JP2021531934A - 目の虹彩角膜角内における治療のための一体型手術システムおよび方法 - Google Patents
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Abstract
Description
Claims (39)
- 角膜と、前眼房と、線維柱帯、シュレム管、およびシュレム管から分岐する1つまたは複数の集水チャネルで形成された眼房水流出経路を備える虹彩角膜角とを有する、目の眼内圧を低減する方法であって、
角膜および前眼房を通して虹彩角膜角内へと、光干渉断層撮影(OCT)ビームおよびレーザービームそれぞれを送達することと、
レーザービームを眼組織に適用して体積を規定することによって、眼組織との光破壊的相互作用で経路抵抗を低減させるかまたは新しい流出経路を作成させることにより、線維柱帯、シュレム管、および1つまたは複数の集水チャネルのうち1つまたは複数に存在する経路抵抗を低減するため、流出経路内の眼組織の体積を修正することと、を含む、方法。 - OCTビームおよびレーザービームそれぞれを送達することが、各ビームを、角膜に結合された窓と窓に結合された出射レンズとを備える第1の光学サブシステムへと方向付けることを含む、請求項1に記載の方法。
- 目が視野方向を備え、第1の光学サブシステムが、視野方向と実質的に整列された第1の光軸を備え、
各ビームを第1の光学サブシステムへと方向付けることが、各ビームを、第1の光軸から角度αでオフセットされた第2の光軸に沿って第1の光学サブシステム内へと方向付けることを含む、請求項2に記載の方法。 - 出射レンズが凸面を備え、各ビームを第1の光学サブシステムへと方向付けることが、各ビームを、凸面に対する面法線に対して角度βで出射レンズの凸面内へと方向付けることを更に含む、請求項3に記載の方法。
- OCTビームおよびレーザービームが共線的に方向付けられる、請求項1に記載の方法。
- OCTビームおよびレーザービームが非共線的に方向付けられる、請求項1に記載の方法。
- レーザービームを適用することが、レーザービームをスキャンして眼組織と相互作用させて体積を規定することを含む、請求項1に記載の方法。
- 眼組織との破壊的相互作用が、前眼房およびシュレム管を接続する線維柱帯を通って開いているチャネルを作成する、請求項1に記載の方法。
- レーザービームの波長が330ナノメートルから2000ナノメートルである、請求項1に記載の方法。
- レーザービームが、20フェムト秒から1ナノ秒のパルス持続時間を有する複数のレーザーパルスで構成される、請求項1に記載の方法。
- 眼組織の体積が、集水チャネルの1つまたは複数の近傍にある、請求項1に記載の方法。
- レーザービームおよびOCTビームがそれぞれ実質的に等しい分解能を有する、請求項1に記載の方法。
- 分解能が約5マイクロメートル以下である、請求項12に記載の方法。
- OCTビームおよびレーザービームそれぞれを送達する前に、
角膜および前眼房を通して虹彩角膜角内へとOCTビームを送達することと、
虹彩角膜角の一部分のOCT画像を獲得することと、
OCT画像に基づいて修正する眼組織の体積を決定することと、を更に含む、請求項1に記載の方法。 - OCT画像が二次元断面画像を含む、請求項14に記載の方法。
- 修正する眼組織の体積を決定することが、OCT画像を表示画面上に提示することを含む、請求項14に記載の方法。
- シュレム管が円周によって特徴付けられ、修正する眼組織の体積を決定することが、
シュレム管の円周の少なくとも一部分の周りにおける集水チャネルの密度分布を決定することと、
閾値基準を上回る密度を有するシュレム管の領域を同定することと、
同定された領域の近傍を修正する眼組織の体積に含めることと、を含む、請求項14に記載の方法。 - 虹彩角膜角から目視観察信号を獲得することを更に含む、請求項14に記載の方法。
- 修正する眼組織の体積を決定することが、OCT画像および目視観察信号を重ねて表示画面上に提示することを含む、請求項18に記載の方法。
- 修正する眼組織の体積を決定することが、OCT画像および目視観察信号を位置合わせして表示画面上に提示することを含む、請求項18に記載の方法。
- 角膜と、前眼房と、線維柱帯、シュレム管、およびシュレム管から分岐する1つまたは複数の集水チャネルで形成された眼房水流出経路を備える虹彩角膜角とを有する、目の眼内圧を低減する一体型手術システムであって、
角膜に結合されるように構成された窓と、窓に結合されるように構成された出射レンズとを含む、第1の光学サブシステムと、
光干渉断層撮影(OCT)ビームを出力するように構成されたOCT画像診断装置と、レーザービームを出力するように構成されたレーザー源と、OCTビームおよびレーザービームの1つまたは複数の調整、スキャン、合成、および方向付けのうち1つまたは複数を行うように構成された複数の構成要素とを含む、第2の光学サブシステムと、
第2の光学サブシステムに結合された制御系と、を備え、制御系が、
角膜および前眼房を通して虹彩角膜角内へと送達するため、OCTビームを出力するようにOCT画像診断装置に、またレーザービームを出力するようにレーザー源に命令し、
レーザービームを眼組織に適用して体積を規定することによって、眼組織との光破壊的相互作用で経路抵抗を低減させるかまたは新しい流出経路を作成させることにより、線維柱帯、シュレム管、および1つまたは複数の集水チャネルのうち1つまたは複数に存在する経路抵抗を低減するため、流出経路内の眼組織の体積を修正するように、レーザー源に命令するように構成された、一体型手術システム。 - 第2の光学サブシステムが、OCTビームおよびレーザービームを第1の光学サブシステムに向かって方向付けるように構成された、請求項21に記載のシステム。
- 目が視野方向を備え、
第1の光学サブシステムが第1の光軸を備え、
第1の光学サブシステムが、第1の光軸が視野方向と実質的に整列されるようにして、目に結合されるように適合され、
OCTビームおよびレーザービームが、第1の光軸から角度αでオフセットされた第2の光軸に沿って、第1の光学サブシステムに向かって方向付けられる、請求項22に記載のシステム。 - 出射レンズが凸面を備え、OCTビームおよびレーザービームが、凸面に対する面法線に対して角度βで、出射レンズの凸面内へと方向付けられる、請求項23に記載のシステム。
- OCTビームおよびレーザービームが共線的に方向付けられる、請求項21に記載のシステム。
- OCTビームおよびレーザービームが非共線的に方向付けられる、請求項21に記載のシステム。
- レーザー源が、レーザービームをスキャンして眼組織と相互作用させて体積を規定することによって、眼組織の体積を修正するように構成された、請求項21に記載のシステム。
- レーザー源が、眼組織との光破壊的相互作用によって眼組織の体積を修正して、前眼房およびシュレム管を接続する線維柱帯を通って開いているチャネルを作成するように構成された、請求項21に記載のシステム。
- レーザービームの波長が330ナノメートルから2000ナノメートルである、請求項21に記載のシステム。
- レーザービームが、20フェムト秒から1ナノ秒のパルス持続時間を有する複数のレーザーパルスで構成される、請求項21に記載のシステム。
- レーザービームおよびOCTビームがそれぞれ実質的に等しい分解能を有する、請求項21に記載のシステム。
- 分解能が約5マイクロメートル以下である、請求項31に記載のシステム。
- 制御系が、眼組織修正の前に、
虹彩角膜角の一部分の診断用OCT画像を獲得するように、OCT画像診断装置に命令し、
OCT画像に基づいて修正する眼組織の体積を決定するように、更に構成された、請求項21に記載のシステム。 - OCT画像が二次元断面画像を含む、請求項33に記載のシステム。
- 制御系がOCT画像を表示画面上に提示するように構成された、請求項33に記載のシステム。
- シュレム管が円周によって特徴付けられ、制御系が、
シュレム管の円周の少なくとも一部分の周りにおける集水チャネルの密度分布を決定し、
閾値基準を上回る密度を有するシュレム管の領域を同定し、
同定された領域の近傍を修正する眼組織の体積に含めるように、
更に構成されることにより、修正する眼組織の体積を決定するように構成された、請求項33に記載のシステム。 - 第2の光学サブシステムが、目視観察信号を虹彩角膜角から獲得するように構成された目視観察デバイスを更に備える、請求項33に記載のシステム。
- 制御系が、診断用OCT画像および目視観察信号を重ねて表示画面上に提示するように更に構成された、請求項37に記載のシステム。
- 制御系が、診断用OCT画像および目視観察信号を位置合わせして表示画面上に提示するように更に構成された、請求項37に記載のシステム。
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