Abstract:
A surgical instrument ( 1 ) is provided with a rigid probe ( 2 ), and cuts off the trabecular meshwork by inserting this probe ( 2 ) into the canal of Schlemm. An inner tube portion having a cutter is equipped inside the probe, and the trabecular meshwork sucked in from a hole portion ( 22 ) is cut off by the cutter due to the movement of the inner tube portion. A protection portion ( 21 ) is formed on the tip the probe ( 2 ) and protects the outer wall of the canal of Schlemm when cutting the trabecular meshwork. According to the invention, an ophthalmic surgical instrument for glaucoma patients is provided, the surgical instrument having excellent operability and preventing cutting of parts that should not be cut off without fail.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The present invention relates to a surgical instrument. 
         [0003]    2. Description of the Conventional Art 
         [0004]    As is well known, since glaucoma is one of main diseases for an eye, and may cause blindness, proper medical treatment is indispensable. The glaucoma comes about in the case that pressure in the eye maintains an abnormally high numerical value over the long term, and an increase of the pressure in the eye is caused by deterioration of an outflow of aqueous humor. Therefore, a medical treatment for appropriately making the aqueous humor outflow is applied to the glaucoma. 
         [0005]    As a medical treatment method of the glaucoma, there is a prescription of a drag (dye drops and oral medication), however, there is also a surgical procedure. Since abnormality in the trabecular meshwork causes deterioration of the outflow of the aqueous humor, there is an operation for removing the trabecular meshwork as the surgical procedure. An instrument for the operation is proposed in the following patent document 1. 
       PRIOR ART DOCUMENT 
     Patent Document 
       [0006]    Patent Document 1: Japanese Unexamined Patent Application Publication (Translation of PCT Application) No. 2002-541975 
       SUMMARY OF THE INVENTION 
     Problem to be Solved by the Invention 
       [0007]    Since an instrument for incising the trabecular meshwork described in patent document 1 has a flexible construction as a whole including a leading end portion which cuts off the trabecular meshwork, the instrument may have an operability which is not high. Further, in the cutting operation of the trabecular meshwork, there is demanded a function of securely preventing the cutting of a portion which should not be cut off, as well as appropriately cutting a portion to be cut off. However, in the instrument described in the patent document 1, a structure for preventing the cutting of the portion which should not be cut off is deemed to be indefinite. 
         [0008]    Accordingly, an object to be solved by the present invention is to provide an instrument for an ophthalmic operation which is excellent in an operability and can securely prevent cutting of a part which should not be cut off. 
       Means for Solving the Problem 
       [0009]    In order to achieve the object mentioned above, a surgical instrument according to the present invention is a surgical instrument used in a cutting operation of a trabecular meshwork, the surgical instrument comprising:
       a grasping portion which a practitioner grasps; and   a probe which is arranged so as to extend like a rod from an end portion of the grasping portion and has a high rigidity,   wherein the probe comprises:   an outflow port which flows out a cleaning liquid toward the trabecular meshwork corresponding to a cut position;   a suction port which is formed in a side surface of the probe, collects the cleaning liquid flowed out of the outflow port as a waste liquid, and sucks the trabecular meshwork into an inner portion of the probe;   a cutting portion which cuts the trabecular meshwork sucked into the suction port; and   a protection portion which is arranged closer to a leading end side of the probe than the suction port and the cutting portion, has such a shape as to be extended to a side surface forming the suction port in the leading end of the probe, and protects an outer wall of a canal of Schlemn corresponding to a non-cut position from the cutting and the suction by being positioned between the cutting portion and the outer wall of the canal of Schlemn during the cutting of the trabecular meshwork by the cutting portion, and   wherein the surgical instrument further comprises:   a first delivery portion which is connected to a power supply portion for cutting a vitreous body in a vitreous body cutting device transmitting power in a vitreous body cutting operation and carrying out the delivery of the cleaning liquid and the collection of the waster liquid, and is provided for feeding the power for cutting from the device to the cutting portion;   a second delivery portion which is connected to a cleaning liquid supply portion for cutting the vitreous body in the vitreous body cutting device, and is provided for feeding the cleaning liquid from the vitreous body cutting device to the outflow port; and   a third delivery portion which is connected to a suction portion for cutting the vitreous body in the vitreous body cutting device, and is provided for feeding the waste liquid sucked by the suction port and the cut trabecular meshwork to the vitreous body cutting device.       
 
         [0021]    As a result, the surgical instrument according to the present invention serves as the ophthalmic surgical instrument which has the probe having the high rigidity and being excellent in the operability and cuts off the trabecular meshwork, and is provided with the protection portion which protects the outer wall of the canal of Schlemn from the cutting and the suction by being positioned between the cutting portion and the outer wall of the canal of Schlemn during the cutting of the trabecular meshwork, in the leading end side of the probe. Therefore, it is possible to securely suppress the cutting of the outer wall of the canal of Schlemn while securely cutting off the trabecular meshwork. Accordingly, it is possible to achieve the surgical instrument which can effectively carry out the surgical procedure in relation to the glaucoma. Further, since the suction port adjacent to the cutting portion is arranged in the side surface of the probe and the protection portion is formed so as to be extended to the side surface forming the suction port in the leading end of the probe, the trabecular meshwork can be cut off, for example, by inserting the probe into the canal of Schlemn, and it is possible to securely protect the outer wall of the canal of Schlemn at the position facing to the leading end of the probe from the cutting and the suction by the protection portion, according to the simple structure mentioned above. Further, it is possible to execute the trabecular meshwork cutting operation in relation to the glaucoma patient by connecting the surgical instrument according to the present invention to the device for the vitreous body cutting operation. As a result, it is possible to achieve a remarkable effect of contributing to a system simplification, a space saving and a cost reduction in a medical treatment, by using the device both as the device of the system for cutting the vitreous body and the device of the system for cutting the trabecular meshwork, which have been conventionally constructed independently. 
         [0022]    Further, an inner tube portion arranged so as to have a longitudinal axis in common may be provided in an inner portion of the probe, and the cutting portion may have a cutting blade which is formed in a side surface of the inner tube portion and cuts the cut position on the basis of a relative rotating motion or a relative translational motion of the inner tube portion in relation to the probe. 
         [0023]    According to the invention, since the relatively movable inner tube portion is provided in the inner portion of the probe, and the cutting blade provided in the inner tube portion achieves the cutting function on the basis of the relative motion of the inner tube portion, a mechanism of moving the cutting blade is formed by the simple structure while utilizing a cylindrical shape of the probe. As a result, it is possible to effectively cut while sucking the cut position. 
         [0024]    Further, a surgical instrument according to the present invention is a surgical instrument used in a cutting operation of a trabecular meshwork, the surgical instrument comprising a probe,
       wherein the probe comprises:   an outflow port which flows out a cleaning liquid toward the trabecular meshwork corresponding to a cut position;   a suction port which is formed in a side surface of the probe, collects the cleaning liquid flowed out of the outflow port as -a waste liquid, and sucks the trabecular meshwork into an inner portion of the probe;   a cutting portion which cuts the trabecular meshwork sucked into the suction port; and   the probe having a high rigidity, and   wherein the probe comprises:   an attaching portion for attaching the surgical instrument;   a protection portion which is arranged closer to a leading end side of the probe than the suction port and the cutting portion, has such a shape as to be extended to a side surface forming the suction port in the leading end of the probe, and protects an outer wall of a canal of Schlemn corresponding to a non-cut position from the cutting and the suction by being positioned between the cutting portion and the outer wall of the canal of Schlemn during the cutting of the trabecular meshwork by the cutting portion; and   an adjusting portion which adjusts a distance between the protection portion and the suction port in a state of being attached to the probe by the attaching portion.       
 
         [0034]    As a result, the surgical instrument according to the present invention can be used by being attached, for example, to the existing ophthalmic surgical instrument, on the basis of the structure having the protection portion and the attaching portion. Therefore, it is possible to achieve a remarkable effect of contributing to a great cost reduction in the ophthalmic operation. Further, since the distance between the protection portion and the suction port can be adjusted, it is possible to contribute to an appropriate operation by adjusting to a distance which is suitable for the ophthalmic operation to be carried out. For example, in the case that the instrument is used in a removing operation of the trabecular meshwork applied to the glaucoma patient, the position of the suction port can be aligned with the position of the trabecular meshwork to be cut off in a state in which the protection portion goes into the canal of Schlemn. Therefore, it is possible to carry out the appropriate trabecular meshwork cutting operation. 
     
    
     
       BRIEF EXPLANATION OF THE DRAWINGS 
         [0035]      FIG. 1  is a view showing a surgical instrument in a first practical example according to the present invention; 
           [0036]      FIG. 2  is a view showing a state of being connected to a control device; 
           [0037]      FIG. 3  is a view showing a first embodiment of the surgical instrument according to the present invention; 
           [0038]      FIG. 4  is a view showing a state in which an inner tube portion rotates in the first embodiment; 
           [0039]      FIG. 5  is a side elevational view showing a second embodiment of the surgical instrument according to the present invention; 
           [0040]      FIG. 6  is a side elevational view showing a third embodiment of the surgical instrument according to the present invention; 
           [0041]      FIG. 7  is a side elevational view showing a fourth embodiment of the surgical instrument according to the present invention; 
           [0042]      FIG. 8  is a view showing a state in which an inner tube portion moves in the fourth embodiment; 
           [0043]      FIG. 9  is a view showing an example of a condition of a glaucoma operation using the surgical instrument according to the present invention; 
           [0044]      FIG. 10  is an enlarged view of  FIG. 9 ; 
           [0045]      FIG. 11  is a view showing the other practical example of the protection portion; 
           [0046]      FIG. 12  is a view in the case that  FIG. 11  is seen from the above; 
           [0047]      FIG. 13A  is a view showing a first example in the case that  FIG. 11  is seen from a side of a hole portion; 
           [0048]      FIG. 13B  is a view showing a second example in the case that  FIG. 11  is seen from the side of the hole portion; 
           [0049]      FIG. 14  is a view showing a condition that the surgical instrument according to the present invention is used both the surgical instrument and a vitreous body cutting system; 
           [0050]      FIG. 15  is an enlarged view of  FIG. 10 ; 
           [0051]      FIG. 16  is a view showing an example of a procedure prior to  FIG. 10  in the glaucoma operation; 
           [0052]      FIG. 17  is a view showing an embodiment of an attaching type of the surgical instrument according to the present invention; 
           [0053]      FIG. 18  is a partly cross sectional view of the attaching type surgical instrument; 
           [0054]      FIG. 19  is a view showing an example of a device for adjusting the attaching type surgical instrument; 
           [0055]      FIG. 20  is a perspective view of a second example of the attaching type surgical instrument; 
           [0056]      FIG. 21  is a perspective view of a third example of the attaching type surgical instrument; and 
           [0057]      FIG. 22  is a view in the case that  FIG. 20  or  21  is seen from a side direction. 
       
    
    
     DESCRIPTION OF REFERENCE NUMERALS 
       [0000]    
       
           1  surgical instrument 
           2  probe 
           3  body portion (grasping portion) 
           4  cable and tube portion 
           40  electric power cable (first delivery portion) 
           40 ′ air tube (first delivery portion) 
           41  cleaning liquid tube (second delivery portion) 
           42  waste liquid tube (third delivery portion) 
       
     
       DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0066]    A description will be given below of a practical example according to the present invention with reference to the accompanying drawings. First of all,  FIG. 1  shows a surgical instrument  1  (hereinafter, refer to as an instrument) in a practical example of the present invention. The instrument  1  is an instrument which is used for cutting off, particularly, a trabecular meshwork in a glaucoma operation, and is provided with a probe  2 , a body portion  3  and a cable and tube portion  4 . 
         [0067]    The probe  2  is a region which extends from a leading end side of the body portion  3  and is inserted into an eye of a patient. The probe has a cylindrical shape which is formed linearly from the body portion  4 , and is constructed by a small diameter portion  2   a  which is positioned in a leading end side and has a smaller diameter, and a large diameter portion  2   b  closer to the body  3 , as is shown by an enlarged portion surrounded by a one-dot chain line. The diameter of the probe  2  (the small diameter portion  2   a  and the large diameter portion  2   b ) may be set to a numerical value which is suitable for cutting off the trabecular meshwork. 
         [0068]    The small diameter portion  2   a  of the probe  2  is structured, as shown in  FIG. 1 , such that a hole portion  20  is formed in a side surface in the vicinity of a leading end of a cylinder portion  20  having a cavity in its inner portion, and a protection portion  21  is provided in an inverse side surface to the hole portion  20  and a leading end surface side of the hole portion  20 . An inner portion of the cylinder portion  20  is connected to a suction mechanism as mentioned later, and a part of the trabecular meshwork is sucked into the inner portion of the hole portion  20 . A cutter (a cutting portion) is provided in the inner portion of the hole portion  20 , and the sucked trabecular meshwork is cut by the cutter and is sucked into the body portion  3 . A cleaning liquid soiled by an operation is also sucked into the body portion  3  from the hole portion  20 . 
         [0069]    The large diameter portion  2   b  of the probe  2  is provided with a hole portion  23  in a side surface in the vicinity of a leading end of the large diameter portion. The hole portion  23  is connected from a region supplying the cleaning liquid, and the cleaning liquid flows out (jets out or injects out) toward a probe leading end direction, that is, toward the periphery of a treatment position, from the hole portion  23  at the operating time. A material of the probe  2  may be set, for example, to a metal or a resin having a high rigidity. 
         [0070]    The body portion  3  (a grasping portion) is a region which a practitioner grasps at the operating time, is formed, for example, as a tubular shape which is suitable for grasping, and is provided in its inner portion with a driving portion driving the cutting portion (mentioned later). Further, the cut trabecular meshwork, the cleaning liquid and the soiled waster liquid are fed from the probe (or to the probe) through the inner portion of the body portion  3 . 
         [0071]    The cable and tube portion  4  extends from a rear end side of the body portion  3  and has relations with an electric power supply, a cleaning liquid supply, a cut position and a waste liquid collection. The cable and tube portion  4  may be provided with a plurality of cables or tubes, for example, may be provided with three cables or tubes constituted by an electric power cable  40 , a cleaning liquid (cleaning fluid) supply tube  41  and a waste liquid tube  42  (or four cables or tubes in the case that both polar lines of the electric power cable  40  are respectively counted), as shown in  FIG. 1 . 
         [0072]    The electric power cable  40  supplies an electric power for a cutting process in the leading end of the probe  2  as mentioned later. The cleaning liquid supply tube  41  is a tube for feeding the cleaning liquid to the treatment portion during the cutting treatment of the trabecular meshwork. The waste liquid tube  42  is a tube for collecting and disposing of the cut trabecular meshwork, the soiled waste liquid after cleaning the treatment portion and bloody issue from the operation region. 
         [0073]    The instrument  1  is used by being connected to a control device  5  at the operating time, as shown in  FIG. 2 . The control device  5  is provided with an electric power supply  50  (an electric power supply portion), a cleaning liquid supply portion  51  and a suction portion  52 , as a main construction. The electric power supply  50  supplies an electric power to the instrument  1  by being connected to the electric power cable  40  of the instrument  1 . On the basis of the supplied electric power, the instrument  1  drives the cutting portion. The electric power supply  50  may be structured such as to convert a commercial power into an electric power suitable for the instrument  1  (for example, a relatively lower electric voltage value) so as to supply to the instrument  1 . The cleaning liquid supply portion  51  supplies the cleaning liquid to the instrument  1  by being connected to the cleaning liquid tube  41  of the instrument  1 . The suction portion  52  sucks the waste liquid and the cut position through the instrument  1  by being connected to the waste liquid tube  42  of the instrument  1 . 
         [0074]      FIGS. 3 to 8  are cross sectional views showing a detailed structure in a plurality of embodiments of the instrument  1 . A description will be given of a structure and a motion of the instrument  1  in each of the embodiments with reference to these drawings.  FIGS. 3 to 8  are schematic views, and a length in a vertical direction of the drawing is compressed, for example. 
         [0075]    First of all,  FIG. 3  shows an axial cross sectional view of the probe  2  and the body portion  3  in a first embodiment. As is shown in the drawing, the probe  2  is provided with an inner tube portion  25  (an inside cylinder portion) in an inner side of an outer tube portion (an outside cylinder portion), the outer tube portion being constructed by the cylinder portion  20  shown in  FIG. 1 . The inner tube portion  25  is arranged so as to be relatively movable in relation to the outer tube portion (the cylinder portion  20 ). 
         [0076]    Then inner tube portion  25  is formed as a cylindrical shape having a cavity in its inner portion, and a hole portion  24  is also formed in the inner tube portion  25  at a position which laps over an inside of the hole portion  22  of the outer tube portion  20  according to a positional relationship in  FIG. 3 . A passage formed in the inner portion of the inner tube portion  25  is connected to the waste liquid tube  41  from the hole portion  24 . The protection portion  21  is arranged over a right side and an upper side in the drawing of the outer tube portion  20 . The protection portion  21  may be formed, for example, as a plate shape which is bent along an outer shape of the outer tube portion  20 . 
         [0077]    As shown in  FIG. 3 , the probe  2  may be structured, for example, such as to be inserted into a hole portion formed in the body portion  3  so as to be fixed. Further, the protection portion  21  may be structured, for example, such as to be inserted into a hole portion formed in a taper portion on the boundary between the small diameter portion  2   a  and the large diameter portion  2   b  so as to be fixed. In  FIG. 3 , the cylinder portion  20  (the outer tube portion) is formed integrally with the large diameter portion  2   b,  however, the cylinder portion  20  (the outer tube portion) may be structured such as to be formed independently from the large diameter portion  2   b  and be inserted into the large diameter portion  2   b.    
         [0078]    A passage for the cleaning liquid is formed in the taper portion on the boundary between the small diameter portion  2   a  and the large diameter portion  2   b,  the passage passing through the hole portion  23 , further passing through the body portion  3  to the cleaning liquid tube. The cleaning liquid is supplied from the cleaning liquid supply portion  51  of the control device  5  together with an appropriate water pressure, and passes through the body portion  3  and the probe  2  so as to be jetted out to the periphery of the operation region from the hole portion  23 . 
         [0079]    In the case that the hole portion  22  and the hole portion  24  come to the overlapping positional relationship at the operating time, the trabecular meshwork in the vicinity of the hole portions  22  and  24  (a part of all the trabecular meshwork) is sucked into the inner portions of the hole portions  22  and  24  on the basis of the suction of the suction portion  52  in the control device  5 . At the same time, the cleaning liquid cleaning the operation region is sucked into the hole portions  22  and  24 . 
         [0080]    In an embodiment in  FIG. 3 , a motor  30  is equipped in the body portion  3 . The motor  30  is arranged at the center position of the body portion  3  so as to have an axis of rotation in common with the axis of the probe  2 . Further, the motor  30  is supplied the electric power from the control device  5  through the electric power cable  40 , and makes the inner tube portion  25  carry out a rotary motion around the axis of the probe  2 .  FIG. 4  shows a state in which the inner tube portion  25  rotates at about 90 degrees. 
         [0081]    A cutter  24   a  is formed in an end portion (for example, an end portion in a lateral direction of the drawing) of the hole portion  24  of the inner tube portion  25 , and the inner tube portion  25  rotates in relation to the outer tube portion  20 , whereby the trabecular meshwork sucked into the hole portions  22  and  24  as mentioned above is cut by the cutter  24   a.  A cutter may be formed in the hole portion  22  of the outer tube portion  20 . The cut trabecular meshwork and waste liquid pass through the passage within the inner tube portion  25  and further pass through the waste liquid tube so as to be sucked into the suction portion  52 . The trabecular meshwork and the waste liquid reserved in the suction portion  52  may be disposed, for example, according to an appropriate method. 
         [0082]    Next,  FIG. 5  shows the other embodiment of the instrument  1 . In the embodiment in  FIGS. 5 to 8 , regions denoted by the same reference numerals as those of  FIGS. 3 and 4  denote the same regions, and an overlapping description will be omitted. 
         [0083]    In the embodiment in  FIG. 5 , a mechanism of an air cylinder is equipped in place of the motor  30 . Further, a control device  5 ′ is equipped with a pump  53  in place of the electric power supply portion  50 . Further, the instrument  1  is equipped with an air tube  40 ′ for supplying air serving as a power in place of the electric power cable  40 . The instrument is formed a cylinder  31  within the body portion  3 , and is provided with a piston  32  and a screw portion  33 . 
         [0084]    The cylinder  31  is formed as a cylindrical shape which has an axis in common with the probe  2 , and the piston  32  is arranged within the cylinder  31  so as to be movable in an up and down direction in the drawing. A thread groove is formed in the piston  32 , and is threadably fitted to a thread groove of the screw portion  33 . The screw portion  33  is fixed to the inner tube portion  25 . 
         [0085]    In the structure mentioned above, in the case that the supply and suction of the air serving as the power are repeated from the pump  53  of the control device  5 ′, the piston  32  moves up and down, the up-and-down motion is converted into a rotary motion of the screw portion  33  by a screw mechanism between the piston  32  and the screw portion  33 . The inner tube portion  25  rotates on the basis of the rotary motion of the screw portion  33 . As a result, the cutter  24   a  of the hole portion  24  of the inner tube portion  25  cuts the trabecular meshwork sucked into the hole portion  24 . 
         [0086]    Next,  FIG. 6  shows a third embodiment of the instrument  1 . The embodiment is also provided with the air cylinder structure. Specifically, the instrument  1  is formed a cylinder  34  within the body portion  3 , and is provided with a piston  35 , a gear  36  and a rack  37 . The cylinder  34  is formed as a cylindrical shape in which an axial direction of the cylinder  34  is orthogonal to the axial direction of the probe  2 , and the piston  35  is arranged within the cylinder  34  so as to be movable in a lateral direction in the drawing. The rack  37  is fixed to the piston  35 , and moves to the right and left integrally with the piston  37 . The gear  36  forms a cam mechanism between the gear  36  and the rack  37 , and converts a translational motion of the rack  37  into the rotary motion. The gear  36  is fixed to the inner tube portion  25 . 
         [0087]    According to the structure mentioned above, in the instrument  1 , in the case that the supply and the suction of the air serving as the power are repeated from the pump  53  of the control device  5 ′, the piston  32  moves to the right and left in the drawing, the rack  37  moves to the right and left integrally with the piston, and the lateral motion is converted into the rotary motion of the gear  36  by the cam mechanism between the rack  37  and the gear  36 . The inner tube portion  25  rotates on the basis of the rotary motion of the gear  36 . As a result, the cutter  24   a  of the hole portion  24  in the inner tube portion  25  cuts the trabecular meshwork sucked into the hole portion  24 . 
         [0088]    The rotary motion of the inner tube portion  25  in  FIGS. 3 and 4  is a rotary motion having a fixed speed in the same direction, and in the rotary motion of the inner tube portion  25  in  FIGS. 5 and 6 , the rotation with a predetermined rotating angle width in forward and backward directions may be repeated. 
         [0089]    Next,  FIGS. 7 and 8  show a fourth embodiment of the instrument  1 . In the embodiment, the inner tube portion  25  moves in parallel in a vertical direction of the drawing. Specifically, the instrument  1  is formed the cylinder  31 , and is provided with a piston  38 . The cylinder  31  is formed as a cylindrical shape which has an axis in common with the probe  2 , and the piston  38  is arranged within the cylinder  31  so as to be movable in a vertical direction in the drawing. The piston  38  is fixed to the inner tube portion  25 . 
         [0090]    In the structure mentioned above, in the case that the supply and the suction of the air serving as the power are repeated from the pump  53  of the control device  5 ′, the piston  38  moves up and down in the drawing. The inner tube portion  25  moves up and down on the basis of the up-and-down motion of the piston  38 .  FIG. 8  shows a state in which the inner tube portion  25  moves downward in the drawing. On the basis of the downward movement of the inner tube portion  25 , the cutter  24   a  of the hole portion  24  in the inner tube portion  25  cuts the trabecular meshwork sucked into the hole portion  24 . 
         [0091]    In the embodiment, the cutter  24   a  may be formed in an upper end portion in the hole portion  24  of the inner tube portion  25 . Alternatively, it is preferable to make a moving distance of the inner tube portion  25  longer, form the cutter  24   a  in both upper and lower end portions in the hole portion  24  of the inner tube portion  25 , and cut the trabecular meshwork by both the upper and lower cutters  24   a.  Of course, the cutter may be provided in the hole portion  22  of the outer tube portion  25 . 
         [0092]    The instrument  1  having the structure mentioned above is used in the cutting work of the trabecular meshwork in the surgical procedure of the glaucoma. Describing with reference to a schematic view of an eye structure shown in  FIG. 9 , an aqueous humor is created in a ciliary body positioned in a lower portion of the drawing of an iris  104  of the eye. Normally, the aqueous humor advances on a crystalline lens  105  and thereafter flows out of a corner I a peripheral direction of an anterior chamber of eye  101 . The trabecular meshwork  102  and the canal of Schlemn  103  exist in the corner. The trabecular meshwork  102  serves as a filter which restricts the outflow of the aqueous humor. The canal of Schlemn  103  has a structure for the aqueous humor flowing out. 
         [0093]    In the case that the trabecular meshwork  102  abnormally deforms or generates a functional abnormality, the flow of the aqueous humor getting out of the anterior chamber of eye  101  is restricted. As a result, the pressure in the eye is abnormally increased, and the glaucoma is generated. The surgical instrument  1  according to the present invention is an effective instrument in a surgical procedure in relation to the glaucoma. One example of the operating method using the instrument  1  is as follows. 
         [0094]    In preparation of the operation, a head position of a patient is decided as well as a microscope is inclined to a practitioner side at 30 degrees to 45 degrees so that the trabecular meshwork can be seen from a front face through a gonioscope. After incising a corner by a knife (for example, 1.7 mm) and evacuating the aqueous humor a little, a visco-elastic material is injected. In order to easily view, the visco-elastic material may be preferably filled particularly in the corner portion. After putting the gonioscope and confirming the trabecular meshwork, the probe  2  is inserted into the canal of Schlemn  103  and the cutting is started. As shown in  FIG. 10 , the instrument  1  is moved toward the side in which the hole portion  21  is formed, within the canal of Schlemn  103 . At this time, the direction in which the instrument  1  moves forward is identical to the direction in which the protection portion  21  is extended. 
         [0095]    In the case that the cutting is advanced in a clockwise direction and is advanced thereafter in a counterclockwise direction, it is possible to cut off from 90 degrees to 120 degrees. (In the case that a cataract operation is simultaneously carried out, a cornea incision wound of 1.7 mm is expanded to 3.0 mm here and the lens is inserted.) After washing the visco-elastic material and the reflex bloody issue so as to completely remove, the fact that any aqueous humor is not leaked from the wound portion is finally checked. In order to keep the pressure in the eye to some degree, the wound is sutured in a stitch (for example, with 10-0 nylon) as occasion demands. 
         [0096]    As an advantage of the operation, for example, there can be listed up a low invasiveness that the incise wound of the cornea  100  is small and the canal of Schlemn is hard to be damaged, and a certainty that the trabecular meshwork can be cut while being actually seen. Further, since a serious complication after the operation is not generated so much, there is a chance of accommodating to the operation more early than the increased number of instillation of drop, as long as the glaucoma has a high pressure in the eye which is equal to or higher than 21 mmHg in the early stage and the middle stage. 
         [0097]    As mentioned above, the trabecular meshwork can be cut (curetted) by using the instrument  1  according to the present invention (the expression of trabecular meshwork cut includes the matter that the inner wall of the canal of Schlemn is cut at a predetermined angle range from the anterior chamber side and the trabecular meshwork is exposed). At this time, the outer wall of the canal of Schlemn is protected by the protection portion  21 . 
         [0098]    The protection portion  21  can be formed as various shapes.  FIGS. 11 to 13  show a first embodiment of the protection portion  21 .  FIG. 11  is a perspective view,  FIG. 12  is a view in the case that  FIG. 11  is seen from the above of the drawing, and  FIG. 13A  is a view in the case that  FIG. 11  is seen from the side of the hole portion  22 . The protection portion  21  is arranged so as to come into contact with a side in an inverse side to the side in which the hole portion  22  is formed in the small diameter portion  2   a  of the probe  2  as mentioned above, is bent along the leading end shape of the probe  2 , and is extended approximately in a parallel direction to the leading end surface of the probe  2 . 
         [0099]    As shown in  FIG. 12 , a front portion  21   a  of the protection portion  21  may be formed as a triangular shape (or a tapered shape) (a corner portion may be formed as a curved surface shape). In the shape, since a tip of the protection portion  21  is narrowed toward a forward moving direction in the case that the probe  2  is moved forward along the canal of Schlemn  103  as shown in  FIG. 10 , the advancing of the probe  2  can be smoothly carried out. As mentioned above, the protection portion  21  also serves as a guide portion for advancing the leading end of the probe along the canal of Schlemn. 
         [0100]    Further, as shown in  FIG. 12 , a leading end  21   b  of the protection portion  21  may be formed as a sharp shape. The shape is preferable for sticking the leading end  21   b  of the protection portion  21  into the trabecular meshwork so as to advance the probe in the case that the leading end of the probe is advanced into the trabecular meshwork at the first time of the operation. 
         [0101]    Further, as shown in  FIG. 13A , an upper end in the drawing of the protection portion  21  may be formed as a rounded concave shape. As a result, since the upper end is along the lines of the curved surface shape of the canal of Schlemn at the operating time, and does not injure the canal of Schlemn, the structure is preferable. The shape of the upper end of the protection portion  21  may be formed as a chevron concave shape. Alternatively, as shown in  FIG. 13B , the upper end in the drawing of the protection portion may be formed as a flat shape. In the present invention, the shape of the upper end in the drawing of the protection portion  21  may be formed as any shape which can play a role of protecting the non-cut portion and serve as a guide portion, without being limited to the examples in  FIGS. 13A and 13B . 
         [0102]    In the shape of the leading end of the probe, it is important to make a distance from (the upper end of) the protection portion  21  to the hole portion  22  appropriate. As shown in  FIG. 15 , a distance d from (the upper end of) the protection portion  21  to the hole portion  22  is set so that the hole portion  22  comes to the position of the trabecular meshwork to be cut off, in a state in which the protection portion  21  is in a range after going into the trabecular meshwork until coming into contact with the canal of Schlemn. The position of the trabecular meshwork to be cut off may be set, for example, to include a side near the center of the eye in the trabecular meshwork within the canal of Schlemn (a side in which the probe is inserted into the canal of Schlemn). 
         [0103]    The surgical instrument  1  of the glaucoma according to the present invention can exist together with the existing medical treatment device. A mechanism thereof is shown in  FIG. 14 . 
         [0104]      FIG. 14  shows an operation system for cutting off the vitreous body. The system is provided with a control device  500  for cutting off the vitreous body and an instrument  100  for cutting off the vitreous body. The control device  500  for cutting off the vitreous body is provided with an electric power supply portion  50  (or a pump  53 ) for culling off the vitreous body, a cleaning liquid supply portion  51 , and a suction portion  52 . The instrument  100  for cutting off the vitreous body is provided with cables or tubes. By connecting the cables or the tubes to the electric power supply portion  50  (or the pump  53 ), the cleaning liquid supply portion  51  and the suction portion  52 , an electric power driving a cutter for cutting off the affected area (the vitreous body) is supplied to a cutting portion of the instrument  100  for cutting off the vitreous body, the cleaning liquid is supplied to the operation region, and the cut region (the vitreous body) and the waste liquid reflowed from the operation region are sucked and collected. As a result, it is possible to achieve the vitreous body cutting operation using the instrument  100  for cutting off the vitreous body. 
         [0105]    According to the knowledge of the inventor, a function required for the control device  5  ( 5 ′) for cutting off the trabecular meshwork is similar to the function of the existing control device  500  for cutting off the vitreous body, and the control devices can be sufficiently used both as the control device for cutting off the trabecular meshwork and the control device for cutting off the vitreous body. In other words, the control device  5  ( 5 ′) mentioned above in relation to the instrument  1  according to the present invention can be substituted by the control device  500  for cutting off the vitreous body in  FIG. 14 . As a result, it is possible to greatly contribute to simplification, space saving and cost reduction of the system in the ophthalmic medical treatment by using the device part both as the device part of the system for cutting off the vitreous body and the device part of the system for cutting off the trabecular meshwork which have been conventionally constructed independently. The device is not limited to the control device  500  for cutting off the vitreous body, but may employ the other device having the same function. 
         [0106]    The practical example may be optionally changed within the range of the spirits described in claims. For example, the instrument  1  can be used for the cutting operation of the vitreous body. Since the instrument  1  has the equipment which is necessary for cutting off the vitreous body, the instrument  1  can achieve a high general versatility so as to correspond to both the glaucoma and the vitreous body. 
         [0107]    The embodiment mentioned above is structured, as shown in  FIG. 1 , such that the protection portion  21  is integrated with the other probe  2 , body portion  3 , and cable and tube portion  4 , however, the present invention is not limited to the embodiment mentioned above.  FIG. 17  shows a perspective view of an attaching type instrument structured such that only the protection portion is attached. This structure may be attached, for example, to the vitreous body surgical instrument  200  shown in  FIG. 14 . A description will be given below of the case that the structure is attached to the instrument  200 . 
         [0108]    It is assumed that the instrument  200  has the same structures and shapes as those of the instrument  1  except the structure that the protection portion is not formed. As shown in  FIG. 18 , a probe of the instrument  200  has a small diameter portion  220  and a large diameter portion  230 , a hole portion  221  is formed in the small diameter portion  220 , and a hole portion  231  is formed in a taper portion from the large diameter portion  230  to the small diameter portion  220 . The cleaning liquid is supplied from the hole portion  231  to the treatment portion. The hole portion  221  is equipped with a cutter, sucks the trabecular meshwork (or the vitreous body), cuts it by the cutter, and feeds it to the control device together with the waste liquid. 
         [0109]    A attaching type surgical instrument  300  (hereinafter, refer to as an instrument) shown in  FIG. 18  is constructed by a leading end side cylinder portion  310  (attaching portion), a body side cylinder portion  320  (an attaching portion), and a connection portion  330  (an adjusting portion). A protection portion  311  is formed in the leading end side cylinder portion  310 , and the leading end side cylinder portion  310 , the body side cylinder portion  320  and the connection portion  330  are arranged in this order from a leading end side of the probe of the instrument  200 . A through hole  312  to which the probe of the instrument  200  is inserted is formed in the leading end side cylinder portion  310 , the body side cylinder portion  320  and the connection portion  330  at the center portion in an axial direction. 
         [0110]      FIG. 18  is a partly cross sectional view in a state in which the instrument  300  is attached to the instrument  200 , that is, the instrument  200  is inserted into the through hole  312 . The instrument  300  is provided with a structure for attaching the instrument  200 , and a structure for positioning the protection portion  311 . A description will be given below of them. 
         [0111]    A collar portion  312  and a fitting portion  313  are formed in the leading end side cylinder portion  310 . The collar portion  312  is formed as a shape protruding outward in a peripheral direction on an outer peripheral surface of the leading end side cylinder portion  310 . The fitting portion  313  is formed in such a manner that concave shapes and convex shapes heading for an axial direction are repeated along the peripheral direction, in a lower end of the drawing, that is, an end portion closer to the body in the leading end side cylinder portion  310 . 
         [0112]    A concave portion  332  and a thread groove portion  331  are formed in the connection portion  330 . The concave portion  332  is a concave shape which is formed along the peripheral direction on an inner peripheral surface of the connection portion  330 , and is fitted to the collar portion  312  of the leading end side cylinder portion  310 . As a result, the leading end side cylinder portion  310  and the connection portion  330  are slidable in the peripheral direction. The thread groove portion  331  is a thread groove which is formed in a lower portion of the drawing than the concave portion  332  on the inner peripheral surface of the connection portion  330 . 
         [0113]    The body side cylinder portion  320  is provided with a thread groove portion  321 , a fitting portion  323  and a bolt  322 . The thread groove portion  321  is a thread groove which is formed on an outer peripheral surface of the body side cylinder portion  320 , and is threadably engaged with the thread groove portion  331  of the connection portion  330 . As a result, the connection portion  330  and the body side cylinder portion  320  relatively move in a vertical direction of the drawing by rotating the connection portion  330  around an axis. 
         [0114]    The fitting portion  323  is formed in such a manner that concave shapes and convex shapes heading for an axial direction are repeated along the peripheral direction, in an upper end side of the drawing of the body side cylinder portion  320 , and is fitted to the leading end side cylinder portion  310  and the fitting portion  313 . As a result, the body side cylinder portion  320  and the leading end side cylinder portion  310  can relatively move in the vertical direction of the drawing while the fitting portions  313  and  323  are fitted. 
         [0115]    The bolt  322  is threadably engaged with a through hole which is formed in a side surface of the body side cylinder portion  320 . The body side cylinder portion  320  is fixed (positioned) in relation to the instrument  200  by fastening the bolt  322  in a state in which the instrument  200  is inserted into the instrument  300  so as to be set to an appropriate position. The body side cylinder portion  320  may be fixed by being pressed into with an appropriate pressure, without provision of the bolt  322 . 
         [0116]    Since the body side cylinder portion  320  is fixed, the connection portion  330  moves upward in the drawing while rotating, by rotating the connection portion  330  rightward around the axis in a state in which the body side cylinder portion  320  is fixed to the instrument  200  by the bolt  322 . Since the collar portion  312  and the concave portion  332  are fitted, the leading end side cylinder portion  310  also moves upward in the drawing according to the upward movement of the connection portion  330 . When the leading end side cylinder portion  310  moves upward, the rotation around the axis of the leading end side cylinder portion  310  is regulated (inhibited). Therefore, the leading end side cylinder portion  310  moves upward in the drawing in parallel without rotating. Of course, the leading end side cylinder portion  310  moves downward in the drawing in parallel by rotating the connection portion  330  in an inverse direction. 
         [0117]    As mentioned above, the leading end side cylinder portion  310  moves in the vertical direction of the drawing in parallel, by inserting the probe of the instrument  200  into the instrument  300 , fixing the body side cylinder portion  320  into the instrument  200  by the bolt  322 , and rotating the connection portion  330  in this state. As a result, an appropriate positioning of the protection portion  311  can be achieved by adjusting an angle of rotation of the connection portion  330 . In other words, it is possible to appropriately adjust a distance (d in  FIG. 15 ) from (an upper end of) the protection portion  311  to the hole portion  221 . Since the attaching type instrument  300  mentioned above can be used by being attached to the existing ophthalmic surgical instrument (for example, the vitreous body surgical instrument, the instrument for the glaucoma, however, the other ophthalmic surgical instruments may be employed without being limited to these instruments), it is possible to remarkably achieve a cost reduction effect. 
         [0118]    The process for appropriately adjusting the distance from (the upper end of) the protection portion  311  to the hole portion  221  by rotating the connection portion  330  may be carried out by a manual step of the practitioner (the worker), however, since the process is a fine positioning, the process may be carried out by a machine. An example of a device for this purpose is shown in  FIG. 19 . 
         [0119]    A device  400  in  FIG. 19  is a device for precisely positioning the protection portion  311  by arranging (grasping) the instrument  300  (which is fixed by the bolt  322  on the basis of the insertion of the instrument  200 ) within a casing. The device  400  is provided with a grasping portion  401 , pinching portions  402  and  403 , a motor  410 , a measuring portion  420  and a control portion  430  as a main structure. 
         [0120]    The grasping portion  401  is a region which grasps the connection portion  330  from an outer side in a diametrical direction. The grasping portion  401  may be arranged so as to be spaced in a peripheral direction or extend over a whole periphery. The pinching portions  402  and  403  form a rod-like region, are movable in a lateral direction of the drawing, and pinch the upper end (a right end of the drawing) of the protection portion  311  and the upper end (a right end of the drawing) of the hole portion  221  (with an appropriate pressure), as shown in  FIG. 19 . 
         [0121]    The motor  410  is constructed, for example, by a step motor, and drives so that the grasping portion  401  rotates at a commanded angle around the axis. The measuring portion  420  measures a distance between respective leading ends of the pinching portions  402  and  403 . A measuring method may employ a well-known electronic measuring method. 
         [0122]    The control portion  430  is provided with the same structure as a typical computer, that is, a CPU for an information processing such as various calculations, a temporarily storing RAM serving as a processing area of the CPU, and a ROM storing necessary various information such as programs. The control portion  430  issues a command of an angle of rotation for setting the distance from (the upper end of) the protection portion  311  to an appropriate distance in the trabecular meshwork cutting operation to the motor  410 , while monitoring results of measurement of the measuring portion  420 . 
         [0123]    The control by the control portion  430  may be set, for example, to a feedback control. In other words, a difference from a target value (a target distance) may be calculated by feeding back a measured value in the measuring portion  420 , the results of calculation may be input to an appropriately designed controller, and the output may be set to an input value to the motor  410 . According to the control mentioned above, it is possible to adjust the distance from (the upper end of) the protection portion  311  to the hole portion  221  to an optimum distance. 
         [0124]    The attaching type embodiment of the surgical instrument according to the present invention is not limited to the above example. The other embodiments are shown in  FIGS. 20 to 21 .  FIG. 20  is a perspective view of a second example of the attaching type surgical instrument,  FIG. 21  is a perspective view of a third example of the attaching type surgical instrument, and  FIG. 22  is a view in the case that  FIG. 20  or  21  is seen from a side direction. The examples in  FIGS. 20 to 22  are the simpler embodiments than the example in  FIG. 17 , and are the embodiments which are attached only to the leading end of the existing instrument (for example, a description will be given of the case of the instrument  200 ). 
         [0125]    An instrument  300   a  shown in  FIG. 20  has a protection portion  311  above a curved portion  340  in the drawing, the curved portion  340  being extended to both right and left sides so as to be curved. The protection portion  311  may be formed as the same shape as the protection portion  21  mentioned above. The instrument  300   a  is installed, for example, from the leading end side of the instrument  200  so that the probe of the instrument  200  is inserted into the curved portion  340 . 
         [0126]    The fixing of the instrument  300   a  to the instrument  200  may be achieved, for example, by the probe of the instrument  200  being pressed into the curved portion  340 . Alternatively, it is possible to employ an embodiment which fixes to the instrument  200  by inserting the probe of the instrument  200  into the curved portion  340  and thereafter caulking (pressing and deforming) the curved portion  340  from an outer side by an instrument such as a nipper. Alternatively, it is possible to form an adhesive agent (a pressure sensitive adhesive) layer in an inner side of the curved portion  340  and fix to the instrument  200  according to the adhesion (the pressure sensitive adhesion). 
         [0127]    In an instrument  300   b  shown in  FIG. 21 , the protection portion  311  is formed above a cylinder portion  341  in the drawing, the cylinder portion having a cylindrical shape. The instrument  300   b  is installed, for example, from the leading end side of the instrument  200  so that the probe of the instrument  200  is inserted into the cylinder portion  341 . 
         [0128]    The fixing of the instrument  300   b  to the instrument  200  may be achieved, for example, by the probe of the instrument  200  being pressed into the cylinder portion  341 . Alternatively, it is possible to employ an embodiment which fixes to the instrument  200  by inserting the probe of the instrument  200  into the cylinder portion  341  and thereafter caulking (pressing and deforming) the cylinder portion  341  from an outer side by an instrument such as a nipper. Alternatively, it is possible to form an adhesive agent (a pressure sensitive adhesive) layer in an inner side of the cylinder portion  341  and fix to the instrument  200  according to the adhesion (the pressure sensitive adhesion). 
         [0129]    Even in the instruments  300   a  and  300   b,  it is necessary to make the distance d from the upper end of the protection portion  311  to the suction port  22  as shown in  FIG. 15  appropriate as mentioned above. For this purpose, for example, a plate-shaped length adjusting portion  311   a  is formed in a lower side of the drawing of the protection portion  311 , as shown in  FIGS. 20 and 21 . 
         [0130]    On the basis of the formation of the length adjusting portion  311   a,  in the case that the instrument  300   a  or  300   b  is fixed to the instrument  200  so that the leading end of the instrument  200  comes into contact with the length adjusting portion  311   a,  as shown in  FIG. 22 , the distance d from the upper end of the protection portion  311  to the suction port  22  becomes a length which is suitable for cutting off the trabecular meshwork of the glaucoma operation in the meaning mentioned above. The thickness of the length adjusting portion  311   a  is set to be suited to the dimension of the existing instrument  200 , in order to satisfy the requirement. It is possible to prepare the instrument for the glaucoma operation at a low cost by installing the instrument  300   a  or  300   b  according to the simple embodiment mentioned above to the existing instrument (which is not limited to the instrument  200 ).