, for example. The instrument 1 includes a gripping portion 2, a distal end member 3 as an intraocular resection member, and a sleeve 4 as an outer member.

[0012] The gripping portion 2 is a portion that is gripped by the practitioner. The gripping portion 2 is a dual-purpose gripping portion that can be used for both the first ophthalmic surgery and the second ophthalmic surgery (e.g., cataract surgery). The gripping portion 2 is formed in a rod shape. More specifically, the gripping portion 2 includes an inner cylinder portion 5 and an outer cylinder portion 6. The inner cylinder portion 5 is formed in a cylindrical shape that forms a first passage 7 that extends linearly inside. The first passage 7 is located on the central axis L1 of the gripping portion 2. In other words, the central axis L1 of the first passage 7 defines the central axis of the gripping portion 2. An opening 7a (first opening) of the first passage 7 is formed at the tip of the inner cylinder portion 7. The first passage 7 is, for example, a passage for aspirating a resection site (e.g., trabecular meshwork) in the eye and drainage from the inside of the eye during ophthalmic surgery. That is, the aspirated material from the resection site flows through the first passage 7.

[0013] The outer cylinder 6 is formed in a cylindrical shape that is coaxial with the inner cylinder 5 and has a larger diameter than the inner cylinder 5 so as to surround the outside of the inner cylinder 5. A second passage 8 that extends linearly in the direction of the central axis L1 is formed inside the outer cylinder 6. The second passage 8 is formed, for example, so as to surround the outside of the inner cylinder 5. That is, the cross section of the second passage 8 perpendicular to the central axis L1 is, for example, annular. The second passage 8 is used, for example, as a passage for flowing irrigation fluid to be supplied to the inside of the eye (specifically, the anterior chamber) during ophthalmic surgery.

[0014] The gripping portion 2 has a female thread portion 9 on the tip side. The female thread portion 9 is formed on the inner surface of the first passage 7 on the tip side (the opening 7a side).

[0015] The gripping part 2 has a mounting part 10 at its tip end to which the sleeve 4 is detachably attached. The mounting part 10 is formed on the outer surface of the tip end side (opening 8a side) of the outer tube part 6. The mounting part 10 is formed so that the mounting position of the sleeve 4 in the direction of the axis L1 can be adjusted. Specifically, the mounting part 10 is formed, for example, in a shape that surrounds the entire circumference around the axis L1 and has a plurality of engagement parts (projections or grooves) in the direction of the axis L1. More specifically, the mounting part 10 may be, for example, a male screw part composed of a spiral projection or groove that advances in the direction of the axis L1 while revolving around the axis L1.

[0016] The gripping portion 2 has a first port 11 and a second port 12 on the base end side. The first port 11 is connected to the first passage 7. The first port 11 is connected to, for example, a suction portion 60 via a tube 61. The second port 12 is connected to the second passage 8. The second port 12 is connected to, for example, a liquid supply portion 50 that supplies irrigation fluid via a tube 51. Note that the liquid supply portion 50 may be connected to the first port 11, and the suction portion 60 may be connected to the second port 12. In this case, the first passage 7 functions as a passage for flowing the irrigation fluid, and the second passage 8 functions as a suction passage.

[0017] The entire grip portion 2 is positioned outside the eye during ophthalmic surgery, and does not have a portion to be inserted into the eye. The first opening 7a and the second opening 8a are positioned outside the eye during ophthalmic surgery.

[0018] The tip member 3 is an excision member that is inserted into the eye during a first ophthalmic surgery (e.g., glaucoma surgery) to excise an intraocular site (e.g., trabecular meshwork). The tip member 3 is formed in an elongated shape, specifically, in a cylindrical shape having a single linearly extending passage 13 therein. The central axis L2 of the passage 13 constitutes the central axis of the tip member 3. The tip member 3 has openings 14, 15 of the passage 13 at the tip and base ends.

[0019] The tip opening 14 is inclined with respect to the central axis L2 of the tip member 3. That is, the tip opening 14 is formed in a shape that gradually progresses in the direction of the axis L2 from one end side to the other end side in the radial direction of the tip member 3. More specifically, the tip opening 14 gradually progresses to the upper side of the paper in Fig. 1 (the side approaching a bent portion 16 described later, the side moving away from the base end 15 of the tip member 3) from the right side to the left side of the paper in Fig. 1 in the radial direction.

[0020] Here, the point 14c (see FIG. 1) closest to the base end 15 of the end face 14a (hereinafter referred to as the tip opening face) (see FIG. 2) forming the tip opening 14 is set as the lower end. In the cross section of FIG. 1, the angle θ1 between the outer shape line L0 of the tip member 3 extending linearly from the lower end 14c parallel to the central axis L2 and the tip opening face 14a is greater than 90° and smaller than 180°. Preferably, the angle θ1 is 120° or more and 160° or less. If the angle θ1 is 120° or more, the length from the lower end 14c through the corner 16b (base end) of the bent portion 16 to the tip 16a of the bent portion 16 can be increased, and the bent portion 16 can be easily formed in the manufacturing process of the tip member 3. Furthermore, if the angle θ1 is 160° or less, the distance between the lower end 14c and the bent portion 16 can be prevented from becoming too large, making it easier to suck the area (e.g., trabecular meshwork) removed by the bent portion 16 during ophthalmic surgery into the passage 13 from the tip opening 14.

[0021] The tip opening surface 14a (see FIG. 2) may be formed in a sharp shape, i.e., a blade surface. In this case, the tip opening surface 14a constitutes a blade portion capable of excising an intraocular site. The tip opening surface 14a may be formed in a non-sharp shape (obtuse angle shape).

[0022] A central axis L2 intersects with the tip opening 14. Also, when viewed in the cross section of Fig. 1 which includes the central axis L2 within its plane, the central axis L2 is located between an upper end 14b (the part farthest from the base end 15) of the tip opening surface 14a and a lower end 14c (the part closest to the base end 15) of the tip opening surface 14. Also, when viewed in the cross section of Fig. 1, the line drawn by the tip opening surface 14a from the lower end 14c to the upper end 14b is, for example, a straight line, but may be a curve or multiple straight lines with different inclinations.

[0023] The tip member 3 has a bent portion 16 at its tip, which is bent in the direction of the central axis L2 (in other words, the direction in which the passage 13 extends). The bent portion 16 is formed in a substantially triangular shape when viewed from the top in Figs. 2 and 3, where the axis L2 is perpendicular to the triangular shape. The bent portion 16 constitutes a blade for excising an intraocular site. Specifically, the tip 16a (see Figs. 1 to 3) of the bent portion 16 is formed in a sharp shape (acute angle shape). The tip 16a may also be formed in a non-sharp shape (obtuse angle shape, rounded shape).

[0024] As shown in Fig. 3, the bent portion 16 has a first blade surface 16c and a second blade surface 16d. These blade surfaces 16c and 16d extend from the base end 16b of the bent portion 16 toward the tip 16a. The distance between the blade surfaces 16c and 16d gradually decreases from the base end 16b toward the tip 16a. The blade surfaces 16c and 16d are connected at the tip 16a. A linear boundary line 16e between the blade surfaces 16c and 16d appears at the tip 16a. The thickness of the bent portion 3 at the boundary line 16e (thickness in a direction perpendicular to the paper surface of Fig. 3) gradually decreases toward the tip 16a.

[0025] The lengths of both blade surfaces 16c, 16d from the base end 16b to the tip 16a may be the same. In addition, when viewed from the direction of Fig. 3, an imaginary line L4 connecting the midpoint of the base end 16b of the bent portion 16 and the tip 16a is defined as the center line of the bent portion. The blade surfaces 16c, 16d may be formed in a shape that is line-symmetrical with respect to the center line L4 of the bent portion. The blade surfaces 16c, 16d face the tip opening 14 side. As shown in Fig. 2, no blade surface is formed on the upper surface of the bent portion 16 (the surface opposite the tip opening 14 side).

[0026] As shown in Fig. 3, the bent portion 16 has an intermediate surface 16f between the blade surfaces 16c and 16d. The intermediate surface 16f is formed in a substantially triangular shape. The intermediate surface 16f may not be curved at the position of the bent portion center line L4, that is, it may extend linearly along the bent portion center line L4. The intermediate surface 16f may be curved along a direction perpendicular to the bent portion center line L4, or may have a flat shape.

[0027] As shown in Figs. 1 and 2, the base end 16b of the bent portion 16 is located at one end in the radial direction of the main body of the tip member 3 (the portion forming the passage 13, the portion other than the bent portion 16).

[0028] The width d1 (see FIG. 1) of the bent portion 16 from the base end 16b to the tip 16a in the direction perpendicular to the axis L2 may be the same as the outer diameter d2 (see FIG. 1) of the main body of the tip member 3, or may be slightly larger than the outer diameter d2, or may be slightly smaller than the outer diameter d2. In other words, the tip 16a may be provided at a position that coincides with the outer surface 3a of the main body of the tip member 3 in the plan view of FIG. 2, or may be located slightly outside the outer surface 3a, or may be located slightly inside the outer surface 3a. The tip 16a may be located on the side farther from the base end 16b than the axis L2 (to the right of the axis L2 on the paper surface of FIG. 1).

[0029] The width d1 of the bent portion 16 is smaller than the inner diameter d3 (see FIG. 1) at the tip side of the sleeve 4. The tip 16a may be located inside the inner diameter d3 of the sleeve 4. Furthermore, the width d1 of the bent portion 16 may be smaller than the diameter of the tip opening 21b of the sleeve 4, may be the same as said diameter, or may be slightly larger than said diameter. By determining the width d1 of the bent portion 16 and the position of the tip 16a as described above, the sleeve 4 can be easily attached to the outside of the tip member 3, and the intraocular site can be easily resected.

[0030] 2, which is perpendicular to the central axis L2 of the tip member 3, the maximum width d4 of the bent portion 16 in a direction perpendicular to the center line L4 may be smaller than the outer diameter d2 of the main body of the tip member 3. In addition, the bent portion 16 has edge portions 16g and 16h that connect the base end 16b and the tip 16a of the bent portion 16 in the plan view of Fig. 2. The maximum width d4 is the maximum width between both edge portions 16g and 16h in the plan view of Fig. 2, in other words, the width of the base end 16b in a direction perpendicular to the center line L4.

[0031] The tip side of the main body of the tip member 3 (the part forming the passage 13, the part other than the bent portion 16) has a narrow width portion 3b (see FIG. 2) in which the outer width d5 ​​(see FIG. 2) in the vertical direction of the paper surface of FIG. 2 gradually decreases toward the bent portion 16 in the direction of the axis L2. The outer diameter width d5 ​​is also the outer diameter width in the direction perpendicular to the paper surface of FIG. 1. The width d5 ​​is the width in the direction perpendicular to both the central axis L2 of the tip member 3 and the center line L4 of the bent portion 16, that is, the width in the direction perpendicular to the paper surface of FIG. 1. The width d5 ​​of the narrow width portion 3b is smaller than the outer diameter d2 of the main body of the tip member 3. The width d5 ​​coincides with the width d4 of the bent portion 16 at the position of the connecting portion 16b with the bent portion 16 (the base end of the bent portion 16).

[0032] The bent portion 16 is located above the distal opening 14 (on the side farther from the base end 15 in the direction of the axis L2). The bent portion 16 is provided so as to face the distal opening 14 in the direction of the axis L2. The bent portion 16 is also provided so as to overlap a part of the distal opening 14 when viewed in the plan view of FIG. 2, where the axis L2 is perpendicular. In other words, the bent portion 16 is provided at a position where the axis L2 intersects. Specifically, the axis L2 intersects with the intermediate plane 16f (see FIG. 3).

[0033] The angle θ2 (see FIG. 1) of the bending portion 16 with respect to the axis L2 is, for example, not less than 60° and not more than 120°. FIG. 1 shows an example in which the angle θ2 is 90°. With this angle θ2, it is possible to easily resect the trabecular meshwork when the bending portion 16 is moved in a circular arc along the outer periphery of the anterior chamber.

[0034] The tip member 3 has a male thread portion 17 on the side of the base end opening 15. The male thread portion 17 is inserted into the first passage 7 from the first opening 7a of the grip portion 2, and is screwed into the female thread portion 9. The base end opening 15 is located within the first passage 7. The passage 13 of the tip member 3 and the passage 7 of the grip portion 2 are in electrical communication through the base end opening 15.

[0035] 1, the tip member 3 has a protruding portion 18 that protrudes laterally from the end of the male thread portion 17 opposite the base end opening 15. The protruding portion 18 is in contact with the end face of the inner cylindrical portion 5 of the grip portion 2.

[0036] The tip member 3 is detachably attached to the gripping portion 2 by the male thread portion 17. That is, the tip member 3 can be removed from the gripping portion 2. A part of the tip of the tip member 3 protrudes from the tip opening 21b of the sleeve 4 on the outside. Specifically, the bent portion 16 and the tip opening 14 of the tip member 3 protrude from the tip opening 21b of the sleeve 4 on the outside. The part of the tip member 3 other than the tip side is provided inside the sleeve 4. The lower end 14c side of the tip opening 14 may be provided inside the sleeve 4. When the tip member 3 is attached to the gripping portion 2, the central axis L2 of the tip member 3 coincides with the central axis L1 of the gripping portion 2.

[0037] The sleeve 4 is detachably attached to the grip portion 2 so as to cover the outside of the tip member 3. The sleeve 4 is made of a material having flexibility (in other words, elasticity) such as silicone rubber. The sleeve 4 is easily deformed when an external force is applied, and returns to its original shape when the external force is released.

[0038] The sleeve 4 has a small diameter portion 19 and a large diameter portion 20 that are arranged on the same axis L3. The cross section of the small diameter portion 19 and the large diameter portion 20 perpendicular to the central axis L3 is annular. The small diameter portion 19 and the large diameter portion 20 form a space 21 on the inside. The space 21 is formed with a diameter larger than the outer diameter of the tip member 3 so as to form a gap that serves as a passage for the irrigation fluid between the outer surface of the tip member 3 and the inner surface of the sleeve 4. Hereinafter, the space 21 may be referred to as a passage. The passage 21 formed between the tip member 3 and the sleeve 4 is formed in a ring shape that surrounds the tip member 3 when viewed in a cross section perpendicular to the axis L3.

[0039] At both ends of the sleeve 4 in the direction of the central axis L3, openings 21a and 21b of the space 21 are formed. Hereinafter, the opening 21a on the large diameter portion 20 side is referred to as the base end opening, and the opening 21b on the small diameter portion 19 side is referred to as the tip opening. The tip opening 21b is formed with a smaller diameter than the base end opening 21a. The tip opening 21b is smaller than the inner diameter d3 of the small diameter portion 19. The diameter of the tip opening 21b is equal to the outer diameter of the tip member 3. The tip opening 21b is a hole for leading the tip side (bent portion 16) of the tip member 3 out of the sleeve 4. The tip opening 21b is set to a diameter that allows the tip side of the tip member 3 to pass through. When the sleeve 4 is attached to the outside of the tip member 3, the outer peripheral edge of the tip opening 21b may contact the outer peripheral surface of the tip member 3.

[0040] The small diameter portion 19 is formed in a cylindrical shape with a smaller diameter than the large diameter portion 20. A hole 23 that is connected to the inner space 21 is formed on the tip side of the small diameter portion 19. The hole 23 is formed separately from the tip opening 21b, and is formed in a shape that penetrates between the outer peripheral surface and the inner peripheral surface of the small diameter portion 19 below the tip opening 21b. The hole 23 may be formed at multiple locations in the circumferential direction around the axis L3 (for example, two locations located 180° opposite each other), or may be formed at one location. The hole 23 functions as an outlet for the irrigation fluid. The small diameter portion 19 is a portion that is inserted into the eye during ophthalmic surgery.

[0041] The large diameter portion 20 is a portion that is located outside the eye during ophthalmic surgery. The large diameter portion 20 has a first portion 20a located on the base end opening 21a side and a second portion 20b located on the small diameter portion 19 side. The first portion 20a is a constant diameter portion whose inner and outer diameters do not change along the direction of the axis L3. The second portion 20b is formed in a shape in which the inner and outer diameters gradually become smaller as it approaches the small diameter portion 19 in the direction of the axis L3.

[0042] The first portion 20a has an attachment portion 22 on its inner surface that is detachably attached to the attachment portion 10 of the grip portion 2. The attachment portion 22 is formed so that the attachment position of the sleeve 4 in the direction of the axis L3 can be adjusted. Specifically, the attachment portion 22 is formed, for example, in a shape that surrounds the entire circumference around the axis L3 and has a plurality of engagement portions (projections or grooves) in the direction of the axis L3. More specifically, the attachment portion 22 may be, for example, a female screw portion that is composed of a spiral projection or groove that advances in the direction of the axis L3 while revolving around the axis L3.

[0043] In addition, when the mounted portion 10 of the gripping portion 2 has a plurality of engaging portions (projections or grooves) in the direction of the axis L1 of the gripping portion 2, the mounting portion 22 of the sleeve 4 may have a shape other than a female thread portion that engages with any of the plurality of engaging portions. Conversely, when the mounting portion 22 of the sleeve 4 has a plurality of engaging portions (projections or grooves) in the direction of the axis L3 of the sleeve 4, the mounted portion 10 of the gripping portion 2 may have a shape other than a male thread portion that engages with any of the plurality of engaging portions.

[0044] The sleeve 4 is attached to the gripping portion 2 so that a portion of the tip side of the gripping portion 2 is inserted into the large diameter portion 20 while covering the tip member 3. When the sleeve 4 is attached to the gripping portion 2, the second passage 8 of the gripping portion 2 and the passage 21 of the sleeve 4 are electrically connected via the second opening 8a of the gripping portion 2. Furthermore, when the sleeve 4 is attached to the gripping portion 2, the central axis L3 of the sleeve 4 coincides with the central axis L2 of the tip member 3.

[0045] The sleeve 4 may be a member that is used for both a first ophthalmic surgery (e.g., glaucoma surgery) and a second ophthalmic surgery (e.g., cataract surgery). That is, when a distal end member 30 (see Figs. 4 and 5) for the second ophthalmic surgery described below is attached to the gripping portion 2 instead of the distal end member 3, the sleeve 4 may be attachable to the gripping portion 2 so as to cover the outside of the distal end member 30. Note that a sleeve for the second ophthalmic surgery (not shown) having a different shape from the sleeve 4 for the first ophthalmic surgery may be provided.

[0046] 4, the above-mentioned tip member 3 for the first ophthalmic surgery and the tip member 30 for the second ophthalmic surgery can be selectively attached to the gripping part 2. That is, the tip member 30 can be attached to the gripping part 2 in place of the tip member 3, and conversely, the tip member 3 can be attached in place of the tip member 30.

[0047] The tip member 30 is a member for treating the inside of the eye in, for example, cataract surgery. In cataract surgery, for example, a first procedure is performed in which the inside of the lens is crushed and emulsified by ultrasound while irrigation water is supplied to the treatment site, and the emulsified tissue within the lens is aspirated together with the irrigation water. After most of the inside of the lens is removed in the first procedure, a second procedure is performed in which the remaining tissue, such as the cortex of the lens capsule, is aspirated while irrigation water is supplied. The tip member 30 may be a member for performing the first procedure (crushing, irrigation, aspirating) or the second procedure (irrigation, aspirating).

[0048] In the examples of Fig. 4 and Fig. 5, the tip member 30 for performing the second treatment is illustrated. As shown in Fig. 5, the tip member 30 is formed in an elongated shape, specifically, in a cylindrical shape having a single linearly extending passage 32 on the inside. The tip 31 of the tip member 30 does not have a part (such as a blade part or an ultrasonic vibration part) for crushing, cutting, etc. the treatment site, and is formed, for example, in a curved shape. In addition, a hole 33 that is conductive to the inner passage 32 is formed on the side surface on the tip 31 side of the tip member 30.

[0049] The base end side of the tip member 30 may be formed in the same shape as the first tip member 3 for ophthalmic surgery. That is, an opening 32a of the passage 32 is formed at the base end of the tip member 30. In addition, a male screw portion 34 is formed at the base end 32a side of the tip member 30. The male screw portion 34 can be inserted into the first passage 7 from the first opening 7a of the grip portion 2 and screwed into the female screw portion 9 of the grip portion 2.

[0050] In a state where the tip member 30 and the sleeve 4 are attached to the grip portion 2, the passage 32 of the tip member 30 and the first passage 7 of the grip portion 2 are electrically connected via the base end opening 32a of the tip member 30. In addition, the passage 21 formed between the sleeve 4 and the tip member 30 and the second passage 8 of the grip portion 2 are electrically connected via the second opening 8a of the grip portion 2. In addition, the tip side (tip 31 and hole 33) of the tip member 30 protrudes to the outside from the tip opening 21b of the sleeve 4.

[0051] For example, when performing the second procedure described above, irrigation fluid is supplied into the eye via the second passage 8 of the gripping portion 2, the passage 21 in the sleeve 4, and the hole 23, while tissue such as the cortex of the lens capsule is aspirated via the hole 33, the passage 32 in the tip member 30, and the first passage 7 of the gripping portion 2.

[0052] Returning to the explanation of FIG. 1, the first ophthalmic surgical instrument 1 includes the above-mentioned gripping part 2, tip member 3, and sleeve 4. The procedure for obtaining the instrument 1 by combining the parts 2 to 4 will be explained below. First, the gripping part 2, tip member 3, and sleeve 4 are prepared in a mutually separated state. When the tip member 30 and sleeve 4 for the second ophthalmic surgical instrument are attached to the gripping part 2 as shown in FIG. 5, the tip member 30 and sleeve 4 are removed from the gripping part 2. In this case, the sleeve 4 is first removed from the gripping part 2 and tip member 30 by pulling it upward on the paper surface of FIG. 5. Next, the tip member 30 is rotated around its central axis to release the screw engagement between the threaded parts 34, 9 of the tip member 30 and the gripping part 2, thereby removing the tip member 30 from the gripping part 2.

[0053] After preparing the gripping portion 2, the tip member 3, and the sleeve 4, the tip member 3 is attached to the gripping portion 2. Specifically, the threaded portions 9, 17 of the gripping portion 2 and the tip member 3 are screwed together. Next, the sleeve 4 is attached to the gripping portion 2 and the tip member 3. Specifically, the tip member 3 is inserted from its tip side into the space 21 from the base end opening 21a side of the sleeve 4. Then, the bent portion 16 of the tip member 3 is brought outward from the tip opening 21b of the sleeve 4, and the mounting portion 22 of the sleeve 4 and the attached portion 10 of the gripping portion 2 are engaged. At this time, the sleeve 4 is moved in the direction of the axis L3 or rotated around the axis L3 to adjust the engagement position of the mounting portion 22 and the attached portion 10, that is, the mounting position in the direction of the axis L3 of the sleeve 4 (in other words, the amount of protrusion of the bent portion 16 from the tip opening 21b of the sleeve 4) is adjusted. At this time, the amount by which the bent portion 16 protrudes from the tip opening 21b of the sleeve 4 may be different from the amount by which the tip 31 of the tip member 30 in Fig. 5 protrudes from the tip opening 21b, and may be, for example, larger than the amount by which the tip 31 protrudes from the tip opening 21b. With the above, the instrument 1 is completed.

[0054] Moreover, when disassembling the instrument 1 into each part 2, 3, 4, the steps for assembling the parts 2, 3, 4 can be carried out in reverse order. That is, first, the sleeve 4 is pulled upward on the paper surface of FIG. 1 to remove it from the grip part 2 and the tip member 3. Next, the tip member 3 is rotated around its central axis L3 to release the screw engagement between the threaded parts 17, 9 of the tip member 3 and the grip part 2, thereby removing the tip member 3 from the grip part 2. This allows the grip part 2 to be used for another ophthalmic surgery.

[0055] The tip member 3 may be manufactured, for example, as follows. First, as shown in FIG. 6, a needle member 100 with an unbent tip is prepared. The needle member 100 has a passage 101 inside that penetrates from the base end to the tip. An opening 102 of the passage 101 is formed at the tip of the needle member 100. The opening 102 and an end surface 103 around it are inclined with respect to the central axis of the needle member 100. The end surface 103 is formed in a sharp shape, that is, a blade surface. The blade surface 103 includes a first blade surface 104 and a second blade surface 105 located on the tip side of the first blade surface 104. A boundary line 106 between the first blade surface 104 and the second blade surface 105 is visible on the blade surface 103. The tip 107 of the blade surface 103 is, for example, sharp, but may be non-sharp. The width between the blade surface 103 located to the left of the opening 102 and the blade surface 103 located to the right of the opening 102 gradually decreases toward the tip 107. That is, the tip side of the needle member 100 has a narrow portion 108 whose outer width d6 in the left-right direction of the paper surface of Figure 6 gradually decreases toward the tip 107. The outer width d6 of the narrow portion 108 is smaller than the outer diameter of the needle member 100.

[0056] By performing bending processing on the tip surface 103 of the needle member 100, a part of the tip surface 103 on the tip 107 side (specifically, for example, narrow width portion 108 (part of second blade surface 105)) is bent. This bent portion corresponds to the bent portion 16 of the tip member 3. Moreover, the second blade surface 105 in the bent portion corresponds to the blade surfaces 16c, 16d of the bent portion 16 (see FIG. 3).

[0057] Furthermore, the base end side of the needle member 100 may be machined in advance into a shape similar to that of the base end side of the tip member 3 (i.e., a male thread shape) before bending the tip side, or may be machined into a shape similar to that of the base end side of the tip member 3 after bending the tip side. In this manner, the tip member 3 is obtained.

[0058] The instrument 1 is used in, for example, a trabecular meshwork resection operation for treating glaucoma as a first ophthalmic surgery. In this case, the suction unit 60 is connected to the first port 11 of the gripping unit 2. The liquid supply unit 50 is connected to the second port 12. The practitioner holds the gripping unit 2 and inserts the tip member 3 from the outer periphery of the cornea of ​​the patient's eye into the anterior chamber. Then, the liquid supply unit 50 is operated to supply irrigation fluid to the anterior chamber via the second passage 8 of the gripping unit 2, the passage 21 in the sleeve 4, and the hole 23. The supply of irrigation fluid can prevent the anterior chamber from shrinking, and can prevent a large amount of blood from flowing into the anterior chamber due to the resection of the trabecular meshwork.

[0059] The bending portion 16 is positioned on the outer periphery of the anterior chamber opposite to the outer periphery of the cornea into which the tip member 3 is inserted. The tip 16a of the bending portion 16 is inserted into the trabecular meshwork while piercing the trabecular meshwork with the tip 16a to form an incision that will be the starting point for resection. The tip 16a is then advanced along the outer periphery of the anterior chamber, which is the extension direction of the trabecular meshwork, so that the bending portion 16 resects the trabecular meshwork along the advancing direction. At this time, the trabecular meshwork cut by the bending portion 16 is guided by the inner surface of the bending portion 16 and the oblique tip opening surface 14a continuous therewith, and is drawn out to the front side. The suction portion 60 is operated to suck the cut trabecular meshwork to the suction portion 60 through the tip opening 14 and passage 13 of the tip member 3 and the first passage 7 of the gripping portion 2. The supply of the irrigation fluid and the suction of the trabecular meshwork may be operated simultaneously, or may be operated at different times during surgery.

[0060] As described above, in this embodiment, the tip of the tip member 3 has the blade portion 16 (bent portion) having a bent shape, which makes it easy to excise the trabecular meshwork. In addition, the tip member 3 is provided separately from the gripping portion 2 and has a structure having a single passage 13, so that the structure of the tip member 3 can be simplified.

[0061] The gripping portion 2 has the first passage 7 and the second passage 8, so that it can easily perform both the supply of irrigation fluid and the suction of the resection site such as the trabecular meshwork. The gripping portion 2 can be used for both the first ophthalmic surgery and the second ophthalmic surgery, improving convenience.

[0062] Since the mounting position of the sleeve 4 in the axial direction is adjustable, the sleeve 4 can be used for both the first and second ophthalmic surgeries. For example, in the first ophthalmic surgery, trabecular meshwork resection, it is necessary to position the bending portion 16 from the outer periphery of the cornea into which the tip member 3 is inserted to the back side of the anterior chamber. By adjusting the mounting position of the sleeve 4 to a lower position in the plane of FIG. 1, the portion of the instrument 1 that can be inserted into the eye (the small diameter portion 19 of the sleeve 4 and the tip side portion of the tip member 3 protruding from the small diameter portion 19) can be lengthened. This makes it easier to position the bending portion 16 at the back side of the anterior chamber.

[0063] In addition, since the sleeve 4 has flexibility, the sleeve 4 can be easily attached to the gripping portion 2 and the tip members 3 and 30. Even if the width d1 (see FIG. 1) of the bent portion 16 is slightly larger than the diameter of the tip opening 21b of the sleeve 4, the flexibility of the sleeve 4 allows the tip opening 21b to be elastically deformed to match the width d1 of the bent portion 16 while passing the bent portion 16 through the tip opening 21b. Furthermore, by attaching the sleeve 4, it is possible to prevent aqueous humor in the eye from leaking out even if the corneal incision for inserting the tip member 3 into the eye is large.

[0064] The present disclosure is not limited to the above embodiment and various modifications are possible. For example, in the above embodiment, an example in which the main body of the tip member 3 is linear is shown, but it may be curved as shown in Figs. 7 and 8. The tip member 40 in Fig. 7 has a cylindrical main body 41 having a single passage inside, a bent blade portion 42 provided at the tip of the main body 41, and a threaded portion 43 provided at the base end of the main body 41. The main body 41 is curved, and specifically, is formed in a curved shape that gradually moves away from the axis L5 of the threaded portion 43 (in other words, the axis L1 of the grip portion 2 in Fig. 1) as it moves from the base end (threaded portion 43) to the tip (blade portion 42). The blade portion 42 is formed in a shape similar to the bent portion 16 in Figs. 1 to 3. The threaded portion 43 is formed in a shape similar to the threaded portion 17 in Fig. 1.

[0065] The tip member 50 in FIG. 8 has a cylindrical main body 51 having a single passage inside, a bent blade portion 52 provided at the tip of the main body 11, and a threaded portion 53 provided at the base end of the main body 51. The main body 51 is curved, specifically, has a first portion 51a provided at the base end side (the threaded portion 53 side) and a second portion 51b provided at the tip side (the blade portion 52 side) continuing from the first portion 51a. The first portion 51a is formed in a curved shape that gradually moves away from the axis L6 of the threaded portion 53 (in other words, the axis L1 of the grip portion 2 in FIG. 1) as it moves from the base end toward the second portion 51b. The second portion 51b is formed in a curved shape that gradually approaches the axis L6 as it moves toward the tip side. The blade portion 52 is formed in a shape similar to the bent portion 16 in FIG. 1 to FIG. 3. The threaded portion 53 is formed in a shape similar to the threaded portion 17 in FIG. 1.

[0066] In the above embodiment, an example was shown in which the sleeve 4 was attached to the gripping portion 2 and the tip member 3, but it is not necessary to attach them. For example, if the corneal incision is small, the outflow of aqueous humor from within the eye can be suppressed even without attaching the sleeve 4. Furthermore, if the sleeve 4 is not attached, ophthalmic surgery may be performed without using the second passage 8 of the gripping portion 2. [Explanation of symbols]

[0067] 1 Ophthalmic surgical instruments 2 Grip part 3, 40, 50: First ophthalmic surgical tip member (intraocular resection member) 4 Sleeve (outer member) 7 First passage of the gripper 8 Second passage of the gripper 9. Female thread of grip 13 Passage of tip components 14 Tip opening of tip member 16, 42, 52 Bending section (blade section) 17, 43, 53 Male thread of tip part 30 Second ophthalmic surgical tip

Claims

1. a combined gripping portion having a first passage and a second passage formed separately on the inside for supplying a suction or irrigation fluid, a first opening which is an opening of the first passage, and a second opening which is an opening of the second passage formed at the tip, the combined gripping portion being used for both the first ophthalmic surgery and the second ophthalmic surgery; an excision member for excising an intraocular site in the first ophthalmic surgery, the excision member being detachably provided at a tip of the combined grip portion, the excision member having a single passage formed therein that is conductive to the first passage, and a bent blade portion and an opening of the single passage at a tip of the excision member; the dual-purpose gripper has a screw portion at a tip to which the excision member is attached, The screw portion is formed to be capable of being screwed onto a distal end member for treating an intraocular space in the second ophthalmic surgery in place of the resection member. Eye surgery instruments.

2. 2. The ophthalmic surgical instrument according to claim 1, further comprising: an outer member that is detachably provided at the tip of the dual-purpose grip portion so as to cover the outside of the cutting member when the cutting member is attached to the dual-purpose grip portion, a tip opening is formed through which the tip side of the cutting member protrudes, and a passage is formed that is conductive to the second passage via the second opening, and the outer member has an opening for the passage.

3. the outer member includes a large diameter portion that is positioned outside the eye during surgery, and a small diameter portion that is formed to have a smaller diameter than the large diameter portion and is inserted into the eye during surgery; the large diameter portion has an attachment portion that is detachably attached to the dual-purpose grip portion, the dual-purpose grip portion has a mounting portion to which the mounting portion is attached, The ophthalmic surgical instrument according to claim 2 , wherein the mounting portion and the mounted portion are formed so that a mounting position of the outer member in an axial direction can be adjusted.

4. 3. The ophthalmic surgical instrument of claim 2, wherein the width of the blade portion perpendicular to the central axis of the resecting member is less than an inner diameter of the outer member.

5. A resection member for resecting an intraocular site in a first ophthalmic surgery, the resection member having a single passage formed therein, a threaded portion at a base end, and a blade portion having a bent shape at a tip end and an opening of the passage, the resection member comprising: The screw portion is detachably attached to a grip portion that is held by a user, the gripping portion has a first passage and a second passage formed separately on the inside thereof for supplying a suction or irrigation fluid, and has a first opening which is an opening of the first passage and a second opening which is an opening of the second passage formed at a tip thereof, and is a dual-purpose gripping portion that can be used for both the first ophthalmic surgery and the second ophthalmic surgery, The gripping portion has a threaded portion to which the threaded portion is attached, The screw portion of the gripping portion is formed to be capable of being screwed onto a tip member for treating an inside of an eye in the second ophthalmic surgery, instead of the resection member; The passage of the excision member is connected to the first passage when the excision member is attached to the gripping portion. An intraocular resection device.

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