U.S. patent number 3,736,938 [Application Number 05/198,885] was granted by the patent office on 1973-06-05 for ophthalmic method and apparatus.
This patent grant is currently assigned to The United States of America as represented by the Administrator of the. Invention is credited to John C. Evvard, William J. McGannon, Donald J. Vargo.
United States Patent |
3,736,938 |
Evvard , et al. |
June 5, 1973 |
OPHTHALMIC METHOD AND APPARATUS
Abstract
A method and apparatus for removing material and components such
as the lens from an eye is described. High speed rotary cutting
members at one end of a rod macerate the lens while an annular
tubing disposed around the cutting members vibrates ultrasonically
to coact with the cutting members in macerating the lens. At the
same time, a liquid is supplied to the chamber behind the cornea of
the eye. Spiral grooves extending along the rotating rod from the
cutting members evacuate the liquid and the macerated material from
the eye. An alternate embodiment of the apparatus includes a tube
through which liquid is supplied to the operative site of the
ultrasonically vibrating tube and the cutting members in the area
of the lens.
Inventors: |
Evvard; John C. (Strongsville,
OH), McGannon; William J. (Lakewood, OH), Vargo; Donald
J. (Seven Hills, OH) |
Assignee: |
The United States of America as
represented by the Administrator of the (Washington,
DC)
|
Family
ID: |
22735269 |
Appl.
No.: |
05/198,885 |
Filed: |
November 15, 1971 |
Current U.S.
Class: |
606/169; 433/131;
606/170; 606/180; 606/128 |
Current CPC
Class: |
A61F
9/00745 (20130101); A61M 3/0279 (20130101); A61M
3/0216 (20140204); A61M 3/0208 (20140204) |
Current International
Class: |
A61F
9/007 (20060101); A61M 3/02 (20060101); A61M
3/00 (20060101); A61b 017/32 (); A61b 017/00 () |
Field of
Search: |
;128/24,305
;32/28,58 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Medbery; Aldrich F.
Claims
What is claimed is:
1. A method of removing material from an eye comprising the steps
of:
rotating a tool member comprising a rod having at least one cutting
member at one end and a spiral groove extending longitudinally from
said cutting edge along said rod;
disposing a tubular sheath over said rod;
ultrasonically vibrating said sheath along its longitudinal
axis;
inserting said rod and sheath through the cornea;
supplying an incoming buffered vehicle solution to the anterior
chamber of the eye; and
engaging matter to be removed with both said sheath and said
cutting member to macerate said matter, the macerated material
being evacuated from the eye by said spiral groove.
2. The method of claim 1 wherein the step of supplying said
solution consists of inserting a hollow needle through the cornea
of the eye prior to inserting said tool member and supplying said
needle with said buffered vehicle solution at a pressure of from
about 15.6 mm to about 25.8 mm of mercury.
3. The method of claim 2 wherein said rod is rotated at a speed
sufficient to produce pumping evacuation of macerated material and
liquid.
4. Apparatus for removing matter from the interior of an eye
comprising:
a rod having at least one cutting edge at one end and at least one
spiral groove extending from said cutting edge along said rod;
drive means for rotating said rod;
a housing disposed over said rod, said housing including a
passageway in which said rod rotates freely, said housing being
thin-walled adjacent to said one end of said rod to form an annular
cutting edge;
means for imparting ultrasonic movement to said housing;
and means for supplying an incoming buffered vehicle solution to
the anterior chamber of the eye.
5. The apparatus of claim 4 wherein said cutting edge extends
radially and slopes in the same direction as the spiral groove.
6. The apparatus of claim 4 wherein a stem extends from said
housing at an oblique angle to said passageway for connection to
said means for imparting ultrasonic movement to said housing, said
stem merging into said housing along a curve.
7. The apparatus of claim 4 and including a hollow needle for
supplying fluid to the eye and a source of liquid connected to said
needle.
8. The apparatus of claim 7 and including flow control means
interposed between said hollow needle and said source of
liquid.
9. The apparatus of claim 8 and including a handle, said flow
control means being disposed on said handle.
10. The apparatus of claim 4 wherein said drive means rotates at a
speed greater than 1,600 RPM.
11. The apparatus of claim 4 wherein said one end of said rod is
flat.
12. The apparatus of claim 4 wherein said one end of said rod is
flush with said annular cutting edge.
13. The apparatus of claim 4 wherein said drive means rotates said
rod at a speed between about 2,600 and 30,000 RPM.
Description
ORIGIN OF THE INVENTION
The invention described herein was made jointly by a
non-Governmental inventor and by employees of the United States
Government. The invention may be manufactured and used by or for
the Government for governmental purposes without the payment of any
royalties thereon or therefor.
BACKGROUND OF THE INVENTION
Removing cataracts from eyes is an extremely delicate task. Up to
the present time the most generally used operative method involves
making an incision of about 180.degree. around the cornea and
teasing the lens out of its position with a suitable instrument.
Such an operation takes on the order of 45 minutes.
In the last few years devices have been developed which utilize
ultrasonic vibrations to drive cutting heads of various
configurations, as for example, chisel shaped or pointed members.
Liquid supplied to the eye for cleansing and for maintaining a
specified pressure in the eye is withdrawn by suction devices.
In the past, the liquid and macerated lens material have been
withdrawn through a conduit connected to a suction means such as a
vacuum pump. Because of the small size of the conduit and the
tendency of the ultrasonic vibration to harden macerated lens
material, clogging of the conduit can occur causing erratic
variations in suction which could cause the eye to collapse.
Furthermore, such clogging can cause dangerous pressure to be
impressed on the eye by fluid being supplied thereto. To avoid both
excessive suction and pressure in the eye, past systems have
utilized complicated and expensive devices to control and adjust
the pressure and the suction of the liquid being supplied to and
withdrawn from the eye, respectively.
Other arrangements have included an internally threaded tool having
cutting members at one end and which is vibrated both
longitudinally and about its axis with a rotary motion. The
ultrasonic motion in combination with an internally threaded
passage effects a pumping action. However, the pumping action is
difficult to maintain with regard to viscous materials of the eye
which once liquified, tend to harden if not quickly removed from
the area of ultrasonic vibrations.
OBJECTS AND SUMMARY OF THE INVENTION
It is an object of the invention to provide an improved method for
removing material and components from an eye.
It is an additional object of the invention to provide a method and
apparatus for removing materials or components such as the lens
from an eye wherein excessive pressure is not built up in the eye
by fluid being supplied thereto.
it is another object of the invention to provide an apparatus for
macerating the lens of an eye and for positively evacuating the
macerated material without endangering the eye with excessive
suction or negative pressure and without requiring complex and
expensive suction and pressure control devices.
Still another object of the invention is to provide a rotating
macerating action in coaction with an ultrasonic vibratory
macerating action for removal of the lens of an eye.
Yet another object of the invention is to provide an opthalmic
probe of the foregoing type wherein liquid is supplied to the
operative site to increase the ultrasonic coupling and which liquid
is evacuated from the eye with the macerated material.
A further object of the invention is to provide an apparatus which
can be used to remove vitreous and vitreous opacities from the
posterior chamber of an eye; hemorrhage from both anterior and
posterior chambers; iris and pupillary adhesions; and matter
causing blockage in angle block glaucoma.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a pictorial drawing of a medical instrument embodying the
invention.
FIG. 2 is a longitudinal cross-sectional view of the operative head
of the medical instrument.
FIG. 3 is a longitudinal cross-sectional view of an embodiment of
the invention wherein liquid is supplied to the operative sight
through the operative head.
DESCRIPTION OF A PREFERRED EMBODIMENT
While the apparatus embodying the invention will be described with
respect to removing the lens from an eye, it can be used to remove
other matter and components from an eye. For example, the opthalmic
instrument is useful for performing a vitrecomy in which vitreous
or vitreous opacities are removed from the posterior chamber. It
may also be used for removal of hemorrhage from both anterior and
posterior chambers. Removal of iris and pupillary adhesions can
also be accomplished by use of the opthalmic probe embodying the
invention.
Referring now to FIG. 1, there is shown a handpiece 10 from which
extends an axially vibrating member 27. The handpiece 10 is
connected to an ultrasonic generator 12 by means of a cord 13. The
handpiece 10, the cord 13 and the ultrasonic generator 12 are
commercially available items. A drive means such as miniature
electric motor 14 is attached to the handpiece 10 by means of a
support bracket 15 which positions the motor 14 such that its shaft
16 is at an angle to the longitudinal axis of the handpiece 10. It
will be understood that motor 14 may be any suitable rotary means
such as a pneumatic or electric motor. An electrical power supply
17 energizes the motor 14 such that it operates at speed sufficient
to provide pumping action of the apparatus which will be described
hereinafter. The motor shaft 16 should rotate at a speed of at
least 1,600 revolutions per minute (RPM) with the preferable speed
being between about 2,600 to 30,000 RPM. The motor shaft 16 drives
a rod 18 through a coupling 19. The rod 18 extends into an
operative head 20, which as will be explained presently, is
utilized to remove the lens from an eye.
It has been found in cataract operations, that the danger of
collapse of the eye may be avoided by supplying fluid under
pressure to the eye. According to the present invention a control
valve 21 is mounted on the handpiece 10 to control fluid being
supplied from a fluid supply 22 via a conduit 23 to a hypodermic
needle 24 which has been inserted into an eye 7, the tip of the
needle being positioned in the anterior chamber 8. The fluid supply
may be a bottle containing a buffered saline solution. The pressure
of the fluid is adjusted to between about 15 and 26 mm of mercury
by raising or lowering the height of the bottle. A suitable valve
(not shown) connected in the conduit 23 between the bottle and the
needle controls the flow rate.
Referring now to FIG. 2 there is shown a longitudinal
cross-sectional view of the operative head 20 wherein parts
corresponding to those in FIG. 1 are identified by like numerals.
The operative head 20 comprises a housing 25 having a longitudinal
passageway 26 extending therethrough and a stem 27 which extends
from the housing 25 at an angle to the longitudinal passageway 26.
Stem 27 is retained in a guide member 11 of handpiece 10. Housing
25 serves as a sheath for rod 18. To prevent the ultrasonic
vibrations of member 27 from producing stresses which might cause
it to separate from the housing 25, the stem 27 merges into the
housing 25 along the curve 28.
One end of the rotating rod 18 may extend slightly out of the
housing 25 and is provided with cutting edges 29 which may be raked
or sloped in the direction of spiral grooves 30 which extend
longitudinally along the rod 18 from the cutting members 29 to a
point outside of the housing 25. One end of the housing 25 forms an
annular cutting edge 31 which is concentric with the rod 18 and
adjacent to the cutting edges 29 of the rod.
The one end of the rod 18 may be flat rather than having raked
cutting edges. The annular edge 31 may be positioned axially above,
below, or flush with the end of rod 18. For maximum macerating
action, the annular edge is positioned slightly above the end of
rod 18. However, for maximum safety, the annular edge 31 is
preferably flush or below the end of the rod 18.
In an actual eye operation, the annular edge 31 of the housing 25
is inserted through a puncture which has been made in the cornea of
the eye 7 until it engages the lens 9 of the eye 7 shown in FIG. 1.
The rotation of the cutting edges 29 and the ultrasonic vibration
of the annular edge 31 coact to macerate the lens material. Prior
to inserting the housing 25 through the cornea, a hypodermic needle
24, as shown in FIG. 1, is inserted into the chamber 8 through a
puncture. The puncture which is to receive the housing 25 allows
fluid to escape thereby avoiding excessive pressure until the
instrument begins to evacuate material.
The macerated material together with the liquid being supplied to
the anterior chamber 8 are pumped up through the housing 25 by the
spiral grooves 30. Advantageously, the removal of the liquid and
lens material is accomplished without undue suction or vacuum being
applied to the eye, thereby avoiding risk of damage to the eye by
such vacuum or suction.
FIG. 3 is a longitudinal cross-sectional view of an alternate
embodiment of the invention and parts corresponding to FIGS. 1 and
2 are identified by like numerals. In FIG. 3 a double wall coaxial
tube 32 is disposed around the housing 25 and extends toward the
operative end of the housing 25 but terminates short of the annular
cutting edge 31. The tube 32 is provided with sealing means and an
annular plenum chamber 33 through which a desired liquid may be
directed into an annular space 34 between the walls of the tube 32.
The liquid serves to maintain a slight pressure in the eye; to
lubricate and cool the rod 18 and the housing 25 to increase the
ultrasonic coupling; and to function as a carrier for the macerated
material. The tube 32 does not vibrate with the housing 25 and
thereby avoids atomizing the liquid being supplied to the operative
tip through the annular space 34. The liquid is removed from the
operative site by the spiral grooves of rod 18 as in the structure
shown in FIG. 2.
It will be understood that the invention described above may be
changed or modified by those skilled in the art without departing
from the spirit and scope of the invention as set forth in the
claims appended hereto.
* * * * *