JPH0586229B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION Field of the Invention The present invention relates generally to intraocular lenses, and more particularly to intraocular lens implant assemblies for facilitating lens insertion and positioning and general handling during surgical procedures. It is something.

[Background of the invention]

Intraocular lenses are widely used to compensate for aphakia, the absence of a crystalline lens in humans. This involves removing the cataract by any of the known methods, including internal capping, external capping, phacoemulsification, and other methods, and then inserting an intraocular lens as a permanent implant into the eye in place of the human crystalline lens for optical compensation. It is installed by aligning the position.

[Conventional technology]

Intraocular lenses of various designs have been previously proposed as disclosed in the patents listed below. These designs of lenses vary with respect to the shape and arrangement of the optical lens body itself as well as the attachment and fixation means for fixing the lens body within the eye and permanently locating it in a stable position. In general, known intraocular lenses are comprised of a number of attachment members, commonly referred to in the industry as haptics, attached to an optical lens body, usually of a suitable plastic or glass. The contacts are typically flexible, made of plastic, and extend away from the lens body. In the final position of the lens body, the contacts contact and are supported by portions of the ocular anatomy, holding the lens body in a stable and permanent position.

The extremely small dimensions of this type of lens structure require considerable dexterity from the surgeon in its handling, intraocular insertion, and positioning.
Various instruments have already been proposed and used in this regard to reduce complexity and avoid damage to the eye, facilitate the intraocular implantation of artificial lenses, and assist the surgeon. Thus, various surgical techniques allow the surgeon to remove the sterile intraocular lens from its packaging on the operating table and prepare and load it into any suitable insertion device, such as forceps. After the lens is thus grasped by the instrument, the surgeon inserts the lens into the eye through the pupil through a suitable keratoscleral incision and according to some insertion method. Since the contacts necessarily and usually extend away from the lens body itself, they are naturally likely to get in the way during lens insertion and subsequent positioning, and may even damage ocular tissues during operation. Moreover, when the contacts extend from the lens body, a larger incision is required than when they do not.
Some surgeons have tried to overcome some of the above-mentioned difficulties by pressing the contacts against the lens body and loading at least one contact during the surgical procedure prior to insertion of the lens into the eye. I tried to overcome it. This is accomplished with the aid of an insertion device that forces the contacts onto the lens body during lens insertion, but even this requires a high degree of manual dexterity, which is often beyond the ability of the surgeon.

Moreover, this type of pre-insertion handling increases the risk of contaminating or dislodging both the lens and the insertion device. Additionally, such techniques can result in improperly securing the lens or damaging the lens or contacts.

The following US patents relate to intraocular lens structures and/or methods of intraocular positioning of such lenses. However, none of these patents suggest an intraocular lens assembly according to the present invention.

U.S. Patent No. 4056855, No. 4092743, No.
No. 4159546, No. 4014049, No. 3991426, No.
No. 4053953, No. 3866249, No. 4118808, No.
No. 4122556, No. 4257521, No. 4190049, No.
No. 4249271.

[Purpose of the invention]

A first object of the present invention is to provide an intraocular lens structure that facilitates handling, insertion, and positioning of the lens during surgery.

Another object of the present invention is to provide an intraocular lens assembly whose insertion into the eye can be accomplished safely and easily, and through a smaller incision than previously practiced.

Another object of the present invention is to provide an intraocular lens structure that can be easily inserted through the pupil.

Another object of the present invention is to provide a prepackaged intraocular lens assembly to effectively prevent contamination during surgical procedures.

In general, it is an object of the present invention to improve the technique of intraocular lens construction and the method of implanting the same into the eye as previously practiced.

[Summary of the invention]

Briefly, the intraocular lens structure according to the present invention comprises a lens body or "optic" made of a suitable plastic, glass, or the like and a plurality of spaced apart flexible contacts. Become. One end of each contact is permanently attached near the periphery of the lens body, while the other free end of each contact typically extends away from the lens body,
It is also pressed or "loaded" onto the lens body, and is temporarily held in this state by suitable holding means so that the external dimensions of the entire lens structure are approximately the same as the external dimensions of the lens body itself. Ru.

The contact is held in the loaded state approximately within the dimensional limits of the lens body itself, and in this state is inserted through the incision into the eye and possibly through the pupil, and only then is it delivered to the surgeon. It is then released or expanded into gentle contact with the surrounding ocular anatomy. This allows the surgeon to position and secure the lens structure without the contact being in the way.

It has been found that particularly good results are achieved when three equally angularly spaced contacts, preferably arcuate, are used. This allows the implant to essentially center itself within a space with normal dimensional differences due to individual differences in human eyes.

In a preferred embodiment, the contacts are arranged such that all the contacts are directed toward the lens body as desired by drawing a suitably looped thread or string through engagement means provided on each contact. Apply force and compress. The end of the thread or string is then temporarily engaged with the clasp on the lens body, but the thread can be gradually loosened when it is desired to spread the contacts again. If the position of the intraocular lens needs to be adjusted, it can be done by tightening the thread and applying force to the contact again.

Some eye surgeons prefer lens structures that load only one of the contacts. In such cases, the eye surgeon would normally use a two-contact lens, although a three-contact lens can be used as well. The invention extends to these embodiments as well.

Considered from another aspect, the present invention also provides a manipulator or insertion device that is removably secured to the lens body during insertion and positioning, and that is removed from the lens body after the lens has been positioned. be. In this case, the lens and operating tool are packaged together as a unit so that the surgeon can remove the entire lens assembly from the casing or box in which it is sterilely contained.

In a preferred embodiment, the contact is force-forced in the manner described above using a crimping thread whose distal end is removably attached to the manipulator. After inserting the lens into the eye through the incision and possibly through the pupil, the surgeon removes the thread from the handle and slowly expands and contracts the contacts until they reach the desired contact area within the eye. Then, cut the thread and take it out, and remove the operating tool from the lens body.

"Loading" should be performed by the surgeon immediately prior to insertion into the eye so as not to adversely affect the ability of the contact to expand away from the lens body and into its normal position. However, if the flexibility "memory" of the contact is not affected by long-term storage of the contact in a compressed or stressed state, compression should be It may also be done laterally. Whether compression is performed at the time of manufacture or before surgery thus depends on the memory properties of the plastic material used to manufacture the contact.

[Structure of the invention]

Embodiments of the present invention will be described below with reference to the accompanying drawings.

In the embodiment of FIGS. 1-3, each arcuate contact has a threading hole member. One of the threading holes is indicated by 8. The contacts serve as fixation members when lens structure 10 is positioned within the eye for implantation purposes. The thread or string 11 is threaded through the threading hole member 8 and through the hole 12 in the lens body 13 to form a loop (see FIG. 2). When the thread is pulled, the three contacts are brought together onto one surface of the lens body 13. It is designed so that it can be pulled towards you. When the thread is completely drawn, all three contacts are then located approximately within the limited space of the periphery of the lens body 13, and only a small portion protrudes from the periphery of the lens body. More specifically, this is shown in FIG. 3, in which the looped end 14 of the thread 11 is temporarily secured to a catch 15 on the peripheral rim portion of the lens body 13.
In this way, the flexible contacts are held in a drawn or stressed condition, with only a small portion of each contact protruding beyond the dimensional limits of the lens body.

Instead of using the threading hole member 8, various types of engagement means can be used to engage the thread. This is shown in FIG. 4, which shows an alternative embodiment of the contact in which the threading hole member of FIG. 1 is replaced by a hook recess 21. The recess 21 provides support and guidance when a thread such as the thread 11 is pulled into a loop.

The invention is not limited to the particular lenses illustrated. These specific embodiments are merely examples. Both the optical lens body and especially the contacts can be of many known shapes depending on their final position in the eye, i.e. anterior chamber, prepupillary, pupil, posterior chamber position, etc. can. In the particular design illustrated here with three equiangularly spaced contacts, when the contacts assume their final position and contact and support selected areas within the eye, the eye It was designed so that it would automatically come to the center within the inner space.

The external dimensions of the lens structure in FIG. 3 are significantly compressed compared to those in FIG. The size of the incision can also be significantly reduced, which is of course a major advantage. It is well known that surgery through minimal incisions helps prevent eye collapse during surgery and provides greater safety. Moreover, when a lens structure such as that shown in FIG. 1 is inserted and positioned by the surgeon with the contacts extended and flared away from the lens body itself,
During the insertion and positioning process, there is a risk that the contacts will cause damage or scratches to the sensory tissues and parts of the ocular anatomy. This is especially true when the lens is inserted through the pupil. According to the present invention, these difficulties can be successfully avoided. Furthermore, if the lens structure had to be inserted with the contact extending away from the lens body, the expanding contact would prevent the lens body from being positioned within the confined space. Final positioning becomes even more difficult. In contrast, when utilizing the configuration shown in FIG. 3, the surgeon uses a suitable instrument, such as a pair of tweezers, to pull the looped end 14 of the thread once the lens body is in its final position. The contact is then disengaged from the detent 15, allowing the contact to slowly expand in a controlled manner. The contact then slowly settles onto the surrounding tissue and final fixation of the lens structure is achieved. If the lens needs to be repositioned, the surgeon can pull the thread again to apply force to the contact and reposition it. Once the lens body and contacts are properly positioned, the surgeon simply cuts the thread and withdraws it through the eye incision.

Referring now to the embodiment of the invention shown in FIGS. 5, 6 and 7, the lenses in these figures are of the same construction as those in FIGS. 1-3. However, the lens body is provided with two angled grooves or depressions 22 and 23 that are shallow enough to penetrate into the periphery of the lens body 25 and not impair the optical properties of the lens body (see Figure 1). ).
A manipulator, generally designated 30, is removably connected to lens body 25 during insertion and positioning of the lens body. The operating tool 30 includes two limb members 26 and 2.
7, which are connected to each other at one end as shown at 28, while the free ends of each have angularly bent point portions 29 and 31 which form grooves or recesses 22 in the lens body. and 23, so that the pointed end engages these recesses and is temporarily fixed to the lens. Two limb members 26 of the operating tool 30
and 27 are essentially tweezers and are elastic. In order to securely hold the tip portions of the manipulator in engagement with the lens body, a strip or band 34, which may be resilient, surrounds the limb members 26 and 27 and holds the tip portions 29 and 31 in place. Hold it in a fixed position as shown in Figure 5 so that it does not move substantially.
When the two limbs are bent so that an outward force is constantly applied to each other, and the grooves of the two limbs are oriented so that the tips fit more firmly into the grooves. The strip 34 can be replaced by a spacer member which is placed between the two limbs to draw the limb members apart from each other. The contacts of the lens structure are pulled together by threads as shown in FIG. However, instead of providing a detent for the looped end of the thread on the lens body as shown in FIG.
It is held at 7. The entire assembly is packaged in a container or box, generally designated 39, as shown in FIG. 8, and is sold in a sterile condition in the container.
Although the assembly shown in Figure 8 is shown with the contacts in the compressed position, the assembly may be packaged with the threads suitably looped and the contacts in their normal expanded position. . In this case, compression is performed by a surgeon.

During a surgical operation, the surgeon opens the box 39, pinches the handle portion 28 of the operating tool, and removes the lens assembly. Once the contacts are in the expanded position, the threads are pulled to apply force to them and the ends of the threads are hooked to the catch member 37. The surgeon inserts the lens into the eye, e.g., through a small keratoscleral incision and sometimes through the pupil, and positions the lens body, e.g., in the posterior chamber of the pupil, by means of a handle that remains attached to the lens body. After that, remove the loop-shaped end of the thread,
Gently release the contacts and allow them to spread until they are stable in the ocular tissue, permanently securing the lens implant. As mentioned above, the contacts can be "retracted" again when repositioning is desired. Then cut the thread and remove it. As a result, the state essentially shown in FIG. 6 is obtained. However, it is not shown that the contact is supported on the ocular tissue and that the lens structure is fixed by conforming to the surrounding shape. When the strip or band 34 is cut after the lens structure is secured and seated in the eye, the resilient limbs move slightly outward to create an angled tip, as shown in FIG. The lens body is disengaged from the recesses 22 and 23 of the lens body. In the case of a modified embodiment in which a spacer member is provided, when this is pushed out, the tip portion is removed from the groove.

FIG. 9 shows an implementation of a lens structure similar to that in FIG. 5, but with two contacts arranged angularly apart, only one of which is subjected to a compression operation. Indicates the mode. Free contact 4
0 extends in the direction away from the lens body, and the other contact 41 is pulled by the thread passing through the threading holes 42 and 44, and the ring-shaped end of the thread is held by the retaining member 45 of the operating tool. It should be noted that When using this embodiment, the surgeon inserts the lens structure with the free contact first, finds a suitable seat for the contact within the eye, and then performs the procedure as described above or as appropriate. The thread can be manipulated to release the second contact and install the lens structure as desired.

The operating tool can be removably attached to the lens body in various embodiments consistent with the purpose and gist of the present invention, and can have various shapes and structures.

[Brief explanation of the drawing]

FIG. 1 is a plan view of a lens structure according to an embodiment of the present invention. FIG. 2 shows the lens of FIG. 1 while the contact is being drawn toward the lens body by a force applied to the thread or string. FIG. 3 shows a lens without a casing in which the thread engages a detent member to hold the contact drawn together after the contact has been drawn onto the lens body. FIG. 4 shows another embodiment of the contact. FIG. 5 is a view roughly corresponding to FIG. 3, in which the contact is compressed or applied a force so that it is below the lens body, and the lens assembly also includes an operating tool that is removably fixed to the lens body. This shows the state in which the thread is attached to the operating tool rather than the lens body. Figure 6 shows the thread being cut and removed.
6 shows the lens assembly shown in FIG. 5 after the contacts have been expanded; FIG. 7 shows the lens assembly of FIG. 5 after the lens has been firmly seated within the eye and the manipulator has been removed. FIG. 8 shows the lens assembly shown in FIG. 5 packaged in a suitable box or casing to enable sterilization. FIG. 9 shows a lens structure having two contacts, only one of which is subjected to force by a thread and a manipulating tool. 25...Lens body, 2, 3, 4... Contactor,
8, 42... Threading hole member, 10... Lens structure, 11... Thread, 12, 44... Hole in lens body, 13... Lens body, 14, 36... Ring-shaped end of thread, 15... ... Thread retaining portion, 26, 27... Two limb members, 28... Operating tool handle portion, 30... Operating tool, 29, 31... Tip portion, 34... Strip or band, 37, 45... Thread puller Fastening member, 39...
Container, 40...free contact, 41...controlled contact.

Claims (1)

[Scope of Claims] 1. A lens assembly that can be inserted into the eye to determine its position, comprising: (a) a lens body; and a free end directly in contact with the periphery of the lens body; and a plurality of flexible contacts having permanently fixed connecting ends, the free ends of the contacts being spaced generally apart from and equiangularly spaced along the periphery of the lens body. (b) the lens assembly further comprises a substantially confined space near the periphery of the lens body and one surface of the lens body before and during intraocular insertion; means for holding the contactor in a compressed state, wherein in the compressed state the overall dimensions of the lens assembly are reduced to facilitate intraocular insertion of the lens assembly; The holding means comprises a thread and the thread retaining means, and each of the contacts has a threading hole member between the free end and the connected end, and the thread is passed through the threading hole of each contact. A ring is formed so that when the thread is pulled through the member, all the free ends of the contact are drawn into the space, and the retaining means is provided on the lens body and pulls the thread. The eye is adjustable so that it can be held in the squeezed state or the thread can be removed, and the operator can expand or select the contact by keeping the thread pulled or removing it. Inner lens assembly. 2. A lens assembly adapted to be inserted into the eye and positioned, wherein: (a) the lens assembly is directly and permanently fixed to the lens body, and the free end is in contact with the periphery of the lens body; 3 with a connecting end
a flexible book contact, the free end of the contact being generally spaced apart from and equiangularly spaced along the lens body periphery;
and a flexible contact having a threading hole member, (b) when the threading hole member of each contact is passed through and squeezed, the free ends of the contacts are all connected to the periphery of the lens body and the lens. (c) a retaining means provided on the lens body, which keeps the thread in a drawn state; An intraocular lens assembly comprising: a retaining means capable of retaining and removing the thread so that nothing other than the contact protrudes from the periphery of the lens. 3. A lens assembly adapted to be inserted into the eye and positioned, wherein: (a) the lens assembly is directly and permanently fixed to the lens body, and the free end is in contact with the periphery of the lens body; 3 with a connecting end
a flexible book contact, the free end of the contact being generally spaced apart from and equiangularly spaced along the lens body periphery;
(b) a flexible contactor having a threading hole member; (b) a two-legged elastic handle portion and a lens-engaging tip portion at one end of the handle portion, wherein the lens body is connected to the tip portion of the handle portion; (c) a threading hole member for each contact having a tip-receiving notch oriented complementary thereto, the tip being removably received in the tip-receiving notch; (d) a thread forming a loop such that when pulled, all the free ends of the contact are drawn into a confined space near the periphery of the lens body and one surface of the lens body; and (d) a thread of the operating member. An intraocular lens assembly characterized in that it is combined with a thread retaining member which is provided on the handle portion and is adapted to hold the thread in a pulled state or to remove it. 4. The intraocular lens assembly according to claim 3, further comprising a casing for storing the lens assembly in a sterile state while the contact is separated from the lens body. 5. The intraocular lens assembly according to claim 3, further comprising a casing for storing the lens assembly in a sterile state while the thread is tightened.