U.S. patent number 3,776,238 [Application Number 05/174,349] was granted by the patent office on 1973-12-04 for ophthalmic instrument.
This patent grant is currently assigned to The Regents of the University of California. Invention is credited to Nicholas A. Dodich, Gholam A. Peyman.
United States Patent |
3,776,238 |
Peyman , et al. |
December 4, 1973 |
OPHTHALMIC INSTRUMENT
Abstract
An ophthalmic instrument is provided for removing vitreous and
fibrous bands from the retina of an eye. The instrument consists of
two tubes mounted coaxially within one another, and with an opening
adjacent the end of the outer tube. Cutting of the vitreous and
fibrous bands is performed by a chopping action set up by the sharp
end of the inner tube against the inner surface of the end of the
outer tube. The vitreous and fibrous bands which are trapped in the
mouth of the instrument are chopped and removed by suction by way
of the inner tube. In the instrument to be described, the vitreous
is replaced continuously by a saline solution, for example, which
is introduced into the instrument by way of a small infusion
tube.
Inventors: |
Peyman; Gholam A. (Chicago,
IL), Dodich; Nicholas A. (Marina Del Rey, CA) |
Assignee: |
The Regents of the University of
California (Berkeley, CA)
|
Family
ID: |
22635839 |
Appl.
No.: |
05/174,349 |
Filed: |
August 24, 1971 |
Current U.S.
Class: |
606/171; 294/15;
606/169 |
Current CPC
Class: |
A61F
9/00763 (20130101) |
Current International
Class: |
A61F
9/007 (20060101); A61f 009/00 (); A61b 017/32 ();
A61m 001/00 () |
Field of
Search: |
;128/305 ;269/81
;294/15,19R |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Pace; Channing L.
Claims
What is claimed is:
1. An ophthalmic instrument for re-ceiving vitreous, lens, and the
like, from the eye, said instrument including:
an elongated tubular housing having an open end and a closed end,
and having an opening in the side wall thereof adjacent said closed
end;
a tubular member mounted coaxially within said tubular housing in
sliding contact with the inner surface of said tubular housing and
extending through the open end thereof, said tubular member
providing a passage for the vitreous material, and the like, to
remove such material from the interior of said tubular housing, and
said tubular member having an annular cutting edge facing said
closed end of said tubular housing;
electrically actuated means for producing relative axial movement
between said tubular housing and said tubular member whereby said
tubular member incises substances drawn into said opening in said
tubular housing;
means coupling said tubular member to a suction pressure source to
draw the incised substances from said housing up through said
tubular member; and
an infusion tube mounted externally on said tubular housing for
introducing a replacement fluid into the eye during the operation
of the instrument, when the tubular housing is inserted into the
eye, to maintain constant pressure within the eye.
2. The combination defined in claim 1, and which includes further
means coupling said infusion tube to a pressurized source of
replacement fluid.
3. The instrument defined in claim 1, and which includes a
manipulator for supporting the instrument, said manipulator having
a ball joint therein through which said tubular housing protrudes,
so as to permit positioning of the instrument at any desired
angular position.
Description
BACKGROUND OF THE INVENTION
Many diseases of the blood vessels of the retina cause massive
hemorrhage into the vitreous. This hemorrhage is partly
re-absorbed, but organized to a large extent as fibrous bands, and
these can reduce the vision to blindness by pulling on the retina
or preventing light to pass through it.
The role of vitreous in retinal detachment has been recognized for
many years. But the vitreous remained more or less untouched until
Shafer (1958) replaced it with human vitreous implant. (D. M.
Shafer, The Treatment of Retinal Detachment by Vitreous Implant.
Transactions American Academy Ophthalmology. Otolaryng. 61:194-200,
1958). Later, Michaelson described in 1960 an instrument capable of
cutting the vitreous bands. (Michaelson, Transcleral Division of
Mid-Vitreous Membrane Under Visual Control, British Journal of
Ophthalmology, 44:634-635, 1960). Cibis in 1964 replaced the
vitreous with silicon and devised instruments for cutting the
vitreous bands. (P. A. Cibis, Vitreous Transfer and Silicon
Injection Transactions American Academy Ophthalmology Oto-laryng.
68:983-997, 1964). Freeman, Schepens, and Anastopoulous introduced
their vitreous scissors in 1967 (Vitreous Surgery II
Instrumentation and Technique Arch. Ophthal. 77:681-682, 1967).
Kasner reported on Vitrectomy in 1968 (D. Kasner Vitrectomy: A New
Approach to the Management of Vitreous Highlights Ophthal.
11:304-309, 1968 (published in July 1969)). More recently,
Machamer, Buettner and Norton in 1970 developed a vitreous
cutter-sucker infusion instrument (Vitrectomy-American Academy
Ophthalmology and Otolaryng. Las Vegas 1970).
Because of the nature of vitreous, which is composed of hyaloronic
acid and collogen fiber, it is not possible simply to remove the
substance by suction and to replace it with a balanced saline
solution. The vitreous must be incised. Thus far, the available
instruments have been plain scissors, as described in the aforesaid
publication by Freeman et al., and the aforesaid instrument devised
by Machemer et al., as described in the above identified
publication of the American Academy of Ophthalmology and
Otolaryng.
The Machamer et al. instrument consists of two tubes mounted
coaxially with one another and with a hole in both tubes. The inner
tube of the Machamer et al. instrument rotates against the inner
surface of the outer tube at one or two rotations per second.
However, the Machamer et al instrument does not provide
satisfactory results because the rotation of the inner tube ends to
cause shearing and traction on the collogen fiber, which result in
a pulling effect and a tendency to injure the retina.
The instrument of the present invention is intended to overcome the
deficiencies of the prior art instruments, and to provide a more
efficient means for removing the vitreous and fibrous bands, this
being achieved by sucking out the substances and incising the
fiber, the instrument acting as a tissue chopper, as will be
described. The rapidity by which the instrument of the invention
can chop the collogen fiber can reach a speed of fifty times per
second. The instrument of the invention has a feature in that there
is no pulling or shearing of the collogen fibers of the vitreous.
The instrument can also be used for the removal of the eye lens by
incising and sucking out the lens material.
Specifically, the instrument of the invention, as described briefly
above, consists of two tubes mounted coaxially within one another,
the outer tube having a closed end with an opening adjacent its
closed end. The inner tube is driven by electromagnetic means so
that it moves reciprocally within the outer tube. The cutting of
the vitreous is performed within the instrument by a chopping
motion. The sharp end of the inner tube repeatedly strikes the base
plate at the end of the outer tube. The vitreous and fibrous bands
which are trapped in the mouth of the instrument are chopped and
removed by suction by way of the inner tube. As mentioned above,
there is no pulling or shearing effect on the fibrous bands or on
the vitreous fibers. As also mentioned above, the vitreous is
replaced continuously by the instrument of the invention by a
saline solution which is introduced into the eye through the
instrument by a small infusion tube.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an elevational view of an ophthalmic instrument
constructed to represent one embodiment of the invention, the
instrument of FIG. 1 being shown in conjunction with a manipulator
which allows the surgeon to move the instrument in any desired
direction, as will be described;
FIG. 2 is a side section of the instrument of FIG. 1;
FIG. 3 is a side section, like FIG. 2, but of merely a fragment of
the instrument, to show the components thereof in an operating
position different from that shown in FIG. 2;
FIG. 4 is a somewhat schematic representation of appropriate
apparatus for providing suction to the instrument of FIG. 1, and
also for providing a replacement fluid for introduction into the
eye as the operation progresses; and
FIG. 5 is a fragmentary schematic representation of the instrument
of FIG. 1, and showing the manner in which the instrument cuts and
removes the vitreous substance.
DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENT
The instrument of the invention includes a housing 10 which, as
shown in FIG. 2 encloses a solenoid 12. The solenoid 12 includes a
usual electric coil 12a, and a plunger 12b. The plunger 12b is
biased upwardly in FIG. 2 by means of a spring 12c. However, when
the solenoid 12 is energized, the plunger 12c is drawn into the
coil 12a against the bias of the spring 12c. A cutting suction tube
14 extends through the plunger 12b, with the plunger being affixed
to the tube 14, so that as the plunger is moved rapidly up and down
due to the successive energizing and deenergizing of the solenoid,
the tube 14 also moves rapidly up and down.
The tube 14 is coaxial with a further tube 16, the latter tube
extending down from the lower part of the housing 10. The outer
tube 16 forms a tubular housing for the inner tube 14. The lower
end of the outer tube 16 is closed by means, for example, by a
plate 18, an opening 20 being provided in the wall of the outer
tube adjacent the plate 18, as shown. The lower end of the inner
tube 14 has a cutting surface formed on it as designated 14a. In a
constructed embodiment, for example, the inner tube had an outer
diameter of 1.2 millimeters, whereas the tubular housing 16 had an
outer diameter of 1.5 millimeters.
The tube 14 is coupled, for example, by means of a flexible suction
tube 24 to an appropriate vacuum source. The representation of FIG.
2 shows the inner tube 14 in a position in which the spring 12c
causes its cutting end 14a to be displaced away from the inner
surface of the plate 18. In the view of FIG. 3, however, the
solenoid is energized, so that the cutting surface of the inner
tube 14 is moved down against the inner surface of the plate
18.
As best shown in FIG. 5, the representation A shows the vitreous
substance being drawn in through the opening 20 adjacent the lower
end plate 18 of the outer tube 16. In the representation A, the
inner tube 14 is displaced up from the inner surface of the end
plate 18, and the representation A corresponds to the
representation of FIG. 2. In FIG. 5, the representation B is
similar to that of FIG. 3, in which the lower tube 14 is moved
down, so that its cutting surface coacts with the inner face of the
end plate 18, and a portion of the vitreous substance is trapped
within the center tube, as shown. In the representation C of FIG.
5, the severed portion of the vitreous substance is drawn upwardly
through the inner tube 14 by suction.
As mentioned above, the vitreous in the eye is replaced
continuously by a saline solution which is introduced into the eye
by way of a small infusion tube 30, the infusion tube having a
diameter, for example, of the order of 0.3 millimeters. The
infusion tube 30 is fastened to the side of the outer tube 16, as
shown in FIGS, 2, 3 and 5, for example. The infusion tube 30 is
coupled to a source of the saline solution by way, for example, of
a flexible tube 32.
The saline solution may be supplied to the infusion tube 30 by
means of the apparatus shown in FIG. 4 and, at the same time, a
suction may be established in the inner tube 14 by the same
apparatus. The aparatus shown in FIG. 4 comprises essentially two
syringes 50 and 52 which are mounted in axial alignment with one
antoher, and which are operated by a common plunger 54. The
flexible tube 32 is coupled to the syringe 52, as shown, whereas
the flexible tube 24 is coupled to the syringe 50.
A bracket 56 (FIG. 4) on the common plunger 54 is coupled by way of
a line 58 to a take-up spool 60, the take-up spool being operated,
for example, by an electric motor 62. As the motor is energized, it
causes the spool 60 to rotate, which, in turn, causes the line 58
slowly to draw the common plunger 54 to the left in FIG. 4. The
syringe 52 constitutes the source of the saline solution which is
introduced to the infusion tube 30 by way of the flexible tube 32.
To that end, the syringe 52 is filled with the appropriate saline
replacement solution. As the plunger 54 moves to the left, it
forces an appropriate replacement solution out of the syringe 52
and through the flexible lead 32 to the infusion tube 30. The
syringe 50, on the other hand, constitutes the vacuum source for
the flexible suction tube 24. At the same time, the common plunger
establishes a suction through the flexible lead 24, so that the
inner tube 14 may perform its desired function.
The instrument, as shown in FIG. 1, may be held by the surgeon in a
manipulator 61, the manipulator being equipped with a ball joint 63
through which the tubular housing 16 of the instrument protrudes.
By holding the manipulator, the surgeon can turn the instrument to
any desired inclination, and set it at that inclination. The
manipulator may be attached to the operating table, for example,
and it can be adjusted to have any desired angular position prior
to the operation.
Any appropriate electrical circuit may be provided for driving the
solenoid 12 at a desired rate.
To remove and replace the vitreous substance, the solenoid 12 is
activated by an intermittent electric current which causes the
inner tubular member 14 to move back and forth within the tubular
housing 16, as the solenoid is energized and deenergized. As
described above, for each downward stroke of the inner tubular
member 14, its cutting end incises and traps a portion of the
vitreous substance drawn into the tubular housing through the
opening 20, and this substance is drawn upwardly through the tube
14 by the suction exerted by the apparatus of FIG. 3.
As the vitreous body is cut and drawn through the inner tubular
member 14, it is replaced with appropriate replacement fluid which
is fed to the eye through the tubular member 30. The apparatus is
adjusted to that the amount of fibrous substance removed and the
amount replaced by the replacement fluid is always equal. The
removing and replacing of the vitreous body is accomplished by the
apparatus of FIG. 4 in the manner described above. The apparatus of
FIG. 4 permits equal removal and replacement of the eye fluid,
thereby maintaining the correct pressure within the eye.
As mentioned above, the instrument of the invention can also be
used for lens removal from the eye. When used for such a purpose,
the opening 20 in the tubular housing 16 is made larger than the
opening used for vitreous removal. The reason for this is that the
lens, being of a more solid and curved configuration, will fit more
easily into the enlarged opening for cutting and removal by suction
by the instrument of the invention.
The instrument described above has been used successfully, and has
been found to perform with a high degree of efficiency in
performing its intended function. The instrument may be operated at
high speed, and there is no pulling or shearing effect on the
fibrous bands or vitreous substance. The instrument also provides,
as described, for the vitreous in the eye to be replaced
continuously by an appropriate replacement solution, such as
saline. The instrument is easy to manipulate inside the vitreous.
Moreover, the instrument may be produced at a relatively low
cost.
While a particular embodiment of the invention has been shown and
described, modifications may be made. For example, the outer
diameter of the instrument can be made smaller than 1.5
millimeters; the instrument can be equipped with optic fibers for
illumination within the eye; the instrument's tip can be made very
flat, and the inner tube can be made as a flat blade for cutting
the membrane close to the surface of the retina. It is intended to
cover in the following claims all modifications which come within
the spirit and scope of the invention.
* * * * *