(19) TZZ __T

(11) EP 2 945 581 B1

(12) EUROPEAN PATENT SPECIFICATION

(45) Date of publication and mention (51) Int Cl.: of the grant of the patent: A61F 9/008 (2006.01) 19.04.2017 Bulletin 2017/16 (86) International application number: (21) Application number: 14703004.3 PCT/US2014/011848

(22) Date of filing: 16.01.2014 (87) International publication number: WO 2014/113569 (24.07.2014 Gazette 2014/30)

(54) ROBUST CUTTING FOR OPHTHALMIC SURGERY ROBUSTES LASERSCHNEIDEN FÜR DIE AUGENCHIRURGIE COUPE AU LASER ROBUSTE POUR CHIRURGIE OPHTALMIQUE

(84) Designated Contracting States: (72) Inventors: AL AT BE BG CH CY CZ DE DK EE ES FI FR GB • FU, Hong GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO Irvine, CA 92602 (US) PL PT RO RS SE SI SK SM TR • TAMKIN, John M. Pasadena, CA 91105 (US) (30) Priority: 16.01.2013 US 201361753319 P (74) Representative: Hoffmann Eitle (43) Date of publication of application: Patent- und Rechtsanwälte PartmbB 25.11.2015 Bulletin 2015/48 Arabellastraße 30 81925 München (DE) (60) Divisional application: 14199237.0 / 3 001 988 (56) References cited: 17156854.6 EP-A1- 1 977 725 WO-A2-2012/135073 DE-A1-102009 012 873 US-A1- 2010 174 274 (73) Proprietor: AMO Development, LLC Santa Ana, CA 92705 (US)

Note: Within nine months of the publication of the mention of the grant of the European patent in the European Patent Bulletin, any person may give notice to the European Patent Office of opposition to that patent, in accordance with the Implementing Regulations. Notice of opposition shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention). EP 2 945 581 B1

Printed by Jouve, 75001 PARIS (FR) 1 EP 2 945 581 B1 2

Description through the opening. In both types of capsulotomies, pulsed laser systems reduce the possibility of irregular, BACKGROUND inaccurate, and imprecise incisions and related compli- cations that may occur with manual surgical techniques. I. Field 5 [0006] Laser eye surgeries are generally performed while the patient is awake. Because a patient’s eye move- [0001] This invention generally relates to the field of mentcan reduce theprocedure’s accuracy and precision, ophthalmic surgery, and more particularly to particular the laser system needs to compensate for and/or reduce cutting techniques and methods used during ophthalmic or stabilize eye movement. One approach to do so uses , including cataract and refractive surgeries. 10 an eye stabilizing device, such as a patient interface that physically attaches to the patient’s eye and prevents II. Background movement. Typically, the patient interface is attached to the eye using mechanical pressure, such as vacuum suc- [0002] Vision impairments such as myopia (i.e. near- tion, which can be uncomfortable for the patient, and may sightedness), hyperopia (i.e. far-sightedness), and astig- 15 even cause post-operative pain and scarring. Thus, cer- matism can be corrected using eyeglasses or contact tain alternate devices have been proposed to compen- lenses. Alternatively, ophthalmic surgery can be used to sate for eye movement. These include an eye tracker, address these same problems. Eye surgery is also com- which tracks the position of the eye during surgery, and monly used to treat conditions such as cataracts, which, provides the system with real time signals about eye po- if left untreated, may cause blurred vision and/or blind- 20 sition. The laser system then uses the position informa- ness. tion from the eye tracker to adjust or reposition the laser [0003] Laser surgery is becoming a preferred tech- beam before making an incision. To ensure accuracy and nique for ophthalmic procedures as a laser is generally precision, the trajectory of the laser beam’s focus must more precise and accurate when compared to manual be corrected in real time to compensate for eye move- surgical tools. In laser refractive surgery, such as the25 ment monitored by the eye tracker. But, there are delays commonly known LASIK (Laser Assisted in Situinherent to eye trackers and their interactions with the Keratomileusis) procedure, a surgeon uses a laser to re- laser system. Because the eye tracker and the laser shape the cornea. The LASIK procedure has three steps, beam delivery mechanics tend to introduce positional er- namely: (1) preparation of a corneal flap; (2) ablation of rors due to latency between eye movement and laser the corneal stroma with an ; and (3) repo- 30 adjustment, the resulting incision pattern in the eye may sitioning the flap. deviate from that which is programmed or desired. These [0004] Previously, a microkeratome was used for cor- can result in less than ideal incisions. neal flap cutting and preparation, but these days, it is [0007] Therefore, it would be beneficial to provide a more common to use a non-ultraviolet (UV) laser that pulsed laser surgical system that uses an eye tracker emits radiation with ultra-short pulse durations in the fem- 35 and allows the laser beam to make robust and accurate tosecond or picosecond range. Besides cutting corneal incisions despite eye tracker/laser beam adjustment la- flaps, pulsed are also useful for making incisions tency issues. in the corneal stroma to correct astigmatism. Ophthalmic [0008] WO 2012/135073 A2 teaches an apparatus ac- lasers provide improvements over microkeratomes as cording to the preamble of claim 1. more patients achieve an improved level of post-opera- 40 tive visual acuity in the months after surgery. Further, SUMMARY laser surgery tends to lessen the chance of irregular, im- precise, and inaccurate cuts and related complications. [0009] An objective of this invention, which is defined [0005] Non-ultraviolet, ultra-short pulsed lasers are al- in claim 1, is to provide a laser ophthalmic system that so being used for cataract surgery, including capsuloto- 45 uses an eye tracker and allows the laser beam to make my procedures. During cataract surgery, a pulsed laser robust and accurate incisions despite latency between beam may be used to create an initial incision in the cor- the eye tracker and laser beam adjustment, which sub- nea, to create openings in the anterior or posterior cap- stantially obviates one or more problems due to limita- sular bag for capsulotomy, as well as to crack or break- tions and disadvantages of the related art. To achieve up the clouded cataractic lens. For example, a pulsed 50 this and other advantages, the present design allows for laser beam can be used to create an opening in the an- a method for performing an ophthalmic laser surgery us- terior capsule for an anterior capsulotomy procedure to ing a non-ultraviolet ultra-short pulsed laser system. The allow access to the cataractic lens. Sometimes, a poste- method includes establishing an initial cutting pattern rior capsulotomy procedure is required after cataract sur- comprising a plurality of original photodisruption points, gery when the posterior capsule becomes cloudy and 55 establishing an enhanced cutting pattern comprising a causes vision problems. In posterior capsulotomy, the plurality of enhanced photodisruption points selected to pulsed laser can be used to create an opening in a cloud- decrease potential adverse effects due to patient move- ed posterior capsule, thereby allowing light to pass freely ment and having increased density over a fixed area as

2 3 EP 2 945 581 B1 4 compared with the plurality of original photodisruption implied theory presented in the preceding background of points, and performing an ocular surgical procedure ac- the invention, brief summary, or the following detailed cording to the enhanced cutting pattern. Each photodis- description. ruptionpoint in theinitial cutting pattern and theenhanced [0013] FIG. 1 illustrates a general overview of a non- cutting pattern comprises a laser target point. Examples 5 ultraviolet pulsed laser system configured to employ an of cutting patterns may include circular cuts around the embodiment of the present design. In FIG. 1, laser engine periphery of a capsule, vertical side cuts for lens frag- 100 includes laser source 101 which provides laser light mentation, raster lamellar cuts, and grid lamellar cuts. in ultra-short pulses to variable attenuator 102 configured Various aspects and features of the disclosure are de- to attenuate the beam, and energy monitors 103 to mon- scribed in further detail below. 10 itorbeam energy level,and first safety shutter104 serving [0010] The above summary and the following detailed as a shutoff device if the beam is unacceptable. Beam description are merely exemplary, illustrative, and ex- steering mirror 105 redirects the resultant laser beam to planatory, and are not intended to limit, but to provide the beam delivery device 110, through articulated arm further explanation of the invention as claimed. Additional 106 to range finding camera 111. The range finding cam- features and advantages of the invention will be set forth 15 era 111 determines the range needed for the desired in the descriptions that follow, and in part, will be apparent focus at the eye 120. Beam delivery device 110 includes from the description, or may be learned by practicing var- second safety shutter 112 and beam monitor 113, beam ious embodiments of the invention. The objectives and pre-expander 114, X-Y (position) scanner 115, and zoom other advantages of the invention will be realized by the beam expander 116. Zoom beam expander 116 expands structures particularly pointed out in the written descrip- 20 the beam toward IR mirror 117 which reflects and trans- tion and claims as well as the accompanying drawings. mits the received beam. Mirror 118 reflects the received beam to video camera 119, which records the surgical BRIEF DESCRIPTION OF THE DRAWINGS procedure on the eye 120. IR mirror 117 also reflects the laser light energy to objective lens 121, which focuses [0011] 25 the laser light energy to eye 120. [0014] In ophthalmic surgery, a non-ultraviolet (UV), FIG. 1 illustrates a general overview of a pulsed laser ultra-short pulsed laser can produce pulsed laser beams system configured to employ an embodiment of the having pulse durations measured in femtoseconds. Such present design. a device as shown in FIG. 1 can provide an intrastromal FIG. 2 is a general diagram including a controller 30 photodisruptiontechnique forreshaping thecornea using configured to control various components illustrated a non-UV, ultra-short (e.g., femtosecond or picosecond in FIG. 1. pulse duration), pulsed laser beam produced by laser FIGs. 3A-3C illustrate a first general cutting tech- source 101 that propagates through corneal tissue and nique for use in a capsulotomy during laser cataract is focused at a point below the surface of the cornea to surgery. 35 photodisrupt stromal tissue at the focal point. The focus- FIGs. 4A and 4B illustrate a second capsulotomy ing , such as beam pre-expander 114, zoom beam procedure. expander 116, IR mirror 117 and objective lens 121, di- FIGs. 5A and 5B illustrate a further embodiment of rect the pulsed laser beam toward an eye 120 (e.g., onto the present design for use in performing a vertical or into a cornea) for plasma mediated (e.g., non-UV) pho- side cut. 40 toablation of superficial tissue, or into the stroma of the FIGs. 6A and 6B show a raster lamellar cut pattern. cornea for intrastromal photodisruption of tissue. In this FIGs. 7A and 7B illustrate an arrangement for per- embodiment, the system may also include a lens to forming a lamellar cut for a corneal flap which is cre- change the shape (e.g., flatten or curve) of the cornea ated to expose the corneal stroma in laser refractive prior to scanning the pulsed laser beam toward the eye. surgery. 45 The system is capable of generating the pulsed laser beam with physical characteristics similar to those of the DETAILED DESCRIPTION laser beams generated by a laser system disclosed in U.S. Pat. No. 4,764,930, U.S. Pat. No. 5,993,438, or the [0012] The following detailed description is merely il- like. lustrative and exemplary in nature and is not intended to 50 [0015] The ophthalmic laser system can produce an limit the embodiments of the subject matter or the appli- ultra-short pulsed laser beam for use as an incising laser cation, and uses of such embodiments. As used in this beam. This pulsed laser beam preferably has laser puls- disclosure, the words "exemplary" and "illustrative" mean es with durations as long as a few nanoseconds or as "serving as an example, instance, or illustration." Any short as a few femtoseconds. For intrastromal photodis- implementation described as exemplary or illustrative is 55 ruption of the tissue, the pulsed laser beam has a wave- not meant to be necessarily construed as preferred or length that permits the pulsed laser beam to pass through advantageous over other implementations. Further, the cornea without absorption by the corneal tissue. The there is no intention to be bound by any expressed or wavelength of the pulsed laser beam is generally in the

3 5 EP 2 945 581 B1 6 range of about 3 mm to about 1.9 nm, preferably between multiple connections are available between the photo- about 400 nm to about 3000 nm, and the irradiance of disruption points, thus increasing the likelihood that suf- the pulsed laser beam for accomplishing photodisruption ficient connections exist among the photodisruption of stromal tissues at the focal point is typically greater points to result in the intended macroscopic tissue sep- than the threshold for optical breakdown of the tissue. 5 aration even in the presence of positional errors. Although a non-UV, ultrashort pulsed laser beam is de- [0020] The present design includes descriptions of var- scribed in this embodiment, the pulsed laser beam may ious patterns of photodisruption points. However, the de- have other pulse durations and different wavelengths in sign is not specifically limited to the techniques and pat- other embodiments. Further examples of devices used terns disclosed herein. Various other patterns and de- in performing ophthalmic laser surgery are disclosed in, 10 signs may be used as ocular surgery can change de- for example, U.S. Patent Nos. 5,549,632, 5,984,916, and pending on a variety of circumstances and new tech- 6,325,792. niques. In general, however, the specific patterns em- [0016] FIG. 2 illustrates a general diagram including a ployed are intended to provide robust cuts depending on controller configured to control various components illus- a number of variables, including the surgical needs, the trated in FIG. 1. Not shown in FIG. 1 is an eye tracker 15 desired cut shape and orientation, the range of actual typically used and placed on or adjacent to the eye to and potential position errors, the eye movement charac- track eye movements. A series of sensors may be pro- teristics, the laser depth of focus, and the laser pulse rate. vided to sense beam diameter, location, and intensity at [0021] In laser ophthalmic surgery, it is generally un- the various mirrors provided. FIG. 2 shows a control unit derstood that virtually any laser position can be attained 201 configured to interface with the laser source 202 to 20 by device and laser beam movement in addition to the transmit the laser, the attenuator 203 to attenuate the precision focus mechanisms available to the laser. In this laser beam, the first safety shutter 204 to enable shutoff regard, a number of different patterns and positions can in extreme circumstances, a sensor 205 provided with be executed or attained. While primarily discussed with beam steering mirror 206, and camera 207. The control respect to making certain cuts, it is to be understood the unit 201 also interfaces with the x-y scanning device 208 25 present design may also be employed to perform frag- to enable x-y scanning of the beam delivery device, and mentation or chopping of a lens. controls range finding camera 209, second safety shutter [0022] FIGs. 3A-3C illustrate a first general cutting 210, a sensor 211 attached to beam monitor 212, the technique for use in a capsulotomy during laser cataract beam pre-expander 213, zoom beam expander 214, and surgery. FIG. 3A is a side view of a capsule region desired the sensor 215 attached to IR mirror 216. The control 30 to be cut, wherein a cut resembling a sine wave is em- unit 201 interfaces with video camera 217 and objective ployed around the outside or periphery of the capsule lens unit 218 which contains the objective lens, and eye region. In FIG. 3A, the laser scans in the z-direction in a tracking system 219. depth range of a certain number of micrometers, i.e. [0017] The present design seeks to control the position scans up and down an approximately equal distance in of the laser with respect to the eye and provide patterns 35 micrometers around the periphery of the capsule. If a and techniques that enable more robust cuts than previ- patient moves his or her eye during this procedure, there ous systems and methods allowed. Certain techniques is a possibility that the cut will not close or complete. using eye tracking systems have been used in the past [0023] FIG. 3B is a top view of one such scan where to make specific cuts. But, because there is latency be- patient movement results in the pattern not being com- tween the tracking system 219 and the control unit 201 40 pleted, i.e. the end of the pattern does not meet the be- sensing eye movement, and the beam delivery device ginning of the pattern and thus leaves an uncut gap 301, adjusting position of the beam to compensate for such resulting in incomplete separation and tear of the capsule movement, the resulting cuts may be imprecise. material. FIG. 3C shows an improved scan according to [0018] In ophthalmic surgery using a non-ultraviolet, the present design, wherein the pattern is altered such pulsed laser beam, a tissue cut is realized when a 2D 45 that overlap exists, i.e. the side cut is over 360 degrees. array of microscopic photodisruption points are connect- In this arrangement, the side cut forms a closed loop. ed by the emitted beam, resulting in a macroscopic tissue Hence in this embodiment, an initial pattern is contem- separation. The present design uses an enhanced laser plated,here having a 360 degree profile,and an improved treatment pattern so that the tolerance for microscopic pattern is established, here a greater than 360 degree positional deviations of photodisruption points is in-50 pattern, going from a revised start point 302, cutting ac- creased and the likelihood of intended macroscopic tis- cording to the pattern, and ending at a revised end point sue separation is improved. 303 resulting in a greater than 360 degree cut. The result [0019] Based on an existing pattern of photodisruption is a likely cut with an overlap at or around point 304. points, the present design establishes an enhanced pat- [0024] In the drawings, the photodisruption points that tern that increases the probability that nearest-neighbor 55 are pictured represent desired target points for the laser photodisruption points will connect. As part of the en- and not the actual cuts or incisions, which may differ in hanced pattern, the present design places secondary, size and shape and may be slightly off-set from the pho- backup, or redundant photodisruption points such that todisruption points pictured.

4 7 EP 2 945 581 B1 8

[0025] Thus the design of FIGs. 3A-3C can be thought (topmost) diagonal line, followed by a cut of a second of as having one disruption point as a baseline cut pat- (lower) diagonal line, and progressing sequentially down- tern, and a revised or enhanced cut pattern that includes ward through successive diagonal lines. Thus, the two disruption points, the start and end point in FIG. 3C, present embodiment includes establishing a baseline cut selected to increase the likelihood of a complete cut and 5 pattern and adding a series of photodisruption points to decrease potential adverse effects due to patient move- the baseline profile selected to provide an enhanced like- ment. lihood of tissue separation in the presence of position [0026] FIGs 4A and 4B illustrate a second capsuloto- errors. my procedure. The top of FIG. 4A is a side perspective [0030] FIGs. 6A and 6B illustrate a raster lamellar cut view of the capsule while the bottom of FIG. 4A is a side 10 for lens fragmentation according to the present design. view of the capsule. The top view of FIG. 4A illustrates FIG. 6A shows a baseline raster pattern a series of circles used to cut the capsule in a series of comprising a series of linear cuts to a plurality of points, slices.The bottom view is a side cut-away viewillustrating such as upper point 601 and lower point 602. Such a the various photodisruption points in the circular pattern. linear cutting profile is subject to positional errors, pos- In FIG. 4A, the laser cuts a circle from point 401 to point 15 sibly resulting in portions of the pattern being uncut, with 402 and back around to point 401, and then proceeds to an increased risk of tearing. The time to complete one the next cut. In the presence of position errors, this cir- raster scan, such as a scan from point 601 to 602, is cular laser cutting trajectory will not return to a point ex- generally less than 10 milliseconds, and this can be actly beneath or above the previous turn, potentially re- enough time to result in positional errors if the eye moves. sulting in no connectivity between turns forming the cut, 20 [0031] FIG. 6B illustrates a raster scan with two sets and therefore, an incomplete cut. of cuts and two sets of photodisruption points, including [0027] FIG. 4B illustrates a spiral pattern for a cap- upper first point 603 and upper second point 604, and sulotomy wherein a series of additional photodisruption lower first point 605 and lower second point 606. The points are established, in this arrangement both vertically time to complete one scan, i.e. from upper first point 603 and horizontally offset from the prior set of photodisrup- 25 to upper second point 604, is typically much less than 10 tion points, i.e. the baseline pattern of FIG. 4A. In oper- milliseconds. A briefer traversal of the raster pattern, and ation, a cut is made around the capsule at points 403 and a smaller raster pattern used, results in a reduction in the 404, and the laser proceeds to a cut around the capsule likelihood of position error. Using the pattern of FIG. 6B, at points 405 and 406, and progresses in this manner via the two halves of the raster period (upstroke/downstroke) all the remaining points. Thus, the design ofFIGs. 4A 30 will more likely connect even in the presence of eye and 4B provide a baseline cut pattern and a modified or movement. enhanced cutting pattern including an additional number [0032] For the case of a longer depth of laser focus, of photodisruption or cut points selected to provide an which depends on the system’s numerical aperture, the enhanced likelihood of tissue separation in the presence two raster patterns tend to be thick in the z-direction, and of position errors. 35 will be connected when there is an overlap between the [0028] FIGs.5A and 5Billustrate a furtherembodiment two shorter raster patterns shown in FIG. 6B. However, of the present design for use in a vertical side cut, useful if the depth of focus is small, the system can apply a three in lens fragmentation and typically employed during re- dimensional (3D) laser pattern or laser pattern array, fractive surgery to create a corneal flap. From FIG. 5A, shown as pattern 610, to reliably connect the two raster a single layer vertical cut is provided, with a series of40 patterns to result in big lamellar cut. photodisruption points. As is understood to those skilled [0033] From FIG. 6B, it is apparent that the disruption in the art, the photodisruption points represent points points 604 in the upper raster scan and 605 in the lower where the laser is focused, and use of the laser at such raster scan enter, in this view, the 3D region, pattern 610. photodisruption points causes penetration of the tissue A different sized 3D region, pattern 610 that touches the and adjacent points are in sufficient proximity to prevent 45 end points of a raster scan or raster scans that do not tearing, i.e. a small enough amount of tissue remains touch or barely touch the 3D region may be used. In gen- such that the tissue separates and a cut made. In the eral, overlap between the raster scans and the 3D pattern depiction of FIG. 5A, the laser progresses sequentially can provided enhanced likelihood of successful cutting. througheach of thediagonal lines presented. Again,such Thus, the present embodiment comprises again estab- a pattern is sensitive to position error in that movement 50 lishing a baseline pattern and providing an increased of the eye can result in an incomplete or inadequate cut. number of photodisruption points designed or intended [0029] FIG. 5B illustrates a multi-layered vertical side to increase likelihood of a robust cut, or decrease the cut in accordance with the present design, wherein ad- potential effects of position errors. ditional disruption points are provided at an offset, both [0034] FIGs. 7A and 7B illustrate an arrangement for vertically and horizontally, from the baseline cut pattern 55 performing a lamellar laser cut for a flap created to ex- of FIG. 5A. This enhanced multi-layered vertical side cut pose the stroma in photoablative refractive surgery. pattern may be traversed in different ways using the ultra- FIG.7A shows a regular pattern, here a square compris- short pulsed laser, such as going over and cutting a first ing a series of cut points shown in a Cartesian grid pat-

5 9 EP 2 945 581 B1 10 tern. In this case, a non-edge, non-corner photodisrup- beam emitted by the laser at a desired position on an tion point has four closest neighbors, and distance be- eye of a patient, and a controller configured to control tween, for example, points diagonal from one another is the laser and the optical elements, wherein the controller longer than points laterally or vertically separated. Posi- is configured to use an enhanced cutting pattern com- tion errors can be an issue with the arrangement of FIG. 5 prising a plurality of enhanced photodisruption points se- 7A. lected to decrease potential adverse effects due to pa- [0035] FIG. 7B illustrates a triangular or hexagonal dis- tient movement and has increased density over a fixed tribution of photodisruption points. In FIG. 7B, a triangular area as compared with the plurality of original photodis- cutting pattern is presented, and use of such a triangular ruption points. Each photodisruption point in the initial photodisruption point pattern effectively reduces issues 10 cutting pattern and the enhanced cutting pattern com- related to position errors. Cutting using the triangu- prises a laser target point. Examples of cutting patterns lar/hexagonal arrangement of FIG. 7B provides a closer may again include circular cuts around the periphery of proximity of nearest neighbor photodisruption points, de- a capsule, vertical side cuts for lens fragmentation, raster creasing issues of improper cuts when the patient moves. lamellar cuts, and grid lamellar cuts, but other patterns [0036] The design of FIGs. 7A and 7B again begin with 15 or scans may be used. a baseline pattern of photodisruption points and provide [0040] In either the method or the apparatus, the plu- an additional quantity of photodisruption points intended rality of enhanced photodisruption points may comprise to decreasepositional errors.In the arrangement of FIGs. a non-zero percentage of the plurality of original photo- 7A and 7B, the photodisruption points do not include the disruption points, or the plurality of enhanced photodis- original pattern with additional photodisruption points20 ruption points may comprise none of the plurality of orig- added, as in previous embodiments, but instead include inal photodisruption points. an increased number of photodisruption points in an [0041] An apparatus implementing the techniques or equivalent area. circuits described herein may be a stand-alone device or [0037] The present design is therefore an apparatus may be part of a larger device or system. In one or more and method for performing ophthalmic laser surgery us- 25 exemplary designs, the functions described may be im- ing a pulsed laser beam, wherein the method comprises plemented in hardware, software, firmware, or any com- establishing an initial cutting pattern comprising a plural- binationthereof. Ifimplemented in software,the functions ity of original photodisruption points, and establishing an may be stored on or transmitted over as one or more enhanced cutting pattern comprising a plurality of en- instructions or code on a computer-readable medium. hanced photodisruption points, the plurality of enhanced 30 Computer-readable media includes both computer stor- disruption points selected to decrease potential adverse age media and communication media including any me- effects due to patient movement and having increased dium that facilitates transfer of a computer program from density over a fixed area than the plurality of original pho- one place to another. A storage media may be any avail- todisruption points. The apparatus or method further in- able media that can be accessed by a computer. By way cludes performing an ocular surgical procedure accord- 35 of example, and not limitation, such computer-readable ing to the enhanced cutting pattern. Each photodisruption media can comprise RAM, ROM, EEPROM, CD-ROM point comprises a laser target point. Examples of cutting or other optical disk storage, magnetic disk storage or patterns may include circular cuts around the periphery other magnetic storage devices, or any other medium of a capsule, vertical side cuts for lens fragmentation, that can be used to carry or store desired program code raster lamellar cuts, and grid lamellar cuts. 40 in the form of instructions or data structures and that can [0038] For example, in the vertical side cut arrange- be accessed by a computer. Also, any connection is prop- ment, the method directs the pulsed laser beam to make erly termed a computer-readable medium. For example, a vertical side cut thereby creating a flap, the vertical side if the software is transmitted from a website, server, or cut traversing a plurality of generally diagonal paths ac- other remote source using a coaxial cable, fiber optic cording to the enhanced fragmentation cutting pattern. 45 cable, twisted pair, digital subscriber line (DSL), or wire- Each photodisruption point in the initial fragmentation lesstechnologies such as infrared, radio, and microwave, cutting pattern and the enhanced fragmentation cutting then the coaxial cable, fiber optic cable, twisted pair, DSL, pattern comprises a laser target point, and wherein the or wireless technologies such as infrared, radio, and mi- vertical side cut traversing the plurality of generally diag- crowave are included in the definition of medium. Disk onal paths provides an increased length scanning pattern 50 and disc, as used herein, includes (CD), relative to a cut made according to the initial fragmenta- laser disc, optical disc, digital versatile disc (DVD), floppy tion cutting pattern. disk and blu-ray disc where disks usually reproduce data [0039] Alternately, the present design comprises an magnetically, while discs reproduce data optically with apparatus for performing an ocular laser surgical proce- lasers. Combinations of the above should also be includ- dure based on an initial cutting pattern comprising a plu- 55 ed within the scope of computer-readable media. rality of original photodisruption points. The apparatus [0042] This disclosure has been provided in an exem- comprises a laser system configured to emit a pulsed plary form with a certain degree of particularity, and de- beam, optical elements configured to focus the pulsed scribes the best mode contemplated of carrying out the

6 11 EP 2 945 581 B1 12 invention to enable a person skilled in the art to make or disruption points form a triangular shape. use embodiments of the invention. Those skilled in the art will understand, however, that various modifications, 7. The apparatus of claim 1, wherein the plurality of alternative constructions, changes, and variations can enhanced photodisruption points comprise a nonze- be made in the apparatus, method, and parts and steps 5 ro percentage of the plurality of original photodisrup- thereof,without departing from the scopeof theinvention. tion points. Hence, the disclosure is not intended to be limited to the specific examples and designs that are described. Rath- 8. The apparatus of claim 1, wherein the plurality of er, it should be accorded the broadest scope consistent enhanced photodisruption points comprise none of with the appended claims 10 the plurality of original photodisruption points.

Claims Patentansprüche

1. An apparatus for performing an ocular laser surgical 15 1. Einrichtung zum Durchführen eines chirurgischen procedure based on an initial cutting pattern com- Augenlaserverfahrens auf der Basis eines anfängli- prising a plurality of original photodisruption points, chen Schneidmusters, das eine Vielzahl von ur- comprising: sprünglichen Photodisruptionspunkten umfasst, umfassend: a laser configured to emit a beam; 20 optical elements configured to focus the beam einen Laser, der so ausgeführt ist, dass er einen emitted by the laser at a desired Strahl emittiert, position on an eye of a patient; and optische Elemente, die so ausgeführt sind, dass a controller configured to control the laser and sie den Strahl, der von dem Laser emittiert wird, the optical elements, 25 auf eine gewünschte Position eines Auges eines characterised in that the controller is config- Patienten fokussiert und ured to use an enhanced cutting pattern com- eine Steuerungseinrichtung, die so ausgeführt prising a plurality of enhanced photodisruption ist, dass sie den Laser und die optischen Ele- points selected to decrease potential adverse mente steuert, effects due to patient movement and having in- 30 dadurch gekennzeichnet, dass creased density over a fixed area as compared die Steuerungseinrichtung so ausgeführt ist, with the plurality of original photodisruption dass sie ein erweitertes Schneidmuster verwen- points; det, das eine Vielzahl von erweiterten Photodis- wherein each photodisruption point in the initial ruptionspunkten umfasst, die so ausgewählt cutting pattern and the enhanced cutting pattern 35 sind, dass sie mögliche abträgliche Effekte auf- comprises a laser target point. grund einer Patientenbewegung verringern, und eine größere Dichte über einen festgelegten Be- 2. The apparatus of claim 1, wherein the enhanced cut- reich im Vergleich zu der Vielzahl von ursprüng- ting patterncomprises a generally circular cutaround lichen Photodisruptionspunkten aufweist; a periphery of a patient capsule. 40 wobei jeder Photodisruptionspunkt in dem an- fänglichen Schneidmuster und dem erweiterten 3. The apparatus of claim 1, wherein the enhanced cut- Schneidmuster einen Laserzielpunkt aufweist. ting pattern comprises a vertical side cut thereby cre- ating a flap, the vertical side cut traversing a plurality 2. Einrichtung nach Anspruch 1, wobei das erweiterte of generally diagonal paths. 45 Schneidmuster einen im Wesentlichen kreisförmi- gen Schnitt um einen Umfang einer Kapsel eines 4. The apparatus of claim 1, wherein the enhanced cut- Patienten umfasst. ting pattern comprises a raster lamellar cut travers- ing two raster regions in at least one raster scanning 3. Einrichtung nach Anspruch 1, wobei das erweiterte pattern. 50 Schneidmuster einen vertikalen Seitenschnitt um- fasst, wodurch ein Lappen hergestellt wird, wobei 5. The apparatus of claim 4, wherein the enhanced cut- der vertikale Seitenschnitt eine Vielzahl von im We- ting pattern further comprises a 3D laser array pat- sentlichen diagonalen Wegen durchläuft. tern generally between the two raster regions. 55 4. Einrichtung nach Anspruch 1, wobei das erweiterte 6. The apparatus of claim 1, wherein the enhanced cut- Schneidmuster einen lamellaren Rasterschnitt um- ting pattern comprises a lamellar cut producing a fasst, der zwei Rasterregionen in mindestens einem flap, wherein at least three of the enhanced photo- Rasterabtastmuster durchläuft.

7 13 EP 2 945 581 B1 14

5. Einrichtung nach Anspruch 4, wobei das erweiterte 4. Appareil de la revendication 1, dans lequel le motif Schneidmuster ferner ein 3D-Laserarraymuster im de découpe amélioré comprend une découpe lamel- Wesentlichen zwischen den zwei Rasterregionen laire tramée traversant deux régions tramées en au umfasst. moins un motif de balayage tramé. 5 6. Einrichtung nach Anspruch 1, wobei das erweiterte 5. Appareil de la revendication 4, dans lequel le motif Schneidmuster einen lamellaren Schnitt umfasst, de découpe amélioré comprend en outre un motif de mit dem ein Lappen produziert wird, wobei mindes- réseau laser 3D généralement entre les deux ré- tens drei der erweiterten Photodisruptionspunkte ei- gions tramées. ne dreieckige Form bilden. 10 6. Appareil de la revendication 1, dans lequel le motif 7. Einrichtung nach Anspruch 1, wobei die Vielzahl von de découpe amélioré comprend une découpe lamel- erweiterten Photodisruptionspunkten einen nicht laire produisant un rabat, au moins trois des points null betragenden Prozentsatz der Vielzahl von ur- de photodisruption améliorés constituant une forme sprünglichen Photodisruptionspunkten umfasst. 15 triangulaire.

8. Einrichtung nach Anspruch 1, wobei die Vielzahl von 7. Appareil de la revendication 1, dans lequel la plura- erweiterten Photodisruptionspunkten keinen der lité de points de photodisruption améliorés com- Vielzahl von ursprünglichen Photodisruptionspunk- prend un pourcentage non nul de la pluralité de ten umfasst. 20 points de photodisruption initiaux.

8. Appareil de la revendication 1, dans lequel la plura- Revendications lité de points de photodisruption améliorés ne com- prend aucun point de la pluralité de points de pho- 1. Appareil destiné à effectuer une procédure de chi- 25 todisruption initiaux. rurgie laser de l’oeil basée sur un motif de découpe initial comprenant une pluralité de points de photo- disruption initiaux, comprenant :

un laser configuré pour émettre un faisceau ; 30 des éléments optiques configurés pour focaliser le faisceau émis par le laser à une position sou- haitée sur un oeil d’un patient ; et un contrôleur configuré pour contrôler le laser et les éléments optiques, 35 caractérisé en ce que le contrôleur est confi- guré pour utiliser un motif de découpe amélioré comprenant une pluralité de points de photo- disruption améliorés choisis pour réduire les ef- fets indésirables potentiels dus aux mouve-40 ments du patient et ayant une densité accrue sur une zone fixe par rapport à la pluralité de points de photodisruption initiaux ; chaque point de photodisruption dans le motif de découpe initial et le motif de découpe amé- 45 lioré comprenant un point cible du laser.

2. Appareil de la revendication 1, dans lequel le motif de découpe amélioré comprend une découpe géné- ralement circulaire autour d’une périphérie d’une50 capsule du patient.

3. Appareil de la revendication 1, dans lequel le motif de découpe amélioré comprend une découpe laté- rale verticale créant ainsi un rabat, la découpe laté- 55 rale verticale suivant une pluralité de trajets généra- lement diagonaux.

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REFERENCES CITED IN THE DESCRIPTION

This list of references cited by the applicant is for the reader’s convenience only. It does not form part of the European patent document. Even though great care has been taken in compiling the references, errors or omissions cannot be excluded and the EPO disclaims all liability in this regard.

Patent documents cited in the description

• WO 2012135073 A2 [0008] • US 5549632 A [0015] • US 4764930 A [0014] • US 5984916 A [0015] • US 5993438 A [0014] • US 6325792 B [0015]

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