Methods and Apparatuses for the Treatment of Glaucoma using visible and infrared ultrashort laser pulses

Abstract

Transcorneal and fiberoptic laser delivery systems and methods for the treatment of eye diseases wherein energy is delivered by wavelengths transparent to the cornea to effect target tissues in the eye for the control of intraocular pressure in diseases such as glaucoma by delivery systems both external to and within ocular tissues. External delivery may be effected under gonioscopic control. Internal delivery may he controlled endoscopically or fiberoptically, both systems utilizing femtosecond laser energy to excise ocular tissue. The femtosecond light energy is delivered to the target tissues to be treated to effect precisely controlled photodisruption to enable portals for the outflow of aqueous fluid in the case of glaucoma in a manner which minimizes target tissue healing responses, inflammation and scarring.

1 . A method of creating an opening in the trabecular meshwork of an eye of a patient, comprising:
 producing ultrashort laser pulses whose fundamental wavelength is in the range of infrared through visible light;   propagating the ultrashort laser pulses through a high numerical aperture optic so as to produce a focused beam of light; and   guiding the beam of light through the eye tissue enclosing the anterior chamber of the eye to focus at a selected location on the trabecular meshwork of the eye.   
     
     
         2 . An apparatus for creating an opening in the trabecular meshwork of an eye of a patient, comprising:
 an ultrashort pulse generating laser having a fundamental wavelength in the range of infrared through visible light;   a high numerical aperture optic coupled to the laser to produce a focused beam of ultrashort pukes generated by the laser;   a goniolens adapted to be fixedly attached to the cornea of an eye; and   a guidance optic fixedly attached to the goniolens for guiding the beam of ultrashort laser pulses; and   a guidance system connected to the guidance optic to move the optic and thereby guide the beam through the eye tissue enclosing the anterior Chamber of the eye to focus at a selected location on the trabecular meshwork of the eye.   
     
     
         3 . The apparatus of  claim 2  further comprising a goniolens mechanical stabilization system having prongs that attach to the cornea. 
     
     
         4 . The apparatus of  claim 2  further comprising goniolens mechanical stabilization system having prongs that attach to the limbus region 
     
     
         5 . A method of creating and maintaining an opening in a trabecular meshwork of a patient's eye to conduct fluid from an anterior chamber to Schlemm's canal of the eye, comprising:
 passing one end of a fiberoptic element through a small perforation in an outermost encapsulating tissue of the eyeball until said one end of said fiberoptic element penetrates into the eye's anterior chamber;   immobilizing and stabilizing said fiberoptic element to maintain precise focus to the target tissue, or   transocularly advancing said one end of the fiberoptic element through the said anterior chamber until the penetrating end of said fiberoptic element is juxtaposed immediately adjacent targeted eye tissue to be treated; and   coupling the opposite end of said fiberoptic element to a photodisruptive laser emitting radiation selected from the class consisting of (1) visible or infrared femtosecond laser radiation having a wavelength of 0.4 to 2.5 microns and at a fluence level sufficient to produce tissue disruption and focusing   the radiation being emitted from the tip of the fiberoptic element upon the target tissue; and   subjecting the adjacent targeted tissue to photodisruption from the radiation while maintaining the end of said fiberoptic element to effect photochemical removal of said target tissue.   
     
     
         6 . The method of  claim 5  wherein the targeted tissue is intermediate an irido-corneal angle of the eye at a level of trabecular meshwork tissue thereof. 
     
     
         7 . The method of  claim 5  comprising applying the laser pulses to form at least one of a drain channel or a humor outflow opening. 
     
     
         8 . The method of  claim 5  wherein the photodisruptive laser is selected from the class emitting (1) visible femtosecond radiation having a wavelength of between about 0.4-1.4 micron and (2) infrared femtosecond radiation having a wavelength of 1.5 to 2.5 microns. 
     
     
         9 . A method of creating and maintaining an opening in a trabecular meshwork of a patient's eye to conduct fluid from an anterior chamber to Schlemm's canal of the eye, comprising:
 focusing the laser beam transcorneal under gonioscopic control on the target tissue;   coupling the opposite end of the optical pathway to a photodisruptive laser emitting radiation selected from the class consisting of (1) visible or infrared femtosecond laser radiation having a wavelength of 0.4 to 2.5 microns and at a fluence level sufficient to produce photochemical tissue disruption and focusing the radiation upon the target tissue and   subjecting the targeted tissue to photodisruption from the laser radiation such that photodisruption is patterned to effect tissue removal with minimal surrounding tissue perturbation.   
     
     
         10 . The method of  claim 9  wherein the targeted tissue is intermediate an irido-corneal angle of the eye at a level of trabecular meshwork tissue thereof. 
     
     
         11 . The method of  claim 9  comprising applying the laser pulses to form at least one of a drain channel or a humor outflow opening. 
     
     
         12 . A method for surgical treatment of the eye by laser radiation comprising the steps of:
 passing one end of a fiberoptic element through a small perforation in an outermost encapsulating tissue of the eyeball until said one end of said fiberoptic element penetrates into the eye's anterior chamber;   immobilizing and stabilizing said fiberoptic element to maintain precise focus to the target tissue; or   transocularly advancing said one end of the fiberoptic element through the said anterior chamber until the penetrating end of said fiberoptic element is juxtaposed immediately adjacent targeted eye tissue to be treated; and   coupling the opposite end of said fiberoptic element to a photodisruptive laser emitting radiation selected from the class consisting of (1) visible or infrared femtosecond laser radiation having a wavelength of 0.4 to 2.5 microns and at a fluence level sufficient to produce tissue disruption and focusing   the radiation being emitted from the tip of the fiberoptic element upon the target tissue; and   subjecting the adjacent targeted tissue to photodisruption from the radiation while maintaining the end of said fiberoptic element to effect removal of said target tissue.   
     
     
         13 . A method for surgical treatment of the eye by laser radiation comprising the steps of:
 focusing the laser beam transcorneal under gonioscopic control on the target tissue;   coupling the opposite end of the laser optic to a photodisruptive laser emitting radiation selected from the class consisting of (1) visible or infrared femtosecond laser radiation having a wavelength of 0.4 to 2.5 microns and at a fluence level sufficient to produce tissue disruption and focusing the radiation   being emitted upon the target tissue; and   subjecting the targeted tissue to photodisruption from the laser radiation, such that photodisruption is patterned to effect tissue removal with minimal surrounding tissue perturbation.   
     
     
         14 . The method of  claim 13  wherein the duration of each laser pulse is in the range of approximately 20 fs-300 ps. 
     
     
         15 . The method of  claim 14  whereby a transcorneal delivery system effects the outflow of aqueous humor through the trabecular meshwork, juxtacanalicular trabecular meshwork and inner wall of Schlemm's canal. 
     
     
         14 . The method of  claim 13  whereby a transcorneal delivery system effects the outflow of aqueous humor through the trabecular meshwork, juxtacanalicular trabecular meshwork and inner wall of Schlemm's canal. 
     
     
         15 . A method of using an optical coupling to enable controlled photodisruptions at the target tissue 
     
     
         16 . The method of  claim 15 , wherein the coupling system of the goniolens controls the intraocular pressure in targeting Schlemm's canal, 
     
     
         17 . The method of  claim 11  where Schlemm's canal is detected optically or by optical coherence tomography (OCT) or by photoaccoustic spectroscopy.