U.S. patent number 3,815,604 [Application Number 05/264,166] was granted by the patent office on 1974-06-11 for apparatus for intraocular surgery.
Invention is credited to Ralph M. Heintz, Sr., Conor C. O'Malley.
United States Patent |
3,815,604 |
O'Malley , et al. |
June 11, 1974 |
APPARATUS FOR INTRAOCULAR SURGERY
Abstract
A pneumatically operated intraocular surgery apparatus which is
of very light weight and small size, the part inserted into the eye
having a diameter of 1 mm. or less. One embodiment of the invention
employs a high frequency electric current electrode for cutting or
severing vitreous or other material, said electrode being provided
with means for removing coagulated material adhering thereto. Other
embodiment of this invention which are also of very small size and
light weight employ concentric tubes with a pneumatic means for
moving one of the tubes with respect to the other at a slow or fast
rate so that vitreous sucked into one of the tubes is sheared off
by the sharp end of the other tube and the severed vitreous is
sucked into a calibrated cylinder and at the same time saline
solution is automatically supplied to the eyeball to replace the
removed vitreous.
Inventors: |
O'Malley; Conor C. (San Jose,
CA), Heintz, Sr.; Ralph M. (Los Gatos, CA) |
Family
ID: |
23004893 |
Appl.
No.: |
05/264,166 |
Filed: |
June 19, 1972 |
Current U.S.
Class: |
604/22; 83/582;
606/45; 606/32; 606/171 |
Current CPC
Class: |
A61B
18/1206 (20130101); A61B 18/12 (20130101); A61M
1/75 (20210501); A61F 9/00763 (20130101); Y10T
83/8776 (20150401); A61B 2018/0066 (20130101); A61B
2017/00544 (20130101); A61F 9/0079 (20130101); A61M
2210/0612 (20130101) |
Current International
Class: |
A61B
18/12 (20060101); A61F 9/007 (20060101); A61M
1/00 (20060101); A61B 17/00 (20060101); A61b
017/32 (); A61m 001/00 () |
Field of
Search: |
;128/2B,276,297,305,311 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
Peyman et al., "Experimental Vitrectomy," In Arch. Ophthal. 68:
548-551. November 1971..
|
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Allen & Chromy
Claims
What we claim is:
1. In an apparatus for intraocular surgery such as cutting or
severing and removal of vitreous or other material from the eyeball
of a patient, the combination of a vitreous cutting and removing
device, a pair of telescoping tubular members, means moving one of
said tubular members back and forth with respect to the other
during the vitreous cutting operation, one of said tubular members
having a hole for receiving vitreous to be severed and removed from
the eye and the other of said tubular member having one end thereof
sharpened to shear the vitreous entering said hole, means attached
to the inner one of said telescoping tubular members for removing
the severed vitreous, said moving means comprising sources of
compressed air and vacuum and pneumatic actuating means connected
to said movable tubular member, means connected to said sources
alternately for reciprocating said pneumatic actuating means and
said movable tubular member, said means attached to said inner
tubular member comprising a hose and means connecting said hose to
said source of vacuum.
2. In an apparatus for intraocular surgery such as cutting or
severing and removal of vitreous or other material from the eyeball
of a patient, the combination as set forth in claim 1, further
characterized in that said means connecting said hose to said
source of vacuum comprises a vacuum control valve periodically
actuated by compressed air and vacuum.
3. In apparatus for intraocular surgery for cutting or severing and
removal of vitreous or other material from the eyeball of a
patient, the combination comprising a tube of very small diameter
having a hole near one end thereof, a second tube concentric with
said first mentioned tube, said tubes fitting snugly together and
one of said tubes being slidable with respect to the other, the end
of said second tube being honed and polished to provide a sharp
cutting edge, means connected to said tubes drawing vitreous into
said hole of said first mentioned tube, means for moving said one
of said tubes so that the sharp end thereof crosses said hole and
shears said vitreous sucked into said hole of said first mentioned
tube, a handle comprising a cylinder with a piston slidable
therein, means connecting said one of said tubes to said piston and
pneumatic means for moving said piston back and forth.
4. In an apparatus for intraocular surgery such as cutting or
shearing and removal of vitreous or other material from the eyeball
of a patient, the combination as set forth in claim 3, further
characterized in that said one of said tubes that is connected to
said piston comprises the tube with said hole near one end thereof
and said one of said tubes being slidable inside of said second
tube.
5. In an apparatus for intraocular surgery such as cutting or
shearing and removal of vitreous or other material from the eyball
of a patient, the combination as set forth in claim 3, further
characterized in that said one of said tubes that is connected to
said piston comprises said second tube and said second tube being
slidable in said first mentioned tube.
6. In an apparatus for intraocular surgery such as cutting or
shearing and removal of vitreous or other material from the eyeball
of a patient, the combination as set forth in claim 3, further
characterized in that said pneumatic means comprises sources of air
pressure and vacuum, and means alternately connecting said sources
to the said cylinder for actuating said piston.
7. In an apparatus for intraocular surgery such as cutting or
shearing and removal of vitreous or other material from the eyeball
of a patient, the combination as set forth in claim 3, further
characterized in that said pneumatic means includes a pair of small
flexible hoses one of which supplies pressure and vacuum from said
sources to actuate said piston and the other of which is connected
to the inner one of the cutting tubes for removal of debris
resulting from the cutting operation.
8. In apparatus for intraocular surgery for cutting or shearing and
removal of vitreous or other material from the eyeball, the
combination of a vitreous cutting device comprising a pair of tubes
of very small diameter, the end of one of said tubes being honed
and polished to provide a sharp cutting edge and the other of said
tubes being provided with a hole for receiving vitreous to be
severed and removed from the eye, said tubes being concentric and
one of said tubes being slidable with respect to the other so that
said sharp cutting edge traverses said hole, means generating a
pulsating electric current, means controlling the frequency of said
pulsating electric current, pneumatic apparatus comprising a vacuum
pump and an air pressure pump, a pneumatic line and means
connecting said line to said cutting device, a two-way valve
connected to said pneumatic line, means connecting said valve to
said pressure pump and to said vacuum pump, means responsive to
said pulsating current for operating said valve and alternately
connecting said pneumatic line to said source of air pressure and
to said source of vacuum through said two-way valve, said cutting
device having means responsive to alternate air pressure and vacuum
pulses transmitted through said pneumatic line.
9. In an apparatus for intraocular surgery such as cutting or
shearing and removal of vitreous or other material from the eyeball
of a patient, the combination as set forth in claim 8, further
comprising a second pneumatic line, means connecting said second
pneumatic line to the inner one of said concentric tubes, means
periodically connecting said second pneumatic line to said vacuum
pump for removing debris from said inner tube.
10. In an apparatus for intraocular surgery such as cutting or
shearing and removal of vitreous or other material from the eyeball
of a patient, the combination as set forth in claim 9, further
characterized in that said second pneumatic line is inside of said
first mentioned pneumatic line and said means periodically
connecting said second pneumatic line to said vacuum pump includes
a pneumatically operated valve.
11. In an apparatus for intraocular surgery such as cutting or
shearing and removal of vitreous or other material from the eyeball
of a patient, the combination as set forth in claim 10, further
characterized in that said pneumatically operated valve comprises a
vacuum control valve operated by a piston slidable in a cylinder,
and means connecting said cylinder to said two way valve to supply
air pressure and vacuum thereto alternately.
Description
DESCRIPTION OF THE INVENTION
This invention relates to apparatus for use in effecting intricate
surgery such as performed by an ophthalmic surgeon.
In certain diseases of the eye or in certain trauma it is necessary
to sever the vitreous which is a relatively complex substance
composed of a framework of long protein molecules with patches of
other protein molecules positioned at the intersections where the
long protein molecules (collagen) are. In addition the vitreous
also includes patches or balls of a second protein molecule
(hyaluronic acid) which help to strengthen the vitreous and
maintain its form and assist in holding water which comprises over
99 percent of the vitreous. The surgeon then finds it necessary to
remove the severed vitreous or extraneous matter from within the
vitreous and this removal must be accomplished without damage to
the retina, to the choroid which underlies the retina or to the
optic nerve or to the blood vessels associated therewith. This, of
course, is no easy task as the vitreous can not be cut by a scalpel
or other similar instrument since the vitreous is relatively tough
and simply folds over the edge of the knife and refuses to be
severed. Various devices have been proposed for vitreous surgery
and reference is made to such devices in the following published
articles.
G. C. Couvillion, H. M. Freeman, and C. L. Schepens on pages 722
and 723 of Volume 83, June 1970, Arch Ophthal, describe vitreous
surgery using scissors. Robert Machemer, Jean-Marie Parel and E. W.
D. Norton on pages 462 to 466 of Volume 76, March-April 1972, Tr.
Am. Acad. Ophth. and Otol., describe a
vitreousinfusion-suction-cutter for vitrectomy. The cutter
described in this article is provided with a rotating inner tube
that is pushed by a spring against an end of an outer tube. A
cutting hole which is slightly laterally displaced, is provided in
the end of the tip. In another article entitled "Experimental
Vitrectomy," in Volume 86, November, 1971, Arch Ophthal, G. A.
Peyman and M. A. Dodich describe an instrument for cutting vitreous
strands by a chopping action produced by an inner tube against the
plane end of an outer tube. The vitreous to be removed is drawn
into the inner tube by suction provided in the inner tube. In this
device another tube is attached alongside the outer tube and saline
solution is supplied through this tube to replace the removed
vitreous. In this device the chopping action is produced by
oscillating the inner tube 5 to 50 times per second and this is
achieved by electrically energizing a small solenoid that is
attached to the inner tube.
Probes energized by radio frequency electric currents have also
been used in ophthalmic surgery and one such device is described by
G. A. Peyman and N. A. Dodich on pages 29 to 37 of the January
February 1972 issue of Ophthalmic Surgery. This article describes
the use of a radio frequency electric current energized probe for
intraocular coagulation. The May, 1954 issue of the American
Journal of Ophthalmology contains an article by Angelos Dellaporta
in which he describes a device using an insulated transbulbar
needle 30 mm. in length which is connected to an electric current
supply and is used to seal retinal holes. This device, according to
this article is manufactured by C. Reiner, Mariannengasse, Vienna
9. The June, 1970 issue of Arch Ophthal contains an article by W.
D. Cockerham, C. L. Schepens and H. MacKenzie Freeman entitled
"Silicone Injection in Retinal Detachment." The authors describe a
procedure in which a 10 cc syringe which is attached to a blunted
No. 18 or No. 20 needle is inserted into the eye through a
meridional sclerotomy placed in the middle of the pars plana
ciliaris for silicone injection.
It is therefore an object of our invention to provide an improved
apparatus for cutting vitreous, severing adhesions and sealing
blood vessels or severing them without causing hemorrhage.
Another object of our invention is to provide an improved device
for operations such as cutting vitreous and sealing blood vessels
that might be displaced or have become dislodged from the retina
and migrated or grown into the body of the vitreous, said improved
device enabling the surgeon to perform such operations with a
minimum of likelihood of hemorrhage either while cutting the
vitreous or during a separate procedure.
Still another object of our invention is to provide improved tools
for use of eye surgeons, said tools being so small that they may be
inserted into the eye through the pars plana.
A further object of our invention is to provide improved tools for
use by eye surgeons, the portion of the tool to be inserted into
the eye having a diameter of 1 mm., or less and the whole
instrument being small and lightweight so that it can be hand-held
and manipulated with ease and with minimal damage to the eye.
Other and further objects of our invention will be apparent to
those skilled in the art to which it relates or will be pointed out
in detail in the following specification, claims and drawing.
By this invention we have provided the eye surgeon with an
operating tool that is characterized by its extremely small size
and light weight for performing surgery within the eye of the
patient. We have developed two types of mechanical vitreous cutting
instruments and one high frequency electrical cutting instrument.
All of these instruments may of course be used for cutting material
other than vitreous by the operating surgeon. One of the mechanical
devices is referred to as the push-cut and the other is referred to
as the pull-cut. Both of these instruments have the same dimensions
and weight (about 4 grams) and in each case the length is about 2
inches overall with the body thereof having a length of 1 inch and
the cutting tube also having a length of 1 inch. The diameter of
the cutting tube is 0.035 inch (0.9 mm.). The push-cut instrument
comprises a cylinder with a piston sliding within it and the
cutting tube is rigidly fastened to the piston and passes through
it to a debris extracting tube. This cutting tube is positioned
inside of an outer tube and is free to slide about 0.020 to 0.040
inches (0.5 - 1. mm.) between limits set by the cylinder head and
piston. A narrow (0.05 mm.) slit is provided in the inner tube and
this slit extends for a considerable length from the sharp cutting
edge through one side of the tube. This slit permits the inner tube
to be sprung out slightly so that the sharpened end of the inner
tube is pressed tightly against the inner surface of the outer tube
thereby insuring a good shearing action when the sharp end of the
inner tube passes the port opening in the outer tube. Vitreous to
be severed is drawn into the port of the outer tube by suction and
this vitreous is cut off when the piston moves the inner tube so
that the sharp end thereof crosses the port of the outer tube. The
frequency of the traverse of the cutting end of the inner tube
across the port of the outer tube is controlled by an electrical
circuit which generates timed electrical pulses for controlling air
pressure and suction pulses to the piston of the cutting device.
This frequency may be controlled by a foot actuated device which is
operated by the surgeon employing this instrument. Thus, this
frequency may be varied from a stationary condition with the port
either open or closed to as many as 60 traverses per second or
more. The speed of excursion is dictated by the nature of the
material being cut, its proximity to the retina, the optic nerve,
blood vessels or other sensitive regions. Air pressure and suction
are applied to the piston of the cutting device through a flexible
tube having a diameter of about one-eighth inch with a bore of
about one-sixteenth inch. The debris tube is positioned inside of
the pressure and suction tube and it has an outside diameter of
about 0.035 inches and an inside diameter of 0.020 inches. Thus,
the annular space between the two tubes serves to supply the
cutting piston with suction and air pressure pulses and the inner
tube supplies suction and conducts the debris out of the eye and
into a measuring cylinder.
The pull-cut instrument has the same dimensions and weight as the
push-out instrument as previously mentioned but instead of cutting
on the outward stroke of the inner tube this tube cuts on its
inward stroke. Thus, the inner tube is, in this case, provided with
the port and the material sucked into the port is sheared off by
the sharpened end of the outer tube. In this case the outer tube is
slit and is sprung inward so that it forms a tight fit against the
outer surface of the inner tube. Also in this case the inner tube
may be provided with two opposing ports thereby permitting easier
flow of vitreous or other material into it. The pull-cut instrument
has some advantage over the push-cut device, but it has the
disadvantage that the inner tube must protrude about three-fourths
mm. from the outer tube on each stroke. In all other respects the
operations of both of the units are equally effective with the
pull-cut instrument being less vulnerable to dulling of its cutting
edge during assembly. However, with care either unit can be
disassembled and reassembled without damage or difficulty.
The high frequency electrical cutting instrument that we have
provided in this invention employs a radio frequency electrical
supply and may be used equally well on frequencies between 13
megaHertz and 140 megaHertz. The source of high frequency power may
be either of the thermionic variety or the solid state variety,
however, the solid state is preferred because of its greater safety
under all operating conditions. The radio frequency current is
supplied to the cutting electrode through an impedance matching
network and a coaxial transmission line terminated in the cutting
device. The electrode is slidable in a dielectric sleeve which is
of fused quartz provided with a thin outer coating of a
fluorocarbon plastic. This coating provides a precautionary measure
so that should the quartz tube break the pieces will be confined
within the plastic sock and be withdrawn without damage to the eye.
The fused quartz sleeve has a small hole of 0.005 inches diameter
and the high frequency electrode which is attached to a small
piston that is movable in the handle of the instrument is slidable
in this quartz tube so that the cutting end of the electrode moves
in and out of the end of the quartz a very short distance. During
this in and out motion of the electrode tip any foreign matter such
as coagulated protein adhering thereto is scraped off of the
electrode by the end of the quartz tube. In order for this high
frequency cutting instrument to function efficiently a reasonably
good impedance match must be provided between it and the high
frequency coaxial transmission line and in our invention we have
provided such an impedance match in the handle of the device by
adjusting the material of the dielectric sleeve and the diameter of
the extendable flexible conductor.
In order to reduce the diameter of the high frequency cutting probe
a metal tube may be employed instead of the fused quartz tube.
Metals such as iridium or a platinum-iridium alloy may be used for
this purpose because of its high strength, stiffness, hardness and
chemical inertness. A metal tube having an outside diameter of 0.01
inches (0.25 mm.) is suitable for this purpose and this tube is
provided with a coating of fluorocarbon plastic of 0.002 to 0.003
inches thickness. Such a tube is flexible enough so that is may not
be necessary to provide a flexible hinge between it and the handle
of the instrument as may be required in the case where a sleeve of
fused quartz is used as previously described.
Further details and features of this invention will be set forth in
the following specification, claims and drawings in which
briefly:
FIG. 1 is a perspective view of an embodiment of this
invention;
FIG. 2 is a schematic diagram showing the various controls provided
to this apparatus;
FIG. 3 is a side view of the pneumatic control device provided to
this invention;
FIG. 4 is a sectional view of the control device shown in FIG.
3;
FIG. 5 is an enlarged view of the pull-type vitreous cutting
device;
FIG. 6 is an exploded view showing the parts of the vitreous
cutting device shown in FIG. 5;
FIG. 7 is a sectional view taken along the line 7--7 of FIG. 6;
FIG. 8 is a sectional view taken along the line 8--8 of FIG. 6;
FIG. 9 is a sectional view taken along the line 9--9 of FIG. 6;
FIG. 10 is a greatly enlarged view of the cutting end of the
pull-type device shown in FIGS. 5 and 6;
FIG. 11 is a greatly enlarged view of a modified form of the
pull-type vitreous cutting device;
FIG. 12 is an enlarged view in perspective of the push-type
vitreous cutting device;
FIG. 13 is an exploded view greatly enlarged of the cutting end of
the device shown in FIG. 12;
FIG. 14 is a longitudinal sectional view of the device shown in
FIG. 13 with the cutting elements assembled;
FIG. 15 is a fragmentary sectional view of the handle portion of
the device shown in FIG. 12;
FIG. 16 is an enlarged view of the high frequency electric current
energized cutting device employed in accordance with this
invention;
FIG. 17 is a longitudinal sectional view of the device shown in
FIG. 16;
FIG. 18 is an exploded view of the device shown in FIGS. 16 and 17;
and
FIG. 19 is a schematic view of a system for injecting normal saline
solution or other liquid into the eye as material is removed from
the eye.
Referring to the drawing in detail reference numeral 10 designates
a cabinet for housing various controls such as shown in FIG. 2 of
the drawing and provided to this apparatus. The motor 11 which is
mechanically connected to the vacuum pump 12 and air pressure pump
13 is housed in the cabinet 10 together with the pumps 12 and 13
which are connected by suitable tubes to the tanks 14 and 15,
respectively. A vacuum gauge 16 is connected by suitable tube to
the tank 14 and a pressure gauge 17 is connected by a suitable tube
to the pressure tank 15. These gauges are located on the front
panel of cabinet 10 so that the dials thereof are visible to the
operator. The motor 11 is connected to a suitable source of
electric power such as is available in the conventional wall outlet
and a switch 18 is provided on the panel of the cabinet for turning
the motor on and off. An auxiliary switch 19 is provided between
the power line and the D.C. power supply 20 which converts the
alternating current supplied thereto to direct current for
energizing the multivibrator 21 and flip-flops 22 and 23.
Multivibrator 21 is provided for triggering the flip-flop 22 which
produces an output designated as mode A signal which may be
supplied to the gate 24 through switch 25 when it is desired to
actuate the solenoid 26 driving the valve 27 in this mode. In mode
A the valve 27 is actuated to connect the output line 28 for equal
intervals to the vacuum line 29 and the pressure line 30
alternately. When the switch 25 is shifted to connect the output of
flip-flop 22 to flip-flop 23 then the apparatus is operated in mode
B and the wave form of this mode is supplied to the gate 24 and to
solenoid 26 for controlling the valve 27 in accordance with this
mode. In mode B the valve 27 is operated so that it connects the
output line 28 to the vacuum or suction line 29 for an interval
approximately three times as long as the interval during which this
line 28 is connected to the pressure line 30. On the other hand the
mode B signal may be used to connect output line 28 to the pressure
line 30 for a longer interval than the interval during which it is
connected to the vacuum line, if desired.
The desired mode may be selected by operating the switch 31 that is
connected to the control box 32. This switch is shown positioned on
the front panel of the cabinet 10 although a suitable foot control
may be provided for actuating this switch. A variable resistor 33
which may also be varied by a conventional foot control, is
connected to the multivibrator 21 for controlling the frequency of
the pulses in modes A and B. Multivibrator 21 supplies electrical
pulses for triggering flip-flop 22 and thus controls the frequency
of the pulses produced by this flip-flop. The variable resistor 33
may also be provided with a foot control although it is shown as
being controlled by the knob 33a provided on the front panel of the
cabinet.
The line 28 is connected to the fitting 28a which is attached to
the front panel of the cabinet. This fitting is of the quick
disconnect Luer type so that the line or tube 28b provided between
it and the vacuum control device 34 may be readily disconnected
therefrom. The vacuum control device 34 which is shown in detail in
FIG. 4, is provided with a T-connection 35 having two arms 35a and
35b and line 28b is connected to arm 35a. Arm 35b is connected to
line 36 which may be connected either to the inlet 37 or inlet 38
of the control device 34 for purposes which will be described more
fully hereinafter. The control device 34 is provided with a piston
39 of plastic that is slidable in the cylinder 40 and the ports 37
and 38 lead into this cylinder, one port 37 leading in below the
piston 39 and the other port 38 leading in at the top end thereof,
and the purpose of this will also be described hereinafter.
A piston rod 41 which is also plastic is attached to the piston 39
and extends into a small cavity 42 into which the small tube 43
also extends. This end of the tube 43 is carefully lapped and
polished and provides a seat for the end of rod 41. Thus the lapped
and polished end of tube 43 is alternately opened and closed by the
end of the piston rod 41 as the piston 39 is moved back and forth
during the operation of this device. The Luer type fitting 44 is
attached to the control device 34 and provides a connection between
the small cavity 42 and the cylinder 45 which may be of 5 cc.
capacity calibrated in one-tenth cc. increments to measure the
vitreous or other material removed from the eye of the patient. The
standpipe 45a in cylinder 45 is connected by the line 46 to the top
of the waste overflow bottle 47. The bottle 47 is also connected to
the vacuum line 48 so that vacuum is provided therein.
The vacuum control device 34 is also provided with an extension
neck 49 and the small tube 43 which has an outer diameter of 0.6
mm., is concentric with the extension neck 49. Tube 43 extends
outward beyond extension 49 so that a small debris tube 50 is
attached to the projecting part of the small tube 43. The tube 50
is positioned inside of the tube 51 and this latter tube is
attached to the projection 49 of the device 34. The tubes 50 and 51
are attached to a cutting and debris extracting device such as
indicated at 52 which may be either of the type indicated at 53
shown in FIGS. 5 to 11 or of the type indicated at 54 shown in
FIGS. 12 to 15. On the other hand a high frequency electric cutting
device 55 such as shown in FIGS. 16 to 18 may be connected to the
fitting 28, shown on the front of the cabinet 10, instead of the
tube 28b so that the cutting device 55 may be used instead of the
cutting devices 53 or 54.
The pull cut device 53 shown in FIGS. 5 to 11, inclusive, is
provided with a housing 56 which also functions as a handle and
which has a tubular projection 57 at one and thereof. The plastic
tube 51 is attached to projection 57 so that alternate air and
suction pulses according to either mode A or mode B are provided on
the inside of this housing to operate the piston 58 which is
slidably positioned in the housing 56. Piston 58 is made of
fluorocarbon plastic and one end thereof is indented to receive the
nut 59 which engages the enlarged threaded portion 61 of the debris
tube. The portion 60 of the debris tube extends out of the piston
and is inserted into the small hose or line 50 through which the
debris is exhausted from the small stainless steel tube 62.
The piston 58 is provided with a flag 63 which projects from one
end thereof and slides in slot 63b which is provided to the cap 64.
This flag keeps the piston from rotating with respect to the cap.
The cap 64 is provided with a knob 65 that is received by slot 66
of the housing 56 when this cap is attached to the housing. Thus,
the flag 63 serves to orient the piston 58 with respect to the cap
64 and the knob 65 serves to orient the cap 64 with respect to the
housing 56. The purpose of this will be described hereinafter. The
cap 64 is provided with four radially extending holes 67 which are
adapted to be aligned with corresponding holes in the housing 56 to
provide venting of the inside of the housing during operation of
this device. Thus, by providing four such holes it is not possible
for the operator of this device to cover all of the holes
simultaneously during use of this device so as to interfere with
the operation thereof. Suitable threaded holes 68 are provided in
the cap 64 and the screws 69 are threaded into these holes through
suitable apertures in the housing 56 when the cap is assembled with
the housing.
A tubular extension 70 is provided to the outside end of the cap 64
for receiving the stainless steel tube 71. The outer end of the
tube or sleeve 71 is tapered and sharpened at 72 as shown in FIG.
10. The outer end of the sleeve 71 is also provided with slots 73
so that the opposite sections of this outer end may be slightly
bent towards each other. Thus the sharp cutting edge 72 of the
sleeve provides sharp shearing action with the sides of the holes
74 which are provided in the inner sleeve 62. The shearing action
takes place as the inner sleeve is moved inward with respect to the
outer sleeve 71 by the piston 58 so that the sharp edge 72 sweeps
across the holes 74 and severs any vitreous sucked into the holes
74. The end of the tube 62 is welded and ground as shown at 62b to
close the end of the tube at this point and give this end a rounded
configuration.
It will be noted that the slots 73 are aligned with the ribs of
tubes 62 between the holes 74 and this alignment is maintained by
the flag 63 which is slidable in the recess 63b of the cap 64 when
the piston 58 moves back and forth in the housing by the compressed
air and suction pulses supplied to the cylinder and piston through
the tube 51. Suction is supplied to the inner sleeve 62 through the
tube 50 so that debris cut from the inside of the eye is exhausted
through the holes 74 formed in the sleeve 62 and through this
sleeve and tube 50.
A modified form of the pull-type cutting device is shown in FIG. 11
in which the tube 71a corresponds to the tube 71 of FIG. 10 and the
inner sleeve 62a corresponds to the sleeve 62 of FIG. 10. The
device shown in FIG. 11 is provided with a triangular shaped
cutting hole 74a through which material to be removed is sucked
into the sleeve 62a and this material is severed by the sharp
cutting edge of the outer sleeve 71a. A slot 73a is provided to the
sleeve 71a so that the end portion of this sleeve may be slightly
compressed to provide a tight fit between it and the sleeve 62a and
facilitate the cutting of the material drawn into the tube 62a when
this tube is moved into sleeve 71a and desired shearing action is
obtained between the sharp cutting edges 72a and 74a.
Another form of this device which is the push type cutting
embodiment, is shown in FIGS. 12, 13, 14 and 15. Certain parts of
this device provided in the housing 76 are the same as
corresponding parts provided in the housing 56 of the pull type
device shown in FIG. 5. The device shown in FIGS. 12 through 15,
inclusive, differs from that shown in FIGS. 5 to 11, inclusive, in
that the outer sleeve 75 which is fixedly attached to the cap 64 is
provided with an inner sleeve 77 which has the end 79 thereof
tapered and honed to a sharp cutting edge. The outer sleeve 75 is
provided with an opening at the outer end portion thereof which is
tapered and honed to a sharp edge so that when the inner sleeve 77
is moved outward these sharp cutting edges 78 and 79 cooperate to
shear off any vitreous or other material that has been sucked into
the sleeve. In order to produce this desired shearing action the
inner sleeve 77 is provided with a slot 80 so that the end portion
of this inner sleeve is expanded slightly and provides a close fit
between it and the inner wall of the outer sleeve 75.
The device 55 shown in FIGS. 16, 17 and 18 is an example of a
cutting device in which high frequency electric current is supplied
to a self-cleaning electrode. This device is provided with a
tubular housing 81 having an air and suction inlet member 82
attached to the side thereof. One end of the air and suction line
83 is attached to the inlet member 82 and the other end is attached
to the fitting 28a provided to the cabinet 10 shown in FIG. 1 after
the other line 28b is detached from this fitting. Air and suction
pulses according to mode A or B are supplied to the inside of the
device 55 through the inlet member 82 and the hole 84 aligned
therewith which communicates with the inside of the tubular housing
81 through the plug 85. This plug is of insulation material and it
is attached to the end of the tubular housing 81 by suitable
bayonet-type attaching means. High frequency coupling member 86 is
attached to the plug 85 and this member is of insulating material
so that the electrode 87 positioned therein is insulated from the
tubular housing. The electrode 87 is connected to the flexible
conductor 88 which is of conventional braided-type and a suitable
source of high frequency of conventional design is connected to the
electrode 87 by a coaxial cable of predetermined impedance. One end
of the braided copper wire conductor 88 is soldered to the small
bolt or screw 89 and the other end is soldered into the sleeve 91.
One end of the coil spring 90 abuts the inner end of the plug 85
and the other end of the coil spring abuts the insulation sleeve 92
that is positioned in the tubular housing 81. The other end of this
insulation sleeve abuts the shoulder provided inside of the tubular
housing 81 as shown in FIG. 17. The screw 89 is inserted into the
piston 93 of fluorocarbon plastic material. Piston 93 is slidable
inside of the housing 81 and it is moved through a short stroke of
about 11/2 mm. by the compressed air and suction pulses supplied
thereto through the pneumatic line 83. The piston 93 is held on the
screw 89 by the nut 94 and it is attached to another nut 95 which
functions as a chuck for the electrode wire 96. Electrode wire 96
is provided with a small knob 97 at the end thereof and this knob
is pressed against the end of the screw 89 when the chuck 95 is
attached to the screw. Electrode wire 96 passes through the central
hole provided in the insulation plug 98. Plug 98 is provided with
threads 99 and is attached thereby to the tubular housing 81.
Another plug 100 is attached by threads 101 to the plug 98 and a
short plastic tube 102 is attached in the central hole provided to
plug 100. One end of the insulation sleeve 103 which is of quartz
coated with a plastic such as Teflon is inserted into the plastic
tube 102 up to the constricted part 104. The plastic tube 102 is
provided with the constricted portion 104 to increase the
flexibility thereof so that the tube 103 may be moved slightly in
the direction of the arrows shown in FIG. 16 by flexing the tube
102 at the area 104. The electrode wire 96 passes through the tube
103 and during the back and forth movement of the piston 93 a small
portion of the electrode wire 96 is exposed at the free end of the
sleeve 103. The amount of this exposure may be controlled by
adjusting the plug 100 with respect to the plug 98. However, as the
electrode wire 96 is moved back and forth the outer end thereof is
cleaned by the outer end of the sleeve 103 so that material such as
coagulated protein adhering to the electrode wire 96 is scraped
therefrom by the end of the sleeve 103.
In FIG. 19 there is shown an arrangement for automatically
injecting normal saline solution or other liquid into the eye of
the patient as material is removed therefrom. This arrangement
includes an L or hook-shaped conduit 105 which has a diameter of
0.6 mm. or less and which is hooked into the eye of the patient so
that it is self retaining. The conduit 105 is connected by the
plastic tube 106 to a bottle 107 of saline solution which is
supported well above the patient so that the solution feeds into
the patient's eye as vitreous or other material is removed
therefrom to replace such removed material and maintain a
predetermined pressure. Conduit 105 is designed to fit snugly
against the eyeball with a low profile so that it is out of the way
of viewing and possible snagging of objects. This conduit could be
made of various materials such as metal, plastic, fused quartz or
glass.
While we have shown and described a preferred form of the
invention, it will be apparent that the invention is capable of
modification and variation from the form shown, so that the scope
thereof should be limited only by the proper scope of the claims
appended hereto.
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