TW202227026A - Methods and systems for combined sonic and laser applications for the eye - Google Patents

Methods and systems for combined sonic and laser applications for the eye Download PDF

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TW202227026A
TW202227026A TW109147058A TW109147058A TW202227026A TW 202227026 A TW202227026 A TW 202227026A TW 109147058 A TW109147058 A TW 109147058A TW 109147058 A TW109147058 A TW 109147058A TW 202227026 A TW202227026 A TW 202227026A
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史考特 安德森
喬治 庫拉圖
蓋瑞Ｐ 格雷
約翰 麥克威爾特
亞瑟 紐頓
瓦拉斯基Ｅ 托伊馬
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美商藍薩爾股份有限公司
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Abstract

Systems and methods for performing laser and phacoemulsification operations. Systems that provide full position and usage around a patient.

Description

用於針對眼睛的組合音波及雷射應用的方法及系統Method and system for combined sonic and laser applications for the eye

本案主張於2020年1月3日提交的美國專利申請第62/956,731號的優先權，其全部揭示藉由引用併入本文。This case claims priority to US Patent Application No. 62/956,731, filed January 3, 2020, the entire disclosure of which is incorporated herein by reference.

本發明係關於用於治療包括動物、哺乳動物、及人類眼睛的眼睛的結構的系統及方法。更特定言之，本發明的實施例係關於用於解決眼睛狀況的包括超音波的音波能量與包括雷射的光能量的組合使用的系統及方法。The present invention pertains to systems and methods for treating structures of the eye, including animal, mammalian, and human eyes. More particularly, embodiments of the present invention relate to systems and methods for the combined use of sonic energy, including ultrasound, and light energy, including lasers, for addressing eye conditions.

在第11圖中一般展示自然人類眼睛的解剖結構，第11圖係為眼睛的橫截面圖。鞏膜131是圍繞除了在角膜101處之外的水晶體103的白色組織。角膜101是包含眼睛的外部表面的透明組織，光首先藉由外部表面而進入眼睛。虹膜102是有色的可收縮的膜，而藉由改變在其中心（瞳孔）的圓形光圈的大小來控制進入眼睛的光量。眼睛或自然晶狀水晶體103（更詳細的圖片展示在第11A圖中（針對類似結構使用類似元件符號））係位於虹膜102之後。術語眼睛水晶體、自然晶狀水晶體、自然水晶體、自然人類晶狀水晶體、及水晶體（當指先前術語時）在本文中可以互換使用，並且指稱人類眼睛的相同解剖結構。The anatomy of a natural human eye is generally shown in Figure 11, which is a cross-sectional view of the eye. The sclera 131 is the white tissue surrounding the lens 103 except at the cornea 101 . The cornea 101 is the transparent tissue that contains the outer surface of the eye through which light first enters the eye. The iris 102 is a tinted retractable membrane that controls the amount of light entering the eye by varying the size of the circular aperture at its center (the pupil). The eye or natural crystalline lens 103 (a more detailed picture is shown in Figure 11A (using similar reference numerals for similar structures)) is located behind the iris 102 . The terms ocular lens, natural phakic lens, natural crystalline lens, natural human crystalline lens, and crystalline lens (when referring to the previous term) are used interchangeably herein and refer to the same anatomy of the human eye.

通常，眼睛水晶體透過睫狀肌108的作用而改變形狀，以允許視覺圖像的聚焦。來自大腦的神經反饋機制允許睫狀肌108藉由韌帶111的附接而起作用，以改變眼睛水晶體的形狀。通常，當光藉由角膜101及瞳孔進入眼睛，然後沿著視軸104行進通過眼睛水晶體103並通過玻璃體110而到達眼睛的後方的視網膜105，在黃斑106處形成圖像，而藉由視神經107轉移到大腦時，就會發生視力。角膜101與視網膜105之間的空間被前房109中的稱為水117以及水晶體的後房中的稱為玻璃體110（凝膠狀的透明物質）的液體所填充。Typically, the lens of the eye changes shape through the action of the ciliary muscle 108 to allow focusing of the visual image. Neurofeedback mechanisms from the brain allow the ciliary muscle 108 to act through the attachment of the ligament 111 to change the shape of the lens of the eye. Typically, when light enters the eye through the cornea 101 and the pupil, then travels along the visual axis 104 through the lens 103 and through the vitreous 110 to the retina 105 at the back of the eye, forming an image at the macula 106, and through the optic nerve 107 Vision occurs when it is transferred to the brain. The space between the cornea 101 and the retina 105 is filled with a liquid called water 117 in the anterior chamber 109 and a liquid called the vitreous 110 (a gel-like transparent substance) in the posterior chamber of the lens.

第11A圖一般展示典型50歲個體的水晶體103的部件以及與之相關的部件。水晶體103係為多結構系統。水晶體103的結構包括皮質113、水晶體核129、及水晶體囊袋114。囊袋114是包裹水晶體其他內部結構的外膜。水晶體上皮細胞123在水晶體赤道121處形成，而產生在圍繞眼睛水晶體的前後生長的帶狀細胞或原纖維。水晶體核129是由將皮質113相繼添加到水晶體核區域而形成。包括水晶體核129的水晶體中的各層的連續體的特徵可以是幾層、水晶體核、或水晶體核區域。這些層包括都在子宮中發育的胚胎核122及胎兒核130，從出生到四歲平均發育約三年的嬰兒核124、從約4歲發育到平均約12歲的***的***核126、及在約18歲及更大時發育的成人核128。Figure 11A generally shows the components of the crystal 103 and components associated therewith of a typical 50-year-old individual. Crystal 103 is a multi-structure system. The structure of the crystal 103 includes the cortex 113 , the crystal nucleus 129 , and the crystal capsular bag 114 . The capsular bag 114 is the outer membrane that surrounds the other internal structures of the crystal. Lens epithelial cells 123 form at the lens equator 121, producing ribbon cells or fibrils that grow anterior and posterior around the lens of the eye. The crystal nucleus 129 is formed by the sequential addition of cortex 113 to the area of the crystal nucleus. The continuum of layers in a crystal including crystal core 129 may be characterized by several layers, crystal cores, or crystal core regions. These layers include the embryonic nucleus 122 and the fetal nucleus 130, both of which develop in the womb, the infant nucleus 124, which develops on average for about three years from birth to four years of age, the pubertal nucleus 126, which develops from about four years of age to puberty on average about 12 years of age, and Adult nucleus 128 that develops at approximately 18 years of age and older.

胚胎核122的赤道直徑（寬度）係為約0.5mm，而前後軸104（AP軸）的直徑（厚度）係為0.425mm。胎兒核130的赤道直徑係為約6.0mm，而AP軸104的直徑係為約3.0mm。嬰兒核124的赤道直徑係為約7.2mm，而AP軸104的直徑係為約3.6mm。***核126的赤道直徑係為約9.0mm，而AP軸104的直徑係為約4.5mm。約36歲的成年核128的赤道直徑係為約9.6mm，而AP軸104的直徑係為約4.8mm。這些都是在離體狀態下的約50歲的典型成人水晶體的平均值。因此，此水晶體（水晶體核及皮質）的赤道直徑係為約9.8mm，而AP軸104直徑係為約4.9mm。因此，水晶體的結構係為分層的或嵌套的，其中最老的層和最老的細胞朝向中心。The equatorial diameter (width) of the embryonic nucleus 122 is about 0.5 mm, while the diameter (thickness) of the anterior-posterior axis 104 (AP axis) is 0.425 mm. The equatorial diameter of the fetal nucleus 130 is about 6.0 mm, while the diameter of the AP axis 104 is about 3.0 mm. The equatorial diameter of the infant nucleus 124 is about 7.2 mm, while the diameter of the AP axis 104 is about 3.6 mm. The equatorial diameter of the pubertal nucleus 126 is about 9.0 mm, while the diameter of the AP axis 104 is about 4.5 mm. The equatorial diameter of an adult nucleus 128 at approximately 36 years of age is approximately 9.6 mm, while the diameter of the AP axis 104 is approximately 4.8 mm. These are the average values for a typical adult crystal in an ex-vivo state of about 50 years of age. Thus, the equatorial diameter of this crystal (nucleus and cortex) is about 9.8 mm, and the diameter of the AP axis 104 is about 4.9 mm. Thus, the structure of the crystal is layered or nested, with the oldest layers and oldest cells facing the center.

水晶體是雙凸形狀，如第8圖及第8A圖所示。水晶體的前側與後側具有不同的曲率，而皮質與不同的水晶體核通常遵循這些曲率。因此，可以將水晶體視為基本上是沿著赤道軸不對稱的分層結構，並且由端到端佈置成形成基本上同心或嵌套的殼的長月牙形纖維單元所組成。這些細胞的端部對準，以在中心及中心附近區域在前側及後側形成縫合線。皮質及水晶體核中的較老組織的細胞功能減弱，在細胞形成幾個月後就失去了細胞核及其他細胞器。The crystal has a biconvex shape, as shown in Figures 8 and 8A. The anterior and posterior sides of the lens have different curvatures, and the cortex and different lens nuclei generally follow these curvatures. Thus, crystals can be viewed as a layered structure that is substantially asymmetric along the equatorial axis and consists of long crescent-shaped fibrous units arranged end-to-end to form a substantially concentric or nested shell. The ends of these cells are aligned to form sutures anteriorly and posteriorly in and near the center. Older tissue in the cortex and lens nucleus had diminished cellular function, losing the nucleus and other organelles months after the cells formed.

隨著時間的流逝，發生水晶體的壓實。每年增長的水晶體纖維的數量在整個生命中相對恆定。但是，水晶體的尺寸不會像新的光纖增長所期望的那麼大。水晶體從出生到3歲是從6mm增長到7.2mm，或者僅在3年內就增長20％。然後，在下一個大約十年中，從7.2mm增長到9mm（亦即，25％）；然而，這超過3倍以上的9年。在下一個大約20年（從12歲到36歲）中，水晶體從9mm增長到9.6mm，或者在24年內增長6.7％，顯示觀察到的生長速度顯著減慢，而我們認為纖維的生長速度在這段時期相對恆定。最後，在上述的最後大約20年（從36歲到54歲）中，水晶體僅增長很小一部分，在18年中，從9.6mm增長到9.8mm或2.1％。儘管存在需要更多水晶體纖維來填充較大外殼的幾何效應，但較舊的水晶體尺寸卻要比考慮幾何效應的纖維生長速率模型所預測的要小得多。認為包括核纖維壓實的纖維壓實可以解釋這些現象。Over time, compaction of the crystals occurs. The number of crystal fibers that grow each year is relatively constant throughout life. However, the size of the crystals will not be as large as expected from the new fiber growth. The crystal grows from 6mm to 7.2mm from birth to 3 years, or 20% in just 3 years. Then, in the next decade or so, from 7.2mm to 9mm (ie, 25%); however, this is more than 3 times over 9 years. Over the next 20 years or so (from 12 to 36 years), the crystal grew from 9mm to 9.6mm, or 6.7% over 24 years, showing a significant slowdown in the observed growth rate, while we believe that the fiber growth rate was This period is relatively constant. Finally, over the last 20 or so years above (from age 36 to 54), the crystal grew only a small fraction, from 9.6mm to 9.8mm or 2.1% over 18 years. Although there are geometric effects that require more crystal fibers to fill the larger shell, the older crystal sizes are much smaller than predicted by fiber growth rate models that take into account geometric effects. Fiber compaction, including nuclear fiber compaction, is thought to explain these phenomena.

通常，老花眼是調節幅度的喪失。通常，屈光不正典型是由於眼睛的軸向長度的變化所引起。近視是指眼睛過長而導致焦點落在視網膜的前方。遠視是指眼睛過短而導致焦點落在視網膜的後方。通常，白內障是足以干擾視力的眼睛水晶體的混濁區域。Typically, presbyopia is a loss of accommodation. In general, refractive errors are typically caused by changes in the axial length of the eye. Myopia is when the eye is so long that the focus is in front of the retina. Hyperopia is when the eye is so short that the focus falls behind the retina. Usually, a cataract is a cloudy area of the lens of the eye enough to interfere with vision.

老花眼最常表現為近視力缺陷，無法閱讀小字（尤其是在約40至45歲後的昏暗照明下）。老花眼或隨年齡而喪失的調節幅度係與眼睛無法改變自然晶狀水晶體的形狀有關，這使人無法在近與遠之間改變焦點，而發生在基本上是100％的人口中。研究表明，在生命的第五個十年中，調節幅度會隨著年齡的增長而穩定下降。Presbyopia is most often manifested as a near-vision deficit and an inability to read small print (especially in dim lighting after about age 40 to 45). Presbyopia, or the loss of accommodation with age, is related to the eye's inability to change the shape of the natural crystalline lens, which prevents a person from changing focus between near and far, and occurs in essentially 100% of the population. Research shows that accommodation declines steadily with age during the fifth decade of life.

如本文所使用，除非另有說明，否則本文中的值的範圍的列舉僅意欲作為獨立指稱落入該範圍內的每一單獨值的簡寫方法。除非本文另外指出，否則可以將範圍內的每一單獨值併入說明書中，如同在本文中單獨列舉。As used herein, unless stated otherwise, the recitation of ranges of values herein are merely intended as a shorthand method of referring individually to each separate value falling within the range. Unless otherwise indicated herein, each individual value within a range can be incorporated into the specification as if individually recited herein.

通常，除非另有說明，否則本文所使用的術語「約」意指包含±10％的變化或範圍以及與取得所述值相關聯的實驗或儀器誤差，以及較佳為其中較大者。Generally, unless otherwise stated, the term "about" as used herein is meant to include a variance or range of ±10% and the experimental or instrumental error associated with obtaining the stated value, and preferably the greater thereof.

如本文所使用，除非另有明確說明，否則術語「超音波晶體乳化」，「超音波乳化」，「超音波乳化系統」應賦予其儘可能廣泛的構造，指稱相同的通用裝備及程序，並且通常關於使用超音波能量驅動針或尖端，以對組織（包括眼組織（例如，水晶體及白內障））進行例如切割、破碎、分離、及乳化。這樣的程序及系統亦可以包括用於抽吸、沖洗、及兩者的組件及方法。As used herein, unless expressly stated otherwise, the terms "ultrasonic phacoemulsification", "phacoemulsification", "phacoemulsification system" shall be given the broadest possible configuration, referring to the same general equipment and procedures, and It is generally related to the use of ultrasonic energy to drive a needle or tip to, for example, cut, disrupt, dissociate, and emulsify tissue, including ocular tissue (eg, lens and cataracts). Such procedures and systems may also include components and methods for aspiration, irrigation, and both.

如本文所使用，除非另有明確說明，否則術語「飛秒雷射」、「飛秒雷射束」、「飛秒脈衝」、及類似的此類術語係用於指稱脈衝持續時間，因此亦指稱雷射束的脈衝長度（亦可以指稱為脈衝寬度），而意指脈衝持續時間小於1皮秒（小於1×10 -12秒）至1飛秒（fs）（1×10 -15秒）的所有雷射及雷射束。 As used herein, unless expressly stated otherwise, the terms "femtosecond laser,""femtosecond laser beam,""femtosecondpulse," and similar such terms are used to refer to pulse duration and thus also Refers to the pulse length (may also refer to the pulse width) of the laser beam, and means the pulse duration is less than 1 picosecond (less than 1× 10-12 seconds) to 1 femtosecond (fs) (1× 10-15 seconds) of all lasers and laser beams.

如本文所使用，除非另有明確說明，否則術語「皮秒雷射」、「皮秒雷射束」、「皮秒脈衝」、及類似的此類術語係用於指稱脈衝持續時間，因此亦指稱雷射束的脈衝長度（亦可以指稱為脈衝寬度），而意指1皮秒（ps）（1×10 -12秒）至1奈秒（ns）（1×10 -9秒）的脈衝持續時間的所有雷射及雷射束。 As used herein, unless expressly stated otherwise, the terms "picosecond laser,""picosecond laser beam,""picosecondpulse," and similar such terms are used to refer to pulse duration and thus also Refers to the pulse length (may also refer to the pulse width) of a laser beam, and means pulses ranging from 1 picosecond (ps) (1×10 −12 sec) to 1 nanosecond (ns) (1×10 −9 sec) All lasers and laser beams for the duration.

如本文所使用，除非另外特別說明，否則術語「遠側」及「近側」具有以下含義。對於雷射、雷射束、及雷射部件而言，遠側意指更靠近雷射束源的一側、定位、或位置。對於超音波晶體乳化系統而言，遠側意指更靠近超音波能量源的一側、定位、或位置。對於雷射、雷射束、及雷射部件而言，術語近側意指沿著雷射束路徑遠離雷射束源的一側、定位、或位置；因此，在操作上更靠近患者。對於超音波晶體乳化系統而言，術語近側意指沿著能量傳輸路徑遠離超音波能量源的一側、定位、或位置。因此，在操作上更靠近患者。相反地，在那些系統的操作期間，雷射部件或超音波晶體乳化部件的遠端遠離患者。As used herein, unless specifically stated otherwise, the terms "distal" and "proximal" have the following meanings. For lasers, laser beams, and laser components, distal means a side, location, or location that is closer to the source of the laser beam. For an ultrasonic phacoemulsification system, distal means the side, location, or location that is closer to the source of ultrasonic energy. For lasers, laser beams, and laser components, the term proximal means the side, location, or location along the laser beam path that is remote from the laser beam source; thus, operationally closer to the patient. For phacoemulsification systems, the term proximal means the side, location, or location along the energy transfer path away from the source of ultrasonic energy. Therefore, it is operationally closer to the patient. Conversely, during operation of those systems, the distal end of the laser component or phacoemulsification component is remote from the patient.

除了作為診斷工具之外，超音波波能量還具有治療用途。超音波能量可以被聚焦、定向、用於移動（例如眼動或振動）、切割裝置、工具、或尖端，以對組織進行切割、軟化、或乳化來產生薄霧及蒸汽，以及可以進行這些的組合及變化。通常，超音波晶體乳化是醫學上公認的技術，該技術使用超音波能量來移除晶狀水晶體。通常，超音波晶體乳化包括進行角膜切口、鞏膜切口、及這些中的一或更多者。超音波晶體乳化機頭藉由這些切口中之一者***，而超音波晶體乳化機頭典型由超音波驅動的針所組成，以對自然晶狀水晶體進行例如乳化（亦即，液化），將白內障破碎成小塊，以及進行這些的組合及變化。經乳化的塊狀物隨後可以使用相同的機頭或另一機頭來移除。然後，外科醫生可以藉由切口將植入物***眼睛。In addition to being a diagnostic tool, ultrasound energy has therapeutic uses. Ultrasonic energy can be focused, directed, used to move (e.g. eye movements or vibrations), cutting devices, tools, or tips to cut, soften, or emulsify tissue to create mists and vapors, as well as Combinations and variations. In general, phacoemulsification is a medically recognized technique that uses ultrasonic energy to remove crystalline crystals. Typically, phacoemulsification involves making a corneal incision, a scleral incision, and one or more of these. The phacoemulsification handpiece is inserted through one of these incisions, and the phacoemulsification handpiece typically consists of an ultrasonically driven needle to e.g. emulsify (i.e., liquefy) the natural crystalline Cataracts are broken into small pieces, and combinations and variations of these are performed. The emulsified mass can then be removed using the same handpiece or another handpiece. The surgeon can then insert the implant into the eye through the incision.

通常，用於眼睛的治療雷射程序包括將患者放置在床或患者支撐物上，將眼睛與雷射系統的雷射束路徑對準，以及在雷射系統與眼睛之間連接患者介面。然後，利用雷射束圖案遞送治療雷射束，以在眼睛（更特定為眼睛的結構或與眼睛相關聯的結構）上進行治療雷射操作，以解決眼睛的狀況。因此，舉例而言，在本領域中已知用於解決白內障、老花眼、屈光不正（自然及誘發）、及眼睛的其他狀況的雷射程序。Typically, therapeutic laser procedures for the eye include placing the patient on a bed or patient support, aligning the eye with the laser beam path of the laser system, and connecting the patient interface between the laser system and the eye. A therapeutic laser beam is then delivered using a laser beam pattern to perform a therapeutic laser operation on the eye (more specifically a structure of the eye or structures associated with the eye) to address the condition of the eye. Thus, for example, laser procedures are known in the art for addressing cataracts, presbyopia, refractive errors (natural and induced), and other conditions of the eye.

至今為止，在手術室及醫療辦公室中，典型的醫療超音波裝置及系統（更特定為超音波晶體乳化系統）是獨立的系統，並具有自己的功率源、控制系統、監視器、控制及指令輸入、殼體、機櫃、及底座。類似地，至今為止，在手術室及醫療辦公室中，典型的醫療雷射治療裝置及系統是獨立的系統，並具有自己的功率源、控制系統、監視器、控制及指令輸入、殼體、機櫃、及底座。To date, in operating theatres and medical offices, typical medical ultrasound devices and systems (more specifically ultrasound phacoemulsification systems) are self-contained systems with their own power sources, control systems, monitors, controls and commands Inputs, enclosures, cabinets, and bases. Similarly, to date, in operating rooms and medical offices, typical medical laser therapy devices and systems are stand-alone systems with their own power sources, control systems, monitors, control and command inputs, housings, cabinets , and the base.

儘管該領域已經表達將超音波裝置與其他治療設備（例如，雷射）組合的需求，並且提供了一些基本組合，但是相信這種需求很大程度上沒有得到解決。至今為止，相信沒有人將治療超音波系統與另一系統（例如，治療雷射遞送系統）成功整合在一起，以提供一種可以滿足法規及醫務人員的要求及需求的緊湊而有效的醫療系統。更特定言之，在本發明之前，相信沒有人將眼用超音波晶體乳化系統與眼用治療雷射系統成功整合在一起，以提供一種滿足法規及醫務人員的要求及需求的緊湊而有效的人體工程學醫療系統。滿足這些要求及需求兩者不僅關於兩個系統的單純組合（該技術領域已經提出了這種組合）。藉由本發明滿足了這些需求，而本發明的實施例提供整合的超音波雷射，特定為滿足法規及醫務人員的要求及需求的緊湊而有效的人體工程學的醫療系統的超音波晶體乳化雷射（phaco-laser）系統。Although the field has expressed a need to combine ultrasound devices with other therapeutic devices (eg, lasers), and some basic combinations have been provided, this need is believed to be largely unaddressed. To date, it is believed that no one has successfully integrated a therapeutic ultrasound system with another system (eg, a therapeutic laser delivery system) to provide a compact and efficient medical system that can meet the requirements and needs of regulations and medical personnel. More specifically, prior to the present invention, it is believed that no one has successfully integrated an ophthalmic phacoemulsification system with an ophthalmic therapeutic laser system to provide a compact and efficient solution that meets the requirements and needs of regulatory and medical personnel. Ergonomic medical system. Satisfying both of these requirements and needs is not only about the mere combination of two systems (which has been proposed in this technical field). These needs are met by the present invention, and embodiments of the present invention provide an integrated ultrasonic laser, ultrasonic crystal emulsion laser specifically for a compact and efficient ergonomic medical system that meets regulatory and medical personnel requirements and needs. The phaco-laser system.

本發明的背景技術部分意欲介紹該領域的各種態樣，這些態樣可以與本發明的實施例相關聯。因此，此部分中的前述討論提供用於更好地理解本發明的框架，並且不應被視為對先前技術的承認。This Background of the Invention section is intended to introduce various aspects of this field, which may be associated with embodiments of the invention. Accordingly, the foregoing discussion in this section provides a framework for a better understanding of the present invention and should not be regarded as an admission of prior art.

長期存在且未滿足以單獨或組合的方式解決及改善手術室及醫療辦公室的系統的尺寸、操作治療室的人體工程學、手術系統及裝備、有效進行程序所需要的時間、患者的舒適度的需要。這些長期的需求已經存在並持續，而在眼科學領域尤其如此，並包括解決白內障，解決基於屈光的問題，解決老花眼，解決眼睛的疾病、狀況、及外傷，以及針對眼睛及附近結構的狀況的其他手術程序。藉由提供本說明書、圖式、及請求項中所闡述的製品、裝置、及方法，本發明解決了這些及其他需求。The long-standing and unmet need to address and improve, individually or in combination, the size of systems in operating rooms and medical offices, the ergonomics of operating the treatment room, the surgical systems and equipment, the time required to perform the procedure effectively, and the comfort of the patient. need. These longstanding needs exist and continue, especially in the field of ophthalmology, and include addressing cataracts, addressing refractive-based problems, addressing presbyopia, addressing diseases, conditions, and traumas of the eye, and conditions targeting the eye and nearby structures other surgical procedures. The present invention addresses these and other needs by providing the articles, apparatus, and methods set forth in this specification, drawings, and claims.

因此，提供所請求的發明以及說明書及圖式中所提供的實施例。Accordingly, the claimed invention and the embodiments provided in the specification and drawings are provided.

此外，提供一種雷射系統，具有：治療雷射系統，具有殼體；患者位置決定系統；具有第一部件及第二部件；第一部件係與治療雷射系統機械關聯；第二部件不與治療雷射系統機械關聯，由此第二部件獨立於治療雷射系統，而藉此相對於治療雷射系統自由移動；以及其中第一部件、第二部件、或二者經配置以決定相對於第一部件的第二部件的相對位置。Furthermore, a laser system is provided, comprising: a therapeutic laser system having a housing; a patient position determination system; having a first component and a second component; the first component is mechanically associated with the therapeutic laser system; the second component is not associated with The therapeutic laser system is mechanically associated whereby the second component is independent of the therapeutic laser system and thereby free to move relative to the therapeutic laser system; and wherein the first component, the second component, or both are configured to determine relative to the therapeutic laser system The relative position of the second part of the first part.

此外，提供一種雷射超音波系統，具有：治療雷射系統；超音波晶體乳化系統，用於提供治療超音波能量；以及安全互鎖，由此當超音波晶體乳化系統處於操作狀態時，防止雷射系統擊發雷射。Additionally, a laser ultrasound system is provided having: a therapeutic laser system; an ultrasonic phacoemulsification system for providing therapeutic ultrasonic energy; and a safety interlock whereby, when the ultrasonic phacoemulsification system is in operation, preventing The laser system fires the laser.

更進一步地，提供一種雷射超音波系統，具有：治療雷射系統；超音波晶體乳化系統，用於提供治療超音波能量；以及整合到系統中的顯微鏡。Still further, a laser ultrasound system is provided having: a therapeutic laser system; an ultrasonic phacoemulsification system for providing therapeutic ultrasound energy; and a microscope integrated into the system.

此外，提供一種雷射超音波系統，具有：治療雷射系統；超音波晶體乳化系統，用於提供治療超音波能量；沙姆（Scheimpflug）相機構件，用於決定眼睛的結構的形狀、位置、及兩者。In addition, a laser ultrasound system is provided, comprising: a therapeutic laser system; an ultrasonic phacoemulsification system for providing therapeutic ultrasound energy; a Scheimpflug camera member for determining the shape and position of the structure of the eye , and both.

此外，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中雷射系統具有整合超音波系統；其中超音波系統係容納在治療雷射殼體內；其中超音波系統係為超音波晶體乳化系統；具有雷射安全互鎖，由此在使用超音波系統時不能發射雷射；其中治療雷射系統係為飛秒雷射系統；其中超音波系統係為超音波晶體乳化系統；其中患者位置決定系統具有選自A/C電磁追蹤系統、電磁追蹤系統、陀螺儀、加速度計、及磁力計所組成的群組的裝置；其中患者位置決定系統具有選自羅盤、雷射位置決定裝置、音波位置決定裝置、RFID裝置所組成的群組的裝置；其中治療雷射系統具有從殼體伸出的臂；其中治療雷射系統具有從殼體伸出的臂，並且在該臂的近端處具有雷射遞送頭；其中所決定的相對位置係在二維空間中；其中所決定的相對位置係在3維空間中；其中患者決定系統具有至少95％的精確度；其中患者決定系統具有至少98％的精確度；其中患者決定系統具有至少99％的精確度；其中該系統經配置以決定臂與患者縱向軸線的角度，並且至少部分依據該角度來調整治療雷射束圖案；其中該角度係決定為在精確度的±5度內；其中該角度係決定為在精確度的±3度以內；其中該角度係決定為在精確度的±2度內；其中患者位置決定系統的第二部件係容納在患者頭枕中；其中治療雷射系統具有用於患者位置決定系統的第二部件的充電站；其中該系統具有PID；其中PID具有彎月形反向器；其中PID包含臂，且其中該臂定義真空通道及生理鹽水通道；其中該系統具有定義四個瞳孔的光學裝置，且其中雷射束路徑延伸通過瞳孔中的兩個；以及其中在瞳孔處係為共軛端心（telocentric）瞳孔。Furthermore, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided having one or more of the following features: wherein the laser system has an integrated Ultrasound system; wherein the ultrasound system is housed within a therapeutic laser housing; wherein the ultrasound system is an ultrasound phacoemulsification system; having a laser safety interlock, whereby the laser cannot be fired when the ultrasound system is in use; wherein The therapeutic laser system is a femtosecond laser system; wherein the ultrasonic system is an ultrasonic phacoemulsification system; wherein the patient position determination system has an A/C electromagnetic tracking system, an electromagnetic tracking system, a gyroscope, an accelerometer, and A device of the group consisting of a magnetometer; wherein the patient position determination system has a device selected from the group consisting of a compass, a laser position determination device, a sonic position determination device, and an RFID device; wherein the therapeutic laser system has a device from the housing an extending arm; wherein the therapeutic laser system has an arm extending from the housing and a laser delivery head at a proximal end of the arm; wherein the determined relative position is tied in two-dimensional space; wherein the determined wherein the patient decision system has an accuracy of at least 95%; wherein the patient decision system has an accuracy of at least 98%; wherein the patient decision system has an accuracy of at least 99%; wherein the system is configured to determine the angle of the arm to the longitudinal axis of the patient, and to adjust the treatment laser beam pattern based at least in part on the angle; wherein the angle is determined to be within ±5 degrees of accuracy; wherein the angle is determined to be within ±5 degrees of accuracy Within 3 degrees; wherein the angle is determined to be within ±2 degrees of accuracy; wherein the second component of the patient position determination system is housed in the patient headrest; wherein the therapeutic laser system has a first for the patient position determination system. A two-part charging station; wherein the system has a PID; wherein the PID has a meniscus reverser; wherein the PID includes an arm, and wherein the arm defines a vacuum channel and a saline channel; wherein the system has optics defining four pupils , and wherein the laser beam path extends through two of the pupils; and wherein the pupil is a conjugate telocentric pupil at the pupil.

進一步提供一種雷射超音波系統，具有：組件，該組件具有：治療雷射，用於沿著雷射束路徑提供治療雷射束；超音波晶體乳化系統，用於提供治療超音波能量；臂，附接至組件；該臂具有遠端及近端，其中遠端係附接至組件；其中近端具有雷射遞送頭；該臂容納雷射束遞送路徑的一部分；其中該組件相對於患者位置成一角度進行定位，其中該角度係由該臂的縱向軸線與患者軸線所定義；該角度係為30度至320度。Further provided is a laser ultrasound system having: an assembly having: a therapeutic laser for providing a therapeutic laser beam along a laser beam path; an ultrasonic crystal emulsification system for providing therapeutic ultrasound energy; an arm , attached to the assembly; the arm has a distal end and a proximal end, wherein the distal end is attached to the assembly; wherein the proximal end has a laser delivery head; the arm accommodates a portion of the laser beam delivery path; wherein the assembly is relative to the patient The position is positioned at an angle defined by the longitudinal axis of the arm and the patient axis; the angle is 30 to 320 degrees.

此外，進一步提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中該角度選自由45°、90°、135°、180°、225°、270°、及315°所組成的角度的群組；其中該臂經配置以環繞組件上的樞軸點進行弧形移動；其中該臂經配置以用於水平移動，由此該臂可以從組件伸出及縮回；其中該臂、該雷射頭、或二者經配置以用於垂直移動；其中具有該臂的雷射束路徑中的雷射束並未準直；其中具有該臂的雷射束路徑中的雷射束係在光纖內；具有定義四個瞳孔的光學裝置，且其中雷射束路徑延伸通過四個瞳孔；其中在瞳孔處係為共軛端心瞳孔；具有用於決定相對於組件的患者位置的構件；其中用於決定患者位置的構件具有第一部件與第二部件；其中第一部件係與雷射超音波系統機械關聯；其中第二部件並未附接至治療雷射系統，由此第二部件獨立於治療雷射系統，並藉此相對於治療雷射系統自由移動；以及其中第一部件、第二部件、或二者經配置以決定相對於第一部件的第二部件的相對位置；其中治療雷射超音波系統具有用於患者位置決定系統的第二部件的充電站；其中雷射系統與超音波晶體乳化系統是整合的；其中雷射系統與超音波晶體乳化系統係容納在殼體內。其中該組件係容納在殼體內；具有雷射安全互鎖，由此在使用超音波晶體乳化系統時無法發射雷射；以及其中治療雷射係為飛秒雷射。In addition, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are further provided having one or more of the following features: wherein the angle is selected from a group of angles of 45°, 90°, 135°, 180°, 225°, 270°, and 315°; wherein the arm is configured to move in an arc around a pivot point on the assembly; wherein the arm configured for horizontal movement whereby the arm can be extended and retracted from the assembly; wherein the arm, the laser head, or both are configured for vertical movement; wherein there is a laser beam path for the arm the laser beam in is not collimated; wherein the laser beam in the laser beam path with the arm is tethered within an optical fiber; has optics defining four pupils, and wherein the laser beam path extends through the four pupils; wherein at the pupil is a conjugate end-center pupil; having means for determining patient position relative to the assembly; wherein the means for determining patient position has a first part and a second part; wherein the first part is connected to the laser The ultrasound system is mechanically associated; wherein the second component is not attached to the therapeutic laser system, whereby the second component is independent of the therapeutic laser system and thereby moves freely relative to the therapeutic laser system; and wherein the first component, The second component, or both, is configured to determine the relative position of the second component with respect to the first component; wherein the therapeutic laser ultrasound system has a charging station for the second component of the patient position determination system; wherein the laser system It is integrated with the ultrasonic crystal emulsion system; the laser system and the ultrasonic crystal emulsion system are accommodated in the casing. Wherein the assembly is accommodated in a housing; has a laser safety interlock, so that the laser cannot be emitted when the ultrasonic crystal emulsification system is used; and wherein the therapeutic laser is a femtosecond laser.

進一步提供一種雷射超音波系統，具有：治療雷射，用於沿著雷射束路徑提供治療雷射束；超音波晶體乳化系統，用於提供治療超音波能量；以及光學裝置，用於定義四個瞳孔，且其中雷射束路徑延伸通過至少兩個瞳孔。Further provided is a laser ultrasound system having: a therapeutic laser for providing a therapeutic laser beam along a laser beam path; an ultrasonic phacoemulsification system for providing therapeutic ultrasound energy; and an optical device for defining Four pupils, and wherein the laser beam path extends through at least two pupils.

此外，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中在瞳孔處係為共軛端心瞳孔；其中治療雷射與超音波晶體乳化系統是整合的；其中治療雷射與超音波晶體乳化系統係容納在殼體內；具有雷射安全互鎖，由此在使用超音波系統時無法發射雷射；以及其中治療雷射系統係為飛秒雷射系統。Furthermore, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided having one or more of the following features: wherein at the pupil is Conjugate end-center pupil; wherein the therapeutic laser and the ultrasonic phacoemulsification system are integrated; wherein the therapeutic laser and the ultrasonic phacoemulsification system are accommodated in the housing; have a laser safety interlock, thereby using the ultrasonic system cannot emit lasers; and the therapeutic laser system is a femtosecond laser system.

此外，提供一種雷射超音波系統，具有：用於提供第一及第二治療雷射束的構件；該系統具有用於定義雷射束路徑的光學裝置；第一及第二雷射束路徑沿著雷射束路徑行進；其中第一治療雷射束具有約1000fs至約2000fs的脈衝寬度；該系統具有用於執行利用第一治療雷射束的水晶體切割的雷射束遞送圖案；其中第二治療雷射束具有約100fs至約500fs的脈衝寬度；該系統具有用於利用第二治療雷射束的角膜切割的雷射束遞送圖案；超音波晶體乳化系統，用於提供治療超音波能量。Furthermore, a laser ultrasound system is provided having: means for providing first and second therapeutic laser beams; the system having optics for defining a laser beam path; first and second laser beam paths traveling along a laser beam path; wherein the first therapeutic laser beam has a pulse width of about 1000 fs to about 2000 fs; the system has a laser beam delivery pattern for performing crystal cutting with the first therapeutic laser beam; wherein the first Two therapeutic laser beams have a pulse width of about 100 fs to about 500 fs; the system has a laser beam delivery pattern for corneal ablation with the second therapeutic laser beam; an ultrasonic phacoemulsification system for providing therapeutic ultrasonic energy .

進一步提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中第一雷射束的波長係為1030nm；其中第二雷射束的波長係為1030nm；其中第一雷射束的波長係為1030nm，而第二雷射束的波長係為1030nm；其中重複率係為320kHz或更少。Further provided are these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus having one or more of the following features: wherein the first laser beam is The wavelength is 1030nm; wherein the wavelength of the second laser beam is 1030nm; wherein the wavelength of the first laser beam is 1030nm, and the wavelength of the second laser beam is 1030nm; wherein the repetition rate is 320kHz or less .

進一步提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中具有沙姆相機構件；其中沙姆相機構件具有n個相機，其中至少n-1個相機在30度至320度的任何患者角度下都具有患者眼睛的遮擋視圖；其中n係為5；其中n係為6；以及其中相機具有至少40度的間隔。These laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are further provided having one or more of the following features: having a Sham camera member therein ; wherein the Sham camera member has n cameras, wherein at least n-1 cameras have an occluded view of the patient's eye at any patient angle from 30 degrees to 320 degrees; wherein n is 5; wherein n is 6; and where the cameras have a separation of at least 40 degrees.

此外，提供一種雷射超音波系統，具有：第一配置，用於向患者提供治療雷射束；以及第二配置，用於針對患者進行超音波晶體乳化程序；以及其中從第一配置到第二配置的轉變花費少於5分鐘。Additionally, a laser ultrasound system is provided having: a first configuration for providing a therapeutic laser beam to a patient; and a second configuration for performing a phacoemulsification procedure on the patient; The transition of the two configurations took less than 5 minutes.

進一步提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中從雷射到超音波乳化的轉變少於3分鐘；其中從雷射到超音波乳化的轉變少於2分鐘；其中從雷射到超音波乳化的轉變少於1分鐘；其中從雷射到超音波乳化的轉變少於45秒；其中從雷射到超音波乳化的轉變係為約30秒；其中從雷射到超音波乳化的轉變係為約1分鐘至30秒。These laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are further provided, having one or more of the following features: wherein from laser to ultrasound The transition from emulsification is less than 3 minutes; wherein the transition from laser to phacoemulsification is less than 2 minutes; wherein the transition from laser to phacoemulsification is less than 1 minute; wherein the transition from laser to phacoemulsification is less than 45 seconds; wherein the transition from laser to phacoemulsification is about 30 seconds; wherein the transition from laser to phacoemulsification is about 1 minute to 30 seconds.

進一步提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中從毫微微雷射到超音波乳化的轉變少於3分鐘；其中從毫微微雷射到超音波乳化的轉變少於2分鐘；其中從毫微微雷射到超音波乳化的轉變少於1分鐘；其中從毫微微雷射到超音波乳化的轉變少於45秒；其中從毫微微雷射到超音波乳化的轉變係為約30秒；其中從毫微微雷射到超音波乳化的轉變係為約1分鐘至30秒。These laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are further provided having one or more of the following features: wherein the femtolaser to The transition from phacoemulsification is less than 3 minutes; wherein the transition from femtolaser to phacoemulsification is less than 2 minutes; wherein the transition from femtolaser to phacoemulsification is less than 1 minute; wherein the transition from femtolaser to phacoemulsification is less than 1 minute The transition to phacoemulsification is less than 45 seconds; where the transition from femtolaser to phacoemulsification is about 30 seconds; where the transition from femtolaser to phacoemulsification is about 1 minute to 30 seconds.

進一步提供一種雷射超音波系統，具有：用於定義佔地面積及體積的組件；該組件具有：治療雷射系統；以及超音波晶體乳化系統，用於提供治療超音波能量；以及其中佔地面積係小於1500平方英吋。Further provided is a laser ultrasound system having: an assembly for defining a footprint and a volume; the assembly having: a therapeutic laser system; and an ultrasonic phacoemulsification system for providing therapeutic ultrasound energy; and a footprint therein The area is less than 1500 square inches.

進一步提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中佔地面積係為約33英吋×約22英吋；其中佔地面積係為約35英吋或更少×約35英吋或更少；其中佔地面積係為約35英吋或更少×約22英吋或更少；其中佔地面積係為約400平方英吋至約800平方英吋；其中體積小於約40立方英呎；其中體積小於約35立方英呎；其中體積小於約30立方英呎；其中體積小於約25立方英呎；以及其中體積小於約20立方英呎。Further provided are these laser systems, laser ultrasound systems, laser phacoemulsification systems, femtosonic emulsification systems, methods, and apparatus having one or more of the following features: wherein the footprint is about 33 inches x about 22 inches; where the footprint is about 35 inches or less x about 35 inches or less; where the footprint is about 35 inches or less x about 22 inches or Wherein the floor area is from about 400 square inches to about 800 square inches; where the volume is less than about 40 cubic feet; where the volume is less than about 35 cubic feet; where the volume is less than about 30 cubic feet; where the volume less than about 25 cubic feet; and wherein the volume is less than about 20 cubic feet.

此外，提供一種雷射超音波系統，具有：治療雷射系統；該治療雷射系統具有：臂，具有近端；雷射頭，附接至該臂的近端；以及電子裝置，用於操作治療雷射系統；超音波晶體乳化系統，用於提供治療超音波能量，並具有用於操作該超音波晶體乳化系統的電子裝置；以及雷射頭與用於超音波晶體乳化系統的電子裝置及用於治療雷射系統的電子裝置電隔離。Furthermore, there is provided a laser ultrasound system having: a therapeutic laser system; the therapeutic laser system having: an arm having a proximal end; a laser head attached to the proximal end of the arm; and electronics for operating Therapeutic laser system; an ultrasonic phacoemulsification system for providing therapeutic ultrasonic energy and having an electronic device for operating the ultrasonic phacoemulsification system; and a laser head and an electronic device for the ultrasonic phacoemulsification system and Electrical isolation of electronics for therapeutic laser systems.

進一步提供一種雷射系統，具有：治療雷射束，用於提供治療雷射束；以及用於定義雷射束路徑的光學裝置；其中雷射束路徑大於300mm；由此，雷射束圖案沿著雷射束路徑傳輸，而雷射束圖案不會擴展。A laser system is further provided, having: a therapeutic laser beam for providing a therapeutic laser beam; and an optical device for defining a laser beam path; wherein the laser beam path is greater than 300 mm; whereby the laser beam pattern extends along the along the path of the laser beam without spreading the laser beam pattern.

此外，提供一種雷射系統，具有：治療雷射束，用於提供治療雷射束；以及用於定義雷射束路徑的光學裝置；其中雷射束路徑大於300mm；由此，雷射束圖案沿著雷射束路徑傳輸，而沒有任何波前誤差。Furthermore, a laser system is provided having: a therapeutic laser beam for providing a therapeutic laser beam; and an optical device for defining a laser beam path; wherein the laser beam path is greater than 300 mm; whereby the laser beam pattern Transmission along the laser beam path without any wavefront error.

此外，提供一種雷射系統，具有：治療雷射束，用於提供治療雷射束；以及用於定義雷射束路徑的光學裝置；其中雷射束路徑大於300mm；由此，雷射束圖案沿著雷射束路徑傳輸，而沒有像差。Furthermore, a laser system is provided having: a therapeutic laser beam for providing a therapeutic laser beam; and an optical device for defining a laser beam path; wherein the laser beam path is greater than 300 mm; whereby the laser beam pattern Transmission along the laser beam path without aberrations.

進一步，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中雷射係為飛秒雷射，並且進一步具有整合的超音波晶體乳化系統。Further, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided having one or more of the following features: wherein the laser is a Second laser, and further has an integrated ultrasonic crystal emulsification system.

此外，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：具有虹膜配準裝置。Furthermore, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided having one or more of the following features: having an iris registration device.

此外，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中超音波系統與雷射系統之間的資料及資訊進行交換；其中資訊具有白內障的等級；其中來自雷射系統的資訊係用於提供推薦的超音波能量。Furthermore, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided, having one or more of the following features: wherein the ultrasound system and the laser data and information are exchanged between the laser systems; wherein the information has the level of cataract; wherein the information from the laser system is used to provide the recommended ultrasonic energy.

此外，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中超音波系統與雷射系統之間的資料及資訊進行交換；以及其中資訊具有白內障的等級。Furthermore, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided, having one or more of the following features: wherein the ultrasound system and the laser exchange of data and information between radiological systems; and where the information has a cataract level.

此外，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：具有OCT成像構件。Furthermore, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided having one or more of the following features: having OCT imaging means.

此外，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：其中該系統具有佔地面積尺寸；以及其中佔地面積尺寸選自少於35×少於35英吋、少於35×25英吋、約35×25英吋、約33×22英吋、及約400平方英吋至約800平方英吋所組成的尺寸群組。Furthermore, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided having one or more of the following features: wherein the system has a footprint Area dimensions; and wherein the footprint dimensions are selected from less than 35 x less than 35 inches, less than 35 x 25 inches, about 35 x 25 inches, about 33 x 22 inches, and about 400 square inches to A size group of approximately 800 square inches.

此外，提供這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統、方法、及裝置，具有下列特徵中之一或更多者：具有定位於雷射束路徑中的雷射頭上的帽，由此當雷射未處於可操作配置時，光學部件得到保護。Furthermore, these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems, methods, and apparatus are provided having one or more of the following features: having a laser beam positioned at A cap on the laser head in the path, whereby the optics are protected when the laser is not in an operational configuration.

進一步提供利用這些雷射系統、雷射超音波系統、雷射超音波乳化系統、毫微微超音波乳化系統中之任一者執行雷射操作及超音波晶體乳化操作的方法。Further provided are methods of performing laser operations and phacoemulsification operations utilizing any of these laser systems, laser ultrasound systems, laser phacoemulsification systems, femto phacoemulsification systems.

般而言，本發明的實施例提供用於解決眼睛（包括角膜、自然晶狀水晶體、及與眼睛相關聯的其他結構）的狀況（並且更特定為用於遞送雷射能量及超音波能量）以及用於解決、緩解、改善、及反轉這些狀況的系統及方法。In general, embodiments of the present invention provide for addressing conditions of the eye (including the cornea, natural crystalline lens, and other structures associated with the eye) (and more specifically for delivering laser energy and ultrasonic energy) And systems and methods for addressing, alleviating, improving, and reversing these conditions.

一般而言，本發明的實施例係關於人體工學系統、整合系統、及這些的組合及變化，並提供使用超音波及雷射束來針對人類眼睛及其相關結構的狀況進行診斷、治療、及這些的組合及變化的能力。在本系統的實施例中，雷射及超音波部件係整合進入單一裝置，該單一裝置經配置以將治療超音波能量及雷射能量操作、控制、及遞送至眼睛。這些整合裝置的實施例可以具有：整合及互動式控制系統；整合患者資訊系統；整合計費系統；整合電子病歷；雷射與超音波系統之間的整合及互動式操作、控制、遞送、及這些系統的組合；雷射與超音波系統之間的包括安全系統的整合及互動式協定；整合及互動式輸入系統，用於讓外科醫生及從業人員將資訊及指令輸入至裝置；整合及互動式監測系統、顯示器、及二者；整合及共同功率源及功率管理；整合的熱負載（例如，熱）管理；無干擾的能量產生及遞送系統；以及這些特徵以及其他特徵的組合及變化。In general, embodiments of the present invention relate to ergonomic systems, integrated systems, and combinations and variations of these, and provide for the use of ultrasound and laser beams for the diagnosis, treatment, diagnosis and treatment of conditions of the human eye and related structures. and the ability to combine and vary these. In an embodiment of the present system, the laser and ultrasound components are integrated into a single device that is configured to operate, control, and deliver therapeutic ultrasound energy and laser energy to the eye. Embodiments of these integrated devices may have: integrated and interactive control systems; integrated patient information systems; integrated billing systems; integrated electronic medical records; integrated and interactive operation, control, delivery, and Combinations of these systems; integrated and interactive agreements between laser and ultrasound systems including safety systems; integrated and interactive input systems for surgeons and practitioners to input information and instructions into the device; integration and interaction integrated and common power sources and power management; integrated thermal load (eg, thermal) management; interference-free energy generation and delivery systems; and combinations and variations of these and other features.

在實施例中，這些整合裝置或系統係與患者支撐床相關聯，並形成進一步系統。在較佳實施例中，這些裝置及此患者支撐床經配置以允許外科醫生藉由多種途徑進入患者的左眼及右眼，而不需要患者的移動或重新佈置。因此，系統的此較佳實施例允許外科醫生基於接近眼睛的一或二者的外科醫生個體較佳方法而容易定位患者，而不需要重新定位患者，並且不需要重新配置雷射、超音波、及二者。以此方式，增強患者的順應性，增強外科醫生的人體工程學，增強效率，增強功效，減少完成患者的整個程序（例如，雙眼）的時間，以及這些的組合及變化，並且可以取得其他益處。In an embodiment, these integrated devices or systems are associated with a patient support bed and form a further system. In preferred embodiments, the devices and the patient support couch are configured to allow the surgeon to access the patient's left and right eyes via multiple routes without requiring movement or rearrangement of the patient. Thus, this preferred embodiment of the system allows the surgeon to easily position the patient based on the surgeon's individual preferred approach to one or both of the eyes, without the need to reposition the patient, and without the need to reconfigure the laser, ultrasound, and both. In this way, patient compliance is enhanced, surgeon ergonomics are enhanced, efficiency is enhanced, efficacy is enhanced, the time to complete a patient's entire procedure (eg, both eyes) is reduced, and combinations and variations of these, and others can be achieved. benefit.

在實施例中，患者係定位於患者支撐件（例如，支撐床）上。然後，將系統移動至患者附近的位置。外科醫生可以在本說明書所描述的多種定向中之任一者上定位系統。然後，使用雷射系統及超音波系統來對患者進行程序。In an embodiment, the patient is positioned on a patient support (eg, a support bed). Then, move the system to a location near the patient. The surgeon may position the system in any of the various orientations described in this specification. The patient is then subjected to procedures using a laser system and an ultrasound system.

這些系統的實施例（例如，整合超音波晶體乳化液雷射系統的實施例）經配置而能夠解決眼睛的各種狀況，並且能夠在眼睛上執行各種程序，包括例如：晶狀體囊切開；客製化形狀的非圓形及非橢圓形晶狀體囊切開；水晶體切割、破碎、切片、及移除；白內障切割、破碎、分離、及移除；水晶體及白內障組織的乳化；角膜切割及切口；角膜瓣及袋的建立；進行角膜緣鬆弛切口；解決及校正屈光不正（自然及誘發）；殘留皮質材料的移除；水晶體上皮細胞的移除；與前玻璃體切除相關聯的玻璃體抽吸及切割；解決雙極凝血；以及人工水晶體注射。Embodiments of these systems (eg, those incorporating an ultrasonic crystal emulsion laser system) are configured to address various conditions of the eye and to perform various procedures on the eye, including, for example: capsulotomy; customized Shaped non-circular and non-elliptical capsulotomy; lens incision, fragmentation, sectioning, and removal; cataract incision, fragmentation, separation, and removal; emulsification of lens and cataract tissue; corneal incision and incision; corneal flaps and Pocket creation; limbal relaxation incision; resolution and correction of refractive errors (natural and induced); removal of residual cortical material; removal of lens epithelial cells; vitreous aspiration and incision associated with anterior vitrectomy; resolution bipolar coagulation; and intraocular lens injection.

這些系統的實施例（例如，整合超音波晶體乳化器雷射系統的實施例）經配置而能夠解決眼睛的各種狀況，並且能夠執行包括放射狀角膜切開術（RK）、散光性角膜切開術（AK）、角膜緣鬆弛切口（LRI）、及這些的組合及變化的各種程序。這些切口可以在超音波乳化程序及水晶體植入之前或之後藉由雷射進行。RK包括微RK、微RK/AK、及傳統RK，而微RK係為較佳的。對於微RK而言，可以在光學區域中使用徑向切口，該光學區域較佳為較大的約5.00mm及更大，但是亦可以設想較小的區域。切口的長度通常為約2.50mm。切口的典型參數係在表1中列出。通常，在微RK程序中，1、2、3或更多個切口係形成於角膜上。 表1 徑向切口參數 範圍 較佳值 預設值 單位 光學區域 4.00 - 6.25 5.00 5.00 mm 與AK的最小間距 0.00 - 0.50 0.20 0.20 mm 所期望的徑向長度 0.50 - 2.50 2.00 2.00 mm 最小殘留基質 100 - 300 150 150 μm 深度 20 - 90 80 80 % 入口過切（+） -0.20 - +0.20 0.06 0.06 mm Embodiments of these systems (eg, those incorporating a phacoemulsification laser system) are configured to address various conditions of the eye and to perform procedures including radial keratotomy (RK), astigmatic keratotomy ( AK), limbal relaxation incisions (LRI), and various procedures for combinations and variations of these. These incisions can be made by laser before or after the phacoemulsification procedure and lens implantation. RK includes micro-RK, micro-RK/AK, and conventional RK, with micro-RK being preferred. For micro-RKs, radial cuts can be used in the optic zone, which is preferably a larger optic zone of about 5.00 mm and larger, although smaller zones are also contemplated. The length of the incision is typically about 2.50 mm. Typical parameters of the incision are listed in Table 1. Typically, in a micro-RK procedure, 1, 2, 3 or more incisions are made on the cornea. Table 1 Radial Cut Parameters scope best value default value unit Optical area 4.00 - 6.25 5.00 5.00 mm Minimum distance from AK 0.00 - 0.50 0.20 0.20 mm desired radial length 0.50 - 2.50 2.00 2.00 mm minimal residual matrix 100 - 300 150 150 μm depth 20 - 90 80 80 % Entrance overcut (+) -0.20 - +0.20 0.06 0.06 mm

在這些系統的實施例中，相關聯患者支撐床係為智慧型患者支撐床。此智慧型患者支撐床具有位置決定裝置（例如，定位裝置、RFID、光學裝置、加速度計、感測器、位置裝置等），該等位置決定裝置係與雷射超音波裝置通訊，以提供相對於雷射束遞送部件、雷射束路徑、雷射對接部件、超音波部件、組合的雷射超音波裝置、及這些的組合及變化的患者的確切位置（更特定為患者的頭部）。In embodiments of these systems, the associated patient support bed is a smart patient support bed. The smart patient support bed has position determining devices (eg, positioning devices, RFID, optical devices, accelerometers, sensors, position devices, etc.) that communicate with the laser ultrasound device to provide relative The exact position of the patient (more specifically the patient's head) on the laser beam delivery components, laser beam paths, laser docking components, ultrasound components, combined laser ultrasound devices, and combinations and variations of these.

在這些系統的實施例中，存在可以與任何標準患者支撐件（例如，患者支撐床）相關聯的相關聯智慧型頭枕。此智慧型頭枕具有位置決定裝置（例如，定位裝置、RFID、光學裝置、加速度計、感測器、位置裝置等），該等位置決定裝置係與雷射超音波裝置通訊，以提供相對於雷射束遞送部件、雷射束路徑、雷射對接部件、超音波部件、組合的雷射超音波裝置、及這些的組合及變化的患者的確切位置（更特定為患者的頭部）。In embodiments of these systems, there is an associated smart headrest that can be associated with any standard patient support (eg, a patient support bed). The smart headrest has position determining devices (eg, positioning devices, RFID, optical devices, accelerometers, sensors, position devices, etc.) that communicate with the laser ultrasound device to provide relative The exact position of the patient (more specifically the patient's head) of the laser beam delivery components, laser beam paths, laser docking components, ultrasound components, combined laser ultrasound devices, and combinations and variations of these.

在這些系統的實施例中，存在可以與患者的頭部或頸部相關聯（例如，由患者所穿戴或放置）的相關聯患者智慧型裝置（例如，患者標籤、帶、或帽）。此患者智慧型裝置具有位置決定裝置（例如，定位裝置、RFID、光學裝置、加速度計、感測器、位置裝置等），該等位置決定裝置係與雷射超音波裝置通訊，以提供相對於雷射束遞送部件、雷射束路徑、雷射對接部件、超音波部件、組合的雷射超音波裝置、及這些的組合及變化的患者的確切位置（更特定為患者的頭部）。In embodiments of these systems, there is an associated patient-smart device (eg, a patient tag, strap, or cap) that may be associated with (eg, worn or placed by) the patient's head or neck. The patient-intelligent device has location-determining devices (eg, positioning devices, RFID, optical devices, accelerometers, sensors, location devices, etc.) that communicate with the laser ultrasound device to provide relative The exact position of the patient (more specifically the patient's head) of the laser beam delivery components, laser beam paths, laser docking components, ultrasound components, combined laser ultrasound devices, and combinations and variations of these.

用於決定相對於雷射的位置與雷射束路徑的患者的位置（例如，患者的頭部）的用於患者的位置決定裝置（亦指稱為用於患者的定向/定位追蹤系統）可以是例如電磁追蹤系統（例如，Polhemus Patriot™ 6-DOF）。在美國專利5,307,072、6,369,594、6,400,139、6,624,626、7,710,395、6,762,600、7,292,948、7,873,491、及8,013,595中揭示及教示這樣的追蹤系統的實施例，每一者的全部揭示內容藉由引用併入本文。這樣的裝置亦可以指稱為患者***或患者定位裝置或系統。A position determination device for a patient (also referred to as an orientation/location tracking system for a patient) for determining the position of the patient (eg, the patient's head) relative to the position of the laser and the path of the laser beam may be Such as electromagnetic tracking systems (eg, Polhemus Patriot™ 6-DOF). Embodiments of such tracking systems are disclosed and taught in US Pat. Nos. 5,307,072; 6,369,594; 6,400,139; 6,624,626; 7,710,395; 6,762,600; 7,292,948; 7,873,491; Such a device may also be referred to as a patient positioner or a patient positioning device or system.

在優先權文件62/956,731的附錄A所描述的Polhemus Patriot系統具有可以放置在身體、頭枕、或二者上的自包含標記，並且不需要連續追蹤的視線。磁場藉由標記而產生，並輸出位置及定向資料，而不需要進行後期分析計算。精確及高品質的資料係以每個標記的50Hz的更新速率進行遞送。添加標記（例如，每個系統四個）。系統在表2中進一步描述。The Polhemus Patriot system described in Appendix A of Priority Document 62/956,731 has self-contained markers that can be placed on the body, headrest, or both, and does not require a continuously tracked line of sight. Magnetic fields are generated by markers and output position and orientation data without the need for post-analysis calculations. Accurate and high quality data is delivered at an update rate of 50Hz per marker. Add tags (for example, four per system). The system is further described in Table 2.

表2 更新速率 50Hz/標記 延遲 約20毫秒 靜態精確度 使用在30英吋（76.2cm）處的一個標記及一個接收器的1.0度及0.3英吋（0.75cm）。精確度取決於安裝，典型的精確度通常可能導致1至3度以及1至3英吋（2.54cm至7.62cm）。 操作溫度 10％至95％的相對濕度處的10C至40C，無冷凝 功率要求 100-240VAC，50-60Hz，單相，4W 軟體工具 包括GUI及SDK 包括用於Microsoft Windows®的USB驅動程式 規範 FCC Part 15, class B CE: EN61326-1: 2013 EMC要求 延遲 約20毫秒 靜態精確度 使用在30英吋（76.2cm）處的一個標記及一個接收器的1.0度及0.3英吋（0.75cm）。精確度取決於安裝，典型的精確度通常可能導致1至3度以及1至3英吋（2.54cm至7.62cm）。 操作溫度（OPERATING TEMPERATURE） 10％至95％的相對濕度處的10C至40C，無冷凝 Table 2 update rate 50Hz/marker Delay about 20 ms static accuracy Use a marker at 30 inches (76.2cm) and a receiver of 1.0 degrees and 0.3 inches (0.75cm). Accuracy depends on installation, typical accuracy may usually result in 1 to 3 degrees and 1 to 3 inches (2.54cm to 7.62cm). operating temperature 10C to 40C at 10% to 95% relative humidity, non-condensing Power requirements 100-240VAC, 50-60Hz, single phase, 4W software tool Includes GUI and SDK Includes USB driver for Microsoft Windows® specification FCC Part 15, class B CE: EN61326-1: 2013 EMC requirements Delay about 20 ms static accuracy Use a marker at 30 inches (76.2cm) and a receiver of 1.0 degrees and 0.3 inches (0.75cm). Accuracy depends on installation, typical accuracy may usually result in 1 to 3 degrees and 1 to 3 inches (2.54cm to 7.62cm). OPERATING TEMPERATURE 10C to 40C at 10% to 95% relative humidity, non-condensing

在實施例中，雷射超音波系統（更特定為雷射超音波乳化系統）經配置而使得可以利用治療雷射束圖案將治療雷射束遞送至患者的一隻或兩隻眼睛，並且可以在患者的一隻或兩隻眼睛上執行超音波晶體乳化程序，而不需要患者或外科醫生相對於雷射超音波乳化系統的相對位置進行移動。In an embodiment, a laser ultrasound system (more specifically a laser phacoemulsification system) is configured such that a therapeutic laser beam can be delivered to one or both eyes of a patient using a therapeutic laser beam pattern, and can The phacoemulsification procedure is performed on one or both eyes of the patient without requiring movement of the patient or surgeon relative to the relative position of the laser phacoemulsification system.

在實施例中，相較於兩個系統並排放置或僅放置在共同殼體或共同艙位中的尺寸，本裝置（例如，整合超音波雷射裝置）的實施例的尺寸大幅減少，以在手術室中提供比單獨的雷射系統及超音波系統所需的總空間更小的佔地面積。此舉提供本發明之前的本領域的重大進步，認為完全整合的雷射超音波系統尚未在手術室中使用或尚未取得規範批准。此實施例的減少的尺寸在效率、功效、及二者上均提供相對於先前技術的數種改善。更換兩個系統的能力、消除在患者的治療期間移動患者、系統、或兩者的需要、消除將患者從手術室轉移到另一手術室的需要（在雷射系統與超音波系統位於不同房間的情況下）可以從這種較小尺寸的裝置實施例中獲得一些益處。此較小尺寸的裝置實施例亦提供在更多（例如，較小的）手術室中使用的能力，其中在手術室中工作的外科醫生及其他專業人員更容易移動。亦可以提供清理操作的優勢，並釋放空間以提供在手術室中安裝其他系統（例如，診斷裝置及顯微鏡）的能力。認為在本發明的實施例之前，該領域並未識別、解決、或解答與將超音波及雷射系統整合至具有此較小佔地面積及較小體積（高度、寬度、長度）的單一裝置相關聯的問題以及針對那些問題的解決方案，而在裝置之間沒有干擾，維持每一裝置按照預期操作的能力，並維持每一裝置所需的功效。In embodiments, embodiments of the present device (eg, integrated ultrasound laser device) are substantially reduced in size compared to the size of two systems placed side-by-side or only in a common housing or bay, to facilitate surgical The chamber provides a smaller footprint than the total space required by the laser and ultrasound systems alone. This provides a significant advance in the art prior to the present invention, considering that fully integrated laser ultrasound systems have not yet been used in the operating room or have not yet achieved regulatory approval. The reduced size of this embodiment provides several improvements over the prior art in efficiency, efficacy, and both. The ability to replace two systems, eliminate the need to move the patient, system, or both during patient treatment, eliminate the need to transfer patients from operating room to case) can gain some benefits from such a smaller size device embodiment. This smaller size device embodiment also provides the ability to be used in more (eg, smaller) operating rooms, where surgeons and other professionals working in the operating room are more mobile. It may also provide advantages for cleaning operations and free up space for the ability to install other systems (eg, diagnostics and microscopes) in the operating room. It is believed that prior to embodiments of the present invention, the art has not identified, solved, or resolved and integrated ultrasound and laser systems into a single device with this small footprint and small volume (height, width, length) Associated problems and solutions to those problems, without interference between devices, maintain the ability of each device to operate as intended, and maintain the desired efficacy of each device.

在這些系統的實施例中，從一個操作模式改變或切換至另一者的時間較佳為快速發生。因此，該裝置從一個模式改變至另一者（例如，從雷射模式改變至超音波晶體乳化模式）可以是約45秒至約10秒、約30秒至約5秒、少於一分鐘、少於30秒、少於15秒、少於10秒、少於5秒、及少於2秒。應理解，在改變裝置模式之後，並且在可以進行特定程序之前，可能需要額外的患者準備時間。In embodiments of these systems, the time to change or switch from one mode of operation to another preferably occurs quickly. Thus, a change of the device from one mode to another (eg, from a laser mode to a phacoemulsification mode) can be about 45 seconds to about 10 seconds, about 30 seconds to about 5 seconds, less than a minute, Less than 30 seconds, less than 15 seconds, less than 10 seconds, less than 5 seconds, and less than 2 seconds. It will be appreciated that additional patient preparation time may be required after changing device modes and before certain procedures can be performed.

在這些雷射超音波系統（例如，整合超音波雷射裝置）的實施例中，該裝置（不包括患者床）的佔地面積係少於約50立方英呎（ft 3）、少於約40立方英呎（ft 3）、少於約35ft 3、少於約30ft 3、少於約25ft 3、少於約200ft 3、約31ft 3、約28至約33ft 3，以及這些的組合及變化，以及更大及更小的值。在實施例中，裝置的體積可以是可調整的，在此情況下，裝置的體積係為最小體積，除非另有明確說明。此裝置的高度可以是約45英吋（in）至約75in、約65in、約60in、約50in、約55in、少於60in、少於58in、約52in至約58in，以及這些的組合及變化，以及更大及更小的尺寸。（在臂、延伸部分、或部件可以移動至垂直位置或大約垂直位置以用於儲存或其他目的之實施例中，當該部件處於可操作配置或定位（例如通常為水平或大約水平）時，應測量高度。）在實施例中，裝置的高度可以是可調整的，在此情況下，裝置的高度係為最短高度，除非另有明確說明。此裝置的長度可以是約30in至約50in、約33in、約38in、約40in、少於約45in、少於40in、約34in至約38in、約36in，以及這些的組合及變體，以及更大及更小的尺寸。在實施例中，裝置的長度可以是可調整的（例如藉由可移動臂組件、托盤或托架），在此情況下，裝置的長度係為最短長度，除非另有明確說明。此裝置的寬度可以是約15in至約40in、約20in、約25in、約30in、少於約45in、少於約30in、約22in至約27in、約20in至約30in，以及這些的組合及變化，以及更大及更小的尺寸。在實施例中，裝置的寬度或長度可以是可調整的（例如藉由可移動臂組件、托盤或托架），在此情況下，裝置的寬度係為最短寬度，除非另有明確說明。這些裝置的實施例的裝置佔地面積（亦即，此裝置所佔用的地面空間的面積）可以是約400in 2至約1300in 2、約400in 2至約600in 2、約400in 2至約500in 2、約450in 2至約700in 2、約450in 2、約500in 2、約550in 2、約600in 2、少於約1200in 2、少於約1100in 2、少於約1000in 2、約1000in 2、約950in 2、約900in 2、約800in 2、約850in 2至約950in 2，以及這些的組合及變化，以及更大及更小的尺寸。在實施例中，裝置的寬度、長度、及兩者可以是可調整的（例如藉由可移動臂組件、托盤或托架），在此情況下，裝置的佔地面積係為最小區域，除非另有明確說明。裝置的長度及寬度可以相同（例如，佔地面積係為正方形或圓形），或者可以不同（例如，佔地面積係為長方形或橢圓形）。應理解，可以預見佔地面積區域的其他形狀（例如，星形、「L」形、「H」形等）。 In embodiments of these laser ultrasound systems (eg, integrated ultrasound laser devices), the footprint of the device (excluding the patient bed) is less than about 50 cubic feet (ft 3 ), less than about 40 cubic feet (ft 3 ), less than about 35 ft 3 , less than about 30 ft 3 , less than about 25 ft 3 , less than about 200 ft 3 , about 31 ft 3 , about 28 to about 33 ft 3 , and combinations and variations of these , and larger and smaller values. In embodiments, the volume of the device may be adjustable, in which case the volume of the device is the minimum volume unless explicitly stated otherwise. The height of such a device may be from about 45 inches (in) to about 75 in, about 65 in, about 60 in, about 50 in, about 55 in, less than 60 in, less than 58 in, about 52 in to about 58 in, and combinations and variations of these, and larger and smaller sizes. (In embodiments where the arm, extension, or component can be moved to a vertical or approximately vertical position for storage or other purposes, when the component is in an operative configuration or orientation (eg, generally horizontal or approximately horizontal), Height should be measured.) In embodiments, the height of the device may be adjustable, in which case the height of the device is the shortest height unless explicitly stated otherwise. The length of the device can be from about 30in to about 50in, about 33in, about 38in, about 40in, less than about 45in, less than 40in, about 34in to about 38in, about 36in, and combinations and variations of these, and greater and smaller sizes. In an embodiment, the length of the device may be adjustable (eg, by means of a movable arm assembly, tray or bracket), in which case the length of the device is the shortest length unless expressly stated otherwise. The width of the device may be from about 15 in to about 40 in, about 20 in, about 25 in, about 30 in, less than about 45 in, less than about 30 in, about 22 in to about 27 in, about 20 in to about 30 in, and combinations and variations of these, and larger and smaller sizes. In an embodiment, the width or length of the device may be adjustable (eg, by means of a movable arm assembly, tray or bracket), in which case the width of the device is the shortest width unless expressly stated otherwise. The device footprint (ie, the area of floor space occupied by the device) of embodiments of these devices may be about 400 in 2 to about 1300 in 2 , about 400 in 2 to about 600 in 2 , about 400 in 2 to about 500 in 2 , About 450in2 to about 700in2 , about 450in2 , about 500in2 , about 550in2 , about 600in2 , less than about 1200in2 , less than about 1100in2 , less than about 1000in2 , about 1000in2 , about 950in2 , About 900in2 , about 800in2 , about 850in2 to about 950in2 , and combinations and variations of these, as well as larger and smaller sizes. In embodiments, the width, length, and both of the device may be adjustable (eg, by means of movable arm assemblies, trays, or brackets), in which case the device footprint is the smallest area unless otherwise clearly stated. The length and width of the devices can be the same (eg, the footprints are square or circular), or they can be different (eg, the footprints are rectangular or oval). It should be understood that other shapes of footprint areas are envisioned (eg, star, "L", "H", etc.).

典型地，超音波晶體乳化裝置具有約20乘以約25in的佔地面積，而因此具有約500in 2的佔地面積（亦即，「標準超音波乳化佔地面積區域」）。因此，超音波乳化雷射整合系統的實施例的佔地面積區域可以是500in 2的典型超音波乳化佔地面積區域的約70％及更小、約80％及更小、約90％及更小、約100％及更小、約110％及更小、約120％及更小、約130％及更小、約140％及更小、約150％及更小。藉由在僅比一個裝置稍大的區域中具有兩個裝置（從而具有兩個治療功能）的本發明的實施例所實現的此協同作用，在手術室及醫療辦公室中、針對工作流程、可以用於患者護理的房間（例如，現在可以使用較小的房間）、患者及工作人員的舒適度、及功效等提供顯著益處及優勢。 Typically, a sonication device has a footprint of about 20 by about 25 in, and thus has a footprint of about 500 in2 (ie, a "standard sonication footprint"). Thus, the footprint of an embodiment of a phacolaser integrated system may be about 70% and less, about 80% and less, about 90% and more of a typical phacoemulsification footprint of 500 in2 Small, about 100% and less, about 110% and less, about 120% and less, about 130% and less, about 140% and less, about 150% and less. This synergy achieved by embodiments of the present invention having two devices (and thus two therapeutic functions) in an area only slightly larger than one device, in operating rooms and medical offices, for workflow, can be achieved. Rooms used for patient care (eg, smaller rooms are now available), patient and staff comfort, and efficacy provide significant benefits and advantages.

此外，即使在超音波晶體乳化系統小於典型的佔地面積的情況下，本發明的組合的雷射超音波系統可以配置成比單獨的雷射以及這種較小的佔地面積的超音波系統佔用更少的空間。In addition, even in cases where the ultrasonic crystal emulsification system is smaller than a typical footprint, the combined laser ultrasound system of the present invention can be configured to be more efficient than a laser alone and such a smaller footprint ultrasound system Takes up less space.

在這些系統的實施例中，藉由使用客製化托盤以及托持及定位用於雷射治療程序、雷射診斷程序、超音波晶體乳化程序、及水晶體植入以及任何屈光程序的各種外科工具、儀器、工具包、及裝備的裝置來實現進一步的協同作用。這些客製化手術托盤及工具包可以是可拆卸地固定至裝置殼體（或藉由裝置殼體托持或在裝置殼體中）的單次使用的拋棄式用品，並且可以是用於托持拋棄式或可重複使用的工具及儀器的整合托盤，以及這些的組合及變化。In embodiments of these systems, various surgical procedures for laser therapy procedures, laser diagnostic procedures, phacoemulsification procedures, and lens implantation, as well as any refractive procedures, are used by using customized trays and holding and positioning. Tools, instruments, kits, and equipment to achieve further synergy. These customized surgical trays and kits can be single-use disposables that are removably secured to (or held by or in the device housing) and can be used to hold Integrated trays to hold disposable or reusable tools and instruments, as well as combinations and variations of these.

轉至第1圖，圖示雷射超音波系統100的實施例的透視圖。系統100係為具有第一殼體101與第二殼體102的裝置。殼體101及102包含功率部件、控制部件、操作部件、分析預測及診斷裝置、位置決定及定位裝備、雷射束產生部件、及超音波產生部件。在較佳實施例中，超音波產生部件係為超音波晶體乳化系統的部件，而雷射束產生部件提供具有約10ps、5ps、2ps、及更短的脈衝長度的雷射束。Turning to FIG. 1 , a perspective view of an embodiment of a laser ultrasound system 100 is illustrated. The system 100 is a device having a first casing 101 and a second casing 102 . The housings 101 and 102 include power components, control components, operating components, analytical prediction and diagnostic devices, position determination and positioning equipment, laser beam generating components, and ultrasonic generating components. In a preferred embodiment, the ultrasonic generating components are components of an ultrasonic crystal emulsification system, and the laser beam generating components provide laser beams with pulse lengths of about 10 ps, 5 ps, 2 ps, and less.

這些部件可能由於以下原因而全部或部分地分佈在兩個殼體101、102之間：為了最佳化空間，為了避免部件之間的干擾，為了管理熱及振動，以及為了提供系統100的更有效控制及操作。兩個殼體101、102可以是在相同的底座或框架150上的獨立殼體，可以在其間具有通訊、控制、功率、光學、及其他連接，可以是單一相同的殼體，可以細分或劃分成第三或第四等殼體或子殼體，以及這些的組合及變化。These components may be distributed in whole or in part between the two housings 101 , 102 for the following reasons: to optimize space, to avoid interference between components, to manage heat and vibration, and to provide more Effective control and operation. The two housings 101, 102 may be separate housings on the same base or frame 150, may have communications, control, power, optics, and other connections therebetween, may be a single identical housing, may be subdivided or divided into third or fourth class casings or sub-casings, as well as combinations and variations of these.

存在將殼體102與殼體106連接的光學導管105。殼體106包含用於治療雷射束的掃描裝置及束成形光學裝置，其中掃描裝置、光學裝置、及兩者均可以用於監視及診斷雷射束及光學路徑。應理解，在實施例中，殼體106的這些部件可以全部或部分地位於另一殼體102、101中的一個，並且同樣地，來自殼體102、101的部件可以位於殼體106中。殼體106可以與殼體102、101整合，或者可以是殼體102、101的一部分。殼體106可以細分或劃分成一或更多個殼體或子殼體，以及這些的組合及變化。在當前較佳實施例中，殼體106包含並隔離掃描器及束成形光學裝置。掃描器及束成形光學裝置或可能包含在殼體106中的其他部件係與系統100的控制器及操作系統進行控制通訊。控制通訊係意指將與裝置的操作有關的資訊發送至裝置以及從裝置發送，將藉由裝置取得或接收的資料發送至裝置以及從裝置發送，以及將控制資訊、指令、或命令發送至裝置以及從裝置發送，以及這些和其他資料及資訊的組合及變化。裝置可以彼此直接進行控制通訊，或者可以彼此間接進行控制通訊（例如藉由與中心（例如，可能亦具有控制能力的系統100控制器、監視器109）進行控制通訊），以及這些的組合及變化。這些裝置亦可以彼此直接及間接進行控制通訊。There is an optical conduit 105 connecting the housing 102 with the housing 106 . Housing 106 contains a scanning device and beam shaping optics for the treatment laser beam, where the scanning device, optics, and both can be used to monitor and diagnose the laser beam and optical path. It should be understood that in embodiments, these components of the housing 106 may be located in whole or in part in one of the other housings 102 , 101 , and likewise components from the housings 102 , 101 may be located in the housing 106 . The housing 106 may be integral with the housings 102 , 101 or may be part of the housings 102 , 101 . Housing 106 may be subdivided or divided into one or more housings or sub-housings, as well as combinations and variations of these. In the presently preferred embodiment, the housing 106 contains and isolates the scanner and beam shaping optics. The scanner and beam shaping optics or other components that may be included in housing 106 are in control communication with the controller and operating system of system 100 . Control communication means sending information related to the operation of the device to and from the device, sending data obtained or received by the device to and from the device, and sending control information, instructions, or commands to the device and sent from the device, and combinations and variations of these and other data and information. Devices may control control communication directly with each other, or may control control communication indirectly with each other (eg, via control communication with a central (eg, system 100 controller, monitor 109, which may also have control capabilities)), and combinations and variations of these . These devices can also control communication directly and indirectly with each other.

光學導管105可以是光管路（例如，具有內部反射表面的中空管或通道，而使得雷射束發射通過中空管內的自由空間，而中空管內的自由空間可以具有部分真空，具有環境中的空氣，包含惰性氣體，及這些的組合及變化）、鉸接式光管路、伸縮式光管路、柔性光管路、光纖、一或更多個光纖、中空導管、束導引器，以及這些及其他雷射束傳輸結構的組合及變化。The optical conduit 105 may be an optical conduit (eg, a hollow tube or channel with an internally reflective surface such that the laser beam is emitted through free space within the hollow tube, which may have a partial vacuum, with ambient air, including noble gases, and combinations and variations of these), articulated light pipes, retractable light pipes, flexible light pipes, optical fibers, one or more optical fibers, hollow conduits, beam guides , as well as combinations and variations of these and other laser beam delivery structures.

殼體106具有臂107，臂107可以沿著箭頭107a及107b的方向移動、延伸、收縮、及這些的組合及變化。臂107及殼體106藉由升降器裝置110沿著垂直方向移動，如箭頭107a所示。臂107具有用於決定眼睛的形狀及位置以及眼睛內的結構的組件或裝置108。臂107的近端（亦即，沿著雷射束路徑最遠的端部，而因此距離雷射束源最遠，並且位於裝置108下方）具有患者介面裝置（PID）（在圖式中未圖示）。臂107具有監視器109，監視器109在多關節臂上沿著箭頭109a的方向移動。監視器可以提供資訊（例如，程序、系統狀況、雷射狀態、超音波狀態、白內障密度、超音波設定、雷射圖案設定），並且可以接收外科醫生的輸入及指令。監視器係與系統100控制系統進行控制通訊，監視器亦可以包含系統100控制系統的一部分或全部。監視器透過系統100控制系統、透過監視器109、及這些的組合及變化直接與雷射控制系統及超音波控制系統進行控制通訊。監視器及其關節臂可以位於系統100中的其他結構上，亦可以單獨設置。可以使用一個、兩個、及額外的監視器。監視器可以具有3D查看或顯示功能。Housing 106 has arms 107 that can move, extend, retract, and combinations and variations of these in the directions of arrows 107a and 107b. The arm 107 and the housing 106 are moved in the vertical direction by the lifter device 110, as indicated by arrow 107a. The arm 107 has components or means 108 for determining the shape and position of the eye and the structure within the eye. The proximal end of arm 107 (ie, the end furthest along the path of the laser beam, and thus furthest from the laser beam source, and below device 108 ) has a patient interface device (PID) (not shown in the figures). diagram). The arm 107 has a monitor 109 that moves on the multi-joint arm in the direction of arrow 109a. The monitor can provide information (eg, procedures, system status, laser status, ultrasound status, cataract density, ultrasound settings, laser pattern settings) and can receive input and commands from the surgeon. The monitor is in control communication with the control system of the system 100 , and the monitor may also include a part or all of the control system of the system 100 . The monitor controls the system through the system 100, controls the system through the monitor 109, and the combinations and variations of these are in direct control communication with the laser control system and the ultrasonic control system. The monitor and its articulated arm may be located on other structures in the system 100, or may be provided separately. One, two, and additional monitors can be used. Monitors can have 3D viewing or display capabilities.

臂107形成或包含雷射束傳輸結構（例如，中空管），以提供用於雷射束的傳送的自由空間。在實施例中，臂107可以包含自由空間中的光束路徑，或者用於將雷射束發送至例如掃描器的光纖，光纖位於管的近端而不是遠端（亦即，靠近殼體106的端部）。臂107亦可以是或包含描述用於光學導管105的類型的雷射束傳輸結構。管亦可以包含光學裝置。在第1圖的實施例中，臂107包含非準直的雷射束，而因此臂107可以指稱為包含非準直的雷射束及雷射束路徑，換言之，臂107沿著雷射束路徑包含、圍繞、或容納「非準直空間」。臂107可以容納或圍繞準直空間，準直空間係為雷射束路徑上的雷射束進行準直的空間。其可以容納包含光學裝置的空間。其可以容納準直及非準直的空間。實施例中的臂107可以從遠端樞轉、旋轉、伸縮、鉸接、及這些的組合及變化。臂107中的雷射束路徑的近端包含鏡或光學裝置，以將雷射束引導通過PID，並到達及進入患者的眼睛。Arm 107 forms or contains a laser beam delivery structure (eg, a hollow tube) to provide free space for delivery of the laser beam. In embodiments, the arm 107 may contain a beam path in free space, or an optical fiber for sending the laser beam to, for example, a scanner, the optical fiber being located at the proximal end of the tube rather than the distal end (ie, near the housing 106 ). Ends). Arm 107 may also be or include a laser beam delivery structure of the type described for optical conduit 105 . The tube may also contain optics. In the embodiment of Figure 1, arm 107 contains a non-collimated laser beam, and thus arm 107 may be referred to as containing a non-collimated laser beam and a laser beam path, in other words, arm 107 along the laser beam Paths contain, surround, or accommodate "non-collimated spaces". The arm 107 can accommodate or surround a collimation space, which is a space in which the laser beam on the laser beam path is collimated. It can accommodate space containing optics. It can accommodate both collimated and non-collimated spaces. The arms 107 of the embodiments may be distally pivotable, swivel, telescoping, articulating, and combinations and variations of these. The proximal end of the laser beam path in arm 107 contains mirrors or optics to direct the laser beam through the PID and to and into the patient's eye.

系統100具有用於將電纜及管線連接至超音波、抽吸、其他工具、及這些的組合及變化的二個埠103、104。在實施例中，這些埠經配置以連接至超音波晶體乳化工具或超音波乳化盒系統。埠103及104係圖示於殼體102上，應理解，可以在殼體101上，或者在系統上的其他位置上，或者可以是已經***系統100中的超音波乳化盒的一部分。The system 100 has two ports 103, 104 for connecting cables and lines to ultrasound, suction, other tools, and combinations and variations of these. In an embodiment, the ports are configured to connect to a phacoemulsification tool or a sonication cartridge system. Ports 103 and 104 are shown on housing 102, it being understood that they could be on housing 101, or at other locations on the system, or could be part of a sonication cartridge that has been inserted into system 100.

在實施例中，雷射系統具有外部、內部、或兩者的冷卻。例如，冷卻流體流入及流出雷射殼體。In embodiments, the laser system has external, internal, or both cooling. For example, cooling fluid flows into and out of the laser housing.

系統100具有箭頭120所示的高度，系統具有箭頭121所示的長度以及箭頭122所示的寬度。寬度及長度定義系統100的佔地面積，而藉由高度120、長度121、及寬度122定義體積。 治療雷射及系統：一般 System 100 has a height shown by arrow 120 , a length shown by arrow 121 and a width shown by arrow 122 . Width and length define the footprint of system 100 , while height 120 , length 121 , and width 122 define volume. Therapeutic Lasers and Systems: General

經配置以提供對於治療眼睛、其結構、及鄰近組織及其狀況有用、安全、及有效的雷射束的任何雷射都可以用於提供治療雷射束。可以使用可調諧雷射、可調整雷射、及這些雷射的組合及變化（例如，可以改變脈衝寬度，可以改變脈衝速率，可以改變功率，以及可以改變波長）。可以使用一種以上的治療雷射。治療雷射可以是脈衝雷射（例如，飛秒雷射或皮秒雷射，以及更長或更短的脈衝）、連續雷射、及其組合。Any laser configured to provide a useful, safe, and effective laser beam for treating the eye, its structures, and adjacent tissues and conditions may be used to provide a therapeutic laser beam. Tunable lasers, adjustable lasers, and combinations and variations of these lasers can be used (eg, the pulse width can be changed, the pulse rate can be changed, the power can be changed, and the wavelength can be changed). More than one therapeutic laser may be used. Therapeutic lasers can be pulsed lasers (eg, femtosecond or picosecond lasers, and longer or shorter pulses), continuous lasers, and combinations thereof.

治療雷射可以具有IR光譜、UV光譜、及其他波長中的波長。治療雷射的波長可以是約300nm至約2500nm、約1000奈米（nm）至約1300nm、1020nm、約1020nm、1030nm、約1030nm、1040nm、約1040nm、1050nm、約1050nm、及約1020至約1050nm，以及這些及其他波長的組合及變化。Therapeutic lasers can have wavelengths in the IR spectrum, UV spectrum, and other wavelengths. The wavelength of the therapeutic laser can be about 300 nm to about 2500 nm, about 1000 nanometers (nm) to about 1300 nm, 1020 nm, about 1020 nm, 1030 nm, about 1030 nm, 1040 nm, about 1040 nm, 1050 nm, about 1050 nm, and about 1020 to about 1050 nm , and combinations and variations of these and other wavelengths.

治療雷射的脈衝持續時間可以是約1fs至約100ps、約200fs至約500ps、約300fs至約100ps、約300fs至約10ps、約300fs至約2000fs，以及這些波長與更長及更短的持續時間的組合及變化。系統的一或更多個「短脈衝持續時間」治療雷射的脈衝寬度可以是300fs、約300fs、350fs、約350fs、400fs、約450fs、500fs、約500fs、300fs至約600fs，以及這些的組合及變化。系統的一或更多個「長脈衝持續時間」治療雷射的脈衝持續時間可以是1000fs、約1000fs、1200fs、約1200fs、1300fs、約1300fs、1500fs、約1500fs、約1200fs至約1600fs，以及這些的組合及變化。The pulse duration of the therapeutic laser can be about 1 fs to about 100 ps, about 200 fs to about 500 ps, about 300 fs to about 100 ps, about 300 fs to about 10 ps, about 300 fs to about 2000 fs, and longer and shorter durations of these wavelengths Combinations and changes in time. The pulse width of the one or more "short pulse duration" therapeutic lasers of the system may be 300fs, about 300fs, 350fs, about 350fs, 400fs, about 450fs, 500fs, about 500fs, 300fs to about 600fs, and combinations of these and changes. The pulse duration of the one or more "long pulse duration" therapeutic lasers of the system may be 1000fs, about 1000fs, 1200fs, about 1200fs, 1300fs, about 1300fs, 1500fs, about 1500fs, about 1200fs to about 1600fs, and these combinations and changes.

治療雷射束的脈衝重複率可以是約50千赫茲（kHz）至約5兆赫茲（Mhz）、約50kHz至約2Mhz、約50kHz至約1Mhz、約50kHz至約750kHz、約100kHz至約200kHz、約150kHz至約350kHz、約100kHz、約150kHz、約200kHz、約300kHz，以及這些與更大及更小的速率的變化及組合。The pulse repetition rate of the therapeutic laser beam may be about 50 kilohertz (kHz) to about 5 megahertz (Mhz), about 50 kHz to about 2 Mhz, about 50 kHz to about 1 Mhz, about 50 kHz to about 750 kHz, about 100 kHz to about 200 kHz, From about 150 kHz to about 350 kHz, about 100 kHz, about 150 kHz, about 200 kHz, about 300 kHz, and variations and combinations of these with greater and lesser rates.

治療雷射束的指定脈衝重複率處的平均輸出功率可以是約1瓦（W）至約8W、約2.5W至約5W、約3W至約4.5W、3W至5W、少於6W、少於5W、發生雷射引起的光學崩塌（LIOB）、光致破裂、或兩者的任何功率，以及這些與更低及更高的功率的組合及變化。The average output power at a given pulse repetition rate of the therapeutic laser beam may be about 1 watt (W) to about 8W, about 2.5W to about 5W, about 3W to about 4.5W, 3W to 5W, less than 6W, less than 5W, any power where Laser Induced Optical Collapse (LIOB), photodisruption, or both, and combinations and variations of these with lower and higher powers.

這些系統的實施例亦可以執行子閾值治療、診斷、及這些的組合及變化。因此，可以利用低於發生LIOB的點的功率或方式將治療雷射束遞送至眼睛。可以利用低於發生光致破裂的點的功率或方式將治療雷射束遞送至眼睛。因此，在本程序的實施例中，可以執行子閾值雷射程序，可以執行引起光致破裂的雷射程序，可以執行超音波晶體乳化，以及可以執行這些程序中的一些或全部的組合及變化，而不需要移動患者或裝置的位置。Embodiments of these systems may also perform subthreshold therapy, diagnosis, and combinations and variations of these. Thus, the therapeutic laser beam can be delivered to the eye with a power or manner below the point at which the LIOB occurs. The therapeutic laser beam may be delivered to the eye with a power or manner below the point at which photodisruption occurs. Thus, in embodiments of the present procedure, sub-threshold laser procedures may be performed, photodisruption-causing laser procedures may be performed, ultrasonic crystal emulsification may be performed, and combinations and variations of some or all of these procedures may be performed , without moving the patient or device.

治療雷射束的脈衝能量可以是約1奈焦耳（nJ）至約2毫焦耳（mJ）、約1nJ至約1mJ、約2微焦耳（µJ）至約70μJ、約5μJ至約45μJ、約2μJ至約35μJ、約10μJ至約30μJ、少於45μJ、少於35μJ、發生光致破裂、LIOB、或兩者的任何脈衝能量，以及這些與更低及更高的能量的組合及變化。The pulse energy of the treatment laser beam may be about 1 nanojoule (nJ) to about 2 millijoules (mJ), about 1 nJ to about 1 mJ, about 2 microjoules (µJ) to about 70 μJ, about 5 μJ to about 45 μJ, about 2 μJ Any pulse energies to about 35 μJ, about 10 μJ to about 30 μJ, less than 45 μJ, less than 35 μJ, photodisruption, LIOB, or both, and combinations and variations of these with lower and higher energies.

本系統的治療雷射束可以具有一或更多個上述束特徵（例如，波長、持續時間、重複率、功率、脈衝能量，以及這些的組合及變化）。The therapeutic laser beam of the present system may have one or more of the beam characteristics described above (eg, wavelength, duration, repetition rate, power, pulse energy, and combinations and variations of these).

可以將產生1030nm波長的超短雷射脈衝的Yb：YAG雷射作為治療雷射。通常，治療雷射所提供的束的波長可以發送通過角膜、水狀液、及水晶體。束可以具有短脈衝長度而與能量及束尺寸一起產生目標眼組織（例如，角膜、角膜緣、水晶體囊、水晶體、白內障組織、混濁組織、及其他組織）的光致破裂、LIOB、或兩者。因此，本文所使用的術語「雷射射擊」或「射擊」係指稱遞送至其自身或與其他脈衝組合（例如，LIOB）產生治療效果的位置的雷射束脈衝。本文所使用的術語「光致破裂」基本上係指稱藉由雷射將物質轉化成氣體。在實施例中，可以採用約300nm至2500nm的波長。可以採用約1飛秒至100皮秒的脈衝寬度。可以採用約1奈焦耳至1毫焦耳的能量。脈衝速率（亦指稱為脈衝重複頻率（PRF）與每秒脈衝（以赫茲為單位））可以是約1kHz至幾GHz。通常，在商業雷射裝置中，較低的脈衝速率係對應於較高的脈衝能量。取決於脈衝長度、能量密度、及其他因素，可以使用多種類型的雷射來產生治療效果（例如，造成眼組織的光致破裂、LIOB、或兩者）。因此，此類雷射器的實例包括：Delmar Photonics Inc. Trestles-20，其為鈦藍寶石（Ti：Sapphire）振盪器，波長範圍係為780至840nm，少於20飛秒的脈衝寬度，約100MHz的PRF，具有2.5奈焦耳；Clark CPA-2161，其為放大的鈦藍寶石，波長係為775nm，少於150飛秒的脈衝寬度，約3KHz的PRF，具有850微焦耳；IMRA FCPA（光纖啁啾脈衝放大）μjewel D系列的D-400-HR，其為Yb：光纖振盪器/放大器，波長係為1045nm，少於1皮秒的脈衝寬度，約5MHz的PRF，具有100奈焦耳；Coherent Staccato，其為YB：Yag，波長係為1030nm，約1.5皮秒的脈衝寬度，約80KHz的PRF，具有30微焦耳；Coherent Rapid，其為YB：Yag，波長係為1030nm，約1.5皮秒的脈衝寬度，可以包括一或更多個放大器，以在25kHz至650kHz之間的PRF處實現約2.5至10瓦的平均功率，亦包括可以閘通兩個單獨的50MHz脈衝序列的多脈衝能力；以及IMRA FCPA（光纖啁啾脈衝放大）pJewel D系列的D-400-NC，其為Yb：光纖振盪器/放大器，波長係為1045nm，少於100皮秒的脈衝寬度，約200KHz的PRF，具有4微焦耳。這些及其他類似的雷射可以作為治療雷射，並用於產生治療雷射束。A Yb:YAG laser that generates ultra-short laser pulses with a wavelength of 1030 nm can be used as a therapeutic laser. Typically, the wavelength of the beam provided by the therapeutic laser can be transmitted through the cornea, aqueous humor, and lens. Beams can have short pulse lengths to produce photodisruption, LIOB, or both of target ocular tissue (eg, cornea, limbus, lens capsule, lens, cataract tissue, opacified tissue, and other tissue) in combination with energy and beam size . Thus, the term "laser shot" or "shot" as used herein refers to a laser beam pulse delivered to a location by itself or in combination with other pulses (eg, LIOB) to produce a therapeutic effect. The term "photodisruption" as used herein basically refers to the conversion of a substance into a gas by means of a laser. In embodiments, wavelengths of about 300 nm to 2500 nm may be employed. Pulse widths of about 1 femtosecond to 100 picoseconds can be employed. Energy of about 1 nanojoule to 1 millijoule may be employed. The pulse rate (also referred to as pulse repetition frequency (PRF) and pulses per second (measured in Hertz)) can be from about 1 kHz to several GHz. Typically, in commercial laser devices, lower pulse rates correspond to higher pulse energies. Depending on pulse length, energy density, and other factors, various types of lasers can be used to produce a therapeutic effect (eg, causing photodisruption of ocular tissue, LIOB, or both). Thus, examples of such lasers include: Delmar Photonics Inc. Trestles-20, which is a Ti:Sapphire oscillator with a wavelength range of 780 to 840 nm, a pulse width of less than 20 femtoseconds, about 100 MHz PRF with 2.5 nanojoules; Clark CPA-2161, which is an amplified Ti:Sapphire with a wavelength of 775 nm, a pulse width of less than 150 femtoseconds, a PRF of about 3 KHz, with 850 microjoules; IMRA FCPA (fiber chirped Pulse Amplification) D-400-HR of μjewel D-Series, which is a Yb: Fiber Oscillator/Amplifier, wavelength system 1045 nm, pulse width less than 1 picosecond, PRF about 5 MHz, with 100 nanojoules; Coherent Staccato, It is YB: Yag with a wavelength of 1030 nm, a pulse width of about 1.5 picoseconds, a PRF of about 80 KHz, with 30 microjoules; Coherent Rapid, which is a YB: Yag of a wavelength of 1030 nm, a pulse width of about 1.5 picoseconds , may include one or more amplifiers to achieve an average power of approximately 2.5 to 10 watts at PRFs between 25kHz and 650kHz, also includes multi-pulse capability that gates two separate 50MHz pulse trains; and IMRA FCPA (Fiber Chirped Pulse Amplification) D-400-NC of the pJewel D-Series, which is Yb: Fiber Oscillator/Amplifier, 1045nm wavelength, pulse width of less than 100 picoseconds, PRF of about 200KHz, with 4 microjoules . These and other similar lasers can be used as therapeutic lasers and used to generate therapeutic laser beams.

在美國專利申請公開號2016/0302971、2015/0105759、2014/0378955以及美國專利號8,262,646及8,708,491中揭示及教示用於在眼睛上執行雷射操作的雷射系統、方法、及設備的實施例，其每一者的全部揭示藉由引用併入本文。 雷射束遞送：一般 Embodiments of laser systems, methods, and apparatus for performing laser operations on the eye are disclosed and taught in US Patent Application Publication Nos. 2016/0302971, 2015/0105759, 2014/0378955, and US Patent Nos. 8,262,646 and 8,708,491, The entire disclosure of each of these is incorporated herein by reference. Laser Beam Delivery: General

通常，用於將治療雷射束遞送至眼睛的自然水晶體的光學裝置的實施例應該能夠利用精確的預先決定的圖案在x、y、及z維度上向自然水晶體提供一系列射擊。光學裝置亦應提供預先決定的束斑尺寸，以利用到達自然水晶體或其他目標組織的雷射能量來造成光致破裂、LIOB、或兩者。因此，光學裝置可以包括但不限於：xy掃描器；z聚焦裝置；及聚焦光學裝置。聚焦光學裝置可以是習知聚焦光學裝置、平場光學裝置、遠心光學裝置、及這些的組合及變化，每一者都具有對應的電腦控制的聚焦，而實現x、y、z維度上的校準。舉例而言，xy掃描器可以是具有位置偵測器反饋的一對閉合迴路檢流計。此類xy掃描器的實例係為Cambridge TechnologyInc.的6450型、SCANLAB hurrySCAN、及AGRES Rhino掃描器。這種z聚焦裝置的實例係為Phsyik International Peizo聚焦單元ESee型的Z聚焦控制以及SCANLAB varrioSCAN。 雷射控制系統：一般 In general, embodiments of an optical device for delivering a therapeutic laser beam to the natural lens of the eye should be able to provide a series of shots to the natural lens in the x, y, and z dimensions with precise predetermined patterns. The optics should also provide a predetermined beam spot size to cause photodisruption, LIOB, or both, with the laser energy reaching the natural crystal or other target tissue. Accordingly, optical devices may include, but are not limited to: xy scanners; z focusing devices; and focusing optics. The focusing optics may be conventional focusing optics, flat-field optics, telecentric optics, and combinations and variations of these, each with corresponding computer-controlled focusing for alignment in x, y, and z dimensions. For example, the xy scanner may be a pair of closed loop galvanometers with position detector feedback. Examples of such xy scanners are the Cambridge Technology Inc. Model 6450, SCANLAB hurrySCAN, and AGRES Rhino scanners. Examples of such z-focusing devices are the Z-focus control of the Phsyik International Peizo focusing unit ESee type and the SCANLAB varrioSCAN. Laser Control System: General

通常，用於遞送治療雷射束的控制系統的實施例可以是能夠選擇及控制xyz掃描參數及雷射擊發等的任何電腦、控制器、軟體硬體、及這些的組合及變形。這些部件通常可以至少部分相關聯於與xy掃描器、z聚焦裝置、雷射、及這些的組合及變化對接的電路板。雷射控制系統可以包含引導雷射通過一或更多個雷射射擊圖案的程式。雷射控制系統亦具有與系統控制系統整合的進一步能力，以及與具有超音波控制及監視器或控制面板的整合系統一起使用或一起工作的功能。系統控制器、雷射控制器、超音波控制器、及這些的組合及變化亦可以控制系統的其他部件，以及維護資料、取得資料、分析資料及圖像、準備及建議表格及治療方法、及執行計算。控制系統可以包含引導雷射通過一或更多個雷射射擊圖案的程式。 位置及形狀決定：一般 In general, an embodiment of a control system for delivering a therapeutic laser beam may be any computer, controller, software and hardware, and combinations and variations of these capable of selecting and controlling xyz scan parameters, laser firing, and the like. These components may generally be associated, at least in part, with circuit boards that interface with xy scanners, z focusing devices, lasers, and combinations and variations of these. The laser control system may include programming to direct the laser through one or more laser shot patterns. The laser control system also has the further ability to integrate with the system control system, as well as the ability to use or work with the integrated system with ultrasonic control and monitor or control panel. System controllers, laser controllers, ultrasonic controllers, and combinations and variations of these can also control other components of the system, as well as maintain data, obtain data, analyze data and images, prepare and recommend forms and treatments, and Perform calculations. The control system may include programming to direct the laser through one or more laser shot patterns. Location and shape determination: general

通常，在實施例中，用於決定眼睛的形狀擊位置以及眼睛內的結構的組件或裝置可以是光學同調斷層掃描（OCT）、具有單一可移動相機的沙姆裝置、多個固定相機、這些的組合及變化、及用於進行此類決定的其他類型的裝置。在實施例中，此裝置決定水晶體的部分（或眼睛或與眼睛相鄰的組織的其他結構）與雷射（例如，光學裝置頭）的相對距離。在實施例中，此距離藉由例如PID維持恆定。在實施例中，此裝置決定相對於所有三個維度上的雷射遞送圖案的掃描坐標的水晶體及其他結構的位置。這可以藉由幾種方法及設備來實現。舉例而言，可以藉由經由同心標號的相機系統及顯示器觀察水晶體或者藉由使用直接觀察光學裝置然後手動將患者的眼睛定位到已知中心來實現水晶體的xy定心。然後，可以藉由使用光學三角測量或雷射及ccd系統的範圍測量裝置（例如，Micro-Epsilon opto NCDT1401雷射感測器、Aculux Laser Ranger LR2-22、及這些的組合及變化）來決定z位置。亦可以使用3維觀看及測量設備來決定水晶體的x、y、及z位置。舉例而言，可以使用Vision Engineering的Hawk3軸非接觸式測量系統來進行這些決定。可以用於決定水晶體的位置的設備的進一步實例係為3維測量設備。此設備包含可以觀看參考物與自然水晶體的一或更多個相機，並且亦包括用於照亮自然水晶體的光源。這樣的光源可以是結構化的光源（例如，經設計以基於幾何形狀來產生3維資訊的狹縫照明）。可以在眼睛周圍定位另一個、兩個、三個、四個、或更多個光源，並利用電子方式啟動，以在多個平面切片中提供眼睛（更特定維角膜及水晶體）的多個視圖、平面圖像，然後可以整合以提供有關這些結構的相對於雷射系統的定位及位置資訊的資料。在美國專利公開號及專利號2018/0085256、2016/0302971、2015/0105759、2012/0330290、2016/0030244、9,180,051、及8,708,491中揭示及教示用於決定相對於雷射、雷射射擊圖案、及雷射束的眼睛及結構的形狀及位置的組件、方法、裝置的實例，其每一者的全部揭示內容藉由引用併入本文。在美國專利公開號2015/0105759中教示及揭示用於決定眼睛的位置的愛爾蘭配準裝置，其全部揭示內容藉由引用併入本文。 患者介面：一般 Typically, in embodiments, the components or devices used to determine the shape and location of the eye and structures within the eye may be optical coherence tomography (OCT), a Sham device with a single movable camera, multiple fixed cameras, these and other types of means for making such decisions. In an embodiment, this device determines the relative distance of the portion of the lens (or other structure of the eye or tissue adjacent the eye) to the laser (eg, the optics head). In an embodiment, this distance is maintained constant by eg PID. In an embodiment, the device determines the position of crystals and other structures relative to the scan coordinates of the laser delivery pattern in all three dimensions. This can be accomplished by several methods and apparatus. For example, xy centering of the lens can be accomplished by viewing the lens through a concentrically numbered camera system and display, or by using direct viewing optics and then manually positioning the patient's eye to a known center. Then, z can be determined by using optical triangulation or range measurement devices of laser and ccd systems (eg, Micro-Epsilon opto NCDT1401 laser sensor, Aculux Laser Ranger LR2-22, and combinations and variations of these) Location. 3-dimensional viewing and measuring equipment can also be used to determine the x, y, and z position of the crystal. These decisions can be made, for example, using Vision Engineering's Hawk 3-axis non-contact measurement system. A further example of a device that can be used to determine the position of a crystal is a 3-dimensional measurement device. The device contains one or more cameras that can view the reference object and the natural crystal, and also includes a light source for illuminating the natural crystal. Such light sources may be structured light sources (eg, slit illumination designed to generate 3-dimensional information based on geometry). Another, two, three, four, or more light sources can be positioned around the eye and activated electronically to provide multiple views of the eye (more specific dimensions of the cornea and lens) in multiple plane slices , planar images, which can then be integrated to provide information about the positioning and location information of these structures relative to the laser system. Disclosed and taught in US Patent Publication Nos. 2018/0085256, 2016/0302971, 2015/0105759, 2012/0330290, 2016/0030244, 9,180,051, and 8,708,491 for determining relative to laser, laser shot patterns, and Examples of components, methods, devices for the shape and location of the eye and structures of the laser beam, the entire disclosures of each of which are incorporated herein by reference. An Irish registration device for determining the position of the eye is taught and disclosed in US Patent Publication No. 2015/0105759, the entire disclosure of which is incorporated herein by reference. Patient Interface: General

這些系統的實施例的進一步部件可以是雷射患者介面或PID。應理解，PID的全部或一些通常不是系統的一部分，而是較佳為在雷射程序之前或在設定雷射程序時針對每一患者添加到系統中的單次使用的裝置（例如，拋棄式）。在實施例中，此介面在程序期間提供自然水晶體與雷射之間的x、y、z位置保持固定，程序包括決定xyz位置的測量步驟以及將雷射利用射擊圖案遞送至水晶體的遞送步驟。介面裝置可以包含光學透明的扁平器。此介面的一個實例係為可以是圓形或橢圓形的吸環扁平器，其固定在眼睛的外表面上，然後定位在雷射光學殼體上，而固定雷射、眼睛、及自然水晶體之間的距離。3維觀看及測量設備的參考標記亦可以放置在此扁平器上。此外，可以觀察到扁平器的下表面與角膜之間的介面，並且這種觀察可以作為參考。雷射患者介面的進一步實例係為具有將介面固定至眼睛的吸取能力的具有下環的裝置。該介面進一步具有平坦底部，平坦底部按壓在眼睛上，而使眼睛的形狀變得平坦。此平坦底部係由透射雷射束（並且亦較佳為（但並非必須）透射可見光譜內的眼睛的光學圖像）的材料所構成。上環具有用於與雷射光學裝置的殼體接合的結構、沿著雷射束的路徑距離雷射已知距離並且相對於雷射固定的一些結構、及這些的組合及變化。在美國專利申請公開號2011/0190739、2017/0290703、2010/0022994、2011/0022035和2015/0088175中揭示及教示的患者介面裝置、用於將PID與眼睛接合的系統、及用於將PID與雷射系統接合的系統的實例，其每一者的全部揭示內容藉由引用併入本文。 超音波/超音波晶體乳化：一般 A further component of embodiments of these systems may be a laser patient interface or PID. It should be understood that all or some of the PIDs are generally not part of the system, but are preferably single-use devices (eg, disposable devices) that are added to the system for each patient prior to the laser procedure or when setting up the laser procedure. ). In an embodiment, this interface provides that the x, y, z positions between the natural crystal and the laser remain fixed during a procedure that includes a measurement step to determine the xyz position and a delivery step to deliver the laser to the crystal using a shot pattern. The interface device may comprise an optically transparent flattener. An example of this interface is a suction ring flattener, which may be circular or oval, which is attached to the outer surface of the eye and then positioned on the laser optics housing, which attaches the gap between the laser, the eye, and the natural crystal. distance between. Reference marks for 3D viewing and measuring equipment can also be placed on this flattener. In addition, the interface between the lower surface of the applanator and the cornea can be observed and this observation can serve as a reference. A further example of a laser patient interface is a device with a lower ring with suction capability to secure the interface to the eye. The interface further has a flat bottom that presses on the eye to flatten the shape of the eye. This flat bottom is composed of a material that transmits the laser beam (and also preferably, but not necessarily, the optical image of the eye in the visible spectrum). The upper ring has structures for engaging with the housing of the laser optics, some structures along the path of the laser beam a known distance from the laser and fixed relative to the laser, and combinations and variations of these. Patient interface devices, systems for interfacing a PID with the eye, and systems for interfacing a PID with Examples of laser systems bonded systems, the entire disclosures of each of which are incorporated herein by reference. Ultrasonic/Ultrasonic crystal emulsification: general

經配置以提供對於治療眼睛、其結構、及鄰近組織及其狀況有用、安全、有效的超音波能量的任何超音波產生器（例如，超音波驅動器、號角、或用於產生超音波能量的其他裝置）可以用於提供本系統的超音波能量。更特定言之，在本系統的實施例中，可以使用或重新配置以使用任何（較佳為醫療裝置規範機構所批准）超音波晶體乳化系統中的部件的一些或全部。Any ultrasonic generator (e.g., an ultrasonic driver, horn, or other device for generating ultrasonic energy) that is configured to provide useful, safe, and effective ultrasonic energy for treating the eye, its structures, and adjacent tissues and conditions. device) can be used to provide the ultrasonic energy of this system. More particularly, in embodiments of the present system, some or all of the components in any (preferably approved by a medical device specification agency) phacoemulsification system may be used or reconfigured to use.

通常，在本整合系統的實施例以及可以執行的方法中，超音波晶體乳化包括較佳利用治療雷射束進行角膜切口、鞏膜切口（以及這些的組合及變化），以及超音波晶體乳化手持件（通常包含超音波驅動的針）的***，以例如乳化（亦即，液化）自然晶狀水晶體，將白內障破碎成小塊，以及這些的組合及變化。較佳地，此超音波程序係在已經藉由雷射束切割、切片、軟化、及這些的組合及變化的水晶體、水晶體材料、白內障材料上進行。經乳化的塊狀物隨後可以使用相同的機頭或另一機頭來移除。然後，外科醫生可以藉由切口將植入物（例如，眼內水晶體（IOL））***眼睛。In general, in embodiments of the present integrated system and methods that may be performed, phacoemulsification includes corneal incisions, scleral incisions (and combinations and variations of these), preferably using a therapeutic laser beam, and an ultrasonic phacoemulsification handpiece Insertion (often involving an ultrasound-driven needle) to, for example, emulsify (ie, liquefy) natural crystalline crystals, break cataracts into small pieces, and combinations and variations of these. Preferably, the ultrasonic procedure is performed on crystals, crystal materials, cataract materials that have been cut by a laser beam, sliced, softened, and combinations and variations of these. The emulsified mass can then be removed using the same handpiece or another handpiece. The surgeon can then insert an implant (eg, an intraocular lens (IOL)) into the eye through the incision.

在實施例中，超音波乳化針的尖端的振動的超音波乳化頻率可以大於約20kHz、大於30kHz、大於40kHz、約30kHz至約50kHz、約30kHz至約45kHz、少於約50kHz、約35kHz至約45kHz、約35kHz、約40kHz、約45kHz、35kHz、40kHz、45kHz、及這些與更高及更低的頻率的組合及變化。In embodiments, the phacoemulsification frequency of the vibration of the tip of the phacoemulsification needle may be greater than about 20 kHz, greater than 30 kHz, greater than 40 kHz, about 30 kHz to about 50 kHz, about 30 kHz to about 45 kHz, less than about 50 kHz, about 35 kHz to about 45kHz, about 35kHz, about 40kHz, about 45kHz, 35kHz, 40kHz, 45kHz, and combinations and variations of these with higher and lower frequencies.

在實施例中，超音波乳化針的行程（縱向移動）的長度可以是約28.1μm至約95.25μm、約25µm至約160μm、約50μm至約90μm、約50μm至約150μm、約25μm至約110μm、約35μm至約100μm、約20μm至約60μm、約80μm至約150μm、以及這些與更大及更小的距離的組合及變化。In embodiments, the length of the stroke (longitudinal movement) of the sonication needle may be about 28.1 μm to about 95.25 μm, about 25 μm to about 160 μm, about 50 μm to about 90 μm, about 50 μm to about 150 μm, about 25 μm to about 110 μm , about 35 μm to about 100 μm, about 20 μm to about 60 μm, about 80 μm to about 150 μm, and combinations and variations of these and larger and smaller distances.

通常，超音波乳化系統的脈衝速率可以是每秒約20個脈衝至每秒約150個脈衝，以及這些與更高及更低的值的組合及變化。並且，這些系統的短脈衝寬度可以是約30毫秒至約4毫秒，以及這些與更高及更低的值的組合及變化。Typically, the pulse rate of a phacoemulsification system can range from about 20 pulses per second to about 150 pulses per second, as well as combinations and variations of these and higher and lower values. Also, short pulse widths for these systems can be from about 30 milliseconds to about 4 milliseconds, and combinations and variations of these with higher and lower values.

在本系統的實施例中，超音波晶體乳化手持件通常耦接至沖洗源及抽吸泵。抽吸泵係位於系統中的殼體。手持件包括用於***患者眼睛的前房內的遠側尖端，遠側尖端發射超音波能量或利用超音波頻率進行振動，以針對晶狀或自然水晶體進行切割、乳化、及這些的組合及變化。手持件進一步包括：接近遠側尖端的沖洗埠，經由沖洗管線耦接至沖洗源；以及在遠側尖端處的抽吸埠，經由抽吸管線耦接至抽吸泵。來自沖洗源的流體（通常是一瓶鹽溶液）係經由沖洗管線及沖洗埠而沖洗進入眼睛，並經由抽吸埠及抽吸管線藉由抽吸泵從眼睛抽吸沖洗流體及經乳化的水晶體材料。In embodiments of the present system, the phacoemulsification handpiece is typically coupled to an irrigation source and a suction pump. The suction pump is located in the housing of the system. The handpiece includes a distal tip for insertion into the anterior chamber of a patient's eye that emits ultrasonic energy or vibrates with ultrasonic frequencies for cutting, emulsification, and combinations and variations of these for crystalline or natural crystalline lenses . The handpiece further includes: an irrigation port proximate the distal tip, coupled to an irrigation source via an irrigation line; and a suction port at the distal tip, coupled to a suction pump via the suction line. Fluid from the irrigation source (usually a bottle of saline solution) is flushed into the eye through the irrigation line and irrigation port, and the irrigation fluid and emulsified crystals are drawn from the eye by a suction pump through the suction port and suction line Material.

超音波系統可以經配置以執行的用於眼睛的其他醫學技術通常亦包括乳化、沖洗眼睛、及抽吸。這樣的程序可以包括或可以不包括使用乳化、沖洗、及抽吸來破壞、改變、或移除自然眼睛的特徵。因此，藉由系統、藉由外科醫生、及藉由這些的組合及變化來選擇及控制由外科手術控制台遞送的超音波功率、藉由沖洗或抽吸控制台流向患者及從患者流出的流體的流動、及控制超音波晶體乳化手持件來遞送前者的後續需要。Other medical techniques for the eye that the ultrasound system can be configured to perform typically also include emulsifying, irrigating the eye, and suctioning. Such procedures may or may not include the use of emulsification, irrigation, and suction to disrupt, alter, or remove natural ocular features. Thus, the ultrasonic power delivered by the surgical console, the fluid flow to and from the patient by the irrigation or suction console are selected and controlled by the system, by the surgeon, and by combinations and variations of these flow, and subsequent needs for controlling the ultrasonic phacoemulsification handpiece to deliver the former.

本系統的實施例的超音波晶體乳化部件（例如，子組件）通常包括控制系統（例如，可程式化微處理器），以及用於控制例如抽吸速率、真空、及超音波功率等級的具有操作者選擇的預設的控制台（在實施例中，控制台係為系統監控器）。超音波晶體乳化手持件可以藉由電纜與系統互連，電纜用於針對提供乳化作用的壓電轉換器進行供電及控制。在控制台的控制下，管狀物透過手持件向眼睛提供沖洗流體，並使抽吸流體能夠從眼睛排出。Ultrasonic phacoemulsification components (eg, subassemblies) of embodiments of the present system typically include a control system (eg, programmable The operator-selected preset console (in an embodiment, the console is a system monitor). The ultrasonic crystal emulsifying handpiece can be interconnected with the system by means of cables that are used to power and control the piezoelectric transducers that provide the emulsifying action. Under the control of the console, the tube provides irrigation fluid to the eye through the handpiece and enables aspiration fluid to drain from the eye.

在實施例中，在手持件的操作期間始終決定及測量與手持件操作相關聯的相位角度及其他態樣（例如，以調整驅動電路，實現最佳相位角度，以及影響從超音波晶體乳化手持件進入組織的能量轉移）。可以藉由監視手持件電訊號並調整頻率及其他態樣以維持與所選擇參數的一致性來提供手持件的自動調諧。In an embodiment, the phase angle and other aspects associated with the operation of the handpiece are determined and measured at all times during operation of the handpiece (eg, to adjust the drive circuit, achieve the optimum phase angle, and affect the transition from the phacoemulsification handpiece to the energy transfer into the tissue). Automatic tuning of the handpiece can be provided by monitoring the handpiece electrical signal and adjusting frequency and other aspects to maintain consistency with selected parameters.

在實施例中，控制系統依據施加至手持件壓電轉換器的電壓與壓電轉換器所汲取的電流之間的相位角度、提供至手持件的功率脈衝的幅度、及這兩者，來解決超音波晶體乳化手持件的功率控制的要求。可以針對特定的手持件來調諧典型的佈置，並且例如可以在外科醫師的控制下以連續方式或以一系列實心短脈衝的形式施加功率。舉例而言，系統可以施加功率150毫秒，然後停止功率350毫秒，並且可以在功率施加的必要持續時間內重複此開/關序列。在前述的150ms週期期間的功率的施加可以定義為25kHz至50kHz的正弦波的恆定施加。在某些情況下，外科醫生或操作者可以在一段持續時間內施加功率短脈衝，然後停止功率的施加，然後以初始或其他功率設定來重新施加。短脈衝的頻率與持續時間通常是可控制的，施加到受影響區域的短脈衝流的長度也是可控制的。不施加功率的時間週期可以啟用可以使用抽吸（例如，可以藉由手持件或輔助抽吸設備所提供）來移除破碎區段的週期。In an embodiment, the control system resolves in terms of the phase angle between the voltage applied to the handpiece piezoelectric transducer and the current drawn by the piezoelectric transducer, the magnitude of the power pulses provided to the handpiece, and both Requirements for power control of ultrasonic phacoemulsification handpieces. A typical arrangement can be tuned for a particular handpiece, and power can be applied, for example, in a continuous fashion or in a series of solid short pulses under the control of the surgeon. For example, the system may apply power for 150 milliseconds, then stop power for 350 milliseconds, and may repeat this on/off sequence for the necessary duration of power application. The application of power during the aforementioned 150 ms period can be defined as a constant application of a sine wave of 25 kHz to 50 kHz. In some cases, the surgeon or operator may apply a short pulse of power for a duration, then stop the application of power, and then reapply at the initial or other power setting. The frequency and duration of the short pulses are generally controllable, as is the length of the stream of short pulses applied to the affected area. A period of time in which no power is applied may enable a period in which suction (eg, which may be provided by a handpiece or an auxiliary suction device) may be used to remove the fragmented segment.

在本系統的實施例中，用於超音波功率遞送的控制方法通常可以處於幾種模式（例如，可變、預先決定可變、面板、及線性）。可變模式針對外科醫生或操作者提供選擇超音波治療的最大靈活性，而可以視為手動。預先決定可變模式係為模式，其中控制系統依據所提供的雷射治療、白內障的等級、及在雷射治療程序之前、期間、及之後系統所取得的其他資訊來決定超音波治療的最佳範圍。因此，在此模式下，與雷射控制器系統及超音波晶體乳化控制系統協同工作的系統可以預先決定並可取得用於超音波晶體乳化程序的推薦且較佳的最佳化範圍及設定。通常，面板模式通常在使用者選擇時提供嚴格的固定值。通常，線性模式僅允許0％至100％的最簡單形式的線性調整。在實施例中，中間調整或超出系統推薦的用於超音波治療的遞送選項或範圍的調整並非可以自由取得（例如，受到限制，部分是為了使手動調整的需要及固有風險最小化）。In embodiments of the present system, the control method for ultrasonic power delivery can generally be in several modes (eg, variable, predetermined variable, panel, and linear). The variable mode provides the surgeon or operator with maximum flexibility in choosing ultrasound therapy, and can be considered manual. The pre-determined variable mode is the mode in which the control system determines the optimal ultrasound treatment based on the laser treatment provided, the level of the cataract, and other information obtained by the system before, during, and after the laser treatment procedure scope. Therefore, in this mode, the systems working with the laser controller system and the phacoemulsification control system can pre-determine and obtain the recommended and better optimized ranges and settings for the phacoemulsification procedure. In general, panel modes usually provide strictly fixed values when selected by the user. In general, linear mode only allows the simplest form of linear adjustment from 0% to 100%. In embodiments, intermediate adjustments or adjustments outside of the delivery options or ranges recommended by the system for ultrasound therapy are not freely available (eg, limited in part to minimize the need for manual adjustments and inherent risks).

超音波晶體乳化超音波探針將能量遞送進入眼睛，以用於在雷射碎裂或切割之後破碎剩餘的白內障水晶體材料，以促進剩餘物的乳化及抽吸。超音波晶體乳化超音波探針將能量遞送進入眼睛，以用於破碎白內障，其中並未執行白內障的雷射碎裂（例如，在外科醫生選擇進行雷射囊切開術及雷射切口，以***超音波晶體乳化探針，但不使用雷射碎裂水晶體或白內障）。超音波晶體乳化超音波探針將能量遞送進入眼睛，以用於破碎白內障，藉由將控制開關（例如，腳踏板）踩到預先決定的位置時利用固定頻率振動來實現此舉，相同控制開關可以控制治療雷射束及圖案的擊發或遞送，亦可以使用其他類型的控制開關、按鈕、觸發器、聲音等。在實施例中，為了增加超音波功率的量，機器增加探針的行程長度。Ultrasonic phacoemulsification ultrasonic probes deliver energy into the eye for fragmentation of the remaining cataractous lens material after laser fragmentation or incision to facilitate emulsification and aspiration of the remainder. A phacoemulsification ultrasound probe delivers energy into the eye for fragmentation of a cataract, where laser fragmentation of the cataract is not performed (eg, where the surgeon chooses to perform a capsulotomy and a laser incision for insertion phacoemulsification probe, but does not use a laser to fragment crystals or cataracts). Ultrasonic phacoemulsification Ultrasonic probes deliver energy into the eye for use in breaking up cataracts by using fixed frequency vibrations when a control switch (eg, foot pedal) is pressed to a predetermined position, the same control The switches may control the firing or delivery of the therapeutic laser beam and pattern, and other types of control switches, buttons, triggers, sounds, etc. may be used. In an embodiment, to increase the amount of ultrasonic power, the machine increases the stroke length of the probe.

通常，探針可以利用縱向方式、橫向方式、及這些的組合及變化來遞送功率。超音波乳化針係以縱向方式前後移動。利用後一種方式，超音波功率亦透過探針的橫向運動進行遞送，並且可以例如藉由減少水晶體材料的排斥而提高切割效率。In general, probes can deliver power using longitudinal, lateral, and combinations and variations of these. The phacoemulsification needle is moved back and forth in a longitudinal fashion. With the latter approach, ultrasonic power is also delivered through lateral motion of the probe, and cutting efficiency can be improved, for example, by reducing the repulsion of the crystal material.

通常，在超音波晶體乳化中存在兩種類型的橫向運動。在扭轉橫向運動中，超音波乳化尖端沿其主軸線以旋轉方式進行振動。在橫跨橫向運動中，超音波乳化尖端沿著橢圓形路徑進行移動。通常，依據其運動類型，扭轉通常對於具有角度的超音波乳化針更好，而橫跨通常對於筆直或成角度的針同樣好。由於白內障材料在一個以上的方向上被乳化，因此將橫向運動超音波乳化與傳統縱向超音波晶體乳化組合可以有助於切割效率。Generally, there are two types of lateral motion in sonication. During torsional lateral motion, the phacoemulsification tip vibrates in a rotational manner along its main axis. In the transverse lateral motion, the phacoemulsification tip moves along an elliptical path. In general, depending on the type of motion, twisting is generally better for angled phacoemulsification needles, while spanning is generally equally good for straight or angled needles. Since the cataract material is emulsified in more than one direction, combining lateral motion phacoemulsification with traditional longitudinal phacoemulsification can aid in cutting efficiency.

儘管該領域將超音波晶體乳化描述為遞送超音波能量，但應理解，當金屬超音波乳化針擊中目標材料（例如，雷射所影響的白內障材料）時，超音波乳化針的行程會產生機械衝擊。通常，由於在超音波乳化針的正前方會形成微孔，所以針亦會產生氣穴及內爆。流體及顆粒波傳播進入白內障材料，最後產生熱來作為副產物。重要的是要避免選擇造成過多熱積聚的超音波乳化功率設定，因為此舉會灼傷角膜並損傷脆弱的眼部結構。藉由周圍沖洗套管的無限制流動也非常重要，因為平衡的鹽溶液圍繞超音波乳化探針移動所產生的恆定冷卻效果有助於防止熱積聚。Although the art describes phacoemulsification as delivering ultrasonic energy, it is understood that when a metal phacoemulsification needle hits a target material (eg, cataract material affected by a laser), the travel of the phacoemulsification needle produces mechanical shock. Usually, cavitation and implosion of the needle also occurs due to the formation of micro-holes directly in front of the phacoemulsification needle. The fluid and particle waves propagate into the cataract material and eventually generate heat as a by-product. It is important to avoid selecting a phacoemulsification power setting that creates excessive heat build-up, as this can burn the cornea and damage the delicate ocular structure. Unrestricted flow through the surrounding irrigation cannula is also important because the constant cooling effect created by the movement of the balanced salt solution around the phacoemulsification probe helps prevent heat build-up.

在本系統的實施例中，在外科手術期間，系統控制器、超音波乳化控制器、及這些的組合及變化可以監視、記錄、及分析以最大百分比給定的平均超音波乳化功率、遞送超音波乳化超音波功率期間的總時間、及其他條件及因素。在實施例中，共同監視器可以將這些值顯示為「U/S AVE」（代表「超音波平均」）、「EPT」（「經過的超音波乳化時間」）、及其他參數及特徵。遞送進入眼睛的總能量係為超音波乳化功率乘以功率開啟時間的乘積（亦即，絕對超音波乳化時間（APT））。藉由將「U/S AVE」乘以「EPT」，系統控制器、超音波乳化控制器、及這些的組合及變化可以自動計算APT，而使得外科醫生可以比較不同情況下遞送的總超音波能量。In an embodiment of the present system, the system controller, the phacoemulsification controller, and combinations and variations of these can monitor, record, and analyze the average phacoemulsification power given at the maximum percentage, deliver ultra Total time during sonication of ultrasonic power, and other conditions and factors. In an embodiment, the co-monitor may display these values as "U/S AVE" (stands for "Ultrasonic Average"), "EPT" ("Elapsed Phaco Time"), and other parameters and characteristics. The total energy delivered into the eye is the product of the phacoemulsification power times the power on time (ie, the absolute phacoemulsification time (APT)). By multiplying "U/S AVE" by "EPT", system controllers, phacoemulsification controllers, and combinations and variations of these can automatically calculate APT, allowing surgeons to compare the total ultrasound delivered in different situations energy.

在實施例中，為了最大程度降低APT，外科醫生需要降低超音波乳化時間、平均超音波乳化功率、及這些的組合及變化。可以藉由在監視器上選擇參數、透過限制控制開關的位置、或者藉由降低機器上的最大超音波乳化功率等級，來降低平均超音波乳化功率。可以僅當白內障物質位於超音波乳化尖端且僅憑真空不足以抽吸物質時才藉由施加超音波功率，來降低超音波晶體乳化時間。此外，可以藉由遞送更短的脈衝或超音波乳化功率的短脈衝來代替連續的超音波功率，或者藉由降低工作循環（開/關脈衝的比率）來減少超音波乳化時間。將超音波功率分解成較小的脈衝及短脈衝包的此方法係稱為超音波乳化功率調變。In an embodiment, to minimize APT, the surgeon needs to reduce the phacoemulsification time, the average phacoemulsification power, and combinations and variations of these. The average sonication power can be reduced by selecting parameters on the monitor, by limiting the position of the control switch, or by lowering the maximum sonication power level on the machine. The phacoemulsification time can be reduced by applying ultrasonic power only when the cataract material is at the phacoemulsification tip and vacuum alone is not sufficient to aspirate the material. Furthermore, the sonication time can be reduced by delivering shorter pulses or short pulses of sonication power in place of continuous sonication power, or by reducing the duty cycle (ratio of on/off pulses). This method of breaking ultrasonic power into smaller pulses and short pulse packets is called phaco power modulation.

在實施例中，基本功率設定可以是連續的、脈衝的、及短脈衝的。在連續的功率設定中，能量遞送是連續的，其中功率的變化係藉由控制開關位置（例如，腳踏板的下踩量）所控制。In embodiments, the base power setting may be continuous, pulsed, and short pulsed. In a continuous power setting, energy delivery is continuous, where changes in power are controlled by controlling switch position (eg, the amount of pedal depression).

在實施例中，因為藉由控制系統與超音波乳化控制系統的結合使用可以利用預先決定的方式更精確地決定及提供功率的變化（以及在某些情況下亦需要由外科醫生輸入），系統可以提供這些的組合及變化以及提供用於提供這些功率模式的混合或混用等級的功率設定。In an embodiment, because the change in power can be more precisely determined and provided in a predetermined manner (and in some cases also requires input by a surgeon) through the use of the control system in conjunction with the phacoemulsification control system, the system Combinations and variations of these may be provided as well as power settings for providing a mix or mix of levels of these power modes.

在實施例中，在脈衝模式下，脈衝功率藉由控制開關的位置（例如，踩下腳踏板多遠）線性增加。定位（例如，壓低）得越遠，則每一連續的能量脈衝的功率越大。脈衝模式操作的實施例的特徵在於，在每一能量脈衝被遞送之後，存在一段在能量脈衝的增加之間沒有能量被遞送的時間週期（亦即，「關閉」週期）。在相等的「開啟」及「關閉」脈衝時間之間進行交替可以減少熱，並將一半的能量遞送進入眼睛。In an embodiment, in pulse mode, the pulse power is increased linearly by the position of the control switch (eg, how far the foot pedal is depressed). The further away you are positioned (eg, depressed), the greater the power of each successive energy pulse. Embodiments of pulsed mode operation are characterized in that after each energy pulse is delivered, there is a period of time (ie, an "off" period) in which no energy is delivered between increases in the energy pulse. Alternating between equal "on" and "off" pulse times reduces heat and delivers half the energy into the eye.

在實施例中，在短脈衝模式中，每一短脈衝具有相同的功率，但是每一短脈衝之間的間隔隨著控制開關的前進（例如，腳踏板被踩下）而降低。在實施例中，控制開關被推進得越遠（例如，腳踏板被踩下），則每一短脈衝之間的「關閉」週期越短。因此，在實施例中，在最大控制開關位置處（例如，在最大腳踏板下壓處），能量的短脈衝變成能量的連續遞送。In an embodiment, in the short pulse mode, each short pulse has the same power, but the interval between each short pulse decreases as the control switch is advanced (eg, a foot pedal is depressed). In an embodiment, the farther the control switch is advanced (eg, the foot pedal is depressed), the shorter the "off" period between each short pulse. Thus, in an embodiment, at the maximum control switch position (eg, at maximum foot pedal depression), a short pulse of energy becomes a continuous delivery of energy.

在實施例中，短脈衝模式可以提供水晶體的水晶體核的超音波乳化輔助抽吸。外科醫生使用超音波乳化機的真空及流體來抽吸白內障，然後僅在必要時才提供超音波乳化功率的較小短脈衝。因為一個（較佳為）控制系統可以針對這些超音波乳化功率的短脈衝進行程式化或推薦成非常短（短至幾毫秒），所以可以有效地遞送數百個小短脈衝，並且仍然少於例如1秒的總超音波乳化時間。In embodiments, the short pulse mode may provide phacoemulsification-assisted aspiration of the crystal nucleus of the crystal. The surgeon uses the phacoemulsification machine's vacuum and fluid to aspirate the cataract, and then delivers smaller, short pulses of phacoemulsification power only when necessary. Since a (preferably) control system can be programmed or recommended to be very short (as short as a few milliseconds) for these short pulses of phacoemulsification power, hundreds of small short pulses can be effectively delivered and still less than For example a total phacoemulsification time of 1 second.

本系統提供脈衝及短脈衝超音波晶體乳化設定以及其他設定的可程式範圍具有與現有系統相同的特徵的實施例，並且在實施例中，大幅擴展現有系統。與任何現有系統不同，本系統的實施例提供具有依據遞送雷射圖案或治療的雷射系統來預先決定及推薦超音波乳化設定的能力，並且可以立即提供那些設定，而不需要外科醫師或患者進行移動。The present system provides embodiments with a programmable range of pulsed and short-pulsed phacoemulsification settings and other settings that have the same characteristics as, and in embodiments, substantially extend, existing systems. Unlike any existing system, embodiments of the present system provide the ability to predetermine and recommend phacoemulsification settings depending on the laser system delivering the laser pattern or treatment, and to provide those settings immediately without the need for a surgeon or patient make a move.

在實施例中，單獨的超音波乳化控制系統或與系統控制系統組合的超音波乳化控制系統可以執行各種主動的監視及控制功能，例如： 監視眼內壓力（IOP）並且可以調整系統的功能，以將IOP維持在所期望的壓力處；監測及控制真空等級；最佳化功率設定；以及預測壓力改變並主動回應閉塞中斷。用於提供針對超音波乳化系統操作參數的監視及自主控制的此資訊及資料的感測器可以位於系統中、位於各種泵及裝置上、基於電流或其他電負載、或者位於手持件中或手持件上。In embodiments, the phacoemulsification control system alone or in combination with the system control system may perform various active monitoring and control functions, such as: monitoring intraocular pressure (IOP) and may adjust the function of the system, to maintain the IOP at the desired pressure; monitor and control vacuum levels; optimize power settings; and predict pressure changes and proactively respond to occlusion interruptions. Sensors used to provide this information and data for monitoring and autonomous control of phacoemulsification system operating parameters can be located in the system, on various pumps and devices, based on current or other electrical loads, or in a handpiece or hand held on the piece.

在本超音波乳化雷射系統中可以使用的效能特徵及部件的實例係為Alcon CENTURION ®視覺系統、Alco ACTIVE SENTRY ®手持件、及INTREPID ®混合尖端。在實施例中，超音波乳化手持件可以具有內建的流體壓力感測器，用於即時偵測壓力並與系統控制系統、光系統控制系統、或兩者進行通訊。在本超音波乳化雷射系統中可以使用的各種特徵及部件的實例係為AMO WHITESTAR SIGNATURE ®PRO超音波晶體乳化系統。 Examples of performance features and components that can be used in this phacolaser system are the Alcon CENTURION ® Vision System, the Alco ACTIVE SENTRY ® Handpiece, and the INTREPID ® Hybrid Tip. In embodiments, the phacoemulsification handpiece may have a built-in fluid pressure sensor for instant pressure detection and communication with the system control system, the optical system control system, or both. An example of the various features and components that can be used in the present phacolaser system is the AMO WHITESTAR SIGNATURE ® PRO phacoemulsification system.

在美國專利號8,020,565、9,549,850、9,549,851、9,849,030、9,877,865、9,931,447、9,937,077、10,258,505、10,314,953、10,111,990以及美國專利公開號2019/0133824、2019/0021906、2019/0099526、2017/0266046、及2017/0112668中揭示並教示超音波乳化系統及子系統的特徵、使用方法、及部件，其每一者的全部揭示內容藉由引用併入本文。在美國專利號8,020,565、9,549,850、9,549,851、9,849,030、9,877,865、9,931,447、9,937,077、10,258,505、10,314,953、10,111,990以及美國專利公開號2019/0133824、2019/0021906、2019/0099526、2017/0266046、及2017/0112668中揭示The features, methods of use, and components of phacoemulsification systems and subsystems are also taught, the entire disclosures of each of which are incorporated herein by reference.

超音波雷射組合：一般Ultrasonic Laser Combination: General

這些實施例包括任何組合的雷射超音波系統，並且更特定為包括組合的超音波晶體乳化雷射系統，以及組合的超音波晶體乳化飛秒雷射系統（「毫微微超音波乳化」或「超音波乳化毫微微」，除非另有特別說明，否則可以互換使用）。這些實施例可以具有或利用本說明書所揭示的治療雷射及系統、雷射束遞送、雷射控制系統、位置及形狀決定、患者介面、及超音波/超音波晶體乳化的一般教示的實施例、特徵、功能、參數、部件、或系統中之一或更多者以及實例中的系統的特徵中之一或更多者。These embodiments include any combination of laser ultrasound systems, and more particularly include a combination of a phacoemulsification laser system, and a combined phacoemulsification femtosecond laser system ("femtophacoemulsification" or "Phacoemulsification"). phacoemulsification femto", are used interchangeably unless otherwise specified). These embodiments may have or utilize the general teachings of therapeutic lasers and systems, laser beam delivery, laser control systems, position and shape determination, patient interface, and ultrasound/ultrasonic phacoemulsification disclosed in this specification , feature, function, parameter, component, or one or more of the system and one or more of the features of the system in the example.

在雷射超音波系統的較佳實施例（特定為雷射超音波乳化系統，並且更特定為毫微微超音波乳化系統）中，該系統具有可以藉由相同或不同的雷射源提供的兩個治療雷射束，一者是短脈衝持續時間雷射束，另一者是長脈衝持續時間雷射束。In a preferred embodiment of a laser ultrasound system (specifically a laser phacoemulsification system, and more specifically a femto sonication system), the system has two laser sources that can be provided by the same or different laser sources. A therapeutic laser beam, one is a short pulse duration laser beam and the other is a long pulse duration laser beam.

通常，短脈衝持續時間雷射係用於執行針對角膜的程序（例如，切割角膜、角膜緣鬆弛切口等）。通常，長脈衝持續時間雷射束係用於執行針對水晶體的程序（例如，囊切開、水晶體碎裂、白內障碎裂等）。Typically, short pulse duration lasers are used to perform procedures on the cornea (eg, cutting the cornea, limbal relaxation incisions, etc.). Typically, long pulse duration laser beams are used to perform procedures on the lens (eg, capsulotomy, lens fragmentation, cataract fragmentation, etc.).

具有多種類型的不同治療雷射束（例如，短脈衝持續時間與長脈衝持續時間）的這些實施例可以具有或利用本說明書所揭示的治療雷射及系統、雷射束遞送、雷射控制系統、位置及形狀決定、患者介面、及超音波/超音波晶體乳化的一般教示的實施例、特徵、功能、參數、部件、或系統中之一或更多者以及實例中的系統的特徵中之一或更多者。These embodiments with multiple types of different therapeutic laser beams (eg, short and long pulse durations) may have or utilize the therapeutic lasers and systems, laser beam delivery, laser control systems disclosed in this specification , one or more of the embodiments, features, functions, parameters, components, or systems of the general teachings of , position and shape determination, patient interface, and ultrasound/ultrasonic phacoemulsification and features of the systems in the examples one or more.

系統（例如，毫微微超音波乳化系統）可以具有多個治療雷射束（例如，具有不同性質的1、2、3、4、或更多個光束）。這些雷射束可以遵循相同的雷射束路徑，而因此行進通過相同的光學部件並與其互動，或者可以行進通過不同的雷射束路徑，而因此行進通過不同的光學部件並與其交互，以及這些的組合及變化。舉例而言，該系統可以包含具有第一脈衝持續時間及第一功率或能量的第一束、具有第二脈衝持續時間及第二功率或能量的第二束、及具有第三脈衝持續時間及第三功率或能量的第三束。第一、第二、及第三脈衝持續時間、第一、第二、及第三功率、及第一、第二、及第三能量可以相同、不同、及這些的組合及變化。A system (eg, a femtophacoemulsification system) may have multiple therapeutic laser beams (eg, 1, 2, 3, 4, or more beams with different properties). These laser beams may follow the same laser beam path and thus travel through and interact with the same optics, or may travel through different laser beam paths and thus travel through and interact with different optics, and these combinations and changes. For example, the system may include a first beam having a first pulse duration and a first power or energy, a second beam having a second pulse duration and a second power or energy, and a third pulse duration and A third beam of third power or energy. The first, second, and third pulse durations, the first, second, and third powers, and the first, second, and third energies may be the same, different, and combinations and variations of these.

在實施例中，多治療雷射束雷射系統係與另一治療裝置（例如，超音波裝置、診斷裝置、及這些的組合及變化）相關聯（整合或模組化）。In an embodiment, a multi-therapy laser beam laser system is associated (integrated or modularized) with another therapeutic device (eg, an ultrasound device, a diagnostic device, and combinations and variations of these).

在藉由相同的治療雷射源提供長脈衝持續時間及短脈衝持續時間的雷射束的實施例中，在脈衝長度之間切換的時間係少於約3秒（sec）、少於約2sec、少於約1.5sec、約3sec至1sec、約2sec、約3sec，以及這些與較長及較短時間的組合及變化。In embodiments where long pulse duration and short pulse duration laser beams are provided by the same therapeutic laser source, the time to switch between pulse lengths is less than about 3 seconds (sec), less than about 2 sec , less than about 1.5 sec, about 3 sec to 1 sec, about 2 sec, about 3 sec, and combinations and variations of these with longer and shorter times.

儘管本發明的較佳實施例係針對雷射超音波（更特定為毫微微超音波乳化系統），但應理解，針對雷射系統的本改善及實施例具有價值，並且可以單獨使用，而不是作為雷射超音波系統的一部分。Although the preferred embodiments of the present invention are directed to laser ultrasound (and more particularly femto phacoemulsification systems), it should be understood that the present improvements and embodiments directed to laser systems are of value and may be used alone, not as part of a laser ultrasound system.

這些本系統的實施例提供優於先前技術的重要優點。因為本系統可以提供最佳化的雷射能量圖案，所以可以在遞送之後針對眼睛進行評估，然後不需要移動患者，然後以最小的時間延遲（少於1分鐘、少於30sec、少於15sec）執行超音波乳化程序，而可以實現在白內障手術期間使用儘可能少的超音波乳化能量的重要目標，並且對於所有患者而言，較佳為利用預先決定的方式完成。 實例 These embodiments of the present system provide important advantages over the prior art. Because the system can provide an optimized laser energy pattern, the eye can be assessed after delivery, then without patient movement, and then with minimal time delay (less than 1 minute, less than 30sec, less than 15sec) The phacoemulsification procedure is performed with the important goal of using as little phacoemulsification energy as possible during cataract surgery, and is preferably done in a predetermined manner for all patients. example

提供下列實施例以說明本發明的系統、系統的部件、處理、組成物、應用、及材料的各種實施例。這些實例僅用於說明目的，可以是預言性，而不應視為限制性，並未以其他方式限制本發明的範圍。The following examples are provided to illustrate various embodiments of the systems, components of the systems, processes, compositions, applications, and materials of the present invention. These examples are for illustrative purposes only, may be prophetic, and should not be considered limiting, and do not otherwise limit the scope of the invention.

這些實例1至36的實施例可以具有或利用本說明書所揭示的治療雷射及系統、雷射束遞送、雷射控制系統、位置及形狀決定、患者介面、超音波/超音波乳化、及超音波乳化毫微微組合一般教示的實施例、處理、方法、特徵、功能、參數、部件、或系統中之一或更多者，以及這些中之每一者的組合及變化；以及本說明書所提供的其他實例與其他實施例中之一或更多者所提供的實施例、處理、方法、特徵、功能、參數、部件、或系統中之一或更多者。Embodiments of these Examples 1-36 may have or utilize the therapeutic lasers and systems, laser beam delivery, laser control systems, position and shape determination, patient interface, ultrasound/phacoemulsification, and ultrasound disclosed herein Sonic Emulsification Femto combines one or more of the generally taught embodiments, processes, methods, features, functions, parameters, components, or systems, and combinations and variations of each of these; and provided by this specification One or more of the embodiments, processes, methods, features, functions, parameters, components, or systems provided by one or more of the other examples and other embodiments.

實例1Example 1

轉至第2圖，圖示毫微微超音波乳化雷射系統200的實施例的局部切除透視圖。系統200具有容納在共同殼體206內的雷射子系統204與超音波晶體乳化子系統205。雷射子系統204包括治療雷射束源，並且在實施例中包括慢脈衝持續時間與長脈衝持續時間的治療雷射束源。雷射子系統204包括用於定義治療雷射束所沿著行進的治療雷射束路徑的雷射以及沿著雷射束路徑定位或放置的光學部件。這些部件包括z方向聚焦光學裝置以及xy掃描器。Turning to Figure 2, a partially cutaway perspective view of an embodiment of a femto phacoemulsification laser system 200 is illustrated. The system 200 has a laser subsystem 204 and a phacoemulsification subsystem 205 housed within a common housing 206 . The laser subsystem 204 includes a therapeutic laser beam source, and in an embodiment, a slow pulse duration and a long pulse duration therapeutic laser beam source. The laser subsystem 204 includes a laser for defining the therapeutic laser beam path along which the therapeutic laser beam travels and optics positioned or placed along the laser beam path. These components include the z-direction focusing optics and the xy scanner.

系統200具有容納治療雷射束路徑以及其他光學路徑的臂201。在實施例中，臂201亦容納或承載用於成像及定位設備203的控制及功率電纜以及對接組件（在此圖式中未圖示）。臂201在其近端處具有治療雷射束遞送頭202。雷射遞送頭202具有位置及形狀決定設備，其可以是OCT系統或本實例的沙姆系統，以及這些與其他形狀及位置決定設備的組合及變化。雷射遞送頭具有用於與PID組合而對接至患者的眼睛的對接及定位系統。System 200 has an arm 201 that accommodates the therapeutic laser beam path as well as other optical paths. In an embodiment, arm 201 also houses or carries control and power cables and docking components (not shown in this figure) for imaging and positioning device 203 . Arm 201 has a therapeutic laser beam delivery head 202 at its proximal end. The laser delivery head 202 has a position and shape determining device, which may be an OCT system or a Sham system in this example, as well as combinations and variations of these and other shape and position determining devices. The laser delivery head has a docking and positioning system for docking to the patient's eye in combination with the PID.

系統200具有用於雷射子系統204及超音波乳化子系統205的共同功率供應器207。共同功率供應器207針對整個系統提供所有功率，而消除對於輔助功率供應器或多個功率源的需求。此舉允許系統***手術室中的單一功率供應器。The system 200 has a common power supply 207 for the laser subsystem 204 and the phacoemulsification subsystem 205 . The common power supply 207 provides all power for the entire system, eliminating the need for auxiliary power supplies or multiple power sources. This allows the system to be plugged into a single power supply in the operating room.

系統200具有共同控制系統208。共同控制系統208具有控制器操作控制軟體或操作指令。在較佳實施例中，共同控制系統208係與下列一或更多者（較佳為全部）進行控制通訊：雷射子系統中的控制系統及控制器212；超音波乳化子系統中的控制系統及控制器211；與操作者介面209進行控制通訊；與緊急停止裝置210進行控制通訊；以及與例如患者醫療紀錄系統、會計系統、及這些配置的組合及變化的網路進行通訊。System 200 has a common control system 208 . The common control system 208 has controller operation control software or operation instructions. In a preferred embodiment, the common control system 208 is in control communication with one or more (preferably all) of the following: the control system and controller 212 in the laser subsystem; the control system in the phacoemulsification subsystem control communication with operator interface 209; control communication with emergency stop device 210; and communication with networks such as patient medical record systems, accounting systems, and combinations and variations of these configurations.

通常，對接系統以及成像及位置決定設備係藉由雷射子系統控制系統進行控制。在實施例中，可以全部或部分地藉由共同控制系統208直接控制。Typically, the docking system as well as the imaging and position determination equipment are controlled by the laser subsystem control system. In an embodiment, it may be directly controlled in whole or in part by the common control system 208 .

在實施例中，雷射控制系統及超音波控制系統係為部分的，並且可以完全整合進入單一共同控制系統。因此，在實施例中，在毫微微超音波乳化系統中僅存在一個控制系統或單一控制系統。In an embodiment, the laser control system and the ultrasonic control system are partial and can be fully integrated into a single common control system. Thus, in an embodiment, there is only one control system or a single control system in the femto phacoemulsification system.

實例2Example 2

轉至第3圖，沿著實例1的線段圖示毫微微超音波乳化系統的實施例，相同數字表示相同部件。在第3圖的實施例中，xy掃描器301係位於雷射遞送頭202中。Turning to Figure 3, an embodiment of a femto phacoemulsification system is illustrated along the line segments of Example 1, like numerals denoting like parts. In the embodiment of FIG. 3 , the xy scanner 301 is located in the laser delivery head 202 .

實例3Example 3

轉至第4圖以及第4A圖至第4D圖，圖示用於本雷射系統、雷射超音波系統、及更特定為毫微微超音波乳化系統的實施例的光學路徑及光學配置的示意圖。Turning to Figures 4 and 4A-4D, schematic diagrams of optical paths and optical configurations for embodiments of the present laser system, laser ultrasound system, and more particularly femto-phacoemulsification systems are shown .

光學系統430具有四個光學系統400、401、402、403，其可以具有不同波長及功率且用於不同目的之光。光學系統400係用於治療雷射束，並且包含光學部件，以及定義治療雷射束所沿著行進的治療雷射束路徑。光學系統403係用於圖像及位置決定設備（例如，沙姆裝置），其決定眼睛的結構的形狀及位置，並且與治療雷射束及雷射束路徑直接相關。光學系統401係用於相機（較佳為IR相機），從圖式中可以看出，此束路徑係沿著治療雷射束路徑400行進（亦即，重合），而在該路徑的大部分中行進。兩個路徑在束分離器處組合，而用於治療雷射的Vario（Z軸雷射偏轉光學裝置）並非相機束路徑401的一部分。光學系統402係用於第二相機（較佳為彩色相機）。此系統共享一些治療雷射束路徑。Optical system 430 has four optical systems 400, 401, 402, 403, which can have light of different wavelengths and powers and used for different purposes. Optical system 400 is used for the treatment laser beam and includes optical components and defines the treatment laser beam path along which the treatment laser beam travels. Optical system 403 is used in image and position determination equipment (eg, a Sham device), which determines the shape and position of the structures of the eye, and is directly related to the treatment laser beam and laser beam path. Optical system 401 is used for a camera (preferably an IR camera), and as can be seen from the drawings, this beam path follows (ie, coincides) the therapeutic laser beam path 400, and over most of the path march in. The two paths are combined at the beam splitter, and the Vario (Z-axis laser deflection optics) for the treatment laser is not part of the camera beam path 401 . Optical system 402 is used for the second camera (preferably a color camera). This system shares some of the therapeutic laser beam paths.

這些光學系統400、401、402、403的區段或部分可以位於或容納在雷射系統的實施例以及雷射超音波系統及毫微微微超音波乳化系統的實施例的各種殼體及部件中。因此，藉由省略圖示，如第4圖所示，光學系統的部分可以容納或包含在遠側殼體420（例如，第5圖的殼體503或第1圖的殼體106）、臂421（例如，第3圖的臂201、第5圖的504的光管路、或第1圖的臂107）、及雷射頭或近側殼體423（例如，近側組件或雷射頭）（例如，第1圖中的臂107的近端、第2圖中的頭202、或第5圖中的頭505）。這些光學系統400、401、402、403亦可以分佈在遠側殼體420a、臂、或連接器421a與近側殼體（例如，近側組件或雷射頭423a）之間並容納於其中，如第4E圖的配置所示。這些光學系統400、401、402、403亦可以分佈在遠側殼體420b、臂421b與近側殼體423b（例如，近側組件或雷射頭）之間並容納於其中，如第4F圖的配置所示。亦可以考慮這些光學系統的其他分佈及包含或容納佈置。Sections or portions of these optical systems 400 , 401 , 402 , 403 may be located or housed in various housings and components of embodiments of laser systems as well as embodiments of laser ultrasound systems and femto phacoemulsification systems . Therefore, by omitting illustration, as shown in FIG. 4, parts of the optical system may be housed or contained in the distal housing 420 (eg, housing 503 in FIG. 5 or housing 106 in FIG. 1), the arm 421 (eg, arm 201 in Figure 3, light pipe at 504 in Figure 5, or arm 107 in Figure 1), and a laser head or proximal housing 423 (eg, a proximal component or laser head ) (eg, proximal end of arm 107 in Figure 1, head 202 in Figure 2, or head 505 in Figure 5). These optical systems 400, 401, 402, 403 may also be distributed between and housed in the distal housing 420a, arm, or connector 421a and the proximal housing (eg, proximal component or laser head 423a), As shown in the configuration in Figure 4E. These optical systems 400, 401, 402, 403 may also be distributed between and housed in the distal housing 420b, arm 421b, and proximal housing 423b (eg, proximal assembly or laser head), as shown in Figure 4F configuration shown. Other distributions and containment or accommodation arrangements of these optical systems are also contemplated.

轉至第4G圖，可以見到光學系統430具有四個瞳孔461、462、463、464。在此實施例中，瞳孔係為共軛遠心瞳孔。應注意，在四個瞳孔中，只有三個沿著治療雷射束路徑。Turning to Figure 4G, it can be seen that the optical system 430 has four pupils 461, 462, 463, 464. In this embodiment, the pupil is a conjugate telecentric pupil. It should be noted that of the four pupils, only three follow the path of the treatment laser beam.

實例3AExample 3A

實例3的實施例具有與治療雷射重合的用於照亮眼睛的結構的掃描雷射，而使得來自403的光學部件等可以拍攝圖像，以知道眼睛的結構位於何處。此外，存在直射眼睛的光源，以在對接處理期間有助於針對患者的直射。針對此光的直射光源及路徑係經由第4G圖中的位於402與403之間的束分離立方體進行。The embodiment of Example 3 has a scanning laser for illuminating the structures of the eye coincident with the therapeutic laser, so that optics etc. from 403 can take images to know where the structures of the eye are located. Additionally, there is a light source directing to the eye to facilitate direct light on the patient during the docking procedure. Direct light source and routing for this light is via the beam splitting cube located between 402 and 403 in Figure 4G.

實例4AExample 4A

毫微微超音波乳化系統具有圖像及位置決定設備，圖像及位置決定設備係為基於超音波的成像系統。在一個實施例中，圖像及位置決定設備係為光學同調斷層掃描（OCT）系統，其可以決定相對於治療雷射及治療雷射束的水晶體的結構及眼睛的結構的形狀及位置。OCT系統係與雷射子系統控制系統、超音波乳化子系統控制系統、毫微微超音波乳化系統控制系統、及這些的組合及變化進行整合及控制通訊。The femto phacoemulsification system has an image and position determination device, and the image and position determination device is an ultrasound-based imaging system. In one embodiment, the image and position determination device is an optical coherence tomography (OCT) system that can determine the shape and position of the structure of the lens and the structure of the eye relative to the treatment laser and treatment laser beam. The OCT system integrates and controls communication with the laser subsystem control system, the phacoemulsification subsystem control system, the femto phacoemulsification system control system, and combinations and variations of these.

亦可以在例如第1圖、第2圖、第3圖、第5圖、第14圖的實施例以及其他實施例中使用OCT系統。The OCT system may also be used in, for example, the embodiments of Figures 1, 2, 3, 5, 14, and other embodiments.

實例4BExample 4B

第1圖、第2圖、第3圖、第5圖、第14圖的實施例具有並使用沙姆相機系統，以作為其圖像及位置決定設備。沙姆相機系統係為與OCT系統完全不同的系統。沙姆相機的操作方式非常不同、功能不同、並且提供與OCT系統非常不同的輸出（例如，結果）。認為本發明的沙姆系統在決定眼睛結構的位置及形狀方面優於OCT。The embodiments of Figs. 1, 2, 3, 5, and 14 have and use a Sham camera system as their image and position determination device. The Sham camera system is a completely different system from the OCT system. Sham cameras operate very differently, function differently, and provide very different outputs (eg, results) than OCT systems. The Sham system of the present invention is believed to be superior to OCT in determining the position and shape of ocular structures.

沙姆相機系統係與雷射子系統控制系統、超音波乳化子系統控制系統、毫微微超音波乳化系統控制系統、及這些的組合及變化進行整合及控制通訊。The Sham camera system integrates and controls communication with the laser subsystem control system, the phacoemulsification subsystem control system, the femto phacoemulsification system control system, and combinations and variations of these.

實例5AExample 5A

在毫微微超音波乳化系統的實施例中，超音波晶體乳化子系統具有整合Peristaltic及Venturi泵的系統的下列部件及特徵，而允許外科醫生獨立選擇用於超音波乳化或玻璃體切除程序的泵模式。此超音波乳化子系統的特點包括：雙泵系統（Peristaltic及Venturi）；高真空閉塞；高速玻璃體切除。超音波乳化子系統能夠執行下列程序：電療、沖洗、雕刻、拍打及切細、切除、黏合。使用者介面及軟體針對這些及其他超音波乳化程序提供選單項目及監視欄位。In an embodiment of a femtophacoemulsification system, the phacoemulsification subsystem has the following components and features of a system that integrates Peristaltic and Venturi pumps, allowing the surgeon to independently select the pump mode for the phacoemulsification or vitrectomy procedure . Features of this phacoemulsification subsystem include: dual pump system (Peristaltic and Venturi); high vacuum occlusion; high speed vitrectomy. The phacoemulsification subsystem is capable of performing the following procedures: electrotherapy, irrigation, engraving, beating and shredding, excision, gluing. The user interface and software provide menu items and monitoring fields for these and other phacoemulsification procedures.

實例5BExample 5B

在毫微微超音波乳化系統的實施例中，超音波晶體乳化子系統具有來自Alcon CENTURION ®視覺系統、Alco ACTIVE SENTRY ®手持件、及INTREPID ®混合件的部件。 In an embodiment of the femtophacoemulsification system, the phacoemulsification subsystem has components from the Alcon CENTURION® vision system, the Alco ACTIVE SENTRY® handpiece, and the INTREPID® hybrid.

實例5CExample 5C

在毫微微超音波乳化系統的實施例中，超音波晶體乳化子系統具有來自AMO WHITESTAR SIGNATURE ®PRO超音波晶體乳化系統的部件。 In an embodiment of the femtophacoemulsification system, the phacoemulsification subsystem has components from the AMO WHITESTAR SIGNATURE® PRO phacoemulsification system.

實例6Example 6

在雷射超音波系統（特定為毫微微超音波系統）的實施例中，系統具有安全互鎖。安全互鎖較佳地位於共同控制系統中，但是可以位於雷射控制系統、超音波乳化控制系統、及這些的組合及變化中，或者作為一部分。安全互鎖可以在超音波乳化系統操作時防止治療雷射被擊發。在較佳實施例中，互鎖系統具有三個階段或閘：（i）超音波乳化系統被關閉：可以操作雷射；（ii）超音波乳化系統被打開，並且正在預熱，但並非可操作狀態或者正在操作：可以操作雷射；以及（iii）超音波乳化在可操作狀態中或正在操作：無法擊發雷射。In an embodiment of a laser ultrasound system, specifically a femto ultrasound system, the system has a safety interlock. The safety interlock is preferably located in the common control system, but may be located in, or as part of, the laser control system, the phacoemulsification control system, and combinations and variations of these. A safety interlock prevents the therapeutic laser from firing while the phacoemulsification system is operating. In the preferred embodiment, the interlocking system has three stages or gates: (i) the phacoemulsification system is off: the laser can be operated; (ii) the phacoemulsification system is on and is warming up, but not operational Operational state or in operation: the laser can be operated; and (iii) the phacoemulsification is in an operational state or in operation: the laser cannot be fired.

在實施例中，階段（iii）在超音波乳化系統在可操作狀態中但並非正在操作時允許操作雷射。在此實施例中，僅當超音波乳化系統正在操作（亦即，遞送超音波能量）時，才鎖定治療雷射（亦即，無法擊發或傳播雷射束）。In an embodiment, stage (iii) allows operation of the laser when the phacoemulsification system is in an operational state but not in operation. In this embodiment, the therapeutic laser is locked (ie, unable to fire or propagate the laser beam) only when the phacoemulsification system is operating (ie, delivering ultrasound energy).

實例7Example 7

轉至第5圖，圖示毫微微雷射裝置或系統500的透視圖。系統具有下部或主殼體501（在圖式中僅部分圖示）。下部殼體501包含超音波乳化系統、超音波乳化藥筒的位置、及程序期間的藥筒、用於產生治療雷射束的治療雷射、及控制系統。滑動機構502係位於主殼體501中。滑動機構502提供上部殼體或可移動殼體503的移動。可移動殼體503藉由滑動機構502沿著箭頭502a的方向（亦即橫向、水平、或朝內及朝外）朝向及遠離患者。Turning to Figure 5, a perspective view of a femtolaser device or system 500 is illustrated. The system has a lower or main housing 501 (only partially shown in the drawings). The lower housing 501 contains the phacoemulsification system, the location of the phacoemulsification cartridge, and the cartridge during the procedure, the therapeutic laser for generating the therapeutic laser beam, and the control system. The sliding mechanism 502 is located in the main housing 501 . The sliding mechanism 502 provides movement of the upper housing or movable housing 503 . The movable housing 503 is moved toward and away from the patient by the sliding mechanism 502 in the direction of arrow 502a (ie, laterally, horizontally, or inward and outward).

滑動機構可以例如藉由例如操縱桿所控制的馬達自動移動，可以手動移動，以及利用這些的組合進行移動（例如，在馬達可以空轉的情況下）。馬達可以具有設定或預先決定的位置，並且亦可以與智慧型頭枕進行控制通訊，以將雷射遞送頭505精確地放置或定位在患者頭枕上方，並藉此可以針對患者及患者的眼睛進行操作。The sliding mechanism can be moved automatically, eg, by a motor controlled by a joystick, for example, manually, and with a combination of these (eg, where the motor can run idly). The motor may have a set or predetermined position and may also be in control communication with the smart headrest to precisely place or position the laser delivery head 505 over the patient's headrest and thereby target the patient and the patient's eyes to operate.

上部或可移動殼體503包含雷射聚焦z方向光學裝置、xy掃描光學裝置、及其他束處理或操控部件。殼體503亦可以包含其他光學系統及光學路徑，如實例3所示。The upper or movable housing 503 contains the laser focusing z-direction optics, xy scanning optics, and other beam processing or steering components. Housing 503 may also contain other optical systems and optical paths, as shown in Example 3.

殼體503藉由鉸接的光管路507與治療雷射進行光學通訊。鉸接的光管路提供自由空間雷射束路徑，自由空間雷射束路徑將雷射束從下部殼體501引導至殼體503，並將治療雷射束沿著雷射束路徑遞送至殼體503中的光學部件。在此實施例中，如第5I圖更詳細所圖示，鉸接的光管路507具有六個接頭，其中每一接頭的內側具有反射表面。較佳地，在殼體503的所有可能的位置及定向上，光管路507使治療雷射及殼體501與殼體503及該殼體中的光學部件保持光學通訊。The housing 503 is in optical communication with the therapeutic laser via a hinged light conduit 507 . The articulated light conduit provides a free space laser beam path that directs the laser beam from the lower housing 501 to the housing 503 and delivers the therapeutic laser beam along the laser beam path to the housing Optical components in 503. In this embodiment, as illustrated in more detail in Figure 5I, the articulated light pipe 507 has six joints, wherein the inside of each joint has a reflective surface. Preferably, in all possible positions and orientations of housing 503, light conduit 507 maintains the therapeutic laser and housing 501 in optical communication with housing 503 and the optical components in the housing.

殼體503具有臂504，臂504係為剛性空心光管路，而容納或包含一或更多個光學路徑（包括治療雷射束路徑，以及如實例3所述的其他路徑）。臂504利用雷射遞送頭505連接殼體503，並使這些部件保持光學通訊。臂504亦可以承載控制及通訊電纜、光纖、或電線，以用於在雷射頭的部件與控制系統之間發送控制並形成控制。雷射頭505係位於臂504的近端，而殼體503係位於臂504的遠端。Housing 503 has arms 504 that are rigid hollow light conduits that house or contain one or more optical paths (including therapeutic laser beam paths, and others as described in Example 3). Arm 504 connects housing 503 with laser delivery head 505 and keeps these components in optical communication. Arm 504 may also carry control and communication cables, optical fibers, or wires for sending and forming controls between components of the laser head and the control system. The laser head 505 is located at the proximal end of the arm 504 and the housing 503 is located at the distal end of the arm 504 .

雷射頭具有位置及形狀決定設備506，位置及形狀決定設備506係為沙姆裝置，並具有五個相機。（在實施例中，存在六個固定相機。在實施例中，存在單一可移動相機。）The laser head has a position and shape determination device 506, which is a Sham device and has five cameras. (In an embodiment, there are six fixed cameras. In an embodiment, there is a single movable camera.)

實例8Example 8

轉至第5A圖至第5H圖，圖示與第5圖的系統一起使用的位置調整機構的各種視圖及實施例（相同數字具有相同含義並指稱相同部件）。Turning to Figures 5A-5H, various views and embodiments of a position adjustment mechanism for use with the system of Figure 5 are illustrated (like numerals have the same meaning and refer to the same parts).

轉至第5A圖，位置調整機構510通常定位於殼體503的遠離臂507的另一側。機構510的一部分可以位於殼體503下方以及在殼體501上或在殼體501中。Turning to FIG. 5A , the position adjustment mechanism 510 is generally positioned on the other side of the housing 503 away from the arm 507 . A portion of mechanism 510 may be located below housing 503 and on or in housing 501 .

第5B圖圖示橫向移動組件531，橫向移動組件531係為位置調整機構510的一部分。橫向移動組件531具有藉由驅動齒輪或輪而與馬達523及522可移動地機械關聯的第一板520及第二板521。板520、521係以弧形方式移動，弧形方式轉換成用於固定柱512的橫向移動（亦即，沿著箭頭502a的方向）。固定柱512係附接至自由移動組件（例如，組件513）。橫向移動組件531係與殼體501機械關聯，並且可以容納在殼體501上，而較佳為容納在殼體501內。FIG. 5B illustrates the lateral movement assembly 531 which is part of the position adjustment mechanism 510 . The lateral movement assembly 531 has a first plate 520 and a second plate 521 movably mechanically associated with the motors 523 and 522 by driving gears or wheels. Plates 520, 521 are moved in an arcuate manner, which translates into lateral movement for securing post 512 (ie, in the direction of arrow 502a). Fixed post 512 is attached to a freely moving assembly (eg, assembly 513). The lateral movement assembly 531 is mechanically associated with the housing 501 and can be received on the housing 501 and is preferably received within the housing 501 .

實例9Example 9

轉至第5C圖，圖示具有四桿連桿機構的橫向移動組件511，四桿連桿機構係為位置調整機構510a的一部分；以及提供沿著箭頭502a的方向的移動。橫向移動組件511係與殼體501機械關聯，並且可以容納在殼體501上，而較佳為容納在殼體501內。Turning to Figure 5C, a lateral movement assembly 511 is shown having a four-bar linkage that is part of the position adjustment mechanism 510a; and provides movement in the direction of arrow 502a. The lateral movement assembly 511 is mechanically associated with the housing 501 and can be received on the housing 501 , and is preferably received within the housing 501 .

應理解，實例8的橫向移動組件510可以與實例9的位置調整機構510a一起使用，而反之亦然。應理解，自由移動組件513可以與橫向移動組件511或橫向移動組件531一起使用。應理解，亦可以使用其他自由移動型機械及機電裝置以及橫向型移動機械及機電裝置。It should be understood that the lateral movement assembly 510 of Example 8 can be used with the position adjustment mechanism 510a of Example 9, and vice versa. It should be understood that free movement assembly 513 may be used with lateral movement assembly 511 or lateral movement assembly 531 . It should be understood that other freely moving mechanical and electromechanical devices as well as laterally moving mechanical and electromechanical devices may also be used.

組件511係附接至固定柱512。該組件沿著箭頭502a的方向移動固定柱502。固定柱512係連接至自由移動組件513。自由移動組件513利用弧形方式、橫向方式、垂直方式、及這些的組合提供殼體503的移動（如箭頭513a的集合通常所示）。組件513係為平行四邊形連桿機構。Assembly 511 is attached to fixed post 512 . The assembly moves the stationary post 502 in the direction of arrow 502a. The fixed post 512 is connected to the freely moving component 513 . The free movement assembly 513 provides for movement of the housing 503 using an arcuate manner, a lateral manner, a vertical manner, and combinations of these (as generally indicated by the set of arrows 513a). Assembly 513 is a parallelogram linkage.

組件513可以是電動的，可以具有預先決定的位置，或者可以利用手進行操作（例如，握住臂504、殼體503、或其他部分，並改變殼體503的位置）。在實施例中，殼體503、臂504、及雷射頭505保持平衡，而使得殼體503可以利用少於10磅的力、少於7磅的力、少於5磅的力、少於2磅的力、約2至約7磅的力、約4至約6磅的力、及這些的組合及變化進行移動。較佳地，一旦移動，則殼體503將保持在所放置的位置上，直到受到足夠的力作用，以進行移動。（為簡單起見，在第5C圖中未圖示臂504及雷射頭505）Assembly 513 may be powered, may have a predetermined position, or may be manipulated by hand (eg, holding arm 504, housing 503, or other portion, and changing the position of housing 503). In embodiments, housing 503, arm 504, and laser head 505 are balanced such that housing 503 can utilize less than 10 pounds of force, less than 7 pounds of force, less than 5 pounds of force, less than 2 pounds of force, about 2 to about 7 pounds of force, about 4 to about 6 pounds of force, and combinations and variations of these move. Preferably, once moved, the housing 503 will remain in place until sufficient force is applied to move. (For simplicity, the arm 504 and the laser head 505 are not shown in Fig. 5C)

第5D圖至第5H圖圖示自由移動組件513可以放置殼體503。第5H圖的位置係為用於系統的儲存及手術室的清潔的概念。第5E圖的位置係用於針對患者進行雷射操作。Figures 5D-5H illustrate that the free movement assembly 513 can place the housing 503. The location of Figure 5H is a concept for storage of the system and cleaning of the operating room. The position in Figure 5E is for the laser procedure on the patient.

實例10Example 10

在實施例中，雷射超音波系統（更特定為毫微微超音波乳化系統）具有附接至系統的患者床或支撐件。In an embodiment, a laser ultrasound system (more specifically a femto phacoemulsification system) has a patient bed or support attached to the system.

實例11Example 11

在實施例中，患者支撐件（例如，床）並未附接至雷射超音波系統（更特定為毫微微超音波乳化系統）。患者支撐件與毫微微超音波乳化系統可以完全相對於彼此進行定位，兩者之間沒有物理限制。因此，毫微微超音波乳化系統可以相對於患者支撐件而定位在任何位置或定向上（前提是患者的頭部係位於臂及超音波乳化管的範圍內）。使用A/C電磁場、陀螺儀、加速度計、及磁力計的定向/定位追蹤系統係用於決定相對於治療雷射及治療雷射束路徑的患者的頭部的定向。此定向追蹤系統可以將臂（例如，第5圖的系統的臂504）的角度決定在±5度、±3度、±2度、及更大及更小的精確度內。使用此角度，較佳地藉由控制系統來調整治療雷射束遞送圖案，以利用正確的患者眼睛的定向角度來遞送雷射束圖案。In an embodiment, the patient support (eg, bed) is not attached to a laser ultrasound system (more specifically a femtophacoemulsification system). The patient support and the femtophacoemulsification system can be positioned completely relative to each other, with no physical constraints between the two. Thus, the femto phacoemulsification system can be positioned in any position or orientation relative to the patient support (provided that the patient's head is within the confines of the arms and phacoemulsification tube). Orientation/positioning tracking systems using A/C electromagnetic fields, gyroscopes, accelerometers, and magnetometers are used to determine the orientation of the patient's head relative to the treatment laser and the treatment laser beam path. This orientation tracking system can determine the angle of the arm (eg, arm 504 of the system of FIG. 5 ) to within ±5 degrees, ±3 degrees, ±2 degrees, and greater and lesser accuracy. Using this angle, the treatment laser beam delivery pattern is adjusted, preferably by the control system, to deliver the laser beam pattern with the correct orientation angle of the patient's eye.

在實施例中，Polhemus Patriot™ 6-DOF追蹤感測器係位於患者頭枕中，其中發射器係安裝在遞送系統的前方附近的系統框架上。此舉提供足夠的資訊來決定相對於雷射遞送系統的頭枕的定向。在附錄A中進一步描述此定向/定位追蹤系統，其全部揭示內容藉由引用併入本文。In an embodiment, the Polhemus Patriot™ 6-DOF tracking sensor is located in the patient headrest, with the transmitter mounted on the system frame near the front of the delivery system. This provides sufficient information to determine the orientation of the headrest relative to the laser delivery system. This orientation/location tracking system is further described in Appendix A, the entire disclosure of which is incorporated herein by reference.

實例12Example 12

電磁追蹤系統係用於不具有超音波乳化子系統的獨立式治療雷射系統。獨立式治療雷射系統具有未附接至雷射系統的患者支撐件。電磁追蹤系統決定患者的眼睛與雷射系統的定向的角度。雷射系統將雷射遞送圖案配置成滿足所決定的角度。The Electromagnetic Tracking System is used in a self-contained therapeutic laser system without a phacoemulsification subsystem. A freestanding therapeutic laser system has a patient support that is not attached to the laser system. The electromagnetic tracking system determines the angle of orientation of the patient's eye to the laser system. The laser system configures the laser delivery pattern to satisfy the determined angle.

實例13Example 13

實例11及12的系統在患者支撐件與治療系統之間具有柔性或可定位的機械附件。電磁追蹤系統用於決定患者的眼睛與治療系統之間的位置（更特定為角度）。雷射系統將雷射遞送圖案配置成滿足所決定的角度。The systems of Examples 11 and 12 have flexible or positionable mechanical attachments between the patient support and the treatment system. Electromagnetic tracking systems are used to determine the position (more specifically the angle) between the patient's eyes and the treatment system. The laser system configures the laser delivery pattern to satisfy the determined angle.

實例14Example 14

電磁追蹤系統的部件（例如，陀螺儀、加速度計、及磁力計）利用各種佈置方式佈置在患者支撐件中、在患者頭部支撐件中、在患者自身上、及在治療系統中，其中陀螺儀、加速度計、磁力計係位於這些部件的一或更多者中。Components of the electromagnetic tracking system (eg, gyroscopes, accelerometers, and magnetometers) are placed in the patient support, in the patient head support, on the patient itself, and in the therapy system using various arrangements, where the gyroscope Meters, accelerometers, magnetometers are located in one or more of these components.

實例15Example 15

在實施例中，裝置（例如，陀螺儀、加速度計、及數位羅盤）的組合係位於患者頭枕中，並且兩個磁力計係定位於毫微微超音波乳化系統中。這提供足夠的裝置來決定定向（例如，患者與雷射臂、雷射束的路徑、及圖案的角度）。In an embodiment, a combination of devices (eg, a gyroscope, an accelerometer, and a digital compass) are located in the patient's headrest, and the two magnetometers are located in the femto-phacoemulsification system. This provides sufficient means to determine orientation (eg, angle of the patient to the laser arm, the path of the laser beam, and the pattern).

使用陀螺儀、加速度計、及磁力計的基於羅盤的位置決定系統來決定患者頭部（更特定為相對於治療雷射及治療雷射束路徑的正要進行手術的眼睛）的位置。此基於羅盤的定位系統可以將臂（例如，第5圖的系統的臂504）的角度決定在±5度、±3度、±2度、及更大及更小的精確度內。使用此角度，較佳地藉由控制系統來調整治療雷射束遞送圖案，以利用正確的患者眼睛的定向角度來遞送雷射束圖案。A compass-based position determination system using gyroscopes, accelerometers, and magnetometers is used to determine the position of the patient's head (more specifically the eye undergoing surgery relative to the therapeutic laser and the path of the therapeutic laser beam). This compass-based positioning system can determine the angle of an arm (eg, arm 504 of the system of FIG. 5 ) to within ±5 degrees, ±3 degrees, ±2 degrees, and greater and lesser accuracy. Using this angle, the treatment laser beam delivery pattern is adjusted, preferably by the control system, to deliver the laser beam pattern with the correct orientation angle of the patient's eye.

在實施例中，陀螺儀及加速度計係位於患者頭枕中，並且兩個磁力計係定位於毫微微超音波乳化系統中。這提供足夠的裝置來決定定向（例如，患者與雷射臂、雷射束的路徑、及圖案的角度）。In an embodiment, the gyroscope and accelerometer are located in the patient headrest, and the two magnetometers are located in the femto-phacoemulsification system. This provides sufficient means to determine orientation (eg, angle of the patient to the laser arm, the path of the laser beam, and the pattern).

基於羅盤的位置決定系統的部件（例如，陀螺儀、加速度計、及磁力計）利用各種佈置方式佈置在患者支撐件中、在患者頭部支撐件中、在患者自身上、及在治療系統中，其中陀螺儀、加速度計、磁力計係位於這些部件的一或更多者中。Components of the compass-based position determination system (eg, gyroscopes, accelerometers, and magnetometers) are placed in the patient support, in the patient head support, on the patient itself, and in the treatment system using various arrangements , wherein the gyroscope, accelerometer, and magnetometer are located in one or more of these components.

實例11及12的系統在患者支撐件與治療系統之間具有柔性或可定位的機械附件。基於羅盤的位置決定系統用於決定患者的眼睛與治療系統之間的位置（更特定為角度）。雷射系統將雷射遞送圖案配置成滿足所決定的角度。The systems of Examples 11 and 12 have flexible or positionable mechanical attachments between the patient support and the treatment system. A compass-based position determination system is used to determine the position (more specifically the angle) between the patient's eye and the treatment system. The laser system configures the laser delivery pattern to satisfy the determined angle.

基於羅盤的位置決定系統係用於不具有超音波乳化子系統的獨立式治療雷射系統。獨立式治療雷射系統具有未附接至雷射系統的患者支撐件。基於羅盤的位置決定系統決定患者的眼睛與雷射系統的定向的角度。雷射系統將雷射遞送圖案配置成滿足所決定的角度。The compass-based position determination system is used in a self-contained therapeutic laser system without a phacoemulsification subsystem. A freestanding therapeutic laser system has a patient support that is not attached to the laser system. The compass-based position determination system determines the angle of the orientation of the patient's eye to the laser system. The laser system configures the laser delivery pattern to satisfy the determined angle.

實例16Example 16

追蹤系統（例如，電磁追蹤系統）的頭枕或其他遠端部件（亦即，並非治療系統的一部分）具有可充電電池，而可以在單獨的充電站處、儲存容器、或在治療系統上進行充電。The headrest or other remote component (ie, not part of the therapy system) of the tracking system (eg, electromagnetic tracking system) has a rechargeable battery, but can be performed at a separate charging station, storage container, or on the therapy system Charge.

實例17Example 17

在毫微微超音波乳化系統的實施例中，控制系統推薦（例如，匹配）白內障等級、雷射功率及圖案、超音波速率、功率、相位角度、及與手持件操作相關聯的其他態樣。以此方式，系統推薦並預先決定遞送至眼睛的所有能量，作為完全整合裝置的治療的一部分。在實施例中，藉由系統控制器來調諧水晶體乳化手持件，以依據先前的雷射程序來最佳化水晶體乳化程序，該先前的雷射程序又依據先前的白內障等級。系統提供單一系統，該單一系統能夠快速且不需要患者或系統的位置的移動來決定角膜的結構（例如，前及後表面）、眼睛的水晶體（例如，前囊、後囊）的形狀及位置，針對白內障的類型或密度進行分級，針對水晶體執行雷射囊切開及雷射碎裂，然後針對經雷射碎裂的水晶體材料執行超音波晶體乳化，以移除該材料來***IOL。系統經配置以使用從該程序的每一先前步驟所取得的資訊來最佳化該程序的下一個步驟。以此方式，該系統在眼科程序期間向眼睛提供完全整合及預先決定的總能量遞送以及能量遞送分佈曲線。在實施例中，總能量遞送與能量遞送分佈曲線係基於所治療的白內障的等級。總能量遞送與能量遞送分佈曲線包括雷射能量及超音波能量。In an embodiment of a femto phacoemulsification system, the control system recommends (eg, matches) cataract grade, laser power and pattern, ultrasound rate, power, phase angle, and other aspects associated with handpiece operation. In this way, the system recommends and predetermines all energy delivered to the eye as part of the treatment of the fully integrated device. In an embodiment, the phacoemulsification handpiece is tuned by the system controller to optimize the phacoemulsification program based on the previous laser program, which in turn is based on the previous cataract level. The system provides a single system capable of determining the structure of the cornea (eg, anterior and posterior surfaces), the shape and position of the lens of the eye (eg, anterior capsule, posterior capsule), quickly and without the need for movement of the patient or the position of the system , grading for the type or density of cataract, performing capsulotomy and laser fragmentation on the crystal, and then performing sonication on the laser-fragmented crystal material to remove the material for insertion of the IOL. The system is configured to use the information obtained from each previous step of the procedure to optimize the next step of the procedure. In this way, the system provides a fully integrated and predetermined total energy delivery and energy delivery profile to the eye during an ophthalmic procedure. In an embodiment, the total energy delivery and energy delivery profile curves are based on the class of cataract being treated. The total energy delivery and energy delivery profiles include laser energy and ultrasonic energy.

實例18Example 18

在實施例中，毫微微超音波乳化系統針對提供程序的外科醫生或從業者提供預先決定可變模式。因此，在此模式下，與雷射控制器系統及超音波晶體乳化控制系統協同工作的系統可以預先決定並可取得用於超音波晶體乳化程序的推薦且較佳的最佳化範圍及設定。此實施例可以進一步基於外科醫生的選擇及偏好來「學習」，以基於外科醫生的實踐及輸入來提供客製化的最佳範圍。In an embodiment, the femtophacoemulsification system provides a predetermined variable mode for the surgeon or practitioner providing the procedure. Therefore, in this mode, the systems working with the laser controller system and the phacoemulsification control system can pre-determine and obtain the recommended and better optimized ranges and settings for the phacoemulsification procedure. This embodiment may further "learn" based on the surgeon's selection and preferences to provide an optimal range of customization based on the surgeon's practice and input.

實例19Example 19

在實施例中，毫微微超音波乳化系統提供可調整模式，以提供更多可變性及預先決定可變性（例如，藉由基於遞送至水晶體的雷射束圖案或雷射治療、較佳為藉由系統決定或可以提供至系統的白內障等級、及其他因素而提供超音波的調整範圍的系統）。然後，系統可以針對程序提供推薦範圍及調整，其中包括：（i）扭轉橫向運動、橫跨橫向運動、或無橫向運動的推薦；（ii）增加碎裂的雷射圖案的推薦，而因此降低水晶體乳化功率，以管理眼睛中的熱積累；（iii）推薦的工作循環。In an embodiment, the femto phacoemulsification system provides an adjustable pattern to provide more variability and predetermined variability (eg, by laser therapy based on the pattern of the laser beam delivered to the crystal, preferably by A system that provides an adjustment range of the ultrasound as determined by the system or can be provided to the system by the cataract level, among other factors). The system can then provide recommended ranges and adjustments for the procedure, including: (i) recommendations for torsional lateral motion, transverse lateral motion, or no lateral motion; (ii) recommendations for increasing the fragmented laser pattern and thus decreasing Crystal emulsification power to manage heat build-up in the eye; (iii) Recommended duty cycle.

工作循環與工作循環推薦可以包括例如針對模式（例如，脈衝模式）的選擇，該模式將水晶體乳化功率脈衝與休止週期交替，預設比率為50：50。這稱為50％的工作循環，因為每一完整循環包含50％的時間的開啟，然後50％的時間的關閉。可以改變此預設比率，以更改超音波能量與休止間隔的比率。舉例而言，给定40：60的比率，40％導致40毫秒的開啟，而60毫秒導致60毫秒的關閉。何時偏好較高或較低的工作循環？答案取決於手術的階段。為了雕刻水晶體核（例如，利用分治技術），外科醫生需要遞送足夠能量以能夠切割凹槽。這需要約40％至60％的工作循環。一旦外科醫生在水晶體核中放置凹槽並達到四分之一圓周的裂紋，則可以在四分之一圓周的超音波乳化輔助抽吸期間使用較低的工作循環。對於此四分之一圓周的移除，可以使用20％至40％的較低工作循環，因為抽吸的主要力係為流體，而不是超音波。Duty cycle and duty cycle recommendations may include, for example, selection for a mode (eg, a pulsed mode) that alternates crystal emulsification power pulses with rest periods, with a preset ratio of 50:50. This is called a 50% duty cycle because each full cycle consists of 50% of the time on and then 50% of the time off. This preset ratio can be altered to change the ratio of ultrasonic energy to rest interval. For example, given a 40:60 ratio, 40% results in 40ms on, and 60ms results in 60ms off. When to prefer a higher or lower duty cycle? The answer depends on the stage of the surgery. To sculpt the lens nucleus (eg, using the divide and conquer technique), the surgeon needs to deliver enough energy to be able to cut the groove. This requires about 40% to 60% duty cycle. Once the surgeon has placed a groove in the lens nucleus and reached a quarter-circle fissure, a lower duty cycle can be used during quarter-circle phaco-assisted aspiration. For this quarter-circle removal, a lower duty cycle of 20% to 40% can be used because the main force of suction is fluid, not ultrasound.

實例20Example 20

在實施例中，例如當雷射切割材料的尺寸小於超音波乳化抽吸針開口的尺寸時，超音波乳化子系統僅用於分離雷射切割材料。In an embodiment, for example when the size of the laser cut material is smaller than the size of the phacoemulsification needle opening, the phacoemulsification subsystem is only used to separate the laser cut material.

實例21Example 21

雷射超音波系統（更特定為毫微微超音波乳化系統）具有整合顯微鏡。Laser ultrasound systems (more specifically femto phacoemulsification systems) have integrated microscopes.

實例22Example 22

配接器係用於超音波乳化毫微微系統的殼體中，以適配或使用多個公司或類型的超音波乳化包及超音波乳化盒。配接器具有必需的硬體配接器及軟體，以提供系統的完整、有效、且經批准的操作。配接器可以是殼體的一部分，可以是殼體的單獨***件或部件，或者可以是盒的一部分或與盒整合。Adapters are used in the housing of the sonication femto system to fit or use multiple companies or types of sonication packs and sonication boxes. Adapters have the necessary hardware adapters and software to provide complete, efficient, and approved operation of the system. The adapter may be part of the housing, may be a separate insert or component of the housing, or may be part of or integrated with the cartridge.

實例23Example 23

轉至第6圖，圖示雷射超音波系統的平面圖（更特定為經定位以用於執行雷射超音波治療程序的毫微微超音波乳化系統）的平面圖。毫微微超音波乳化系統610係利用頭側位置與頭上位置之間的角度進行定位。雷射遞送頭可以延伸至患者，以執行雷射手術，並且可以如箭頭620所示從患者移開，以進行超音波程序。頭枕612與患者支撐件613係相對於毫微微超音波乳化系統進行定位。系統與患者支撐件具有定位系統（例如，電磁定位系統），其決定相對於患者頭枕及患者的雷射系統的角度630、角度630a、或兩者。所測量的角度係為在臂的縱向軸線631與患者（更特定為由頭枕決定的患者的頭部）的縱向軸線632之間的角度。Turning to Figure 6, illustrated is a plan view of a laser ultrasound system, more particularly a plan view of a femto phacoemulsification system positioned for use in performing a laser ultrasound treatment procedure. The femto phacoemulsification system 610 is positioned using the angle between the cranial position and the supracephalic position. The laser delivery head can be extended to the patient to perform laser surgery and removed from the patient as indicated by arrow 620 to perform ultrasound procedures. The headrest 612 and patient support 613 are positioned relative to the femto phacoemulsification system. The system and patient support have a positioning system (eg, an electromagnetic positioning system) that determines an angle 630, an angle 630a, or both relative to the patient headrest and the patient's laser system. The angle measured is the angle between the longitudinal axis 631 of the arm and the longitudinal axis 632 of the patient (more specifically the patient's head as determined by the headrest).

圖示外科醫生的三個位置，頭上641及頭側642、642。可以看出，無論外科醫生對於位置的偏好如何，雷射臂都不會干擾程序。Three positions of the surgeon are shown, cephalad 641 and cephalad 642, 642. As can be seen, the laser arm did not interfere with the procedure, regardless of the surgeon's preference for location.

此外，可以輕易且容易地將雷射頭重新定位以在患者的兩隻眼睛上進行並執行雷射程序，而不需要重新定位患者支撐件或毫微微超音波乳化系統的位置。Furthermore, the laser head can be easily and easily repositioned to perform and perform laser procedures on both eyes of the patient without requiring repositioning of the patient support or the femtophacoemulsification system.

在實施例中，雷射系統可以經定位以具有約30度至約320度的角度630，以及在此範圍內的任何角度。針對此角度的唯一限制係為患者支撐件所在的區域。外科醫生能夠定位於頭上或任一頭側位置等。In an embodiment, the laser system may be positioned to have an angle 630 of about 30 degrees to about 320 degrees, and any angle within this range. The only limit to this angle is the area where the patient support is located. The surgeon can position on the head or in either cephalic location, etc.

實例24Example 24

轉至第7圖，圖示這些可能配置與外科醫生位置中的幾種，所有這些都提供外科醫生的完整進出路徑。針對這些配置中之每一者，此完整進出路徑係針對患者的任一眼睛。因此，雷射超音波系統610可以位於：45度角656、90度角（亦即，頭側）855、135度角654、180度角（亦即，頭上）653、225度角852、270角度（亦即，頭側）851、及315度角650。應理解，雷射超音波系統可以位於圖式中所示的任何角度位置。因此，提供圍繞患者的眼睛中之每一者的完整定位（例如，雷射超音波系統的「時鐘形」）。Turning to Figure 7, several of these possible configurations and surgeon positions are illustrated, all of which provide the surgeon's complete access path. For each of these configurations, this complete access path is for either eye of the patient. Thus, the laser ultrasound system 610 may be located at: 45 degree angle 656, 90 degree angle (ie, head side) 855, 135 degree angle 654, 180 degree angle (ie, overhead) 653, 225 degree angle 852, 270 Angle (ie, head side) 851 , and angle 650 of 315 degrees. It should be understood that the laser ultrasound system can be located at any of the angular positions shown in the figures. Thus, complete positioning around each of the patient's eyes is provided (eg, the "clock shape" of the laser ultrasound system).

實例25Example 25

第8圖係為用於本系統的雷射遞送頭的沙姆形狀及位置決定組件的實施例。此實施例係為5相機配置，其中相機間隔40度。此放置允許系統以實例23及24的任何配置進行操作。即使在一些配置中並且針對一些患者而言，一個或兩個相機可能被阻擋，但該系統仍然進行操作並針對決定形狀及位置提供可靠的圖像。Figure 8 is an example of a sham shape and position determining element for a laser delivery head of the present system. This embodiment is a 5-camera configuration, where the cameras are spaced 40 degrees apart. This placement allows the system to operate in any configuration of instances 23 and 24. Even though in some configurations and for some patients, one or both cameras may be blocked, the system still operates and provides reliable images for shape and position determination.

實例26Example 26

第9圖係為用於本系統的雷射遞送頭的沙姆形狀及位置決定組件的實施例。此實施例係為6相機配置，其中相機間隔40度。此放置允許系統以實例23及24的任何配置進行操作。即使在一些配置中並且針對一些患者而言，一個、兩個、或三個相機可能被阻擋，但該系統仍然進行操作並針對決定形狀及位置提供可靠的圖像。Fig. 9 is an embodiment of a sham shape and position determining element for a laser delivery head of the present system. This embodiment is a 6-camera configuration, where the cameras are spaced 40 degrees apart. This placement allows the system to operate in any configuration of instances 23 and 24. Even though in some configurations and for some patients, one, two, or three cameras may be blocked, the system still operates and provides reliable images for determining shape and position.

實例27 轉至第10A圖及第10B圖，圖示具有對接系統的近側雷射組件的透視圖的不同角度視圖。在第10B圖中，移除頭的外罩，而展示沙姆相機（例如，1001a）。近側雷射組件1000係附接至臂1040的近端，臂1040係為容納操作期間的治療雷射束路徑與雷射束的光管路。組件1000具有自動對接系統1010，自動對接系統1010具有驅動組件1011，驅動組件1011連接至對接環1020，對接環1020對接至PID並形成PID的一部分。對接系統1010較佳為藉由控制系統進行控制，並且可以藉由外科醫生使用操縱桿來進行全部或部分操作。控制系統亦控制對接系統的操作，並且可以具有負載感測器、速度控制、及其他安全及控制系統。 Example 27 Turning to Figures 10A and 10B, different angled views of perspective views of a proximal laser assembly with a docking system are shown. In Figure 10B, the cover of the head is removed and the Sham camera (eg, 1001a) is shown. The proximal laser assembly 1000 is attached to the proximal end of the arm 1040, which is the light conduit that accommodates the therapeutic laser beam path and laser beam during operation. Assembly 1000 has an automated docking system 1010 having a drive assembly 1011 connected to a docking ring 1020 that interfaces to and forms part of the PID. The docking system 1010 is preferably controlled by a control system and may be operated in whole or in part by a surgeon using a joystick. The control system also controls the operation of the docking system and may have load sensors, speed control, and other safety and control systems.

實例28Example 28

用於本系統及治療中的治療雷射束的實施例具有高品質的束特性。雷射束的M 2因子可以是1至約2.5、少於2、少於1.5、及少於1.2。 Embodiments of the therapeutic laser beam used in the present system and therapy have high quality beam characteristics. The M2 factor of the laser beam can be 1 to about 2.5, less than 2, less than 1.5, and less than 1.2.

實例29Example 29

在本系統的實施例中，包括解除雷射的對接，將雷射臂移開，並使超音波乳化工具可以用於***（在實施例中亦包括將超音波乳化工具***眼睛）的從毫微微到超音波乳化的轉換可能需要少於5分（分鐘）、少於4分、3分及更少、2分及更少、約3至5分、約3至4分、約2分至4分、及更長或更短的時間。In an embodiment of the present system, a millisecond includes disengaging the laser, removing the laser arm, and making the phacoemulsification tool available for insertion (in this embodiment also including insertion of the phacoemulsification tool into the eye). Conversion from pico to phacoemulsification may take less than 5 minutes (minutes), less than 4 minutes, 3 minutes and less, 2 minutes and less, about 3 to 5 minutes, about 3 to 4 minutes, about 2 to 2 minutes 4 points, and longer or shorter.

實例30Example 30

在實施例中，針對具有32x22英吋的佔地面積的毫微微超音波乳化系統，床佈置自由度允許將裝置定位於6呎3吋及更短的患者周圍的任何位置。此系統提供真正靈巧的系統。此靈巧的系統可以針對外科醫生提供圍繞每一眼睛的雷射的完整時鐘形以及頭側以及頭上的方式。In an embodiment, for a femto phacoemulsification system with a 32x22 inch footprint, the couch arrangement freedom allows the device to be positioned anywhere around a patient 6 feet 3 inches and shorter. This system provides a truly nimble system. This ingenious system can provide the surgeon with a complete clock shape of the laser around each eye as well as a cephalic and on-cephalic approach.

實例31Example 31

各種實施例（例如，實例的實施例）的與雷射系統相關的部件係用於獨立式雷射系統中，獨立式雷射系統沒有整合在一起的超音波乳化系統。The laser system-related components of the various embodiments (eg, example embodiments) are used in stand-alone laser systems that are not integrated into a phacoemulsification system.

實例32Example 32

在這些裝置的實施例中，地板區域佔地面積（亦即，由外殼體形成的裝置外殼）係為5平方英呎（22英吋x33英吋=726平方英呎/144=5平方英呎）。此裝置的高度係為57英吋至65英吋。雷射臂及其光學頭主要為水平移動。臂不會環繞樞軸點旋轉。在儲存時，臂完全適配於裝置外殼（亦即，22英吋x33英吋）內。針對標稱位置的初始設定，雷射臂及其光學頭係在「X」上行進最大的33英吋。一旦處於標稱位置，則運動平台可以在X上移動+/-2英吋，在Y上移動+/-2英吋，在Z上移動+5/-3英吋，以針對患者進行精細調整。（本實例所使用的X係為裝置的長軸，Y係為裝置的橫向軸，Z係為裝置的垂直軸。）  因此，在此實施例中，臂在X及Y上移動，而使得在儲存時手臂及其光學頭完全適配於裝置佔地面積內。殼體係為不可調整，因此其寬度及橫向尺寸不會改變。In these device embodiments, the floor area footprint (ie, the device enclosure formed by the outer shell) is 5 square feet (22 inches x 33 inches = 726 square feet/144 = 5 square feet ). The height of this device is 57 inches to 65 inches. The laser arm and its optical head mainly move horizontally. The arm does not rotate around the pivot point. When stored, the arms fit completely within the device housing (ie, 22 inches x 33 inches). For the initial setting of the nominal position, the laser arm and its optical head travel a maximum of 33 inches on the "X". Once in the nominal position, the motion platform can move +/-2 inches in X, +/-2 inches in Y, and +5/-3 inches in Z for fine adjustment to the patient . (As used in this example, X is the long axis of the device, Y is the lateral axis of the device, and Z is the vertical axis of the device.) Therefore, in this embodiment, the arm moves in X and Y such that in The arm and its optical head fit completely within the device footprint when stored. The shell system is not adjustable, so its width and lateral dimensions do not change.

實例33Example 33

轉至第14圖，圖示毫微微超音波乳化系統1400的實施例的透視圖。第15圖、第15A圖、第15B圖、第16A圖、第16B圖、第16C圖、第17A圖、第17B圖、第17C圖圖示第14圖的系統的各種部件及配置。在這些圖式中，相同數字表示相同部件。Turning to FIG. 14, a perspective view of an embodiment of a femto phacoemulsification system 1400 is illustrated. Figures 15, 15A, 15B, 16A, 16B, 16C, 17A, 17B, 17C illustrate various components and configurations of the system of Figure 14. In these figures, the same numerals refer to the same parts.

毫微微超音波乳化雷射系統1400具有用於形成系統1400的底座1403的殼體1401。移動機構殼體1402係位於底座1403上方，並附接至殼體1401。殼體1402包含用於可伸出組件1409的用於水平移動的機構（亦即，伸出及縮回）。轉換滑動平台1410係藉由水平移動機構1420伸出及縮回。轉換滑動平台1410支撐光學組件及掃描器殼體1406。此殼體1406亦包含垂直移動機構1425以及垂直移動轉換滑動平台1411。Femto phacoemulsification laser system 1400 has a housing 1401 that forms a base 1403 of system 1400 . The moving mechanism housing 1402 is positioned above the base 1403 and is attached to the housing 1401 . Housing 1402 includes a mechanism for horizontal movement (ie, extending and retracting) for extendable component 1409 . The conversion sliding platform 1410 is extended and retracted by the horizontal movement mechanism 1420 . Transition slide platform 1410 supports optical assemblies and scanner housing 1406 . The casing 1406 also includes a vertical movement mechanism 1425 and a vertical movement conversion sliding platform 1411 .

可伸出組件1409包括殼體1406、臂1407、及雷射束遞送頭1408，臂1407包含系統的各種光學路徑以及控制電纜。雷射束遞送頭1408包括形狀及位置決定設備1412及PID 1470。The extendable assembly 1409 includes a housing 1406, an arm 1407 that contains the various optical paths and control cables of the system, and a laser beam delivery head 1408. Laser beam delivery head 1408 includes shape and position determination device 1412 and PID 1470.

在第17圖中，圖示具有一個監視器1413的系統1400。系統可以具有一個或兩個附加的監視器（如第16A圖至第16C圖所示）。系統可以具有整合顯微鏡（在這些圖式中未圖示）。In Figure 17, a system 1400 with one monitor 1413 is illustrated. The system can have one or two additional monitors (as shown in Figures 16A-16C). The system may have an integrated microscope (not shown in these figures).

在第15圖中，圖示附接至轉換滑動平台1410的可伸出組件1409。平台1410具有可伸出/可縮回底座1424以及柔性可伸出/可縮回外罩1422。平台1410提供組件1409的水平移動。平台1410係定位於殼體1402內，並且部分形成該殼體的頂表面。殼體1402係附接至殼體1401。In Figure 15, the extendable assembly 1409 attached to the conversion slide platform 1410 is shown. The platform 1410 has an extendable/retractable base 1424 and a flexible extendable/retractable cover 1422 . Platform 1410 provides horizontal movement of assembly 1409. Platform 1410 is positioned within housing 1402 and forms part of the top surface of the housing. Housing 1402 is attached to housing 1401 .

轉至第15A圖以及第15圖，水平移動機構1420係包含在殼體1402內。機構1420可以直接附接至殼體1402、殼體1401、及這些的組合及變化。殼體1402亦包含用於托持（亦即，捲繞及鬆開）柔性外罩1422的捲軸1423。殼體1402亦包含輥1421，柔性外罩1422係在輥1421上方進行移動。Turning to FIGS. 15A and 15 , the horizontal movement mechanism 1420 is contained within the housing 1402 . Mechanism 1420 may be attached directly to housing 1402, housing 1401, and combinations and variations of these. The housing 1402 also includes a reel 1423 for holding (ie, winding and unwinding) the flexible housing 1422 . Housing 1402 also includes rollers 1421 over which a flexible cover 1422 is tied for movement.

第15A圖圖示水平移動機構1420，其中外罩1402被移除。機構1420具有馬達、驅動機構、感測器、及控制。機構1420具有水平滑動機構1426，水平滑動機構1426係為一者在另一者內側的一對滑動軌道。支撐件1428將內部軌道與垂直滑動機構1427連接，其中滑動機構形成垂直移動機構1425的一部分（參見第15圖）。第15B圖圖示處於第一伸出位置的第15A圖的軌道組件，第一伸出位置係為用於進行雷射操作的位置。Figure 15A illustrates the horizontal movement mechanism 1420 with the cover 1402 removed. Mechanism 1420 has motors, drive mechanisms, sensors, and controls. The mechanism 1420 has a horizontal sliding mechanism 1426, which is a pair of sliding rails with one inside the other. Supports 1428 connect the inner rail with a vertical slide mechanism 1427, which forms part of a vertical movement mechanism 1425 (see Figure 15). Fig. 15B shows the track assembly of Fig. 15A in a first extended position, which is the position for laser operation.

第16A圖係為具有3個監視器的第14圖的系統1400的平面圖。系統1400係位於手術室或患者治療室中。系統1400處於完全縮回（例如，停放）的位置。在停放位置中，可伸出組件1409不會從底座1403伸出。因此，在此位置中，可伸出組件1409不會延伸超出系統的佔地面積或外殼（虛線1480）內（亦即，完全在內側）。相對於患者床1490及人來圖示系統1400。Figure 16A is a plan view of the system 1400 of Figure 14 with three monitors. System 1400 is located in an operating room or patient treatment room. The system 1400 is in a fully retracted (eg, parked) position. In the parked position, the extendable assembly 1409 does not extend from the base 1403 . Thus, in this position, the extendable component 1409 does not extend beyond the footprint or housing (dashed line 1480 ) of the system (ie, completely inside). The system 1400 is illustrated with respect to a patient bed 1490 and a person.

第16B圖圖示處於伸出位置（第一位置或第一伸出位置）的用於執行治療雷射操作的系統。儘管利用相對於患者90度的定向角度圖示系統，但應理解，此系統可以利用任何角度相對於患者進行定位。舉例而言，此系統可以利用實例23及24的任何角度進行定位。可伸出組件1409水平延伸超過系統的殼體，以將雷射頭定位在患者上方。Figure 16B illustrates the system for performing a therapeutic laser procedure in an extended position (either the first position or the first extended position). Although the system is illustrated with an orientation angle of 90 degrees relative to the patient, it should be understood that the system may be positioned relative to the patient using any angle. For example, the system can utilize any angle of instances 23 and 24 for positioning. Extendable assembly 1409 extends horizontally beyond the housing of the system to position the laser head over the patient.

第16C圖圖示處於完全伸出位置的用於執行治療雷射操作的系統。利用與患者成135度的定向角度來圖示系統。完全伸出的位置使系統的殼體維持距離患者足夠遠，以提供從業者與患者之間的適當、舒適、及符合人體工程學的進出路徑。可伸出組件1409水平延伸超過系統的殼體，以將雷射頭定位在患者上方。將第16C圖與第16B圖進行比較，圖示第16C圖的完全伸出位置的組件1409比第16B圖的第一伸出位置更長（亦即，雷射頭更遠離底座）。Figure 16C illustrates the system for performing a therapeutic laser procedure in a fully extended position. The system is illustrated with an orientation angle of 135 degrees from the patient. The fully extended position maintains the housing of the system far enough from the patient to provide a proper, comfortable, and ergonomic entry and exit path between the practitioner and the patient. Extendable assembly 1409 extends horizontally beyond the housing of the system to position the laser head over the patient. Comparing Fig. 16C with Fig. 16B, the assembly 1409 is shown in the fully extended position of Fig. 16C is longer (ie, the laser head is further away from the base) than the first extended position of Fig. 16B.

第17A圖至第17C圖係為一系列照片，展示第14圖的系統的可伸縮組件在伸出及縮回時的特定位置。第17A圖圖示用於雷射系統的測試及校準的中性伸出位置。第17B圖圖示用於治療雷射操作的第一操作伸出位置。第17C圖圖示用於治療雷射操作的第二操作伸出位置（完全伸出）。Figures 17A-17C are a series of photographs showing specific positions of the retractable components of the system of Figure 14 when extended and retracted. Figure 17A illustrates the neutral extension position for testing and calibration of the laser system. FIG. 17B illustrates the first operating extended position for the therapeutic laser operation. Figure 17C illustrates the second operating extended position (fully extended) for the therapeutic laser operation.

因此，系統可以具有四個預先決定的位置。在停放位置中，雷射頭及可伸出組件係位於裝置的佔地面積內。在中間位置中，只有雷射頭水平延伸超過裝置的佔地面積。在第一伸出位置中，可以針對患者進行雷射治療活動。在第二或完全伸出位置中，可以針對患者進行雷射治療活動。可以藉由停止件、基於機械、基於控制軟體、及這些的組合及變化來控制四個預先決定的位置。系統亦可以經配置以具有從中間到完全伸出的任意數量的其他伸出長度（係為預先決定的或單獨由操作者所決定的，以及這些的組合及變化）。Thus, the system can have four predetermined positions. In the parked position, the laser head and extendable components are located within the footprint of the device. In the intermediate position, only the laser head extends horizontally beyond the footprint of the device. In the first extended position, a laser therapy activity can be performed on the patient. In the second or fully extended position, laser therapy activities can be performed on the patient. The four predetermined positions can be controlled by stops, mechanical based, control software based, and combinations and variations of these. The system may also be configured to have any number of other extension lengths (predetermined or determined by the operator alone, and combinations and variations of these) from intermediate to full extension.

殼體包含功率部件、控制部件、操作部件、分析預測及診斷裝置、位置決定及定位裝備、雷射束產生部件、及超音波產生部件。在較佳實施例中，超音波產生部件係為超音波晶體乳化系統的部件，而雷射束產生部件提供具有約2ps及更短的脈衝長度的雷射束。The housing includes power components, control components, operating components, analysis, prediction and diagnostic devices, position determination and positioning equipment, laser beam generating components, and ultrasonic generating components. In a preferred embodiment, the ultrasonic generating component is a component of an ultrasonic crystal emulsification system, and the laser beam generating component provides a laser beam having a pulse length of about 2 ps and less.

這些部件可能由於以下原因而全部或部分地分佈在兩個殼體1401、1402之間：為了最佳化空間，為了避免部件之間的干擾，為了管理熱及振動，以及為了提供系統1400的更有效控制及操作。兩個殼體1401、1402可以是在相同的底座或框架上的獨立殼體，可以在其間具有通訊、控制、功率、光學、及其他連接，可以是單一相同的殼體，可以細分或劃分成第三或第四等殼體或子殼體，以及這些的組合及變化。These components may be distributed, in whole or in part, between the two housings 1401 , 1402 for the following reasons: to optimize space, to avoid interference between components, to manage heat and vibration, and to provide greater flexibility to the system 1400 Effective control and operation. The two housings 1401, 1402 may be separate housings on the same base or frame, may have communications, control, power, optics, and other connections therebetween, may be a single identical housing, may be subdivided or divided into A third or fourth class housing or sub-housing, and combinations and variations of these.

連接器1505係為將殼體1401與殼體1406連接的光學導管。殼體1406包含用於治療雷射束的掃描裝置及束成形光學裝置，其中掃描裝置、光學裝置、及兩者均可以用於監視及診斷雷射束及光學路徑。（殼體1406亦包含垂直移動機構。）  應理解，在實施例中，殼體1406的這些部件可以全部或部分地位於另一殼體中的一個，並且同樣地，來自另一殼體的部件可以位於殼體1406中。殼體1406可以細分或劃分成一或更多個殼體或子殼體，以及這些的組合及變化。在當前較佳實施例中，殼體1406包含並隔離掃描器及束成形光學裝置。掃描器及束成形光學裝置或可能包含在殼體1406中的其他部件係與系統1400的控制器及操作系統進行控制通訊。裝置可以彼此直接進行控制通訊，或者可以彼此間接進行控制通訊（例如藉由與中心（例如，可能亦具有控制能力的系統1400控制器、監視器1413）進行控制通訊），以及這些的組合及變化。這些裝置亦可以彼此直接及間接進行控制通訊。Connector 1505 is an optical conduit connecting housing 1401 to housing 1406 . Housing 1406 contains a scanning device and beam shaping optics for the treatment laser beam, where the scanning device, optics, and both can be used to monitor and diagnose the laser beam and optical path. (The housing 1406 also contains a vertical movement mechanism.) It should be understood that in embodiments, these components of the housing 1406 may be located in whole or in part in one of the other housings, and likewise, components from the other housing Can be located in housing 1406 . Housing 1406 may be subdivided or divided into one or more housings or sub-housings, as well as combinations and variations of these. In the presently preferred embodiment, housing 1406 contains and isolates the scanner and beam shaping optics. The scanner and beam shaping optics or other components that may be included in housing 1406 are in control communication with the controller and operating system of system 1400 . Devices may control control communication directly with each other, or may control control communication indirectly with each other (eg, by control communication with a central (eg, system 1400 controller, monitor 1413, which may also have control capabilities)), and combinations and variations of these . These devices can also control communication directly and indirectly with each other.

光學導管1405可以是光管路（例如，具有內部反射表面的中空管或通道，而使得雷射束發射通過中空管內的自由空間，而中空管內的自由空間可以具有部分真空，具有環境中的空氣，包含惰性氣體，及這些的組合及變化）、鉸接式光管路、伸縮式光管路、柔性光管路、光纖、一或更多個光纖、中空導管、束導引器，以及這些及其他雷射束傳輸結構的組合及變化。Optical conduit 1405 may be an optical conduit (eg, a hollow tube or channel with an internally reflective surface such that the laser beam is emitted through free space within the hollow tube, which may have a partial vacuum, with ambient air, including noble gases, and combinations and variations of these), articulated light pipes, retractable light pipes, flexible light pipes, optical fibers, one or more optical fibers, hollow conduits, beam guides , as well as combinations and variations of these and other laser beam delivery structures.

殼體1406係附接至臂1407。臂1407及殼體1406係藉由垂直移動機構1425沿著垂直方向移動。臂1407具有用於決定眼睛的形狀及位置以及眼睛內的結構的組件或裝置1412。臂1407的近端（亦即，沿著雷射束路徑最遠的端部，而因此距離雷射束源最遠，並且位於裝置1412下方）具有患者介面裝置（PID）1470。殼體1406具有監視器1413。監視器可以在例如關節臂上移動。監視器可以提供資訊（例如，程序、系統狀況、雷射狀態、超音波狀態、白內障密度、超音波設定、雷射圖案設定），並且可以接收外科醫生的輸入及指令。監視器係與系統1400控制系統進行控制通訊，監視器亦可以包含系統1400控制系統的一部分或全部。監視器透過系統1400控制系統、透過監視器1413、及這些的組合及變化直接與雷射控制系統及超音波控制系統進行控制通訊。監視器及其關節臂可以位於系統1400中的其他結構上，亦可以單獨設置。可以使用一個、兩個、及額外的監視器。監視器可以具有3D查看或顯示功能。Housing 1406 is attached to arm 1407 . The arm 1407 and the housing 1406 are moved in the vertical direction by the vertical movement mechanism 1425 . The arm 1407 has components or devices 1412 for determining the shape and position of the eye and structures within the eye. The proximal end of arm 1407 (ie, the end furthest along the path of the laser beam, and thus furthest from the laser beam source, and below device 1412 ) has a patient interface device (PID) 1470 . The housing 1406 has a monitor 1413 . The monitor can be moved eg on an articulated arm. The monitor can provide information (eg, procedures, system status, laser status, ultrasound status, cataract density, ultrasound settings, laser pattern settings) and can receive input and commands from the surgeon. The monitor is in control communication with the control system of the system 1400 , and the monitor may also include a part or all of the control system of the system 1400 . The monitor controls the system through the system 1400, controls the system through the monitor 1413, and combinations and variations of these, in direct control communication with the laser control system and the ultrasonic control system. The monitor and its articulated arm may be located on other structures in the system 1400, or may be provided separately. One, two, and additional monitors can be used. Monitors can have 3D viewing or display capabilities.

臂1407形成或包含雷射束傳輸結構（例如，中空管），以提供用於雷射束的傳送的自由空間。在實施例中，臂1407可以包含自由空間中的光束路徑，或者用於將雷射束發送至例如掃描器的光纖，光纖位於管的近端而不是遠端（亦即，靠近殼體1406的端部）。臂1407亦可以是或包含描述用於光學導管1405的類型的雷射束傳輸結構。管亦可以包含光學裝置。在第14圖的實施例中，臂1407包含非準直的雷射束，而因此臂1407可以指稱為包含非準直的雷射束及雷射束路徑，換言之，臂1407沿著雷射束路徑包含、圍繞、或容納「非準直空間」。臂1407可以容納或圍繞準直空間，準直空間係為雷射束路徑上的雷射束進行準直的空間。其可以容納包含光學裝置的空間。其可以容納準直及非準直的空間。實施例中的臂1407可以從遠端樞轉、旋轉、伸縮、鉸接、及這些的組合及變化。臂1407中的雷射束路徑的近端包含鏡或光學裝置，以將雷射束引導通過PID，並到達及進入患者的眼睛。Arm 1407 forms or contains a laser beam delivery structure (eg, a hollow tube) to provide free space for delivery of the laser beam. In an embodiment, the arm 1407 may contain a beam path in free space, or an optical fiber used to send the laser beam to, for example, a scanner, the optical fiber being located at the proximal end of the tube rather than the distal end (ie, near the housing 1406 ). Ends). Arm 1407 may also be or include a laser beam delivery structure of the type described for optical conduit 1405. The tube may also contain optics. In the embodiment of FIG. 14, arm 1407 includes a non-collimated laser beam, and thus arm 1407 may be referred to as including a non-collimated laser beam and a laser beam path, in other words, arm 1407 along the laser beam Paths contain, surround, or accommodate "non-collimated spaces". The arm 1407 can accommodate or surround a collimation space, which is the space in which the laser beam on the laser beam path is collimated. It can accommodate space containing optics. It can accommodate both collimated and non-collimated spaces. The arm 1407 in an embodiment may be distally pivotable, swivel, telescoping, articulating, and combinations and variations of these. The proximal end of the laser beam path in arm 1407 contains mirrors or optics to direct the laser beam through the PID and to and into the patient's eye.

實例34Example 34

在實施例中，雷射系統具有外部、內部、或兩者的冷卻。In embodiments, the laser system has external, internal, or both cooling.

實例35Example 35

轉至第12A圖至第12J圖，圖示PID（患者介面裝置），該PID係附接至本雷射超音波系統中之任一者並與其一起使用，並且亦與獨立式雷射系統一起使用。在第12A圖至第12J圖中，相同數字係對應於相同結構。如第12A圖至第12J圖所示，此實例中的PID 1200的實施例具有以下部件： 1201：PID臂 1202：上部窗口 1204：目鏡 1204a：目鏡外裙部 1204b：目鏡內裙部 1205：上部環 1206：下部環 1207a：卡扣 1207b：卡扣 1207c：卡扣 1208a：緩衝器 1208b：緩衝器 1208c：緩衝器 1209：彎月形反向器 1210：儲液環 1211：上部環側壁 1212：鹽水填充通道 1213：真空埠 1220：附接方塊 1221：臂 1221a：臂的鎖定位置 1222：接收夾具 1223：接合球 1224：狹槽（運動狹槽） 1225：用於展示臂移動的箭頭 1226：用於展示方塊接合移動的箭頭 1250：眼睛 1260：雷射超音波裝置 Turning to Figures 12A-12J, PIDs (patient interface devices) are shown attached to and used with any of the present laser ultrasound systems, and also with the stand-alone laser system use. In FIGS. 12A to 12J, the same numerals correspond to the same structures. As shown in Figures 12A-12J, the embodiment of the PID 1200 in this example has the following components: 1201: PID Arm 1202: Upper window 1204: Eyepiece 1204a: Eyepiece Outer Skirt 1204b: Eyepiece inner skirt 1205: Upper Ring 1206: Lower Ring 1207a: Snap 1207b: Snap 1207c: Snap 1208a: Buffer 1208b: Buffer 1208c: Buffer 1209: Meniscus reverser 1210: Reservoir Ring 1211: Upper Ring Sidewall 1212: Brine Fill Channel 1213: Vacuum port 1220: Attachment Blocks 1221: Arm 1221a: Locked position of arm 1222: Receiving fixture 1223: Engagement Ball 1224: Slot (Motion Slot) 1225: Arrows used to show arm movement 1226: Arrows used to show block joint movement 1250: Eyes 1260: Laser Ultrasonic Device

此患者介面裝置係附接至眼睛，以作為單一組件。附接至雷射頭的整個裝置係定位並接合至眼睛的表面。PID臂係藉由夾具機構附接至雷射系統。The patient interface device is attached to the eye as a single component. The entire device attached to the laser head is positioned and bonded to the surface of the eye. The PID arm is attached to the laser system by a clamp mechanism.

在對接期間，將PID臂的吸取杯輕輕定位於角膜表面上方，而使得吸取環與眼睛的表面接觸，然後啟動真空以限制眼睛的相對運動，藉此穩定相對於PID的位置，以進行精確的雷射治療。During docking, the suction cup of the PID arm is gently positioned over the corneal surface so that the suction ring is in contact with the surface of the eye, then a vacuum is activated to limit relative movement of the eye, thereby stabilizing the position relative to the PID for precision of laser therapy.

PID臂上的3個球形特徵係與夾具機構上的運動狹槽特徵接合。在位置接合期間，球將彈簧力施加至PID臂。一旦PID就位，則控制桿啟動CAM機構，以將球加載到PID，並將運動安裝架進行鎖定就位。The 3 spherical features on the PID arm engage with the motion slot features on the gripper mechanism. During position engagement, the ball applies a spring force to the PID arm. Once the PID is in place, the lever activates the CAM mechanism to load the ball into the PID and lock the kinematic mount into place.

吸取杯介面或「眼睛杯介面」覆蓋眼睛的前表面並附接至眼睛。玻璃窗口定義患者介面裝置的第一平坦表面。軟體演算法所使用的第一折射表面的位置參考係用於計算從照明或雷射束所發出的光的焦點的精確位置。The suction cup interface or "eye cup interface" covers the front surface of the eye and is attached to the eye. The glass window defines a first flat surface of the patient interface device. The positional reference frame of the first refractive surface used by the software algorithm is used to calculate the exact position of the focal point of the light emitted from the illumination or laser beam.

3個卡扣係用於托持窗口。3個覆蓋成形緩衝器將窗口推動以緊密接合卡扣底切。PID臂的流體腔室係設計成具有向窗口的近側延伸的圓形壁。這允許在流體腔室填充期間流體彎月形在與窗口接觸之前進行反向。流體與窗口的適當接觸（亦即，從窗口的中心向外至周邊）有助於防止氣泡滯留於窗口下方，而氣泡可能會破壞雷射束。3 clasps are used to hold the window. 3 Overlay forming bumpers push the window to tightly engage the snap undercut. The fluid chamber of the PID arm is designed with a circular wall extending proximally of the window. This allows the fluid meniscus to reverse prior to contact with the window during fluid chamber filling. Proper fluid contact with the window (ie, from the center of the window outward to the perimeter) helps prevent air bubbles from trapping under the window, which could disrupt the laser beam.

PID臂的流體腔室係延伸至儲液環，其中來自腔室的多餘流體被排出。這亦作為屏障，以防止腔室中的鹽溶液（BSS）接觸患者皮膚，這可能導致其藉由毛細作用而排出。The fluid chamber of the PID arm extends to the reservoir ring, where excess fluid from the chamber is drained. This also acts as a barrier to prevent the saline solution (BSS) in the chamber from contacting the patient's skin, which could lead to its expulsion by capillary action.

PID臂在其底部具有柔性附接環，柔性附接環適於與患者的眼睛的前表面對接。附接環包括由矽樹脂製成的柔性環形外裙部及內裙部，在眼杯被固定時與眼睛的表面接合。內裙部及外裙部描繪用於真空連通通道的環形抽取通道。The PID arm has a flexible attachment ring at its bottom adapted to interface with the front surface of the patient's eye. The attachment ring includes flexible annular outer and inner skirts made of silicone that engage the surface of the eye when the cup is secured. The inner and outer skirts depict annular extraction passages for the vacuum communication passages.

在設計的其他態樣中，PID臂在其一側具有真空埠，真空埠係用於在環形抽取通道中產生抽取力，而使眼杯介面能夠整齊地附接至患者的眼睛。緊鄰第一埠的第二埠係連接到醫療級管，以利用鹽溶液（BSS）填充眼杯介面腔室。In other aspects of the design, the PID arm has a vacuum port on its side that is used to create an extraction force in the annular extraction channel, allowing the eyecup interface to attach neatly to the patient's eye. A second port next to the first port is connected to medical grade tubing to fill the eyecup interface chamber with saline solution (BSS).

實例35AExample 35A

轉至第13圖，圖示PID 1300的透視圖。PID 1300具有PID臂1301、上部（遠側）窗口1302、及下部（近側）玻璃窗口1303，上部（遠側）窗口1302可以是玻璃，並且較佳為針對治療雷射具有高透射率，下部（近側）玻璃窗口1303可以是玻璃，並且較佳為針對治療雷射具有高透射率。Turning to Figure 13, a perspective view of the PID 1300 is shown. The PID 1300 has a PID arm 1301, an upper (distal) window 1302, and a lower (proximal) glass window 1303, which may be glass and preferably has high transmittance for therapeutic lasers, and a lower (proximal) glass window 1303. The (proximal) glass window 1303 may be glass and preferably has high transmittance for the therapeutic laser.

實例36Example 36

轉至第18圖及第19圖，分別圖示用於直射光光學組件及路徑以及沿著例如到達眼睛的治療雷射束遞送路徑的一部分的向下管路（DTP），其中光學組件及路徑係利用相機觀看眼睛。在較佳實施例中，直射光學路徑的大部分係與DTP觀看路徑重合。Turning to Figures 18 and 19, which illustrate the direct light optics and paths, respectively, and Downward Pipeline (DTP) along a portion of the therapeutic laser beam delivery path, eg, to the eye, wherein the optics and paths Use the camera to see the eyes. In the preferred embodiment, the majority of the direct optical path coincides with the DTP viewing path.

應理解，在本說明書中標題的使用是為了清楚及參考之目的，而不是利用任何方式進行限制。因此，標題所描述的處理組成物及揭示內容應該結合包括各種實施例的整個說明書在上下文中進行閱讀。本說明書中的標題的使用不應限制本發明所提供的保護範圍。It should be understood that headings in this specification are used for the purpose of clarity and reference and are not limiting in any way. Accordingly, the process compositions and disclosures described in the headings should be read in context with the entire specification, including the various embodiments. The use of headings in this specification should not limit the scope of protection afforded by this invention.

應理解，不需要提供或解決新穎及開創性的處理、雷射操作、雷射圖案、增強及改善的視覺、或與本發明的實施例有關或相關聯的主題的其他有益特徵及性質的理論。然而，在本說明書中，提供各種理論以進一步推進該領域的技術。本說明書所提出的理論，除非另有明確說明，否則並非以任何方式限制或縮限所要求保護的發明的保護範圍。在利用本發明時，不需要或不實踐這些理論。亦應理解，本發明可以導致新的且至今未知的理論來解釋本發明的方法、雷射圖案、雷射操作、眼睛的功能、裝置、及系統的實施例的功能特徵；並且這種後來發展的理論不應限制本發明所提供的保護範圍。It should be understood that no theory is required to provide or address the novel and groundbreaking processes, laser operations, laser patterns, enhanced and improved vision, or other beneficial features and properties of the subject matter pertaining to or associated with embodiments of the present invention . However, in this specification, various theories are provided to further advance the technology in this field. The theory presented in this specification, unless expressly stated otherwise, is not intended to limit or narrow the scope of the claimed invention in any way. These theories are not required or practiced in utilizing the present invention. It is also to be understood that the present invention may lead to new and heretofore unknown theories explaining the functional characteristics of embodiments of the methods, laser patterns, laser operations, eye functions, devices, and systems of the present invention; and such subsequent developments theory should not limit the scope of protection provided by the present invention.

除了本說明書所揭示的圖式的那些實施例之外，本說明書所闡述的裝置、系統、雷射射擊圖案、活動、及操作的各種實施例亦可以與各種測量、診斷、外科、及治療雷射系統一起使用，或與其結合使用。本說明書所闡述的裝置、系統、雷射射擊圖案、活動、及操作的各種實施例可以與下列各者一起使用：將來可能開發的其他測量、診斷、外科、及治療系統：可以部分依據本說明書的教示進行修改的現有測量、診斷、外科、及治療雷射系統；以及其他類型的測量、診斷、外科、及治療系統。此外，本說明書所闡述的裝置、系統、雷射射擊圖案、活動、及操作的各種實施例可以利用不同及各種組合彼此一起使用。因此，例如本說明書的各種實施例所提供的配置可以彼此一起使用。舉例而言，根據本說明書的教示，具有A、A'、及B的實施例的部件以及具有A''、C、及D的實施例的部件可以利用各種組合彼此一起使用（例如，A、C、D、及A、A''、C、及D等）。因此，本發明所提供的保護範圍不應限制在特定實施例、實例或特定圖式中的實施例所闡述的特定實施例、配置、或佈置中。In addition to those embodiments of the drawings disclosed in this specification, the various embodiments of the devices, systems, laser shot patterns, activities, and operations set forth in this specification may also be used with various measurement, diagnostic, surgical, and therapeutic lasers. used in conjunction with or in combination with a radio system. The various embodiments of the devices, systems, laser shot patterns, activities, and operations set forth in this specification may be used with other measurement, diagnostic, surgical, and therapeutic systems that may be developed in the future: may rely in part on this specification Existing measurement, diagnostic, surgical, and therapeutic laser systems that modify the teachings of the present invention; and other types of measurement, diagnostic, surgical, and therapeutic systems. Furthermore, the various embodiments of the devices, systems, laser shot patterns, activities, and operations set forth in this specification may be used with each other in different and various combinations. Thus, configurations such as those provided by the various embodiments of this specification can be used with each other. For example, in accordance with the teachings of this specification, components of embodiments having A, A', and B and components of embodiments having A'', C, and D may be used with each other in various combinations (eg, A, C, D, and A, A'', C, and D, etc.). Therefore, the scope of protection provided by this disclosure should not be limited to the particular embodiments, configurations, or arrangements set forth in particular embodiments, examples, or embodiments in particular drawings.

在不悖離本發明的精神或基本特徵的情況下，可以利用不同於本文所具體揭示的其他形式來實施本發明。所描述的實施例在所有態樣中僅視為說明性而非限制性。The present invention may be embodied in other forms than those specifically disclosed herein without departing from the spirit or essential characteristics of the invention. The described embodiments are to be regarded in all respects only as illustrative and not restrictive.

100:系統 101:殼體 102:殼體 103:埠 104:埠 105:光學導管 106:殼體 107:臂 107a:箭頭 107b:箭頭 108:裝置 109:監視器 109a:箭頭 110:升降器裝置 120:箭頭 121:箭頭 122:箭頭 150:框架 200:系統 201:臂 202:雷射遞送頭 203:成像及定位設備 204:雷射子系統 205:超音波晶體乳化子系統 206:共同殼體 207:共同功率供應器 208:共同控制系統 209:操作者介面 210:緊急停止裝置 211:控制系統及控制器 212:控制系統及控制器 301:xy掃描器 400:光學系統 401:光學系統 402:光學系統 403:光學系統 420:遠側殼體 420a:遠側殼體 420b:遠側殼體 421:臂 421a:連接器 421b:臂 423:近側殼體 423a:雷射頭 423b:近側殼體 430:光學系統 461:瞳孔 462:瞳孔 463:瞳孔 464:瞳孔 500:系統 501:殼體 502:滑動機構 502a:箭頭 503:可移動殼體 504:臂 505:雷射遞送頭 506:位置及形狀決定設備 507:光管路 510:機構 510a:位置調整機構 511:橫向移動組件 512:固定柱 513:自由移動組件 513a:箭頭 520:板 521:板 522:馬達 523:馬達 531:橫向移動組件 610:系統 612:頭枕 613:患者支撐件 620:箭頭 630:角度 630a:角度 631:縱向軸線 632:縱向軸線 641:頭上 642:頭側 650:角 651:角 652:角 653:角 654:角 655:角 656:角 1000:組件 1001a:沙姆相機 1010:自動對接系統 1011:驅動組件 1020:對接環 1040:臂 1200:PID 1201:PID臂 1202:上部窗口 1204:目鏡 1204a:目鏡外裙部 1204b:目鏡內裙部 1205:上部環 1206:下部環 1207a:卡扣 1207b:卡扣 1207c:卡扣 1208a:緩衝器 1208b:緩衝器 1208c:緩衝器 1209:彎月形反向器 1210:儲液環 1211:上部環側壁 1212:鹽水填充通道 1213:真空埠 1220:附接方塊 1221:臂 1221a:臂的鎖定位置 1222:接收夾具 1223:接合球 1224:狹槽（運動狹槽） 1225:用於展示臂移動的箭頭 1226:用於展示方塊接合移動的箭頭 1250:眼睛 1260:雷射超音波裝置 1300:PID 1301:PID臂 1302:上部（遠側）窗口 1303:下部（近側）玻璃窗口 1400:系統 1401:殼體 1402:殼體 1403:底座 1405:光學導管 1406:殼體 1407:臂 1408:雷射束遞送頭 1409:可伸出組件 1410:轉換滑動平台 1411:垂直移動轉換滑動平台 1412:裝置 1413:監視器 1420:水平移動機構 1421:輥 1422:柔性外罩 1423:捲軸 1424:底座 1425:垂直移動機構 1426:水平滑動機構 1427:垂直滑動機構 1428:支撐件 1470:患者介面裝置（PID） 1480:虛線 1490:患者床 100: System 101: Shell 102: Shell 103: port 104: port 105: Optical catheter 106: Shell 107: Arm 107a: Arrow 107b: Arrow 108: Device 109: Monitor 109a: Arrow 110: Lifter device 120: Arrow 121: Arrow 122: Arrow 150: Frame 200: System 201: Arm 202: Laser Delivery Head 203: Imaging and positioning equipment 204: Laser Subsystem 205: Ultrasonic crystal emulsion subsystem 206: Common housing 207: Common Power Supply 208: Common Control System 209: Operator Interface 210: Emergency stop device 211: Control systems and controllers 212: Control systems and controllers 301: XY Scanner 400: Optical System 401: Optical System 402: Optical System 403: Optical System 420: Distal Housing 420a: Distal housing 420b: Distal housing 421: Arm 421a: Connector 421b: Arm 423: Proximal Housing 423a: Laser head 423b: Proximal Housing 430: Optical System 461: Pupil 462: Pupil 463: Pupil 464: Pupil 500: System 501: Shell 502: Sliding mechanism 502a: Arrow 503: Removable housing 504: Arm 505: Laser Delivery Head 506: Position and shape determine equipment 507: Light Pipe 510: Institutions 510a: Position adjustment mechanism 511: Lateral Movement Components 512: Fixed column 513: Free Movement Components 513a: Arrow 520: Board 521: Board 522: Motor 523: Motor 531: Lateral Movement Components 610: System 612: Headrest 613: Patient Support 620: Arrow 630: Angle 630a: Angle 631: Longitudinal axis 632: Longitudinal axis 641: on the head 642: head side 650: Corner 651: Corner 652: Horn 653: Horn 654: Corner 655: Corner 656: Corner 1000: Components 1001a: Sham Camera 1010: Automatic Docking System 1011: Drive Components 1020: Butt Ring 1040: Arm 1200:PID 1201: PID Arm 1202: Upper window 1204: Eyepiece 1204a: Eyepiece Outer Skirt 1204b: Eyepiece inner skirt 1205: Upper Ring 1206: Lower Ring 1207a: Snap 1207b: Snap 1207c: Snap 1208a: Buffer 1208b: Buffer 1208c: Buffer 1209: Meniscus reverser 1210: Reservoir ring 1211: Upper Ring Sidewall 1212: Brine Fill Channel 1213: Vacuum port 1220: Attachment Block 1221: Arm 1221a: Locked position of arm 1222: Receiving fixture 1223: Engagement Ball 1224: Slot (Motion Slot) 1225: Arrows used to demonstrate arm movement 1226: Arrows used to show block joint movement 1250: Eyes 1260: Laser Ultrasonic Device 1300:PID 1301: PID Arm 1302: Upper (distal) window 1303: Lower (proximal) glass window 1400: System 1401: Shell 1402: Shell 1403: Base 1405: Optical conduit 1406: Shell 1407: Arm 1408: Laser Beam Delivery Head 1409: Extendable Components 1410: Convert Sliding Platform 1411: Vertical shift transition sliding platform 1412: Device 1413: Monitor 1420: Horizontal Movement Mechanism 1421: Roller 1422: Flexible Cover 1423: Scroll 1424: Base 1425: Vertical Movement Mechanism 1426: Horizontal sliding mechanism 1427: Vertical sliding mechanism 1428: Supports 1470: Patient Interface Device (PID) 1480: dotted line 1490: Patient Bed

第1圖係為根據本發明的雷射超音波系統的實施例的透視圖。Figure 1 is a perspective view of an embodiment of a laser ultrasound system according to the present invention.

第2圖係為根據本發明的毫微微超音波乳化系統的實施例的透視圖。Figure 2 is a perspective view of an embodiment of a femto phacoemulsification system in accordance with the present invention.

第3圖係為根據本發明的毫微微超音波乳化系統的實施例的透視圖。Figure 3 is a perspective view of an embodiment of a femto phacoemulsification system according to the present invention.

第4圖係為根據本發明的用於毫微微第二雷射系統的光學系統及光學路徑的實施例以及毫微微超音波乳化系統的實施例的示意圖。FIG. 4 is a schematic diagram of an embodiment of an optical system and an optical path for a femto second laser system and an embodiment of a femto phacoemulsification system according to the present invention.

第4A圖係為治療及掃描雷射光學系統的實施例與第4圖的實施例的光學路徑的示意圖。FIG. 4A is a schematic diagram of an embodiment of the treatment and scanning laser optical system and the optical path of the embodiment of FIG. 4 .

第4B圖係為沙姆光學系統的實施例與第4圖的實施例的光學路徑的示意圖。FIG. 4B is a schematic diagram of the optical path of the embodiment of the Sham optical system and the embodiment of FIG. 4 .

第4C圖係為沿著治療雷射（沿著管路而下）光學系統的光學路徑與第4圖的實施例的光學路徑觀看的IR照相機的實施例的示意圖。FIG. 4C is a schematic diagram of an embodiment of an IR camera viewed along the optical path of the therapeutic laser (down the tubing) optical system and the optical path of the embodiment of FIG. 4 .

第4D圖係為沿著治療雷射（沿著管路而下）光學系統的光學路徑與第4圖的實施例的光學路徑觀看的彩色照相機的實施例的示意圖。FIG. 4D is a schematic diagram of an embodiment of a color camera viewed along the optical path of the therapeutic laser (down the tubing) optical system and the optical path of the embodiment of FIG. 4 .

第4E圖係為根據本發明的光學系統與路徑的實施例的示意圖。Figure 4E is a schematic diagram of an embodiment of an optical system and path according to the present invention.

第4F圖係為根據本發明的光學系統與路徑的實施例的示意圖。Figure 4F is a schematic diagram of an embodiment of an optical system and path according to the present invention.

第4G圖係為根據本發明的光學系統與路徑的實施例的示意圖。Figure 4G is a schematic diagram of an embodiment of an optical system and path according to the present invention.

第5圖係為根據本發明的系統的透視圖。Figure 5 is a perspective view of a system according to the present invention.

第5A圖係為根據本發明的系統的實施例的一部分的頂視圖。Figure 5A is a top view of a portion of an embodiment of a system according to the present invention.

第5B圖係為根據本發明的定位組件的實施例的透視圖。Figure 5B is a perspective view of an embodiment of a positioning assembly according to the present invention.

第5C圖係為根據本發明的定位組件的實施例的透視圖。Figure 5C is a perspective view of an embodiment of a positioning assembly according to the present invention.

第5D圖至第5H圖係為根據本發明的本系統的實施例的位置的側視圖。Figures 5D-5H are side views of locations of embodiments of the present system in accordance with the present invention.

第5I圖係為根據本發明的鉸接式光管路的實施例的透視圖。Figure 5I is a perspective view of an embodiment of an articulated light pipe according to the present invention.

第6圖係為根據本發明的系統的配置的實施例的頂視圖。Figure 6 is a top view of an embodiment of the configuration of the system according to the present invention.

第7圖係為根據本發明的系統的配置的實施例的頂視圖。Figure 7 is a top view of an embodiment of the configuration of the system according to the present invention.

第8圖係為根據本發明的沙姆組件的實施例的頂視圖。Figure 8 is a top view of an embodiment of a sham assembly in accordance with the present invention.

第9圖係為根據本發明的沙姆組件的實施例的頂視圖。Figure 9 is a top view of an embodiment of a sham assembly in accordance with the present invention.

第10A圖及第10B圖係為根據本發明的近端組件及對接系統的實施例的透視圖。Figures 10A and 10B are perspective views of an embodiment of a proximal assembly and docking system in accordance with the present invention.

第11圖係為人類眼睛的橫截面圖。Figure 11 is a cross-sectional view of a human eye.

第11A圖係為第11圖的眼睛的水晶體的橫截面圖。FIG. 11A is a cross-sectional view of the lens of the eye of FIG. 11. FIG.

第12A圖係為根據本發明的患者介面裝置（PID）的實施例的透視圖。Figure 12A is a perspective view of an embodiment of a patient interface device (PID) according to the present invention.

第12B圖係為第12A圖的PID的放大透視圖。Figure 12B is an enlarged perspective view of the PID of Figure 12A.

第12C圖係為第12A圖的PID的頂部透視圖。Figure 12C is a top perspective view of the PID of Figure 12A.

第12D圖係為第12A圖的PID的橫截面圖。Figure 12D is a cross-sectional view of the PID of Figure 12A.

第12E圖係為第12A圖的PID的透視圖。Figure 12E is a perspective view of the PID of Figure 12A.

第12F圖係為第12A圖的PID的橫截面圖。Figure 12F is a cross-sectional view of the PID of Figure 12A.

第12G圖係為將第12A圖的PID附接至根據本發明的雷射超音波系統的實施例的方式的透視圖。Figure 12G is a perspective view of the manner in which the PID of Figure 12A is attached to an embodiment of a laser ultrasound system according to the present invention.

第12H圖係為附接至根據本發明的雷射超音波系統的實施例的第12A圖的PID的透視圖。Figure 12H is a perspective view of the PID of Figure 12A attached to an embodiment of a laser ultrasound system in accordance with the present invention.

第12I圖係為用於將PID附接至根據本發明的雷射超音波系統的實施例的鎖定機構的實施例的透視圖。12I is a perspective view of an embodiment of a locking mechanism for attaching a PID to an embodiment of a laser ultrasound system in accordance with the present invention.

第12J圖係為從另一側觀察的第12I圖的鎖定機構的透視圖。Fig. 12J is a perspective view of the locking mechanism of Fig. 12I viewed from the other side.

第13圖係為根據本發明的PID的實施例的透視圖。Figure 13 is a perspective view of an embodiment of a PID according to the present invention.

第14圖係為根據本發明的毫微微超音波乳化系統的實施例的透視圖。Figure 14 is a perspective view of an embodiment of a femto phacoemulsification system in accordance with the present invention.

第15圖係為第14圖的毫微微超音波乳化系統的一部分的透明透視圖。FIG. 15 is a transparent perspective view of a portion of the femto phacoemulsification system of FIG. 14. FIG.

第15A圖係為第14圖的毫微微超音波乳化系統的水平及垂直移動機構的透視圖。FIG. 15A is a perspective view of the horizontal and vertical movement mechanisms of the femto phacoemulsification system of FIG. 14 .

第15B圖係為根據本發明的處於伸出位置的第15A圖的機構的透視圖。Figure 15B is a perspective view of the mechanism of Figure 15A in an extended position in accordance with the present invention.

第16A圖係為根據本發明的在手術室中且處於完全縮回位置的第14圖的系統的平面圖。Figure 16A is a plan view of the system of Figure 14 in an operating room and in a fully retracted position in accordance with the present invention.

第16B圖係為根據本發明的在手術室中且處於部分伸出的雷射操作配置（第一位置）的第14圖的系統的平面圖。16B is a plan view of the system of FIG. 14 in an operating room and in a partially extended laser operating configuration (first position) in accordance with the present invention.

第16C圖係為根據本發明的在手術室中且處於完全伸出的雷射操作配置的第14圖的系統的平面圖。16C is a plan view of the system of FIG. 14 in an operating room and in a fully extended laser operating configuration in accordance with the present invention.

第17A圖至第17C圖係為一系列照片，展示第14圖的系統的可伸縮組件在伸出及縮回時的特定位置。第17A圖圖示用於雷射系統的測試及校準的中性伸出位置。第17B圖圖示用於治療雷射操作的第一操作伸出位置。第17C圖圖示用於治療雷射操作的第二操作伸出位置（完全伸出）。Figures 17A-17C are a series of photographs showing specific positions of the retractable components of the system of Figure 14 when extended and retracted. Figure 17A illustrates the neutral extension position for testing and calibration of the laser system. FIG. 17B illustrates the first operating extended position for the therapeutic laser operation. Figure 17C illustrates the second operating extended position (fully extended) for the therapeutic laser operation.

第18圖係為根據本發明的直射光學路徑的實施例的示意圖。Figure 18 is a schematic diagram of an embodiment of a direct optical path according to the present invention.

第19圖係為根據本發明的沿著管路而下（DTP）的彩色光學路徑的實施例的示意圖。19 is a schematic diagram of an embodiment of a down-the-pipe (DTP) color optical path in accordance with the present invention.

國內寄存資訊(請依寄存機構、日期、號碼順序註記) 無 國外寄存資訊(請依寄存國家、機構、日期、號碼順序註記) 無 Domestic storage information (please note in the order of storage institution, date and number) none Foreign deposit information (please note in the order of deposit country, institution, date and number) none

100:系統 100: System

101:殼體 101: Shell

102:殼體 102: Shell

103:埠 103: port

104:埠 104: port

105:光學導管 105: Optical catheter

106:殼體 106: Shell

107:臂 107: Arm

107a:箭頭 107a: Arrow

107b:箭頭 107b: Arrow

108:裝置 108: Device

109:監視器 109: Monitor

109a:箭頭 109a: Arrow

110:升降器裝置 110: Lifter device

120:箭頭 120: Arrow

121:箭頭 121: Arrow

122:箭頭 122: Arrow

150:框架 150: Frame

Claims (66)

一種雷射系統，包含： a，一治療雷射系統，包含一殼體； b，一患者位置決定系統；包含一第一部件及一第二部件； i，該第一部件係與該治療雷射系統機械關聯； ii，該第二部件不與該治療雷射系統機械關聯，由此該第二部件獨立於該治療雷射系統，而藉此相對於該治療雷射系統自由移動；以及 iii，其中該第一部件、該第二部件、或二者經配置以決定相對於該第一部件的該第二部件的一相對位置。 A laser system comprising: a, a therapeutic laser system, comprising a housing; b, a patient position determination system; comprising a first part and a second part; i, the first component is mechanically associated with the therapeutic laser system; ii, the second component is not mechanically associated with the therapeutic laser system, whereby the second component is independent of the therapeutic laser system and thereby free to move relative to the therapeutic laser system; and iii, wherein the first part, the second part, or both are configured to determine a relative position of the second part relative to the first part. 如請求項1所述的雷射系統，其中一超音波系統係：a，容納在該治療雷射殼體內；或b，與該雷射系統整合。The laser system of claim 1, wherein an ultrasound system is: a, housed in the therapeutic laser housing; or b, integrated with the laser system. 如請求項2所述的雷射系統，其中該超音波系統係為一超音波晶體乳化系統。The laser system of claim 2, wherein the ultrasonic system is an ultrasonic crystal emulsification system. 如請求項1至3中之任一者所述的雷射系統，包含一雷射安全互鎖，由此當使用該超音波系統時無法發射該雷射。The laser system of any one of claims 1 to 3, including a laser safety interlock whereby the laser cannot be fired when the ultrasonic system is in use. 如請求項1至3中之任一者所述的雷射系統，其中該治療雷射系統係為一飛秒雷射系統。The laser system of any one of claims 1 to 3, wherein the therapeutic laser system is a femtosecond laser system. 如請求項1所述的雷射系統，其中該患者位置決定系統包含選自一A/C電磁追蹤系統、一電磁追蹤系統、陀螺儀、加速度計、及磁力計所組成的一第一群組的一裝置，或包含選自一羅盤、一雷射位置決定裝置、一音波位置決定裝置、一RFID裝置所組成的一第二群組的一裝置。The laser system of claim 1, wherein the patient position determination system comprises a first group selected from the group consisting of an A/C electromagnetic tracking system, an electromagnetic tracking system, a gyroscope, an accelerometer, and a magnetometer a device, or a device selected from a second group consisting of a compass, a laser position determination device, a sonic position determination device, and an RFID device. 如請求項1、2、3或6所述的雷射系統，其中該治療雷射系統包含從該殼體伸出的一臂。The laser system of claim 1, 2, 3, or 6, wherein the therapeutic laser system includes an arm extending from the housing. 如請求項1、2、3至6所述的雷射系統，其中該治療雷射系統包含從該殼體伸出的一臂，並且在該臂的一近端處具有一雷射遞送頭。The laser system of claims 1, 2, 3 to 6, wherein the therapeutic laser system includes an arm extending from the housing and having a laser delivery head at a proximal end of the arm. 如請求項1至3中之任一者所述的雷射系統，其中所決定的該相對位置係在二維空間或三維空間中。The laser system of any one of claims 1 to 3, wherein the determined relative position is in a two-dimensional space or a three-dimensional space. 如請求項1至3中之任一者所述的雷射系統，其中該患者決定系統的一精確度係為至少95％、至少98％、或至少99％。The laser system of any one of claims 1-3, wherein an accuracy of the patient determination system is at least 95%, at least 98%, or at least 99%. 如請求項10所述的雷射系統，其中該系統經配置以決定該臂與一患者縱向軸線的一角度，並且至少部分依據該角度來調整一治療雷射束圖案。The laser system of claim 10, wherein the system is configured to determine an angle of the arm to a patient longitudinal axis and to adjust a treatment laser beam pattern at least in part based on the angle. 如請求項17所述的雷射系統，其中該角度係決定為在±5度的精確度內、在±3度的精確度內、或在±2度的精確度內。The laser system of claim 17, wherein the angle is determined to be within an accuracy of ±5 degrees, within an accuracy of ±3 degrees, or within an accuracy of ±2 degrees. 如請求項1至3中之任一者所述的雷射系統，其中該患者位置決定系統的該第二部件係容納在一患者頭枕中。The laser system of any one of claims 1 to 3, wherein the second component of the patient position determination system is housed in a patient headrest. 如請求項1所述的雷射系統，包含一PID，且其中該PID包含一彎月形反向器及/或用於定義一真空通道及一生理鹽水通道的一臂。The laser system of claim 1, comprising a PID, and wherein the PID comprises a meniscus reverser and/or an arm for defining a vacuum channel and a saline channel. 如請求項1所述的雷射系統，包含用於定義四個瞳孔的光學裝置，且其中一雷射束路徑延伸通過該等瞳孔中的兩個。The laser system of claim 1, comprising optics for defining four pupils, and wherein a laser beam path extends through two of the pupils. 一種雷射超音波系統，包含： a，一組件，該組件包含： i，一治療雷射器，用於沿著一雷射束路徑提供一治療雷射束； ii，一超音波晶體乳化系統，用於提供治療超音波能量； b，一臂，附接至該組件； i，該臂具有一遠端及一近端，其中該遠端係附接至該組件； ii，其中該近端具有一雷射遞送頭； iii，該臂容納該雷射束遞送路徑的一部分； c，其中該組件相對於一患者位置成一角度進行定位，其中該角度係藉由該臂的一縱向軸線與一患者軸線所定義； d，其中該角度係為30度至320度。 A laser ultrasound system, comprising: a, a component that contains: i, a therapeutic laser for providing a therapeutic laser beam along a laser beam path; ii, an ultrasonic crystal emulsification system for providing therapeutic ultrasonic energy; b, an arm, attached to the assembly; i, the arm has a distal end and a proximal end, wherein the distal end is attached to the assembly; ii, wherein the proximal end has a laser delivery head; iii, the arm accommodates a portion of the laser beam delivery path; c, wherein the assembly is positioned at an angle relative to a patient position, wherein the angle is defined by a longitudinal axis of the arm and a patient axis; d, wherein the angle is 30 degrees to 320 degrees. 如請求項16所述的雷射超音波系統，其中該角度係選自45°、90°、135°、180°、225°、270°、及315°所組成的角度群組。The laser ultrasound system of claim 16, wherein the angle is selected from the group of angles consisting of 45°, 90°, 135°, 180°, 225°, 270°, and 315°. 如請求項16或17所述的雷射超音波系統，其中該臂經配置以用於環繞該組件上的一樞軸點進行弧形移動，及/或經配置以用於水平移動，由此，該臂可以從該組件伸出及縮回。The laser ultrasound system of claim 16 or 17, wherein the arm is configured for arcuate movement about a pivot point on the component, and/or is configured for horizontal movement, thereby , the arm can be extended and retracted from the assembly. 如請求項16或17所述的雷射超音波系統，其中該臂、該雷射頭、或二者經配置以用於垂直移動。The laser ultrasound system of claim 16 or 17, wherein the arm, the laser head, or both are configured for vertical movement. 如請求項16或17所述的雷射超音波系統，其中，在具有該臂的該雷射束路徑中的該雷射束係為未準直及/或在一光纖內。The laser ultrasound system of claim 16 or 17, wherein the laser beam in the laser beam path with the arm is uncollimated and/or within an optical fiber. 如請求項16所述的雷射超音波系統，包含用於定義四個瞳孔的光學裝置，且其中該雷射束路徑延伸通過該四個瞳孔。The laser ultrasound system of claim 16, comprising optics for defining four pupils, and wherein the laser beam path extends through the four pupils. 如請求項21所述的雷射超音波系統，其中在該等瞳孔處係為共軛端心（telocentric）瞳孔。The laser ultrasound system of claim 21, wherein at the pupils are conjugated telocentric pupils. 如請求項16所述的雷射超音波系統，包含用於決定相對於該組件的一患者位置的一構件。The laser ultrasound system of claim 16 including a means for determining a patient position relative to the assembly. 如請求項23所述的雷射超音波系統，其中用於決定一患者位置的該構件包含一第一部件及一第二部件；其中該第一部件係與該雷射超音波系統機械關聯；其中該第二部件並未附接至該治療雷射系統，由此該第二部件獨立於該治療雷射系統，而藉此相對於該治療雷射系統自由移動；以及其中該第一部件、該第二部件、或二者經配置以決定相對於該第一部件的該第二部件的一相對位置。The laser ultrasound system of claim 23, wherein the means for determining a patient position comprises a first component and a second component; wherein the first component is mechanically associated with the laser ultrasound system; wherein the second component is not attached to the therapeutic laser system, whereby the second component is independent of the therapeutic laser system and thereby free to move relative to the therapeutic laser system; and wherein the first component, The second part, or both, is configured to determine a relative position of the second part relative to the first part. 如請求項16、17或22中之任一者所述的雷射系統，包含一PID。The laser system of any one of claims 16, 17 or 22, comprising a PID. 如請求項25所述的雷射系統，其中該PID包含一彎月形反向器及/或用於定義一真空通道及一生理鹽水通道的一臂。The laser system of claim 25, wherein the PID includes a meniscus reverser and/or an arm for defining a vacuum channel and a saline channel. 如請求項23所述的雷射超音波系統，其中用於決定一患者位置的該構件包含選自一A/C電磁追蹤系統、一電磁追蹤系統、陀螺儀、加速度計、及磁力計所組成的一第一群組的一裝置，或包含選自一羅盤、一雷射位置決定裝置、一音波位置決定裝置、一RFID裝置所組成的一第二群組的一裝置。The laser ultrasound system of claim 23, wherein the means for determining the position of a patient is selected from the group consisting of an A/C electromagnetic tracking system, an electromagnetic tracking system, a gyroscope, an accelerometer, and a magnetometer A device of a first group, or a device selected from a second group consisting of a compass, a laser position determination device, a sonic position determination device, and an RFID device. 如請求項16所述的雷射超音波系統，其中該系統經配置以決定該臂與一患者縱向軸線的一角度，並且至少部分依據該角度來調整一治療雷射束圖案。The laser ultrasound system of claim 16, wherein the system is configured to determine an angle of the arm to a patient longitudinal axis and to adjust a treatment laser beam pattern based at least in part on the angle. 如請求項28所述的雷射超音波系統，其中該角度係決定為在±5度的精確度內、在±3度的精確度內、或在±2度的精確度內。The laser ultrasound system of claim 28, wherein the angle is determined to be within ±5 degrees of accuracy, within ±3 degrees of accuracy, or within ±2 degrees of accuracy. 如請求項24所述的雷射超音波系統，其中該患者位置決定系統的該第二部件係容納在一患者頭枕中。The laser ultrasound system of claim 24, wherein the second component of the patient position determination system is housed in a patient headrest. 如請求項16、17、21、24或27中之任一者所述的雷射超音波系統，其中雷射系統與該超音波晶體乳化系統係經整合及/或容納在一殼體內。The laser ultrasound system of any one of claims 16, 17, 21, 24 or 27, wherein the laser system and the ultrasound phacoemulsification system are integrated and/or housed in a housing. 如請求項16、17、21、24或27中之任一者所述的雷射超音波系統，包含一雷射安全互鎖，由此當使用該超音波晶體乳化系統時無法發射該雷射。The laser ultrasound system of any one of claims 16, 17, 21, 24, or 27, including a laser safety interlock whereby the laser cannot be fired while the ultrasound phacoemulsification system is in use . 如請求項16、17、21、24或27中之任一者所述的雷射超音波系統，其中該治療雷射係為一飛秒雷射。The laser ultrasound system of any one of claims 16, 17, 21, 24 or 27, wherein the therapeutic laser is a femtosecond laser. 一種雷射超音波系統，包含： a，一治療雷射器，用於沿著一雷射束路徑提供一治療雷射束； b，一超音波晶體乳化系統，用於提供治療超音波能量；以及 c，光學裝置，用於定義四個瞳孔，且其中該雷射束路徑延伸通過至少兩個瞳孔。 A laser ultrasound system, comprising: a, a therapeutic laser for providing a therapeutic laser beam along a laser beam path; b, an ultrasonic phacoemulsification system for delivering therapeutic ultrasonic energy; and c, Optical means for defining four pupils and wherein the laser beam path extends through at least two pupils. 如請求項34所述的雷射超音波系統，其中在該等瞳孔處係為共軛端心（telocentric）瞳孔。The laser ultrasound system of claim 34, wherein at the pupils are conjugated telocentric pupils. 如請求項34所述的雷射超音波系統，其中該治療雷射與該超音波晶體乳化系統係經整合及/或容納在一殼體內。The laser ultrasound system of claim 34, wherein the therapeutic laser and the ultrasound phacoemulsification system are integrated and/or housed in a housing. 如請求項34、35或36所述的雷射超音波系統，包含一雷射安全互鎖，由此當使用該超音波系統時無法發射該雷射。A laser ultrasound system as claimed in claim 34, 35 or 36, including a laser safety interlock whereby the laser cannot be fired while the ultrasound system is in use. 如請求項34、35或36中之任一者所述的雷射超音波系統，其中該治療雷射系統係為一飛秒雷射系統。The laser ultrasound system of any one of claims 34, 35 or 36, wherein the therapeutic laser system is a femtosecond laser system. 一種雷射超音波系統，包含： a，用於提供一第一及一第二治療雷射束的一構件； b，該系統具有用於定義一雷射束路徑的光學裝置； c，該第一及該第二雷射束路徑沿著該雷射束路徑行進； d，其中該第一治療雷射束具有約1500fs至約2000fs的一脈衝寬度；該系統包含用於執行利用該第一治療雷射束的一水晶體切割的一雷射束遞送圖案； e，其中該第二治療雷射束具有約200fs至約500fs的一脈衝寬度；該系統包含用於執行利用該第二治療雷射束的一角膜切割的一雷射束遞送圖案； f，一超音波晶體乳化系統，用於提供治療超音波能量。 A laser ultrasound system, comprising: a, a member for providing a first and a second therapeutic laser beam; b, the system has optics for defining a laser beam path; c, the first and the second laser beam paths travel along the laser beam path; d, wherein the first therapeutic laser beam has a pulse width of about 1500 fs to about 2000 fs; the system includes a laser beam delivery pattern for performing a crystal cut with the first therapeutic laser beam; e, wherein the second treatment laser beam has a pulse width of about 200 fs to about 500 fs; the system includes a laser beam delivery pattern for performing a corneal ablation with the second treatment laser beam; f, An ultrasonic phacoemulsification system for delivering therapeutic ultrasonic energy. 如請求項39所述的雷射超音波系統，其中該第一雷射束與該第二雷射束中之至少一者的一波長係為1030nm。The laser ultrasound system of claim 39, wherein a wavelength of at least one of the first laser beam and the second laser beam is 1030 nm. 如請求項39至40中之任一者所述的雷射超音波系統，其中該重複率係為320kHz或更少。The laser ultrasound system of any one of claims 39 to 40, wherein the repetition rate is 320 kHz or less. 一種雷射超音波系統，包含： a，一治療雷射系統； b，一超音波晶體乳化系統，用於提供治療超音波能量；以及 c，一安全互鎖，由此當該超音波晶體乳化系統進行操作時，防止該雷射系統擊發該雷射。 A laser ultrasound system, comprising: a, a therapeutic laser system; b, an ultrasonic phacoemulsification system for delivering therapeutic ultrasonic energy; and c, a safety interlock, thereby preventing the laser system from firing the laser when the phacoemulsification system is in operation. 一種雷射超音波系統，包含： a，一治療雷射系統； b，一超音波晶體乳化系統，用於提供治療超音波能量；以及 c，一顯微鏡，整合至該系統中。 A laser ultrasound system, comprising: a, a therapeutic laser system; b, an ultrasonic phacoemulsification system for delivering therapeutic ultrasonic energy; and c, A microscope integrated into the system. 一種雷射超音波系統，包含： a，一治療雷射系統； b，一超音波晶體乳化系統，用於提供治療超音波能量；以及 c，一沙姆相機構件，用於決定一眼睛的一形狀、一位置、或二者。 A laser ultrasound system, comprising: a, a therapeutic laser system; b, an ultrasonic phacoemulsification system for delivering therapeutic ultrasonic energy; and c, A sham camera member for determining a shape, a position, or both of an eye. 如請求項44所述的雷射超音波系統，其中沙姆相機構件包含n個相機，其中至少n-1個相機在30度至320度的任何患者角度中都具有一患者的一眼睛的一無阻礙視野。The laser ultrasound system of claim 44, wherein the Sham camera member comprises n cameras, wherein at least n-1 cameras have an eye of a patient in any patient angle from 30 degrees to 320 degrees. Unobstructed view. 如請求項44所述的雷射超音波系統，其中n係為5或6。The laser ultrasound system of claim 44, wherein n is 5 or 6. 如請求項44或45所述的雷射超音波系統，其中該等相機具有至少40度的一間隔。The laser ultrasound system of claim 44 or 45, wherein the cameras have a separation of at least 40 degrees. 一種雷射超音波系統，包含： a，一第一配置，用於將依治療雷射束提供至一患者； b，一第二配置，用於在一患者上進行一超音波晶體乳化程序；以及 c，其中從該第一配置至該第二配置的該轉換花費少於5分鐘。 A laser ultrasound system, comprising: a, a first configuration for providing the therapeutic laser beam to a patient; b, a second configuration for performing an ultrasonic phacoemulsification procedure on a patient; and c, wherein the transition from the first configuration to the second configuration takes less than 5 minutes. 如請求項48所述的雷射超音波系統，其中該轉換係少於3分鐘、少於2分鐘、或少於1分鐘。The laser ultrasound system of claim 48, wherein the conversion is less than 3 minutes, less than 2 minutes, or less than 1 minute. 一種雷射超音波系統，包含： a，一組件，用於定義一佔地面積及一體積； b，該組件包含： i，一治療雷射系統；以及 ii，一超音波晶體乳化系統，用於提供治療超音波能量；以及 c，其中該佔地面積係少於1500平方英吋。 A laser ultrasound system, comprising: a, a component, used to define a footprint and a volume; b, the component contains: i, a therapeutic laser system; and ii, an ultrasonic phacoemulsification system for providing therapeutic ultrasonic energy; and c, where the footprint is less than 1500 square inches. 如請求項50所述的雷射超音波系統，其中該佔地面積係為： a，約33英吋乘以約22英吋； b，約35英吋或更少乘以約35英吋或更少； c，約35英吋或更少乘以約22英吋或更少；或者 d，約400平方英吋至約800平方英吋。 The laser ultrasound system of claim 50, wherein the footprint is: a, about 33 inches by about 22 inches; b, about 35 inches or less by about 35 inches or less; c, about 35 inches or less by about 22 inches or less; or d, about 400 square inches to about 800 square inches. 如請求項50至51中之任一者所述的雷射超音波系統，其中該體積係為： a，少於約40立方英呎； b，少於約35立方英呎； c，少於約30立方英呎； d，少於約25立方英呎；或者 e，少於約20立方英呎。 The laser ultrasound system of any one of claims 50 to 51, wherein the volume is: a, less than about 40 cubic feet; b, less than about 35 cubic feet; c, less than about 30 cubic feet; d, less than about 25 cubic feet; or e, less than about 20 cubic feet. 一種雷射超音波系統，包含： a，一治療雷射系統；該治療雷射系統包含：具有一近端的一臂；附接至該手臂的該近端的一雷射頭；以及用於操作該治療雷射系統的電子裝置； b，一超音波晶體乳化系統，用於提供治療超音波能量，並包含用於操作該超音波晶體乳化系統的電子裝置；以及 c，該雷射頭係與用於該超音波晶體乳化系統的該等電子裝置以及用於該治療雷射系統的該等電子裝置電隔離。 A laser ultrasound system, comprising: a, a therapeutic laser system; the therapeutic laser system includes: an arm having a proximal end; a laser head attached to the proximal end of the arm; and an electronic device for operating the therapeutic laser system ; b, an ultrasonic phacoemulsification system for providing therapeutic ultrasonic energy and including electronics for operating the ultrasonic phacoemulsification system; and c. The laser head is electrically isolated from the electronic devices used in the ultrasonic crystal emulsification system and the electronic devices used in the therapeutic laser system. 一種雷射系統，包含： a，一治療雷射束，用於提供一治療雷射束；以及 b，一光學裝置，用於定義一雷射束路徑；其中該雷射束路徑係大於300mm；由此，一雷射束圖案沿著該雷射束路徑傳輸，而該雷射束圖案不會擴展。 A laser system comprising: a, a therapeutic laser beam for providing a therapeutic laser beam; and b, an optical device for defining a laser beam path; wherein the laser beam path is greater than 300 mm; thus, a laser beam pattern travels along the laser beam path, and the laser beam pattern does not extension. 一種雷射系統，包含： a，一治療雷射束，用於提供一治療雷射束；以及 b，一光學裝置，用於定義一雷射束路徑；其中該雷射束路徑係大於300mm；由此，一雷射束圖案沿著該雷射束路徑傳輸，而沒有任何波前誤差。 A laser system comprising: a, a therapeutic laser beam for providing a therapeutic laser beam; and b, an optical device for defining a laser beam path; wherein the laser beam path is greater than 300 mm; thus, a laser beam pattern is transmitted along the laser beam path without any wavefront error. 如請求項54至55中之任一者所述的雷射系統，其中該雷射係為一飛秒雷射，並且進一步包含一整合超音波晶體乳化系統。The laser system of any one of claims 54 to 55, wherein the laser is a femtosecond laser, and further comprising an integrated ultrasonic crystal emulsification system. 如請求項1、2、6、16、21、27、34、39、42、45、48、49或50中之任一者所述的系統，包含一虹膜配準裝置。The system of any one of claims 1, 2, 6, 16, 21, 27, 34, 39, 42, 45, 48, 49 or 50, comprising an iris registration device. 如請求項1、2、6、16、21、27、34、39、42、48、49或50中之任一者所述的系統，包含與該雷射程序、該眼睛的一結構、或二者有關的資訊；以及其中該系統經配置而使得該資訊在該超音波系統與該雷射系統之間進行交換。The system of any one of claims 1, 2, 6, 16, 21, 27, 34, 39, 42, 48, 49, or 50, comprising the laser procedure, a structure of the eye, or information about the two; and wherein the system is configured such that the information is exchanged between the ultrasound system and the laser system. 如請求項58所述的系統，其中該資訊包含一白內障的一等級。The system of claim 58, wherein the information includes a grade of a cataract. 如請求項58所述的系統，其中來自該雷射系統的該資訊係用於提供一推薦的超音波能量。The system of claim 58, wherein the information from the laser system is used to provide a recommended ultrasound energy. 如請求項1、2、6、16、21、27、34、39、42、48、49或50中之任一者所述的系統，包含一沙姆成像構件。The system of any one of claims 1, 2, 6, 16, 21, 27, 34, 39, 42, 48, 49, or 50, comprising a sham imaging member. 如請求項1、2、6、16、21、27、34、39、42、44、48、49或50中之任一者所述的系統，包含一OCT成像構件。The system of any one of claims 1, 2, 6, 16, 21, 27, 34, 39, 42, 44, 48, 49, or 50, comprising an OCT imaging member. 如請求項1、2、6、16、21、27、34、39、42、44、48、49或50中之任一者所述的系統，其中該系統具有一佔地面積尺寸；以及該佔地面積尺寸選自少於35×少於35英吋、少於35×25英吋、約35×25英吋、約33×22英吋、及約400平方英吋至約800平方英吋所組成的尺寸群組。The system of any one of claims 1, 2, 6, 16, 21, 27, 34, 39, 42, 44, 48, 49, or 50, wherein the system has a footprint size; and the Floor space dimensions selected from less than 35 x less than 35 inches, less than 35 x 25 inches, about 35 x 25 inches, about 33 x 22 inches, and about 400 square inches to about 800 square inches The size group formed by it. 如請求項1、2、6、16、21、27、34、39、42、44、48、49或50中之任一者所述的系統，包含定位於該雷射束路徑中的該雷射頭上的一帽，由此當該雷射未處於一可操作配置時，該等光學部件得到保護。The system of any one of claims 1, 2, 6, 16, 21, 27, 34, 39, 42, 44, 48, 49, or 50, comprising the laser positioned in the laser beam path A cap on the shooter, whereby the optics are protected when the laser is not in an operational configuration. 一種患者頭枕，該頭枕包含用於利用如請求項1、2、6、16、16、21、27、34、39、42、44、48、49或50中之任一者所述的雷射系統來決定該頭枕的一位置的一構件。A patient headrest comprising a headrest for use as described in any one of claims 1, 2, 6, 16, 16, 21, 27, 34, 39, 42, 44, 48, 49 or 50 A component of a laser system to determine a position of the headrest. 如請求項65所述的頭枕，其中用於決定該頭枕的該位置的該構件包含選自由一A/C電磁追蹤系統、一電磁追蹤系統、陀螺儀、加速度計、及磁力計所組成的部件群組中的一部件。The headrest of claim 65, wherein the means for determining the position of the headrest comprises a member selected from the group consisting of an A/C electromagnetic tracking system, an electromagnetic tracking system, a gyroscope, an accelerometer, and a magnetometer A part of the part group of .
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