Ophthalmic surgical robot

Abstract

A system for performing an ophthalmic procedure includes a robotic positioning system that includes an end effector. The robotic positioning system is configured to position the end effector in at least five degrees of freedom. The ophthalmic surgical instrument is mounted to the end effector with an attachment device configured to assist the ophthalmic surgical instrument in performing an ophthalmic treatment. The robotic positioning system may be controlled to implement anatomical boundary constraints and implement predetermined motion profiles.

Description

Cross Reference to Related Applications

[0001] This application claims priority to U.S. Provisional Application No. 63 / 582,227, filed on September 12, 2023, which is incorporated herein by reference in its entirety. Background Technology

[0002] This disclosure generally pertains to the performance of ophthalmic surgeries.

[0003] Light received by the eye is focused by the cornea and lens onto the retina, which contains photoreceptor cells, at the back of the eye. The area between the cornea and lens is called the anterior chamber. The interior of the eye between the lens and retina is called the posterior chamber, and it is filled with a transparent gel called the vitreous humor. Many eye conditions can be treated with ophthalmic procedures performed inside the eye or in the posterior chamber.

[0004] Facilitating the implementation of ophthalmic treatments would be a step forward in the field. Summary of the Invention

[0005] In some embodiments, a system for performing ophthalmic surgery includes a robotic positioning system comprising an end effector configured to position the end effector with at least five degrees of freedom. Ophthalmic surgical instruments are mounted onto the end effector. Accessories are mounted onto the end effector and configured to assist the ophthalmic surgical instruments in performing ophthalmic treatments. Attached Figure Description

[0006] To gain a detailed understanding of the features described above, reference can be made to the embodiments for a more specific description of the disclosure, some of which are illustrated in the accompanying drawings. However, it should be noted that the drawings illustrate only exemplary embodiments and should not be construed as limiting the scope of the disclosure, and may allow for other equally effective embodiments.

[0007] Figure 1A This is an isometric view of a robotic arm according to certain embodiments, on which surgical instruments and imaging devices are mounted.

[0008] Figure 1B This is a diagram illustrating an implementation of a remote motion center according to certain embodiments.

[0009] Figure 1C This is a dotted line diagram of the posterior chamber of the eye according to certain embodiments.

[0010] Figure 2A This is a diagram illustrating an ophthalmic treatment performed using surgical instruments and an imaging device according to certain embodiments.

[0011] Figure 2BThis is a diagram illustrating an ophthalmic treatment performed using surgical instruments and imaging devices incorporating lasers, according to certain embodiments.

[0012] Figure 2C This is a diagram illustrating an ophthalmic treatment performed using surgical instruments and an imaging device incorporating a therapeutic laser, according to certain embodiments.

[0013] Figure 2D This is a diagram illustrating an ophthalmic treatment performed according to certain embodiments using surgical instruments including forceps and an imaging device.

[0014] Figure 3 This is a diagram illustrating a remote-controlled robotic arm according to certain embodiments.

[0015] Figure 4 This is a process flowchart of a method for controlling a remote-controlled robotic arm according to certain embodiments.

[0016] Figure 5 This is a diagram illustrating a robotic arm and an external light source according to certain embodiments.

[0017] Figure 6 This is a diagram illustrating a robotic arm and a light source inserted into the posterior chamber of an eye, according to certain embodiments.

[0018] Figure 7A and Figure 7B An example probe comprising one or more light sources is shown according to certain embodiments.

[0019] For ease of understanding, the same reference numerals have been used where possible to refer to common elements in the figures. It is conceivable that elements and features of one embodiment may be advantageously combined with those of other embodiments without further elaboration. Detailed Implementation

[0020] refer to Figure 1A A system 100 for performing ophthalmic treatments or assisting surgeons in performing ophthalmic treatments includes an instrument 102 configured to act on tissues of a patient's eye. The system 100 further includes an accessory device 104. The accessory device 104 may include some or all of a light source, a therapeutic laser, a two-dimensional or three-dimensional surface imaging device (e.g., a monocular or stereo camera), a slice imaging device (e.g., an optical coherence tomography (OCT) imaging device), or other types of imaging devices. An example accessory device 104 and its use are described in more detail below.

[0021] The device 102 and the accessory 104 can be used as or connected to the end effector 106 of the robotic arm 108. The robotic arm 108 includes a base 110 and a plurality of links 112a-112f, which are connected to the base 110, to each other, and to the end effector 106 via one or more joints 114a-114f. The base 110 can be fixed relative to a support surface, such as by mounting it to a floor, ceiling, wall, or a wheeled trolley. The joints 114a-114f collectively define one or more degrees of freedom, such as at least five or at least six degrees of freedom. These degrees of freedom enable the robotic arm 108 to position the end effector 106 in two-dimensional or three-dimensional space and to orient the end effector with two or three rotational degrees of freedom. The kinematic solution that translates the position and orientation of the end effector 106 into the orientation of the links 112a-112f can be calculated using any method known in the art.

[0022] The robotic arm 108 is an example of a robot localization system that can be used to locate the end effector 106 as described herein. The robotic arm 108 can be replaced by other types of robot localization systems, such as one or more linear tracks and corresponding actuators (e.g., multidimensional frames), parallel actuation, or other types of robot actuators.

[0023] refer to Figure 1B For example, a patient's eye 120 includes a cornea 122 and a lens 124, which cooperate to focus light onto photoreceptor cells of the retina 128. The space between the cornea 122 and the lens 124 and iris 126 is called the anterior chamber, while the space between the lens 124 and the retina 128 is called the posterior chamber and is filled with a transparent gel called the vitreous humor. An instrument 102 can be inserted into either the anterior or posterior chamber through an incision 130. For example, the incision can be at or near the limbus 132, which is the boundary between the cornea 122 and the sclera 134 (i.e., the white of the eye). The incision 130 can also be within the sclera 134 itself, such as... Figure 1B As shown.

[0024] The robotic arm 108 can be controlled to maintain a remote center of motion (RCM) 136 at the incision 130, for example, using a target-locking algorithm. For example, the target-locking algorithm can include the manner described in U.S. Patent 11,336,804B2, which is hereby incorporated herein by reference in its entirety. The proximal end of the instrument 102 (external to the eye 120) can be moved by the robotic arm 108 in various directions defined relative to the axis 138 of the incision 130, such as inserting a cannula into the incision 130. For example, an axial direction 140a can be defined as movement parallel to the axis 138, an angular direction 140b can be defined as rotation in a plane passing through the axis 138, and a precession direction 140c is defined as rotation about the axis 138. The position and orientation of the robotic arm 108 are independent of the position of the surgical microscope used by the surgeon to view the eye 120. Accordingly, desired insertion positions and orientations can be selected without requiring the surgical microscope to be placed at an angle uncomfortable for the patient and / or surgeon. The surgical microscope can be implemented using the NGENUITY 3D visualization system provided by Alcon Inc. in Fort Worth, Texas.

[0025] refer to Figure 1C With free movement around directions 140a, 140b, 140c, the distal end of the device 102 can be positioned at a point array 142 in three-dimensional space within the posterior or anterior chamber of the eye, including a spherical shape corresponding to the shape of the retina 128.

[0026] refer to Figure 2A In some embodiments, the instrument 102 and accessory device 104 are used to perform ophthalmic treatments on the eye 120. Treatments can be performed in the anterior or posterior chamber. For example, treatment of the anterior chamber may include treatments for glaucoma (e.g., minimally invasive glaucoma surgery (MIGS)), such as placing a stent or making an incision in the trabecular meshwork. Treatments may be for cataracts, such as performing capsulorhexis, capsulorhexis, and phacoemulsification followed by placement of an intraocular lens (IOL). Treatment of the posterior chamber may include vitrectomy (removal of the vitreous), intravitreal injection, membrane (e.g., internal limiting membrane (ILM)) or epiretinal membrane (ERM) peeling, retinal reattachment, or other procedures. The instrument 102 and accessory device 104 may be used as part of a small incision lenticule extraction (SMILE) procedure.

[0027] Therefore, the instrument 102 can be implemented as an instrument for performing any of the above-described procedures, including phacoemulsification-vitrectomy tools for performing phacoemulsification or vitrectomy, instruments for making incisions or placing stents, rods including fiber optic cables for emitting laser pulses, surgical forceps, or other tools for performing membrane dissection, or other ophthalmic surgical instruments. The instrument 102 can be removably attached to the end effector 106, such that any number of different instruments 102 configured to perform any of the above-described ophthalmic treatments can be secured to the end effector 106.

[0028] Instrument 102 can be inserted into incision 130. Incision 130 can be located at or near the limbus 132, at or near the sclera 134, or elsewhere on the eye 120 through which instrument 102 is inserted. During use of instrument 102, accessory device 104 can be used to assist in the safe execution of ophthalmic treatment. In the first example, instrument 102 is a phacoemulsification-vitrectomy instrument for performing vitrectomy, and accessory device 104 is an OCT. OCT can be used in various ways. With instrument 102 in place, robotic arm 108 (see...) Figure 1A The OCT can be moved to multiple locations around the eye 120. Using the known positions of the OCT from the kinematic state of the robotic arm 108, three-dimensional images of the eye 120 can be generated using cross-sectional images of the OCT from each location. With the instrument 102 in place and during ophthalmic treatment, the OCT can continue to be used to generate three-dimensional images of the eye 120, capturing, for example, changes in the anatomy of the eye 120 caused by the ophthalmic treatment and the possible position of the distal end 200 of the instrument 102. The three-dimensional images can be generated using the OCT and the output of another imaging device, such as images from a surgical microscope or other camera. For example, a camera can be used to perform eye tracking. The three-dimensional images generated from the OCT output can then be rotated correspondingly to the eye movements detected by eye tracking and aligned with images obtained using a surgical microscope or other camera.

[0029] For example, the three-dimensional images of the eye generated during surgery can be analyzed to identify the anatomical structures of the eye 120, and the identified anatomical structures can be used in some or all of the following ways: • Three-dimensional images, along with labels of any anatomical structures that may be identifiable in the three-dimensional images, can be shown to surgeons during ophthalmic treatments to enable visualization of previously invisible areas using a surgical microscope. • Anatomical labels can be used to control the robotic arm 108 or guide the surgeon. For example, anatomical labels can be used in conjunction with treatment planning to provide precise location of the anatomy of the eye 120 and the distal end 200 of the instrument 102, guiding the selection of locations to be moved relative to the anatomy of the eye for performing ophthalmic treatments, such as the point in the posterior chamber to remove vitreous, the point in the capsular bag of the eye 120 to perform phacoemulsification, the point in the trabecular meshwork to place an incision or stent, or the location in the retina to which laser pulses are guided for retinal reattachment or other actions. • When the distal end 200 of the instrument 102 approaches a boundary (such as the retina, the capsule surrounding the lens 124, or other boundaries defined in the treatment plan for the patient's eye 120), it provides feedback to the surgeon or the algorithm controlling the robotic arm 108. • Identify the remaining amount of material (membrane, vitreous body, lens 204, etc.) to be removed in the 3D map and provide feedback to the surgeon or the algorithm controlling the robotic arm 108 on where to move the distal end 200 of the instrument 102 to remove the remaining material.

[0030] The examples listed above are merely illustrative, and any other ophthalmic treatment can also be guided by 3D mapping, labels of eye anatomy in the 3D mapping, and other data describing the ophthalmic treatment.

[0031] refer to Figure 2B In another example use case, the accessory 104 is an OCT, and the therapeutic laser 210 is also coupled to the end effector 106 of the robotic arm 108. The focus of the therapeutic laser 210 can be (a) fixed at a point near the distal end of the instrument 102 (e.g., within 0.1 mm), and (b) variable with respect to parameters such as the angle of the optical axis 212 of the therapeutic laser 210 and the distance along the optical axis 212. In the variable case, mounting the therapeutic laser 210 to the actuator of the end effector 106 can be used to change the aforementioned parameters of the focus.

[0032] The therapeutic laser 210 can be used to perform procedures such as photocoagulation, retinal reattachment, incision making (e.g., capsulotomy, capsulotomy, etc.) or other operations. The therapeutic laser 210 can be used in conjunction with the instrument 102, for example, to perform any of the aforementioned operations after the instrument 102 has performed a previous action, such as performing photocoagulation, retinal reattachment, or other operations after performing vitrectomy, retinal membrane peeling, or other actions performed relative to the posterior chamber of the retina 128 or other locations in the eye 120.

[0033] exist Figure 2BIn one embodiment, the optical axis 214 of the OCT can be fixed or controlled to substantially (e.g., within 0.1 mm) intersect the focal point of the treatment laser 210 in order to image the anatomical structure of the eye 120 to be treated by the treatment laser 210.

[0034] refer to Figure 2C In another embodiment, device 102 is itself part of a therapeutic laser system. Device 102 may include a therapeutic laser 216, and device 102 may include an optical fiber that conducts light from the therapeutic laser 216 to the distal end 200 of device 102. Alternatively, the therapeutic laser 216 may be located remotely from end effector 106 and device 102, wherein light is also conducted via an optical fiber to the distal end 200 of device 102. Light from the therapeutic laser 216 can be used to form incisions in the trabecular meshwork, perform photocoagulation, perform retinal repositioning, or perform other actions.

[0035] As for Figure 2B In one embodiment, the optical axis 214 of the OCT can be fixed or controlled to substantially (e.g., within 0.1 mm) intersect the focal point of the treatment laser 216 in order to image the anatomical structure of the eye 120 to be treated by the treatment laser 226. refer to Figure 2D In some embodiments, the instrument 102 includes a surgical forceps 218 at a distal end 200. The surgical forceps 218 may be a surgical forceps configured to hold the retina (e.g., ILM or ERM). The surgical forceps 218 may be configured to place sutures, such as corneal sutures, sutures for closing incision 130, or other types of sutures. The surgical forceps 218 may be configured to hold and remove corneal microlenses as part of a SMILE procedure. A force / torque sensor 220 may be incorporated into the instrument 102, for example, into the lever 222 on which the surgical forceps 218 is mounted. The force / torque sensor 220 may be additionally or alternatively incorporated into one or both arms of the surgical forceps 218. The force / torque sensor 220 measures the amount of force and / or torque transmitted through the surgical forceps 218. The force / torque sensor 220 may be positioned at various locations on the instrument 102 other than the lever 222, such as portions of the instrument 102 or lever 222 that are not inserted into the eye during use. The model of device 102 can then be used to convert the force / torque detected by force / torque sensor 220 into force / torque applied at the distal end of rod 222.

[0036] refer to Figure 3The surgeon 300 can control the robotic arm 108 through various interfaces. In the illustrated embodiment, the surgeon 300 actuates the robotic arm 302. The robotic arm 302 may have the same number of degrees of freedom as the robotic arm 108, or it may have more or fewer degrees of freedom. The robotic arm 302 may have links 112a-112f and joints 114a-114f of the same configuration or different configurations. The robotic arm 302 may have the same size as the robotic arm 108, or it may be scaled to be larger or smaller than the robotic arm 108.

[0037] Robotic arm 302 is an example of an interface used to control robotic arm 108. Robotic arm 302 can be implemented as any of the robot positioning systems described above, as a possible alternative to robotic arm 108. Robotic arm 302 can also be replaced by a joystick, controller (e.g., a tablet with buttons and one or more joysticks, which can be used to control video games), foot pedal, or any other type of input device with sufficient degrees of freedom to control the degrees of freedom of robotic arm 302.

[0038] In use, the surgeon can grasp the handle 304 at the distal end of the robotic arm 108, for example, in joints and links of the robotic arm 302 with corresponding positions corresponding to the end effector 106 of the robotic arm 108. The robotic arm 302 may include sensors, such as force / torque sensors, configured to sense the state of the joints of the robotic arm 302, which can then be processed to obtain the position and orientation of the handle 304. Additionally or alternatively, cameras, local positioning systems, ultrasonic position sensors, or any other type of position detection method may be used to detect the position and orientation of the handle 304 in three-dimensional space. The robotic arm 302 may further include actuators configured to control the position and orientation of the handle 304 and provide a desired level of resistance to the movement of the handle 304, as discussed in more detail below.

[0039] The robotic arm 302 can also be used to trigger functions such as opening and closing the surgical forceps 218, extending and retracting the surgical forceps 218, activating the treatment lasers 210 and 216, activating the pump, activating the phacoemulsification-vitrectomy tool, or other actions. For example, the handle 304 may include one or more interface elements 304a that trigger any of the above functions when interacting with the surgeon 300. In other embodiments, the robotic arm 302 includes one or more additional degrees of freedom, such that movement in these additional degrees of freedom triggers other functions, such as opening and closing the surgical forceps 218.

[0040] The surgeon can also see the display device 306. The display device 306 may present the output of an accessory device 104 implemented as an imaging device, the output of a surgical microscope, or some other imaging device. The display device 306 can be used in a split-screen mode, in which images of two or more different imaging modalities are displayed in different areas of the display device 306. Alternatively, an image according to one imaging modality can be displayed along with a stack of images according to another imaging modality or derived from images according to another imaging modality, such as one or more labels for one or more anatomical structures. The display device 306 may be one of multiple displays, each displaying images from different imaging modalities or different views according to the same imaging modality (e.g., different views or sections of a three-dimensional image). Therefore, the surgeon can use visual feedback on the display device 306 to guide the movement of the handle 304. The detected movement of the handle 304, as discussed above, can then be translated into a corresponding movement of the end effector 106 of the robotic arm 108.

[0041] The sensors and actuators of robotic arms 108 and 302 can be coupled to a common controller 308. The controller 308 can further receive images from some or all of the accessories 104, which are implemented as OCT, surgical microscopes, or other imaging devices. The controller 308 can also receive images from imaging devices not mounted on the end effector 106 of robotic arm 108, such as a surgical microscope that places the eye 120 in its field of view.

[0042] The controller 308 may include an anatomical structure recognition module 310. The anatomical structure recognition module 310 analyzes the images received by the controller 308 and creates a three-dimensional image of the eye 120, identifying anatomical structures within the eye, such as the cornea 122, lens 124, iris 126, retina 128, capsule, trabecular meshwork, Schlemm's canal, membranes on the retina, or any other anatomical structure that forms part of the eye 120. The anatomical structure recognition module 310 may include one or more machine learning models, each trained to label specific anatomical structure items. Each machine learning model may be implemented as a neural network, deep neural network (DNN), convolutional neural network (CNN), recurrent neural network (RNN), Bayesian network, genetic algorithm, multiple linear regression model, multiple multinomial regression model, support vector regression model, or any other type of machine learning model.

[0043] Since images can be received throughout the ophthalmic treatment, the anatomy recognition module 310 can process these images continuously or periodically to obtain current labels for anatomical items that can reflect changes in anatomical items caused by the ophthalmic treatment, such as changes in membranes during the dissection process, the remaining vitreous body during vitrectomy, the remaining portion of the lens 124 during phacoemulsification, incisions or supports placed in the trabecular meshwork, or other changes in the anatomy of the eye 120.

[0044] The controller 308 may include a boundary recognition module 312. The boundary recognition module 312 may, for example, identify one or more anatomical structures, or areas adjacent to anatomical structures, that the distal end 200 of the instrument 102 should not enter, based on default settings or a treatment plan provided to the boundary recognition module 312 for a given ophthalmic treatment. For example, for phacoemulsification, the boundary may include the capsular bag or an artificial surface offset inward from the capsular bag. For vitrectomy, the boundary may include the retina, lens, and / or choroid, or an artificial surface offset inward from any of these anatomical structures. For glaucoma treatment, the boundary may include the lens, ciliary body, or other anatomical structures that the distal end 200 of the instrument 102 should not contact. For retinal detachment, the boundary may include any anatomical structures of the eye not covered by the membrane to be detached, including portions of the retina where the membrane does not extend. Other ophthalmic treatments may include boundaries corresponding to anatomical structures that should not be contacted during surgery.

[0045] The controller 308 may include a motion contour module 314. The motion contour module 314 performs predefined movements using the robotic arm 108, or constrains movements triggered by the surgeon 300 based on one or more motion contours. Motion contours can be defined relative to anatomical structures, allowing the surgeon to select an anatomical structure or a portion thereof to trigger the execution of one or more actions defined relative to the anatomical structure or a portion thereof within the motion contour.

[0046] In the first example, the actions required to peel off the membrane are highly complex, and excessive pressure must not be applied to the retina 128. Accordingly, the motion profile may include: (a) using surgical forceps 218 to perform a membrane clamping action at a location indicated by the surgeon, limiting pressure on the retina 128 and / or clamping the membrane with an appropriate clamping force, or (b) imposing restrictions on clamping actions triggered by the surgeon 300 to prevent excessive pressure on the retina 128 and to limit the clamping force to an appropriate amount. The motion profile can be defined dynamically, for example, by calculating the movement of the motion profile based on feedback from the force / torque sensor 220, such as to maintain the output of the force / torque sensor 220 below a threshold. In some embodiments, the threshold is obtained by measuring the force and torque values ​​generated by the surgeon manually performing the peel. Three-dimensional imaging can be used to provide additional feedback. For example, if retinal detachment begins, the traction force can be reduced or stopped.

[0047] Artificial intelligence models can be used to control detachment. Detachment can be controlled by the artificial intelligence model through feedback and adjustment in response to feedback as described above (e.g., feedback from force / torque sensors and / or feedback regarding retinal detachment).

[0048] An AI model can be trained using a dataset where each entry describes membrane detachment in a region, whether it's complete detachment or a specific detachment action. For example, each entry could represent individual clamping and detachment actions. Each entry could record some or all of the surgeon's traction angle, the trajectory of the detached membrane, and values ​​output by force / torque sensors during detachment as the desired output. Each entry could include the degree of adhesion of the membrane to be detached and a portion of an OCT image representing the detachment area as input. Each entry could include measures of patient outcome, such as whether retinal detachment occurred and how much retinal detachment occurred. The data entries can be used to train the AI ​​model to generate motion profiles, such as traction, angle, trajectory, and force / torque thresholds for detaching the membrane from the retina without retinal detachment.

[0049] In some membrane peeling procedures, a curette is used to lift the flap before it is grasped with surgical forceps. The flap lifting operation (including selecting the site for flap lifting) can also have a corresponding motion profile, which can also include an artificial intelligence machine learning model trained to perform the task. The motion profile can select parameters such as scraping force, angle, placement position, and tension. The flap lifting motion profile can also be controlled based on feedback from a force / torque sensor. For example, in response to the force / torque sensor output exceeding a threshold, the curette pressure on the membrane can be paused or slowed. Similarly, if retinal detachment is detected during flap lifting, the movement can be stopped or slowed. In some embodiments, a curette can also be used for peeling instead of surgical forceps.

[0050] In some embodiments, one or more second machine learning models are used to automatically select the starting point for detachment, which may include an initial scraping step. The one or more second machine learning models may further generate a pattern scheme for detaching the entire membrane. The one or more second machine learning models may take as input a three-dimensional image of the retina covered by the membrane, which may include labels identifying portions of the membrane corresponding to the retina in the three-dimensional image. Data entries may be used to train the one or more second machine learning models. Each data entry may include, as the desired output, a pattern scheme followed by the surgeon during membrane removal, and may include representations of patient prognosis (such as the amount of retinal detachment, the severity of retinal hemorrhage, or other indicators). Each entry may include some or all of the following as input: a three-dimensional image of the eye including the membrane, labels indicating portions of the membrane corresponding to the retina in the three-dimensional image, the degree of membrane adhesion, or other values. Therefore, training data entries may be used to train one or more second machine learning models to generate a pattern scheme for retinal detachment, including the starting and ending points of the pattern scheme. For example, an AI model may be trained to identify areas of weak retinal attachment and ultimately perform detachment on such areas, such as detaching in a spiral pattern around areas of relatively weak retinal attachment. For example, adjustments to the detachment pattern can be made in response to feedback, such as avoiding areas where retinal detachment may occur until a later point in the detachment pattern.

[0051] In the second example, the motion profile defines the placement of the corneal suture or any other type of suture. Other suture alternatives (such as staples or adhesives) can be implemented in a similar manner. For example, the motion profile can perform one or both of the following: (a) defining a series of movements of the surgical forceps 218 to place the suture in the position specified by the surgeon 300 and to apply a predetermined amount of tension to the corneal portion joined by the suture during keratoplasty; (b) defining a restriction on the movement of the surgical forceps 218 triggered by the surgeon 300 to achieve the application of the predetermined amount of tension to the suture. For example, for sutures placed around the periphery of the transplanted cornea, it is desirable that the tension in all sutures be equal to avoid corneal deformation. Therefore, the motion profile can assist in the placement of the suture, thereby providing uniform tension. The motion profile can also be defined for placing adhesives or using laser bonding instead of sutures.

[0052] In the third example, the motion profile defines the placement of the incision or stent within the trabecular meshwork of eye 120 or elsewhere in the eye for the treatment of glaucoma. For example, the motion profile may perform one or both of the following: (a) defining a series of movements of instrument 102 to place the incision or stent at a location selected by the surgeon or defined in the treatment plan; (b) defining restrictions on movements of instrument 102 triggered by surgeon 300 to assist in placing the incision or stent at the correct depth and in the correct location within the anterior chamber of eye 120.

[0053] In the fourth example, the surgeon 300 selects a point on the image to be treated by the therapeutic laser, according to any of the embodiments disclosed above, and invokes a motion profile to perform laser treatment (e.g., photocoagulation or retinal reattachment). The point can be selected by tapping a touchscreen, using a pointing device to move a cursor relative to the image (e.g., a datum line), or some other input. In response to the selection of the point, the controller 308 moves the distal end 200 of the instrument 102 at an appropriate distance and angle relative to the position in the eye 120 corresponding to the point on the image and emits pulses. The surgeon can also trace a line on the image to instruct the controller to emit a series of pulses at predetermined intervals along a path corresponding to the anatomical structure of the eye 120. The therapeutic laser is capable of emitting multiple independently guideable beams, allowing the therapeutic laser to treat multiple points simultaneously.

[0054] In the fifth example, the motion profile defines the clamping and retrieval of a corneal microlens created as part of a SMILE procedure. For example, since the corneal microlens itself can be created using computer-controlled initiation of a laser, the position of the corneal microlens can be known, and the motion profile can then define the retrieval of the corneal microlens using surgical forceps 218. Clamping and retrieval can be performed using feedback from a force / torque sensor. Clamping and retrieval can also be performed using a machine learning model trained with data from previous clamping and retrieval operations.

[0055] The motion profile module 314 can use other motion profiles to perform or limit movements as part of other ophthalmic treatments. The motion profiles used by the motion profile module 314 can be manually programmed. Motion profiles can be obtained by recording the movement of the instrument 102 (whether coupled to a handheld device held by a surgeon or a handheld device controlled by a robotic arm 302) during a previous ophthalmic treatment.

[0056] The controller 308 may include a motion tracking module 316 configured to track the movement of the instrument 102 (particularly the distal end 200) relative to the anatomy of the eye. The motion tracking module 316 can identify a representation of the instrument 102 in three-dimensional images generated during ophthalmic treatment. The motion tracking module 316 can estimate the position and orientation of the instrument 102 in three dimensions, and possibly its first or second derivative. The motion tracking module 316 can predict the future position of the instrument 102, for example, using Kalman filtering or another motion prediction algorithm. For example, model-based estimation can predict one or more samples in front and may be suitable for implementing the motion tracking module 316.

[0057] Accordingly, if the actual or predicted position of the device 102 (particularly the distal end 200) is incident on or outside the boundary defined by the boundary recognition module 312, the controller 308 can prevent the device 102 from moving across the boundary. For example, the prevention and / or blocking of the device 102 from moving across the boundary can be implemented in a manner described in the following documents, each of which is incorporated herein by reference in its entirety: U.S. Patent Application Serial No. 63 / 315,129, filed on March 1, 2022, entitled "ROBOTIC IMAGING SYSTEM WITH FORCE-BASED COLLISION AVOIDANCE MODE"; and U.S. Patent Application Serial No. 63 / 315,130, filed on March 1, 2022, entitled “ROBOTIC IMAGING SYSTEM WITH VELOCITY-BASED COLLISION AVOIDANCE MODE”.

[0058] The controller 308 may include a surgeon's interface 318. The surgeon's interface 318 may receive input from the surgeon 300 in the form of voice commands, gestures, or input via a touchscreen, pointing device, keyboard, joystick, foot pedal, or other input device. The surgeon 300 may provide input such as invoking the execution or application of motion contours, adjusting the resistance of the robotic arm 302, activating the accessory device 104, adjusting portions of the three-dimensional image displayed on the display device 306, adjusting the imaging modality of the image displayed on the display device 306, or adjusting other aspects of the operation of the robotic arm 302, robotic arm 108, and accessory device 104.

[0059] Figure 4An example method 400 that can be executed by controller 308 is shown. Method 400 includes capturing an image at step 402. The image may be a three-dimensional image of eye 120 captured using one or more imaging modalities as described above. Method 400 includes identifying the anatomical structures of eye 120 represented in the three-dimensional image at step 404, such as using any of the methods described above with respect to the anatomical structure recognition module 310.

[0060] Method 400 includes evaluating at step 406 whether movement of the robotic arm 302 is detected. If so, method 400 may include evaluating at step 408 whether movement of the robotic arm 108 corresponding to movement of the robotic arm 302 would result in actual or predicted collision of the instrument 102 with a boundary (e.g., the boundary identified by the boundary recognition module 312 as described above, and the actual or predicted position of the instrument 102 relative to the motion tracking module 316 as described above).

[0061] If not, method 400 may include, at step 410, moving instrument 102 in response to detected movement of robotic arm 108 using robotic arm 108. If yes, the method may include one or both of the following: (a) avoiding movement of instrument 102 in response to movement of robotic arm 302; and (b) triggering actuators of robotic arm 302 to generate resistance to movement of robotic arm 302 at step 412. For example, step 412 may include activating brakes in one or more joints of robotic arm 302, or activating actuators to generate torque that is opposite to but less than the torque applied by surgeon 300 to the joints of robotic arm 302. In this way, feedback is provided to the surgeon to avoid unwanted contact with marked anatomical structures.

[0062] In some embodiments that only predict collisions, step 412 may include moving the robotic arm 108 in accordance with the movement of the robotic arm 302, wherein the resistance to the movement of the robotic arm 302 increases as the instrument 102 approaches the boundary. In other embodiments, the resistance to the movement of the robotic arm 302 increases as the instrument 102 approaches the boundary, starting from a predetermined distance from the boundary, for example according to a linear, quadratic, or exponentially increasing function of proximity, such as A / x or Ax, where x is the distance from the boundary and is a predetermined parameter. In some embodiments, the resistance to movement simulates a virtual spring between the instrument 102 and the boundary and resists movement toward the boundary and possible recoil away from the boundary.

[0063] Method 400 may further include, at step 414, assessing whether the surgeon has selected a motion profile (e.g., via surgeon interface 318). If so, the motion profile, such as any of the motion profiles described above, is implemented at step 416. Implementing the selected profile may include performing one or more predetermined actions as defined in the motion profile at a location specified by the surgeon (e.g., the current position and orientation of instrument 102). As described above, implementing the motion profile may include imposing restrictions on actions triggered by the surgeon using robotic arm 302 based on the motion profile. Feedback related to the restrictions imposed based on the motion profile may be provided in the form of resistance to movement of robotic arm 302, such as greater resistance to movement of robotic arm 302 away from the defined motion profile, as described above.

[0064] refer to Figure 5 In some embodiments, the accessory 104 is mounted to the end effector 106 of the robotic arm 108, while the instrument 102 is mounted to a handheld device 500 held in the surgeon's hand or to a separate robotic arm. The accessory 104 can be implemented as an OCT or other imaging device. In the illustrated embodiments, the accessory can be moved to various points along a circular path 502 around the eye 120 and oriented at various angles relative to the eye 120. Thus, the accessory 104 can be moved to positions and orientations that are (a) not currently obstructed by the instrument 102; and (b) the optical axis of the accessory 104 is positioned and oriented at an angle that is not substantially parallel and collinear with the optical axis of the eye 120, such as an angle between 5 and 90 degrees relative to the optical axis of the eye, and an offset from the optical axis of the eye 120 between 1 and 20 mm. The position and orientation of this range enable the accessory device 104 to image anatomical structures that may not be visible to a surgical microscope that images the eye 120 through the iris 126, wherein the optical axis of the surgical microscope 504 is substantially (e.g., within 5 degrees) parallel to the optical axis of the eye 120.

[0065] The path followed by the end effector 106 can be controlled in various ways. In some embodiments, the treatment plan specifies the movement of the end effector 106 throughout the surgical procedure. Therefore, the controller 308 can move the end effector 106 according to the treatment plan, such as in response to input from the surgeon indicating that a step in the treatment plan has been completed or begun. The movement of the end effector 106 can be automatic, such as in response to movement of the instrument 102. For example, the controller 308 can automatically position the end effector 106 such that the distal end of the instrument 102 is within the field of view of the accessory device 104 implemented as an OCT. In other embodiments, the position and orientation of the end effector 106 can be controlled by the surgeon, such as by means of one or more foot pedals, voice commands, gestures, or other inputs to the surgeon interface 318. For example, using a touchscreen, the surgeon can specify a point and orientation that instructs the OCT to be pointed at that point and that the optical axis of the OCT has a specified orientation. In another example, the surgeon can, for example, mark an area of ​​the eye 120 in the treatment plan. The surgeon can then select the marked area to trigger imaging of that area using the OCT.

[0066] refer to Figure 6 In another embodiment, the accessory device 104 includes a probe 600 adapted for insertion into the eye 120. The robotic arm 108 can move the probe 600 around the RCM located in the incision with the same range of motion, as described above with respect to instrument 102. The probe 600 may include a fiber optic cable that emits light 602 into the posterior or anterior chamber of the eye 120. For example, the probe 600 may be an endoscope with an integrated light source, as described below with respect to instrument 102. Figure 7A and Figure 7B As described. The probe 600 can also be used to emit light to the outside of the eye 120.

[0067] The robotic arm 108 can be used to guide light 602 onto a desired area of ​​the eye 120. For example, in some embodiments, the surgeon 300 can select an anatomical feature or region of the eye 120 from a three-dimensional image representing the eye 120, such as using the surgeon interface 318 described above. The controller 308 can then select the position and orientation of the probe 600 to illuminate that anatomical feature or region. In particular, by means of... Figure 6 The retraction of probe 600, as shown, can increase the area of ​​eye 120 illuminated by light 602. For example, surgeon 300 can draw lines on a touchscreen to further insert or withdraw probe 600 relative to incision 130. In some embodiments that track the position of instrument 102, controller 308 can select the position and orientation of probe 600 to illuminate an area near the distal end 200 of instrument 102, for example, within 5 mm, 3 mm, 2 mm, or 1 mm of the distal end 200.

[0068] refer to Figure 7A and Figure 7B The instrument 102 and / or probe 600 can be implemented as the distal portion 700a or 700b shown. For example, the hollow rod 702 may include a fitting 704 fastened thereto. The distal end of the fitting 704 may include a light source, such as the annular light source 706a shown for the distal portion 700a or one, two, or more individual light sources 706b for the distal portion 700b. Each light source 706a, 706b can be implemented as one or more light-emitting diodes (LEDs), which may or may not have lenses or diffusers for distributing light from the one or more LEDs. Each light source 706a, 706b may be a lens or other transparent structure for transmitting light received from an optical fiber passing through the hollow rod 702.

[0069] The distal end of accessory 704 may further define an opening 708. Objective lens 710 may be positioned within the opening. Objective lens 710 can focus light onto a camera positioned within accessory 704 or onto an optical fiber that transmits light to a camera positioned elsewhere. For example, objective lens 710 and camera can be used as an endoscope. Images captured by lens 701 can be displayed on display device 306, used to generate three-dimensional images and images from one or more other imaging devices (such as surgical microscopes and / or OCT), or used for some other purpose.

[0070] The distal end of accessory 704 may define an additional opening 712. The additional opening 712 may perform one or more functions. The additional opening 712 may permit the injection of a stent, infusion fluid, viscoelastic fluid, IOL, or other structure or fluid into the patient's eye 120. The additional opening 712 may be used to aspirate fluid from the eye 120. The additional opening 712 may be used to emit light from a therapeutic laser, which is coupled to the additional opening 712 via an optical fiber or located within accessory 704.

[0071] Accessory 704 may be visible within eye 120 to imaging devices (such as accessory 104 implemented as OCT). Accessory 704 may be visible due to the material forming accessory 704 or due to marking material attached thereto. The visibility of accessory 704 facilitates the identification and positioning of accessory 704 in a 3D image for motion tracking and boundary constraints, as described above. Accessory 704 may be removably attached to hollow rod 702 and may be disposable. Additional considerations

[0072] The foregoing description is provided to enable any person skilled in the art to practice the various embodiments described herein. Various modifications to these embodiments will be apparent to those skilled in the art, and the general principles defined herein can be applied to other embodiments. For example, changes can be made to the function and arrangement of the elements discussed without departing from the scope of this disclosure. Various examples may be appropriately omitted, substituted, or added to various procedures or components. Furthermore, features described with respect to some examples may be combined in some other examples. For example, any number of aspects set forth herein can be used to implement an apparatus or practice. Additionally, the scope of this disclosure is intended to cover such apparatus or methods practiced using other structures, functions, or structures and functions other than or different from the aspects of this disclosure set forth herein. It should be understood that any aspect of this disclosure may be embodied by one or more elements of the claims.

[0073] As used herein, the phrase “at least one of a series of items” refers to any combination of those items, including a single member. For example, “at least one of a, b, or c” is intended to cover a, b, c, ab, ac, bc, and abc, as well as any combination of multiples of the same element (e.g., aa, aaa, aab, aac, abb, acc, bb, bbb, bbbc, cc, and ccc, or any other order of a, b, and c).

[0074] As used herein, the term "determine" encompasses a wide variety of actions. For example, "determine" can include calculation, operation, processing, derivation, investigation, searching (e.g., searching in a table, database, or other data structure), ascertainment, etc. Furthermore, "determine" can include receiving (e.g., receiving information), accessing (e.g., accessing data in memory), etc. Additionally, "determine" can include parsing, selecting, picking, building, etc.

[0075] The methods disclosed herein include one or more steps or actions for implementing the methods. The method steps and / or actions may be interchanged without departing from the scope of the claims. In other words, unless a specific order of steps or actions is specified, the order and / or use of specific steps and / or actions may be modified without departing from the scope of the claims. Furthermore, the various operations of the above methods can be performed by any suitable means capable of performing the corresponding functions. These means may include various hardware and / or software components and / or modules, including but not limited to circuits, application-specific integrated circuits (ASICs), or processors. Typically, where operations are illustrated in the figures, those operations may have corresponding means and functional components with similar numbering.

[0076] The various illustrative logic blocks, modules, and circuits described in connection with this disclosure may be implemented or executed using a general-purpose processor, digital signal processor (DSP), application-specific integrated circuit (ASIC), field-programmable gate array (FPGA) or other programmable logic device (PLD), discrete gate or transistor logic, discrete hardware components, or any combination thereof, designed to perform the functions described herein. The general-purpose processor may be a microprocessor, but alternatively, the processor may be any commercially available processor, controller, microcontroller, or state machine. The processor may also be implemented as a combination of computing devices, such as a combination of a DSP and a microprocessor, multiple microprocessors, one or more microprocessors incorporating a DSP core, or any other such configuration.

[0077] The processing system can be implemented using a bus architecture. Depending on the specific application and overall design constraints of the processing system, the bus can include any number of interconnect buses and bridges. The bus can link together various circuits, including processors, machine-readable media, and input / output devices. User interfaces (e.g., keypads, displays, mice, joysticks, etc.) can also be connected to the bus. The bus can also link various other circuits, such as timing sources, peripherals, voltage regulators, power management circuits, etc., which are well known in the art and therefore will not be described further. The processor can be implemented using one or more general-purpose and / or special-purpose processors. Examples include microprocessors, microcontrollers, DSP processors, and other circuit systems capable of executing software. Those skilled in the art will recognize how best to implement the described functions for the processing system, depending on the specific application and the overall design constraints imposed on the system as a whole.

[0078] If implemented in software, functionality can be stored or transmitted as one or more instructions or code on or through a computer-readable medium. Software should be interpreted broadly as instructions, data, or any combination thereof, whether referred to as software, firmware, middleware, microcode, hardware description language, or others. Computer-readable media includes both computer storage media and communication media (such as any medium that facilitates the transfer of computer programs from one place to another). The processor may be responsible for managing the bus and general processing, including the execution of software modules stored on the computer-readable storage medium. The computer-readable storage medium may be coupled to the processor, allowing the processor to read information from and write information to the storage medium. Alternatively, the storage medium may be integrated into the processor. For example, the computer-readable medium may include a transmission line, a carrier wave modulated by data, and / or a computer-readable storage medium on which instructions separate from the wireless node are stored, all accessible to the processor via a bus interface. Alternatively or additionally, the computer-readable medium or any portion thereof may be integrated into the processor, for example, in cases where it may have a cache and / or a general-purpose register file. Examples of machine-readable storage media may include RAM (random access memory), flash memory, ROM (read-only memory), PROM (programmable read-only memory), EPROM (erasable programmable read-only memory), EEPROM (electrically erasable programmable read-only memory), registers, disks, optical disks, hard disks, or any other suitable storage media, or any combination thereof. Machine-readable media may be embodied in computer program products.

[0079] Software modules can comprise a single instruction or a number of instructions, and can be distributed across several different code segments, across different programs, and across multiple storage media. Computer-readable media can include multiple software modules. Software modules include instructions that, when executed by a device such as a processor, cause the processing system to perform various functions. Software modules can include transmission modules and reception modules. Each software module can reside in a single storage device or be distributed across multiple storage devices. For example, when a triggering event occurs, a software module can be loaded from a hard disk drive into RAM. During the execution of a software module, the processor can load some instructions into a cache to improve access speed. Then, one or more cache lines can be loaded into a general-purpose register file for processor execution. When referring to the functionality of a software module, it should be understood that this functionality is implemented by the processor when executing the instructions from that software module.

[0080] The following claims are not intended to be limited to the embodiments shown herein, but are given the full scope consistent with the language of the claims. In the claims, references to singular elements, unless specifically stated otherwise, are not intended to mean “one and only one”, but rather “one or more.” Unless otherwise specifically stated otherwise, the term “some” means one or more. No element of any claim shall be interpreted in accordance with 35 U.SC §112(f) unless such elements are expressly described using the phrase “means for…” or, in the case of a method claim, using the phrase “steps for…”. All structural and functional equivalents of the elements of the various aspects described throughout this disclosure that are known to or will be known hereafter by one of ordinary skill in the art are expressly incorporated herein by reference and are intended to be covered by the claims. Furthermore, nothing disclosed herein is intended for public disclosure, whether or not such disclosure is expressly stated in the claims.

Claims

1. A system for performing ophthalmic surgery, the system comprising: A robot localization system, the robot localization system including an end effector, the robot localization system being configured to position the end effector with at least five degrees of freedom; An ophthalmic surgical instrument, wherein the ophthalmic surgical instrument is mounted on the end effector; as well as An auxiliary device, which is mounted on the end effector and configured to assist the ophthalmic surgical instruments in performing ophthalmic treatments.

2. The system as claimed in claim 1, wherein, The accessory device is a therapeutic laser.

3. The system as described in claim 1, wherein, The ophthalmic surgical instrument is a phacoemulsification-vitrectomy instrument.

4. The system as claimed in claim 1, wherein, The ophthalmic surgical instrument is configured to emit therapeutic laser pulses.

5. The system as claimed in claim 1, wherein, The ophthalmic surgical instrument includes an opening for injecting at least one of a structure and a fluid into a patient's eye.

6. The system of claim 1, wherein, The ophthalmic surgical instruments include surgical forceps.

7. The system of claim 6, wherein, The ophthalmic surgical instrument includes a sensor configured to sense at least one of a force or torque transmitted through the surgical forceps.

8. The system as claimed in claim 1, wherein, The ophthalmic surgical instrument in question is an endoscope.

9. The system as claimed in claim 1, wherein, The ophthalmic surgical instruments include a light-emitting structure.

10. The system of claim 1, wherein, The auxiliary device is an imaging device.

11. The system of claim 10, wherein, The imaging device is an optical coherence tomography (OCT) imaging device.

12. The system of claim 11, further comprising a controller coupled to the OCT imaging device, the controller being configured to generate a three-dimensional image of the patient's eye based on images received from the OCT imaging device.

13. The system of claim 12, wherein, The processor is further configured to: The boundaries are defined relative to the anatomical structure of the eye as represented in the three-dimensional image; Detecting the representation of the ophthalmic surgical instruments in the three-dimensional image; and The movement of the ophthalmic surgical instruments across the boundary is restricted.

14. The system of claim 13, wherein, The robot positioning system is a first robot positioning system, and the system further includes a second robot positioning system and a handle fixed to the second robot positioning system; The controller is further configured as follows: The first robot positioning system is controlled to position the end effector in a manner corresponding to the position and orientation of the handle; and The movement of the ophthalmic surgical instruments across the boundary is restricted by resisting the movement of the second robotic positioning system.

15. The system of claim 12, wherein, The processor is further configured to: Receives calls to motion profiles; and The motion contour is performed relative to the patient's eyes.

16. The system of claim 15, wherein, The motion contour defines the action of placing the suture in the patient's eye.

17. The system of claim 15, wherein, The motion contour line defines the action of peeling the membrane off the patient's retina.

18. The system of claim 15, wherein, The motion contour line defines the action of placing at least one of the incision or stent into the patient's trabecular meshwork.

19. A system for performing ophthalmic surgery, the system comprising: A robot localization system, the robot localization system including an end effector, the robot localization system being configured to position the end effector with at least five degrees of freedom; An imaging device, which is mounted on the end effector; A controller, connected to the robot positioning system and the imaging device, is configured to: The robot positioning system is controlled during ophthalmic treatment relative to the patient's eye to change the position and orientation of the imaging device relative to the patient's eye, thereby capturing cross-sectional images of the patient's eye; A three-dimensional image of the patient's eye is generated during the ophthalmic treatment. as well as At least a portion of the three-dimensional image is output to a display device during the ophthalmic treatment.

20. The system of claim 19, wherein, The controller is configured to select the position and orientation of the imaging device relative to the eye according to the treatment plan of the ophthalmic treatment.

Images