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
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
  • A61F9/00827—Refractive correction, e.g. lenticle
• • B—PERFORMING OPERATIONS; TRANSPORTING
  • B23—MACHINE TOOLS; METAL-WORKING NOT OTHERWISE PROVIDED FOR
  • B23K—SOLDERING OR UNSOLDERING; WELDING; CLADDING OR PLATING BY SOLDERING OR WELDING; CUTTING BY APPLYING HEAT LOCALLY, e.g. FLAME CUTTING; WORKING BY LASER BEAM
  • B23K26/00—Working by laser beam, e.g. welding, cutting or boring
  • B23K26/14—Working by laser beam, e.g. welding, cutting or boring using a fluid stream, e.g. a jet of gas, in conjunction with the laser beam; Nozzles therefor
  • B23K26/1462—Nozzles; Features related to nozzles
• • 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
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
  • A61F2009/00872—Cornea

Definitions

• the invention relates to a method for removing waste products that arise during the removal of material in transparent objects by laser-induced plasma formation, in particular in the intrastromal ablation of tissue from the cornea of the eye for ametropia correction.
• Heisterkamp et al "Application of ultrashort laser pulses for intrastromal refractive surgery," Graefes Arch Clin Exp Ophthalmol 238 (1), 2000 , 33-9; G. Maatz, A. Heisterkamp, H. Lubatschowski et al: "Chemical and physical side effects at application of ultrashort laser pulses for intrastromal refractive surgery," J. Opt. A: Pure Appl. Opt 2 , 2000, 59-64; A. Vogel, J. Noack, K. Hahen et al: "Laser-induced breakdown in the eye at pulse durations from 8 0 ns to 1 00 fs, "SPIE- Proceedings, Vol.
• the thickness and curvature of the cornea can be changed without at least mechanically affecting the cornea in the central area of the eye.
• the incision of the cornea means permanent extensive damage. Errors when folding back the flap essentially determine the achievable quality of the optical correction.
• the incision of the cornea greatly changes its mechanical properties. This can lead to the fact that a measurement of the intraocular pressure using the usual applanation tonometry can lead to completely wrong values.
• C. Knapp, H. Mittelviefhaus "Almost blindness after LASIK, poster for the 99th conference of the German Ophthalmological Society, Berlin, September 29 - January 2, 2001, a case was demonstrated in which glaucoma was overlooked in this way, which led to a massive Eye damage resulted.
• the object of the invention is therefore to remove waste products arising in laser-induced plasma formation in transparent objects as quickly as possible and with little damage.
• At least one channel preferably with a capillary diameter, is created or opened between the removal area of the laser material processing inside the object and its outer surface for a free or forced discharge of the solid, liquid or gaseous waste products resulting from plasma formation.
• at least a small channel that deliberately affects the object or its surface only in capillary size is accepted in order to extract the waste products formed during the plasma formation from the interior of the object without further mechanical damage to the object, which is particularly important for the cornea of the Eye is significant.
• the surface of the cornea is not mechanically processed to change its shape are needed, but a defined material removal in the cornea is possible even with plasma formation of the material to be removed, the waste products escaping freely or forcedly without the cornea having to be cut open over a large area.
• the at least one capillary channel can, for example, be created peripherally in such a way that it does not, or at least not noticeably, impair the eyesight of the treated eye. It has been shown that at least one disposal channel of the said small size is sufficient for removing the waste products.
• a forced exit of the waste products can be forced, for example, by mechanical pressure on the cornea. Other possibilities arise, inter alia, in the use of suction and flushing devices or expulsion gas or in the combination thereof.
• At least one channel for removing the waste products at least one channel (also of small size) is provided for introducing media, such as expulsion gas or flushing liquid, into the removal area of the object.
• the pressure inside the object to be processed thereby increases, as a result of which individual liquid or gaseous waste products, such as local gas bubbles, become uniform in the removal area of the object Connect volume.
• the tissue can expand as a result of the pressure increase, so that after the pressure effect caused by the medium has ended, a mechanical force effect is additionally exerted by the processing object itself to squeeze out the remaining waste products, which cause the removal further supported. It is also possible not to create the at least one disposal channel continuously, but rather to leave a diffusion path through which the waste products diffuse to the outside for their removal.
• Fig.! shows the removal of waste products during intrastromal plasma generation in the cornea of the eye by introducing media under pressure and squeezing out the media including the waste products.
• a cornea 1 of the eye For intrastromal processing of a cornea 1 of the eye, it is first flattened by a pressure plate 2 in order to achieve a defined focal plane for a focusing lens 3, through which the pulses of a processing laser 4 in the stroma of the cornea 1 with an irradiance of more than 10 10 W / cm 2 generate a plasma, which creates ablation bubbles 5.
• a suitable means for example capillary mechanical incision, an inflow channel 6 is produced for the ablation bladders 5, through which an expulsion gas (symbolized by an arrow 7 in FIG. 1) is pressed into the corneal region in which the plasma formation took place. There, the expulsion gas brings together the individual ablation bladders 5 by tearing open remaining cell connections.
• the union-related cavity from the ablation bladders 5 and also the cornea 1 extend during the treatment until the growing void volume reaches the end of an outflow channel 1 0, which was introduced into the cornea 1 before the start of treatment, for example also by capillary mechanical incision.
• the pressed-in expulsion gas including the waste products resulting from the laser treatment, flows out through this outflow channel 10 (arrow 11).
• the elasticity of the cornea 1 in conjunction with the intra-ocular pressure of the eye cause the waste products to be pressed out further via the outflow channel 1 0.

Landscapes

• Health & Medical Sciences (AREA)
• Engineering & Computer Science (AREA)
• Optics & Photonics (AREA)
• Physics & Mathematics (AREA)
• Ophthalmology & Optometry (AREA)
• Heart & Thoracic Surgery (AREA)
• Surgery (AREA)
• Biomedical Technology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Vascular Medicine (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Plasma & Fusion (AREA)
• Mechanical Engineering (AREA)
• Laser Surgery Devices (AREA)

Applications Claiming Priority (3)

Publications (1)

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• 2001
  • 2001-12-12 DE DE10162166A patent/DE10162166A1/de not_active Ceased
• 2002
  • 2002-12-11 US US10/498,395 patent/US20050090813A1/en not_active Abandoned
  • 2002-12-11 EP EP02804587A patent/EP1453444A1/de not_active Withdrawn
  • 2002-12-11 JP JP2003550707A patent/JP2005511204A/ja active Pending
  • 2002-12-11 WO PCT/EP2002/014055 patent/WO2003049656A2/de active Application Filing

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