CN107095735B - 利用多对弧形激光角膜切口矫正散光的系统及方法 - Google Patents
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Abstract
一种用于减轻或消除具有散光轴的眼睛散光的方法，该方法包括确定眼睛的散光轴；在被散光轴一分为二的眼睛角膜内形成第一组切口。该方法包括在被散光轴一分为二的眼睛角膜内形成第二组切口，第一组切口和第二组切口减轻或消除眼睛的散光。
Description
本申请为申请日2012年3月23日，申请号201280014253.3，发明名称为“利用多对弧形激光角膜切口矫正散光的系统及方法”的发明专利申请的分案申请。
技术领域
本发明涉及用于改进散光矫正外科手术的系统及方法。
背景技术
散光矫正外科手术常用的方法是在眼睛内形成角膜缘松懈切口(LRIs，limbalrelaxing incisions)。如图1所示,LRIs 100通常是在眼睛104的角膜102内形成的成对弧形切口(incisions/cuts)，其中LRIs 100相对于眼睛104的中心106成一个角度，角度范围在约20°～100°之间。图1所示的实例中，角度大约是65°。切口100通常由钻石或其他刀片形成，以致于它们的深度通常是角膜102的厚度的80％到100％，且在眼角膜缘周围约0.5～2mm的范围内。成对的弧形切口100在角膜102内完全对称，且沿着角膜斜轴分布。切口相对于所示的眼周范围形成角度。图1中的点角度("clock"angle)20°沿着散光的斜轴方向。其他标注的角度，如本实例中的65°,是相对于眼睛中心形成的弧角，它与正在治疗的散光的严重程度相关。如图1所示，切口100被散光轴108一分为二。切口的标准深度是角膜缘附近角膜厚度的90％(在某些情况下，或者是标准的约600μm的厚度，这个深度是眼膜缘附近平均角膜厚度的90％)。既可以通过刀片手动形成切口，也可以通过飞秒激光器(femtosecondlaser)自动形成切口。通过飞秒激光器意味着激光的脉冲宽度大约在100～10000fs之间。
通过LRIs 100减轻或消除散光的原理是通过切口100引起角膜102生物力学结构的变化。尤其是，切口100导致角膜表面形状的改变，从而使 得角膜表面沿连接成对弧形切口100的轴线方向的曲率变小(flattening of the curvature)。角膜102的特殊形式和曲率大小是眼内压(intraocular pressure或IOP)施加的外力与收缩胶原纤维(stressedcollagen fibrils)回复力产生的内力之间达到平衡的结果，胶原纤维构成了角膜102的大部分。弧形切口100切割胶原纤维导致切口100在垂直于切口纵向方向(the length of theincision)上弱化(weakening)。这种弱化允许更大的张力或切口后部未受损伤的纤维拉长，从而导致垂直于切口纵向的角膜的曲率变小。
尽管LRIs已被广泛用于矫正残余近视散光，尤其是那些进行了白内障手术的病人，但该方法仅仅只在相对一小部分符合条件的病人身上应用(参考EyeNet Magazine,article 000506,American Academy of Ophthalmology；Nichamin et al,Cataract andRefractive Surgery Today,"Corneal Relaxing Incisions",August,2009)。该方法没有被广泛应用的一个原因在于该方法在矫正散光时的结果是不稳定的(参考Mingo-Botin etal,Journal of Cataract&Refractive Surgery Volume 36,Issue 10,Pages 1700-1708,October 2010；Walter Bethke,Review of Ophthalmology,March2011)。结果不稳定的根源虽然没有被完全理解，但部分原因可能是这几种因素，例如：1)切口深度或形状的变化(由于手术灵敏度的限制等)；2)不同病人角膜的胶原纤维的形状或排列的变化(使得相同的切口对于不同的病人具有不同的效果)；以及3)受到切口影响的角膜长期健康状况，这些切口靠近角膜或完全穿过角膜。
最近，通过固定或深度可变的刀片手动产生切口的方式开始被通过飞秒激光器自动产生切口的方式替代(参考Maxine Lipner,EyeWorld,"What's Ahead,Femtosecondtechnology changing the cataract landscape",201 1-3-248:45:27)。通过使超短激光脉冲聚焦在一个确定好的焦点上，引起焦点处的组织发生膜调节的光致破裂(photodisruption)以产生切口。通过一段连续的脉冲以能够导致所期望的切口形成的方式产生切口。脉冲模式的联合效应会导致目标平面组织撕裂。通过这样的激光可以产生任何复杂的切口形状。飞秒激光器能够产生更加精确，深度更一致的切口，以及产生曲率与所期望的弧形切口更加精确匹配的切口。尽管激光的使用消除了之前提到 的第一种因素，如由于切口精度引起的LRIs临床结果的不稳定，但激光的使用并不能消除其他两种因素，如不同病人角膜胶原纤维的形状或排列有变化以及受到深度切口影响的角膜长期健康。
发明内容
本发明的一方面涉及一种用于减轻或消除具有散光轴的眼睛散光的方法，该方法包括确定眼睛中的散光轴以及在被散光轴一分为二的眼角膜内形成第一组切口。该方法包括在被散光轴一分为二的角膜内形成第二组切口，所述的第一组切口和第二组切口减轻或消除眼睛的散光。
本发明的第二个方面涉及一种给眼睛提供弧形切割图案(arcuate shotpattern)的系统，以减轻由于白内障手术导致的散光，该系统包括一个用于产生激光束的激光治疗仪和用于引导激光及指引激光束施加到眼睛的光学器件，以形成如下：1)在被散光轴一分为二的眼睛角膜内的第一组切口；2)在被所述散光轴一分为二的所述角膜内的第二组切口，所述的第一组切口和第二组切口减轻或消除所述眼睛的散光。
本发明的另一方面在于在通过外科手术减轻或消除散光的过程中，降低不同病人胶原纤维形状不同所导致的效果不稳定情况。
本发明的另一方面在于在角膜形成切口后，改善角膜长期的健康，以及降低外科手术在减轻或消除散光方面效果不稳定的情况。
基于本发明的说明书以及附图公开的内容，本领域技术人员能够想到在实施本发明的过程中可以对实施例和实施方式进行各种变化。本发明的实施例不应理解为对本发明保护范围的限制。
附图说明
图1是描述已知的减轻或消除眼睛散光外科手术方法的示意图。
图2A是根据本发明在角膜形成弧形切口形状以减轻或消除眼睛散光的第一个实施例示意图。
图2B是图2A中一部分角膜的剖视图。
图3是基于角膜有限元分析(finite element analysis，FEA)，比较根据 本发明图2所示的方式和图1所示的方式产生的弧形切口散光矫正系数的图表。
图4A是根据本发明在角膜形成弧形切口形状以减轻或消除眼睛散光的第二个实施例示意图。
图4B是图4A中一部分角膜的剖视图。
图5是根据本发明在角膜形成弧形切口形状以减轻或消除眼睛散光的第三个实施例示意图。
图6是本发明中用于产生LRIs的飞秒激光器系统的方框图。
具体实施方式以及最佳实施例
一般来说，本发明涉及一种减轻或消除眼睛散光的方法。该方法涉及在眼角膜内形成多个切口。既可以通过钻石或刀片手动形成切口，也可以通过激光系统自动形成切口，取决于切口的复杂度。在使用激光系统的实施例中，激光系统通常具有一个激光治疗仪、用于将治疗激光仪产生的激光束传递到眼睛的光学部件以及一种用于提供治疗激光束在角膜内的定位以产生组织切除的弧形区域的特殊模式。这样一种激光系统的实施例如美国专利申请No.12/831,783(申请号)中所描述，该专利的全部内容在此作为本发明的参照。
依据本发明对眼睛104进行外科手术的实施例如图2A所示。尤其是，在眼睛104的角膜102内形成了两组切口200A和200B。切口200A和切口200B相对于轴线114形成镜像，轴线114垂直于散光轴108。200A和200B中的每一个切口都在角膜的靶区范围内(targetvolume of the cornea)，靶区被限定为在角膜102环形截面内的角膜前90％的区域内，通常在离角膜缘0.5～3mm的地方。每一个切口都被包含在与角膜的前表面也就是眼睛的外表面相平行的连续区域内。如图2B所示，每一个切口都在第一共同垂直线212(commonvertical level)开始，通常是角膜的前表面，在第二共同垂直线214结束，尽管也可能选择切口的方向与眼睛轴线平行或其他角度，但切口的方向通常垂直于角膜的表面，只要切点处残存的角膜厚度是临近眼膜缘角膜厚度的约10～20％。如图2B所示，线214与线212基本平行。靶 区限定在线212和线214之间虚线区域(dashed area)内。此外，切口200A和200B被散光轴108平分。
每组弧形切口200A和200B形成角度β，当从瞳孔102的中心106开始计算时，β的范围为20°～100°。如图2A所示，在每一组切口中有3个切口。每个切口的深度大致相等，其深度是角膜厚度的40％～80％。在图2A-B所示的实施例中，其深度是角膜厚度的60％。更进一步，在每一组具体的切口中，相邻的切口彼此分离，距离0.25～1mm。每一组切口中距离瞳孔最远的切口与角膜缘212的距离大约为0.25～0.5mm。
如图3中的表所示，当每一组切口包含3个切口，且切口的深度是角膜厚度的60％，形成的弧度是90°时，散光矫正系数是按照类似于图1所示的切口的两个单一切口所产生的散光矫正系数的90％，其中每个切口的深度是角膜厚度的90％。
需要注意的是，每一组切口可以有两个、三个或更多个切口。在每一组切口有两个切口，切口的深度是角膜厚度的60％时，散光矫正系数是按照类似于图1所示的两个单一切口所产生的散光矫正系数的60％，其中每个切口的深度是角膜厚度的90％。数据如图3所示。
总的来说，相对较浅的一组切口中多对同轴切口能够产生所期望的散光矫正，而且相对于常规的厚度为90％切口来说，能够留下一个更厚，因此结构更加稳固的角膜。
如图4A所示，是图2中所示的相对较浅的多对同轴LRIs 200A,200B的另一种实施方式，采用不连续的LRIs(dashed LRIs)300A,300B中多对同轴切口，每个切口中的每一段的切口深度是角膜厚度的90％。与图2A-B中的连续切口200A,200B相比，不连续LRIs 300A,300B的切口深度更深。需要采用更深的切口的原因是与LRIs200A,200B相比，不连续的切口切割的角膜纤维更少。通过加大不连续LRIs的切口深度以弥补不连续LRIs的不足。
LRIs 300A,300B中被认为有切口被迫位于平行的弧线或直线302,304上，其中每条弧线上有多个切口。每条弧线或直线被包含在一个共同的连续区域内，该区域与角膜的前表面也就是眼睛的外表面相平行。在一条特 定弧线上的相邻切口被空隙306彼此隔开，空隙306的宽度W为0.25～2mm，切口的长度与空隙的宽度差不多。如图4A所示，一条弧线上的空隙306可能与相邻弧线上的切口重叠。但是，在一条特定弧线上的切口长度和空隙可以在一个合适的范围内变化，仍然能够达到同样的效果。与图2B所示的方式类似，图4B中的每一条弧线上的每一个切口都在第一共同垂直线312开始，在第二共同垂直线314结束。而且，切口的深度大约是角膜厚度的80～90％，且形成的角度ψ大约为20°～100°。需要注意的是，在图4B所示的横截面内弧线上的切口是用实线标记的，而没有在图4B所示的横截面内平行弧线上的切口是用虚线标记的。
由于切口是不连续的，图4A-B中的切口无法用手动刀片技术切割出来，但是用飞秒激光器可以很容易地切割出来。由于不连续的切口和连续的未切割角膜组织带，未切割角膜组织带跨过部分的不连续切口前后相连，切口的形状保留了角膜结构完整性。需要注意的是，切口是交错排列的以达到前述的效果。但是，眼内压(IOP)产生的角膜中胶原纤维的张力会引起切口下方未受损伤的纤维收缩或拉长，其收缩或拉长程度与常规的单对完整弧形切口的收缩或拉长程度相同。因此，在减少垂直于切口方向上的角膜曲率(也就是减轻散光)方面的效果与常规LRIs的效果类似，但是对角膜结构的损伤更小。
由于角膜内纤维的局部取向效应，两对或更多对不连续LRIs的交错排列能够引起平均效应(averaging effect)，这种平均效应能够降低结果的不稳定性。如上面提到的，切点区域内角膜胶原纤维的局部取向的可变性引起不同病人切口效果的不同，即使是同样的深度和弧形形状的切口。两对或更多对不连续LRIs的交错排列实际上是在更大的角膜区域内取样(sample)，使得更大区域内的基本随机取向的胶原纤维变得平均。因此降低了角膜曲率改变和散光矫正的不稳定性。角膜内胶原纤维的排列整体上来说具有共同的组织结构，对于分布在角膜各个区域内的纤维来说，这种组织结构具有统计学优先取向。这种大规模的组织结构保证了角膜的强度和基本一致的的厚度，但是在角膜不同小区域内各个纤维的局部取向基本是随机的(参考Nigel Fullwood,"Fibril Orientation and CornealCurvature", Structure,Volume 12(2),pp169-170,February,2004；Richard H.Newtonand Keith M.Meek,"The integration of the corneal and limbal fibrils in thehuman eye",Biophysical Journal,volume 75,pp 2508-2512November,1998)。这种不连续的LRIs因此也消除了前述第二个和第三个因素，这两个因素阻碍了LRIs更广泛的应用。
图5描述了第二种替代实施方式，其中显示了靠近角膜缘的角膜的剖视图。在该实施例中，多对同轴弧形切口600穿过(across)角膜深度垂直交错，每一个弧形切口的深度是角膜厚度的30～60％。换一种方式说，图5中最外层(相当于眼睛的中心)的LRI被包含在第一连续区域，该区域与角膜前表面相平行，其中前表面是眼睛的外表面。最里层的LRI被包含在第二连续区域，该区域与第一连续区域相平行，且距离角膜的前表面更远。中间层LRI在角膜中更深，被包含一个连续区域内，该区域与第一和第二连续区域相平行。连续区域能够形象化成洋葱层。首先将洋葱对半切开，去掉纵向层和大部分内层，只留下最外面三层。第一和第二连续区域类似于洋葱的最外层和临近最外层的那一层。中间层LRI是在这三层洋葱的最里面一层切割的。(因为图仅仅只显示了角膜的一边，穿过角膜与之相对的另一组相关切口没有显示出来。)在图5所示的三对切口的情况下，每一条弧线上的切口都是连续的，由上可知，因此其表现与图2A所示的方式类似。垂直交错排列的多对切口的效果与不连续LRIs的效果类似：由于各个更浅的切口的交错排列，它们可能具有相类似的散光矫正系数，但是对角膜结构完整性的损伤更小。与不连续的LRIs一样，垂直交错排列的LRIs实际上是在更大的角膜区域内取样(sample)，使得更大区域内的基本随机取向的胶原纤维变得平均，因此降低了角膜曲率改变和散光矫正的不稳定性。
在图5的实施例中，不同LRIs的每个切口的深度范围为200～400μm，其中最外层、中间层、最里层LRIs的切口深度可以相同也可以不同。此外，每一层切口之间，如最外层LRI和相邻的中间层LRI之间的间隔约为0.25～1mm。同样的，不同切口层距离表面的深度为0～400μm。每个切口层所形成的角度与图2所示的实施例形成的角度一样。每一组切口的垂直深度都应当超过角膜缘上角膜深度的80％～90％。
需要注意的是，尽管之前的描述涉及到连续环(continuous rings)、不连续环或交错排列环中每一种，但可以预期到将图2、图4、图5实施例中的两种或多种结合起来可以实现本发明的目的。
为了形成图2-5中的弧形形状，图6提供了一种激光系统，该激光系统如美国专利No.12/831,783(申请号)中所描述，该专利的全部全部内容作为本发明的参考。尤其是，该激光系统包括一个激光治疗仪601，该激光治疗仪601能够提供激光束604。激光束应该是短脉冲宽度，结合能量与光束大小一起产生光致破裂(photodisruption)。因此，在本发明中，术语“激光射击(laser shot)或射击(shot)”是指将一个激光束脉冲传递到一个地方，从而导致光致破裂。在本发明中，术语“光致破裂(photodisruption)”实质上是指通过激光将物质转换成气体，这个转换过程伴随着冲击波和空化气泡。术语“光致破裂”通常也称为激光诱导光破裂(Laser Induced Optical Breakdown(LIOB))。尤其是，采用300～2500nm的波长。采用1飞秒到100秒的脉冲宽度。采用1纳焦耳(nanojoule)到1微焦耳的能量。脉冲速率(也称为脉冲重复频率(PRF)和以赫兹计算的每秒脉冲)可以为1KHz到几GHz。一般来说，在商用激光装置中，更低的脉冲速率相当于更高的脉冲能量。各种类型的激光器可以用来引起眼组织的光致破裂，这取决于脉冲宽度和能量密度。因此,公开号为2007/084694 A2和WO2007/084627 A2的美国专利申请公开了这种激光的实施例，这两个专利公开的全部内容在此作为本发明的参考。这些以及其他类似的激光器可以被用作激光治疗仪。在角膜手术中，可以使用在此描述的相同类型的激光治疗仪，选择合适的能量和焦点以进行所期望的手术。
一般来说，传递激光束604到眼睛结构的光学部件应当能够在x,y,z方向上以精准和预先设定的模式提供一系列射击到自然晶状体。Z方向在本发明中是指其轴线相当于眼睛前后(AP)轴线或者与眼睛前后轴线平行的方向。光学部件应该提供一个预先设定的束斑大小，以便与到达需要切割的眼睛结构的能量一起引起光致破裂。
一般来说，用于传递激光束604的控制系统603可以是任何计算机、控制器和/或软件硬件的结合，只要能够选择和控制x-y-z扫描参数和激光发 射。这些部件典型地至少与电路板相关，电路板与x-y扫描仪、z调焦器件和/或激光器接触。控制系统也可以但不必要具有控制系统其它部件以及保存数据、获取数据和进行计算的能力。因此，控制系统可能包含指导激光器产生一个或多个激光射击形状的程序。类似的，控制系统可能能够处理来自于裂隙扫描激光器(slit scanned laser)和/或裂隙扫描激光器系统中一个单独的控制器的数据。
用于传递激光束104的激光光学部件602包括一个扩束望远镜(beam expandertelescope)605，一个z调焦器件606，一个光束组合器607，一个x-y扫描仪608和聚焦光学部件609。还进一步包括继电器光学部件610，摄像光学部件611，光学部件611包括一个变焦的和第一ccd摄像机612。
眼睛的光学图像614，特别眼睛104的自然晶状体615的光学图像是沿着路径613传递的。路径613与激光束604的路径相同，从自然晶状体穿过激光病人界面(laser patientinterface)616，聚焦光学部件609，x-y扫描仪608和光束组合器607。还进一步提供了一个激光病人界面616、结构型光源617和结构型光学摄像机618，包括晶状体。可选择性部署结构型光源与激光光束的路径一样。美国临时专利61/228,457和12/509,021(申请号)公开了在本系统中起作用的病人界面和相关设备的实施例，这两个专利与本发明同一天提交，其公开的全部内容在此作为本发明的参考。
结构型光源(structured source)617可能是一个具有聚焦和结构型光投影光学组件的裂隙灯(slit illumination)，如Schafter+Kirchhoff Laser Macro LineGenerator Model 13LTM+90CM 13LTM+90CM(型号13LTM-250S-41+90CM-M60-780-5-Y03-C-6)或StockerYale Model SNF-501L-660-20-5，也被称为裂隙扫描激光器。在该实施例中，结构型光源617还包括裂隙扫描装置619。
使用裂隙扫描照明光源时，操作过程包括将裂隙光源照在晶状体的一边，拍照，然后移动裂隙光源大约一个裂隙的宽度，再次拍照，重复该过程直到整个晶状体观察完毕。例如，100μm裂隙宽度扫描一个表面为9mm直径的扩大瞳孔需要拍照约90次，使用30Hz帧频的相机时大约花费3秒。为了获得前表面单一而没有重叠的图像，裂隙光源应该和AP轴线有一个角 度，例如，它不应当和AP轴线平行。表面裂隙的角度距离AP轴线大约15～30°。在相机敏感度以内的任何可视的或接近IR波长的光源均可以使用。优先使用低相干长度(Lowcoherence length)的光源以减少斑点噪声。
结构型光源617和结构型摄像机118的安放角度相关。该角度关系可以但不要求满足众所周知的所谓的沙伊姆弗勒条件(Scheimpflug configuration)。结构型光源617连同裂隙扫描装置619以一个角度或许多角度投射一条光线和/或许多光线到眼睛晶状体615。眼睛晶状体615散射的光形成晶状体看到的图像以及在摄像系统618聚焦形成图像。由于相对于摄像机618，眼睛晶状体能够看到很大的角度内的裂隙照明图像，这在摄像机上呈现出一个很大的景深，整个裂隙图像可能不是聚焦在相机上的形状。通过向一个或多个角度倾斜相机，沿着照明平面的图像可能有更清晰的焦点。针对某些情况下无法获得一个更清晰的焦点，本发明进一步提供了算术数据分析装置以使照明结构相对于激光装置更精确定位。
来自于摄像机618的图像被传递到控制器603以进行分析和在操作系统时进一步使用。它们也可能被送到一个单独的处理器和/或控制器，这些处理器或控制器转而与控制器603进行交流。结构型光源617、摄像机618和裂隙扫描装置619包括一种用于确定与激光系统相关的晶状体的位置和轴线的装置。
可以使用其他用于计算角膜位置的系统以替代裂隙激光器，如上述的Scheimpflug摄像系统，美国专利2009/0131921公开了一个基于OCT(光学相干断层扫描(Optical Coherence Tomography))的系统的实施例，用于引导眼科激光。任何这样的系统均可以在本发明中使用。
需要注意的是，图2-5有替代的结构可以被用于形成弧形形状，如美国临时专利No.61/455,178(申请号)和美国专利No.2010/0022995(公开号)公开的激光系统，这两个专利的全部的内容在此作为本发明的参考。此外，关于图6所示的实施例，上述的结构型光源和Scheimpflug摄像机可以被光学相干断层扫描(OCT)所替换，OCT的方式虽然有轻微的差别，但具有同样的功能，即在激光限定的x,y,z坐标系内精确计算眼睛内眼部结构的位置和形状(尤其是前后角膜和晶状体表面)，以得到角膜和晶状体内激光切 口的正确位置。
由上所述，本领域技术人员可以依据本发明内容的思想，在具体实施方式及应用范围上对本发明作各种改动或修改，这些等价形式同样落于本申请所附权利要求书所限定的范围内。
Claims (12)
1.一种用于减轻或消除具有散光轴的眼睛散光的系统，所述系统包括：
在被所述散光轴一分为二的眼睛角膜内形成第一组切口以及在被所述散光轴一分为二的所述眼睛角膜内形成第二组切口的系统，所述的第一组切口和第二组切口减轻或消除所述眼睛散光；
其中所述的第一组切口包括第一连续切口和第二连续切口，所述第一连续切口和所述第二连续切口为弧形切口；其中所述的第一连续切口位于相对于眼睛的中心的最外层，并被包含在第一连续区域内，所述的第一连续区域与角膜前表面相平行，所述的第二连续切口位于相对于眼睛的中心的最里层，并被包含在第二连续区域内，所述的第二连续区域与所述的第一连续区域相平行，且距离所述角膜前表面更远。
2.如权利要求1所述的系统，其中所述的第一组切口包括第一连续切口和第二连续切口，其中所述的第一连续切口和所述的第二连续切口相对于眼睛的中心形成一个共角。
3.如权利要求2所述的系统，其中所述的第二组切口包括第三连续切口和第四连续切口，其中所述的第三连续切口和所述的第四连续切口均相对于所述眼睛的中心形成第二共角，其中所述的共角和所述的第二共角大小相等。
4.如权利要求3所述的系统，其中所述的第三连续切口和所述的第四连续切口被包含在一个与眼睛外表面相平行的连续区域内。
5.如权利要求3所述的系统，其中所述的第三连续切口被包含在所述的第一连续区域内，所述的第四连续切口被包含在所述的第二连续区域内。
6.如权利要求1所述的系统，其中所述的第一组切口实质上是所述的第二组切口相对于一条垂直于所述散光轴的轴线的镜像。
7.如权利要求6所述的系统，其中所述的第一组切口包括第一连续切口和第二连续切口，其中所述的第一连续切口和第二连续切口相对于眼睛的中心形成一个共角。
8.如权利要求7所述的系统，其中所述的第二组切口包括第三连续切口和第四连续切口，其中所述的第三连续切口和第四连续切口均相对于所述眼睛的中心形成第二共角，其中所述的共角和所述的第二共角大小相等。
9.如权利要求8所述的系统，其中所述的第三连续切口和所述的第四连续切口被包含在连续区域内。
10.如权利要求8所述的系统，其中所述的第三连续切口被包含在所述的第一连续区域内，所述的第四连续切口被包含在所述的第二连续区域内。
11.如权利要求1所述的系统，其中所述的第二组切口包括第三连续切口和第四连续切口，其中所述的第三连续切口被包含在所述的第一连续区域内，所述的第四连续切口被包含在所述的第二连续区域内。
12.如权利要求1所述的系统，其中所述的第一组切口包括弧形的第一切口，所述的第二组切口包括弧形的第二切口。
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| CN201610913857.1A Active CN107095735B (zh) | 2011-03-25 | 2012-03-23 | 利用多对弧形激光角膜切口矫正散光的系统及方法 |
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-
2012
- 2012-03-22 US US13/427,149 patent/US10463541B2/en active Active
- 2012-03-23 WO PCT/US2012/030247 patent/WO2012134979A1/en active Application Filing
- 2012-03-23 CN CN201280014253.3A patent/CN103501687B/zh active Active
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- 2012-03-23 CN CN201610913857.1A patent/CN107095735B/zh active Active
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| WO2012134979A1 (en) | 2012-10-04 |
| CN103501687A (zh) | 2014-01-08 |
| US20200170840A1 (en) | 2020-06-04 |
| EP2688461A1 (en) | 2014-01-29 |
| CN107095735A (zh) | 2017-08-29 |
| CN103501687B (zh) | 2016-10-12 |
| US20120296321A1 (en) | 2012-11-22 |
| US10463541B2 (en) | 2019-11-05 |
| EP2688461A4 (en) | 2014-08-27 |
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