Methods 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 affected 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 one or more openings in a trabecular meshwork of an eye of a patient to conduct fluid from an anterior channel into a Schlemm's canal of the eye, comprising:
ablating a first region to a first depth in the trabecular meshwork with first laser pulses;
ablating a second region to a second depth in the trabecular meshwork with second laser pulses; and
extending the first region with third laser pulses to a third depth and extending the second region with fourth laser pulses to a fourth depth, wherein the first region is extended to the third depth and the second region is extended to the fourth depth after the second region has been extended to the second depth, so as to form a channel between the Schlemm's Canal and the trabecular meshwork, to form the one or more openings to conduct fluid from the anterior channel into the Schlemm's canal;
wherein each of the 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 comprising adjacent regions in the trabecular meshwork to form the one or more openings.
5. The method of claim 4 , wherein the one or more openings is formed concurrently and wherein of the one or more openings is subsequently extended to enter Schlemm's canal and to form the one or more 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 one or more 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 photoacoustic 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 one or more openings in the trabecular meshwork.
13. The method of claim 1 , wherein at least a portion of the trabecular meshwork comprises a lattice structure having voids, and the channel results in fluid communication between the Schlemm's Canal and one or more of the voids.