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WO1992001424A1 - Appareil de microchirurgie a endolaser - Google Patents

Appareil de microchirurgie a endolaser Download PDF

Info

Publication number
WO1992001424A1
WO1992001424A1 PCT/US1990/005843 US9005843W WO9201424A1 WO 1992001424 A1 WO1992001424 A1 WO 1992001424A1 US 9005843 W US9005843 W US 9005843W WO 9201424 A1 WO9201424 A1 WO 9201424A1
Authority
WO
WIPO (PCT)
Prior art keywords
probe
sapphire
tubular member
outer cylindrical
laser
Prior art date
Application number
PCT/US1990/005843
Other languages
English (en)
Inventor
Hanspeter Loertscher
Original Assignee
Hanspeter Loertscher
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 Hanspeter Loertscher filed Critical Hanspeter Loertscher
Publication of WO1992001424A1 publication Critical patent/WO1992001424A1/fr

Links

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
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • 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
    • A61F2009/00868—Ciliary muscles or trabecular meshwork
    • 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
    • A61F2009/00891—Glaucoma
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/84—Drainage tubes; Aspiration tips

Definitions

  • Q-switched YAG laser pulses have been delivered by means of specially designed mirror-contact lens across the anterior chamber and aimed at the sclera anteriorly to the trabeculum meshwork.
  • the difficulties and uncertainties of this method are: 1) The high energies (50 mj and more) per pulse hemorrhages of this iris due to the shock waves. Consequently, the iris base is preoperatively photocoagulated. 2) Special precautions are necessary to not inadvertently penetrate the conjunctiva. The energy per pulse can be reduced by injecting silver oxide intralimbally, which complicates the procedure.
  • cw-YAG laser was delivered through a sapphire contact probe, which was inserted through the cornea opposite to the area of trabecular meshwork to be perforated.
  • the tissue touched by the sapphire tip was vaporized.
  • a 193 nm excimer had been used ab externo after removal of the conjunctiva. This wavelength cannot be transmitted through an optical fiber.
  • Another object of the present invention is to provide an apparatus for performing microsurgery that is used in conjunction with a suitable laser delivery system for ablating tissue and aspirating the ablated tissue and/or fluids using the same instrument.
  • a further object of the present invention is to provide an intraocular probe for use in microsurgery that provides safe and effective delivery of the laser energy to a very limited and specific area.
  • a still further object of the present invention is to provide a means of coupling the laser energy delivery system to the intraocular probe/aspiration means.
  • the present invention relates to an intraocular probe capable of delivering pulses of laser energy to a specifically defined area to form, for example, a drainage fistula through the sclera in cases of otherwise poorly controlled glaucoma.
  • the probe contemplated by the present invention is coupled to a suitable laser delivery system and includes a passageway integrally formed therewith for aspiration of ablated tissue and/or fluids.
  • the method contemplated by the present invention involves the formation of an incision at a site remote from the drainage fistula so as to minimize or eliminate completely the possibility of the fistula being closed by the healing of the original incision in the case of a sclerostomy.
  • the probe is substantially rigid and is manipulated either manually or mechanically to the appropriate site for the tissue ablation.
  • Figure 1A is a partial cross-sectional view of a human eye, illustrating the initial incision
  • Figure IB is a partial cross-sectional view similar to the preceding figure, illustrating the formation of the drainage fistula
  • Figure 1C is a partial cross-sectional view similar to the preceding figure, illustrating the completed procedure
  • Figure 2 is a partial perspective and side elevational view of one embodiment of the coupling of the laser delivery means and the intraocular probe;
  • Figure 3 is a partial perspective and side elevational view of an alternate embodiment of coupling the laser delivery means to the intraocular probe
  • Figure 4 is a partial perspective and side elevational view of another embodiment of the coupling of the laser delivery means to the intraocular probe
  • Figure 5 is a partial cross-sectional and side elevational view of one embodiment of the intraocular probe ;
  • Figure A is a cross-sectional view, taken on line 5A- 5A of Figure 5;
  • Figure 6A is a cross-sectional view taken on line 6A- 6A of Figure 6;
  • Figure 7 is a partial cross-sectional and fragmentary side elevational view of another embodiment of the probe.
  • Figure 7A is a cross-sectional view taken on line TA ⁇ TA of Figure 7;
  • Figure 8 is a partial cross-sectional and side elevation view of another embodiment of the probe;
  • Figure 8A is a cross-sectional view taken on line 8A- 8A of Figure 8.
  • numeral 10 indicates generally a human eye, shown in partial cross-section.
  • the portions of the eye relative to the present invention are illustrated and include the sclera 12, the conjunctiva 14, the cornea 16, the iris 18, and the ciliary body 20.
  • FIGS 1A, IB and 1C illustrate the present inventive method for a sclerostomy procedure.
  • An intraocular probe 22 which is coupled to a laser delivery system (not shown) is used to ablate a small incision in the conjunctiva 14 at a site remote from the site of the drainage fistula to be formed.
  • the rigid probe is moved anteriorly which causes the elastic conjunctiva to be displaced, as shown in Figure IB.
  • Pulses of laser energy from, for example, a Holmium laser (2.1 micron wavelength, penetration in water 300 microns), an Erbium laser (wavelength 2.94 microns, penetration in water 1 micron) or a similar laser system, are delivered through the.
  • a major advantage of the present method is the formation of the drainage fistula 24 at a site remote from the site of the incision. Any scarring which may occur at the site of the incision, which could possibly block the fistula if the operation were performed at a single site, is avoided with the present technique. The method will be further detailed along with the description of the probe hereinafter.
  • Vitrectomy is of fundamental importance in the treatment of vitroretinal diseases.
  • the removal of the gel-like vitreous and associated membranes is a difficult and delicate procedure, particularly when strands attached to the retina are present.
  • Various mechanical instruments have been devised for cutting vitreous and removing fragments.
  • the inherent disadvantage of such devices is the traction exerted on adjacent structures when vitreous and especially bands are sheared, as any mechanical disturbance of such strands will tear the retina.
  • C0 2 lasers have been investigated mainly because its tissue vaporizing effects avoid traction on the retina.
  • the laser beam is delivered through an articulated arm or special optical fibers into an intraocular probe, consisting basically of a hollow metal tube (typically 1mm diameter) closed by an infrared transmitting window.
  • the disadvantages with the C0 2 Laser consisted in either a slow cutting rate resulting in a rather lengthy procedure, or in causing remote damage to surrounding tissues, such as the retina.
  • the remote damages consisted of coagulations due to head diffusion, steam formation and convection of heated and liquified vitreous.
  • the present invention suggests the use of pulsed lasers, the pulse widths of which are smaller than the specific thermal relaxation time, and the wavelength of which is highly absorbed by water.
  • pulsed lasers the pulse widths of which are smaller than the specific thermal relaxation time, and the wavelength of which is highly absorbed by water.
  • such laser pulses are able to ablate thin layers of tissue (in the order of up to 10 micron depth) with minimal damage to the remaining tissue. Because of the high absorption and small penetration depth, the volume of the evaporated or ablated mass per pulse is relatively limited.
  • This invention therefore proposes the use of an intraocular probe, which is able to deliver the laser beam to an area of tissue which is significantly larger than the area of the optical fiber able to transmit that laser pulse, and which allows the aspiration of the ablated material, and in which the diameter of the probe does not exceed approximately 1.0mm to 1.5mm.
  • Figure 2 illustrates a laser delivery means 40 comprising a bundle of optical fibers 42 contained within a suitable housing 44.
  • a central passageway 46 is maintained for aspiration of ablated material.
  • the fibers are coupled to a suitable laser delivery system (not shown) in a conventional manner.
  • the delivery means 40 in Figure 2 is coupled through suitable means (not shown) to a tubular member 48, preferentially of sapphire, which also contains a central passageway 50, which is coaxially aligned with passageway 46.
  • Sapphire is the preferred material for the tube due to its superior laser transmission properties, high mechanical strength, and high melting point, although other suitable materials having like qualities may be used.
  • Figures 3 and 4 illustrate alternate embodiments of delivering the laser energy to the sapphire tube.
  • a single optical fiber 52 delivers the laser energy to a sapphire prism (which is shown in perspective view for clarity) which splits the beam into two or more components for transmission into the sapphire tube 56. Coupling of the prism to the tube 56 is accomplished in any suitable manner, such as with a high temperature adhesive or a suitable tubular sleeve (not shown) .
  • Tube 56 also contains a central passageway 58 for aspiration of ablated material and may also include a secondary, offset passageway 60 for irrigation and/or aspiration purposes.
  • a third embodiment couples the optical fiber 62 to a sapphire cone 64, which diverts the laser energy to the sapphire tube 66.
  • a suitable connecting sleeve 68 couples the cone 64 to the tube 66.
  • a central aspiration passageway 70 is provided through tube 66 along with a secondary offset passageway 72 which communicates with passageway 70 similar to that shown in Figure 3 for irrigation or aspiration.
  • a central theme of the present application is the use of an intraocular probe, typically comprising a relatively thick-walled tube of approximately 15 to 30 millimeters in length and a diameter of approximately 1 millimeter.
  • Certain required characteristics for the probe include: a) mechanical rigidity, so that it does not break or fracture upon its manipulations inside the eye or other organ; b) transmission of laser energy within its walls; c) the probe is unaffected by the laser interaction with the tissue; and d) the aspiration of evaporated or ablated tissue through a central passageway.
  • the intraocular probe is typically a hollow tube comprised of an optical material able to transmit laser wavelengths which are highly absorbed by water.
  • the cylindrical tube wall has sufficient thickness to transmit sufficient laser energy to ablate the tissue.
  • the central cylindrical passageway has sufficient diameter to aspirate evaporated or ablated material or fragments thereof.
  • a suitable aspiration system known in the art, is connected to the central passageway or secondary passageway in any suitable manner.
  • specialized probe design is required. When combined with a Holmium laser (2.1 micron wavelength, penetration in water 300 microns) the laser light is reflected from the inner and outer surfaces of the tube by total reflection, thus the probe can be that illustrated in Figures 2 through 5.
  • FIGS. 6 through 8A illustrate an embodiment of a probe 78 with a sapphire tube 80 having a central passageway 82 in which the tube 80 and passageway 82 are surrounded by a reflective coating or a cladding material 84 having a low index of refraction.
  • Figures 7 and 7A illustrate an embodiment of a probe 88 having a sapphire tube 90 with a central passageway 92.
  • FIGS. 8 and 8A illustrate another modification wherein the probe 98, comprised of a bundle of optical fibers 100 with a central passageway 101, all are contained within or between two coaxial tubes 102 and 103 which can be metallic tubes, sapphire tubes, or other suitable material, the probe 98 contains a sapphire window 104 for transmission of the laser light and for sealing the distal end of the probe, the window having a central aspiration passageway 106.
  • the invention is also useful for other procedures in ophthalmic surgery, for example, a substitute for ultrasonic phacoemulsification in cataract surgery and in vitreous surgery.
  • the irrigation necessary in closed-eye surgery can be combined with the invention using common
  • the central ' canal can be used for irrigation as well.
  • the invention can also be used in other surgical areas, for example in lithotripsy (removal of gallstones and kidney stones) , in angioplasty (removal of atherosclerotic plaques) , in bone surgery
  • the central canal of the invention can be used as an instrument channel and for carrying a guide-wire (angioplasty) .
  • the invention contemplates the following: Wavelengths which are highly absorbed by the sclera,
  • the two wavelength regions are: 1.4 to 10 micron, and below 200 nm.
  • the probe can be used ab interna, by inserting the probe through the cornea opposite to the area of the corneoscleral tissue to be perforated.
  • Possible lasers to be used are: Erbium: YAG laser at 2.94 micron, Holmium: YAG or Holmium: YSGG at 2.1 micron, and argon fluoride excimer laser at 193 mm.
  • Erbium: YAG laser at 2.94 micron Holmium: YAG or Holmium: YSGG at 2.1 micron
  • argon fluoride excimer laser at 193 mm At 2.94 micron, Zirconium fluoride fibers can be used to transmit this wavelength, whereas at 2.1 micron, silica fibers can be used.

Landscapes

  • 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)

Abstract

Procédé et appareil permettant de faire de la microchirurgie à l'aide d'un endolaser. L'appareil comprend un système d'émission de laser (68) couplé à une sonde (66) capable de transmettre l'énergie du faisceau laser via un support adapté tel qu'un saphir. La sonde est pourvue d'un canal coaxial (70) par lequel sont aspirés les tissus ayant subi une ablation et/ou les liquides. Dans ce procédé, on effectue une ablation des tissus par le laser puis on aspire les tissus ainsi enlevés et/ou les liquides. Parmi les différentes utilisations, ce procédé s'avère particulièrement utile pour effectuer des sclérostomies, des vitrectomies et c'est également un procédé utile en tant que procédé de remplacement de la phacoémulsification par ultrasons.
PCT/US1990/005843 1990-07-23 1990-10-11 Appareil de microchirurgie a endolaser WO1992001424A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US55690090A 1990-07-23 1990-07-23
US556,900 1990-07-23

Publications (1)

Publication Number Publication Date
WO1992001424A1 true WO1992001424A1 (fr) 1992-02-06

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Family Applications (1)

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PCT/US1990/005843 WO1992001424A1 (fr) 1990-07-23 1990-10-11 Appareil de microchirurgie a endolaser

Country Status (1)

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WO (1) WO1992001424A1 (fr)

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4122853A (en) * 1977-03-14 1978-10-31 Spectra-Med Infrared laser photocautery device
US4273109A (en) * 1976-07-06 1981-06-16 Cavitron Corporation Fiber optic light delivery apparatus and medical instrument utilizing same
US4385832A (en) * 1979-09-11 1983-05-31 Yuzuru Doi Laser power transmitting optical fiber damage detecting device
US4693244A (en) * 1984-05-22 1987-09-15 Surgical Laser Technologies, Inc. Medical and surgical laser probe I
US4806289A (en) * 1987-01-16 1989-02-21 The Dow Chemical Company Method of making a hollow light pipe
US4819632A (en) * 1986-05-19 1989-04-11 Davies David H Retrolasing catheter and method
US4846172A (en) * 1987-05-26 1989-07-11 Berlin Michael S Laser-delivery eye-treatment method
US4878492A (en) * 1987-10-08 1989-11-07 C. R. Bard, Inc. Laser balloon catheter

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4273109A (en) * 1976-07-06 1981-06-16 Cavitron Corporation Fiber optic light delivery apparatus and medical instrument utilizing same
US4122853A (en) * 1977-03-14 1978-10-31 Spectra-Med Infrared laser photocautery device
US4385832A (en) * 1979-09-11 1983-05-31 Yuzuru Doi Laser power transmitting optical fiber damage detecting device
US4693244A (en) * 1984-05-22 1987-09-15 Surgical Laser Technologies, Inc. Medical and surgical laser probe I
US4819632A (en) * 1986-05-19 1989-04-11 Davies David H Retrolasing catheter and method
US4806289A (en) * 1987-01-16 1989-02-21 The Dow Chemical Company Method of making a hollow light pipe
US4846172A (en) * 1987-05-26 1989-07-11 Berlin Michael S Laser-delivery eye-treatment method
US4878492A (en) * 1987-10-08 1989-11-07 C. R. Bard, Inc. Laser balloon catheter

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