CN1094606A - 角膜海绵及其使用方法 - Google Patents

角膜海绵及其使用方法 Download PDF

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CN1094606A
CN1094606A CN93109739A CN93109739A CN1094606A CN 1094606 A CN1094606 A CN 1094606A CN 93109739 A CN93109739 A CN 93109739A CN 93109739 A CN93109739 A CN 93109739A CN 1094606 A CN1094606 A CN 1094606A
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伊藤清治
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Katsuhiko Mukai
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Abstract

本发明涉及一种海绵，它被放置在要进行激光治 疗的眼角膜上用以吸收从眼球周围无法避免渗出的 液体。这种角膜海绵提供了保护性，使用方便并提高 了角膜激光放射治疗的有效性。这种角膜海绵具有 一个手术开口使要治疗的角膜区域裸露出来，而且海 绵上作有标记，可精确容易地对显微镜视野进行找 正。这种角膜海绵还含有一个冷却眼液，可最大程度 地减轻炎症反应。这种炎症可能会引起手术后的并 发症，诸如角膜混浊和不协调性角膜折射。

Description

为了实施角膜切除，近期已研制出一种波长为193nm的激光器。对光折射切除手术也进行了研究，并已用于角膜屈光校正的治疗之中。这种激光器可用于光线角膜切除手术，例如角膜白斑、翼状胬肉、角膜糜烂以及疱疹的手术。它还可以用于穿透式角膜补合手术和层状角膜成形手术。
为了对角膜基质施行手术，在激光切除之前要用眼铲人工地移开要治疗的角膜上皮，并且至少使用下述中的一种眼药水，如抗生素眼液（antibiotics）、缩瞳类药剂（miotics）、midriatics或麻醉剂（anesthetics）。
当用于保证眼脸张开的开睑器压迫眼球时，眼药水难免随眼泪一起渗流到角膜表面。目前是人工用普通海绵吸干这种渗液或者是用一根固定在眼睑上的吸管来排除不断流出的渗液。
由于角膜上的渗液将部分光反射到显微镜里，同时还吸收一些激光，因此它妨碍手术的进行，并且降低了角膜切除的有效性。
为了从角膜上排除这些渗液使用了梯杆式合成吸管、纱布或者排液管。但是在渗液量突然增加的情况下，这些技术就难以胜任而且也不便利，特别是在激光治疗手术中更显突出。
由于激光加热了角膜组织，引起较严重的炎症反应并改变角膜的厚度从而导致手术后的角膜混浊。为了尽量减轻这种炎症，患者在激光手术后必须开始皮质类甾醇的疗程。
据报导使用与甾族类化合物有关的药物超过几个月会有潜在危害。
精确的轴线对准不仅对于要达到最佳效果的激光散光校正是必需的，而且在任何角膜手术中也必须遵循。
纽约lgaku-shoin医药出版公司（Igaku-Shoin        Medical        Pub-lishers，Inc.，New        Yonk）出版的“激光外科”一书中的第42和43页上登载了一个环状海绵，它是以前激光切除手术的一个例子。因为要对角膜作“标记”以便后续作业使用，所以该环状海绵是放在角膜的外边。环状海绵在麻醉剂中浸泡后放在眼睛上，然后用一个钩子标出瞳孔中心位置，标记作好后拿掉环状海绵。仅当作麻醉用的环状海绵有一个长臂，使得操作方便。
正如前之所述，渗液使手术操作变得复杂了。为了在激光手术中防止渗液复盖角膜表面设计了一种新型的角膜海绵，下文给予叙述。
设计的角膜海绵与常见的角膜表面形状相吻合，它吸收渗液，具有至少一个手术口以便裸露出要治疗的角膜区。角膜海绵可以做成凸状的，也可以在周边上开一些切口形成折翼，以适配于角膜表面形状，改善贴合质量。
本发明的角膜海绵是用吸水材料做成的，这种吸水材料是从塑料泡沫、纤维素、吸水纸、棉花、碳纤维和复合吸收材料中精心挑选出来的。
激光手术通过海绵上的手术口进行。手术口可开在角膜海绵内部也可开在边上。患者需要角膜治疗时，直接将海绵放在角膜表面上即可。
可以在角膜海绵上作出位置标记以便在角膜上精确定位和显微镜视野的找正。标记可以是任意一种形式，比如切口或印记。
这种海绵还能蓄存冷却液以避免激光切除时生热可能引起的角膜并发症。
按照本发明的教导，在激光手术进行时角膜海绵要吸干渗到角膜表面的泪与眼药水的混合液体，这些液体的产生是不可避免的。对需要角膜激光治疗的患者来说，要让角膜海绵保持在角膜表面以便吸干渗液，使激光手术下的角膜部分保持干燥。
本发明达到的另一个目的是角膜海绵可作出靶点标记，用来对准要治疗的角膜。
本发明所达到的进一步目的是角膜海绵的手术孔与要治疗的角膜区相分离，因而可作为激光导孔。
本发明达到的另一个目的是角膜海绵具有蓄存冷却眼液的作用，从而保护角膜表面不受激光切除时产生的热危害。也就是说，在对患者进行角膜激光治疗的过程中，把含有冷却眼液的角膜海绵放在角膜表面可以最大程度地减轻可能导致角膜混浊的术后炎症。
图1是本发明的角膜海绵优选实例的透视图;
图2是该实例的平面视图;
图3是沿图2中Ⅲ-Ⅲ线的剖视图;
图4是本发明的角膜海绵另一个优选实例的透视图;
图5是它的平面视图。
激光的有效性因渗出的眼泪和眼药水侵入角膜而降低，因为这些液体吸收并反射激光。本发明的角膜海绵能吸收这些液体，使要治疗的角膜区保护干燥。角膜海绵还遮盖和保护角膜的其余部分防止激光束进入。
本发明的角膜海绵为显微镜视野的靶点找正至少提供一个位置标记。在光折射角膜切除手术中，特别在需要轴线精确对正的散光手术中这些标记非常有用。任何形式的标记，印记式的或切口形的，都可用于显微镜视野的定靶。
角膜海绵提供形为凸状，具有大约7至8毫米的曲率半径，它可以和形状一致的眼角膜相贴合。如果在角膜海绵周边开一些切口形成折翼，就没有必要做成拱形。
角膜海绵至少一个切口作为手术孔，通过手术孔可进入要进行治疗的角膜区。手术孔可开在角膜海绵上的任意地方，形状不限。
建议手术孔大于1毫米，最大直径不要超过30毫米，否则眼睑或开睑器会使角膜海绵错位。
据报导人的眼角膜半径直径大约是11到12毫米，所以稍大于12毫米直径的角膜海绵就能复盖眼角膜外围组织。
手术中由于几百次的激光脉冲使眼角膜被短时加热到摄氏10到15度，引起角膜炎症加重并且角膜厚度发生改变。在光折射角膜切除手术和光线角膜切除手术中这些症状会导致角膜混浊或不协调性角膜折射。
含有冷却眼液的角膜海绵能够最大程度地减少对角膜的伤害。比如眼液可以被冷却到摄氏4度这样一个理想温度。建议在激光手术中使用温度为2℃-10℃的眼液以维持角膜温度在常温以下。
由于减少了角膜混浊的发生率，手术后就能最小量地使用与甾族化合物有关的药物，从而降低青光眼和白内障的发病率。
例1
图1、图2和图3是凸状角膜海绵的图例。该角膜海绵1由合成的吸水材料制成，形如炸面圈，直径为11毫米。该海绵有4个楔形的切口5即位置标记，4个切口相隔90°分布。该海绵还有一个6毫米直径的手术孔3，允许由此进入需治疗的角膜区。
手术孔形如圆形开口2，而角膜海绵具有凸形曲率。为了与眼角膜的曲率相吻合，该角膜海绵的曲率半径做成的是8毫米。
使用这种角膜海绵已成功地对近视患者进行了光折射角膜切除手术。所用激光系统为Excimed        UV200LA，Summit        Technology。手术设定的激光器模态为：切割域为4.5毫米直径，238次脉冲，切割率为0.25微米/脉冲。
角膜海绵1在手术中非常有用，它不仅防止渗液进入手术区，而且帮助了角膜的对准，并保护了手术区外的角膜部分。
例2
图4和图5所示的角膜海绵1′在其周边，上有一个手术口4′，它是是从海绵的边缘2′上切去一块形成的。
在该角膜海绵1的手术口内成功地在裸露出的角膜上施行了翼状胬内切除手术。角膜海绵抑制了眼泪和眼药水进入角膜的手术区，保障了手术顺利完成。
例3
一种眼平衡盐溶液（BBS        PLUS，Alcon        Surgical，Inc.）在使用前被冷却到摄氏4度，蓄存在海绵1中。在对免眼施行激光手术前用这种海绵把兔眼角膜表面温度从36.8℃降低到了22℃。在4.5毫米直径的角膜切除域上用0.25微米/脉冲的切割速率进行了300次脉冲后，兔眼的角膜表面温度只升高了约2℃。
手术后出现的角膜混浊程度明显比普通激光切除手术后的低。
角膜表面的温度是用辐射温度计测量的。
含有冷却眼液的这种角膜海绵使激光切除下的眼角膜保持较低的温度，防止了炎症的发生。
尽管说明的只是发明所选的一个实例，但可以推测会存在其它的例证，所做的变动不会背离发明的精神和范围。

Claims (10)

1、一种角膜海绵，由吸水材料制成，所指材料中有一个开口以便由此进入要进行激光治疗的眼角膜，至少有一个位置标记用于显微镜视野的靶点找正。
2、如权利要求1中所述的角膜海绵，其特征在于，其材料做成凸状并具有大约7-8毫米的曲率半径，其中所指材料的直径不超过30毫米。
3、如权利要求1中所述的角膜海绵，其特征在于，所指材料是从塑料泡沫、纤维素、吸水纸、棉花、碳纤维和复合吸收材料中挑选出来的。
4、如权利要求1中所述的角膜海绵，其特征在于，所指位置标记是由所指材料周边的一个切口形成。
5、如权利要求1中所述的角膜海绵，其特征在于，位置标记的数量为4，由切口形成的每个标记都在所指材料的周边上并且相互间隔为90°。
6、如权利要求1中所述的角膜海绵，其特征在于，开口大体位于所指材料的中心且直径约6毫米。
7、如权利要求1中所述的角膜海绵，其特征在于，开口在沿所指材料的周边上。
8、一种带手术开口和位置标记的角膜海绵的使用方法，包括直接把海绵放在患者的眼角膜上，利用位置标记找正角膜，通过海绵的手术开口在角膜的裸露区施行激光手术以及用海绵吸收渗到处于手术下的角膜表面的眼泪。
9、如权利要求8中所述的带手术开口和位置标记的角膜海绵的使用方法，进一步包括把海绵浸透大约2到10℃的冷却液，由此来冷却手术产生的热，保护角膜表面。
10、如权利要求9中所述的带手术开口和位置标记的角膜海绵的使用方法，其特征在于，外科手术为激光切除术。
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US5368590A (en) 1994-11-29
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