EP0070306A1 - Dispositif et procede de chirurgie corneenne - Google Patents

Dispositif et procede de chirurgie corneenne

Info

Publication number
EP0070306A1
EP0070306A1 EP19820900735 EP82900735A EP0070306A1 EP 0070306 A1 EP0070306 A1 EP 0070306A1 EP 19820900735 EP19820900735 EP 19820900735 EP 82900735 A EP82900735 A EP 82900735A EP 0070306 A1 EP0070306 A1 EP 0070306A1
Authority
EP
European Patent Office
Prior art keywords
cornea
blade
pulses
pulse
probe
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP19820900735
Other languages
German (de)
English (en)
Inventor
Frederick B. Kremer
Edward R. O'brien
Original Assignee
Accutome Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Accutome Inc filed Critical Accutome Inc
Publication of EP0070306A1 publication Critical patent/EP0070306A1/fr
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/013—Instruments for compensation of ocular refraction ; Instruments for use in cornea removal, for reshaping or performing incisions in the cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/10—Eye inspection
    • H—ELECTRICITY
    • H03—ELECTRONIC CIRCUITRY
    • H03K—PULSE TECHNIQUE
    • H03K5/00—Manipulating of pulses not covered by one of the other main groups of this subclass
    • H03K5/01—Shaping pulses
    • H03K5/04—Shaping pulses by increasing duration; by decreasing duration

Definitions

  • Radial keratotomies involve the reshaping of the cornea to improve refractive error.
  • Fyodorov developed a technique in Moscow for making partial thickness radial corneal incisions for the reduction of myopia (nearsightedness) . Since that time, the procedure has been performed on approximately 1500 persons in the Soviet Union. A review of the risks and benefits of this procedure is expected to be published in the Annals of Opthamology. It is aniticipated that a major problem inherent in the procedure will be the possibility of corneal perforation. If such perforation occurs there is risk of infection and ensuing visual loss. One purpose of the present invention is therefore to reduce greatly this risk.
  • TTL transistor-transistor logic
  • ECL emitter-coupled logic
  • One approach that has been suggested for solving the high clock frequency problem discussed above would be to average individual measurement cycles at a lower clock rate. With this method, instead of the counter being reset after each single real-time pulse measurement, the counter is allowed to count up for a predetermined number of pulse echo cycles (such as 100) and therefore, the clock frequency could be decreased. This approach presents at least three problems. First, real-time measurements are not possible.
  • the present invention solves the above-described problems by providing an apparatus and method for automatically adjusting the depth of the cutting blade in response to electronic signals representing the local thickness of the cornea.
  • a pulse of energy preferably an ultrasonic pulse
  • the ultrasonic transducer has a plastic water filled probe tip which transmits the ultrosonic pulses directly to the anterior corneal surface (ACS) .
  • the ACS therefore is the first pulse to be received. This pulse arms a gate which then expects to receive a reflected pulse from the posterior corneal surface. (PCS) .
  • the two reflected pulses, from the ACS and the PCS, are converted into a single gage pulse which begins with the ACS pulse and ends with the PCS pulse.
  • This gate pulse is then stretched by a predetermined factor, such as 10, and its width is measured by counting the number of pulses emitted by an electronic clock during the time that the stretched gate pulse is present.
  • the width is converted to a corresponding distance (based on the acoustic velocity of the cornea) and is displayed digitally.
  • a separate hand-held blade may be manually adjusted to an appropriate length and in the second, an electronic signal representing the instantaneous measured thickness of the corneas at the position of the probe can be used to automatically control the cutting depth of an automated blade.
  • the cutting depth of the blade can be set by several different means—including either an electric motor, a pneumatic means, a hydraulic means, or an electro-magnetic means.
  • the blade can be adjusted to cut at a constant depth (as measured from the anterior corneal surface) or at a constant percentage of the total cornea! thickness, cr at a constant distance from the posterior corneal surface.
  • the probe and blade assembly is moved over the eye, corneal thickness is repeatedly and automatically remeasured and the cutting blade is automatically adjusted accordingly.
  • the apparatus performs the above-described steps a great many times, and the time required for each cornea measurement and blade adjustment cycle must therefore be extremely short.
  • Fig. 1 is a cross-sectional view of the probe touching the surface of the eye in an idealized, hypothetical application, wherein the end of the probe corresponds precisely to the outer surface of the eye.
  • Fig. 2 is a diagram showing the relative amplitudes and shapes of the pulse directed towards the eye and the two reflected pulses in the idealized configuration of Fig. 1.
  • Fig. 3 is an elevational view of a modified ultrasonic probe applied to the eye, wherein there is a thin layer of liquid film between the probe tip and the cornea and wherein the probe is solid.
  • / - Fig. 8 is a diagram showing the relative amplitudes of the reflected pulses as observed in the configuration of Fig. 7.
  • Fig. 10 is a cross-sectional view of the probe tip as applied to the cornea.
  • Fig. 11 is a block diagram indicating the conventional means by which reflected pulses are converted into a measurement of corneal thickness.
  • Fig. 12. is a schematic circuit diagram shoving the pulse stretcher of the present invention.
  • Figs. 1, 2 and 11 illustrate the ideal configuration for measuring corneal thickness.
  • the probe 1 contained a forward ultrasonic transducer 2 which emits ultrasonic waves, as indicated by the cashed lines 4, through a water medium 7, towards the eye 6.
  • the water medium 7 is distilled water, which water will remain within the interior cavity defined by the probe tip through the action of normal surface tension of the water.
  • Ultrasonic pulses are reflected from the anterior corneal surface 8 (ACS) and from the posterior corneal surface 10 (PCS) (i.e. the inner surface) and are reconverted into electrical energy at the transducer 2. It should be noted that in the ideal configuration of Fig. 1, the end of probe 1 lies precisely along anterior cornea surface 8.
  • Figs. 1, 2 and 11 There is a problem which can arise when the idealized configuration of Figs. 1, 2 and 11 is put into practice.
  • Fig. 5 wherein bubbles 38 and/or foreign matter 39 may be trapped in the water 7 or liquid film 30 and may further cause distortion in the received pulses.
  • intermediate peaks 40 and 41 may also be observed, these peaks being caused by reflections from the bubbles and foreign matter.
  • the pulses 42 and 43 correspond to the pulses 14 and 16 of Fig. 2, respectively, but may be reduced in amplitude, due to the poor transition through the mixture (liquid, bubbles and/or foreign matter) .
  • Fig. 7 An advantage inherent with the idealized configuration of Fig.l is illustrated in Fig. 7.
  • the probe 1 is seen to be slightly tilted so that the cornea echo pulse would be greatly reduced in magnitude.
  • the shape of such a reflected pulse is illustrated in Fig. 8.
  • the pulse 46 and the pulse 47 represent reflections from the cornea. This reduction in pulse amplitude would not allow the necessary gates to be triggered, thus avoiding a non-perpendicular and erroneous reading from being taken.
  • FIG. 1 Another advantage of the liquid filled probe tip is inherent in the design of Fig. 1. Should the tip of probe 1 not actually rest precisely on the corneal surface 8, there may be a liquid film similar to the film 30 formed between the tip 31 of probe 1 and the cornea surface 8. Because the probe 1 is liquid filled, only pulses 32 and 33 as shown in Fig. 4 from the anterior cornea surface 8 and the posterior surface 10, will be generated. Spurious pulse 34 would not be generated. This spurious pulse would result, however, with the solid probe tip. See Fig. 3.
  • the probe 301 is provided with a forward ring or tip 302 in position to contact the anterior cornea surface 8 in substantially circular overall contact to thereby discourage the generation of undefined cornea echo pulses 40 and 41 (Fig. 6) and to define a definite initial pulse 14 (Fig. 2) representing the anterior cornea surface 8.
  • Fig. 11 illustrates how the reflected pulses are converted into a usable numerical output.
  • the pulses 15 and 17, which are schematically illustrated in Fig. 11, correspond to the pulses 14 and 16 of Fig. 2 and represent the anterior cornea surface and the posterior cornea surface as described above.
  • these pulses are converted into a gate pulse 18, which begins with the anterior cornea surface pulse and ends with the posterior cornea surface pulse.
  • a clock 20, which generates a constant string of pulses 21 of equal amplitude and spacing, is connected to AND gate 23 at the input line 24.
  • the input line 25 is connected to the source of the gate pulse 18.
  • the AND gate 23 allows clock pulses to pass through the gate and the output of the gage 23 will be the pulses 27.
  • These output pulses 27 are counted in the usual manner by the counter 28. The number of such pulses therefore represents the width of the gate pulse 18, which in turn represents the thickness of the cornea.
  • FIG. 13 A block diagram of an apparatus which solves the above problems is illustrated in Fig. 13.
  • This apparatus is an ultrasonic pachometer, or "corneometer”.
  • the "corneometer” functions as follows: Pulses are generated by the clock 50, which preferably generates pulses having a frequency of 5 kHz. The clock pulses are used to excite an ultrasonic generator 52 which drives a transducer 54 which converts electrical pulses into ultrasonic energy in known manner. When the ultrasound beam from the transducer encounters a surface, or object, part of the energy is reflected back to the transducer. These reflected echo pulses are converted to electrical energy again by the transducer 54, and the echo pulses are fed into the amplifier 56 and to the absolute value rectifier 58.
  • the output of the clock 50 is extracted along the line 75 (designed by the label "TO A") and is connected to the point labeled "A", where it is passed through a 6-microsecond delay 76 corresponding to the nominal time required for the reflected echo pulse from the anterior surface to reach the transducer and a 1-microsecond window 77.
  • the 1-microsecond window allows for dimensional variations of the probe tip.
  • AND gate 70 will have a positive output only when pulse 63 is detected. A pulse not arriving within the proper window is treated by the circuit as a spurious pulse, and is discarded. If the pulse is spurious, the absence of a positive output in AND gate 70 will inhibit further measurement of corneal thickness during this particular cycle of operation.
  • the output of the AND gate 70 is passed through a 300 nanosecond delay 78 and a 1.5 microsecond window 79, the output of which is ended with the posterior cornea surface echo pulse 64.
  • the AND gate 74 will show a positive output upon detection of the posterior surface.
  • the output of the AND gate 70 is connected to the SET input of the flip-flop 84 and the output from the AND gate 74 is connected to the RESET side of flip-flop 84.
  • the output of the flip-flop 84 is therefore the gate pulse 86, whose leading edge 87 represents the beginning of the cornea anterior surface echo pulse and whose trailing edge 88 represents the cornea posterior surface echo pulse.
  • the gate pulse 86 corresponds to the gage pulse 18 shown in Fig. 1, but of course, the gate pulse 86 is, in practice, very narrow due to the thinness of the cornea, as described, above.
  • the gate pulse 86 is then directed into the pulse stretcher 90 which increases the width of the gate pulse by a predetermined factor, preferably ten.
  • the output of pulse stretcher 90 is connected to an input of the AND gate 92.
  • the other input of the AND gate 92 is an 8.1 MHz clock 94 which generates pulses in a manner similar to that of the clock 20 in Fig. 11. Because the pulses produced by the pulse stretcher 90 are ten times wider than they were originally, the clock 94 can operate at the relatively low frequency of 8.1 MHz and retain the desired accuracy and resolution in the readout.
  • the pulses leaving the AND gate 92 are counted in the counter 96, and the output of the counter 96 is displayed in a visual digital display unit 98 in an appropriate manner.
  • switch SI is turned off, switch S2 is turned on, and the operational amplifier 101 has an output which settles to a small negative voltage determined by -(RF/R+) 5 volts.
  • the solid state switches can be field effect transistors, but more preferably are a combination of field effect transistors to provide better isolation and sharper switching response.
  • the slightly negative output of the operational amplifier 101 biases the comparator 102 low, which in turn keeps the solid state switch S2 closed, by virtue of the invertor 103.
  • T Q is the output pulse width
  • ⁇ is the input pulse width
  • K is the time multiplication factor (gain)
  • L RF is changed.
  • the resistor RF sets the equilibrium state and therefore determines how much of the input pulse is spent in overcoming this negative state before the output starts. L will be zero when this effect exactly cancels the termination delay caused by the hysteresis resistor RH.
  • Figs. 14, 15 and 16 there are diagrammatically illustrated three approaches to show various systems that could be employed to automatically extend or retract a cutting blade 114 in response to changes in thickness of the cornea as measured by apparatus hereinbefore described.
  • the tip 110 of the cutting instrument 112 houses both the blade 114 and the ultrasonic probe 120 in side by side juxtaposition whereby the blade 114 will be automatically movable between respective retracted positions 116 as illustrated in full lines, to extended positions, as shown in broken lines, in response to variations in the cornea thickness as detected by the ultrasonic probe 120.
  • the echo pulses from the ultrasonic probe 120 are received at the corneometer thickness reader 122 wherein the cornea thickness is transmitted to the blade extension logic 124.
  • the blade extension logic is equipped with a manually preset cornea percent penetration selection switch 126 so that the cutting blade can always be maintained at a cutting depth corresponding to a predetermined, constant precentage of the thickness of the cornea.
  • the blade 114 could be adjusted automatically to maintain a predetermined distance from the posterior corneal surface or to cut at a constant depth, as measured from the anterior corneal surface.
  • the blade extension logic powers a pneumatic power supply 128, which through the feed and return lines 130, 132 functions the cylinder 132 to control reciprocal movement of the piston 136.
  • the piston rod 138 directly connects to the cutting blade 114 to move the blade between its retracted position 116 and extended position 118 substantially instantaneously in response to variations in the actual corneal thickness, as detected by the ultrasonic probe 120.
  • a safety stop 140 is affixed to the piston rod 138 in position to be engaged by the adjustable set screw 142 to precisely set the extended limit of the blade extended position 118.
  • a position detector sensor 144 can be employed to continuously sense the position of the cutting blade as detected by the sensing coil 146.
  • the cutting instrument 112, blade 114, ultrasonic probe 120, corneal thickness reader 122, blade extension logic 124 and cornea percent penetration selection switch 126 are identical to the apparatus shown in Figs. 14 and 15.
  • the blade extension logic 124 controls extension and retraction of the cutting blade 114 through a stepping motor drive 154 which may include a driving sprocket 156 and screw type blade extension cable 158.
  • a safety stop 140 and adjustable set screw 142 are provided in known manner to precisely limit the maximum possible depth of cut.
  • a position detector sensor 144 can be employed in conjunction with the sensing coil 146 to monitor the exact position of the cutting blade 114 relative to the cutting instrument tip 110.
  • th preferred embodiment is only illustrative of the manner in which the present invention can be practiced.
  • the pulses could be electromagnetic and not ultrasonic.
  • the precise manner in which the probe and blade assembly is constructed can be varied.
  • the mechanism for advancing the blade may use electromagnetic, hydraulic, or pneumatic force. It is understood that these and other variants are included within the scope of the claims appended hereto.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Vascular Medicine (AREA)
  • Nonlinear Science (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Eye Examination Apparatus (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)

Abstract

Dispositif permettant de mesurer l'epaisseur de la cornee et de regler la profondeur d'une lame chirurgicale (114) par rapport a l'epaisseur locale de la cornee. L'epaisseur corneenne est mesuree en dirigeant d'abord des impulsions ultrasonores vers la cornee et en calculant l'intervalle entre les impulsions reflechies (14, 16). Le dispositif comprend aussi un reducteur d'impulsions (90) permettant d'augmenter la largeur de l'impulsion representant l'intervalle entre les impulsions reflechies depuis les surfaces interieure et exterieure de la cornee (10, 8) de maniere a pouvoir mesurer avec precision le temps entre les impulsions au moyen d'une horloge electronique conventionnelle a basse frequence (94). La presente realisation comprend en outre des moyens de porte electroniques (70, 74) permettant de rejeter des impulsions parasites
EP19820900735 1981-01-23 1982-01-22 Dispositif et procede de chirurgie corneenne Withdrawn EP0070306A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US22775381A 1981-01-23 1981-01-23
US227753 1981-01-23

Publications (1)

Publication Number Publication Date
EP0070306A1 true EP0070306A1 (fr) 1983-01-26

Family

ID=22854315

Family Applications (1)

Application Number Title Priority Date Filing Date
EP19820900735 Withdrawn EP0070306A1 (fr) 1981-01-23 1982-01-22 Dispositif et procede de chirurgie corneenne

Country Status (3)

Country Link
EP (1) EP0070306A1 (fr)
CA (1) CA1194978A (fr)
WO (1) WO1982002485A1 (fr)

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5308355A (en) * 1992-11-06 1994-05-03 Alexander Dybbs Ophthalmic surgical instrument and method
US5486188A (en) * 1993-11-15 1996-01-23 Smith; Alan D. Keratoscopic surgical instrument for making radial and arcuate corneal incisions
US6315727B1 (en) * 1999-09-29 2001-11-13 Cornel Research Foundation, Inc. Method and apparatus for ultrasound corneal scanning
CN102599939B (zh) * 2012-03-27 2013-08-07 徐州市凯信电子设备有限公司 基于脉冲细分法的角膜厚度测量方法

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Publication number Priority date Publication date Assignee Title
SU428743A1 (ru) * 1972-03-14 1974-05-25 Б. Н. Алексеев Устройство для ультразвукового исследованияглаза
US3827287A (en) * 1972-07-05 1974-08-06 Western Electric Co Methods of and apparatus for measuring the thickness of successive sections of a cable jacket
US3869624A (en) * 1973-05-21 1975-03-04 Nasa Peak holding circuit for extremely narrow pulses
FR2292457A1 (fr) * 1974-11-28 1976-06-25 Guiset Jacques Instrument chirurgical de diagnostic par ultra-sons et d'intervention simultanee
US3986496A (en) * 1975-03-06 1976-10-19 Medtronic, Inc. Apparatus for sensing and transmitting a pacemaker's stimulating pulse
US4009402A (en) * 1975-08-20 1977-02-22 Sperry Rand Corporation Time expander circuit for a frequency-to-digital converter
DE2855819C3 (de) * 1977-12-26 1981-05-21 Takeda Riken Kogyo K.K., Tokyo Zeitintervall-Meßeinrichtung
US4301360A (en) * 1979-10-25 1981-11-17 Tektronix, Inc. Time interval meter
US4261367A (en) * 1979-10-25 1981-04-14 Radionics Limited Apparatus for measuring the axial length of an eye

Non-Patent Citations (1)

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Title
See references of WO8202485A1 *

Also Published As

Publication number Publication date
WO1982002485A1 (fr) 1982-08-05
CA1194978A (fr) 1985-10-08

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Inventor name: KREMER, FREDERICK B.