KR20080014804A - Epithelial Bag Expansion Tool and Combination of Epithelial Dissociator and Corneal Correction - Google Patents

Abstract

The described device is useful in the field of ophthalmology. The device and device usage include separating or lifting the corneal epithelium into a substantially continuous layer from the eye to form a flap or pocket. In particular, the device generally employs a non-cutting separator or incision device configured to separate the epithelium from the naturally occurring cutting plane in the eye, especially between the epithelium and the corneal parenchyma (Bowman's membrane), specifically transparent Lamina separation occurs in the region of lucida ). The incision can vibrate during detachment. The separator or incision may also have a structure that expands after forming the epithelial bag. Independently, the separation device or incision device may also include a structure that alone or in combination with various energy sources to correct the underlying cornea in the course of refraction, or to treat other diseases. After this step, a portion of epithelial tissue may be placed back on the cornea, or on the eye lens after placing the eye lens on the eye.

Description

EPITHELIAL POCKET EXPANDING TOOL AND COMBINATION EPITHELIAL DELAMINATING DEVICE AND CORNEAL REFORMER}

The described device is useful in the field of ophthalmology. The device and device usage include separating or lifting the corneal epithelium into a substantially continuous layer from the eye to form a flap or pocket. In particular, the device generally employs a non-cutting separator or incision device configured to separate the epithelium from the naturally occurring cutting plane in the eye, especially between the epithelium and the corneal parenchyma (Bowman's membrane), specifically transparent Lamina separation occurs in the region of lucida ). The incision can vibrate during detachment. The separator or incision may also have a structure that expands after forming the epithelial bag. Independently, the separation device or incision device may also include a structure that alone or in combination with various energy sources to correct the underlying cornea in the course of refraction, or to treat other diseases. After this step, a portion of the epithelial tissue may be placed back on the ocular lens after placing the ocular lens on the cornea or on the eye.

Refractive surgery is a series of surgical procedures that change the eye's innate vision or focal control. These changes alleviate the need for glasses or contact lenses that one can rely on for clear vision. In human eyes, focusing power is largely defined by the curvature of the air-liquid interface, where the refractive index is changed to its maximum. This curved interface is the outer surface of the cornea. The refractive power of this interface accounts for about 70% of the total magnification of the eye. Light that makes the image pass through the cornea, anterior, lens and vitreous fluid to focus on the retina to form an image. The magnification of this curved air-corneal interface provides the field of refractive surgery with the opportunity to surgically correct visual defects.

Early refractive surgery corrected myopia by flattening the curvature of the cornea. The first highly successful procedure is called Radial Keratotomy (RK). RK was widely used in the 1970s and early 1980s, where a radially oriented incision was made on the outer periphery of the cornea. These incisions allow the peripheral cornea to bend outwards, resulting in a flat optic in the center of the cornea. This was such an easy and popular method, but it could hardly reduce its dependence on glasses or contact lenses.

Many failed processes, called epikeratophakia, were developed during the RK's time. This is essentially an academic anomaly today. Superficial corneal lens transplantation provides a new curvature to the outer curvature of the cornea by implanting a thin layer of preserved corneal tissue over the cornea. The preservation method used in superficial corneal lens transplantation is lyophilization, which freezes the cornea. Corneal tissue is not acellularized but is not alive. During the freeze drying process, the cornea is also polished to a specific curvature.

The superkeratoscopy lens was surgically placed in the eye. After complete removal of the epithelium, an annular 360 ° incision is made in the cornea, where the superkeratoplasty lens is placed. The outer circumference of the lens is inserted into the annular incision, continuously closed and fixed in place. Superficial keratoplasty has several problems: 1) The lens remained cloudy until parenchyma fibroblasts formed colonies on the lens, which could take months; 2) Disconnected epithelium became a lesion of infection until the migrated epithelium grew along the incision site above the lens surface; 3) Above the surgical site, the ahmal epithelium sometimes moved into the space between the lens and the cornea. Currently, superkeratoplasty is limited in its use. It is now used in pediatric apical patients who cannot tolerate very steep contact lenses.

Major industrial research efforts have attempted to produce composites of superficial corneal lens grafts called synthetic onlays in synthetic epilenses. Different synthetic polymers (hydroxyethyl methacrylate, polyethylene oxide, lidofilcon, polyvinyl alcohol) were used. Hydrogels of these materials usually did not have a surface that facilitated the growth and fixation of epithelial cells on these synthetic surfaces. This was one of the major drawbacks of synthetic onlays. Epithelial cells did not heal enough in these lenses.

Another problem with these synthetic lenses is that they do not adhere well to the surface of the eye. Conventional sutures have been difficult, and the use of biological glue has also been a disadvantage. Glue was not an ideal biocompatible material for the cornea.

Finally, the permeability of these hydrogels was quite limited. Living epithelial cells on the surface were difficult to achieve sufficient nutrition. The trophic flow of the corneal epithelium flows from the aqueous humor to the outside of the epithelial cell through the cornea. In the end, industrial efforts failed to develop a suitable synthetic superkeratoplasty lens.

By the mid-1990s, the process of sculpting the cornea with a laser that started in place of radial keratotomy was successful. First-generation corneal laser ablation is called photorefractive keratectomy (PRK). In PRK, a cutting laser (eg, excimer laser) focuses on the cornea and engraves a new curvature on the cornea surface. In PRK, the epithelium is destroyed and a new outer surface curve is obtained. Over time, the epithelium should grow or heal again in place. This epithelial healing caused problems for most patients because of the pain in the cornea revealed by the cutting of the epithelium. It is also difficult to see at the beginning of this, and this "recovery time" can last from several days to a week or more.

LASIK, a subsequent variant of PRK corneal laser cutting, has become very popular. LASIK procedure is known as corneal laser cutting angioplasty (L aser I n S itu K eratomileusis), the public have a means such as laser vision correction. LASIK surgically cuts the outer part of the cornea (or strap-like lens) from the corneal surface (80-150 microns thick). This is done by a device called a microkeratome. Microkeratotomy is a device that cuts circular flaps from the corneal surface while leaving the epithelium hinged at one edge. This flap is folded back and a portion of the exposed surgical layer is removed or corrected using an ablation (excimer) laser. The flap is put back in place. When the flap is put back in place, the flap will conform to the laser-deformed surface and the cornea will gain new curvature. Epithelial cells are not removed or damaged during this process. Epithelial cells are simply cut off at the edge of the flap. When the flap is placed back on the corneal layer, the epithelium heals again at the incision site. This process essentially requires no recovery time and results are almost instantaneous. Because the operation takes very little time (15 minutes in each eye) and the results are consistent and very accurate, LASIK is currently considered the best way to perform refractive surgery.

The high volume of Refractive Surgery Society practitioners and some laser cutting subepithelial corneal surgery; there is a process called (LASEK L aser A ssisted S ubepithelial K eratomileusis) and evaluated with the latest technology. In LASEK "flaps" are made of epithelium only. This epithelial layer is lifted from the cornea in a manner similar to LASIK. The cutting laser focuses directly on the surface of the exposed cornea (in the same way as in the PRK). However, this epithelial flap is intact, ie the epithelium is not destroyed. This is much less recovery time compared to PRK because it simply repositions after reshaping the curvature of the anterior cornea. Currently the LASEK method is not as good as LASIK, but the result is better than PRK.

The corneal epithelium is a multilayered epithelial structure, typically about 50 μm thick. It is not awakened. Outer cells are living cells that are flat in nature. Basal epithelial cells are cuboidal and lie on the parenchyma surface on a structure known as the Bowman's membrane. The basal cell layer is typically about 1 mil thick (0.001 "). Basal cells produce the same keratin as produced in the envelope, ie skin. Basal epithelial cells express keratin 5 and 14 and produce keratin 6 and 9 It is possible to differentiate into flat epithelial cells of the corneal epithelium, which have many important properties: 1) transparent; 2) impermeable; 3) barrier to external factors; 4) highly Nervous tissue: The nerves in the cornea lead directly to the epithelium, so defects in this organ cause pain.

Epithelial cells are laterally attached by transmembrane molecules called desmosomes. Another transmembrane protein, hemidesmosome, is linked to collagen type 7 and is present on the basal surface of basal epithelial cells. Hemidesmosomes anchor the epithelium to the lower collagen part of the parenchyma. The junction between the epithelium and the corneal parenchyma is called the basement membrane (BMZ).

When LASEK is performed, a physical well is placed or formed on the epithelium and filled with a selection of 20% ethanol and a balanced salt solution. Contact with the solution will probably loosen the adhesion of epithelial cells to BMZ by destroying part of the epithelial cell population. The epithelium is then lifted by pushing the epithelium in a manner similar to peeling off the painted wall, for example with a Weck sponge. Next, the exposed collagen portion of the corneal parenchyma is cut and its surface reshaped. The weakened epithelium is then returned back to place to act as a bandage. However, this "bandage" does not restore the epithelium to its original state, that is, it does not preserve the integrity of the epithelium, thereby reducing the transparency of the epithelium, impermeability to water, and barrier function. Moreover, the ability of the epithelium to adhere to corneal parenchymal surfaces is also impaired.

US Pat. Nos. 6,099,541 and 6,030,398 to Klopotek describe microkeratome device and method for preparing the eye by cutting corneal epithelial layer for LASIK or other reshaping process. Repositioned epithelium is attached using surgical techniques.

None of the cited references represent or suggest the devices described herein.

references

Kiistala, U. (1972) "Dermal-Epidermal Separation. II. External Factors in Suction Blister Formation with Special Reference to the Effect of Tempera-ture," Ann. Clin. Res. 4 (4): 236-246.

Azar et al. (2001) "Laser Subepithelial Keratomileusis: Electron Micro-scopy and Visual Outcomes of Flap Photorefractive Keratectomy," Curr. Opin. Ophthalmol 12 (4): 323-328.

Beerens et al. (1975) "Rapid Regeneration of the Dermal-Epidermal Junc-tion After Partial Separation by Vacuum: An Electron Microscopic Study," J. Invest. Dermatol. 65 (6): 513-521.

Willsteed et al. (1991) "An Ultrastractural Comparison of Dermo-Epider-mal Separation Techniques," J. Cutan. Pathol. 18 (1): 8-12.

Van der Leun et al. (1974) "Repair of Dermal-Epidermal Adherence: A Ra-pid Process Observed in Experiments on Blistering with Interrupted Suction," J. Invest. Dermatol, 63 (5): 397-401.

Katz S.I. (1984) "The Epidermal Basement Membrane: Structure, Ontogeny and Role in Disease," Ciba. Found. Symp. 108: 243-259.

Green et al. (1996) "Desmosomes and Hemidesmosomes: Structure and Func-tion of Molecular Components," FASEB. J. 10 (8): 871-881.

Summary of the Invention

The present description includes mechanical non-cutting devices and methods for forming epithelium isolated from the eye or for lifting the epithelium into a generally continuous layer from the underlying support structure. This epithelial delaminator is used to make epithelial flaps or pockets. The flap or pocket may be used in the course of refractive surgery or in the placement of the refractive lens.

Epithelial delaminators may be mechanical in nature. This mechanical delaminator lifts the epithelium from the front of the eye to a generally continuous layer by applying mechanical force to cut without cutting. Mechanical delaminators specifically include dull incisions and wire-based incisions with passive or active wires applied to the eye.

Moreover, the described devices and methods form a portion of epithelial tissue, such as a pouch or flap, and correct the underlying corneal surface without removing the device, which is used to prepare the epithelium in the cornea in preparation for a reshaping or correction process such as LASEK. It may be used in various ways to remove, to form a pocket into which contact lenses are placed, or to expand the pocket so formed if desired.

1A-1D are schematic diagrams of a general method of using the general apparatus described herein.

2A-2E are cross-sectional views of various orientations of a combination device for forming a portion of epithelial tissue and correcting the cornea below it.

3A is a cross-sectional view of a combined corneal correction device generally disposed at the laser emission site.

3B is a bottom view of the apparatus of FIG. 3A.

4 is a cross-sectional view of the corneal correction apparatus using a laser and a heat absorption conductive contact layer.

FIG. 5 is a device similar to the device of FIG. 4 but instead includes a separate thermally conductive member.

6 and 7 depict examples of forming separate thermally conductive sites suitable for use with the variant shown in FIG. 5.

FIG. 8A is an RF device wherein the incision device (shown in FIG. 8B) has a plurality of RF-receiving sites that are heated upon application of RF, and selectable RF transmission sites for cooperatively heating the receiving sites overlying the incision apparatus Includes an external RF antenna source. The antenna source is shown as a bottom view in FIG. 8C.

9A and 9B are further variations of the RF source incision combination.

10 is a combination incision device comprising a plurality of thermal heat sources.

FIG. 11 is a side cross-sectional view of the device similar to the device of FIG. 10 but also having a separate thermally conductive portion.

12A and 12B are side views of an incision device configured to form and expand an epithelial bag.

13A and 13B are cross-sectional views of the cutting device as in FIGS. 12A and 12B with hinged rotating members.

14A and 14B are side cross-sectional views of the cutting device having a hydraulic expansion member.

15A and 15B are side cross-sectional views of the expansion incision device with the device center portion extended.

At certain epithelial surfaces, such as the skin, respiratory epithelium, intestinal epithelium, and cornea, an epithelial cell layer is attached to the underlying basal membrane. Blisters are formed under the epithelium when the epithelium is separated from the basement membrane and the underlying collagen tissue. In general, coarse separation of less than 1 mm in diameter is called blistering, and separation of more than 1 mm in diameter is actually bleb.

Corneal epithelium can be separated or lifted from the front of the eye to a continuous layer by applying various mechanical forces to the front of the eye, the basal cell layer, or the junction between the basal cell layer and the Bowman's layer or membrane (transparent plate). As used herein, the term “continuous” means “not disconnected”. As used herein, the term “mechanical force” refers to any physical force produced by a person, machine or device. Examples of mechanical forces include suction, shear, and blunt forces.

By epithelial delamination, a mechanical force is applied to the epithelium, such as the corneal epithelium. As used herein, the term "epithelial delaminator" refers to any machine or device that applies mechanical force to separate the epithelium from the basement membrane. In addition, the epithelium can be separated or lifted from the front of the eye by contacting the front of the eye with a chemical composition that induces separation of the epithelium from the parenchyma below.

Incision and Corneal Correction Combination

1A-1D show the entire process of using the described incision and corneal correction apparatus combination.

1A is a side view of the eye 200 and the incision-corneal straightener combination 202 described below approaching the eye. The other suitable blade of the leading edge 204 and the incision combination 202 is sufficient to not cut or remove tissue from the front of the cornea, ie the Bowman's membrane, as it passes axially along the corneal surface after penetrating the epithelium. It is dull. If desired, the incision-calibrator 202 can oscillate laterally or axially. In general, the device provides a portion of epithelial tissue wherein at least a portion of the separated epithelial tissue edge is attached to the cornea, perhaps in a bag-shaped fashion.

1B is a cross-sectional view of the incision body 208 disposed below the epithelium 210, in which a pocket-shaped epithelial portion 206 is formed.

1C shows a blade body 208 positioned above the eye 200 with an opening 212 towards the epithelial bag or portion of epithelial tissue 206 with the incision-corneal corrector combination still in place.

In the incision-corneal correction device 202 of FIG. 1C, this device can be used to apply the energy for correcting the corneal shape to the corneal surface in a very specific manner. Variations of suitable devices for changing the shape of the corneal surface in this way will be discussed below. Alternatively, if the device is suitable for expanding the epithelial bag 206, an expansion step may occur at this point. Expansion device variations of the device will also be described below.

FIG. 1D shows the withdrawal of the combination device 202 from the eye 200, leaving some consequences of which steps have been performed. The epithelial portion 206 is in close contact with the eye and, due to its nature, will heal to some extent from the cornea.

2A-2E illustrate one variation of a combination of an incision device and a corneal correction device.

2A is a perspective view of a general version of the combination device 220 having the blade body 222 and the blade 224. Again, the blades can vibrate laterally, axially, or in any combination of these two directions. Again, the blade initially penetrates the epithelial layer of the eye, but is blunt enough to not cut the underlying corneal tissue.

2B is a cross-sectional view of the device shown in FIG. 2A. Looking at the corneal side 226 of the incision body 222, one can see a number of energy-emitting points 228 or an array of energy-emitting points (better seen in the bottom view (FIG. 2D)).

These energy release points 228 can be of any of a variety of types. For example, these may be laser diodes (eg, those manufactured by Tyco Electronics, Laser Diode Incorporated, Sanyo, or Sony), and are selected to emit light of a wavelength that interacts with corneal collagen or transduction dye. This generates or provides sufficient heat at a known or desired site depending on the placement of the diode in the device to correct nearby or adjacent corneal tissue.

As an alternative, the calibration light source may be disposed away from the blade body 222, and the light is introduced through the optical fiber toward the emission point 228. An energy conduit 230 is visible in the support 232. In cross-sectional view of the support 232, the conduit 230 may be an electrically conductive wire or ribbon when the energy source is a light emitting source or a resistive heat source located in the blade body 222, and the energy source is the blade body 222. When it is far away from it, it can be essentially an optical fiber. Indeed, energy conduits can inherently pass fluid, allowing heated, cooled, or reactive fluid to pass toward the eye surface.

2C is a top view of the device shown in FIG. 2A.

3A and 3B show a variant of the present combination device in which the blade body 222 is equipped with a laser diode 228, specifically of the blade body 222 adjacent to the epithelium when the blade is positioned below the epithelium. Light is emitted from the side 229. The light emitting laser diode 228 emits light directly on the spot, and is reflected directly on the cornea to collide with the cornea to correct the corneal shape. Containing an opaque fluid or heat-absorbing material, for example a slurry of biocompatible metals such as platinum or gold, in the blade body during use to promote absorption of light and conversion of heat to heat. It can be introduced into the eye from below. In this variation, the energy conduit 232 is simply an electrical conductor that powers the diode 228.

Once the necessary corrections to the eye have been determined, the order and location of the diodes to be activated are naturally determined as customary. The diodes can be turned on independently as needed to suit the appropriate calibration. These are continuously lit according to some position, among others, and can achieve desirable corrections for various ocular abnormalities such as, for example, myopia, astigmatism, or even presbyopia. Again, depending on the nature of the energy source selected, this arrangement can be used to introduce light for corneal correction, or heat for corneal correction, or light that generates heat for corneal correction.

4 shows a variation of the described apparatus 230 in which a laser diode 232 is disposed behind the light absorbing, heat conducting member 234. In the variant shown in FIG. 4, the conductor 234 may be a substantially continuous area intended to cover a particular area of the cornea that the user wishes to correct. In this variant, selected members in the laser diode collection are activated to provide light to the absorber-conductor 234. Absorber-conductor 234 absorbs light, thereby heating this diode region. Clearly, the warmed or heated area of conductor 234 in turn heats the cornea, thereby correcting adjacent corneal tissue. The device works similarly when the light source is located far away and energy is introduced onto the conductor 234 by the optical fiber.

5 is a cross-sectional view of the blade body 240 in a design and configuration similar to that shown in FIG. In this variant, the conductors 242 and 244 are heated by the laser diode 232. 6 and 7 show two variations of the design shown in FIG. 5. As shown in FIGS. 6 and 7, these separate absorber-conductors 244, 246 can be placed or placed on the blade body in various patterns suitable for the user to treat the cornea and correct vision as desired. Again, this pattern may be chosen to treat a particular type of ocular abnormality, or this pattern may generally allow for selective or local application of heat during the time the incision body is in contact with the cornea under the epithelium. Can be. In other words, in the treatment of myopia only the corneal region around the cornea should be heated. Various sizes of absorber-conductors 244 and 246 and their spacing may be provided by a skilled designer, depending only on the need for separation of the various separate absorber-conductors and the size of the corneal area to be treated. Again, materials with high absorbency and high thermal conductivity are quite suitable. Clearly, these material candidates selected include members of the precious metal family of the periodic table, such as platinum, rhodium, and various alloys of these metals. Of course, the absorbency of the absorber-conductor can be adjusted by surface treatment, such as blackening the reflective surface to enhance light absorption.

8A, 8B, and 8C provide a description of other variations of the incision-corneal corrector combination. In this variant, the device uses radio frequency (RF) to perform corneal correction or modification. In understanding this variant, it is essential to recognize that there are two cooperating pieces in the device. One is an RF transmitter provided outside of the eye, and the other is an incision device containing one or more susceptors or RF receivers or members of an “antenna array” that is locally heated when receiving and receiving RF. The heated susceptor is heated by RF and this heat is transferred to the front of the cornea to be calibrated.

8A shows an arrangement in use of the various components. This figure is a cross sectional view of the various components. An anterior region of the eye 300 with various stratified components is depicted. Also shown is an incision blade body 304 with various separate energy-receiving regions or susceptors 306. Each of these susceptors 306 is made of a material such as a ferromagnetic metal or alloy that is heated when placed at the site receiving RF. This material may be selected and manipulated so that a suitable or controllable temperature rise can be provided by mixing with other materials, for example a phase change material such as paraffin or salt designed to absorb significant heat at a particular temperature, Alternatively, it may be physically treated to provide a flat temperature gradient throughout the device, for example by granulation and mixing of different crystalline particulate materials having different melting points. When it is desirable to separate the effects on the cornea, it may be desirable for each separated member and the member next to it to be thermally insulated. Similarly, the RF emission area above the antenna rod 310 is also separated (FIGS. 8A and 8C).

Returning to FIG. 8A, an antenna component 310 having a plurality of separate antenna portions 312 is shown outside the epithelium 314. An incision with an RF receiving element or susceptor 306 is shown disposed between epithelium 314 and cornea 300.

In operation, this variant will work in the following manner: A separate antenna, for example, reference number 310a starts to transmit an activated RF. Relatively close susceptor 306a will be heated. Heat from the susceptor 306a is transferred to the nearby cornea, causing contraction of the area 316, which further leads to corneal correction, which will change the refractive index of the cornea. When using LASIK or LASEK or PRK, careful planning of the placement of light and heat over the cornea changes the refractive index of the cornea to suit the purpose of improving the vision of the eye.

9A is another partial cross-sectional view of the blade body 350 in which the separated RF emitting member is coupled to the blade body 350 in pairs with the separated RF susceptor 354.

9B shows another variation of blade body 360 using RF emitter 362 where RF energy passes directly towards the cornea to be calibrated. In each of these variations, in order to produce the desired refraction change in the cornea, the RF emitting regions may each independently produce emission of RF energy, or may be used in combination, or in a pattern encompassing both spatial and temporal patterns.

10 shows another variation in which the electrically resistive heating element 372 is mounted to the blade body 370. In this variant, conductors 374, which can be handled one by one, extend to each resistive heating element 372. The current recovery line is generated through the common bus 376.

In a similar concept, FIG. 11 depicts a blade body 380 having a plurality of resistive heating elements 372, where each element is adjacent to the thermal conductor 374 and focuses the heat applied to the adjacent cornea. It can be focused or out of focus.

In summary, the general combinatorial device of the present invention is to separate epithelium from the cornea and to undergo or participate in the refraction correction process before withdrawing the device under epithelial tissue.

Epithelial tissue partial expansion device

In some instances, the volume of part or pocket of epithelial tissue formed is not sufficient to introduce other therapeutic devices into the pocket. Some type of larger device may simply be needed.

12A provides a general description of device functionality. Generally, the expansion device 400 includes a blunt tip 402 that can penetrate the epithelium and separate epithelial tissue from the cornea without cutting the corneal tissue. In addition, the blade body region 404 can be at least partially expanded as shown by arrow 406 in FIG. 12B. Such movement may be caused by hydraulic actuation, electrical behavior (heating of the motor or preformed shape memory nitinol member), or other actuation actuators.

FIG. 13A shows a variation 406 including an inflatable balloon 408 placed in an interior space between two members of the movable epithelial member 410 and the fixed corneal side member 412.

13B is a side cross-sectional view of the blade body 406 with the inner balloon 408 expanded.

14A shows a similar deformation 430 in which the inflatable balloon 432 contacts the epithelium while introducing the blade body 430 and then expanding it. 14B shows expanded balloon 432. The balloon does not need to be made of a hard slippery material such as nylon or teflon, but the type commonly used for cardiovascular balloons of constant diameter can provide certain advantages.

Finally, FIGS. 15A and 15B are cross-sectional views of another deformation 440 extending from the center rather than the leading hinge as the epithelial surface of the blade body 442 is shown in FIGS. 12A-14B. 15A shows the blade 440 before expansion, and FIG. 15B shows the blade 440 after expansion.

Claims (19)

A blade that provides an opening to the epithelium and separates at least a portion of the epithelium from the cornea without corneal cutting, and When the blade separates the epithelium from the cornea, the first surface lies adjacent to the epithelium and the second surface lies adjacent to the cornea. Wherein the first surface and the second surface are capable of moving away from each other after the initial separation of at least a portion of the epithelium from the cornea. The apparatus of claim 1, further comprising a mover configured to move the first surface from the second surface. The apparatus of claim 2 wherein the movable device comprises an inflatable balloon. The apparatus of claim 2 wherein the movable device comprises a first surface, a second surface, or a first surface and a second surface. The apparatus of claim 2 wherein the movable device is arranged hydraulically. 3. The device of claim 2, wherein the movable device is electrically operated. The apparatus of claim 2 wherein the movable device is mechanically actuated. The device of claim 1, wherein at least one of the first surface, the second surface, or the blade is at least partially lubricious. A blade configured to provide an opening to the epithelium and also configured to separate at least a portion of the epithelium from the cornea without corneal cutting to form a portion of epithelial tissue, and Member of the corneal correction device configured to correct the cornea adjacent to the cornea and under a portion of at least partially separated epithelial tissue Corneal correction device for changing the shape of the cornea in the eye with a cornea and epithelium comprising. 10. The device of claim 9, wherein the corneal correction device comprises one or more light sources. 10. The device of claim 9, wherein the corneal correction device comprises one or more heat sources. 10. The device of claim 9, wherein the corneal correction device comprises one or more heat and light sources. 10. The apparatus of claim 9, wherein the corneal corrector comprises one or more energy absorbing, conducting members that can be placed adjacent to the cornea during calibration and configured to correct the cornea by increasing temperature during calibration. . 11. The corneal correction device of claim 10, wherein the corneal correction device includes one or more energy absorbing, conducting members that may be disposed adjacent to the cornea during correction and configured to correct the cornea by absorbing light and raising the temperature during correction. Characterized in that the device. 12. The corneal correction apparatus of claim 11, wherein the corneal correction device includes one or more energy absorbing, conducting members that may be disposed adjacent to the cornea during calibration and configured to correct the cornea by absorbing heat and raising the temperature during calibration. Characterized in that the device. 13. The corneal correction device of claim 12, wherein the corneal correction device includes one or more energy absorbing, conducting members that may be disposed adjacent to the cornea during calibration and configured to absorb light and heat during calibration to correct the cornea by raising the temperature. Device characterized in that. 10. The device of claim 9, wherein the corneal corrector further comprises one or more fluid sources and configured to correct the cornea by absorbing light and heat during calibration. 10. The corneal correction device of claim 9, wherein the corneal correction device may be disposed adjacent to the cornea during calibration, and wherein the corneal correction device comprises one or more RF susceptors configured to correct the cornea by absorbing RF energy from the RF energy source and raising the temperature during calibration. Apparatus comprising a. 19. The apparatus of claim 18, further comprising an RF energy source configured to cooperatively send RF energy toward one or more RF susceptors of the corneal correction device for correction of the cornea.

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