Method and apparatus for laser surgery

Apparatus for performing laser surgery comprising:

• a handpiece having proximal and distal ends,
• means for introducing a laser beam into said proximal end,
• means in said handpiece for focussing said beam to a focus spot including an objective lens at said distal end,
• said handpiece having a tubular terminal portion, with an open distal end, said terminal portion extending beyond the distal end of said handpiece and coaxially with said objective lens for engaging a body, said objective lens being spaced from the distal end of said terminal portion, and
• means for causing a flow of liquid through the tubular terminal portion and out of the distal end thereof,
• whereby said objective lens is spaced a predetermined distance from said body and said laser beam passes through the liquid in said tubular terminal portion.

Apparatus for delivery of laser energy comprising:

• a probe comprising a substantially cylindrical quartz rod having proximal and distal ends,
• said quartz rod at the distal end thereof having a beveled end surface for emitting radiation, and
• means for delivering a divergent beam of laser radiation to said proximal end of said quartz rod and for causing radiation to be conveyed through said rod by internal reflection, and
• means for causing fluid to flow across said bevelled end surface of said rod comprising:
• (a) means for discharging fluid from said probe at the distal end thereof comprising a discharge port which is beveled and lies in the same plane as the bevelled end surface of said quartz rod,
• (b) means for aspirating fluid from the vicinity of the distal end of said probe comprising an aspiration port which has a bevelled end portion which lies in the same plane as the bevelled end surface of said quartz rod, said bevelled end surface of said rod being between said ports,
• whereby the radiation emitted from said quartz rod is sharply defined beyond said bevelled end surface.

A method of surgically cutting or modifying only tissue which is located at a short, predetermined distance from the surface thereof comprising:

• providing a handpiece having a distal end with a focussing lens at a distal end thereof,
• placing against the surface of said tissue the focussing lens at the distal end of said handpiece,
• generating a laser beam in TEM(oo) mode,
• passing said laser beam through said handpiece toward and through said focussing lens at said distal end and thence into said tissue with said lens thereagainst, and
• cutting or modifying only said tissue at a distance from said surface by focussing said laser beam to a focus spot located a short distance into said tissue from the surface thereof.

A method of surgically cutting or modifying a body having a surface with an exposure site comprising:

• generating a laser beam of photoablative property in TEM(oo) mode;
• directing said laser beam into a handpiece having therein focussing means including an objective lens for forming a focus spot,
• placing said objective lens a predetermined distance from said surface with said exposure site such that said focus spot is at a predetermined position relative to said exposure site, and
• causing a stream of liquid to move across said exposure site.

A method of treatment of the human body comprising:

• generating a beam of TEM(oo) mode laser radiation,
• conducting said beam through a laser radiation transmitting rod having a distal end,
• causing said beam to be internally reflected in said rod and to pass out of the distal end thereof,
• focussing said beam at a location beyond the distal end of said rod, and
• causing fluid to flow across said distal end of said rod.

A method of modifying the stroma comprising:

• generating a laser beam of photoablative property in the TEM(oo) mode;
• directing said laser beam into a handpiece and thence into a cornea, and through a portion of the thickness thereof, and
• focussing said laser beam to a focus spot located in the intrastromal layer,
• whereby only the intrastromal layer is modified by said laser beam.