Systems and methods for accessing different tissue targets in the eye

Abstract

An integrated surgical system for accessing one of a plurality of target volumes of ocular tissue includes a first optical delivery subsystem optically coupled to receive a first optical beam, an optical assembly, and a control system. The optical assembly has an optical axis and is configured to be coupled to the eye to align its optical axis with the optical axis of the eye. The optical assembly is coupled to the first optical delivery subsystem to receive the first optical beam along one of a plurality of first input axes and to direct the first optical beam to one of a corresponding plurality of first output axes that is aligned with one of a plurality of target volumes of ocular tissue of the corresponding eye. The control system is configured to control the first optical delivery subsystem to direct the first optical beam in alignment with a selected one of the plurality of first input axes.

Description

[Technical Field]

[0001]

[0001] The present disclosure relates generally to the field of medical devices and treatment of diseases in ophthalmology, and more particularly to systems and methods for accessing various tissue targets within the eye, including the iridocorneal angle, cornea, lens, posterior lens capsule, anterior lens capsule, vitreous humor, and retina. [Background technology]

[0002] Before describing the various types of glaucoma and current diagnostic and treatment options, a brief overview of the anatomy of the eye will be provided.

[0003]

[0003] Anatomy of the eye

[0004] Referring to FIG. 1, the outer tissue layers of eye 1 include the sclera 2, which provides the structure and shape of the eye. In front of the sclera 2 is the cornea 3, which is composed of a transparent tissue layer that allows light to enter the interior of the eye. Inside eye 1 is the lens 4, which is connected to the eye by fibrous zonules 5, which in turn connect to the ciliary body 6. Between the lens 4 and the cornea 3 is the anterior chamber 7, which contains a flowing, clear fluid called aqueous humor 8. Surrounding the periphery of the lens 4 is the iris 9, which forms the pupil around approximately the center of the lens. The vitreous body 10 is located between the lens 4 and the retina 11. Light entering the eye is optically focused through the cornea 3 and the lens.

[0004]

[0005] Referring to FIG. 2, as an optical system, the eye 1 is represented by an optical model described by idealized central and rotational symmetry planes, entry and exit pupils, and six cardinal points (foci in object and image space, first and second principal planes, and first and second nodal points). Angular directions for the human eye are often defined relative to the optical axis 24, visual axis 26, pupillary axis 28, and line of sight 29 of the eye. The optical axis 24 is an axis of symmetry, a line connecting the vertices of the ideal surface of the eye. The visual axis 26 connects the foveal center 22 with the first and second nodal points to the object. The line of sight 29 connects the fovea to the object via the exit and entry pupils. The pupillary axis 28 is perpendicular to the anterior surface of the cornea 3 and is directed toward the center of the entry pupil. These ocular axes differ from each other by only a few degrees and fall within a range commonly referred to as the line of sight.

[0005]

[0006] Different surgical procedures require access to different target tissues of the eye. For example, a treatment for glaucoma may require access to target tissues in the iridocorneal angle. Other procedures may require access to the cornea, lens, posterior lens capsule, anterior lens capsule, vitreous, or retina. In known systems, such as those disclosed in U.S. Patent Nos. 8,747,395 and 9,028,069, accessing different target tissues of the eye requires an optical assembly including different projection optics mechanically connected to each other, which allows the different optics to be mechanically rotated and aligned with the light delivery system. Summary of the Invention

[0006]

[0007] The present invention relates to an integrated surgical system for accessing one of multiple target volumes of ocular tissue within an eye. The system includes a first optical delivery subsystem optically coupled to receive a first optical beam, an optical assembly having an optical axis, and a control system. The optical assembly is configured to couple to the eye to align its optical axis with the optical axis of the eye. The optical assembly is coupled to the first optical delivery subsystem to receive the first optical beam along one of a plurality of first input axes and to direct the first optical beam to a corresponding one of a plurality of first output axes, the first output axes being aligned with a corresponding one of multiple target volumes of ocular tissue within the eye. The control system is configured to control the first optical delivery subsystem to direct the first optical beam in alignment with a selected one of the plurality of first input axes.

[0007]

[0008] The present disclosure relates to a method for accessing one of a plurality of target volumes of ocular tissue. The method includes receiving a first optical beam with a first optical delivery subsystem and directing, by the first optical delivery subsystem, the first optical beam to a selected one of a plurality of first input axes of an optical assembly coupled to an eye, the optical assembly having an optical axis and configured to couple to the eye for aligning the optical axis with the optical axis of the eye. The method further includes directing, by the optical assembly, the first optical beam along the selected one of the plurality of first input axes to a corresponding one of a plurality of first output axes of the optical assembly aligned with the corresponding one of the plurality of target volumes of ocular tissue of the eye.

[0008]

[0009] The present disclosure also relates to a focusing objective head configured to couple to a patient interface. The patient interface has a window configured to couple to the cornea of ​​an eye having an optical axis. The focusing objective head includes a first optical delivery subsystem optically coupled to receive a first optical beam and an optical assembly having an optical axis. The optical assembly is configured to couple to the eye to align its optical axis with the optical axis of the eye. The optical assembly is coupled to the first optical delivery subsystem to receive the first optical beam along one of a plurality of first input axes and direct the first optical beam to a corresponding one of a plurality of first output axes, the first output axes being aligned with a corresponding one of a plurality of target volumes of ocular tissue in the eye. The first optical delivery subsystem is configured to direct the first optical beam to be aligned with a selected one of the plurality of first input axes.

[0009]

[0010] It is understood that other aspects of the apparatus and method will become apparent to those skilled in the art from the following detailed description, wherein various aspects of the apparatus and method are shown and described by way of illustration. As will be understood, these aspects may be implemented in other different forms, and their several details may be modified in various other respects. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive.

[0010]

[0011] Various aspects of systems, apparatus and methods are presented in the detailed description, by way of example and not limitation, with reference to the accompanying drawings. [Brief explanation of the drawings]

[0011] [Figure 1]

[0012] 1 is a cross-sectional schematic diagram of the human eye and its internal anatomical structures. [Figure 2]

[0013] 1 is a schematic cross-sectional view of the human eye showing the various axes associated with the eye. [Figure 3]

[0014] 1 is a cross-sectional schematic diagram of optical beam paths to different tissue targets of the eye provided by the integrated surgical system for ophthalmic surgery disclosed herein. [Figure 4]

[0015] FIG. 1 is a block diagram of an integrated surgical system for ophthalmic surgery. [Figure 5a]

[0016] FIG. 5 is a detailed block diagram of the integrated surgical system of FIG. 4, configured to deliver one or more light beams along a single beam path to selected tissue targets in the eye. [Figure 5b]

[0017] FIG. 5 is a detailed block diagram of the integrated surgical system of FIG. 4, configured to deliver one or more light beams along multiple beam paths to selected tissue targets in the eye. [Figure 6a]

[0018] FIG. 1 is a schematic diagram of an embodiment of an integrated surgical system having a focusing objective head with a symmetrical optical assembly coupled to the eye via a patient interface. [Figure 6b] FIG. 1 is a schematic diagram of an embodiment of an integrated surgical system having a focusing objective head with a symmetrical optical assembly coupled to the eye via a patient interface. [Figure 7a]

[0019] FIG. 1 is a schematic diagram of an embodiment of an integrated surgical system having a focusing objective head with an asymmetric optical assembly coupled to the eye via a patient interface. [Figure 7b] FIG. 1 is a schematic diagram of an embodiment of an integrated surgical system having a focusing objective head with an asymmetric optical assembly coupled to the eye via a patient interface. [Figure 8a]

[0020] 7b is a schematic diagram of another configuration of an asymmetric optical assembly that can be used in place of the optical assembly of FIG. 7a. [Figure 8b] 7b is a schematic diagram of another configuration of an asymmetric optical assembly that can be used in place of the optical assembly of FIG. 7a. [Figure 8c] 7b is a schematic diagram of another configuration of an asymmetric optical assembly that can be used in place of the optical assembly of FIG. 7a. [Figure 8d] 7b is a schematic diagram of another configuration of an asymmetric optical assembly that can be used in place of the optical assembly of FIG. 7a. [Figure 8e1]

[0021] FIG. 7b is an isometric view of an embodiment of an asymmetric optical assembly that can be used in place of the optical assembly of FIG. 7a. [Figure 8e2] FIG. 7b is an isometric view of an embodiment of an asymmetric optical assembly that can be used in place of the optical assembly of FIG. 7a. [Figure 8e3] FIG. 7b is an isometric view of an embodiment of an asymmetric optical assembly that can be used in place of the optical assembly of FIG. 7a. [Figure 9]

[0022] 1 is a schematic diagram of an embodiment of an integrated surgical system having a focusing objective head rotatably coupled to an eye via an interface structure and a patient interface. [Figure 10]

[0023] FIG. 10 is a schematic diagram of another embodiment of an integrated surgical system having a focusing objective head rotatably coupled to an eye via an interface structure and a patient interface. [Figure 11]

[0024] 1 is a flowchart of a method for accessing one of a plurality of target volumes of ocular tissue. [Figure 12]

[0025] FIG. 1 is a three-dimensional schematic diagram of the anatomical structure of the iridocorneal angle, including the trabecular meshwork, Schlemm's canal, the collector channels branching from Schlemm's canal, and the surgical volume of ocular tissue treated by the integrated surgical system. [Figure 13]

[0026] 12 is a two-dimensional schematic diagram of the anatomical structure of the iridocorneal angle and a three-dimensional laser treatment pattern applied by the integrated surgical system to affect the surgical volume of ocular tissue between Schlemm's canal and the anterior chamber as shown in FIG. [Figure 14]

[0027] 14 is a three-dimensional schematic view of FIG. 12 after treating a surgical volume of ocular tissue with a laser according to the laser treatment pattern of FIG. 13 to form an opening between Schlemm's canal and the anterior chamber of the eye. [Figure 15a]

[0028] FIG. 1 is a schematic diagram of a three-dimensional laser treatment pattern formed by stacking multiple two-dimensional treatment planes or layers. [Figure 15b]

[0029] FIG. 1 is a schematic diagram of a two-dimensional treatment layer defined by an array of spots. DETAILED DESCRIPTION OF THE INVENTION

[0012]

[0030] The integrated surgical system disclosed herein is configured to access various tissue targets within the eye via one or more optical delivery subsystems and optical assemblies. Examples of tissue targets include the iridocorneal angle, cornea, lens, posterior lens capsule, anterior lens capsule, vitreous, and retina. The optical delivery subsystem is configured to direct an optical beam incident on a surface of the optical assembly along any one of a number of input axes to the optical assembly. To this end, the optical delivery subsystem can include one or more alignment mechanisms, such as mechanically actuated flip mirrors, mechanically actuated angular deflectors, fiber optic cables, etc., positioned and oriented relative to the input surface of the optical assembly and configured to reposition and redirect the optical beam into alignment with the selection of the input axis of the optical assembly. The optical assembly is configured to direct (e.g., reflect, bend, etc.) the incident optical beam through the optical assembly to an output axis aligned with the ocular tissue target. In addition to being configured to direct a light beam to the optical assembly, the optical delivery system can be further configured to mechanically rotate relative to the optical axis of the eye to access tissue targets around the eye. In some configurations, the optical assembly is asymmetric and is mechanically coupled to rotate with the optical delivery subsystem about the optical axis of the eye. In other configurations, the optical assembly is symmetric and is mechanically coupled to remain in a predetermined position relative to the eye while the optical delivery subsystem rotates about the optical axis of the eye.

[0013]

[0031] The integrated surgical system disclosed herein allows access to various target tissues of the eye without requiring an optical assembly formed with different optics that requires mechanical rotation to align with the optical delivery system to target the appropriate tissue, as disclosed in U.S. Patent Nos. 8,747,395 and 9,028,069. In other words, the integrated surgical system disclosed herein accesses various tissue targets within the eye via one or more optical delivery subsystems and an optical assembly having a set, non-reconfigurable optical configuration.

[0014]

[0032] Accessing targets in the eye

[0033] In the following description, the term "beam" may refer to any one of a laser beam, an OCT beam, an illumination beam, a visual observation beam, a dual aiming beam, or any other type of light beam, depending on the context. The term "collinear beam" refers to two or more different beams that are combined by the optics of an integrated surgical system and share the same path to the same target location on the eye when entering the eye. The term "non-collinear beam" refers to two or more different beams that take different paths to the eye. The term "co-target beam" refers to two or more different beams that take different paths to the eye but target the same location on the eye. In a collinear beam, different beams are combined by a dichroic or polarizing beam splitter to share the same path to the eye and are transmitted along the same optical path through multiplexing of different beams. In a non-collinear beam, different beams are transmitted to the eye along different optical paths that are separated spatially or by the angle between the beams. In the following description, any of the aforementioned beams or combined beams may be collectively referred to as a light beam. The terms "distal" and "proximal" may be used to designate the direction of travel of the beam or the physical location between components in an integrated surgical system. Distal direction refers to the direction toward the eye. Proximal direction refers to the direction away from the eye.

[0015]

[0034] Referring to FIG. 3 , a feature provided by the integrated surgical system disclosed herein is the ability to access different tissue targets within the eye via one or more optical delivery subsystems and an integrated optical assembly, eliminating the need to mechanically align different optical systems with the optical delivery system to access different tissue targets, as disclosed in U.S. Patent Nos. 8,747,395 and 9,028,069. Integrated in this context means that the optical assembly is a single optical component or a combination of multiple optical components fixed together. Various tissue targets accessible by the integrated surgical system disclosed herein include, for example, the iridocorneal angle 13, the cornea 3, the lens 4, the posterior lens capsule 21, the anterior lens capsule 23, the vitreous humor 10, and the retina 11.

[0016]

[0035] In some embodiments, a tissue target can be accessed by one or more light beams along a single beam path. For example, one or more of a laser beam, an imaging beam, and a visual observation beam can access the cornea 3 along a first beam path 30. Given the angular orientation of the first beam path 30 relative to the optical axis 24 of the eye, the first beam path may be referred to as an angled beam path. In another example, one or more of a laser beam, an imaging beam, and a visual observation beam can access the vitreous humor 10 along a second beam path 31 that is substantially parallel to the optical axis 24 of the eye. Given this orientation of the second beam path 31, it may be referred to as a parallel beam path. By substantially parallel, we mean within 20 degrees of parallelism. In some embodiments, a target can be accessed by different light beams along different non-collinear beam paths 32, 33. For example, the iridocorneal angle 13 of the eye can be accessed by one or more beams along angled beam paths 32 that pass through the cornea 3 and through the aqueous humor 8 in the anterior chamber 7, while one or more other beams can access the iridocorneal angle 13 along parallel beam paths 33 that pass through the cornea 3 and enter the iridocorneal angle 13 of the eye without passing through the aqueous humor 8 in the anterior chamber 7.

[0017]

[0036] Integrated Surgical System

[0037] 4 , in some embodiments, an integrated surgical system 1000 for ophthalmic laser surgery disclosed herein includes a control system 100, one or more user interfaces 110, a surgical component 200, one or more image / vision components 300, 400, and a target positioning device 450. Other components of the integrated surgical system 1000 include a beam conditioner and scanner 500, a beam combiner 600, and a focusing objective head 700 that couples to a patient interface 800.

[0018]

[0038] The surgical component 200 may be a femtosecond laser source that outputs a laser beam 201. Femtosecond lasers provide highly localized, non-thermal, photodisruptive laser-tissue interaction while minimizing collateral damage to surrounding ocular tissue. For optically transparent tissue, photodisruptive laser interaction is utilized. The primary mechanism by which laser energy is deposited in ocular tissue is not through absorption, but through a highly nonlinear multiphoton process. This process is only effective at the focal point of a pulsed laser with high peak intensity. Regions through which the beam passes but not the focal point are unaffected by the laser. Therefore, the interaction region with ocular tissue is highly localized both laterally and axially along the laser beam. This process can also be used in weakly absorbing or scattering tissue. While femtosecond lasers with photodisruptive interaction have been effectively used in ophthalmic surgical systems and commercialized in other ophthalmic laser procedures, none have been used in integrated surgical systems to access the iridocorneal angle.

[0019]

[0039] The first imaging / vision component 300 may be an OCT imaging device that outputs an OCT beam 301. OCT technology provides images that aid in diagnosing, localizing, and guiding laser surgery for various tissue targets within the eye. For example, referring to FIG. 3, OCT imaging can be used to determine the structural and geometric conditions of the iridocorneal angle 13 and determine the accessibility of ocular tissue for treatment. OCT imaging provides the spatial resolution, tissue permeability, and contrast necessary to resolve fine details of ocular tissue. Scanning OCT images yield two-dimensional (2D) cross-sectional images of ocular tissue. As another aspect of the integrated surgical system, the 2D cross-sectional images can also be processed and analyzed to determine the size, shape, and location of ocular structures targeted for surgery. While it is possible to reconstruct a three-dimensional (3D) image from multiple 2D cross-sectional images, this is often not necessary. 2D images can be acquired, analyzed, and displayed more quickly while still providing all the information necessary for accurate surgical targeting.

[0020]

[0040] The second imaging / vision component 400 may be a visual observation device that outputs a visual observation beam 401 and an illumination source. The visual observation device 400 provides an image that aids in identifying the surgical site. Examples of visual observation devices include video cameras and telescopes. The camera may be a digital camera equipped with a gonioscopic lens to provide a gonioscopic image of the eye. The illumination source is positioned to optimally illuminate an object, such as a tissue target within the eye. The illumination source may be an LED or light transmitted via a fiber optic cable. There are many illumination methods: a refractive ballistic method, in which the light source is placed in air and the light refracts through an optical element to reach the trabecular meshwork; a transmission ballistic method, in which the illumination source is inserted into a pre-drilled hole or feature inside the lens and glued in place using a refractive index-matching epoxy; or a reflective method, in which light from the illumination source reflects off a designed reflective surface of the lens close to the eye before hitting the trabecular meshwork.

[0021]

[0041] Target locator 450 is a dual aiming beam device such as that disclosed in U.S. Patent Application Publication No. 2021 / 0235986, "System and Method for Locating a Surface of Ocular Tissue for Glaucoma Surgery Based on Dual Aiming Beams," the contents of which are incorporated herein by reference. Dual aiming beam device 450 outputs a pair of light beams, referred to herein as dual aiming beams 451 a / 451 b, for use in detecting the surface of ocular tissue in the surgical field.

[0022]

[0042] The beam conditioner and scanner 500 is configured to set beam parameters of the light beam, including beam size and divergence. Beam conditioning can also include additional functions, such as setting the beam power or pulse energy and turning the beam on or off with a shutter. As shown in FIG. 4 , the laser beam 201 from the femtosecond laser source 200 and the OCT beam 301 from the OCT imaging device 300 are directed toward the beam conditioner and scanner 500. The beam conditioner and scanner 500 includes components, such as scanning mirrors, for scanning the laser beam 201 and the OCT beam 301 independently of each other. Various types of scanners can be used to scan the laser beam 201 and the OCT beam 301. For scanning laterally relative to the light beams 201 and 301, angle-scanning galvanometer scanners are available, for example, from Cambridge Technology, Inc. of Bedford, Massachusetts, and Scanlab, Inc. of Munich, Germany. To optimize scan speed, scanner mirrors are typically set to the smallest size that can support the required scan angle and numerical aperture of the beam at the target location. The ideal beam size at the scanner is typically different from the beam size of the laser beam 201 or OCT beam 301, and different from what is required at the entrance to the focusing objective head 700. Therefore, beam conditioners may be applied before, after, or between individual scanners.

[0023]

[0043] The beam combiner 600 is configured to split and combine light beams. The beam combiner 500 may include a dichroic or polarizing beam splitter that splits and recombines light beams of different wavelengths and / or polarizations. The beam combiner 600 may also include optics for modifying certain parameters of the individual light beams, such as beam size, beam angle, and divergence. As shown in FIG. 4 , two or more of the laser beam 201, the OCT beam 301, the visual observation beam 401, and the dual aiming beams 451 a / 451 b may be combined with a dichroic, polarizing, or other type of beam combiner 600 and provided as a combined beam 701 to a focusing objective head 700 to reach a common target volume of ocular tissue in the eye 1. For example, referring to FIG. 3 , in some embodiments, all of these light beams 201, 301, 401, 451 a / 451 b may be combined to reach a common target along common beam paths 30, 31. In some embodiments, different sets of light beams may be combined to reach a common target along different beam paths 30, 31. For example, a first set of beams including laser beam 201, visual observation beam 401, and dual aiming beams 451a / 451b may be combined to reach the iridocorneal angle 13 along a first beam path 30, and a second set of beams including OCT beam 301 may be combined to reach the iridocorneal angle along a second beam path 31.

[0024]

[0044] The implementation of the functions of beam conditioner and scanner 500 and beam combiner 600 may occur in a different order than that shown in FIG. 4 . The specific optical hardware that manipulates the beams to perform these functions can have multiple configurations for how the optical hardware is arranged. They can be arranged to manipulate individual light beams separately, or in other embodiments, a single component can integrate functions to manipulate different beams. In the embodiment disclosed herein, two sets of scanners are included: one for scanning laser beam 201 and one for scanning OCT beam 301. Individual beam conditioners within beam conditioner and scanner 500 set the beam parameters for each of laser beam 201 and OCT beam 301.

[0025]

[0045] The focusing objective head 700 includes one or more optical delivery subsystems optically coupled to receive one or more optical beams 701 a, 701 b from the beam combiner 600. The optical beams, hereafter identified by reference numerals 701 a or 701 b, may be individual beams, such as the laser beam 201, the OCT beam 301, the visual observation beam 401, the dual aiming beams 451 a / 451 b, or other types of beams, or a combination of two or more of these individual beams. The focusing objective head 700 also includes an optical assembly. The optical delivery subsystems are configured to direct the received optical beams 701 a, 701 b to be aligned with one of multiple input axes of the optical assembly. The optical delivery subsystems may be further configured for axial scanning of the one or more optical beams. The optical assembly is configured to direct the received optical beams along the input axes to corresponding output axes aligned with one or more tissue targets of the eye. For further details on the optical transmission subsystem and optical assembly, see below.

[0026]

[0046] The control system 100 is connected to the other components 200, 300, 400, 450, 500, 700 of the integrated surgical system 1000. Control signals from the control system 100 to the femtosecond laser source 200 function to control the internal and external operating parameters of the laser source, e.g., power, repetition rate, beam shutter, etc. Control signals from the control system 100 to the OCT imaging device 300 function to control OCT beam parameters and to acquire, analyze, and display OCT images of tissue within the surgical field.

[0027]

[0047] Control signals from the control system 100 to the dual aiming beam device 450 function to control the output of beams of light by one or more aiming beam sources of the dual aiming beam device. Control signals from the control system 100 to the visual observation device 400 function to control the capture, image processing, and display of video images of tissue in the surgical field and light spots on the tissue surface in the surgical field resulting from the one or more beams of light output by the dual aiming beam device 450. Thus, the line of sight of the visual observation device 400 can be aligned with the femtosecond laser and directed to a target area of ​​the eye.

[0028]

[0048] Control signals from the control system 100 to the beam conditioner and scanner 500 function to control the scanning of the laser beam output by the femtosecond laser source 200 and the scanning of the OCT beam output by the OCT imaging device 300. The control signals to the beam conditioner and scanner 500 may include the position, size, and shape of the surgical pattern, expressed in terms of the intended location of the laser focal spot and the position coordinates of the laser's scan path throughout the surgical volume. These types of control signals may be preprogrammed, allowing the operator to select one or more control parameters. The control parameters of the surgical pattern may include the position of the laser pulse pattern, the pattern shape, length, width, depth, laser spot, line and layer separation, and energy. Prior to operating the surgical system, the control signals between the various subsystems and components are adjusted. Calibration involves calibrating pixel coordinates acquired and displayed by the visual observation device 400 and the OCT imaging device 300 to actual physical coordinates within the eye, and calibrating the commanded operation of the OCT and laser scanner systems to the actual OCT and laser beam displacements within the eye.

[0029]

[0049] Control signals from the control system 100 to the focusing objective head 700 can function to control the axial scanning of either or both of the laser beam 201 and the OCT beam 301 through the motorized focusing objective. Control signals from the control system 100 to the focusing objective head 700 also function to control mechanical elements of one or more optical delivery subsystems, thereby directing one or more optical beams 701 a, 701 b into alignment with the input axis of the optical assembly. See below for further details of the optical delivery subsystem and optical assembly.

[0030]

[0050] Instructing the integrated surgical system 1000 to perform a surgical incision involves docking the system to the eye, acquiring and displaying on a computer screen visual observation images and OCT images including spots from the dual aiming beams, determining coordinate locations and other parameters of the intended surgical incision based on the displayed images, and instructing the control system 100 to execute a surgical pattern based on information gathered from these images. The image-based parameters may be determined by an operator of the integrated surgical system 1000 or by image processing and analysis computer algorithms. Instructions using these parameters may be provided by the operator as input data in the form of text, mouse clicks, or drag-and-drop commands on a computer screen. Alternatively, a system processor included in the control system 100 generates instructions to be executed by the control system based on the previously determined parameters.

[0031]

[0051] Single Optical Transmission Subsystem

[0052] 5a, according to embodiments disclosed herein, an integrated surgical system includes a single optical delivery subsystem and optical assembly configured to deliver one or more of a laser beam 201, an OCT beam 301, a visual observation beam 401, and a pair of aiming light beams 451a, 451b distally along a single beam path toward the eye 1, and to receive one or more of an OCT return beam 301 and a visual observation reflected beam 401 returning from the eye 1 along the single beam path. In the exemplary embodiment of FIG. 5a, the single beam path is within a target volume 720 of ocular tissue of the eye at the iridocorneal angle. According to embodiments disclosed above with reference to FIG. 3, the single beam path may extend into other target volumes 720 of ocular tissue of the eye, including the cornea, lens, posterior lens capsule, anterior lens capsule, vitreous humor, and retina.

[0032]

[0053] Regarding laser beam transmission, the laser beam 201 output by the femtosecond laser source 200 passes through a beam conditioner 510, where basic beam parameters, such as beam size and divergence, are set. The beam conditioner 510 may also include additional functions such as setting the beam power or pulse energy and shuttering the beam on and off. After exiting the beam conditioner 510, a pair of lateral scanning mirrors 530, 532, rotated by galvanometer scanners, scan the laser beam 201 in two essentially orthogonal lateral directions, e.g., the x- and y-directions. The laser beam 201 is then directed toward a dichroic or polarizing beam splitter 540, where it is reflected toward a beam combining mirror 601 configured to combine the laser beam 201 and the OCT beam 301.

[0033]

[0054] Regarding OCT beam transmission, the OCT beam 301 output by the OCT imaging device 300 passes through a beam conditioner 511 and a lateral scanner comprising scanning mirrors 531 and 533. Traveling distally toward the eye 1 and after scanning mirrors 531 and 533, the OCT beam 301 is combined with the laser beam 201 by a beam combining mirror 601. The OCT beam 301 and laser beam 201 components of the combined laser / OCT beam 210 / 301 are multiplexed and travel in the same direction. The combined laser / OCT beam 210 / 301 propagates to a second beam combining mirror 602, where it is combined with one or more aiming light beams 451a / 451b and the visual observation beam 401 to form a combined laser / OCT / visual / aiming beam 701a.

[0034]

[0055] The distally traveling combined light beam 701a (hereafter referred to as the first light beam) passes through a focusing objective 750a and is reflected by an alignment mechanism 740a, such as a beam folding mirror, to align with an input axis 706i of an exit lens 710 of the optical assembly 1001. The alignment mechanism 740a and the focusing objective 750a are components of an optical delivery subsystem 1001a that can move the first light beam 701a to align with any one of multiple input axes 706i of the optical assembly 1001. The first light beam 701a passes through the exit lens 710 and exits the exit lens along an output axis 706o, passing into and through a window 801 of the patient interface to a focal point within the target volume 720. The focusing objective 750a may include a single lens or a group of lenses and may be moved in the axial direction 722 by a servo motor, stepper motor, or other control mechanism. Moving the focusing objective 750a in the axial direction 722 changes the axial distance between the focal points of the laser beam 201 and the OCT beam 301 at the focal point.

[0035]

[0056] The scattered OCT return beam 301 from the target volume 720 of ocular tissue travels in the proximal direction and returns to the OCT imaging device 300 along the same path in reverse order as just described. The reference beam 302 of the OCT imaging device 300 passes through the reference delay path and returns to the OCT imaging device from the movable mirror 330. The reference beam 302 is coherently integrated with the OCT return beam 301 on its return within the OCT imaging device 300.

[0036]

[0057] Multiple optical transmission subsystems

[0058] 5b, according to embodiments disclosed herein, an integrated surgical system may include multiple optical delivery subsystems and an optical assembly configured to deliver one or more of a laser beam 201, an OCT beam 301, a visual observation beam 401, and a pair of aiming light beams 451a, 451b distally toward the eye 1 along any of multiple beam paths, and to receive one or more of an OCT return beam 301 and a visual observation reflected beam 401 returning from the eye 1 along any of multiple beam paths. In the exemplary embodiment of FIG. 5b, the laser beam 201 and the visual observation beam 401 are delivered along a first optical path or first beam path to a region of the eye 1 including the target volume 720, and the OCT beam 301 is delivered along a second optical path or second beam path to the same region of the eye. Thus, the laser beam 201 and the OCT beam 301 are co-targeted, non-collinear beams. As shown in Figure 5b, the first beam path and the second beam path enter a target volume 720 of ocular tissue of the eye at the iridocorneal angle. According to the embodiment disclosed above with reference to Figure 3, the laser beam 201 and the OCT beam 301 can be simultaneously co-targeted along different beam paths to other target volumes 720 of ocular tissue of the eye, including the cornea, the lens, the posterior lens capsule, the anterior lens capsule, the vitreous humor, and the retina. Alternatively, the laser beam 201 and the OCT beam 301 can be targeted to different target volumes 720 along different beam paths.

[0037]

[0059] Regarding laser beam transmission, the laser beam 201 output by the femtosecond laser source 200 passes through a beam conditioner 510, where basic beam parameters, such as beam size and divergence, are set. The beam conditioner 510 can also perform additional functions, such as setting the beam power or pulse energy and turning the beam on or off with a shutter. After exiting the beam conditioner 510, the laser beam 201 enters a pair of lateral scanning mirrors 530, 532, rotated by galvanometer scanners, which scan the laser beam 201 in two essentially orthogonal lateral directions, e.g., the x- and y-directions. The laser beam 201 is then directed toward a beam combining mirror 602, which is configured to combine the laser beam 201 with the visual observation beam 401 and the dual aiming beams 451a / 451b to form a combined laser / OCT / visual / aiming beam 701a.

[0038]

[0060] The distally traveling combined light beam 701a (hereafter referred to as the first light beam) passes through a first focusing objective 750a and is directed by a first alignment mechanism 740a, e.g., a beam folding mirror, to be aligned with a first input axis 706i of an exit lens 710 of the optical assembly 1001. The first alignment mechanism 740a and the first focusing objective 750a are components of a first optical delivery subsystem 1002a that can move the first light beam 701a to align with any one of multiple first input axes 706i of the optical assembly 1001. The first light beam 701a passes through the exit lens 710 and exits the exit lens along a first output axis 706o, entering and passing through a window 801 of the patient interface to a focal point within the target volume 720. The first focusing objective 750a can include a single lens or a group of lenses and is movable in the axial direction 722 by a servo motor, stepper motor, or other control mechanism. Moving the first focusing objective 750a in the axial direction 722 changes the axial distance of the focal point of the laser beam 201 component of the first light beam 701a at the focal point.

[0039]

[0061] With regard to transmission of the OCT beam, the OCT beam 301 output by the OCT imaging device 300 passes through a lateral scanner including a beam conditioner 511 and scanning mirrors 531 and 533. After passing through the scanning mirrors 531 and 533 and traveling distally toward the eye 1, the OCT beam 301 (hereinafter referred to as the second optical beam) passes through a second focusing objective 750b and is directed by a second alignment mechanism 740b, e.g., a beam folding mirror, to be aligned with the second input axis 707i of the prism 752 of the optical assembly 1001. The second alignment mechanism 740b and the second focusing objective 750b are components of a second optical transmission subsystem 1002b that can be moved to align the second optical beam 701b with any one of multiple second input axes 707i of the optical assembly 1001. The second light beam 701b then passes through the prism 752 and the exit lens 710 of the optical assembly 1001 and exits the exit lens along a second output axis 707o and enters and passes through a window 801 of the patient interface to a focal point within the target volume 720. The second focusing objective lens 750b may include a single lens or a group of lenses and is movable in the axial direction 723 by a servo motor, stepper motor, or other control mechanism. Moving the second focusing objective lens 750b in the axial direction 723 changes the axial distance of the focal point of the OCT beam 301 at the focal point.

[0040]

[0062] The scattered OCT return beam 301 from the ocular tissue travels in the proximal direction and returns to the OCT imaging device 300 along the same path as just described in reverse order. The reference beam 302 of the OCT imaging device 300 passes through the reference delay path and returns to the OCT imaging device from the movable mirror 330. The reference beam 302 is coherently combined with the OCT return beam 301 on its return within the OCT imaging device 300.

[0041]

[0063] Symmetrical Optical Assembly

[0064] 6a and 6b are schematic diagrams of an embodiment of a focusing objective head 700 of an integrated surgical system 1000 having a symmetrical optical assembly 1001 optically coupled to a first optical delivery subsystem 1002a and an optional second optical delivery subsystem 1002b, each optically coupled to a respective component (not shown) for receiving a first optical beam 701a and a second optical beam 701b. The optical assembly 1001 is mechanically coupled to a non-rotating distal portion 702b of a housing 702 of the focusing objective head 700, while one or more components of the first optical delivery subsystem 1002a and the optional second optical delivery subsystem 1002b are mechanically coupled to a rotatable proximal portion 702a of the housing. Thus, in this embodiment, the first optical delivery subsystem 1002a and the second optical delivery subsystem 1002b (if present) can rotate relative to the optical assembly 1001, which remains fixed relative to the eye. Although the details of the mechanical coupling of the optical assembly 1001, the first optical transmission subsystem 1002a, and the second optical transmission subsystem 1002b to the housing 702 are not shown, various means or mechanisms can be used to secure these components in the appropriate positions within the housing and maintain their respective optical coupling.

[0042]

[0065] Continuing with the embodiment of Figures 6a and 6b, the optical assembly 1001 includes the exit lens 710. The first optical delivery subsystem 1002a includes the first focusing objective lens 750a and the first alignment mechanism 740a, and is connected to the first input axis 706. i 1001. The surface 712 of the exit lens 710 on which the first light beam 701a is incident is sometimes referred to herein as the input surface of the optical assembly 1001 or the entrance surface of the optical assembly. The exit lens 710 directs the first light beam 701a along a first output axis 706 of the optical assembly 1001. oThe first optical beam 701a may be a laser beam, an OCT beam, a visual observation beam, a dual aiming beam, or any other type of optical beam, or a combination thereof. The optional second optical delivery subsystem 1002b includes a second focusing objective lens 750b and a second alignment mechanism 740b, and is optically coupled to receive the second optical beam 701b incident on a surface of an exit lens 710 along a second input axis 707i. The exit lens 710 directs the second optical beam 701b onto a second output axis 707i of the optical assembly 1001. o The second light beam 701b may be a laser beam, an OCT beam, a visual observation beam, a dual aiming beam, or any other type of light beam, or a combination thereof.

[0043]

[0066] The optical assembly 1001 has an optical axis 705. The optical assembly 1001 is configured to be coupled to the eye via the patient interface 800 and to align its optical axis 705 with the optical axis 24 of the eye. The optical assembly 1001 is optically coupled to a first optical delivery subsystem 1002a and has a plurality of first input axes 706 incident on an input face 712 of the optical assembly. i and outputs the first light beam 701 a along one of the plurality of target volumes of the ocular tissue through the optical assembly to a plurality of first output shafts 706 aligned with a corresponding one of the plurality of target volumes of the ocular tissue. o , directing a light beam to a corresponding one of the

[0044]

[0067] Referring to FIG. 6b (for clarity of illustration, the optional second optical transmission subsystem 1002b is not shown), in some configurations, the first alignment mechanism 740a of the first optical transmission subsystem 1002a aligns the first optical beam 701a with the first input axis 706 of the optical assembly 1001. iTo this end, the first alignment mechanism 740a is positioned and oriented relative to the input face 712 of the optical assembly 1001 to direct the first light beam 701a along the selected first input axis 706 of the optical assembly. i The light source is configured to be repositioned and / or reoriented relative to the entrance surface so as to be aligned with the light source.

[0045]

[0068] In some embodiments, the first alignment mechanism 740a receives the first light beam 701a along an incident angle and reflects the light beam at a reflection angle to the plurality of first input axes 706 of the optical assembly 1001. i , 532。 Alternatively, the first light beam 701a may be oriented along the selected first input axis 706 by simultaneously reorienting the pair of lateral scanning mirrors 530, 532 and repositioning the focusing objective lens 750a. i The combined movement of the pair of lateral scanning mirrors 530, 532 and the first alignment mechanism 740a facilitates alignment of the first input shaft 706. i Both the position and angle of the focusing objective lens 750a can be controlled. If the objective lens aperture of the first optical delivery subsystem 1002a is designed to be oversized to accommodate an expanded range of field positions of the input and output light beams, repositioning of the focusing objective lens 750a may not be necessary.

[0046]

[0069] In some embodiments, the first alignment mechanism 740a may comprise a fiber optic cable and a positioning mechanism. The fiber optic cable is configured to transmit light and has an optical input end coupled to receive the first light beam 701a and an optical output end configured to output the first light beam. The positioning mechanism is mechanically coupled to the fiber optic cable and responsive to control signals from the control system 100 to align the selected first input axis 706 of the optical assembly. i The optical output end is configured to reposition and / or reorient the optical output end so that it is aligned with the optical output end.

[0047]

[0070] Continuing to refer to FIG. 6b, in another configuration, the first focusing objective lens 750a of the first optical delivery subsystem 1002a moves relative to the first alignment feature 740a to direct the first optical beam 701a toward the first input axis 706 of the optical assembly 1001. i To this end, the first focusing objective 750a is positioned and oriented relative to the first alignment mechanism 740a and configured to be mechanically repositioned and / or reoriented relative to the first alignment mechanism to direct the first light beam 701a to the selected first input axis 706 of the optical assembly. i The first focusing objective 750a is directed to the first alignment mechanism at an angle of incidence that aligns it with the reflective surface of the first alignment mechanism 740a. For example, the first focusing objective 750a may be mounted for rotational movement relative to the reflective surface of the first alignment mechanism 740a. Control signals from the control system 100 control the positioning and orientation of the first focusing objective 750a.

[0048]

[0071] In other configurations, both the first alignment mechanism 740a and the first focusing objective 750a focus the first light beam 701a onto the first input axis 706 of the optical assembly 1001. i In the above-described embodiment of FIG. 6b, the optical assembly 1001 can be configured to move to align with a selected one of the three different first input axes 706. iHowever, it is understood that the number of first input shafts 706i is not limited to three, but can be configured with an essentially infinite number of shafts.

[0049]

[0072] Referring to FIG. 6a, the optical assembly 1001 is optically coupled to a second optical transmission subsystem 1002b (if present) and includes a plurality of second input shafts 707 incident on an input face 712 of the optical assembly. i a plurality of second output axes 707 that receive the second light beam 701b along one of the plurality of target volumes of ocular tissue within the eye; o The second optical transmission subsystem 1002b may be configured similarly to the first optical transmission subsystem 1002a described above. In other words, the second alignment mechanism 740b is positioned and oriented relative to the input face 712 of the optical assembly 1001 to direct the second optical beam 701b to a selected second input axis 707 of the optical assembly. i Similarly, the second focusing objective lens 750b is positioned and oriented relative to the second alignment mechanism 740b and is configured to be mechanically repositioned and / or reoriented relative to the second alignment mechanism to direct the second light beam 701b toward the selected second input axis 707 of the optical assembly 1001. i and directing a second light beam onto a second alignment feature at an aligning angle of incidence.

[0050]

[0073] In the embodiment of Figures 6a and 6b, the components of the first optical delivery subsystem 1002a and the second optical delivery subsystem 1002b (if present) are configured to rotate about the optical axis 705 of the optical assembly 1001 to align with eye tissue targets at various angular locations around the eye, but the optical assembly itself does not rotate and remains fixed relative to the eye. To this end, as previously disclosed, the optical assembly 1001 is coupled to the non-rotating distal portion 702b of the housing 702 of the focusing objective head 700, and one or more components of the first optical transmission subsystem 1002a, e.g., the first alignment mechanism 740a and / or the first focusing objective 750a, are mechanically coupled to the rotatable proximal portion 702a of the housing and positioned relative to other components (e.g., the beam conditioner and scanner 500 and the beam combiner 600) so as to maintain optical coupling with these components and receive the first optical beam 701a regardless of the rotational position of the proximal portion of the housing. Similarly, if a second optical transmission subsystem 1002b is present, one or more components of the second optical transmission subsystem 1002b, e.g., the second alignment mechanism 740b and the second focusing objective lens 750b, are mechanically coupled to the rotatable proximal portion 702a of the housing 702 and positioned relative to the other components (e.g., the beam conditioner and scanner 500 and the beam combiner 600) to maintain optical coupling with these components to receive the second optical beam 701b regardless of the rotational position of the proximal portion of the housing.

[0051]

[0074] The optical assembly 1001 provides an interface to the eye via the patient interface 800. To this end, the exit lens 710 of the optical assembly 1001 has a concave surface facing the eye and a convex surface opposite the concave surface. The convex surface of the exit lens 710 corresponds to the incident or entrance surface of the optical assembly 1001. The concave surface is configured to couple with the convex surface of the window 801 of the patient interface 800. In some embodiments, the exit lens 710 is aspheric and has a meniscus shape, similar to that shown in Figures 6a and 6b. In other configurations, the exit lens may be a spherical lens. In one embodiment, the exit lens 710 is formed of fused silica and has a refractive index n x is 1.45.

[0052]

[0075] The patient interface 800 optically and physically couples the eye 1 to the exit lens 710. The patient interface 800 secures the eye relative to the components of the integrated surgical system, creates a sterile barrier between the components and the patient, and provides optical access between the eye and the instruments. The patient interface 800 is a sterile, disposable, single-use device that is removably coupled to the eye 1 and the exit lens 710. The patient interface 800 includes a window 801 having a concave surface facing the eye and a convex surface facing the objective lens opposite the concave surface. Thus, the window 801 has a meniscus shape. The concave surface is configured to couple to the eye 1 either directly or via an index-matching material, liquid, or gel disposed between the concave surface and the eye 1. The window 801 is formed of glass and has a refractive index n w In one embodiment, window 801 is formed from fused silica and has a refractive index n w is 1.45.

[0053]

[0076] The window 801 is surrounded by a wall 803 of the patient interface 800 and a fixation device, such as a suction ring 804. When the suction ring 804 contacts the eye 1, an annular cavity 805 is formed between the suction ring and the eye. When a vacuum is applied to the suction ring 804 and the cavity via a vacuum tube or vacuum pump (not shown in FIGS. 6a and 6b), the eye is attached to the patient interface 800 by the vacuum force between the eye and the suction ring during surgery. Releasing the vacuum releases or removes the eye 1. The end of the patient interface 800 opposite the eye 1 includes an attachment interface 806 configured to attach to the non-rotating distal portion 702b of the housing 702 of the focusing objective head 700, thereby fixing the position of the eye relative to the other components of the integrated surgical system 1000. The attachment interface 806 can operate using mechanical, vacuum, magnetic, or other principles and is also detachable from the integrated surgical system.

[0054]

[0077] Asymmetric Optical Assembly

[0078] 7a and 7b are schematic diagrams of an embodiment of a focusing objective head 700 of an integrated surgical system 1000 having an asymmetric optical assembly 1001 optically coupled to a first optical delivery subsystem 1002a and an optional second optical delivery subsystem 1002b, each optically coupled to a respective component (not shown) for receiving a first optical beam 701a and a second optical beam 701b. The optical assembly 1001 is mechanically coupled to a housing 702 of the focusing objective head 700. One or more components of the first optical delivery subsystem 1002a and the optional second optical delivery subsystem 1002b are also mechanically coupled to the housing 702. Thus, in this embodiment, the optical assembly 1001, the first optical delivery subsystem 1002a, and the second optical delivery subsystem 1002b (if present) can be rotated relative to the eye. Although the details of the mechanical coupling of the optical assembly 1001, the first optical transmission subsystem 1002a, and the second optical transmission subsystem 1002b to the housing 702 are not shown, various means or mechanisms can be used to secure these components in the appropriate positions within the housing and maintain their respective optical coupling.

[0055]

[0079] Continuing with the embodiment of Figures 7a and 7b, optical assembly 1001 includes prism 752 and exit lens 710 having a reflective surface 742. First optical transmission subsystem 1002a is optically coupled to receive first light beam 701a and direct the first light beam along first input axis 706i to a surface 712 of exit lens 710. Surface 712 of exit lens 710 on which first light beam 701a is incident may be referred to herein as a first input surface of optical assembly 1001 or a first entry surface of the optical assembly. Reflective surface 742 of exit lens 710 receives first light beam 701a and directs the first light beam along first output axis 706i of optical assembly 1001. oThe first light beam 701 a may be a laser beam, an OCT beam, a visual observation beam, a dual aiming beam, or any other type of light beam, or a combination thereof.

[0056]

[0080] The optional second optical delivery subsystem 1002b is optically coupled to receive the second optical beam 701b and direct the second optical beam along a second input axis 707i to an input face 753 of a prism 752. The input face 753 of the prism 752 may be referred to herein as the second input face of the optical assembly 1001 or the second input face of the optical assembly. The prism 752 directs the second optical beam 701b to an exit face 755 of the prism and to an exit lens 710, which directs the second optical beam to be aligned with the second output axis 707o of the optical assembly 1001. The second optical beam 701b may be a laser beam, an OCT beam, a visual observation beam, a dual aiming beam, or any other type of optical beam, or a combination thereof.

[0057]

[0081] Although not shown in Figures 7a and 7b, the first optical delivery subsystem 1002a can include either or both of a first focusing objective and a first alignment mechanism, and the second optical delivery subsystem 1002b can include either or both of a second focusing objective and a second alignment mechanism, as described in the embodiment of Figures 6a and 6b. The first optical delivery subsystem 1002a and the second optical delivery subsystem 1002b can include beam conditioning and other components such as the scanner 500 and the beam combiner 600.

[0058]

[0082] The optical assembly 1001 has an optical axis 705. The optical assembly 1001 is configured to be coupled to the eye via the patient interface 800 and to align its optical axis 705 with the optical axis 24 of the eye. The optical assembly 1001 is optically coupled to a first optical delivery subsystem 1002a and has a plurality of first input axes 706 incident on a first input face 712 of the optical assembly. i and outputs the first light beam 701 a along one of the plurality of target volumes of the ocular tissue through the optical assembly to a plurality of first output shafts 706 aligned with a corresponding one of the plurality of target volumes of the ocular tissue. o , directing a light beam to a corresponding one of the

[0059]

[0083] Referring to FIG. 7b (for clarity of illustration, optional second optical transmission subsystem 1002b is not shown), in some configurations, first optical transmission subsystem 1002a transmits first optical beam 701a to first input axis 706 of optical assembly 1001. i 6a and 6b. To this end, the first optical transmission subsystem 1002a may include a first alignment mechanism similar to that described above for the embodiment of Figures 6a and 6b. The first alignment mechanism, e.g., an actuated flip mirror, an actuated angular deflector, or a fiber optic cable, is positioned and oriented relative to the first input face of the optical assembly 1001 and configured to be repositioned and / or reoriented relative to the input face to direct the first optical beam 701a toward the selected first input axis 706 of the optical assembly. i Orient it so that it is aligned with

[0060]

[0084] 7b, in other configurations, one or more components of the first optical delivery subsystem 1002a may be configured to move relative to the optical assembly 1001 to align the first optical beam 701a with a selected one of the first input axes 706i of the optical assembly. To this end, the first optical delivery subsystem 1002a may include a first focusing objective similar to that described above for the embodiment of FIGS. 6a and 6b. The first focusing objective is positioned and oriented relative to the input face 712 of the optical assembly to align the first optical beam 701a with a selected one of the first input axes 706i of the optical assembly. i 7. The optical axis of the first light beam 701a may be configured to be mechanically repositioned and / or reoriented relative to the entrance face to direct the first light beam 701a along the incident plane to the exit lens 710.

[0061]

[0085] In other configurations, the first optical delivery subsystem 1002a may include both the first alignment mechanism and the first focusing objective. In the example of FIG. 7b, the three different first input axes 706 of the optical assembly 1001 i However, it is understood that the number of first input shafts 706i is not limited to three, but can be configured with an essentially infinite number of shafts.

[0062]

[0086] Referring to FIG. 7a, the optical assembly 1001 is optically coupled to a second optical transmission subsystem 1002b (if present) and includes a plurality of second input shafts 707 incident on a second input face 753 of the optical assembly. i a plurality of second output axes 707 that receive the second light beam 701b along one of the plurality of target volumes of ocular tissue within the eye; o The second optical transmission subsystem 1002b may be configured similarly to the first optical transmission subsystem 1002a described above.

[0063]

[0087] 7a and 7b, the components of the first optical delivery subsystem 1002a and the second optical delivery subsystem 1002b (if present) are configured to rotate with the optical assembly 1001 about the optical axis 705 of the optical assembly 1001, while the patient interface 800 remains fixed in place. To this end, the optical assembly 1001, along with one or more components of the first optical delivery subsystem 1002a, are mechanically coupled to the rotatable housing 702 of the focusing objective head 700. The components of the first optical delivery subsystem 1002a are positioned relative to other components (e.g., beam conditioner and scanner 500 and beam combiner 600) to maintain optical coupling with these components for receiving the first optical beam 701a, regardless of the rotational position of the rotatable housing 702. Similarly, if the second optical delivery subsystem 1002b is present, one or more components of the first optical delivery subsystem are mechanically coupled to the housing 702 and positioned relative to the other components (e.g., the beam conditioner and scanner 500 and the beam combiner 600) so as to maintain optical coupling with these components to receive the second optical beam 701b regardless of the rotational position of the housing 702. Rotating the housing 702 of the focusing objective head 700 in this manner causes the optical assembly 1001, the first optical beam 701a, and the second optical beam 701b to rotate together about the optical axis 705 of the optical assembly relative to the fixed window 801 of the patient interface 800. This allows each of the optical beams 701a, 701b to optically access various tissue targets of the eye 1 throughout 360 degrees around the eye 1.

[0064]

[0088] The optical assembly 1001 provides an interface to the eye via the patient interface 800. To this end, the exit lens 710 of the optical assembly 1001 has a concave surface facing the eye and a generally convex surface 712 opposite the concave surface. The prism 752 includes an input or entrance surface 753 and an output or exit surface 755. The generally convex surface 712 of the exit lens 710 includes a modified front surface 719 configured to couple to the exit surface 755 of the prism 752. In one configuration, the modified surface 719 is a flat surface having a shape that matches the shape of the exit surface 755 of the prism 752. The shape may be, for example, rectangular. Thus, the exit lens 710 can be described as having a generally meniscus shape with the modified surface 719. The exit lens 710 and the prism 752 may be formed of the same or similar solid material as the window 801 of the patient interface 800. In one embodiment, the exit lens 710 is formed from fused silica and has a refractive index n x The prism 752 is made of fused silica and has the same refractive index, n p The patient interface 800 optically and physically couples the eye 1 to the exit lens 710. The patient interface 800 may be configured in a similar manner as described above with reference to Figures 6a and 6b.

[0065]

[0089] 8a, 8b, 8c, 8d, and 8e, alternative configurations of optical assembly 1001 are contemplated, each of which can be used in place of the optical assembly of FIGS. 7a and 7b. In each of FIGS. 8a, 8b, 8c, 8d, and 8e, optical assembly 1001 includes an exit lens 710 having an entrance surface 712 and an extended side area with a reflective surface 742. The entrance surface 712 receives a first light beam 701a along a first input axis 706i that is incident on the entrance surface. The reflective surface 742 receives the first light beam 701a and reflects the first light beam 701a into alignment with a first output axis 706o of the optical assembly 1001.

[0066]

[0090] 8a and 8b, prisms 752 are similar to those of Figures 7a and 7b. These prisms 752 receive a second light beam 701b incident on their entrance faces 753a, 753b along a second input axis 707i and direct the second light beam 701b into their exit face 755 and into an exit lens 710, which then directs the second light beam into alignment with the second output axis 707o of the optical assembly 1001.

[0067]

[0091] 8c, 8d, and 8e, each prism 752 has one or more reflective surfaces from which second light beam 701b reflects into exit lens 710, which then directs the second light beam into alignment with second output axis 707o of optical assembly 1001. In these configurations, prism 752 includes 1) entrance face 753, 2) one or more reflective surfaces 757, 759, and 3) exit face 755. These configurations of prism 752 are solutions that address two challenges: 1) the very tight space constraints within focusing objective head 700, and 2) ensuring that second light beam 701b reaches target volume 720.

[0068]

[0092] Referring to the optical assembly of FIG. 8e, the curved upper surface 712e of the exit lens 710e allows the second input axis 707e to be aligned in the absence of the prism 752e. iThe angle of incidence of the input light beam along the curved upper surface 712e of the focusing objective head 700 becomes higher, resulting in a steeper refraction angle. Given the extremely limited space within the focusing objective head 700, it can be geometrically challenging to direct the second light beam 701b at an angle relative to the curved upper surface 712e of the exit lens 710e so that the second light beam strikes the target volume 720. To address this, the prism 752 of FIG. 8e has three faces: an entrance face 753, a reflecting face 757, and an exit face 755. The prism 752 is designed and mechanically positioned so that the nominal angle of incidence of the second light beam 701b on the entrance face 753 is normal, with only a small deviation (+ / −10 degrees) from the second light beam scanner (if any), minimizing refraction and aberrations in the scanned beam. Several other design measures are implemented to reduce the variation in the refraction angle. First, prism 752 is made of the same material as exit lens 710. Second, a region of top surface 712 is modified to machine an angled flat for positioning and aligning the prism so that it couples to exit lens 710. Modified surface 719 is aligned with exit face 755 of prism 752 and includes an angled flat. Because exit face 755 of prism 752 and modified surface 719 are parallel and the prism and exit lens 710 are made of the same material, no refraction occurs when second light beam 701b passes through the prism-lens interface.

[0069]

[0093] 7a and 7b, the focusing objective head 700 and patient interface 800 are configured to allow the focusing objective head 700 to rotate within the additional component without transmitting rotational torque to the patient interface 800, which is fixed to the eye. To this end, the additional component can be included between the focusing objective head 700 and the patient interface 800. The additional component is fixed relative to the patient interface 800 but not fixed relative to the focusing objective head 700. Figures 9 and 10 are examples of such a configuration.

[0070]

[0094] 9 is a schematic diagram of a configuration in which the housing 702 of the focusing objective head 700 is docked with the patient interface 800 via an interface structure 810a that couples to the patient interface. This docking provides an indirect contact coupling between the optical assembly 1001 of the focusing objective head 700 and the window 801 of the patient interface 800. The housing 702 of the focusing objective head 700 and the interface structure 810a are mechanically configured and coupled such that the optical assembly 1001 and the light delivery subsystems 1002a, 1002b within the interface structure can rotate relative to the patient interface 800, which is configured to be fixedly coupled to and decoupled from the eye. In this configuration, the light delivery subsystems 1002a, 1002b can rotate about the optical axis 705 of the optical assembly 1001 without transmitting rotational torque to the patient interface 800, which is fixed to the eye. The mounting interface 806 of the patient interface 800 is attached to the non-rotating interface structure 810a. Thus, rotation of the focusing objective head 700 does not transmit a rotational torque to the patient interface coupled to the eye. In this configuration, the interface structure 810a includes a transparent window 811 through which the light rays 701a, 701b pass to the window 801 of the patient interface 800.

[0071]

[0095] 10 is a schematic diagram of another configuration in which the housing 702 of the focusing objective head 700 is docked with the patient interface 800 via an interface structure 810b that couples to the patient interface. This docking provides an indirect contact coupling between the optical assembly 1001 of the focusing objective head 700 and the window 801 of the patient interface 800. As in the configuration of FIG. 9, the housing 702 of the focusing objective head 700 and the interface structure 810b are mechanically configured and coupled to allow the optical assembly 1001 and light delivery subsystems 1002a, 1002b within the interface structure to rotate relative to the patient interface 800, which is configured to be fixedly coupled to and decoupled from the eye. In this configuration, the light delivery subsystems 1002a, 1002b can rotate about the optical axis 705 of the optical assembly 1001 without transmitting rotational torque to the patient interface 800, which is fixed to the eye. The mounting interface 806 of the patient interface 800 is attached to a non-rotating interface structure 810a. Therefore, rotation of the focusing objective head 700 does not transmit rotational torque to the patient interface coupled to the eye. In this configuration, the interface structure 810b includes an opening 814 through which the light beams 701a, 701b pass into the window 801 of the patient interface 800. An index-matching material, liquid, or gel 807 is placed on the convex surface of the window 801, creating a layer between the exit lens 710 and the window when the components 800, 810b, 700 are coupled.

[0072]

[0096] Focusing objective lens head

[0097] 5a-10, a focusing objective head 700 configured to couple to a patient interface 800 is disclosed. The patient interface has a window 801 configured to couple to the cornea 3 of the eye 1 having an optical axis 24. The focusing objective head 700 includes a first optical delivery subsystem 1002a optically coupled to receive a first optical beam 701a, and an optical assembly 1001 having an optical axis 705. The optical assembly 1001 is configured to couple to the eye such that its optical axis 705 coincides with the optical axis 24 of the eye. The optical assembly 1001 is coupled to the first optical delivery subsystem 1002a to receive the first optical beam 701a along one of a plurality of first input axes 706i and direct the first optical beam to a corresponding one of a plurality of first output axes 706o, which are aligned with a corresponding one of a plurality of target volumes 720 of ocular tissue of the eye.

[0073]

[0098] The first optical transmission subsystem 1002a is configured to direct the first optical beam 701a to be aligned with a selected one of the plurality of first input axes 706i. To this end, the first optical transmission subsystem includes a means 740a for aligning the first optical beam 701a with one of the plurality of first input axes 706i. In some embodiments, the means for aligning the first optical beam 701a with one of the plurality of first input axes 706i includes at least one adjustable reflective surface 740a optically aligned to receive the first optical beam along an incident angle and reflect the first optical beam at a reflected angle to align it with a corresponding one of the plurality of first input axes.

[0074]

[0099] In some embodiments, the first optical delivery subsystem 1002a is optically coupled to receive a plurality of different types of optical beams and includes a means 600 for collinearly combining the plurality of optical beams into a first optical beam 701a. In some embodiments, the first optical delivery subsystem 1002a includes a focusing objective 750a controlled by the control system 100 and configured to focus the first optical beam 701a onto a corresponding one of the plurality of target volumes 720 of the ocular tissue.

[0075]

[0100] The focusing objective head 700 includes a housing 702 configured to rotate a first optical delivery subsystem 1002a about an optical axis 705 of an optical assembly 1001. To this end, one or more components 740a, 750a, 500, and / or 600 of the first optical delivery subsystem 1002a are mechanically coupled to the housing 702 for rotation about the optical axis 705 of the optical assembly 1001. The optical assembly 1001 is mechanically coupled to the housing 702 and can also rotate about the optical axis 705 of the optical assembly.

[0076]

[0101] In some embodiments, the focusing objective head 700 includes a second optical delivery subsystem 1002b optically coupled to receive the second optical beam 701b. The optical assembly 1001 is coupled to the second optical delivery subsystem 1002b to receive the second optical beam 701b along one of a plurality of second input axes 707i and direct the second optical beam to a corresponding one of a plurality of second output axes 707o that are aligned with a corresponding one of a plurality of target volumes 720 of ocular tissue of the eye.

[0077]

[0102] The second optical transmission subsystem 1002b is configured to direct the second optical beam 701b to be aligned with a selected one of the plurality of second input axes 707i. To this end, the second optical transmission subsystem 1002b includes a means 740b for aligning the second optical beam 701b with one of the plurality of second input axes 707i. In some embodiments, the means for aligning the second optical beam 701b with one of the plurality of second input axes 707i includes at least one adjustable reflective surface 740b optically aligned to receive the second optical beam along an incident angle and reflect the second optical beam at a reflected angle to align it with a corresponding one of the plurality of second input axes.

[0078]

[0103] In some embodiments, the second optical delivery subsystem 1002b is optically coupled to receive multiple different types of optical beams and includes a means 600 for collinearly combining the multiple optical beams into a second optical beam 701b. The second optical delivery subsystem 1002b includes a focusing objective 750b configured to focus the second optical beam 701b onto a corresponding one of multiple target volumes 720 of ocular tissue. One or more components 740b, 750b, 500, and / or 600 of the second optical delivery subsystem 1002b are mechanically coupled to a housing 702 configured to rotate a portion of the second optical delivery subsystem about an optical axis 705 of the optical assembly 1001.

[0079]

[0104] Access to organizational targets

[0105] Referring to Figure 11, a method of accessing one of a plurality of target volumes of ocular tissue is described, which may be performed using an integrated surgical system configured as described above with reference to Figures 4-10.

[0080]

[0106] 4 through 10, in block 1102, a first optical beam 701a is received at a first optical transmission subsystem 1002a. The first optical beam 701a can be any one of a laser beam, an OCT beam, a visual observation beam, and a dual aiming beam. The first optical beam may also be a collinear combination of two or more of a laser beam, an OCT beam, a visual observation beam, and a dual aiming beam.

[0081]

[0107] In block 1104, the first light beam 701 a is directed by the first light delivery subsystem 1002 a to a selected one of a plurality of first input axes 706 i of the optical assembly 1001 coupled to the eye. To this end, the position of the alignment mechanism of the first light delivery subsystem 1002 a can be controlled, e.g., rotated, flipped, etc., to align the first light beam 701 a with the selected first input axis 706 i.

[0082]

[0108] In block 1106, the first light beam 701 a is directed by the optical assembly 1001 along a selected one of a plurality of first input axes 706 i to a corresponding one of a plurality of first output axes 706 o of the optical assembly aligned with a corresponding one of a plurality of target volumes 720 of the ocular tissue. Directing the first light beam 701 a may include reflecting or bending the first light beam through one or more optics of the optical assembly.

[0083]

[0109] In block 1108, a second optical beam 701b is received at the second optical transmission subsystem 1002b. The second optical beam 701b may be received simultaneously with the first optical beam 701a. The second optical beam 701b can be any one of a laser beam, an OCT beam, a visual observation beam, and a dual aiming beam. The second optical beam may also be a collinear combination of two or more of a laser beam, an OCT beam, a visual observation beam, and a dual aiming beam.

[0084]

[0110] In block 1110, the second optical beam 701b is directed by the second optical transmission subsystem 1002b to a selected one of the plurality of second input axes 707i of the optical assembly 1001. To this end, the position of an alignment mechanism of the second optical transmission subsystem 1002b can be controlled, e.g., flipped, rotated, etc., to align the second optical beam 701b with the selected second input axis 707i.

[0085]

[0111] In block 1112, the second light beam 701b is directed by the optical assembly 1001 along a selected one of a plurality of second input axes 707i to a corresponding one of a plurality of second output axes 707o of the optical assembly aligned with a corresponding one of a plurality of target volumes 720 of the ocular tissue. Directing the second light beam 701b may include reflecting or bending the second light beam through one or more optics of the optical assembly.

[0086]

[0112] In some approaches, the target volume 720 of ocular tissue aligned with the first output axis 706o of the optical assembly 1001 and the target volume of ocular tissue aligned with the second output axis 707o of the optical assembly may be the same target volume. For example, with reference to FIG. 5b, both the first output axis 706o and the second output axis 707o of the optical assembly may be aligned with a target volume 720 within the iridocorneal angle of the eye. In other approaches, the target volume 720 of ocular tissue aligned with the first output axis 706o of the optical assembly 1001 and the target volume of ocular tissue aligned with the second output axis 707o of the optical assembly may be different target volumes.

[0087]

[0113] minimally invasive surgical treatment

[0114] The ability to select different targets in the eye allows for minimally invasive surgical treatment of a variety of conditions. For example, it may be desirable to access one or more of the iridocorneal angle, cornea, lens, posterior lens capsule, anterior lens capsule, vitreous humor, and retina. It may also be desirable to access different targets in the eye simultaneously. An example of treating glaucoma by accessing the iridocorneal angle is described below.

[0088]

[0115] Treatment of glaucoma

[0116] FIG. 12 is a three-dimensional schematic diagram of the ocular anatomy relevant to surgical treatments enabled by the integrated surgical system 1000. To lower IOP, laser treatment targets ocular tissues affecting the trabecular outflow pathway 40. These ocular tissues include the trabecular meshwork 12, scleral spine 14, Schlemm's canal 18, and collecting duct 19. The trabecular meshwork 12 is composed of three layers: the uvea 15, the corneoscleral meshwork 16, and the proximal canalicular tissue 17. These layers are porous and water-permeable, with the uvea 15 being the most porous and water-permeable, followed by the corneoscleral meshwork 16. The least porous and least permeable layer of the trabecular meshwork 12 is the proximal canalicular tissue 17. The inner wall 18a of Schlemm's canal 18 is also porous and water-permeable, with similar properties to the proximal canalicular tissue 17.

[0089]

[0117] Figure 13 includes a three-dimensional illustration of a treatment pattern P1 applied by integrated surgical system 1000 to affect surgical volume 900 of ocular tissue shown in Figure 12, as well as a two-dimensional schematic illustration of treatment pattern P1 superimposed on the anatomical structure being treated. Figure 13 is a three-dimensional schematic illustration of the ocular anatomical structure, including an opening 902 through the trabecular meshwork 12 resulting from application of the laser treatment pattern of Figure 13. The opening 902 is also referred to as a channel or aperture. The opening 902 provides an outflow pathway 40 that reduces flow resistance within the ocular tissue, increasing the flow of aqueous humor from the anterior chamber 7 to Schlemm's canal 18, thereby lowering the IOP of the eye.

[0090]

[0118] Surgical treatment involves reducing resistance in the outflow pathway and minimizing ocular tissue alteration through the design and selection of laser treatment patterns. The treatment pattern is considered to define a collection of laser-tissue interaction volumes, referred to here as cells. The size of the cells is determined by the extent of the impact of the laser-tissue interaction. When laser spots, i.e., cells, are closely spaced along a line, the laser creates a narrow, fine channel. By closely spacing multiple laser spots within the cross-section of the channel, a wider channel can be created. The arrangement of cells may be similar to the arrangement of atoms in a crystal structure.

[0091]

[0119] 13, treatment pattern P1 can take the form of a cubic structure containing individual cells arranged in regularly spaced rows, columns, and sheets or layers. Treatment pattern P1 is characterized by x, y, and z dimensions, and the x, y, and z coordinates of the cells are calculated sequentially from adjacent cell to adjacent cell in the order of column position (x coordinate), row position (y coordinate), and layer position (z coordinate). Treatment pattern P1 defines a three-dimensional model of the ocular tissue to be modified by the laser or a three-dimensional model of the ocular fluid affected by the laser.

[0092]

[0120] The treatment pattern P1 is typically defined by a set of surgical parameters. The surgical parameters may include one or more treatment areas A, which represent surface regions or layers of ocular tissue through which the laser passes. The treatment area A is determined by the treatment height h and the lateral extent w of the treatment. The treatment thickness t represents the level at which the laser cuts the ocular tissue, from the distal extent or boundary of the treatment volume at or near Schlemm's canal 18 to the proximal extent or boundary at or near the surface of the trabecular meshwork 12. Thus, the laser applied according to the treatment pattern may affect or create a surgical volume that resembles a three-dimensional model of the treatment pattern, or may affect fluids within the ocular structures that resemble the three-dimensional model.

[0093]

[0121] Additional surgical parameters define the placement of the surgical or affected volume within the eye. For example, with reference to Figures 12 and 13, the placement parameters may include one or more of a location l, which represents where the treatment will occur relative to the circumferential angle of the eye, and a treatment depth d, which represents the location of a three-dimensional model of the ocular tissue or fluid within the eye relative to reference ocular structures. The treatment depth d is shown and described below relative to the region where the anterior chamber 7 meets the trabecular meshwork 12. The combination of the treatment pattern and the placement parameters defines a treatment plan.

[0094]

[0122] Femtosecond lasers provide highly localized, non-thermal, photodisruptive laser-tissue interaction while minimizing collateral damage to surrounding ocular tissue. Optically transparent tissue utilizes photodisruptive laser interaction. The primary mechanism by which laser energy is deposited in ocular tissue is not absorption, but rather a highly nonlinear multiphoton process. This process is only effective at the focal point of a pulsed laser with high peak intensity. Regions through which the beam passes but not the focal point are unaffected by the laser. Therefore, the region of interaction with ocular tissue is highly localized both laterally and axially along the laser beam.

[0095]

[0123] 12 and 13 , a surgical volume 900 of ocular tissue to be treated is identified by the integrated surgical system 1000, and a treatment pattern P1 corresponding to the surgical volume is designed by the integrated surgical system. Alternatively, the treatment pattern P1 may be designed first, and then an appropriate surgical volume 900 for applying the treatment pattern may be identified. The surgical volume 900 of ocular tissue may include a portion of the trabecular meshwork 12 and Schlemm's canal 18. For example, the surgical volume 900 of ocular tissue shown in FIG. 14 includes the uvea 15, the corneoscleral meshwork 16, the proximal canal tissue 17, and a portion of the inner wall 18a of Schlemm's canal 18. The treatment pattern P1 defines a laser scanning procedure in which a laser is focused at various depths in the ocular tissue and scanned in multiple directions to affect a three-dimensional volume of tissue containing multiple sheets or layers of affected tissue.

[0096]

[0124] 13 and 14 , during a laser scanning procedure, a surgical laser beam 201 scans ocular tissue according to a treatment pattern P1, forming openings 902 penetrating from the anterior chamber 7 through the uvea 15, the corneoscleral meshwork 16, the tubular tissue 17 of the trabecular meshwork 12, and the inner wall 18a of Schlemm's canal 18. While the exemplary opening 902 in FIG. 16 is depicted as a continuous, single lumen defining a fluid pathway, the opening may also be defined as an array of adjacent pores, or a combination thereof, forming a sponge-like structure defining a fluid pathway. While the exemplary opening 902 in FIG. 14 is cubic in shape, the opening may have other geometric shapes.

[0097]

[0125] The movement of the laser as it scans and impacts the surgical volume 900 follows a treatment pattern P1, which is defined by a set of surgical parameters including a treatment area A and a thickness t. The treatment area A is defined by a width w and a height h. The width can be defined as a measurement around a circular angle. For example, the width w can be defined in terms of an angle, e.g., 90 degrees, centered around the circular angle.

[0098]

[0126] Referring to FIG. 13, the initial placement of the laser focus within the eye is determined by the depth d and the position l The laser treatment is defined by a set of geometry parameters including: Location l defines the point around the circumference of the eye where laser treatment begins, and depth d defines the point between the anterior chamber 7 and Schlemm's canal 18 where laser treatment begins or ends. Depth d is measured relative to the area where the anterior chamber 7 meets the trabecular meshwork 12. Thus, a first point closer to the Schlemm's canal 18 side of the trabecular meshwork 12 can be said to be deeper than a second point closer to the anterior chamber 7 side of the trabecular meshwork 12. Alternatively, the second point may be described as being shallower than the first point.

[0099]

[0127] 14 , the opening 902 resulting from the laser application of treatment pattern P1 resembles the surgical volume 900 and is characterized by an area A and a thickness t similar to the surgical volume and treatment pattern. The thickness t of the resulting opening 902 extends from the anterior chamber 7 to the inner wall 18a of Schlemm's canal 18, and the area A defines the cross-sectional area of ​​the opening 902.

[0100]

[0128] During the laser scanning procedure, the laser focal point is moved to different depths d in the ocular tissue and then scanned in two lateral dimensions or directions defined by the treatment pattern P1 to affect a three-dimensional surgical volume 900 of ocular tissue that includes multiple sheets or layers of affected tissue. The two lateral dimensions are typically orthogonal to the axis of movement of the laser focal point. With reference to FIG. 14 , the movement of the laser focal point during laser scanning is described herein with reference to the x, y, and z directions or axes. 1) Movement of the laser focal point to different depths d through the thickness t of the treatment pattern P1 or the surgical volume 900 of the tissue corresponds to movement of the focal point along the z-axis, and 2) movement of the laser focal point in two dimensions or directions orthogonal to the z-axis corresponds to movement of the laser focal point along the width w of the treatment pattern P1 or the surgical volume 900 of the tissue in the x-direction and along the height h of the treatment pattern P1 or the surgical volume 900 of the tissue in the y-direction.

[0101]

[0129] As used herein, scanning of the laser focus generally corresponds to raster-type movement of the laser focus in the x, y, and z directions. The laser focus is positioned at a point in the z direction and then raster-scanned in two dimensions or directions in the x and y directions. The laser focus in the z direction is sometimes referred to as the depth d or surgical volume 900 of tissue within the treatment pattern P1. The two-dimensional raster scanning of the laser focus defines layers of laser scanning, generating layers of tissue affected by the laser.

[0102]

[0130] During the laser scan, laser pulse shots are delivered to tissue within the volume of ocular tissue corresponding to the treatment pattern P1. Because the laser interaction volume is small, on the order of a few micrometers (μm), each laser shot of the repetitive laser interacts with the ocular tissue, locally destroying the ocular tissue at the laser's focal point. The laser pulse duration for the photodisruptive interaction with the ocular tissue ranges from a few femtoseconds to a few nanoseconds, with pulse energies ranging from a few nanojoules to tens of microjoules. The laser pulse at the focal point breaks intramolecular chemical bonds through a multiphoton process, locally photodissociating tissue material and generating gas bubbles within the moist tissue. When the laser pulses are delivered close to each other along geometric lines and surfaces, the mechanical stresses resulting from the decomposition of tissue material and the formation of gas bubbles fragment the tissue, creating clean, continuous cuts.

[0103]

[0131] 15a and 15b, a 3D treatment pattern P1 may be defined by multiple 2D treatment layers 1502, or treatment planes, stacked to form a 3D treatment pattern characterized by a width w, a height h, and a depth or thickness t. Each individual treatment layer 1502 is characterized by a pattern height h (equal to the height h of the 3D treatment pattern P1) and a pattern width w (equal to the width w of the 3D treatment pattern P1), and is composed of an array of spots 1504 spaced apart to establish or match the height and width. The pattern width w corresponds to the distance along the circumference of the corneal angle parallel to the trabecular meshwork. This direction is also referred to as the circumferential direction. The pattern height h corresponds to the distance across the circumference of the corneal angle perpendicular to the trabecular meshwork. This direction is also referred to as the azimuthal direction.

[0104]

[0132] Each spot 1504 in the treatment pattern P1 corresponds to a site within the target volume of ocular tissue where light energy is applied at the laser focus to create a micro-photodisruption site. Referring to FIG. 15b, each spot 1504 in the treatment layer 1502 is separated from adjacent spots by a programmable distance referred to as the spot separation (spot separation 1506) and line separation (line separation 1508). The treatment layer 1502 is completed with a programmed pattern width w 1510 and pattern height h 1512. Each treatment layer 1502 in the 3D treatment pattern P1 is separated from adjacent layers by a layer separation (Layer Sep).

[0105]

[0133] Treatment pattern P1 can be defined by a set of programmable parameters as shown in Table 1.

[0106]

[0134] Table 1 TIFF2025528840000002.tif64170

[0107]

[0135] Other, non-rectangular, more irregular treatment patterns can also be programmed to be created in tissue. These irregular patterns can be broken down into spots, lines, or layers, with areas characterized by width, height, and depth. Examples of irregular treatment patterns are described in U.S. Patent Application Publication No. 2021 / 0307964, entitled "Method, System, and Apparatus for Generating Three-Dimensional Treatment Patterns for Laser Surgery of Glaucoma," the disclosure of which is incorporated herein by reference.

[0108]

[0136] In the example treatment pattern P1, the parameters are as follows: Width=750μm Height = 250 μm Depth = 350 μm Spot separation = 10 μm Line separation = 10 μm Layer separation=10μm

[0109]

[0137] During laser treatment, each treatment layer 1502 is individually created by scanning the laser focal point in two dimensions, e.g., width and height, or z and y, to various spots 1504 that define the layer, while the focal point is fixed in three dimensions, e.g., depth or Z, and once a treatment layer 1502 is created, the focal point is moved in the depth or z direction to create the next treatment layer in the stack. This process is repeated until all treatment layers 1502 in the 3D treatment pattern P1 have been created. Details of this type of scanning are disclosed in U.S. Patent Application Publication No. 2021 / 0220176, the entire disclosure of which is incorporated herein by reference.

[0110]

[0138] In another treatment, instead of creating a treatment pattern P1 one treatment layer 1502 at a time, the focus of the laser beam 201 is scanned in three dimensions. For example, the laser focus oscillates axially back and forth across depth (e.g., in the z direction) while being moved laterally across height and / or width, e.g., in the x and / or y directions. A treatment pattern P1 characterized by such scanning of the laser focus can be referred to as a "clearing pattern." The depth oscillation of the laser focus in the z direction occurs simultaneously with the lateral movement of the laser focus in the x and y directions. An example of scanning the laser according to a clearing pattern is also disclosed in U.S. Patent Application Publication No. 2021 / 0220176.

[0111]

[0139] Various aspects of this disclosure are provided to enable those skilled in the art to practice the invention. Various modifications to the exemplary embodiments presented throughout this disclosure will be readily apparent to those skilled in the art. Accordingly, the claims are not intended to be limited to various aspects of this disclosure, but are to be accorded the full scope consistent with the language of the claims. All structural and functional equivalents to the various components of the exemplary embodiments described throughout this disclosure that are known or later become known to those skilled in the art are expressly incorporated herein by reference and are intended to be encompassed by the claims. Furthermore, the subject matter disclosed herein is intended to be published, whether or not expressly recited in the claims. No claim element shall be construed under the provisions of 35 U.S.C. §112, sixth paragraph, unless the element is expressly recited using the word "means" or, in the case of a method claim, using the word "step."

[0112]

[0140] It is to be understood that the embodiments of the invention described herein are merely illustrative of the application of the principles of the invention, and references to details of the illustrated embodiments are not intended to limit the scope of the claims, which themselves recite features regarded as essential to the invention.

Claims

1. 1. An integrated surgical system for accessing one of a plurality of target volumes of ocular tissue in an eye, comprising: a first optical transmission subsystem optically coupled to receive the first optical beam; an optical assembly having an optical axis configured to be coupled to the eye such that its optical axis is aligned with an optical axis of the eye, the optical assembly being optically coupled to the first light delivery subsystem to receive the first light beam along one of a plurality of first input axes and direct the first light beam to a corresponding one of a plurality of first output axes that are aligned with a corresponding one of the plurality of target volumes of ocular tissue in the eye; a control system configured to control the first optical transmission subsystem to direct the first optical beam into alignment with a selected one of the plurality of first input axes; An integrated surgical system, including:

2. The integrated surgical system of claim 1 , wherein said first optical delivery subsystem includes means for aligning said first optical beam with said one of said plurality of first input axes.

3. 3. The integrated surgical system of claim 2, wherein the means for aligning the first optical beam includes at least one adjustable reflective surface optically aligned to receive the first optical beam along an incident angle and reflect the first optical beam at a reflection angle aligned with a corresponding one of the plurality of first input axes.

4. The integrated surgical system of claim 3 , wherein the adjustable reflective surface comprises an actuated flip mirror or an actuated angular deflector.

5. the means for aligning the first light beam comprises: a fiber optic cable configured to transmit light, the fiber optic cable having an optical input end coupled to receive the first optical beam and an optical output end configured to output the first optical beam; a positioning mechanism mechanically coupled to the fiber optic cable and configured to move the optical output end into alignment with one of the plurality of first input shafts; The integrated surgical system of claim 2 , comprising:

6. 10. The integrated surgical system of claim 1, wherein the first optical delivery subsystem is optically coupled to receive a plurality of different types of optical beams and includes means for collinearly combining the plurality of different types of optical beams into the first optical beam.

7. 7. The integrated surgical system of claim 6, wherein the means for collinearly combining the plurality of different types of light beams into the first light beam comprises at least one beam splitter and its fiber optic equivalent.

8. The integrated surgical system of claim 7 , wherein the at least one beam splitter comprises at least one polarizing beam splitter and its fiber optic equivalent.

9. The integrated surgical system of claim 7 , wherein the at least one beam splitter comprises at least one dichroic or multi-wavelength beam splitter and their fiber optic equivalents.

10. 2. The integrated surgical system of claim 1, wherein the first optical delivery subsystem includes a focusing objective lens, and the control system is configured to control the focusing objective lens to focus the first optical beam at a corresponding one of the plurality of target volumes of the ocular tissue.

11. The integrated surgical system of claim 1 , wherein the first light beam is a laser beam.

12. The integrated surgical system of claim 1 , further comprising a laser source configured to output the first light beam.

13. The integrated surgical system of claim 1 , wherein the first light beam is a collinear beam including a laser beam and at least one of an OCT beam, a visual observation beam, and a pair of dual aiming beams.

14. 10. The integrated surgical system of claim 1, wherein one or more components of the first optical delivery subsystem are mechanically coupled to a structure configured to rotate a portion of the first optical delivery subsystem about the optical axis of the optical assembly.

15. The integrated surgical system of claim 14 , wherein the optical assembly is mechanically coupled to a structure for rotation about the optical axis of the optical assembly.

16. a second optical transmission subsystem optically coupled to receive the second optical beam; the optical assembly is coupled with the second optical delivery subsystem to receive the second optical beam along one of a plurality of second input axes and direct the second optical beam to a corresponding one of a plurality of second output axes that is aligned with a corresponding one of the plurality of target volumes of ocular tissue of the eye; 2. The integrated surgical system of claim 1, wherein the control system is configured to control the second optical delivery subsystem to direct the second optical beam into alignment with a selected one of the plurality of second input axes.

17. 17. The integrated surgical system of claim 16, wherein said second optical delivery subsystem includes means for aligning said second optical beam with one of said plurality of second input axes.

18. 17. The integrated surgical system of claim 16, wherein the second optical delivery subsystem is optically coupled to receive a plurality of different types of optical beams and includes means for combining the plurality of different types of optical beams into the second optical beam.

19. 17. The integrated surgical system of claim 16, wherein the second light beam comprises at least one of a laser beam, an OCT beam, a visual observation beam, and a pair of dual aiming beams.

20. 17. The integrated surgical system of claim 16, wherein the second optical delivery subsystem includes a focusing objective, and the control system is configured to control the focusing objective to focus the second optical beam at a corresponding one of the plurality of target volumes of the ocular tissue.

21. 17. The integrated surgical system of claim 16, wherein one or more components of the second optical delivery subsystem are mechanically coupled to a structure configured to rotate a portion of the second optical delivery subsystem about the optical axis of the optical assembly.

22. The integrated surgical system of claim 1 , wherein the multiple target volumes of ocular tissue include the iridocorneal angle, the cornea, the lens capsule, and the lens.

23. 1. A method of accessing one of a plurality of target volumes of an ocular tissue, comprising: receiving a first optical beam at a first optical transmission subsystem; directing, by the first light delivery subsystem, the first light beam to a selected one of a plurality of first input axes of an optical assembly coupled to the eye, the optical assembly having an optical axis and configured to be coupled to the eye such that the optical axis is aligned with an optical axis of the eye; directing, by the optical assembly, the first light beam along the selected one of the plurality of first input axes to a corresponding one of a plurality of first output axes of the optical assembly aligned with a corresponding one of the plurality of target volumes of ocular tissue of the eye; A method comprising:

24. 24. The method of claim 23, wherein directing the first light beam by the first optical transmission subsystem to a selected one of a plurality of first input axes of the optical assembly comprises controlling a position of an alignment mechanism of the first optical transmission subsystem.

25. 24. The method of claim 23, wherein the first light beam is one of a laser beam, an OCT beam, a visual observation beam, and a dual aiming beam.

26. 24. The method of claim 23, wherein the first light beam is a collinear combination of two or more of a laser beam, an OCT beam, a visual observation beam, and a dual aiming beam.

27. receiving a second optical beam at a second optical transmission subsystem; directing, by the first light delivery subsystem, the second light beam to a selected one of a plurality of second input axes of the optical assembly coupled to the eye; directing, by the optical assembly, the second light beam along a selected one of the plurality of second input axes to a corresponding one of a plurality of second output axes of the optical assembly aligned with a corresponding one of the plurality of target volumes of ocular tissue of the eye; 24. The method of claim 23, further comprising:

28. 28. The method of claim 27, wherein directing the second light beam by the second optical transmission subsystem to a selected one of a plurality of second input axes of the optical assembly comprises controlling a position of an alignment mechanism of the second optical transmission subsystem.

29. 28. The method of claim 27, wherein receiving the first light beam and receiving the second light beam occur simultaneously.

30. 28. The method of claim 27, wherein the target volume of ocular tissue aligned with the first output axis of the optical assembly and the target volume of ocular tissue aligned with the second output axis of the optical assembly are the same target volume.

31. 28. The method of claim 27, wherein the target volume of ocular tissue aligned with the first output axis of the optical assembly and the target volume of ocular tissue aligned with the second output axis of the optical assembly are different target volumes.

32. 1. A focusing objective head for coupling to a patient interface having a window configured to couple to a cornea of ​​an eye having an optical axis, a first optical transmission subsystem optically coupled to receive the first optical beam; an optical assembly having an optical axis configured to be coupled to the eye such that its optical axis is aligned with an optical axis of the eye, the optical assembly being optically coupled to the first light delivery subsystem to receive a first light beam along one of a plurality of first input axes and direct the first light beam to a corresponding one of a plurality of first output axes, the first output axes being aligned with a corresponding one of a plurality of target volumes of ocular tissue in the eye; Including, a focusing objective head, wherein the first optical delivery subsystem is configured to direct the first optical beam into alignment with a selected one of the plurality of first input axes.

33. 33. The focusing objective of claim 32, wherein the first optical delivery subsystem includes means for aligning the first optical beam with the one of the plurality of first input axes.

34. 34. The focusing objective lens head of claim 33, wherein the means for aligning the first light beam with the one of the plurality of first input axes includes at least one adjustable reflective surface that receives the first light beam along an incident angle and reflects the first light beam at a reflection angle so that it becomes aligned with a corresponding one of the plurality of first input axes.

35. 33. The focusing objective lens head of claim 32, wherein the first optical transmission subsystem is optically coupled to receive a plurality of different types of light beams and includes means for collinearly combining the plurality of different types of light beams into the first light beam.

36. 33. The focusing objective head of claim 32, wherein the first optical delivery subsystem includes a focusing objective controlled by a control system and configured to focus the first optical beam at a corresponding one of the plurality of target volumes of the ocular tissue.

37. a housing configured to rotate the first optical transmission subsystem about the optical axis of the optical assembly; 33. The focusing objective head of claim 32, wherein one or more components of the first optical delivery subsystem are mechanically coupled to the housing for rotation about the optical axis of the optical assembly.

38. 38. The focusing objective head of claim 37, wherein the optical assembly is mechanically coupled to the housing for rotation about the optical axis of the optical assembly.

39. a second optical transmission subsystem optically coupled to receive the second optical beam; the optical assembly is coupled to the second optical transmission subsystem to receive the second optical beam along one of a plurality of second input axes and direct the second optical beam to a corresponding one of a plurality of second output axes that is aligned with a corresponding one of the plurality of target volumes of ocular tissue in the eye; 33. The focusing objective lens head of claim 32, wherein the second optical transmission subsystem is configured to direct the second optical beam to be aligned with a selected one of the plurality of second input axes.

40. 40. The focusing objective head of claim 39, wherein the second optical delivery subsystem includes means for aligning the second optical beam with one of the plurality of second input axes.

41. 40. The focusing objective lens head of claim 39, wherein the second optical transmission subsystem is optically coupled to receive a plurality of different types of light beams and includes means for collinearly combining the plurality of different types of light beams into the second light beam.

42. 40. The focusing objective head of claim 39, wherein the second optical delivery subsystem includes a focusing objective configured to focus the second optical beam at a corresponding one of the plurality of target volumes of the ocular tissue.

43. 40. The focusing objective lens head of claim 39, wherein one or more components of the second optical transmission subsystem are mechanically coupled to a housing configured to rotate a portion of the second optical transmission subsystem about the optical axis of the optical assembly.

Images