CA2745145A1 - Flow control system based on leakage - Google Patents
Flow control system based on leakage Download PDFInfo
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- CA2745145A1 CA2745145A1 CA2745145A CA2745145A CA2745145A1 CA 2745145 A1 CA2745145 A1 CA 2745145A1 CA 2745145 A CA2745145 A CA 2745145A CA 2745145 A CA2745145 A CA 2745145A CA 2745145 A1 CA2745145 A1 CA 2745145A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/71—Suction drainage systems
- A61M1/74—Suction control
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/71—Suction drainage systems
- A61M1/77—Suction-irrigation systems
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
- A61F9/00745—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments using mechanical vibrations, e.g. ultrasonic
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/33—Controlling, regulating or measuring
- A61M2205/3331—Pressure; Flow
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/50—General characteristics of the apparatus with microprocessors or computers
- A61M2205/502—User interfaces, e.g. screens or keyboards
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/06—Head
- A61M2210/0612—Eyes
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- Health & Medical Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Biomedical Technology (AREA)
- Vascular Medicine (AREA)
- Engineering & Computer Science (AREA)
- Anesthesiology (AREA)
- Hematology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
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- Pulmonology (AREA)
- External Artificial Organs (AREA)
- Infusion, Injection, And Reservoir Apparatuses (AREA)
Abstract
An ophthalmic surgical (100) system utilizes a needle (128) through which fluid is aspirated from a surgical sit (110)e, and a sleeve (122) coaxially received over the needle to define a flow passage (126) between the sleeve and needle through which fluid is communicated to the surgical site. The system further includes a container (130) that provides an adjustable infusion pressure. An aspiration pump (140) urges aspiration of fluid from the surgical site, and a sensor (160) detects the rate of aspiration flow. A controller (200) is configured to calculate an intraocular eye pressure based on the infusion pressure and a pressure drop due to a resistance to the flow rate, which flow includes the sensed flow rate and a predicted leakage selected from a look-up table based on a size of the needle (128), a size of a sleeve (122), and a size of an incision (112) through which the needle and the sleeve are placed.
Description
FLOW CONTROL SYSTEM BASED ON LEAKAGE
FIELD
The present invention is related to ophthalmic microsurgical systems and more specifically, to ophthalmic microsurgical systems controlling the flow of fluids into and out of an eye being operated on.
BACKGROUND
The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.
Ophthalmic surgical procedures on the eye generally require cutting and/or making an incision through which a phacoemulsification (phaco) or other type of instrument is inserted into the interior portion of the eye. The use of microsurgical needles or cannulas in ophthalmic surgery is well known, and phaco needles are typically inserted via an incision of about 4 millimeters or less.
The surgeon may cause a flow of fluids for aspiration from the site during the eye surgery. However, it is important to prevent collapsing the eye or over-pressurizing the eye to avoid trauma on the retina, i.e., the separation of the retina from the choroid, a retinal tear, or, other damage to the eye. The introduction of fluids and application of suction for aspirating fluids from the eye may accordingly pose certain risks.
SUMMARY
In accordance with one aspect of the present application, an ophthalmic surgical system is provided that includes a sleeve coaxially received over a needle so as to define a flow passage between the sleeve and the needle through which irrigation fluid is communicated to a surgical site. The needle includes a central passage through which fluid is aspirated from the surgical site, where the sleeve and needle are inserted into an eye, through an incision of a predetermined size. The system further includes a container that is configured to be adjustably elevated above the surgical site, and provides an adjustable infusion pressure for urging the flow of irrigation fluid within the container towards the sleeve for infusion to the surgical site. The system includes a vacuum source that is configured to establish a vacuum pressure, for urging the aspiration of fluid from a surgical site through the passage in the needle. The system further includes a sensor for providing a signal indicative of the vacuum being applied, and a flow sensing or estimating device for providing a signal indicative of the rate that fluid is being aspirated from the surgical site. The system includes a controller that is configured to receive the input of a needle size, a sleeve size, and an incision size. The controller is configured to estimate an intraocular eye pressure based on the infusion pressure, less a pressure drop due to a predetermined resistance to the irrigation flow, as determined by the combination of the sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision. The predicted leakage rate exiting the incision is select from a look-up table, based on values of the needle size, sleeve size, incision size, and the infusion pressure. The controller uses the predicted leakage rate for estimating the total irrigation flow, to obtain a more accurate estimate of intraocular eye pressure. This estimated intraocular eye pressure may be used in controlling the infusion pressure, to thereby adjust irrigation flow to maintain a desired intraocular eye pressure.
Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way.
Fig. 1 shows a cross-sectional perspective view of one embodiment of a needle and aspiration flow control system in accordance with the present invention;
Fig. 2 is a functional block diagram of one embodiment of a method for a flow control system in accordance with one aspect of the present application;
and Fig. 3 is a functional block diagram of another embodiment of a method for a flow control system in accordance with one aspect of the present application;
and Fig. 4 shows a cross-sectional perspective view of one embodiment of a needle and aspiration flow control system in accordance with the present invention.
DETAILED DESCRIPTION
The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. Various embodiments and their advantages are best understood by referring to Figures 1 through 4 of the drawings, like numerals being used for like and corresponding parts of the various drawings.
Fig. 1 shows one embodiment of an ophthalmic surgical system 100, in which fluid flow into and out of an eye 110, through an incision 112, is regulated or controlled to thereby control the intraocular eye pressure in the eye 110. The system 100 comprises an ophthalmic device 120 having a sleeve 122 coaxially received over a needle 128, such as in a phaco needle. The ophthalmic device 120, shown in Fig. 1, includes a sleeve 122 coaxially received over a needle 128, so as to define a flow passage 126 between the sleeve 122 and the needle 128, through which irrigation fluid is communicated to a surgical site (eye 110).
The needle includes a central needle passage 129, through which fluid is aspirated from the surgical site, where the sleeve 122 and needle 128 are inserted into a medium such as an eye, through an incision 112 of a predetermined size.
The system 100 further includes a container 130 that is configured to be adjustably elevated above the surgical site, and provides an adjustable infusion pressure for urging the flow of irrigation fluid within the container 130 towards the sleeve 122 for infusion to the surgical site. The system includes a vacuum source 140 that is configured to establish a vacuum pressure, for urging the aspiration of fluid from a surgical site through the passage in the needle 128.
The system further includes a sensor 160 for providing a signal indicative of the vacuum being applied, and a flow sensing device 162 for providing a signal indicative of the rate that fluid is being aspirated from the surgical site.
The system includes a controller 200 that is configured to receive the input of at least a needle size, a sleeve size, and an incision size. These inputs may be provided by a surgeon, for example. The controller 200 is configured to estimate an intraocular eye pressure based on the infusion pressure, less a pressure drop due to a predetermined resistance to the irrigation flow. It should be noted that the infusion pressure at the container 130 may be determined simply by the height of the container 130 above the eye 110, or by a device for measuring a value indicative of the infusion pressure (such as the container height), or by a pressure sensor. The irrigation flow entering the eye is determined by the combination of the sensed fluid flow rate (determined by sensor 160) and a predicted leakage rate of fluid exiting the incision 112. The predicted leakage rate exiting the incision 112 may be selected from a look-up table, based on values of the needle size, sleeve size, incision size, and the infusion pressure.
Since the total fluid flow entering the eye is equal to the aspiration flow out of the eye and the leakage flow, the controller uses the predicted leakage rate for estimating the total irrigation flow, to obtain a more accurate estimate of intraocular eye pressure. This estimated intraocular eye pressure may be used in controlling the infusion pressure, to thereby adjust irrigation flow to maintain a desired intraocular eye pressure. Obviously, assuming unobstructed flow, the irrigation flow rate will typically be set higher than a desired flow rate that did not account for leakage.
The relationship between irrigation flow and infusion pressure may be understood in view of the following explanation. Under the Bernoulli principle, the total pressure is constant along a streamline for a particular fluid system. The total fluid pressure may be given by Bernoulli's equation:
pv2/2 + pgh + p = C
where pv2/2 is the dynamic pressure, pgh is the head pressure associated with fluid free-falling from a height h above a reference, and p is the static pressure, or pressure at a given point in a steady flowing fluid. As shown in Fig.
1, the flow velocity v may be affected by different cross-sectional areas (A;
and As) in two sections along the streamline. For example, the fluid portion 132 may represent the flow rate v; of irrigation fluid flowing out of the irrigation bottle 130, and the fluid portion 134 may represent the flow rate vs of irrigation fluid flowing between the coaxially arranged sleeve 122 and needle 128. Similarly, the fluid portion 136 may represent the flow rate va of fluid through the aspiration line 139.
Assuming conservation of fluid flow, the various flow velocities may be related by the following equation, for example:
pviA1v212 + pvAighi = pvsAsvs2/2 + pvvAsghs where pv;A;v;2/2 is associated with kinetic energy and pv;A;gh; is associated with potential energy.
From the above, it can be deduced that a difference in height between h;
and hs will cause the irrigation fluid at rest in bottle 130 to establish a flow velocity that increases as the fluid falls through the irrigation line 138 towards the sleeve 122. Likewise, a reduction in cross-sectional area between two points in the infusion line at can also affect the fluid flow velocity between the two points.
From the above, it should be understood that the flow rate or pressures in the two or more sections along a streamline can be determined using the basic equations above.
In applying the above equations to the system of Fig. 1, the absolute pressure in the eye 110 can be determined from the atmospheric pressure po, the head pressure of the irrigation fluid due to the bottle height, less the pressure drop through the irrigation line 138. It should be noted that the flow in the irrigation line 138 may be affected by flow restrictions f2; in the irrigation line, which act against the head pressure to impede the infusion flow rate Q (or pv 1).
The pressure of the fluid exiting the irrigation line 138 may be determined from the pressure Pb ;of the irrigation bottle less the change in pressure Api along the irrigation line, and may be expressed as:
P1= Pub - APB
Similarly, the pressure of the fluid being aspirated may be determined from the pressure po at the collection reservoir 150 (the pressure measured by sensor 160 associated with a vacuum pump device 140, for example), less the change in pressure Apa along the aspiration line, and may be expressed as:
P=Apa+Po Assuming no leakage of fluid out of the eye through the incision, the intraocular pressure in the eye (Peye) for the system in Fig. 1 can be represented by the equation:
Pb-OPi=Peye=APa+Po where Pib is the pressure of the fluid in the irrigation bottle 130, and Ap' is equal to:
Api = (Q - Qi) and po is the pressure or vacuum at the collection reservoir 150, and Lpa is related to the resistance 0a in the aspiration line, as given by:
AN = (Q - Qa) By knowing the bottle height (or the infusion pressure at the bottle 130), the needle cannula 128 inner and outer diameters, the sleeve 122 inner diameter and sleeve area 126, we can predict an intraocular pressure based on the flow rate and vacuum. Specifically, the resistance to irrigation flow ni and resistance to aspiration flow Da can be predetermined, using lab data to develop an estimate of a predetermined flow resistance associated with the irrigation and aspiration flow lines typically employed in ophthalmic surgical procedures.
The aspiration flow rate Q, infusion pressure at the bottle Pb iand aspiration/vacuum pressure põ can be measured. It is accordingly possible to monitor the flow rate Q of fluid aspirated from the eye, and to control the infusion pressure at the bottle Pib and/or vacuum pressure p,,, to maintain a constant intraocular pressure by adjusting the infusion pressure Pb iof the irrigation fluid in the bottle 130 (by adjusting the bottle height or by adjusting the bottle pressure). From the above data, intraocular pressure can be estimated and used as a surgical parameter.
The prediction of intraocular pressure can be accomplished by the method shown in the flow chart in Figure 2, for example, which calculates the absolute pressure in the eye Peye based on the irrigation flow as follows:
Peye = Po + Pib - (Q . Ui) equation (1) where PO is the Atmospheric pressure, P;b is the head pressure due the height of the infusion bottle 130, Q is the irrigation flow rate (equal to the aspiration flow rate, assuming no leakage) and Q; is the resistance to irrigation flow through the tubing.
At step 310, the surgeon or user enters into the controller 200 a configuration for the device, which may be detected by a bar code or other similar method, from which the size of the needle and sleeve may be entered.
The incision size may is also entered by the surgeon. It should be noted that the predetermined resistance to irrigation flow Qi may be stored as a default within the controller 200 as part of a look-up table, for example, or the flow resistance associated with the geometry of the particular device may be entered via bar code or by the user. The pressure Pib of the irrigation fluid in the irrigation bottle 130 is then set, by adjusting the bottle height, or pressurization of the infusion bottle, etc. The system then monitors fluid flow rate using a positive displacement pump, a flow sensor, electromagnetic flow technology, or other similar flow sensing or estimating technology. From the resistance to irrigation flow S2;
identified in a look-up table and the infusion pressure at the bottle P;b, the intraocular pressure Pete of the eye is determined as outlined in equation 1 above, for example. The intraocular pressure Peye may be displayed on a Graphical User Interface (not shown). Once the Intraocular pressure Peye is determined, the infusion pressure P;b, vacuum P,,, or flow Q can be adjusted to maintain a constant desired intraocular pressure Peye.
However, the above determination assumes no leakage of fluid out of the eye through the incision. Where there is a difference between the size of the incision 112 and the size of the needle 128 and/or sleeve 122 of a phaco-needle, some leakage of fluids may occur. As an example, the incision tool used by the surgeon may be configured to make an incision 4 millimeters in length, while the needle and/or sleeve may have a diameter of 1.8 millimeters.
Given that some fluids may leak out of the incision during aspiration, it is desirable to account for this leakage rate, to more accurately control aspiration and irrigation flow to prevent collapsing the eye or over-pressurizing the eye.
Where leakage occurs, the leakage rate of irrigation fluid from the incision 112 can be estimated by the present ophthalmic surgical system 100, which can predict leakage based in part on the size of the needle 128, the size of the sleeve 122, and size of the incision 112. Surgeons can enter these surgical parameters at the start of a procedure, to allow a predicted leakage to be estimated based on these parameters, and identified from a look up table based on the current infusion pressure. Alternatively, a predicted leakage can be estimated, or selected from a look-up table, based on the size of the needle, sleeve, incision, and an estimated intraocular eye pressure (Peye) that is calculated assuming no leakage using equation (1).
To then account for leakage, the intraocular eye pressure Peye for the system in Fig. 1 can be represented by the equation:
Pib - APi = Peye = AN + Pv where Pb ;is the pressure of the irrigation fluid in bottle 130, and Apt is related to the leakage QW and resistance Q; in the infusion line, as given by:
Ap; = (Q + QW) D;
Likewise, põ is the pressure or vacuum at the collection reservoir 150, and AN is related to the resistance Qa in the aspiration line, as given by:
AN = (Q - Da) By knowing the incision size, the needle cannula 128 inner and outer diameters, the sleeve 122 or sleeve diameter or cross-sectional area 126, and bottle height, the predicted wound leakage is estimated, and used to better control the intraocular pressure in the eye.
This predictor can be utilized in the control of intraocular pressure, as described by the methods shown in the flow charts in Fig.'s 2 and 3, for example, which calculates aspiration resistance Da from absolute pressure in the eye Peye based on aspiration flow, as shown in equation (2) below:
Põ = Peye - (Q = Qa), or Da = (Peye - Põ )/Q equation (2) The aspirated flow out of the eye, Q represents the flow into the eye minus the flow leakage. The vacuum pressure põ measured at the collection reservoir 150 (the pressure measured by transducer or sensor 160 associated with a vacuum pump device 140, for example) is equal to the pressure in the eye (Peye) minus the pressure drop Apa through the aspiration line, where Opa equals the flow rate Q x the aspiration resistance Da. However, Da is a dynamic variable based on occlusion, fluid density, and aspiration system compliance.
The present solution to predicting the intraocular pressure under leakage is to estimate the flow loss using a table based on wound size, needle, and estimated intraocular pressure. The initial estimated intraocular pressure default would assume no flow loss. The system would then measure the flow exiting the eye, e.g. - the combination of the aspiration flow rate Q and the predicted or estimated loss QW (obtained from a look-up table), to arrive at the total flow rate and is equal to the irrigation flow entering the eye. This establishes a better estimate of Peye by using a more accurate Q in equation 1.
This initial estimate of Peye from eq. (1) can be used to calculate the aspiration resistance Da using the sensed pressure reading Põ and eq. (2).
This calculated Da can be used to monitor viscosity changes and occlusions. The initial estimate of Peye can also be used to refine the predicted flow leakage using the look-up table. By refining the leakage rate, the infusion flow rate into the eye can be again determined, and used in equation (1) to determine a refined intraocular pressure Peye, which may be used to control irrigation flow for subsequently maintaining a constant desired pressure Peye, To this end, the methods in Fig.'s 2 and 3 take leakage into account to determine a more accurate flow rate Q, which is used in equation (1) to arrive at an initial estimate of the intraocular pressure Peye that accounts for leakage.
Referring to Fig. 3, after the intraocular pressure Peye is estimated at step using equation (1), the predicted leakage QH, from the wound is identified in a look up table based on the incision, needle and sleeve size, and the initial estimate or measurement of the intraocular eye pressure Peye. The system then monitors the aspiration fluid flow rate at step 430, using a positive displacement pump, a flow sensor, electromagnetic flow technology, or other similar flow sensing technology. At step 440, the method calculates the infusion flow rate entering the eye 110 based on the measured aspiration flow rate and the predicted flow loss (leakage) or loss rate.
The method then takes the calculated infusion flow rate Qi from step 440, and uses it, at step 450, in equation (1) for estimating a more refined intraocular pressure Peye. This calculation of a refined Peye using a more accurate determination of Q that includes the leakage provides a better estimate of Peye.
From the refined Peye, the controller 200 can calculate, at step 460, the aspiration flow resistance Qa from equation (2), using the pressure Peye, the pressure P0, and measured flow Q. At step 470, the method estimates or looks up leakage Qw again from a look-up table, and calculates, at step 480, a new infusion flow which is used to calculate yet another more accurate intraocular pressure Peye, at step 490. Once the Intraocular pressure Peye is determined, the aspiration flow vacuum Po, flow Q, or infusion pressure P;b can be adjusted to maintain a constant Intraocular pressure Peye.
Referring to Fig. 4, a second embodiment of an ophthalmic surgical system is shown. The system 400 is similar in many respects to the embodiment in Fig. 1. The system 400 generally comprises an ophthalmic device 120 that includes a needle 128 having a needle passage 129 through which fluid is aspirated from a surgical site. The ophthalmic device 120 includes a sleeve coaxially extending over the needle 128 so as to define a flow passage 126 between the sleeve 122 and the needle 128, through which passage 126 irrigation fluid is communicated to a surgical site. The ophthalmic device 120 is configured to be inserted into a medium (such as an eye 110) through an incision 112 of a predetermined size.
The system 400 provides for irrigation flow to the eye using an irrigation line 138, through which irrigation fluid is communicated between a fluid container 130 and the sleeve 122. The fluid container 130 is configured to provide an adjustable infusion pressure for urging flow of irrigation fluid through the irrigation line 138 and sleeve 122 to the surgical site, either by adjusting the elevation of the container 130 or by adjusting the pressure in the container. The system may further include a measuring device 180 for measuring a value indicative of the infusion pressure at the fluid container 130. It should be noted that the infusion pressure at the container 130 may be determined simply by measuring a value indicative of the infusion pressure, such as the container height, or by a measuring device 180 that senses pressure.
The system 400 provides for aspiration of fluids from the eye using an aspiration line 139, through which fluid is communicated between the needle passage 129 of the needle 128 and an aspiration pump 170. A pump 170 is provided that is configured to establish a vacuum or flow rate, which is applied to urge the flow of fluid aspirated from a surgical site through the needle 128 and aspiration line 139. A pressure sensing device 160 or transducer is provided for generating a signal indicative of the level of vacuum being applied by the pump 170. Similarly, a flow sensing device may be provided for generating a signal indicative of the flow rate of fluid being aspirated from the surgical site.
It should be noted that the flow rate may be sensed or monitored by a positive displacement pump 170, or may alternatively be monitored by a flow sensor, electromagnetic flow technology, or other similar flow sensing technology.
The system 400 may further include a user interface 402 for entering the information of the needle size, sleeve size, and predetermined size of the incision. The system 400 further includes a controller 200 in communication with the user interface 402, pressure sensing device 160, the vacuum pump and/or the flow sensing device 170, and second pressure sensing device 180. The control 200 is configured to calculate an intraocular eye pressure based on the sensed infusion pressure less the pressure drop caused by a predetermined resistance to the irrigation fluid flow, which flow is determined as a combination of a sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision. The predicted leakage rate of fluid exiting the incision is selected from a look-up table of the controller, based on at least the needle size, sleeve size, incision size, and infusion pressure. Alternatively, a predicted leakage can be estimated, or selected from a look up table, based on the size of the needle, sleeve, incision, and an estimated intraocular eye pressure (Peye) that is calculated assuming no leakage using equation (1). The controller 200 may then adjust the infusion pressure, or vacuum pump 170, or both, based on the calculated intraocular eye pressure, to thereby maintain a desired intraocular eye pressure.
The controller 200 may be further configured to calculate a more refined intraocular eye pressure. As outlined in Fig. 3, the calculation of a refined intraocular eye pressure is based on infusion pressure less the pressure drop due to the predetermined resistance to irrigation flow, as determined by a combination of the sensed fluid flow rate and a predicted leakage rate that is selected from a look-up table based on needle size, sleeve size, incision size, and the initially estimated intraocular eye pressure. The controller 200 may be further configured to determine an aspiration flow resistance based on the determined intraocular pressure, the vacuum pressure applied by the vacuum source, and the sensed fluid flow rate, whereby the aspiration flow resistance is used by the controller to monitor occlusions.
In another aspect of the present application, embodiments of a method for controlling an ophthalmic surgical system to control fluid flow are provided, for maintaining intraocular pressure in an eye. In one embodiment, the method for controlling the operation of a controller for regulating irrigation flow through an ophthalmic device in an ophthalmic surgical system comprises receiving the input of a needle size, a sleeve size, and an incision size, and identifying a predetermined resistance to irrigation fluid flow associated with the ophthalmic device. The method performs the steps of obtaining a variable that is indicative of the infusion pressure of irrigation fluid at an elevated container, and selecting a predicted leakage rate of fluid exiting the incision from a look-up table, based on the needle size, sleeve size, incision size, and infusion pressure. The method then calls for sensing a fluid flow rate of irrigation fluid as detected by a flow sensor, and determining an intraocular eye pressure based on the sensed infusion pressure less the pressure drop caused by a predetermined resistance to the irrigation fluid flow. The irrigation fluid flow is determined as a combination of a sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision, where the predicted leakage rate of fluid exiting the incision is selected from a look-up table based on the needle size, sleeve size, incision size, and infusion pressure.
In another embodiment of a method for controlling an ophthalmic surgical system to control fluid flow are provided, for maintaining intraocular pressure in an eye. In one embodiment, the method for controlling the operation of a controller for regulating irrigation flow through an ophthalmic device in an ophthalmic surgical system comprises receiving the input of a needle size, a sleeve size, and an incision size, and identifying a predetermined resistance to irrigation fluid flow associated with the ophthalmic device. The method performs the steps of obtaining a variable that is indicative of the infusion pressure of irrigation fluid at an elevated container, and sensing the fluid flow rate of irrigation fluid detected by a flow sensor, for use in estimating an intraocular eye pressure value, based on the sensed infusion pressure less the pressure drop caused by a predetermined resistance to fluid flow. The estimation of an intraocular eye pressure value is based on a fluid flow determined only from the sensed fluid flow rate detected by the flow sensor, and does not include any predicted leakage flow. The method then calls for selecting a predicted leakage rate from a look-up table based on needle size, sleeve size, incision size and the estimated intraocular eye pressure value, for use in calculating a refined intraocular eye pressure. The refined intraocular eye pressure is calculated based on the sensed infusion pressure less the pressure drop caused by a predetermined resistance to the irrigation fluid flow, which flow is determined as a combination of a sensed fluid flow rate and the predicted leakage rate of fluid exiting the incision that was selected from the look-up table. In either embodiment, the method may then use the determined intraocular eye pressure for subsequently controlling the flow of irrigation fluid in the system, based on the refined intraocular eye pressure, to thereby maintain a desired intraocular eye pressure.
From the above, it may be appreciated that the present invention provides improved apparatus and methods of performing vitrectomy surgery. The present invention is illustrated herein by example, and various modifications may be made by a person of ordinary skill in the art.
It is believed that the operation and construction of the present invention will be apparent from the foregoing description. While the apparatus and methods shown or described above have been characterized as being preferred, various changes and modifications may be made therein without departing from the spirit and scope of the invention as defined in the following claims.
FIELD
The present invention is related to ophthalmic microsurgical systems and more specifically, to ophthalmic microsurgical systems controlling the flow of fluids into and out of an eye being operated on.
BACKGROUND
The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.
Ophthalmic surgical procedures on the eye generally require cutting and/or making an incision through which a phacoemulsification (phaco) or other type of instrument is inserted into the interior portion of the eye. The use of microsurgical needles or cannulas in ophthalmic surgery is well known, and phaco needles are typically inserted via an incision of about 4 millimeters or less.
The surgeon may cause a flow of fluids for aspiration from the site during the eye surgery. However, it is important to prevent collapsing the eye or over-pressurizing the eye to avoid trauma on the retina, i.e., the separation of the retina from the choroid, a retinal tear, or, other damage to the eye. The introduction of fluids and application of suction for aspirating fluids from the eye may accordingly pose certain risks.
SUMMARY
In accordance with one aspect of the present application, an ophthalmic surgical system is provided that includes a sleeve coaxially received over a needle so as to define a flow passage between the sleeve and the needle through which irrigation fluid is communicated to a surgical site. The needle includes a central passage through which fluid is aspirated from the surgical site, where the sleeve and needle are inserted into an eye, through an incision of a predetermined size. The system further includes a container that is configured to be adjustably elevated above the surgical site, and provides an adjustable infusion pressure for urging the flow of irrigation fluid within the container towards the sleeve for infusion to the surgical site. The system includes a vacuum source that is configured to establish a vacuum pressure, for urging the aspiration of fluid from a surgical site through the passage in the needle. The system further includes a sensor for providing a signal indicative of the vacuum being applied, and a flow sensing or estimating device for providing a signal indicative of the rate that fluid is being aspirated from the surgical site. The system includes a controller that is configured to receive the input of a needle size, a sleeve size, and an incision size. The controller is configured to estimate an intraocular eye pressure based on the infusion pressure, less a pressure drop due to a predetermined resistance to the irrigation flow, as determined by the combination of the sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision. The predicted leakage rate exiting the incision is select from a look-up table, based on values of the needle size, sleeve size, incision size, and the infusion pressure. The controller uses the predicted leakage rate for estimating the total irrigation flow, to obtain a more accurate estimate of intraocular eye pressure. This estimated intraocular eye pressure may be used in controlling the infusion pressure, to thereby adjust irrigation flow to maintain a desired intraocular eye pressure.
Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way.
Fig. 1 shows a cross-sectional perspective view of one embodiment of a needle and aspiration flow control system in accordance with the present invention;
Fig. 2 is a functional block diagram of one embodiment of a method for a flow control system in accordance with one aspect of the present application;
and Fig. 3 is a functional block diagram of another embodiment of a method for a flow control system in accordance with one aspect of the present application;
and Fig. 4 shows a cross-sectional perspective view of one embodiment of a needle and aspiration flow control system in accordance with the present invention.
DETAILED DESCRIPTION
The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. Various embodiments and their advantages are best understood by referring to Figures 1 through 4 of the drawings, like numerals being used for like and corresponding parts of the various drawings.
Fig. 1 shows one embodiment of an ophthalmic surgical system 100, in which fluid flow into and out of an eye 110, through an incision 112, is regulated or controlled to thereby control the intraocular eye pressure in the eye 110. The system 100 comprises an ophthalmic device 120 having a sleeve 122 coaxially received over a needle 128, such as in a phaco needle. The ophthalmic device 120, shown in Fig. 1, includes a sleeve 122 coaxially received over a needle 128, so as to define a flow passage 126 between the sleeve 122 and the needle 128, through which irrigation fluid is communicated to a surgical site (eye 110).
The needle includes a central needle passage 129, through which fluid is aspirated from the surgical site, where the sleeve 122 and needle 128 are inserted into a medium such as an eye, through an incision 112 of a predetermined size.
The system 100 further includes a container 130 that is configured to be adjustably elevated above the surgical site, and provides an adjustable infusion pressure for urging the flow of irrigation fluid within the container 130 towards the sleeve 122 for infusion to the surgical site. The system includes a vacuum source 140 that is configured to establish a vacuum pressure, for urging the aspiration of fluid from a surgical site through the passage in the needle 128.
The system further includes a sensor 160 for providing a signal indicative of the vacuum being applied, and a flow sensing device 162 for providing a signal indicative of the rate that fluid is being aspirated from the surgical site.
The system includes a controller 200 that is configured to receive the input of at least a needle size, a sleeve size, and an incision size. These inputs may be provided by a surgeon, for example. The controller 200 is configured to estimate an intraocular eye pressure based on the infusion pressure, less a pressure drop due to a predetermined resistance to the irrigation flow. It should be noted that the infusion pressure at the container 130 may be determined simply by the height of the container 130 above the eye 110, or by a device for measuring a value indicative of the infusion pressure (such as the container height), or by a pressure sensor. The irrigation flow entering the eye is determined by the combination of the sensed fluid flow rate (determined by sensor 160) and a predicted leakage rate of fluid exiting the incision 112. The predicted leakage rate exiting the incision 112 may be selected from a look-up table, based on values of the needle size, sleeve size, incision size, and the infusion pressure.
Since the total fluid flow entering the eye is equal to the aspiration flow out of the eye and the leakage flow, the controller uses the predicted leakage rate for estimating the total irrigation flow, to obtain a more accurate estimate of intraocular eye pressure. This estimated intraocular eye pressure may be used in controlling the infusion pressure, to thereby adjust irrigation flow to maintain a desired intraocular eye pressure. Obviously, assuming unobstructed flow, the irrigation flow rate will typically be set higher than a desired flow rate that did not account for leakage.
The relationship between irrigation flow and infusion pressure may be understood in view of the following explanation. Under the Bernoulli principle, the total pressure is constant along a streamline for a particular fluid system. The total fluid pressure may be given by Bernoulli's equation:
pv2/2 + pgh + p = C
where pv2/2 is the dynamic pressure, pgh is the head pressure associated with fluid free-falling from a height h above a reference, and p is the static pressure, or pressure at a given point in a steady flowing fluid. As shown in Fig.
1, the flow velocity v may be affected by different cross-sectional areas (A;
and As) in two sections along the streamline. For example, the fluid portion 132 may represent the flow rate v; of irrigation fluid flowing out of the irrigation bottle 130, and the fluid portion 134 may represent the flow rate vs of irrigation fluid flowing between the coaxially arranged sleeve 122 and needle 128. Similarly, the fluid portion 136 may represent the flow rate va of fluid through the aspiration line 139.
Assuming conservation of fluid flow, the various flow velocities may be related by the following equation, for example:
pviA1v212 + pvAighi = pvsAsvs2/2 + pvvAsghs where pv;A;v;2/2 is associated with kinetic energy and pv;A;gh; is associated with potential energy.
From the above, it can be deduced that a difference in height between h;
and hs will cause the irrigation fluid at rest in bottle 130 to establish a flow velocity that increases as the fluid falls through the irrigation line 138 towards the sleeve 122. Likewise, a reduction in cross-sectional area between two points in the infusion line at can also affect the fluid flow velocity between the two points.
From the above, it should be understood that the flow rate or pressures in the two or more sections along a streamline can be determined using the basic equations above.
In applying the above equations to the system of Fig. 1, the absolute pressure in the eye 110 can be determined from the atmospheric pressure po, the head pressure of the irrigation fluid due to the bottle height, less the pressure drop through the irrigation line 138. It should be noted that the flow in the irrigation line 138 may be affected by flow restrictions f2; in the irrigation line, which act against the head pressure to impede the infusion flow rate Q (or pv 1).
The pressure of the fluid exiting the irrigation line 138 may be determined from the pressure Pb ;of the irrigation bottle less the change in pressure Api along the irrigation line, and may be expressed as:
P1= Pub - APB
Similarly, the pressure of the fluid being aspirated may be determined from the pressure po at the collection reservoir 150 (the pressure measured by sensor 160 associated with a vacuum pump device 140, for example), less the change in pressure Apa along the aspiration line, and may be expressed as:
P=Apa+Po Assuming no leakage of fluid out of the eye through the incision, the intraocular pressure in the eye (Peye) for the system in Fig. 1 can be represented by the equation:
Pb-OPi=Peye=APa+Po where Pib is the pressure of the fluid in the irrigation bottle 130, and Ap' is equal to:
Api = (Q - Qi) and po is the pressure or vacuum at the collection reservoir 150, and Lpa is related to the resistance 0a in the aspiration line, as given by:
AN = (Q - Qa) By knowing the bottle height (or the infusion pressure at the bottle 130), the needle cannula 128 inner and outer diameters, the sleeve 122 inner diameter and sleeve area 126, we can predict an intraocular pressure based on the flow rate and vacuum. Specifically, the resistance to irrigation flow ni and resistance to aspiration flow Da can be predetermined, using lab data to develop an estimate of a predetermined flow resistance associated with the irrigation and aspiration flow lines typically employed in ophthalmic surgical procedures.
The aspiration flow rate Q, infusion pressure at the bottle Pb iand aspiration/vacuum pressure põ can be measured. It is accordingly possible to monitor the flow rate Q of fluid aspirated from the eye, and to control the infusion pressure at the bottle Pib and/or vacuum pressure p,,, to maintain a constant intraocular pressure by adjusting the infusion pressure Pb iof the irrigation fluid in the bottle 130 (by adjusting the bottle height or by adjusting the bottle pressure). From the above data, intraocular pressure can be estimated and used as a surgical parameter.
The prediction of intraocular pressure can be accomplished by the method shown in the flow chart in Figure 2, for example, which calculates the absolute pressure in the eye Peye based on the irrigation flow as follows:
Peye = Po + Pib - (Q . Ui) equation (1) where PO is the Atmospheric pressure, P;b is the head pressure due the height of the infusion bottle 130, Q is the irrigation flow rate (equal to the aspiration flow rate, assuming no leakage) and Q; is the resistance to irrigation flow through the tubing.
At step 310, the surgeon or user enters into the controller 200 a configuration for the device, which may be detected by a bar code or other similar method, from which the size of the needle and sleeve may be entered.
The incision size may is also entered by the surgeon. It should be noted that the predetermined resistance to irrigation flow Qi may be stored as a default within the controller 200 as part of a look-up table, for example, or the flow resistance associated with the geometry of the particular device may be entered via bar code or by the user. The pressure Pib of the irrigation fluid in the irrigation bottle 130 is then set, by adjusting the bottle height, or pressurization of the infusion bottle, etc. The system then monitors fluid flow rate using a positive displacement pump, a flow sensor, electromagnetic flow technology, or other similar flow sensing or estimating technology. From the resistance to irrigation flow S2;
identified in a look-up table and the infusion pressure at the bottle P;b, the intraocular pressure Pete of the eye is determined as outlined in equation 1 above, for example. The intraocular pressure Peye may be displayed on a Graphical User Interface (not shown). Once the Intraocular pressure Peye is determined, the infusion pressure P;b, vacuum P,,, or flow Q can be adjusted to maintain a constant desired intraocular pressure Peye.
However, the above determination assumes no leakage of fluid out of the eye through the incision. Where there is a difference between the size of the incision 112 and the size of the needle 128 and/or sleeve 122 of a phaco-needle, some leakage of fluids may occur. As an example, the incision tool used by the surgeon may be configured to make an incision 4 millimeters in length, while the needle and/or sleeve may have a diameter of 1.8 millimeters.
Given that some fluids may leak out of the incision during aspiration, it is desirable to account for this leakage rate, to more accurately control aspiration and irrigation flow to prevent collapsing the eye or over-pressurizing the eye.
Where leakage occurs, the leakage rate of irrigation fluid from the incision 112 can be estimated by the present ophthalmic surgical system 100, which can predict leakage based in part on the size of the needle 128, the size of the sleeve 122, and size of the incision 112. Surgeons can enter these surgical parameters at the start of a procedure, to allow a predicted leakage to be estimated based on these parameters, and identified from a look up table based on the current infusion pressure. Alternatively, a predicted leakage can be estimated, or selected from a look-up table, based on the size of the needle, sleeve, incision, and an estimated intraocular eye pressure (Peye) that is calculated assuming no leakage using equation (1).
To then account for leakage, the intraocular eye pressure Peye for the system in Fig. 1 can be represented by the equation:
Pib - APi = Peye = AN + Pv where Pb ;is the pressure of the irrigation fluid in bottle 130, and Apt is related to the leakage QW and resistance Q; in the infusion line, as given by:
Ap; = (Q + QW) D;
Likewise, põ is the pressure or vacuum at the collection reservoir 150, and AN is related to the resistance Qa in the aspiration line, as given by:
AN = (Q - Da) By knowing the incision size, the needle cannula 128 inner and outer diameters, the sleeve 122 or sleeve diameter or cross-sectional area 126, and bottle height, the predicted wound leakage is estimated, and used to better control the intraocular pressure in the eye.
This predictor can be utilized in the control of intraocular pressure, as described by the methods shown in the flow charts in Fig.'s 2 and 3, for example, which calculates aspiration resistance Da from absolute pressure in the eye Peye based on aspiration flow, as shown in equation (2) below:
Põ = Peye - (Q = Qa), or Da = (Peye - Põ )/Q equation (2) The aspirated flow out of the eye, Q represents the flow into the eye minus the flow leakage. The vacuum pressure põ measured at the collection reservoir 150 (the pressure measured by transducer or sensor 160 associated with a vacuum pump device 140, for example) is equal to the pressure in the eye (Peye) minus the pressure drop Apa through the aspiration line, where Opa equals the flow rate Q x the aspiration resistance Da. However, Da is a dynamic variable based on occlusion, fluid density, and aspiration system compliance.
The present solution to predicting the intraocular pressure under leakage is to estimate the flow loss using a table based on wound size, needle, and estimated intraocular pressure. The initial estimated intraocular pressure default would assume no flow loss. The system would then measure the flow exiting the eye, e.g. - the combination of the aspiration flow rate Q and the predicted or estimated loss QW (obtained from a look-up table), to arrive at the total flow rate and is equal to the irrigation flow entering the eye. This establishes a better estimate of Peye by using a more accurate Q in equation 1.
This initial estimate of Peye from eq. (1) can be used to calculate the aspiration resistance Da using the sensed pressure reading Põ and eq. (2).
This calculated Da can be used to monitor viscosity changes and occlusions. The initial estimate of Peye can also be used to refine the predicted flow leakage using the look-up table. By refining the leakage rate, the infusion flow rate into the eye can be again determined, and used in equation (1) to determine a refined intraocular pressure Peye, which may be used to control irrigation flow for subsequently maintaining a constant desired pressure Peye, To this end, the methods in Fig.'s 2 and 3 take leakage into account to determine a more accurate flow rate Q, which is used in equation (1) to arrive at an initial estimate of the intraocular pressure Peye that accounts for leakage.
Referring to Fig. 3, after the intraocular pressure Peye is estimated at step using equation (1), the predicted leakage QH, from the wound is identified in a look up table based on the incision, needle and sleeve size, and the initial estimate or measurement of the intraocular eye pressure Peye. The system then monitors the aspiration fluid flow rate at step 430, using a positive displacement pump, a flow sensor, electromagnetic flow technology, or other similar flow sensing technology. At step 440, the method calculates the infusion flow rate entering the eye 110 based on the measured aspiration flow rate and the predicted flow loss (leakage) or loss rate.
The method then takes the calculated infusion flow rate Qi from step 440, and uses it, at step 450, in equation (1) for estimating a more refined intraocular pressure Peye. This calculation of a refined Peye using a more accurate determination of Q that includes the leakage provides a better estimate of Peye.
From the refined Peye, the controller 200 can calculate, at step 460, the aspiration flow resistance Qa from equation (2), using the pressure Peye, the pressure P0, and measured flow Q. At step 470, the method estimates or looks up leakage Qw again from a look-up table, and calculates, at step 480, a new infusion flow which is used to calculate yet another more accurate intraocular pressure Peye, at step 490. Once the Intraocular pressure Peye is determined, the aspiration flow vacuum Po, flow Q, or infusion pressure P;b can be adjusted to maintain a constant Intraocular pressure Peye.
Referring to Fig. 4, a second embodiment of an ophthalmic surgical system is shown. The system 400 is similar in many respects to the embodiment in Fig. 1. The system 400 generally comprises an ophthalmic device 120 that includes a needle 128 having a needle passage 129 through which fluid is aspirated from a surgical site. The ophthalmic device 120 includes a sleeve coaxially extending over the needle 128 so as to define a flow passage 126 between the sleeve 122 and the needle 128, through which passage 126 irrigation fluid is communicated to a surgical site. The ophthalmic device 120 is configured to be inserted into a medium (such as an eye 110) through an incision 112 of a predetermined size.
The system 400 provides for irrigation flow to the eye using an irrigation line 138, through which irrigation fluid is communicated between a fluid container 130 and the sleeve 122. The fluid container 130 is configured to provide an adjustable infusion pressure for urging flow of irrigation fluid through the irrigation line 138 and sleeve 122 to the surgical site, either by adjusting the elevation of the container 130 or by adjusting the pressure in the container. The system may further include a measuring device 180 for measuring a value indicative of the infusion pressure at the fluid container 130. It should be noted that the infusion pressure at the container 130 may be determined simply by measuring a value indicative of the infusion pressure, such as the container height, or by a measuring device 180 that senses pressure.
The system 400 provides for aspiration of fluids from the eye using an aspiration line 139, through which fluid is communicated between the needle passage 129 of the needle 128 and an aspiration pump 170. A pump 170 is provided that is configured to establish a vacuum or flow rate, which is applied to urge the flow of fluid aspirated from a surgical site through the needle 128 and aspiration line 139. A pressure sensing device 160 or transducer is provided for generating a signal indicative of the level of vacuum being applied by the pump 170. Similarly, a flow sensing device may be provided for generating a signal indicative of the flow rate of fluid being aspirated from the surgical site.
It should be noted that the flow rate may be sensed or monitored by a positive displacement pump 170, or may alternatively be monitored by a flow sensor, electromagnetic flow technology, or other similar flow sensing technology.
The system 400 may further include a user interface 402 for entering the information of the needle size, sleeve size, and predetermined size of the incision. The system 400 further includes a controller 200 in communication with the user interface 402, pressure sensing device 160, the vacuum pump and/or the flow sensing device 170, and second pressure sensing device 180. The control 200 is configured to calculate an intraocular eye pressure based on the sensed infusion pressure less the pressure drop caused by a predetermined resistance to the irrigation fluid flow, which flow is determined as a combination of a sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision. The predicted leakage rate of fluid exiting the incision is selected from a look-up table of the controller, based on at least the needle size, sleeve size, incision size, and infusion pressure. Alternatively, a predicted leakage can be estimated, or selected from a look up table, based on the size of the needle, sleeve, incision, and an estimated intraocular eye pressure (Peye) that is calculated assuming no leakage using equation (1). The controller 200 may then adjust the infusion pressure, or vacuum pump 170, or both, based on the calculated intraocular eye pressure, to thereby maintain a desired intraocular eye pressure.
The controller 200 may be further configured to calculate a more refined intraocular eye pressure. As outlined in Fig. 3, the calculation of a refined intraocular eye pressure is based on infusion pressure less the pressure drop due to the predetermined resistance to irrigation flow, as determined by a combination of the sensed fluid flow rate and a predicted leakage rate that is selected from a look-up table based on needle size, sleeve size, incision size, and the initially estimated intraocular eye pressure. The controller 200 may be further configured to determine an aspiration flow resistance based on the determined intraocular pressure, the vacuum pressure applied by the vacuum source, and the sensed fluid flow rate, whereby the aspiration flow resistance is used by the controller to monitor occlusions.
In another aspect of the present application, embodiments of a method for controlling an ophthalmic surgical system to control fluid flow are provided, for maintaining intraocular pressure in an eye. In one embodiment, the method for controlling the operation of a controller for regulating irrigation flow through an ophthalmic device in an ophthalmic surgical system comprises receiving the input of a needle size, a sleeve size, and an incision size, and identifying a predetermined resistance to irrigation fluid flow associated with the ophthalmic device. The method performs the steps of obtaining a variable that is indicative of the infusion pressure of irrigation fluid at an elevated container, and selecting a predicted leakage rate of fluid exiting the incision from a look-up table, based on the needle size, sleeve size, incision size, and infusion pressure. The method then calls for sensing a fluid flow rate of irrigation fluid as detected by a flow sensor, and determining an intraocular eye pressure based on the sensed infusion pressure less the pressure drop caused by a predetermined resistance to the irrigation fluid flow. The irrigation fluid flow is determined as a combination of a sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision, where the predicted leakage rate of fluid exiting the incision is selected from a look-up table based on the needle size, sleeve size, incision size, and infusion pressure.
In another embodiment of a method for controlling an ophthalmic surgical system to control fluid flow are provided, for maintaining intraocular pressure in an eye. In one embodiment, the method for controlling the operation of a controller for regulating irrigation flow through an ophthalmic device in an ophthalmic surgical system comprises receiving the input of a needle size, a sleeve size, and an incision size, and identifying a predetermined resistance to irrigation fluid flow associated with the ophthalmic device. The method performs the steps of obtaining a variable that is indicative of the infusion pressure of irrigation fluid at an elevated container, and sensing the fluid flow rate of irrigation fluid detected by a flow sensor, for use in estimating an intraocular eye pressure value, based on the sensed infusion pressure less the pressure drop caused by a predetermined resistance to fluid flow. The estimation of an intraocular eye pressure value is based on a fluid flow determined only from the sensed fluid flow rate detected by the flow sensor, and does not include any predicted leakage flow. The method then calls for selecting a predicted leakage rate from a look-up table based on needle size, sleeve size, incision size and the estimated intraocular eye pressure value, for use in calculating a refined intraocular eye pressure. The refined intraocular eye pressure is calculated based on the sensed infusion pressure less the pressure drop caused by a predetermined resistance to the irrigation fluid flow, which flow is determined as a combination of a sensed fluid flow rate and the predicted leakage rate of fluid exiting the incision that was selected from the look-up table. In either embodiment, the method may then use the determined intraocular eye pressure for subsequently controlling the flow of irrigation fluid in the system, based on the refined intraocular eye pressure, to thereby maintain a desired intraocular eye pressure.
From the above, it may be appreciated that the present invention provides improved apparatus and methods of performing vitrectomy surgery. The present invention is illustrated herein by example, and various modifications may be made by a person of ordinary skill in the art.
It is believed that the operation and construction of the present invention will be apparent from the foregoing description. While the apparatus and methods shown or described above have been characterized as being preferred, various changes and modifications may be made therein without departing from the spirit and scope of the invention as defined in the following claims.
Claims (16)
1. A system for regulating pressure in an ophthalmic surgical system comprising:
a sleeve coaxially received over a needle so as to define a flow passage between the sleeve and the needle through which irrigation fluid is communicated to a surgical site, and a needle passage through which fluid is aspirated from the surgical site, the sleeve and needle for insertion into a medium through an incision of a predetermined size;
a container configured to provide an adjustable infusion pressure for urging a flow of irrigation fluid within the container to the sleeve, for infusion to the surgical site;
a vacuum source configured to establish a vacuum for urging an aspiration of fluid from the surgical site through the needle passage;
a sensor for providing a signal indicative of the vacuum being applied;
a flow sensing or estimating device for providing a signal indicative of a flow rate of fluid being aspirated from the surgical site; and a controller configured to receive an input of a needle size, a sleeve size, and the incision size, and to estimate an intraocular eye pressure based on the infusion pressure less a pressure drop due to a predetermined resistance to the fluid flow, which fluid flow does not include any predicted leakage flow and wherein the controller is configured to obtain a more refined estimate of the intraocular eye pressure based on the infusion pressure and a combination of the sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision selected from a look-up table based on the need size, the sleeve size, and the incision size, wherein the controller uses the refined estimate to control fluid flow to maintain a desired intraocular pressure.
a sleeve coaxially received over a needle so as to define a flow passage between the sleeve and the needle through which irrigation fluid is communicated to a surgical site, and a needle passage through which fluid is aspirated from the surgical site, the sleeve and needle for insertion into a medium through an incision of a predetermined size;
a container configured to provide an adjustable infusion pressure for urging a flow of irrigation fluid within the container to the sleeve, for infusion to the surgical site;
a vacuum source configured to establish a vacuum for urging an aspiration of fluid from the surgical site through the needle passage;
a sensor for providing a signal indicative of the vacuum being applied;
a flow sensing or estimating device for providing a signal indicative of a flow rate of fluid being aspirated from the surgical site; and a controller configured to receive an input of a needle size, a sleeve size, and the incision size, and to estimate an intraocular eye pressure based on the infusion pressure less a pressure drop due to a predetermined resistance to the fluid flow, which fluid flow does not include any predicted leakage flow and wherein the controller is configured to obtain a more refined estimate of the intraocular eye pressure based on the infusion pressure and a combination of the sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision selected from a look-up table based on the need size, the sleeve size, and the incision size, wherein the controller uses the refined estimate to control fluid flow to maintain a desired intraocular pressure.
2. The system of claim 1, wherein the controller is further configured to determine an aspiration flow resistance based on the refined intraocular pressure, the vacuum applied by the vacuum source, and the sensed or estimated fluid flow rate, whereby the aspiration flow resistance is used by the controller to monitor occlusions.
3. The system of claim 1 further comprising an irrigation line through which irrigation fluid is communicated between the fluid container and the sleeve.
4. The system of claim 1 further comprising an aspiration line through which fluid is communicated between the needle and the aspiration vacuum source.
5. The system of claim 1 further comprising a vacuum sensor for sensing a level of vacuum applied by the vacuum source for establishing aspiration of fluid flow from the surgical site.
6. The system of claim 1, wherein the vacuum source is a vacuum pump, which the controller is configured to control to adjust the level of vacuum applied by the vacuum pump for controlling the flow rate of fluid being aspirated from the surgical site.
7. The system of claim 1, wherein a height of the container may be altered to adjust the infusion pressure of the irrigation fluid in the container.
8. A control system for controlling aspiration of fluids within an ophthalmic surgical system, comprising:
an ophthalmic device including a needle having a cannula therein through which fluid is aspirated from a surgical site, and a sleeve coaxially extending over the needle so as to define a flow passage between the sleeve and the needle, through which passage irrigation fluid is communicated to a surgical site, wherein the ophthalmic device is configured to be inserted into a medium through an incision of a predetermined size;
an irrigation line through which irrigation fluid is communicated between a fluid container and the sleeve;
the fluid container having the irrigation fluid therein, the container being configured to provide an adjustable infusion pressure for urging flow of the irrigation fluid through the irrigation line and sleeve to the surgical site;
a measuring device for measuring a value indicative of the infusion pressure at the fluid container;
an aspiration line through which fluid is communicated between the needle cannula and an aspiration pump;
the aspiration pump configured to urge the flow of fluid aspirated from the surgical site through the needle cannula and aspiration line;
a pressure sensing device for providing a signal indicative of the level of pressure being applied by the aspiration pump;
a flow sensing device for providing a signal indicative of a flow rate of fluid being aspirated from the surgical site;
a user interface for entering a needle size, a sleeve size, and the predetermined size of the incision;
a controller in communication with the user interface, the measuring device, the flow sensing device, the pressure sensing device and the aspiration pump, the controller being configured to calculate an intraocular eye pressure based on the measured infusion pressure less a pressure drop caused by a predetermined resistance to an irrigation fluid flow, which irrigation fluid flow is a combination of the sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision, where the predicted leakage rate is selected from a look-up table based on the needle size, the sleeve size, the incision size, and an estimated intraocular eye pressure; and wherein the controller adjusts either the infusion pressure or the aspiration pump based on the calculated intraocular eye pressure to maintain a desired intraocular eye pressure.
an ophthalmic device including a needle having a cannula therein through which fluid is aspirated from a surgical site, and a sleeve coaxially extending over the needle so as to define a flow passage between the sleeve and the needle, through which passage irrigation fluid is communicated to a surgical site, wherein the ophthalmic device is configured to be inserted into a medium through an incision of a predetermined size;
an irrigation line through which irrigation fluid is communicated between a fluid container and the sleeve;
the fluid container having the irrigation fluid therein, the container being configured to provide an adjustable infusion pressure for urging flow of the irrigation fluid through the irrigation line and sleeve to the surgical site;
a measuring device for measuring a value indicative of the infusion pressure at the fluid container;
an aspiration line through which fluid is communicated between the needle cannula and an aspiration pump;
the aspiration pump configured to urge the flow of fluid aspirated from the surgical site through the needle cannula and aspiration line;
a pressure sensing device for providing a signal indicative of the level of pressure being applied by the aspiration pump;
a flow sensing device for providing a signal indicative of a flow rate of fluid being aspirated from the surgical site;
a user interface for entering a needle size, a sleeve size, and the predetermined size of the incision;
a controller in communication with the user interface, the measuring device, the flow sensing device, the pressure sensing device and the aspiration pump, the controller being configured to calculate an intraocular eye pressure based on the measured infusion pressure less a pressure drop caused by a predetermined resistance to an irrigation fluid flow, which irrigation fluid flow is a combination of the sensed fluid flow rate and a predicted leakage rate of fluid exiting the incision, where the predicted leakage rate is selected from a look-up table based on the needle size, the sleeve size, the incision size, and an estimated intraocular eye pressure; and wherein the controller adjusts either the infusion pressure or the aspiration pump based on the calculated intraocular eye pressure to maintain a desired intraocular eye pressure.
9. The system of claim 8, wherein the estimated intraocular eye pressure used in selecting a predicted leakage rate from a look-up table is estimated based on the measured infusion pressure, less the pressure drop caused by a predetermined resistance to fluid flow, which fluid flow is determined only from the sensed fluid flow rate detected by the flow sensing device, and not any leakage flow.
10. The system of claim 8, wherein the controller is further configured to determine an aspiration flow resistance based on the calculated intraocular pressure, the pressure applied by the aspiration pump, and the sensed fluid flow rate, whereby the aspiration flow resistance is used by the controller to monitor occlusions.
11. The system of claim 8, wherein the controller is configured to adjust a level of pressure applied by the aspiration pump, to adjust the flow rate of fluid from the surgical site.
12. The system of claim 8, wherein a height of the container may be altered to adjust the infusion pressure of the irrigation fluid in the container.
13. The system of claim 8, wherein the measuring device is a pressure sensor.
14. A method of controlling the operation of a controller for regulating fluid flow in an eye and through an ophthalmic device in an ophthalmic surgical system, comprising:
the controller receiving an input of a needle size, a sleeve size, and an incision size;
identifying in the controller, a predetermined resistance to a fluid flow associated with the ophthalmic device, including connected aspiration and irrigation tubing;
obtaining in the controller an infusion pressure of the irrigation fluid at a container connected to the surgical system;
selecting a predicted leakage rate of fluid exiting the incision from a look-up table stored in the surgical system, based on the needle size, the sleeve size, the incision size, and the infusion pressure;
sensing in the controller a fluid flow rate of the fluid by a flow sensor placed in the aspiration tubing;
determining an intraocular eye pressure based on the infusion pressure less a pressure drop caused by the predetermined resistance to the irrigation fluid flow, which irrigation fluid flow is a combination of the sensed fluid flow rate and the predicted leakage rate of fluid exiting the incision; and controlling the flow of fluid in the eye based on the determined intraocular eye pressure to maintain a desired intraocular eye pressure.
the controller receiving an input of a needle size, a sleeve size, and an incision size;
identifying in the controller, a predetermined resistance to a fluid flow associated with the ophthalmic device, including connected aspiration and irrigation tubing;
obtaining in the controller an infusion pressure of the irrigation fluid at a container connected to the surgical system;
selecting a predicted leakage rate of fluid exiting the incision from a look-up table stored in the surgical system, based on the needle size, the sleeve size, the incision size, and the infusion pressure;
sensing in the controller a fluid flow rate of the fluid by a flow sensor placed in the aspiration tubing;
determining an intraocular eye pressure based on the infusion pressure less a pressure drop caused by the predetermined resistance to the irrigation fluid flow, which irrigation fluid flow is a combination of the sensed fluid flow rate and the predicted leakage rate of fluid exiting the incision; and controlling the flow of fluid in the eye based on the determined intraocular eye pressure to maintain a desired intraocular eye pressure.
15. A method of controlling the operation of a controller for regulating fluid flow in an eye and through an ophthalmic device in an ophthalmic surgical system, comprising:
the controller receiving the input of a needle size, a sleeve size, and an incision size;
identifying in the controller a predetermined resistance to a fluid flow associated with the ophthalmic device, including connected aspiration and irrigation tubing;
obtaining in the controller an infusion pressure of irrigation fluid at a container connected to the surgical system;
sensing in the controller a fluid flow rate of the fluid by a flow sensor placed in the aspiration tubing;
estimating an intraocular eye pressure value, based on the infusion pressure less a preliminary pressure drop caused by the predetermined resistance to fluid flow, which fluid flow does not include any predicted leakage flow;
selecting a predicted leakage rate from a look-up table stored in the surgical system based on the needle size, the sleeve size, the incision size and the estimated intraocular eye pressure value;
calculating a refined intraocular eye pressure based on the infusion pressure less a refined pressure drop caused by the predetermined resistance to the fluid flow, which fluid flow is determined as a combination of the sensed fluid flow rate and the predicted leakage rate; and controlling the flow of fluid in the system based on the refined intraocular eye pressure to maintain a desired intraocular eye pressure.
the controller receiving the input of a needle size, a sleeve size, and an incision size;
identifying in the controller a predetermined resistance to a fluid flow associated with the ophthalmic device, including connected aspiration and irrigation tubing;
obtaining in the controller an infusion pressure of irrigation fluid at a container connected to the surgical system;
sensing in the controller a fluid flow rate of the fluid by a flow sensor placed in the aspiration tubing;
estimating an intraocular eye pressure value, based on the infusion pressure less a preliminary pressure drop caused by the predetermined resistance to fluid flow, which fluid flow does not include any predicted leakage flow;
selecting a predicted leakage rate from a look-up table stored in the surgical system based on the needle size, the sleeve size, the incision size and the estimated intraocular eye pressure value;
calculating a refined intraocular eye pressure based on the infusion pressure less a refined pressure drop caused by the predetermined resistance to the fluid flow, which fluid flow is determined as a combination of the sensed fluid flow rate and the predicted leakage rate; and controlling the flow of fluid in the system based on the refined intraocular eye pressure to maintain a desired intraocular eye pressure.
16. The method of claim 15, further comprising the step of determining in the controller an aspiration flow resistance based on the refined intraocular pressure, a pressure applied by the an aspiration pump, and the sensed fluid flow rate, whereby the aspiration flow resistance is used by the controller to monitor occlusions.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
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| US12/329,863 US8162919B2 (en) | 2008-12-08 | 2008-12-08 | Flow control system based on leakage |
| US12/329,863 | 2008-12-08 | ||
| PCT/US2009/066683 WO2010077563A2 (en) | 2008-12-08 | 2009-12-04 | Flow control system based on leakage |
Publications (2)
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| CA2745145A1 true CA2745145A1 (en) | 2010-07-08 |
| CA2745145C CA2745145C (en) | 2013-10-15 |
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| JP (1) | JP5542151B2 (en) |
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| ES2536417T3 (en) | 2015-05-25 |
| ES2536417T5 (en) | 2018-04-11 |
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| EP2379126B2 (en) | 2018-03-07 |
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| EP2379126B1 (en) | 2015-04-22 |
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| US8162919B2 (en) | 2012-04-24 |
| CN102245222A (en) | 2011-11-16 |
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