WO2012083402A1 - Techniques d'incision à 180° - Google Patents

Techniques d'incision à 180° Download PDF

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Publication number
WO2012083402A1
WO2012083402A1 PCT/BR2011/000490 BR2011000490W WO2012083402A1 WO 2012083402 A1 WO2012083402 A1 WO 2012083402A1 BR 2011000490 W BR2011000490 W BR 2011000490W WO 2012083402 A1 WO2012083402 A1 WO 2012083402A1
Authority
WO
WIPO (PCT)
Prior art keywords
vitreous
apertures
cutter
cutting
eye
Prior art date
Application number
PCT/BR2011/000490
Other languages
English (en)
Inventor
Luiz Henrique SOARES GONÇALVES DE LIMA
Original Assignee
Soares Goncalves De Lima Luiz Henrique
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 Soares Goncalves De Lima Luiz Henrique filed Critical Soares Goncalves De Lima Luiz Henrique
Publication of WO2012083402A1 publication Critical patent/WO2012083402A1/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
    • 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
    • A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
    • A61F9/00763—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments with rotating or reciprocating cutting elements, e.g. concentric cutting needles
    • 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
    • A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
    • A61F9/00745—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments using mechanical vibrations, e.g. ultrasonic

Definitions

  • vitreous cutters of the prior art have only one port. With such a configuration, the surgeon is typically forced to spend a long time to remove the vitreous. Indeed, the surgeon typically has to do many movements around to cut the vitreous.
  • Multiport vitreous cutters exist, however, such cutters present ports all on same side.
  • US Patent No. 5,843,111 assigned to Ophthalmic Research Center International BV, which describes a surgical instrument provides improved precision and performance for use in highly intricate surgeries such as vitrectomy.
  • the instrument includes two concentric tubes, an outer tube having ports near the closed end, and a slidabie inner tube which fits snugly inside the outer tube.
  • the inner tube includes a sharp cutting edge formed on one end that slides back and forth across the ports to cut vitreous, and an axial passage to pass the cut portions of vitreous.
  • Such a surgical instrument maintains highly effective and accurate cutting member for removing vitreous without cutting into the retina.
  • Such prior art multiport de- signs can present similar resulting restrictions on motion and time consumption as single port cutter designs.
  • the present disclosure provides methods, systems, techniques and apparatus that address the issues described above for the prior art by providing/utilizing cutting apertures at different angular orientations around the 360 degree (2 pi) circumference of a cutting tip.
  • a 180 degree cutter or variations of 180 degree cutter can be used.
  • Embodiments of the present disclosure can thus provide for a decrease in the time of the surgery and can make it easier for a surgeon to perform surgery.
  • the cutter operates by removing vitreous from multiple sides of the vitrectomy cutter tip.
  • the cutter may have two ports (as shown in figure 1), or more ports.
  • the design consists of a dual port cutter, with ports located 180 degrees from each other.
  • the ports can vary in shape, size and number.
  • the new port can have the same size and shape of the original one or the ports can have different size and shape from each other.
  • one of the ports can have a round and regular hole and irregular holes or a rectangular horizontal hole.
  • Another variable is the size of the ports.
  • one port could be shorter or larger than the other one. In this design, bulk vitrectomy can be done with the two or more ports.
  • the cutting techniques of the present disclosure can be used for all ocular diseases where vitrectomy or lensectomy are required. Additionally, cutting techniques described herein may be used for cutting of other types of tissue.
  • FIG. 1 depicts a side view photograph of an embodiment of a 180-degree cutter in accordance with an exemplary embodiment of the present disclosure
  • FIG. 2 depicts a side view of a diagram of an embodiment of the present disclosure.
  • FIG. 3 depicts a diagram of a method in accordance with an exemplary embodiment of the present disclosure
  • the present disclosure provides methods, systems, techniques and apparatus useful for cutting and removal of the tissue such as the vitreous.
  • the present disclosure relates to a new devices for intraocular vitrectomy, providing designs and methods utilizing cutting apertures at dif- ferent angular orientations around the 360 degree (2 pi) circumference of a cutting tip.
  • a 180 degree cutter or variations of 180 degree cutter can be used.
  • the present disclosure provides techniques to accomplish cutting (e.g., as in a intraocular vitrectomy) that substantially improve the vitreous cutting efficiency and, therefore, shortens the time required for one to perform the vitrectomy in a human or mammalian subjects.
  • Cutters according to the present disclosure may also be combined within, coupled to, or otherwise employed with various suitable surgical instruments and/or components of surgical instruments and/or surgical systems.
  • cutter can be used with a needle probe (e.g., with ultrasonic transducer), a cryogenic (cryo) probe, a laser probe, an illumination probe, and/or a cautery probe as used for various parts of the body, including internal body cavities.
  • a needle probe e.g., with ultrasonic transducer
  • cryogenic (cryo) probe e.g., a cryogenic (cryo) probe
  • laser probe e.g., a laser probe
  • an illumination probe e.g., an illumination probe
  • cautery probe e.g., a laser probe
  • cautery probe e.g., a laser probe
  • cautery probe e.g., a laser probe
  • cautery probe e.g., a laser probe
  • cautery probe e.g., a laser probe, an
  • vitrectomy has been performed with a single-port cutter. This requires the surgeon to maneuver the cutter to remove vitreous.
  • the 180 degrees cutting provides a new concept of performing and it can change the surgical technique during bulk vitrectomy.
  • vitreous flow rates may not be higher than corresponding cutters, the cutters of the present disclosure will reduce the amount of maneuvering the surgeon has to complete. This should clinically reduce operative time, making the vitrectomy a quicker procedure with less motion.
  • this cutter is the first known with two or more ports located 180 degrees from each other. It provides for a new standard of performance for vitreous removal, making it a quicker procedure with less dynamic motion of the vitreous. Therefore, less complications (retinal detachment) will appear as well as the cost to surgeon and patient will decrease.
  • the cutter may have two or more ports.
  • the design consists of dual port cutter, with ports located 180 degrees from each other.
  • the ports can vary in shape, size and number.
  • the new port can have the same size and shape of the original one or the ports can have different size and shape from each other.
  • one of the ports can have a round and regular hole and the other one can have several small regular / irregular holes or a rectangular horizontal hole.
  • Another variable is the size of the ports. For example, one port could be shorter or larger than the other one. In this design, bulk vitrectomy can be done with the two or more ports.
  • the dual port cutter has a drive system that allows one of the ports to be closed when needed.
  • a slide could be made from a thin walled (0.0002 inch) polyester sleeve, or a thicker stainless sleeve.
  • the sleeve could be controlled with an adjustable bar near the tip, or it could be automatically adjusted from the console.
  • Other gauges and thicknesses of cutting tips may be used within the scope of the present disclosure. See, for example, S. Y. Fang, et al., "Performance Analysis of New-Generation Vitreous Cutters," Graefes Arch. Clin. Exp. Ophthalmology (published online 2007) 246:61-67, the entire contents of which are incorporated herein by reference.
  • vitreous flow rates may not be higher than corresponding cutters, the cutter will reduce the amount of maneuvering required for the surgeon to complete the vitreous removal.
  • one or more of the following can be realized (e.g., in a clinical setting): (1) A shortening of the duration of surgical procedures for vitreous removal which are used for correction of ocular diseases as retinal detachment and macular hole; (2) An improvement in cutting efficiency of the vitrector tip; and/or (3) Controls and provides methods to avoid undesired complications of vitrectomy, namely accidental damage to adjacent retina.
  • the surgeon can use a cutter having cutting apertures at different angular orientations around the 360 degree (2 pi) circumference of a cutting tip.
  • a 180 degree cutter or variations of 180 degree cutter can be used.
  • FIG. 1 depicts a side view photograph of an embodiment of a 180-degree cutter 100 in accordance with an exemplary embodiment of the present disclosure.
  • the cutter 100 operates by removing vitreous from multiple sides of the vitrectomy cutter tip 202.
  • the cutter tip 202 is shown with a proximal end/direction 202A to a drive/surgical system and a distal end 202B.
  • the cutter may have two ports 204, 206(as shown in figure 1), or more ports.
  • FIG. 2 depicts a side view of a diagram of an embodiment of the present disclosure, similar to that of FIG. 1.
  • cutter 200 can include a cutter tip 202, with proximal and distal ends 202A, 202B.
  • First and second apertures 204 and 206 can be present within the cutter tip 202 as shown.
  • a cutting member 203 can be located within the cutting tip for reciprocal motion to slide past the apertures for the cutting of tissue.
  • Cutting member 203 can include a hollow region 208 for facilitating removal of cut tissue.
  • the design of FIGS. 1-2 can include of a dual port cutter, with ports located 180 degrees from each other.
  • the ports can vary in shape, size and number.
  • the new port can have the same size and shape of the original one or the ports can have different size and shape from each other.
  • one of the ports can have a round and regular hole and the other one can have several small regular/irregular holes or a rectangular horizontal hole.
  • Another variable is the size of the ports. For example, one port could be shorter or larger than the other one. In this design, bulk vitrectomy can be done with the two or more ports.
  • the reason for the 180 degrees cutting has more effectiveness comparing to the current and regular cutter can be a higher flow rate or a vent mechanism generated by new ports added.
  • the dual port cutter has a drive system that allows one of the ports to be closed when only one port is needed. This may be an adjustable duty cycle/stroke cutter as disclosed in previous work, or another mechanism (manual slide that is deployed to cover the port).
  • a slide could be made from a thin walled (0.0002-inch) polyester sleeve, or a thicker stainless sleeve.
  • the sleeve could be controlled with an adjustable bar near the tip, or it could be automatically adjusted from the console.
  • FIG. 3 depicts a diagram of a method 300 in accordance with an exemplary embodiment of the present disclosure.
  • a 180-degree cutter can be inserted into a patient's eye, as described at 302. Vitreous of the eye can be cut with a first aperture of the cutter, as described at 304. Vitreous of the eye can be cut with a second aperture of the cutter, as described at 306.
  • vitreous can be removed from the eye, as described at 308. As described at 310, vitreous can be removed from the eye by multiple apertures/orifices of the cutter.
  • this cutter is the first known with two or more ports located 180 degrees from each other, providing a mechanism for controlling at least one port's opening and, therefore, preventing accidental damage to adjacent retina.
  • the 180 degrees cutting can be used for all ocular diseases where vitrectomy or lensectomy are required.

Landscapes

  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)

Abstract

La présente invention concerne de nouveaux dispositifs pour effectuer une vitrectomie intraoculaire, ainsi que des conceptions et des procédés utilisant des ouvertures d'incision à des orientations angulaires différentes autour de la circonférence de 360° (2 π) d'un bout coupant. Dans les modes de réalisation de l'invention, on peut utiliser un dispositif d'incision à 180° ou les variantes d'un dispositif d'incision à 180° (deux orifices, trois orifices, etc.). L'invention concerne aussi des techniques permettant d'accomplir une incision (par ex. lors d'une vitrectomie intraoculaire) qui améliorent sensiblement l'efficacité de l'incision du corps vitré et, par conséquent, diminuent le temps requis pour réaliser la vitrectomie sur des sujets humains ou mammifères. Les dispositifs d'incision utilisés peuvent être accouplés à d'autres instruments chirurgicaux dans les modes de réalisation exposés à titre d'exemple.
PCT/BR2011/000490 2010-12-23 2011-12-22 Techniques d'incision à 180° WO2012083402A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
BRPI005732-3 2010-12-23
BRPI1005732A BRPI1005732B1 (pt) 2010-12-23 2010-12-23 instrumento de corte a 180 graus para remoção do vítreo do olho

Publications (1)

Publication Number Publication Date
WO2012083402A1 true WO2012083402A1 (fr) 2012-06-28

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PCT/BR2011/000490 WO2012083402A1 (fr) 2010-12-23 2011-12-22 Techniques d'incision à 180°

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BR (1) BRPI1005732B1 (fr)
WO (1) WO2012083402A1 (fr)

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN105310821A (zh) * 2015-05-15 2016-02-10 以诺康医疗科技（苏州）有限公司 一种超声玻切针头及其装置
US9615969B2 (en) 2012-12-18 2017-04-11 Novartis Ag Multi-port vitrectomy probe with dual cutting edges
US9693898B2 (en) 2014-11-19 2017-07-04 Novartis Ag Double-acting vitreous probe with contoured port
US10639197B2 (en) 2017-06-19 2020-05-05 Alcon Inc. Vitrectomy probe

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3884237A (en) * 1972-06-19 1975-05-20 Malley Conor C O Apparatus for intraocular surgery
US5843111A (en) 1995-06-19 1998-12-01 Ophthalmic Research Center International Bv Vitreous removing apparatus
WO2002058607A2 (fr) * 2001-01-25 2002-08-01 Ferrone Philip J Canule de perfusion et methode pour procedures chirurgicales vitreo-retiniennes
US20080234602A1 (en) * 2007-03-19 2008-09-25 Oostman Clifford A Biological unit removal tools with retention mechanism
US20100106054A1 (en) * 2007-03-06 2010-04-29 Kyoto University Probe type device for removing living body tissue

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3884237A (en) * 1972-06-19 1975-05-20 Malley Conor C O Apparatus for intraocular surgery
US5843111A (en) 1995-06-19 1998-12-01 Ophthalmic Research Center International Bv Vitreous removing apparatus
WO2002058607A2 (fr) * 2001-01-25 2002-08-01 Ferrone Philip J Canule de perfusion et methode pour procedures chirurgicales vitreo-retiniennes
US20100106054A1 (en) * 2007-03-06 2010-04-29 Kyoto University Probe type device for removing living body tissue
US20080234602A1 (en) * 2007-03-19 2008-09-25 Oostman Clifford A Biological unit removal tools with retention mechanism

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
S. Y. FANG ET AL.: "Performance Analysis of New-Generation Vitreous Cutters", GRAEFES ARCH. CLIN. EXP. OPHTHALMOLOGY, vol. 246, 2007, pages 61 - 67, XP019563332, DOI: doi:10.1007/s00417-007-0672-8

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9615969B2 (en) 2012-12-18 2017-04-11 Novartis Ag Multi-port vitrectomy probe with dual cutting edges
US9693898B2 (en) 2014-11-19 2017-07-04 Novartis Ag Double-acting vitreous probe with contoured port
CN105310821A (zh) * 2015-05-15 2016-02-10 以诺康医疗科技（苏州）有限公司 一种超声玻切针头及其装置
US10639197B2 (en) 2017-06-19 2020-05-05 Alcon Inc. Vitrectomy probe

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BRPI1005732A2 (pt) 2013-04-24
BRPI1005732B1 (pt) 2020-05-05

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