US20010018570A1

US20010018570A1 - Liquefaction handpiece

Info

Publication number: US20010018570A1
Application number: US09/442,231
Authority: US
Inventors: Glenn Sussman; Thomas G. Capetan; Donald M. Cohen
Original assignee: Alcon Manufacturing Ltd
Current assignee: Alcon Research LLC
Priority date: 1998-06-04
Filing date: 1999-11-17
Publication date: 2001-08-30
Anticipated expiration: 2018-06-04
Also published as: US6110162A; US6080128A; US6287274B1

Abstract

A surgical handpiece having at least two lumens mounted to a body. At least one lumen is used for aspiration and at least one other lumen is used to inject heated surgical fluid for liquefying a cataractous lens. A portion of the second lumen is enlarged to form a pumping chamber. The pumping chamber works by boiling a small volume of the surgical fluid. As the fluid boils, it expands rapidly, thereby propelling the liquid downstream of the pumping chamber out of the second lumen. The pumping chamber may use any type of heater, such as a resistive heater or an induction heater. The handpiece may also contain other lumens for injecting relatively cool surgical fluid

Description

BACKGROUND OF THE INVENTION

This invention relates generally to the field of cataract surgery and more particularly to a handpiece for practicing the liquefaction technique of cataract removal.

The human eye in its simplest terms functions to provide vision by transmitting light through a clear outer portion called the cornea, and focusing the image by way of the lens onto the retina. The quality of the focused image depends on many factors including the size and shape of the eye, and the transparency of the cornea and lens.

When age or disease causes the lens to become less transparent, vision deteriorates because of the diminished light which can be transmitted to the retina. This deficiency in the lens of the eye is medically known as a cataract. An accepted treatment for this condition is surgical removal of the lens and replacement of the lens function by an artificial intraocular lens (IOL)

In the United States, the majority of cataractous lenses are removed by a surgical technique called phacoemulsification. During this procedure, a thin phacoemulsification cutting tip is inserted into the diseased lens and vibrated ultrasonically. The vibrating cutting tip liquifies or emulsifies the lens so that the lens may be aspirated out of the eye. The diseased lens, once removed, is replaced by an artificial lens.

A typical ultrasonic surgical device suitable for ophthalmic procedures consists of an ultrasonically driven handpiece, an attached cutting tip, and irrigating sleeve and an electronic control console. The handpiece assembly is attached to the control console by an electric cable and flexible tubings. Through the electric cable, the console lanes the poser level transmitted by the handpiece to the attached cutting tip and the flexible tubings supply irrigation fluid to and draw aspiration fluid from the eye through the handpiece assembly

The operative part of the handpiece Is a centrally located, hollow resonating bar or horn directly attached to a set of piezoelectric crystals. The crystals supply the required ultrasonic vibration needed to drive both the horn and the attached cutting tip during phacoemulsification and are controlled by the console. The crustal/horn assembly is suspended within the hollow body or shell of the handpiece by flexible mountings. The handpiece body terminates in a release diameter portion or nosecone at the body's distal end. The nosecone is externally threaded to accept the irrigation sleeve Likewise, the horn bore is internally threaded at its distal end to receive the external threads of the cutting tip. The irrigation sleeve also has an internally threaded bore that is screwed onto the external threads of the nosecone. The cutting tip is adjusted so that the tip projects only a predetermined amount past the open end of the irrigating sleeve. Ultrasonic handpieces and cutting tips are more fully described in U.S. Pat. Nos. 3,589,363; 4,223,676; 4,246,902; 4,493,694; 4,515,583: 4,589,415; 4,609,368: 4,869,715; 4,922,902; 4,989,583; 5,154,694 and 5,359,996, the entire contents of which are incorporated herein by reference.

In use, the ends of the cutting tip and irrigating sleeve are inserted into a small incision of predetermined width in the cornea, sclera, or other location. The cutting tip is ultrasonically vibrated along its longitudinal axis within the irrigating sleeve by the crystal-driven ultrasonic horn, thereby emulsifying the selected tissue in situ. The hollow bore of the cutting tip communicates with the ore in the horn that in turn communicates with the aspiration line from the handpiece to the console A reduced pressure or vacuum source in the console draws or aspirates the emulsified tissue from the eye through the open end of the cutting tip, the cutting tip and horn bores and the aspiration line and into a collection device The aspiration of emulsified tissue is aided by a saline flushing solution or irrigation that is injected into the surgical site through the small annular gap between the inside surface of the irrigating sleeve and the cutting tip.

Recently, a new cataract removal technique has been developed that involves the injection of hot (approximately 45° C. to 105° C.) water or saline to liquefy or gellate the hard lens nucleus, thereby making it possible to aspirate the liquefied lens from the eye. Aspiration is conducted with the injection of the heated solution and the injection of a relatively cool solution, thereby quickly cooling and removing the heated solution This technique is more fully described in U.S. Pat. No 5,616,120 (Andrew, et al.), the entire contents of which is incorporated herein reference. The apparatus disclosed in the publication, however, heats the solution separately from the surgical handpiece Temperature control of the heated solution can be difficult because the fluid tubings feeding the handpiece typically are up to two meters long, and the heated solution can cool considerably as it travels down the length of the tubing.

Therefore, a need continues to exist for a surgical handpiece that can heat internally the solution used to perform the liquefaction technique.

BRIEF SUMMARY OF THE INVENTION

The present invention improves upon the prior art by providing a surgical handpiece having at least two lumens mounted to a body. At least one lumen is used for aspiration and at least one other lumen is used to inject heated surgical fluid for liquefying a cataractous lens A portion of the second lumen is enlarged to form a pumping chamber. The pumping chamber works by boiling a small volume of the surgical fluid As the fluid boils, it expands rapidly, thereby propelling the liquid downstream of the pumping chamber out of the second lumen. The pumping chamber may use any type of heater, such as a resistive heater or an induction heater. The handpiece may also contain other lumens for injecting relatively cool surgical fluid.

Accordingly, one objective of the present invention is to provide a surgical handpiece having at least two lumens.

Another objective of the present invention is to provide a surgical handpiece having a pumping chamber.

Another objective of the present invention is to provide a surgical handpiece having a device for delivering the surgical fluid through the handpiece in pulses.

These and other advantages and objectives of the present invention will become apparent from the detailed description and claims that follow

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front, upper left perspective view of the handpiece of the present invention [0015]
FIG. 2 is a rear, upper right perspective view of the handpiece of the present invention. [0016]
FIG. 3 is a cross-section of the handpiece of the present invention taken along a plane passing through the irrigation channel [0017]
FIG. 4 is a cross-sectional view of the handpiece of the present invention taken along a plane passing through the aspiration channel [0018]
FIG. 5 is an enlarged partial cross-sectional views of the handpiece of the present invention taken at [0019] circle 5 in FIG. 4
FIG. 6 is an enlarged partial cross-sectional view of the handpiece of the present invention taken at [0020] circle 6 in FIG. 3.
FIG. 7 is an enlarged cross-sectional view of the handpiece of the present invention taken at circle [0021] 7 in FIGS. 3 and 4, and shorting a resistive boiler pump
FIG. 8 is a schematic cross-sectional view of a heating element boiler pump that may be used With the present invention [0022]
FIG. 9 is an exploded, partial cross-section view of one embodiment of the handpiece of the present invention [0023]

DETAILED DESCRIPTION OF THE INVENTION

[0024] Handpiece 10 of the present intention generally includes handpiece body 12 and operative tip 16. Body 12 generally include external irrigation lumen 18 and aspiration fitting 20 Body 12 is similar in construction to well-known in the art phacoemulsification handpieces and may be made from plastic, titanium or stainless steel As best seen in FIG. 6, operative tip 16 includes tip/cap sleeve 26, needle 28 and lumen 30. Sleeve 26 may be any suitable commercially available phacoemulsification tip/cap sleeve or sleeve 26 may be incorporated into other, times as a multi-lumen tube Needle 28 may be any commercially available phacoemulsification cutting tip, such as the TUROBOSONICS tip available from Alcon Laboratories. Inc, Fort Worth, Tex. Lumen 30 may be any suitably sized tubing to fit within needle 28, for example 29 gauge hypodermic needle tubing.
As best seen in FIG. 5. [0025] lumen 30 is free on the distal end and connected to pumping chamber 42 on the proximal end Lumen 30 and pumping chamber 42 may be sealed fluid tight by any suitable means having a relatively high melting point, such as silver solder. Fitting 44 holds lumen 30 within bore 48 of aspiration horn 46 Bore 48 communicates with fitting 20, which is journaled into norm 46 and sealed with O-ring seal 50 to form an aspiration pathway through horn 46 and out fitting 20. Horn 46 is held within body 12 by O-ring seat 56 to form irrigation lumen 52 which communicates with irrigation lumen 18 at port 54
As best seen in FIG. 7, in a first embodiment of the present invention, [0026] pumping chamber 42 contains a relatively large pumping reservoir 43 that is sealed on both ends by electrodes 45 and 47. Electrical power is supplied to electrodes 45 and 47 by insulated wires 49 and 51, respectively In use, surgical fluid (e g saline irrigating solution) enters reservoir 43 through port 55, lumen 34 and check valve 53 electrical current (preferably RFAC) is delivered to and across electrodes 45 and 47 because of the conductive nature of the surgical fluid. As the current flows through the surgical fluid, the surgical fluid boils As the surgical fluid boils, it expands rapidly out of pumping chamber 42 through port 57 and into lumen 30 (check valve 53 prevents the expanding fluid from entering lumen 34) The expanding gas bubble pushes the surgical fluid in lumen 30 downstream of pumping chamber 42 forward Subsequent pulses of electrical current form sequential gas bubbles that move surgical fluid down lumen 30 The size and pressure of the fluid pulse obtained by pumping chamber 42 can be varied by varying the length, timing and/or power of the electrical pulse sent to electrodes 45 and 47 and by varying the dimensions of reservoir 43. In addition, the surgical fluid may be preheated prior to entering pumping chamber 42. Preheating the surgical fluid will decrease the power required by pumping chamber 42 and/or increase the speed at which pressure pulses can be generated
While several embodiments of the handpiece of the present invention are disclosed, any handpiece producing adequate pressure pulse force, rise time and frequency may also be used. For example, any suitable handpiece producing a pressure pulse force of between 0 03 grams and 3 0 grams, with a rise time of between 1 grams/sec and 3,000 gram/sec and a frequency of between 1 Hz and 100 Hz may be used, with between 20 Hz and 100 Hz being most preferred The pressure pulse force and frequency, will vary with the hardness of the maternal being removed. For example, he inventors have found that a lower frequency with a higher pulse force is most efficient at debulkling and removing the relatively hard nuclear material, with a higher frequency and looser pulse force being useful in removing softer epinuclear and cortical material. Infusion pressure aspiration flow rate and vacuum limit are similar to current phacoemulsification techniques [0027]
As best seen in FIG. 8, the fluid in [0028] reservoir 143 in pumping chamber 142 may also be heated by the use of heating element 145 that is internal to reservoir 143 Heating element 145 may be, for example, a coil of 0 003 inch diameter stainless steel wire which is energized by power source 147. The size and pressure of the fluid pulse obtained by pumping chamber 142 can be varied by varied the length and timing of the electrical pulse sent to element 145 by power source 147 aid by varying the dimensions of reservoir 143.
As best seen in FIGS. [0029] 3 4 and 7, surgical fluid may be supplied to pumping chamber 43 through lumen 34 or, as seen in FIG. 9, surgical fluid may he supplied to pumping chamber 243 through irrigation fluid lumen 234 which branches off main irrigation lumen 235 supplying cool surgical fluid to the operative size. As seen in FIG. 9 aspiration lumen 237 may be contained internally, to handpiece 10
Any of a number of methods can be employed to order limit the amount of heat introduced into the eye For example, the pulse train duty cycle of the heated solution can be varied so that the total amount of heated solution introduced into the eye does not vary with the pulse frequency. Alternatively, the aspiration flow rate can be varied as a function of pulse frequency so that is pulse frequency increases aspiration flow rate increases proportionally [0030]
This description is given for purposes of illustration and explanation. It will be apparent to those skilled in the relevant art that changes and modifications may be made to the invention described above Without departing from its scope or spirit For example, it will be recognized by those skilled in the art that the present invention may be combined with ultrasonic and/or rotating cutting tips to enhance performance. [0031]

Claims

We claim:

1. A liquefaction handpiece, comprising:

a) a body having an irrigation lumen; and

b) a pumping chamber attached to the irrigation lumen, the pumping chamber having a pair of electrodes that allow electrical current to flow across the electrodes when a surgical fluid is contained within the pumping chamber.

2. The handpiece of

claim 1

further comprising a second irrigation lumen.

3. The handpiece of

claim 2

wherein the second irrigation lumen is mounted on the exterior of the body.

4. The handpiece of

claim 1

wherein the electrical current flowing across the electrodes is capable of boiling the surgical fluid.

5. A liquefaction handpiece comprising:

a) a body having a first irrigation lumen, a second irrigation lumen and an aspiration lumen, and

b) a pumping chamber having a pair of electrodes across which electrical current will flow, the electrodes being attached to the first irrigation lumen.

6. The handpiece of

claim 5

, wherein electrical current flowing across the electrodes is capable of boiling a surgical fluid contained between the electrodes.

7. A liquefaction handpiece, comprising:

a) a body having a hollow interior, a first irrigation lumen and an aspiration lumen mounted within the hollow interior; and

b) a pumping chamber having a pair of electrodes across which electrical current will flow, the electrodes attached to the first irrigation lumen.

8. The handpiece of

claim 7

wherein electrical current flowing across the electrodes are capable of boiling a surgical fluid contained between the electrodes.

9. The handpiece of

claim 7

further comprising a second irrigation lumen.

10. The handpiece of

claim 7

wherein the second irrigation lumen is mounted on the exterior of the body.

11. A liquefaction handpiece, comprising

a) a body having a first irrigation lumen and an aspiration lumen; and

b) a pumping chamber attached to the first irrigation lumen, the pumping chamber having an internal heating element capable of boiling a surgical fluid contained within the pumping chamber.

12. The handpiece of

claim 11

further comprising a second irrigation lumen.

13. The handpiece of

claim 12

wherein the second irrigation lumen is mounted on the exterior of the body.

14. A liquefaction handpiece, comprising:

a) a body having a first irrigation lumen and an aspiration lumen, and

b) a pumping chamber attached to the first irrigation lumen, the pumping chamber having an external heating element capable of boiling a surgical fluid contained within the pumping chamber.

15. The handpiece of

claim 14

further comprising a second irrigation lumen.

16. The handpiece of

claim 15

wherein the second irrigation lumen is mounted on the exterior of the body.

17. A liquefaction handpiece, comprising:

a) a body having a first irrigation lumen, and

b) a pumping chamber attached to the first irrigation lumen, the pumping chamber capable of producing pressure pulses with

i) a force of between 0.03 grams and 30 grams,

ii) a rise time of between 1 gram/second and 3,000 grams/second and

iii) a frequency of between 1 Hz and 200 Hz.