JP6492411B2 - Ophthalmic laser surgery device - Google Patents

Description

  The present invention relates to an ophthalmic laser surgical apparatus for treating a patient's eye by irradiating the patient's eye with a laser beam.

  In recent years, a technique for treating (for example, cutting or crushing) a tissue of a patient's eye by irradiating a laser has been proposed. For example, the apparatus described in Patent Document 1 focuses a laser beam on a target position of eyeball tissue to form a laser spot. As a result, the eyeball tissue is mechanically broken (cut).

  By the way, in the apparatus as described above, an apparatus for setting a surgical condition using a tomogram of a patient's eye is known (refer to Reference 2).

Special table 2010-538700 gazette JP 2013-248304 A

  However, in the conventional apparatus, since much time is required for planning, the time for the entire operation becomes long, which places a burden on the operator and the patient.

  In view of the above problems, an object of the present invention is to provide an ophthalmic laser surgical apparatus capable of performing a smooth operation.

  In order to solve the above-mentioned problems, the present invention has the following configuration.

(1) A scanning optical system that three-dimensionally scans laser light emitted from a laser light source is provided, and treatment of a patient's eye lens is performed by irradiating each target position corresponding to a preset treatment region with laser light. An ophthalmic laser surgery device for
The first data set relating to the structure of the patient's eye lens acquired in advance for planning the treatment region including the lens of the patient's eye, which is arranged as a separate housing from the ophthalmic laser surgical apparatus The patient's eye acquired when the first data set acquired by the anterior segment tomography apparatus and the treatment area are planned, and then the treatment with the laser light is performed based on the planned treatment area A second data set relating to the structure of the crystalline lens, the second data set obtained by the anterior segment tomography device provided in the ophthalmic laser surgical apparatus ,
A change that compares the first data set with the second data set to obtain change information of the patient's eye that is at least one of structural change information of the patient's eye and change information of the gaze direction of the patient's eye An information acquisition means is provided.

It is an external appearance block diagram of the ophthalmic laser surgery apparatus of a present Example. It is a perspective view when an irradiation end unit is expanded. It is the schematic which shows the internal structure of a present Example. It is a figure for demonstrating the 2nd movement unit of a present Example. It is a figure for demonstrating attachment and detachment of an eyeball fixing unit. It is a figure for demonstrating a tomogram imaging unit. It is a figure explaining a monitor display. It is a figure explaining a monitor display. It is a block diagram which shows the control system of a present Example. It is a flowchart which shows the control action of a present Example. It is a figure for demonstrating operation | movement of a fixation visual guidance unit. It is a figure for demonstrating a part of alignment operation | movement of a present Example. It is a figure for demonstrating the control method of a 1st, 2nd movement unit. It is a figure for demonstrating operation | movement of a focus adjustment unit. It is a figure for demonstrating regarding the alignment detection of a present Example. It is a figure for demonstrating planning. It is a figure for demonstrating correction of the planning content. It is a figure for demonstrating the example of a change of a focus adjustment unit. It is a figure explaining the example of a change of a tomographic imaging unit.

<Overview>
[First Embodiment]
The outline of the first embodiment relating to docking will be described below. The ophthalmic laser surgical apparatus (hereinafter also referred to as this apparatus or a surgical apparatus, see FIG. 1) 1 according to the present embodiment focuses laser light on the tissue of the patient eye E to treat the patient eye E. For example, the present apparatus 1 may include an irradiation optical system 320 (see FIG. 3). For example, the irradiation optical system 320 irradiates the patient's eye E with laser light emitted from a laser light source. The irradiation optical system 320 may include, for example, an objective lens 305 for condensing the laser with respect to the tissue of the patient eye E. For example, the apparatus 1 may include a moving unit 10, an eye detector (for example, the control unit 100), a control unit 100, and the like.

  The moving unit may be provided, for example, to move the eyeball fixing unit 280 for fixing the patient's eye E on the optical axis of the laser irradiation unit 300 toward the patient's eye E.

  For example, the eye detector fixes an eyeball based on a captured image (for example, a front image, a tomographic image, or the like) captured by an imaging optical system (for example, the observation optical system 70) for capturing an image of the patient's eye E. The patient eye E before being fixed by the unit 280 may be detected.

  The control unit 100 controls driving of the driving unit based on the detection signal from the eye detector, and automatically moves the eyeball fixing unit 280 with respect to the patient's eye E before being fixed by the eyeball fixing unit 280. Also good.

  For example, the control unit 100 may automatically start and complete the docking operation when it is determined that the alignment, the tilt of the patient's eyes, etc. are appropriate. The control unit 100 may automatically move the eyeball fixing unit 280 based on the eye detection result.

  The apparatus 1 may include a delivery unit 41. The delivery unit 41 guides laser light to the patient's eye E. The delivery unit 41 may include at least a part of the irradiation end unit 42 and the irradiation optical system 320, for example.

  The moving unit 10 may include a drive unit 12. The moving unit 10 may be connected to the laser irradiation end unit 300 and the delivery unit 41 by driving of the driving unit 12. The moving unit 10 may be provided to integrally move the eyeball fixing unit 280 for fixing the patient's eye E on the optical axis of the laser irradiation unit 300 toward the patient's eye E. The moving unit 10 may be provided to move the eyeball fixing unit 280 integrally with the irradiation optical system 320, for example.

  The eye detector may include, for example, at least one of an alignment detector (for example, the control unit 100) and a tilt detector (for example, the control unit 100). For example, the alignment detector may detect the alignment state of the patient's eye E with respect to the irradiation optical system 320 based on the captured image. For example, the inclination detector may detect the inclination state of the patient's eye E with respect to the irradiation optical system 320 based on the captured image.

  The control unit 100 controls the driving of the driving unit 100 and determines the eyeball fixing unit 280 for the patient's eye E when it is determined that at least one of the alignment state and the tilted state is appropriate in the detection result of the eye detector. It is also possible to automatically make contact.

  The apparatus 1 may further include a fixation guidance unit 120. The fixation guidance unit 120 may guide the fixation direction of the patient eye E by moving the presentation position of a fixation target (for example, the light source 121) presented to the patient eye E. In this case, the control unit 100 drives the driving unit so that the patient eye E and the irradiation optical system 320 have a predetermined positional relationship based on the detection result of the alignment state of the patient eye E with respect to the irradiation optical system 320 by the eye detector. 12 may be controlled for automatic alignment. Thereafter, the control unit 100 controls the fixation guiding unit 120 to automatically perform fixation target presentation so that the irradiation optical axis (for example, the optical axis L1) and the inclination of the patient's eye E have a predetermined relationship. Also good. At this time, for example, the control unit 100 automatically controls the driving unit 12 to automatically move the moving unit 10 so that a predetermined positional relationship is obtained again with respect to the alignment deviation caused by moving the fixation target presentation position. The patient's eye E may be fixed by the eyeball fixing unit 280. The eyeball fixing unit 280 may be manually performed by an examiner, and the irradiation optical system 320 may be automatically performed by a control unit.

  Note that the control unit 100 may control the fixation guiding unit 120 based on, for example, the detection result of the tilt state of the patient's eye E with respect to the irradiation optical system 320 by the eye detector. Accordingly, the control unit 100 may automatically move the fixation target presentation position. The control unit 100 may detect the tilt state of the eye E as needed and move the fixation target presentation position as needed.

  The apparatus 1 may further include an alignment projection optical system (for example, an illumination light source 60). For example, the alignment projection optical system may project alignment light toward the patient's eye E. In this case, the alignment detector may detect the misalignment of the laser irradiation unit with respect to the patient's eye E by receiving the reflected light from the anterior segment due to the alignment light with the light receiving element. The alignment detector acquires a tomographic image of the patient's eye E, acquires the shape of the characteristic part of the patient's eye E from the acquired tomographic image, and detects the misalignment of the laser irradiation unit 300 with respect to the patient's eye E. Also good.

  Note that the eyeball fixing unit 280 may have a suction ring 281. The suction ring 281 may be a ring-shaped member that comes into contact with the patient's eye E. The eyeball fixing unit 280 may suck and fix the patient's eye E on the irradiation optical axis by the suction ring 281. The moving unit 10 may be capable of moving the irradiation optical system 320 and the eyeball fixing unit 280 integrally. The control unit 100 may control the driving of the driving unit 12 and move the eyeball fixing unit 280 to a position where the patient's eye E and the suction ring 281 come into contact with each other. Then, for example, when the eyeball fixing unit 280 is moved to a position where the patient's eye E and the suction ring 281 come into contact with each other, the control unit 100 controls the fixation guiding unit 120 and the irradiation optical axis of the laser irradiation unit 300. In order to match the optical axis of the patient's eye E (for example, the optical axis S1), the position of the fixation target presented to the patient's eye E may be moved.

  The control unit 100 controls the drive unit 12 so that the patient eye E and the suction ring 281 come into contact again with respect to the misalignment caused by moving the fixation target presentation position. The patient's eye E may be aspirated and fixed by the eyeball fixing unit 280.

  The control unit 100 controls the fixation guidance unit 120 to move the fixation lamp presentation position in order to correct the optical axis shift of the fixation target refracted by the liquid injected inside the suction ring 281. You may let them.

  The apparatus may include an observation optical system 70 and a focus adjustment unit 80. The observation optical system 70 may include a light receiving element 76. The observation optical system 70 may be provided in the laser irradiation unit 300 in order to capture an anterior ocular segment observation image of the patient's eye E by the light receiving element 76. The focus adjustment unit 80 may adjust the focus of the observation optical system 70 with respect to the patient's eye E, for example.

  The focus adjustment unit 80 may be capable of correcting a focus shift of the observation optical system 70 due to driving of the moving unit 10. In this case, the eye detector may detect the alignment state of the patient's eye E with respect to the irradiation optical system 320 using the anterior ocular segment observation image corrected by the focus adjustment unit 80. Furthermore, the control unit 100 may control the driving unit 12 based on the alignment detection result by the eye detector to move at least a part of the irradiation end unit 42 with respect to the patient's eye E.

[Second Embodiment]
Hereinafter, an outline of the second embodiment relating to planning before surgery (setting of surgical conditions) will be described. In addition, the same number is attached | subjected and demonstrated to the structure similar to 1st Embodiment. The ophthalmic laser surgical apparatus (hereinafter, also referred to as “this apparatus” or “surgical apparatus”) 1 according to the second embodiment treats the patient's eye E by, for example, condensing laser light on the tissue of the patient's eye E. The apparatus 1 may include, for example, a scanning optical system (for example, a scanning unit 330). For example, the scanning optical system may three-dimensionally scan the laser light emitted from the laser light source. For example, the apparatus 1 may perform treatment of the patient's eye E by irradiating each target position corresponding to a preset treatment region with laser light.

The apparatus 1 may include, for example, a change information acquisition unit (for example, the control unit 100). For example, the change information acquisition unit may acquire the first data set and the second data set. The first data set may relate to, for example, the structure of the patient eye E acquired in advance for planning a treatment region including the inside of the tissue of the patient eye E. The second data set may relate to the structure of the patient's eye E acquired when performing treatment with a laser beam based on the planned treatment area after the treatment area is planned. The change information acquisition unit is, for example,
The acquired first data set is compared with the second data set, and the change information of the patient's eye E that is at least one of the structural change information of the patient's eye E and the change information of the line of sight of the patient's eye E is obtained. Also good.

  The structure of the patient's eye E may be at least one of a corneal shape, a crystalline lens shape, an iris shape, and a corner shape, for example. The treatment region may be, for example, a region inside the cornea or a lens.

The first or second data set may be, for example, an anterior segment tomographic image, an anterior segment front image, or three-dimensional data. The structural change may include a structural change in at least the depth direction or the transverse direction.
The change information acquisition unit may obtain, for example, the astigmatic axis of the patient's eye E from the cornea shape and obtain the rotation direction of the eyeball. For example, the change information acquisition unit may determine the eye direction of the eyeball by determining the optical axis of the crystalline lens from the center of curvature radius of the front or rear surface of the crystal. In addition, the change information acquisition unit may obtain an iris plane from the corner of the patient's eye E, and obtain the line-of-sight direction of the eyeball. The change information acquisition unit may determine the position of the eyeball in the optical axis direction from the iris plane. The change information acquisition unit may determine the position of the patient's eye from the cataract distribution in the lens. The change information acquisition unit may calculate the above information for the first data and the second data, respectively, and compare the first data and the second data.

  For example, when the eyeball is fixed by the eyeball fixing unit 280, the cornea may be deformed by the suction ring 281 and the position of the crystalline lens may be displaced. Note that the shape of the eyeball may change depending on the sitting position or the sleeping position. For example, the change information acquisition unit may acquire change information of these eyeballs.

  Note that the treatment with laser light may be, for example, before docking, after docking, or during laser irradiation.

  The ophthalmic laser surgical apparatus may incise the eyeball tissue by moving the laser spot three-dimensionally and continuously connecting the laser spots.

Note that the first data set may be acquired based on an image photographed by a first ophthalmologic photographing apparatus that is a separate apparatus for photographing the patient's eye E in the sitting position.
As the ophthalmologic photographing apparatus, for example, an anterior ocular segment image photographing apparatus such as an optical coherence tomography, an SLO (Scanning laser opthalmoscopeoct) Shine peak camera, or the like may be used.

  The apparatus 1 may further include a fixation guidance unit 120 and a control unit 100. For example, the fixation guidance unit 120 may guide the fixation direction of the patient eye E by moving the presentation position of the fixation target presented to the patient eye E. For example, the control unit 100 may control the fixation guidance unit based on the change information of the line-of-sight direction of the patient's eye E acquired by the change information acquisition unit. At this time, the control unit 100 may correct the change in the line-of-sight direction of the patient's eye E with respect to when the first data set used for planning is acquired. Thus, this apparatus 1 may correct | amend the shift | offset | difference of the gaze direction of the examiner's eye E. FIG.

  The apparatus may further include a setting unit (for example, the control unit 80). The setting unit may set the irradiation position of the laser beam based on the treatment region planned based on the first data set and the change information of the patient's eye E acquired by the change information acquisition unit.

  For example, the setting unit may correct the laser irradiation position set in advance based on the treatment area based on the change information. For example, when setting the irradiation position based on the treatment region, the setting unit may set the irradiation position in consideration of change information.

  The change information acquisition unit may acquire a second data set relating to the structure of the patient's eye E whose fixation direction is corrected by the control unit 100 as the second data set. At this time, the setting unit sets the irradiation position of the laser beam based on the treatment region planned based on the first data set and the change information of the patient's eye E acquired by the change information acquisition unit. Also good.

  The first data set and the second data set may each be a data set including data related to the corner structure of the patient's eye E. In this case, the change information acquisition unit may compare the data related to the corner structure in the first data set with the data related to the corner structure in the second data set. Then, the change information acquisition unit may acquire the change information of the patient's eye E that is at least one of the structure change information of the patient's eye E and the change information of the visual line direction of the patient's eye E.

  Note that each of the first data set and the second data set may be a data set including data related to at least one of the corneal structure, the lens structure, and the iris structure of the patient eye E.

[Third Embodiment]
The outline of the third embodiment relating to the tomography unit will be described below. Hereinafter, an outline of the second embodiment relating to planning before surgery (setting of surgical conditions) will be described. In addition, the same number is attached | subjected to the structure similar to 1st or 2nd embodiment, and description may be abbreviate | omitted.

  The ophthalmic laser surgical apparatus (hereinafter, also referred to as “this apparatus” or “surgical apparatus”) 1 according to the second embodiment treats the patient's eye E by, for example, condensing laser light on the tissue of the patient's eye E. The apparatus 1 mainly includes at least an irradiation optical system 320, a tomographic image acquisition unit (for example, a tomographic image capturing unit 71), a first reference optical system 721, and a second reference optical system 731. The tomographic image acquisition unit may include an OCT light source 711, a measurement optical path, a reference optical path, a photodetector 717, an image processor (for example, the control unit 80), and the like. The measurement optical path may share at least a part of the optical path with the irradiation optical system 320. The light detector 717 may detect an interference signal between the measurement light guided to the patient's eye E via the measurement light path and the reference light from the reference light path. The image processor may process the interference signal from the photodetector 717 to obtain a tomographic image.

  The reference optical path may include a first reference optical system 714 and a second reference optical system 715. In the first reference optical system 714, an optical path length may be set to obtain a tomographic image of the patient's eye E. The second reference optical system 715 may be set to have an optical path length shorter than that of the first reference optical system 714 in order to obtain a tomographic image of the interface unit 50.

  The image processor removes either the real image or the virtual image included in the tomographic image obtained by processing the interference signal between the measurement light guided to the patient's eye E and the reference light of the first reference optical system 714. 1 full range processing may be performed. The image processor removes one of the real image and the virtual image included in the tomographic image obtained by processing the interference signal between the measurement light guided to the interface 50 and the reference light of the second reference optical system. A full range process may be performed.

  Note that the tomographic image of the patient's eye E may be a tomographic image including at least one of the cornea and the crystalline lens, for example.

  The image processor synthesizes the first tomographic image obtained by the first full-range processing and the second tomographic image obtained by the second full-range processing by image processing. A third tomographic image including at least a region up to the crystalline lens of the patient's eye E may be acquired.

  The apparatus 1 includes an irradiation end unit 42 that houses at least the objective lens 305 and an interface unit 50 attached to the irradiation end unit 42 so as to move integrally toward the patient's eye E. And a movement control unit 100 that controls the movement unit 10 so that a tomographic image of the patient's eye E is acquired. The moving unit 10 may include a drive unit 12.

  The device 1 may include a distance detector (for example, the control unit 100). The distance detector includes, for example, the patient eye E included in the first tomographic image obtained by the first full range processing and the interface 50 included in the second tomographic image obtained by the second full range processing. Detection may be performed by image processing, and the relative distance between the patient's eye E and the interface 50 may be detected based on the detection result.

  The apparatus 1 may include a position detector (for example, the control unit 100). The position detector performs image processing on the patient eye E included in the first tomographic image obtained by the first full range processing and the interface included in the second tomographic image obtained by the second full range processing. Detection may be performed, and a relative position between the patient's eye E and the interface may be detected based on the detection result.

  The apparatus 1 includes, for example, an optical path length adjustment unit for changing the optical path length of the reference light by moving an optical member (for example, the second reference mirror 731) disposed in the second reference optical system; An optical path length control unit (for example, the control unit 100) that controls the optical path length adjustment unit so that a tomographic image of the patient's eye E may be acquired. The optical path length control unit may include a drive unit.

  The optical path length control unit may control the optical path length adjustment unit so that a tomographic image of the patient's eye E is acquired according to changes in the movement positions of the irradiation end unit and the interface unit.

  The optical path length control unit may shorten the optical path length of the reference light as the irradiation end unit 42 and the interface unit 50 approach the patient's eye E. Accordingly, the optical path length control unit may correct the shortening of the optical path length of the measurement optical path accompanying the approach of the irradiation end unit 42 and the interface unit 50. The change amount of the optical path length may be calculated in advance based on the distance between the patient's eye E and the device.

  The optical path length control unit sets the optical path length adjustment unit so that a tomographic image of the patient's eye E is acquired in accordance with a change in the movement position of the imaging target included in the tomographic image acquired by the tomographic image acquisition unit. You may control. For example, the optical path length adjustment unit may be controlled according to a change in the movement position of the patient's eye in the tomographic image.

<Example>
Hereinafter, one exemplary embodiment of the present invention will be described with reference to the drawings. In the following description, as an example, the direction along the optical axis of the laser light applied to the patient's eye E is defined as the Z direction. One of the directions intersecting the Z direction (vertically intersecting in the present embodiment) is defined as the X direction. A direction that intersects both the Z direction and the X direction (vertically intersects in this embodiment) is defined as a Y direction. The X, Y, and Z directions may be set as appropriate. For example, when the direction is defined based on the patient's vertical and horizontal directions, the X direction may be the patient's horizontal direction, the Y direction may be the patient's vertical direction, the X direction is the patient's vertical direction, and the Y direction is the patient's horizontal direction. The Z direction may be the axial direction of the eye E. FIG. 1 is a schematic view showing the external appearance of the apparatus 1. FIG. 3 is a schematic diagram illustrating a schematic configuration of the optical system and the control system of the apparatus 1.

<Overall configuration>
The ophthalmic laser surgical apparatus 1 according to the present embodiment is used for treating the tissue of the patient's eye E. In this embodiment, an ophthalmic laser surgical apparatus 1 capable of treating the crystalline lens of the patient's eye E is illustrated. However, the technique exemplified in the present embodiment may be applied to, for example, treatment of other parts of the patient's eye E (for example, the cornea and the fundus). This technique may of course be applied to the treatment of anterior segment tissues including the cornea and the lens.

  An ophthalmic laser surgical apparatus (hereinafter referred to as a surgical apparatus) 1 according to the present embodiment includes, for example, a first moving unit 10, a second moving unit 200, a laser irradiation unit 300, an interface unit 50, a control unit 100, and a fixation guidance unit 120. Is mainly provided. The surgical apparatus 1 may include an illumination light source 60, an observation / photographing unit 70, a focus adjustment unit 80, and an operation unit 400.

  The laser irradiation unit 300 (see FIG. 3) includes a laser light source unit 310 and a laser irradiation optical system (laser delivery) 320. The laser light source unit 310 is disposed inside the main body 2. The laser irradiation optical system (light guide optical system) 320 is an optical system arranged to guide the laser light from the laser light source unit 310 to the eye E.

  At least a part of the laser irradiation optical system 320 is provided in the delivery unit 41 (see FIGS. 1 and 2). The laser emitted from the laser light source unit 310 is guided to the irradiation end unit 42 in the delivery unit 41 via the laser irradiation optical system 320 (details will be described later). The irradiation end unit 42 is provided with at least an objective optical system (for example, an objective lens 305) for condensing a laser beam, and the laser is irradiated from the emission end of the irradiation end unit 42 toward the eye E. . Note that an observation / photographing unit 70 may be disposed in the irradiation end unit 42 of the delivery unit 41 and is used for observation / photographing of the eye E.

  The first moving unit 10 is arranged to move the irradiation end unit 42 at least XYZ with respect to the main body 2. An interface unit 50 is provided at the emission end of the irradiation end unit 42. In addition, an eyeball fixing unit 280 is disposed in the delivery unit 41 via the second moving unit 200. Therefore, when the irradiation end unit 42 is moved by the first moving unit 10, as a result, the interface unit 50, the eyeball fixing unit 280, and the second moving unit 200 are moved together with the irradiation end unit 42.

  The first moving unit 10 is provided, for example, in the delivery unit 41, and the irradiation end unit 42 is moved with respect to the main body 2 (see, for example, Japanese Patent Laid-Open No. 2000-152951 for the moving mechanism). ). However, it is not limited to this. For example, the first moving unit 10 may be provided in the main body 2, and the first moving unit 10 moves the delivery unit 41 relative to the main body 2 to move the irradiation end unit 42 to the main body 2. You may move relatively.

  The second moving unit 200 is arranged to move the eyeball fixing unit 280 relative to the irradiation end unit 42. The second moving unit 200 is used, for example, to reduce the displacement of the eyeball fixing unit 280 toward the patient's eye E when the irradiation end unit 42 is moved by the first moving unit 10 described above. That is, the eyeball fixing unit 280 is moved by the first moving unit 10 regardless of the presence or absence of the eye E. However, the second moving unit 200 can move independently in the direction opposite to the moving direction of the irradiation end unit 42 (details will be described later, see FIGS. 4 and 13).

  2 and 4, the second moving unit 200 is provided in the irradiation end unit 42 of the delivery unit 41, but is not limited thereto. For example, it may be provided at the base of the delivery unit 41.

  In more detail, the 2nd movement unit 200 can attach the eyeball fixing unit 280 mentioned later so that attachment or detachment is possible. The second moving unit 200 can move the eyeball fixing unit 280 in the Z direction. The eyeball fixing unit 280 fixes and holds the eyeball of the patient's eye E with respect to the laser irradiation unit 300. The laser irradiation unit 300 irradiates the patient's eye E with laser light. The irradiation end unit 42 is provided with an objective lens 305 for condensing the laser light on the patient's eye E.

  The interface unit 50 is close to the cornea of the patient's eye E, reduces the refractive index difference, and reduces the aberration of the laser light generated by the refractive index difference. This reduces surface reflections at the cornea and lens, for example. The illumination light source 60 illuminates the patient's eye E. The observation / imaging unit 70 captures a front image of the anterior segment of the patient's eye E and a tomographic image of the anterior segment. The observation / imaging unit 70 includes, for example, an optical coherence tomography unit (abbreviated as (OCT: Optical Coherence Tomography) unit) 71 and a front imaging unit 75. The optical coherence tomography unit 71 captures (acquires) a tomogram of the patient's eye E. The front imaging unit 75 captures an anterior segment image of the patient's eye E. The focus adjustment unit 80 adjusts the focus of the front photographing unit 75. The operation unit 400 is provided for operating the apparatus 1. The control unit 100 performs overall control of the entire apparatus.

<First mobile unit>
More specifically, the first moving unit 10 (see FIG. 1) integrally moves the irradiation end unit 42, the second moving unit 200, the eyeball fixing unit 280, the interface unit 50, the observation / photographing unit 70, and the like. Thereby, the irradiation end unit 42, the eyeball fixing unit 280, and the interface unit 50 can be aligned with the patient's eye E.

  The first moving unit 10 includes, for example, a moving mechanism 11 and a drive unit (motor, actuator, etc.) 12. The moving mechanism 11 moves a part of the main body such as the eyeball fixing unit 280 and the interface unit 50 with respect to the main body 2. The drive unit 12 drives the moving mechanism 11. The first moving unit 10 has the irradiation end unit 42 (its optical axis L1), the eyeball fixing unit 280, and the interface unit 50 (its central axis) shown in FIG. Move to. Here, the optical axis L1 and the central axes of the eyeball fixing unit 280 and the interface unit 50 coincide with each other. Further, a central axis of a suction ring 281 described later coincides with a central axis of the interface unit 50.

  In addition, regarding the moving mechanism 11 and the driving unit 12, the moving mechanism and the driving unit for moving the irradiation end unit 42 may be arranged at different positions with respect to the X direction, the Y direction, and the Z direction. For example, a moving mechanism and a driving unit related to the X direction and the Y direction may be provided in the main body 2, and a moving mechanism and a driving unit related to the Z direction may be arranged at the base of the delivery unit 41.

  The first moving unit 10 is connected to the control unit 100 and moves the irradiation end unit 42, the eyeball fixing unit 280 and the interface unit 50 with respect to the main body 2 based on a control signal from the control unit 100. The surgeon performs alignment in the XY direction (XY alignment) and alignment in the Z direction (Z alignment) while confirming the patient's eye E displayed on the monitor 92. Here, at least the irradiation end unit 42, the eyeball fixing unit 280, and the interface unit 50 move integrally. The first moving unit 10 moves the suction ring 281 and the interface unit 50 along the Z-axis direction. The first moving unit 10 includes a sensor such as an encoder inside. For this reason, the positions of the eyeball fixing unit 280 and the interface unit 50 are acquired by the control unit 100.

  The first moving unit 10 may be configured to move at least in the Z-axis direction. For example, a configuration in which the laser irradiation unit 300, the eyeball fixing unit 280, and the interface unit 50 are attached to another apparatus (connected to the laser irradiation unit 300) such as a surgical microscope, and the operator moves the XY alignment by holding it. It may be.

<Laser irradiation unit>
As shown in FIG. 3, the laser irradiation unit 300 may include, for example, a laser light source unit 310, a laser irradiation optical system (laser delivery) 320, and a position detection unit 370. The laser light source unit 310 emits surgical laser light (laser beam). The laser irradiation optical system 320 includes an optical member for guiding laser light. The laser irradiation optical system 320 is built in the main body 2 and the delivery unit 41. The laser irradiation optical system 320 includes, for example, a scanning unit 330, an objective lens 305, and various optical members. The objective lens 305 is provided on the optical path between the scanning unit 330 and the patient's eye E. The objective lens 305 focuses the laser light that has passed through the scanning unit 330 on the tissue of the patient's eye E. The position detection unit 370 detects the absolute position of the patient eye E.

  Laser light emitted by the laser light source unit 310 is used to induce plasma in the tissue by nonlinear interaction. Non-linear interaction is one of the interactions caused by light and a substance, and is an effect in which a response that is not proportional to the intensity of light (that is, the density of photons) appears. The ophthalmic laser surgical apparatus 1 according to the present embodiment condenses (focuses) the laser light in the transparent tissue of the patient's eye E, so that the condensing position (also referred to as “laser spot”) or the condensing position. Rather, it causes multiphoton absorption slightly upstream of the optical path (light flux). The probability that multiphoton absorption occurs is not proportional to the intensity of light and is nonlinear. When an excited state is generated by multiphoton absorption, a plasma bubble is generated in the tissue, and the tissue is cut and crushed. The above phenomenon is sometimes referred to as photodisruption. In optical breakdown due to nonlinear interaction, the influence of heat from laser light is unlikely to be applied around the condensing position. Therefore, a fine treatment is possible. As the pulse width of the laser beam is reduced, optical destruction is efficiently performed with less energy.

  As the laser light source unit 310, a device that emits laser light having a pulse width of 1 femtosecond to 10 nanoseconds is used. As the laser light source, for example, a device that emits infrared laser light having a pulse width of 500 femtoseconds and a center wavelength of 1040 nm (wavelength width is ± 10 nm) may be used. Further, as the laser light source, a laser light source that emits an ultraviolet laser having a pulse width of 10 picoseconds and having a wavelength width of ± 10 nm with a central wavelength of 450 nm may be used. The laser light source unit 310 is a laser light source that can emit laser light with an output that causes breakdown when the spot size of the laser spot is 1 to 15 μm.

  In the laser irradiation optical system 320, the laser light source unit 310 is the upstream and the patient eye E is the downstream. Then, the mirror 301 and the mirror 302, the Hall mirror 371 to the lens 303, the lens 304, and the beam combiner 72 are arranged along the optical axis L1 from the laser light source unit 310 toward the downstream.

The mirrors 301 and 302 adjust the optical axis of the laser light. The hall mirror 371 is used as a beam splitter that divides the optical axis L1 of the laser light and the optical axis L2 of the position detection unit 370. The lens 303 is used to form an intermediate image of the scanning unit 330 and laser light. The lens 304 forms a pupil conjugate position. The beam combiner 72 combines the optical axis L1 and the optical axis L3 of the observation / photographing unit 70.
The mirrors 301 and 302 are configured such that their reflection surfaces are orthogonal to each other, and are held by tiltable holding members. The optical axis of the laser light emitted from the laser light source unit 310 can be adjusted by moving and tilting the reflecting surfaces of the mirrors 301 and 302. By adjusting the mirrors 301 and 302, the axis of the laser beam is aligned with the optical axis L1.

<Scanning unit>
The scanning unit 330 scans the condensing position of the laser light collected by the objective lens 305 (details will be described later) by scanning the laser light. That is, the scanning unit 330 moves the condensing position of the laser light to the target position. The scanning unit 330 of this embodiment includes a Z scanning unit 350 and an XY scanning unit 360.

  The Z scanning unit 350 of this embodiment includes a concave lens 351, a convex lens 352, and a drive unit 353. The drive unit 353 moves the concave lens 351 along the optical axis L1. As the concave lens 351 moves, the divergence state of the beam that has passed through the concave lens 351 changes. As a result, the laser beam condensing position (laser spot) moves in the Z-axis direction.

  The XY scanning unit 360 of this embodiment includes an X scanner 361, a Y scanner 364, and lenses 367 and 368. The X scanner 361 causes the drive unit 362 to swing the galvano mirror 363, thereby scanning the laser light in the X direction. The Y scanner 364 scans the laser light in the Y direction by swinging the galvanometer mirror 366 by the driving unit 365. The lenses 367 and 368 conjugate the two galvanometer mirrors 363 and 366.

  The scanning unit 330 may have any configuration that can scan laser light in the XY directions. For example, the scanning in the X direction may be a polygon mirror, and the scanning in the Y direction may be a galvano mirror. A resonant mirror may be used corresponding to the X direction and the Y direction. Moreover, the structure which rotates two prisms independently may be sufficient. In this manner, the laser spot is moved three-dimensionally (in the XYZ directions) within the eyeball tissue (in the target) of the patient's eye E by the scanning unit 330.

  A beam combiner (beam splitter) 72 is arranged between the scanning unit 330 and the objective lens 305 so that the laser optical axis and the observation / photographing optical axis are coaxial. The combiner 72 has a characteristic of reflecting laser light and transmitting illumination light of the observation / photographing unit 70. The objective lens 305 is a lens that is fixedly disposed with respect to the irradiation end unit 42. As shown in FIG. 4, the objective lens 305 is held by the irradiation end unit 42. The objective lens 305 forms an image on the target using laser light as a laser spot. The spot size of the laser spot is, for example, about 1 to 15 μm.

  Although not shown, the laser irradiation unit 300 is provided with an aiming light source that emits aiming light (aiming light) for the operator to confirm the laser irradiation position.

<Position detection unit>
The position detection unit 370 is used to detect the position of the patient eye E with respect to the scanning unit 330. The ophthalmic laser surgical apparatus 1 according to the present embodiment detects the position of the patient's eye E with respect to the scanning unit 330, thereby associating the condensing position where the laser light is condensed with a tomographic image (details will be described later). Control data for controlling the scanning unit 330 and the like can be set using the tomographic image by associating the condensing position with the tomographic image. For details of the position detection unit 370, refer to, for example, Japanese Patent Laid-Open No. 2013-248304.

<Irradiation end unit>
The irradiation end unit 42 (see FIGS. 2 and 4) integrally holds, for example, the objective lens 305, the interface unit 50, and the illumination light source 60. The irradiation end unit 42 includes a lens barrel 44, for example. The lens barrel 44 is cylindrical and holds the objective lens 305 and the like inside. An illumination light source 60 is fixed to the end of the lens barrel 44 on the patient eye E side. A guide 46 is formed at the end of the lens barrel 44 on the patient's eye E side. The interface unit 50 is detachably attached to the guide 46.

  The irradiation end unit 42 is moved in the XYZ axial directions with respect to the main body 2 by the first moving unit 10. The objective lens 305, the interface unit 50, the illumination light source 60, etc. held by the irradiation end unit 42 are moved by the first moving unit 10 together with the irradiation end unit 42.

<Interface unit>
The interface unit 50 (see FIG. 4) is close to the cornea of the patient's eye E, and has a role of facilitating reaching (condensing) the laser light to the eyeball tissue such as a crystalline lens by weakening the refractive power of the cornea. The interface unit 50 of the present embodiment is configured to cover at least a part of the cornea without directly contacting the cornea. The interface unit 50 mainly includes a cover glass 51 and a holder 52. The cover glass 51 is an optical member that covers the cornea, for example. The cover crow 51 may be, for example, an applanation lens or an immersion lens. For example, an applanation lens transmits laser and applanates the front surface of the cornea. The holder 52 holds the cover glass 51, for example. The interface unit 50 is detachably attached to the lens barrel 44 of the irradiation end unit 42 via the holder 52.

  The cover glass 51 is a member that covers the cornea and has a size that covers at least the NA on which the laser spot is focused. The cover glass 51 is a transparent member having translucency, and is formed of, for example, glass or resin. The cover glass 51 is positioned on the liquid surface described later and has a role of covering the liquid. The holder 52 is a tapered member formed in a conical shape, and supports the cover glass 51 at the tip of the cone. In addition, a fitting portion that fits each other is formed on the holder 52 so as to be detachably held by the lens barrel 44 of the irradiation end unit 42. In this embodiment, for example, a slider 53 is formed on the upper portion of the holder 52. Then, the interface unit 50 is attached and detached by sliding the slider 53 with respect to the guide 46 formed in the irradiation end unit 42.

  The interface unit 50 has a shape that fits inside a suction ring 281 described later. Each member of the interface unit 50 is formed of a biocompatible material. The interface unit 50 is a disposable type that is discarded after a single use.

  The interface unit 50 is close to the cornea of the patient's eye E adsorbed by a suction ring 281 described later. Alternatively, the suction ring 281 may be adsorbed after the positions of the patient eye E and the interface unit 50 are determined in advance. The suction ring 281 is filled with, for example, a liquid (saline). The refractive power of the cornea is canceled by the cover glass 51 and the liquid. This suppresses the laser light from being refracted from the objective lens 305 to the target crystalline lens.

  The interface unit 50 may be configured to be in direct contact with the cornea. For example, the interface unit 50 may be a unit that contacts the cornea with the cover glass 51 to applanate the cornea. As a result, the cornea comes into contact with the cover glass 51 so that the position of the cornea is positioned with respect to the laser irradiation optical system 320. The cover glass 51 may have a contact surface that covers the cornea so as to cover a laser irradiation region such as the inside of the cornea.

<Light source>
The illumination light source 60 (see FIGS. 3 and 4) illuminates the patient's eye E. Illumination light source 60 is provided with, for example, a light source for forming a bright spot on patient eye E and a light source for increasing the contrast of the pupil. In the present embodiment, for example, an infrared light source is used as a light source for forming a bright spot. This can reduce the feeling that the patient feels dazzling. For example, a visible light source is used as a light source for increasing the contrast of the pupil. More specifically, for example, a green or red light source is used as the visible light source.

  In addition, as the illumination light source 60, one light source may serve as both a light source used for bright spot formation and a light source used for improving pupil contrast.

  The illumination light source 60 forms a bright spot as a cornea reflection image on the patient's eye E. This bright spot is observed by a front photographing unit 75 or the like which will be described later. The control unit 100 described later may detect the position of the patient's eye E from the position of the bright spot, for example.

<Fixing guidance unit>
The fixation guidance unit 120 projects, for example, a fixation target for fixing the eye to be examined (see FIG. 3). The fixation guidance unit 120 may change the line-of-sight direction of the patient's eye E before docking by changing the presentation position of the fixation target. The fixation guidance unit 120 guides the fixation direction of the eye E in order to guide the irradiation optical axis of the surgical laser and the optical axis of the patient's eye to a predetermined positional relationship.

  The fixation guidance unit 120 is controlled by the control unit 100. The control unit 100 may control the fixation guiding unit 120 based on an operation signal from an operation unit operated by an operator, or the control unit 100 may automatically control the fixation guiding unit 120. (It will be described later in detail).

  In more detail, the fixation guidance unit 120 may include, for example, a light source 121, a dichroic mirror 122, and the like. The light source 121 may project a fixation target onto the patient's eye E. The dichroic mirror 122 branches the optical axis L5 of the front photographing unit 75 and the optical axis L6 of the fixation guidance unit 120, for example. As the light source 121, a light source that emits light including at least visible light is used. The light source 121 may include, for example, a plurality of fixation lamps, and the fixation lamps are arranged at different positions on a plane orthogonal to the optical axis. The control unit 100 can switch the lighting position of the fixation lamp in order to switch the viewing direction of the patient's eye E. Note that the fixation guidance unit 120 may switch the lighting position of the fixation lamp by moving a single fixation lamp by the drive unit, or a display device (for example, a liquid crystal display, an organic EL display, etc.). It may be used to switch the lighting position of the fixation lamp. Note that the fixation guidance unit 120 may move the optical axis of the fixation lamp, or may use means such as a liquid crystal projector.

<Second mobile unit>
As illustrated in FIG. 4, for example, the second moving unit 200 may hold the eyeball fixing unit 280 with respect to the objective lens 305 so as to be drivable in the Z-axis direction. The second moving unit 200 may include, for example, a base 201, an arm 202, a link unit 210, an encoder 203, a link driving unit 220, a lock unit 230, a position sensor 240, a load cell 206, and a connecting unit 250.

  The base 201 holds each configuration of the second moving unit 200. The arm 202 connects the base 201 to the lens barrel 44 of the irradiation end unit 42 (see FIG. 4). As described above, the irradiation end unit 42 is moved in the XYZ directions by the first moving unit. The second moving unit connected to the lens barrel 44 is also moved in the XYZ directions. The arm 202 may be attached to the lens barrel 44 so as to be rotatable in the horizontal direction. For example, the position of the second moving unit 200 with respect to the lens barrel 44 may be changed. For example, the second moving unit 200 may be provided so as to be rotatable about the lens barrel 44 in the XY directions. For example, the position of the second moving unit 200 may be switched between when the right eye of the patient is treated and when the left eye is treated. This may prevent the second mobile unit from contacting the patient. The second moving unit 200 may be detachably attached to the lens barrel 44.

<Link unit>
The link unit 210 forms a moving mechanism for moving the eyeball fixing unit 280 in the Z-axis direction. The link unit 210 includes, for example, a link 211, a link 212, a joint 213, and a joint 214. The link 211 has a rectangular shape. The link 212 has a rod shape. The link 211 and the link 212 form a link mechanism. One end of the link 211 is rotatably connected to the base 201 by a joint 213. The other end of the link 211 is connected to the end of the link 212 by a joint 214. The link 212 is inserted into the cylindrical guide 215. The moving direction of the link 212 is defined by the guide 215 in the Z-axis direction.

  In the second moving unit, the mechanism for moving the eyeball fixing unit 280 in the Z-axis direction may not be the link mechanism as described above. For example, the eyeball fixing unit 280 may be moved in the Z-axis direction by a rack and pinion mechanism.

  The support base 216 is fixed to the link 212. The support base 216 is moved in the Z-axis direction together with the link 212. The load cell 206 has a rectangular shape and detects a load applied from both ends. One end of the load cell 206 is fixed to the support base 216. The other end of the load cell 206 is fixed to the connecting portion 250. That is, the load cell 206 detects a load applied between the support base 216 and the connecting portion 250.

  The connection part 250 adsorbs and holds the eyeball fixing unit 280 so as to be detachable (see FIG. 5). The connecting part 250 includes, for example, a seal member 251, a suction hole 252, and a connection pipe 253. The seal member 251 enhances the airtightness of the connecting portion 250 and the eyeball fixing unit 280 when adsorbing the eyeball fixing unit 280. The seal member 251 is mainly an elastic body. The suction hole 252 opens in the connection surface 250 a of the connection part 250. A connecting pipe 253 is fitted in the suction hole 252. A hose extending from a suction device (not shown) is connected to the connection pipe 253. The suction device sucks air in the space R formed between the connection surface 250a and the recess 283. By sucking air, a negative pressure is generated in the space R. Due to this negative pressure, the connecting portion 250 and the eyeball fixing unit 280 are pulled together and consequently adsorbed.

  When a large load is applied to the eyeball fixing unit 280, the load cell 206 may break down due to the transmitted load. When a large load is applied to the eyeball fixing unit 280, the control unit 100 may set the suction pressure of the suction device so that the eyeball fixing unit 280 is detached from the connecting portion 250.

  For example, when a load exceeding a predetermined value is applied to the eyeball fixing unit 280, the eyeball fixing unit 280 is detached from the connecting portion 250. Therefore, since a large load on the load cell 206 can be reduced, the failure of the load cell 206 is reduced.

  The connecting portion 250 fixes the eyeball fixing unit 280 by suction pressure, but any fixing method may be used. For example, the connecting part 250 and the eyeball fixing unit 280 may be fixed by screwing screws formed with each other. Further, the connecting part 250 and the eyeball fixing unit 280 may be fixed by a magnetic force. Moreover, the connection part 250 and the eyeball fixing unit 280 may be fixed by fitting each other. Further, the connecting part 250 and the eyeball fixing unit 280 may be fixed by an adhesive substance.

<Link drive unit>
The link drive unit 220 includes, for example, a pin 221, a spring 222, a feed screw 223, a nut 224, a holder 225, and a drive unit (actuator) 226. A feed screw 223 is connected to the rotary shaft 226a of the drive unit 226. When the drive unit 226 rotates, the feed screw 223 rotates. When the feed screw 223 rotates, the nut 224 screwed to the feed screw 223 is moved up and down.

  A holder 225 is fixed to the top of the nut. A pin 221 is attached to the holder 225 via a spring 222. When the nut rises, the pin 221 rises at the same time. When the pin 221 rises, it contacts the link 211. When the pin 221 continues to rise, the link 211 is pushed up by the pin 221 on which the elastic force of the spring 222 acts, and rotates with the joint 213 as a base point. When the link 211 rotates, the link 212 is moved upward together with the joint 214. The link 212 is moved along the guide 215 in the Z-axis direction.

  The load cell 206 is fixed to the link 212. Further, the connecting portion 250 is fixed to the link 212 via the load cell 206. The load cell 206 and the connecting portion 250 are moved together with the link 212 in the Z-axis direction. An eyeball fixing unit 280, which will be described later, is adsorbed to the connecting portion 250. Therefore, the eyeball fixing unit 280 is moved along with the link 212 in the Z-axis direction.

<Encoder>
The encoder 203 detects the movement amount or position of the link 212. In the link 212 of the present embodiment, magnetic lines are formed at a plurality of locations. The encoder 203 detects the magnetism of the line, and detects the movement amount or position of the link 212 based on the number of passages of the line. The encoder 203 is not limited to magnetism, and various encoders (or potentiometers) that can detect the amount or position of movement of the member may be used.

<Position detection sensor>
The position detection sensor 240 detects the drive limit of the link 212. For example, a shield plate is fixed to the link 212. The position detection sensor 240 includes, for example, a U-shaped terminal. For example, magnetism is always generated between U-shaped terminals. When a shielding plate is inserted between the terminals, the magnetism is interrupted. Then, the position detection sensor 240 detects that the magnetism has been cut off, and detects that the link 212 is in a predetermined region. In the present embodiment, for example, a sensor 241 that detects that the link 212 is at the upper limit of the drive region and a sensor 242 that detects that the link 212 is located at the lower limit may be provided.

  The position detection sensor is not limited to a magnetic sensor, and may be a sensor using other principles. For example, an optical sensor such as a photo interrupter may be used.

<Lock part>
For example, the lock unit 230 regulates the movement of the link 212. The lock part 230 is provided on the side opposite to the joint 214 side of the link 212. The lock unit 230 includes, for example, a housing 231, a lock member 232, a spring 233, and a drive unit 234. The lock member is rotatably provided on the housing 231. The lock member 232 is, for example, annular. A hole 232a is formed in the lock member 232. The link 212 passes through the hole 232a. The lock member 232 is rotatably provided on the housing 231. The lock member 232 is biased so as to be rotated in a certain direction by the spring 233. The lock member 232 is rotated by the spring 233, and the hole 232 a contacts the link 212. When the hole 232a of the lock member 232 contacts the link 212, the link 212 is fixed. The drive unit 234 rotates the lock member 232 in the opposite direction to the rotation direction due to the elastic force of the spring 233. The drive member 234 rotates the lock member 232 until it becomes horizontal.

  For example, the lock member 230 is in a state in which the lock member 232 is rotated by the elastic force of the spring 233 and the link 212 is always locked. For example, when the link unit 210 is moved by the drive unit 226, the control unit 100 described later drives the drive unit 234 at the same time and rotates the lock member 232 until it is in the horizontal direction. Then, the lock of the link 212 is released and the link 212 can be moved in the Z-axis direction.

  When the drive unit 234 is stopped by the lock unit 230, the lock is applied. As a result, when the drive unit 234 is stopped, it is possible to prevent the lock from being released and leading to a malfunction or the like.

  The lock unit 230 is not limited to the above-described configuration, and it is sufficient that the movement of the link 212 can be restricted. For example, a solenoid or an electromagnetic brake may be used. As described above, the lock unit 230 may electrically control the movement of the link 212.

<Eyeball fixing unit>
The eyeball fixing unit 280 (see FIGS. 4 and 5) is a unit for fixing the patient's eye E to the objective lens 305. By fixing the patient's eye E to the objective lens 305, the laser can be suitably focused on the patient's eye E. The eyeball fixing unit 280 includes, for example, a suction ring 281, a support portion 282, a concave portion 283, a suction pipe 284, and the like. The suction ring 281 is a contact portion that contacts the patient's eye E (for example, the sclera). The support portion 282 supports the suction ring 281. The recess 283 is connected to the connecting part 250 of the second moving unit 200. The suction pipe 284 is a flow path (vent hole) that applies suction pressure to the suction ring 281. The eyeball fixing unit 280 transmits (adds) suction pressure applied from a suction pump (not shown) to the suction ring 281 via the suction pipe 284.

  The suction ring 281 has an opening along the curved surface of the sclera. The opening of the suction ring 281 has a shape that surrounds the annular portion (corneal peripheral portion) of the eyeball, and has a ring shape that matches the eyeball fixing unit 280. Thereby, the eyeball is uniformly adsorbed to the suction ring 281. The support portion 282 has a wall shape surrounding the suction ring 281 (eyeball) so that the liquid can fill the inside of the support portion 282 with the eyeball adsorbed to the suction ring 281.

  The eyeball fixing unit 280 is formed with a space 280S for housing the interface unit 50 in a non-contact (non-interference) manner. The space 280 may be formed inside the support portion 282, for example. The support portion 282 has a shape (fitting shape) that can be attached to and detached from the connecting portion 250. The pipe 284 is connected to a suction tube from a suction pump provided in the apparatus main body (or a separate unit). Due to the suction pressure generated by the operation of the suction pump, the inside of the suction tube, pipe 284 and suction ring 281 becomes negative pressure, and the sclera of the patient's eye E is adsorbed to the opening of the suction ring 281.

  The eyeball fixing unit 280 of the present embodiment further includes, for example, a liquid supply / discharge pipe (hereinafter, abbreviated as a liquid pipe) not shown. The liquid pipe is a flow path (through hole) formed through the support portion 282, and liquid may be supplied and discharged. The liquid pipe may be connected to a perfusion suction unit (not shown) via a tube or the like. Before the laser irradiation, the liquid is supplied into the eyeball fixing unit 280 by the operation of the perfusion suction unit. After the operation, the liquid in the eyeball fixing unit 280 is discharged. The liquid may be simply supplied via the liquid pipe. It is good also as a structure which discards a liquid by the operation | work which removes the eyeball fixing unit 280 from the patient's eye E to the patient's eye E. FIG. The liquid may be injected into the eyeball fixing unit 280 by the operator. For example, after the fixation of the patient's eye E is completed by the eyeball fixing unit 280, the operator may inject liquid into the suction ring 281 with a syringe or the like.

  The eyeball fixing unit 280 is formed of a material such as biocompatible resin or metal. The eyeball fixing unit 280 is a disposable type like the interface unit 50. For this reason, it is preferable to become a structure which can be attached or detached with respect to the 2nd movement unit 280 (refer FIG. 5).

  In this way, the eyeball fixing unit 280 and the interface unit 50 can be independently moved in the Z direction. Further, in the present embodiment, the eyeball fixing unit 280 and the interface unit 50 are configured not to move in the XY directions with respect to the objective lens 305, and thus work such as adsorption of the patient's eye E is facilitated.

<Observation optical system 70>
An observation optical system 70 (also referred to as an observation / imaging unit) 70 (see FIG. 3) causes the operator to observe the patient's eye E and images the tissue to be treated. As an example, the observation optical system 70 of the present embodiment includes a tomographic imaging unit 71 and a front imaging unit 75. The optical axis L3 of the observation optical system 70 is made coaxial with the optical axis L1 of the laser beam by the beam combiner 72. The optical axis L3 is branched by the beam combiner 73 into an optical axis L4 of the tomography unit 71 and an optical axis L5 of the front imaging unit 75. Note that the observation optical system 70 may function as a part of a detection unit that detects the positional relationship between the surgical apparatus 1 and the patient's eye E. For example, the observation optical system 70 may function as a first detection unit that detects the position of the patient's eye E in the XY directions. The observation optical system 70 may function as a second detection unit that detects the position of the patient's eye E in the optical axis direction.

<Tomography unit 71>
The tomographic imaging unit 71 acquires a tomographic image of the tissue of the patient's eye E using the optical interference technique. For the observation optical system 70 of this apparatus, for example, a tomographic imaging unit 71 capable of full-range imaging may be used. The full-range imaging referred to here is imaging by removing one of the real image and virtual image acquired by the tomographic imaging unit 71. For details, refer to JP2012-223264A.

  The ophthalmic laser surgical apparatus 1 according to the present embodiment can set a position where laser light is condensed based on a tomographic image of the patient's eye E photographed before surgery. As a result, the ophthalmic laser surgical apparatus 1 can create control data for controlling the operation of irradiating laser light (for example, the operation of the drive units 353, 362, and 365) using the tomographic image.

  As shown in FIG. 6, the tomography unit 71 includes, for example, a light source 711, an optical splitter 712 (for example, a coupler), an optical switch 713, a first reference optical system 714, a second reference optical system 715, and an optical scanner 716. And a detector 717 and the like.

  The light source 711 emits measurement light (for example, infrared light). The light splitter 712 splits the light beam emitted from the light source 711 into measurement light and reference light. The measurement light emitted from the light splitter 712 is guided to the patient's eye E. The reference light emitted from the optical splitter 712 is guided to the optical switch 713. The optical switch 713 guides the reference light generated by being split by the light splitter 712 to the first reference optical system 714 or the second reference optical system 715. The optical switch 713 switches between the optical path to the first reference optical system 714 and the optical path to the second reference optical system 715. The light splitter 712 may be a beam splitter or the like in addition to the coupler.

  The first reference optical system 714 may include, for example, a first reference mirror 721, a collimator lens 722, a condenser lens 723, and the like. The first reference mirror 721 reflects the first reference light so as to have a predetermined optical path length. The collimator lens 722 makes the first reference light a parallel light beam. For example, the condensing lens 723 collects the first reference light toward the first reference mirror 721.

  The first reference light emitted from the optical switch 713 passes through the optical fiber and is guided to the first reference optical system 714. For example, the first reference light passes through the collimator lens 722 and becomes a parallel light flux. For example, the first reference light converted into a parallel light beam is collected by the condenser lens 723 and then reflected by the first reference mirror 721. The first reference light reflected by the first reference mirror 721 is guided to the optical switch 713 again.

  The optical path length of the first reference light is determined by the optical arrangement of the first reference optical system 714. For example, the optical path length of the first reference light is determined by the position of the first reference mirror 721. For example, in the first reference optical system 714, the position of the first reference mirror 721 may be set so that the optical path length of the measurement light reflected by the interface unit 50 matches the optical path length of the first reference light ( (See FIG. 6). As a result, in the tomographic imaging unit 71, an imaging region in which the eyeball fixing unit 280 can be imaged can be set as the first imaging region.

  The second reference optical system 715 may include a second reference mirror 731, a collimator lens 732, a condenser lens 733, and the like. The second reference mirror 731 reflects the second reference light so as to have a predetermined optical path length. The collimator lens 732 turns the second reference light into a parallel light beam. The condensing lens 733 collects the second reference light on the second reference mirror 731.

  The second reference light emitted from the optical switch 713 passes through the optical fiber and is guided to the second reference optical system 715. For example, the first reference light passes through the collimator lens 732 and becomes a parallel light flux. For example, the second reference light converted into a parallel light beam is collected by a condenser lens 733 and reflected by a second reference mirror 731. The second reference light reflected by the second reference mirror 731 is guided again to the optical switch 713.

  The optical path length of the second reference light is determined by the optical arrangement of the second reference optical system 715. For example, the optical path length of the second reference light is determined by the position of the second reference mirror 731. For example, in the first reference optical system 714, even if the position of the second reference mirror 731 is set so that the optical path length of the measurement light reflected by the cornea of the patient's eye E matches the optical path length of the second reference light. Good (see FIG. 6). As a result, in the tomography unit 71, an imaging region in which the cornea of the patient's eye E can be imaged can be set as the second imaging region.

  The first reference light and the second reference light enter the optical switch 713 and then enter the optical splitter 712 again. The light splitter 712 combines the measurement light reflected by the patient's eye E with the first reference light or the second reference light. The combined light of the reference light and the measurement light is detected by the detector 717. For example, the first reference light reflected by the first reference mirror 721 may be combined with the measurement light reflected by the interface unit and received by the detector 717 (light receiving element) 120. For example, the second reference light reflected by the second reference optical system 715 may be combined with the measurement light reflected by the cornea of the patient's eye E and received by the detector 717 (light receiving element) 120.

  As in the tomographic imaging unit 71 of the present embodiment, for example, the first imaging area U1 and the second imaging area U2 are set by providing the first and second reference optical systems having different optical path lengths. It is also possible (see FIG. 6).

  As described above, the surgical apparatus according to the present embodiment is provided with the imaging region U1 in which the interference signal can be acquired by the first reference optical system 714 and the imaging region U2 in which the interference signal can be acquired by the second reference optical system 715. Thus, the imaging range of normal OCT can be widened. Accordingly, it is possible to observe both the contact position W where the cornea of the patient's eye E contacts the suction ring 281 and the interface unit 50.

  The optical scanner 716 deflects the measurement light emitted from the light source. The optical scanner 716 may be configured by, for example, two galvanometer mirrors. In this case, the rotation axes of the two galvanometer mirrors are preferably orthogonal to each other. The optical scanner 716 deflects the measurement light two-dimensionally based on a command signal from the control unit 100. The control unit 100 controls the optical scanner 716 to scan the measurement light in the XY directions with respect to the patient's eye E. In this embodiment, the measurement light is scanned with the anterior segment of the patient's eye E. For example, the control unit 100 obtains a tomographic image by arranging depth information (depth information) obtained at each scanning position on a straight line (so-called B scan).

  The optical scanner 716 may be any mechanism that deflects light. For example, in addition to a reflection mirror (galvano mirror, polygon mirror, resonant scanner), an acousto-optic element (AOM) that changes (deflects) the traveling direction of light is used.

  The detector 717 detects an interference state between the measurement light reflected by the fundus and the reference light. In the case of the Fourier domain type, the spectral intensity of light is detected by the detector 717, and a depth profile (A scan signal) is obtained by Fourier-transforming data relating to the spectral intensity. Examples of the tomographic imaging unit 71 include Spectral-domain (SD system) and Swept-source (SS system). Moreover, Time-domain (TD system) may be used. In this case, a technique of optical coherence tomography can be used. For example, refer to JP2013-248303A and JP2013-248304A.

<Front shooting unit>
The front imaging unit 75 (see FIG. 3) acquires a front image of the patient's eye E. The front photographing unit 75 of this embodiment includes, for example, a relay lens 77 and a light receiving element 76. The front imaging unit 75 images the patient's eye E illuminated with visible light or infrared light. The front image of the patient's eye E photographed by the front photographing unit may be displayed on the monitor 92 (described later). The surgeon can observe the patient's eye E from the front by looking at the monitor 92.

  Note that the front observation unit 75 of this embodiment may be a telecentric optical system, for example. Thereby, even if the focus position of the front image photographed by the front observation unit 75 is changed, the magnification of the image may not be changed. For example, the surgical apparatus 1 may focus on the cornea or lens of the patient's eye depending on the content of the operation. For this reason, a telecentric optical system may be used so that the magnification of the image need not be adjusted even when the focus position is changed.

<Focus adjustment unit>
The focus adjustment unit 80 (see FIG. 3) adjusts the focus of the front photographing unit 75. The focus adjustment unit 80 of the present embodiment adjusts the focus of the anterior segment image of the patient's eye E acquired by the front imaging unit 75.

  The focus adjustment unit 80 of this embodiment includes, for example, a drive unit 81 that moves the light receiving element 76 (see FIGS. 17 and 18). The drive unit 81 moves the light receiving element 76 in the direction of the photographing optical axis (optical axis L5). Thereby, the focus adjustment unit 80 can adjust the focus position of the light receiving element 76 in the direction of the imaging optical axis.

  As the light receiving element 76, for example, a two-dimensional imaging element is used. Of course, the front imaging unit 75 is not limited to a configuration using a two-dimensional imaging device, and may be, for example, a scanning laser imaging device, an optical coherence tomography, or the like.

<Operation unit>
The operation unit 400 (see FIG. 3) may include, for example, a trigger switch 410, a display unit 420, and the like. The trigger switch 410 inputs a trigger signal for emitting treatment laser light from the laser irradiation unit 300. The display unit 420 is used as a display unit that displays a tomographic image and an anterior segment image of the patient's eye E, and displays surgical conditions. The display unit 420 may have a touch panel function, and may also serve as input means for setting surgical conditions and setting a surgical site (laser irradiation position) on a tomographic image. A mouse that is a pointing device, a keyboard that is an input device for inputting numerical values, characters, and the like can also be used as input means.

  The display unit 420 may display a planning screen, a docking operation screen, and the like. As shown in FIG. 7, for example, an anterior ocular segment image display unit display area 430, a tomographic image display area 440, a surgical condition display unit 450, a switch 421, and a switch 422 may be displayed on the planning screen. The anterior segment image display unit display area 430 displays the anterior segment of the operative eye E. The tomographic image display area 440 displays a tomographic image of the anterior segment of the operative eye E. The operation condition display unit 450 displays operation conditions. The switch 421 starts a surgical site setting operation (planning). The switch 422 determines the designated surgical site (confirms planning). In the tomographic image display area 440, the operator designates a surgical site (laser irradiation range). The surgical site designated on the display unit 420 is set as the laser irradiation position in the tomographic image. The surgical site set by the control unit 100 is stored in the RAM 103. The switches 421 and 422 have a function of switching the mode of the device 1 to the planning mode. The display unit 420 (tomographic image display region 440) functions as a surgical site setting unit.

  As the docking operation screen, for example, an anterior segment image display unit display region 430 that displays the anterior segment of the patient's eye E, a tomogram display region 440 that displays a tomogram of the anterior segment of the patient's eye E, and surgery. A surgical condition display unit 450 that displays conditions, an eyeball fixing operation unit (eyeball fixing / interface operation unit) 460 that performs an operation for fixing the eyeball, and a moving unit operation unit 470 that operates the movement of the irradiation end unit 42 are displayed. (See FIG. 8).

  The tomographic image display region 440 (monitor 92) plays a role of displaying the suction ring 281 and the interface unit 50 on the tomographic image so that the operator can easily visually align the eyeball fixing unit 280 and the interface unit 50. You may have it.

  In the present embodiment, the tomographic image is displayed as a moving image in the tomographic image display area 440 until at least the positioning of the eyeball fixing unit 280 and the interface unit 50 is completed. In the tomographic image, the cornea of the patient's eye E and the periphery of the cornea (the sclera around the limbus, the eyeball fixing unit 280 (suction ring 281) are photographed. The cornea of the patient's eye E and a suction ring 281. The tomographic image at the time of positioning of the cover glass 51 includes at least the cornea and the cover glass 51.

  The eyeball fixing operation unit 460 includes a suction pressure setting unit 461 for setting a suction pressure applied to the suction ring 281, a suction pressure setting unit 462 for inputting a command signal for attracting an eyeball by the suction ring 281, and a suction ring 281. Supply switch 463 for inputting a command signal for supplying liquid, discharge switch 464 for inputting a command signal for discharging liquid from inside suction ring 281, and vertical movement switch 465 for adjusting the position (height position) of interface unit 50. Is arranged.

  When the suction pressure setting unit 461 is operated, a numeric keypad for setting a numerical value of the suction pressure is displayed. When a numerical value is input, it is stored in a memory 71 (described later) as a set value. The control unit 100 controls the suction pump based on the set suction pressure. When the suction pressure setting unit 462 is operated, the suction pressure applied (applied) to the suction ring 281 is turned on / off. When the switch 463 is operated, a command signal is sent to the control unit 100. Upon receiving the signal, the control unit 100 controls the perfusion suction unit, supplies the liquid into the suction ring 281 via a liquid pipe (not shown), and maintains a constant water level. When the switch 464 is operated, a command signal is sent to the control unit 100. Upon receiving the signal, the control unit 100 controls the suction / discharge unit to discharge the liquid in the suction ring 281 through the liquid pipe.

  The switch 465 includes a cursor 466 pointing upward and a cursor 467 pointing downward. When the cursor 466 is operated, a command signal (operation signal) for moving the interface unit 50 upward along the Z direction is sent to the control unit 100. Upon receiving the signal, the control unit 100 controls the drive unit 12 and moves the cover glass 51 upward. Conversely, when the cursor 467 is operated, the control unit 100 moves the cover glass 51 downward. Although details will be described later, the surgeon moves the eyeball fixing unit 280 while watching the moving image of the patient's eye E displayed on the monitor 92 to fix the eyeball. For this reason, the monitor 92 becomes a means (monitoring unit) for positioning the eyeball fixing unit 280.

  The moving unit operation unit 470 is an input means for inputting a command signal (operation signal) for moving the first moving unit 10 in the XYZ directions. The operation unit 470 includes a cursor arranged in positive and negative directions with respect to the X direction, the Y direction, and the Z direction. By operating the cursor, a command signal corresponding to the direction is sent to the control unit 100.

<Control unit 100>
The control unit 100 (see FIGS. 3 and 9) includes a CPU 101, a ROM 102, a RAM 103, a nonvolatile memory (not shown), and the like. The CPU 101 governs various controls of the ophthalmic laser surgical apparatus 1 (for example, control of creation of control data described later, control of the laser light source unit 310, control of the scanning unit 330, control of adjustment of the scanning speed of the condensing position, etc.). The ROM 102 stores various programs, initial values, and the like for controlling the operation of the ophthalmic laser surgical apparatus 1. The RAM 103 temporarily stores various information. A nonvolatile memory is a non-transitory storage medium that can retain stored contents even when power supply is interrupted.

  The control unit 100 includes a first moving unit 10, a second moving unit 200, a laser irradiation unit 300, an illumination light source 60, an observation / photographing unit 70, a focus adjustment unit 80, an operation unit 400, a fixation guidance unit 120, and a suction pump. , Perfusion suction unit, etc. are connected.

  After the fixation of the patient's eye E is completed by the eyeball fixing unit 280 and the interface unit 50, the control unit 100 acquires the absolute position of the characteristic part (anterior lens capsule) of the patient's eye E using the position detection unit 370, The laser irradiation position is corrected (alignment).

  The control unit 100 determines the surgical laser based on the surgical site (region) set in the tomographic image display region 440 and the absolute information acquired by the position detection unit 370 before the irradiation of the surgical laser light. The position information for irradiating light is corrected. The control unit 100 emits laser light from the laser light source unit 310 based on the corrected surgical site, surgical conditions, and irradiation pattern, and controls the scanning units (galvanomirrors 363 and 366) to make the laser spot in the eyeball tissue. Move, cut and crush eyeball tissue.

  The control unit 100 drives and controls the first moving unit 10 based on a command signal from the eyeball fixing operation unit 96, and moves the eyeball fixing unit 280 and the interface unit 50 together with the irradiation end unit 42 in the XYZ directions. Thereby, the alignment of the eyeball fixing unit 280 and the interface unit 50 in the XY direction and the alignment of the coarse movement in the Z direction can be performed.

  The control unit 100 performs image processing on the tomographic image acquired by the tomographic imaging unit 71 and the like, and acquires (detects and calculates) and displays (displays) the position and shape of the tissue of the eyeball fixing unit 280, the interface unit 50, and the patient's eye E. Control). In addition, the control unit 100 displays a tomographic image or performs monitoring for monitoring the positions of the eyeball fixing unit 280 and the interface unit 50 by controlling the driving of the eyeball fixing unit 280 and the interface unit 50 based on the image processing result. Responsible for (part of) the function of the unit.

<Preoperative planning>
Hereinafter, an example of planning performed preoperatively using this apparatus will be described. In this embodiment, the shape information of the patient's eye E is acquired before the operation, and the operation planning is performed using the acquired image. Examples of the planning include irradiation planning such as a pattern of corneal incision, anterior capsulotomy, crystal crushing, and a treatment position, or planning of a docking process when the patient's eye E is fixed by the eyeball fixing unit 280. As the shape information of the patient's eye E used for planning, for example, a corneal shape, a crystalline lens shape, an iris shape, a corner shape, and the like are acquired.

  For example, the surgeon acquires the shape information of the patient's eye E with the anterior segment imaging device several days before the operation. The anterior ocular segment imaging apparatus may be an anterior ocular segment imaging apparatus arranged as a separate housing from the surgical apparatus 1, and the anterior ocular segment imaging apparatus is an apparatus that captures the patient's eye E in the sitting position. There may be. Further, the anterior ocular segment imaging device may be an anterior ocular segment imaging device (for example, the observation / imaging unit 70) provided integrally with the surgical apparatus 1, and the anterior ocular segment imaging device is located sideways. It may be a device that photographs the patient's eye E in the sleeping state.

  For example, at least one of a tomographic image and a front image of the patient's eye E is captured by the anterior segment imaging device, and the shape information of the patient's eye E is acquired. For the tomographic image of the patient's eye E, for example, a device capable of taking a tomographic image non-invasively such as OCT, SLO, and Scheinproof camera may be used.

  The control unit 100 may acquire a plurality of tomographic images having different B scan directions and store them in the RAM 103. For example, a B-scan tomographic image is acquired every 30 degrees with respect to the Y direction. For example, six images of 90 degrees, 120 degrees, 150 degrees, 180 degrees, 210 degrees, and 240 degrees may be acquired. It is advantageous to obtain a plurality of (at least two cross-sectional) tomographic images as described above, because three-dimensional data of the anterior segment can be obtained. The control unit 100 may acquire three-dimensional data of the anterior segment composed of a plurality of adjacent tomographic images by raster scanning in the XY directions. The control unit 100 is preferably configured to acquire at least two tomographic images orthogonal to each other including the optical axis of laser irradiation.

  When an external anterior segment imaging device is used, it is preferable that data can be exchanged between the external anterior segment imaging device and the surgical apparatus 1. For example, it may be connected by wire or wireless, and data may be exchanged by a storage medium such as a flash memory. The control unit 100 acquires a preoperative observation image photographed by an external observation apparatus and stores it in the RAM 103 or the like. The control unit 100 may perform imaging of the eyeball shape of the patient's eye E from the observation image. And control unit 100 may acquire shape information based on the result of imaging, and may perform operation condition setting (irradiation planning). Of course, the observation image used for the preoperative planning may be taken by, for example, the observation optical system 70 (for example, the observation / photographing unit 70) provided in the surgical apparatus 1.

  FIG. 7 is a diagram showing a display screen of the display unit 420. As shown in FIG. 7, when an operator operates (touches) the switch 421 after an observation image is acquired by an anterior segment imaging device or the like, a command signal for starting planning is sent to the control unit 100. Sent. Based on the command signal, the control unit 100 displays, for example, the acquired still image of the anterior segment image of the patient's eye E in the anterior segment image display area 430, and displays the still image of the anterior segment tomogram as a tomographic image display. It is displayed in the area 440.

  For example, the control unit 100 is in a state in which a surgical site can be designated on the anterior segment image display area 430 and the tomographic image display area 440. The operator designates an anterior capsulotomy area (circle diameter, etc.) on the anterior eye image in the anterior eye image display area 430. The control unit 100 displays the position (circle) of the anterior capsulotomy with respect to the center of the pupil by image processing of the anterior segment image. Further, the operator designates an area where the cornea and the lens are to be crushed or incised on the tomographic image in the tomographic image display area 440. The control unit 100 designates a crush area by image processing of the anterior segment tomogram (details will be described later). The surgical site (region) in the lens is determined in the depth direction (Z direction). When the switch 422 is operated, the planning at the current stage is confirmed. The control unit 100 stores information on the anterior capsule incision position in the anterior ocular segment image and information on the surgical site (region) on the tomographic image in the RAM 103 as surgical site information (planning information) (setting of the surgical site) .

<Monitor display and planning>
Next, designation of the surgical site on the monitor and image processing will be described. Here, processing after the switch 421 is operated will be described.

  In the anterior segment image display area 430, an anterior segment image of the surgical eye E is displayed. An incision size display field 431 that indicates the size of the anterior capsulotomy circle is disposed below the anterior segment image display area 430. The control unit 100 performs image processing and acquires the pupil center of the anterior segment image. The control unit 100 determines the position of the pupil center from the shape of the iris IR in the anterior segment image. When the anterior segment image display area 430 is operated, the control unit 100 displays the pupil center CP in the anterior segment image. Then, the control unit 100 displays a circle C1 centered on the pupil center CP on the anterior segment image. A circle C1 indicates an incision position of the anterior capsule by laser irradiation. The diameter of the circle C1 is displayed to be the diameter shown in the incision size display field 431. When the operator operates the incision size display field 431, an increase / decrease switch (not shown) is displayed. The incision size can be changed by the increase / decrease switch. The incision size displayed in the incision size display field 431 is stored in the RAM 103.

  Note that the shape of the anterior capsulotomy is not limited to a circle, and a pre-set figure such as an ellipse may be selected. Further, the circle C1 (the center thereof) may be decentered from the pupil center CP (shifted in the XY direction). For example, a field for inputting a distance for decentering the circle C1 is displayed, and a distance desired by the operator is input. The center of the circle C1 is not limited to the center of the pupil, and may be the apex of the crystalline lens. The apex of the crystalline lens is obtained by extracting the apex of the anterior capsule in a plurality of tomographic images.

  In the tomographic image display area 440, a tomographic image in the Y direction passing through the central optical axis of the laser irradiation optical system (the central optical axis of the laser light) in the surgical eye E is displayed. Below the tomographic image display area 440, a margin display field 441 for displaying a margin amount in crushing (incision) of the lens nucleus is arranged. The margin here is an area where the laser beam is not irradiated from the posterior capsule PP1 of the lens to the near side (from the anterior capsule AP1) so as not to damage the lens capsule with the laser beam. The margin is set to 50 to 1000 μm, for example, and is 500 μm here. When the margin display field 441 is operated, an increase / decrease switch (not shown) is displayed. With this increase / decrease switch, the margin can be changed. The margin displayed in the margin display field 441 is stored in the RAM 103.

  In the tomographic image display area 440, an area A1 indicating a surgical site is displayed. The control unit 100 performs image processing on the image data forming the tomographic image, and obtains an area (hereinafter, abbreviated as area A1) A1 indicating the surgical site. The control unit 100 highlights the area corresponding to the area A1 on the tomographic image.

  The control unit 100 detects the position of the anterior capsule AP1 of the lens LE1, the position of the posterior capsule PP1 of the lens LE1, and the iris IR in front of the periphery of the anterior capsule AP1 in the tomographic image. The control unit 100 determines an area between the anterior capsule AP1 and the posterior capsule PP1 based on the margin stored in the memory 71, and excludes a portion where the iris IR is applied to the anterior capsule AP1 (an area behind the iris IR). Define the area. At this time, the control unit 100 does not set a margin at a position corresponding to the circle C1. Further, the control unit 100 displays the margin area M1 on (inside) the crystalline lens LE1. The control unit 100 sets the area M1 by the margin from the anterior capsule AP1 to the back side, and does not set a margin in the area corresponding to the circle C1. Further, the control unit 100 sets the area M1 by the margin from the posterior capsule PP1 to the near side.

  The area A1 can be changed (finely adjusted) by the operator's operation. The line of the area A1 can be freely changed, and the operator can change the shape of the area A1 by touching and dragging the line of the area A1. At this time, the control unit 100 prevents the laser irradiation area A1 from being changed beyond the margin. In other words, the control unit 100 prevents the area A1 from being set in the margin area. When the surgeon tries to set the laser irradiation area A1 beyond the margin, the control unit 100 may control a buzzer (not shown) to warn the surgeon and not accept the change of the area A1.

  In the operation condition display unit 450, for example, the irradiation position of the laser beam when performing a corneal incision may be set by an operation of the operator. For example, the case of setting the irradiation position when performing a corneal incision will be described with reference to FIG. First, the operator selects a position for performing a corneal incision in the front image of the anterior segment of the patient imaged by the front observation unit 75. For example, the surgeon selects a corneal portion near the sclera away from the corneal apex on the front image of the anterior segment. The operation unit 400 receives an operation from the operator and transmits an operation signal to the control unit 100. When receiving the operation signal from the operation unit 400, the control unit 100 displays the incision mark J at the position of the anterior segment image selected by the operator. Further, the control unit 100 may display the shape of the incision pattern K stored in the RAM 103 or the like at a position corresponding to the operator's selection in the tomographic image in the tomographic image display area 440. The operator may confirm the position of the incision pattern K displayed in the tomographic image display area 440 and change the position at which the incision is made. For example, when the incision pattern K is displayed on the sclera, the operator may change the setting by operating the operation unit 400 so that the display position of the incision pattern K is on the cornea. For example, the incision pattern K may be moved by a drag operation. The control unit 100 may receive an operation signal from the operation unit 400 and record the change of the corneal incision position in the RAM 103 or the like. The control unit 100 may change or edit the corneal incision irradiation pattern F based on an operation signal from the operation unit 400 by the operator. For example, the control unit 100 may edit the angle or length of the incision.

  When the switch 422 is operated, information on the circle C1 and the area A1 (coordinate information in the image) is stored in the RAM 103. The information of the areas A1 and M1 is two-dimensional, but the control unit 100 converts the area A1 into three-dimensional surgical position information regarding the surgical area and stores it in the RAM 103. For example, the control unit 100 interpolates a tomographic image in a direction not photographed by rotating the region A1 with the central axis of the lens LE1 (here, the axis passing through the pupil center determined from the iris IR) as the rotation axis. Then, three-dimensional value information related to the surgical region is obtained. Alternatively, a surgical region set on a plurality of tomographic images is interpolated by an interpolation algorithm such as spline interpolation to obtain three-dimensional information. As a result, information on the surgical site set using the tomographic image is generated and stored in the RAM 103. The irradiation planning method may use the method described in Japanese Patent Publication No. 2013-248304.

  As planning for the docking process, for example, the control unit 100 may obtain the visual axis of the eyeball or the structural axis (also referred to as the optical axis) from the OCT image of the patient's eye E. Thereby, the lighting position of the fixation lamp can be obtained in advance so that the optical axis of the apparatus matches the visual axis of the patient's eye E or the eyeball structure axis. For example, at the time of corneal irradiation such as LASIK surgery, it is preferable that the eyeball visual axis coincides with the apparatus optical axis. Therefore, the lighting position of the fixation lamp can be controlled so that the fixation lamp can be projected from the optical axis direction of the apparatus. In addition, for example, at the time of lens irradiation such as cataract surgery, it is preferable that the eyeball structure axis (eyeball optical axis) and the device optical axis coincide. Therefore, the lighting position of the fixation lamp may be controlled obliquely with respect to the optical axis direction of the apparatus.

  Thus, if the relationship between the structural axis of the patient's eye E and the visual axis is obtained in advance and the lighting position of the fixation lamp is calculated, the eyeball is appropriately fixed without taking unnecessary time during the operation. be able to.

<Surgery flow and control action>
Next, the operation flow and the control operation of the apparatus 1 will be described with reference to FIG. In the following, a case will be described in which surgery is started after setting surgical conditions (step 1) using an observation image of the patient's eye E before surgery.

<Intraoperative operation method>
First, the surgeon attaches the eyeball fixing unit 280 to the connecting portion 250. The surgeon fits the eyeball fixing unit 280 into the connecting portion 250. Next, the surgeon presses the suction start button of the operation unit. When the suction start button is pressed, the control unit 100 sends an operation signal to the suction device. The suction device sucks the air in the space R formed between the connecting portion 250 and the concave portion 283 based on the operation signal sent from the control unit 100. When the air in the space R is sucked, a negative pressure is applied inside the space R. As a result, the eyeball fixing unit 280 is adsorbed to the connecting portion 250.

  Next, the surgeon attaches the interface unit 50 to the holder 52 of the irradiation end unit 42. The surgeon operates the operation unit and sends a signal for starting docking (eyeball fixation) to the control unit 100. The control unit 100 receives an operation signal from the operation unit by the operator and starts automatic docking.

<Automatic docking>
Hereinafter, a control operation related to docking (step 2) of the present embodiment will be described. The apparatus of this embodiment can be docked with the patient's eye E automatically. As a result, the time required for docking can be shortened and docking can be performed without burden.

<XY alignment>
The control unit 100 may position the optical axis L1 of the laser irradiation unit 300 with respect to the patient's eye E (XY alignment). For example, the control unit 100 moves the first moving unit in the XY directions based on the position of the patient's eye detected by the alignment detection unit (for example, the observation optical system 70, the control unit 100).

  The alignment detection unit is used to detect the position of the eye E in the lateral direction (XY direction) relative to the apparatus. For example, the alignment detection unit may detect the position of the patient's eye E in the XY direction by combining the illumination optical system and the observation optical system 70. For example, the alignment detection unit may detect the position of the patient's eye E in the XY direction by performing image processing on the anterior segment image captured by the observation optical system 70. For example, the position of the corneal reflection image of the illumination light reflected in the anterior segment image may be detected. Alignment may be performed so that the position of the corneal reflection image is moved to a predetermined position on the screen.

  Note that the alignment detection unit may detect the position of the patient's eye E in the lateral direction with respect to the apparatus from the tomographic image, for example. In this case, for example, a corneal flare image may be detected from the tomographic image. More specifically, since the measurement light is strongly reflected on the cornea surface perpendicular to the measurement optical axis of the tomography unit 71, the intensity of the interference signal is increased. Accordingly, a stripe parallel to the measurement optical axis is generated in the image near the apex of the cornea. This muscle is called a corneal flare image. The control unit 100 may detect the corneal flare image by image processing, control the first moving unit so that the light streak is at the center of the image, and perform alignment in the XY directions.

  Alternatively, three-dimensional shape data may be constructed from the tomographic image, and the positional relationship between the apparatus and the patient's eye E may be detected from the shape information. For example, the control unit 100 constructs three-dimensional shape data of the iris from the tomographic image. The control unit 100 may calculate the center of the pupil from the three-dimensional shape data of the iris, and may perform XY alignment by aligning this pupil center with the optical center of the apparatus. As described above, the control unit 100 may automatically perform the alignment in the XY directions while detecting the position of the patient's eye E using the tomographic image or the anterior segment image.

<Z direction alignment>
When the XY alignment is completed, the control unit 100 may perform the alignment in the Z direction by controlling the drive unit 12 and moving the irradiation end unit 42 toward the patient's eye E. As a result, the interface unit 50, the eyeball fixing unit 280, and the second moving unit 200 are moved together with the irradiation end unit 42.
For example, the control unit 100 may detect the position of the patient's eye E in the optical axis direction (Z direction) with respect to the apparatus 1. Then, based on the detected position of the patient's eye E, the first moving unit 10 may be moved in the Z-axis direction, and the laser irradiation unit 300 may be arranged at a predetermined position with respect to the patient's eye E. For example, the control unit 100 may detect the position of the patient eye E in the optical axis direction using the front observation unit 75. More specifically, the state of the bright spot of the illumination light source reflected in the front image of the patient's eye E taken by the front observation unit 75 may be detected. For example, the position of the patient's eye E may be detected based on the blurring state of the bright spot. For example, when the position of the patient's eye E is away from a predetermined position with respect to the irradiation unit 42, the bright spot detected by the light receiving element 76 is bright (see FIG. 14A). In this case, the light receiving range from the bright spot detected by the light receiving element is increased and the intensity is decreased. Therefore, the position of the patient eye E in the optical axis direction can be detected by measuring the positional relationship between the bright state of the bright spot and the patient eye E in advance. Note that the control unit 100 may detect not only the bright spot but also the blurred state of the anterior segment image and the position of the patient's eye E in the optical axis direction.

Note that the second detection unit may detect the position of the patient eye E in the optical axis direction based on the tomographic image of the patient eye E captured by the tomographic image capturing unit 71. For example, if the optical path length of the reference light of the tomographic imaging unit 71 is constant, the imaging region captured by the tomographic image is constant. Therefore, the position of the patient eye E can be obtained from the position of the tomographic image acquired by the detector 717. When the optical path length of the reference light of the reference optical system can be changed, for example, the position of the patient's eye E in the optical axis direction may be detected based on the position of the cover glass 51 shown in the tomographic image.
<Fixation guidance>
When the position of the laser irradiation unit 300 is arranged at a predetermined position with respect to the patient's eye E, the control unit 100 may control the fixation guidance unit 120 to start fixation guidance of the patient's eye E. For example, the control unit 100 detects the tilt of the eyeball by the tilt detection unit. Then, the control unit 100 may control the visual axis guidance of the fixation guidance unit 120 based on the inclination of the eyeball. For example, the tomography unit 71 may be used as the tilt detection unit. For example, the inclination of the eyeball may be detected based on the tomographic image captured by the tomographic image capturing unit 71. For example, the control unit 100 may construct three-dimensional shape data from tomographic images of two or more cross sections (preferably three or more cross sections), and obtain the inclination from the shape information. For example, the inclination detection unit may detect the direction of a line passing through the center of curvature of the anterior capsule and the center of curvature of the posterior capsule detected by the tomogram as the optical axis S1 of the eyeball. For example, the inclination detection unit may detect the direction of a line passing through the center of curvature of the front surface of the cornea and the center of curvature of the rear surface detected from the tomogram as the optical axis S1 (structure axis) of the eyeball. For example, the tilt detection unit may detect how many times the optical axis S1 or the visual axis S2 of the eyeball is tilted with respect to the optical axis L1 of the apparatus. An anterior segment tomography apparatus using a Shine-Pluke optical system may be used for the tilt detection unit.

  The control unit 100 controls the visual axis guidance of the fixation guidance unit 120 based on the tilt of the patient's eye E detected by the tilt detection unit. For example, as shown in FIG. 11, the control unit 100 controls the fixation guiding unit 120 so that the optical axis S1 or the visual axis S2 is in an appropriate position with respect to the optical axis L1 of the apparatus, and the visual axis S2 To induce. For example, when irradiating a crystalline lens with a laser, it is preferable that the optical axis S1 of the eyeball coincides with the optical axis L1 of the apparatus as shown in FIG. In such a case, the fixation guidance unit 120 is controlled to project a fixation lamp obliquely with respect to the optical axis L1 of the apparatus. For example, when irradiating the cornea with a laser, it is preferable that the visual axis S2 and the optical axis L1 of the apparatus coincide with each other as shown in FIG. In such a case, the fixation guidance unit 120 is controlled to project a fixation lamp from the direction of the optical axis L1 of the apparatus.

  When the distance between the suction ring 281 and the patient's eye E is far from a predetermined position, the fixation lamp guided by the fixation guidance unit 120 may not be visually recognized. For example, even if the patient's eye E presents a fixation with a viewing angle of 5 ° with a predetermined distance from the suction ring 281, the luminous flux may be blocked by the suction ring 281 and not enter the eyeball. is there. Therefore, the control unit 100 controls the fixation guidance unit 120 to present a fixation at a visual angle of 0 ° at first. When the patient's eye E comes closer to the suction ring 281 than the predetermined distance, the control unit 100 controls the fixation guidance unit 120 and starts fixation fixation at a viewing angle of 5 °.

  In this way, the control unit 100 may bring the suction ring 281 and the patient's eye E close to a position where the fixation light beam guided by the fixation guiding unit is incident on the patient's eye E. Thereby, the patient's fixation can be surely guided.

  Note that the observation image of the patient eye E may be used as the distance between the suction ring 281 and the patient eye E. For example, the distance between the suction ring 281 and the patient's eye E may be acquired from the focus state of the anterior segment image. For example, when the focus adjustment unit 80 is always focused on the anterior segment of the patient by moving the position of the light receiving element 76, the control unit 100 acquires the position of the patient eye E from the position of the light receiving element 76. May be.

  As described above, the control unit 100 may acquire the distance between the suction ring 281 and the patient's eye E from the observation image. Then, when the patient's eye E is closer than a predetermined distance, for example, the viewing angle may be changed from 0 ° to 5 ° by the fixation guidance unit 120. The viewing angle is not limited to 5 ° and may be any number.

<Alignment correction by fixation guidance>
By the way, when the position of the fixation lamp is moved by the fixation guidance unit 120, the position of the corneal bright spot formed on the cornea of the patient's eye E may be shifted. In this case, the control unit 100 may correct the alignment position by the amount displaced by the movement of the fixation lamp. For example, the fixation fixation guidance is controlled based on the result of detecting the tilt of the intraocular eyeball imaged by the tomography unit 71. At this time, the bright spot may be shifted due to fixation fixation. The control unit 100 may control the first moving unit 10 based on the position of the corneal bright spot image photographed by the observation optical system 70, and may perform optimum alignment in the XY directions even after fixation fixation guidance.

  For example, as shown in FIG. 12, in this embodiment, the bright spot generated in the cornea of the patient's eye E is formed with reference to the point closest to the apparatus side (irradiation end unit side) in the cornea of the patient's eye E. When the fixation position is switched by the fixation guidance unit 120, the position of the corneal bright spot may be shifted in the left-right direction. This is because the center of curvature of the cornea and the center of rotation of the eyeball are different. For example, before switching the fixation position, it is assumed that a bright spot is arranged at the center of the front image as shown in FIG. When the fixation position is moved in this state, for example, as shown in FIG. 12B, the bright spot photographed in the front image is shifted.

  Therefore, when the lighting position of the fixation lamp is switched by fixation guidance, the control unit 100 may detect an alignment deviation in the XY directions by using the first detection unit, for example. Then, the control unit may perform alignment in the XY directions again by moving the first moving unit 10 based on the detected misalignment. For example, the alignment may be performed again from the misalignment state shown in FIG. 12B until the alignment shown in FIG.

  Even if the bright spot is not used, for example, an alignment shift amount may be obtained from the shape of the patient's eye E detected from the tomogram, and the alignment in the XY directions may be obtained.

  In addition to the rotation of the eyeball by fixation fixation, it is conceivable that the position of the bright spot is moved by the head moving. Also in this case, the control unit 100 may detect the alignment deviation in the X and Y directions by the first detection unit (for example, the observation optical system 70), and perform the alignment in the X and Y directions again by the first moving unit 10.

  The control unit 100 performs image processing on the tomographic image that is a moving image acquired by the tomographic imaging unit 71, extracts the corneal shape of the patient's eye E, and extracts the position of the corneal apex. Further, the control unit 100 extracts the iris of the patient's eye E and obtains the pupil center position. Then, the control unit 100 sets the line passing through the corneal apex and the pupil center as the direction of the patient's eye E (axis information indicating the axis of the eyeball). The control unit 100 superimposes and displays a symbol (mark) F1 indicating an axis on the tomographic image (see FIG. 8). In addition, the control unit 100 performs image processing on the front image acquired by the front image acquisition unit 350 and extracts the pupil center position. The control unit 100 superimposes and displays the symbol F2 indicating the pupil center position on the front image. The symbols F1 and F2 are updated and displayed in real time.

  When it is determined that the alignment state in the XY direction with respect to the eye to be examined and the tilt state of the patient's eye E are appropriate, the control unit 100 controls the drive unit 12 and further directs the irradiation end unit 42 toward the patient's eye E in the Z direction. By moving, the suction ring 281 and the patient's eye E are brought into contact with each other.

  When the suction ring 281 comes into contact with the patient's eye E, the load cell 206 detects the force with which the eyeball fixing unit 280 is pushed up by the patient's eye E. When the force is detected by the load cell 206, the control unit 100 stops driving the first moving unit 10. At this time, for example, the control unit 100 acquires the position of the link 212 from the encoder 203 and stores it in the RAM 103 as the position where the suction ring 281 and the patient's eye E are in contact.

  Note that when the suction ring 281 contacts the patient's eye E, the position of the patient's eye E may shift. Also in this case, for example, the control unit 100 may detect an alignment deviation in the X and Y directions using the observation optical system 70 and the like, and may perform alignment in the X and Y directions again using the first moving unit 10.

  Next, as shown in FIGS. 13A and 13B, the control unit 100 drives the drive unit 226 to move the pin 221 downward. The links 211 and 212 are moved downward by gravity. The suction ring 281 is pressed against and closely contacts the patient's eye E by the weight of the link unit 210, the connecting portion 250, the eyeball fixing unit 280, and the like. Thus, the control unit 100 releases the support of the suction ring 281 by the pin 221 and presses the suction ring 281 against the patient's eye E. Thereby, the sealing property between the suction ring 281 and the patient's eye E is enhanced, and the suction ring 281 is easily adsorbed to the patient's eye E.

  In step 6, the load when the suction ring 281 is pressed against the patient's eye E may be set to be 300 g or less, more preferably 200 g, for example. Moreover, it is preferable that an appropriate load is applied to the patient's eye E so that the patient's eye can be satisfactorily attracted by the suction ring 281. For example, the link unit 210 may be designed so that the load applied to the patient's eye E is 300 g or less in a state where the link unit 210 is disconnected from the drive unit 226.

  For example, the control unit 100 may cancel the load applied to the patient's eye E by the magnitude of the elastic force of the spring 222 by controlling the drive unit 226 and bringing the pin 221 into contact with the link 211.

  For example, the load applied to the patient's eye E may be canceled by installing a balance adjusting mechanism in the link unit 210, not limited to the elastic force of the spring 222. For example, a weight may be fixed to the end of the link 211 on the joint 213 side. As a result, a moment acts on the link 211 in the direction of moving the suction ring 281 upward, and the load applied to the patient's eye E is cancelled.

  Next, the control unit 100 sends a control signal to the suction device. The control unit 100 controls the suction pressure when the eyeball is sucked by the suction device, and sucks the eyeball with an appropriate suction pressure. Thereby, it is possible to reduce an increase in intraocular pressure of the patient's eye E. The suction device starts the pump and sucks the suction ring 281 to the patient's eye E. When the adsorption of the patient's eye E is completed, the control unit 100 fills the suction ring 281 with the liquid.

  If the suction ring 281 is filled with a liquid, the position of the fixation target viewed from the patient may be shifted due to a difference in refractive index between the air and the liquid. At this time, since the eyeball is adsorbed by the suction ring 281, when the patient observes the fixation lamp, a load is applied to the patient's eye E.

  In order to prevent this, the control unit 100 may control the fixation guiding unit when the suction ring 281 is filled with liquid. For example, the control unit 100 may move the lighting position of the fixation lamp. For example, the control unit 100 may move the lighting position of the fixation lamp in consideration of the refraction angle at which the light flux of the fixation lamp is refracted on the liquid surface based on the refractive index of the liquid. The refraction angle or the like may be stored in the ROM 102 or the like, or may be calculated by the control unit 100.

  Note that the fixation angle in the air (the visual angle when viewing the fixation target) varies depending on the patient. Therefore, the control unit 100 may control the fixation guiding unit 120 according to the fixation angle of the patient. For example, the control unit 100 may acquire the fixation angle of the patient from the cross-sectional image and perform fixation fixation based on the acquired fixation angle.

  In a state where the patient's eye E is sucked by the suction ring 281, the control unit 100 returns the position of the suction ring 281 to the position when the patient's eye E is touched. The control unit 100 reads out the position when the suction ring 281 contacts the patient's eye E from the RAM 103. The control unit 100 drives the drive unit 226 according to the position read from the RAM 103 and moves the pin 221 upward. The link 211 is pushed up by the pin 221. When the link 211 is pushed up, the link 212 rises in the Z-axis direction. By moving the link unit 210 upward, the eyeball fixing unit 280 is moved upward, and the position of the suction ring returns to the position when it contacts the patient's eye E. As a result, the pressing force applied to the patient's eye E from the suction ring 281 is released. Thus, the control unit 100 returns the position of the eyeball fixing unit 280 to the original position.

<Laser irradiation unit and interface positioning>
Next, the operator determines the positions of the laser irradiation unit 300 and the interface unit 50 in the Z direction with respect to the patient's eye E (step 3). The control unit 100 performs image processing on the tomographic image, and controls the first moving unit 10 and the second moving unit 100 while calculating the position of the cover glass 51 (the height position in the Z direction) and the position of the cornea. The front surface (lower surface) of the cover glass 51 is in a certain positional relationship with respect to the cornea (vertex). As a positional relationship, for example, the apex of the cornea and the front surface of the cover glass 51 are set to a distance of about 1 mm. This is a distance that does not affect the surface of the liquid and does not place a burden on the patient because the cover glass 51 directly contacts the cornea.

  The control unit 100 sends a command signal to the first moving unit 10. The control unit 100 drives the first moving unit 10 to move the irradiation end unit 42 and the interface unit 50 in the Z-axis direction with respect to the patient's eye E.

  The second moving unit 200 is attached to the irradiation end unit 42 by an arm 202. Therefore, the second moving unit 200 is moved in the direction of the patient's eye E together with the irradiation end unit 42 by driving the first moving unit 10.

  In the present embodiment, as shown in FIG. 13, when the interface unit 50 and the second moving unit 200 are moved by the first moving unit 10, the control unit 100 sets the position of the eyeball fixing unit 280 to the patient's eye E (or The driving of the second moving unit 200 is controlled so as to be held constant with respect to the installation surface (floor surface) of the apparatus.

  For example, the movement amount by which the first moving unit 10 moves the second moving unit 200 and the eyeball fixing unit 280 in a direction approaching the patient's eye E is ΔZ1, and the second moving unit 200 moves the eyeball fixing unit 280 with respect to the irradiation end unit 42. The amount of movement to move in a relatively close direction is ΔZ2. In the control unit 100 of the present embodiment, for example, the driving of the first moving unit 10 and the second moving unit 200 is controlled so that the moving amount ΔZ1 and the moving amount ΔZ2 are equal.

  For example, the control unit 100 controls the driving amount (for example, the number of pulses of the pulse motor) and the link 212 (or the eyeball fixing unit 280) for the driving units 12 and 226 of the first moving unit 10 and the second moving unit 200, respectively. ) Is stored. Therefore, the control unit 100 may control the driving of the second moving unit according to the driving amount of the first moving unit 10. Thus, the first moving unit 10 and the second moving unit 200 can be controlled so that the moving amount ΔZ1 and the moving amount ΔZ2 are equal.

  In this embodiment, the downward movement amount ΔZ1 of the second movement unit 200 by the first movement unit 10 and the upward movement amount ΔZ2 of the eyeball fixing unit 280 by the second movement unit 200 are offset. Accordingly, the interface unit 50 can be positioned with respect to the patient's eye E in a state where the position of the eyeball fixing unit 280 in the Z-axis direction is kept stationary with respect to the patient's eye E. Therefore, the eyeball fixing unit is pressed against the patient's eye E by the movement of the first moving unit 10, and the increase in the intraocular pressure of the patient's eye E is reduced. That is, the burden on the patient during the operation can be reduced.

  In addition, while observing the pressure detection result by the load cell 206, it is possible to fix the eyeball while suppressing fluctuations in intraocular pressure without servo-controlling the first moving unit 10 and the second moving unit 200.

  In the present embodiment, the detection value of the load cell 206 is not fed back to the movement control of the first moving unit 10 and the second moving unit. However, the detection result of the load cell 206 is constantly monitored, and when the pressure reaches a threshold value or more, the lock by the lock unit 230 is released. Thereby, it is suppressed that an excessive load is applied to the patient's eye E.

  Further, in the present embodiment, for example, the control unit 100 is configured so that when the first moving unit 10 is driven, the eyeball fixing unit 280 is constantly held at a fixed position with respect to the patient's eye E. 2 The mobile unit 200 is controlled.

  For example, the first moving unit 10 integrally moves the second moving unit 200 and the eyeball fixing unit 280 in a direction approaching the patient's eye E, and the second moving unit 200 moves the eyeball fixing unit 280 away from the patient's eye E. Let's move to. At this time, the magnitude of the moving speed in the Z-axis direction when the eyeball fixing unit 280 is moved by the first moving unit 10 is V1, and the Z-axis direction when the eyeball fixing unit 280 is moved by the second moving unit 200. Let V2 be the magnitude of the movement speed. In the present embodiment, the control unit 100 controls the first moving unit 10 and the second moving unit 200 so that the magnitudes V1 and V2 of the moving speed in the Z-axis direction are equal.

  For example, the control unit 100 relates to the driving units 12 and 226 of the first moving unit 10 and the second moving unit 200, the driving speed (for example, the rotational speed of the motor) and the link 212 (or the eyeball fixing unit 280). The relationship with the moving speed is stored. Therefore, the control unit 100 may control the driving of the second moving unit 200 according to the driving amount of the first moving unit. Thus, the first moving unit 10 and the second moving unit 200 can be controlled so that the moving speed magnitude V1 and the moving speed magnitude V2 are equal.

  Thereby, the control unit 100 can position the interface unit 50 (cover glass 51) with respect to the patient's eye E in a state where the eyeball fixing unit 280 is always kept at a fixed position with respect to the patient's eye E. Accordingly, the movement of the eyeball fixing unit 280 can reduce the increase in intraocular pressure due to the patient's eye E being pressed against the suction ring 281.

  As described above, the position of the eyeball fixing unit 280 may not necessarily be constant with respect to the patient's eye E. However, it is preferable to hold the position of the eyeball fixing unit 280 to such an extent that an excessive load is not applied to the patient's eye E.

  Note that the control unit 100 may be configured to detect the position of the front surface of the cover glass 51 and the position of the upper surface of the eyeball fixing unit 280 by image processing of the tomographic image to position the cover glass 51.

  In this way, the eyeball of the patient's eye E is fixed and the interface unit 50 is positioned. The operator can easily perform the positioning operation by moving the suction ring 281 and the interface unit 50 in the Z direction while viewing a moving image such as an anterior segment image or a tomographic image. Also, by checking the moving image of the patient's eye E, it is possible to fix the eyeball suitable for the patient's eye E, corresponding to the position of the sclera and cornea that varies depending on the patient's eye E.

  Further, the apparatus of the present embodiment has a configuration in which the suction ring 281 and the interface unit 50 provided in the apparatus main body can be independently moved in the Z direction, and the patient eye E fixed by the suction ring 281 is used. The interface unit 50 is moved. Thereby, since the positional relationship between the patient's eye E fixed by the suction ring 281 and the interface unit can be adjusted suitably, it corresponds to the position of the sclera and cornea that differs depending on the patient's eye E, and the eyeball suitable for the patient's eye E. Can be fixed. Furthermore, since the interface unit 50 can move in the Z-axis direction with respect to the suction ring 281 in a state where movement in the XY directions is restricted by the second moving unit, the interface unit 50 and the suction ring 281 It is possible to avoid the occurrence of deviation in the XY direction.

  Further, the apparatus of the present embodiment has a configuration in which the suction ring 281 and the interface unit 50 provided in the apparatus main body can be independently moved in the Z direction, and the suction ring 281 is fixed to the patient's eye E, and the suction ring 281. Adjustment of the positional relationship between the patient's eye E fixed by the interface unit 50 and the interface unit 50 can be performed smoothly, and an efficient operation can be performed.

<Adjusting the focus>
In the apparatus 1 of the present embodiment, when the front photographing unit 75 and the objective lens 305 are moved in the Z-axis direction by the first moving unit 10, the front of the front is adjusted by the focus adjusting unit 80 so that the patient's eye E is in focus. The focus of the photographing unit 75 is adjusted.

  For example, it is assumed that the first moving unit 10 moves toward the patient's eye E as shown in FIGS. At this time, the distance of the objective lens 305 to the patient's eye E and the distance of the front photographing unit 75 to the patient's eye E are shortened. Therefore, the image of the patient's eye E that has been imaged at the position of the light receiving element 76 by the optical system of the front photographing unit 75 is formed at a distance from the light receiving element 76. Therefore, the front image of the patient's eye E detected by the light receiving element 76 is an out-of-focus image.

  For example, the focus of the front photographing unit 75 is adjusted with respect to the patient's eye E before being fixed by the eyeball fixing unit 280. For example, in the initial state, it is assumed that the light receiving element 76 is focused at a position 15 mm away from the suction ring 281 toward the patient. Thus, the surgeon can grasp the position of the patient's eye E before the patient's eye E contacts the suction ring 281.

  First, the surgeon brings the eyeball fixing unit 280 closer to the patient's eye E using the first moving unit 10. When the patient's eye E is positioned 15 mm away from the suction ring 281 by moving the eyeball fixing unit 280, the focus of the light receiving element 76 is aligned with the patient's eye E. However, if the first moving unit 10 is further moved to bring the suction ring 281 into contact with the patient's eye E, the focus position of the light receiving element 76 is shifted with respect to the patient's eye E. When the focus position is shifted, the front image of the patient's eye E acquired by the light receiving element 76 is blurred, and the positioning of the patient's eye E and the eyeball fixing unit 280 in the X and Y directions is hindered.

  In such a case, in this embodiment, the control unit 100 detects the position or movement amount of the first moving unit 10 after the light receiving element 76 is focused on the patient's eye E by the movement of the first moving unit 10, for example. Control of the focus adjustment unit 80 according to the above may be started. Then, the control unit 100 changes the position of the light receiving element 76 so that the image of the patient's eye E formed by the objective lens 305 and the front imaging unit 75 is formed at the light receiving position of the light receiving element 76. For example, the distance between the light receiving element 76 and the patient's eye E on the observation optical path is changed (see FIGS. 14A and 14B).

  For example, as illustrated in FIG. 14B, the control unit 100 controls the drive unit 81 of the focus adjustment unit to move the light receiving element 76. When the objective lens 305 and the patient's eye E are moved closer to each other by the first moving unit 10, the control unit 100 moves the position of the light receiving element 76 away from the patient's eye E by the driving unit 81. Thus, the control unit 100 can adjust the focus position of the front photographing unit 75 by the focus adjustment unit 80. The relationship between the amount of movement when the objective lens 305 is moved closer to the patient's eye E and the amount of movement when the light receiving element 76 is moved depends on the optical system of the apparatus and can be obtained experimentally. Further, the movement amount of the objective lens 305 and the movement amount of the light receiving element 76 can be theoretically obtained as design values. For example, when the objective lens 305 is moved closer to the patient's eye E by 35 mm, the light receiving element 76 can be focused on the patient's eye E by moving the light receiving element 76 away by 2 mm.

  Thus, when the arrangement of the front imaging unit 75 is moved in accordance with the movement of the irradiation end unit 42, the image of the patient's eye E captured by the light receiving element 76 is not focused. When the image is out of focus, for example, the suction ring 281 is positioned with an unclear image. Therefore, for example, the patient eye E is fixed in a state where the optical axis S1 of the patient eye E is shifted and tilted with respect to the optical axis L1 of the laser irradiation optical system 320.

  As in the present embodiment, when the distance between the front photographing unit 75 and the patient's eye E changes and the light receiving element 76 becomes out of focus, for example, the focus adjusting unit 80 focuses the front photographing unit 75 on the patient's eye E. To match.

  In this way, by adjusting the focus of the front photographing unit 75, the state of the patient's eye E can be easily observed. The positioning of the suction ring 281 and the positioning of the interface unit 50 can be suitably performed.

  Further, in this embodiment, after the patient's eye E is fixed by the eyeball fixing unit 280, the irradiation end unit 42 is aligned with the patient's eye E, or the focus of the front photographing unit 75 is adjusted. Good.

  For example, the control unit 100 moves the first moving unit 10 to bring the objective lens 305 and the interface unit 50 closer to the patient eye E fixed to the eyeball fixing unit 280. Then, the patient's eye E is placed at the irradiation position for irradiating the laser. As the first moving unit 10 is moved, the front photographing unit 75 is also moved. That is, the focus position of the front photographing unit 75 is shifted. At this time, the control unit 100 controls the focus adjustment unit 80 to move the position of the light receiving element 76, for example. Accordingly, the focus adjustment unit 80 focuses the front photographing unit 75 on the patient eye E that can be placed from the standby position of the eyeball fixing unit 280 before the patient eye E is fixed to the irradiation position for laser irradiation. Can do. This makes it easier for the surgeon to check the state of the patient's eye E until the laser is irradiated before the eyeball is fixed.

  Note that the focus adjustment unit 80 may adjust the focus of the light receiving element 76 in real time according to the height of the eyeball fixing unit 280. For example, the control unit 100 detects the real-time height of the eyeball fixing unit from the movement amount of the first moving unit 10 or the second moving unit 200. Then, the control unit 100 may adjust the focus of the light receiving element 76 in real time by controlling the focus adjustment unit 80 according to the detected real time height.

<Auto focus + Auto alignment>
In the present embodiment, the patient eye E may be autofocused while the front image is focused by the focus adjustment unit. When the front image is in focus, the bright spots in the front image become clear. The control unit 100 may automatically perform focus adjustment using a bright spot appearing in the front image.

  For example, as shown in FIG. 15A, when the front image is not in focus, the entire image is blurred, and there is a possibility that the error is large when a bright spot is detected. Therefore, the control unit 100 controls the focus adjustment unit 80 to automatically adjust the focus of the front image of the anterior segment. As a result, the bright spot of the front image of the anterior segment can be detected satisfactorily (see FIG. 15B).

  The control unit 100 detects the position of the bright spot from the front image focused on the bright spot of the patient's eye E. Then, the irradiation end unit 42 is aligned based on the position of the detected bright spot. For example, the control unit 100 determines the pupil center from the position of the bright spot, moves the irradiation end unit 42 so that the determined pupil center is arranged at the center of the front image, and performs alignment.

  As described above, when the alignment is performed, the position of the bright spot can be satisfactorily detected by adjusting the focus to the bright spot. Accordingly, the control unit 100 can easily perform alignment based on the position of the focus bright spot.

  The focus adjustment unit 80 does not necessarily need to focus the front photographing unit 75 on the corneal bright spot. For example, the focus may be on the cornea, cornea ring, iris, or crystalline lens.

  In the above description, alignment is performed using corneal bright spots, but the present invention is not limited to this. For example, the control unit 100 may determine the center of the pupil of the patient's eye E from the front image captured by the front imaging unit 75 to detect the pupil, corneal limbal movement, and the like, and perform alignment.

<Reflection of planning content>
When the eyeball fixation (step 2) is completed, the control unit 100 acquires an observation image of the patient's eye E by the observation optical system 70 (step 4). For example, the control unit 100 may acquire a tomographic image of the patient's eye E using the tomographic imaging unit 71. The control unit 100 associates the observation image photographed before the operation with the intraoperative observation image photographed by the observation optical system 70 (step 5). As a result, the planning content set before surgery can be associated with the intraoperative observation image. Therefore, the control unit 100 can perform an operation according to an operation condition set before the operation.

  Note that the observation image of the patient's eye E that has been undocked taken by an external observation device before surgery and the observation image after the docking of the patient's eye E taken by the observation optical system 70 may not match. For example, the cornea, iris, lens, etc. are deformed. For example, the inclination of the crystalline lens changes. For example, in the case of preoperative imaging, when imaging is performed in a state where it has occurred, and imaging is performed while lying down during surgery, the shape of the patient's eye E may change. For example, during the operation, the shape of the patient's eye E may change because the eyeball is fixed by the eyeball fixing unit.

  As described above, when the shape of the eyeball image acquired before and during the operation does not match, the control unit 100 changes the planning content set based on the preoperative observation image to the content suitable for the intraoperative observation image. You may correct | amend (step 6). For example, as shown in FIG. 16, the control unit 100 first detects at least one of corneal shape, iris shape, crystalline lens shape, corner shape information, and the like from the tomographic image. Subsequently, the control unit 100 associates the preoperative observation image with the intraoperative observation image. Thus, the surgical condition set based on the preoperative image is associated with the intraoperative image. The control unit 100 can calculate the position of the patient eye E corresponding to the apparatus from the intraoperative image position. Therefore, the control unit 100 can irradiate the patient's eye E with the laser light according to the surgical region associated with the intraoperative image. That is, the control unit 100 can treat the patient's eye E under the surgical conditions set by planning.

  For example, the control unit 100 associates the preoperative image and the intraoperative image based on the detected shape information. For example, the control unit 100 acquires the shape of the iris for each of the preoperative and intraoperative images. Then, a plane D1 including a corner angle (the root of the iris and cornea) and a line D2 perpendicular to the plane and passing through the center of the pupil are calculated for each image (see FIG. 16).

  For example, the control unit 100 may associate the preoperative and intraoperative observation images so that the plane D1 and the line D2 coincide with each other. The control unit 100 may associate the preoperative image with the intraoperative image so that the line D2 and the apex of the anterior capsule of the crystalline lens coincide.

  The control unit 100 may correct the contents of the planning set based on the preoperative observation image so as to be suitable for the intraoperative image by associating the preoperative and intraoperative observation images.

  For example, as shown in FIG. 17, as a result of matching the preoperative planning contents with the intraoperative observation image, the preoperative planning contents do not match the intraoperative observation image due to changes in the preoperative and preoperative eye shapes. There is a case. In such a case, the control unit 100 may correct the preoperative planning contents so as to become contents suitable for the operation. For example, assume that the lens thickness has changed before and during surgery. In this case, you may correct | amend area | region A1 irradiated with a laser according to the variation | change_quantity of the thickness of a crystalline lens. For example, when the thickness of the crystalline lens is increased by 0.5 mm, an extra 0.5 mm remains without being irradiated with the laser with respect to the set margin (see FIG. 17A). Therefore, the control unit 100 may increase the thickness A1 of the laser by 0.5 mm (see FIG. 17B). For example, the control unit 100 may correct a laser irradiation region (also referred to as a treatment region) from the region A1 to the region A2 within a margin range set for the anterior capsule and the posterior capsule.

  For example, the control unit may correct the position of the corneal incision set in the preoperative planning according to the corneal shape during the operation. For example, the control unit 100 may correct the position of the corneal incision in accordance with changes in the corneal shape before and during the operation. For example, it is assumed that the incision pattern K is displayed on the sclera as a result of associating preoperative planning contents with an intraoperative observation image. In this case, the control unit may detect the boundary between the cornea and the sclera from the intraoperative observation image. Then, the position of the incision pattern K may be corrected closer to the cornea than the detected boundary.

  Note that the control unit 100 may also correct the laser irradiation area A1 depending on the mydriatic state. For example, when the pupil is greatly opened during the operation compared to before the operation, the control unit 100 may correct the laser irradiation area A1 to the area A2 in accordance with the pupil diameter.

  In this way, the surgery can be performed more smoothly by correcting the surgical conditions set for the preoperative image based on the intraoperative image. For example, if the preoperative eyeball shape is different from the intraoperative eyeball shape, there is a possibility that the surgery cannot be performed according to the surgical conditions planned at the time of planning. In such a case, by making it possible to correct the contents of the planning, it is possible to save the trouble of re-planning from the beginning.

  Note that the planning content may be corrected automatically by the control unit 100 or manually by the operator. For example, the control unit 100 may automatically correct the planning content so that the surgeon can check the corrected planning content and manually correct it by operating the operation unit if necessary. .

  In addition, you may plan by another apparatus (The filing system etc. which display a tomogram). In this case, the planning data is read into the surgical apparatus.

  The control unit 100 displays the corrected irradiation planning content on the display unit. When the surgeon confirms the contents of the corrected irradiation planning, the operator operates the operation unit 90 and sends a control signal for starting laser irradiation to the control unit 100. When receiving the control signal from the operation unit 90, the control unit 100 performs laser irradiation based on the irradiation planning information (step 7).

  The lens of the patient's eye E is cut and crushed by laser irradiation, and the anterior lens capsule is incised. When the laser irradiation is completed, the control unit 100 notifies the operator by a buzzer (not shown).

  When the laser irradiation is completed, the control unit 100 moves the interface unit 50 upward. Subsequently, the liquid in the suction ring 281 is discharged. Thereafter, the control unit 100 releases the suction by the suction ring 281 and removes the suction ring 281 from the patient's eye E.

  The patient's eye E from which the eyeball fixing unit 280 and the interface unit 50 are removed is operated by another surgical apparatus, for example, an ultrasonic cataract surgical apparatus.

  In addition to the content of irradiation planning, the planning content of the docking process may be corrected. For example, if the visual axis or optical axis of the eyeball is different between the preoperative image and the intraoperative image, the control unit 100 is configured to perform a visual axis guidance so as to automatically correct the direction of the axis. 120 may be controlled.

  In the present embodiment, the focus adjustment unit 80 has been described as adjusting the focus of the observation / photographing unit 70 by moving the light receiving element 76 of the observation / photographing unit 70 relative to the objective lens 305. Not limited to this. For example, as shown in FIG. 18A, a focus adjustment lens may be inserted into and removed from the optical path of the observation / photographing unit 70. For example, it is assumed that the observation / photographing unit 70 has a concave lens 83 disposed on the optical path, and the light receiving element 76 is in focus 15 mm away from the suction ring 281. When the patient's eye E gradually approaches and comes to a position 15 mm away from the suction ring 281, the focus of the observation / imaging unit 70 coincides with the patient's eye E.

  Next, when the patient's eye E reaches a position in contact with the suction ring 281, the control unit 100 retracts the concave lens 82 out of the optical path of the observation / imaging unit 70. As a result, the light receiving element 76 is focused on the vicinity of the patient's eye E docked on the suction ring 281. Further, when the irradiation end unit 42 approaches the laser irradiation position, the control unit 100 inserts the convex lens 83 on the optical path of the observation / photographing unit 70. As a result, the light receiving element 76 comes into focus in the vicinity of the patient's eye E arranged at the laser irradiation position.

  As described above, the focus position of the observation / photographing unit 70 can also be adjusted by inserting / removing optical elements (for example, the concave lens 82 and the convex lens 83) on the optical path of the observation / photographing unit 70.

  Further, for example, as shown in FIG. 18B, the focus of the observation / photographing unit 70 may be adjusted by moving the objective lens 305. For example, the irradiation end unit 42 is moved in the direction of the patient's eye E. At this time, the objective lens 305 is moved in a direction away from the patient's eye E. Even if the focus position is shifted by changing the positions of the patient's eye E and the light receiving element 76, the focus of the light receiving element 76 can be adjusted to the patient's eye E by moving the objective lens 305.

  Further, for example, the focus of the observation / photographing unit 70 may be adjusted by moving an imaging lens (not shown) provided in the observation / photographing unit 70.

  As described above, the focus adjustment unit 80 may adjust the focus of the light receiving element 76 of the observation / photographing unit 70 by adjusting the arrangement of the light receiving elements 76.

  For example, the focus adjustment unit may switch a plurality of light receiving elements (not shown) provided according to the height of the patient's eye E, for example. As described above, the focus adjustment unit may be able to adjust the focus of the front photographing unit 75 by switching a plurality of light receiving elements having different focus positions.

  In the light receiving element 76 of the present embodiment, the focus is in the distance from the suction ring 281 before the eyeball is fixed. As described above, the patient's eye E before coming into contact with the suction ring 281 can be suitably detected by focusing on the far side of the suction ring 281. Further, as described above, by adjusting the focus of the light receiving element 76 to the patient's eye E, a focused image is taken from before the patient's eye E contacts the suction ring 281 until the laser is irradiated. be able to. Thus, the surgeon can appropriately observe the state of the patient's eye E during the operation.

  In this embodiment, for example, the focus is on a position 15 mm away from the suction ring 281. From the cover glass 51, for example, the focus is at a position 35 mm away. The focus of the light receiving element 76 may be at least at a position 5 mm away from the suction ring 281. Preferably, the cover glass 51 is focused, for example, 25 mm away. It is preferable that the light receiving element 76 is focused on the patient eye E before the patient eye E contacts the suction ring 281 at least.

  In the present embodiment, the control unit 100 may detect the position of the patient's eye E based on the anterior segment image of the patient's eye E acquired by the observation / imaging unit 70. For example, the control unit 100 may detect the bright spot on the cornea formed by the illumination light from the illumination light source from the front image. Then, the control unit 100 may determine the distance of the patient's eye E from the device in the XY direction or the Z-axis direction based on the detected bright spot position. Thus, the front imaging unit 75 may function as a detection unit that detects the position of the patient's eye E. For example, the control unit 100 may detect the position of the patient's eye E relative to the irradiation end unit 42 from the position of the corneal bright spot shown in the front image (see FIG. 12). Thus, the front observation unit 75 may function as a detection unit that detects the position of the patient's eye. In the front image, there may be a bright spot formed by reflecting the illumination light on the cover lens 51 or the like (see FIG. 15). For example, the case where illumination light reflects in the cover lens 51 at the time of LASIK surgery is mentioned. The bright spots of the cover lens 51 and the like are always detected at the same position in the front image. The control unit 100 may read the position where the bright spot is previously stored and stored in the storage unit, and distinguish the corneal bright spot from the bright spot of the cover lens 51. In addition, the bright spot of the cover lens 51 often appears larger than the corneal bright spot. For this reason, the control unit 100 may distinguish the corneal bright point and the bright point of the cover lens 51 from the bright spot size.

  Note that the control unit 100 may control the first moving unit 10 so that the position of the corneal bright spot shown in the front image is arranged at the center of the display unit 93.

  The position of the patient's eye E may be detected by the tomography unit 71. For example, the position of the patient's eye E may be detected from the anterior segment tomogram of the patient's eye E photographed by the tomography unit 71. The tomographic imaging unit 71 also captures a corneal tomographic image of the patient's eye E, an eyeball fixing unit 280, an interface unit 50, and the like. Therefore, the tomography unit 71 may function as a detection unit that detects the position of the patient's eye E with respect to the apparatus. The control unit 100 may adjust the focus of the light receiving element 76 by controlling the focus adjustment unit 80 according to the position of the patient's eye E with respect to the apparatus detected by the tomography unit 71.

  Note that after the patient's eye E is fixed by the suction ring 281, the position of the patient's eye E may be detected from the position of the eyeball fixing unit 280. For example, the control unit 100 detects the position of the eyeball fixing unit 280 from the driving amount of the first moving unit or the second moving unit (number of pulses of the pulse motor, etc.).

  As described above, the surgical apparatus 1 may detect the position of the patient's eye E by the detection unit (for example, the observation / imaging unit, the control unit 100). Then, the control unit 100 may adjust the focus of the front imaging unit 75 by controlling the focus adjustment unit based on the detected position of the patient's eye E.

  The detection unit may detect a corneal bright spot, a pupil, a corneal ring dance, a conjunctival blood vessel, and the like. The detection unit may switch the detection target in accordance with the operation of the surgical apparatus 1. For example, when detecting the alignment state between the device 1 and the patient's eye E, the detection unit may set a corneal bright spot as a detection target. The corneal bright spot is easy to detect, and the detection accuracy of the alignment state can be increased. Further, as a detection target, a laser irradiation target (for example, a crystalline lens, a cornea, or the like) may be the detection target. For example, when performing surgery planning or the like, it is preferable that the observation image is focused on the irradiation target in order to confirm the laser irradiation target with a clear image. Accordingly, the detection unit may detect the laser irradiation target and adjust the focus of the observation / imaging unit 70. The focus may be adjusted by detecting the irradiation target.

  The control unit 100 may always perform focus adjustment of the light receiving element 76 by the focus adjustment unit 80 and calculate the distance from the irradiation end unit 42 to the patient's eye E based on the position of the light receiving element 76. For example, the position at which the light receiving element 76 is focused can be calculated based on the optical design value. As described above, the position of the patient's eye E in the Z-axis direction may be acquired using the focus state of the light receiving element 76.

  In the above description, the focus adjustment unit 80 has the drive unit 81 and is automatically controlled by the control unit 100. However, the present invention is not limited to this. For example, the focus adjustment may be performed by manually moving the position of the light receiving element 76 or the like by an operator.

  In this embodiment, the position of the patient's eye E is detected over a wide area from the position before the patient's eye E and the suction ring 281 are docked to the position where the laser is applied to the patient's eye E. For this reason, in the present embodiment, the optical path from when the patient's eye E is far from the objective lens 305 to when the light emitted from the illumination light source 60 is reflected by the cornea and received by the light receiving element 76 is different. .

  For example, when the patient's eye E is far from the objective lens 305, the illumination light passes through the outside of the cover glass 51, passes through the inside of the suction ring 281, and reaches the cornea. The illumination light reflected by the cornea is reflected in the Z-axis direction and received by the light receiving element 76. On the other hand, when the patient's eye E is close to the objective lens 305, the illumination light passes through the inside of the cover glass 51, passes through the inside of the suction ring 281 and reaches the cornea. The illumination light reflected by the cornea is reflected in the Z-axis direction and received by the light receiving element 76.

  Thus, in this embodiment, the illumination light source 60 is arranged so that a bright spot can be formed on the cornea in both cases where the patient's eye E is far from and close to the objective lens 305. Thereby, it is possible to form bright spots on the cornea in a long region using the same illumination light source 60.

  In the above description, the second moving unit 200 is moved in the XYZ directions by the first moving unit 10, but the present invention is not limited to this. For example, the second moving unit 200 may be attached to the main body 2 that is not affected by the driving of the first moving unit 10. In this case, the second moving unit 200 may be able to hold the eyeball fixing unit 280 so as to be movable in the XYZ directions with respect to the main body 2. In this case, the driving of the second moving unit 200 in the XY directions may be synchronized with the driving of the first moving unit 10.

  In addition, this apparatus 1 may be provided with the optical path length adjustment unit 740, for example (refer FIG. 19). The optical path length adjustment unit 740 may adjust the optical path length of the reference light by moving the reference mirror of the reference optical system. Thereby, the imaging region of the tomographic imaging unit 71 may be changed. For example, the optical path length adjustment unit 740 may move at least one reference mirror provided in the reference optical system by driving a drive unit. For example, the optical path length adjustment unit 740 moves the second reference mirror 731 provided in the second reference optical system 715.

  The optical path length adjustment unit 740 can change the optical path length of the second reference optical system 715 by moving the second reference mirror 731. When the optical path length of the second reference optical system 715 is changed, the position of the tomographic image acquired by the detector 717 is changed.

  For example, it is assumed that the second reference mirror 731 is disposed at the reference position A as shown in FIG. At this time, a tomographic image for an area located far from the eyeball fixing unit 280 is acquired. Next, for example, the second reference mirror 731 is moved to the position B by the drive unit 741, and the optical path length of the second reference optical system 715 is shortened. Thereby, when the second reference light and the measurement light of the second reference optical system 715 are combined, a tomographic image for a region near the suction ring 281 is acquired. For example, when the second reference mirror 731 is disposed at the position B, a tomographic image of an area located 10 mm away from the suction ring 281 is acquired.

  Thus, by moving the second reference mirror 731 by the optical path length adjustment unit 740, a tomographic image of the patient's eye E in a wide region from a region located far from the suction ring 281 to a region located near. Can be obtained.

  By changing the optical path length of the second optical path that has passed through the second reference optical system 715, the imaging region of the tomographic image can be moved. Thereby, when the cornea moves with respect to the irradiation end unit 42, the imaging region of the tomographic imaging unit 71 can be changed in accordance with the movement of the cornea. Thereby, when the eyeball fixing unit 280 approaches the patient's eye E, it is possible to observe how the eyeball fixing unit and the patient's eye E approach.

  Note that the optical path length adjustment unit 740 may move the second reference mirror 731 based on the signal detected by the observation optical system 70. For example, the second reference mirror 731 may be moved based on the position information of the patient's eye E acquired by analyzing the tomographic image. Thereby, the imaging region of the tomographic imaging unit 71 can be matched with the patient's eye E.

  Note that the optical path length adjustment unit may move the second reference mirror 731 in conjunction with the amount of movement of the apparatus, for example. For example, the control unit 100 measures the drive amount of the drive unit 12 that drives the first moving unit. Then, the second reference mirror 731 may be moved according to the measured drive amount of the drive unit 12. Thus, the imaging region of the tomographic imaging unit 71 can be aligned with the patient eye E without detecting the position of the patient eye E.

  In the above description, the optical path length adjustment unit 740 has been described as moving the second reference mirror 731, but is not limited thereto. For example, the first reference mirror 721 may be moved, or both the first reference mirror 721 and the second reference mirror 731 may be moved.

  The optical path adjustment unit may automatically adjust the position of each optical member so that the tomographic imaging unit 71 has a predetermined optical arrangement corresponding to the anterior segment imaging mode so that the optical path adjustment unit is at a predetermined position. .

  Note that the position of the suction ring 281 may be detected by a position sensor (for example, the encoder 203) on the eyeball fixing unit 280, and the drawing of the suction ring 281 may be superimposed on the tomographic image based on the detected position. Further, a tomographic image or a curvature shape up to the corneal limbus may be acquired by a preoperative examination. Based on the information, the contour line of the corneal limbus may be superimposed and displayed on the tomographic image at the time of docking. By displaying these two on the tomographic image at the same time, the operator can observe the positional relationship between the corneal limbus serving as a contact point at the time of docking and the suction ring 281.

  In the above description, the suction ring and the interface unit are disposable types (one-use type), but are not limited thereto. It may be a reusable type as long as the eyeball can be fixed. In this case, each unit is formed using a material that can be repeatedly sterilized, stainless steel, glass, or the like.

  In the present embodiment described above, the interface unit is brought into contact with the patient's eye E after the suction of the patient's eye E by the suction ring. However, the present invention is not limited to this. It is sufficient if the eyeball can be fixed, and the order of operations may be reversed.

  In the above description, the suction ring and the interface unit are configured to move in the Z direction. However, the present invention is not limited to this. The two units may be configured to move independently, and each unit may be configured to rotate (or rotate) in the XY directions.

  In the above description, the tomographic image is configured to position the eyeball fixing unit using a captured image (moving image). However, the present invention is not limited to this. For example, at least a symbol (illustration, frame, etc.) indicating the position of the ring of the suction ring may be displayed superimposed on the tomographic image. For example, the position of the ring of the suction ring may be obtained from the structure of the member of the suction ring and the detection signal of the sensor of the first holding unit and displayed on the tomographic image. As a result, the position of the member that is difficult to appear in the image can be confirmed on the monitor.

  Alternatively, the shape of the patient's eye E may be extracted from the tomographic image by image processing by the control unit 100 or the like and used for eyeball fixation or the like. For example, a tomographic image acquired before the eyeball fixing operation (or a tomographic image acquired by another imaging apparatus) is image-processed, and the shape of the cornea and the shape of the periphery of the cornea (corneal limbus) in contact with the suction ring (eyeball) Shape). The eyeball shape is preferably a three-dimensional shape acquired by orthogonal lines (B scan) passing through the vicinity of the apex of the cornea. During the eyeball fixing operation, the shape and position of the patient's eye E around the cornea are acquired by acquiring the cornea shape of the patient's eye E and matching it with the previously acquired cornea shape. The position of the shape around the obtained cornea is displayed as a symbol on a tomographic image. Thus, even if the tomographic imaging unit 71 cannot capture the periphery of the cornea, the operator can position the suction ring while confirming (predicting) the position of the periphery of the cornea.

  In the above description, the tomographic imaging unit 71 acquires a tomographic image including at least a part of the eyeball fixing unit and the interface unit. However, the present invention is not limited to this. Any configuration in which the position and shape of the eyeball fixing unit and the like are known on the tomographic image may be used. For example, an illustration showing a part of the eyeball fixing unit or the like may be displayed as a symbol on the tomographic image. Specifically, the control unit 100 acquires the position of the suction ring from the information of the sensor and alignment unit (position detection result), and displays an illustration of the shape imitating the suction ring on the tomographic image. The illustration mimics the shape from the design information of the suction ring. The control unit 100 updates the display based on the sensor position information. The illustration on the tomographic image allows the operator to know the position of the suction ring and facilitates alignment. Similarly, in the case of the interface unit, information on the drive unit and the alignment unit is acquired and displayed on a tomographic image showing an illustration (at least) of the cover glass of the interface unit. A part of the eyeball fixing unit and the interface unit may be displayed as a symbol even if they are included in the tomographic image.

  In the above description, the suction ring and the interface unit are aligned by the operator's operation. However, the present invention is not limited to this. Any configuration may be used as long as each unit can be aligned. For example, the control unit 100 may be configured to identify the position of the patient's eye E based on a tomographic image or the like and adjust the position of the eyeball fixing unit or the like. Specifically, the control unit 100 acquires the position of the suction ring based on the design information of the suction ring unit and the detection result of the sensor in the suction ring. In addition, the position of the ring portion with which the suction ring contacts is acquired from the tomographic image (or predicted from the corneal shape). The control unit 100 is configured to obtain the axis of the patient's eye E and perform alignment and suction operations of the suction ring in the XYZ directions using these pieces of information. Similarly, in the case of the interface unit, the interface unit is based on the cornea (vertex) position of the patient's eye E, the shape and position of the cover glass, and the positional relationship between the cornea and the cover glass (the height of the cover glass). It is set as the structure which performs alignment of Z direction.

  Further, the control unit 100 may be configured to align the XY positions of the eyeball fixing unit and the interface unit (laser irradiation unit). The control unit 100 calculates the difference in the XY direction between the corneal apex position or the pupil center position acquired from the tomographic image and the central axis (optical axis L1) of the eyeball fixation / interface unit. The control unit 100 moves the eyeball fixing unit and the interface unit by controlling the alignment unit so that there is no difference in the calculation results. At this time, the first moving unit is controlled so that the axis of the patient's eye E coincides with the central axis.

  In the above description, the moving image of the tomographic image is displayed on the monitor. However, the present invention is not limited to this. The control unit 100 may be configured to be able to perform monitoring when aligning the eyeball unit or the like. The taken tomographic image may be processed internally. In this case, the control unit 100 functions as a monitoring unit.

  In the above description, the tomographic imaging unit 71 is configured to use an interference optical system, but is not limited thereto. It is only necessary to capture depth information and tomographic images of the patient's eye E. For example, a configuration using a Shine proof camera unit may be used.

  In the above description, a tomographic image or the like is used for alignment of the eyeball fixing unit before laser irradiation (before surgery), but is not limited thereto. It is good also as a structure which monitors (confirms) the state of eyeball fixation using a tomogram during laser irradiation (in operation). For example, the control unit 100 is configured to detect the movement of the patient's eye E from the tomogram by image processing. The control unit 100 obtains information on the characteristic portions of the patient's eye E such as the corneal shape and the corneal apex position from the tomographic image. The control unit 100 monitors the position of the feature portion and detects the movement of the feature portion. For example, when the eyeball has moved due to a suction break or the like, the control unit 100 is configured to stop laser irradiation based on the detection result and notify the operator. In such a case, the detection of the suction state can be performed faster than the detection of the suction state using a sensor that monitors the suction pressure of the suction ring. Moreover, it is good also as a structure which detects the change of the patient's eye E from a tomogram etc. not only in an adsorption | suction state, but performs control which correct | amends the laser irradiation (the position) which stops laser irradiation.

  In the above description, at least a part of the eyeball fixing unit and at least a part of the interface unit are reflected in the tomographic image. However, the present invention is not limited to this. Any configuration that allows alignment of the interface unit is sufficient, and a part of the interface unit may be reflected in the tomographic image. Thereby, the positional relationship between the cornea and the interface unit in image display and image processing can be easily obtained.

  In the above description, a part of the eyeball fixing unit and a part of the interface unit are reflected in the tomographic image. However, the present invention is not limited to this. Any configuration capable of aligning the eyeball fixing unit and the interface unit with respect to the cornea may be used. Each unit does not necessarily appear in the tomographic image. The positional relationship between the tomographic imaging unit 71 and the cornea (surface) can be acquired from the captured tomographic image. Therefore, the positional relationship between the cornea (patient eye E) and the eyeball fixing unit is determined using the tomographic image in which the eyeball fixing unit or the like is not reflected by determining the positional relationship between the tomography unit 71, the eyeball fixing unit, and the interface unit. Can be obtained to align each unit.

  In the above description, in the alignment of the eyeball fixing unit and the interface unit using the tomographic image, each unit is fixedly arranged on the apparatus main body. However, the present invention is not limited to this. What is necessary is just the structure which fixes an eyeball with respect to a laser irradiation unit. For example, the eyeball fixing unit may be a unit independent of the device. In this case, the use of a tomographic image or the like in the eyeball fixing operation facilitates positioning of the independent eyeball fixing unit.

  In the above description, the eyeball fixing unit (suction ring) is configured to suck and fix the eyeball by suction, but is not limited thereto. Any configuration that can fix the eyeball is acceptable. For example, an eyeball fixing unit that contacts the eyeball and suppresses the movement of the eyeball may be used.

  In the above description, an ophthalmic laser surgical apparatus including a laser beam is taken as an example, but the present invention is not limited to this. Any structure may be used as long as the eyeball of the patient's eye E (patient eye E) is fixed and the eyeball tissue of the fixed patient's eye E is irradiated with laser light for surgery and treatment. For example, it may be an ophthalmic laser surgical apparatus for performing selective trabeculoplasty. In this case, the laser light is a visible light laser or the like, and the size of the laser spot is set to several hundred μm, and the trabecular meshwork at the corner angle E of the patient's eye is irradiated.

  As described above, the present invention is not limited to the embodiment, and various modifications are possible. The present invention includes such modifications within the scope of making the technical idea the same.

DESCRIPTION OF SYMBOLS 1 Ophthalmic laser surgery apparatus 10 1st movement unit 200 2nd movement unit 300 Laser irradiation unit 50 Interface unit 60 Illumination light source 70 Observation optical system 80 Focus adjustment unit 90 Operation unit 100 Control unit 280 Eyeball fixing unit 281 Suction ring

Claims (3)

An ophthalmologist that includes a scanning optical system that three-dimensionally scans laser light emitted from a laser light source and irradiates each target position corresponding to a preset treatment region with laser light to treat a patient's ocular lens Laser surgical device for
The first data set relating to the structure of the patient's eye lens acquired in advance for planning the treatment region including the lens of the patient's eye, which is arranged as a separate housing from the ophthalmic laser surgical apparatus The patient's eye acquired when the first data set acquired by the anterior segment tomography apparatus and the treatment area are planned, and then the treatment with the laser light is performed based on the planned treatment area A second data set relating to the structure of the crystalline lens, the second data set obtained by the anterior segment tomography device provided in the ophthalmic laser surgical apparatus ,
A change that compares the first data set with the second data set to obtain change information of the patient's eye that is at least one of structural change information of the patient's eye and change information of the gaze direction of the patient's eye An ophthalmic laser surgical apparatus comprising an information acquisition unit. A fixation guidance unit for moving the fixation position of the fixation target to be presented to the patient's eye and guiding the fixation direction of the patient's eye;
The gaze direction of the patient eye relative to when the first data set used for planning is acquired by controlling the fixation guiding unit based on the change information of the gaze direction of the patient eye acquired by the change information acquisition unit. 2. The ophthalmic laser surgical apparatus according to claim 1 , further comprising: a control unit that corrects a change in the first and second steps.   A setting unit configured to set the irradiation position of the laser beam based on the treatment area planned based on the first data set and the change information of the patient's eye acquired by the change information acquisition unit; The ophthalmic laser surgical apparatus according to claim 1 or 2.