KR100495595B1 - Refractory Hydrojet Device - Google Patents

Abstract

The device for supporting and guiding the movement of the high velocity liquid jet for eye dissection includes a fixture for removably securing the device to the apex of the cornea. The corneal apex extends through the opening of the fixture, and the concentric suction ring secures the fixture to the eye. Proximal portions of the fixture are provided with internal cutouts to allow elastic horizontal bending of the proximal portions. The first linear mover is arranged to translate the first flexible bracket horizontally with precise control movement. In a direction orthogonal to the fixture, a second flexible bracket with internal cutouts allowing elastic vertical flexion is incorporated. One end of the second flexible bracket is firmly fixed to the fixture, and the micrometer mover is incorporated into the movable end of the second flexible bracket to position it vertically at precise control intervals. The high pressure liquid jet nozzle extends from the movable end of the second flexible bracket and is oriented generally horizontally toward the corneal apex in the opening of the first bracket. The target receptacle is coaxially aligned with the liquid jet and connected to the vacuum line to remove the liquid discharged within the liquid jet. The aflation member extends from the rigid portion of the first flexible bracket to impinge on the corneal apex. The vacuum line is secured to the movable end of the second flexible bracket to move in concert with the cutting jet.

Description

Hydrojet Devices for Refractive Surgery

FIELD OF THE INVENTION The present invention relates generally to hydrojet surgical devices, in particular hydrojet devices used for refractive surgery.

In recent years, the use of surgical techniques to correct ocular refractory dysfunction has evolved from experimental laboratory surgery to routine procedures that are widely used. Radial keratotomy (RK), photorefractive keratotomy (PRK), and myopic keratomileusis (MKM) have all become common techniques in ophthalmology. Such aggressive surgical treatment is a relatively new development in ophthalmology. However, many patients need good comparative vision for various occupations, such as airplane pilots or career activists, while others require good comparative vision for cosmetic or psychological reasons. Moreover, some patients have abnormal vision even when optimally corrected with glasses or contact lenses, and seek surgical correction for improved vision.

Some photorefractive surgery techniques include lamellar keratotomy in which a hinged flap of apical corneal tissue is created by an incision of the cornea that is generally perpendicular to the original visual axis. Next, a second cut is made in which the keratin thin wafer is removed. The flap then returns to its initial position and allows healing in place. Removal of the keratinous thin wafers alters the structure of the corneal apex and thus modifies the refractive properties of the cornea. Clearly, the thickness and planarity of the first cutout as well as the placement and shape of the second cutout are important factors for the success of this technique.

Laminar keratotomy has been performed using a microkeratotomy device in which a high-speed rotary cutting head supports the blades producing the corneal cut. However, the blade thickness as well as the mechanical vibration and movement of the moving cutter limit the fineness or flatness of the incision, which also limits the potential for successful outcome of the surgery.

Recently, in a technique called hydroreactive corneal keratoplasty (HRK), high-speed water jets have been used in laminar keratotomy. Water jets with a diameter of 50-100 μm are used to form the corneal incision. The water jet is much smaller in diameter than the thickness of the cutting blade, so the incisions become much finer, resulting in less tissue trauma, better healing, and greater success. The water jet is a linear "beam" that passes through corneal tissue to perform the required incision. The mechanism for performing the beam motion generally consists of a track on which the water jet nozzle is mounted in a slidable manner. However, in mechanical engineering, the two slidable surfaces should have a gap of about ± 0.0254 mm (± 0.001 in), equivalent to 25.4 μm. Thus, the free play of the sliding mechanism is 25% to 50% of the cutting beam diameter, which virtually negates the advantage of using a hydrojet as a fine cutting tool. The prior art demonstrates the need for an improved mechanism for guiding hydrojet cutting beams at greater resolution and control.

In general, the present invention includes a device for guiding and supporting the movement of a high velocity liquid jet, which is used for cutting, especially in the formation of an eye incision. A distinctive feature of the device is that it eliminates the mechanical play of prior art sliding or rolling devices, making full use of the advantages of the extremely fine cutting beams created by high pressure cutting jets and creating an unprecedented plan view and thin incision. It's there.

The device includes a fixture for removably securing the device to the apex of the cornea. The remote end of the fixture is provided with an opening through which the corneal apex or crown can extend. Around the opening is provided a suction ring for securing the fixture to the eye with the corneal apex properly positioned within the opening. The remote end of the fixture is incorporated into the side bar, which is fixed to the rigid horizontal support. The proximal portion of the fixture includes a first flexible bracket provided with an internal cutout configured to allow elastic horizontal flexion of the proximal portion while preventing vertical flexion. The first linear mover is fixed to the horizontal support and the armature of the mover is connected to the first flexible bracket so that the linear mover can be operated to translate the first flexible bracket horizontally in a precisely controlled motion.

A second flexible bracket is incorporated in a direction orthogonal to the first flexible bracket, and the second flexible bracket is provided with an internal cutout that allows elastic vertical bending while preventing horizontal movement. One end of the second flexible bracket is rigidly secured to the first flexible bracket and the second linear mover is incorporated into the rigid end of the second flexible bracket. By incorporating the armature of the second linear mover into the other movable end of the second flexible bracket, the linear mover can be operated to vertically translate the second flexible bracket in a precisely controlled state. The second linear mover preferably comprises a micrometer and the armature position can be set very precisely to select the thickness of the vertex flap formed in the present invention.

A high pressure liquid jet nozzle is supported on the movable end of the second flexible bracket and is oriented generally horizontally toward the corneal apex in the opening of the first bracket. The target receptacle is disposed in coaxial alignment with the liquid jet and connected to the vacuum line to remove the volume of liquid that is released within the liquid jet. The applanation member extends from the stop end of the second flexible bracket and is adapted to impinge on the corneal apex in a closely spaced relationship to the liquid cutting jet. As the vacuum line is secured to the movable end of the second flexible bracket, the target receptacle moves in coordination with the cutting jet.

The device of the present invention is used by first positioning the first bracket such that the corneal apex extends through its opening and the suction ring is connected to a low pressure source to secure the device to the eye. The attachment member may be formed of a transparent material having a reticle or other tick marks to determine the appropriate effect of aflation on the process to be performed. The surface of the abundance member in contact with the cornea may be planar or have a predetermined radius of curvature. In the rest position, the jet nozzle is aligned such that the liquid jet cannot contact the corneal tissue.

The liquid jet is then activated to produce a fine beam of ultrafast liquid extending from the nozzle to the target receptacle. The first linear mover is then activated to translate the nozzle horizontally by flexing the first flexible bracket so that the liquid jet beam is translated horizontally through the corneal tissue. The incision in the cornea is extremely planar and very thin due to the fact that the diameter of the cutting jet is 50 μm or less and there is no outlay in the mechanism for translating the cutting jet. The incision is thus smooth and removes an absolute minimum of tissue, thus facilitating rapid healing and precisely controlling the refractive properties.

The micrometer can be actuated as needed to set the vertical position of the incision and determine the thickness of the vertex flap. Thus, the apparatus can orient the cutting jet to perform all the incisions necessary for MKM or HRK. Conversely, the device can only be used to perform a first planar incision that forms an anterior apex corneal flap, thus setting the stage for a stomal resection step that can be performed by other surgical means.

In general, the present invention includes an apparatus 11 for supporting and guiding the movement of a high velocity liquid jet which is used for cutting, especially in the formation of an eye incision. 1 to 4, the device 11 comprises a plate-shaped fixture 12 adapted to engage the front surface 14 of the eye. The lower surface of the fixture is provided with a suction ring 13 for receiving and releasably fixing the front surface 14. Feed tube 10 extends into the suction ring to provide a low pressure source and attaches the suction ring to the eye as needed. An opening 16 extends through the upper surface of the fixture to communicate in coaxial alignment with the suction ring, which opening 16 is dimensioned such that the corneal crown or apex 17 can extend upwards therethrough. Thus, the fixture 12 defines a surgical site for corneal refraction or treatment, and also supports and guides the hydrojet cutting mechanism in a fixed relationship to the corneal apex, as described below.

Fixture 12 is firmly incorporated into side bar 21, which is secured to horizontal support 22 extending from a stable base structure (not shown). The proximal end 23 of the fixture 12 includes a first flexible bracket that is not attached to the horizontal support 22 or the support bar 21. An inner opening 24 is disposed in the portion 23. The opening 24 is quadrilateral with a protruding rounded corner portion defining a thin sidewall portion 26. The thin side wall portion 26 is elastically flexible in the horizontal plane (the nominal plane of the fixture 12). However, due to the vertical thickness of the structure, the side wall portion 26 is highly resistant to vertical bending. Thus, the structure of the opening 24 allows the first flexible bracket 23 to translate horizontally relative to the rigid support end of the fixture 12.

The horizontal linear actuator 27 is fixed to the horizontal support 22. The armature 28 of the linear actuator 27 is coupled to the proximal end 23 of the fixture, so that the actuation of the actuator 27 causes the portion 23 to translate horizontally. This translational motion can be controlled very precisely because there is no sliding or rolling surface contact required to perform this motion.

The second plate-shaped flexible bracket 31 extends in a generally orthogonal direction from the first flexible bracket 23. The bracket 31 is provided with an inner opening 32 that is similar in structure and function to the opening 24, whereby the bracket 31 can be elastically curved in the vertical plane while exhibiting high rigidity in the horizontal plane. The rigid support bracket 33 is fixed to the movable portion 23 of the first flexible bracket and extends substantially vertically therefrom. One edge 34 of the second flexible bracket 31 is fixed to a portion of the bracket 33, while the opposite end 36 freely translates vertically in a curved manner.

The rigid linear bracket 41 is fixed to the rigid support bracket 33. The armature 42 of the linear mover 41 is coupled to the end 36 of the second flexible bracket 31. The operation of the linear actuator 41 translates the end 36 vertically in the form of an elastic flexural motion. This translational motion can be controlled very precisely because there is no sliding or rolling surface contact required to perform this motion. The vertical linear mover preferably comprises a micrometer, so that the vertical position of the jet nozzle and thus the thickness of the vertex flap formed by the instrument can be selected with great precision.

A high pressure liquid jet nozzle 43 is supported on the movable end 36 of the second flexible bracket 31. The liquid jet 44 is directed generally horizontally towards the corneal apex 17 in the opening of the fixture 12. The target receptacle 46 is disposed in coaxial alignment with the liquid jet 44 and connected to the vacuum line 47 to remove the volume of liquid discharged within the liquid jet. The vacuum line 47 extends from the movable end 36 of the second flexible bracket 31 such that the target receptacle moves in concert with the liquid jet so that the jet is oriented by the vertical and horizontal linear actuators. Block the jet accordingly.

The apparatus also provides an aflation member 48 that includes a planar tabular member disposed to impinge on the apex surface of the cornea presented within the opening 16. The attenuation member 48 is supported by a standoff 49 on the fixture of the fixture 12. The planar member 48 is closely spaced in the vertical direction with respect to the liquid jet 44 and is stationary with respect to the liquid jet so as to maintain a relatively constant distance therefrom.

The jet nozzle 43 is connected to an extremely high pressure liquid and is designed to generate a liquid jet having an extremely high velocity and a diameter of 50 μm or less. This jet defines a cutting beam that does not exhibit a significant increase in diameter at the distance traveled to the target receptacle, which cuts easily the interposed corneal tissue. The device 11 is used by positioning the first bracket so that the corneal apex 17 extends through the opening 16 and the suction ring 13 is movable to secure the device to the eye. The attachment member 48 may be formed of a transparent material with crosshairs or other tick marks to determine the appropriate effect of aflation on the process to be performed. The surface of the aflation member 48 in contact with the vertex 17 may be planar or have a predetermined radius of curvature. In the rest position, the jet nozzle is aligned such that the liquid jet cannot contact the corneal tissue.

Liquid jet 44 is then initiated to produce an ultrafast liquid beam that extends from nozzle 43 to target receptacle 46. Then, the first linear mover 27 is operated to translate the nozzle 43 horizontally by bending the first flexible bracket 23 so that the liquid jet beam is translated horizontally through the corneal tissue. Are exercised. The incision of the cornea is extremely planar and very thin due to the fact that the diameter of the cutting jet is 50 μm or less and that there is no play in the mechanism for translating the cutting jet. In other words, the bending mechanism of the present apparatus makes the most of the extremely fine cutting capability of the liquid jet. Thus, the incision is very smooth and removes only the absolute minimum amount of tissue, thereby promoting rapid healing and precisely controlling the refractive properties.

The second linear mover 41 can be actuated as necessary to set the vertical position of the incision, which determines the depth (vertical depth) of the vertex flap formed by the present invention. The vertical deflection mechanism formed by the brackets 31 and 32 and the mover 41 is fully supported on the horizontal deflection mechanism, whereby the position of the jet nozzle 43 is vertical and horizontal translational movement performed by the device 11. It should be noted that the sum of

The apparatus 11 can orient the cutting jet 44 to perform all the incisions necessary for MKM, HRK, ALK and the like. Conversely, the device can only be used to perform a first planar incision that forms the anterior apex corneal flap, thus setting the stage for interstitial ablation measures that can be performed by other surgical means.

It should be noted that the incision made by the apparatus 11 can be performed not only with extreme precision but also extremely quickly. Formation of the apex corneal flap only requires approximately 1 to 5 seconds, and interstitial excision can require approximately the same amount of time.

The foregoing description of the preferred embodiment of the present invention has been presented for purposes of illustration and description. The present invention is not to be exhaustive or to limit the precise form disclosed, and many modifications and variations are possible in light of the above teachings without departing from the spirit and scope of the invention. The described embodiments are chosen to best explain the principles of the invention and its practical application, and accordingly those skilled in the art will appreciate the invention in various embodiments and in various modifications suitable for the specific purpose intended. Make the best use of The scope of the invention should be defined by the claims appended hereto.

In accordance with the present invention, by eliminating the mechanical surface of the advantages of prior art sliding or rolling devices, it takes full advantage of the extremely fine cutting beams produced by high pressure cutting jets and provides an unprecedented plan view and thin thickness incision. do.

1 is a perspective view of an apparatus for supporting and orienting a liquid cutting jet for refractive surgery.

FIG. 2 is a side view of the apparatus shown in FIG. 1 for supporting and orienting a liquid cutting jet for refractive surgery. FIG.

FIG. 3 is a partial cutaway plan view of the device shown in FIGS. 1 and 2 for supporting and orienting a liquid cutting jet for refractive surgery. FIG.

4 is a partial cutaway end view of the device shown in FIGS. 1-3 for supporting and orienting a liquid cutting jet for refractive surgery.

<Description of the symbols for the main parts of the drawings>

10: feed tube

11: device

12: fixture

13: suction ring

14: front surface

16: opening

17: vertex

21: support bar

22: horizontal support

23: first flexible bracket

27: horizontal linear actuator

28: armature

31: second flexible bracket

41: vertical linear actuator

42: armature

43: High Pressure Liquid Nozzle

44: liquid jet

46: target receptacle

48: absence member

Claims (18)

Fastener means for releasably engaging with the anterior surface of the eye, Liquid jet nozzle means for generating a high velocity liquid jet capable of cutting ocular tissue, Bending means for extending from said fastener means to perform translational movement bending without sliding contact, and A precision mover means coupled to the flexure means for flexibly translating the flexure means and orienting the high velocity liquid jet upon cutting of the eye tissue coupled within the fixture means, And said liquid jet nozzle means extends from said bending means. 2. The ophthalmic surgical device of claim 1, wherein the fixture means comprises an opening dimensioned to receive a corneal vertex of the eye extending therethrough. 3. The ophthalmic surgical device of claim 2, wherein the fixture comprises a suction ring disposed concentrically with respect to the opening to releasably engage the anterior eye surface surrounding the corneal apex. 2. The ophthalmic surgical device of claim 1, wherein the flexure means comprises a first flexible bracket extending from the fixture means. The apparatus of claim 4, wherein the first flexible bracket includes a first plate member extending in a first plane and further comprising an inner opening formed in the first plate member and extending through the first plane. Ophthalmic surgical device, characterized in that. 6. The method of claim 5, wherein the inner opening defines a plurality of thin sidewall portions in the first plate-like member, wherein the thin sidewall portions are flexibly elastically easily within the first plane and bent out of the first plane. Ophthalmic surgical device, characterized in that strongly resistant. 7. The apparatus of claim 6, wherein the precision mover means comprises a first linear mover secured to a fixture means, the linear mover configured to bend and translate the first flexible bracket within the first plane. 1. An ophthalmic surgical device comprising a movable armature coupled to a flexible bracket. 8. The ophthalmic surgical device of claim 7, further comprising a second flexible bracket operatively connected to the first flexible bracket. The apparatus of claim 8, wherein the second flexible bracket includes a second plate-like member extending in a second plane and further includes an inner opening formed in the second plate-like member and extending through the second plane. An ophthalmic surgical device, characterized in that. 10. The ophthalmic surgical device of claim 9, wherein the second plane intersects the first plane. 11. The method of claim 10, wherein the inner opening defines a plurality of thin sidewall portions in the second plate-like member, wherein the thin sidewall portions are elastically easily bent in the second plane and bent out of the second plane. An ophthalmic surgical device, characterized by strong resistance to the thing. 12. The method of claim 11, wherein the precision mover means comprises a second linear mover secured to the first flexible bracket means, the second linear mover flexing the second flexible bracket within the second plane. And a movable armature coupled to the second flexible bracket for translational movement. 13. The apparatus of claim 12 wherein the liquid jet nozzle means is secured to the second flexible bracket means and configured to be oriented proximate to the front surface portion of the eye coupled within the fixture means. A translational bending movement of the brackets is imparted to the liquid jet nozzle means in an additional manner. 14. The ophthalmic surgery of claim 13, further comprising target receptacle means supported on the second flexible bracket and spaced relative to the liquid jet nozzle means and arranged to receive the high velocity liquid jet. Device. 2. The ophthalmic ophthalmic device of claim 1, further comprising an aflation means for impinging the anterior surface portion of the eye coupled within the fixture means and for imparting a predetermined mating surface to the corneal apex of the eye. Surgical device. 16. The ophthalmic ophthalmic device of claim 15, further comprising a spacer means extending from the fixture means for supporting the aflation means in a fixed relationship to the anterior surface portion of the eye coupled within the device. Surgical device. 17. An ophthalmic surgical device as recited in claim 16, wherein said aflation means comprises a planar surface arranged to impinge on an anterior surface portion of an eye coupled within said device. 14. The ophthalmic surgical device of claim 13, wherein the second linear mover comprises a micrometer for precisely positioning the liquid jet nozzle with respect to the plane of the first flexible bracket.

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