Lens holder for contact vitrectomy lens

A lens holder for holding a vitrectomy lens during a surgical procedure may include a support ring sized and shaped to receive a portion of the vitrectomy lens to provide visualization of a surgical site in an eye of the patient. The support ring may be configured to rest upon the eye of the patient during a surgical treatment procedure performed on the eye. The lens holder may also include a transparent, flexible membrane disposed along a bottom plane of the support ring and configured to conform to a surface feature on the eye. It may also include an overflow trough to control contact of a wetting agent with the eye.

TECHNICAL FIELD

This disclosure is directed to a lens holder for a contact vitrectomy lens. More particularly, this disclosure is directed to a lens holder that may be positioned and maintained on an eye during a surgical procedure.

BACKGROUND

When performing vitreoretinal surgeries, surgeons use surgical microscopes to perceive tissue in the eye. In some cases, the surgical microscopes are aligned with a contact lens placed directly on the eye. Viscoelastic is often used between the cornea and the contact lens to eliminate any air gap between the two that would otherwise be present due to imperfect matching of the lens curvature to the cornea. The viscoelastic may have a similar refractive index as the lens and cornea to prevent reflections from occurring at their surfaces however the viscoelastic also acts as a lubricant and the lens may easily slide from atop the cornea due to gravity.

One conventional approach for reducing movement of the contact lens due to the force of gravity includes suturing a lens holder to the eye and inserting the lens. Another approach includes attaching the lens to an access cannula implanted in the eye during the surgical procedure. While these approaches reduce the chance of the contact lens displacing along the cornea during the surgical procedure, these approaches also eliminate the opportunity to adjust the lens during the surgical procedure.

Another conventional approach for reducing movement of the contact lens includes using an assistant to manually hold the lens in place during the surgery. This type of approach however is cumbersome and the assistant must have very steady hands for good results.

The present disclosure is directed to systems and methods holding a lens to an eye during a vitreoretinal surgical procedure.

SUMMARY

According to an exemplary aspect, the present disclosure is directed to a lens holder for holding a vitrectomy lens during a surgical procedure. The lens holder may include a support ring sized and shaped to receive a portion of the vitrectomy lens to provide visualization of a surgical site in an eye of the patient. The support ring may be configured to rest upon the eye of the patient during a surgical treatment procedure performed on the eye. The lens holder may also include a transparent, flexible membrane disposed along a bottom plane of the support ring and configured to conform to a surface feature on the eye.

In some aspects, the support ring may include an interior surface, an exterior surface, and a perforation extending through a side of the support ring from the interior surface to the exterior surface. The perforation may include a plurality of perforations equally spaced along the support ring. In some aspects, the lens holder may include an overflow wall adjacent the support ring. The overflow wall may be supported by a lower edge of the support ring. The support ring may include an interior surface and an exterior surface. The overflow wall may form an overflow trough about the exterior surface of the support ring. The overflow wall may include a lower edge connected to a lower edge of the support ring. The overflow trough may be arranged to minimize loss of wetting agent due to overflow/spillage so that additional wetting agent does not need to be reapplied when the lens is positioned or repositioned. The overflow wall may include an interior surface facing the support ring. The interior surface may extend at an oblique angle or a curve relative to the support ring. The transparent, flexible membrane may be configured to separate a wetting agent in the support ring from the eye.

According to another exemplary aspect, the present disclosure is directed to a lens holder with a support ring that may have an inner surface and an outer surface, may have a transparent, flexible membrane disposed along a bottom plane of the support ring that is configured to conform to a surface feature on the eye, and may have a trough disposed outside the outer surface of the support ring. The trough may be configured to inhibit fluid flow from the support ring to the eye.

In some aspects, the support ring may include an inner surface, an outer surface, and a perforation extending through a side of the support ring from the inner surface to the outer surface. The perforation may be one or more perforations equally spaced along the support ring. The overflow wall may be supported by a lower edge of the support ring. In some aspects, an overflow wall may extend about the support ring. The overflow wall may form the overflow trough. The overflow wall may include an interior surface facing the support ring. The interior surface may extend at an oblique angle or curve relative to the support ring.

According to another exemplary aspect, the present disclosure is directed to methods of using a lens system to perform a surgical procedure on an eye. The method may include introducing a wetting agent into a support ring of a lens holder and introducing a vitrectomy lens into the support ring so that an overflow portion of the wetting agent flows out of the support ring. In some implementations, it may include capturing the overflow portion of the wetting agent to inhibit the wetting agent from coming in contact with a surface of the eye.

In some aspects, introducing a wetting agent into a support ring may include introducing the wetting agent onto a transparent flexible membrane. The method also may include placing the lens system directly on the eye so that the flexible membrane conforms to a surface of the eye. In some aspects, the method may include viewing a surgical site through the vitrectomy lens and the wetting agent while performing a surgical procedure.

It is to be understood that both the foregoing general description and the following drawings and detailed description are exemplary and explanatory in nature and are intended to provide an understanding of the present disclosure without limiting the scope of the present disclosure. In that regard, additional aspects, features, and advantages of the present disclosure will be apparent to one skilled in the art from the following.

These Figures will be better understood by reference to the following Detailed Description.

DETAILED DESCRIPTION

For the purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the implementations illustrated in the drawings and specific language will be used to describe them. It will nevertheless be understood that no limitation of the scope of the disclosure is intended. Any alterations and further modifications to the described devices, instruments, methods, and any further application of the principles of the present disclosure are fully contemplated as would normally occur to one skilled in the art to which the disclosure relates. In addition, this disclosure describes some elements or features in detail with respect to one or more implementations or Figures, when those same elements or features appear in subsequent Figures, without such a high level of detail. It is fully contemplated that the features, components, and/or steps described with respect to one or more implementations or Figures may be combined with the features, components, and/or steps described with respect to other implementations or Figures of the present disclosure. For simplicity, in some instances the same or similar reference numbers are used throughout the drawings to refer to the same or like parts.

The present disclosure relates generally to a lens holder for vitreoretinal surgery. The lens holder is configured to have a higher coefficient of friction than conventional lens holders because it includes a transparent membrane that separates a wetting agent, such as viscoelastic, from coming into direct contact with the cornea. The wetting agent may have a similar refractive index as the lens and cornea to prevent reflections from occurring at their surfaces. Since the wetting agent may include lubricous properties, separating it from the cornea may result in a more stable positioning of the lens. Instead of disposing the wetting agent between the lens and the cornea, the wetting agent is disposed between the lens and the transparent membrane. The transparent membrane may have a similar refractive index as the lens and cornea and wetting agent to prevent reflections from occurring at their surfaces. In some exemplary aspects, the lens holder also includes an overflow trough for capturing excess wetting agent that may be disposed between the lens and the transparent membrane. Because the membrane is in contact with the eye rather than the wetting agent, the holding friction is much higher than in conventional systems and the lens may stay in position without slippage. Furthermore the user can easily reposition the lens by lifting it and placing it in a desired position. The wetting agent flows in and out of the overflow trough through perforations to continuously maintain the wetting agent in place without the need for the surgeon to reapply it during lens repositioning.

FIG. 1illustrates a lens system100including a vitrectomy lens102and a lens holder104. The lens system100may be used during an ocular surgery to enable a user such as a surgeon to be able to view a surgical site. In some implementations, the lens system100is disposed upon and placed in contact with an eye undergoing a surgical procedure. Here, the vitrectomy lens102is shown separate from but disposed above the lens holder104. The lens holder104may be used with any of a large variety of vitrectomy lenses. Accordingly, a surgeon may select any desired vitrectomy lens and it may cooperate with the lens holder104to provide desired visualization capability. In some implementations, the lens holder104is compatible with specific vitrectomy lenses or family of lenses. In some implementations, the lens holder104may be one of a set of similarly shaped lens holders, each designed to be used with a specific vitrectomy lens or family of lenses.

The vitrectomy lens102may include a body106divided into a wide diameter lens holding portion108and a smaller diameter lens holding portion110. The wide diameter lens holding portion108may include a lens112, and the smaller diameter lens holding portion110may include an additional lens that is not shown in this embodiment. Light may pass through open ends of the body106, and through the lenses. The lenses may cooperate together to magnify a surgical site for viewing by a user.

The lens holder104may be sized and arranged to receive a portion of the body106of the vitrectomy lens102. In this implementation, the lens holder104is sized and arranged to receive the smaller diameter lens holding portion110. The lens holder104is sized and shaped to separate the vitrectomy lens102from direct contact with an eye. In this implementation, the lens holder104includes a main body, referred to herein as a support ring120, an overflow wall122, and a flexible membrane124.

FIGS. 2 and 3illustrate a side view and a top view of the lens holder104. Referring toFIGS. 1, 2, and 3, the support ring120includes an inner surface130and an outer surface and132. The support ring120has a diameter sized slightly larger than the diameter of the smaller diameter lens holding portion110of the vitrectomy lens102ofFIG. 1. The support ring120is configured to receive the smaller diameter lens holding portion110in a manner that permits insertion and removal. In some implementations, the support ring120has a diameter within the range of about 0.1 to 1 inches. Smaller and larger diameters are also contemplated. The support ring120has an upper edge136and a lower edge138, best seen inFIG. 2. The lower edge138may form a bottom portion of the lens holder104. The support ring120may have a height H1measured from the upper edge136to the lower edge138within a range of about 0.05 to 0.2 inch. Smaller and larger heights are also contemplated. In this exemplary embodiment, the support ring120is cylindrical and includes a series of perforations134formed therein. The perforations134extend from the inner surface130to the outer surface132. These perforations134are sized and arranged to allow a wetting agent, such as viscoelastic, to flow therethrough. In the embodiment shown, the perforations134are rectangular shaped. However the perforations134may be any shape suitable for passing a wetting agent, including viscoelastic, therethrough. For example, the perforations may be round, oval, square, or other geometric shape. In the implementation shown, the upper edge136is a closed circle, while in other implementations, the upper edge may include gaps or breaks.

In the exemplary implementation shown, the overflow wall122extends from the lower edge138of the support ring120in an upward direction tapering outwardly from the support ring120. Thus, in this exemplary implementation, the overflow wall122is in the shape of a frustum. The overflow wall122includes an interior surface144, an exterior surface146, and upper edge148, and a lower edge150.

In this implementation, the overflow wall122has a length L and a height H2, with the length L being greater than the height H2. Here, the upper edge148of the overflow wall122is at approximately the same height H2as the height H1of the upper edge136of the support ring120. In other implementations, the overflow wall122may have a greater or lower height H2than the height H1of the support ring120. For example, the height H2may range from about 0.05-0.5 inches in some embodiments. Other heights and ranges are contemplated.

The overflow wall122may extend at an angle relative to the support ring120. In the implementation shown, the overflow wall122extends at about a 40° angle as measured from a plane including the lower edge138of the support ring120. Other implementations include an overflow wall122at a different angle. For example, in some implementations the overflow wall122is formed at an angle from a plane including the lower edge138within a range of about 5° to 70°. Some overflow walls are angled within a range of about 20° to 50°. Still other angles are contemplated. The lower edge150of the overflow wall122may extend from the lower edge138of the support ring120. In some implementations, only the interior surface144of the overflow wall122is angled. In some implementations, the interior surface144and exterior surface146of the overflow wall122are at non-similar angles.

The area between the interior surface144of the overflow wall122and the outer surface132of the support ring120forms an overflow trough154. The overflow trough154is arranged to capture the wetting agent, such as the viscoelastic, that may be disposed between the vitrectomy lens102and the lens holder104. The overflow trough154may therefore act to reduce or minimize the amount of wetting agent in contact with a patient's cornea or that drips or otherwise escapes from its intended location between the vitrectomy lens102and the lens holder104. Since the interior surface144is disposed at an angle, the wetting agent may be inclined to flow through the perforations134and into the support ring120.

The flexible membrane124is disposed at a very bottom portion of the lens holder104and spans the opening defined by the support ring120. The membrane124may be located in a position to contact and lie upon the cornea of a patient when the lens holder104is in use. Because the flexible membrane124may stretch, bend, flex, or otherwise deform its shape, the flexible membrane may conform to the shape of the cornea, so that air gaps or other features that may affect visualization are minimized. The flexible membrane124may be clear so that visualization through the vitrectomy lens102is maximized. The flexible membrane124may be made from a hydrogel material, such as silicone hydrogel, polyvinyl alcohol hydrogel, polyethylene glycol based hydrogel, or other hydrogels. The material of flexible membrane124may have high water content and/or high water permeability so that the cornea of the eye remains moist or well-wetted during the surgical procedure. The material may also have high oxygen permeability. The material may be micro or macro porous to improve water or oxygen permeability. The flexible membrane124may be made from other clear materials such as polyvinyl chloride, low density polyethylene, or others. The flexible membrane124may have a high degree of elasticity so that it can conform to the shape of the cornea. The thickness of the flexible membrane124may be within the range of 0.001 inches to 0.1 inches. Thinner and thicker thicknesses are also contemplated. In some embodiments, the flexible membrane124has a coefficient of friction that is greater than a vitrectomy lens placed directly on a wetting agent that is directly on the cornea. Accordingly, the lens holder104is less inclined to move across the cornea than a vitrectomy lens placed directly on the eye.

While the lens holder104has been described as having multiple elements that together make up the lens holder104, in some implementations the support ring120and the overflow wall122are a single monolithic component. In some implementations the support ring120and the overflow wall122are formed of a material that may include, for example, plastic, polymer, metal, glass, or other materials. In other implementations, the support ring120and the overflow wall122are formed as separate components and assembled together to form the lens holder104. The flexible membrane124may be secured to the lower edge138of the support ring120. In some implementations, the flexible membrane124is sealed to the lower edge138of the support ring120in a manner that prevents fluids, including wetting agents, from passing out of the support ring120.

In some implementations, the lens holder104is a disposable lens holder. It may be formed of an inexpensive polymer material and may be discarded after each use. In some implementations, the lens holder104may be integrated into a disposable vitrectomy lens and the entire assembly disposed of after the surgical procedure. In other implementations, the lens holder104may be reusable. In such implementations, it may be autoclavable for re-sterilization.

A single lens170inFIG. 5Ais disposed above the lens holder104. In this Figure, the lens170represents the vitrectomy lens102. Although only the single lens170is shown, it should be understood that the single lens170is only one lens of the vitrectomy lens102and is shown in this manner for simplicity. The lens170is shown in cross-section, and its two concave surfaces form the lens. In other implementations, other lenses may be used.

An exemplary method of using the support ring120in a surgical application is described with reference toFIGS. 4 and 5A through 5D.FIG. 4describes an exemplary method400for using the lens holder104.FIGS. 5A through 5Dillustrate portions of the exemplary method400and show cross-sectional images of the lens holder104to hold a vitrectomy lens170against a patient's eye.

The method begins at402by a user selecting a vitrectomy lens, such as the vitrectomy lens102, for use during the surgical application. The vitrectomy lens may be any conventional lens including, for example only, a biconcave lens, a magnifying lens, a wide-field the lens, a prism lens, an inverted image lens, or other lens. In some implementations, the user may select a single vitrectomy lens or a plurality of lenses. In some instances, the user may select a single vitrectomy lens and combine it with an additional bite vitrectomy lens within a lens holding body, such as the lens holding body106.

FIG. 5Ashows the lens holder104and a vitrectomy lens170in cross-section above a cornea162of the patient's eye160. Here, the vitrectomy lens170may be a lens forming a part of the fight vitrectomy lens102ofFIG. 1. In some implementations, the vitrectomy lens170may be a lens disposed within the smaller diameter lens holding portion110of the vitrectomy lens102.FIG. 5Ashows the lens holder104disposed immediately above the cornea162. Since the lens holder104is shown in cross-section, the flexible membrane124may be seen relative to the support ring120and the overflow wall122. Here, the flexible membrane124is disposed adjacent to or flush with the lower edge138of the inner surface130so that it forms the bottom plane of the lens holder. Accordingly, when the lens holder104is placed on the eye160, the flexible membrane124is disposed in contact with the cornea162of the eye160. As described further below, the membrane124is located in a position to contact and conform to the shape of the cornea162in a manner that eliminates any gaps or bubbles.

Returning toFIG. 4, at404, a wetting agent180is introduced into the support ring120of the lens holder104atop the flexible membrane.FIG. 5Bshows the lens holder104after having been filled with a wetting agent180. The wetting agent180may include any conventional material used in surgical applications with vitrectomy lenses to fill gaps and reduce bubbles that may impact visualization through the lenses. In some implementations, the wetting agent is a viscoelastic material. Other wetting agents may also be utilized. As can be seen inFIG. 5B, the wetting agent180is disposed directly on the flexible membrane124within the support ring120. Here, the wetting agent180is not in contact with the cornea162.

At406inFIG. 4, the vitrectomy lens is introduced into the support ring120.FIG. 5Cshows the lens170after being introduced into the lens holder104. The lens170may be introduced into the support ring120so that it becomes embedded in the wetting agent180. In some implementations, the vitrectomy lens snaps into a top portion of the support ring120. This also compresses the wetting agent180against the flexible membrane124. In some implementations, the membrane may flexed, distorted, or otherwise displaced when the wetting agent180is compressed between the lens170and flexible membrane124. In this position, the wetting agent is continuous between the flexible membrane124and a bottom surface of the vitrectomy lens. As such, air or gaps between the wetting agent180and the lens170or between the wetting agent and flexible membrane124may be minimized or prevented. As the lens170is introduced into the support ring120, excess wetting agent180may flow through the perforations134(FIG. 2) and into the overflow trough154. The overflow trough154may prevent the wetting agent overflow from coming into contact with the cornea162or being lost from the lens holder. In some embodiments, the support ring120may include hard stops182formed as shoulders on the inner surface130that limit the distance that the lens170may enter the support ring120. Here, the lens170abuts the hard stops182.

With the lens170disposed within the support ring120the lens system, including both the lens170and the support ring120, may be introduced to the eye160. At408inFIG. 4, the lens holder104may be placed directly on the eye so that the flexible membrane124conforms to the surface of the cornea162of the eye160.FIG. 5Dshows the lens system in contact with the cornea162of the eye160. Since the flexible membrane124is configured and arranged to conform to the shape of the cornea, the flexible membrane124matches and aligns with the cornea shape. As such, during the process of placing the lens system on the cornea162, the flexible membrane displaces into an interior region of the support ring120. When the flexible membrane bows upwardly to match the curvature of the cornea, additional wetting agent180may flow out of the perforations134and into the overflow trough154. Again, the overflow trough154captures the wetting agent180and helps keep the wetting agent from becoming disposed on the cornea162or lost as waste. In some methods, the eye160may be moistened with a wetting agent, including drops or viscoelastic prior to placing the lens holder104on the eye160.

At410inFIG. 4, a user may latterly move the lens holder for a desired alignment with and to view target tissue with a surgical microscope. Since the lens system, including the vitrectomy lens170and the lens holder104, may be displaced manually independent of the microscope, a user may orient the lens system as desired. For example, a user may slide the lens system across the cornea to a desired position, or the user may lift the lens system off of the cornea and place it in another position on the cornea as desired. When the lens system is moved along the cornea, the flexible membrane124may displace so that the flexible membrane maintains direct contact with the cornea162or other surface features of the eye. When the lens system is lifted off the cornea, the flexible membrane124may displace to the position shown inFIG. 5C. When this occurs, the volume between the vitrectomy lens170and the flexible membrane124increases. Wetting agent may flow from the overflow trough, through the perforations, and into the support ring120. Accordingly, even when the lens system is displaced, it may not be necessary to apply additional wetting agent. That is, the wetting agent may flow into and out of the support ring120through the perforations134. When the lens system is placed in a new position, some of the wetting agent may again flow from inside the support ring, through the perforations, into the overflow trough154. The angled shape of the interior surface144of the overflow trough154may help prevent spillover of wetting agent from the overflow trough154and assist the flow of wetting agent into the perforations and into the support ring120.

At a step412, a user may perform a surgical procedure while visualizing the surgical site through the lens system. Here, the lens holder may be maintained in place by friction between the flexible membrane124and the surface of the cornea162or other part of the eye160. Because the flexible membrane, rather than the wetting agent, is in contact with the eye, the holding friction is much higher than conventional systems and the lens system may stay in position without slipping. That is, because the wetting agent180is not in contact with the cornea162, the coefficient of friction of the flexible membrane122may be maintained at a level sufficient to prevent the lens holder104with the vitrectomy lens102from sliding on the eye160in response to the force of gravity. Accordingly, during a surgical procedure, an extra person may not be required to hold the lens holder104in place. Instead, the lens holder104may be maintained in place simply by friction between the cornea162and the membrane122. In addition, because the lens system may be movable about an eye during a single surgical procedure, the lens system provides advantages over lens holders that are sutured to an eye of the patient. Here, the wetting agent180still performs its purpose of eliminating gaps due to curvature mismatch or imperfections found between the cornea162and the lens170. The flexible membrane124may conform to the shape of the cornea162so that it to eliminate any gaps or air that may be found between the cornea and the flexible membrane124. Therefore, a user may be able to obtain good visualization of the interior of the eye160through the lens170, the wetting agent180, and the cornea162.

Persons of ordinary skill in the art will appreciate that the implementations encompassed by the present disclosure are not limited to the particular exemplary implementations described above. In that regard, although illustrative implementations have been shown and described, a wide range of modification, change, combination, and substitution is contemplated in the foregoing disclosure. It is understood that such variations may be made to the foregoing without departing from the scope of the present disclosure. Accordingly, it is appropriate that the appended claims be construed broadly and in a manner consistent with the present disclosure.