Device for improving drainage of the aqueous humor within the eye of a living being

• US 6,764,439 B2
• Filed: 07/11/2001
• Issued: 07/20/2004
• Est. Priority Date: 11/24/1999
• Status: Expired due to Term

• Current Assignee: Alcon Incorporated
• Original Assignee: Grieshaber & Company AG Schaffhausen
• Inventors: Stegmann, Robert, Schaaf, Hansgeorg, Maag, Werner
• Primary Examiner(s): Leubecker, John P.
• Application Number:
  US09/902,850
• Publication Number:
  US 20010053873A1
• Time in Patent Office: 1,105 Days
• Field of Search: 600/104, 600/105, 600/106, 600/109, 600/138, 600/153, 600/160, 600/167, 606/169, 606/171
• US Class Current: 600/106
• CPC Class Codes: A61B 1/00193 adapted for stereoscopic vision
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/042 characterised by a proximal camera, e.g. a CCD camera
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/3201 Scissors for biopsy A61B10/02
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/305 Tweezer like handles with tubular extensions, inner slidable actuating members and distal tools, e.g. microsurgical instruments
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2090/3614 using optical fibre
• CPC Class Codes: A61F 9/00781 Apparatus for modifying intraocular pressure, e.g. for glaucoma treatment drainage implants in general A61M27/002

Abstract

A device is disclosed for ophthalmologic microsurgery for improving the drainage of the aqueous humor in the eye of a living being, wherein the device has an endoscope connected to a monitor screen and includes a tube-shaped probe adapted for insertion into an eye, and one or more channels co-axially disposed therein and provided with optical elements for focusing and transmitting images from the viewing field in the eye, and wherein the probe houses a surgical tool which is movable in axial direction and about the longitudinal axis so that by means of the oscillating and/or vibrating tool a passageway can be opened in the tissue of the trabecular meshwork for connecting the anterior chamber with the Schlemm'"'"'s canal.

Claims

1. A device for microsurgically improving drainage of the aqueous humor via the trabecular meshwork into Schlemm'"'"'s canal of the eye of a living being comprising:

an endoscope;

a tubular probe, having a proximal end operatively connected to the endoscope and adapted for insertion into the anterior chamber in the direction of the trabecular meshwork of the eye, wherein the probe has an optical channel and a working channel in axial relationship with the probe; and

an optical guide disposed in axial relationship with the optical channel for focusing and transmitting images from a viewing field;

a surgical tool, disposed in the working channel and movable at least in axial direction with respect to a distal end of the probe, for providing a passageway in the trabecular tissue to thereby connect the anterior chamber with the Schlemm'"'"'s canal of the eye;

wherein the surgical tool is operated by an electric motor coupled to a proximal end of the endoscope, said electric motor is disposed in a housing and is in operative connection by means of at least two catch members with an axially slidable sliding member disposed at the outer circumference of the housing for the manual adjusting movement of the surgical tool in axial direction of the probe;

wherein the surgical tool is disposed on the electric motor with at a coupling member.

2. The device according to claim 1, wherein the optical guide is configured for transmitting a monoscopic visual representation of images from the viewing field.

3. The device according to claims 1, further comprising at least one optical element coaxially disposed within and at a distal end of the optical channel for focusing and precisioning the viewing field.

4. The device according to claim 3, wherein the optical guide at a distal end thereof is provided with at least one the optical element for focusing and precisioning the viewing field.

5. The device according to claim 4, wherein the optical element is an optical lens.

6. The device according to claim 5, wherein the optical lens is attached in the optical channel at a distance to the distal end of the optical guide.

7. The device according to claim 6, wherein the optical lens and the optical guide are configured for focusing on the viewing field in dependence on a distance of the surgical tool to a viewing position and which is adjustable in axial direction relative to a distal end of the probe.

8. The device according to claim 5, wherein the optical channel is sealed by a translucent disc and wherein the optical lens disposed in the optical channel is positioned between the distal end of the optical guide and the disc.

9. The device according to claim 3, wherein the optical guide has a front face at a distal end which is configured as lens-shaped optical element.

10. The device according to claim 1, further comprising a second tube-shaped optical channel co-axially disposed in the probe and at a distance from the one optical channel;

and wherein the optical elements are disposed in each optical channel for focusing and precisioning the viewing field in dependence on a distance of the surgical tool which is adjustable in axial direction relative to a distal end of the probe.

11. The device according to claim 10, wherein the two optical channels with the optical elements disposed therein are configured for the stereoscopic transmission of images from the focused viewing field.

12. The device according to claim 10, further comprising a second optical guide and wherein each of the two optical channels are housing one optical guide configured at a distal end as a lens-shaped optical element for focusing and precisioning the viewing field.

13. The device according to claim 10, wherein at least one optical lens is disposed at the distal end of each of the optical guides attached in the optical channel for focusing and precisioning of the viewing field.

14. The device according to claim 1, further comprising a tube-shaped channel disposed in the probe in addition to the optical and working channels and extending in axial direction to the distal end of the probe and configured for receiving a light guide and adapted for lighting the focused viewing field.

15. The device according to claim 14, wherein the light guide is connected to a light source coupled to the endoscope.

16. The device according to claim 1, wherein the endoscope is connected to a camera for transmission of one of monoscopic or stereoscopic images from the viewing field that is focused by means of the optical elements;

and wherein by means of a monitor screen connected to the camera the transmitted images of the viewing field can be visualized.

17. The device according to claim 1, wherein the surgical tool which is slidably movable in axial direction is adjustable at a predetermined advance into a fixed position.

18. The device according to claim 17, wherein the surgical tool is adjustable into a fixed position at a predetermined advance while focusing the viewing field.

19. The device according to claim 1, wherein the working channel which is stationary further comprises a guide tube co-axially disposed in the stationary working channel and in which the surgical tool is co-axially disposed;

said guide tube is configured such that the surgical tool and the guide tube are slidably movable together or separately in axial direction relative to the distal end of the working channel.

20. The device according to claim 1, wherein the surgical tool is provided at the distal end with a head piece configured for microsurgery and together with the surgical tool is slidably movable in an axial direction and is rotatable about the longitudinal axis of the surgical tool for providing at least one of or both an oscillating and vibrating movement for surgical treatment of the trabecular meshwork.

21. The device according to claim 20, wherein the head piece of the surgical tool is configured as one of a one-edged or two-edged knife.

22. The device according to claim 20, wherein the distal head piece of the surgical tool is configured as one of a hollow cylindrical cannula or a drill.

23. The device according to claim 22, wherein the hollow cylindrical cannula is configured at a front face as one of a saw-toothed router or a cutting edge.

24. The device according to claim 20, wherein the head piece of the surgical tool is either configured in a shape selected from the group consisting of a forceps, a clamping element and a scissors for cuttingly and clampingly bringing into engagement with the tissue of the trabecular meshwork by means of the surgical tool which is axially movable relative to the guide tube.

25. The device according to claim 1, and further comprising another working channel co-axially disposed within the probe and extending to the distal end of the probe and which is connected to an aspiration and irrigation unit coupled to the endoscope by means of a coupling line.

26. The device according to claim 1, wherein the optical channel and the working channel disposed in the probe are each in the shape of a tube.

27. The device according to claim 26, wherein the probe has one of an elliptical-shaped or an oval-shaped cross section with an outer width (B) of about 2.4 mm and an outer height (H) of about 1.25 mm.

28. The device according to claim 1, wherein the electric motor drive is provided with means for moving the surgical tool in at least one of an axial movement and a rotational movement within the probe.

29. The device according to claim 1, wherein the means for driving the surgical tool is an electric motor drive and wherein the surgical tool has a proximal end which is in operative connection via a coupling with a drive shaft of the electric motor for rotational movement about a longitudinal axis and for a manually driven axially slidable adjusting movement.

30. The device according to claim 1, wherein the endoscope is configured in two or more parts that are coupled to each other by means of bayonet closures.

31. The device according to claim 1, wherein the endoscope is configured in two or more parts coupled to each other by means of a locking cone connector.

32. The device according to claim 1, wherein the surgical tool is co-axially disposed in a guide tube which is configured as a flexible guide tube for insertion into the working channel of the probe.

33. The device according to claim 1, wherein the endoscope is coupled to one end of a coupling member and another end of the coupling member is slidably movable in the housing and against the restoring force of a spring, and wherein a control member is axially disposed in the coupling member and the housing, said control member is in operative connection at one end with the surgical tool via a coupling and at an opposite end with the electric motor via the drive shaft.

34. The device according to claim 33, wherein the surgical tool is at the proximal end thereof operatively connected by means of the coupling to a drive control member which is drivable by the electric motor for rotational movement about the longitudinal axis and for the manual adjustment movement in axial direction.

35. The device according to claim 34, wherein the control member disposed in the housing is configured at a proximal end as a threaded spindle, which is axially slidable as a result of the rotation of the drive shaft.

36. The device according to claim 35, wherein the axial movement of the control member can be actuated by a switch disposed at the housing and connected to a control unit.

37. The device according to claim 1, further comprising a drive mechanism for coupling to a proximal end of the endoscope and which is manually controllable for the axial adjusting movements and the rotational movement about the longitudinal axis of the surgical tool.

38. The device according to claim 37, further comprising an adapter part for coupling engagement with the proximal end of the endoscope and configured as a housing and has at one end a housing section integrally formed thereon, and is provided at another end with an elongated hollow cylindrical housing section with an actuator disposed therein which is slidably movable against the restoring force of a pressure spring.

39. The device according to claim 37, wherein the surgical tool is disposed within the endoscope and operatively connected to an actuator at the proximal end of the surgical tool, said tool is movable about the rotational axis by means of manual operation of the actuator and against the restoring force of the pressure spring for the axial adjusting movement of the surgical tool.