The specific embodiment
Below, with reference to the accompanying drawings, embodiments of the present invention are described.Fig. 1 is installed in head on the front end and the summary pie graph of the control system that is connected with head with ultrasonic operation with cutter head.Fig. 2~4th is to the figure that describes with the front end shape ofcutter head 60 as the ultrasonic operation of an embodiment of the invention.
The head 1 of [0008] being controlled by operator is connected to have omitted on the illustrated apparatus main body and uses.Inside at head 1, keeping producing the ultrasonic vibrator 3 of ultrasonic vibration, vibrator 3 has the functions that make cutter head described later 60 straight moving vibrations, simultaneously, has and makes thecutter head 60 whirling vibrations function of (twisting vibration (referring to that the rotation take the major axis ofcutter head 60 as axle moves back and forth)).Vibrator 3 is by the energy drives of supplying with fromdriving device 30 through electrified cable 4.Amplifier unit (horn) the 5th, with the parts of the ultrasonic vibration amplification that produced by vibrator 3, amplifier unit 5 and vibrator 3 are fixed by one such as bolt and nuts.In addition, straight moving vibration and convolution (reversing) vibration as thecutter head 60 that has used the vibrator that carries out supersonic oscillations can utilize the technology of putting down in writing in No. 6077285 description of United States Patent (USP).
[0009] front end at amplifier unit 5 is fixed wtih theultrasonic cutter bit 60 of crystalline lens being examined the pulverizing usefulness of the tubulose of pulverizing emulsifying.Theattraction path 67 that is formed on the inside ofcutter head 60 is being communicated with the attraction path 7 that forms in amplifier unit 5 and vibrator 3 etc., attracts the rear end in path 7 to be connected with suction catheter 8.Give suction pressure bysuction device 31 in suction catheter 8, thissuction device 31 is made of suction pump etc., and the refuse that attracts is discharged in the waste fluid bag (omitting diagram).
[0010] is installed in thesleeve 11 that the perfusion of the front end of head 1 is used, has for hollow part from perfusate to ophthalmic that supply with, with about the protruding 1mm of the leading section ofcutter head 60, the rearward end ofcutter head 60 is covered (with reference to the length Y of Fig. 1 and Fig. 4).Sleeve 11 is made of the silicones with sufficient elastic force etc., is provided with for the tap hole of supplying with perfusate in eyeball at its front end.In the head 1 thatsleeve 11 has been installed, arrange theperfusion path 20 of perfusate tosleeve 11 interior guiding, the rear end ofperfusion path 20 is connected with perfusion tube 21.Perfusate is through perfusion tube 21, sends from theperfusion device 32 of perfusion control valve with outflow control of carrying out perfusate.
[0011]control device 33 hasinput part 34, based on the setting ofinput part 34 etc., respectivelydriving device 30,suction device 31 and theperfusion device 32 that connects is driven control.Based on the vibration of thecutter head 60 of vibrator 3, be driven in straight moving vibration or the whirling vibration any one bycontrol device 33 anddriving device 30 conversions here.
[0012] then, thecutter head 60 of using as the ultrasonic operation of an embodiment of the invention is described.Fig. 2 is the axonometric chart of the leading section ofcutter head 60, and Fig. 3 is the front view that the past end side is seencutter head 60, and Fig. 4 is the side view of cutter head 60.In Fig. 4,sleeve 11, its allocation position with respect tocutter head 60 schematically represents with chain-dotted line.
[0013]cutter head 60, are by forming protuberance described later (projection) at the leading section (end) ofaxle 61 as the hollow tubule that is cylindric extension, connect at the other end ofaxle 61 that above-mentioned amplifier unit 5 uses.Axle 61 is made into the shape (oviduct shape) of forward end expansion by the metal forming of the wall thickness 0.1mm (wall thickness T of Fig. 2 (c)) of external diameter 0.9mm, internal diameter 0.7mm, and the external diameter of the leading section ofcutter head 60 is made into 1.1mm.Axle 61 shown in the arrow B among Fig. 2, is given reciprocal whirling vibration by vibrator 3 take central shaft (major axis) L as rotating shaft.In addition,axle 61 is given as shown by arrow A such reciprocal straight moving vibration by vibrator 3 in the central axis L direction.Here, whirling vibration adopts the swing angle (anglec of rotation) that is about 16 degree to the maximum, and the double vibrations that is to the maximum about 0.1mm is adopted in straight moving vibration.
[0014] at the leading section ofaxle 61, later end direction is the degree of depth (highly) direction, along the circumference of leading section, forms a plurality of (being 22)protuberance 65 here.Protuberance 65 is by to not having theaxle 61 of inclination at leading section, by the discharge processing of using fine rule, cuts out the recess (groove) corresponding withprotuberance 65, forms as illustrated.The bottom surface (rearward end side) of the recess that here, will cut out accordingly withprotuberance 65 is called base portion 66.In Fig. 4, (distance or height) H from the leading section ofprotuberance 65 tobase portion 66 length of (among Fig. 3, representing with oblique line), preferably form with below half of the length Y from the leading section ofcutter head 60 tosleeve 11, be more preferably below 1/3rd of length Y.If represent with actual size, then length H is preferably in below the 0.5mm, is more preferably below 0.3mm.In the present embodiment, length H is taken as 0.15mm.By such formation length H, theattraction path 67 ofcutter head 60 is being given the captivation that is produced bysuction device 31, crystalline lens is examined in the situation of the leading section that is connected tocutter head 60,protuberance 65 bites in the crystalline lens nuclear, substantially makes theattraction path 67 ofcutter head 60 become closed state (crystalline lens nuclear is without the state that attracts, is adsorbed with leaking maintenance).That is, the length H that attractspath 67 bites into to rely on to be given in the crystalline lens nuclear (the crystalline lens nuclear of average hardness) that the captivation that attractspath 67 attracts, and makes to attractpath 67 to become that the length of closed state roughly forms.
[0015] width W 1 from the width W of the convolution direction (circumferencial direction) of theprotuberance 65 that is positioned atbase portion 66 to the convolution direction foremost that is positioned atprotuberance 65 that be made into from of the shape (side view) of the convolution direction ofprotuberance 65 becomes the coniform of taper.In the present embodiment,protuberance 65 is formed the general triangular shape from the side the time.In addition, the width W 1 ofprotuberance 65 is formed in below the gap W2 of the convolution direction between the adjacent protuberance 65.In addition, be positioned at the wall thickness ofprotuberance 65 radially, be formed along with from base portion 66 (perhapsbase portion 66 and foremost between the way) forward end goes and becomes the coniform of taper.Wall thickness S from from the wall thickness T ofaxle 61 to the front end ofprotuberance 65 is made into coniform.The width of the convolution direction of protuberance 65 (width of the outer circumferential side of diameter) W is made into about 0.08mm, and the wall thickness S of the front end ofprotuberance 65 is made into about 0.05mm.
[0016] by with soconiform formation protuberance 65, the front end of cutter head 60 (protuberance 65) and the area of crystalline lens nuclear butt have been dwindled.Therefore, theattraction path 67 ofcutter head 60 is being given the captivation that is produced bysuction device 31, crystalline lens is examined in the situation of the leading section that is connected tocutter head 60, andprotuberance 65 penetrates in the crystalline lens nuclear easily, and crystalline lens nuclear bites intobase portion 66 easily always.Therefore,cutter head 60 becomes closed state (state that crystalline lens nuclear is kept bycutter head 60 absorption) easily.And then if circle round vibratingblade head 60 under closed state, theprotuberance 65 that has then bitten in the crystalline lens nuclear is carried out respectively whirling vibration, and crystalline lens nuclear is pulverized (by the periphery cut-out crystalline lens nuclear of protuberance 65) by protuberance 65.Therefore, coniform ifprotuberance 65 is formed, then the amount of nipping of crystalline lens nuclear increases, and the crush efficiency of crystalline lens nuclear improves.
[0017] and then, in the periphery of the leading section ofcutter head 60 because the width W foremost 1 ofprotuberance 65 is made into below the gap W2 between theadjacent protuberance 65, so, reduce with the area of the leading section of thecutter head 60 of crystalline lens nuclear butt.Thus, the leading section ofcutter head 60 bites in the crystalline lens nuclear easily, and is same with the explanation of front, becausecutter head 60 becomes closed state easily, so, improved the crush efficiency that crystalline lens is examined.
[0018] then, the swing angle of whirling vibration and the configuration relation ofprotuberance 65 are described.In the drawings, interval P represents the distance (outside diameter) between the central part ofprotuberance 65, the swing angle of angle [alpha] (about 16 degree) expression cutter head 60.At 22protuberances 65 of front-end configuration ofcutter head 60, interval P is made the configuration quantity ofprotuberance 65 of the front end periphery ofcutter head 60 divides one, that is, and 1/22nd.Diameter at the front end ofcutter head 60 is in the situation of 1.1mm, and interval P is about 0.16mm.At this moment, because angle [alpha] is that 360 degree are divided by the value of the configuration quantity ofprotuberance 65, namely, corresponding with (360/22) degree=about 16 degree, so, the leading section ofcutter head 60, by the whirling vibration of angle [alpha] amount, its outer peripheral portion moves about 0.16mm to the convolution direction.
[0019] therefore, by with the intervalP configuration protuberance 65 corresponding with angle [alpha], rely on the whirling vibration of angle [alpha],protuberance 65 moves to the position of contiguous protuberance 65.Allprotuberances 65 of the front end by being configured incutter head 60 are mobile suitable with angle [alpha] amount of movement (amount of movement that is equivalent to interval P) only, and crystalline lens nuclear is correspondingly all-round upper pulverizing the (by the periphery cut-out of protuberance 65) of the diameter (point diameter of cutter head 60) of theprotuberance 65 of having nipped.Thus, improve the probability of in a whirling vibration, pulverizing crystalline lens nuclear, improved crush efficiency.
[0020] shape and the number of theprotuberance 65 of Fig. 1~shown in Figure 4 are best examples, and interval P shown in Figure 3 also can not be the value corresponding with angle [alpha].So long as in that cutter head is become in the situation of closed state, be accompanied by whirling vibration, examine the movement of the convolution direction ofinterior protuberance 65 by biting into crystalline lens, the structure that crystalline lens nuclear is pulverized gets final product.Even this depends on that the crystalline lens nuclear that exists with the front end butt (nipping) of cutter head is not pulverized on all-round, the situation that the crystalline lens nuclear of having pulverized also is attracted, also have by whirling vibration repeatedly, the crystalline lens ofprotuberance 65 peripheries is examined pulverized situation.
[0021] in addition, preferably dispose (protuberance disposes opposite to each other take central axis L as benchmark) in point-symmetric mode.Thus, because being processed to form in the situation of protuberance by the discharge of using fine rule, as long as fine rule is processed centered by the central shaft of axle rotatably, so, locate easily.Thus, the processing of leading section becomes easy.
[0022] as above-mentioned illustrated, by cutter head 60 (axle 61) being made the tubule of the unbent linearity of leading section, in whirling vibration, only be that the periphery ofcutter head 60 is rotated centered by central axis L.Therefore, operator is held the position of the leading section ofcutter head 60 easily, and the identity of the cutter head in the operation improves.In addition, the leading section ofcutter head 60 is described the whirling vibration of circular arc significantly unlike the crooked cutter head of point with respect to rotating shaft.Therefore, the situation thatcutter head 60 unexpectedly contacts with rear capsule reduces, and in operation rear capsule is produced the probability of damaging and reduces.
[0023] in addition, the attraction hole ofcutter head 60 front end of path 67 (attract), by the leading section ofaxle 61 having been made the shape of oviduct, than the carrying out shown in the patent documentation 2 the attraction hole of cutter head of die forging processing broad.Therefore, compare with the cutter head of die forging processing, the absorption hold facility ofcutter head 60 is high.Thus,protuberance 65 bites in the crystalline lens nuclear easily, andcutter head 60 becomes closed state easily.Therefore, same with the explanation of front, improved the crush efficiency of the crystalline lens nuclear that is undertaken by whirling vibration.And then, because the attraction hole of the cutter head of the attraction boring ratio die forging ofcutter head 60 processing is broad, so in the removing of nuclear sheet (fragment of crystalline lens nuclear),cutter head 60 can attract to remove large nuclear sheet.Therefore, improved the removing workability.In addition, because the leading section ofcutter head 60 is made into the oviduct shape, so rotation (convolution) radius of theprotuberance 65 that accompanies with the whirling vibration ofcutter head 60 increases, and has improved the crush efficiency of crystalline lens nuclear.In addition, in the above description, enumerated bycutter head 60 being made the advantage with respect to the cutter head of processing by die forging of oviduct shape, still,cutter head 60 also can not be the oviduct shape.As long as with respect to for the cutter head of ground inswept the die forging processing cutter head, be that the large cutter head of diameter of front end gets final product.For example,axle 61 also can be cylindric (linearity).
[0024] in addition, by making leading section is arranged on structure on theaxle 61 of such linearity, the bullet that has reduced the pulverizing crystalline lens nuclear that the cutter head because of the leading section bending causes flies, and has reduced and emulsifying attracts the operation damage to eye inner tissue (the especially damage of corneal endothelium) together.
[0025] in addition, in the above-described present embodiment,axle 61 has been made the oviduct shape, but is not limited thereto.So long as in the situation ofcutter head 60 whirling vibrations, leading section is that the shape of easily identification gets final product, and also can beprotuberance 65 is arranged on structure on theaxle 61 of linearity.
[0026] in addition, in the above-described present embodiment,protuberance 65 has been made to have as from the structure ofbase portion 66 towards the shape of the cone shape general triangular of leading section, still is not limited thereto.So long as protuberance bites in the crystalline lens nuclear easily, the shape of closed state gets final product can to makecutter head 60 become roughly.For example, can list and be from the side the protuberance of square shape, perhaps have the protuberance etc. of the projection of general triangular at the front end of square shape.
[0027] then, to theultrasonic cutter bit 70 and 80 as variation of the present invention, by with the difference ofcutter head 60 centered by describe.Fig. 5 is the outside drawing ofcutter head 70, and Fig. 6 is the outside drawing ofcutter head 80.
[0028] at first, carry out the explanation of cutter head 70.Fig. 5 A represents the axonometric chart ofcutter head 70, and Fig. 5 B represents the side view of cutter head 70.Cutter head 70 has take central axis L as major axis, theaxle 71 that forms linearlyly; With the leading section ataxle 71, the shape (side view) of convolution direction is theprotuberance 75 of general square shape.Same withcutter head 60, the bottom surface (rearward end side) of the recess that forms accordingly with the formation ofprotuberance 75 is by as base portion 76.Protuberance 75 disposes six along the periphery ofaxle 71 is impartial (point symmetry).Protuberance 75 be made into the convolution direction have the square of width, the length frombase portion 76 to protuberance till 75 the front end (highly) is made into H1.Below,contrast cutter head 60 andcutter head 70 are enumerated its difference.The first, because the side ofprotuberance 75 is general square shape, configuration quantity is six, socutter head 70 is processed easily.The second, because the wall thickness radially ofprotuberance 75 certain (not being made into coniform), so, the handling ease of cutter head 70.The 3rd, because the width of the wall thickness radially ofprotuberance 75 and convolution direction is large, so the rigidity of the front end ofcutter head 70 is high.
[0029] then, carries out the explanation of cutter head 80.Fig. 6 A represents the axonometric chart ofcutter head 80, and Fig. 6 B represents the side view of cutter head 80.Same withcutter head 70, incutter head 80, at the leading section ofaxle 81protuberance 85,base portion 86 are set.Protuberance 85 and six ofcutter head 70 same configurations, the shape of convolution direction is made into coniform (side view is general triangular) that becomes taper towards front end, and wall thickness radially also is to be formed forward end the coniform of taper that become.Here, the length till 85 the front end is made into H2 frombase portion 86 to protuberance.In addition, length H1 and the length H2 relation of getting H1<H2.If relativelycutter head 80 andcutter head 70, then becauseprotuberance 85 radially and the convolution direction be made into coniform, so with respect tocutter head 70,cutter head 80 has easily (the thrusting easily) advantage in the crystalline lens nuclear of nipping.
Cutter head 70 and thecutter head 80 that [0030] will consist of in this wise compare.The difference ofcutter head 70 andcutter head 80 isprotuberance 75,85 shape andprotuberance 75,85length.Protuberance 75 and crystalline lens nuclear between abutting part becauseprotuberance 75 is square shapes, thus be wire, andprotuberance 85 and crystalline lens nuclear between abutting part becauseprotuberance 85 is made into the general triangular shape, so be point-like roughly.Therefore, the front end ofcutter head 80 becomes the structure sharper than cutter head 70.Thus, in attracting action,cutter head 70 is compared withcutter head 80, is not easy to bite in the crystalline lens nuclear.Therefore, for the closed state that is made crystalline lens nuclear bycutter head 70 andcutter head 80 reaches equal extent, length H2 can be done longlyer than length H1.
[0031] does like this, by reducing cutter head with respect to the butt area of crystalline lens nuclear, can increase the length (the backward degree of depth of end direction) of protuberance.In addition, bite on the cutter head at crystalline lens nuclear, protuberance is carried out in the situation of whirling vibration, and crystalline lens nuclear is correspondingly pulverized in the length convolution direction of protuberance.Therefore, the length of protuberance is long, can improve the crush efficiency of crystalline lens nuclear.
Use has confirmed to cause because of cataract the pulverizing operation of the crystalline lens nuclear of nebulousurine with the above-mentionedcutter head 70 that is shaped as the basis making shown in Figure 5.Thecutter head 70 of producing is, the leading section oftubule 71 that will have diameter and be the external diameter of 0.9mm is extended to the oviduct shape, makes diameter foremost become 0.98mm.In Fig. 5 A, 5B, the distance W 2 (length of periphery) that makes gap (groove) 76a between theadjacent protuberance 75 is 0.25mm, and at this moment, the width W 1 of the periphery ofprotuberance 75 is about 0.26mm, for distance W 2 length about equally.Length H1 frombase portion 76 to protuberance till 75 the front end makes with 0.135mm.When the pulverizing of using thiscutter head 70 to carry out the crystalline lens nuclear of average hardness is performed the operation, by giving captivation, theprotuberance 75 of the front end ofcutter head 70 bites in the crystalline lens nuclear, make the attraction path that is formed in thecutter head 70 become roughly closed state, crystalline lens nuclear is adsorbed on the leading section ofcutter head 70 well.When having pulverized crystalline lens nuclear when give whirling vibration to cutterhead 60 under this state, compare with the situation that does not formprotuberance 75, the crush efficiency of crystalline lens nuclear improves, and can shorten operating time.
Relative therewith, at the long cutter head of the length H1 that makesprotuberance 75, as can be known, theattraction path 77 that is formed in thecutter head 70 is not easy to become closed state when having carried out the pulverizing operation of crystalline lens nuclear.In addition, madeprotuberance 75 that length H1 increases with shown in Figure 5 slightly different, the structure of having cut away take the front end of cutter head is tilted (30 ° angles) is for basic, distance W 2 by forming the periphery of recesses (groove) at two positions is the structure of 0.5mm, makeprotuberance 75 become two, in addition, form the greatest length of length H1 with 0.6mm.Affirmation result according to the closed state of the leading section in this cutter head, as shown in Figure 5, in thecutter head 70 of making sixprotuberances 75, if the length ofprotuberance 75 is below 0.15mm at least, when average crystalline lens nuclear absorption, the attraction path of the leading section ofcutter head 70 just can be closed.
In addition, according to above-mentioned affirmation result, the front end ofprotuberance 85 become taper at thecutter head 80 shown in Fig. 6 and in thecutter head 60 shown in Fig. 2, with regard to its length H2 and H1, if below 0.3mm, when the absorption of average crystalline lens nuclear, the attraction path of the leading section ofcutter head 70 just is closed easily, if below 0.2mm, then the leading section ofcutter head 70 is closed more reliably.
[0032] if situation according to the above description, the protuberance that then preferably will be arranged on the leading section of cutter head is determined in such a way.If its number of protuberance is few, then the crush efficiency of crystalline lens nuclear reduces.In order to ensure the crush efficiency of practicality, the number of protuberance preferably has six at least.But if more than the number corresponding with the swing angle α of cutter head 60 (22), then it is not easy to make, and does not improve on the contrary crushing effect, therefore, and preferably below the number corresponding with the swing angle α of cutter head 60.The length of protuberance, from guaranteeing the viewpoint of crush efficiency, preferably protuberance relies on and is given to the length that the captivation that attracts the path bites in the crystalline lens nuclear, attracts the path to be closed, and is set longly as best one can.In addition, the shortest length of protuberance is preferably at least more than 0.01mm.If below it, even then carry out the whirling vibration of cutter head, can not expect by having formed the raising of the crush efficiency that protuberance brings.
In addition, bite into easily in the crystalline lens nuclear in order to make protuberance, preferably as thecutter head 80 of thecutter head 60 of Fig. 2 and Fig. 6, along with forward end is gone and the taper that becomes.And then, preferably as thecutter head 60 of Fig. 2~4, be the wall thickness radially of the protuberance shape towards the front end attenuation.
In addition, as above-mentioned illustrated, by the leading section at cutter head a plurality of protuberances are set, dwindled the butt area of the front end of cutter head and crystalline lens nuclear.Therefore, the front end of cutter head penetrates in the crystalline lens nuclear easily, the attraction by crystalline lens nuclear etc., and the front end of cutter head becomes closed state easily.Thus, even be carried out at cutter head in the situation of straight moving vibration, also can improve the crush efficiency of crystalline lens nuclear.In addition, be not easy to become in the situation that such hard crystalline lens nuclear of closed state pulverizes at the front end to cutter head, because the front end of cutter head thrusts easily, so the easy grinding crystalline lens nuclear of straight moving vibration by protuberance.Therefore, even in straight moving vibration, also can improve the crush efficiency of crystalline lens nuclear.