JP2012513258A - 水晶体の光破壊レーザ治療 - Google Patents
水晶体の光破壊レーザ治療 Download PDFInfo
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- 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
- A61F9/00838—Correction of presbyopia
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- 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
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- 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
- A61F9/009—Auxiliary devices making contact with the eyeball and coupling in laser light, e.g. goniolenses
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- 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
- A61F2009/00844—Feedback systems
- A61F2009/00851—Optical coherence topography [OCT]
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
- A61F2009/0087—Lens
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- 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
- A61F2009/00885—Methods or devices for eye surgery using laser for treating a particular disease
- A61F2009/00895—Presbyopia
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- 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
- A61F2009/00897—Scanning mechanisms or algorithms
Abstract
【選択図】 図1
Description
このPCT出願は、2007年9月6日に出願された、米国仮出願第60/970,454号、発明の名称「Photodisruptive Laser Treatment of the Crystalline Lens」の優先権を主張して、2008年9月5日に出願された、米国特許出願番号第12/205,842号、発明の名称「Photodisruptive Laser Treatment of the Crystalline Lens」の一部継続出願である、2008年12月23日に出願された、米国特許出願番号第12/343,418号、発明の名称「Photodisruptive Laser Treatment of the Crystalline Lens」の優先権を主張する。上述した特許文献の開示内容の全体は、引用により、本願の一部として援用される。
視軸:固視点(point of fixation)から中心窩(Fovea)と呼ばれる網膜の中心上の画像を通過する線
照準線:対象点(object point)から瞳孔の入射孔の中心を通過する線
瞳孔軸:角膜の中心及び瞳孔の入射孔の中心を垂直に通る線
実際には、これらの軸は、互いに近くにあることが多い。更に、また、例えば、上述した軸のうちの何れか2つ又は3つの間に位置する中間軸(compromise axis)を定義することもできる。本明細書の以下の部分では、用語「眼の軸」の範囲は、これらの定義の全てを含むものとする。また、眼の軸をZ軸とも呼ぶ。典型的な実施例では、レーザビームは、Z軸に沿って方向付けることもできる。但し、レーザビームがZ軸に対して角度を形成する他の実施例も、ここに開示する方法の範囲に含まれる。Z軸を横断する2つの方向は、慣例的な用語に従い、X軸及びY軸と呼ぶ。
Claims (39)
- 眼の水晶体をレーザで処置する方法において、
水晶体の手術領域を選択するステップと、
前記選択された手術領域内レーザパルスを適用して、少なくとも1つの切込みを形成するステップとを有し、
前記切込みの一部の向きは、前記水晶体の線維に交差する向き及び前記眼の軸を横断しない向きの何れかであり、
前記切込みは水晶体の特性を変更する方法。 - 前記切込みの横断しない向きは、
前記眼の軸に実質的に平行な向き及び
前記眼の軸に90度より小さい角度を形成する向きの何れかである請求項1記載の方法。 - 前記切込みの前記眼の軸に沿った空間的な広がりは、前記眼の軸を横断する空間的な広がりより長い請求項1記載の方法。
- 前記切込みの眼の軸に沿った空間的な広がりは、0.5mm〜12mmの範囲内にあり、
前記切込みの眼の軸を横断する空間的な広がりは、1μm〜500μmの範囲内にある請求項3記載の方法。 - 前記眼の軸は、視軸、光軸、照準線及び瞳孔軸のうちの1つである請求項1記載の方法。
- 前記切込みは、概ね前記切込みと前記線維との交差部において、前記線維を部分に切断し、
前記水晶体の特性の変更は、前記水晶体の生体力学的な特性を弱めることである請求項1記載の方法。 - 前記切込みは、前記線維の縫合線又はその近傍において、前記線維を切断する請求項1記載の方法。
- 前記切込みは、前記水晶体内の縫合線の切断を回避する請求項1記載の方法。
- 前記レーザパルスを適用するステップは、
前記レーザパルスを適用して、前記切込みを形成する気泡を生成するステップを含み、
前記切込みの向きは、前記生成される気泡の拡張の優先的な方向に整列される請求項1記載の方法。 - 前記レーザパルスを適用するステップは、
前記適用されたレーザビームの焦点を、前記水晶体内で後方から前方の方向に動かすステップを含む請求項1記載の方法。 - 前記切込みは、
前記水晶体の核の広がりに少なくとも等しい広がりと、
2mmを超えるX−Y直径及び0.5mmを超えるZ方向の広がりと、
4mmを超えるX−Y直径及び1mmを超えるZ方向の広がりとのうちの1つを有し、前記X−Y直径は、前記軸を横断する方向における切込み全体の空間的な広がりの測定値である請求項1記載の方法。 - 前記方法は、1つのみの切込みを形成するステップを有し、
前記レーザパルスは、連続的に適用され、前記レーザの位置を変更することなく及び前記レーザの適用を中断することなく、前記切込みを形成する請求項1記載の方法。 - 前記切込みは、前記眼の軸に整列された形状を有し、前記形状は、
円筒、一組の同心の円筒、1つ以上の接続線によって接続された一組の円筒、曲面、円錐、渦巻、滑らかな線によって接続された積層された渦巻、並びに傾斜した円筒のうちの少なくとも1つである請求項1記載の方法。 - 前記切込みは、前記眼の軸に整列された形状を有し、前記形状は、
平面、2つ以上の交差する平面、平面と平面を接続する円弧との組合せ、並びに平面及び円筒の組合せのうちの少なくとも1つである請求項1記載の方法。 - 前記レーザパルスを適用するステップは、
層毎に切込みを形成するステップを含む請求項1記載の方法。 - 前記層毎に切込みを形成するステップは、
前記水晶体の後方の層内の、2つの切込み又は同じ切込みの2つの部分に属する標的位置にレーザパルスを適用するステップと、
前記後方の層より前方の層内の、前記同じ2つの切込み又は前記同じ切込みの同じ2つの部分に属する標的位置にレーザパルスを適用するステップとを有する請求項15記載の方法。 - 前記レーザパルスを適用するステップは、
前記レーザパルスを適用して、前記水晶体の後方の層内に第1の半径を有する第1のリングを形成するステップと、
前記レーザパルスを適用して、前記後方の層内に前記第1のリングと第2のリングとの間の接続線を形成するステップと、
前記レーザパルスを適用して、前記後方の層内に、第2の半径を有する前記第2のリングを形成するステップと、
前記後方の層より連続的に前方の層において、前記第1のリング、前記第2のリング及び前記接続線の形成を複数回繰り返すステップとを有し、
前記連続する層の第1のリングは、第1の円筒を形成し、前記第2のリングは、第2の円筒を形成し、前記円筒は、前記接続線によって接続されている請求項1記載の方法。 - 前記連続する層内の接続線は、
整列されて接続平面を形成するか、
層毎に整列されていないかの何れかである請求項17記載の方法。 - 後方の層内に後方の渦巻を形成するステップと、
前記後方の層内の前記後方の渦巻の端部の近傍から開始し、前記後方の層より前方の層の中心領域に向かって滑らかに湾曲し、上昇する滑らかな接続線を形成するステップと、
前記前方の層の中心領域において、前記滑らかな接続線の端部から開始される前方の渦巻を形成するステップとを有する請求項1記載の方法。 - 前記後方の渦巻及び前方の渦巻は、実質的に整列され、Z方向に広がりがある渦巻を形成する請求項19記載の方法。
- 前記レーザパルスを適用するステップは、
水晶体内に気泡を生成するためには十分であるが、前記眼の網膜に害を引き起こす程ではないレーザパラメータを選択するステップを含む請求項1記載の方法。 - 前記レーザパルスを適用するステップは、
前記切込みが前記眼の軸を横断しているとすれば、除去に適切な程度に前記水晶体を断片化するには不十分となるレーザパラメータでレーザパルスを適用する請求項1記載の方法。 - 前記レーザパラメータは、
0.5μJから50μJまでの範囲のレーザパルスエネルギ、
0.005ピコ秒から25ピコ秒までの範囲のレーザパルスの継続時間、
1kHzから10MHzの範囲のレーザパルスを適用する繰返し率、及び
1μmから100μmまでの範囲のレーザパルスの標的領域の分離距離を含む請求項22記載の方法。 - 前記レーザパルスを適用するステップは、
前記切込みを形成しながら、エネルギが変化するレーザパルスを適用するステップを含む請求項1記載の方法。 - 前記エネルギは、
Z方向の走査及び
X−Y方向の走査の少なくとも1つの間に変化する請求項24記載の方法。 - 前記エネルギは、眼組織の光学的特性の測定に関係して変化する請求項24記載の方法。
- 前記切込みを層毎に形成するステップを有し、
1つ以上の層が、少なくとも部分的に、レーザ供給システムの曲がった焦点面に沿って形成される請求項1記載の方法。 - 前記1つ以上の切込みの層を形成する際、Z方向のスキャナをX−Y方向のスキャナより遅い速度で調整するステップを有する請求項1記載の方法。
- 前記水晶体の後方部分に、前記切込みを形成するために適用される前記レーザパルスの大部分を遮蔽するように配置された保護層を形成するステップを更に有する請求項1記載の方法。
- 前記切込みは、前記水晶体の少なくとも一部を断片化し、前記方法は、
前記水晶体の前記断片化された一部を除去するステップを更に有する請求項1記載の方法。 - 前記レーザパルスを適用するステップは、
眼の網膜に持続的なダメージを与えないレーザパラメータで前記レーザパルスを適用するステップを含み、
前記レーザパルスは、前記水晶体を除去に適切な程度に断片化し、
前記断片化の時間は、1未満分である請求項30記載の方法。 - 眼の手術方法において、
レーザパルスを適用して、眼の水晶体内に切込みを形成するステップを有し、前記レーザパルスは、前記レーザパルスの適用を中断することなく、前記水晶体の核の全体に亘って、前記レーザパルスを走査するように構成されているレーザシステムによって適用される眼の手術方法。 - 前記切込みは、前記水晶体の線維に交差する請求項32記載の方法。
- 前記切込みの少なくとも一部は、前記眼の軸を実質的に横断しない請求項32記載の方法。
- 前記切込みは、円筒、一組の同心の円筒、接続線によって接続された一組の同心の円筒、円錐、交差する平面、円弧によって接続された交差する平面、渦巻、滑らかな線によって接続された積層された渦巻のうちの少なくとも1つである請求項32記載の方法。
- 眼の水晶体を断片化するレーザシステムにおいて、
レーザパルスからなるレーザビームを生成するように構成されているパルスレーザと、
前記レーザビームを適用して、前記眼の水晶体内に、前記レーザの適用を中断することなく、前記眼の軸に沿った2mmより長い空間的な広がりと、前記眼の軸を横断する4mmより大きい空間的な直径とを有する切込みを作成するように構成されている光供給システムとを備えるレーザシステム。 - 前記光供給システムは、前記水晶体の後方から前方の方向に前記レーザの焦点を動かすように構成されている請求項36記載のレーザシステム。
- 前記光供給システムは、レーザを制御して、
選択された水晶体領域内で光破壊を達成するために十分であるが、
上記眼の網膜に害を引き起こす程ではないレーザパラメータでレーザビームを生成するように構成されている請求項36記載のレーザシステム。 - 前記光供給システムは、前記パルスレーザを制御して、
0.5μJから50μJまでの範囲のレーザパルスエネルギ、
1μmから100μmまでの範囲のレーザパルスの標的領域の分離距離、
0.005ピコ秒から25ピコ秒までの範囲のレーザパルスの継続時間、及び
1kHzから10MHzの範囲のレーザパルスを適用する繰返し率のレーザパラメータでレーザパルスを生成する請求項38記載のレーザシステム。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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US12/343,418 US9456925B2 (en) | 2007-09-06 | 2008-12-23 | Photodisruptive laser treatment of the crystalline lens |
US12/343,418 | 2008-12-23 | ||
PCT/US2009/069510 WO2010075571A2 (en) | 2008-12-23 | 2009-12-23 | Photodisruptive laser treatment of the crystalline lens |
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JP2014167367A Division JP5932918B2 (ja) | 2008-12-23 | 2014-08-20 | 水晶体の光破壊レーザ治療 |
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JP2014167367A Active JP5932918B2 (ja) | 2008-12-23 | 2014-08-20 | 水晶体の光破壊レーザ治療 |
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EP (1) | EP2367512A4 (ja) |
JP (2) | JP2012513258A (ja) |
DE (1) | DE112009001166T5 (ja) |
WO (1) | WO2010075571A2 (ja) |
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JP5932918B2 (ja) | 2016-06-08 |
US9456925B2 (en) | 2016-10-04 |
EP2367512A4 (en) | 2013-02-20 |
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DE112009001166T5 (de) | 2011-04-14 |
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WO2010075571A3 (en) | 2010-11-04 |
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US20090171327A1 (en) | 2009-07-02 |
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