JP2018523526A - System for modifying ocular tissue and intraocular lens - Google Patents

Abstract

A system for ophthalmic surgery delivers an ultraviolet laser beam comprising a laser pulse having a wavelength of 320 nm to 370 nm to photolyse one or more intraocular targets in the eye using chromophore absorbance. A laser source configured as described above. The pulse energy, pulse duration, and focus are sufficient for the irradiance at the focus to photolyse one or more intraocular targets without exceeding the threshold of plasma formation and associated cavitation events. There is something like that. An optical system operably coupled to a laser source and configured to focus an ultraviolet laser beam at a focal point and direct the focal point in a pattern to one or more intraocular targets. The optical system focuses the laser beam at a numerical aperture that provides a focal point for scanning over a scanning range of 6 mm to 10 mm.

Description

(Cross-reference of related applications)
This application is a U.S. provisional patent application 61 / 293,357 filed Jan. 8, 2010, 35 U.S. Pat. S. C. This is a continuation-in-part of US patent application Ser. No. 12 / 987,069, filed Jan. 7, 2011, claiming benefit under §119. The above applications are hereby incorporated by reference in their entirety as if fully set forth herein. The full Paris Convention priority is expressly retained herein.

  Cataract extraction is one of the most commonly performed surgical procedures in the world. Cataract is the opacity of the lens of the eye or the capsular bag that is its membrane. It varies in degree from slight turbidity to complete turbidity that blocks the passage of light. In the early stages of cataract with age, the refractive power of the lens increases and can cause myopia (myopia), and the progressive yellowing and opacity of the lens absorbs the blue wavelength, Scattering at may cause a reduction in blue perception. Cataracts typically progress slowly and cause vision loss, and can cause blindness if untreated.

  The procedure is performed by removing the opaque lens and replacing it with an artificial intraocular lens (IOL). Currently, an estimated 3 million cases are performed in the United States each year and 15 million cases are performed worldwide. This market includes intraocular lenses for implantation, viscoelastic polymers to facilitate surgical procedures, disposable instruments (including ultrasonic phacoemulsification tips, tubes, and various knives and tweezers) It consists of various categories.

  Modern cataract surgery typically uses an ultrasonic tip with associated perfusion and suction ports to cut a relatively hard lens nucleus and an anterior capsulotomy or more recently a continuous circular capsule rupture ( This is done using a technique called phacoemulsification, which promotes its removal through an opening made in the anterior lens capsule, called CCC). Finally, an artificial foldable intraocular lens is inserted through the small incision into the remaining capsular bag of the eye.

  One of the most technically difficult and important steps in this surgery is to create a capsule rupture. This step uses a sharp needle to puncture the anterior lens capsule in a circular fashion, followed by removal of a circular fragment of the lens capsule typically in the range of 5-8 mm in diameter. Resulted from a previous technique called incision. This facilitated the next step of nuclear cutting by phacoemulsification suction. Due to the various complications associated with early can opener techniques, attempts have been made by leading experts in the field to develop better techniques for removal of the anterior lens capsule prior to the emulsification process. It was.

  The concept of continuous circular film rupture provides a smooth continuous circular opening that not only allows the phacoemulsification suction of the nucleus to be performed safely and easily, but also for easy insertion of an intraocular lens. It is. It provides both clear central access for insertion, permanent opening for patient transfer of images to the retina, and support for the IOL inside the remaining sac that would limit the possibility of translocation. provide.

  The surgeon is not able to fully visualize the sac due to lack of red reflexes, inadequately grips it, is properly sized without causing radial tears and stretches, and Problems associated with the inability to open a smooth circular opening at the correct location may occur. There are also technical difficulties associated with maintaining anterior chamber depth after the initial opening, small size pupils, or lack of red reflex due to lens opacity. Some of the visualization problems are minimized by using dyes such as methylene blue or indocyanine green. In patella fragile patients (typically elderly patients) and infants who have very soft and elastic sac and are very difficult to control and reliably tear open the sac Cause further complications.

  Many cataract patients have astigmatic visual errors. Astigmatism may occur when the corneal curvature is not the same in all directions. Recently, IOLs have been used to correct astigmatism, but require precise rotation and centering. In addition, even though many patients have more serious abnormalities, IOLs are not used to correct astigmatism above 5D. Higher correction beyond 5D is required to reshape the cornea to become more spherical. There are many approaches that include cornea plasticity, astigmatism correcting corneal incision, corneal reducing incision (CRI), and limbal reducing incision (LRI). All operations except Corneaplasty are performed by placing the corneal incision in a well-defined manner and depth, allowing the cornea to change shape so that it becomes more spherical. Nowadays, these delicate cuts are manually placed, which affects its limited accuracy.

  But ophthalmic therapy doesn't just require a cut. There is also a need for milder modification of the ocular tissue that results in weakening of the mechanical properties of the tissue and / or changes in the optical properties of the treated tissue. In this case, the action should be gentle enough to allow structural modification of the ocular tissue without mechanical disruption. Ding et al. (IOVS, 2008 (49), 12, pp 5532-5539) shows the modification of corneal tissue using a sub-rapture femtosecond laser pulse, and by applying a diffraction pattern in the corneal tissue, approximately 1% refraction. The change in rate could be demonstrated. However, the practical application of the Ding technique is limited by the need to apply 100,000,000 laser pulses per cubic micrometer of tissue to be treated.

  Vogel et al. (US 2010/01635540 A1) describes a method for machining and cutting a transparent material using a temporary smooth laser beam that generates a low density plasma without forming a plasma emission. In that teaching, linear absorption of the exposed material should be specifically avoided because it describes that the linear absorption results in random generation of seeding electrons, which results in stochastic fluctuations in the plasma threshold. ing. In addition, it states that low density plasma formation is always associated with cavitation bubble formation.

  This is in sharp contrast to the present invention where two working regimens are described. It has been discovered that by using a laser wavelength that has some degree of linear absorption in the target tissue, it is possible to produce very low threshold effects. In addition, a temporary smooth pulse shape is not required in the present invention. Also, the formation of cavitation bubbles is undesirable in one embodiment of the present invention because its action is induced by photolysis enhanced by linear absorption. Vogel data also shows that there is still a difference of more than two orders of magnitude in achieving plasma formation when compared to IR femtosecond lasers and 355 sub-ns lasers. In our embodiment, for the use of tissue intrinsic chromophore line absorption (or by the addition of an extrinsic chromophore), the energy threshold for a 355 nm sub-nanosecond laser is femto using the same numerical aperture optical element. Slightly lower when compared to second laser pulses.

  Braun et al. (DE 198 55 623 C1) describes a method for precisely machining the interior of glass using a laser having a wavelength outside the glass transmission plateau. This laser is then used in particular to create material defects inside the glass without including the surface. This method allows material defects to be placed closer to the surface without damaging the surface itself. The effect of the surface is not described. It is also used only on glass where no cavitation bubbles are formed, so it does not cause any cavitation events.

  Koenig et al. (WO 2007/057174) claims a system for surgical surgical intervention by using femtosecond laser pulses in the UV spectral range. In that teaching, it is stated that by using a higher numerical aperture of 0.8 for the invention, the threshold is greatly reduced to a nanojoule regimen. However, it is optically difficult to combine these numerical apertures with the wide scan range of 6-10 mm that is commonly used for ophthalmic applications, so it would be very helpful to convert this system into a usable product. Make it difficult. Also, the generation of femtosecond UV laser pulses is technically difficult.

  Therefore, there is a need for methods, techniques, and devices for improving standard care for ophthalmic patients.

  Accordingly, the present disclosure provides a system and method for use in a suitable ophthalmic laser surgical system to obviate one or more problems due to limitations and disadvantages of the related art. One embodiment relates to a system for ophthalmic surgery, a laser beam comprising a plurality of laser pulses having a wavelength of about 320 nanometers to about 430 nanometers and a pulse duration of about 1 picosecond to about 100 nanoseconds. An interaction between the laser source and the laser source operatively coupled to the laser source and the one or more targets and the laser pulse is a plasma formation or associated cavitation event Configured to focus and direct a laser beam in one pattern to one or more intraocular targets in a patient's eye as characterized by photolysis enhanced by linear absorption without And an optical system. The wavelength may be about 355 nm. The pulse duration may be between about 400 picoseconds and about 700 picoseconds. The pulse may have a pulse energy of about 0.01 microjoules to about 500 microjoules. The pulse may have a pulse energy of about 0.5 microjoules to about 10 microjoules. The plurality of laser pulses may have a repetition rate of about 500 hertz to about 500 kilohertz. The optical system focuses the laser beam to provide a beam diameter of about 0.5 micrometers to about 10 micrometers (about 0.5 microns to about 10 microns) within one or more intraocular targets. It may be configured to. At least one of the one or more intraocular targets may be selected from the group consisting of cornea, rim, sclera, lens capsule, lens, and artificial intraocular lens implant. The pattern is selected from the group consisting of a corneal extension incision, a limbal extension incision, an astigmatism correction corneal incision, and a capsulotomy, and includes one of an incision (incision) in the intraocular target and a change in refractive index. Or it may be configured to result in more than one physical modification. The optical system and laser source may be configured to structurally modify at least one of the one or more intraocular targets such that the refractive index of the modified tissue structure target changes. Good.

  Another embodiment relates to a system for ophthalmic surgery, a laser comprising a plurality of laser pulses having a wavelength of about 320 nanometers to about 430 nanometers and a pulse duration of about 1 picosecond to about 100 nanoseconds. A plasma configured to deliver a beam, a plasma operably coupled to the laser source, and the interaction between one or more targets and the laser pulse is facilitated by linear absorption An optical system configured to focus and direct a laser beam in a pattern to one or more tissue structure targets in a patient's eye, as characterized by the local formation of Prepare. The wavelength may be about 355 nm. The pulse duration may be between about 400 picoseconds and about 700 picoseconds. The pulse may have a pulse energy of about 0.01 microjoules to about 500 microjoules. The pulse may have a pulse energy of about 0.5 microjoules to about 10 microjoules. The plurality of laser pulses may have a repetition rate of about 500 hertz to about 500 kilohertz. The optical system focuses the laser beam to provide a beam diameter of about 0.5 micrometers to 10 micrometers (about 0.5 microns to about 10 microns) within one or more tissue structure targets. It may be configured as follows. At least one of the one or more tissue structure targets may be selected from the group consisting of cornea, rim, sclera, lens capsule, lens, and artificial intraocular lens implant. The pattern is configured to be selected from the group consisting of a corneal extension incision, a limbal extension incision, an astigmatism correction corneal incision, and a capsulotomy, and one or more incisions in an intraocular target that is a tissue structure target May be configured to make.

  Another embodiment relates to a system for ophthalmic surgery, a laser comprising a plurality of laser pulses having a wavelength of about 320 nanometers to about 430 nanometers and a pulse duration of about 1 picosecond to about 100 nanoseconds. A laser source configured to deliver a beam and an interaction between one or more targets and the laser pulse operatively coupled to the laser source may form plasma or associated cavitation. Configured to focus and direct the laser beam in one pattern to one or more targets in the patient's eye as characterized by photolysis enhanced by linear absorption without events And an optical system. The pattern may be configured such that the operation of the optical system and the laser source causes physical modification of one or more targets. A physical change may be indicated as a change in the refractive index of one or more targets, or one or more incisions. At least one of the one or more targets may be a cornea or an artificial intraocular lens. The physical change may be configured to change the refractive profile of the target.

  Another embodiment relates to a system for ophthalmic surgery, a laser comprising a plurality of laser pulses having a wavelength of about 320 nanometers to about 430 nanometers and a pulse duration of about 1 picosecond to about 100 nanoseconds. A laser source configured to deliver a beam and an interaction between one or more targets and the laser pulse operatively coupled to the laser source may form plasma or associated cavitation. To focus and direct the laser beam in a pattern to one or more tissue structure targets in the patient's eye, as characterized by photolysis enhanced by linear absorption without events A configured optical system and an integrated imaging subsystem that captures in confocal back-reflected light from the sample provided by the laser source. That. The laser pulse may induce fluorescence collected by the imaging subsystem. The system may be configured to provide a lower energy pulse for alternating imaging and a higher energy pulse for treatment. The imaging subsystem may include an optical coherence tomography system, a Purkinje imaging system, and / or a Scheimpflug imaging system. The system may further comprise a controller configured to determine the position and shape of the eye structure, determine pattern placement and / or laser parameters, and position the pattern within the defined target.

  Another embodiment relates to a system for ophthalmic surgery, a laser comprising a plurality of laser pulses having a wavelength of about 320 nanometers to about 430 nanometers and a pulse duration of about 1 picosecond to about 100 nanoseconds. A laser source configured to deliver a beam and an interaction between one or more targets and the laser pulse operatively coupled to the laser source may form plasma or associated cavitation. To focus and direct the laser beam in a pattern to one or more tissue structure targets in the patient's eye, as characterized by photolysis enhanced by linear absorption without events Constructed with an optical system and an exogenous chromophore introduced into the target structure to produce / enhance line absorption. The exogenous chromophore may be trypan blue.

  Another embodiment relates to a system for ophthalmic surgery, a laser comprising a plurality of laser pulses having a wavelength of about 320 nanometers to about 430 nanometers and a pulse duration of about 1 picosecond to about 100 nanoseconds. A laser source configured to deliver a beam and an interaction between one or more targets and the laser pulse operatively coupled to the laser source may form plasma or associated cavitation. Configured to focus and direct a laser beam in a pattern to one or more intraocular targets in a patient's eye, as characterized by photolysis enhanced by event-free linear absorption And a second laser source configured to fragment the lens utilizing a wavelength of about 800 nm to about 1100 nm. It has been. The second laser may be a pulsed infrared laser. The second laser may have a pulse duration of about 1 picosecond to about 100 nanoseconds. The second laser may be a Q-switched Nd: YAG laser.

  Another embodiment relates to a system for ophthalmic surgery of a patient's eye, which uses 320 to 370 nanometers to photolyze one or more intraocular targets in the eye using chromophore absorbance. A laser configured to deliver an ultraviolet laser beam comprising a plurality of ultraviolet laser pulses having a wavelength, a pulse duration of 1 picosecond to 100 nanoseconds, and a pulse energy of 0.01 microjoules to 500 microjoules From a group consisting of a cornea, a rim, a sclera, a lens capsule, a lens, and an artificial intraocular lens implant in a focused pattern with an ultraviolet laser beam focused on the focus An optical system configured to direct to one or more selected intraocular targets, pulse energy, pulse duration And the focal point photolysis of one or more intraocular targets using chromophore absorbance without the irradiance of the ultraviolet laser beam at the focal point exceeding the threshold of plasma formation and associated cavitation events. An aperture that provides a focal point for the laser beam to be scanned over a scan range of 6 mm to 10 mm transverse to the Z axis aligned with the laser beam. In number, the optical system focuses on one or more intraocular targets. The numerical aperture of the system is less than 0.6, preferably 0.05 to 0.4.

  Another embodiment relates to a system for ophthalmic surgery of a patient's eye, which is configured to deliver an ultraviolet laser beam comprising a plurality of ultraviolet laser pulses having a wavelength, pulse duration, and pulse energy. A laser source, wherein the plurality of ultraviolet laser pulses have a wavelength of 320 to 370 nanometers for photolyzing one or more intraocular targets in the eye using chromophore absorbance From a group consisting of a cornea, a rim, a sclera, a lens capsule, a lens, and an artificial intraocular lens implant in a focused pattern with an ultraviolet laser beam focused on the focus An optical system configured to direct to one or more selected intraocular targets, wherein the pulse energy, pulse duration, and focus are in focus The irradiance of the ultraviolet laser beam in the light source is sufficient to photolyze one or more intraocular targets using chromophore absorbance without exceeding the threshold of plasma formation and associated cavitation events And the ultraviolet laser beam is focused to one or more intraocular targets by an optical system at a numerical aperture of less than 0.6. The numerical aperture of the system is preferably 0.05 to 0.4.

  This summary and the following detailed description are exemplary, illustrative and explanatory only and are not intended to limit the invention described in the claims, but provide a further description thereof. With the goal. Further aspects, features, objects and advantages of the present invention will become apparent from the specification, taken in conjunction with the accompanying drawings which are set forth in the following description and in part illustrate the principles of the invention by way of example. Or can be learned by practice of the invention.

The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages may be facilitated by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are used, and the accompanying drawings, of which like Numbers refer to similar parts. However, like parts do not necessarily have like reference numbers. Furthermore, the drawings are not to scale, but rather focus on illustrating the principles of the invention. All figures are for the purpose of conveying concepts, and the relative size, shape, and other detailed attributes may be illustrated schematically rather than illustrated as such or precisely.
Fig. 4 shows a high level flowchart according to an embodiment of the invention. 1 is a diagram of a system embodiment. 1 is a diagram of a system embodiment. 6 shows a flowchart of a method according to an alternative embodiment. FIG. 6 is a diagram of line patterns applied across the lens for depth ranging (OCT, confocal reflection, confocal autofluorescence, ultrasound) of the axial profile of the anterior chamber of the eye. It is a top view of a rotationally asymmetric capsule rupture incision. FIG. 6 is a top view of a complementary rotationally asymmetric IOL. FIG. 6 is a top view of the IOL of FIG. 6 positioned within the lens capsule of FIG. FIG. 7 is a side view of the rotationally asymmetric IOL of FIG. 6. FIG. 7 is a side view of the rotationally asymmetric IOL of FIG. 6. FIG. 4 shows the fragmentation pattern of an ocular lens provided by an embodiment of the present invention. A line pattern 501 applied across the cornea 504 and the lens for depth ranging (OCT, confocal reflection, confocal autofluorescence, ultrasound) of the axial profile of the anterior chamber of the eye is shown. It examines the iris 502 and the lens 402 (not shown). Fig. 4 shows a scanning pattern measured across the cornea and lens that can be used for depth ranging by OCT. FIG. 4 shows a scanning pattern measured across the lens that can be used for depth ranging by confocal autofluorescence using a 320 NM to 430 NM pulsed laser. FIG. 4 is another diagram of a system according to an embodiment of the invention. FIG. 3 shows a histological cross section of a corneal cut produced by one embodiment of the present invention, where no cavitation bubbles were formed, but the tissue was modified. FIG. 6 shows a histological cross section of an open corneal incision produced by one embodiment of the present invention, where cavitation bubbles were not formed as shown in FIG. The incision was easily cut along the modified tissue structure. FIG. 4 shows a histological cross section of a corneal cut produced by one embodiment of the present invention, where cavitation bubbles have been formed. A diagram of refractive index change 822 locally induced in corneal tissue 504 by the invention is shown. As shown in FIG. 15, cavitation bubbles are not formed in this case. This effect induces a change in the refractive index profile of the corneal tissue. FIG. 6 shows a high resolution SEM image of an isolated human lens capsule treated with the present invention. Compared to FIG. 20, this sample has a much smoother edge quality and does not show any effect of cavitation bubbles. FIG. 5 shows a high resolution SEM image of an isolated human lens capsule treated with a femtosecond laser. FIG. Since the mechanical effect of cavitation causes rupture of the sac tissue, the effect of each single laser shot with a spacing of 5 micrometers is seen. FIG. 6 is a graph of laser average power (W) as a function of NA with 355 nm laser light at respective repetition rates of 70 kHz and 100 kHz. The time required to modify the tissue, i.e. to complete the cut, is also a function of the system NA. FIG. 4 is a graph of the “cutting time” per mm ² required to modify tissue as a function of NA with 355 nm light at respective repetition rates of 70 kHz and 100 kHz. FIG. 6 is a graph of relative exposure ratio as a function of NA as a function of NA with 355 nm light at repetition rates of 70 kHz and 100 kHz, respectively. This is a combination of cutting time and iris exposure considerations.

  The present invention relates to a method and system for making an incision in ocular tissue and altering its mechanical or optical properties. The following description is presented to enable one of ordinary skill in the art to make and use the invention and is provided in the context of a patent application and its requirements. Various modifications to the embodiments and general principles and features described herein will be readily apparent to those skilled in the art. Accordingly, the present invention is not intended to be limited to the embodiments shown, but is to be accorded the widest scope consistent with the principles and features described herein.

  As shown in the drawings for purposes of illustration, a method and system for making an incision in an eye tissue or changing its mechanical or optical properties is disclosed. In various embodiments, the methods and systems disclosed herein provide many advantages over current standard treatments. Specifically, rapid and precise opening in the lens capsule is possible using a 320 nm to 430 nm laser, which promotes intraocular lens placement and stability.

  Other surgeries enabled by the techniques described herein include the treatment of astigmatism. Intraocular lenses (IOLs) are typically used for correction of astigmatism, but require precise placement, orientation, and stability. Complete and long lasting correction using IOL is difficult. It often involves further surgical intervention to make the corneal shape more spherical or at least less radially asymmetric. This can be accomplished by making a cornea or limbal incision. Other operations include the generation of corneal valves for LASIK surgery and the generation of matching corneal implant shapes in the donor and recipient corneas. The present invention can be used to perform these delicate incisions.

  FIG. 1 is a flowchart of a method according to one embodiment. The first step 101 involves generating a light beam from a 320 nm to 430 nm laser system having at least a first light pulse. The next step 102 involves passing the light beam through the optical element so that the light beam is focused at a predetermined depth in the eye tissue. By implementing this method, a quick and precise opening in the capsular bag is possible, thereby facilitating the placement and stability of the intraocular lens.

  The present invention may be implemented by a system 200 that projects or scans an optical beam onto a patient's eye 20, such as the system shown in FIG. 2A. System 200 includes control electronics 210, light source 220, attenuator 230, beam expander 240, focusing lenses 250, 260, and reflecting means 270. The control electronics 210 may be a computer, microcontroller or the like. Scanning uses one or more movable optical elements (eg, lenses 250, 260, reflecting means 270) that can be controlled by the control electronics 210 via input and output devices (not shown) as well. Can be achieved. Another scanning means may be enabled by an electro-optic deflector device (single axis or two axes) in the optical path.

  In operation, the light source 220 generates an optical beam 225 so that the reflecting means 270 can be tilted to deflect the optical beam 225 and direct the beam 225 toward the patient's eye 20. The focusing lenses 250, 260 can be used to focus the optical beam 225 onto the patient's eye 20. The positioning and characteristics of the optical beam 225 and / or the scanning pattern it forms on the eye 20 may be further controlled by using an input device such as a joystick or any other suitable user input device.

  Alternatively, the present invention may be implemented by a system 700 that performs additional ranging of the patient's eye 20, such as the system shown in FIG. System 700 includes control electronics 210, light source 220, attenuator 230, beam expander 701, optical variable beam attenuator 230, separate focus lens combination 704, and beam reflection and scanning means 270. . The light beam 225 of the light source 220 is focused to its target position 20 through the focusing lens 260. This is controlled by the electronic device 210 connected to the deflection unit 270. In addition, the autofluorescence 725 of the target structure 20 is back-scanned by a similar optical path shared with the laser light 225 by the preferred means of the dichroic beam splitter 703 and focused by the lens 720. The aperture pinhole 721 is placed at the focal point of the formed beam 725 as a conjugate of the laser beam (225) focal point in the target structure 20. The intensity of the autofluorescence transmitted through the beam aperture 721 is detected and converted into an electrical signal that can be read by the control unit 210. Also, the image of the treatment area is imaged by a lens 711 on an image capture device 710 that may be a CCD or CMOS camera. This signal is also transmitted to the control unit 210.

  In another variation of system 700, detection combination units 703, 720, 721, 722 are used for confocal detection of the back reflected light of beam 225 from sample 20.

  The basic mechanism of the different embodiments uses a 320 nm to 430 nm laser source. The ultraviolet optical spectrum is technically subdivided into three main spectral regions: UVA (400 nm to 315 nm), UVB (315 nm to 280 nm), and UVC (280 nm to 100 nm). UVB and UVC light are generally associated with carcinogenic effects due to their high single photon energy due to their ability to recombine DNA directly. Water is still permeable up to 200 nm, but protein absorption increases greatly around 240 nm. This strong absorption of proteins in the UVC spectral region is also a major absorption in corneal tissue, but has recently been used clinically to precisely excise corneal tissue in laser corneal cutting (LASIK) surgery. .

  UVC lasers have been used to ablate biological tissue through photodissociation, absorption of high energy photons to break bonds within organic molecules. A list of such general bonds is shown in the table below along with their dissociation energies listed in terms of wavelength. The shorter the wavelength, the stronger the coupling.

  From this table, Blum, et al. It is clear that high energy photons are required for photodissociation of biological materials, as discussed in US Pat. This action is the basis of many opto-medical systems, especially in ophthalmology where 193 nm excimer lasers are commonly used for cornea modification. Embodiments of the present invention utilize all the different physical phenomena and different spectral regions (UVA to green) to modify and / or ablate biological tissue, which does not exist in the prior art and has been studied. Absent.

  In one embodiment, light source 220 is a 320 nm to 430 nm laser source, such as a Nd: YAG laser source operating at a third harmonic wavelength, 355 nm. The transmissivity of the cornea at 355 nm is about 85% and begins to decline significantly at 320 nm (50% transmissivity), reaching 300 nm with a transmissivity of about 2%, while the absorption of the lens is ~ 99%. is there. In addition, for the elderly, corneal light scattering is minimal, while lens light scattering is markedly increased (cataract).

The effect of light scattering is sensitive to wavelength. If the scattering center is smaller than the wavelength used, the scattering coefficient is λ- ⁴ . For larger scatterers with a size range within the size of the wavelength, the Mie approximation is well suited to describe the scattering function. For particles having a size of 350-700 nm, the scattering coefficient is λ- ¹ . The aged lens itself absorbs all wavelengths shorter than 420 nm and is a strong scatterer. This protects the retina by effectively attenuating the light that is ultimately placed there, while shorter wavelengths can be used for laser cutting of the anterior lens, especially the lens capsule, Suggest that it works.

  A Q-switched infrared laser having an energy of a few millijoules and within the IR spectral range (1064 nm) is commonly used to treat posterior cataract opacity. They do this by providing reliable plasma formation directly behind the posterior lens capsule. These pulses produce cavitation bubbles with a size of a few millimeters and a peak pressure in the kilobar range. The mechanical influence of cavitation bubbles with a size in the millimeter range is a limiting factor for high precision cutting in liquid environments. In order to reduce bubble size and incisions with insufficient edge quality, and therefore equivalent mechanical side effects resulting in insufficient mechanical strength, the laser pulse energy must be significantly reduced. However, such interactions are well suited for lens accommodation applications.

  Q-switched green lasers with energy of a few millijoules and pulse durations of a few nanoseconds are commonly used to treat open-angle glaucoma of the eye. This therapy, called selective laser trabeculoplasty (SLT), takes advantage of the specific targeting of the melanin chromophore naturally present in the trabecular meshwork. The laser itself uses a relatively large 200 micrometer spot size to cover most of the target tissue area. The laser also creates cavitation bubbles around the melanin absorber, but this effect is due to linear heating rather than plasma formation used in posterior cataract treatment using Q-switched IR laser pulses.

  In one embodiment of the present invention, the use of UV wavelengths significantly reduces the threshold for plasma formation and associated cavitation bubble formation, but for several reasons, without absorbing cavitation bubbles, linear absorption. Also reduces the threshold energy required for enhanced photolysis. First, the diameter of the focal point varies in proportion to the wavelength that adapts the peak radiation exposure in the focal plane. Second, since more laser energy is initially absorbed by the target structure, the linear absorption of the material itself allows for even lower thresholds for plasma formation or low density photolysis. Third, the use of nanosecond and sub-nanosecond UV laser pulses allows photolysis and chromophore induced ionization enhanced by linear absorption.

  In addition, this chromophore induced ionization greatly reduces the threshold for ionization during plasma formation, and the threshold for low density photolysis for material modification or modification without cavitation, even under very weak absorption. Reduce. High fluence density greatly reduces the threshold for effect even with minimal line absorption. It has been shown that the threshold for plasma formation and cavitation bubble generation can be reduced by an order of magnitude simply by changing from high purity water to water with a physiological NADH concentration of 38 mMol (Colombelli et al., Rev. Sci). .Inst .. 2004, Vol 75, pp. 472-478). Linear absorption also allows for specific treatment of the local lens structure (eg, lens capsule) because the optical penetration depth of the laser beam is limited by the linear absorption of the lens. This is especially true for aged lenses whose absorption in the UV blue spectral region is greatly increased compared to young lenses.

  In addition, in another embodiment of the present invention, the linear absorption effect on the target structure can be further enhanced by applying an exogenous chromophore. One such useful chromophore is trypan blue, which is commonly used in surgery to stain the lens capsule when the fundus red reflex is lacking. Trypan blue also has increased linear absorption at wavelengths shorter than 370 nm. This linear absorption further reduces the energy required to produce the disclosed effect on the capsular bag surface.

This method can also be used to change the total refractive power of the human eye by:
i. Making a cut (incision) in the cornea and changing its shape to change its refractive power.
ii. Modifying the refractive index of corneal tissue to induce a change in its effective refractive power.
iii. Modifying the refractive index of the implanted artificial IOL to change its effective refractive power by writing a Fresnel lens or other such analog to the IOL material.
iv. Any combination of i, ii, and iii.

The system of the present invention utilizes 320 nm to 430 nm pulsed lasers to perform high precision physical modification of eye targets including tissues (lens, lens capsule, cornea, etc.) and artificial intraocular lens implants. Enable surgical techniques. This can be done in two different modes of operation with or without cavitation bubble formation. The subcavitation scheme can also be used to modify the refractive index of the eye target. Although the wavelength used in the present invention is shorter than or within the wavelength associated with retinal blue phototoxicity, the absorption of 320 nm to 400 nm laser light in the aged lens further causes the light to be in the lens volume. To minimize the risk of retinal damage. In addition, the risk of damaging the corneal endothelium or other corneal structures is minimized. Threshold pulse _energy, becomes ^{_{E th = Φ * d 2/}} 4, where, [Phi is a threshold radiation exposure, d is the focal diameter. Here, the focal diameter, d is d = λF / D _b , where λ is the wavelength, F is the focal length of the last focusing element, and D _b is the beam of the last lens Diameter. For stable and reproducible operation, the pulse energy should exceed the threshold at least twice, but the energy level can be adjusted to avoid damage to the corneal endothelium.

  The incident light of lasers used for ocular tissue modification generally has a wavelength of 320 nm to 430 nm, preferably 320 to 400 nm, preferably 320 to 370 nm, and more preferably 340 nm, 360 nm. In many embodiments, the laser light has a wavelength of 355 nm.

  The pulse energy of the laser pulse is generally 0.01 μJ to 500 μJ. In many embodiments, the pulse energy will be 0.1 μJ to 100 μJ, or more precisely 0.1 μJ to 40 μJ, or 0.1 μJ to 10 μJ, or 0.5 μJ to 8 μJ.

  The pulse repetition rate of the laser pulse is generally between 500 Hz and 500 kHz. In many embodiments, the pulse repetition rate is 1 kHz to 200 kHz or 1 KHz to 100 KHz.

  The laser pulse spot size is generally smaller than 10 μm. In many embodiments, the spot size is preferably less than 5 μm, typically between 0.5 μm and 3 μm. In some embodiments, the spot size is in the range of 1 μm to 2 μm.

  The pulse duration of the laser pulse is generally between 1 ps and 100 ns. In many embodiments, the pulse duration is 100 ps to 10 ns or 100 ps to 1 ns. In a preferred embodiment, the pulse duration is 300 ps to 700 ps, preferably 400 ps to 700 ps.

In some embodiments, it referred beam quality both ^{M 2} factor is 1 to 1.3. M ² factor is a common measure of beam quality of the laser beam. Briefly, the M ² factor is defined as the ratio of the actual spread of the beam to the ideal diffraction limited Gaussian TEM ₀₀ beam spread having the same waist size and position as described in ISO standard 11146.

The peak power density (irradiance) obtained by dividing the peak power of the laser pulse by the area of the focal point is generally expressed in units of GW / cm ² . In general, the peak power density (irradiance) of the laser pulse should be high enough to modify the ocular tissue being treated. As will be appreciated by those skilled in the art, peak power density (irradiance) depends on many factors, including pulse energy, pulse duration, and focal spot size. Note that wavelength indirectly affects irradiance because the minimum focal spot size for any given convergence angle is proportional to wavelength. The practical effect is that smaller focal points are more easily obtained using shorter wavelengths. In some embodiments, generally the peak power density in the range of 20GW ^/ cm ² ~2000GW ^/ cm 2 is used for cutting eye tissue using 355nm light. Note that the “peak” power density (irradiance = power per unit area) in a Gaussian beam is typically calculated using the beam diameter specified by the “1 / e of peak intensity” width. I want to be. In this case, the average pulse power is calculated from the pulse energy divided by the pulse duration at the full width half maximum point. The average irradiance in time at the geometric peak (beam center) of the intensity profile is then the power divided by the “1 / e” beam diameter. This ^is the value represented in the range of ^{20GW / cm 2 ~2000GW / cm 2} . True peak instantaneous irradiance and beam center are actually higher due to “Gaussian” like time shape of pulse power.

  The scanning range of the laser surgical system is preferably in the range of 6-10 mm.

  In many embodiments for eye tissue modification, the spot spacing between adjacent laser pulses is typically in the range of about 0.20 μm to 10 μm, preferably 0.2 μm to 6 μm.

Preferably, a numerical aperture that provides the focal point of the laser beam to be scanned across a scan range of 6 mm to 10 mm transverse to the Z axis aligned with the laser beam should be selected. The NA of the system should be in the range of less than 0.6, preferably less than 0.5, and more preferably 0.05 to 0.4, typically 0.1 to 0.3. In some specific embodiments, the NA is 0.15. For each selected NA, the preferred pulse energy range and beam quality (M ² value) required to achieve peak power density (irradiance) within the range required to cut ocular tissue. As measured). Additional considerations when selecting NA include the available laser power and pulse repetition rate, as well as the time required to make the cut. Furthermore, in selecting an appropriate NA, it is preferable to ensure that there are safe incidental exposures of the iris and other ocular tissues that are not targeted for cutting.

  FIG. 21 is a graph of laser average power (W) as a function of NA with 355 nm laser light at respective repetition rates of 70 kHz and 100 kHz. The laser power required to modify tissue as a function of NA increases as NA decreases. Thus, smaller NA values generally lead to potentially undesirable needs for larger (higher average power) lasers. As shown in FIG. 21, the average power is preferably less than about 4W.

The time required to modify the tissue, i.e. to complete the cut, is also a function of the system NA. FIG. 22 is a graph of the time required to modify tissue as a function of NA with 355 nm light, ie, “cutting time” per mm ² , at respective repetition rates of 70 kHz and 100 kHz. is there. The time required for cutting a unit area (1 mm ² ) increases with increasing NA for lower threshold energy and the resulting need for increased number of pulses. As shown in FIG. 22, increasing the NA results in longer disconnect times and tends to include lower NA systems in this regard.

In addition, these so-called “cutting times” affect the exposure of non-target tissue that is incidentally exposed during the creation of a laser cut in the eye tissue. For example, the limit of safe exposure of the iris while treating the cornea may be expressed according to the following equation:
L (J / cm ² ) = C × T ^0.75 ,
Where L is the safe limit of safe exposure, C is a constant, and T is the total exposure time for modifying the tissue. FIG. 23 is a graph of relative exposure ratio as a function of NA as a function of NA with 355 nm light at repetition rates of 70 kHz and 100 kHz, respectively. In FIG. 23, the relative exposure ratio is defined as the ratio of the actual resulting exposure divided by the exposure safety limit, L. In the relative exposure ratio of FIG. 23, the value of C is normalized to match the exposure at 0.15 NA to show the effect of different NAs on relative exposure. As shown in FIG. 22, the relative exposure ratio increases with decreasing NA.

  FIG. 24 is a graph combining FIGS. 22 and 23, ie, FIG. 24 combines cutting time and iris exposure considerations. From FIG. 24, it can be seen that there exists an optimum value at an intermediate NA in the range of 0.05 to 0.40, and preferably 0.1 to 0.3.

  Tables 1 and 2 below show typical representative laser beam parameters according to many embodiments of the present invention.

In Tables 1 and 2, θ is the divergence half angle, BP is the beam parameter product, SS is the spot size, and the area is the area of the laser spot. Here, the 1 / e ² width is equal to the distance between two points on the peripheral distribution with 1 / e ² = 0.135 × maximum value.

  An example of the results of such a system for an actual human lens is shown in FIG. A 4 μJ, 400 ps pulsed beam delivered at a 0.5 kHz pulse repetition rate from a laser operating at a wavelength of 355 nm was focused at NA = 0.15 using an irradiance of about 120 gigawatts per square centimeter. . This resulted in a capsulotomy pattern in the human lens shown in FIG. In this case, no cavitation bubbles were formed to induce cutting. This was confirmed visually under a microscope, but was also confirmed by using a hydrophone for detection of acoustic waves emitted by cavitation bubbles. For laser cataract surgery, the only precise cut of the lens itself is the capsulotomy. Due to the softening or fragmentation of the lens nucleus, the pattern does not require high spatial confinement. Thus, for this application, higher fluence and / or irradiance thresholds are acceptable even in the presence of longer pulses.

  FIG. 3 shows a flowchart of a method according to an alternative embodiment. The first step 301 involves generating a light beam from a 320 nm to 430 nm laser system. Step 302 involves translating the focused light beam in the ocular tissue in a controlled manner, thereby forming an incision. In one embodiment, the incision is made in the anterior lens capsule of the ocular tissue in performing a capsule rupture. Alternatively, the incision may be in the cornea for purposes of correcting astigmatism or for creating surgical access. For example, a transparent corneal cataract instrument and a puncture incision can be used to provide surgical access.

  Control electronics 210 and light source 220 target the surface of the target structure in eye 20 and ensure that beam 225 is focused as necessary to prevent unintentional damage to non-target tissue. Can be set to For example, diagnostic imaging methods described herein such as optical coherence tomography (OCT), Purkinje imaging, Scheinproof imaging, autofluorescence imaging, confocal autofluorescence, confocal reflection imaging, or ultrasound And techniques can be used to determine position, measure the thickness of the lens and lens capsule, and provide higher accuracy with laser focusing methods including 2D and 3D patterning. Laser focusing also includes direct observation of the aiming beam, OCT, Purkinje imaging, Scheinproof imaging, structured light irradiation, ultrasound, or other known ophthalmic or medical imaging, and / or combinations thereof, It can be achieved using one or more methods. It should be noted that the imaging depth needs to include only the forefront portion of the intraocular target, but not necessarily the entire eye or even the anterior chamber.

  In addition, the confocal reflectometry can detect whether a cavitation bubble has formed after the laser pulse and adjust the energy of subsequent laser pulses or monitor laser-induced changes in the refractive index of the tissue. In order to be possible, it can be used for adjustment of the laser energy transmitted during the procedure.

  Accordingly, a three-dimensional application of laser energy can be applied across the sac along the pattern generated by the laser-induced effect in a number of ways. For example, a laser can be used to continuously produce a scan of several circles or other patterns at different depths in a process equal to the axial length of the effect area. Thus, the depth of focus (waist) of the tissue is increased or decreased with each successive scan. The laser pulses can be applied to the same lateral at different depths of tissue, for example, using an axial scan of the focusing element, or optionally adjusting the refractive power of the focusing element while simultaneously or sequentially scanning the lateral pattern. Sequentially applied to directional patterns.

  The adverse effects of scattering of the laser beam on bubbles, cracks, and / or tissue fragments before reaching the focal point first cause pattern / focusing at the maximum required depth in the tissue and then more in subsequent passes. It can be avoided by focusing on a shallow tissue space. This “bottom-up” treatment technique not only reduces unwanted beam attenuation in the tissue on the target tissue layer, but also helps protect the underlying tissue of the target tissue layer. These defects help protect the underlying retina by scattering laser radiation transmitted beyond the focal point on bubbles, crevices and / or tissue fragments generated by previous scans. Similarly, when segmenting the lens, the laser can be focused on the last part of the lens and then moved more forward as the surgery continues.

  The present invention may be implemented by a system that projects or scans an optical beam onto a patient's eye 68, such as the system 2 shown in FIG. 2B that includes a TREATMENT light source 4 (eg, a 355 nm short pulse laser). Using this system, the beam can be scanned in the patient's eye in three dimensions: X, Y, Z. While safety limits for unintentional damage to non-target tissue indicate an upper limit for repetition rate and pulse energy, threshold energy, time to complete surgery, and stability are lower limits for pulse energy and repetition rate. Show.

  Laser 4 is controlled by control electronics 300 via input and output device 302 to provide optical beam 6. The control electronic device 300 may be a computer, a microcontroller, or the like. In this embodiment, the entire system is controlled by the controller 300 and data travels through the input / output device IO 302. A graphical user interface GUI 304 may be used to set system operating parameters, process user input (UI) 306 on the GUI 304, and display collected information such as images of eye structures.

  The generated TREATMENT light beam 6 passes through the half-wave plate 8 and the linear polarizer 10 and travels toward the patient's eye 68. The polarization state of the beam can be adjusted so that a desired amount of light passes through the half-wave plate 8 and the linear polarizer 10, and the half-wave plate 8 and the linear polarizer 10 together are a variable attenuation for the TREATMENT beam 6. Serves as a vessel. In addition, the orientation of the linear polarizer 10 determines the incident polarization state incident on the beam combiner 34, thereby optimizing the beam combiner throughput.

  The TREATMENT beam travels through the shutter 12, aperture 14, and pickoff device 16. The system controlled shutter 12 ensures laser on / off control for surgical and safety reasons. The aperture sets the effective outer diameter for the laser beam, and the pickoff monitors the output of the effective beam. The pickoff device 16 includes a partial reflector 20 and a detector 18. Pulse energy, average power, or combination can be measured using detector 18. The information can be used to feed back to the half-wave plate 8 for attenuation, or to verify whether the shutter 12 is open or closed. In addition, the shutter 12 may have a position sensor to provide redundant state detection.

  The beam passes through a beam adjustment stage 22 where beam parameters such as beam diameter, divergence, roundness, and astigmatism can be modified. In this exemplary embodiment, the beam conditioning stage 22 includes a two element beam expanding telescope comprised of spherical optical elements 24 and 26 to achieve the intended beam size and collimation. Although not illustrated herein, anamorphic or other optical systems can be used to achieve the desired beam parameters. Factors used to determine these beam parameters include the laser output beam parameters, the overall magnification of the system, and the desired numerical aperture (NA) at the treatment location. In addition, the optical system 22 can be used to image the aperture 14 at a desired location (eg, a central location between the two-axis scanning device 50 described below). In this way, the amount of light that passes through the aperture 14 is ensured to pass through the scanning system. The pickoff device 16 is a reliable measure of usable light.

  After exiting the adjustment stage 22, the beam 6 is reflected to the folding mirrors 28, 30 and 32. These mirrors may be adjustable for alignment purposes. The beam 6 is then incident on the beam combiner 34. The beam combiner 34 reflects the TREATMENT beam 6 (and transmits both the OCT 114 and aiming 202 beams described below). For efficient beam combiner operation, the angle of incidence is preferably kept below 45 degrees and the polarization of the beam is fixed if possible. For the TREATMENT beam 6, the orientation of the linear polarizer 10 provides a fixed polarization.

  Following the beam combiner 34, the beam 6 continues to a z adjustment or Z scanning device 40. In this exemplary embodiment, the z adjustment includes a Galileo telescope having two lens groups 42 and 44 (each lens group includes one or more lenses). The lens group 42 moves along the z-axis with respect to the collimating position of the telescope. Thus, the focal position of the spot in the patient's eye 68 moves along the z-axis as shown. In general, there is a linear relationship between the movement of the lens 42 and the movement of the focus. In this case, the z-adjusting telescope has a beam expansion ratio of about 2 times and a 1: 1 relationship of lens 42 movement to focus movement. Alternatively, the lens group 44 may move along the z axis to activate and scan the z adjustment. The z adjustment is a z scanning device for treatment within the eye 68. It can be controlled automatically and dynamically by the system and can be selected to be independent of or interact with the XY scanning device described next. The mirrors 36 and 38 can be used to align the optical axis with the axis of the z adjustment device 40.

  After passing through the z adjustment device 40, the beam 6 is directed to the xy scanning device by mirrors 46 and 48. The mirrors 46 and 48 may be adjustable for alignment purposes. XY scanning is accomplished by scanning device 50, preferably using two mirrors 52 and 54, under the control of control electronics 300, which can be a motor, a galvanometer, or any other known optical. Rotate orthogonally using a moving device. The mirrors 52 and 54 are located near the telecentric position of the objective lens 58 and contact lens 66 combination described below. By tilting these mirrors 52/54, they refract the beam 6 and cause a lateral displacement in the plane of the TREATMENT focus located in the patient's eye 68. Objective lens 58 may be a compound multi-element lens element as shown and may be represented by lenses 60, 62, and 64. The complexity of the lens 58 depends on the scan range size, the focal point size, the working distance available on both the proximal and distal sides of the objective lens 58, and the amount of aberration control. An example is an objective lens 58 with a focal length of 60 mm, which has an input beam size of 20 mm in diameter and operates in the range of 7 mm. Alternatively, XY scanning by the scanner 50 can be accomplished by using one or more movable optical elements (eg, lenses, diffraction gratings), which can also be used with the input and output devices 302. Via the control electronics 300.

  Aiming and treatment scan patterns can be automatically generated by the scanner 50 under the control of the controller 300. Such a pattern may consist of a single light spot, multiple light spots, a continuous light pattern, a multiple light continuous pattern, and / or any combination thereof. In addition, the aiming pattern (using the aiming beam 202 described below) need not be identical to the treatment pattern (using the light beam 6), but preferably the treatment light is for patient safety. In order to ensure that it is transmitted only within the desired target area. This can be done, for example, by having the aiming pattern provide the contour of the intended treatment pattern. Thus, if not the exact location of the individual spots themselves, the spatial extent of the treatment pattern can be known to the user, and thus the scan can be optimized for speed, efficiency and accuracy. The aiming pattern can also be recognized as blinking to further enhance its visibility to the user.

  Any contact lens 66, which can be any suitable ophthalmic lens, can be used to help further focus the optical beam 6 on the patient's eye 68 while at the same time helping to stabilize the position of the eye. . The positioning and features of the optical beam 6 and / or the scan pattern that the beam 6 forms on the eye 68 may be a joystick or any other suitable user input device (eg, GUI 304) for positioning the patient and / or optical system. ) And the like can be further controlled.

  The TREATMENT laser 4 and the controller 300 target the surface of the target structure in the eye 68 and ensure that the beam 6 is focused as needed and does not unintentionally damage non-target tissue. Can be set to For example, diagnostic imaging methods described herein such as optical coherence tomography (OCT), Purkinje imaging, Scheinproof imaging, structured light illumination, confocal back reflection imaging, fluorescence imaging, or ultrasound And techniques to determine position, measure the thickness of the lens and capsular bag, by laser focusing methods including 2D and 3D patterning, or other known ophthalmic or medical imaging and / or combinations thereof Can be used to provide high accuracy. In the embodiment of FIG. 2A, an OCT device 100 is described, but other diagnostic methods are within the scope of the present invention. An OCT scan of the eye provides information regarding the axial position of the anterior and posterior lens capsules, the boundary of the cataract nucleus, and the depth of the anterior chamber. This information is then loaded into the control electronics 300 and used to program and control subsequent laser-based surgery. The information is also used to determine a wide range of parameters related to surgery, for example, the upper and lower axial limits of the focal plane used to modify capsular capsules, corneas, and artificial intraocular lens implants, among others. Can be done.

  The OCT device 100 of FIG. 2A includes a broadband or swept light source 102 that is split into a reference arm 106 and a sample arm 110 by a fiber coupler 104. The reference arm 106 includes a module 108 that includes a reference reflection with suitable dispersion and path length compensation. The sample arm 110 of the OCT device 100 has an output connector 112 that serves as an interface to the rest of the TREATMENT laser system. The feedback signals from both the reference arm 106 and the sample arm 110 are then directed by the coupler 104 to the detection device 128, which in the following uses one of the time domain, frequency domain, or single point detection techniques. . In FIG. 2A, the frequency domain technique is used with an OCT wavelength of 920 nm and a bandwidth of 100 nm.

  As OCT beam 114 exits connector 112, it is collimated using lens 116. The size of the parallel beam 114 is determined by the focal length of the lens 116. The size of the beam 114 depends on the desired NA at the eye focus and the magnification of the beam train to the eye 68. In general, the OCT beam 114 does not require the same height NA in the focal plane as the TREATMENT beam 6, so the OCT beam 114 is smaller in diameter than the TREATMENT beam 6 at the position of the beam combiner 34. The collimating lens 116 is followed by an aperture 118 that further modifies the resulting NA of the OCT beam 114 in the eye. The diameter of the aperture 118 is selected to optimize the intensity of the OCT light incident on the target tissue and the return signal. A deflection control element 120, which may be active or dynamic, is used, for example, to compensate for changes in polarization state that can be induced by individual differences in corneal birefringence. The mirrors 122 and 124 are then used to direct the OCT beam 114 toward the beam combiners 126 and 34. The mirrors 122 and 124 may be adjustable for alignment purposes, specifically to superimpose the OCT beam 114 on the TREATMENT beam 6 after the beam combiner 34. Similarly, beam combiner 126 is used to combine OCT beam 114 with aiming beam 202 described below.

  Once the OCT beam 114 is combined with the TREATMENT beam 6 after the beam combiner 34, it follows the same path as the TREATMENT beam 6 through the rest of the system. Thus, the OCT beam 114 indicates the position of the TREATMENT beam 6. The OCT beam 114 passes through the z scanning device 40 and the xy scanning device 50, then the objective lens 58 and the contact lens 66 and enters the eye 68. Reflections and scatters of structures in the eye return through the optical system to enter the connector 112 and provide a return beam through the coupler 104 to the OCT detector 128. These return reflections provide an OCT signal that is interpreted by the system with respect to the X, Y, Z position of the focal position of the TREATMENT beam 6.

  The OCT device 100 operates on the principle of measuring the optical path length difference between its reference arm and sample arm. Thus, passing the OCT through the z adjustment 40 does not expand the z range of the OCT system 100 because the optical path length does not change as a function of 42 movement. The OCT system 100 has a unique z-range associated with the detection scheme, and in the case of frequency domain detection, it is particularly related to the position of the spectrometer and reference arm 106. For the OCT system 100 used in FIG. 2A, the z range is about 1-2 mm in an aqueous environment. Extending this range to at least 4 mm involves adjusting the path length of the reference arm in the OCT system 100. Placing the OCT beam 114 into the sample arm through the z-adjustment 40 z-scan allows optimization of the OCT signal intensity. This is accomplished by focusing the OCT beam 114 onto the target structure while adjusting the extended optical path length by proportionally increasing the path in the reference arm 106 of the OCT system 100.

  Due to the fundamental differences in OCT measurements for TREATMENT focus devices due to effects such as immersion index, refraction, and both chromatic and monochromatic aberrations, care must be taken in the analysis of OCT signals for TREATMENT beam focus positions. A calibration or alignment procedure as a function of X, Y, Z should be performed to match the OCT signal information to the TREATMENT focus position and to relate it to the absolute dimensional quantity.

  Aim beam observations can also be used to help the user direct the TREATMENT laser focus. In addition, an aiming beam that is visible to the naked eye instead of infrared OCT and TREATMENT beams can be useful for alignment provided that the aiming beam accurately represents the infrared beam parameters. The aiming subsystem 200 is used in the configuration shown in FIG. 2A. The aiming beam 202 is generated by an aiming beam light source 201 such as a helium neon laser operating at a wavelength of 633 nm. Alternatively, laser diodes in the range of 630-650 nm can be used. The advantage of using a 633 nm helium neon beam is its long coherence length, which allows the use of an aiming path as an unequal optical path laser interferometer (LAPI), for example, to measure the optical quality of a beam train To.

  It should also be noted that the TREATMENT beam can be attenuated to the nanojoule level and used instead of the OCT system described above. Such a configuration provides the most direct correlation between the position of the focal position for imaging and treatment. They are the same beam.

  In this embodiment, the same laser assembly is used for both target tissue treatment (ie, modification) and imaging. For example, the target tissue can be imaged by raster scanning a pulsed laser beam along the target tissue to provide a plurality of data points, each data point having a position for imaging the target tissue and Has strength associated with it. In some embodiments, the raster scan is selected to deliver a sparse pattern to limit patient exposure while still identifying a reasonable map of the intraocular target. In these embodiments, the spacing between at least two adjacent laser spots during a raster scan of the target tissue is greater than the spacing between adjacent laser spots in the same target tissue treatment scan. In order to image the target tissue, the treatment laser beam (ie, the laser beam having the parameters suitably selected above for tissue modification) is preferably nano-sized for imaging the structure being treated. Attenuated to joule level. An attenuated laser beam may be referred to as an imaging beam when used for imaging. In many embodiments, the treatment beam and the imaging beam may be the same except that the pulse energy of the laser source is lower than the treatment beam when the laser beam is used for imaging. In many embodiments, the pulse energy of the laser beam when used for imaging is preferably about 0.1 nJ to 10 nJ, preferably less than 2 nJ, and more preferably less than 1.8 nJ. Using the same laser beam for both treatment and imaging provides the most direct correlation between the position of the focal position for imaging and treatment. They are the same beam. This attenuated imaging beam can be used directly in a back reflection measurement configuration, but can alternatively be used indirectly in a fluorescence detection scheme. Both increases in backscatter and fluorescence within the tissue structure become evident and both approaches have advantages.

  In a preferred embodiment, the imaging of the first target region to be modified is performed sequentially with the modification of the formula in the first target range before proceeding to the second different target range, i.e. the imaging is , Sequentially with treatment within a predetermined target range. Thus, for example, imaging of the capsular bag is preferably followed by treatment of the capsular bag followed by imaging of any other structure such as the cornea or iris. In another embodiment, imaging of a first target area where a first incision is made is performed sequentially with a treatment beam for performing an incision within the first target area, after which the first incision is made. Proceeding to a second target area for performing two incisions, i.e. imaging of the area to be incised is performed sequentially with the treatment beam being scanned within the predetermined target area.

  In another embodiment, the cataract surgery includes a capsulotomy and at least one of a cataract and limbal incision. In one embodiment, imaging of the target tissue where the capsulotomy is performed is followed by a treatment scan to perform the capsulotomy, and then the treatment beam is scanned to perform the capsulotomy. Imaging of the target tissue followed by at least one of a cataract incision (CI) and a limbal incision incision (LRI) followed by a treatment beam to perform at least one of the LRI and CI. Scanned. When LRI is selected, this minimizes the likelihood that the patient will move between the imaging and the treatment, which is most important for eye movement between the imaging and the treatment / Because it is sensitive. In addition, compared to corneal and capsular incisions, the accuracy and inclusion size required for lens adjustment is much relaxed, so the present invention provides a Q-switched Nd for treatment of posterior opacity: As noted above in the discussion of using millijoule pulses from a YAG laser, it is contemplated to add a short pulse IR laser source to the lens treatment system described above. Such pulse energy results in larger inclusions, which are inadequate for sac and corneal incisions, and can result in a strong separation of the cataractous lens. NIR wavelengths are not strongly absorbed or scattered by the lens, in contrast to shorter wavelengths. This second processing source may combine its beam with the beam of the first treatment beam by another beam splitter. The large difference in wavelength makes this a fairly simple design. However, as described above with respect to FIG. 2B, that same spectral difference requires different alignment for imaging and / or ranging.

  FIG. 4 is an illustration of a line pattern applied across the lens for OCT measurement of the axial profile of the anterior chamber of the eye 20. OCT imaging of the anterior chamber of the eye 20 can be performed along a simple linear scan across the lens, using the same laser and / or the same scanner used to generate the pattern for cutting. This scan provides information regarding the axial position of the anterior and posterior lens capsules, the boundaries of the cataract nucleus, and the depth of the anterior chamber. This information can then be loaded into a laser scanning system and used to program and control subsequent laser-based surgery. Information is used, for example, to determine a wide range of parameters related to surgery, such as the upper and lower axial limits of the focal plane for capsular cutting and lens cortex and nucleus division, capsular capsule thickness, among others. Can be done.

  5-9 illustrate different aspects of one embodiment of the present invention, which may be implemented using the system 200 described above. As shown in FIG. 5, a capsule breaching incision 400 (which can be made using system 200) is adjusted for an astigmatism correcting intraocular lens (IOL). Such an astigmatism correction IOL not only needs to be placed in the correct position within the sac 402 of the eye 20, but also needs to be oriented at the correct rotation / clocking angle. Thus, they have an inherent rotational asymmetry, unlike spherical IOLs. The incision 400 shown in this example is oval, but other shapes are also useful. The incision 400 may be made continuously or may be made piecewise to primarily maintain the structural integrity of the lens capsule organ of the patient's eye 20.

  Such incomplete incisions 400 can be considered as perforation incisions and can be made to be gently removed to minimize the likelihood that they will inadvertently spread the rupture of the capsule. In any case, the incision 400 is an enclosed incision, which for the purposes of this disclosure means starting and ending at the same location and surrounding a certain amount of tissue inside. The simplest example of an enclosed incision is a circular incision, in which a round piece of tissue is surrounded by the incision. Thus, the encapsulated treatment pattern (ie, generated by the system 200 for forming an encapsulated incision) results in a pattern that begins and ends at the same location, thereby defining a space to be enclosed.

  One important feature of the encapsulated incision 400 is that it includes an alignment feature that orients the IOL disposed therein. With respect to the illustrated oval incision 400, its oval shape is its alignment feature, which allows precise placement of the IOL due to its inherent rotational asymmetry, unlike the desired circular result of manual CCC. . The elliptical major axis 404 and minor axis 406 of the incision 400 are shown. The major axis 404 and the minor axis 406 are not equal. The incision 400 is shown in this example in the plane of the iris and its major axis 404 is shown to be located along the horizontal, but can be made at any rotational angle with respect to the patient's eye 20. Incision 400 is intended to match one or more complementary alignment features on the IOL. System 200 can be used to precisely define the surface of sac 402 to be incised. This serves to nominally isolate the laser pulses in the vicinity of the target capsule 402 itself, thereby minimizing the energy and treatment time required, and proportional to patient safety and overall efficiency. Can be increased.

  As shown in FIG. 6, the IOL 408 includes an optical portion 410 that is used to focus the light, and a haptic 416 that is used to position the IOL 408. The optic 410 is a rotationally asymmetric lens (about its optic axis) that includes complementary alignment features that coincide with the oval outer peripheral side wall or edge 412, the oval incision 400. In this embodiment, the elliptical edge 412 includes a major axis 418 and a minor axis 420. The major axis 418 and the minor axis 420 are not equal. The IOL 408 further includes a surface 414 that holds the haptic element 416 and secures the optic 410 of the intraocular lens 408 with the capsule 402 in the proper orientation and position within the capsule 402 of the patient's eye 20. Provides a stationary position for Although surface 414 is shown as an ellipse, it need not be.

  The haptic 416 may serve to secure the edge 412 of the intraocular lens 408 within the incision 400 by providing stability and applying a retention force toward the anterior portion of the sac 402. The haptic part 416 can be arranged in any orientation. The cylindrical correction orientation of the optical portion 410 of the intraocular lens 408 can be matched to either its long axis 418 or its short axis 420. In this manner, the intraocular lens IOL 408 and the optic 410 may be manufactured in a standardized manner, with the rotational orientation of the incision 400 and the spherical and cylindrical light intensity of the optic 410 being adapted to the individual eye 20 of the patient Can be varied to suit the optical formulation of

  FIG. 7 shows the proper and immediate placement of the intraocular lens 408 once installed in the sac 402 with the matching alignment feature edge 412 and incision 400 engaged and resting on the surface 414. . The major axis 404 and the major axis 418 are not equal in length. The short axis 406 and the short axis 420 are not the same length. This is done to accommodate the fact that the sac 402 can contract shortly after the capsule breaching incision. These axial length differences are intended to allow the sac 402 to contract and still allow the intraocular lens 408 to be better positioned within the sac 402 through the incision 400. The These differences should be limited to allow reasonable contraction, but not to allow significant rotation of the intraocular lens 408. Typical values for these length differences may be, for example, in the range of 100 μm to 500 μm.

  FIG. 8 shows a side view of the same intraocular lens 408 shown in FIGS. In this schematic illustration, the edge 412 is shown on the same side of the optical portion 410 as the surface 424 of the intraocular lens 408. The surface 422 of the intraocular lens 408 serves to maintain the integrity of the fit between the edge 412 and the incision 400. Edge 412 is seen as a protrusion on surface 422 in the alternative views shown in FIGS. An optical axis 411 of the optical unit 410 is shown. The haptic part 416 is located along the line of sight in this figure.

  FIG. 9 is a side view of the lens configuration of FIG. 8, but rotated 90 degrees to show that the display surface 426 is not curved in either direction (ie, formed as a cylindrical lens). This cylindrical or annular optical system of the optical section 410 provides a cylindrical correction for astigmatism of the patient. The haptic part 416 is positioned perpendicular to the line of sight in this figure.

  As shown in FIG. 15, the system can be used, for example, to modify the structure of corneal tissue without producing the cavitation bubbles shown in FIG. These corneal tissue modifications can be used to shape the refractive index profile of the cornea 504 itself, as shown in FIG. A number of small local modifications 822 can be induced in the cornea, which change the refractive profile by altering not only the refractive index itself, but also the mechanical strength of the corneal tissue. Thus, not only refractive index changes, but also corneal topography changes can be used. This is accomplished by utilizing the beam deflection unit 270 and the focus shift unit 704 through the focusing unit 260 to tightly control the lateral spacing of the laser effect.

  As shown in the drawings for purposes of illustration, methods and systems have been disclosed for performing physical modifications (structural changes) or incisions in ocular tissue. In various embodiments, the methods and systems disclosed herein provide many advantages over current standard treatments. Specifically, rapid and precise opening in the lens capsule is possible using a 320 nm to 430 nm laser, which promotes intraocular lens placement and stability. However, changing the refractive power of the corneal tissue is also possible by locally changing the refractive index and reshaping the corneal topography.

  Without further analysis, the above provides the current knowledge, without omitting the features that others constitute, from a prior art point of view, a substantial feature of the general or specific aspects of the present invention. The main point of the concept of the present invention is fully clarified that, by application, it can be easily adapted to various uses. Accordingly, such uses are to be understood as being within the meaning and scope of the equivalents of the following claims. Although the invention has been described with reference to certain specific embodiments, other embodiments that are apparent to those skilled in the art are also within the scope of the invention.

  All patents and patent applications listed herein are hereby incorporated by reference in their entirety.

  In the context of describing the present invention (especially in the context of the following claims), the use of the terms “a”, “an”, and “the”, and similar indicators, are Unless otherwise indicated, or unless clearly contradicted by context, this shall be interpreted to include both the singular and plural. The terms “comprising”, “having”, “including”, and “including” are to be interpreted as open-ended terms unless otherwise specified (ie, including, but not limited to, “ means). The term “connected” shall be construed to be contained, attached or coupled together, partially or completely within, even in the presence of something intervening. The recitation of value ranges herein is intended only to serve as a concise way of referring individually to each distinct value in the range, unless otherwise indicated herein. The values of are incorporated herein as if they were individually listed herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of all examples or exemplary languages (eg, “etc.”) provided herein are intended only to better describe embodiments of the invention and are recited in the claims below. No limitation is imposed on the scope of the invention to be made. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.

  While certain specific embodiments of the present disclosure have been shown and described in illustrative forms having a certain degree of specificity, those skilled in the art will appreciate that the embodiments are provided by way of example only and that the spirit of the invention It will be understood that various modifications may be made without departing from the scope. Accordingly, this disclosure is intended to embrace all modifications, alternative constructions, alterations, substitutions, alterations and parts that fall within the spirit and scope of the invention as generally represented by the following claims and their equivalents. It is intended to encompass combinations and arrangements of structures and processes.

Embodiment
(1) A system for ophthalmic surgery of a patient's eye,
320 nanometer to 370 nanometer wavelength, 1 picosecond to 100 nanosecond pulse duration, and 0 to photolyse one or more intraocular targets in the eye using chromophore absorbance A laser source configured to deliver an ultraviolet laser beam comprising a plurality of ultraviolet laser pulses having a pulse energy of .01 microjoules to 500 microjoules;
From the group consisting of a cornea, a rim, a sclera, a lens capsule, a lens, and an artificial intraocular lens implant in a pattern that is operably coupled to the laser source and focuses the ultraviolet laser beam into a focus. An optical system configured to direct to the one or more intraocular targets selected, wherein the pulse energy, the pulse duration, and the focal point are the ultraviolet laser at the focal point The beam irradiance is sufficient to photolyze the one or more intraocular targets using chromophore absorbance without exceeding the threshold of plasma formation and associated cavitation events. Configured,
At the numerical aperture providing the focal point of the laser beam for scanning the ultraviolet laser beam across a scanning range of 6 mm to 10 mm transverse to the Z axis aligned with the laser beam, the optical system A system that is focused on one or more intraocular targets.
(2) The system according to embodiment 1, wherein the wavelength is 355 nm.
(3) The system of embodiment 1, wherein the pulse duration is between 400 picoseconds and 700 picoseconds.
(4) The system according to embodiment 1, wherein the numerical aperture of the system is 0.05 to 0.4.
(5) The system according to embodiment 1, wherein the pulse energy is 0.5 microjoules to 10 microjoules.

(6) The system of embodiment 1, wherein the plurality of laser pulses have a repetition rate of 500 hertz to 500 kilohertz.
7. The system of embodiment 1, wherein the focal spot diameter is 0.5 to 10 micrometers (0.5 to 10 microns) within the one or more intraocular targets. .
(8) The pattern is one or more corneal extension incisions, one or more limbal extension incisions, one or more astigmatic correction corneal incisions, one or more One or more in the one or more intraocular targets in a configuration selected from the group consisting of: a corneal valve, one or more corneal implant shapes, and one or more capsulotomy The system of embodiment 1, configured to make two or more incisions.
(9) The system of embodiment 1, wherein the refractive index of the modified target is altered.
(10) The system of embodiment 1, wherein the irradiance is 120 gigawatts or less per square centimeter.

(11) connected to the laser source and optical system by a controller and configured to confocally detect back reflected light from the at least one or more intraocular targets; and (1) the target Further comprising an imaging system configured to locate the structure and (2) monitor the occurrence of cavitation events associated with plasma formation;
The system of embodiment 1, wherein detection of a cavitation event results in a reduction of the pulse energy of a subsequent laser pulse to avoid cavitation.
(12) The pattern includes a section in the Z-axis aligned with the laser beam, and the optical system comprises an XY scanning device and a Z scanning device, the Z scanning device comprising the laser Operable to automatically move the focus along the section in the z-axis aligned with a beam, the XY scanning device focusing the focus in a direction transverse to the z-axis. 2. The system of embodiment 1, wherein the system is operable to move and the laser beam propagates in the Z scanning device before propagating to the XY scanning device.
(13) The system according to embodiment 1, wherein the numerical aperture is 0.15.
(14) Coupled to the laser source and optical system by a controller and confocally detecting back reflected light from the at least one or more intraocular targets, thereby the one or more An imaging system configured to acquire image data corresponding to the intraocular target of
The system of claim 1, wherein the controller is configured to automatically generate a treatment scan pattern based at least in part on the image data.
(15) A system for ophthalmic surgery of a patient's eye,
A laser source configured to deliver an ultraviolet laser beam comprising a plurality of ultraviolet laser pulses having a wavelength, a pulse duration, and a pulse energy, wherein the plurality of ultraviolet laser pulses is between 320 and 370 nanometers. A laser source having a wavelength and photodegrading one or more intraocular targets in the eye using chromophore absorbance;
From the group consisting of a cornea, a rim, a sclera, a lens capsule, a lens, and an artificial intraocular lens implant in a pattern that is operably coupled to the laser source and focuses the ultraviolet laser beam into a focus. An optical system configured to direct to the one or more intraocular targets selected, wherein the pulse energy, the pulse duration, and the focal point are the ultraviolet laser at the focal point The beam irradiance is sufficient to photolyze the one or more intraocular targets using chromophore absorbance without exceeding the threshold of plasma formation and associated cavitation events. Configured,
The system, wherein the ultraviolet laser beam is focused by the optical system onto the one or more intraocular targets at a numerical aperture of less than 0.6.

(16) The system according to embodiment 15, wherein the numerical aperture of the system is 0.05 to 0.4.
17. The system of embodiment 15, further comprising a second laser source configured to fragment the lens using a wavelength between 800 nanometers and 1100 nanometers.
(18) coupled to the laser source and optical system by a controller and configured to confocally detect back-reflected light from the at least one or more intraocular targets, and further to position the target structure 16. The system of embodiment 15, further comprising an imaging system configured to identify the.
(19) The system according to embodiment 15, wherein the numerical aperture is 0.15.
(20) coupled to the laser source and optical system by a controller and confocally detecting back reflected light from the at least one or more intraocular targets, thereby the one or more An imaging system configured to acquire image data corresponding to the intraocular target of
16. The system of embodiment 15, wherein the controller is configured to automatically generate a treatment scan pattern based at least in part on the image data.

Claims (20)

A system for ophthalmic surgery of a patient's eye,
320 nanometer to 370 nanometer wavelength, 1 picosecond to 100 nanosecond pulse duration, and 0 to photolyse one or more intraocular targets in the eye using chromophore absorbance A laser source configured to deliver an ultraviolet laser beam comprising a plurality of ultraviolet laser pulses having a pulse energy of .01 microjoules to 500 microjoules;
From the group consisting of a cornea, a rim, a sclera, a lens capsule, a lens, and an artificial intraocular lens implant in a pattern that is operably coupled to the laser source and focuses the ultraviolet laser beam into a focus. An optical system configured to direct to the one or more intraocular targets selected, wherein the pulse energy, the pulse duration, and the focal point are the ultraviolet laser at the focal point The beam irradiance is sufficient to photolyze the one or more intraocular targets using chromophore absorbance without exceeding the threshold of plasma formation and associated cavitation events. Configured,
At the numerical aperture providing the focal point of the laser beam for scanning the ultraviolet laser beam across a scanning range of 6 mm to 10 mm transverse to the Z axis aligned with the laser beam, the optical system A system that is focused on one or more intraocular targets.   The system of claim 1, wherein the wavelength is 355 nm.   The system of claim 1, wherein the pulse duration is between 400 picoseconds and 700 picoseconds.   The system of claim 1, wherein the numerical aperture of the system is 0.05 to 0.4.   The system of claim 1, wherein the pulse energy is between 0.5 microjoules and 10 microjoules.   The system of claim 1, wherein the plurality of laser pulses have a repetition rate of 500 hertz to 500 kilohertz.   The system of claim 1, wherein the focal spot diameter is 0.5 to 10 micrometers (0.5 to 10 microns) within the one or more intraocular targets.   The pattern is one or more corneal extension incisions, one or more limbal extension incisions, one or more astigmatic keratotomy, one or more corneal valves One or more in the one or more intraocular targets in a configuration selected from the group consisting of one or more corneal implant shapes and one or more capsulotomy The system of claim 1, wherein the system is configured to make an incision.   The system of claim 1, wherein the refractive index of the modified target is altered.   The system of claim 1, wherein the irradiance is 120 gigawatts per square centimeter or less. Coupled to the laser source and optical system by a controller and configured to confocally detect back reflected light from the at least one or more intraocular targets; and (1) position of the target structure And (2) further comprising an imaging system configured to monitor the occurrence of cavitation events associated with plasma formation;
The system of claim 1, wherein detection of a cavitation event results in a reduction of the pulse energy of subsequent laser pulses to avoid cavitation.   The pattern includes a section in the Z-axis that is aligned with the laser beam, and the optical system comprises an XY scanning device and a Z scanning device, the Z scanning device being aligned with the laser beam. And is operable to automatically move the focus along the section in the z-axis so that the XY scanning device moves the focus in a direction transverse to the z-axis. The system of claim 1, wherein the laser beam propagates in the Z scanning device before propagating to the XY scanning device.   The system of claim 1, wherein the numerical aperture is 0.15. Coupled to the laser source and optical system by a controller and confocally detecting back reflected light from the at least one or more intraocular targets, thereby providing the one or more intraocular Further comprising an imaging system configured to obtain image data corresponding to the target;
The system of claim 1, wherein the controller is configured to automatically generate a treatment scan pattern based at least in part on the image data. A system for ophthalmic surgery of a patient's eye,
A laser source configured to deliver an ultraviolet laser beam comprising a plurality of ultraviolet laser pulses having a wavelength, a pulse duration, and a pulse energy, wherein the plurality of ultraviolet laser pulses is between 320 and 370 nanometers. A laser source having a wavelength and photodegrading one or more intraocular targets in the eye using chromophore absorbance;
From the group consisting of a cornea, a rim, a sclera, a lens capsule, a lens, and an artificial intraocular lens implant in a pattern that is operably coupled to the laser source and focuses the ultraviolet laser beam into a focus. An optical system configured to direct to the one or more intraocular targets selected, wherein the pulse energy, the pulse duration, and the focal point are the ultraviolet laser at the focal point The beam irradiance is sufficient to photolyze the one or more intraocular targets using chromophore absorbance without exceeding the threshold of plasma formation and associated cavitation events. Configured,
The system, wherein the ultraviolet laser beam is focused by the optical system onto the one or more intraocular targets at a numerical aperture of less than 0.6.   The system of claim 15, wherein the numerical aperture of the system is 0.05 to 0.4.   The system of claim 15, further comprising a second laser source configured to fragment the lens using a wavelength between 800 nanometers and 1100 nanometers.   Coupled to the laser source and optical system by a controller and configured to confocally detect back reflected light from the at least one or more intraocular targets and further locate the target structure The system of claim 15, further comprising an imaging system configured as described above.   The system of claim 15, wherein the numerical aperture is 0.15. Coupled to the laser source and optical system by a controller and confocally detecting back reflected light from the at least one or more intraocular targets, thereby providing the one or more intraocular Further comprising an imaging system configured to obtain image data corresponding to the target;
The system of claim 15, wherein the controller is configured to automatically generate a treatment scan pattern based at least in part on the image data.

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