Microfemtotomy methods and systems

Abstract

Methods and systems for performing laser-assisted surgery on an eye form one or more small anchoring capsulotomies in the lens capsule of the eye. The one or more anchoring capsulotomies are configured to accommodate corresponding anchoring features of an intraocular lens and/or to accommodate one or more drug-eluting members. A method for performing laser-assisted eye surgery on an eye having a lens capsule includes forming an anchoring capsulotomy in the lens capsule and coupling an anchoring feature of the intraocular lens with the anchoring capsulotomy. The anchoring capsulotomy is formed by using a laser to incise the lens capsule. The anchoring feature can protrude transverse to a surface of the intraocular lens that interfaces with the lens capsule adjacent to the anchoring capsulotomy.

What is claimed is: 
     
         1 . A method for performing laser-assisted surgery on an eye having a lens capsule, the method comprising:
 forming an anchoring capsulotomy in the lens capsule by using a laser to incise the lens capsule, the anchoring capsulotomy being configured to accommodate an anchoring feature of an intraocular lens (IOL); and   coupling the anchoring feature of the IOL with the anchoring capsulotomy.   
     
     
         2 . The method of  claim 1 , wherein the anchoring feature protrudes transverse to a surface of the IOL that interfaces with the lens capsule adjacent to the anchoring capsulotomy. 
     
     
         3 . The method of  claim 1 , wherein each of the anchoring features comprises a location on the IOL prior to placement and wherein each of the plurality of anchoring capsulotomies is located on the capsule to align a center of the IOL with an optical axis of the eye and to align an aberration correcting axis of the IOL with a rotational axis of the eye in order to align the IOL with the optical axis and align the IOL with the rotational axis of the eye to correct the aberration. 
     
     
         4 . The method of  claim 1 , wherein a plurality of anchoring capsulotomies are formed in the lens capsule by using the laser to incise the lens capsule, each of the anchoring capsulotomies being configured to accommodate a corresponding anchoring feature of the IOL and wherein the corresponding feature on the IOL comprises a first portion and a second portion, the first portion comprising a first cross-sectional dimension sized to pass through the anchoring capsulotomy, the second portion comprising a second cross-sectional dimension less than the first cross-sectional dimension and wherein the feature extends a distance from a body of the IOL such that the first portion is retained on a first side of the capsule when the second portion extends through the capsule. 
     
     
         5 . The method of  claim 4 , wherein at least one of the anchoring capsulotomies has a shape different from the other anchoring capsulotomies and wherein the anchoring capsulotomy has a shape that is selected from the group consisting of: buttonhole, linear, bone-shaped, teardrop-shaped, round, rectangular with rounded corners, rectangular with sharp corners, and elliptical. 
     
     
         6 . The method of  claim 4 , wherein the anchoring capsulotomies and the IOL are configured to orient the IOL relative to the eye to provide correction of astigmatism of the eye and wherein the IOL comprises a predetermined arrangement of locations of the feature with respect to an aberration correcting axis of the IOL and wherein the anchoring capsulotomies are placed at locations to align the aberration correcting axis of the IOL to an aberration axis the eye in order to provide aberration correction of the eye and wherein locations of the anchoring capsulotomies are rotated in relation to the aberration correcting axis of the eye to align the IOL with the axis of the eye. 
     
     
         7 . The method of  claim 4 , wherein the anchoring capsulotomies are arranged such that the anchoring capsulotomies form a pattern that is selected from the group consisting of: rotationally symmetric, rotationally asymmetric, bilaterally symmetric, and bilaterally asymmetric. 
     
     
         8 . The method of  claim 7 , wherein the asymmetry is oriented such that it corresponds to a direction of natural asymmetry of capsular contraction. 
     
     
         9 . The method of  claim 4 , wherein at least one of the anchoring capsulotomies is elongated tangential to a circle passing through the anchoring features of the IOL when the IOL is implanted, wherein at least one of the anchoring features protrudes transverse to a surface of the IOL that interfaces with the lens capsule adjacent to the corresponding anchoring capsulotomy. 
     
     
         10 . The method of  claim 1 , wherein:
 the eye has an anterior chamber;   the lens capsule includes an anterior capsule and a posterior capsule; and   the IOL is placed in a location selected from the group consisting of: within the anterior chamber, on or within the lens capsule, on the anterior side of the posterior capsule, and on the posterior side of the anterior capsule.   
     
     
         11 . The method of  claim 1 , wherein the IOL is a piggyback IOL. 
     
     
         12 . The method of  claim 4 , further comprising:
 coupling a second IOL to the lens capsule so that both the IOL and the second IOL are coupled to the lens capsule, wherein the second IOL is positioned anteriorly relative to the IOL, and wherein an orientation of the second IOL relative to the lens capsule is restrained using two or more anchoring capsulotomies created through the lens capsule with the laser.   
     
     
         13 . The method of  claim 4 , wherein:
 the lens capsule includes an anterior capsule and a posterior capsule; and   the anchoring capsulotomies are placed in locations selected from the group consisting of: the anterior capsule, the posterior capsule, and both the anterior and posterior capsules.   
     
     
         14 . A system for performing laser-assisted surgery on an eye having a lens capsule, the system comprising:
 a laser source configured to produce a treatment beam comprising a plurality of laser pulses;   an integrated optical system comprising an imaging assembly operatively coupled to a treatment laser delivery assembly such that they share at least one common optical element, the integrated optical system being configured to acquire image information pertinent to one or more targeted tissue structures and direct the treatment beam in a three-dimensional pattern to cause breakdown in at least one of the targeted tissue structures; and   a controller operatively coupled with the laser source and the integrated optical system, the controller being configured to control the system to cut an anchoring capsulotomy in the lens capsule, the anchoring capsulotomy being configured to accommodate an anchoring feature of an intraocular lens (IOL).   
     
     
         15 . The system of  claim 14 , wherein the anchoring feature protrudes transverse to a surface of the IOL that is configured to interface with the lens capsule adjacent to the anchoring capsulotomy. 
     
     
         16 . The system of  claim 14 , wherein each of the anchoring features comprises a location on the IOL prior to placement and wherein each of the plurality of anchoring capsulotomies is located on the capsule to align a center of the IOL with an optical axis of the eye and to align an aberration correcting axis of the IOL with a rotational axis of the eye in order to align the IOL with the optical axis and align the IOL with the rotational axis of the eye to correct the aberration. 
     
     
         17 . The system of  claim 14 , wherein a plurality of anchoring capsulotomies are formed in the lens capsule by using the laser to incise the lens capsule, each of the anchoring capsulotomies being configured to accommodate a corresponding anchoring feature of the IOL and wherein the corresponding feature on the IOL comprises a first portion and a second portion, the first portion comprising a first cross-sectional dimension sized to pass through the anchoring capsulotomy, the second portion comprising a second cross-sectional dimension less than the first cross-sectional dimension and wherein the feature extends a distance from a body of the IOL such that the first portion is retained on a first side of the capsule when the second portion extends through the capsule. 
     
     
         18 . The system of  claim 17 , wherein at least one of the anchoring capsulotomies has a shape different from the other anchoring capsulotomies and wherein the anchoring capsulotomy has a shape that is selected from the group consisting of: buttonhole, linear, bone-shaped, teardrop-shaped, round, rectangular with rounded corners, rectangular with sharp corners, square with rounded corners, square with sharp corners, a linear, and elliptical. 
     
     
         19 . The system of  claim 17 , wherein the anchoring capsulotomies and the IOL are configured to orient the IOL relative to the eye to provide correction of astigmatism of the eye and wherein the IOL comprises a predetermined arrangement of locations of the feature with respect to an aberration correcting axis of the IOL and wherein the anchoring capsulotomies are placed at locations to align the aberration correcting axis of the IOL to an aberration axis the eye in order to provide aberration correction of the eye and wherein locations of the anchoring capsulotomies are rotated in relation to the aberration correcting axis of the eye to align the IOL with the axis of the eye. 
     
     
         20 . The system of  claim 17 , wherein the anchoring capsulotomies are arranged such that they form a pattern that is selected from the group consisting of: rotationally symmetric, rotationally asymmetric, bilaterally symmetric, and bilaterally asymmetric. 
     
     
         21 . The system of  claim 20 , wherein the asymmetry is oriented such that it corresponds to a direction of natural asymmetry of capsular contraction. 
     
     
         22 . The system of  claim 17 , wherein at least one of the anchoring capsulotomies is elongated tangential to a circle passing through the anchoring features of the IOL when the IOL is implanted, wherein at least one of the anchoring features protrudes transverse to a surface of the IOL that is configured to interface with the lens capsule adjacent to the corresponding anchoring capsulotomy. 
     
     
         23 . The system of  claim 15 , wherein:
 the eye has an anterior chamber;   the lens capsule includes an anterior capsule and a posterior capsule; and   the IOL is configured to be placed in a location selected from the group consisting of: within the anterior chamber, on or within the lens capsule, on the anterior side of the posterior capsule, and on the posterior side of the anterior capsule.   
     
     
         24 . The system of  claim 15 , wherein the IOL is a piggyback IOL. 
     
     
         25 . The system of  claim 17 , wherein the anchoring capsulotomies are configured to couple a second IOL to the lens capsule so that both the IOL and the second IOL are coupled to the lens capsule, wherein the second IOL is positioned anteriorly relative to the IOL, and wherein an orientation of the second IOL relative to the lens capsule is restrained using two or more anchoring capsulotomies created through the lens capsule by the system. 
     
     
         26 . The system of  claim 15 , wherein:
 the lens capsule includes an anterior capsule and a posterior capsule; and   the anchoring capsulotomies are placed in locations selected from the group consisting of: the anterior capsule, the posterior capsule, and both the anterior and posterior capsules.   
     
     
         27 . A system for performing laser-assisted surgery on an eye having a lens capsule, the system comprising:
 a laser source configured to produce a treatment beam comprising a plurality of laser pulses;   an integrated optical system comprising an imaging assembly operatively coupled to a treatment laser delivery assembly such that they share at least one common optical element, the integrated optical system being configured to acquire image information pertinent to one or more targeted tissue structures and direct the treatment beam in a three-dimensional pattern to cause breakdown in at least one of the targeted tissue structures; and   a controller operatively coupled with the laser source and the integrated optical system, the controller being configured to control the system to cut a plurality of anchoring capsulotomies in the lens capsule, the anchoring capsulotomies being configured to accommodate a corresponding plurality of anchoring features of an second IOL configured to be installed at a preferred orientation to a first IOL, the first IOL being coupled in situ to the lens capsule.   
     
     
         28 . A method for performing a laser-assisted treatment of an eye having a lens capsule, the method comprising:
 forming an anchoring capsulotomy in the lens capsule by using a laser to incise the lens capsule, the anchoring capsulotomy being configured to accommodate a drug eluting member; and   removably coupling the drug eluting member to the anchoring capsulotomy, wherein a mechanical feature of the drug eluting member is removably fitted through the anchoring capsulotomy to retain the drug eluting member's position relative to the lens capsule.   
     
     
         29 . A system for performing a laser-assisted treatment of an eye having a lens capsule, the system comprising:
 a laser source configured to produce a treatment beam comprising a plurality of laser pulses;   an integrated optical system comprising an imaging assembly operatively coupled to a treatment laser delivery assembly such that they share at least one common optical element, the integrated optical system being configured to acquire image information pertinent to one or more targeted tissue structures and direct the treatment beam in a three-dimensional pattern to cause breakdown in at least one of the targeted tissue structures; and   a controller operatively coupled with the laser source and the integrated optical system, the controller being configured to control the system to cut an anchoring capsulotomy in the lens capsule, the anchoring capsulotomy being configured to accommodate a drug eluting member, wherein a mechanical feature of the drug eluting member is configured to be removably fitted through the anchoring capsulotomy to retain the drug eluting member's position relative to the lens capsule.   
     
     
         30 . A method of ophthalmic intervention, the method comprising:
 creating a pattern of anchoring capsulotomies in a lens capsule of an eye, the pattern of anchoring capsulotomies being configured to be mechanically coupled to anchoring features of an intraocular lens (IOL); and   coupling the IOL to the lens capsule by mechanically engaging the anchoring features with the pattern of anchoring capsulotomies.   
     
     
         31 . The method of  claim 30 , wherein at least one of the anchoring features protrudes transverse to a surface of the IOL that interfaces with the lens capsule adjacent to the corresponding anchoring capsulotomy. 
     
     
         32 . The method of  claim 30 , wherein at least one of the anchoring capsulotomies has a shape selected from the group consisting of: a buttonhole shape, a teardrop shape, a round shape, a rectangular shape with sharp corners, a rectangular shape with rounded corners, a linear shape, a bone shape, and an elliptical shape. 
     
     
         33 . The method of  claim 30 , further comprising creating a primary capsulotomy. 
     
     
         34 . The method of  claim 33 , wherein the primary capsulotomy defines a boundary shape selected from the group consisting of: a circular shape, an elliptical shape, a polygonal shape, an arcuate shape, and a linear shape. 
     
     
         35 . The method of  claim 34 , wherein creating a pattern of anchoring capsulotomies comprises placing two or more anchoring capsulotomies at locations substantially equivalently spaced apart about the boundary shape of the primary capsulotomy. 
     
     
         36 . The method of  claim 34 , wherein creating a pattern of anchoring capsulotomies comprises placing two or more anchoring capsulotomies at locations non-homogeneously spaced apart about the boundary shape of the primary capsulotomy. 
     
     
         37 . The method of  claim 30 , wherein creating a pattern of anchoring capsulotomies comprises incising the lens capsule with a laser. 
     
     
         38 . The method of  claim 33 , wherein creating a primary capsulotomy comprises incising the lens capsule with a laser. 
     
     
         39 . The method of  claim 30 , further comprising:
 determining a roll orientation to be established between the lens capsule and the IOL; and   placing the anchoring capsulotomies in locations configured to accomplish the determined roll orientation upon assembly of the IOL with the lens capsule.   
     
     
         40 . The method of  claim 39 , further comprising:
 determining an astigmatic axis of the eye; and   determining the roll orientation based at least in part upon the astigmatic axis of the eye.   
     
     
         41 . The method of  claim 30 , further comprising confirming that the IOL is at the determined roll orientation relative to the lens capsule before coupling the IOL to the lens capsule. 
     
     
         42 . The method of  claim 41 , wherein the confirming that the IOL is at the determined roll orientation comprises observing a roll orientation of a keyed feature of the IOL. 
     
     
         43 . The method of  claim 42 , wherein the confirming that the IOL is at the determined roll orientation comprises observing a roll orientation of a keyed feature of the lens capsule. 
     
     
         44 . The method of  claim 43 , wherein the keyed feature of the IOL is the relative positioning of the anchoring features. 
     
     
         45 . The method of  claim 44 , wherein:
 the pattern can be bisected along a bisecting axis to result in two symmetric pattern halves; and   the bisecting axis is utilized as the keying feature.   
     
     
         46 . The method of  claim 42 , wherein the keyed feature of the IOL is one or more keying markers created in the IOL. 
     
     
         47 . The method of  claim 43 , wherein the keyed feature of the lens capsule comprises one or more anatomic landmarks of the lens capsule. 
     
     
         48 . The method of  claim 43 , wherein the keyed feature of the lens capsule comprises one or more markers created in the lens capsule. 
     
     
         49 . The method of  claim 40 , wherein the pattern of anchoring capsulotomies is created to have a symmetry selected from the group consisting of: rotationally symmetric, rotationally asymmetric, bilaterally symmetric, and bilaterally asymmetric. 
     
     
         50 . The method of  claim 40 , wherein the determined roll orientation correspond to a direction of natural asymmetry of contraction of the lens capsule. 
     
     
         51 . The method of  claim 29 , wherein the IOL, upon coupling to the lens capsule, is located in an anterior chamber of the eye, in a capsular bag of the eye, on the anterior side of a posterior capsule of the eye, or on the posterior side of an anterior capsule of the eye.