Apparatus and method for improving follow-up in laser-based ocular surgery

Abstract

Devices and methods for improving follow-up in laser-based ocular surgery are disclosed. In some embodiments, the ophthalmic instrument includes a protrusion at the distal end of the shaft or cannula, the protrusion having a distal surface proximate the distal end of the optical fiber, the distal surface adapted to be positioned facing a treatment region during use of the ophthalmic instrument. An example method includes delivering laser energy through an optical fiber to a treatment region, where a distal surface of the protrusion inhibits bubbles formed during surgery from moving distally away from a distal end of the ophthalmic instrument.

Description

Technical Field

[0001] The present disclosure relates to devices and methods for improving follow-up in laser-based ocular surgery. Background Art

[0002] Lasers are used in many different medical procedures, including many different ophthalmic surgeries. For example, lasers can be used in cataract surgery, such as to fragment and / or emulsify a cataractous lens. In some surgeries, a laser is used to achieve initial fragmentation of the lens, followed by phacoemulsification of the lens by an ultrasonic handpiece to complete the breakdown of the lens for removal. In other surgeries, a laser can be used for complete fragmentation and / or emulsification of the lens for removal without the need for separate application of ultrasonic energy. Lasers can also be used for other steps in cataract surgery, such as for making one or more corneal incisions and / or opening the capsule.

[0003] U.S. Patent Application Publication No. 2018 / 0360657 discloses examples of ophthalmic laser systems. The application describes uses of lasers, such as for forming surgical incisions or for photorupturing ophthalmic tissue and for cataract surgery, such as laser-assisted cataract surgery (LACS). U.S. Patent Application Publication No. 2019 / 0201238 discloses other examples of ophthalmic laser systems. The application describes uses of lasers, such as for cutting or breaking vitreous fibers in a vitrectomy probe. U.S. Patent Application Publication No. 2018 / 0360657 and U.S. Patent Application Publication No. 2019 / 0201238 are expressly incorporated herein by reference in their entirety.

[0004] Some laser systems emit pulses, where the pulses have a desired duration and repetition rate. Operating a laser in a pulsed manner can achieve desirable power and energy characteristics for a particular application.

[0005] The basic mechanism for emulsifying or destroying the lens or other ocular tissue (e.g., in cataract surgery) is by delivering laser energy with appropriate wavelength and pulse duration to the end of an optical fiber (e.g., sapphire fiber). The laser immediately initiates a plasma zone just in front of the optical surface due to the absorption of the laser energy by the surrounding material. The laser-induced plasma nucleates and begins to form bubbles, which are used to destroy their surroundings by the expansion and subsequent collapse of the bubbles. When the lens, cataract lens, and other ocular tissues are present in the bubble zone, they can be ruptured and emulsified by the laser bubble action. Summary of the invention

[0006] The present disclosure relates to devices and methods for improving follow-up in laser-based ocular surgery.

[0007] In some embodiments, an ophthalmic device includes: a shaft having a distal end suitable for insertion into a patient's eye toward a treatment area; an optical fiber for delivering laser energy to the treatment area, the optical fiber having a distal end suitable for positioning facing the treatment area during use of the ophthalmic device; and a protrusion located at the distal end of the shaft, the protrusion having a distal surface proximate the distal end of the optical fiber, the distal surface suitable for positioning facing the treatment area during use of the ophthalmic device.

[0008] In some embodiments, the surface area of ​​the distal surface of the projection is at least twice the surface area of ​​the end face of the shaft. In some embodiments, the surface area of ​​the distal surface of the projection can be at least eight times the surface area of ​​the end face of the shaft. In some embodiments, the distal surface of the projection has a length of 0.020 inches to 0.090 inches and a width of 0.020 inches to 0.060 inches. Smaller or larger lengths and / or widths may be used.

[0009] In some embodiments, the shaft is tubular. The optical fiber can be located inside the shaft. In other embodiments, the optical fiber can be located outside the shaft. The shaft can be a cannula suitable for aspirating from the treatment area.

[0010] In some embodiments, the ophthalmic instrument may include a tip positioned on the distal end of the shaft, wherein the protrusion is part of the tip. The tip may be transparent. The tip may be composed of a polymer material such as polycarbonate.

[0011] The ophthalmic instrument may include an irrigation cannula. The irrigation cannula includes a proximal hub adapted to be coupled to a housing of the ophthalmic instrument and a distal tube adapted to be fitted around a shaft. The distal tube of the irrigation cannula may have: a distal end; an end opening located at the distal end of the distal tube adapted to be fitted around the distal end of the shaft; and at least one side opening located at the distal end of the distal tube proximal to the end opening adapted to allow irrigation fluid to flow therethrough.

[0012] In some embodiments, the protrusion may be part of an irrigation sleeve.The irrigation sleeve may be constructed of an elastomeric material such as silicone rubber.

[0013] The shaft may have a longitudinal axis, and the protrusion may be asymmetric about the longitudinal axis of the shaft.The protrusion may be angled relative to the longitudinal axis of the shaft.

[0014] In some embodiments, a method of performing an ophthalmic surgical procedure comprises: inserting a distal end of an ophthalmic instrument into an eye of a patient toward a treatment area, the ophthalmic instrument comprising a shaft, an optical fiber, and a protrusion; positioning the distal end of the ophthalmic instrument adjacent to the treatment area such that the distal end of the optical fiber faces the treatment area and a distal surface of the protrusion faces the treatment area; and delivering laser energy to the treatment area through the optical fiber; wherein the distal surface of the protrusion is used to inhibit bubbles formed during the procedure from moving distally away from the distal end of the ophthalmic instrument.

[0015] Other examples and features of embodiments of the present invention will be apparent from the accompanying drawings and detailed description. BRIEF DESCRIPTION OF THE DRAWINGS

[0016] The drawings illustrate example implementations of the systems and methods disclosed herein and, together with the description, serve to explain the principles of the present disclosure.

[0017] Figure 1 An example of an ophthalmic instrument with a laser fiber is shown.

[0018] Figure 2 Shows Figure 1 Magnified view of the distal end of an ophthalmic instrument.

[0019] Figure 3 A tip for an ophthalmic instrument according to an embodiment of the present disclosure is shown.

[0020] Figure 4 The embodiment according to the present disclosure is shown Figure 3 The distal end of an ophthalmic instrument.

[0021] Figure 5 Shows Figure 4 Another view of the distal end of an ophthalmic instrument.

[0022] Figure 6 A distal end of an ophthalmic instrument according to another embodiment of the present disclosure is shown.

[0023] The drawings can be better understood with reference to the following detailed description. DETAILED DESCRIPTION

[0024] For the purpose of promoting understanding of the principles of the present disclosure, reference will now be made to the implementations illustrated in the accompanying drawings, and specific language will be used to describe those implementations and other implementations. Nevertheless, it will be understood that the examples shown in the drawings or described herein are not intended to limit the scope of the claims. Those skilled in the art in the technical field to which the present disclosure relates are generally fully able to envision any changes and further modifications to the illustrated or described systems, devices, instruments or methods, as well as any further applications of the principles of the present disclosure. In particular, the features, components and / or steps described with respect to one embodiment of the present disclosure may be combined with the features, components and / or steps described with respect to other embodiments of the present disclosure. For simplicity, in some cases, the same reference numerals are used throughout the drawings to refer to the same or similar parts.

[0025] The names "first" and "second" as used herein are not meant to indicate or imply any particular positioning or other characteristics. Rather, when the names "first" and "second" are used herein, they are only used to distinguish one component from another. Unless direct or indirect attachment, connection, coupling, etc. is specified, the terms "attachment", "connection", "coupling", etc. indicate that one part is attached, connected, coupled, etc. to another part directly or indirectly through one or more other parts.

[0026] The ophthalmic instruments as described herein may be used with an ophthalmic surgical console. The ophthalmic surgical console may be similar to that shown and described in U.S. Patent No. 9,931,447, the entire disclosure of which is hereby expressly incorporated herein by reference. The ophthalmic surgical console may be similar to that known and used in, for example, the ophthalmic surgical console available from Alcon Laboratories, Inc. (Fort Worth, Texas, USA). Vision systems are available from Alcon Laboratories, Inc. (Fort Worth, Texas, USA). vision system, or any other ophthalmic surgical console suitable for use with the principles described herein.

[0027] The surgical console may include one or more systems that may be used to perform ophthalmic surgery. For example, the surgical console may include a fluid system including an irrigation system for delivering fluid to the eye and / or a suction system for aspirating fluid and other substances from the eye.

[0028] An example surgical system according to the present disclosure may include a laser system suitable for one or more ophthalmic surgeries. The laser system may include a laser that may be housed within a surgical console or elsewhere, such as in a separate console that communicates with the surgical console. The laser system may have other components. For example, the laser system may include components for operating the laser, such as a power supply, a controller, a laser pump, a laser energy control unit, and / or a monitor. In addition, the laser system may include components located in the optical path of the laser output, such as one or more lenses, reflectors, and / or optical fibers.

[0029] In some embodiments, the laser system can be suitable for cataract surgery. In some embodiments, the output energy of the laser system is suitable for fragmentation and / or emulsification of a cataractous lens. In some examples, the laser output is used to fragment and / or emulsify the lens to a degree sufficient to remove the lens.

[0030] The laser may be any type of laser suitable for the desired application. The laser may output suitable electromagnetic radiation of any suitable wavelength. For example, the laser may emit electromagnetic radiation of one or more wavelengths of visible wavelengths, infrared wavelengths, and / or ultraviolet wavelengths. The laser may operate or be operated to emit a continuous beam of electromagnetic radiation. Alternatively, the laser may operate or be operated to emit a pulsed beam.

[0031] In one example, the laser operates in the infrared range. For example, the laser can output electromagnetic radiation in the mid-infrared range, such as in a wavelength range of about 2.0 microns to about 4.0 microns. Some example wavelengths include about 2.5 microns to about 3.5 microns, such as about 2.775 microns, about 2.8 microns, or about 3.0 microns. Such a laser can be suitable, for example, for lens fragmentation or emulsification in cataract surgery, or for other surgeries.

[0032] The laser system is designed to direct the laser electromagnetic radiation from the laser to the output port. The laser system may direct the laser electromagnetic radiation from the laser to the output port via one or more optical components, such as lenses and mirrors.

[0033] The ophthalmic instrument can be optically connected to the laser system to receive laser electromagnetic radiation from the output port. The ophthalmic instrument can be, for example, a handpiece for ophthalmic surgery. The instrument (e.g., a handpiece) can be connected to the laser system, for example, by a cable having an optical fiber. The connection (e.g., a cable) can be flexible and relatively long so that the operator has flexibility when manipulating the handpiece at a distance from the laser system. The laser electromagnetic radiation can be transmitted from the laser system to the handpiece via the optical fiber of the connecting cable. The optical fiber of the connecting cable can continue to pass through the handpiece or can be optically connected to the optical fiber in the handpiece. In either case, the handpiece can include an optical fiber that terminates at a distal end that is located at the distal end of the handpiece. The optical fiber carries the laser electromagnetic energy from the laser and emits it from the distal end of the optical fiber located at the distal end of the handpiece to the desired target, such as a lens or lens fragment in the patient's eye.

[0034] As described above, the ophthalmic instrument can be connected to the console or laser system via a cable having one or more optical fibers for delivering laser energy. The ophthalmic instrument can also have one or more other connections to the console or control system. For example, the ophthalmic instrument can be connected to the console via one or more irrigation tubes for supplying irrigation fluid from the console to the instrument and / or one or more aspiration tubes for providing suction and aspiration through the instrument.

[0035] Figure 1 An example of an ophthalmic instrument 100 having a laser fiber 140 (eg, a sapphire fiber) is shown. Figure 2 Shows Figure 1 An enlarged view of the distal end 102 of the ophthalmic instrument 100 is shown.

[0036] The ophthalmic instrument 100 includes a housing 104 and a shaft 110, such as a cannula or other shaft, extending from a distal end of the housing 104. The housing 104 may be hollow, having an interior chamber in which the internal components of the instrument 100 may be housed and protected. The housing 104 may have an exterior surface that may be grasped by an operator of the instrument 100, such as a surgeon.

[0037] The shaft 110 can be tubular, for example, a hollow tube such as a cannula, having an opening 114 at its distal end 112 that can be used for suction. For example, suction is applied through the suction channel from the proximal end of a suction luer located at the proximal end of the housing 104, so that fluid and / or tissue (such as a lens or other tissue fragments) can be suctioned through the opening 114 in the distal end 112 of the shaft 110.

[0038] The optical fiber 140 can be located inside the shaft 110, as shown. In other embodiments, the optical fiber 140 can be located outside the shaft 110. The optical fiber tip 142 can be flush (in the same plane) with the end face 116 of the shaft 110. In other embodiments, the optical fiber tip 142 can extend beyond the end face 116 of the shaft 110, or the end face 116 of the shaft 110 can extend beyond the optical fiber tip 142. The optical fiber tip 142 does not need to be located inside the aspiration port 114, but only needs to be close so that the material affected by the laser action can be easily aspirated.

[0039] The ophthalmic device 100 may also include an irrigation cannula 120. The irrigation cannula 120 may be used to direct an irrigation fluid (e.g., saline) to the distal end 102 of the device 100. The housing 104 may have an irrigation supply line through which an irrigation fluid may be introduced. The irrigation cannula 120 may be coupled directly to the housing 104 or to the housing 104 through another portion of the ophthalmic device 100. In one example, the housing 104 may have external threads at its distal end, and the irrigation cannula 120 may have internal threads at its proximal end through which the irrigation cannula 120 may be attached to the housing 104. Figure 1 As can be seen in FIG. 1 , the irrigation sleeve 120 generally has a proximal hub 126 having a relatively large diameter for coupling to the housing 104 and a distal tube 128 in the shape of a narrow tube having a relatively small diameter for fitting around the shaft 110 in a size small enough to be inserted through an incision in the eye.

[0040] In the illustrated example, the irrigation sleeve 120 is positioned around the shaft 110 to provide a fluid passage or channel through the space between the irrigation sleeve 120 and the shaft 110 from where it is attached to the housing 104. The irrigation sleeve 120 may have an end opening 123 at its distal end 122 through which the distal end 112 of the shaft 110 extends, and one or more side openings 124 at its distal end 122 adjacent to the end opening 123. At the end openings 123, the irrigation sleeve 120 fits snugly around the shaft 110. When irrigation fluid is introduced through a supply line in the housing 104, the irrigation fluid passes through the passage of the irrigation sleeve 120 and flows out of the side openings 124 at the distal end 122 of the irrigation sleeve 120.

[0041] As an example, the distal tube 128 of the irrigation sleeve 120 can have an outer diameter in the range of 0.030 inches to 0.080 inches to fit through an incision in the eye, and an inner diameter in the range of 0.020 inches to 0.070 inches to accommodate the shaft 110. The end opening 123 at the distal end 122 of the irrigation sleeve 120 (through which the distal end 112 of the shaft 110 protrudes) can be a circular opening with a diameter in the range of 0.010 inches to 0.065 inches, which can be equal to or slightly smaller than the outer diameter of the distal end 112 of the shaft 110 to form a snug fit around the distal end 112 of the shaft 110. The examples of sizes and size ranges represent possible embodiments; other embodiments with different sizes can be used.

[0042] The irrigation sleeve 120 can be made of an elastomeric material, such as a compliant silicone rubber. The irrigation sleeve 120 can alternatively be made of other materials, such as polyurethane, ethylene propylene, neoprene, or other suitable materials. The elastomeric material used for the irrigation sleeve 120 allows for a certain degree of compliance and facilitates a snug fit between the irrigation sleeve 120 and the shaft 110 in the area of ​​the end opening 123. The elastomeric material used for the irrigation sleeve 120 also facilitates a sealing fit or snug fit between the irrigation sleeve 120 and adjacent eye tissues at the incision site, such as the cornea or sclera, which can help minimize leakage of the eye between the eye tissue and the irrigation sleeve 120.

[0043] In operation of the device, the operator inserts the distal end 102 of the ophthalmic instrument 100 through a suitable incision in the patient's eye and positions the distal end 102 of the ophthalmic instrument 100 at a desired location, such as adjacent to the patient's cataractous lens. The distal end 112 of the shaft 110 is directed toward the treatment area, with the tip 142 at the distal end of the optical fiber 140 positioned facing the treatment area. An irrigation fluid (such as saline) can be supplied from the console through the irrigation supply line and the irrigation cannula 120, so that the irrigation fluid flows out of the side opening 124 to the target area. The laser can be activated to emit laser energy from the tip 142 of the optical fiber 140 (i.e., the distal end of the optical fiber 140), which can break up and emulsify the desired tissue (such as the cataractous lens). At the same time, a pumping module can be used to apply suction through the shaft 110 to suck the fluid and tissue and / or lens fragments that have been separated by the action of the laser through the opening 114.

[0044] Figure 3 A tip 150 for an ophthalmic instrument 100 is shown in accordance with an embodiment of the present disclosure. Figure 4 Shows that there is Figure 3 The distal end 102 of the ophthalmic instrument 100 has a tip 150 . Figure 5 Shows Figure 4 Another view of the distal end 102 of the ophthalmic instrument 100.

[0045] The end 150 has a cylindrical hub 152 and a protrusion 154. The cylindrical hub 152 is suitable for fitting and covering the distal end 112 of the shaft 110, such as Figure 4 and Figure 5 Visible. In the example shown, the tip 150 has a central hole that provides access to the passage of the shaft 110 for suction. In the example shown, the optical fiber 140 is located inside the shaft 110 and inside the central hole of the tip 150. In an alternative example, the tip 150 still has a central hole that provides access to the passage of the shaft 110 for suction, but the optical fiber 140 is located outside the shaft 110, and the optical fiber 140 is located inside or outside the central hole of the tip 150. In some embodiments, positioning the optical fiber 140 outside the shaft 110 can deviate the laser action from the suction channel, thereby helping to reduce blockage of the suction channel.

[0046] like Figure 4 and Figure 5 As shown, the tip 150 is part of the instrument 100, and the protrusion 154 is located at the distal end 112 of the shaft 110 and the distal end 102 of the instrument 100. The protrusion 154 has a distal surface 160 adjacent to the distal tip 142 of the optical fiber 140. The distal surface 160 faces the area to which the optical fiber tip 142 is directed. When the instrument 100 is in use with the optical fiber tip 142 facing the treatment area, the distal surface 160 also faces the treatment area.

[0047] The projection 154 with the distal surface 160 provides a significantly larger surface area facing the treatment area than the surface area facing the treatment area without the projection. For example, in the illustrated device 100, without the projection 154, the end surface 116 of the shaft 110 (see Figure 2 ) is the only surface facing the treatment area other than the tip 142 of the optical fiber 140 itself. Compared to the end face 116 of the shaft 110, the protrusion 154 provides a significantly larger surface area facing the treatment area.

[0048] In one example, the end face 116 has an outer diameter of 0.0243 inches, an inner diameter of 0.0187 inches, and a surface area of ​​0.000198 square inches. In one example of the protrusion 154, the surface area of ​​the distal surface 160 facing the treatment area is 0.00164 square inches. Thus, in this example, the surface area of ​​the distal surface 160 of the protrusion 154 is more than eight times the surface area of ​​the end face 116 of the shaft 110.

[0049] In other examples, the surface area of ​​the distal surface 160 of the protrusion 154 can be at least twice the surface area of ​​the end surface 116 of the shaft 110, or at least four times the surface area of ​​the end surface 116 of the shaft 110, or at least six times the surface area of ​​the end surface 116 of the shaft 110. The distal surface 160 of the protrusion 154 can have a length of 0.020 inches to 0.090 inches and a width of 0.020 inches to 0.060 inches. Smaller or greater lengths and / or widths can be used. In one example, the distal surface 160 of the protrusion 154 has a length of about 0.050 inches and a width of about 0.020 inches. The distal surface 160 of the protrusion 154 can be dished or curved in whole or in part to present a concave surface facing the treatment area to better conform to the shape of the bubble caused by the laser action.

[0050] The distal surface 160 of the projection 154 presents a surface area that faces the area being processed by the laser, helping to inhibit the migration of bubbles formed by the laser away from the fiber tip 142. Without the surface area of ​​the projection, the action of the laser and the bubble dynamics may, in some cases, cause the bubbles formed by the laser to migrate away from the distal end of the device. This may reduce the efficiency of the laser action or otherwise adversely affect the performance of the device.

[0051] This problem is best understood through the behavior of a bubble that nucleates at the tip of a laser fiber in the absence of an adjacent surface (such as the distal surface 160 of the protrusion 154), and undergoes a life cycle from nucleation to collapse. As described above, emulsification or destruction of the lens or other ocular tissue (e.g., in cataract surgery) can be achieved by delivering laser energy (e.g., short laser pulses) of appropriate wavelength and pulse duration to the tip of an optical fiber. When the optical fiber is immersed in a medium that can readily absorb the laser energy, a plasma region is generated at the tip of the optical fiber. The vaporized material will begin to expand into a bubble.

[0052] During the life cycle, the bubble begins to expand after the laser energy is delivered. The bubble continues to expand until it reaches a maximum diameter. The maximum bubble size depends on the amount of energy delivered to the fiber tip. In an example, the bubble can grow to wrap around the delivery fiber. The bubble can displace fluid as it expands.

[0053] In a typical bubble life cycle, the bubble begins to collapse after reaching its maximum diameter. As the bubble collapses, the bubble wall near the fiber may collapse at a faster rate than the front of the bubble (opposite to the fiber) due to the presence of the fiber. Typically, when the bubble wall reaches the end of the fiber, it separates from the fiber but continues to collapse.

[0054] At this point, the detached bubble is typically asymmetric because the detached wall penetrates the bubble. The center of the bubble is no longer located in front of the optical fiber, which is the origin of bubble nucleation. In the continuation of the life cycle of the bubble formed by the system without adjacent surfaces (such as the distal surface 160 of the protrusion 154), the bubble gains forward momentum or repulsion away from the optical fiber.

[0055] In the continuation of a typical bubble life cycle, after a period of time, the bubble collapses again completely, generating very high pressures and temperatures, which will rebound again or cause another bubble to expand. In a typical bubble formation situation (without adjacent surfaces, such as the distal surface 160 of the protrusion 154), the bubble may be significantly moved or repelled away from the original position. The second bubble may also collapse and rebound again before the energy is completely dissipated by the surrounding medium. The completed bubble may be substantially moved away from the nucleation site.

[0056] A potential problem is that in addition to the destructive (tissue cutting / ablation) effects of the laser energy and bubble dynamics, there may be a repulsion effect that may be detrimental to the efficiency of the system. The repulsion generated by the system may tend to push away the material that the operator is working with. When this method is used to emulsify cataractous lenses, the cutting action is typically combined with an irrigation and suction system. Suction can help reduce the repulsion problem of the laser system when the repetition frequency of the laser in the laser system is very low (e.g., 50 Hz or less) or there are pauses in the laser emission. If higher laser powers or material cutting rates are desired, the suction rate (e.g., a rate of up to 40 cc / min) may not be sufficient to control the repulsion effect of the laser. Higher material cutting rates can be in the range of 1500 Hz (repetition rate) or even higher.

[0057] Thus, without the projection and associated surface area facing the treatment area (e.g., projection 154 with distal surface 160), the system may have good retention for high vacuum levels or low power settings, but at higher laser power settings, the laser action and bubble dynamics may cause the generated bubbles to be repelled. As a result, the cutting ability or emulsification efficiency is significantly reduced because the target tissue or material moves away from the distal end of the instrument tip instead of being ruptured and drawn into the cannula.

[0058] Using a protrusion (e.g., protrusion 154) with a larger surface area facing the treatment area (e.g., the surface area of ​​distal surface 160) helps inhibit the movement of bubble effects distally from the fiber tip 142. This at least reduces the repulsive effect of laser-induced bubble dynamics. In some embodiments, it can reverse the effect so that repulsion becomes attraction. In terms of cataract surgery, using a protrusion with its surface area facing the treatment area improves followability.

[0059] Because the protrusion with its surface facing the treatment area causes the bubble to collapse toward the surface, thereby improving followability. When bubbles nucleate near a solid boundary (e.g., approximately equal to or larger than the largest bubble), then when collapsing, the bubble will tend to collapse into the boundary.

[0060] This phenomenon can be understood by considering the mass flux as a bubble begins to collapse near such a solid boundary. As the bubble begins to collapse, fluid mass from the surrounding medium moves in to fill the void, but the "filling" is asymmetric due to the presence of the adjacent solid boundary. Mass cannot flow in from this location since the solid boundary acts as a restrictor. The net effect is therefore to cause the bubble to collapse towards the solid boundary, minimizing repulsion and potentially creating fluid flow towards the solid boundary.

[0061] By using a protrusion (e.g., protrusion 154) with a larger surface area facing the treatment area (e.g., the surface area of ​​the distal surface 160), the bubble dynamics are transformed so that the movement of bubbles away from the device is inhibited or reduced. In some embodiments, the bubbles will collapse into the cannula, thereby completely minimizing or even eliminating rejection.

[0062] In summary, therefore, the repulsive effects of laser action and subsequent bubble collapse can be significantly reduced by fitting or modifying the distal end of the instrument in such a way as to form a surface that "captures" the bubble, either to capture the bubble and force it to collapse inward, or to apply a force to the bubble toward the instrument, thereby minimizing repulsion.

[0063] The shape of the protrusion and its distal surface can control the way the bubble collapses. In one example, the tip 150 with the protrusion 154 is a plastic component added to the shaft 110 (e.g., a metal cannula). The protrusion can also be formed by the shaft or cannula itself. Depending on the performance requirements, the shape of the protrusion can have different configurations. The surface shape can be modified so that different bubble collapse geometries can be produced.

[0064] The tip 150 (including the hub 152 and the protrusion 154) can be transparent to facilitate visualization by the operator through the material. The tip can be constructed of a polymer material. As an example, the tip can be constructed of polycarbonate.

[0065] The projection 154 and the distal surface 160 can be asymmetrical about the longitudinal axis 118 of the shaft 110. This can allow for a cutting or shaving action on one side of the instrument 100.

[0066] The projection 154 can be angled relative to the longitudinal axis 118 of the shaft 110, i.e., not perpendicular to the longitudinal axis. This can facilitate insertion of the distal end 102 of the instrument 100 into the eye. That is, the operator can tilt the instrument 100 at a first angle to manipulate the projection 154 through an incision in the eye, and then tilt the instrument 100 at a second angle to manipulate the shaft 110 through the incision in the eye.

[0067] Figure 6 The distal end of an ophthalmic instrument 200 according to another embodiment of the present disclosure is shown. The ophthalmic instrument 200 may be the same as the ophthalmic instrument 100, except that an irrigation cannula 220 incorporates a protrusion 254 having a distal surface 260 instead of the tip 150. Thus, the protrusion 254 is part of the irrigation cannula 220. The distal surface 260 functions similarly to the distal surface 160. In the illustrated example, the irrigation cannula 220 has a central bore that provides access to the passageway of the shaft 110 for aspiration. In the illustrated example, the optical fiber 140 is located inside the shaft 110 and inside the central bore of the irrigation cannula 220. In an alternative example, the irrigation cannula 220 still has a central bore that provides access to the passageway of the shaft 110 for aspiration, but the optical fiber 140 is located outside the shaft 110, and the optical fiber 140 is located inside or outside the central bore of the irrigation cannula 220.

[0068] The irrigation sleeves 160, 260 (including the projections 154, 254) can be transparent to facilitate visualization by the operator through the material. The projections 154, 254 can be formed of the same material as the irrigation sleeves 160, 260 or a different material, for example, a polymeric material such as polycarbonate or an elastomeric material such as silicone rubber.

[0069] As with projection 154, projection 254 and distal surface 260 can be asymmetrical about longitudinal axis 118 of shaft 110. This can allow for a cutting or shaving action on one side of instrument 100. Likewise, projection 254 can be angled relative to longitudinal axis 118 of shaft 110, i.e., not perpendicular thereto, to facilitate insertion of the distal end of instrument 200 into the eye, as described above.

[0070] In the method of performing an ophthalmic surgical procedure, an operator inserts the distal end of the ophthalmic instrument 100, 200 into the patient's eye toward the treatment area. The operator positions the distal end of the ophthalmic instrument 100, 200 adjacent to the treatment area so that the distal end of the optical fiber faces the treatment area and the distal surface 160, 260 of the protrusion 154, 254 faces the treatment area. The operator delivers laser energy to the treatment area through the optical fiber. The distal surface 160, 260 of the protrusion is used to inhibit bubbles formed during the procedure from moving distally away from the distal end of the ophthalmic instrument 100, 200.

[0071] As will be appreciated by those skilled in the art, the systems and methods disclosed herein have advantages over existing systems and methods. For example, the systems and methods described herein can improve the tracking and laser action, thereby improving the simplicity, time, efficiency, accuracy, effectiveness and / or cost of the surgery.

[0072] It will be appreciated by those skilled in the art that the embodiments encompassed by the present disclosure are not limited to the specific example embodiments described above. Although illustrative embodiments have been shown and described, a wide range of modifications, changes, and substitutions are contemplated in the foregoing disclosure. It will be appreciated that such changes may be made to the foregoing without departing from the scope of the present disclosure. Accordingly, it will be appreciated that the appended claims should be interpreted broadly and in a manner consistent with the present disclosure.

Claims

1. An ophthalmic instrument comprising: a shaft having a distal end adapted for insertion into an eye of a patient toward a treatment area; an optical fiber for delivering laser energy to the treatment area, the optical fiber having a distal end adapted to be positioned facing the treatment area during use of the ophthalmic device; as well as A protrusion is located at the distal end of the shaft, the protrusion having a distal surface proximate the distal end of the optical fiber, the distal surface being adapted to be positioned facing the treatment area during use of the ophthalmic instrument.

2. The ophthalmic instrument of claim 1, wherein: The shaft has an end surface at its distal end, wherein the surface area of ​​the distal surface of the projection is at least twice the surface area of ​​the end surface of the shaft.

3. The ophthalmic instrument of claim 2, wherein: The surface area of ​​the distal surface of the projection is at least eight times the surface area of ​​the end surface of the shaft.

4. The ophthalmic instrument of claim 1, wherein: The distal surface of the projection has a length of 0.020 inches to 0.090 inches and a width of 0.020 inches to 0.060 inches.

5. The ophthalmic instrument of claim 1, wherein: The shaft is tubular, and wherein the tubular shaft is adapted for use in drawing suction from the treatment area.

6. The ophthalmic instrument of claim 5, wherein: The optical fiber is located inside the shaft.

7. The ophthalmic instrument of claim 5, wherein: The optical fiber is located outside the shaft.

8. The ophthalmic instrument of claim 1, wherein: The ophthalmic instrument includes a tip positioned on a distal end of the shaft, and wherein the projection is a portion of the tip.

9. The ophthalmic instrument of claim 8, wherein: The tip is transparent.

10. The ophthalmic instrument of claim 9, wherein: The tip is made of a polymer material.

11. The ophthalmic instrument of claim 10, wherein: The end cap is made of polycarbonate.

12. The ophthalmic instrument of claim 1, wherein: The ophthalmic instrument includes an irrigation cannula.

13. The ophthalmic instrument of claim 12, wherein: The irrigation cannula includes a proximal hub adapted to be coupled to a housing of the ophthalmic instrument and a distal tube adapted to fit around the shaft.

14. The ophthalmic instrument of claim 13, wherein: The distal tube of the irrigation sleeve has: a distal end; an end opening, which is located at the distal end of the distal tube and is suitable for being assembled around the distal end of the shaft; and at least one side opening, which is located at the distal end of the distal tube near the end opening and is suitable for allowing irrigation fluid to flow therethrough.

15. The ophthalmic instrument of claim 12, wherein: The projection is part of the irrigation sleeve.

16. The ophthalmic device of claim 15, wherein: The irrigation sleeve is composed of an elastomeric material.

17. The ophthalmic instrument of claim 16, wherein: The irrigation sleeve is made of silicone rubber.

18. The ophthalmic instrument of claim 1, wherein: The shaft has a longitudinal axis, and wherein the protrusion is asymmetric about the longitudinal axis of the shaft.

19. The ophthalmic device of claim 1, wherein: The shaft has a longitudinal axis, and wherein the projection is angled relative to the longitudinal axis of the shaft.

20. A method of performing ophthalmic surgery, the method comprising: inserting a distal end of an ophthalmic instrument into an eye of a patient toward a treatment area, the ophthalmic instrument comprising a shaft, an optical fiber, and a projection; positioning the distal end of the ophthalmic device adjacent the treatment area such that the distal end of the optical fiber faces the treatment area and the distal surface of the projection faces the treatment area; as well as delivering laser energy to the treatment area via the optical fiber; Wherein the distal surface of the projection inhibits bubbles formed during the procedure from migrating distally away from the distal end of the ophthalmic instrument.

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