CONTROL APPARATUS FOR AN OPHTHALMIC SURGICAL SYSTEM, OPHTHALMIC SURGICAL SYSTEM AND COMPUTER PROGRAM PRODUCT

Abstract

A control apparatus for an ophthalmic surgical system includes a receiver module which received a signal containing at least one geometric size of a pupil of an eye to be treated at least at a first time during a surgical procedure on the eye, at which fluid is supplied to and/or removed from the eye to be treated on the basis of set values of fluidic parameters of a fluidic apparatus. An evaluation unit allows the signal with the geometric sizes of the pupil to be compared to a geometric reference size of the pupil. An output module outputs an output signal of the evaluation unit, which contains information in respect of the geometric size of the pupil and/or information in respect of the above comparison to a control unit of the ophthalmic surgical system.

Claims

1. A control apparatus for an ophthalmic surgical system, the control apparatus comprising: a receiver module for receiving a signal containing at least a geometric size of a pupil of an eye to be treated at least at a first time point during a surgical procedure on the eye to which fluid is or has been supplied to and/or removed from the eye to be treated on the basis of set values of fluidic parameters of a fluidic apparatus of said ophthalmic surgical system; an evaluation unit configured to compare said signal to a geometric reference size of said pupil; an output module with which an output signal of said evaluation unit is outputted, said output signal of said evaluation unit containing information as to the geometric size of said pupil and/or information as to the comparison of the captured geometric size of said pupil to said reference size of said pupil; and, said output module being configured to output said output signal of said evaluation unit.

2. The control apparatus of claim 1, wherein said ophthalmic surgical system includes a control unit and an output unit; and, said output module is configured to output said output signal of said evaluation unit to said control unit and/or said output unit.

3. The control apparatus of claim 1, wherein said output module is configured to output said output signal of said evaluation unit to said output unit of said ophthalmic system for a user on said output unit.

4. The control apparatus of claim 2, further comprising: said control unit, during the surgical procedure including a phacoemulsification of the eye to be treated, being configured to adjust at least a pressure and/or a volumetric flow including in an irrigation line of an irrigation apparatus and/or in an aspiration line of an aspiration apparatus of a fluid of said fluidic apparatus in dependence upon said output signal of said output module and/or the value of the pressure and/or the value of the volumetric flow being provided at said output unit of the ophthalmic surgical system for a user.

5. The control apparatus of claim 1, wherein said receiving module for receiving a signal which contains at least a geometric size of a pupil of an eye to be treated at least at a first preparatory time, at which fluid is or has been supplied to and/or removed from the eye to be treated on the basis of a first set of values of fluid parameters of said fluidic apparatus of the ophthalmic surgical system during a preparation phase prior to the surgical procedure and which receiving module receives a further signal containing at least said geometric size of the pupil of the eye to be treated at least at a second preparation time following said first preparation time, during the preparation phase prior to which an artificial occlusion was produced in the eye and/or prior to which an artificial breakthrough of an occlusion in the eye was produced; and, said evaluation unit with which the signals with the geometric sizes of the pupil detected at the two preparation times can be evaluated.

6. The control apparatus of claim 5, further comprising said evaluation unit, with which at least one reference fluidic parameter setting during the preparation phase can be determined on the basis of the geometric sizes of the pupil captured at the two preparation times, said reference fluidic parameter setting being able to be set in the case of a breakthrough of an occlusion during the surgical procedure.

7. The control apparatus of claim 5, wherein said evaluation unit is configured to predetermine the reference size of the pupil during a preparation phase prior to the surgical procedure.

8. The control apparatus of claim 5, wherein a ratio of geometric sizes of the pupil can be formed and an actual ratio can be determined thereby via said evaluation unit, wherein the actual ratio can be compared to an intended ratio by way of said evaluation unit and, on the basis of the comparison, said evaluation unit determines whether the fluidic parameter setting preset at the first preparation time allows setting of a specific position setting of the lens in the eye toward a relative reference position (R), which is specified by the fluidic parameter setting at the first preparation time, following a breakthrough of the occlusion, wherein this position setting, starting from the relative position of the lens at the time of the occlusion prior to the breakthrough of said occlusion, to the relative reference position (R) is implemented without an overshoot or without an overshoot beyond this relative reference position (R) that is greater than a tolerance value.

9. The control apparatus of claim 8, wherein the fluidic parameter setting at the first preparation time can be assessed as suitable by the evaluation unit and said fluidic parameter setting is a reference fluidic parameter setting if the actual ratio equals 1.

10. The control apparatus of claim 8, wherein the fluidic parameter setting that was set at the first preparation time can be stored by the evaluation unit when the actual ratio equals or substantially equals the intended ratio.

11. The control apparatus of claim 5, wherein any signal containing respectively one geometric size of the pupil at a plurality of preparation times including at many preparation times, following the breakthrough of the occlusion up to a standstill of the movement of the capsular bag and the lens can be received by said receiver module, wherein said receiver module and/or said evaluation unit allow this plurality of signals to be analysed in terms of which has the smallest value of the geometric size of the pupil, wherein this signal with the smallest geometric size of the pupil can be set as that for the second preparation time.

12. The control apparatus of claim 3, further comprising: said receiver module, which allows a signal to be received, the latter containing at least one geometric size of a further eye part of the eye, differing from the pupil, of the eye to be treated at the first time during the surgical procedure on the eye, at which fluid is or has been supplied to and/or removed from the eye to be treated on the basis of set values of fluidic parameters of said fluidic apparatus of the ophthalmic surgical system; said evaluation unit, which allows the signal with the geometric size of the eye part which was captured at the first time during the surgical procedure on the eye to be compared to a geometric reference size of the eye part; and, said output module which allows the output of an output signal of the evaluation unit, which contains information in respect of the geometric size of the eye part and/or information in respect of the comparison of the captured geometric size of the eye part with the reference size of the eye part including allowing the output thereof to said control unit of the ophthalmic surgical system and/or allowing the output thereof on said output unit of the ophthalmic surgical system, for a user.

13. The control apparatus of claim 12, further comprising: said receiver module, which allows a signal to be received, the latter containing at least one geometric size of the eye part of the eye to be treated at least at one first preparation time, at which fluid is or has been supplied to and/or removed from the eye to be treated on the basis of a first set values of fluidic parameters of said fluidic apparatus of the ophthalmic surgical system during a preparation phase prior to a surgical procedure, and which allows a further signal to be received, the latter containing at least this geometric size of the eye part of the eye to be treated at least at one second preparation time, following the first preparation time, during the preparation phase prior to which an artificial occlusion was produced in the eye and/or prior to which an artificial breakthrough of an occlusion in the eye was produced; said evaluation unit with which the signals with the geometric sizes of the eye part captured at the two preparation times can be evaluated; and, the control unit with which, during the surgical procedure, including a phacoemulsification of the eye to be treated, at least one pressure and/or a volumetric flow in an irrigation line of an irrigation apparatus and/or in an aspiration line of an aspiration apparatus, of a fluid of said fluidic apparatus is adjustable on the basis of the output signal of the output module and/or the value of the pressure and/or the value of the volumetric flow is providable including on the output unit of the ophthalmic surgical system, for a user.

14. The control apparatus of claim 12, wherein the further eye part is the limbal ring and/or the cornea and/or the sclera and/or the capsular bag of the eye; and/or, the value of the pressure and/or the value of the volumetric flow is providable on an output unit for a user.

15. The control apparatus of claim 3, wherein the geometric size of the pupil is an area (A1, A2, A3, A4) or a change in area of the pupil and/or a diameter or a change in diameter of the pupil and/or a circumference of the pupil or a change in circumference of the pupil.

16. The control apparatus of claim 3, further comprising a display unit, on which the first values of the fluidic parameters and/or the captured geometric sizes and/or the evaluated geometric sizes are displayed.

17. The control apparatus of claim 1, wherein the evaluation unit allows geometric sizes of a pupil, which are no further apart than 500 ms in time, to be compared to one another.

18. An ophthalmic surgical system comprising: a control apparatus; the control apparatus including: a receiver module for receiving a signal containing at least a geometric size of a pupil of an eye to be treated at least at a first time point during a surgical procedure on the eye to which fluid is or has been supplied to and/or removed from the eye to be treated on the basis of set values of fluidic parameters of a fluidic apparatus of said ophthalmic surgical system; an evaluation unit configured to compare said signal to a geometric reference size of said pupil; an output module with which an output signal of said evaluation unit is outputted, said output signal of said evaluation unit containing information as to the geometric size of said pupil and/or information as to the comparison of the captured geometric size of said pupil to said reference size of said pupil; and, said output module being configured to output said output signal of said evaluation unit.

19. The ophthalmic surgical system of claim 18, further comprising an optical capturing apparatus for capturing said at least one geometric size of at least one pupil.

20. The ophthalmic surgical system of claim 19, wherein said optical capturing apparatus is at least one camera.

21. A computer program product comprising commands which, when the program is executed by a processor, prompt the latter to carry out a method for controlling a fluidic apparatus of an ophthalmic surgical system, the computer program product being stored on a non-transitory computer readable storage medium; the method comprising the following steps: setting fluidic parameters of a fluidic apparatus of the ophthalmic surgical system and supplying fluid to an eye on the basis of the fluidic parameters set at a first time during a surgical procedure on the eye; providing a signal having a geometric size of a pupil of the eye to be treated, during and/or after the supply of the fluid and/or removal of fluid, on the basis of the first fluidic parameters, to a receiver module of the ophthalmic surgical system; evaluating the signal with the geometric size of the pupil which was captured at the first time during the surgical procedure on the eye by a comparison with a geometric reference size of the pupil; outputting an output signal, which contains information in respect of the geometric size of the pupil and/or information in respect of the comparison of the captured geometric size of the pupil with the reference size of the pupil, via an output module of the ophthalmic surgical system including to a control unit of the ophthalmic surgical system and/or on an output unit of the ophthalmic surgical system, for a user; setting an operating state including at least one pressure and/or a volumetric flow in an irrigation line of an irrigation apparatus and/or in an aspiration line of an aspiration apparatus, of a fluid of the fluidic apparatus on the basis of the output signal using a control unit of the ophthalmic surgical system during the surgical procedure including phacoemulsification on the eye to be treated.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0104] The invention will now be described with reference to the drawings wherein:

[0105] FIG. 1 shows a schematic illustration of an embodiment of an ophthalmic surgical system showing an embodiment of a control apparatus;

[0106] FIG. 2A shows a plan view of a portion of an eye to be treated, in which the eye to be treated is shown in an influence state and a geometric size of the pupil of this eye is shown as a reference;

[0107] FIG. 2B shows the portion of the eye to be treated as per FIG. 2A in a state of an artificially produced occlusion or in an artificially produced occlusion-like state during a preparation phase before a surgical procedure, wherein the geometric size of the pupil has increased in relation to the reference in FIG. 2A in this artificially produced state;

[0108] FIG. 2C shows the portion of the eye to be treated, as per FIG. 2A and 2B, in a state of an artificially produced breakthrough of the occlusion or in an artificially produced occlusion breaking-like state, wherein the geometric size of the pupil has decreased in relation to FIG. 2A and FIG. 2B;

[0109] FIG. 3A shows a position of a capsular bag with a lens in an eye in a normal state, in which no surgical instrument has been inserted into the eye;

[0110] FIG. 3B shows a schematic of a position of the capsular bag with the lens in an influence state, in which a surgical instrument has been inserted into the eye and/or fluidic parameters have been preset;

[0111] FIG. 3C shows a schematic of a position of the capsular bag with the lens in a state in which an occlusion has been produced in an aspiration line;

[0112] FIG. 3D shows a schematic of a position of the capsular bag with the lens in a state in which a breakthrough of an occlusion in an aspiration line has been produced and there is a setting of at least one fluidic parameter in the case of which the smallest geometric size of the pupil, which occurred during the movement of the lens and the capsular bag, is the same size or substantially the same size as in the influence state as per FIG. 3B;

[0113] FIG. 3E shows a schematic of a position of the capsular bag with the lens in a state in which a breakthrough of an occlusion in the aspiration line has been produced and there is a setting of at least one fluidic parameter in the case of which the smallest geometric size of the pupil, which occurred during the movement of the lens and the capsular bag, is significantly smaller than in the influence state as per FIG. 3B;

[0114] FIG. 3F shows a schematic of a position of the capsular bag with the lens in a state as per FIG. 3B;

[0115] FIG. 4 shows a diagram, in which two different fluidic parameters of a fluidic apparatus of the ophthalmic surgical system as per FIG. 1 are plotted and a characteristic line is illustrated, the latter indicating the specific fluidic parameter value pairs at which the geometric size of the pupil of the eye to be treated in the state as per FIG. 3D equals the geometric size of the pupil in the influence state as per FIG. 3B; and,

[0116] FIG. 5 shows a diagram as per FIG. 4, showing the characteristic line for a different eye to that of FIG. 4.

DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION

[0117] In the figures, identical or functionally equivalent elements are provided with the same reference signs.

[0118] FIG. 1 shows a schematic of an ophthalmic microsurgical system or an ophthalmic surgical system 1 for phaco-surgery on an eye 2. The illustration according to FIG. 1 shows a few of the components of the system 1 in symbolic fashion for a simplified explanation of the basic general functionality of the system 1.

[0119] The system 1 comprises a device unit 3, which can be, for example, a trolley or the like. Preferably, an operating unit 4 is arranged in or on the device unit 3. By way of example, this operating unit 4 may comprise a user interface, an input unit such as a keyboard or the like and a display unit, in particular as an output unit 4a , such as a monitor or display. Furthermore, a fluidic apparatus 5 that comprises a pump and a control unit for controlling the pump and connected components, in particular, is preferably arranged in the device unit 3. The fluidic apparatus 5 comprises an irrigation apparatus 6 with an irrigation branch or an irrigation line and an aspiration apparatus 7 with an aspiration branch or an aspiration line. The irrigation apparatus 6 comprises a container 8 for rinsing liquid, for example a BSS solution, which is a fluid for irrigation and which is guided to a phaco-handpiece. The phaco-handpiece is an ophthalmic surgical handpiece 9. In particular, it is a constituent part of the ophthalmic surgical system 1. The aspiration apparatus 7 is likewise connected to the ophthalmic surgical handpiece 9. Moreover, the device unit 3 comprises an ultrasonic unit 10 in particular, the latter being embodied to excite an oscillation of piezoelectric elements 11 in the ophthalmic surgical handpiece 9, by means of which a hollow needle 12 of the ophthalmic surgical handpiece 9 is excited to oscillate. Further, the device unit 3 comprises a control unit 13, in particular. The control unit 13 can also be embodied to control a vitrectomy handpiece 14, which, in particular, may be a constituent part of the ophthalmic surgical system 1. Preferably, the vitrectomy handpiece 14 is also connected to the fluidic apparatus 5, in particular by a further aspiration line 15. Moreover, provision can be made for a further control unit 16, the latter controlling a preferably available further surgical instrument 17, for example for diathermy. Moreover, the system 1 and, in particular, the device unit 3 could comprise further modules. This also comprises further internal units, and also peripheral devices.

[0120] Moreover, the ophthalmic surgical system 1 preferably comprises a foot control panel 22, which is connected to the device unit 3, more particularly to communication devices and control units of the device unit 3.

[0121] Moreover, FIG. 1 schematically shows a natural lens 23 in the eye 2. This lens 23 can be removed by the ophthalmic surgical system 1, in particular by phacoemulsification.

[0122] In an alternative embodiment, provision can be made for the ophthalmic surgical system 1 to comprise a tank 8 (FIG. 1) that is separate from the container 8. In such an embodiment, the cooling fluid, which is provided to cool the incision, is provided separately from the irrigation apparatus 6 and separately from the container 8. The tank 8 can be arranged separately from the handpiece 9 and, for example, can be connected to the handpiece 9 via a line, such as a tube connection.

[0123] In a further embodiment, provision can be made for the separate tank 8 to be arranged in the handpiece 9. It can be arranged in the handpiece 9 in a non-destructively non-detachable or non-destructively detachable fashion. Provision could also be made for a first separate tank 8 to be arranged in the handpiece 9 and for a further separate tank 8 to be arranged outside of the handpiece 9. This further tank 8 outside of the handpiece 9 can be connected in fluid-conducting fashion to the tank 8 arranged in the handpiece 9.

[0124] In particular, this ophthalmic surgical system 1 comprises a control apparatus 18. In particular, this control apparatus 18 comprises at least one receiver module 18a.

[0125] The ophthalmic surgical system 1 preferably comprises at least one optical capturing apparatus 19. In particular, at least one geometric size of a pupil of the eye 2 to be treated can be captured with this optical capturing apparatus 19. This can be carried out, in particular, at least at one first time during a surgical procedure on the eye, at which fluid is or has been supplied to and/or is or has been removed from the eye 2 to be treated on the basis of set values of fluidic parameters of the fluidic apparatus 5. Likewise, the geometric size of the pupil can be also captured by the optical capturing apparatus 19 during a preparation phase before the surgical procedure. This can be carried out, in particular, at least at one first preparation time during the preparation phase. During the preparation phase, the hollow needle 12 has been injected into the eye 2 but is arranged at such a distance from the capsular bag and the natural lens 23 in the eye 2 that there is no impairment by the hollow needle 12 in the case of a movement of the capsular bag with the lens 23, in contrast to the actual surgical procedure. In particular, there has not yet been any artificial production of an occlusion or a breakthrough of the occlusion in the eye 2 at this first time, which is during a preparation phase prior to an actual phacoemulsification. Thus, an influence state on the eye 2, in particular, is also produced at this first preparation time. This influence state differs from a normal state of the eye 2, in which no surgical instrument has been inserted into the eye 2 and no other surgical examination influence is exerted on the eye 2.

[0126] The optical capturing apparatus 19 is further embodied to allow the capture of at least one geometric size of the pupil of the eye 2 to be treated at least at one second preparation time during the preparation phase, prior to which an artificial occlusion was produced in the eye 2 and/or an artificial breakthrough of the occlusion was produced in the eye 2. This is generated artificially and in time-defined fashion, in particular immediately before the second time of the breakthrough of the occlusion, that is, in particular less than 200 ms therebefore.

[0127] In one embodiment, the control apparatus 18 includes: [0128] a receiver module 18a which allows a signal to be received, the latter containing at least one geometric size of a pupil 25 (for example, FIG. 2A) of an eye 2 to be treated at least at one first time during a surgical procedure on the eye 2, at which fluid is or has been supplied to and/or removed from the eye 2 to be treated on the basis of set values of fluidic parameters of a fluidic apparatus 5 of the ophthalmic surgical system 1; [0129] an evaluation unit 20 which allows the signal with the geometric size of the pupil 25 which was captured at the first time during the surgical procedure on the eye 2 to be compared to a geometric reference size of the pupil 25; [0130] an output module 18b which allows the output of an output signal of the evaluation unit 20, which contains information in respect of the geometric size of the pupil 25 and/or information in respect of the comparison of the captured geometric size of the pupil 25 with the reference size of the pupil 25, in particular allows the output thereof to a control unit 21 of the ophthalmic surgical system 1 and/or allows the output thereof on an output unit 4a , in particular of the ophthalmic surgical system 1, for a user.

[0131] In particular, the control apparatus 18 comprises a control unit 21 by means of which, during the surgical procedure, in particular phacoemulsification, of the eye 2 to be treated, at least one pressure and/or a volumetric flow, in particular in an irrigation line of an irrigation apparatus 6 and/or in an aspiration line of an aspiration apparatus 7, of a fluid of the fluidic apparatus 5 is adjustable on the basis of the output signal of the output module 18b and/or the value of the pressure and/or the value of the volumetric flow is providable, more particularly provided, on the output unit 4a , in particular of the ophthalmic surgical system 1, for a user.

[0132] In this embodiment, the control apparatus 18 is arranged outside of the optical capturing apparatus 19.

[0133] In a further embodiment, provision can be made for the receiver module 18a , the evaluation unit 20 and the output module 18b to be constituent parts of the optical capturing apparatus 19. In this further embodiment, these components are integral constituent parts of the optical capturing apparatus 19. In a further embodiment, the control unit 21, in particular, is arranged outside of the optical capturing apparatus 19 and is not a constituent part of the optical capturing apparatus 19.

[0134] In a yet further embodiment, provision can be made for the optical capturing apparatus 19 to only comprise the receiver module 18a of the control apparatus 18.

[0135] In particular, provision can be made for at least two such different fluidic parameter settings to be set as basic settings during a preparation phase or test phase before the phacoemulsification to be actually carried out on the eye 2 to be treated. This is respectively followed in time by, in particular, an artificially produced break of an occlusion during this preparation phase and the geometric size of the pupil is also optically captured in each case here, particularly shortly after this event. In particular, the geometric size of the pupil can be captured, in particular in individual images or as a video, by the optical capturing apparatus 19 over the entire time duration during this preparation phase, from the break of the occlusion up to the standstill of the movement of the lens 23 and of the capsular bag in the eye 2.

[0136] In particular, the fluidic parameters relate to a pressure and/or a volumetric flow of the fluid in the aspiration line of the aspiration apparatus 7. In addition or as an alternative thereto, the fluidic parameters can relate to a pressure and/or a volumetric flow of the fluid in the irrigation line 6. In respect of the fluidic parameters of the fluid in the irrigation line, it is also possible to take account of the height of the container 8 in relation to a reference level, in particular the floor, at which the ophthalmic surgical system 1 has been set up. Taking account of this height, it is possible to determine a pressure of the fluid in the irrigation line.

[0137] In particular, this fluid is supplied into the eye 2 during this preparation phase, and so it is possible to assess during this preparation phase the reaction of this eye 2 to be treated on the basis of this individual fluid supply, as is then defined by the fluidic parameter settings.

[0138] The optical capturing apparatus 19 is preferably a surgical microscope. Therefore, it is not necessary to use an optically complicated and expensive OCT system. The surgical microscope can comprise the output module 18b . The optical capturing apparatus 19 can also comprise at least one camera.

[0139] This also allows decision information to be providable for a selection of a physical operation component during the subsequent phacoemulsification, which also includes the implantation of an intraocular lens into the eye 2, of the eye 2 to be treated on the basis of these evaluated geometric sizes of the pupil 25.

[0140] In particular, the control apparatus 18 also allows different fluidic parameter settings to be set during the specified preparation phase and allows a potential occlusion and/or a potential break of an occlusion to be simulated very realistically or to be artificially produced. This then allows the determination and prediction of very precise conclusions in respect of the reaction of the eye 2 during the subsequent actual phacoemulsification, during which an actual occlusion and an actual break of such an occlusion may occur. As a result of the aforementioned advantageous embodiment, in which these evaluated geometric sizes obtained during the preparation phase are used as a basis for setting the operating state of the fluidic apparatus 5 during the subsequent phacoemulsification, it is possible to very exactly set the operating state in order to identify an actual occlusion during the phacoemulsification and/or an actual break in best possible and timely fashion and in order to be able to react very precisely thereto. In particular, an adapted fluid supply and an adapted fluid removal from the eye 2 are carried out as a result of this operating state then set in the case of such an occlusion. The same then also applies to a break of an occlusion during the phacoemulsification. Such a state can also be implemented by the control unit 21 by setting the very specific operating state of the fluidic apparatus 5 to the effect that the eye 2 remains in a virtually stable state, even in the case of such a break. This means that the movement of the capsular bag and of the lens is reduced, in particular that, following a break of the occlusion, an overshoot beyond a relative reference position toward the cornea can be at least reduced. The disadvantages set forth at the outset, which may occur as a result of an occlusion and/or break of such an occlusion during phacoemulsification and which can accordingly impair the eye 2, can be at least significantly reduced by this procedure.

[0141] Provision can also be made for the control unit 13 and/or the control unit 16 to be constituent parts of the control apparatus 18.

[0142] Provision can also be made for one of the control units 13 and/or 16 to be the control unit 21.

[0143] For the geometric size of the pupil, provision can also be made for an area or a change in area of this pupil to be taken into account and/or for a diameter or a change in diameter of the pupil to be taken into account. In particular, such an area is considered in a plane, in particular a projection plane, in the case of a plan view of the eye 2 to be treated.

[0144] In the case of a break of an occlusion, there is a fast and significant drop of pressure in the ocular chamber on account of the volumetric flows in the irrigation line and in the aspiration line, which change over a very short period of time, and there subsequently is a reduction in the volume of the anterior chamber of the eye. The pressure drop can lead to the cornea sinking in. Contact between the inner side of the cornea and surgical instruments introduced into the eye may damage the internal terminating corneal tissue, the endothelium. A significantly damaged endothelium may lead to necrosis of the cornea. A further disadvantage that may occur as a result of this instability in the eye on account of the different inflows and outflows is an aspiration of the back capsular bag wall. The break of the occlusion can lead to the aspiration of the back capsular bag wall in the case of eyes where the lens has been removed. In the process, the thin skin of the capsular bag can be permanently injured and this can make the subsequent insertion of the intraocular lens significantly more difficult. The task is to avoid these impairments and this is facilitated, in particular, using the aforementioned control apparatus 18, and so an anterior chamber of the eye 2 that is as stable as possible during actual phacoemulsification is facilitated. Consequently, such an instability in the eye 2 is, in particular, a change in the volume, in particular a change in the form, of the anterior chamber of the eye.

[0145] In addition to determining the geometric size of a pupil of the eye 2 to be treated, it is also possible to capture and assess at least one eye part of the eye 2 that differs from the pupil. In particular, this can also be implemented during the preparation phase in order to also carry out appropriate analyses in this case, as have already been explained above in respect of the geometric size of the pupil. In particular, it is also possible, to this end, to capture a geometric size of the eye part at least at two different preparation times. In particular, this can also be implemented using the optical capturing apparatus 19. By way of example, the limbal ring of the eye 2 to be treated and/or the cornea of the eye 2 to be treated and/or the sclera of the eye 2 to be treated and/or the capsular bag of the eye 2 to be treated can be specified as such a different eye part. In particular, it is also possible to capture and assess a geometric size in the case of the limbal ring, in particular the area and/or the diameter. Using this, it is also possible to draw conclusions about an occlusion and/or a break of the occlusion on the basis of changes in size in the case of these different fluidic parameter settings. The limbal ring describes the boundary between the iris, the cornea and the sclera.

[0146] Observing the cornea advantageously allows a formation of folds to be captured optically. These folds form on the cornea in the case of a transition from a stable chamber with a convex cornea to a collapsed chamber. Consequently, the occurrence of such folds is considered to be an indication of an unstable chamber. An increase in the corneal radius is expected before the occurrence of such folds in the case of a drop in pressure in the eye, in particular in the anterior chamber of the eye.

[0147] Additionally, the structure or the pattern of the iris can also be captured during these different fluidic parameter settings and can be used for the assessment as to whether an occlusion is imminent or has taken place and/or whether a break of an occlusion is imminent or has taken place.

[0148] In particular, a possible tilt of the eye 2 to be treated, which may affect the analysis, is also taken into account. This can be carried out using known image evaluation methods.

[0149] In view of setting the operating state of the fluidic apparatus 5 by the control unit 21, the latter can be implemented during the surgical procedure, in particular the phacoemulsification, to the effect of there being a message to the surgeon that there is a need for action and/or, optionally, which action is needed to stabilize the anterior chamber of the eye. Provision can also be made for the control unit 21 to independently and automatically operate the fluidic apparatus 5 so as to be able to counteract a destabilizing event. This also is the setting of such a specific operating state. These courses of action can be both for the short term and for the long term. This allows immediate events to be counteracted in the short term and for a restricted amount of time.

[0150] At least the first values of the fluidic parameters and/or the captured geometric sizes and/or the evaluated geometric sizes can be displayed on the output unit 4a of the operating unit 4.

[0151] FIG. 2A shows a plan view of a portion of the eye 2 to be treated, with a pupil 25 being surrounded by an iris 24. Shown here is a state in which the eye 2 to be treated is in a stable state during this preparation phase prior to phacoemulsification; this state is denoted an influence state, as already mentioned above. Here, an area A1 of the pupil 25 is shown as a reference. The absolute value of the area A1 is equated to an opening size of the pupil 25 of 100 percent. Proceeding from this state at a first preparation time, fluidic states are set during this preparation phase. In the process, an occlusion-like state is also set artificially. By way of example, the aspiration line of the aspiration apparatus 7 can be bent to this end or the volumetric flow flowing therein can be reduced in any other way such that the throughflow is significantly reduced or prevented. This is shown in FIG. 2B. However, preferably, a magnetic valve 26 (FIG. 1) could also be arranged in the aspiration line of the aspiration apparatus 7, which magnetic valve can be opened and closed accordingly.

[0152] What was found in this set state, which is shown in FIG. 2B, is that there has been a change in the geometric size of the pupil 25; in particular, the latter has increased to the area A2. By way of example, an increase by up to 10 percent in comparison with the area A1 may occur here. This, too, is optically captured by the optical capturing apparatus 19. As may be identified in FIG. 2A and 2B, the tip 27 of the hollow needle 12, in particular, has been introduced during this preparation phase into the eye 2 to be treated so that fluid can be supplied by the irrigation line of the irrigation apparatus 6 and can be aspirated from the eye 2 to be treated by the aspiration line of the aspiration apparatus 7. Proceeding from the state shown in FIG. 2B, the break of the occlusion can then be produced artificially during the preparation phase. By way of example, this can be simulated or artificially produced by ending the bend in the aspiration line or, if a magnetic valve 26 is preferably present, by opening the magnetic valve 26. In particular, in this context, it is consequently also possible to break up an occlusion simulated as per FIG. 2B and, as per the illustration in FIG. 2C, bring about such a break of an occlusion, which was simulated or produced in an artificially defined fashion, as an occlusion breaking-like state.

[0153] As may be identified in the illustration of FIG. 2C, there once again is a characteristic change in the geometric size of the pupil 25 in this context. Specifically, there is a reduction to the area A4. This reduction occurs both in relation to the reference, specifically the area A1 as per FIG. 2A, and in relation to the increased area A2 as per FIG. 2B. In particular, there are reductions here of up to 10 percent, in particular of up to 8 percent, in comparison with the reference in FIG. 2A.

[0154] Provision can be made for a respective influence state to be produced at a plurality of different preparation times during the preparation phase, the influence states being different as their values of the fluidic parameters are set in defined different fashion. Hence, an even more precise statement can be made during the preparation phase in respect of the reaction of the eye 2 to be treated in the case of specific states, in particular in the case of a potential occlusion and/or a potential break of such an occlusion.

[0155] In addition to observing the area of the pupil 25 in the case of these different fluidic parameter settings during the preparation phase for phacoemulsification, further characteristic eye parts can be observed in respect of their geometric size. In particular, this relates to a limbal ring 28. Here, too, the corresponding change in area can also be observed and evaluated. In particular, this can be implemented in accordance with what was explained above and will be explained below in relation to the pupil. In addition or as an alternative thereto, it is also possible to capture and assess a sclera, which is not shown in FIG. 2A to 2C. It is also possible to observe a cornea 29 of the eye 2 to be treated. In particular, it is possible to identify in this context that folds 30 occur in the cornea 29 in the case of a state as per FIG. 2C and consequently in the case of such a simulated break of the occlusion. The folds can likewise be captured by the optical measuring apparatus 19.

[0156] Below, FIG. 3A to FIG. 3F are used to explain the processes occurring in the eye 2 to be treated when these different stability states occur in the eye 2 on account of the corresponding fluidic states. FIG. 3A shows the aforementioned normal state. The capsular bag 31 with the lens 23 is arranged in a specific relative position. In a plan view of the eye 2, this results in a visible area A0 of the pupil 25.

[0157] FIG. 3B shows a schematic illustration in which the eye 2 is in an aforementioned influence state. A hollow needle 12 is pierced into the eye 2 and fluid is supplied by the irrigation line and/or removed by the aspiration line. As a result, this also sets first values of fluidic parameters at a first time. In this influence state, the pupil 25 has a visible area A1 in the plan view. This area A1 is slightly larger than the area A0. This area A1 can be a reference size of the pupil 25. It can be predetermined as a reference size.

[0158] What was found here is that, in the state as per FIG. 3B and in the lower illustration in that case which shows a simplified sectional view, a lens 23 in a capsular bag 31 is arranged in a relative reference position or reference position R when the interior of the eye 2 to be treated is stable. In this context, the reference position R is defined, for example, in relation to a front side 32, in particular a maximum of the convexly curved front side 32, which faces the cornea 29. In FIG. 3B, first values of fluidic parameters, which cause this stable relative position of the lens 23, have been set.

[0159] If the pressure in the interior of the eye 2 is now increased and consequently more fluid is supplied than aspirated, as already explained in relation to FIG. 2B, it is possible to identify that the lens 23 has moved out of its reference position R as per FIG. 3B; specifically, it is moved further away from the cornea 29. This is shown in the lower illustration of FIG. 3C. Accompanying this, it was observed that the pupil 25 increases to the area A2 in comparison with the area A1, as shown in FIG. 3C in the schematic plan view of the upper illustration there. In particular, this is caused by an occlusion-like state, which causes this reaction in the eye 2. Thus, FIG. 3C shows the position of the capsular bag 31 and of the lens 23 in the case of an occlusion.

[0160] If then, proceeding from the state in FIG. 3C, a break of such an occlusion is produced, in particular if an occlusion breaking-like state is caused, it was observed that the lens 23 can carry out a movement toward the cornea 29; see FIG. 3D and FIG. 3E. This is effected by way of moving beyond the reference position R. Consequently, there is, as it were, a certain amount of overshoot beyond the reference position R, shown in FIG. 3B, to the cornea 29, as shown in FIG. 3E. In this context, it was also possible to determine that the area A4 of the pupil 25 is set. The area A4 is smaller than both the area A2 and the area A1. The position of the lens 23 is shown in the lower illustration of FIG. 3E; the area A4 is shown in the upper plan view illustration of FIG. 3E.

[0161] Proceeding from this position in FIG. 3E, the lens 23 then moves back into the initial relative position, as was illustrated in FIG. 3B and as is shown again in FIG. 3F. This is once again accompanied by a change in the pupil 25, from the area A4 to the area A1, as shown in FIG. 3F. These processes in the eye 2 relate to the lens 23 and the capsular bag 31. Consequently, they relate to the change in size of the pupil 25, in particular the change in area of the pupil 25. This accompanies the change in pressure in the eye 2. Hence, as already presented above, very precise statements about the reaction of the eye 2 to be treated can be made in the case of the different fluidic parameter settings by way of using the relatively simple optical capture of this area of the pupil 25 in these different fluidic parameter settings. Particularly if these fluidic parameter settings are occlusion-like states and/or occlusion breaking-like states, very precise conclusions can consequently be drawn during the preparation phase as to which actual fluidic parameter settings are required during the phacoemulsification in order to be able to maintain a more or less stable state in the eye 2, even in the case of an occlusion during the phacoemulsification or a break of an occlusion during the phacoemulsification. Then, these settings are reference fluidic parameter settings.

[0162] In order to avoid the position of the lens 23 as per FIG. 3E, and hence in order to avoid or at least significantly reduce the overshoot, the areas of the pupil 25 are captured during the preparation phase following the artificially produced break of the occlusion, at least at a preparation time, in particular at a plurality of preparation times, in particular continuously, by means of the optical capturing apparatus 19. Thus, for example, FIG. 3D shows an illustration that has occurred after the artificial break of the occlusion. An area A3 of the pupil 25 has been captured by the capturing apparatus 19. In particular, this is the smallest area that occurred during the travel of the capsular bag 31 and the lens 23 following an artificially produced break of the occlusion, from the relative position in FIG. 3C, which also counts as an example of an artificially produced occlusion, up to the standstill of the capsular bag 31 and the lens 23. The changes in area of the pupil 25 accompanying this movement are captured. This smallest area A3 is then considered to be the area captured at a second preparation time.

[0163] If this smallest area A3 is smaller than the area A1, the capsular bag 31 and the lens 23 have overshot the relative reference position R toward the cornea 29. By forming a ratio from the actual ratios of the geometric sizes of the pupil 25, in particular the areas A1 and A3 at the two preparation times, it is possible to identify that these associated set first values of the fluidic parameters are not suitable, for example, to sufficiently prevent the overshoot in this specific eye 2 during the actual surgical procedure. In particular, this ratio of the areas A1/A3 is compared to a specified intended ratio. This intended ratio preferably equals 1.

[0164] Since the ratio A1/A3 is (significantly) greater than 1 in this case, this fluidic parameter setting is unsuitable. It therefore does not represent a reference fluidic parameter setting.

[0165] If this smallest area A3 is greater than the area A1, then the capsular bag 31 and the lens 23 no longer reach the relative reference position R with this specific fluidic parameter setting. Then, the ratio A1/A3 is (significantly) less than 1 in this case. These could be reference fluidic parameter settings.

[0166] However, if this smallest area A3 has the same size as the area A1, or at least substantially the same size, as shown in FIG. 3D, for example, it is possible to identify that the lens 23 and the capsular bag 31 have reached the relative reference position R without overshooting beyond the relative reference position R. Then, the ratio A1/A3 equals 1 or substantially equals 1. Hence, a fluidic parameter setting has been identified, which is advantageous for the specific eye 2 in a subsequent surgical procedure for the purposes of avoiding an overshoot. They therefore represent a reference fluidic parameter setting.

[0167] The geometric size of at least the pupil 25 can be captured, in particular continuously, by the optical capturing apparatus 19 during the subsequent surgical procedure. Thus, the evaluation unit can compare this captured geometric size of at least the pupil 25 with the predetermined geometric reference size, in particular using the evaluation unit 20. It is possible to determine, in particular continuously determine, a deviation or a change in the deviation of the geometric size of at least the pupil 25 from the geometric reference size of at least the pupil 25. Depending thereon, it is then possible to identify at least one state during the surgical procedure, in the case of which a real break of a real occlusion is imminent. It is then possible to react thereto by virtue of setting a reference fluidic parameter setting. Consequently, what can also be achieved is that an area A4, as explained above, no longer occurs during the surgical procedure. This is successful since is it possible to avoid an overshoot of the capsular bag 31 beyond the relative reference position R toward the cornea 29. In particular, this also renders it possible to avoid the tip 27 injuring the back capsular bag wall.

[0168] FIG. 4 shows, in a simplified example, a diagram in which the horizontal axis shows, as a fluidic parameter, the height of the container 8 in relation to a reference level, in particular the aforementioned floor. By way of example, it is possible to determine the pressure in the irrigation line of the irrigation apparatus 6 on the basis of this height and/or, in particular, on the basis of further parameters. Shown on the vertical axis of this diagram is the pressure in the aspiration line of the aspiration apparatus 7 as a further fluidic parameter. The diagram shows a characteristic line I. This characteristic line I characterizes information about a stable and an unstable state obtained during a preparation phase for a specific eye 2 to be treated. Here, the characteristic line I characterizes those points at which value pairs of the fluidic parameters are present, as were set as per FIG. 3B in an influence state, and at which the lens 23 and the capsular bag 31 have adopted the state as per FIG. 3D with an area ratio of the area A1 to the area A3 of 1 or of substantially 1 and, in this respect, there is no corresponding overshoot from the state in FIG. 3C beyond the relative reference position R to the cornea if a break of the occlusion is produced. On the basis of this characteristic line I and consequently on the basis of the characteristic fields thereabove and therebelow, it is possible to clearly identify those fluidic parameter settings which are advantageous or disadvantageous during the phacoemulsification of this eye 2 to be treated. In particular, this can be seen in respect of a stable state of this eye 2 to be treated during phacoemulsification, when an occlusion occurs or when a break of an occlusion occurs.

[0169] FIG. 5 shows a corresponding diagram as in FIG. 4, but for a different eye than in FIG. 4. A characteristic line II shown here therefore deviates from the characteristic line I in FIG. 4.

[0170] The diagrams as per FIG. 4 and FIG. 5 can likewise be displayed on the output unit 4a of the ophthalmic surgical system 1 in an advantageous embodiment.

[0171] The characteristic lines I and II can each be produced by determining a multiplicity of value pairs of these fluidic parameters, as explained above. However, it is also possible to only determine a few such value pairs, for example at least two such value pairs, and the characteristic line could be produced by interpolation, for example.

[0172] In particular, the ophthalmic surgical system 1, in particular the control apparatus 18, can have a computer program product comprising commands which, when the computer program product is stored on the control unit 21, are able to carry out the steps of the aforementioned method. In particular, the computer program product can be stored on a computer-readable medium, such as a hard drive. However, this computer program product could also be stored in a cloud, for example.

[0173] A further aspect of the invention relates to the use of the control apparatus 18. In particular, the control apparatus 18 is used when controlling the fluidic apparatus 5 of the ophthalmic surgical system 1, in particular when controlling fluidic parameters of a fluid of the fluidic apparatus 5, in particular of the irrigation fluid and/or of the aspiration fluid, during phacoemulsification.

[0174] It is understood that the foregoing description is that of the preferred embodiments of the invention and that various changes and modifications may be made thereto without departing from the spirit and scope of the invention as defined in the appended claims.