Abstract:
A method of laser ocular surgery for treating glaucoma is disclosed. The method can include imaging a treatment eye to obtain an image of the treatment eye and aligning a laser on a region of the treatment eye based on the image of the treatment eye. The method can also include firing a plurality of laser pulses from the laser to ablate tissue in the region of the treatment site, wherein the tissue ablation creates micro-perforations in the region of the treatment site to incite an inflammatory reaction.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefits of priority under 35 U.S.C. §§119 and 120 to U.S. Provisional Application No. 61/565,953, filed on Dec. 1, 2011, the entirety of which is incorporated herein by reference. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure is directed towards laser ocular surgery, and more particularly, the use of a laser ocular surgery for treating glaucoma. 
       BACKGROUND 
       [0003]    Glaucoma is caused by the body&#39;s inability to drain the clear, transparent liquid called the aqueous humor. Aqueous humor flows through the inner eye continuously. Typically, the aqueous fluid drains from the anterior chamber to the sclera, through a variety of drainage channels or canals. However, these channels can become smaller with age or become clogged by deposits. Inadequate drainage of the aqueous humor from the anterior chamber can lead to an abnormally high fluid pressure results within the eye. This is referred to as glaucoma. The high fluid pressure can lead to a slow loss of peripheral vision and eventually blindness. 
         [0004]    Traditional glaucoma treatments can include forming a channel in the sclera of the eye to drain aqueous fluid from the anterior chamber of the eye, reducing fluid pressure. Typically, the channel in the sclera is made by a knife or other mechanical devices. These mechanical devices can cause trauma to the scleral tissue, resulting in scar tissue formation that can eventually obstruct the channel. 
         [0005]    It is accordingly an object of the present disclosure to provide an improved system and method for reducing the high fluid pressure in the anterior chamber of the eye. 
       SUMMARY 
       [0006]    In accordance with the present disclosure, one aspect of the present disclosure is directed to a method of laser ocular surgery for treating glaucoma. The method can include imaging a treatment eye to obtain an image of the treatment eye and aligning a laser on a region of the treatment eye based on the image of the treatment eye. The method can also include firing a plurality of laser pulses from the laser to ablate tissue in the region of the treatment site, wherein the tissue ablation creates micro-perforations in the region of the treatment site to incite an inflammatory reaction. 
         [0007]    In another embodiment, a system can be configured for laser ocular surgery. The system can include an imaging device configured to image a portion of a treatment eye, and a laser configured to generate a beam having power sufficient to create micro-perforations in the portion of the treatment eye. The system can also include an interface device coupling the laser to the treatment eye, wherein the interface device is configured to adjust a path of the beam based on output from the imaging device 
         [0008]    Additional objects and advantages of the present disclosure will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the present disclosure. The objects and advantages of the present disclosure will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims. 
         [0009]    It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the present disclosure, as claimed. 
         [0010]    The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several embodiments of the present disclosure and together with the description, serve to explain the principles of the present disclosure. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0011]      FIG. 1  is schematic diagram of an ocular surgical system, according to an exemplary embodiment. 
           [0012]      FIG. 2  is a flow diagram illustrating a method of ocular surgery, according to an exemplary embodiment. 
           [0013]      FIG. 3  is a flow diagram illustrating a method of ocular surgery, according to another exemplary embodiment. 
           [0014]      FIG. 4  is a diagram of a part of an eye. 
       
    
    
       [0015]    Reference will now be made in detail to the present embodiments of the present disclosure, an examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts. 
       DETAILED DESCRIPTION 
       [0016]    It is understood that the embodiments described herein are not limited thereto. Those having ordinary skill in the art and access to the teachings provided herein will recognize additional modifications, applications, embodiments, and substitution of equivalents that all fall with the scope of the present disclosure. Accordingly, the present disclosure is not limited by the foregoing or following descriptions. 
         [0017]      FIG. 1  is a schematic diagram of a surgical system  110  for performing ocular surgery using a laser, according to an exemplary embodiment. Surgical system  110  can comprise a laser  120 , an interface device  130 , an imaging device  140 , and a controller  150 . Laser  120  can include a femtosecond laser. In some aspects, laser  120  can include a type of laser configured to create micro-perforations in a portion of a treatment eye. For example, laser  120  can have sufficient power to form a plurality of micro-perforations in a trabecular meshwork of a treatment eye. Laser  120  can be further configured to ablate part of the treatment eye. Such treatment can be used to provoke an immune response to aid remodeling of tissue associated with the treatment eye. 
         [0018]    Interface device  130  can be configured to couple patient  160  to laser  120 . Device  130  can include attachments (not shown) configured to contact patient  160  to ensure laser  120  remains secure during a procedure. When coupled, interface device  130  can be positioned between laser  120  and a treatment eye  170  of patient  160 . 
         [0019]    In some embodiments, interface device  130  can comprise a mirror, a reflective substrate, or equivalent substrate configured to optically direct the path of laser  120  towards the treatment site of treatment eye  170 . The treatment site can include the anterior segment of the eye, the trabecular meshwork, or the anterior sclera. Other regions of the eye may also be treated. 
         [0020]    Imaging device  140  can comprise an optical coherence tomography (OCT) device, Schiemflug imaging device, or other equivalent imaging device capable of capturing images of ocular anatomy. Various other imaging devices may also be used. In addition, controller  150  can be part of imaging device  140  or can be a separate device. Controller  150  can be configured to receive data from imaging device  140  and output a signal to orient the mirror or reflective substrate of interface device  130  to direct laser  120  at the treatment site. 
         [0021]      FIG. 4  shows a diagram of an eye  170 , which is used to describe the method according to an exemplary embodiment. The eye comprises a lens  410 , a pupil  420 , a cornea  430 , an iris  440 , a conjunctiva  450 , a sclera (anterior)  460 , an anterior chamber  470 , a travecular meshwork  480 , a Schwalbe&#39;s line  490 , a corneal limbus  500 , an anterior segment  510 , and a posterior segment  520 . 
         [0022]      FIG. 2  shows a flow chart  200 , for a method of performing ocular surgery, according to an exemplary embodiment. The first step, S 210 , can comprise attaching interface device  130  as described in relation to  FIG. 1 . Attaching interface device  130  can comprise aligning the interface device between laser  120  and treatment eye  170 . Interface device  130  can be configured to expose anterior segment  510  of treatment eye  170  when attached. After completing step S 210 , the next step S 220 , can comprises directing imaging device  140  at the treatment eye  170 . 
         [0023]    Once Step S 220  is completed, step S 230  can comprise using imaging device  140  to detect and register the image and convert the image to a pixel coordinate plane by way of the imaging device software program. Following step S 230 , step S 240  can comprise the controller  150  using the pixel coordinate data to align the mirror or reflective substrate of interface device  140  towards the treatment site. Controller  150  can be integrated into imaging device  140  and can include processor, computer readable data, and software programming. The treatment site can include the trabecular meshwork and angle of anterior segment  510  of treatment eye  170 . 
         [0024]    Next, step S 250 , can comprise laser  120  being energized and aimed at this tissue plane of the treatment site and the tissue can be ablated with various spot sizes of laser  120 , in a  180  or  360  degree fashion. In other example, arcs of less than 360 degrees may be created on or about a region of the treatment eye. 
         [0025]    Following step S 250 , step S 260  can comprise creating micro-perforations of the travecular meshwork  480 . These can be used to incite a mild inflammatory reaction in order to recruit macrophages and trabecular meshwork cells to the treatment site in order to initiate tissue remodeling at the treatment site. 
         [0026]    In another embodiment, a method similar to that described above in relation to  FIG. 2  is shown in  FIG. 3  as flow chart  300 . The method described in flow chart  300  uses an interface device  130  configured to extend beyond the corneal limbus  500  to allow laser  120  to target the anterior sclera  460 , adjacent to the Schwalbe&#39;s line  490  and the trabecular meshwork  480  of treatment eye  170 . In alternative embodiments (not shown), a different device than interface device  130  can be used to target laser  120  to the treatment site. 
         [0027]    The method of flow chart  300  can begin with Step S 310 , which comprises attaching a larger interface device that allows extending beyond the corneal limbus, as described above. Steps S 320 , S 330 , S 340 , and S 350  can each be similar to corresponding steps S 220 , S 230 , S 240 , and S 250  described above in relation to  FIG. 2 . Step S 360 , however, can be different than previously described step S 260 . Step S 360  can comprise creating micro-perforations through anterior sclera  460 . These micro-perforations can form a type of micro-drainage channel that may allow aqueous fluid to exit anterior chamber  470  of the treatment eye  170 . The fluid could flow into a subconjunctival space between the subconjuctiva  450  and sclera (anterior)  460 . 
         [0028]    In another embodiment, S 360  can comprise creating micro-channel perforations, which may allow aqueous fluid to escape the anterior chamber via the uveo-scleral outflow pathway. 
         [0029]    In another embodiment, S 360  can comprise creating micro-channel perforations using laser  120  in conjunction with a subconjunctival injection/delivery system (not shown). Such a delivery system can be configured to introduce a micro-stent through the conjunctiva and into the micro-channel to the anterior chamber created by laser  120 . Micro-stents of various shapes and sizes could be configured for specific use with a portion of the treatment eye. Various other devices and systems may also be required to ensure proper delivery of the micro-stents relative to the micro-channels in the treatment eye. 
         [0030]    Other embodiments of the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the present disclosure disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the present disclosure being indicated by the following claims.