OPHTALMOLOGICAL TREATMENT AND MANUFACTURE APPARATUS

Abstract

An ophthalmological treatment apparatus for resecting a patient cornea element form a patient cornea in posterior lamellar keratoplasty, an ophthalmological manufacture apparatus for manufacturing from a donor cornea a cornea implant, as well as corresponding manufacture and implantation methods are disclosed. The patient cornea cut pattern that is implemented in the patient cornea defines a patient cornea interlocking structure, the patient cornea interlocking structure being configured to interlock the patient cornea with a cornea implant after replacing the patient cornea element by the cornea implant. The corneal implant may have a corresponding cornea implant interlocking structure. The patient cornea interlocking structure and the cornea implant interlocking structure may be arranged at the posterior side of the patient cornea element and the cornea implant, respectively. The ophthalmological treatment apparatus and the ophthalmological manufacture apparatus may include in each case an ophthalmological laser device, in particular with a femtosecond laser source.

Claims

1. Ophthalmological treatment apparatus for resecting a patient cornea element form a patient cornea in posterior lamellar keratoplasty, the ophthalmological treatment apparatus including: a) a treatment laser device for implementing cornea cuts; b) a computerized treatment control device in operative coupling with the treatment laser device, the treatment control device configured to control the treatment laser device to implement a number of patient cornea cuts, the patient cornea cuts forming, in combination, a patient cornea cut pattern with a geometry of the patient cornea element being defined by the patient cornea cut pattern, the number of patient cornea cuts including: a patient anterior lamellar cut, the patient anterior lamellar cut extending in the patient cornea at a patient anterior lamellar cut distance from a patient posterior cornea surface of the patient cornea, the patient anterior lamellar cut defining a patient anterior cornea element surface, a patient side cut, the patient side cut extending in the patient cornea from a circumferential edge of the patient anterior lamellar cut towards the patient posterior cornea surface in a circumferentially closed manner, the patient side cut defining, at least in part, a circumferential patient cornea element surface, a patient access cut, the patient access cut extending in the patient cornea from the patient side cut to a peripheral region of the patient anterior cornea surface, the patient access cut forming an access passage in the patient cornea, the patient cornea cut pattern further defining a patient cornea interlocking structure, the patient cornea interlocking structure being configured to interlock the patient cornea with a cornea implant after replacing the patient cornea element by the cornea implant.

2. Ophthalmological treatment apparatus according to claim 1, wherein the treatment control device is configured to control the treatment laser device to implement the patient anterior lamellar cut subsequent to the patient side cut and the patient access cut subsequent to the patient anterior lamellar cut.

3. Ophthalmological treatment apparatus according to claim 1, wherein the patient side cut does not extend to the patient posterior cornea surface, the patient cornea cut pattern further including: a patient posterior lamellar cut, the patient posterior lamellar cut extending circumferentially in the patient cornea from a posterior edge of the patient side cut inwards with respect to the patient cornea, in particular with a constant distance to the patient anterior lamellar cut, a patient auxiliary side cut, the patient auxiliary side cut extending from an inner edge of the patient posterior lamellar cut to the patient posterior cornea surface.

4. Ophthalmological treatment apparatus according to claim 3, wherein the treatment control device is configured to control the treatment laser device to implement the patient posterior lamellar cut subsequent to the patient auxiliary side cut and prior to the patient side cut.

5. Ophthalmological treatment apparatus according to claim 1, wherein the patient cornea interlocking structure is defined, at least in part, by a patient posterior cornea element surface.

6. Ophthalmological treatment apparatus according to claim 1, wherein the patient cornea element includes a circumferential step in the patient posterior cornea element surface, in particular in a peripheral region of the patient posterior cornea element surface.

7. Ophthalmological treatment apparatus according to claim 1, wherein the patient access cut meets the patient anterior cornea surface in an acute angle.

8. Ophthalmological treatment apparatus according to claim 1, wherein the patient cornea cut pattern includes an auxiliary patient access cut, the auxiliary patient access cut extending in the patient cornea from the patient side cut to the peripheral region of the patient anterior cornea surface, wherein the auxiliary patient access cut is arranged with respect to a circumference of the patient side cut opposite to the patient access cut, the auxiliary patient access cut forming an auxiliary access passage in the patient cornea.

9. Ophthalmological treatment apparatus according to claim 8, wherein the patient auxiliary access cut meets the patient anterior cornea surface in a perpendicular or substantially perpendicular manner.

10. Ophthalmological treatment apparatus according to claim 1, wherein the treatment control device is configured to implement the patient cornea cuts that define the geometry of the patient cornea element in sequence one after the other.

11. Opthalmological treatment apparatus according to claim 1, wherein the cornea implant including: a spherically curved cornea implant anterior surface, a spherically curved cornea implant posterior surface, the cornea implant posterior surface being displaced with respect to the anterior cornea implant surface in a posterior direction, a circumferential cornea implant surface, the circumferential cornea implant surface extending between a circumferential edge of the cornea implant anterior surface and a circumferential edge of the cornea implant posterior surface; a cornea implant interlocking structure, the cornea implant interlocking structure being configured to interlock a patient cornea with the cornea implant after replacing a patient cornea element of a patient cornea with the cornea implant, wherein the cornea implant interlocking structure is arranged at and/or forms part of the cornea implant posterior surface.

12. Opthalmological treatment apparatus according to claim 11, wherein the cornea implant is made from tissue of a donor cornea.

13. Opthalmological treatment apparatus according to claim 11, wherein the cornea implant posterior surface includes a circumferential step in a peripheral region of the cornea implant posterior surface.

14. Ophthalmological manufacture apparatus for manufacturing from a donor cornea a cornea implant suited for use in in posterior lamellar keratoplasty, the ophthalmological manufacture apparatus including: a) a manufacture laser device for implementing cornea cuts; b) a computerized manufacture control device in operative coupling with the manufacture apparatus, the manufacture control device being designed to control the manufacture laser device to implement a number of donor cornea cuts, the donor cornea cuts forming, in combination, a donor cornea cut pattern with a geometry of the cornea implant being defined by the donor cornea cut pattern, the number of donor cornea cuts including: a donor anterior lamellar cut, the donor anterior lamellar cut extending in the donor cornea at a donor anterior lamellar cut distance from a donor posterior cornea surface, the donor anterior lamellar cut defining a cornea implant anterior surface, a donor side cut, the donor side cut extending in the donor cornea from the donor anterior lamellar cut towards the donor posterior cornea surface in a circumferentially closed manner, wherein a junction of the donor side cut and the donor anterior lamellar cut is displaced with respect to a circumferential edge of the donor anterior lamellar cut, the donor side cut defining, at least in part, a circumferential cornea implant surface; a donor access cut, the donor access cut extending from a periphery, in particular a circumferential edge, of the donor anterior lamellar cut to a donor anterior cornea surface, the donor cornea cut pattern further defining a cornea implant interlocking structure, the cornea implant interlocking structure being configured to interlock a patient cornea with the cornea implant after replacing the patient cornea element by the cornea implant.

15. Method for manufacturing from a donor cornea a cornea implant suited for use in in posterior lamellar keratoplasty, the method comprising: implementing, by a laser device, a number of donor cornea cuts, the number of donor cornea cuts forming, in combination, a donor cornea cut pattern with a geometry of the cornea implant being defined by the donor cornea cut pattern, wherein the number of donor cornea cuts including: a donor anterior lamellar cut, the donor anterior lamellar cut extending in the donor cornea at a donor anterior lamellar cut distance from the donor posterior cornea surface, the donor anterior lamellar cut defining a cornea implant anterior surface, a donor side cut, the donor side cut extending in the donor cornea from the donor anterior lamellar cut towards the donor posterior cornea surface in a circumferentially closed manner, wherein a junction of the donor side cut and the donor anterior lamellar cut is displaced with respect to a circumference edge of the donor anterior lamellar cut, the donor side cut defining, at least in part, a circumferential cornea implant surface, and a donor access cut, the donor access cut extending from a circumferential edge of the donor anterior lamellar cut to a donor anterior cornea surface, wherein the donor cornea cut pattern further defining a cornea implant interlocking structure, the cornea implant interlocking structure being configured to interlock a patient cornea with the cornea implant after replacing the patient cornea element by the cornea implant.

16. Ophthalmological surgical method for replacing a patient cornea element with a cornea implant by way of posterior lamellar keratoplasty, comprising: implementing, by a laser device, a number of patient cornea cuts, the patient cornea cuts forming, in combination, a patient cornea cut pattern with a geometry of the patient cornea element being defined by the patient cornea cut pattern, wherein the number of donor cornea cuts including: a patient anterior lamellar cut, the patient anterior lamellar cut extending in the patient cornea at a patient anterior lamellar cut distance from a patient posterior cornea surface of the patient cornea, the patient anterior lamellar cut defining a patient anterior cornea element surface, a patient side cut, the patient side cut extending in the patient cornea from a periphery, in particular a circumferential edge, of the patient anterior lamellar cut towards the patient posterior cornea surface in a circumferentially closed manner, the patient side cut defining, at least in part, a circumferential patient cornea element surface, a patient access cut, the patient access cut extending in the patient cornea from the patient side cut to a peripheral region of the patient anterior cornea surface, the patient access cut forming an access passage in the patient cornea, wherein the patient cornea cut pattern further defining a patient cornea interlocking structure, the patient cornea interlocking structure being configured to interlock the patient cornea with a cornea implant after replacing the patient cornea element by the cornea implant. the method further including: removing the patient cornea element from the patient cornea, in particular via the patient access, cut, thereby creating a patient cornea cavity in the patient cornea, placing a cornea implant in the patient cornea cavity, in particular via the patient access cut, interlocking the cornea implant with the patient cornea by engagement of the patient cornea interlocking structure a cornea implant interlocking structure of the cornea implant.

Description

BRIEF DESCRIPTION OF THE FIGURES

[0080] The herein described disclosure will be more fully understood from the detailed description given herein below and the accompanying drawings which should not be considered limiting to the disclosure described in the appended claims. The drawings show:

[0081] FIG. 1 illustrates an embodiment of an ophthalmological treatment and manufacture apparatus according to the present disclosure in a schematic sectional view;

[0082] FIG. 2 illustrates a patient cornea with implemented patient cornea cuts according to an embodiment of the present disclosure in a schematic sectional side view;

[0083] FIG. 3 illustrates the patient cornea with implemented patient cornea cuts corresponding to FIG. 2 in a schematic top view;

[0084] FIG. 4 illustrates a donor cornea with implemented donor cornea cuts according to an embodiment of the present disclosure in a schematic sectional side view;

[0085] FIG. 5 illustrates the donor cornea with implemented donor cornea cuts corresponding to FIG. 4 in a schematic top view;

[0086] FIG. 6 illustrates a configuration for the insertion of a cornea implant into a patient cornea in accordance with the present disclosure in a schematic side view; and

[0087] FIG. 7 illustrates the positioning of a cornea implant in accordance with the present disclosure in a schematic top view.

EXEMPLARY EMBODIMENTS

[0088] In the following, reference is first made to FIG. 1. FIG. 1 shows an exemplary embodiment of an ophthalmological treatment and manufacture apparatus 1, 3 in accordance with the present disclosure and in interaction with a human eye (patient eye) 2 in a schematic view.

[0089] For the human eye 2, the cornea 21, the lens 22, the retina 23 and the sclera 29 are shown. Further, the limbus (not separately referenced) is present as transition area between the cornea 21 and the sclera 29.

[0090] In FIG. 1 as well as further figures, an anterior-pointing direction is indicated by “a” and a posterior-pointing direction is indicated by “p”. The anterior-pointing direction a and the posterior-pointing direction p are defined in the same manner for the patient eye 2 as well as its parts, as well as a donor cornea and a cornea implant as illustrated in further figures below.

[0091] The ophthalmological treatment and manufacture apparatus comprises the computerized ophthalmological treatment and manufacture control device 1 (in the following generally referred to as control device) and the ophthalmological laser device 3 (in the following generally referred to as laser device) that is exemplarily based on a femtosecond laser source in operative coupling with a projection lens that is part of an application head (components as laser sources, scanners and beam delivery and shaping optics are not separately shown).

[0092] From the laser device 3 respective its projection lens, laser radiation is emitted and focused onto a point of the patient cornea 21 (indicated by radiation cone 32), or similarly, of a donor cornea. In a situation of use, laser device 3 is coupled to the patient eye 2 or a donor cornea via a patient interface 31 that is typically designed for one-way use and couples with the surgical laser device 3 respectively its application head via releasable mechanical coupling and for coupling with the eye 2 respective its sclera 29 and/or cornea 21 via a suction ring 33. Coupling is not mandatory if the laser can compensate for eye movement or is fast enough. The patient interface 31 may be designed to deform the eye surface to a desired shape for the surgical procedure, e. g. planar, spherical or aspherical shape with an applanation-type coupling and a transparent contact element. Alternatively, the patient interface 31 may be designed to couple with the patient eye 2, in particular the patient cornea 21, or a donor cornea, via a contact liquid, e. g. saline solution, substantially without causing deformation. An exemplary patient interface is disclosed in the EP2853247.

[0093] The control device 1 is exemplarily shown as being based on a general-purpose computing device 15, such as a PC or workstation, in operative coupling with a user interface that includes an input unit 16 (shown with a keyboard and a mouse for exemplary purposed) and an output unit 17 (exemplarily shown as computer monitor with an image area 171. Other devices for the input unit 16 and/or the output unit 17 may be used as well. For example, the input unit 16, may include a track ball and/or a touch pad. The output unit 17 may, for example, be or include a beamer or glasses with integrated display, to be worn by an operator.

[0094] The control device 1 includes a number of functional modules 1′, which include interface circuitry for coupling with the laser device 3 via an (typically electrical) operative coupling. The control device 1 further includes one or more processors, e. g. microprocessors and/or microcontrollers for controlling operation of the control device 1 and the ophthalmological treatment and manufacture apparatus as a whole in accordance with corresponding program code. The control device 1 further includes volatile and/or non-volatile memory that store program code and/or data.

[0095] In FIG. 1, the control device is 1 shown as a compact unit. The control device 1 may, however, also be distributed between a number of computing devices, each with particular functional units 1′. The computing devices may be coupled via data interfaces such as a LAN network or USB connection for data transfer and/or between which data may be transferred via physical media, such as CD-ROMS, DVDs, magnetic storage discs, or the like. Further, the control device 1 may be fully or partly integrated with the surgical laser device 3.

[0096] It is noted that rather than an ophthalmological treatment and manufacture apparatus, a dedicated and distinct ophthalmological treatment apparatus and ophthalmological manufacture apparatus may be used as explained in the general description to be used. While typically deviating regarding the program code and/or data, a distinct ophthalmological treatment apparatus and an ophthalmological manufacture apparatus may in each case generally be designed as depicted in FIG. 1.

[0097] In the following, reference is additionally made to FIG. 2 and FIG. 3. FIG. 2 shows a schematic sectional side view of the patient cornea 21 with the patient cornea element 211 and the patient cornea cuts respectively patient cornea cut pattern as described in the following. FIG. 3 shows a corresponding schematic top view of the patient cut pattern. The patient cornea axis is referenced with “PCA”. It is noted that like in further figures as discussed below, in particular FIG. 4, hatchings are omitted for clarity reasons. Further it is noted that the top views of FIG. 3 and FIG. 5 are shown somewhat smaller as compared to the side sectional views of FIG. 2 and FIG. 4. It is noted that the figures generally show the cornea and cornea cuts in their natural shape, i.e. without applanating, for clarity reasons. Also references to the geometry of particular elements or cuts are made with reference to this configuration, if not stated differently.

[0098] An anterior-pointing respectively posterior-pointing direction is referenced with “a” respectively “p”. An inwards-pointing direction (towards a center of the patient cornea 21) is referenced with “i” and an outwards-pointing direction (towards the periphery of the patient cornea 21) is referenced with “o”. The same notation is used in further figures below for the donor cornea and the cornea implant in an analogue manner. It is noted that the inwards-pointing direction I and the outwards-pointing direction o are radial respectively lateral directions. It is noted in this context that the patient cornea, the donor cornea as well as the cornea implant are here generally assumed as rotationally symmetric, which is typically approximately but not necessarily strictly the case in practice.

[0099] The patient anterior lamellar cut P-D extends in the patient cornea 21 and approximately equidistant to the patient anterior cornea surface 21 and has for example a diameter of about 10 mm. The patient anterior lamellar cut P-D lies fully within the patient cornea 21 between the patient anterior cornea surface 21a and the patient posterior cornea surface 21p. The patient anterior lamellar cut P-D extends in a substantially equidistant manner to the patient anterior cornea surface 21a as well as in substantially equidistant manner to the patient posterior cornea surface 21p. Typically, the patient anterior lamellar cut P-D is further substantially spherical and centered with respect to the patient cornea axis PCA. The patient anterior lamellar cut P-D is spaced apart from the patient anterior cornea surface 21a by about 100 micrometer or somewhat more in a typical embodiment. The same applies for the distance between the donor anterior lamellar cut D-D and the donor cornea surface as discussed further below. Generally, a small distance between the patient respectively donor anterior cornea surface and the patient respectively donor anterior side cut is preferably, without, while ensuring that a sufficient amount of tissue remains, in particular at the patient cornea, to ensure stability respectively avoid damage of the cornea tissue anterior of the patient cornea element.

[0100] The patient side cut P-C is a circumferential cut and extends from the circumferential edge 212 of the patient anterior lamellar cut towards P-D towards the patient posterior cornea surface 21p in a circumferentially closed manner. In the shown embodiment, the patient side cut P-C is for example an inverted 150 degrees cut in the applanated state and may run substantially parallel to the patient cornea axis PCA, which however is not essential. In alternative embodiments, the patient side cut may be angled respectively oblique to the patient cornea axis PCA. In the shown design, the patient side cute P-C does not extend full to the patient posterior cornea surface 21p, bud ends within the patient cornea, spaced apart from the patient posterior cornea surface 21p for interlocking purposes as explained further below. It is noted that the circumferential edge 212 of the patient anterior lamellar cut is at the same time an anterior edge of the patient side cut P-C.

[0101] In the shown embodiment, a patient posterior lamellar cut P-B runs from the posterior edge 213 of the patient side cut P-C inwards. The patient posterior lamellar cut P-B extends in a circumferentially closed manner inward. In the shown embodiment, the patient posterior lamellar cut P-B extends with constant distance to the patient anterior lamellar cut P-D in a coaxial respectively centered manner and is preferably spherical. It is noted that the posterior edge 213 of the patient side cut P-C is at the same time a circumferential outer edge of the patient posterior lamellar cut P-B. Further, a patient auxiliary side cut P-A runs from a circumferential inner edge 214 of the patient posterior lamellar cut P-B to the patient posterior cornea surface 21p and extends to the posterior cornea surface 21p.

[0102] The patient anterior lamellar cut P-D, the patient posterior lamellar cut P-B and the patient posterior cornea surface 21p delimit, in combination, a patient cornea element 211 in axial respectively anterior-posterior-direction. Further, the patient side cut P-C and patient auxiliary side cut P-A delimit the patient cornea element 211 in the radial direction. Via patient cornea cuts P-A, P-B, P-C, P_D, the patient cornea element 211 is separated from the further tissue of the patient cornea 21. The patient cornea element 211 is formed by respectively comprises the generally pathological respectively defective portion of the patient cornea that is resected and subsequently replaced by a cornea implant. The patient anterior cornea element surface is defined by the patient anterior lamellar cut P-D, while the patient posterior cornea element surface 211b is defined by the patient posterior cornea surface 21p in a central part (in radial direction from the patient cornea axis PCA to the patient auxiliary side cut P-A), and by the patient posterior lamellar cut P-B in a peripheral part (in radial direction outwards from the patient auxiliary side cut P-A).

[0103] Via the patient posterior lamellar cut P-B and the patient auxiliary side cut P-A, an annular step is formed in the patient posterior cornea element surface 211p, respectively an annular recess is formed at the posterior side of the patient cornea element 211. The portion of tissue that is separated from the patient cornea element 211 by the patient posterior lamellar cut P-B and the patient auxiliary side cut P-A is a patient cornea tissue ring 21′ and is complementary to the recess in the patient cornea element 211.

[0104] In addition to the patient cornea cuts P-A, P-B, P-C, P-D which define, in combination the shape of the patient cornea element 211, the patient cornea cut pattern includes two additional patient cornea cuts that serve the surgical procedure, namely a patient access cut P-E and an auxiliary patient access cut P-F. A patient access cut P-E extends in the patient cornea 21 from the patient side cut P-C to a peripheral region of the patient anterior cornea surface 21a . In the shown design, the patient access cut P-E meets the patient side cut P-C at its anterior edge 212. It could, however, also meet the patient side cut P-C somewhat further posterior in direction towards its posterior edge 213. Favorably, the patient access cut P-E meets the patient anterior cornea surface in an acute respectively shallow angle. The patient access cut P-E may be implanted starting at the periphery anterior cornea surface 21a and ending at the patient side cut P-E.

[0105] In the shown embodiment, the patient access cute P-E meets the patient anterior cornea surface 21a as a circular arc and generally concentrically to the patient cornea axis PCA: This, however, is not essential. In alternative embodiments, the patient access cut P-E may meet patient anterior cornea surface 21a in a straight line or as outwards-curved arc, i.e. away from the patient cornea axis P-A.

[0106] As best visible in FIG. 3, the patient access cut is a sectoral cut that is not circumferentially thoroughgoing but extends over an arc length in a typical range of about 4mm to 5mm. The patient access cut P-E provides a tunnel-shaped access channel for removing the patient cornea element 211 as well as inserting and positioning the cornea implant. The patient access cut is favorably shaped to allow the insertion of an insertion spatula.

[0107] In the shown embodiment, an auxiliary patient access cut P-F is provided diametrically opposed to the patient access cut P-E. The auxiliary patient access cut P-F extends form the patient side cut P-C to the peripheral region of the patient anterior cornea surface 21a . In the shown design, the auxiliary patient access cut meets the patient side cut P-C at its posterior edge 213. It could, however, also meet the patient side cut P-C somewhat further anterior in direction towards its anterior edge 212. The auxiliary patient access cut P-F provides a tunnel-shaped auxiliary access channel for positioning the cornea implant with an auxiliary forceps that is introduced via the auxiliary patient access cut P-F.

[0108] While the patient cornea cuts may generally be implemented respectively executed in different orders, an advantageous order that is particularly favorable is P-A, P-B, P-C, P-D, P-E, P-F.

[0109] After removing the patient cornea element 211, a patient cornea cavity of generally same shape and dimension will be present in the patient cornea.

[0110] In the following, reference is additionally made to FIG. 4 and FIG. 5. FIG. 4 shows a schematic sectional side view of the donor cornea 41 from which the cornea implant 411 is manufactured respectively produced, as well as the donor cornea cuts respectively the donor cornea cut pattern. FIG. 5 shows a corresponding schematic top view of the donor cut pattern. The donor cornea axis is referenced with “DCA”, generally corresponding to the cornea implant axis CIA which is referenced as CIA. Since a number of donor cornea cuts corresponds to patient cornea cuts as discussed before, the following description generally focusses on the differences and particular aspects of the manufacture of cornea implant 411.

[0111] The donor side cut D-C, the donor posterior lamellar cut D-B and the donor auxiliary side cut D-A generally correspond to the patient side cut P-C, the patient posterior lamellar cut P-B, and the patient auxiliary side cut P-A. The donor auxiliary side cut D-A, however, may have in a particular implementation have a somewhat smaller diameter in a viewing direction along the donor cornea axis DCA as compared to the patient auxiliary side cut P-A in a viewing direction along the patient cornea axis PCA, respectively the donor auxiliary side cut D-A may be somewhat closer to the donor cornea axis DCA than the patient auxiliary side cut P-A is to the patient cornea axis PCA. The distance between the patient anterior lamellar cut P-D to the patient posterior lamellar cut B-B is generally identical to the distance between the donor anterior lamellar cut D-D and the donor posterior lamellar cut D-B.

[0112] Further, the radial extension of the donor posterior lamellar cut D-B may in an embodiment be somewhat larger as compared to the patient posterior lamellar cut P-B. In this way, the radius r′ (see FIG. 5) of the cornea implant 411 is slightly larger as compared to the radius r of the patient cornea element 211, respectively the lateral dimension of the cornea implant 411 is slightly larger respectively has a slight oversize as compared to the patient cornea element 211. In this way, it is ensured that the cornea implant sits snugly in the patient cornea cavity after insertion.

[0113] Other embodiments, however, may be used as well. In particular, the patient cornea cuts and the corresponding donor cornea cuts may correspond to each other as closely as possible.

[0114] Further, the lateral extension of the donor anterior lamellar cut D-D may in an embodiment be wider respectively the circumferential edge 412 of the donor anterior lamellar cut D-E as compared to the patient anterior lamellar cut P-D. As a consequence, the donor side cut D-C does not meet with the donor anterior lamellar cut D-D at its circumferential edge 412. Instead, the donor side cut D-C is displaced inwards and a junction of its anterior edge 415 with the donor anterior lamellar cut is displaced inwards respectively within the area as delimited by the circumferential edge 412 of the donor anterior lamellar cut D-D. Further, the donor access cut D-E is a circumferential cut that extends from the circumferential edge 412 to the donor anterior cornea surface 41a.

[0115] As a consequence of the here-described cut arrangement a donor cover element 6 is created that laterally projects over the cornea implant 6 that is manufactured via the donor cornea cuts. The donor cover element 6 is generally separated from the further parts of the donor cornea 41 via the donor anterior lamellar cut D-D and the donor access cut D-E. In the shown embodiment, the donor access cut is circumferentially closed respectively thronging. Subsequent to implementing the donor cornea cuts, the donor cover element 6 can be simply peeled or lifted off, using a suited instrument such as forceps. Subsequently, the manufactured cornea implant 411 can be removed from the remaining tissue of the donor cornea 41. In an alternative embodiment, the donor side cut D-E is not circumferential through going, but a tissue bridge remains via which the donor cover element 6 may be flipped away in a hinge-like manner to provide access to the cornea implant 411.

[0116] When inserting and positioning the cornea implant 411 in the patient cornea cavity of the patient cornea 41, the peripheral part of the cornea implant posterior surface 411p will abut the anterior surface of the patient cornea tissue ring 21′ such that the cornea implant 411 rests on the patient cornea tissue ring 21′. In a variant, the cornea tissue ring 21′ does not extend transverse to the patient cornea axis PCA respectively cornea implant axis CIA, but extend oblique, in particular in anterior direction. The circumferential recess of the cornea implant 411 is designed accordingly in this case. For the donor the same applies in an analogue manner.

[0117] While the donor cornea cuts may generally be implanted in different orders, an advantageous order that is particularly favorable is D-A, D-B, D-C, D-D, D-E.

[0118] In the following, reference is additionally made to FIG. 6 and FIG. 7, schematically illustrating the insertion and placing of the cornea implant 411 in the patient cornea 21. FIG. 6 illustrated the situation prior the actual insertion if the cornea implant 411. An insertion spatula 7 with the cornea implant 411 (not visible in FIG. 6) is positioned to allow introduction via the patient access cut P-E (not visible in FIGS. 6 and 7) into the patient cornea cavity 216 which has been created before by resecting and removing the patient cornea tissue element 211 as mentioned. Further, auxiliary forceps are positioned and introduced into the patient cornea cavity 416 via the auxiliary patient access cut P-F.

[0119] FIG. 7 illustrates the positioning of the cornea implant 411 in a schematic top view. By grasping the cornea implant 411 with auxiliary forceps 8, the cornea implant 8 can maneuvered, in particular pulled, into the correct position within the patient cornea cavity 216. In the schematic illustration of FIG. 7, the cornea implant 411 is directly grasped in a peripheral region by auxiliary forceps 8. It may, however, also be manipulated differently, for example via a length of suture which is fixed to the cornea implant 411 in its peripheral region.

REFERENCE SIGNS

[0120] 1 ophthalmological treatment and manufacture apparatus control device/control device [0121] 1′ functional unit [0122] 15 general-purpose computing device [0123] 16 input unit [0124] 17 output unit [0125] 171 image area [0126] 2 patient eye [0127] 21 patient cornea [0128] 21′ patient cornea tissue ring [0129] 21a patient anterior cornea surface [0130] 21p patient posterior cornea surface [0131] 211 patient cornea element [0132] 211a patient anterior cornea element surface [0133] 211p patient posterior cornea element surface [0134] 212 circumferential edge of patient anterior lamellar cut/anterior edge of patient side cut [0135] 213 circumferential outer edge of patient posterior lamellar cut/posterior edge of patient side cut [0136] 214 circumferential inner edge of patient posterior lamellar cut/anterior edge of patient auxiliary side cut [0137] 216 patient cornea cavity [0138] 22 lens [0139] 23 retina [0140] 29 sclera [0141] 3 ophthalmological laser device/laser device [0142] 31 patient interface [0143] 32 radiation cone [0144] 33 suction ring [0145] 41 donor cornea [0146] 41′ donor cornea tissue ring [0147] 41a donor anterior cornea surface [0148] 41p donor posterior cornea surface [0149] 411 cornea implant [0150] 411a cornea implant anterior surface [0151] 411p cornea implant posterior surface [0152] 412 circumferential edge of donor anterior lamella cut; posterior edge of patient access cut [0153] 413 circumferential outer edge of donor posterior lamellar cut/posterior edge of donor side cut [0154] 414 circumferential inner edge of donor posterior lamellar cut/anterior edge of auxiliary side cut [0155] 415 anterior edge of donor side cut [0156] 5 cornea implant [0157] 5a cornea implant anterior surface [0158] 5p cornea implant posterior surface [0159] 6 donor cover element [0160] 7 insertion spatula [0161] 8 auxiliary forceps [0162] a anterior-point direction [0163] p posterior-pointing direction [0164] i inwards-pointing direction [0165] o outwards-pointing direction [0166] r radius of patient cornea element [0167] r′ radius of cornea implant [0168] CIA corneal implant axis [0169] PCA patient cornea axis [0170] DCA donor cornea axis [0171] P-A patient auxiliary side cut [0172] P-B patient posterior lamellar cut [0173] P-C patient side cut [0174] P-D patient anterior lamellar cut [0175] P-E patient access cut [0176] P-F auxiliary patient access cut [0177] D-A donor auxiliary side cut. [0178] D-B donor posterior lamellar cut [0179] D-C donor side cut [0180] D-D donor anterior lamellar cut [0181] D-E donor access cut