WO2001024746A1 - Dispositif et procede pour realiser une thermocoagulation - Google Patents

Dispositif et procede pour realiser une thermocoagulation Download PDF

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Publication number
WO2001024746A1
WO2001024746A1 PCT/DE2000/003510 DE0003510W WO0124746A1 WO 2001024746 A1 WO2001024746 A1 WO 2001024746A1 DE 0003510 W DE0003510 W DE 0003510W WO 0124746 A1 WO0124746 A1 WO 0124746A1
Authority
WO
WIPO (PCT)
Prior art keywords
eye
light beam
treated
holder
automatically
Prior art date
Application number
PCT/DE2000/003510
Other languages
German (de)
English (en)
Inventor
Benedikt Jean
Thomas Bende
Original Assignee
Benedikt Jean
Thomas Bende
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Benedikt Jean, Thomas Bende filed Critical Benedikt Jean
Priority to DE10082974T priority Critical patent/DE10082974D2/de
Priority to AU19925/01A priority patent/AU1992501A/en
Publication of WO2001024746A1 publication Critical patent/WO2001024746A1/fr

Links

Classifications

    • 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
    • A61F9/00821—Methods or devices for eye surgery using laser for coagulation
    • 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
    • A61F2009/00853—Laser thermal keratoplasty or radial keratotomy
    • 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
    • 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

Definitions

  • the invention relates to a method and a device for carrying out a contact thermokeratoplasty on the eye with means for releasably attaching the device directly or indirectly to an eye to be treated and at least one holder for holding the directional part of means for applying the bundled Beam of light on the eye.
  • a fixation mask is fixed by applying negative pressure to the cornea or to the coma-scleral transition area of the eye, whereupon prepared disks with bores for the directional part of a laser device, which serve as templates, are inserted into the fixation mask that a laser beam can be directed into the eye through the bores at predefined locations or a handpiece of a laser can be placed on the eye, which triggers coagulation there.
  • the cornea can also be attached using a ring?
  • Laser thermokeratoplasty in which the cornea is changed by introducing rotationally symmetrical coagulation foci of defined geometry and precisely defined depth of coagulation into the cornea, or by dividing the flatter meridian by sectorally applied points at a defined distance from the flat axis, has proven to be an effective and long-term stable procedure proven to correct farsightedness, presbyopia and high astigmatism.
  • non-contact methods are also known, for example from DE 197 52 949 AI, which, however, is described in generally do not allow long-term stable changes to the cornea, since the non-contact methods mainly coagulate in the upper and middle third of the cornea thickness, while scientific studies have shown that the coagulation foci reach between 80 and 100% of the cornea thickness for an effective and long-term stable correction have to.
  • thermokeratoplasty also depends critically on the depth of coagulation.
  • the diameter of the coagulation zones with regard to the individual corneal diameter plays an important role, and the individual corneal thickness, which is typically between about 520 and 700 ⁇ m, must also be taken into account.
  • the angle of attachment of the handpiece should be approximately 90 ° to the surface, and the horn skin extension at the place of application should be optimal. All these points have to be considered in the rotationally symmetrical application for hyperopia and press biopy correction as well as in the sectoral application for astigmatism correction.
  • asymmetrical coagulation patterns on the cornea are required to correct irregular astigmatisms.
  • the object of the invention is to specify a method and a device which allow contact thermokeratoplasty to be carried out particularly precisely, but also quickly.
  • the object is achieved on the one hand by a device of the type mentioned at the outset, in which the at least one holder can be moved automatically in at least two directions which are not parallel to the optical axis of the eye to be treated in such a way that the light beam strikes any points on the cornea of the person to be treated Eye can be directed.
  • the device allows a fully or at least largely automated implementation of a contact keratoplasty and has the great advantage that it can also be retrofitted to existing keratoplasty devices.
  • existing light sources usually lasers
  • the light from a laser source is directed onto the eye by means of flexible optical fibers, so-called optical fibers.
  • the end of the optical fiber (s) determines the direction of the light beam emerging from the fiber (s) and can be clamped in the automatically positionable holder or otherwise secured in the holder.
  • the device itself can also have means, in particular a laser, preferably a diode laser, for generating the light beam to be directed onto an eye to be treated in thermo-keratoplasty.
  • a laser preferably a diode laser
  • the device can advantageously be developed in such a way that, without changing the position of the holder, at least two light beams hitting an eye to be treated at different points at the same time or in succession can be generated.
  • This can be realized in different ways, for example by a beam splitter with two or more beam outputs, or by separate lasers, each with its own light guide.
  • the light beam (s) can be directed to any location on the cornea.
  • the holder it has proven to be particularly expedient to design the holder to be rotatable automatically about a first axis which is essentially parallel to the main line of sight of an eye to be treated and to be movable along a translation direction which is essentially perpendicular to the first axis.
  • the holder can be provided on a rail rotatably mounted about the first axis and can be moved along this rail.
  • a further automation and thus elimination of human error sources can advantageously be achieved in that means for moving the directional parts inserted into the holder towards and away from an eye to be treated and / or means for adjusting the angle at which the or the light beam (s) are irradiated on the eye will / will be provided.
  • Means for determining the contact pressure of the part of the means for contacting an eye to be treated for applying a light beam to an eye against the eye are preferably also provided.
  • means for regulating the energy of the incident light rays can be provided.
  • the position of the focal point of the incident light rays can also preferably be adjusted.
  • the wavelength of the light rays incident on the eye can even be changeable.
  • a further automation is possible if means are also provided on the device for measuring the eye topography and / or the internal structure of the eye body. These then allow automatic adjustment of the light rays to be guided to the eye on the basis of data "online" determined about the eye to be treated.
  • a central evaluation is preferably used to control the device and in particular to automatically set certain positions of the holder relative to an eye to be treated? and control unit, which can also be a multifunctional unit, for example a PC or a workstation, by means of which data about the treatment and the patient being treated can then also be processed and stored.
  • control unit which can also be a multifunctional unit, for example a PC or a workstation, by means of which data about the treatment and the patient being treated can then also be processed and stored.
  • the keratoplasty performed can be, for example, the positions at which light rays were directed into the eye, the energy radiated per hearth, the exposure time per hearth, the total energy per hearth, the number of hearths per ring, the number of rings and the Diameter of the rings.
  • the stated object is achieved by a method for carrying out thermokeratoplasty on the eye, means for applying at least one bundled light beam to an eye to be treated being attached directly or indirectly to the eye, whereupon at least that part of the part which determines the direction of the at least one light beam Means for applying the light beam is automatically moved to different locations of the eye, at which locations the light beam is then applied to the eye.
  • the method can be carried out in such a way that the eye topography and / or the internal structure of the eye body is at least partially automatically measured before the light beam is applied.
  • the positioning of the part of the means for applying the light beam which determines the direction of the light beam can then advantageously take place on the basis of automatically acquired data about the eye topography and / or the internal structure of the eye body.
  • the method according to the invention can be carried out such that the energy of the incident light beam, the focal point of the radiated light beam and possibly also the wavelength of the radiated light beam can be changed taking patient-specific data into account in order to achieve an optimal treatment result.
  • a laser for example a diode laser
  • FIG. 1 shows a device according to the invention with a holder for the directional part of means for applying a light beam to an eye, which can be moved translationally along a rail rotatably mounted about a first axis,
  • Fig. 2 shows the device of FIG. 1 in side view, it was indicated schematically that the end piece of an optical fiber was inserted into the holder, and
  • FIG. 3 shows a control and laser unit for controlling the device shown in FIGS. 1 and 2 and generating laser beams to be directed onto the eye.
  • a device for carrying out a contact thermokeratoplasty on the eye designated in its entirety by 10, is shown, the main components of which are a handpiece 12 and an attachment part 14, the attachment part 14 being known per se and not shown here Can be fixed to an eye to be treated, in particular by applying a negative pressure so that the attachment part 14 is sucked onto the eye and remains fixed in a certain position during the execution of the keratoplasty.
  • An inner ring 16 is rotatably mounted in the attachment part 14, the axis of rotation roughly corresponding to the main line of sight of an eye to be treated and coinciding with the axis of the attachment part 14 which is circular in this exemplary embodiment.
  • the inner ring 16 is rotated about the said axis by means of a bevel gear 18 engaging in a corresponding toothing on the outside of the inner ring 16, the bevel gear 18 being driven by an exactly controllable stepper motor provided in the handpiece 12 in this exemplary embodiment and not shown here is, so that an accurate positioning of the rotational position of the inner ring 16 about the first axis is possible.
  • a rail 20 provided with micro-toothing in this exemplary embodiment is stretched across the inner ring 16, along which the actual holder 24 for the directional parts 26 of means for applying a bundled light beam to an eye to be treated can be moved by means of a corresponding stepping motor 22.
  • the direction-giving parts of the means for applying a bundled light beam are generally the end of an optical fiber through which a laser beam can be guided.
  • an intermediate element which can be automatically moved towards and away from an eye can be held in the holder 24.
  • Piece 28 may be provided, which advantageously allows the contact pressure of the parts of the means for applying the bundled light beam coming into contact with the eye to be varied. Means provided for determining this contact pressure are also not shown.
  • means for changing the angular position of the light dome with respect to the first axis can also be provided.
  • the control and laser unit shown in FIG. 3, designated in its entirety by 30, in this exemplary embodiment comprises three assemblies, namely a diode laser 32, a power supply unit 34 for supplying the respective assemblies and the device shown in FIGS. 1 and 2 Power and a control and monitoring unit 36 which contains the actual control electronics and control software and which has various input means 38, 40, 42, 44 for inputting control and control instructions and a control monitor 46 which can be tilted in this exemplary embodiment.
  • an optical fiber 26 is attached at one end to the laser 32 and at the other end in the holder 24, so that a laser beam generated by the laser 32 through the optical fiber 26 onto an eye to be treated gelei- can be tet.
  • the attachment ring 14 is then fixed to the eye to be treated by applying a negative pressure.
  • the holder 24 After entering appropriate control instructions either directly on the control unit 36 or e.g. Via a PC (not shown further here) which is coupled to the control unit 36 in a manner known per se, the holder 24 is brought into a position by moving the inner ring 16 and moving the holder along the rail 20, at which coagulation is triggered by the application of a laser beam shall be. There is the end of the optical fiber 26 coming into contact with the eye to be treated or a lens provided at the end of this fiber or a corresponding contact piece by means of the intermediate piece 28 or? if the contact pressure is too high - moved away from it. It should be noted at this point that by appropriately designing the device 10, in particular the holder 24, it is also easily possible to change the angle at which the laser beam is directed onto the eye and to set it in the desired manner.
  • a laser beam is generated by means of the laser 32 and applied to the eye, whereby coagulation is triggered.
  • the holder 24 is then positioned in the manner described above over the next point at which coagulation is to take place.
  • the number of foci per ring can be varied. Usual numbers are, for example, 8, 10 or 12 herds per ring. The distance between the coagulation points also changes with the number of foci per ring. This can be used both rotationally symmetrically for hyperopia / press biopia and sectorally for astigmatism corrections.
  • the depth of the foci with a defined geometry depends on the constant angle (typically 90 °) at the respective point on the cornea.
  • the coagulation result can be further optimized by appropriately securely anchoring the direction-giving part of the means for applying the light beam, that is to say generally the end of an optical fiber and constant contact pressure on the cornea.
  • the aim is to achieve optimal, maximum deep coagulation with sufficient volume while optimally protecting the endothelium.
  • the respective positions are recorded and documented for the individual treatment, so that a treatment protocol from energy 13
  • the data can be correlated, e.g. with the topographically determined result of the operation, and can be combined into an archive of treatment data and clinical results. Numerous such protocols can then be used to determine refined treatment normograms from the sum of the data obtained from many doctors and many patients.
  • variable control of asymmetrical locations, such as those e.g. for the treatment of irregular astigmatisms of the cornea, variable control is required in order to obtain a spherical or precisely defined toric corneal surface by asymmetrical division after successful execution of the keratoplasty.
  • the respective control coordinates at which light rays are to be directed onto the eye in order to trigger coagulation can be combined partly from a data memory, partly from the individual patient examination (e.g. diameter of the cornea, corneal thickness etc.) and linked to a treatment program.
  • An important advantage of the automation of the control of the individual coagulation points according to the invention is the possibility of automatic operation data archiving.
  • the clinical result can later be assigned to this data, so that a database can finally be set up which allows defined starting situations with earlier ones Compare treatment results and the geometries on which they are based in order to receive individual treatment suggestions.
  • variable sizes still outstanding today for optimizing the laser thermokeratoplasty in the three-dimensional application can be optimized for the respective individual case.
  • Operating points are controlled safely and reproducibly, the coagulation results are optimized geometrically and energy-efficiently and fluctuations in hands-free application are avoided.
  • the reduction of the variable parameters leads to an increase in therapeutic accuracy and thus to a new qualitative dimension of thermokeratoplasty.
  • the introduction of a highly precise, mask-mediated application enables the individual biological range of variation resulting from patient age and other variable sizes to be recorded more precisely and correction criteria for keratoplasty to be derived from this.
  • the device described above or the method described can be connected to any measuring devices or measuring methods for determining the eye topography or the internal structure of the eye body. In this way it can be determined at which points and / or to what extent a light beam should be directed onto the eye. In particular, it is possible to form a data pool so that, depending on the measured or determined corneal thickness, corneal structure or the measurements of the inside of the eye, in particular the optically see properties of the inside of the eye, automatically suggested or determined where the light beam is to be used.

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  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Optics & Photonics (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Laser Surgery Devices (AREA)

Abstract

L'invention concerne un dispositif et un procédé pour réaliser une thermokératoplastie. Selon l'invention, on utilise des moyens servant à fixer de manière libérable le dispositif sur l'oeil à traiter et au moins une fixation destinée à maintenir la partie directrice desdits moyens afin d'appliquer un faisceau lumineux sur l'oeil. La ou les fixations peuvent se déplacer automatiquement dans au moins deux directions indépendantes et non parallèles à l'axe optique de l'oeil à traiter, de sorte que le faisceau lumineux puisse être dirigé sur n'importe quel point de la cornée de l'oeil à traiter. L'invention permet d'augmenter la précision et la vitesse de traitement, dans l'intérêt du patient.
PCT/DE2000/003510 1999-10-05 2000-10-05 Dispositif et procede pour realiser une thermocoagulation WO2001024746A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
DE10082974T DE10082974D2 (de) 1999-10-05 2000-10-05 Vorrichtung und Verfahren zur Durchführung einer Thermokoagulation
AU19925/01A AU1992501A (en) 1999-10-05 2000-10-05 Device and method for carrying out thermocoagulation

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE19947778.7 1999-10-05
DE1999147778 DE19947778A1 (de) 1999-10-05 1999-10-05 Vorrichtung zur Durchführung einer Thermokoagulation

Publications (1)

Publication Number Publication Date
WO2001024746A1 true WO2001024746A1 (fr) 2001-04-12

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Application Number Title Priority Date Filing Date
PCT/DE2000/003510 WO2001024746A1 (fr) 1999-10-05 2000-10-05 Dispositif et procede pour realiser une thermocoagulation

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AU (1) AU1992501A (fr)
DE (2) DE19947778A1 (fr)
WO (1) WO2001024746A1 (fr)

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE10330821B3 (de) * 2003-07-08 2004-09-30 Gebauer Gmbh Lasertrepan

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1995015134A1 (fr) 1993-12-02 1995-06-08 Sunrise Technologies, Inc. Systeme laser destine a la remise en forme de la cornee
US5437658A (en) * 1992-10-07 1995-08-01 Summit Technology, Incorporated Method and system for laser thermokeratoplasty of the cornea
DE19752949A1 (de) 1996-11-29 1998-06-04 Nidek Kk Vorrichtung zum Bearbeiten einer Kornea
US5779696A (en) * 1990-07-23 1998-07-14 Sunrise Technologies International, Inc. Method and apparatus for performing corneal reshaping to correct ocular refractive errors

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5820624A (en) * 1995-07-17 1998-10-13 Quadrivium, L.L.C. System for altering corneal tissue

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5779696A (en) * 1990-07-23 1998-07-14 Sunrise Technologies International, Inc. Method and apparatus for performing corneal reshaping to correct ocular refractive errors
US5437658A (en) * 1992-10-07 1995-08-01 Summit Technology, Incorporated Method and system for laser thermokeratoplasty of the cornea
WO1995015134A1 (fr) 1993-12-02 1995-06-08 Sunrise Technologies, Inc. Systeme laser destine a la remise en forme de la cornee
DE19752949A1 (de) 1996-11-29 1998-06-04 Nidek Kk Vorrichtung zum Bearbeiten einer Kornea

Also Published As

Publication number Publication date
DE10082974D2 (de) 2002-01-24
DE19947778A1 (de) 2001-04-12
AU1992501A (en) 2001-05-10

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