WO2016208725A1

WO2016208725A1 - Intraocular lens insertion instrument, intraocular lens extraction assistance tool, and method for manufacturing intraocular lens insertion instrument

Info

Publication number: WO2016208725A1
Application number: PCT/JP2016/068852
Authority: WO
Inventors: 小林　研一; 修治安部; 玄洋翠川
Original assignee: 興和株式会社
Priority date: 2015-06-25
Filing date: 2016-06-24
Publication date: 2016-12-29
Also published as: JPWO2016208725A1; JP7042083B2

Abstract

Provided is an intraocular lens insertion instrument whereby operability of a plunger is enhanced. The intraocular lens insertion instrument according to the present invention is provided with: a substantially cylindrical instrument body having at a distal end thereof an insertion cylinder for inserting an intraocular lens into an eye; an intraocular lens extrusion member for pressing an intraocular lens, moving the intraocular lens to the insertion cylinder, and pushing the intraocular lens out into the eye, the intraocular lens extrusion member being provided so as to be able to slide through the inside of the instrument body; a cylindrical member fixed to the instrument body; a fluid supply means for supplying a fluid into the cylindrical member; and a moving member for moving due to pressure of the supplied fluid, the moving member being provided in the cylindrical member; the intraocular lens extrusion member being configured so as to slide through the inside of the instrument body by being pushed by the moving member.

Description

Intraocular lens insertion device, intraocular lens pushing aid, and method for manufacturing intraocular lens insertion device

The present invention relates to an intraocular lens insertion device, an intraocular lens pushing aid, and a method for manufacturing an intraocular lens insertion device.

Intraocular lenses that are inserted as a substitute for the crystalline lens in order to correct the refraction by replacing the human turbid crystalline lens in the treatment of cataract are in practical use. In intraocular lens insertion surgery in the treatment of cataracts, for example, a few millimeters of incision wound (incision) is provided at the edge of the cornea, cornea, etc., and the lens is crushed by ultrasonic phacoemulsification, etc. After removal, the intraocular lens is inserted and fixed by an intraocular lens insertion device. In recent years, techniques for assisting insertion of an intraocular lens into the eye using an intraocular lens insertion device have been proposed (for example,

Patent Documents

1, 2, and 3).

JP 2004-261263 A Special table 2012-505066 gazette International Publication No. 2008/149927

In a conventional intraocular lens insertion device, the intraocular lens housed in the intraocular lens housing portion of the device body is moved by the plunger to move within the device body and is released from the device body into the eye. . The surgeon performs an operation of releasing the intraocular lens into the eye by pushing the plunger toward the instrument body with a finger.

However, during a series of operations in which the surgeon pushes the plunger with a finger to release the intraocular lens from the instrument body into the eye, the plunger is at that moment when the intraocular lens is released from the distal end of the insertion instrument. The resistance force received from the intraocular lens instantaneously decreases. At this time, if the surgeon does not loosen the force of pressing the plunger, the plunger may protrude vigorously from the instrument body. As described above, when the surgeon pushes the plunger with a finger, the surgeon needs to adjust the force for pushing the plunger according to the movement state of the intraocular lens.

The technology disclosed herein has been made in view of the above circumstances, and an object thereof is to provide an intraocular lens insertion instrument that improves the operability of the plunger.

The intraocular lens insertion instrument of the present disclosure is provided with a substantially cylindrical instrument body having an insertion cylinder part at the tip for inserting an intraocular lens into the eye, and slidable within the instrument body, and presses the intraocular lens. An intraocular lens pushing member that is moved to the insertion tube and pushed into the eye, a tubular member fixed to the instrument body, a fluid supply means for supplying fluid into the tubular member, and a tubular member And a moving member that moves under the pressure of the supplied fluid, and the intraocular lens pushing member slides in the instrument main body by being pushed by the moving member. Accordingly, the surgeon can move the intraocular lens pushing member by using the movement of the moving member pushed by the fluid without pushing the intraocular lens pushing member with a finger or the like. The member can be moved.

The cylindrical member extends in the sliding direction of the intraocular lens pushing member, and the moving member is a plate wall that partitions the inside of the cylindrical member into a first region and a second region, and the intraocular lens The pushing member is disposed in the second region, the fluid is supplied to the first region by the fluid supply means, and the moving member is the inner wall of the cylindrical member by the pressure of the fluid supplied to the first region. It is good also as a structure which moves, contacting.

Furthermore, the plate wall body may have an elastic member that comes into contact with the inner wall of the cylindrical member. In addition, the cross-sectional area of the cross section of the plate wall body in the plane perpendicular to the sliding direction of the intraocular lens pushing member may be larger than the cross-sectional area of the cross section of the instrument main body in the plane perpendicular to the sliding direction. The fluid supply means may have a supply port for supplying fluid into the cylindrical member, and the inner diameter of the supply port may be smaller than the inner diameter of the cylindrical member. Furthermore, a tube formed of a flexible member can be connected to the supply port of the fluid supply means. The fluid supply means has a supply port for supplying a fluid into the cylindrical member, and an intraocular lens insertion device is further connected to the supply port. In addition, it may be configured to include a flow path switching means for switching between a fluid flow path and a flow path different from the fluid flow path, and a syringe barrel connected to the separate flow path. Alternatively, the fluid supply means has a supply port for supplying the fluid in the cylindrical member, and an intraocular lens insertion device is further connected to the supply port, and is formed by a flexible member and a tube. It is good also as a structure provided with the flow-path opening-and-closing means which controls interruption | blocking and opening | release of the fluid flow path.

The intraocular lens push-out assisting tool of the present disclosure includes a cylindrical member that is fixed to a substantially cylindrical instrument body that has an insertion cylindrical portion at the tip for inserting the intraocular lens into the eye, and a fluid in the cylindrical member. And a fluid supply means provided in the cylindrical member and moving with the pressure of the fluid supplied, and provided in a slidable manner within the instrument body, pressing the intraocular lens The intraocular lens pushing member that is moved to the insertion tube and pushed into the eye slides inside the instrument body when pushed by the moving member.

Further, a manufacturing method of the intraocular lens insertion device of the present disclosure is a manufacturing method for the above intraocular lens insertion device, the step of inserting an intraocular lens extrusion member into the device body, and an intraocular lens extrusion member After the step of inserting, there is a step of fixing the cylindrical member provided with the fluid supply means and the moving member to the instrument body. Alternatively, as another manufacturing method, after the step of inserting the intraocular lens pushing member into the cylindrical member provided with the fluid supply means and the moving member and the step of inserting the intraocular lens pushing member, The manufacturing method may include a step of fixing the instrument body. Alternatively, as yet another manufacturing method, a step of inserting an intraocular lens extruding member into a cylindrical member formed integrally with the instrument body in advance, a step of inserting an intraocular lens extruding member into the cylindrical member, A manufacturing method including a step of providing fluid supply means on the cylindrical member may be used.

The intraocular lens insertion device of the present disclosure manufactured by the manufacturing method as in the above three examples may be shipped from the manufacturing site as a product only for the insertion device and distributed to the market. The intraocular lens may be housed in an intraocular lens insertion device, and the product may be shipped from the manufacturing site and distributed to the market as a product in which the insertion device and the lens are integrated, ie, a so-called preload type (preset type) product.

According to the technique disclosed herein, an intraocular lens insertion device that improves the operability of the plunger can be provided.

It is a figure which shows schematic structure of the intraocular lens insertion instrument in one Embodiment. It is a figure which shows schematic structure of the intraocular lens in one Embodiment. It is a figure which shows schematic structure of the nozzle main body in one Embodiment. It is a figure which shows schematic structure of the positioning member in one Embodiment. It is a figure which shows schematic structure of the plunger in one Embodiment. FIG. 6A and FIG. 6B are diagrams illustrating the movement of the plunger of the intraocular lens insertion device in one embodiment. Fig.7 (a) and FIG.7 (b) are figures which show the manufacturing method of the intraocular lens insertion instrument in one Embodiment. FIG. 8A and FIG. 8B are diagrams showing a method for manufacturing an intraocular lens insertion device in one modification. FIG. 9A and FIG. 9B are diagrams showing a method for manufacturing an intraocular lens insertion device in one modification. FIG. 10A and FIG. 10B are diagrams showing a schematic configuration of an intraocular lens insertion device according to a modification. FIG. 11 is a diagram illustrating a schematic configuration of an intraocular lens insertion device according to a modification. FIG. 12 is a diagram illustrating a schematic configuration of an intraocular lens insertion device according to a modification.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.

〔Example〕
In FIG. 1, schematic structure of the intraocular lens insertion instrument 1 of this embodiment is shown. 1A is a plan view of the intraocular lens insertion instrument 1 when the stage lid 13 is opened, and FIG. 1B is a side view of the intraocular lens insertion instrument 1 when the stage lid 13 is closed. The figure is shown. The intraocular lens insertion instrument 1 includes a nozzle body 10 as an instrument body, a plunger 30 as an intraocular lens pushing member, a stage unit 12 and a stage lid unit 13 as an intraocular lens storage unit, And an intraocular lens push-out assisting tool 20 that assists in pushing out the lens. The stage unit 12 is provided integrally with the nozzle body 10 or separately. A plunger 30 is inserted into the nozzle body 10. The intraocular lens 2 is set on the stage unit 12. The stage lid portion 13 is formed integrally with the stage portion 12. The intraocular lens extrusion assisting tool 20 is a hollow cylindrical member, and one end thereof is engaged with the holding portion 11 of the nozzle body 10. In addition, the shape of the intraocular lens extrusion assisting tool 20 is not limited to a cylinder, and can be formed in an arbitrary shape.

The nozzle main body 10 of the intraocular lens insertion device 1 is formed in a cylindrical shape having a substantially rectangular cross section, and one end of the nozzle body 10 is greatly open (hereinafter, the side having the large opening is referred to as the rear end 10b), and the other side. The nozzle part 15 and the front-end | tip part 10a narrowed down are provided in the edge part. As shown in FIG.1 (b), the front-end | tip part 10a is opening diagonally. The plunger 30 is inserted into the nozzle body 10 and can reciprocate.

In the following description, the direction from the rear end 10b of the nozzle body 10 to the front end 10a is the front direction, the opposite direction is the rear direction, the front side of the page in FIG. 1A is the upper direction, and the reverse direction is the lower direction. In FIG. 1B, the front side of the page is the left direction, and the opposite direction is the right direction. In this case, the upper side is the front side of the optical axis of the lens body 2a, which will be described later, the lower side is the rear side of the optical axis of the lens body 2a, the front side is the front side in the pressing direction by the plunger 30, and the rear side is pressed by the plunger 30 Corresponds to the rear side.

In the vicinity of the rear end portion 10b of the nozzle body 10, there is integrally provided a holding portion 11 that protrudes like a plate and can be hooked by the user when the plunger 30 is pushed into the front end side of the nozzle body 10. It has been. A stage portion 12 for setting the intraocular lens 2 is provided on the rear side of the nozzle portion 15 in the nozzle body 10. The stage portion 12 is configured such that the upper side of the nozzle body 10 is opened by opening the stage lid portion 13. Further, a positioning member 50 is attached to the stage portion 12 from the lower side of the nozzle body 10. By this positioning member 50, the intraocular lens 2 is stably held in the stage portion 12 even before use (during transportation).

That is, in the intraocular lens insertion instrument 1, the intraocular lens 2 is placed on the stage unit 12 and the front side of the optical axis is in a state where the stage lid unit 13 is opened and the positioning member 50 is attached to the stage unit 12. Set to be on top. Then, after the stage lid 13 is closed, it is shipped and sold. Then, the user removes the positioning member 50 with the stage lid portion 13 closed, and then pushes the plunger 30 into the distal end side of the nozzle body 10. As a result, the intraocular lens 2 is pressed by the plunger 30 and moved to the nozzle part 15, and then the intraocular lens 2 is released into the eyeball from the distal end part 10 a. In addition, the nozzle main body 10, the plunger 30, and the positioning member 50 in the intraocular lens insertion device 1 are formed of a resin material such as polypropylene. Polypropylene is a material with a proven track record in medical equipment and high reliability such as chemical resistance.

The intraocular lens extrusion assisting tool 20 has a cylindrical tubular member 20 a extending in the extending direction of the plunger 30 inserted into the nozzle body 10. Moreover, the through-hole 20b which penetrates the cylindrical member 20a is provided in the side surface of the cylindrical member 20a. A packing 20c as a moving member is provided on the rear end side of the cylindrical member 20a so as to contact the inner wall of the cylindrical member 20a. The packing 20c is slidably provided on the inner wall while being in close contact with the inner wall of the cylindrical member 20a. It is desirable that the packing 20c has a rigidity that does not bend when sliding. However, even when the packing 20c does not have such rigidity, if the outer diameter L2 of the pressing plate portion 33 is set to be approximately equal to the inner diameter of the packing 20c, the packing 20c can be prevented from being bent during sliding. . Furthermore, if the diameter of the packing 20c is larger than the inner diameter L1 of the cylindrical member 20a, the pushing load on the packing 20c when the packing 20c is slid increases, and from there, the pushing out as the diameter of the packing 20c approaches the inner diameter L1. The load becomes smaller. Furthermore, the rear end of the intraocular lens extrusion assisting tool 20 is provided with a fluid supply unit 20d as a fluid supply means for supplying a fluid to a space surrounded by the intraocular lens extrusion assisting tool 20 and the packing 20c. Yes.

Further, a region surrounded by the cylindrical member 20a, the packing 20c, and the fluid supply unit 20d is a sealed space. Of the space surrounded by the cylindrical member 20a, the region on the fluid supply part 20d side is defined as the first region 20f with the packing 20c as a boundary, and the region on the plunger 30 side inserted into the nozzle body 10 is defined as the second region. The region 20g. The through-hole 20b has a function of causing the fluid supplied to the first region 20f to flow out of the intraocular lens push-out assisting tool 20.

Furthermore, an engagement portion 20 h for engaging with the hold portion 11 of the nozzle body 10 is provided on the distal end side of the intraocular lens push-out assisting tool 20. As shown in FIG. 1B, in this embodiment, since the holding portion 11 of the nozzle body 10 extends in the vertical direction, the engaging portion 20h is an intraocular lens in a state of being received by the nozzle body 10. A pair of extrusion assisting tools 20 are provided in the vertical direction. Each engagement portion 20h is provided with a through hole 20i through which a part of the hold portion 11 passes.

When the intraocular lens push-out assisting tool 20 is attached to the nozzle body 10, both ends of the hold part 11 of the nozzle body 10 are inserted through the through holes 20i of the engaging part 20h. Further, notches 11 a are provided at both ends of the hold unit 11. For this reason, once the engaging part 20h of the intraocular lens pushing auxiliary tool 20 is attached to the hold part 11, the engagement between the engaging part 20h and the hold part 11 is not released by the notch 11a. Note that the notch may be provided in the engaging portion 20h instead of the holding portion 11 or in addition to the holding portion 11 as long as the engaging portion 20h and the holding portion 11 are not disengaged. When the intraocular lens extrusion assisting tool 20 is attached to the nozzle main body 10, at least one of the intraocular lens extrusion assisting tool 20 and the nozzle main body 10 is connected so that the second region 20 g does not become a sealed space. It is necessary to provide an opening structure. This is because the air existing in the second region 20g before the attachment of the intraocular lens pushing aid 20 and the nozzle body 10 needs to be discharged to the outside as the packing 20c moves.

An opening 20e through which the fluid supplied from the tube 40 passes is provided on the rear end face of the fluid supply unit 20d. The fluid supply unit 20d has a front side connected to the rear end of the cylindrical member 20a and a rear side connectable to the tip of the tube 40. An inner diameter L1 of the cylindrical member 20a is provided to be larger than an outer diameter L2 of the pressing plate portion 33 of the plunger 30. In addition, when the inflow amount per unit time of the fluid to be supplied is constant, the pushing speed of the packing 20c and the plunger 30 becomes slower as the inner diameter L1 of the cylindrical member 20a becomes larger, but the stability by the stronger pushing force is increased. Extrusion is possible. On the other hand, the opening diameter L3 of the opening 20e of the fluid supply unit 20d is provided to be smaller than the inner diameter L1 of the cylindrical member 20a. And the opening 20e is made into the dimension which can be engaged with the internal diameter or outer diameter of a general medical tube. Alternatively, the opening 20e and the tube 40 may be connected via a connector. A highly versatile medical tube can be connected to the fluid supply unit 20d, and it is not necessary to prepare a special tube. In addition, a fluid supply source (not shown) for supplying fluid into the first region 20f is connected to the other end of the tube 40 connected to the fluid supply unit 20d. Examples of the fluid supply source include a compressor for supplying compressed air and a pump for supplying cold / hot water.

FIG. 2 is a diagram showing a schematic configuration of the intraocular lens 2. 2A is a plan view and FIG. 2B is a side view. The intraocular lens 2 is a so-called three-piece type. The intraocular lens 2 is formed of a lens body 2a having a predetermined refractive power and two beard-shaped

support portions

2b, 2b connected to the lens body 2a for holding the lens body 2a in the eyeball. Has been. The lens body 2a and the support portion 2b are made of a flexible resin material. In the intraocular lens insertion device 1 in the present embodiment, the intraocular lens is arranged such that one of the two

support portions

2b and 2b is disposed on the rear side of the lens body 2a and the other is disposed on the front side of the lens body. 2 is set.

FIG. 3 shows a plan view of the nozzle body 10. As described above, in the nozzle body 10, the intraocular lens 2 is set on the stage unit 12. In this state, the intraocular lens 2 is pressed by the plunger 30 and is released from the distal end portion 10a. In addition, a through hole 10 c whose cross-sectional shape changes according to a change in the outer shape of the nozzle body 10 is provided in the nozzle body 10. When the intraocular lens 2 is released, the intraocular lens 2 is deformed and folded according to a change in the cross-sectional shape of the through hole 10c in the nozzle body 10, and is formed on the patient's eyeball. It is released after being transformed into a shape that is easy to enter an incision.

Further, the tip portion 10a has a shape cut obliquely so that the upper region of the nozzle portion 15 is in front of the lower region. Note that the shape of the tip portion 10a that is obliquely cut may be linearly obliquely cut when viewed from the left-right direction, or may have a bulge outward, that is, a curved shape. It may be cut into

A stage groove 12 a having a width slightly larger than the diameter of the lens body 2 a of the intraocular lens 2 is formed in the stage portion 12. The dimension in the front-rear direction of the stage groove 12 a is set to be larger than the maximum width dimension including the

support portions

2 b and 2 b extending on both sides of the intraocular lens 2. A set surface 12b is formed by the bottom surface of the stage groove 12a. The vertical position of the set surface 12b is set higher than the height position of the bottom surface of the through hole 10c of the nozzle body 10, and the set surface 12b and the bottom surface of the through hole 10c are connected by a bottom slope 10d. .

The stage portion 12 and the stage lid portion 13 are integrally formed. The stage lid portion 13 has the same size in the front-rear direction as the stage portion 12. The stage lid portion 13 is connected by a thin plate-like connecting portion 14 formed by extending the side surface of the stage portion 12 to the stage lid portion 13 side. The connecting portion 14 is formed to be bendable at the center portion, and the stage lid portion 13 can be closed by overlapping the stage portion 12 from above by bending the connecting portion 14.

In the stage lid 13,

ribs

13 a and 13 b are provided on the surface facing the set surface 12 b when the lid is closed in order to reinforce the stage lid 13 and stabilize the position of the intraocular lens 2. Further, a guide protrusion 13 c is provided as a guide on the upper side of the plunger 30. The stage lid 13 is provided with an injection hole 16 for injecting a viscoelastic material for smooth movement of the intraocular lens in the nozzle. On the outside of the stage lid portion 13, there is provided a projection portion 17 in which a part of the outer periphery of the injection hole 16 is raised. The protrusion 17 has a function of making it easier to inject the viscoelastic material by guiding the needle of the syringe to be injected into the injection hole 16.

A positioning member 50 is detachably provided below the set surface 12b of the stage portion 12. FIG. 4 shows a schematic configuration of the positioning member 50. FIG. 4A shows a plan view of the positioning member 50, and FIG. 4B shows a left side view of the positioning member 50. The positioning member 50 is configured as a separate body from the nozzle main body 10, and has a structure in which a pair of

side wall portions

51, 51 are connected by a connecting portion 52. At the lower ends of the respective side wall portions 51, holding

portions

53, 53 extending outward and extending are formed.

A pair of first mounting

portions

54 and 54 protruding upward are formed at the upper end portions of the

side wall portions

51 and 51, respectively. Further,

first positioning portions

55 and 55 are formed to protrude from the outer peripheral side of the upper end surfaces of the

first placement portions

54 and 54. The distance between the inner sides of the

first positioning portions

55 and 55 is set slightly larger than the diameter of the lens body 2 a of the intraocular lens 2.

Also, a pair of second mounting

portions

56 and 56 projecting upward are formed at both ends in the front-rear direction inside the

side wall portions

51 and 51. The heights of the upper surfaces of the second mounting

parts

56 and 56 are equal to the heights of the upper surfaces of the first mounting

parts

54 and 54. Furthermore,

second positioning portions

57 and 57 that protrude further upward are formed on the outer portions of the upper surfaces of the

second placement portions

56 and 56 over the entire left and right direction of the

second placement portions

56 and 56. . The distance between the inner sides of the

second positioning portions

57 and 57 is set to be slightly larger than the diameter dimension of the lens body 2 a of the intraocular lens 2. In addition, locking

claws

58, 58 that slightly protrude in the front-rear direction are formed on the upper ends of the

second placement portions

56, 56 over the entire left-right direction.

The positioning member 50 is assembled from below the set surface 12b of the nozzle body 10. The set surface 12b of the nozzle body 10 is formed with a set surface through hole 12c that penetrates the set surface 12b in the thickness direction. The outer shape of the set surface through-hole 12c is a substantially similar shape that is slightly larger than the shape of the

first placement portions

54 and 54 and the

second placement portions

56 and 56 of the positioning member 50 as viewed from above. When the positioning member 50 is attached to the nozzle body 10, the

first placement portions

54 and 54 and the

second placement portions

56 and 56 are inserted into the set surface through hole 12c from the lower side of the set surface 12b. , Protruding above the set surface 12b.

At that time, the locking

claws

58, 58 provided in the

second positioning portions

57, 57 protrude through the set surface through hole 12c to the set surface 12b and are locked to the upper surface of the set surface 12b. Accordingly, the positioning member 50 is assembled from the lower side of the nozzle body 10, and the

first placement portions

54 and 54 and the

second placement portions

56 and 56 are fixed in a state of protruding from the set surface 12b. When the intraocular lens 2 is set on the setting surface 12b, the bottom surface of the outer peripheral portion of the lens body 2a is placed on the upper surfaces of the

first placement portions

54 and 54 and the

second placement portions

56 and 56. The Further, the position of the lens body 2a is restricted with respect to the horizontal direction (the direction horizontal to the set surface 12b) by the

first positioning portions

55, 55 and the

second positioning portions

57, 57.

When inserting the intraocular lens 2 into the eyeball, the positioning member 50 is removed from the nozzle body 10 after an appropriate amount of viscoelastic material is injected from the injection hole 16. As a result, the

first placement portions

54 and 54 and the

second placement portions

56 and 56 that have supported the lens body 2a of the intraocular lens 2 are retracted from the set surface 12b, and the intraocular lens 2 is on the set surface 12b. Is movably mounted.

Subsequently, the distal end portion 10a of the nozzle portion 15 of the nozzle body 10 is inserted into the incision provided in the eye tissue. Here, since the distal end portion 10a has an oblique opening shape, it can be easily inserted into the incision. Then, after inserting the nozzle portion 15 into the incision, the pressing plate portion 33 of the plunger 30 is pushed into the distal end side of the nozzle body 10. Thereby, the front-end | tip part 31c of the action part 31 of the plunger 30 contact | abuts to the lens main body 2a outer periphery of the intraocular lens 2 set to the setting surface 12a, and the intraocular lens 2 faces the front-end | tip part 10a with the plunger 30. Guided.

Next, a schematic configuration of the plunger 30 is shown in FIGS. 5 (a) and 5 (b). The plunger 30 has a slightly larger longitudinal length than the nozzle body 10. And it forms from the action part 31 of the front end side based on a column shape, and the insertion part 32 of the rear end side based on a rectangular rod shape. And the action part 31 is comprised including the cylindrical part 31a made into the column shape, and the thin plate-shaped flat part 31b extended in the left-right direction of the cylindrical part 31a.

A notch 31 c is formed at the tip of the action part 31. As shown in FIG. 5A, the notch 31c is formed in a groove shape that opens upward in the action portion 31 and penetrates in the left-right direction. Further, as shown in FIG. 5B, the groove wall on the distal end side of the notch 31 c is formed with an inclined surface that goes upward as it goes to the distal end side of the action portion 31. On the other hand, the insertion part 32 has a substantially H-shaped cross section as a whole, and the horizontal and vertical dimensions thereof are set slightly smaller than the through hole 10 c of the nozzle body 10. In addition, a disc-shaped pressing plate portion 33 is formed at the rear end of the insertion portion 32 so as to spread in the vertical and horizontal directions.

A claw portion 32 a that protrudes upward from the insertion portion 32 and that can move up and down by the elasticity of the material of the plunger 30 is formed at a portion of the insertion portion 32 that is ahead of the center in the front-rear direction. When the plunger 30 is inserted into the nozzle body 10, the locking hole 10e shown in FIG. 3 provided in the thickness direction on the upper surface of the nozzle body 10 and the claw portion 32a are engaged. The relative position between the nozzle body 10 and the plunger 30 in the initial state is determined. It should be noted that the claw portion 32a and the locking hole 10e are formed at the positions where the distal end of the action portion 31 is located on the rear side of the lens body 2a of the intraocular lens 2 set on the stage portion 12 in the engaged state. The support portion 2b on the rear side of the main body 2a is set so that the cutout portion 31c can be supported from below.

Prior to the accommodation of the intraocular lens 2 of the intraocular lens insertion device 1 configured as described above, the plunger 30 is inserted into the nozzle body 10 and disposed at the initial position. Further, as described above, the positioning member 50 is attached to the nozzle body 10 from below the set surface 12b. Thereby, the 1st mounting part 54 and the 2nd mounting part 56 of the positioning member 50 are hold | maintained in the state protruded to the set surface 12b.

Next, the lens body 2 a of the intraocular lens 2 is placed and positioned on the upper surfaces of the first placement part 54 and the second placement part 56 with the support part 2 b facing the front-rear direction of the nozzle body 10. In this state, a part of the support portion 2b on the rear side of the intraocular lens 2 is sandwiched between the notches 31c of the plunger 30 and is supported by the bottom surface thereof.

Next, FIG. 6 illustrates the positional relationship between the plunger 30 and the packing 20c of the plunger push-out assisting tool 20 when the intraocular lens 2 moves to the tip 10a of the nozzle body 10. In the present embodiment, when the surgeon moves the intraocular lens 2 housed in the intraocular lens insertion device 1 using the plunger 30, the operator operates the fluid supply source connected to the tube 40 to maintain a constant level. A fluid having a flow rate is supplied to the first region 20f via the tube 40 and the fluid supply unit 20d. The first region 20f is filled with fluid.

When the fluid is further supplied to the first region 20f, the pressure acting on the packing 20c increases. And if the force which moves packing 20c based on the said pressure becomes larger than the maximum static frictional force of packing 20c, packing 20c will move to the front side, ie, nozzle body 10 side. As shown in FIG. 6A, the packing 20 c comes into contact with the pressing plate portion 33 of the plunger 30.

When the fluid is further supplied to the first region 20f, the packing 20c moves toward the nozzle body 10 and presses the plunger 30 toward the nozzle body 10 to move it. Thereby, the intraocular lens 2 can be moved to the tip portion 10 a side of the nozzle body 10. At that time, it is desirable that the center of the plunger 30 in the pushing direction coincides with the center of the packing 20c in the moving direction. Thereby, it can be expected that the pushing of the plunger 30 by the packing 20c is more stable. Next, the function of the through hole 20b will be described. As shown in FIG. 6B, when the packing 20c moves beyond the hole 20b, the fluid supplied to the first region 20f flows out from the hole 20b.

Here, for example, when the operator operates the fluid supply source unintentionally, it is considered that the hole 20b is not blocked by the operator's hand. In that case, even if the fluid is supplied to the first region 20f after the packing 20c has moved to the position illustrated in FIG. 6B, the fluid flows out of the cylindrical member 20a from the hole 20b. As a result, the packing 20c stops at the position shown in FIG. 6B without being pushed by the fluid. In this manner, by providing the hole 20b in the plunger push-out assisting tool 20, even if fluid is erroneously supplied to the first region 20f, the packing 20c pushes the plunger 30 toward the tip 10a side of the nozzle body 10. The continuing phenomenon can be avoided. As a result, it is possible to prevent the intraocular lens 2 from being released from the distal end portion 10a of the nozzle body 10 against the operator's intention.

On the other hand, when the operator intentionally operates the fluid supply source, the hole 20b is considered to be blocked by the operator's hand. In this state, when the fluid is supplied to the first region 20f after the packing 20c has moved to the position illustrated in FIG. 6B, the fluid does not flow out of the cylindrical member 20a from the hole 20b. As a result, when the fluid continues to be supplied to the first region 20f, the packing 20c is pushed by the fluid and further moves from the position illustrated in FIG. 6B to the tip portion 10a side of the nozzle body. Then, the plunger 30 is pressed and moved by the packing 20c, and further moves the intraocular lens 2 to the tip portion 10a side of the nozzle body 10.

When the packing 20c moves further from the position illustrated in FIG. 6B to the tip 10a side of the nozzle body, the operator releases the fluid from the hole 20b and removes the packing by releasing the finger from the hole 20b. The movement of 20c can be stopped. Therefore, the surgeon can control the movement of the packing 20c pushed by the fluid by closing the hole 20b with a finger or the like, or separating the finger or the like that has closed the hole 20b from the hole 20. Thereby, the operator does not need to operate the plunger 30 with a finger, and can concentrate on other operations and treatments such as adjustment of the position of the nozzle body 10 with respect to the incision.

In the present embodiment, the fluid is supplied to the intraocular lens extrusion assisting tool 20 at a constant flow rate using the fluid supply source, so that the movement of the packing 20c and the plunger 30 can be moved at a constant speed. Thereby, according to the intraocular lens insertion instrument 1 of this embodiment, the intraocular lens 2 can be moved and inserted into the eye at a stable moving speed in the nozzle body 10. Therefore, the intraocular lens can be more stably ejected into the eye than a conventional intraocular lens insertion device. In addition, since the movement of the intraocular lens is stabilized, the burden on the incision provided in the eyeball is reduced.

Next, a method for manufacturing the intraocular lens insertion device 1 according to this embodiment will be described with reference to FIG. When manufacturing the intraocular lens insertion device 1, first, as shown in FIG. 7A, the plunger 30 shown in FIG. 5 is attached to the nozzle body 10 shown in FIG. 3 from the rear end portion 10b side of the nozzle body 10. insert. The claw portion 32a of the plunger 30 inserted into the nozzle body 10 engages with the locking hole 10e, and the nozzle body 10 and the plunger 30 are relatively positioned.

Next, the intraocular lens push-out assisting tool 20 is guided so that the rear end portion 10b of the nozzle body 10, the insertion portion 32 of the plunger 30 and the pressing plate portion 33 are accommodated in the cylindrical member 20a. Then, both ends of the holding portion 11 of the nozzle body 10 are inserted into the respective through holes 20i of the intraocular lens push-out assisting tool 20, and the engaging portion 20h and the holding portion 11 are engaged. Thereby, the assembly of the intraocular lens insertion device 1 according to the present embodiment is completed.

The above is the description of the present embodiment, but the configuration of the insertion portion and the like is not limited to the above-described embodiment, and various modifications can be made within the scope that does not lose the technical idea of the present invention. Is possible. For example, in the intraocular lens insertion device 1 according to the present embodiment, the notch 11a may not be provided. In the present embodiment, the packing 20c and the pressing plate portion 33 of the plunger 30 are provided as separate bodies as in the state shown in FIG. 6A, but the pressing plate portion 33 and the packing 20c are integrated in advance. You may provide as.

Hereinafter, a modified example of the manufacturing method of the intraocular lens insertion device according to the above embodiment will be described. In the following description, components corresponding to the components in the above-described embodiment are denoted by the same reference numerals, and the description thereof is omitted unless otherwise specified.

[Modification 1]
A method for manufacturing the intraocular lens insertion device 100 in Modification 1 will be described with reference to FIG. In this modification, first, as shown in FIG. 8A, the intraocular lens extrusion assisting tool 20 is fixed so that the opening 20j at one end of the intraocular lens extrusion assisting tool 20 is vertically upward. Furthermore, the plunger 30 is disposed in the intraocular lens pushing aid 20. At this time, the pressing plate portion 33 of the plunger 30 is placed on the packing 20c. Then, the nozzle body 200 is attached to the intraocular lens pushing assisting tool 20.

The nozzle body 200 in the present modification has a configuration in which the rear end portion of the nozzle body 10 in the above embodiment is deleted from the stage portion 12 and the hold portion 11 is connected to the rear end side of the stage portion 12. It has become. Therefore, when the nozzle body 200 is attached to the intraocular lens push-out assisting tool 20, the tip of the plunger 30 is inserted into the stage part 12, and both ends of the hold part 11 are the engaging parts 20h of the intraocular lens push-out assisting tool 20. Is inserted through the through hole 20i. As a result, as shown in FIG. 8B, the assembly of the intraocular lens insertion device 100 according to this modification is completed.

In this modification, the intraocular lens push-out aid 20 is fixed so that the opening 20j at one end of the intraocular lens push-out aid 20 is vertically upward, but the intraocular lens insertion device 100 can be assembled. If so, the posture of the intraocular lens extrusion assisting tool 20 is not limited to this. For example, when the plunger 30 is placed in the intraocular lens push-out assisting tool 20, the pressing plate portion 33 of the plunger 30 is bonded to the packing 20c, or a depression is formed in the packing 20c to form the pressing plate portion 33 in the depression. Or the like, the intraocular lens insertion aid 100 can be assembled with the intraocular lens push-out assisting tool 20 in a posture other than vertically upward.

[Modification 2]
Next, a method for manufacturing the intraocular lens insertion device 300 in Modification 2 will be described with reference to FIG. In this modification, the nozzle body 10 and the cylindrical member 20a of the intraocular lens push-out assisting tool 20 in the above embodiment are integrally formed in advance. Note that the intraocular lens push-out assisting tool 20 of the intraocular lens insertion device 300 has the engagement portion 20h of the intraocular lens push-out assisting tool 20 in the above embodiment removed, and one end of the cylindrical member 20a is the nozzle body It is joined to the hold unit 18.

In this modification, first, as shown in FIG. 9A, the plunger 30 is inserted through the cylindrical member 20 a, and the tip of the plunger 30 is further moved from the rear end portion 10 b of the nozzle body 10 to the nozzle body 10. Plugged in. Next, the packing 20c is fitted into the cylindrical member 20a from the rear end side of the cylindrical member 20a. And the fluid supply part 20d is joined to the rear end of the cylindrical member 20a. As a result, as shown in FIG. 9B, the assembly of the intraocular lens insertion device 300 according to this modification is completed.

[Modification 3]
Next, an intraocular lens insertion device 400 in Modification 3 will be described with reference to FIG. In the present modification, a hook 400a is provided on the distal end portion 10a side of the nozzle body 10 of the hold portion 11 in a side view of the intraocular lens insertion device 400 (FIG. 10A). As illustrated in FIG. 10A, one hook 400 a is provided on each of the upper end side and the lower end side of the hold unit 11. As shown in FIG. 10B, a nozzle cover 420 that protects the nozzle body 10 can be attached to the hook 400a. The attachment structure of the nozzle cover 420 that protects the nozzle body 10 is not limited to the hook 400a, and may be an attachment structure that fits by press fitting. Thereby, when the operator is holding the intraocular lens insertion device 400, it is possible to prevent the positioning member 50 from being unintentionally detached from the stage portion 12 or opening the stage lid portion 13 unintentionally. Furthermore, since the nozzle body 10 and the plunger 30 are protected by the intraocular lens extrusion assisting tool 20 and the nozzle cover 420, it is not necessary to use a so-called blister case for housing the intraocular lens insertion instrument, It is only necessary to store the intraocular lens insertion device 400 in a sterile bag as it is.

[Modification 4]
Next, an intraocular lens insertion device 500 in Modification 4 will be described with reference to FIG. In this modification, a cock 510 is provided in the tube 40 connected to the opening 20e on the rear end face of the fluid supply unit 20d. The tip of a syringe barrel 520 is connected to the cock 510. The cock 510 corresponds to an example of a flow path switching unit. When the plunger 520a of the syringe barrel 520 is pushed into the distal end side of the syringe barrel 520, the air between the packing 520b and the distal end of the syringe barrel 520 moves to the fluid supply portion 20d via the cock 510 and the tube 40. To do. Further, when the plunger 520a of the syringe barrel 520 is pulled back to the rear end side of the syringe barrel 520, the air between the cock 510 and the packing 20c passes through the cock 510 and the tip of the packing 520b and the syringe barrel 520. Move between.

During the storage of the intraocular lens insertion device 500, the packing 20c may adhere to the inner wall of the cylindrical member 20a of the intraocular lens push-out assisting tool 20. In such a case, if air is continuously supplied from the fluid supply source to the first region 20f surrounded by the cylindrical member 20a, the packing 20c, and the fluid supply unit 20d, the air pressure in the first region 20f increases. Then, there is a possibility that the packing 20c is released from being fixed to the inner wall of the tubular member 20a and the movement of the packing 20c starts at a timing not intended by the operator. In this modification, the surgeon operates the plunger 520a to send air from the syringe barrel 520 to the first region 20f before starting the supply of air to the first region 20f by the fluid supply source. Thus, the fixing of the packing 20c to the inner wall of the cylindrical member 20a can be released. In addition, as a method for releasing the fixation of the packing 20c, not only supplying air but also sucking air may be used. Thus, since the supply of air to the first region 20f by the fluid supply source can be started after the fixation of the packing 20c is released, the movement of the packing 20c starts almost simultaneously with the start of air supply. can do. As a result, when the air is supplied to the first region 20f by the fluid supply source, the movement of the packing 20c can be prevented from starting at a timing not intended by the operator as described above.

If the packing 20c and the pressing plate portion 33 of the plunger 30 are integrally fixed, the surgeon pulls back the plunger 520a of the syringe barrel 520 to the rear end side of the syringe barrel 520, so that the nozzle body The plunger 30 that has moved to the tip portion 10a side of 10 can be pulled back to the fluid supply portion 20d side again. In the above description, the fluid supplied from the fluid supply source and the syringe barrel 520 has been described as air. However, the fluid to be used is not limited to air. Further, the shape of the syringe barrel 520 is not limited to the shape shown in the present modified example as long as it has a function of supplying or sucking fluid.

[Modification 5]
Next, an intraocular lens insertion device 600 in Modification 5 will be described with reference to FIG. In this modification, a cock 610 is provided in the tube 40 connected to the opening 20e on the rear end face of the fluid supply unit 20d. The flow path of the fluid supplied from the fluid supply source in the tube 40 is blocked in advance by the cock 610. Then, when starting the supply of fluid to the first region 20f by the fluid supply source, the operator operates the cock 610 to open the fluid flow path. Since the supply of fluid to the first region 20f by the fluid supply source can be controlled by the cock 610 in this manner, for example, during preparation for the operator to use the intraocular lens insertion device 600, it is not intended. It can be prevented that the fluid is supplied to the first region 20f by the fluid supply source and the packing 20c starts to move. The cock 610 corresponds to an example of the channel opening / closing means of the tube 40.

1, 100, 300 Intraocular lens insertion device 2 Intraocular lens

2a Lens body

2b Support unit

10, 200 Nozzle body 20 Intraocular lens extrusion assisting tool 20a Tubular member 20b Hole 20c Packing 20d Fluid supply unit 20e Opening 20f First Region 20g Second region 20h Engagement portion 20i Through hole 30 Plunger 33

Pressing plate portion

510, 610 Cock 520 Syringe

Claims

A substantially cylindrical instrument body having an insertion tube portion for inserting an intraocular lens into the eye at the tip;
An intraocular lens pushing member that is slidably provided in the instrument body, pushes the intraocular lens, moves it to the insertion tube, and pushes it into the eye;
A cylindrical member fixed to the instrument body;
Fluid supply means for supplying fluid into the tubular member;
A moving member provided in the cylindrical member and moved by the pressure of the supplied fluid;
With
The intraocular lens pushing member is slid in the device body by being pushed by the moving member.
The cylindrical member extends in the sliding direction of the intraocular lens pushing member,
The moving member is a plate wall that partitions the inside of the cylindrical member into a first region and a second region,
The intraocular lens pushing member is disposed in the second region;
The fluid is supplied to the first region by the fluid supply means;
2. The intraocular lens insertion device according to claim 1, wherein the moving member moves while abutting against an inner wall of the cylindrical member by pressure of the fluid supplied to the first region.
The intraocular lens insertion device according to claim 2, wherein the plate wall body includes an elastic member that comes into contact with an inner wall of the cylindrical member.
The cross-sectional area of the cross-section of the plate wall body in the plane perpendicular to the sliding direction of the intraocular lens pushing member is larger than the cross-sectional area of the cross-section of the instrument body in the plane perpendicular to the sliding direction;
The intraocular lens insertion device according to claim 2 or 3.
The intraocular lens insertion device according to any one of claims 2 to 4, wherein the first region in the cylindrical member is not a closed space.
The fluid supply means has a supply port for supplying the fluid into the cylindrical member,
The intraocular lens insertion device according to any one of claims 1 to 5, wherein an inner diameter of the supply port is smaller than an inner diameter of the cylindrical member.
The intraocular lens insertion device according to claim 6, wherein a tube formed of a soft member is connectable to the supply port of the fluid supply means.
The fluid supply means has a supply port for supplying the fluid into the cylindrical member,
The intraocular lens insertion device further comprises:
A tube formed of a flexible member connected to the supply port;
A flow path switching means provided in the tube, for switching between the flow path of the fluid and a flow path different from the flow path of the fluid;
The intraocular lens insertion device according to any one of claims 1 to 5, further comprising an injection cylinder connected to the another flow path.
The fluid supply means has a supply port for supplying the fluid into the cylindrical member,
The intraocular lens insertion device further comprises:
A tube formed of a flexible member connected to the supply port;
The intraocular lens insertion device according to any one of claims 1 to 5, further comprising: a channel opening / closing unit that is provided in the tube and that controls blocking and opening of the fluid channel.
The intraocular lens according to any one of claims 1 to 9, wherein an intraocular lens is accommodated in the intraocular lens insertion device in advance in the insertion tube portion of the intraocular lens insertion device. Insertion instrument.
A cylindrical member fixed to a substantially cylindrical instrument body having an insertion cylindrical portion for inserting an intraocular lens into the eye;
Fluid supply means for supplying fluid into the tubular member;
A moving member provided in the cylindrical member and moved by the pressure of the supplied fluid;
With
An intraocular lens push-out member that is slidably provided in the instrument body, presses the intraocular lens, moves it to the insertion tube portion, and pushes it into the eye is pushed by the moving member, thereby the instrument body An intraocular lens extruding aid characterized by sliding inside.
A method for manufacturing an intraocular lens insertion device according to any one of claims 1 to 10,
Inserting the intraocular lens pushing member into the instrument body;
After the step of inserting the intraocular lens pushing member, the step of fixing the cylindrical member provided with the fluid supply means and the moving member to the instrument body is provided. A method for manufacturing an insertion device.
A method for manufacturing an intraocular lens insertion device according to any one of claims 1 to 10,
Inserting the intraocular lens pushing member into the cylindrical member provided with the fluid supply means and the moving member;
A method of manufacturing an intraocular lens insertion device, comprising: a step of fixing the device body to the cylindrical member after the step of inserting the intraocular lens pushing member.
A method for manufacturing an intraocular lens insertion device according to any one of claims 1 to 10,
Inserting the intraocular lens extruding member into the tubular member formed integrally with the instrument body in advance;
Inserting the moving member into the tubular member;
And a step of providing the fluid supply means on the tubular member. A method for manufacturing an intraocular lens insertion device.