Ophthalmic surgery operating system, computer program and method for providing assessment information concerning the guidance of a surgical tool

Abstract

An ophthalmic surgery operating system (10) for performing a surgical operation in an operating site (11) on a patient's eye (15) comprises a surgical tool (30) with which it is possible to act on tissue structures of the patient's eye (15) that are arranged in a region of action (76), which is a spatially extended region of possible actions of the surgical tool (30) within a time window of action. According to the invention, a computer program includes a surgical tool program routine for providing a model of the region of action and a routine for determining the spatial position of the model of the operating site with respect to the model of the region of action from the reference measurement data, wherein the computer program has a prognosis routine which is designed to determine, from the spatial position of the model of the operating site with respect to the spatial position of the model of the region of action, a continuously adapted model, valid for a time interval that includes the time window of action, concerning the predicted result of the surgical operation on the patient's eye.

Description

[0001] Eye surgery operating system, computer program and method for providing evaluation information regarding the guidance of a surgical tool

[0002] Description

[0003] The invention relates to an eye surgery operating system for performing a surgical operation in an operation site on a patient's eye with a surgical tool that enables an action on tissue structures of the patient's eye that are arranged in an action area, which is a spatially extended area of ​​possible actions of the surgical tool within an action time window, with a computer unit that contains a program memory with a computer program that has an operation site model program routine for providing a model of the operation site, and that is designed for the continuous acquisition of referencing measurement data on the patient's eye and on the surgical tool.The invention also relates to a computer program for providing evaluation information relating to the guidance of a surgical tool in a surgical operation on a patient's eye and to a computer-implemented method for providing evaluation information relating to the guidance of a surgical tool in a surgical operation on a patient's eye.

[0004] An eye surgery system of the type mentioned above is known from DE 10 2020 102 011 A1. This eye surgery system contains an OCT device that serves to detect the position of a surgical tool in a model of a patient's eye, which can be displayed to a surgeon as a 3D reconstruction of a region of the patient's eye. The display unit enables the display of an actual and a target position for the surgical tool. WO 2019 / 170669 A1 describes the generation of control data for an ophthalmological laser therapy device that serves to create a structure in the tissue of the patient's eye that reduces intraocular pressure and by means of which the cornea is bridged.

[0005] From DE 10 2018 124 065 A1 it is known to display to a surgeon in an eye surgery operating system position information relating to a surgical incision or surgical incisions that is referenced to a patient's eye.

[0006] US 10 842 573 B2 describes an eye surgery operating system which includes a computer unit for generating a calculation model to assist eye surgeons, which enables an estimation of the stress on the retina during membrane peeling.

[0007] US 2018 / 000339 A1 states that in an ophthalmological operation, the model of a patient's eye is determined based on intraoperatively recorded data in order to display information about the model to a surgeon during the ophthalmological operation.

[0008] For the insertion of intraocular lenses into a patient's eye, surgical tool guide templates are known which are aligned with markings applied preoperatively to a patient's eye and which assist a surgeon in guiding surgical tools.

[0009] The object of the invention is to provide an eye surgery operating system and to specify a computer program and method that increases the precision of surgical interventions on a patient's eye.

[0010] This object is achieved by an eye surgery operating system for performing a surgical operation in an operation site on a patient's eye having the features of claim 1, a computer program having the features of claim 24, and a method having the features of claim 25. Advantageous embodiments and further developments of the invention are specified in the dependent claims.

[0011] An eye surgery operating system according to the invention for performing a surgical operation in an operation site on a patient's eye contains a surgical tool that enables an action on tissue structures of the patient's eye arranged in an action zone, wherein the action zone is a spatially extended area of ​​possible action by the surgical tool within an action time window. The eye surgery operating system has a computer unit that contains a program memory with a computer program that has an operation site model program routine for providing a model of the operation site. The computer unit is designed for the continuous acquisition of referencing measurement data relating to the patient's eye and the surgical tool. The computer program has a surgical tool program routine for providing a model of the action zone.The computer program contains a routine for determining the spatial position of the model of the surgical site relative to the model of the impact area from the referencing measurement data. The computer program has a prediction routine designed to determine, from the spatial position of the model of the surgical site relative to the spatial position of the model of the impact area, a continuously adjusted model of the predicted outcome of the surgical operation on the patient's eye that is valid for a time interval encompassing the impact time window, i.e., a model that is valid for a time interval encompassing the impact time window.The computer program contains a routine for the continuous provision of evaluation information relating to the guidance of the surgical tool in the surgical operation, which takes into account the model of the area of ​​impact and the model of the surgical site and the provided, continuously recorded referencing measurement data as well as the model of the predicted result of the surgical operation on the patient's eye, e.g. by determining the evaluation information from the model of the area of ​​impact and the model of the surgical site and the provided, continuously recorded referencing measurement data as well as the model of the predicted result of the surgical operation on the patient's eye.

[0012] A basic idea of ​​the invention is to provide the surgeon with information at any time during an eye operation as to whether and how well the surgical tool application would achieve the desired surgical result in the current position of the surgical tool relative to the surgical site. An advantage of the invention lies in the consideration of the dynamics of the existing system consisting of the surgical site and the surgical tool.

[0013] A surgical tool within the meaning of the invention is, for example, a lancet, a laser, a needle, a stabilized needle, a drill, a puncture injector, a plasma cutter, an endoscope with a laser for tissue ablation or tissue coagulation, an endoscopic laser probe for tissue ablation or coagulation, an implant injector, a cutting tool for goniotomy, a trabecular meshwork trephine, a dilatation catheter for Schlemm's canal penetrating the trabecular meshwork or a laser system for LASIK (laser in situ keratomelesis).

[0014] An effective time window within the meaning of the invention is a time window in which the surgical tool acts on tissue structures in the patient's eye. An effective time window can, for example, have a length Iw for which the following applies: 16 ps < Iw < 0.4 s, preferably 1 ps < Iw < 0.3 s or 1 ms < Iw < 0.2 s or 10 ms < Iw < 0.1 s. An effective time window within the meaning of the invention is, for example, the time window in which sections of the cornea in a patient's eye are exposed to the laser light of a laser system for LASIK in order to correct the patient's eye. An effective time window can, however, also be the time window in which a surgeon performs a pricking movement into the cornea of ​​the patient's eye with a lancet or needle. An effective time window can also be the time window in which a surgeon injects an implant into a patient's eye using an implant injector.In particular, an effective time window can be the time window in which a surgeon makes a goniotomy incision in the cornea of ​​a patient's eye using a cutting tool for goniotomy when the cutting tool is applied to the cornea.

[0015] For the purposes of the invention, a model of an object is a construct that describes only those properties of a model that are considered important, in order to arrive at an abstract representation of the model through this simplification that is understandable, mathematically calculable, or suitable for experimental investigations. A model within the meaning of the invention always describes at least the geometric shape of the object. In addition, a model of an object within the meaning of the invention can describe properties of the object from the group of local blood flow in the object, the course of tissue in the object, in particular blood vessels, spectral absorption of light in the object, blood circulation in the object, tissue types in the object, mechanical properties of the object, or mechanical properties such as pressure, tension, or elasticity in parts of the object.

[0016] A model of the surgical site within the meaning of the invention can, for example, be a point cloud describing the surgical site. The model of the surgical site can also describe the surface shape of a cornea of ​​the patient's eye. In particular, a model of the surgical site can be a CAD model and / or a height profile of a section of the patient's eye and / or a distance profile of the patient's eye and / or a depth profile of the patient's eye and / or a three-dimensional surface representation of a section of the patient's eye and / or a two-dimensional surface representation of a section of the patient's eye.

[0017] In a corresponding manner, a model of the area of ​​action of the surgical tool on the patient's eye can be a point cloud or a CAD model or a three-dimensional line sequence as the description of a particularly spatially extended zone in which the surgical tool can act on body tissue in the patient's eye and / or media arranged in the patient's eye.

[0018] A valid model for the predicted outcome of the surgical operation on the patient's eye for a time interval encompassing the effective time window is understood here to mean a model that describes the predicted outcome of the surgical operation meaningfully, i.e., with sufficient accuracy, at least for a time interval encompassing the effective time window. In particular, a valid model can take into account predefined tolerances, for example, for guiding the surgical tool, particularly during an effective time window. In other words, with a valid model, the predicted outcome can take into account predefined possible deviations when guiding the surgical tool, particularly during the effective time window.

[0019] The invention is based on the finding that the precise position of the area of ​​action of a surgical tool used by a surgeon during a surgical procedure on a patient's eye is decisive for the success of the surgical operation performed with it, i.e. for whether and to what extent the postoperative result corresponds to expectations.

[0020] For example, in the case of the so-called limbal relaxing incision, in which a change in astigmatism is to be achieved by making an incision in the limbus of the patient's eye during cataract surgery, it has been shown that making incisions without any evaluation information based solely on the experience of a surgeon or on the basis of a pen mark on the surface of the eye often leads to unsatisfactory results for inexperienced surgeons.

[0021] The same applies to the insertion of so-called translimbal drainage stents for glaucoma treatment, which are positioned within a translimbal or transcorneal incision in the patient's eye. Here, the position and angle of the incision in the patient's eye largely determine the resulting position of the implant in the anterior chamber between the iris and cornea.

[0022] Preferably, the length Iz of the effective time window encompassing the time interval and the length Iw of the effective time window are:

[0023] Iz > Iw + 0.1 s

[0024] The following particularly preferably applies to the length Iz of the time interval encompassing the effective time window:

[0025] Iz > L, where L is the latency for deploying the model of the predicted outcome of the surgical operation on the patient's eye.

[0026] It is advantageous if the surgical site model program routine is designed for continuous adjustment of the surgical site model based on the continuously acquired referencing measurement data. This allows the surgeon to be provided with a predicted surgical outcome during the operation, which can predict any changes in the surgical site during the operation.

[0027] The model of the predicted outcome of the surgical operation on the patient's eye can in particular be a model for the position of an implant in the patient's eye.

[0028] The routine for continuously providing the evaluation information can further take into account the model for the predicted outcome of the surgical operation on the patient's eye. In particular, the evaluation information regarding the guidance of the surgical tool can contain evaluation information or be evaluation information resulting from a comparison of the model for the predicted outcome of the surgical operation with a reference. The evaluation information is then a measure of the expected surgical success.

[0029] In particular, the evaluation information can be binary information, e.g. “Move on” or “Pull back” or traffic light information “red”, “green” etc., for example depending on whether the evaluation of the predicted surgical outcome falls below or exceeds an acceptance threshold

[0030] The eye surgery system may include a device for displaying the assessment information, which, for example, displays the assessment information as an acoustic and / or optical and / or haptic display signal. The reference may be a model created for the patient's eye for an optimal surgical outcome. The model created for the patient's eye may be based on preoperatively acquired patient data.

[0031] A further idea of ​​the invention is to show the surgeon for an eye operation in a surgical scenario, on the one hand, the spatial position of the impact section of a surgical tool in an object area on or in a patient's eye with the patient's eye in a three-dimensional coordinate system, e.g. in the form of a point cloud, wherein the coordinate system is referenced to the patient's eye.

[0032] A further aspect of the invention is to display planning information regarding an incision to the surgeon in the surgical scenario. This planning information can be planning information determined preoperatively for a patient's eye, whereby it is advantageous if the planning information is adapted during the operation based on data obtained for the patient's eye.

[0033] The data preferably comprises three-dimensional image data containing depth information. The computer program can be designed to adapt the planning information depending on structures in the three-dimensional image data detected by image analysis.

[0034] The three-dimensional image data can be acquired, for example, using a stereo camera system, a confocal scanner, an OCT system, a Scheimpflug camera, and / or an ultrasound system. In particular, the three-dimensional image data can be composed of image data covering spatial regions of different widths and / or depths and / or spatial resolutions and / or spectrally recorded regions.

[0035] In particular, the computer program for determining the position of the active portion of the surgical tool can contain a tracking routine that detects characteristic surgical tool features from the group of opacity, shadows, edge shape, surface shape and light signals by means of image recognition and / or markings on the surgical tool.

[0036] It is advantageous if the three-dimensional data covers the entire eye socket. It should be noted that the position of the eye in the eye socket represents degrees of freedom or parameters that must be taken into account during planning. It should also be noted that eyes can be positioned and fixed relative to the eye socket during eye surgery, for example using tools in access ports, but sometimes also using temporarily sewn sutures. The planning information can be based on patient data collected preoperatively. It is advantageous if the computer program uses a registration routine to determine the position of the effective section of the surgical tool in the three-dimensional coordinate system from continuously acquired three-dimensional image data of the object area and the patient's eye as well as the surgical tool, which takes into account light refraction at interfaces in the patient's eye and / or index gradients in the patient's eye.

[0037] For referencing the spatial position of the model of the effective area to the model of the surgical site in a coordinate system, the computer program can contain a referencing routine with a tracking routine that evaluates characteristic surgical tool features from the group of opacity, shadows, edge or surface shape, light signals by means of image recognition and / or markings on the surgical tool.

[0038] Three-dimensional image data are preferably provided as referencing measurement data, wherein the computer program uses a registration routine that takes into account light refraction at interfaces in the patient's eye and / or index gradients in the patient's eye.

[0039] The eye surgery operating system may comprise a magnetic tracking system, wherein the referencing measurement data includes location data acquired by the magnetic tracking system to the surgical tool.

[0040] The model of the surgical site can in particular be a model from the group of point cloud describing the surgical site, surface shape of a cornea of ​​the patient's eye, CAD model, height profile of a section of the patient's eye, distance profile of the patient's eye, depth profile of the patient's eye, three-dimensional surface representation of a section of the patient's eye, two-dimensional surface representation of a section of the patient's eye or a model that is combined from the models specified above.

[0041] The model of the impact zone can also be a point cloud describing a zone in which the surgical tool can impact body tissue in the patient's eye and / or media located within the patient's eye. In addition to the coordinates of the impact zone, the points of the point cloud can also describe properties of the impact zone, such as tissue color, tissue annotation, calculated or measured mechanical properties such as stresses, pressure, etc.

[0042] The computer program may contain a routine for continuously providing displacement information relating to the guidance of the surgical tool in the surgical operation, which is determined from the model of the area of ​​impact and the model of the surgical site and the provided, continuously recorded referencing measurement data.

[0043] The displacement information for guiding the surgical tool can be information from the group of spatial position of the surgical tool and direction for displacing the surgical tool in the coordinate system of the eye surgery operating system or relative to the model of the surgical site.

[0044] The eye surgery operating system may comprise a device for displaying the information from the group of spatial position of the surgical tool and direction for displacing the surgical tool in the coordinate system of the eye surgery operating system or relative to the model of the surgical site as an acoustic and / or an optical and / or a haptic display signal.

[0045] A further aspect of the invention is to perform surgical planning based on preoperatively acquired data with image information about the patient's eye, in which a preferred application position for the surgical tool or a preferred location range for the surgical tool is determined based on this image information. In particular, one idea of ​​the invention is to register intraoperatively acquired image information about eye structures with preoperatively acquired image information about eye structures in order to adapt the preferred application position for the surgical tool or the preferred location range for the surgical tool and to track and display deviations from a preferred application position to a surgeon.

[0046] The registration of pre- and intra-operatively acquired image information can be achieved, for example, through a nonlinear coordinate transformation, which minimizes the positional deviation of corresponding landmarks in the ocular structures. In particular, by subjecting a pre-operative application position for a surgical tool to a nonlinear coordinate transformation, it is possible to represent the application position for the surgical tool with a position correction relative to the intra-operatively acquired image information.

[0047] One aspect of the invention is to display the displacement information to the surgeon, based on a current position of the active section of the surgical tool, as a movement to be carried out with the surgical tool, e.g. a cutting movement of a lancet.

[0048] In particular, one idea of ​​the invention is to use an intraoperatively tracked position of a surgical tool to determine a hypothetical position for the surgical tool or a hypothetical position range for the surgical instrument that can be expected from a specific movement of the surgical tool based on its actual position. The invention proposes that a hypothetical application position for a surgical tool be displayed to a surgeon as evaluation information or displacement information, in comparison to a preoperatively planned application position.

[0049] Furthermore, the invention proposes that, in order to determine the evaluation information, a determination and evaluation of a hypothetical surgical result based on a hypothetical movement of the surgical tool is carried out.

[0050] For example, the limbal relaxation incision that can be realized from a current position and orientation of a surgical tool designed as a scalpel during hypothetical forward movement can be evaluated with regard to the resulting astigmatism correction, e.g. whether the strength and angle are within the tolerance range around the target values.

[0051] The display of the evaluation information as information on the continuously adjusted model about the predicted result of the operation on the patient's eye in the form of an evaluation of an implant placement resulting from a hypothetical puncture position and puncture direction of a translimbal drainage implant inserted by means of a surgical tool in the form of an implant injector with regard to sufficient distances from sensitive eye structures, such as corneal endothelium or iris, is also possible according to the invention.

[0052] In particular, it is also possible to display the evaluation information as an evaluation of the refractive results of the expected placement of scleral-fixed IOLs based on an evaluation of hypothetical puncture sites for the application of fixation threads.

[0053] Within the scope of the invention, the display of the evaluation information is also possible based on an evaluation of the expected mechanical relief of the retina for the hypothetical local vitreous transection during vitreotraction.

[0054] Within the scope of the invention, the display of the evaluation information is also possible based on an evaluation of the expected reduction in the intraocular pressure IOP of the patient's eye due to a hypothetical application of a surgical tool designed as a needle or an endoscopic excimer laser probe or a Schlemm canal stent or trabecular meshwork shunt injector for a specific tool position, for example in relation to collector vessel positions or collector vessel alignments or in relation to the trabecular meshwork position.

[0055] Within the scope of the invention, the display of the evaluation information is also possible based on an evaluation of the expected IOP reduction due to the application strength of a hypothetical application of a surgical tool designed as a needle or an endoscopic excimer laser probe, ie the expected size of holes created in the trabecular meshwork by ablation.

[0056] Finally, within the scope of the invention, it is possible to generate the evaluation information based on a current, possibly unfavorable position of the surgical tool and its orientation by warning of a membrane rupture during a hypothetical capsularrhexis execution based on a current, possibly unfavorable position of the surgical tool and its orientation and generating a warning signal.

[0057] In addition, it is possible to generate the evaluation information based on a current, possibly unfavorable position and orientation of a surgical tool designed as a pair of tweezers, in order to warn, for example, of a retinal tear with bleeding during a hypothetical membrane peeling movement based on a current, possibly unfavorable position and orientation of a surgical tool designed as a pair of tweezers.

[0058] One aspect of the invention is, for generating the guidance information, to further analyze post-operatively acquired data with image information of a patient's eye with pre-operatively and / or intra-operatively acquired image information of the patient's eye for detecting deviations between a planned result of an operation and an actual result of an operation by registering the image information.

[0059] In this way, for example, the deviation of a planned from an actual incision-induced astigmatism or the deviation of a planned from an actual position of a translimbal implant can be better determined and this information can be used for further pre- or intra-operative outcome predictions.

[0060] One aspect of the invention is also to use pairs of pre- and post-operative image information in a machine learning algorithm in the computer unit of the eye surgery operating system for result projections to generate the evaluation information.

[0061] In particular, it is an idea of ​​the invention that the evaluation information predicts the result of a movement of the surgical tool and evaluates it based on data containing information about structures of the patient's eye. The invention proposes, for the prediction of the result of the movement of the surgical tool, taking into account in particular forces exerted on the patient's eye by the surgical tool or mechanical stresses induced on the patient's eye, e.g. stress in membranes or in the retina during so-called membrane peeling. For this purpose, the eye surgery system can contain a device coupled to the computer unit for detecting a force exerted on the patient's eye by the surgical tool, wherein the routine for the continuous provision of the displacement information takes this force into account for the provision of further displacement information.

[0062] Forces exerted by surgical instruments on ocular structures can be measured, for example, by force sensors. Forces in the axial direction can be measured, for example, using force-dependent compressible elements, such as a spring, in conjunction with displacement measuring systems that detect its compression. Lateral forces or torsional forces can be measured, for example, using bending gauges attached to or integrated into the surgical instrument. It is also possible to design the surgical instrument in such a way that a force-dependent deformation detectable with the imaging systems of the surgical microscope can be detected, for example, the extended length of a spring-mounted surgical instrument part or the lateral deflection of an elastic surgical instrument.

[0063] Forces exerted on eye structures can be approximated, for example, by determining local surface deformations, e.g. by determining strong surface normal changes caused, for example, by indenting the cornea of ​​a patient's eye shortly before a puncture or lifting a retinal membrane using forceps or as a result of vitreotraction.

[0064] Another option for determining forces in tissue is the spatially resolved determination of compressions and tensions, i.e. the force per area, using optical coherence elastography (OCE). This is a sub-type of optical coherence tomography (OCT) in which biomechanical tissue properties can be determined by detecting local sample deformations with depth resolution as a function of artificially induced compressions. In addition to tissue properties such as elasticity, this can be used to determine spatially resolved mechanical compressions and tensions in tissues. The required induced compressions can thus be generated in a variety of ways, for example by external mechanical squeezing, mechanical vibration, ultrasound excitation or by varying the intraocular pressure, as described in Kling et al.“Optical Coherence Elastography-Based Corneal Strain Imaging During Low-Amplitude Intraocular Pressure Modulation”, https: / / doi.org / 10.3389 / fbioe.2019.00453 is described.

[0065] One idea of ​​the invention is, in particular, to warn the surgeon when there is a risk of injury to structures of the patient's eye or when there is a risk that minimum distances between the effective section of the surgical tool or an implant and certain structures of the patient's eye are not maintained, e.g. a distance between the effective section of the surgical tool and the iris of the patient's eye or the distance between an implant in the patient's eye and its iris.

[0066] The invention proposes indicating such a danger to the surgeon during an operation by means of a warning signal, e.g., by means of an acoustic, optical, or haptic warning signal. It is also possible, based on the displacement information provided, to change the configuration and / or setting of the surgical tool, in particular automatically, for example, to deactivate an active cutting function, e.g., by switching off the cutting function of a mechanical cutter or a laser or plasma cutter, or by folding in a lancet tip, or by modifying a laser's focus setting in order to alter the geometric extent of the laser's effective area or the preselected power of a laser or plasma cutter, whereby the effective time window and the model of the effective area can also change.In particular, it is possible, based on the provided evaluation information, to configure a surgical tool designed as a blade or injector with regard to a range for forces to be applied and penetration depths or to provide a mechanical stopper in order to mechanically limit penetration of the surgical tool to certain tissue layers.

[0067] Another idea of ​​the invention is to ensure the penetration of the surgical tool into a specific tissue layer, e.g. penetration into the conjunctiva or sclera or into the suprachoroidal space, for example in order to inject a substance there.

[0068] The invention further proposes limiting the force exerted by the surgical tool depending on the provided evaluation information, e.g., by electromechanically releasing a mechanical lock. However, the force exerted by the surgical tool can also be limited by actively retracting the surgical tool, e.g., by means of an electromechanical, pneumatic, or hydraulic drive acting on a movable lancet tip, in order to avoid unwanted tissue contact.

[0069] The continuously recorded data relating to the object area, the patient's eye, and the surgical tool can, in particular, include location data relating to the surgical tool acquired using a magnetic tracking system. The eye surgery system can include a warning signal generator that serves to generate a warning signal dependent on the determined position of the surgical tool's operative section.

[0070] It is advantageous if the computer program for determining the assessment information or displacement information for the surgical tool takes into account the force exerted on structures of the patient's eye. It is also advantageous if the computer program for determining the assessment information or displacement information takes into account continuously measured intraocular pressure.

[0071] One idea of ​​the invention is, in particular, to record intra-operatively not only image information about the structures of the patient's eye but also the intraocular pressure over time.

[0072] For this purpose, the eye surgery operating system can contain a device coupled to the computer unit for detecting the intraocular pressure of the patient's eye, wherein the routine for continuously providing the evaluation information takes the detected intraocular pressure into account.

[0073] Intraocular pressure can be measured using an intraocular pressure probe or an extraocular tonometer, such as a contact lens tonometer, an airpuff, a rebound tonometer, or a shock wave tonometer. Furthermore, it is possible to determine intraocular pressure, at least relatively, by measuring a parameter influenced by intraocular pressure, such as corneal or scleral tension using OCE or scleral curvature or changes in corneal speckle distribution using an OCT system, as described in Niemczyk's publication "The effect of intraocular pressure elevation and related ocular biometry changes on corneal OCT speckle distribution in porcine eyes," https: / / doi.org / 10.1371 / iournal.pone.0249213M.

[0074] It should be noted that the time intervals for recording the intraocular pressure between the recording of intra-operative image information can vary. For example, it is possible for the recording of intra-operative image information to be triggered when predetermined values ​​for the intraocular pressure are recorded, or equidistantly or non-equidistantly at specific times. One idea of ​​the invention is also to trigger the recording of image information at predetermined intraocular pressure (IOP) or time values. It should also be noted that a change in eye structural positions can be projected for as yet unrecorded intraocular pressure values ​​or time values. For example, on the basis of a mechanical eye model, conclusions can be drawn about the intraocular pressure or its temporal development from a change in eye structural positions.It is possible that the mechanical eye model has parameters that are determined from pre- and intraoperatively determined geometry-pressure combinations, e.g. parameter values ​​from the group of eye size and eye shape at certain different intraocular pressures, in order to then infer the intraocular pressure IOP for a certain geometry of the patient's eye.

[0075] It should also be noted that the occurrence of new geometric situations can be estimated and brought to the attention of the surgeon, e.g. the situation that the patient's eye reaches a dangerously low intraocular pressure after a certain period of time, e.g. after 30 seconds, or the situation that the patient's eye will have sunk too deeply into the eye socket, so that certain structures in the patient's eye are no longer accessible for surgical instruments.

[0076] The eye surgery operating system may include a device for irrigating the patient's eye depending on the acquired data about the patient's eye.

[0077] The eye surgery operating system may include a microrobot having a control unit that receives the provided evaluation information or the provided displacement information from the computing unit for controlling the microrobot.

[0078] The computer program according to the invention for providing evaluation information relating to the guidance of a surgical tool during a surgical operation on a patient's eye contains a surgical site model program routine for providing a model of a surgical site and a surgical tool program routine for providing a model of an impact area of ​​a surgical tool, which describes a spatially extended area of ​​possible impacts of the surgical tool within an impact time window. The computer program includes a routine for determining the spatial position of the model of the surgical site relative to the model of the impact area from continuously acquired referencing measurement data.The computer program contains a prediction routine designed to determine a continuously adjusted model of the predicted outcome of the surgical operation on the patient's eye based on the spatial position of the model of the surgical site relative to the spatial position of the model of the impact area. The computer program has a routine for continuously providing evaluation information regarding the guidance of the surgical tool, which routine takes into account the model of the impact area, the model of the surgical site, the continuously acquired referencing measurement data, and the model of the predicted outcome of the surgical operation on the patient's eye.

[0079] A computer-implemented method according to the invention for providing evaluation information for guiding a surgical tool in a surgical operation on a patient's eye comprises the following steps:

[0080] Providing a model of a surgical site and providing a model of an impact area of ​​a surgical tool that describes a spatially extended area of ​​possible impacts of the surgical tool within an impact time window, determining the spatial position of the model of the surgical site to the model of the impact area from continuously recorded referencing measurement data,

[0081] Determining a continuously adjusted model, valid for a time interval encompassing the effective time window, of the predicted result of the surgical operation on the patient's eye from the spatial position of the model of the surgical site to the spatial position of the model of the effective area,

[0082] Providing evaluation information regarding the guidance of the surgical tool, taking into account the model of the area of ​​impact and the model of the surgical site and the continuously recorded referencing measurement data as well as the model of the predicted outcome of the surgical operation on the patient's eye.

[0083] The invention is particularly suitable for the following operations:

[0084] Anterior vitrectomy, i.e. the removal of the front part of the vitreous to prevent vitreous loss during cataract or corneal surgery or to remove displaced vitreous in conditions such as aphakia or pupillary block glaucoma;

[0085] Pars plana vitrectomy or trans-pars plana vitrectomy, i.e. the removal of vitreous opacities and membranes through an incision in the pars plana;

[0086] Panretinal photocoagulation;

[0087] Repair of a retinal detachment;

[0088] Application of a scleral buckle for the repair of a retinal detachment to indent or buckle the sclera inward, usually by sewing a piece of preserved sclera or a piece of silicone rubber to the surface; laser photocoagulation or photocoagulation therapy to close a retinal tear;

[0089] Pneumatic retinopexy;

[0090] Retinal cryopexy or cryotherapy to create a chorioretinal scar and destroy retinal or choroidal tissue;

[0091] Macular hole repair;

[0092] Partial lamellar sclerovectomy;

[0093] Partial lamellar sclerocyclochoridectomy;

[0094] Partial lamellar sclerochoroidectomy;

[0095] Posterior sclerotomy, i.e. the creation of an opening into the vitreous through the sclera, e.g. for a retinal detachment or the removal of a foreign body;

[0096] Radial optic neurotomy;

[0097] Macular translocation surgery through 360° retinotomy or scleral imbrication technique;

[0098] Refractive surgery and corneal surgery;

[0099] Penetrating keratoplasty;

[0100] keratoprosthesis;

[0101] Phototherapeutic keratectomy;

[0102] Pterygium removal;

[0103] Callus tattoo;

[0104] Osteo-odontokeratoprosthesis;

[0105] Surgeries to change eye color through an iris implant, the so-called brightocular, or by removing the top layer of pigment in the eye, the so-called stromal procedure;

[0106] cataract surgery;

[0107] Glaucoma surgery;

[0108] Eye muscle surgery;

[0109] Oculoplastic surgery;

[0110] Operations on the lacrimal system. The invention is explained in more detail below using exemplary embodiments schematically illustrated in the drawings.

[0111] They show:

[0112] Fig. 1 shows an eye surgery operating system with a device for visualizing an operating area, with a display and with an operating tool for a surgical operation;

[0113] Fig. 2 shows the display of the eye surgery system with a digital model of the surgical site on the patient's eye, a digital model of the area of ​​impact of the surgical tool and a digital model of the predicted outcome of the surgical operation;

[0114] Fig. 3 shows a three-dimensional digital model of the surgical site with a three-dimensional digital model of the area of ​​impact of the surgical tool and a three-dimensional digital model of the predicted result of the operation in the form of a drainage implant arranged in a desired position in the surgical site;

[0115] Fig. 4 shows a possible movement path on which a surgeon moves the tip of a surgical tool designed as a lancet from a starting position to an intervention position in a surgical operation;

[0116] Fig. 5 shows a flowchart with program routines of a computer program loaded into a program memory of a computer unit in the ophthalmic surgery system; Fig. 6 shows an effective time window in a time interval at a time in which a continuously adjusted model regarding the predicted outcome of the surgical operation on the patient's eye is valid;

[0117] Fig. 7 an observation image for a surgeon looking into the binocular tube;

[0118] Fig. 8 shows a possible movement path on which a surgeon moves a surgical tool designed as a laser from a starting position to an intervention position in a surgical operation;

[0119] Fig. 9 shows another eye surgery operating system with a device for visualizing an operating area, with a display and with an operating tool for a surgical operation;

[0120] Fig. 10 the display of the eye surgery operating system;

[0121] Fig. 11 A to Fig. 11 E show a representation of a patient's eye at different stages of an ophthalmological operation;

[0122] Fig. 12 is a flowchart with program routines of a computer program loaded into a program memory of a computer unit in the further eye surgery operating system;

[0123] Fig. 13 shows the display of the further eye surgery system with a digital model of the surgical site, a digital model of the impact area of ​​the surgical tool, and a digital model of the result of the surgical operation; Fig. 14 shows a further eye surgery system with a device for visualizing a surgical area, with a display, and with a surgical tool for a surgical operation;

[0124] Fig. 15 is a curve describing the change in intraocular pressure IOP in an ophthalmological operation over time t;

[0125] Fig. 16A and Fig. 16B show a representation of a patient's eye at different stages of an ophthalmic operation;

[0126] Fig. 17 is a flowchart with program routines of a computer program loaded into a program memory of a computer unit in the further eye surgery operating system;

[0127] Fig. 18 shows the display of the further eye surgery operating system with a digital model of the surgical site, a digital model of the area of ​​action of the surgical tool and display information to the surgeon via an evaluation display for the surgical operation;

[0128] Fig. 19 shows another eye surgery operating system with a device for visualizing an operating area, with a display and with an operating tool for a surgical operation;

[0129] Fig. 20 is a flowchart with program routines of a computer program loaded into a program memory of a computer unit in the further eye surgery operating system; and

[0130] Fig. 21 shows a representation of a section of a patient's eye after a trabeculectomy. The eye surgery system 10 shown in Fig. 1 contains a surgical microscope 12 as a device for visualizing the object area 14, which serves for the stereoscopic viewing of an object area 14 on a patient's eye 15 with a surgical site 11. The surgical microscope 12 has imaging optics with a microscope main objective system 16, which is housed in a base body. The eye surgery system 10 includes an illumination device 18, which enables the illumination of the object area 14 with an illumination beam path that passes through the microscope main objective system 16. The surgical microscope 12 has an afocal magnification system 20, through which a first stereoscopic partial observation beam path 22 and a second stereoscopic partial observation beam path 24 are guided.The surgical microscope 12 has a binocular tube 26 connected to an interface of the base body, which has a first eyepiece and a second eyepiece for a surgeon's left and right eyes. The microscope main objective system 16 in the surgical microscope 12 is penetrated by the first stereoscopic partial observation beam path 22 and the second stereoscopic partial observation beam path 24.

[0131] The eye surgery operating system 10 includes a control unit 28 for device settings and a surgical tool 30 designed as a lancet, which has an operating section 32 designed as a scalpel. It should be noted that the surgical tool 30 can also be designed as a scalpel, a plasma cutter, or even a laser.

[0132] The eye surgery operating system 10 includes a computer unit 36 ​​connected to a device 38 for providing stereoscopic images with first spatial image data of the object area 14, to an OCT device 40, and to a Scheimpflug camera 42. The device 38 for providing stereoscopic images with first spatial image data of the object area 14 has a first image capture device 44 with an objective lens system 46 and an image sensor 48 and serves to capture data with image information from the first stereoscopic partial observation beam path 22 in the surgical microscope 12. The device 38 includes a second image capture device 50, by means of which corresponding image information from the second stereoscopic partial observation beam path 24 in the surgical microscope 12 can be captured.The second image capture device 50 also has an objective lens system 46 and an image sensor 48 for this purpose. The device 38 includes an image calculation stage 52 that converts data containing image information from the first image capture device 44 and the second image capture device 50 into spatial image data.

[0133] The OCT device 40 is designed for scanning an object region volume 54 with an A-, B-, and C-scan on the patient's eye 15. To scan the object region volume 54, the OCT device 40 generates an OCT scanning beam 56 with short-coherent light, which can be moved over the object region volume 54. The OCT scanning beam 56 is used to acquire data with spatial image information in the form of image data for slice images of the object region volume 54, as described, for example, in A. Ehnes, "Development of a slice segmentation algorithm for the automatic analysis of individual retinal layers in optical coherence tomography - B scans," dissertation, University of Giessen (2013), Chapter 3, pages 45 to 82.

[0134] The OCT device 40 has adjustable scanning mirrors 58, 60 for moving the OCT scanning beam 56. In the ophthalmic surgical system 10, the OCT scanning beam 56 is guided via beam splitters 62 and 64 and the microscope main objective system 16 into the object region volume 54 on the patient's eye 15. The light of the OCT scanning beam 56 scattered in the object region volume 54 returns, at least partially, to the OCT device 40 via the same light path. In the OCT device 40, the path of the scanning light is then compared with a reference distance. This allows the precise position of scattering centers in the object region volume 54, in particular the position of optically effective surfaces, to be detected with an accuracy corresponding to the coherence length Ic of the short-coherence light in the OCT scanning beam 56. In the eye surgery operating system 10, there is a control device 66 for controlling the OCT scanning beam 56 provided by the OCT device 40.The control device 66 enables the adjustment of the spatial position and orientation of the object area volume 54 scanned with the OCT scanning beam 56 in the object area 14.

[0135] It should be noted that the OCT device can also be designed as a so-called SS-OCT device, which is used to scan the object area with quasi-short-coherent light.

[0136] The Scheimpflug camera 42 enables the acquisition of image data in a displaceable Scheimpflug camera plane 68. The Scheimpflug camera 42 is movable by means of a motor drive about the optical axis 25 of the microscope's main objective system 16 in the direction of the arrows 70. By moving the Scheimpflug camera 42 about the optical axis 25 of the microscope's main objective system 16, it is possible to acquire spatial image data of the object area 14 with image information that covers a portion of the interior of the patient's eye 15.

[0137] The surgical tool 30 has a first marking 72 and a second marking 74. In the eye surgery operating system, the first and second markings 72, 74 are resolved as geometric structures in image information of the object region 14 acquired by both the first image acquisition device 44 and the second image acquisition device 50 when the effective section 32 of the surgical tool 30 is located in the surgical region 14. The surgical tool 30 enables an action on tissue structures of the patient's eye 15 that are arranged in an action region 76, which is an area of ​​possible actions of the surgical tool 54 within an action time window that has a device-specific temporal extension determined by the handling of the surgical tool 30 by the surgeon, which is assumed here to be independent of time. The action time window can, for example, have a length Iz, for which the following applies: Iz < 0.4 s.However, the length of the effective time window can also be: Iz < 0.3s or Iz < 0.2s or Iz < 0.1s.

[0138] The computer unit 36 ​​in the ophthalmic surgery operating system 10 serves to control the device 38 for providing stereoscopic images, the OCT device 40, and the Scheimpflug camera 42. It is connected to a device 77, 77' for projecting data into the stereoscopic partial observation beam paths 22, 24 of the surgical microscope 12 to enable the display of information and / or, for example, preoperatively acquired image data in this partial observation beam path. The computer unit 36 ​​has a program memory and is connected to a display 78 for displaying a user interface 79.

[0139] Fig. 2 shows the display 78 of the eye surgery operating system 10 with a first representation 84', 86', 88' and a second representation 84", 86", 88" of a three-dimensional digital model 84 of the surgical site shown in Fig. 3, a three-dimensional digital model 86 of the area of ​​impact of the surgical tool 30 in the surgical operation shown in Fig. 3 and a three-dimensional digital model 88 of the predicted result of the operation in the form of a drainage implant arranged in a desired position in the surgical site shown in Fig.4 shows a movement path 90 on which a surgeon moves the tip 92 of the active portion 32 of the surgical tool 30 designed as a lancet during a surgical operation from a starting position 94 into an intervention position 96 as a favorable starting position for the surgical instrument 30 in an acceptance area 98 for performing a surgical procedure in the patient's eye.

[0140] The starting position 94 contains the digital model 86 of the surgical tool's impact area, where a puncture could be performed within a time interval typically ranging from 0.1 s to 0.25 s. In this specific example, the puncture from the starting position 94 would not reach the tissue, and no digital model 88 of an acceptable surgical outcome can be predicted.

[0141] The intervention position 96 is a favorable starting position for the surgical instrument 30, in which, due to the spatial displacement, the displaced digital model 86 of the area of ​​action of the surgical tool there exists, in which, in turn, a puncture could be carried out within a time interval with the typical length of 0.1 s to 0.25 s.

[0142] From the intervention position 96, a surgeon can perform a surgical intervention in the patient's eye 15 using the surgical tool 30 in the form of a stabbing movement corresponding to the arrow 99, in order to thereby produce an incision aligned in a desired position in the surgical site 11, which is indicated on the digital model 88 via the predicted outcome of the operation. If the surgical tool 30 is positioned in the acceptance area 98, the intervention in the patient's body tissue can be performed with a high probability of success within the effective time window with the length or duration Iw.

[0143] The positioning of the surgical tool 30 in the acceptance area 98 can be supported in particular by the use of displacement information which is determined from a digital model 86 of the area of ​​action as well as a digital model of the surgical site and provided, continuously recorded referencing measurement data as well as a model of the predicted result of the surgical operation on the patient's eye.

[0144] For this purpose, the computer unit 36 ​​in the eye surgery operating system 10 has a program memory with a computer program that includes a surgical site model program routine for providing the digital model 84 of the surgical site 11 shown in Fig. 3. In the present case, the digital model 84 of the surgical site is a CAD data model of a section of the patient's eye in which a surgical operation is to be performed.

[0145] The computer program also includes a surgical tool program routine that serves to provide the digital model 86 of the impact area 76 of the surgical tool 30 shown in Fig. 3. Here, the digital model of the impact area 76 of the surgical tool 30 is a CAD data model of the spatially extended area of ​​possible impacts of the surgical tool 30 on tissue structures located in the area within the impact time window in which a surgeon uses the surgical tool 30.

[0146] The computer unit 36 ​​receives first spatial image data of the object area 14 acquired by the device 38 for providing stereoscopic images, second spatial image data of the object area 14 acquired by the OCT device 40, and third spatial image data of the object area 14 acquired by the Scheimpflug camera 42 as referencing measurement data at a sampling rate rt that enables continuous referencing of the spatial position of the provided digital model of the surgical site 84 and the provided digital model of the impact area 86 in the surgical operation in a coordinate system 110 of the ophthalmic surgery operating system 10. Fig. 5 shows a flowchart 101 with program routines of the computer program loaded into the program memory of the computer unit 36 ​​in the ophthalmic surgery operating system 10.

[0147] The digital model 84 of the surgical site 11 provided in the surgical site model program routine 100 is supplied to a surgical site position routine 102 and the digital model 86 of the impact area 76 of the surgical tool 30 provided in the surgical tool program routine 104 is supplied to a surgical tool position routine 106.

[0148] In the surgical site location routine 102, the spatial position of the digital model 84 of the surgical site provided by the surgical site model program routine 100 is determined from the continuously acquired referencing measurement data 108 in the coordinate system 110 of the eye surgery operating system 10.

[0149] Accordingly, in a surgical tool positioning routine 106, the spatial position of the digital model 86 of the action area 76 of the surgical tool 30 is determined from the provided, continuously recorded referencing measurement data in the coordinate system 110 of the eye surgery operating system 10.

[0150] From the spatial position of the digital model 84 of the surgical site determined by the surgical site position routine 102 and from the spatial position of the digital model 86 of the impact area 76 of the surgical tool 30 determined by the surgical tool position routine 106, the relative actual spatial position of the digital model 84 of the surgical site to the digital model 86 of the impact area 76 of the surgical tool 30 is then continuously determined in a referencing routine 112. The surgical site position routine 102 and the surgical tool storage routine 106, together with the referencing routine 112, thus form a routine 111 for determining the spatial position of the model 84 of the surgical site to the model 86 of the impact area 76 from the referencing measurement data 108.In a target state position routine 114, a target state for the spatial position of the digital model 86 of the impact area 76 of the surgical tool 30 in relation to the digital model 84 of the surgical site is determined.

[0151] The target state for the spatial position of the digital model 86 of the impact area 76 of the surgical tool 30 relative to the digital model 84 of the surgical site from the target state position routine 114 and the relative actual spatial position of the digital model 84 of the surgical site to the digital model 86 of the impact area 76 of the surgical tool 30 are then continuously processed in a displacement information routine 116 to provide displacement information for the surgeon who moves the surgical tool 30. The displacement information is information about a reasonable displacement of the surgical tool 30.For this purpose, in the displacement information routine 116, a distance of the target state for the spatial position of the digital model 86 of the action area 76 of the surgical tool 30 in relation to the digital model 84 of the surgical site from the relative spatial actual position of the digital model 84 of the surgical site to the digital model 86 of the action area 76 of the surgical tool 30 is determined in order to determine from this distance a displacement information which contains the direction in which the surgical tool 30 must be moved in order to bring about the target state for the spatial position of the digital model 86 of the action area 76 of the surgical tool 30.

[0152] In a prognosis routine 118, a continuously adjusted model 88 of the predicted outcome of the surgical operation on the patient's eye 15 is determined from the spatial position of the digital model 84 of the surgical site determined in the routine 111 to the spatial position of the digital model 86 of the area of ​​action 76 of the surgical tool 30.

[0153] The surgical tool 30 enables an action on tissue structures of the patient's eye 15, which are arranged in an action area 76, wherein the action area is a spatially extended area of ​​possible actions of the surgical tool 30 within an action time window 124, which can be seen in Fig. 6.

[0154] Fig. 6 shows the effective time window 124 and the time interval 126 comprising it at a time 128 at which the continuously adjusted model 88 regarding the predicted outcome of the surgical operation on the patient's eye 15 is valid, wherein the effective time window 124 and the time interval 126 move with an increment corresponding to the sampling rate rt on the time axis 130 in which the referencing measurement data are provided to the computer unit 36.

[0155] The model 88 determined in the prediction routine 118 regarding the predicted outcome of the surgical operation on the patient's eye 15 is valid in a time interval 126 in which the effective time window 124 lies. By continuously adapting the model 88 regarding the predicted outcome of the surgical operation on the patient's eye 15, the effective time window 124 and the time interval 126 move on the time axis 130 with an increment corresponding to the sampling rate rt.

[0156] From the spatial position of the digital model 84 of the surgical site determined by the surgical site position routine 102 and from the spatial position of the digital model 86 of the action area 76 of the surgical tool 30 determined by the surgical tool position routine 106, evaluation information regarding the guidance of the surgical tool 30 during the surgical operation is determined in a routine 122 for the continuous provision of evaluation information regarding the guidance of the surgical tool 30. In the routine 122, this evaluation information is determined by comparing it with the criterion that the surgical tool 30 is positioned relative to the digital model 84 of the surgical site in the acceptance area 98, from which the intervention in the patient's body tissue can be performed with a satisfactory probability of success within the effective time window with the duration Iw.In the routine 122, an evaluation metric is used for this purpose, which determines an evaluation information which contains the evaluation information that the surgical procedure can now be carried out using the surgical instrument 30 with a high chance of success.

[0157] The displacement information of the displacement information routine 116 is supplied to a first display routine 120, which causes the displacement information to be displayed on the display 78 in the ophthalmic surgery operating system 10.

[0158] The evaluation information from the prognosis routine is provided to a second display routine 123 in order to display the evaluation information to the surgeon on the display 78 in the eye surgery operating system 10.

[0159] The displacement information is a direction indicator on the display 78, which shows the surgeon the direction in which the surgical tool 30 must be moved in order to achieve the greatest possible surgical success.

[0160] The evaluation information is an evaluation of the expected surgical result on the display 78.

[0161] The routine 118 continuously references the spatial position of the provided digital model 84 of the surgical site 11 based on the referencing measurement data 108 supplied at referencing times 132 to the spatial position of the provided digital model 86 of the area of ​​impact 76 in the surgical operation at a rate corresponding to the sampling rate rt in the coordinate system 110 of the eye surgery operating system 10.

[0162] In the prediction routine, model 88 is determined based on the predicted outcome of the surgical operation on the patient's eye 15. Model 88 is thus continuously adjusted based on the supplied reference data at a rate corresponding to the sampling rate, allowing model 88 to change over time.

[0163] The time interval 126 in which the model 88 regarding the predicted outcome of the surgical operation on the patient's eye 15 is valid is understood here to be a time interval in which the relative deviations of characteristic quantities of the model 88 with respect to the model at the beginning of the time interval are less than 10%.

[0164] The time interval is thus longer than the latency time L of the provision of the model 88, which is understood to be the time period required by the routine 118 to specify the model 88 about the predicted result of the surgical operation on the patient's eye 15 from a supplied data set of acquired referencing data to the digital model 84 of the surgical site 11 and to the digital model 86 of the area of ​​impact 76 in the surgical operation.

[0165] The extent of the time interval 126, in which the model 88 regarding the predicted outcome of the surgical operation on the patient's eye 15 is valid according to the above definition, can vary over time t. In contrast, the extent of the effective time window 126, as a specific size of the surgical tool 30, is fundamentally invariant.

[0166] The evaluation information is displayed to a surgeon as information about the continuously adjusted model 88 about the predicted result of the surgical operation on the patient's eye 15 in the eye surgery operating system 10 in the form of a model 88 about the predicted result of the surgical operation on the patient's eye on the display 78.

[0167] Fig. 7 shows an observation image for a surgeon when looking into the binocular tube 26 of the eye surgery operating system 10. By means of the devices 77, 77' for mirroring data into the stereoscopic partial observation beam paths 22, 24 of the surgical microscope 12, the surgeon is shown in the left and right stereoscopic observation channels 22', 24' a representation 88' of the model 88, which is dependent on the position and orientation, of the predicted surgical result together with the displacement information 89 for the surgeon, which indicates to the surgeon the position into which the surgical tool 30 must be displaced relative to the model 91 for an optimal surgical result.

[0168] Fig. 8 shows a movement path 90 for a surgical tool 30 designed as a laser, which is moved in a surgical operation from a starting position 94 with the digital model 86 into an intervention position 96 as a favorable starting position for the surgical instrument 30 in an acceptance area 98.

[0169] Due to the spatial displacement, a displaced model 86 of the surgical tool's effective area exists in the intervention position 96. From the intervention position 96, a surgeon performs a surgical procedure in the patient's eye 15 using the surgical tool 30 by emitting a laser light pulse 103 within a characteristic effective time window with a duration of Iw, in order to thereby produce a digital model 88 of the predicted outcome of the operation in the form of a drainage implant arranged in a desired position in the surgical site 11. If the surgical tool 30 is arranged in the acceptance area 98, the intervention in the patient's body tissue can be performed with a high probability of success within the effective time window with a duration of Iw.

[0170] Fig. 9 shows a further ophthalmic surgery operating system 10'. To the extent that components and elements of the further ophthalmic surgery microscopy system correspond to components and elements of the ophthalmic surgery microscopy system 10 described above with reference to Figs. 1 to 8, these are identified by the same numbers as reference symbols.

[0171] The eye surgery operating system 10' contains a lancet as a surgical tool 30 for making an incision in a connection area of ​​the sclera and the cornea of ​​the patient's eye 15, in which an implant can be arranged through which fluid can be drained from the anterior chamber of the patient's eye in order to thereby reduce the intraocular pressure.

[0172] The computer unit 36 ​​is connected to a device 38 for providing stereoscopic images with first spatial image data of the object area 14 and to an OCT device 40, which provides the computer unit with referencing measurement data.

[0173] Here, too, the computer unit 36 ​​receives the referencing data at a sampling rate rt, which enables continuous referencing of the spatial position of the provided digital model of the surgical site and the provided digital model of the area of ​​impact in the surgical operation in a coordinate system 110 of the eye surgery operating system.

[0174] Fig. 10 shows the display 78 of the ophthalmic surgery system 10' with a first view 80 and a second view 82 of a digital model 84 of the surgical site displayed thereon, as well as a digital model 86 of the impact area of ​​the surgical tool 30 during the surgical operation and a digital model 88 of the predicted outcome of the operation. The digital model 88 of the predicted outcome of the operation contains the position of the implant relative to the incision in the patient's eye 15, which corresponds to the digital model 86 of the impact area of ​​the surgical tool 30 based on its current position.

[0175] For this purpose, the image information from the device 38 for providing stereoscopic images and the image information from the OCT device 40 are calculated in the computer unit 36 ​​with image information from preoperatively determined image data, which includes a predetermined position of the implant.

[0176] The computer unit 36 ​​calculates the stereoscopic images from the device 38 with the image information from the OCT device 40 using a registration method which evaluates geometric structures of the patient's eye 15 in the form of a section of the sclera and in the form of a section of the cornea for the registration.

[0177] It should be noted that this registration can basically be carried out by recording and evaluating the structures of a partial area of ​​the patient's eye 15 from the group of vessels, sclera, section of the cornea, limbus, conjunctival vessels as geometric structures.

[0178] Fig. 11 A to Fig. 11 D explain the procedure of an ophthalmological operation in which an incision for positioning the implant is made in the patient's eye 15 by means of the surgical tool 30.

[0179] Fig. 11A shows a plan view of a section of a patient's eye 15 with an intervention path 97 for making an incision in a connection area of ​​the sclera 136 to the cornea 138. The incision enables the implant to be positioned in the patient's eye 15, through which fluid can be drained from the anterior chamber of the patient's eye 15 in order to reduce the intraocular pressure. Fig. 11B is a partial section of the patient's eye 15 with the intervention path 97. The position intended for the implant during ophthalmological surgery is indicated here by a dashed structure 125. To enable this position, it is necessary for a surgeon to align the active section 32 of the surgical tool 30 with the intervention path 97 when making the incision.

[0180] Fig. 11C shows a partial section of the patient's eye 15 with the surgical tool 30. Fig. 11D shows the partial section of the patient's eye 15 with an incision 140 made therein and the implant 134. The geometry and position of the incision 140 in the patient's eye 15 define the position of the implant 134 therein. After making the incision 140, the surgeon inserts the implant 134 into the patient's eye 15 using a manipulation tool. Fig. 11E is a partial section of the patient's eye 15 with the implant 134 arranged therein.

[0181] An operating mode can be set for the eye surgery operating system 10' which serves to facilitate a surgeon who guides the surgical instrument 30 to make an ideal incision in the patient's eye 15.

[0182] For this purpose, the computer unit 36 ​​contains a computer program in its program memory which, when this operating mode is set, enables the determination of an actual position of the surgical tool 30 in the object area 14 with the surgical site 11 on the patient's eye 15 and a target location of the effective portion 56 of the surgical tool 54 in the coordinate system 110 referencing the patient's eye 15 from acquired and predefined surgical system data in order to display this on the display 78. Fig. 12 shows a flowchart 101 with program routines of a computer program that is loaded into a program memory of a computer unit in the eye surgery surgical system 10'.

[0183] The digital model 84 of the surgical site 11 provided in the surgical site model program routine 100 and the digital model 86 of the impact area 76 of the surgical tool 30 provided in the surgical tool program routine 104 are fed directly to a routine 111 which determines a spatial position of the model 84 of the surgical site relative to the model of the impact area 86 from referencing measurement data 108 relative to the patient's eye 15 and to the surgical tool 30.

[0184] The spatial position of the model 84 of the surgical site relative to the model of the action area 86, determined in the routine 111, is assigned to a prediction routine 118. The prediction routine 118 calculates a continuously adjusted model 88 from the spatial position of the model 84 of the surgical site relative to the spatial position of the model of the action area 86, which model is valid in a time interval that includes an action time window in which the surgical tool 30 acts on tissue structures in the patient's eye 15.

[0185] In the routine 122, the continuously adjusted model 88 is evaluated via the predicted result of the surgical operation on the patient's eye 15 and, based on the evaluation, is provided as information about the continuously adjusted model 88 in the form of evaluation information 142 for the positioning of the surgical tool 30 by a surgeon, which is position evaluation information.

[0186] Figure 13 shows the display 78 with a first and second image 144, 146 of the object area 14 in this operating mode. For the images 144, 146 of the object area 14, the digital model 88 of the predicted outcome of the operation in the form of the position of the implant 134 relative to the incision in the patient's eye 15 is displayed, which corresponds to the position of the digital model 86 of the surgical tool's impact area relative to the digital model of the patient's eye 15.

[0187] On the display 78 of the eye surgery operating system 10', the evaluation information is provided as information to the model 88 about the predicted result of the surgical operation on the patient's eye 15 in the form of a surgical tool positioning signal.

[0188] The surgical tool positioning signal here is a graphic marker 135 that indicates an undesirable surgical result or a negative assessment of a probable surgical result. This graphic marker can, for example, indicate in color the degree of an undesirable approach, e.g., yellow, or a conflicting space-occupying lesion, e.g., red, between the implant and tissue, e.g., the tissue of the cornea or the tissue of the iris, and the implant to be implanted in the incision potentially created by the surgical tool 30 in its operative section 76. The surgeon guides the surgical tool 30 by varying the surgical tool position to intuitively reduce the negative assessment until an acceptable level is indicated, e.g., until it is indicated that no predicted undesirable approach is present anymore.

[0189] The computer unit 36 ​​in the eye surgery system 10' shown in Fig. 9 contains a signal generator that converts the surgical tool positioning signal into an acoustic signal for a loudspeaker 148. In this way, a surgeon can be informed of the placement of the surgical tool 30 from a desired position during a surgical operation.

[0190] It should be noted that, alternatively or in addition to the signal generator that converts the surgical tool positioning signal into an acoustic signal for a loudspeaker 148, the ophthalmic surgery system 10' may also include a signal generator that converts the surgical tool positioning signal into a vibration signal. The vibration signal may, for example, trigger the vibration of a handle of the surgical tool 30. In this way, it is possible to haptically indicate to a surgeon that the surgical tool 30 has been moved from a desired position during a surgical operation.

[0191] Fig. 14 shows a further eye surgery operating system 10". To the extent that components and elements of the further eye surgery microscopy system correspond to the components and elements of the eye surgery microscopy systems 10, 10' described above with reference to Figs. 1 to 13, these are identified by the same numbers as reference symbols.

[0192] The eye surgery operating system 10" contains a device 150 connected to the computer unit 36 ​​for continuously recording the intraocular pressure of the patient's eye 15. The eye surgery operating system 10" includes a device 152 for irrigating the patient's eye 15. The eye surgery operating system 10" has a surgical tool 30 designed as a surgical needle for a surgical intervention in the chamber angle and has a mirror gonioscope 154 applied to the patient's eye 15.

[0193] Figure 15 shows a curve 156 depicting the change in intraocular pressure (IOP) over time t during an ophthalmic operation. Typically, during ophthalmic operations, intraocular pressure decreases as a function of time t between irrigations or injections due to aqueous humor outflow. It should be noted that the curve is an idealized representation, as intraocular pressure can be modulated depending on the heartbeat (typical amplitude 2-4 mm Hg). However, this can be taken into account by recording the heartbeat via electrodes in surgical situations and using it to trigger tonometric measurements with fixed references to the heartbeat. Figure 16A shows the patient's eye 15 with an intraocular pressure (IOP) above the threshold value S indicated in Figure 14. Intervention in the chamber angle is possible here. In Fig. 16B, the patient's eye 15 can be seen with an intraocular pressure IOP below the threshold value S.Here, the chamber angle of the patient's eye 15 is no longer accessible for the surgical tool 30 designed as a surgical needle because the patient's eye 15 has sunk into the eye socket here.

[0194] Fig. 17 is a flowchart 101 with program routines of a computer program that is loaded into a program memory of a computer unit in the eye surgery operating system 10".

[0195] The digital model 84 of the surgical site 11 provided in the surgical site model program routine 100 and the digital model 86 of the impact area 76 of the surgical tool 30 provided in the surgical tool program routine 104 are again fed to a routine 111. Routine 111 continuously receives referencing measurement data 108 for the patient's eye 15 and the surgical tool 30, as well as the intraocular pressure IOP in the form of intraocular pressure measurement data 158 from the device 150 for continuously recording the intraocular pressure of the patient's eye 15.

[0196] From the supplied referencing measurement data 108, the spatial position of the provided digital model 84 of the surgical site 11 is referenced in the routine 111 to the spatial position of the provided digital model 86 of the impact area 76 in the surgical operation in a coordinate system 110 of the eye surgery operating system 10 in order to determine therefrom, in a prognosis routine 118, the continuously adjusted model 88 about the prognosticated result of the surgical operation on the patient's eye 15, which is valid for a time interval encompassing the impact time window 124.The computer program has a routine 122 which evaluates the continuously adjusted model 88 on the predicted result of the surgical operation on the patient's eye 15 from the prediction routine 118 taking into account the detected intraocular pressure IOP and, based on the evaluation, provides as information about the continuously adjusted model 88 a display 162 of evaluation information which indicates to the surgeon whether the surgical procedure on the patient's eye 15 can be performed or not.

[0197] Fig. 18 shows the display 78 of the further eye surgery operating system 10" with a digital model of the surgical site 11, a digital model of the impact area of ​​the surgical tool 30, and the display information 162 about the performance of the surgical operation for the surgeon. To counteract a drop in the intraocular pressure (IOP) of the patient's eye 15, a surgeon in the eye surgery microscopy system 10" has the option of supplying an irrigation fluid to the patient's eye 15 by means of the device 152 for irrigating the patient's eye 15.

[0198] It should be noted that in a modified embodiment of the eye surgery operating system 10", it can be provided that, in a program routine of the computer program for the computer unit, conclusions about the intraocular pressure or its temporal development can be drawn from a change in the positions of the eye structure on the basis of a mechanical eye model. In this case, it is possible for the mechanical eye model to have parameters which are determined from geometry-pressure combinations determined pre- and intraoperatively, e.g. parameter values ​​from the group of eye size and eye shape at certain different intraocular pressures, in order to draw conclusions about the intraocular pressure IOP for a certain geometry of the patient's eye 15. Fig. 19 shows a further eye surgery operating system 10'". Insofar as assemblies and elements of the further eye surgery microscopy system correspond to the assemblies and elements of the system shown in Figs. 1 to 3.17 correspond to the eye surgery microscopy systems 10, 10' and 10" described above, they are identified by the same numbers as reference symbols.

[0199] In the eye surgery operating system 10'", there is a microrobot 164 for moving the surgical tool 30. The microrobot 164 has a control unit 166 connected to the computer unit 36. By means of the computer unit 36, a movement path can be specified for the active section 32 of the surgical tool 30 in a coordinate system 110 referenced to the patient's eye 15, on which the microrobot 164 moves the active section 32 of the surgical tool 30 from an initial position to a start position for a target position in order to automatically perform the surgical operation, a trabeculectomy, using the surgical tool 30 within the active time window when an enable signal FS is present.

[0200] Fig. 20 shows a flow chart 101 with program routines of a computer program that is loaded into a program memory of the computer unit 36 ​​in the eye surgery operating system 10'".

[0201] The digital model 84 of the surgical site 11 provided in the surgical site model program routine 100 and the digital model 86 of the impact area 76 of the surgical tool 30 provided in the surgical tool program routine 104 are in turn fed to a routine 111 which determines a spatial position of the model 84 of the surgical site relative to the model of the impact area 86 from referencing measurement data 108 relating to the patient's eye 15 and to the surgical tool 30.The calculated spatial position of the model 84 of the surgical site relative to the model of the impact area 86 is assigned to a prognosis routine 118 in which a continuously adjusted model 88 is determined from the spatial position of the provided digital model 84 of the surgical site 11 relative to the spatial position of the provided digital model 86 of the impact area 76 regarding the predicted result of the surgical operation on the patient's eye 15, which model is valid for a time interval encompassing the impact time window.

[0202] The routine 122 of the computer program evaluates the predicted result of the surgical operation and, if evaluation information is present that corresponds to a positive evaluation of the predicted result of the surgical operation based on an evaluation criterion, provides the release signal FS to the control unit 166 as a guide signal that controls the microrobot 164 such that it automatically performs the trabeculectomy on the patient's eye 15 as a surgical procedure specified for it.

[0203] Fig. 21 is a representation of a section of a patient's eye 15 after a trabeculectomy with a relief channel 170 automatically prepared by means of the eye surgery operating system 10'", in which ocular fluid can flow from the interior of the patient's eye 15 in the direction of the arrows 172 into a relief volume 174 ("bleb").

[0204] In summary, the following preferred features are particularly noteworthy: An eye surgery operating system 10 for performing a surgical operation in an operation site 11 on a patient's eye 15 contains a surgical tool 30 that enables an action on tissue structures of the patient's eye 15 that are arranged in an action area 76, which is a spatially extended area of ​​possible actions of the surgical tool 30 within an action time window 124. The eye surgery operating system 10, 10', 10", 10'" has a computer unit 36 ​​that contains a program memory with a computer program that has a surgical site model program routine 84 for providing a model of the surgical site 11. The computer unit 36 ​​is designed to continuously acquire referencing measurement data 108 for the patient's eye 15 and the surgical tool 30.The computer program has a prediction routine 118 designed to determine, from the spatial position of the model 84 of the surgical site 84 to the spatial position of the model of the impact area 86, a continuously adjusted model, valid for a time interval 126 encompassing the impact time window 124, regarding the predicted outcome of the surgical operation on the patient's eye 88. The computer program contains a routine 122 relating to the continuous provision of evaluation information for guiding the surgical tool 30 during the surgical operation, which routine takes into account the model of the impact area 86 and the model of the surgical site 84, the provided, continuously acquired referencing measurement data 108, and the model of the predicted outcome of the surgical operation on the patient's eye 88.

[0205] List of reference symbols

[0206] 10, 10', 10", 10'" Eye Surgery Surgical System

[0207] 11 Surgical site

[0208] 12 surgical microscope

[0209] 14 Object area

[0210] 15 patient eye

[0211] 16 Microscope main objective system

[0212] 18 Lighting equipment

[0213] 20 magnification system

[0214] 22 first stereoscopic partial observation beam path

[0215] 22' left stereoscopic observation channel

[0216] 24 second stereoscopic partial observation beam path

[0217] 24' right stereoscopic observation channel

[0218] 25 optical axis

[0219] 26 Binocular tube

[0220] 28 Control unit

[0221] 30 surgical tools

[0222] 32 active section

[0223] 36 computer unit

[0224] 38 Device for providing stereoscopic images

[0225] 40 OCT device

[0226] 42 Scheimpflug camera

[0227] 44 first image capture device

[0228] 46 objective lens system

[0229] 48 image sensor

[0230] 50 second image capture device

[0231] 52 image processing stage

[0232] 54 object area volume

[0233] 56 OCT scanning beam

[0234] 58, 60 Scanning mirror

[0235] 62, 64 Beam splitter 66 Control device

[0236] 68 Scheimpflug camera plane

[0237] 70 Arrow

[0238] 72, 74 marking

[0239] 76 Area of ​​influence

[0240] 77, 77' Device for mirroring data

[0241] 78 Display

[0242] 79 User interface

[0243] 80, 82 View

[0244] 84 Model of the surgical site

[0245] 84' Representation model of the surgical site

[0246] 86 Model of the impact area

[0247] 86', 86" Representation model of the impact area

[0248] 88 Model of predicted surgical outcome

[0249] 88', 88" Representation model predicted surgical outcome

[0250] 89 Relocation information

[0251] 90 Movement path

[0252] 91 Model for optimal surgical outcome

[0253] 92 lace

[0254] 94 Initial situation

[0255] 96 Intervention position

[0256] 97 Intervention path

[0257] 98 Acceptance area

[0258] 99 Arrow

[0259] 100 Operation Site Model Program Routine

[0260] 101 Flowchart

[0261] 102 Surgical site positioning routine

[0262] 104 Operation tool program routine

[0263] 106 Surgical tool position routine

[0264] 108 referencing measurement data

[0265] 110 Coordinate system

[0266] 111 Routine relative position models 112 Referencing routine

[0267] 114 Target state position routine

[0268] 116 Relocation information routine

[0269] 118 Forecast routine

[0270] 122 Routine Assessment Information

[0271] 120, 123 display routine

[0272] 124 effective time windows

[0273] 125 Structure

[0274] 126 time interval

[0275] 128 Time

[0276] 130 Timeline

[0277] 132 Referencing time

[0278] 134 Implant

[0279] 135 Marking

[0280] 136 Dermis

[0281] 138 Cornea

[0282] 140 cut

[0283] 142 Situation assessment information

[0284] 144, 146 Image

[0285] 148 speakers

[0286] 150 Device for measuring intraocular pressure

[0287] 152 Irrigation facility

[0288] 154 Mirror gonioscope

[0289] 156 Curve

[0290] 158 intraocular pressure measurement data

[0291] 162 ad

[0292] 164 microrobots

[0293] 166 Control unit

[0294] 170 relief channel

[0295] 172 arrows

[0296] 174 relief volume

[0297] Iz Length of time interval, the effective time window includes Iw Length of effective time window

Claims

Patent claims 1. An eye surgery system (10, 10', 10", 10"') for performing a surgical operation in an operation site (11) on a patient's eye (15), comprising a surgical tool (30) that enables an action on tissue structures of the patient's eye (15) that are arranged in an action area (76), wherein the action area is a spatially extended area of ​​possible actions of the surgical tool (30) within an action time window (124), comprising a computer unit (36) that contains a program memory with a computer program that has an operation site model program routine (100) for providing a model (84) of the operation site (11), and that is designed for the continuous acquisition of reference measurement data (108) relating to the patient's eye (15) and to the surgical tool (30), characterized in thatthat the computer program has a surgical tool program routine (104) for providing a model of the action area (86) and a routine (111) for determining the spatial position of the model (84) of the operation site to the model of the action area (86) from the continuously acquired referencing measurement data (108), wherein the computer program has a prognosis routine (118) which is designed to generate a continuously adapted model (88) which is valid for a time interval (126) comprising the action time window (124) from the spatial position of the model (84) of the operation site to the spatial position of the model of the action area (86), to determine the predicted result of the surgical operation on the patient's eye (15), and wherein the computer program contains a routine (122) for the continuous provision of evaluation information relating to the guidance of the surgical tool (30) during the surgical operation, which takes into account the model of the area of ​​action (86) as well as the model of the surgical site (84) and the continuously acquired referencing measurement data (108) as well as the model of the predicted result of the surgical operation on the patient's eye (88). The eye surgery operating system according to claim 1, characterized in that the effective time window (124) has a length Iw for which the following applies: 16 ps < Iw < 0.4 s, preferably 1 ps < Iw < 0.3 s or 1 ms < Iw < 0.2 s or 10 ms < Iw < 0.1 s.Eye surgery operating system according to claim 1 or 2, characterized in that the following applies to the length Iz of the time interval (126) comprising the effective time window (124) and the length Iw of the effective time window (101): Iz > Iw + 0.1 s Eye surgery operating system according to claim 3, characterized in that the following applies to the length Iz of the time interval (126) comprising the effective time window (124):. Iz > L, where L is the latency for providing the model of the predicted outcome of the surgical operation on the patient's eye (15).

5. Eye surgery operating system according to one of claims 1 to 4, characterized in that the operation site model program routine (100) is designed for continuous adaptation of the model of the operation site (11) based on the continuously acquired referencing measurement data (108).

6. Eye surgery operating system according to one of claims 1 to 5, characterized in that the model of the predicted result of the surgical operation on the patient's eye (88) is a model for the position of an implant (134) in the patient's eye (15).

7. Eye surgery operating system according to claim 6, characterized in that the evaluation information relating to the guidance of the surgical tool (30) contains evaluation information about an expected surgical result or is evaluation information about an expected surgical result which is determined from a comparison of the model for the predicted result of the surgical operation with a reference.

8. Eye surgery operating system according to claim 7, characterized by a device for displaying the evaluation information as an acoustic and / or an optical and / or a haptic display signal.

9. Eye surgery operating system according to claim 7 or 8, characterized in that the reference is a model created for the patient's eye (15) for an optimal surgical result.

10. Eye surgery operating system according to claim 9, characterized in that the model created for the patient's eye (15) for an optimal surgical result is based on preoperatively recorded patient data. The eye surgery operating system according to one of claims 1 to 10, characterized in that the model of the surgical site (84) is a point cloud describing the surgical site and / or the surface shape of a cornea of ​​the patient's eye (15) and / or a CAD model and / or a height profile of a section of the patient's eye (15) and / or a distance profile of the patient's eye (15) and / or a depth profile of the patient's eye (15) and / or a three-dimensional surface representation of a section of the patient's eye (15) and / or a two-dimensional surface representation of a section of the patient's eye (15). The eye surgery operating system according to one of claims 1 to 11, characterized in that the model of the action area (86) is a point cloud describing a zone in which the surgical tool (30) can act on body tissue in the patient's eye (15) and / or media arranged in the patient's eye (15).The eye surgery operating system according to one of claims 1 to 12, characterized in that the computer program contains a routine (120) for continuously providing displacement information relating to the guidance of the surgical tool (30) during the surgical operation, which displacement information is determined from the model of the area of ​​action (84) and the model of the surgical site (84), as well as the provided, continuously acquired referencing measurement data. The eye surgery operating system according to claim 13, characterized in that the displacement information relating to the guidance of the surgical tool (30) is information from the group consisting of the spatial position of the surgical tool (30) and the direction for displacing the surgical tool (30) in the coordinate system (110) of the eye surgery operating system or relative to the model of the surgical site (84). Eye surgery operating system according to claim 14, characterized by a device for displaying the displacement information as an acoustic and / or optical and / or haptic display signal. Eye surgery operating system according to one of claims 1 to 15, characterized by a device (150) coupled to the computer unit (36) for detecting the intraocular pressure of the patient's eye (15), wherein the routine (118) for continuously providing the evaluation information takes the detected intraocular pressure into account. Eye surgery operating system according to one of claims 13 to 15, characterized by a device (150) coupled to the computer unit (36) for detecting the intraocular pressure of the patient's eye (15), wherein the routine (120) for continuously providing displacement information takes the detected intraocular pressure into account.An eye surgery operating system according to one of claims 15 to 18, characterized by a microrobot (164) with a control unit (166) that receives the displacement information from the computer unit (36). An eye surgery operating system according to one of claims 15 to 18, characterized by a microrobot (164) with a control unit (166) that receives the displacement information from the computer unit (36). An eye surgery operating system according to one of claims 1 to 19, characterized in that the computer program for... Referencing the spatial position of the model of the impact area (86) to the model of the surgical site (84) in a coordinate system (110) of the ophthalmic surgery operating system includes a referencing routine (112) with a tracking routine that evaluates characteristic surgical tool features from the group of opacity, shadows, edge or surface shape, light signals using image recognition, and / or markings on the surgical tool (30). The ophthalmic surgery operating system according to claim 20, characterized in that the computer program uses a registration routine that takes into account light refraction at interfaces in the patient's eye (15) and / or index gradients in the patient's eye (15).An ophthalmic surgery operating system according to one of claims 1 to 21, characterized by a magnetic tracking system, wherein the referencing measurement data (108) contain location data acquired by means of the magnetic tracking system for the surgical tool (30). An ophthalmic surgery operating system according to one of claims 1 to 22, characterized in that the surgical tool (30) is a surgical tool from the group consisting of a lancet, laser, needle, stabilized needle, drill, puncture injector, endoscope with laser for tissue ablation or tissue coagulation, implant injector, cutting tool for goniotomy, trabecular meshwork trephine, and plasma cutter. A computer program for providing evaluation information relating to the guidance of a surgical tool in a surgical operation on a patient's eye (15), characterized by: a surgical site model program routine (100) for providing a model of a surgical site (84) and a surgical tool program routine (104) for providing a model of an impact area of ​​a surgical tool (86), which describes a spatially extended area of ​​possible impacts of the surgical tool (30) within an impact time window (124), a routine (111) for determining the spatial position of the model (84) of the surgical site in relation to the model of the impact area (86) from continuously acquired referencing measurement data (108), a prognosis routine (118) which is designed to generate a continuously adapted model (88) about the predicted result of the surgical operation from the spatial position of the model (84) of the surgical site in relation to the spatial position of the model (86) of the impact area, which model is valid for a time interval (126) encompassing the impact time window (124). on the patient’s eye (15),and a routine (122) for continuously providing evaluation information regarding the guidance of the surgical tool (30), which takes into account the model of the impact area (86) and the model of the surgical site (84), the continuously acquired referencing measurement data (106), and the model of the predicted outcome of the surgical operation on the patient's eye (88). A computer-implemented method for providing evaluation information for evaluating a surgical tool in a surgical operation on a patient's eye (15), characterized by: Providing a model (84) of an operation site (11) and providing a model (86) of an area of ​​action (76) of the surgical tool (30), which describes a spatially extended area (76) of possible effects of the surgical tool (30) within an effective time window (124), Determining the spatial position of the model (84) of the surgical site relative to the model of the impact area (86) from continuously recorded reference measurement data (108), Determining a continuously adjusted model (88) valid for a time interval (126) encompassing the effective time window (124) about the predicted result of the surgical operation on the patient's eye (15) from the spatial position of the model (84) of the surgical site to the spatial position of the model of the effective area (86), Providing the evaluation information relating to the guidance of the surgical tool (30) taking into account the model of the area of ​​action (86) and the model of the surgical site (84) and the continuously recorded referencing measurement data (106) as well as the model of the predicted result of the surgical operation on the patient's eye (88).

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