Treatment of age-related macular degeneration

Abstract

Age-related macular degeneration is treated by radiation delivered from a miniature x-ray tube inserted via a catheter around the globe of the eye, to a position behind the macula. The process can employ an applicator with several parallel guides, inserted around the eye to receive the catheter with x-ray tube (or an isotope) at a matrix of different positions. Methods are described for properly locating the catheter and x-ray tube, using illumination on the catheter and viewing through the front of the eye, or sensors on the catheter and a scanned beam shone from the front of the eye. Fluorescent material excited by x-rays can also be used. Also described are methods and devices for immobilizing the probe once properly located in the eye, for standoff of the x-ray tube from the target tissue, and for achieving prescription radiation dose in the choroid while eliminating dose to adjacent tissues. The x-ray treatment can be enhanced using a radiosensitizing drug, and can be combined with PDT.

1 - 43 . (canceled)  
   
   
       44 . A method for inserting and correctly locating an applicator having parallel guides by insertion peripherally around the globe of the eye, for therapeutic treatment of the eye, comprising locating the applicator behind the macular region by activating light sources on the applicator, and viewing the light sources using an optical instrument from the front of the eye, the light sources being visible through the sclera, choroid and retina.  
   
   
       45 . The method of  claim 44 , wherein the light sources at the probe or applicator comprise optical fibers receiving light from a source of illumination at a console to which the fibers are connected.  
   
   
       46 . The method of  claim 45 , wherein the optical fibers have angularly cleaved ends as said light sources of the probe or applicator.  
   
   
       47 . A method for inserting and correctly locating a therapeutic probe or applicator by insertion around the globe of the eye, for therapeutic treatment of the eye, comprising locating the distal end of the probe or applicator behind the macular region by directing a preselected pattern of light toward the retina from the front of the eye, and detecting the pattern of light using detectors located near the distal end of the probe or applicator, in such a way as to indicate a direction of movement for correction of the position of the probe or applicator.  
   
   
       48 . The method of  claim 47 , wherein the pattern of light comprises repeated expanding rings of light.  
   
   
       49 . The method of  claim 47 , wherein the pattern of light comprises a grid of light lines illuminated sequentially.  
   
   
       50 . The method of  claim 47 , wherein the pattern of light comprises a color gradation pattern, with color indicating location.  
   
   
       51 . The method of  claim 47 , wherein the pattern of light comprises a moving pattern of light and the method includes temporally sensing the position of the probe or applicator by reference to the moving pattern.  
   
   
       52 . A method for inserting and correctly locating a therapeutic probe or applicator by insertion peripherally around the globe of the eye, for therapeutic treatment of the eye, comprising locating the distal end of the probe or applicator by a protrusion in the surface of the probe or applicator, near its distal end, and the method including viewing the retina from the front of the eye as the probe or applicator is inserted, thus observing a protrusion in the retina caused by the protrusion on the probe or applicator, until the probe or applicator is properly positioned.  
   
   
       53 - 62 . (canceled)