WO2001054569A1 - Dispositif et procede pour determiner le rayon ou une grandeur equivalente de l'angle irido-corneen - Google Patents

Dispositif et procede pour determiner le rayon ou une grandeur equivalente de l'angle irido-corneen Download PDF

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Publication number
WO2001054569A1
WO2001054569A1 PCT/EP2000/004302 EP0004302W WO0154569A1 WO 2001054569 A1 WO2001054569 A1 WO 2001054569A1 EP 0004302 W EP0004302 W EP 0004302W WO 0154569 A1 WO0154569 A1 WO 0154569A1
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WO
WIPO (PCT)
Prior art keywords
chamber
radius
insertion body
cornea
angle
Prior art date
Application number
PCT/EP2000/004302
Other languages
German (de)
English (en)
Inventor
Manfred Tetz
Stephan Schruender
Original Assignee
Bioshape Ag
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 Bioshape Ag filed Critical Bioshape Ag
Publication of WO2001054569A1 publication Critical patent/WO2001054569A1/fr

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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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/14—Eye parts, e.g. lenses, corneal implants; Implanting instruments specially adapted therefor; Artificial eyes
    • A61F2/16—Intraocular lenses
    • A61F2/1602—Corrective lenses for use in addition to the natural lenses of the eyes or for pseudo-phakic eyes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/1005—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions for measuring distances inside the eye, e.g. thickness of the cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1076—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions inside body cavities, e.g. using catheters
    • 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/14—Eye parts, e.g. lenses, corneal implants; Implanting instruments specially adapted therefor; Artificial eyes
    • A61F2/16—Intraocular lenses
    • A61F2/1602—Corrective lenses for use in addition to the natural lenses of the eyes or for pseudo-phakic eyes
    • A61F2/161—Posterior chamber lenses for use in addition to the natural lenses of the eyes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/117—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions for examining the anterior chamber or the anterior chamber angle, e.g. gonioscopes
    • 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/14—Eye parts, e.g. lenses, corneal implants; Implanting instruments specially adapted therefor; Artificial eyes
    • A61F2/16—Intraocular lenses
    • 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

Definitions

  • the invention relates to a measuring device and a method for measuring or estimating the radius or a size equivalent to the radius of the substantially circular surface enclosed by the ventricular angle line of the anterior chamber of an eye.
  • Posterior chamber lenses for implantation in phakic eyes are still relatively new. These are thin, soft intraocular sleeves that are implanted into the sulcus ciliaris through the dilated pupil in front of the natural lens.
  • the Worst Iris Claw lens which is also suitable for implantation in phakic eyes, is a biconcave intraocular lens made of PMMA, which is fixed in the middle peripheral immobile part of the iris by means of a claw-shaped haptic.
  • Anterior chamber lenses in the field of which the present invention is located, are inserted into the anterior chamber after a cut in the cornea and clamped in the chamber angle.
  • Fig. 1 shows such a lens from Bausch & Lomb, which is known under the name "NuVita".
  • the advantage of the anterior chamber lenses is considered to be the technically relatively easy implantation. A potentially dangerous contact with the still existing natural lens can also be avoided in the case of anterior chamber lens implantation.
  • They can be designed to be flexible and therefore can also be implanted in the anterior chamber using small incision technique through corneal incisions with a diameter of approximately 3.5 mm, for example. If rigid lenses are used, the cutting diameter is e.g. 5 mm. In both cases, the induction of surgical astigmatism can usually be avoided.
  • Anterior chamber lenses can also be used in aphakic eyes. Here they take over the function of the eye lens. In aphakic eyes, due to lentil lens more space available, so that the spatial conditions favor the use of intraocular tubes.
  • the diameter of the anterior chamber in the area of the chamber angle is generally between 10 and 13 mm.
  • the size of the implanted lenses is typically 0.5 - 1 mm larger in order to avoid dislocation or rotation.
  • the size of the lens used is currently estimated by measuring the limbus diameter (transition from cornea to sclera). In this case, the diameter is estimated from the outside by means of a measuring circle by measuring two opposite points of the cornea-dermis transition (so-called white-to-white measurement) and 1 mm is added to this distance in order to ensure that the To ensure intraocular lens in the anterior chamber.
  • this estimate is naturally relatively imprecise.
  • the device comprises an insertion body, which can be inserted through an opening in the cornea into the anterior chamber, and a determination unit functionally coupled to the insertion body or to the insertion body, which is designed in this way that the relative position of at least two points of the aforementioned surface, in particular their distance, can be determined, it being possible to infer the radius or an equivalent size from this relative position.
  • this object is achieved in the method of the type mentioned at the outset in that this method comprises the following steps: an opening is cut into the cornea; an insertion body of a measuring device is inserted through the opening into the front chamber; and the relative position of at least two points of the said surface, in particular the distance thereof, is determined with the aid of the insertion body in such a way that it is possible to infer the said radius or the equivalent size from this relative position.
  • the advantages of the invention can be seen in particular in the fact that it is possible by means of the method or the device presented to advance a suitable measuring instrument through the opening in the cornea, through which the lens should preferably be subsequently introduced, into the anterior chamber. From the determination of the relative position of at least two points of the area enclosed by the chamber angle circumference line, the radius of the anterior chamber can then be deduced in a known manner - for example using simple geometric formulas or in the simplest case by reading directly from a scale. It is assumed that the chamber angular circumference defines an arc. Deviations from this circular arc shape are essentially negligible and are therefore not taken into account.
  • the radius or the equivalent size can be measured directly without any obstacles in the way - in the case of measurements from the outside, this is the cornea
  • the term “radius” is generally used instead of “radius or an equivalent size”, the term also includes the equivalent sizes mentioned.
  • Equivalent size also includes, for example, the determination of the distance from a point of the To understand the chamber angle to a point on the axis of symmetry of the eye that is not the center of said circular area. This distance is related to said radius via simple trigonometric functions - such as the sine or cosine function
  • the determination of the at least two points mentioned can be determined, for example, by means of optical and / or acoustic methods (reflection or absorption measurements, transit time measurements) and / or mechanical methods.
  • a light or sound transmitter and / or a is on the import body Light or sound receiver arranged If the transmitter and receiver are placed, for example, on the axis of symmetry of the circle enclosed by the chamber angular circumference, the radius can be deduced from the transit time of the signal reflected at the chamber angle.
  • such measurements allow much more precisely than in the prior art Determine the radius (or the diameter or another equivalent size) of the area enclosed by the chamber angle circumference and use these values to select the optimal anterior chamber lens for implantation
  • the radius or the equivalent size can be determined by the determination unit depending on the position of the import body in the front chamber
  • the determination of the relative position of the points consists of the determination of their distance.
  • the distance from two points is measured on or near the chamber angle orbit, the direct connection of which runs through the mentioned center point and which thus describes the diameter of the chamber angle orbit Define circular area
  • the distance from the opening of the cornea to the opposite chamber angle section can be determined and - to improve the measurement accuracy with optional consideration that the opening in the cornea for spatial reasons above the chamber angle It must lie - conclude from the diameter of the ventricular angular circumference
  • center point and point on the chamber angular circumference does not necessarily mean the ideal position in the center or on the chamber angular circumference, points with slight deviations from the center point or from the chamber angular circumference also fall under the aforementioned terms
  • the side length of an isosceles triangle essentially in the area enclosed by the chamber angular circumference, is determined, of which two corner points lie on the chamber angular circumference and the third corner point lies on or near the said center point and thus the leg length of the triangle is equal to that Radius searched for
  • This three-point measurement increases the measuring accuracy compared to the previously described two-point measurement, consisting of measuring the distance from the center of the circular area enclosed by the chamber angle circumference to a point on the chamber angle circumference
  • the determination unit is preferably designed in such a way that the radius or the equivalent size can be determined via the determination unit due to the position of the insertion body in the front chamber.
  • the measuring device advantageously has an insertion body designed as a measuring rod. This is preferably introduced eccentrically through the cornea into the anterior chamber and advanced through the anterior chamber in such a way that the insertion body is in a feed position substantially above and preferably close to the center of the circular area delimited by the chamber angular circumference and with the chamber angle section opposite the cornea opening at least one point in contact or as close as possible to that point.
  • the said radius can then be determined according to the possible advance of the insertion body via a determination unit arranged on or coupled to the insertion body, the determination unit advantageously comprising a reading or display unit.
  • the determination unit is located outside of the said center on the axis of symmetry of the eye, corrections are necessary for accurate measurements in order to take into account the angle between the circular area enclosed by the chamber angle circumference line on the one hand and the connecting line between the determination unit and the point of contact of the chamber angle on the other hand. This can already be taken into account when calibrating the determination unit;
  • the opening in the cornea in the different eyes should then advantageously be incised in the same place, if possible, in order to find approximately the same angular relationships in each case.
  • the said radius of the area enclosed by the chamber angle circumferential line or the said equivalent size through the cornea can be read by the determination unit when the insertion body is in a feed position in contact with the chamber angle.
  • the determination unit as a scale on the Introducer body is formed and that a light beam from outside the anterior chamber along the axis of symmetry of the eye - which intersects the center of the circular area delimited by the chamber angular circumference - is radiated onto the scale and generates a readable signal there.
  • the light beam is reflected on the scale division in such a way that the value can be read directly from the section of the scale at which the light beam strikes.
  • the scale has, for example, ten graduation marks, without the numbers or the like necessarily being applied to the scale.
  • the operator of the measuring device can infer the radius from the position of the light beam on the scale alone.
  • the individual graduation marks can also be designed differently (for example, different lengths) in order to achieve an exact assignment.
  • the scale is preferably calibrated in such a way that the radius of the approximated circular area can be read directly and, based on this value, the suitable lens for implantation can be selected quickly and inserted into the anterior chamber through the opening in the cornea after removal of the measuring device.
  • calibrating it can be taken into account that, in the measuring position, the scale is not arranged entirely in the area defined by the chamber angular circumference, but mostly above.
  • the cornea is marked at the point intersecting the axis of symmetry.
  • a metal tip is placed on a guide above the cornea on the axis of symmetry or the optical axis of the eye and the cornea is scored with this metal tip.
  • a light beam is then directed centrally along the axis of symmetry of the eye to this marked point, so that the marking is shown on the scale and the radius can be read using this signal.
  • a semiconductor is provided on the insertion body, which is a location-dependent one depending on the point of impact of the incident light beam generates an electrical signal, which is passed via a line from the front chamber to an evaluation and display unit.
  • This line expediently runs in or along the import body
  • the determination unit of the measuring device is designed as a scale that cuts the cornea, for example, when the measuring device is in the maximum advanced position, so that the diameter or the radius - depending on the calibration of the scale - can preferably be read at this interface with the naked eye
  • the opening in the cornea does not lie on the circumferential angle of the chamber, but lies above it.
  • both in the region of the said center of the chamber angular circumference and scales provided in the area of the insertion body which intersects the cornea opening
  • the emptying body has a shape that allows it to be introduced into the front chamber in an elongated configuration.
  • the embodying body either inherently has such an elongated shape or can be brought into such a shape, for example by folding or other volume reduction
  • At least two formations are preferably arranged at the distal end of the insertion body, which simulate the foot plates of known anterior chamber sockets. In this way, not only can the future position of the intraocular lens in the anterior chamber be estimated, but the measurement accuracy can also be measured increase the additional contact of the import body with another ventricular angle point
  • the measuring device advantageously consists of at least one proximal and one distal part, which are arranged at an angle to one another.
  • a measuring position of the measuring device this is in the anterior chamber advanced that the distal part is on the axis of symmetry - in a preferred embodiment, preferably at a short distance above the center - of the circular area enclosed by the chamber angular circumference or intersects this center.
  • the proximal part points away from the eye lens and protrudes through the opening in the cornea to the outside in order to pass there into a handle body for, for example, manual handling of the measuring device.
  • the body of the schr has a flat distal end. This reduces the risk of injury to the sensitive endothelial layer on the inner corneal side
  • the embodying body is formed at least as consisting of two mutually movable parts.
  • a pivoting arrangement is articulated on a base body of the insertion body that is elongated in advance, which is essentially pivotable in the area defined by the circumferential chamber angle so that it adjusts the chamber angle touches at least two spaced-apart points.
  • the swivel arrangement can be essentially rod-shaped, for example, so that in the pivoted position it spans a cross with the base body. The two free ends of the swivel arrangement touch the chamber angle at different sections
  • the above described guide body with the rod-shaped swivel arrangement can be used to measure said radius in two ways.
  • the radius can be read from the cornea by means of the aforementioned light beam from a first scale on the base body or the swivel arrangement
  • the body of the imprompher is withdrawn, but remains in the front chamber.
  • the swivel arrangement can then be pivoted - advantageously by means of leverage, i.e. force that is eccentrically offset with respect to the axis of rotation by means of pulling or pushing
  • the end of a rigid wire is eccentrically connected to the swivel arrangement.
  • the wire runs along the base body and out of the eye through the opening in the cornea.
  • the body of the schr is again proposed in this way choben that the free ends of the swivel assembly each touch the chamber angle. Make sure that the base body is above the center of the circle defined by the chamber angle circulation
  • the base body has a second measuring scale for reading said radius, which is as close as possible in this second measuring position of the import body Located above or in the center of the chamber angular orbit and which is preferably calibrated in such a way that the radius can again be read directly.
  • the second measuring scale can either be located in the area of said center point and / or also at the entry of the measuring device into the front chamber.
  • a stop can be provided on the base body and / or the swivel arrangement, which prevents further swiveling.
  • the distal end of the insertion body has a loop which, when the measuring device is advanced into the front chamber, is designed to be extendable and retractable and partially extends into a section of the chamber angle when extended.
  • the radius can be determined from the length of the loop on the one hand and from the position of the scale in the front chamber on the other hand, since the loop lies in the chamber angle in a predetermined and reproducible manner due to its material properties.
  • the distal end of the insertion body is designed as a tube.
  • the distal end of the insertion body can have two legs which can be folded out at a defined angle, so that two opposite loop sections in the maximally extended, ie advanced state of the loop on the opened legs of the insertion body and place the loop section connecting the two loop sections against the chamber angle section opposite the two legs.
  • a maximum feed position is defined for the insertion body, from which the radius (r) or an equivalent size can be determined, for example by means of the scale intersecting said axis of symmetry in the feed position. Due to the multi-point contact of the loop with the chamber angle, a high measuring accuracy can be achieved.
  • the correct position of the import body in the anterior chamber is essential for all embodiments of the invention.
  • the body of the nostir or the base body must have the axis of symmetry of the anterior chamber (simultaneously the axis of symmetry of the cornea and the eye ) cut
  • light is advantageously radiated onto the cornea by means of an illumination device opposite the cornea, in order to infer the position of the insertion body in the anterior chamber on the basis of the light reflections on the cornea and on the lens.
  • a ring light is advantageously used , which is arranged essentially symmetrically with respect to the cornea.
  • the body can thus be centered in the anterior chamber in such a way that it crosses the axis of symmetry of the anterior chamber.
  • a centrally illuminating light source can also be used ne point-shaped reflex generated
  • a marking is applied in the center of the cornea, light is radiated along the axis of symmetry and the body is positioned in the anterior chamber in such a way that the marking is imaged on the body or on its scale
  • the sensor body has an elongated base body and at least two sensors which are movable relative to the body body. These sensors can be extended in opposite directions when the body is inserted into the front chamber, whereby they slide into the respective chamber angle section aligned that their direct connecting line runs through the axis of symmetry of the circular surface enclosed by the chamber angular circumference. In this way, the diameter of said surface is obtained
  • a special embodiment for this alternative embodiment provides that the base body is hollow and its distal end is divided into two in opposite directions pipes passes with openings from which wires can be extended, at the ends of which a sensor is arranged. If the tubular elements are curved, the sensors can be guided in these opposite directions.
  • a push / pull device or a screw device is advantageously formed in the region of the proximal end of the base body, which is coupled to the sensors, for example, via the wires mentioned.
  • An operable part of the pushing / pulling device or the screwing device preferably protrudes from the cornea.
  • the amount of advance of the sensors in the front chamber can be adjusted by pushing / pulling or screwing.
  • the wires are guided in a sleeve so as to be longitudinally displaceable (for example with a worm thread), the sleeve preferably having an eye thread which is in screw engagement with an internal thread of the base body. If the sleeve is screwed out of the base body or screwed further into the base body, the wires are inserted into the base body or further out of it.
  • the diameter detected by the sensors is preferably read from a determination unit designed as a scale, the scale being arranged on the push-pull device or the screw device.
  • the scale is arranged, for example — outside the cornea in the transition region to the tube of the base body — in the inserted state of the insertion body. The diameter can then advantageously be read from the measure of the advance of the scale.
  • the sensors When using the latter device, it is pushed into the front chamber in such a way that the two openings of the base body are as close as possible to the center of the circle enclosed by the chamber angular circumference, then the sensors are extended and preferably the insertion body when the sensors are extended in this way is pushed back and forth until the sensors are at a maximum distance from each other.
  • the sensors are also conveniently always pushed back and forth so that they can always detach themselves from the chamber angle.
  • the two sensors measure the diameter of the said circle.
  • FIG. 2 shows a cross section through an eye with a first embodiment of the invention in a front chamber in the maximum advanced position
  • FIG. 3 a plan view of the measuring device according to FIG. 2;
  • FIG. 6 a schematic plan view of the measuring device according to FIG. 5 in the pivoted state and in the maximally advanced position (second measuring position); and 7 shows a thematic top view of a third embodiment of the invention with an extendable loop in the maximum advanced position.
  • Fig. 8 a schematic plan view of a fourth embodiment of the invention with two extendable sensors in the maximum advanced position.
  • a lens body 2 is provided centrally, which has two curved arms 4 on two opposite edge regions, which are supported on footplates 3 during implantation in a front chamber in the chamber angle.
  • the anterior chamber lens 1 is designed to be elastic so that it can be inserted into the anterior chamber through a small opening in the cornea in the compressed state.
  • the structure of the schematically illustrated eye is shown briefly with reference to FIG. 2.
  • the anterior chamber 30 is delimited from the outside world by the cornea 31, which has a mechanically very sensitive endothelial layer on its side facing the anterior chamber 30 (not shown).
  • the anterior chamber 30 is delimited towards the inside of the eye by the iris (also known as the iris) 32 with the pupil 33 lying centrally and the lens 34 arranged underneath.
  • the circumferential section in which the cornea 31 and the iris 32 meet is the chamber angle or the chamber angle circumference 35.
  • the measuring device 10 according to FIG. 2 (shown in the advanced state in the front chamber 30) and FIG. 3 is designed as an angled rod and has a narrow handle body 11 and a narrow insertion body 12.
  • the insertion body 12 is divided into a proximal section 12a and a distal section 12b, which are angled to one another.
  • the free end 13 of the distal section 12b - at the same time the distal end of the measuring device 10 - runs out narrow and flat
  • This end 13 is preferably rounded in such a way that its radius of curvature is smaller than the radius of the essentially circular chamber angular circumference 35.
  • the distal part 12b of the insertion body 12 has a scale 14, which is divided, for example, into half millimeter intervals and A scale 14a is additionally provided on the proximal part 12a with appropriate illumination from the outside of the eye with appropriate lighting. In one embodiment of the invention, not shown, only one of the two scales 14, 14a is provided
  • an opening is cut eccentrically into the cornea 31 and the body 12 - while holding the grip body 11 - through the opening 36 formed in the cornea 31 into the anterior chamber 30 and until its narrow distal end is touched 13 advanced with the chamber angle 35 opposite the opening 36, without touching the endothelial layer on the inside of the cornea 31 as far as possible.
  • the body 11 still protrudes from the opening 36.
  • the scale 14 is as close as possible to the center 20 the area described by the chamber angular circumference 35, the radius r or diameter of which is ultimately to be determined.
  • both the distal end 13 and the scale 14 are essentially in the circular plane enclosed by the chamber angular circumference 35, so that measurement errors in the radius determination are due to from Hoh
  • the overall width of the scale 14 is chosen such that both unusually small and large anterior chamber radii r can be determined
  • the scale 14a on the proximal section 12a of the insertion body 12 is in the advanced state of the measuring device 10 in the region of the opening 36 of the cornea 31 and is taking into account the angular conditions (because of the position of the opening 36 above the chamber angular circumference line) 35) is calibrated such that the radius r or the diameter can also be read from this scale 14a
  • the most accurate possible position of the insertion body 12 in the anterior chamber 30, namely as precisely as possible above the center 20 of the chamber angular circumference 35, can be achieved in that light from an illumination device (not shown) arranged opposite the cornea 31 is radiated onto the eye, for example from a ring light.
  • the position of the insertion body 12 in the anterior chamber 30 can then be checked by observing the reflexes on the cornea 31 and / or on the lens 34.
  • a centrally illuminating light source with a small beam diameter can be used, which generates a point-like reflection in the center of the front chamber.
  • a light beam is preferably radiated onto the scale 14 from outside the eye along the axis of symmetry 37 of the anterior chamber 30 or the eye, which intersects the center 20 of the circular area enclosed by the circumferential chamber angle 35.
  • This light beam is reflected on the scale 14, the point of impact on the scale 14 can be observed through the cornea 31, possibly with the aid of a deflecting mirror for the reflected beam. In this way, an extremely easy yet precise reading of the radius r is possible.
  • a ring light is used that emits a light beam with an annular cross-section along the axis of symmetry through the cornea and is not used (only) to adjust the position of the insertion body in the anterior chamber, but to read the radius from the scale.
  • the radius can be inferred from the points of impact of the ring beam.
  • the cornea 31 is incised at its intersection with the axis of symmetry 37.
  • a metal tip on a guide is used, which is arranged centrally above the cornea (not shown).
  • a mask (not shown) with a central hole is placed over the cornea 31 and the corneal area aligned with this hole is cut marked - for example by tiny scratches.
  • a light beam is directed along the axis of symmetry 37 of the eye to the marked point. The marking is thereby mapped onto the scale 14 and the radius r can be read off.
  • the reflected or observed signal is different.
  • holes can also be provided along the scale division. If the holes continuously become smaller in one direction and the light beam with a defined diameter can therefore pass through these holes to different degrees at different radii r of the front chamber 30, the radius r can be concluded from the reflected signal.
  • the distal end of the insertion body 12 has two projections 13a, which the shape of the foot plates 3 of the anterior chamber lens 1 shown in FIG. 1 and thus the To simulate the seat of this lens to be implanted.
  • the two projections 13a give the insertion body 12 a more stable position in the chamber angle 35 during the measuring process.
  • the measuring device 110 again consists of a handle body 11 (not shown in the top view of FIGS. 5 and 6) and an insertion body 112, which in this case consists of two movable parts Share is trained.
  • the insertion body 112 in this case has a base body 115 and a pivoting arrangement 116 articulated on its distal end, which in the exemplary embodiment shown is rod-shaped and can be pivoted essentially in the plane defined by the chamber angle circumference line 35.
  • the base body 115 has two scales arranged next to one another, a distal, first scale 114 and a proximal, second scale 11
  • the length of the rod-shaped swivel arrangement 116 is selected such that it does not cover the first scale 114 with the base body 115 when in alignment.
  • the first scale 114 is arranged on the swivel arrangement 116 which is long enough.
  • the measuring device 110 is brought into a position for insertion into the front chamber 30 through the opening 36, in which the base body 115 and the swivel arrangement 116 are aligned with one another.
  • the measuring device 110 is then advanced against the chamber angle 35 opposite the opening 36, taking care that the base body 115 intersects the axis of symmetry 37 of the anterior chamber 30 (which coincides with the optical axis of the eye) and the first scale 114 is thus close above or on the center 20 of the ventricular angle rotation (FIG. 5).
  • the radius r can be read from the first scale 114 by irradiating a light beam.
  • a scale is provided at the opening 36 (see the exemplary embodiment described first).
  • a control measurement or also an independent measurement by means of the measuring device 110 according to FIGS. 5 and 6 is possible if the measuring device 110 is pulled back a little from the chamber angle 35 and the swivel arrangement 116, for example by means of a wire (not eccentrically articulated with respect to the swivel axis 117) shown), which engages the swivel arrangement 116 and is guided out of the front chamber 30 through the opening 36 along the measuring device 110.
  • the second scale 119 lies above said center point 20 on the axis of symmetry 37 of the eye.
  • the second scale 119 is calibrated in such a way that the radius r sought can also be read directly from it.
  • Such a calibration obeys simple geometric laws, since in the end the side lengths of an isosceles triangle are determined, from which two corner points on the circumferential angle 35 of the chamber and the third corner point the center point 20 of the chamber angular circumference 35 and thus the length of the legs corresponds to said radius r.
  • the second scale 119 can accordingly be calibrated according to simple and known geometric formulas
  • the swivel arrangement 116 is brought back into the position aligned with the base body 115
  • FIG. 7 shows a third exemplary embodiment of the invention.
  • the principle of operation is similar to that of the exemplary embodiment according to FIGS. 5 and 6.
  • the distal end of the insertion body 212 can be folded out in the longitudinal direction into two legs 212a, which extend For example, let it fold out only up to a maximum angle ⁇ by means of a stop.
  • the body 212 is hollow in shape.
  • a loop 216 is arranged inside it, which can be extended or retracted, for example, by pressure or tension.
  • the body 212 is in the folded state the leg 212a has been inserted into the front chamber 30, the loop 216 is extended, causing the legs 212a to spread.
  • the legs 212a fold again, for example caused by a spring acting between them accordingly; alternatively, the legs 212a are pressed together with the loop 216 retracted when the insertion body 212 is pulled out of the front chamber 30 through the narrow point of the opening 36.
  • the insertion body 312 has a tubular base body 315 which ends at its distal end in two curved, oppositely hollowed-out tube pieces 315a with openings 315b.
  • the tube pieces 315a can be designed to be elastic to a certain degree in order to facilitate insertion through the opening 36.
  • a flexible, at least two-wire wire 316 runs as part of the insertion body 312 within the base body 315, sensors 313 being arranged at the free end of each wire 316, which are formed slightly fanned out in the exemplary embodiment shown.
  • the respective other free end of the wires 316 is led out of the tubular base body 315 outside the cornea 31.
  • a scale 314 is arranged on the wire in this area.
  • the sensors 313 can be moved into or away from the chamber angle 35 by pushing or pulling on the wires 316, the wires being guided in the base body 315 and in particular in the tube pieces 315a.
  • This embodiment represents a simple push / pull device.
  • the at least two wires 316 are preferably connected to one another in the region of the proximal end of the base body 315 (not shown), so that the sensors 313 can be moved back and forth to the same extent.
  • the wires 316 are loose at their distal end so that they can be passed through the respective opening 315b.
  • the measuring device 310 is passed through the opening
  • the aim is to extend the two sensors 316 to the maximum, since they represent the diameter in this position. Accordingly, by pushing the interconnected wires 316, on the one hand the sensors 313 are extended and, expediently, the base body 315 is pushed back and forth in the insertion direction at the same time until the sensors 316 are at a maximum distance from one another, which is also the desired diameter. The diameter can then be read off the scale 314 and there preferably on the edge of the base body 315. In this case too, the scale 314 can be calibrated according to the height offset relative to the said circular area.
  • the wires 316 are connected to a screwing device, for example a sleeve which is mounted in the base body 315 and can be rotated about its longitudinal axis.
  • the stamp has, for example, an external thread and the base body 315 has a correspondingly designed internal thread.

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Abstract

L'invention concerne un dispositif de mesure utilisé, lors de la définition de la grandeur correcte d'un cristallin à implanter dans la chambre intérieure d'un oeil phakique, pour mesurer ou évaluer le rayon (r) ou une grandeur équivalente de la face, considérée comme circulaire, entourée par la ligne périphérique d'angle irido-cornéen (35) de la chambre antérieure. Le dispositif de mesure (10) comprend un corps à insérer (12), qui peut être inséré dans la chambre antérieure (30) par une ouverture (36) ménagée dans la cornée (31), ainsi qu'une unité de détermination (14) placée sur le corps à insérer (12) ou couplée fonctionnellement avec celui-ci, qui est conçue de telle sorte que la position relative d'au moins deux points de ladite face, en particulier la distance séparant ces deux points, puisse être déterminée, ledit rayon (r) ou la grandeur équivalente pouvant être défini(e) à partir de cette position relative. L'invention concerne également un procédé permettant de mesurer le rayon (r) ou la grandeur équivalente.
PCT/EP2000/004302 2000-01-24 2000-05-12 Dispositif et procede pour determiner le rayon ou une grandeur equivalente de l'angle irido-corneen WO2001054569A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
DE10002672A DE10002672C2 (de) 2000-01-24 2000-01-24 Vorrichtung und Verfahren zur Bestimmung des Radius oder des Durchmesssers des Kammerwinkels eines Auges
DE10002672.9 2000-01-24
EPPCT/EP00/00672 2000-01-28
EP0000672 2000-01-28

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WO2001054569A1 true WO2001054569A1 (fr) 2001-08-02

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Cited By (22)

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WO2006032263A2 (fr) * 2004-09-23 2006-03-30 Geuder Ag Dispositif servant a mesurer la chambre anterieure d'un oeil
WO2008134322A1 (fr) * 2007-04-24 2008-11-06 Advanced Medical Optics, Inc. Indicateur d'angle pour la mesure des dimensions d'un sac capsulaire
WO2009120910A1 (fr) 2007-04-24 2009-10-01 Abbott Medical Optics Inc. Systèmes de mesure oculaire
US7794497B2 (en) 2003-03-21 2010-09-14 Abbott Medical Optics Inc. Ophthalmic sizing devices and methods
WO2011107084A1 (fr) * 2010-03-05 2011-09-09 Geuder Ag Dispositif de mesure du sac capsulaire d'un oeil
CN103971348A (zh) * 2014-04-08 2014-08-06 杭州电子科技大学 基于Schwalbe线的眼前房角参数自动测量方法
US8862447B2 (en) 2010-04-30 2014-10-14 Amo Groningen B.V. Apparatus, system and method for predictive modeling to design, evaluate and optimize ophthalmic lenses
US8926092B2 (en) 2009-12-18 2015-01-06 Amo Groningen B.V. Single microstructure lens, systems and methods
US8974526B2 (en) 2007-08-27 2015-03-10 Amo Groningen B.V. Multizonal lens with extended depth of focus
US9216080B2 (en) 2007-08-27 2015-12-22 Amo Groningen B.V. Toric lens with decreased sensitivity to cylinder power and rotation and method of using the same
US9454018B2 (en) 2008-02-15 2016-09-27 Amo Groningen B.V. System, ophthalmic lens, and method for extending depth of focus
US9456894B2 (en) 2008-02-21 2016-10-04 Abbott Medical Optics Inc. Toric intraocular lens with modified power characteristics
WO2016160645A1 (fr) * 2015-03-31 2016-10-06 Reichert, Inc. Détermination de modules de flexion viscoélastiques dynamiques continus de la cornée
US10624735B2 (en) 2016-02-09 2020-04-21 Amo Groningen B.V. Progressive power intraocular lens, and methods of use and manufacture
US10649234B2 (en) 2016-03-23 2020-05-12 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band
US10646329B2 (en) 2016-03-23 2020-05-12 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band
US10653556B2 (en) 2012-12-04 2020-05-19 Amo Groningen B.V. Lenses, systems and methods for providing binocular customized treatments to correct presbyopia
US10739227B2 (en) 2017-03-23 2020-08-11 Johnson & Johnson Surgical Vision, Inc. Methods and systems for measuring image quality
US11013594B2 (en) 2016-10-25 2021-05-25 Amo Groningen B.V. Realistic eye models to design and evaluate intraocular lenses for a large field of view
US11282605B2 (en) 2017-11-30 2022-03-22 Amo Groningen B.V. Intraocular lenses that improve post-surgical spectacle independent and methods of manufacturing thereof
US11506914B2 (en) 2010-12-01 2022-11-22 Amo Groningen B.V. Multifocal lens having an optical add power progression, and a system and method of providing same
US11886046B2 (en) 2019-12-30 2024-01-30 Amo Groningen B.V. Multi-region refractive lenses for vision treatment

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US4398812A (en) * 1980-06-18 1983-08-16 Kelman Charles D Apparatus and method for measuring the anterior chamber diameter of the eye
US4750498A (en) * 1986-02-21 1988-06-14 Coopervision, Inc. Method and tool for inserting an intraocular lens

Cited By (53)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7794497B2 (en) 2003-03-21 2010-09-14 Abbott Medical Optics Inc. Ophthalmic sizing devices and methods
US8500804B2 (en) 2003-03-21 2013-08-06 Abbott Medical Optics Inc. Ophthalmic sizing devices and methods
WO2006032263A3 (fr) * 2004-09-23 2006-07-27 Geuder Ag Dispositif servant a mesurer la chambre anterieure d'un oeil
WO2006032263A2 (fr) * 2004-09-23 2006-03-30 Geuder Ag Dispositif servant a mesurer la chambre anterieure d'un oeil
US8696601B2 (en) 2007-04-24 2014-04-15 Abbott Medical Optics Inc. Systems and methods for ocular measurements
AU2008245833B2 (en) * 2007-04-24 2013-08-15 Johnson & Johnson Surgical Vision, Inc. Angle indicator for capsular bag size measurement
US8002827B2 (en) 2007-04-24 2011-08-23 Abbott Medical Optics Inc. Systems and methods for ocular measurements
US7993398B2 (en) 2007-04-24 2011-08-09 Abbott Medical Optics Inc. Angle indicator for capsular bag size measurement
US8231672B2 (en) 2007-04-24 2012-07-31 Abbott Medical Optics Inc. Systems and methods for ocular measurements
US8241353B2 (en) 2007-04-24 2012-08-14 Abbott Medical Optics Inc. Angle indicator for ocular measurements
WO2009120910A1 (fr) 2007-04-24 2009-10-01 Abbott Medical Optics Inc. Systèmes de mesure oculaire
WO2008134322A1 (fr) * 2007-04-24 2008-11-06 Advanced Medical Optics, Inc. Indicateur d'angle pour la mesure des dimensions d'un sac capsulaire
US9987127B2 (en) 2007-08-27 2018-06-05 Amo Groningen B.V. Toric lens with decreased sensitivity to cylinder power and rotation and method of using the same
US11452595B2 (en) 2007-08-27 2022-09-27 Amo Groningen B.V. Multizonal lens with enhanced performance
US10265162B2 (en) 2007-08-27 2019-04-23 Amo Groningen B.V. Multizonal lens with enhanced performance
US8974526B2 (en) 2007-08-27 2015-03-10 Amo Groningen B.V. Multizonal lens with extended depth of focus
US9216080B2 (en) 2007-08-27 2015-12-22 Amo Groningen B.V. Toric lens with decreased sensitivity to cylinder power and rotation and method of using the same
US9454018B2 (en) 2008-02-15 2016-09-27 Amo Groningen B.V. System, ophthalmic lens, and method for extending depth of focus
US10034745B2 (en) 2008-02-15 2018-07-31 Amo Groningen B.V. System, ophthalmic lens, and method for extending depth of focus
US9456894B2 (en) 2008-02-21 2016-10-04 Abbott Medical Optics Inc. Toric intraocular lens with modified power characteristics
AU2009228146B2 (en) * 2008-03-28 2015-06-04 Johnson & Johnson Surgical Vision, Inc. Systems for ocular measurements
US10288901B2 (en) 2008-05-13 2019-05-14 Amo Groningen B.V. Limited echellette lens, systems and methods
US9557580B2 (en) 2008-05-13 2017-01-31 Amo Groningen B.V. Limited echelette lens, systems and methods
US9581834B2 (en) 2008-05-13 2017-02-28 Amo Groningen B.V. Single microstructure lens, systems and methods
US10180585B2 (en) 2008-05-13 2019-01-15 Amo Groningen B.V. Single microstructure lens, systems and methods
US8926092B2 (en) 2009-12-18 2015-01-06 Amo Groningen B.V. Single microstructure lens, systems and methods
WO2011107084A1 (fr) * 2010-03-05 2011-09-09 Geuder Ag Dispositif de mesure du sac capsulaire d'un oeil
US8862447B2 (en) 2010-04-30 2014-10-14 Amo Groningen B.V. Apparatus, system and method for predictive modeling to design, evaluate and optimize ophthalmic lenses
US11506914B2 (en) 2010-12-01 2022-11-22 Amo Groningen B.V. Multifocal lens having an optical add power progression, and a system and method of providing same
US10653556B2 (en) 2012-12-04 2020-05-19 Amo Groningen B.V. Lenses, systems and methods for providing binocular customized treatments to correct presbyopia
US11389329B2 (en) 2012-12-04 2022-07-19 Amo Groningen B.V. Lenses, systems and methods for providing binocular customized treatments to correct presbyopia
CN103971348A (zh) * 2014-04-08 2014-08-06 杭州电子科技大学 基于Schwalbe线的眼前房角参数自动测量方法
US10806342B2 (en) 2015-03-31 2020-10-20 Reichert, Inc. Determination of continuous dynamic corneal viscoelastic bending moduli
WO2016160645A1 (fr) * 2015-03-31 2016-10-06 Reichert, Inc. Détermination de modules de flexion viscoélastiques dynamiques continus de la cornée
US20180092532A1 (en) * 2015-03-31 2018-04-05 Reichert, Inc. Determination of continuous dynamic corneal viscoelastic bending moduli
US10624735B2 (en) 2016-02-09 2020-04-21 Amo Groningen B.V. Progressive power intraocular lens, and methods of use and manufacture
US10709550B2 (en) 2016-02-09 2020-07-14 Amo Groningen B.V. Progressive power intraocular lens, and methods of use and manufacture
US11116624B2 (en) 2016-02-09 2021-09-14 Amo Groningen B.V. Progressive power intraocular lens, and methods of use and manufacture
US10670885B2 (en) 2016-03-23 2020-06-02 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band with freeform refractive surfaces
US11281025B2 (en) 2016-03-23 2022-03-22 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band by modifying refractive powers in uniform meridian distribution
US10649234B2 (en) 2016-03-23 2020-05-12 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band
US11123178B2 (en) 2016-03-23 2021-09-21 Johnson & Johnson Surgical Vision, Inc. Power calculator for an ophthalmic apparatus with corrective meridians having extended tolerance or operation band
US11231600B2 (en) 2016-03-23 2022-01-25 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band with freeform refractive surfaces
US11249326B2 (en) 2016-03-23 2022-02-15 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band
US10646329B2 (en) 2016-03-23 2020-05-12 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band
US10712589B2 (en) 2016-03-23 2020-07-14 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band by modifying refractive powers in uniform meridian distribution
US11291538B2 (en) 2016-03-23 2022-04-05 Johnson & Johnson Surgical Vision, Inc. Ophthalmic apparatus with corrective meridians having extended tolerance band
US11013594B2 (en) 2016-10-25 2021-05-25 Amo Groningen B.V. Realistic eye models to design and evaluate intraocular lenses for a large field of view
US11385126B2 (en) 2017-03-23 2022-07-12 Johnson & Johnson Surgical Vision, Inc. Methods and systems for measuring image quality
US10739227B2 (en) 2017-03-23 2020-08-11 Johnson & Johnson Surgical Vision, Inc. Methods and systems for measuring image quality
US11282605B2 (en) 2017-11-30 2022-03-22 Amo Groningen B.V. Intraocular lenses that improve post-surgical spectacle independent and methods of manufacturing thereof
US11881310B2 (en) 2017-11-30 2024-01-23 Amo Groningen B.V. Intraocular lenses that improve post-surgical spectacle independent and methods of manufacturing thereof
US11886046B2 (en) 2019-12-30 2024-01-30 Amo Groningen B.V. Multi-region refractive lenses for vision treatment

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DE10002672A1 (de) 2001-09-06

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