CA2129124A1 - Method and apparatus for phaco-emulsification - Google Patents
Method and apparatus for phaco-emulsificationInfo
- Publication number
- CA2129124A1 CA2129124A1 CA002129124A CA2129124A CA2129124A1 CA 2129124 A1 CA2129124 A1 CA 2129124A1 CA 002129124 A CA002129124 A CA 002129124A CA 2129124 A CA2129124 A CA 2129124A CA 2129124 A1 CA2129124 A1 CA 2129124A1
- Authority
- CA
- Canada
- Prior art keywords
- shield
- probe
- nucleus
- opening
- base
- Prior art date
- Legal status (The legal status 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 status listed.)
- Abandoned
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
- A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/320084—Irrigation sleeves
-
- 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
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0801—Prevention of accidental cutting or pricking
- A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs
Abstract
Abstract of the Disclosure A surgical method for removing cataracts from the eye by disrupting them but minimizing the danger of piercing neighboring tissue through the use of a phaco-shield (30). The phaco-shield has two flexible flaps (23) which are guided by a Y-shaped wire guide (26) to surround the nucleus of the lens (11). A
disrupting probe (40) is inserted through a central opening (24) in the base (22) of the phaco-shield to break up the cataract nucleus (16). The flaps are of a length to cover the end of the probe prior to the probe's contact with the posterior capsule (21) in order to prevent damage to the capsule.
disrupting probe (40) is inserted through a central opening (24) in the base (22) of the phaco-shield to break up the cataract nucleus (16). The flaps are of a length to cover the end of the probe prior to the probe's contact with the posterior capsule (21) in order to prevent damage to the capsule.
Description
¦ W093/1~0' 212 912 /1 PCT/US93/00600 : ' '. :.
TITLE
METHOD AND APPARATUS FOR PHACO-EMULSIFICATION
. . .
.i ~ F~E~D OF ~E INVENT~ON
j This invention relates to cataract surgery andj more particularly, to the process of surgically removing the j : "diseased" lens or cataract more safely than heretofore.
i~ Speci~ically, the present invention relates to the use of a il specially designed shield for perfor~i~g the emulsification ~¦ of the diseased lens tphaco-emulsification) and removing the ~j 10 "emulsion" in a safe, effective manner.
i .. ; .
~CRG20~ND OF T~E INVEN~ON
,.; . ~
As shown in Figure 1 (the drawing showing the various parts of the eye), the lens ll is perhaps the ~ost critical element within the eye in providing vision for the human or animal. It is suspended behind the cornea 12. the anterior chamber 13 and the iris 14 by the zonular fibers which connect it with the ciliary body of muscles 1~ around its periphery.
~,~
The lens is composed of a central region, the nucleus 16. surrounded by a softer outer region, the cortex 1~. It is encapsulated in the lens capsule 18. which is a thin transparent membrane. The front part of the membrane is .
~O 93/1~,0~ 2 ~ 2 ~ 1 2 ~ PC~ S93/00600 , called the ante-ior capsule 20 and the rear part, the posterior capsule 21.
The function of the lens is to focus light rays upon the sensitive retina 19. To focus light from a distant object, the ciliary muscles 15 relax, thu, tightening the zonular fibers and reducing the thickness of the lens to its minimal - : dimension. To focus light from a near object, the ciliary muscles 15 release the tension on the zonular fibers to increase the thickness of the lens, the lens assuming a near spherical shape. This change increases the lens refractive power to again obtain focusing of the light rays on the retina 19.
The lens consists of about 35% protein and 65% water.
j When the proteinaceous material hardens or becomes suffused ~5 with minerals, the lens becomes Glolldy or opague. A cloudy lens or an opaque, non-functional lens is a cataract. Most cataracts are not visible to the casual observer until they become dense enough to cause blindness.
. . -~
Cataract surgery involves the removal of the "diseased"
lens from the eye. Two principal procedures for lens extractions are practiced currently. Intracapsular surgery involves removal of the lens together with its surrounding capsule. Where the posterior capsule may be attached slightly to the vitreous membrane, extracapsular extraction ..
.~.
- . . .. .. -, " , ,,,., "",, . s .,j", ", ",.,, ~ , " ; ~
~ w093/]~lo~ 212~12~ PCT/~S93/00600 -: 3 . of the lens is much preferred. Xupturing the vitreous : membrane, a definite hazard in intracapsular surgery, has serious consequences, including vitreous loss, vitreous hemorrhage, retina detachment etc.
., This invention rolates to extracapsular extraction, the . procedure cor.~idered e safest. However, even in .~ extracapsular surgery ~here a probe or similar instrument is used to remove the lens, either aS a complete lens or by - first dissolving the cortex and then shattering or breaking down the nucleus into smaller bits or pieces and extracting the bits, the danger of the surgical instrument penetrating through the posterior capsule exists, even with the most . careful surgeon. Vitreous loss or hemorrhage, retina detachment, etc. may result.
One of the currently used procedures for extracapsular extraction of cataracts is disclosed in U . S . Patent No.
3,996,935. For this procedure, the anterior capsule is ~irst ruptured and removed, followed by removal of the cortex and p nucleus of the lens, leaving the posterior capsule intact.
~s The pri~ary objec~ of the present invention is to reduce the chances to su~stantially zero of penetrating the ~:i posterior capsule in perfor~ing cataract surgery while retaining the anterior capsule substantially intact.
,.~,, ;
w093/l~io~ 2 1 2 9 1~ PCTtUS93/00600 ~ ~ 4 A further object is to provide an instrument or device for achieving a successful procedure for re~oving unwanted objects from within t~e body without injuring neighboring body tissue.
A still further object is to provide a device that will not only almost insure success in cataract surgery, but : provide an option to the surgeon for simplifying the procedure, using a smaller incision to retain the anterior capsule substantially intact and to use less co~plicated secondary instrumentation than had previously been necessary.
i i, 8UM~ARY OF ~E INVENT~ON -The objects of this invention are accomplished by employing an extracapsular procedure called phaco~
emulsification. In general terms, this procedure involves the following steps: puncturing the anterior lens capsule;
breaking up the lens; removing the broken bits of the lens while preventing the lens capsule ~rom collapsing.
Tn practicing phaco-emulsification, a procedure of using ~-~
a hollow tubular probe having a scalpel-like front edge, the probe being capable of drawing a vacuum through its hollow central portion. The sharp edge is used to break up or shatter the lens. The probe is surrounded by a cylindrical perforated tube, through which liquid is passed into the lens capsule. The liquid is used to emulsify the bits of lens so ;
WO93/l~0~ PCT/~593/00600 - 212~124 that they are withdrawn as part of an emulsion by the vacuum applied to the central portion of the probe. The liquid also serves to maintain the volume within the lens capsule at a constant level to prevent collapse of the capsular bag.
Applying the proper vacuum in conjunction with the proper liquid feeding rate to prevent collapse of the capsule while removing the emulsion containing the bits of diseased lens requires extreme care and caution. Any collapse of the capsule against the sharp edge Ot' the probe can puncture the capsule resulting in disaster. The improvement of the present invention will minimize and in most cases avoid the disaster possibility.
Specifically, the invention involves the insertion of a phaco-shield to partially surround the nucleus of the lens to be shattered. The shield having at least one flap extending beyond the leading sharp edge of the probe used for shattering. The shield is usually composed of two flaps of biocompatible ~lexible plastic material attached to a base of a similar ~lexible material. When in place, the ~ase extends over the cornea and sclera and the two flaps extend partially over the upper and lower portions of the nucleus of the lens.
~hen the hollow probe is inserted, it is disposed within the phaco-shield. The probe is designed so that it never ex~ends beyond the outer ext-emities of the flaps o~ the shield. In fact, the probe is maintained sur~iciently . ..
w093/l~ o~ PCT/~S93/00600 ~` 6 2~2~2 , ' distant from the extremities of the flap so that at least one flap will fold over the hollow opening of the probe to cut ` off the vacuum before the sharp edge of the pxobe can contact the posterior lens capsule. The flap must be sufficiently ! 5 strong and resilient to resist penetration by the tip of the probe.
., ,,~
Although a sharp, scalpel-like tip is illustrated as the -leading edge of the probe, other designs are operable.
Basically, the leading edge of the probe is adapted to disrupt or shatter tissue. When oscillated or moved into ., contact with the tissue, the leading edge will convert the tissue to particles or bits by shattering, breaking or abrading the unwanted cataract, tumor or foreign object, etc.
Besides protecting against penetration of the tip of the probe into the capsular bag, the shield is also capable of supporting the capsular bag physically and thus, preventing ~5 complete collapse of the capsular bag should the equilibrium be disturbed between the vacuum removing the emulsion containing the shattered bits of lens and the pressure of the replacement liquid being fed into the capsular bag.
The fact that the shield is capable of preventing complete collapse of the lens capsule provides the basis for another simplification in instrumentation for performing phaco-emulsification. The cylindrical perforated tube ~ ~ A . , . , , ~ ~ , ~ , , , wos3/l~,o~ PCT/~S93/00600 -~~ 7 2~2~124 concentric with the hollow probe, as used currently, is no longer required. Without the danger of complete collapse, - the liquid ~usually a mild saline solution) can be fed into the lens capsule through a very small tubular entry at a constant relatively slow rate. Concern a~out maintaining j flow rate to offset volume reduction due ~o withdrawing t~e emulsified lens particles under vacuum is avoided by the use : o~ the phaco-shield.
The invention will be more clearly understood by referring to the drawings and the description which follow.
THE DRAWI~~
Figure 1 is a cross-secticnal view of the eye;
, Figure 2 is a view, in perspective, o~ a phaco-shield of the invention;
Figures 3a and 3b are views in perspective of inserter glides for guiding the phaco-shield into position;
Figures 4a and 4~ are schematic partial, cross-section views of shattering probes and the protective flaps of the phaco-shield; and Figures 5-9 are schematic, partial, cross-sectional views of the eye with assorted instruments being used during the surgical procedure of shattering, emulsifying and removing the bits of shatterPd lens from the eye.
.
w093/1~,0~ PCT/~S93/00600 212~12~
DET~I~ED DESCRIPTIoN OF TXE INvENT~ON
Referring to Figure 2, a phaco-shield ~Q is co~posed of ~ two basic elements, the base 22 and at least one, preferably j at least two protective flaps 23 connected to the base 22.
~ 5 Since the flaps 23 are adapted to protect-a shattering probe j 40 inserted through the base 22. the ba5e 22 will have an opening preferably a "central" opening ?4 through which the I probe 40 is inserted. The opening 24 also fits over the ~ -stiff wire-like "Y" inserter 26 that guides the flaps 23 into position.
The phaco-shield 30 is manufactured from a polymeric material. The thicXness of the base 22 must be such that it is su~ficiently flexible to fit over, and conform to, the curved sur~ace of the sclera or the cornea. The thickness is generally ~rom 0.5 mm to 1.5 mm, preferably about 0.?5 mm, dependin~ upon the actual polymer and its molecular weight.
The shape of the base ~2 is elliptical, about 8 mm in length and about 4.5-5 mm in width. The central opening 24 in the base 22 is also elliptical, about 2.5-3 mm in length and about 1 mm in width.
The flaps 23 which may be molded integrally with base 22 or bonded thereto, may be thinner than the base. Vsually, their thickness is the same as the thickness of base 22 ~40 93/1~,0' PCr/1,S93/00600 ~ 9 212~12~
about 0.75 mm, but may be as thln as 0.25mm. Their thic~ness is such that the flaps 23 are guidable by the inserter 26 but -i sufficiently floppy to cover the opening and shut the vacuum . in the shattering probe 31 , should the probe tip get too :
- 5 close to the posterior capsule of the eye.
:
Preferably, the base 22 should have a second, tiny ~: : opening 28. through which fluid may be added during surgery l to provide any additional liquid, besides body fluid, tha~
'.............. may be necessary in the emulsification of the shattered bitsof the diseased lens. The fluid may also serve to prevent collapse of the capsular bag in which the lens lies.
The polymeric material used in the manufacture of the shield may be any of those currently in use where ~iocompati~ility is a requirement. Typically, such material comprise polysilicones, acrylic polymers, fluorocarbon polymers as well as olefinic polymer. The material should be clear, strong and ~lexible.
~he inserter 26 shown in Figure 3a is composed of three integrated elements, a "handle" 25. a body or shank of the inserter 26 and the "Y" inserter end 27. It is manufactured as a single unit of spring metal, e.g. spring steel, and then split at the ends to provide the "Y" guiding portion, shown at 27. When inserted into the eye to oontact the opaque, hardened nucleus o~ the cataract the split ends 27 separate .
~Q:~
A '~
WO93/1~70' PCT/IS93/00~0 o 2~ 2~124 further before guiding the flaps 23 of the phaco~shield over the nucleus. A substantially rigid plastic that also has the capa~ility of separating without breaking at one end in the manner shown for spring steel may also be used to make the S inserter. Polypropylene or high density polyethylene are candidate polymers.
~ The shattering probe 40 shown in Figures 4a and 4b is J, composed of a cylindrical portion 31 and a sharp, scalpel -like forward edge 32. ~he metallic probe is adapted to 3 10 vibrate at about 30,000 cycles per second enabling the forward edge 32. in the hands of a skilled surgeon, to gradually shatter the nucleus of the lens. The shattered bits 33. shown in Figure 4b, are withdrawn in the form of a emulsion by applying a vacuum through the cylindrical opening lS 34 of the probe 40.
Variously shaped leading edges 32 for shattering are shown in a series of patents to Anton Banko. Among these are U.S. Patent Nos. 3,996,935; 3,937,222; 3,618,594; 4,167,944;
3,945,375; 3,732,858; 4,117,843; and 4,368,734. Any of these edges can be adapted for use in utilizing the present invention; and the disclosures of these patents are hereby incorporated by reference into this specification.
In Figure 4b, a probe havin~ a concentric cylinder 3S
with perforatlons 36 is disclosed. Liquid, fed into the ~, , ' .
~ I ~~............. ,~ ., , `
~ I
; ~0~3/l~,0~ Pcr/~93/oo6oo ~ 1' 212~12 :' ~- capsular bag through the perforations, prevents collapse ofthe capsule and the li~uid pressure offsets that of the vacuum being applied to withdraw the emulsified, shattered - bits 33. Since the probe of Figure 4b would require a larger , .~
~ 5 opening for insertion, it is not preferred. As stated ,:!
earlier, using the specially designed phaco-shield of this invention serves to cut off the vacuum and prevent collapse of the lens capsule if the probe approaches the posterior capsule.
The steps of the surgical procedure, commonly called "phaco-emulsification", as practiced with the invented shield, are shown in Figures 5-9.
First, an incision of about 3 mm diameter is made in the anterior capsule of the eye. Through this incision, a 30 gauge cannula 41 is inserted for "hydro-dissection", as shown in Figure 5. Fluid, usually a mild saline solution, is allowed to flow into the capsular area through the cannula 41 to separate the softer cortex 17 from the relatively hard nucleus 16 of the lens and to create a space between the lens and the posterior capsule.
After the cannula 41 is withdrawn, the relatively stiff insert device or shield guide 25 is inserted through the same -3 mm incision, as shown in Figure 6a. When first inserted, the guiding ends 27 of the inserter 26 are in a horizontal ~",,,~
~,, -. - . : , . ,. ., . . ,................ .. -g~;., . . ~ , - . -, ~ . ,,, - : .
' ~'093/l~,0' pCT/~'S93~00600 -~ }~ 212~1~4 position to engage an edge of th,e nucleus 16. The inserter ', 26 is then rotated as in Figure 6b to the vertical position 'f which serves to spread the ends 27 so that they surround a , portion of the nucleus.
:~ 5 In Figure 7, the phaco-shield of the invention 30-is~, shown being slid over the inserter 26. The central opening 24 in the base 22 of the shield 30 is adapted to be fitted over the inserter ~ The shield 30 is slid carefully along and over the insert device 26 so that the flaps 23 are vertically oriented.
As shown in Figure 8, the flaps 23 are deflected or guided by the spread ends 27 of the inserter 26 to fill the space between the cortex and the nucleus and to surround a portion of the nucleus of the diseased lens. When the flaps 23 have engaged abou~ 50% of the surface of the nucleu~ to the satisfaction of the surgeon, and the base 22 is flush with the sclera or cornea, the insert device 26 is rotated to the horizontal position and removed.
. . ~
In Figure 9, the shattering probe 40 is shown, having been inserted within the opening 24 of the shield 30 to replac~ the removed inserter 26. The small tube 28 has also been inserted through the opening in the base 2 As shown in this figure, about l/3 of the nucleus has been shattered by the sharp leading edge '2 of the vibrating probe 40; and the shattered bits have been removed as an emulsion by the .. ..
:
wos3/1~/o' PCT/~S93/00600 ^ 13 2~2~12~
vacuum applied though the cylindrical opening in the probe 40. The emulsion of the shattered ~its is formed with the liquid that is allowed to flow by force of gravity into the capsule through the tube 28. The re~aining nucleus is rotated with the probe tip to be shattered and then removed.
; It should be understood that there are alternative methods of fitting the flaps 23 of the shield 30 over a portion of the nucleus. One alternative is to introduce both the shield 30 and the inserter 2~ within the shield simultaneously; and rotate only the inserter 26 so that its spring steel ends 27 deflect outwardly to spread the flaps 23 over the nucleus.
An alternative inserting device is shown in Figure 3b.
It is compased of a hollow tube 50 with a solid rod 51 within it and having a split end 52 under tension such that when projected as shown by the arrow beyond the end of the tube 50 will spread apart to form the "Y" inserter guide for the phaco-shield. Projection of this inserting device 51 can be accomplished by using a spring-set trigger mechanism, not shown, that is operated by the surgeon.
Another possibility would be to have the split end 52 project beyond the end of tube 5~ maintained under tension by a surrounding ring. By sliding the ring bac~ (by an electromagnetic device), the split ends 52 will spread apart .. '' wos3~,0~ PCT/~593/00600 ^ l; 212.~124 "
. ~
~ to form the "Y" inserter.
,........................................................................ .
~ It is also possible to use the combination shown in ....
Figure 3b to accomplish the steps shown in Figures 6-9 in a ~ single step. The hollow tube 50 can be considered equivalent . 5 to the probe 40 shown in Figure 4a. Before the vacuum is applied, the solid rod 51 can be slid within the probe 40 and the phaco-shield 30 can be slid over the probe 40. After triggering the rod 51 to spread the ends 5~. the rod is rotated and the phaco-shield 30 is slid into place. The flaps 23 are guided over the nucleus; the rod 51 is rotated and re~oved; the vibrating mechanism is attached to the rod 50 (probe 40) and the vacuum is applied through the space ~-vacated by rod 51 (the inserting device). ~
::~
Although the invented phaco-shield has been described for use in the removal of cataracts from the eye, it can be used in a variety of areas in the body wbere unwanted materials are found within, and in proximity to, delicate, vulnerable body tissue. Such areas include, but should not be considered limited to:
l. Foreign objects within the vitreous humor of the eye to be removed withou~ damaging the retina;
TITLE
METHOD AND APPARATUS FOR PHACO-EMULSIFICATION
. . .
.i ~ F~E~D OF ~E INVENT~ON
j This invention relates to cataract surgery andj more particularly, to the process of surgically removing the j : "diseased" lens or cataract more safely than heretofore.
i~ Speci~ically, the present invention relates to the use of a il specially designed shield for perfor~i~g the emulsification ~¦ of the diseased lens tphaco-emulsification) and removing the ~j 10 "emulsion" in a safe, effective manner.
i .. ; .
~CRG20~ND OF T~E INVEN~ON
,.; . ~
As shown in Figure 1 (the drawing showing the various parts of the eye), the lens ll is perhaps the ~ost critical element within the eye in providing vision for the human or animal. It is suspended behind the cornea 12. the anterior chamber 13 and the iris 14 by the zonular fibers which connect it with the ciliary body of muscles 1~ around its periphery.
~,~
The lens is composed of a central region, the nucleus 16. surrounded by a softer outer region, the cortex 1~. It is encapsulated in the lens capsule 18. which is a thin transparent membrane. The front part of the membrane is .
~O 93/1~,0~ 2 ~ 2 ~ 1 2 ~ PC~ S93/00600 , called the ante-ior capsule 20 and the rear part, the posterior capsule 21.
The function of the lens is to focus light rays upon the sensitive retina 19. To focus light from a distant object, the ciliary muscles 15 relax, thu, tightening the zonular fibers and reducing the thickness of the lens to its minimal - : dimension. To focus light from a near object, the ciliary muscles 15 release the tension on the zonular fibers to increase the thickness of the lens, the lens assuming a near spherical shape. This change increases the lens refractive power to again obtain focusing of the light rays on the retina 19.
The lens consists of about 35% protein and 65% water.
j When the proteinaceous material hardens or becomes suffused ~5 with minerals, the lens becomes Glolldy or opague. A cloudy lens or an opaque, non-functional lens is a cataract. Most cataracts are not visible to the casual observer until they become dense enough to cause blindness.
. . -~
Cataract surgery involves the removal of the "diseased"
lens from the eye. Two principal procedures for lens extractions are practiced currently. Intracapsular surgery involves removal of the lens together with its surrounding capsule. Where the posterior capsule may be attached slightly to the vitreous membrane, extracapsular extraction ..
.~.
- . . .. .. -, " , ,,,., "",, . s .,j", ", ",.,, ~ , " ; ~
~ w093/]~lo~ 212~12~ PCT/~S93/00600 -: 3 . of the lens is much preferred. Xupturing the vitreous : membrane, a definite hazard in intracapsular surgery, has serious consequences, including vitreous loss, vitreous hemorrhage, retina detachment etc.
., This invention rolates to extracapsular extraction, the . procedure cor.~idered e safest. However, even in .~ extracapsular surgery ~here a probe or similar instrument is used to remove the lens, either aS a complete lens or by - first dissolving the cortex and then shattering or breaking down the nucleus into smaller bits or pieces and extracting the bits, the danger of the surgical instrument penetrating through the posterior capsule exists, even with the most . careful surgeon. Vitreous loss or hemorrhage, retina detachment, etc. may result.
One of the currently used procedures for extracapsular extraction of cataracts is disclosed in U . S . Patent No.
3,996,935. For this procedure, the anterior capsule is ~irst ruptured and removed, followed by removal of the cortex and p nucleus of the lens, leaving the posterior capsule intact.
~s The pri~ary objec~ of the present invention is to reduce the chances to su~stantially zero of penetrating the ~:i posterior capsule in perfor~ing cataract surgery while retaining the anterior capsule substantially intact.
,.~,, ;
w093/l~io~ 2 1 2 9 1~ PCTtUS93/00600 ~ ~ 4 A further object is to provide an instrument or device for achieving a successful procedure for re~oving unwanted objects from within t~e body without injuring neighboring body tissue.
A still further object is to provide a device that will not only almost insure success in cataract surgery, but : provide an option to the surgeon for simplifying the procedure, using a smaller incision to retain the anterior capsule substantially intact and to use less co~plicated secondary instrumentation than had previously been necessary.
i i, 8UM~ARY OF ~E INVENT~ON -The objects of this invention are accomplished by employing an extracapsular procedure called phaco~
emulsification. In general terms, this procedure involves the following steps: puncturing the anterior lens capsule;
breaking up the lens; removing the broken bits of the lens while preventing the lens capsule ~rom collapsing.
Tn practicing phaco-emulsification, a procedure of using ~-~
a hollow tubular probe having a scalpel-like front edge, the probe being capable of drawing a vacuum through its hollow central portion. The sharp edge is used to break up or shatter the lens. The probe is surrounded by a cylindrical perforated tube, through which liquid is passed into the lens capsule. The liquid is used to emulsify the bits of lens so ;
WO93/l~0~ PCT/~593/00600 - 212~124 that they are withdrawn as part of an emulsion by the vacuum applied to the central portion of the probe. The liquid also serves to maintain the volume within the lens capsule at a constant level to prevent collapse of the capsular bag.
Applying the proper vacuum in conjunction with the proper liquid feeding rate to prevent collapse of the capsule while removing the emulsion containing the bits of diseased lens requires extreme care and caution. Any collapse of the capsule against the sharp edge Ot' the probe can puncture the capsule resulting in disaster. The improvement of the present invention will minimize and in most cases avoid the disaster possibility.
Specifically, the invention involves the insertion of a phaco-shield to partially surround the nucleus of the lens to be shattered. The shield having at least one flap extending beyond the leading sharp edge of the probe used for shattering. The shield is usually composed of two flaps of biocompatible ~lexible plastic material attached to a base of a similar ~lexible material. When in place, the ~ase extends over the cornea and sclera and the two flaps extend partially over the upper and lower portions of the nucleus of the lens.
~hen the hollow probe is inserted, it is disposed within the phaco-shield. The probe is designed so that it never ex~ends beyond the outer ext-emities of the flaps o~ the shield. In fact, the probe is maintained sur~iciently . ..
w093/l~ o~ PCT/~S93/00600 ~` 6 2~2~2 , ' distant from the extremities of the flap so that at least one flap will fold over the hollow opening of the probe to cut ` off the vacuum before the sharp edge of the pxobe can contact the posterior lens capsule. The flap must be sufficiently ! 5 strong and resilient to resist penetration by the tip of the probe.
., ,,~
Although a sharp, scalpel-like tip is illustrated as the -leading edge of the probe, other designs are operable.
Basically, the leading edge of the probe is adapted to disrupt or shatter tissue. When oscillated or moved into ., contact with the tissue, the leading edge will convert the tissue to particles or bits by shattering, breaking or abrading the unwanted cataract, tumor or foreign object, etc.
Besides protecting against penetration of the tip of the probe into the capsular bag, the shield is also capable of supporting the capsular bag physically and thus, preventing ~5 complete collapse of the capsular bag should the equilibrium be disturbed between the vacuum removing the emulsion containing the shattered bits of lens and the pressure of the replacement liquid being fed into the capsular bag.
The fact that the shield is capable of preventing complete collapse of the lens capsule provides the basis for another simplification in instrumentation for performing phaco-emulsification. The cylindrical perforated tube ~ ~ A . , . , , ~ ~ , ~ , , , wos3/l~,o~ PCT/~S93/00600 -~~ 7 2~2~124 concentric with the hollow probe, as used currently, is no longer required. Without the danger of complete collapse, - the liquid ~usually a mild saline solution) can be fed into the lens capsule through a very small tubular entry at a constant relatively slow rate. Concern a~out maintaining j flow rate to offset volume reduction due ~o withdrawing t~e emulsified lens particles under vacuum is avoided by the use : o~ the phaco-shield.
The invention will be more clearly understood by referring to the drawings and the description which follow.
THE DRAWI~~
Figure 1 is a cross-secticnal view of the eye;
, Figure 2 is a view, in perspective, o~ a phaco-shield of the invention;
Figures 3a and 3b are views in perspective of inserter glides for guiding the phaco-shield into position;
Figures 4a and 4~ are schematic partial, cross-section views of shattering probes and the protective flaps of the phaco-shield; and Figures 5-9 are schematic, partial, cross-sectional views of the eye with assorted instruments being used during the surgical procedure of shattering, emulsifying and removing the bits of shatterPd lens from the eye.
.
w093/1~,0~ PCT/~S93/00600 212~12~
DET~I~ED DESCRIPTIoN OF TXE INvENT~ON
Referring to Figure 2, a phaco-shield ~Q is co~posed of ~ two basic elements, the base 22 and at least one, preferably j at least two protective flaps 23 connected to the base 22.
~ 5 Since the flaps 23 are adapted to protect-a shattering probe j 40 inserted through the base 22. the ba5e 22 will have an opening preferably a "central" opening ?4 through which the I probe 40 is inserted. The opening 24 also fits over the ~ -stiff wire-like "Y" inserter 26 that guides the flaps 23 into position.
The phaco-shield 30 is manufactured from a polymeric material. The thicXness of the base 22 must be such that it is su~ficiently flexible to fit over, and conform to, the curved sur~ace of the sclera or the cornea. The thickness is generally ~rom 0.5 mm to 1.5 mm, preferably about 0.?5 mm, dependin~ upon the actual polymer and its molecular weight.
The shape of the base ~2 is elliptical, about 8 mm in length and about 4.5-5 mm in width. The central opening 24 in the base 22 is also elliptical, about 2.5-3 mm in length and about 1 mm in width.
The flaps 23 which may be molded integrally with base 22 or bonded thereto, may be thinner than the base. Vsually, their thickness is the same as the thickness of base 22 ~40 93/1~,0' PCr/1,S93/00600 ~ 9 212~12~
about 0.75 mm, but may be as thln as 0.25mm. Their thic~ness is such that the flaps 23 are guidable by the inserter 26 but -i sufficiently floppy to cover the opening and shut the vacuum . in the shattering probe 31 , should the probe tip get too :
- 5 close to the posterior capsule of the eye.
:
Preferably, the base 22 should have a second, tiny ~: : opening 28. through which fluid may be added during surgery l to provide any additional liquid, besides body fluid, tha~
'.............. may be necessary in the emulsification of the shattered bitsof the diseased lens. The fluid may also serve to prevent collapse of the capsular bag in which the lens lies.
The polymeric material used in the manufacture of the shield may be any of those currently in use where ~iocompati~ility is a requirement. Typically, such material comprise polysilicones, acrylic polymers, fluorocarbon polymers as well as olefinic polymer. The material should be clear, strong and ~lexible.
~he inserter 26 shown in Figure 3a is composed of three integrated elements, a "handle" 25. a body or shank of the inserter 26 and the "Y" inserter end 27. It is manufactured as a single unit of spring metal, e.g. spring steel, and then split at the ends to provide the "Y" guiding portion, shown at 27. When inserted into the eye to oontact the opaque, hardened nucleus o~ the cataract the split ends 27 separate .
~Q:~
A '~
WO93/1~70' PCT/IS93/00~0 o 2~ 2~124 further before guiding the flaps 23 of the phaco~shield over the nucleus. A substantially rigid plastic that also has the capa~ility of separating without breaking at one end in the manner shown for spring steel may also be used to make the S inserter. Polypropylene or high density polyethylene are candidate polymers.
~ The shattering probe 40 shown in Figures 4a and 4b is J, composed of a cylindrical portion 31 and a sharp, scalpel -like forward edge 32. ~he metallic probe is adapted to 3 10 vibrate at about 30,000 cycles per second enabling the forward edge 32. in the hands of a skilled surgeon, to gradually shatter the nucleus of the lens. The shattered bits 33. shown in Figure 4b, are withdrawn in the form of a emulsion by applying a vacuum through the cylindrical opening lS 34 of the probe 40.
Variously shaped leading edges 32 for shattering are shown in a series of patents to Anton Banko. Among these are U.S. Patent Nos. 3,996,935; 3,937,222; 3,618,594; 4,167,944;
3,945,375; 3,732,858; 4,117,843; and 4,368,734. Any of these edges can be adapted for use in utilizing the present invention; and the disclosures of these patents are hereby incorporated by reference into this specification.
In Figure 4b, a probe havin~ a concentric cylinder 3S
with perforatlons 36 is disclosed. Liquid, fed into the ~, , ' .
~ I ~~............. ,~ ., , `
~ I
; ~0~3/l~,0~ Pcr/~93/oo6oo ~ 1' 212~12 :' ~- capsular bag through the perforations, prevents collapse ofthe capsule and the li~uid pressure offsets that of the vacuum being applied to withdraw the emulsified, shattered - bits 33. Since the probe of Figure 4b would require a larger , .~
~ 5 opening for insertion, it is not preferred. As stated ,:!
earlier, using the specially designed phaco-shield of this invention serves to cut off the vacuum and prevent collapse of the lens capsule if the probe approaches the posterior capsule.
The steps of the surgical procedure, commonly called "phaco-emulsification", as practiced with the invented shield, are shown in Figures 5-9.
First, an incision of about 3 mm diameter is made in the anterior capsule of the eye. Through this incision, a 30 gauge cannula 41 is inserted for "hydro-dissection", as shown in Figure 5. Fluid, usually a mild saline solution, is allowed to flow into the capsular area through the cannula 41 to separate the softer cortex 17 from the relatively hard nucleus 16 of the lens and to create a space between the lens and the posterior capsule.
After the cannula 41 is withdrawn, the relatively stiff insert device or shield guide 25 is inserted through the same -3 mm incision, as shown in Figure 6a. When first inserted, the guiding ends 27 of the inserter 26 are in a horizontal ~",,,~
~,, -. - . : , . ,. ., . . ,................ .. -g~;., . . ~ , - . -, ~ . ,,, - : .
' ~'093/l~,0' pCT/~'S93~00600 -~ }~ 212~1~4 position to engage an edge of th,e nucleus 16. The inserter ', 26 is then rotated as in Figure 6b to the vertical position 'f which serves to spread the ends 27 so that they surround a , portion of the nucleus.
:~ 5 In Figure 7, the phaco-shield of the invention 30-is~, shown being slid over the inserter 26. The central opening 24 in the base 22 of the shield 30 is adapted to be fitted over the inserter ~ The shield 30 is slid carefully along and over the insert device 26 so that the flaps 23 are vertically oriented.
As shown in Figure 8, the flaps 23 are deflected or guided by the spread ends 27 of the inserter 26 to fill the space between the cortex and the nucleus and to surround a portion of the nucleus of the diseased lens. When the flaps 23 have engaged abou~ 50% of the surface of the nucleu~ to the satisfaction of the surgeon, and the base 22 is flush with the sclera or cornea, the insert device 26 is rotated to the horizontal position and removed.
. . ~
In Figure 9, the shattering probe 40 is shown, having been inserted within the opening 24 of the shield 30 to replac~ the removed inserter 26. The small tube 28 has also been inserted through the opening in the base 2 As shown in this figure, about l/3 of the nucleus has been shattered by the sharp leading edge '2 of the vibrating probe 40; and the shattered bits have been removed as an emulsion by the .. ..
:
wos3/1~/o' PCT/~S93/00600 ^ 13 2~2~12~
vacuum applied though the cylindrical opening in the probe 40. The emulsion of the shattered ~its is formed with the liquid that is allowed to flow by force of gravity into the capsule through the tube 28. The re~aining nucleus is rotated with the probe tip to be shattered and then removed.
; It should be understood that there are alternative methods of fitting the flaps 23 of the shield 30 over a portion of the nucleus. One alternative is to introduce both the shield 30 and the inserter 2~ within the shield simultaneously; and rotate only the inserter 26 so that its spring steel ends 27 deflect outwardly to spread the flaps 23 over the nucleus.
An alternative inserting device is shown in Figure 3b.
It is compased of a hollow tube 50 with a solid rod 51 within it and having a split end 52 under tension such that when projected as shown by the arrow beyond the end of the tube 50 will spread apart to form the "Y" inserter guide for the phaco-shield. Projection of this inserting device 51 can be accomplished by using a spring-set trigger mechanism, not shown, that is operated by the surgeon.
Another possibility would be to have the split end 52 project beyond the end of tube 5~ maintained under tension by a surrounding ring. By sliding the ring bac~ (by an electromagnetic device), the split ends 52 will spread apart .. '' wos3~,0~ PCT/~593/00600 ^ l; 212.~124 "
. ~
~ to form the "Y" inserter.
,........................................................................ .
~ It is also possible to use the combination shown in ....
Figure 3b to accomplish the steps shown in Figures 6-9 in a ~ single step. The hollow tube 50 can be considered equivalent . 5 to the probe 40 shown in Figure 4a. Before the vacuum is applied, the solid rod 51 can be slid within the probe 40 and the phaco-shield 30 can be slid over the probe 40. After triggering the rod 51 to spread the ends 5~. the rod is rotated and the phaco-shield 30 is slid into place. The flaps 23 are guided over the nucleus; the rod 51 is rotated and re~oved; the vibrating mechanism is attached to the rod 50 (probe 40) and the vacuum is applied through the space ~-vacated by rod 51 (the inserting device). ~
::~
Although the invented phaco-shield has been described for use in the removal of cataracts from the eye, it can be used in a variety of areas in the body wbere unwanted materials are found within, and in proximity to, delicate, vulnerable body tissue. Such areas include, but should not be considered limited to:
l. Foreign objects within the vitreous humor of the eye to be removed withou~ damaging the retina;
2. Fatty deposits or blocd clots within arterial areas to be shattered without damaging the walls of the ~ ,.~'s ~.,. ,,.-, .,,., ~.. , ,s ,.. ...
3i-'.'' ~093/1~iO~ PCTI~S93/00600 ~ 1, 2~2~
.
arteries;
3i-'.'' ~093/1~iO~ PCTI~S93/00600 ~ 1, 2~2~
.
arteries;
3. Lumbar discs to be removed by emulsification. The shield can be modified to prevent injury to nerves or laterally to the spinal cord;
4. Polyps in the intestine; and
5. Stones in the kidney.
.",.;
Thus, in its broadest sense, this invention relates to the use of a device having a substantially sharp leading edge that is manipulated by the surgeon to remove, usually by shattering, of an unwanted object, either foreign or d~veloped naturally, e.g. cataracts, tumors, kidney stones, etc., that is disposed in proximity to body tissue that is vulnerable or can be damaged by the sharp edge. The invention provides protection for the vulnerable tissue by providing at least one plastic flap extending ove- the device in such manner that the flap will cover the sharp leading edge i~mediately prior to any contact of the edge with the vulnerable body tissue.
, '' . . ~.' ~ h~
~ . ,,.,s.,~
.",.;
Thus, in its broadest sense, this invention relates to the use of a device having a substantially sharp leading edge that is manipulated by the surgeon to remove, usually by shattering, of an unwanted object, either foreign or d~veloped naturally, e.g. cataracts, tumors, kidney stones, etc., that is disposed in proximity to body tissue that is vulnerable or can be damaged by the sharp edge. The invention provides protection for the vulnerable tissue by providing at least one plastic flap extending ove- the device in such manner that the flap will cover the sharp leading edge i~mediately prior to any contact of the edge with the vulnerable body tissue.
, '' . . ~.' ~ h~
~ . ,,.,s.,~
Claims (9)
1. A process for surgically removing a cataract from an eye which comprises the following steps:
a) puncturing the anterior lens capsule to form an opening;
b) separating the cortex from the hard nucleus of the lens;
c) inserting a relatively stiff shield guide through the opening, the guide having a rod-like body with two wire-like separable ends extending into the eye;
d) rotating the shield guide in such manner that said separable ends separate and surround a portion of the nucleus;
e) sliding a phaco-shield over the rod-like body of said shield guide, the phaco-shield having a bass adapted to fit closely over a portion of the sclera or cornea, a central opening in the base adapted to fit over the body of said shield and at least two flexible flaps adapted to fit through the opening in the anterior capsule and to slide over the body of said shield guide and over the separated ends of the shield guide to engage or partially surround the surface of the nucleus;
f) removing the shield guide through the opening in the base of the phaco-shield;
g) inserting a cylindrical probe through the opening in the base of the shield, the probe having a forward edge adapted to disrupt the nucleus upon contact.
h) introducing liquid into the capsular area while vibrating the probe to disrupt the nucleus and to form an emulsion of the disrupted particles of the nucleus in the liquid;
i) applying a vacuum through the central opening of the cylindrical probe to withdraw the emulsion formed in step (h);
j) controlling the vacuum with the flexible flaps that engage the surface of the nucleus and surround the vibrating probe, at least one flap being adapted to cover the central opening of the probe when said flap contacts the surface of the posterior capsule.
a) puncturing the anterior lens capsule to form an opening;
b) separating the cortex from the hard nucleus of the lens;
c) inserting a relatively stiff shield guide through the opening, the guide having a rod-like body with two wire-like separable ends extending into the eye;
d) rotating the shield guide in such manner that said separable ends separate and surround a portion of the nucleus;
e) sliding a phaco-shield over the rod-like body of said shield guide, the phaco-shield having a bass adapted to fit closely over a portion of the sclera or cornea, a central opening in the base adapted to fit over the body of said shield and at least two flexible flaps adapted to fit through the opening in the anterior capsule and to slide over the body of said shield guide and over the separated ends of the shield guide to engage or partially surround the surface of the nucleus;
f) removing the shield guide through the opening in the base of the phaco-shield;
g) inserting a cylindrical probe through the opening in the base of the shield, the probe having a forward edge adapted to disrupt the nucleus upon contact.
h) introducing liquid into the capsular area while vibrating the probe to disrupt the nucleus and to form an emulsion of the disrupted particles of the nucleus in the liquid;
i) applying a vacuum through the central opening of the cylindrical probe to withdraw the emulsion formed in step (h);
j) controlling the vacuum with the flexible flaps that engage the surface of the nucleus and surround the vibrating probe, at least one flap being adapted to cover the central opening of the probe when said flap contacts the surface of the posterior capsule.
2. A process for surgically removing a cataract from an eye which comprises the following steps:
a) puncturing the anterior lens capsule to form an opening;
b) inserting a cannula through the opening into the capsular area;
c) flowing a mild saline solution through the cannula to dissolve the cortex in the solution and, thus separating the cortex from the hard nucleus of the lens;
d) withdrawing the cannula and inserting a relatively stiff shield guide through the opening, the guide having a rod-like body with two wire-like separable ends extending into the eye;
e) rotating the shield guide in such manner that said separable ends separate and surround a portion of the nucleus;
f) sliding a phaco-shield over the rod-like body of said shield guide, the phaco-shield having a base adapted to fit closely over a portion of the sclera or cornea, a central opening in the base adapted to fit over the body of said shield guide and at least two flexible flaps adapted to fit through the opening in the anterior capsule and to slide over the body of said shield guide and over the separated ends of the shield guide to engage or partially surround the surface of the nucleus;
g) removing the shield guide through the opening in the base of the phaco-shield;
h) inserting a cylindrical probe through the opening in the base of the shield, the probe having a sharp, scalpel-like forward edge adapted to shatter the nucleus upon contact;
i) introducing liquid into-the capsular area while vibrating the probe to shatter the nucleus into bits and to form an emulsion of the bits in the liquid;
j) applying a vacuum through the central opening of the cylindrical probe to withdraw the emulsion formed in step (i);
k) controlling the vacuum with the flexible flaps that engage the surface of the nucleus and surround the vibrating probe, at least one flap being adapted to cover the central opening of the probe when said flap contacts the surface of the posterior capsule.
a) puncturing the anterior lens capsule to form an opening;
b) inserting a cannula through the opening into the capsular area;
c) flowing a mild saline solution through the cannula to dissolve the cortex in the solution and, thus separating the cortex from the hard nucleus of the lens;
d) withdrawing the cannula and inserting a relatively stiff shield guide through the opening, the guide having a rod-like body with two wire-like separable ends extending into the eye;
e) rotating the shield guide in such manner that said separable ends separate and surround a portion of the nucleus;
f) sliding a phaco-shield over the rod-like body of said shield guide, the phaco-shield having a base adapted to fit closely over a portion of the sclera or cornea, a central opening in the base adapted to fit over the body of said shield guide and at least two flexible flaps adapted to fit through the opening in the anterior capsule and to slide over the body of said shield guide and over the separated ends of the shield guide to engage or partially surround the surface of the nucleus;
g) removing the shield guide through the opening in the base of the phaco-shield;
h) inserting a cylindrical probe through the opening in the base of the shield, the probe having a sharp, scalpel-like forward edge adapted to shatter the nucleus upon contact;
i) introducing liquid into-the capsular area while vibrating the probe to shatter the nucleus into bits and to form an emulsion of the bits in the liquid;
j) applying a vacuum through the central opening of the cylindrical probe to withdraw the emulsion formed in step (i);
k) controlling the vacuum with the flexible flaps that engage the surface of the nucleus and surround the vibrating probe, at least one flap being adapted to cover the central opening of the probe when said flap contacts the surface of the posterior capsule.
3. A process for surgically removing a cataract from an eye which comprises the following steps:
a) puncturing the anterior lens capsule to form an opening;
b) separating the cortex from the hard nucleus of the lens;
c) guiding a phaco-shield having a base and at least one non-self supporting flexible flap over the hard nucleus to engage or partially surround the surface of the nucleus;
d) inserting a cylindrical probe through an opening in the base of the shield, the probe having a forward edge adapted to disrupt the nucleus upon contact;
e) introducing liquid into the capsular area while vibrating the probe to disrupt the nucleus and to form an emulsion of the disrupted particles of the nucleus in the liquid;
f) applying a vacuum through the central opening of the cylindrical probe to withdraw the emulsion formed in step (e);
g) controlling the vacuum with the flexible flap that engages the surface of the nucleus and surrounds the vibrating probe, the flap being adapted to cover the forward edge of the probe when said flap contacts the surface of the posterior capsule.
a) puncturing the anterior lens capsule to form an opening;
b) separating the cortex from the hard nucleus of the lens;
c) guiding a phaco-shield having a base and at least one non-self supporting flexible flap over the hard nucleus to engage or partially surround the surface of the nucleus;
d) inserting a cylindrical probe through an opening in the base of the shield, the probe having a forward edge adapted to disrupt the nucleus upon contact;
e) introducing liquid into the capsular area while vibrating the probe to disrupt the nucleus and to form an emulsion of the disrupted particles of the nucleus in the liquid;
f) applying a vacuum through the central opening of the cylindrical probe to withdraw the emulsion formed in step (e);
g) controlling the vacuum with the flexible flap that engages the surface of the nucleus and surrounds the vibrating probe, the flap being adapted to cover the forward edge of the probe when said flap contacts the surface of the posterior capsule.
4. A surgical article of manufacture comprising a device having a leading edge sized and configured to shatter or remove an unwanted object disposed in proximity to vulnerable body tissue, in combination with at least one plastic non-self-supporting flexible flap extending above said leading edge and sized and configured to cover said leading edge just prior to any contact of said leading edge with said vulnerable body tissue to prevent dmage to said tissue.
5. The article as in claim 4 wherein two flexible plastic flaps are present, one sized and configured to extend above and one sized and configured to extend below said leading edge.
6. The article as in claim 4 wherein said device is sized and configured to shatter a cataract without damaging the posterior capsule of the eye.
7. The article as in claim 4 wherein at least one flap is transparent.
8. A phaco-shield consisting essentially of a base, a central opening in said base, at least one flexible non-self-supporting flap extending longitudinally and directly from said base, on either side of said opening, the base curved to fit flush over the cornea or sclera of an eye, the opening adapted to receive a probe having a sharp leading edge; and said at least one flap sized and configured to prevent contact between the sharp leading edge of the probe and the posterior capsule of the eye by one flap folding over said sharp edge when said flap contacts said posterior capsule.
9. A phaco-shield as in claim 8 wherein two flexible non-self-supporting flaps extend longitudinally and directly from said base, one above and one below said opening.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US82726492A | 1992-01-29 | 1992-01-29 | |
| US827,264 | 1992-01-29 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2129124A1 true CA2129124A1 (en) | 1993-08-05 |
Family
ID=25248748
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002129124A Abandoned CA2129124A1 (en) | 1992-01-29 | 1993-01-22 | Method and apparatus for phaco-emulsification |
Country Status (7)
| Country | Link |
|---|---|
| US (2) | US5403323A (en) |
| EP (1) | EP0625026B1 (en) |
| JP (1) | JPH08504106A (en) |
| AU (1) | AU681575B2 (en) |
| CA (1) | CA2129124A1 (en) |
| DE (1) | DE69326323T2 (en) |
| WO (1) | WO1993014702A1 (en) |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| AU681575B2 (en) * | 1992-01-29 | 1997-09-04 | Stewart Gregory Smith | Method and apparatus for phaco-emulsification |
| US5676669A (en) * | 1993-04-30 | 1997-10-14 | Colvard; Michael | Intraocular capsular shield |
| US5968058A (en) * | 1996-03-27 | 1999-10-19 | Optonol Ltd. | Device for and method of implanting an intraocular implant |
| IL113723A (en) * | 1995-05-14 | 2002-11-10 | Optonol Ltd | Intraocular implant |
| AU5857396A (en) * | 1995-05-14 | 1996-11-29 | Optonol Ltd. | Intraocular implant, delivery device, and method of implanta tion |
| US5645530A (en) * | 1995-08-28 | 1997-07-08 | Alcon Laboratories, Inc. | Phacoemulsification sleeve |
| US5819571A (en) * | 1997-02-10 | 1998-10-13 | Johnson; Stephen | Apparatus for bending surgical instruments |
| US8313454B2 (en) | 1997-11-20 | 2012-11-20 | Optonol Ltd. | Fluid drainage device, delivery device, and associated methods of use and manufacture |
| US6203513B1 (en) * | 1997-11-20 | 2001-03-20 | Optonol Ltd. | Flow regulating implant, method of manufacture, and delivery device |
| ATE249800T1 (en) * | 1998-02-09 | 2003-10-15 | Tomalla Karin | DEVICE FOR PROTECTING EYE ORGANS LOCATED IN THE AREA OF THE ANTERIOR CHAMBER OF AN EYE DURING OPERATION ON THE EYE LENS |
| EP0941692B1 (en) * | 1998-03-09 | 2002-09-11 | Schwind eye-tech-solutions GmbH & Co. KG | Method and device for examining the eye |
| ES2244028T3 (en) * | 1998-10-26 | 2005-12-01 | Human Med Ag | DEVICE FOR ELIMINATING FOCUSES OF DISEASES IN HUMAN AND VETERINARY MEDICINE. |
| US6358279B1 (en) | 1999-02-22 | 2002-03-19 | University Of Miami | Minicapsulorhexis valve |
| US6558342B1 (en) | 1999-06-02 | 2003-05-06 | Optonol Ltd. | Flow control device, introducer and method of implanting |
| ATE448762T1 (en) * | 2000-11-28 | 2009-12-15 | Anthony Maloof | DEVICE FOR SEALING THE CAPSULE SACK OF AN EYE |
| AUPR173100A0 (en) * | 2000-11-28 | 2000-12-21 | Maloof, Anthony | A device for sealing the capsular bag of an eye and a method for delivering fluid or treatment substances to the lens of an eye |
| ATE520362T1 (en) | 2001-12-03 | 2011-09-15 | Ekos Corp | CATHETER WITH MULTIPLE ULTRASONIC EMITTING PARTS |
| US20050234473A1 (en) * | 2004-04-14 | 2005-10-20 | Jaime Zacharias | Phacoemulsification probe with tip shield |
| BRPI0418744A (en) | 2004-04-15 | 2007-09-11 | Richard J Mackool | system for instructing cataract tissue removal |
| US7862531B2 (en) * | 2004-06-25 | 2011-01-04 | Optonol Ltd. | Flow regulating implants |
| US8496631B2 (en) * | 2005-07-05 | 2013-07-30 | David C. Brown | Apparatus and method for increasing flow resistance around a probe |
| US20070093892A1 (en) * | 2005-10-20 | 2007-04-26 | Alcon Manufacturing, Ltd. | Maintaining preoperative position of the posterior lens capsule after cataract surgery |
| WO2008086372A1 (en) | 2007-01-08 | 2008-07-17 | Ekos Corporation | Power parameters for ultrasonic catheter |
| US10182833B2 (en) * | 2007-01-08 | 2019-01-22 | Ekos Corporation | Power parameters for ultrasonic catheter |
| EP2494932B1 (en) | 2007-06-22 | 2020-05-20 | Ekos Corporation | Apparatus for treatment of intracranial hemorrhages |
| WO2009046301A1 (en) * | 2007-10-05 | 2009-04-09 | Anita Nevyas-Wallace | Expandable shield instrument for use in intraocular surgery |
| US8109896B2 (en) | 2008-02-11 | 2012-02-07 | Optonol Ltd. | Devices and methods for opening fluid passageways |
| US8678593B2 (en) | 2010-10-26 | 2014-03-25 | Alcon Research, Ltd. | Ophthalmoscopic contact lens |
| JP6324013B2 (en) * | 2013-09-30 | 2018-05-16 | マニー株式会社 | Cannula |
| US10656025B2 (en) | 2015-06-10 | 2020-05-19 | Ekos Corporation | Ultrasound catheter |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US3659607A (en) * | 1968-09-16 | 1972-05-02 | Surgical Design Corp | Method for performing surgical procedures on the eye |
| US3882872A (en) * | 1970-01-05 | 1975-05-13 | Nicholas G Douvas | Method and apparatus for cataract surgery |
| US3937222A (en) * | 1973-11-09 | 1976-02-10 | Surgical Design Corporation | Surgical instrument employing cutter means |
| EP0117519A1 (en) * | 1983-02-23 | 1984-09-05 | Johannes Dipl.-Ing. Theermann | Catheter |
| US4611594A (en) * | 1984-04-11 | 1986-09-16 | Northwestern University | Medical instrument for containment and removal of calculi |
| US4643185A (en) * | 1984-10-01 | 1987-02-17 | Iolab Corporation | Intraocular lens insertion guide |
| US4773415A (en) * | 1985-02-21 | 1988-09-27 | Tan Ben G | Lens posterior capsule instrument |
| US4744363A (en) * | 1986-07-07 | 1988-05-17 | Hasson Harrith M | Intra-abdominal organ stabilizer, retractor and tissue manipulator |
| SU1500316A1 (en) * | 1987-03-02 | 1989-08-15 | 2-й Московский государственный медицинский институт им.Н.И.Пирогова | Apparatus for draining tympanic cavity |
| US4811735A (en) * | 1987-07-30 | 1989-03-14 | Kensey Nash Corporation | Stone destroying catheter and method of use |
| US5007913A (en) * | 1989-09-19 | 1991-04-16 | Alcon Surgical, Inc. | Apparatus and method for implantation of intraocular lenses |
| US4978353A (en) * | 1989-09-25 | 1990-12-18 | Furillo Michael L | Method and means for protecting corneal endothelium and iris during IOL implantation |
| US5071421A (en) * | 1990-02-08 | 1991-12-10 | Stahl Norman O | Method for preventing damage to tissue during ultrasonic surgery |
| US5234436A (en) * | 1991-07-17 | 1993-08-10 | Eaton Alexander M | Sheath structure for a surgical knife |
| AU681575B2 (en) * | 1992-01-29 | 1997-09-04 | Stewart Gregory Smith | Method and apparatus for phaco-emulsification |
-
1993
- 1993-01-22 AU AU34827/93A patent/AU681575B2/en not_active Ceased
- 1993-01-22 JP JP5513352A patent/JPH08504106A/en active Pending
- 1993-01-22 DE DE69326323T patent/DE69326323T2/en not_active Expired - Fee Related
- 1993-01-22 EP EP93903647A patent/EP0625026B1/en not_active Expired - Lifetime
- 1993-01-22 WO PCT/US1993/000600 patent/WO1993014702A1/en active IP Right Grant
- 1993-01-22 CA CA002129124A patent/CA2129124A1/en not_active Abandoned
- 1993-05-13 US US08/059,953 patent/US5403323A/en not_active Expired - Fee Related
-
1995
- 1995-03-23 US US08/368,346 patent/US5540699A/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| US5540699A (en) | 1996-07-30 |
| EP0625026A1 (en) | 1994-11-23 |
| US5403323A (en) | 1995-04-04 |
| AU681575B2 (en) | 1997-09-04 |
| DE69326323D1 (en) | 1999-10-14 |
| AU3482793A (en) | 1993-09-01 |
| JPH08504106A (en) | 1996-05-07 |
| EP0625026B1 (en) | 1999-09-08 |
| WO1993014702A1 (en) | 1993-08-05 |
| DE69326323T2 (en) | 2000-04-13 |
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