Laser Vitreous Resection and Illumination Probe

Abstract

The present disclosure relates generally to microsurgical instruments for ophthalmic surgical procedures, and more particularly to microsurgical instruments that combine illumination and laser vitrectomy functions. 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 may further include one or more optical fibers configured to project laser light and illumination light into the main lumen. According to some embodiments, as vitreous material is drawn into the probe, for example through the port, the vitreous material passes through a volume illuminated by laser light emitted by the optical fiber, separating the vitreous material. Simultaneously, the illumination light enhances visualization of the intraocular space during separation and removal of the vitreous material.

Description

Technical Field

[0001] Cross - Reference to Related Applications This application claims the benefit of priority of U.S. Provisional Patent Application No. 62 / 991,639, filed on Mar. 19, 2020, entitled "LASER VITRECTOMY AND ILLUMINATION PROBE", with inventor Paul R. Hallen, and is hereby incorporated by reference in its entirety as if fully and completely set forth herein.

[0002] Embodiments of the present disclosure generally relate to small - gauge instruments for surgical procedures, and more particularly, to small - gauge instruments for laser vitrectomy.

Background Art

[0003] 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 back of the lens capsule. The posterior segment of the eye includes the vitreous humor, the retina, the choroid, the optic nerve, and all the eye structures behind the anterior vitreous membrane.

[0004] Retinal vitrectomy is generally performed within the posterior segment of the human eye to treat serious conditions such as age - related macular degeneration (AMD), macular holes, epiretinal membranes, retinal detachment, subretinal membranes, cytomegalovirus (CMV) retinitis, diabetic retinopathy, vitreous hemorrhage, and other ophthalmic conditions. In such surgeries, it is often necessary to separate and remove a portion of the vitreous humor, a colorless gel - like substance that constitutes about two - thirds of the volume of the eye, from the posterior segment. In vitrectomy surgery, the surgeon inserts microsurgical instruments through one or more incisions made in the eye and cuts and removes the vitreous from within. When using multiple instruments simultaneously, separate incisions may be provided for each microsurgical instrument.

[0005] Typical microsurgical instruments utilized during vitrectomy include a vitrectomy probe for separating and removing the vitreous, and an illumination probe for providing illumination within the intraocular space. Adequate illumination of the intraocular space is advantageous for appropriately observing the vitreous to the extent possible for the purpose of removal by the surgeon using the vitrectomy probe. In some cases, in order to reach the vitreous located in the peripheral region of the eye, the surgeon can also move the retina inward using a scleral depressor in addition to other microsurgical instruments. Thus, during any given vitrectomy, three or more microsurgical instruments may be used simultaneously, but the surgeon has only two hands for performing the surgery.

SUMMARY OF THE INVENTION

MEANS FOR SOLVING THE PROBLEM

[0006] The present disclosure generally relates to microsurgical instruments for ophthalmic surgical procedures, and more specifically to microsurgical instruments that combine illumination and laser vitrectomy functionality.

[0007] In one embodiment, a surgical instrument is provided. The surgical instrument includes a base unit and a probe disposed through an opening at the distal end of the base unit. The probe further 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 fibers project laser light for irradiating a region proximate to the port to cut the collagen fibers of the vitreous material aspirated through the port, and illumination light for illuminating the intraocular space of the patient.

[0008] To enable a more detailed understanding of the features of the present disclosure enumerated above, a more detailed description of the present disclosure, briefly summarized above, can be obtained by reference to the embodiments, some of which are shown in the accompanying drawings. However, it should be noted that the accompanying drawings merely illustrate exemplary embodiments and should not be considered as limiting the scope thereof, as other equally effective embodiments may be recognized.

BRIEF DESCRIPTION OF THE DRAWINGS

[0009]

Figure 1

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

[0011] The present disclosure generally relates to a microsurgical instrument for ophthalmic surgical procedures, and more particularly to a microsurgical instrument that combines illumination and laser vitrectomy functionality. In some embodiments, the surgical instrument includes a base portion 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, and the single optical fiber is configured to project both laser light and illumination light. According to some embodiments, when vitreous material is drawn (e.g., immediately) into the probe, e.g., through a port, the vitreous material passes through a volume irradiated by the laser light emitted by the optical fiber, thereby separating the vitreous material. At the same time, the illumination light enhances visualization of the intraocular space during separation and removal of the vitreous material. In some other embodiments, separate optical fibers can be used to project the laser light and the illumination light. For example, in such embodiments, a first optical fiber can be used to project the laser light, while one or more additional optical fibers can be used to project the illumination light.

[0012] FIG. 1 shows a perspective view of an exemplary surgical instrument 100 according to a particular embodiment 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 partially and longitudinally through the distal end 121 of the base unit 120 and may be attached directly or indirectly within an internal chamber of the base unit 120. It should be noted that, as described herein, the distal end or a portion of a component refers to the end or portion that is closer to the patient's body during its use. On the other hand, the proximal end or a portion of a component refers to the end or portion that is further away from the patient's body.

[0013] In some embodiments, the base unit 120 is a handpiece having an external surface configured to be held by a user, such as a surgeon. For example, the base unit 120 can depict an ergonomic contour to substantially fit in a user's hand. In some embodiments, the external surface may be textured or may 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, a polymer, or other suitable materials. In some embodiments, the base unit 120 may be sterilized and used for two or more surgical procedures, or it may be a disposable device.

[0014] The base unit 120 further provides one or more ports 123 at its proximal end 125 such that one or more supply lines are routed into the internal chamber of the base unit 120 (e.g., one port 123 is shown in FIG. 1). For example, the port 123 can provide a connection between the base unit 120 and a vacuum line of a vacuum source for suction. The port 123 can also provide a connection to an optical fiber cable that couples to one or more light sources for providing laser light and illumination light.

[0015] Figure 2A shows a plan view of the distal end 121 of the probe 110 and the base unit 120. As shown, the probe 110 can be an elongated laser cutting member that can be inserted into the eye, for example, through an insertion cannula, to perform vitrectomy that can be either aspirating or non-aspirating. Thus, the probe 110 can be formed of a material suitable for minimally invasive retinal vitreous surgery. In some embodiments, the probe 110 includes one or more portions formed of a material configured to transmit laser light, visible light, ultraviolet light, infrared light, or any other type of light. For example, the probe 110 can include one or more portions formed of a translucent or transparent material such as a plastic and / or polymer material. The probe 110 can further include one or more portions formed of more conventional surgical grade materials such as stainless steel and / or aluminum.

[0016] In certain embodiments, the probe 110 has a length L of from about 15 millimeters (mm) to about 30 mm, although in some embodiments it may have a longer or shorter length. The probe 110 can include 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 outer diameters. For example, as shown in FIG. 2A, the probe 110 can include a proximal portion 212 having an outer diameter larger than that of 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. In some embodiments, the proximal portion 212 has an outer diameter of about 25 gauge and the distal portion 214 has an outer diameter of about 27 gauge. In some embodiments, the proximal portion 212 has an outer diameter of about 27 gauge and the distal portion 214 has an outer diameter of about 29 gauge. In some embodiments, the proximal portion 212 functions as an injection portion and is configured to direct an injection fluid into an operating space adjacent to the probe during use. Thus, the proximal portion 212 can include one or more coaxial injection ports that are concentrically disposed around the distal portion 214 and are fluidly connected to a fluid source through the base unit 120. Delivery of the injection fluid into the interior of the eye during vitreoretinal surgery enables maintenance of the intraocular pressure, thereby preventing collapse of the eye during the surgical procedure.

[0017] In some embodiments, the surgical instrument 100 further includes a reinforcement member 230 fixedly or slidably coupled to at least a portion of the probe 110 and substantially surrounding the probe 110. For example, the reinforcement member 230 is slidably coupled to the outer surface 236 (shown in FIGS. 2B-2C) of the probe 110 and can extend from and retract into the base unit 120. The reinforcement member 230 can be adjustable relative to the probe 110, allowing a user to position the reinforcement member 230 at different points along the length L of the probe 110 outside of the base unit 120. Accordingly, the user can selectively adjust the level of stiffness of the probe 110 by repositioning the reinforcement member 230 relative to the distal tip 216, thereby manipulating the amount of support provided to the probe 110 and stabilizing the surgical instrument 100 while using the instrument.

[0018] As described above, in some embodiments, the surgical instrument 100 provides a single optical fiber configured to project both laser light and illumination light. Various examples of using a single optical fiber to project both laser light and illumination light are shown in FIGS. 2B-3C. In some other embodiments, one or more optical fibers can be used to project the laser light, while one or more additional optical fibers can be used to project the illumination light. Various examples of using multiple fibers to project laser light and illumination light are shown in FIGS. 4A-5B.

[0019] Figures 2B and 2C show a stylized longitudinal cross - section of the distal portion 214 of the probe 110 with the optical fiber 240 housed therein. As shown, the probe 110 includes a main lumen 260 and a port 222 near the distal tip 216. In one example, the main lumen 260 has a substantially circular cross - section as shown in FIGS. 3A - 5B. 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 206 during vitrectomy. In some examples, the vitreous collagen fibers can be aspirated into the main lumen 206 through the port 222. As further described below, the optical fiber 240 is configured to project laser light 241 to separate the vitreous fibers entering the port 222.

[0020] The optical fiber 240 can be designed to operate as an optical waveguide and propagate the laser light 241 through its distal end portion 242. The characteristics of the laser light 241 propagated through the optical fiber 240 are such that the laser light 241 causes the destruction of vitreous collagen fibers within the path of the laser light 241. Destruction refers to the destruction of tissue by the rapid ionization of the molecules of that tissue. In some examples, the laser light 241 can be generated by a laser light source 264 optically coupled to the optical fiber 240 using an optical fiber cable as described above. In some embodiments, the laser light 241 propagated by the optical fiber 240 is ultraviolet ( "UV") (<350 nm) laser light. In other embodiments, the laser light 241 is argon blue - green laser light (488 nm), Nd - YAG laser light such as frequency - doubled Nd - YAG laser light (532 nm), krypton red laser light (647 nm), diode laser light (805 - 810 nm), or other suitable types of laser light for ophthalmic surgery.

[0021] In some embodiments, the laser light source 264 can generate laser light 241 having a pulse rate in the range of about 10 kilohertz (kHz) to about 500 kHz. This range can effectively provide for the destruction of the vitreous body. Other pulse rate ranges can also provide for destruction and are thus similarly contemplated. In some examples, the laser light source 264 generates picosecond or femtosecond laser light 241. In some embodiments, the laser light source 264 can generate continuous coherent laser light 241. For example, the laser light source 264 can generate continuous coherent laser light 241 at a low output.

[0022] In certain embodiments, the optical fiber 240 is disposed within the main lumen 260 and terminates at a terminal end 242 near the port 222 such that the laser light 241 projected from the optical fiber 240 is projected across the port 222 at an output sufficient to separate the vitreous collagen fibers. In the embodiment shown in FIG. 2B, the optical fiber 240 is rigidly suspended within the main lumen 260 such that the optical fiber 240 is separated from the inner sidewall 226 of the probe 110 and the optical fiber 240 is circumferentially surrounded by the space 228. The space 228 formed between the optical fiber 240 and the inner sidewall 226 of the probe 110 provides a coaxial path for the aspiration of the vitreous collagen fibers separated through the probe 110. In some embodiments, the optical fiber 240 can be disposed at the center within the main lumen 260 such that the radial distance between the inner sidewall 226 and the optical fiber 240 is uniform along the circumference of the optical fiber 240.

[0023] In the embodiment shown in FIG. 2C, the optical fiber 240 can be disposed (e.g., coupled) along the inner sidewall 226. For example, the optical fiber 240 can be coupled to the inner sidewall 226 along its longitudinal length. In some embodiments, the optical fiber 240 is coupled to a portion of the inner sidewall 226 that is radially aligned with the port 222 such that the terminal end 242 of the optical fiber 240 terminates at a point radially inward of the port 222 with respect to the longitudinal central axis of the probe 110. The optical fiber 240 can be coupled to the inner sidewall 226 using any suitable adhesive or joining mechanism such as an epoxy or acrylic adhesive.

[0024] The terminal end 242 of the optical fiber 240 can terminate at any point along the length L of the probe 110 and enable optimal separation and aspiration of the vitreous fibers. In some embodiments, the terminal 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 terminal end 242 of the optical fiber 240 terminates at a point substantially aligned with the proximal end 224 within the main lumen 260. In still other embodiments, the terminal end 242 of the optical fiber 240 terminates at a point proximal to the proximal end 224 within the main lumen 260.

[0025] In some embodiments, the laser light 241 projected by the optical fiber 240 has a diameter or width that is substantially smaller than the diameter or width of the port 222. For example, the port 222 can have a diameter or width of about 200 μm (micrometers) to about 500 μm, such as about 250 μm to about 450 μm, such as about 300 μm. The laser light 241 can have a diameter or width of about 5 μm to about 50 μm, such as about 10 μm to about 40 μm, such as about 15 μm to about 30 μm. In some examples, the laser light 241 projected by the optical fiber 240 is scanned across the port 222.

[0026] In the embodiments of FIGS. 2B - 2D, the optical fiber 240 is further configured to propagate illumination light 243 (shown in FIG. 2D) in addition to and separated from the laser light 241. For example, an illumination light source 266 can be used to provide the illumination light 243 to the optical fiber 240. The optical fiber 240 propagates the illumination light 243 in one of various ways to illuminate the intraocular space. Examples of the illumination light source 266 include a UV (ultraviolet) light source, a violet light source, a blue light source, a white light source, an infrared (IR) light source, or any other suitable type of illumination light source. For example, an LED - based (light - emitting diode - based) illumination light source 266 can be utilized. In a further example, a xenon or halogen - based illumination light source 266 can be utilized.

[0027] In embodiments where a single optical fiber 240 is used to project both laser light and illumination light, the laser light source 246 may be configured to focus the laser light 241 into the core of the optical fiber 240, and thus the laser light 241 is transmitted through the core. In some embodiments, the illumination light source 266 is configured to focus the illumination light 243 into both the core and the cladding of the optical fiber 240, in which case both the cladding and the core transmit the illumination light 243. In still some other embodiments, the illumination light source 266 is configured to focus the illumination light 243 into only the core or the cladding, in which case only one of the core or the cladding transmits the illumination light 243. Thus, the optical fiber 240, including the core and the cladding, can transmit the laser light 241 (through the core) and the illumination light 243 (through the cladding and the core) within the same fiber. In some embodiments, the illumination light 243 is propagated through one or more additional cores within the optical fiber 240. Thus, the optical fiber 240 can include one or more cores through which the laser light 241 and the illumination light 243 are transmitted separately.

[0028] In some embodiments, the illumination light 243 is coaxially projected with the laser light 241 from the end portion 242 of the optical fiber 240. In some embodiments, the illumination light 243 is diffusely projected from the end portion 242. In some embodiments, the illumination light 243 undergoes total internal reflection within the optical fiber 240 and is thus projected only from the end portion 242. For example, the optical fiber 240 is an end-emitting optical fiber. In some embodiments, the illumination light 243 is not completely reflected within the optical fiber 240 and can be emitted through the sidewall of the cladding instead of, or in addition to, the end portion 242. For example, the optical fiber 240 is an end-emitting or side-emitting optical fiber, and the illumination light 243 is emitted radially outward therefrom. The illumination light 243 is propagated simultaneously with the laser light 241 or is sequentially pulsed with the laser light 241. In certain embodiments, the propagation of the illumination light 243 through the optical fiber 240 into the intraocular space can be modulated by using different types of illumination light sources 266, using different materials for the optical fiber 240, modifying the physical arrangement of the optical fiber 240 within the probe 110, and / or using different materials for the probe 110.

[0029] FIG. 2D shows an example of an optical fiber 240 that propagates both the laser light 241 and the illumination light 243. In the example of FIG. 2D, the laser light 241 is emitted through the end portion 242 of the optical fiber 240, while the illumination light 243 is emitted radially outward from the optical fiber 240. In other words, in the example of FIG. 2D, the laser light 241 is focused on the core of the optical fiber 240, while the illumination light 243 is focused on the cladding of the optical fiber 240. However, as described above, in some other embodiments, the illumination light 243 may instead be focused on both the cladding and the core of the optical fiber 240. In such embodiments, the illumination light 243 is emitted not only radially but also through the end portion 242 of the optical fiber 240. In still other embodiments, the illumination light 243 is focused only on the core of the optical fiber 240.

[0030] In some embodiments, the optical fiber 240 is communicatively coupled to a digital visualization system, such as Alcon's NGENUITY® 3D visualization system. Other digital visualization systems, including those manufactured by other manufacturers, may also be used in conjunction with the embodiments described herein. Utilization of a digital visualization system enables modification of the color and intensity of the illumination light 243 emitted from the optical fiber 240 by adjustment of hue, saturation, gamma, color combination, and / or other light parameters.

[0031] Although "light" is discussed herein, the scope of the present disclosure is not intended to be limited to visible light. Rather, other types of radiation, such as UV and IR radiation, may be transmitted from the optical fiber 240, and the term "light" is intended to encompass all types of radiation for use with the optical fiber 240. In some examples, non-visible light is transmitted by the optical fiber 240 and captured by a non-visible light sensor for analysis by the digital visualization system described above. Accordingly, a non-visible light source can be coupled to the optical fiber 240 in addition to the illumination light source 266 and / or the laser light source 264, and the non-visible light can be pulsed and propagated simultaneously or sequentially with the laser light 241 and the illumination light 243.

[0032] In some embodiments, the optical fiber 240 has a diameter of from about 20 μm to about 120 μm, such as from about 40 μm to about 100 μm. For example, the optical fiber 240 has a diameter of from about 50 μm to about 80 μm. However, smaller or larger diameters are also contemplated. In some embodiments, an optical sleeve assembly including a plurality of optical fibers 240 is utilized. For example, an optical sleeve including a plurality of optical fibers 240 having uniform or different diameters can be utilized. In further embodiments, the optical fiber 240 is a multimode end-emitting fiber, a single mode end-emitting fiber, or the like.

[0033] 3A-3C show an example cross-sectional front view of the probe 210 of FIGS. 2A-2D with an optical fiber 240 housed therein for projecting both laser light and illumination light. As shown, the probe 210 has a circular cross-section defined by an inner sidewall 226 and an outer surface 236. In general, the optical fiber 240, according to an embodiment of the present disclosure, includes a core 344 and a cladding 346 circumferentially surrounding the core 344. The core 344 may include any transparent material, such as fused silica or glass. In some embodiments, the core 344 is doped. For example, the core 344 may be silica doped with germanium. Doping the core 344 with germanium or a similar dopant increases the refractive index of the core 344 compared to the refractive index of the cladding 346 material, thus enabling laser and light guiding properties within the core 344.

[0034] The cladding 346 may also comprise a transparent material such as fused silica or glass. In some embodiments, the cladding 346 is doped in addition to or instead of doping the core 344. For example, the cladding 346, which may comprise fused silica, is doped with a dopant that reduces the refractive index of the cladding 346 relative to the refractive index of the core 344. Examples of dopants include fluorine (F), chlorine (Cl), boron (B), and the like. When doped, the cladding 346 has a lower refractive index than the core 344, thus enabling light guiding properties within the core 344. Although one cladding 346 is shown in each of FIGS. 3A-3C, the optical fiber 340 may further include one or more additional claddings.

[0035] In one example, the core 344 has a diameter in the range of 5 μm to about 100 μm, such as a diameter of about 20 μm to about 80 μm, such as a diameter of about 75 μm. However, smaller or larger diameters are also contemplated. In one example, the cladding 346 has a thickness of about 5 μm to about 50 μm, such as a thickness of about 15 μm to about 40 μm, such as a thickness of about 25 μm. However, smaller or larger thicknesses are also contemplated.

[0036] In some embodiments shown in FIGS. 3B and 3C, the optical fiber 240 is disposed within the sleeve 348. The sleeve 348 is coupled directly or indirectly to the outside of the cladding 346 and can circumferentially surround the cladding 346 and the core 344 of the optical fiber 240. The sleeve 348 can function as a tubular structure for providing structural support and alignment of the optical fiber 240 within the main lumen 260 of the probe 210. Similar to the core 344 and the cladding 346, the sleeve 348 can include a transparent material such as fused silica and glass. In further embodiments, the sleeve 348 is doped with a dopant to manipulate the refractive index of the sleeve 348 as desired. The sleeve 348 can have a thickness of about 5 μm to about 50 μm, such as a thickness of about 15 μm to about 40 μm, such as a thickness of about 25 μm. However, smaller or larger thicknesses are also contemplated. In embodiments where the sleeve 348 is directly coupled to the optical fiber 240, the inner surface of the sleeve 348 can have an inner diameter substantially similar to the outer diameter of the optical fiber 240.

[0037] FIGS. 3A and 3B show an exemplary arrangement in which the optical fiber 240 is disposed relative to the inner sidewall 226 of the probe 210. The optical fiber 240 can be coupled to the inner sidewall 226 along its longitudinal portion radially aligned with the port 222 (shown in FIGS. 2A-2C). Thus, the space 228 is formed within the main lumen 260 around the optical fiber 240, except for the longitudinal portion of the inner sidewall 226 to which the optical fiber 240 is coupled. Such a configuration can enable improved aspiration of the separated vitreous collagen fibers through the interior of the probe 210. The optical fiber 240 can be coupled or joined to the inner sidewall 226 via any suitable adhesive or coupling mechanism. For example, the outer surface of the cladding 346 or the sleeve 348 can be joined to the inner sidewall 226 of the probe 210 using an epoxy or acrylic adhesive. However, other adhesives are also contemplated.

[0038] FIG. 3C shows an alternative exemplary arrangement in which the optical fiber 240 is suspended within the main lumen 260. In some examples, the sleeve 348 can provide structural support and rigidity to the optical fiber 240 such that the optical fiber 240 can be suspended inside the main lumen 260 without coupling the optical fiber 240 to the inner sidewall 226. As shown in FIG. 3C, the optical fiber 240 can be disposed at the center within the main lumen 260 such that the radial distance between a point on the outer surface of the optical fiber 240 and the inner sidewall 226 is uniform over the entire circumference of the optical fiber 240.

[0039] FIGS. 4A-4D show exemplary front cross-sectional views of a probe 410 that houses at least two optical fibers 440a, 440b therein. Thus, the first optical fiber 440a can be utilized to propagate laser light for vitreous fiber separation, and the second optical fiber 440b can be utilized to propagate illumination light for illuminating the intraocular space. Each of the optical fibers 440a, 440b further includes a core 444a, 444b, and a cladding 446a, 446b, respectively. The cores 444a, 444b and the claddings 446a, 446b can be formed of any material suitable for propagation of laser and illumination light beams, respectively. For example, the cores 444a, 444b and the claddings 446a, 446b can include a transparent material such as fused silica or glass as described above. The cores 444a, 444b and the claddings 446a, 446b can be further doped with one or more dopants depending on the desired refractive properties of the respective optical fibers 440a, 440b.

[0040] The dimensions of the optical fibers 440a, 440b including the cores 444a, 444b and the claddings 446a, 446b can be substantially similar to the dimensions of the optical fiber 240, the core 344, and the cladding 346 described above. Although shown to have different dimensions in FIGS. 4A-4D, the optical fibers 440a, 440b, the cores 444a, 444b, and the claddings 446a, 446b can have similar or different dimensions from each other.

[0041] As shown in FIGS. 4A and 4B, both of the optical fibers 440a, 440b are disposed within the secondary lumen 462 of the sleeve 448. Similar to the sleeve 348, the sleeve 448 can provide structural support and containment of the optical fibers 440a, 440b within the primary lumen 460 of the probe 410. The sleeve 448 can include a transparent material such as fused silica and glass. In further embodiments, the sleeve 448 is doped with a dopant to manipulate the refractive index of the sleeve 448 as desired. The sleeve 448 can have any suitable thickness, such as a thickness of about 5 μm to about 50 μm, such as a thickness of about 15 μm to about 40 μm, to provide suitable support and rigidity to the optical fibers 440a, 440b. For example, the sleeve 448 can have a thickness of about 25 μm. However, smaller or larger thicknesses are also contemplated. In some embodiments, a transparent filling material may be used within the secondary lumen 462 to prevent movement of the internal optical fibers 440a, 440b. For example, an adhesive can be used to fill all regions within the secondary lumen 462 not occupied by the optical fibers 440a, 440b. In other embodiments, the optical fibers 440a, 440b are disposed within the secondary lumen 462 without utilizing a filling material.

[0042] Figures 4C and 4D show alternative exemplary arrangements of the optical fibers 440a, 440b without using the sleeve 448. In Figure 4C, the optical fibers 440a, 440b are disposed within the main lumen 460 of the probe 410 without any surrounding structure other than the probe 410 itself. In some examples, the optical fibers 440a, 440b can be joined together within the main lumen 460, such as by bonding with an adhesive. In other embodiments, the optical fibers 440a, 440b can be separated from each other and insulated within the main lumen 460. In Figure 4D, the optical fibers 440a, 440b are disposed through a spacer tube 470 having one or more longitudinal bores 472 drilled therethrough to enable the placement of the optical fibers 440a, 440b. The spacer tube 470 operates in substantially the same manner as the sleeve 448 and can provide structural support and containment for the optical fibers 440a, 440b. The spacer tube 470 can be formed from any suitable transparent material, including fused silica and / or glass.

[0043] Regardless of whether the optical fibers 440a, 440b are housed within another structure within the main lumen 460, the optical fibers 440a, 440b can be arranged either in direct or indirect contact with the inner sidewall 426 or suspended without contacting the inner sidewall 426. Figures 4A, 4C, and 4D show examples where the optical fibers 440a, 440b are coupled to the inner sidewall 426 of the probe 410 either directly or indirectly. As described above, the optical fibers 440a, 440b can be coupled to the inner sidewall 326 either directly or indirectly via any suitable adhesive or joining mechanism, such as an epoxy or acrylic adhesive. Alternatively, the optical fibers 440a, 440b can be disposed within the main lumen 460 so as not to directly or indirectly contact the inner sidewall 426, as shown in Figure 4B. Only two optical fibers 440a, 440b are shown in Figures 4A - 4D, but three or more optical fibers can be utilized with a substantially similar configuration.

[0044] FIG. 5A and FIG. 5B show exemplary front cross-sectional views of a probe 510 having a first optical fiber 550 configured to propagate laser light and a plurality of second optical fibers 540 surrounding the first optical fiber 550 and configured to propagate illumination light. The first optical fiber 550 and the second optical fibers 540 each include a core 554, 544 and a cladding 556, 546. The materials and dimensions of the cores 554, 544 and the claddings 556, 546 may be substantially the same as those of the optical fibers 240 and 440 described above. However, as shown in FIGS. 5A and 5B, the dimensions of the second optical fibers 540 may be smaller than the dimensions of the first optical fiber 550, providing sufficient volume in the space 528 within the main lumen 560 to allow aspiration of the vitreous collagen fibers therethrough.

[0045] In the exemplary configuration of FIG. 5A, a single first optical fiber 500 is disposed within the main lumen 560 and is circumferentially surrounded by a plurality of second optical fibers 540 along its outer diameter. In other words, a ring of second optical fibers 540 is disposed around and in contact with the cladding 556 of the first optical fiber 550 such that the center of the core 554 is equidistant or at least substantially equidistant from the center of the core 544. In a further embodiment, an optional sleeve 548 is disposed around the plurality of second optical fibers 540 and is configured to hold the second optical fibers 540 firmly against the first optical fiber 550. The sleeve 548 may have any suitable thickness and dimensions to ensure that the second fibers 540 are tightly packed and there is no room for the second fibers 540 to loosen or move. Although shown as being suspended centrally within the main lumen 560, the first optical fiber 550 and the surrounding second optical fibers 540 may be disposed at any suitable location within the main lumen 560. For example, the first optical fiber 550 and the surrounding second optical fibers 540 may be coupled to the inner sidewall 526 of the probe 510 along a longitudinal portion radially aligned with the port 222.

[0046] FIG. 5B shows another exemplary arrangement of a single first optical fiber 550 and a plurality of second optical fibers 540 within the main lumen 560. Different from FIG. 5A, the second optical fibers 540 are arranged along the inner sidewall 526, rather than along the outer diameter of the laser fiber 500. Thus, although the second optical fibers 540 still surround the first optical fiber 550, the center of the core 554 is not equidistant or substantially equidistant from the center of the core 544. Further, the vitreous collagen fibers may be drawn into the space 528 located radially inside the second optical fibers 540. In some embodiments, the first optical fiber 550 is suspended within the main lumen 560 so as not to contact any of the second optical fibers 540 lining the inner sidewall 526. However, in the embodiment of FIG. 5B, the first optical fiber 550 is disposed relative to one or more second optical fibers 540, and thus the first optical fiber 550 is indirectly coupled to the inner sidewall 526 by one or more second optical fibers 540. The arrangements of the first optical fiber 550 and the second optical fibers 540 shown in FIGS. 5A and 5B can improve the illumination of the intraocular space during its use due to the 360-degree arrangement of the second optical fibers 540 around the first optical fiber 550.

[0047] In addition to utilizing different arrangements of optical fibers within the probe of the surgical instrument, the propagation of illumination light into the surgical area (e.g., the intraocular space) can be modified by utilizing different materials for the probe and / or by using masks. For example, the probe can include one or more portions formed of a translucent or transparent material and one or more portions formed of an opaque or semi-opaque material. In some embodiments, the distal portion of the probe is formed of a translucent or transparent material, while the proximal portion of the probe is formed of a metal such as stainless steel or aluminum. In some embodiments, only the distal tip of the probe (including the region around the port) is formed of a translucent or transparent material, and the remaining portion of the distal portion and the entire proximal portion are formed of a metal. In further embodiments, both the distal and proximal portions of the probe are entirely formed of a translucent or transparent material.

[0048] Figures 6A - 6D show external plan views of a probe 610 having different exemplary arrangements of a mask 680 that modifies the propagation of illumination light through a distal portion 614 and a proximal portion 612 formed of an otherwise translucent or transparent material. The mask 680 refers to any suitable device, material, or mechanism for reducing or preventing the transmission of illumination light. For example, the mask 680 may refer to a region of the probe 610 having a higher refractive index than other regions of the probe 610. In some examples, the mask 680 refers to an opaque or semi - opaque portion of the probe 610 through which the illumination light that can pass is reduced or absent. In other examples, the mask 680 refers to an opaque or semi - opaque film or layer applied to an external or internal surface of the probe 610. In yet other examples, the mask 680 refers to a metallic portion of the probe 610. In any form, the mask 680 is arranged in any suitable configuration along the length L of the probe 610 to provide optimal illumination of the intra - ocular space and reduce glare to the user of the surgical instrument caused by the illumination light.

[0049] In one exemplary embodiment shown in FIG. 6A, the mask 680 substantially surrounds the proximal portion 612 and the distal portion 614 of the probe 610, except for a translucent or transparent portion T adjacent to the port 622. The region T begins proximal to the port 622, ends at the distal tip 616, and circumferentially wraps around the probe 610. Thus, the transmission of illumination light from one or more optical fibers within the probe 610 to the surrounding environment is substantially reduced or prevented along most of the length L proximal to the translucent or transparent portion T covered by the mask 680. Rather, most of the illumination light emitted from the probe 610 of FIG. 6A can be propagated 360° radially outward from the translucent or transparent portion T. Thus, the illumination during use of the probe 610 can be limited to the region within the operating region (e.g., the intra - ocular space) adjacent to the port 622 that can separate and aspirate the vitreous material, reducing glare to its user and improving visibility.

[0050] FIG. 6B shows another exemplary embodiment substantially similar to that of FIG. 6A, where mask 680 extends further around port 622. For example, mask 680 can form a perimeter around (e.g., surround) port 622, and port 622 can be described as being "surrounded" by mask 680. The additional mask around port 622 can further reduce glare caused by the illumination light transmitted through the sidewalls of probe 610 and improve the visibility of the intraocular space.

[0051] In the exemplary embodiment shown in FIG. 6C, the distal portion 614 of probe 610 is substantially transparent except for the region covered by mask 680 at distal tip 616. The covered region begins at the distal end of port 622 and encompasses the distal tip 616 of probe 610. During vitrectomy, the distal tip 616 of probe 610 is often positioned close to the retina of the patient's eye, and excessive illumination passing through distal tip 616 can cause retinal damage. Thus, by utilizing the mask arrangement of FIG. 6C, retinal damage caused by the illumination light transmitted near the patient's retina can be reduced or eliminated, and the illumination light can be transmitted only radially outward from probe 610 between the distal end of port 622 and proximal portion 612 through the translucent or transparent portion T.

[0052] FIG. 6D shows another exemplary embodiment of the mask arrangement for the probe 610. As shown in FIG. 6D, the mask 680 covers only the longitudinal quadrant 682 of the distal portion 614 and extends along the length L of the probe 610 across the proximal portion 612. The longitudinal quadrant 682 covered by the mask 680 includes the port 622, and thus, the illumination light is not emitted from the probe 610 along the user's line of sight towards the port 622 along the probe 610. Thus, the illumination light is transmitted radially outward from the probe 610 in a direction away from the user's line of sight during vitreoretinal surgery, and thus, interference glare can be reduced or eliminated. Although shown as covering only the longitudinal quadrant 682, it is also contemplated that the mask 680 can cover a wider or narrower region of the probe 610, such as a longitudinal hemisphere of the probe 610.

[0053] In summary, embodiments of the present disclosure include devices and structures for performing vitreoretinal surgery. In particular, the surgical instruments described above combine the functions of laser vitrectomy and intraocular illumination to enable a more efficient performance of vitrectomy. The use of a laser vitrectomy probe enables the easy removal of the collagen fibers of the vitreous substance and can reduce the retinal traction caused by the removal of the vitreous substance. Further, the propagation of illumination light through a vitrectomy probe having a portion formed of a translucent material enables diffuse intraocular illumination without the need for a secondary illumination device that may provide inefficient intraocular illumination or limit the operating site within the intraocular space. Still further, the embodiments described herein provide a configuration that reduces the occurrence of glare to the user of the vitrectomy probe, which is a common problem with conventional ophthalmic illuminators. Thus, the described embodiments enable a more efficient, less invasive, and safer performance of vitreoretinal surgery.

[0054] Vitreous surgery is discussed as an example of a surgical procedure that can benefit from the embodiments described, but the advantages of the surgical devices and systems described herein can similarly benefit other surgical procedures.

[0055] Examples of embodiments disclosed in this specification include a surgical instrument, the surgical instrument including a base unit and a probe disposed through an opening at a distal end of the base unit, the probe having a port formed proximate a distal tip thereof, a lumen formed through the probe, and one or more optical fibers disposed within the lumen, the one or more optical fibers projecting laser light for irradiating a region proximate the port to cut collagen fibers of vitreous material aspirated through the port, and the one or more optical fibers further projecting illumination light for illuminating an intraocular space of a patient, and a probe including the one or more optical fibers. The one or more optical fibers may include a single optical fiber configured to project laser light and illumination light. The laser light can be focused on the core of the optical fiber, and the illumination light can be focused on the cladding of the optical fiber. The illumination light can also be focused on the core of the optical fiber. The one or more optical fibers may include a first optical fiber configured to project laser light and a second optical fiber configured to project illumination light. The illumination light can be focused on the core or cladding (or both) of the second optical fiber. The laser light may be continuous or pulsed laser light. The pulsed laser light may be picosecond or femtosecond laser light. The laser light and the illumination light can be coaxially projected from the one or more optical fibers. The probe may further include one or more portions formed of a translucent or transparent material to facilitate transmission of the illumination light. The illumination light can be emitted radially outward from the optical fiber and transmitted through the translucent or transparent material of the probe. The probe may further include an opaque material to reduce transmission of the illumination light and reduce glare caused by the illumination light. A portion of the probe adjacent to the port can be formed of a translucent or transparent material, and the remaining portion of the probe can include an opaque material. The opaque material can further form a peripheral portion of the port. A longitudinal quadrant along the length of the probe can include an opaque material, and the remaining portion of the probe can be formed of a translucent or transparent material. The laser light and the illumination light can be simultaneously projected through the one or more optical fibers. The laser light and the illumination light can be sequentially pulsed n times through the one or more optical fibers.One or more optical fibers may be suspended within the lumen such that the aspiration space circumferentially surrounds the one or more optical fibers. The one or more optical fibers may be coupled to the sidewall of the lumen and aligned with the port.

[0056] While the foregoing is directed to embodiments of the present disclosure, other and further embodiments of the present disclosure may be devised without departing from the basic scope thereof, which is determined by the following claims. In addition, the aspects of the present disclosure also include the following. 〔Aspect 1〕 A surgical instrument, a base unit, a probe disposed through an opening at the distal end of the base unit, 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 one or more optical fibers projecting laser light for irradiating a region proximate to the port to cut collagen fibers of the vitreous material aspirated through the port, and the one or more optical fibers further projecting illumination light for illuminating the intraocular space of a patient. A probe comprising: a surgical instrument. 〔Aspect 2〕 The surgical instrument according to Aspect 1, wherein the one or more optical fibers include a single optical fiber configured to project the laser light and the illumination light. 〔Aspect 3〕 The surgical instrument according to Aspect 2, wherein the laser light is focused on the core of the optical fiber, and the illumination light is focused on the cladding of the optical fiber. 〔Aspect 4〕 The surgical instrument according to Aspect 3, wherein the illumination light is also focused on the core of the optical fiber. 〔Aspect 5〕 The surgical instrument according to Aspect 1, wherein the one or more optical fibers include a first optical fiber configured to project laser light and a second optical fiber configured to project illumination light. 〔Aspect 6〕 The surgical instrument according to Aspect 5, wherein the illumination light is focused on the cladding of the second optical fiber. 〔Aspect 7〕 The surgical instrument according to Aspect 5, wherein the illumination light is focused on the core of the second optical fiber. 〔Aspect 8〕 The surgical instrument according to Aspect 6, wherein the illumination light is also focused on the core of the second optical fiber. 〔Aspect 9〕 The surgical instrument according to Aspect 1, wherein the laser light is pulsed laser light. 〔Aspect 10〕 The surgical instrument according to Aspect 9, wherein the pulsed laser light is picosecond laser light. 〔Aspect 11〕 The surgical instrument according to Aspect 9, wherein the pulsed laser light is femtosecond laser light. 〔Aspect 12〕 The surgical instrument according to Aspect 1, wherein the laser light is continuous laser light. 〔Aspect 13〕 The surgical instrument according to Aspect 1, wherein the illumination light is pulsed illumination light. 〔Aspect 14〕 The surgical instrument according to aspect 1, wherein the laser light and the illumination light are coaxially projected from the one or more optical fibers. 〔Aspect 15〕 The surgical instrument according to aspect 1, wherein the probe further includes one or more portions formed of a translucent or transparent material to facilitate transmission of the illumination light.

Claims

1. A surgical instrument, comprising a base unit, a probe disposed at a distal end of the base unit, a port formed in a side wall of the probe proximate to a distal tip of the probe, a lumen formed in the probe, one or more optical fibers disposed within the lumen, the one or more optical fibers comprising a first optical fiber configured to project laser light generated by a laser light source for cutting collagen fibers of vitreous material aspirated through the port by irradiating a region proximate to the port, and further comprising a second optical fiber configured to project illumination light generated by an illumination light source for illuminating an intraocular space of a patient, wherein the first optical fiber and the second optical fiber are each coupled to a side wall of the lumen, and terminal ends of the first optical fiber and the second optical fiber are each aligned with a proximal end of the port, the surgical instrument.

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

3. The surgical instrument according to claim 2, wherein the laser light is focused on a core of the optical fiber and the illumination light is focused on a cladding of the optical fiber.

4. The surgical instrument according to claim 3, wherein the illumination light is also focused on the core of the optical fiber.

5. The surgical instrument according to claim 1, wherein the illumination light is focused on a cladding of the second optical fiber.

6. The surgical instrument according to claim 1, wherein the illumination light is focused on a core of the second optical fiber.

7. The surgical instrument according to claim 5, wherein the illumination light is also focused on the core of the second optical fiber.

8. The surgical instrument according to claim 1, wherein the laser light is pulsed laser light.

9. The surgical instrument according to claim 8, wherein the pulsed laser light is picosecond laser light.

10. The surgical instrument according to claim 8, wherein the pulsed laser light is femtosecond laser light.

11. The surgical instrument according to claim 1, wherein the laser light is continuous laser light.

12. The surgical instrument according to claim 1, wherein the illumination light is pulsed illumination light.

13. The surgical instrument according to claim 1, wherein the laser light and the illumination light are coaxially projected from the one or more optical fibers.

14. The surgical instrument according to claim 1, wherein the probe further includes one or more portions formed of a translucent or transparent material to facilitate transmission of the illumination light.

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