Robotic capsulotomy

Abstract

An apparatus and method for performing a capsulotomy procedure on a patient's eye is provided. The diathermy capsulotomy tool (50) includes a diathermy cutting element (58) at its tip (54). An imaging system (22) images the diathermy capsulotomy tool (50) and the patient's eye. A computer processor (28) drives a robotic unit (20) to insert the diathermy capsulotomy tool (50) into the patient's eye through an incision in the cornea of ​​the patient's eye and position the tool's tip (54) within the patient's eye and position the tool's remote center of motion within the incision. The computer processor (28) drives the robotic unit (20) to move the cutting element (58) in a circular motion while maintaining the tool's remote center of motion within the incision. Other uses are also described.

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Patent Application No. 63 / 412,475 to Glozman, entitled "Robotic Capsulotomy," filed October 2, 2022, which provisional application is incorporated herein by reference.

[0002] Some applications of the present invention relate generally to medical devices and methods, and more particularly to devices and methods for robotically performing microsurgical procedures. [Background technology]

[0003] Cataract surgery involves removing the eye's cloudy natural lens (known as a cataract) and replacing it with an intraocular lens. Such surgery typically involves several standard steps performed in succession.

[0004] In the first step, the patient's face around the eyes is disinfected (typically with an iodine solution) and then draped with sterile drapes so that only the eyes are exposed. Once disinfection and draping are complete, the eyes are anesthetized with a local anesthetic, typically administered in the form of liquid eye drops. The eyeball is then exposed using a lid speculum, which holds the upper and lower eyelids open. One or more incisions (typically two or three) are made in the cornea. The incision or incisions are usually made with a specialized blade called a keratome. At this stage, lidocaine is typically injected into the anterior chamber of the eye to further anesthetize the eye. This step is followed by a viscoelastic injection through the corneal incision or incisions. The viscoelastic injection is administered to stabilize the anterior chamber and help maintain intraocular pressure during the remainder of the procedure, as well as to expand the lens capsule.

[0005] The next step, also known as capsulorhexis or capsulorhexis (these terms are used interchangeably in this application), involves removing a portion of the anterior lens capsule. Various enhanced techniques have been developed to perform capsulorhexis, including laser-assisted capsulorhexis, zeptorhexis (which utilizes precision nanopulse technology), and marker-assisted capsulorhexis (which uses a predetermined marker to mark the cornea to indicate the desired size of the capsular opening). Most commonly, capsulorhexis is performed using a technique called serial circular capsulorhexis. In this technique, a bent needle is used to create a tear in the anterior lens capsule, which is then enlarged around the anterior lens capsule using the same needle and / or forceps. It is usually important to precisely cut the anterior lens capsule and to center the tear to maintain a central position for the intraocular lens. There is evidence that even slight off-centering of the intraocular lens can reduce vision and introduce astigmatism.

[0006] Subsequently, in a step known as hydrodissection, a fluid wave is typically injected through the corneal incision to cut the outer cortical layer of the cataract. In the next step, known as hydrodelineation, the injection of a fluid wave separates the outer, soft nucleus of the lens from the inner, hard nucleus. The next step is phacoemulsification of the lens, a process known as phacoemulsification. The nucleus is first broken up using a chopper, and then the outer fragments of the lens are typically broken up and removed using a phacoemulsification probe. Aspiration is also typically performed using a separate tool during phacoemulsification. After phacoemulsification is complete, the remaining cortical (i.e., outer layer of the lens) material is aspirated from the capsule. To maintain fluid pressure in the anterior chamber during phacoemulsification and aspiration, a balanced salt solution is typically used instead of the aspirated fluid. Optionally, the capsule is polished, if necessary. An intraocular lens (IOL) is then inserted into the capsule. The IOL is typically foldable and is inserted in a folded configuration and then expanded within the capsule. At this stage, the viscoelastic material is typically removed using the same suction device previously used to aspirate fluid from the capsule. If necessary, the incision or incisions are sealed by increasing pressure within the bulbus oculi (i.e., globe of the eye), e.g., by pressing the inner tissue against the outer tissue of the incision to force the incision closed. Summary of the Invention

[0007] According to some embodiments of the present invention, a robotic unit inserts a diathermy capsulotomy tool into a patient's eye through an incision in the patient's cornea. According to some applications, a computer processor is configured to drive the robotic unit to move the tip of the diathermy capsulotomy tool within the eye while simultaneously constraining movement of the tool at a location within the incision where the tool is positioned (referred to herein as the "remote center of tool movement location"). In some applications, the computer processor determines the placement of the tool relative to the incision by analyzing images of the tool and the patient's eye. In some applications, the computer processor constrains movement of the tool at the remote center of tool movement location to prevent the tip of the tool from moving beyond the edge of the incision.

[0008] Typically, according to some applications of the present invention, the tip of the diathermy capsulotomy tool is moved in a circular motion over the patient's anterior lens capsule while maintaining the position of the diathermy capsulotomy tool's entry point relative to the patient's eye within the incision or incision zone in the patient's cornea. Typically, the tip of the diathermy capsulotomy tool includes a diathermy cutting element configured to cut the anterior lens capsule. Typically, the cutting element is an electrode pair through which high-frequency energy (e.g., energy at a frequency greater than 100 kHz, e.g., 200 kHz to 1 MHz, or 300 kHz to 700 kHz) is driven into the tissue of the anterior lens capsule, thereby cutting the anterior lens capsule. The cutting element is typically surrounded by an insulating material, e.g., a polymeric material, that isolates the cutting element from the exterior of the diathermy capsulotomy tool. As described above, typically, the tip of the diathermy capsulotomy tool is moved in a circular motion on the patient's anterior lens capsule while the position of the tool's entry point relative to the patient's eye (i.e., the remote center of the tool's movement position) is maintained within the incision or incision zone in the patient's cornea. Another constraint is that there is typically a height difference between the incision and the anterior lens capsule. Therefore, the robotic unit is configured to move and actuate the diathermy capsulotomy tool subject to the following constraints: A) Initially, the tool must be inserted through the incision, and as the tip of the tool advances into the anterior lens capsule, the tool's entry into the patient's eye must remain within the incision (or incision zone). Typically, the tip of a diathermy capsulotomy tool is not straight. Therefore, as the tool tip advances through the incision, the robotic unit must advance the tool along a non-linear path to maintain the tool's entry into the patient's eye within the incision (or incision zone). B) While activating the cutting element to apply radio frequency energy to the anterior lens capsule; Circular movement of the cutting element relative to the anterior lens capsule; holding the end of the tool at an angle relative to the patient's eye so that the cutting element is positioned on the patient's anterior lens capsule but the entry of the tool into the patient's eye remains within the incision or incision zone along the y-direction (i.e., the "y-axis", which is a direction perpendicular to the x-direction as defined below); The tool's entry into the patient's eye is constrained to stay within the incision or incision zone along the x-direction (i.e., the "x-axis" which is parallel to the incision and in the direction of the tangent to the cornea at the incision).

[0009] In some applications, the computer processor analyzes an image of the patient's eye, determines the location of the patient's visual axis, and drives the robotic unit to move the cutting element in a circle centered on the patient's visual axis. In this regard, it should be noted that the patient's visual axis is typically not located directly at the center of the cornea or limbus. In some applications, the imaging system includes coaxial light sources. In some such applications, the computer processor determines the location of the patient's visual axis by directing light from each of the coaxial light sources toward the patient's eye. The patient is typically instructed to look at the coaxial light sources, either by the computer processor automatically generating voice instructions and / or by one of the operators instructing the patient to do so. The computer processor then identifies a Purkinje image (i.e., a reflection of light from the eye structure) in the image of the eye acquired by the imaging system. Typically, the computer processor identifies the patient's visual axis as being located at a point that is the center of the Purkinje image. As described above, the computer processor typically drives the robotic unit to move the cutting element in a circle centered on the patient's visual axis.

[0010] Typically, the robotic unit is configured to move the diathermy capsulotomy tool without violating the above-described constraints on movement. The robotic unit typically moves the tool in six degrees of freedom (e.g., x-axis, y-axis, z-axis, and pitch, yaw, and roll movement). More typically, a computer processor receives images of the diathermy capsulotomy tool and the patient's eye and analyzes these images to determine, for example, (a) the current position of the tip relative to the patient's visual axis and (b) the current position of the remote center of motion of the tool relative to the incision. Based on the computer processor's image analysis, the computer processor drives the diathermy capsulotomy tool to move and / or actuate the cutting element to apply radiofrequency energy to the anterior lens capsule, subject to the constraints described herein.

[0011] It should be noted that, due to the relatively small size of the eye and the above-mentioned constraints on the movement of the diathermy capsulotomy tool, a computer processor can typically drive the diathermy capsulotomy tool to perform a circular capsulotomy about the patient's visual axis more precisely than a human surgeon capable of performing these movements. It should also be noted that in some applications, the robotic unit automatically drives the diathermy capsulotomy tool to automatically perform the above-mentioned movements (i.e., entering the eye and then making a circular cut while maintaining the remote center of the movement position within the incision or incision zone) in response to receiving instructions from an operator. This is in contrast to an operator controlling the movement of the diathermy capsulotomy tool via a control component (a "master-slave approach").

[0012] It should further be noted that the robotic unit is configured to move and actuate the diathermy capsulotomy tool throughout the patient's eye movement, subject to the above-mentioned constraints. Typically, a computer processor receives images of the diathermy capsulotomy tool and the patient's eye, analyzes these images to determine the patient's eye movement, and dynamically adjusts the placement and / or movement of the diathermy capsulotomy tool to correspond to the patient's eye movement. For example, the computer processor dynamically adjusts the placement of the diathermy capsulotomy tool as the patient's eye moves so that the remote center of the diathermy capsulotomy tool's movement position remains within the incision. Alternatively or additionally, the computer processor dynamically adjusts the circular movement of the cutting element to match the patient's eye movement. Still alternatively or additionally, the computer processor dynamically adjusts the circular movement of the cutting element as the patient's eye moves so that the circular movement of the cutting element remains centered on the patient's visual axis.

[0013] Thus, in accordance with some applications of the present invention, there is provided an apparatus for performing a capsulotomy procedure on a patient's eye, the apparatus comprising: a diathermy capsulotomy tool including a diathermy cutting element disposed at a distal end of the diathermy capsulotomy tool; a robotic unit configured to move a diathermy capsulotomy tool; an imaging system configured to image the diathermy capsulotomy tool and the patient's eye; at least one computer processor, receiving one or more images of the diathermy capsulotomy tool and the patient's eye from the imaging system; inserting a diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye and driving the robotic unit such that a tip of the diathermy capsulotomy tool is positioned within the patient's eye and a remote center of motion position of the diathermy capsulotomy tool is positioned within the incision; activating the diathermy cutting element to apply diathermy energy to the anterior lens capsule of the patient's eye and driving the robotic unit to move the cutting element in a circular motion while maintaining a remote center of motion position of the diathermy capsulotomy tool within the incision; at least one computer processor configured to: Includes:

[0014] In some applications, to drive the robotic unit to move the cutting element in a circular motion while activating the diathermy cutting element to apply diathermy energy to the anterior lens capsule of the patient's eye and maintaining the remote center of the movement position of the diathermy capsulotomy tool within the incision, the computer processor is configured to drive the robotic unit to hold the end of the diathermy capsulotomy tool at an angle relative to the patient's eye so that the diathermy cutting element is positioned on the anterior lens capsule of the patient's eye but the entry point of the tool into the patient's eye remains within the incision.

[0015] In some applications, the computer processor is configured to determine movement of the patient's eye and dynamically adjust the placement of the diathermy capsulotomy tool so that the remote center of movement position of the diathermy capsulotomy tool is maintained within the incision.

[0016] In some applications, the computer processor is configured to determine eye movement of the patient and to dynamically adjust the circular movement of the cutting element to match the eye movement of the patient.

[0017] In some applications, the tip of the diathermy capsulotomy tool is non-straight, and the computer processor is configured to drive the robotic unit to advance the diathermy capsulotomy tool along a non-linear path to drive the robotic unit to insert the diathermy capsulotomy tool through the incision into the patient's eye.

[0018] In some applications, the computer processor is configured to determine the position of the patient's visual axis and to move the cutting element in a circular motion by moving the cutting element in a circular motion about the patient's visual axis.

[0019] In some applications, the computer processor is configured to determine the patient's eye movement and to dynamically adjust the circular movement of the cutting element to maintain the circular movement of the cutting element centered on the patient's visual axis.

[0020] In some applications, the device further includes a coaxial light source disposed on the imaging system, and the computer processor is configured to determine the location of the patient's visual axis by sending light from the coaxial light source toward the patient's eye, identifying a Purkinje image in one or more of the images acquired by the imaging system, and identifying the patient's visual axis as being located at a point that is a center of the Purkinje image.

[0021] Further, in accordance with some applications of the present invention, there is provided a method for performing a capsulotomy procedure on a patient's eye using a diathermy capsulotomy tool including a diathermy cutting element disposed at a tip thereof. The method includes: imaging the diathermy capsulotomy tool and the patient's eye with an imaging element; Using at least one computer processor, receiving one or more images of the diathermy capsulotomy tool and the patient's eye from the imaging system; inserting a diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye and driving the robotic unit such that a tip of the diathermy capsulotomy tool is positioned within the patient's eye and a remote center of motion position of the diathermy capsulotomy tool is positioned within the incision; activating the diathermy cutting element to apply diathermy energy to the anterior lens capsule of the patient's eye while driving the robotic unit to move the cutting element in a circular motion while maintaining a remote center of motion position of the diathermy capsulotomy tool within the incision; Includes:

[0022] In some applications, to activate the diathermy cutting element to apply diathermy energy to the anterior lens capsule of the patient's eye and move the cutting element in a circular motion while maintaining a remote center of movement position of the diathermy capsulotomy tool within the incision, the method further includes using a computer processor to drive the robotic unit to hold the end of the diathermy capsulotomy tool at an angle relative to the patient's eye so that the diathermy cutting element is positioned on the anterior lens capsule of the patient's eye but the entry point of the tool into the patient's eye remains within the incision.

[0023] In some applications, the method further includes using a computer processor to determine movement of the patient's eye and dynamically adjust the placement of the diathermy capsulotomy tool so that the remote center of movement position of the diathermy capsulotomy tool is maintained within the incision.

[0024] In some applications, the method further includes using a computer processor to determine movement of the patient's eye and dynamically adjust the circular movement of the cutting element to match the movement of the patient's eye.

[0025] In some applications, the tip of the diathermy capsulotomy tool is not straight, and driving the robotic unit to insert the diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye includes driving the robotic unit to advance the diathermy capsulotomy along a non-linear path.

[0026] In some applications, the method further includes determining, with a computer processor, a position of the patient's visual axis, and driving the robotic unit to move the cutting element in a circular motion includes driving the robotic unit to move the cutting element in a circular motion about the patient's visual axis.

[0027] In some applications, the method further includes using a computer processor to determine movement of the patient's eye and dynamically adjust the circular movement of the cutting element to maintain the circular movement of the cutting element centered on the patient's visual axis.

[0028] In some applications, determining the location of the patient's visual axis includes sending light from a coaxial light source toward the patient's eye, identifying a Purkinje image in one or more of the images acquired by the imaging system, and identifying the patient's visual axis as being located at a point that is the center of the Purkinje image.

[0029] The present invention will be more fully understood from the following detailed description of the embodiments, taken in conjunction with the drawings, in which: [Brief explanation of the drawings]

[0030] [Figure 1] FIG. 1 is a schematic diagram of a robotic system configured for use in microsurgical procedures, such as intraocular surgery, in accordance with some applications of the present invention. [Figure 2] 1 is a schematic diagram of an incision in a patient's cornea, in accordance with some applications of the present invention. [Figure 3]FIG. 1 is a schematic diagram of a robotic unit inserting a diathermy capsulotomy tool into a patient's eye through an incision in the patient's cornea, according to some applications of the present invention. [Figure 4A] FIG. 10 is a schematic diagram of a robotic unit that moves the diathermy tip of a diathermy capsulotomy tool to form a circle on a patient's anterior lens capsule while maintaining the position of the diathermy capsulotomy tool's entry point relative to the patient's eye within the incision or incision zone, according to some applications of the present invention. [Figure 4B] FIG. 10 is a schematic diagram of a robotic unit that moves the diathermy tip of a diathermy capsulotomy tool to form a circle on a patient's anterior lens capsule while maintaining the position of the diathermy capsulotomy tool's entry point relative to the patient's eye within the incision or incision zone, according to some applications of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0031] Reference is now made to FIG. 1 , which is a schematic illustration of a robotic system 10 configured for use in microsurgical procedures, such as intraocular surgery, in accordance with some applications of the present invention. Typically, when used in intraocular surgery, the robotic system 10 includes one or more robotic units 20 (configured to hold a tool 21), in addition to an imaging system 22, one or more displays 24, and a control component unit 26. Typically, the control component unit includes one or more control components 30 (e.g., a pair of control components 30 as shown in the enlarged portion of FIG. 1 ), through which one or more operators 25 (e.g., medical professionals such as doctors and / or nurses) can control the robotic unit 20. Typically, the robotic system 10 includes one or more computer processors 28, through which the components of the system and one or more operators 25 operatively interact. The scope of this application includes mounting one or more robotic units in any of a variety of different locations.

[0032] Typically, the movement of the robotic unit (and / or control of other aspects of the robotic system) is controlled, at least in part, by one or more operators (e.g., medical professionals such as doctors and / or nurses). For example, the operator may receive images of the patient's eye and the robotic unit and / or tools disposed thereon via the display 24. Typically, such images are acquired by the imaging system 22. In some applications, the imaging system 22 is a stereoscopic imaging device, and the display 24 is a stereoscopic display. Based on the received images, the operator typically performs steps of the procedure. In some applications, the operator provides commands to the robotic unit via the control component unit 26. Typically, such commands include commands to control the position and / or orientation of tools disposed within the robotic unit and / or commands to control operations performed by the tools. For example, the commands may control a blade, a phacoemulsification tool (e.g., the operating mode and / or suction power of the phacoemulsification tool), and / or an injection tool (e.g., which fluid (e.g., viscoelastic fluid, saline, etc.) to be injected and / or at what flow rate). Alternatively or additionally, the operator can input commands to control the imaging system (e.g., zoom, focus, and / or xy positioning of the imaging system). In some applications, the commands include controlling an intraocular lens manipulator tool to manipulate the intraocular lens within the eye to precisely position the intraocular lens within the eye.

[0033] Typically, the control component unit 26 includes one or more control components 30 configured to correspond to each robotic unit 20 of the robotic system. For example, as shown, the system may include first and second robotic units, and the control component may include first and second control components as shown. Typically, each control component is a control component arm including multiple links interconnected via joints. In some applications, the control component includes a respective control component tool 32, as shown in FIG. 1 (to represent a robotic unit). Typically, a computer processor determines the XYZ position and orientation of the tip of the control component tool 32 and drives the robotic unit such that the tip of the ophthalmic tool 21 being used to perform the procedure tracks the movement of the tip of the control component tool. In some applications, the robotic unit is configured to move the tool tip in six degrees of freedom (e.g., x-axis, y-axis, z-axis, and pitch, yaw, and roll movement). In some applications, for some tools, in response to input from use, the computer processor drives the tool to automatically perform a given action on a patient's eye. For example, in response to user input, the computer processor may automatically drive the tip of a diathermy capsulotomy tool 50 (an example of an ophthalmic tool 21, shown in Figures 3-4B) to make a circular incision in the anterior lens capsule, as described in more detail below.

[0034] Reference is now made to FIG. 2, which is a schematic illustration of an incision 40 in a patient's cornea 42, in accordance with some applications of the present invention. As discussed in the "Background" section, typically during cataract procedures, one or more incisions (typically two or three incisions) are made in the cornea of ​​an eye. The incision or incisions are usually made using a specialized blade called a keratome. Typically, a robotic unit is configured to insert a tool 21 into the patient's eye such that entry of the tool into the patient's eye occurs through the incision 40 and the tip of the tool is positioned within the patient's eye. More typically, the robotic system 10 is configured to move the tip of the tool within the patient's eye such that entry of the tool into the patient's eye is constrained to remain within the incision. In some applications, the incision width is equal to the keratome width. The incision center point 43 is thereby defined as the point on the corneal surface that is centered within the incision width. Additional axes have been added to FIG. 2. The x-axis is parallel to the incision and is tangent to the cornea at the incision, and the y-axis is perpendicular to the x-axis and is tangent to the cornea at the incision. Examples of the present invention will be described below in relation to the x-axis and y-axis.

[0035] To perform non-robotic anterior segment surgery, a surgeon typically makes one or more incisions in the patient's cornea, which later serve as entry points for various surgical tools. Tools are inserted through the incisions and manipulated within the eye to achieve the surgical goal. During this manipulation, it is medically preferable for the tool not to press too hard against the incision edge, move upward, or move too far downward. Such movements can cause tears at the incision edge, widening the incision and adversely affecting the surgical outcome. Ideally, the surgeon manipulates the tool at its entry point through the incision so that it rotates about the center of the incision but does not move laterally. This movement of the tool through the incision is referred to herein as maintaining a center of motion. In robotic procedures such as those described herein, the tools are typically controlled remotely (via the control component unit 26), and therefore the above-described movement of the tool 21 is referred to as maintaining a remote center of motion. In non-robotic procedures, manually maintaining a center of motion can be difficult, especially when the surgeon needs to focus on the tool tip performing the current surgical operation.

[0036] Reference is now made to FIG. 3 , which is a schematic illustration of a robotic unit 20 inserting a diathermy capsulotomy tool 50 into a patient's eye through an incision 40 in the patient's cornea, according to some applications of the present invention. According to some applications of the present invention, a computer processor is configured to drive the robotic unit to move the tip of the diathermy capsulotomy tool 50 within the eye, while simultaneously constraining movement of the tool at a location within the incision where the tool is positioned (referred to herein as the "remote center of tool movement location"). In some applications, the computer processor determines the placement of the tool relative to the incision by analyzing images of the tool and the patient's eye. In some applications, the computer processor constrains movement of the tool at the remote center of tool movement location to prevent the end of the tool from moving beyond the edge of the incision.

[0037] Reference is now made to FIGS. 4A and / or 4B, which are schematic illustrations of a robotic unit that moves the tip 54 of a diathermy capsulotomy tool 50 to form a circle on a patient's anterior lens capsule 56 while maintaining the position of the diathermy capsulotomy tool's entry point relative to the patient's eye within the incision 40 or incision zone in the patient's cornea, according to some applications of the present invention. As shown in FIG. 4A, the tip of the diathermy capsulotomy tool typically includes a diathermy cutting element 58 configured to cut the anterior lens capsule. The cutting element is typically an electrode pair through which high-frequency energy (e.g., energy at frequencies greater than 100 kHz, e.g., 200 kHz to 1 MHz, or 300 kHz to 700 kHz) is driven into the tissue of the anterior lens capsule, thereby cutting the anterior lens capsule. The cutting element is typically surrounded by an insulating material 60, such as a polymeric material, that isolates the cutting element from the exterior 62 of the diathermy capsulotomy tool. As described above, typically, the tip 54 of the diathermy capsulotomy tool 50 is moved in a circle over the patient's anterior lens capsule 56 while the tool's entry position relative to the patient's eye (i.e., the remote center of the tool's movement position) is maintained within the incision 40 or incision zone in the patient's cornea. Another constraint is that there is typically a height difference between the incision and the anterior lens capsule. Therefore, the robotic unit is configured to move and actuate the diathermy capsulotomy tool 50 subject to the following constraints: A) Initially, the tool must be inserted through the incision, and as the tip of the tool advances into the anterior lens capsule, the tool's entry into the patient's eye must remain within the incision (or incision zone). It should be noted that, as shown, the tip 54 of the diathermy capsulotomy tool 50 is typically not straight. Thus, as the tool tip advances through the incision, the robotic unit must advance the tool along a non-linear path to maintain the tool's entry into the patient's eye within the incision (or incision zone). B) While activating the cutting element to apply radio frequency energy to the anterior lens capsule; Circular movement of the cutting element relative to the anterior lens capsule; holding the end of the tool at an angle relative to the patient's eye so that the cutting element is positioned on the patient's anterior lens capsule but the entry of the tool into the patient's eye remains within the incision or incision zone along the y-direction; The tool's entry into the patient's eye is constrained to stay within the incision or incision zone along the x-direction.

[0038] As described above, the robotic unit typically moves the cutting element 58 in a circular motion relative to the anterior lens capsule 56. In some applications, a computer processor analyzes an image of the patient's eye, determines the location of the patient's visual axis, and drives the robotic unit to move the cutting element in a circular motion centered on the patient's visual axis. It should be noted in this regard that the patient's visual axis is typically not located directly at the center of the cornea or limbus. In some applications, the imaging system 22 (shown in FIG. 1 ) includes coaxial light sources 23. (The light sources themselves are not visible in FIG. 1 , but are typically located on a surface facing the patient's eye, as indicated by the reference numeral 23.) In some such applications, the computer processor determines the location of the patient's visual axis by directing light from each of the coaxial light sources toward the patient's eye. The patient is typically instructed to look at the coaxial light sources, either by the computer processor automatically generating voice prompts and / or by one of the operators instructing the patient to do so. The computer processor then identifies Purkinje images within the image of the eye acquired by the imaging system. Typically, the computer processor identifies the patient's visual axis as being located at the point that is the center of the Purkinje image. As described above, the computer processor typically drives the robotic unit to move the cutting element in a circle centered on the patient's visual axis.

[0039] Typically, the robotic unit is configured to move the diathermy capsulotomy tool 50 without violating the constraints on movement described above. As described above, the robotic unit typically moves the tool in six degrees of freedom (e.g., x-axis, y-axis, z-axis, and pitch, yaw, and roll movement). More typically, a computer processor receives images of the diathermy capsulotomy tool 50 and the patient's eye and analyzes these images to determine, for example, (a) the current position of the tip relative to the patient's visual axis and (b) the current position of the remote center of motion of the tool relative to the incision. Based on the computer processor's image analysis, the computer processor drives the diathermy capsulotomy tool 50 to move and / or actuate the cutting element to apply radiofrequency energy to the anterior lens capsule, subject to the constraints described herein.

[0040] It should be noted that, due to the relatively small size of the eye and the above-described constraints on the movement of the diathermy capsulotomy tool 50, a computer processor can typically drive the diathermy capsulotomy tool 50 to perform a circular capsulotomy about the patient's visual axis more precisely than a human surgeon capable of performing these movements. It should also be noted that in some applications, the robotic unit automatically drives the diathermy capsulotomy tool 50 to automatically perform the movements described above (i.e., entering the eye and then making a circular cut while maintaining the remote center of the movement position within the incision or incision zone) in response to receiving instructions from an operator. This is in contrast to an operator controlling the movement of the diathermy capsulotomy tool 50 via the control component 30 (a "master-slave approach").

[0041] It should further be noted that the robotic unit is configured to move and actuate the diathermy capsulotomy tool 50 throughout the patient's eye movements, subject to the above-mentioned constraints. Typically, a computer processor receives images of the diathermy capsulotomy tool 50 and the patient's eye, analyzes these images to determine the patient's eye movements, and dynamically adjusts the positioning and / or movement of the diathermy capsulotomy tool 50 to correspond to the patient's eye movements. For example, the computer processor dynamically adjusts the positioning of the diathermy capsulotomy tool as the patient's eye moves so that the remote center of the diathermy capsulotomy tool's movement position remains within the incision. Alternatively or additionally, the computer processor dynamically adjusts the circular movement of the cutting element to match the patient's eye movements. Still alternatively or additionally, the computer processor dynamically adjusts the circular movement of the cutting element as the patient's eye moves so that the circular movement of the cutting element remains centered on the patient's visual axis.

[0042] Although some applications of the present invention have been described in connection with cataract surgery, the scope of this application includes applying the devices and methods described herein, mutatis mutandis, to other medical procedures. In particular, the devices and methods described herein for other medical procedures may be applied to other microsurgical procedures performed using microsurgical techniques, such as general surgery, orthopedic surgery, gynecological surgery, ENT surgery, neurosurgery, oral and maxillofacial surgery, plastic surgery, podiatric surgery, vascular surgery, and / or pediatric surgery. In some such applications, the imaging system includes one or more microscopic imaging units.

[0043] It should be noted that the scope of this application includes, mutatis mutandis, the application of the devices and methods described herein to intraocular procedures other than cataract surgery. Such procedures may include collagen crosslinking, endothelial keratoplasty (e.g., DSEK, DMEK, and / or PDEK), DSO (Descemet's membrane stripping without grafting), laser-assisted corneal transplantation, corneal transplantation, LASIK / PRK, SMILE, pterygium, ocular surface cancer treatment, secondary IOL placement (suture, transconjunctival, etc.), iris repair, IOL repositioning, IOL exchange, lamellar keratectomy, minimally invasive glaucoma surgery (MIGS), limbal stem cell transplantation, astigmatic keratectomy, limbal relaxing incision (LRI), amniotic membrane transplantation (AMT), glaucoma surgery (e.g., trub, tube, minimally invasive glaucoma surgery), automated lamellar keratoplasty (ALK), anterior vitrectomy, and / or pars plana anterior vitrectomy.

[0044] The applications of the invention described herein may take the form of a computer program product accessible from a computer-usable or computer-readable medium (e.g., a non-transitory computer-readable medium) that provides program code for use by or in connection with a computer or any instruction execution system, such as computer processor 28. For purposes of this description, a computer-usable or computer-readable medium may be any apparatus that can contain, store, transmit, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device. The medium may be an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system (or apparatus or device) or propagation medium. Typically, the computer-usable or computer-readable medium is a non-transitory computer-usable or computer-readable medium.

[0045] Examples of computer-readable media include semiconductor or solid state memory, magnetic tape, removable computer diskettes, random access memory (RAM), read-only memory (ROM), rigid magnetic disks, and optical disks, current examples of which include compact disk read-only memory (CD-ROM), compact disk read / write (CD-R / W), DVD, and USB drives.

[0046] A data processing system suitable for storing and / or executing program code includes at least one processor (e.g., computer processor 28) coupled directly or indirectly to memory elements via a system bus. The memory elements may include local memory utilized during the actual execution of the program code, mass storage devices, and cache memory that provides temporary storage of at least some of the program code to reduce the number of times the code must be retrieved from mass storage devices during execution. The system is capable of reading instructions of the present invention on a program storage device and performing the method of an embodiment of the present invention in accordance with these instructions.

[0047] Coupling a network adapter to a processor enables the processor to be coupled to other processors or remote printers or storage devices through intervening private or public networks. Modems, cable modems, and Ethernet cards are just a few examples of currently available types of network adapters.

[0048] Computer program code for carrying out operations of the present invention can be written in any combination of one or more programming languages, including object-oriented programming languages, such as Java, Smalltalk, C++, and conventional procedural programming languages, such as the C programming language or similar programming languages.

[0049] It will be understood that the algorithms described herein can be embodied by computer program instructions. These computer program instructions can be provided to a processor of a general-purpose computer, special-purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, when executed by the processor of the computer (e.g., computer processor 28) or other programmable data processing apparatus, produce means for performing the functions / acts specified in the algorithms described herein. These computer program instructions can also be stored on a computer-readable medium (e.g., a non-transitory computer-readable medium) to direct the computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored on the computer-readable medium can produce an article of manufacture including instruction means for performing the functions / acts specified in the algorithms. The computer program instructions can also be loaded onto a computer or other programmable data processing apparatus to perform a series of operational steps on the computer or other programmable data processing apparatus to produce a computer-implemented process, such that the instructions, when executed on the computer or other programmable data processing apparatus, provide the process for performing the functions / acts specified in the algorithms described herein.

[0050] Computer processor 28 is typically a hardware device that is programmed with computer program instructions to create a special-purpose computer. For example, when programmed to execute the algorithms described with reference to the figures, computer processor 28 typically acts as a special-purpose robotics system computer processor. Typically, the operations described herein as being performed by computer processor 28 change the physical state of a memory, which is an actual physical item, having a different magnetic polarity, charge, etc., depending on the memory technology being used. In some applications, the operations described herein as being performed by a computer processor are performed by multiple computer processors in combination with each other.

[0051] It will be appreciated by those skilled in the art that the present invention is not limited to what has been specifically shown and described above, and the scope of the present invention includes both combinations and subcombinations of the various features described above, as well as variations and modifications that are not present in the prior art and that would occur to one skilled in the art upon reading the foregoing description.

Claims

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

2. 2. The apparatus of claim 1, wherein the computer processor is configured to drive the robotic unit to hold the end of the diathermy capsulotomy tool at an angle relative to the patient's eye so that the diathermy cutting element is positioned on the anterior lens capsule of the patient's eye but the entry point of the tool into the patient's eye remains within the incision, in order to drive the robotic unit to move the cutting element in a circular motion while activating the diathermy cutting element to apply diathermy energy to the anterior lens capsule of the patient's eye and while maintaining a remote center of the movement position of the diathermy capsulotomy tool within the incision.

3. 2. The device of claim 1, wherein the computer processor is configured to determine movement of the patient's eye and dynamically adjust the placement of the diathermy capsulotomy tool so that a remote center of the movement position of the diathermy capsulotomy tool is maintained within the incision.

4. 10. The device of claim 1, wherein the computer processor is configured to determine movement of the patient's eye and dynamically adjust the circular movement of the cutting element to coincide with the movement of the patient's eye.

5. 2. The device of claim 1, wherein the tip of the diathermy capsulotomy tool is not straight, and the computer processor is configured to drive the robotic unit to advance the diathermy capsulotomy tool along a non-linear path to drive the robotic unit to insert the diathermy capsulotomy tool through the incision into the patient's eye.

6. 6. The apparatus of claim 1, wherein the computer processor is configured to determine a position of the patient's visual axis and to move the cutting element in a circular motion by moving the cutting element in a circular motion about the patient's visual axis.

7. 7. The device of claim 6, wherein the computer processor is configured to determine eye movement of the patient and to dynamically adjust the circular movement of the cutting element to maintain the circular movement of the cutting element centered on the patient's visual axis.

8. 7. The apparatus of claim 6, further comprising: a coaxial light source disposed on the imaging system; and wherein the computer processor is configured to determine the location of the patient's visual axis by sending light from the coaxial light source toward the patient's eye, identifying a Purkinje image in one or more of the images acquired by the imaging system, and identifying the patient's visual axis as being located at a point that is a center of the Purkinje image.

9. 1. A method for performing a capsulotomy procedure on a patient's eye using a diathermy capsulotomy tool, the diathermy capsulotomy tool including a diathermy cutting element disposed at a tip thereof, the method comprising: imaging the diathermy capsulotomy tool and the patient's eye with an imaging element; Using at least one computer processor, receiving one or more images of the diathermy capsulotomy tool and the patient's eye from the imaging system; inserting the diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye and driving the robotic unit such that the tip of the diathermy capsulotomy tool is positioned within the patient's eye and a remote center of motion position of the diathermy capsulotomy tool is positioned within the incision; driving the robotic unit to move the cutting element in a circular motion while activating the diathermy cutting element to apply diathermy energy to the anterior lens capsule of the patient's eye and while maintaining a remote center of the movement position of the diathermy capsulotomy tool within the incision; A method comprising:

10. 10. The method of claim 9, wherein the method further comprises using the computer processor to drive the robotic unit to hold the end of the diathermy capsulotomy tool at an angle relative to the patient's eye so that the diathermy cutting element is positioned on the anterior lens capsule of the patient's eye but the entry point of the tool into the patient's eye remains within the incision, to move the cutting element in a circular motion while activating the diathermy cutting element to apply diathermy energy to the anterior lens capsule of the patient's eye and maintaining a remote center of the movement position of the diathermy capsulotomy tool within the incision.

11. 10. The method of claim 9, further comprising using the computer processor to determine movement of the patient's eye and dynamically adjusting the placement of the diathermy capsulotomy tool so that the remote center of the movement position of the diathermy capsulotomy tool is maintained within the incision.

12. 10. The method of claim 9, further comprising using the computer processor to determine movement of the patient's eye and dynamically adjusting the circular movement of the cutting element to match the movement of the patient's eye.

13. 10. The method of claim 9, wherein the tip of the diathermy capsulotomy tool is not straight, and driving the robotic unit to insert the diathermy capsulotomy tool into the patient's eye through an incision in the cornea of ​​the patient's eye comprises driving the robotic unit to advance the diathermy capsulotomy tool along a non-linear path.

14. 14. The method of claim 9, further comprising determining, with the computer processor, a position of the patient's visual axis, and wherein driving the robotic unit to move the cutting element in the circular motion comprises driving the robotic unit to move the cutting element in a circular motion about the patient's visual axis.

15. 15. The method of claim 14, further comprising using the computer processor to determine eye movement of the patient and dynamically adjusting the circular movement of the cutting element to maintain the circular movement of the cutting element centered on the patient's visual axis.

16. 15. The method of claim 14, wherein determining the location of the patient's visual axis comprises sending light from a coaxial light source toward the patient's eye, identifying a Purkinje image in one or more of the images acquired by the imaging system, and identifying the patient's visual axis as being located at a point that is a center of the Purkinje image.

Images