Robotic capsulotomy

Abstract

Devices and methods for performing a capsulotomy procedure on an eye of a patient are described. The diathermic capsulotomy tool (50) includes a diathermic cutting element (58) at a tip (54) thereof. An imaging system (22) images a diathermy capsulotomy tool (50) and an eye of a patient. The computer processor (28) drives the robotic unit (20) to insert the diathermy capsulotomy tool (50) into the eye of the patient via an incision in the cornea of the eye of the patient such that the tip (54) of the tool (50) is disposed within the eye of the patient and the remote center of motion position of the tool (50) is disposed within the incision. The computer processor (28) drives the robotic unit (20) to move the cutting element (58) in a circular motion while maintaining a remote center of motion position of the tool (50) within the incision. Other applications are also described.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to U.S. Provisional Patent Application No. 63 / 412,475, filed by Glozman on October 2, 2022, entitled “Robotic Capsulotomy,” which is incorporated herein by reference.

[0003] Field of the Invention

[0004] Some applications of the present invention generally relate to medical devices and methods. In particular, some applications of the present invention relate to devices and methods for robotically performing microsurgical procedures.

[0005] background

[0006] Cataract surgery involves removing the eye's natural lens, which has become cloudy (called a cataract), and replacing it with an artificial lens. This surgery usually involves a number of standard steps that are performed in a sequence.

[0007] In the initial steps, the face around the patient's eyes is disinfected (usually with iodine solution), and their face is covered with a sterile drape so that only the eyes are exposed. When disinfection and draping are completed, the eyes are usually anesthetized with a local anesthetic, which is administered in the form of liquid eye drops. Then, the eyeball is exposed using a lid speculum that keeps the upper and lower eyelids open. One or more incisions (and usually two or three incisions) are cut in the cornea of ​​the eye. The incisions are usually formed using a special blade called a keratome blade. At this stage, lidocaine is usually injected into the anterior chamber of the eye to further anesthetize the eye. After this step, a viscoelastic injection is performed through the corneal incision. The viscoelastic injection is performed to stabilize the anterior chamber and help maintain intraocular pressure during the remainder of the operation, and also to expand the lens capsule.

[0008] In a subsequent step called a capsulotomy or capsulorhexis (these terms are used interchangeably in this application), a portion of the anterior lens capsule is removed. Various enhanced techniques for performing capsulorhexis have been developed, such as laser-assisted capsulorhexis, zepto-rhexis (using precision nano-pulse technology), and marker-assisted capsulorhexis (in which the cornea is marked with predefined markers to indicate the desired size of the capsule opening). Most commonly, a capsulorhexis is performed using a technique called continuous curvilinear capsulorhexis, in which a rip is cut in the anterior lens capsule using a curved needle, and then the rip is extended around the anterior lens capsule using the same needle and / or forceps. It is generally important that the anterior lens capsule is precisely cut and that the incision is centered so that the intraocular lens is kept in a centered position. There is evidence that even slight dispersion of the intraocular lens can reduce vision and cause astigmatism.

[0009] Subsequently, fluid waves are usually injected through corneal incisions to dissect the outer cortical layer of cataract in a step called hydrodissection. In a subsequent step called hydrodelineation, the outer softer outer core (epi-nucleus) of the lens is separated from the harder inner core (endo-nucleus) by injecting fluid waves. In the next step, in a process called phacoemulsification, ultrasonic emulsification of the lens is performed. First, the nucleus of the lens is broken using a chopper, and then, the outer fragments of the lens are usually broken and removed using an ultrasonic phacoemulsification probe. In addition, usually, a separate tool is used to perform suction during phacoemulsification. When phacoemulsification is completed, the remaining lens cortex (that is, the outer layer of the lens) material is aspirated from the capsule. During phacoemulsification and aspiration, the aspirated fluid is usually replaced with a balanced salt rinsing solution to maintain the fluid pressure in the anterior chamber. In some cases, if it is considered necessary, the capsule is polished. Subsequently, an intraocular lens (IOL) is inserted into the capsule. The IOL is usually foldable and is inserted in a folded configuration before being unfolded inside the capsule. At this stage, the viscoelastic is usually removed using the suction device previously used to aspirate the fluid from the capsule. If necessary, the incision is sealed by increasing the pressure inside the bulbus oculi (i.e., the globe of the eye), pressing the internal tissue against the external tissue of the incision in order to force the incision closed.

[0010] Overview

[0011] According to some applications of the invention, a robotic unit inserts a diathermy capsulotomy tool into an eye of a patient through an incision in the patient's cornea. According to some applications, a computer processor is configured to drive the robotic unit to move a tip of the diathermy capsulotomy tool within the eye, but simultaneously constrain the motion of the tool at a location where the tool is disposed within the incision (this location is referred to herein as the "center of remote motion position of the tool"). For some applications, the computer processor determines the placement of the tool relative to the incision by analyzing images of the tool and the patient's eye. For some applications, the computer processor constrains the motion of the tool at the center of remote motion position of the tool such that an edge of the tool is prevented from moving beyond an edge of the incision.

[0012] Typically, according to some applications of the present invention, the tip of the diathermic capsulotomy tool is moved to form a circle on the anterior lens capsule of the patient, while the position where the tool enters the patient's eye is maintained within the incision or within the incision zone within the patient's cornea. Typically, the tip of the diathermic capsulotomy tool includes a diathermic cutting element configured to cut the anterior lens capsule. Typically, the cutting element is an electrode pair, and high-frequency energy (e.g., energy with a frequency greater than 100kHz, such as between 200kHz and 1MHz, or between 300kHz and 700kHz) is driven into the tissue of the anterior lens capsule via the electrode pair, thereby cutting the anterior lens capsule. The cutting element is typically surrounded by an insulating material (e.g., a polymer material) that isolates the cutting element from the exterior of the diathermic capsulotomy tool. As described above, typically, when the tip of the diathermic capsulotomy tool is moved to form a circle on the anterior lens capsule of the patient, the position where the tool enters the patient's eye (i.e., the remote center of motion position of the tool) is maintained within the incision or within the incision zone within the patient's cornea. Another constraint is that there is usually a height difference between the incision and the anterior lens capsule. Therefore, the robotic unit is configured to move and actuate the diathermy capsulotomy tool, subject to the following constraints:

[0013] A) Initially, the tool must be inserted through the incision, and the tool's entry point into the patient's eye must remain within the incision (or incision zone) as the tip of the tool is advanced into the anterior lens capsule. Typically, the tip of a diathermy capsulotomy tool is not straight. Therefore, as the tip of the tool is advanced through the incision, the robotic unit must advance the tool along a non-linear path so that the tool's entry point into the patient's eye must remain within the incision (or incision zone).

[0014] B) upon activation of the cutting element to apply high frequency energy to the anterior lens capsule:

[0015] The cutting element moves in a circular motion relative to the anterior lens capsule;

[0016] the end of the tool is maintained at an angle relative to the patient's eye so that the cutting element is disposed on the anterior lens capsule of the patient, but the entrance of the tool into the patient's eye is maintained within the incision or incision zone along the y-direction (i.e., the "y-axis," which is the direction perpendicular to the x-direction, as defined below); and

[0017] • Constraining the entry of the tool into the patient's eye so that the entry of the tool into the patient's eye remains within the incision or incision zone along the x-direction (ie, the "x-axis," which is the direction parallel to the incision and tangential to the cornea at the incision).

[0018] For some applications, a computer processor analyzes an image of the patient's eye, determines the position of the patient's visual axis, and drives a robotic unit to move a cutting element in a circle centered on the patient's visual axis. In this regard, it should be noted that the patient's visual axis is typically not directly located at the center of the cornea or limbus. For some applications, the imaging system includes coaxial light sources. For some such applications, the computer processor determines the position of the patient's visual axis by directing light from each coaxial light source toward the patient's eye. The patient is typically instructed to look at the coaxial light sources by automatically generating audio instructions through the computer processor and / or by one of the operators instructing the patient to do so. The computer processor then identifies a Purkinje image (i.e., a reflection of light from the structure of the eye) within the image of the eye acquired by the imaging system. Typically, the computer processor identifies the patient's visual axis as being located at a point centered around the Purkinje image. As described above, the computer processor typically drives a robotic unit to move a cutting element in a circle centered on the patient's visual axis.

[0019] Typically, the robotic unit is configured to move the diathermy capsulotomy tool without violating the above-described constraints on its motion. The robotic unit typically moves the tool through six degrees of freedom (e.g., movement along the x-axis, y-axis, and z-axis, as well as pitch, yaw, and roll). Further typically, the computer processor receives an image of the diathermy capsulotomy tool and the patient's eye and analyzes the image, such as to determine (a) the current arrangement of the distal end relative to the patient's visual axis, and (b) the current arrangement of the remote center of motion position of the tool relative to the incision. Based on the computer processor's analysis of the image, the computer processor drives the diathermy capsulotomy tool to move and / or activates the cutting element to apply high-frequency energy to the anterior capsule of the lens, subject to the constraints described herein.

[0020] It should be noted that due to the relatively small size of the eye and the above-mentioned constraints on the movement of the diathermal capsulotomy tool, the computer processor is generally able to drive the diathermal capsulotomy tool to perform a circular capsulotomy centered on the patient's visual axis more accurately than a human surgeon can perform these movements. It should also be noted that for some applications, the robotic unit automatically drives the diathermal capsulotomy tool in response to receiving instructions from the operator to automatically perform the above-mentioned movements (i.e., first enter the eye and then perform the circular cutting movement while maintaining the remote center of motion position within the incision or incision area), as opposed to the operator controlling the movement of the diathermal capsulotomy tool via the control component (in a "master-slave" manner).

[0021] It is also noted that the robotic unit is configured to move and actuate the diathermic capsulotomy tool, subject to the above-mentioned constraints and while the patient's eye is experiencing motion. Typically, the computer processor receives images of the diathermic capsulotomy tool and the patient's eye and analyzes the images, for example to determine the motion experienced by the patient's eye, and dynamically adjusts the arrangement and / or motion of the diathermic capsulotomy tool, for example to account for the motion of the patient's eye. For example, the computer processor dynamically adjusts the arrangement of the diathermic capsulotomy tool so that when the patient's eye is experiencing motion, the remote center of motion position of the diathermic capsulotomy tool remains within the incision. Alternatively or additionally, the computer processor dynamically adjusts the circular motion of the cutting element to conform to the motion experienced by the patient's eye. Further alternatively or additionally, the computer processor dynamically adjusts the circular motion of the cutting element so that when the patient's eye is experiencing motion, the circular motion of the cutting element remains centered around the patient's visual axis.

[0022] Thus, according to some applications of the present invention, there is provided an apparatus for performing a capsulotomy procedure on an eye of a patient, the apparatus comprising:

[0023] a diathermy capsulotomy tool comprising a diathermy cutting element disposed at a distal end of the diathermy capsulotomy tool;

[0024] a robotic unit configured to move a diathermy capsulotomy tool;

[0025] an imaging system configured to image the diathermy capsulotomy tool and the patient's eye; and

[0026] At least one computer processor configured to:

[0027] receiving one or more images of a diathermy capsulotomy tool and a patient's eye from an imaging system,

[0028] driving the robotic unit to insert a diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye such that a distal end of the diathermy capsulotomy tool is disposed within the patient's eye and a remote center of motion position of the diathermy capsulotomy tool is disposed within the incision; and

[0029] The robotic unit is driven to move the cutting element in a circular motion while activating the diathermic cutting element to apply diathermic energy to the anterior lens capsule of the patient's eye and while maintaining a remote center of motion position of the diathermic capsulotomy tool within the incision.

[0030] In some applications, to drive the robotic unit to move the cutting element in a circular motion while activating the diathermic cutting element to apply diathermic energy to an anterior lens capsule of an eye of the patient, and simultaneously maintain a remote center of motion position of the diathermic capsulotomy tool within an incision, the computer processor is configured to drive the robotic unit to maintain an end of the diathermic capsulotomy tool at an angle relative to the patient's eye such that the diathermic cutting element is disposed on the anterior lens capsule of the patient's eye, but an entrance of the tool into the patient's eye remains within the incision.

[0031] In some applications, the computer processor is configured to determine the motion experienced by the patient's eye and dynamically adjust the placement of the diathermy capsulotomy tool so that the remote center of motion position of the diathermy capsulotomy tool remains within the incision.

[0032] In some applications, the computer processor is configured to determine the motion experienced by the patient's eye and dynamically adjust the circular motion of the cutting element to conform to the motion experienced by the patient's eye.

[0033] In some applications, the tip of the diathermy capsulotomy tool is not straight, so that to drive the robotic unit to insert the diathermy capsulotomy tool through the incision into the patient's eye, the computer processor is configured to drive the robotic unit to advance the diathermy capsulotomy tool along a non-linear path.

[0034] In some applications, the computer processor is configured to determine the location of the patient's visual axis and is configured to move the cutting element in a circular motion by moving the cutting element in a circular motion centered about the patient's visual axis.

[0035] In some applications, the computer processor is configured to determine the motion experienced by the subject's eye and dynamically adjust the circular motion of the cutting element so that the circular motion of the cutting element remains centered about the patient's visual axis.

[0036] In some applications, the apparatus further includes a coaxial light source disposed on the imaging system, and the computer processor is configured to determine the position of the patient's visual axis by directing light from the coaxial light source toward an eye of the patient, identifying a Purkinje image within one or more of the images acquired by the imaging system, and identifying the patient's visual axis as being located at a point around which the Purkinje image is centered.

[0037] According to some applications of the present invention, there is also provided a method of performing a capsulotomy procedure on an eye of a patient using a diathermy capsulotomy tool, the diathermy capsulotomy tool comprising a diathermy cutting element disposed at a distal end thereof, the method comprising:

[0038] imaging the diathermy capsulotomy tool and the patient's eye using an imaging system; and

[0039] Use at least one computer processor:

[0040] receiving one or more images of a diathermy capsulotomy tool and an eye of a patient from an imaging system;

[0041] driving the robotic unit to insert a diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye such that a distal end of the diathermy capsulotomy tool is disposed within the patient's eye and a remote center of motion position of the diathermy capsulotomy tool is disposed within the incision; and

[0042] The robotic unit is driven to move the cutting element in a circular motion while activating the diathermic cutting element to apply diathermic energy to the anterior lens capsule of the patient's eye and while maintaining a remote center of motion position of the diathermic capsulotomy tool within the incision.

[0043] In some applications, to move the cutting element in a circular motion while activating the diathermic cutting element to apply diathermic energy to an anterior lens capsule of the patient's eye, and while maintaining a remote center of motion position of the diathermic capsulotomy tool within the incision, the method further includes using a computer processor to drive the robotic unit to maintain an end of the diathermic capsulotomy tool at an angle relative to the patient's eye such that the diathermic cutting element is disposed on the anterior lens capsule of the patient's eye, but an entrance of the tool into the patient's eye remains within the incision.

[0044] In some applications, the method further includes determining, using a computer processor, motion experienced by the patient's eye and dynamically adjusting the placement of the diathermy capsulotomy tool such that a remote center of motion position of the diathermy capsulotomy tool remains within the incision.

[0045] In some applications, the method also includes determining, using a computer processor, motion experienced by an eye of the patient and dynamically adjusting the circular motion of the cutting element to conform to the motion experienced by the eye of the patient.

[0046] In some applications, the tip of the diathermy capsulotomy tool is not straight, such that driving the robotic unit to insert the diathermy capsulotomy tool into the patient's eye through the incision in the cornea of ​​the patient's eye includes driving the robotic unit to advance the diathermy capsulotomy tool along a non-linear path.

[0047] In some implementations, the method further includes determining, using a computer processor, a position of a visual axis of the patient, and driving the robotic unit to move the cutting element in a circular motion includes driving the robotic unit to move the cutting element in a circular motion centered about the visual axis of the patient.

[0048] In some applications, the method further includes determining, using a computer processor, motion experienced by the patient's eye and dynamically adjusting the circular motion of the cutting element so that the circular motion of the cutting element remains centered about the patient's visual axis.

[0049] In some applications, determining the location of the patient's visual axis includes directing light from a coaxial light source toward the patient's eye, identifying a Purkinje image within one or more of the images acquired by the imaging system, and identifying the patient's visual axis as being located at a point around which the Purkinje image is centered.

[0050] The present invention will be more fully understood from the following detailed description of embodiments of the present invention taken in conjunction with the accompanying drawings, in which: BRIEF DESCRIPTION OF THE DRAWINGS

[0052] Figure 1 is a schematic diagram of a robotic system according to some applications of the present invention, the robotic system being configured for microsurgery, such as intraocular surgery;

[0053] Figure 2 is a schematic diagram of an incision in a patient's cornea according to some applications of the present invention;

[0054] Figure 3 is a schematic diagram of a robotic unit according to some applications of the present invention, the robotic unit inserting a diathermy capsulotomy tool into an eye of a patient through an incision in the patient's cornea; and

[0055] Figure 4A and Figure 4B is a schematic diagram of a robotic unit according to some applications of the present invention that moves the diathermy tip of a diathermy capsulotomy tool to form a circle on the anterior lens capsule of a patient while the position of the tool entering the patient's eye remains within the incision or incision zone. DETAILED DESCRIPTION

[0056] Reference now Figure 1, which is a schematic diagram of a robotic system 10 according to some applications of the present invention, the robotic system 10 being configured for microsurgery, such as intraocular surgery. Typically, when used for intraocular surgery, the robotic system 10 includes one or more robotic units 20 (which are configured to hold a tool 21) in addition to an imaging system 22, one or more displays 24, and a control unit unit 26. Typically, the control unit unit includes one or more control units 30 (e.g., a pair of control units 30, such as Figure 1 ), one or more operators 25 (e.g., healthcare professionals, such as doctors and / or nurses) are able to control the robotic unit 20 via the one or more control components 30. Typically, the robotic system 10 includes one or more computer processors 28 through which the components of the system and the operators 25 can operatively interact with each other. The scope of the present application includes mounting one or more robotic units in any of a variety of different positions relative to each other.

[0057] Typically, the movement of the robotic unit (and / or the control of other aspects of the robotic system) is at least partially controlled by one or more operators 25 (e.g., health care professionals, such as doctors and / or nurses). For example, the operator can receive images of the patient's eyes and the robotic unit and / or the tools disposed therein through the display 24. Typically, such images are acquired by the imaging system 22. For some applications, the imaging system 22 is a stereoscopic imaging device and the display 24 is a stereoscopic display. The operator typically performs the steps of the surgery based on the received images. For some applications, the operator provides commands to the robotic unit via the control component unit 26. Typically, such commands include commands to control the position and / or orientation of the tools disposed within the robotic unit, and / or commands to control the actions performed by the tools. For example, these commands can control a blade, a phacoemulsification tool (e.g., the operating mode and / or suction of the phacoemulsification tool) and / or an injector tool (e.g., which fluid (e.g., viscoelastic fluid, saline, etc.) should be injected and / or what the flow rate is). Alternatively or additionally, the operator can input commands to control the imaging system (e.g., zoom, focus, and / or xy positioning of the imaging system). For some applications, the commands include controlling an intraocular lens manipulator tool, for example, causing the tool to manipulate an intraocular lens within an eye to precisely position the intraocular lens within the eye.

[0058] Typically, the control component unit 26 includes one or more control components 30, which are configured to correspond to the corresponding robot unit 20 of the robot system. For example, as shown in the figure, the system may include a first robot unit and a second robot unit, and the control component unit may include a first control component and a second control component, as shown in the figure. Typically, each of the control components is a control component arm, which includes a plurality of links connected to each other via joints. For some applications, such as Figure 1 As shown, the control component includes a corresponding control component tool 32 therein (so as to replicate the robotic unit). Typically, the computer processor determines the XYZ position and orientation of the end of the control component tool 32, and drives the robotic unit so that the end of the ophthalmic tool 21 used to perform the procedure tracks the movement of the end of the control component tool. For some applications, the robotic unit is configured to move the end of the tool through six degrees of freedom (e.g., movement along the x-axis, y-axis, and z-axis, as well as pitch, yaw, and roll). For some applications, in the case of some tools, in response to input from the user, the computer processor drives the tool to automatically perform a given action with respect to the patient's eye. For example, the computer processor can automatically drive the diathermy capsulotomy tool 50 (which is an example of an ophthalmic tool 21, and in Figures 3 to 4B ) to cut a circular incision in the anterior lens capsule, as described in further detail below.

[0059] Reference now Figure 2 , which is a schematic diagram of an incision 40 in a cornea 42 of a patient according to some applications of the present invention. As described in the background section above, typically during cataract surgery, one or more incisions (typically two or three incisions) are made in the cornea of ​​the eye. The incisions are typically made using a specialized blade called a keratome blade. Typically, the robotic unit is configured to insert the tool 21 into the patient's eye such that the tool enters the patient's eye via the incision 40 and the end of the tool is disposed within the patient's eye. In addition, typically, the robotic system 10 is configured to move the end of the tool within the patient's eye such that the entrance of the tool into the patient's eye is constrained to remain within the incision. For some applications, the incision width is equal to the width of the keratome blade. The incision center point 43 is defined herein as a point on the corneal surface centered in the direction of the incision width. Figure 2 In the embodiment of the invention, the axes have been added, wherein the x-axis is parallel to the incision and tangent to the cornea at the incision, and the y-axis is perpendicular to the x-axis and tangent to the cornea at the incision. Examples of the invention will be described below with reference to the x-axis and the y-axis.

[0060] In order to perform non-robotic pre-ophthalmic surgery, surgeons usually make one or more incisions on the patient's cornea, which are then used as entry points for various surgical tools. The tool is inserted through the incision and manipulated in the eye to achieve the surgical goal. When this manipulation occurs, it is medically preferred that the tool not be pressed on the edge of the incision with excessive force, lifted upward or pressed downward. This movement may cause tearing at the edge of the incision, thereby expanding the incision and may have a negative impact on the surgical results. Ideally, the surgeon will manipulate the tool so that at the entry point of the tool through the incision, the tool rotates around the center of the incision, rather than moving laterally, wherein this movement of the tool at the incision is described herein as maintaining the center of motion. For robotic surgery, such as those described here, the above-mentioned movement of tool 21 is described as maintaining the remote center of motion, because the tool is usually controlled from a distance (via control component unit 26). In non-robotic surgery, it is difficult to manually maintain the center of motion, especially when the surgeon needs to focus on the end of the tool that is performing the current surgical action.

[0061] Reference now Figure 3 , which is a schematic diagram of a robotic unit 20 inserting a diathermy capsulotomy tool 50 into a patient's eye through an incision 40 in the patient's cornea, according to some applications of the present invention. According to some applications of the present invention, the computer processor is configured to drive the robotic unit to move the tip of the diathermy capsulotomy tool 50 within the eye, but at the same time constrain the movement of the tool at a location where the tool is disposed within the incision (this location is referred to herein as the "remote center of motion location of the tool"). For some applications, the computer processor determines the placement of the tool relative to the incision by analyzing images of the tool and the patient's eye. For some applications, the computer processor constrains the movement of the tool at the remote center of motion location of the tool so that an edge of the tool is prevented from moving past an edge of the incision.

[0062] Reference now Figure 4A and Figure 4B , which is a schematic diagram of a robotic unit moving the tip 54 of a diathermy capsulotomy tool 50 to form a circle on the anterior lens capsule 56 of a patient while the tool enters the patient's eye at a position maintained within the incision 40 or incision zone within the patient's cornea, according to some applications of the present invention. Figure 3As shown in Figure A, typically, the tip of the diathermic capsulotomy tool includes a diathermic cutting element 58 configured to cut the anterior lens capsule. Typically, the cutting element is an electrode pair, and high-frequency energy (e.g., energy with a frequency greater than 100 kHz, such as between 200 kHz and 1 MHz, or between 300 kHz and 700 kHz) is driven into the tissue of the anterior lens capsule via the electrode pair, thereby cutting the anterior lens capsule. The cutting element is typically surrounded by an insulating material 60 (e.g., a polymer material) that isolates the cutting element from the exterior 62 of the diathermic capsulotomy tool. As described above, typically, when the tip 54 of the diathermic capsulotomy tool 50 moves to form a circle on the anterior lens capsule 56 of the patient, the position of the tool entering the patient's eye (i.e., the remote center of motion position of the tool) remains within the incision 40 or within the incision zone within the patient's cornea. Another constraint is that there is typically a height difference between the incision and the anterior lens capsule. Thus, the robotic unit is configured to move and actuate the diathermy capsulotomy tool 50, subject to the following constraints:

[0063] A) Initially, the tool must be inserted through the incision, and the tool's entry point into the patient's eye must remain within the incision (or incision zone) as the tip of the tool is advanced into the anterior lens capsule. It should be noted that, as shown, the tip 54 of the diathermy capsulotomy tool 50 is generally not straight. Therefore, as the tip of the tool is advanced through the incision, the robotic unit must advance the tool along a non-linear path so that the tool's entry point into the patient's eye must remain within the incision (or incision zone).

[0064] B) upon activation of the cutting element to apply high frequency energy to the anterior lens capsule:

[0065] The cutting element moves in a circular pattern relative to the anterior lens capsule;

[0066] the end of the tool is held at an angle relative to the patient's eye so that the cutting element is disposed on the anterior lens capsule of the patient, but the entrance of the tool into the patient's eye remains within the incision or incision zone in the y-direction; and

[0067] • Constraining the entry of the tool into the patient's eye so that the entry of the tool into the patient's eye remains within the incision or incision region along the x-direction.

[0068] As described above, typically, the robotic unit moves cutting element 58 in a circle relative to anterior lens capsule 56. For some applications, the computer processor analyzes an image of the patient's eye, determines the location of the patient's visual axis, and drives the robotic unit to move the cutting element in a circle centered on the patient's visual axis. In this regard, it should be noted that the patient's visual axis is typically not directly located at the center of the cornea or limbus. For some applications, imaging system 22 (e.g., Figure 1 As shown) includes a coaxial light source 23. (In Figure 1 ) For some such applications, the computer processor determines the position of the patient's visual axis by directing light from each coaxial light source toward the patient's eye. The patient is instructed to look at the coaxial light sources, typically by the computer processor automatically generating audio instructions and / or by one of the operators instructing the patient to do so. The computer processor then identifies a Purkinje image within an image of the eye acquired by the imaging system. Typically, the computer processor identifies the patient's visual axis as being located at a point around which the Purkinje image is centered. As described above, the computer processor typically drives the robotic unit to move the cutting element in a circle centered on the patient's visual axis.

[0069] Typically, the robotic unit is configured to move the diathermy capsulotomy tool 50 without violating the above-described constraints on its motion. As described above, the robotic unit typically moves the tool through six degrees of freedom (e.g., movement along the x-axis, y-axis, and z-axis, as well as pitch, yaw, and roll). Further typically, the computer processor receives an image of the diathermy capsulotomy tool 50 and the patient's eye and analyzes the image, such as to determine (a) the current placement of the distal end relative to the patient's visual axis, and (b) the current placement of the tool's remote center of motion relative to the incision. Based on the computer processor's analysis of the image, the computer processor drives the diathermy capsulotomy tool 50 to move and / or activate the cutting element to apply high-frequency energy to the anterior capsule of the lens, subject to the constraints described herein.

[0070] It should be noted that due to the relatively small size of the eye and the above-mentioned constraints on the movement of the diathermal capsulotomy tool 50, the computer processor is generally able to drive the diathermal capsulotomy tool 50 to perform a circular capsulotomy centered on the patient's visual axis more accurately than a human surgeon can perform these movements. It should also be noted that for some applications, the robotic unit automatically drives the diathermal capsulotomy tool 50 in response to receiving instructions from the operator to automatically perform the above-mentioned movements (i.e., first enter the eye and then perform the circular cutting movement while maintaining the remote center of motion position within the incision or incision area), as opposed to the operator controlling the movement of the diathermal capsulotomy tool 50 via the control component 30 (in a "master-slave" manner).

[0071] It is also noted that the robotic unit is configured to move and actuate the diathermal capsulotomy tool 50, subject to the above-mentioned constraints and while the patient's eye is experiencing motion. Typically, the computer processor receives images of the diathermal capsulotomy tool 50 and the patient's eye and analyzes the images, for example to determine the motion experienced by the patient's eye, and dynamically adjusts the arrangement and / or motion of the diathermal capsulotomy tool 50, for example to account for the motion of the patient's eye. For example, the computer processor dynamically adjusts the arrangement of the diathermal capsulotomy tool so that when the patient's eye is experiencing motion, the remote center of motion position of the diathermal capsulotomy tool remains within the incision. Alternatively or additionally, the computer processor dynamically adjusts the circular motion of the cutting element to conform to the motion experienced by the patient's eye. Further alternatively or additionally, the computer processor dynamically adjusts the circular motion of the cutting element so that when the patient's eye is experiencing motion, the circular motion of the cutting element remains centered around the patient's visual axis.

[0072] Although some applications of the present invention are described with reference to cataract surgery, the scope of the present application includes the application of the devices and methods described herein to other medical procedures after appropriate modifications. In particular, the devices and methods described herein for other medical procedures can be applied to other microsurgical procedures, such as general surgery, orthopedic surgery, gynecological surgery, otolaryngology surgery, neurosurgery, oral and maxillofacial surgery, plastic surgery, podiatric surgery, vascular surgery, and / or pediatric surgery performed using microsurgical techniques. For some such applications, the imaging system includes one or more microscopic imaging units.

[0073] It should be noted that the scope of the present application includes the application of the devices and methods described herein, mutatis mutandis, to intraocular surgeries other than cataract surgery. Such surgeries may include collagen cross-linking, endothelial keratoplasty (e.g., DSEK, DMEK, and / or PDEK), DSO (Descemet's membrane stripping without transplant), laser-assisted keratoplasty, keratoplasty, LASIK / PRK, SMILE, pterygium, ocular surface cancer treatment, secondary IOL implantation (secondary IOL implantation after suturing, secondary IOL implantation through the conjunctiva, etc.), iris repair, IOL repositioning, IOL exchange, superficial keratectomy, minimally invasive glaucoma surgery (MIGS), limbal stem cell transplantation, astigmatic keratotomy, limbal relaxing incision (LRI), amniotic membrane transplantation (AMT), glaucoma surgery (e.g., trabeculectomy (trabs), tubes implantation (tubes), minimally invasive glaucoma surgery), automated lamellar keratoplasty (ALK), anterior vitrectomy, and / or pars plana anterior vitrectomy.

[0074] Applications of the invention described herein may take the form of a computer program product accessible from a computer-usable or computer-readable medium (e.g., a non-transitory computer-readable medium) that provides program code for use by or in conjunction with a computer or any instruction execution system (e.g., a computer processor 28). For the purposes of this description, a computer-usable or computer-readable medium may be any device that may contain, store, transmit, propagate, or convey a program for use by or in conjunction with an instruction execution system, device, or apparatus. The medium may be an electronic medium, a magnetic medium, an optical medium, an electromagnetic medium, an infrared medium, or a semiconductor system (or device or apparatus) or a propagation medium. Typically, a computer-usable or computer-readable medium is a non-transitory computer-usable or computer-readable medium.

[0075] Examples of computer readable media include semiconductor or solid-state memory, magnetic tape, removable computer diskette, random access memory (RAM), read-only memory (ROM), rigid magnetic disk, and optical disk. Current examples of optical disks include compact disk-read-only memory (CD-ROM), compact disk-read / write (CD-R / W), DVD, and USB drives.

[0076] A data processing system suitable for storing and / or executing program code will include at least one processor (e.g., computer processor 28) coupled directly or indirectly to a memory element via a system bus. The memory element may include a local memory, a bulk memory, and a cache memory that provides temporary storage of at least some program code to reduce the number of times the code must be retrieved from the bulk memory during execution. The system may read the instructions of the present invention on the program storage device and follow these instructions to perform the method of an embodiment of the present invention.

[0077] A network adapter may be coupled to a processor to enable the processor to become coupled to other processors or remote printers or storage devices through intervening private or public networks. Modems, cable modem and Ethernet cards are just a few of the currently available types of network adapters.

[0078] Computer program code for carrying out operations of the present invention may be written in any combination of one or more programming languages ​​including object oriented programming languages ​​(such as Java, Smalltalk, C++, etc.) and traditional procedural programming languages ​​(such as the C programming language or similar programming languages).

[0079] It will be understood that the algorithm described herein can be implemented by computer program instructions. These computer program instructions can be provided to a processor of a general-purpose computer, a processor of a special-purpose computer, or a processor of other programmable data processing devices for producing machines, so that the instructions executed by the processor of the computer (e.g., computer processor 28) or the processor of other programmable data processing devices produce means for implementing the functions / actions specified in the algorithm described in this application. These computer program instructions can also be stored in a computer-readable medium (e.g., a non-transitory computer-readable medium), which can instruct a computer or other programmable data processing device to act in a particular manner, so that the instructions stored in the computer-readable medium produce an article, which includes an instruction means for implementing the functions / actions specified in the algorithm. Computer program instructions can also be loaded onto a computer or other programmable data processing device so that a series of operating steps are executed on a computer or other programmable device to produce a computer-implemented process, so that the instructions executed on a computer or other programmable device provide a process for implementing the functions / actions specified in the algorithm described in this application.

[0080] The computer processor 28 is typically a hardware device that is programmed with computer program instructions to produce a special-purpose computer. For example, when the computer processor 28 is programmed to execute the algorithm described with reference to the accompanying drawings, the computer processor 28 typically acts as a special-purpose robotic system computer processor. Generally, the operations performed by the computer processor 28 described herein convert the physical state of the memory (which is a real physical item) into different magnetic polarity, charge, etc. according to the memory technology used. For some applications, the operations described as being performed by a computer processor are performed by multiple computer processors in combination with each other.

[0081] Those skilled in the art will recognize that the present invention is not limited to what has been specifically shown and described above. Rather, the scope of the present invention includes the combinations and sub-combinations of the various features described above, as well as changes and modifications of these features that will occur to those skilled in the art upon reading the foregoing description and that are not in the prior art.

Claims

1. An apparatus for performing a capsulotomy procedure on an eye of a patient, the apparatus comprising: a diathermy capsulotomy tool comprising a diathermy cutting element disposed at a distal end of the diathermy capsulotomy tool; a robotic unit configured to move the diathermy capsulotomy tool; an imaging system configured to image the diathermy capsulotomy tool and an eye of a patient; and at least one computer processor configured to: receiving one or more images of the diathermy capsulotomy tool and a patient's eye from the imaging system, driving the robotic unit to insert the diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye such that the distal end of the diathermy capsulotomy tool is disposed within the patient's eye and a remote center of motion position of the diathermy capsulotomy tool is disposed within the incision; and The robotic unit is driven to move the cutting element in a circular motion while activating the diathermic cutting element to apply diathermic energy to an anterior lens capsule of an eye of a patient and while maintaining the remote center of motion position of the diathermic capsulotomy tool within the incision.

2. The device according to claim 1, wherein: To drive the robotic unit to move the cutting element in a circular motion while activating the diathermic cutting element to apply diathermic energy to an anterior lens capsule of an eye of the patient, and simultaneously maintain the remote center of motion position of the diathermic capsulotomy tool within the incision, the computer processor is configured to drive the robotic unit to maintain an end of the diathermic capsulotomy tool at an angle relative to the patient's eye such that the diathermic cutting element is disposed on the anterior lens capsule of the patient's eye, but an entrance of the tool into the patient's eye remains within the incision.

3. The device according to claim 1, wherein: The computer processor is configured to determine motion experienced by the patient's eye and dynamically adjust the placement of the diathermy capsulotomy tool such that the remote center of motion position of the diathermy capsulotomy tool remains within the incision.

4. The device according to claim 1, wherein: The computer processor is configured to determine motion experienced by an eye of the patient and dynamically adjust the circular motion of the cutting element to conform to the motion experienced by the eye of the patient.

5. The device according to claim 1, wherein: The distal end of the diathermy capsulotomy tool is not straight, such that in order to drive the robotic unit to insert the diathermy capsulotomy tool into the patient's eye through the incision, the computer processor is configured to drive the robotic unit to advance the diathermy capsulotomy tool along a non-linear path.

6. The device according to any one of claims 1 to 5, wherein: The computer processor is configured to determine a position of a visual axis of the patient and is configured to move the cutting element in a circular motion by moving the cutting element in a circular motion centered about the visual axis of the patient.

7. The device according to claim 6, wherein: The computer processor is configured to determine motion experienced by an eye of a subject and dynamically adjust circular motion of the cutting element such that the circular motion of the cutting element remains centered about a visual axis of the patient.

8. The apparatus of claim 6, further comprising a coaxial light source disposed on the imaging system, wherein the computer processor is configured to determine a position of the patient's visual axis by directing light from the coaxial light source toward an eye of the patient, identifying a Purkinje image within one or more of the images acquired by the imaging system, and identifying the patient's visual axis as being located at a point around which the Purkinje image is centered.

9. A method of performing a capsulotomy procedure on an eye of a patient using a diathermy capsulotomy tool comprising a diathermy cutting element disposed at a distal end thereof, the method comprising: imaging the diathermy capsulotomy tool and the patient's eye using an imaging system; and Use at least one computer processor: receiving one or more images of the diathermy capsulotomy tool and a patient's eye from the imaging system; driving a robotic unit to insert the diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye such that a distal end of the diathermy capsulotomy tool is disposed within the patient's eye and a remote center of motion position of the diathermy capsulotomy tool is disposed within the incision; as well as The robotic unit is driven to move the cutting element in a circular motion while activating the diathermic cutting element to apply diathermic energy to an anterior lens capsule of an eye of a patient and while maintaining the remote center of motion position of the diathermic capsulotomy tool within the incision.

10. The method according to claim 9, wherein: To move the cutting element in a circular motion while activating the diathermic cutting element to apply diathermic energy to an anterior lens capsule of an eye of the patient, and while maintaining the remote center of motion position of the diathermic capsulotomy tool within the incision, the method further includes driving the robotic unit using the computer processor to maintain an end of the diathermic capsulotomy tool at an angle relative to the patient's eye such that the diathermic cutting element is disposed on the anterior lens capsule of the patient's eye, but an entrance of the tool into the patient's eye remains within the incision.

11. The method of claim 9, further comprising determining, using the computer processor, motion experienced by the patient's eye and dynamically adjusting the placement of the diathermy capsulotomy tool such that the remote center of motion position of the diathermy capsulotomy tool remains within the incision.

12. The method of claim 9, further comprising determining, using the computer processor, motion experienced by an eye of the patient and dynamically adjusting the circular motion of the cutting element to conform to the motion experienced by the eye of the patient.

13. The method according to claim 9, wherein: The distal end of the diathermy capsulotomy tool is not straight such that driving the robotic unit to insert the diathermy capsulotomy tool into the patient's eye via the incision in the cornea of ​​the patient's eye includes driving the robotic unit to advance the diathermy capsulotomy tool along a non-linear path.

14. The method of any one of claims 9-13, further comprising determining, using the computer processor, a position of a visual axis of the patient, wherein driving the robotic unit to move the cutting element in a circular motion comprises driving the robotic unit to move the cutting element in a circular motion centered about the visual axis of the patient.

15. The method of claim 14, further comprising determining, using the computer processor, the motion experienced by the patient's eye and dynamically adjusting the circular motion of the cutting element so that the circular motion of the cutting element remains centered about the patient's visual axis.

16. The method according to claim 14, wherein: Determining the position of the patient's visual axis includes directing light from a coaxial light source toward the patient's eye, identifying a Purkinje image within one or more of the images acquired by the imaging system, and identifying the patient's visual axis as being located at a point around which the Purkinje image is centered.

Images