JP7292390B2 - 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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- 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
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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
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- A61F9/007—Methods or devices for eye surgery
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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
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Description
Claims (19)
- 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み、窓が凹面および凸面を備え、出射レンズが凹面および凸面を備え、出射レンズの凹面が窓の凸面に結合するように構成された、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1の光学サブシステムと光学的に結合された第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、
第1の光学サブシステムを通して、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、第1の光学サブシステムは、OCTビームとレーザービームを受信し、OCTビームとレーザービームを角度付き光路に沿って角膜、前眼房及び線維柱帯を通して、シュレム管に方向付けるように構成され、
体積を規定する眼組織にレーザービームを適用することによって、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し、それにより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1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2に記載のシステム。 - 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3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1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1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体積を規定する眼組織と相互作用させることによって、眼組織の体積を修正するように構成された、請求項1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1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1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1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1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11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1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13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13に記載のシステム。
- 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、シュレム管は円周によって特徴付けられ、システムは、
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、
第1の光学サブシステムを通して、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、第1の光学サブシステムは、OCTビームとレーザービームを受信し、OCTビームとレーザービームを角度付き光路に沿って角膜、前眼房及び線維柱帯を通して、シュレム管に方向付けるように構成され、
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、OCT画像診断装置に命令し、その際、
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、
閾値基準を上回る集水チャネルの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し、
体積を規定する眼組織にレーザービームを適用することによって、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し、それにより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、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13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17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17に記載のシステム。
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US16/036,833 US10821023B2 (en) | 2018-07-16 | 2018-07-16 | Integrated surgical system and method for treatment in the irido-corneal angle of the eye |
PCT/US2019/039033 WO2020018242A1 (en) | 2018-07-16 | 2019-06-25 | Integrated surgical system and method for treatment in the irido-corneal angle of the eye |
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US10821024B2 (en) | 2018-07-16 | 2020-11-03 | Vialase, Inc. | System and method for angled optical access to the irido-corneal angle of the eye |
US11986424B2 (en) | 2018-07-16 | 2024-05-21 | Vialase, Inc. | Method, system, and apparatus for imaging and surgical scanning of the irido-corneal angle for laser surgery of glaucoma |
US10821023B2 (en) | 2018-07-16 | 2020-11-03 | Vialase, Inc. | Integrated surgical system and method for treatment in the irido-corneal angle of the eye |
US11110006B2 (en) * | 2018-09-07 | 2021-09-07 | Vialase, Inc. | Non-invasive and minimally invasive laser surgery for the reduction of intraocular pressure in the eye |
US11246754B2 (en) | 2018-07-16 | 2022-02-15 | Vialase, Inc. | Surgical system and procedure for treatment of the trabecular meshwork and Schlemm's canal using a femtosecond laser |
US11173067B2 (en) | 2018-09-07 | 2021-11-16 | Vialase, Inc. | Surgical system and procedure for precise intraocular pressure reduction |
US11564567B2 (en) | 2020-02-04 | 2023-01-31 | Vialase, Inc. | System and method for locating a surface of ocular tissue for glaucoma surgery based on dual aiming beams |
EP4099967A4 (en) * | 2020-02-07 | 2024-04-03 | Ellex Medical PTY Ltd | METHOD AND APPARATUS FOR DIRECT LASER TRABECULOPLASTY |
US11612315B2 (en) | 2020-04-09 | 2023-03-28 | Vialase, Inc. | Alignment and diagnostic device and methods for imaging and surgery at the irido-corneal angle of the eye |
DE102020215583A1 (de) | 2020-12-09 | 2022-06-09 | Carl Zeiss Meditec Ag | Vorrichtung zur Erzeugung eines gesteigerten Abflusses von Kammerwasser zur Senkung des Augeninnendruckes bei Glaukom |
DE102021204066A1 (de) | 2021-04-23 | 2022-10-27 | Carl Zeiss Meditec Ag | Vorrichtung zur automatisierten Laserbearbeitung des Trabekelwerkes |
US12002567B2 (en) | 2021-11-29 | 2024-06-04 | Vialase, Inc. | System and method for laser treatment of ocular tissue based on patient biometric data and apparatus and method for determining laser energy based on an anatomical model |
US20230255479A1 (en) * | 2022-02-14 | 2023-08-17 | Vialase, Inc. | System and method for eye region visualization in a laser surgical system |
US11903641B1 (en) | 2022-10-20 | 2024-02-20 | Femto Vox Incorporated | Apparatus and techniques for surgical laser delivery |
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