Photodisruptive laser treatment of the crystalline lens

• US 9,456,925 B2
• Filed: 12/23/2008
• Issued: 10/04/2016
• Est. Priority Date: 09/06/2007
• Status: Active Grant

• Current Assignee: Alcon Incorporated
• Original Assignee: Alcon LenSx, Inc. (Alcon Incorporated)
• Inventors: Kurtz, Ronald M., Raksi, Ferenc, Goldstein, Peter
• Primary Examiner(s): Thomson, William
• Assistant Examiner(s): Shapiro, Victor
• Application Number:
  US12/343,418
• Publication Number:
  US 20090171327A1
• Time in Patent Office: 2,842 Days
• Field of Search: 606/6, 606/5, 606/8, 606/10, 606/4, 600/439, 356/450
• US Class Current: 1/1
• CPC Class Codes: A61F 2009/00851 Optical coherence topography [OCT]
• CPC Class Codes: A61F 2009/0087 Lens
• CPC Class Codes: A61F 2009/00895 Presbyopia
• CPC Class Codes: A61F 2009/00897 Scanning mechanisms or algorithms
• CPC Class Codes: A61F 9/008 using laser
• CPC Class Codes: A61F 9/00838 Correction of presbyopia
• CPC Class Codes: A61F 9/009 Auxiliary devices making contact with the eyeball and coupling in laser light, e.g. goniolenses apparatus for eye examination A61B3/0008

Abstract

Apparatus and methods of treating a hard lens region of an eye with a laser where one method includes identifying a boundary of the hard lens region, selecting a laser-parameter to enable a photodisruptive procedure in the hard lens region and to control a spreading of bubbles in the hard lens region, modifying a mechanical property of a posterior portion of the hard lens region in a proximity of the identified boundary by the photodisruptive procedure, and modifying a mechanical property of a portion anterior to the modified posterior portion of the hard lens region by the photodisruptive procedure. The laser bubbles can be applied to form incisions which are non transverse to an axis of the eye and intersect the lens fibers.

Claims

1. A method of treating a crystalline lens of an eye with a laser, the method comprising:

selecting a surgical region of the lens; and

forming an incision in the surgical region on a layer-by-layer basis by scanning a laser beam with an XY scanner of a laser delivery optics along a curved focal plane of the laser delivery optics to form a line of bubbles in each layer without adjusting a Z scanner of the laser delivery optics at a scanning rate of the XY scanner, wherein;

an orientation of a portion of the incisions is one of an orientation intersecting fibers of the lens and an orientation non-transverse to an axis of the eye; and

the incision has a spatial extent in a Z direction in the range of 0.5-10 mm, and in an X-Y plane in the range of 2-10 mm.

2. The method of claim 1, wherein the non-transverse orientation of the incision is one of:

an orientation substantially parallel to the axis of the eye; and

an orientation making a less than 90 degree angle with the axis of the eye.

3. The method of claim 1, wherein:

a spatial extent of the incision along the axis of the eye is longer than the spatial extent transverse to the axis of the eye.

4. The method of claim 1, wherein:

the axis of the eye is one of a visual axis, an optic axis, a line of sight and a pupillary axis.

5. The method of claim 1, wherein:

the incision cuts the fibers into parts approximately at the intersection of the incision and the fibers; and

the modified property of the lens is a weakening of a biomechanical property of the lens.

6. The method of claim 1, wherein:

the incision cuts the fibers at or near sutures of the fibers.

7. The method of claim 1, wherein:

the incision avoids cutting sutures in the lens.

8. The method of claim 1, wherein the applying laser pulses comprises:

applying the laser pulses to generate gas bubbles which form the incision,

wherein an orientation of the incision is aligned with a preferential direction of expansion of the generated gas bubbles.

9. The method of claim 1, wherein the applying the laser pulses comprises:

moving the focal point of the applied laser beam along a posterior to anterior direction within the lens.

10. The method of claim 1, wherein:

the method comprises forming no more than one incision; and

the laser pulses are applied in a continuous manner to form the incision without repositioning the laser or interrupting the application of the laser.

11. The method of claim 1, wherein the incision has a form aligned with the axis of the eye, the form being of at least one of:

a cylinder, a set of concentric cylinders, a set of cylinders connected by one or more connecting line, a curved surface, a cone, a spiral, a layered spiral with smooth lines connecting layers of the spiral and a tilted cylinder.

12. The method of claim 1, wherein the incision has a form aligned with the axis of the eye, the form being at least one of:

a plane, two or more crossing planes, a combination of planes and connecting arcs, and a combination of planes and cylinders.

13. The method of claim 1, wherein the applying the laser pulses comprises:

applying the laser pulses to form a first ring with a first radius in a posterior layer of the lens;

applying the laser pulses to form a connector line between the first and a second ring in the posterior layer;

applying the laser pulses to form the second ring with a second radius in the posterior layer; and

repeating multiple times the formation of the first ring, the second ring and the connector line in layers sequentially anterior to the posterior layer,

wherein the first rings in the sequential layers form a first cylinder, the second rings form a second cylinder, the cylinders being connected by the connector lines.

14. The method of claim 13, wherein:

the connector lines in sequential layers are one of;

aligned to form connector planes; and

not-aligned from layer to layer.

15. The method of claim 1, comprising:

forming a posterior spiral in a posterior layer;

forming a smooth connector line starting near an end of the posterior spiral in the posterior layer, the connector line smoothly bending and rising to a central region of a layer anterior to the posterior layer; and

forming an anterior spiral starting at the end of the smooth connector line in the central region of the anterior layer.

16. The method of claim 15, wherein the posterior spiral and the anterior spiral are essentially aligned to form a spiral with an extent in the Z direction.

17. The method of claim 1, wherein the applying the laser pulses comprises:

selecting laser-parameters sufficient to create bubbles in the lens, but insufficient to cause harm to a retina of the eye.

18. The method of claim 1, wherein the applying the laser pulses comprises:

applying the laser pulses with laser-parameters insufficient to fragment the lens to a degree suitable for removal, if the incision were transverse to the axis of the eye.

19. The method of claim 18, wherein the laser-parameters comprise:

a laser pulse energy in the range of 0.5 microJ to 50 microJ;

a duration of a laser pulse in the range of 0.005 picoseconds to 25 picoseconds;

a repetition rate of applying laser pulses in the range of 1 kHz to 10 MHz; and

a separation distance of target regions of laser pulses in the range of 1 micron to 100 microns.

20. The method of claim 1, wherein the applying the laser pulses comprises:

applying the laser pulses with varying energy as the incision is formed.

21. The method of claim 20, wherein the energy is varied during at least one of:

a Z directional scanning; and

an X-Y directional scanning.

22. The method of claim 20, wherein the energy is varied in relation to a measurement of an optical property of an eye tissue.

23. The method of claim 1, comprising:

forming the incision on a layer-by-layer basis, wherein

one or more layers are at least partially formed along a curved focal plane of a laser delivery system.

24. The method of claim 1, comprising:

a Z directional scanner is adjusted at a slower rate than an X-Y directional scanner when forming a layer of one or more incisions.

25. The method of claim 1, further comprising:

forming a protection layer in a posterior portion of the lens, positioned to block a large portion of the laser pulses applied to form the incision.

26. The method of claim 1, wherein the incision fragments at least a portion of the lens, the method further comprising:

removing the fragmented portion of the lens.

27. The method of claim 26, wherein the applying the laser pulses comprises:

applying laser pulses with laser parameters which do not cause lasting damage to a retina of the eye, wherein

the laser pulses fragment the lens to a degree suitable for removal; and

the time of the fragmentation is less than a minute.