Hydraulic Delivery of Surgical Implants

Abstract

A system or apparatus for using a cartridge for ophthalmic surgery. The implant can be mechanically advanced to a sealed position in a first stage, and then, in a second stage, the implant can be advanced into the eye via hydraulic pressure or fluid flow. The actuator can include a chamber configured to receive a hollow plunger and a cartridge. The actuator can be configured to fluidly couple the cartridge to the implant compartment. In a first delivery stage, the actuator can move the plunger to advance the implant to the nozzle. In a second delivery stage, the actuator can move a working fluid from the cartridge through the plunger to advance the implant through the nozzle.

Description

Technical Field

[0001] The present invention as described in the appended claims generally relates to ophthalmic surgery. More particularly, without limitation, the claimed subject matter relates to systems, devices, and methods for inserting an implant into an eye.

Background Art

[0002] The human eye is susceptible to many diseases that can cause anything from mild vision loss to complete vision loss. Contact lenses and glasses can compensate for some conditions, but others may require ophthalmic surgery. In some instances, implants may be advantageous or desirable. For example, intraocular lenses can replace a cloudy natural lens within the eye to improve vision.

Summary of the Invention

Problems to be Solved by the Invention

[0003] Although the advantages of intraocular lenses and other implants are known, improvements to delivery systems, components, and processes continue to be made to improve outcomes and provide benefits to patients.

Means for Solving the Problems

[0004] Novel and useful systems, devices, and methods for ophthalmic surgery are described in the appended claims. Exemplary embodiments are also provided so that those skilled in the art can manufacture and use the claimed subject matter.

[0005] For example, some embodiments may include or consist essentially of a device for delivering an implant, such as an intraocular lens, using hydraulic pressure or fluid flow. The device can be combined with a disposable hydraulic cartridge, such as a vial of working fluid, to provide a fully disposable system for storing, advancing, and delivering the implant.

[0006] In a more specific example, the device may include a rigid plunger for advancing the implant to the sealed position in a first stage, and a bore through the rigid plunger that enables an actuating fluid to advance the implant into the eye via hydraulic pressure in a second stage. For example, a hollow rigid plunger may be used to first advance an intraocular lens having a support portion in a linear configuration to a point where a seal is created around the intraocular lens within the delivery lumen. Thereafter, the lens may be advanced hydraulically for delivery by passing an actuating fluid through the hollow bore of the plunger. The device may further include a plunger stop configured to stop the advancement of the implant interface or the plunger.

[0007] In an even more specific embodiment, the device may have a nozzle, a plunger, a plunger rod, and a chamber configured to receive a cartridge between the plunger and the plunger rod. To maintain a compact configuration, the plunger rod may be placed in a forward position for transportation and storage. For operation, the plunger rod may be placed in a rearward position to enable insertion of the cartridge into the chamber between the plunger and the plunger rod. The plunger rod can be advanced towards the cartridge to couple the cartridge to the plunger. The plunger rod, cartridge, and plunger can be further advanced to advance the implant to the sealed position of the nozzle. Further advancement of the plunger rod can drive an actuating fluid from the cartridge and through a bore in the plunger to eject the implant from the nozzle.

[0008] More generally, a system for using a cartridge for ophthalmic surgery can include a nozzle, an implant compartment coupled to the nozzle, an implant disposed within the implant compartment, and an actuator. The actuator can include a chamber configured to receive a plunger and a cartridge. The actuator can be configured to fluidly couple the cartridge to the implant compartment. In a first delivery stage, the actuator can move the plunger to advance the implant toward the nozzle. In a second delivery stage, the actuator can move an actuating fluid from the cartridge through the plunger to advance the implant through the nozzle. In more specific embodiments, the actuator can further include a plunger rod and a bore through the plunger. The plunger rod can be configured to advance the plunger and move the actuating fluid from the cartridge through the bore to advance the implant through the nozzle. Some embodiments of the plunger can include a coupling configured to fluidly couple the cartridge to the implant compartment. Additionally or alternatively, some embodiments of the system can include a lead nut that can be threaded onto a threaded portion of the plunger rod. The plunger rod can be configured to be rotated through the lead nut to move the actuating fluid and to maintain a relative position between the plunger rod and the cartridge as the implant is advanced from the implant compartment to the nozzle. In even more specific embodiments, the cartridge can include a cartridge seal and the plunger rod can be configured to advance the cartridge seal to move the actuating fluid. For example, the plunger rod can be configured to be rotated through the lead nut to advance the cartridge seal.

[0009] In other examples, a system for using a hydraulic cartridge for ophthalmic surgery can include a nozzle, an implant compartment coupled to the nozzle, an implant disposed within the implant compartment, a housing coupled to the implant compartment, a plunger disposed within the housing, and a plunger rod at least partially disposed within the housing. The system can be fluidly coupled to the implant compartment, which can further include a bore through the plunger. The chamber can be configured to receive the hydraulic cartridge between the plunger and the plunger rod. The plunger rod can be configured to move the hydraulic cartridge and the plunger within the housing in a first delivery stage to advance the implant from the implant compartment to the nozzle. The plunger rod can be operable to drive actuation fluid through the bore from the hydraulic cartridge in a second delivery stage to advance the implant through the nozzle.

[0010] In yet other examples, a system for using a hydraulic cartridge for ophthalmic surgery can include a nozzle, an implant compartment coupled to the nozzle, an implant disposed within the implant compartment, a housing coupled to the implant compartment, a plunger configured to slide within the housing, a bore through the plunger, and a plunger rod having a threaded end disposed within the housing. A lead nut can be threaded onto the threaded end of the plunger rod, and the chamber can be configured to receive the hydraulic cartridge between the plunger and the lead nut. The plunger rod can be configured to be pushed or otherwise slid in a first delivery stage to advance the lead nut, the hydraulic cartridge, and the plunger to advance the implant from the implant compartment to the nozzle. The plunger rod can be configured to be rotated through the lead nut in a second delivery stage to drive actuation fluid through the bore from the hydraulic cartridge to advance the implant through the nozzle.

[0011] The features, elements, and aspects described in connection with some embodiments may be omitted, combined, or replaced by alternative features. Other features, objects, advantages of the claimed subject matter, and suitable manners of manufacturing and using it will be described in more detail below with reference to the accompanying drawings of the exemplary embodiments.

[0012] The accompanying drawings show some objects, advantages, and suitable manners of manufacturing and using some embodiments of the claimed subject matter. Like reference numerals represent like parts throughout the examples.

Brief Description of the Drawings

[0013]

Figure 1

Figures 2A-2B

Figure 3

Figures 4A-4B

Figures 5A-5B

Modes for Carrying Out the Invention

[0014] The following description of the exemplary embodiments provides information that enables those skilled in the art to make and use the subject matter recited in the appended claims, but may omit certain details already known in the art. Accordingly, it should be understood that the following detailed description is merely exemplary and not limiting.

[0015] Exemplary embodiments may be described below with reference to the relationships of various elements in space or the orientations of various elements in the space depicted in the accompanying drawings. In general, such relationships or orientations assume a reference frame that is aligned with or relative to the patient at the location where the implant is received. However, as will be appreciated by those skilled in the art, this reference frame is not a strict specification but merely a convenience for explanation purposes.

[0016] FIG. 1 is a schematic view of a system 100 that can be used to deliver an implant to an eye. For example, as shown in FIG. 1, some embodiments of the system 100 may include a nozzle 105, an implant compartment 110 that can be coupled to the nozzle 105, and an actuator 115 that can be coupled to the implant compartment 110. First, the various components of the system 100 can be assembled as needed. In the example of FIG. 1, the nozzle 105, the implant compartment 110, and the actuator 115 are fixed to each other to form a unitary structure. In other embodiments, the system 100 may include two or more modules that can be configured to be coupled and separated as appropriate for storage, assembly, use, and disposal.

[0017] In general, the components of the system 100 can be coupled directly or indirectly. For example, the nozzle 105 can be directly coupled to the implant compartment 110 and indirectly coupled to the actuator 115 through the implant compartment 110. The coupling can include fluid, mechanical, thermal, electrical, or chemical bonding (such as chemical bonding) or, in some situations, a combination of couplings. For example, the actuator 115 can be mechanically and fluidly coupled to the nozzle 105. In some embodiments, the components can be coupled by physical proximity such that they are integrated into a single structure or formed from the same piece of material.

[0018] The nozzle 105 generally includes a tip adapted for insertion through an incision into the eye. The size of the tip can be adapted to surgical requirements and techniques as needed. For example, a small incision is generally preferred to shorten or minimize the healing time. In some examples, an incision less than 3 millimeters may be preferred, and in some embodiments, the tip of the nozzle 105 can have a width of less than 3 millimeters.

[0019] The implant compartment 110 generally represents a variety of devices suitable for storing the implant prior to delivery into the eye. In FIG. 1, for example, the implant 120 is disposed within the implant compartment 110. In some embodiments, the implant 120 can include an intraocular lens having a shape similar to the natural lens of the eye and can be manufactured from a number of materials. Examples of suitable materials can include silicone, acrylic, and combinations of such suitable materials. In some examples, the implant 120 can include an intraocular lens filled with fluid, such as an accommodative intraocular lens filled with fluid. The implant 120 can also include an intraocular lens that includes one or more features for positioning the intraocular lens within the eye. For example, the implant 120 can include one or more supports that can be oriented by the implant compartment 110 prior to delivery.

[0020] In some embodiments, the implant compartment 110 can be configured, additionally or alternatively, to prepare the implant 120 for delivery. For example, some embodiments of the implant compartment 110 can be configured to be actuated by a surgeon or other operator to prepare the implant 120 for delivery by subsequent operation of the actuator 115. In some examples, the implant compartment 110 can be configured to actively deform, extend, expand, or otherwise manipulate the features of the implant 120 before advancing the implant 120 into the nozzle 105. For example, some embodiments of the implant compartment 110 can be configured to orient, fold, or unfold the implant.

[0021] The actuator 115 of FIG. 1 generally includes a housing 125, a plunger rod 130, a plunger 135, and a bore 140 within the plunger 135. The plunger rod 130 and the plunger 135 are generally composed of a substantially rigid material such as a medical-grade polymer material. The plunger 135 may further include a coupling portion 145. A lead nut 150 may be coupled to the plunger rod 130. A portion of the plunger 135 may extend into the implant compartment 110.

[0022] In some embodiments, the actuator 115 may further include a nozzle seal 160. As shown in the example of FIG. 1, the nozzle seal 160 may be a ring seal such as an O-ring circumferentially disposed around a portion of the plunger 135. In other examples, an umbrella seal may be suitable. In more specific embodiments, the nozzle seal 160 may be disposed distal to the coupling portion 145.

[0023] As shown in the example of FIG. 1, the system 100 may also include a chamber 165. The chamber 165 of FIG. 1 is generally formed between the plunger 135 and an end of the housing 125 and may be accessible through a slot 170 in the housing 125 or other suitable opening in the actuator 115. In some configurations, the plunger rod 130 may be advanced toward the plunger 135 to shorten the length of the system 100, which may be advantageous for transportation and storage of the system 100. Prior to use, the plunger rod 130 may be retracted to open the chamber 165 as shown in the example of FIG. 1.

[0024] Chamber 165 can be configured to receive a cartridge 175 that can contain a working fluid 180. Suitable working fluids can include, but are not limited to, liquids such as saline or viscous lubricants having non-Newtonian properties. Thereafter, the cartridge 175 can be inserted into the chamber 165 to prepare the system 100 for delivering the implant 120. In other examples, the cartridge 175 can be transported and stored within the chamber 165. The cartridge 175 generally includes a cartridge tip 185 and a cartridge seal 190. A cap 195 can initially be placed over the cartridge tip 185. The cartridge seal 190 and the cap 195 can together contain the working fluid 180 within the cartridge 175, which can be suitable for the transport and storage of the cartridge 175. In some embodiments, the cartridge 175 can include or consist essentially of a vial of the working fluid. Suitable working fluids can include, but are not limited to, liquids such as saline or viscous lubricants having non-Newtonian properties.

[0025] Figures 2A and 2B are also schematic diagrams of the system 100, showing further details that can be associated with the use of some embodiments. The actuator 115 is generally configured to enable the plunger 135 to mechanically advance the implant 120 from the implant compartment 110 to the nozzle 105 in a first stage of delivery, as shown in the example of Figure 2A, and to enable the working fluid 180 to be moved from the cartridge 175 through the implant compartment 110 and the nozzle 105 to fluidically or hydraulically advance the implant 120 through the nozzle 105 in a second stage, as shown in the example of Figure 2B.

[0026] For example, when assembled as shown in FIGS. 2A and 2B, the implant compartment 110 can be disposed between the nozzle 105 and the actuator 115. In the example of FIGS. 2A and 2B, a cap 195 (not shown) has been removed from the cartridge tip 185, and the cartridge 175 is inserted into the chamber 165. The actuator 115 can fluidly couple the working fluid 180 within the cartridge 175 to the implant compartment 110 and / or the nozzle 105. For example, the coupling 145 can be configured to receive the cartridge tip 185 and fluidly couple the working fluid 180 within the cartridge 175 to the implant compartment 110 and the nozzle 105 through the bore 140, as shown in FIGS. 2A and 2B. The plunger rod 130 can also be coupled to the cartridge 175. For example, the plunger rod 130 or a portion thereof can be configured to slide within the housing 125 and push on the cartridge 175, which, in a first delivery stage, can then push on the plunger 135 and the implant 120. In a more specific example, the lead nut 150 can engage the cartridge 175 on the opposite side of the cartridge tip 185 when the plunger rod 130 is advanced and advance the cartridge 175 through the chamber 165.

[0027] In the example of FIG. 2A, the cartridge 175 is inserted into the chamber 165, and the plunger rod 130 is pushed to advance the cartridge 175 and the plunger 135. As shown in FIG. 2A, the lead nut 150 can maintain the relative position of the plunger rod 130 and the cartridge 175 when both the plunger rod 130 and the cartridge 175 advance through the housing 125 during the first delivery stage. For example, some embodiments of the plunger rod 130 may have a threaded end disposed within the housing 125, and the lead nut 150 may be threaded onto the threaded end of the plunger rod 130. When the plunger rod 130 is pushed, the lead nut 150 applies a force to the flange 205 of the cartridge 175 to rigidly move the cartridge 175 and the plunger 135 while maintaining the relative position of the plunger rod 130 and the cartridge seal 190, thereby enabling the working fluid 180 to be retained within the cartridge 175.

[0028] In the example of FIG. 2A, the implant 120 is also advancing into the nozzle 105 by the plunger 135. The nozzle seal 160 is also advancing into the nozzle 105 to create a seal in the nozzle 105 behind the implant 120. In some examples, the nozzle seal 160 may also prevent further advancement of the plunger 135 and the cartridge 175. In other examples, the system 100 may have a plunger stop configured to prevent further advancement. Optionally, the implant 120 may also form a seal within the nozzle 105. In the configuration of FIG. 2A, the bore 140 may fluidly couple the working fluid 180 within the cartridge 175 to the nozzle 105.

[0029] As shown in the example of FIG. 2B, the implant 120 is advancing into the nozzle 105, and the plunger rod 130 can be advanced from the position of FIG. 2A in the second stage of delivery to move the actuating fluid 180 from the cartridge 175 through the plunger 135. For example, the plunger rod 130 can be threaded and advanced distally of the plunger rod 130 through the threads of the lead nut 150, while the housing 125 can prevent rotation of the lead nut 150. By advancing the plunger rod 130, the cartridge seal 190 can be advanced, thereby allowing the actuating fluid 180 to be pushed into the nozzle 105 behind the implant 120 through the bore 140. The movement of the actuating fluid 180 from the bore 140 to the nozzle 105 under pressure by the cartridge seal 190 can increase the pressure and flow rate of the actuating fluid 180 in the nozzle 105 behind the implant 120, thereby allowing the implant 120 to be further advanced within the nozzle 105 until the implant 120 is discharged from the nozzle 105.

[0030] FIG. 3 is a schematic diagram of another example of a system 100 that can be used to deliver an implant to an eye. The example of FIG. 3 is similar or analogous to the example of FIG. 1 in several respects. For example, the system 100 of FIG. 3 can include a nozzle 105, an implant compartment 110, and an actuator 115.

[0031] The actuator 115 of FIG. 3 generally includes a housing 125, a plunger rod 130, a plunger 135, and a bore 140 within the plunger 135. The plunger 135 can further include a coupling portion 145. In the example of FIG. 3, the lead nut 150 can be coupled to the threaded portion of the plunger rod 130 and can be coupled to the end of the housing 125. In a more specific example, the threaded portion of the plunger rod can penetrate the wall of the chamber 165, and the lead nut 150 can be coupled to the chamber 165. A portion of the plunger 135 can extend into the implant compartment 110.

[0032] The chamber 165 of FIG. 3 is generally formed between the plunger 135 and the lead nut 150 and may be accessible through the slot 170 or other suitable opening of the actuator 115. In some configurations, the chamber 165 may be advanced toward the plunger 135 to shorten the length of the system 100, which may be advantageous for the transportation and storage of the system 100. In FIG. 3, for example, a portion of the chamber 165 may slide over at least a portion of the plunger 135 between the housing 125 and the plunger 135. Prior to use, the chamber 165 may be retracted to expose the slot 170, as shown in the example of FIG. 3.

[0033] FIGS. 4A and 4B are also schematic views of the system 100 of FIG. 3 and show further details that may be associated with the use of some embodiments. The actuator 115 is generally configured to enable the plunger 135 to mechanically advance the implant 120 from the implant section 110 to the nozzle 105 in a first stage of delivery, as shown in the example of FIG. 4A, and to enable the working fluid 180 to move from the cartridge 175 through the implant section 110 and the nozzle 105 to fluidly or hydraulically advance the implant 120 through the nozzle 105 in a second stage, as shown in the example of FIG. 4B.

[0034] For example, when assembled as shown in FIGS. 4A and 4B, the implant compartment 110 can be disposed between the nozzle 105 and the actuator 115. In the example of FIGS. 4A and 4B, a cap 195 (not shown) has been removed from the cartridge tip 185, and the cartridge 175 is inserted into the chamber 165. The actuator 115 can fluidly couple the working fluid 180 within the cartridge 175 to the implant compartment 110 and / or the nozzle 105. For example, the coupling 145 can be configured to receive the cartridge tip 185 and fluidly couple the working fluid 180 within the cartridge 175 to the implant compartment 110 and the nozzle 105 through the bore 140, as shown in FIGS. 4A and 4B. The plunger rod 135 can be coupled to the cartridge seal 190. The chamber 165 or a portion thereof can be configured to slide within the housing 125 and push the cartridge 175, which can then, in a first delivery stage, push the plunger 135 and the implant 120. In a more specific example, the slot 170 can engage the cartridge 175 on the side opposite the cartridge tip 185.

[0035] In the example of FIG. 4A, the cartridge 175 is inserted into the chamber 165, and the chamber 165 is being pushed to advance the cartridge 175 and the plunger 135. As shown in FIG. 4A, the lead nut 150 can maintain the relative positions of the plunger rod 130 and the cartridge 175 as both the plunger rod 130 and the cartridge 175 advance through the housing 125 during a first delivery stage. For example, some embodiments of the plunger rod 130 can have a threaded end disposed within the lead nut 150, and the lead nut 150 can be coupled to the end of the chamber 165. When the lead nut 150 is pushed, the slot 170 can apply a force to the flange 205 of the cartridge 175 to rigidly move the cartridge 175 and the plunger 135 while maintaining the relative positions of the plunger rod 130 and the cartridge seal 190, thereby allowing the working fluid 180 to be retained within the cartridge 175.

[0036] In the example of FIG. 4A, the implant 120 is also advancing into the nozzle 105 by the plunger 135. The nozzle seal 160 is also advancing into the nozzle 105 and can create a seal in the nozzle 105 behind the implant 120. In some examples, the nozzle seal 160 can also prevent further advancement of the plunger 135 and the cartridge 175. In other examples, the system 100 can have a plunger stop configured to prevent further advancement. Optionally, the implant 120 can also form a seal within the nozzle 105. In the configuration of FIG. 4A, the bore 140 can fluidly couple the working fluid 180 within the cartridge 175 to the nozzle 105.

[0037] As shown in the example of FIG. 4B, the implant 120 is advancing into the nozzle 105, and the plunger rod 130 is advanced from the position of FIG. 4A in the second stage of delivery to move the working fluid 180 from the cartridge 175 through the plunger 135. For example, the lead nut 150 can be threaded to advance the plunger rod 130 through the threads of the lead nut 150, while the chamber 165 can prevent rotation of the plunger rod 130. By advancing the plunger rod 130, the cartridge seal 190 can be advanced, thereby pushing the working fluid 180 into the nozzle 105 behind the implant 120 through the bore 140. The movement of the working fluid 180 from the bore 140 to the nozzle 105 under pressure by the cartridge seal 190 can increase the pressure and flow rate of the working fluid 180 within the nozzle 105 behind the implant 120, thereby allowing the implant 120 to be further advanced within the nozzle 105 until the implant 120 is discharged from the nozzle 105.

[0038] Figures 5A-5B are schematic diagrams further showing an exemplary use of system 100 for delivering implant 120 to eye 500. As shown, for example, an incision 505 can be created within eye 500 by a surgeon. In some examples, incision 505 can be formed through sclera 510 of eye 500. In other examples, the incision can be formed in cornea 515 of eye 500. Incision 505 can be sized to allow insertion of a portion of nozzle 105 for delivering implant 120 into capsular bag 520. For example, in some examples, incision 505 can have a length of less than about 3000 microns (3 millimeters). In other examples, incision 505 can have a length of about 1000 microns to about 1500 microns, about 1500 microns to about 2000 microns, about 2000 microns to about 2500 microns, or about 2500 microns to about 3000 microns.

[0039] After incision 505 is created, nozzle 105 can be inserted through incision 505 such that the tip of nozzle 105 aligns with incision 505, allowing nozzle 105 to extend into inner portion 525 of eye 500. System 100 can then inject implant 120 into capsular bag 520 of eye 500 through nozzle 105 as described above with reference to FIGS. 2A-2B or FIGS. 4A-4B generally.

[0040] In some embodiments, implant 120 can include an intraocular lens. In some examples, implant 120 can include a fluid-filled intraocular lens, such as an accommodative intraocular lens filled with fluid. Implant 120 can also include an intraocular lens that includes one or more features for positioning the intraocular lens within the eye, such as a support portion. In the examples of FIGS. 5A and 5B, implant 120 exemplifies an intraocular lens having an optical body 530, a front support 535, and a rear support 540.

[0041] In some applications, the implant 120 can be delivered in a folded, straightened, or expanded configuration and can return to an initial resting state within the lens capsule 520 as shown in FIG. 5B. The lens capsule 520 can hold the implant 120 within the eye 500 in a relationship to the eye 500 such that the optical body 530 refracts light directed toward the retina (not shown). The front support 535 and the rear support 540 can engage the lens capsule 520 to secure the implant 120 within the lens capsule 520. After supplying the implant 120 into the lens capsule 520, the nozzle 105 can be removed from the eye 500 through the incision 505, and the eye 500 can heal over time.

[0042] The systems, devices, and methods described herein can provide significant advantages. For example, some embodiments can be particularly advantageous for the delivery of intraocular lenses that include fluid-filled focus-adjustable lenses, which can present unique challenges for delivery. Some embodiments can compress a relatively large lens to pass through an acceptably small incision, manage deformations caused by fluid movement during compression and as the lens exits the nozzle, and perform the delivery in a predictable and controlled manner. Additionally, some embodiments can reduce the complexity of the system and the number of delivery steps while maintaining consistency in the support location. Some embodiments can also reduce the amount of operating fluid for delivery. For example, a single vial of an ophthalmic viscosurgical device (OVD), such as a vial of CELLUGEL OVD, PROVISC OVD, or DISCOVISC OVD, can be used to drive some embodiments of the system 100 and provide the operating fluid for delivery. Additionally or alternatively, some embodiments can be particularly advantageous for providing multiple delivery modes with a single device. For example, a first delivery mode can allow an operator to advance the implant to a retention position by pushing a plunger rod. A second delivery mode can allow an operator to thread the plunger rod to advance the implant, whereby the operator can perform more precise position control when the implant is being delivered.

[0043] Although shown in a few exemplary embodiments, those skilled in the art will recognize that the systems, devices, and methods described herein are capable of various modifications and variations that are included within the scope of the appended claims. Further, descriptions of various alternative ways using terms such as "or" do not require mutual exclusivity unless clearly required by the context, and the indefinite articles "a" or "an" do not limit the subject matter to a single instance unless clearly required by the context. Components can be combined or excluded in various configurations for the purpose of sale, manufacture, assembly, or use. For example, in some configurations, the nozzle 105, the implant compartment 110, and the actuator 115 can be separated from each other for manufacture or sale or combined in various ways.

[0044] The claims can also include additional subject matter that is not specifically described in detail. For example, a particular feature, element, or aspect can be excluded from the claims if it is not necessary to distinguish novel and inventive features from those already known to those skilled in the art. Features, elements, and aspects described in connection with some embodiments can be omitted, combined, or replaced with alternative features that serve the same, equivalent, or similar purposes without departing from the scope of the invention as defined by the appended claims.

Claims

1. A system for using a cartridge for ophthalmic surgery, comprising: a nozzle; an implant compartment coupled to the nozzle; an actuator including a plunger and a chamber configured to receive the cartridge; wherein the actuator is configured to move the plunger to advance an implant from the implant compartment to the nozzle, fluidly couple a working fluid within the cartridge to the implant compartment, and move the working fluid from the cartridge through the plunger to advance the implant through the nozzle.

2. The system of claim 1, wherein the plunger includes a coupling configured to fluidly couple the cartridge to the implant compartment.

3. The actuator further includes a plunger rod and a bore through the plunger, and the plunger rod is configured to move the working fluid from the cartridge through the bore to advance the implant through the nozzle. The system of claim 1 or 2.

4. The system of claim 3, further comprising a lead nut threaded onto the plunger rod, the lead nut being configured to advance the plunger rod to move the working fluid.

5. The system of claim 4, wherein the lead nut is configured to maintain a relative position between the plunger rod and the cartridge when the implant is advanced from the implant compartment to the nozzle.

6. The cartridge includes a cartridge seal, and the plunger rod is configured to advance the cartridge seal to move the working fluid. The system of claim 4 or 5.

7. The system of claim 6, wherein the lead nut is configured to advance the cartridge through the chamber, and the plunger rod is configured to be rotated through the lead nut to advance the cartridge seal.

8. The chamber is configured to advance the cartridge and the plunger, the lead nut is coupled to an end of the chamber, and The system according to claim 6, wherein the lead nut is configured to rotate around the plunger rod to advance the cartridge seal. **Claim 9** A system for using a hydraulic cartridge for ophthalmic surgery, comprising: a nozzle; an implant compartment coupled to the nozzle; an implant disposed within the implant compartment; a housing coupled to the implant compartment; a plunger disposed within the housing; a bore through the plunger that is fluidly coupled to the implant compartment; a plunger rod at least partially disposed within the housing; and a chamber configured to receive the hydraulic cartridge between the plunger and the plunger rod. The plunger is configured to advance the implant from the implant compartment to the nozzle in a first delivery stage, and the plunger rod is operable to drive actuating fluid from the hydraulic cartridge through the bore to advance the implant through the nozzle in a second delivery stage. **Claim 10** The system of claim 9, wherein the plunger includes a coupling configured to receive the hydraulic cartridge and fluidly couple the hydraulic cartridge to the bore. **Claim 11** The system of claim 9 or 10, further comprising a lead nut threaded onto the plunger rod, the lead nut configured to advance the plunger rod to drive the actuating fluid through the bore. **Claim 12** The system of claim 11, wherein the lead nut is configured to maintain a relative position of the plunger rod and the hydraulic cartridge when the implant is advanced from the implant compartment to the nozzle. **Claim 13** The hydraulic cartridge includes a cartridge seal, and the plunger rod is configured to be rotated through the lead nut to advance the cartridge seal to drive the actuating fluid, according to the system of claim 11 or 12. **Claim 14** The chamber is configured to advance the cartridge and the plunger, the lead nut is coupled to an end of the chamber, and The system according to claim 11, wherein the lead nut is configured to rotate around the plunger rod to advance the cartridge seal.

15. A system for using a hydraulic cartridge for ophthalmic surgery, comprising: a nozzle; an implant compartment coupled to the nozzle; an implant disposed within the implant compartment; a housing coupled to the implant compartment; a plunger configured to slide within the housing; a bore through the plunger that is fluidly coupled to the implant compartment; a plunger rod having a threaded end disposed within the housing; a lead nut threaded onto the threaded end of the plunger rod; a chamber configured to receive the hydraulic cartridge between the plunger and the lead nut; wherein the plunger rod is configured to be pushed to rigidly move the lead nut, the hydraulic cartridge, and the plunger to advance the implant from the implant compartment to the nozzle, and wherein the plunger rod is configured to be rotated through the lead nut to drive actuating fluid from the hydraulic cartridge through the bore to advance the implant through the nozzle.

16. The system of claim 15, wherein the plunger includes a coupling configured to receive the hydraulic cartridge and fluidly couple the hydraulic cartridge to the bore.

17. The system of claim 15 or 16, wherein the lead nut is configured to maintain a relative position of the plunger rod and the hydraulic cartridge when the implant is advanced from the implant compartment to the nozzle.

18. The hydraulic cartridge includes a cartridge seal, and the plunger rod is configured to advance the cartridge seal to drive the actuating fluid from the hydraulic cartridge through the bore, the system of any one of claims 15-17.

19. A system for ophthalmic surgery, comprising: a nozzle; an implant compartment coupled to the nozzle; an implant disposed within the implant compartment; a housing coupled to the implant compartment; A plunger configured to slide within the housing, A bore through the plunger that is fluidly coupled to the implant compartment, A plunger rod having a threaded end disposed within the housing, A lead nut threaded onto the threaded end of the plunger rod, A chamber between the plunger and the lead nut, A cartridge disposed within the chamber comprising, the cartridge includes a tip fluidly coupled to the bore through the plunger, a cartridge seal, and a working fluid disposed between the tip and the cartridge seal, The plunger rod is configured to be pushed to advance the lead nut, the cartridge, the plunger, and the implant from the implant compartment to the nozzle, and the plunger rod is configured to be rotated through the lead nut to advance the cartridge seal, thereby driving the working fluid through the bore to advance the implant through the nozzle. A system.

20. A system for using a hydraulic cartridge for ophthalmic surgery, A nozzle, An implant compartment coupled to the nozzle, An implant disposed within the implant compartment, A housing coupled to the implant compartment, A plunger disposed within the housing, A bore through the plunger that is fluidly coupled to the implant compartment, A plunger rod at least partially disposed within the housing, A chamber configured to receive the hydraulic cartridge between the plunger and the plunger rod comprising, the chamber is configured to advance the implant from the implant compartment to the nozzle in a first delivery stage, and the plunger rod is operable to drive a working fluid from the hydraulic cartridge through the bore to advance the implant through the nozzle in a second delivery stage. A system.

21. A method of ejecting an implant from an implant delivery system, Providing the implant to an implant compartment of the implant delivery system, Insert a hydraulic cartridge into the chamber of the implant delivery system and couple the hydraulic cartridge to the plunger of the implant delivery system; Advance the hydraulic cartridge and the plunger, thereby advancing the implant from the implant compartment to a nozzle coupled to the implant compartment; Hold the hydraulic cartridge in a position fixed relative to the implant delivery system; Rotate the plunger rod to push a working fluid from the hydraulic cartridge and move the working fluid through a bore in the plunger to the nozzle; Advance the implant through the nozzle with the working fluid A method comprising. **Claim 22** A system, apparatus, and method substantially as described herein.

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