JP2016165465A - 視力を矯正する角膜インレー設計および方法 - Google Patents
視力を矯正する角膜インレー設計および方法 Download PDFInfo
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Abstract
Description
stigative Ophthalmology and Visual Science、vol.26、pp.240−243(1985)で単純な生物機械学的反応を提案している。この生物機械学モデル(「Watskyモデル」)では、前方角膜表面の曲率半径は、前方角膜表面と角膜インレーの前面との間の薄層角膜材料(すなわちフラップ)の厚さに、インレーの前面の曲率半径を加えたものに等しいと想定されている。
the corneal response to intracorneal lens insertion and laser in situ keratomileusis with flap creation using IntraLase(角膜内レンズ挿入、およびIntraLaseを使用するフラップ形成による生体内レーザ屈折矯正術に対する角膜反応の共焦点評価)」、J.Cataract Refract.Surg.;vol.32、pp1119−1128(July 2006)。
本発明の一態様は、老視を矯正するために角膜に対し矯正処置を行う方法である。この方法は、老視を矯正するための所望の角膜実質組織改変を決定するステップと、老視を矯正するために角膜の角膜実質層を改変するステップとを含み、老視を矯正するために角膜の角膜実質層を改変するステップは、角膜実質層改変に反応した角膜の上皮層の上皮整形を補償するステップを含む。
ある。前面12は、ある前方曲率半径を有し、後面18は、ある後方曲率半径を有する。外縁部16は、後面18とベベル部14をつなぐ。ベベル部は前面の一部分と考えることも、前面と後面の間の別個の面と考えることもできる。例示的なインレー10は、例えば、それだけには限らないが、老視を治療するのに使用することができる。
07/0129797 A1号)、および2006年6月1日出願の米国特許出願第11/421,597号(米国特許出願公開第2007/0280994 A1号)に見出すことができる。
力を得る例示的な一実施形態を示す。眼は、角膜110、瞳115、水晶体120、および網膜125を含む。図4で、インレー(図示せず)を角膜の中心に移植すると、角膜内に小さな直径の「作用」ゾーン130が作り出される。インレー直径も作用ゾーン直径も瞳115の直径より小さい。「作用」ゾーン130により、角膜の中心領域で前方角膜表面の曲率を増大させ、したがって「作用」ゾーン130のジオプター屈折力を増大させることによって、近方視力が得られる。「作用」ゾーン周辺の角膜の領域135では、直径が瞳の直径よりも小さく、遠方視力が得られる。したがって、被術者の近方視力は、治療される眼の遠方視力の喪失を最小限にしながら改善される。
含む。この方法が中心での近方視力を得て周辺での遠方視力を得るために角膜内にインレーを移植することを含む、特定の一実施形態を説明する。いくつかの実施形態では、急峻な移行部を有する前方角膜表面の中心ゾーンが選択される(すなわち、図3では見ることができる外側作用ゾーンが実質的にない)。急峻な移行部により、近方屈折力効率と遠方屈折力効率の両方が最大になる。実際には、上皮整形の効果により通常は「急峻な」移行部が生じないよう防止される。経験的に、インレーによって生じる前面変化は、少なくとも8次の対称式で与えることができる。
[0056]ここで、「Elev」はインレーによる前方角膜表面高さの変化、a0、a2、a4、a6およびa8は形状を支配する係数である。また、「r」は、前面変化中心からの半径範囲位置である。
a2=2×α/rz2−β/2/rz
a4=β/2/rz3−α/rz4
ここで
α=−hctr−a6×rz6−a8×rz8
β=−6×a6×rz5−8×a8×rz7
[0059]したがって、理想的な前方角膜高さ変化は4つの独立パラメータ、すなわちhctr、rz、a6およびa8によって表すことができる。
を表す。画像品質は、選択された空間周波数における各MTF値がそれらの最高値を有したときに最大化される。
ンレーが角膜内に配置された後、角膜前面に生じた形状変化を上皮層が低減しようとすることが分かった。インレーの径方向上方の目立った上皮菲薄化502と、インレーの直径をわずかに越えた位置での上皮肥厚化504とがあった。外側領域506では上皮層は変化しないままであった。この上皮整形は、角膜前面に生じた曲率の増加をならす、または低減するための上皮層による自然な反応であるように見える。領域502で菲薄化し、領域504で肥厚化することによって、上皮は前面を整形し、その術前の形状に戻そうとする。上皮整形とは、この文脈では、角膜内の異物の移植によって生じた変化を上皮層が低減しようとする仕方のことである。菲薄化および肥厚化は、それぞれ約10ミクロンであることが観察された。
グラフで示す。
6mmから9mmの範囲にあることが示唆される。インレーの下に隙間ができるいかなる可能性も回避するには、いくつかの実施形態では、後方曲率半径は約10mmになる。
Claims (36)
- 視力を矯正する方法であって、
視力を矯正するための角膜前面の所望の形状変化を決定するステップと、
前記角膜前面に前記所望の形状変化を生じさせる厚さプロファイルを有する角膜インレーを選択するステップと、
前記角膜内に前記インレーを移植し、それによって前記角膜前面に前記所望の形状変化を生じさせるステップとを含み、
前記角膜前面に前記所望の形状変化を生じさせる前記厚さプロファイルを有する前記インレーを選択するステップでは、前記角膜内に前記インレーを移植することに反応した前記角膜の上皮層の上皮整形を補償する、方法。 - 請求項1に記載の方法において、前記角膜前面の所望の形状変化を決定するステップが、前記角膜前面の、前記角膜の光軸に沿って置かれる中心部分の所望の形状変化を決定するステップを含む方法。
- 請求項1に記載の方法において、前記角膜前面の中心部分の所望の形状変化を決定するステップが、前記中心部分の周辺に置かれた前記角膜前面の周辺領域の形状変化は回避しながら、前記角膜前面の中心部分の所望の形状変化を決定するステップを含み、前記中心部分と前記周辺部分の間の界面の直径が瞳の直径よりも小さい方法。
- 請求項1に記載の方法において、前記角膜前面の所望の形状変化を決定するステップが、近方視力を得るために前記角膜の中心部分を急勾配にし、かつ前記中心部分の周辺の領域での遠方視力が得られる形状変化を決定するステップを含み、前記角膜内に前記インレーを移植するステップでは、前記中心部分に急勾配化を生じさせて、前記中心部分の周辺での遠方視力を得ながら近方視力を得る方法。
- 請求項1に記載の方法において、視力を矯正するための前記角膜前面の所望の形状変化を決定するステップが、老視を矯正するための所望の角膜屈折力変化を決定するステップを含む方法。
- 請求項5に記載の方法において、老視を矯正するための所望の角膜屈折力変化を決定するステップが、前記所望の角膜屈折力を約1.5ジオプターから約3.5ジオプターに決定するステップを含む方法。
- 請求項1に記載の方法において、前記厚さプロファイルが、中心厚さ、直径、前方曲率半径および後方曲率半径のうちの少なくとも1つを含み、ある厚さプロファイルを有する角膜インレーを選択するステップが、角膜内にインレーを移植することに反応した前記角膜の上皮層の上皮整形を補償するために、中心厚さ、直径、前方曲率半径および後方曲率半径のうちの少なくとも1つを選択するステップを含む方法。
- 請求項7に記載の方法において、上皮整形を補償するために前記中心厚さ、直径、前方曲率半径および後方曲率半径のうちの少なくとも1つを選択するステップが、約50ミクロン以下の中心厚さを有する角膜インレーを選択するステップを含む方法。
- 請求項8に記載の方法において、約50ミクロン以下の中心厚さを有する角膜インレーを選択するステップが、約25ミクロンから約40ミクロンの中心厚さを有する角膜インレーを選択するステップを含む方法。
- 請求項7に記載の方法において、上皮整形を補償するために前記中心厚さ、直径、前方
曲率半径および後方曲率半径のうちの少なくとも1つを選択するステップが、約1mmから約3mmの直径を有する角膜インレーを選択するステップを含む方法。 - 請求項10に記載の方法において、約1mmから約3mmの直径を有する角膜インレーを選択するステップが、約1.5mmから約2mmの直径を有する角膜インレーを選択するステップを含む方法。
- 請求項1に記載の方法において、前記角膜内に前記インレーを移植するステップが、前記角膜内にフラップを作り出すステップと、前記フラップの下に前記インレーを配置するステップとを含む方法。
- 請求項1に記載の方法において、前記角膜内に前記インレーを移植するステップが、前記角膜内にポケットを形成するステップと、前記ポケット内に前記インレーを配置するステップとを含む方法。
- 請求項1に記載の方法において、前記角膜の前記上皮層の上皮整形を補償するステップが、前記角膜の光軸に沿って前記インレーの上の上皮菲薄化を補償するステップを含む方法。
- 請求項1に記載の方法において、前記角膜の前記上皮層の上皮整形を補償するステップが、前記インレーの周辺の上皮肥厚化を補償するステップを含む方法。
- 請求項1に記載の方法において、前記角膜内に前記インレーを移植することに反応した前記角膜の前記上皮層の上皮整形を補償するステップが、前記角膜内に前記インレーを移植することに反応した前記角膜前面の形状の変化を低減するように前記上皮層整形を補償するステップを含む方法。
- 請求項1に記載の方法において、前記角膜前面の所望の形状変化を決定するステップが、前記角膜前面の中心部分の所望の高さ変化部直径を決定するステップを含み、前記角膜前面に前記所望の高さ変化部直径を生じさせる厚さプロファイルを有する角膜インレーを選択するステップが、インレーの直径を選択するステップを含み、
前記インレーの直径を選択するステップが、前記所望の高さ変化部直径から約1.8mm〜約2.4mmを引いたインレーの直径を選択するステップを含む方法。 - 請求項17に記載の方法において、前記インレーの直径を選択するステップが、前記所望の高さ変化部直径から約2mmを引いたインレーの直径を選択するステップを含む方法。
- 請求項1に記載の方法において、前記角膜前面の所望の形状変化を決定するステップが、前記角膜前面の中心部分の所望の中心高さ変化を決定するステップを含み、前記角膜前面に前記所望の中心高さ変化を生じさせる厚さプロファイルを有する角膜インレーを選択するステップが、インレー中心の厚さを選択するステップを含み、
インレー中心の厚さを選択するステップが、前記所望の中心高さ変化の約3倍〜7倍であるインレー中心の厚さを選択するステップを含む方法。 - 請求項19に記載の方法において、インレー中心の厚さを選択するステップが、前記所望の中心高さ変化の約5倍であるインレー中心の厚さを選択するステップを含む方法。
- 請求項1に記載の方法において、前記角膜内にインレーを移植するステップが、ボーマン層に中心高さ変化を生じさせるステップを含む方法。
- 請求項1に記載の方法において、前記インレーが前記角膜の屈折率とは異なる屈折率を有し、それによって前記インレーに固有の屈折力を与える方法。
- 老視を矯正するために角膜に対し矯正処置を行う方法であって、
老視を矯正するための所望の角膜実質組織改変を決定するステップと、
前記老視を矯正するために前記角膜の角膜実質層を改変するステップとを含み、
前記老視を矯正するために前記角膜の角膜実質層を改変するステップが、前記角膜実質層改変に反応した前記角膜の上皮層の上皮整形を補償するステップを含む、方法。 - 請求項23に記載の方法において、前記老視を矯正するために前記角膜の角膜実質層を改変するステップが、レーザを使用して前記角膜実質層を改変するステップを含む方法。
- 請求項24に記載の方法において、レーザを使用して前記角膜実質層を改変するステップが、レーザで前記角膜を整形するステップを含む方法。
- 請求項25に記載の方法において、前記レーザで前記角膜を整形するステップが、角膜組織を切除するステップを含む方法。
- 請求項26に記載の方法において、角膜組織を切除するステップが、LASIK処置を行うステップを含む方法。
- 請求項24に記載の方法において、レーザを使用して前記角膜実質層を改変するステップが、紫外レーザを使用して前記角膜実質層を改変するステップを含む方法。
- 請求項24に記載の方法において、レーザを使用して前記角膜実質層を改変するステップが、フェムト秒レーザを使用して前記角膜実質層を改変するステップを含む方法。
- 請求項23に記載の方法において、前記老視を矯正するために前記角膜の前記角膜実質層を改変するステップが、角膜実質組織を弱めるステップを含む方法。
- 請求項23に記載の方法において、前記老視を矯正するために前記角膜の前記角膜実質層を改変するステップが、前記角膜内に異物を配置するステップを含む方法。
- 請求項31に記載の方法において、前記角膜内に異物を配置するステップが、前記角膜内にインレーを配置するステップを含む方法であって、前記角膜内に前記インレーを配置することによって前記角膜前面の形状を修正するステップをさらに含む方法。
- 請求項32に記載の方法において、前記角膜前面の前記形状を修正するステップが、中心部分の周辺の前記角膜の領域で遠方視力を得ながら近方視力を得るために前記中心部分を急勾配にするステップを含む方法。
- 視力を矯正する方法であって、
角膜前面の、近方視力を得るための中心ゾーンの勾配増大を含む所望の形状変化を決定するステップと、
中心部分の周辺の前記角膜の領域で遠方視力を得ながら近方視力を得るために、前記角膜前面の中心部分の勾配を増大させる視力矯正処置を行うステップとを含み、
視力矯正処置を行うステップでは、前記角膜前面に対する上皮整形を補償する、方法。 - 請求項34に記載の方法において、前記中心部分の周辺の前記角膜の領域で遠方視力を
得ながら近方視力を得るために、前記角膜前面の中心部分の勾配を増大させる視力矯正処置を行うステップが、角膜組織内に角膜内インレーを配置するステップを含む方法。 - 請求項35に記載の方法において、角膜組織内に角膜内インレーを配置するステップが、前記インレーを前記角膜実質組織内の、前記角膜前面から測定して約200ミクロン以下の深さに配置するステップを含む方法。
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- 2009-04-03 EP EP09728872.4A patent/EP2265217A4/en not_active Withdrawn
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JP5908618B2 (ja) | 2016-04-26 |
US20090198325A1 (en) | 2009-08-06 |
JP6272376B2 (ja) | 2018-01-31 |
EP2265217A2 (en) | 2010-12-29 |
WO2009124268A2 (en) | 2009-10-08 |
AU2009231636A1 (en) | 2009-10-08 |
JP2015107346A (ja) | 2015-06-11 |
CA2720573A1 (en) | 2009-10-08 |
WO2009124268A3 (en) | 2010-01-07 |
EP2265217A4 (en) | 2018-04-04 |
US8900296B2 (en) | 2014-12-02 |
US20150080865A1 (en) | 2015-03-19 |
JP2011516180A (ja) | 2011-05-26 |
AU2009231636B2 (en) | 2014-07-24 |
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