Surgery – Instruments – Cutting – puncturing or piercing
Patent
1995-11-15
1997-11-04
Dawson, Glenn K.
Surgery
Instruments
Cutting, puncturing or piercing
606167, A61B 1714
Patent
active
056834080
DESCRIPTION:
BRIEF SUMMARY
This application is a 371 of PCT/FR94/01311, filed on Nov. 9, 1994.
The invention relates to the field of surgical instruments, and more particularly to instruments of the punch forceps type for eye surgery, for the purpose of performing trabeculectomy in association with a cataract operation.
Trabeculectomy is a surgical act that is frequently performed when treating glaucoma.
Glaucoma or hypertension of the eye is a serious eye disease that gives rise to an increase in the pressure within the eyeball due to excessive secretion of aqueous humor or to insufficient natural drainage thereof. This complaint constitutes the major cause of blindness, so treatment thereof is under continuous research.
The treatment of glaucoma is generally purely medical to begin with (using substances such as beta-blockers), but the way in which the pathology progresses often leads to the surgical solution of performing trabeculectomy.
Trabeculectomy is also often associated with a cataract operation even though the two complaints are due to causes that are very different. Under such circumstances, the operation consists initially in performing the cataract operation, and then in proceeding with trabeculectomy.
In general, trabeculectomy is a surgical operation that consists in perforating the trabeculum, so as to allow the aqueous humor under excess pressure within the anterior chamber of the eye to flow out therethrough, thus regulating intraocular pressure.
The traditionally-used technique consists in opening the conjunctiva and in making a flap or trap-door in the sclera so as to be able to perforate the trabeculum (see for example documents WO-A-82 03168 and SU-A-1 734 735).
In general, this ablation is performed by means of a sharp instrument such as a scalpel, a chisel, or punch forceps, which instrument is often referred to by the person skilled in the art as a "punch".
The punch used under such circumstances comprises an elongate body having an elongate lever hinged thereto together with a punch proper constituted by a tubular blade rigidly fixed to the end of the body and a plunger that slides within the tubular blade, the distal end of the plunger having a notch with a cutting edge and having its proximal end engaged with the end of the lever.
Return is provided in the forceps by means of a spring blade urging the forceps to a rest position in which the operating handles (behind the hinge) are spaced apart: in this position, the notch having a cutting edge projects beyond the circular cutting edge of the tubular blade. When the surgeon clamps the operating handles together, the lever retracts the cutting plunger into the inside of the tubular blade, and tissue is clamped between the circular cutting edge of the tubular blade and the cutting edge of the notch in the cutting plunger, thereby cutting the tissue.
It should be observed that this type of punch is designed to perform perforation together with cutting out, and therefore differs considerably from punches used in other fields of surgery and designed for taking samples or fragments of bone (with such punches being described, for example, in documents EP-A-0 244 491, GB-A-2 022 421, and DE-U-85 18 482).
Accompanying FIG. 10 shows the usual trabeculectomy procedure using a punch of the above-specified type.
This figure shows an eye 1 together with its cornea 2 covered in conjunctiva 3, and associated with its sclera 4. There can also be seen the iris 5, the anterior chamber 6 occupied by aqueous humor, the lens 7, and the zonula 8 attached thereto, together with the posterior chamber 9 occupied by the vitreous humor. The annular zone 10 includes the zonular muscles and the trabeculum.
After opening the conjunctiva, the surgeon then cuts a flap 11 of side 5 mm to 7 mm in the outer thickness of the sclera, and installs a thread 19 to hold the flap open. A window 12 is then cut through the inner thickness of the sclera so as to give access to the tissues of the trebeculum. Using forceps (not shown) a portion of the trebeculum is withdrawn and then cut by means of sc
REFERENCES:
patent: 4509516 (1985-04-01), Richmond
patent: 4667684 (1987-05-01), Leigh
patent: 5171257 (1992-12-01), Ferzli
Database WPI Section PQ, Week 9319, Derwent Publications Ltd., London, GB. Class P, AN 93-157600 & SU A 1 734 735 (Eye Microsurgery Res. cite dans la demande.
Database WPI Section PQ, Week 9411, Derwent Publications Ltd., London, GB Class P, AN 94-08999 & SU A 2 003 353 (Don Med. Inst.).
Crozafon Philippe
De Laage De Meux Patrice
Cole Thomas W.
Dawson Glenn K.
Ferguson Jr. Gerald J.
Moria S.A.
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