Source: https://patents.google.com/patent/US7886747?oq=6289460
Timestamp: 2018-03-18 01:06:47
Document Index: 696029797

Matched Legal Cases: ['§119', 'Application No. 60', 'Application No. 02775192', 'Application No. 10159723', 'Application No. 09178195', 'Application No. 10159723', 'Application No. 1314', 'Application No. 2001', 'Application No. 161936', 'Application No. 02775192', 'Application No. 00922836', 'Application No. 2003', 'Application No. 2001']

US7886747B2 - Non-penetrating filtration surgery - Google Patents
US7886747B2
US7886747B2 US10495649 US49564904A US7886747B2 US 7886747 B2 US7886747 B2 US 7886747B2 US 10495649 US10495649 US 10495649 US 49564904 A US49564904 A US 49564904A US 7886747 B2 US7886747 B2 US 7886747B2
US10495649
US20050096639A1 (en )
The present application is a U.S. national application of PCT Application No. PCT/IL02/00872, filed on Nov. 3, 2002. This application is a continuation in part of PCT Application No. PCT/IL00/00263, filed on May 8, 2000, now U.S. application Ser. No. 10/240,505. This application also claims the benefit under §119(e) of U.S. Provisional Application No. 60/331,402, filed on Nov. 15, 2001. The disclosure of all of these applications are incorporated herein by reference.
U.S. Pat. No. 5,370,641 to O'Donnell, the disclosure of which is incorporated herein by reference, describes using an Excimer laser or an Erbium laser to ablate the sclera overlying the Schlemm's canal and the trabecular meshwork thereby forming a porous membrane. The laser spot size and treatment area are not described. This patent states that when a sufficient amount of the corneoscleral bed is removed, aqueous humor comes through the remaining ultra-thin Schlemm's canal and trabecular meshwork and the energy of the laser is absorbed by the out-flowing humor, creating a self-regulating end point.
However, even though many years have passed since this patent was issued, the method taught in the patent has not found wide-spread use, in spite of a great need in the art of treating Glaucoma, a disease for which there is no completely satisfactory treatment. One possible reason is that the '641 patent uses lasers that remove very thin (micron sized) layers of material. Further, once even a weak percolation starts, the laser is only effective to remove the percolation, not further tissue, while at the same time possibly causing thermal damage to the underlying tissue. This thermal damage may be a cause of later scarring.
In an exemplary embodiment of the invention, the laser is a diode laser operating at 1.8 microns, a 13C16O2 isotope laser or an Erbium:YSGG laser. In contrast to Erbium:YAG lasers, for example, the above listed lasers have an ablation depth that is greater than the small ablation depth of 1-3 microns of the Erbium:YAG laser. This is also the percolation thickness which may be expected to exist, in many cases, long before the membrane is thin enough. While the thickness of the percolation is dependent on the time between pulses, practical reasons, such as laser pulse rate, thermal damage and shock wave damage potentially caused by the laser pulse transfer generally prevent the practical use of low (e.g., micron) ablation depth lasers such as the Excimer and Er:YAG for the application of ablation. It should be noted that in the field of skin resurfacing, the standard (non isotopic) 12C16O2 laser rules supreme. While this laser does have some degree of flexibility the minimum ablation depth (where a minimum of charring is produced) is about 30 to 50 microns, which may not be fine enough for some patients and/or protocols. In addition, it should be noted that unlike in skin applications, thermal damage to the membrane and/or other eye tissue does not heal as readily and is more likely to scar, for example due to the lack of underlying healing tissue.
In an exemplary embodiment of the invention, the apparatus includes a scanner for automatically scanning an area of the eye using a laser spot, thereby ablating over the entire area. Optionally, a continuous scan is used, with the laser beam on at all times. A potential advantage of using a scanner is the ability to provide a large total amount of energy to a large area of the eye using a relatively inexpensive laser and scanning the beam over the area. Optionally, a pulsed 13C16O2 laser such as an ultrapulse laser with a scanner, for example, a galvanometric scanner, is used.
An aspect of some embodiments of the invention relates to using a sensor, for example, an automatic vision system for monitoring a non-penetrating filtration procedure. In one embodiment of the invention, the vision system detects percolation of liquid from the ablated sclera or cornea, thus identifying that ablation at the percolating point should be stopped. Optionally, this allows a greater degree of safety. Alternatively or additionally, the vision system controls the scanner (or laser) to reduce or eliminate the scanning of the laser at some points, while continuing the scanning at other points in the eye.
In an alternative embodiment of the invention, a pressure sensor is used to measure an intra-ocular pressure, during and/or after a procedure. The measurement may be, for example, continuous or intermittent. The measurement may be performed during pauses in the procedure and/or may be performed while the procedure continues. In some cases, for example, if the pressure goes down this may indicate a successful percolation. If the pressure does not go down enough, this may indicate that a larger area should be ablated. If the pressure goes down too much, possibly the procedure should be stopped at once. This sensor may be coupled to the system to operate automatically. For example, an input from the sensor may be used to automatically stop or change ablation parameters. Alternatively, the sensor is used to generate an alarm, through the ablation system or on its own (e.g., by setting a pressure at which to sound an alarm). Alternatively or additionally, the sensor is used manually, for example, with a physician entering new ablation parameters into the ablation system (e.g., using a suitable input) based on the pressure reading and/or entering pressure values which are interpreted by the ablation system to change its parameters.
In an exemplary embodiment of the invention, the pressure sensor is a non-penetrating sensor that optionally contacts the outside of the eye. Alternatively, a penetrating pressure sensor is used, for example, as part of a system that penetrates the eye and controls the intra-ocular pressure by providing or removing fluid, as needed.
In an exemplary embodiment of the invention, said position controller comprises an ophthalmic frame operative to fixing a relative position and angle of said laser source and an eye of a patient. Alternatively or additionally, said position controller comprises a scanner comprising an input for said laser beam and an output of a spatially scanned laser beam. Optionally, the apparatus comprises controlling circuitry that drives said scanner to remove tissue in a desired pattern on the eye. Optionally, the apparatus comprises a sensor which monitors an indication of progression of said surgery, on said eye, to produce a progression signal. Optionally, the apparatus comprises:
In an exemplary embodiment of the invention, said sensor measures an intra-ocular pressure. Alternatively or additionally, said sensor is a non-penetrating sensor. Alternatively or additionally, said sensor is a contact sensor.
In an exemplary embodiment of the invention, said laser source comprises an isotopic 13C16O2 laser source.
In an exemplary embodiment of the invention, said laser source comprises an Erbium:YSGG laser source.
In an exemplary embodiment of the invention, said laser source comprises a diode laser source operated at a wavelength near 1.8 microns.
In an exemplary embodiment of the invention, said laser is a CO2 laser. Alternatively, said laser is a 13C16O2 laser. Alternatively, said laser is an Er:YSGG laser. Alternatively, said laser is a diode laser operated near 1.8 microns wavelength.
forming a percolation zone adjacent a Schlemm's canal of an eye
FIG. 3A is a schematic illustration of an exemplary scanner suitable for the system of FIG. 1;
Referring first to an eye 40, an exemplary filtration procedure using system 50 comprises ablating parts of an area 31 of a sclera 41 and/or a cornea 42 in an area 30. Some of the ablation is directed to those areas overlying a Schlemm's canal 34 and/or trabecular meshwork 32. The size of area 30 is exaggerated in FIG. 1, as in many procedures, area 30 is significantly smaller than area 31 and may comprise substantially only the boundary area between cornea 42 and sclera 41 that overlies the Schlemm's canal. In some procedures, however, a larger portion of the cornea may be ablated. Optionally, a scanner is used to scan a laser spot over an area of the sclera larger than the spot. A more detailed description of an exemplary filtration procedure and an exemplary scanner is provided below. Also shown are optional sensors 35, 37 and/or 39, described below.
Laser ablation operates by light being absorbed by tissues in a thin layer, for example between 1 and 50 microns thick and the light causing heating of the tissue, so that the absorbing tissue explodes. This explosion can also cause (generally unwanted) damage by means of a shockwave produced by the explosion or by heat that is absorbed by underlying and/or adjacent tissue. When the membrane is thin enough, fluid percolates through the membrane and covers it. This fluid is generally very similar to the sclera tissue, especially with regard to optical absorption and heat dissipation properties. Thus, the fluid ablates in much the same way and parameters as sclera tissue. As can be expected, each type of laser wavelength has different interaction parameters with the sclera tissue and has further functional limitations caused by the physical limitations of the laser, for example commercially viable power level and pulse rate.
In some cases, an interesting result of these two properties, self-limiting of ablation, can be achieved. For example, if a laser has a given ablation depth and the fluid has the same ablation properties as the sclera and the local pulse rate of the laser is low enough to allow fluid to percolate to the ablation thickness, repeated laser pulses will only remove (the self renewing) fluid and not further ablate the sclera. In some cases, however, this self-limiting behavior can be self defeating or meaningless. FIGS. 2A-2C show the effects of various types of laser on sclera tissue.
FIG. 2A shows the situation where a highly absorbed laser, such as Erbium:YAG is used. Reference 43 indicates the amount of fluid that percolated through a membrane 48 since the laser pulse. Reference 44 indicates the area that can be ablated by a single Erbium:YAG laser pulse. As can be seen, the ablation of membrane 48 cannot continue if fluid 43 percolates faster than the pulse rate. The effective pulse rate is moreover limited by the damage caused by shockwave of the laser and by the laser itself which has a limited pulse rate. If scanning is desired, this further limits the effective pulse rate of the laser, in as much as percolation from adjoining areas may also cover the ablated area.
FIG. 2B shows the situation where a low absorption laser is used, for example, a 12C16O2 laser. This laser is characterized by a large ablation depth 44 (e.g., 30-50 microns as opposed to 1-3 microns of an Erbium:YAG laser) and also a large thermal damage depth 46. Thus, in the configuration shown, the small amount of percolation does not prevent a large thickness of sclera from being ablated. However, the remaining sclera is likely to be thermally damaged. Also, it is difficult to fine tune the exact thickness of membrane 48, in as much as the depth of ablation is so large. Thus, the percolation rate, which is dependent on the thickness of membrane 48, is more difficult to exactly achieve. In fact, the self-limiting point may be skipped by the laser inadvertently ablating clear through the sclera. In many cases, however, even such rough approximation may be good enough, for example, by ablating different thickness of membrane over different parts of the eye, so that the total effective (e.g., averaged) percolation rate is as desired, while taking care to not over-ablate the sclera and penetrate the eye. Alternatively or additionally, the local pulse rate may be selected to be low enough (e.g., by modifying the pulse rate and/or scanning pattern) so that a sufficiently thick layer of fluid 43 percolates and serves to control the amount of actual sclera tissue ablated.
FIG. 2C shows the situation where an intermediate absorption laser is used, for example, an isotopic 13C16O2 laser, an Erbium:YSGG or a diode laser at 1.8 microns wavelength. The thickness of ablation and of thermal damage is relatively small, especially relative to a final desired membrane thickness, but still greater than percolation that occurs when the membrane is not at its target thickness. It should be noted that there may be a variation in percolation rate between patients and/or intra-ocular eye pressures, so that even if a same membrane thickness and/or percolation properties are desired, different fluid percolation rates may be observed during the procedure.
FIG. 2D is a graph showing the relative utility of lasers for sclera surgery, in accordance with an exemplary embodiment of the invention the different lasers are compared using a unit N which indicates thickness of membrane 48 in units of minimum ablation thickness of the laser. The thickness of membrane 48 is taken to be 100 microns, thus, N=(100 microns/ablation thickness). If a different thickness is selected, different values of N will be generated. A more exact presentation of N and the ablation depth (based on a minimum or typical penetration depth that provided effective ablation) is shown in a table below. The one sided “error” bars indicate the depth of thermal damage to be expected. Two bands are marked on the figure. The shaded band indicates a range of values for N which apparently afford control while allowing a desired ablation to be performed. The dotted lines enclose a wider band where control is marginal but may be suitable for various applications. In general, as N is larger, finer control can be achieved, but procedure time is longer and is in danger of being limited by non-final percolation. As N is smaller, less control but surer ablation can be achieved. For some lasers, it is possible to control the penetration depth by modifying the pulse duration and/or the energy of the pulse. However, many lasers are limited by the physical properties of the laser and/or the degree of control is not sufficient to allow a laser that is not useful to become useful.
As can be appreciated, these indications are not absolute. For example, if the desired membrane thickness is greater, lasers with a currently low N may become more useful. Lasers with a high N, however, suffer from being self limiting when there is percolation, thus, to be effective, the laser must be able to provide multiple pulses in the time it takes for percolation the thickness of the ablation depth to occur, if this percolation is not the desired final effect. Also, some method of preventing damage from shockwave and other artifacts may be required. Thus, other useful values of N (for a 100 micron thickness) are below 50, 20, 10 and 6 and/or above 2, 3, 4, 5, 7 and 10. In general, a useful value of N for any thickness may depend on the precision desired in setting the thickness, so the above listed possibly useful values of N may apply to an N calculated using a different membrane thickness.
As can be seen, Erbium:YAG and Excimer lasers have too small an ablation thickness, while 12C16O2 is marginal and Ho:YAG has too large an ablation thickness. Diode lasers operated at 1.8 micron wavelength, Erbium:YSGG and isotopic 13C16O2 operated at 11.2 microns wavelength have an intermediate ablation thickness which allows for freedom in manipulating the thickness (e.g., by increasing the energy) and more exact approximation of the final membrane thickness, even under conditions of partial percolation. Other lasers may be used as well, if they have spectral characteristics (and/or absorbency characteristics) that match the areas and lines shown in FIG. 2D.
Penetration depth in water
(1/e) = approximate ablation N (for thickness of
Laser Type depth 100 microns)
Excimer 1 micron 100
Diode at 1.8 micron 20 microns 5
Holmium:YAG 100-200 microns 1-0.5
Er:YSGG 15 micron 7
Er:YAG 1-3 micron 100-30
12C16O2 30-50 micron 2-3
13C16O2 15 micron 7
The laser source is shown in FIG. 1 as a laser source 52.
In some embodiments of the invention, the image analysis is used to detect the percolation of aqueous humor. Alternatively or additionally, the image processing confirms that ablation beam 54 (or the aiming beam) are within a designated safety area. Alternatively or additionally, the image processing detects the depth of ablation, for example using stereoscopic images, by shadow analysis and/or by virtue of thin tissue being more transparent. The thickness of the tissue may be then determined, for example, by shining a strong light into the eye and measuring the relative or absolute amount of light exiting through the ablated tissue. Optionally, dye is provided into the eye, for example using iontophoresis (or injection) and the degree of percolation is determined by viewing the color intensity of the percolating aqueous humor.
FIG. 3A is a schematic illustration of an exemplary scanner 56 suitable for system 50. A beam 54 from laser source 52 is scanned in a first axis by a mirror 100, powered by a motor 102. A second mirror 104, powered by a second motor 106 scans the beam in another, optionally orthogonal axis. The two mirrors may be controlled by a scanning controller 108. The scanning is optionally continuous over a defined scanned area. In some embodiments, a same scanner may be used for scanning different sized and shaped areas. A beam attenuator 110 is optionally provided to selectively attenuate beam 54, for particular scanned locations in area 30 and 31 (FIG. 1). Attenuator 110 may be a one cell attenuator or it may be a spatial modulator. It should be noted that many different scanner designs can be used to generate a scanned beam, for example scanners using rotating prisms and acusto-optical scanners.
(d) when uniform ablation is desired, allowing selection of uniform depth or uniform tissue thickness;
(e) varying the scanning speed, intensity, pulse rate and/or other parameters based on the tissue type. Controller 74 may be used to simultaneously control laser 52 and scanner 56 to achieve various desired laser effects; and/or
FIG. 5 is a perspective view of eye 40 showing an exposed ablation area 30 and 31, in accordance with an exemplary embodiment of the invention. In one embodiment of the invention, the flaps are opened so that they unroll in different directions. Thus, when the flaps are closed, the tip of one flap is under the base of the other flaps. This may provide a stronger seal. In the embodiment shown, the two flaps open in opposite directions, however, other angular relationships may be provided, for example an orthogonal relationship. Alternatively or additionally, the tip of sclera flap 27 is over sclera 41, for example, so that any swelling or inflammation will be less likely to affect the lens. Alternatively, the tip of flap 27 is over cornea 42 or, alternatively, over the boundary between the sclera and cornea.
The target area may be shown, for example as a marking on mirror 122 (FIG. 3B). Alternatively or additionally, a computer display may be provided showing an image of the eye and an estimated or imaged position of the laser beam. In some embodiments, a computer generated display showing, for example, scanning parameters, is combined with microscope 58, so viewer 62 can view the display via the microscope.
(c) Beam intensity. This may be controlled, for example, by modulating the laser source or using attenuator 110, or another attenuator (uniform or spatially modulating) elsewhere along the optical path. The attenuators may selectively attenuate only the ablating beam (and not the optional aiming beam) for example having frequency selective properties or being having a suitable physical location. In some cases, the beam may be turned off for part of the scan. An exemplary source beam intensity is between 5 W and 15 W. The actual intensity that should be delivered to the eye can depend on various parameters, for example, the dwell time (and spot size), the age of the eye tissue, and the type of effect desired, e.g., ablation or coagulation. In particular, increasing the beam intensity can increase the thickness of ablation.
(g) Laser pulse parameters, such as pulse length, pulse envelope and pulse repetition rate. In some embodiments, a pulsed laser is used. The laser may generate a pulsed beam or a continuous pulsed beam may be further temporally modulated. In one exemplary embodiment, a CW laser is used and modulated to have pulses between 1 μs and 1 ms and a repetition between 1 Hz and 1 kHz. Alternatively, a continuous beam is provided at the eye. In a particular example, pulse duration is reduced, in order to reduce thermal damage.
Alternatively or additionally to detection percolation using image processor 68, other feedback mechanisms may be used to control ablation, set ablation parameters and/or to provide alarm signals. Image processor 68 is optionally used to detect the thickness of the sclera and/or the depth of ablation. Several depth and distance measuring methods are known in the art, for example, using stereoscopic imaging, or by detecting shadows or changes in patterns of light that are projected from a side light (not shown). Alternatively or additionally, an optional dedicated sensor 37 (FIG. 1) is used, for example, for detecting percolation or measuring the thickness of the sclera or the depth of ablation, for example, optically or using ultrasonic reflection. A thickness sensor may also be used prior to the procedure, for example for mapping (e.g., to set ablation parameters in general or for different locations).
Alternatively or additionally to directly monitoring the ablation or the percolation, an optional sensor 39 (FIG. 1) may be used for monitoring the pressure in eye 40. Various types of such pressure sensors may be used, for example sensors which require applying pressure to the eye. Possibly, such sensors did not find use during surgery in previous times, due to fears of a possible interaction between such pressure (which may be deforming) and the delicacy of the procedure or the forcing of fluid from the eye. A potential advantage in accordance with an exemplary embodiment of the invention is the ability to receive feedback in real-time or near real-time on the effect of a part of the procedure, so that a more finely tuned effect on intra-ocular may be achieved.
As shown, reservoir 222 and percolation zone 220 have different geometries, which can include different shapes, sizes and/or depths. In an exemplary embodiment, percolation zone 220 is 3×3 mm and reservoir 222 is 5×3 mm. Alternative exemplary sizes for percolation zone 220 are between 2 and 5 mm by between 2 and 5 mm. Alternative exemplary sizes for reservoir 222 are between 3 and 5 mm by between 3 and 5 mm. The actual sizes of the zones may be fixed. Alternatively, one or both sizes decided ahead of time based on patient characteristics, for example, eye-size, age and intra-ocular pressure. Alternatively or additionally, the actual sizes may be decided during the procedure, for example, based on the percolation rate. Alternatively or additionally, the sizes of percolation zone 220 and/or reservoir 222 may be adjusted (up or down) in a later procedure.
In an exemplary embodiment of the invention, the self-limiting behavior of the laser interaction with the sclera is used as a control feature or a safety feature, depending on the laser and on the degree of certainty. In one example, the self-limiting behavior is used as a control feature. The laser is set to have an ablation depth (e.g., power, pulse length) equal to the expected percolation rate when a desired membrane is achieved. This percolation rate may depend, for example, on the intra-ocular pressure and/or on other parameters, such as results from a previous or a same operation on the patient. Another possible setting is a matching between ablation depth in sclera and in fluid. This setting may vary, for example, if the sclera or intra-ocular fluid are dyed or otherwise have significantly different absorption at the laser wavelength. Optionally, the scan settings are modified to provide a local pulse rate that matches the expected percolation rate. In an exemplary embodiment of the invention, the power setting is 3 J/cm2 and the pulse duration is 1 ms. Higher power, such as 10 or 20 J/cm2 at this pulse duration will provide a greater ablation depth. Exemplary durations are thus between 1-2000 μs, for an isotopic CO2 laser. Exemplary power levels are between 2.5 and 50 J/cm2. In contrast, an Erbium:YAG can work at 1.5 J, but has undesirable self-limiting behavior. The exact power setting may depend of course on the exact spectral wavelength of the laser and/or on the absorbency characteristics of the sclera. Also, the sclera and/or the percolating fluid (e.g., the eye) may be dyed to have desired absorbency characteristics.
In a safety method, the same setting settings are applied, However, the operator does not trust the system or is worried that thermal damage may be caused by repeated ablation of fluid. Instead, the operator sets the ablation depth and ablates until he sees fluid and then ablates at a slower rate (e.g., using less often applied manual “zap” instructions) and/or at a lower ablation thickness setting, until the percolation rate appears to be correct. If the operator makes a mistake, the ablation should not penetrate through the sclera, as it is self-limiting.
It should be noted that the same procedure, possibly with different parameters may be applied to a wide range of patients. These patients may be characterized, for example, by different percolation rates and/or different target percolation rates. For example, the non-penetrating filtration procedure may be applied as a precautionary measure or in patients with slightly elevated intra-ocular pressures, such as pressures, between 14 mmHg and 21 mmHg or below 30 mmHg.
It will be appreciated that the above described methods of selective ablation of sclera and corneal tissue may be varied in many ways, including, changing the order of steps and the types of tools used. In addition, a multiplicity of various features, both of method and of devices have been described. In some embodiments mainly methods are described, however, also apparatus adapted for performing the methods are considered to be within the scope of the invention. It should be appreciated that different features may be combined in different ways. In particular, not all the features shown above in a particular embodiment are necessary in every similar embodiment of the invention. Further, combinations of the above features are also considered to be within the scope of some embodiments of the invention. Also within the scope of the invention are surgical kits which include sets of medical devices suitable for performing a single or a small number filtration procedures. When used in the following claims, the terms “comprises”, “includes”, “have” and their conjugates mean “including but not limited to”.
1. A method of performing a non-penetrating filtration procedure, comprising:
(a) opening a flap in an eye, overlying a Schlemm's canal of said eye;
(b) forming a percolation zone adjacent said Schlemm's canal by:
(i) removing, by ablation with a laser, a tissue thickness of between 5 and 50 microns, at a time; and
(ii) repeating said removing after a delay sufficient to detect percolation, said removing being repeated until sufficient percolation is achieved and without penetrating into a body of said eye;
(c) closing said flap.
2. A method according to claim 1, wherein forming a percolation zone comprises cleaning away charred tissue from said percolation zone.
3. A method according to claim 1, wherein forming a percolation zone comprises forming by automatic scanning with a laser.
4. A method according to claim 3, wherein automatic scanning with a laser comprises automatically controlling at least one parameter of the scanning responsive to an effect of the laser on the tissue.
5. A method according to claim 3, wherein said laser is a pulsed laser configured to provide multiple pulses during the scanning of a point.
6. A method according to claim 1, wherein said laser is a CO2 laser.
7. A method according to claim 6, wherein said laser is a 13C16O2 laser.
8. A method according to claim 1, wherein said laser is an Er:YSGG laser.
9. A method according to claim 1, wherein said laser is a diode laser operated near 1.8 microns wavelength.
10. A method according to claim 1, comprising placing a protective sticker on said eye prior to forming said percolation zone, said protective sticker having a spatial window that admits a wavelength of said laser and a body that block said wavelength from parts of the eye other than an area to be ablated.
11. A method according to claim 1, wherein said laser has a dwell time for said removing of over 100 micro seconds.
12. A method according to claim 1, wherein said laser has a spot size of over 100 microns.
13. A method according to claim 1, wherein each tissue removing has a duration of over 1 milliseconds.
14. A method according to claim 1, wherein said forming includes removing in a concave pattern.
15. A method according to claim 1, wherein said removing comprises removing between 10 and 30 microns at a time.
16. A method according to claim 1, wherein said removing comprises removing between 16 and 25 microns at a time.
17. A method according to claim 1, wherein said removing comprises removing between 16 and 20 microns at a time.
18. A method according to claim 1, wherein said removing comprises removing between 5 and 30 microns at a time.
19. A method according to claim 1, comprising forming a reservoir in a sclera of said eye and in fluid connection with said percolation zone.
20. A method according to claim 1, wherein said laser is a continuous laser.
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US33140201 true 2001-11-15 2001-11-15
PCT/IL2002/000872 WO2003041623A1 (en) 2001-11-15 2002-11-03 Non-penetrating filtration surgery
US10495649 US7886747B2 (en) 2000-05-08 2002-11-03 Non-penetrating filtration surgery
US12981585 US20110092965A1 (en) 2000-05-08 2010-12-30 Non-penetrating filtration surgery
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US7886747B2 true US7886747B2 (en) 2011-02-15
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US10495649 Active 2024-01-24 US7886747B2 (en) 2000-05-08 2002-11-03 Non-penetrating filtration surgery
US12981585 Abandoned US20110092965A1 (en) 2000-05-08 2010-12-30 Non-penetrating filtration surgery
US (2) US7886747B2 (en)
JP (2) JP4427327B2 (en)
EP (2) EP2158883A3 (en)
WO (1) WO2003041623A1 (en)
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