Vitreous cutter sleeve and a vitreous cutter system using the same

A vitreous cutter sleeve is disclosed herein. The vitreous cutter sleeve includes an elongate tubular body with a peripheral sidewall and a central passageway disposed through the elongate tubular body, the central passageway of the elongate tubular body configured to receive a vitreous cutter therein, at least a portion of the elongate tubular body being formed from a material that is transparent to visible light, the material being further configured to conduct at least one of infrared radiation, radiofrequency radiation, and an electrical current; and an illumination device operatively coupled to the elongate tubular body such that the illumination device is capable of providing illumination to an inside portion of an eye through at least a portion of the peripheral sidewall of the elongate tubular body. A vitreous cutter system that includes a vitreous cutter and a vitreous cutter sleeve is also disclosed herein.

Not Applicable.

NAMES OF THE PARTIES TO A JOINT RESEARCH AGREEMENT

Not Applicable.

Not Applicable.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention is related to vitreous cutters and sleeves that are used in vitrectomy procedures to remove vitreous from the eye. In particular, the present invention is related to vitreous cutters and sleeves having a light source to illuminate a portion of the eye.

2. Background and Description of Related Art

Vitrectomy is a procedure in which the degenerative vitreous is removed to clear the opaque optical media (vitreous) or to eliminate traction on the retina which produces a localized or generalized retinal detachment. The function of a vitrectomy instrument is described in U.S. Pat. No. 4,099,529 to Peyman, the entire contents of which are herein incorporated by reference. That is, generally, the cutting part includes concentric tubing. An inner tube serves as the inner cutting edge of the instrument and has an oscillating action, and the opening in the tightly fit outer tube serves as the outer edge of the cutting. The vitreous is aspirated through a small opening close to the tip of the outer stationary tube, i.e., the outer cutting edge. The aspiration force, generated by a pump, when applied through the inner tube draws the vitreous through the outer hole toward the inside of the inner tube. The oscillation of the inner tube cuts the vitreous/tissue trapped in the opening of the outer tube and is aspirated into a reservoir. To balance the intraocular pressure, physiologic saline solution is infused through a second independent “infusion tube” placed inside the eye cavity through a separate incision in the eye wall.

During the procedure, the vitreous cavity is illuminated through a separate fiber optic brought inside the eye through a third incision. The diameter of the vitrectomy cutting cutters varies between 20-23-25-27 gauge. The most desirous sizes are 23 gauge, 25 gauge, and 27 gauge tubes because these sizes eliminate the need to close the incision in the eye wall by a suture and the smaller the instrument is, the less traumatic the surgery becomes.

There are several disadvantages of the conventional systems. First, there is a need for at least three incisions for the cutter, infusion and the light sources. Second, the 25 gauge and 27 gauge tips, because of their size are too flexible inside the eye. That is, the slightest pressure that moves the eye during surgery also can bend the shaft of the cutter in one direction at the incision site while the inside portion of the shaft moves in another direction. This movement can be disturbing to an operator who does not expect motion in the opposite direction than that which was intended and can cause injury to the fine structure of the lens or the retina. Third, in myopic eyes having a longer axial length than normal, a longer (36-38 mm) than normal shaft (e.g., 30 mm) is required. This makes the instrument flimsy and not desirable.

In addition, in conventional systems, the tip of the vitrectomy instrument, which often contacts a contaminated portion of the eye, such as a tumor, may spread contaminated and cancerous tissue to other healthy portions of the eye. As such, what is needed is a device for containing the contaminated tip of the vitrectomy instrument after it is used to penetrate contaminated tissue of the eye so that any residual contaminated tissue present on the tip of the vitrectomy cutter is not spread to other, healthy portions of the eye as the vitrectomy instrument is being removed from the eye at the conclusion of the procedure. In addition, there is a need for the device, which contains the contaminated tip of the vitrectomy instrument, to incorporate other integral features that facilitate the performance of the procedure on eye.

BRIEF SUMMARY OF EMBODIMENTS OF THE INVENTION

Accordingly, the present invention is directed to a vitreous cutter sleeve and a vitreous cutter system using the same that substantially obviates one or more problems resulting from the limitations and deficiencies of the related art.

In accordance with one or more embodiments of the present invention, there is provided a vitreous cutter sleeve that includes an elongate tubular body having a first end and a second end disposed opposite to the first end, the elongate tubular body including a peripheral sidewall and a central passageway disposed through the elongate tubular body, the central passageway of the elongate tubular body configured to receive a vitreous cutter therein, at least a portion of the elongate tubular body being formed from a material that is transparent to visible light, the material being further configured to conduct at least one of infrared radiation, radiofrequency radiation, and an electrical current; and an illumination device operatively coupled to the elongate tubular body such that the illumination device is capable of providing illumination to an inside portion of an eye through at least a portion of the peripheral sidewall of the elongate tubular body.

In a further embodiment of the present invention, the illumination device is in the form of a fiber optic; and wherein the first end of the elongate tubular body comprises a connector member for connecting the fiber optic to the elongate tubular body of the vitreous cutter sleeve so that light is capable of being transmitted from the fiber optic to an interior of the peripheral sidewall of the elongate tubular body, the connector member being disposed on a portion of the elongate tubular body that does not enter the eye.

In yet a further embodiment, at least one of following devices is operatively coupled to the vitreous cutter sleeve: (i) a laser generation device for generating electromagnetic radiation ranging from blue light to infrared radiation, inclusive, (ii) a radiofrequency generation device for generating radiofrequency radiation, and (iii) an electrocautery device for generating an electrical current that is capable of cauterizing tissue of the eye.

In still a further embodiment, the first end of the elongate tubular body comprises a flared end portion configured to prevent the vitreous cutter sleeve from entering too deep into the eye, and wherein the vitreous cutter sleeve further includes a pierceable membrane disposed within the central passageway of the elongate tubular body proximate to the first end, the pierceable membrane configured to create a substantially liquid-tight seal between an outer peripheral surface of the vitreous cutter and an inner peripheral surface of the peripheral sidewall of the vitreous cutter sleeve after the vitreous cutter has penetrated the pierceable membrane.

In yet a further embodiment, the second end of the elongate tubular body comprises a pointed tip configured to cut through tissue of the eye.

In still a further embodiment, the elongate tubular body comprises a plurality of opaque band portions spaced apart along a length thereof, each of the plurality of opaque bands portions being spaced apart from one another by a respective one of a plurality of transparent band portions, each of the plurality of transparent band portions being transparent to visible light.

In yet a further embodiment, each of the plurality of opaque band portions are spaced apart from one another by a substantially constant distance such that the plurality of opaque bands portions and the plurality of transparent band portions are capable of being used to determine a depth of insertion of the vitreous cutter sleeve into tissue of the eye.

In still a further embodiment, the plurality of opaque band portions of the elongate tubular body are formed by coating the peripheral sidewall of the elongate tubular body with a black material.

In yet a further embodiment, the elongate tubular body comprises an opaque coating from the first end to an exposed tip at the second end so as to enable the exposed tip to function as a localized light source.

In still a further embodiment, the material is transparent to visible light from 400-800 nm, and wherein the material comprises one of: (i) metal glass, (ii) amorphous glass, (iii) palladium alloy, (iv) zirconium alloy, and (v) aluminum nitryloxyde.

In yet a further embodiment, the elongate tubular body comprises insulation from the first end to an exposed tip at the second end so as to enable the exposed tip to function as a localized cauterizer.

In accordance with one or more other embodiments of the present invention, there is provided a vitreous cutter sleeve that includes an elongate tubular body having a first end and a second end disposed opposite to the first end, the elongate tubular body including a peripheral sidewall and a central passageway disposed through the elongate tubular body, the central passageway of the elongate tubular body configured to receive a vitreous cutter therein, at least a portion of the elongate tubular body being formed from a material that is transparent to visible light, the material being further configured to conduct at least one of infrared radiation, radiofrequency radiation, and an electrical current, the first end of the elongate tubular body comprising a flared end portion configured to prevent the vitreous cutter sleeve from entering too deep into the eye, and the second end of the elongate tubular body comprising a pointed tip configured to cut through tissue of the eye; and an illumination device operatively coupled to the elongate tubular body such that the illumination device is capable of providing illumination to an inside portion of an eye through at least a portion of the peripheral sidewall of the elongate tubular body.

In a further embodiment of the present invention, the elongate tubular body comprises a plurality of opaque band portions spaced apart along a length thereof, each of the plurality of opaque bands portions being spaced apart from one another by a respective one of a plurality of transparent band portions, each of the plurality of transparent band portions being transparent to visible light.

In yet a further embodiment, each of the plurality of opaque band portions are spaced apart from one another by a substantially constant distance such that the plurality of opaque bands portions and the plurality of transparent band portions are capable of being used to determine a depth of insertion of the vitreous cutter sleeve into tissue of the eye.

In still a further embodiment, at least one of following devices is operatively coupled to the vitreous cutter sleeve: (i) a laser generation device for generating electromagnetic radiation ranging from blue light to infrared radiation, inclusive, (ii) a radiofrequency generation device for generating radiofrequency radiation, and (iii) an electrocautery device for generating an electrical current that is capable of cauterizing tissue of the eye.

In accordance with yet one or more other embodiments of the present invention, there is provided a vitreous cutter system comprising a vitreous cutter and a vitreous cutter sleeve. The vitreous cutter includes an elongate outer tube with a body having a closed end tip, the body of the elongate outer tube including a sidewall extending in axial direction from the closed end tip, the body of the elongate outer tube defining a linear passageway closed at a distal end by the closed end tip, the elongate outer tube further including an opening disposed in the sidewall of the body, the opening being disposed proximate to the closed end tip of the body, and the opening being configured to enable cutting of vitreous or tissue; and an elongate inner tube arranged concentrically within the elongate outer tube, the elongate inner tube being configured to oscillate so as to be capable of cutting the vitreous or the tissue that enters the opening in the body of the elongate outer tube. The vitreous cutter sleeve includes an elongate tubular body having a first end and a second end disposed opposite to the first end, the elongate tubular body including a peripheral sidewall and a central passageway disposed through the elongate tubular body, the central passageway of the elongate tubular body slidingly receiving the vitreous cutter therein, at least a portion of the elongate tubular body being formed from a material that is transparent to visible light, the material being further configured to conduct at least one of infrared radiation, radiofrequency radiation, and an electrical current; and an illumination device operatively coupled to the elongate tubular body such that the illumination device is capable of providing illumination to an inside portion of an eye through at least a portion of the peripheral sidewall of the elongate tubular body.

In a further embodiment of the present invention, the elongate inner tube of the vitreous cutter is configured to remove the cut vitreous or the cut tissue by the vitreous cutter applying an aspiration force to the cut vitreous or the cut tissue.

In yet a further embodiment, the aspiration force applied by the vitreous cutter is configured to draw the cut vitreous or the cut tissue through the opening disposed in the sidewall of the body of the elongate outer tube.

In still a further embodiment, the vitreous cutter sleeve is configured to contain the closed end tip of the vitreous cutter when the vitreous cutter is being removed from the eye so as to prevent the closed end tip from contacting and contaminating healthy tissue in the eye.

In yet a further embodiment, the elongate tubular body comprises a plurality of opaque band portions spaced apart along a length thereof, each of the plurality of opaque bands portions being spaced apart from one another by a respective one of a plurality of transparent band portions, each of the plurality of transparent band portions being transparent to visible light. Each of the plurality of opaque band portions are spaced apart from one another by a substantially constant distance such that the plurality of opaque bands portions and the plurality of transparent band portions are capable of being used to determine a depth of insertion of the vitreous cutter sleeve into tissue of the eye.

It is to be understood that the foregoing general description and the following detailed description of the present invention are merely exemplary and explanatory in nature. As such, the foregoing general description and the following detailed description of the invention should not be construed to limit the scope of the appended claims in any sense.

Throughout the figures, the same parts are always denoted using the same reference characters so that, as a general rule, they will only be described once.

DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION

An object of one or more embodiments of the present invention is to provide vitrectomy cutters 1) with harder than stainless steel material that eliminate the short coming of the vitreous cutters; 2) that eliminate the need for additional incisions made for the fiber optic illumination by bringing the light through the shaft of the cutter; 3) that can be used as a needle for penetrating the tissue as a biopsy probe; and 4) one could have a combination of a probe for cutting, illumination and infusion in a single instrument that would have a 23-25 gauge diameter, and would not require an additional incision or suturing the entrance wound. This modification would eliminate all of the above-described shortcomings of the conventional systems and would also provide an instrument with a longer shaft of up to 38 mm long or longer.

It is a further object of one or more embodiments to create a 30 gauge cutter made of two concentric tubes. The outer tube has an opening in its distal end of its body through which vitreous or tissue is aspirated inside the inner tube (seeFIG. 5). The inner tube simultaneously has an oscillating and cutting action. The cut and aspirated matter is removed through the inner tube connected with a vacuum system. These and other embodiments can be used also for obtaining tissue biopsy from not only the intraocular tumors but other tumors such as breast, prostate etc.

In one or more embodiments, these objects may be accomplished by a vitrectomy cutter including a needle with a body and a tip, the needle being made from one of metal glass and amorphous glass, and an illumination device disposed inside the needle body, such that the illumination device is capable of providing illumination to an entire portion of the eye through at least one of the tip of the needle and the body of the needle.

As shown inFIGS. 2-4B, an illustrative vitrectomy method uses a system10that includes a cutter device or instrument12with illumination and an infusion line14. The instrument12includes a tip16and body18. Such a system enables fewer incisions to be made in the eye, relative to conventional systems. In one embodiment, the tip16of the cutter device12can be made to be like standard needles used for vein puncture to draw blood from a subject. In another embodiment, a simple needle can be created with these characteristics for infusion or drawing blood from a subject.

The instrument can be illuminated by any standard illuminating system providing the needed light intensity. The illumination device can be disposed inside or outside the needle or in any suitable position relative to the needle. The illumination device is preferably connected to the needle/cutter at a site that does not enter the body. It can either illuminate the entire needle/cutter or the outer surface of the instrument can be coated with a thin layer of black material20(seeFIG. 4B) leaving only the tip16or an area24adjacent the tip free to permit the light26to exit the instrument. The illumination permits visualization of the tissue, once the needle has penetrated a soft tissue and can be followed by observing its path and position of the needle tip. This eliminates guessing how far a needle has penetrated the tissue.

It is to be understood that the tip of the instrument can be made with any desired shape, which includes round, pointed, sharp blade, etc. or any length.

The cutter12can be made from various composites such as metal glass, amorphous glass or similar alloys such as palladium alloy and zirconium alloy, or any other suitable material. These compounds are tougher than presently used stainless steel for conventional vitrectomy cutters or needles. These compounds are also transparent to visible light from 400-800 nanometers (nm), such that it is possible to direct the light for visualization through the body of the cutter without increasing the diameter of the instrument or the need for additional incision for a fiber optic. Similarly, aluminum nitryloxyde is a transparent polycrystalline ceramic structure composed of aluminum and oxygen. This compound is harder than fused silica glass and sapphire or magnesium aluminum. It is light weight and resistant to damage by oxidation or radiation. The manufacturing technique is known and is as with conventional ceramic powder.

In one or more embodiments, the vitreous cutter or needle12is made of a hard resistance metal glass alloy. The wall of the outer tubing or the entire needle may be illuminated when connected to a light source. The instrument, when inserted inside the tissue or the eye, provides illumination, thereby illuminating the surrounding tissue structure and eliminating the need for additional internal or external illumination.

It should be understood that the invention is not limited to the above-described materials, but rather, other suitable compounds that can provide the hardness and light transparency, and are not brittle, may be used.

Now, with reference toFIGS. 6 and 7, a first illustrative embodiment of a vitreous cutter sleeve30will be described. As shown in these figures, the vitreous cutter sleeve30includes an elongate tubular body32having a first end32aand a second end32bdisposed opposite to the first end32a. The elongate tubular body32further includes a peripheral sidewall (i.e., the tubular sidewall inFIG. 6) and a central cylindrical passageway33disposed through the elongate tubular body32. The central cylindrical passageway33of the elongate tubular body32is configured to receive a vitreous cutter therein (e.g., as shown inFIG. 8), and at least a portion of the elongate tubular body32is formed from a material that is transparent to visible light (as will be described in more detail hereinafter). The material forming the elongate tubular body32of the sleeve30may be further configured to conduct at least one of infrared radiation, radiofrequency radiation, and an electrical current. Referring again toFIGS. 6 and 7, it can be seen that the vitreous cutter sleeve30further includes an illumination device (e.g., fiber optic40) operatively coupled to the elongate tubular body32via a light-transmitting connector member42so that the illumination device40is capable of providing illumination to an inside portion of an eye through at least a portion of the peripheral sidewall of the elongate tubular body32(i.e., through the transparent bands38inFIG. 6).

As depicted inFIGS. 6 and 7, the first end32aof the elongate tubular body32of the vitreous cutter sleeve30comprises a flared end portion (i.e., a bell-shaped end portion) configured to prevent the vitreous cutter sleeve30from entering too deep into the eye. That is, the peripheral flange of the flared end portion of the elongate tubular body32prevents the over-insertion of the vitreous cutter sleeve30into the eye. Obviously, the over-insertion of the sleeve30into the eye of the patient could pose a substantial safety risk to the patient. For example, without the flared end portion thereon, the first end32aof the vitreous cutter sleeve30could potentially pass completely through its insertion hole in the eye, and possibly become lodged inside the eye of the patient.

Turning again toFIGS. 6 and 7, it can be seen that the vitreous cutter sleeve30further includes a pierceable membrane74disposed within the central passageway33of the elongate tubular body32proximate to the first end32athereof. The pierceable membrane74near the entrance of the elongate tubular body32of the sleeve30is configured to create a substantially liquid-tight seal between an outer peripheral surface of the vitreous cutter and an inner peripheral surface of the peripheral sidewall of the vitreous cutter sleeve30after the vitreous cutter has penetrated the pierceable membrane74(e.g., seeFIGS. 9 and 13). In an exemplary embodiment, the pierceable membrane74may be formed from a flexible, pierceable material, such as silicone or another suitable polymeric material or plastic. During the use of the vitreous cutter system, when the vitreous cutter is first inserted into the central cylindrical passageway33of the sleeve30, an application of an axial force to the proximal end of the vitreous cutter by a user results in the piercing of the pierceable membrane74by the tip16of the vitreous cutter. After the pierceable membrane74has been pierced by the tip16of the vitreous cutter, the pierceable membrane74makes a generally liquid-tight seal so as to prevent intraocular fluid, cells, tissue, etc. from escaping from the first end32aof the sleeve30, and passing outside of the sleeve30over the surgical field. Advantageously, the generally liquid-tight seal formed by the pierceable membrane74prevents the spreading of biological tissue and cells outside the eye (e.g., malignant cells, etc.). Also, the sleeve30may be of a disposable type when used for the vitreous of a tumor biopsy.

While it is preferable to provide the pierceable membrane74near the entrance of the vitreous cutter sleeve30at the first end32athereof, it is possible for the pierceable membrane to be located at other positions within the central cylindrical passageway33of the sleeve30. For example, as illustrated inFIG. 7, a pierceable membrane76alternatively may be provided proximate to the second end32bof the vitreous cutter sleeve30. The pierceable membrane76has the same construction as the pierceable membrane74described above, and performs in the same manner as the pierceable membrane74. In still another embodiment, the vitreous cutter sleeve30may be provided with a plurality of pierceable membranes disposed in its central cylindrical passageway33for additional liquid-tight protection (e.g., the pierceable membrane74near the entrance of the sleeve30and the pierceable membrane76near the exit of the sleeve30).

InFIGS. 6 and 7, it can be seen that the second end32bof the elongate tubular body32of the vitreous cutter sleeve30comprises a pointed tip34configured to cut through tissue of the eye. That is, when the sleeve30is first inserted into the eye, the pointed tip34of sleeve30readily pierces the outer layer of the eye (i.e., the sclera of the eye) so that the sleeve30can be easily placed in the vitreous cavity of the eye. In the illustrative embodiment ofFIG. 6, it can be seen that the pointed tip34of sleeve30has a generally tapered geometry with a side profile resembling that of a fountain pen tip.

With reference again toFIGS. 6 and 7, it can be seen that the elongate tubular body32of the vitreous cutter sleeve30comprises a plurality of opaque band portions36spaced apart along a length thereof. Each of the plurality of opaque bands portions36are spaced apart from one another by a respective one of a plurality of transparent band portions38(i.e., an alternating pattern of opaque bands portions36and transparent band portions38are disposed along the length of the elongate tubular body32of the sleeve30). Each of the plurality of transparent band portions38are transparent to visible light so that visible light44may be transmitted through the sidewall of the sleeve (e.g., as diagrammatically shown inFIGS. 7 and 9for several representative transparent band portions38near the second end32bof the body32). In the illustrative embodiment, each of the plurality of opaque band portions36are spaced apart from one another by a substantially constant distance such that the plurality of opaque bands portions36and the plurality of transparent band portions38are capable of being used to determine a depth of insertion of the vitreous cutter sleeve30into tissue of an eye. In the illustrative embodiment, the plurality of opaque band portions36of the elongate tubular body32of the sleeve30are formed by coating the peripheral sidewall of the elongate tubular body32with a thin layer of black material (e.g., as was described above for the vitreous cutter), while the transparent band portions38of the elongate tubular body32of the sleeve30are merely formed by exposed sections of the elongate tubular body32that is formed from a light-transmitting material, as will be described in more detail hereinafter.

Advantageously, the illuminated vitreous cutter sleeve30with the alternating opaque and transparent band portions36,38allows the distance from the tip34of the sleeve30to be easily determined by a user thereof (e.g., by a retinal surgeon using the illuminated sleeve30). Because light only shines through the transparent band portions38of the sleeve body32, the user of the sleeve30can determine how many transparent band portions38of the sleeve30are covered up by the tissue in which it is embedded (e.g., tumor tissue). Because the transparent band portions38are spaced a generally constant, predetermined distance apart from one another by the opaque band portions36(e.g., a spacing distance of 1 to 2 millimeters), the quantity of transparent band portions38that are covered up by the tissue is indicative of the depth of insertion into the tissue (e.g., if one transparent band portion38is covered up by the tissue such that no that light is visible to the user passing through the covered transparent band portion38, the insertion depth of the sleeve30may be 3.0 millimeters, which may correspond to the depth of the tissue being measured, such as the depth of a tumor).

Next, referring toFIG. 12, a second illustrative embodiment of a vitreous cutter sleeve30′ will be described. Referring to this figure, it can be seen that, in many respects, the second illustrative embodiment is similar to that of the first embodiment. Moreover, many elements are common to both such embodiments. For the sake of brevity, the elements that the second embodiment of the vitreous cutter sleeve has in common with the first embodiment will not be discussed because these components have already been explained in detail above. Furthermore, in the interest of clarity, these elements are denoted using the same reference characters that were used in the first embodiment.

In the second illustrative embodiment ofFIG. 12, the elongate tubular body32′ of the vitreous cutter sleeve30′ comprises an opaque coating37(e.g., a thin layer of black material) from the first, flared end32aof the body32′ to a transparent tip portion39at the second end32bof the body32′ so as to enable the transparent tip portion39to function as a localized light source. Thus, rather than being provided with the alternating opaque and transparent band portions36,38as the sleeve30of the embodiment ofFIGS. 6 and 7, the body32′ of the vitreous cutter sleeve30′ inFIG. 12has a continuous coating from its first end32ato the exposed tip portion39proximate to its second end32b. In addition to the coating37being opaque, the coating37may serve as an insulator in the illustrated embodiment ofFIG. 12so as to enable the exposed tip portion39to function as a localized cauterizer (as will be described in more detail hereinafter). Alternatively, the elongate tubular body32′ of the sleeve30′ may comprise a separate layer of insulation from the first end32ato the exposed tip portion39at the second end32b(e.g., a layer of insulation disposed underneath the opaque coating37).

In addition, as shown inFIG. 12, the vitreous cutter sleeve30′ may comprise any one or all of the following devices operatively coupled to the elongate tubular body32′ thereof: (i) a laser source and/or visible light source78for generating from blue to infrared light, (ii) a radiofrequency generation device80for generating radiofrequency radiation, and (iii) an electrocautery device72for generating an electrical current that is capable of cauterizing tissue of the eye. Specifically, referring toFIG. 12, it can be seen that the laser source and/or visible light source78may be operatively connected to the body32′ of the sleeve30′ by means of the fiber optic40. In the illustrative embodiment, the laser source and/or visible light source78is capable of generating electromagnetic radiation ranging from blue visible light to infrared radiation, and all wavelengths of radiation between blue visible light and infrared radiation. Also, inFIG. 12, it can be seen that the radiofrequency generation device80may be operatively connected to the body32′ of the sleeve30′ by means of the connecting wire79so that a radiofrequency current may be delivered to tissue at the location of the exposed tip portion39of the sleeve30′ inside the eye of the patient. In addition as shown inFIG. 12, the electrocautery device72may be operatively connected to the body32′ of the sleeve30′ by means of an electrically conductive wire70and a clip or connector68that electrically couples the wire70to the sleeve body32′. As such, an electrical current that is generated by the electrocautery device72is capable of being transmitted through the conductive wire70and connector68so that it may be transmitted to the tissue of the eye by the electrically conductive material forming the sleeve30′ (as will be described hereinafter). Advantageously, when operatively coupled to the electrocautery device72, the vitreous cutter sleeve30′ is capable of simultaneously cauterizing and penetrating a vascularized tissue of the eye. Similarly, when operatively coupled to the laser source78, the vitreous cutter sleeve30′ is capable of coagulating vessels in the eye to stop any bleeding from the vessels. This is particular important if the sleeve30′ is being used to penetrate a tissue that is heavily vascularized and can readily bleed, such as the retina and the choroid of the eye.

Similar to the vitreous cutter12described above, the bodies32,32′ of the vitreous cutter sleeves30,30′ may be formed from a material is transparent to visible light from 400-800 nanometers (nm). The material forming the bodies32,32′ of the vitreous cutter sleeves30,30′ may also conduct infrared radiation, radiofrequency radiation, and/or an entire spectrum range of electromagnetic radiation ranging from visible blue light to infrared radiation. In addition, the material forming the bodies32,32′ of the vitreous cutter sleeves30,30′ may also be electrically conductive so as to transmit an electrical current therethrough. In the illustrative embodiment, the material forming the body32of the vitreous cutter sleeve30, or the body32′ of the vitreous cutter sleeve30′, may comprise one of: (i) metal glass, (ii) amorphous glass, (iii) palladium alloy, (iv) zirconium alloy, and (v) aluminum nitryloxyde. Advantageously, the use of a composite material, such as a metal glass, for the bodies32,32′ of the vitreous cutter sleeves30,30′ allows the bodies32,32′ of the sleeves30,30′ to conduct electricity as well as light. Therefore, the vitreous cutter sleeves30,30′ may transmit electricity through the bodies32,32′ thereof so that they can function as cauterizers (i.e., when connected to electrocautery device72ofFIG. 12). Also, advantageously, the use of a composite material, such as a metal glass, allows the bodies32,32′ of the sleeves30,30′ to transmit not only light and electricity, but also infrared radiation and radiofrequency radiation.

Next, with reference toFIGS. 8 and 9, a vitreous cutter system comprising the vitreous cutter sleeve30described above and a vitreous cutter instrument12will be explained. As shown in these figures, the central cylindrical passageway33of the elongate tubular body32of the vitreous cutter sleeve30receives the vitreous cutter12therein. The vitreous cutter12generally includes an elongate outer tube18and an oscillating elongate inner tube22slidingly disposed in the elongate outer tube18. InFIGS. 8 and 9, it can be seen that the elongate outer tube has a body18with a closed end tip16. The body18of the elongate outer tube includes a sidewall extending in axial direction from the closed end tip16, and the body18of the elongate outer tube defines a linear passageway closed at a distal end by the closed end tip16. The elongate outer tube further includes an opening or aperture28disposed in the sidewall of the body18. The opening28is disposed proximate to the closed end tip16of the body18, and the opening28is configured to enable cutting of vitreous or tissue. Referring to the longitudinal sectional view ofFIG. 9, it can be seen that the elongate inner tube22of the vitreous cutter12is arranged generally concentrically within the elongate outer tube. The elongate inner tube22is configured to oscillate back-and-forth within the elongate outer tube so as to be capable of cutting the vitreous or the tissue that enters the opening28in the body18of the elongate outer tube.

In the vitreous cutter system ofFIGS. 8 and 9, the elongate inner tube22of the vitreous cutter12is configured to remove the cut vitreous or the cut tissue by the vitreous cutter12applying an aspiration force to the cut vitreous or the cut tissue. That is, the vitreous cutter12includes a vacuum source or vacuum pump82that is fluidly coupled to the passageway of the elongate inner tube22via fluid line81(seeFIG. 8) so that cut vitreous or cut tissue is capable of being suctioned from the passageway of the elongate inner tube22after being cut thereby. In particular, the aspiration force applied by the vacuum pump82of the vitreous cutter12is configured to draw the cut vitreous or the cut tissue through the opening28disposed in the sidewall of the body18of the elongate outer tube.

In the vitreous cutter system ofFIGS. 8 and 9, the vitreous cutter sleeve30is configured to contain the closed end tip16of the vitreous cutter12when the vitreous cutter12is being removed from the eye so as to prevent the closed end tip16from contacting and contaminating healthy tissue in the eye. That is, one advantage of the combination vitreous cutter12and sleeve30is that both instruments can be removed from the eye as a one-piece unit to prevent contamination resulting from the tip16of the vitreous cutter12. Another advantage of the combination vitreous cutter12and sleeve30is that both instruments also can be inserted into the eye as a one-piece unit. When inserted as a one-piece unit into the eye, the combination vitreous cutter12and sleeve30is capable of passing through the conjunctiva, sclera, etc. without the need for an incision beforehand and the subsequent separate insertion of the cutter12into the incision. In one or more embodiments, the combination vitreous cutter12and sleeve30may be preassembled as a one-piece unit so as to maximize ease of use and sterility.

While the vitreous cutter sleeve30is described above in conjunction with the vitreous cutter system, it is to be understood that the vitreous cutter sleeve30′ may alternatively be used in conjunction with the vitreous cutter12of the vitreous cutter system. The selection of the particular one of the vitreous cutter sleeves30,30′ that is used in the vitreous cutter system will depend on the particular medical/surgical procedure(s) that is being performed, and the steps that are involved in that procedure.

Now, referring toFIGS. 10 and 11, an exemplary manner in which the combination vitreous cutter12and sleeve30are used to remove tumor tissue from an eye50of a patient will be explained. Initially, the vitreous cutter12and sleeve30are inserted as single unit through the sclera56and conjunctiva of the eye50, and into the vitreous cavity60of the eye50until the tip34of the sleeve30reaches a location that is proximate to a tumor66located in a posterior portion of the eye50. When the vitreous cutter12and the vitreous cutter sleeve30are inserted as a single unit into the eye50, the sharp tip34of the sleeve30is used to penetrate the outer layers of the eye50, namely the conjunctiva, sclera, etc. Also, in the illustrative embodiment, when the cutter12and the vitreous cutter sleeve30are inserted into the eye50, the tip16of the vitreous cutter12is recessed within the cylindrical cavity33of the sleeve30such that the sharp tip34of the sleeve30penetrates through the outer layers of the eye50, and not the tip16of the vitreous cutter12. In the illustrative embodiment ofFIGS. 10 and 11, it can be seen that the unit comprising the cutter12and the sleeve30are inserted into the eye50at location that is disposed behind the anterior portion of the eye50(i.e., at a location behind the cornea52and the lens54of the eye50). When inserted into the eye50, the tip34of the vitreous cutter sleeve30is disposed proximate to the posterior portion of the eye (i.e., at a location proximate to the retina58, arteries62, and optic nerve64of the eye).

Next, after the unit comprising the cutter12and the sleeve30has been inserted into the eye50, the tip16of the vitreous cutter12is displaced out of the tip34of the vitreous cutter sleeve30until it reaches the position illustrated inFIGS. 10 and 11where the tip16of the cutter12is embedded in the tumor66. The cutter12is displaced out of the tip34of the sleeve30by the user applying a generally axial force against the proximal end portion of the cutter12so that it is slidingly displaced relative to the sleeve30until reaching the position ofFIGS. 10 and 11wherein it has penetrated the interior of the tumor66. Once in position, the vitreous cutter12is used to remove the tissue of the tumor66. In particular, tumor tissue that enters the cutter12through the opening28in the outer tube thereof is cut by the oscillating inner cutting tube22of the cutter12. After which, the cut tissue of the tumor66is removed from the oscillating inner cutting tube22of the cutter12by the aspiration force that is generated by vacuum source/pump82that is fluidly coupled to the cutter inner tube22. Once all of the tumor tissue has been removed, or at least substantially removed from the eye50of the patient, the tip16of the cutter12is retracted back into the sleeve30so that the tip16of the cutter12is completely contained within the cylindrical passageway33of the sleeve30, and thus not exposed to the vitreous cavity60and the healthy tissue of the eye50of the patient. As such, the tip16of the cutter12, which contacted the tissue of the tumor66, is not able to contact and contaminate the vitreous cavity60and the healthy tissue of the eye50. With the tip16of the cutter12in its retracted position within the sleeve30, the vitreous cutter12and sleeve30are removed as a single unit from the eye50, thereby minimizing any contamination by preventing the tip16of the cutter12from coming into contact with the eye50during the removal process. The cutter12and the sleeve30may also be used in a biopsy procedure where only a sample portion of the tumor tissue is removed, rather than the entire tumor66. In the biopsy procedure, all of the other steps would be the same as that described above.

Advantageously, when the cutter12is removed from the eye50in the surgical procedure described above, the sleeve30houses the tip16of the cutter12therein so that any tumor cells contained thereon do not contaminate the wound by being left behind in the eye50. If the tumor66is malignant, any tumor cells left behind by the cutter12can grow in another area of the eye50. The containment of the tip16of the cutter12in the sleeve30prevents this dangerous spreading of tumor cells in the eye50. Also, during the procedure, the sleeve30is advantageously able to be brought close to the tumor surface without actually penetrating the tumor surface (seeFIGS. 10 and 11). Then, after the cutter12is retracted inside the sleeve30, the cutter12can be simultaneously removed from the eye50with the sleeve30so as to not contaminate the exit wound. In addition, the sharp edges of the needle-like tip34of the sleeve30also may be used to advantageously to the cut the retina for gaining access to choroidal tumors, thereby creating a path for the generally blunt tip16of the cutter12.

While the vitreous cutter sleeve30is described above in conjunction with the procedure for removing tumor tissue from the eye50of the patient, it is to be understood that the vitreous cutter sleeve30′ may alternatively be used in conjunction with this surgical procedure. The selection of the particular one of the vitreous cutter sleeves30,30′ that is used in the surgical procedure will depend on the requisite steps of the procedure.

In addition to being used with the vitreous cutter12in the applications explained above, it is to be understood that the sleeves30,30′ described herein may also be used in other medical applications, such as in medical imaging applications with various visualization devices. For example, the sleeves30,30′ described herein may also be used with an endoscope, laser imaging probe, an optical coherence tomography (OCT) probe, a multiphoton probe, etc. These imaging probes may be contained within the cylindrical passageway33of the sleeve30in the same manner that the vitreous cutter12is contained therein. As such, these visualization devices may be used in conjunction with the sleeve30to image various portions of the eye or another portion of the body of the patient so as to determine surface geometries, thicknesses of body structures, etc. In addition, it is to be understood that the sleeves30,30′ may also be used in conjunction with a laser coagulation probe so that the blood vessels or arteries within the eye (e.g., the blood vessels or arteries62in the eye50ofFIGS. 10 and 11) may be coagulated during a surgical procedure being performed on the eye. In another suitable application, the sleeves30,30′ described herein may be used in conjunction with an infusion tube inserted into the cylindrical passageway33of the sleeve30,30′. In this application, the pierceable membrane74,76inside the cylindrical passageway33of the sleeve30,30′ operates as a fluid lock to prevent the escaping of fluids from the sleeve30,30′.

Any of the features or attributes of the above described embodiments and variations can be used in combination with any of the other features and attributes of the above described embodiments and variations as desired.

Although the invention has been shown and described with respect to a certain embodiment or embodiments, it is apparent that this invention can be embodied in many different forms and that many other modifications and variations are possible without departing from the spirit and scope of this invention.