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Robust Laser Cutting for Ophthalmic Surgery Robustes Laserschneiden Für Die Augenchirurgie Coupe Au Laser Robuste Pour Chirurgie Ophtalmique

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Robust Laser Cutting for Ophthalmic Surgery Robustes Laserschneiden Für Die Augenchirurgie Coupe Au Laser Robuste Pour Chirurgie Ophtalmique (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 LASER 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 laser surgery, 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 excimer laser; 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 lasers 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.
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