Abstract:
An iris retractor ( 10, 30, 50, 150, 170, 190, 200 ) including a plurality of hooks ( 12, 32, 52, 152, 172, 192, 202 ) disposed or formed at a distal end of slender elements ( 14, 34, 54, 154, 174, 194, 204 ), and a proximal handle ( 20, 40, 60, 176, 196, 206 ) at a proximal end of the slender elements ( 14, 34, 54, 154, 174, 194, 204 ), the slender elements ( 14, 34, 54, 154, 174, 194, 204 ) resiliently moving between retracted and expanded positions by manipulation of the slender elements, wherein in the retracted position, the hooks ( 12, 32, 52, 152, 172, 192, 202 ) are close to one another and the slender elements ( 14, 34, 54, 154, 174, 194, 204 ) are close to one another, and wherein in the expanded position, the hooks are separate and spaced apart from each other and distal portions of the slender elements are separate and spaced apart from each other.

Description:
FIELD OF THE INVENTION 
       [0001]    The present invention relates generally to an iris retractor used in ophthalmic surgical procedures. 
       BACKGROUND OF THE INVENTION 
       [0002]    There are various ophthalmic procedures that require the dilation of the pupil. For example, a lens with a cataract is typically removed from the eye by phacoemulsification. This procedure breaks up the lens typically with an ultrasonically driven tool. The tool has an aspiration port that aspirates the broken lens material from the patient&#39;s ocular-chamber. It is desirable to extend the pupil during phacoemulsification to provide the surgeon with a wide view of the lens. One technique for extending the pupil includes pulling back or retracting the iris with what is referred to as an iris retractor, and holding the iris at its outer edges. 
       SUMMARY OF THE INVENTION 
       [0003]    The present invention seeks to provide an improved iris retractor, as is described more in detail hereinbelow. 
         [0004]    There is thus provided in accordance with an embodiment of the present invention an iris retractor including a plurality of iris grabbing hooks disposed or formed at a distal end of slender elements, and a proximal handle at a proximal end of the slender elements, the slender elements resiliently moving between retracted and expanded positions by manipulation of the slender elements, wherein in the retracted position, the hooks are close to one another and the slender elements are close to one another, and wherein in the expanded position, the hooks are separate and spaced apart from each other and distal portions of the slender elements are separate and spaced apart from each other. 
         [0005]    In accordance with an embodiment of the present invention a retaining element retains the slender elements in the retracted position until the handle is manipulated to move the slender elements to the expanded position. 
         [0006]    In accordance with another embodiment of the present invention a portion of the retaining element is formed with a groove, and in the expanded position, the handle is received in the groove. 
         [0007]    In accordance with yet another embodiment of the present invention the retaining element includes a groove formed in one of the slender elements for receiving therein the other slender element. 
         [0008]    In accordance with still another embodiment of the present invention the slender elements are pivotally attached to one another at a pivot. 
         [0009]    In accordance with an embodiment of the present invention a tip of the slender element includes a U-shaped hook with a short distal extension. 
         [0010]    In accordance with an embodiment of the present invention a tip of the slender element extends from a proximal sleeve. 
         [0011]    In accordance with an embodiment of the present invention the hook is retractable into the slender element. 
         [0012]    There is also provided in accordance with an embodiment of the present invention a method for retraction of an iris including providing an iris retractor that includes a plurality of hooks disposed or formed at a distal end of slender elements, and a proximal handle at a proximal end of the slender elements, the slender elements resiliently moving between retracted and expanded positions by manipulation of the handle, wherein in the retracted position, the hooks are close to one another and the slender elements are close to one another, and wherein in the expanded position, the hooks are separate and spaced apart from each other and distal portions of the slender elements are separate and spaced apart from each other, inserting the slender elements in the retracted position through a small incision near a limbus of an eye, manipulating the handle to move the slender elements to the expanded position, and grasping and retracting a portion of the iris with the hooks. 
         [0013]    The incision for insertion of the slender elements can be made at a different position than an incision for phacoemulsification. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]    The present invention will be understood and appreciated more fully from the following detailed description taken in conjunction with the drawings in which: 
           [0015]      FIGS. 1A-1C  are simplified perspective, top-view and side-view illustrations, respectively, of an iris retractor, in a non-expanded orientation, constructed and operative in accordance with an embodiment of the present invention; 
           [0016]      FIGS. 1D-1E  are simplified perspective and side-view illustrations, respectively, of the iris retractor of  FIGS. 1A-1C , in the non-expanded orientation placed on an eye; 
           [0017]      FIGS. 2A-2C  are simplified perspective, side-view and top-view illustrations, respectively, of the iris retractor of  FIGS. 1A-1C , in a partially expanded orientation, in accordance with an embodiment of the present invention; 
           [0018]      FIGS. 3A-3C  are simplified perspective, side-view and top-view illustrations, respectively, of the iris retractor of  FIGS. 1A-1C , in a fully expanded orientation, in accordance with an embodiment of the present invention; 
           [0019]      FIGS. 3D-3E  are simplified side-view and perspective illustrations, respectively, of the iris retractor of  FIGS. 1A-1C , in the fully expanded orientation placed on the eye; 
           [0020]      FIGS. 4A-4C  are simplified perspective, side-view and top-view illustrations, respectively, of an iris retractor, in a non-expanded orientation, constructed and operative in accordance with another embodiment of the present invention; 
           [0021]      FIGS. 4D-4E  are simplified perspective and side-view illustrations, respectively, of the iris retractor of  FIGS. 4A-4C , in the non-expanded orientation placed on an eye; 
           [0022]      FIGS. 5A-5C  are simplified perspective, top-view and side-view illustrations, respectively, of the iris retractor of  FIGS. 4A-4C , in an expanded orientation, in accordance with an embodiment of the present invention; 
           [0023]      FIGS. 5D-5E  are simplified side-view and perspective illustrations, respectively, of the iris retractor of  FIGS. 4A-4C , in the expanded orientation placed on the eye; 
           [0024]      FIG. 5F  is a simplified perspective illustration of a modified version of the iris retractor of  FIGS. 4A-4C , in accordance with an embodiment of the present invention; 
           [0025]      FIGS. 6A-6C  are simplified perspective, side-view and top-view illustrations, respectively, of an iris retractor, in a non-expanded orientation, constructed and operative in accordance with yet another embodiment of the present invention; 
           [0026]      FIGS. 6D-6E  are simplified side-view and perspective illustrations, respectively, of the iris retractor of  FIGS. 6A-6C , in the non-expanded orientation placed on an eye; 
           [0027]      FIGS. 7A-7C  are simplified perspective, top-view and side-view illustrations, respectively, of the iris retractor of  FIGS. 6A-6C , in an expanded orientation, in accordance with an embodiment of the present invention; 
           [0028]      FIGS. 7D-7E  are simplified side-view and perspective illustrations, respectively, of the iris retractor of  FIGS. 7A-7C , in the expanded orientation placed on the eye; 
           [0029]      FIGS. 8 and 9  are simplified perspective illustrations of different tips for the iris retractor of any of the above embodiments, in accordance with different embodiments of the present invention; 
           [0030]      FIG. 9A  is a simplified perspective illustration of the iris retractor with the distal extension of  FIG. 8  or  9  in use, in accordance with an embodiment of the present invention; 
           [0031]      FIGS. 10A-10E  are simplified perspective illustrations of a retractable tip for the iris retractor of any of the above embodiments, in accordance with an embodiment of the present invention, shown gradually from fully extended to fully retracted positions; 
           [0032]      FIG. 11  is a simplified pictorial illustration of an iris retractor, constructed and operative in accordance with another embodiment of the present invention; 
           [0033]      FIGS. 12A-12D  are simplified pictorial illustrations of an iris retractor, constructed and operative in accordance with yet another embodiment of the present invention; 
           [0034]      FIGS. 13A-13H  are simplified pictorial illustrations of a manipulator for operating the iris retractor of  FIGS. 12A-12D , constructed and operative in accordance with an embodiment of the present invention; 
           [0035]      FIGS. 14A-14D  are simplified pictorial illustrations of an iris retractor, constructed and operative in accordance with still another embodiment of the present invention; and 
           [0036]      FIGS. 15A-15E  are simplified pictorial illustrations of an iris retractor, constructed and operative in accordance with another embodiment of the present invention. 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0037]    Reference is now made to  FIGS. 1A-3C , which illustrate an iris retractor  10 , constructed and operative in accordance with a non-limiting embodiment of the present invention. 
         [0038]    Iris retractor  10  includes a plurality of iris grabbing hooks  12  ( FIGS. 2A-3C ) disposed or formed at a distal end of one or more slender elements  14 . In the illustrated embodiment, there are two slender elements  14 . The slender elements  14  are arranged to move through a retaining element  16  from a fully retracted position ( FIGS. 1A-1C ) to a partially expanded position ( FIGS. 2A-2C ) to a fully expanded position ( FIGS. 3A-3C ). A proximal portion  18  of retaining element  16  is formed with a groove  19 . The proximal ends of slender elements  14  terminate in a proximal handle  20 . The slender elements  14  may be joined as a single element before connection to handle  20  or may be joined at the handle  20 . In the fully expanded position, handle  20  is pushed completely into groove  19  and is squeezed and held in this position by the side walls of groove  19 . (Alternatively, handle  20  may “click” into groove  19 . Accordingly, there can be a fixed configuration, wherein handle  20  clicks into groove  19  and slender elements  14  have a fixed expansion, or an adjustable expansion configuration, wherein the more the slender elements  14  are inserted into the eye the larger is their lateral expansion.) Retaining element  16  retains slender elements  14  in the retracted position until handle  20  is pushed towards groove  19 . 
         [0039]    Slender elements  14  and hooks  12  may be constructed of a metal or plastic wire, such as but not limited, NITINOL or stainless steel or a medically safe plastic with suitable resilience, e.g., a shape memory polymer plastic. 
         [0040]      FIGS. 1D-1E  illustrate a pair of iris retractors  10  in a non-expanded orientation (i.e., retracted position) placed on an eye. A portion of retaining element  16  abuts against the cornea  22 , typically but not necessarily at the limbus  23 . As seen in the figures, iris retractor  10  is inserted through a small incision (e.g., 1.0-1.5 mm incision) at the limbus  23 . Retaining element  16  prevents iris retractor  10  from encroaching too much into the cornea  22 . 
         [0041]    Pushing handle  20  towards retaining element  16  deploys slender elements  14  and hooks  12  out of retaining element  16 . As seen in  FIGS. 3D-3E , hooks  12  grab and hook onto the iris  24  and retract the iris  24  for exposing the lens  25  to provide a good working opening for the surgeon. Retaining element  16  anchors the retractor  10  by applying a counter force on the outside of the limbus  23 . 
         [0042]    Hooks  12  are separate and spaced apart from each other upon distal movement of slender elements  14  through retaining element  16 . Thus, a single iris retractor provides spaced apart retraction points, as opposed to some prior art iris retractors which only work at a single point. 
         [0043]    The incision for insertion of the iris retractor may be made at a different position (e.g., perpendicular thereto) than the incision made for phacoemulsification. This is advantageous because in this manner the iris retractor does not get in the way of the surgeon. 
         [0044]    Reference is now made to  FIGS. 4A-5E , which illustrate an iris retractor  30 , constructed and operative in accordance with another embodiment of the present invention. 
         [0045]    Iris retractor  30  includes a plurality of hooks  32  disposed or formed at a distal end of one or more slender elements  34 . In the illustrated embodiment, there are two slender elements  34 . The proximal ends of slender elements  34  terminate in a proximal handle  40 . Handle  40  and slender elements  34  are made of a resilient, flexible material (e.g., metal or plastic) to form a kind of resilient tweezers or pliers. The slender elements  34  are held in the non-expanded (retracted) orientation by a retaining element  36  (which may be formed as a loop) of the slender elements  34  being caught in one or more proximal grooves  38  formed in the other slender element  34 . Another option for keeping iris retractor  30  in its non-expanded state is by pressing elements  37 , without slender elements  34  being caught in grooves  38 . 
         [0046]      FIGS. 4D-4E  illustrate a pair of iris retractors  30  in a non-expanded orientation (i.e., retracted position) placed on the eye. A portion of retaining element  36  abuts against the cornea  22 , typically but not necessarily at the limbus  23 . 
         [0047]    Squeezing handle  40  releases the slender element  34  that is initially caught in groove  38  of retaining element  36 . (For the other option mentioned above, iris retractor  30  moves to the expanded position by releasing elements  37 .) By virtue of their resilience, slender elements  34  spring outwards to the expanded position in  FIGS. 5A-5E . As seen in  FIGS. 4A-5E , the geometry of iris retractor  30  enables expansion of hooks  32  without resulting in significant expansion in the area of retaining elements  36 . 
         [0048]    As seen in  FIGS. 5D-5E , hooks  32  grab and hook onto the iris  24  and retract the iris  24  for exposing the lens  25  to provide a good working opening for the surgeon. Retaining element  36  anchors the retractor  30  by applying a counter force on the outside of the limbus  23 . 
         [0049]    Reference is now made to  FIG. 5F , which illustrates a modified version of the iris retractor  30 , in accordance with an embodiment of the present invention. In this embodiment, iris retractor  30  is provided with a flexible clip  42  in handle  40 . This design allows making the retractor smaller and may provide more spring (expansion) force. 
         [0050]    Reference is now made to  FIGS. 6A-7E , which illustrate an iris retractor  50 , constructed and operative in accordance with yet another embodiment of the present invention. 
         [0051]    Iris retractor  50  includes a plurality of hooks  52  disposed or formed at a distal end of one or more slender elements  54 . In the illustrated embodiment, there are two slender elements  54 , which pivot about a pivot  56 . The proximal ends of slender elements  54  terminate in a proximal handle  60 . Handle  60 , pivot  56  and slender elements  54  form a kind of scissors. Iris retractor  50  is normally expanded and slender elements  54  are held in the non-expanded (retracted) orientation by the resilience of handle  60  (thus handle  60  serves as the retaining element for initially holding the slender elements  54  in the retracted orientation. 
         [0052]      FIGS. 6D-6E  illustrate a pair of iris retractors  50  in a non-expanded orientation (i.e., retracted position) placed on the eye. A portion of iris retractor  50  (e.g., near the pivot  56 ) abuts against the cornea  22 , typically but not necessarily at the limbus  23 . 
         [0053]    Manipulating handle  60  “scissors out” the slender elements  54  to the expanded position in  FIGS. 7A-7E . As seen in  FIGS. 7D-7E , hooks  52  grab and hook onto the iris  24  and retract the iris  24  for exposing the lens  25  to provide a good working opening for the surgeon. A portion of iris retractor  50  (e.g., near the pivot  56 ) anchors the retractor  50  by applying a counter force on the outside of the limbus  23 . 
         [0054]    Reference is now made to  FIGS. 8 and 9 , which illustrate different tips for the iris retractor of any of the above embodiments, in accordance with different embodiments of the present invention. In  FIG. 8 , a tip  70  is shown that has a U-shaped hook with a short distal extension  72 . In  FIG. 9 , the same tip  70  is shown extending from a proximal sleeve  74 . The sleeved hooks (as shown in  FIG. 9 ) can be retracted as shown in  FIG. 10 . 
         [0055]    Reference is now made to  FIG. 9A , which illustrates the iris retractor with the distal extension  72  of  FIG. 8  or  9  in use, in accordance with an embodiment of the present invention. It is seen that distal extension  72  firmly and positively sets the tool against the edges of the iris, and thus helps ensure proper, reliable and safe retraction of the iris. 
         [0056]    Reference is now made to  FIGS. 10A-10E , which illustrate a sleeved hook  80  for the iris retractor of any of the above embodiments, in accordance with an embodiment of the present invention, shown gradually from fully extended to fully retracted positions. Sleeved hook  80  is similar to the hook shown on  FIG. 9 , and may or may not have a distal extension like the embodiment of  FIG. 9 . Any suitable retracting mechanism (not shown) may be used to retract and/or extend retractable hook  80  into and/or out of the slender elements. 
         [0057]    Reference is now made to  FIG. 11 , which illustrates an iris retractor  150 , constructed and operative in accordance with another embodiment of the present invention. 
         [0058]    Iris retractor  150  includes a plurality of hooks  152  disposed or formed at distal ends of a first slender element  154 . The first slender element  154  may be adjustable in length, such as by means of a flexible and extendable member  155  at a central portion thereof. A second slender element  156  (which may be arranged to move through a guide element, not shown, similar to that described above) is pivotally attached to first slender element  154 . An anchor element  158  is mounted at a proximal position on the second slender element  156 . The proximal end of second slender element  156  terminates in a proximal handle  160 . 
         [0059]    As seen in  FIG. 11 , the hooks  152  and first slender element  154  are inserted through a small incision at the limbus  144  and are manipulated by the surgeon so that hooks  152  spread apart and retract the iris  134 . Anchor element  158  anchors the retractor by applying a counter force on the outside of limbus  144 . 
         [0060]    Reference is now made to  FIGS. 12A-12D , which illustrate an iris retractor  170 , constructed and operative in accordance with another embodiment of the present invention. 
         [0061]    Iris retractor  170  includes a plurality of hooks  172  disposed or formed at a distal end of one or more slender elements  174 . In the illustrated embodiment, there are two slender elements  174 . The proximal ends of slender elements  174  terminate in a proximal handle  176 . Handle  176  and slender elements  174  are made of a resilient, flexible material (e.g., metal or plastic) to form a kind of resilient tweezers or pliers. The hooks  172  in this embodiment curve back onto slender elements  174  and may optionally abut against slender elements  174 . 
         [0062]      FIG. 12C  illustrates iris retractor  170  in a non-expanded orientation inserted through a small incision at the limbus  23 .  FIG. 12D  illustrates iris retractor  170  in an expanded orientation, wherein hooks  172  grab and hook onto the iris  24  and retract the iris  24  for exposing the lens to provide a good working opening for the surgeon. 
         [0063]    Reference is now made to  FIGS. 13A-13H , which illustrate a manipulator  180 , for operating iris retractor  170 , constructed and operative in accordance with an embodiment of the present invention. 
         [0064]    Manipulator  180  includes a retaining element  181  pivotally connected to a toggle lever  182 , which is in turn pivotally connected at a pivot  183  on a distal end of a handle  184 . The distal end of a handle  184  includes an anvil  185  formed with a hole  186  through which retaining element  181  passes. Handle  176  of iris retractor  170  fits on a lug  187  (e.g., pin) that protrudes from the bottom side of anvil  185 . Lug  187  fits into the center of handle  176 . 
         [0065]    In  FIGS. 13A ,  13 B,  13 E and  13 F, toggle lever  182  is moved to the position wherein retaining element  181  is moved down to clamp around the slender elements  174  of iris retractor  170 , thus retaining slender elements  174  in the non-expanded orientation (retracted position). In  FIGS. 13C ,  13 D,  13 G and  13 H, toggle lever  182  is moved to the position (indicated by arrow F) wherein retaining element  181  is moved up to release the slender elements  174  of iris retractor  170 , thus allowing slender elements  174  to expand to the expanded orientation. 
         [0066]    Reference is now made to  FIGS. 14A-14D , which illustrate an iris retractor  190 , constructed and operative in accordance with another embodiment of the present invention. 
         [0067]    Iris retractor  190  includes a plurality of hooks  192  disposed or formed at a distal end of one or more slender elements  194 . In the illustrated embodiment, there are two slender elements  194 . The proximal ends of slender elements  194  terminate in a proximal handle  196 . Handle  196  and slender elements  194  are made of a resilient, flexible material (e.g., metal or plastic or shape memory) to form a kind of resilient tweezers or pliers. Handle  196  in this embodiment is sufficiently resilient such that it flattens into an oblong shape when squeezed, as seen in  FIG. 14B . Handle  196  springs back to its original shape to move iris retractor  190  to the expanded orientation. 
         [0068]      FIG. 14C  illustrates iris retractor  190  in a non-expanded orientation inserted through a small incision at the limbus  23 . As mentioned before, handle  196  flattens into an oblong shape.  FIG. 14D  illustrates iris retractor  190  in an expanded orientation, wherein hooks  192  grab and hook onto the iris  24  and retract the iris  24  for exposing the lens to provide a good working opening for the surgeon. 
         [0069]    Reference is now made to  FIGS. 15A-15E , which illustrate an iris retractor  200 , constructed and operative in accordance with another embodiment of the present invention. 
         [0070]    Iris retractor  200  includes a plurality of hooks  202  disposed or formed at a distal end of one or more slender elements  204 . In the illustrated embodiment, there are two slender elements  204 . The proximal ends of slender elements  204  form a proximal handle that includes two scissor handles  206 . Handles  206  are spring loaded by a biasing device  208 , such as a coil spring which has ends attached to the handles  206 . 
         [0071]      FIG. 15D  illustrates iris retractor  200  in a non-expanded orientation inserted through a small incision at the limbus  23 . Handles  206  are squeezed and held together so that slender elements  204  are retracted together, as shown in  FIG. 15B .  FIG. 15E  illustrates iris retractor  200  in an expanded orientation, wherein hooks  202  grab and hook onto the iris  24  and retract the iris  24  for exposing the lens to provide a good working opening for the surgeon. 
         [0072]    It will be appreciated by persons skilled in the art that the present invention is not limited by what has been particularly shown and described hereinabove. Rather the scope of the present invention includes both combinations and subcombinations of the features described hereinabove as well as modifications and variations thereof which would occur to a person of skill in the art upon reading the foregoing description and which are not in the prior art.