Dual-port laser vitreous fragmentation device

Abstract

A vitreous fragmentation device having multiple intake ports and a laser for vitreous fragmentation. The probe includes a needle for accommodating the ports for more continuous and fluidic intake of vitreous from the patient's eye. In addition, the use of a laser can be utilized to fragment the vitreous to avoid port blockage and thus further promote fluidic intake. The laser can reach the ports of the channel substantially simultaneously or sequentially. Furthermore, the use of a laser for fragmentation means that cutter vibration can be reduced.

Description

[Background technology]

[0001] Over the years, many dramatic advances have occurred in the field of ophthalmic surgery. In many cases, retinal procedures may involve a vitrectomy as at least a portion of the procedure. Vitrectomy is the removal of some or all of the vitreous humor from a patient's eye. In some cases, surgery is limited to the removal of cloudy vitreous humor, and vitrectomy may comprise the majority of the procedure. However, vitrectomy may be accompanied by surgery for retinal repair to address premacular membranes or other post-implant host tissue.

[0002] The vitreous humor itself is a clear gel that can be removed by an elongated probe inserted through a cannula previously placed in the eye. More specifically, the probe comprises a tubular instrument with an internal lumen or central channel for removing the vitreous humor. Naturally, removal of the vitreous humor requires greater care than simply applying a vacuum through the channel of the probe. This is because the vitreous humor contains a fibrous matrix of collagen fibers. That is, the fibrous nature of the gel is such that drawing the gel into the probe with a vacuum will also pull on the retina, optic nerve, or other delicate ocular structures.

[0003] To address this issue, vitrectomy probes are configured to cut the vitreous humor as it is drawn into the probe's channel. This way, the gel-like substance continues to be aspirated in a fibrous form without pulling on delicate ocular structures. In some vitrectomy cutters, the fluid intake of vitreous humor can be interrupted by the reciprocating motion of the cutter, which closes the intake port after each cut. This means that the intake flow may not be continuous, even with some probes that can achieve 5 to 10,000 cuts per minute. Summary of the Invention [Means for solving the problem]

[0004] A vitreous fragmentation device is disclosed. In one embodiment, a probe includes a tubular instrument having proximal and distal ports for drawing vitreous humor into a channel defined by the instrument. The probe further includes a laser emitter coupled to the instrument for delivering a laser through the channel and cutting the vitreous humor therein adjacent the port. [Brief explanation of the drawings]

[0005] [Figure 1] FIG. 1 is a perspective view of one embodiment of a dual port laser vitreous fragmentation device. [Figure 2] FIG. 2 is an enlarged cross-sectional view of the needle of the vitreous fragmentation device taken from 2-2 in FIG. [Figure 3A] 3A is a cross-sectional view of the needle of FIG. 2 during the initial uptake of vitreous humor during the vitrectomy shown in FIG. [Figure 3B] 3B is a cross-sectional view of the needle of FIG. 2 during laser cutting proximal to the vitreous humor intake portion shown in FIG. 3A. [Figure 3C] 3C is a cross-sectional view of the needle of FIG. 2 during cutting distal to the vitreous humor intake portion shown in FIG. 3B. [Figure 4] FIG. 4 is an overview of one embodiment of a vitrectomy procedure performed using the vitreous fragmentation device of FIG. [Figure 5] FIG. 5 is a flow chart summarizing one embodiment of employing a dual-port laser vitreous fragmentation device in a surgical procedure. DETAILED DESCRIPTION OF THE INVENTION

[0006] In the following description, numerous details are set forth to provide an understanding of the present disclosure. However, those skilled in the art will understand that the described embodiments may be practiced without these specific details. Furthermore, numerous variations or modifications may be employed without departing from what is contemplated by the specifically described embodiments.

[0007] Embodiments will be described with reference to specific types of vitreous fragmentation surgical procedures. In particular, procedures in which vitreous humor is removed / fragmented to address vitreous hemorrhage are illustrated. However, the tools and techniques detailed herein may be used in a variety of other procedures. For example, embodiments of the vitreous fragmentation device detailed herein may be used to address retinal detachment, premacular membranes, macular holes, floaters, diabetic retinopathy, or various other ocular conditions. Nevertheless, significant benefits may be realized to the extent that the vitreous fragmentation device incorporates dual-port vitreous humor intake combined with laser ablation of the vitreous humor.

[0008] Referring now to FIG. 1 , a perspective view of an embodiment of a dual-port laser vitreous fragmentation device 101 is shown. The probe 101 may include features such as a shell or support 125 and a housing 150 that allows the probe to rest on the base of the surgeon's index finger, near the thumb, during a vitrectomy procedure. Similarly, a probe instrument or needle 175 is provided to facilitate access to the interior of a patient's eye 450 (see FIG. 4 ), as described in more detail below. More notably, however, the needle 175 is configured with multiple ports 177, 179 for capturing vitreous humor or other intraocular substances and particles. In the illustrated embodiment, two ports 177, 179 are shown. However, in other embodiments, three or more ports 177, 179 may be utilized.

[0009] The use of multiple ports 177, 179, combined with the vitreous humor cutting method, may allow the probe 101 to more easily capture vitreous humor and other intraocular material in a fluid manner. That is, in a conventional “vitreous probe,” the combination of a single port and an internal cutter results in the vitreous being periodically chopped or cut as a result of mechanical reciprocating motion, combined with port closure. Thus, the capture of intraocular material through the needle 175 may be more fragmented rather than fluid. This means that in a conventional vitrectomy, delicate ocular features are intermittently pulled as the vitreous is removed. However, as described in more detail below, these risks are substantially eliminated with the multi-port embodiment shown, especially when combined with cutting the vitreous in a manner that does not require port closure.

[0010] 2, there is shown an enlarged cross-sectional view of needle 175 of vitreous fragmentation device 101 taken from 2-2 in FIG. 1. In this view, channel 250 is shown into which vitreous humor may be aspirated during a surgical procedure using needle 175 inserted into a patient's eye 450, as shown in FIG. 4. In this view, it is clear how ports 177, 179 may function to allow the inflow of the aforementioned substances, respectively.

[0011] 2, unlike mechanical chopper vitrectomy probes, needle 175 does not include a cutter within channel 200. As a result, ports 177, 179 are not blocked by a cutter during the aforementioned uptake of vitreous and other intraocular material. Instead, a laser 200 directed through channel 250 is used to cut / fragment types of material, such as vitreous, as described in further detail below.

[0012] It is worth noting that the ports 177, 179 in the illustrated embodiment are axially aligned with one another. That is, they are located on the same side of the needle 175, along the same axis on its outer surface. This can be useful for promoting fluid uptake of types such as vitreous, as described below. However, in practice, this can also serve to assist the surgeon in directing the ports 177, 179 to a particular intraocular location of interest, thereby avoiding the additional problem of the ports 177, 179 potentially having widely varying circumferential positions relative to the location of interest. Of course, depending on the nature of the application, other embodiments may benefit from utilizing different circumferential needle positions for the ports 177, 179, for example, when the needle 175 is inserted into a site of injury to the vitreous or other injury-related material within the eye.

[0013] 3A, there is shown a cross-sectional view of the needle 175 of FIG. 2 during the initial uptake of vitreous humor during the vitrectomy procedure shown in FIG. 4. More specifically, two distinct fluid flow paths 325, 375 are provided into the channel 250 through ports 177, 179. Thus, the influx of fluid material from the interior 310 of the patient's eye may proceed.

[0014] 3B, a cross-sectional view of the needle 175 of FIG. 2 is shown during proximal laser cutting / fragmentation. Specifically, a laser 200 directed from a proximal location (e.g., from a laser on an attached surgical console or from a laser in a vitreous fragmentation device handpiece) is transmitted through the channel 250 (e.g., through air or an optical fiber aligned with the channel) and ultimately reaches the vitreous flow 375 at the more proximal side of the port 177. Thus, similar to an internal cutter, the entrapped portion of vitreous or other material at the proximal port 177 is cut / fragmented. In this manner, fibrous pulling caused by the entrapped portion 375 shown can be substantially reduced.

[0015] In some embodiments, laser 200 may include a biocompatible picosecond or femtosecond laser. In some embodiments, laser 200 is pulsed non-continuously. For example, laser 200 may be set to operate at 50-90K (50,000-90,000) pulses per minute. In this manner, modulated or controlled cutting / fragmentation may be achieved. However, if the pulsation is fast enough, laser 200 provides a substantially continuous beam. Thus, cut / fragmented material 375 may be provided in a substantially untethered, fluid-like state. Of course, laser 200 may also be provided through channel 250 more continuously.

[0016] Referring now to FIG. 3C , a cross-sectional view of the needle 175 of FIG. 2 is shown during distal cutting 325 of the vitreous intake portion through the distal port 179. In this view, the proximal intake 375 shown in FIG. 3B has already been cut / fractured (see FIG. 3B ) and does not pose any significant obstacle to the laser 200 reaching the more distal vitreous intake 325. In fact, depending on a number of factors, the laser 200 may cut the intakes 325, 375 at both ports substantially simultaneously. However, in situations where the more proximal intake 375, as shown in FIG. 3B , poses an obstacle to the laser 200, cutting / fracturing this intake 375 allows the laser 200 to reach and cut / fracture the more distal intake 325 there. Nevertheless, the vitreous intake can remain substantially continuous and fluid-like by using multiple ports 177, 179 that are not closed during the aforementioned intake process. In some embodiments, the laser can be delivered to the front of the port through ambient air or an optical fiber (e.g., optical fiber 189) located proximate the most proximal port 177. In some embodiments, the laser can be delivered through multiple optical fibers (e.g., one optical fiber terminating near each port 177, 179). Furthermore, while two ports 177, 179 are shown, additional ports can be included that can also have adjacent laser pulses to cut the vitreous entering the additional ports.

[0017] FIG. 4 is an overview of one embodiment of a vitrectomy procedure performed using the vitreous fragmentation device 101 of FIG. 1. During the procedure, the beveled end 400 of the needle 175 of the vitreous fragmentation device 101 is inserted through a previously placed cannula 430 and directed toward the area 310 from which vitreous humor is to be removed. Specifically, as previously described, suction is applied, and ports 177, 179 are used to capture vitreous humor or other material. For example, in the illustrated procedure, bleeding may be occurring in area 310, and the blood, along with the vitreous humor, is drawn into ports 177, 179.

[0018] As also mentioned above, and with further reference to FIG. 2 , to facilitate this delicate procedure, the reciprocating cutter within needle 175 has been replaced with laser 200. This means that ports 177, 179, respectively, can remain open throughout the procedure to promote a more consistent fluid flow of vitreous and other material uptake from region 310. Utilizing laser 200 instead of a reciprocating cutter has the added advantage that the cutting / fragmenting is substantially vibration- and noise-free; that is, vibrations caused by the reciprocating motion of the cutter are completely eliminated. Therefore, in this regard, any disturbance or audible vibration discomfort to the surgeon performing the procedure is reduced.

[0019] Continuing with reference to FIG. 4, the illustrated procedure involves reaching the eye 450 with the probe 101 and illuminator 425 through cannulae 415, 430, which are offset and positioned on the sclera 470. In this manner, the more delicate cornea 490 and lens 480 can be avoided. Similarly, the optic nerve 460 and retina 475 are also extremely delicate. Thus, given that the needle 175 can reach these delicate features at the posterior of the eye 450, minimizing pulling on these features by maintaining a more fluid uptake of the vitreous, as described above, can be of substantial benefit. Similarly, eliminating vibrations that may cause distraction to the surgeon, as described herein, can also be highly beneficial.

[0020] Referring now to FIG. 5, a flowchart summarizing one embodiment employing a dual-port laser vitreous fragmentation device in a surgical procedure is shown. As shown at 510, a needle of the vitreous fragmentation device can be inserted into a patient's eye for a vitrectomy procedure. In this manner, vitreous and other materials can be withdrawn from inside the eye. Indeed, as shown at 530, vitreous can be withdrawn through multiple ports. Furthermore, a laser can be utilized to cut / fracture the vitreous within the needle at the location of the ports (see 590). As a result, no cutter or other instrument is used that would close the ports, allowing the vitreous to be continuously aspirated. Additionally, if cutting / fracturing the vitreous itself would pose an obstacle to the laser's path, cutting / fracturing can be performed sequentially through the first (more proximal) port (see 550), then the second port (see 570), and so on, depending on the number of ports utilized. Overall, this means that interruptions in vitreous uptake may be substantially reduced, and thus vitreous may be withdrawn more fluidly and continuously, which may allow for improved withdrawal with less of the aspirated vitreous pulling on delicate ocular structures.

[0021] The above-described embodiments include a vitreous fragmentation device capable of achieving a more fluid capture of vitreous and other materials from a patient's eye. Again, this is achieved without closing ports and increasing the likelihood that the vitreous will pull on delicate ocular structures. Thus, the overall safety and efficiency of the vitrectomy procedure can be achieved.

[0022] The foregoing description has been presented with reference to presently preferred embodiments. However, other embodiments and / or features disclosed but not specifically described may also be employed. Moreover, those skilled in the art and technology to which these embodiments pertain will recognize that still other substitutions and modifications in the described structure and method of operation may be practiced without significantly departing from the principles and scope of these embodiments. Additionally, the foregoing description should not be read as relating solely to the exact structure described and shown in the accompanying drawings, but rather as supporting the following claims, which are to have their fullest and most reasonable scope.

Claims

1. A vitreous body fragmentation device, a tubular device having at least two ports for the intake of vitreous humor into a channel defined by said device; at least one laser emitting device in a surgical console coupled to the instrument for delivering a laser to the channel through an optical fiber and for fracturing vitreous humor adjacent to the at least two ports during uptake; A vitreous body breaking device comprising:

2. 10. The vitreous fragmentation device of claim 1, wherein the at least two ports include a third port in the tubular instrument for drawing in the vitreous humor.

3. The vitreous fragmentation device of claim 1 , wherein the at least two ports are axially aligned on the instrument.

4. The vitreous fragmentation device of claim 1 , wherein the laser emitter is located proximal to the probe relative to the at least two ports.

5. A vitreous body fragmentation device, a tubular device having at least two ports for the intake of vitreous humor into a channel defined by said device; at least one laser emitting device within the vitreous fragmentation device for delivering a laser through the channel and for fragmenting the vitreous humor adjacent to the at least two ports during capture; A vitreous body breaking device comprising:

6. The vitreous body fragmentation device according to claim 5 , wherein the laser is one of a picosecond laser and a femtosecond laser.

7. 6. The vitreous fragmentation device of claim 5, wherein the at least two ports are axially aligned on the instrument.

8. The vitreous body fragmentation device according to claim 5 , wherein the laser is one of a continuous laser and a pulsed laser.

9. 1. A method of performing a vitrectomy, comprising: advancing a vitreous fragmentation device instrument into the patient's eye; drawing vitreous through at least two ports of the instrument and into a channel thereof; fracturing the vitreous body with a laser within the channel; A method comprising:

10. The method of claim 9 , wherein the at least two ports are axially aligned on the instrument.

11. The method of claim 10 , wherein the fracturing comprises cutting the vitreous body in the channel at the at least two ports substantially simultaneously.

12. 11. The method of claim 10, wherein the fracturing comprises cutting the vitreous body in the channel more proximal to the at least two ports before cutting the vitreous body more distal to the at least two ports.

13. 10. The method of claim 9, wherein the withdrawal of the vitreous through the at least two ports is unimpeded.

14. 10. The method of claim 9, wherein the laser is a pulsed laser operating at about 50,000 to about 90,000 pulses per minute.

15. 10. The method of claim 9, wherein the fracturing of the vitreous body is performed substantially one of without vibration and without noise.

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