JP2003111789A - Probe for entoptic illumination and ophthalmic operating instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an ophthalmic operating instrument for inspecting an eyeground during an eyeground operation and also efficiently performing the eyeground operation and an eyeground examination, and also to provide an entoptic illumination probe to be preferably used for the instrument. SOLUTION: A visible laser beam in a wavelength area from green to blue which is outputted from a first laser diode 36 is reduced to be in a safety level with which retina is not damaged through the use of a laser output safety control pat 33. Then the beam is emitted to the inner part of an eye from the entoptic illumination probe 10 which has a fiber shape and has an end worked in a bullet shape. Then the laser beam can be utilized as the illumination light of an FAG, the eyeground is efficiently and reliably examined and an illumination light source and an operating light source are made into one integrated light source part 30. Thus, the eyeground is efficiently and reliably examined by the FAG even in the midst of the operation.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ophthalmic surgical apparatus capable of performing eye examination of a subject during fundus surgery, and is particularly suitable for examination of the retina or choroid by fluorescent fundus imaging. A probe for ophthalmic lighting used,
The present invention relates to an ophthalmic surgery apparatus capable of simultaneously performing inspection and surgery by utilizing this.

[0002]

2. Description of the Related Art Among various diseases in the field of ophthalmology, fundus diseases are mainly caused by vascular abnormalities in the posterior wall of the eyeball, that is, the fundus of the eye, and vascular lesions such as bleeding. Therefore, examination of the fundus is very important in the treatment thereof. Becomes Among them, a fluorescent fundus imaging method is used as one of the most important inspection methods when more accurately inspecting a vascular lesion in the retina or choroid.

In the fluorescent fundus imaging method, a contrast agent that emits fluorescence is injected into a subject (or patient) to circulate the contrast agent in blood vessels. Then, by illuminating the fundus with illumination light having a wavelength corresponding to the contrast agent, the contrast agent circulating in the blood vessel is excited to generate fluorescence (excitation light), and the blood vessel is imaged.

In this test method, the blood vessels of the retina and choroid can be accurately imaged in almost the same state, so that it is possible to examine the state of blood vessels and tissues in detail and to grasp the circulatory dynamics of the retina and choroid. become. Therefore, not only can the fundus be examined accurately, but it can also be used very suitably for the purpose of determining the target site, that is, the site to be operated upon, when operating the retina or choroid.

In recent years, the fluorescent fundus imaging method has made great progress, and as a result, more precise examinations can be carried out for the diagnosis of fundus diseases, and even in photocoagulation, which is important as surgery for fundus diseases, the target site for surgery. Has become an integral part of the decision. However, if vitreous hemorrhage or vitreous opacity occurs, observation of the fundus of the eye is hindered, and thus fundus examination by a fluorescent fundus imaging method cannot be performed before surgery. Therefore, it becomes difficult to determine the site to be operated.

Therefore, conventionally, an operation of removing a bleeding site, turbid substances, etc. from the vitreous body was first performed, and then an image of the fundus was recorded by a fluorescent fundus imaging method, and the operation was performed while observing this image. . Vitreous surgery in this case is performed based on the findings with a surgical microscope, but the findings with a surgical microscope alone may not be sufficient to grasp the avascular zone and new blood vessels. Later, rebleeding may occur in the vitreous cavity and fluorescent fundus imaging may not be performed.

Therefore, in recent years, various techniques have been proposed for clarifying the surgical target site by performing fundus examination during surgery.

[0008] Specifically, for example, Reference 1: JMGoog
e et al (Ophthalmology vol.100, No.8, 1167-1170, 1
993), Reference 2: Kazuyuki Imai et al.
2-796, 1994), Reference 3: H. Terasaki et al.
(Retina vol.19, No.4, 302-308, 1999), etc., fundus examination by fluorescein fluorescence fundus angiography (FAG), and lecture 4: Yoshiaki Kabata et al. Lecture at the 4th Annual Meeting of the Japanese Society of Ophthalmological Surgery 20
4 V-24, held from January 26 to 28, 2001), etc., indocyanine green fluorescence fundus imaging (ICG
A, a technique of performing fundus examination by infrared fluorescence contrast method) during surgery has been proposed.

Further, Document 5: JP-A-6-31976.
Japanese Patent Publication No. 5 has proposed a surgical device which irradiates the fundus of the eye to be examined with light of a plurality of different wavelengths. With this technology,
Since it is possible to guide coagulation laser light for surgery, visible light for visible observation, and infrared laser light for ICGA from a plurality of light sources to the fundus with one optical fiber,
It is possible to perform fundus examination by ICGA during surgery.

[0010]

However, any of the above-mentioned conventional techniques has a problem in that fundus surgery and fundus examination cannot be performed more efficiently.

[0012] Specifically, among the above-mentioned techniques, in the documents 1 to 3, fundus examination by FAG is carried out, but due to the problem of the light source, sufficient fluorescence fundus imaging cannot be performed, and the reliability of the fundus examination is uncertain. Or the operability of surgery is reduced.

In FAG, in order to excite fluorescein as a contrast agent, it is necessary to use visible light in the wavelength range from green to blue as excitation light for contrast (contrast light).
Visible light in this wavelength range is generated by transmitting light from a white light source through an excitation filter. Therefore, the amount of contrast light that illuminates the fundus is reduced, and the fluorescence of fluorescein due to excitation is also weak. Such weak fluorescence can be captured only by a high-sensitivity image pickup tube. Therefore, it may be difficult to clearly observe the entire image of the fundus, and it may not be possible to directly observe the diseased part, so that a sense of distance during surgery may not be grasped.

Similarly, in the lectures 4 and 5 among the above techniques, the fundus examination by ICGA is carried out, but it solves any of the above problems, that is, the problem of contrast light in the fundus examination by FAG. is not. In particular, although infrared laser light is used as the contrast light in these techniques, laser light is used as the contrast light in fundus imaging by FAG because the wavelength region of the contrast light used in FAG has high retinal phototoxicity. Can not. Therefore, the techniques of the above-mentioned lecture 4 and reference 5 cannot be applied to fundus examination during surgery by FAG.

In Reference 3 and Lecture 4 among the above techniques, since the endoscope is used for the fundus examination, the reliability and operability of the fundus examination deteriorate.

That is, the fundus image obtained by the endoscope tends to have a low resolution, and the endoscope has a difficulty in grasping the positional relationship of the surgical target portion, and requires skill in operation technique. Will decrease. Further, since the fundus examination apparatus including the endoscope has a completely different configuration from the surgical microscope, the overall configuration of the apparatus used during surgery becomes large or complicated, which may reduce the operability of surgery. .

Further, in Document 5 among the above techniques, since the intraocular illumination probe using an optical fiber illuminates the inside of the eye, the irradiation area of the contrast light emitted from the tip of the intraocular illumination probe is widened. I can't. Even when the tip of the probe for intraocular illumination is maximally separated from the fundus, the irradiation area of the contrast light does not greatly expand, and the irradiation area of the contrast light that irradiates the fundus is only a dot shape with a radius of several mm. Therefore, the operability of surgery cannot be improved.

In the first place, the fundus examination device and the surgical device are large in size due to the structure of the light source, the optical system, and the light guide system that guides various kinds of light into the eye. This makes it difficult to perform fundus examination. Therefore, usually, the patient has to move between the respective devices, which not only reduces the operability of the examination and the operation on the side of the operator who performs the operation, but also on the side of the patient,
It will be a heavy burden both physically and mentally,
It lacked practicality.

In order to solve this problem, various techniques have been proposed in which the above-described examination and surgery are used in combination, but all of them have sufficient operability for surgery and fundus examination. It has not improved.

The present invention has been made in view of the above problems, and an object thereof is an ophthalmology capable of performing fundus examination during fundus surgery and more efficiently performing both fundus surgery and fundus examination. An object of the present invention is to propose a surgical device and an intraocular illumination probe that is preferably used for this device.

[0020]

The inventors of the present invention have made extensive studies in view of the above-mentioned problems, and as a result, devised the shape of the probe for intraocular illumination to provide a wavelength with high retinal phototoxicity used in fundus examination by FAG. It is possible to use a laser light source as the contrast light (excitation light) of the region, and by using the laser light source as the FAG contrast light, a laser photocoagulation apparatus for fundus surgery is provided, and a fluorescence fundus during surgery. The inventors have uniquely found that they can be applied to an ophthalmologic examination apparatus that can easily and reliably perform imaging, and have completed the present invention.

That is, in order to solve the above-mentioned problems, the probe for intraocular illumination according to the present invention has a fiber-shaped main body made of a material that transmits light.
During ophthalmic surgery, by being inserted through a port opened on the side of the eye to be inspected, in the probe for intraocular illumination capable of emitting light for illuminating the inside of the eye to be inspected from the tip, to the tip. Is characterized in that when the light transmitted from the light source is laser light, a scattering optical section for scattering the laser light is provided.

According to the above construction, since the fiber-shaped intraocular illumination probe has the scattering optical section, it is possible to scatter and irradiate the laser light output from the light source. Therefore, it is possible to reduce the intensity of laser light per unit area. For example, if the laser light is a visible laser light in the wavelength range from green to blue, the irradiation intensity is set to a safety level that is almost free of retinal phototoxicity. The visible laser light can be applied to a wide area in the eye to be inspected. As a result, it can be very suitably used as an intraocular illuminating means especially in the fluorescent fundus imaging method.

In the intraocular illumination probe, it is preferable that the scattering optical portion is formed by processing the tip portion of the main body portion into a bullet shape having a parabolic cross section.

With the above arrangement, since the intraocular illumination probe has a bullet shape, it is possible to irradiate a wide range of laser light emitted from the tip portion (scattering optical portion) and to irradiate visible laser light. The state becomes a concentric circle in which the irradiation intensity decreases from the center toward the periphery. Therefore, not only can a wide range be illuminated, but also a portion to be particularly confirmed can be illuminated brighter.

Further, the ophthalmic surgery apparatus according to the present invention comprises:
In order to solve the above problems, an intraocular illuminating means for illuminating the inside of the eye of the subject, an intraocular observing means for observing the state inside the illuminated eye, and a port opened on the side of the eye to be examined. A probe for photocoagulation to be inserted into the eye through the, and a surgical light source for outputting coagulation laser light to the probe for photocoagulation, and by the probe for photocoagulation with respect to a target site in the eye. In an apparatus for ophthalmologic surgery for performing photocoagulation by irradiating a coagulation laser beam, the intraocular illumination means includes an illumination light source that emits an illumination laser beam as illumination light, and a bullet-shaped tip portion having a parabolic cross section. And has a fiber-shaped intraocular illumination probe, wherein the intraocular illumination probe is inserted into the eye through a port opened on the side of the eye to be inspected, thereby providing an illumination light source. The illumination laser light output from Is adapted to Akira, further,
The illumination light source included in the intraocular illumination means and the surgical light source are integrated as an integrated light source means,
The integrated light source means is provided with a laser output safety control means for reducing the output of the illumination laser light to a safety level that does not damage the retina.

According to the above construction, the probe for intraocular illumination having the scattering optical portion at the tip portion is used, and the laser output safety control means can attenuate the laser light to a safety level. Therefore, it becomes possible to use visible laser light in the wavelength range of green to blue as the illumination light particularly for fluorescein fluorescence fundus imaging (FAG).
As a result, since the fundus examination by FAG can be performed efficiently and reliably, the light source for illumination and the light source for surgery can be integrated as one integrated light source unit as described above.
The fundus examination by FAG can be performed efficiently and reliably even during surgery.

In particular, if fundus examination can be performed during fundus surgery, it is possible to surely determine the target site (surgical site) even when the fundus examination cannot be performed in advance due to bleeding or turbidity in the vitreous body. Instead, it is possible to immediately grasp the influence on the circulatory dynamics during surgery of the retina. As a result, more accurate and efficient fundus surgery can be performed.

In the apparatus for ophthalmic surgery, a visible laser light source that emits visible laser light having a wavelength for exciting fluorescein is used as the illumination light source, and the intraocular observation means includes an eyepiece lens and an objective lens. And a laser light filtering filter for blocking a laser light of a specific wavelength arranged between these lenses, and a high pass filter for blocking a laser light having a wavelength of less than 515 nm is used as the laser light filtering filter. Is preferably provided.

According to the above configuration, the illumination light for FAG is not generated from the white light source through the excitation filter as in the conventional case, but has the wavelength as the excitation light from the beginning. Become. Therefore, it is possible to procure enough excitation light to generate sufficient fluorescence, and the operator (inspector) can visually confirm the fluorescence of fluorescein.

Further, in the above structure, the FAG filter is applied to a protection filter used to protect the eyes of an operator in a general surgical microscope. Therefore, not only the contrast image can be detected by the filtration filter, but also the observation light having a wavelength that adversely affects the eyes of the observer (operator) can be cut by the filtration filter. Moreover, switching of the protection filter and the filtration filter can be minimized. As a result, the operation of the ophthalmic surgery apparatus can be further simplified.

In the above eye surgery apparatus, further,
An infrared laser light source that emits an infrared laser light having a wavelength that excites indocyanine green is preferably used as the illumination light source, and further, the laser light filter has a wavelength of 815n.
It is more preferable that a high-pass filter that blocks a laser beam of less than m is used and that a filter switching unit that switches the high-pass filters is provided.

According to the above arrangement, the ophthalmic surgery apparatus according to the present invention can perform not only FAG but also indocyanine green fluorescence fundus imaging (ICGA). In general, fundus diseases are often caused by vascular lesions of the retina and choroid. Therefore, if fundus examination by ICGA as well as FAG can be performed during surgery as in the above configuration, a wide range of fundus diseases is possible. Therefore, the versatility of the ophthalmic surgery apparatus according to the present invention can be improved.

Further, according to the above construction, since the two types of high-pass filters are switched by the filter switching means,
The operator (device operator) does not need to switch the high-pass filter one by one. As a result, the operation of the ophthalmic surgery apparatus can be further simplified.

In the above ophthalmic surgery apparatus, further,
The integrated light source means has a filter switching control means for activating the filter switching means included in the intraocular observation means based on the type of laser light output from the integrated light source means to switch the high pass filters. It is preferable that

With the above arrangement, the output of the laser light from the integrated light source means and the switching of the high pass filter in the intraocular observation means can be synchronized. Therefore, a more appropriate switching operation can be performed, and the switching operation can be performed at the minimum necessary, so that the operation of the ophthalmic surgery apparatus can be further simplified.

In the ophthalmic surgery apparatus, the integrated light source means uses one argon laser light source.
It is preferable that the visible laser light source and the surgical light source among the light sources for illumination are used together.

According to the above construction, the laser light can be attenuated to a safe level by the laser output safety control unit, so that the retinal phototoxic argon laser light used as the coagulation laser light should be used as the illumination light of the FAG. It is possible to perform fundus examination by FAG efficiently and reliably, and it is possible to reduce the number of members.
Some optical paths can be shared. Therefore, the structure of the integrated light source unit can be simplified and downsized, and the manufacturing cost can be reduced.

In the above-mentioned ophthalmic surgery apparatus, an image pickup means for picking up an intraocular image of the subject obtained by the intraocular observation means, and an image recording means for recording the intraocular image output from the image pickup means, It is preferable to include an intraocular image visualization means having a display means for displaying the intraocular image output from the imaging means or the image recording means.

According to the above arrangement, the result of the fundus examination is imaged and recorded so that it can be visualized so as to be confirmed by the operator, so that the reliability of the fundus examination can be further improved. Further, in particular, in FAG, since visible laser light can be used for illumination, the fluorescence of fluorescein becomes strong, and it is not necessary to use a super-sensitive one as in the conventional case as an image pickup means, and it is possible to use an ordinary high-sensitive light Things will be enough. As a result, the increase in cost can be avoided and
The efficiency and certainty of the fundus examination can be further improved.

The above-mentioned ophthalmic surgery apparatus is provided with a light source control means for controlling the operation of the integrated light source means, and the light source control means is a simultaneous light emission control for simultaneously emitting the illumination laser light and the coagulation laser light. It is preferable to perform any one of switching emission control for switching between the illumination laser light and the coagulation laser light. Further, when the integrated light source means has a light source for infrared illumination, the light source control means,
It is more preferable to perform illumination light switching control for switching between visible laser light and infrared laser light.

According to the above structure, the ophthalmologic surgery apparatus according to the present invention realizes, as the operation modes, the fluorescence fundus imaging alone mode (the FAG alone mode or the ICGA alone mode), the surgery alone mode, and the surgery / fluorescein fundus imaging combined mode. Besides, it is possible to switch between these operation modes with one touch with a single switch. Therefore, it is possible to provide a highly versatile ophthalmic surgical device.

In the ophthalmic surgical apparatus, the visible
The wavelength of visible laser light output from the laser light source is 4
88 nm and 512 nm and professional for intraocular illumination
The irradiation intensity of the visible laser light source emitted from the probe
0.22 mW / cm at the fundus surface of the eye²To be
Very preferred, emitted from the infrared laser source
The wavelength of the infrared laser light is 790 nm, and
Irradiation of infrared laser light source emitted from the illumination probe
The intensity is 0.22 mW / cm on the fundus surface of the eye to be examined. ²Below
It is highly preferred to have

According to the above construction, when the laser light has the above wavelength, the irradiation intensity at the time when the laser light is emitted from the intraocular illumination probe into the eye and reaches the surface of the fundus as the irradiation target. By setting it to 0.22 mW / cm ² or less, it is possible to achieve a safety level in which the retinal phototoxicity of the laser light is sufficiently reduced. Therefore, if this safety level is determined in advance and the setting of the laser output attenuation in the laser output safety control means is set as this safety level, the laser light can be easily and surely used as the illumination light (excitation light) during fluorescence fundus imaging.
Can be used as

In the above ophthalmic surgery apparatus, it is preferable that the light source control means controls the irradiation time of the visible laser light or the infrared laser light to 60 seconds or less.

According to the above construction, it is not preferable to irradiate the fundus with visible laser light for a long time although the retinal phototoxicity is low, but if the irradiation time is within the above time,
The influence of visible laser light on the eye to be inspected can be almost eliminated. As a result, the safety at the time of fluorescent fundus imaging can be further improved.

[0046]

BEST MODE FOR CARRYING OUT THE INVENTION [First Embodiment] The following description will explain a first embodiment of the present invention with reference to FIGS. 1 to 3. The present invention is not limited to this.

The probe for intraocular illumination according to the present invention has a scattering optical section at its tip so that it can be used for fundus examination by fluorescence fundus imaging by scattering and attenuating laser light. The ophthalmic surgery apparatus according to the present invention includes means for attenuating the output intensity of laser light, and uses the intraocular illumination probe.

Therefore, laser light in the wavelength range having retinal phototoxicity can be used as light for fundus examination, and further, the surgical apparatus and the apparatus for fundus examination can be made compact together, and thus fundus surgery. The fundus examination can be performed therein, and both the fundus surgery and the fundus examination can be performed more efficiently.

Specifically, as shown in FIG. 1, the apparatus for ophthalmologic surgery according to the present embodiment has an intraocular illumination probe 1 as shown in FIG.
0, a photocoagulation probe 20, an integrated light source section (integrated light source means) 30, a surgical microscope (intraocular observation means) 40, and an intraocular monitor section (intraocular image visualization means) 50.

The intraocular illumination probe 10 is connected to the integrated light source section 30 by the illumination light guide cable 12, and has a fiber-shaped main body section 11 as shown in FIG. The body 11 is covered with a cannula 13,
Further, a handpiece 14 is provided so as to cover a part of the cannula 13. In addition, the tip of the cannula 13, that is, the end on the side where the main body 11 projects is
A flange portion 15 is formed so as to project outward from the side surface of the cannula 13.

The illumination laser light output from the integrated light source unit 30 is guided to one end (incident end, not shown in FIG. 2) of the main body 11 by the illumination light guide cable 12, and the main body 11 is illuminated. The light is emitted from the other end (emission end / tip). Further, in the intraocular illumination probe 10 according to the present invention, the emission end portion is provided with the scattering optical portion 11a that scatters the emitted light.

As will be described later, the scattering optical section 11a scatters the visible laser light in the wavelength range of green to blue outputted from the integrated light source section 30 and guided to the main body section 11. Therefore, it is possible to reduce the intensity of visible laser light per unit area, it is possible to reduce the retinal phototoxicity of the visible laser light, and to irradiate a wide area in the eye to be examined with visible laser light. Therefore, the fundus examination by fluorescence fundus imaging can be performed more efficiently and reliably.

The specific structure of the main body 11 is not particularly limited as long as it is made of a material that transmits light and has a fiber shape, but a general optical fiber can be preferably used. . Various optical materials used for optical fibers and the like can be preferably used as the material that transmits the light, and the material is not particularly limited, but in the present invention, silicon dioxide (SiO ₂
Quartz) glass is particularly preferably used. Since silicon dioxide glass has the lowest light transmission loss, the visible laser light emitted from the integrated light source unit 30 can be efficiently emitted into the eye to be inspected. Of course, glass components such as various oxides and fluorides may be added to silicon dioxide in order to adjust the refractive index of the main body 11. Further, in order to improve the strength of the main body portion 11, its periphery may be covered with urethane resin, epoxy resin, silicon resin, or the like.

The specific structure of the scattering optical section 11a is as follows.
It is not particularly limited as long as it has a structure capable of scattering at least visible laser light, but it is particularly preferable that the tip end portion (emission end portion) of the main body portion 11 has a parabolic shape as shown in FIG. It has a bullet shape that is processed to have a cross section.

When the intraocular illumination probe 10 has a bullet shape, it can irradiate a wide range of visible laser light emitted from the tip portion (scattering optical portion 11a), and
The irradiation state of the visible laser light is a concentric circle in which the irradiation intensity attenuates from the center toward the periphery. Therefore, there is an advantage that not only a wide range can be illuminated, but also a portion to be particularly confirmed can be illuminated brighter.

Further, by processing the tip of the main body 11 to integrally form the scattering optical portion 11a, it is possible to avoid an increase in the number of members of the intraocular illumination probe 10. Further, as shown in FIG. 1, the intraocular illumination probe 10 is designed to be inserted into the eye to be inspected through the port P ₁ formed on the side of the eye to be inspected, so that the scattering optical unit 11 a is provided in the main body 11. It is possible to avoid the occurrence of an accident such that it is detached from the body and remains in the eye.

Further, the detailed shape of the scattering optical part 11a is not particularly limited as long as the cross section in the direction along the longitudinal direction is parabolic at the tip part of the main body part 11.

The method for processing the tip end portion (emission end portion) of the main body portion 11 into the bullet-shaped scattering optical portion 11a is not particularly limited. Generally, an optical fiber has a two-layer structure of a high refractive index layer called a core layer that transmits light and a clad layer having a low refractive index that surrounds the core layer and reflects light. It suffices to process so that only the removed core layer portion has a bullet shape.

The specific structure of the light guide cable 12 for illumination is not particularly limited, and a general optical fiber can be used. The size, material, etc. are not particularly limited, and silicon dioxide glass may be used as in the case of the main body 11.

The specific structure of the cannula 13 is not particularly limited, and various cannulas used in the medical field can be preferably used. In this embodiment, a general stainless steel cannula (for example, having a diameter of 21G) is used. Also, the above handpiece 1
The specific configuration of 4 is not particularly limited as long as it is easy to grasp the intraocular illumination probe 10 during fundus examination or surgery. In the present embodiment, a tubular handpiece made of ABS resin and covering the cannula 13 on the incident end side of the main body 11 can be used.

The specific configuration of the collar portion 15 is not particularly limited, either, and the position on the rear side of the scattering optical portion 11a, for example, the end portion of the cannula 13 on the side where the main body portion 11 projects is ". It may be formed so as to have a “flange” -shaped structure. In the present embodiment, as shown on the right side of FIG. 2, the flange portion 15 having a substantially disc shape is formed.
Are formed. Since the collar portion 15 is provided, the intraocular illumination probe 10 will be described later.
It is possible to avoid a situation in which is excessively pushed into the eyeball.

The flange portion 15 may be integrated with the cannula 13 or may be a separate body from the cannula 13. The material is not particularly limited as long as it has a strength capable of functioning as a stopper of the intraocular illumination probe 10 and does not adversely affect the eye to be examined.

The photocoagulation probe 20 is connected to the integrated light source section 30 by the coagulation light guide cable 22,
Like the intraocular illumination probe 10, it has a fiber shape. The laser light for photocoagulation emitted from the integrated light source unit 30 is guided to one end (incident end) of the photocoagulation probe 20 by the light guide cable for coagulation 22 and the other end (emission end / tip). ) Is to be emitted from.
The specific configuration of the photocoagulation probe 20 is not particularly limited, and it is possible to suitably use an optical fiber dedicated to surgery used in conventionally known photocoagulation surgery.

As shown in FIGS. 1 and 3, the integrated light source section 30 includes a light source control section (light source control means) 31, a filter operation synchronization section 32, a laser output safety control section (laser output safety control means) 33, Argon laser light source (abbreviated as Ar laser in FIG. 1) 34, guide light laser diode (abbreviated as guide in FIG. 1) 35, first laser diode (abbreviated as LD1 in FIG. 1) 36, optical system 3
7, illumination light output switch 23, coagulation light output switch 2
4, an illumination / coagulation changeover switch 25, and a laser output detector 26.

The light source control section 31 is a control means for controlling the operation of the integrated light source section 30. As will be described later, the light source control section 31 controls the emission of laser light from each of the light sources so that fundus examination can be performed during surgery. To do. The specific configuration is not particularly limited, and a general arithmetic control circuit or the like can be preferably used.

The filter operation synchronizing section 32 operates the filter switching section 49 of the surgical microscope 40 to switch the laser light filtering filter 48 into and out of the optical path. This switching control is performed based on the type of laser light emitted from the integrated light source unit 30, as described later. The specific configuration is not particularly limited, and a general arithmetic control circuit or the like can be preferably used. Further, the control circuit may be integrated with the light source control section 31.

The laser output safety control unit 33 reduces the output of various laser lights used for intraocular illumination among the various light sources included in the integrated light source unit 30 to a safety level that does not damage the retina. The specific configuration is not particularly limited, but when the illumination light source is a laser diode, the output of laser light can be reduced by an electric circuit. On the other hand, when the laser light source for intraocular illumination is an argon laser tube, an ND filter can be used.

In the present embodiment, the laser light source for intraocular illumination is the first laser diode 36. When such a laser diode is used as a light source, the maximum output is as low as several tens of mW, the minimum output can correspond to the irradiation intensity of fundus contrast, and there is an advantage that power consumption is low. Therefore, if the first laser diode 36 is used as the illumination light source, the output of the illumination laser light can be controlled only by the electric circuit. Therefore,
The laser output safety control unit 33 in the present embodiment may actually be an arithmetic control circuit that can be integrated with the light source control unit 31, and the display of blocks in FIG. 1 is for explaining the present invention. It is for convenience.

It is more preferable that the laser output safety control section 33 is provided with a white light source 33a having an emission path parallel to the emission path of the laser light. When the laser light as the illuminating light source is not output, the illuminating light for observation can be constantly guided from the white light source 33a to the intraocular illuminating probe 10 from the illuminating light guide cable 12. Therefore, it is possible to more reliably and effectively observe the inside of the eye by the operator's visual observation without fluorescent fundus contrast.

As will be described later, the ophthalmic surgery apparatus according to the present invention can also be used when performing vitrectomy surgery. Here, in general, in vitrectomy surgery without fluorescent fundus imaging, the surgery is performed while illuminating the inside of the eye with white light. Therefore, it is more preferable that the white light source 33a is provided so that the white light can be radiated into the eye as the illumination light without performing the fluorescent fundus imaging. For convenience of explanation, in the block diagram of FIG.
The description of 3a is omitted.

The part where the white light source 33a is provided is not limited to the laser output safety control part 33, of course. However, in the configuration including the laser output safety control unit 33 as in the present invention, the laser output safety control unit 33 is provided with the white light source 33a so as to have an emission path parallel to the emission path of the laser light. It is preferable because the white light can be irradiated into the eye without being attenuated.

When the laser output safety control unit 33 in this embodiment is actually an arithmetic control circuit that can be integrated with the light source control unit 31, the laser output safety control unit 33 is simply parallel to the laser light emission path. The white light source 33a may be independently provided so as to have such an emission path. Therefore, depending on the configuration of the integrated light source unit 30, the white light source 33a may be the laser output safety control unit 3 as in the present embodiment.
The expression "provided in 3" may be an expression for convenience of explanation. The white light emitted from the white light source 33a and the laser light emitted from the laser output safety control unit 33 are switched by the switching mirror 37h and emitted from the intraocular illumination probe 10. .

The argon laser light source 34 is a surgical light source that emits coagulation laser light that is emitted from the tip of the photocoagulation probe 20 to a target site (surgical site) on the fundus in the eye to be examined, and is generally argon. A laser tube can be used.

The argon laser has a particularly strong oscillation line at a green wavelength of about 515 nm and a blue-green wavelength of about 488 nm, and is preferably used as a medical laser for ophthalmology, dermatology and the like. Further, as described in detail in the third embodiment, light in the wavelength range from green to blue also serves as excitation light that excites and fluoresces fluorescein, and thus may be used as contrast light in fluorescein fluorescence fundus imaging. It is possible.

The guide light laser diode 35.
Is an index light source that emits laser light (guide light) as an index that mixes with coagulation laser light (argon laser light) to guide the spot of coagulation laser light to the surgical target site. The specific configuration is not particularly limited as long as it is a laser light source that can emit laser light that can serve as guide light. In this embodiment, about 640
A laser diode that emits laser light having a red wavelength of nm is used.

The first laser diode 36 is the illumination light source (visible laser light source) in the present invention, and for illuminating the visible laser light in the wavelength range of green to blue that excites and fluoresces fluorescein, that is, the inside of the eye. Emits laser light. Since laser light in the wavelength range of 465 nm to 490 nm can be preferably used as the excitation light of fluorescein, the wavelengths of visible laser light in the present embodiment are about 488 nm and about 5 nm.
It is 12 nm. Further, the irradiation intensity on the fundus, that is, the tip portion of the intraocular illumination probe 10 (the scattering optical unit 11
The irradiation intensity when the light is emitted from a) and reaches the fundus surface of the eye to be inspected is 0.22 mW / cm ² or less. The grounds for limiting the numerical value of the irradiation intensity will be described in detail in Examples.

The irradiation intensity on the fundus surface of the eye to be examined will be described. The illumination laser light emitted from the intraocular illumination probe 10 reaches the fundus surface while being scattered. On the retina surface when reaching the retina, the wavelengths of visible laser light are 488 nm and 512 nm, and the irradiation intensity after being emitted from the probe for intraocular illumination is 0.22 mW / cm ² or less on the fundus surface of the eye to be examined. If so, the retina is not damaged. Therefore, when illuminating the inside of the eye, if the irradiation intensity of the illuminating laser light is set within a predetermined range on the fundus surface that is the final illuminated site, it is possible to avoid the influence on the retina due to retinal phototoxicity. Become.

Since the average size of the human eyeball (axial length) is 23 mm, ideally, the output of the illumination laser light when entering the illumination light guide cable 12 is 100.
If mW, the illumination laser light emitted from the intraocular illumination probe 10 inserted into the subject's eye is scattered almost uniformly, and the irradiation intensity on the fundus surface about 20 mm away is 0.
It becomes 22 mW / cm ² .

Therefore, when the intraocular illumination probe 10 is closer to the irradiation plane (fundus surface) than about 20 mm, the irradiation intensity of the illuminating laser light becomes strong, and when it is more than 20 mm away from the irradiation plane (fundus surface), the irradiation is performed. The strength becomes weak. On the contrary, when the irradiation interval of the illuminating laser light is more than about 20 mm, if the intensity of the illuminating laser light when entering into the light guide cable 12 for illumination is increased to more than 100 mW, the required irradiation intensity is the fundus. It becomes possible to scatter and reflect the illumination laser light on the surface.

In the present invention, the irradiation intensity of the illuminating laser light on the fundus surface is set within a predetermined range by performing feedback control that reflects the detection result of the laser output detector 26 in the control by the laser output safety controller 33. is doing.

Here, the fluorescence fundus imaging method performed in this embodiment will be briefly described. With fluorescein angiography,
Applications differ depending on the wavelength of fluorescence emitted from the contrast agent and its characteristics. Specifically, when a blood vessel of the retina is imaged and examined, fluorescein (Fluorescei) is used as a contrast agent.
Fluorescein fluorescein angiography (FAG) using n) as visible light in the green to blue wavelength range as illumination light is particularly suitable. In the present invention, in this FAG, visible laser light in a wavelength range which has not been used at all in the past due to retinal phototoxicity is used as illumination light.

The laser light from each of the above light sources is emitted from the optical system 3
7 is emitted to the outside of the integrated light source unit 30 and is guided to the intraocular illumination probe 10 and the photocoagulation probe 20 by the illumination light guide cable 12 and the coagulation light guide cable 22.
The fundus of the eye to be examined is irradiated.

In this embodiment, the optical system 37 includes
A lens 37a that collects the coagulated laser light emitted from the argon laser light source 34, a lens 37b that collects the guide light emitted from the guide light laser diode 35,
A half mirror (semi-transparent mirror) 37c used to mix the coagulation laser light with the guide light, and a lens 37 for condensing the visible laser light emitted from the first laser diode 36.
d, laser output safety controller 33 or white light source 33a
It includes optical components such as a switching mirror 37h for switching the light emitted from the. The specific configurations of these optical components are not particularly limited, and conventionally known configurations can be used. Further, other optical components may be included depending on the shape of the integrated light source unit 30 and the like, or some of the above optical components may not be provided.

As shown in FIG. 1, the argon laser light source 34 and the guide laser diode 35 are arranged so that the optical paths of the laser beams intersect each other substantially vertically, and the half mirror 37c is inclined at the intersection. Is provided. Since the half mirror 37c has a semi-transmissive property, the coagulated laser light incident from the back surface can be directly transmitted and emitted from the integrated light source unit 30.
Further, the half mirror 37c arranged so as to be inclined can reflect the guide light incident from the side in the same direction as the coagulation laser light and emit the guide light from the integrated light source unit 30.
Therefore, the guide light can be mixed with the coagulation laser light by the half mirror 37c.

The illumination light output switch 23 and the coagulation light output switch 24 are both start switches for outputting the illumination laser light or the coagulation laser light from the integrated light source section 30. Lighting / coagulation changeover switch 2
Reference numeral 5 is for switching the type of laser light emitted from the integrated light source unit 30, and in other words, it is also a mode switching means for switching various operation modes of the apparatus for ophthalmologic surgery according to the present embodiment. The configuration of each of these switch means is not particularly limited, and conventionally known general switches can be used.

The laser output detector 26 is a power sensor for detecting the intensity of the illuminating laser light. By outputting the detection result to the laser output safety controller 33, the output of the illuminating laser light on the fundus surface, that is, the irradiation of the illuminating laser light, is performed. It functions as a calibration device that keeps the intensity constant.

Depending on the subject or patient who undergoes fundus examination or fundus surgery, there are individual differences in the size of the eyeball. Therefore, even if the illumination laser light is emitted from the intraocular illumination probe 10 at a constant irradiation intensity, it is not always possible to illuminate the fundus with an appropriate irradiation intensity at an irradiation interval of about 20 mm. Therefore, it is necessary to calibrate the intensity of the illuminating laser light irradiated to the fundus surface to 0.22 mW / cm ² or less according to the size of the eyeball of the subject (patient) before performing the fluorescent fundus imaging. is there.

Generally, when performing vitreous surgery, the axial length is measured as a preoperative examination. In addition, a surgical instrument using laser light is generally equipped with an intensity meter. Therefore, in the apparatus for ophthalmic surgery according to the present invention, first, the length of the eyeball of the eye to be examined (axial length) is measured, and the irradiation intensity of the illumination laser light is detected by the laser output detection unit 26, and these measurements are performed. The light source control unit 31 displays the result and the detection result.
The output of the illuminating laser light on the fundus surface, that is, the irradiation intensity is made constant by feeding back to the.

It should be noted that the feedback control by the laser output detection unit 26 may be performed only once for one patient before fluorescence fundus imaging or surgery based on the measurement of the axial length of the eye, and is performed during the surgery. No need.

As shown in FIG. 1, the surgical microscope 40 includes an objective lens 41, a variable power lens 42, and a filter section 4.
3, an observation light separation unit 44, an eyepiece lens 45, an imaging mirror 46,
It is equipped with a side-view endoscope 47. The observation light splitting unit 44 is provided with at least a beam splitter 44a, and the observation light from the subject's eye received via the objective lens 41, the magnification varying lens 42, and the filter unit 43 is attached to the eyepiece 45 side.
The image pickup mirror 46 side and the side endoscope 47 side are separated.

With regard to the surgical microscope 40 and each of the above-mentioned members and means constituting the same, a conventionally known configuration can be used except for the filter section 43, and the detailed configuration is not particularly limited. . As shown in FIG. 1, the optical system of the surgical microscope 40 is provided so as to form two optical paths so as to correspond to both eyes of the operator, and for the optical components such as various lenses, the objective lens 4 is used.
Almost all except 1 are provided in two optical paths.

The filter section 43 is the objective lens 41.
And the eyepiece lens 45. In the present embodiment, the objective lens 41 and the variable magnification lens 4
2. The filter unit 43, the observation light separating unit 44, and the eyepiece lens 45 are arranged in this order. This filter unit 43 is
It has a laser light filtering filter 48, a frame 48c, and a filter switching unit 49, and is inserted into the optical path between the objective lens 41 and the eyepiece lens 45, and the laser light filtering filter 48 or the frame 48c. The objective lens 41 and the eyepiece lens 45.
It is designed to be inserted in the optical path between and.

Specifically, the laser light filter 4
When 8 is inserted in the optical path, it blocks light of a specific wavelength (laser light in this embodiment) included in the observation light from the eye to be inspected. On the other hand, in the state where the frame body 48c is inserted in the optical path, the observation light from the eye to be inspected is passed as it is,
It is designed to reach the eyepiece lens 41.

As the laser light filtering filter 48, a high pass filter that cuts off light having a wavelength of less than 515 nm is used in this embodiment. Specifically, the wavelength of laser light that photocoagulates the retina or performs fundus imaging (wavelengths of 515 nm and 488 nm)
If observed as is, the eyes of the operator may be damaged. In a conventional surgical microscope, a protection filter is incorporated in the optical path, and when the eye to be inspected is irradiated with a laser beam, the protection filter is generally inserted in the optical path in conjunction therewith.

The protective filter in this case had a filter characteristic of almost cutting off light having a wavelength of 530 nm or less, since the purpose of the protective filter was to protect the operator's eyes. Here, if the protection filter having such characteristics is directly applied to the FAG, the wavelength peak of the emitted light of fluorescein excited by the illumination laser light is 515n.
Since it is around m, the radiated light due to fluorescence cannot be sufficiently transmitted. Therefore, in the present invention, in order to prioritize the contrast function, the laser filtering filter 48 is set to 515.
A filter having a filter characteristic that cuts light having a wavelength of less than nm is adopted. Thereby, the contrast light can be sufficiently detected, and the laser light having a wavelength that is irritating to the operator's eye can be blocked.

Further, the above laser light filtering filter 48
It is very preferable that the is removed from the state of being inserted in the optical path between the objective lens 41 and the eyepiece lens 45. Therefore, it is very preferable that the frame 48c is provided as described above.

In general, it is difficult to remove the vitreous opacity to the extent that the fundus cannot be seen through by the known treatment technique using laser irradiation. This is because the vitreous body Vb subtly adheres to the retina Re and depending on the intraocular region,
This is because it has a close relationship with. Even if the vitreous body Vb is partially turbid, if it is not completely removed, complications such as retinal detachment may occur after surgery, and therefore it is rarely partially removed. In many surgeries, the retina R
The vitreous body Vb is carefully separated from e, and all vitreous bodies Vb
To remove. Since such a delicate procedure is required in the vitrectomy operation, at present, a dedicated device is required for the vitrectomy.

When performing the vitrectomy operation, it is not necessary to perform fundus imaging. In this case, when the laser light filtering filter 48 is arranged in the optical path of the surgical microscope 40, the laser light filtering is performed. The filter 48 blocks the irradiation of white light, making it difficult for the operator to observe the inside of the eye. Therefore, as described above, it is highly preferable that the laser light filtering filter 48 is adapted to be inserted into or removed from the optical path.

The vitrectomy device is made of metal,
It is a 21 G size probe, and generally has a structure in which the tip has a cutter that rotates at high speed. In this structure, the vitreous body Vb is separated and sucked. Note that, for convenience of explanation, this configuration is referred to as a vitreous body dissection / aspiration type device.

Also in the ophthalmic surgery apparatus according to the present invention, it is very preferable that the apparatus for use in combination with the above-described vitreous body cutting suction type equipment is used together. When performing surgery using this type of equipment, when observing the inside of the eye,
It is easier to see through the eye by using a white light source. In fact
A known vitrectomy / suction type equipment is equipped with a white light source, and a dedicated optical fiber is connected to the white light source.

Therefore, as described above, the white light source 33a
In addition to the laser light filtering filter 48, the filter portion 43 has the same outer shape as the laser light filtering filter 48 as shown in FIG. A frame body 48c having only holes is provided. By this, by appropriately switching the laser light filtering filter 48 and the frame 48c, it becomes possible for the ophthalmic surgery apparatus according to the present invention to use a vitreous body cutting suction type device together.

As shown in FIGS. 1 and 3, the intraocular monitor section 50 includes a CCD camera (imaging means) 51, a recording section (image recording means) 52, a display section (display means) 53, and a monitor control section 54. Is equipped with.

The CCD camera 51 is used for the surgical microscope 4
The intraocular image of the subject's eye obtained from 0 is captured as a digital image via the imaging mirror 46, and the recording unit 52 and the display unit 5
Output to 3. The recording unit 52 records the intraocular image obtained from the CCD camera 51. The display unit 53 is a CCD
The intraocular image output from the camera 51 or the recording unit 52 is displayed. The operation of the intraocular monitor unit 50 is controlled by the monitor control unit 54. Particularly in this embodiment,
As shown in FIG. 3, the monitor controller 54 and the light source controller 3
Since it is possible to input and output control signals with 0,
The operation of the intraocular monitor unit 50 is synchronized with the operation of the integrated light source unit 30. As a result, an intraocular image can be captured and recorded with good timing at the time of fundus examination.

In the present embodiment, the CCD camera 51 may be any one as long as it can capture the fluorescence of fluorescein, and its specific structure is not particularly limited. Particularly, in the present invention, the fluorescence of fluorescein can be made stronger than that of the conventional intraocular examination apparatus for combined use during surgery, so that it is not necessary to use an ultra-sensitive camera, which is advantageous in terms of cost.

The recording section 52 and the display section 53 are not particularly limited, and conventionally known structures can be preferably used. In this embodiment, a known video deck and liquid crystal display are used.

Next, the operation of the ophthalmic surgery apparatus according to this embodiment will be described.

In the above eye surgery apparatus, at least FA
It is possible to take three operation modes: a G-only mode, a surgery-only mode, and a surgery / FAG combination mode. Therefore, in the present embodiment, appropriate surgery can be performed by switching the above operation modes according to the condition of the fundus disease.

Specifically, as shown in FIG.
The structure of the lens is, in order from the cornea Co, the lens Le and the vitreous V.
b, the fundus M, and the fundus M has a multilayer structure in which the retina Re, the choroid Ch, and the sclera Sc are sequentially stacked from the vitreous body Vb side. Here, when the retina Re has a vascular lesion, the retina Re can be inspected by the FAG, but if the vitreous Vb in front of the retina Re has no bleeding or opacity, the retina Re should be inspected by the FAG. However, if there is bleeding or turbidity, FAG
The retinal image is disturbed and the retina Re cannot be inspected.

Therefore, in fundus surgery using the above-mentioned ophthalmic surgical apparatus, (1) when there is no bleeding or turbidity in the vitreous body Vb, fundus examination is performed in the FAG single mode, and then in the single surgery mode. It is only necessary to switch and perform fundus surgery. On the other hand, (2) when the vitreous body Vb has bleeding or turbidity and the fundus examination cannot be performed before the surgery, the fundus examination is performed during the fundus surgery in the combined surgery / FAG mode.

(1) When fundus examination is performed first (1-1) FAG-only mode First, the eye E to be inspected is prepared in advance. That is, as shown in FIG. 1, a surgical contact lens CL is attached to an eye to be inspected, and a hole called a port is formed in a side portion. In the present embodiment, an intraocular pressure holding port (not shown) formed for holding intraocular pressure, an illumination port P1 formed for inserting the intraocular illumination probe 10 into the eye, and photocoagulation Three ports in total including a coagulation port P2 formed for inserting the probe 20 into the eye are formed. In this state, the patient is under general anesthesia.

Next, the illumination / coagulation changeover switch 25 is operated to select the FAG single mode. By this, the first
A visible laser light can be output from the laser diode 36. The operator inserts the intraocular illumination probe 10 into the eye through the illumination port P1. At this stage, the visible laser light is not yet guided into the subject's eye.

The position of the tip of the intraocular illumination probe 10 to be inserted is almost directly below the eyeball insertion hole.
Since the collar portion 15 is provided on the intraocular illumination probe 10, it is possible to avoid the situation where the operator unknowingly pushes the intraocular illumination probe 10 into the eyeball excessively.

Next, a patient (subject) is intravenously injected with a fluorescein injection solution prepared under predetermined conditions under predetermined conditions. Fluorescein is usually 10 after injection
Since it arrives at the central artery of the retina Re in a few seconds, the operator
In accordance with this, the illumination light output switch 23 is operated. In synchronization with this, in the filter unit 43, the frame body 48c inserted in the optical path is switched to the laser filtration filter 48. After that, the visible laser light as the illuminating laser light is output from the integrated light source unit 30 and emitted from the intraocular illumination probe 10 into the eye to illuminate the fundus M. At the same time, an intraocular image is captured and recorded by the intraocular monitor unit 50. The timing for illuminating the fundus M with the illumination laser light may be determined using a timer or the like.

In this state, the first laser diode 3
The visible laser light of medium power output from 6 is attenuated to a safe level without retinal phototoxicity by passing through the laser output safety control unit 33, and the light guide cable for illumination 1
The light is emitted from the tip portion of the intraocular illumination probe 10 into the eye via the lens 2. Here, as described above, since the scattering optical section 11a integrated with the main body section 11 is provided at the tip of the intraocular illumination probe 10, a low-output visible laser attenuated to a safe level. Light is scattered in the eye.

Therefore, it is possible to irradiate a wide range of the fundus M with the visible laser light, and the output of the visible laser light is attenuated to a sufficiently safe level by the scattering by the scattering optical section 11a. Therefore, it is possible to illuminate the inside of the eye while avoiding a situation in which the retina Re is damaged.

Moreover, the first laser diode 36 is
The visible laser light output from the device is not generated from a white light source through an excitation filter as in the conventional case, but has a wavelength as excitation light from the beginning. Therefore, it is possible to procure enough excitation light to generate sufficient fluorescence, and the operator (inspector) can visually confirm the fluorescence of fluorescein.

Furthermore, in the surgical microscope 40, the filter portion 43 can cut the observation light of a wavelength that adversely affects the eyes of the observer (operator). Therefore, it is possible to more accurately and surely grasp the surgery target site. Further, when the fluorescence is strong as described above, the intraocular monitor unit 50 does not need to use a conventional super-sensitive imaging unit, and the efficiency and certainty of the fundus examination can be further improved.

Further, in the present invention, the filter for FAG is applied to the protection filter used to protect the eyes of the operator in the general surgical microscope 40. Therefore, in the present embodiment, it is not necessary to switch the protection filter and the filtration filter, so that the operation of the ophthalmic surgery apparatus can be further simplified. Further, as in (1-2) described later, fundus surgery and fundus examination can be performed concurrently.

Further, the light source control section 31 controls the irradiation time so that the irradiation time of the visible laser light output from the first laser diode 36 is set to 60 seconds or less. It is not preferable to irradiate the fundus M with the visible laser light for a too long time although the retinal phototoxicity is low, but if the irradiation time is within this time, the eye E
This is because it is possible to almost completely eliminate the influence of visible laser light on the laser beam and further improve safety. In addition,
The maximum irradiation time will also be described in the later examples.

When the fundus examination is completed as described above, the operation target site of the fundus M is specifically determined.

(1-2) Single Surgery Mode Next, the operator operates the illumination / coagulation changeover switch 25 to select the single surgery mode. As a result, the coagulation laser light can be output from the argon laser light source 34. The operator extracts the intraocular illumination probe 10 from the eye through the illumination port P1 and inserts the photocoagulation probe 20 into the eye through the coagulation port P2.

Then, the coagulation light output switch 24 is operated while checking the fundus M of the eye E to be examined and the red guide light guided into the eye from the guide light laser diode 35 with the surgical microscope 40. In synchronization with this, after the frame 48c inserted into the optical path in the filter unit 43 is switched to the laser filtration filter 48, the coagulation laser light is output from the argon laser light source 34. afterwards,
Coagulation laser light is emitted from the photocoagulation probe 20 to the operation target site, and the photocoagulation operation is performed.

In this state, the argon laser light source 34
High power coagulation laser light from the half mirror 37c
Even after passing through the optical system 37 such as
Photocoagulation probe 20 via light guide cable 22 for coagulation
The light is emitted from the tip of the eye to the surgical target site in the eye.

Here, the coagulation laser light is an argon laser light, and includes laser light having wavelengths of about 488 nm and about 512 nm, which have retinal phototoxicity, but the surgical microscope 40 is provided with a filter section 43. ing. Therefore, the observation light of less than 515 nm is blocked by the laser light filtering filter 48 switched from the frame 48c, so that the laser light of each of the above wavelengths is also blocked, but the light of other wavelength regions including the guide light is almost excluded. Not cut off. Therefore, the operator can efficiently perform the operation without adversely affecting the eyes.

(2) When fundus examination is performed during surgery (surgery / FAG combined mode) For the preparation for the eye E, see (1-1) above.
The description is omitted because it is the same as the above. Next, the illumination / coagulation changeover switch 25 is operated to select the surgery / FAG combination mode. As a result, the argon laser light source 3
The coagulation laser light can be output from 4 and the visible laser light can be output from the first laser diode 36. The operator inserts the intraocular illumination probe 10 through the illumination port P1 and the photocoagulation probe 20 through the coagulation port P2 into the eye.

Then, the bleeding site and the cloudy site in the vitreous body Vb are removed by using the above-described vitreous body cutting and suction type equipment.
Thereafter, a patient (subject) is intravenously injected with a fluorescein injection solution prepared under predetermined conditions under predetermined conditions. In accordance with this, the operator operates the illumination light output switch 23 to guide the visible laser light into the eye to illuminate the fundus M for visual observation, and at the same time, the intraocular monitor 50 captures an intraocular image. To record.

As a result, the fundus examination is completed, and the site to be operated on the fundus M is specifically determined. After that, it is not necessary to switch the operation mode, and the coagulation light output switch 2
By only operating 4, it is possible to operate the operation target site by photocoagulation in the same manner as (1-2).

Further, as shown in FIG. 1, if FAG is carried out in parallel with the photocoagulation process, the retina circulatory dynamics during surgery can be confirmed. Therefore, it is possible to immediately understand the influence of the surgery on the retina, and it is possible to more reliably perform the surgery.

As described above, in the apparatus for ophthalmologic surgery according to the present embodiment, the probe for intraocular illumination having the scattering optical section at the tip portion is used, and the retinal phototoxicity of laser light is investigated in advance. Therefore, the laser output safety control unit can attenuate the laser light to a safe level. Therefore, it becomes possible to use laser light as the illumination light of the FAG, and not only can the fundus examination by the FAG be performed efficiently and reliably, but also the illumination light source and the surgical light source can be combined as one integrated light source unit. Therefore, the fundus examination by FAG can be efficiently and reliably performed even during the operation.

In particular, if fundus examination can be performed during fundus surgery, it is possible to reliably determine a target site (surgical site) even when the fundus examination cannot be performed in advance due to bleeding or turbidity in the vitreous body. Instead, it is possible to immediately grasp the influence on the circulatory dynamics during surgery of the retina. As a result, more accurate and efficient fundus surgery can be performed.

Further, in the light source control section provided in the integrated light source section, either the simultaneous light emission control for simultaneously emitting the illumination laser light and the coagulation laser light or the switching light emission control for switching between the illumination laser light and the coagulation laser light is controlled. Therefore, in the ophthalmic surgery apparatus according to the present embodiment, the FA
The G operation mode, the operation operation mode, and the operation / FAG combination mode can be switched with one touch. Therefore, it is possible to provide a highly versatile ophthalmic surgical device.

In the present invention, the irradiation intensity of the illumination laser light may be 0.22 mW / cm ² or less on the fundus surface of the eye to be examined. That is, the upper limit of the irradiation intensity of the illuminating laser light may be 0.22 mW / cm ² , but the lower limit may be an irradiation intensity that excites fluorescein to a visible level, and is not particularly limited. Absent.

The minimum intensity of the laser light for illumination that can excite fluorescein has not been known so far, and the visible level varies depending on the characteristics of the laser light filtration filter, the concentration of fluorescein in blood, and the like. In the present invention, under the condition that the average human axial length is 23 mm and the general intravenous injection amount of fluorescein is 0.07 ml / kg, the light exposure concentration on the retina is 0.1 mW / cm ^2. For example, it is possible to observe the fluorescence of fluorescein with the naked eye.

[Embodiment 2] The following description will discuss Embodiment 2 of the present invention with reference to FIGS. 4 to 6. The present invention is not limited to this. Further, for convenience of description, description of the same configurations and methods as those described in the first embodiment will be omitted.

In the ophthalmic surgery apparatus according to the first embodiment, fundus surgery and fundus examination by FAG can be performed. In the present embodiment, indocyanine green (Indocyanine Green) is further used as a contrast agent. Also, fundus examination by the indocyanine green fluorescent fundus examination method (ICGA) using near-infrared light as illumination light is also possible.

As described above, the fluorescent fundus imaging method has different applications depending on the wavelength of fluorescence generated from the contrast agent and its characteristics. FAG is a particularly effective method when contrast-enhanced blood vessels of the retina Re are inspected, and ICGA is particularly effective when contrast-enhanced blood vessels of the choroid are inspected.
Generally, in the fundus disease, of the three layers of the sclera Sc, the choroid Ch, and the retina Re existing in the fundus M, the vascular lesion of the sclera Sc is rarely caused, and the vascular lesion of the retina Re or choroid Ch is caused. Often. Therefore, as in the present embodiment, if fundus examination by ICGA as well as FAG can be performed during surgery, a wide range of fundus diseases can be dealt with, and the versatility of the ophthalmic surgery apparatus according to the present invention can be improved. Can be increased.

The ophthalmic surgery apparatus according to this embodiment is
As shown in FIG. 4, an intraocular illumination probe 10, a photocoagulation probe 20, an integrated light source unit 30, a surgical microscope 40, and an intraocular monitor unit 50 are provided, and the basic configuration is the same as in the first embodiment. Is similar to the ophthalmic surgery device in.

Since the specific configurations of the intraocular illumination probe 10, the photocoagulation probe 20, and the intraocular monitor unit 50 are exactly the same as the respective configurations described in the first embodiment, the description thereof will be omitted. To do.

Further, the specific configurations of the integrated light source section 30 and the surgical microscope 40 are basically the same as the respective configurations described in the first embodiment, but different from the first embodiment. Is, as shown in FIG.
0, a second laser diode 38 as an ICGA illumination light source, a filter operation synchronization unit (filter switching control means), and a mirror drive unit 39 are provided, and the filter unit 43 of the surgical microscope 40 has two types. Laser light filter 48 (first filter 4 in FIG. 5)
8a and the second filtration filter 48b) are provided.

Specifically, first, in the integrated light source means 30,
Similar to the first embodiment, the light source control unit 31, the laser output safety control unit 33, the argon laser light source (abbreviated as Ar laser in FIG. 4) 34, the guide light laser diode (abbreviated as guide in FIG. 4) 35, A first laser diode (abbreviated as LD1 in FIG. 1) 36, an optical system 37, an illumination light output switch 23, a coagulation light output switch 24, and an illumination / coagulation changeover switch 25 are provided, and a filter operation synchronization unit 32 and a second laser diode are provided. A laser diode 38 and a mirror drive unit 39 are provided.

The second laser diode 38 is an infrared laser light source according to the present invention, and is an infrared laser light in a wavelength range that excites indocyanine green to cause fluorescence.
That is, it emits illumination laser light for illuminating the inside of the eye. Since the laser light in the wavelength range of 750 nm to 820 nm can be preferably used as the excitation light of indocyanine green, the wavelength of the infrared laser light in the present embodiment is about 790 nm. Further, the irradiation intensity on the fundus M, that is, the intraocular illumination probe 10
The irradiation intensity after being emitted from the distal end portion (scattering optical portion 11a) is 0.22 mW / cm ² or less on the fundus surface of the eye to be inspected (see Examples described later).

The specific configuration of the second laser diode 38 in the present embodiment is preferably a general infrared laser diode and is not particularly limited.

The laser light from each of the light sources is passed through the optical system 37 and the integrated light source section 30 as in the first embodiment.
The light is emitted to the outside, is guided to the intraocular illumination probe 10 and the photocoagulation probe 20 by the illumination light guide cable 12 and the coagulation light guide cable 22, and is irradiated to the fundus M of the eye E to be examined. The specific optical system 37 is also the same as in the first embodiment.
However, in the present embodiment, a laser output safety is achieved by appropriately switching the lens 37e for condensing the infrared laser light output from the second laser diode 38 and the visible laser light and the infrared laser light. A variable mirror 37f for guiding to the control unit 33 is included.

As shown in FIG. 4, the first laser diode 36 and the second laser diode 38 are arranged so that the output portions of the illumination laser light thereof are opposed to each other, and the variable mirror 37f has an inclination angle between them. It is arranged so that it can change. In other words, the optical path starting from each of the above-mentioned illumination light sources is a straight line connecting the output parts of each other, and the variable mirror 37f is provided at the intermediate position. The mirror surface (reflection surface) of the variable mirror 37f is
The variable mirror 37f faces the laser output safety controller 33 side regardless of the inclination angle of the variable mirror 37f. The variable mirror 37f is driven by the mirror drive unit 39 so as to change the tilt angle.

The specific configurations of the variable mirror 37f and the mirror driving section 39 are not particularly limited, and the mirrors and driving means used in various conventionally known optical devices can be preferably used. Further, the present invention is not limited to the optical path configuration including the variable mirror 37f as described above as long as the illumination laser light can be appropriately switched.

The filter operation synchronizing section 32 operates the filter switching section 49 of the surgical microscope 40 to switch between the two types of laser light filtering filters 48 and the frame 48c. The switching control is performed by the integrated light source unit 3 as described later.
It is performed based on the type of laser light or white light emitted from 0. The specific configuration is not particularly limited, and a general arithmetic control circuit or the like can be preferably used. Further, the control circuit may be integrated with the light source control section 31.

Further, in the surgical microscope 40, as in the first embodiment, the objective lens 41 and the eyepiece lens 45 are used.
The filter part 43 is disposed between the two, and in this filter part 43, as shown in FIG. 5, two types of laser light filtering filters 48, that is, a first filtering filter 48a and a second filtering filter 48b, Frame 48
c and a filter switching unit 49 are provided.

As shown in FIGS. 4 and 5, in the present embodiment, a control signal can be output from the filter operation synchronizing section 32 of the integrated light source section 30 to the filter section 43 of the surgical microscope 40. The filter switching unit 49 of the filter unit 43 is appropriately included in the observation light from the eye to be inspected by appropriately switching the first filtering filter 48a or the second filtering filter 48b based on the control signal from the filter operation synchronization unit 32. Blocks light of a certain wavelength.

The above two types of laser light filtering filters 4
Of the eight, as the first filter 48a, a high-pass filter that blocks light with a wavelength of less than 515 nm is used as in the first embodiment. On the other hand, as the second filtration filter 48b, a high-pass filter that blocks light with a wavelength of less than 815 nm is used.

As described above, since the filter switching unit 49 appropriately switches between the two types of laser light filtering filters 48, the operator (operator of the apparatus) does not need to switch the laser light filtering filters 48 one by one. Further, if a control signal can be output from the filter operation synchronization unit 32 to the filter unit 43 of the surgical microscope 40, the output of various laser lights in the integrated light source unit 30 and the laser in the filter unit 43 of the surgical microscope 40 are performed. The switching of the optical filter 48 can be synchronized. Therefore, more appropriate switching operation can be performed, and
The switching operation is the minimum necessary. As a result, the operation of the apparatus for ophthalmologic surgery according to the present embodiment can be further simplified.

Further, as described in the first embodiment, it is not necessary to perform fundus imaging when performing vitrectomy surgery. Therefore, the first and second filtration filters 48
By switching between a and 48b and the frame 48c,
It is highly preferable that these two types of laser light filter 48 can be removed from the optical path.

Next, the operation of the eye surgery apparatus according to the present embodiment will be described.

In the above eye surgery apparatus, at least FA
G only mode, ICGA only mode, surgery only mode,
There are five operation modes: surgery / FAG combination mode and surgery / ICGA combination mode. Therefore, in the present embodiment, appropriate surgery can be performed by switching the above operation modes according to the condition of the fundus disease.

That is, in fundus surgery using the above-mentioned ophthalmic surgery apparatus, (3) fundus examination in at least one of the FAG single mode and the ICGA single mode when there is no bleeding or turbidity in the vitreous body Vb. Then, the fundus surgery may be performed by switching to the surgery-only mode. On the other hand, (4) if the vitreous Vb has bleeding or turbidity and fundus examination cannot be performed before surgery, fundus examination during fundus surgery in at least one operation mode of surgery / FAG combination mode and surgery / ICGA combination mode. Carry out.

(3) When fundus examination is performed first (3-1) Preparation before FAG-only mode surgery is the same as that at the time of surgery in (1) of the first embodiment, and therefore description thereof is omitted. To do. Next, operate the lighting / coagulation changeover switch 25 to
Select the AG only mode. This enables the first laser diode 36 to output visible laser light.

At this time, by the control of the integrated light source unit 30,
The mirror driving unit 39 drives the variable mirror 37f. As a result, as shown in FIG. 4, the mirror surface (reflection surface) has the first laser diode 36 and the laser output safety control unit 33.
The second laser diode 38 faces toward the side and has a back surface.
The tilt angle of the variable mirror 37f changes so as to face the side.

At the same time, under the control of the optical control unit 31, the laser output safety control unit 33 also adjusts the setting so that the visible laser light can be attenuated to a predetermined safety level. Then, the optical control unit 31
Under the control of, the filter operation synchronizing unit 32 outputs a control signal to the filter unit 43 of the surgical microscope 40. The preparation for irradiation with visible laser light is now complete.

Next, the operator inserts the intraocular illumination probe 10 into the eye through the illumination port P1. Then, the patient (subject) is intravenously injected with the injection solution of the fluorescein injection solution prepared under the predetermined conditions under the predetermined conditions.
The operator operates the illumination light output switch 23 in accordance with arrival at the central artery of the retina Re of fluorescein. In synchronization with this, in the filter unit 43, switching from the frame 48c inserted in the optical path to the laser light filtering filter 48 is performed. At this time, the first of the two types of laser light filtering filters 48 is selected. The filter 48a is selected and placed in the observation light path.

In this state, the operator guides the visible laser light output from the integrated light source unit 30 into the eye to illuminate the fundus M and visually confirms it, and at the same time, the intraocular monitor unit 50 captures an intraocular image. To record. At this time, since the irradiation intensity and the irradiation time of the visible laser light are at the safe level, the eye E to be inspected is not adversely affected.

Moreover, at this time, in the surgical microscope 40, the first filtration filter 48 in the filter section 43 is used.
By a, it is possible to cut the observation light of a wavelength that adversely affects the eyes of the observer (operator). Therefore, as in the case of the first embodiment, it is possible to more accurately and surely grasp the surgical target site and further improve the efficiency and certainty of the fundus examination.

Further, in the present invention, the FAG filter is applied to the protection filter used to protect the eyes of the operator in the surgical microscope 40. Therefore, in the present embodiment, switching of the filters can be suppressed to a necessary minimum, and the operation of the ophthalmic surgery apparatus can be further simplified.

(3-2) Preparation before the ICGA single mode operation is the same as that at the time of the operation (1) in the first embodiment, and therefore the description thereof will be omitted. Next, by operating the illumination / coagulation changeover switch 25, I
Select the CGA single mode. This enables the second laser diode 38 to output visible laser light.

At this time, by the control of the integrated light source unit 30,
The mirror driving unit 39 drives the variable mirror 37f. As a result, as shown in FIG. 6, the mirror surface (reflection surface) has the second laser diode 38 and the laser output safety control unit 33.
While facing the side, the back surface is the first laser diode 36.
The tilt angle of the variable mirror 37f changes so as to face the side.

At the same time, under the control of the optical control unit 31, the laser output safety control unit 33 also adjusts the setting so that the infrared laser light can be attenuated to a predetermined safety level. Then, the optical control unit 31
Under the control of, the filter operation synchronizing unit 32 outputs a control signal to the filter unit 43 of the surgical microscope 40. The infrared laser light is now ready for irradiation.

Next, the operator inserts the intraocular illumination probe 10 into the eye through the illumination port P1. Then, the patient (subject) is intravenously injected with an injection solution of indocyanine green injection solution prepared under predetermined conditions. Then, the operator adjusts the illumination light output switch 23 to arrive at the central choroid artery of indocyanine green.
To operate. In synchronization with this, the second filtering filter 48b is selected from the two types of laser light filtering filters 48 and is switched to the frame 48c inserted in the optical path. After that, the infrared laser light output from the integrated light source unit 30 is guided into the eye to illuminate the fundus M, and the intraocular image is captured and recorded by the intraocular monitor unit 50.

At this time, the light source control section 31 controls the irradiation time of the infrared laser light output from the second laser diode 38 to be 60 seconds or less, like the visible laser light. . by this,
The influence of the infrared laser light on the eye E to be examined can be almost eliminated, and the safety can be further improved. It goes without saying that the irradiation intensity of infrared laser light is also at the above-mentioned safety level.

Further, in the surgical microscope 40, the second filtering filter 48b in the filter section 43 can cut the observation light of a wavelength that adversely affects the eyes of the observer (operator). Therefore, the fundus examination by ICGA can also perform the fundus examination efficiently and surely like the fundus examination by FAG, and can grasp | ascertain a surgery target site more correctly and reliably.

When the fundus examination is completed as described above, the target site of the fundus M, that is, the surgical site is specifically determined. In addition, the above-mentioned FAG single mode and ICG
The A-only mode may be performed individually, or both may be performed before the surgery-only mode. Further, the order of implementation is not particularly limited, and the FAG single mode may be first and the ICGA single mode may be first.

(3-3) Single operation mode Next, the illumination / coagulation changeover switch 25 is operated to select the single operation mode. As a result, the coagulation laser light can be output from the argon laser light source 34.

At this time, in the integrated light source section 30, the filter operation synchronizing section 32 outputs a control signal to the filter section 43 of the surgical microscope 40 under the control of the light source control section 31.
Now that the preparation for the photocoagulation of the target site by the coagulation laser light is completed, the operator extracts the intraocular illumination probe 10 from the illumination port P1 from the eye, and the coagulation port P2 is used for the photocoagulation. The probe 20 is inserted into the eye.

Then, while confirming the fundus M of the eye E to be examined and the red guide light guided from the guide light laser diode 35 into the eye with the surgical microscope 40, the photocoagulation probe 20 coagulates the surgical target site. A laser beam is irradiated to perform a photocoagulation operation. Here, of the two types of laser light filtering filters 48, the first filtering filter 4
8a is selected and arranged in the observation optical path of the surgical microscope 40. However, if the fundus examination performed immediately before is based on the FAG single mode, the first filtration filter 48a is already selected and arranged in the filter unit 43. Because
There is no particular need to switch.

The coagulation laser beam is an argon laser beam, and has a retinal phototoxicity of about 488 nm and about 51 nm.
Although it contains laser light having a wavelength of 2 nm, in the filter section 43 of the surgical microscope 40, the first filtration filter 4
8a is selectively arranged. Therefore, since the observation light of less than 515 nm is blocked by the first filtration filter 48a, the laser light of each wavelength is also blocked, but the light of other wavelength regions including the guide light is hardly blocked. Therefore, the operator can efficiently perform the operation without adversely affecting the eyes.

(4) When fundus examination is performed during surgery (4-1) Surgery / FAG combination mode Preliminary preparation for the eye to be inspected is the same as in (1-1) above, and therefore its explanation is omitted. Next, the illumination / coagulation changeover switch 25 is operated to select the surgery / FAG combination mode. As a result, the argon laser light source 34
From the state where coagulation laser light can be output from
The visible laser light can be output from the first laser diode 36. The operator inserts the intraocular illumination probe 10 through the illumination port P1 and the photocoagulation probe 20 through the coagulation port P2 into the eye.

At this time, similarly to (3-1) above, the mirror driving section 39 drives the variable mirror 37f under the control of the light source control section 31, and as shown in FIG.
While changing the inclination angle of f, the laser output safety control unit 33 adjusts the setting so that the visible laser light can be attenuated to a predetermined safety level.

Then, the bleeding site and the cloudy site in the vitreous body Vb are removed by using the above-described vitreous body cutting and suction type equipment.
Thereafter, a patient (subject) is intravenously injected with a fluorescein injection solution prepared under predetermined conditions under predetermined conditions. The operator operates the illumination light output switch 23 in accordance with this. In synchronization with this, in the filter section 43 of the surgical microscope 40, the first filtration filter 48a is selected and inserted into the optical path. After that, the operator guides the visible laser light into the eye, illuminates the fundus M, and visually observes it.
An intraocular image is captured and recorded by the intraocular monitor unit 50.

Thus, the fundus examination is completed, and the target site of the fundus M, that is, the site to be operated, is specifically determined.
After that, it is not necessary to switch the operation mode, and only by operating the coagulation light output switch 24, the operation target site can be operated by photocoagulation in the same manner as (3-3).

(4-2) Surgery / ICGA Combined Mode In this operation mode, the tilt angle of the variable mirror 37f is changed by the control of the light source control unit 31 (see FIG. 6), the laser output safety control unit 33 is set, and the operation is performed. Other than the selection of the second filtration filter 48b in the filter unit 43 of the microscope 40, the procedure is the same as in (4-1) above, and therefore its description is omitted.

As described above, also in the ophthalmic surgery apparatus according to this embodiment, the same intraocular illumination probe as in the above-mentioned Embodiment 1 is used, and the laser output safety controller controls the laser light to a safe level. It can be attenuated. Further, in the light source control unit included in the integrated light source unit, similar to the first embodiment, the simultaneous light emission control or the switching light emission control can be performed, and the visible laser light and the infrared laser light are used as the illumination laser light. Therefore, the illumination light switching control for switching these can also be performed.

Therefore, in the apparatus for ophthalmologic surgery according to the present embodiment, the FAG is set as the single mode of the fluorescence fundus imaging method.
In addition to the single mode and ICGA single mode, FAG can be used even in the combined operation / fluorescein fundus imaging mode.
Alternatively, ICGA can be implemented respectively. Therefore, it is possible to provide a highly versatile ophthalmic surgical device.

[Third Embodiment] The third embodiment of the present invention will be described below with reference to FIGS. 7 to 10. The present invention is not limited to this. Further, for convenience of description, description of the same configurations and methods as those described in the first or second embodiment will be omitted.

In the first and second embodiments described above, the integrated light source unit 30 uses the argon laser light source 34 as the light source for coagulation.
The first laser diode 36 is provided as a visible laser light source of the illumination light source and the second laser diode 38 is provided as an infrared laser light source of the illumination light source. However, in the present embodiment, each of these light sources is provided. Among them, one argon laser light source serves as both the light source for coagulation and the visible laser light source.

The apparatus for ophthalmic surgery according to this embodiment is
As shown in FIG. 7, an intraocular illumination probe 10, a photocoagulation probe 20, an integrated light source unit 30, a surgical microscope 40, and an intraocular monitor unit 50 are provided, and the basic configuration is the same as in the first embodiment. This is the same as the ophthalmic surgical device in and. The specific configuration of the surgical microscope 40 is also basically the same as the configuration described in the second embodiment.

The structure of the integrated light source unit 30 in the present embodiment is also basically the same as the structure described in the second embodiment, but as shown in FIGS. 7 and 8, the first laser diode 36 is used. (And guide laser light source 35)
The difference is that is not provided.

Specifically, the first laser diode 36
Is not provided, the argon laser light source 34
The second laser diode 38 and the second laser diode 38 are arranged such that the optical paths of the laser beams intersect each other substantially vertically. Further, a half mirror 37b is provided at the intersection so as to be inclined. Further, on the extension of the optical path from the argon laser light source 34, there is provided a variable mirror 37g for appropriately switching between coagulation laser light and infrared laser light.
The variable mirror 37g is driven by the mirror driving unit 39 like the variable mirror 37f. Further, as the variable mirror 37g, a conventionally known configuration can be used similarly to the variable mirror 37f.

At the position where the variable mirror 37g is arranged, a laser output safety control section 33 and a connection port for the coagulation light guide cable 22 are provided so as to face each other. Therefore, the coagulation laser light and the infrared laser light are
The half mirror 37b to the variable mirror 37g share the same optical path, but when the tilt angle of the variable mirror 37g changes, the coagulated laser light is used as the connection port and the infrared laser light is used as the laser output safety control unit 33. Will lead.

In this embodiment, the argon laser light source 34 is used as a light source for illumination. In general, the minimum output of the argon laser light source 34 is as high as several hundred mW, and therefore the irradiation intensity is too strong for use as a fundus contrast light source. This is the reason why laser light sources are used only in retinal photocoagulators. Therefore, in the present embodiment,
An ND filter is used as the laser output safety control unit 33.

The ND filter is also called a gray filter or a neutral filter and is a filter capable of attenuating the intensity of light without changing the relative spectral distribution of light energy. Therefore, the laser light emitted from the argon gas laser light source 34 can be attenuated only in intensity, and can be used as illumination laser light for illuminating the fundus.

The ND filter as the laser output safety control section 33 in this embodiment is optically and physically inserted in the optical path from the argon laser light source 34 to the light guide cable 12 for illumination, and the output intensity of the laser light is adjusted. As long as it can be attenuated, its configuration and arrangement are not particularly limited.

Next, the operation of the ophthalmic surgery apparatus according to this embodiment will be described.

Also in the above ophthalmic surgery apparatus, as in the second embodiment, at least the FAG single mode, the ICGA single mode, the surgery single mode, the surgery / FAG combined mode,
There are five operation modes, surgery and ICGA combined mode. Therefore, also in the present embodiment, (5) when there is no bleeding or turbidity in the vitreous body Vb, fundus examination is performed in at least one of the FAG single mode and the ICGA single mode, and then the surgery single mode. It is possible to perform fundus surgery by switching to. (6) If there is bleeding or turbidity in the vitreous Vb and fundus examination cannot be performed before surgery, the surgery / FAG combination mode and surgery / I
The fundus examination is performed during fundus surgery in at least one operation mode of the CGA combination mode.

(5) When fundus examination is performed first (5-1) Preparation before FAG-only mode surgery is the same as that at the time of surgery (1) in the first embodiment, and therefore description thereof is omitted. To do. Next, operate the lighting / coagulation changeover switch 25 to
Select the AG only mode. In this case, unlike the second embodiment, the visible laser light can be output from the argon laser light source 34.

At this time, under the control of the integrated light source section 30, the mirror driving section 39 drives the variable mirror 37g. As a result, as shown in FIG. 7, the tilt angle of the variable mirror 37g changes so that the mirror surface (reflection surface) faces the laser output safety control unit 33 side. Further, at the same time, under the control of the optical control unit 31, the laser output safety control unit 33 adjusts the setting so that the visible laser light from the argon laser light source 34 can be attenuated to a predetermined safety level. Then, under the control of the optical control unit 31, the filter operation synchronization unit 32 outputs a control signal to the filter unit 43 of the surgical microscope 40. The preparation for irradiation with visible laser light is now complete.

Next, the operator inserts the intraocular illumination probe 10 into the eye through the illumination port P1. Then, the patient (subject) is intravenously injected with the injection solution of the fluorescein injection solution prepared under the predetermined conditions under the predetermined conditions.
The operator operates the illumination light output switch 23 in accordance with arrival at the central artery of the retina Re of fluorescein. In synchronization with this, in the filter unit 43, the first filtration filter 48a is selected, and the surgical microscope 4 is used instead of the frame 48c.
It is arranged in the optical path of 0. After that, the operator operates the integrated light source unit 3
The visible laser light output from 0 is guided into the eye to illuminate the fundus M for visual confirmation, and the intraocular monitor unit 50
To capture and record the intraocular image.

The visible laser light output from the argon laser light source 34 is the same as the coagulation laser light. However, with an argon laser, a particularly strong wavelength is about 48.
8 nm and about 512 nm, which is a sufficient wavelength for fluorescein to fluoresce. Therefore, the laser output safety control unit 33 only attenuates the visible laser light to a safe level, and the illumination laser light (excitation light) of the FAG is the same as the visible laser light from the first laser diode 36 in the first and second embodiments. ) Can be used as

Therefore, also in the present embodiment, as in the first and second embodiments, it is possible to more accurately and surely grasp the surgical target site, and further improve the efficiency and certainty of the fundus examination. Can be made.

(5-2) Preparation before the ICGA single mode operation is the same as that at the time of the operation (1) in the first embodiment, and therefore the description thereof will be omitted. Next, by operating the illumination / coagulation changeover switch 25, I
Select the CGA single mode. This enables the second laser diode 38 to output visible laser light.

At this time, the mirror driving unit 39 drives the variable mirror 37g under the control of the integrated light source unit 30. As a result, as shown in FIG. 9, the tilt angle of the variable mirror 37g changes so that the mirror surface (reflection surface) faces the laser output safety control unit 33 side. Further, at the same time, under the control of the optical control unit 31, the laser output safety control unit 33 adjusts the setting so that the infrared laser light can be attenuated to a predetermined safety level. Then, the optical control unit 31
Under the control of, the filter operation synchronizing unit 32 outputs a control signal to the filter unit 43 of the surgical microscope 40. The infrared laser light is now ready for irradiation.

Since the subsequent intraocular illumination process of the infrared laser light is the same as (3-2) in the above-mentioned embodiment, its explanation is omitted. The second filtration filter 48b is selected as the laser filtration filter 48 arranged in the observation optical path.

As described above, also in the present embodiment, the fundus examination by ICGA can be efficiently and surely carried out similarly to the second embodiment, and the operation target site can be grasped more accurately and surely. .

When the fundus examination is completed as described above, the operation target site of the fundus M is specifically determined. In the present embodiment also, the FAG single mode and I
The CGA single mode may be performed individually, or both may be performed before the surgery single mode,
The order of implementation is not particularly limited.

(5-3) Surgery-only mode Next, the illumination / coagulation changeover switch 25 is operated to select the surgery-only mode. Also in this case, as in the case of (5-1), the coagulation laser light can be output from the argon laser light source 34.

At this time, under the control of the integrated light source section 30, the mirror driving section 39 drives the variable mirror 37g. As a result, as shown in FIG. 10, the tilt angle of the variable mirror 37g changes so that the mirror surface (reflection surface) faces the connection port side of the light guide cable 22 for solidification. After that, the optical control unit 3
Under the control of 1, the filter operation synchronization unit 32 outputs a control signal to the filter unit 43 of the surgical microscope 40.
This completes the preparation for irradiation with the coagulation laser light.

Since the subsequent photocoagulation process of the operation target site by irradiation of coagulation laser light is the same as (3-3) in the above-mentioned embodiment, the description thereof will be omitted.

The first filtration filter 48a is selected as the laser filtration filter 48 arranged in the observation optical path. Of course, the fundus examination performed immediately before is FAG.
In the case of the single mode, the first filtering filter 48a is already selectively arranged in the filter unit 43, so that it is not necessary to switch it.

(6) When fundus examination is performed during surgery (6-1) Surgery / FAG combination mode Preliminary preparation for the eye to be inspected is the same as in (1-1) above, and therefore its explanation is omitted. Next, the illumination / coagulation changeover switch 25 is operated to select the surgery / FAG combination mode. In this case, only the coagulation laser light can be output from the argon laser light source 34. The operator operates the intraocular illumination probe 10 through the illumination port P1.
The photocoagulation probe 20 is inserted into the eye from the coagulation port P2.

At this time, the laser output safety control unit 33 is controlled by the light source control unit 31 as in (5-1).
Then, the setting is adjusted so that the visible laser light can be attenuated to a predetermined safety level.
In the filter unit 43 of 0, the first filtration filter 48a
However, for the variable mirror 37g, (5-
Similar to 3), as shown in FIG. 10, the inclination angle changes so that the mirror surface (reflection surface) faces the connection port side of the light guide cable 22 for solidification.

Next, the bleeding site and opaque site in the vitreous body Vb are removed using the above-described vitreous body cutting and suction type equipment. Thereafter, a patient (subject) is intravenously injected with a fluorescein injection solution prepared under predetermined conditions under predetermined conditions. When the operator operates the illumination light output switch 23 in accordance with this, the light source control unit 31 causes the light source control unit 31 to perform the same operation as (5-1).
As shown in FIG. 7, the tilt angle of the variable mirror 37g is changed so that the mirror surface (reflection surface) faces the laser output safety control unit 33 side.

Then, the first filtration filter 48a is switched to the frame body 48c, and the intraocular illumination probe 10 is used.
Then, an argon laser (visible laser light) attenuated to a safe level is guided into the eye to illuminate the fundus M for visual observation, and an intraocular image is captured and recorded by the intraocular monitor unit 50.

As a result, the fundus examination is completed, and the site to be operated on the fundus M is specifically determined. After that, it is not necessary to switch the operation mode, and the coagulation light output switch 2
By only operating 4, it is possible to operate the operation target site by photocoagulation in the same manner as (5-3).

(6-2) Surgery / ICGA Combination Mode For the preparation for the eye E to be inspected, refer to (1-1) above.
The description is omitted because it is the same as the above. Next, the illumination / coagulation changeover switch 25 is operated to select the surgery / ICGA combination mode. In this case, the argon laser light source 34
From the state where coagulation laser light can be output from
Infrared laser light can be output from the second laser diode 38. The operator inserts the intraocular illumination probe 10 through the illumination port P1 and the photocoagulation probe 20 through the coagulation port P2 into the eye.

At this time, the laser output safety control unit 33 is controlled by the light source control unit 31 in the same manner as (5-2).
Then, the setting is adjusted so that the infrared laser light can be attenuated to a predetermined safety level.
In the filter unit 43 of 0, the second filtration filter 48b
Is selected. Regarding the variable mirror 37g,
Similar to (5-3), as shown in FIG. 10, the inclination angle changes so that the mirror surface (reflection surface) faces the connection port side of the light guide cable 22 for solidification.

Next, the bleeding site and opaque site in the vitreous body Vb are removed by using the above-described vitreous body cutting and suction type equipment. Then, the patient (subject) is intravenously injected with an indocyanine green injection solution prepared under predetermined conditions under predetermined conditions. When the operator operates the illumination light output switch 23 in accordance with this, the light source control unit 31 causes the mirror surface (reflection surface) to have the laser output safety control unit as shown in FIG. 9 as in (5-2). The tilt angle of the variable mirror 37g is changed so as to face the 33 side.

Then, infrared laser light is guided from the intraocular illumination probe 10 into the eye to illuminate the fundus M for visual observation, and an intraocular image is captured and recorded by the intraocular monitor unit 50.

As a result, the fundus examination is completed, and the site to be operated on the fundus M is specifically determined. After that, by operating the coagulation light output switch 24, the filter unit 43
The second filtration filter 48b is the first filtration filter 48a.
The operation target site can be operated by photocoagulation in the same manner as (5-3).

As described above, the ophthalmic surgery apparatus according to the present embodiment also uses the same intraocular illumination probe as in the first or second embodiment, and the laser output safety controller controls the safety of laser light. It is possible to attenuate to the level. Therefore, it becomes possible to use the argon laser light used as the coagulation laser light as the illumination light of the FAG, and not only can the fundus examination by the FAG be performed efficiently and reliably, but also the number of members can be reduced and some optical paths can be used. Can share. Therefore, the structure of the integrated light source unit can be simplified and downsized, and the manufacturing cost can be reduced.

Although detailed description is omitted, in the first to third embodiments described above, the F
Only the fundus examination by AG or ICGA may be performed. In this case, without using the probe for intraocular illumination that is used by being inserted into the eye in the form of fiber, if an intraocular illumination means of the objective lens type capable of irradiating visible laser light into the eye from the front of the subject's eye is used, Good. Accordingly, the ophthalmic surgery apparatus can be used as an ophthalmic examination apparatus that performs only FAG or ICGA fundus examination.

[0217]

EXAMPLES The present invention will be described in more detail with reference to Examples and FIG. 11, but the present invention is not limited thereto.

Example 1 In the present invention, an argon laser beam used for surgery, that is, a visible laser beam in a wavelength range from green to blue is used as the excitation light of the FAG. Light in this wavelength range has retinal phototoxicity that damages the retina. Therefore, when an argon laser tube is used as a light source for illumination, what is the output level of light in this wavelength range that causes damage to the eyes, but what is the output level below which it is safe? The laser irradiation intensity that did not damage the laser was examined.

First, using the intraocular illumination probe (barret type probe) described in the first embodiment, the light intensity distribution on the retina surface of the eye to be received is measured with a beam view analyzer. As the test subject, a colored rabbit of Dutch species was used.

[0220] Specifically, the lens-vitreous of both eyes was excised from 18 colored rabbits described above under general anesthesia. And about 488 nm and about 5 for one eye
After irradiating an argon laser beam with a wavelength of 12 nm,
The irradiation intensity and irradiation time were arbitrarily changed, and the entire retinal field was irradiated from near the pars plana of the ciliary body with a probe. The other eye was used as a control. Furthermore, changes in retinal function were evaluated by electroretinogram (ERG) by total retinal stimulation.

Recording was performed before irradiation and 7 and 14 days after irradiation, and the latency and amplitude of binocular ERG were compared. Paired-t tes
Tested with t (p <0.05) was considered significant. Also retina nitr
O-blue-tetrazolium (NBT) staining was performed, and the tissue change of photodamage was examined in the free radical active state of the outer segment immediately after irradiation. The irradiation intensity and time were examined from the above-mentioned effects of the laser on the retina.

As a result, the output intensity of the argon laser is 1
There was no difference in postoperative ERG with irradiation of 2 mW for 60 seconds or less. The irradiation intensity of the retinal surface irradiated with the argon laser light showed a concentric distribution, and attenuated toward the periphery.
The intensity was 0.22 mW / cm ² at the strongest central part, and no morphological difference between left and right was observed in NBT staining immediately after irradiation under these conditions. Therefore, it was found that the irradiation conditions of the argon laser in the eye in the present invention were a maximum irradiation intensity of 0.22 mW / cm ² and a maximum irradiation time of 60 sec on the fundus surface of the eye to be examined.

Example 2 In the same manner as in Example 1, 18 colored rabbits were subjected to general anesthesia and the crystalline lens of both eyes was changed.
After excision of the vitreous body, the probe for intraocular illumination (barret type probe) described in the first embodiment is inserted from the pars plana of the eye to be examined, and the entire retina area is irradiated with argon laser light. . At the same time, a commercially available fluorescein sodium injection was intravenously injected to perform FAG. In addition,
The output intensity of the argon laser light was 12 mW, and the irradiation time was 30 sec or less.

[0224] The intensity distribution of the argon laser light on the retinal surface due to the irradiation of the probe for intraocular illumination was examined with a Beam View analyzer (COHERENT). The fundus image was recorded on a video tape recorder using a near infrared sensitive CCD camera.

As a result, the argon laser light was scattered and irradiated onto a wide area of the retina by the probe for intraocular illumination. The intensity distribution of the irradiated argon laser light spread concentrically on the retina surface and attenuated toward the periphery. Further, on the fundus surface of the eye to be examined, even in the strongest central portion, it was 0.22 mW / cm ² as in Example 1. Fluorescein circulating in the retina was excited by the irradiation of an argon laser beam of this intensity and emitted fluorescence.

The fluorescence of fluorescein passed through the laser light filtering filter of the surgical microscope, and as shown in FIG. 11, it was possible to sufficiently capture it as a contrast image with the above CCD camera. In addition, the operation of the operator did not require any particular skill, and the contrast image could be clearly confirmed even with the naked eye.

From these results, as the FAG conditions in the present invention, the results of Example 1 (maximum irradiation intensity of argon laser light: 0.22 mW / cm ² , maximum irradiation time: 60 sec)
In addition to c), the dose of fluorescein is 0.07 ml / kg body weight (in the case of commercially available sodium fluorescein injection), but the characteristics of the CCD camera are near infrared sensitive CCD.
Maximum illuminance 2.0 × 10 ^-4 Lx using a device, S / N ratio 4
It has been found that 8 dB is suitable.

[0228] At present, there is an operation type laser ophthalmoscope (SLO) as the only clinical instrument that uses an argon laser beam as a fundus for irradiation of fundus contrast (medical device approval number 20300BZY00).
69000). SLO scans the fundus with a point light source having a diameter of about 7 μm and emits 60 μW laser light to perform fundus examination by ICGA. Since the technique of the scanning laser microscope is applied to SLO, the method of irradiating the fundus with laser light is different from that of the present invention.

That is, in the scanning laser microscope, the laser light whose beam diameter is expanded by the beam expander passes through two scanners for two-dimensional direction scanning of the sample,
The light is focused once, and a spot is formed on the sample surface through the objective lens. In the case of reflected light such as fluorescence, it returns to the original position along the incident path of the laser light, enters the detection system by the dichroic mirror or the polarization beam splitter, and is displayed on the monitor after being signal processed.

In this SLO, when the irradiation amount of laser light to the retina per second is converted into continuous irradiation amount, it is about 0.3 m.
Although it is W / cm ² , in the present invention, as described above, 0.
It is 22 mW / cm ² . That is, in SLO, the laser light having a light amount of about 1.5 times that of the present invention is irradiated into the eye. Therefore, in the present invention, the irradiation energy amount of the laser light can theoretically be smaller than the irradiation energy amount of the laser light, so that the damage to the retina of the eye to be inspected can be extremely reduced.

Therefore, it is considered that the clinical use of the present invention makes it possible to elucidate the pathological condition of various fundus diseases and to improve the effect of intraoperative treatment, leading to improvement of surgical technique and improvement of results. To be

[0232]

As described above, the apparatus for ophthalmic surgery according to the present invention uses laser light in the wavelength range used for photocoagulation as illumination light (excitation light) for fundus examination by FAG. is there. Further, the probe for intraocular illumination according to the present invention is preferably used in the above-mentioned apparatus for ophthalmologic surgery, and has a fiber shape and a bullet-shaped tip.

As can be seen from the argon laser beam used for surgery, visible laser light in the wavelength range from green to blue had a strong retinal phototoxicity that damages the retina. Therefore, conventionally, no one has paid attention to the use of the laser light in the above wavelength range as the excitation light of the FAG.

However, as a result of earnest studies by the present inventors, by devising the structure of the probe for intraocular illumination as described above and providing the laser output safety control unit for attenuating the laser light, the retinal photocoagulation treatment is performed. It is possible to use the laser light used for the FAG illumination light.
Further, by applying a filtration filter for fluorescence fundus imaging such as FAG to a protection filter for protecting an operator's eye in a surgical microscope, it is possible to perform a fundus imaging examination concurrently with surgery.

Therefore, according to the present invention, in particular, it is possible to appropriately deal with a fundus case in which fluorescent fundus angiography could not be performed before the operation and also to perform fluorescent fundus angiography during the operation. Therefore, it is possible to immediately grasp the influence of the retina and choroid on the circulatory dynamics during surgery.

[Brief description of drawings]

FIG. 1 is an explanatory diagram showing a schematic configuration of an ophthalmologic surgery apparatus according to a first embodiment of the present invention.

FIG. 2 is a partial cross-sectional view (left) showing a schematic configuration of an intraocular illumination probe according to the first embodiment of the present invention, and a front view (right) corresponding to the distal end portion.

FIG. 3 is a block diagram of the ophthalmic surgery apparatus shown in FIG.

FIG. 4 is an explanatory diagram showing a schematic configuration of an ophthalmologic surgery apparatus according to a second embodiment of the present invention, showing a state in which FAG is performed during surgery.

5 is a block diagram of the ophthalmic surgery apparatus shown in FIG. 4. FIG.

FIG. 6 is an explanatory diagram showing a state where ICGA is performed during surgery in the apparatus for ophthalmic surgery shown in FIG.

FIG. 7 is an explanatory diagram showing a schematic configuration of an ophthalmic surgery apparatus according to a third embodiment of the present invention, showing a state in which FAG is being performed.

8 is a block diagram of the apparatus for ophthalmic surgery shown in FIG. 7. FIG.

FIG. 9 is a diagram showing an ICGA of the ophthalmic surgery apparatus shown in FIG.
It is explanatory drawing which shows the state which is implementing.

10 is an explanatory diagram showing a state in which photocoagulation is being performed in the apparatus for ophthalmologic surgery shown in FIG.

FIG. 11 is an image captured by the apparatus for ophthalmic surgery according to the present invention;
It is a contrast image (fundus image) of a papilla blood vessel in the optic nerve of a rabbit.

[Explanation of symbols]

10 Intraocular Illumination Probe (Intraocular Illumination Means) 11 Main Body 11a Scattering Optical Unit 20 Photocoagulation Probe 30 Integrated Light Source Unit (Integrated Light Source Means / Intraocular Illumination Means) 31 Light Source Control Unit (Light Source Control Unit) 32 Filter Operation Synchronous unit (filter switching control means) 33 Laser output safety control unit (laser output safety control means) 34 Argon laser light source (surgical light source / visible laser light source) 36 1st laser diode (illumination light source / visible laser light source) 38th 2 laser diode (infrared laser light source) 40 surgical microscope (intraocular observation means) 41 objective lens 45 eyepiece lens 48 laser light filtering filter 48a first filtering filter 48b second filtering filter 49 filter switching unit (filter switching means) 50 Intraocular monitor (intraocular image visualization means) 51 C CD camera (imaging unit) 52 recording unit (image recording unit) 53 display unit (display unit) E eye to be inspected P1 and P2 ports

─────────────────────────────────────────────────── ─── Continuation of the front page (51) Int.Cl. ⁷ Identification symbol FI theme code (reference) A61F 9/00 511 A61B 3/12 E (72) Inventor Kazuo Nakatsuka 1-7 Takaodai, Oita City, Oita Prefecture 8 F term (reference) 4C082 RA08 RC02 RC09 RE01 RE02 RE17 RE40 RJ06 RL02 RL03 RL13 RL16 RL17

Claims (14)

[Claims] 1. A fiber-shaped main body formed of a light-transmitting material, which is inserted into a side of an eye to be examined through a port opened at the time of an ophthalmologic operation so that the distal end thereof is inserted. In the probe for intraocular illumination capable of emitting light for illuminating the inside of the eye to be inspected from the part, the tip has a scattering optical part that scatters the laser light when the light transmitted from the light source is the laser light. A probe for intraocular illumination, comprising: 2. The probe for intraocular illumination according to claim 1, wherein the scattering optical portion is formed by processing the tip portion of the main body portion into a bullet shape having a parabolic cross section. . 3. Intraocular illumination means for illuminating the inside of the eye of the subject,
Intraocular observation means for observing the inside of the illuminated eye, a photocoagulation probe inserted into the eye through a port opened on the side of the eye to be examined, and a coagulation laser beam on the photocoagulation probe In the apparatus for ophthalmologic surgery for performing photocoagulation by irradiating a coagulation laser beam by the photocoagulation probe to a target site in the eye, the intraocular illumination means is And an illumination light source that emits an illumination laser beam as illumination light, and a fiber-shaped intraocular illumination probe whose tip is processed into a bullet shape having a parabolic cross section. Is adapted to illuminate the inside of the eye with the illumination laser light output from the light source for illumination by inserting the eye into the eye through the port opened on the side of the eye to be examined. For lighting of lighting means Sources and the above surgical light, with are integrated as an integrated light source unit, the integrated light source unit, the output of the illumination laser beam,
An ophthalmic surgical device comprising a laser output safety control means for reducing the safety level to a level that does not damage the retina. 4. A visible laser light source that emits a visible laser light having a wavelength that excites fluorescein is used as the illumination light source, and the intraocular observation means includes an eyepiece lens and an objective lens.
It has a laser light filtering filter arranged between each of these lenses to block a laser light of a specific wavelength. The laser light filtering filter has a wavelength of 515n.
The ophthalmic surgery apparatus according to claim 3, wherein a high-pass filter that blocks laser light of less than m is used. 5. The apparatus for ophthalmologic surgery according to claim 4, wherein an infrared laser light source that emits infrared laser light having a wavelength that excites indocyanine green is used as the illumination light source. . 6. The laser light filter further comprises a high-pass filter for blocking laser light having a wavelength of less than 815 nm, and a filter switching means for switching between the high-pass filters. The apparatus for ophthalmologic surgery according to claim 5, wherein: 7. The integrated light source means operates the filter switching means included in the intraocular observation means based on the type of laser light output from the integrated light source means to operate the high-pass filters. The ophthalmic surgery apparatus according to claim 6, further comprising a filter switching control means for switching. 8. The integrated light source means according to claim 4, wherein one argon laser light source serves as both a visible laser light source and a surgical light source among the illumination light sources. The ophthalmic surgery apparatus according to Item 1. 9. An image pickup means for picking up an intraocular image of the subject obtained by the intraocular observation means, an image recording means for recording the intraocular image output from the image pickup means, and the image pickup means or 9. The ophthalmic surgery according to claim 3, further comprising an intraocular image visualization means having a display means for displaying the intraocular image output from the image recording means. apparatus. 10. A light source control means for controlling the operation of the integrated light source means is provided, and the light source control means is a simultaneous light emission control for simultaneously emitting the illumination laser light and the coagulation laser light, or the illumination laser light. 10. The apparatus for ophthalmologic surgery according to claim 3, wherein any one of switching emission control for switching between a coagulation laser beam and a coagulation laser beam is performed. 11. If the integrated light source means has a light source for infrared illumination, the light source control means performs illumination light switching control for switching between visible laser light and infrared laser light. The ophthalmic surgical device of claim 10, wherein the ophthalmic surgical device comprises: 12. The visible laser light emitted from the visible laser light source has wavelengths of 488 nm and 512 nm, and the irradiation intensity of the visible laser light emitted from the intraocular illumination probe is 0. 22 mW / c
The ophthalmic surgical device according to any one of claims 4 to 11, characterized in that it is m ² or less. 13. The infrared laser light output from the infrared laser light source has a wavelength of 790 nm, and the irradiation intensity of the infrared laser light emitted from the intraocular illumination probe is 0 on the fundus surface of the eye to be examined. The apparatus for ophthalmologic surgery according to claim 5, wherein the apparatus has an intensity of 0.22 mW / cm ² or less. 14. The light source control means performs irradiation time control for setting the irradiation time of the visible laser light or infrared laser light to 60 seconds or less.
The ophthalmic surgery device according to item 1.