DE102017104673B4 - Attachment for an optical fiber for the treatment of glaucoma, method for making the attachment and optical fiber assembly - Google Patents

Abstract

An optical waveguide head (100) directing light from a proximal end (108) to a distal end, the head (100) for treating glaucoma, comprising a proximal end (108) having a receiving device (111) for an optical fiber cable (102 '), - a distal end (108') with a spherical-concave surface (103) for resting on the human eye in the area of the sclera of the cornea or the limbus, - one at the proximal end ( 108) for receiving the optical waveguide (102 '), which merges into a further bore (106), characterized in that the bore (106) reaches just before the spherical-concave surface (103) and does not break through ,

Description

The invention relates to an attachment for an optical waveguide, which guides light from a proximal end to a distal end, wherein the attachment for the treatment of glaucoma is provided, comprising a proximal end with a receiving device for an optical fiber cable, a distal end with a spherical-concave Surface for abutment on the human eye in the area of the sclera of the cornea or the limbus, a bore at the proximal end for receiving the optical waveguide, which merges into a further bore.

For the treatment of a pathologically increased intraocular pressure (glaucoma) in humans, it is known to open the natural outflow routes for the eye fluid, which in the trabecular meshwork in the peripheral region of the iris of the human eye by a laser treatment. Depending on the surgical technique, a distinction is made between a trabeculectomy and a trabeculotomy. The exact details of these surgical techniques are subject to the medical expertise of ophthalmic surgeons.

In order to direct laser light, which is used for ablation or cutting of the depending on treatment technique of the corresponding tissue of the eye to be treated, to the application site, it is known to provide laser light by means of optical waveguides, wherein at the end of the optical waveguide a special is arranged on the application adapted optical fiber tip. This optical fiber tip has a spherical-concave surface adapted to the ball diameter of the sclera, cornea or limbus of the human eye. Since this optical fiber tip definitely has a complex shape, this is usually sprayed from plastic and holes and threads are introduced after injection into the optical fiber tip. Tips made of plastic are not suitable for transmitting laser light for ablation or for cutting biological tissue, since the absorption of the laser light by the plastic would lead to the destruction of the tip itself. Clear plastics are usually polymethyl methacrylate (PMMA), polycarbonate (PC) or polystyrene. (PS) In order to avoid the penetration of the plastic by the high-energy laser light, an opening to a channel is provided approximately in the middle of this spherical-concave area through which a tip of the optical waveguide protrudes. The optical fiber tip thus constructed enables the ophthalmic surgeon to reproducibly apply the optical fiber to the human eye so that both the focal point of a lens incorporated in the distal end of the optical fiber and the angle at which the laser light is incident on the human eye Setting up between individual treatments can be reproduced. The use of this optical fiber tip thus improves the treatment success compared to a hands-free placement of the optical fiber tip.

In the international PCT application WO 2014/162268 A1 discloses an optical fiber tip having a hockey stick shape intended to improve the application of laser light to laser ablation of human tissues. In this tip, laser light is derived by internal reflection and refraction of light from the tip. The optical fiber tip disclosed therein is suitable for ablation of tissue of larger organs, wherein in the WO 2014/162268 A1 as an application example of the treatment of benign prostate hyperplasia is called and differs in its structure from the paper presented here.

In the US patent application US 2010/0 076 419 A1 there is disclosed a handpiece with which a surgeon can place an optical fiber on the human eye for the treatment of glaucoma. As a positioning aid, the handpiece has a concave surface whose concave radius corresponds to the convex radius of the human. From an opening in the concave surface peeks out an optical fiber, which is pressed with the handpiece into the surface of the sclera or the limbus. In the pressed-in state, the laser is switched on in pulses and ablates tissue from the surface of the eye.

In the US patent US 8 914 098 B2 a probe for the diagnosis of the retina is disclosed. This probe has a handpiece that uses laser light to screen the human eye for vision through invasive diagnostics. At the tip of the handpiece, laser light can be controlled in a controlled manner by means of optical elements.

In the international patent application WO 2009/158 517 A2 An optical imaging system for use in implantation in the human eye is disclosed. The system includes a handpiece which can be inserted intraoperatively into the limbus in the area of Schlemm's canals into the human eye.

The human eye is constantly filled with a tear film. Furthermore, the human eye always communicates with the mouth and throat via the tear duct. When using the optical fiber tip described above, tear fluid is drawn by capillary action into the channel of the optical fiber tip and thus contaminates the optical fiber tip. Since the Optical waveguide is housed in a sheath, which covers the optical waveguide similar to an insulation of an electric cable, the tears entering during use can also reach into the space between optical waveguide and sheath, where they can not be completely removed. The space between fiber optic cable and sheath also protects viruses and bacteria from possible autoclaving, so even autoclave disinfection does not provide safe infection protection when used repeatedly between different patients. As a result, the optical fiber, which consists of optically high-purity quartz glass, and the optical fiber tip must be destroyed after a single use. The material costs for a one-time treatment are thereby driven upwards.

The object of the invention is to provide a reusable attachment for an optical waveguide for the treatment of glaucoma.

The object according to the invention is achieved by an attachment, by a method for producing the attachment and by an optical waveguide arrangement. In particular, the object is achieved in that the bore for receiving the light guide extends to just before the spherical-concave surface and this does not break. Further advantageous embodiments are specified in the subclaims to claim 1.

According to the idea of the invention, it is thus provided that the bore for receiving the optical waveguide does not allow the concave contact surface to be broken in order to avoid capillaries. Without capillaries it is ensured that tear fluid or wound fluid, which exits the tissue during the irradiation, is not drawn into the optical waveguide cable, whereby the problems described above in the cleaning and disinfection of the generic articles are reliably avoided.

Depending on the configuration of the tip of the optical waveguide, the exiting laser light is fanned out, focused or the laser light emerges collimated from the optical waveguide. Since the article itself has a different refractive index from air, an effect such as an optical refractive element is inevitable. Since the bearing surface of the attachment for the optical waveguide is curved spherically concave, this acts like a concave lens which has a widening the exit angle of the exiting laser light effect. In an embodiment of the invention, it is therefore provided that the region of the spherical-concave surface in the region of the extended bore has a diffractive element, such as a diffractive lens, or a stepped or un-graded Fresnel zone plate, which has an effect that focuses the exiting laser light. The spherical-convex curvature or the curvature of a solidified droplet of melt from the material of the attachment provides an effect that focuses the exiting laser light.

In order to avoid that the material of the attachment during use itself takes damage by absorption of high-energy laser light is provided in a further embodiment of the invention that the article itself consists of quartz glass or a biocompatible and high-temperature-resistant glass such as Ormocere. Since the introduction of bores in quartz glass, although in principle possible, but requires an increased expenditure on equipment in the production, it can be provided to produce the article by a sol-gel process. For this purpose, a concentrated silicate solution, which tends to gel, used as a molding material for a mold. The shape is much larger than the article to be produced. The gelled article body is then subjected to heat treatment under controlled conditions, whereby the water contained in the gel evaporates, leaving behind an ever-shrinking body. This process is continued with a gradual increase in temperature until the silicate contained in the gel solidifies to quartz glass. To drive out the last water from the resulting quartz glass, temperatures between 1,000 ° C and 1,400 ° C in the last temperature interval of the manufacturing process are needed. The sol-gel process offers the opportunity to pour the attachment downright cold and fix it later by heat treatment. In this case, the article can be formed of two parts in order to mold internal structures during casting, which cause no problems in the demolding of the gel blank, such as undercuts. In this case, the manufacturing method is characterized by creating two mutually corresponding halves of the article by a sol-gel process, wherein the two mutually corresponding halves of the attachment made of quartz glass, joining each two mutually corresponding halves to an essay and sintering of the two mutually corresponding halves at a temperature between 1,000 ° C and 1,400 ° CC, preferably between 1,080 ° C and 1,180 ° C, so that they combine to form a coherent essay. Furthermore, it is also possible to glue the two mutually corresponding halves or to solder with low-melting solder glass. Within the attachment, an internal thread may be formed on the proximal side, undercuts or a roughening to form an ideal base layer. The internal thread on the proximal side serves to screw the attachment onto a distal end of an optical fiber cable.

In a particular embodiment, an optically effective inner life can be generated by the production of the article by joining two mutually corresponding halves. This can be constructed so that approximately in the middle of the essay acting as a lens refractive or diffractive element is present. This lens-acting element sheds light on a diffraction grating located inside the cap where the light is diffracted more or less by the action of the diffraction grating corresponding to the wavelength of the light in the internal reflection. From the first grid on a first inner side, the light then strikes a second diffraction grating on another inner side of the attachment, where it is coupled back into the refractive or diffractive element acting as a lens and redirected towards the source, the returning light passing through a semitransparent light Mirror is decoupled and by a high-resolution spectrometer, which is optimized for the wavelength range of the reflected light is detected. When using the attachment, this can heat up strongly due to the high power of the laser light. The article expands thermally. The thermal expansion results in a change in the lattice constant of the diffraction grating, which changes the main wavelength of the back-reflected light. By detecting a change in the main wavelength of the back-reflected light, the temperature of the tip can thus be determined.

In order to prevent capillary action between the abutting contact surfaces, namely the proximal end of the attachment and the distal flange or the distal threaded collar of the optical waveguide, tear fluid and / or wound fluid, which may be contaminated with infectious germs, reach the interior of the optical waveguide cable, it can be provided that the proximal end has an autoclavable flange seal. The attachment and the optical fiber can thus be separated from each other after use, if a detachable connection is provided, and the attachment can be cleaned in an ultrasonic bath or in a medical disinfection system and then autoclaved. This makes it possible to reuse the usually high-priced laser probe without the risk of infection from patient to patient. If, however, the attachment is provided with an adhesive surface at the proximal end, then the attachment can be adhesively bonded permanently and cleaned together with the optical waveguide in an ultrasonic bath or in a medical disinfection system and then autoclaved

A special function is the spherical-concave surface for support to the human eye. It is envisaged that this concave surface rests directly on the eye and that depending on the desired surgical intervention, the support surface rests on the sclera or even on the cornea. For this purpose, it is provided that the curvature of the spherical-concave surface has a spherical radius of curvature 10 mm to 25 mm, preferably 22 mm to 25 mm. The smaller diameters correspond to the spherical radius of curvature of the cornea, namely in the range of 10 mm to 11 mm, wherein the radius of curvature does not correlate strongly with the body size of the patient. The larger radii of curvature correspond to the average diameter of the eyeball in the area of the sclera of approx. 23 mm, whereby, depending on the size of the eye, the spherical radius of curvature lies between 22 mm and 25 mm.

If the area of the spherical-concave surface in the region of the extended bore has a refractive element, such as a spherical-convex curvature, which has an effect that focuses the exiting laser light, the refractive element can be introduced in various ways. On the one hand, it is possible to mold in the region of the spherical-concave surface only an approximately spherical-convex or cylindrical element which, after completion of the blank, is flattened with a very small and pointed high-temperature flame, such as an acetylene flame or oxyhydrogen flame. This melts only about spherical-convex or cylindrical element and during the melting process, the forming surface tension of the melt draws the molten material in a wetting droplet shape, which comes very close to the spherical-convex shape. As a result, the microlens part of the monolithic overall shape and must not be treated later. This type of production has the advantage that the surface of the refractive element does not have to be specially annealed, because the melting process in the clean and low-emissivity flame creates a surface of sufficient optical quality. On the other hand, it is also possible to place a biconvex or plano-convex microlens in the region of the spherical-concave surface, which lies in the extension of the bore for the optical waveguide. In this case, the radius of curvature of the biconvex microlens on the side lying on the spherical-concave surface of the attachment corresponds to the radius of curvature of the spherical-concave surface. By sintering the biconvex lens and the attachment are connected together. Similarly, it is possible to move with the plano-convex lens, wherein the flat side rests on the spherical-concave surface. It is thus advantageously provided to place a biconvex or plano-convex lens on the spherical-concave surface and then sinter the biconvex or plano-convex lens and the spherical-concave surface, so that the lens and the spherical-concave surface combines with loss of an interface and is optically transparent.

• 1 ein Aufsatz für einen Lichtwellenleiter zur Behandlung eines Glaukoms in einer Ansicht von vorn auf die sphärisch-konkave Fläche zur Auflage auf das zu behandelnde Auge aus dem STAND DER TECHNIK,
• 1' der Aufsatz aus 1 aus dem STAND DER TECHNIK in einer Ansicht von der Seite,
• 1" der Aufsatz aus 1 aus dem STAND DER TECHNIK in einer Ansicht von der Seite, mit eingesetztem Lichtwellenleiter,
• 2 ein erfindungsgemäßer Aufsatz für einen Lichtwellenleiter zur Behandlung eines Glaukoms in einer Ansicht von vorn auf die sphärisch-konkave Fläche zur Auflage auf das zu behandelnde Auge,
• 2' der Aufsatz aus 2 in einer Ansicht von der Seite,
• 2" der Aufsatz aus 2 mit eingesetztem Lichtwellenleiter,
• 3 der Aufsatz aus 2 mit als Widerhaken wirkenden Flügelprofilen,
• 4 eine Skizze zur Darstellung der Herstellung eines refraktiven Elements in der sphärisch-konkaven Fläche des Aufsatzes,
• 5 eine Skizze zur Darstellung eines Ansatzes, der aus zwei Hälften besteht und sowohl ein refraktives als auch ein diffraktives Element aufweist,
• Fog. 6 eine Skizze zur Darstellung eines Ansatzes, der aus zwei Hälften besteht und mehr als eine Bohrung für je einen Lichtwellenleiter aufweist.

The invention will be explained in more detail with reference to the following figures. It shows:

• 1 an attachment for an optical waveguide for the treatment of glaucoma in a view from the front on the spherical-concave surface for resting on the eye to be treated from the prior art,
• 1' the essay 1 from the state of the art in a view from the side,
• 1 "the essay 1 from the prior art in a view from the side, with inserted optical waveguide,
• 2 an optical waveguide attachment according to the invention for the treatment of glaucoma in a front view of the spherical-concave surface for resting on the eye to be treated,
• 2 ' the essay 2 in a view from the side,
• 2 "the essay 2 with inserted optical waveguide,
• 3 the essay 2 with barbed wing profiles,
• 4 a sketch to illustrate the production of a refractive element in the spherical-concave surface of the essay,
• 5 a sketch to illustrate an approach, which consists of two halves and has both a refractive and a diffractive element,
• Fog. FIG. 6 shows a sketch for illustrating a projection which consists of two halves and has more than one bore for one optical waveguide each.

In 1 is an essay 1 for an optical fiber 2 for the treatment of glaucoma from the prior art in a view from the front, ie on the spherical-concave surface 3 shown to rest on the eye to be treated. The drawn net in the spherical-concave area 3 serves here only to represent the curvature of the surface and has no real counterpart. The spherical-concave surface 3 is on a shoe 4 arranged as a distal end 8th' on the tower 1 extends and toward the proximal end 8th in a tapered neck 5 passes. In the rejuvenated neck 5 is a hole 6 containing the spherical-concave surface 3 breaks through to the human eye and an opening 7 in the spherical-concave surface 3 forms. Below tapered neck 5 closes around a bottle-shaped proximal end 8th of the essay 1 on, which is an extended hole 9 which is at the foot 10 the bottle-shaped proximal end 8th in an internal thread 11 passes.

In 1' is the essay off 1 in a side view on the shoe 4 shown. The radius of curvature is clear K the spherical-concave surface 3 to recognize, depending on the application between 10 mm and 25 mm. The smaller radius range in the range of 10 mm to 11 mm is used for a support on the cornea of the human eye, while the radius range in the range between 22 mm and 25 mm is used for resting on the sclera.

In 1 "is finally shown as an optical fiber cable 2 ' to the proximal end 8th of the essay 1 screwed on and with the fiber optic cable 2 ' extending optical waveguide 2 through the opening 7 in the spherical-concave surface 3 enough. It is in the distal end of the optical waveguide 2 formed a lens which the exiting laser light 15 focused. In the very narrow annulus R between the fiber optic cable 2 and the hole 6 during use tears and / or wound fluid is drawn by capillary action. The capillary action pulls the liquids up to the exit point of the optical waveguide 2 from the jacket 2 ' and there the liquids can be in the space between sheathing 2 ' and optical fibers 2 occur where they can no longer be removed and where infectious germs are protected from autoclaving.

In 2 is an inventive made of quartz glass in the sol-gel process essay 100 for an optical fiber 102 shown directing light from a proximal end to a distal end, wherein the attachment 100 is intended for the treatment of glaucoma. The drawn net in the spherical-concave area 103 serves here only to show the curvature and has no real counterpart. The spherical-concave surface 103 is on a shoe 104 arranged as a distal end 108 ' on the tower 100 extends and into a tapered neck 105 passes. In the rejuvenated neck 105 is a hole 106 containing the spherical-concave surface 103 however, does not break through to the contact with the human eye and does not form an opening. Below the tapered neck 105 closes around a bottle-shaped proximal end 108 of the essay 100 that's an extended hole 109 which is at the foot 110 the bottle-shaped proximal end 108 in an internal thread 111 passes. At the thread collar 112 or on the annular foot 110 of the essay 1 there is an autoclavable flange gasket 113 , This flange seal 113 Prevents the use of potentially infectious liquids by capillary action in the interior of the fiber optic cable 102 ' to be pulled. Essential to this essay 100 is that the bore 106 the spherical-concave surface 103 does not break through and that the bore 106 until just before the spherical-concave surface 103 enough. To the escaping laser light 115 to focus, is provided in this embodiment of the invention, that the area of the spherical-concave surface 103 in the area of the extended bore 106 a refractive element 120 has, such as a spherical-convex curvature, which is an emerging laser light 115 focused. This spherical-convex curvature can already be molded in the original cold-casting process in the sol-gel process and can optionally be drawn into a teardrop shape by flaming and melting, with the drop shape being formed by the surface tension of the melt itself. However, it is also possible to place a microlens at the appropriate place after the cold-casting and the temperature treatment of the attachment and there by sintering with the attachment 100 connect to.

In 3 Finally, it is an alternative embodiment of the article 100 represented, which is characterized in that the receiving device in the proximal end 108 inwardly and towards the distal end directed and circular wing profiles 111 ' that when plugging in an optical fiber cable 102 ' with a corresponding profile like barbs and the essay 100 on the fiber optic cable 102 ' hold tight. In this illustration is the essay 100 along the cutting plane AA in 2 ' cut. The obliquely hatched areas show the cutting plane through the attachment 100 ,

In 4 is finally shown in a sketch, as in an alternative method, the refractive element 120 on the spherical-concave surface 103 can be generated. In a first step, a plano-convex or a biconvex microlens 121 in place on the spherical-concave surface 103 placed so that these above the hole 106 rests. Then in a second step the essay 100 and the microlens 121 by sintering at a temperature between 1,000 ° C and 1,400 ° C, or by blunting with an oxyhydrogen flame or with an acetylene flame, so that the biconvex or plano-convex microlens 121 and the spherical-concave surface 103 combine with loss of an interface and become optically transparent. Finally, the refractive element arises 102 in the area of the extended bore 106 that's a fiber optic cable 2 in bore 106 emerging laser light 115 has a focusing effect.

In 5 are two mutually corresponding essay halves 200 ' and 200 ' shown, which are mirror-inverted in this case. The mirror symmetry is not absolutely necessary, but depends on the desired content. It is important that the neck halves correspond to each other. Based on the two mutually corresponding essay halves 200 ' and 200 ' It can be seen how an inner refractive element in the form of two approximately aligned concave surfaces is formed, wherein the aligned concave surfaces as a pair of concave surfaces 201 ' and 202 ' as well as concave surfaces 201 ' and 202 ' available. The pairs of surfaces from the concave surfaces 201 ' and 202 ' as well as concave surfaces 201 ' and 202 ' together form a biconcave lens that expands the aperture angle of an optical light beam passing through it. As a result of the widening, the light beam which is refracted outwards strikes a first diffraction grating 203 ' or 203 ", where it differs and diffracts to different extents depending on the wavelength of the light, thereby expanding the light beam again by separating the wavelength range of the light beam L and hits another diffraction grating 204 ' respectively. 204 ' where the light beam is diffracted and reflected differently by wavelength of the light. The double diffraction on two diffraction gratings results in a high resolution of the wavelength separation. Through the second diffraction grating 204 ' respectively. 204 ' reflected light is returned to the optical fiber through the biconcave lens described above L passed where it is coupled after passage through a semitransparent mirror S and in a spectrometer D spectrally analyzed.

At a temperature change of the tip 200 from the mutually corresponding essay halves 200 ' and 200 ' Due to the thermal expansion, the lattice constant of the diffraction grating changes 203 ' respectively. 203 ' and 204 ' respectively. 204 ' , whereby the main wavelength returned to the light guide changes. This change can be detected after decoupling and assigned to a predetermined temperature. The refractive element and the diffraction gratings together thus form a good indicator with a temperature-dependent wavelength selection for detecting a temperature change.

In 6 are two mutually corresponding essay halves 300 ' and 300 ' shown, which are also mirrored in this case. The two neck halves 300 ' and 300 ' show how the inner structure of the later approach can not be rotationally symmetric, for example, as in this example, two different optical fibers 302 and 302 ' with various functions to bring to the treatment site, using a first optical fiber 302 within the approach of a first recess 306 is arranged and a second optical fiber 302 ' within the approach of a second recess 306 ' is arranged, with the recesses 306 and 306 ' to a common recess 309 are adjacent and connected to this. It is therefore provided that the approach to be created from the halves has an inner structure deviating from the rotational symmetry, to more than one optical waveguide 302 . 302 ' with various functions to bring to the treatment site, with a first recess 306 for a first optical fiber 302 is disposed within the approach, and wherein a second recess 306 ' optical fiber 302 ' is arranged within the approach.

In the example shown here, it is provided that a first optical waveguide 302 is constructed as a multimode fiber and can conduct high light output to the treatment site. Since in the treatment with high light output, the temperature at the treatment site can be very high, namely in temperature ranges of more than 100 ° C to even 1,000 ° C can range, it is provided that a second optical waveguide 302 ' constructed as a single-mode fiber, which is at its peak 303 ' a registered fiber Bragg grating (Fiber Bragg grating) has inscribed. When writing a fiber Bragg grating in an optical waveguide, the structure of the fiber of the optical waveguide is changed with a short-time laser, so that the refractive index of the fiber material of the optical waveguide at the treated with the short-term laser location slightly from the refractive index of the environment of the same fiber material different. As a result, a partial reflection of the light conducted through the fiber of the optical waveguide takes place at the resulting interface between regions of different refractive index. If the refractive index of the fiber of the optical waveguide in short, successive sections at a distance of λ / 4 with respect to a reference wavelength changed so that form pairs of fibers in the fiber material of the optical waveguide, which together have a length of λ / 4 with respect to a reference wavelength Thus, these fiber Bragg gratings act like an antireflective coating on a photographic lens, but which is very wavelength specific. The reference wavelength is reflected and sent back to the source of the light. Now warms the optical fiber 302 ' at the top 303 ' , the thermal expansion causes the length of the section pairs to change, so that the back-reflected wavelength changes. On the basis of the change in the reflected-back wavelength, it is thus possible to measure the temperature in the attachment in which a detector is used D the wavelength of the reflected light is accurately determined. For the correct functioning of the thermometer thus constructed, it is only necessary to use the fiber Bragg grating only at the top 303 ' of the optical fiber.

LIST OF REFERENCE NUMBERS

1

essay

2

optical fiber

2 '

optical fiber

2 '

jacket

3

spherical-concave surface

4

shoe

5

neck

6

drilling

7

opening

8th

proximal end

8th'

distal end

9

drilling

10

foot

11

inner thread

15

laser light

100

essay

102

optical fiber

102 '

optical fiber

102 '

jacket

103

spherical-concave surface

104

shoe

105

neck

106

drilling

108

proximal end

108 '

distal end

109

drilling

110

foot

111

inner thread

111 '

wing-shaped profile

112

threaded collar

113

flange

115

laser light

120

refractive element

121

microlens

200 '

top half

200 '

top half

201 '

concave surface

201 '

concave surface

202 '

concave surface

202 '

concave surface

203 '

diffraction grating

203 '

diffraction grating

204 '

diffraction grating

204 '

diffraction grating

300 '

top half

300 '

top half

302

optical fiber

302 '

optical fiber

306

recess

306 '

recess

309

recess

D

detector

L

optical fiber

K

radius of curvature

R

annulus

Claims (12)

An optical waveguide attachment (100) for directing light from a proximal end (108) to a distal end, the attachment (100) for treating glaucoma, comprising - a proximal end (108) having a receiving device (111) for an optical fiber cable (102 '), - a distal end (108') with a spherical-concave surface (103) for resting on the human eye in the area of the sclera of the cornea or the limbus, - one at the proximal end ( 108) present bore (109) for receiving the optical waveguide (102 '), which merges into a further bore (106), characterized in that the bore (106) extends just before the spherical-concave surface (103) and this not breaks through. Essay after Claim 1 , characterized in that the area of the spherical-concave surface (103) in the region of the extended bore (106) - a refractive element (120), such as a spherical-convex curvature, - a diffractive element, such as a diffractive lens, or - a stepped or ungraded Fresnel zone plate having an outgoing laser light (115) focusing effect. Essay after Claim 1 or 2 , characterized in that it consists of quartz glass or of a biocompatible and high temperature resistant glass such as Ormocere. Essay after one of the Claims 1 to 3 , characterized in that the receiving device in the proximal end (108) has an internal thread (111) for screwing in an optical waveguide cable (114 '), wherein the proximal end (108) has an autoclavable flange seal (113) or an adhesive surface. Essay after one of the Claims 1 to 4 , characterized in that the curvature of the spherical-concave surface (103) has a spherical curvature radius K of 10 mm to 25 mm, preferably 22 mm to 25 mm. Essay after one of the Claims 1 to 5 , characterized in that it is autoclavable. Essay after one of the Claims 1 to 6 , characterized in that approximately in the center of the attachment acting as a lens refractive or diffractive element, for example in the form of concave surfaces (201 ', 201 ", 202", 202') is present, said acting as a lens element light on a first diffraction grating (204 ', 204 ") disposed inside the cap where the light is diffracted more or less by the action of the diffraction grating (204', 204") corresponding to the wavelength of the light in the internal reflection , and wherein the light from the first diffraction grating (204 ', 204 ") on a first inner side of the attachment then strikes a second diffraction grating (203', 203") on another inner side of the attachment, where the light returns to that position Lens acting refractive or diffractive element is coupled and returned to the source. Essay after one of the Claims 1 to 7 characterized in that it has an internal structure other than rotational symmetry for bringing more than one optical waveguide (302, 302 ') of different functions to the treatment site, wherein a first recess (306) for a first optical fiber (302) within the Approach is arranged, and wherein a second recess (306 ') optical waveguide 302' is disposed within the approach. An optical waveguide arrangement for the treatment of glaucoma, comprising an attachment for an optical waveguide Claim 1 to 8th , Method for producing an attachment (100) for an optical waveguide according to one of the Claims 1 to 9 characterized by - creating two mutually corresponding halves of the attachment (100) by a sol-gel method, wherein the mutually corresponding halves of the attachment of or from a biocompatible and high-temperature-resistant glass such as Ormocere arise, - joining the two each sintering or gluing the two mutually corresponding halves or soldering the two mutually corresponding halves with solder glass, wherein the sintering at a temperature between 1000 ° C and 1400 ° C, preferably between 1080 ° C and 1180 ° C is performed so that they connect to a coherent essay (100). Method according to Claim 10 , characterized by a flattening of the spherical-concave surface (103), so that the spherical-convex curvature is drawn by the surface tension of the melt in a spherical-convex shape. Method according to Claim 11 characterized by placing a bi-convex or plano-convex microlens (121) on the spherical-concave surface (103) and then sintering or flattening the bi-convex or plano-convex microlens (121) and the spherical-concave surface (103) such that the bi-convex or Planoconvex microlens (121) and the spherical-concave surface (103) combine with loss of an interface and become optically transparent.

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