U.S. patent application number 13/867783 was filed with the patent office on 2013-11-21 for retinal instrument.
This patent application is currently assigned to University of Tennessee Research Foundation. The applicant listed for this patent is University of Tennessee Research Foundation, UT-Battelle, LLC. Invention is credited to Justin S. BABA, Charles L. BRITTON, Edward CHAUM, Brian R. D'URSO, M. Nance ERICSON, John T. SIMPSON, Robert J. WARMACK.
Application Number | 20130310861 13/867783 |
Document ID | / |
Family ID | 41089663 |
Filed Date | 2013-11-21 |
United States Patent
Application |
20130310861 |
Kind Code |
A1 |
BRITTON; Charles L. ; et
al. |
November 21, 2013 |
RETINAL INSTRUMENT
Abstract
In one embodiment, the present invention provides a method of
removing scar tissue from an eye that includes inserting a device
including an array of micro-rods into an eye, wherein at least one
glass micro-rod of the array of glass micro-rods includes a sharp
feature; contacting a scar tissue with the array of micro-rods; and
removing the array of micro-rods and the scar tissue from the eye.
In another embodiment, the present invention provides a medical
device for engaging a tissue including and an array of glass
micro-rods, wherein at least one glass micro-rod of the array of
glass micro-rods includes a sharp feature opposite a base of the
array of glass micro-rods that is connected to the cannula, wherein
the sharp feature of the at least one micro-rod is angled from a
plane that is normal to a face of the base of the array of glass
micro-rods.
Inventors: |
BRITTON; Charles L.; (Alcoa,
TN) ; D'URSO; Brian R.; (Clinton, TN) ; CHAUM;
Edward; (Memphis, TN) ; SIMPSON; John T.;
(Clinton, TN) ; BABA; Justin S.; (Knoxville,
TN) ; ERICSON; M. Nance; (Knoxville, TN) ;
WARMACK; Robert J.; (Knoxvile, TN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
UT-Battelle, LLC;
University of Tennessee Research Foundation; |
|
|
US
US |
|
|
Assignee: |
University of Tennessee Research
Foundation
Knoxvilee
TN
UT-Battelle, LLC
Oak Ridge
TN
|
Family ID: |
41089663 |
Appl. No.: |
13/867783 |
Filed: |
April 22, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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12052992 |
Mar 21, 2008 |
8425596 |
|
|
13867783 |
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Current U.S.
Class: |
606/162 |
Current CPC
Class: |
A61B 17/205 20130101;
A61F 9/00727 20130101; A61F 9/00736 20130101; A61F 9/007
20130101 |
Class at
Publication: |
606/162 |
International
Class: |
A61F 9/007 20060101
A61F009/007 |
Goverment Interests
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
[0002] This invention was made with Government support under
Contract No. DE-AC05-000R22725 awarded by the United States
Department of Energy. The Government has certain rights in this
invention.
Claims
1. A medical device for engaging a tissue comprising: a cannula;
and an array of glass micro-rods, wherein at least one glass
micro-rod of the array of glass micro-rods includes a sharp feature
opposite a base of the array of glass micro-rods that is connected
to the cannula, wherein the sharp feature of the at least one
micro-rod is angled from a plane that is normal to the base of the
array of glass micro-rods.
2. The medical device of claim 1, wherein the tissue that is
engaged by the array of glass micro-rods is scar tissue present on
a retina of an eye.
3. The medical device of claim 1, wherein the sharp feature of the
at least one micro-rod further comprises a barb.
4. The medical device of claim 1, wherein the glass micro-rods
comprise a silica containing material.
5. The medical device of claim 4, wherein the silica containing
material comprises sodium silicate glass, boro silicate glass or
leaded glass.
6. The medical device of claim 1, wherein the at least one
glass-micro-rod has a length of less than 60 microns.
7. The medical device of claim 1, wherein the array of glass
micro-rods includes a plurality of glass micro-rods, wherein
adjacent glass micro-rods are separated by a distance ranging from
about 5 microns to about 40 microns.
8. The medical device of claim 1, wherein the base of the array of
the glass micro-rods has a substantially circular geometry or a
multi-faced geometry.
9. The medical device of claim 1, wherein the sharp feature of the
at least one micro-rod is angled from the plane that is normal to
the base of the array of glass micro rods, by an angle ranging from
about 0 to about 70 degrees.
10. The medical device of claim 1, wherein the array of glass
micro-rods comprises a plurality of glass micro-rods of uniform
length.
11. A method of removing scar tissue from an eye comprising:
inserting a device comprising an array of micro-rods into an eye,
wherein at least one glass micro-rod of the array of micro-rods
includes a sharp feature; engaging the scar tissue or underlying
tissue on which the scar tissue is present with the array of
micro-rods; and removing the array of micro-rods and the scar
tissue or the underlying tissue on which the scar tissue is present
from the eye.
12. The method of claim 11, wherein the scar tissue is present on a
retina of the eye and removing the scar tissue from the eye
includes removing the scar tissue from the retina.
13. The method of claim 12, further comprising measuring the
thickness of the scar tissue before inserting the device comprising
the array of glass micro-rods into the eye, and providing an array
of micro-rods having a micro-rod length that is less than or equal
to the thickness of the scar tissue.
14. The method of claim 12, wherein the measuring of the thickness
of the scar tissue comprises optical coherence tomography (OCT) or
Heidelberg retinal tomopgrapy.
15. The method of claim 12, wherein the device further includes a
cannula engaged to a base of the array of glass micro-rods, wherein
the sharp feature is opposite the base of the array of glass
micro-rods, wherein the sharp feature of the at least one glass
micro-rod is angled from a plane that is normal to a face of the
base of the array of glass micro-rods.
16. The method of claim 12, wherein the engaging of the scar tissue
or the underlying tissue on which the scar tissue is present with
the sharp feature of the array of glass micro-rods comprises
rotating the array of glass micro-rods about an axis that is
substantially perpendicular to the surface of the scar tissue.
17. The method of claim 12, wherein the array of glass micro-rods
comprise a silicon containing material.
18. The method of claim 12, wherein the at least one
glass-micro-rod has a length of less than 40 microns.
19. The method of claim 12, wherein the array of glass micro-rods
includes a plurality of glass micro-rods, wherein adjacent glass
micro-rods are separated by a distance ranging from about 5 microns
to about 40 microns.
20. The method of claim 12, wherein the base of the array of the
glass micro-rods has a substantially circular geometry or a
multi-faced geometry.
21. The method of claim 12, wherein the sharp feature of the at
least one glass micro-rod is angled from the plane that is normal
to the face of the base of the array of glass micro rods, by an
angle ranging from about 0 degrees to about 70 degrees.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 12/052,992 to "Retinal Instrument", filed Mar.
21, 2008, the entire content and disclosure of which is
incorporated herein by reference.
FIELD OF THE INVENTION
[0003] The present invention in one embodiment relates to surgical
instruments. In another embodiment, the present invention relates
to a method of removing tissue, such as scar tissue from an
eye.
BACKGROUND OF THE INVENTION
[0004] Repair of macular pucker or epiretinal membrane (ERM) is
accomplished through vitreoretinal surgery. Using microsurgical
instruments, a procedure known as vitrectomy or removal of vitreous
gel from the posterior chamber of the eye is performed. Specialized
microsurgical instruments are then used to gently peel and remove
the scar tissue from the surface of the retina, relieving the
traction and reducing the distortion to the retinal surface. The
membrane peel involves identifying the outer edge of the membrane
and creating a dissection plane with the use of blunt-tipped pic,
bent needle, or diamond dusted silicone cannula. The epiretinal
membrane may be gently lifted off the retinal surface with the use
of a pic or fine forceps. This procedure is relatively straight
forward if the edge of the epiretinal membrane is visible.
[0005] When the edge is difficult to identify the surgeon can
create a slit on the thickest part of the epiretinal membrane with
a straight microvitreoretinal blade and using the opening produced
by this slit as an edge to begin peeling of the epiretinal membrane
from the retina. The peeling is performed moving the forceps in a
circular motion. Petechial hemorrhage along the internal retinal
surface may be seen as the membrane is peeled off the retina.
Significant bleeding may occur when an underlying vessel is damaged
as a strongly adherent epiretinal membrane is peeled from the
retina. Postoperative complications include cystoid macular edema
(CME), retinal phototoxicity, endophthalmitis, subretinal
neovascularization, and recurrent epiretinal membrane.
[0006] An alternative approach that has gained favor since the
introduction of 25-gauge (25g) instrumentation is direct peeling of
the internal limiting membrane of the retina, which may be referred
to as the internal limiting membrane (ILM) peel. The ILM is
innermost surface of the retina and is comprised of a thin lamina.
In an ILM PEEL, an edge in the ILM is created with a sharp
microvitreoretinal blade and an ILM maculorhexis performed with
fine forceps, peeling away both the ILM and the overlying adherent
ERM.
[0007] Removal of epiretinal membrane from the retina by manual
peeling is technically demanding and difficult. The retina is
between 160 microns and 240 microns thick and is generally
transparent. The epiretinal membrane that is grown on the retinal
surface is thinner than the retina typically 10-30 microns thick as
measured by optical coherence tomography (OCT) and is often
friable. This anatomical relationship results in extremely minute
tolerances in manual attempt to engage the membrane. The
application of too much pressure or misalignment of the position of
the tip of the peeling instrument may result in a vision
threatening injury that can result from damaging a portion of the
retina, such as a region of the fovea.
SUMMARY OF THE INVENTION
[0008] The present invention provides medical devices and methods
for removing scarred tissue, particularly scarred tissue from an
eye. The medical devices of the present invention are characterized
by an array of micro-needles or micro-spikes, where the array is
capable of engaging a scar tissue including, for example, engaging
a large area of the scar tissue and to a desirable depth. The
medical devices of the present invention permit removal of the scar
tissue, for example, in a smooth peeling fashion, or "en bloc" by
acting like a surgical Velcro.
[0009] In one embodiment, the method of the present invention
includes: [0010] inserting a device including an array of glass
micro-rods into an eye, at least one of the glass micro-rods
including at least one sharp feature; [0011] contacting a scar
tissue or an underlying tissue on which the scar tissue is present
with the array of glass micro-rods; and [0012] removing the array
of glass micro-rods from the eye, wherein the scar tissue is
engaged to the array of glass micro-rods or the array of glass
micro-rods is engaged to the underlying tissue on which the scar
tissue is present.
[0013] In one embodiment, the scarred tissue that is being removed
from the eye is present on a retina. In one embodiment, the method
further includes measuring the thickness of the scar tissue before
inserting the device including the array of glass micro-rods into
the eye, and providing an array of glass micro-rods having a
micro-rod length that is less than or equal to the thickness of the
scar tissue. In one embodiment, the measuring of the thickness of
the scarred tissue includes optical coherence tomography (OCT) or
Heidelberg retinal tomopgrapy.
[0014] In one embodiment, each of the sharp features of the
plurality of glass micro-rods has a uniform length. The term
uniform length means that the each of the sharp features in the
array of micro-rods has substantially the same length. In one
embodiment, the sharp feature of each glass micro-rod extends has a
length that extends the entire length of the glass micro-rod. In
another embodiment, the sharp feature of each glass micro-rods
extends a portion of the length of the glass micro-rod. In one
embodiment, the length of the sharp features is selected to
penetrate and retain the scar tissue to a fixed depth without
penetrating the underlying tissue of the eye, such as the retina.
In another embodiment, the glass micro-rods of the array of glass
micro-rods has a uniform dimension.
[0015] In one embodiment, the device further includes a cannula
that is engaged to the base of the array of micro-rods. In one
embodiment, in which at least one sharp feature corresponding to
each glass micro-rod of the array of glass micro-rods is opposite
the base of the array of micro-rods, the sharp feature of the at
least one micro-rods is angled from a plane that is normal to a
face of the base of the array of glass micro-rods.
[0016] In another embodiment, the device further includes a cannula
engaged to the base of the array of micro-rods, wherein the length
of the sharp feature is normal to the base of the array of
micro-rods, wherein a plane parallel to the face of the base of the
array of micro-rods that is engaged to the cannula is angled
relative to a direction that is parallel to the length of the
cannula.
[0017] In another embodiment, the device further includes a cannula
engaged to the base of the array of micro-rods, wherein the length
of the sharp feature is normal to the base of the array of
micro-rods, wherein the face of the base of the array of micro-rods
that is engaged to the cannula is angled relative to a direction
that is parallel to the length of the cannula.
[0018] In another embodiment, in which the device further includes
a cannula engaged to the base of the array of micro-rods, the
length of the sharp feature or sharp features is normal to the base
of the array of micro-rods, wherein the face of the base of the
array of micro-rods that is engaged to the cannula is angled
relative to a direction that is parallel to the length of the
cannula, wherein at least a portion of the cannula is curved.
[0019] In one embodiment, contacting the scar tissue or the
underlying tissue on which the scar tissue is present means that
the scar tissue or underlying tissue is engaged by the sharp
feature or sharp features of the at least one glass micro-rod of
the array of glass micro-rods. In one embodiment, the engagement of
the sharp feature or sharp features of the array of glass
micro-rods is a hook type engagement, wherein the length of the
sharp feature or sharp features does not penetrate to a depth that
is greater than the thickness of the scar tissue or underlying
tissue that is being removed. In one embodiment, the sharp feature
or sharp features is an angled sharp feature. In one embodiment,
contacting the scar tissue means that as the array of glass
micro-rods is traversed along a first direction, the angled sharp
features engage the scar-tissue or the underlying tissue on which
the scar tissue is present, wherein the angled sharp features hook
or penetrate into the scar tissue or underlying tissue. In one
embodiment, as the array of glass micro-rods is traversed along a
second direction that is substantially opposed to the first
direction, the array is traversed so that the angled sharp features
of the array of glass micro-rods do not hook or penetrate into the
scar tissue or the underlying tissue on which the scar tissue is
present. Instead, when traversed along the second direction the
sharp features glide atop the scar tissue. This mechanism allows
for the medical device to be selectively positioned on the scar
tissue or the underlying tissue on which the scar tissue is present
without damaging the non-targeted structures of the eye where the
scar tissue is not present, such as the retina, wherein once the
array of glass micro-rods is in the desired location the sharp
features may be engaged to the scar tissue or underlying tissue on
which the scar tissue is present by traversing the array of glass
micro-rods in a direction that enables the angled sharp features to
hook or penetrate into the scar tissue or underlying tissue and
peel the scarred tissue from the eye, e.g., peel the scar tissue
from the retina of the eye.
[0020] In one embodiment, contacting the scar tissue with the array
of micro-rods includes engaging the sharp feature or sharp features
of the micro-rods to a central portion of the scarred tissue. In
this embodiment, in which the micro-rods are oriented in a 30
degree to 45 degree angle circumferentially around the tip of the
instrument, contacting the scar tissue with the array of micro-rods
is achieved by rotating the array of micro-rods about an axis that
is substantially perpendicular to the surface of the scarred
tissue. In one embodiment, removing the scar tissue from the eye
includes peeling the scarred tissue from the retina, which may be
an en-bloc scar tissue removal. By "en bloc" it is meant that the
scarred tissue is removed in a single piece, i.e., in its totality,
as opposed to the scarred tissue being removed in a plurality of
pieces.
[0021] In another aspect of the present invention, a medical device
is provided for removing tissue from an eye that includes an array
of angled glass micro-rods. In one embodiment, the large array of
angled glass micro-rods may be arranged in a pad geometry, and may
be referred to as surgical Velcro. In one embodiment, the large
array of angled glass micro-rods enables the device to be traversed
across the scar tissue in a first direction without engaging the
scar tissue, hence essentially gliding over the scar tissue, and to
engage the scar tissue when traversed along a second direction,
wherein the second direction substantially opposes the first
direction. In one embodiment, the medical device includes: [0022] a
cannula; and [0023] an array of glass micro-rods, wherein at least
one glass micro-rod of the array of glass micro-rods includes a
sharp feature opposite a base of the array of glass micro-rods that
is connected to the cannula, wherein the sharp feature of the at
least one micro-rod is angled from a plane that is normal to a face
of the base of the array of glass micro-rods.
[0024] In one embodiment, the glass micro-rods include a silica
containing material. In one embodiment, the glass composition is a
soda lime silicate, boro silicate, and lead silicate glass. In one
embodiment, the array of glass micro-rods include a plurality of
glass micro-rods, wherein adjacent glass micro-rods are separated
by a distance ranging from about 5 microns to about 40 microns In
one embodiment, at least one of the glass-micro-rods of the array
has a length of less than 30 microns. In one embodiment, the base
of the array of the glass micro-rods has a substantially circular
geometry or a multi-faced geometry.
[0025] In one embodiment, the sharp feature of the at least one
micro-rod is angled to provide a barb. In one embodiment, the sharp
feature of the at least one micro-rod is angled from the plane that
is normal to the face of the base of the array of glass micro rods,
by an angle ranging from about 30 degrees to about 60 degrees.
[0026] In another embodiment, a medical device is provided for
removing tissue from an eye including an array of glass micro-rods
having a sharp feature that is configured to be normal to a base of
the glass mirco-rods, wherein the base of the glass micro-rods is
angled at the attachment of cannula to the array of glass
micro-rods. In one embodiment, the medical device includes:
[0027] a cannula; and
[0028] an array of glass micro-rods, wherein at least one glass
micro-rod of the array of glass micro-rods includes a sharp feature
opposite a base of the array of glass micro-rods that is connected
to the cannula, the sharp feature of the at least one micro-rod is
normal to a face of the base of the array of glass micro-rods,
wherein the face of the base of the array of micro-rods that is
engaged to the cannula is angled relative to a direction that is
parallel to a length of the cannula.
[0029] In another embodiment, a medical device is provided for
removing tissue from an eye including an array of glass micro-rods
having a sharp feature that is configured to be normal to a base of
the glass mirco-rods, wherein the cannula includes a curvature to
angle the array of glass micro-rods. In one embodiment, the medical
device includes:
[0030] a cannula; and
[0031] an array of glass micro-rods, wherein at least one glass
micro-rod of the array of glass micro-rods includes a sharp feature
opposite a base of the array of glass micro-rods that is connected
to the cannula, the sharp feature of the at least one micro-rod is
normal to a face of the base of the array of glass micro-rods,
wherein at least a portion of the cannula is curved.
BRIEF DESCRIPTION OF THE DRAWINGS
[0032] The following detailed description, given by way of example
and not intended to limit the invention solely thereto, will best
be appreciated in conjunction with the accompanying drawings,
wherein like reference numerals denote like elements and parts, in
which:
[0033] FIG. 1 is a pictorial view of one embodiment of a medical
device for removing tissue from an eye, in accordance with the
present invention.
[0034] FIG. 2 is a magnified perspective view of one embodiment of
a glass micro-rod array as used in a medical device for removing
tissue from an eye, in accordance with the present invention.
[0035] FIG. 3 is a side cross sectional view of one embodiment of a
medical device for removing tissue from an eye, in accordance with
the present invention.
[0036] FIG. 4 is a micrograph of one embodiment of a glass
micro-rod array of angled glass micro-rods, in accordance with the
present invention.
[0037] FIG. 5 is a micrograph of another embodiment of a glass
micro-rod array of angled glass micro-rods, in accordance with the
present invention.
[0038] FIG. 6 is a side cross sectional view of another embodiment
of a medical device for removing tissue from an eye, in accordance
with the present invention.
[0039] FIG. 7 is a micrograph of one embodiment of a glass
micro-rod array in which the length of the glass micro-rods is
normal to the base of the array of glass micro-rods, in accordance
with the present invention.
[0040] FIG. 8 is a side cross sectional view of another embodiment
of a medical device for removing tissue from an eye, in accordance
with the present invention.
[0041] FIG. 9 is a side cross-section view depicting one method for
removing a tissue from an eye, in accordance with the present
invention.
DETAILED DESCRIPTION OF THE INVENTION
[0042] Detailed embodiments of the present invention are disclosed
herein; however, it is to be understood that the disclosed
embodiments are merely illustrative of the invention that may be
embodied in various forms. In addition, each of the examples given
in connection with the various embodiments of the invention are
intended to be illustrative, and not restrictive. Further, the
figures are not necessarily to scale, some features may be
exaggerated to show details of particular components. Therefore,
specific structural and functional details disclosed herein are not
to be interpreted as limiting, but merely as a representative basis
for teaching one skilled in the art to variously employ the present
invention.
[0043] The embodiments of the present invention relate to medical
devices and methods for removing tissue, such as removing scar
tissue from an eye. When describing the following structures and
methods, the following terms have the following meanings, unless
otherwise indicated.
[0044] The term "glass" denotes a non-crystalline solid.
[0045] The term "micro-rod" denotes a structure having a height of
less than 100 microns and having an aspect ratio of length to width
on the order of approximately 5:1 or greater, having a height no
greater than 100 microns wherein a cross section perpendicular to
the height is multi-sided or of arcular geometry.
[0046] The phrase "sharp feature" is defined herein to mean a
tapered structure that terminates into a point. In one embodiment,
the sharp surface feature tapers from a base portion having a first
cross sectional area to a point portion opposite the base portion
having a reduced cross sectional area that is no more than 30% of
the first cross sectional area, such as 25%, 20%, 15%, 10%, 8%, 6%,
5%, 4%, 3%, 2%, 1%, or less than 1% of the first cross sectional
area. In one embodiment, the sharp surface feature is a spike. In
one embodiment, a spike has a base with a circumferential geometry
and a tip with a circumferential geometry.
[0047] The term "cannula" means a tube that can be inserted into a
body cavity, organ or duct.
[0048] References in the specification to "one embodiment", "an
embodiment", "an example embodiment", etc., indicate that the
embodiment described may include a particular feature, structure,
or characteristic, but every embodiment may not necessarily include
the particular feature, structure, or characteristic. Moreover,
such phrases are not necessarily referring to the same embodiment.
Further, when a particular feature, structure, or characteristic is
described in connection with an embodiment, it is submitted that it
is within the knowledge of one skilled in the art to affect such
feature, structure, or characteristic in connection with other
embodiments whether or not explicitly described.
[0049] For purposes of the description hereinafter, the terms
"upper", "lower", "right", "left", "vertical", "horizontal", "top",
"bottom", and derivatives thereof shall relate to the invention, as
it is oriented in the drawing figures.
[0050] The present invention in one embodiment is directed to
removing scarred tissue from the eye. A macular pucker is one form
of scar tissue that forms on the surface of the retina, typically
being in the macula, and typically located in the center of the
retina. The formation of macular puckers can cause blurred and
distorted central vision. The formation of macular puckers may
result from a condition known as vitreous detachment. The eye's
interior is filled with a vitreous, gel-like substance that fills
about 80 percent of the eye. The vitreous contains on the order of
millions of fine fibers that are attached to the surface of the
retina. As the eye ages, the vitreous shrinks and pulls away from
the retina typically resulting in the formation of microscopic
damage to the retina's surface. As this occurs, the retina begins a
healing process to the damaged area and forms scarred tissue, i.e.,
epiretinal membrane (ERM), on the surface of the retina. ERMs are
hypocellular and collagenous proliferations. ERMs represent a form
of proliferative vitreoretinopath (PVR) caused by cells that are
released into the vitreous cavity and subsequently become attached
to the retina. These cells proliferate and secrete collagen to form
sheets of membranes over the retina. Because of the presence of
contractile proteins in these cells, they may exhibit
myofibroblastic properties that enable them to change shape within
the collagenouse scaffold of the membrane and exert traction on the
retina.
[0051] When this focal area of damage or irritation occurs in the
macular region, the retina initiates a healing response with
mobilization and migration of cells found within the retina itself,
which tend to spread outward along the surface of the retina, in an
attempt to heal the areas of damage. This scarred tissue is
attached to the retina surface. When the scarred tissue contracts
it can cause the retina to wrinkle and the central vision degrades.
Hereafter, macular puckers and epiretinal membranes (ERM) are
referred to as scarred tissue. Other examples of scarred tissue
that may be removed from the eye using the method and structures of
the present invention include proliferative vitreoretinopathy,
fibrovascular proliferation, and adherent posterior hyaloid tissue.
It is noted, that the above examples of scar tissue are provided
for illustrative purposes only and that other types of scarred
tissue have been contemplated and are within the scope of the
invention.
[0052] In one embodiment, the present invention removes the scarred
tissue by removing the underlying tissue on which the scarred
tissue is present. In one embodiment, the underlying tissue that
the scarred tissue is present on is a thin lamina layer on an inner
surface of the retina. In one embodiment, the lamina layer on the
inner surface of the retina that provides the underlying tissue on
which the scar tissue is present is the internal limiting membrane
(ILM).
[0053] FIG. 1 depicts one embodiment of a medical device 100 for
removing tissue from an eye, such as scar tissue from the retina of
the eye. In one embodiment, the medical device 100 includes an
array of glass micro-rods 50 that are positioned at the insertion
end 110 of a cannula 55 for engaging the scarred tissue. More
specifically, in one embodiment, the array of glass micro-rods is
positioned so that once the cannula 55 is inserted into the eye the
array of glass micro-rods 50 may be manipulated to contact and
engage the scarred tissue, wherein once the array of glass
micro-rods 50 is engaged to the scarred tissue the medical device
100 is removed from the eye, hence removing the scar tissue.
[0054] In another embodiment, the array of glass micro-rods 50 may
be manipulated to separate an underlying tissue that the scarred
tissue is present on from the retina. In this embodiment, the
underlying tissue is separated from the retina in a peeling
process. The underlying tissue is separated from the retina. The
scar tissue attached to the underlying tissue is removed from the
retina. This process may also be referred to as an ILM peel.
[0055] FIG. 2 is a magnified perspective view of one embodiment of
an array of glass micro-rods 50. In one embodiment, the array of
glass micro-rods 50 may be provided by a pad having a width equal
to about 1 mm to about 5 mm, and a length equal to about 1 mm to
about 3 mm, wherein the pad has on the order of approximately
350,000 or less micro-rods.
[0056] In one embodiment, in which the pad diameter is on the order
of about 3 mm with a spacing between adjacent micro-rods on the
order of about 5 microns, the resulting number of glass micro-rods
is on the order of 350,000. In another embodiment, for a pad
diameter on the order of about 1 mm with a spacing between adjacent
micro-rods on the order of about 100 microns, the resulting number
of glass micro-rods can be on the order of about 100 glass
micro-rods.
[0057] Referring to FIG. 1, in one embodiment, the insertion end
110 of the medical device 100 includes a 25 gauge tip on which the
array of glass micro-rods 50 is present, wherein the array of glass
micro-rods 50 includes at least one glass micro-rod that includes a
sharp feature that is angled. In one embodiment, the glass rods
have an aspect ratio of length to width on the order of about 10:1
or greater. In another embodiment, the glass rods have an aspect
ratio of length to width on the order of about 100:1.
[0058] In one embodiment, the sharp feature 51 is a spike. In one
embodiment, a spike has a base with a circumferential geometry and
a tip with a circumferential geometry. In another embodiment, the
base portion 52 may have a multisided geometry, such as a hexagonal
shape.
[0059] FIG. 3 is a side cross-sectional view of an array of glass
micro-rods, in which the sharp feature 51 of each glass micro-rod
is angled. In one embodiment, the angle at which each sharp feature
51 is positioned may be defined by the angle .alpha. at the
intersection of a plane parallel P.sub.1 to the length L.sub.1 of
the sharp feature 51 of the glass micro-rod and a plane P.sub.2
that is normal to the base 10 of the array of micro-rods 50. In one
embodiment, the base 10 of the array of glass micro-rods 50 is
connected to the cannula 55. In one embodiment, the length L.sub.1
of the sharp feature 51 extends from the base portion 10 of the
glass micro-rod to the point portion 53 of the glass micro-rod. It
is noted that although, the sharp feature 51 is depicted in the
supplied figures as extending the entire length of each of the
glass micro-rods, embodiments of the present invention have been
contemplated that include where the sharp feature 51 only extends
along a portion of the length of the glass micro-rods.
[0060] Still referring to FIG. 3, in one embodiment, the length
L.sub.1 of the sharp feature 51 may be angled a from about
15.degree. to about 90.degree. from a plane P.sub.2 that is normal
to a face of the base 10 of the array of glass micro-rods 50. In
another embodiment, the length L.sub.1 of the sharp feature 51 may
be angled from about 15.degree. to about 50.degree. from a plane
P.sub.2 that is normal to a face of the base 10 of the array of
glass micro-rods 50
[0061] FIG. 4 is a magnified view of one embodiment of an array of
glass micro-rods 50, in which the sharp feature of the glass
micro-rods are angled approximately 45 degrees, as measured by the
angle .alpha. defined at the intersection of a plane parallel to
the length of the sharp feature of the glass micro-rod and the
plane that is normal to the face of the base of the array of glass
micro-rods 50.
[0062] FIG. 5 depicts a scanning electron microscope image of one
embodiment of a glass micro-rod, in which the sharp feature of the
glass micro-rods are angled approximately 30 degrees, as measured
by the angle defined at the intersection of a plane parallel to the
length of the sharp feature of the glass micro-rod and the plane
that is normal to the face of the base of the array of glass
micro-rods 50.
[0063] FIG. 6 depicts another embodiment of a medical device 100
for removing scar tissue from an eye including an array of glass
micro-rods 50 having a sharp feature 51 that is positioned to be
normal to a base 10 of the array of glass mirco-rods 50, wherein
the base 10 of the array of glass micro-rods 50 is angled at the
attachment of cannula 55 to the array of glass micro-rods 50. In
one embodiment, the medical device 100 includes a cannula 55 and an
array of glass micro-rods 50, wherein at least one glass micro-rod
of the array of glass micro-rods includes a sharp feature 51
opposite a base 10 of the array of glass micro-rods 50 that is
connected to the cannula 55, the sharp feature 51 of the at least
one micro-rod is normal to a face of the base 10 of the array of
glass micro-rods 50, wherein the face of the base 10 of the array
of glass micro-rods 50 that is engaged to the cannula 55 is angled
relative to a direction that is parallel to a length L2 of the
cannula 55. The term "normal" as used herein means that the plane
P1 parallel to the length L1 of the sharp feature 51 and the plane
P3 that is parallel to the width of the base 10 of the array of
glass micro-rods 50 is approximately 90 degrees.
[0064] In one embodiment, when the sharp features 51 are normal to
the base of the array of glass micro-rods 50, the base 10 of the
array of glass micro-rods 50 is angled relative to cannula 55 to
provide an angle .beta. at the intersection of the plane P3
parallel to the width of the base 10 of the array of glass
micro-rods 50 and the plane P4 parallel to the length L2 of the
cannula 55 that ranges from about 0.degree. to about 70. In another
embodiment when the sharp features 51 are normal to the base 10 of
the array of glass micro-rods 50, the base 10 of the array of glass
micro-rods 50 is angled relative to cannula 55 to provide an angle
.beta. at the intersection of the plane P3 parallel to the width of
the base 10 of the array of glass micro-rods 50 and the plane P4
parallel to the length L2 of the cannula 55 that ranges from about
20.degree. to about 50.degree. from the plane P.sub.3 parallel to
the length L2 of the cannula 55
[0065] FIG. 7 is a magnified view of one embodiment of an array of
glass micro-rods 50, in which the sharp features of the glass
micro-rods are normal to the base of the array of glass micro-rods,
which may also be referred to as a vertically aligned array of
glass micro-rods.
[0066] FIG. 8 depicts another embodiment of a medical device 100
for removing tissue from an eye including an array of glass
micro-rods 50 having a sharp feature 51 that is configured to be
normal to a base 10 of the array of glass mirco-rods 50, wherein
the cannula 55 includes a curvature to angle the array of glass
micro-rods. In one embodiment, the medical device 100 includes a
cannula 55; and an array of glass micro-rods 50, wherein at least
one glass micro-rod of the array of glass micro-rods 50 includes a
sharp feature 51 opposite a base 10 of the array of glass
micro-rods 50 that is connected to the cannula 55, the sharp
feature 51 of the at least one micro-rod is normal to a face of the
base 10 of the array of glass micro-rods 50, wherein at least a
portion of the cannula 55 is curved.
[0067] In another aspect of the present invention, a method of
manufacturing a medical device is provided. In one embodiment, the
sharp features of the array of glass micro-rods are made of a
composite material that is etched using a selective etch process.
The composite material may be made from any two components that
provide suitable differential etching characteristics relative to
one another. Suitable materials include, for example, glasses,
metals (including alloys), ceramics, polymers, resins, and the
like. In one embodiment, the composite material may include a
recessive component and a protrusion component, wherein the
recessive component is etched selective to the protrusion
component. In one embodiment, the composite material includes a
core, such as rods, and a matrix, such as cladding present on the
exterior of the rod.
[0068] In one embodiment, the protrusive component is a core of the
composite material. In one embodiment, the protrusive component of
the composite material may be composed of glass rods composed of
Corning 0120. Corning 0120 is composed of a
K.sub.2--O--PbO--B.sub.2--O.sub.3--SiO.sub.2 system. It is noted
that other materials may be suitable for the protrusive component,
so long as the material selected etched at a slower rate than the
recessive component. In one embodiment, the recessive component is
present on the exterior of the core of the protrusive component. In
one embodiment, the recessive component of the composite material
may be composed of a cladding composed of Corning 8161. Corning
8161 is composed of about 51 wt. %, PbO, about 39 wt. % SiO.sub.2,
about 6 wt. % K.sub.2O, and about 2 wt. % KaO. The two glasses are
differentially etched such that the cladding glass is etched away
from the core glass, while the core glass becomes sharpened
(tapered) by the etching process. It is noted that the above glass
compositions are noted for illustrative purposes only and are not
intended to limit the scope of the present invention, since other
compositions have been contemplated and are within the scope of the
present invention. One factor that is considered in selecting glass
compositions for use with the present methods and structures is
that the glass compositions selected for the core, i.e., protrusive
component, and the cladding, i.e., recessive component, should be
"drawable", that is their softening temperatures (Tg) should
overlap. In one embodiment, a carbon nanotube structure may be
used, as opposed to a glass composition, to provide the
micro-rods.
[0069] In one embodiment, the recessive component of the composite
material is etched selective to the protrusion component. Etch
selectively means that one component, i.e., the recessive component
of the composite material, is etched at a faster rate than a second
component, i.e., the protrusion component. In one embodiment, the
etchant is composed of an organic or inorganic acid or alkali;
polar, nonpolar, organic, inorganic, or mixed solvent; or mixtures
of any of the foregoing. The etchant is selected to selectively
etch the composite material as described herein. For example, an
acid such as HF, HCl, HBr, or HI is selected to differentially etch
glass compositions.
[0070] In one embodiment, the etchant is composed of a "mixed
etchant system" which includes of a mixture of a plurality of
etchants that provide selective etch contrast ratios when applied
to the composite material. For example, in one embodiment the
etchant can selectively etch one phase while the other etchant can
selectively etch the other phase. One example of a mixed etchant
system is a mixture of HF and HCl.
[0071] In another embodiment, a plurality of etchants can be used
in a series of two or more sequential etching steps. For example,
in one embodiment HF is applied to the composite material in a
first etching step, rinsed away, and then HCl is applied to the
composite material in a second etching step.
[0072] In one embodiment when the composite material is composed of
a core, e.g., rods of a protrusive component, and a matrix, e.g.,
cladding material of a recessive material, prior to etching the
core and the matrix are bundled into an aligned array (hereafter
referred to as a bundle). In one embodiment, the matrix has a
multi-sided, e.g., hexagonal, cross-sectional shape to minimize
voids while the core has a circular cross-section. In another
embodiment, the matrix has a circular cross-section. In one
embodiment, the matrix material and core material are selected
based on differential etchability, wherein the core material has a
lower etch rate than the matrix material, and forms protrusive,
sharp features upon etching of the composite material.
[0073] In one embodiment, the bundle can heated to a temperature
sufficient to soften the materials comprising the bundle, but low
enough to avoid damage, decomposition, or other deleterious
changes. In one embodiment, the bundle is then drawn along the axis
of the bundled rods to fuse and reduce the diameter of the bundle.
In one embodiment, the drawn bundle has reduced size matrix
material and core material.
[0074] The drawn bundle is cut transversely into sections that can
be re-bundled to increase the number of core material cores in the
cross-section thereof. In a following process step, the bundle can
then be drawn again. In one embodiment, it is noted that a
twice-drawn bundle has further reduced size matrix material and
core material. The twice-drawn bundle may then be cut transversely
into sections that are re-bundled to further increase the number of
cores in the cross-section thereof. It is noted that the process of
bundling, drawing, and cutting can be performed a single time or
repeated many times until the desired diameter and spacing of the
core material is obtained. In one embodiment, after the final draw
(which may be the first draw), the bundle can be cut, bundled, and
fused in order to obtain a larger diameter bundle.
[0075] In one embodiment, in which the fused fibers are aligned
parallel to the axis of the bundled rod, if the rod is cut
perpendicular to this axis, the subsequently etched glass
micro-rods will be normal to the base surface. In another
embodiment, cutting the rod at any other angle will cause the
subsequently etched glass micro-rods to deviate from the normal
direction by the angle at which the rod is cut.
[0076] Subsequently, in one embodiment, one or both of the cut
(composite) surfaces of the bundle are etched to create an array of
sharp features composed of core material on one or both sides of
the cut bundle. The composite surface can be contacted with an
etchant, (HF, for example), which etches the matrix material
(recessive component) faster than the core material (protrusive
component). The etching continues until the matrix material is
etched back to the desired depth, leaving some of the core material
protruding from the surface. The result is that the core material
is sharpened to a cone-shaped spike that provides the sharp feature
51 that extends from a base 10. In one embodiment, the aspect ratio
of the spike is dependent on the ratio of the matrix material and
core material etch rates. Hereafter, the composite material that
has been etched to provide the sharp features that extend from the
base is referred to as the array of glass micro-rods.
[0077] In a following step, the base of the array of glass
micro-rods is connected to the cannula. In one embodiment, the
attachment of the array glass micro-rods is connected to the
cannula by adhesive. In one embodiment in which the sharp feature
of the array of glass micro-rods are positioned normal to the base
of the array of glass micro-rods, the base of the cannula may be
angled relative to cannula to provide an angle .beta. at the
intersection of the plane parallel to the length of the sharp
features and the plane parallel to the length of the cannula. In
one embodiment, the cannula has a diameter that is suitable for
insertion into on eye. In one embodiment, the cannula has a
diameter of 25-20 gauge or less. In another embodiment, the cannula
has a diameter of 3 mm or less. In one embodiment, a fiber optic is
contained within the cannula, wherein the fiber-optic glass fiber
that illuminates the insertion portion of the device.
[0078] In one embodiment, the medical device of the present
invention is suitable for engaging, i.e., hold and not just tear,
the scarred tissue from a central portion of the scarred tissue. In
one embodiment, the medical device is soft enough to engage the
scarred tissue without putting undue pressure on the retina. In one
embodiment, the insertion portion of the medical device has
dimensions allowing for the array of glass micro-rods to be able to
pass through an incision in the eye wall being less than 20 gauge
in diameter. In one embodiment, the medical device includes sharp
features of a specified depth (depending on the ERM or ILM so as to
adhere to, i.e. penetrate and retain, the scarred tissue without
engaging the retina of the eye. In another embodiment the medical
device is fabricated in a thin sheet so as to engage a large
surface of the scarred tissue en bloc. In one embodiment, the
medical device is sterilizable, as well as disposable.
[0079] In another aspect, the present invention provides a method
of removing scarred tissue from an eye using the above-described
medical devices 100. In one embodiment, the method of removing the
scarred tissue 21 includes inserting a device including an array of
glass micro-rods 50 into an eye, wherein at least one glass
micro-rod of the array of glass micro-rods 50 includes a sharp
feature; contacting a tissue 21 with the array of glass micro-rods
50; and removing the array of glass micro-rods 50 and the tissue
from the eye.
[0080] Referring to FIG. 9, in one embodiment of the present
invention, the sharp feature of the array of glass mirco-rods 50
hook into the scar tissue that has grown on the retina and pull the
scar tissue from the retina. More specifically, in one embodiment,
the array of glass micro-rods provides a plurality of sharp
features, wherein the plurality of sharp features engage and retain
the scar tissue in a manner that the scar tissue is removed from
the underlying tissue of the eye in a single unit, e.g., with a
peeling motion. In one embodiment, the plurality of sharp features
provides a plurality of attachment points that are spread across
the surface of the scar tissue, hence distributing the force that
is applied to the scar tissue as it is being peeled from the
underlying tissue of the eye. By providing a plurality of
attachment points to the scar tissue, the incidence of tearing the
tissue during the removal step is substantially reduced
[0081] In one embodiment, the method further includes measuring the
thickness of the scar tissue 21 before inserting the device
including the array of glass micro-rods 50 into the eye 20, and
providing an array of glass micro-rods 50 having a micro-rod length
that is less than or equal to the thickness of the scar tissue 20.
For example, in one embodiment, when the ERM has a thickness on the
order of about 20 microns to about 30 microns, the length of the
sharp feature is on the order of about 20 microns to about 30
microns to correspond to the thickness of the ERM.
[0082] In one embodiment, the method enables a surgeon to apply an
array of angled sharp features 51 to engage and strip a scar tissue
20 from the retina 22, including the internal limiting membrane at
defined depths selected for the patient's unique pathology based
upon optical coherence tomography (OCT) imaging. Optical coherence
tomography (OCT) is an interferometric, non-invasive optical
tomographic imaging technique
[0083] More specifically, in one embodiment, the height and pitch
of the engaging sharp features of the array of glass micro-rods 50
can be engineered for desired parameters corresponding to the
membrane thickness. In one embodiment, different dimensions can be
selected for the length of the sharp feature 51 of the array of
glass micro-rods 50 from a selection of disposable instrument
choices to match the specific measured pathology of the patient
based upon OCT imaging studies. In one embodiment, by matching the
histopathology to the choice of instrument, the surgeon will be
able to fully engage the scar tissue, but will not be able to
penetrate the sensory retina. Similarly, a 20 micron instrument can
be selected to use for an ILM peel to protect against injury to the
underlying neurosensory retina. It is noted that the above examples
are provided for illustrative purposes only and do not limit the
present invention to the dimensions described above, as the present
invention is applicable to removing scar tissues having any
thickness.
[0084] In one embodiment, inserting the device including the array
of glass micro-rods 50 into the eye includes making an incision in
the eye wall, wherein the length of the incision is selected to
allow a 20 gauge to 25 gauge instrument to enter the eye. Following
the formation of the incision in the eye wall, the insertion
portion 110 of the cannula 55 and the glass micro-rod array 55 are
inserted into the eye 20. In one embodiment, contacting the scar
tissue 21 with the array of glass micro-rods 50 includes engaging
the sharp feature of the glass micro-rods to a central portion of
the scar tissue 21. In another embodiment, contacting the scar
tissue 21 with array of glass micro-rod array 50 includes
contacting a perimeter portion of the scar tissue 21. In one
embodiment, the vitreous gel is removed from the eye prior to
insertion of the glass micro-rod array 50 to permit direct access
of the array of glass micro-rods to the retina surface.
[0085] In one embodiment, depending on the geometry of (either
linear or circumferential) the cannula 55 is manipulated to engage
the sharp features into the scar tissue 21 either by a linear or
twisting motion, i.e., rotating motion. For example, in one
embodiment, contacting the scar tissue 21 with the array of glass
micro-rods 50 includes rotating the array of micro-rods 50 about an
axis that is substantially perpendicular to the surface of the scar
tissue 21. In another embodiment, contacting the scar tissue 21
with the array of glass micro-rods 50 includes rotating R1 the
array of micro-rods 50 about an axis that is substantially parallel
to the length L2 of the cannula 55 after the sharp features of the
array of glass micro-rods 50 have engaged the scar tissue 21.
[0086] In one embodiment in which the sharp features engage a
central portion of the scar tissue, the scar tissue may be removed
en bloc. In another embodiment, removing the scar tissue from the
eye includes peeling the scar tissue from the retina.
[0087] The following examples are provided to further illustrate
aspects of the present invention and demonstrate some advantages
that arise therefrom. It is not intended that the invention be
limited to the specific examples disclosed.
[0088] While the present invention has been particularly shown and
described with respect to the preferred embodiments thereof, it
will be understood by those skilled in the art that the foregoing
and other changes in forms of details may be made without departing
form the spirit and scope of the present invention. It is therefore
intended that the present invention not be limited to the exact
forms and details described and illustrated, but fall within the
scope of the appended claims.
* * * * *