JP2013248303A - Ophthalmic laser surgical apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an ophthalmic laser surgical apparatus capable of suitably fixing an eyeball according to an eye to be operated.SOLUTION: An ophthalmic laser surgical apparatus includes an apparatus body including a laser irradiation optical system, which is an irradiation optical system for irradiating a target position with surgical laser beams, having a moving optical system for moving a laser beam spot three-dimensionally, and operates an eye to be operated, with laser beams through a laser irradiation port provided in the apparatus body. The ophthalmic laser surgical apparatus includes an eyeball fixing unit mounted to the apparatus body; an interface unit disposed inside the eyeball fixing unit and having a light-transmitting optical member that covers at least a part of the cornea of the eye to be operated; and a first alignment unit having a first moving mechanism for moving the optical member in the depth direction of the eye to be operated with respect to the eyeball fixing unit, and aligning the optical member with the eye to be operated, fixed to the apparatus body by the eyeball fixing unit.

Description

  The present invention relates to an ophthalmic laser surgical apparatus for performing surgery such as tissue cutting by irradiating a surgical eye with laser light.

  In recent years, there has been proposed a technique for cutting (crushing) a tissue such as a cornea or a lens of a patient's eye (operative eye) by irradiating an ultrashort pulse laser beam whose pulse width is in the femtosecond order (for example, Patent Documents 1 and 2). In such an apparatus, a laser is focused on a target position of the eyeball tissue to form a laser spot, and the eyeball tissue is mechanically broken (cut). In such an apparatus, the eyeball tissue is incised by moving the laser spot three-dimensionally and continuously connecting the laser spots. In such a device, an adsorption unit that adsorbs the eyeball to prevent the eyeball from moving during laser irradiation, and a cornea to compress the laser spot with high accuracy (position the optical system). Equipped with an equal interface unit (contact unit).

JP 2000-116694 A Special table 2004-53344 gazette

  In the device of Patent Document 1, the suction unit (suction ring) and the interface unit are integrated, and the fixed state of the operative eye (corneal applanation state) cannot be adjusted. In the apparatus of Patent Document 2, the suction unit and the interface unit are separated, and an operation for holding the interface unit with respect to the suction unit is required, which is troublesome.

  An object of the present invention is to provide an ophthalmic laser surgical apparatus capable of fixing an appropriate eyeball according to a surgical eye.

In order to solve the above-mentioned problems, the present invention has the following configuration.
(1) An apparatus optical body for irradiating a laser beam for surgery to a target position, the apparatus main body including a laser irradiation optical system having a moving optical system for moving a spot of the laser light three-dimensionally. In an ophthalmic laser surgical apparatus for operating a surgical eye with laser light through a laser irradiation port provided in
An eyeball fixing unit attached to the apparatus body;
An interface unit having a translucent optical member disposed inside the eyeball fixing unit and covering at least part of the cornea of the surgical eye;
A first moving mechanism for moving the optical member in the depth direction of the surgical eye with respect to the eyeball fixing unit, and the optical with respect to the surgical eye fixed to the apparatus main body by the eyeball fixing unit; A first alignment unit for aligning the members;
It is characterized by comprising.
(2) In the ophthalmic laser surgical apparatus according to (1),
A second movement mechanism for moving the eyeball fixing unit along the depth direction of the surgical eye, and a second alignment unit for aligning the eyeball fixing unit with respect to the surgical eye before eyeball fixation;
It is characterized by that.
(3) The ophthalmic laser surgical apparatus according to (1) or (2),
A drive control means having an operation unit operated by an operator and controlling the drive of the first moving mechanism based on an operation signal from the operation unit;
It is characterized by that.
(4) In any one of the ophthalmic laser surgery apparatuses according to (1) to (3),
A sensor for detecting a position in a depth direction of the eyeball fixing unit with respect to the apparatus main body;
Restricting means for restricting the movement of the eyeball fixing unit in the depth direction so that the position of the surgical eye in the depth direction relative to the laser irradiation optical system is located within a predetermined alignment range based on the detection result of the sensor. Restriction means for restricting movement of the eyeball fixing unit;
It is characterized by providing.
(5) In the ophthalmic laser surgical apparatus according to any one of (3) to (5),
The first alignment unit includes a buffer mechanism that buffers movement of the eyeball fixing unit in order to reduce a load applied to the surgical eye after contacting the eyeball fixing unit.
It is characterized by that.
(6) The ophthalmic laser surgical apparatus according to any one of (1) to (5),
A tomography unit that obtains at least a tomogram of the cornea of the operative eye;
A monitor for displaying a tomogram taken by the tomography unit;
It is characterized by comprising.
(7) In the ophthalmic laser surgical apparatus according to any one of (3) to (6),
A position detection unit that detects at least the position of the cornea of the surgical eye;
The drive control means controls the first movement mechanism based on the detection result of the position detection unit so that the optical member of the interface unit covers the cornea of the surgical eye at a predetermined position with respect to the surgical eye. And comprising.
(8) In the ophthalmic laser surgical apparatus according to any one of (1) to (7),
The eyeball fixing unit includes an adsorbing portion that adsorbs a surgical eye by an added negative pressure.
It is characterized by that.
(9) In the ophthalmic laser surgical apparatus according to any one of (1) to (8),
The eyeball fixing unit includes a wall for filling a liquid inside with the surgical eye fixed.
The optical member covers the cornea of the surgical eye via a liquid filled inside the eyeball fixing unit,
It is characterized by that.
(10) In the ophthalmic laser surgical apparatus according to any one of (1) to (9),
The optical member is a member that contacts the cornea of the surgical eye.
It is characterized by that.
(11) In the ophthalmic laser surgical apparatus according to any one of (1) to (10),
The laser light source is a laser light source that emits pulsed laser light that causes breakdown at a focused spot.

  According to the present invention, suitable eyeball fixation can be performed according to the surgical eye.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a schematic configuration diagram of an ophthalmic laser surgical apparatus according to the present embodiment. FIG. 2 is a configuration diagram of the eyeball fixing unit. In this embodiment, the axial direction (depth direction) of the operative eye E will be described as the Z direction, the horizontal direction as the X direction, and the vertical direction as the Y direction.

<Overall configuration of device>
An outline of the configuration of the apparatus will be described. This apparatus is an ophthalmic laser surgical apparatus that irradiates a surgical laser beam (laser beam) to an eyeball tissue (lens LE) of an operating eye (patient eye) E to cut and crush the crystalline lens.

  The ophthalmic laser treatment apparatus 500 is roughly divided into a laser irradiation unit (main body unit) 100 that irradiates the surgical eye E with pulsed laser light, and an eyeball fixing / fixing and holding the eyeball of the surgical eye E with respect to the laser irradiation unit 100. An interface unit 200, an observation / imaging unit 300 for photographing a front image of the anterior segment of the operative eye E and a tomographic image of the anterior segment, an operation unit 400 for operating the apparatus 500, and a control for overall control of the entire apparatus. Part 70. The observation / imaging unit 300 includes an optical coherence tomography unit (abbreviated as an OCT: Optical Coherence Tomography unit) 310 for capturing (acquiring) a tomographic image of the operative eye E, and an anterior segment image of the operative eye E. And a front observation unit 350 for photographing.

<Laser irradiation unit>
The laser irradiation unit 100 includes a laser light source unit 110 that emits a pulsed laser beam (laser beam) for surgery, a laser irradiation optical system 120 that includes an optical member for guiding the laser beam, and an absolute position of the surgical eye. And a position detection unit 190 for detection. The laser irradiation optical system 120 is built in the apparatus main body. A laser irradiation optical system (laser delivery) 120 includes a beam expander unit 130 for moving the laser spot along the Z direction, a scanning unit 140 for moving the laser spot in the XY direction, and a laser beam as a laser spot at the target position. An objective lens 150 as a condensing optical system (imaging optical system) for condensing and various optical members for guiding laser light are provided.

  The laser light source unit 110 is a laser light source that emits a pulse laser that generates plasma (causes breakdown) at a condensing point (a focused laser spot). Plasma is generated at the laser spot. Breakdown (light destruction) occurs at the target position (spot) by the plasma, and the eyeball tissue at the target position is mechanically destroyed. When the laser spots are connected, the lens that is the eyeball tissue is cut and crushed. As the laser light source unit 110, a device that emits pulsed laser light having a pulse width of 1 femtosecond to 10 nanoseconds is used. In the present embodiment, a laser light source that emits a pulse laser in the ultraviolet region having a pulse width of 10 picoseconds and having a wavelength width of ± 10 nm with a center wavelength of 450 nm is used. The laser light source unit 110 is a laser light source that can emit laser light with an output that causes breakdown when the spot size of the laser spot is 1 to 15 μm. As a laser light source, a device that emits infrared pulse laser light having a pulse width of 500 femtoseconds and a wave center wavelength of 1040 nm (wavelength width is ± 10 nm) may be used.

  The beam expander unit 130 (hereinafter simply referred to as an expander) includes a plurality of optical elements, and changes the divergence state of the beam of the pulsed laser light that has passed through the expander 130 to change the laser spot in the Z direction (optical axis). L1). The expander 130 of this embodiment includes a lens having a negative refractive power and a lens having a positive refractive power from the upstream side (laser light source unit 110 side), and the upstream lens is arranged along the optical axis. To be moved. Thereby, the divergence state (divergence angle, convergence angle, etc.) of the beam emitted from the expander 130 is changed. Depending on the divergence state of the pulsed laser light incident on the objective lens 150, the condensing position of the laser spot changes in the Z direction.

The scanning unit (optical scanner unit) 140 includes a galvanometer mirror for moving the laser beam in the X direction and a galvanometer mirror for moving the laser beam in the Y direction. The scanning unit 140 may have any configuration that can scan laser light in the XY directions. For example, the scanning in the X direction may be a polygon mirror, and the scanning in the Y direction may be a galvano mirror. A resonant mirror may be used corresponding to the X direction and the Y direction. Moreover, the structure which rotates two prisms independently may be sufficient.
In this manner, the expander 130 and the scanning unit 140 move the laser spot three-dimensionally (XYZ direction) within the eyeball tissue (within the target) of the surgical eye E. The expander 130 and the scanning unit 140 constitute a moving optical system. By arranging the expander 130 upstream of the scanning unit 140, the laser light does not pass through the expander 130 after being swung in the XY directions. For this reason, the effective diameter and size of the optical member of the expander 130 can be reduced. Here, since the lens 131 can be made small, the movement of the laser spot in the Z direction can be accelerated.

  A beam combiner (beam splitter) 301 is arranged between the scanning unit 140 and the objective lens 150 so that the laser optical axis and the observation / photographing optical axis are coaxial. The combiner 301 has a characteristic of reflecting pulsed laser light and transmitting illumination light of the observation / photographing unit. The objective lens 150 is a lens that is fixedly arranged with respect to the apparatus main body. As shown in FIG. 2, the objective lens 150 is held by a lens holder 151 fixed to the apparatus main body. The objective lens 150 forms an image of the laser beam on the target as a minute laser spot having a spot size of about 1 to 15 μm.

  Although not shown, the laser irradiation unit 100 is provided with an aiming light source that emits aiming light (aiming light) for the operator to check the laser irradiation position.

<Position detection unit>
The position detection unit 190 shares the laser irradiation optical system 120. The position detection unit 190 includes a confocal aperture plate and a light receiving element. The opening of the confocal aperture plate is a conjugate of the position of the laser spot. Thereby, the light receiving element can detect light at the laser spot position (light reflected from the tissue). Information on the absolute position of the laser spot can be acquired from the position information of the optical elements of the expander 130 and the scanning unit 140. For example, the reflected light at the laser spot position is received by the light receiving element, and the light intensity is obtained, so that the information on the laser spot (target) position whose absolute position is determined can be obtained. In detecting the absolute position, the output of the laser light source unit 110 is reduced by an attenuator or the like so that breakdown does not occur at the laser spot position. In addition,
The position detection unit is configured to detect the absolute position of the characteristic part of the surgical eye, but is not limited to this configuration. It is good also as a structure which obtains the control information of the laser irradiation optical system 120 by position detection operation.

<Eyeball fixation / Interface unit unit>
The eyeball fixing / interface unit 200 has a role of fixing (holding) the eyeball of the operation eye E to the laser irradiation optical system 120 (device main body) and guiding laser light to the tissue of the operation eye E. The eyeball fixing / interface unit 200 is disposed around the end of the laser irradiation optical system 120 (around the objective lens 150). The objective lens 150 is held by a holder 151 that is fixedly disposed on the apparatus main body. The eyeball fixing / interface unit 200 is roughly divided into a suction ring (suction unit, eyeball fixing unit) 210 for fixing the surgical eye E by suction, and a first holding unit (suction) for holding the suction ring 210 to the apparatus main body. A ring holding unit) 250, an interface unit 220 for covering the cornea of the surgical eye E and guiding laser light to the eyeball tissue, and a second holding unit 260 for holding the interface unit 220 with respect to the apparatus main body. .

  The suction ring 210 includes a ring 211 serving as a contact portion that contacts the sclera of the surgical eye E, a support portion 212 that supports the ring 211, a suction pipe 214 that is a flow path (ventilation hole) for applying suction pressure to the ring 211, A fluid supply / discharge pipe 215 for supplying / discharging the liquid is provided, which is a flow path (through hole) formed through the support portion 212. The suction ring 210 has a conical shape that tapers from a base portion 213 formed at the base end of the support portion 212 toward the ring 211. The suction ring 210 transmits (adds) suction pressure applied from a suction pump (not shown) to the ring 211 via the pipe 214.

  The ring 211 has an opening along the curved surface of the sclera. The opening of the ring 211 has a shape that surrounds the annular portion (corner peripheral portion) of the eyeball, and has a ring shape that matches the ring 211. Thereby, the eyeball is attracted uniformly to the ring 211. The support part 212 has a wall shape surrounding the ring 211 (eyeball) so that the liquid can fill the inside of the support part 212 with the eyeball adsorbed to the ring 211. In the suction ring 210, a space is formed inside the support portion 212 so that the interface unit 220 can be accommodated without contact (interference). The base portion 213 of the support portion 212 has a shape (fitting shape) that allows the support portion 212 to be attached to and detached from the first holding unit 250 (details will be described later). A suction tube from a suction pump provided in the apparatus main body (or a separate unit) is connected to the pipe 214. Due to the suction pressure generated by the operation of the suction pump, the inside of the suction tube, pipe 214 and ring 211 becomes negative pressure, and the sclera of the surgical eye E is adsorbed to the opening of the ring 211. An end portion (opening) of the pipe 215 is formed on the inner wall of the support portion 212. The pipe 215 is connected to a perfusion suction unit (not shown) via a tube or the like. Prior to laser irradiation, the liquid is supplied into the suction ring 210 by the operation of the perfusion suction unit. After the operation, the liquid in the suction ring 210 is discharged. The liquid may be simply supplied via the pipe 215. The operation may be such that the liquid is discarded by removing the suction ring 210 from the surgical eye E.

  The suction ring 210 is made of a material such as a biocompatible resin or metal. The suction ring 210 is a disposable type that is discarded after a single use. For this reason, it is preferable that the first holding unit 250 be detachable.

  The first holding unit 250 is attached to the apparatus main body side. The first holding unit 250 includes a holding portion (fitting portion) 251 fitted to the base portion 213, a rail (shaft) 253 for guiding the moving direction of the base portion 252 formed at the base end of the holding portion 251 in the Z direction, and a base portion An elastic member 254 disposed above and below 252, a regulation unit 255 that regulates movement of the holding unit 251, and a sensor 256 that detects the position of the holding unit 251 in the Z direction.

  The holding part 251 has a ring shape with a diameter larger than the diameter of the objective lens 150. The holding portion 251 (the front end thereof) has a structure that fits with the base portion 213 of the support portion 212 to hold the support portion 212 in a detachable manner. The holding part 251 has a role of holding and positioning the suction ring 210. For example, a groove (ring-shaped groove) is formed in the holding portion 251, and a protrusion (ring-shaped protrusion) is formed in the base 213. When the base portion 213 is pressed against the holding portion 251, the protrusion is fitted into the groove, and the suction ring 210 is held by the holding portion 251.

  As another configuration, the holding portion 251 and the base portion 213 are formed with screw threads that are screwed together, and the base portion 213 is screwed (fitted) to the holding portion 251 by the rotation of the suction ring 210. Good. Alternatively, the base 213 may be configured to hold the holding portion 251 so as to be detachable by magnetic force, suction, or the like.

  The base 252 of the holding part 251 forms a flange of the holding part 251. The base 252 of the holding part 251 has a ring shape. A hole (reference numeral is omitted) in which the rail 253 fits is formed in the base 252 along the Z direction. The rail 253 is fixedly disposed on the apparatus main body, and is disposed along the Z direction (matching the vertical direction) so that the movement direction of the base 252 is the Z direction. The elastic members 254 are respectively disposed on the upper side and the lower side of the base portion 252. The base 252 and the rail 253 of the holding portion 251 are a moving mechanism that allows the first holding unit 250 and the suction ring 210 to move in the Z direction. The first holding unit 250 is used as a moving unit (alignment unit) that moves the suction ring 210. The elastic member 254 is disposed in the Z direction along the rail 253 and biases the base 252 in the Z direction. As the elastic member 254, a spring, rubber, or the like is used as long as it has a biasing force (restoring force). The elastic member 254 positioned above the base 252 has an upper end fixed and a lower end in contact with (fixed to) the base 252. The elastic member 254 located on the lower side of the base portion 252 is in contact with (fixed to) the base portion 252 on the upper side, and has a lower end fixed. The elastic member 254 positioned on the lower side of the base 252 biases the base 252 upward. The elastic member 254 located on the upper side of the base 252 biases the base 252 downward. The base 252 (the holding portion 251 and the like) is balanced and positioned on the rail 253 by the elastic member 254.

  When an excessive force is applied to the base 252 in a state where the base 252 is biased by the elastic member 254, the base 252 (holding portion 251) receives the force and escapes. For example, in a state where the surgical eye E is attracted to the suction ring 210 and the suction ring 210 moves downward, the surgical eye E is pushed by the suction ring 210. When the pressure received by the surgical eye E exceeds the urging force of the elastic member 254, the base 252 receives an upward force. The suction ring 210, the holding part 251 and the base part 252 move upward (escape). Thereby, the surgical eye E becomes difficult to receive a certain pressure or more (the force on the surgical eye E is buffered). Thus, the 1st holding | maintenance unit 250 will be equipped with the buffer mechanism with respect to the force of a Z direction. In this way, the first holding unit 250 (moving unit) includes the buffer mechanism.

  The restricting portion 255 has a role of fixing (locking) the position of the base portion 252 in the Z direction. Here, the restricting portion 255 has a mechanism for gripping the base portion 252 and is configured to fix the position of the base portion 252 at any position in the Z direction based on a command signal. The restriction unit 255 is connected to the control unit 70, and fixes (restricts) the base 252 based on a signal from the control unit 70.

  The sensor 256 has a role of detecting the position of the holding unit 251 in the Z direction. For example, the sensor 256 is a potentiometer that detects the position of the holding unit 251. The sensor 256 is connected to the control unit 70 and sends position detection information to the control unit 70. The control unit 70 sends a command signal to the restricting unit 255 based on the detection signal from the sensor 256, and fixes the position of the base 252. As a condition for the restricting unit 255 to fix the base 252, for example, the position of the surgical eye E is optically suitable for laser irradiation (alignment range) with respect to the laser irradiation optical system 120 (objective lens 150). Position. The sizes of the suction ring 210, the holding portion 251 and the base portion 252 are known by design. Therefore, the control unit 70 that has received the detection signal of the sensor 256 can grasp the position of the ring 211 relative to the objective lens 150.

  The sensor 256 may be a photo sensor. For example, the light shielding plate is attached to the base 252. A photo interrupter is configured by the photo sensor and the light shielding plate. In this case, the photosensor is configured to send a detection signal to the control unit 70 when the base 252 is within a certain range.

  The interface unit 220 is close to the cornea of the operative eye E and has a role of facilitating (condensing) the laser light to the eyeball tissue such as a crystalline lens by weakening the refractive power of the cornea. The interface unit 220 of the present embodiment is configured to cover at least a part of the cornea without directly contacting the cornea. The interface unit 220 includes a cover glass (contact glass) 221 that is an optical member that covers the cornea, and a support portion 222 that supports the cover glass 211. The interface unit 220 is installed in the second holding part 260 via a base part 223 formed at the base end of the support part 222.

  The cover glass (cover) 221 is a member that covers the cornea and has a size that covers at least the NA on which the laser spot is focused. The cover glass 221 is a transparent member having translucency, and is formed of, for example, glass or resin. In the present embodiment, the cover glass 221 has a planar shape (plate shape). The cover glass 221 is located on the liquid surface of the liquid described later and has a role of covering the liquid. The support part 222 is a tapered member formed in a conical shape, and supports the cover glass 221 at the tip of the cone. The base portion 223 is formed with a fitting portion that fits together so as to be detachably held by the second holding unit 260.

  The interface unit 220 has a shape that fits inside the suction ring 210. Each member of the interface unit 220 is formed of a biocompatible material. The interface unit 220 is a disposable type like the suction ring 210.

  The second holding unit (interface unit holding unit) 260 is provided in the apparatus main body similarly to the first holding unit 250 and is arranged around the objective lens 150. The second holding unit 260 is disposed inside the first holding unit 250. The second holding unit 260 is fitted to the base portion 223 of the support portion 222 so as to hold the support portion 222 and the moving direction of the base portion 262 formed at the base end of the holding portion 261. A feed screw (shaft) 263 that guides the feed screw 263 in the Z direction, and a drive unit 264 that rotates the feed screw 263 to move the base 262.

  The holding unit 261 is a ring-shaped member that surrounds the objective lens 150. The holding portion 261 is configured to be fitted to the support portion 222 in order to hold the support portion 222 in a detachable manner. The base 262 of the holding part 261 forms a flange of the holding part 261. The base 262 of the holding part 261 is a ring-shaped member having a diameter smaller than the diameter of the base 252.

  A female medium (not shown) is formed on the base 262 along the vertical direction and is screwed with the feed screw 263. The drive unit 263 is, for example, a pulse motor. A feed screw 263 is fixed to the shaft of the drive unit 264. Thereby, the feed screw 263 is axially rotated. The base 262 is fed along the Z direction by the rotation of the feed screw 263. The base 262 and the feed screw 263 constitute a moving mechanism. The base unit 262, the feed screw 263, and the drive unit 264 constitute a moving unit (alignment unit) that can move the interface unit 220 and the second holding unit 260. The drive unit 264 is connected to the control unit 70, moves the holding unit 261 based on a command signal from the control unit 70, and moves the interface unit 220 along the Z direction. The control unit 70 sends the operation signal input from the operation unit 400 to the drive unit 264 as a command signal, and moves the interface unit 220. In the present embodiment, the operator determines the position of the cover glass 221 using the operation unit 400.

  The interface unit 220 abuts on the cornea of the surgical eye E adsorbed on the suction ring 210. At this time, the inside of the suction ring 210 is filled with a liquid (physiological saline) LQ. The cover glass 221 is in contact with the cornea through the liquid without directly contacting the cornea. The refractive power of the cornea is canceled by the cover glass 221 and the liquid LQ, and the laser light is guided without being refracted from the objective lens 150 to the target crystalline lens.

  The interface unit 220 may be configured to be in direct contact with the cornea. For example, the cover glass is brought into contact with the cornea, the cornea is applanated, and the ocular tissue (corneal substance) to be irradiated with laser light is positioned. When the cornea contacts the cover glass, the absolute position of the cornea is determined with respect to the laser irradiation optical system. In this case, the cover glass only needs to have a contact surface that covers the cornea so as to cover the laser irradiation region such as the inside of the cornea.

  In this way, the suction ring 210 and the interface unit 220 can be independently moved in the Z direction. Further, in the present embodiment, the suction ring 210 and the interface unit 220 are configured not to move in the XY directions, and therefore work such as suction of the surgical eye E is facilitated.

  The apparatus 500 includes an alignment unit 180 (coarse movement) for aligning the laser irradiation unit 100 and the eyeball fixation / interface unit 200 with the surgical eye E. The moving unit 180 has a moving mechanism for moving a part of the main body of the eyeball fixing / interface unit 200 and the like, and a driving unit (motor, actuator, etc.) for driving the moving mechanism, and the laser irradiation unit 100 (optical axis L1 thereof). The eyeball fixing / interface unit 200 (the central axis thereof) is moved in a three-dimensional direction with respect to the surgical eye E. Here, the optical axis L1 coincides with the central axis of the eyeball fixing / interface unit 200. Further, the central axis of the suction ring 210 and the central axis of the interface unit 220 coincide with each other. The moving unit 180 is connected to the control unit 70 and moves the laser irradiation unit 100 eyeball fixing / interface unit 200 based on an operation signal from the operation unit 400. While confirming the surgical eye E displayed on the monitor 420, the surgeon performs alignment in the XY directions (XY alignment) and aligns in the Z direction (Z alignment). Here, at least the laser irradiation unit 100 and the eyeball fixing / interface unit 200 move integrally. The moving unit 180 is an alignment unit that moves the suction ring 210 and the interface unit 220 along the Z direction. The alignment unit includes a sensor such as an encoder inside. For this reason, the position of the eyeball fixing / interface unit 200 or the like is acquired by the control unit 70. The alignment moving unit may be configured to move at least in the Z direction. For example, the laser irradiation unit 100 and the eyeball fixation / interface unit 200 are configured to be attached to another apparatus (connected to the laser irradiation unit 100) such as a surgical microscope, and the XY alignment is moved by the operator. May be.

<Observation / Photographing Unit>
The observation / imaging unit 300 includes an OCT unit 310 that acquires a tomographic image of the operative eye E, and a front image acquisition unit 350 that acquires a front image of the operative eye E. The observation / photographing unit 300 is coaxial with the laser optical axis L1 by the beam combiner 301. The optical axis L2 of the observation / photographing unit 300 is used. The optical axis L2 is divided into the optical axis L3 of the OCT unit 310 by the beam combiner 302. The beam combiner 302 is a dichroic mirror, and has a characteristic of reflecting the measurement light of the OCT unit 310 and transmitting the illumination light (reflected light) for the front observation unit 350.

<Optical tomography unit>
The optical coherent tomography unit (OCT unit) 310 includes an interference optical system (OCT optical system) 320 that shares the objective lens 150 and captures a tomographic image of the operative eye E (anterior eye portion). .

  The OCT optical system 320 irradiates the surgical eye E with measurement light. The OCT optical system 320 detects the interference state between the measurement light reflected from the surgical eye E and the reference light by the light receiving element (detector 325). The OCT optical system 320 includes an optical scanner 330 that is an irradiation position changing unit that changes the irradiation position of the measurement light on the surgical base E in order to change the imaging position of the surgical eye E. The optical scanner 330 is connected to the control unit 70, and the control unit 70 controls the operation of the optical scanner 330 based on the set imaging position information, and generates a tomographic image based on the light reception signal from the detector 325. get.

  The OCT optical system 320 has an apparatus configuration of a so-called ophthalmic optical tomographic interferometer. In this embodiment, the OCT optical system 320 captures at least a tomographic image of the surgical eye E before irradiation with pulsed laser light. The OCT optical system 320 divides light (infrared light) emitted from the measurement light source 321 into measurement light (sample light) and reference light by a coupler (light splitter) 322. Then, the OCT optical system 320 guides the measurement light to the surgical eye E and guides the reference light to the reference optical system 323 by the measurement optical system. Thereafter, interference light obtained by combining the measurement light reflected by the surgical eye E and the reference light is received by a detector (light receiving element). The detector detects an interference state between the measurement light and the reference light. In the case of Fourier domain OCT, the spectral intensity of the interference light is detected by a detector, and a depth profile (A scan signal) in a predetermined range is acquired by Fourier transform on the spectral intensity data. Examples include Spectral-Domain OCT (SD-OCT) and Swept-Source OCT (SS-OCT). Moreover, Time-Domain OCT (TD-OCT) may be used.

  The light emitted from the light source is divided into a measurement light beam and a reference light beam by a coupler. The measurement light flux passes through the optical fiber and is then emitted into the air. The light beam is condensed on the surgical eye E via the measurement optical system and the optical scanner. Then, the light reflected by the surgical eye E is returned to the optical fiber through the same optical path. The reference optical system generates reference light that is combined with reflected light acquired by reflection of measurement light by the surgical eye E.

  The reference optical system has a configuration that changes the optical path length difference between the measurement light and the reference light by moving an optical member in the reference light path. For example, the reference mirror is moved in the optical axis direction. The configuration for changing the optical path length difference may be arranged in the measurement optical path of the measurement optical system.

  The OCT unit 310 includes an optical scanner for deflecting the measurement light beam. The optical scanner is composed of two galvanometer mirrors whose rotation axes are orthogonal to each other. The optical scanner has a function of deflecting the measurement light beam two-dimensionally based on a command signal from the control unit 70. The optical scanner scans the measurement light with the surgical eye E in the XY directions (transverse directions). In this embodiment, the measurement light is scanned with the anterior segment of the surgical eye E. For example, the optical scanner 330 is operated linearly (for example, in the Y direction), and a tomogram is obtained by arranging the depth information (depth information) acquired by the detector in a linear shape (so-called B scan).

  In this manner, the reflection (advance) direction of the light beam emitted from the light source is changed, and the light beam is scanned in an arbitrary direction by the anterior eye part. Thereby, the imaging position of the surgical eye E is changed. The optical scanner only needs to be configured to deflect light. For example, in addition to a reflection mirror (galvano mirror, polygon mirror, resonant scanner), an acousto-optic element (AOM) that changes (deflects) the traveling direction of light is used. For the detailed configuration of the OCT unit, refer to, for example, Japanese Patent Application Laid-Open No. 2008-29467.

<Front observation unit>
The front observation unit 350 has a function of acquiring a front image of the anterior segment of the surgical eye E. In the present embodiment, the front observation unit 350 captures an anterior segment image of the surgical eye E illuminated with visible light and displays it on a monitor described later. The front observation unit 350 includes an observation optical system (front image observation optical system), a camera unit including a two-dimensional image sensor, and a relay lens for relaying an observation image. The front image observation unit 350 shares the objective lens 150. An illumination light source 390 that emits visible illumination light is disposed around the front of the surgical eye E. The photographed front image is sent to the control unit 70.

<Operation unit>
The operation unit 400 displays a trigger switch 410 for inputting a trigger signal for emitting treatment laser light from the laser irradiation unit 100, a tomographic image of the operative eye E, an anterior ocular segment image, and display means for displaying a surgical condition. The monitor 420 is provided. The monitor 420 has a touch panel function, and also serves as input means for setting surgical conditions and setting a surgical site on a tomographic image. A mouse that is a pointing device, a keyboard that is an input device for inputting numerical values, characters, and the like can also be used as input means.

  The monitor 420 includes an anterior segment display unit 430 that displays the anterior segment of the surgical eye E, an OCT image display unit 440 that displays a tomographic image of the anterior segment of the surgical eye E, and a surgical condition display unit 450 that displays surgical conditions. , An eyeball fixing operation unit (eyeball fixing / interface operation unit) 460 that performs an operation for fixing the eyeball, and a moving unit operation unit 470 that operates movement of the laser irradiation unit 100 and the like.

  In the OCT image display unit 440, the surgical site (the range of laser irradiation) is designated graphically by the operator. The surgical site designated on the monitor 420 is sent to the control unit 70 as a signal designating an area on the OCT image. In the operation condition display unit 450, an irradiation pattern of treatment laser light for crushing (incising) the crystalline lens is set by an operator's operation. A plurality of irradiation patterns are prepared in advance, and are set by the operator's selection. When the irradiation pattern is set on the operation condition display unit 450, the monitor 420 sends a setting signal to the control unit 70. In this embodiment, the laser output, the spot size of the laser spot, and the like are not changed and the operator does not change the setting. However, the operator may set the setting.

  The OCT image display unit 440 (monitor 420) serves to graphically display the suction ring 210 and the interface unit 220 on the OCT image so that the operator can easily visually align the suction ring 210 and the interface unit 220. have.

  In the present embodiment, the OCT image is displayed as a moving image in the OCT image display unit 440 until at least the positioning of the suction ring 210 and the interface unit 220 is completed. In the OCT image, the cornea of the operative eye E and the periphery of the cornea (the sclera around the limbus, the suction ring 210 (ring 211) are captured. Here, in the OCT image when the eyeball is fixed, at least the operative eye The cornea of E and the ring 211. The OCT image at the time of positioning of the cover glass 221 includes at least the cornea and the cover glass 221.

  The eyeball fixing operation unit 460 includes a suction pressure setting unit 461 that sets a suction pressure applied to the suction ring 210 (ring 211), a suction switch 462 that inputs a command signal for attracting an eyeball by the suction ring 210, and a suction ring 210. A supply switch 463 for inputting a command signal for supplying liquid into the interior, a discharge switch 464 for inputting a command signal for discharging liquid from the suction ring 210, and a vertical movement for adjusting the position (height position) of the interface unit 220. A switch 465 is disposed.

  When the suction pressure setting unit 461 is operated, a numeric keypad for setting a numerical value of the suction pressure is displayed. When a numerical value is input, it is stored in a memory 71 (described later) as a set value. The control unit 70 controls the suction pump based on the set suction pressure. When the suction switch 462 is operated, the suction pressure applied (applied) to the ring 211 is turned on / off. When the switch 463 is operated, a command signal is sent to the control unit 70. Upon receiving the signal, the control unit 70 controls the perfusion suction unit and supplies the liquid into the suction ring 210 via the pipe 215 so that the water level is constant. When the switch 464 is operated, a command signal is sent to the control unit 70. Upon receiving the signal, the control unit 70 controls the suction / discharge unit and discharges the liquid in the suction ring 210 via the pipe 215. The switch 465 includes a cursor 465a pointing upward and a cursor 465b pointing downward. When the cursor 465 a is operated, a command signal (operation signal) for moving the interface unit 260 upward along the Z direction is sent to the control unit 70. The control unit 70 that has received the signal controls the drive unit 264 to move the cover glass 221 upward. Conversely, when the cursor 465b is operated, the control unit 70 moves the cover glass 221 downward. Although details will be described later, the surgeon moves the eyeball fixing unit while viewing the moving image of the operative eye E displayed on the monitor 420 to fix the eyeball. For this reason, the monitor 420 becomes a means (monitoring unit) for positioning the eyeball fixing unit.

  The moving unit operation unit 470 is an input means for inputting a command signal (operation signal) for moving the moving unit 180 in the XYZ directions. The operation unit 270 includes a cursor arranged in positive and negative directions with respect to the X direction, the Y direction, and the Z direction. By operating the cursor, a command signal corresponding to the direction is sent to the control unit 70.

<Control system>
A control unit 70 that controls and controls (display control, drive control) the entire apparatus 500 is a CPU (Central Processing Unit). The control unit 70 includes a laser light source unit 110, an expander 130, a scanning unit 140, a position detection unit 190, a regulation unit 255, a sensor 256, a drive unit 264, an OCT unit 310, a front observation unit 350, an operation unit 400 (trigger switch 410, monitor 420), movement unit 180, suction pump, perfusion suction unit. The control unit 70 is connected to a memory 71 that stores surgical conditions, an irradiation pattern (pattern for moving a laser spot), a control program for the eyeball fixation / interface unit 200, and the like. The control unit 70 is connected to a buzzer 72 for notifying the operator of work completion, warning, and the like. The eyeball fixing unit 160 and the illumination light source 390 are driven individually.

  The control unit 70 acquires the absolute position of the characteristic part (anterior lens capsule) of the surgical eye E using the position detection unit 190 after the fixation of the surgical eye E by the eyeball fixing / interface unit 200, and performs laser irradiation. Correct the position (alignment).

  Based on the surgical site (region) set by the OCT image display unit 440 and the absolute information acquired by the position detection unit 190 before the irradiation of the surgical laser light, the control unit 70 operates the surgical laser. The position information for irradiating light is corrected. The control unit 70 emits laser light from the laser light source unit 110 based on the corrected surgical site, surgical conditions, and irradiation pattern, and causes the expander unit 130 (drive unit 135) and the scanning units (galvano mirrors 141 and 144) to be operated. By controlling, the laser spot is moved in the eyeball tissue, and the eyeball tissue is cut and crushed.

  The control unit 70 drives and controls the alignment unit 180 based on a command signal from the eyeball fixing operation unit 470, and moves the eyeball fixing / interface unit 200 together with the laser irradiation unit 100 in the XYZ directions. Thereby, the alignment of the eyeball fixing / interface unit 200 in the XY direction and the alignment of the rough copper in the Z direction can be performed.

  The control unit 70 performs image processing on the tomographic image acquired by the OCT unit 310 or the like, and acquires (detects and calculates) and displays (display control) the position and shape of the tissue of the eyeball fixation / interface unit 200 and the surgical eye E. Have a role. Further, the control unit 70 displays a tomographic image or functions as a monitoring unit that monitors the position of the eyeball fixing / interface unit 200 by controlling the driving of the eyeball fixing / interface unit 200 based on the image processing result ( Part of).

<Surgery flow>
Next, the flow of the operation will be described focusing on the eyeball fixing operation. FIG. 3 shows a state in which the interface unit 220 is at the top of the eyeball fixing / interface unit 200. FIG. 4 is a diagram showing the OCT image display unit 440.

  The surgeon attaches the suction ring 210 to the holding portion 251 and the interface unit 220 to the holding portion 261. The surgeon operates the operation condition display unit 450 of the monitor 420 to set the operation conditions. Here, an irradiation pattern for crushing the crystalline lens is selected. Irradiation patterns include, for example, a pattern in which only the anterior capsule of the lens is incised, an anterior capsule incision and a pattern in which the lens nucleus is divided (eg, di-segment, quadrant, eight-segment, etc.), anterior capsule incision and lens nucleus Select from patterns to be crushed. The suction setting unit 461 sets the suction pressure when the eyeball is fixed. The irradiation pattern setting signal and the suction pressure setting signal are sent to the control unit 70 and stored in the memory 71.

  Next, the surgeon positions (XY alignment) the optical axis L1 of the apparatus main body on the surgical eye E of a patient (subject) who lies on a bed or the like. The main body of the apparatus is moved in the Z direction to bring the suction ring 210 (ring 211) closer to the sclera of the surgical eye E. At this time, the surgeon works while viewing the moving images displayed on the anterior segment display unit 430 and the OCT image display unit 440. The surgeon confirms the contact state of the suction ring 210 to the sclera while viewing the moving image (front image, OCT image). The control unit 70 performs image processing on the OCT image, which is a moving image acquired by the OCT unit 310, extracts the corneal shape of the surgical eye E, and extracts the position of the corneal apex. Further, the control unit 70 extracts the iris of the surgical eye E and obtains the pupil center position. Then, the control unit 70 sets the line passing through the corneal apex and the pupil center as the direction of the operative eye E (axis information indicating the axis of the eyeball). The control unit 70 superimposes and displays a symbol (mark) A1 indicating an axis on the OCT image. Further, the control unit 70 performs image processing on the front image acquired by the front image acquisition unit 350 and extracts the pupil center position. The control unit 70 superimposes and displays the symbol A2 indicating the pupil center position on the front image. The symbols A1 and A2 are updated and displayed in real time. As a result, the operator can confirm the direction of the operative eye E while looking at the monitor 420 and can easily align the central axis of the operative eye E with the center of the suction ring 210. The symbol A2 may indicate the corneal apex position. Further, the symbol A2 may be configured to indicate the symbol A1 (corneal apex position). In this case, it is preferable to extract the corneal apex position in each of a plurality of OCT images having different B-scan directions.

  Even after the suction ring 210 contacts the sclera of the surgical eye E, the operator lowers the apparatus main body in the Z direction. At this time, the suction ring 210 is unlikely to apply excessive pressure to the surgical eye E by the buffer mechanism of the first holding unit 250. The control unit 70 monitors the detection signal of the sensor 256 and determines whether or not the suction ring 210 is located within the alignment range. If it is determined that the suction ring 210 is positioned within the alignment range, the control unit 70 sends a command signal to the restricting unit 255. The restricting unit 255 locks the movement of the suction ring 210 based on the command signal. The control unit 70 controls the buzzer 72 and notifies the surgeon that the movement of the suction ring 210 is locked. The surgeon operates the switch 462 to attract the surgical eye E to the suction ring 210. When the operator operates the switch 463, the liquid is filled in the suction ring 210. The control unit 70 may be configured to start suction together with the movement lock of the suction ring 210. Alternatively, the control unit 70 may supply liquid based on the completion of adsorption by the suction ring 210.

  Next, the surgeon positions the interface unit 220 with respect to the cornea. The surgeon operates the cursor 265b (or the cursor 265a) while confirming the position of the cover glass 221 (the height position in the Z direction) and the position of the cornea while viewing the OCT image, and the cornea (vertex) ) So that the front surface (lower surface) of the cover glass 221 has a certain positional relationship. As a positional relationship, the distance between the corneal apex and the front surface of the cover glass 221 is about 1 mm. This is a distance that does not affect the surface of the liquid and does not place a burden on the patient because the cover glass 221 directly contacts the cornea.

  The control unit 70 sends the operation signal input from the operation unit 400 to the drive unit 264 as a command signal. The control unit 70 drives the drive unit 264 to move the interface unit 220 in the Z direction with respect to the eye to be examined. When the operation signal from the operation unit 400 is turned off, the control unit 70 stops driving the drive unit 264 and stops the interface unit 220. Note that the control unit 70 may be configured to detect the position of the front surface of the cover glass 221 and the position of the top of the cornea by performing image processing of the OCT image to position the cover glass 221.

  In this way, the eyeball of the surgical eye E is fixed and the cover glass 211 is positioned. The operator can easily perform the positioning operation by moving the suction ring and the interface unit in the Z direction while viewing a moving image such as an OCT image. Further, by confirming the moving image of the surgical eye, it is possible to fix the eyeball suitable for the surgical eye, corresponding to the position of the sclera and cornea that varies depending on the surgical eye.

  In addition, the apparatus of this embodiment has a configuration in which the suction ring and the interface unit provided in the apparatus main body can be independently moved in the Z direction, and the interface unit is moved with respect to the surgical eye fixed by the suction ring. Let Thereby, since the positional relationship between the surgical eye fixed by the suction ring and the interface unit can be suitably adjusted, the eyeball can be suitably fixed according to the surgical eye, corresponding to the positions of the sclera and cornea that differ depending on the surgical eye. Further, since the interface unit is movable in the Z direction with respect to the suction ring in a state where movement in the XY direction is restricted by the guide mechanism in the Z direction, the interface unit and the suction ring are displaced in the XY direction. Can be avoided.

  In addition, the apparatus of the present embodiment has a configuration in which the suction ring and the interface unit provided in the apparatus body can be independently moved in the Z direction, and the suction ring is fixed to the surgical eye, and the operation is fixed by the suction ring. The positional relationship between the eye and the interface unit can be adjusted smoothly, enabling efficient surgery.

  When the eyeball fixation is completed, the operator sets the surgical site. The surgeon operates the switch of the OCT image display unit 440 to perform planning. When the planning is completed, the control unit 70 controls the position detection unit 190 to acquire the absolute position of the characteristic part of the eyeball tissue of the operation eye E and correct the laser irradiation position information. The correction result is stored in the memory 71.

  When the operator operates the trigger switch 410, the control unit 70 performs laser irradiation based on the surgical condition, irradiation pattern, and corrected laser irradiation position information set based on the trigger signal (laser irradiation optical system 120). Control).

  The lens of the surgical eye is cut and broken by laser irradiation, and the anterior lens capsule is incised. When the laser irradiation is completed, the control unit 70 notifies the operator by the buzzer 72. The surgeon operates the switch 465a to move the interface unit 220 upward. Further, the operator operates the switch 464 to discharge the liquid in the suction ring 210. Then, the surgeon operates the switch 462 to release the suction by the suction ring 210 and removes the suction ring 210 from the surgical eye E. In addition, it is good also as a structure which the control unit 70 performs the process after completion of laser irradiation.

  The surgical eye from which the eyeball fixing / interface unit 200 has been removed is operated by another surgical apparatus, for example, an ultrasonic cataract surgical apparatus.

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

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

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

  In the above description, the suction ring moves. However, the present invention is not limited to this. It is sufficient if the suction ring and the interface unit move relatively. For example, a mechanism for moving the suction ring in the Z direction is not necessarily required.

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

  Further, the configuration may be such that the shape of the surgical eye is extracted from the OCT image by image processing such as a control unit and used for eyeball fixation or the like. For example, an OCT image acquired before the eyeball fixing operation (an OCT image acquired by another imaging apparatus) may be image-processed to extract a corneal shape and a shape around the cornea (eyeball shape) in contact with the suction ring. Keep it. The eyeball shape is preferably a three-dimensional shape acquired by orthogonal lines (B scan) passing through the vicinity of the apex of the cornea. During the eyeball fixing operation, the corneal shape of the surgical eye is acquired and matched with the previously acquired corneal shape, thereby acquiring the shape and position around the cornea of the surgical eye. The shape and position around the obtained cornea are displayed as symbols on the OCT image. Thereby, even if the OCT unit cannot capture the periphery of the cornea, the operator can position the suction ring while confirming (predicting) the position around the cornea.

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

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

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

  In the above description, the moving image of the OCT image is displayed on the monitor. However, the present invention is not limited to this. Any configuration may be used as long as the control unit can perform monitoring when aligning the eyeball unit or the like. The captured OCT image may be processed internally. In this case, the control unit functions as a monitoring unit.

  In the above description, the OCT unit is used as the tomography unit, but the present invention is not limited to this. It is only necessary to be able to capture depth information and tomographic images of the operative eye. For example, a configuration using a Shine proof camera unit may be used.

  In the above description, the OCT image or the like is used for alignment of the eyeball fixing unit before laser irradiation (before surgery), but is not limited to this. It is good also as a structure which monitors (confirms) the state of eyeball fixation using an OCT image during laser irradiation (in operation). For example, the control unit is configured to detect movement of the surgical eye from the OCT image by image processing. The control unit obtains information on the characteristic features of the operative eye such as the corneal shape and the corneal apex position from the OCT image. The control unit monitors the position of the feature portion and detects the movement of the feature portion. For example, when the eyeball has moved due to a suction break or the like, the control unit is configured to stop laser irradiation based on the detection result and notify the operator. In such a case, the detection of the suction state can be performed faster than the detection of the suction state using a sensor that monitors the suction pressure of the suction ring. Further, not only the suction state but also a configuration in which a change in the operating eye is detected from an OCT image or the like, the laser irradiation is stopped, and the control for correcting the laser irradiation (position) is performed.

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

  In the above description, a part of the eyeball fixing unit and a part of the interface unit are reflected in the OCT image. However, the present invention is not limited to this. Any configuration capable of aligning the eyeball fixing unit and the interface unit with respect to the cornea may be used. Each unit does not necessarily have to be reflected in the OCT image. The positional relationship between the OCT unit and the cornea (surface) can be acquired from the captured OCT image. For this reason, by determining the positional relationship between the OCT unit, the eyeball fixing unit, and the interface unit, the positional relationship between the cornea (operating eye) and the eyeball fixing unit is obtained using an OCT image that does not include the eyeball fixing unit. , Each unit can be aligned.

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

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

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

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

It is a block diagram of the ophthalmic laser surgery apparatus of this embodiment. It is sectional drawing of an eyeball fixation and an interface unit. It is sectional drawing of the eyeball fixation and interface unit in which an interface unit is in the highest position. It is a figure explaining a monitor display.

DESCRIPTION OF SYMBOLS 100 Laser irradiation unit 200 Eyeball fixation and interface unit 210 Suction ring 211 Ring 220 Interface unit 221 Cover glass 250 1st holding unit 260 2nd holding unit 310 OCT unit 400 Operation unit 420 Monitor 440 OCT image display part 500 Ophthalmic laser surgery apparatus

Claims (11)

An irradiation optical system for irradiating a target laser beam for surgery to a target position, the apparatus main body having a laser irradiation optical system having a moving optical system for moving a laser beam spot three-dimensionally, and provided in the apparatus main body In an ophthalmic laser surgery apparatus that operates a surgical eye with a laser beam through a laser irradiation port,
An eyeball fixing unit attached to the apparatus body;
An interface unit having a translucent optical member disposed inside the eyeball fixing unit and covering at least part of the cornea of the surgical eye;
A first moving mechanism for moving the optical member in the depth direction of the surgical eye with respect to the eyeball fixing unit, and the optical with respect to the surgical eye fixed to the apparatus main body by the eyeball fixing unit; A first alignment unit for aligning the members;
An ophthalmic laser surgical apparatus comprising: The ophthalmic laser surgical apparatus according to claim 1,
A second movement mechanism for moving the eyeball fixing unit along the depth direction of the surgical eye, and a second alignment unit for aligning the eyeball fixing unit with respect to the surgical eye before eyeball fixation;
An ophthalmic laser surgical apparatus characterized by that. The ophthalmic laser surgical apparatus according to claim 1 or 2,
A drive control means having an operation unit operated by an operator and controlling the drive of the first moving mechanism based on an operation signal from the operation unit;
An ophthalmic laser surgical apparatus characterized by that. The ophthalmic laser surgical apparatus according to any one of claims 1 to 3,
A sensor for detecting a position in a depth direction of the eyeball fixing unit with respect to the apparatus main body;
Restricting means for restricting the movement of the eyeball fixing unit in the depth direction so that the position of the surgical eye in the depth direction relative to the laser irradiation optical system is located within a predetermined alignment range based on the detection result of the sensor. Restriction means for restricting movement of the eyeball fixing unit;
An ophthalmic laser surgical apparatus comprising: The ophthalmic laser surgical apparatus according to any one of claims 3 to 5,
The first alignment unit includes a buffer mechanism that buffers movement of the eyeball fixing unit in order to reduce a load applied to the surgical eye after contacting the eyeball fixing unit.
An ophthalmic laser surgical apparatus characterized by that. The ophthalmic laser surgical apparatus according to any one of claims 1 to 5,
A tomography unit that obtains at least a tomogram of the cornea of the operative eye;
A monitor for displaying a tomogram taken by the tomography unit;
An ophthalmic laser surgical apparatus comprising: The ophthalmic laser surgical apparatus according to any one of claims 3 to 6,
A position detection unit that detects at least the position of the cornea of the surgical eye;
The drive control means controls the first movement mechanism based on the detection result of the position detection unit so that the optical member of the interface unit covers the cornea of the surgical eye at a predetermined position with respect to the surgical eye. And an ophthalmic laser surgical apparatus. The ophthalmic laser surgical apparatus according to any one of claims 1 to 7,
The eyeball fixing unit includes an adsorbing portion that adsorbs a surgical eye by an added negative pressure.
An ophthalmic laser surgical apparatus characterized by that. The ophthalmic laser surgical apparatus according to any one of claims 1 to 8,
The eyeball fixing unit includes a wall for filling a liquid inside with the surgical eye fixed.
The optical member covers the cornea of the surgical eye via a liquid filled inside the eyeball fixing unit,
An ophthalmic laser surgical apparatus characterized by that. The ophthalmic laser surgical apparatus according to any one of claims 1 to 9,
The optical member is a member that contacts the cornea of the surgical eye.
An ophthalmic laser surgical apparatus characterized by that. The ophthalmic laser surgical apparatus according to any one of claims 1 to 10,
An ophthalmic laser surgical apparatus, wherein the laser light source is a laser light source that emits pulsed laser light that causes breakdown at a focused spot.

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