US2033397A - Method of and apparatus for the intracapsular extraction of the crystalline lens of an eye - Google Patents

Description

' Marsh 10, 1936. F RICHMAN 2,033,397

METHOD OF AND APPARATUS FOR THE INTRACAPSULAR EXTRACTION OF THE GRYSTALLINE LENS OF AN EYE Filed May 25, 1935 IIIIII/II/IIIIIIIIII \NVENTOR Frances BY ATTORNEY Patented Mar. 10, 1936 UNH'E'EE STATES PATENT QFFECE Frances Richman, Brooklyn, N. Y.

Application May 25, 1935, Serial No. 23,345

10 Claims.

This invention relates to a method and apparatus for ocular surgery, and more particularly to the intracapsular extraction of the crystalline lens of the eye.

Ocular diseases and disorders frequently necessitate the removal of the crystalline lens,

which can be accomplished by any of several wellknown surgical operative methods. Perhaps the most commonly employed method is the extracapsular, where the lens capsule is first ruptured and the lens proper thereafter separately expressed; but recent progress in ocular surgery has developed various methods of intracapsular extraction where the capsule and lens are removed as a unit upon a rupturing of the zonular suspensory ligament. Although such methods have repeatedly been employed with success, the utmost caution and the rarest degree of skill and surgical technique are required, not alone because of the intricacies of the method, but also because of the danger inherent in a delicate operation of this kind, such as the loss of fluid vitreous, or other unhappy consequences. It is hence to overcome these disadvantages that I have conceived this in- 5 vention whereby an intracapsular extraction can be performed in a simple, quick and effective manner, wherein is employed an apparatus adapted to effect precision and accuracy without complete dependence therefor upon the operators technique, and whereby the danger of the loss of vitreous or other complications resulting from the manipulations ordinarily employed is entirely eliminated,the accomplishment of all of which constitutes the prime objects and purposes of my invention.

Briefly, this invention, in a preferred form thereof, consists of the steps of inserting two needles through the anterior surface of the capsule into the lens of the eye and then passing a high at frequency current through the tissue therebetween, thereby causing a coagulation of such tissue and a frictional gripping of the needles by the coagulated matter, whereupon the needles with the adhering lens and capsule are together withdrawn,the zonular ligament being ruptured either by the tension induced therein by the contraction of the lens tissue upon coagulation. or by movably manipulating the lens with the inserted instrument to cause a severing of the said ligament. It is thus seen that the only portion of the lens tissue affected is that between the two needles, which constitute a bipolar system,the tissues or nerves in other regions being free from the destructive action of the current,--a condition which could not exist in a system having a single needle pole with an indifferent terminal contacting another portion of the patients body.. The apparatus or instrument employed in this method consists of a saddle applied to the anterior surface of the lens, and a pair of normally retracted needles in proximity to the saddle and adapted to be sharply projected through the capsule and. into the body of the lens by spring means upon the release of a catch,the needles being electrically connected to a source of high frequency current supply. It is thus apparent that once the saddle is properly positioned within the eye (after an incision has been made), no probing is required and no manual pressure to effect a piercing necessary, as the needles are automatically snapped forward and sharply projected into the lens. The coagulation of the tissue produced by the action of the current causes an adhesion and mechanical binding thereof about the needles, the surface of which can be serrated or notched, thereby producing a sufficient gripping effect for the purpose of extracting the lens and capsule.

By the use of this invention, lens extractions can be performed in senile cataracts at any stage. from incipiency to maturity and beyond, it being unnecessary to Wait for a ripening of the cataract and a hardening of the cortex; and it can be applied in cases of cataracts complicated by fluid vitreous where there is danger of loss of the. vitreous when the usual operative methods are employed, in traumatic cataracts to avoid repeated needlings, in high myopia where the crystalline lens should preferably be removed, in diabetic cataracts, and in many other cases.

Other features, advantages and objects will appear from the drawing and the description hereinafter given.

Referring to the drawing,

Figure 1 illustrates the apparatus or instrument of my invention operatively inserted into an eye.

Figure 2 is an enlarged longitudinal partial section of the apparatus shown in Figure 1.

Figure 3 is a fragmentary longitudinal section of the apparatus taken at right angles to that of Figure 2.

Figure 4 is a fragmentary side view of the lower portion of the said apparatus, showing the needles projected and illustrating the preferred shape of the lower stem and saddle.

Figure 5 is a transverse section of Figure 2 taken along line 5-5, and

Figure 6 is an enlarged fragmentary view showing the relative positions of the saddle and the projected extremities of the needles of the apparatus just prior to their withdrawal from the eye socket, in a supplementary step of this method.

In the drawing, the needle guide member or stem ID, the lower portion of which is preferably curved for convenience, contains therein a pair of substantially parallel channels housing the two retractible flexible needles I l and 12, the terminal portions of which flank the base of the stem containing the saddle [3, when the needles are projected through the holes 64 in the stem in the manner hereinafter described. Secured to the inner terminal portions of the needles and in longitudinal axial alignment therewith are the two metallic rods or needle-actuating members I5 and I6 slidably movable longitudinally within the channels IT and IS in the stem. The upper portions of the rods are secured, preferably by threads as shown, to the ferrules l9 and 20 constituting terminal connections contained within and suitably attached to the slide-socket 2|. The conductors 22 and 23, connected to a source of high voltage, low amperage, high frequency current supply, are electrically connected to the rods I5 and IS in any suitable manner, a preferred arrangement being by compressed engagement of the bent ends thereof between the said rods and the shoulders of the ferrules. The stem, saddle and slide-socket are all made of insulating material.

. stop or abutment to limit the downward stroke of the socket and the parts attached thereto. A spring 28, preferably of helical form, is suitably secured to the socket axially with respect thereto; and the lower portion of the spring is positioned within the axial recess or channel 29 of the stem, the bottom end of the spring being affixed to the cylindrical block slidably movable within the recess 29. Attached to said block is the pin 3! which extends through and is slidably movable within the slot 32 longitudinally disposed in the upper wall of the stem-said pin being riveted to the slidably mounted annular sleeve 33. This sleeve is slidably moved downwardly along the stem, during the assembling of the device, and secured thereto by the screw 34 which extends through the sleeve and into threaded engagement with a transverse hole in the stem predetermined as to position so as to produce the required tension in the spring 28 for best operative results.

The sleeve 33 carries the spring catch 35 pivotally mounted at 35 and urged inwardly by the spring clip 31 so as to normally keep the terminal end 38 thereof in engagement with the bottom edge of wall 25 of the socket, thereby releasably holding the socket and attached parts in their retracted positions.

The saddle l3 constituting the base of the stem contains a concave undersurface curved to conform to the anterior contour of the lens, the rear portion of the saddle containing a relatively short tip 39 the bottom surface of which is coextensive with the undersurface of the rest of the saddle.

In the operation of this device, which is one form of apparatus that can be employed in the method constituting my invention, the saddle H3 is inserted into the anterior chamber 40 of the eye between the lips formed by a proper cataract incision. The tip 39 is then brought under the portion 4| of the iris to move it back and thereby clear the anterior surface of the capsule 42 encasing the lens 43 for the subsequent operation. The saddle is then operatively applied to the lens by placing its concave undersurface upon the anterior surface of the capsule, preferably in the position shown in Figures 1 and 6. By pressing the lower portion of the lever of the catch 35, the terminal end 38 will be moved outwardly, thereby releasing the socket 2| to permit the spring 28 to snap the socket and attached rods l5 and I6 downwardly to the stop 2'1, causing the needles to be sharply projected through the capsule into the lens 33. A suitably positioned switch is then actuated to close the circuit and cause the passage of the current through the conductors 22 and 23, the rods l5 and I6, the needles H and l 2, and the lens tissue between the terminal portions of the needles projected into the lens. After an interval of time determined by experience to be sufficient, the current is turned off prior to the step of withdrawing the lens, as will be hereinafter set forth.

During the passage of the current, the lens tissue between the bipolar terminals of the needles H and l2 become coagulated,an eifect which is well known. I have discovered, however, that the coagulated tissue adjacent the needles becomes adhesively secured thereto with considerable frictional gripping eifect. I have hence utilized this discovery as a step in the method constituting this invention. After the current is shut off upon a sufficient coagulation of the tissue, the instrument with the adhering capsule-encased lens is movably manipulated within the socket of the eye to rupture the Zonular ligament 44, after which the lens and capsule as a unit are withdrawn through the incision.

It 'should be noted that the coagulation of the tissue generally produces a contraction thereof, and if the tension on the suspensory ligament is sufiiciently great due to the pull of the contracting tissue, the ligament will become severed, in this way obviating the above-described step of manipulating the lens to eifect a rupturing of said ligament.

As is obvious, this method of intracapsular extraction eliminates the dangers inherent in methods requiring the use of grasping forceps for the lens or the application of pressure for delivering the lens, and is otherwise relatively simple and effective. And as only the tissue of the lens between the inserted portion of the needles is affected by the current, the apparatus is safe to use on a patient; and inasmuch as the instrument is thoroughly insulated, it is likewise safe for the operator.

For best operative results, the needles should be inserted into the central portion of the lens, it being of course important that the needles should not pass through and emerge from the lens to pierce the opposite portion of the iris or the vitreous, or enter the posterior chamber. This can be avoided not alone by the operators caution and skill, but by a proper design of the length and stroke of the needles.

To produce a firmer grip upon the needles, the surfaces thereof may be notched or serrated. Also, instead of employing only two needles as described in the above preferred form of my invention, one or more additional needles can be used thereby providing a proportionately greater surface to which the coagulated tissue could adhere, or hooked needles may be employed.

InFigure 6 is illustrated a supplementary step that can be employed in this method of lens extraction. After the current is discontinued, the stem is moved downwardly, (in the direction of the arrow) causing the saddle to move rearwardly towards the lens to decrease the distance between the undersurface thereof and the needles. The latter, being flexible and firmly embedded into the lens, will remain practically stationary while the saddle is being moved, thereby causing a depression in the lens as shown, and a compression of the tissue between the saddle and the needles. It is obvious that such a compression or pinching efieot produces a better grip on the lens, and thereby facilitates its removal.

It is of course understood that other additional forms and modifications of the apparatus and adaptations of the method constituting this invention can be employed beyond and in addition to those hereinbefore described, all within the scope of the appended claims.

What I claim is:

1. In a method for the intracapsular extraction of the crystalline lens of an eye, the steps of projecting two spaced needles through the anterior surface of the lens capsule and into the body of the lens, passing an electric current through the lens tissue between the needles to cause a coagulation of said tissue and an adhesion and frictional gripping of portions thereof upon the surface of said needles, and withdrawing the needles with the attached lens and capsule thereon.

2. In a method for the intracapsular extraction of the crystalline lens of an eye, the steps of applying to the anterior surface of the lens capsule the base of a needle guide member containing two substantially parallel channels therein, adjusting the member to a predetermined position, projecting two needles through said channels to pierce the anterior surface of the lens capsule and enter the body of the lens, passing an electric current through the lens tissue between the needles to cause a coagulation of said tissue and a frictional adhesion of portions thereof to the surface of said needles, and withdrawing said member and needles with the attached capsule-encased lens.

3. In a method for intracapsular extraction of the crystalline lens of an eye, the steps of applying to the anterior surface of the lens capsule the base of a needle guide member containing two retracted spaced flexible needles therein, adjusting the guide member to a predetermined operative position upon the anterior surface of the lens capsule, sharply projecting the said needles forwardly to pierce said capsule and enter the body of the lens, passing a high frequency current through the lens tissue between the needles to cause a coagulation of said tissue and a frictional gripping of the needles by contiguous portions of the coagulated tissue, manipulating the guide member to reduce the distance of its lens-engaging surface from the inserted portions of the needles and thereby compressing the tissue therebetween, and withdrawing the guide member and needles with the attached capsule-encased lens.

4. A method of intracapsular extraction of the crystalline lensof an eye comprising the steps of pushing back a portion of the iris from its position on the lens, sharply projecting two spaced needles through the anterior surface of the lens capsule and into the body of the lens, passing a suitable electric current through the lens tissue between the needles to cause a coagulation of said tissue and a frictional gripping of the needles by contiguous portions of the coagulated tissue, applying pressure to the anterior surface of the lens to compress the tissue therebehind against the needles, rupturing the zonular suspensory ligament, and withdrawing the needles with the attached capsule-encased lens.

5. In an apparatus for the intracapsular extraction of the crystalline lens of an eye, a saddle adapted to rest upon the anterior surface of the lens capsule, a pair of retractible needles associated with the saddle and adapted to be projected into the body of the lens, means to operatively actuate said needles, and conducting means for electrically connecting said needles to a source of current supply.

6. In an apparatus for the intracapsular extraction of the crystalline lens of an eye, a saddle adapted to rest upon the anterior surface of the lens capsule, a plurality of retractible needles associated with the saddle and adapted to be projected into the body of the lens, spring means operatively connected with the needles to urge them into their projected positions, holding means to keep the needles in their retracted positions against the action of the said spring means, means to release said holding means, and conducting means for electrically connecting said needles to a source of current supply.

7. In an apparatus for the intracapsular extraction of the crystalline lens of an eye, a saddle containing a concave surface adapted to rest upon the anterior surfaceof the lens capsule, a tip on the saddle having its underside substantially coextensive with said concave surface and adapted for engagement with a portion of the iris to move same away from its position on the lens during the operative positioning of the saddle, a pair of retractible needles associated with the saddle and adapted to be projected into the body of the lens, a stem connected to the saddle, spring means within the stem operatively connected to the needles to urge them into their projected positions, a releasable catch associated with the stem and the spring means to yieldably hold the needles in their retracted positions, and conducting means electrically connecting said needles to a source of current supply.

8. In an apparatus for the intracapsular extraction of the crystalline lens of an eye, a saddle containing a concave surface adapted to rest upon the anterior surface of the lens capsule, a pair of flexible retractible needles associated with the saddle and adapted to be projected into the body of the lens, the protruding portions of the needles when in their projected positions flanking the saddle, spring means constantly urging the needles into their projected positions, stop means to limit the operative stroke of the needles, releasable holding means to keep the needles in their retracted positions against the action of said spring means, and conducting means electrically connecting the needles to a source of current supply.

9. An apparatus for the intracapsular extraction of the crystalline lens of an eye comprising a stem, a saddle at the base thereof and adapted to rest upon the anterior surface of the lens capsule, said stem and saddle being non-conductors of electricity, a pair of substantially parallel retractible needles longitudinally disposed within the stem and adapted to be projected therefrom into the body of the lens, a pair of needle actuators made of conducting material operatively attachedto the needles, spring means positioned within the stem and operatively connected with said actuators to urge them and the attached needles into'their projected positions, stop means on the stem to limit the operative movement of the actuators, a releasable catch to hold the actuators and the attached needles in their retracted positions against the action of said spring means, and terminal connections electrically joining said actuators to a source of current supply.

10. An apparatus for the intracapsular extraction of the crystalline lens of an eye comprising a stem, a saddle at the base thereof and 1 adapted to rest upon the anterior surface of the lens capsule, said stem and saddle being nonconductors of electricity, a pair of substantially parallel retractible needles longitudinally disposed within the stem and adapted to be pro- 2'()" jected therefrom into the body of the lens, a pair of rods of conducting material secured to the inner ends of said needles and in longitudinal axial alignment therewith, said rods being movably positioned within said stem, a pair of terminal connections electrically joining said rods to a source of current supply, an insulated socket containing and having attached thereto the junctures of said rods and terminal connections, said socket being slidably mounted over said stern, a stop on the stem to limit the movement of the socket and its attached parts, a spring within the stem having one end attached to the body thereof and the other end to said socket to constantly urge the socket and attached parts into their projected positions, and a releasable spring catch secured to the stem and operatively engageable with said socket to hold it in its retracted position against the action of said spring.

FRANCES RICHMAN.

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