GB2284766A - Laser adjustment of suture tension - Google Patents
Laser adjustment of suture tension Download PDFInfo
- Publication number
- GB2284766A GB2284766A GB9425166A GB9425166A GB2284766A GB 2284766 A GB2284766 A GB 2284766A GB 9425166 A GB9425166 A GB 9425166A GB 9425166 A GB9425166 A GB 9425166A GB 2284766 A GB2284766 A GB 2284766A
- Authority
- GB
- United Kingdom
- Prior art keywords
- suture
- laser
- tension
- laser radiation
- eye
- 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.)
- Granted
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
- A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
- A61B3/107—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions for determining the shape or measuring the curvature of the cornea
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06166—Sutures
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L17/00—Materials for surgical sutures or for ligaturing blood vessels ; Materials for prostheses or catheters
- A61L17/06—At least partially resorbable materials
- A61L17/10—At least partially resorbable materials containing macromolecular materials
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
-
- 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
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Ophthalmology & Optometry (AREA)
- Heart & Thoracic Surgery (AREA)
- Biomedical Technology (AREA)
- Vascular Medicine (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Physics & Mathematics (AREA)
- Epidemiology (AREA)
- Materials Engineering (AREA)
- Optics & Photonics (AREA)
- Chemical & Material Sciences (AREA)
- Biophysics (AREA)
- Laser Surgery Devices (AREA)
Abstract
Laser apparatus and method associated therewith for adjusting the tension in thermoplastic (polyamide, polyester or polypropylene) sutures. The sutures 4 are irradiated causing them to soften and equilibrate to the desired tension using an argon-ion or carbon dioxide laser beam 5 which is brought to a line-focus 4 commensurate in size with the sutures. An embodiment for use following ophthalmic surgery to reduce astigmatism is shown with an optical fibre 20 transmitting the laser beam to the focusing and directing head 21 containing the lenses 22, 23 which produce the line focus 4. Also attached is a hood 28 which includes lights 29, a translucent screen 30 with a set of placido rings 31. A television camera 32 is used to view the curvature of the patients eye 3 and position of the laser beam via a beam splitter 25. Distortion of the eye by inappropriately tensioned sutures is thus reduced. <IMAGE>
Description
Suture Tensioninq
The present invention relates to a method of and apparatus for adjusting the tension in sutures, and more specifically to those which are used in ophthalmic surgical procedures.
In general medical practice, when sutures are used to hold together the edges of a wound, in order to minimise the formation of scar tissue, it is important to ensure that the edges of the wound just butt together.
In the case of ophthalmic surgery there is included the additional requirement that distortion of the eyeball can affect its optical performance and hence the quality of vision of the patient. A high level of skill is required which can result in considerable stress to the surgeon, particularly in a busy practice.
The present invention provides a method and apparatus which enables the tension in sutures to be adjusted after they have been inserted.The main advantage is the consequent reduction in post-operative distortion (astigmatism) in the patient, but also there is a reduction in the stress to the surgeon and the production of minimum scarring to the patient is facilitated.
According to the present invention there is provided a method of adjusting the tension in sutures made of a thermoplastic material comprising the operation of irradiating the suture with laser radiation of an intensity sufficient to soften but not melt the suture and maintaining the irradiation of the suture until a desired tension in the suture has been achieved.
Also according to the present invention there is provided an apparatus for adjusting the tension in a suture made of a thermoplastic material, wherein there is included means for producing a beam of laser radiation having an elongated cross-section with dimensions approximately equal to those of a suture the tension in which is to be adjusted and means for superimposing the beam of laser radiation upon the suture the tension in which is to be adjusted.
Some thermoplastic materials shrink initially when heated, some merely soften prior to melting, and others do both according to the temperature to which they are heated or the original tension in them. The present invention can be used with sutures of all the above types, but preferably uses sutures made of a material which equilibrates to a single tension at a given temperature. That is to say, if the original tension in the suture is greater than the equilibrium tension, it relaxes until that value is reached, if the original tension in the suture is less than that value, the suture shrinks until the equilibrium tension is reached.
A preferred material for the sutures is polyamides, coloured so as to improve the absorption of the laser radiation.
Suitable lasers include argon-ion and carbon dioxide lasers, particularly the former because they produce radiation in the visible region of the spectrum, which assists in aligning the laser radiation with the suture.
On the other hand, the output radiation from a carbon dioxide laser is eye safe.
An example of the invention will now be described, by way of example, with reference to the accompanying drawings in which
Figure 1 shows diagrammatically the use of the invention following an ophthalmic surgical procedure; and
Figure 2 illustrates diagrammatically an apparatus for carrying out the invention.
Referring to Figure 1 of the drawings, an incision 1, made in the cornea 2, of an eye 3, is closed by sutures 4 in the usual way. The sutures 4 are made of a polyamide or other thermoplastic material, such as polypropylene or polyester, and, as is usual, have a diameter of about 20 microns. A beam of radiation 5 from an argon ion laser, which is not shown, is brought to a line focus commensurate in size with the sutures 4 and superimposed upon a suture 4 the tension in which is to be adjusted.
The curvature of the cornea 2 of the eye 3 is monitored by a surgeon who is carrying out the suture tension adjustment, by observing the reflection in the eye 3 of a system of illuminated translucent and opaque rings 6, known as a Placido disk, in the usual way. The surgeon is represented schematically by another eye 7.
Any distortion of the surface of the cornea 2 of the eye 3 produces a corresponding distortion of the reflection of the system of circles 6 projected on the eye 3. For convenience, the Placido disk 6, laser beam 5 and surgeon, eye 9, are shown widely separated. In practice the angular separation is much smaller.
The surgeon having satisfied himself that the laser beam is aligned accurately upon a given suture 4, subjects the suture 4 to pulses of laser radiation of about 100 ms duration and at power levels of between 10 and 100 mW. After each pulse of laser radiation, the distortion of the surface of the cornea 2 of the eyeball 3 is checked by the surgeon 9 and the power level of the laser radiation is adjusted. The pulses of laser radiation cause the loosening of tight sutures and shrinkage in loose sutures, so tightening them. The higher the power level of the pulses, the greater the respective loosening or tightening effect.
The process is carried out until the surgeon is satisfied that the distortion of the surface of the cornea 2 of the eye 3 is minimised. The process may need to be carried out more than once as relaxation/healing of the eye which has been operated upon takes place.
Referring to Figure 2 of the Drawings, an apparatus for carrying out the invention comprises an optical fibre 20 which transmits laser radiation from an argon-ion laser, which is not shown, to a focusing and directing head 21. In the focusing and directing head 21 are a biconvex lens 22, a first plano-convex focusing lens 23, a second plano-convex focusing lens 24 and a beam splitter 25. The plano-convex lenses 23 and 24 produce a line focus, approximately 1.5mm long and 50 wide, of the laser beam at the eye 4 of a patient 26. These dimensions correspond to the normal dimensions of an ophthalmic suture. Conventional laser beam delivery systems produce laser energy distributions which are approximately circular in form. Such a form is not appropriate to the present invention because if the laser spot is small enough so as not to impinge on the eye of the patent, then only a small region of the suture will be treated, with a high risk of rupturing the suture indeed, lasers have been used for this purpose - or, on the other hand if the laser spot is large enough to cover the suture, then a relatively large area of the patient's eye will be irradiated as well. Not only does this pose a risk of damage to the patient, but it is wasteful of laser energy.
The focusing and directing head 21 is held in a mounting 27 which can be moved towards or away from the eye 4 to be treated to bring the laser beam 5 to a focus on the eye 4, or sideways to enable one eye, or the other, of the patient to be treated to be selected for attention. These motions are shown as x and y, respectively. Crude adjustment of the position of the focus of the laser beam 5 in the vertical direction z is provided by means of an adjustable head rest 34 for the head 26 of the patient whose eye 4 is to be treated. The mounting 27 is also such as to enable the directing and focusing head 21 to be tilted about a vertical axis to control the horizontal pointing of the laser beam 5 about an horizontal axis to control the vertical pointing (z) of the laser beam 5 and rotated about its optical axis to enable the azimuth 8 of the line focus of the laser beam 5 to be varied. Attached to the mounting 27 is a hood 28 which includes a number of lights 29, a translucent screen 30 which has a set of Placido 31 rings upon it and a television camera 32 which is positioned to view the patient's eye, the reflection of the placido rings, and the position of the laser beam on the eye.
The camera 32 is connected to a monitor 33 which traces, displays, and if required, stores data relating to the position of the line focus of the laser beam 5.
Claims (18)
1. A method of adjusting the tension in a suture made of a thermoplastic material, wherein there is included the operations of irradiating the suture with laser radiation of an intensity sufficient to soften but not melt the thermoplastic material out of which the suture is made and maintaining the irradiation of the suture until a desired tension in the suture is achieved.
2. A method according to Claim 1 wherein the thermoplastic material is coloured to enhance the absorption of the laser radiation.
3. A method according to Claim 1 or Claim 2 wherein the suture is made of a polyamide, polypropylene or polyester material.
4. A method according to Claim 3 wherein the suture is made of a polyamide material.
5. A method according to any preceding claim wherein the laser is adapted to produce pulses of laser radiation having a power level within the range 10 to 100 mW and a duration of the order of 100 Rs.
6. A method according to Claim 5 wherein the laser is an argon-ion laser.
7. A method according to any preceding claim wherein the suture is inserted in an eye and there is included the operation of monitoring the curvature of the surface of the eye to determine when the desired tension in the suture is achieved.
8. Apparatus for adjusting the tension in a suture made of a thermoplastic material, wherein there is included means for producing a beam of laser radiation having an elongated cross-section with dimensions approximately equal to those of a suture the tension in which is to be adjusted and means for superimposing the beam of laser radiation upon the suture the tension in which is to be adjusted.
9. Apparatus according to Claim 8 wherein the means for superimposing the beam of laser radiation upon the suture includes a beam focusing and delivery head which is so mounted as to be capable of rotation about three perpendicular axes one of which is coincident with the optical axis of the beam focusing and delivery head.
10. Apparatus according to Claim 8 or Claim 9 wherein the means for superimposing the beam of laser radiation upon the suture includes means for bringing the laser beam to a line focus upon the suture.
11. Apparatus according to Claim 8, Claim 9 or Claim 10 wherein the aspect ratio of the major and minor dimensions of the laser beam is approximately 30:1.
12. Apparatus according to any of Claims 8 to 11 wherein the means for producing a beam of laser radiation includes a laser adapted to produce pulses of laser radiation having a power between 10 and 100 mW and a duration of approximately 100Rs.
13. Apparatus according to Claim 12 wherein the laser is an argon-ion laser.
14. Apparatus according to any of Claims 8 to 13 wherein there is included means for monitoring the curvature of the surface of an eye in which the suture is inserted.
15. Apparatus according to Claim 14 wherein the means for monitoring the curvature of the eye includes a screen having a set of Placido rings formed upon it and a light source arranged to illuminate the screen.
16. Apparatus according to any of Claims 8 to 15 wherein there is included means for monitoring and displaying the position of the laser beam.
17. A method of adjusting the tension in a suture made of a thermoplastic material substantially as hereinbefore described and with reference to the accompanying drawings.
18. An apparatus for adjusting the tension in a suture substantially as hereinbefore described and with reference to Figure 2 of the accompanying drawings.
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
GB939325764A GB9325764D0 (en) | 1993-12-16 | 1993-12-16 | Suture tensioning |
Publications (3)
Publication Number | Publication Date |
---|---|
GB9425166D0 GB9425166D0 (en) | 1995-02-08 |
GB2284766A true GB2284766A (en) | 1995-06-21 |
GB2284766B GB2284766B (en) | 1997-11-26 |
Family
ID=10746723
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
GB939325764A Pending GB9325764D0 (en) | 1993-12-16 | 1993-12-16 | Suture tensioning |
GB9425166A Expired - Fee Related GB2284766B (en) | 1993-12-16 | 1994-12-13 | Suture tensioning |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
GB939325764A Pending GB9325764D0 (en) | 1993-12-16 | 1993-12-16 | Suture tensioning |
Country Status (3)
Country | Link |
---|---|
AU (1) | AU1117295A (en) |
GB (2) | GB9325764D0 (en) |
WO (1) | WO1995016415A1 (en) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6848791B2 (en) * | 2002-12-16 | 2005-02-01 | Bausch & Lomb Incorporated | Single-curvature placido plate with additional surfaces |
GB2576561A (en) * | 2018-08-24 | 2020-02-26 | Univ Plymouth | Optometry device |
Families Citing this family (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8550979B2 (en) | 2010-06-15 | 2013-10-08 | Coloplast A/S | Method of treating incontinence |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1992012673A1 (en) * | 1991-01-18 | 1992-08-06 | Eaton Alexander M | Adjustable sutures and methods of making and using same |
Family Cites Families (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4648400A (en) * | 1985-05-06 | 1987-03-10 | Rts Laboratories, Inc. | Ophthalmic surgery system |
JPH03500620A (en) * | 1987-08-28 | 1991-02-14 | ツェントラルノエ、コンストルクトルスコエ ビューロー、ウニカルノボ、プリボロストロエニア、アカデミー、ナウク、エスエスエスエル | A method for laser processing an object and a device for carrying out the method |
US5110200A (en) * | 1989-06-30 | 1992-05-05 | Technitex, Inc. | Video keratometer |
-
1993
- 1993-12-16 GB GB939325764A patent/GB9325764D0/en active Pending
-
1994
- 1994-12-12 AU AU11172/95A patent/AU1117295A/en not_active Abandoned
- 1994-12-12 WO PCT/GB1994/002666 patent/WO1995016415A1/en active Application Filing
- 1994-12-13 GB GB9425166A patent/GB2284766B/en not_active Expired - Fee Related
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1992012673A1 (en) * | 1991-01-18 | 1992-08-06 | Eaton Alexander M | Adjustable sutures and methods of making and using same |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6848791B2 (en) * | 2002-12-16 | 2005-02-01 | Bausch & Lomb Incorporated | Single-curvature placido plate with additional surfaces |
GB2576561A (en) * | 2018-08-24 | 2020-02-26 | Univ Plymouth | Optometry device |
Also Published As
Publication number | Publication date |
---|---|
GB2284766B (en) | 1997-11-26 |
AU1117295A (en) | 1995-07-03 |
GB9325764D0 (en) | 1994-02-16 |
GB9425166D0 (en) | 1995-02-08 |
WO1995016415A1 (en) | 1995-06-22 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
EP0164858B1 (en) | Apparatus for removing cataractous lens tissue by laser radiation | |
US4164222A (en) | Laser ophthalmological unit | |
US5057102A (en) | Contrast adjustor for aiming laser | |
US5252999A (en) | Laser apparatus including binocular indirect ophthalmoscope | |
US6494878B1 (en) | System and method for accurate optical treatment of an eye's fundus | |
US7766903B2 (en) | Patterned laser treatment of the retina | |
EP0402250B1 (en) | Noncontact laser microsurgical apparatus | |
EP0591191B1 (en) | Apparatus for performing corneal reshaping to correct ocular refractive errors | |
JP3889904B2 (en) | Photocoagulator | |
JPH10503940A (en) | Eye movement detection method and system | |
US5643249A (en) | Optical ophthalmic treatment apparatus | |
JPH0343904B2 (en) | ||
JPS6137265A (en) | Light coagulating and emitting system | |
EP1059872A1 (en) | System for treating the fundus of an eye | |
US3487835A (en) | Surgical laser photo-coagulation device | |
US6217570B1 (en) | Method of aligning the optical axis of a laser for reshaping the cornea of a patients eye with the visual axis of the patient's eye | |
US3456651A (en) | Instrument for the medical treatment of human and animal tissue using lasers | |
JPH0366895B2 (en) | ||
EP1192919B1 (en) | Laser surgery apparatus | |
JP3872219B2 (en) | Laser therapy device | |
CN106163467A (en) | Laser assisted cataract operation | |
GB2284766A (en) | Laser adjustment of suture tension | |
US20240335324A1 (en) | SINGLE AND/OR DUAL (532 AND/OR 577) nm LASER DELIVERY SYSTEM ATTACHED TO AN OPHTHALMIC MICROSCOPE | |
JP4546062B2 (en) | Laser therapy device | |
JPH0368356A (en) | Laser therapeutic device for ophthalmology |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
732E | Amendments to the register in respect of changes of name or changes affecting rights (sect. 32/1977) | ||
PCNP | Patent ceased through non-payment of renewal fee |
Effective date: 19981213 |