Non-invasive and minimally invasive laser surgery for the reduction of intraocular pressure in the eye
Intraocular pressure in an eye is reduced by delivering a high resolution optical coherence tomography (OCT) beam and a high resolution laser beam through the cornea, and the anterior chamber into the irido-corneal angle along an angled beam path. The OCT beam provides OCT imaging for surgery planning and monitoring, while the laser beam is configured to modify tissue or affect ocular fluid by photo-disruptive interaction. In one implementation, a volume of ocular tissue within an outflow pathway in the irido-corneal angle is modified to create a channel opening in one or more layers of the trabecular meshwork. In another implementation, a volume of fluid in the Schlemm's canal is affected by the laser to bring about a pneumatic expansion of the canal. In either implementation, resistance to aqueous flow through the eye is reduced.
1. A method of reducing intraocular pressure in an eye having a cornea, an anterior chamber, and an irido-corneal angle comprising an aqueous humor outflow pathway formed of a trabecular meshwork, a Schlemm's canal, and one or more collector channels branching from the Schlemm's canal, the method comprising:
delivering each of an optical coherence tomography (OCT) beam and a laser beam through the cornea, and the anterior chamber into the irido-corneal angle; and
modifying a volume of ocular tissue within the outflow pathway to reduce a pathway resistance present in one or more of the trabecular meshwork, the Schlemm's canal, and the one or more collector channels by applying the laser beam to ocular tissue defining the volume to thereby cause photo-disruptive interaction with the ocular tissue to reduce the pathway resistance or create a new outflow pathway, wherein:
the modified volume of ocular tissue provides a channel opening at least partially through the trabecular meshwork and extends between a wall of the Schlemm's canal and a layer of ocular tissue between the anterior chamber and the wall of the Schlemm's canal,
the channel opening has a first end in fluid communication with the Schlemm's canal and a second end that terminates in a layer of ocular tissue between the anterior chamber and the wall of the Schlemm's canal,
the ocular tissue between the anterior chamber and the wall of the Schlemm's canal comprises one of a juxtacanalicular tissue, a corneoscleral meshwork and a uveal, and
the second end of the channel opening terminates in one or more of the juxtacanalicular tissue, the corneoscleral meshwork and the uveal.
2. The method of claim 1 , further comprising modifying one or more additional volumes of ocular tissue.
3. The method of claim 2 , wherein the volume of ocular tissue in combination with the one or more additional volumes of ocular tissue form a plurality of channel openings.
4. A method of reducing intraocular pressure in an eye having a cornea, an anterior chamber, and an irido-corneal angle comprising an aqueous humor outflow pathway formed of a trabecular meshwork, a Schlemm's canal, and one or more collector channels branching from the Schlemm's canal, the method comprising:
delivering each of an optical coherence tomography (OCT) beam and a laser beam through the cornea, and the anterior chamber into the irido-corneal angle; and
modifying a volume of ocular tissue within the outflow pathway to reduce a pathway resistance present in one or more of the trabecular meshwork, the Schlemm's canal, and the one or more collector channels by applying the laser beam to ocular tissue defining the volume to thereby cause photo-disruptive interaction with the ocular tissue to reduce the pathway resistance or create a new outflow pathway, wherein:
the modified volume of ocular tissue provides a channel opening at least partially through the trabecular meshwork and extends between a wall of the anterior chamber and a layer of ocular tissue between the anterior chamber and the wall of the Schlemm's canal,
the channel opening has a first end in fluid communication with the anterior chamber and a second end that terminates in a layer of ocular tissue between the anterior chamber and the wall of the Schlemm's canal,
the ocular tissue between the anterior chamber and the wall of the Schlemm's canal comprises one of a juxtacanalicular tissue, a corneoscleral meshwork and a uveal, and
the second end of the channel opening terminates in one or more of the juxtacanalicular tissue, the corneoscleral meshwork and the uveal.
5. The method of claim 4 , further comprising modifying one or more additional volumes of ocular tissue.
6. The method of claim 5 , wherein the volume of ocular tissue in combination with the one or more additional volumes of ocular tissue form a plurality of channel openings.
7. An integrated surgical system for reducing intraocular pressure in an eye having a cornea, an anterior chamber, and an irido-corneal angle comprising an aqueous humor outflow pathway formed of a trabecular meshwork, a Schlemm's canal, and one or more collector channels branching from the Schlemm's canal, the integrated surgical system comprising:
a first optical subsystem including a focusing objective configured to be coupled to the cornea:
a second optical subsystem including: a laser source configured to output a laser beam, and a plurality of components configured to one or more of condition, scan, and direct the laser beam; and
a control system coupled to the second optical subsystem and configured to:
instruct the laser source to output a laser beam, for delivery through the cornea, and the anterior chamber into the irido-corneal angle, and
instruct the laser source to modify a volume of ocular tissue within the outflow pathway to reduce a pathway resistance present in one or more of the trabecular meshwork, the Schlemm's canal, and the one or more collector channels by applying the laser beam to ocular tissue defining the volume to thereby cause photo-disruptive interaction with the ocular tissue to reduce the pathway resistance or create a new outflow pathway, wherein:
the modified volume of ocular tissue provides a channel opening at least partially through the trabecular meshwork and extends between a wall of the Schlemm's canal and a layer of ocular tissue between the anterior chamber and the wall of the Schlemm's canal,
the channel opening has a first end in fluid communication with the Schlemm's canal and a second end that terminates in a layer of ocular tissue between the anterior chamber and the wall of the Schlemm's canal,
the ocular tissue between the anterior chamber and the wall of the Schlemm's canal comprises one of a juxtacanalicular tissue, a corneoscleral meshwork and a uveal, and
the second end of the channel opening terminates in one or more of the juxtacanalicular tissue, the corneoscleral meshwork and the uveal.
8. An integrated surgical system for reducing intraocular pressure in an eye having a cornea, an anterior chamber, and an irido-corneal angle comprising an aqueous humor outflow pathway formed of a trabecular meshwork, a Schlemm's canal, and one or more collector channels branching from the Schlemm's canal, the integrated surgical system comprising:
a first optical subsystem including a focusing objective configured to be coupled to the cornea;
a second optical subsystem including: a laser source configured to output a laser beam, and a plurality of components configured to one or more of condition, scan, and direct the laser beam; and
a control system coupled to the second optical subsystem and configured to:
instruct the laser source to output a laser beam, for delivery through the cornea, and the anterior chamber into the irido-corneal angle, and
instruct the laser source to modify a volume of ocular tissue within the outflow pathway to reduce a pathway resistance present in one or more of the trabecular meshwork, the Schlemm's canal, and the one or more collector channels by applying the laser beam to ocular tissue defining the volume to thereby cause photo-disruptive interaction with the ocular tissue to reduce the pathway resistance or create a new outflow pathway, wherein:
the modified volume of ocular tissue provides a channel opening at least partially through the trabecular meshwork and extends between a wall of the anterior chamber and a layer of ocular tissue between the anterior chamber and the wall of the Schlemm's canal, and
the channel opening has a first end in fluid communication with the anterior chamber and a second end that terminates in a layer of ocular tissue between the anterior chamber and the wall of the Schlemm's canal.