DE102023108808A1 - Ophthalmic surgical instrument with opening device for opening a capsular bag - Google Patents

Abstract

The invention relates to an ophthalmic surgical instrument (1) with a tube (3), a cannula (2) surrounding the tube (3), wherein a cannula opening (11) is provided between the tube (3) and the cannula (2), and the tube (3) has a longitudinal tube end (20) which is arranged outside the cannula (2), a longitudinal tube direction (6) directed towards the longitudinal tube end (20), an interior space (5) and a tube opening (21) which is arranged outside the cannula (2) and via which the interior space (5) is accessible, an intermediate space (4) which is arranged inside the cannula (2), and an opening device (9) which is arranged outside the cannula (2) and in a radial direction (12) related to the longitudinal tube direction (6) outside of the tube (3) and/or is designed as a part of the tube (3) and/or is inserted into the interior space (5) of the tube. (3) is designed to protrude and is configured to introduce an opening (14) into a capsular bag (7) of an eye, wherein the instrument (1) is configured to irrigate the eye via the intermediate space (4) and via the cannula opening (11) and/or a further opening in the cannula (2) and to aspirate via the interior space (5) and via the tube opening (21) or to aspirate the eye via the intermediate space (4) and via the cannula opening (11) and/or a further opening in the cannula (2) and to irrigate via the interior space (5) and via the tube opening (21).

Description

The invention relates to an ophthalmic surgical instrument with an opening device for opening a capsular bag.

When treating an eye for cataract, a number of different steps must be carried out by a doctor performing the cataract treatment. In particular, an initial opening must be made in the capsular bag of the eye using a first instrument, such as a curved needle (cystotome) or tweezers (forceps). The initial opening is then enlarged until the opening is approximately 5 mm in diameter. During hydrodissection, a second instrument is used to introduce a fluid between the capsular bag and the lens of the eye in order to separate the lens from the capsular bag. The lens is crushed using phacoemulsification using a third instrument and then suctioned out of the capsular bag. The capsular bag is then freed of the remaining part of the lens by an instrument suctioning the inner surface of the capsular bag. Different instruments are required for the various steps of cataract treatment, which are inserted into the eye one after the other. This means that cataract treatment is a laborious task for the doctor because each instrument change (removing the current instrument from the eye and inserting the next instrument) takes time and requires great care in handling the instruments.

The object of the invention is therefore to create an ophthalmic surgical instrument with which cataract treatment can be carried out more easily and quickly.

The ophthalmic surgical instrument according to the invention has a tube and a cannula surrounding the tube, wherein a cannula opening is provided between the tube and the cannula. In addition, the tube has a longitudinal tube end that is arranged outside the cannula, a longitudinal tube direction directed towards the longitudinal tube end, an interior space and a tube opening that is arranged outside the cannula and via which the interior space is accessible. The instrument has an intermediate space that is arranged inside the cannula. The instrument also has an opening device, wherein the opening device is arranged outside the cannula and in a radial direction related to the longitudinal tube direction outside of the tube and/or is designed as a part of the tube and/or is designed to protrude into the interior of the tube. The opening device is designed to make an opening in a capsular lacuna of an eye. The instrument is designed to irrigate the eye via the interspace and via the cannula opening and/or another opening in the cannula and to aspirate via the interior and via the tube opening. Alternatively, the instrument is designed to aspirate the eye via the interspace and via the cannula opening and/or another opening in the cannula and to irrigate via the interior and via the tube opening.

“Irrigation” means the supply of liquid, such as rinsing fluid, while “aspiration” means the removal of liquid, which may also contain particles.

The instrument can be used to both open the capsular bag and rinse the eye. This eliminates the need to insert and remove a separate probe to perform the rinse, meaning fewer instruments are needed to perform the cataract treatment than in a conventional cataract treatment. A doctor performing cataract treatment after the rinse can therefore open the capsular bag, rinse and emulsify the lens of the eye using just one instrument, saving the doctor time and effort.

The opening device preferably has a tip. The tip can, for example, become narrower with increasing distance from the tube. The tip can be attached to the tube or formed integrally with the tube. Alternatively, it is conceivable that the instrument has a pin which is arranged in the intermediate space, extends through the cannula opening and to which the tip is attached. It is preferred that the pin is arranged in the intermediate space so that it can be displaced longitudinally. The pin can be displaced back and forth between a retracted state in which the tip is arranged in the intermediate space and an extended state in which the tip is arranged outside the cannula. In the retracted state, accidental injury to the eye by the tip can be avoided.

As an alternative to arranging the pin in the intermediate space, it is preferred that the pin is arranged in the interior space and extends through the pipe opening, with the tip being attached to the pin. The tip can, for example, be arranged protruding into the interior space. It is preferred that the pin is arranged in the interior space such that it can be displaced longitudinally. The pin can be displaced back and forth between a retracted state in which the tip is arranged in the interior space and an extended state in which the Tip is arranged outside the tube. In the retracted state, accidental injury to the eye by the tip can be avoided. In the extended state, it is conceivable that the pen is rotated so that the tip is arranged outside of the tube in the radial direction.

It is preferred that the opening device has a clamping device that is designed to clamp at least part of the capsular bag. After the part of the capsular bag has been clamped, the capsular bag can be torn open by moving the instrument. The clamping device preferably has a stop that is arranged outside the cannula and is attached to the outside of the tube, and a slider that is arranged to be longitudinally displaceable in the intermediate space and is designed to abut against the stop when the slider is displaced in the longitudinal direction of the tube relative to the tube. The capsular bag can thus be clamped between the stop and the slider. The slider preferably has the shape of a sleeve and can be arranged to be longitudinally displaceable relative to the tube.

As an alternative to providing the stop together with the slider, the clamping device preferably has a stop which is arranged outside the cannula and is attached to the outside of the tube, wherein the tube is arranged in the cannula so as to be longitudinally displaceable and the stop is designed to strike the cannula when the tube is displaced relative to the cannula in the opposite direction to the longitudinal direction of the tube. The capsular bag can thus be clamped between the stop and the cannula.

It is also conceivable that the clamping device is formed by means of the pin. In the case that the pin is arranged in the intermediate space, the clamping device can be formed by the pin and the cannula, whereby the capsular bag can be clamped between the pin and the cannula. In the case that the pin is arranged in the interior space, the clamping device can be formed by the pin and the tube, whereby the capsular bag can be clamped between the pin and the tube.

Preferably, the clamping device is designed with a flat surface and a surface with a raised area, wherein the flat surface and the raised area are designed to abut one another. This allows the capsular bag to be clamped between the flat surface and the raised area and then opened like an anvil scissors. The raised area can, for example, have a V-shaped cross-section.

It is preferred that the instrument is designed to cause the tube to vibrate. The vibration can be used to create an opening in the capsular bag using the opening device provided on the tube. The vibration is also advantageous because it can be used to crush a lens of the eye using phacoemulsification. The instrument is thus designed both to create the opening in the capsular bag and to crush the lens, meaning that a separate instrument for carrying out the phacoemulsification does not need to be provided. This makes cataract treatment even less complex. The vibration preferably has a component in the longitudinal direction of the rotor, in a circumferential direction related to the longitudinal direction of the rotor and/or in a direction transverse to the longitudinal direction of the rotor. It is conceivable that the lens is only crushed with the vibration in the longitudinal direction of the rotor. To open the capsular bag, it is conceivable that the vibration in the circumferential direction is used, alone or in combination with one or both of the other components. It is also conceivable that the vibration in the direction transverse to the rotor longitudinal direction is used to open the capsular bag, alone or in combination with one of the other components.

Alternatively to the instrument being arranged to cause the pipe to vibrate, it is preferred that the instrument not be arranged to generate vibration.

• 1 eine perspektivische Ansicht einer ersten Ausführungsform eines ophthalmochirurgischen Instruments zu einem ersten Zeitpunkt,
• 2 eine perspektivische Ansicht einer zweiten Ausführungsform eines ophthalmochirurgischen Instruments zu einem ersten Zeitpunkt;
• 3 eine perspektivische Ansicht einer dritten Ausführungsform eines ophthalmochirurgischen Instruments zu einem ersten Zeitpunkt;
• 4 die Ansicht aus 1 zu einem zweiten Zeitpunkt,
• 5 die Ansicht aus 1 zu einem dritten Zeitpunkt,
• 6 die Ansicht aus 1 zu einem vierten Zeitpunkt,
• 7 eine perspektivische Ansicht einer vierten Ausführungsform des Instruments,
• 8 eine perspektivische Ansicht einer fünften Ausführungsform des Instruments und
• 9 eine perspektivische Ansicht einer sechsten Ausführungsform des Instruments.

The invention is explained in more detail below with reference to the attached schematic drawings. They show:

• 1 a perspective view of a first embodiment of an ophthalmic surgical instrument at a first point in time,
• 2 a perspective view of a second embodiment of an ophthalmic surgical instrument at a first point in time;
• 3 a perspective view of a third embodiment of an ophthalmic surgical instrument at a first point in time;
• 4 the view from 1 at a second point in time,
• 5 the view from 1 at a third point in time,
• 6 the view from 1 at a fourth point in time,
• 7 a perspective view of a fourth embodiment of the instrument,
• 8 a perspective view of a fifth embodiment of the instrument and
• 9 a perspective view of a sixth embodiment of the instrument.

How it looks 1 to 9 As can be seen, an ophthalmic surgical instrument 1 has a tube 3 and a cannula 2 surrounding the tube 3, wherein a cannula opening 11 is provided between the tube 3 and the cannula 2. The tube 3 has a longitudinal tube end 20 which is arranged outside the cannula 2, a longitudinal tube direction 6 directed towards the longitudinal tube end 20, an interior space 5 and a tube opening 21 which is arranged outside the cannula 2 and via which the interior space 5 is accessible. In addition, the instrument 1 has an intermediate space 4 which is arranged inside the cannula 2 and an opening device 9 which is arranged outside the cannula 2 and in a radial direction 12 related to the longitudinal tube direction 6 outside of the tube 3 (see 1 and 4 to 9 ) and/or as a part of the pipe 3 (see 2 ) and/or protruding into the interior 5 of the tube 3 (see 3 ) and is configured to create an opening 14 in a capsular bag 7 of an eye. The instrument 1 is configured to irrigate the eye via the intermediate space 4 and via the cannula opening 11 and/or a further opening in the cannula 2 and to aspirate via the interior space 5 and via the tube opening 21 or to aspirate the eye via the intermediate space 4 and via the cannula opening 11 and/or a further opening in the cannula 2 and to irrigate via the interior space 5 and via the tube opening 21.

The pipe 3 has a pipe end face 22 which is arranged facing the pipe longitudinal direction 6. It is conceivable that the normal of the pipe end face 22 forms an angle with the pipe longitudinal direction 6 which lies in a range from 10° to 80° or from 30° to 60°. The pipe opening 21 can be introduced into the pipe end face 22, compare 1 to 9 Alternatively, it is conceivable that the pipe opening 21 is introduced into a peripheral surface of the pipe 3, which is arranged facing outwards in the radial direction 12.

1 to 7 and 9 show that the opening device 9 can have a tip 30. The tip 30 can be narrower with increasing distance from the tube 3. The tip 30 can be attached to the tube 3, compare 1, 3 to 6 and 9 . It is conceivable that the tip 30 is attached to the peripheral surface. It is also conceivable that the tip 30 is attached in a region of the pipe 3 that extends counter to the pipe longitudinal direction 6 starting from the pipe longitudinal end 20, wherein the region in the pipe longitudinal direction 6 has a length of 5 mm, in particular 2 mm. In particular, the tip 30 can directly adjoin the pipe longitudinal end 20, compare 1 to 6 and 9 .

Alternatively to attaching the tip 30 to the tube 3, the instrument 1 may comprise a pin 31 arranged in the space 4 and extending through the cannula opening 11, the tip 30 being attached to the pin 31, see 7 . Here too, it is conceivable that the tip 30 is directly adjacent to the longitudinal end 35 of the pin located in the insertion direction 6. The pin 31 can be arranged so that it can be displaced longitudinally in the intermediate space 4. In particular, the pin 31 can be arranged so that it can be displaced longitudinally in the insertion direction 6 and against the insertion direction 6 and can have a retracted state in which the tip 30 abuts against a cannula longitudinal end 10 located in the tube longitudinal direction 6 or the tip 30 is arranged completely in the intermediate space 4, and an extended state in which the tip 30 is arranged outside the cannula 2 and at a distance from the cannula longitudinal end 10.

2 shows that the opening device 9 can be designed as a section of the tube 3. The opening device 9 can have the shape of a tip 30. The tip 30 can become narrower with increasing distance from the cannula 2, it being conceivable that the longitudinal end 20 of the tube is formed by the tip 30. 2 shows that a recess 36 can be made in the pipe 3 in such a way that the pipe end face 22 is interrupted and not, as in 1 and 4 to 9 shown, closed. As a result, the opening device 9 can have two of the tips 30.

It is conceivable that the opening device 9 is designed to protrude into the interior 5 of the tube 3, compare 3 . Just like in 2 The recess 36 can be made in the pipe 3 in such a way that the pipe end face 22 is interrupted and not, as in 1 and 4 to 9 shown, closed. It is conceivable that the opening device 9 has the shape of a tip 30. The tip 30 can become narrower in the direction opposite to the radial direction 12.

8 shows that the opening device 9 can have a clamping device 32 which is designed to clamp the capsular bag 7. For this purpose, the clamping device 32 can have a stop 33 which is arranged outside the cannula 2 and is attached to the outside of the tube 3, and a slider 34 which is arranged in the intermediate space 4 so as to be longitudinally displaceable and is designed to strike against the stop 33 when the slider 34 is displaced in the longitudinal direction 6 of the tube. The capsular bag 7 can be clamped between the stop 33 and the slider 34, compare 8 The stop 33 can be arranged completely outside the cannula 2 and spaced from the cannula 2 in the longitudinal direction 6 of the tube. The slider 34 can, for example, have the shape of a sleeve (see 8 ), whereby the tube 3 is arranged inside the sleeve. It is also conceivable that the stop 33 has the shape of a ring (see 8 ), wherein the tube 3 is arranged within the ring.

1 to 9 show that the intermediate space 4 in the radial direction 12 can be delimited externally by a wall of the cannula 2. 1 to 7 and 9 show that the gap 4 in the radial direction 12 can be limited inside by the tube 3. For the embodiment according to 8 the intermediate space 4 can be limited in the radial direction 12 inside by the slider 34.

In 1 and 4 to 6 It is shown how the opening 14 can be made in the capsular bag 7 using the instrument 1 and how the opening 14 can then be enlarged. The time progresses from 1 , 4 until 6 always moving forward. In 1 and 4 to 6 the case is shown that the instrument 1 is set up to irrigate the eye via the space 4 and the cannula opening 11 and to aspirate via the interior 5 and the tube opening 21. In 1 it is shown that the gripping device 9 has introduced the opening 14 into the capsular bag 7 and has thus exposed the lens 8 of the eye. In the case that the gripping device 9 has the tip 30, it is conceivable to then rotate the tip 30 away from the capsular bag 7 by rotating the tube 3, compare 4 The opening 14 can be enlarged by aspirating via the tube opening 21 and the interior 5 so that part of the capsular bag 7 enters the tube opening 21, compare 5 , whereby it is conceivable that irrigation takes place simultaneously via the cannula opening 11 and the intermediate space 4. In one example, the tube opening 21 can be blocked by a part of the capsular bag 7, so that the capsular bag 7 can be grasped with the instrument 1 and by moving the instrument 1, the capsular bag 7 is torn, whereby the opening 14 is enlarged. In another example, the capsular bag 7 can be sucked into the interior 5, whereby the capsular bag 7 is torn and the opening 14 is enlarged, compare 6 .

How it looks 9 As can be seen, the instrument 1 can be set up to cause the tube 3 to oscillate and thus to crush a lens 8 of the eye by phacoemulsification. It is conceivable that the oscillation has a first component in the rotor longitudinal direction 6 (see arrow a), a second component in a circumferential direction 13 related to the rotor longitudinal direction 6 (see arrow b) and/or a third component in a direction transverse to the rotor longitudinal direction 6 (see arrow c).

It is conceivable to provide a treatment device that has the instrument 1 and a surgical microscope. The treatment device can be set up to adjust, based on an image recorded by the surgical microscope, which of the first component, second component and/or third component the tube 3 oscillates with. Alternatively, a doctor performing cataract treatment can adjust, based on the image, which of the first component, second component and/or third component the tube 3 oscillates with.

Alternatively to the instrument 1 being arranged to cause the pipe 3 to vibrate, the instrument 1 may also be arranged not to cause the pipe 3 to vibrate.

list of reference symbols

1

Ophthalmic surgical instrument

2

cannula

3

Pipe

4

space between

5

interior

6

pipe longitudinal direction

7

capsular bag

8

lens

9

opening device

10

longitudinal end of the cannula

11

cannula opening

12

radial direction

13

circumferential direction

14

opening

20

pipe longitudinal end

21

pipe opening

22

pipe face

30

Great

31

Pen

32

clamping device

33

stop

34

glider

35

pin's longitudinal end

36

recess

a

component in the rotor longitudinal direction

b

component in the circumferential direction

c

component transverse to the rotor longitudinal direction

Claims (10)

Ophthalmic surgical instrument with a tube (3), a cannula (2) surrounding the tube (3), wherein a cannula opening (11) is provided between the tube (3) and the cannula (2), and the tube (3) has a longitudinal tube end (20) which is arranged outside the cannula (2), a longitudinal tube direction (6) directed towards the longitudinal tube end (20), an interior space (5) and a tube opening (21) which is arranged outside the cannula (2) and via which the interior space (5) is accessible, an intermediate space (4) which is arranged inside the cannula (2), and an opening device (9) which is arranged outside the cannula (2) and in a radial direction (12) related to the longitudinal tube direction (6) outside of the tube (3) and/or is designed as a part of the tube (3) and/or is designed and arranged to protrude into the interior space (5) of the tube (3), to make an opening (14) in a capsular bag (7) of an eye, wherein the instrument (1) is designed to irrigate the eye via the intermediate space (4) and via the cannula opening (11) and/or a further opening in the cannula (2) and to aspirate via the interior space (5) and via the tube opening (21) or to aspirate the eye via the intermediate space (4) and via the cannula opening (11) and/or a further opening in the cannula (2) and to irrigate via the interior space (5) and via the tube opening (21). Ophthalmic surgical instrument according to claim 1 , wherein the opening device (9) has a tip (30). Ophthalmic surgical instrument according to claim 2 , wherein the tip (30) is attached to the tube (3). Ophthalmic surgical instrument according to claim 2 , wherein the instrument (1) has a pin (31) which is arranged in the intermediate space (4), extends through the cannula opening (11) and to which the tip (30) is attached. Ophthalmic surgical instrument according to claim 4 , wherein the pin (31) is arranged to be longitudinally displaceable in the intermediate space (4). Ophthalmic surgical instrument according to one of the Claims 1 until 5 , wherein the opening device (9) has a clamping device (32) which is designed to clamp at least a part of the capsular bag (7). Ophthalmic surgical instrument according to claim 6 , wherein the clamping device (32) has a stop (33) which is arranged outside the cannula (2) and is fastened to the outside of the tube (3), and a slider (34) which is arranged longitudinally displaceably in the intermediate space (4) and is designed to abut against the stop (33) when the slider (34) is displaced in the tube longitudinal direction (6). Ophthalmic surgical instrument according to claim 7 , wherein the slider (34) has the shape of a sleeve. Ophthalmic surgical instrument according to one of the Claims 1 until 8 , wherein the instrument (1) is arranged to cause the tube (3) to vibrate and thus to crush a lens (8) of the eye by phacoemulsification. Ophthalmic surgical instrument according to claim 9 , wherein the vibration has a component in the rotor longitudinal direction (6), in a circumferential direction (13) related to the rotor longitudinal direction (6) and/or in a direction transverse to the rotor longitudinal direction (6)

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