Electrosurgical procedure for the treatment of the cornea

Abstract

This invention is a device and procedure for the correction of optical abnormalities in a human eye. It involves use of an inventive electrosurgical energy probe with specific physical configurations. The process preferably utilizes a high frequency RF electro-desiccation or ablation device. The procedure involves the initial step of forming at least one access site allowing access to the corneal volume behind the Bowman's Layer. It preferably is placed in the anterior surface of the cornea through and ending posterior to the Bowman's layer of the eye. The electrosurgical probe is then introduced into the access site and, depending upon the visual abnormality to be corrected, the probe is activated to adjust the volume of the corneal stromal layers through ablation or desiccation. The shape of the volume desiccated or ablated is dependent upon the aberration to be corrected. For instance, if the optical aberration to be alleviated is hyperopia, a circular corneal volume reduction taking place about the outer periphery of the corneal mass may be accomplished. In other instances, such as for the treatment of astigmatism, certain smaller sections of the corneal volume may be shrunk. In certain circumstances, Bowman's layer may be cut to allow the curvature of the cornea to change after the corneal volume adjustment. These relief cuts may be radial, circular, semicircular or any other form appropriate for the option adjustment needed.

What is claimed is:  
     
         1 . A procedure for altering the shape of the anterior corneal surface of an eye having a corneal mass posterior to the anterior corneal surface, wherein the corneal mass has a volume, the procedure comprising the steps of: 
 initiating at least one access site into the corneal mass posterior to Bowman's layer;    introducing through the at least one access site an electrosurgical probe, the electrosurgical probe having a support end and a circular contact end, wherein the contact end has at least one active tissue contacting site, the active site is in electrical connection with an insulated conductor residing within the contact end and extending to the support end, the insulated conductor being adapted to be coupled to an electrosurgical signal source; and    actuating the electrosurgical probe to modify the volume of the corneal mass adjacent to the electrosurgical probe.    
     
     
         6 . The procedure of  claim 1  wherein the step of modifying the corneal mass is by desiccation.  
     
     
         7 . The procedure of  claim 1  wherein the electrosurgical probe is a bipolar RF electrode.  
     
     
         8 . The procedure of  claim 1  wherein the electrosurgical probe is a monopolar RF electrode.  
     
     
         9 . The procedure of  claim 1  wherein the electrosurgical RF electrode is used in a sesquipolar configuration.  
     
     
         10 . The procedure of claim  3  therein the electrosurgical probe forms a circular probe of less than about 350°.  
     
     
         11 . The procedure of  claim 1  wherein the modification of the volume of the corneal mass is to correct hyperopia.  
     
     
         12 . The procedure of claim  4  wherein the modification of the volume of the corneal mass is to correct hyperopia or astigmatism.  
     
     
         13 . The procedure of  claim 7  wherein the modification of the volume of the corneal mass is to correct hyperopia, myopia or astigmatism.  
     
     
         14 . The procedure of  claim 1  further comprising the placement of a relief cut in at least a portion of Bowman's layer.  
     
     
         15 . The procedure of  claim 1  wherein the modification of the volume of the corneal mass is to alleviate astigmatism.  
     
     
         16 . The procedure of  claim 1  wherein the modification of the volume of the corneal mass is to correct myopia.  
     
     
         17 . The procedure of  claim 16 , wherein the modification of the volume of the corneal mass takes place at or near the center of the cornea.  
     
     
         18 . An electrosurgical probe comprising a support end and a circular contact end, the contact end comprising at least one active tissue contacting site, the active site being in electrical connection with an insulated conductor residing within the contact end and extending to the support end, the active site being raised above a substantial portion of the contact end, and the circular contact end being adapted for introduction through an access site into a corneal mass posterior to Bowman's layer, wherein the insulated conductor is adapted for coupling to an electrosurgical signal source.  
     
     
         19 . The electrosurgical probe of  claim 18 , wherein the raised active site is removably couple to the contact end.  
     
     
         20 . The electrosurgical probe of  claim 18 , wherein the contact end is adapted to be coupled to raised active sites of varying heights.  
     
     
         21 . The electrosurgical probe of  claim 18 , further comprising a handle attached to the support end at an angle with respect to the contact end.  
     
     
         22 . The electrosurgical probe of  claim 18 , further comprising a generally cylindrical barrel coupled to the support end, wherein the support end is angled with respect to a plane of the contact end, and a barrel axis is substantially normal to the contact end plane and substantially coincident to an axis of the contact end.  
     
     
         23 . The electrosurgical probe of  claim 22 , further comprising a generally cylindrical support base adapted to receive the contact end and adapted for positioning on the eye, wherein an axis of the base is adapted to be positioned substantially coincident to a central visual axis of the eye.  
     
     
         24 . The electrosurgical probe of  claim 23 , wherein at least one return electrode for contact with the eye is disposed on the base.  
     
     
         25 . The electrosurgical probe of  claim 18 , the probe comprising two active tissue contacting sites, the active sites being in electrical connection with a single insulated conductor residing within the contact end and extending to the support end.  
     
     
         26 . The electrosurgical probe of  claim 18 , the probe comprising a single active tissue contacting site, the active site being located in a tip of the circular contact end.  
     
     
         27 . The electrosurgical probe of  claim 18 , the probe comprising a single active tissue contacting site wherein the active site comprises an arc of less than about 350°.  
     
     
         28 . The electrosurgical probe of  claim 18 , the probe comprising two active tissue contacting sites that are each in electrical connection with their own separate conductor residing within the contact end and extending to the support end.  
     
     
         29 . The electrosurgical probe of  claim 18 , the probe comprising a single active tissue contacting site located near a tip of the contact end on a top portion of the probe.  
     
     
         30 . The electrosurgical probe of  claim 18 , the probe comprising a single active tissue contacting site located near a tip of the contact end and raised and pointed in a retracting direction of the probe.  
     
     
         31 . An electrosurgical probe comprising a support end and a straight contact end, the contact end comprising at least one active tissue contacting site, the active site being in electrical connection with an insulated conductor residing within the contact end and extending to the support end, the active site being raised above a substantial portion of the contact end, and the contact end being adapted for introduction through an access site into a corneal mass posterior to Bowman's layer, wherein the insulated conductor is adapted for coupling to an electrosurgical signal source.  
     
     
         32 . The electrosurgical probe of  claim 31 , the probe comprising a single active tissue contacting site, the active site extending along the length of the straight contact end and located on the top portion of the probe.  
     
     
         33 . The electrosurgical probe of  claim 31 , the probe comprising a two active tissue contacting sites that are each in electrical connection with their own separate conductor residing within the contact end and extending to the support end.  
     
     
         34 . The electrosurgical probe of  claim 31 , the probe comprising a single active tissue contacting site located near a tip of the contact end located on a top portion of the probe.  
     
     
         35 . The electrosurgical probe of  claim 31 , wherein a single active tissue contacting site is located near the tip of the contact end and raised and pointed in a retracting direction of the probe.  
     
     
         36 . The electrosurgical probe of  claim 31 , wherein the contact end is broadened and wherein a single active tissue contacting site is located within the broadened contact end.  
     
     
         37 . The electrosurgical probe of  claim 31  further comprising a washer-shaped active tissue contacting site at a distal end of the contact end.  
     
     
         38 . The electrosurgical probe of  claim 31  further comprising a disc-shaped active tissue contacting site at a distal end of the contact end.  
     
     
         39 . The electrosurgical probe of  claim 38  wherein a wire loop forms the surface of the disc-shaped active site.  
     
     
         40 . A sesquipolar electrosurgical kit for electrosurgically altering the shape of the corneal surface of the eye, the kit comprising in packaged combination: 
 (a) at least one electrosurgical probe with at least one active tissue contacting site, wherein the at least one active site is raised above a substantial portion of a contact end of the probe; and    (b) a sesquipolar return electrode adapted for positioning on or near the eye.    
     
     
         41 . The kit of claim  40  the at least one probe including a plurality of removable active sites of different heights.  
     
     
         42 . The kit of claim  40  the at least one probe comprising a first probe and a second probe, wherein the height of the active site of the first probe is different from the height of the active site of the second probe.