System and method for mitigating post-occlusion destructive surge

Abstract

A surgical cassette for an ophthalmic surgical system includes an irrigation system and an aspiration system. The irrigation system is in fluid communication with a handpiece and transports fluids toward a surgical site. The aspiration system is in fluid communication with the handpiece and transports fluids away from the surgical site. The aspiration system includes an aspiration pump and tubing for an aspiration conduit. The aspiration pump creates a normal vacuum pressure in the aspiration conduit to transport fluids away from the surgical site during normal operation. The tubing has a larger cross-sectional area in response to the normal vacuum pressure. The tubing contracts from a larger cross-sectional area to a smaller cross-sectional area in response to an occlusion, maintains the smaller cross-sectional area during a post-occlusion breakdown surge to mitigate the post-occlusion breakdown surge, and returns to the larger cross-sectional area after the post-occlusion breakdown surge.

Description

【Technical Field】 【0001】 The present disclosure relates to an ophthalmic surgical system and method, and more particularly, to a system and method for reducing post-occlusion disruption surgery during ophthalmic surgery. 【Background Art】 【0002】 In cataract surgery, the cataractous lens is removed and replaced with an artificial intraocular lens (IOL). The cataractous lens is typically removed by fragmenting the lens and aspirating the lens fragments out of the eye. The lens can be fragmented using, for example, a phacoemulsification aspiration handpiece, a laser handpiece, or other suitable handpieces. During the procedure, the handpiece fragments the lens, and the fragments are aspirated out of the eye through, for example, a hollow needle. Throughout the procedure, irrigation fluid is pumped into the eye to maintain intraocular pressure (IOP) and prevent collapse of the eyeball. 【0003】 Complications occur when there is a clogging or occlusion of the needle. When irrigation fluid and emulsified tissue are aspirated through the hollow needle, a piece of tissue may clog the tip and a vacuum pressure may build up within the tip. Occlusion disruption occurs when the tissue breaks freely and moves through the needle. When this happens, the vacuum pressure in the anterior chamber suddenly drops, resulting in a post-occlusion disruption surgery. In some cases, a relatively large amount of fluid and tissue may be rapidly aspirated out of the eye by the post-occlusion disruption surgery, which may cause the eye to collapse and / or the lens capsule to rupture. Known techniques for reducing this surgery are not effective enough to be satisfactory in certain situations. 【Summary of the Invention】 【Means for Solving the Problems】 【0004】 According to a particular embodiment, a surgical cassette for an ophthalmic surgical system includes a perfusion system and a suction system. The perfusion system communicates fluid with the handpiece and delivers fluid toward the surgical site. The suction system communicates fluid with the handpiece and delivers fluid away from the surgical site. The suction system includes a suction pump and a suction conduit tube. The suction pump normally generates vacuum pressure within the suction conduit to deliver fluid away from the surgical site during normal operation. The tube normally has a larger cross-sectional area depending on the vacuum pressure. In response to occlusion, the tube shrinks from a larger cross-sectional area to a smaller cross-sectional area, maintains a smaller cross-sectional area during the post-occlusion rupture surge to mitigate the rupture surge, and returns to a larger cross-sectional area after the rupture surge. 【0005】 Embodiments may not include any of the following features, or may include one, some or all of them: A surgical cassette according to claim 1, wherein the tube comprises a reducing viscoelastic material that allows the tube to shrink from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion and to maintain a smaller cross-sectional area during a post-occlusion rupture surge. A surgical cassette according to claim 1, wherein the tube comprises a reducing cross section that allows the tube to shrink from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion and to maintain a smaller cross-sectional area during a post-occlusion rupture surge. A surgical cassette according to claim 1, wherein the tube comprises one or more reducing sections. Each reducing section allows the tube to shrink from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion and to maintain a smaller cross-sectional area during a post-occlusion rupture surge. The reducing section may comprise a reducing viscoelastic material and / or a reducing cross section. A first reducing section may comprise a reducing viscoelastic material, and a second reducing section may comprise a reducing cross section. The relief section may have a length of 0.1 to 10 centimeters (cm). 【0006】 According to a particular embodiment, a method for mitigating a post-occlusion rupture surge includes transporting fluid toward the surgical site by a perfusion system in fluid communication with a handpiece; transporting fluid away from the surgical site by a suction system in fluid communication with a handpiece; generating a normal vacuum pressure in the suction conduit by a suction pump of the suction system to transport fluid away from the surgical site during normal operation; and reducing the cross-sectional area of ​​the suction conduit tube in response to occlusion, wherein the tube normally has a larger cross-sectional area in response to vacuum pressure; reducing the cross-sectional area during a post-occlusion rupture surge by maintaining a smaller cross-sectional area; and returning to a larger cross-sectional area after a post-occlusion rupture surge. 【0007】 Embodiments may not include any of the following features, or may include one, some, or all of them: The reduction of the tube from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion is provided by the mitigating viscoelastic material of the tube. The maintenance of a smaller cross-sectional area during a post-occlusion rupture surge is provided by the mitigating viscoelastic material of the tube. The reduction of the tube from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion is provided by the mitigating section of the tube. The maintenance of a smaller cross-sectional area during a post-occlusion rupture surge is provided by the mitigating section of the tube. The reduction of the tube from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion is provided by a mitigating section among one or more mitigating sections of the tube. The maintenance of a smaller cross-sectional area during a post-occlusion rupture surge is provided by a mitigating section. A mitigating section may include a mitigating viscoelastic material and / or a mitigating section. A first mitigating section may include a mitigating viscoelastic material, and a second mitigating section may include a mitigating section. The relief section may have a length of 0.1 to 10 centimeters (cm). 【0008】 According to a particular embodiment, a surgical cassette for an ophthalmic surgical system includes a perfusion system and a suction system. The perfusion system communicates fluid with the handpiece and delivers fluid toward the surgical site. The suction system communicates fluid with the handpiece and delivers fluid away from the surgical site. The suction system includes a suction pump and a tubing for a suction conduit. The suction pump normally generates a vacuum pressure within the suction conduit to deliver fluid away from the surgical site during normal operation. The tubing normally has a larger cross-sectional area depending on the vacuum pressure. The tubing includes relief sections. Each relief section allows the tubing to shrink from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion, maintain a smaller cross-sectional area during the post-occlusion rupture surge, and return to a larger cross-sectional area after the post-occlusion rupture surge. At least the first relief section includes a relief viscoelastic material that allows the tubing to shrink from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion and maintain a smaller cross-sectional area during the post-occlusion rupture surge. At least the second mitigation section includes a mitigation section that allows the tube to shrink from a larger cross-sectional area to a smaller cross-sectional area in response to occlusion and to maintain a smaller cross-sectional area during post-occlusion rupture surge. 【0009】 Embodiments may include the following features: at least a third mitigation section includes a mitigation viscoelastic material and a mitigation cross section. [Brief explanation of the drawing] 【0010】 [Figure 1] Figure 1 shows an example of an ophthalmic surgical system that may be used to perform ophthalmic procedures on the eye, according to a specific embodiment. [Figure 2] Figure 2 shows an example of a subsystem of the console of the ophthalmic surgery system shown in Figure 1, according to a specific embodiment. [Figure 3] Figure 3 shows an example of a fluid subsystem that may be used with the surgical console of the ophthalmic surgical system shown in Figures 1 and 2, according to a specific embodiment. [Figure 4]Figure 4 shows an example of the fluid subsystem from Figure 3, including an example of a variable volume chamber that can mitigate post-occlusion surge. [Figure 5] Figure 5 shows an example of the handpiece from Figure 3, which includes a variable volume chamber that can reduce post-occlusion surge. [Figure 6] Figure 6 shows an example of a method that may be used by the fluid subsystem in Figure 3 to mitigate post-occlusive rupture surges during surgical procedures, according to a specific embodiment. [Figure 7] Figure 7 shows an example of the fluid subsystem of Figure 3, including an example of a chamber system that can mitigate post-occlusion surge. [Figure 8] Figure 8 shows an example of a method that may be used by the fluid subsystem in Figure 3 to mitigate post-occlusive disruptive surges during surgical procedures, according to a specific embodiment. [Figure 9] Figure 9 shows an example of the fluid subsystem from Figure 3, which implements a priming procedure that can improve the reduction of post-occlusion surge. [Figure 10] Figure 10 shows an example of the fluid subsystem of Figure 3, including an example of a perfusion system that can mitigate post-occlusion surge. [Figure 11] Figure 11 shows an example of a method that may be used by the fluid subsystem in Figure 3 to mitigate post-occlusive disruptive surges during surgical procedures, according to a specific embodiment. [Figure 12] Figure 12 shows an example of a tube containing a viscoelastic material. [Figure 13A] Figure 13A shows an example of a tube with a reduced cross-section. [Figure 13B] Figure 13B shows an example of a tube with a reduced cross-section. [Figure 14A] Figure 14A shows an example of a tube having a relief section with a relief cross-section. [Figure 14B] Figure 14B shows an example of a tube having a relief section with a relief cross-section. [Figure 14C] Figure 14C shows an example of a tube having a relief section with a relief cross-section. [Modes for carrying out the invention] 【0011】 To facilitate understanding of the principles of this disclosure, embodiments shown in the drawings will be referenced here, and specific language will be used to describe them. Nevertheless, it should be understood that this is not intended to limit the scope of this disclosure. Any alternative and further modifications to the devices, apparatus, and methods described, as well as any further applications of the principles of this disclosure, are fully assumed to be as commonly conceivable by those skilled in the art to which this disclosure relates. In particular, features, components, and / or steps described in relation to one embodiment are fully assumed to be combined with features, components, and / or steps described in relation to other embodiments of this disclosure. However, for the sake of brevity, numerous iterations of these combinations will not be described separately. For the sake of simplification, the same or similar parts will be referenced using the same reference numerals throughout the drawings, where applicable. 【0012】 This disclosure generally relates to devices, systems, and methods for performing lens fragmentation procedures. During fragmentation, mitigating post-occlusion disruptive surges can be important for the success of the procedure. The devices, systems, and methods disclosed herein include features for mitigating post-occlusion disruptive surges. 【0013】 Figure 1 shows an example of an ophthalmic surgical system 10 that may be used to perform ophthalmic procedures on the eye according to a particular embodiment. In the illustrated example, the system 10 includes a console 100, a housing 102, a display screen 104, an interface device 107 (e.g., a foot pedal), a fluid subsystem 110, and a handpiece 112, coupled together as shown and described in more detail with reference to Figure 2. 【0014】 FIG. 2 is an example of a subsystem of the console 100 of the ophthalmic surgical system 10 according to a particular embodiment. The console 100 includes a housing 102 that houses subsystems 106, 110, and 116 that support a computer 103 (having an associated display screen 104), as well as an interface device 107 and handpieces 112 (112a-c). The interface device 107 receives inputs to the surgical system 10, transmits outputs from the system 10, and / or processes inputs and / or outputs. Examples of the interface device 107 include foot pedals, manual input devices (e.g., keyboards), and displays. The interface subsystem 106 receives inputs from the interface device 107 and / or transmits outputs to the interface device 107. 【0015】 The handpiece 112 can be any suitable ophthalmic surgical instrument, such as an ultrasonic-driven phacoemulsification aspiration (phaco) handpiece, a laser handpiece, an irrigation cannula, a vitrectomy handpiece, or other suitable surgical handpiece. The fluid subsystem 110 provides fluid control for one or more handpieces 112 (112a-c). For example, the fluid subsystem 110 can manage the fluid for an irrigation cannula. The handpiece subsystem 116 supports one or more handpieces 112. For example, the handpiece subsystem 116 can manage ultrasonic vibrations for a phaco handpiece, supply laser energy to a laser handpiece, control the operation of an irrigation cannula, and / or manage the functions of a vitrectomy handpiece. 【0016】 The computer 103 controls the operation of the ophthalmic surgical system 10. In a particular embodiment, the computer 103 includes a controller that transmits instructions to components of the system 10 to control the system 10. The display screen 104 shows data provided by the computer 103. 【0017】 <\ FIG. 3 shows an example of a fluid subsystem 110 that can be used with the surgical console 100 of the ophthalmic surgical system 10 of FIGS. 1 and 2 according to a particular embodiment. Generally, a controller 360 (such as computer 103) controls portions of the fluid subsystem 110 to maintain a target intraocular pressure (IOP) of the eye (e.g., a value within the range of 0 to 110 millimeters of mercury (mmHg)) during a surgical procedure performed using the handpiece 112. If the controller 360 determines that the IOP is outside the target range, the controller 360 controls the fluid subsystem 110 to return the pressure to the target range. For example, post-occlusion disruption can create a surge in volume demand from the eye that is not tolerable. To mitigate the surge, the fluid subsystem can satisfy the fluid demand before the volume is demanded from the eye. 【0018】 In the illustrated example, the fluid subsystem 110 has a cassette body 301 that can be housed by the surgical console 100 as a surgical cassette. The fluid subsystem 110 includes a perfusion system 300 and a suction system 305 that are controlled by the controller 360. The perfusion system 300 and the suction system 305 are in fluid communication with the handpiece 112. During normal operation, the perfusion system 300 conveys fluid toward the surgical site, and the suction system 305 conveys fluid away from the surgical site. A perfusion conduit 302 provides fluid communication between the perfusion system 300 and the handpiece 112, and a suction conduit 303 provides fluid communication between the suction system 305 and the handpiece 112. Portions that are in fluid communication with each other are portions where fluid can flow between (to and / or from) the portions. 【0019】 The suction system 305 transports fluid away from the surgical site by generating and maintaining a vacuum pressure (or negative pressure) in the vacuum path of the suction conduit 303. Vacuum pressure can be described as negative pressure. Therefore, increasing the vacuum pressure can be described as increasing the negative pressure or decreasing the pressure, and decreasing the vacuum pressure can be described as decreasing the negative pressure or increasing the pressure. In certain embodiments, the suction pump of the suction system 305 may be reversed to supply fluid to the suction conduit 303 in order to mitigate post-occlusion surge. 【0020】 The handpiece 112 includes a perfusion channel 320, a suction channel 355, and a handpiece pressure sensor (HPS) 365. The perfusion channel 320 may be a perfusion tip or perfusion sleeve that provides fluid to the surgical site and surrounds the suction channel 355. The suction channel 355 may be a hollow needle that vibrates at a constant frequency to break up tissue. Fluid and tissue can be aspirated through the needle. In certain embodiments, the handpiece 112 may be an ultrasonically driven phaco handpiece or a laser handpiece that uses laser energy to fragment the lens to facilitate the emulsification and aspiration process. 【0021】 The HPS365 is a perfusion pressure sensor that detects the perfusion pressure within the perfusion conduit 302. In the illustrated example, the HPS365 is positioned on the handpiece 112 close to the surgical site, for example, less than 12 inches from the surgical site. Proximity to the surgical site allows for rapid detection of pressure changes (which may occur during occlusion rupture), enabling real-time surge suppression. In some examples, the HPS365 detects pressure changes within 50 milliseconds of occlusion rupture, which may allow the controller 360 to respond to pressure deviations before the IOP is excessively adversely affected. Generally, the perfusion pressure sensor may be positioned at any suitable location on the handpiece 112 (e.g., the proximal end, distal end, or near the perfusion channel 320), at any suitable location along the perfusion conduit, or in any suitable component that is in fluid communication with the surgical site (e.g., in a separate tube or probe). 【0022】 The controller 360 is a computer that controls parts of the fluid subsystem 110, such as valves or pumps, in response to pressure changes in order to maintain a target pressure at the surgical site. The controller 360 can determine the IOP from the pressure associated with the surgical site of the eye, i.e., the "surgical site pressure," which may be measured at the surgical site or elsewhere. The surgical system 10 may have one or more sensors at different locations for measuring the surgical site pressure. For example, a sensor may be placed at or inside the eye to directly measure the IOP of the eye. As another example, the perfusion pressure measured in the perfusion conduit and / or the suction pressure measured in the suction conduit may indicate the IOP. The surgical site pressure may not be the same as the IOP, and may correspond to the IOP in that a higher surgical site pressure indicates a higher IOP, and a lower surgical site pressure indicates a lower IOP. The surgical site pressure may have a target range corresponding to the target IOP of the eye, for example, a value within the range of 0 to 110 mmHg (e.g., a value within the range of 10 to 30, 30 to 55, 55 to 80 and / or 80 to 100 mmHg, for example, 30 to 80 mmHg). For example, the perfusion pressure may have a target range of 0 to 110 mmHg (e.g., a value within the range of 0 to 30, 30 to 70 or 70 to 110 mmHg), or the suction pressure may have a target range of -760 to 110 mmHg (e.g., a value within the range of -760 to -300, -300 to -100 or -100 to 110 mmHg). 【0023】 The controller 360 can retrieve one or more pressure thresholds from memory. Upon detecting that the pressure has reached a pressure threshold, the controller 360 provides instructions to return the pressure to the target range. For example, to mitigate post-occlusion rupture volume surge, a first pressure threshold may indicate when the surgical site pressure has decreased to an unacceptable threshold in response to occlusion rupture, for example, when an undesirable volume demand is generated. In response, the controller 360 reduces the vacuum pressure in the suction conduit 303 and / or perfusion conduit 302 to mitigate the rapid decrease in surgical site pressure. For example, the controller 360 may supply fluid to satisfy the undesirable volume demand in order to bring the surgical site pressure closer to the desired level. The first pressure threshold may have any suitable value, for example, a value in the range of 0 to 207 mmHg (e.g., a value in the range of 0 to 35, 35 to 100, or 100 to 207 mmHg). 【0024】 A second pressure threshold may indicate when the surgical site pressure is at an acceptable threshold, signifying that the surgical site pressure has recovered. In response, the controller 360 stops reducing the vacuum pressure in the suction conduit 303 and / or perfusion conduit 302. The second pressure threshold may have any appropriate value, for example, a value in the range of -760 to 207 mmHg (e.g., a value in the range of -760 to -600, -600 to -400, -400 to -200, -200 to 0, or 0 to 207 mmHg). In some embodiments, the second pressure threshold may be selected so that the controller 360 stops reducing the vacuum pressure before reaching the target IOP range, since the vacuum pressure usually continues to decrease for a short time after the controller 360 has acted to stop reducing it. 【0025】 In the example above, a first pressure threshold defined in terms of perfusion pressure and a second pressure threshold defined in terms of suction pressure are used, but the first and second thresholds may be defined in terms of using an appropriate type of pressure (e.g., suction pressure, perfusion pressure, or intraocular pressure) from any appropriate sensor indicating pressure at the surgical site. In addition, the first and / or second thresholds may be defined with respect to the same or different types of pressure; for example, both thresholds may be defined with respect to suction pressure. 【0026】 Variable volume chamber Figure 4 shows an example of the fluid subsystem 110 of Figure 3, including an example of a variable volume chamber 36 that can mitigate post-occlusion surge. 【0027】 In the illustrated embodiment, the fluid subsystem 110 includes a perfusion system 300 and a suction system 305 that manage the fluid for the handpiece 112. The suction system 305 includes a suction conduit 303, a chamber 36, a suction pressure sensor (APS) 330, a suction pump 335, and a drain reservoir 340, which communicate with the fluid along the suction path as shown. The APS 330 detects the suction pressure in the suction conduit 303. The suction pump 335 generates vacuum pressure in the suction conduit 303 between the pump 335 and the eye, drawing fluid from the surgical site into the drain reservoir 340. In certain embodiments, the suction pump 335 may be reversed to supply fluid to the suction conduit 303 to mitigate post-occlusion surge. The drain reservoir 340 receives fluid from the surgical site. 【0028】 Chamber 36 is a variable-volume (or contractible) chamber that expands to store fluid and contracts to move fluid to meet volume requirements in the suction conduit 303, thereby mitigating post-occlusion rupture surge. "Expanding" means increasing the volume, and "contracting" means decreasing the volume. Chamber 36 can expand and contract in any suitable manner. In certain embodiments, Chamber 36 includes a piston that moves in a first direction to expand Chamber 36 to store fluid and in a second direction to contract Chamber 36 to move fluid. The piston may have any suitable size and shape to fit closely within at least a portion of Chamber 36 to form a fluid-tight seal. For example, the piston may have a cylindrical shape (or other shape) that fits within a cylindrical tube (or other corresponding shape of tube) of Chamber 36. When the piston moves in the first direction, the volume of Chamber 36 increases. When the piston moves in the second direction (typically the opposite direction to the first direction), the volume of Chamber 36 decreases. 【0029】 In certain embodiments, the chamber 36 includes a membrane that changes into a first shape that expands the chamber 36 to store fluid, and into a second shape that contracts the chamber 36 to move fluid. The membrane may be a flexible, optionally stretchable sheet material forming at least a portion of the chamber 36, and may have any suitable size and shape for storing fluid within the chamber 36. The first shape of the membrane may be a shape (e.g., spherical) in which the membrane holds a larger (or even larger) volume of fluid, and the second shape of the membrane may be a shape in which the membrane holds a smaller (or even smaller) volume of fluid. 【0030】 In certain embodiments, the chamber 36 includes a foldable portion that expands the chamber 36 to store fluid and folds it to contract the chamber 36 to move the fluid. The foldable portion may be a semi-rigid sheet material having one or more folds that form at least a portion of the chamber 36 and may have any suitable size and shape for storing fluid in the chamber 36. At least one fold can be expanded to increase the volume of the chamber 36, and at least one fold can be folded to decrease the volume of the chamber 36. As an example, the foldable portion may be accordion-shaped. 【0031】 Chamber 36 may have any suitable components that facilitate expansion and / or contraction of the chamber 36. For example, chamber 36 may have a valve (e.g., a solenoid valve) that expands the chamber 36 to store fluid and contracts the chamber 36 to move fluid. 【0032】 Chamber 36 can be actively or passively expanded and / or contracted (for example, in response to instructions from controller 36). In an active embodiment, controller 360 can instruct chamber 36 to contract in response to pressure detected by one or more pressure sensors. In a passive embodiment, chamber 36 may be configured to contract to move fluid to meet volume requirements in the suction conduit, even without instructions from controller 360. For example, chamber 36 may have a pressure-sensitive actuator that contracts chamber 36 in response to pressure changes from a post-occlusion surge. 【0033】 Figure 5 shows an example of the handpiece 112 of Figure 3, which includes a variable volume chamber 36 that can mitigate post-occlusion surge. The chamber 36 is a variable volume chamber that expands to store fluid and contracts to move the fluid to meet the volume requirements in the suction conduit 303, thereby mitigating post-occlusion surge. The chamber 36 may be as described with respect to Figure 4. 【0034】 Figure 6 shows an example of a method 400 that may be used by the fluid subsystem 110 of Figure 3 to mitigate post-occlusive rupture surges during surgical procedures, according to a specific embodiment. The method begins in step 410, where a perfusion system delivers fluid toward the surgical site and a suction system delivers fluid away from the surgical site. 【0035】 The chamber of the suction system expands to store fluid in step 414. In certain embodiments, the chamber includes a piston that moves in a first direction to expand the chamber. In other embodiments, the chamber includes a membrane that changes into a first shape to expand the chamber. In yet another embodiment, the chamber includes a foldable portion that unfolds to expand the chamber. 【0036】 In step 416, a post-occlusion surge may occur. If a post-occlusion surge occurs, the method proceeds to step 420, where the mitigation process may be active or passive. If the process is active, the method proceeds to step 422, where the controller instructs the fluid to move into the chamber. The method then proceeds to step 424. If the process is passive, the method proceeds directly to step 424. If no post-occlusion surge occurs, the method proceeds to step 428. 【0037】 The chamber is reduced in step 424 by moving fluid to meet the volume requirement and to mitigate post-occlusion surge. In certain embodiments, the chamber includes a piston that moves in a second direction (e.g., the opposite direction to the first direction in step 414) to reduce the chamber. In other embodiments, the chamber includes a membrane that changes into a second shape to reduce the chamber. In yet another embodiment, the chamber includes a foldable portion that folds to reduce the chamber. 【0038】 The chamber expands in step 426 to store fluid and prepare for another post-occlusion surge. The chamber may expand in the manner described in step 414, and may expand actively or passively. The procedure may end in step 428. If the procedure is not completed, the method returns to step 416. If the procedure is completed, the method terminates. 【0039】 Chamber system Figure 7 shows an example of the fluid subsystem 110 of Figure 3, including an example of a chamber system 35 that can mitigate post-occlusion disruptive surges. In the illustrated embodiment, the fluid subsystem 110 includes a perfusion system 300 and a suction system 305 that manage fluid for the handpiece 112. The suction system 305 includes a suction conduit 303, a chamber system 37(37a-c), a suction pressure sensor (APS) 330, a suction pump 335, a drain reservoir 340, and a reservoir 333, all of which communicate fluid along the suction path as shown. The APS 330 detects the suction pressure in the suction conduit 303. The suction pump 335 generates vacuum pressure in the suction conduit 303 between the pump 335 and the eye, drawing fluid from the surgical site into the drain reservoir 340. In certain embodiments, the suction pump 335 may be reversed to supply fluid to the suction conduit 303 in order to mitigate post-occlusion disruptive surges. The drain reservoir 340 receives fluid from the surgical site. Reservoirs 333 store fluid that can be used for surge reduction and may be implemented as one or more reservoirs. Examples of reservoirs 333 include venturi, drain, vent, perfusion, and other suitable reservoirs. 【0040】 The chamber system 35 includes a plurality of chambers 37 (37a-c). The chamber system 35 stores fluid in the chambers 37 and satisfies the volume requirements in the suction conduit by moving fluid from one or more of the chambers 37 to mitigate post-occlusion surge. The chambers 37 can be located in any suitable position. For example, chamber 37a may be located along a drain path leading to a drain reservoir 340. As another example, chamber 37b may be located along a reservoir path leading to a reservoir 333. As yet another example, chamber 37c may be located along a perfusion conduit 302 of the perfusion system 300. 【0041】 In certain embodiments, the chamber system 35 can satisfy volume requirements by moving fluid. The chamber system 35 can move fluid based on the characteristics of the post-occlusion rupture surge. Examples of such movement include: (1) The chamber system 35 can move fluid from more chambers 37 for larger post-occlusion rupture surges and from fewer chambers 37 for smaller post-occlusion rupture surges. (2) The chamber system 35 can move fluid from one or more larger chambers 37 for larger post-occlusion rupture surges and from one or more smaller chambers 37 for smaller post-occlusion rupture surges. (3) Chambers 37 closer to the pressure increase associated with the surge can move fluid before or instead of chambers 37 further from the pressure increase. 【0042】 In certain embodiments, the chamber system 35 can actively or passively satisfy volume requirements by actively or passively moving fluid. The chamber system 35 can actively or passively move fluid (for example, in response to instructions from the controller 36). In certain active embodiments, the controller 36 can determine the size and / or location of a post-occlusion rupture surge and then instruct the chamber system 35 to respond as described above. In certain passive embodiments, the chambers 37 may have pressure-sensitive members such that the chambers 37 move fluid as described above. For example, a chamber 37 closer to an increase in surge-related pressure can move fluid before a chamber 37 further away. As another example, more chambers 37 can move fluid in response to a larger increase in surge-related pressure than to a smaller increase. 【0043】 Figure 8 shows an example of a method 440 that may be used by the fluid subsystem 110 of Figure 3 to mitigate post-occlusive rupture surges during surgical procedures, according to a specific embodiment. The method begins in step 450, where a perfusion system delivers fluid toward the surgical site and a suction system delivers fluid away from the surgical site. 【0044】 The chamber of the suction system's chamber system stores the fluid in step 454. In certain embodiments, the chamber can receive and / or expand to store the fluid provided by the fluid source. 【0045】 In step 456, a post-occlusion rupture surge may occur. If a post-occlusion rupture surge occurs, the method proceeds to step 460, where the mitigation process may be active or passive. If the process is active, the method proceeds to step 462, where the controller instructs the chamber system to move fluid. The controller can determine the characteristics of the surge and then move the fluid according to those characteristics. Next, the method proceeds to step 464. If the process is passive, the method proceeds directly to step 464. If no post-occlusion rupture surge occurs in step 456, the method proceeds to step 468. 【0046】 The chamber system moves fluid in step 464 to mitigate the post-occlusion surge. The method by which the fluid is moved may be based on the characteristics of the surge. The procedure may end in step 468. If the procedure is not complete, the procedure returns to step 454, where the chamber stores fluid in preparation for mitigating the next surge. If the procedure is complete, the procedure ends. 【0047】 Priming treatment Figure 9 shows an example of the fluid subsystem 110 of Figure 3 that performs a priming procedure that can improve the mitigation of post-occlusion rupture surges. Generally, bubbles trapped in the vacuum path may shrink during surge mitigation, impairing the effectiveness and predictability of the mitigation. The priming procedure can improve surge mitigation by oscillating the suction flow back and forth to reduce bubbles trapped in the vacuum path. In certain embodiments, the controller 360 sends an instruction to perform the priming procedure. This instruction may be sent automatically (e.g., before the procedure) or in response to user input. 【0048】 In the illustrated embodiment, the fluid subsystem 110 includes a perfusion system 300 and a suction system 305 that manage the fluid for the handpiece 112. The suction system 305 includes a suction conduit 303, a suction pressure sensor (APS) 330, a suction pump 335, a drain reservoir 340, a reservoir 333, and a valve 377, all of which communicate with the fluid along the suction path as shown. The APS 330 detects the suction pressure in the suction conduit 303. The suction pump 335 generates vacuum pressure in the suction conduit 303 between the pump 335 and the eye, drawing fluid from the surgical site into the drain reservoir 340. The drain reservoir 340 receives the fluid from the surgical site. 【0049】 Reservoir 333 stores fluid that can be used for surge mitigation and may be implemented as one or more reservoirs. Examples of reservoirs 333 include venturis, drains, vents, perfusions, and other suitable reservoirs. Valve 337 manages the fluid in the suction conduit 303 to perform a priming procedure. Valve 377 may be implemented as one or more valves. "Opening" a valve may mean opening one of several valves, and "closing" a valve may mean closing the same valve or another of several valves. In certain embodiments, controller 360 transmits an instruction to valve 337 to perform a priming procedure. 【0050】 The priming procedure involves moving the fluid in the suction conduit 303 back and forth, for example, by vibration, to reduce air (e.g., bubbles) in the suction conduit 303. This procedure can vibrate the fluid at any suitable frequency, in the range of low frequencies to ultrasonic frequencies, e.g., once per second vibration ~70 kHz. The movement can be generated in any suitable way. Examples of techniques for generating movement include: (1) Valve 337 can vibrate the fluid by rapidly switching between opening to move the fluid into the suction conduit 303 and closing to stop the fluid movement. (2) Suction pump 335 can vibrate the fluid by rapidly changing the vacuum pressure in the suction conduit 303. (3) Suction pump 335 can vibrate the fluid by changing the vacuum pressure so that valve 337 can vibrate the fluid in coordination with it. (4) The cassette body 301 can be mechanically vibrated using a fluid mechanism located in console 100. (5) Tube 302 or 303 itself can be mechanically vibrated. (6) The phaco handpiece 112 can be operated during priming. In certain embodiments, the controller 360 transmits instructions to the relevant components to perform the priming procedure. 【0051】 In certain embodiments, the suction conduit 303 may include a tube that facilitates the removal of air bubbles. In embodiments, the tube may have an inner surface that is less prone to air bubble adhesion. For example, the surface may be hydrophilic or superhydrophilic (e.g., a very low water contact angle of less than 10°), which allows water droplets to disperse in seconds. An example of such a tube is a superhydrophilic polydimethylsiloxane (PDMS) tube. 【0052】 Perfusion system reduction Figure 10 shows an example of the fluid subsystem 110 of Figure 3, including an example of a perfusion system 300 that can mitigate post-occlusion rupture surge. In this embodiment, the perfusion system 300 delivers fluid toward the surgical site via a perfusion conduit. In response to a post-occlusion rupture surge, the perfusion system 300 moves additional fluid to meet the volume requirements within the perfusion conduit in order to mitigate the post-occlusion rupture surge. 【0053】 In the illustrated embodiment, the fluid subsystem 110 includes a perfusion system 300 and a suction system 305 for managing the fluid for the handpiece 112. The perfusion system 300 includes a perfusion conduit 302, a perfusion fluid source (IFS) 310, a perfusion pump 317, a perfusion pressure sensor (IPS) 316, and a chamber 36, which communicate with the fluid along the perfusion path as shown. The IPS 316 measures the pressure in the perfusion conduit 302. The IFS 310 supplies the perfusion fluid, for example, sterile saline. The perfusion pump 317 generates pressure to supply fluid from the IFS 310 to the perfusion conduit 302. 【0054】 Chamber 36 stores fluid and moves the fluid to meet the volume requirements of the perfusion conduit 302. In certain embodiments, chamber 36 is a variable volume chamber that expands to store fluid and contracts to move fluid (as described with respect to Figures 4-6). In other embodiments, chamber 36 represents a chamber system of the perfusion system 300 (as described with respect to Figures 7 and 8) that stores fluid and moves fluid from one or more chambers in the chamber system. In certain embodiments, controller 360 sends instructions to the perfusion system 300 to mitigate post-occlusion surge. 【0055】 In certain embodiments, in response to changes in vacuum pressure indicating blockage or surge, the perfusion system 300 moves additional fluid (such as pressurized fluid) into the perfusion conduit 302 to mitigate post-blockage surge. The perfusion system 300 can move additional fluid in any suitable manner, including one or more of the following examples: (1) A perfusion pump 317 increases the pressure to supply additional fluid from the IFS 310 to the perfusion conduit 302. (2) A chamber 36 is a variable volume chamber that expands to store additional fluid and contracts to move additional fluid into the perfusion conduit 302. (3) The chamber 36 is a chamber system that moves additional fluid from one or more chambers of a chamber system to the perfusion conduit 302. (4) A valve or other fluid switch can move additional fluid stored in any suitable fluid source at any suitable location in the perfusion path. The stored additional fluid may be pressurized fluid from a pneumatic supply source, a perfusion bag chamber, a peristaltic pump and / or a suitable chamber in the perfusion path. 【0056】 The movement of fluid can be active or passive. In an active embodiment, the controller 360 detects when the pressure reaches a threshold and instructs a component of the perfusion system 300 (e.g., perfusion pump 317, chamber 36, or valve) to move additional fluid into the perfusion conduit 302. In a passive embodiment, the components of the perfusion system 300 move fluid into the perfusion conduit 302 in response to the pressure reaching a threshold. 【0057】 Figure 11 shows an example of a method 478 that may be used by the fluid subsystem 110 of Figure 3 to mitigate post-occlusive rupture surges during surgical procedures, according to a specific embodiment. The method begins in step 480, where a perfusion system delivers fluid toward the surgical site and a suction system delivers fluid away from the surgical site. 【0058】 The perfusion system stores additional fluid in step 484. The additional fluid can be stored, for example, in a chamber (e.g., a variable volume chamber or chamber system), an infusion fluid source (IFS), or other suitable fluid source. In certain embodiments, the fluid may be pressurized. In step 486, a post-occlusion rupture surge may occur. If a post-occlusion rupture surge occurs, the method proceeds to step 490, where the mitigation process may be active or passive. If the process is active, the method proceeds to step 492, where the controller instructs the perfusion system to move the additional fluid stored therein. The method then proceeds to step 494. If the process is passive, the method proceeds directly to step 494. If no post-occlusion rupture surge occurs in step 486, the method proceeds to step 498. 【0059】 The perfusion system moves additional fluid in step 494 to mitigate the post-occlusion surge. The procedure may end in step 498. If the procedure is not complete, the method returns to step 484, where the perfusion system stores fluid in preparation for mitigating the next surge. If the procedure is complete, the method ends. 【0060】 Surge reduction tube Figures 12–14C show an example of a tube 40 in the suction system 305 of the fluid subsystem 110 of Figure 3, which can mitigate post-occlusion rupture surges during surgical procedures. In certain embodiments, the suction pump normally generates a vacuum in the suction conduit during normal operation to transport fluid away from the surgical site. The suction pressure may have a target range of -760 to 0 mmHg, as described with reference to Figure 3. The tube 40 has a larger cross-sectional area under normal suction flow and vacuum than under occlusion. 【0061】 The blockage increases the vacuum in the suction conduit to the blockage vacuum limit, which can range from 0 to 760 mmHg. Depending on the duration of the blockage vacuum (e.g., longer than 10 milliseconds (ms)), tube 40 shrinks from a larger cross-sectional area to a smaller cross-sectional area. When the blockage ruptures, it generates a post-blockage rupture surge. Tube 40 resists the surge and maintains a smaller cross-sectional area for the duration of the surge (possibly longer). Typically, the surge lasts up to 500 milliseconds, but can last up to 1 second (s). After the surge duration, tube 40 returns to a larger cross-sectional area. 【0062】 Tube 40 has a mitigating viscoelastic material and / or cross section, which allows tube 40 to shrink to maintain a smaller cross-sectional area and reduce surge. The mitigating viscoelastic material and / or cross section may be present throughout tube 40 or within one or more mitigating sections of tube 40. The mitigating sections may have any suitable length, such as 0.1 to 10 centimeters (cm) (e.g., values ​​within the range of 0.1 to 1, 1 to 2, 2 to 5, 7 and / or 7 to 10 cm). Tube 40 may have one or more mitigating sections, each section having a mitigating viscoelastic material or a mitigating cross section or both. Examples of such tubes are illustrated with reference to Figures 12 to 14B. 【0063】 Figure 12 shows an example of a tube 40 containing a viscoelastic material. In this example, the tube 40 has a viscoelastic section 42 containing a viscoelastic material 43. Examples of such materials include low-durometer polyvinyl chloride, silicone elastomer, polyurethane, or high-density polyethylene. 【0064】 Figures 13A and 13B show an example of a tube 40 having a relief cross section 44. The cross section 44 may have an elliptical (including circular), marquise, polygonal, X-shaped, or any other suitable shape. In this example, the cross section 44 is elliptical. 【0065】 Figures 14A to 14C show an example of a tube 40 having a relief section 42 with a relief cross section 44. In this example, the relief cross section 44 of the relief section 42 is elliptical, and the cross section 45 of the rest of the tube 40 is circular. 【0066】 The components of the systems and apparatus disclosed herein (such as computer 103 or controller 360) may include interfaces, logic and / or memory, any of which may include hardware and / or software. Interfaces may receive inputs to a component, transmit outputs from a component, and / or process inputs and / or outputs. Logic may perform operations of a component. Logic may include one or more electronic devices that process data, for example, by executing instructions to produce an output from an input. Examples of such electronic devices include computers, processors or microprocessors (e.g., central processing units (CPUs)) and computer chips. Logic may include computer software that encodes instructions that can be executed by the electronic devices to perform operations. Examples of computer software include computer programs, applications and operating systems. 【0067】 Memory may include tangible, computer-readable and / or computer-executable storage media capable of storing information. Examples of memory include computer memory (e.g., random-access memory (RAM) or read-only memory (ROM)), mass storage media (e.g., hard disks), removable storage media (e.g., compact discs (CDs) or digital video or multi-purpose discs (DVDs)), databases and / or network storage (e.g., servers), and / or other computer-readable media. Certain embodiments may involve memory encoded using computer software. 【0068】 While this disclosure has described specific embodiments, modifications to the embodiments (e.g., altered, replaced, added, omitted, and / or other modifications) will be apparent to those skilled in the art. Thus, modifications to the embodiments can be made without departing from the scope of the invention. For example, modifications can be made to the systems and apparatus disclosed herein. The components of the systems and apparatus can be integrated or separated, or the operation of the systems and apparatus can be performed by more, fewer, or other components. As another example, modifications can be made to the methods disclosed herein. The methods may include more, fewer, or other steps, and the steps may be performed in any preferred order. 【0069】 With respect to exemplary embodiments, parts described as internal to a component may be distributed externally to the component. In certain embodiments, parts of the suction system and / or perfusion system may be external to the cassette body. In certain embodiments, parts of the pump of the suction system within the cassette body may be external to the cassette body. For example, the motor that drives the pump may be located in the console. In certain embodiments, parts of the sensor of the suction system within the cassette body may be external to the cassette body. For example, the processor that receives sensor readings may be located in the console. 【0070】 To assist the Patent Office and readers in interpreting the claims, the applicant wishes to note that no claim or claim element is intended to exercise Section 112(f) of the U.S. Patent Act unless the words “means for” or “steps for” are expressly used in any particular claim. Any other use of terms in the claims (e.g., “mechanism,” “module,” “device,” “unit,” “component,” “element,” “member,” “apparatus,” “machine,” “system,” “processor,” or “controller”) is understood by the applicant to refer to a structure known to those skilled in the art and is not intended to exercise Section 112(f) of the U.S. Patent Act.

Claims

[Claim 1] A surgical cassette for an ophthalmic surgical system, A perfusion system configured to communicate with the handpiece and deliver fluid toward the surgical site, A suction system that communicates with the handpiece and is configured to transport fluid away from the surgical site, The suction system includes, A suction pump configured to generate normal vacuum pressure within a suction conduit and transport fluid away from the surgical site during normal operation, The suction conduit tube having a larger cross-sectional area depending on the normal vacuum pressure, In response to occlusion, the cross-sectional area decreases from the larger area to the smaller area, During the post-occlusion rupture surge, maintain a smaller cross-sectional area than described above to reduce the post-occlusion rupture surge, After the aforementioned occlusion-induced surge, the cross-sectional area returns to the larger area mentioned above. A tube configured to perform the following: Surgical cassettes, including those mentioned. [Claim 2] The tube is, In response to the aforementioned blockage, the cross-sectional area is reduced from the larger cross-sectional area to the smaller cross-sectional area, During the post-occlusion rupture surge, maintain a smaller cross-sectional area. A surgical cassette according to claim 1, comprising a viscoelastic material that enables the following: [Claim 3] The tube is, In response to the aforementioned blockage, the cross-sectional area is reduced from the larger cross-sectional area to the smaller cross-sectional area, During the post-occlusion rupture surge, maintain a smaller cross-sectional area. A surgical cassette according to claim 1, having a reduced cross-section that enables the following procedure. [Claim 4] The tube has one or more relief sections, and each relief section is such that the tube is In response to the aforementioned blockage, the cross-sectional area is reduced from the larger cross-sectional area to the smaller cross-sectional area, During the post-occlusion rupture surge, maintain a smaller cross-sectional area. A surgical cassette according to claim 1, which enables the following: [Claim 5] The surgical cassette according to claim 4, wherein at least one relief section comprises a relief viscoelastic material. [Claim 6] The surgical cassette according to claim 4, wherein at least one relief section includes a relief cross section. [Claim 7] The surgical cassette according to claim 4, wherein at least one relief section includes a relief viscoelastic material and a relief cross section. [Claim 8] At least the first mitigation section includes a mitigating viscoelastic material, and The surgical cassette according to claim 4, wherein at least the second relief section includes a relief cross section. [Claim 9] The surgical cassette according to claim 4, wherein at least one relief section has a length of 0.1 to 10 centimeters (cm). [Claim 10] A surgical cassette for an ophthalmic surgical system, A perfusion system configured to communicate with the handpiece and deliver fluid toward the surgical site, A suction system that communicates with the handpiece and is configured to transport fluid away from the surgical site, The suction system includes, A suction pump configured to generate normal vacuum pressure within a suction conduit and transport fluid away from the surgical site during normal operation, The suction conduit tube having a larger cross-sectional area depending on the normal vacuum pressure, comprising a plurality of relief sections, each relief section being such that the tube In response to occlusion, the cross-sectional area decreases from the larger area to the smaller area, During the post-occlusion rupture surge, maintain a smaller cross-sectional area than described above, After the aforementioned occlusion-induced surge, the cross-sectional area returns to the larger area mentioned above. A tube and Includes, At least the first relief section is such that the tube is In response to the aforementioned blockage, the cross-sectional area is reduced from the larger cross-sectional area to the smaller cross-sectional area, During the post-occlusion rupture surge, maintain a smaller cross-sectional area. It includes a mitigating viscoelastic material that makes it possible to perform the following: At least the second relief section is such that the tube is In response to the aforementioned blockage, the cross-sectional area is reduced from the larger cross-sectional area to the smaller cross-sectional area, During the post-occlusion rupture surge, maintain a smaller cross-sectional area. A surgical cassette including a reduced cross-section that makes it possible to perform the procedure. [Claim 11] The surgical cassette according to claim 10, wherein at least a third relief section includes the relief viscoelastic material and the relief cross section.

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