DEVICES AND METHODS FOR OCULAR SURGERY

US 20180064578A1
Filed: 01/29/2017
Published: 03/08/2018
Est. Priority Date: 01/30/2016
Status: Active Grant

First Claim

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1. A device for removing material in a medical procedure, comprising:

a shaft having a lumen, the lumen extending through the shaft to an opening;

a suction source;

a suction path extending from the suction source to the opening and including the lumen, material is suctioned into the opening and through the lumen along the suction path by the suction source in use.

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Abstract

A hand-held aspiration device is provided which has a relatively small suction volume along a suction path to improve responsiveness of the aspiration device when the device is activated. The device may be manually powered and may be provided without electronic controls. The device has a suction path which may be purged into a disposal enclosure to reduce the volume of material under the influence of the suction pressure during the procedure. The suction source may also be part of the hand-held unit to further reduce the suction path and suction volume.

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364 Claims

1. A device for removing material in a medical procedure, comprising:
- a shaft having a lumen, the lumen extending through the shaft to an opening;
  
  a suction source;
  
  a suction path extending from the suction source to the opening and including the lumen, material is suctioned into the opening and through the lumen along the suction path by the suction source in use.
- View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48)
- - 2. The device of claim 1, further comprising:
    - a disposal enclosure coupled to the suction path to receive material from the suction path.
  - 3. The device of claim 1, further comprising:
    - an actuator positioned along the suction path, the actuator being operable by the user to an open position which exposes the opening to the suction source and a closed position which isolates the opening from the suction source.
  - 4. The device of claim 1, wherein:
    - the actuator is movable to a first open position and a second open position, the first open position providing a different magnitude of suction than the second open position.
  - 5. The device of claim 1, wherein:
    - the actuator is continuously variable between the first position and the second position to provide a continuously variable magnitude of suction selected by the user.
  - 6. The device of claim 1, wherein:
    - the lumen has a deformable portion defining a portion of the suction path;
      
      the actuator engaging the deformable portion of the suction path.
  - 7. The device of claim 1, wherein:
    - the deformable portion of the suction path is variably deformable between the first position and the second position.
  - 8. The device of claim 1, further comprising:
    - a valve positioned between the disposal enclosure and the suction path, the valve permitting material to move from the suction path to the disposal enclosure when open and isolating the disposal enclosure from the suction path when closed.
  - 9. The device of claim 1, wherein:
    - the valve is a one-way valve positioned between the disposal enclosure and the suction path which permits material to move from the suction path to the disposal enclosure, the one-way valve isolating the disposal enclosure from the suction path when the suction source applies suction to draw material into the opening and through the suction path.
  - 10. The device of claim 1, wherein:
    - the disposal enclosure is isolated from the suction path when the suction source draws material into the opening, the disposal enclosure being isolated so that the disposal enclosure is not under the influence of suction pressure from the suction path when the suction source draws material into the opening.
  - 11. The device of claim 1, further comprising:
    - the disposal enclosure is configured to be supported independently, the disposal enclosure having a disposal lumen extending from the suction path to the disposal enclosure.
  - 12. The device of claim 1, wherein:
    - the suction path is entirely hand-held
  - 13. The device of claim 1, wherein:
    - the suction path is more than half non-manually deformable.
  - 14. The device of claim 1, wherein:
    - the suction path is at least 90% non-manually deformable.
  - 15. The device of claim 1, wherein:
    - the suction path has a length of less than 20 cm.
  - 16. The device of claim 1, wherein:
    - the suction path has a volume of no more than 25 ml.
  - 17. The device of claim 1, wherein:
    - the suction path has a volume of no more than 15 ml.
  - 18. The device of claim 1, further comprising:
    - an actuator positioned along the suction path, the actuator being movable between an open position which and a closed position, the closed position preventing flow through the suction path;
      
      the suction path having a proximal volume proximal to the actuator and a distal volume distal to the actuator, the distal volume being less than 2 ml.
  - 19. The device of claim 1, wherein:
    - the proximal volume is less than 25 ml.
  - 20. The device of claim 1, wherein:
    - the lumen is sized for introduction into the eye, the shaft having a longitudinal axis with a cross-sectional area of no more than 0.8 mm(2) measured from an outer diameter the shaft, the lumen having a cross-sectional area of at least 0.28 mm(2).
  - 21. The device of claim 1, wherein:
    - the suction source is a movable element which is displaced in a direction to draw the material into the opening and through the suction path.
  - 22. The device of claim 1, wherein:
    - the movable element is displaced in an opposite direction to the direction to move material in the suction path into the disposal enclosure.
  - 23. The device of claim 1, wherein:
    - the movable element is part of hand held unit.
  - 24. The device of claim 1, wherein:
    - the suction source is hand-held.
  - 25. The device of claim 1, wherein:
    - the suction source includes no electronic control and no electric powered parts.
  - 26. The device of claim 1, wherein:
    - a power source coupled to the suction source, the power source being powered by the user.
  - 27. The device of claim 26, wherein:
    - the power source is a compressed spring which is compressed by the user
  - 28. The device of claim 1, wherein:
    - the device is manually purged.
  - 29. The device of claim 1, further comprising:
    - a purging mechanism coupled to the suction path, the purging mechanism moving the material from the suction path to the disposal enclosure.
  - 30. The device of claim 29, wherein:
    - the purging mechanism moves the material through the suction path in an opposite direction to suction of material along the suction path.
  - 31. The device of claim 29, wherein:
    - the purging mechanism has a movable element; and
      
      the suction device also including the movable element to create suction pressure in the suction path.
  - 32. The device of claim 31, wherein:
    - the movable element is coupled to a spring to load the movable element with a spring load.
  - 33. The device of claim 31, wherein:
    - the movable element is spring loaded by the user.
  - 34. The device of claim 31, wherein:
    - the movable element is manually spring loaded by the user.
  - 35. The device of claim 1, further comprising:
    - a disposal enclosure;
      
      means for purging the suction path, the purging means moving material in the suction path distally when moving the material in the suction path to the disposal enclosure.
  - 36. The device of claim 1, wherein:
    - the suction source is a bellows.
  - 37. The device of claim 36, wherein:
    - the bellows are compressed with a foot of the user.
  - 38. The device of claim 36, wherein:
    - the bellows are compressed to move material in the suction path into a disposal enclosure.
  - 39. The device of claim 36, wherein:
    - the bellows are compressed to move material within the bellows into the disposal enclosure.
  - 40. The device of claim 1, wherein:
    - the suction source is a bladder.
  - 41. The device of claim 40, wherein:
    - the bladder is deformed manually by the user.
  - 42. The device of claim 40, wherein:
    - the bladder is compressed manually by the user, wherein compression is manually maintained on the bladder to stop suction, wherein reducing compression on the bladder produces suction to suction the material into the opening.
  - 43. The device of claim 40, wherein:
    - the bladder is moved from an unbiased stated to a compressed state, the user releasing compressing from the compressed state to begin suctioning material into the opening.
  - 44. The device of claim 40, further comprising:
    - a disposal enclosure coupled to the suction path;
      
      the bladder being coupled to a disposal enclosure so that movement of the bladder from the unbiased state to the compressed state moves the material in the suction path into the disposal enclosure.
  - 45. The device of claim 1, wherein:
    - the suction source is a venturi.
  - 46. The device of claim 45, wherein:
    - the suction source include a source of pressurized gas, the source of pressurized gas being hand-held.
  - 47. The device of claim 45, further comprising:
    - a disposal enclosure;
      
      the venture directs the source of pressurized gas into the disposal enclosure together with material in the suction path.
  - 48. The device of claim 1, further comprising:
    - an irrigation lumen having an irrigation outlet.

49. A method of aspirating an eye during a procedure on the eye, comprising:
- introducing a lumen of a device into an eye, the lumen having an opening positioned in the eye, the device also having a suction path from a suction source to the opening in the lumen; and
  
  exposing the opening to suction pressure from the suction source so that material in the eye enters the opening under the influence of the suction source, the material being drawn along the suction path by the suction source, the suction path defining a suction volume under the influence of the suction pressure by the suction source.
- View Dependent Claims (50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100)
- - 50. The method of claim 49, wherein:
    - the exposing is carried out with an actuator positioned along the suction path, the actuator being operable by the user to an open position which exposes the opening to the suction source and a closed position which isolates the opening from the suction source.
  - 51. The method of claim 49, wherein:
    - the exposing is carried out with the actuator being movable to a first open position and a second open position, the first open position providing a different magnitude of suction than the second open position.
  - 52. The method of claim 49, wherein:
    - the exposing is carried out with the actuator being continuously variable between the first position and the second position to provide a continuously variable magnitude of suction selected by the user.
  - 53. The method of claim 49, wherein:
    - the exposing is carried out with the actuator engaging a deformable portion of the suction path.
  - 54. The method of claim 49, wherein:
    - the exposing is carried out with the deformable portion of the suction path being variably deformable between the first position and the second position.
  - 55. The method of claim 49, wherein:
    - the exposing is carried out with the suction path having a distal volume which is distal to the actuator of less than 2 ml.
  - 56. The method of claim 49, wherein:
    - the exposing is carried out with the suction path having a proximal volume of less than 25 ml which is proximal to the actuator and between the suction source and the actuator, the proximal volume being a minimum working volume.
  - 57. The method of claim 49, wherein:
    - the introducing is carried out with the device also including a disposal enclosure coupled to the suction path to receive material from the suction path.
  - 58. The method of claim 49, wherein:
    - the introducing is carried out with a valve positioned between the disposal enclosure and the suction path, the valve permitting material to move from the suction path to the disposal enclosure when open and isolating the disposal enclosure from the suction path when closed.
  - 59. The method of claim 49, wherein:
    - the introducing is carried out with the valve being a one-way valve positioned between the disposal enclosure and the suction path, the one-way valve permitting material to move from the suction path to the disposal enclosure.
  - 60. The method of claim 49, wherein:
    - the introducing is carried out with the disposal enclosure being isolated from the suction path when the suction source draws material into the opening, the disposal enclosure being isolated so that the disposal enclosure is not under the influence of suction pressure from the suction path when the suction source draws material into the opening.
  - 61. The method of claim 49, wherein:
    - the introducing is carried out with the device having a disposal enclosure configured to be supported independently, the disposal enclosure having a disposal lumen extending from the suction path to the disposal enclosure.
  - 62. The method of claim 49, wherein:
    - the introducing is carried out with the device having the suction path is entirely hand-held
  - 63. The method of claim 49, wherein:
    - the introducing is carried out with the device having the suction path is more than half non-manually deformable.
  - 64. The method of claim 49, wherein:
    - the introducing is carried out with the device having the suction path is at least 90% non-manually deformable.
  - 65. The method of claim 49, wherein:
    - the introducing is carried out with the device having the suction path having a length of less than 20 cm.
  - 66. The method of claim 49, wherein:
    - the introducing is carried out with the device having the suction path has a volume of less than 25 ml.
  - 67. The method of claim 49, wherein:
    - the introducing is carried out with the device having the suction path has a volume of less than 15 ml.
  - 68. The method of claim 49, wherein:
    - the introducing is carried out with the device having a proximal volume under the influence of suction pressure by the suction source proximal to the actuator when the actuator is in the closed position, the proximal suction volume having a volume of less than 25 ml.
  - 69. The method of claim 49, wherein:
    - the introducing is carried out with the device having a proximal volume under the influence of suction pressure by the suction source when the actuator is in the closed position, the proximal suction volume less than 25 ml.
  - 70. The method of claim 49, wherein:
    - the introducing is carried out with the lumen being sized for introduction into the eye, the shaft having an outer perimeter having a cross-sectional area of no more than 0.8 mm(2), the lumen having a cross-sectional area of at least 0.28 mm(2).
  - 71. The method of claim 49, wherein:
    - the introducing is carried out with the suction source including a movable element which is displaced in a direction to draw the material into the opening and proximally along the suction path.
  - 72. The method of claim 49, wherein:
    - the introducing is carried out with the movable element being displaceable in an opposite direction to the direction to move material in the suction path into the disposal enclosure.
  - 73. The method of claim 49, wherein:
    - the introducing is carried out with the movable element being part of a hand held unit.
  - 74. The method of claim 49, wherein:
    - the introducing is carried out with the device having the suction source is a hand-held unit.
  - 75. The method of claim 49, wherein:
    - the introducing is carried out with the suction source having no electronic control and no electric powered parts.
  - 76. The method of claim 49, wherein:
    - the introducing is carried out with the device having a power source which is powered by the user.
  - 77. The method of claim 76, wherein:
    - the introducing is carried out with the power source being a compressed spring which is compressed by the user.
  - 78. The method of claim 49, further comprising:
    - purging the fluid path by moving the material into the disposal enclosure.
  - 79. The method of claim 78, wherein:
    - the purging is carried out independent of suctioning.
  - 80. The method of claim 49, wherein:
    - the purging is carried out with the device being manually purged.
  - 81. The method of claim 49, wherein:
    - the purging is carried out with the device having a purging mechanism coupled to the suction path, the purging mechanism moving the material from the suction path to the disposal enclosure.
  - 82. The method of claim 49, wherein:
    - the purging is carried out with the device moving the material through the suction path in an opposite direction to suction of material along the suction path.
  - 83. The method of claim 82, wherein:
    - the purging is carried out with a purging mechanism having a movable element.
  - 84. The method of claim 83, wherein:
    - the exposing is carried out with the suction device also including the movable element to create suction pressure in the suction path.
  - 85. The method of claim 83, wherein:
    - the exposing is carried out with the movable element being coupled to a spring to load the movable element with a spring load.
  - 86. The method of claim 85, wherein:
    - the exposing is carried out with the movable element being spring loaded by the user.
  - 87. The method of claim 83, wherein:
    - the exposing is carried out with the movable element being manually spring loaded by the user to create suction pressure along the suction path.
  - 88. The method of claim 49, wherein:
    - the exposing is carried out with the suction source being a bellows.
  - 89. The method of claim 88, wherein:
    - the exposing is carried out with the bellows being compressed with a foot of the user.
  - 90. The method of claim 88, wherein:
    - the exposing is carried out with the bellows being compressed to move material in the suction path into a disposal enclosure.
  - 91. The method of claim 88, wherein:
    - the exposing is carried out with the bellows being compressed to move material within the bellows into the disposal enclosure.
  - 92. The method of claim 49, wherein:
    - the exposing is carried out with the suction source being a bladder.
  - 93. The method of claim 92, wherein:
    - the exposing is carried out with the bladder being deformed manually by the user and hand-held.
  - 94. The method of claim 92, wherein:
    - the exposing is carried out with the bladder being compressed by the user, wherein compression is maintained on the bladder to stop suction, wherein reducing compression on the bladder produces suction to suction the material into the opening.
  - 95. The method of claim 92, wherein:
    - the exposing is carried out with the suction source including a bladder which is movable from an unbiased stated to a compressed state, the user releasing compression from the compressed state to begin suctioning material into the opening.
  - 96. The method of claim 92, wherein:
    - the exposing is carried out with the bladder being coupled to a disposal enclosure so that movement of the bladder from the unbiased state to the compressed state moves the material in the suction path into the disposal enclosure.
  - 97. The method of claim 49, wherein:
    - the exposing is carried out with the suction source being a venturi.
  - 98. The method of claim 97, wherein:
    - the exposing is carried out with the suction source including a source of pressurized gas, the source of pressurized gas being hand-held.
  - 99. The method of claim 97, wherein:
    - the exposing is carried out with the venturi directing the source of pressurized gas to a disposal enclosure together with material in the suction path.
  - 100. The method of claim 49, further comprising:
    - irrigating the eye through an irrigation lumen having an irrigation outlet.

101. A suction tip for a suction device used to suction material from an eye, comprising;
- a shaft;
  
  a lumen extending through the shaft;
  
  a distal opening in the shaft, the distal opening having an area which is defined by an opening axis which maximizes a size of the opening, the opening area defining an effective diameter defined as the diameter equivalent to a circle having the same size as the opening area; and
  
  a restrictor extending over the distal opening when viewed along the opening axis.
- View Dependent Claims (102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122)
- - 102. The suction tip of claim 101, wherein:
    - the restrictor has a support arm extending from the distal end of the shaft.
  - 103. The suction tip of claim 101, wherein:
    - the restrictor has a stop attached to the support arm, the stop being spaced apart from the distal opening and positioned over the distal opening when viewed along the opening axis
  - 104. The suction tip of claim 101, wherein:
    - the restrictor is spaced apart from the distal opening 0.80 to 1.10 times the effective diameter along the opening axis and aligned with the distal opening when viewed along the opening axis.
  - 105. The suction tip of claim 101, wherein:
    - the restrictor is spaced apart from the distal opening 0.85 to 1.00 times the effective diameter.
  - 106. The suction tip of claim 101, wherein:
    - the restrictor has a distal end that extends no more than 1.5 times the effective diameter from the distal opening measured along the opening axis from the distal opening.
  - 107. The suction tip of claim 101, wherein:
    - the restrictor has an area of when viewed along the opening axis, the area of the restrictor being 0.1 to 1.2 times the opening area of the distal opening when viewed along the opening axis.
  - 108. The suction tip of claim 101, wherein:
    - the restrictor has a support arm extending from the distal end, the support arm having an angular extent when viewed along the opening axis of no more than 90 degrees, the distal opening being free of obstruction apart from the support arm between the distal opening and the restrictor when viewed along the opening axis.
  - 109. The suction tip of claim 101, wherein:
    - the restrictor forms a feed opening leading to the distal opening, the feed opening defining a surface extending between and defined by the restrictor and the distal end of the shaft
  - 110. The suction tip of claim 101, wherein:
    - the restrictor forms the feed opening with the surface being an elongate surface with a length of 2.5-3.5 times the effective diameter.
  - 111. The suction tip of claim 101, wherein:
    - the restrictor forms the feed opening with the surface having a width of 0.8 to 1.1 times the effective diameter.
  - 112. The suction tip of claim 101, wherein:
    - the restrictor has a support arm that is movably coupled to the shaft.
  - 113. The suction tip of claim 101, wherein:
    - the support arm is longitudinally movable relative to the shaft to adjust a longitudinal position of the support arm, the support arm being movable from a working position to a displaced position, the working position being a position used when suctioning material into the distal opening.
  - 114. The suction tip of claim 101, wherein:
    - the restrictor is formed with the support arm having the displaced position being longitudinally displaced relative to the working position.
  - 115. The suction tip of claim 101, wherein:
    - the shaft has a longitudinal axis; and
      
      the restrictor is formed with the support arm rotating relative to the longitudinal axis of the support shaft when in the displaced position.
  - 116. The suction tip of claim 101, wherein:
    - the restrictor is formed with the displaced position being longitudinally displaced to move the support shaft in a proximal direction toward the distal opening.
  - 117. The suction tip of claim 101, wherein:
    - the restrictor is formed so that the displaced position moves material between the restrictor and the distal opening toward the distal opening.
  - 118. The suction tip of claim 101, wherein:
    - the restrictor is mounted over the shaft and is longitudinally slidable relative to the shaft, the restrictor being movable to a stored position in which the entire restrictor is positioned proximal to the distal opening.
  - 119. The suction tip of claim 118, wherein:
    - the restrictor is deformed when in the stored position
  - 120. The suction tip of claim 118, wherein:
    - the restrictor has a living hinge which is deformed when the restrictor is in the stored position.
  - 121. The suction tip of claim 120, wherein:
    - the restrictor has a support arm which forms at least part of the living hinge.
  - 122. The suction tip of claim 101, wherein:
    - the restrictor is longitudinally movable to a position which is at least two effective diameters of the distal opening measured along an orientation that maximizes an area of the distal opening.

123. A method of suctioning material from an eye, comprising;
- positioning a distal end of shaft within an eye, the shaft having a lumen extending through the shaft, the shaft also having a distal opening in the shaft, the distal opening having an area which is defined by an opening axis having an orientation which maximizes a size of the opening, the opening area defining an effective diameter which is defined as the diameter equivalent of an equivalent circle having the opening area, wherein a restrictor extends over the distal opening when viewed along the opening axis in a working position; and
  
  suctioning material into the distal opening and through the lumen.
- View Dependent Claims (124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144)
- - 124. The method of claim 123, wherein:
    - suctioning is carried out with the restrictor having a support arm extending from the distal end of the shaft.
  - 125. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor having a stop attached to the support arm, the stop being spaced apart from the distal opening and positioned over the distal opening when viewed along the opening axis.
  - 126. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor spaced apart from the distal opening 0.80 to 1.10 times the effective diameter along the opening axis and aligned with the distal opening along the opening axis in the working position.
  - 127. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor being spaced apart from the distal opening 0.85 to 1.00 times the effective diameter in the longitudinal direction and longitudinally aligned with the distal opening in the working position.
  - 128. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor having a distal end that extends no more than 1.5 times the effective diameter from the distal opening measured along the opening axis from the distal opening in the working position.
  - 129. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor having an area when viewed along the opening axis, the area of the restrictor being 0.1 to 1.2 times the opening area of the distal opening in the working position.
  - 130. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor having a support arm extending from the distal end, the support arm having an angular extent when viewed along the opening axis of no more than 90 degrees, the distal opening being free of obstruction apart from the support arm between the distal opening and the restrictor in the working position.
  - 131. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor forming a feed opening leading to the distal opening, the feed opening defining a surface extending between the restrictor and the distal end of the shaft.
  - 132. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor forming the feed opening with the surface being an elongate surface with a length of 2.5-3.5 times the effective diameter.
  - 133. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor forming the feed opening with the surface having a width of 0.8 to 1.1 times the effective diameter.
  - 134. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor having a support arm that is movably coupled to the shaft.
  - 135. The method of claim 123, wherein:
    - the suctioning is carried out with the support arm being longitudinally movable relative to the shaft to adjust a longitudinal position of the support arm, the support arm being movable from the working position to a displaced position, the working position being a position used when suctioning material into the distal opening.
  - 136. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor being formed with the support arm being movable to a displaced position which is longitudinally displaced relative to the working position.
  - 137. The method of claim 123, wherein:
    - the suctioning is carried out with the shaft having a longitudinal axis, the restrictor being formed with the support arm being rotatable relative to the longitudinal axis of the support shaft.
  - 138. The method of claim 123, wherein:
    - the suctioning is carried out with the restrictor being longitudinally movable to move the support shaft in a proximal direction toward the distal opening.
  - 139. The method of claim 123, further comprising:
    - displacing the restrictor toward the distal opening to move material toward the distal opening.
  - 140. The method of claim 123, further comprising:
    - displacing the restrictor longitudinally relative to the shaft, the restrictor being mounted over the shaft and being longitudinally slidable relative to the shaft, the restrictor being movable to a stored position in which the entire restrictor is positioned proximal to the distal opening.
  - 141. The method of claim 123, further comprising:
    - storing the restrictor in a stored position, the restrictor being deformed when in the stored position.
  - 142. The method of claim 141, wherein:
    - the storing is carried out with the restrictor having a living hinge which is deformed by the shaft when the restrictor is in the stored position.
  - 143. The method of claim 141, wherein:
    - the storing is carried out with the restrictor having a support arm which forms at least part of the living hinge.
  - 144. The method of claim 123, further comprising:
    - displacing the restrictor longitudinally to a position which is at least two effective diameters from the distal opening measured along an orientation that maximizes an area of the distal opening.

145. A tissue manipulatora shaft having a lumen with a distal opening;
- a first loop having a first leg and a second leg, at least one of the first and second legs extending through the lumen, the first loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the lumen and out the distal opening in the lumen; and
  
  a second loop having a first leg and a second leg, at least one of the first and second legs extending through the lumen, the second loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the lumen and out the distal opening in the lumen.
- View Dependent Claims (146, 147, 148, 149, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, 160, 161, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 198, 199, 200, 201, 202, 203, 204)
- - 146. The tissue manipulator of claim 145, wherein:
    - the shaft is sized for introduction of a distal end of the shaft into any eye.
  - 147. The tissue manipulator of claim 145, wherein:
    - the first loop has an unbiased shape, wherein the unbiased shape of the first loop bounds an area defined in an orientation that maximizes the area, the area having an effective diameter which is equal to the diameter of a circle having the area, the first loop moving toward the unbiased shape when moving from the collapsed position to the expanded position.
  - 148. The tissue manipulator of claim 145, wherein:
    - the effective diameter of the area of the first loop is 4.5 mm to 6.5 mm.
  - 149. The tissue manipulator of claim 145, wherein:
    - the effective diameter of the area of the first loop is 5.0 mm to 6.0 mm.
  - 150. The tissue manipulator of claim 145, wherein:
    - the first loop has an effective diameter of the expanded position being 4.5 to 6.5 mm.
  - 151. The tissue manipulator of claim 145, wherein:
    - the first loop has an effective diameter of the expanded position being 5.0 to 6.0 mm.
  - 152. The tissue manipulator of claim 145, wherein:
    - the effective diameter of the unbiased shape of the second loop being within 20% of an effective diameter of the expanded position of the second loop.
  - 153. The tissue manipulator of claim 145, wherein:
    - the second loop has an unbiased shape, wherein the unbiased shape of the second loop bounds an area defined in an orientation that maximizes the area, the area having an effective diameter which is equal to the diameter of a circle having the area, the second loop moving toward the unbiased shape when moving from the collapsed position to the expanded position.
  - 154. The tissue manipulator of claim 145, wherein:
    - the effective diameter of the area of the second loop is 4.5 mm to 6.5 mm.
  - 155. The tissue manipulator of claim 145, wherein:
    - the effective diameter of the area of the second loop is 5.0 mm to 6.0 mm.
  - 156. The tissue manipulator of claim 145, wherein:
    - the effective diameter of the unbiased shape of the second loop being within 20% of an effective diameter of the expanded position of the second loop.
  - 157. The tissue manipulator of claim 145, wherein:
    - the shaft has a longitudinal axis at a distal end of the shaft;
      
      the first loop has an orientation which maximizes an area of the first loop when in the expanded position when viewed along the orientation, the orientation being within 45 degrees of perpendicular to the longitudinal axis.
  - 158. The tissue manipulator of claim 145, wherein:
    - the shaft has a longitudinal axis at a distal end of the shaft;
      
      the second loop has an orientation which maximizes an area of the second loop when in the expanded position when viewed along the orientation, the orientation being within 45 degrees of perpendicular to the longitudinal axis.
  - 159. The tissue manipulator of claim 145, wherein:
    - the first loop is spaced apart from the second loop to define a volume therebetween when the first and second loops are in the expanded position, the volume therebetween being 0.48 mm(3) to 0.84 mm(3).
  - 160. The tissue manipulator of claim 145, wherein:
    - an intermediate element positioned between the first loop and the second loop.
  - 161. The tissue manipulator of claim 145, wherein:
    - the intermediate element is a third loop positioned between the first loop and the second loop.
  - 162. The tissue manipulator of claim 145, wherein:
    - the intermediate element includes an interconnecting element extending between the first loop and the second loop.
  - 163. The tissue manipulator of claim 145, wherein:
    - the interconnecting element of the intermediate element is integrally formed with the first loop and the second loop.
  - 164. The tissue manipulator of claim 145, wherein:
    - the interconnecting element is a flexible filament extending between the first loop and the second loop.
  - 165. The tissue manipulator of claim 145, wherein:
    - the third loop formed by the intermediate element has a first leg and a second leg, at least one of the first and second legs extending through the lumen, the third loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the lumen and out the distal opening in the lumen.
  - 166. The tissue manipulator of claim 145, wherein:
    - the third loop has an unbiased shape, wherein the unbiased shape of the third loop bounds an area defined in an orientation that maximizes the area, the area having an effective diameter which is equal to the diameter of a circle having the area, the third loop moving toward the unbiased shape when moving from the collapsed position to the expanded position.
  - 167. The tissue manipulator of claim 145, wherein:
    - the effective diameter of the area of the third loop is 4.5 mm to 6.5 mm.
  - 168. The tissue manipulator of claim 145, wherein:
    - the effective diameter of the area of the third loop is 5.0 mm to 6.0 mm
  - 169. The tissue manipulator of claim 145, wherein:
    - the shaft has a longitudinal axis at a distal end of the shaft;
      
      the third loop has an orientation which maximizes an area of the first loop when in the expanded position when viewed along the orientation, the orientation being within 30 degrees of perpendicular to the longitudinal axis.
  - 170. The tissue manipulator of claim 145, wherein:
    - the third loop is configured to cut material contained within the third loop when the third loop moves from the expanded position toward the collapsed position.
  - 171. The tissue manipulator of claim 145, wherein:
    - the first loop and the second loop defining an exposed surface between the first loop and the second loop when the first and second loops are both in the expanded position.
  - 172. The tissue manipulator of claim 145, wherein:
    - the exposed surface between the first loop and the second loop has an area of 15 mm(3) to 60 mm(3).
  - 173. The tissue manipulator of claim 145, wherein:
    - the first loop has an unbiased shape, wherein the unbiased shape of the first loop bounds an area defined by an orientation that maximizes the area, the area having an effective diameter which is equal to the diameter of a circle having the area, the first loop moving toward the unbiased shape when moving from the collapsed position to the expanded position; and
      
      the exposed surface between the first loop and the second loop is 3-10 times the effective diameter.
  - 174. The tissue manipulator of claim 145, wherein:
    - the exposed surface between the first loop and the second loop having 2-8 independent cells.
  - 175. The tissue manipulator of claim 145, wherein:
    - the exposed surface between the first loop and the second loop having 2-6 independent cells.
  - 176. The tissue manipulator of claim 145, wherein:
    - the exposed surface between the first loop and the second loop having 2-4 independent cells.
  - 177. The tissue manipulator of claim 145, wherein:
    - the exposed surface between the first loop and the second loop having 2 independent cells.
  - 178. The tissue manipulator of claim 145, wherein:
    - the exposed surface has an area which is at least 4 times larger than an area of the intermediate element positioned between the first loop and the second loop when the exposed surface is viewed radially inward with respect to the first and second loops.
  - 179. The tissue manipulator of claim 145, wherein:
    - the first loop has at least 80% of the loop being 1.5-3.5 mm from the second loop.
  - 180. The tissue manipulator of claim 145, wherein:
    - the first loop is configured to cut material contained within the first loop when the first loop moves from the expanded position toward the collapsed position.
  - 181. The tissue manipulator of claim 145, wherein:
    - the second loop is configured to cut material contained within the first loop when the first loop moves from the expanded position toward the collapsed position.
  - 182. The tissue manipulator of claim 145, further comprising:
    - a first support element extending from a distal end of the shaft when the first loop is in the expanded position, the first support element being an elongate element that extends to a free end.
  - 183. The tissue manipulator of claim 145, wherein:
    - the first support element is positioned with the free end positioned within an area of the first loop when viewing the first loop along an orientation that maximizes the area of the first loop.
  - 184. The tissue manipulator of claim 145, wherein:
    - the first loop has an effective diameter when in the expanded position, the effective diameter being a diameter of a circle having the area of the first loop in the expanded position; and
      
      the first support element extends into the area of the first loop so that the free end is positioned 0.05 to 0.30 times the effective diameter of the first loop.
  - 185. The tissue manipulator of claim 145, further comprising:
    - a second support element extending from a distal end of the shaft when the second loop is in the expanded position, the second support element being an elongate element that extends to a free end.
  - 186. The tissue manipulator of claim 145, wherein:
    - the second support element is positioned with the free end positioned within an area of the second loop when viewing the second loop along an orientation that maximizes the area of the second loop.
  - 187. The tissue manipulator of claim 145, wherein:
    - the second loop has an effective diameter when in the expanded position, the effective diameter being a diameter of a circle having the area of the second loop in the expanded position; and
      
      the second support element extends into the area of the second loop so that the free end is positioned 0.05 to 0.30 times the effective diameter of the second loop.
  - 188. The tissue manipulator of claim 145, further comprising:
    - the first loop having at least one interconnecting element extending from a first connection to the first loop to a second connection to the first loop;
      
      the second loop having at least one interconnecting element extending from a first connection to the second loop to a second connection to the second loop.
  - 189. The tissue manipulator of claim 145, wherein:
    - the first loop is free of cross-elements extending between any two parts of the first loop.
  - 190. The tissue manipulator of claim 145, wherein:
    - the second loop is free of cross-elements extending between any two parts of the second loop.
  - 191. The tissue manipulator of claim 145, wherein:
    - the third loop is free of cross-elements extending between any two parts of the third loop.
  - 192. The tissue manipulator of claim 145, further comprising:
    - a source of suction coupled to the lumen.
  - 193. The tissue manipulator of claim 145, wherein:
    - the first leg and the second leg of the first loop are both movable within the lumen.
  - 194. The tissue manipulator of claim 145, wherein:
    - the first leg and the second leg of the second loop are both movable within the lumen.
  - 198. The tissue manipulator of claim 145, wherein:
    - the first loop is positioned entirely distal to the distal opening in the expanded position.
  - 199. The tissue manipulator of claim 145, wherein:
    - the second loop is positioned entirely distal to the distal opening in the expanded position.
  - 200. The tissue manipulator of claim 145, wherein:
    - the first loop comprises a superelastic material within a superelastic range when in the collapsed position; and
      
      the second leg comprises a superelastic material within a superelastic range when in the collapsed position.
  - 201. The device of claim 145, further comprising:
    - a rotating cutter having a cutting element at a distal end, the rotating cutter having a working position adjacent the distal opening in the shaft.
  - 202. The device of claim 145, wherein:
    - the working position of the rotating cutter has the cutting element positioned proximal to the distal opening.
  - 203. The device of claim 145, wherein:
    - the rotating cutter is coupled to the shaft and is longitudinally movable relative to the shaft to move the cutting element into the working position.
  - 204. The device of claim 145, wherein:
    - the rotating cutter includes a lumen through which material may be suctioned.

195. The tissue manipulator of claim PREV, wherein:
- the first leg and the second leg of the first loop are coupled to an actuator extending through the lumen so that movement of the actuator moves the first leg and the second leg between the collapsed position and the expanded position.

196. The tissue manipulator of claim PREV, wherein:
- the first leg and the second leg of the second loop are coupled to an actuator extending through the lumen so that movement of the actuator moves the first leg and the second leg between the collapsed position and the expanded position.

197. The tissue manipulator of claim PREV, wherein:
- the first leg and the second leg of the third loop are coupled to an actuator extending through the lumen so that movement of the actuator moves the first leg and the second leg between the collapsed position and the expanded position.

205. A method of manipulating tissue in the eye;
- comprising;
  
  introducing a distal end of a shaft within an eye, the shaft having a lumen with a distal opening also positioned in the eye;
  
  expanding a first loop from a collapsed position to an expanded position within the eye, the first loop having a first leg and a second leg, at least one of the first and second legs extending through the lumen, the first loop being movable from the collapsed position to the expanded position when the at least one of the first and second legs is advanced through the lumen and out the distal opening in the lumen;
  
  expanding a second loop from a collapsed position to an expanded position within the eye, the second loop having a first leg and a second leg, at least one of the first and second legs extending through the lumen, the second loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the lumen and out the distal opening in the lumen.
- View Dependent Claims (206, 207, 208, 209, 210, 211, 212, 213, 214, 215, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236, 237, 238, 239, 240, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 253, 254, 255, 256, 257, 258, 259, 260, 261, 262, 263, 264, 265, 266)
- - 206. The method of claim 205, further comprising:
    - positioning material within the first loop; and
      
      collapsing the first loop from the expanded position toward the collapsed position so that the first loop is collapsed around the material.
  - 207. The method of claim 205, further comprising:
    - the positioning is carried out with the material also positioned within the second loop; and
      
      collapsing the second loop from the expanded position toward the collapsed position so that the second loop is collapsed around the material.
  - 208. The method of claim 205, wherein:
    - the first loop collapsing and the second loop collapsing are carried out simultaneously.
  - 209. The method of claim 205, further comprising:
    - cutting the material during the first loop collapsing.
  - 210. The method of claim 205, further comprising:
    - cutting the material during the second loop collapsing.
  - 211. The method of claim 205, wherein:
    - the expanding the first loop and the expanding the second loop is carried out simultaneously.
  - 212. The method of claim 205, wherein:
    - the first loop expanding is carried out with the first loop having an unbiased shape, wherein the unbiased shape of the first loop bounds an area defined in an orientation that maximizes the area, the area having an effective diameter which is equal to the diameter of a circle having the area, the first loop moving toward the unbiased shape when moving from the collapsed position to the expanded position.
  - 213. The method of claim 205, wherein:
    - the first loop expanding is carried out with the effective diameter being 4.5 mm to 6.5 mm
  - 214. The method of claim 205, wherein:
    - the first loop expanding is carried out with the effective diameter being 5.0 mm to 6.0 mm
  - 215. The method of claim 205, wherein:
    - the second loop expanding is carried out with the second loop having an unbiased shape, wherein the unbiased shape of the second loop bounds an area defined in an orientation that maximizes the area, the area having an effective diameter which is equal to the diameter of a circle having the area, the second loop moving toward the unbiased shape when moving from the collapsed position to the expanded position.
  - 216. The method of claim 205, wherein:
    - the second loop expanding is carried out with the effective diameter being 4.5 mm to 6.5 mm
  - 217. The method of claim 205, wherein:
    - the second loop expanding is carried out with the effective diameter being 5.0 mm to 6.0 mm
  - 218. The method of claim 205, wherein:
    - the introducing is carried out with the shaft having a longitudinal axis at the distal end of the shaft;
      
      the first loop expanding is carried out with the first loop having an orientation which maximizes an area of the first loop when in the expanded position when viewed along the orientation, the orientation being within 45 degrees of perpendicular to the longitudinal axis.
  - 219. The method of claim 205, wherein:
    - the introducing is carried out with the shaft having a longitudinal axis at the distal end of the shaft;
      
      the second loop expanding is carried out with the second loop having an orientation which maximizes an area of the second loop when in the expanded position when viewed along the orientation, the orientation being within 45 degrees of perpendicular to the longitudinal axis.
  - 220. The method of claim 205, wherein:
    - the second loop expanding is carried out so that the first loop and the second loop are spaced apart to define a volume therebetween when the first and second loops are in the expanded position, the volume therebetween being 0.48 mm(3) to 0.84 mm(3).
  - 221. The method of claim 205, further comprising:
    - deploying an intermediate element between the first loop and the second loop.
  - 222. The method of claim 205, wherein:
    - the deploying is carried out with the intermediate element being a third loop positioned between the first loop and the second loop.
  - 223. The method of claim 205, wherein:
    - the deploying is carried out with the intermediate element including an interconnecting element extending between the first loop and the second loop, the deploying being carried out during at least one of the first loop expanding and the second loop expanding.
  - 224. The method of claim 205, wherein:
    - the deploying is carried out with the interconnecting element of the intermediate element being integrally formed with the first loop and the second loop.
  - 225. The method of claim 205, wherein:
    - the deploying is carried out with the interconnecting element being a flexible filament extending between the first loop and the second loop.
  - 226. The method of claim 205, wherein:
    - the deploying is carried out with a third loop formed by the intermediate element having a first leg and a second leg, at least one of the first and second legs extending through the lumen, the third loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs of the third loop is advanced through the lumen and out the distal opening in the lumen.
  - 227. The method of claim 205, wherein:
    - the deploying is carried out with the third loop having an unbiased shape, wherein the unbiased shape of the third loop bounds an area defined in an orientation that maximizes the area, the area having an effective diameter which is equal to the diameter of a circle having the area, the third loop moving toward the unbiased shape when moving from the collapsed position to the expanded position.
  - 228. The method of claim 205, wherein:
    - the deploying is carried out with the effective diameter of the area of the third loop being 4.5 mm to 6.5 mm.
  - 229. The method of claim 205, wherein:
    - the deploying is carried out with the effective diameter of the area of the third loop being 5.0 mm to 6.0 mm.
  - 230. The method of claim 205, wherein:
    - the introducing is carried out with the shaft having a longitudinal axis at the distal end of the shaft;
      
      the deploying is carried out with the third loop having an orientation which maximizes an area of the first loop when in the expanded position when viewed along the orientation, the orientation being within 30 degrees of perpendicular to the longitudinal axis.
  - 231. The method of claim 205, further comprising:
    - collapsing the third loop from the expanded position toward the collapsed position, the third loop being configured to cut material contained within the third loop when the third loop moves from the expanded position toward the collapsed position.
  - 232. The method of claim 205, wherein:
    - the second loop expanding defines an exposed surface between the first loop and the second loop when the first and second loops are both in the expanded position.
  - 233. The method of claim 205, wherein:
    - the second loop expanding is carried out with the exposed surface between the first loop and the second loop having an area of 15 mm(3) to 60 mm(3).
  - 234. The method of claim 205, wherein:
    - the first loop expanding is carried out with the first loop having an unbiased shape, wherein the unbiased shape of the first loop bounds an area defined by an orientation that maximizes the area, the area having an effective diameter which is equal to the diameter of a circle having the area, the first loop moving toward the unbiased shape when moving from the collapsed position to the expanded position;
      
      the second loop expanding is carried out to define an exposed surface between the first loop and the second loop, the exposed surface being 3-10 times the effective diameter of the area of the first loop in the unbiased shape.
  - 235. The method of claim 205, wherein:
    - the second loop expanding is carried out with the exposed surface between the first loop and the second loop having 2-8 independent cells.
  - 236. The method of claim 205, wherein:
    - the second loop expanding is carried out with the exposed surface between the first loop and the second loop having 2-6 independent cells.
  - 237. The method of claim 205, wherein:
    - the second loop expanding is carried out with the exposed surface between the first loop and the second loop having 2-4 independent cells.
  - 238. The method of claim 205, wherein:
    - the second loop expanding is carried out with the exposed surface between the first loop and the second loop having 2 independent cells.
  - 239. The method of claim 205, wherein:
    - the second loop expanding is carried out with the exposed surface being at least 4 times larger than an area of the intermediate element positioned between the first loop and the second loop.
  - 240. The method of claim 205, wherein:
    - the second loop expanding is carried out with the first loop having at least 80% of the loop being 1.5-3.5 mm from the second loop.
  - 241. The method of claim 205, further comprising:
    - extending a first support element from a distal end of the shaft, the first support element being an elongate element that extends to a free end.
  - 242. The method of claim 205, wherein:
    - the extending is carried out with the first support element being positioned with the free end positioned within an area of the first loop when viewing the first loop along an orientation that maximizes the area of the first loop.
  - 243. The method of claim 205, wherein:
    - the extending is carried out with the first loop having an effective diameter when in the expanded position, the effective diameter being a diameter of a circle having the area of the first loop in the expanded position; and
      
      the first support extending is carried out so that the first support element extends into the area of the first loop so that the free end is positioned 0.05 to 0.30 times the effective diameter of the first loop when viewed along the orientation.
  - 244. The method of claim 205, wherein:
    - the first support extending is carried out simultaneously with the first loop expanding.
  - 245. The method of claim 205, further comprising:
    - extending a second support element from the distal end of the shaft, the second support element being an elongate element that extends to a free end.
  - 246. The method of claim 205, wherein:
    - the second support element extending is carried out with the free end positioned within an area of the second loop when viewing the second loop along an orientation that maximizes the area of the second loop.
  - 247. The method of claim 245, wherein:
    - the second support element extending is carried out with the second loop having an effective diameter when in the expanded position, the effective diameter being a diameter of a circle having the area of the second loop in the expanded position, the second support element extends into the area of the second loop so that the free end is positioned 0.05 to 0.30 times the effective diameter of the second loop.
  - 248. The method of claim 245, wherein:
    - the second support element extending is carried out simultaneously with the second loop expanding.
  - 249. The method of claim 205, further comprising:
    - the second loop expanding is carried out with the first loop having at least one interconnecting element extending from a first connection to the first loop to a second connection to the first loop, the interconnecting element being deployed during at least the second loop expanding, the second loop also having at least one interconnecting element extending from a first connection to the second loop to a second connection to the second loop.
  - 250. The method of claim 205, wherein:
    - the first loop expanding is carried out with the first loop being free of cross-elements extending between any two parts of the first loop.
  - 251. The method of claim 205, wherein:
    - the second loop expanding is carried out with the second loop being free of cross-elements extending between any two parts of the second loop.
  - 252. The method of claim 205, wherein:
    - the deploying is carried out with the third loop being free of cross-elements extending between any two parts of the third loop.
  - 253. The method of claim 205, further comprising:
    - suctioning the material into the lumen through the distal opening.
  - 254. The method of claim 205, wherein:
    - the first loop expanding is carried out independently of the second loop expanding.
  - 255. The method of claim 205, wherein:
    - the first loop expanding is carried out with the first leg and the second leg of the first loop being coupled to an actuator extending through the lumen so that movement of the actuator moves the first leg and the second leg between the collapsed position and the expanded position.
  - 256. The method of claim 205, wherein:
    - the second loop expanding is carried out with the first leg and the second leg of the second loop being coupled to an actuator extending through the lumen so that movement of the actuator moves the first leg and the second leg between the collapsed position and the expanded position.
  - 257. The method of claim 205, wherein:
    - the deploying is carried out with the first leg and the second leg of the third loop being coupled to an actuator extending through the lumen so that movement of the actuator moves the first leg and the second leg between the collapsed position and the expanded position.
  - 258. The method of claim 205, wherein:
    - the first loop expanding is carried out with the first loop being positioned entirely distal to the distal opening in the expanded position.
  - 259. The method of claim 205, wherein:
    - the second loop expanding is carried out with the second loop being positioned entirely distal to the distal opening in the expanded position.
  - 260. The method of claim 205, wherein:
    - the first loop expanding is carried out with the first loop including a superelastic material within a superelastic range when in the collapsed position; and
      
      the second loop expanding is carried out with the second loop including a superelastic material within a superelastic range when in the collapsed position.
  - 261. The method of claim 205, further comprising:
    - cutting material with a rotating cutter having a cutting element at a distal end, the rotating cutter having a working position adjacent the distal opening in the shaft.
  - 262. The method of claim 205, wherein:
    - the rotating cutter cutting is carried out with the working position having the cutting element positioned proximal to the distal opening.
  - 263. The method of claim 205, wherein:
    - the rotating cutter cutting is carried out with is coupled to the shaft and is longitudinally movable relative to the shaft to move the cutting element into the working position.
  - 264. The method of claim 205, wherein:
    - the rotating cutter cutting is carried out with the rotating cutter including a lumen.
  - 265. The method of claim 205, further comprising:
    - suctioning material through the lumen in the rotating cutter.
  - 266. The method of claim 265, wherein:
    - the suctioning with the rotating cutter is carried out during the cutting with the rotating cutter.

267. A tissue manipulator, comprising:
- a first loop having a first leg and a second leg, at least one of the first and second legs extending through the lumen, the first loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through a lumen in a shaft and out a distal opening in the lumen; and
  
  a concave element coupled to the first loop, the concave element and the loop forming a basket to receive material.
- View Dependent Claims (268, 269, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 280, 281, 282)
- - 268. The tissue manipulator of claim 267, wherein:
    - the shaft is configured for introduction into the eye so that a distal end and the distal opening are positioned in the eye.
  - 269. The tissue manipulator of claim 267, wherein:
    - the concave element is integrally formed with the loop.
  - 270. The tissue manipulator of claim 267, wherein:
    - the concave element has a first end and a second end, the first end being integrally formed with the loop.
  - 271. The tissue manipulator of claim 267, wherein:
    - the second end of the concave element is integrally formed with the loop.
  - 272. The tissue manipulator of claim 267, wherein:
    - the second end of the concave element is movable within the lumen of the shaft.
  - 273. The tissue manipulator of claim 267, wherein:
    - the first leg and the second leg are both movable within the lumen of the shaft.
  - 274. The tissue manipulator of claim 267, wherein:
    - the second leg of the concave element is independently movable within the lumen of the shaft from the at least one of the first and second legs.
  - 275. The tissue manipulator of claim 267, wherein:
    - the loop is made of a superelastic material.
  - 276. The tissue manipulator of claim 267, wherein:
    - the concave element is made of a superelastic material.
  - 277. The tissue manipulator of claim 267, wherein:
    - the shaft has a longitudinal axis at a distal end; and
      
      the loop has an orientation which maximizes an area of the loop when in the expanded position, the orientation being within 30 degrees from perpendicular to the longitudinal axis.
  - 278. The tissue manipulator of claim 267, wherein:
    - the loop is positioned entirely distal to the distal opening when in the expanded position.
  - 279. The device of claim 267, further comprising:
    - a rotating cutter having a cutting element at a distal end, the rotating cutter having a working position adjacent the distal opening in the shaft.
  - 280. The device of claim 267, wherein:
    - the working position of the rotating cutter has the cutting element positioned proximal to the distal opening.
  - 281. The device of claim 267, wherein:
    - the rotating cutter is coupled to the shaft and is longitudinally movable relative to the shaft to move the cutting element into the working position.
  - 282. The device of claim 267, wherein:
    - the rotating cutter includes a lumen through which material may be suctioned.

283. A method of manipulating tissue within an eye, comprising:
- introducing a distal end of a shaft into an eye, the shaft having a lumen with a distal opening, a first loop having a first leg and a second leg being coupled to the shaft, at least one of the first and second legs extending through the lumen, the first loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the lumen and out the distal opening in the lumen, a concave element being coupled to the first loop, the concave element and the loop forming a basket to receive material;
  
  expanding the loop from the collapsed position to the expanded position;
  
  manipulating the basket to position material in the basket; and
  
  collapsing the loop so that the material is held within the basket.
- View Dependent Claims (284, 285, 286, 287, 288, 289, 290, 291, 292, 293, 294, 295, 296, 297, 298, 299, 300, 301)
- - 284. The method of claim 283, wherein:
    - the collapsing is carried out with the concave element being integrally formed with the loop.
  - 285. The method of claim 283, wherein:
    - the collapsing is carried out with the concave element having a first end and a second end, the first end being integrally formed with the loop.
  - 286. The method of claim 283, wherein:
    - the collapsing is carried out with the second end of the concave element being integrally formed with the loop.
  - 287. The method of claim 283, wherein:
    - the collapsing is carried out with the second end of the concave element being movable within the lumen of the shaft.
  - 288. The method of claim 283, wherein:
    - the introducing is carried out with the first leg and the second leg both movable within the lumen of the shaft.
  - 289. The method of claim 283, wherein:
    - the introducing is carried out with the second leg of the concave element being independently movable within the lumen of the shaft from the at least one of the first and second legs.
  - 290. The method of claim 283, wherein:
    - the introducing is carried out with the loop comprising made of a superelastic material.
  - 291. The method of claim 283, wherein:
    - the introducing is carried out with the concave element comprising made of a superelastic material.
  - 292. The method of claim 283, wherein:
    - the introducing is carried out with the shaft having a longitudinal axis at a distal end; and
      
      the expanding is carried out with the loop having an orientation which maximizes an area of the loop when in the expanded position, the orientation being within 30 degrees from perpendicular to the longitudinal axis.
  - 293. The method of claim 283, wherein:
    - the expanding is carried out with the loop being positioned entirely distal to the distal opening when in the expanded position.
  - 294. The method of claim 283, wherein:
    - the collapsing cuts the material contained within the basket.
  - 295. The method of claim 283, further comprising:
    - suctioning material into the lumen of the shaft.
  - 296. The method of claim 283, further comprising:
    - cutting material with a rotating cutter having a cutting element at a distal end, the rotating cutter having a working position adjacent the distal opening in the shaft.
  - 297. The method of claim 283, wherein:
    - the rotating cutter cutting is carried out with the working position having the cutting element positioned proximal to the distal opening.
  - 298. The method of claim 283, wherein:
    - the rotating cutter cutting is carried out with is coupled to the shaft and is longitudinally movable relative to the shaft to move the cutting element into the working position.
  - 299. The method of claim 283, wherein:
    - the rotating cutter cutting is carried out with the rotating cutter including a lumen.
  - 300. The method of claim 283, further comprising:
    - suctioning material through the lumen in the rotating cutter.
  - 301. The method of claim 300, wherein:
    - the suctioning with the rotating cutter is carried out during the cutting with the rotating cutter.

302. A tissue manipulator, comprisinga first shaft having a first lumen with a distal opening;
- a second shaft extending through the first lumen of the first shaft;
  
  a first loop having a first leg and a second leg, at least one of the first and second legs extending through the first lumen, the first loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the first lumen and out the distal opening in the first lumen; and
  
  a second loop having a first leg and a second leg, at least one of the first and second legs extending through the first lumen, the second loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the lumen and out the distal opening in the lumen.
- View Dependent Claims (303, 304, 305, 306, 307, 308, 309, 310, 311)
- - 303. The tissue manipulator of claim 302, further comprising:
    - a first concave element coupled to the first loop, the first concave element and the first loop forming a first basket;
      
      a second concave element coupled to the second loop, the second concave element and the second loop forming a second basket.
  - 304. The tissue manipulator of claim 302, wherein:
    - the first concave element includes a first concave shaped loop; and
      
      the second concave element includes a second concave shaped loop.
  - 305. The tissue manipulator of claim 302, wherein:
    - the second shaft is rotatable relative to the first shaft so that the second basket is rotatable relative to the first basket between an open position and a closed position, the open position having the first basket and the second basket at least partially nested and the closed position having the first basket facing the second basket.
  - 306. The tissue manipulator of claim 302, wherein:
    - the second shaft is rotatable to the closed position with the first basket and the second basket forming an enclosure.
  - 307. The tissue manipulator of claim 302, wherein:
    - the first loop is configured to cut material when the first loop is moved from the expanded position to the collapsed position.
  - 308. The device of claim 302, further comprising:
    - a rotating cutter having a cutting element at a distal end, the rotating cutter having a working position adjacent the distal opening in the shaft.
  - 309. The device of claim 302, wherein:
    - the working position of the rotating cutter has the cutting element positioned proximal to the distal opening.
  - 310. The device of claim 302, wherein:
    - the rotating cutter is coupled to the shaft and is longitudinally movable relative to the shaft to move the cutting element into the working position.
  - 311. The device of claim 302, wherein:
    - the rotating cutter includes a lumen through which material may be suctioned.

312. A method of manipulating tissue, comprising:
- introducing a device having a first shaft and a second shaft into an eye, the first shaft having a first lumen with a distal opening, the second shaft extending through the lumen of the first shaft, a first loop having a first leg and a second leg coupled to at least one of the first shaft and the second shaft, at least one of the first and second legs extending through the first lumen, the first loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the first lumen and out the distal opening in the first lumen, a second loop having a first leg and a second leg, at least one of the first and second legs extending through the lumen, the second loop being movable from a collapsed position to an expanded position when the at least one of the first and second legs is advanced through the second lumen and out the distal opening in the lumen, a first concave element coupled to the first loop, the first concave element and the first loop forming a first basket, a second concave element coupled to the second loop, the second concave element and the second loop forming a second basket;
  
  expanding the first loop;
  
  expanding the second loop; and
  
  rotating the first loop and second loop relative to one another about a longitudinal axis of the first shaft.

317. The method of claim C, further comprising:
- cutting material with a rotating cutter having a cutting element at a distal end, the rotating cutter having a working position adjacent the distal opening in the shaft.

323. A method of cutting a lens in a cataract procedure, comprising:
- introducing a distal end of a device into an eye, the device having a shaft and an elongate element coupled to the shaft, the shaft having a first shaft part and a second shaft part, the first shaft part and the second shaft part being movable relative to one another between a first position and a second position, the elongate element having a first end coupled to the first shaft part and a second end coupled to the second shaft part, the device forming a loop with at least part of the elongate element forming the loop, the loop being movable from a collapsed position to an expanded position when the first shaft part and the second shaft part move from the first position to the second position;
  
  expanding the loop from the collapsed position to the expanded position by moving the first and second shaft parts from the first position to the second position;
  
  positioning the loop around material to be cut; and
  
  cutting the material by collapsing the loop from the expanded position toward the collapsed position, the loop being collapsed by moving the first and second shaft parts from the second position toward the first position to cut the material positioned within the loop.
- View Dependent Claims (313, 314, 315, 316, 318, 319, 320, 321, 322, 324, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 335, 336, 337, 338, 339)
- - 313. The method of claim 323, wherein:
    - the introducing is carried out with the first concave element including a first concave shaped loop and the second concave element includes a second concave shaped loop.
  - 314. The method of claim 323, wherein:
    - the rotating is carried out with the second shaft being rotatable relative to the first shaft so that the second basket is rotatable relative to the first basket between an open position and a closed position, the open position having the first basket and the second basket at least partially nested and the closed position having the first basket facing the second basket.
  - 315. The method of claim 323, wherein:
    - the rotating is carried out with the second shaft rotatable to the closed position with the first basket and the second basket forming an enclosure.
  - 316. The method of claim 323, further comprising:
    - cutting the material by collapsing the first loop and the second loop to cut material when the first loop and the second loop are moved from the expanded position to the collapsed position.
  - 318. The method of claim 323, wherein:
    - the rotating cutter cutting is carried out with the working position having the cutting element positioned proximal to the distal opening.
  - 319. The method of claim 323, wherein:
    - the rotating cutter cutting is carried out with is coupled to the shaft and is longitudinally movable relative to the shaft to move the cutting element into the working position.
  - 320. The method of claim 323, wherein:
    - the rotating cutter cutting is carried out with the rotating cutter including a lumen.
  - 321. The method of claim 323, further comprising:
    - suctioning material through the lumen in the rotating cutter.
  - 322. The method of claim 321, wherein:
    - the suctioning with the rotating cutter is carried out during the cutting with the rotating cutter.
  - 324. The method of claim 323, wherein:
    - the expanding is carried out with the loop advancing between a capsular bag and a whole lens contained within the capsular bag;
      
      the positioning is carried out with the material being a whole lens, the loop being positioned around an anterior surface and a posterior surface of the lens; and
      
      the cutting is carried with the whole lens being separated into at least a first fragment and a second fragment.
  - 325. The method of claim 323, wherein:
    - the first flexible portion has a length of 20-60% of a length of the intermediate portion.
  - 326. The method of claim 323, wherein:
    - the introducing is carried out with the elongate element having a first flexible portion at the first end, wherein an intermediate portion between the first end and the second end is at least 1.5 more stiff than the first flexible portion.
  - 327. The method of claim 323, wherein:
    - the introducing is carried out with the elongate element having a second flexible portion at the second end, wherein the intermediate portion between the first end and the second end is at least 1.5 more stiff than the second flexible portion.
  - 328. The method of claim 323, wherein:
    - the expanding is carried out with the first end having an orientation that changes an angular orientation by at least 120 degrees with respect to the shaft adjacent to the second end of the elongate element when the first and second shaft parts move from the first position to the second position.
  - 329. The method of claim 323, wherein:
    - the expanding is carried out with the first end being coupled to a flexible distal end of the shaft, the flexible distal end of the shaft changing orientation with respect to the shaft adjacent the second end by at least 30 degrees when the first and second shaft parts move from the first position to the second position.
  - 330. The method of claim 323, wherein:
    - the expanding is carried out with the first end being rotatably coupled to the shaft.
  - 331. The method of claim 323, wherein:
    - the expanding is carried out with the first end being rotatable relative to the shaft for an angle of at least 120 degrees.
  - 332. The method of claim 323, wherein:
    - the expanding is carried out with the first end being rotatably coupled to the shaft to rotate for 180 degrees+/−
      
      45 degrees when the first and second shaft parts move from the first position to the second position.
  - 333. The method of claim 323, wherein:
    - the expanding is carried out with the loop advancing distally beyond a distal end of the shaft as the loop moves from the collapsed position to the expanded position.
  - 334. The method of claim 323, wherein:
    - the expanding is carried out with the second end changing in orientation relative to the shaft adjacent the second end by 90 degrees+/−
      
      45 degrees when the first and second shaft parts move from the first position to the second position.
  - 335. The method of claim 323, wherein:
    - the expanding is carried out with the second end being rotating relative to the shaft when the first and second shaft parts move from the first position to the second position.
  - 336. The method of claim 323, wherein:
    - the expanding is carried out with the second end changing an orientation with respect to the shaft adjacent the second end being rotatably coupled to the shaft to rotate for 90 degrees+/−
      
      45 degrees when the first and second shaft parts move from the first position to the second position.
  - 337. The method of claim 323, wherein:
    - the introducing is carried out with the elongate element being without a preset shape.
  - 338. The method of claim 323, wherein:
    - the introducing is carried out with the elongate element not including a superelastic material.
  - 339. The method of claim 323, wherein:
    - the expanding is carried out with the loop moving from an unbiased position toward a biased position when moving from the collapsed position to the expanded position.

340. A device for cutting material, comprising:
- a shaft having a distal end, the shaft having a first shaft part and a second shaft part, the first shaft part and the second shaft part being movable relative to one another between a first position and a second position; and
  
  an elongate element coupled to the shaft, the elongate element having a first end coupled to the first shaft part and a second end coupled to the second shaft part, at least part of the elongate element forming a loop, the loop being movable from a collapsed position to an expanded position when the first shaft part and the second shaft part move from the first position to the second position.
- View Dependent Claims (341, 342, 343, 344, 345, 346, 347, 348, 349, 350, 351, 352, 353, 354, 355, 356, 357, 358, 359, 360, 361, 362, 363)
- - 341. The device of claim 340, wherein:
    - the loop is advanced between a capsular bag and a whole lens contained within the capsular bag in use when expanded from the collapsed position to the expanded position.the loop being movable around an anterior surface and a posterior surface of the whole lens to separate the whole lens into at least a first fragment and a second fragment.
  - 342. The device of claim 340, wherein:
    - the elongate element has a first flexible portion at the first end and a second flexible portion at the second end, wherein an intermediate portion between the first end and the second end is at least 1.5 more stiff in bending than the first and second flexible portions when expanding.
  - 343. The device of claim 340, wherein:
    - the first flexible portion has a length of 20-60% of a length of the intermediate portion.
  - 344. The device of claim 340, wherein:
    - the first end has an orientation that changes by at least 120 degrees with respect to the shaft at the second end of the elongate element when the first and second shaft parts move from the first position to the second position.
  - 345. The device of claim 340, wherein:
    - the shaft has a flexible distal end coupled to the first end, the flexible distal end of the shaft changing orientation with respect to the shaft adjacent the second end by at least 30 degrees when the first and second shaft parts move from the first position to the second position; and
      
      the first end of the elongate element being coupled to a flexible distal end of the shaft,
  - 346. The device of claim 340, wherein:
    - the first end is rotatably coupled to the shaft.
  - 347. The device of claim 340, wherein:
    - the first end is rotatable relative to the shaft for an angle of at least 120 degrees.
  - 348. The device of claim 340, wherein:
    - the first end being rotatably coupled to the shaft to rotate for 180 degrees+/−
      
      45 degrees when the first and second shaft parts move from the first position to the second position.
  - 349. The device of claim 340, wherein:
    - the loop formed at least in part by the elongate element advances distally beyond a distal end of the shaft as the loop moves from the collapsed position to the expanded position.
  - 350. The device of claim 340, wherein:
    - the second end changes in orientation relative to the shaft adjacent the second end by 90 degrees+/−
      
      45 degrees when the first and second shaft parts move from the first position to the second position.
  - 351. The device of claim 340, wherein:
    - the second end rotates relative to the shaft when the first and second shaft parts move from the first position to the second position.
  - 352. The device of claim 340, wherein:
    - the second end changes an orientation with respect to the shaft adjacent the second end and is rotatably coupled to the shaft to rotate for 90 degrees+/−
      
      45 degrees when the first and second shaft parts move from the first position to the second position.
  - 353. The device of claim 340, wherein:
    - the first end of the elongate element is rotatably coupled to the shaft.
  - 354. The device of claim 340, wherein:
    - the first end of the elongate element is rotatable relative to the shaft for an angle of at least 120 degrees.
  - 355. The device of claim 340, wherein:
    - the first end of the elongate element is rotatably coupled to the shaft to rotate for 180 degrees+/−
      
      45 degrees when the first and second shaft parts move from the first position to the second position.
  - 356. The device of claim 340, wherein:
    - the first end of the elongate element rotates so that the loop advances distally beyond a distal end of the shaft as the loop moves from the collapsed position to the expanded position.
  - 357. The device of claim 340, wherein:
    - the second end of the elongate element is rotatably coupled to the shaft.
  - 358. The device of claim 340, wherein:
    - the second end of the elongate element is rotatable relative to the shaft for an angle of at least 120 degrees when the first and second shaft parts move from the first position to the second position.
  - 359. The device of claim 340, wherein:
    - the second end of the elongate element is rotatably coupled to the shaft to rotate for 180 degrees+/−
      
      45 degrees when the first and second shaft parts move from the first position to the second position.
  - 360. The device of claim 340, wherein:
    - the second end of the elongate element rotates relative to the shaft so that the loop advances proximally as the loop moves from the collapsed position to the expanded position.
  - 361. The device of claim 340, wherein:
    - the elongate element is without a preset shape.
  - 362. The device of claim 340, wherein:
    - the elongate element does not include a superelastic material.
  - 363. The device of claim 340, wherein:
    - the loop formed at least in part by the elongate element moves from an unbiased position toward a biased position when moving from the collapsed position to the expanded position.

364. An ocular surgical device comprised of:
- hand held piecea suction mechanism manually activated by a usera source of pressurized fluidwherein the hand held piece is connected to the suction mechanism and the source of fluida user input on the hand held mechanism for controlling the flow of suction or fluida tip on the distal end of the hand held piece capable of providing both suction and delivery of fluid

Specification

Resources

Litigation Campaign Assessment

Current Assignee
Carl Zeiss Meditec Cataract Technology Inc. (Carl-Zeiss-Stiftung)
Original Assignee
Iantech, Inc. (Carl-Zeiss-Stiftung)
Inventors
CLAUSON, LUKE, Chamness, Scott, Schaller, Michael

Granted Patent

US 10,624,785 B2
Time in Patent Office

Days
Field of Search
US Class Current
CPC Class Codes

A61B 17/221   Gripping devices in the for...

A61B 17/320016   Endoscopic cutting instrume...

A61B 17/32002   with continuously rotating,...

A61B 17/3203   Fluid jet cutting instruments

A61B 17/32056   Surgical snare instruments ...

A61B 17/320725   with radially expandable cu...

A61B 2017/00867   shape memory effect for pro...

A61B 2017/2212   having a closed distal end,...

A61B 2017/320052   Guides for cutting instrume...

A61B 2217/005   with suction drainage system

A61B 2217/007   with irrigation system

A61F 9/0008   Introducing ophthalmic prod...

A61F 9/00736   Instruments for removal of ...

A61F 9/00745   using mechanical vibrations...

A61F 9/00754   for cutting or perforating ...

A61F 9/00781   Apparatus for modifying int...

A61F 9/008   using laser

A61F 9/013   Instruments for compensatio...

DEVICES AND METHODS FOR OCULAR SURGERY

First Claim

2 Assignments

0 Petitions

Accused Products

Abstract

32 Citations

364 Claims

Specification

Solutions

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DEVICES AND METHODS FOR OCULAR SURGERY

First Claim

2 Assignments

Subscription Required

Subscription Required

0 Petitions

Subscription Required

Accused Products

Subscription Required

Abstract

32 Citations

364 Claims

Specification

Subscription Required

Solutions

Use Cases

Quick Links