DE102015116215B3 - Visualization system for eye surgery - Google Patents

Abstract

An eye surgery visualization system comprises a surgical microscope (2) comprising an optical imaging device (8) for optical imaging of the eye (3) and a first optical coherence tomography (OCT) device (9, 10, 12, 11) for generating first OCT image data (16) of structures of the eye (3), the first OCT image data (16) covering a three-dimensional first object area of the eye (3), a probe (14) insertable into the eye and having a second optical coherence tomography (OCT) device (15, 12, 11) for generating second OCT image data (17) of structures of the eye (3), wherein the second OCT image data (17) comprises a second object region of the Covering (3), which is smaller than the three-dimensional first object area, a display device (6) for displaying an image of the eye (3) comprising an OCT representation of the eye based on at least the first OCT image data (16), and a Control device (5), the ers received in the first and second OCT image data (16, 17) a relative position of the first and second object area, determines an associated with the relative position information and display them on the display device (6) displays.

Description

The invention relates to a visual surgery system for ophthalmic surgery, comprising a surgical microscope with an optical imaging device for optical imaging of the eye and a first optical coherence tomography (OCT) device for generating first OCT image data of structures of the eye, the first OCT image data covering a three-dimensional first object area of the eye, a control device receiving the first OCT image data, and a display device for displaying an image of the eye.

Visualization systems comprising a surgical microscope, which images the eye optically as well as optical coherence tomography are, for example, from US 2014/0 024 949 A1 known. In this image, the stereoscopic images of the microscope are supplemented by OCT image data. These surgical microscopes are used successfully in particular in ophthalmic surgery, because in addition to stereoscopic data of the eye, depth information about the eye and its structures is also obtained.

From the US 2012/0 019 777 A1 Furthermore, a system and a method for the visualization of objects is known, and the US 2012/0 226 150 A1 describes a system and method for the visual detection and identification of clinically important anatomical landmarks for surgical procedures.

Further, in ophthalmic surgery, it is known to integrate OCT imaging systems into probes which are introduced into the eye. The publication Yu H., et al., "Evaluation of microsurgical tasks with OCT-guided and / or robot assisted ophthalmic forceps", Biomedical Optics Express, Vol. 2, January 9, 2015, pp. 457-472, describes the integration of an OCT system into a surgically deployable forceps. Such tweezers provide an OCT image during their use and thus assist a surgeon in ophthalmological surgery.

The invention has for its object to provide a visualization system that provides improved information when used in eye surgery.

The invention is defined in claim 1.

In ophthalmic surgery, procedures are performed on the anterior chamber and / or the retina. Since the anatomical structures of the eye are often transparent or semitransparent and usually very small, such interventions make high demands on the visualization. The invention provides for these requirements an integrated visualization system which provides both by means of a surgical microscope an OCT image of the eye in the three-dimensional first object area and with the aid of the probe a local image in the second object area. The surgical microscope generates by means of the OCT device contactless volume data of the eye, in particular the retina in a large angular range and can therefore be understood as a global visualization of the eye. In contrast, the probe provides intraocular OCT image data from a relatively smaller area, which can be understood as local visualization data. The invention now integrates these two images in such a way that the visualization system produces OCT image data of excellent quality in a non-contact, fast and extensive manner, which also uses information from the global visualization data for the local visualization data. For this purpose, the control device determines the relative position of the two object areas and determines an associated item. This information can be the actual position of the second object area, i. H. the local visualization data, in the first object area, d. H. include the global visualization data. The surgeon then sees where the probe is exactly.

Alternatively or additionally, it is possible in one embodiment to provide a kind of navigation support in that the indication comprises a desired position of the probe, that is, an indication of where the probe should be moved. This target position is based on the global visualization data, i. H. related to the first object area. In particular when the probe is designed as a surgical instrument, such navigation information assists the surgeon and, in particular, facilitates the performance of an ophthalmological surgical procedure. When using the visualization system, during insertion of the probe into the eye, a situation may occur that the second object area is not (yet) within the three-dimensional first object area. Then, of course, the display of the position of the second object area within the first object area is not possible. However, an indication is possible that the second object area is (still) outside the three-dimensional first object area. It is therefore provided for embodiments of the invention that the control device checks whether the second object area lies within the three-dimensional first object area and, if so, represents on the display device an image of the eye which contains the second object area in the three-dimensional first object area shows, and otherwise determines as a relative position that the second object area is outside the three-dimensional first object area.

The relative position of the first object area and the second object area can be determined by the control device determining the position of the probe in the first object area, ie the three-dimensional, global visualization data. This can be accomplished in a particularly simple manner by the control device detecting the probe in the first OCT image data, ie the global visualization data, and determining therefrom the relative position of the first and second object regions. In this determination, it becomes known how the second object area lies relative to the structure of the probe, for example an imaging distance, a plane of a B-scan or other optical data which are relevant in the generation of the second OCT image data.

The first OCT optical device and the second OCT optical device can be formed as completely self-contained OCT systems, i. H. work completely independently of each other in terms of the generation of the OCT image data. However, in order to simplify the visualization system, an embodiment is preferred in which the first and second optical coherence tomography (OCT) devices share a common OCT base unit comprising an OCT radiation source and an OCT detector, in that the first and second optical coherence tomography (OCT) devices are connected to the OCT base unit via an optical switch which selectively connects the OCT base unit to the first or second optical coherence tomography (OCT) device optically connects, wherein the control means drives the optical switch for generating the first and second OCT image data in a multiplex operation.

The feature that the first OCT device or the second OCT device is designed to generate first or second OCT image data, therefore, does not exclude the fact that the two OCT devices have common components and, for example, with regard to the radiation input. and -auskopplung on the eye, for example by suitable optical fibers, distinguish. The common components may also include a scanner to produce a multi-dimensional image. Alternatively, however, it is also possible for one or both OCT devices to have an individual scanner which effects the beam deflection for multidimensional imaging completely independently of or in addition to a scanner contained in the common module.

The second OCT image data may be combined with the first OCT image data to form an overall image. This can contain, for example, in the second object area additional image information obtained by means of the second OCT device of the probe. Alternatively or additionally, the control device can use the second OCT image data to remove a shadow cast by the probe in the first OCT image data from the overall image.

In principle, the information displayed on the display device may in all embodiments also include the image of the eye based on the optical image that is performed with the optical imaging device. Furthermore, the control device can also use this optical image to determine the relative position of the first and second object regions, in that the control device determines the position of the probe on the basis of the optical image and determines therefrom the relative position of the first and second object regions.

The probe can be designed in particular as tweezers, Phakohandstück for cataract surgery, Endoilluminator and / or Retinalaser.

The invention will be explained in more detail with reference to the drawings by way of example. In the drawing shows:

1 a schematic representation of a visualization system for eye surgery,

2 a schematic representation of OCT image data generated by the visualization system and the location of a probe of the visualization system in this generated image data and

3 in a display device of the visualization system of 1 displayed image consisting of two partial images, namely an optical image of a retina of an eye and a cross-sectional view through the retina obtained using the OCT image data.

1 schematically shows a visualization system 1 for eye surgery. It comprises a surgical microscope as the centerpiece 2 , for example, the construction in the mentioned US 2014/0 024 949 A1 can correspond and serves one eye 3 and especially there a retina 4 map. The surgical microscope 2 is from a control unit 5 controlled, and a surgeon can use a stereo viewer 6 Pictures of the eye 3 and in particular the retina 4 see while doing a surgical procedure on the eye 3 performs.

The control unit 5 is connected to corresponding elements of the visualization system via dashed control and data lines and controls the operation of the visualization system.

The surgical microscope 2 forms in a beam path 7 the eye 3 by means of an optical imaging device 8th and produces a stereo image on the stereo 6 is controlled. The stereo viewer 6 can be an optical eyepiece. Alternatively or additionally, the stereo viewer contains 6 an electronic display, the additional information or even one from the optical imaging device 8th recorded image brings to the display.

The beam path 7 is via a beam splitter 9 split and leads to a scanner 10 , About the beam splitter 9 becomes an OCT beam path to the beam path 7 coupled, as is done for example in the cited US-font. A scanner 10 scans the OCT beam over the eye 3 , The scanner 10 is with an optical switch 12 optionally, the scanner 10 or a hand piece to be explained later with an OCT base unit 11 combines. The OCT base unit 11 includes an OCT radiation source 11a , an OCT reference beam path 11b and an OCT detector 11c and is adapted to perform optical coherence tomography according to the SD-OCT, TD-OCT, or SS-OCT principle. Connects the optical switch 12 the optical base unit 11 with the scanner 10 , causes the surgical microscope 2 over the beam splitter 9 through the beam path 7 an OCT volume image of the eye 3 , In this way, an OCT device is through the elements 7 . 9 . 10 . 12 . 11 educated.

The optical switch 12 however, it alternatively allows the OCT base unit 11 with an optical fiber 15 to connect that to a handpiece 13 which leads with a probe 14 connected is. The optical fiber 15 leads up to the probe 14 , The probe 14 may be formed, for example, as tweezers, Phakohandstück, Endoilluminator and / or Retinalaser. She is basically trained in the eye 3 to be introduced. At the end of the probe 14 is over the optical fiber 15 OCT imaging near the probe 14 possible if the optical switch 12 the OCT base unit with the optical fiber 15 combines. In this case, form the elements 15 . 12 . 11 an OCT unit. The imaging in this case is much smaller and can, for example, only a two-dimensional image, ie a B-scan of the field in front of the probe 14 To run. For example, for the probe 14 the construction of the aforementioned article by Yu H., et al., Are used.

The two possible positions of the optical switch 12 are in 1 dotted marked. The upper position, in which the surgical microscope 2 introduces OCT imaging, denoted by A, the lower position of the optical switch 12 in which the OCT imaging via the probe 14 done with B.

In position A of the switch 12 becomes a volume image of the eye 3 won. Such a volume image is known in the art for surgical microscopy and is also referred to as a so-called data cube. It is schematic in 2 as a volume image 16 shown. Was the probe 14 in the eye 3 introduced, this produces a local OCT image in the form of a B-scan 17 , in front of the tip of the probe 14 and the optical fiber ending there 15 when the optical switch is in the B position.

The control unit 5 turns on the switch 12 constantly back and forth between the positions A and B, so that the volume image 16 and the B-scan 17 be generated in a multiplex mode. This change occurs so quickly that for a viewer on the stereobook 6 the information is quasi present at the same time.

3 shows an example of a picture that a viewer can see in the stereo viewer. He sees a retina image 18 in the left part of the display, for example, based on the optical imaging device 8th won. Next is a cutting line 19 drawn along the an OCT sectional image 27 based on the volume image 16 was won. The OCT sectional image 27 shows different depth structures in the area of the cutting line 19 ,

The control unit 5 determines the relative position of the volume image 16 and B-scan 17 and draws the location where the B-scan 17 is obtained as the actual location of this image capture in the retina image. This is in the form of the 3 through a cross 21 entered. The actual location of the point where the B-scan 17 is taken is with a corresponding cross 22 into the retinal section 27 entered. The retinal cut image 27 is additionally the information from the B-scan 17 added. In the presentation of the 3 is an additional cone 28 entered in the other or other information obtained from the B-scan 17 is registered.

The control unit 5 Depending on the operation to be performed, a user may also provide navigation information by, for example, using an arrow 23 in the supervisory image indicates which target position 25 the probe 14 has to be moved. In the retinal section 27 a similar navigation information is entered here as an arrow 24 , In addition, where also the depth of the specified position there 25 recognizable to a user. In this way, the user can use the OCT image information from the volume image 16 recognize the location of the image information obtained there and receives a navigation information that not only the lateral position, but also the distance to object structures, here to the retina 4 , indicates. The navigation information thus allows the probe 14 to guide three-dimensionally exactly.

In a further preferred variant, the control unit fills 5 missing information in the volume image 16 due to shadowing by the probe 14 in the beam path 7 in the volume image 16 is not present, based on the OCT image data, using the probe 14 were won on.

The determination of the relative position of the volume image 16 and B-scans 17 can be done in different ways. So can the controller 5 by suitable image evaluation of the optical image, the position of the probe 14 determine and thus the location of the B-scan 17 , Alternatively or additionally, the control unit 5 the location of the probe 14 in the volume image 16 recognize directly. In another alternative or additional option, the B-scan is correlated 17 to the volume image 16 , so that at matching image information about structures of the eye the location of the B-scan 17 in the volume image 16 is recognized and derived from the relative position and ultimately the navigation support.

Claims (10)

Visualization system for ophthalmic surgery, comprising: - a surgical microscope ( 2 ), which has an optical imaging device ( 8th ) for optical imaging of the eye ( 3 ) and a first optical coherence tomography (OCT) device ( 9 . 10 . 12 . 11 ) for generating first OCT image data ( 16 ) of structures of the eye ( 3 ), wherein the first OCT image data ( 16 ) a three-dimensional first object area of the eye ( 3 ), - a probe insertable into the eye ( 14 ) comprising a second optical coherence tomography (OCT) device ( 15 . 12 . 11 ) for generating second OCT image data ( 17 ) of structures of the eye ( 3 ), the second OCT image data ( 17 ) a second object area of the eye ( 3 ) which is smaller than the three-dimensional first object area, - a display device ( 6 ) for displaying an image of the eye ( 3 ) comprising an OCT representation of the eye based on at least the first OCT image data ( 16 ), - a control device ( 5 ) containing the first and second OCT image data ( 16 . 17 ) receives in the first and second OCT image data ( 16 . 17 ) determines a relative position of the first and second object regions, determines an indication associated with the relative position and displays them on the display device ( 6 ). A visualization system according to claim 1, wherein the control device ( 5 ) checks whether the second object area lies within the three-dimensional first object area and, if so, on the display device an image of the eye (FIG. 3 ), which shows the second object area in the three-dimensional first object area, and otherwise determines as a relative position that the second object area lies outside the three-dimensional first object area. A visualization system according to claim 1 or 2, wherein the indication is a desired position ( 25 ) of the probe ( 14 ) within the first object area and / or navigation instructions ( 23 ) of the probe ( 14 ) within the first object area and / or, if the second object area lies within the three-dimensional first object area, an actual position ( 21 ) of the probe ( 14 ) within the first object area. Visualization system according to one of the above claims, wherein the control device ( 5 ) checks whether the second object area lies within the three-dimensional first object area and, if so, the probe ( 14 ) in the first OCT image data ( 16 ) and determines therefrom the relative position of the first and second object areas. Visualization system according to one of the above claims, wherein the control device ( 5 ) checks whether the second object area lies within the first object area and, if so, the second ( 17 ) with the first OCT image data ( 16 ) and determines the relative position of the first and second object areas. A visualization system according to any one of the preceding claims, wherein the first and second optical coherence tomography (OCT) devices are a common OCT base unit ( 11 ), which is an OCT radiation source ( 11a ) and an OCT detector ( 11c ), share parts ( 9 . 10 . 15 ) of the first and second optical coherence tomography (OCT) devices with the OCT base unit ( 11 ) via an optical switch ( 12 ), which is the OCT base unit ( 11 optionally optically connects to the first or the second optical coherence tomography (OCT) device, wherein the control device ( 5 ) the optical switch ( 11 ) for generating the first and second OCT image data ( 16 . 17 ) in a multiplex mode. A visualization system according to claim 6, wherein the common OCT base unit ( 11 ) an OCT reference beam path ( 11b ) and the first and / or the second optical coherence tomography (OCT) device optical fiber (s) ( 15 ) having (each) an optical path length, wherein the optical path length (s) is / are adapted to an optical path length of the reference beam path. Visualization system according to one of the above claims, wherein the control device ( 5 ) the first and second OCT image data ( 16 . 17 ) to an overall picture ( 27 ). A visualization system according to claim 8, wherein the control means detects one of the probes ( 14 ) in the first OCT image data ( 16 ) using the second OCT image data ( 17 ) in the overall picture ( 27 ) away. Visualization system according to one of the above claims, wherein the probe ( 14 ) is designed as an ophthalmological instrument, in particular as tweezers, phaco handpiece, endo-illuminator and / or retinal laser.

Images