Radiofrequency vitrectomy device

Abstract

Certain embodiments provide a radiofrequency vitrectomy device including a handpiece having an outer tube attached thereto, with a vibrating inner tube within the outer tube and coupled to a drive diaphragm. Extension and retraction air pressure control valves receive pressure from the extension and retraction channels and control the flow of gas from a pressurized gas source to the extension and retraction sides, respectively, of a chamber housing the drive diaphragm. The handpiece may include an input diaphragm coupled to a valve stem to which the extension and retraction valves are connected. One side of the chamber housing the input diaphragm is coupled to the extension channel, and the other is coupled to the retraction channel. An aspiration line passes through the input diaphragm and the valve stem and has an end in fluid communication with the inner tube.

Description

[Technical Field]

[0001] The present disclosure relates generally to surgical instruments for performing vitrectomy procedures. [Background technology]

[0002] Vitreoretinal procedures can include a variety of surgical procedures performed to restore, maintain, and improve vision. Vitreoretinal procedures can be suitable for treating many serious conditions in the posterior segment of the eye. Vitreoretinal procedures can treat conditions such as age-related macular degeneration (AMD), diabetic retinopathy and diabetic vitreous hemorrhage, macular hole, retinal detachment, epiretinal membrane, CMV (cytomegalovirus) retinitis, and many other eye diseases.

[0003] The vitreous is a normally clear, gel-like substance that fills the center of the eye. It can occupy approximately two-thirds of the eye's volume and is formed and shaped before birth. Certain problems affecting the back of the eye may require a vitrectomy, or surgical removal of the vitreous. Removal of the vitreous may require a vitrectomy device that functions like a small guillotine, using vibrating, microscopic cutters to remove the vitreous gel in a controlled manner. The vitrectomy device is powered by a pneumatic vitrectomy machine integrated into a surgical console that contains one or more pneumatic valves (also called drive valves).

[0004] The vitrectomy device is coupled to the surgical console by first and second channels, which may be implemented as separate tubes or different sections of a single tube. The surgical console alternatively couples the first and second channels to a high-pressure source to vibrate the cutter of the vitrectomy device. The lengths of the first and second channels are typically greater than one meter and may be up to two meters. As a result, pressure in the vitrectomy device is significantly attenuated, thereby increasing the time required to build up enough pressure to redirect the cutter. Summary of the Invention [Means for solving the problem]

[0005] SUMMARY The present disclosure generally relates to a vitrectomy device having an integrated valve and directly connected to a high voltage source to achieve higher cutting frequencies.

[0006] Certain embodiments provide a system for performing vitrectomy surgery, including a pressurized gas source and an air pressure control system having an extension port and a retraction port. The air pressure control system is configured to alternately supply gas from the pressurized gas source to the extension port and the retraction port. The system further includes a vitrectomy device including a handpiece defining an extension channel coupled to the extension port, a retraction channel coupled to the retraction port, and a supply channel coupled to the pressurized gas source. An outer tube is attached to the handpiece and defines a side opening. An inner tube is slidably disposed within the outer tube. A drive diaphragm within the handpiece is configured to vibrate the inner tube. An extension air pressure control valve is attached to the handpiece and in fluid communication with the supply channel. The extension air pressure control valve is configured to couple the supply channel to an extension side of a drive diaphragm chamber that houses the drive diaphragm in response to pressure applied to the extension channel. The retraction air pressure control valve is attached to the handpiece and in fluid communication with the supply channel. The retraction air pressure control valve is configured to couple the supply channel to the retraction side of the actuation diaphragm chamber in response to pressure being applied to the retraction channel.

[0007] The following description and the annexed drawings set forth in detail certain illustrative features of the one or more embodiments.

[0008] The accompanying drawings depict only examples of certain embodiments of the present disclosure and therefore should not be considered as limiting the scope of the present disclosure. [Brief explanation of the drawings]

[0009] [Figure 1]1 illustrates a cutter suitable for use with a radio frequency vitrectomy device, according to certain embodiments. [Figure 2] 1 shows a schematic diagram of a pneumatic system for controlling a radio frequency vitrectomy device, according to certain embodiments. [Figure 3] 1 shows a schematic diagram of a radio frequency vitrectomy device, according to certain embodiments. [Figure 4A] 1 illustrates a radio frequency vitrectomy device at the distal end of an oscillation cycle, according to certain embodiments. [Figure 4B] 1 illustrates a radio frequency vitrectomy device at the proximal end of an oscillation cycle, according to certain embodiments. [Figure 5] FIG. 1 illustrates an exemplary handpiece incorporating a valve for implementing a radiofrequency vitrectomy device, in accordance with certain embodiments. DETAILED DESCRIPTION OF THE INVENTION

[0010] For ease of understanding, the same reference numerals have been used wherever possible to designate identical elements that are common to the figures. It is contemplated that elements and features of one embodiment may be beneficially incorporated in other embodiments without further recitation.

[0011] Although features provided herein may be discussed below with reference to particular embodiments and figures, all embodiments discussed herein may include one or more of the advantageous features discussed herein. In other words, although one or more embodiments may be discussed as having particular advantageous features, one or more of such features may be used in accordance with various other embodiments discussed herein. Similarly, although example embodiments may be discussed below as device, apparatus, or method embodiments, it should be understood that such example embodiments may be implemented in a variety of devices, apparatus, and methods.

[0012] FIG. 1 illustrates a cutter 100 that can be used with a radiofrequency vitrectomy device according to embodiments disclosed herein. The cutter 100 is merely exemplary; any cutter suitable for performing a vitrectomy procedure according to embodiments disclosed herein can be used. The cutter 100 includes an outer tube 102 having a covered distal end 104 and a side opening 106. The side opening 106 extends through the cylindrical wall of the outer tube 102. An inner tube 108 oscillates within the outer tube 102, with a distal direction 110 defined as movement toward the distal end 104 and a proximal direction 112 defined as movement away from the distal end 104. The inner tube 108 is coupled to an aspirator, i.e., vacuum pressure. The vacuum draws vitreous 114 into the outer tube 102 through the side opening 106. As the inner tube 108 crosses the side opening 106, the inner tube 108 cuts away a piece of vitreous, which is then pulled out of the inner tube 108 by vacuum pressure. The range of motion of the inner tube 108 can be from an extended position, in which the inner tube 108 extends completely across the side opening 106, to a retracted position, in which the inner tube 108 does not extend over the side opening 106 or only partially extends across the side opening 106.

[0013] At least three aspects of the operation of the cutter 100 are improved using the vitrectomy device disclosed herein. First, as the vibration frequency of the inner tube 108 increases, the size of the chunks of vitreous 114 cut by the inner tube 108 becomes smaller and more numerous, resulting in less force being exerted on the surrounding vitreous. In other words, the vibration frequency increases, resulting in reduced traction on the surrounding vitreous. Second, with certain existing cutters, such as the cutter 100, when the inner tube 108 vibrates, some vibrations 116 are transmitted to the vitreous, which can be harmful to sensitive tissues such as the retina. By increasing the frequency of vibration of the inner tube 108 using the embodiments disclosed herein, the frequency of the vibrations 116 increases, resulting in more rapid decay. Third, because friction between the inner tube 108 and the outer tube 102 may be unavoidable, the embodiments disclosed herein allow for more force to be applied to the inner tube 108, thereby enabling higher frequency vibrations.

[0014] FIG. 2 shows a schematic diagram of a pneumatic system 200 for controlling a radiofrequency vitrectomy device according to embodiments disclosed herein. Components of the pneumatic system 200 may be incorporated into a surgical console. The pneumatic system 200 controls the pressure of high-pressure gas supplied to the extension channel 202 and the retraction channel 204 at a user-specified, default, or automatically selected pressure. The pneumatic system 200 alternately supplies high-pressure gas to the extension channel 202 and the retraction channel 204 at a user-specified, default, or automatically selected frequency. For example, the high-pressure gas may be received from a wall outlet in a typical medical facility, which may have a pressure of 58 to 120 pounds per square inch (psi) (4 to 8.3 bar). The pneumatic system 200 is exemplary only. The radiofrequency vitrectomy device disclosed herein advantageously can be used with any pneumatic system known in the art without requiring modification of such a system.

[0015] The exemplary pneumatic system 200 includes a pneumatic valve 206 for coupling a pressure source 208 (e.g., a regulated pressure source such as a gas cylinder or wall-outlet gas supply) to output ports 210 and 212. Output port 210 is coupled to extension channel 202, and output port 212 is coupled to retraction channel 204. Pressure sensors 210a, 212a can sense the pressure of the gas supplied to output ports 210, 212, respectively, and provide the pressure measurements to controller 214 so that controller 214 can adjust the pressure supplied to output ports 210, 212.

[0016] The extension channel 202 and the retraction channel 204 may be embodied as multi-channel tubing or separate tubing. In some embodiments, the pneumatic valve 206 may be controlled by a controller 214, which may itself control the pneumatic valve 206 according to control parameters such as a desired cutting speed and / or duty cycle. In some embodiments, the pressure of the pressure source 208 may also be regulated by the controller 214 or a separate controller (e.g., internal to a surgical console). The controller 214 may adjust the pressure (e.g., to balance low pressure for reduced gas consumption and high pressure for faster cutting speeds and / or to increase the dynamic range of available cutting speeds).

[0017] The pneumatic valve 206 may include a solenoid operable to move the pneumatic valve 206 between two positions as dictated by a control signal from the controller 214. In the extended position, the pneumatic valve 206 may allow pressurized gas to pass through the pneumatic valve 206 to the output port 210 to supply the high-pressure gas to the extension channel 202, while exhausting the pressurized gas from the output port 212 through the exhaust port 216. In the retracted position, the pneumatic valve 206 may supply the pressurized gas to the output port 212 and exhaust the pressurized gas from the output port 210 through the exhaust port 216.

[0018] 3 illustrates an exemplary embodiment of a radio frequency vitrectomy device 300. The radio frequency vitrectomy device 300 includes multiple pneumatic components, such as valves and diaphragms, that are mounted within the handpiece and can be used to amplify the alternating pressure received from the extension channel 202 and retraction channel 204 using gas received from a pressure source 208 to drive oscillation of the inner tube 108 within the outer tube 102. The outer tube 102 is mounted to the handpiece.

[0019] The radiofrequency vitrectomy device 300 includes an input diaphragm chamber 302 divided into two sides by an input diaphragm 304. An extension side 302a of the input diaphragm chamber 302 is connected to the extension channel 202, and a retraction side 302b of the diaphragm chamber is connected to the retraction channel 204. The radiofrequency vitrectomy device 300 further includes a drive diaphragm chamber 306 divided into two sides by a drive diaphragm 308. An extension side 306a of the drive diaphragm chamber 306 is connected to the extension drive channel 310a, and a retraction side 306b of the drive diaphragm chamber 306 is connected to the retraction drive channel 310b. An aspiration line 326 coupled to a vacuum pressure source may pass through the drive diaphragm 308 and connect to the inner tube 108.

[0020] Input diaphragm 304 is connected to extend valve 314a and retract valve 314b by coupler 312. Coupler 312 is a mechanical coupling that changes the position of extend valve 314a and retract valve 314b in response to movement of input diaphragm 304. As such, coupler 312 can be a rigid body to which valves 314a, 314b are fixed, a push-pull cable or cable system, or any mechanical coupling known in the art.

[0021] The extension valve 314a is disposed within an extension valve chamber 316a having an exhaust valve surface 318a connected to an exhaust line 320. The extension valve chamber 316a further has a supply valve surface 322a connected to a supply line 324. The extension valve chamber 316a is further coupled to the extension actuation channel 310a. The supply line 324 may be connected to the pressure source 208 or a different pressure source. The gas supplied to the supply line 314 may be regulated to the same or a different pressure than the pressure supplied to the output ports 210, 212.

[0022] Reverse valve 314b is disposed within a reverse valve chamber 316b having an exhaust valve surface 318b connected to an exhaust line 320. Reverse valve chamber 316b further has a supply valve surface 322b connected to a supply line 324. Reverse valve chamber 316b is further coupled to a reverse actuation channel 310b.

[0023] 4A and 4B illustrate different operating states of the radio frequency vitrectomy device 300. As used in the following description, closing the valve surfaces 318a, 318b, 322a, 322b may be understood as substantially closing the valve surfaces such that the flow of gas through the valve surfaces is substantially reduced, for example, by at least 80 percent, at least 90 percent, or at least 99 percent of the gas flow when the valve surfaces 318a, 318b, 322a, 322b are open.

[0024] With particular reference to FIG. 4A , in the extended state (i.e., when the inner tube 108 is actuated or in the extended position), the extension channel 202 is connected to the pressure source 208, thereby pressurizing the extension side 302a of the input diaphragm chamber 302. In this state, the input diaphragm 304 is displaced such that the coupler 312 actuates the extension valve 314a toward the exhaust valve surface 318a and the retract valve 314b toward the supply valve surface 322b. Thus, the exhaust valve surface 318b and the supply valve surface 322a are open. In the extended state, with the supply valve surface 322a open, the supply line 324 is connected to the extension side 306a of the actuating diaphragm chamber 306 via the valve chamber 316a and the extension actuating channel 310a. Thus, the actuating diaphragm 308 is displaced in the distal direction 110, actuating the inner tube 108 in the distal direction 110.

[0025] In the extended state, the retracted side 306b of the actuating diaphragm chamber 306 is connected to the exhaust line 320 through the valve chamber 316b by the open exhaust valve surface 318b, thereby allowing gas to be exhausted from the retracted side 306b into the exhaust line 320.

[0026] 4B , in the retracted state (i.e., when the inner tube is actuated or in the retracted position), the retraction channel 204 is connected to the pressure source 208, thereby pressurizing the retraction side 302b of the input diaphragm chamber 302. In this state, the input diaphragm 304 is displaced such that the coupler 312 actuates the retraction valve 314b toward the exhaust valve surface 318b and the extension valve 314a toward the supply valve surface 322a, thereby closing the exhaust valve surface 318b and the supply valve surface 322a. Thus, the exhaust valve surface 318a and the supply valve surface 322b are open. In the retracted state, with the supply valve surface 322b open, the supply line 324 is connected to the retraction side 306b of the actuating diaphragm chamber 306 via the valve chamber 316b and the retraction actuating channel 310b. Thus, drive diaphragm 308 is displaced in proximal direction 112 , driving inner tube 108 in proximal direction 112 .

[0027] In the retracted state, the extension side 306a of the actuating diaphragm chamber 306 is connected to the exhaust line 320 through the valve chamber 316a by the exhaust valve surface 318a being open, thereby allowing gas to be exhausted from the extension side 306a into the exhaust line 320.

[0028] The vitrectomy device 300 oscillates the valves 314a, 314b and diaphragms 304, 308 between extended and retracted states. Gas flow through the extension channel 202 and retraction channel 204 only needs to pressurize the sides 302a, 302b of the input diaphragm chamber 302 enough to change the position of the valves 314a, 314b, which is much less force than is required to overcome the friction and inertia of the inner tube 108. The supply line 324 can be maintained at a constant pressure, and gas from the supply line 324 only needs to traverse a relatively short path through one of the valve chambers 316a, 316b and either the extension drive channel 310a or the retraction drive channel 310b. Thus, the force applied to the inner tube 108 can be much greater and switched much faster.

[0029] 5 illustrates an exemplary handpiece 500 incorporating components for implementing a radiofrequency vitrectomy device, according to certain embodiments. The handpiece 500 is described below, beginning with the proximal end 500a of the illustrated portion of the handpiece 500 and proceeding to the distal end 500b.

[0030] The handpiece 500 includes an aspiration tube 502. The aspiration tube 502 may be cylindrical in shape, e.g., a cylindrical tube, and various other components of the handpiece 500 may be substantially centered (e.g., within 1-3 mm (millimeters)) about a central axis 502a of the aspiration tube 502. In use, the aspiration tube 502 is connected to a vacuum pressure source. The handpiece 500 further defines an extension channel 504 that is coupled to the extension channel 202 in use, and a retraction channel 506 that is connected to the retraction channel 204 in use. The handpiece 500 defines a supply channel 508 that is connected to the pressure source 208 or other source of pressurized gas in use. In the illustrated embodiment, the aspiration tube 502, extension channel 504, retraction channel 506, and supply channel 508 extend parallel to one another toward the proximal end 500a of the handpiece 500, although other arrangements are possible.

[0031] The handpiece 500 defines an input diaphragm chamber 510 having an input diaphragm 512 disposed therein that divides the input diaphragm chamber 510 into an extension side 510a and a retraction side 510b. The input diaphragm 512 may be substantially centered on a central axis 502a and generally symmetrical about the central axis 502a. The suction tube 502 passes through the input diaphragm 512, and a seal 512a incorporated in the input diaphragm 512 may permit sliding of the input diaphragm 512 relative to the suction tube 502 while preventing gas flow through the interface between the input diaphragm 512 and the suction tube 502. The diaphragm's oscillation may be substantially parallel (e.g., within 2 degrees) to the central axis 502a. The extension side 510a of the diaphragm chamber is connected to the extension channel 504, and the retraction side 510b is connected to the retraction channel 506.

[0032] The input diaphragm 512 is connected to a valve stem 514 such that the valve stem 514 vibrates in response to vibration of the input diaphragm 512. The valve stem 514 is substantially centered about a central axis 502a and may be symmetrical about the central axis 502a. The valve stem 514 extends from the input diaphragm 512 through a valve stem channel 516. A seal 518 may be disposed within the valve stem channel 516 to prevent gas flow through the valve stem channel 516.

[0033] The valve stem 514 passes through an extension valve chamber 520a and a retract valve chamber 520b. The valve stem 514 similarly passes through an extension exhaust chamber 522a, a retract exhaust chamber 522b, and a supply chamber 526. Each exhaust chamber 522a, 522b includes an exhaust opening 524a, 524b that exhausts gas from the handpiece 500 directly to the atmosphere or through an exhaust tube. The supply chamber 526 is in fluid communication with the supply channel 508 and is disposed between the valve chambers 520a, 520b. The extension exhaust chamber 522a is in fluid communication with the valve chamber 520a and is disposed between the valve chamber 520a and the valve stem channel 516. The retract exhaust chamber 522b is in fluid communication with the valve chamber 520b, and the valve chamber 520b is disposed between the retract exhaust chamber 522b and the supply chamber 526.

[0034] This configuration is illustrative only. For example, assume that supply chamber 526 is connected to an exhaust opening, while exhaust chambers 522a, 522b are connected to supply channel 508 and do not have exhaust ports 524a, 524b. In this case, vibration is still possible, but in the opposite direction (pressurizing extension channel 504 causes movement of inner tube 108 in proximal direction 112, and pressurizing retraction channel 506 causes movement in distal direction 110).

[0035] [Extension valve chamber 520a is connected by extension drive channel 528a to extension side 530a of drive diaphragm chamber 530, which has drive diaphragm 532 disposed therein. Retract valve chamber 520b is connected by retract drive channel 528b to retract side 530b of drive diaphragm chamber 530.

[0036] The inner tube 108 passes through the drive diaphragm 532, and a seal 532a incorporated into the drive diaphragm 532 allows the inner tube 108 to slide relative to the drive diaphragm while preventing gas flow between the extension side 530a and the retraction side 530b through the drive diaphragm 532. The inner tube 108 can enter the suction tube 502 by passing through another seal 534 located in a cavity 536 in the extension side 530a, while remaining slidable within the suction tube 502.

[0037] An extension valve 536a is disposed within extension valve chamber 520a, and a retract valve 536b is disposed within retract valve chamber 520b. Each valve chamber 520a, 520b has an exhaust side 538a, 538b and a supply side 540a, 540b, respectively. Each valve chamber 520a, 520b is connected to a corresponding exhaust chamber 522a, 522b through an opening in the exhaust side 538a, 538b, respectively. Each valve chamber 520a, 520b is connected to a supply chamber 526 through an opening in the supply side 540a, 540b, respectively. When pressed against the supply side 540a, 540b, each valve 536a, 536b substantially seals the valve chamber 520a, 520b from the supply chamber 526. When pressed against the exhaust side 538a, 538b, each valve 536a, 536b can substantially seal the valve chamber 520a, 520b from the higher corresponding exhaust chamber 522a, 522b. The portion of the valve 536a, 536b that contacts each side 538a, 538b, 540a, 540b can be covered with a material to enhance the seal, such as an elastomeric material.

[0038] In the illustrated implementation, supply sides 540a, 540b face inward toward each other and toward supply chamber 526. Exhaust sides 538a, 538b face outward from each other toward exhaust chambers 522a, 522b. Surfaces of valves 536a, 536b that contact exhaust sides 538a, 538b and supply sides 540a, 540b may be coated with a sealing material, such as an elastomer, to facilitate sealing.

[0039] In the extended state, pressurized gas is supplied to extension channel 504, driving input diaphragm 532 toward distal end 500b (in distal direction 110). This forces extension valve 536a against exhaust side 538a of extension valve chamber 520a, pushing valve stem 514 and valves 536a, 536b away from supply side 540a. In this state, extension valve chamber 520a is in fluid communication with supply chamber 526 and is substantially sealed from extension exhaust chamber 522a, allowing gas from pressure source 208 or other pressurized gas source to flow through extension drive channel 528a and into extension side 530a. This urges drive diaphragm 532 and inner tube 108 in distal direction 110.

[0040] In the extended state, retract valve 536b is forced against supply side 540b and away from exhaust side 538b. In this state, retract valve chamber 520b is in fluid communication with retract exhaust chamber 522b and is substantially sealed from supply chamber 526, placing retract side 530b in fluid communication with exhaust port 524b and allowing pressurized gas to exit retract side 530b.

[0041] In the retracted state, pressurized gas is supplied to the retraction channel 506, driving the input diaphragm toward the proximal end 500a (in the proximal direction 112). This forces the retraction valve 536b against the exhaust side 538b of the retraction valve chamber 520b, pushing the valve stem 514 and valves 536a, 536b away from the supply side 540b. In this state, the retraction valve chamber 520b is in fluid communication with the supply chamber 526 and is substantially sealed from the retraction exhaust chamber 522b, allowing pressurized gas from the pressure source 208 or other pressurized gas source to flow through the retraction drive channel 528b and into the retraction side 530b. This biases the drive diaphragm 532 and inner tube 108 in the proximal direction 112.

[0042] In the retracted state, extension valve 536a is forced against supply side 540a and away from exhaust side 538a. In this state, extension valve chamber 520a is in fluid communication with extension exhaust chamber 522a and is substantially sealed from supply chamber 526, placing extension side 530a in fluid communication with exhaust port 524a and allowing pressurized gas to exit retracted side 530b.

[0043] As is evident from FIG. 5 and the above description, extension valve chamber 520a and retract valve chamber 520b remain in fluid communication with extension drive channel 528a and retract drive channel 528b, respectively, regardless of the state of valves 536a, 536b.

[0044] The above description is provided to enable those skilled in the art to practice the various embodiments described herein. Various modifications to these embodiments will be readily apparent to those skilled in the art, and the general principles defined herein may be applied to other embodiments. Accordingly, the claims are not intended to be limited to the embodiments shown herein, but are to be accorded the full scope consistent with the language of the claims.

Claims

1. an outer tube defining a side opening; an inner tube disposed within the outer tube; a handpiece defining an extension channel, a retraction channel, and a supply channel, the outer tube being attached to the handpiece; a plurality of pneumatic components within the handpiece configured to amplify alternating pressures supplied to the extension channel and the retraction channel using gas supplied through the supply channel to drive oscillation of the inner tube within the outer tube; 1. A vitrectomy device comprising:

2. The plurality of pneumatic components in the handpiece include: a drive diaphragm chamber; a drive diaphragm in the drive diaphragm chamber configured to oscillate an inner tube of a cutter; an extension air pressure control valve mounted within the handpiece and in fluid communication with a supply channel, the extension air pressure control valve configured to couple the supply channel to an extension side of a drive diaphragm chamber that houses the drive diaphragm in response to pressure being applied to the extension channel; a retraction air pressure control valve mounted within the handpiece and in fluid communication with the supply channel, the retraction air pressure control valve configured to couple the supply channel to a retraction side of the actuation diaphragm chamber in response to pressure being applied to the retraction channel; The vitrectomy device of claim 1 , comprising:

3. the handpiece defining at least one exhaust opening; the extension pneumatic control valve is further configured to couple the at least one exhaust opening to the extension side of the actuation diaphragm chamber in response to pressure being applied to the retraction channel; and 3. The vitrector of claim 2, wherein the retraction air pressure control valve is further configured to couple the at least one exhaust opening to the extension side of the actuation diaphragm chamber in response to pressure being applied to the extension channel.

4. 4. The vitrectomy device of claim 3, further comprising an input diaphragm within an input diaphragm chamber defined by the handpiece, the extension channel in fluid communication with an extension side of the input diaphragm chamber, and the retraction channel in fluid communication with a retraction side of the input diaphragm chamber, the input diaphragm connected to the extension air pressure control valve and the retraction air pressure control valve by a coupler.

5. 5. The vitrectomy device of claim 4, wherein the coupler is a valve stem, and the extend air pressure control valve and the retract air pressure control valve are fixed to the valve stem.

6. 8. The vitrectomy device of claim 7, further comprising an aspiration tube extending through the input diaphragm, the valve stem, and the drive diaphragm, the distal end of the aspiration tube being in fluid communication with the inner tube.

7. 6. The vitrectomy device of claim 5, wherein the handpiece defines an extension valve chamber and a retraction valve chamber, the extension air pressure control valve disposed in the extension valve chamber, and the retraction air pressure control valve disposed in the retraction valve chamber, the extension valve chamber in fluid communication with the extension side of the drive diaphragm chamber, and the retraction valve chamber in fluid communication with the retraction side of the drive diaphragm chamber.

8. 8. The vitrector of claim 7, further comprising a supply chamber disposed between the extension valve chamber and the retraction valve chamber and in fluid communication with the extension valve chamber and the retraction valve chamber, the valve stem extending through the supply chamber, and the supply chamber in fluid communication with the supply channel.

9. the at least one exhaust opening is an extending exhaust opening and a retracting exhaust opening; 9. The vitrectomy device of claim 8, wherein the handpiece defines an elongated exhaust chamber in fluid communication with the elongated exhaust opening and a retracted exhaust chamber in fluid communication with the retracted exhaust opening, the elongated valve chamber disposed between the elongated exhaust chamber and the supply chamber, and the retracted valve chamber disposed between the retracted exhaust chamber and the supply chamber.

10. 10. The vitrector of claim 9, further comprising a first seal extending around the valve stem and disposed between the input diaphragm and the elongated exhaust chamber.

11. 11. The vitrector of claim 10, further comprising a second seal extending around the valve stem and disposed between the back-up exhaust chamber and the drive diaphragm.

12. 3. The vitrector of claim 2, wherein the inner tube is slidably disposed within the outer tube, the inner tube being connected to the drive diaphragm such that the inner tube vibrates in response to vibration of the drive diaphragm.

13. 1. A system for performing a vitrectomy, comprising: a source of pressurized gas; a pneumatic control system having an extension port and a retraction port, the pneumatic control system being configured to alternately supply gas from the pressurized gas source to the extension port and the retraction port; 1. A vitrectomy device comprising: a handpiece defining an extension channel coupled to the extension port, a retraction channel coupled to the retraction port, a supply channel coupled to the pressurized gas source, and a drive diaphragm chamber; an outer tube attached to the handpiece and defining a side opening; an inner tube slidably disposed within the outer tube; a drive diaphragm disposed within the drive diaphragm chamber and configured to vibrate the inner tube; an extension air pressure control valve mounted within the handpiece and in fluid communication with the supply channel, the extension air pressure control valve configured to couple the supply channel to an extension side of a drive diaphragm chamber that houses the drive diaphragm in response to pressure being applied to the extension channel; a retraction air pressure control valve mounted within the handpiece and in fluid communication with the supply channel, the retraction air pressure control valve configured to couple the supply channel to a retraction side of the actuation diaphragm chamber in response to pressure being applied to the retraction channel; a vitrectomy device including: A system including:

14. the handpiece defining at least one exhaust opening; the extension pneumatic control valve is further configured to couple the at least one exhaust opening to the extension side of the actuation diaphragm chamber in response to pressure being applied to the retraction channel; and 14. The system of claim 13, wherein the retraction air pressure control valve is further configured to couple the at least one exhaust opening to the extension side of the actuation diaphragm chamber in response to pressure being applied to the extension channel.

15. 15. The system of claim 14, further comprising an input diaphragm within an input diaphragm chamber defined by the handpiece, the extension channel in fluid communication with an extension side of the input diaphragm chamber and the retraction channel in fluid communication with a retraction side of the input diaphragm chamber, the input diaphragm connected to the extension air pressure control valve and the retraction air pressure control valve by valve stems.

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