Retinal membrane peeling instruments

Abstract

The ophthalmic surgical instrument for peeling a retinal membrane includes a handpiece and an actuator mounted on the handpiece. An outer tube has a proximal end attached to the handpiece. A dissecting spatula can be extended outward relative to the distal end of the outer tube in response to movement of the actuator, the dissecting spatula defining a channel connected to an opening proximate the distal edge of the dissecting spatula. A distribution system is in fluid communication with the channel. The distribution system may include a reservoir within the handpiece. The fluid may be dyed blue to enhance visibility of the peeled portion of the retinal membrane.

Description

[Technical Field]

[0001] The internal limiting membrane (ILM) is a thin, transparent membrane located between the vitreous and retina of the eye. The ILM plays a role during eye development but is not necessary for proper function of the adult eye. The ILM pulls on the retina, causing conditions such as macular holes, macular atrophy, vitreomacular traction syndrome, diabetic macular edema, and cystoid macular edema, which are secondary to inflammation or venous occlusive disease and other conditions. An epiretinal membrane (ERM) is a membrane that can form on the retina in response to damage to the retina, such as from posterior vitreous detachment. [Background technology]

[0002] The ILM or ERM may need to be detached from the retina to prevent damage to the retina. Peeling the ILM or ERM may also be required in preparation for a surgical procedure to be performed on the retina. To detach the ILM or ERM, a surgical instrument is inserted through a cannula in the patient's eye. Forceps or a specialized scraper extend from the instrument and are used to lift a flap of the ILM or ERM. The flap is then grasped by the forceps, and the ILM or ERM is detached from the retina using a circular motion. If excessive force is applied to the forceps, the retina may be punctured.

[0003] Reducing the risk of retinal damage resulting from membrane detachment would be an advancement in the art. Summary of the Invention [Means for solving the problem]

[0004] The present disclosure relates generally to structures for peeling retinal membranes.

[0005] Certain aspects provide an ophthalmic surgical instrument for peeling a retinal membrane, the ophthalmic surgical instrument including a handpiece and an actuator mounted on the handpiece. An outer tube has a proximal end attached to the handpiece. A dissecting spatula is extendable outwardly relative to a distal end of the outer tube in response to movement of the actuator, the dissecting spatula defining a channel connected to an opening proximate a distal edge of the dissecting spatula. A dispensing system is in fluid communication with the channel.

[0006] The following description and the annexed drawings set forth in detail certain illustrative features of the one or more embodiments.

[0007] The accompanying drawings depict certain aspects of one or more embodiments and therefore should not be considered as limiting the scope of the disclosure. [Brief explanation of the drawings]

[0008] [Figure 1A] FIG. 1 illustrates an isometric view of a surgical instrument having a dissecting spatula with an integrated channel, in accordance with certain embodiments. [Figure 1B] FIG. 1 is a side view of a dissecting spatula, in accordance with certain embodiments. [Figures 2A-2C] 10A-10C are cross-sectional views illustrating dissection using a dissecting spatula with integrated channels, according to certain embodiments. [Figure 3] FIG. 10 is an isometric view showing the ILM being peeled away using forceps after peeling, according to certain embodiments. DETAILED DESCRIPTION OF THE INVENTION

[0009] To facilitate understanding, the same reference numerals will be used, whenever possible, to designate identical elements common to the figures. It is contemplated that elements and features of one embodiment may be beneficially incorporated in other embodiments without further recitation.

[0010] Aspects of the present disclosure provide a surgical instrument for peeling a membrane from a patient's retina. Note that, as used herein, the distal end of a component refers to the end closer to the patient's body, while the proximal end of a component refers to the end away from the patient's body, or, for example, the end proximal to the handpiece of a surgical instrument.

[0011] 1A illustrates a surgical instrument 100 including a handpiece 102 sized and contoured to be grasped by the hand of a surgeon performing an ophthalmic surgical procedure, such as peeling a membrane, such as an ILM or ERM, from the retina of a patient's eye, according to certain embodiments. The surgical instrument 100 can be used to peel the membrane from the retina, after which the membrane can be removed using forceps or other grasping instruments.

[0012] The dissecting spatula 104 can extend from the distal end of an outer tube 106, which is connected to the handpiece 102. The proximal end of the outer tube 106 is connected to the handpiece 102. The handpiece 102 can have one or more manual control structures attached thereto. In the embodiment of FIG. 1A, the manual control structures include a slider 108 and a button 110. The manual control structures shown are exemplary only, and other manual control structures can be used. In particular, the slider 108 can be used to control the extension of the dissecting spatula 104 relative to the outer tube and can be replaced with a deformable basket.

[0013] The dissecting spatula 104 is connected to and defined about a hollow rod 112 that extends through the outer tube 106. In a first implementation, the hollow rod 112 is fixed relative to the handpiece 102, while the outer tube 106 is slidable relative to the handpiece 102 and is coupled to and actuated by a slider 108. In a second implementation, the hollow rod 112 is coupled to and actuated by the slider 108, while the outer tube 106 is fixed relative to the handpiece 102.

[0014] A longitudinal direction 114a may be defined parallel to and collinear with the axis of symmetry of the outer tube, a transverse direction 114b may be defined perpendicular to the longitudinal direction 114a, and a vertical direction 114c may be defined perpendicular to the longitudinal direction 114a and the transverse direction 114b.

[0015] Dissecting spatula 104 extends distally from hollow rod 112 and increases in width in transverse direction 114b such that dissecting spatula 104 at its widest point in transverse direction 114b is many times greater than the thickness of dissecting spatula 104 perpendicular to transverse direction 114b, e.g., 2, 5, 10, 20, or more than 30 times the thickness. The width of dissecting spatula 104 at its widest point is also greater than the inner diameter of outer tube 106, e.g., 1.1 to 2 times the inner diameter. Thus, when retracted within outer tube 106, dissecting spatula 104 can curl or bend to fit within outer tube 106. Dissecting spatula 104 and hollow rod 112 can be made of a flexible material, such as a superelastic alloy (e.g., nitinol), spring steel, or a flexible polymer.

[0016] The dissecting spatula 104 may be curved in one or more section planes. For example, the dissecting spatula 104 may be curved in a plane parallel to the longitudinal direction 114a and the vertical direction 114c. During use, the recessed side of the dissecting spatula may face away from the retina. The curvature of the dissecting spatula 104 may facilitate bending of the dissecting spatula 104, thereby reducing pressure on the retina.

[0017] Dissecting spatula 104 defines a channel 116. Channel 116 passes through dissecting spatula 104 from the attachment point between dissecting spatula 104 and hollow rod 112 to an opening 118 proximate a rounded distal edge 120 of dissecting spatula 104. Opening 118 may be formed in edge 120 itself or may be proximate edge 120, for example, within 0.1, 0.01, or 0.001 millimeters (mm). Hollow rod 112 may be hollow such that a continuous channel is defined between hollow rod 112 and channel 116 defined by dissecting spatula 104. For example, hollow rod 112 and dissecting spatula 104 may be monolithically formed such that channel 116 in dissecting spatula 104 and the interior of hollow rod 112 are a single channel.

[0018] The channel of the hollow rod 112 may be in fluid communication with a fluid reservoir 122. In the implementation shown, the reservoir 122 is housed within the handpiece 102. The reservoir shown is exemplary only, and other arrangements are possible, such as a reservoir separate from the handpiece 102 and connected to the handpiece 102 by tubing. The reservoir 122 may be coupled to a pump 124, such as a mechanically, pneumatically, or electrically actuated pump. The pump 124 may be controlled by a button 110, such as a button 110 that mechanically activates the pump 124 in response to depression by a surgeon's finger. In other embodiments in which the pump 124 is connected to or incorporated into a surgical console, the pump 124 may be controlled by a foot switch in wired or wireless communication with the surgical console. For example, the foot switch may trigger activation of the pump 124 in response to depression by the surgeon's foot. Pump 124 may be coupled to, for example, hollow rod 112 by tube 126. Thus, in response to actuation of button 110, fluid from reservoir 122 may be pumped out through tube 126, hollow rod 112, and channel 116 to opening 118.

[0019] The button 110, reservoir 122, pump 124, and tubing 126 may collectively be considered a distribution system for supplying fluid to the hollow rod 112. It should be understood that there may be various implementations of the distribution system in which the button 110 is omitted from the handpiece 102 and may be coupled to the hollow rod 112, including one in which the button 110 is omitted from the handpiece 102 and is on a remote device such as a foot pedal connected to the handpiece 102 by tubing. Similarly, the button 110 may be considered a control structure that may be replaced with a lever, diaphragm, touch-sensitive electronic component, or other component that may receive interaction from the surgeon to cause the pumping of fluid into the hollow rod 112.

[0020] 1B , in some embodiments, one or more tines 104a are fixed to or formed on the distal end of dissecting spatula 104. Teeth 104a may be angled such that the outward-facing surface of tine 104a (facing away from dissecting spatula 104) defines an angle 104b with respect to the top surface of dissecting spatula 104. For example, angle 104b may be between 20 and 40 degrees, between 25 and 35 degrees, or between 29 and 31 degrees. For example, an angle 104b of 30 degrees has been found to be effective. In certain embodiments, tines 104a may have a length (e.g., height) of between about 1 micrometer (μm) and about 20 μm from the top side of dissecting spatula 104, such as between about 1 μm and about 10 μm in length. The tines can be used to scrape the membrane 200 (e.g., ILM) from the retina 202 before the dissecting spatula 104 is turned (e.g., rotated) to peel the membrane 200 from the retina 202. In certain embodiments, the tines 104a can be sized and angled to limit the amount of penetration of the edge 120.

[0021] 2A-2C show a dissecting spatula 104 having teeth 104a in use. The dissecting spatula 104 is first inserted through a trocar cannula in a patient's eye. As the outer tube 106 is inserted through the trocar cannula, the dissecting spatula 104 may be retracted into the outer tube 106. Once the distal end of the outer tube 106 is inserted into the eye, the dissecting spatula 104 may then be extended relative to the outer tube 106 to contact the membrane 200 formed on the retina 202.

[0022] As shown in FIG. 2A , the dissecting spatula 104 is initially pressed against the membrane 200 with the top surface of the dissecting spatula 104 facing the membrane 200. Thus, in the embodiment of FIGS. 2A-2C , the teeth 104 a on the top surface of the dissecting spatula 104 are pressed into the membrane 200 to penetrate therein. In such an embodiment, the extent (i.e., length) and angle 104 b of the teeth 104 a from the top surface of the dissecting spatula 104 can be selected so that the teeth 104 a do not penetrate the underlying retina 202 when pressed against the membrane 200. For example, the teeth 104 a can extend outward from the top surface by 10 microns or less. Alternatively, if the teeth 104 a are omitted or not used, a press can be performed whereby the edge 120 cuts through the membrane 200. The width and rounded shape of the edge 120 can facilitate cutting the membrane 200 without damaging the retina 202.

[0023] In FIG. 2B, the dissecting spatula 104 is pulled across the membrane 200 to scrape the membrane 200 and create an opening 200a therein. For example, the tines 104a on the top surface of the dissecting spatula 104 are pulled toward the acute angle defined between the dissecting spatula 104 and the membrane 200 (to the right in FIG. 2A), scraping the membrane 200 and forming the opening 200a. Stated another way, the tines 104a can be pulled in a direction such that the distal ends of the tines 104a point to form the opening 200a. In FIGS. 2B and 2C, the opening 200a is exaggerated for clarity.

[0024] In FIG. 2C, the dissecting spatula 104 is then rotated so that the tines 104a face away from the retina 202 and the underside of the dissecting spatula 104 (the surface opposite the top side) faces the membrane 200. The dissecting spatula 104 may then be pushed through the opening 200a in a direction opposite the pulling motion of FIG. 2B. The surgeon then actuates the button 110 to dispense fluid 204 from the reservoir 122 between the membrane 200 and the retina 202, thereby detaching a portion 206 of the membrane 200 from the retina 202. The fluid 204 may be dyed, for example, blue, to enhance the visibility of the portion of the membrane 200 that has been detached. The fluid 204 may be substantially inert, for example, a saline solution.

[0025] Referring to FIG. 3 , after peeling, the dissecting spatula 104 may be retracted into the outer tube 106, which may be retracted through the trocar cannula. Forceps 300 may then be inserted into the trocar cannula and used to grasp a portion of the membrane 200, such as adjacent to the area where the collapse occurred, and peel the membrane 200 using a circular motion. By injecting fluid 204 between the membrane 200 and the retina 202 to peel the portion 206, the area to be peeled becomes more easily identifiable by the surgeon during the procedure, and the act of peeling is easier with reduced pulling of the portion 206 on the underlying retina 202. Thus, the dissecting spatula 104 offers improved efficiency and safety compared to more conventional devices used for membrane peeling.

[0026] The foregoing description is provided to enable those skilled in the art to practice the various embodiments described herein. Various modifications to these embodiments will be apparent to those skilled in the art, and the general principles defined herein may be applied to other embodiments. Accordingly, the claims are not intended to be limited to the embodiments shown herein, but are to be accorded the full scope consistent with the language of the claims.

Claims

1. An ophthalmic surgical instrument for peeling off a retinal membrane, comprising: A handpiece and an actuator mounted on the handpiece; an outer tube having a proximal end attached to the handpiece; a dissecting spatula extendable outwardly relative to a distal end of the outer tube in response to movement of the actuator, the dissecting spatula defining a channel connected to an opening proximate a distal edge of the dissecting spatula; a distribution system in fluid communication with the channel; 1. An ophthalmic surgical instrument, comprising:

2. The ophthalmic surgical instrument of claim 1 , wherein the actuator is configured to move the outer tube relative to the handpiece.

3. The ophthalmic surgical instrument of claim 1 , wherein the dissecting spatula is wider than the inner diameter of the outer tube.

4. The ophthalmic surgical instrument of claim 1 , wherein the dissecting spatula comprises nitinol.

5. The ophthalmic surgical instrument of claim 1 , further comprising a hollow rod connecting said dissecting spatula to said handpiece, said hollow rod in fluid communication with said channel and said distribution system.

6. The ophthalmic surgical instrument of claim 1 , wherein the dispensing system includes one of a button attached to the handpiece and a foot switch configured to enable fluid flow through the channel.

7. The ophthalmic surgical instrument of claim 1 , wherein the dispensing system includes a reservoir within the handpiece.

8. 2. The ophthalmic surgical instrument of claim 1, wherein the outer tube defines a longitudinal direction collinear with an axis of symmetry of the outer tube, and the dissecting spatula is at least twice as wide in a transverse direction perpendicular to the longitudinal direction as a thickness of the dissecting spatula perpendicular to the transverse direction.

9. The ophthalmic surgical instrument of claim 8 , wherein the dissecting spatula is curved in a plane parallel to the longitudinal direction and in a vertical direction perpendicular to the longitudinal and transverse directions.

10. 1. A method for detaching a membrane from a retina, said method comprising: indenting the membrane with the distal edge of a dissecting spatula; and dispensing a fluid from proximal to the distal edge between the membrane and the retina to detach a portion of the membrane from the retina.

11. The method of claim 10, further comprising removing the portion of the membrane from the retina.

12. The method of claim 10 , wherein the dissecting spatula defines a channel in fluid communication with an opening adjacent the distal edge.

13. the dissecting spatula is part of an ophthalmic instrument; A handpiece and an actuator mounted on the handpiece; an outer tube having a proximal end attached to the handpiece, the dissecting spatula being extendable outwardly relative to a distal end of the outer tube in response to movement of the actuator; a distribution system in fluid communication with the channel; 13. The method of claim 12, comprising:

14. The method of claim 13 further comprising dispensing the fluid in response to interaction with a control element of the distribution system.

15. The method of claim 13 , wherein dispensing the fluid comprises dispensing the fluid from a reservoir within the handpiece.

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