Intraocular lens insertion device

Details Intraocular lens insertion device Intraocular lens insertion device

2000-02-14

2001-10-09

Hirsch, Paul J. (Department: 3732)

Surgery

Instruments

Means for removing, inserting or aiding in the removal or...

C623S006120

Reexamination Certificate

active

06299618

ABSTRACT:

FIELD OF THE INVENTION
The present invention relates to an intraocular lens insertion device, and, more particularly, to an insertion device which is employed when a posterior chamber lens is sutured on an aphakic eye from which a posterior capsule of lens has been extracted or lost due to cataract surgery, accident or injury.
PRIOR ART
Conventionally, a lens whitened by a cataract is extracted by surgical means. As shown in FIG.
1
and
FIG. 2
, a lens
10
has a nucleus
11
and a cortex
12
, and the entire is capsulated by a lens capsule
13
. At a time when an intraocular lens was not developed, the nebular or whitened lens
10
was extracted by ICCE (Intracapsular Cataract Extraction) together with the entire lens capsule
13
or was extracted by ECCE (Entracapsular Cataract Extraction) while a posterior capsule
14
of the lens capsule
13
was left. In cataract surgery at this period, the intraocular lens could not be used, and the patient required very thick eyeglasses for correcting an intense hypermetropia.
Thereafter, as an intraocular lens, an anterior chamber lens to be inserted into an anterior chamber
15
of the eye was developed. The anterior chamber lens could be inserted into an aphakic eye to which ICCE or ECCE had been applied. However, the anterior chamber lens caused complications such as bullous keratopathy at a high rate, and thus, the anterior chamber lens was obsolete.
In place of the anterior chamber lens, a posterior chamber lens
16
to be inserted into the lens capsule
13
was developed. The posterior chamber lens
16
brought a relatively good eyesight to the patient without causing postoperative complications. In a current, typical cataract surgery employing the posterior chamber lens
16
, an anterior capsule
17
of the lens capsule
13
is cutout in a circular shape, the nucleus
11
and the cortex
12
inside the lens capsule
13
are removed by employing a phacoemulsifier aspirator, and then, the posterior chamber lens
16
is inserted into the lens capsule
13
. As shown in
FIG. 3
, the posterior chamber lens
16
has a pair of elongated elastic supporters (haptics)
18
,
18
. The haptics
18
,
18
are expanded within the lens capsule
13
by their own resilience, and abut against an inner surface
19
of the lens capsule
13
, thereby maintaining the posterior chamber lens
16
at its predetermined position.
The posterior lens
16
had a further advantage that the lens can be mounted to an eye to which a traditional cataract surgery had been applied. In the case of the patient undergoing ECCE for extracting the lens
10
leaving the posterior capsule
14
of the lens capsule, an easy, simple operation, i.e., inserting the posterior lens
16
into the left lens capsule
13
became possible.
The posterior lens
16
could be also mounted on an eye from which the entire lens
10
had been extracted by ICCE. In order to mount the posterior lens
16
on an eye which has no lens
10
, i.e., no tissues for supporting the posterior lens
16
, “ab externo approach” and “ab interno approach” were developed. In any approach, the haptics
18
of the posterior lens
16
is inserted into a ciliary sulcus
22
between an iris
20
and a ciliary body
21
, and is sutured on a sclera
23
with a thread. In these two approaches, a direction in which a needle is passed through the sclera
23
is different from another one.
FIG. 4A
to
FIG. 4E
show a process of the ab externo approach. In the ab externo approach, a piercing needle
26
through which a thread
25
with a suturing needle
24
is inserted is passed through an eye from the outside of the eye to the inside of the eye via the ciliary sulcus
22
(FIG.
4
A), a hook
28
is inserted into the inside of the eye via an incision
27
formed at the sclera
23
, and a part of the thread
25
in the eye is pulled out by the hook
28
to the outside of the eye (FIG.
4
B). Then, when a free end
29
of the thread
25
is completely pulled out via the incision
27
to the outside of the eye, and the suture needle
26
is removed from the eye, the state shown in
FIG. 4C
is obtained. In this state, the free end
29
of the thread
25
is tied with the first haptics
18
of the posterior chamber lens
16
, and a free end
29
of another thread
25
treated similarly is tied with the second haptics
18
(FIG.
4
D). Next, when the posterior chamber lens
16
is inserted into the inside of the eye via the incision
27
, and the threads
25
,
25
are pulled, the haptics
18
,
18
are introduced to the ciliary sulcus
22
, and finally, the threads
25
are sutured on the sclera
23
by the needle
24
. In this manner, as shown in
FIG. 4E
, insertion of the posterior chamber lens
16
is completed.
FIGS. 5A
to
5
E show a process of the ab interno approach. In the ab interno approach, a weak curved suturing needle
24
with the thread
25
is inserted into the inside of the eye via the incision
27
of the sclera
23
(FIG.
5
A), the needle
24
is put into the ciliary sulcus
22
(FIG.
5
B), and then the needle
24
is pulled out to the outside of the eye (FIG.
5
C). Next, the free end
29
of the thread
25
is tied with the first haptics
18
of the posterior chamber lens
16
, and another thread
25
treated similarly is tied with the second haptics
18
(FIG.
5
D). And, when the posterior chamber lens
16
is inserted into the inside of the eye via the incision
27
, and the threads
25
,
25
are pulled, the haptics
18
,
18
are guided to the ciliary sulcus
22
, and finally, the threads
25
are sutured on the sclera
23
by the needle
24
. In this manner, as shown in
FIG. 5E
, insertion of the posterior chamber lens
16
is completed.
The most disadvantageous point in the ab externo approach and the ab interno approach is that it is difficult to accurately guide the needle
24
or
26
to the ciliary sulcus
22
. In the ab externo approach, although the needle
26
is put into the sclera
23
based on the instinct and experience of the surgeon, there is no guarantee that the needle
26
is accurately guided to the ciliary sulcus
22
. In the ab interno approach, since the ciliary sulcus
22
is hidden by the iris
20
, the needle
24
advances toward the ciliary sulcus
22
blindly. Inaccurate needle insertion damages the ciliary sulcus
22
or iris
20
. In addition, if the haptics
18
are not correctly fitted to the ciliary sulcus
22
, a good eyesight cannot be expected.
SUMMARY OF THE INVENTION
An object of the present invention is to provide an intraocular lens insertion device to be used when the needle is put into the ciliary sulcus by the ab interno approach. This insertion device guides the needle to the ciliary sulcus accurately, can fit the haptics to the ciliary sulcus correctly, and prevents undesirable invasion.


REFERENCES:
patent: 4349027 (1982-09-01), DiFrancesco
patent: 5718677 (1998-02-01), Capetan et al.
patent: 5908404 (1999-06-01), Elliott
patent: 6059292 (2000-05-01), Josephberg
patent: 6156042 (2000-12-01), Aramant
patent: 6159218 (2000-12-01), Aramant et al.
patent: 6162229 (2000-12-01), Feingold et al.

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