JP5398092B1 - Intraocular lens - Google Patents

Abstract

An object of the present invention is to provide a structure suitable for a treatment in which a support part is inserted from the ciliary groove and fixed to the sclera, and is inserted into the eye after the lens is removed and fixed to the sclera. Provided is an intraocular lens that is securely fixed without sewing.
An intraocular lens (1) includes a lens (2) and a pair of left and right loop-shaped support portions (3), and a folding portion (30) at the tip of the support portion (3). An intrascleral tunnel is formed in the circumferential direction at two half-thickness depth positions symmetrical with respect to the visual axis in the scleral edge adjacent portion. The intraocular lens 1 is fixed in the eye by pulling the tip of the support part 3 out of the ciliary groove and inserting it into the intrascleral tunnel. Further, at that time, the folded portion 30 is hooked somewhere inside the intrascleral tunnel, whereby the support portion 3 is strongly restrained in the intrascleral tunnel, and the intraocular lens is more reliably fixed.
[Selection] Figure 1

Description

  The present invention relates to an intraocular lens.

  As is well known, surgery for inserting an intraocular lens (IOL) into the eye after the patient's clouded lens has been removed as a treatment for cataract of the eye is widely performed. For example, Patent Document 1 below proposes an intraocular lens that is inserted into the eye after the lens is removed and sewn on the ciliary body in the treatment of cataract.

Japanese Patent No. 2792588

  In the technique described in Patent Document 1, the intraocular lens is sewn to the ciliary body (intraocular lens sewing method). On the other hand, the intraocular lens is fixed in the sclera without sewing. A technique has also been proposed (intraocular lens scleral fixation). In this method, for example, by inserting the tip of the support part of the intraocular lens into a tunnel-shaped hole formed in the sclera in the circumferential direction, the tunnel is tightened and the tip stays in the tunnel as it is. The intraocular lens is supported without sewing.

  With this method, for example, it is not necessary to acquire an intraocular lens sewing technique necessary for intraocular lens sewing. In addition, using this method, the intraocular lens can be accurately placed at the center of the eye, the lens fixing stability (especially the axial stability of the lens) is improved, and the lens is less likely to tilt. The effect of has been reported.

  Such an intrascleral fixation method can be performed without changing a conventional intraocular lens, which is considered as one of the advantages. Certainly, it is an advantage that a conventional intraocular lens can be used as it is, but conversely, development of an intraocular lens suitable (or specialized) for intrascleral fixation may be insufficient.

  As described above, it has been reported that the intraocular lens can be effectively supported by the intrascleral fixation. For example, the shape of the support part of the intraocular lens is made suitable for the intrascleral fixation, and the scleral tunnel is If the support part can be fixed more securely inside, intraocular lens intrascleral fixation may be further improved. This problem is not limited to intrascleral fixation, but to any treatment that fixes to a portion of the sclera, such as the outer surface of the sclera.

  Therefore, the problem to be solved by the present invention is to insert the support part from the ciliary groove into the eye after the lens is removed by having a configuration suitable for the treatment of inserting the support part from the ciliary groove and fixing it to the sclera. Another object of the present invention is to provide an intraocular lens that can be securely fixed without sewing by a procedure of fixing to the sclera.

  In order to solve the above-described problem, an intraocular lens according to the present invention is disposed in the posterior chamber of the eye from which at least a part of the crystalline lens is removed, and performs a lens function of the crystalline lens. While extending in the shape of a leg from the side edge radially outward with respect to the visual axis, the tip has a shape extending in the circumferential direction, and the tip is inserted from the ciliary groove to fix the lens unit to the back chamber A portion inserted from the ciliary groove in the support portion has a shape that is folded back and returns in the direction opposite to the extending direction from the lens portion, and is applied to a part of the sclera. It has the folding | turning part which stops. As a result, the folded portion inserted into the sclera from the ciliary groove is hooked somewhere in the sclera, thereby strongly restraining the support portion in the sclera. Therefore, the intraocular lens is securely fixed. Also, the intraocular lens can be placed at an appropriate position in the posterior chamber by insertion from the ciliary groove.

  The folded portion may be folded at an angle that allows insertion into a tunnel-like hole formed in the sclera together with a part of the support portion other than the folded portion. As a result, the folded portion can be inserted into a tunnel-like hole formed in the sclera, so that the folded portion inserted into the sclera is hooked somewhere in the sclera, thereby supporting the support portion. Is strongly restrained in the sclera. Therefore, the intraocular lens is securely fixed.

  Further, when the folded portion is inserted into a tunnel-like hole formed in the sclera together with a part of the support portion other than the folded portion, the entire folded portion is accommodated in the hole portion. It may be adjustable in length. As a result, the entire folded portion can be accommodated in a tunnel-shaped hole formed inside the sclera, so that the folded portion inserted in the sclera is hooked somewhere in the sclera, The support is strongly restrained in the sclera. Therefore, the intraocular lens is securely fixed.

  The support portion may be formed such that the folded portion is hooked on the outer surface of the sclera in a state where the lens portion is disposed in the posterior chamber. Accordingly, the intraocular lens can be reliably fixed in the eye in a form in which the folded portion is hooked on the outer surface of the sclera.

  Further, the support portion may be formed in a plurality of loop shapes extending in a line-symmetric shape with respect to the visual axis from the side edge of the lens portion, and the folded portion may be formed at the tips of all the support portions. . As a result, the plurality of loop-shaped support portions are strongly restrained in the sclera by the folded portion at the tip thereof, so that the intraocular lens can be reliably fixed.

  The support portion may be formed in two loop shapes extending in a line-symmetric shape with respect to the visual axis from the side edge of the lens portion, and the folded portion may be formed at the tips of the two support portions. . As a result, the two loop-shaped support portions are strongly restrained in the sclera by the folded portion at the tip thereof, so that the intraocular lens can be reliably fixed.

  In addition, graduation lines may be displayed on the folded portion at intervals in the length direction. Accordingly, the folded portion can be easily folded and separated using the scale line, so that the length of the folded portion can be easily adjusted to an appropriate length.

The front view of 1 embodiment of the intraocular lens of this invention. The side view of the intraocular lens of FIG. The figure which shows the front-end | tip of an intraocular lens. The figure which shows the state which inserted and fixed the intraocular lens in the eye. The figure which shows the 1st example of the state in the middle of the transplant operation of an intraocular lens. The figure which shows the 2nd example of the state in the middle of the transplant operation of an intraocular lens. The figure which shows the example which fixes an intraocular lens outside the sclera.

  Embodiments of the present invention will be described below with reference to the drawings. 1 to 3 show an intraocular lens 1 in one embodiment of the present invention. FIG. 1 is a front view of the intraocular lens 1, and FIG. 2 is a side view (note that the description regarding the direction of the side, front, etc. refers to the direction (side surface) in the face (or eye) of the patient with the intraocular lens fixed in the eye. , Front, etc.)).

  The intraocular lens 1 includes a lens 2 and a support portion 3 as main components. The lens 2 is, for example, removed from the patient's eye after the lens that has become cloudy due to cataract (total or partial removal) is placed in the posterior chamber of the eye (or the posterior chamber of the eye, that is, the region behind the iris) and removed. Act as the lens function of the lens.

  The support part 3 is a part that supports the lens 2 in the posterior chamber. As shown in FIG. 1 and the like, the support portion 3 is extended from two locations on the side edge of the lens 2 into a pair of loop shapes (or leg shapes, haptic shapes), and the visual axis (the center of the lens 2). (Axis) has a line-symmetric shape. The loop shape is, for example, a curved shape that extends radially outward with respect to the visual axis and also extends in the circumferential direction (especially at the distal end side).

  As shown in FIG. 2, the shape viewed from the side of the support portion 3 may be, for example, a shape that fits in substantially the same plane as the lens 3. Or you may form the support part 3 so that it may extend in the diagonal direction toward the front or back in the eye from the side edge of the lens 3 seeing from the side.

  What is necessary is just to form the material of the intraocular lens 1 of this invention with the material (for example, PMMA etc.) similar to the conventional intraocular lens. Thereby, the intraocular lens 1 has flexibility (elasticity and flexibility), and can be rolled into a rod shape and inserted into the eye using an injector or the like. The support portion 3 may be molded integrally with the lens 2 using, for example, a resin material. Alternatively, they may be formed separately from the lens 2 and joined (adhered later).

  As an essential part of the present invention, the intraocular lens 1 has a folded portion 30 that is folded and extends in the reverse direction on the distal end side of the support portion 3. The shape of the folded portion in the folded portion 30 may be folded so as to have a corner, or may be folded in a curved shape without the corner.

  As described above, the support portion 3 has elasticity. For example, in a natural state (that is, a state in which no force is applied from the other), the folded portion 30 and the other portions are separated as shown in FIG. Also good. In this case, when the folded portion 30 is folded (that is, the folded portion 30 is overlapped with the other supporting portions 3 in a straight line), the folded portion 30 and the other portions are separated as shown in FIG. It is assumed that an elastic restoring force works so as to return. Or the bending part of the front-end | tip of the support part 3 does not have sufficient elasticity as mentioned above, and you may always maintain the shape of FIG.

  FIG. 4 shows details of the folded portion 30. The folded portion 30 is folded at the bent portion 32, and the folded-side tip 33 faces in the direction opposite to the extending direction of the support portion 3. As described above, the folding at the bent portion 32 may be folded with a corner or curved with no corner, but the folding angle at the bent portion 32 should not be excessively widened, as described later. What is necessary is just to make it the angle which the folding | returning part 30 and the other support parts 3 can insert in the bending part 32 in the head in a tunnel.

  A scale line 31 is displayed on the folded portion 30 by printing, for example, at intervals in the length direction. As shown in FIG. 4, the number of the scale lines 31 may be plural, and the distance between the scale lines 31 may be an equal interval such as 0.5 mm. One scale line 31 may be used.

  Since the support part of the intraocular lens 1 is formed of the same material as that of the conventional intraocular lens, if the practitioner folds an arbitrary part of the folded part 30 using an appropriate medical instrument, the support part can be folded relatively easily. Separate at the designated location. Accordingly, the operator can easily adjust the length of the folded portion 30 by folding the folded portion 30 at an appropriate length with the scale line 31 as a guide. Therefore, the length of the folded portion 30 can be set to an appropriate length according to the length of the intrascleral tunnel described later.

  FIG. 4 shows an example of a state in which the intraocular lens 1 is implanted (mounted) in the eye. Examples of the state during the operation are shown in FIGS.

  The intraocular lens 1 of the present invention is fixed to the posterior chamber of the eye (total posterior chamber) after all or part of the lens that has become clouded due to, for example, cataract, is fixed (without sewing). Is done. As shown in FIG. 4, the folded portion 30 of the support portion 3 formed in a pair on the left and right in the figure from the lens 2 in a state where the lens 2 is disposed at the position behind the iris 102 is embedded in the sclera 101. It becomes a state. FIG. 4 shows a case where the entire lens has been extracted.

  The procedure of the intraocular lens implantation operation of the present invention is similar to the procedure shown in, for example, Amar Agarwal et al. (Journal of Cataract and Refractive Surgery, vol.34, pp.1433-1438 (2008)). Well, one example is as follows.

  After a conjunctival resection or the like, as shown in FIG. 5, a scleral half-layer valve 104, which is a valve of approximately half the thickness of the sclera, is positioned adjacent to the limbus of the cornea 100 in the sclera 101. Form. The positions where the scleral half-layer valve 104 is formed are two symmetrical with respect to the visual axis at the position adjacent to the edge of the sclera surface. FIG. 5 shows one of the two scleral half-layer valves 104 thus formed.

  Then, a scleral incision is formed from one place below the scleral half-layer valve 104 in the sclera 101, for example, toward the center of the eyeball (or toward the ciliary groove or the ciliary body flat part). Further, in the side wall of the portion where the scleral half-layer valve 104 is cut, the portion 105 having a depth of, for example, about half the thickness of the sclera from the sclera surface is used as an inlet, that is, in a direction substantially parallel to the edge, that is An intrascleral tunnel 106 is formed in the circumferential direction with respect to the visual axis. The intrascleral tunnel 106 may be formed with an appropriate length (for example, 2 mm to 3 mm) so as to penetrate the sclera surface as an outlet.

  Then, the intraocular lens 1 is inserted into the eye with a predetermined injector or the like in a state of being rounded into a rod shape from an incision formed in the cornea 100, for example. At the time of insertion, one support part 3 is set to the front side, and the other support part 3 is set to the rear side. Even when the front support 3 and the lens 2 are inserted into the eye, the rear support 3 is partly exposed to the outside from the incision of the cornea 100.

  As shown in FIG. 5, with the scleral half-layer valve 104 opened, the distal end portion (for example, the folded portion 30) of the leading support portion 3 inserted into the eye is moved to, for example, a 25-g forceps. With the instrument, it is withdrawn from the posterior chamber through the scleral incision and exposed from the lower part of the scleral half-layer valve 104 to the outside of the eye. At that time, the entire folded portion 30 is exposed outside the eye.

  Then, the folded portion 30 exposed to the outside of the eye is inserted into the intrascleral tunnel 106 formed above. In this procedure, an instrument such as a 25-g forceps may be used as described above. In this insertion, the bent portion 32 is inserted at the head.

  In order to enable this insertion, the folding angle at the bent portion 32 may be an angle at which the bending portion 32 can be inserted into the intrascleral tunnel 106 together with a part of the support portion 3 other than the folded portion. The length of the folded portion may be such that the entirety is accommodated in a tunnel-like hole formed inside the sclera together with a part of the support portion 3 other than the folded portion. As described above, the practitioner sets the length of the folded portion 30 to an appropriate length in advance using the scale line 31 as a guide.

  The folded portion 30 is inserted until the folded-side tip 33 enters the intrascleral tunnel 106, that is, until the entire folded portion 30 is accommodated inside the intrascleral tunnel 106. As a result, both the bent portion 32 and the folded-back tip 33 are accommodated in the intrascleral tunnel 106. The same procedure is performed on the other support 3. Thereby, both the two support parts 3 will be in the state where the front-end | tip including the folding | returning part 30 was accommodated in the inside of the intrascleral tunnel 106 in the symmetrical position about the visual axis.

  When the above procedure is completed, the two scleral half-layer valves 104 are closed. At this time, for example, a fibrin glue is applied to the scleral half-layer valve 104 (the back side thereof) or the opposite surface. Then, the scleral half layer valve 104 is adhered to the sclera 101. The above is an example of the main procedure of intraocular lens intrascleral fixation. By the above procedure, the intrascleral tunnel 106 tightens the support part 3 so that the support part 3 is restrained and held in the intrascleral tunnel 106, and the intraocular lens 1 is fixed in the eye without sewing. .

  Alternatively, the intraocular lens 1 of the present invention can be intraocularly treated in the same manner as described in Gabor B. Scharioth et al. (Journal of Cataract and Refractive Surgery, vol. 33, pp.1851-1854 (2007)). May be transplanted.

  In this method, the scleral half-layer valve 104 is not formed, and a scleral incision is made from the surface of the sclera 101 toward the posterior chamber. Then, the intrascleral tunnel 106 (hole) is formed with an appropriate length (for example, in the circumferential direction with respect to the visual axis) from a position about half the thickness of the sclera in the scleral incision in a direction substantially parallel to the edge. 2 to 3 mm) to penetrate the scleral surface as an outlet.

  In the same manner as described above, the support portion 3 including the folded portion 30 is inserted into the intrascleral tunnel 106. In this case, the scleral incision after insertion of the scleral tunnel at the tip may be sewn if necessary. In addition, when implanting the intraocular lens 1 of the present invention into the eye, it is not limited to the technique of the above two documents, and any intrascleral fixation technique can be used.

  In the present invention, the folded portion 30 has the following effects. When the folded portion 30 (particularly the folded portion) has sufficient elasticity, the folded portion 30 is overlapped with the other portions of the support portion 3 when inserted into the scleral tunnel 106 in the above procedure. Fold it into a shape and insert it. When housed in the scleral tunnel 106, the folded portion 30 pushes against the inner wall of the scleral tunnel 106 in an attempt to reopen by its own elastic restoring force.

  In response to this, the inner wall of the scleral tunnel 106 is considered to expand. However, the distal end including the folded portion 30 is pushed back from the outside after being stretched to some extent by the strength of the sclera. This balances the pushing force and the pushing back force. The existence of this tension state makes it difficult for the tip including the folded portion 30 to move in the scleral tunnel 106.

  Further, when a force is applied so that the support portion 3 is pulled out from the entrance 105 of the intrascleral tunnel 106, the turn-up side tip 33 is hooked (locked) somewhere on the inner wall of the intrascleral tunnel 106. Therefore, it is strongly suppressed that the support part 3 comes out of the intrascleral tunnel 106. With the above operation, the intraocular lens 1 is securely fixed in the eye.

  Note that the bent portion 32 may not have elasticity enough to fold the folded portion 30 (the folded portion thereof). In that case, the folded portion 30 is inserted into the intrascleral tunnel 106 in such a manner as to push and widen the intrascleral tunnel 106 without being folded.

  Also in this case, when a force is applied so that the folded portion 30 pushes the inner wall of the intrascleral tunnel 106 and further pulls the folded portion 30 from the entrance 105, the tip of the folded portion 30 becomes the inner wall of the intrascleral tunnel 106. Hang somewhere. Therefore, it is strongly suppressed that the support part 3 moves in the intrascleral tunnel 106, and the intraocular lens 1 is reliably fixed in the eye.

  The above embodiments may be modified within the scope of the spirit described in the claims. For example, in the above embodiment, the number of supporting portions is two, but the present invention is not limited to this, and may be other than two, such as three, four, five, and six. Further, in the above example, the support portion has a loop shape, but other than the loop shape, a shape extending in the shape of a leg from the side edge of the lens 2 radially outward with respect to the visual axis and a shape in which the tip extends in the circumferential direction. You should prepare.

  Further, the folding direction of the folded portion 30 is folded inward (side closer to the center of the lens 2) in the example of FIG. 1, but it may be folded outward, and in other directions, that is, the support portion 3 ( Alternatively, it may be folded back in a direction intersecting the plane including the lens 3).

  In the above example, a tunnel is formed in the sclera, and the support part including the folded part 30 is inserted therein. However, in the present invention, the sclera can be used as long as the support part is inserted from the ciliary groove. It may be fixed at a location different from the inside. For example, FIG. 7 shows an example in which the outer surface of the sclera is fixed. In this example, the support portion 3 including the folded portion 30 is pulled out from the ciliary groove 104 to the outside of the sclera 101, and the folded portion 30 is hooked on the outer surface of the sclera 101. In this example, for example, the scleral half-layer valve 104 may not be formed.

  When the support part 3 is pulled out of the sclera 101, when a force that pulls the support part 3 into the eye is applied, the folding part 30 is pulled by being hooked on the outer surface of the sclera 101. Resist. Accordingly, the fall off of the support portion 3 is suppressed by the folded-back portion 30, so that the intraocular lens 1 is reliably fixed in the eye. In this example, the length of the support portion 3 may be set to a length suitable for the entire folded portion 30 to be pulled out of the sclera 101. Similarly, in the example of FIG. 4 and the like, the length of the support portion 3 may be set to a length suitable for inserting the entire folded portion 30 into the sclera 101.

1 Intraocular lens 2 Lens (lens part)
3 Support part 30 Folding part

Claims (7)

A lens unit that is placed in the posterior chamber of the eye from which at least a part of the lens has been removed, and performs the lens function of the lens;
While extending in the shape of a leg from the side edge of the lens portion radially outward with respect to the visual axis, the tip has a shape extending in the circumferential direction, and the tip is inserted from a ciliary groove to A support that is secured to the posterior chamber;
With
The portion inserted from the ciliary groove in the support portion has a shape that is folded back and returns in the direction opposite to the extending direction from the lens portion, and has a folded portion that latches on a part of the sclera. Characteristic intraocular lens.   The intraocular lens according to claim 1, wherein the folded portion is folded at an angle that allows insertion into a tunnel-shaped hole formed in the sclera together with a part of the support portion other than the folded portion.   When the folded portion is inserted into a tunnel-like hole formed in the sclera together with a part of the support portion other than the folded portion, the entire folded portion is accommodated in the hole. The intraocular lens according to claim 1, which is adjustable to a length to be adjusted.   The intraocular lens according to claim 1, wherein the support portion is formed so that the folded portion is hooked on an outer surface of the sclera in a state where the lens portion is disposed in the posterior chamber. The support part is formed in a plurality of loop shapes extending in a symmetrical shape with respect to the visual axis from the side edge of the lens part,
The intraocular lens according to any one of claims 1 to 4, wherein the folded portion is formed at the tips of all the support portions. The support portion is formed in two loop shapes extending symmetrically with respect to the visual axis from the side edge of the lens portion,
The intraocular lens according to any one of claims 1 to 5, wherein the folded portion is formed at tips of two support portions.   The intraocular lens according to any one of claims 1 to 6, wherein graduation lines are displayed at intervals in the length direction on the folded portion.

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