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WO1989003202A2 - Procede et dispositif d'emulsification au laser - Google Patents

Procede et dispositif d'emulsification au laser Download PDF

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Publication number
WO1989003202A2
WO1989003202A2 PCT/US1988/003595 US8803595W WO8903202A2 WO 1989003202 A2 WO1989003202 A2 WO 1989003202A2 US 8803595 W US8803595 W US 8803595W WO 8903202 A2 WO8903202 A2 WO 8903202A2
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WO
WIPO (PCT)
Prior art keywords
optic fiber
probe
end portion
light
extension
Prior art date
Application number
PCT/US1988/003595
Other languages
English (en)
Other versions
WO1989003202A3 (fr
Inventor
Richard T. Schneider
Richard H. Keates
Original Assignee
Schneider Richard T
Keates Richard H
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Schneider Richard T, Keates Richard H filed Critical Schneider Richard T
Publication of WO1989003202A2 publication Critical patent/WO1989003202A2/fr
Publication of WO1989003202A3 publication Critical patent/WO1989003202A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B2018/2255—Optical elements at the distal end of probe tips
    • A61B2018/2272—Optical elements at the distal end of probe tips with reflective or refractive surfaces for deflecting the beam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/0087—Lens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00885—Methods or devices for eye surgery using laser for treating a particular disease
    • A61F2009/00887—Cataract

Definitions

  • the present invention relates to laser surgery, and in particular to surgical operations on the eye.
  • the present invention concerns a method and apparatus for the emulsification and removal of cataracts, or similar surgical procedures.
  • a cataract is a breakdown, or development of an opaque region in the crystal lens of the eye.
  • the deterioration process is not reversible. Rather, the typical current treatment is to remove the cataract or lens material completely.
  • artificial lenses are provided to facilitate vision.
  • Such lenses may be of a variety of types, including extraocular eye frames and lenses, extraocular contacts, and intraocular contact lens devices.
  • microsurgery techniques have been developed to enable easier removal of the cataracts.
  • One relatively frequently used includes phaeco-emulsification.
  • a small incision is made in the eye, and a probe is inserted therethrough.
  • the probe includes a tip which vibrates in the ultrasonic region, on the order of 20,000 times per second.
  • Such a probe is typically brought into direct contact with the lens, and the vibrations are used to break up, or emulsify, the lens material. This lens material is then withdrawn from the eye through means of suction devices or the like.
  • phaeco-emulsification does offer many advantages over former surgical methods, it is still not fully accepted, nor is it completely advantageous.
  • What has been needed has been a method for cataract removal which does not involve phaeco-emulsification, i.e., use of a vibrating probe, and which is substantially free of the inconveniences and problems inherently associated therewith, but which otherwise utilizes the advantages of a microsurgery technique. Further, what has been needed has been an apparatus for application of the needed method.
  • the objects of the present invention are: to provide an apparatus for advantageous removal of cataract, or lens material from the eye; to provide such an apparatus wherein laser surgery is applied to accomplish emulsification of the cataract; to provide a preferred such apparatus which utilizes light of a wavelength generally not posing substantial unacceptable risk of damage to the eye; to provide a preferred surgical tool for implementation of laser emulsificacion including a probe extension having an optical fiber removably mounted thereon, for transmission of a laser emission to the region of the eye in which the cataract is positioned; to provide such a device wherein the fiber is readily removable and replaceable; to provide such a device wherein the fiber is mounted in a probe extension including a suction means for removal of emulsified lens material; to provide such a tool including fluid transmission means, providing for transmission of fluid to a site of emulsification, following emulsification, in order to fill the volume vacated and/or to rinse same; to provide such a device wherein the optical fiber includes a probe tip; to provide such
  • the present invention concerns the provision of an apparatus for utilization in association with laser surgery to emulsify lens or catact material in the eye.
  • Laser probes, and laser surgery are well-known.
  • problems have related to transmission of the necessary light to a region remote from the light source or laser, in this instance the eye, for surgical operation.
  • Light such as that generated by erbium-, carbon dioxide-, holmium-, neodymium-, or argon fluoride lasers would be preferred.
  • the wavelengths of such lasers are as follows: argon fluoride, 0.193 micrometers; neodymium, 1.06 micrometers; holmium, 2.08 micrometers; erbium, 2.94 micrometers; and, carbon dioxide, 10.6 micrometers.
  • Such light having a wavelength of between 0.193 micrometers and 10.6 micrometers, is generally sufficient to cause emulsification, although the mechanism causing emulsification may be different for light of different wavelengths.
  • Fiberoptic systems are being used to transmit laser beams over considerable distance, and around bends.
  • materials suitable to be drawn into fibers and to transmit light of the desired wavelength for emulsification procedures, without substantial loss of energy, are not readily available.
  • transmission from the source of the laser energy to the probe has been a problem.
  • Many materials which do not appreciably absorb light of the wavelengths mentioned as desirable for laser emulsification surgery also do not readily form optical fibers.
  • Such materials include: potassium chloride, greater than 90% transmission of light between 0.5 and 15.0 microns; potassium bromide, greater than 90% transmission of light between 0.6 and 20 microns; lithium fluoride, about 90% transmission of light between 0.3 and 5.0 microns; sodium chloride, about 90% transmission of light between 0.4 and 10 microns; barium fluoride, greater than 90% transmission of light between about 0.3 and 8.0 micrometers; calc ium fluoride, about 90% transmission of light between 0.4 and 7.0 micrometers; and, magnesium fluoride, about 90% transmission of light between about 0.4 and 7.0 micrometers.
  • Other materials having similar properties may also be usable in systems according to the present invention.
  • a laser emulsification apparatus for use in optical surgery.
  • the probe comprises a tool including a handle member or portion utilizable by the surgeon to manipulate a fiberoptic probe into the immediate vicinity of the lens or cataract.
  • the fiberoptic probe is removable and replaceable, as needed for example to facilitate a sterilized process.
  • a plurality of shapes of fiberoptics are provided, each of which is shaped for a preferred use during surgery. Such probes can be removed from, and can be replaced in, the overall device, as necessary.
  • the removable and replaceable optical fiber is mounted within a probe extension.
  • the preferred probe extension includes a mounting and release mechanism to facilitate removal and replacement of the optic fiber.
  • the probe extension has two fluid communication systems therein.
  • a first of these is a chamber which provides a means or system for application of a suction, or fluid draw, from the immediate vicinity of emulsification.
  • a second fluid flow system in the probe extension provides a system for transmission of fluid or the like into the region wherefrom the emulsified lens is removed.
  • This transmission system can provide for a cleansing wash of the area.
  • a fluid such as a saline solution can be provided to fill any void created by destruction of the lens.
  • the second fluid flow system comprises a fluid jacket or chamber around the probe extension.
  • the preferred device according to the present invention is particularly well suited for utilization in association with erbium, argon fluoride, carbon dioxide, holmium and neodymium lasers.
  • Erbium lasers for example, generate light having a wavelength on the order of about 2.94 micrometers.
  • Light of such a wavelength is generally desirable for use in association with laser emulsification surgery since it is of relatively low energy and is readily absorbed by materials in the body such as water and carbon dioxide. Thus, it will generally be absorbed by body tissue before it is transmitted a sufficient distance to cause significant damage to tissues other than those in the immediate vicinity of the probe tip, for example, damage to portions of the eye other than those which are intended to be emulsified.
  • Fiberoptic techniques provide a preferred method of transmitting light energy from a laser source to a remote surgical tool or probe.
  • a problem is that many conventional fiberoptic materials absorb light of wavelengths on the order of those generated by the low energy lasers described above. Thus, if relatively long extensions of conventional fiberoptic materials are utilized, it may be difficult to provide sufficient laser energy for transmission of adequate light to the remote working tip of the probe, to ensure effective and efficient emulsification.
  • Synthetic quartz for example, is a commonly used substance for elongate, solid, optical or optic fibers. This material is relatively inexpensive and readily available. However, it does have a tendency to absorb light of some desired wavelengths for laser emulsification. It would be possible to utilize such a material in association with higher energy light, for example, u.v. light, but not for some of the lower energy lasers mentioned previously.
  • the preferred embodiment according to the present invention utilizes only a relatively short extension of synthetic quartz fiberoptic material. That is, light is transmitted through fiberoptic material only over a relatively short distance, so minimizing undesired absorption and energy loss. For the most part, light being transmitted from a laser source to a probe according to the present invention is transmitted through materials not suitable for manufacture into fibers, but which generally minimize absorption and energy reduction.
  • Hollow tubes having reflective inner surfaces could be used for the transmission of light.
  • Such tubes may have a mirrored inner surface, provided, for example, by means of a gold, silver or aluminum reflecting surface. While such tubes may be utilized in devices according to the present invention, they often are not preferred since they do not necessarily generate 100%, or near 100%, internal reflection. That is, some, and on occasion substantial, energy may be lost during transmission.
  • Preferred devices according to the present invention utilize light transmission means involving filled tubes having multi-layered inner cores comprising materials of different refractive indices, whereby the central layer has a refractive index greater than the outer layer. Light passing longitudinally through the central layer or core will generally be reflected at the interface between the core and outer layer and be directed back into the core.
  • the straight tube sections of the light transmission means comprise glass or metal walled cylindrical tubing having two layers of material therein: a central core having a refractive index of about 1.5244 (NaCl); and, the next outer layer having a refractive index of about 1.4179 (CaF 2 ).
  • a critical angle 68.5°, and thus a high efficiency of light transmission.
  • refractive index is wavelength dependent and the figures given are for an erbium laser, 2.94 micrometers.
  • the light transmission arrangement includes means for guiding the laser light through large angles. That is, it includes elongate straight tubular portions, such as those previously described, and it also includes at least one bendable elbow portion. Conventional arrangements, utilizing mirrors to transmit light around corners or bends, are thus avoided.
  • a bundle of optical fibers each of which is bendable, is provided at the elbow. The light is transmitted around the elbow, by means of the bundle of optical fibers.
  • the optical fibers are mounted in a rotatable bearing arrangement, to facilitate degrees of freedom. Such an arrangement is very flexible and represents a significant departure from former mirror arrangements requiring frequent adjustments.
  • a plurality of small hollow flexible tubes are used, each having a reflective inner surface.
  • the packed tubes can bend, providing, transmission of light around a bend.
  • a single, flexible, main optical fiber is utilized to transmit light along the entire distance between the light source and the removable and replaceable optical fiber mounted within the probe.
  • This main optical fiber would not be composed of synthetic quartz material, which unfortunately absorbs light of the desired wavelengths to a substantial degree. Rather, the fiberoptic would be manufactured using zirconium fluoride fiberoptic material, which is flexible and which does not appreicably absorb light of the desired wavelengths, for example light emitted by erbium lasers.
  • Fig. 1 is a fragmentary perspective view of a laser emulsification device or arrangement according to the present invention.
  • Fig. 2 is an enlarged fragmentary cross-sectional view taken generally along line 2-2, Fig. 1.
  • Fig. 3 is an enlarged, end elevational view, taken generally from the perspective of line 3-3, Fig. 2.
  • Fig. 4 is a side elevational view of that portion of the apparatus depicted in Fig. 3; specifically Fig. 4 is a fragmentary side elevational view of a removable and replaceable optical fiber utilized in association with the device depicted in Figs. 1 and 2.
  • Fig. 5 is a fragmentary side elevational view of an alternative optical fiber to that shown in Fig. 4.
  • Fig. 6 is an end elevational view of the optical fiber depicted in Fig. 5.
  • Fig. 7 is a side elevational view of an alternate to the optical fiber depicted in Figs. 4 and 5.
  • Fig. 8 is an end elevational view of the optical fiber shown in Fig. 7.
  • Fig. 9 is a side elevational view of an alternate optical fiber to that depicted in Figs. 4, 5 and 7.
  • Fig. 10 is an end elevational view of the optical fiber depicted in Fig. 9.
  • Fig. 11 is a fragmentary end elevational view of an alternate optical fiber to that depicted in Figs. 4, 5 , 7 and 9.
  • Fig. 12 is an end elevational view of the optical fiber depicted in Fig. 11.
  • Fig. 13 is an enlarged fragmentary side elevational view of a portion of the apparatus depicted in Fig. 1, with phantom lines indicating portions out of view.
  • Fig. 14 is an enlarged fragmentary cross-sectional view of a preferred embodiment taken generally from the prospective of line 14-14, Fig. 13.
  • Fig. 15 is a cross-sectional view taken generally along line 15-15, Fig. 13.
  • Fig. 16 is a fragmentary cross-sectional view of a portion device according to an alternate embodiment of the present invention, taken generally from the point of view of Fig. 14.
  • Fig. 17 is a fragmentary perspective view of a device according to yet another alternate embodiment of the present invention.
  • the present invention comprises a method and apparatus for use in emulsification procedures and the like.
  • the reference numeral 1 generally designates a device or apparatus 1 according to the present invention.
  • the apparatus 1 comprises a laser emulsification tool 2 to which light is transmitted from a laser by means of a transmission mechanism 3.
  • a transmission mechanism 3 may be utilized in association with many of the principles of the present invention, to obtain advantages.
  • several unique and advantageous systems are preferred, for reasons presented in detail below. Initially, for purposes of description attention will focus on the tool portion 2 of the device 1.
  • the tool 2 includes a handle member 10 and a probe extension 11.
  • portions of the probe extension 11 are inserted into the eye, and brought into alignment with the lens or cataract material to be emulsified and removed.
  • Laser energy is transmitted longitudinally through the probe extension 11, and is directed at the cataract to be emulsified.
  • the probe extension 11 includes means, as described below, to provide for withdrawal of emulsified cataract material. Further, the probe extension 11 includes means described below which provide for direction of fluid into the cavity from which the emulsified lens material has been removed. By such means, a washing of the lens chamber can be accomplished. Further, any space left void by the removal of the lens can be readily filled. Referring to Fig. 2, handle or handle member
  • Probe extension 11 is mounted. It will be understood that handle 10 may be formed from a variety of materials, including plastics, and may be designed in a variety of shapes. Generally it will be preferred that a convenient shape for gripping, such as a cylindrical shape, be provided. Probe extension 11 includes a tubular member 12 having first and second end portions, 13 and 14 respectively. The probe extension 11 juts outwardly from handle 2, and carries a working optical fiber 15 therein.
  • the preferred optical fiber is a solid, elongate, optical fiber having a generally circular cross-section on the order of about 300 microns in diameter.
  • Such an optical fiber is small enough to be maneuvered close to individual cataracts, while probe extension 11 is inserted through a relatively small incision, and can be brought into, or manuevered into, very close contact with a lens or cataract to be emulsified.
  • materials including ones yet to be developed, may be utilized for the optical fiber 15.
  • synthetic quartz materials may be utilized, even though they absorb, to some degree, light of preferred wavelengths for emulsification according to the present invention, i.e. light having wavelength on the order of 0.19-10.6 micrometers, generated from erbium lasers, or argon fluoride-, carbon dioxide-, neodymium-, or holmium- lasers.
  • fiber optic material 15 is removeably mounted within extension 11 by means of a mounting and release mechanism. Referring to Fig. 2, for the preferred embodiment the mounting and releasing mechanism operates by means of a pair of bushings, preferably comprising internal bushing 18 and external end bushing 19.
  • Internal bushing 18 is mounted within handle portion 10 in the first end portion 13 of member 12, and includes a central aperture through which fiber 15 extends during use.
  • End bushing 19 forms an aperture in the end of extension 11, i.e. the second end portion 14 of tubular member 14, through which fiber 15 extends to project outwardly. It will be understood that fiber 15 is preferably mounted through frictional contact with appatures provided at bushings 18 and 19 respectively.
  • Synthetic quartz is a preferred material for fiber 15, and it will often be preferred that fiber 15 be disposed of after use or wear. Synthetic quartz materials are relatively inexpensive and readily available.
  • probe extension 11 comprises a multi-walled extension 20 projecting outwardly from handle portion 10.
  • Extension 20 comprises a first, in this instance inner, chamber system or cylindrical wall 21 forming a tubular chamber 23 having fiber 15 extending therethrough.
  • wall 21 extends into handle portion 10, and is in communication with relief chamber 26.
  • a suction or fluid draw can be applied through suction means to the volume immediately surrounding working probe or fiber 15.
  • This suction or vacuum can be applied, for example, through tube 27 attached by means of hose connector 28.
  • Cylindrical wail or tubular element 21 includes an extension 30 thereon, in the immediate vicinity of working tip or probe tip 31 of the fiber 15.
  • Extension 30 is insertable into the eye, in the region of the cataract, during a laser emulsification operation.
  • a preferred diameter for extension 30 is on the order of about 500 micrometers.
  • Extension 30 includes at least one drainage aperture 35 therein providing for fluid flow communication with chamber 23.
  • aperture 35 when extension 30 is inserted into the eye, and into the area of the cataract to be emulsified, emulsified material can be withdrawn through aperture 35 and chamber 23 by means of suction applied through 27 at connector 28 and passageway 26.
  • aperture 35 is positioned substantially near tip 31, so that emulsified cataract material can be readily withdrawn.
  • aperture 35 for preferred uses is on the order of about 30 microns in diameter.
  • Probe extension 11 also includes a second chamber system, preferably comprising an outer tube member or portion 40, forming a jacket member, fluid transmission system, or chamber 41 around an outer portion of tube 21. Near end portion 30, tube 40 terminates short of aperture 35, as shown at 42, Fig. 1.
  • a pair of fluid flow apertures 43 Positioned substantially near end 42 are a pair of fluid flow apertures 43, for the preferred embodiment each having a diameter of about 100 microns. It will be understood that when probe extension 11 is inserted into the eye, fluids such as saline solution may be introduced therein by passage through chamber 41 and appatures 43. Exterior to the eye, fluid flow communication with chamber 41 is provided by means of passage 50, and hcse 51. The hose 51 is mounted by means of hose connector 52, in a conventional matter.
  • probe extension 11 is inserted into an eye, in a manner bringing the tip 31 of the optical fiber 15 into the immediate vicinity of the lens or cataract material could be emulsified.
  • light is transmitted to and through the optical fiber 15, and the cataract material is emulsified.
  • a vacuum draw applied by means of hose 27 is used to withdraw emulsified material, through appature 35 and chamber 23, outwardly from the eye.
  • Saline solution introduced through chamber 41 and appature 43 can selectively provide for flusning of the site of surgery and also replacement of lost volume.
  • probe extension 11 is readily withdrawn from the eye.
  • the inner chamber 23 is for suction
  • the outer 41 is for insertion of fluid.
  • probe extension 11 is relatively short, for easy control and to reduce the extension of fiber 15, for synthetic quartz fibers or the like, through which the laser energy must pass. By this latter, undesired absorption and loss of energy are at least reduced to at or below acceptable minima.
  • tool 2 is constructed in a manner permitting optic fiber 15 to be readily removed and replaced.
  • optic fiber 15 is mounted by means of bushings 18 and 19, and thus can be removed simply by pulling same outwardly from the bushing. Insertion of fiber 15 may be accomlished in a reverse manner. As a result, optic fiber 15 can be readily removed for purposes of sterilization and/or disposal. Further, it is foreseen that a variety of different optical fibers may be desired, for a variety of uses. This will be understood by reference to Figs. 3-12.
  • kits can readily be provided, to facilitate laser emulsification surgery, the kit comprising the tool 2 as described, a light transmission mechanism 3 and at least one optical fiber.
  • a plurality of optical fibers, of different shapes, may be provided in the kit.
  • Figs. 3 and 4 comprise end, and fragmentary side elevational views, respectively, of probe tip 31 of fiber optic 15 depicted as mounted tool 2, in Fig. 2. It will be understood from Figs. 3 and 4 that optic fiber 15 is circular in cross-section, and includes a blunt tip 31, i.e. tip 31 is truncated at substantially 90° to a longitudinal axis of optic 15. In a conventional manner light emitted from tip 31 will have a more or less Gaussion energy distribution across the circular cross-section, defined by the entire blunt tip 31.
  • fiber 15 presents a broad, blunt, working fiber that can be used to transmit a substantial amount of energy to the cataract, to help break it up in conjunction with physical manipulations.
  • Figs. 5 and 6 an alternate optical fiber 60 is depicted, in fragmentary side elevational and end elevational views respectively.
  • optical fiber 60 has an angu- larly truncated end 61 forming a tip or forward edge 62.
  • end 61 is shaped in a manner which still provides for a Gaussion light distribution, throughout the circular cross-section, and also in a high energy passage.
  • edge 62 provides a cutting or knife edge that can be used to facilitate the surgical process.
  • a variety of truncating angles may be used, the one of about 45° disclosed in Fig. 5 providing a preferred example. Preferred angles are between about 40-60°, as they are relatively easy to effect and provide sharp, yet strong, cutting edges.
  • FIG. 7 Yet another alternate embodiment is depicted in Figs. 7 and 8, in fragmentary side elevational and fragmentary end elevational views respectively.
  • fiber 65 is shown truncated along two planes 66 and 67, to form a tip 68 having a central ridge 69 extending thereacross and projecting therefrom.
  • a tip 68 provides a cutting tool, similar to the arrangement shown in Figs. 5 and 6. It also provides for a Gaussion light distribution in cross-section, and is easily handled.
  • a variety of angles of tips may be used, the angles of about 52° between planes 66 and 67 providing an example.
  • optical fiber 71 of the embodiment shown in Figs. 9 and 10 has a rounded tip 12. While variety of curvatures for tip 72 might be selected, for the preferred embodiment shown in Figs. 9 and 10 tip 72 is semi-spherical. Optical fiber 71 is particularly well suited for use close to the surface of the lens, whereat extreme care is necessary to avoid unintended damage to the eye. Tip 72 having only curved edges is (mechanically) non-cutting and thus unlikely to damage tissue. Also, a preferred form of tip 72 includes a reflective portion 73 thereon. For the embodiment shown in Figs.
  • spot 73 is formed from a spot or reflecting barrier of reflective material such as gold, silver, or the like, coated onto fiber 71. This material will tend to reflect light directed there against, from inside the fiber 71, back into the fiber. Thus, a substantial amount of laser energy is prevented from the being emitted outwardly from fiber 71 in the vicinity of spot 73.
  • spot 73 can be directed toward portions of the eye which are particularly sensitive to damage from laser surgery. That is, spot 73 is used to block light from being directed into particularly sensitive areas. Thus, emulsification can be effected relatively safely, even in particularly sensitive areas of the eye .
  • Optical fiber 80, of Figs. 11 and 12 is shaped into a point 81, thus the tip 82 of fiber 80 is conically shaped.
  • a very fine, sharp, point such as point 81 can be used, for example, to initially insert the probe into the eye without use of a separate incision. That is, tip 82 can simply be punched through a portion of the eye.
  • light emission distribution would be fairly constant acrcss the entire cross-section of the fiber 80. Alternate arrangements can be provided.
  • a particular problem to the utilization of laser emulsification methods for cataract surgery involves the transmission of light of appropriate energy or wavelength to the site of emulsification.
  • relatively low energy light on the order of 0.19-10.6 micrometers and preferably about 2.94 micrometers in wavelength.
  • Light in the above range of wavelengths, particularly light of about 2.94 micrometers is of low energy and is of a wavelength readily absorbed by materials found in the body, such as carbon dioxide and. water.
  • the laser energy is substantially dissipated, in part through absorption by bodily fluids, before it can be transmitted a sufficient distance to cause much damage to more remote optical tissue regions.
  • the second primary method of overcoming the light transmission problem involves utilization of a tube transmission mechanism. That is, the light is transmitted along the inside of a tube.
  • a tube transmission would comprise a hollow glass, quartz or metal tube is provided with an internal reflective surface by means of a conventional coating such as silver or the like.
  • Light transmitted along the longitudinal axis of the tube may tend to diffuse toward the walls, however it is reflected back into the main path of light by means of the reflective surface.
  • One problem with such reflective or mirrored surface tubes is that they are not 100% efficient in transmitting light, that is, each reflection introduces a small but significant loss of energy.
  • tube transmitters are preferred.
  • straight tube portions are filled with solid or liquid material capable of transmitting light of appropriate wavelength.
  • a central core and an outer cylinder of materials having different indices of refraction are used. If organized, as described below, in a preferred manner total reflection, meaning 100% reflection longitudinally along the tube, takes place.
  • a major problem with conventional tube transmission systems concerns the introduction of degrees of freedom into the transmission mechanism. That is, ends, joints, elbows, and the like may be necessary to facilitate ease of use of the tool, but may be difficult to provide in such systems, since light propagates in a straight line.
  • ends, joints, elbows, and the like may be necessary to facilitate ease of use of the tool, but may be difficult to provide in such systems, since light propagates in a straight line.
  • some conventional systems have used relatively complex mechanical arrangements formed from mirrors and the like. These have generally been undesirable since they lack substantially complete freedom of movement and use, are relatively expensive and complicated, and have, in the past, used somewhat inefficient reflective means.
  • either of two preferred general light transmissions may be provided for efficiently transmitting light from a laser source, not shown, to the probe or tool tube.
  • a first of these (with elbow portions) is depicted in Figs. 1, 2, 13, 14 and 15, with an alternate shown in Fig. 16.
  • the second (using an elongate flexible fiber) is depicted in Fig. 17.
  • light transmission mechanism 3 depicted comprises a tube/elbow system 100.
  • one end 101 of the system 100 is provided in communication with tool 2, while the other end 102 provides for communication with a source of laser energy, not shown.
  • tube/elbow system 100 includes straight tube portions 105 and at least one flexible, or elbow, portion 106.
  • the embodiment depicted thereat includes three straight tube portions 110 , 111 and 112 connected by two elbow portions 113 and 114.
  • tube section 112 is depicted in cross-section.
  • tube portions 110 and 111 may be substantially identical in cross-section.
  • Tube section 112 generally comprises an elongate, cylindrical outer wall or tube 120, which may or may not be transparent, for the transmission of light along a longitudinal axis 121 thereof. It will be understood that a variety of materials may be utilized for tube 120.
  • a preferred, highly efficient, system of providing reflection along axis 121 is provided by means of layers 122 and 123.
  • Layers 122 and 123 are materials applied to an inside surface 125 of the tube 120. Specifically, layer 122 is provided against surface 125, and layer 123 fills the remainder of tube 120 as a core. The material of this core may be solid or liquid in nature.
  • the materials comprising layers 122 and 123 are such as to permit the transmission of light of the selected waveiength(s) therethrough. However, importantly, the refractive index of layer 123 is greater than 122. Some of the light passing through layer 123 is reflected as it encounters layer 122. In this case it is reflected back into layer 123 as indicated by arrow 131.
  • the critical angle A c can be defined as follows:
  • Angle A c is the critical angle measured from a normal line, for example line 132. Any light directed against the interface between sections 122 and 123 will be substantially 100% reflected, if it is directed at a greater angle to the norm 132 than A c , according to Snell's Law. If materials having appropriate light transmission characteristics are chosen for the layers, nearly 100% transmission of light energy along axis 121 can be achieved. It is noted that the index of refraction of a material will depend on the wavelength of light being tranmitted therethrough.
  • the critical angle is no less than about 60°, i.e. the ratio n 122 /n 123 is no less than about 0.866.
  • Preferred critical angles will be about 80-89°. It will be understood that a variety of materials can be utilized to achieve this.
  • tubing extension 101 is mounted on tool 2 by a conventional engagement using a bayonet type disconnect 126.
  • Such connections are conventional and are not detailed herein. They generally involve a mating of coupling members on each of two components. Locking is typically achieved by means of a pin/groove engagement. It is noted that disconnection permits access to end 127 of fiber 15, for removal and replacement. It will be understood that conventional adhesives, clamps, or other connection arrangements may be provided to make a secure engagement in place of a bayonet system.
  • a lens mechanism 140 is shown depicted in the foremost tube extension 101, i.e. the extension in engagement with tool 2.
  • Lens 140 is preferably positioned to collect light traveling longitudinally through transmission mechanism 3 and to focus same on the optical fiber 15, Fig. 2, mounted in the tool 2.
  • lens 140 is in a hollow portion 141 of the system 100.
  • a partial vacuum if desired, could be provided in portion 141 to facilitate transmission without absorption by air, for those wavelengths which are subject to absorption in air.
  • lens 140 could be provided with means for adjustment to focus light onto, and into, optical fiber 15.
  • transmission mechanism 3 comprises tube/elbow arrangement 100. That is, a bending means is provided between extensions of tube transmission portions, such as portions 110, 111 and 112. Referring to Fig. 3, this is provided by elbows 113 and 114. For the preferred embodiment the two elbows 113 and 114 are substantially identical and are as described below. Attention is directed to Fig. 15, which shows a portion of elbow 113 in cross-section, and also Fig. 13.
  • Elbow 113 comprises a bundle of small transmission units 150.
  • the units 150 comprise fibers 151 closely packed into a pair of bearings 152 and 153, by which the bundle of fibers 151 are mounted in, and communicate between, an associated pair of tube sections, for example sections 111 and 112, Fig. 13.
  • closely packed it is meant that the units 150, for example fibers 151 preferred ones of which are about 300 microns in diameter, are packed as closely as the geometry of the individual fibers permits and therefore transmit as much light as theoretically possible around the bend. While a variety of sizes of tubing for sections 113 and 114 may be utilized, generally relatively small diameters will be preferred, to facilitate bending. It is generally desirable to maintain fibers
  • fiber lengths of about 5-10 cm with fiber diameters of 4-6 mm will be effective and preferable in providing sufficient bending for needed articulation.
  • the end bearings for example bearings 152 and 153 for joint 113, provide means for rotation of tube 112 with respect to tube 111 and add some additional degrees of freedom to the tube/elbow system. That is, the elbow 113 can be rotated with respect to the two arms 111 and 112 in which it is mounted.
  • This rotational engagement between the bearings 152 and 153 and the straight arm sections 111 and 112 may be provided by conventional means.
  • units 150 can comprise flexible hollow tubes having mirrored inner surfaces, closely packed in bearings 152 and 153. Generally, diameters on the order of about 1-3 mm would be flexible enough to be usable and still large enough for relatively easy internal mirror coating.
  • the flexible bundle of tubes may comprise hollow, transparent, tubes with a refractive index of n 1 , filled with a material, solid or liquid, having a refractive index n 2 . If the materials are chosen such that n 2 is greater than n 1 , then internal reflection according to Shell's law, analogously to that previously described, will occur. From the above, it will be understood that a relatively lightweight, flexible and easily handleable light transportation system is provided.
  • Fig. 16 An alternate to the filled tube system of Fig. 14 is shown in Fig. 16.
  • the tube 157 (analogous to tube 112) is hollow, and has a mirror coating 158 on an inner surface thereof.
  • the mirror coating 158 may be gold, silver or the like. If desired, vacuum can be provided within the tube 157, to inhibit loss of energy by absorption of air.
  • a straight tube section such as tube 157 may be used analogously to section 122 previously discussed.
  • FIG. 17 An alternate overall light transmission mechanism is illustrated in Fig. 17.
  • tool 162 with probe 163 extending outwardly therefrom, is shown having light transmission mechanism 165 mounted in association therewith, for transmission of light thereto.
  • Mechanism 165 includes a single elongate fiber 167.
  • fiber 167 is composed of a material, such as zirconium fluoride, which does not appreciably absorb light of the desired wavelengths for use in optical surgery involving laser emulsification. If fiber 167 is substantially larger in diameter than removeable and replaceable fiber 168, mounted in extension 163, then lens and/or focus means, not shown, may be provided to concentrate light passing through fiber 167 and focus same on fiber 168.
  • Mechanism 165 includes a flexible sheath 169, for protection of fiber 167.
  • steps of the method comprise application of laser emulsification through the utilization of a device such as that described capable of transmitting relatively low energy laser emissions to a selected point of surgery within a patient's eye. More specifically, the preferred method involves utilization of a tool having a removeable and replaceable optical fiber therein, the fiber optic member being, for one in preferred embodiment, constructed from synthetic quartz or the like.
  • the tool 2 utilized to effect the method includes means associated therewith for removal of emulsified material, and also fluid transport means for provision of a saline solution or the like into the location from which the emulsified material has been removed.
  • Priority Country US Before the expiration of the time limit for amending t claims and to be republished in the event of the receipt amendments.
  • Agent HAMRE, Curtis, B.; Merchant, Gould, Smith, Edell, Welter & Schmidt, 1600 Midwest Plaza Building, Minneapolis, MN 55402 (US).
  • the apparat comprises a tool (2) having a probe (11) extension thereon comprising a removeable and replaceable optical fiber (15), inner tubular wall defining a first chamber (23), and an outer tubular wall defining a second chamber (41).
  • the first cha ber has the optical fiber mounted therein and extending therethrough, and surrounds same with an open chamber, i.e. t first chamber, to which suction can be applied.
  • the first chamber is preferably an outer chamber useable to remove emul fied material from a patient's eye.
  • the outer chamber i.e.
  • second chamber surrounds the inner chamber and, for examp provides means by which fluids such as a saline solution can be injected into the region of emulsification.
  • Preferred artic lated arm arrangements are provided, to facilitate transmission of light from a laser source to the removeable and repla able fiber optic.
  • a variety of designs for the removeable and replaceable optical fiber are provided, to facilitate tissue a cataract handling.

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  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Optics & Photonics (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Laser Surgery Devices (AREA)
  • Radiation-Therapy Devices (AREA)

Abstract

Procédé et dispositif permettant d'effectuer l'émulsification au laser de cataractes et similaires. Le dispositif comprend un outil (2) présentant un prolongement servant de sonde (11) comportant une fibre optique (15) amovible et remplaçable, une paroi tubulaire interne délimitant une première chambre (23), et une paroi tubulaire externe délimitant une deuxième chambre (41). La première chambre contient la fibre optique, qui s'étend à travers la chambre, et l'entoure avec une chambre ouverte, c'est-à-dire la première chambre, à laquelle on peut appliquer une source d'aspiration. La première chambre est de préférence une chambre externe utilisable pour extraire les matières émulsifiées de l'oeil du patient. La chambre externe, c'est-à-dire la deuxième chambre, entoure la chambre interne et permet, par exemple, l'injection de fluides tels qu'une solution saline dans la région d'émulsification. Des agencements préférés à brs articulé facilitent la transmission de lumière d'une source laser à la fibre optique amovible et remplaçable. Des fibres optiques amovibles et remplaçables de formes différentes facilitent le traitement du tissu et de la cataracte.
PCT/US1988/003595 1987-10-14 1988-10-14 Procede et dispositif d'emulsification au laser WO1989003202A2 (fr)

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US108,553 1987-10-14

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Cited By (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1992017138A3 (fr) * 1991-04-04 1992-11-12 Premier Laser Systems Inc Sonde chirurgicale a faisceau laser
EP0565694A4 (fr) * 1991-11-06 1994-10-19 Surgical Technologies Inc Systeme d'application de laser.
WO1996032895A3 (fr) * 1995-04-17 1997-01-09 Coherent Inc Procede et appareil permettant de manipuler, couper, enlever et coaguler des tissus cibles dans le corps d'un patient
US5688261A (en) * 1990-11-07 1997-11-18 Premier Laser Systems, Inc. Transparent laser surgical probe
US5707368A (en) * 1990-10-31 1998-01-13 Premier Laser Systems, Inc. Contact tip for laser surgery
US5722970A (en) * 1991-04-04 1998-03-03 Premier Laser Systems, Inc. Laser surgical method using transparent probe
WO1999015120A1 (fr) * 1997-09-23 1999-04-01 Alcon Laboratories, Inc. Piece a main chirurgicale
US6120498A (en) * 1998-03-05 2000-09-19 Jani; Mahendra G. Aspirating handpieces for laser surgical operations
WO2000067687A1 (fr) * 1999-05-05 2000-11-16 Glautec Ag Dispositif permettant de traiter le glaucome
US6328732B1 (en) 1996-12-10 2001-12-11 Wavelight Laser Technologies Gmbh Device for treating bodily substances
DE19702353C5 (de) * 1997-01-23 2004-03-25 Wavelight Laser Technologie Gmbh Vorrichtung für die intraokulare Kataraktchirurgie
WO2005070153A2 (fr) 2004-01-08 2005-08-04 Biolase Technology, Inc. Pointes de fibres optiques a sorties modifiees
EP1590038A4 (fr) * 2003-01-31 2006-12-06 Univ Rochester Sonde lumineuse pour la transduction genetique d'activation par la lumiere ultraviolette
US7524327B2 (en) 2002-01-31 2009-04-28 University Of Rochester Light activated gene transduction using long wavelength ultraviolet light for cell targeted gene delivery
US7704272B2 (en) 2002-01-31 2010-04-27 University Of Rochester Method for introducing an ultraviolet light activated viral vector into the spinal column
US7998136B2 (en) 2003-11-10 2011-08-16 Biolase Technology, Inc. Medical radiation device with a tapered fused waveguide
US8221117B2 (en) 2007-09-19 2012-07-17 Biolase, Inc. Probes and biofluids for treating and removing deposits from tissue surfaces
US8977085B2 (en) 2008-11-04 2015-03-10 The University Of Queensland Surface structure modification
CN113081472A (zh) * 2019-12-23 2021-07-09 上海微创医疗器械（集团）有限公司 一种超声乳化手持件及系统

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US3982541A (en) * 1974-07-29 1976-09-28 Esperance Jr Francis A L Eye surgical instrument
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US4583539A (en) * 1982-01-12 1986-04-22 Cornell Research Foundation, Inc. Laser surgical system
EP0105706B1 (fr) * 1982-09-29 1987-08-19 Laakmann Electro-Optics Inc. Guide d'ondes diélectrique et flexible pour transmettre efficacement des longueurs moyennes d'ondes infrarouges
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Cited By (22)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5707368A (en) * 1990-10-31 1998-01-13 Premier Laser Systems, Inc. Contact tip for laser surgery
US5688261A (en) * 1990-11-07 1997-11-18 Premier Laser Systems, Inc. Transparent laser surgical probe
WO1992017138A3 (fr) * 1991-04-04 1992-11-12 Premier Laser Systems Inc Sonde chirurgicale a faisceau laser
US5722970A (en) * 1991-04-04 1998-03-03 Premier Laser Systems, Inc. Laser surgical method using transparent probe
EP0565694A4 (fr) * 1991-11-06 1994-10-19 Surgical Technologies Inc Systeme d'application de laser.
WO1996032895A3 (fr) * 1995-04-17 1997-01-09 Coherent Inc Procede et appareil permettant de manipuler, couper, enlever et coaguler des tissus cibles dans le corps d'un patient
US6328732B1 (en) 1996-12-10 2001-12-11 Wavelight Laser Technologies Gmbh Device for treating bodily substances
DE19702353C5 (de) * 1997-01-23 2004-03-25 Wavelight Laser Technologie Gmbh Vorrichtung für die intraokulare Kataraktchirurgie
WO1999015120A1 (fr) * 1997-09-23 1999-04-01 Alcon Laboratories, Inc. Piece a main chirurgicale
US6120498A (en) * 1998-03-05 2000-09-19 Jani; Mahendra G. Aspirating handpieces for laser surgical operations
WO2000067687A1 (fr) * 1999-05-05 2000-11-16 Glautec Ag Dispositif permettant de traiter le glaucome
DE19920615A1 (de) * 1999-05-05 2000-12-07 Tui Laser Ag Vorrichtung zur Glaucornbehandlung des Auges
US8439904B2 (en) 2001-08-24 2013-05-14 Biolase, Inc. Tapered fused waveguide for teeth whitening
US7704272B2 (en) 2002-01-31 2010-04-27 University Of Rochester Method for introducing an ultraviolet light activated viral vector into the spinal column
US7524327B2 (en) 2002-01-31 2009-04-28 University Of Rochester Light activated gene transduction using long wavelength ultraviolet light for cell targeted gene delivery
EP1590038A4 (fr) * 2003-01-31 2006-12-06 Univ Rochester Sonde lumineuse pour la transduction genetique d'activation par la lumiere ultraviolette
US7998136B2 (en) 2003-11-10 2011-08-16 Biolase Technology, Inc. Medical radiation device with a tapered fused waveguide
EP1711849A4 (fr) * 2004-01-08 2010-12-01 Biolase Tech Inc Pointes de fibres optiques a sorties modifiees
WO2005070153A2 (fr) 2004-01-08 2005-08-04 Biolase Technology, Inc. Pointes de fibres optiques a sorties modifiees
US8221117B2 (en) 2007-09-19 2012-07-17 Biolase, Inc. Probes and biofluids for treating and removing deposits from tissue surfaces
US8977085B2 (en) 2008-11-04 2015-03-10 The University Of Queensland Surface structure modification
CN113081472A (zh) * 2019-12-23 2021-07-09 上海微创医疗器械（集团）有限公司 一种超声乳化手持件及系统

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