WO2011071669A1 - Système d'endo-illumination ophtalmique - Google Patents

Système d'endo-illumination ophtalmique Download PDF

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Publication number
WO2011071669A1
WO2011071669A1 PCT/US2010/057024 US2010057024W WO2011071669A1 WO 2011071669 A1 WO2011071669 A1 WO 2011071669A1 US 2010057024 W US2010057024 W US 2010057024W WO 2011071669 A1 WO2011071669 A1 WO 2011071669A1
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WO
WIPO (PCT)
Prior art keywords
light beam
light
modulation apparatus
endoillumination
optical fiber
Prior art date
Application number
PCT/US2010/057024
Other languages
English (en)
Inventor
Michael M. Martin
Michael James Papac
Andrew Mason Hahn
Argelio Michael Olivera
Original Assignee
Alcon Research, Ltd.
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 Alcon Research, Ltd. filed Critical Alcon Research, Ltd.
Publication of WO2011071669A1 publication Critical patent/WO2011071669A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • 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
    • A61B3/0008—Apparatus for testing the eyes; Instruments for examining the eyes provided with illuminating means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
    • 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

  • This disclosure relates in general to an illuminator for use is ophthalmic surgery and more particularly to an ophthalmic illuminator using light modulation to adjust the qualities of the light output.
  • the eye is divided into two distinct parts-the anterior segment and the posterior segment.
  • the anterior segment includes the lens and extends from the outermost layer of the cornea (the corneal endothelium) to the posterior of the lens capsule.
  • the aqueous humour fills the space between the lens and the cornea and helps maintain intraocular pressure.
  • the posterior segment includes the portion of the eye behind the lens capsule.
  • the posterior segment extends from the anterior hyaloid face to the retina, with which the posterior hyaloid face of the vitreous body is in direct contact.
  • the posterior segment is much larger than the anterior segment.
  • the posterior segment includes the vitreous body ⁇ a clear, colorless, gel-like substance. It makes up approximately two-thirds of the eye's volume, giving it form and shape before birth. It is composed of approximately 1 % collagen and sodium hyaluronate and 99% water.
  • the anterior boundary of the vitreous body is the anterior hyaloid face, which touches the posterior capsule of the lens, while the posterior hyaloid face forms its posterior boundary, and is in contact with the retina.
  • the vitreous body is not free-flowing like the aqueous humor and has normal anatomic attachment sites. One of these sites is the vitreous base, which is a 3-4 mm wide band that overlies the ora serrata.
  • the optic nerve head, macula lutea, and vascular arcade are also sites of attachment.
  • the vitreous body's major functions are to hold the retina in place, maintain the integrity and shape of the globe, absorb shock due to movement, and to give support for the lens posteriorly.
  • the vitreous body In contrast to aqueous humor, the vitreous body is not continuously replaced.
  • the collagen of the vitreous body may break down and result in retinal detachment.
  • Vitrectomy and other vitreoretinal surgical procedures are commonly performed in the posterior segment of the eye. Vitreo-retinal procedures are appropriate to treat many serious conditions of the posterior segment. Vitreo-retinal procedures treat conditions such as age-related macular degeneration (AMD), diabetic retinopathy and diabetic vitreous hemorrhage, macular hole, retinal detachment, epiretinal membrane, CMV retinitis, and many other ophthalmic conditions.
  • AMD age-related macular degeneration
  • diabetic retinopathy and diabetic vitreous hemorrhage macular hole
  • retinal detachment epiretinal membrane
  • CMV retinitis CMV retinitis
  • a surgeon performs vitreo-retinal procedures with a microscope and special lenses designed to provide a clear image of the posterior segment. Several tiny incisions just a millimeter or so in length are made on the sclera at the pars plana. The surgeon inserts microsurgical instruments through the incisions such as a fiber optic light source to illuminate inside the eye, an infusion line to maintain the eye's shape during surgery, and instruments to cut and remove the vitreous body.
  • microsurgical instruments through the incisions such as a fiber optic light source to illuminate inside the eye, an infusion line to maintain the eye's shape during surgery, and instruments to cut and remove the vitreous body.
  • louvers may have relatively large gratings and require motors or manual actuators for operation. Rotating louvers may also require significant space in the system.
  • Correcting spatial nonuniformities of the propagating light beam is often performed using spatial filters. These spatial filters are an inconvenience because they are not adjustable and a series of filters may need to be swapped in and out to achieve the proper correction. This also introduces the potential for contaminants to enter the system. Adjusting the color of the light beam using color filters presents similar problems. Additionally, traditional methods of correcting chromatic aberration, such as colored ring formations, may be achieved using specially designed lenses. These corrective lenses are often expensive, difficult to manufacture, large in size, and specially engineered for a particular system.
  • New systems and methods are needed for adjusting the properties and quality of light used to provide illumination to the inside of the eye.
  • an endoillumination system comprises a system controller and a light modulation apparatus responsive to the controller to alter at least one parameter associated with an input light beam to generate a modulated light beam.
  • the endoillumination system further comprises an optical fiber for carrying the modulated light beam and a probe through which at least a portion of the optical fiber extends. The probe is sized for insertion into an eye.
  • an ophthalmic endoillumination system comprises a light source for generating an input light beam and a light modulation apparatus comprising a pixel array for generating a modulated light beam.
  • the system further comprises a controller in communication with the light modulation apparatus to alter at least one pixel in the pixel array and a condensing device for condensing the modulated light beam.
  • the system further comprises an optical fiber for transmitting the condensed and modulated light beam and an endoillumination probe through which at least a portion of the optical fiber extends.
  • a method for ophthalmic endoillumination comprises providing a light source for producing an input light beam and modulating a light parameter with a light modulation apparatus to generate a modulated light beam. The method further comprises directing the modulated light bream onto an optical fiber and transmitting an output light beam from the optical fiber.
  • Figure 1 is a diagram of an endoillumination system according to one embodiment of the present disclosure.
  • Figures 2-7 depict various configurations of pixel arrays in the endoillumination systems of the present disclosure.
  • Figure 8 is a cross section view of an endoillumination system positioned within an eye according to one embodiment of the present disclosure.
  • Figure 9 is a flowchart describing a method of ophthalmic illumination.
  • Figure 10 is a diagram of an endoillumination system according to another embodiment of the present disclosure.
  • Figure 1 1 is a diagram of an endoillumination system according to another embodiment of the present disclosure.
  • Figure 1 shows an endoillumination system 100 including a light source 102, a light modulation apparatus 104, a controller 106, and an optical fiber 108.
  • the light source 102 may include one or more light emitting diodes (LEDs), lasers, or a lamp including, for example, a metal halide lamp, a halogen lamp, a xenon lamp, a tungsten lamp, or any type of filament or gas lamp.
  • the light source 102 generates a light beam 1 10.
  • the light beam 1 10 may be further adjusted through the use of filters, lenses, reflectors, prisms, or other structures to control the properties and direction of the light beam 1 10. See, e.g., Figures 10 and 1 1.
  • the light modulation apparatus 104 modulates the characteristics of the light beam 1 10 as will be described in detail.
  • a light modulation apparatus may include a liquid crystal display (LCD), a liquid crystal on silicon (LCOS) device, a digital micro-mirror device (DMD), and/or other light modulation devices as would be apparent to one skilled in the art.
  • LCD liquid crystal display
  • LCOS liquid crystal on silicon
  • DMD digital micro-mirror device
  • the light modulation apparatus 104 may be a liquid crystal apparatus such as an LCD.
  • the LCD 104 is positioned in the optical path of the light beam 1 10.
  • the LCD 104 in an electronically controlled panel comprising a pixel array 120 which includes a plurality of pixels 122 (See, e.g., Figures 2-4).
  • Each pixel 122 comprises liquid crystal which can be manipulated to alter the parameters of the light beam 1 10 to generate a modulated light beam 1 12.
  • the controller 106 which may comprise hardware and software, provides control instructions to the LCD 104 based on any of a variety of input data including commands from a medical practitioner or other user, a predetermined program, or feedback received from a monitoring system which may detect characteristics of the input light beam 1 10, the modulated light beam 1 12, and/or an output light beam 1 14.
  • the controller 106 may employ a variety of different control algorithms to control the LCD 104.
  • the controller 106 may communicate with the LCD 104 through a wired or wireless connection to control the pixel array 120.
  • the controller 106 may control the pixel array 120 to darken selected pixels to attenuate the light beam 1 10 and generate a modulated light beam 1 12 having a reduced intensity.
  • the pixel array 120 has no darkened pixels 122 which generates a modulated light beam 1 12 having substantially the same parameters as the input light beam 1 10.
  • the pixel array 120 has an evenly distributed number of darkened pixels 122 which comprise approximately fifty percent of the pixel array. This configuration of darkened pixels generates a modulated light beam 1 12 having approximately fifty percent light attenuation as compared to the input light beam 1 10.
  • the system 100 may provide improved optical density in the modulated and output light. Bands of light and darkness generated by louvers may be reduced or eliminated. Additionally, space to rotate the louvers is no longer needed as the liquid crystal apparatus is stationary and relatively thin. Optically, the liquid crystal apparatus may be superior to traditional attenuation devices because the pixels are very small and are more evenly distributed than louvers. This finer resolution results in more uniformly distributed attenuation across an image.
  • the controller 106 may control the pixel array 120 to correct for spatial intensity nonuniform ities in optical fiber output light beam 1 14. If monitoring of the output light beam 1 14, without any modulation of the light properties, indicates spatial nonuniformities such as a relatively bright center with a relatively dim periphery, the controller 106, may control the pixel array 120 to darken selected pixels to create a more uniform light intensity in the output beam 1 14. For example, as shown in Figure 4, the pixels 122 near the center of the array 120 may be darkened with gradually fewer pixels darkened in the areas near the periphery of the array. This configuration of pixels may generate a modulated light beam 1 12 having a darker central region and a brighter peripheral region.
  • the fiber As the modulated light beam 1 12 passes through the optical fiber 108, the fiber, as earlier noted, may tend to dim the brighter peripheral regions of the beam.
  • the resultant output light beam may thus have more spatial light uniformity than an uncorrected light beam transmitted by the optical fiber 108.
  • the system 100 may provide greater adjustability and thus may be more widely applicable. Because an LCD is controlled by software, the pattern on a single LCD can be manipulated to correct both stable and dynamic inconsistencies using feedback control. This allows for fine tuning of individual systems using non-specialized hardware. If the system characteristics drift over time, the same hardware can be used to correct a new configuration. Additionally, because the insertion and removal of filters is not required, the likelihood of contamination is reduced.
  • the controller 106 may control a pixel array 124 to provide color correction or color filtering. It is understood that the pixel array 124 may also perform any of the light modulation described above for Figures 2-4.
  • the pixel array comprises pixels 126, each of which include a set of subpixels 128, 130, and 132. In this example, each pixel 126 includes a red (R) subpixel 128, a green (G) subpixel 130, and a blue (B) subpixel 132. This is merely one example of a color pixel array and other configurations, pixel shapes, and quantities of subpixels per pixel may used in the alternative.
  • the controller 106 may activate the color subpixels 128, 130, 132 in combination to generate a modulated light beam 1 12 having a selected color as shown in the pixel array of Figure 6.
  • the liquid crystal apparatus may serve as a color filter, allowing only light of specified wavelengths to pass through. A user may select different colors to accentuate particular illuminated features or may correct color properties of the light beam 1 10 to whiten or otherwise adjust the color of the modulated light beam 1 12.
  • the system 100 may provide greater color adjustability and thus may be more widely applicable.
  • a single LCD may filter almost any color desired. By controlling the number of activated red, blue, and green pixels, almost any color in the visible spectrum may be projected.
  • An LCD may be permanently contained within a system housing and requires no breeching of the encasement to change filter colors. Because the insertion and removal of filters is not required, the likelihood of contamination is reduced. Additionally, when the system housing is used as a Faraday cage to block external static electric fields, a system that does not require adding and removing filters may be preferable.
  • the controller 106 may control the color pixel array 124 to offset chromatic aberration of the modulated light beam 1 12 or the output light beam 1 14 caused by other optical components in the system including optical fiber, lenses, or filters.
  • the controller 106 may control the pixels and subpixels to create corrective patterns which offset the effect of the chromatic aberrations. For example, if the uncorrected output light beam 1 14 has a blue tint in the central region and a red tint in the peripheral regions, the pixel array 124 may be controlled to filter out more blue light in the central region and more red light in the peripheral regions. The resultant corrected output light beam 1 14 may be more spectrally uniform than the uncorrected beam.
  • the color pixel array 124 may also be used to project still or moving images by controlling the operation of the pixels and subpixels.
  • system 100 may comprise more universally available and applicable components, the system 100 may provide a less expensive, easier to manufacture solution.
  • liquid crystal apparatus may perform the function of multiple other components. Combining these functionalities into a single liquid crystal apparatus conserves space and may reduce the cost of hardware and supporting electronics.
  • Probe 152 carries optical fiber 108 which may terminate in the eye to provide illumination.
  • the optical fiber 108 may be a small gauge fiber. In certain embodiments, the optical fiber may be tapered.
  • Hand piece 150 may include finger gripping surfaces or other ergonomic features which allow the user to maintain a comfortable grasp and manipulate the probe 152 within an eye.
  • probe 152 may be inserted into an eye 154 through an incision in the pars plana region. Probe 152 illuminates the inside or vitreous region 156 of eye 154. In this configuration, the probe 152 may be used, for example, to provide illumination for vitreo-retinal surgery. Other insertion locations and surgical procedures that will benefit from the use of endoillumination will be clear to a person having ordinary skill in the art.
  • the light source 102 provides light for the light modulation apparatus such as the liquid crystal apparatus 104.
  • quality parameters such as light intensity, uniformity of light intensity, color, and chromatic uniformity may be monitored anywhere along the optical path, including prior to the liquid crystal apparatus 104, after the liquid crystal apparatus, or after transmission through the optical fiber 108.
  • a user or a computer associated with the controller 106 may determine whether and how much to adjust the intensity of the monitored light. Based upon this determination, the liquid crystal apparatus 104, under the control of controller 106, may selectively adjust the brightness of the pixels in the pixel array.
  • a user or computer associated with the controller 106 may detect spatial nonuniformities and determine corrective action. Based upon this determination, the liquid crystal apparatus 104, under the control of controller 106, may selectively darken pixels in the pixel array to correct for the spatial nonuniformities.
  • a user or computer associated with controller 106 may detect light color and determine whether it should be altered. Based upon this determination, the liquid crystal apparatus 104, under the control of the controller 106, may selectively change the color or all or a portion of the pixels in the pixel array to adjust the light color.
  • a user or computer associated with controller 106 may detect light color nonuniformities and determine corrective action.
  • the liquid crystal apparatus 104 may adjust select pixels in the pixel array 200 to create more uniform light color.
  • the modulated light 1 12 or the output light 1 14 may be further monitored and further adjustment or correction may be made.
  • the modulated light 1 12 may be transmitted along the optical fiber 108 to illuminate, for example, the interior tissues of an eye.
  • the method 200 may be performed while the probe 150 carrying the optical fiber 108 is inserted into an eye or may be performed while the probe 150 is entirely external of the eye, such as during preparation for surgery.
  • an endoillumination system 300 may comprise a light source 302, a light modulation apparatus 304, a controller 306, and an optical fiber 308. These components of the system 300 may be identical or substantially similar in structure and/or function to the components of the same name identified in endoillumination system 100.
  • the system 300 may further comprise a collimating lens 310 positioned between the light source 302 and the light modulation apparatus 304, which is a liquid crystal apparatus in this embodiment.
  • the collimating lens 310 may be a fiber lens, ball lens, aspherical lens, graded index (GRIN) lens, cylindrical lens, or any other type of device, including optical fiber, which can be used to collimate light into a substantially parallel light beam.
  • GRIN graded index
  • the system 300 may further comprise a condensing lens 312 which may be, for example, a biconvex or plano-convex spherical lens, an aspheric lens, or any other type of device which can be used to focus a light beam for launching the beam into a small diameter optical fiber.
  • a condensing lens 312 which may be, for example, a biconvex or plano-convex spherical lens, an aspheric lens, or any other type of device which can be used to focus a light beam for launching the beam into a small diameter optical fiber.
  • an input light beam 314 from light source 302 may be collimated by collimating lens 310 before passing to the liquid crystal apparatus 304.
  • a modulated light beam 316 generated by liquid crystal apparatus 304 may be focused, using condensing lens 312, to pass through the optical fiber 308.
  • An output light beam 318 is transmitted from the optical fiber 308.
  • the liquid crystal apparatus 304 may be controlled by the controller 306 in the same or similar manner as previously described for the liquid crystal apparatus 104 to adjust the uniformity, intensity, color, or color patterns in the modulated light beam 316.
  • the collimating lens 310 and the condensing lens 312 may be positioned on the same side, (either the input or output side) of the liquid crystal apparatus 304 or the lenses 310 may be connected or integrally formed. It is further understood that additional lenses, mirrors, or other optical devices may be used to further control the direction and properties of the light passing through endoillumination system 300.
  • the 400 may comprise a light source 402, a light modulation apparatus 404, a controller 406, and an optical fiber 408.
  • the system 400 may further comprise a collimating lens 410 positioned between the light source 402 and the light modulation apparatus 404 and a condensing lens 412 positioned between the light modulation apparatus 404 and the optical fiber 408.
  • the light modulation apparatus 404 is reflective rather than transmissive. It may controlled by the controller 406 to perform the same light modulation functions as described above.
  • a suitable reflective light modulation apparatus may be a liquid crystal on silicon (LCOS) device. It us understood that additional reflective surfaces, such as mirrors, DMDs, lenses, prisms, or other optical devices may be used to control the direction and properties of the light passing through endoillumination system 400.
  • LCOS liquid crystal on silicon

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Medical Informatics (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Pathology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Ophthalmology & Optometry (AREA)
  • Liquid Crystal (AREA)

Abstract

L'invention porte sur un système d'endo-illumination comprenant un dispositif de commande de système et un appareil de modulation de lumière réceptif au dispositif de commande et destiné à modifier au moins un paramètre associé à un faisceau lumineux d'entrée afin de générer un faisceau lumineux modulé. Le système d'endo-illumination comprend en outre une fibre optique destinée à transporter le faisceau lumineux modulé et une sonde au travers de laquelle s'étend au moins une partie de la fibre optique. La sonde est dimensionnée de façon à être insérée dans un œil.
PCT/US2010/057024 2009-12-11 2010-11-17 Système d'endo-illumination ophtalmique WO2011071669A1 (fr)

Applications Claiming Priority (2)

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US28568109P 2009-12-11 2009-12-11
US61/285,681 2009-12-11

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