CN101208055A - Methods for treating diseases of the eye - Google Patents

Methods for treating diseases of the eye Download PDF

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Publication number
CN101208055A
CN101208055A CNA2006800230045A CN200680023004A CN101208055A CN 101208055 A CN101208055 A CN 101208055A CN A2006800230045 A CNA2006800230045 A CN A2006800230045A CN 200680023004 A CN200680023004 A CN 200680023004A CN 101208055 A CN101208055 A CN 101208055A
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China
Prior art keywords
conjunctiva
sclera
treated tissue
tissue
electromagnetic energy
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CNA2006800230045A
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Chinese (zh)
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杰夫瑞·W·琼斯
马沙·安琪拉·范维伦
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Biolase Technology Inc
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Biolase Technology Inc
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Abstract

Architectures and techniques for treating conditions of the eye, such as presbyopia, utilize sources of treatment energy, such as electromagnetic energy emitting devices, to implement non-corneal manipulations. According to these devices and methods, the sources of treatment energy are activated to direct energy onto parts of the eye, such as the conjunctiva and sclera, to treat presbyopia. The treatments can affect at least one property of the eye and enhance an accommodation of the eye.

Description

The method of treatment ophthalmic
Technical field
The present invention relates to therapeutic treatment (medical treatment), particularly about in order to the treatment for example as the apparatus structure and the technology of presbyopia's ophthalmics such as (presbyopia), it comprises infrared laser (infrared laser), ultrasound (ultrasound) and radio frequency (radio-frequency) etc. with employed energy.
Background technology
Be commonly most known to the masses two kinds and be myopia (myopia) and hypermetropia (hyperopia) with ophthalmic diseasess that focal length imbalance (focusing disorders) is relevant.The vision refraction anomaly of myopia (myopia or nearsightedness) for being produced before at retina (retina) owing to the light focusing of bringing eyes into, and cause distant objects to seem to seem smudgy.On the other hand, hypermetropia (hyperopia or farsightedess) then is the vision refraction anomaly that is produced afterwards at retina (retina) owing to owing to the light focusing of bringing eyes into, and causes object nearby to seem to seem smudgy (blurred or fuzzy).
A mutation of hypermetropia is exactly presbyopia (presbyopia), and it generally is because people lack the ability that closely focuses on, and it normally takes place with advancing age and gradually.It is generally acknowledged that the presbyopia is the growth along with people's age, and lose gradually accurately adjust or focus on vision (near vision) closely ability caused.Therefore, the presbyopia means that generally the amplitude that eyes are regulated reduces at large.
Myopia can be passed through surgical operation therapy with hypermetropia, include cornea adjustment (cornealinterventions), for example transform the surface curvature (surface curvarure) that (reshaping) is positioned at the cornea (comea) in limbus of corneae zone (limbus area), and the treatment of non-pass cornea (non-corneal manipulations), for example change sclera (sclera) (being positioned at outside the limbus of corneae zone (limbus area)), ciliary muscle (ciliary muscle), the characteristic of ciliary zonule of eyes (zonules) or the crystal of eyes (lens) etc.Therein in prior treatment method, can comprise the surface of excision (ablating) cornea itself and form " many burnt (multifocal) " arrangement (arrangement), for example plan according to the treatment of single vision correcting technology (monovision), with eyes wherein as distance vision (distance vision), and read vision (reading vision) with another eyes, and help sufferer to watch near-end object and remote objects.And in a nearest prior treatment method, its comprise introduce otch (kerfs) in the sclera (sclera) of part thus in increase the regulating power (accommodation) of eyes.The adjustment (non-corneal interventions) of typical non-pass cornea comprises the conjunctiva (conjunctiva), the use tweezers (forceps) that temporarily remove or retract (pulling-back) sufferer and clamps with shears (scissors) and cut off, with and/or one or more dissecting knife (scalpels) cut, burn (cautery), plasma (plasma) and laser methods such as (laser), and in the actual treatment (non-cornealmanipulations) of carrying out non-pass cornea, for example form otch (kerfs) in the sclera of part, use afterwards.Behind the otch in finishing sclera, conjunctiva then is sewn go back to original position.
Summary of the invention
The present invention in order to treatment for example as the apparatus and method of presbyopia's ophthalmics such as (presbyopia), for example utilize electromagnetic energy emitting device (electromagnetic energyemitting devices) etc. as treatment energy source (source oftreatment energy), and go to implement the treatment (non-corneal manipulations) of non-pass cornea.According to apparatus structure of the present invention and technology, the treatment energy source is excited and energy is directed on the part position of eyes, for example conjunctiva (conjunctiva) and sclera (sclera) are with the treatment presbyopia, and wherein this energy can influence the speciality (property of the eye) of at least one eyes and the raising that causes eyes regulating power (accommodation of the eye).
This treatment energy source can comprise an electromagnetic-energy, for example laser.In some embodiments, this laser is erbio (Erbiumbased) pulse laser (pulsed laser) that an emission luminous energy enters sclera (sclera) in the eyes.Import the treatment energy and enter the raising that can increase or help eyes regulating power (accommodation of the eye) in the sclera, thereby alleviate presbyopic influence.
When these apparatus and method for do with the correct syntax on functional explanation by or when being described, what need be paid special attention to is, unless it meets the content that united states patent law 35 USC 112 are set forth really claim, not so be cannot with any for " device (means) " or " step (steps) " explanation and as necessary restriction of the present invention, but it must be under the principle (doctrine of equivalents) of just equalization opinion, the meaning (meaning) and equivalent (equivalents) that meet defined all scopes of claim, unless and claim its meet really under the situation of the content that united states patent law 35 USC 112 are set forth, be the legal equivalents (statutoryequivalents) that meets united states patent law 35 USC 112 defineds fully.
In these features, comprise arbitrary combination of these features, not with content of the present invention and description, and those skilled in the art's general knowledge do not have under the state that does not meet, any feature described herein or combination of feature described here all is included in the scope of the present invention.In addition, the arbitrary feature or the combination of feature can be excluded outside arbitrary embodiment of the present invention.For the present invention that makes a summary, purposes more of the present invention, advantage and novel features are in this schematic description.Certainly, can be for what masses to understand, it is optional that all purposes, advantage and novel features all are recorded in the arbitrary special embodiment of the present invention.Additional advantage of the present invention and purpose are recorded in following detailed description and claims.
Description of drawings
Fig. 1 to Fig. 4 is the icon of treatment procedure of the various treatment ophthalmics of first embodiment of the invention;
Fig. 5 to Figure 14 is the icon of treatment procedure of the various treatment ophthalmics of second embodiment of the invention;
Figure 15 is in order to the schematic diagram of device of treatment ophthalmic in one embodiment of the invention;
Figure 16 A to Figure 18 is the icon of treatment procedure of the various treatment ophthalmics of third embodiment of the invention;
Figure 19 A to Figure 20 by the apparatus structure of the various treatment ophthalmics of fourth embodiment of the invention and with the icon of its corresponding treatment procedure;
Figure 21 to Figure 23 is the icon of apparatus and method of the various treatment ophthalmics of fifth embodiment of the invention;
Figure 24 A to Figure 24 C by the apparatus structure of the various treatment ophthalmics of sixth embodiment of the invention and with the icon of its corresponding treatment procedure;
Figure 25 to Figure 28 B is the icon of apparatus and method of the various treatment ophthalmics of seventh embodiment of the invention;
Figure 29 A to Figure 29 B by the apparatus structure of the various treatment ophthalmics of eighth embodiment of the invention and with the icon of its corresponding treatment procedure;
Figure to Figure 31 B by the apparatus structure of the various treatment ophthalmics of ninth embodiment of the invention and with the icon of its corresponding treatment procedure;
Figure 32 A to Figure 32 B by the apparatus structure of the various treatment ophthalmics of tenth embodiment of the invention and with the icon of its corresponding treatment procedure;
Figure 33 A to Figure 33 B by the apparatus structure of the various treatment ophthalmics of eleventh embodiment of the invention and with the icon of its corresponding treatment procedure.
Symbol description among the figure
245 eyelets
247 main bodys
249 conjunctiva processus hyoideus
251 leading edges
255 eyelets
257 conjunctiva processus hyoideus
261 grasp otch
263 slits
265 tumblers
266 conjunctivas
267 rectangular windows
268 optical fiber heads
269 support arms
271 laser handpieces
272 slits
273 optical fiber heads
275 laser handpieces
277,279 corresponding points
281 eyelets
283 conjunctiva processus hyoideus
285 leading edges
287 optical fiber heads
289 vacuum tube accessories
291 eyelets
293 fluid passages
302 eyelets
304 conjunctiva processus hyoideus
306 leading edges
311 vacuum tube accessories
313 openings
315 fluid passages
321 otch dilators
323 conjunctiva processus hyoideus
324 windows
325 openings
327 corneas contact cup
329 pointers
333 reference axis
341 conjunctiva processus hyoideus
343 conjunctiva processus hyoideus
345 windows
351 otch dilators
353 opened front end
355 windows
The specific embodiment
The present preferred embodiment of the present invention will be in following detailed description, and each embodiment is disclosed in the corresponding icon.Under any possible situation, identical or similar label is in order to be indicated in identical or similar element in icon and the description.Arbitrary icon of the present invention is all an icon of simplifying and does not represent its accurate ratio.In this manual, employed directivity wording, for example top, bottom, the left side, the right, upwards, downwards, words such as top, below, the back side and front, only for can make things convenient for clearly describe relative in icon in structure.The wording of these directivity should be used as limitation of the scope of the invention by any way.
Though disclosed certain some specific embodiment that are demonstrated that are meant of this paper,, can be understood that these embodiment are in order to as example, rather than in order to as restriction.Though following being described in detail is that exemplary embodiment is discussed, but can be understood that to contain all modification (modification), succedaneum (alternatives) and the equivalent (equivalents) of the embodiment of the invention, as long as it falls within spirit of the present invention and the defined scope of claims.Can be understood that process step that the document of this paper institute reference is described or comprised and structure do not contain this paper description puts into practice all flow processs of the present invention.The present invention can link with the traditional treatment device of prior art and implement, and is beneficial to understand the present invention but only need propose to describe in detail to the general embodiment step that this paper comprised.
In these features, comprise arbitrary combination of these features, not with content of the present invention and description, and those skilled in the art's general knowledge do not have under the state that does not meet, any feature or the combination of feature described here all is included in the scope of the present invention.
As used herein " regulating (accommodation) " word is meant the focal length that changes eyes by the ability of remote objects near objects, and this ability can weaken along with the age.
As used herein " choroid (choroid) " word is meant eyes sclera (sclera) many vascular laminas (highly vascular layer) afterwards.
As used herein " ciliary muscle (ciliary muscle) " word is meant to be positioned at sclera (sclera) afterwards, and the circular muscle meat tissue (muscular ring of tissue) that is connected with crystal (lens) by ciliary zonule (zonules).
As used herein " conjunctiva (conjunctiva) " word is meant the thin and transparent tissue that is covered in outside the sclera.
As used herein " cornea (cornea) " word is meant the hyaline tissue (clear central front tissue of eye) in eyes central authorities the place ahead, and it is considered to the key element of eyes focusing system.
As used herein " corneal epithelial tissue (cornea epithelium) " word is meant the cortex or the rete of cornea outermost.
As used herein " limbus of corneae (limbus) " word is meant the boundary of cornea and sclera.
As used herein " retina (retina) " word, be meant the photosensitive layer tissue (light-sensitive layer of tissue) that is arranged in the eyeball back side, it is sent to brain via optic nerve (optic nerve) with vision pulse (visual impulses).
As used herein " sclera (sclera) " word is meant the peripheral supporting construction (outer supporting structure) or the white of the eye (the white of the eye) of eyes.
As used herein " vitreous body (vitreous body) " word be meant the jelly that is filled in crystal eyeball afterwards clear, colorless partly, and it is surrounded by a frangible glass-film (delicate hyaloid membrane).
As used herein " ciliary zonule (zonules) " word is meant that the annular of the gluey fiber that radial distributes is formed, and its inner (inner end) connects crystal, and outer end (outer end) then connects ciliary muscle.
Eyes can't focus on the near-end object clearly and be called presbyopia (presbyopia), and are normally relevant with the age growth, and mainly are owing to weakening of eyes regulating power (accommodation) caused.According to arbitrary embodiment described herein, use treatment energy (for example laser ablation (laser ablation)), can increase or help to increase the regulating power (accommodation) of eyes, thereby alleviate presbyopic influence.In the typical embodiment of the present invention, to scleral tissue, can increase the regulating power of corpus ciliare (ciliary body) by guiding treatment energy, thereby presbyopic patient can clearly be seen nearby with at a distance.
(aspect) according to various embodiments of the present invention, the regulating power of eyes can improve via using several treated tissue (tissue treatments), it is meant formation, speckle form for example, slit (apertures), or the indenture (pit) that for example forms via excision (ablation), or to one or more tissue regions (tissue areas), cornea (cornea) for example, limbus of corneae (limbus), conjunctiva (conjunctiva), sclera (sclera), ciliary muscle (ciliary muscle), crystal (lens) and ciliary zonule (zonules) etc., contact treatment energy and tissue regions is had obvious or unconspicuous influence by different way.This tissue regions (tissue areas) can be formed to eyes by exterior guiding by treating energy, with/maybe endoscope apparatus (endoscopicdevice) can be introduced near near the zone the eyes, thus the treatment energy transmitted.The treatment energy that these are transmitted can help the formation of treated tissue described herein (tissue treatments).
About via forming treated tissue (tissue treatments) in for example crystal, it can pass through treated tissue (for example slit (micro-aperture)) and be treated (for example cut or boring (drilled)), and the regulating power of raising eyes, in this process, should be noted that is careful makes the crystal attenuation or avoids the distortion of crystalline visual characteristic.In an example of the present invention, treated tissue, for example (for example slit (micro-aperture)), size, arrangement, the degree of depth and/or other characteristic be can be controlled, so that increase for example crystalline regulating power (for example crystalline elasticity (flexibility)).Through a treatment thus, crystal can obtain the preferable change shape and the ability of focusing.For example, according to certain embodiments of the invention, scope is in about 1 to 5 micron perforation that (micron) is less relatively (perforations), for example tool makings such as micro drill (micro-drill), laser or syringe needle.In other example, alternate or extra treated tissue, the slit that for example has point-like, can be formed in a similar fashion among the crystal, or use is different from aforementioned instrument in order to treated tissue, and on identical or different position, identical or At All Other Times on, and form the treated tissue of identical or different size.
In the embodiment of some improvement, arbitrary treated tissue can have size (for example maximum gauge) and be equal to or less than 1 micron, with/or size be equal to or greater than 1 micron (for example in certain embodiments, the size of treated tissue surpasses 5 microns or surpass 100 microns, even bigger).Whether these inwalls with perforation (perforations) of minute diameter (for example about 1 micron to 5 microns) may oneself collapse easily and must go to observe and calculate, or go to avoid this probability as far as possible.
Characteristic of laser is to adjust according to the degree of depth of for example wanting cut-out and diameter.For example, form laser that slit (apertures) with several micrometer depth can be by using relative higher-wattage with/or the mode that forms relative less diameter reach.
Slit (micro-apertures) can be formed on the crystal, the treatment energy that does not relatively have focusing by for example guiding forms via the pupil (pupil) or the iris (iris) that have in alignment with the treatment energy focus of therapeutic goal on the crystal, or these slits also can form by the endoscope technology.According to some embodiment, this focus can be moved (for example moving towards the retina direction), when the degree of depth increase of cutting enters crystalline the time, in this example, the result forms conical slit (conically-shaped apertures), this is an example of the present invention, and the example that it proposed may be helpful to some example.In some improvement embodiment, slit (micro-apertures) can the endoscope technology and be formed in the crystal.Endoscope can enter via for example limbus of corneae (limbus), and it also can be via near the position of limbus of corneae or the position about 1 micron apart from limbus of corneae enters.
In certain embodiments, can be in for example operation on sclera (scleral procedure), the subsidiary slit (micro-apertures) that forms is in crystal, and this operation on sclera can comprise as this paper puies forward the formation treated tissue in the flow process of sclera.Treated tissue (for example slit in the crystal) also can be according to the present invention additional embodiments and forming, with at least one tissue characteristics (property oftissue) that influences treated tissue.For example, crystalline calcification material can remove near the inwall (wall) of treated tissue and bottom (floor).Remove by removing sedimentary calcium in the crystal and can improve crystalline elasticity (elasticity), and therefore strengthen crystalline regulating power.
Low order laser (low-level laser) or phototherapy (light therapy) or to a position of eyes or the biostimulation (biostimulation) of several positions (for example crystal), more can with so that the tissue of eyes restore.In an example, strengthen crystalline regulating power thereby can increase crystalline elasticity.In such example, crystal can be regarded as destination organization (targettissue).In general, the wavelength of the luminous energy that is used can cooperate crystalline organizational patterns (aligned with a tissue type of the lens).
In another embodiment, low order laser (low-level laser) or phototherapy (lighttherapy) or photodynamic therapy (light dynamic therapy is called for short PDT) be used among the near zone of ciliary muscle (ciliary muscle) or on, for example be close to the tissue of ciliary muscle, and ciliary muscle is restored, and then help the raising of the regulating power of eyes.Applied light can be various wavelength in the typical embodiment of the present invention, for example 670,795,819, with 980 nanometers (nm).Various light source comprises that low order laser (low-level laser) and light emitting diode (light-emitted diodes) can be applied to this.Continuous wave (continuous-wave with high relatively spectral line energy (peakenergy); Abbreviation CW) energy or pulse energy (pulsedenergy) are of great use to the treatment of this ciliary muscle.In some examples, ciliary muscle can continuous wave, for example opens a sluice gate the continuous wave of about 200 milliseconds (ms) and barrier gate about 200 milliseconds (ms), and giving ciliary muscle stimulates.This stimulation can be younger state so that ciliary muscle is replied.According to the embodiment of some improvement, the application of some low orders also can be applied to scleral tissue, and for example low order laser therapy (low-level laser therapy) is applied to sclera, and with so that sclera is replied (rejuvenation).Scanning (scanning) can be applied to for example less relatively mottle (spots) size.Any scanning means that this paper carried can be by the providing an of control stick (joystick), and help it to scan.In other example, a bigger mottle size (larger spotsize) can be used and not scanning.Low order phototherapy (lowOlevel light therapy) can help to treat sclera than large part, for example relatively large zone or whole zone.Relative lower of power density (power densities) of treatment energy, it is similar to treatment, for example tennis elbow (tennis elbow), temporo jaw joint (temporomandibular joint; Be called for short TMJ), tendinitis (tendonitis) etc., employed power density, and general typical embodiment has and is less than following feature: the power density at the tissue surface of being treated is approximately 1.47 watts of/square centimeter (W/cm 2), be approximately 0.39 watt of/square centimeter (W/cm in the power density of the organization internal of being treated 2), once the energy of Xi Shouing (a dose of energy) is approximately 23.6 joules of/square centimeter (J/cm 2) (once being exposed under 60 seconds the state of laser), with/or by the energy about 33.5 joules (J) of the energy about 9 joules (J) of the organization internal of being treated and the tissue surface of being treated.
In one embodiment, low order laser therapy, phototherapy or photodynamic therapy can be used to increase the effect of ciliary zonule (zonules) or make ciliary zonule become tight.Ciliary zonule can for example shorten the length of ciliary zonule by the treatment of endoscopy surgery technology.This technology enters via cornea zone (peripheral cornealarea) or limbus of corneae zone (limbus area) on every side by using an endoscope laser (endoscopic laser).One attachment point forward (anterior insertion) or side protruding (posterior site) can cause it more to directly act on corpus ciliare (ciliary body) via laser therapy.One can comprise a usefulness so that the cut operation on ciliary body that ciliary zonule becomes tighter (for example part connects the ciliary muscle of ciliary zonule) according to medical procedures of the present invention.According to one embodiment of the invention, ciliary zonule can be colored and indicate its destination organization (target chromoform) for operation, thereby when being exposed to luminous energy following time, optionally treating can ciliary zonule.
The one roomy embodiment (a board aspect) according to the present invention, various multi-form treatment energy are used for forming one or several treated tissue described herein (tissuetreatment), for example with one or several electromagnetic radiation (electromagnetic radiation) (for example, the cutting luminous energy (ablating optic energy), hot luminous energy (thermal optic energy), low order treatment luminous energy (low level therapeutic energy) or radio-frequency (RF) energy (radio frequencyenergy)), ultrasound (ultrasound), magnetic force (magnetism) carries out separately or implements with disposing (therapeutic intervention) in conjunction with acupuncture therapy (acupuncture) or other therapeutic.The application of low order therapeutic luminous energy (low-level therapeutic optical energyapplications) is described in the co-applications case of the present invention, this co-applications case is a U.S. Provisional Patent Application case number 60/687,256, its applying date is on June 3rd, 2005 and its patent name is " tissue treatment device and method (TISSUE TREATMENT DEVICE ANDMETHOD) ", and the whole contents of this co-applications case is incorporated in herein in order to as reference.Some embodiment can use for example laser acupuncture therapy (laser acupuncture), laser accunputure thorn therapy (light acupuncture), laser/radio frequency acupuncture therapy therapies such as (laser/RF acupuncture) and similar therapy.In the embodiment that some were improved, any treated tissue described herein (tissue treatment) can be by using cutting (cutting) or puncture (piercing) instrument separately, for example syringe needle (needle) or dissecting knife (scalpel), or anyly form instrument (tissue-treatment generating implements) with aforesaid treated tissue and make and be used for forming treated tissue.Usually, in case be identified when meridians point (meridian point) or stimulation point (trigger point), can implement acupuncture therapy.Magnetitum (magnets) with/or magnetic force (magnetism) combine with technology discussed in this article or ultrasound (ultrasound) and help treating.Particularly separately or merge and use ultrasound, radio frequency, laser, light and/or Magnetitum to organize answer (tissue rejuvenation).Ultrasound is applied to eyes can repairs eyes, the ultrasound of for example using various different frequencies is in eye tissue.
In the embodiment of Therapeutic Method of the present invention, first treated tissue (for example being placed in crystalline slit (micro-apertures)) can be according to the disclosed content of this paper, and being formed at one or several positions of eyes, its bent light that can be attached to other (for example different) form is corrected in (refractive treatment) or the operation (surgery) and is finished.Bent light is like this corrected or operation can comprise, second treated tissue (second tissue treatment) for example, its otherwise form and its generation type as described herein, but having the part mode at least is to be different from described hereinly, and for example its employed one or more devices, method or time etc. are different from and form first treated tissue.For instance, the bent light of a non-laser form (non-laserform) is corrected or operation can comprise and uses radio-frequency (RF) energy in corneal lens (cornealens), with/maybe can comprise conductivity keratoplasty (conductive keratoplasty; Be called for short CK).The conductivity keratoplasty, presbyopia that it is fit to the treatment moderate can comprise and makes eyes that slight myopia be arranged so that these eyes of being treated can be read by correcting spectacle lens (corrective glasses).For instance, crystalline temperature may rise, and the edge of cornea may undergo surgery and crystal is transformed.Such Therapeutic Method can cause crystalline softening (softening), and restores the ability that crystal changes shape.Folded iol (foldable lens) is also referred to as strand refining crystal (hinge lenses), also can be inserted into and as another example.
According to another embodiment widely of the present invention, treated tissue can be made among sclera and the ciliary muscle.In the implementation process of example, each treated tissue can be the shape of similar round dot (dot), speckle (spot), a short-term (short dash) or other object.Therefore, treated tissue shape in certain embodiments may not be to take the arc (arc) or the line (line) of a lengthening.For instance, the greatest length size of treated tissue can be in the scope of about 0.01 millimeter (mm) to about 1 millimeter (mm), and its maximum width dimensions can be at about 0.01 millimeter (mm) to the scope of about 1 millimeter (mm), and its maximum depth dimensions can arrive the scope (or can approximately greater than 1 millimeter (mm)) of about 5 millimeters (mm) about 0.01 millimeter (mm) more than.The shape of treated tissue and position can be according to " draw (mapping) " in the eyes, for example the position strictly described of sclera structure or ciliary muscle structure.Eye muscle (eyemuscles) also can be played the part of the shape that determines needed treated tissue and the role of position.
In certain embodiments, treated tissue can be formed and have maximum gauge about 1 micron (micron) to about 100 microns (micron), in special embodiment, then has maximum gauge about 20 microns (micron) to about 50 microns (micron).May be with or without at other and to comprise (consist of) or to comprise (comprise) and use cutting luminous energy (ablating opticalenergy) in the embodiment of sclera that other definition or meaning for " treated tissue (tissue treatment) " can be employed.
One or several treated tissue can be utilized various multi-form treatment energy, for example with one or the treatment energy of several electromagnetic radiation (electromagnetic radiation) (for example, cutting luminous energy (ablatingoptic energy), hot luminous energy (thermal optic energy), low order treatment luminous energy (low leveltherapeutic energy) or radio-frequency (RF) energy (radio frequency energy)), ultrasound (ultrasound), magnetic force forms such as (magnetism) make.
Make treated tissue about using the treatment energy, usually provide the device of treatment energy can comprise an electromagnet source (electromagnetic source), the laser (as semiconductor laser (diode laser)), the ultrasonic energy, with predetermined pulse that for example have presetted wavelength have predefined ablation device (cautery device), and it interacts with the predetermined position of eyes and forms combining of treated tissue, a radio-frequency module, a ultrasound member (ultrasonic componment) and these devices.Electromagnetic energy devices can comprise the laser with all wavelengths, for example has about 0.15 micron (micron) laser to about 3.2 microns (micron) range of wavelength.The size of laser beam point (laser beam spot) can be in the scope (or greater than about 2.0 microns (micron)) that approximately arrives about 1 micron (micron) greater than 0.001 micron (micron), each pulse value of laser energy (laser energy per pulse values) can be in about 0.1 megajoule (mJ) in the scope of about 50 megajoules (mJ), its foundation, for example the pulse duration (pulse duration) determines with the size of laser beam point (laser beam spot).Usually pulsed laser width (pulselaser widths) is in about 100 nanoseconds (nanosecond) arrive the scope of about 1000 nanoseconds (nanosecond).Can be by the zone of being treated with blood vessel laser (vascular laser), or even with long pulse Er, Cr:YSGG laser or long pulse Er:YAG laser are described (pre traced) in advance and are come out and drop to the amount of bleeding minimum.
Particularly in order to use structural laser such as for example sclera can comprise Er:YAG laser, Er:YSGG laser, Er laser, Cr:YSGG laser or CTE:YAG laser etc. with wavelength at about 2.69 microns (micron) to the scope of about 2.8 microns (micron) in and be approximately the laser that 2.94 microns (micron) operates; Be approximately the XeCl excimer laser (XeCl excimer lasers) of 308 nanometers (nm) running with wavelength; Frequency conversion solid-state laser (frequency-shifted solid lasers) with wavelength from about 0.15 micron (micron) to about 3.2 microns (micron) running; Wavelength is approximately the ArF excimer laser (excimer lasers of ArF) of 93 nanometers (nm); Harmonic wave (harmonic generateon) laser that Nd:YAG, Nd:YAL or Ti:sapphire etc. operate from about 190 nanometers (nm) to about 220 nanometers (nm) with wavelength; Be approximately carbon monoxide laser (CO lasers) of 6.0 microns (micron) running and the carbon dioxide laser (carbon dioxide lasers) that is approximately 10.6 microns (micron) running with wavelength with wavelength; Semiconductor laser (diodelasers) with wavelength from about 0.8 micron (micron) to about 2.1 microns (micron) running; Gas laser (gas lasers) with wavelength from about 2.6 microns (micron) to about 3.2 microns (micron) running; And other gaseous state or solid-state laser, it comprises the flash lamp (flash-lamp) and semiconductor laser (diode-laser) excitation laser (pumped lasers) from about 0.5 micron (micron) to about 10.6 microns (micron) running with wavelength; And with optical parameter concussion laser (the opticalparametric oscillation lasers of wavelength from about 2.6 microns (micron) to about 3.2 microns (micron) running; Be called for short OPO laser).
One ultrasonic energy that can wash (irrigation) and puncture (aspiration) can be used to form or help to form treated tissue, and it can be accompanied by the utensil of inner chamber keeper (chamber maintainer) for example.The purpose of inner chamber keeper (chamber maintainer) is to guarantee that the pressure in the eyes is maintained at a suitable pressure limit, so that can not produce the phenomenon of (prolapse) or perforation (perforation) in the process that forms treated tissue.Irrigator (irrigation) can also comprise air except fluid.Fluid can comprise the combination of one or more sterilized water (sterile water), an antimicrobial component (anti-bacterial composition), an antiviral ingredients (anti-viral composition) and these compositions.Fluid can be steroid or narcotic substance.Ablation device (cautery devices) also can be used to form or group's formation treated tissue under setting in advance.According to the exemplary embodiment of applied energy (for example cutting luminous energy (ablating opticenergy)) in tissue (for example conjunctiva or sclera), any as " a plurality of treated tissue (plurality of tissue treatments) ", " treated tissue (tissue treatments) ", " treatment (treatments) " or words such as " labelling (marking) " can refer to treated tissue clustering (tissue treatment groupings) and in certain embodiments corresponding to the cybotactic treated tissue labelling of treated tissue.Arbitrary this class term, in identical embodiment and embodiment or embodiment and embodiment, can be meant two or a plurality of treated tissue that is arranged at (for example pattern (pattern)) in tissue non-linear (non-linear) and non-arch (non-arcuate) clustering (grouping) at other.The treated tissue or the clustering of treated tissue can comprise line style (straight line, curve or other line style) arbitrarily, or can comprise and be formed at one according to being the treatment of a zone customization and the line style (straight line, curve or other line style) in the pattern of decision in advance.
May be with or without at other and to comprise (consist of) or to comprise (comprise) and use cutting luminous energy (ablating optical energy) in the embodiment of sclera, other definition or meaning can be employed.Typical embodiment can comprise the treated tissue clustering of (grid-like) of trellis, and wherein discrete treated tissue can become row (in rows) and embark on journey to be staggered or the noninterlace arrangement (in columns).Other exemplary embodiments can comprise the treated tissue clustering that contains trellis, with/or other evenly or roughly treated tissue clustering uniformly.Other embodiment can comprise (non-uniform) treated tissue clustering uniformly.These clusterings are making by hand, with/or make by for example being well known to those skilled in the art help computer-controlled or sub-scanning instrument automation equipments (automated devices) such as (aidedscanner).
About forming clustering by manual method (manual means), one output (output), the optical fiber head in the example for the treatment of (fiber optic tip) for example with electromagnetic energy, can be used so that electromagnetic energy (for example luminous energy) is focused on conjunctiva and the sclera, has the treated tissue that the degree of depth is about 60% to about 99% scleral thickness (for example about 500 microns to 700 microns) and form, and in the embodiment of example, its degree of depth is about 90% to about 99% scleral thickness.The embodiment of one demonstration can comprise one and have 600 microns (micron) or quartzy (quartz) or with 1.25 watts (W) Er with the sapphire head (sapphire (contact) tip) of 2.78 microns runnings, Cr:YSGG laser, wherein form about 4 microns long otch with laser energy after, kerf width may expand to more than 2 millimeters (mm).In such embodiment, distance between otch may be marked at 2.5 millimeters, have only 2 millimeters but may measure after laser therapy, the degree of depth then is with thickness (thickness) different variations to be arranged according to for example hardness of sufferer sclera (rigidity).In other embodiments, the discussion and the degree of depth described in the embodiment that optical fiber head is connected before a surgical knife (surgicalscalpel) (for example diamond blade) can be used to form and have.In a further embodiment, plasma technology can be applied to wherein.
About forming clustering by automatic scanning (automated scanning), the typical case can comprise wavelength with prior decision and the cutting laser (ablative lasers) that has focused on by lens in order to the optical system (optic system) that the treatment energy is provided, it is directed on the one scan instrument in order to form pattern on the sufferer eyes, for example can be by using specularly reflected.Scanner therefore automatically the guided laser energy to tissues such as the conjunctiva of for example eyes and scleras, and the predetermined pattern of formation, thereby and form and to have the treated tissue that the degree of depth is about 60% to about 99% scleral thickness (for example about 500 microns to 700 microns), and in the embodiment of example, its degree of depth is about 90% to about 99% scleral thickness.The operating parameter of laser can and have the repetition rate of 0 to 100 hertz (Hz) for 0.75 watt (watts) to 2.0 watts (watts).Ablation device parameter (cautery device parameters) can unique technique (technique specific) and can be determined according to its usage and the application desiring to carry out.Yet the degree of depth that penetrates surpasses 90% and can remain unchanged.Therefore, the output of ablation device can be made manufacturer and difference along with different ablation devices.
One or more different advantages can learn via the described scanner embodiment of the many embodiment of this paper, and these advantages comprise the uniformity and the speed of relative position of uniformity (uniformity of tissue treatment sizes), the separation between the treated tissue and the treated tissue of accuracy (precision), repeatable (repeatability), result's expection property (predictability of results), treated tissue size and/or shape.In addition, as well-known to those skilled in the art, scanner can be decided the surface texture (surface topographies) and the thickness of each layer of eyes by utilization.In addition, the embodiment of utilization scanner can provide one to give the benefit that the sufferer transmutability is treated further.For example, one clustering (grouping) or a plurality of clustering can be formed on (for example surgical operation (surgical procedure) during a sufferer is gone to a doctor) in the single medical procedure (procedure) that the sufferer eyes are carried out, and the demand generation that should have the one or more subsequent medical programs (for example repeatedly go to a doctor in sufferer and implement) that need carry out the eyes of sufferer subsequently therebetween.These medical procedures can be any order implement, with/or the order of any clustering (sub grouping) all can implement.
The degree of accuracy of treated tissue and effect can be reinforced, when the tissue that is affected (for example entering the degree of depth of sclera) is accurately determined and control.Make with manual mode in the treated tissue preamble carry, the surgeon can observe, the change color of the scleral tissue of being treated for example, and determine that when the degree of depth of treated tissue has arrived the degree of depth of desiring to reach.In the medical procedure that on sclera, carries out that preamble is carried, the surgeon may stop to form or excising the color (hue) of treated tissue when the treated tissue bottom that forms in desire and begin to change, and the optics that this color is mentioned before cuts in (optical ablating) than more obvious in scalpel excision (scalpel cutting).(for example removing) color deepening that causes because the tissue in the treated tissue bottom is affected, it may be expression, for example remaining less sclera and the rete (for example being with blood-vessels film (vascularized choroid) and ciliary muscle) that exposes more below, this moment, the surgeon can determine to slow down or stop the formation of all treated tissue, or stops it to form together.
When scanning means or other automatization or semi-automation (semi-automated) system in order to participate in producing treated tissue, it can measure the scleral thickness of sufferer, for example before operation, measure the scleral thickness of sufferer in advance, and the degree of depth of therefore controlling treated tissue is in some more representative embodiments, scan laser (scanning laser) or any its are the popular known rete measuring equipment of organizing, can be in order to the degree of depth of decision treated tissue and subsequently in order to control this degree of depth.For instance, scan laser can turn round use and detect this degree of depth in the lump with other optics or ultrasonic energy.Magnetic devices (magnetic device) also can be used and reach same purpose.Induction apparatus also can be as a substitute, by Auto-Sensing, and change in color when laser surgery for example, and the degree of depth of decision treated tissue.In general, one device, for example optical detector (optical detector), colorimeter (colorimeter), ultrasound scanner head (ultrasound probe), purpose can be used for measuring the degree of depth of cutting to produce with device, the tonometer devices such as (tonometer) of detecting electric field and magnetic field.Particularly tonometer (tonometer) can be checked pressure, and therefore the motility of the real-time feedback of estimation of Depth is provided.Though the degree of depth that tonometer is measured may be accurate as the degree of depth that postoperative (post-healing) measures, and is height correlation between the two.The method of other estimation degree of depth includes the bottom of monitoring (monitoring) otch (kerf), or other seeks the technology of swelling (bulging).The change of temperature also can be in order to the indication (indication of depth) that the degree of depth is provided, and its temperature acute variation that terminal point produced by reaching otch (incision or kerf) is as the indication of the degree of depth.
With reference to Figure 21, Figure 22 and Figure 23, according to some example, it can comprise a camera 160, for example a glance inner fiber camera (intraocular fiber optic camera).Camera 160 can be used with the vision auxiliary (optical aid) that related operative region is provided, with/or determine to be relevant to choroidal notch depth.The change color of eye structure (ocular structure) can help to determine when otch has reached suitable penetration level (penetration level).In other embodiments, camera 160 (for example outer (extraocular) camera of ophthalmic (intraocular) or eye), can be mounted and in order to assisting in real time or the formation of clinical follow treated tissue, or help automatization or control semi-automatedly in order to form the program of treated tissue.In the embodiment of the formation of a Real Time Observation treated tissue, its can comprise use the ophthalmic camera with form treated tissue in sclera in, help subconjunctival state is carried out Real Time Observation.When using camera to monitor the formation of treated tissue, the variation on its color can by with the detecting of mechanical automation ground and by user with visual observation.If the degree that penetrates surpasses the choroid structure, then may cause the generation of herpes (bled) or perforation (perforation), therefore, in some embodiments, must set up end-point method (endpoint method) with the probability avoiding ocular hypotension (hypotony) and take place or intraocular pressure (intraocular pressure) is reduced.
In exemplary embodiment, camera 160 can engage with the delivery (output tip) of a system (a for example laser system), and it provides the treatment energy as Figure 21, Figure 22 and shown in Figure 23 via an optical fiber head 165 (fiber optic tip).In Figure 21, delivery (output tip) can comprise barb 163 (barbs), and it is in order to helping delivery and can be easier to pass conjunctiva (conjunctiva) and to insert, in case and its insert then stop the delivery that has barb by moving in the conjunctiva.This optical fiber camera 160 can be incorporated in the mobile phone (handpiece), A1 as depicted, or can be gone out by delivery branch (brabch), B1 as demonstrated.Similarly structure can be applied among the oval-shaped delivery, as shown in figure 22.Other similar structure can comprise an optical fiber camera or center on the optical fiber camera lens 160 (fiber opticcamera lens) of optical fiber head 165.According to arbitrary embodiment described herein, camera 160 can comprise the visual optical fiber (visualizationfiber optic) that is communicated with the camera that is arranged at long-range (for example not being arranged on the delivery).Optical fiber can be arranged in the sleeve pipe (cannula), and it more can hold (contain) one or more treatment energy waveguide (treatment-energy waveguide) (a for example optical fiber head), a visual light source (visualization light source), fluid output (fluid output) and a suction source (aspiration source) (standardization suction source (calibrated aspiration source) for example.Fluid is liquid (for example water) and air for example, can be directed on the lens of ophthalmic camera, with and/or the visual field (field of view) of crossing the ophthalmic camera with set up a preferable ken (viewingarea) with/maybe can use a liposuction technique and with fluid by removing in around the lens or the visual field.Except that or as the selection, the combination of fluid of being discussed and suction structure and technology and for example camera lens, anti-water coating (water repelling coats) in a glance (for example SOPUS Products ofHouston, the Rain-X  Original Glass Treatment of Tx. manufacturing) can be applied to lens and strengthen vision definition (visual c; Arity).
According to an embodiment, make water clean delivery and coating is arranged or do not have the ophthalmic camera lens of coating in order to cleaning.Clean the delivery or the embodiment of other clean lens with/or any this paper describe among the embodiment of relevant water (for example sterilized water (sterile water)), gelation water (gelledwater) or tool stickiness and elastic gel (viscoelastic gel) (gel based on stickiness water (viscouswater) for example, for example viscasil  this one can utilize network address Www.viscasil.comThe product of ordering) these can be transparent water or gel, can use separately or with water, other fluid or liquid uses.Any previous embodiment is used the fluid (for example water) with clean lens, can merge to add fluid (for example water) with method described herein and structure.
Can be included in before medical procedure (or the operation) beginning in order to the intraocular pressure measurement technology (tonometric technologies) that fathoms, measure the pressure of several positions (for example 3 or 4 positions) on the sclera earlier.Can according to reset pressure (initial pressure) learn its degree of depth at the pressure that medical procedure (or operation) measures therebetween, it illustrates by the comparison to measured depth.Another kind of similar techniques method in order to measured depth is to use electric field, magnetic field and chemistry detecting.In mechanical aspects, a Q-tip multi-wave length laser device (Q-tip multiwavelength laser device) can be by utilization to measure the degree of depth of otch.For instance, a kind of wavelength (for example color) may be represented the degree of depth, and another kind of color may be represented the vascularization (vascularization) that is relevant to the cancer growth.Black light (black light) is for confirming that white is very useful, and therefore, it is exactly the part of cutting constantly up to again can't see white that a kind of mode is arranged.In other embodiments, when observing proper depth, ultraviolet light is placed and zone in order to can determine simply to be treated.In addition, if the wavelength of selecting is blue visible light, then cutting can last till till the color of observing blueness always.Roughly, the light of different wavelength can be used to the different speciality of detecting tissue (for example sclera).Different light sensitivitys (sensitiveity) can be utilized to determine that the situation of each layer all is different in the tissue by the situation of treated tissue (for example sclera).
In addition, doctor can do a puncture (for example extracting core sample (core sample)) that enters the sclera testability via conjunctiva, indexes such as the elasticity (elasticity), rigidity (rigidity) that this test can provide sclera and the degree of depth.This index can be used for decision and improves treatment procedure (for example number, position and the degree of depth etc. of Qie Chu form (type of ablation), excision).When using color to help confirm the composition of sclera, the narrow positions in the sclera (strictures) is can be relevant with the elasticity of sclera.In one embodiment, the combination of above-mentioned instrument comprises olfactory sensation detector (olfactorydetector) (for example olfactory organ (sniffer)), can carry out the position and the appropriate time of medical procedure (or operation) in order to decision.In certain embodiments, it is except the substitute that is applicable to above-mentioned feature, the pattern (pattern) of tissue can decide by a device, but its labelling and be organized in some zones according to rigidity theory (rigidity theory) application of treatment, wherein treated tissue is given and enters predetermined zone in the sclera mode of for example scan laser (so that with).
Before art, measure the degree of depth of (pre-operative measurements) influenced each layer structure, the degree of depth of the residue organized layer (remaining tissue layer) of treated tissue bottom can treated tissue form during (for example with real-time mode) measured, it is by the result according to the real-time measurement degree of depth, and adjust one or more operating parameters (operating parameter), for example remain the time that treated tissue forms (for example cutting), pulsewidth (pulse width), repetition rate (repetitionrate), mean power (average power), coolant (coolant) carries out with the mode of other parameter.For instance, scanning before the art measures and can determine the thickness of sclera to be approximately 700 microns (micron), with the formation that entered treated tissue in 1/2 second, and a real-time degree of depth measures about 325 microns of the residue degree of depth (remaining depth) of the sclera that can represent to be formed on the treated tissue bottom.May determine (for example decision of automatization) to continue to form treated tissue at that time at another 1/2 second.This repeatedly program can repeat, and wherein for example can be measured after a while 1/4 second at the real-time measurement of about 100 microns residue degree of depth subsequently, therefore, excites for example to continue the decision that forms at another 1/8 second.Various depth analysis (depthanalysis) between other parameter, cutting mode (cutting type), speed controlling (speed controk) combines and embodiment with feedback calculation (feedback algorithms), can various mode make up and implement, in order to monitor and the degree of depth of control treated tissue formation and the speciality of formation, and in order between other things, to obtain degree of accuracy that one or more preferable supervision controls (monitoring control) and treated tissue form for instance, laser can have 600 microns laser head, and works as it with the ultrasound technology, Aunar Meath technology (artemis technology), confocal microscope (confocalmicroscopy), tonometer (tonometry), when laser or ultraviolet light etc. are observed.Its power will be in the scope of 1.25 watts (watts) and repetition rate be 35 hertz (Hz), but can be according to the device of different vendor's made and different.
Moreover, when scanner is used, its initial step comprises the reference point that determines one or more eyes (pupil (center of pupil for example, one or more point on sufferer retina (retina), triangulation point on iris (triangulated unique points), with/or in the operation initial stage, in order for example to use these treated tissue as purposes such as reference points, the treated tissue that on the sufferer eyes, forms or other labelling), this initial step can be implemented so that the position of treated tissue can be defined, with/or record be relevant to one or more reference points and use for the initial stage that forms in treated tissue, with/or in order to use during down-stream, wherein the treated tissue that treated tissue can be modified and extra can be formed.According to this purpose, be used in operation initial stage or the early stage formed treated tissue of performing the operation be used as reference point during the remaining step at the initial stage of undergoing surgery, with/or in order to form extra treated tissue at ensuing intra-operative.For instance, can use rigidity drawing (rigidity mapping), wherein use ultrasound to help the detecting tissue surface, topographical surface (surface topography) (for example previous treated tissue that forms) for example is in order to as with reference to point.The degree of depth of the previous treated tissue that forms also can for example enlarge the degree of depth of one or more treated tissue by detecting so that selection to be provided according to definite plan.One topographical unit (topographyunit) will be depicted the stiffness distribution and formation one grid network (grid) of sclera.This grid network will be positioned on the eyes with the treated tissue place that is labeled, and carries out cut or treatment by the mode that removes scleral tissue then.
With reference to Fig. 1, it shows the right eye of sufferer with plane graph, and Fig. 2 then is the side view of the eyes showed among Fig. 1.According to purpose of the present invention, treated tissue (for example treated tissue clustering (group of tissue treatments)) can be applicable to some positions of eyes, for example is positioned at the surface of the sclera between superior rectus (superior rectus muscle), medial rectus (medial revtus muscle), inferior retcus (inferiorrectus muscle) and the lateral rectus (lateral revtus muscle).Some treated tissue clusterings are showed in the example with a form of perforation (point perforation), as Fig. 1 and shown in Figure 2, wherein describe the treated tissue clustering according to polar coordinate system (polar coordinate system).About the polar coordinate system, for instance, the central point 36 of eyes is designated as the utmost point (pole) straight line 38 and then is designated as pole axis (polar axis) (for example 0 degree (zero degrees)).
In the embodiment that Fig. 1 and Fig. 2 showed, the form that treated tissue is perforated (perforation) is applied in the area for treatment, this area for treatment is defined within by the internal diameter size 12 (inner radial dimension) with virtual boundary line 16 (phantom boundary) expression, and by between the outside dimension 14 (outer radialdimension) with virtual boundary line 18 (phantom boundary) expression.In typical embodiment, internal diameter size 12 may overlap with the eye's cornea edge.In typical program (or operation), internal diameter size 12 all is arranged on the sclera with outside dimension 14.According to exemplary embodiment of the present invention, the distance 20 between internal diameter size 12 and the outside dimension 14 can arrive in about 8 millimeters scope at about 5 millimeters.
The position of being paid close attention on sclera is at the distance limbus of corneae general 3 millimeters and extend to crystalline position.In general the thickness at this position be 400 millimeters to 700 millimeters, and perforation can be at random to be distributed in this position.Scleral tissue on four rectus (superior rectus, medial rectus, inferior retcus, lateral rectus) can be treated or can not treated, but according to some embodiment, can be treated in the sclera zone (scleral area) of contiguous a pair of muscle always.One first clustering 22 is arranged between superior rectus and the lateral rectus, and it includes 5 fixed angle clusterings (angularly-fixed groupings), wherein each fixed angle clustering includes 4 treated tissue, it is provided with corresponding to pole axis 38 with roughly the same angle with each treated tissue, but puts 36 different radius distance (radial distance) and be provided with the distance eye center.Treated tissue in the adjacent fixed angle clustering be do not have staggered.In this embodiment and ensuing embodiment, (for example 5 the fixed angle clusterings of the specific distribution of some treated tissue (distributions), position and quantity, each has 4 treated tissue) selected with usefulness as explanation, but not with this as restriction of the present invention.For instance, less treated tissue number, for example a glance about 50 to about 500 treated tissue, or more treated tissue number, for example about 5 of a glance all can be adopted to about 30 treated tissue.Treated tissue can be provided with according to any clustering (groupings) or pattern (patterns) predetermined or that produce in real time, with/or can form random or patterning assemble arbitrarily or the distribution of relatively flat ground, it is reached by using treatment energy (for example being come by scan laser) according to the priority of wanting and the demand of sufferer.One second clustering 24 is arranged between lateral rectus and the inferior retcus, and it includes 5 fixed angle clusterings (angularly-fixed groupings), wherein each fixed angle clustering includes 4 treated tissue, it is provided with corresponding to pole axis 38 with roughly the same angle with each treated tissue, but is provided with the radius distance (radialdistance) different with eye center point 36 distances.In this embodiment, the treated tissue in the adjacent fixed angle clustering is staggered, and corresponding treated tissue is put 36 different radiis distance with distance center and is provided with in the therefore adjacent fixed angle clustering.
The 3rd clustering 26 or four group poly-28 lays respectively between inferior retcus and the medial rectus, each clustering comprises 2 fixed angle clusterings (angularly-fixed groupings), wherein each fixed angle clustering includes 4 treated tissue, it is provided with roughly the same angle with each treated tissue, puts on the 36 different radius distance (radialdistance) but be arranged at apart from eye center.In these embodiments, the treated tissue in the adjacent fixed angle clustering is staggered, and corresponding treated tissue is put 36 different radiis distance with distance center and is provided with in the therefore adjacent fixed angle clustering.
According to some embodiment of the present invention, it is the application of treatment tissue to implement repeatedly medical procedure (or operation) (for example being implemented on when sufferer is repeatedly gone to a doctor), one or more initial stage medical procedure (or operation) can comprise one or more more sparse treated tissue clustering (relativelysparsely-populated grouping) relatively of formation, therefore during ensuing one or more programs (or operation), extra treated tissue can be made one or a plurality of more sparse treated tissue clustering relatively comparatively dense that becomes by making.For instance, in one embodiment, the 3rd clustering 26 can form at the operation beginning initial stage, then formed four group poly-28 with subsequently program or follow-up (follo-up) program.Before follow-up (follo-up) program is carried out, the effect that must determine the 3rd clustering 26 is dissatisfactory (sub-optimal) and sufferer is made extra treated tissue is useful, after decision, poly-28 of four group can be made formation in follow-up program (or operation).After four group poly-28 formed, can carry out another may be useful dependent evaluation or similarly assessment to sufferer about whether making more treated tissue.
In this example or other example, but the initial stage is used as the group that difference has different boundary with follow-up treated tissue shared portion or whole identical borders (the same boundaries), and similar the 3rd clustering 26 and four group gather 28 those treated tissue of being showed.For instance, first of the 3rd clustering 26 and four group poly-28 partly can form at treatment procedure (or operation) initial stage, then forms second part of the 3rd clustering 26 and four group poly-28 with subsequently program or follow-up (follo-up) program.Before follow-up (follo-up) program is carried out, must determine that first partly the effect is dissatisfactory (sub-optimal) and partly be useful for sufferer making first, after decision, second of the 3rd clustering 26 and four group poly-28 partly then can form in follow-up program (or operation), gathers 28 whole shape and distribution as the 3rd clustering 26 that Fig. 1 described and four group and produce.
According to another example, after second portion formed, can assess the 3rd part of whether making the 3rd clustering 26 and four group poly-28 may be useful or similarly assess sufferer.
In various embodiment, various clustering can have various very different structures, comprises different treated tissue shapes, distributes and/or density.In addition, in further embodiments, part, for example first and second portion can comprise different structures, for example different treated tissue shapes, distribute and/or density.In one embodiment, first partly can comprise one with the structure of the represented similar of label 32, and can produce just like label 30 represented clusterings in first the time when the adding second portion.Third part comprises the clustering of a like numerals will 30 or 32 representatives, so the summation of first, second portion and third part can produce the clustering of one or more similar the 3rd clusterings 26 or four group poly-28.
First clustering 22, second clustering 24, the 3rd clustering 26 and four group poly-28 can be undertaken partly by variety of way or whole improvement, merge or duplicate, in order to cover the part sclera between superior rectus, medial rectus, inferior retcus and lateral rectus, show as Fig. 1 and Fig. 2.For instance, a treatment procedure (or operation) can comprise configuration (placement) first clustering 22 between each open area (open areas) that is formed between superior rectus, medial rectus, inferior retcus and the lateral rectus.As another embodiment, a treatment procedure (or operation) can comprise the central authorities of each open area of configuration the 3rd clustering in 4 open areas (open areas) that are defined between superior rectus, medial rectus, inferior retcus and the lateral rectus.
According to one embodiment of the invention, treated tissue (for example treated tissue clustering) can be applied to all of sclera or roughly all surf zones, as shown in Figure 3.According to another embodiment of the invention, treated tissue (for example treated tissue clustering) be applied to sclera with the eclipsed part of superior rectus, medial rectus, inferior retcus and lateral rectus, as shown in Figure 4.Be showed among Fig. 3 and Fig. 3 with a treated tissue group that perforation is showed, and according to polar coordinate (contrast central point 36 with pole axis 38) and enlightening card coordinate (cartesian coordinates) (pole axis 38 represent X-axis, with a Y-axis) clustering among Fig. 3 is described, and use polar coordinate (contrast central point 36 and pole axis 38) to describe the clustering among Fig. 4.
With reference to Fig. 3, the area for treatment of sclera whole or roughly all surfaces is manufactured with treated tissue.In a representative embodiment, area for treatment (treatment area) is in the preamble description area for treatment relevant with Fig. 1 and Fig. 2 (treatment zone).The treated tissue that covers area for treatment can comprise various structure, and it comprises different treated tissue shapes, distributes and/or density.The distribution (distribution) of 4 treated tissue shown in Figure 3, wherein any one all can be by with any change (permutation), in conjunction with (combination) or the mode of duplicating, and in order to cover part or whole area for treatment.42 patterns corresponding to first clustering 22 (in figure and figure) that distribute, the distribution 44 of treated tissue are then corresponding to second clustering 24 (in figure and figure).The distribution 46 of treated tissue comprises the treated tissue and the treated tissue that is arranged among the row (column) of almost parallel Y-axis 40 among the row (row) that are arranged on almost parallel X-axis 38, and wherein each row is not staggered each other with treated tissue of each row.On the other hand, the distribution 48 of treated tissue comprises the treated tissue and the treated tissue that is arranged among the row (column) of almost parallel Y-axis 40 among the row (row) that are arranged on almost parallel X-axis 38, wherein the treated tissue arrangement interlaced with each other of each row and each row.
Treated tissue 50,52,54 and 56 shown in Figure 4 is applied in episcleral area for treatment, or is applied in conjunctiva and episcleral area for treatment simultaneously, and these area for treatment and superior rectus, medial rectus, inferior retcus and lateral rectus are overlapping.Conjunctiva is first tissue that is run through fully, and sclera then is to be punctured to a degree of depth, and along with detecting (seeing) choroidal as described previously blueness/brown, and allow stopped treatment.Such treatment can give vigor, makes people's health or the structure of other benefit to these muscle and vicinity is provided.For instance, pierce through or lunge among the embodiment of superior rectus, medial rectus, inferior retcus and lateral rectus in treated tissue, be removed on these muscle or affected zone, wherein at least one part is permeated (infiltrated) with surgeon and the employed composition of health (components).
When treated tissue 50,52,54 and 56 covers superior rectuss, medial rectus, inferior retcus and lateral rectus, according to various embodiment, it can comprise various structure configuration, these structure configurations comprise different treated tissue shapes, distribute and/or density, and the pattern that these structures that are showed in Fig. 4 dispose is corresponding to first clustering 22 (Fig. 1 and Fig. 2).
According to the embodiment of improvement, any part or all clusterings 22,24,26,28,30,32,42,44,46,48,50,52,54 or 56 can be formed and have non-linear (for example curved) or a treated tissue of asymmetrical speciality or arrangement.For instance, about first group 22,4 treated tissue (it is the cybotactic treated tissue of 5 fixed angle clusterings (angularly-fixed groupings) one or more fixed angle) can be arranged on the different angles of or several corresponding pole axis 38, are arranged on the roughly the same angle of corresponding pole axis 38 and replace.As another about distribute 46 example of the treated tissue among Fig. 3, one or the treated tissue of multiple row (row) and/row (column) can paralleled by X axis 38 or the mode of Y-axis 40 be provided with, and replace with non-linear or asymmetrical arrangement mode setting.
In certain embodiments, treated tissue is used in the some of conjunctiva and sclera.For instance, one or more treated tissue can non-invasive wholly or in part mode be applied to beneath rete.In a special embodiment, one or more treated tissue can be employed, and using in non-invasive mode wholly or in part can be with the treatment energy focusing on the sclera of below or in the sclera rather than focus on part (components) in the conjunctiva.
According to an example more specifically, can use optical instrument and light is excised energy (ablatingoptical energy) focusing and enter in the sclera, and make light excision can peak concentration (peakconcentrateion) occurring among the sclera, and the luminous energy concentration at conjunctiva is lower haply, in one embodiment, its concentration is lower than a laser ablation threshold values (ablation threshold).Can help the dyestuff of treated tissue can be used for helping determining that treatment energy (for example laser energy) penetrates predetermined zone, it can use the different colours dyestuff to indicate, determining that treatment energy (for example laser energy) has is penetrated into suitably and the degree of depth of decision in advance, it can use different concentration (consistencies) and dyeing (colorations) to finish up to treatment procedure (or operation), can preferable observation be arranged to area for treatment, wherein dyestuff can be used in the conjunctiva, and highlight the zone that is colored with suitable light source, and the light of background can reduce and strengthens highlighting the zone that is colored.For instance, sclera can dye with weld, and for example the isostructural position of ciliary muscle then can highlight it with a dark yellow.In a word, highlight the method for treated tissue about the present invention with dyestuff, dyestuff can be red, green or darker Natural color, and can highlight the degree of depth, length or the width of the otch of the tissue of being treated.Such method generally can combine with the treatment energy, for example infrared energy.Operating parameter (operating parameter) can be along with frequency spectrum of the employed kind that is highlighted treated tissue kind, tissue, the predetermined degree of depth, length and width and employed energy etc. different and different.Therefore, for example in the example that pro-is carried, its employed " Noninvasive (non-invasively) " speech, the conjunctiva that is penetrated by the treatment energy that should be interpreted as partly is unaffected haply, or its zone of being treated energy affect is less than beneath sclera.
Use now as this paper, but not only be limited to the example of now being carried, it is employed, and " " speech, the tissue (for example sclera or any other tissue) that should be interpreted as partly being penetrated by the treatment energy are subjected to the influence (for example excision) of treated tissue to invasive (invasively) haply.Carrying out invasive by the treatment energy penetrates and can form treated tissue.
In other embodiments, one or more treated tissue be can use and conjunctiva (influence that conjunctiva partly is subjected to, for example cut) and treatment (for example excision) sclera passed.According to a special embodiment, can guide the collimated light beam (collimated beam) of a treatment energy to pass main or most of thickness of conjunctiva and sclera, so all cut along this collimated light beam on conjunctiva and sclera through the place.In one embodiment, its parameter can be according to length, the width of wavelength that want, decision in advance or expectation, otch, affected organizational parameter/kind (tissue parameters/types) can comprise conjunctiva and scleral tissue with highly changing.In certain embodiments, treatment energy light beam can be fashioned into the external form (for example Jia Chang otch) of whole treated tissue.One draw (mapping) will according to the contraction (muscle contraction) of rigidity, muscle, regulating power (accommodation), with the corpus ciliare position, and decision needs position, pattern, shape and the view (landscape) of area for treatment.Treatment energy light beam can with pulse mode or the laser energy of continuous mode with near treatment region the position contact or noncontact is finished, it is to use an optical fiber or scanning device transfer system (fiber based or scanner based delivery system) and is finished with the software pattern (software pattern) be scheduled to or template (template).One beam splitter (beam splitter) can be used to the energy dispersive light beam and the pattern of corresponding area for treatment.
Highlighting the organizational form of being treated with dyestuff can be employed and be implemented on the present invention.Dyestuff can comprise for example red, green or other relatively dark color, and can in order to highlight (for example optionally highlighting some zone and binding or pairing) with laser species and tissue and making a choice property of dyestuff kind or influence treated notch depth, length, width or the further feature of tissue.For instance, one zone can by with have can by blood haply or the laser of the wavelength of high absorption handle in advance and dye, after dyeing, coagulant laser energy (coagulating laser energy) can be directed on the painted treated tissue and cause blood coagulation (coagulation), or can be in order to influence the bleeding tendency in treated tissue zone during follow-up formation treated tissue.In certain embodiments, treated tissue labelling itself can be formed as pigmented section.In other embodiments, notch depth, length, width or the further feature of the tissue of being treated, can with by with have can by blood haply or the laser energy of the wavelength of high absorption contact, after contact, coagulant laser energy (coagulating laser energy) can be directed on the painted treated tissue and cause blood coagulation (coagulation), or can be in order to influence the bleeding tendency in treated tissue zone during follow-up formation treated tissue.
According to general embodiment, but predetermined coagulant laser energy of its step connection confirming or ensuing excision energy (ablating energy) can not have the step of bad influence to retina or other tissue.Such embodiment can comprise one or several and relative higher absorption wavelength (for example Nd:YAG or Er, Cr:YSGG) Pi Pei relatively low energy, tissue types and/or color (for example use dyestuff produced color), and with Energy Efficient focus on retina before.
Any aforesaid method all can be implemented or with combine with the application mode of infrared light as the treatment energy, what wherein operating parameter (operating parameter) can be according to the frequency spectrum of the employed kind that is highlighted treated tissue kind, tissue, the predetermined degree of depth, length and width and employed energy is different and different.
The size of treated tissue (for example section shape or the zone of coming out) by the orientation measurement that is transverse to treatment energy dissipation direction, the degree of depth that can run through whole tissue all keeps identical size (for example conjunctiva and sclera), perhaps can change along with the degree of depth of tissue.For instance, one or more treated tissue can be formed and have section shape or zone, it reduces (perhaps increasing) along with the degree of depth that enters sclera, for example in a case, circular treated tissue has the diameter that reduces along with the degree of depth increase that enters sclera.In general embodiment, a treated tissue (the conical as previously described treated tissue of example) can comprise a diameter, and the degree of depth of 1 percentage ratio of every decline, then this diameter reduces about 1 to about 100 percentage ratios.In a special example, 1 of every decline in the degree of depth of 20 percentage ratios, the diameter of treated tissue 1 percentage ratio that can descend then.At an implanting tissue (tissue implant) (for example conical implanting tissue), the mode that guiding treatment energy by Noninvasive passes conjunctiva is formed in the example in the sclera, the size of implanting tissue (for example diameter) can diminish in sclera gradually, the degree of depth of 1 percentage ratio of every decline, then this diameter then reduces about 1 to about 100 percentage ratios.In a special example, in sclera in the degree of depth of 1 percentage ratio of the every decline of the degree of depth, the diameter of treated tissue 1 to 20 percentage ratio that can descend then.
The zone that is removed or is affected (removed or affected areas) of corresponding treated tissue can be filled with any known bio-compatible material (biocomparable materials) by the surgeon, for example Tisseal biogum, antibiotic medicine (anti-inflammatories) or antibiotic (antibiotics).According to goal of the invention of the present invention, the zone that is removed or is affected of corresponding treated tissue is at least partly filled with conjunctiva bottom tissue (sub-conjunctiva tissue) by the human body natural reaction of human body (for example via), and it can improve the performance of eyes.For instance, in the case of a sclera, knit the zone that (sub-conjunctivacollagen-based tissue) infiltration is removed or is affected so that collagen is basis set in new conjunctiva bottom and can make it more flexible than original scleral tissue.Human body adopts conjunctiva bottom tissue to enter the zone that is removed or is affected, and can therefore increase the elasticity of one or more scleras and ciliary muscle, with/or cause the increase of ciliary zonule to the outstanding ability of crystal.Be arranged in the example of sclera capsulociliary function and other characteristic under the new conjunctiva bottom tissue in sclera can help or improve in the zone that is removed or is affected.Therefore in some example, corpus ciliare response eyes are seen near and are seen that the required regulating power of demand far away can increase.
According to general embodiment, scleral tissue can treat to episcleral mode by using laser technology to guide the treatment energy to pass conjunctiva, therefore can aim at the previous sclera of carrying of treatment energy (for example laser energy) treatment of (for example focusing on) conjunctiva bottom, and not make the conjunctiva fracture.For instance, laser energy can be directed and focus on or accumulate on the beneath sclera, wherein laser energy on conjunctiva, have one comparatively speaking lower power density arranged, in this simultaneously, on sclera, has higher comparatively speaking power density (for example less relatively luminous point (spots) size), and wherein treated tissue can have an absorbance and absorb laser energy laser energy, makes laser energy form the otch of " V " font of a cutting scleral tissue in sclera.As discussed below, conjunctiva can obtain some effects, for example preferable cosmetic result (cosmetic effects) (for example reducing eyes reddens) by being done by different positions to rotate in various degree or twist.The treated tissue (for example otch) of using such program to form can have the different shape of before being carried.General shape can comprise " U " font or " V " font.Otch also can be made as many than marginal position of tissue that its center has.In general, the width of an otch is according to different sclera rigidity key element (rigidityfactor) and the thickness that are had in different scleras, and change.Yet the scleral incision degree of depth of treated tissue (inscisionalsclera depth) is the scleral thickness that remains on greater than 90% in some embodiments.According to some embodiment, a ultrasound unit (ultrasound unit) can be in order to remove conjunctival tissue and scleral tissue.In a specific embodiment, can use the technology of burning (cautery) to improve the definition and the generation medical organization of the position of treated tissue formation.In addition, in certain embodiments, one has the light of particular color, and for example black light (black light) can be used to help to observe scleral tissue.Moreover various color can be placed on an observer (scope) (for example microscope), in order to strengthen observing capacity (vision) (for example surgical identification ability).For instance, green may make the easier and clear degree of depth of seeing puncture of user.Therefore, a tonometer can be used for detecting the degree of depth in treated tissue zone, with/or a femtosecond (femtosecondlaser) can be used and in order to remove or resection organization.
One or more treated tissue can be introduced by the appropriate location on the conjunctiva, and wherein conjunctiva can be retained on the sclera with spontaneous orientation (naturally-occurring orientation).In such embodiments, the path (penetration path) that penetrates that pass through/enters conjunctiva and sclera can be (aligned) aligned with each other or roughly aligned with each other.For instance, a branch of electromagnetic energy can be directed and passes the conjunctiva that is not subjected to image and most of thickness by sclera.Noninvasive that this electromagnetism beam was stated in the past or invasive mode be by conjunctiva, and therefore, in example after a while, organizing all of conjunctiva and sclera can be along the path of electromagnetism beam and cut.Before introducing one or more treated tissue or therebetween, one or more treated tissue described herein, can be in arbitrary order or steps in order, by changing partly or roughly whole conjunctivas is introduced (for example remove, ressemble (reconfigured) or the modes such as (reposition) that resets, for example rotate conjunctiva corresponding to the sclera position or cut apart and/or mobile conjunctiva).Therefore, in certain embodiments, with arbitrary embodiment described herein, conjunctiva partly can be operated utilization (manipulated), when conjunctiva of other part is retained in spontaneous orientation episcleral the time.Part conjunctiva in other embodiment on sclera is received treatment the position of tissue can be operated utilization, with/or other conjunctiva partly on sclera is received treatment the position of tissue be retained on the sclera with spontaneous orientation.In addition, with arbitrary embodiment described herein, can be by corresponding sclera and all conjunctivas are partly roughly ressembled (reconfigured) or reset (reposition).
In addition, extra or as substitute the present invention before the application of treatment tissue or during to the change of conjunctiva, before the state that other embodiments of the invention can be included in conjunctiva changes or after the change, guide one or more treated tissue to pass conjunctiva.About before application of treatment energy and formation treated tissue, the embodiment that conjunctiva is resetted, in case conjunctiva is brought to the configuration of (or bringing back to) spontaneous structure or orientation (perhaps at least very near this structure configuration or orientation) (or otherwise arriving configuration structure or orientation after the treatment with it), some or whole paths that penetrates of passing or piercing into conjunctiva and sclera just can not be aligned with each other.These penetrate that the path is not formed at partly or whole conjunctiva in embodiment in, penetrating of conjunctiva and sclera lacks para-position (alignment) between the path, or pass conjunctiva to penetrate the path covered, it can be fit to perfect (structural integrity) in order to the therapeutic effect that the rete of one or more sealing process (sealing effect) in order to strengthen being affected is provided with structure.
Refer again to Fig. 1, the example that conjunctiva is resetted can be included in before the application of treatment tissue, rotates conjunctiva in the mode of corresponding sclera.Can catch (gripped) and rotate an angle near central point 36, for example about 1 to 2 degree angle or about 1 is to an angle of 90 degrees.In other embodiment, the angle of rotation can perhaps be rotated bigger angle about 1 in the scope of miter angle, with/or the different parts of sclera can rotate at different time points, with different directions rotate with/or rotate different angles.After such rotation, conjunctiva can (or can not) be fixed in the position of rotation, for example, and when some or whole treated tissue are employed.After using some or whole treated tissue, conjunctiva can be retracted, so that conjunctiva is whole or partly retract its spontaneous orientation.
In other embodiments, after using some or whole treated tissue, conjunctiva can be rotated in the opposite direction, and the amplitude of its rotation is bigger than the amplitude that it rotates for the first time, and for example clockwise direction rotates the above an angle of 90 degrees that arrives in about 1 degree angle.In the rotation of any conjunctiva described herein or move, with/or any intermediate steps after, part or whole reformed conjunctiva can be any interim or fixed method implement.
In other embodiments, after using some or whole treated tissue, conjunctiva can be rotated in the opposite direction, and the amplitude of its rotation is bigger than the amplitude that it rotates for the first time, and for example clockwise direction rotates the above an angle of 90 degrees that arrives in about 1 degree angle.In the rotation of any conjunctiva described herein or move, with/or any intermediate steps after, part or whole reformed conjunctiva can be any interim as previously mentioned or fixing means implement.
In other embodiments, after the initial rotation of conjunctiva, one or more treated tissue (for example the treated tissue or the string of a radiation wire (in shape of radially-extending line) form linear treated tissue) can be employed, and pass one or more treated tissue (for example tall and thin otch or slit (apertures)) in conjunctiva.Conjunctiva can be rotated with equidirectional then, and the amplitude of its rotation is bigger than the amplitude that it rotates for the first time.Then, one or more treated tissue (for example the treated tissue of a radiation wire or string form linear treated tissue), can be formed on identical treatment tissue in the conjunctiva previously via those, be formed in the sclera once more, and make the influence of conjunctiva is reduced to minimum.This program can repeat, and is formed on identical treatment tissue in the conjunctiva previously via those, has identical shaped extra treated tissue in the sclera and be formed on.In this example, by form treated tissue via the identical opening in the conjunctiva in each step, conjunctiva can little by little rotate in a direction.In the embodiment of some improvement, conjunctiva (for example by primary spontaneous orientation) in the opposite direction turns to various angles, and help to form one or more treated tissue (for example the treated tissue of a radiation wire or string form linear treated tissue) in sclera, previously be formed on identical treatment tissue in the conjunctiva by those, and make the influence of conjunctiva is reduced to minimum again.Therefore, conjunctiva can be rotated with equidirectional and rightabout, and helps to form various treated tissue in sclera by the identical opening (for example treated tissue) in conjunctiva.Owing to reduce the result of the treated tissue quantity in conjunctiva, blood-shot eye illness (redness) and healing time can be reduced or get rid of.
Fig. 5 has showed that to Figure 14 various modes with corresponding sclera make reset (reposition) implementation method of (or rotate) of conjunctiva.Treated tissue in conjunctiva and sclera can comprise leptosomic or seam shape (aperture-shaped) treated tissue, for example Fig. 5 is to embodiment that Figure 14 showed, with/or its can be included in any treated tissue clustering of before having been discussed, or it (is for example showed as these icons with combining with arrangement of pattern in various diverse locations, shape, minority or most leptosomic treated tissue, in the position at 0 degree angle, an angle of 90 degrees, 180 degree angles and 270 degree angles, has identical or different length for example).For instance, these are showed in one or more (for example each) among the figure and have the treated tissue of tall and thin shape (elongated shapes), can comprise the less treated tissue (clustering 30 or 32 among contrast Fig. 3) that string forms with same shape, and substitute tall and thin shape otch (elongated kerf) as shown in these figures.In addition, one or more treated tissue in conjunctiva can comprise the treated tissue of size of all kinds (for example minification), and its be formed at subconjunctival sclera in treated tissue corresponding, show and illustrate embodiment to Figure 10, Figure 12 and Figure 14 as Fig. 7.
To Fig. 5 E, it describes (a rotation process) who rotates program in proper order with reference to Fig. 5 A, wherein treated tissue be labeled (marked) at 0 degree angle, an angle of 90 degrees, 180 degree angles and 270 spend the position at angles.In Fig. 5 A, the formation position of treated tissue is marked on the conjunctiva, and in Fig. 5 B, and conjunctiva is by with some method or moving to the mode of some angle, and moves (for example rotating or reverse (torqued)) or move (shift).Conjunctiva can be touched (for example catching (gripped)) and be moved by using conjunctiva plate device (conjunctiva template device).
Fig. 5 C shows that treated tissue can then be formed in conjunctiva and the sclera through mobile mark position, and in Fig. 5 D, and conjunctiva can be with some method or moving to the mode of some angle, and is moved again.For instance, conjunctiva can be moved (for example rotate, reverse and/or move) with some method or in the mode that moves to some angle, and treated tissue at least partly is formed in the sclera, and in certain embodiments, whole is formed in the sclera, and these treated tissue that are formed in the sclera are not had the zone of treated tissue to cover on the conjunctiva.According to some embodiment, conjunctiva can be retracted by its direction that moves for the first time, but in the embodiment of some improvement, it can partly be moved to be different from the direction that moves for the first time (for example with under the first time, mobile range compared, identical mobile range, less mobile range or bigger mobile range carry out).Show as present embodiment, conjunctiva can be rotated and make the position, angle (angular locations) of labelling change the position through the position, angle of moving from it, and in the example that Fig. 5 E is showed, conjunctiva is rotated and makes it make the angle position change of labelling and retract the pairing position of labelling before carrying out any move, for example mark position in the orientation of generation naturally of corresponding conjunctiva.Conjunctiva can pass through some devices, and for example the conjunctiva plate device moves.After any conjunctiva described herein moves step, with/or in any intermediary step, part or whole conjunctivas can be by described herein or known interim or fixture, for example conjunctiva plate devices.
In certain embodiments; the fluid (conditioned fluids) that fluid comprises water, sterilized water (sterile water) or was adjusted; for example U.S. Patent number 5; 785,521 and 6,350; 123 two pieces of described fluids of patent; the content of these two pieces of patents and this paper merge and in order to as reference, above-mentioned fluid can be added into the demand (cosmetic appeal) to beauty treatment in order to the tissue of guaranteeing or helping to realize to be treated, with/or in order to promotion healing time or other performance.For instance, fluid (for example sterilized water) can be by using an air atomizer (air mister) that is fixed on a device (for example discharger (applinator device) or delivery (output tip)) (for example from be arranged on nearby or long-range jar (canister) or dropper (dropper) come), and the step of using the treatment energy each other or it would be desirable using the treatment energy during use, therefore and can reduce or discharge the generation of carbonization, with/or wash out blood.In his example, fluid (for example sterilized water) can be fixed on the air atomizer (air mister) of treatment energy (for example laser) device (for example mobile phone (handpiece)) or spray pipeline (sprayerline) by using one, and is used in above-mentioned time and purpose.This sprays pipeline can comprise the pipe (tubing) that is engaged in a device outside or builds on a device inside, and a fluid that is arranged on this device distributes input equipment (fluid dispensing input).This fluid distribution input equipment can be in order to help in manual mode or with power-actuated mode distributing fluids.Can pass through in manual distributing fluids mode, guiding one removable container (for example separable chest (pod)) or a pipeline integrally formed for example with removable container, and implement, this removable container can be pushed and distributing fluids by user.And can turn on the power by a shift knob (toggle button) switching with power-actuated mode distributing fluids, and the fluidic output of beginning under low relatively low flow velocity and pressure.The spray dislocation (atomizeddistribution) of one fluid (for example sterilized water) particle can automatically be applied in the destination organization that will treat during the application of treatment tissue.In other embodiments, Wei Liang fluid (for example sterilized water) can before the application of treatment energy or during be used.In further embodiments, the treatment energy can be used in combination with help with fluid (for example sterilized water) and carry out, as previously mentioned two pieces of electromagnetic induction machine cuts (electromagnetically induced mechanical cutting) that patent is mentioned, and improve cutting attribute (cutting attributes).Liposuction technique (suction) can be applied in the aforesaid embodiment, and in order to mobile fluid, fragment (debris) and liquid.Embodiment for any use liposuction technique, it can be used for reaching arbitrary purpose described herein, for example fix a structure to the surface of eyes, special surface (specialized surface) (for example relatively under more imperforate surface catch and fixing eye structure in the suction mode in order to helping), and surface treatment (surface treatment) (for example above mentioned) on.
Shown in Fig. 5 E, treated tissue in conjunctiva can be used the known technology in this field, for example sew up (sutures), surgical stapling (surgical tacks), screw togather (screws) or hook together modes such as (staples), with/or reach in the mode of smearing cement (adhesives).In the embodiment that some were improved, one or more steps that Fig. 5 B and Fig. 5 D are showed, with/or Fig. 5 E close step (closure step), can partly or all be reduced, strengthen or omit.
To Fig. 6 E, it shows a rotation program with reference to Fig. 6 A, and the labelling of treated tissue is formed on the position at 0 degree angle, an angle of 90 degrees, 180 degree angles and 270 degree angles on the conjunctiva therein.Shown in Fig. 6 A, can be arranged on the conjunctiva in groups mode (in sets) (for example paired mode (pairs)) in order to the position that produces treated tissue.One or more groups (for example whole) can comprise several above-mentioned treated tissue or treated tissue clustering, one or more groups treated tissue or the treated tissue clustering is built into wherein and allows follow-up treated tissue that forms or treated tissue clustering structure interlaced with each other in sclera.In this embodiment, treated tissue in groups or treated tissue clustering are to allow and follow-up treated tissue or staggered (the following icon of contrast Fig. 6 D) of treated tissue clustering that is formed in the sclera.As shown in the present embodiment, each group treated tissue or treated tissue clustering are separated (spaced) with other group in different distance, and for example this distance can be greater than the distance of those examples of being showed among Fig. 5 A.
In Fig. 6 B,, and conjunctiva is moved (for example rotating or reverse (torqued)) or moves (shift) in some above-mentioned mode or moving to the mode of some angle.Conjunctiva can be by using conjunctiva plate device (conjunctiva template device) to be touched (for example catching (gripped)) and carrying out above-mentioned moving.Conjunctiva can be rotated, and the position, angle that makes labelling is changed by the position, angle of labelling before moving, and, show as embodiment herewith, make the position, angle that each group moves the back labelling, have at least between the position, angle of dropping on original (moving preceding) two labellings of this group.According to the embodiment that Fig. 6 B shows, each group moves the position, angle of back labelling, has at least between the position of dropping on original (moving preceding) two labellings of this group.In Fig. 6 C, treated tissue can be formed on the position of corresponding above-mentioned mobile back labelling in conjunctiva and the sclera, and in Fig. 6 D, conjunctiva can move in mode as previously described, and treated tissue can be by to seal as preamble and the described mode of Fig. 5 E.In addition, the embodiment that improves to the embodiment of Fig. 5 E with the correlogram 5A that discussed of institute before similar also can implement at this.
To Fig. 7 D, it shows a rotation program with reference to Fig. 7 A, and the labelling of treated tissue is formed on the position at 0 degree angle, an angle of 90 degrees, 180 degree angles and 270 degree angles on the conjunctiva therein.Shown in Fig. 7 A, can be arranged on the conjunctiva in groups mode (for example paired mode) in order to the position that produces treated tissue.One or more groups (for example whole) can comprise several above-mentioned treated tissue or treated tissue clustering, wherein in conjunctiva the labelling of treated tissue (with/or treated tissue) comprise, with respect to the labelling of the treated tissue among Fig. 1 (with/or treated tissue) for, have the treated tissue of the size of comparatively dwindling labelling (with/or treated tissue).According on the other hand, illustrated as Fig. 7 to the embodiment that Figure 10, Figure 12 and Figure 14 showed, the labelling of treated tissue in the conjunctiva (with/or treated tissue) comprise, with respect to the labelling of the treated tissue in the sclera that is about to be formed under it (with/or treated tissue) for, have the treated tissue of the size of comparatively dwindling labelling (with/or treated tissue).In this embodiment, the labelling of each treated tissue (with/or treated tissue) comprise the treated tissue of slot-shaped separately (aperture shape) labelling (with/or treated tissue) be arranged on (on the position, angle after for example each moves) on each position, angle, wherein will in the sclera of this position, angle correspondence, form treated tissue or treated tissue clustering.
In Fig. 7 B,, and conjunctiva is moved (for example rotating or reverse (torqued)) or moves (shift) in some above-mentioned mode or moving to the mode of some angle.Conjunctiva can be by using conjunctiva plate device (conjunctiva template device) to be touched (for example catching (gripped)) and carrying out above-mentioned moving.Conjunctiva can be rotated, and the position, angle of labelling is changed by the position, angle of labelling before moving.In Fig. 7 C, treated tissue can be formed on the position of corresponding above-mentioned mobile back labelling in conjunctiva and the sclera, and in Fig. 7 D, and conjunctiva can move in mode as previously described.Then, treated tissue can be sealed in mode as previously described.In addition, the embodiment that improves to the embodiment of Fig. 5 E with the correlogram 5A that discussed of institute before similar also can implement at this.
A special embodiment of the flow process that Fig. 8 A is showed to Fig. 7 D for Fig. 7 A to Fig. 8 D, wherein the labelling of a pair of treated tissue is formed at 0 degree angle on the conjunctiva, an angle of 90 degrees, 180 degree angles and spends on the position at angles with 270.In the described embodiment of Fig. 8 A, the diameter of a cornea (cornea) about 16 millimeters (mm), and each is to the treated tissue labelling in the treated tissue labelling be separated by each other about 3 microns (micron).In Fig. 8 B, conjunctiva is rotated or is reversed degree angle, about 20 degree angle to 30 in a clockwise direction.In Fig. 8 C, treated tissue can be formed in conjunctiva and the sclera on the mark position after corresponding above-mentioned the moving, wherein the treated tissue in conjunctiva comprises the slit (apertures) of (for example moving on the position, angle of back labelling at each) on the position, angle that is arranged on each labelling, and treated tissue corresponding with it comprises the tall and thin shape treated tissue (for example tall and thin otch) of extending to external radiation with the position, angle of fixed angle or almost fixed in the sclera under it.In this embodiment, each has the width of about 2 millimeters (mm) to the treated tissue in the sclera, and about 1 millimeter (mm) at interval.In Fig. 8 D, conjunctiva is by counterclockwise being rotated or to be reversed degree angle, about 20 degree angles to 30, and gets back on its spontaneous orientation, and then, treated tissue is sealed in mode as previously described.
To Fig. 9 D, it shows a rotation program with reference to Fig. 9 A, and the labelling of treated tissue is formed on the position at 0 degree angle, an angle of 90 degrees, 180 degree angles and 270 degree angles on the conjunctiva therein.Shown in Fig. 7 A, can be arranged on the conjunctiva in groups mode (for example paired mode) in order to the position that produces treated tissue.One or more groups (for example whole) can comprise several above-mentioned treated tissue or treated tissue clustering.The embodiment that similar Fig. 7 A is showed to Fig. 7 D, the treated tissue labelling on the conjunctiva or in the conjunctiva (with/or treated tissue) comprise labelling with respect to the treated tissue among Fig. 1 (with/or treated tissue) for, have the treated tissue of the size of comparatively dwindling labelling (with/or treated tissue).According to this mode, treated tissue labelling in conjunctiva (with/or treated tissue) comprise, with respect to the labelling of the treated tissue in the sclera that is about to be formed under it (with/or treated tissue) for, have the treated tissue of the size of comparatively dwindling labelling (with/or treated tissue).Show that as it each separates different distances each other to treated tissue or the cybotactic labelling of treated tissue, for example the distance between the labelling showed greater than Fig. 5 A of its distance separating.In this embodiment, the treated tissue labelling comprises the slit (apertures) of (for example moving on the position, angle of back labelling at each) on the position, angle that is arranged on each labelling, wherein will form treated tissue or treated tissue clustering in the sclera of this position, angle correspondence.In addition, in this embodiment, the cybotactic labelling of one or more groups treated tissue or treated tissue is to be built into, permission is with one or more treated tissue or treated tissue clusterings corresponding in conjunctiva, with follow-up treated tissue that forms in sclera or treated tissue clustering structure interlaced with each other.In this embodiment, each group treated tissue or the cybotactic labelling of treated tissue are to allow, with each treated tissue or treated tissue clustering corresponding in conjunctiva, with each follow-up treated tissue that in sclera, forms or treated tissue clustering (icon below contrast Fig. 9 D) interlaced with each other.
In Fig. 9 B,, and conjunctiva is moved (for example rotating or reverse (torqued)) or moves (shift) in some above-mentioned mode or moving to the mode of some angle.Conjunctiva can be by using conjunctiva plate device (conjunctiva template device) to be touched (for example catching (gripped)) and carrying out above-mentioned moving.Conjunctiva can be rotated, and the position, angle that makes labelling is changed by the position, angle of labelling before moving, and, show as embodiment herewith, make the position, angle that each group moves the back labelling, have at least between the position, angle of dropping on original (moving preceding) two labellings of this group.According to the embodiment shown in Fig. 9 B, position, angle after one or more move in each group echo is arranged between the position, angle of original (moving preceding) two labellings of this group.In Fig. 9 C, treated tissue can be formed in conjunctiva and the sclera on the mark position after corresponding above-mentioned the moving.Treated tissue labelling or treated tissue in conjunctiva for the labelling or treated tissue of the treated tissue in the sclera under being formed at it, have the size of comparatively dwindling.Shown in present embodiment, be formed at the treated tissue (for example slit) that treated tissue in the conjunctiva or treated tissue clustering comprise reduced size, and treated tissue corresponding with it comprises the tall and thin shape treated tissue (for example tall and thin otch) of extending to external radiation with the position, angle of fixed angle or almost fixed in the sclera under it.In Fig. 9 D, conjunctiva can move (for example retracting original position) in mode as previously described, and afterwards, treated tissue can be sealed in mode as previously described.In addition, can improve present embodiment to the embodiment of Fig. 5 E with the correlogram 5A that discussed of institute before similar.
A special embodiment of the flow process that Figure 10 A is showed to Fig. 9 D for Fig. 9 A to Figure 10 D, wherein the labelling of a pair of treated tissue is formed at 0 degree angle on the conjunctiva, an angle of 90 degrees, 180 degree angles and spends on the position at angles with 270.In the described embodiment of Figure 10 A, the diameter of a cornea (cornea) about 16 millimeters (mm), and each is to the treated tissue labelling in the treated tissue labelling be separated by each other about 4 microns (micron).In Figure 10 B, conjunctiva is rotated or is reversed degree angle, about 7 degree angle to 12 in a clockwise direction, so that in the ensuing program treated tissue in conjunctiva will, interlaced with each other with the follow-up treated tissue that is formed in the sclera, and the treated tissue in sclera can not come out.
In Figure 10 C, treated tissue can be formed in conjunctiva and the sclera on the mark position after corresponding above-mentioned the moving, the treated tissue that wherein is formed in the conjunctiva comprises the slit, and treated tissue corresponding with it comprises the tall and thin shape treated tissue (for example tall and thin otch) of extending to external radiation in the sclera under it.In this embodiment, each has the width of about 2 millimeters (mm) to the treated tissue in the sclera, and about 2 millimeters (mm) at interval.In Figure 10 D, conjunctiva is by counterclockwise being rotated or to be reversed degree angle, about 7 degree angles to 12, and is moved back on its spontaneous orientation, and then, treated tissue is sealed in mode as previously described.
Figure 11 A is the perspective view of Fig. 5 C, and Figure 11 B is the perspective view of Fig. 5 D.
Figure 12 A is the perspective view of Fig. 7 C, and Figure 12 B is the perspective view of Fig. 7 D.About on conjunctiva (or in conjunctiva) slot-shaped (aperture-shaped) treated tissue labelling (with/or treated tissue), these labellings (or size and shape of treated tissue) can be formed with the size of minimum as much as possible, but still can be formed on treated tissue or the treated tissue clustering that forms correspondence in the sclera it under by it.In this embodiment, comprise circle (circular shapes) in treated tissue labelling on the conjunctiva and treated tissue in conjunctiva near optical fiber head (fiber optic tip) cross section (cross-section), this optical fiber head, in the present embodiment, the treated tissue in the sclera under can being used for being formed on.Use laser shown in Figure 12 A and in conjunctiva and sclera, form the method for treated tissue, can be with various device and technology and reach, these methods comprise following one or more methods: (a) by by near a syringe needle inlet point (needle entry point) that is positioned at the limbus of corneae, and inject (injecting) fluid, an epinephrine base flow body (epinephrine-based fluid) for example is between conjunctiva and the sclera and conjunctiva is separated on by sclera; (b) via a treated tissue that is positioned near centre position (approximately midway), and prolonging treated tissue (for example tall and thin otch) or treated tissue clustering (for example gathering of less relatively treated tissue under one, its approaching or tall and thin kerf of being showed by demarcating) length direction, insert an optical fiber head, the orientation of passing through then to change optical fiber head is shown in the cut-away view of Figure 12 A, and formation treated tissue or treated tissue clustering are in sclera; And (c) via between arbitrary contiguous limbus of corneae and the intermediate point (point midway) (with/or comprise limbus of corneae and intermediate point) the position, and prolonging treated tissue or the cybotactic length direction of treated tissue under one, insert an optical fiber head.
The embodiment of method (a) can comprise the surgeon to be selected with need be in order to keep the comfortable minimum anaesthesia dosage (a minimum amount of anesthesia) of sufferer, and its anesthetis that uses comprises at least a following local anesthetic (local anesthesics): use 1% tetracaine (Tetracaine) and reaching five minutes in centering on capsulociliary annular gauze (circular ring pledget); Lignocaine with 2% (Lidocaine) carries out injection under the local fascia, a shot 1/4th; And before surgical operation, the bitter happy caine gel of breath of the body surface of partial use 2% (topical 2%Xylocaine gel) 20 to 30 minutes.2% proparacaine (topical 1%Proparacaine) can be before surgical operation partial use five minutes, and according to the reaction of sufferer to pain, by the surgeon in good time do the use of one-period property at intra-operative.Tetracaine (Tetracaine) or 2% lignocaine (Lidocaine) that also can partial use 1%.One comprises the lignocaine (Lidocaine) and 0.75% the numb good ball week injection of carrying out because of (Marcaine) blended 50/50 mixture (50/50 mixture) (peribulbar injection) with 2%, can according to researcher's (investigator) clinical judgment sufferer whether not by any above-mentioned method or effective anesthesia implement.The local antibiotic medicine (topical non-steroidalanti-inflammatory) of the antibiotic (a drop of antibiotic) of trace (for example moxifloxacin eye drop (Vigamox), Xerox relax eyedrop (Ciloxan) or gatifloxacin eye drop (Zymar)) and the no steroid of trace (Acular LS eye drop or obey he peaceful (Voltaren) and also can be used for example.Sufferer can be prepared according to general refractive surgery program, and inserts an eyelid dilator (lid speculum), places a corneal protection device (cornea protector) subsequently on cornea.Limbus of corneae labelling (inter-muscular limbal marking) can be formed at the position (7:30 o ' clock position) of the position (1:30 o ' clock position) of some halfs, the position (4:30 o ' clockposition) of 4 halfs, 7 halfs and the position (10:30 o ' clock position) of 10 halfs between eight muscle, and to implement subsequently with the fornix be the peritomy (fornix-based peritomy) of substrate.If needs are arranged, can use cautery (cautery) stop blooding (hemositasis).And if have needs, surgeon also can produce once one or more labellings, in order to describe the position of (in each quadrant) treated tissue (for example otch (incision)) in each quadrant.Two radial labellings (radially orientated marls) can be formed in the quadrant area apart from limbus of corneae 0.75 millimeter (mm) (quadrant area) (can't be in sight via cornea again at this position iris), and each labelling in two radial labellings was all prolonged the length of about 5 millimeters (mm) afterwards on corpus ciliare, and Vitrealy before stopped cutting to, separated 2.5 millimeters (mm) between each labelling.
Two corresponding treated tissue (for example otch) can then be created in the quadrant area that is labeled, and wherein scleral tissue is cut about 95% scleral thickness (for example about 500-550 micron (microns)).These otch can frequency of utilization be 30 hertz (Hz), and wavelength is that 2.78 microns (microns) and spot definition (spot size) are the Er of 600 microns (microns), and Cr:YSGG laser produces and make.The surgeon can observe the dark blue color (characteristic dark blue hue) of the uniqueness of choroid (choroid) and be used as each cutting flow process (ablationprocess) terminal point.Above-mentioned step can repeat to implement and the outer paired otch (pairs ofincision) of yield in remaining other three quadrants.Then, each ring-type cut point (peritomysite) can be burnt (bipolar forceps), suture with bipolar electricity to be sewed up (sutures) or seals with the method for Tisseal biogum gummed, and then places a non-steroid antibiotic medicine (NSAID) and an antibiotic (antibiotic) in wherein.Eyeshield (eye patch) only just uses when needing having, and sufferer can be apprised of after surgical operation, can use immediately eyes see normally near with see far away.
Figure 12 A is to the embodiment of Figure 12 B methods of exhibiting (b), and it comprises or do not comprise partly or whole method (a) steps.Comprise or do not comprise the general embodiment of the method (c) of method (a) steps partly or whole, can comprise and form a treated tissue in conjunctiva on limbus of corneae or near the position of limbus of corneae, then move forward (advancing) optical fiber head and other treated tissue and form device, and terminal away from limbus of corneae (farthest away from limbus of corneae) to being formed at the treated tissue in the sclera or the end of treated tissue group subsequently.This optical fiber head advances under the conjunctiva, and in this embodiment, it advances between conjunctiva and the sclera.The step of moving fiber head under the conjunctiva can be abideed by a kind of or two kinds of methods wherein of following two kinds of methods and implement, at least partly to combine or the form of change and implementing with any.According to a method wherein, when the optical fiber head end advances, its can be excited (activated)/operation (operated) and form those treated tissue that will in sclera, form or treated tissue clustering, with/or according to other method, optical fiber head may be advanced to (whole advancing to) those treated tissue that will form or the cybotactic end of treated tissue in sclera, probably exciting (activated)/operation (operated) optical fiber head with when the treated tissue that forms or treated tissue clustering are in sclera, then with its withdrawal.
Figure 13 A is the perspective view of Fig. 6 C, and Figure 13 B is the perspective view of Fig. 6 D; Figure 14 A is the perspective view of Fig. 9 C, and Figure 19 B is the perspective view of Fig. 7 D.About in treated tissue labelling and treated tissue on the conjunctiva or among conjunctiva and sclera, these labellings or treated tissue can be with described methods of Figure 12 B before and are made formation.
When carrying out example that conjunctiva resets when doing a difference with rotating manner with above-mentioned displaying, other example that resets (repositioning) conjunctiva can be included in before the application of treatment tissue, corresponding sclera and move the conjunctiva of (shifting) whole or at least one part.In some embodiments, some or all being positioned at the conjunctiva that sclera will receive treatment on the position of tissue is partly moved, rather than use similar, similar or roughly with the identical technology of any aforesaid rotation processing method.With reference to Fig. 3, partly or whole conjunctivas can use the conjunctiva plate device and be booked (gripped), and moving a bit of distance with X-axis 40 directions, for example probably be higher than the distance of an angle of 90 degrees.In other embodiments, this segment distance can be at about 0 degree angle in the scope of about an angle of 90 degrees, with/or the conjunctiva of different parts can be on different time points, with different directions with/or moved with different distances.Catch with will be partly or whole conjunctivas moves a bit of distance in X-axis 40 directions after, when some or whole treated tissue are employed, can use the conjunctiva plate device and conjunctiva is fixed on the allochthonous position.After some or whole treated tissue are employed, conjunctiva can be by using the conjunctiva plate device to be moved (for example moving back to) integral body or partly getting back on its spontaneous orientation, with/maybe can discharge conjunctiva (for example removing anchor clamps (gripping device) or fixture (holding device)), and make conjunctiva integral body or part get back on its spontaneous orientation.About any rotation described herein and/or move the method for conjunctiva, with/or any art before (pre-operative) or intermediate steps, partly or whole reformed conjunctiva can be by treatment in order to, control over bleeding amount for example.A kind of method that is used for control over bleeding is described in Application No. 60/591,934, the applying date is on July 27th, 2004, denomination of invention is in the patent of " MESIACLLASER HAVING DUAL-TEMPERARURE FLUID OUTPUT ", and the whole contents of this patent is incorporated in this paper in order to as reference.According to the method for this reference, cooling material (cooled matter) (for example fluid) can pass through to stimulate vasoconstrictive mode, and it is hemorrhage to be used to minimizing.This cooling material (for example air and room temperature following water) can be applied to tissue and control over bleeding, and this tissue hemorrhage may be because of cut, excision or structural other wound cause hemorrhage.Such cooling material (for example fluid, gel, ice bag) can be used in eyes and slow down or stop at afterwards hemorrhage of excision program (or operation) (for example cutting operation that carries out with laser).Shown in example, cooling material can use before meeting described herein causes hemorrhage step, during or afterwards.For instance, cooling material can be in the journey of rotating or move conjunctiva and be applied on the eyes.
When rotating or moving conjunctiva, it is impaired to it must be noted that the minimizing tissue causes because of over-drastic mobile conjunctiva, for example complete vascularization (de-vascularization) and gangrene (necrosis).In certain embodiments, partly the conjunctiva that is moved can be used known technology and with it by separating on the sclera, therefore can in the control tissue injury, help to move conjunctiva with bigger amplitude.According to some embodiment, one fluid, for example an epinephrine base flow body (epinephrine-based fluid) (for example anesthetis (anesthetic) and vasoconstrictor (vasalconstrictor)) can be directed using (for example using the boundary vicinity at conjunctiva and one or more cornea, choroid and ciliary muscle), before the mobile conjunctiva or before the bottom by conjunctiva separates.In improveing embodiment, fluid can have the stickiness also bigger than water.For instance, fluid can comprise a gel, for example a transparent aqueous gel (water based gel).
After rotation described herein and moving the step of conjunctiva, with/or in any intermediate steps, partly or all reformed conjunctiva can be fixed with interim or stationary device.For instance, after conjunctiva is retracted its spontaneous orientation, or retract but have afterwards and cross a little after its spontaneous orientation, treated tissue in conjunctiva can be used the known technology in this field, sew up (sutures), surgical stapling (surgical tacks), screw togather (screws) or hook together (staples), with/or can be used for fixedly conjunctiva on this position in the mode of smearing cement (adhesives).
Conjunctiva reverses (torquing) or rotates (rotating) and can use any diverse ways and device and reach.Therefore when almost whole collagen was formed, conjunctiva was full of blood vessel, should be handled carefully and made amount of bleeding reduce to minimum.Conjunctiva also can be by (extensively) extension (stretched) widely.Move (contrast Fig. 5 B) about conjunctiva as shown herein, can use an instrument to rotate conjunctiva, and makes the position, angle of labelling mobile and change from the position, angle (for example position, angle of labelling before moving) of its original labelling.Such moving (for example rotating) afterwards, when some or whole treated tissue then were employed, conjunctiva can be by using a device, conjunctiva plate device for example, and be fixed on position after moving.
Before reversing conjunctiva, conjunctiva can be by to charge into a fluid expand (ballooned).For instance, a fluid (for example comprising adrenergic fluid) can be injected under the conjunctiva, thus with conjunctiva by separating on the beneath sclera.
According to one embodiment of the invention, a paired otch (for example top otch and bottom otch) can be formed in the conjunctiva, and an instrument with relative two feet can be inserted between conjunctiva and the sclera.Figure 15 A and Figure 15 B promptly describe such embodiment with instrument 61 of relative two feet 63 and 65.Figure 15 A is the side view of instrument 61, the vertical view that Figure 15 B then provides instrument 61 to overlook from the straight line 15b-15b ' of Figure 15 A downwards.Two feet 63 of instrument 61 and 65 comprise middle part 67 and 69 respectively, and lower portion 71 and 73.When in use, lower portion 71 and 73 can be inserted via the otch of conjunctiva, and makes it contact and to be positioned on the sclera, and makes middle part 67 and 69 still be arranged in otch and contact with the sidewall of otch.In typical embodiment, the orientation of this paired otch can corresponding middle part 67 and 69 transverse cross-sectional shape, and make middle part 67 and 69 be close to otch, and be positioned in otch and contact with the sidewall of otch, but then, the size of otch is reduced to minimum to avoid that conjunctiva is caused unnecessary wound.
When instrument 61 rotated around turning cylinder 75, lower portion 71 was slided on sclera with 73 (for example contact with sclera or contactless), and middle part 67 contacts and use rotatory force in the otch sidewall with 69, and so mobile (for example rotation) conjunctiva.Therefore, instrument 61 can be used to reverse conjunctiva at first direction.Then, otch can be in the relative both sides of each foot of instrument 61 by with cut (therefore forming four otch), and make otch penetrate sclera and form treated tissue in sclera.Conjunctiva can be then after same direction be further reversed, then form extra treated tissue in a similar fashion, with/or after helping to form extra treated tissue with similar method, conjunctiva can be reversed in the second direction opposite with first direction.This reverses with treated tissue formation flow process and can be repeated with any order.In a specific embodiment, bottom otch and top otch can be fabricated in the sclera, its 90 and 270 the spending on the angular ranges of orientation (be respectively 6 o'clock and 12 o'clock orientation) originally.
Instrument leg 63 and 65 can then be inserted into bottom otch and top otch.Instrument 61 can then be used and reverse miter angle in a clockwise direction.Two otch can be formed with cut on arbitrary side of each instrument leg, then, conjunctiva is by with the counter clockwise direction opposite with first direction, rotate an angle of 90 degrees around turning cylinder 75, and conjunctiva is moved to counterclockwise away from the conjunctiva original-party bit position, form two otch on arbitrary side of each instrument leg with cut more thus.After conjunctiva is then reversed back on its primary orientation, remove this instrument or this instrument and can be removed and allow conjunctiva to get back on its primary orientation or other the identical orientation.When conjunctiva is got back on its primary orientation, this program causes miter angle, 135 degree angles, the 225 degree angles of the polar coordinate system that the otch (double kerfs) of four bilayers formerly quoted to be spent on the position at angles with 315.Therefore, the otch of these four bilayers on north-east, northwest, southwest and the southeast position of eyes, these positions corresponding to the initial point that defines coordinate system with as the pupil of the pole axis 38 of the coordinate system that Fig. 1 showed (for example the position, angle is spent in west or 0).
According to the implementation method of just having described, can use a conjunctiva plate device, and help to form treated tissue under conjunctiva.Figure 16 A and Figure 16 B are respectively the attempting thoroughly and side view of conjunctiva plate device 90 of embodiments of the invention.The conjunctiva plate device 90 of this embodiment can comprise a fixed form 92 (built-in template), and this fixed form 92 can comprise one or more in order to put zone 96 and the episcleral slit 94 (slots) of treated tissue (for example otch) on conjunctiva.
This fixed form 92 can comprise four arm tools (arm implements) that is arranged on 0 degree angle, an angle of 90 degrees, 180 degree angles and 270 degree positions, angle, and can comprising one or more slit, slit 94 is arranged in each arm tool, for example be provided with two parallel slits in each arm tool, or two slits form " H " shapes and are arranged in each arm tool.Treated tissue or treated tissue clustering can be formed under should the conjunctiva of shape of slit, or having the size of comparatively dwindling (for example has approximately identical with the delivery cross section when big or small when the slit, by formed treated tissue of delivery or treated tissue clustering) treated tissue or treated tissue clustering sclera down below in, it can be included in the locational radial outward extending elongated shape in angle (elongated shape) (for example otch of Yan Changing) (contrasting Figure 12 A and Figure 14 A) of fixing or almost fixed.Therefore, a slot-shaped treated tissue can be formed in the conjunctiva under each slit central area, and the treated tissue that prolongs can be formed in the sclera and at corresponding each slit in shape.
Two slits in each arm tool (for example parallel slit), part connects two slits by a less lateral slit (transverse slot), and the slit that forms one " H " shape gets among the embodiment in each arm tool, one delivery, for example columned sapphire laser delivery (cylindrically-shaped sapphire laser output tip), can be inserted into this lateral slit and pass through conjunctiva (for example by forming a little otch), and make delivery be positioned over conjunctiva between sclera.In order to help to insert the input and output head via near the conjunctiva area for treatment (for example paired area for treatment), treated tissue (for example slot-shaped treated tissue has the shape with corresponding delivery transverse cross-sectional shape) can be formed in the conjunctiva, and quantitatively with the position on corresponding to those lateral slit.Placing the lateral slit central area of delivery between two parallel slits, and by after the slot-shaped treated tissue of conjunctiva of conjunctiva, delivery can be moved first parallel slits that enters in two parallel slits with the direction (for example prolongation direction of principal axis of parallel transverse slit) of crossing first direction, and can be moved with the second direction opposite with first direction and enter second parallel slits in two parallel slits.According to embodiments of the invention, on the fixed position that the conjunctiva plate device can be fixed in relative with eyes (for example relative with cornea), therefore move delivery with a specified direction, conjunctiva (near for example conjunctiva part delivery) is also moved with this specified direction.For instance, the conjunctiva plate device can by conjunctiva plate device contact cornea (with/or limbus of corneae) part, partly mesh with near the eyes that cornea, stop the conjunctiva plate device to rotate, and be fixed on the fixed position relative with eyes.For instance, one comprises the structure as templates such as fixed form guiding (template guide), can be placed (for example engaging) to limbus of corneae with draw-out device (suction), with in order to hold or provide the appropriate location that is relevant to one or more treated tissue, size, with the index (indications) of shape (for example length), and can comprise degree of depth guiding (depth guide).
Suction can be applied to contact portion, and wherein contact portion can be fabricated and operate as Figure 19 A to shown in Figure 19 C.In one embodiment, delivery by at first direction by moving that carry out the central area of lateral slit, make conjunctiva (for example some of conjunctiva) move at first direction, and delivery by in second direction by moving that carry out the central area of lateral slit, make conjunctiva (for example some of conjunctiva) move in second direction.According to another embodiment, delivery by at first direction by moving that carry out the central area of lateral slit, make the some of conjunctiva move the distance (corresponding distance) (for example almost equal distance) of a correspondence at first direction, delivery by in second direction by moving that carry out the central area of lateral slit, make the some of conjunctiva move the distance (corresponding distance) (for example almost equal distance) of a correspondence in second direction.Therefore, according to embodiments of the invention, conjunctiva can be moved (for example rotate or reverse) or move in two opposite directions, and with forming two different treated tissue in the sclera that helps down below.
In a specific embodiment, wherein delivery inserts via the slot-shaped treated tissue on the conjunctiva under one " H " shape slit central area, this delivery can be moved (some of conjunctiva moves at equidirectional with it) and enter first or second slit of formation " H " shape slit, at that time, it is described with reference to figure 12A and Figure 14 A as this paper that delivery can form a treated tissue that prolongs.Delivery can be via retracting at the bottom of " H " shape slit central area then, and then moving (some with conjunctiva moves at equidirectional with it) enters in other parallel slits, at that time, delivery can form the treated tissue of another prolongation as hereinbefore described.Then, delivery can be moved back at the bottom of " H " shape slit central area, and by regaining in the slot-shaped treated tissue.Then, single therapy tissue on the conjunctiva between the treatment of episcleral two prolongations is lived (for example circular) can be closed, and sews up (sutures) or seals with the method that gel glues together by using bipolar electricity to burn (bipolar forceps), suture.In the embodiment that improved, form the treated tissue zone condense energy (coagulatingenergy) can be used in the treated tissue zone before or during.
This conjunctiva tumbler (conjunctivalrotating device) or to the structure of this conjunctiva tumbler, operation, with improvement can be similar with this paper part described above, identical or just the same haply.For instance, a contact portion that is arranged at the center of conjunctiva tumbler can be fabricated and operate as the hereinbefore described contact portion that can be used for fixing to cornea to aspirator.One output can be inserted via the slot-shaped treated tissue on the conjunctiva under the central area of a window by head, then move delivery and arrive same position as previously described at first direction, with to form a treated tissue that prolongs forming as previously described position as previously described location method, then move delivery to same position as previously described, and to form a treated tissue that prolongs forming as previously described position as previously described location method in second direction.
In other embodiments, a discharger (applinator device) can be placed on the ocular surface, in order to discharge or to force discharges (force out) blood and in order to minimizing or restriction of blood flow.For instance, Figure 17 A and Figure 17 B are respectively the perspective view and the side view of the discharger 100 of one embodiment of the invention, and Figure 18 A is the bottom perspective view of discharger 100.Discharger 100 among this embodiment can roughly cover and seal the part zone of the eyes 104 of being treated or all.This discharger 100 can comprise a suction ring 102 (suction ring) that is looped around around the discharger 100, this suction ring 102 surface one effective closure in order to eyeball 104 to be provided.According to an embodiment, aspirator (suction) is employed with the effect that a similar tourniquet is provided (tourniquet-like effect), and the flow (for example blood) of liquid is lowered or eliminates.One embodiment comprises placement one and has the discharger of aspirator near the position that blood vessel on the eyes enters.This embodiment more comprises a pipe 106 (tube), and it is made as the some of suction ring 102 in this embodiment.Blood or other fluid may be kept away from the surface of eyes 104; And/or blood and other fluid collected between the surface of eyes 104 and discharger 100 can discharge via pipe 106, when using pipe 106 by external source and aspirate.Discharger 100 can be taken as in order to place and to form a guiding (for example half tone (stencil) or template (template)) of treated tissue, wherein aspirator can these programs carry out during, in order to closely fixedly discharger 100 to eyes 104.
In addition, leader (handle) can be used for closely fixedly discharger 100 to eyes 104, identical or similar program carry out during.In the embodiment of an improvement discharger can comprise labelling with/maybe can comprise in order to prop up the opening of angle 63 and 65 (shown in Figure 15 A and Figure 15 B) use for above-mentioned instrument.The structure of the discharger 100 of the embodiment shown in Figure 17 A and Figure 17 B, comprise a template (template), it has on the position that is structured in previously described northeast, northwest, the southeast and southwest and as the slit (for example arch slit (arcuate slots)) of the aforesaid purposes of this paper.For instance, treated tissue or treated tissue clustering can be formed in the conjunctiva of some of corresponding at least shape of slit, or can have the size of dwindling (for example has approximately identical with the delivery cross section when big or small when the slit, by formed treated tissue of delivery or treated tissue clustering) treated tissue or treated tissue clustering sclera down below in, it can be included in the locational radial outward extending elongated shape in angle (elongated shape) (for example otch of Yan Changing) of fixing or almost fixed.This embodiment comprises one to have by the template 103 of construction as " H " shape slit 118 of the aforesaid purposes of this paper.For instance, treated tissue or treated tissue clustering can be formed and be in a ratio of in the corresponding or less conjunctiva with shape of slit in size, with the treated tissue or the treated tissue clustering that comprise elongated shape in down below the sclera.
Figure 19 A describes the embodiment of a conjunctiva mobile device 122 (conjunctivaldisplacement device) to Figure 19 C.The top perspective of this conjunctiva mobile device 122, bottom perspective view and side view are provided at respectively among Figure 19 A, Figure 19 B and Figure 19 C.This conjunctiva mobile device 122 can be used to help one or more conjunctivas to move and place treated tissue in sclera.The conjunctiva mobile device 122 of this embodiment comprises a contact site 125 and one or several support arms 127 (arm implement).According to this embodiment, contact site 125 can be fabricated and in order to the core of contact eyes, and for example cornea and limbus of corneae, one or several support arms 127 then are fabricated and are positioned over the non-central part of eyes in order to help, and for example conjunctiva is on sclera.
In the embodiment of an improvement, whole or part contact site 125 can be placed non-centrally with or make up, and do not contact cornea and limbus of corneae.For instance, the contact site can optionally or the extra suction that comprises encircles and pipe, for example described suction ring 102 of Figure 17 A and Figure 19 B and pipe 106.The exemplary embodiment of the embodiment of this improvement, the support arm that may still comprise one or more structure and rotate in order to around the core of device (for example around the core at eyes), but the core of this device can need and eye contact, or owing to the suction ring provides with contacting of eyes and can not need and eye contact.The center that such typical embodiment therefore can comprise similar contact site 125 is provided with position (centrally-disposed portions), but different be that the center of this improvement is provided with the position and does not contact cornea and limbus of corneae.By the center of improvement support arm (supportarms) that the position extends to suction ring being set can be provided to the centre of support top that the position is positioned at ocular surface is set.One or more supports bridge (support bridges) (for example two support bridges are configured to 180 degree angles separately) and can be provided.To supporting the degree of the most desirable rotation (for example 180 or 360 degree angles) that bridge can hinder one or more support arms, two or more support arms can be assembled and template can be assembled in each on support arm.In an embodiment who comprises two support arms, each support arm is set up with another support arm spends angles at a distance of 180, and comprise a template, two can provide effective or optimal paired support arm (arm implement pair) move angle scope relative to rotating of support arm.
As present embodiment, support arm 127 comprises the auxiliary or guiding (a user aid orguide) of a user, and it comprises at least one template 132 that is used for placing treated tissue (for example otch) zone in conjunctiva and sclera.Show that as present embodiment template 132 can comprise the slit of one " H " shape, or for example at other embodiment, comprise two slits (for example parallel slit).
This conjunctiva mobile device 122 (conjunctival displacement device) or to the structure of this conjunctiva mobile device, operation, with improvement can with this paper part described above, it is similar or identical haply having some at least.For instance, the contact site 125 that provides of conjunctiva mobile device 122 can be equipped with a pipe 135, its can be in whole or in part by in mode as previously described and make up and operate, and with reference to the embodiment of preamble carry about pipe 106, it comprises via a pipe 135 and aspirates, to help closely to connect or fixed contact divides 125 to eyes.Pipe 135 can be made as a contact portion 125 isolating somes or be whole some.When pipe 135 is used in combination with contact portion 125, with when suction is applied to pipe 135 from external source when, pipe 135 can provide following function with combining of contact portion 125: resist the locomotivity (shifting force) that puts on the contact portion 125; Rotatory force around the opposing central shaft 129, it can put on the contact portion 125; Provide an effective closure to one or more eye's cornea and limbus of corneae; Keep blood or other fluid away from area for treatment; With discharge blood or other fluids via pipe 135.In addition, leader (handle) can be used for closely fixedly conjunctiva mobile device 122 to eyes, identical or similar program carry out during.According to another embodiment of the present invention, (alignment indicia) is arranged on the contact portion 125 to bit pointer 141, in order to auxiliary user conjunctiva mobile device 122 carried out para-position, and particularly auxiliary contact portion 125 is to help to put treated tissue.In a typical embodiment, user is aimed at top and bottom the south and north direction (for example an angle of 90 degrees and 270 degree angles) of eyes to bit pointer 141, with/or limit and left side cornea arranged with what the East and West direction (for example 0 spend angle and 180 spend angles) of eyes or eyes were aimed in the right with Left Indent pointer 141.
According to another embodiment of the present invention, position integrated structure (position engagementstructure) is provided on one or more contact portion 125 and the support arm 127.As what this paper showed, this position integrated structure comprises the recess 144 (indentations) that is arranged on precalculated position on the contact portion 125, and be arranged on projection 146 (protuberances) on the support arm, wherein projection 146 is made into and can combines with recess 144 and need not rotate the size and shape of (rotation-inhibitingengagement).Support arm 127 can be used as single support arm and is provided, and it comprises structure and element as depicted in FIG. and/or more comprises as described previously position integrated structure, and perhaps support arm 127 can combine with second support arm 128.
Provide support arm 127 as single support arm, its can by or be not fixed in support arm 127 by projection and with corresponding contact position recess mode sealed (rotation-locking engagement) to rotate.Typical embodiment can further comprise one second support arm 128, its can comprise be fixed in support arm 127 and with the corresponding mode sealed projection of contact position recess to rotate.For instance, carry among some embodiment, for example the embodiment that shows of these icons except support arm 127, has only second support arm 128 to be equipped with projection.When one or more support arms 127 by independent providing, or combine with second support arm 128, some is illustrated in embodiment in these icons and can comprises a pair of identical in fact support arm 127 (for example not having projection exists) and be disposed on each contact portion 125 with second support arm 128 (for example not having projection exists).In the embodiment of improvement, two or more support arms 127 (for example not having projection exists) can be configured on each contact portion 125 with one second support arm 128 (for example not having projection exists).Other embodiment can comprise two or more support arms 127 (for example being configured to 180 degree angles separates).For instance, two or more support arms 127 can be mounted on the contact portion 125, and do not have second support arm 128, and wherein one or more support arms 127 include projection.In a specific embodiment, single support arm 127 or whole support arm 127 all is equipped with projection.
When contact portion 125 comprises a contact portion 125 that is arranged at the center, support arm 127 can rotate or remove, and can closely be fixed on the different position, angle around the contact portion 125 at center.In a typical embodiment, support arm 127 is built into and can rotates around the central shaft 129 of contact portion 125, and it can use any those skilled in the art material and structure known and suitable and that can implement these purposes to make.Comprise one or more support arms 127 and one or more second support arms 128, can comprise syndeton (connecting structure) and link between one or more support arms 127 and one or more second support arm 128.In an example, this syndeton can comprise a connecting ring 131 (connectingring), its altogether in heart (concentrically) be arranged at around the central shaft, and the rotation displacement of the rotation displacement of support arm 127 and second support arm 128 is coupled together.In a concrete example, connecting ring 131 is fixed together the rotation displacement of the rotation displacement of support arm 127 and second support arm 128, and make one of them rotation displacement of support arm 127 and second support arm 128, cause corresponding (for example identical rotation displacement) rotation displacement of other support arm 127 and rotation displacement of second support arm 1 28 with support arm 127.Therefore, in this example, support arm 127, second support arm 128 all link together with syndeton (for example connecting ring 131), and can corresponding contact portion 125 and rotate together.In other embodiments, syndeton is omitted by whole or part, makes one or more support arms 127 not be connected with one or more second support arms 128.
In the embodiment of demonstration, the rotation of support arm 127, it is with respect to the contact portion 125 that is fixed on the eyes, can help the rotation of conjunctiva or moves.According to general embodiment, at least one conjunctiva processus hyoideus (conjunctiva tongue) can be placed on each support arm, in order to catch and the local part that moves at least one conjunctiva.In the embodiment that is showed, can put two conjunctiva processus hyoideus 138 on support arm 127, and more it can be placed on the relative both sides of support arm 127, described as Figure 19 B.In use, can form one and grasp otch (grippinginscision) (not shown) in sclera, in order to hold (accommodate) conjunctiva processus hyoideus 138 wherein.A size or a shape that grasps otch is to determine in advance, perhaps can change according to the size or the shape of conjunctiva processus hyoideus.For instance, in the embodiment shown in Figure 19 A, wherein conjunctiva processus hyoideus 138 has an edge, this edge gets length in direction d1 calculating and is approximately 6 millimeters (mm), can be formed in the conjunctiva and grasp otch, and having complementation or the shape that conforms to, it gets length in parallel direction d1 calculating and is approximately 10 millimeters (mm).One of them of these two conjunctiva processus hyoideus, be arranged on the leading edge (leading edge) of support arm 127, when support arm 127 rotates in a clockwise direction, this conjunctiva processus hyoideus can be inserted one and grasp in the otch, the predetermined angle of rotating support arm 127 in a clockwise direction then, therefore, this one move cause conjunctiva also with equidirectional mobile phase with or less angle.For instance, support arm 127 can rotate (for example rotating about miter angle) in a clockwise direction, corresponding recess 144 sealed (lockingly engage) in the projection on second support arm 128 and contact portion 125, at that time, one or more as mentioned before treated tissue can be formed.
Two near-ends (proximal ends) (for example near the position of pipe 135) can then be extruded (pinch) or otherwise one of them near-end be moved (for example pressing together) to another near-end, and with projection 146 by with the combining of recess 144 in discharge and help to carry out extra rotation.For instance, this extra rotation can comprise in the opposite direction (for example counterclockwise) and rotate (for example approximately rotating miter angle), can shift out in the otch with till another conjunctiva processus hyoideus can be inserted in the identical extracting otch by grasping up to a conjunctiva processus hyoideus, then continue with the predetermined angle of counter clockwise direction rotating support arm to, therefore, this one move cause conjunctiva also with equidirectional mobile phase with or less angle.For instance, support arm 127 continuous rotation (continued rotation) in the counterclockwise direction, the continuous rotation that can comprise an about miter angle up to recess 144 corresponding in projection on second support arm 128 and the contact portion 125 in conjunction with till, at that time, one or more as mentioned before treated tissue can be formed.Two near-ends (for example near the position of pipe 135) can move one of them near-end again to another near-end, and with projection 146 by with the combining of recess 144 in discharge and optionally help to carry out extra rotation.At this moment, treated tissue has been formed in the Southwest Quadrant and southeast quadrant of conjunctiva, with same method, can form treated tissue in the Northeast Quadrant and Northwest Quadrant of conjunctiva.
According to one embodiment of the invention, one or more conjunctiva brake units (conjunctivacatches) can be assemblied on the support arm.In a typical embodiment, each support arm can comprise a conjunctiva and collect prominent 148 (the conjunctiva collecting ridge) of ridge.In the embodiment of improvement, that the conjunctiva brake unit of other embodiment can form separately or collect prominent combination of ridge with the conjunctiva of above-mentioned or improvement and form.In addition, one or more conjunctiva brake units can be assemblied on the corresponding support arm individually, or are assemblied on the corresponding support arm with one or more conjunctiva processus hyoideus combinations.Show that as icon the quantity correspondence of conjunctiva brake unit is arranged at the conjunctiva processus hyoideus quantity on each support arm.According to typical embodiment, each conjunctiva brake unit all is arranged between the template of conjunctiva processus hyoideus and corresponding support arm, in order to when support arm rotates, catches and with the part of conjunctiva.For instance, when when support arm rotates, conjunctiva collection ridge prominent 148 can stop conjunctival tissue to move up and enter template.
Anti-rotational structure (anti-rotational structure) or characteristic (properties) about contact portion, according to one embodiment of the invention, one or a plurality of claw (paws) (not shown) can assemble and in order to getting back to the direction that (reach back) measured to retina by cornea, and grasp zone (gripping region) and help the fluid-tight engagement (securing) of contact portion in order to of contact eyes.This fluid-tight engagement (securing) can or stop moving or rotational motion of contact portion by utilization and in order to opposing.Comprising one or more claws (paws) can implement separately, or combine and implement with the embodiment that aspirator (for example via a pipe) is wherein arranged, and can comprise a size that meets sufferer eyes size in order to each claw of fluid-tight engagement (securing) (paws) that helps contact portion, with/maybe can comprise a polymer, polymethyl methacrylate (polymerthylmethacrylate for example; Be called for short PMMA).Each claw (paws) more can be the support arm or the some of second support arm, perhaps can be formed and extends rearward to individually and grasp zone (gripping region).The shape of claw (paws) can be taked various shape, wedge shape (wedge shape) for example, and the surface of claw (paws) can comprise for a short time and fastens (tiny cleats), barb (barbs), fold (corrugateions), rib (ribs), suction cup (suction cup), viscose (adhesives) or other can produce other device that is well known to those skilled in the art that grasps fixing action between the surface or rete and claw of eyes.
In certain embodiments, claw (paw), for example an interlayer pawl (inter-layer paw) can fluid-tight engagement between two retes of eyes, for example between conjunctiva and the sclera.This interlayer pawl (inter-layer paw) can have any structure and function of before being discussed, wedge shape for example, and it can comprise an expandable object (expandable material), it can be after being seated in the extracting zone, and helping increases or change its size at least one orientation of interlayer pawl.In an example, claw (paws) can comprise an expansible wedge (inflatable wedge), it can insert or be placed among the near zone that grasps the zone with other method, then draw water or air (for example via a pipeline and reservoir, this reservoir is grabbed squeezable pipeline that son assembled with the hands extruding by each by user and guided fluid to enter to grab in the son) in order to firmly grasp.One actuator (regulator) or relief valve (release valve) can be provided and in order to prevent claw (paws) excessive expansion.In other embodiments, one or more claws (paws) can comprise a distensible object (expandable material), an expandable cellular rubber (expandable foam) for example, it can be flat before inserting or otherwise make its volume-diminished rather than expansion, its after inserting (for example insert 10 to 15 seconds back) be placed in contact area after, claw (paws) can expand and is returned to original size according to the memory of itself.Embodiment for any use claw (paws), at least one surface of claw (paws) is built into a low friction surface is of value to insertion and the storing that helps claw (paws), and after, at least one surface of claw (paws) is built into a high friction surface to be of value to and to help claw (paws) to catch eyes.For reaching this purpose, (for example relative more imperforate surface is by the insertion of low friction is carried out in help so that viscasil  gel is lubricated on special surface, then, more imperforate relatively surperficial result becomes a high friction surface) can implement in mode well-known to those skilled in the art.
According to other structure of the present invention, template or slit location comprise obstacle (stops), it in fact or visually provide or help to award indication that stops or the function that stops to move for the formation of position, top 77 and 79 (upper portions) and surgical twisting action and treated tissue.For instance, obstacle (stops) can be operated by instrument 61 and limit torsional displacement and move in the scope of positive and negative miter angle.
Discharger (applinator device) can be made as the some of dilator (speculum).Discharger (applinator device) can be built into and have several hook shape components (hook-like members) in one embodiment, and it can be in order to provide the function of dilator (speculum).Suction also can be provided by using discharger (applinator device).In the embodiment of a demonstration, discharger (applinator device) can be fabricated (for example when making or by utilization or the structure of discharger when being applied to eyes), and in order to be provided at the suction of carrying out in eyes conjunctive tissue (connective tissue) near zone.Conjunctive tissue (connective tissue) is determined with the configuration of the tissue that is connected these muscle by muscle.Believe that generally conjunctive tissue is to be positioned at superior conjunctival fornix (superior fornix of the conjunctiva), therefore use the suction ring to aspirate the blood transfusion that can reduce scleral tissue.In typical embodiment, can dispose an aspirator below discharger (applinator device), wherein the contact portion of discharger is fixed and suction is provided, and the template part of discharger can be rotated.(piezeoelectric) of one piezoelectricity or other launch device (motor device) can be provided in some embodiment, and cut in order to automatically helping along each template or slit, with/or in order to automatically moving a predetermined moving range, and in order to put or provide treated tissue.In more violent embodiments, such aspirator can be used to contact with help conjunctiva by remove on the sclera with/or separate (for example lifting).
In other embodiment and embodiment, conjunctiva mobile device 122 (conjunctivaldisplacement device) (Figure 19 A is to Figure 19 C), or the device of describing before any, conjunctiva plate device 90 (Figure 16 A is to Figure 16 B) for example, can be fabricated so that two slits (for example parallel slit) in each support arm are whole haply and connect (for example having and those two length that parallel slit is the same) with a bigger slit, and therefore form an independent rectangular slot (single rectangular-shaped slot) or window (window) in each support arm, as Figure 24 A to shown in Figure 24 C.
In other embodiments, independent rectangular window in this each support arm, can have the identical or long length of length with parallel slit, but it has width smaller, as shown in figure 20, wherein independent Road narrows (single narrow channel) are formed in each support arm, if or only have one to be used in an independent support arm.With reference to icon, Road narrows 151 can provide big with/or different visibility to the zone that centers on surgical location.According to other embodiment, support arm 153 can use rather than other device with the less marking (footprint) on conjunctiva.For instance, support arm 153 can be assembled two conjunctiva processus hyoideus 155 that are positioned on the opposite both sides of support arm 153, and in order to being fit into independent slit cut 157 (single-slotincision), rather than two otch or " I " notched cut that prolongs (the later icon of contrast Figure 28).
One of them conjunctiva processus hyoideus 155 can insert each treated tissue of independent slit cut in forming two treated tissue during, or two conjunctiva processus hyoideus 155 can insert independent slit cut at the same time, in order to form corresponding treated tissue.According to one embodiment of the invention, each treated tissue can be formed at the zone of corresponding Road narrows shape in the conjunctiva, maybe can have the size of dwindling (for example has approximately and zone, optical fiber head cross section size about equally when a slit, by the formed treated tissue of delivery) treated tissue sclera down below in, it can be included in the locational radial outward extending elongated shape in angle (elongated shape) (for example otch of Yan Changing) of fixing or almost fixed, and has the shape near Road narrows 151.At this embodiment or any in the embodiment of this description, the mentioned slit that can be formed in the conjunctiva, can be formed on the rear portion (posterior part) of corresponding window, slit or Road narrows, and make the eyelid of sufferer, will more can cover the optical fiber head inlet point in subsequently program.
With reference to Figure 24 A, Figure 24 B and Figure 24 C, a conjunctiva mobile device 222 is assembled a contact portion 225 (for example cornea suction cup of silicon making) can make the handle 230 (handle) of being used as place tool or handle (stem) with one.The exemplary embodiment of this embodiment comprises one first support arm 227 and one second support arm 228, each support arm is arranged at a distance of the position at another support arm 180 degree angles and comprises a template, wherein the rotation of two relative support arms can provide an effective or optimal move angle scope to support arm to (arm implement pair).The top rotary part 231 of one conjunctiva mobile device 222 (upper rotatable portion) is fixed on first support arm 227 and second support arm 228.On the other hand, handle 230 (handle) is fixed to contact portion 225 (for example the cup-like portion with contact portion 225 is cast as integrally formed).Leader 230 joint knot 232 (nub) are fit into three recess (indentations) 233a, 233b and 233c that form by circular tusk (rounded teeth), wherein three three orientation that the corresponding handle 230 of recess is set.
In the embodiment of improvement, joint knot (nub) can comprise a cylinder, its length axle is parallel to the turning cylinder of top rotary part 231, and makes cylindrical arcuate surface (arcuate surface) fit into the surface with the complementary shape of arcuate surface of having of three recess 233a, 233b and 233c.Cylinder or other similar structures are called as an indication stabilising arrangement (indexing detent), and when tying 232 (nub) embodiment with joint, it can be cast into contact portion 225 and be one of the forming.First support arm 227 and second support arm 228, each can be called as laser aiming sheet (laserguide paddle), its pivot joint (pivot) between three positions and lock (lock) on three positions, miter angle is separated in each position.The template of the template of first support arm 227 and second support arm 228 can be referred to as twist-lock template (swivel-lock templates).With reference to Figure 24 B, a breach 237 (gap) allows that joint knot 232 (nub) deflection (deffected) is when it rotates the indication gear.This icon is according to the profile of the window of first support arm 227, and goes out two treated tissue positions that are formed at the sclera under the conjunctiva with dotted lines.
Handle 230 can various angles be connected on the top rotary part 231 of conjunctiva mobile device 222.For instance, shown in Figure 24 A, handle 230 can fluid-tight engagement in main orientation (central orientation), as icon, and also can fluid-tight engagement in two less important orientation (secondary orientation), this less important orientation is arranged on the orientation of the positive and negative miter angle in the main orientation of distance.Be fixed on the contact portion 225, handle 230 any one in two less important orientation moves, and can cause the corresponding rotation of first support arm 227 and second support arm 228.
In a stronger embodiment, handle 230 is not connected with the top rotary part 231 of conjunctiva mobile device 222.But part or all of handle 230 is fixedly entered contact portion 225 (for example being cast as integrally formed), or connect removably.Recess (indentations) 233a, 233b and 233c that circular tusk (rounded teeth) forms, can be integrally formed with top rotary part 231, or fixing (for example fixing with respect to the rotation of top rotary part 231) be on top rotary part 231.Joint knot 232, cylinder or other similar structures can be made into integrally formed with contact portion 225.
Handle 230 can optionally be made up and be comprised a vacuum tube 234 (vacuum tube), and it can whole or partly be fabricated and operate pipe 106 and 235 as described previously.Vacuum tube 234 can be set in the handle 230, and wherein handle can be connected to a pair of angle gauge clevis seat (caliper mount) by passage.In one embodiment, handle 230 is formed two big finger pieces (large finger) (left side of contrast Figure 30) in order to load onto caliper splint (caliper).In addition, vacuum tube 234 can comprise a vacuum tube accessory 241 (vacuum tube fitting), shown in Figure 24 C.Figure 24 C is a perspective view of describing conjunctiva mobile device 222 belows, it illustrates the opening of a vacuum tube 234, and this opening is referred to as vacuum port (vacuum port) and its and is formed and produces a flushing surface opening (flush-surface opening) on the surface, inside of contact portion 225.According to the embodiment that comprises vacuum tube 234, the cornea suction cup of contact portion 225 (corneasuction cup) can be made by a tartan, and can be fixed on the conjunctiva by the vacuum pressure that vacuum tube 234 comes.Comprise among the embodiment of a vacuum source this or other, vacuum source can be taken as a suction source (aspiration source) may be at the more cumulative useless fluids of intra-operative in order to discharge.
Except leader's 230, one torque tools 235 (twist tool) can be a rigid ring or a semirigid ring.The two ends of torque tool 235 can be inserted torque tool slot 237a and 237b (twist tool receptacle) removably, and in order to use rotatory force to top rotary part 231.Particularly, first end of torque tool 235 inserts among the one first torque tool slot 237a, and second end of torque tool 235 inserts among the one second torque tool slot 237b.
Other embodiment can omit torque tool, joint knot (nub), recess and/or relevant structure, an embodiment for example, and wherein the conjunctiva mobile device is equipped with a connection first support arm, second support arm, the 3rd support arm, and the contact portion of the 4th support arm.With respect to contact portion, first support arm of one or more (for example would rather all), second support arm, the 3rd support arm, can be rotated and fix with the 4th support arm.First support arm, second support arm, the 3rd support arm, can be by with an angle separate coequally (for example separate an angle of 90 degrees of central point) with the 4th support arm, and be used as four quadrant template/laser guiding devices.
Refer again to Figure 19 C, arbitrary support arm described herein, can be fabricated and be arranged on the otch of a conjunctiva (for example being in contact with it) or among (for example by one or more conjunctiva processus hyoideus).In addition, in other embodiments, with reference to the following icon of figure 31B (it is a side view), any support arm described herein can be fabricated and be arranged at a bit of distance above the conjunctiva, for example 1.5 millimeters (mm).This distance can allow the conjunctiva of sclera top to expand, shown in Figure 31 B.According to an embodiment of the present invention, one instrument with/or technology be provided and in order to insert and to contact conjunctiva, for example at the template of a support arm or the center of window, afterwards, this instrument is by being full of the space that builds between conjunctiva and the sclera with fluid, and can move (for example action of grasping or lifting) conjunctiva away from sclera by a suction, then or connect an eyelet (eyelet) or other expansion tool (spreader implement) (for example an eyelet can be fixed on the neutrality or the middle body of window by the conjunctiva processus hyoideus) to conjunctiva.The support arm embodiment of any of these kind can be used whether no matter the conjunctiva processus hyoideus arranged.In a specific embodiment, the conjunctiva processus hyoideus is non-to be formed on the support arm, perhaps be formed at the conjunctiva processus hyoideus but be not used, and support arm is built into and contacts ocular surface or stay on the ocular surface, and eyelet can be fabricated and use in be formed at the window of support arm.
When being disclosed any window or formwork structure with this paper, produce these eyelets of the present invention with any corresponding support arm structure, with reference to Figure 25 one specific embodiment is described.In this icon, a rectangular window 267 is configured in the support arm 269.According to an embodiment, support arm 269 can then be placed to four treated tissue position quadrants (tissue-treatment site quadrants), and according to another embodiment, two support arms that match can form an integrated structure that can rotate on two positions, therefore make four all quadrants to be covered by these two support arms.In a further embodiment, four support arms can be assembled into the disclosed structure as this paper.
Figure 26 A describes an eyelet 245 that uses in the window of support arm.The main body 247 (body) of one eyelet can comprise a slit 263 or other torque application structure (torque-applicationstructure), and it can hold a tumbler 265.In the embodiment that is showed, slit 263 comprises a hexagon interior wall, and tumbler 265 comprises a hexagon handle that matches.Figure 26 B provides the profile of the eyelet 245 among Figure 26 A, its displaying be, eyelet 245 be inserted into be fixed in the conjunctiva after the profile of eyelet 245.Insert via conjunctiva 266 eyelet 245 and fixing (for example sealing or conjunctiva processus hyoideus expand) its in conjunctiva 266 after, tumbler 265 can be removed by the operation torque applications position (operativetorque-applying position) in the slit 263, and leaves eyelet 245 in position.In other embodiments, slit 26 can have difformity, and for example circular, oval (shape that for example meets the optical fiber head profile among Figure 22) are perhaps with other shape.Same, tumbler 265 can have different shapes, and itself and slit 26 shapes can be to match or unmatched, or can be omitted together.
Eyelet 245 comprises one or more conjunctiva processus hyoideus 249.In the embodiment that is showed, conjunctiva processus hyoideus 249 comprises puncture (for example thrust or the cut) leading edge 251 (penetrating leading edge) of a tool continuous helical shape.Other of this guiding puncture limit and conjunctiva processus hyoideus 249 partly (for example all edges) is more sharp-pointed.Conjunctiva processus hyoideus 249 can form and have other structure, and the protrusion that for example Figure 25 described is (tabs) partly.In Figure 25, eyelet 255 is formed and has four circular bulge parts of equidistantly being separated by, is formed at extracting otch 261 (gripping incision) in the conjunctiva in order to insertion.During this program was carried out, on arbitrary specified time point, one or more circular conjunctiva processus hyoideus of protruding 257 (rounded-tabconjunctiva tongues) can be inserted one and grasp in the otch.Therefore, the conjunctiva processus hyoideus 257 protruded of, two or whole circle can be inserted into one and grasp in the otch 261 before the laser step of operation be carried out.Identical, the conjunctiva processus hyoideus 249 of Figure 26 A can be inserted in the extracting otch of a conjunctiva, or can oneself selected one grasp otch and insert in the conjunctiva.
Insert eyelet 255 enter grasp otch 261 before, simultaneously or be right after thereafter, partly be affected (for example bleeding too much) conjunctiva can by, the electrosurgery laser (electrosurgery laser), vasoconstrictor, the electricity folder instruments such as (electro-pinchers) that for example have green glow or yellow wavelengths are handled.This eyelet 255 can comprise one or a plurality of (for example four) conjunctiva processus hyoideus 249, it can be folded, crooked or otherwise produce a short structure (low-profile configuration), therefore help to insert eyelets 255 via grasping otch 261.In addition, conjunctiva processus hyoideus 249 is in a typical embodiment, can produce or revert to a tall and big structure (high-profile configuration) by folding or unbending mode, be inserted in the conjunctiva or at eyelet 255 and be engaged in the conjunctiva with other method.
In one embodiment, eyelet 255 can comprise a circle as shown in figure 25, and it can form with an extensible or flexible material, this material eyelet 255 can be extruded or or otherwise be deformed into a short shape (for example oval) but do not collapse, and grasp in the otch 261 in order to help conjunctiva processus hyoideus 257 to insert (for example with/or draw (tucking) in).Extruding eyelet 255 can be reached by some modes, for example eyelet 255 is placed in and grasps on the otch 261, and the plane that makes eyelet 255 substantially and the conjunctival surface parallel (for example in the orientation of painting as icon) that is to grasp otch, contact with 279 with two corresponding points 277 of the main body 247 of eyelet 255 then, with/or contact with 279 with two corresponding points 277 on the conjunctiva processus hyoideus 257 of eyelet 255, and extruding eyelet 255.
, the distance between tweezers causes dwindling of two corresponding points 277 and 279 distances so can being shortened.Dwindling of two corresponding points 277 and 279 distances causes eyelet 255 distortion, particularly causes profile this change accordingly of eyelet 255, and makes the insertion profile of eyelet 255 more similar and corresponding with the profile that grasps otch 261.Follow-up eyelet 255 inserts and grasps otch 261 steps, can one more can not cause the disruptive mode of conjunctiva to carry out, or carry out in the mode of the less extracting otch 261 of needs.Inserting eyelet 255 in this way after grasping otch 261, extruding eyelet or the strength that eyelet is out of shape can be removed by eyelet 255 (for example by two corresponding points 277 and 279), therefore make eyelet 255 be returned to previous shape (for example circular), eyelet 255 in grasping otch 261 thereby provide further fixing thus, when conjunctiva processus hyoideus 257 was beneath expansible on the surface of conjunctiva, wherein conjunctiva processus hyoideus 257 can comprise minority or a plurality of continuous or discontinuous processus hyoideus around eyelet 255 in certain embodiments.
By move the slit 263 of back at it without any the eyelet 245 that switches through moving device 265 existence, and by the fixing eyelet 245 conjunctiva processus hyoideus 249 to the conjunctiva 266, the slit 263 of eyelet 245 can hold the optical fiber head 268 of a laser handpiece 271 (laser handpiece), shown in Figure 26 B.Same, with reference to Figure 25, after eyelet was fixed on the conjunctiva, the slit 272 of eyelet 245 can hold the optical fiber head 273 of a laser handpiece 275.In some embodiments, slit 263 or slit 272 can be formed and in order to hold one or a plurality of as delivery that Figure 21, Figure 22 and Figure 23 described, wherein such delivery can be different part, part or size and form, and can have or not have a barb 163, but according to some embodiment, the in-profile of the external form of a delivery (for example fiber output head) and corresponding slit (for example 263 or 272) is to be complementary.
According to one embodiment of the invention, open slit 263 or 272 can be as the inlet of the excision program of being carried out on down below the sclera, and also can carry out the inlet of video picture (for example by an optical fiber camera) or to the inlet of other monitoring at the position under program or the conjunctiva (for example treated tissue position) as one.Insert for the first time among slit 263 or 272 about optical fiber head, the slit may or may non-ly extend through conjunctiva (for example can not grasped otch and not hinder by a pair of being defined as) unblockedly.Laser or mechanical energy or strength can be employed to open the slit to the degree that is fit to use at once.Slit 263 or 272 can be used as also that down below the cutting process of sclera carries out during, in order to the inlet that engages with the window or the template of support arm, therefore make can produce accurately and similar treated tissue.In addition, slit 263 or 272, holding an optical fiber head or delivery in wherein, except providing one to form the inlet of (for example by optical fiber camera as herein described) with the pass treated tissue in order to form treated tissue, also can be used as one provides the inlet that carries out blood suction (for example by a suction source that is connected optical fiber head or delivery, as Figure 21, Figure 22 or shown in Figure 23), all slits 263 or 272 are all in conjunctiva in the minimum otch (for example grasping otch).
By among the slit 263 or 272 of eyelet 245 or 255, place and delivery or the optical fiber head of operating laser handpiece, when the eyelet joint is fixed on the conjunctiva, can use locomotivity on eyelet 245 or 255.These locomotivities can be oppressed slit 263 or 272 inwalls produce by optical fiber head.Moving therefore of optical fiber head can cause the strength (for example pressure) of various varying strengths and direction to act on eyelet 245 or 255, and causes the locomotivity can mobile eyelet 245 or 255, and result's generation can mobile eyelet 245 or 255 locomotivity.One user therefore can change locomotivity and guide eyelet 245 or 255 to one or more on pattern in advance, for example the pattern of one " H " font or Figure 24 B be with the pattern of dotted lines, it is positioned among the window or template of support arm.Since eyelet 245 or 255 joins on the conjunctiva, eyelet 245 or 255 move and will cause grasping otch is made equivalent in conjunctiva displacement.As a result, one or a plurality of bigger treated tissue can be formed at the extracting otch below (for example be extended and compress when grasping near the otch conjunctiva) of minimum volume, and the extracting otch of this minimum volume is located in the template or the conjunctiva in the window of support arm.Therefore one optical fiber head can be positioned over and engage in the slit of being fixed in the eyelet on the conjunctiva (for example entering from a support arm window), and therefore optical fiber head can describe (for example the guide edge along window moves) on a pattern, to form one or a plurality of treated tissue, it is being with eyelet to carry out pattern plotter with conjunctiva.
About moving of conjunctiva, according to typical embodiment, conjunctiva processus hyoideus 249 and 257 can be separately positioned on corresponding eyelet 245 and 255, in order to firmly grasp and to move the conjunctiva of a part of (part in the support arm window that for example engages with eyelet) at least within it.When in use, can confirm the placement location of a position (for example position of an extracting otch 261) as eyelet.This position can be in the neutrality or the center of support arm window, and therefore, the pulling of conjunctiva and distortion (for example in the pattern of one " H " shape) can cause the homogeneous deformation of conjunctiva at different directions.The position of this affirmation can a corresponding follow-up storing extracting otch (subsequently-placed grippingincision), it forms before eyelet is inserted conjunctiva or when eyelet is inserted conjunctiva.
Various difformities can be formed in the conjunctiva with the extracting otch of size, in order to hold various multi-form conjunctiva processus hyoideus.For instance, shape and a size that grasps otch can determine in advance, or along with the shape of conjunctiva processus hyoideus with big or small and change.For instance, in embodiment as shown in figure 25, wherein the diameter of an eyelet is approximately 3 millimeters (mm), and a pair of conjunctiva processus hyoideus 257 can have identical size or bigger diameter, for example is approximately 3.5 millimeters (mm).In this example, this grasps otch and can be formed in the conjunctiva in advance, and has the shape (a for example straight slits) that matches or conform to, and its maximum size (for example length) about 7 millimeters (mm).In other embodiments, grasp otch and form the long rectilinear form of one about 4 millimeters (mm) (for example in order to insert just two protrusion parts, or insert partly corresponding about processus hyoideus) less than half eyelet girth, or in another embodiment, grasp otch and form half circle (otch of contrast Fig. 3 1), its length is calculated with the straight line of origin-to-destination and must be approximately 3.5 millimeters (mm) (for example protrude partly in order just to insert two, or insert partly corresponding approximately less than the processus hyoideus of half eyelet girth).In another embodiment, the diameter of eyelet is approximately 1.25 millimeters (mm), and a pair of conjunctiva processus hyoideus can have identical or than its bigger a little full-size, for example 1.5 millimeters (mm), and grasping otch can be formed in the conjunctiva in advance, and have the shape (a for example straight slits) that matches or conform to, and its maximum size (for example length) about 2.5 millimeters (mm).In other embodiments, grasp otch and form the long rectilinear form of one about 2.0 millimeters (mm) (for example in order to insert just two protrusion parts, or insert partly corresponding about processus hyoideus) less than half eyelet girth, or in another embodiment, grasp otch and form half circle (otch of contrast Fig. 3 1), its length is calculated with the straight line of origin-to-destination and must be approximately 1.75 millimeters (mm) (for example protrude partly in order just to insert two, or insert partly corresponding approximately less than the processus hyoideus of half eyelet girth).
Figure 27 A and Figure 27 B show that another has the embodiment of the eyelet 281 of three posts designs (three-post design), and it comprises one and has the conjunctiva processus hyoideus 283 of sharp-pointed leading edge 285.One optical fiber head 287 can insert and center by eyelet 281 partly, and eyelet 281 more can comprise a vacuum tube accessory 289.Figure 27 B is the perspective view of eyelet 291 bottoms, and it is depicted on it in order to carry out the opening 291 that fluid transmits with vacuum tube accessory 289.Opening 291 can be formed and produce the flushing surface opening (flush-surface opening) that is connected with fluid passage 293 on the lower surface of eyelet 281.In some embodiments, structure 283 can be whole or partly as an eyes area suction cup (eye-surface suction cup), and by carrying out evacuation by opening 291 separately, or carry out evacuation with the combining of structure 283 of grasping otch in inserting conjunctiva by opening 291, and be fixed on the eyes.According to the embodiment of some improvement, eyelet 281 can have a size of amplifying with/maybe can operate and not need support arm window or template.
Figure 28 A and Figure 28 B show that one is the embodiment of the eyelet 302 of single-column form (single-post), and it comprises a conjunctiva processus hyoideus 304 (perhaps ocular surface suction cup), and this conjunctiva processus hyoideus 304 can comprise a sharp-pointed leading edge 306.One optical fiber head 302 can insert and a centre by eyelet 302, and eyelet 302 more can comprise a vacuum tube accessory 311.Figure 28 B is the perspective view of eyelet 302 bottoms, and it is depicted on it in order to carry out the opening 313 that fluid transmits with vacuum tube accessory 311.Opening 313 can be connected on the lower surface of eyelet 302 with fluid passage 315.
Figure 29 A and Figure 29 B show that one has the embodiment of the otch dilator 321 (incision spreader) of three posts designs (three-post design), and in one embodiment, it comprises at least one conjunctiva processus hyoideus 323.This otch dilator 321 can be as a laser aiming sheet (laserguide paddle) or support arm.In illustrated embodiment, two conjunctiva processus hyoideus 323 can be assemblied in the two opposite sides of otch dilator 321.Therefore this otch dilator 321 as shown in the figure, can comprise two conjunctiva processus hyoideus 323, and each conjunctiva processus hyoideus 323 has a comparatively sharp-pointed edge in order to put into an extracting otch that is formed in the conjunctiva.This otch dilator 321 more can comprise a vacuum tube accessory, and it provides negative pressure to arrive opening 325 in order to the suction tube via open side type.One comparatively in the embodiment of preference, the structure that comprises element 323 can whole or partly be used as an eyes area suction cup or a machinery, and by carrying out evacuation through the opening 325 in otch dilator 321 lower surface, and be fixed on the eyes.At otch dilator 321 with after eyes engage, by conjunctiva processus hyoideus 323 and the suction that provided to opening 325 by vacuum tube accessory 311, an optical fiber head and eyelet (not shown) can make and be used for undergoing surgery in the template of otch dilator 321 or window 324.According to some embodiment, otch dilator 321 can have a size of amplifying with being done by being made without any need for other support arm window or template, except the structure 324 that itself structure provided.In illustrated embodiment, one cornea contact cup, 327 (cornea contacting cup) can be provided, and this cornea contact cup 327 has setting thereon in order to the pointer 329 (indicia) of incision site or reference axis 333 (reference axes) to be provided.Otch for example grasps otch as discussed herein, or in other embodiments, on the position that can be arranged at corresponding " I " notched cut pointer 329 in the conjunctiva as shown in the figure.
The embodiment of an improvement of the three pillar type eyelet of Figure 30 exploded view 27A and Figure 27 B, wherein has only an independent conjunctiva processus hyoideus 341, Figure 31 A and Figure 31 B show that then one has the three pillar type eyelet embodiment of four conjunctiva processus hyoideus 343, and the conjunctiva processus hyoideus has similar structure among conjunctiva processus hyoideus 343 and Figure 25.The space that the conjunctiva processus hyoideus is 343 can in order under the issuable fine vacuum power of intra-operative (high vacuum force) (for example fine vacuum that produces suddenly), prevent that eyelet from sticking together on sclera as air-vent (vents).
Figure 32 A and Figure 32 B show the embodiment of a wound dilator 341 (wound spreader), and it comprises the structure of similar otch dilator 321, and its purposes is also similar with otch dilator 321.For instance, wound dilator 341 can comprise one for the design of open side type, a pair of relative conjunctiva processus hyoideus 343 (with/or the ocular surface suction cup), with a template or window 345, optical fiber head and eyelet (not shown) can be in order to undergoing surgery in this template or window 345, and allow wound dilator 341 is used as laser aiming sheet or support arm.This wound dilator 341 can be with a material, porex for example, (for example molded) is made, its guiding fluid (for example blood) enters into the handle of wound dilator 341 or handgrip on arrow A 1 and the A2 direction partly, therefore helps to provide one relatively not have the zone of blood and make treated tissue.Therefore, wound dilator 341 may be constructed such does not need the vacuum tube accessory.
Just like the otch dilator 351 shown in Figure 33 A and Figure 33 B, can comprise or corresponding any one or a plurality of element that in Figure 29 A, Figure 29 B, Figure 32 A and Figure 32 B, is provided, and the main element of these structures is a template or the windows 355 with design (open-frontdesign) of opened front end 353.This opened front end 353 can provide extra work space and visibility.
According to the embodiment of some improvement, treated tissue clustering of the present invention can be arranged at wound (cuts) (for example otch (kerfs)) on every side, and according to other technology sclera is implemented treatment.In the embodiment of other improvement, it substitutes or additional embodiment as arbitrary embodiment's described herein, and treated tissue can be aligned to approaching or the formed shape of similar previous surgical technic.For instance, treated tissue can be applied to the described correction pattern of patent (correctional patterns) of similar U.S. Patent number 6,263,879, or pattern bonded with it, is merged with this paper and as the usefulness of reference at this piece patent content.In the embodiment of treated tissue of the present invention and described pattern of one or more aforementioned patent or the use of excision combination of patterns, treated tissue can along part or the border of whole linear excision patterns be provided with, and whether no matter the excision of formation pattern be arranged.In the embodiment that improved, any above-mentioned treated tissue can with any other eye therapy, can be a suitable degree, or improve with this treated tissue and under the appropriateness that obtains, and in conjunction with using those skilled in the art.For instance, descriptions now and treated tissue in the sclera form relevant conjunctiva and change (for example rotate and move), can be modified with/or with comprise application or formation and treat (excision) and be used in combination in episcleral other technology (for example patent of being carried in front).
The above embodiments are provided as example, but the present invention is not restricted to these examples.Disclosed embodiment under the degree that the cognition of the description of not carried with those skilled in the art opposite is not repelled mutually, can be carried out various variations and improvement.In addition, other combination, omission, replacement or improvement also can be implemented according to this paper for those skilled in the art.Therefore, the present invention is not subjected to disclosed embodiment and limits, but should limit as it with the disclosed claims of this paper.

Claims (32)

1. an Eye disease treating method in order to treat the eyes of one of needs or several physiological correctings and a vision correction, is characterized in that, comprises:
Throw the pattern of an electromagnetic energy on a conjunctiva with point-like or lonizing radiation form; And
Focus on an electromagnetic energy by this pattern and enter a sclera.
2. Eye disease treating method as claimed in claim 1, wherein, this focus steps comprises this sclera of cutting.
3. Eye disease treating method as claimed in claim 1, wherein, this focus steps comprise form one than the big pattern of the pattern of this projection in sclera.
4. Eye disease treating method as claimed in claim 3, wherein, this projection step is with respect to this sclera, and partly this conjunctiva rotates or moves second kenel by first kenel.
5. Eye disease treating method as claimed in claim 4 wherein, more comprises, and after the projection step, rotates or move at least one part of this part conjunctiva towards the direction of getting back to first kenel.
6. Eye disease treating method as claimed in claim 5, wherein, the projection step comprises this sclera of cutting.
7. Eye disease treating method as claimed in claim 1, wherein, the pattern of this projection is a point, and this electromagnetic energy focuses on this sclera with the form of a point-like.
8. Eye disease treating method as claimed in claim 7, wherein, this projection step is with respect to this sclera, and partly this conjunctiva rotates or move second kenel by first kenel, and after the projection step, rotate or move at least one part of this part conjunctiva towards the direction of getting back to first kenel.
9. Eye disease treating method as claimed in claim 1, wherein, the pattern of this projection is a point, and this electromagnetic energy focuses on this sclera with the form of lonizing radiation.
10. Eye disease treating method as claimed in claim 9, wherein, this projection step is with respect to this sclera, and partly this conjunctiva rotates or move second kenel by first kenel, and after the projection step, rotate or move at least one part of this part conjunctiva towards the direction of getting back to first kenel.
11. Eye disease treating method as claimed in claim 9 wherein, more comprises:
Throw second pattern of an electromagnetic energy on a conjunctiva with one second point format; And
With one second actinoid form focus on this electromagnetic energy by this second point-like with focus on the sclera.
12. Eye disease treating method as claimed in claim 11 wherein, more comprises:
With one thirdly the shape form throw the 3rd pattern of an electromagnetic energy on a conjunctiva;
With one the 3rd actinoid form focus on this electromagnetic energy by this thirdly shape with focus on the sclera;
Throw the 4th pattern of an electromagnetic energy on a conjunctiva with one the 4th point format; And
With one the 4th actinoid form focus on this electromagnetic energy by the 4th point-like with focus on the sclera.
13. Eye disease treating method as claimed in claim 12, wherein, this projection step is with respect to this sclera, and partly this conjunctiva rotates or moves second kenel by first kenel, and after the projection step, rotate or move at least one part of this part conjunctiva towards the direction of getting back to first kenel.
14. Eye disease treating method as claimed in claim 1, wherein, the pattern of this projection is a point, and this electromagnetic energy focuses on this sclera with the form of one group of lonizing radiation.
15. Eye disease treating method as claimed in claim 14, wherein, this projection step is with respect to this sclera, and partly this conjunctiva rotates or moves second kenel by first kenel, and after the projection step, rotate or move at least one part of this part conjunctiva towards the direction of getting back to first kenel.
16. Eye disease treating method as claimed in claim 15, wherein, these group lonizing radiation are separated with this point on a rough averagely.
17. Eye disease treating method as claimed in claim 14, wherein, these group lonizing radiation are separated with this point on a rough averagely.
18. Eye disease treating method as claimed in claim 14 wherein, more comprises:
Throw second pattern of an electromagnetic energy on a conjunctiva with one second point format; And
With one group of second actinoid form focus on this electromagnetic energy by this second point-like with focus on the sclera.
19. Eye disease treating method as claimed in claim 18 wherein, more comprises:
With one thirdly the shape form throw the 3rd pattern of an electromagnetic energy on a conjunctiva;
With one group of the 3rd actinoid form focus on this electromagnetic energy by this thirdly shape with focus on the sclera;
Throw the 4th pattern of an electromagnetic energy on a conjunctiva with one the 4th point format; And
With one group of the 4th actinoid form focus on this electromagnetic energy by the 4th point-like with focus on the sclera.
20. Eye disease treating method as claimed in claim 19, wherein, these second group of lonizing radiation, the 3rd group of lonizing radiation and the 4th group of lonizing radiation on a rough averagely respectively with this second point, this thirdly with the 4th separation.
21. Eye disease treating method as claimed in claim 1, wherein, the pattern of this projection is lonizing radiation, and this electromagnetic energy focuses on this sclera with the form of sclera lonizing radiation.
22. Eye disease treating method as claimed in claim 21, wherein, this projection step is with respect to this sclera, and partly this conjunctiva rotates or moves second kenel by first kenel, and after the projection step, rotate or move at least one part of this part conjunctiva towards the direction of getting back to first kenel.
23. Eye disease treating method as claimed in claim 21 wherein, more comprises:
Throw second pattern of an electromagnetic energy on a conjunctiva with one second projection lonizing radiation form; And
With the actinoid form of one second sclera focus on this electromagnetic energy by this second the projection lonizing radiation with focus on the sclera.
24. Eye disease treating method as claimed in claim 23 wherein, more comprises:
Throw the 3rd pattern of an electromagnetic energy on a conjunctiva with one the 3rd projection lonizing radiation form;
Focusing on this electromagnetic energy with the actinoid form of one the 3rd sclera throws lonizing radiation and focuses on the sclera by the 3rd;
Throw the 4th pattern of an electromagnetic energy on a conjunctiva with one the 4th projection lonizing radiation form; And
Focusing on this electromagnetic energy with the actinoid form of one the 4th sclera throws lonizing radiation and focuses on the sclera by the 4th.
25. Eye disease treating method as claimed in claim 24, wherein, this projection step is with respect to this sclera, and partly this conjunctiva rotates or moves second kenel by first kenel, and after the projection step, rotate or move at least one part of this part conjunctiva towards the direction of getting back to first kenel.
26. Eye disease treating method as claimed in claim 1, wherein, the pattern of this projection is lonizing radiation, and this electromagnetic energy focuses on this sclera with the form of one group of sclera lonizing radiation.
27. Eye disease treating method as claimed in claim 26, wherein, this projection step is with respect to this sclera, and partly this conjunctiva rotates or moves second kenel by first kenel, and after the projection step, rotate or move at least one part of this part conjunctiva towards the direction of getting back to first kenel.
28. Eye disease treating method as claimed in claim 27, wherein, these group sclera lonizing radiation are separated with these projection lonizing radiation on a rough averagely.
29. Eye disease treating method as claimed in claim 26, wherein, these group sclera lonizing radiation are separated with these projection lonizing radiation on a rough averagely.
30. Eye disease treating method as claimed in claim 26 wherein, more comprises:
Throw second pattern of an electromagnetic energy on a conjunctiva with one second projection lonizing radiation form; And
With one group of second actinoid form of sclera focus on this electromagnetic energy by this second the projection lonizing radiation with focus on the sclera.
31. Eye disease treating method as claimed in claim 30 wherein, more comprises;
Throw the 3rd pattern of an electromagnetic energy on a conjunctiva with one the 3rd projection lonizing radiation form;
Focusing on this electromagnetic energy with one group of the 3rd actinoid form of sclera throws lonizing radiation and focuses on the sclera by the 3rd;
Throw the 4th pattern of an electromagnetic energy on a conjunctiva with one the 4th projection lonizing radiation form; And
Focusing on this electromagnetic energy with one group of the 4th actinoid form of sclera throws lonizing radiation and focuses on the sclera by the 4th.
32. Eye disease treating method as claimed in claim 31, wherein, these second group of sclera lonizing radiation, the 3rd group of sclera lonizing radiation and the 4th group of sclera lonizing radiation are separated with these projection lonizing radiation, these projection lonizing radiation and this projection lonizing radiation respectively on a rough averagely.
CNA2006800230045A 2005-04-26 2006-04-26 Methods for treating diseases of the eye Pending CN101208055A (en)

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US67516205P 2005-04-26 2005-04-26
US60/675,162 2005-04-26
US60/687,991 2005-06-06
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US60/709,737 2005-08-19
US60/776,023 2006-02-22

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN110091524A (en) * 2018-01-31 2019-08-06 北京金风科创风电设备有限公司 Technological equipment for curing and molding magnetic pole protective coating
CN111481294A (en) * 2020-04-26 2020-08-04 四川大学华西医院 Automatic injection robot system and automatic injection method
CN111970956A (en) * 2018-04-03 2020-11-20 林臣 Perimeter

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN110091524A (en) * 2018-01-31 2019-08-06 北京金风科创风电设备有限公司 Technological equipment for curing and molding magnetic pole protective coating
CN111970956A (en) * 2018-04-03 2020-11-20 林臣 Perimeter
CN111970956B (en) * 2018-04-03 2024-05-24 林臣 View meter
CN111481294A (en) * 2020-04-26 2020-08-04 四川大学华西医院 Automatic injection robot system and automatic injection method

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