Method for removal of retained lens fragments using small diameter fragmatome

Abstract

A medical instrument is disclosed, comprising a tubular member with proximal and distal ends. The distal end of the tubular member provides an elongated section having a substantially constant outside diameter of no more than 23-gauge (about 0.57 mm). The tubular member is in energy communication with an emulsification energy source disposed to deliver emulsification energy at the distal end of the tubular member. The tubular member may also be in suction communication with a suction source disposed to deliver suction at the distal end of the tubular member. The medical instrument may be used in a method to remove lens fragments from the eye, through incisions in the eye that are small enough not to require suturing after the operation.

1 . A method for removing at least one lens fragment from within an eye, the method comprising the steps of:
 (a) making incisions in the eye, each incision no larger than about 0.8 mm;   (b) inserting a fragmatome through a first one of the incisions, the fragmatome no larger than 23-gauge;   (c) using the fragmatome to emulsify the at least one lens fragment into a plurality of emulsified fragments; and   (d) aspirating ones of the plurality of emulsified fragments from the eye.   
     
     
         2 . The method of  claim 1 , in which step (b) further includes the substep of inserting a trochar into the first one of the incisions prior to inserting the fragmatome therethrough, the trochar suitable to port instrumentation of a diameter of at least 23-gauge. 
     
     
         3 . The method of  claim 1 , in which step (d) includes the substeps of (i) withdrawing the fragmatome and then inserting a vitrector through the first one of the incisions, the vitrector no larger than 23-gauge, and (ii) using the vitrector to aspirate ones of the plurality of emulsified fragments from the eye. 
     
     
         4 . The method of  claim 1 , in which step (d) includes the substeps of (i) withdrawing the fragmatome and then inserting a suction tube through the first one of the incisions, the suction tube no larger than 23-gauge, and (ii) using the suction tube to aspirate ones of the plurality of emulsified fragments from the eye. 
     
     
         5 . The method of  claim 1 , in which step (b) further includes, prior to inserting the fragmatome through the first one of the incisions, the substeps of (i) inserting a vitrector through the first one of the incisions, the vitrector no larger than 23-gauge, (ii) using the vitrector to aspirate vitreous from around the at least one lens fragment, and (iii) withdrawing the vitrector from the first one of the incisions. 
     
     
         6 . The method of  claim 5 , in which step (b) further includes, prior to inserting the fragmatome through the trochar, the substeps of (i) inserting a vitrector through the trochar, the vitrector no larger than 23-gauge, (ii) using the vitrector to aspirate vitreous from around the at least one lens fragment, and (iii) withdrawing the vitrector from the trochar. 
     
     
         7 . The method of  claim 1 , in which step (c) further includes the substep of impaling the at least one lens fragment with the fragmatome prior to using the fragmatome to emulsify the at least one lens fragment. 
     
     
         8 . A method for removing at least one lens tissue fragment from within an eye, the method comprising the steps of:
 (a) making first, second and third incisions in the eye, the incisions each no larger than about 0.8 mm;   (b) inserting an infusion cannula into the first incision, the infusion cannula no larger than 23-gauge;   (c) inserting a light pipe into the second incision, the light pipe no larger than 23-gauge;   (d) inserting a vitrector into the third incision, the vitrector no larger than 23-gauge;   (e) using the vitrector to aspirate vitreous immediately surrounding the at least one lens tissue fragment situated within the eye;   (f) withdrawing the vitrector from the third incision and inserting a fragmatome into the eye through the third incision, the fragmatome no larger than 23-gauge;   (g) using the fragmatome to emulsify the at least one lens tissue fragment within the eye into a plurality of emulsified fragments;   (h) withdrawing the fragmatome from the third incision and then inserting the vitrector through the third incision; and   (i) aspirating ones of the plurality of emulsified fragments from the eye through the vitrector.   
     
     
         9 . The method of  claim 8 , in which step (a) further includes the substep of inserting a trochar into ones of the first, second and third incisions prior to inserting instrumentation into the eye, the trochars suitable to port 23-gauge instrumentation. 
     
     
         10 . The method of  claim 8 , in which steps (h) and (i) are substituted for the step of:
 (h) aspirating ones of the emulsified fragments from the eye through the fragmatome.   
     
     
         11 . The method of  claim 8 , in which steps (h) and (i) are substituted for the steps of:
 (h) withdrawing the fragmatome from the third incision and then inserting a suction tube through the third incision; and   (i) aspirating ones of the plurality of emulsified fragments from the eye through the suction tube.   
     
     
         12 . The method of  claim 8 , in which steps (d), (e) and (f) are substituted for the single step of inserting a fragmatome into the eye through the third incision, the fragmatome no larger than 23-gauge. 
     
     
         13 . The method of  claim 8 , in which step (g) further includes the substep of impaling the at least one lens fragment with the fragmatome prior to using the fragmatome to emulsify the at least one lens fragment.