Non-penetrating filtration surgery

• US 20050096639A1
• Filed: 11/03/2002
• Published: 05/05/2005
• Est. Priority Date: 05/08/2000
• Status: Active Grant

• Current Assignee: I Optima Ltd.
• Original Assignee: I Optima Ltd.
• Inventors: Harel, Alex, Shargil, Adi, Slatkine, Michael, Assia, Ehud
• Granted Patent: US 7,886,747 B2
• Time in Patent Office: Days
• US Class Current: 606/5
• CPC Class Codes: A61F 2009/00865 Sclera
• CPC Class Codes: A61F 2009/00868 Ciliary muscles or trabecular meshwork
• CPC Class Codes: A61F 2009/00872 Cornea
• CPC Class Codes: A61F 2009/00891 Glaucoma
• CPC Class Codes: A61F 2009/00897 Scanning mechanisms or algorithms
• CPC Class Codes: A61F 9/00802 for photoablation
• CPC Class Codes: A61F 9/00821 for coagulation
• CPC Class Codes: A61F 9/00825 for photodisruption

Abstract

Apparatus for ophthalmic surgery, especially non-penetrating filtration surgery, comprising a laser source that ablates sclera tissue at steps of intermediate thickness. Optionally, the beam is scanned using a scanner and its results viewed using an ophthalmic microscope.

Claims

1. Apparatus for ophthalmic surgery on an eye comprising:

a laser source that generates a laser beam, adapted to ablate a sclera tissue thickness of between 5 and 30 microns in a single shot, without causing substantial shockwave or thermal damage to said eye, said beam contacting said eye for at least one of a dwell time of above 100 micro-seconds and a spot size of over 100 microns; and

an ophthalmicly effective position controller adapted to aim said beam at said eye from outside said eye.

2. Apparatus according to claim 1, comprising an ophthalmic microscope operative to view an eye during an ophthalmic procedure that uses said laser beam.

3. Apparatus according to claim 2, comprising a monitor for displaying a view of said tissue removal viewed by said microscope.

4. Apparatus according to claim 2, comprising a beam combiner for combining a line of sight of said laser and said microscope.

5. Apparatus according to claim 1, wherein said position controller comprises an ophthalmic frame operative to fixing a relative position and angle of said laser source and an eye of a patient.

6. Apparatus according to claim 1, wherein said position controller comprises a scanner comprising an input for said laser beam and an output of a spatially scanned laser beam.

7. Apparatus according to claim 6, comprising controlling circuitry that drives said scanner to remove tissue in a desired pattern on the eye.

8. Apparatus according to claim 7, comprising a sensor which monitors an indication of progression of said surgery, on said eye, to produce a progression signal.

9. Apparatus according to claim 8, wherein said sensor comprises:

a camera which acquires an image of said tissue removal; and

an image processor that processes said image.

10. Apparatus according to claim 8, comprising circuitry that uses said progression signal to generate an indication of the tissue removal state.

11. Apparatus according to claim 10, wherein said circuitry uses said indication to close a control loop of said tissue removal.

12. Apparatus according to claim 10, wherein said indication of tissue removal state comprises an indication of the thickness of remaining tissue in the area of tissue removal.

13. Apparatus according to claim 10, wherein said indication of tissue removal state comprises an indication of a percolation rate through the remaining tissue in the area of tissue removal.

14. Apparatus according to claim 8, wherein said sensor measures an intra-ocular pressure.

15. Apparatus according to claim 8, wherein said sensor is a non-penetrating sensor.

16. Apparatus according to claim 8, wherein said sensor is a contact sensor.

17. Apparatus according to claim 8, wherein said controlling circuitry receives signals from said sensor.

18. Apparatus according to claim 8, comprising a user input, wherein said controlling circuitry is adapted to receive and interpret entries on said input as indicating signals from said sensor.

19. Apparatus according to claim 1, comprising a frame attached to said combiner, which frame blocks said laser beam from at least one part of said eye.

20. Apparatus according to claim 1, wherein said laser source comprises a CO₂ laser source.

21. Apparatus according to claim 1, wherein said laser source comprises an isotopic ¹³C¹⁶O₂ laser source.

22. Apparatus according to claim 1, wherein said laser source comprises an Erbium:

YSGG laser source.

23. Apparatus according to claim 1, wherein said laser source comprises a diode laser source operated at a wavelength near 1.8 microns.

24. Apparatus according to claim 1, wherein said laser source comprises a UV laser source.

25. Apparatus according to claim 1, wherein said laser source generates a second, visible wavelength, aiming beam aligned with said laser beam.

26. Apparatus according to claim 1, wherein said laser beam is a pulsed laser, each pulse being a single shot.

27. Apparatus according to claim 1, wherein said laser beam is a pulsed laser, a plurality of pulses being grouped as a single shot.

28. Apparatus according to claim 1, wherein said laser beam is a continuous laser that is artificially gated to generate shots.

39. Apparatus according to claim 1, wherein said dwell time is over 100 micro seconds.

40. Apparatus according to claim 1, wherein said spot size is over 100 microns.

41. Apparatus according to claim 26, wherein each shot has a duration of over 1 milliseconds.

42. Apparatus according to claim 6, wherein said circuitry is configured to remove sclera tissue in the shape of a reservoir suitable for non-penetrating trabeculectomy.

43. Apparatus according to claim 6, wherein said circuitry is configured to remove sclera tissue in the shape of a percolation area suitable for non-penetrating trabeculectomy.

44. Apparatus according to claim 1, wherein said beam has a power of over 5 watts.

45. Apparatus according to claim 1, wherein said laser ablates between 10 and 30 microns in a single shot.

46. Apparatus according to claim 1, wherein said laser ablates between 16 and 25 microns in a single shot.

47. Apparatus according to claim 1, wherein said laser ablates between 16 and 20 microns in a single shot.

29. A method of performing a non-penetrating filtration procedure, comprising:

opening a flap in an eye, overlying a Schlemm'"'"'s canal of said eye;

forming a percolation zone adjacent said Schlemm'"'"'s canal by ablation using a laser that ablates a tissue thickness of between 5 and 30 microns, each shot;

forming a reservoir in a sclera of said eye and in fluid connection with said percolation zone; and

closing said flap.

30. A method according to claim 29, wherein forming a percolation zone comprises cleaning away charred tissue from said percolation zone.

31. A method according to claim 29, comprising forming by automatic scanning with a laser.

32. A method according to claim 31, wherein automatic scanning with a laser comprises automatically controlling at least one parameter of the scanning responsive to an effect of the laser on the tissue.

33. A method according to claim 29, wherein said laser is a CO₂ laser.

34. A method according to claim 33, wherein said laser is a ¹³C¹⁶O₂ laser.

35. A method according to claim 33, wherein said laser is an Er:

YSGG laser.

36. A method according to claim 33, wherein said laser is a diode laser operated near 1.8 microns wavelength.

37. A method according to claim 29, comprising placing a protective sticker on said eye prior to forming said percolation zone, said protective sticker having a spatial window that admits a wavelength of said laser and a body that block said wavelength from parts of the eye other than an area to be ablated.

38. A method of performing a non-penetrating filtration procedure, comprising:

forming a percolation zone adjacent a Schlemm'"'"'s canal of an eye

measuring an intra-ocular pressure of said eye in response to said forming a percolation zone; and

modifying parameters of said forming in response to said measuring.