CATARACT EXTRACTION METHOD AND INSTRUMENTATION

Abstract

A tip for a phacoemulsification handpiece, including a tubular structure having an elongate portion with generally parallel sides and a flared end portion extending outwardly from the elongate portion and presenting a mouth that is larger in diameter than a lumen diameter of the elongate portion. The tip may include a plurality of internally extending structures coupled to an interior of the tubular structure. A method of surgically removing a crystalline lens of an eye, including evaluating the crystalline lens to determine the level of nuclear sclerosis, sectioning at least a central portion of the crystalline lens into a plurality of lens fragments by application of femtosecond laser energy and aspirating the lens fragments from the eye using a phaco-aspiration tip coupled to a source of suction. The method may include application of pulsed vacuum to aspirate lens fragments.

Claims

1. A tip for a phacoemulsification handpiece, comprising: a tubular structure including an elongate portion having generally parallel sides and a flared end portion extending outwardly from the elongate portion and presenting a mouth that is larger in diameter than a lumen diameter of the elongate portion; a plurality of internally extending structures coupled to an interior of the tubular structure; wherein the tubular structure is coupled to the phacoemulsification handpiece which in turn is coupled to a source of suction by which fragments of a crystalline lens may be drawn into the lumen of the tubular structure.

2. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the internally extending structures comprise spikes or blades.

3. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the flared end portion is frustoconical in shape.

4. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the mouth defines an inner diameter of approximately 1200 m.

5. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the internally extending structures are located within the flared end portion.

6. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the internally extending structures extend internally a distance between 100 and 400 m

7. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the internally extending structures are located proximate a junction between the flared end portion and the elongate portion having generally parallel sides.

8. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the internally extending structures are located within the elongate portion having generally parallel sides.

9. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the source of vacuum is structured to supply vacuum in a pulsed fashion.

10. The tip for a phacoemulsification handpiece as claimed in claim 1, wherein the tubular structure defines an inner diameter of approximately 900 m.

11. A method of surgically removing a crystalline lens of an eye, the method comprising: evaluating the crystalline lens to determine a level of nuclear sclerosis; sectioning at least a central portion of the crystalline lens into a plurality of lens fragments by application of femtosecond laser energy; aspirating the lens fragments from the eye using a phaco-aspiration tip coupled to a source of suction; selecting or making the phaco-aspiration tip to include an elongate tube defining a flared end portion and a parallel side tubular portion.

12. The method as claimed in claim 11, further comprising engaging internally extending structures of the phaco-aspiration tip with the lens fragments.

13. The method as claimed in claim 11, further comprising applying no ultrasound energy to the eye during aspiration.

14. The method as claimed in claim 11, further comprising applying aspiration suction in a pulsed fashion.

15. The method as claimed in claim 11, further comprising sectioning the crystalline lens so that the lens fragments comprise cuboids.

16. The method as claimed in claim 15, further comprising making the cuboids to have it dimension of approximately 300 m.

17. The method as claimed in claim 11, further comprising applying at least one further femtosecond laser pulse centrally within at least some of the lens fragments when the level of nuclear sclerosis exceeds a preselected value.

18. The method as claimed in claim 17, further comprising applying the at least one further femtosecond laser pulse when the preselected value for the level of nuclear sclerosis exceeds 2+.

19. The method as claimed in claim 11, further comprising applying additional femtosecond laser energy to at least some of the lens fragments thereby facilitating disruption of the lens fragments and aspiration of the lens fragments to which additional femtosecond laser energy is applied.

20. The method as claimed in claim 11, further comprising sectioning at least a portion of a lens nucleus by the application of femtosecond laser energy.

21. The method as claimed in claim 11, further comprising sectioning substantially an entirety of the crystalline lens by the application of femtosecond laser energy.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Subject matter hereof may be more completely understood in consideration of the following detailed description of various embodiments in connection with the accompanying figures, in which:

[0022] FIG. 1 is a schematic cross sectional depiction of a crystalline lens which has been divided by femtosecond laser application into 300 m cuboids according to an example embodiment of the invention;

[0023] FIG. 2 is a schematic cross sectional depiction of a crystalline lens which has been divided by femtosecond laser application into 300 m cuboids and to which a central femtosecond pulse application has been applied to facilitate lens aspiration according to an example embodiment of the invention;

[0024] FIG. 3 is a side schematic cross sectional view of a phaco aspiration tip according to an example embodiment of the invention;

[0025] FIG. 4 is a front sectional view of a lumen of a frustoconical portion of the phaco aspiration tip including internally directed spikes according to an example embodiment of the invention;

[0026] FIG. 5 is a flowchart depicting a method according to an example embodiment of the invention;

[0027] FIG. 6 is a schematic cross sectional depiction of a crystalline lens depicting a crystalline lens including the nucleus and cortex.

[0028] While various embodiments are amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the claimed inventions to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the subject matter as defined by the claims.

DETAILED DESCRIPTION

[0029] Referring to FIGS. 1-6, according to an example embodiment of the invention crystalline lens 10 is sectioned by femtosecond laser energy into a plurality of cuboids 12. According to an example embodiment depicted in FIG. 1, cuboids 12 are approximately 300 m on each side. While the volume occupied by cuboids 12 is depicted as occupying a particular portion of the schematically depicted crystalline lens 10 this should not be considered limiting. Volume 13 occupied by cuboids 12 can be greater or lesser than that schematically depicted. Nor should the 300 m dimension be considered limiting as the invention contemplates other sizes. Cuboids 12 need not be aligned as in the schematic depiction. The alignment depicted is purely an example.

[0030] Referring particularly to FIG. 2, according to another example embodiment of the invention each cuboid 12 may be occupied and further treated by at least one plasma bubble 14. Pulsed femtosecond laser energy may be applied to a central portion of cuboid 12 to create centrally located plasma bubble 14 to support disruption and disassembly of cuboids 12 occupying a treated cuboidal volume 13 in FIG. 2.

[0031] As is known to those skilled in the art and depicted schematically in FIG. 6, lens nucleus 16 is generally centrally located in crystalline lens 10. Lens nucleus 16 is denser than lens cortex 20, particularly in crystalline lens 10 that is affected by a nuclear sclerotic cataract. Treated cuboidal portion 18 of crystalline lens 10, for the purposes of this application generally includes volume 13 of crystalline lens 10 that is sectioned by femtosecond laser and which contains cuboids 12.

[0032] Referring now to FIG. 3, according to an example embodiment, the invention includes a phaco-aspiration tip 22. Phaco-aspiration tip 22 is intended to be coupled to generally conventional phacoemulsification handpiece 24. Phacoemulsification handpiece 24 is in turn coupled to console 26 which supplies vacuum for aspiration, fluid for fluid replacement and electrical power for ultrasonic energy application if needed. Console 26 is generally conventional, and because it is known to those skilled in the art, will not be further described here.

[0033] Phaco-aspiration tip 22 generally includes tubular portion 28 and end portion 30. Tubular portion 28 and end portion 30 may be formed from rigid materials such as Nitinol or stainless steel or other rigid materials and may be formed, for example, as a unitary structure.

[0034] Tubular portion 28 generally presents elongate tube 32 defining lumen 34. According to the depicted example embodiment, elongate tube 32 has inner diameter 36 of approximately 900 m. In this context, for the purposes of this application approximately means 900 m plus or minus 100 m.

[0035] End portion 30 generally presents flared portion 38 defining mouth 40, flared lumen 42 and narrow end 44. Flared portion 38 may also be bell-shaped or otherwise curved rather than straight sided. Mouth 40 has an inner diameter 46 greater than inner diameter 36. Narrow end 44 meets and is coupled to tubular portion 28 and has inner diameter 36.

[0036] End portion 30 further presents internally extending structures 48. Internally extending structures 48 may take the form of spikes or blades. Internally extending structures 48 may, in the depicted example, include four internally extending structures 48 located at approximately 90 intervals around an internal circumference of flared lumen 42. A greater or lesser number of internally extending structures 48 may be utilized.

[0037] Referring now to FIG. 4, internally extending structures 48 may be spaced uniformly or non-uniformly within flared lumen 42. According to other example embodiments, internally extending structures 48 may be located within elongate tube 32 or at junction 50 between elongate tube 32 and frustoconical portion 38. Internally extending structures 48 may be formed of the same material as tubular portion 28 or may be formed of a different material coupled to put tubular portion 28.

[0038] Internally extending structures 48 may extend inwardly normal to a longitudinal axis of phaco-aspiration tip 22, may be tilted toward mouth 40 as depicted in FIG. 3 or may be tilted away from mouth 40. Internally extending structures 48 may vary in length from 100 to 400 m.

[0039] Other embodiments of the invention include a method that includes evaluating a crystalline lens to determine a level of nuclear sclerosis S1. The method further includes sectioning at least a central portion of a crystalline lens into a plurality of lens fragments or cuboids 12 by application of femtosecond laser energy S2. If the level of nuclear sclerosis exceeds a preselected value, for example, 2+ embodiments of the method includes applying at least one additional laser pulse to a central portion of at least one of the plurality of lens fragments to create plasma bubble 14 thus creating a treated cuboidal portion 18 S3. When the application of femtosecond laser pulses is at least partially completed, the method may include, aspirating lens fragments or cuboids 12 from the eye using a phaco-aspiration tip 22 coupled to a source of suction such as console 26 S4. According to a further example embodiment, phacoaspiration tip is utilized including at least one internally directed structure S5. According to another example embodiment of the invention, the method includes making or selecting the phaco-aspiration tip such that the at least one internally directed structure comprises a spike or blade S6. The method may optionally include applying suction to the phaco-aspiration tip in a pulsed fashion S7.

[0040] In operation, femtosecond laser energy is applied to crystalline lens 10 to section at least a partial volume 13 of crystalline lens 10 into cuboids 12. Optionally, in the case of crystalline lens 10 having, for example, 3+ and above nuclear sclerosis, femtosecond laser energy is further applied to crystalline lens 10 to further create plasma bubble 14 within cuboids 12, for example, at or near a center of cuboids 12. The application of femtosecond energy to create plasma bubble 14 creates treated cuboidal portion 18. Volume 14 may include at least a portion of lens nucleus 18. According to an example embodiment volume 14 encompasses all of lens nucleus 18. The application of femtosecond laser energy to create plasma bubble 14 is expected to be useful to facilitate aspiration in the case of a lens nucleus demonstrating, for example, 3+ nuclear sclerosis or greater. According to different embodiments of the invention, volume 13 may encompass a portion of crystalline lens 10 or substantially all of crystalline lens 10.

[0041] Following sectioning by application of femtosecond laser energy phaco-aspiration tip 22 is used to aspirate cuboids 12 or treated cuboidal portions 18. It is expected that aspiration can be accomplished with a minimal application of ultrasonic energy. It is expected that with the use of phaco-aspiration tip 22 it will be possible to aspirate the material of crystalline lens 10 completely without the application of ultrasonic energy.

[0042] Phaco-aspiration tip 22 is manipulated via phacoemulsification handpiece 24 to place mouth 40 of frustoconical portion 38 in proximity of cuboids 12. This is accomplished through a corneal or scleral incision as is known to those skilled in the art. It is expected that with the application of steady or pulsed vacuum cuboids 12 or treated cuboidal portion 18 of lens nucleus 16 and lens cortex 20 will be aspirated and removed from the eye.

[0043] When brought into proximity or contact with mouth 40 and flared lumen 42 of phaco-aspiration tip 22, cuboids 12 or treated cuboidal portions 18 are drawn into flared lumen 42 by application of suction. Cuboids 12 or treated cuboidal portions 18 encounter and are engaged by internally extending structures 48. Internally extending structures 48 assist in the prehension and retention of cuboids 12 or treated cuboidal portions 18 within flared lumen 42 which are then aspirated through lumen 34 of elongate tube 32. Internally extending structures 48 may assist in deconstruction of cuboids 12 thus assisting the aspiration process. Once cuboids 12 or treated cuboidal portions 18 pass junction 50 they are overcome by fluid flow and are expected to be removed permanently from the eye.

[0044] In an alternative embodiment, pulsed suction is applied via lumen 34. In this embodiment, micro vacuum surges of suction assist in drawing cuboids 12 or treated cuboidal portions 18 through flared lumen 42 into lumen 34 and onward to console 26.

[0045] After lens nucleus 16 and lens cortex 20 of crystalline lens 10 are removed, an intraocular lens implant may be placed in the lens capsule according to techniques known to those skilled in the art.

[0046] Various embodiments of systems, devices, and methods have been described herein. These embodiments are given only by way of example and are not intended to limit the scope of the claimed inventions. It should be appreciated, moreover, that the various features of the embodiments that have been described may be combined in various ways to produce numerous additional embodiments. Moreover, while various materials, dimensions, shapes, configurations and locations, etc. have been described for use with disclosed embodiments, others besides those disclosed may be utilized without exceeding the scope of the claimed inventions.

[0047] Persons of ordinary skill in the relevant arts will recognize that the subject matter hereof may comprise fewer features than illustrated in any individual embodiment described above. The embodiments described herein are not meant to be an exhaustive presentation of the ways in which the various features of the subject matter hereof may be combined. Accordingly, the embodiments are not mutually exclusive combinations of features; rather, the various embodiments can comprise a combination of different individual features selected from different individual embodiments, as understood by persons of ordinary skill in the art. Moreover, elements described with respect to one embodiment can be implemented in other embodiments even when not described in such embodiments unless otherwise noted.

[0048] Although a dependent claim may refer in the claims to a specific combination with one or more other claims, other embodiments can also include a combination of the dependent claim with the subject matter of each other dependent claim or a combination of one or more features with other dependent or independent claims. Such combinations are proposed herein unless it is stated that a specific combination is not intended.

[0049] Any incorporation by reference of documents above is limited such that no subject matter is incorporated that is contrary to the explicit disclosure herein. Any incorporation by reference of documents above is further limited such that no claims included in the documents are incorporated by reference herein. Any incorporation by reference of documents above is yet further limited such that any definitions provided in the documents are not incorporated by reference herein unless expressly included herein.

[0050] For purposes of interpreting the claims, it is expressly intended that the provisions of 35 U.S.C. 112(f) are not to be invoked unless the specific terms means for or step for are recited in a claim.