Methods and apparatuses for the treatment of glaucoma using visible and infrared ultrashort laser pulses
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 be 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 a plurality of openings in a trabecular meshwork of a patient's eye to conduct fluid from an anterior chamber into a Schlemm's canal of the eye, comprising:
ablating a first crater to a first depth in the trabecular meshwork adjacent to the Schlemm's canal with first laser pulses without entering the Schlemm's canal;
ablating a second crater to a second depth in the trabecular meshwork adjacent to the Schlemm's canal with second laser pulses without entering the Schlemm's canal;
extending the first crater with third laser pulses to a third depth and extending the second crater with fourth laser pulses to a fourth depth, wherein the first crater is extended to the third depth and the second crater is extended to the fourth depth after the second crater has been extended to the second depth, so as to penetrate an inner wall of the Schlemm's Canal, to form the plurality of openings to conduct fluid from the anterior chamber to the Schlemm's canal, and to decrease optical pathway obscuration by blood reflux from the Schlemm's canal; and
wherein each of the femtosecond laser pulses comprises a wavelength of within a range from 0.4 to 2.5 microns, a fluence level to produce optical breakdown, and a pulse duration in a range from 20 femtoseconds to 300 picoseconds.
2. The method of claim 1 , wherein the laser pulses are directed through a cornea of the eye to ablate the trabecular meshwork.
3. The method of claim 1 , wherein a gonioscopic lens is coupled to the eye and the laser pulses are transmitted through the gonioscopic lens.
4. The method of claim 1 , wherein the laser pulses are scanned in an ablation pattern of adjacent regions in the trabecular meshwork to form each of a plurality of craters, the plurality of craters comprising the first crater and the second crater, the pattern in the trabecular meshwork comprising a surface dimension within a range from 20 to 200 microns.
5. The method of claim 4 , wherein the plurality of craters is formed concurrently and wherein of the plurality of craters is subsequently extended to enter Schlemm's canal and to form the plurality of openings.
6. The method of claim 1 , wherein the laser pulses are reflected off a curved mirror and wherein the laser pulses are scanned and focused into a curved trabecular meshwork to form the plurality of openings in the curved trabecular meshwork.
7. The method of claim 1 , wherein an intraocular pressure of the eye is lowered to allow targeting Schlemm's canal and then elevated to prevent blood reflux.
8. The method of claim 1 , wherein Schlemm's canal is detected optically or by optical coherence tomography (OCT) or by photoaccoustic spectroscopy.
9. The method of claim 1 , wherein the laser pulses are directed through a sclera of the eye to ablate the trabecular meshwork.
10. The method of claim 1 , wherein an intraocular pressure of the eye is lowered to allow targeting of Schlemm's canal.
11. The method of claim 1 , wherein an intraocular pressure of the eye is elevated to prevent blood reflux.
12. The method of claim 1 , wherein the laser pulses are reflected off a flat mirror to form the plurality of openings in the trabecular meshwork.