WO2001058398A1 - Appareil et procedure ameliores pour l'ablation au laser ultraviolet - Google Patents

Appareil et procedure ameliores pour l'ablation au laser ultraviolet Download PDF

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Publication number
WO2001058398A1
WO2001058398A1 PCT/AU2001/000136 AU0100136W WO0158398A1 WO 2001058398 A1 WO2001058398 A1 WO 2001058398A1 AU 0100136 W AU0100136 W AU 0100136W WO 0158398 A1 WO0158398 A1 WO 0158398A1
Authority
WO
WIPO (PCT)
Prior art keywords
liquid
laser
laser beam
ablated
ablation
Prior art date
Application number
PCT/AU2001/000136
Other languages
English (en)
Inventor
Paul Phillip Van Saarloos
Original Assignee
Q-Vis Limited
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 Q-Vis Limited filed Critical Q-Vis Limited
Priority to AU29895/01A priority Critical patent/AU780488B2/en
Priority to US10/204,188 priority patent/US7090669B2/en
Publication of WO2001058398A1 publication Critical patent/WO2001058398A1/fr
Priority to US11/088,286 priority patent/US7364575B2/en

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
    • 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
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00804—Refractive treatments
    • 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
    • A61F2009/00844—Feedback systems
    • A61F2009/00846—Eyetracking
    • 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

  • This invention relates generally to ultraviolet laser ablation, used for example in laser eye treatment, and is of particular, though by no means exclusive, utility in ophthalmic refractive surgery operations such as laser in situ keratomiluesis (LASIK).
  • LASIK laser in situ keratomiluesis
  • a number of refractive surgery operations involve the removal of small amounts of corneal tissue to effect a refractive change.
  • laser operations such as photorefractive keratectomy (PRK)
  • PRK photorefractive keratectomy
  • the epithelial layer is manually removed and then Bowman's membrane and part of the stroma are ablated by laser energy. This operation can lead to unwanted side effects, such as corneal haze, and is not suitable for higher refractive errors.
  • LASIK laser in situ keratomiluesis
  • the LASIK refractive surgery procedure produces fewer side effects and quicker healing relative to PRK, as the epithelium and Bowman's membrane are left intact. Because the epithelium is generally not touched in LASIK, there is also less pain for the patient and the healing process is enhanced with LASIK, presumably because the healing region is protected: there is moreover only one type of tissue involved in the healing process instead of two. It is thought that about 80% of laser eye surgery is now LASIK rather than PRK.
  • LASIK a known problem with LASIK is that the corneal surface formed by the microkeratome cut is relatively rough and this reduces the patient's vision for watching the fixation light, important for maintaining the pupil correctly aligned, and furthermore reduces the vision of the eye tracker device used to guide the laser delivery system. It is thought that these two issues contribute to the known outcome that the statistical success rate of LASIK is similar to PRK despite the enhanced healing process.
  • the invention involves recognition of the benefits of using particular wavelengths for the ablation, and of carrying out the ablation in a manner which departs in one notable respect from the conventional approach.
  • a problem issue with this wavelength has always been that it is very strongly absorbed by water and the presence of any stray fluid, including natural eye tissue fluid, dramatically alters the ablation process. There is therefore a requirement to minimise liquid in the ablation region.
  • physiological saline solution conventionally added to wash away the area in front of the eye before the treatment must be collected and extracted prior to the ablation, even though saline solution may be added again afterwards for washing purposes.
  • the invention entails the application of a physiologically compatible liquid in contact with the surface to be ablated, and the use for the ablation of a laser beam of a wavelength that is substantially not absorbed by the liquid.
  • the invention provides, in a first aspect, apparatus for performing ultraviolet laser ablation of a surface, eg. an eye surface, including a laser delivery system having a laser source for generating a laser beam and optics for applying the laser beam to the surface to be ablated, means for providing a compatible liquid in contact with the surface to be ablated, in a position whereby said laser beam is applied to said surface through the liquid, wherein the laser beam is of a wavelength that substantially is not absorbed by the liquid.
  • a laser delivery system having a laser source for generating a laser beam and optics for applying the laser beam to the surface to be ablated, means for providing a compatible liquid in contact with the surface to be ablated, in a position whereby said laser beam is applied to said surface through the liquid, wherein the laser beam is of a wavelength that substantially is not absorbed by the liquid.
  • the invention provides a method of performing ultraviolet laser ablation of a surface, eg. an eye surface, including having a compatible liquid in contact with the surface to be ablated, and applying a laser beam to the surface through the liquid to effect ablation of the surface with the laser beam, wherein the laser beam is of a wavelength that substantially is not absorbed by the liquid.
  • the liquid may be provided by retaining the liquid in contact with the surface to be ablated.
  • the liquid is a physiologically compatible liquid.
  • the physiologically compatible liquid retained in contact with the surface to be ablated is natural liquid of the eye.
  • the liquid is introduced to the eye and the retaining means may then include cap or ring means for contacting the surface to be ablated to retain liquid within the cap means.
  • An advantageous wavelength suitable for the purposes of the invention is about 213 nm.
  • Such a laser beam may be produced from a solid state laser using frequency doubling and mixing crystals.
  • a suitable arrangement, utilising a Q-switched neodymium YAG laser as the primary source, is described, for example in international patent publication WO 99/04317
  • liquid retaining means is a cap or ring device
  • it preferably further includes overlying wall means spaced from the eye surface which has a lens through which the ablating laser beam is directed
  • the lens is preferably arranged to allow the patient to see the fixation light in reasonable focus and to provide an even better optical surface to see with than the water alone.
  • the retaining means may include means for holding it against the surface to be ablated. Such may be a suitable suction or vacuum arrangement.
  • the laser ablation is a step in a LASIK procedure.
  • the apparatus may further include microkeratome means for cutting a flap from the cornea to expose an interior surface to be ablated.
  • a common ring may serve as both the microkeratome guide ring and the liquid retaining means of the invention.
  • the method may further include cutting a flap from the cornea to expose an anterior surface to be ablated
  • Figure 1 depicts an arrangement for performing LASIK according to a first embodiment of the invention, shown at the point at which the liquid has been applied to the exposed corneal surface in preparation for the ablation step,
  • Figure 2 is a view similar to Figure 1 of an alternative embodiment
  • Figure 3 is an enlargement of part of Figure 2
  • Figure 4 is a view similar to Figure 3 showing a modified embodiment.
  • a surgical laser source 1 preferably a frequency converted solid state laser or any other laser emitting a suitable wavelength as aforedescribed, eg. 213 nm, directs a surgical laser beam 2, via delivery system 7, and laser mirror 3 (which is transparent to infra-red and visible light) towards the cornea of an eye 4 to be treated.
  • laser mirror 3 which is transparent to infra-red and visible light
  • the patient's gaze is fixated on a flashing LED 5 located beneath a surgical microscope 6 with which the surgeon views the procedure.
  • an eye tracking system generally indicated at 40.
  • System 40 may typically generate a collimated infra-red beam 8 which is directed via beamsplitter 10 onto the optic axis of the eye coincident with main laser beam 2 and the fixation line of sight 9.
  • Laser source 1 may comprise a solid state laser and a plurality of frequency doubling and mixing crystals for deriving the said laser beam from the output beam of the laser.
  • a suitable arrangement, utilising a Q-switched neodymium:YAG laser as the primary source, is described, for example in international patent publication WO 99/04317.
  • a LASIK procedure has already commenced on eye 4 and a microkeratome (not shown) has been utilised to part and draw back a surface flap 12 of the cornea, including the epithelium.
  • the operator now uses a supply tube 20 to apply and maintain a liquid layer 32 of physiologically compatible solution over exposed corneal surface 4a.
  • This is the inverse of the conventional step in excimer laser refractive surgery (at 193nm) of removing the solution from in front of the corneal surface prior to ablation.
  • the ablating beam 8 is applied through liquid 32, to ablate surface 4a.
  • the beam is dimensioned by delivery system 7, and scanned in accordance with a predetermined control schedule in computer control 50, which also manages other components.
  • the physiologically compatible saline solution may typically be dextran, a fluid commonly used to avoid swelling of tissue, or balanced salt solution.
  • the interposed retained liquid 32 helps cool the corneal tissue because there is substantially no absorption of the ablating light: the liquid remains cool and this helps reduce the limited degree of tissue damage relative to the damage known to occur to a small degree in excimer ablation.
  • a further advantage of the liquid overlay 32 is that there is no gas plume.
  • the gas plume is the vaporised material produced by the ablation which in conventional excimer ablation hovers over the ablated surface after each pulse and diminishes the effect of the next succeeding pulse in a non-uniform fashion, despite the application of suction to remove the plume. Some surgeons also suspect that the plume has made them sick. To avoid the excessive build-up of ablation products dissolved in the fluid, it is preferred that the fluid be replaced or flows over the ablation surface during the procedure.
  • the material to be ablated is not tissue there would be similar advantages to do the ablation under a layer of water. This includes the cooling effect of the fluid and the softening of the ablation process that would help protect delicate structures or materials beneath the ablation site.
  • One such non-tissue application is the restoration of art works by laser ablation.
  • a cap or ring device 21 is positioned to confine and define the overlying layer of liquid 32.
  • the cap or ring device 21 is generally cylindrical and is applied to the exposed corneal surface 4a by the operator once flap 12 has been excised and drawn aside.
  • the cylindrical body 22 of the ring device is open at its forward rim in contact with surface 4a and, in the simple embodiment shown in Figures 2 and 3, also open at its rear.
  • the ring 21' may be closed at its rearward end by a wall 24 including or consisting of a lens 26 pre-fitted within ring 20, or applied in situ.
  • Lens 26 preferably has an optically flat interior face 28 as illustrated, though it could be convex or concave, and a convex exterior face 29.
  • Ring 20, 21' defines a chamber 30 which is filled with physiologically compatible saline solution 32, introduced, for example, through the tubes 33 ( Figure 4), which allow the fluid to flow over the surface.

Abstract

Appareil pour l'ablation au laser ultraviolet d'une surface, telle que, par exemple, la surface de l'oeil, comprenant un système à laser (7) doté d'une source laser (1) pour générer un faisceau laser (2) et de dispositifs optiques pour l'application du rayon laser sur la surface à enlever, de moyens (20, 20') pour produire un liquide compatible (32) en contact avec la surface à enlever, dans une position dans laquelle ledit rayon laser (2) est appliqué sur ladite surface à travers le liquide, le rayon laser présentant une longueur d'onde n'étant sensiblement pas absorbée par le liquide.
PCT/AU2001/000136 2000-02-14 2001-02-14 Appareil et procedure ameliores pour l'ablation au laser ultraviolet WO2001058398A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
AU29895/01A AU780488B2 (en) 2000-02-14 2001-02-14 Improved apparatus and procedure for ultraviolet laser ablation
US10/204,188 US7090669B2 (en) 2000-02-14 2001-02-14 Apparatus and procedure for ultraviolet laser ablation
US11/088,286 US7364575B2 (en) 2000-02-14 2005-03-24 Apparatus and procedure for ultraviolet laser ablation

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AUPQ5594A AUPQ559400A0 (en) 2000-02-14 2000-02-14 Improved apparatus and procedure for ultraviolet laser ablation
AUPQ5594 2000-02-14

Related Child Applications (2)

Application Number Title Priority Date Filing Date
US10204188 A-371-Of-International 2001-02-14
US11/088,286 Continuation US7364575B2 (en) 2000-02-14 2005-03-24 Apparatus and procedure for ultraviolet laser ablation

Publications (1)

Publication Number Publication Date
WO2001058398A1 true WO2001058398A1 (fr) 2001-08-16

Family

ID=3819710

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AU2001/000136 WO2001058398A1 (fr) 2000-02-14 2001-02-14 Appareil et procedure ameliores pour l'ablation au laser ultraviolet

Country Status (2)

Country Link
AU (1) AUPQ559400A0 (fr)
WO (1) WO2001058398A1 (fr)

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1989006519A2 (fr) * 1988-01-25 1989-07-27 Refractive Laser Research & Development Program, L Procede et appareil de chirurgie au laser
US5133708A (en) * 1988-01-14 1992-07-28 Smith Robert F Method for controlled corneal ablation
WO1995015134A1 (fr) * 1993-12-02 1995-06-08 Sunrise Technologies, Inc. Systeme laser destine a la remise en forme de la cornee
WO1995030392A1 (fr) * 1994-05-06 1995-11-16 Fowler Bernard J Dispositif d'irrigation pour les operations chirurgicales de l'×il
DE19501279A1 (de) * 1995-01-18 1996-07-25 Blz Gmbh Verfahren zur abtragenden Bearbeitung von Werkstücken mit Laserstrahlung
US5616139A (en) * 1992-11-20 1997-04-01 Shinseiro Okamoto Method and apparatus for operating a cornea
EP0818181A1 (fr) * 1996-07-10 1998-01-14 Trw Inc. Dispositif et méthode pour la suppression de caries dentaires en utilisant un rayonnement laser

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5133708A (en) * 1988-01-14 1992-07-28 Smith Robert F Method for controlled corneal ablation
WO1989006519A2 (fr) * 1988-01-25 1989-07-27 Refractive Laser Research & Development Program, L Procede et appareil de chirurgie au laser
US5616139A (en) * 1992-11-20 1997-04-01 Shinseiro Okamoto Method and apparatus for operating a cornea
WO1995015134A1 (fr) * 1993-12-02 1995-06-08 Sunrise Technologies, Inc. Systeme laser destine a la remise en forme de la cornee
WO1995030392A1 (fr) * 1994-05-06 1995-11-16 Fowler Bernard J Dispositif d'irrigation pour les operations chirurgicales de l'×il
DE19501279A1 (de) * 1995-01-18 1996-07-25 Blz Gmbh Verfahren zur abtragenden Bearbeitung von Werkstücken mit Laserstrahlung
EP0818181A1 (fr) * 1996-07-10 1998-01-14 Trw Inc. Dispositif et méthode pour la suppression de caries dentaires en utilisant un rayonnement laser

Also Published As

Publication number Publication date
AUPQ559400A0 (en) 2000-03-09

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