DE102010016629B4 - Device with vitrectomy lens - Google Patents

Abstract

Apparatus (101-113) comprising: a vitrectomy lens (1) intended to be placed and held by hand on an eye; at least one light source (2) arranged to be that from the at least one light source (2) illuminates the vitrectomy lens (1) in the eye, and a glare shield (14, 15) integrated with the vitrectomy lens (1).

Description

The invention relates to a device with a lens, in particular a vitrectomy lens, through which the eye or another organ can be viewed in minimally invasive procedures, in particular in ophthalmology.

Due to the increasing age, it is increasingly common to age-related diseases of the eye, such. Retinal changes or cataracts, cataracts, cataracts, age-related macular degeneration or diabetes-related retinopathy. In most of these diseases, surgery inside the eye is essential, which implies that the surgeon must bring light into the eye to accurately identify his operating area.

Devices for examining the eye and for introducing light into the eye are from the writings US 6,221,028 B1 . WO 98/19642 A1 . US 2007/0268450 A1 . DE 20 2007 012 432 U1 and DE 10 2008 011 836 A1 known.

Any intervention on the eye is a heavy burden on the organ, which is why the trend in ophthalmology to ever smaller approaches using so-called trocars. Trocars are instruments with a hollow tube that give the surgeon access to the inside of the body. The light source then has the task of illuminating the operating area, the position of the trocar and the working direction of the instruments guided therewith.

Endo-illumination systems are often used, endoscopic instruments that are guided into the interior of the eye next to the cornea. Endoillumination systems usually consist of a handpiece and an external light source. The handpiece is equipped with an optical fiber or an optical fiber bundle, which transports the light into the eye. For this purpose, the front part of the handpiece is guided through a small access to the inside of the eye. The external light source may be a xenon lamp, a diode laser or another light source.

In most procedures, the surgeon also uses so-called vitrectomy lenses to view the eye. Their task is to compensate for the natural curvature of the cornea and to transform it into a flat imaging surface so that the surgeon can better see the fundus. The lens may be made of plastic, glass or other transparent material. It is placed on the eye by hand during the procedure. For this purpose, it can be held on the edge, and there are also handles, with the help of which they can be better positioned. Frequently, the vitrectomy lenses are also enclosed in a ring, which facilitates the placement on the cornea. Such a ring is usually made of a soft material such. As silicone, so he can adapt to the surface of the cornea.

The vitrectomy lenses used in ophthalmology, in particular in posterior segment surgery, are usually plano-concave lenses, which transform the curvature of the cornea into a plane surface. There are for other applications and lenses with special optical properties, such. B. a magnification effect, a wide-angle effect, etc. or special geometry, such. As aspherical lenses used. There are also known vitrectomy lenses with additional optical elements such as prisms, which allow the viewer to look into the eye at an oblique angle.

The invention is based on the problem that the surgeon when using a Endoilluminationssystems during the operation with the handpiece and several instruments handle, put on the Vitrektomielinse and in many cases even move a surgical microscope. He is dependent on the assistance of an assisting person who holds the vitrectomy lens, moves the surgical microscope or performs other tasks. There is still the difficulty of coordinating these tasks with the activities of the surgeon, which can be very stressful because of stupid holding tasks and also does not always optimally succeed for lack of knowledge of the exact direction of the surgeon.

In addition, the introduction of the endo-illumination system places an additional burden on the patient as it requires invasive access to the inside of the eye with all the associated difficulties such as scarring, risk of infection, etc.

The invention solves the above-mentioned problems by the features of the independent claims. Advantageous developments and refinements of the invention are specified in the subclaims.

According to one embodiment, a device comprises a lens and at least one, d. H. one or more light sources. The lens is intended to be placed on an eye of a patient. The at least one light source is connected to the lens in such a way that the light generated by it falls at least partially into the eye of the patient via the lens.

The lens, in cooperation with the cornea, may in particular act in such a way that the doctor of outside, either directly or through a microscope to look at the fundus.

The beam path of the light generated by the light source passes through a part of the lens. The light generated by the light source can be used for minimally invasive surgery, especially in ophthalmology to illuminate the inside of the eye.

The device delivers light through the lens and pupil rather than via an invasive approach to the eye. The additional handpiece can be dispensed with, giving the surgeon a free hand. Instead, two tasks, optical imaging and lighting, are taken over by a single instrument.

The light source connected to the lens has the advantage that the surgeon no longer has to guide and hold a light source guided on a second instrument into the eye, whereby he can use the free hand for other manipulations. In addition, an otherwise required invasive access is avoided.

The light sources can be dimensioned such that different spatial arrangements of the light sources and thus different illumination patterns can be realized. It is also possible to incorporate several different types of light sources into a lens and to use them either simultaneously during the operation or to switch between the different light sources. For example, it is possible to switch between light with different wavelength ranges. In this way it becomes possible, for example, to switch back and forth between a realistic color impression of the objects to be illuminated and a targeted excitation of dyes.

The device can also be used to specifically excite the dyes frequently used in operations, with which certain structures are marked, with light sources in a selected wavelength range for fluorescence. It is also possible to represent the other structures simultaneously or alternately with white light.

The inner surfaces or surfaces of the lens may be coated. In this way, it is possible, for example, to refract the lens to allow the viewer a better view of the eye. In addition, it is also possible to coat the lens such that z. B. the excitation light for dyes does not reach the viewer.

As a result, a higher contrast of the fluorescent light emitted by the dye is achieved without the need for additional filters or beam splitters.

The compact design of the device allows lateral movement or rotation of the lens together with the one or more light sources on the eye. In this way it becomes possible to align the light of the light source (s) by simple movements.

As indicated above, the device can be used in procedures where minimally invasive instruments are operated in or on the eye. A common example of such an intervention is the vitrectomy, in which a thin instrument in addition to the cornea is guided into the interior of the eye, for. B. to manipulate the fundus. But it is also possible to use the combination of lens and one or more built-in light sources in minimally invasive surgery on other organs in the body. Thus, for example, it is possible to place the lens on the brain surface with one or more built-in light sources in order to view blood vessels near the meninges or fluorescence-marked tumor areas during a neurosurgical procedure. If the device is to be used in operations of organs other than the eye, the device may have the same configurations as described in this application.

The device can also be designed such that a connection between the light source connected to the lens and an electronic assembly serving to drive the light source can be easily released. In this way it is possible to design the lens and the associated light source as a disposable lens and to reuse only the electronic control. Ie. The lenses do not need to be cleaned and sterilized but can be disposed of after each operation. The one-time sterilization of the disposable lenses can be done in a machine process immediately following manufacture, and the lenses can be stored in sterile packaging until ready for use. In this way, a higher hygienic safety can be achieved and costs for reprocessing saved.

The invention will be explained in more detail below by way of example with reference to the drawings. In these show:

1A and 1B schematic representations of a device with a lens and a light source introduced into the lens;

2 a schematic representation of a device with a lens and a plurality of introduced into the lens light sources;

3A and 3B schematic representations of a device with a lens and a plurality of introduced into a groove of the lens light sources;

4 a schematic representation of a device with a lens, a retaining ring and a light source introduced into the retaining ring;

5 to 9 schematic representations of devices with a lens, a light source introduced into the lens and means for optical imaging of the light source;

10 and 11 schematic representations of devices with a lens, a lens introduced into the lens and a glare shield;

12 and 13 schematic representations of devices with a lens, a lens introduced into the lens and a drive device; and

14 to 16 schematic representations of devices with a lens, a lens introduced into the lens and optical coatings.

1A and 1B show schematic cross-sectional views of a device 101 , It shows 1A a cross-sectional view along in 1B drawn line A-A ', and 1B shows a cross-sectional view along in FIG 1A marked line B-B '.

The device 101 consists of a lens 1 , in particular a vitrectomy lens, and a light source 2 , In 1A is that of the light source 2 radiated light cone 3 shown schematically. The Lens 1 can in a retaining ring 4 be framed, the lens 1 annularly surrounding in the present embodiment. One version without retaining ring 4 is possible, too. Furthermore, differently designed brackets can be provided.

During the intended use of the device 101 this is put on an eye of a patient. In 1A is schematically the front part 5 the cornea of the eye.

The Lens 1 can be made of plastic, glass or other transparent material. The Lens 1 can have a concave surface 6 and one of the concave surface 6 opposite plane surface 7 exhibit. The Lens 1 comes with the concave surface 6 put on the eye. The geometry of the lens 1 Causes the doctor to clear the back of the eye through the flat surface 7 can look at.

The Lens 1 may also be implemented as a doublet, triplet or other arrangement of multiple lens surfaces. Instead of in 1A shown plano-concave configuration, the lens 1 also have a different geometry to z. B. a magnification effect, a wide-angle effect, etc. to achieve. The Lens 1 may be formed in particular aspherical and / or achromatic. Furthermore, additional optical elements such as prisms can enter the lens 1 be installed, which allow the viewer to look at an oblique angle in the eye.

The light source 2 is in the lens 1 brought in. The light source 2 may be embedded in the lens material and may be overmolded by a material for attachment. The light source 2 is oriented such that the light generated by it at least partially falls over the pupil into the interior of the eye and there illuminates the fundus. The one from the light source 2 radiated light cone 3 goes through a part of the lens 1 ,

As a light source 2 can z. As an LED (light-emitting diode), a thin-film O-LED (organic light-emitting diode), an SMD LED (surface-mounted device light-emitting diode), an EL film (electroluminescent film) or a light guide can be used , These light sources can be made very compact and can have dimensions of sometimes less than 1 mm.

The light source 2 can be arranged so that it is outside of the lens 1 imaged area so that it lies outside the visible field of the observer.

The coupling of the light from the lens 1 An eye can detect refractive index matching of the material of the lens 1 and / or via a liquid or gel with refractive index matching. The extraction of light from the lens 1 One can look into the eye via reflective and / or scattering materials.

The position of the lens 1 Can be changed laterally on the eye or the lens 1 can be turned. Due to the rigid connection of the light source 2 with the lens 1 can thereby the light of the light source 2 targeted.

In the following, developments of the device 101 described.

2 shows a schematic cross-sectional view of a device 102 , in addition to the light source 2 yet another light source 2 ' having. The light source 2 ' is also in the lens 1 introduced and that of the light source 2 ' radiated light cone 3 ' glows in the interior of the eye, with the light cone 3 ' a part of the lens 1 passes. In general, the devices described in this application may contain any number of light sources, e.g. B. 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 light sources.

The light sources can be spatially arranged or geometrically designed such that a desired illumination pattern of the inside of the eye is achieved. When using a plurality of light sources can be provided that each light source or groups of light sources can be controlled separately, so that during an operation optionally only a certain part of the light sources or all the light sources can be switched on simultaneously. In addition, several different types of light sources can be in the same lens 1 to be built in. In this case, for example, a first group of light sources can be designed to allow a realistic color impression of the objects to be illuminated, and a second group of light sources can effect a targeted excitation of dyes with which certain structures in the eye can be marked. During the operation, the two sets of light sources can be used either simultaneously or switched between the two groups. For controlling the light sources, a control device may be provided.

Furthermore, the light sources can be controlled by means of the control device in a predetermined time cycle or a predetermined time pattern in order to distinguish between different observation modes, for. B. white light mode and fluorescence mode, switch back and forth.

In many operations directly on the retina, dyes such as ICG, Trypan Blue or Brilliant Blue are used, which can be excited to fluoresce at specific wavelengths. In this way it is possible to better distinguish individual components. For example, the Membrana limitans interna (ILM) is often stained if it is to be detached from the retina during the operation. This process is also known as membrane peeling. The detection of the fluorescent light is facilitated by optical filters, which can also be realized as coated surfaces. By using special light sources as described above, the contrast of the dyed tissue to the undyed tissue can be significantly enhanced.

In addition, the light sources can have broad emission spectra. In addition, it is possible to superimpose multiple light sources with different emission spectra to completely cover the visible wavelength range or to produce a mixed spectrum of different wavelengths. By changing the intensity of the individual light sources, virtually any spectral distributions can be adjusted in this way.

3A and 3B show schematic cross-sectional views of a device 103 in which in the side surface of the lens 1 a groove 8th is provided in the light sources 2 . 2 ' and 2 '' are attached. The light sources 2 . 2 ' and 2 '' and possibly other light sources may be in any arrangement and orientation in the groove 8th be attached. The groove 8th can completely surround the lens 1 around or just over part of the circumference of the lens 1 extend.

4 shows a schematic cross-sectional view of a device 104 , at least one of the light sources 2 in the retaining ring 4 is embedded. The retaining ring 4 must be at least in the area through which the light cone 3 the light source 2 falls into the eye, be made of a transparent or at least translucent material. If instead of the retaining ring 4 a differently designed holder is provided, the light source 2 also be integrated into this bracket. It may also be provided a recess in the holder, in which the light source 2 is used.

In the following 5 to 9 are various embodiments of a means for optical imaging of the light source 2 shown.

5 shows a schematic cross-sectional view of a device 105 , in the beam path of the light source 2 an element 9 , z. B. a lens for focusing the light of the light source 2 is introduced. The element 9 is in the lens 1 embedded and can by a variation of the refractive index in the material of the lens 1 or through one in the lens 1 introduced material with a different refractive index or otherwise realized.

6 shows a schematic cross-sectional view of a device 106 in which the surface 6 the lens 1 in the area of the beam path of the light source 2 such a design 10 , z. B. has curvature that an optical image of the light source 2 he follows.

7 shows a schematic cross-sectional view of a device 107 , in the beam path of the light source 2 an element 11 , z. B. a lens for expanding the light of the light source 2 is introduced. The element 11 is in the lens 1 embedded and can by a variation of the refractive index in the material of the lens 1 or through one in the lens 1 introduced material with a different refractive index or otherwise realized.

8th shows a schematic cross-sectional view of a device 108 in the lens 1 a reflector 12 is introduced to the light pipe of the light source 2 generated light is used. The reflector 12 For example, via a shaping, a material change, a doping, an introduced material or another type of refractive index variation, a light conduction within the lens can take place 1 , For example, cause total reflection. The reflector 12 For example, from the light source 2 to the surface 6 the lens 1 pass.

9 shows a schematic cross-sectional view of a device 109 , in the beam path of the light source 2 a light-scattering material 13 in the lens 1 is introduced, which leads to a widening of the light cone 3 the light source 2 leads or the light cone 3 diffused broadened. The same effect can be achieved by roughening at least one area of the surface 6 the lens 1 through which the beam path of the light source 2 leads to be achieved.

In the 10 and 11 are embodiments of the lens 1 Shown with antiglare, that prevents from the light source 2 generated light reaches the viewer.

10 shows a schematic cross-sectional view of a device 110 , at the edge of the light source 2 and in the direction of the observer, a glare protection 14 is provided.

11 shows a schematic cross-sectional view of a device 111 , in which the glare protection by a coating 15 certain areas of one or more surfaces and / or inner surfaces of the lens 1 is realized. The glare protection 14 . 15 can be generated by blackening, metallization and / or light blockage.

12 shows a schematic view of a device 112 in which the light source 2 with a control unit 21 for controlling and powering the light source 2 connected is. Between the control unit 21 and the light source 2 can be a detachable connection 22 , z. B. in the form of a connector. This allows the lens 1 together with the light source 2 to dispose of after an operation and only the control unit 21 reuse. The control unit 21 and the light source 2 are via respective interconnections 23 with the plug connection 22 connected.

13 shows a schematic view of a device 113 in which several light sources 2 and 2 ' with the control unit 21 via signal amplifier 24 respectively. 24 ' and plug connections 22 respectively. 22 ' are connected. The light sources 2 and 2 ' radiate light of different wavelengths in the present embodiment. The control unit 24 can be constructed so that the light sources 2 and 2 ' and possibly other light sources with different intensity shine. In this way, a desired light spectrum can be generated.

In the 14 to 16 are certain surfaces or surfaces of the lens 1 provided with an optical coating that prevents the excitation light for dyes reaches the viewer.

14 shows a schematic cross-sectional view of a device 114 , on the flat surface 7 the lens 1 an optical coating 31 is applied to the light 3 the light source 2 , with which a dye is to be excited to fluoresce, reflects and transmits the fluorescent light emitted by the dye.

15 shows a schematic cross-sectional view of a device 115 in which the lens 1 is executed as a lens doublet and from the parts 1' and 1'' consists. The inner surface between the two parts 1' and 1'' of the lens doublet 1 is with an optical coating 32 provided that have the same properties as the optical coating 31 out 14 having.

16 shows a schematic cross-sectional view of a device 116 , which is a further education of in 15 shown device 115 represents. In addition to the coating 32 is on the concave surface 6 the lens 1 an optical coating 33 Applied to both the light 3 the light source 2 as well as the fluorescent light lets through. On the flat surface 7 the lens 1 is an optical coating 31 ' applied, which serves as an antireflection coating for the fluorescent light.

In 16 are also a section of the fundus 41 and a dye 42 represented, with which certain structures can be marked. The light 3 the light source 2 achieved due to the coating 33 the dye 42 and stimulates this to fluorescence. That of the dye 42 emitted fluorescent light 51 can the coatings 33 . 32 and 31 ' go through and get to the viewer. At the same time prevents the coating 32 that the light 3 the light source 2 reached the viewer. This will give a higher contrast of the dye 42 emitted fluorescent light 51 reached.

Claims (21)

Contraption ( 101 - 113 ), full: a vitrectomy lens ( 1 ), which is intended to be placed and held by hand on an eye, at least one light source ( 2 ) arranged in such a way that that of the at least one light source ( 2 ) generated light via the Vitrektomielinse ( 1 ) in the eye, and a glare shield ( 14 . 15 ) inserted into the vitrectomy lens ( 1 ) is integrated. Contraption ( 101 - 113 ) according to claim 1, wherein the at least one light source ( 2 ) is an LED, an O-LED, an SMD-LED, an EL-foil or a light guide. Contraption ( 103 ) according to claim 1 or 2, wherein a plurality of light sources ( 2 . 2 ' . 2 '' ) into a common groove ( 8th ) in the vitrectomy lens ( 1 ) are admitted. Contraption ( 101 . 102 . 105 - 113 ) according to one of the preceding claims, wherein the at least one light source ( 2 ) into the lens material of the vitrectomic lens ( 1 ) is embedded. Contraption ( 101 - 113 ) according to one of the preceding claims, wherein the at least one light source ( 2 ) is encapsulated for attachment of a material. Contraption ( 104 ) according to one of the preceding claims, wherein a retaining ring ( 4 ) the vitrectomy lens ( 1 ) and the at least one light source ( 2 ) in the retaining ring ( 4 ) is integrated. Contraption ( 105 - 109 ) according to any one of the preceding claims, further comprising an agent ( 9 - 13 ) for optically imaging the at least one light source ( 2 ). Contraption ( 106 ) according to claim 7, wherein the optical image about the shape of the vitrectomy lens ( 1 ) in front of the at least one light source ( 2 ) he follows. Contraption ( 105 . 107 . 108 . 109 ) according to claim 7 or 8, wherein the optical imaging via a location-dependent refractive index change within the Vitrektomielinse ( 1 ) he follows. Contraption ( 101 - 113 ) according to any one of the preceding claims, wherein the vitrectomy lens ( 1 ) is designed such that the vitrectomy lens ( 1 ) is movable and / or rotatable on the eye. Contraption ( 101 - 113 ) according to any one of the preceding claims, wherein the vitrectomy lens ( 1 ) has a coating on at least one inner surface or surface. Contraption ( 101 - 113 ) according to claim 11, wherein the coating as anti-reflection of the vitrectomy lens ( 1 ) is executed. Contraption ( 101 - 113 ) according to claim 11 or 12, wherein the coating suppresses the transmission of light of certain wavelengths. Contraption ( 101 - 113 ) according to one of claims 11 to 13, wherein the coating is designed such that it suppresses the wavelengths of the light used to excite a dye, so that only the fluorescent light of the dye passes to the viewer. Contraption ( 101 - 113 ) according to one of the preceding claims, wherein the at least one light source ( 2 ) Generates light with specific wavelengths for exciting dyes. Contraption ( 101 - 113 ) according to one of the preceding claims, wherein a plurality of light sources ( 2 . 2 ' . 2 '' ) Generate light of different wavelengths. Contraption ( 101 - 113 ) according to claim 16, wherein in a mixture of the light sources ( 2 . 2 ' . 2 '' ) produces a spectrally homogeneous white light. Contraption ( 101 - 113 ) according to claim 16 or 17, wherein the light sources ( 2 . 2 ' . 2 '' ) are driven in such a way that optionally white light or light of a certain wavelength range is generated. Contraption ( 101 - 113 ) according to one of claims 16 to 18, wherein the power of the light sources ( 2 . 2 ' . 2 '' ) is separately adjustable so that the intensities of different wavelengths are separately adjustable. Contraption ( 101 - 113 ) according to any one of claims 16 to 19, wherein the light sources ( 2 . 2 ' . 2 '' ) are controlled in such a way that light of different wavelengths, in particular alternating white light and light for fluorescence excitation, is generated in a predetermined temporal pattern. Contraption ( 101 - 113 ), comprising: a vitrectomy lens ( 1 ), which is intended to be placed and held by hand on one eye, and several light sources ( 2 . 2 ' . 2 '' ) which are arranged such that the light sources ( 2 . 2 ' . 2 '' ) generated light via the Vitrektomielinse ( 1 ) in the eye, the light sources ( 2 . 2 ' . 2 '' ) into the vitrectomy lens ( 1 ) or a retaining ring ( 4 ), the Vitrectomielinse ( 1 ), are incorporated and the light sources ( 2 . 2 ' . 2 '' ) Generate light of different wavelengths and are controlled in such a way that either white light or light for fluorescence excitation is generated.

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