US 3476112 A
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Description (OCR text may contain errors)
J. K. ELSTEIN 3,476,112
SURGICAL lNSfRUMENT FOR REMOVAL OF THIN LAYERS Nov. 4, 1969 r iled De:
2 Sheets-Sheet 1 iii N. mm
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SURGICAL INSTRUMENT FOR REMOVAL OF THIN LAYERS Nov. 4, 1969 2 Sheets-Sheet Filed Dec. 5-.
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A T'OZIVE X United States Patent 3,476,112 SURGICAL INSTRUMENT FOR REMOVAL OF THIN LAYERS Jacob K. Elstein, 670 E. Lincoln Ave., Mount Vernon, N.Y. 10552 Filed Dec. 5. 1966, Ser. No. 599,310 Int. Cl. A61b 17/32; B26b 7/02 US. Cl. 128-305 20 Claims ABSTRACT OF THE DISCLOSURE This invention relates to a surgical instrument for dissection of lamellar (partial thickness) grafts from the ocular cornea, which instrument shall also be useful for removal of thin and uniform layers of flexible plastic lenses or of other tissues such as skin, cartilage and buccal mucous membrane for transplants. It is particularly directed to an instrument which shall be good for refractive keratoplasty corneal g-raft transplants for improvement of visual acuity and which shall be highly accurate, optically uniform, which shall be adapted for cutting parallel or cylindrical discs of pre-set thickness and diameter and which may be used to cut in vivo (on a living patient) or from a donors enucleated eye.
An object of this invention is to provide an instrument of the character described which shall comprise a guide means provided with a ring, which may be placed over an eyeball or the part from which a layer is to be shaved, and suction means to create vacuum between the ring and said eyeball or part, to hold the eyeball or part in fixed relation to the guide means.
Yet another object of this invention is to provide means slidable with respect to said guide means and comprising an applanation plate to flatten down the eyeball or part held to the ring, a head movable with said flattening applanation'plate and carrying a transversely reciprocating insert supporting a blade projecting beneath the applanation plate, and an electric motor movable with said head on said guide means and having means to reciprocate said insert whereby to cut or shave a layer from the eyeball or part.
Still another object of this invention is to provide in aninstrument of the character described, means operated by the motor for automatically advancing the slidably mounted means relative to the guide means for cutting a layer from said eyeball or part.
Yet another object of this invention is to provide in an instrument of the character described, spring means interposed between the reciprocating insert and the blade.
A further object of this invention is to provide an instrument of the character described in which the applanation plate has a lower convex or concave surface of uniform transverse cross-section, so that the cut off disc may be of desired cross-sectional shape to correct astigmatism of the eye.
Yet a further object of this invention is to provide in an instrument of the character described, an applanation plate which is transparent, to permit direct visual control over the size of the disc and the cutting process.
Still a further object of this invention is to provide 3,476,112 Patented Nov. 4, 1969 in an instrument of the character described, a head having a slot leading from the underside of the applanation plate to an exposed inclined surface at the front of the head and extending upward from the slot, so that the sliced off disc slides off evenly and lays flatly on the inclined surface, from where it can be picked up easily.
Yet another object of this invention is to provide a compact and durable instrument of the character described which shall be easy to manipulate, inexpensive to manufacture, smooth and positive in operation and yet practical and eflicient to a high degree.
Other objects of this invention will in part be obvious and in part hereinafter pointed out.
The invention accordingly consists in the features of construction, combinations of elements, and arrangement of parts which will be exemplified in the construction hereinafter described, and of which the scope of invention will be indicated in the following claims.
In the accompanying drawing, in which are shown various illustrative embodiments of this invention,
FIG. 1 is a top plan view of an instrument embodying the invention, with parts broken away and in crosssection;
FIG. 2 is a side elevational view thereof, with parts broken away and in cross-section, and showing the fixation ring on an eyeball;
FIG. 3 is a bottom plan view of the front end of the instrument shown in FIG. 1 with parts broken away and and in cross-section;
FIG. 4 is a cross-sectional view taken on lines 44 of FIG. 1; 7
FIG. 4a is an enlarged view of a portion of the structure shown in FIG. 2;
FIG. 4b is a cross-sectional view taken on lines 4b-4b of FIG. 1;
FIG. 5 is a view similar to FIG. 2, but illustrating a modified construction;
FIG. 6 is a cross-sectional view taken on lines 6-6 of FIG. 5;
FIG. 7 is a cross-sectional view taken on lines 7-7 of FIG. 5;
FIG. 8 is a cross-sectional view taken of FIG. 5; and
FIG. 9. is a view similar to the front end of FIG. 2, and illustrating a still further modified construction.
Referring now in detail to the drawing, 10 designates an instrument embodying the invention and comprised generally of a fixation guide device 11, a head 12 slidably mounted thereon, and an electric motor 13 attached to the head and also guided on the guide device 11.
The guide device 11 comprises a front ring 15. Ring 15 comprises a plate 16 having a semi-circular curved front edge 17 and parallel side edges 18 extending from said front edge. Said plate 16 has a flat top surface 19 formed with a circular opening 20. Extending down from the opening 20 is an annular, outwardly flaring convex undersurface 21. Surface 21 extends to a circular horizontal flat undersurface 22 parallel to surface 19. Extending downwardly from the outer end of annular surface 22 is an inner cylindrical surface 23. Extending outwardly from the lower end of cylindrical surface 23 is a downwardly and outwardly flaring transverse curved or convex surface 25. Extending from the lower end of the surface 25 is a flat undersurface 26. Extending upwardly from the flat upper surface 19 are parallel portions 27 formed at their inner sides with inwardly opening guide grooves 28 for the purpose hereinafter appearing.
Plate 16 is formed with drilled parallel openings 30 leading to the cylindrical surface 23 and communicating with enlarged drilled openings 31, coaxial with the openon lines 88 ings and leading to the rear transverse edge 32 of said plate 16. Inserted into the openings 31 and fixed to plate 16 are parallel guide tubes 34 extending rearwardly. The tubes 34 are interconnected by spaced downwardly curved spaced transverse members 36, 37 which have openings through which said tubes pass to hold the tubes in parallel relation. Fitted onto the rear ends of said tubes 34 are flexible tubes 39 leading to an adaptor 40 which may be connected by any suitable coupling means 41 to a means for producing a vacuum.
The head 12 with the motor 13 attached thereto are slidably mounted on member 11. The head 12 comprises a metal member which may be made of stainless steel or other metal. Said member 50 comprises a transverse plate 51 from the rear end of which extends upwardly a transverse wall 52 having a rear surface 53. Plate 51 has at its sides forward extensions 54. Said plate and its extensions have outwardly extending parallel guide flanges 55 slidably received within the grooves 28 of plate 16 so that the head may slidably move forwardly and rearwardly relative to the fixation member 11. Said plate 51 has an upper inclined surface 56. The head has an upwardly and rearwardly inclined wall 57 from the upper end of which extends rearwardly, portion 58, merging with the upper end of vertical wall 52.
The side extensions 54 are interconnected at their front ends by a transverse strip 60, and at the lower end of inclined wall 57, by transverse portion 61. Rearwardly of wall 61 is a transverse slot 62 communicating with the underside of plate 51. The side extensions 54 are formed at their inner sides with parallel guide grooves 64 extending to the outer ends thereof. Received in said grooves 64 is an applanation plate 65 preferably made of transparent plastic. The plate 65 may be frictionally wedge in the grooves 64 but is preferably removable and replaceable. The upper surface of inclined wall 57 is preferably slanted downwardly and forwardly forming an acute angle with surface 56 and terminating in a transverse edge 70. The lower forward under edge 71 of wall 57 is inclined forwardly and downwardly in parallel spaced relation above the inclined surface 56 forming a slot 72a therewith. The side extensions 54 are formed with slots extending to their outer surfaces and forming extension of the slot 72a formed between the lower end 71 of wall 57 and the surface 56.
The rear wall 52 is formed with an internally screw threaded opening 75 centrally located and having a horizontal axis.
The motor 13 slidably rests on the transverse members 36, 37. It comprises an outer casing to which is fixed a front wall 81. Fixed to the front wall 81 and extending forwardly therefrom is a tube 82, the front end of which has external screw threads 85 which may be screwed into the threaded opening 75. The motor may be of usual construction and comprises a front rotary shaft 86 extending to the front end of the internally screw threaded tube 82. Extending forwardly from the motor shaft 86 is an eccentric pin 87.
Slidably mounted within the head 12 is an insert 90. The insert 90 has a front upwardly and rearwardly inclined surface 91 located at the inner surface of wall 57, and a downwardly and forwardly inclined lower surface 92. The surface 92 is parallel to and spaced above the surface 56 and makes a much smaller angle with the horizontal than does the surface 91. The insert 90 has a rear vertical surface 94 formed with a central vertical slot 95 into which eccentric pin 87 projects. When the motor rotates eccentric pin 87 causes reciprocation of insert 90. At the underside of insert 90 is a cutting blade which lies on the inclined surface 56. The insert 90 is of less transverse length than the head. It is of such dimension that its outer ends will move to the outer side surfaces of the head as said insert is reciprocated. The blade 100 is coextensive from side to side with the insert 90. Extending downwardly from the underside of the insert 90 are a pair of pins 101 projecting down into openings 102 in the blade 100. The forward cutting edge of the blade projects forwardly of the forward edge of plate 51 and slightly forwardly of the rear edge of the applanation plate 65. The cutting edge of the blade 100 projects beneath the applanation plate 65 by a distance equal to the thickness of the layer to be cut. As the motor operates both the insert and the plate reciprocate together sideways. As the motor is moved forwardly a layer will be cut by the blade.
In FIG. 2, the ring is shown placed over an eyeball I. The plate 65 flattens the top corneal portion of the eye. The suction applied to the tubes 34 creates a vacuum in the channel or circular space between the eyeball and the surfaces 22 and 23 of the ring. This channel is ring shaped and is of substantially triangular transverse crosssection. The suction holds the ring to the eyeball to prevent movement therebetween. The transverse member 36 may have an extension tip 36a into which may be inserted the lower end of a tubular handle 36b. The handle may be used for holding device 11 steady. The casing of the head is preferably made of stainless steel. The reciprocating insert may be made of Teflon or acrylic or other material having a low coeflicient of friction. The applanation plate is interchangeable in the guide slots. A 25 volt motor may be used. It will be noted that one exact thickness may be cut at a time. The layer moves through a slot 62 unto the edge 70 and up the inclined surface of inclined wall 57 and lays there so that it can be easily removed. The corneal thickness varies from .5 mm. to .7 mm. Usually .3 mm to .4 mm is shaved off. Other thicker layers may be shaved off with this instrument. The motor and head may be pushed forwardly manually on the fixation guide.
The purpose of the corneal graft is to cut out diseased or scratched cornea so that one can replace it with a disc from a donors cornea. The disc of a good cornea can also be cut with this instrument for improvement of the refractive status of the eye. The donors are mostly dead people with healthy eyes. Grafts usually are acceptable. The grafts could be made from live persons. The cornea could also be shaved off, then lathed into a lens and stitched back to correct vision.
There are known methods of shaping corneal tissue. The corneal disc can be frozen for lathing it to make a lens. It will now be understood that a novel feature of the invention is the provision of the ring and guide unit used for fixation of the eye and for guidance of the instrument head (called the Keratome head) and motor, and also the achievement of fixation by means of a vacuum.
In the circular channel the cornea protrudes through the circular opening 20 when the suction holds the eye to the ring and the corneal portion of the eye is flattened by the plastic plate so that one can see the whole disc to be cut. In cases of astigmatism, the flattened shape of the cornea may be oval instead of round. In making an operation the instrument is held on the ocular axis of the eye. The ring may be of different heights and can be selected or interchanged for proper height of cut before slicing. With the suction on the motor is energized to reciprocate the blade. The motor may be moved forward with one finger against the casing in the cutting direction. The ring and guide member may be held by means of the handle. The cut disc slides up the take off surface 57a and lies flat on said surface so that it can be easily removed. Either lamellar thickness may be cut or penetrat ing thickness may be cut. Holding the instrument with the handle keeps the weight off the eye and stablizes the position of the eye. The patient should be anesthetized generally and locally for this operation.
In FIGS. 5-8 there is shown an instrument 10a embodying a modified form of the invention. This instrument is similar to the instrument 10 except for the parts referred to hereinafter. In the instrument 10a, guide tubes 134 are connected to a front ring similar to the front ring of instrument 10. These tubes, however, have rack teeth 135 in their upper sides. The motor shaft extends rearwardly as at 136 as well as forwardly. The rear shaft 136 is provided with a worm 137. Attached to the motor casing and extending rearwardly therefrom, are bracket arms 138 supporting a horizontal cross shaft 139 journalled therein. On the cross shaft 139 are pinions 140, meshing with the rack teeth 135. Fixed to the central part of the shaft 139 is a worm wheel 142 meshing with the worm 137. Thus when the motor is energized worm wheel 142 is slowly rotated. Rotation of the worm wheel 142 causes rotation of the shaft 139 which causes rotation of the pinions 140; Due to engagement of the pinions 140, with the rack teeth 135, the motor casing is automatically moved forwardly for the cutting operation while the insert and its blade reciprocate.
Another difference between the instrument a and the instrument 10 is as follows. The insert 90 of instrument 10 is replaced by a plate 160 having upper and lower parallel edge portions slidable in upper and lower opposed grooves 161 in the head casing. Said plate 160 is formed with a vertical slot 162 at its rear side to receive an eccentric pin 163 in the front motor shaft 164. Thus when the motor is operating, plate 160 reciprocates. Attached to the front end of the plate 160 by means of screws 165 is a flat plate spring 166 having downwardly and rearwardly curved spring fingers 167 inserted in openings 168 of a transversely moving member 170. Attached to the underside of member 170 is the blade 100. Member 170 has downwardly extending pins 101 projecting into openings 102 in the blade. The applanation plate 65a of instrument 10a may have a cylnidrical undersurface as shown at 65b in FIG. 7. This surface is uniform throughout the length of said plate. Otherwise the head of instrument 10a is the same as the head of instrument 10.
In FIG. 9 there is shown an instrument 10b similar to instrument 10a except that the reciprocating member 160 and spring 166 are replaced by a modified reciprocating member and spring. In FIG. 9, the head 200 is bored transversely to receive a reciprocating plastic rod 201. The rod 201 is prevented from rotating by a fixed plastic pin 202 received on a base section 203 in rod 201, which matches with bore section 204 in the head 200. Pin 203 may be cemented in bore section 204. Rod 201 is formed with a transverse slot 205. A spring 206 has a flange 207 wedged in slot 205 and spring fingers 208 similar to fingers 167 received in openings 209 and block 170.
Block 170 is same as said block or reciprocating member 170 of FIG. 5 and has pins 101 received in openings 102 in the blade 100.
Rod 201 has at its rear side, a vertical slot 211. The motor casing 212 may be attached to head 200 by screws 213. The front end 214 of the motor shaft has a forwardly projecting eccentric pin 216 projecting into slot 211. Thus when the motor is energized, eccentric pin 216 causes reciprocation of the rod 201 which in turn, causes reciprocation of the blade 100.
It will thus be seen that there is provided an apparatus, and article in which the several objects of this invention are achieved, and which is well adapted to meet the conditions of practical use.
As possible embodiments might be made of the above invention, and as various changes might be made in the embodiments above set forth, it is to be understood that all matter herein set forth or shown in the accompanying drawings, is to be interpreted as illustrative and not in a limiting sense.
1. In combination, guide means, a head, means to slidably mount said head on said guide means for forward and rearward movement thereon, a flat blade having a straight cutting edge, means to control said blade in said head for reciprocation transversely of said head, and means to reciprocate said blade controlling means for reciprocating said blade in a direction at right angles to the direction of sliding movement of .said head.
2. The combination of claim 1, said guide means having a ring portion formed with an opening to receive therethrough, a portion of a body to be shaved by said blade, and said blade having a cutting edge positioned to sweep across and above said opening as said head is' slidably moved relative to said guide means.
3. The combination of claim 2, and said ring portion having an annular channel at its underside, surrounding said opening and adapted to be closed by said body, and means to create vacuum in said channel to hold said body to said ring portion.
4. The combination of claim 3, and said means to reciprocate said blade controlling means comprising a motor having a casing attached to said head, and said means to mount said blade for reciprocation in said head comprising a member slidable transversely of and within said head and having a vertical slot, and said motor having a rotary shaft provided with an eccentric pin projecting into said slot.
5. The combination of claim 3, and means on said head to flatten the portion of said body projecting through said opening in said ring portion.
6. The combination of claim 5, said flattening means comprising a transparent plate slidably mounted on said head.
7. The combination of claim 5, and said head having means to support said blade in a downwardly and forwardly inclined position, and said blade having a forward cutting edge disposed below said flattening means.
8. The combination of claim 7, and said head having a rearwardly and upwardly inclined front wall, and being formed with a slot disposed rearwardly of said flattening means and above said blade and leading to the front surface of said front wall so that a shaved layer may slide through said slot up onto said front surface.
9. The combination of claim 3, and means controlled by said means for reciprocating asid blade controlling means, for automatically causing sliding movement of said head relative to said guide means.
10. The combination of claim 3, said guide means comprising a pair of tubes attached to said ring portion and communicating with said channel, and said means to create vacuum being connected to said tubes.
11. The combination of claim 1, said head comprising a bottom wall having a downwardly and forwardly inclined upper surface extending to the underside of said bottom wall, said blade lying on said inclined surface, said head having a front upwardly and rearwardly inclined wall the lower edge of which forms a slot with said inclined surface, said blade passing through said slot, said head having a portion extending forwardly of said bottom wall and forming a slot with said front Wall of said casing, and a flattening plate on said forwardly extending portion, said blade having a forward cutting edge disposed below the underside of said plate and forwardly of the front end of said inclined upper surface.
12. The combination of claim 11, said flattening plate being transparent and removably mounted on said forwardly extending portion.
13. The combination of claim 11, said blade controlling means comprising an insert transversely slidably mounted in said head, and having means to releasably interengage said blade for transverse movement therewith.
14. The combination of claim 13, and said means to reciprocate said blade controlling means, comprising an electric motor mounted for forward and rearward sliding movement on said guide means, means to attach the easing of said motor to said head and said motor having a rotary shaft, and an eccentric pin on said shaft and said insert being formed with a slot receiving said pin.
15. The combination of claim 1, said means to slidably mount said head on said guide means comprising sliding interengaging parallel, longitudinal flange and groove means on said head and guide means.
16. The combination of claim 1, and said blade controlling means comprising means to resiliently press the blade forwardly.
17. The combination of claim 1, said head having a transverse cavity open at its ends and said blade controlling means and said blade being insertable into said cavity in said head through its open ends.
18. The combination of claim 1, said blade controlling means comprising a round rod slidable transversely in said head, and a spring atached to said rod and releasably engaging said blade to reciprocate said blade.
19. The combination of claim 1, said means to reciprocate said blade being slidable on said guide means for forward and rearward movement together with said head.
20. The combination of claim 2, and means in-said head to flatten said portion of said body, and said flattening means comprising a plate having a concave undersurface of uniform longitudinal cross-section.
References Cited UNITED STATES PATENTS 1,158,741 11/1915 Stearns 128-305.5 1,736,246 11/1929 Blair 128-305.5 1,935,605 11/1933 Altruda 128305.5 2,249,906 7/1941 Longoria 128-305 2,419,114 4/1947 Briegel 128-305.5 2,428,018 9/1947 Eidam 128305.5 2,457,772 12/1948 Brown et a1. 128305.5 2,838,050 6/1958 Ara 128-3 10 3,058,471 10/1962 Shope 128305 3,074,407 1/1963 MOOn et a1 128-310 RICHARD A. GAUDET, Primary Examiner MARTIN F. MAJESTIC, Assistant Examiner