JP5487470B2 - Rear scleral curing device - Google Patents

Description

  The present invention relates to a posterior scleral sclerosis apparatus and is suitable for treatment of intensity myopia and staphyloma in the fundus.

  Conventionally, a treatment method for keratoconus has been disclosed in which the cornea to which riboflavin is administered is irradiated with ultraviolet rays to induce a cross-linking reaction of collagen in the cornea to increase the hardness of the cornea (Non-patent Document 1). reference).

  The sclera has a structure embedded in collagen fibers in the same manner as the cornea, so that it is cured when the sclera to which riboflavin is administered is irradiated with ultraviolet rays. The sclera is a film that wraps the eyeball as shown in FIG.

  If the sclera is cured, it is considered that the extension of the eye axis is suppressed, and pathological conditions such as intense myopia and staphyma are avoided or alleviated. That is, hardening of the sclera in the back of the eye can be expected as one of useful myopia treatment methods. At present, no myopia treatment that is useful for posterior staphyloma has been found.

Gregor Wollensak, MD, Eberhard Spoerl, PhD and Theo Seiler, PhD, MD, “Riboflavin / Ultraviolet-A-induced Collagen Crosslinking for the Treatment of Keratoconus”, American Journal of Ophthalmology, Vol. 135, NO.5, (2003) p620 -p627

  However, when irradiating ultraviolet rays from the cornea side to the posterior sclera, the ultraviolet rays are absorbed by the cornea, so that it is essential to increase the intensity of the ultraviolet rays to the extent that it reaches the posterior sclera. However, when the light intensity is increased, the retina and the like are damaged, which is not suitable as one of useful myopia treatment methods.

  Therefore, it becomes a problem to be able to cure the posterior sclera by irradiating light to the posterior sclera without passing through the cornea.

  In order to solve such a problem, the present invention is a posterior scleral curing device, a light source for irradiating light having a wavelength corresponding to the absorption characteristics of a sensitizer involved in collagen cross-linking reaction, and a sheet-like shape for transmitting light A transmission portion, an irradiation portion that radiates forward light guided to the side of the plate from the transmission portion, and a wire that surrounds the side of the irradiation portion and extends along the side of the transmission portion. Have.

  In addition, the present invention is a posterior scleral sclerosis device, which is involved in a collagen cross-linking reaction centering on an LED that emits guide light that can be observed by a device that observes a posterior site inside the eyeball from the side facing the cornea. A plate-like LED chip in which LEDs that emit light having a wavelength corresponding to the absorption characteristic of the sensitizer are arranged in a grid, and a wire that surrounds the side of the LED chip and extends in a direction away from the LED chip And a cooling mechanism for heat generated in the LED chip.

  When the irradiation unit or the LED chip is arranged in the posterior site via the living body from the outside of the eyeball, it is preferable that the distance from the outside of the eyeball to the posterior site is the shortest in terms of reducing the burden on the patient. The distance will go through a path along the surface to the eyeball.

  In this posterior region observing apparatus, the transmission unit to be inserted into the living body is in the form of a sheet, and the irradiation unit or LED chip is in the shape of a plate. The irradiation unit or the LED chip can be quickly arranged, and as a result, the burden on the patient can be reduced.

  On the other hand, the tissue in the vicinity of the surface of the eyeball is interspersed with fibers, but since the wire surrounding the side of the member to be inserted into the living body reinforces, the irradiation part or the LED chip is attached to the posterior region of the eye. It becomes possible to distribute quickly and easily. In addition, since the wire maintains the bending state of the optical fiber according to the curvature of the eyeball, it is possible to keep the angle and distance of the irradiated part with respect to the affected part constant. As a result, the irradiation amount per unit time to the affected part is constant. It becomes possible.

It is a figure which shows roughly the structure of the eye in a human. It is a figure which shows the structure of a treatment system roughly. It is a graph which shows the absorption spectrum of riboflavin. It is a figure which shows the arrangement | positioning state of an optical fiber roughly. It is a figure which shows the structure of an irradiation part schematically. It is a figure which shows the partial photograph of the 2 wavelength fiber bundle 23 and the irradiation part 15. FIG. It is a figure which shows a coating film schematically. It is a flowchart which shows a back part scleral hardening procedure. It is a figure which shows schematically the structure (1) of the optical transmission part in other embodiment. It is a figure which shows schematically the structure (2) of the optical transmission part in other embodiment. It is a figure which shows schematically the in-vivo insertion part in other embodiment. It is a figure which shows roughly the structure (1) of the rear part scleral hardening apparatus in other embodiment. It is a figure which shows roughly the structure (2) of the rear part scleral hardening apparatus in other embodiment.

Hereinafter, modes for carrying out the invention will be described. The description will be in the following order.
<1. Embodiment>
[1-1. Configuration of treatment system]
[1-2. Configuration of rear scleral curing device]
[1-3. Rear scleral curing procedure]
[1-4. Effect]
<2. Other embodiments>

<1. Embodiment>
[1-1. Configuration of treatment system]
In FIG. 2, the treatment system 1 is shown. The treatment system 1 includes a posterior eye region observation device 2 and a posterior scleral curing device 3.

  The posterior region observation apparatus 2 can observe the posterior region inside the eyeball from the side facing the cornea. A specific example is a fundus mirror.

  The posterior scleral curing device 3 can irradiate the sclera with ultraviolet rays without going through the retina.

[1-2. Configuration of rear scleral curing device]
In this embodiment, the rear scleral curing device 3 includes a curing induction light source 11, an illumination light source 12, a light source control unit 13, a light transmission system 14, and an irradiation unit 15, as shown in FIG. .

  The curing induction light source 11 irradiates light including a wavelength corresponding to the absorption characteristic of riboflavin involved in collagen cross-linking reaction (hereinafter also referred to as curing induction light). As is clear from FIG. 3, riboflavin has an absorption characteristic having peaks at approximately 260 [nm], 365 [nm], and 445 [nm]. Therefore, for example, an LED (Light Emitting Diode) or LD (Laser Diode) having a center wavelength in the wavelength range of 360 [nm] to 460 [nm] is applied as the curing inducing light source 11.

  At present, it is difficult to obtain an LED (Light Emitting Diode) or LD (Laser Diode) having a central wavelength in the range of 250 [nm] to 270 [nm]. However, when irradiating light in this wavelength range, for example, the curing-inducing light source 11 that irradiates light having a wavelength of about 266 [nm] using the nonlinear optical effect (Second Harmonic Generation) of a DPSS (semiconductor excited solid) green laser. Applicable.

  The illumination light source 12 emits light that can be observed by the posterior site observation device 2 (hereinafter also referred to as guide light). Specifically, the illumination light source 12 having a center wavelength in the wavelength range of 500 [nm] to 800 [nm], which is unlikely to cause an unnecessary photochemical reaction in the eyeball and has high transmittance to the eyeball, is applied.

  In addition, since the amount of scattering is reduced as the wavelength is longer, it is more preferable to have the center wavelength in the wavelength range of 700 [nm] to 800 [nm] from the viewpoint of transparency to the eyeball. However, when the posterior site observation apparatus 2 has sensitivity to near infrared light in addition to visible light, the illumination light source 12 that irradiates near infrared light is applicable.

  The light source control unit 13 varies the irradiation timing, the light amount, and the wavelength of the irradiation light with respect to the curing inducing light source 11 or the illumination light source 12 based on information set by an operation with an operation unit (not shown). It has been made so that it can.

  The optical transmission system 14 can be divided into a system 14A for transmitting curing induction light, a system 14B for transmitting guide light, and a system 14C for transmitting curing induction light and guide light.

  In the system 14A for transmitting the curing-inducing light, a bundle of 18 optical fibers (hereinafter also referred to as a curing-induced optical fiber bundle) 21 is used. One end of the curing inducing optical fiber bundle 21 is connected to the curing inducing light source 11 and the other end is connected to a first input end of the optical connector LCN.

  In the system 14B for transmitting guide light, one optical fiber (hereinafter also referred to as guide optical fiber) 22 is used. One end of the guide optical fiber 22 is connected to the illumination light source 12, and the other end is connected to a second input end of the optical connector LCN.

  In the system 14C for transmitting the curing induction light and the guide light, a bundle of optical fibers (hereinafter also referred to as a two-wavelength fiber bundle) 23 corresponding to the input end of the optical connector LCN is used. One end of the two-wavelength fiber bundle 23 is connected to the output end of the optical connector LCN, and the other end is connected to the irradiation unit 15.

  Since the two-wavelength fiber bundle 23 is introduced along the outer periphery (surface) of the eyeball, flexibility is required. Therefore, each optical fiber in the two-wavelength fiber bundle 23 is a plastic fiber having strength against bending as compared with a glass fiber.

  The fiber diameter is preferably 1 [mm] or less, but the smaller the fiber diameter, the worse the transmission efficiency. Therefore, from the viewpoint of satisfying both flexibility and transmission efficiency, it is preferable to select the fiber diameter from 200, 400, 600, or 800 [μm] according to the number of the two-wavelength fiber bundles 23.

  The types of the optical fibers in the curing-induced optical fiber bundle 21 and the guide optical fibers 22 are not particularly limited. However, plastic fibers are preferable from the viewpoint of bending strength and flexibility, and quartz glass fibers are preferable from the viewpoint of long-distance transmission of ultraviolet rays.

  Further, since the two-wavelength fiber bundle 23 is introduced along the outer periphery (surface) of the eyeball, it is required to reduce the burden on the patient. Therefore, as shown in FIG. 4 (A), in the two-wavelength fiber bundle 23, the previous part (hereinafter also referred to as the in vivo insertion part) BIP to be inserted into the living body is orthogonal to the transmission direction. It is arranged in a line in the direction to form a sheet.

  Based on the anatomical knowledge of the eyeball portion, this in vivo insertion portion BIP has a width (length in the row direction) of 5 [mm] or more and 10 [mm] or less, and a thickness of 2 [mm] or less, preferably Is preferably 1 [mm] or less from the viewpoint of reducing the burden on the patient.

  Further, the arrangement of the optical fibers in the two-wavelength fiber bundle 23 up to the in-vivo insertion section BIP is, for example, as shown in FIG. 4B, and the arrangement of the optical fibers in the in-vivo insertion section BIP is, for example, in FIG. It is in the state shown.

  4B and 4C, among the optical fibers in the two-wavelength fiber bundle 23, the position of the optical fiber corresponding to the guide optical fiber 22 is the center position of the width of the in-vivo insertion portion BIP. The As a result, it is possible to transmit the guide light to the center of the irradiation unit 15 without crossing the optical fibers in the two-wavelength fiber bundle 23.

  The irradiation unit 15 is configured to uniformly irradiate curing-inducing light and guide light transmitted from the light transmission system 14. Specifically, as shown in FIGS. 5A to 5C, the reflecting panel 31, the light guide plate 32, and the diffusion plate 33 are sequentially stacked to form a disk shape. The front end of each optical fiber in the two-wavelength fiber bundle 23 is brought into contact with the side surface of the light guide plate 32.

  Based on the anatomical knowledge of the eyeball portion, the irradiation unit 15 reduces the burden on the patient when the diameter is 10 [mm] or less and the thickness is 2 [mm] or less, preferably 1 [mm] or less. It is more preferable from the viewpoint of.

  The reflection panel 31 reflects light, which is scattered from the side of the light guide plate 32, scattered backward with respect to the irradiation surface (diffusion plate 33) to the irradiation surface.

  The light guide plate 32 guides light incident from the light guide plate 32 to the diffusion plate 33 by V-line-shaped grooves formed at predetermined intervals with respect to the surface facing the reflection panel 31. Note that the surface facing the reflective panel 31 may be formed by sand surface polishing.

  The diffusion plate 33 is light guided from the light guide plate 32 by a V-line-shaped groove formed in a state orthogonal to the V-line-shaped groove in the light guide plate 32 with respect to the surface facing the light guide plate 32. Is spread evenly forward.

  The connection portion between the side surface of the light guide plate 32 and the tip of each optical fiber in the two-wavelength fiber bundle 23 is fixed to the outer periphery of the tip of the two-wavelength fiber bundle 23 with the tip of the optical fiber in contact with the side surface. The reinforcing member 34 is bonded.

  Therefore, the durability of the optical fiber at the connection portion with the light guide plate 32 is improved as compared with a case where a connection structure in which the tip portion of the optical fiber is inserted into one side surface of the light guide plate 32 is employed. For example, an acrylic material such as polymethyl methacrylate resin (PMMA: Polmethyl Methacrylate) is applied to the reinforcing member 34.

  As shown in FIG. 5D, the reinforcing member 34 has one optical fiber in the two-wavelength fiber bundle 23 in a V-line-shaped groove formed on the opposing surface of the two acrylic plates 34A and 34B. In a sandwiched state, the two-wavelength fiber bundle 23 is fixed to the outer periphery of the tip. Therefore, the durability of the optical fiber at the connection portion with the light guide plate 32 is further improved.

  However, since a substantial strength is maintained even when a hole having an optical fiber diameter is provided on one side surface of the light guide plate 32 and the tip portion of the optical fiber is inserted into the hole, the reinforcing member 34 is omitted. However, it has been confirmed that there is virtually no problem.

  Here, the photograph which shows the real thing of the 2 wavelength fiber bundle 23 (in-vivo insertion part BIP) in the back part scleral hardening apparatus 3 and the irradiation part 15 is shown in FIG. In this FIG. 6, as can be seen from the comparison with the diameter of one fiber, the two-wavelength fiber bundle 23 and the irradiating portion 15 are formed in a thin plate shape.

  By the way, in-vivo insertion part BIP and irradiation part 15 in this embodiment are covered with a thin cover member (hereinafter also referred to as a coating film) 41 as shown in FIG. The material of the coating film 41 is a material that is biocompatible, sterilizable, and transparent, such as silicon rubber. In addition, when it is set as the exchangeable structure, it is not necessary to be able to sterilize.

  In addition, a U-shaped wire 42 is provided inside the covering film 41 so as to surround the side of the in-vivo insertion part BIP and the irradiation part 15. In this embodiment, the wire diameter is 0.6 [μm].

[1-3. Rear scleral curing procedure]
Next, the rear scleral curing procedure will be described with reference to the flowchart of FIG.

  As a first step, a riboflavin solution is administered to the eyeball (affected area), for example, 5 minutes before the start of irradiation with curing-inducing light.

  As a second stage, the in vivo insertion part BIP is introduced along the outer periphery (surface) of the eyeball so that the irradiation part 15 is arranged in the posterior region of the eye. The in-vivo insertion portions BIP are arranged in a line in a direction orthogonal to the transmission direction and have a sheet shape. Therefore, at this stage, it is possible to bend flexibly according to the curvature of the eyeball, and to reduce the burden on the patient. As a result, the irradiation unit 15 can be quickly and easily arranged with respect to the posterior segment of the eye.

  As a third stage, the irradiation unit 15 is aligned with the affected part. Specifically, the light source control unit 14 is operated so as to drive only the illumination light source 12, and the in vivo insertion unit BIP is moved while observing the guide light emitted from the illumination light source 12 with the posterior site observation device 2. . The irradiation unit 15 irradiates guide light from the center of the irradiation surface. Accordingly, at this stage, not only the affected part can be visually recognized, but also the irradiation part 15 can be accurately positioned on the affected part using the guide light as a reference for alignment.

  As a fourth stage, the sclera in the affected area at the posterior segment of the eye is cured. Specifically, the light source control unit 14 is operated so as to drive only the curing inducing light source 11, and for example, irradiation of curing inducing light having a wavelength of 350 to 450 [nm] and a power of 3 [mW / cm2] is performed at a predetermined interval. Repeat every 5 minutes.

  In the rear scleral curing device 3, the in vivo insertion part BIP and the irradiation part 15 are covered with a coating film 41, and the inside of the coating film 41 is lateral to the in vivo insertion part BIP and the irradiation part 15. A U-shaped wire 42 is provided so as to surround. Therefore, at this stage, the curved state of the optical fiber according to the curvature of the eyeball is maintained, and the angle and distance of the irradiation unit 15 with respect to the affected part can be kept constant. As a result, the dose per unit time for the affected area can be made constant.

  In addition, the above-mentioned back scleral hardening procedure is an example to the last, and is not limited to this procedure.

[1-4. Effect]
In the above configuration, the posterior site observation device 2 emits curing-inducing light having a wavelength corresponding to the absorption characteristics of riboflavin from the curing-inducing light source 11 (see FIGS. 2 and 3), and a direction orthogonal to the transmission direction. Transmission is performed by a sheet-like optical fiber bundle 23 arranged in a row (see FIG. 4). Then, the posterior site observation device 2 uniformly irradiates the curing induction light guided from the side of the irradiation unit 15 by the optical fiber bundle 23 from the front irradiation surface (see FIG. 5).

  When the irradiation unit 15 is arranged from the outside of the eyeball to the posterior site via the inside of the living body, it is preferable that the distance from the outside of the eyeball to the posterior site is the shortest in terms of reducing the burden on the patient. The eyeball will go through a path along the surface.

  The in-vivo insertion portions BIP of the optical fiber bundle 23 in the posterior region observation apparatus 2 are arranged in a line in a direction orthogonal to the transmission direction into a sheet shape, and thus can be flexibly bent according to the curvature of the eyeball. As a result, the burden on the patient can be reduced.

  On the other hand, the tissue in the vicinity of the surface of the eyeball is interspersed with fibers. However, since the wire 42 surrounding the side of the in-vivo insertion part BIP supplements the strength of the optical fiber, the irradiation part 15 can be quickly applied to the posterior part of the eye. And it becomes possible to distribute easily. Further, since the wire 42 maintains the bending state of the optical fiber in accordance with the curvature of the eyeball, the angle and distance of the irradiation unit 15 with respect to the affected part can be kept constant. As a result, the irradiation amount per unit time with respect to the affected part Can be made constant.

  Although there are individual differences in the thickness and permeability of the sclera, it has been confirmed in experiments using pig eyeballs that the sclera permeability is approximately 1% or less. Incidentally, in the two-wavelength fiber bundle 23 used in this animal experiment, the core diameter of each optical fiber is 0.24 [mm] and the outer diameter is 0.25 [mm], and the outer diameter of the entire two-wavelength fiber bundle is 1. .25 [mm] and length was 60 [mm].

  By the way, this posterior site observation device 2 emits guide light that can be observed by the posterior segment observation device 2 such as a fundus mirror that observes the posterior site inside the eyeball from the side facing the cornea from the illumination light source 12 ( (See FIG. 2). Then, the posterior site observation device 2 transmits the light to the irradiation unit 15 through an optical fiber arranged in the center of the sheet-like optical fibers (see FIG. 5).

  Therefore, in this posterior region observation apparatus 2, the guide light is irradiated from the center of the irradiation surface in the irradiation unit 15, so that the affected part can be visually recognized in the posterior region observation apparatus 2. In addition to this, the optical fiber bundle 23 can be adjusted by moving the optical fiber bundle 23 so that the irradiation unit 15 is accurately positioned on the affected part using the guide light as a reference for alignment. This is particularly useful in terms of myopia treatment.

  According to the above configuration, it is possible to realize the rear scleral curing device 2 that can irradiate the rear sclera without passing through the cornea and cure the rear sclera.

<2. Other embodiments>
In the above-described embodiment, riboflavin is applied as a sensitizer to be administered to the eye. However, the sensitizer is not limited to this embodiment. For example, fluorescein (absorption peak wavelength 494 [nm]), rose bengal (absorption peak wavelength 580 [nm]) or indocyanine green (absorption peak wavelengths 715 [nm], 780 [nm]) involved in the cross-linking reaction of collagen Any sensitizer may be used.

  In the above-described embodiment, the number of fibers of the curing-induced optical fiber bundle 21 is 18. However, the number of fibers of the curing-induced optical fiber bundle 21 is not limited to this embodiment, and various fiber numbers can be used. The number of fibers is preferably as large as possible in terms of increase in the amount of irradiation light, and is preferably as small as possible in terms of reduction in patient burden.

  In the above-described embodiment, the number of optical fibers of the system 14B that transmits the guide light is one. However, the number of fibers in the system 14B for transmitting the guide light is not limited to this embodiment, and various numbers of fibers can be used. However, considering that the hardening of the sclera is the main objective, one or several fibers less than the number of fibers of the curing-induced optical fiber bundle 21 are preferable.

  In the above-described embodiment, one optical fiber in the two-wavelength fiber bundle 23 is a dedicated transmission line for guide light transmitted from the guide optical fiber 22. However, this single optical fiber may be switched as a transmission line between the guide light and the curing inducing light.

  Specifically, the transmission form shown in FIG. 9 in which the same reference numerals are assigned to the corresponding parts in FIG. 1 is applicable. In this transmission mode, 19 curing-induced optical fiber bundles 51 connected to the curing-induced light source 11 are separated into 18 curing-induced optical fiber bundles 52 and one curing-induced optical fiber 53. Curing-induced light transmitted to the curing-induced optical fiber bundle 52 is applied to the electronic shutter 55 as parallel rays by the convex lens 54 and collected by the convex lens 56 in the curing-induced optical fiber bundle 57 connected to the first input end of the optical connector LCN. Shined.

  On the other hand, the curing inducing light transmitted to the curing inducing optical fiber 53 is given to the electronic shutter 59 as a parallel light beam by the convex lens 58, reflected by the die lock mirror 60, and connected to the second input end of the optical connector LCN by the convex lens 61. Then, the light is condensed on the optical fiber 62. On the other hand, the guide light transmitted to the guide optical fiber 22 connected to the illumination light source 12 is given to the electronic shutter 64 as a parallel light beam by the convex lens 63, passes through the die lock mirror 60, and is condensed on the optical fiber 62 by the convex lens 61. The

  Each electronic shutter 55, 59, 64 is controlled by a shutter control unit (not shown). Specifically, when the irradiation unit 15 is aligned with the affected part, the electronic shutters 55 and 58 are closed and the electronic shutter 64 is opened. As a result, only the guide light is transmitted to the two-wavelength fiber bundle 23 connected to the output end of the optical connector LCN.

  On the other hand, when the sclera in the affected part in the posterior eye region is cured, the electronic shutters 55 and 58 are opened and the electronic shutter 64 is closed. As a result, the curing-induced light transmitted from the curing-induced optical fiber bundle 52 and the curing-induced light transmitted from the curing-induced optical fiber 53 are transmitted to the two-wavelength fiber bundle 23.

  Thus, in this transmission mode, one optical fiber in the two-wavelength fiber bundle 23 is switched as a transmission line between the guide light and the curing inducing light. Therefore, compared with the above-described embodiment, the uniformity of the curing-induced light for the affected area is greatly improved. Moreover, since the irradiation light quantity with respect to an affected part is increased, without raising the irradiation intensity | strength in the hardening induction light source 11, the crosslinking reaction of collagen is accelerated | stimulated, suppressing the unnecessary photochemical reaction in an eyeball.

  The transmission mode shown in FIG. 9 is electrically switched using the electronic shutters 54, 57 and 62, but may be manually switched using the optical connector LCN as shown in FIG. This manual switching can suppress a reduction in light transmission efficiency compared to electric switching.

  In the above-described embodiment, the guide light having a fixed wavelength is emitted from the illumination light source 12. The illumination light source 12 may be a light source that emits light of two wavelengths (guide light and curing induction light). Specifically, the light source emits guide light when the irradiation unit 15 is aligned with the affected area, and irradiation of curing induction light when the sclera in the affected area in the posterior region of the eye is cured. In this way, the same effects as described above in the transmission form can be obtained more easily than in the transmission form shown in FIG.

  In the above-described embodiment, the in vivo insertion portions BIP are arranged in a line in a direction orthogonal to the transmission direction. However, the number of arrangements is not limited to one row and may be two or more rows. In short, the in vivo insertion portion BIP only needs to be in the form of a sheet having a certain thickness or less.

  In the above-described embodiment, the in-vivo insertion portion BIP has a structure in which the optical fibers in the two-wavelength fiber bundle 23 are arranged in a direction orthogonal to the transmission direction. However, the structure of the in vivo insertion portion BIP is not limited to this embodiment. For example, the in-vivo insertion part BIP shown in FIG. 11 which attaches | subjects the same code | symbol to the corresponding part with FIG. 7 is applicable.

  In this in vivo insertion portion BIP, a sheet-shaped curing-induced optical fiber bundle 21 arranged in a sheet shape is inserted through a reinforcing member 34 into a sheet-shaped silicon rubber 71 that is an ultraviolet light transmission type, and the tip of the silicon rubber 71 The irradiation unit 15 is attached to one surface of the. Further, the surface of the silicon rubber 71 is coated with a reflective material 72 such as aluminum except for the insertion portion of the curing-induced optical fiber bundle 21 and the irradiation portion 15, and a wire is formed on the reflective material 72 on the side surface of the silicon rubber 71. 42 is attached. In the in-vivo insertion part BIP shown in FIG. 11, the transmission efficiency of curing-inducing light is improved as compared with the case of the above-described embodiment.

  Further, in the in-vivo insertion portion BIP shown in FIG. 11, the illumination light source 12, the guide optical fiber 22, the two-wavelength fiber bundle 23, and the optical connector LCN in the above-described embodiment are omitted. In the case of irradiating guide light that can be observed by the posterior site observation device 2 in the in vivo insertion portion BIP shown in FIG. Just embed the LED. However, a mechanism for cooling the heat generated in the lighting LED is required. Details of the cooling mechanism will be described later.

  In the above-described embodiment, the wire 42 is provided in the coating film 41 that covers the in vivo insertion part BIP and the irradiation part 15. The wire 42 is a shape memory alloy wire that is bent and stretched in a direction perpendicular to the surface facing the eyeball when heat is applied, and is bent along the eyeball by energizing the wire through the electric wire. May be. If the shape memory alloy wires are arranged at equal intervals and the amount of current flowing through them is varied, the wire can be bent further along the eyeball.

  In the above-described embodiment, the irradiation unit 15 has a circular plate shape. However, various shapes such as a rectangular flat plate can be adopted as the shape of the irradiation unit 15. Note that the entire plate-shaped irradiation unit 15 may be curved to have a curved plate shape (a bowl shape). The curved plate-shaped irradiation unit 15 can concentrate the curing-inducing light on the affected part as compared with the flat plate-shaped irradiation unit 15. However, in the curved plate-shaped irradiation unit 15, the irradiation amount from the irradiation surface (diffusion plate 33) differs between the center and the periphery thereof and becomes non-uniform. However, it can be solved.

  Specifically, the curvature (degree of curvature) of the irradiation plate 15 and the irradiation amount ratio between the center and the periphery of the irradiation surface (diffusion plate 33) are in a fixed relationship. Therefore, instead of the illumination light source 12, a light source that irradiates the above-described two-wavelength light (guide light and curing induction light) is employed. If the intensity of the curing-inducing light to be irradiated from this light source is reduced by a ratio corresponding to the curvature of the irradiation plate 15 with respect to the intensity of the curing-inducing light to be irradiated from the curing inducing light source 11, the irradiation surface (diffusion plate 33) is obtained. The dose ratio between the center and the surrounding area in FIG. Note that the transmission form shown in FIG. 9 is also applicable.

  In the above-described embodiment, the coating film 41 and the reflection panel 31 in the irradiation plate 15 are separated. However, they can be formed as one piece. Specifically, the back surface of the coating film 41 is coated with a reflective material such as aluminum. In this way, since the reflective panel 31 can be reduced, the number of parts and the thickness can be reduced as compared with the case of the above-described embodiment.

  In the above-described embodiment, the rear scleral curing device 3 in which the curing inducing light source 11 and the illumination light source 12 are provided outside the clothing film 41 in the in vivo insertion section BIP is applied. However, when the LED is applied as the curing inducing light source 11 and the illumination light source 12, the rear sclera curing device 80 shown in FIG.

  This rear scleral curing device 80 is configured such that an LED chip 81 and a diffusion plate 82 are arranged in a layered manner at the tip of the clothing film 41. The LED chip 81 includes, for example, one or several illumination LEDs arranged at the center of the irradiation surface, and a plurality of curing induction LEDs arranged in a lattice pattern in the other areas. It is connected to a power source (not shown) outside the coating film 41 via a not shown.

  In this rear scleral curing device 80, the curing-induced optical fiber bundle 21, the guide optical fiber 22, the two-wavelength fiber bundle 23, and the optical connector LCN can be omitted, which is useful in terms of miniaturization.

  However, in the posterior scleral curing device 80, the body temperature at the time of treatment is kept constant at about 37 [° C.], so a cooling mechanism for heat generated in the LED chip 81 is required. In this cooling mechanism, as shown in FIG. 12, one end of the heat sink 83 is attached to the back surface of the LED chip 81, and the Peltier element 84 and the cooling fin 85 are connected to the other end of the heat sink 83 located outside the clothing film 41. It is possible to apply a configuration such as providing. Incidentally, the cooling fins 85 may be omitted. As another example, in place of the Peltier element 84 and the cooling fin 85, a configuration in which a cooling pipe 86 is provided as shown in FIG. Incidentally, for example, water cooling is applied to the cooling pipe 86.

  The present invention can be used in the medical industry such as treatment or follow-up of patients, biological experiments, and creation of medicines.

  DESCRIPTION OF SYMBOLS 1 ... Treatment system, 2 ... Rear eye part observation apparatus, 3,80 ... Back scleral hardening apparatus, 11 ... Curing induction light source, 12 ... Illumination light source, 13 ... Light source control part, 14 ... Light Transmission system 15... Irradiation unit 21, 51, 52, 57... Curing-induced optical fiber bundle 22. Guide optical fiber 23. Two-wavelength fiber bundle 31. Reflection panel 32. , 82 .. Diffuser, 34 .. Reinforcing member, 41 .. Coating film, 42... Wire, 53 .. Curing-induced optical fiber, 54, 56, 58, 61, 63 .. Convex lens, 55, 59, 64 ... Electronic shutter, 60 ... Die-lock mirror, 71 ... Silicone rubber, 81 ... LED chip, 83 ... Heat sink, 84 ... Peltier element, 85 ... Cooling fin, 86 ... Cooling pipe, BIP ... In vivo insertion part.

Claims (9)

A light source that emits light of a wavelength corresponding to the absorption characteristics of the sensitizer involved in the cross-linking reaction of collagen;
A sheet-like transmission unit for transmitting the light;
An irradiation unit that is plate-shaped and irradiates light guided to the side of the plate from the transmission unit forward;
A rear scleral curing device having a wire surrounding a side of the irradiation unit and extending along a side of the transmission unit. It is made of a material that is biocompatible and transparent, and further includes a cover member that covers part or all of the transmission unit and the irradiation unit,
The rear scleral curing device according to claim 1, wherein the wire is provided inside the cover member. The transmission unit is a plurality of optical fibers arranged in a direction orthogonal to the transmission direction,
A light source that emits guide light that can be observed by a device that observes the rear part of the eyeball from the side facing the cornea;
The rear scleral curing device according to claim 1, further comprising: an optical fiber that is arranged at a center of the plurality of sheet-like optical fibers and transmits the guide light. The transmission unit is a plurality of optical fibers arranged in a direction orthogonal to the transmission direction,
A two-wavelength light source capable of switching and irradiating the light and a guide light that can be observed by a device for observing the posterior site inside the eyeball from the side facing the cornea;
The rear scleral curing device according to claim 1, further comprising: an optical fiber that is disposed at a center of the plurality of sheet-like optical fibers and transmits light emitted from the two-wavelength light source. The irradiation part has a curved plate shape,
The rear scleral curing device according to claim 4, wherein the intensity of light emitted from the two-wavelength light source is reduced by a ratio corresponding to the curvature of the irradiation unit with respect to the intensity of light emitted from the light source. The transmission unit is a sheet-like silicon rubber,
The rear scleral curing device according to claim 1, wherein the irradiation part is provided on a surface of one end of the silicon rubber, and a reflective material is coated on the other surface. Centering on the LED that emits the guide light that can be observed by the device that observes the posterior site inside the eyeball from the side facing the cornea, the light of the wavelength corresponding to the absorption characteristics of the sensitizer involved in the collagen cross-linking reaction A plate-like LED chip in which the LEDs to be irradiated are arranged in a grid, and
A wire that surrounds the side of the LED chip and extends away from the LED chip;
A rear scleral curing device comprising a cooling mechanism for heat generated in the LED chip. It is made of a biocompatible and transparent material, and further includes a cover member that covers the LED chip,
The rear scleral curing device according to claim 7, wherein the wire is provided inside the cover member. The cooling mechanism is
A heat sink having one end attached to the back surface of the LED chip and extended outside the cover member;
The rear scleral curing device according to claim 8 , further comprising: a Peltier element provided on an outer portion of the cover member with respect to the heat sink.