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WO1992019414A1 - Cyclodestruction par micro-ondes a commande par thermostat permettant de traiter le glaucome - Google Patents

Cyclodestruction par micro-ondes a commande par thermostat permettant de traiter le glaucome Download PDF

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Publication number
WO1992019414A1
WO1992019414A1 PCT/US1992/003425 US9203425W WO9219414A1 WO 1992019414 A1 WO1992019414 A1 WO 1992019414A1 US 9203425 W US9203425 W US 9203425W WO 9219414 A1 WO9219414 A1 WO 9219414A1
Authority
WO
WIPO (PCT)
Prior art keywords
given
method defined
temperature
ciliary
microwave energy
Prior art date
Application number
PCT/US1992/003425
Other languages
English (en)
Original Assignee
Mmtc, Inc.
North Shore University Hospital Research Corporation
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 Mmtc, Inc., North Shore University Hospital Research Corporation filed Critical Mmtc, Inc.
Publication of WO1992019414A1 publication Critical patent/WO1992019414A1/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
    • A61F9/00781—Apparatus for modifying intraocular pressure, e.g. for glaucoma treatment
    • 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
    • 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
    • A61B18/1815—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 microwaves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/02—Radiation therapy using microwaves

Definitions

  • cyclodestruction procedures i.e., procedures for destroying the ciliary body
  • the clinical standard cyclodestruction procedure employs cryotherapy.
  • Other known cyclodestruction procedures include therapeutic ultrasound and Neodymium:Yag cyclophotocoagulation.
  • all of these known cyclodestruction procedures have demonstrated different negative tissue reactions.
  • Cryotherapy has been characterized by discomfort and edema, therapeutic sound by induced scleral changes, and Neodymium.Yag cyclophotocoagulation has been shown to cause characteristic spot-like conjunctival lesions.
  • Other less specific morbidities have included corneal-scleral thinning, hyphema, cataract, vitritis, retinal detachment, cystoid macula edema, and hypotony. These potential complications have defined cyclodestruction procedures as a last treatment for refractory cases.
  • the present invention is directed to a microwave cyclodestruction procedure which avoids negative tissue reactions and minimizes potential complications.
  • the microwaves are applied to the ciliary body by a novel miniature microwave applicator placed in contact with a spot on the outer surface of the sclera.
  • the miniature microwave applicator incorporates a thermocouple on its anterior radiating surface, so that the thermocouple also contacts the spot on the outer surface of the sclera.
  • the thermocouple thermostatically controls the output of the microwave generator energizing the applicator to ensure that the temperature of the scleral tissue never rises to an unsafe level.
  • scleral tissue absorbs less microwave energy
  • ciliary-body tissue absorbs more microwave energy
  • most of the applied applied microwave energy penetrates through the sclera to, and is absorbed by, the underlying ciliary body. This raises the temperature of the ciliary body to the point at which some cyclodestruction occurs. This process may be repeated at several separate spots of the sclera to complete the microwave cyclodestruction procedure.
  • FIGURE 1 is a functional block diagram showing the relationship between a miniature microwave applicator incorporating a thermocouple (which may take the form shown in FIGURE 2) and a thermostatically-controlled microwave generator for energizing the applicator;
  • FIGURE 2 illustrates the physical form of a preferred embodiment of the miniature microwave applicator incorporating a thermocouple that is used for microwave cyclodestruction
  • FIGURE 3 is a first chart useful in explaining the principles of the present invention.
  • FIGURE 4 is a second chart useful in explaining the principles of the present invention.
  • thermocouple 102 which may take the form shown in FIGURE 2
  • the thermocouple of applicator 102 generates a control signal having a value which is a function of the temperature at the microwave radiating aperture of applicator 102.
  • This control signal which is fed back to microwave generator 100 over connection 106 to thermostatically control microwave generator 100, prevents microwave energy from being forwarded from the output of microwave generator 100 over transmission line 104 to the input of applicator 102 whenever the temperature of the thermocouple rises to a certain preselected temperature.
  • applicator 102 comprises thin- wall metal dielectric-filled waveguide.200.
  • waveguide 200 is fabricated from a block of ceramic material that exhibits a high dielectric constant (e.g., 85) that is machined to the proper size and shape. The longitudinal surface of this properly sized and shaped ceramic material is first electrolessly plated with metal and then electroplated with metal to produce the thin metal wall of waveguide 200.
  • a high dielectric constant e.g. 85
  • the length of waveguide 200 is preferably about one inch; the width of waveguide 200 is preferably about 0.2 inch (i.e., 200 mils); and the thickness of waveguide 200 preferably tapers from about 0.1 inch (i.e., 100 mils) at at its posterior end, to which microwave input connector 202 is attached, to about 0.15 inch (i.e., 150 mils) at its anterior end, which forms dielectric radiating aperture 204.
  • the area of dielectric radiating aperture 204 is quite small, being only 0.03 square inch.
  • the dielectric anterior surface which is preferably flat, has a groove 206 machined therein in which thermocouple 208 is fixedly secured substantially at the center thereof.
  • the thickness of the thermocouple is preferably sufficient to protrude very slightly from the flat dielectric anterior surface.
  • Thermocouple output wires 210 connected to thermocouple 208, extend through the length of groove 206 to the outside of waveguide 200, as shown in FIGURE 2.
  • Thermocouple output wires 210 constitute feedback connection 106 of FIGURE 1.
  • the therapeutic purpose of applicator 102 in the treatment of glaucoma is to apply sufficient microwave energy to the ciliary body to effect cyclodestruction without creating collateral eye damage. This is accomplished by first positioning 0.03 square inch dielectric radiating aperture 204 in contact with the anterior surface of applicator 102 in contact with a 0.03 square inch spot on the outer surface of the sclera which overlies the ciliary body (e.g., a spot displaced about 2 millimeters beyond the outer edge of the iris). This inherently places thermocouple 208 in in contact with this spot.
  • the applicator is energized with microwave energy having a frequency (e.g.
  • the microwave energy is applied to the spot for a given time (e.g., one minute) which is a sufficient time for the irradiated spot of the ciliary body to be heated to a high enough temperature to cause cyclodestruction, while the sclera itself is never heated enough to raise its temperature sufficiently high to result in damage thereto.
  • a given time e.g., one minute
  • the thermostatic control of microwave generator 100 is set so that the radiated microwave energy is cut off whenever the temperature of thermocouple 208 rises to a preselected therapeutic temperature which is below the temperature at which scleral damage occurs.
  • the continuous monitoring of sclera-spot surface temperature by thermocouple 208 maintains the temperature substantially constant at the therapeutic temperature and also ensures that the operation is fail-safe.
  • the above-described process is applied sequentially to each of several (e.g., five) displaced spots on the outer surface of the sclera. More specifically, after the above-described process with respect to one of the several displaced spots is completed, the applicator is displaced by about the width of applicator 102 (200 mils) to another similar scleral spot overlying the ciliary body. Thus, the resulting several displaced spots tend to lie on the circumference of a circle having a radius about 2 millimeters larger than that of the iris.
  • FIGURE 3 chart there is shown the penetration depth as a function of frequency at which 1/e (where e is the base of natural logarithm) of incident microwave energy is absorbed by low-water-content human tissue and by high-water- content human tissue, respectively. It is apparent from this chart that low-water-content human tissue is much more microwave absorbent than high-water-content human tissue. Scleral human tissue is low-water-content human tissue and ciliary-body tissue is high-water-content human tissue. Thus, most of the applied microwave energy merely passes through the thickness of the scleral tissue to be then highly absorbed by the underlying ciliary-body tissue, thereby preferentially heating the underlying ciliary-body tissue.
  • FIGURE 4 chart there is shown temperature- time duration thresholds for damage to occur in different types of mammalian tissue.
  • tissue e.g., corneal tissue
  • some types of tissue e.g., corneal tissue
  • corneal tissue are damaged substantially less than others.
  • both corneal and scleral tissue are not damaged by, and tolerate well, being heated to a temperature up to about 50° C for at least one minute. Therefore, the aforesaid fail-safe thermostatically-controlled therapeutic temperature for a heating duration of scleral tissue for one minute certainly may be set at 50° C, and perhaps even somewhat higher.
  • the high dielectric constant of the dielectric filling of waveguide 200 of applicator 102 serves two important purposes. First, by reducing the microwave wavelength traveling therein for a given microwave frequency, the size of applicator 102 for transporting that given microwave frequency may be reduced (i.e., miniaturized). Second, the high dielectric constant of the dielectric filling of waveguide 200 more nearly matches the high dielectric constant of the high-water content ciliary body, and, therefore, enhances microwave power transfer from dielectric radiating aperture 204 to the ciliary body.
  • the impedance at the microwave input to applicator 102 at the posterior end of waveguide 200 should closely match that presented by transmission line 104, and the impedance at the microwave output from applicator 102 at dielectric radiating aperture 204 (located at the anterior end of waveguide 200) should closely match that presented by the scleral tissue with which it is in contact.
  • the proper impedance matching at both the posterior and anterior ends of waveguide 200 is achieved by the above- discussed tapering of the thickness of waveguide 200 from 100 mils at its posterior end to 150 mils at its anterior end.

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

Abstract

Applicateur miniaturisé à micro-ondes comprenant un guide d'ondes (200) à paroi mince rempli de métal diélectrique dans lequel un thermocouple (208) est placé dans une rainure (206) située dans la surface de l'ouverture radiante diélectrique du guide d'ondes (200). Lorsqu'on met en contact l'ouverture avec une tâche située sur la surface externe de la sclérotique recouvrant le corps ciliare afin de cyclodétruire par la chaleur produite par l'énergie absorbée des micro-ondes qui ont irradié la zone pendant une période donnée, le thermocouple (208) qui surveille la température de la surface de la sclérotique permet d'éviter la surchauffe des tissus de la sclérotique qui provoquerait des altérations au niveau de ces tissus. Le thermocouple (208) sert à commander de manière thermostatique l'énergie des micro-ondes fournie au guide d'ondes de sorte que la température des tissus de la sclérotique se maintienne sensiblement constante à une valeur inférieure à celle qui produirait l'altération des tissus. L'opération telle qu'on désire l'effectuer, dépend du fait qu'une très faible quantité de l'énergie des micro-ondes est absorbée par les tissus de la sclérotique à faible teneur en eau lorsqu'elle les traverse alors que cette même énergie est très fortement absorbée par les tissus du corps ciliaire sous-jacents à forte teneur en eau.
PCT/US1992/003425 1991-04-26 1992-04-24 Cyclodestruction par micro-ondes a commande par thermostat permettant de traiter le glaucome WO1992019414A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US69172091A 1991-04-26 1991-04-26
US691,720 1991-04-26

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Cited By (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1996034568A1 (fr) * 1995-05-05 1996-11-07 Knowlton Edward W Appareil de resurfacage de la peau
WO1997024992A1 (fr) * 1996-01-05 1997-07-17 Knowlton Edward W Procede de formation et de contraction de collagene cicatriciel
US5755753A (en) * 1995-05-05 1998-05-26 Thermage, Inc. Method for controlled contraction of collagen tissue
US6350276B1 (en) 1996-01-05 2002-02-26 Thermage, Inc. Tissue remodeling apparatus containing cooling fluid
US6425912B1 (en) 1995-05-05 2002-07-30 Thermage, Inc. Method and apparatus for modifying skin surface and soft tissue structure
US6430446B1 (en) 1995-05-05 2002-08-06 Thermage, Inc. Apparatus for tissue remodeling
US7006874B2 (en) 1996-01-05 2006-02-28 Thermage, Inc. Treatment apparatus with electromagnetic energy delivery device and non-volatile memory
US7022121B2 (en) 1999-03-09 2006-04-04 Thermage, Inc. Handpiece for treatment of tissue
US7115123B2 (en) 1996-01-05 2006-10-03 Thermage, Inc. Handpiece with electrode and non-volatile memory
US7141049B2 (en) 1999-03-09 2006-11-28 Thermage, Inc. Handpiece for treatment of tissue
US7189230B2 (en) 1996-01-05 2007-03-13 Thermage, Inc. Method for treating skin and underlying tissue
US7229436B2 (en) 1996-01-05 2007-06-12 Thermage, Inc. Method and kit for treatment of tissue
US7267675B2 (en) 1996-01-05 2007-09-11 Thermage, Inc. RF device with thermo-electric cooler
US7452358B2 (en) 1996-01-05 2008-11-18 Thermage, Inc. RF electrode assembly for handpiece
US7481809B2 (en) 1996-01-05 2009-01-27 Thermage, Inc. Handpiece with RF electrode and non-volatile memory
CN109069204A (zh) * 2016-05-03 2018-12-21 柯惠有限合伙公司 便于在微波消融程序中施加适当的热剂量的系统和方法

Citations (7)

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US4190053A (en) * 1977-06-20 1980-02-26 Rca Corporation Apparatus and method for hyperthermia treatment
US4204549A (en) * 1977-12-12 1980-05-27 Rca Corporation Coaxial applicator for microwave hyperthermia
US4271848A (en) * 1979-01-11 1981-06-09 Bio Systems Design, Corp. Apparatus for electromagnetic radiation of living tissue and the like
US4282887A (en) * 1979-10-11 1981-08-11 Rca Corporation Ridge-waveguide applicator for treatment with electromagnetic energy
US4311154A (en) * 1979-03-23 1982-01-19 Rca Corporation Nonsymmetrical bulb applicator for hyperthermic treatment of the body
US4589424A (en) * 1983-08-22 1986-05-20 Varian Associates, Inc Microwave hyperthermia applicator with variable radiation pattern
US4841990A (en) * 1985-06-29 1989-06-27 Tokyo Keiki Co., Ltd. Applicator for use in hyperthermia

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4190053A (en) * 1977-06-20 1980-02-26 Rca Corporation Apparatus and method for hyperthermia treatment
US4204549A (en) * 1977-12-12 1980-05-27 Rca Corporation Coaxial applicator for microwave hyperthermia
US4271848A (en) * 1979-01-11 1981-06-09 Bio Systems Design, Corp. Apparatus for electromagnetic radiation of living tissue and the like
US4311154A (en) * 1979-03-23 1982-01-19 Rca Corporation Nonsymmetrical bulb applicator for hyperthermic treatment of the body
US4282887A (en) * 1979-10-11 1981-08-11 Rca Corporation Ridge-waveguide applicator for treatment with electromagnetic energy
US4589424A (en) * 1983-08-22 1986-05-20 Varian Associates, Inc Microwave hyperthermia applicator with variable radiation pattern
US4841990A (en) * 1985-06-29 1989-06-27 Tokyo Keiki Co., Ltd. Applicator for use in hyperthermia

Cited By (30)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6377854B1 (en) 1995-05-05 2002-04-23 Thermage, Inc. Method for controlled contraction of collagen in fibrous septae in subcutaneous fat layers
US6377855B1 (en) 1995-05-05 2002-04-23 Thermage, Inc. Method and apparatus for controlled contraction of collagen tissue
US5755753A (en) * 1995-05-05 1998-05-26 Thermage, Inc. Method for controlled contraction of collagen tissue
US5871524A (en) * 1995-05-05 1999-02-16 Thermage, Inc. Apparatus for controlled contraction of collagen tissue
US5919219A (en) * 1995-05-05 1999-07-06 Thermage, Inc. Method for controlled contraction of collagen tissue using RF energy
US5948011A (en) * 1995-05-05 1999-09-07 Thermage, Inc. Method for controlled contraction of collagen tissue via non-continuous energy delivery
US6241753B1 (en) 1995-05-05 2001-06-05 Thermage, Inc. Method for scar collagen formation and contraction
WO1996034568A1 (fr) * 1995-05-05 1996-11-07 Knowlton Edward W Appareil de resurfacage de la peau
EP1407720A1 (fr) * 1995-05-05 2004-04-14 Thermage Appareil de resurfaçage de la peau
US6381498B1 (en) 1995-05-05 2002-04-30 Thermage, Inc. Method and apparatus for controlled contraction of collagen tissue
US6470216B1 (en) 1995-05-05 2002-10-22 Thermage, Inc. Method for smoothing contour irregularities of skin surface
US6381497B1 (en) 1995-05-05 2002-04-30 Thermage, Inc. Method for smoothing contour irregularity of skin surface by controlled contraction of collagen tissue
US6425912B1 (en) 1995-05-05 2002-07-30 Thermage, Inc. Method and apparatus for modifying skin surface and soft tissue structure
US6430446B1 (en) 1995-05-05 2002-08-06 Thermage, Inc. Apparatus for tissue remodeling
US6438424B1 (en) 1995-05-05 2002-08-20 Thermage, Inc. Apparatus for tissue remodeling
US6453202B1 (en) 1995-05-05 2002-09-17 Thermage, Inc. Method and apparatus for controlled contraction of collagen tissue
US6461378B1 (en) 1995-05-05 2002-10-08 Thermage, Inc. Apparatus for smoothing contour irregularities of skin surface
US6350276B1 (en) 1996-01-05 2002-02-26 Thermage, Inc. Tissue remodeling apparatus containing cooling fluid
WO1997024992A1 (fr) * 1996-01-05 1997-07-17 Knowlton Edward W Procede de formation et de contraction de collagene cicatriciel
US6749624B2 (en) 1996-01-05 2004-06-15 Edward W. Knowlton Fluid delivery apparatus
US7006874B2 (en) 1996-01-05 2006-02-28 Thermage, Inc. Treatment apparatus with electromagnetic energy delivery device and non-volatile memory
US7115123B2 (en) 1996-01-05 2006-10-03 Thermage, Inc. Handpiece with electrode and non-volatile memory
US7189230B2 (en) 1996-01-05 2007-03-13 Thermage, Inc. Method for treating skin and underlying tissue
US7229436B2 (en) 1996-01-05 2007-06-12 Thermage, Inc. Method and kit for treatment of tissue
US7267675B2 (en) 1996-01-05 2007-09-11 Thermage, Inc. RF device with thermo-electric cooler
US7452358B2 (en) 1996-01-05 2008-11-18 Thermage, Inc. RF electrode assembly for handpiece
US7481809B2 (en) 1996-01-05 2009-01-27 Thermage, Inc. Handpiece with RF electrode and non-volatile memory
US7022121B2 (en) 1999-03-09 2006-04-04 Thermage, Inc. Handpiece for treatment of tissue
US7141049B2 (en) 1999-03-09 2006-11-28 Thermage, Inc. Handpiece for treatment of tissue
CN109069204A (zh) * 2016-05-03 2018-12-21 柯惠有限合伙公司 便于在微波消融程序中施加适当的热剂量的系统和方法

Also Published As

Publication number Publication date
AU1893692A (en) 1992-12-21
CA2092406C (fr) 2003-07-15
CA2092406A1 (fr) 1992-10-27

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