This patent application is related to the following co-filed US non-provisional patent applications: U.S. patent application Ser. No. 14/193,630 titled “Laser Assisted Cataract Surgery”, U.S. patent application Ser. No. 14/193,671 titled “Laser Assisted Cataract Surgery”, and U.S. patent application Ser. No. 14/193,716 titled “Laser Assisted Cataract Surgery”; each of which is incorporated herein by reference in its entirety.
The invention relates generally to laser assisted ophthalmic surgery, and more particularly to methods and devices using one or more lasers in performing a capsulorrhexis.
Cataracts are a common cause of poor vision and are the leading cause of blindness. There are at least 100M eyes with cataracts causing visual acuity of less that 6/60 in meters (or 20/200 in feet). Cataract extraction is the most commonly performed surgical procedure in the world with estimates of over 22 million cases worldwide and over 3 million cases being performed annually in North America. Generally, there are two types of cataract surgery: small incision cataract surgery with phacoemulsification, and extra-capsular cataract extraction.
In small incision cataract surgery with phacoemulsification, the more common approach, about a 2 millimeter (mm) incision is made in the cornea and the opacified natural lens is removed with irrigation, aspiration, and phacoemulsification while leaving the elastic lens capsule intact to allow implantation and retention of an intraocular lens (IOL). Currently, extra-capsular cataract extraction surgery is a more invasive procedure and is performed in the developing countries where there are fewer resources. In this procedure a large incision of 6 mm or more is made in the sclera, and the complete opacified natural lens is removed.
One of the more critical components of both of these surgical procedures is the capsulorrhexis, which is the incision in the lens capsule made to permit removal of the lens nucleus and cortex. The lens capsule is a transparent, homogeneous basement membrane that comprises collagen. It has elastic properties without being composed of elastic fibers. The capsule has a smooth surface contour except at its equator where zonules attach.
Typically the capsulorrhexis creates a symmetric circular incision, centered about the visual axis and sized appropriately for the IOL and the patient's condition. The mechanical integrity around the newly formed incision edge needs to be sufficient to withstand the forces experienced during cataract extraction and IOL implantation. Postoperatively, the newly formed capsule rim hardens and the opening contracts, providing further strength and structural support for the IOL to prevent dislocation and misalignment.
The current standard of care for capsulorrhexis is Continuous Curvilinear Capsulorrhexis (CCC). The concept of CCC is to provide a smooth continuous circular opening through the anterior lens capsule for phacoemulsification and insertion of the intraocular lens, minimizing the risk of complications including errant tears and extensions. Currently, the capsulorrhexis is performed manually utilizing forceps or a needle. This technique depends on applying a shear force and minimizing in-plane stretching forces to manually tear the incision. One complication that may develop when performing a capsulorrhexis in this manner is an errant tear. Errant tears are radial rips and extensions of the capsulorrhexis towards the capsule equator. If an errant tear encounters a zonular attachment the tear may be directed out to the capsular fornix and possibly through to the posterior of the capsule. Posterior capsule tears facilitate the nucleus being “dropped” into the posterior chamber, resulting in further complications.
Further problems that may develop in capsulorrhexis are related to inability of the surgeon to adequately visualize the capsule due to lack of red reflex (reddish reflection of light from the retina), to grasp it with sufficient security, or to tear a smooth symmetric circular opening of the appropriate size. Additional difficulties may relate to maintenance of the anterior chamber depth after initial opening, small size of the pupil, or the absence of a red reflex due to the lens opacity. Additional complications arise in older patients with weak zonules and very young children that have very soft and elastic capsules, which are very difficult to mechanically rupture.
Following cataract surgery there is a rapid 1-2 day response where the capsule hardens and capsule contraction starts. This contraction continues over a 4-6 week period where fibrosis of the capsulorrhexis and IOL optic interface and of the IOL haptic and capsule interfaces also occurs. Even beyond one year the capsule continues to contract to a lesser degree. Thus positioning the capsulorrhexis is a critical factor in the long-term success.
Accordingly, there is a need in the art to provide new ophthalmic methods, techniques and devices to advance the standard of care for capsulorrhexis.
This specification discloses laser assisted ophthalmic surgery methods and devices.
In one aspect, a device for creating an opening in the anterior lens capsule of the eye comprises a scanning treatment laser beam having a programmed scan profile for a predetermined treatment pattern that forms a closed curve at the anterior lens capsule. The treatment laser has a wavelength selected to be strongly absorbed at the anterior lens capsule and a power selected to cause thermal denaturing of collagen in the anterior lens capsule resulting in thermal tissue separation along the closed curve without ablating anterior lens capsule tissue. The device also comprises a scanning visualization laser beam having a programmed scan profile for a predetermined visualization pattern at the anterior lens capsule and a wavelength in the visible spectrum.
The visualization pattern differs from the treatment pattern in size and geometry. At least a portion of the visualization pattern may, for example, indicate desired boundaries of the opening to be created in the anterior lens capsule and thereby facilitate aligning the treatment pattern on the anterior lens capsule. Typically, the desired boundaries of the opening differ in location from the closed curve of the treatment pattern as a result of contraction of anterior lens capsule tissue adjacent to the closed curve during and after thermal tissue separation. Alternatively, or in addition, at least a portion of the visualization pattern may correspond to one or more anatomical features of the eye, and thereby facilitate aligning the treatment pattern with respect to those anatomical features.
In another aspect, a device for creating an opening in the anterior lens capsule of the eye comprises a treatment laser beam and a two-dimensional scanner on which the treatment laser beam is incident. The scanner has a programmed scan profile for a predetermined treatment pattern in which the treatment laser beam is scanned to form a closed curve at the anterior lens capsule. The device comprises a lens positioned to focus the treatment laser beam to a waist at the anterior lens capsule, with the treatment beam expanding from its waist to be defocused on the retina of the eye. The treatment pattern passes through a treatment pattern invariant and/or a treatment pattern waist between the lens and the eye. The treatment laser beam has a wavelength selected to be strongly absorbed at the anterior lens capsule and a power selected to cause thermal denaturing of collagen in the anterior lens capsule resulting in thermal tissue separation along the closed curve of the treatment pattern without ablating anterior lens capsule tissue.
The treatment pattern may diverge in the eye and consequently be expanded in size and area on the retina compared to its size and area at the anterior lens capsule. As a result, the treatment pattern may avoid the fovea on the retina.
In another aspect, a device for creating an opening in the anterior lens capsule of the eye comprises a continuous wave scanning treatment laser beam having a programmed scan profile for a predetermined treatment pattern forming a closed curve at the anterior lens capsule in a single pass. The treatment laser has a wavelength selected to be strongly absorbed at the anterior lens capsule, and a power selected to cause thermal denaturing of collagen in the anterior lens capsule resulting in thermal tissue separation along the closed curve without ablating anterior lens capsule tissue. At the beginning of the treatment pattern the power of the treatment laser ramps up from about zero to about 90% of its full power during a period of about 5 milliseconds to about 200 milliseconds. This ramp-up may minimize the likelihood of the capsule tearing at the starting point of the treatment pattern by allowing the tissue near the starting point of the pattern to initially stretch without separating, thereby reducing the shear stress/tension at the start of the pattern, and/or by avoiding or minimizing local shock waves in the fluid adjacent to the target tissue that might otherwise be generated by the growth and collapse of one or more vapor bubbles accompanying a faster thermal turn-on.
In another aspect, a device for creating an opening in the anterior lens capsule of the eye comprises a treatment laser beam and a two-dimensional scanner on which the treatment laser beam is incident. The scanner has a programmed scan profile for a predetermined treatment pattern in which the treatment laser beam is scanned to form a closed curve at the anterior lens capsule. The device comprises a lens positioned to focus the treatment laser beam to a waist at the anterior lens capsule, with the treatment laser beam expanding from its waist to be defocused on the retina of the eye. The treatment laser beam has a wavelength selected to be strongly absorbed at the anterior lens capsule and a power selected to cause thermal denaturing of collagen in the anterior lens capsule resulting in thermal tissue separation along the closed curve of the treatment pattern without ablating anterior lens capsule tissue. The device also comprises a first visible light visualization laser beam sharing an optical path with the treatment laser beam, and a second visible light visualization laser beam intersecting the first visualization laser beam at or approximately at the waist of the treatment laser beam.
The first visualization laser beam and the second visualization laser beam may be produced, for example, from a single visible light laser beam incident on the scanner by dithering the scanner between the optical path of the first visualization laser beam and the optical path of the second visualization laser beam.
These and other embodiments, features and advantages of the present invention will become more apparent to those skilled in the art when taken with reference to the following more detailed description of the invention in conjunction with the accompanying drawings that are first briefly described.
The following detailed description should be read with reference to the drawings, in which identical reference numbers refer to like elements throughout the different figures. The drawings, which are not necessarily to scale, depict selective embodiments and are not intended to limit the scope of the invention. The detailed description illustrates by way of example, not by way of limitation, the principles of the invention. This description will clearly enable one skilled in the art to make and use the invention, and describes several embodiments, adaptations, variations, alternatives and uses of the invention, including what is presently believed to be the best mode of carrying out the invention. As used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context clearly indicates otherwise.
As described in more detail below, this specification discloses ophthalmic surgery methods and devices that utilize one or more treatment laser beams to create a shaped opening in the anterior lens capsule of the eye when performing a capsulorrhexis procedure. In the procedure, a light absorbing agent may optionally be added onto or into the lens capsule tissue, and the treatment laser wavelength selected to be strongly absorbed by the light absorbing agent. Alternatively, the treatment laser wavelength may be selected to be absorbed or strongly absorbed by the tissue itself, in which case no additional light absorbing agent need be used. In either case, as used herein the phrase “strongly absorbed” is intended to mean that transmission of the treatment beam through the tissue to be treated (e.g., the anterior lens capsule) is less than about 65%, or less than about 40%. The treatment laser beam is directed at the lens capsule tissue along a predetermined closed curve to cause a thermal effect in the tissue resulting in separation of the tissue along the laser beam path. The predetermined closed curve may have, for example, a circular or elliptical shape. Any other suitable shape for the closed curve may also be used. Typically, the shape is selected to reduce the likelihood of tears developing during cataract surgery, on the edge of the separated edge of the tissue that is formed exterior to the closed curve. Visualization patterns produced with one or more target laser beams may be projected onto the lens capsule tissue to aid in the procedure.
General aspects of these methods and devices may be better understood with reference to
Referring now to
For clarity and convenience, various features and aspects of the inventive methods and devices are described below under separately labeled headings. This organization of the description is not meant to be limiting. Variations of the methods and devices described herein may include or employ any suitable combination of aspects or features described under the separate headings.
Treatment Beam Patterns
Any other suitable treatment beam patterns may also be used. One or more treatment beam pattern shapes may be preprogrammed into a laser capsulorrhexis device (described in more detail below) by the manufacturer, for example. At or prior to the time of treatment an operator may then, for example, select the size (e.g., diameter) and shape of the closed curve defining the treatment pattern, or of the desired rhexis to be produced by the closed curve of the treatment pattern.
Visualization/Target Patterns
As noted above, visualization patterns produced with one or more laser beams, which typically differ in wavelength from the treatment beam, may be projected onto the lens capsule tissue to aid in the treatment procedure. The shape and diameter of the visualization pattern may differ from that of the treatment beam pattern. Although the visualization pattern or portions of the visualization pattern may overlie the closed curve of the treatment pattern to indicate at least portions of the path to be taken by the treatment beam, this is not required. Instead, or in addition, at least part of the visualization pattern may overlie the intended location of the outer rim of the opening that will be produced by the tissue-separating treatment beam, or otherwise indicate the desired outcome of the treatment. The location of that outer rim typically differs from and is of larger diameter than the closed curve of the treatment beam pattern for two reasons: (i) the lens capsule tissue is under tension when in the eye (very much like a drum skin), so as the tissue along the closed curve is separated the exterior portion is under tension and pulled peripherally, thus enlarging the diameter; (ii) the mechanism of action for the treatment laser is to locally heat the irradiated anterior capsule on a closed curve, this heating tends to cause the collagen tissue to contract, shrink, and separate exteriorly and interiorly away from the heated closed curve. Alternatively, or in addition, at least part of the visualization pattern may correspond to one or more particular anatomical features of the eye. This may facilitate centering of the visualization pattern (and thus the treatment beam pattern) on the anatomy of the eye, or otherwise facilitate aiming the visualization and treatment beams. The visualization pattern may optionally include a cross-hair.
Any other suitable visualization beam patterns may also be used. One or more visualization beam pattern shapes may be preprogrammed into a laser capsulorrhexis device (described in more detail below) by the manufacturer, for example. At or prior to the time of treatment an operator may then, for example, select a pattern size and shape to be used to guide the treatment.
The location of the visual axis relative to center on the limbus or dilated pupil may also be measured on a separate diagnostic device. The offset data from center may then also be manually or automatically input into the laser capsulorrhexis device. In such cases, the visualization pattern may be arranged so that when an exterior portion of the visualization pattern (e.g., a circle) is positioned or centered on the eye anatomy of the limbus or dilated pupil, the center of an interior portion (e.g., a circle or ellipse) of the visualization pattern is offset from the center of the limbus or dilated pupil to lie on the visual axis. The center of the closed curve of the treatment pattern may be correspondingly offset from the center of the limbus or dilated pupil, so that the central circle or ellipse of the visualization pattern indicates the perimeter of the desired rhexis.
The visualization pattern laser beam may have any suitable wavelength in the visible spectrum. The visualization beam may be scanned across the tissue to be treated at, for example, a speed greater than about 450 mm/second, though it may also dwell to form dots or other brighter features in the visualization pattern. Any suitable scanning speeds may be used. The diameter of the visualization light beam on the tissue surface may be, for example, about 50 to about 600 microns. The visualization laser beam power at the tissue may be, for example, less than about 10 mW or less than about 1 mW when the beam is dwelling on a dot in the visualization pattern. When the visualization beam is scanning its power may be, for example, less than about 30 mW. Generally the power and the wavelength of the laser beam are selected to provide a sufficiently visible visualization pattern without significantly depleting any absorbing agent that has been deposited on the tissue to facilitate treatment.
Treatment Beam and Scanning Parameters
Generally, parameters characterizing the treatment laser beam and the treatment beam scanning procedure are selected to provide the desired laser induced thermal separation of tissue at the treated tissue while minimizing or reducing the risk of damage to the retina. These laser and scanning parameters may include, for example, laser wavelength, laser beam power, spot size at the treated tissue, fluence and peak irradiation at the treated tissue, spot size on the retina, fluence and peak irradiation on the retina, scanning speed, temporal profile of the laser beam during the scan, and scanning pattern size and location on the retina.
Typically, a treatment beam from a continuous wave laser traces the treatment beam pattern in a single pass in a time period of, for example, less than about 10 seconds, less than about 5 seconds, less than about 1 second, about 10 seconds, about 5 seconds, or about 1 second. The treatment beam may move across the treated tissue at a speed, for example, of about 20 millimeters/second (mm/s) for a 1 second scan to about 2 mm/s for a 10 second scan, but any suitable scanning speed and duration may be used. The formation of irregularities or tears in the resulting rim of tissue is reduced or avoided because movement of the continuous wave laser beam along the treatment path occurs during irradiation of the treated tissue (rather than between discrete laser pulses, for example), and thus all portions of the rim are formed with the same or similar irradiation and thermal conditions. Using a single pass of the treatment beam also helps to ensure completion of the capsulorrhexis even if there is slight movement of the eye relative to the trajectory.
In variations in which the treatment beam path begins on the interior of the closed curve of the treatment pattern (see
Referring now to the plot of laser power versus time shown in
As shown in
As noted earlier in this specification, the treatment laser beam wavelength may be selected to be strongly absorbed by a light absorbing agent optionally added onto or into the tissue to be treated. The treatment laser may operate at a wavelength of about 577 nanometers or about 810 nanometers, for example. In such examples the light absorbing agent, if used, may be Trypan Blue or Indocyanine Green, respectively. Alternatively, the treatment laser wavelength may be selected to be absorbed or strongly absorbed by the tissue itself. Any suitable wavelength for the treatment beam may be used.
As described in more detail below, typically the treatment laser beam is focused to a waist at or near the location of the tissue to be treated, and then expands in diameter as it propagates to the retina. Also, typically the scanning pattern is expanded on the retina compared to its size on the treated tissue. Consequently, parameters such as fluence and peak irradiation for the treatment beam may have different and larger values at the treated tissue compared to their values at the retina.
The methods and devices disclosed herein typically rely on laser induced thermal separation of tissue rather than on laser induced ablation, and may therefore use much lower treatment beam fluence and peak irradiation values at the treated tissue than typically required by other laser based surgical procedures. In addition, the methods and devices disclosed herein may use treatment laser beams having relatively high average power without producing peak irradiation values that are potentially damaging to the retina or other eye tissue, because these methods and devices may use long (e.g., 1 to 10 second) pulses from a continuous wave laser. In contrast, laser based surgical procedures using much shorter Q-switched or mode-locked laser pulses may be required to operate at much lower average powers to avoid potentially damaging peak irradiance values, which may increase the time required to provide a desired fluence.
The average power of the treatment beam, which is selected depending in part on the absorption strength of the absorbing agent at the treatment beam wavelength or the absorption strength of the treated tissue at the treatment beam wavelength, may be for example about 300 mW to about 3000 mW. Any suitable average power may be used.
The treatment beam fluence on a particular tissue depends on the average power in the treatment beam, the diameter of the treatment beam at that tissue, and the scanning speed of the treatment beam across that tissue. For the methods and devices disclosed herein, at the tissue to be treated (e.g., the anterior lens capsule) the treatment beam fluence for a 1 second scan may be for example about 80 Joules/centimeter2 (J/cm2) to about 450 J/cm2. For a 5 second scan the fluence at the tissue to be treated may be for example about 100 J/cm2 to about 1600 J/cm2. For a 10 second scan the fluence at the tissue to be treated may be for example about 100 J/cm2 to about 2000 J/cm2.
The treatment beam peak irradiance on particular tissue depends on the peak power in the treatment beam and the diameter of the treatment beam at that tissue. For the methods and devices disclosed herein, at the tissue to be treated (e.g., the anterior lens capsule) the treatment beam peak irradiance may be, for example, less than about 50,000 Watt/centimeter2 (W/cm2), or less than about 100,000 W/cm2, or less than about 150,000 W/cm2, or less than about 200,000 W/cm2.
In general, at the retina the treatment beam fluence is less than about 200 J/cm2 and the irradiance is less than about 2000 W/cm2. In one embodiment with an NA of about 0.03 and a beam diameter of about 1,400 microns on the retina, for a 1 second scan speed for example, the fluence at the retina has a maximum of about 5 J/cm2. For a 5 second scan the fluence at the retina may for example have a maximum of about 25 J/cm2. For a 10 second scan the fluence at the retina may for example have a maximum of about 50 J/cm2. The irradiance may have for example a maximum for example of about 200 W/cm2 on the retina, across these 1, 5 and 10 second scan speeds for a system with an NA of about 0.03.
Referring now to
Hence it may be preferable to use a treatment beam having a diameter of about 200 microns at the treated tissue. This may reduce the required irradiance in the treatment beam and thus decrease the risk of damaging the retina. More generally, the treatment laser beam may have a diameter of, for example, about 50 microns to about 400 microns at the treated tissue.
Use of Surgical Contact Lens
A surgical contact lens may be used to neutralize or approximately neutralize the cornea's focusing power on the retina to further reduce risk of damaging the retina, and in particular to protect the fovea. (The fovea is located in the center of the macula region of the retina, and is responsible for sharp central vision).
Use of a surgical contact lens as just described to refract the scanned treatment beam pattern away from the fovea allows the treatment laser to be operated at a higher power, without damaging the fovea or other portions of the retina, than might otherwise be the case. Such use of a surgical contact lens is optional, however.
Treatment/Scanning Device
Referring now to
The two-dimensional scanner 1940 has different tilt positions to create a scanned pattern on the anterior capsule. The solid line depiction of the scanner represents one example tilt position, and the dash line depiction of the scanner represents a second tilt position. In this example device the optics are designed such that there is a scanner pattern invariant 1985 (a location at which there is no apparent motion of the scanned pattern) and waist between the lens 1950 and its focus. Compared to a system lacking a scanner pattern invariant located in this manner, this arrangement has the advantages of reducing or minimizing the size of the optical device, reducing or minimizing the required two-dimensional scanner tilt, reducing or minimizing the area required on the optional final mirror, and providing additional divergence of the scanned pattern along the optical path so that for the same size and shape pattern on the anterior capsule, the projection on the retina has a larger diameter and therefore less fluence and less associated temperature rise at the retina.
Example device 1900 also includes an optional light detector 1990. The two-dimensional scanner 1940 may deflect the treatment or visualization laser beams to detector 1990, which may be used for example to measure their power. Detector 1990 may be a detector array, for example, in which case the two-dimensional scanner 1940 may scan the treatment or visualization laser beam across the detector array to confirm that the scanner is functioning properly.
Device 1900 further includes an optional aberrometer 1995, which may be used to make refractive measurements of the eye to be treated. This may be accomplished, for example, by tilting the two-dimensional scanner 1940 to direct an output light beam from aberrometer 1995 along the optical path used for the visualization and treatment beams into the eye. Alternatively, a light beam from aberrometer 1995 could optionally be introduced into the optical path of device 1900 with a dichroic beam splitter, for example.
Device 1900 includes a scanner controller 1928. The scanner controller may be preprogrammed with one or more treatment beam pattern shapes and one or more visualization pattern shapes by the manufacturer, for example. At or prior to the time of treatment an operator may then, for example, select treatment and visualization pattern sizes and shapes to be used in a particular treatment procedure.
Any other suitable device design may also be used to perform the procedures described herein.
Integration with Microscope
Example device 1900 described above may be integrated with a microscope.
Any other suitable integration with a microscope may also be used.
Depth Alignment
A preliminary step in using device 1900 is to adjust the position of the device, or of the optical elements within the device, with respect to the patient's eye so that the waist (focus) of the treatment beam is at or approximately at the tissue to be treated. This may be done, for example, by viewing a visualization pattern (e.g., as described above) that is projected onto the tissue to be treated and adjusting device 1900 to bring the visualization pattern into focus on the tissue. However, in this approach any uncorrected deficiency in the operator's vision (e.g., myopia) may affect the operator's judgment as to whether or not the visualization pattern is in focus on the tissue to be treated. This may result in an incorrect adjustment of the treatment device.
Referring now to
Beam 2210 follows the optical path of the treatment and visualization laser beams described above with respect to
If the intersection of beams 2210 and 2215 (and thus the treatment beam waist) is not properly positioned at the treatment tissue, the position of device 2200 or of optical elements within the device may be adjusted with respect to the patient's eye to move the intersection of the visualization beams, and thus the treatment beam waist, to the desired position.
Referring now to
Although the illustrated example uses a line 2310 and a dot 2315, any other suitable patterns for intersecting beams 2210 and 2215 may be used to identify and adjust the position of the treatment beam waist with respect to the tissue to be treated. Typically the visualization patterns used in depth alignment mode differ from those described earlier in this specification. Although in the illustrated example intersecting beams 2210 and 2215 are produced from a single visualization laser beam by dithering the scanner 1940, any other suitable method of intersecting visible beams to identify the location of the treatment beam waist may also be used. Beams 2210 and 2215 may have the same wavelength, as in the example just described, or different wavelengths.
Device 2200 may be switchable between several different operating modes including the depth alignment mode just described. For example, in some variations device 2200 may be switchable between at least the following modes:
Referring to
Some variations of device 2220 may also be switchable into and out of a Visualization Sizing Mode. In the Visualization Sizing Mode, a visualization sizing pattern is projected onto the anterior lens capsule to guide positioning of the desired rhexis and thus positioning of the desired closed curve of the treatment beam. The size (e.g., diameter or another dimension) of the visualization sizing pattern is adjustable to increase or decrease a corresponding dimension of the desired rhexis to be formed by the treatment beam. In these variations, the device may be switched between modes in the following order, for example: Standby Mode, Depth Alignment Mode, Visualization Sizing Mode, Ready Mode, Standby Mode. This may be done, for example, by sequential activation of button 2405 (
Referring to
Any other suitable switching mechanism may be used to switch between the operating modes just described. The switching mechanism may be or include switches intended to be hand operated, for example. Further, variations of foot-operable control 2400 described above, or of any other suitable switching mechanism, may be configured to allow the device to be switched from Depth Alignment Mode to Standby Mode, from Visualization Sizing Mode (if available) to Depth Alignment Mode, or from Ready Mode to Visualization Mode (if available) or Depth Alignment Mode. This may be accomplished using additional switching buttons for these transitions, for example, or with a button that reverses the direction in which button 2405 moves the device through the sequence of modes.
Detecting a Light Absorbing Agent
In variations of the procedures described herein in which a light absorbing agent is used to facilitate laser assisted thermal tissue separation, it may be desirable to optically or visually confirm that the light absorbing agent has been correctly placed prior to performing the treatment. This may be done, for example, with a detection laser beam having a wavelength selected to be reflected rather than absorbed by the light absorbing agent (and thus different from the wavelength of the treatment beam). For example, if the light absorbing agent is Trypan Blue the detection beam may be chosen to have a wavelength in the blue region of the visible spectrum. Alternatively, the light absorbing agent may be detected with the treatment beam by exciting and detecting fluorescence from the light absorbing agent. In the latter case the measurement may preferably be made at a position away from the treatment location to avoid depleting light absorbing agent required for the treatment scan.
Reflected light or fluorescence indicating the presence of the light absorbing agent may be observed or detected, for example, through a microscope integrated with the treatment device as described above. A detection laser beam (e.g., from detection laser 1926 in
This disclosure is illustrative and not limiting. Further modifications will be apparent to one skilled in the art in light of this disclosure and are intended to fall within the scope of the appended claims. For example, in some variations pulsed lasers may be use instead of continuous wave lasers to produce visualization and/or treatment laser beams in the methods and devices described above.
Number | Name | Date | Kind |
---|---|---|---|
3971382 | Krasnov | Jul 1976 | A |
3982541 | L'Esperance, Jr. | Sep 1976 | A |
4367744 | Sole | Jan 1983 | A |
4481948 | Sole | Nov 1984 | A |
4538608 | L'Esperance, Jr. | Sep 1985 | A |
4907586 | Bille et al. | Mar 1990 | A |
5261923 | Soares | Nov 1993 | A |
5283598 | McMillan et al. | Feb 1994 | A |
5296787 | Albrecht et al. | Mar 1994 | A |
5346491 | Oertli | Sep 1994 | A |
5350374 | Smith | Sep 1994 | A |
5437658 | Muller et al. | Aug 1995 | A |
5507740 | O'Donnell, Jr. | Apr 1996 | A |
5520679 | Lin | May 1996 | A |
5569280 | Kamerling | Oct 1996 | A |
5620435 | Belkin et al. | Apr 1997 | A |
5722970 | Colvard et al. | Mar 1998 | A |
5798349 | Levy et al. | Aug 1998 | A |
5860994 | Yaacobi | Jan 1999 | A |
5873883 | Cozean, Jr. et al. | Feb 1999 | A |
5958266 | Fugo et al. | Sep 1999 | A |
5984916 | Lai | Nov 1999 | A |
6010497 | Tang et al. | Jan 2000 | A |
6033396 | Huang et al. | Mar 2000 | A |
6063073 | Peyman | May 2000 | A |
6159205 | Herekar et al. | Dec 2000 | A |
6165190 | Nguyen | Dec 2000 | A |
6171336 | Sawusch | Jan 2001 | B1 |
6210401 | Lai | Apr 2001 | B1 |
6280470 | Peyman | Aug 2001 | B1 |
6325792 | Swinger et al. | Dec 2001 | B1 |
RE37504 | Lin | Jan 2002 | E |
6351663 | Flower et al. | Feb 2002 | B1 |
6367480 | Coroneo | Apr 2002 | B1 |
6375449 | Coroneo | Apr 2002 | B1 |
6471691 | Kobayashi | Oct 2002 | B1 |
6520955 | Reynard | Feb 2003 | B2 |
6533769 | Holmen | Mar 2003 | B2 |
6575962 | Hohla | Jun 2003 | B2 |
6607527 | Ruiz et al. | Aug 2003 | B1 |
6673067 | Peyman | Jan 2004 | B1 |
6720314 | Melles | Apr 2004 | B1 |
7014991 | Buono | Mar 2006 | B2 |
7691099 | Berry | Apr 2010 | B2 |
8408182 | Mordaunt | Apr 2013 | B2 |
8562596 | Mordaunt | Oct 2013 | B2 |
20030213780 | Fugo et al. | Nov 2003 | A1 |
20040111083 | Gross et al. | Jun 2004 | A1 |
20040206364 | Flower | Oct 2004 | A1 |
20050173383 | Coccio et al. | Aug 2005 | A1 |
20050284774 | Mordaunt | Dec 2005 | A1 |
20050288745 | Andersen et al. | Dec 2005 | A1 |
20060111697 | Brinkmann et al. | May 2006 | A1 |
20060195074 | Bartoli | Aug 2006 | A1 |
20060195076 | Blumenkranz et al. | Aug 2006 | A1 |
20070043339 | Horvath | Feb 2007 | A1 |
20070055156 | Desilets et al. | Mar 2007 | A1 |
20070093868 | Fugo | Apr 2007 | A1 |
20070121069 | Andersen et al. | May 2007 | A1 |
20070126985 | Wiltberger et al. | Jun 2007 | A1 |
20070129709 | Andersen et al. | Jun 2007 | A1 |
20070129775 | Mordaunt et al. | Jun 2007 | A1 |
20070147730 | Wiltberger et al. | Jun 2007 | A1 |
20070189664 | Andersen et al. | Aug 2007 | A1 |
20070230520 | Mordaunt et al. | Oct 2007 | A1 |
20070265602 | Mordaunt et al. | Nov 2007 | A1 |
20080015553 | Zacharias | Jan 2008 | A1 |
20080281303 | Culbertson et al. | Nov 2008 | A1 |
20080284979 | Yee et al. | Nov 2008 | A1 |
20090088734 | Mordaunt | Apr 2009 | A1 |
20090137993 | Kurtz | May 2009 | A1 |
20100215066 | Mordaunt et al. | Aug 2010 | A1 |
20110172649 | Schuele et al. | Jul 2011 | A1 |
20110178511 | Blumenkranz et al. | Jul 2011 | A1 |
20110178512 | Blumenkranz et al. | Jul 2011 | A1 |
20110245817 | Yokosuka | Oct 2011 | A1 |
20120029489 | Mordaunt et al. | Feb 2012 | A1 |
20120242957 | Mordaunt | Sep 2012 | A1 |
20120245571 | Mordaunt et al. | Sep 2012 | A1 |
20120259320 | Loesel et al. | Oct 2012 | A1 |
20120316545 | Blumenkranz et al. | Dec 2012 | A1 |
20130023864 | Blumenkranz et al. | Jan 2013 | A1 |
20130072915 | Grant et al. | Mar 2013 | A1 |
20130100409 | Grant et al. | Apr 2013 | A1 |
20130103010 | Grant et al. | Apr 2013 | A1 |
20130103011 | Grant et al. | Apr 2013 | A1 |
20130103012 | Grant et al. | Apr 2013 | A1 |
20130103015 | Grant et al. | Apr 2013 | A1 |
20130197634 | Palanker et al. | Aug 2013 | A1 |
20130231645 | Mordaunt | Sep 2013 | A1 |
20130289543 | Mordaunt | Oct 2013 | A1 |
20130294668 | Mordaunt et al. | Nov 2013 | A1 |
20130345683 | Mordaunt et al. | Dec 2013 | A1 |
20140046310 | Mordaunt | Feb 2014 | A1 |
20140128686 | Klaffenbach et al. | May 2014 | A1 |
20140135749 | Goh et al. | May 2014 | A1 |
20140135751 | Hohla et al. | May 2014 | A1 |
20140228826 | Blumenkranz et al. | Aug 2014 | A1 |
20140228827 | Blumenkranz et al. | Aug 2014 | A1 |
20140257257 | Grant et al. | Sep 2014 | A1 |
20140316386 | Blumenkranz et al. | Oct 2014 | A1 |
20140347632 | Mordaunt | Nov 2014 | A1 |
20150009576 | Mordaunt et al. | Jan 2015 | A1 |
20150038951 | Blumenkranz et al. | Feb 2015 | A1 |
20150038952 | Blumenkranz et al. | Feb 2015 | A1 |
20150100049 | Mordaunt et al. | Apr 2015 | A1 |
20150141968 | Blumenkranz et al. | May 2015 | A1 |
20150157507 | Mordaunt et al. | Jun 2015 | A1 |
Number | Date | Country |
---|---|---|
1759672 | Mar 2007 | EP |
1999058160 | Nov 1999 | WO |
2001003620 | Jan 2001 | WO |
2014039093 | Mar 2014 | WO |
Entry |
---|
Haritoglou et al., “An Evaluation of Novel Vital Dyes for Intraocular Surgery”, Investigative Ophthalmology & Visual Science, Sep. 2005, vol. 46, No. 9, pp. 3315-3322. |
PCT International Search Report and Written Opinion of the ISA, PCT/US2015/018158, dated Jul. 13, 2015, 14 pages. |
Fritz, Wolfram L., M.D., “Fluorescein blue, light-assisted capsulorhexis for mature or hypermature cataract”, J Cataract Refract Surg—vol. 24, Jan. 1998, pp. 19-20. |
Gimbel, Howard V., M.D., et al., “Development, advantages, and methods of the continuous circular capsulorhexis technique”, J Cataract Refract Surg—vol. 16, Jan. 1990, pp. 31-37. |
Hoffer, Kenneth J., J.D., et al., “Intracameral Subcapsular Fluorescein Staining for Improved Visualization During Capsulorhexis in Mature Cataracts”, J Cataract Refract Surg—vol. 19, Jul. 1993, 1 page. |
Horiguchi et al., “Staining of the Lens Capsule for Circular Continuous Capsulorrhexis in Eyes with White Cataract”, Arch Ophthalmol, vol. 116, Apr. 1998, http://archopht.jamanetwork.com, Jan. 24, 2015, pp. 535-537. |
Burk, Scott E., M.D., et al., “Indocyanine Green-assisted Peeling of the Retinal Internal Limiting Membrane”, Association of University Professors of Ophthalmology, 2000, the American Academy of Ophthalmology, pp. 2010-2014. |
Norn, “Per Operative Trypan Blue Vital Staining of Corean Endothelium Eight Years' Follow Up”, ACTA Opthalmologica, vol. 58, 1980, pp. 550-555. |
Nor, “Pachometric Study on the Influence of Corneal Endothelial Vital Staining Corneal Thickness after Cataract Extraction Studies by Vital Staining with Trypan Blue”, ACTA Opthalmologica, vol. 51, 1973, pp. 679-686. |
Solomon, Kerry D., M.D., et al., “Protective Effect of the Anterior Lens Capsule during Extracapsular Cataract Extraction,” Department of Ophthalmology, Medical University of South Carolina, Charleston, Aug. 1, 1988, pp. 591-597. |
Melles, Gerrit, R.J., M.D., et al., “Trypan blue capsule staining to visualize the capsulorhexis in cataract surgery”, J Cataract Refract Surg—vol. 25, Jul. 1999, pp. 7-9. |
Chang, David F., M.D., “Trypan Blue Versus Indocyanine Green”, Cataract & Refractive Surgery Today, Mar. 2005, 4 pages. |
Kochubey et al., “Spectral Characteristics of Indocyanine Green upon Its Interaction with Biological Tissues”, Optics and Spectroscopy, vol. 99, No. 4, 2005, pp. 560-566. |
Graham, et al. “Experimental and theoretical study of the spectral behavior of Trypan Blue in various solvents”, Journal of Molecular Structure 1040 (2013) 1-8. |
Search Report corresponding the CN Application No. 201580016670.5, dated May 2, 2018, 2 pages. |
Number | Date | Country | |
---|---|---|---|
20150245947 A1 | Sep 2015 | US |