Laser Vitrectomy and Hemostatic Tools

Abstract

The present disclosure generally relates to a surgical instrument. The surgical instrument includes a base unit and a probe. The probe is disposed through an opening in the distal end of the base unit. The probe includes a port formed proximate to the distal tip of the probe. The distal tip includes a window, a lumen formed through the probe, and one or more optical fibers disposed within the lumen. The one or more optical fibers project a first laser light for illuminating an area proximate to the port to sever collagen fibers of vitreous material aspirated through the port. The one or more optical fibers further project a second laser light for cauterizing bleeding in the intraocular space of a patient.

Description

[Technical Field]

[0001] The present invention relates to laser vitrectomy and hemostatic tools. [Background technology]

[0002] Anatomically, the human eye is divided into two distinct regions: the anterior segment and the posterior segment. The anterior segment includes the lens and extends from the outermost layer of the cornea to the posterior lens capsule. The posterior segment of the eye includes the anterior hyaloid membrane and all ocular structures behind it, such as the vitreous humor, retina, choroid, and optic nerve.

[0003] Vitreoretinal procedures are commonly performed within the posterior segment of the human eye to treat serious conditions such as age-related macular degeneration (AMD), macular hole, premacular fibrosis, retinal detachment, epiretinal membrane, cytomegalovirus (CMV) retinitis, diabetic retinopathy, vitreous hemorrhage, and other ophthalmic conditions. Such procedures often require the separation and removal of a portion of the vitreous humor, a colorless, gel-like substance that makes up approximately two-thirds of the eye's volume, from the posterior segment. In a vitrectomy procedure, a surgeon inserts microsurgical instruments through one or more incisions made in the eye to cut and remove the vitreous from within.

[0004] Microsurgical instruments typically utilized during vitrectomy include a vitrectomy probe for cutting and removing the vitreous from the intraocular space. During a vitrectomy procedure, retinal bleeding can occur as a result of vitreoretinal traction caused during vitreous cutting and removal. Bleeding can increase intraocular pressure (IOP), or intraocular fluid pressure, creating additional problems during the procedure. To stop bleeding, a diathermy needle can be used to cauterize the bleeding site on the retinal surface. However, to use the diathermy needle, the surgeon must first remove the microsurgical instrument used to cut / remove the vitreous, thereby complicating the procedure and reducing overall efficiency. Furthermore, cauterized tissue can adhere to the metal tip of the diathermy needle, potentially reopening the bleeding site. Therefore, a more efficient method for stopping bleeding during a vitrectomy procedure has been and is needed. Summary of the Invention [Means for solving the problem]

[0005] The present disclosure relates generally to microsurgical instruments for ophthalmic surgical procedures, and more particularly to microsurgical instruments having combined laser vitrectomy and cauterization functionality.

[0006] In one embodiment, a surgical instrument is provided. The surgical instrument includes a base unit and a probe. The probe is positioned through an opening in the distal end of the base unit. The probe includes a port formed proximate to the distal tip of the probe. The distal tip includes a window, a lumen formed through the probe, and one or more optical fibers disposed within the lumen. The one or more optical fibers project a first laser light for illuminating an area proximate to the port to sever collagen fibers of vitreous material aspirated through the port. The one or more optical fibers further project a second laser light for cauterizing bleeding in the intraocular space of the patient.

[0007] In another embodiment, a surgical instrument is provided. The surgical instrument includes a base unit and a probe. The probe is disposed through an opening in the distal end of the base unit. The probe includes a port formed proximate to the distal tip of the probe, a lumen formed through the probe, and one or more optical fibers disposed within the lumen. The optical fiber projects a first laser light for illuminating an area proximate to the port to sever collagen fibers in vitreous material aspirated through the port. The one or more optical fibers further project a second laser light for cauterizing bleeding in the patient's intraocular space. The distal tip includes a window configured to allow the second laser light to pass through the distal tip and to prevent the first laser light from passing through the distal tip.

[0008] So that the above-described features of the present disclosure can be understood in detail, a more particular description of the present disclosure briefly summarized above can be had by reference to embodiments, some of which are illustrated in the accompanying drawings. It should be noted, however, that the accompanying drawings illustrate only exemplary embodiments and should not be considered as limiting the scope thereof, as other equally effective embodiments may be recognized. [Brief explanation of the drawings]

[0009] [Figure 1] 1 shows a perspective view of an exemplary surgical instrument according to some embodiments of the present disclosure. [Figure 2A] 2 shows a top view of a portion of the surgical instrument of FIG. 1 according to some embodiments of the present disclosure. [Figure 2B] 1A-1C show stylized longitudinal cross-sectional views of a portion of a surgical instrument according to some embodiments of the present disclosure. [Figure 2C] 1 shows another stylized longitudinal cross-sectional view of a portion of a surgical instrument according to some embodiments of the present disclosure. [Figure 3A] 2 shows a stylized longitudinal cross-sectional view of a portion of the surgical instrument of FIG. 1 according to some embodiments of the present disclosure. [Figure 3B]1 shows another stylized longitudinal cross-sectional view of a portion of a surgical instrument according to some embodiments of the present disclosure. [Figure 4A] 2 shows a front cross-sectional view of the exemplary surgical instrument of FIG. 1 according to some embodiments of the present disclosure. [Figure 4B] 1 illustrates another cross-sectional front view of an exemplary surgical instrument, according to some embodiments of the present disclosure. [Figure 5A] 2 shows a front cross-sectional view of the exemplary surgical instrument of FIG. 1 according to some embodiments of the present disclosure. [Figure 5B] 1 illustrates another cross-sectional front view of an exemplary surgical instrument, according to some embodiments of the present disclosure. [Figure 5C] 1 illustrates another cross-sectional front view of an exemplary surgical instrument, according to some embodiments of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0010] For ease of understanding, the same reference numerals have been used, where possible, to refer to the same elements common to the figures. It is contemplated that elements and features of one embodiment may be incorporated into other embodiments as appropriate without further recitation.

[0011] FIELD OF THE DISCLOSURE The present disclosure relates generally to microsurgical instruments for ophthalmic surgical procedures, and more particularly to microsurgical instruments that combine laser vitrectomy and ablation functions.

[0012] In some embodiments, the surgical instrument includes a base and a probe having a main lumen and a port at its distal tip. In some embodiments, the probe can further include a single optical fiber within the main lumen, the single optical fiber configured to project both the first laser light and the second laser light. According to some embodiments, when (e.g., upon) vitreous material is drawn into the probe (e.g., through the port) during an ophthalmic surgical procedure, the vitreous material passes through a volume proximal to the port, which is illuminated by the first laser light emitted by the optical fiber, thereby cutting the vitreous material. The cut vitreous material can then be aspirated proximally from the eye through the probe. Additionally, in the event of bleeding during the surgical procedure, the optical fiber can emit light of an alternative wavelength (e.g., a second laser light) to cauterize the bleeding site.

[0013] In some other embodiments, separate optical fibers can be used to project the first and second laser lights. For example, in such embodiments, a first optical fiber can be used to project the first laser light to cut the vitreous material, and a second optical fiber can be used to project the second laser light to cauterize the bleeding site.

[0014] FIG. 1 illustrates a perspective view of an exemplary surgical instrument 100, in accordance with certain embodiments described herein. As shown in FIG. 1, the surgical instrument 100 includes a probe 110 and a base unit 120. The probe 110 is disposed longitudinally partially through a distal end 121 of the base unit 120 and may be directly or indirectly mounted within an internal chamber of the base unit 120. It should be noted that, as described herein, a distal end or portion of a component refers to the end or portion that is closer to the patient's body during its use, whereas a proximal end or portion of a component refers to the end or portion that is farther away from the patient's body.

[0015] In some embodiments, the base unit 120 is a handpiece having an exterior surface configured to be held by a user, such as a surgeon. For example, the base unit 120 can be ergonomically contoured to fit substantially in a user's hand. In some embodiments, the exterior surface may be textured or have one or more gripping features formed therein, such as one or more grooves and / or ridges. The base unit 120 can be made from any material commonly used for such instruments and suitable for ophthalmic surgery. For example, the base unit 120 can be formed from lightweight aluminum, polymer, or other suitable material. In some embodiments, the base unit 120 can be sterilized and used for more than one surgical procedure, or it can be a disposable device.

[0016] Base unit 120 further provides one or more ports 123 at its proximal end 125 (e.g., one port 123 is shown in FIG. 1 ) for routing one or more supply lines to the internal chamber of base unit 120. For example, port 123 can provide a connection between base unit 120 and a vacuum line of a vacuum source for suction. Port 123 can also provide a connection to a fiber optic cable coupled to one or more light sources for providing laser light.

[0017] 2A shows a plan view of the distal end 121 of the probe 110 and the base unit 120. As shown, the probe 110 may be an elongated laser cutting member that may be inserted into the eye, for example, through an insertion cannula, to perform a vitrectomy, which may be with or without aspiration. Accordingly, the probe 110 may be formed of a material suitable for minimally invasive vitreoretinal surgery. For example, the probe 110 may include one or more portions formed of an opaque material, such as a plastic and / or polymeric material. The probe 110 may further include one or more portions formed of a more surgical-grade material, such as stainless steel and / or aluminum.

[0018] In certain embodiments, the probe 110 has a length L of about 15 mm (millimeters) to about 30 mm, although in some embodiments the length may be longer or shorter. The probe 110 may comprise a hollow tube having an outer diameter of less than about 20 gauge. In some embodiments, the probe 110 is segmented into two or more portions (e.g., regions or segments) having different sized outer diameters. For example, as shown in FIG. 2A , the probe 110 may include a proximal portion 212 having a larger outer diameter than a distal portion 214 that terminates at a distal tip 216. In some embodiments, the proximal portion 212 has an outer diameter of about 23 gauge, and the distal portion 214 has an outer diameter of about 25 gauge.

[0019] In some embodiments, the proximal portion 212 has an outer diameter of approximately 25 gauge, and the distal portion 214 has an outer diameter of approximately 27 gauge. In some embodiments, the proximal portion 212 has an outer diameter of approximately 27 gauge, and the distal portion 214 has an outer diameter of approximately 29 gauge. In some embodiments, the proximal portion 212 functions as an infusion portion and is configured to direct infusion fluid into an operating space adjacent to the probe during use. Accordingly, the proximal portion 212 may include one or more coaxial infusion ports concentrically disposed about the distal portion 214 and fluidly connected to a fluid source through the base unit 120. Delivery of infusion fluid to the interior of the eye during vitreoretinal surgery allows for maintenance of intraocular pressure (IOP), thereby preventing collapse of the eye during the surgical procedure.

[0020] In some embodiments, the surgical instrument 100 further includes a stiffener 230 fixedly or slidably coupled to at least a portion of the probe 110 and substantially surrounding the probe 110. For example, the stiffener 230 can be slidably coupled to an exterior surface 236 (shown in FIGS. 2B-2C ) of the probe 110 and extend from and retract into the base unit 120. The stiffener 230 can be adjustable relative to the probe 110, allowing a user to position the stiffener 230 at different points along the length L of the probe 110 outside of the base unit 120. Thus, by repositioning the stiffener 230 relative to the distal tip 216, a user can selectively adjust the level of stiffness of the probe 110, thereby manipulating the amount of support provided to the probe 110 and stabilizing the surgical instrument 100 during use of the instrument.

[0021] As discussed above, in some embodiments, the surgical instrument 100 provides a single optical fiber configured to project multiple wavelengths of laser light. Various examples of using a single optical fiber to project multiple wavelengths of laser light are shown in Figures 2B, 2C, 4A, and 4B. In some other embodiments, one or more optical fibers can be used to project a first laser light, while one or more additional optical fibers can be used to project a second laser light. Various examples of using multiple fibers to project the first and second laser lights are shown in Figures 3 and 5A-5C.

[0022] 2B and 2C show stylized longitudinal cross-sectional views of the distal portion 214 of the probe 110 with an optical fiber 240 housed therein. As shown, the probe 110 includes a main lumen 260 and a port 222 near (e.g., proximal to) the distal tip 216. In one example, the main lumen 260 has a substantially circular cross-section. The port 222, located at the distal tip 216 of the distal portion 214, is sized and shaped to allow vitreous collagen fibers to enter the main lumen 260 during vitrectomy. In some examples, the vitreous collagen fibers can be aspirated into the main lumen 260 through the port 222. As described further below, the optical fiber 240 is configured to project a first laser beam 241 to cut vitreous fibers that enter the port 222.

[0023] 2B and 2C, the distal tip 216 comprises a flat tip. In other words, the distal tip 216 is disposed at an angle perpendicular to the central longitudinal axis of the probe 110. However, other configurations of the distal tip 216 are also contemplated, such as that shown and described with reference to FIG.

[0024] The optical fiber 240 may be designed to operate as an optical waveguide and propagate a first laser light 241 through its terminal end 242. The properties of the first laser light 241 propagated through the optical fiber 240 are such that the first laser light 241 causes disruption of vitreous collagen fibers within the path of the first laser light 241. Disruption refers to the destruction of tissue by rapid ionization of the tissue's molecules. In some examples, the first laser light 241 may be generated by a first laser source 264 optically coupled to the optical fiber 240 using a fiber optic cable, as described above. In some embodiments, the first laser light 241 propagated by the optical fiber 240 is ultraviolet (“UV”) (<350 nm (nanometers)) laser light. In other embodiments, the first laser light 241 is an argon blue-green laser light (488 nm), a Nd-YAG laser light (532 nm) such as a frequency-doubled Nd-YAG laser light, a krypton red laser light (647 nm), a diode laser light (805-810 nm), or other suitable type of laser light for ophthalmic surgery.

[0025] In some embodiments, the first laser light source 264 can generate the first laser light 241 having a pulse rate within a range of about 10 kilohertz (kHz) to about 500 kHz. Pulses in this range can effectively provide disruption of the vitreous body. Other pulse rate ranges can also provide disruption and are therefore considered. In some examples, the first laser light source 264 generates picosecond or femtosecond first laser light 241. In some embodiments, the first laser light source 264 can generate continuous coherent first laser light 241. For example, the first laser light source 264 can generate low-power, continuous coherent first laser light 241.

[0026] In certain embodiments, optical fiber 240 is positioned within main lumen 260 and terminates at a terminal end 242 near port 222 such that a first laser beam 241 projected from optical fiber 240 is projected across port 222 with sufficient power to sever vitreous collagen fibers. In the embodiment shown in FIG. 2B , optical fiber 240 is separated from an inner sidewall 226 of probe 110 and is rigidly suspended within main lumen 260 such that optical fiber 240 is circumferentially surrounded by a space 228. Space 228 formed between optical fiber 240 and inner sidewall 226 of probe 110 provides a coaxial path for aspiration of separated vitreous collagen fibers through probe 110. In some embodiments, optical fiber 240 can be centered within main lumen 260 such that the radial distance between inner sidewall 226 and optical fiber 240 is uniform along the circumference of optical fiber 240.

[0027] 2C , the optical fiber 240 may be disposed (e.g., coupled) along the interior sidewall 226. For example, the optical fiber 240 may be coupled to the interior sidewall 226 along its longitudinal length. In some embodiments, the optical fiber 240 is coupled to the interior sidewall 226 along a portion of the interior sidewall 226 that is radially aligned with the port 222, such that the terminating end 242 of the optical fiber 240 terminates at a point radially inward of the port 222 relative to the central longitudinal axis of the probe 110. The optical fiber 240 may be coupled to the interior sidewall 226 using any suitable adhesive or bonding mechanism, such as an epoxy or acrylic adhesive.

[0028] The terminating end 242 of the optical fiber 240 can terminate at any point along the length L of the probe 110 to allow for optimal severing of and aspiration of the vitreous fibers. In some embodiments, the terminating end 242 of the optical fiber 240 terminates at a point distal to the proximal end 224 of the port 222 within the main lumen 260. In other embodiments, the terminating end 242 of the optical fiber 240 terminates at a point substantially aligned with the proximal end 224 within the main lumen 260. In yet other embodiments, the terminating end 242 of the optical fiber 240 terminates at a point proximal to the proximal end 224 within the main lumen 260.

[0029] 2B-2C, optical fiber 240 is further configured to propagate second laser light 244 in addition to and separately from first laser light 241. For example, in certain embodiments, second laser light source 266 can be used to provide second laser light 244 to optical fiber 240. However, in certain other embodiments, second laser light 244 can be generated and provided to optical fiber 240 via first laser light source 264, which can be configured to generate both first laser light 241 and second laser light 244. Optical fiber 240 propagates second laser light 244 in one of a variety of ways to facilitate cauterization of bleeding sites within the eye to prevent further bleeding during the surgical procedure.

[0030] The characteristics of the second laser light 244 propagating through the optical fiber 240 are such that the second laser light 244 can cauterize bleeding sites on the surface of the retina that occur unintentionally during vitrectomy. Bleeding during surgery occurs primarily due to inadvertent damage to blood vessels within the retina, such as by vitreoretinal traction, and is a serious complication during vitrectomy. If not promptly controlled, such bleeding can prevent successful completion of the surgery. In some examples, the second laser light 244 can be generated by a second laser source 266 optically coupled to the optical fiber 240 using a fiber optic cable, as described above. In some embodiments, the second laser light 244 propagated by the optical fiber 240 is green laser light (497 nm to 577 nm, e.g., 532 nm).

[0031] In some embodiments, the second laser source 266 can generate the second laser light 244 having a pulse rate within a range of approximately 10 kilohertz (kHz) to approximately 500 kHz. This range can effectively ablate bleeding within the eye without the use of additional microsurgical instruments (e.g., metal diathermy tips) and therefore without delaying the procedure. Furthermore, the second laser light 244 can ablate bleeding without tissue adhering to the metal diathermy tip (which could potentially cause bleeding to resume). Other pulse rate ranges can also provide ablation and are therefore contemplated. In some examples, the second laser source 266 generates picosecond or femtosecond second laser light 244. In some embodiments, the second laser source 266 can generate continuous coherent second laser light 244. For example, the second laser source 266 can generate low-power, continuous coherent second laser light 244.

[0032] In embodiments in which a single optical fiber 240 is used to project both the first laser beam 241 and the second laser beam 244, the laser source may be configured to focus the first laser beam 241 and the second laser beam 244 into the core of the optical fiber 240, such that the first laser beam 241 and the second laser beam 244 are transmitted through the core. In some embodiments, the second laser source 266 is configured to focus the second laser beam 244 into both the core and cladding of the optical fiber 240, in which case both the cladding and the core transmit the second laser beam 244. In some embodiments, the first laser source 264 is configured to focus the first laser beam 241 into both the core and cladding of the optical fiber 240, in which case both the cladding and the core transmit the first laser beam 241.

[0033] In yet some other embodiments, second laser source 266 is configured to focus second laser light 244 only in the core or cladding, in which case only one of the core or cladding transmits second laser light 244. In yet some other embodiments, first laser source 264 is configured to focus first laser light 241 only in the core or cladding, in which case only one of the core or cladding transmits first laser light 241. Thus, optical fiber 240, which includes a core and a cladding, can transmit first laser light 241 (via the cladding and / or core) and second laser light 244 (via the cladding and / or core) within the same fiber. In some embodiments, first laser light 241 and second laser light 244 are propagated through one or more additional cores within optical fiber 240. Thus, optical fiber 240 can include one or more cores through which first laser light 241 and second laser light 244 are separately propagated.

[0034] In some embodiments, the second laser light 244 is projected coaxially with the first laser light 241 from the terminating end 242 of the optical fiber 240. In certain embodiments, the propagation of the first laser light 241 and the second laser light 244 through the optical fiber 240 and into the intraocular space can be modulated by using different types of laser light sources, using different materials for the optical fiber 240, modifying the physical placement of the optical fiber 240 within the probe 110, and / or using different materials for the probe 110.

[0035] In some embodiments, first laser light 241 and second laser light 244 can be turned on or off, and / or a user can use a foot pedal to switch between first laser light 241 and second laser light 243. In some embodiments, first laser light 241 and second laser light 244 can be turned on or off, and / or a user can use a button or switch on base unit 120 to switch between first laser light 241 and second laser light 243.

[0036] In some embodiments, the optical fiber 240 has a diameter of about 20 μm (micrometers) to about 120 μm, such as a diameter of about 40 μm to about 100 μm. For example, the optical fiber 240 has a diameter of about 50 μm to about 80 μm. However, smaller or larger diameters are also contemplated. In some embodiments, an optical sleeve assembly including multiple optical fibers 240 is utilized. For example, an optical sleeve including multiple optical fibers 240 having uniform or varying diameters can be utilized. In further embodiments, the optical fiber 240 is a multimode end-emitter optical fiber, a single-mode end-emitter optical fiber, or the like.

[0037] 2B and 2C, the distal tip 216 includes a window 270. The window 270 can be configured to allow all or some wavelengths of light to pass through the distal tip 216. In some embodiments, the window 270 is fabricated to allow only certain wavelengths of light to pass through the distal tip 216. For example, in FIG. 2B, the window 270 is configured to allow the second laser beam 244 to pass through the distal tip 216, but is further configured to prevent the first laser beam 241 from passing through the distal tip 216. By allowing only the second laser beam 244 of the two laser beams 241, 244 to pass through the distal tip 216 of the probe 110, the targeting and ablation of bleeding sites within the eye is efficiently enabled, while also preventing undesired transmission of the first laser beam 241 through the distal tip 216 during vitrectomy. The modified window 270 therefore prevents unnecessary damage to the patient's eye during vitrectomy by containing the first laser light 241 within the probe 110, while also facilitating targeted ablation through the distal tip 216.

[0038] 2C , the window 270 may be fabricated to allow all wavelengths of light to pass through the distal tip 216, but may be fully or partially coated with a filtering film 280. The filtering film 280 may not allow any wavelengths of light to pass through the distal tip 216, or may only allow certain wavelengths of light to pass through the distal tip 216. For example, the filtering film 280 may be fabricated to allow the second laser light 244 to pass through the distal tip 216, but may be fabricated to prevent the first laser light 241 from passing through the distal tip 216. This facilitates cauterization of the bleeding site through the distal tip 216, while including the first laser light 241 within the probe 110 also prevents excessive damage to the eye during vitrectomy.

[0039] Figure 3A shows a stylized longitudinal cross-sectional view of a distal portion 314 of an alternative probe 310a according to certain embodiments described herein. Figure 3B shows a stylized longitudinal cross-sectional view of a distal portion 314 of an alternative probe 310b according to certain embodiments described herein. The alternative probes 310a, 310b are substantially similar to probe 110, but include a beveled distal tip 316 and two optical fibers housed therein, a first optical fiber 340a and a second optical fiber 340b. Accordingly, like reference numerals are used to refer to like elements where applicable.

[0040] The beveled distal tip 316 may be angled (e.g., disposed at a non-perpendicular angle relative to the major axis (e.g., central longitudinal axis) of the probe 110. For example, the beveled distal tip 316 may be disposed at an angle of about 0 to about 90 degrees relative to the central longitudinal axis of the probe 110. However, other configurations of the distal tip 316, such as those shown and described with reference to FIGS. 2B and 2C, are also contemplated.

[0041] Each of the optical fibers 340a and 340b of the probes 310a and 310b may be configured to transmit different types and / or wavelengths of laser light, as described elsewhere herein. For example, the optical fiber 340a of FIGS. 3A and 3B may be configured to transmit the first laser light 241, while the second optical fiber 340b may be configured to transmit the second laser light 244. In such embodiments, the first optical fiber 340a may be disposed (e.g., coupled) along the interior sidewall 326, and the second optical fiber 340b may be disposed (e.g., coupled) along the interior sidewall 326 opposite the main lumen 360. In some embodiments, the second optical fiber 340b is coupled to the interior sidewall 326 along a portion of the interior sidewall 326 radially opposite the port 322. The optical fibers 340a and 340b may be coupled to the interior sidewall 326 using any suitable adhesive or bonding mechanism, such as an epoxy or acrylic adhesive.

[0042] The terminating ends 342a, 342b of the optical fibers 340, 340b may terminate at any point along the length L of the probe 110 to allow for optimal severing of the vitreous fibers for vitrectomy and cauterization of the bleeding site, and aspiration of the vitreous fibers and their blood, respectively. In some embodiments, the terminating ends 342a, 342b of the optical fibers 340a and / or 340b terminate within the main lumen 360 at a point distal to the proximal end 324 of the port 322. In other embodiments, as shown in FIG. 3A , the terminating ends 342a, 342b of the optical fibers 340a, 340b terminate at a point within the main lumen 360 that is substantially aligned with the proximal end 324. In yet other embodiments, the terminating ends 342a, 342b of the optical fibers 340a, 340b terminate within the main lumen 360 at a point proximal to the proximal end 324. In certain embodiments, the terminating ends 342a, 342b of the optical fibers 340a, 340b terminate at different points along the length L of the probe 110. For example, as shown in FIG. 3B , the terminating end 342a of the optical fiber 340a may terminate distal to or adjacent to the proximal end 324, while the terminating end 342b of the optical fiber 340b may terminate distal to the proximal end 324 (e.g., the terminating end 342b of the optical fiber 340b forms part of the distal end 316, as described below).

[0043] In some embodiments, the beveled distal tip 316 comprises a window 370 that can form all or substantially all of the distal end surface 318 of the beveled distal tip 316 (e.g., the window 370 can span the entire lateral width or diameter of the distal end surface 318). The window 370 can be fabricated to allow all light or specific wavelengths or light to pass through the beveled distal tip 316. In certain embodiments, the window 370 can be a modified window fabricated to allow only specific wavelengths of light to pass through the beveled distal tip 316. For example, the modified window 370 can be fabricated to allow the second laser light 244 to pass through the modified window 370 while not allowing the first laser light 241 to pass through the modified window 370. In certain embodiments, the window 370 may be fabricated to allow all wavelengths of light to pass through the beveled distal tip 316, but may be further coated with a filtering film (e.g., the filtering film 280 described above) across the entire lateral width or diameter of the window 370, or across only a portion of the lateral width or diameter of the window 370. The filtering film may allow the second laser light 244 to pass through the modified window 370, while not allowing the first laser light 241 to pass through the modified window 370. In certain embodiments, the filtering film 280 may cover only a portion of the lateral width or diameter of the window 370, such as the portion aligned with the optical fiber 340a, and may not allow any laser light to pass through. In such embodiments, the filtering film 280 may be opaque.

[0044] In yet another embodiment, as shown in FIG. 3A , the window 370 may only partially form the distal end surface 318 of the beveled distal tip 316. For example, in certain embodiments, a portion of the distal end surface 318 includes the window 370, while another portion of the distal end surface 318 includes a wall 320 formed of the probe material. The probe material may include an opaque material, such as a plastic and / or polymeric material. Alternatively, the window 370 may be fabricated to allow all wavelengths of light to pass through the beveled distal tip 316, or to allow only certain wavelengths of light to pass through. Furthermore, in certain embodiments, the window 370 may also be coated with a filtering film.

[0045] In embodiments in which the window 370 forms only a portion of the distal end face 318, the window 370 is generally axially aligned with the optical fiber 340b, and the wall 320 is axially aligned with the first optical fiber 340a. Thus, the wall 320 prevents the first laser beam 241 from passing through the beveled distal tip 316 of the probe 310a, and thus, containing the first laser beam 241 within the probe 310a prevents the first laser beam 241 from causing damage to the eye during vitrectomy. However, the window 370 allows the second laser beam 244 to pass through the distal end face 318 for cauterization of bleeding sites within the eye. By allowing the second laser beam 244 to pass through the beveled distal tip 316 of the probe 310a, the bleeding site can be more easily targeted with the probe 310.

[0046] In yet another embodiment, as shown in FIG. 3B , the wall 320 only partially forms the distal end face 318 of the beveled distal tip 316. For example, the wall 320 includes a probe material that forms a portion of the distal end face 318, while another portion of the distal end face 318 of the beveled distal tip 316 is formed by the terminating end 342b of the optical fiber 340b. The probe material may include an opaque material, such as a plastic and / or polymeric material. In embodiments in which the terminating end 342b of the optical fiber 340b forms a portion of the distal end face 318, the wall prevents the first laser beam 241 from passing through the beveled distal tip 316 of the probe 310b, thus containing the first laser beam 241 within the probe 310b and preventing the first laser beam 241 from causing damage to the eye during vitrectomy. However, end face 342b allows second laser light 244 to pass through distal end face 318 for cauterization of the bleeding site within the eye. By allowing second laser light 244 to pass through beveled distal tip 316 of probe 310b, the bleeding site can be more easily targeted with probe 310.

[0047] 4A-4B show exemplary cross-sectional front views of the probe 110 of FIGS. 2A-2C , with a single optical fiber 240 housed therein for projecting both a first laser beam 241 and a second laser beam 244. As shown, the probe 110 has a circular cross-section defined by an interior sidewall 226 and an exterior surface 236. Generally, the optical fiber 240, according to embodiments of the present disclosure, includes a core 444 and a cladding 446 circumferentially surrounding the core 444. The core 444 may include any transparent material, such as fused silica or glass. In some embodiments, the core 444 is doped. For example, the core 444 may be silica doped with germanium. Doping the core 444 with germanium or a similar dopant increases the refractive index of the core 444 compared to the refractive index of the cladding 446 material, thus enabling laser and light-guiding properties within the core 444.

[0048] The cladding 446 may also comprise a transparent material such as fused silica or glass. In some embodiments, the cladding 446 is doped in addition to or instead of doping the core 444. For example, the cladding 446, which may comprise fused silica, is doped with a dopant that reduces the refractive index of the cladding 446 relative to the refractive index of the core 444. Examples of dopants include fluorine (F), chlorine (Cl), boron (B), etc. When doped, the cladding 446 has a lower refractive index than the core 444, thus enabling light guiding properties within the core 444. Although one cladding 446 is shown in each of FIGS. 4A-4B, the optical fiber 440 may further include one or more additional claddings.

[0049] In one example, core 444 has a diameter ranging from 5 μm to about 100 μm, such as from about 20 μm to about 80 μm, such as about 75 μm in diameter. However, smaller or larger diameters are also contemplated. In one example, cladding 446 has a thickness ranging from about 5 μm to about 50 μm, such as from about 15 μm to about 40 μm, such as about 25 μm in thickness. However, smaller or larger thicknesses are also contemplated.

[0050] In some embodiments, the optical fiber 240 is disposed within a sleeve. The sleeve may be directly or indirectly coupled to the exterior of the cladding 446 and circumferentially surround the cladding 446 and core 444 of the optical fiber 240. The sleeve may function as a tubular structure to provide structural support and alignment for the optical fiber 240 within the main lumen 260 of the probe 110. Like the core 444 and cladding 446, the sleeve may comprise a transparent material such as fused silica and glass. In further embodiments, the sleeve is doped with a dopant to manipulate the refractive index of the sleeve as desired.

[0051] FIG. 4A illustrates an arrangement in which the optical fiber 240 is positioned against the interior sidewall 226 of the probe 110. The optical fiber 240 may be coupled to the interior sidewall 226 along a longitudinal portion thereof that is radially aligned with the port 222 (shown in FIGS. 2A-2C). Thus, a space 228 is formed within the main lumen 260 around the optical fiber 240, except for the longitudinal portion of the interior sidewall 226 to which the optical fiber 240 is coupled. The optical fiber 240 may be bonded or bonded to the interior sidewall 226 via any suitable adhesive or bonding mechanism. For example, the outer surface 236 of the cladding 446 or sleeve 448 may be bonded to the interior sidewall 226 of the probe 110 using an epoxy or acrylic adhesive. However, other adhesives are contemplated.

[0052] 4B shows an alternative exemplary arrangement in which optical fiber 240 is suspended within main lumen 260. In some examples, a sleeve can provide structural support and rigidity to optical fiber 240, allowing optical fiber 240 to be suspended inside main lumen 260 without bonding optical fiber 240 to interior sidewall 226. As shown in FIG. 4B, optical fiber 240 can be centered within main lumen 260 such that the radial distance between a point on the exterior surface of optical fiber 240 and interior sidewall 226 is uniform around the entire circumference of optical fiber 240.

[0053] 5A-5C show exemplary cross-sectional front views of a probe 310 containing at least two optical fibers 340a and 340b. As described above, the first optical fiber 340a can be used to transmit a first laser beam 241 for vitreous fiber ablation. Meanwhile, the second optical fiber 340b can be used to transmit a second laser beam 244 for cauterizing a bleeding site. Each of the optical fibers 340a and 340b further includes a core 544a and a cladding 546a and a cladding 546b, respectively. The cores 544a and 544b and the cladding 546a and 546b can be formed of any material suitable for transmitting a laser beam. For example, the cores 544a and 544b and the cladding 546a and 546b can include a transparent material such as fused silica or glass, as described above. The cores 544a, 544b and claddings 546a, 546b may be further doped with one or more dopants depending on the desired refractive properties of the optical fibers 340a, 340b, respectively.

[0054] The dimensions of optical fibers 340a, 340b, including cores 544a, 544b and claddings 546a, 546b, can be substantially similar to the dimensions of optical fiber 240, core 444, and cladding 446 described above. Although shown in Figures 5A-5C as having different dimensions, optical fibers 340a, 340b and cores 544a, 544b and claddings 546a, 546b can have similar or different dimensions from one another.

[0055] In some embodiments, both optical fibers 340a, 340b are disposed within the secondary lumen of the sleeve. The sleeve can provide structural support and containment for the optical fibers 340a, 340b within the main lumen 360 of the probe 310. The sleeve can comprise a transparent material such as fused silica or glass. In further embodiments, the sleeve is doped with a dopant to manipulate the refractive index of the sleeve as desired. The sleeve can have any suitable thickness to provide appropriate support and rigidity for the optical fibers 340a, 340b. In some embodiments, a transparent filler material can be used within the secondary lumen to prevent movement of the optical fibers 340a, 340b therein. For example, an adhesive can fill all areas within the secondary lumen not occupied by the optical fibers 340a, 340b. In other embodiments, the optical fibers 340a, 340b are disposed within the secondary lumen without utilizing a filler material.

[0056] 5A-5C show alternative exemplary arrangements of optical fibers 340a, 340b without the use of a sleeve. In FIG. 5A, optical fibers 340a, 340b are disposed within main lumen 360 of probe 310 without any surrounding structure other than probe 310 itself.

[0057] 5A, the optical fibers are bonded to one another and to the interior sidewall 326. Thus, a space 328 is formed within the main lumen 360 around the optical fibers 340a, 340b, except for the longitudinal portion of the interior sidewall 326 where the optical fibers 340a, 340b are bonded. The optical fibers 340a, 340b may be bonded or bonded to the interior sidewall 326 via any suitable adhesive or bonding mechanism. For example, the outer surfaces of the claddings 546a, 546b may be bonded to the interior sidewall 326 of the probe 310 using an epoxy or acrylic adhesive. However, other adhesives are contemplated.

[0058] 5B and 5C, the optical fibers 340a, 340b may be separated and isolated from one another within the main lumen 360. In FIG. 5B, the optical fibers 340a, 340b are disposed within the main lumen 360 such that the first optical fiber 340a is coupled to the interior sidewall 326 and the second optical fiber 340b is suspended within the main lumen 360. In some examples, a sleeve may provide structural support and rigidity to the second optical fiber 340b to allow the second optical fiber 340b to be suspended inside the main lumen 360 without being coupled to the interior sidewall 326. The second optical fiber 340b may be centered within the main lumen 360 such that the radial distance between a point on the exterior surface 336 of the second optical fiber 340b and the interior sidewall 326 is uniform around the entire circumference of the second optical fiber 340b.

[0059] 5C , optical fibers 340a, 340b are positioned against the interior sidewall 326 of the probe 310. The optical fibers 340 may be coupled to the interior sidewall 326 along a longitudinal portion thereof that is radially aligned with the ports 322. Thus, a space 328 is formed within the main lumen 360 around the optical fibers 340a, 340b, except for the longitudinal portion of the interior sidewall 326 to which the optical fibers 340a, 340b are coupled. The optical fibers 340a, 340b may be bonded or bonded to the interior sidewall 326 via any suitable adhesive or bonding mechanism. For example, the outer surfaces of the claddings 546a, 546b may be bonded to the interior sidewall 326 of the probe 310 using an epoxy or acrylic adhesive. However, other adhesives are contemplated.

[0060] In some embodiments, the optical fibers 340 a, 340 b are disposed through a spacer tube 470 having one or more longitudinal bores drilled therethrough to allow for the placement of the optical fibers 340 a, 340 b. The spacer tube may act in a manner substantially similar to a sleeve, providing structural support and containment for the optical fibers 340 a, 340 b. The spacer tube may be formed from any suitable transparent material, including fused silica and / or glass.

[0061] In summary, embodiments of the present disclosure include devices and structures for performing vitreoretinal surgery. In particular, the surgical instruments described above combine the functionality of laser vitrectomy and intraocular ablation, enabling more efficient vitreous removal. Utilizing a first laser beam from a vitrectomy probe facilitates removal of collagen fibers in the vitreous substance, thereby reducing retinal traction caused by the removal of the vitreous substance. Furthermore, propagation of a second laser beam through the vitrectomy probe enables ablation of intraocular bleeding without the need for a secondary ablation device, which may provide inefficient ablation or limit surgical space within the intraocular space. Furthermore, the embodiments described herein provide a configuration for controlling the dispersion of the first and second laser beams within the eye for a user of the vitrectomy probe, thereby enabling more precise targeting of the second laser beam for ablation and preventing dispersion of the first laser beam within the eye to prevent further bleeding. Thus, the described embodiments enable the performance of more efficient, less invasive, and safer vitreoretinal surgery.

[0062] Although vitreous surgery is discussed as an example of a surgical procedure that may benefit from the described embodiments, other surgical procedures may similarly benefit from the advantages of the surgical devices and systems described herein.

[0063] While the foregoing is directed to embodiments of the present disclosure, other and further embodiments of the disclosure may be devised without departing from the basic scope thereof, the scope of which is determined by the claims that follow.

Claims

1. 1. A surgical instrument for performing a vitrectomy, comprising: A base unit and a probe coupled to a distal end of the base unit; The probe comprises: a distal tip disposed at a distal end of the probe, the distal tip comprising a window; a port formed in a sidewall of the probe and proximate the distal tip; a lumen formed through the probe; one or more optical fibers disposed within the lumen, the optical fibers being configured to project a first laser light to illuminate an area proximate the port to cut collagen fibers of vitreous material aspirated through the port, and further configured to project a second laser light through the window to cauterize a bleeding site; A surgical instrument comprising:

2. The surgical instrument of claim 1 , wherein the one or more optical fibers comprise a single optical fiber configured to project the first laser light and the second laser light.

3. 3. The surgical instrument of claim 2, wherein the window is configured to allow the second laser light to pass through the distal tip and to prevent the first laser light from passing through the distal tip.

4. 3. The surgical instrument of claim 2, wherein the window is coated with a filtering membrane configured to allow the second laser light to pass through the distal tip and prevent the first laser light from passing through the distal tip.

5. 10. The surgical instrument of claim 1, wherein the one or more optical fibers comprise a first optical fiber configured to project the first laser light and a second optical fiber configured to project the second laser light.

6. 6. The surgical instrument of claim 5, wherein the probe further comprises a distal end face disposed at the distal tip, the window forming a portion of the distal end face aligned with the second optical fiber, whereby the distal end face allows the second laser light to pass through the distal tip and prevents the first laser light from passing through the distal tip.

7. 6. The surgical instrument of claim 5, wherein the window is coated with a filtering membrane configured to allow the second laser light to pass through the distal tip and prevent the first laser light from passing through the distal tip.

8. 6. The surgical instrument of claim 5, wherein a portion of the window aligned with the first optical fiber is coated with an opaque film configured to prevent the first laser light and the second laser light from passing through the distal tip.

9. 1. A surgical instrument for performing a vitrectomy, comprising: A base unit and a probe positioned through an opening in the distal end of the base unit; The probe comprises: a distal tip comprising a window; a port formed proximate the distal tip; a lumen formed through the probe; one or more optical fibers disposed within the lumen, the optical fibers being configured to project a first laser light to illuminate an area proximate the port to sever collagen fibers of vitreous material aspirated through the port, and further configured to project a second laser light to cauterize bleeding in the patient's intraocular space, the window being configured to allow the second laser light to pass through the distal tip and to prevent the first laser light from passing through the distal tip; A surgical instrument comprising:

10. The surgical instrument of claim 9 , wherein the one or more optical fibers comprise a single optical fiber configured to project the first laser light and the second laser light.

11. 11. The surgical instrument of claim 10, wherein the window is coated with a filtering membrane configured to allow the second laser light to pass through the distal tip and prevent the first laser light from passing through the distal tip.

12. 10. The surgical instrument of claim 9, wherein the one or more optical fibers comprise a first optical fiber configured to project the first laser light and a second optical fiber configured to project the second laser light.

13. 13. The surgical instrument of claim 12, wherein the probe further comprises a distal end face disposed at the distal tip, the window forming a portion of the distal end face aligned with the second optical fiber, whereby the distal end face allows the second laser light to pass through the distal tip and prevents the first laser light from passing through the distal tip.

14. 13. The surgical instrument of claim 12, wherein the window is coated with a filtering membrane configured to allow the second laser light to pass through the distal tip and prevent the first laser light from passing through the distal tip.

15. 13. The surgical instrument of claim 12, wherein a portion of the window aligned with the first optical fiber is coated with an opaque film configured to prevent the first laser light and the second laser light from passing through the distal tip.

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