Method and device for preventing or reducing proliferation or migration of epithelial cells at the inside of a lens-capsule bag of a human or animal eye

Abstract

The invention relates to a device for preventing or reducing proliferation or migration of epithelial cells at the inside of a lens capsule bag of a human or animal eye. The device comprises means for generating pressure pulses in a liquid medium inside the lens capsule bag during which the liquid medium is adjacent to or covers the epithelial cells to be removed. These pressure pulses are selected or provided in such a manner that the epithelial cells can be or are removed from the wall of the lens capsule bag by the impinging pressure pulses whereby, at the same time, no opening or comparable damage, in particular, caused by the pressure pulses occurs in the wall of the lens capsule bag when removing the epithelial cells. the invention relates to a device for preventing or reducing proliferation or migration of epithelial cells at the inside of a lens capsule bag of a human or animal eye. The device comprises means for generating pressure pulses in a liquid medium inside the lens capsule bag during which the liquid medium is adjacent to or covers the epithelial cells to be removed. These pressure pulses are selected or provided in such a manner that the epithelial cells can be or are removed from the wall of the lens capsule bag by the impinging pressure pulses whereby, at the same time, no opening or comparable damage, in particular, caused by the pressure pulses occurs in the wall of the lens capsule bag when removing the epithelial cells.

1 . Method for preventing or reducing proliferation or migration of epithelial cells at the inside of a lens-capsule bag of a human or animal eye comprising the step of 
 a) generating pressure pulses in a fluid medium within the lens-capsule bag, such that the fluid medium is adjacent to or covers the epithelial cells, which pressure pulses impact on the epithelial cells,    b) detaching epithelial cells from the wall of the lens-capsule bag and/or inhibiting epithelial cells which remain at the wall of the lens-capsule bag by the impacting pressure pulses, so that the detached or inhibited epithelial cells are prevented from proliferating or migrating at the inside of the lens-capsule bag,    c) wherein the pressure pulses are so formed or selected that, during detaching or inhibiting of the epithelial cells no hole or comparable damage is produced in the wall of the lens-capsule bag by the pressure pulses.    
     
     
         2 . Method according to  claim 1 , in which the pressure pulses each comprise a pressure current and/or a pressure wave and/or a shock wave and/or in which the pressure pulses have the form of a pressure jet of the fluid medium that is or can be directed onto the epithelial cells, and/or exhibit at least one preferential direction or main propagation direction.  
     
     
         3 . Method according to  claim 1 , in which the pressure pulses are generated in at least one pulse-output region in the fluid medium within the lens-capsule bag, in which preferably the pressure pulses propagate substantially radially outward from the pulse-output region.  
     
     
         4 . Method according to  claim 3 , in which the maximal pressure of the pressure pulses at a prespecified or prespecifiable distance from the associated pulse-output region can be or is adjusted so as to be below or at most coincident with at least one prespecified or prespecifiable maximal pressure value that is above the atmospheric pressure, wherein preferably the prespecified maximal pressure value of the pressure pulses decreases with increasing distance from the associated pulse-output region and/or the maximal pressure value of the pressure pulses at a prespecified or prespecifiable distance, in particular at a distance of 0.5 mm, from the pulse-output region is in a range from 50 bar to 1,000 bar, in particular in a range between 50 bar and 300 bar.  
     
     
         5 . Method according to  claim 3 , in which by at least one pressure pulse practically all epithelial cells ate detached from or inhibited in an area or region of the lens-capsule bag that depends on a prespecified or prespecifiable distance of the epithelial cells from the pulse-output region and/or in which by at least one pressure pulse practically all epithelial cells are detached from or inhibited in an area or region the lens-capsule bag of about 0.5 mm 2  to about 15 mm 2  when the prespecified or prespecifiable distance of the epithelial cells from the pulse-output region is about 1 mm or of about 0.1 mm 2  to about 12 mm 2  when the prespecified or prespecifiable distance of the epithelial cells from the pulse-output region is about 4 mm.  
     
     
         6 . Method according to  claim 3 , in which, when the prespecified or prespecifiable distance from the pulse-output region is 4 mm, a pressure pulse removes or inhibits epithelial cells in an area of the lens-capsule bag that is about 10% to about 80%, in particular 20% to 60%, smaller than when the distance is 1 mm.  
     
     
         7 . Method according to  claim 3 , in which at least one pulse-output region within the lens-capsule bag is adjusted and/or moved to set the prespecified or prespecifiable distance of the pulse-output region from the epithelial cells, preferably to at least two different prespecified or prespecifiable positions within the lens-capsule bag, and in which in each of these prespecified or prespecifiable positions at least one pressure pulse is generated, wherein preferably at least two of the prespecified or prespecifiable positions of the pulse-output region are situated so as to be offset from one another along the inside of the lens-capsule bag and/or are at the same distance from the epithelial cells.  
     
     
         8 . Method according to  claim 1 , in which the pulse repetition rate of the pressure pulses can be adjusted within a prespecified range by an operating person employing at least one input unit and/or in which the pulse repetition rate of the pressure pulses and/or the adjustable range of the pulse repetition rate of the pressure pulses is selected or adjusted or adjustable in such a way that the wall of the capsule bag, after a pressure pulse, can become sufficiently relaxed or can or does enter a low-tension state by the time the next pressure-pulse occurs and/or in which the pulse repetition rate of the pressure pulses is at most 10 or 4 or 2 pulses or 1 pulse per second, and/or in which the adjustable range of the pulse repetition rate of the pressure pulses extends to 10 or 4 or 2 or 1 pulses per second and/or in which the pulse repetition rate of the pressure pulses is above 1 pulses per second, and/or the adjustable range of the pulse repetition rate of the pressure pulses extends to minimally 1 pulses per second.  
     
     
         9 . Method according to  claim 1  carried out during or after a cataract operation at the eye to reduce the risk of a secondary cataract.  
     
     
         10 . Method according to  claim 1 , in which pressure pulses are generated by irradiating a target with laser radiation and causing a shock wave by optical breakdown generated by absorption at the target material, wherein preferably the laser radiation is pulsed, with a pulse duration between 5 ns and 20 ns, preferably from 8 ns to 12 ns, and/or with a pulse energy between 1 and 20 mJ, preferably between 6 and 10 mJ, such that each laser pulse generates at least one pressure pulse.  
     
     
         11 . Method according to  claim 1 , in which the lens-capsule bag is filled, at least predominantly, with the fluid medium and/or further comprising introducing fluid medium into the lens-capsule bag, preferably directly into the lens-capsule bag.  
     
     
         12 . Device for preventing or reducing of proliferation or migration of epithelial cells at the inside of a lens-capsule bag of a human or animal eye, comprising: 
 a) means for generating pressure pulses in a fluid medium within the lens-capsule bag, such that the fluid medium is adjacent to or covers the epithelial cells,    b) wherein the pressure pulses are so formed or selected    b1) that epithelial cells can be or are detached from the wall of the lens-capsule bag by the impacting pressure pulses and/or that epithelial cells which remain at the wall of the lens-capsule bag can be or are inhibited by the impacting pressure pulses, and at the same time    b2) no hole or comparable damage is produced in the wall of the lens-capsule bag by the pressure pulses.    
     
     
         13 . Device according to  claim 12 , in which the pressure pulses each comprise a pressure current and/or a pressure wave and/or a shock wave and/or in which the pressure pulses have the form of a pressure jet of the fluid medium that is or can be directed onto the epithelial cells, and/or exhibit at least one preferential direction or main propagation direction.  
     
     
         14 . Device according to  claim 12 , in which the means for generating the pressure pulses generate the pressure pulses in at least one pulse-output region in the fluid medium within the lens-capsule bag, in which preferably the pressure pulses propagate substantially radially outward from the pulse-output region.  
     
     
         15 . Device according to  claim 12 , in which the maximal pressure of the pressure pulses at a prespecified or prespecifiable distance from the associated pulse-output region can be or is adjusted so as to be below or at most coincident with at least one prespecified or prespecifiable maximal pressure value that is above the atmospheric pressure, wherein preferably the prespecified maximal pressure value of the pressure pulses decreases with increasing distance from the associated pulse-output region and/or the maximal pressure value of the pressure pulses at a prespecified or prespecifiable distance, in particular at a distance of 0.5 mm, from the pulse-output region is in a range from 100 bar to 1,000 bar, in particular in a range between 150 bar and 300 bar.  
     
     
         16 . Device according to  claim 15 , in which control means are provided with which to adjust and/or move at least one pulse-output region within the lens-capsule bag to set the prespecified or prespecifiable distance of the pulse-output region from the epithelial cells, wherein preferably the control means adjust the pulse-output region to at least two different prespecified or prespecifiable positions within the lens-capsule bag, and drive the means for generating the pressure pulses in such a way that in each of these prespecified or prespecifiable positions at least one pressure pulse is generated, wherein preferably at least two of the prespecified or prespecifiable positions of the pulse-output region are situated so as to be offset from one another along the inside of the lens-capsule bag and/or are at the same distance from the epithelial cells.  
     
     
         17 . Device according to  claim 12 , in which the pulse repetition rate of the pressure pulses can be adjusted within a prespecified range by an operating person employing at least one input unit and/or in which the pulse repetition rate of the pressure pulses and/or the adjustable range of the pulse repetition rate of the pressure pulses is selected or adjusted or adjustable in such a way that the wall of the capsule bag, after a pressure pulse, can become sufficiently relaxed or can or does enter a low-tension state by the time the next pressure-pulse occurs and/or in which the pulse repetition rate of the pressure pulses is at most 10 or 4 or 2 or 1 pulses per second, and/or the adjustable range of the pulse repetition rate of the pressure pulses for removing the epithelial cells extends to 10 or 4 or 2 or 1 pulses per second and/or in which the pulse repetition rate of the pressure pulses is above 1 pulse per second, and/or the adjustable range of the pulse repetition rate of the pressure pulses extends to minimally 1 pulse per second.  
     
     
         18 . Device according to  claim 12 , in which the means for generating the pressure pulses comprise at least one pressure-pulse generator that is or can be coupled to the fluid medium and/or the pulse-output region, in particular by way of a pulse-transmission line, wherein in particular the at least one pressure-pulse generator generates a plasma which in turn generates at least one pressure pulse in the fluid medium.  
     
     
         19 . Device according to  claim 18 , in which the pressure-pulse generator comprises at least one laser to produce, in general pulsed, laser radiation and at least one target toward which the laser radiation is aimed, and the laser radiation is selected such that as a result of optical breakdown generated by absorption at the target material a shock wave or a pressure pulse is generated, wherein preferably the means for producing the pressure pulses comprise at least one light guide to transmit the laser radiation to the target material, such that preferably a free end of the light guide is so disposed that the emerging laser radiation passes through an intervening space and strikes the target material directly, wherein preferably the space intervening between the free end of the light guide and the target material is in communication with the fluid medium and/or is or can be filled therewith and/or in which preferably the laser radiation is pulsed, with a pulse duration between 5 ns and 20 ns, preferably from 8 ns to 12 ns, and/or with a pulse energy between 1 and 20 mJ, preferably between 6 and 10 mJ, such that each laser pulse generates at least one pressure pulse.  
     
     
         20 . Device according to  claim 12 , in which the means for generating the pressure pulses or the pressure-pulse generator comprise at least one of a piezoelectric element, for example a piezoceramic element, an electric spark-discharge device for producing a pressure or shock wave or a pressure pulse, an electromagnetic or inductive pressure-impact or pressure-surge source and a drivable membrane.  
     
     
         21 . Device according to  claim 12 , in which the means for generating the pressure pulses comprise at least one instrument that can be or is inserted into the lens-capsule bag.  
     
     
         22 . Device according to  claim 21 , in which the instrument generates the pressure pulses in the at least one pulse-output region in the fluid medium within the lens-capsule bag, wherein preferably the pulse-output region is formed by or at an exit opening in a wall in the instrument, in particular in the region of a free end of the instrument, and/or in which the instrument is made flexible and/or bendable at least in the end region that can be or is inserted into the lens-capsule bag and in or at which the pulse-output region is disposed and/or comprising several instruments that are differently constructed, in particular exhibit different curvatures or lengths, at least in their end regions that can be or are inserted into the lens-capsule bag and in or at which the pulse-output region is disposed.  
     
     
         23 . Device according to  claim 21  in which a pressure-pulse generator is disposed in an interior space of the instrument that is enclosed by its wall, and the pressure pulses emerge to the exterior, in particular into the lens-capsule bag, by way of the exit opening.  
     
     
         24 . Device according to  claim 21 , in which the instrument comprises at least one preferential direction or main propagation direction for the pressure current and/or pressure wave, and with this preferential direction or main propagation direction can be or is directed towards the epithelial cells and/or in which the instrument comprises at least one channel for transporting fluid medium and at least one outlet for the fluid medium, into which the channel opens and/or in which the interior of the instrument is closed in a pressure-tight manner at a side away from the exit opening and/or no means for producing a low pressure are attached.  
     
     
         25 . Device according to  claim 12 , comprising an imaging means to produce an image of at least the region of the lens-capsule bag where the epithelial cells to be removed or inhibited are located, or from which they have been removed or in which they are inhibited, wherein the imaging means preferably comprise an endoscope.  
     
     
         26 . Device according to  claim 21 , comprising an imaging means to produce an image of at least the region of the lens-capsule bag where the epithelial cells to be removed or inhibited are located, or from which they have been removed or in which they are inhibited, wherein the imaging means comprise an endoscope, wherein the endoscope is integrated into the instrument and/or the instrument together with the endoscope constitutes a structural unit.  
     
     
         27 . Device according to  claim 12 , in which the lens-capsule bag is filled, at least predominantly, with the fluid medium and/or further comprising introducing means to introduce fluid medium into the lens-capsule bag, preferably directly into the lens-capsule bag, wherein preferably the introducing means conduct the fluid medium to the means for generating the pressure pulses.  
     
     
         28 . Device for removing epithelial cells from the inside of a lens-capsule bag of a human or animal eye, comprising: 
 a) means for generating pressure pulses in a fluid medium within the lens-capsule bag, such that the fluid medium is adjacent to or covers the epithelial cells that are to be removed,    b) wherein the pressure pulses are so formed or selected that    b1) the epithelial cells can be or are detached from the wall of the lens-capsule bag by the impacting pressure pulses, and at the same time    b2) during removal of the epithelial cells no hole or comparable damage is produced in the wall of the lens-capsule bag, in particular by the pressure pulses.