Multi-spot laser probe with irradiation function

Abstract

Multi-fiber laser probes utilize relative motion of the fibers and other laser probe elements to provide multi-spot beam delivery while maintaining small gauge compatibility, or to provide selective delivery of single-spot or multi-spot beam patterns. An example probe includes fibers having distal ends that are movable as a group on a distal tilt element attached to the distal end of a cannula, such that the distal ends of the fibers can be moved between a retracted position where the distal ends of the fibers are within the cannula or tilt element, and an extended position where the distal ends of the fibers are guided by a groove or channel in the tilt so that they extend at least partially through an external opening in the distal end of the laser probe and are angled away from the longitudinal axis of the cannula. [Selected figure] Figure 3

Description

[Technical Field]

[0001] Priority claim This application claims the benefit of priority to U.S. Provisional Patent Application No. 62 / 585,631, filed November 14, 2017, entitled "MULTI-SPOT LASER PROBE WITH ILLUMINATION FEATURES," inventors of which are Jochen Horn, Alireza Mirsepassi, Chenguang Diao, Mark Harrison Farley, and Ronald T. Smith, all of which are incorporated by reference as if fully set forth herein.

[0002] This application relates to laser probes for use in ophthalmic procedures, and in particular to multi-spot laser probes with illumination capabilities. [Background technology]

[0003] Laser photocoagulation treatment addresses retinal detachments and tears caused by diseases such as diabetes, as well as eye conditions such as proliferative retinopathy. Abnormally high blood sugar levels in diabetics stimulate retinal blood vessels to release growth factors, which in turn promote the unwanted proliferation of blood vessels and capillaries on the retinal surface. These proliferated blood vessels are extremely delicate and easily bleed into the vitreous. The body responds to the damaged blood vessels by producing scar tissue, which can then lead to retinal detachment and eventual blindness.

[0004] In laser photocoagulation, a laser probe is used to ablate blood vessels at various laser ablation spots throughout the retina. Because the laser also damages the rods and cones present in the retina that enable vision, vision and blood vessels are adversely affected. Because vision is most acute in the central macula, surgeons place the resulting laser ablation spots in the peripheral regions of the retina. In this method, some peripheral vision is sacrificed to preserve central vision. During the procedure, the surgeon activates the probe with a non-ablation aiming beam to illuminate the retinal area to be photocoagulated. Due to the availability of low-power red laser diodes, the aiming beam is typically low-power red laser light. Once the surgeon positions the laser probe to illuminate the desired retinal spot, the surgeon activates the laser via a foot pedal or other means, which then photocoagulates the illuminated area. After ablating a retinal spot, the surgeon repositions the probe to illuminate a new spot with the aiming light, activates the laser, repositions the probe, and so on, until a suitable array of ablated laser spots is distributed across the retina.

[0005] The number of laser photocoagulations required for any one treatment of the retina is large. For example, 1,000 to 1,500 spots are typically ablated. It is readily appreciated that the photocoagulation procedure would be faster (assuming sufficient laser source power) if the laser probe were a multi-spot probe, allowing for the ablation of multiple spots at once. Accordingly, various multi-spot laser probes have been developed, which can be divided into two categories. The first category, referred to herein as "multi-fiber, multi-spot" laser probes, generates its multiple laser beams through a corresponding array of optical fibers. The second category uses only a single fiber and, therefore, referred to herein as "single-fiber, multi-spot" laser probes.

[0006] During ophthalmic procedures such as endolaser photocoagulation, surgeons may need to perform autoscleral drop or bimanual procedures. They may also require additional task lighting on the probe. While illuminated laser probes offer a solution for these cases, current designs of optical fibers impose limitations on the probe due to the materials and size involved. For example, currently available plastic optical fibers are typically over 100 microns in diameter, occupying a significant portion of the probe's cannula and leaving little room for other components. The efficiency of these fibers for carrying visible light is low, meaning that the resulting brightness of illumination can be quite low. Furthermore, plastic fibers are susceptible to thermal damage.

[0007] Therefore, there is a need in the art for a multi-spot laser probe with improved illumination capabilities. Summary of the Invention

[0008] The need for improved illumination capabilities in a multi-spot laser probe is addressed by several embodiments disclosed herein and illustrated in the accompanying drawings. An example multi-fiber, multi-spot laser probe according to several of these embodiments includes a plurality of fibers extending from a proximal end of the laser probe to at least near a distal end of the laser probe, the proximal end of the laser probe being configured to couple to a laser source via an adapter interface. The example probe further includes a cannula having a distal end and surrounding the plurality of fibers along at least a portion of the laser probe at or near the distal end of the laser probe, and an illumination fiber extending from the proximal end of the laser probe to at least near the distal end of the laser probe. The illumination fiber has a diameter substantially smaller than the corresponding diameters of the plurality of fibers and is positioned at the proximal end of the fiber for coupling to a visible light source via the adapter interface.

[0009] The illumination fiber in some of these embodiments may have a diameter of less than 50 microns, for example, compared to a diameter of at least 90 microns for other fibers. In some embodiments, the illumination fiber extends along the laser probe inside the cannula, for example, at or near the longitudinal center of the cannula. In other embodiments, the illumination fiber extends along the exterior surface of the cannula, along the laser probe outside of the cannula.

[0010] Other embodiments of the laser probe disclosed herein include one or more fibers extending from a proximal end of the laser probe to at least near a distal end of the laser probe, the one or more fibers being configured such that the proximal end of the laser probe is coupled to a laser source via an adapter interface, and a cannula having a distal end and surrounding the one or more fibers along at least a portion of the laser probe at or near the distal end of the laser probe. In these embodiments, a light emitting diode is attached to the cannula at or near the distal end of the cannula, the light emitting diode being electrically coupled to a power source via the adapter interface. In some embodiments, the light emitting diode forms part of a light emitting diode ring surrounding the cannula at or near the distal end of the cannula. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 is a longitudinal cross-sectional view of a laser source coupled to an adapter element including a gradient index (GRIN) lens for coupling to the proximal end of a multi-fiber, multi-spot laser probe. [Figure 2] FIG. 2 shows a radial cross section of the multi-fiber array within the proximal end of the probe of FIG. [Figure 3] FIG. 3 is a longitudinal cross-sectional view of a laser source coupled to an adapter element including two gradient index (GRIN) lenses and a diffractive beam splitter for coupling to the proximal end of a multi-fiber, multi-spot laser probe. [Figure 4]FIG. 4 shows a radial cross section of the multi-fiber array within the proximal end of the probe of FIG. [Figure 5] FIG. 5 shows a GRIN lens for angularly separating the projected beams emanating from the multi-fiber array of FIG. [Figures 6A-6B] 6A and 6B show an exemplary embodiment of the distal end of a multi-fiber multi-spot laser probe incorporating a diffusing spacer at the distal end of the laser probe configured to allow the fibers within the probe to slide from a retracted, non-operating position to an extended, operating position. [Figure 7A-7C] 7A, 7B, and 7C show examples of illumination fiber terminations. [Figures 8A-8C] 8A, 8B, and 8C are diagrams of an example multi-fiber, multi-spot laser probe incorporating an illumination fiber. [Figure 9A-9B] 9A and 9B are diagrams of another example multi-fiber, multi-spot laser probe incorporating an illumination fiber. [Figures 10A-10C] 10A, 10B, and 10C are diagrams of an example multi-fiber, multi-spot laser probe incorporating illumination fibers and lens elements disposed at the distal end of the laser probe cannula. [Figure 11] FIG. 11 shows another example laser probe that includes a GRIN lens disposed at the distal end of the laser probe cannula. [Figures 12A-12C] 12A, 12B, and 12C show an example of a laser probe configuration in which the illumination fiber is carried within a fiber that also carries the laser light. [Figure 13] FIG. 13 shows an example laser probe that includes an LED ring at the distal end of the laser probe cannula. [Figure 14] FIG. 14 shows an example mechanism for combining the illumination fiber with the laser fiber at the proximal end of the example laser probe. [Figure 15]FIG. 15 shows an example setup for coupling illumination light and laser light into a single-core fiber at the proximal end of an example laser probe. DETAILED DESCRIPTION OF THE INVENTION

[0012] As discussed above, improved illumination capabilities are needed for multi-spot laser probes. Embodiments reflecting several approaches to addressing this problem are disclosed herein and may be categorized into three groups: - probes utilizing nanofibers for radiation delivery; - A probe that uses the same fiber to carry multi-spot laser light and illumination beams; and - Probes that use LED-based illumination.

[0013] Some of the disclosed embodiments are compatible with multi-fiber, multi-spot laser probes, while other embodiments are compatible with single-fiber, multi-spot laser probes. While some of the embodiments described in detail herein are described and illustrated in the context of particular multi-fiber, multi-spot probes, it will be appreciated that these embodiments can readily be adapted to single-fiber, multi-spot probes. Similarly, it will be appreciated that these embodiments described herein in the context of single-fiber, multi-spot probes can be adapted to multi-fiber, multi-spot probes.

[0014] Referring now to the drawings, certain details of a multi-fiber, multi-spot laser probe 100 are shown in FIG. 1. Not shown in FIG. 1 are details of the proximal end of laser probe 100, details of several implementations of the proximal end are provided below. It will be appreciated that the portion of multi-fiber, multi-spot laser probe 100 shown in FIG. 1 is also shown in U.S. Pat. No. 8,951,244, and therefore the details shown in FIG. 1 represent an example of the prior art. It should be noted that illumination-related techniques and devices discussed further below are compatible with laser probe 100, but may also be compatible with laser probes having different designs at their proximal ends.

[0015] Returning to FIG. 1 , it can be seen that laser source 105 drives probe 100 via an appropriate interconnect. A common standardized interconnect for laser source 105 is a Subminiature Version A (SMA) adapter. Accordingly, laser source 105 includes a female SMA adapter 110. However, it will be appreciated that laser probe 100 is readily adapted to mate with any conventional standardized optical interconnect, so long as the laser source interconnect presents a focused beam spot, such as laser waist 115, at the proximal end of the male connector from the laser probe. Accordingly, the following discussion assumes, without loss of generality, that laser probe 100 couples to light source 105 via a customized SMA adapter 120.

[0016] To receive the laser waist 115, the inner diameter of the SMA adapter 120 contains a gradient index (GRIN) lens 125. The GRIN lens 125 may be a simple single-element cylindrical GRIN rod lens that is easily inserted into such an inner diameter. The GRIN lens 125 is designed to relay a focused beam to a second focused spot 130 and then to a collimated beam wavefront at its distal end. As is known in SMA technology, the SMA adapter 120 is secured to the SMA adapter 110 by a threaded cylinder 135 and a retaining ring 140. The SMA adapter 120 has both a male end for insertion into the SMA adapter 110 as well as a female end for receiving a conventional optical interconnect, such as a male SMA 905 fiber connector 145. The connector 145 is secured to the adapter 120 by a threaded cylinder or ring 160 and a retaining ring 165. The connector 145 contains an array of optical fibers 150 within its inner diameter. The proximal end 151 of the array 150 is spaced from the distal end of the GRIN lens 125 by a suitable air gap, such as a 220 μm air gap. The connector 145 connects to a flexible cable that encloses the fiber 150 leading to a handpiece and cannula, as is known in the laser probe art.

[0017] An exemplary embodiment of the fiber array 150 is shown in cross section in FIG. 2. Laser beam boundaries at the proximal end 151 in FIG. 1 are shown for both the green laser beam boundary 205 from the light source 105 and the red aiming beam boundary 210. The array 150 includes a central fiber circumferentially surrounded by six outer fibers. In one embodiment, each fiber 220 has a numerical aperture (NA) of 0.22, achieved by a 75 μm glass core encased in a 90 μm cladding surrounded by a 101 μm jacket. To minimize the amount of uncoupled laser energy into the array 150, the GRIN lens 125 is configured so that the laser beam boundary 205 just surrounds the six outer fibers. Because the laser beam and the array 150 are at least generally axisymmetric, clocking of the array 150 relative to the laser beam is not an issue. The array 150 extends to the distal end of the laser probe, details of several embodiments of the distal end of the laser probe are discussed in more detail below.

[0018] An advantageous feature of such a proximal interconnection is that a complex multi-lens relay system is not required. Instead, the GRIN lens 125 is easily inserted into the inner diameter of the adapter 120, to which a standardized adapter, such as the male SMA adapter 145, can attach a disposable laser probe receiving the fiber array 150. Without the GRIN lens 125 and its adapter 120, it would be necessary to change the standardized adapter 110 on the laser source 105, which is clearly undesirable because it would require simultaneously changing other attachments for the light source 105. Alternatively, the light source's adapter could remain standard, which would require a multi-lens relay system. However, the SMA adapter 120 and GRIN lens 125 eliminate such complexity. While the SMA adapter 120 is therefore highly advantageous, it should be appreciated that, as can be seen in FIG. 2 , approximately 50% of the laser energy is delivered to the gaps between the fibers in the array 150. This laser energy is therefore unavailable for use in photocoagulation, thereby increasing the required laser source power and / or the time required to generate the laser ablation spot.

[0019] Turning now to FIG. 3 , a diffractive embodiment is shown that does not illuminate the interstices of the fiber array. As discussed with respect to FIG. 1 , the customized SMA adapter 120 allows a user to conveniently attach a disposable probe to the adapter 120 to drive laser energy onto the fiber array. However, in the embodiment shown in FIG. 3 , the adapter 120 includes a diffractive beam splitter 305 within its inner diameter, positioned between a first GRIN lens 301 and a second GRIN lens 310. The GRIN lens 301 is configured to collimate the laser beam emanating from the laser waist 115 into a collimated wavefront that is presented to the diffractive beam splitter 305. The GRIN lens 310 is configured to focus the multiple diffracted laser beams resulting from the splitter 305 onto the proximal face 151 of the fiber array 320, which is contained within the inner diameter of the male SMA adapter 145. The fiber array 320 includes multiple fibers arranged according to the diffractive properties of the diffractive beam splitter 305. For example, if the diffractive beam splitter produces a symmetric pentagonal distribution of five diffracted beams, the fiber array 320 is arranged in a corresponding pentagonal distribution. Figure 4 shows such an arrangement of the fiber bundle 320 at its proximal face 151.

[0020] In one embodiment, each optical fiber 400 has a 75 μm glass core cladding within a 90 μm cladding, which is then surrounded by a 101 μm jacket to achieve an NA of 0.22. The resulting projection of the diffracted green laser beam from splitter 305 is shown by boundary 405. Because diffraction is wavelength dependent, the projection of the aiming beam has a different alignment than the fiber array 320. Thus, splitter 305 and fiber array 320 are positioned such that boundary 405 is axially aligned with each fiber 400, while boundary 410 of the red aiming beam is radially displaced relative to the center or longitudinal axis of each fiber.

[0021] In one embodiment, the off-axis displacement provided to each green diffracted beam by splitter 305 is 1.45 degrees. GRIN lens 310 focuses the resulting collimated diffracted beam onto the entrance face of each fiber 400 in array 320. Such proper clocking of array 320 relative to the diffracted beams achieves effective coupling of each diffracted and aiming beam to each fiber 400. In that regard, other types of adapters, such as ferrule connectors (FC) or standard connectors (SC), commonly used in the telecommunications industry, may be used in place of SMA adapter 120 to aid in optimal clocking. As discussed with respect to FIG. 1 , assembly of optical components onto SMA adapter 120 is advantageously convenient in that optical adhesive may be applied to GRIN lenses 301 and 310 and the intervening diffracting beam splitter 305, which may then be slid into the inner diameter of adapter 120 and abutted end-to-end against each other. In contrast, aligning refractive lenses is tedious and comparatively difficult.

[0022] As discussed above with respect to either Figure 1 or Figure 3, because the laser beam from the light source is split and propagates telecentrically through the fiber array, the problem of projecting a focused laser spot at an angle from the laser probe remains. U.S. Patent No. 8,951,244 discloses a GRIN lens solution, an example of which is shown in Figure 5. It will be appreciated that while the exemplary embodiment shown in Figure 5 is specifically adapted for compatibility with the fiber array 320 of Figure 3, a similar embodiment could easily be constructed for the fiber array 150 of Figure 1.

[0023] 5, laser probe cannula 500, e.g., a stainless steel cannula, receives a GRIN lens 505 at its distal end. The distal end of fiber array 320 is displaced inside the cannula to project a diverging beam 510 at the proximal end face of GRIN lens 505. GRIN lens 505 then focuses the beam onto retinal surface 520. The distribution of the resulting focused beam on the retina depends on the distribution of the fibers at the distal end of array 320.

[0024] In that regard, while the distribution at the proximal end of array 320 ( FIG. 3 ) should be axially symmetric, the fibers can be arranged in any suitable distribution at the distal end. For example, as can be seen in FIG. 5 , array 320 is arranged linearly at the distal end. The resulting laser spot is therefore a magnified version of the image (in this embodiment, a linear array) presented to GRIN lens 505. In one embodiment, GRIN lens 505 focuses the angularly distributed beam to a distance of 4 mm from the distal end of cannula 500. Advantageously, GRIN lens 505 eliminates any need to bend the fibers to the desired angular distribution (and the associated problems of such bending), chamfer the distal end faces of the fibers, or add optical elements to the distal end face. Fibers can even touch each other within array 320, and GRIN lens 505 will still be effective.

[0025] Many alternatives to the configuration shown in Figure 5 for the distal end of a multi-fiber laser probe are possible, including embodiments in which the GRIN lens 505 is removed from the laser beam path at the distal end of the probe and embodiments that have no optical elements distal to the optical fibers. Some embodiments may provide actuation means to induce angular beam separation via fiber curvature. Various embodiments offer advantages such as compact gauge compatibility and / or switchable quasi-single-spot and multi-spot beam delivery.

[0026] Some of these embodiments are detailed below and presented with respect to four-fiber and five-fiber embodiments of the invention, shown in axial and cross-sectional views. However, it will be understood that the number of fibers is not limited to four or five, and that fewer or more fibers may be used in various embodiments. Furthermore, the embodiments are not presented in any particular order. The embodiments disclosed herein may be implemented in a laser probe compatible with either of the adapters described above, i.e., those of FIGS. 1 and 3, which provide a means for splitting a beam and focusing the resulting multiple beams into the proximal end of an optical fiber, with each such fiber carrying its own beam. However, it will be understood that the embodiments described below may be implemented in laser probes having different splice configurations at the proximal end and / or with different adapters or interfaces for coupling one or more laser sources to the multiple fibers of a multi-fiber laser probe.

[0027] A first exemplary embodiment of the distal end of a multi-fiber, multi-spot laser probe that omits a GRIN lens at the distal end is shown in FIGS. 6A and 6B. As can be seen, this example laser probe includes fibers 610 with cleaved or polished ends that are movable as a group on a distal tilt element 620 so that the fibers 610 can be moved between two states. The first state is shown in FIG. 6A and represents a retracted, non-operating position that provides a compact outer diameter for insertion and extraction, for example, with a small-gauge trocar access system. FIG. 6B represents an extended, operating position in which the fibers 610 are translated toward the distal end of the laser probe and forced by the tilt element 620 to bend outward and at least partially through an external opening in the distal end of the laser probe to send angularly separated beams 630 to achieve a multi-spot pattern.

[0028] As can be seen in FIGS. 6A and 6B , the tilt element 620 fits into or on the distal end of a cannula 600 that surrounds the fibers 600 along at least the depicted portion of the laser probe, i.e., at or near the distal end of the laser probe. The tilt element 620 may be formed from a separate machined component having four angular holes large enough to allow the passage of the fibers, which turn at their proximal ends and diverge distally. The tilt element may also be fabricated by additive or subtractive microfabrication processes. It will be appreciated that the tilt element 620 comprises channels and / or grooves for each of the fibers 610 such that the fibers 610 are guided by the channels and / or grooves when the fibers 610 translate toward the distal end, and thus to an extended position, and when the fibers retract toward the proximal end of the probe (not shown), to a retracted position.

[0029] Illumination functionality can be added to the laser probes shown in Figures 6A and 6B in any of several ways. Some approaches are based on the use of nanofibers to deliver visible light to the end of the cannula. It will be appreciated that it is important to minimize obstruction to the inner and / or outer diameter of the multi-spot laser probe, and therefore the diameter of the optical fiber should be as small as possible. Accordingly, some of the embodiments described herein utilize nanofibers, e.g., made of glass, having a diameter of less than 50 microns to deliver visible light along the cannula to the distal end of the laser probe.

[0030] In particular, light spreading at the tip of the fiber is another important factor. Described below are three general approaches to achieving a desired spread of visible light as it exits the illumination fiber. These are shown in Figures 7A, 7B, and 7C.

[0031] 7A, is to form a tapered tip 710 at the end of the illumination fiber 705. This taper can be formed by a mechanical process, such as polishing, or by a chemical etching process, or by a thermal process. In either case, the result of the tapered tip 710 is that the light exiting the illumination fiber 705 emerges at a wide angle, where the width of the angle is specified by the angle and length of the taper.

[0032] 7B is to form a scattering tip 720, which may be, for example, approximately spherical, at the end of the illumination fiber 715. This scattering tip 720 may have a refractive index gradient that disperses the light exiting the end of the illumination fiber 715 in a desired scattering pattern. Example techniques for forming scattering tips are described in detail in U.S. Patent Application Publication No. 2017 / 0176660 A1, published June 22, 2017, the entire contents of which are incorporated herein by reference.

[0033] In a third approach, shown in Figure 7C, the illumination fiber 725 is flat-cleaved. This requires a high angle launch of visible light into the fiber 725. The illumination fiber 725 should also have a high numerical aperture to transmit visible light.

[0034] Any one of the approaches shown in Figures 7A-7C can be used in combination with the multi-spot laser probes shown in Figures 5 and 6A and 6B. Figures 8A and 8B, for example, show two different approaches to adding illumination fibers to a multi-spot laser probe similar to that shown in Figures 6A and 6B. Shown in each of these figures is the distal end of a multi-fiber, multi-spot laser probe comprising multiple fibers 610 (four in this case) extending from the proximal end of the laser probe to at least near the distal end of the laser probe, where the proximal end of the laser probe is configured to be coupled to a laser source via an adapter interface, as discussed above in connection with Figures 1-3. As with the laser probes shown in Figures 6A and 6B, the laser probes shown in Figures 8A and 8B each include a cannula 600 having a distal end and enclosing multiple fibers along at least a portion of the laser probe at or near the distal end of the laser probe.

[0035] In each of the embodiments shown in FIGS. 8A and 8B , the laser probe further includes an illumination fiber 810 extending from the proximal end of the laser probe to at least near the distal end of the laser probe. The illumination fiber 810 has a diameter that is substantially smaller than the corresponding diameter of the fiber, e.g., less than 50 microns, compared to the 90 micron or larger diameter of fiber 610. Although not shown in FIGS. 8A and 8B , the illumination fiber 810 is disposed at the proximal end of the fiber for coupling to a visible light source. FIG. 14 illustrates an exemplary configuration for coupling a visible light source to the illumination fiber 810. In the illustrated embodiment, the illumination fiber 810 and the laser fiber 610 are spliced ​​by a combiner 1410 at the proximal end of the laser probe. Note that in FIGS. 8A and 8B , the illumination fiber is shown with a generally spherical scattering tip, as shown in FIG. 7B . It will be appreciated that other approaches for scattering the illumination light as it exits the illumination fiber 810 may alternatively be used, including those approaches illustrated in FIGS. 8A and 8C .

[0036] 8A, illumination fiber 810 extends alongside the laser probe within cannula 600. In this case, illumination fiber 810 is positioned approximately in the longitudinal center of cannula 600. In other embodiments, illumination fiber 810 may not be centrally positioned; for example, illumination fiber 810 may be positioned along the inner wall of cannula 600 in some embodiments.

[0037] 8A , in the embodiment shown in FIG. 8B , illumination fiber 810 instead extends along the exterior surface of cannula 600, alongside the laser probe outside of cannula 600. In some embodiments, illumination fiber 810 may be disposed within a groove 815 that extends longitudinally along at least a portion of cannula 600. A cross-sectional schematic illustrating the placement of illumination fiber 810 within groove 815 is provided in FIG. 8C , it will be appreciated that fiber 610 and other components within cannula 600 have been omitted from this view for simplicity.

[0038] 9A and 9B show two additional examples of a multi-fiber, multi-spot laser probe including an illumination fiber 810. Again, each of these figures shows the distal end of a multi-fiber, multi-spot laser probe with multiple fibers 610 (four in this case) extending from the proximal end of the laser probe to at least near the distal end of the laser probe. Again, the laser probes each include a cannula 600 having a distal end and enclosing multiple fibers along at least a portion of the laser probe at or near the distal end of the laser probe. In these embodiments, the laser probes each include a helical spacer 915 disposed within the cannula 600, where the helical spacer 915 creates a tangential angular separation of the fibers 610 by arranging them in a helical configuration.

[0039] It will be appreciated that this configuration allows for a continuous central region between fibers 610 that provides a convenient location for disposing illumination fiber 810 that extends along a laser probe inside cannula 600, as shown in FIG. 9A. Once again, this illumination fiber 810 has a diameter that is substantially smaller than the corresponding diameter of the fiber, e.g., less than 50 microns, compared to the 90 micron or larger diameter of fiber 610. Again, while illumination fiber 810 is shown with a generally spherical scattering tip as shown in FIG. 7B, it will be appreciated that other approaches for scattering illumination light as it exits illumination fiber 810 may alternatively be used. One or more other fibers may also occupy this central passageway of cannula 600 in some embodiments.

[0040] 9B, the illumination fiber 810 extends along the outer surface of the cannula 600, alongside the laser probe outside of the cannula 600. In some embodiments, the illumination fiber 810 may be disposed within a groove extending longitudinally along at least a portion of the cannula 600, as shown in FIG.

[0041] Illumination fiber 810, such as that shown in the examples of FIGS. 7A-7C, 8A-8C, 9A, and 9B, may also be employed in a multi-fiber, multi-spot laser probe that further includes a lens element inside cannula 600 at or near the distal end of cannula 600. Examples of these embodiments are shown in FIGS. 10A, 10B, and 10C, each featuring a ball lens 1015, a microlens array 1020, and a microwedge array 1025. Microlens array 1020 and microwedge array 1025 pair each element of the array with a corresponding fiber. More generally, each of these lens elements is positioned such that light from illumination fiber 810 passes through the lens element along with light from fiber 610. It will be appreciated that these lens elements may be configured to provide a beam with near-field focusing, collimation, or gently diverging characteristics in various embodiments. These can offer several advantages, including, depending on the degree of beam focusing, near-field focusing of individual beams that can nearly overlap, providing essentially a single beam at a working distance approximately equal to the focal length, while providing individual beams at longer working distances. Alternatively, lenses adapted to provide collimation or near collimation can provide a design that is insensitive to working distance, thus offering greater ease of use with smaller spots and therefore requiring less total power to provide the intensity necessary for surgical treatment. Lenses configured to provide slight beam divergence can be used to provide embodiments that produce adequate spot separation at shorter working distances, while still providing relatively low sensitivity to working distance compared to the raw output from a lensless fiber.

[0042] 11 shows yet another example of the placement of illumination fiber 810 in a multi-spot laser probe. In this example, illumination fiber 810 is positioned inside cannula 600, along the inner wall of cannula 600. The laser delivery fiber 610 in this example stops short of the distal end of cannula 600, and a lens element 1110, in this case a GRIN lens, is positioned inside cannula 600 at or near its distal end. Note that in this embodiment, lens element 1110 is positioned such that light from fiber 610 passes through lens element 1110, but light from illumination fiber 810 does not.

[0043] The exemplary embodiments described above include embodiments in which visible light is delivered to the distal tip of the laser probe via a separate fiber. Another approach is to use the fiber used to deliver laser light to deliver visible light as well. Several examples of this approach are shown in FIGS. 12A, 12B, and 12C. The example shown in FIG. 12A utilizes a multifaceted optical element to split a single beam from the distal fiber tip into multiple beams (four in this illustration). The examples shown in FIGS. 12B and 12C utilize a GRIN lens 1220 and a sapphire lens 1230, respectively, positioned inside the cannula 600 at its distal end so that both the laser light and visible light from the fiber 1210 pass through the lens. The light is split by a diffractive optical element (DOE) 1260 in front of the GRIN lens 1220 or sapphire lens 1230.

[0044] FIG. 13 illustrates yet another example approach for delivering illumination from the distal end of a laser probe. In this example, the laser probe includes one or more fibers extending from the proximal end of the laser probe to at least near the distal end of the laser probe. The laser probe further includes a cannula 600 having a distal end and enclosing one or more fibers along at least a portion of the laser probe at or near the distal end of the laser probe. In FIG. 13, these one or more fibers are omitted from the drawing for simplicity. The example laser probe of FIG. 13 also includes a light-emitting diode mounted in the cannula 600 at or near its distal end, the light-emitting diode being electrically coupled to a power source via an adapter interface of the laser probe by an electrical wire 1320.

[0045] 13, the light emitting diodes form part of a light emitting diode ring 1310 that surrounds the cannula 600 at or near its distal end. In some embodiments, the light emitting diode ring 1310 comprises a light guide for directing light from the light emitting diodes to an illumination area beyond the distal end of the laser probe. The light emitting diode ring 1310 may include a blue LED with a phosphor to produce white light.

[0046] The various embodiments described above and illustrated in the accompanying drawings provide additional illumination to a laser probe with minimal impact on the size and shape of the laser probe. This is particularly important in the context of multi-fiber, multi-spot laser probes, where there are already tight constraints on the outer diameter of the laser probe cannula. Some of the described approaches enable additional illumination to such probes without any need to increase the cannula gauge size. The use of glass nanofibers to deliver visible light to the distal end of the cannula provides an additional advantage compared to plastic optical fibers in that, in some embodiments, this approach offers improved thermal robustness.

[0047] Various embodiments described herein address several needs for multi-spot laser probes with added illumination. Embodiments may enable self-scleral compression for peripheral visualization / access. They may enable bimanual surgery without a fourth chandelier incision. Additionally, they may provide additional task lighting.

[0048] The above-described embodiments are illustrative of the invention, but not limiting, and it will be appreciated that many modifications and variations are possible in accordance with the principles of the invention. The present disclosure also includes the following inventions. The first aspect is A multi-fiber, multi-spot laser probe comprising: a plurality of fibers extending from a proximal end of the laser probe to at least near a distal end of the laser probe, the proximal end of the laser probe configured to be coupled to a laser source via an adapter interface; a cannula having a distal end and surrounding the plurality of fibers along at least a portion of the laser probe at or near the distal end of the laser probe; an illumination fiber extending from the proximal end of the laser probe to at least near the distal end of the laser probe, the illumination fiber having a diameter substantially smaller than corresponding diameters of the plurality of fibers, the illumination fiber positioned at the proximal end of the fiber for coupling to a visible light source via the adapter interface; A multi-fiber, multi-spot laser probe comprising: The second aspect is In a first aspect, the multi-fiber, multi-spot laser probe has a diameter of at least 90 microns, and the illumination fiber has a diameter of less than 50 microns. The third aspect is The illumination fibers extend along the laser probe within the cannula, in a first embodiment being a multi-fiber, multi-spot laser probe. The fourth aspect is In a third embodiment, the illumination fiber is positioned approximately in the longitudinal center of the cannula. The fifth aspect is A third aspect of the multi-fiber, multi-spot laser probe is one in which the illumination fiber extends near the distal end of the cannula but does not reach the distal end of the cannula, and the multi-fiber, multi-spot laser probe further comprises a lens element inside the cannula at or near the distal end of the cannula so that light from the illumination fiber passes through the lens element. The sixth aspect is The multi-fiber, multi-spot laser probe of a third aspect further comprises a lens element positioned inside the cannula at or near the distal end of the cannula such that light from the multiple fibers passes through the lens element but light from the illumination fiber does not pass through the lens element. A seventh aspect is The illumination fibers extend along the outer surface of the cannula, along with the laser probe outside the cannula, in a first embodiment being a multi-fiber, multi-spot laser probe. The eighth aspect is A seventh aspect of the multi-fiber, multi-spot laser probe, wherein the cannula includes a groove extending longitudinally along at least a portion of the cannula, and the illumination fiber is disposed within the groove. A ninth aspect is A laser probe, one or more fibers extending from a proximal end of the laser probe to at least near a distal end of the laser probe, the proximal end of the laser probe configured to be coupled to a laser source via an adapter interface; a cannula having a distal end and surrounding the one or more fibers along at least a portion of the laser probe at or near the distal end of the laser probe; a light emitting diode attached to the cannula at or near the distal end of the cannula, the light emitting diode being electrically coupled to a power source via the adapter interface; The laser probe includes: A tenth aspect is In a ninth aspect, the laser probe is one in which the light emitting diode forms part of a light emitting diode ring that surrounds the cannula at or near the distal end of the cannula. An eleventh aspect is A tenth aspect of the laser probe is that the light emitting diode ring comprises a light guide for directing light from the light emitting diodes beyond the distal end of the laser probe to an illumination area. A twelfth aspect is A laser probe, a fiber extending from a proximal end of the laser probe to at least near a distal end of the laser probe, the proximal end of the laser probe configured to be coupled to a laser source and to a visible light source via an adapter interface such that the fiber is positioned to carry both laser light and visible light to the distal end of the laser probe; a cannula having a distal end and surrounding the fiber along at least a portion of the laser probe at or near the distal end of the laser probe; an optical element disposed at or near the distal end of the cannula and configured to split laser light and visible light exiting the distal end of the laser probe into multiple beams; The laser probe includes: A thirteenth aspect is A twelfth aspect of the laser probe is that the optical element is a multifaceted element configured to split the laser light and visible light exiting the distal end of the laser probe into the multiple beams. A fourteenth aspect is A twelfth aspect of the present invention is a laser probe, wherein the optical element is a diffractive optical element (DOE), and the laser probe further comprises a GRIN lens disposed between the fiber and the DOE. A fifteenth aspect is A twelfth aspect of the present invention is a laser probe, wherein the optical element is a diffractive optical element (DOE), and the laser probe further comprises a sapphire lens disposed between the distal end of the fiber and the DOE.

Claims

1. A multi-fiber, multi-spot laser probe comprising: a plurality of fibers extending from a proximal end of the multi-spot laser probe to at least near a distal end of the multi-spot laser probe, the proximal end of the multi-spot laser probe being configured to be coupled to a laser source; a cannula having a distal end and surrounding the plurality of fibers along at least a portion of the multi-spot laser probe at or near the distal end of the multi-spot laser probe; an illumination fiber extending from the proximal end of the multi-spot laser probe to at least near the distal end of the multi-spot laser probe, the illumination fiber having a diameter substantially smaller than the corresponding diameters of the plurality of fibers, the illumination fiber being positioned for coupling to a visible light source at the proximal end of the fiber; Equipped with the illumination fiber extends within the cannula along the multi-spot laser probe; the illumination fiber is radially centrally disposed within the cannula; the plurality of fibers may be moved as a group on one or more distal tilt elements configured to bend the plurality of fibers outward relative to one another; a multi-fiber, multi-spot laser probe, wherein the illumination fiber is fixed relative to the multi-spot laser probe such that the distally diverging fibers move apart relative to the illumination fiber, guided by the one or more distal tilt elements fitted at or near the distal end of the cannula.

2. 10. The multi-fiber, multi-spot laser probe of claim 1, wherein each of said plurality of fibers has a diameter of at least 90 microns and said illumination fiber has a diameter of less than 50 microns.

3. 3. The multi-fiber, multi-spot laser probe of claim 1, wherein the illumination fibers extend near but not to the distal end of the cannula, and the multi-fiber, multi-spot laser probe further comprises a lens element inside the cannula at or near the distal end of the cannula so that light from the illumination fibers passes through the lens element.

4. 3. The multi-fiber, multi-spot laser probe of claim 1, further comprising a lens element positioned inside the cannula at or near the distal end of the cannula such that light from the plurality of fibers passes through the lens element but light from the illumination fiber does not pass through the lens element.

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