JP5632980B1 - Suture hole creating apparatus and control method of suture hole creating apparatus - Google Patents

Abstract

[PROBLEMS] To enable a suture needle to be smoothly inserted into a donor's cornea and a recipient's cornea without depending on the level of proficiency of a practitioner, etc., and to reproduce the donor's cornea and the recipient's cornea with good reproducibility. Allow stitching. An input tool for inputting suturing conditions including a shape of a donor cornea 41a and a recipient cornea 41b, the number of sutures, and a hole position for needle insertion / removal, and a needle guide for connecting two hole positions. The hole position in the cornea 41a of the donor and the hole position in the cornea 41b of the recipient are set based on the medical laser device 20 that forms the tunnel 42, and the suture condition, and each of the corneas 41a and 41b after setting is set. And a control unit 35 that controls the output of the medical laser device 20 so as to form a plurality of cross-sectional arc-shaped tunnels in the tissue and to form the transplant incision 41x in the recipient's cornea 41b almost simultaneously. [Selection] Figure 1

Description

The present invention relates to a corneal transplantation support device that supports a surgeon's suture operation during corneal suturing that affects the results of corneal transplantation, a suture hole creation device applicable to the corneal suture surgery method, and a control method for the suture hole creation device It is.

  As a method of corneal transplantation performed as an ophthalmic surgery, first the cornea of the donor and the recipient must be cut. As a cutting method, conventionally, a method of punching the cornea into a circle with a cutting tool such as a trepan and a punch is used. It was taken.

In recent years, femtosecond lasers have made it possible to cut donor and recipient corneas more precisely at the desired size. Here, a femtosecond laser is an optical medical device capable of forming a cavity in a tissue without generating heat by causing a plasma explosion in the cornea in an extremely short time of the order of femtosecond (10 ^-15 ). Say. A cut surface like a perforation can be formed by connecting the cavities. Since the cutting means is a laser beam, the tissue surface is, for example, the cornea, and in the case of LASIK surgery, a flap is created without damaging the corneal surface. The scope of application is expanding in the field of ophthalmology.

  In addition, this femtosecond laser has the characteristic that the cut surface can be cut not only in the vertical direction but also in the diagonal direction and the horizontal direction, so select the most appropriate cutting method from the state of the patient's cornea, Based on this, it became possible to cut the cross section of the corneal junction of each donor and recipient into a step or zigzag shape to increase the contact area and strengthen the adhesion. As a result, it has been reported that the number of stitches can be reduced.

  16 and 17 are cross-sectional views showing cutting examples (parts 1 and 2) of the cornea 41 according to the conventional example. FIGS. 16A, 16B, 17A, and 17B are cross-sectional views showing an example of a cornea cutting method (shape) made possible by a femtosecond laser. According to the cut example of the cornea 41 shown in FIG. 16A, in the cornea donor and the cornea transplanter (also used as a figure), the central portion of the cornea 41 (cornea 41a) is formed into a mushroom shape using a femtosecond laser. It is made to cut out. In the figure, 41b is a recipient's cornea, and is a site | part to which the donor's cornea 41a is transplanted.

  According to the example of cutting the cornea 41 shown in FIG. 16B, the cornea donor and the cornea transplanter cut the central portion (cornea 41c) of the cornea 41 into a top hat shape using a femtosecond laser. . In the figure, 41d is a recipient's cornea, and is a site | part to which the donor's cornea 41c is transplanted.

  According to the cut example of the cornea 41 shown in FIG. 16C, in the cornea donor and the cornea transplanter, the central portion of the cornea 41 is formed in a disc shape (using a corneal epithelium trepan and punch (about 7 to 8 mm)). (Cylindrical shape). The disc-shaped cornea 41e has a standard cut shape, and can be produced as a donor cornea 41e from a cornea donor. In the figure, reference numeral 41f denotes a recipient's cornea, which is a site where a donor's cornea 41e is transplanted.

  According to the example of cutting the cornea 41 shown in FIG. 17A, the cornea donor and the cornea transplanter cut the central portion of the cornea 41 (cornea 41g) into a ZIGZAG shape using a femtosecond laser. In the figure, reference numeral 41h denotes a recipient's cornea, which is a site where a donor's cornea 41g is transplanted.

  According to the example of cutting the cornea 41 shown in FIG. 17B, the cornea donor and the cornea transplanter cut the central portion of the cornea 41 (cornea 41i) into a Christmas tree shape using a femtosecond laser. . In the figure, reference numeral 41j denotes a recipient's cornea, which is a site where the donor's cornea 41i is transplanted.

  FIG. 18 is a cross-sectional view showing an example of stitching the corneas 41b and 41k. According to the combination example of the donor cornea 41k by the top hat modified method shown in FIG. 18 and the recipient cornea 41b shown in FIG. 16, the thickness of the donor cornea 41k is larger than the thickness of the recipient cornea 41b. This is the case when it is thicker. In this case, the practitioner uses a suture needle 51 engaged with the suture thread 52 and inserts it into the tissue for a time and sutures the donor cornea 41k and the recipient cornea 41b.

  Note that, in connection with an apparatus for assisting suture operation during this type of corneal transplantation, Patent Literature 1 discloses a surgical microscopy system. According to the inspection system, an eye image of a patient under operation is acquired in a corneal transplantation operation, and the eye image, a zigzag suture line set in advance, and a wide variety of seams extending in a radial direction are included. An image such as a suture line is superimposed and displayed on the monitor. When such a superimposed image is displayed on a monitor, the surgeon can easily perform a corneal suture operation while looking at the monitor.

JP 2011-200767 A

By the way, according to the device and method for supporting the suturing operation or the like during the corneal transplantation operation according to the conventional example, there are the following problems.
i. Even if the donor's cornea (suture) and the recipient's cornea (sutted material) are cut into a precise and accurate shape in units of several μm by the femtosecond laser, the final stage of corneal suturing is performed by the practitioner (surgeon). Since it is performed by experience, there is a problem that the postoperative result depends on the skill level of the practitioner.

  In addition to the skill level of the practitioner, the suture needle to be used repeatedly passes through the tissue at the time of corneal transplant suturing, so that the needle to be used gradually becomes difficult to cut depending on the number of sutures (it is difficult to pierce the cornea) In addition, there is a problem in that tissue is damaged by a suture needle that is difficult to cut.

  As one of the factors that increase the difficulty of the practitioner, the suturing method at the time of corneal transplantation includes continuous suturing and end-to-end suturing. However, in any suturing method, the difficulty is 500 μm (0 μm). It is necessary to sew at a depth of about 90% of the corneal thickness while taking out the needle from the side of the cornea to the surface or from the surface to the side without penetrating the cornea of about 5 mm).

  Further, since the thicknesses of the corneas of the donor and the recipient are often different as shown in FIG. 18, it is necessary to sew the cornea surface so that there is no step. If there is a step on the corneal surface after surgery, there is a problem that the postoperative visual acuity is greatly affected by the occurrence of irregular astigmatism.

  Also, even if the surface height is the same, even in the case of continuous stitching, if the distance from the adjacent hole is not stitched correctly at regular intervals, the cornea center If they are not sutured concentrically with an equal distance and the same force, the corneas such as donors and recipients will be drawn in any biased direction after surgery. As a result, the spherical shape of the cornea collapses, leading to the occurrence of corneal astigmatism. For this reason, many astigmatisms remain even in the case of corneal transplantation using femtosecond lasers, and it has been reported that even if the skill level of surgery is increased, it is difficult to improve.

Therefore, the present invention solves such a problem, and allows a suture needle to be smoothly inserted into a sutured object and a sutured object without depending on the skill level of a practitioner and the suture. It is an object of the present invention to provide a stitching hole creation device and a stitching hole creation device control method capable of stitching an object and an object to be stitched with high reproducibility.

In order to solve the above-described problem, the suture hole creating device according to claim 1 is a suture hole creating device for creating a hole for guiding a needle when a suture is sutured to an object to be sutured. In order to connect the shape of the sutured object and the sutured object, the number of sutures, the hole position for needle insertion / extraction, the input part for inputting the sewing conditions including the suture procedure, and the hole position of the sutured object and the hole position of the sutured object and the hole forming element for forming a hole, the hole position of the based on the sewing condition setting a plurality of holes located in the object to be sewn product with a plurality of holes located in the suture material, the suture material after setting And a position of a hole arrangement pattern of the suture to be sutured and the sutured object included in the finished suture image is created based on the stitch position of the suture to be sutured and the sutured object. The coordinate data is determined based on the suture boundary line. The position coordinate data of the sewing object and the position coordinate data of the hole arrangement pattern of the sutured object are decomposed into two groups, and the hole position is set in the sutured object by the position coordinate data of one of the groups, and the stitching is performed. Forming a plurality of holes in the tissue connecting the hole position of the object and the suture boundary line , and setting the hole position in the object to be sutured according to the position coordinate data of the other group, And a control unit that controls an output of the hole forming unit so as to form a hole in a tissue connecting a hole position and the suture boundary line .

According to the suture hole creation device according to claim 1, when creating a hole for guiding a needle when a suture is sutured to a suture, the input portion is the shape of the suture and the suture, and the number of sutures. It is operated to input a suture condition including a needle insertion / extraction hole position and a suture procedure . The hole forming part forms a hole part for connecting the hole position of the sutured object and the hole position of the sutured object. Assumes this shape of the control unit suture material and the suture material, suture number, hole position of needle insertion, and controls the output of the hole forming element based on the sewing conditions including suturing procedure, a suture material A completed suture image relating to the object to be sutured is created. The control unit uses the position coordinate data of the hole arrangement pattern of the sutured object and the sutured object included in the completed suture image, the position coordinate data of the hole arrangement pattern of the sutured object as the reference, and the hole of the sutured object. It is divided into two groups with the position coordinate data of the arrangement pattern. The hole forming part sets a plurality of hole positions in the sutured object and a plurality of hole positions in the sutured object, and forms the hole part in the tissue connecting the sutured object and the hole position of the sutured object and the suture boundary line after the setting. To come.

According to a second aspect of the present invention, there is provided the suture hole creating device according to the first aspect, wherein either one of clockwise rotation and counterclockwise rotation can be set with respect to the suture procedure, and the control unit corresponds to the clockwise rotation and the counterclockwise rotation. The hole arrangement pattern is set for the hole forming portion. According to a third aspect of the present invention, there is provided the suture hole creating apparatus according to the first aspect, wherein the control unit forms at least an opening serving as a transplant target portion in the sutured object together with the formation of the hole of the sutured object. The output of the hole forming part is controlled.

The suture hole creation device according to claim 4 is the stitching hole creation device according to claim 1, wherein the control unit at least stitches the hole position of the sutured object and the hole position of the sutured object individually, or The hole forming part is controlled so as to form a hole part for continuous stitching that continuously stitches the hole position of the sutured object and the hole position of the sutured object.

The suture hole creating apparatus according to claim 5 is the suture hole creation device according to claim 4 , wherein the control unit sets a first hole position of a predetermined number of stitches at a peripheral edge portion of the suture object, and an opening peripheral edge of the suture object. A second hole position having the same number of sutures is set in the first portion, the first hole portion for guiding the needle from the peripheral edge of the suture to the first hole position, and the opening peripheral edge of the sutured object The hole forming portion is controlled so as to form the second hole portion for guiding the needle from the end portion to the second hole position.

A suture hole creating device according to a sixth aspect is the device according to the fifth aspect , wherein the sutured object having a shape to be sutured is combined with the sutured object that is opened in a substantially circular shape, or is opened in a substantially elliptical shape. In the case where the suture to be sutured is combined with the suture to be sutured, the position where the control unit stitches the suture and the suture to be sutured is defined as the number of stitches η, and the hole of the suture is obtained. When the set pitch angle of the hole portion connecting the position and the hole position of the sutured object is θ and the center position when the sutured object and the sutured object are sutured is the suture center position, the suture center Based on the position, the set pitch angle θ is set to 360 ° / η.

The suture holes creating apparatus according to claim 7 according to claim 6, when the control unit has a meridian radial line segment that passes through the suture center position, the second hole position of the object to be sutured object is set The η / 2 diameter lines thus formed are rotated by an angle θ / 2 with respect to the suture center position, and the first suture of the suture set on the diameter line rotated by an angle θ / 2 is set. The hole forming part is controlled so as to form the needle guiding hole part connecting the hole position and the second hole position of the sutured object set on the radial line before rotation.

The suture hole creating apparatus according to claim 8 is the medical laser according to claim 7 , wherein the hole forming portion forms a cavity by causing a plasma explosion in a short time within the tissue of the sutured object and the sutured object. An apparatus is used, and the control unit controls the medical laser device to connect the cavities at a hole connecting the first and second hole positions.

The method of suture holes creation device according to claim 9, suturing was a control method of suture holes creating apparatus for creating a hole for the needle guidance when sutured to the sewing object, the suture holes created device has a control unit and a hole forming element, wherein the control unit includes the steps of inputting the shape of the suture material and the suture material, suture number, hole position of needle insertion, the suture conditions including suturing procedure, the input A step of creating a completed suture image related to the stitching of the suture and the sutured object based on the stitched condition, and a hole arrangement pattern of the suture and the sutured object included in the created suture image Decomposing the position coordinate data into two groups of the position coordinate data of the hole arrangement pattern of the suture object and the position coordinate data of the hole arrangement pattern of the suture object, with reference to the suture boundary line; One group after Setting a hole position in the suture by position coordinate data and controlling the hole forming part so as to form a hole in a tissue connecting the hole position of the suture and the suture boundary line; The hole forming portion is set so that a hole position is set in the tissue connecting the hole position of the suture object and the suture boundary line by setting a hole position in the suture object according to the position coordinate data of the other group of And executing the controlling step .

The control method of the suture hole creating device according to claim 10 is the method according to claim 9 , wherein the cornea of the cornea donor is handled for the suture, and the cornea of a corneal transplant patient is handled for the suture. .

According to the suture hole creating device according to claim 1 and the control method of the suture hole creating device according to claim 9 , the shape includes the shape of the suture and the object to be sutured, the number of sutures, the hole position for needle insertion / extraction , and the suture procedure. A control unit that controls the output of the hole forming unit based on the conditions is provided, and the control unit sets a plurality of hole positions in the sutured object and a plurality of hole positions in the sutured object . Further, the control unit creates a completed suture image after setting, and uses the position coordinate data of the hole arrangement pattern of the sutured object and the sutured object contained in the completed suture image as the reference position coordinates of each hole arrangement pattern. Disassemble the data and set the hole position in the sutured object and the sutured object. A hole formation part comes to form a cavity in the structure | tissue of the sutured material and to-be-sewn material after setting.

With this configuration, since the hole position of the sutured object and the hole position of the sutured object can be accurately aligned at the time of suturing, the suture needle can be attached to the sutured object and the sutured object without depending on the skill level of the operator. Can be smoothly inserted , and the suture and the sutured object can be sutured with good reproducibility without the suture being biased in one direction with respect to the sutured object . Moreover, since a suture needle having a rounded tip can be used, not only can the thread pass outside the tunnel, but also the damage to the tissue can be reduced. Thereby, it becomes possible to provide a corneal transplantation support device and a corneal suturing operation method capable of supporting a suturing operation by a practitioner at the time of corneal suturing that affects the result of corneal transplantation.

It is a block diagram which shows the structural example of the cornea transplant assistance apparatus 100 as embodiment which concerns on this invention. 2 is a block diagram showing an example of the internal configuration of a medical laser device 20. FIG. It is a fragmentary sectional view showing the example of simultaneous formation of tunnel 42 and transplant cut opening 41x in cornea 41b. (A) And (B) is a graph which shows the example of laser focus depth control. It is a flowchart which shows the example of control at the time of sewing hole creation. It is a layout figure which shows the example of a hole arrangement pattern for end-to-end stitching. It is a top view which shows the formation example (the 1) of tunnel 42a-42p. It is a top view which shows the formation example (the 2) of tunnel 42a-42p. (A) And (B) is sectional drawing which shows the stitching | suture example of cornea 41a, 41b. It is a top view which shows the example of an end-to-end suture of cornea 41a, 41b. It is a layout figure which shows the example of a hole arrangement pattern for continuous stitching. It is a top view which shows the formation examples (the 1), such as tunnels 43a-43p. It is a top view which shows the example of formation (the 2), such as tunnels 43a-43p. It is a top view which shows the example of continuous stitching | corning of the corneas 41a and 41b. It is a top view which shows the continuous stitching example (inversion) of the corneas 41a and 41b. (A)-(C) are sectional drawings which show the cutting example (the 1) of the cornea 41 which concerns on a prior art example. (A) And (B) is sectional drawing which shows the example of a cutting | disconnection of the cornea 41 (the 2). It is sectional drawing which shows the example of suture of the cornea 41 which concerns on a prior art example.

Hereinafter, the suture hole creating device and the control method of the suture hole creating device according to the present invention will be described with reference to the drawings. The corneal transplantation support device 100 shown in FIG. 1 constitutes an example of a suture hole creation device, and a cornea 41a (suture) of a donor (corneal donor) is placed on a cornea 41b (subject to be sutured) of a recipient (corneal transplant patient). A hole for a suturing needle (hereinafter referred to as tunnel 42: see FIG. 3) for transplanting and suturing is created and an opening (hereinafter referred to as a transplant incision 41x) to be transplanted is substantially formed in the recipient's cornea 41b. It is formed at the same time.

  In this example, a tunnel 42 (see FIG. 9 (A)) is formed in advance in, for example, a mushroom-type cornea 41a provided from a donor, and then, in the recipient's cornea 41b, For example, a mushroom (mushroom) transplant cut opening 41x having a step at the peripheral edge is formed and a tunnel 42 is created. Then, a case where a donor cornea 41a is combined with a recipient's cornea 41b and sutured is taken as an example. Of course, on the donor side, the formation of the tunnel 42 in the cornea 41a and the incision thereof may be performed simultaneously.

  The corneal transplantation support device 100 includes an imaging device 11, a medical laser device 20, and a personal computer (hereinafter referred to as a personal computer 30). The personal computer 30 includes an input tool 12, an input / output port 33, a display device 34, and a control unit 35. The input tool 12 constitutes a part of the input section, and includes a graft shape of the cornea 41 (donor cornea 41a and recipient cornea 41b), a stitching method thereof, a number of stitches η thereof, and a suture position including a hole position for needle insertion / extraction. It is operated when inputting conditions.

  In this example, end-to-end stitching and continuous stitching are prepared for the stitching method. Here, the end-to-end suture refers to a method of individually stitching the hole position of the donor cornea 41a and the hole position of the recipient cornea 41b, and the continuous stitching refers to the hole position of the donor cornea 41a and the recipient cornea 41b. This is a method of continuously stitching with the hole position. In this example, either end-to-end stitching or continuous stitching can be selected. Further, for continuous stitching, either clockwise or counterclockwise can be set as the operator's stitching procedure. As a result, it is possible to select a suturing method suited to the dominant hand of a practitioner who is good at clockwise corneal suturing or a practitioner who is good at counterclockwise corneal suturing.

  The setting method D31 and D32 indicating the stitching method of the cornea 41, the stitching procedure, the number of stitches η, and the hole position set here are output to the control unit 35 via the input / output port 33. As the input tool 12, a mouse 31, a keyboard 32, or the like is used. The mouse 31 and the keyboard 32 are connected to the input / output port 33. The input / output port 33 is connected to the control unit 35 and controls input and output of various data. In addition to the mouse 31 and the keyboard 32, the corneal analyzer 10 may be used for the input tool 12 described above.

  For example, the corneal analysis device 10 is connected to the input / output port 33, the corneal measurement data D10 obtained from the corneal analysis device 10 is input to the control unit 35, the corneal measurement data D10 is analyzed by the control unit 35, and the recipient's cornea is analyzed. You may make it determine the transplant range of 41b, and the transplant shape. As the cornea analyzing apparatus 10, a multifunctional anterior segment analyzing and measuring apparatus, an optical coherence tomography (OCT) or the like can be used.

  In addition to the input tool 12, the imaging device 11, the medical laser device 20, and the display device 34 are connected to the input / output port 33. The imaging device 11 and the medical laser device 20 are attached to a pole (not shown), for example, a pole extending from a gantry and an arm extending from the pole. The imaging device 11 and the medical laser device 20 have an XY scanning function (not shown) and a lifting / lowering function (servo mechanism) in the Z direction, and can freely move in the XYZ direction at a position facing the eyeball field of a recipient, a donor, or the like. It is made movable.

  For example, the imaging device 11 acquires images of a donor cornea 41a and a recipient cornea 41b at the time of corneal transplantation and outputs corneal image data D11 to the personal computer 30. In addition to ophthalmic imaging devices such as a CCD camera, a CMOS camera, and an infrared camera, an electron microscope or the like for enlarging a cornea image is used for the imaging device 11.

  The display device 34 receives display data D34 from the control unit 35 via the input / output port 33, and displays images of the donor cornea 41a, the recipient cornea 41b, and the like at the time of corneal transplantation based on the display data D34. The display data D34 is obtained by converting the corneal image data D11 into image data after image processing. As the display device 34, a display monitor such as a liquid crystal display or a plasma display (PDP) is used.

  The control unit 35 correlates the cornea 41a based on the extraction conditions of the donor cornea 41a and the recipient cornea 41b, the stitching method, the stitching procedure, the number of stitches η, and the needle insertion / extraction hole position. A plurality of hole positions in the cornea 41b and a plurality of hole positions in the cornea 41b are set, a plurality of arcs of tunnels 42 are formed in the tissue of the donor cornea 41a and the recipient cornea 41b after the setting, and the transplant incision 41x ( The output of the medical laser device 20 is controlled so that the opening peripheral edge V in FIG. 3 and FIG. 7B is simultaneously formed on the recipient's cornea 41b.

  The medical laser device 20 constitutes an example of a hole forming portion, and in the donor's cornea 41a and the recipient's cornea 41b, a tunnel 42 for inserting a suture needle is created in advance, and in the recipient's cornea 41b The transplant incision 41x is controlled to be formed almost simultaneously. A femtosecond laser or the like is used for the medical laser device 20. In the femtosecond laser, the servo mechanism in the Z direction and the XY scanning mechanism are independent, and processing of a three-dimensional fine shape is possible, and there are a spiral scanning type and a raster scanning type. In the example described below, a case of a spiral scanning type in which laser light is scanned in a spiral shape (circular shape) from a deep position to a shallow position will be described.

  Here, with reference to FIGS. 2 to 4, a configuration example of the medical laser device 20 and a function example thereof will be described including the function of the control unit 35 of the personal computer 30. A medical laser device 20 shown in FIG. 2 includes, for example, a light source unit 21, an optical system 22, a lens driving mechanism 23, a stage driving mechanism 24, a control unit 25, and a detection unit 26, and spiral scanning control and laser light of the optical system 22. By controlling the depth of focus, a tunnel 42 having a cross-sectional arc shape was formed in the tissue of the cornea 41, and a transplant incision 41x was formed in the recipient's cornea 41b almost simultaneously.

  The light source unit 21 is connected to the control unit 25 and operates to generate a medical laser having a predetermined intensity (hereinafter simply referred to as laser light) based on the laser intensity data D21 and to emit the laser light to the optical system 22. The optical system 22 includes a lens 201, a half mirror 202, a mirror (not shown), and the like. For example, the laser light incident from the light source unit 21 is polarized by the mirror or the half mirror 202, and the polarized laser light is converted into a lens. It functions to form a focal point through a tissue in the tissue such as the cornea 41b of the recipient through 201.

  The lens driving mechanism 23 constitutes a Z-direction servo mechanism, is connected to the control unit 25, and operates to drive the lens 201 based on the lens driving data D23 and adjust the focal depth of the laser light. For example, a piezoelectric actuator or the like is used for the lens driving mechanism 23.

  The stage drive mechanism 24 constitutes an XY scanning mechanism, is connected to the control unit 25, and scans a stage equipped with an optical drive system (not shown) in the xy direction (see FIG. 1) of the xyz coordinate system based on the stage drive data D24 (see FIG. 1). Move) and operate to spiral scan the laser light. The optical drive system includes the light source unit 21, the optical system 22, the lens drive mechanism 23, and the detection unit 26 described above. For example, a stepping motor or a solenoid is used for the stage drive mechanism 24.

  The detection unit 26 is disposed on the optical axis, detects a reflection component of the laser light, and generates a laser detection signal S26. For the detection unit 26, a photodiode or the like is used. Note that the imaging device 11 shown in FIG. 1 may be incorporated in place of the detection unit 26.

  The control unit 25 is connected to the detection unit 26. The control unit 25 receives the laser detection signal S26, and inputs / outputs the light source unit 21, the optical system 22, the lens driving mechanism 23, and the stage driving mechanism 24 based on the laser detection signal S26 and the laser control data D20 input from the personal computer 30. Come to control. For example, the control unit 25 has a communication function, decodes the laser control data D20 received from the personal computer 30 using the communication function, and creates, for example, laser intensity data D21, lens drive data D23, and stage drive data D24. To do.

  The laser intensity data D21 is data for adjusting the intensity of the laser beam, and is output from the control unit 25 to the light source unit 21. The lens drive data D23 is data (Z direction) for adjusting the focal depth of the laser light, and is output from the control unit 25 to the lens drive mechanism 23. The stage drive data D24 is data for spiral scanning with laser light, and is output from the control unit 25 to the stage drive mechanism 24. Of course, when the raster scanning type is applied, the stage driving data D24 for raster scanning is used.

  The stage drive data D24 for spiral scanning includes position coordinate data for setting the formation position of the tunnel 42 on the donor cornea 41a and the formation position of the tunnel 42 on the recipient cornea 41b during spiral scanning with laser light, The laser irradiation timing at the time of creating the incision site to be transplanted in the donor cornea 41a and the tunnel inside thereof, and the laser irradiation timing at the time of creating the transplant incision 41x and the tunnel outside thereof by the recipient's cornea 41b are shown. Timing data is included.

  According to the spiral scanning, the laser beam irradiation timing continues from the deep position to the shallow position in the incision portion in the donor cornea 41a and the recipient cornea 41b, but the laser light is turned on in the tunnel creation portion, Except for the tunnel creation part, an intermittent operation in which the laser beam is turned off is involved. That is, in the spiral scanning, when only the formation portion of the tunnel 42 is noticed (seen) in the white arrow X (radial direction) shown in FIG. 2, the irradiation timings are seen continuously from the deep position to the shallow position. However, since the laser light is accompanied by scanning that rotates in a spiral shape on the circumference, there is a section where the laser light is not irradiated except for the tunnel forming part during the spiral scanning.

  Information obtained by synthesizing these position coordinate data and timing data is used as laser control data D20 for almost simultaneously forming and incising the tunnel 42 in at least one of the donor cornea 41a and the recipient cornea 41b. Come to compose. The laser control data D20 is data for controlling the spiral scanning control of the medical laser device 20 and the focal depth of the laser light almost simultaneously.

  The laser control data D20 is data for controlling the output of the medical laser device 20 so as to form a plurality of arc-shaped tunnels 42 (cavities) in the tissue of the recipient's cornea 41b and simultaneously form the transplant incision 41x. It is. Moreover, the laser control data D20 is data for forming a plurality of arc-shaped tunnels (cavities) in the tissue of the donor cornea 41a and simultaneously cutting out the shape of the size of the donor cornea 41a. By correcting the laser control data D20, it is possible to make the cut shape different, for example, by cutting the donor cornea 41a that is slightly larger than the transplant cut opening 41x or making the perfect circle an ellipse or the like.

  The control unit 35 described above has a memory unit 36. The memory unit 36 stores the laser control data D20 described above. The laser control data D20 forms a cross-section arc-shaped tunnel 42 (see FIG. 4A) reflecting the curved characteristic curve shown by the laser focal depth characteristic (see FIG. 4B), For example, it becomes a control target value when the transplant cut opening 41x having a stepped cross section is simultaneously formed in the recipient's cornea 41b. As the memory unit 36, a hard disk, a CD-ROM or the like that does not lose data even when the power is turned off is used.

  In addition to the laser control data D20, for example, program data for supporting corneal transplantation is described in the memory unit 36. The description includes the steps of inputting suturing conditions including the shape of the donor cornea 41a and the recipient cornea 41b, the number of stitches, the hole position for needle insertion / extraction, the suturing method, the suturing procedure, and the like. A step of setting a hole position in the donor's cornea 41a, a hole position in the recipient's cornea 41b, and an opening shape in each of the corneas 41a and 41b, and the donor cornea 41a and the recipient's cornea 41b after the setting. Forming a tunnel 42 having a cross-sectional arc shape in the tissue and simultaneously forming a transplant incision 41x in the cornea 41b of the recipient.

  In FIG. 2, t is the thickness of the recipient's cornea 41b (or donor's cornea 41a), for example. δ is the depth [mm] (height) of the tunnel 42 from the cornea surface, and is a control target when adjusting the laser beam focal depth. γ is a laser beam irradiation section [mm], and is a scanning distance in the X direction from the laser beam irradiation start position to, for example, the hole position M in spiral scanning. Become.

The hollow ellipse shown in FIG. 2 is a cavity, and when a femtosecond laser is used for the medical laser device 20, a plasma explosion occurs in the tissue of the cornea 41b in an extremely short time of the order of femtosecond (10 ⁻¹⁵ ). It is a part formed. When the hollow portion is continued, an arc-shaped tunnel portion, a crank-shaped incision site, or the like can be formed. The white oval portion in the figure is a portion where a cavity has already been formed, and the dashed oval portion is a portion where a cavity is expected to be formed. By connecting cavities formed on the left side, a tunnel 42 having an arc cross section can be formed. Further, by connecting cavities formed on the upper side, for example, a transplant cut opening 41x having a stepped cross section as shown in FIG. 3 can be formed. The transplant incision 41x is obtained by excising the transplant replacement site 41b ′ (see the two-dot chain line in FIGS. 1 and 3) from the recipient's cornea 41b.

  In FIG. 3, V is an opening peripheral edge part, and is a peripheral part of the stepped portion of the transplant cut opening 41x. The transplant incision 41x forms an incision portion to be transplanted with the donor cornea 41a. The transplant cut opening 41x extends upward from the bottom, bends to the left halfway, bends further upward, and has a step shape (crank shape) in cross section. The transplant incision 41x is obtained by executing spiral scanning control and laser focal depth control, and the Z axis is set at the stitching center position (see the center point q shown in FIG. 6), and the cross-sectional level difference is based on the Z axis. The three-dimensional opening shape obtained when the shape is rotated once is formed. Actually, the laser beam is scanned so as to rotate on the circumference with respect to the Z axis. 2 and 3, the cornea 41b is shown in a rectangular shape for convenience, but actually, as shown in FIG. 9A, the cross section of the cornea 41a has a curved shape such as an arc.

  In the medical laser device 20 shown in FIG. 2, at least in the recipient's cornea 41b, a transplant incision 41x is formed and a tunnel 42 is created. In this case, the tunnel 42 is formed in advance in the cornea 41a provided by the donor, and then the donor cornea 41a is combined with the recipient cornea 41b and sutured. In this case, it is necessary to determine the direction in which the suture needle advances in addition to the number of stitches η, the laser light irradiation interval γ, and the depth δ from the corneal surface, in accordance with the selection of the graft shape of the cornea 41a and the stitching method. The laser light irradiation section γ and the depth δ determine the tunnel length (sewing distance) and the transplant incision 41x.

  In this example, the tip probe of the optical system 22 of the medical laser apparatus 20 is spirally scanned from a deep position of the recipient cornea 41b toward a shallow position, for example. In the spiral scanning, the laser beam makes one round along the stitching boundary line I (opening edge edge V: see FIG. 4B) and returns to the original position with reference to the stitching center position. Become. In FIG. 2 and FIG. 4 (A), the laser beam is accompanied by a plurality of rounds. As a result, as shown by the white arrow X, the suture boundary line is formed on the right side to the left side of the paper, for example, the recipient's cornea 41b. Laser light is spirally scanned from I to the hole position M.

  That is, control is performed so that the tip locus of the laser beam gradually rises with a spiral from a deep position to a shallow position, and the spiral diameter of the tip locus gradually increases from the inside to the outside. . In the laser irradiation section γ, laser light is irradiated based on irradiation conditions such as 100,000 times / second. Of course, it is a tip probe that emits laser light that is spirally scanned. In addition to the tip probe, the stage itself equipped with an optical drive system may be rotationally scanned.

  In the cross-sectional view of the cornea 41b and the like shown in FIG. 4A, the ideal cross-sectional shape of the tunnel 42 is, for example, an arcuate suture needle 51 (FIG. 9B, It is preferable to follow the shape of FIG. In order to make the tunnel 42 have an ideal cross-sectional arc shape, the medical laser device 20 may be controlled as follows.

  For example, in the recipient's cornea 41b, the laser beam is spirally scanned from the peripheral edge V of the opening defining the transplant incision 41x toward the hole position M, and the focal depth of the laser beam is simultaneously adjusted in accordance with this spiral scanning. Control. Of course, in the cornea 41a of the donor, although not shown, the laser beam is spirally scanned from the peripheral edge IV toward the set hole position m and the depth of focus is simultaneously controlled.

  By this control, an opening peripheral edge V (see FIG. 3) is defined, and a cut (incision portion) is formed in the recipient's cornea 41b to remove the transplant replacement site 41b '. When the transplant replacement site 41b 'is removed, a transplant incision 41x having an opening peripheral edge V defined in FIG. 3 is formed. In this state, for example, the tunnel 42 from the stitching boundary line I (opening peripheral edge V) to the hole position M can be confirmed. Thereby, in the recipient's cornea 41b shown in FIG. 3, the tunnel 42 and the transplant incision 41x can be formed simultaneously.

  In order to form the above-described tunnel 42 and transplant cut opening 41x at the same time, it is necessary to combine (superimpose) the spiral scanning control and the focal depth control of the laser light at the same time. In FIG. 4A, the left vertical axis is the thickness t of the cornea 41, and the depth t of the tunnel 42 and the notch of the transplant cut opening 41x are combined with the thickness t. In FIG. 4B, the vertical axis on the right is the focal depth [%] of the laser beam.

  4A and 4B, the horizontal axis represents the laser irradiation interval γ [mm]. The solid line represents the laser focal depth characteristic, and the arc-shaped solid line reflects the shape of the cross section of the tunnel 42 of the recipient's cornea 41b shown in FIG. 4A, and the crank-shaped solid line represents the transplant incision. It reflects the mouth 41x. The arc-shaped broken line reflects the shape of the cross section of the tunnel 42 of the donor cornea 41a.

  According to the method of simultaneously performing the spiral scanning control and the focal depth control of this laser beam, for example, the laser focal depth penetrating through the cornea 41b having the donor thickness t is set to 100%, and the tunnel 42 having the depth δ [mm] is formed. When the depth of focus of the laser beam is 90%, the depth of focus is changed from 90% to the hole position M from the side of the stitching boundary line I, and a continuous and smooth arc shape is obtained in increments of several%. The multi-step reduction control of the focal depth of the laser beam is executed from a deep position toward the corneal surface in an extremely fine step.

  For the transplant incision 41x, spiral scanning is performed while maintaining the same spiral diameter while performing multi-step reduction control with the laser focal depth being changed from 100% to 50% (first stage). Next, spiral scanning is performed while gradually increasing the spiral diameter while maintaining the laser focal depth = 50% (second stage). Further, spiral scanning is performed while maintaining the same spiral diameter while performing multi-step reduction control with the laser focal depth from 50% to 0% (third step).

  As a result, the tunnel 42 having an arcuate cross section with a moderately curved cross section and the transplant cut opening 41x having the opening peripheral edge V can be formed simultaneously. The peripheral edge V of the opening has a stepped (inverted flange) shape obtained by rotating the cross-sectional crank part. A corneal flap at the time of LASIK is that the opening peripheral edge V is left as a hinge portion without continuing the opening peripheral edge V over the entire circumference.

  By utilizing such a function of creating a corneal flap during LASIK by a medical laser such as a femtosecond laser, a transplant incision 41x that defines a corneal transplant range in the recipient, and a depth δ from the surface of the cornea 41b. Can be created simultaneously and accurately. In the cornea 41a of the donor, a tunnel 42 is formed on the side of the cornea 41a to be transplanted into the recipient, and the peripheral edge IV is cut out (incised) at the same time.

  The tunnel 42 is preferably created so that the depth δ from the corneal surface of each of the donor and the recipient is the same distance. For example, when the expansion coefficient of the donor cornea 41a is known from a storage solution or the like, the depth δ may be set slightly larger in anticipation of the contraction of the donor cornea 41a. After the stitching, the donor cornea 41a contracts so that the depth δ of the tunnel 42 and the depth δ of the tunnel 42 of the recipient cornea 41b become the same depth. Thus, the medical laser device 20 having a spiral scanning mechanism, a Z-direction servo mechanism, and the like is configured.

Then, with reference to FIGS. 1-15, the control method of the suture hole preparation apparatus which concerns on this invention is demonstrated. In this example, first, in the cornea 41a of the donor, 16 tunnels 42a to 42p are formed and the eyeball is incised to simultaneously form the mushroom-shaped peripheral edge portion IV. After the donor cornea 41a with the tunnels 42a to 42p is prepared, 16 tunnels 42a to 42p are formed in the recipient's cornea 41b, and the transplant incision 41x that defines the opening peripheral edge V is simultaneously formed. An example is a case where a donor cornea 41a and a recipient cornea 41b are combined, and the respective tunnels 42a to 42p are connected and sutured (see FIGS. 9A and 9B). .

  In this case, the case where the personal computer 30 shown in FIG. 2 predicts the corneal stitching completion pattern on the memory, creates the laser control data D20, and controls the medical laser device 20 based on the laser control data D20 will be described. do. The laser control data D20 includes, for example, data when 16 cross-section arc-shaped tunnels 42a to 42p are formed in the tissue of the recipient cornea 41b and the transplant incision 41x is formed almost simultaneously.

  The medical laser device 20 decodes the laser control data D20, reproduces the laser intensity data D21, the lens drive data D23, and the stage drive data D24, and performs spiral scanning control of the tip probe of the optical system 22 based on these data. Simultaneously controls the depth of focus of the laser beam (Z-direction servo mechanism, etc.). By this control, tunnels 42a to 42p with 16 cross-section arcs were formed, and step-shaped transplant cut openings 41x to be transplanted portions were simultaneously formed in the recipient's cornea 41b. In addition, as a method for suturing the corneas 41a and 41b, a case where two methods of end-to-end stitching and continuous stitching are prepared will be described as an example. The suture needle 51 shown in FIG. 9B is basically inserted from the donor cornea 41a side into the recipient cornea 41b side.

  With these as the stitching hole forming conditions, first, at step ST1 shown in FIG. 5, the control unit 35 receives an input of the stitching conditions. This stitching condition includes the transplantation range of the recipient's cornea 41b. The practitioner refers to, for example, the corneal measurement data D10 obtained from the corneal analyzer 10 shown in FIG. 1, etc., confirms the symptom of the recipient's cornea 41b, determines the transplant range, and extracts the cornea 41a cut out from the donor. Determine shape, etc. Regarding corneal transplantation, in addition to corneal transplanters who have deteriorated and can no longer obtain visual acuity, corneal transplants that are desired to be replaced with corneas that have not deteriorated but have better ophthalmic characteristics than existing ones. The person is included.

  As for the transplant range in the recipient's cornea 41b, for example, a hole arrangement pattern having a substantially circular shape and a hole arrangement pattern having a substantially elliptical shape, which are examples of the shape to be sutured, are prepared. Of course, other polygonal shapes or irregularly shaped hole arrangement patterns may be included, and in this case, a circular hole arrangement pattern (basic) setting method can be used.

  In this example, for the sake of convenience, in order to make it easy to understand the explanation regarding the formation of the suture hole, a case where a circular hole arrangement pattern is set for the transplantation range of the recipient's cornea 41b will be described as an example. In this case, the donor cornea 41a is cut out in a circular (circular) shape from the eyeball of the corneal donor, and the recipient's cornea 41b remains after the portion to be transplanted is excised into a circular opening (transplanted opening 41x). It becomes part of. Of course, the transplant incision 41x is not limited to a perfect circular opening, and the cornea 41b may be incised into an elliptical opening in anticipation of astigmatism correction. On the contrary, the recipient's cornea 41b may be cut into a circular shape, the donor's cornea 41a may be cut into an elliptical shape, and the stitches may be combined, or the elliptical corneas 41a and 41b may be stitched together. Good.

  In addition to the above-mentioned transplantation range, the stitching conditions include end-to-end stitching, continuous stitching, the number of stitches η, and the stitching procedure such as clockwise and counterclockwise for continuous stitching. . As an example, a case where end-to-end stitching is selected as the stitching method and η = 16 is set as the stitching number η will be described. The practitioner determines a scanning (stitching) distance and a stitching method in advance and sets the number of stitches η in the control unit 35 for, for example, the hole positions A and a of the tunnel 42a serving as the entrance / exit of the suture needle on the cornea surface side.

  This setting is to create the same number of hole positions (entrances / exits) in the donor's cornea 41a and the recipient's cornea 41b according to the number of sutures η at necessary intervals. In this example, when a sewing method or a sewing procedure is set, the formation direction of the tunnel 42 is automatically determined. Accordingly, the direction in which the suturing needle 51 (see FIG. 9B) is directed (the suturing direction) is also determined by the suturing method.

  In this example, according to the hole arrangement pattern example for end-to-end suture shown in FIG. 6, when the cornea is sutured, it is based on the case where the suture needle is inserted from the donor cornea 41 a side to the recipient cornea 41 b side. Beginning with the needle guiding tunnel 42a connecting the hole position a of the donor cornea 41a and the hole position A of the recipient cornea 41b, the hole position b of the donor cornea 41a and the hole position B of the recipient cornea 41b Similarly, a total of 16 locations (16) of tunnels 42c to 42p connecting the hole positions c to p of the donor cornea 41a and the hole positions CP to the corresponding cornea 41b of the recipient cornea 41b are connected continuously. I was able to conclude well. For this reason, the controller 35 makes the following measures. Since the transplantation range of the cornea 41 is determined to be a circular shape (perfect circle), the suture boundary I is also set to a circular shape (perfect circle) in the example of the hole arrangement pattern for end-to-end stitching.

  The hole arrangement patterns of the first hole positions a to p and the second hole positions AP that are expected upon completion of the stitching between the recipient's cornea 41b and the donor's cornea 41a are developed on the memory, and the stitch boundary I Is divided into two groups of position coordinate data consisting of a hole arrangement pattern including the hole positions AP of the recipient cornea 41b and a hole arrangement pattern including the hole positions ap of the donor cornea 41a. .

  In the actual donor cornea 41a shown in FIG. 7 (A), the peripheral edge of the donor cornea 41a shown in FIG. 7A is set by the position coordinate data based on the hole arrangement pattern of the donor cornea 41a after decomposition. Tunnels 42a to 42p from the part IV to the corresponding hole positions a to p are set. Further, hole positions A to P are set in the recipient's cornea 41b based on the position coordinate data based on the hole arrangement pattern of the recipient's cornea 41b after decomposition, and the actual recipient's cornea 41b shown in FIG. The tunnels 42a to 42p from the opening peripheral edge V to the corresponding hole positions AP are set.

  The setting reference for the hole positions A to P and the hole positions a to p at that time is based on the suture center position. When the cornea 41 is, for example, a perfect circle (diameter Dφ = 7 to 8 mm), the stitching center position is the regular circle center point q shown in FIG. 6 or the regular circle center point q shown in FIG. Hereinafter, the center point q is also referred to as a stitching center position q. If the cornea 41 to be transplanted is other than an ellipse or a regular circle, for example, the center of gravity of the corresponding shape may be set. Thereby, tunnels 42a to 42p for end-to-end stitching or continuous stitching can be formed with good reproducibility.

  In the example of the hole arrangement pattern shown in FIG. 6, the stitching boundary line I is a circular boundary line that is formed when a recipient's cornea 41 b having a perfect circular opening shape and a cornea 41 a having a perfect circular shape are combined. The suture inner ring line II is a concentric circle set inside the suture boundary line I with reference to the suture center position q. The suturing conditions include suturing distances α, β and the like in addition to the above-described transplantation range and suturing method. Here, the stitching distance α is a distance from the stitching boundary line I to the stitching inner ring line II in the end-to-end stitching hole arrangement pattern example shown in FIG.

  For example, the stitching distance α is set to a comma number to a few mm in accordance with the tunnel depth δ and the shape of the suture needle. The stitching distance β is a distance from the stitching boundary line I to the stitching outer ring line III in the same pattern example. For example, the stitching distance β is also set to a comma number to a few millimeters corresponding to the tunnel depth δ and the shape of the suture needle 51. The stitched outer ring line III is a concentric circle set outside the stitching boundary line I on the same basis.

  Next, at step ST2 shown in FIG. 5, the control unit 35 branches control depending on whether end-to-end stitching is set or other stitching methods are set. If end-to-end stitching is set by the above-described stitching condition input, the process proceeds to step ST3, and the control unit 35 creates laser control data D20 from the end-to-end stitching hole arrangement pattern. The laser control data D20 is data for performing raster scanning or spiral scanning that enables position coordinate data indicating the position of a hole such as the tunnel 42a, position coordinate data that demarcates the transplant opening 41x, etc., to be processed into a three-dimensional fine shape. Converted to format. Since an existing technique can be used for this conversion process, the description thereof is omitted.

  In this example, in the hole arrangement pattern for end-to-end stitching shown in FIG. 6, the recipient's cornea 41b opened in a circular shape (transplant cut opening 41x) shown in FIG. An example is shown in which a circular donor cornea 41a having substantially the same size shown in FIG. Of course, the transplant incision 41x is not limited to a circular shape, and may be cut in an elliptical shape.

  The control unit 35 sets the number of stitches η as the place where the donor's cornea 41a and the recipient's cornea 41b are stitched, and sets the hole position ap of the donor cornea 41a and the hole position AP of the recipient's cornea 41b. The set pitch angle θ of the tunnels 42a to 42p to be connected is θ, and the set pitch angle θ is set to 360 ° / η with reference to the suture center position q when the donor cornea 41a and the recipient cornea 41b are sutured. . Of course, it is a case where an oval donor cornea 41a having an approximately equal size is combined with a recipient's cornea 41b opened in an oval shape (not shown) and stitched, and a slightly larger circular donor It may be a case where the cornea 41a is combined and sutured.

Here, the set pitch angle θ means an angle formed by a diametrical line segment (hereinafter referred to as a radial line) passing through the sewing center position q shown in FIG. 6 and another radial line. Since the number of stitches η is η = 16 in the above example, the set pitch angle θ is set to θ = 22.5 °, and 16 / η radial lines (1) to (8) are obtained. The hole arrangement pattern example shown in FIG. 6 is a completed suture image when end-to-end suture is selected at the time of corneal transplantation. When the control unit 35 controls the medical laser device 20, for example, on the memory area. And serves as a basis for creating laser control data D20 such as laser intensity data D21, lens drive data D23, stage drive data D24 (position coordinate data D (xa ya) of hole position), and the like.

  Specifically, hole positions a and i (black dots) are set at positions where the radial line (1) and the suture inner ring line II intersect, and the suture outer ring line III on the extension line of the radial line (1) is Hole positions A and I (black dots) are set at the intersecting positions. Similarly, hole positions b and j are set at positions where the radial line (2) and the suture outer ring line II intersect, and holes are formed at positions where the suture outer ring line III on the extension line of the radial line (2) intersects. Positions B and J are set.

  Similarly, hole positions c to p and hole positions CP are set for the remaining radial lines (2) to (8). As a result, position coordinate data is obtained from the hole arrangement pattern for end-to-end sutures, and the hole positions a to p for needle insertion / extraction can be set at the peripheral edge portion IV of the cornea 41a of the donor. The position coordinate data for specifying the hole positions a, b,... P is represented by, for example, D (xa ya), D (xb yb),... D (xp yp) in the XY coordinate system.

Moreover, the hole positions AP for needle insertion / extraction can be set at the opening peripheral edge IV of the cornea 41b of the recipient. The position coordinate data specifying the hole positions A, B,... P is represented by, for example, D (xA yA), D (xB yB)... D (xP yP) in the XY coordinate system. The position coordinate data D (xaya) developed on the memory area indicating the setting state is converted into display data D14, and a finished stitched image of end-to-end stitching is displayed on the display device 34 based on the display data D14. May be.

  The 16 hole positions a to p and the 16 hole positions A to P indicated by the black dots described above constitute laser control data D <b> 20 to be transmitted to the medical laser device 20. In this example, the laser control data D20 is applied to the donor cornea 41a and the recipient cornea 41b to dissect the donor cornea 41a and simultaneously form tunnels 42a-42p, and then to the recipient cornea 41b. The tunnels 42a to 42p were formed, and the transplant incision 41x was simultaneously formed.

[Incision of donor cornea 41a and creation of tunnels 42a-42p]
In this example, in step ST4, the control unit 35 shown in FIG. 1 controls the medical laser device 20 so as to cut the donor cornea 41a into a mushroom shape and sequentially form tunnels 42a to 42p in the tissue. For example, the control unit 35 reads the laser control data D20 from the memory unit 36, incises the donor cornea 41a so as to define a circular peripheral end portion IV as shown in FIG. The output of the medical laser device 20 is controlled so as to sequentially form the tunnels 42a to 42p that respectively connect the end IV and the corresponding hole positions a to p.

  The medical laser device 20 receives the laser control data D20, and decodes data necessary for spiral scanning control of the laser light and its focal depth control from the laser control data D20. In this data decoding, stage drive data D24 for spirally scanning the laser light on the donor cornea 41a along the stitching boundary line I shown in FIG. 6 from the stitching boundary line I toward the stitching inner ring line II is obtained. Played. The donor cornea 41a is dissected so as to define the peripheral edge IV by spiral scanning from a deep position to a shallow position (Z direction) based on the stage drive data D24, and a tunnel is formed from the deep position of the cornea 41a toward the surface thereof. 42a to 42p are sequentially formed. The sixteen tunnels 42a to 42p are formed almost simultaneously while the peripheral edge portion IV is sequentially defined by the spiral scanning control and the focal depth control described above.

Focusing on the order of formation of the donor cornea 41a with respect to the tunnels 42a to 42p, the focal depth of the laser beam is adjusted at the deepest position where the formation of the tunnels 42a to 42p is started in the first clockwise spiral scanning. Formation of tunnels 42a to 42p corresponding to the hole positions a to p is started for each rotation angle order (22.5 °). Of course, turned on the irradiation timing of the laser beam on the diameter line (1) to (8), the hole position a-b on the same circumference, b-c, c-d , d-e, e-g, gh, hi, i-j, j-k, k-l, l-m, m-n, n-o, op, and p-a are turned off.

In the next clockwise spiral scan, when the depth of focus is adjusted so that the depth position is slightly smaller than the above-mentioned depth position, and the vortex diameter is slightly narrowed inward, the rotation angle order Formation of the tunnels 42a to 42p corresponding to the hole positions a to p is continued every (22.5 °). Since the irradiation timing of the off interval of the laser beam on the same circumference is gradually shorter length of the arc, is off interval shorter it in the proportion.

Further, in the next clockwise spiral scanning, in the state where the depth of focus is adjusted so that the depth of focus is further reduced from the above-mentioned depth position and the diameter of the spiral is further narrowed inward, the rotation angle order (22 .5 °), the tunnels 42a to 42p corresponding to the hole positions a to p are continuously formed. Irradiation timing of off interval of the laser light is also the same as described above. The donor cornea 41a is cut out (incised) in a mushroom shape in the same manner as in the conventional method.

  By performing spiral scanning of the tissue of the donor cornea 41a from a deep position toward a shallow position in a clockwise direction by the number of times (ν times) of clearing the thickness t of the cornea 41a and the depth δ of the tunnel 42, The peripheral edge IV of the donor cornea 41a as shown in FIG. 7A can be defined, and 16 tunnels 42a to 42p regularly arranged on the peripheral edge IV can be formed simultaneously. This formation makes it possible to prepare a donor cornea 41a having a mushroom shape as shown in FIG. 9A and having tunnels 42a, 42i and the like.

[Creation of tunnels 42a-42p and transplant incision 41x of recipient cornea 41b]
When the donor cornea 41a is prepared, the process proceeds to step ST5, where the control unit 35 forms the tunnels 42a to 42p in the tissue of the recipient cornea 41b and simultaneously forms the transplant incision 41x (opening peripheral edge V). The medical laser device 20 is controlled as described above. For example, the control unit 35 reads the laser control data D20 from the memory unit 36 and incises the recipient's cornea 41b so as to define the opening peripheral edge V, and the opening peripheral edge V and the hole positions AP. The output of the medical laser device 20 is controlled so as to sequentially form tunnels 42a to 42p that connect each other in correspondence.

In this example, the control unit 35 outputs laser control data D20 to the medical laser device 20 to control the depth of focus (Z direction) of the laser light, and the hole arrangement pattern shown in FIG. For example, on the basis of the suture center position, spiral scanning is performed to scan the laser beam in a circumferential manner, and the laser beam irradiation is turned on in the laser beam irradiation section γ shown in FIG. By moving the irradiation position of the laser beam on the circumference, the tunnels 42a to 42p and the opening peripheral edge V (see FIG. 7B) are simultaneously formed in the recipient's cornea 41b.
The

  The medical laser device 20 receives the laser control data D20, and decodes data necessary for spiral scanning control of the laser light and its focal depth control from the laser control data D20. In this data decoding, stage drive data D24 for spirally scanning the laser beam on the cornea 41b of the recipient so as to go from the stitching boundary line I to the stitching outer ring line III along the stitching boundary line I shown in FIG. Is played. By spiral scanning from a deep position to a shallow position (Z direction) based on the stage drive data D24, the recipient's cornea 41b is dissected so as to define the peripheral edge V of the opening, and from the deep position of the cornea 41b to the surface thereof. Tunnels 42a to 42p are formed sequentially. The sixteen tunnels 42a to 42p are formed almost simultaneously while the aperture peripheral edge V is sequentially defined by the spiral scanning control and the focal depth control described above.

Focusing on the formation order of the recipient's cornea 41b with respect to the tunnels 42a to 42p, the focal depth of the laser light is adjusted at the deepest position where the formation of the tunnels 42a to 42p is started in the first spiral scan, and the rotation angle Formation of tunnels 42a to 42p corresponding to the hole positions A to P is started at every rank (22.5 °). Of course, meridian (1) irradiation timing of the laser beam on to (8) is turned on, the hole position A-B on the same circumference, B-C, C-D , D-E, E-F, It is turned off among FG, GH, HI, IJ, JK, KL, LM, MN, NO, OP, and PA.

In the state where the depth of focus is adjusted so that the depth position is slightly smaller than the above-mentioned depth position in the next spiral scan, and the diameter of the spiral is slightly expanded outward, the rotation angle order (22. The formation of the tunnels 42a to 42p corresponding to the hole positions A to P is continued every 5 °. Since the irradiation timing of the off interval of the laser beam on the same circumference is gradually longer lengths of arc is off interval becomes longer it in the proportion.

Further, in the next spiral scan, in the state where the depth of focus is adjusted so as to reduce the depth of focus further than the above-mentioned depth position, and the diameter of the spiral is further spread outward, the rotation angle order (22.5 ° ), The formation of the tunnels 42a to 42p corresponding to the hole positions A to P is continued. Irradiation timing of off interval of the laser light is also the same as described above.

  By repeating spiral scanning ν times clockwise from the deep position to the shallow position of the tissue of the recipient's cornea 41b, the peripheral edge of the opening of the recipient's cornea 41b as shown in FIG. V can be defined, and 16 tunnels 42a to 42p regularly arranged at the peripheral edge V of the opening can be formed simultaneously.

  The transplant cut opening 41x of the recipient cornea 41b is formed in a stepped shape in the same manner as in the conventional method. For example, in the first stage, while gradually reducing the focal depth of the laser light from the back surface side to the front surface side of the cornea 41b, the irradiation timing is continuously repeated and spiral scanning is repeated, and the tissue of the cornea 41b is moved to a predetermined depth. An incision is formed in a cylindrical shape. Thereafter, spiral scanning is performed continuously with the irradiation timing so that the diameter of the spiral is gradually expanded outward while the focal depth of the laser light is fixed in the second stage following the first stage. Thereby, a flat portion having a stepped cross section can be formed.

  Then, in the third stage subsequent to the second stage, while gradually reducing the depth of focus of the laser beam from the flat portion having a stepped cross section toward the surface side, the irradiation timing is continuously repeated and spiral scanning is repeated. The tissue of 41b is cut and formed in a cylindrical shape. Thereby, the transplant cut opening 41x having a stepped cross section can be formed.

  In addition, although the case where the incision of the transplant incision 41x is performed after the formation of the 16 tunnels 42a to 42p has been described, the present invention is not limited to this, and the tunnel 42a to 42p of the tunnel 42a to 42p is formed after the first stage of the transplant incision 41x. The tunnels 42a to 42p may be formed after the second stage is formed. As a result, the tunnel 42a having an arc cross section shown in FIG. 9A and the cornea 41b of the recipient having a stepped shape can be prepared for suturing.

  When these are prepared, for example, the donor cornea 41a formed with the tunnels 42a to 42p shown in FIG. 7A and the recipient cornea 41b formed with the tunnels 42a to 42p shown in FIG. Are aligned (see FIG. 9A), and the tunnels 42a to 42p are combined as shown in FIG. 8 and FIG. 9B. As a result, 16 tunnels 42a to 42p for end-to-end stitching (impeller shape in which individual blades extend radially) as shown in FIG. 8 can be formed.

  Thereafter, as shown in FIG. 10, the donor cornea 41a and the recipient cornea 41b are sutured. The practitioner can suture the cornea 41 end-to-end accurately simply by passing the suture needle through the tunnels 42 a to 42 p created by the medical laser device 20. At this time, a marker may be provided on the tunnels 42a to 42p using a suture marker as in the conventional method.

  In this example, since end-to-end stitching is selected as the suturing method, the practitioner first inserts the suturing needle 51 engaged with the suturing thread 52 shown in FIG. The thread 52 is extracted from the hole position A side through the tunnel 42a between the hole positions a and A (direction at 12 o'clock). The ends of the suture thread 52 are connected to each other, and the corneas 41a and 41b are sutured and bound.

  Next, the position to be sewn is changed by an angle of 180 ° as shown in FIG. 10, for example, and the hole positions i-I are sewn in the same manner (direction of 6 o'clock). Next, the position to be sewn is changed by changing the position of the angle 90 °, similarly, the hole positions m-M are sewn, and further, the hole positions e-E are sewn (directions of 9 o'clock and 3 o'clock). Further, the position to be stitched is changed by an angle of 45 °, the hole positions o-O are similarly stitched, and the hole positions g-G are similarly stitched.

  Further, the position to be stitched is changed by an angle of 90 °, the hole positions c-C are similarly stitched, and the hole positions k-K are similarly stitched. Next, the position to be stitched is changed by an angle of 22.5, the hole positions b and B are similarly stitched, and the hole positions j and J are similarly stitched. Further, the position to be stitched is changed by an angle of 90 °, the holes n-N are similarly stitched, and the holes f-F are similarly stitched.

  Further, the position to be stitched is changed by an angle of 45 °, the hole positions l-L are similarly stitched, and the hole positions d-D are similarly stitched. Finally, the position of the stitching position is changed by an angle of 90 °, the hole positions p-P are similarly stitched, and the hole positions h-H are stitched similarly. Of course, the suturing procedure is not limited to this. As a result, the recipient's cornea 41b and the donor's cornea 41a can be easily and evenly stitched end-to-end regularly (see FIG. 10).

  If continuous stitching is set in step ST2 described above, the process proceeds to step ST6, and the control unit 35 branches control in accordance with the setting of the stitching procedure. When the counterclockwise direction is set, the process proceeds to step ST7, and the control unit 35 sets a hole arrangement pattern (for counterclockwise direction) for continuous stitching. According to this hole arrangement pattern for continuous stitching, the stitches are stitched one by one at the four end points of the cross, that is, at the 12 o'clock, 3 o'clock, 6 o'clock, and 9 o'clock positions, and then continuous stitching is performed. To be made. This is to prevent deviation of the stitching position of the donor cornea 41a with respect to the recipient's cornea 41b.

  In the example of the hole arrangement pattern for continuous stitching shown in FIG. 11 (counterclockwise), in this example as well, the recipient's circular cornea 41b opened in a circular shape shown in FIG. A case will be described in which a perfect circular cornea 41a having substantially the same size shown in FIG. In FIG. 11, the control unit 35 sets the number of stitches η = 16 at the portion where the donor cornea 41a and the recipient cornea 41b are stitched, and sets the set pitch angle of the entrance (hole position A) of the tunnel 43 (cavity) to θ1. In this case, the set pitch angle θ1 is set to θ1 = 22.5 ° (360 ° / η). Of course, it may be a case where an oval or circular donor cornea 41a of approximately the same size is combined with an oval shaped recipient's cornea 41b and stitched together.

Thereby, eight radial lines (1) to (8) are obtained in the same manner as the example of the hole arrangement pattern for end-to-end stitching. The hole arrangement pattern example shown in FIG. 11 is a completed suture image of continuous stitching at the time of corneal transplantation. When the control unit 35 controls the medical laser device 20, it is developed on the memory area and laser intensity data This is a basis for creating laser control data D20 such as D21, lens drive data D23, stage drive data D24 (position coordinate data D (xa ya) of hole position).

  In this example, the control unit 35 sets the hole position a on the radial line (1) for the recipient hole arrangement pattern in which the hole position A is set on the radial line (1) shown in FIG. The donor hole arrangement pattern thus formed is rotated by an angle θ2 = θ1 / 2 = 11.25 °, and the position of a new radial line (1) ′ in which the hole position a is set is set as shown in FIG. . The other radial lines (2) to (8) are similarly set. Accordingly, eight radial wires (1) 'to (8)' are obtained in the same manner as the above-described radial wires (1) to (8).

Also in this example, a case where the laser control data D20 is generated in anticipation of a state in which the cornea 41a having a perfect circular shape on the memory area is combined with the cornea 41b having a circular opening is taken as an example. The cornea 41b of the recipient are set hole position A~P for needle insertion at position rotated One not a angle .theta.2 = 11.25 °, the cornea 41a of the donor, the hole position a~p for needle insertion Is set.

  Specifically, hole positions a and i (black dot marks) are set at positions where the diameter line (1) ′ and the suture inner ring line II shown in FIG. 11 intersect, and stitching on the extension line of the diameter line (1) is performed. Hole positions A and I (black dots) are set at positions where the outer ring line III intersects. Similarly, the hole positions b and j are set at a position where the radial line (2) ′ and the suture outer ring line II intersect, and at the position where the suture outer ring line III on the extension line of the radial line (2) intersects. Set hole positions B and J. As a result, the hole positions A, a, and B form isosceles triangles having respective vertices.

  Furthermore, hole positions c and k (black dot marks) are set at positions where the radial line (3) ′ and the suture inner ring line II intersect, and the suture outer ring line III on the extension line of the radial line (3) intersects. Set the hole positions C and K (black dots) in the position. Similarly, the hole positions d and l are set at positions where the radial line (4) ′ and the suture outer ring line II intersect, and at the position where the suture outer ring line III on the extension line of the radial line (4) intersects. Set the hole positions D and L.

  Thereby, the hole positions a, B, and b form isosceles triangles that are the vertices, and the hole positions B, b, and C form isosceles triangles that are the vertices. Similarly, hole positions C to P are set for the remaining radial lines (5) to (8), and hole positions c to p are set for the radial lines (5) 'to (8)'.

  Also in this example, since the tunnels 43a to 43p are separately formed and placed separately in the donor cornea 41a and the recipient cornea 41b, the isosceles connecting the hole positions A, a, and B shown in FIG. Considering the triangle and two isosceles triangles connecting the hole positions p, A, a, the line segment Aa intersecting with the radial line (1) ′ is the direction of the tunnel 43a. The angle θ3 formed by the radial line (1) ′ and the line segment Aa is ½ of ∠AaB. Based on this angle θ3, the laser beam irradiation timing is controlled to perform spiral scanning, and a half of the tunnel 43a is formed on the cornea 41a side. Similarly, tunnels 43b to 43p are formed for the other radial lines (2) to (8) and radial lines (2) 'to (8)'.

  On the other hand, the line segment Aa intersecting the radial line (1) is also in the direction of the tunnel 43a, and the angle θ4 formed by the radial line (1) and the line segment Aa is ½ of ∠pAa. Based on this angle θ4, the laser beam irradiation timing is controlled to perform spiral scanning, and the remaining half of the tunnel 43a is formed on the cornea 41b side. Thus, when the donor cornea 41a is combined with the recipient cornea 41b, 16 tunnels 43a to 43p having a shape as shown in FIG. 13 can be formed.

  In this example, a hole position A′-a ′ for forming an end-to-end stitching tunnel 43a ′ and a end-to-end stitching tunnel 43i ′ are further provided at positions slightly off to the left or right from the radial line (1). And the hole position I′-i ′ for forming. A hole position E′-e ′ for forming an end-to-end stitching tunnel 43e ′ and an end-to-end stitching tunnel 43m ′ are formed at positions slightly above or below the radial line (5). The hole position M′-m ′ is set. For the tunnels 43a ', 43e', 43a ', 43e', please refer to Figs.

Thereby, a hole arrangement pattern for continuous stitching (counterclockwise use) is obtained, and the hole positions a to p for needle insertion / extraction can be set at the peripheral edge portion IV of the cornea 41a of the donor. Moreover, the hole positions AP for needle insertion / extraction can be set in the opening peripheral edge V of the cornea 41b of the recipient. In this setting, the position coordinate data D (xaya) developed on the memory area is converted into display data D14, and a completed stitch expected image at the time of continuous stitching based on the display data D14 is displayed on the display device 34. May be.

24 hole position A~P shown in the above-described black spot marks, A ', E', I ', M', a ', e', i ', m' and, One not a angle .theta.2 = 11.25 ° The shifted 16 hole positions a to p constitute laser control data D20 to be transmitted from the control unit 35 to the medical laser device 20. The laser control data D20 includes laser intensity data D21, lens drive data D23, stage drive data D24 (position coordinate data D (xa ya) of hole position), and the like.

  In this example, the laser control data D20 is applied to the donor cornea 41a and the recipient cornea 41b to incise the donor cornea 41a and to tunnels 43a-43p and tunnels 43a ′, 43e ′, 43i ′, 43m. 'Were formed almost simultaneously, and then the tunnels 43a to 43p and tunnels 43a', 43e ', 43i', 43m 'were formed in the recipient's cornea 41b, and the transplant incision 41x was formed almost simultaneously.

[Incision of donor cornea 41a and creation of tunnels 43a-43p, etc.]
In this example, the process proceeds to step ST9, where the control unit 35 shown in FIG. 1 cuts the donor cornea 41a into a mushroom shape, and tunnels 43a to 43p, tunnels 43a ′, 43e ′, 43i ′, and 43m ′ into the tissue. The medical laser device 20 is controlled so as to form For example, the control unit 35 reads the laser control data D20 from the memory unit 36, incises the donor cornea 41a so as to define a circular peripheral end portion IV as shown in FIG. Outputs of the medical laser device 20 so as to form tunnels 43a to 43p respectively connecting the end portions IV and the corresponding hole positions a to p and end-to-end tunnels 43a ', 43e', 43i ', 43m'. To control.

  The medical laser device 20 receives the laser control data D20, and decodes data necessary for spiral scanning control of the laser light and its focal depth control from the laser control data D20. In this data decoding, a stage drive for spirally scanning laser light on the donor cornea 41a in a clockwise direction along the stitching boundary line I shown in FIG. 11 from the stitching boundary line I toward the stitching inner ring line II. Data D24 is reproduced. A spiral scan from a deep position to a shallow position (Z direction) based on the stage drive data D24 cuts the donor cornea 41a so as to demarcate the peripheral edge IV, and from the deep position of the cornea 41a toward the surface thereof. Tunnels 43a to 43p are sequentially formed.

  While the peripheral edge portion IV is sequentially defined by the above-described spiral scanning control and focal depth control, for example, the irradiation timing of the laser light is slightly shifted so as to reach each hole position ap from the peripheral edge portion IV at an angle θ3. However, 16 tunnels 43a to 43p and 4 tunnels 43a ′, 43e ′, 43i ′, and 43m ′ for end-to-end stitching are formed almost simultaneously. The angle θ3 is ½ of the isosceles triangle ａAaB having the hole positions A, a, and B as vertices (see FIGS. 11 and 12A).

  Focusing on the order of formation of the tunnels 43a to 43p of the donor cornea 41a and the end-to-end suture tunnels 43a ', 43e', 43i ', and 43m' shown in FIG. 12A, the first clockwise spiral scanning is performed. For example, the focal depth of the laser beam is adjusted at the deepest position where the formation of the tunnels 43a to 43e ′, the tunnels 43e to 43i ′, the tunnels 43i to 43m ′, and the tunnels 43m to 43a ′ is started, and the hole position p− a tunnel 43a 'between the hole positions de, a tunnel 43e' between the hole positions de, a tunnel 43i 'between the hole positions hi, and a tunnel 43m' between the hole positions lm; The formation of tunnels 43a to 43p corresponding to the hole positions a to p is started every 5 °.

  The control unit 25 includes a line segment Aa, a line segment Bb, a line segment Cc... Connecting the radial lines (1) to (8) shown in FIG. The medical laser device 20 is controlled to turn on the irradiation timing of the laser beam on the line segment Pp. Of course, hole positions ab, bc, cd, ef, fg, gh, ij, jk, kl, mn, n on the same circumference. It is turned off between -o and op.

In the next clockwise spiral scan, in the state where the depth of focus is adjusted so that the depth position is slightly decreased from the above-mentioned deepest position, and the diameter of the spiral is slightly narrowed inward, the hole position p -A includes the tunnel 43a ', between the hole positions de, the tunnel 43e', between the hole positions hi, the tunnel 43i 'and between the hole positions lm, and the tunnel 43m'. .5 °), the tunnels 43a to 43p corresponding to the hole positions a to p are continuously formed. Since the irradiation timing of the off interval of the laser beam on the same circumference is gradually shorter length of the arc, is off interval shorter it in the proportion.

Further, in the next clockwise spiral scanning, in the state where the depth of focus is adjusted so as to reduce the depth of focus further than the above-mentioned depth position, and the diameter of the spiral is further narrowed inward, the hole position pa Includes a tunnel 43a ′ between the hole positions de, a tunnel 43e ′ between the hole positions de, a tunnel 43i ′ between the hole positions hi, and a tunnel 43m ′ between the hole positions lm; °) The tunnels 43a to 43p corresponding to the hole positions a to p are continuously formed. Irradiation timing of off interval of the laser light is also the same as described above. The donor cornea 41a is cut out (incised) in a mushroom shape in the same manner as in the conventional method.

  By repeating such a clockwise spiral scan from the deep position to the shallow position of the cornea 41a for ν times, the peripheral edge IV of the donor cornea 41a as shown in FIG. 12A can be defined. 20 tunnels 43a, 43b, 43c, 43d, 43e ', 43e, 43f, 43g, 43h, 43i', 43i, 43j, 43k, 43l, 43m ', 43m, regularly arranged at the peripheral edge IV 43n, 43o, 43p, and 43a 'can be formed almost simultaneously. This makes it possible to prepare tunnels 43a to 43p having arcs in cross section, tunnels 43a ', 43e', 43i ', and 43m' and a cornea 41a for a continuous suture having a mushroom shape.

[Incision of recipient's cornea 41b and creation of tunnels 43a-43p, etc.]
When the donor cornea 41a is prepared, the process proceeds to step ST10, and the control unit 35 shown in FIG. 1 adds tunnels 43a to 43p, tunnels 43a ′, 43e ′, 43i ′, and 43m ′ to the tissue of the recipient cornea 41b. The medical laser device 20 is controlled so that the graft incision 41x is simultaneously formed. For example, the control unit 35 reads the laser control data D20 from the memory unit 36 and incises the recipient's cornea 41b so as to define the opening peripheral edge V, and the opening peripheral edge V and the hole positions AP. The output of the medical laser device 20 is controlled so as to form tunnels 43a to 43p and tunnels 43a ′, 43e ′, 43i ′, and 43m ′ that respectively connect them to each other.

  The medical laser device 20 receives the laser control data D20, and decodes data necessary for spiral scanning control of the laser light and its focal depth control from the laser control data D20. In this data decoding, a laser beam is spirally scanned on the cornea 41b of the recipient counterclockwise so as to go from the stitching boundary line I to the stitching outer ring line III along the stitching boundary line I shown in FIG. Stage drive data D24 is reproduced. By spiral scanning from a deep position to a shallow position (Z direction) based on the stage drive data D24, the recipient's cornea 41b is dissected so as to define the peripheral edge V of the opening, and from the deep position of the cornea 41b to the surface thereof. Tunnels 43a to 43p are formed sequentially.

  While the aperture peripheral edge V is sequentially defined by the spiral scanning control and the focal depth control described above, for example, the laser light irradiation timing is slightly changed from the aperture peripheral edge V to each hole position AP at an angle θ4. While shifting one by one, 16 tunnels 43a to 43p and 4 tunnels 43a ', 43e', 43i ', 43m' for end-to-end stitching are formed almost simultaneously. The angle θ4 is ½ of the isosceles triangle ∠pAa having the hole positions p, A, and a as the vertices (see FIGS. 11 and 12A).

  Focusing on the formation order of the tunnels 43a to 43p of the recipient's cornea 41b and the end-to-end suture tunnels 43a ′, 43e ′, 43i ′, and 43m ′ shown in FIG. For example, tunnels 43a ′, 43p, 43o, 43n, 43m, 43m ′, 43l, 43k, 43j, 43i, 43i ′, 43h, 43g, 43f, 43e, 43e ′, 43d, 43c, 43b, The depth of focus of the laser beam is adjusted at the deepest position where formation of 43a starts, and tunnel 43a 'is formed between hole positions PA, tunnel 43e' is formed between hole positions DE, and tunnel is formed between hole positions HI. 43i ′ and a tunnel 43m ′ between the hole positions LM, and the others are tunnels 43p to 4 corresponding to the hole positions P to A at every rotation angle order (22.5 °). Formation of a is started.

  About the length of 16 tunnels 43p-43a (descending order), line segment Aa which connects radial line (1) '-(8) shown in FIG. 11 and corresponding radial line (1)'-(8) '. , Line segment Bb, line segment Cc,..., Line segment Pp, the medical laser device 20 is controlled to turn on the irradiation timing of the laser beam. Of course, hole positions PO, ON, NM, LK, KJ, IH, HG, GF, DC, CB, B on the same circumference. Between -A is turned off except for the laser irradiation interval γ.

In the next counterclockwise spiral scan, the depth of focus is adjusted so that the depth position slightly decreases from the above-mentioned depth position, and the hole position is slightly expanded outward. A-P includes a tunnel 43a ', a hole position ML includes a tunnel 43m', a hole position I-H includes a tunnel 43i ', and a hole position ED includes a tunnel 43e'. The formation of the tunnels 43p to 43a corresponding to the hole positions P to A (descending order) is continued every 22.5 °. Since the irradiation timing of the off interval of the laser beam on the same circumference is gradually shorter arc length, shortened it in the proportion.

Further, in the next counterclockwise spiral scan, the depth of focus is adjusted so that the depth of focus is further reduced from the above-described depth position, and the hole position A− Tunnel 43a 'between P, tunnel 43m' between hole positions ML, tunnel 43i 'between hole positions I-H and tunnel 43e' between hole positions ED, and the other rotation angle ranking (22. The formation of the tunnels 43p to 43a corresponding to the hole positions P to A (descending order) is continued every 5 °. Irradiation timing of off interval of the laser light is also the same as described above. The incision of the recipient's cornea 41b is formed in a mushroom shape in the same manner as in the conventional method.

  By repeating counterclockwise spiral scanning ν times from a deep position to a shallow position in the tissue of the recipient's cornea 41b, the peripheral edge of the opening of the recipient's cornea 41b as shown in FIG. The portion V can be defined, and 20 tunnels 43a, 43b, 43c, 43d, 43e ', 43e, 43f, 43g, 43h, regularly arranged at the peripheral edge V of the opening (stepped transplant opening 41x), 43i ', 43i, 43j, 43k, 43l, 43m', 43m, 43n, 43o, 43p, 43a 'can be formed almost simultaneously. This makes it possible to prepare tunnels 43a to 43p having an arc cross section having an angle θ4, tunnels 43a ′, 43e ′, 43i ′, and 43m ′ for end-to-end sutures, and a donor cornea 41a for continuous stitching having a mushroom shape. become.

  When the recipient's cornea 41b is ready for suturing, the donor cornea 41a is aligned with the recipient's cornea 41b as described in FIGS. 9 (A) and 9 (B). As shown, tunnels 43a-43p and tunnels 43a ′, 43e ′, 43i ′, 43m ′ are combined. Then, as shown in FIG. 14, the donor cornea 41a and the recipient cornea 41b are sutured. At this time, the practitioner simply stitches the tunnels 43a ′, 43e ′, 43i, 43m ′ first, stabilizes the posture of the donor cornea 41a, and then passes the suture needle through the tunnels 43a to 43p. The cornea 41 can be continuously sutured accurately.

  For example, the donor cornea 41a with respect to the recipient's cornea 41b is stitched end-to-end at the four cross points, ie, at the 12 o'clock, 3 o'clock, 6 o'clock, and 9 o'clock positions on the watch dial. As shown in FIG. 14, the practitioner who is good at suturing first inserts the suture needle 51 (see FIG. 9) from the hole position a through the tunnel 43a in the counterclockwise direction. Pull out from. Next, the hole positions Ap are exposed, and the hole positions p to P are stitched through the tunnel 43p.

  Similarly, between hole positions P → o is exposed and between hole positions o → O is tunnel 43o (upper case → lower case: exposure, lower case → upper case: tunnel), O → n → N → m → M → l → L → k → K → j → J → i → I → h → H → g → G → f → F → e → E → d → D → c → C → b → B → a Suture. One end and the other end of the suture thread 52 are connected between the hole positions B → a. Of course, the sewing start position is not limited to the hole position a. As a result, the recipient's cornea 41b and the donor's cornea 41a can be continuously sutured in a zigzag manner with good regularity.

  When the clockwise direction is set for the sewing procedure, the control branches in step ST6, and the process proceeds to step ST8 so that the control unit 35 makes the tunnel position (excavation direction) opposite to the exposure position. Invert the hole placement pattern. Based on the hole arrangement pattern reversed here, a practitioner skilled in suturing clockwise performs suturing. For example, since the excavation direction of the tunnels 43a to 43p is changed from counterclockwise to clockwise for the stitching procedure, the tunnel 43a shown in FIG. 15 is located between the hole positions a and B, and the tunnel 43b is located as the hole position b-C. Between: the tunnel 43p is formed between the hole positions pA, and the suture needle 51 (see FIG. 9) is inserted from the hole position a through the tunnel 43a and pulled out from the hole position B. Next, the hole position B-b is exposed, and the hole position b to C are stitched through the tunnel 43b.

  Similarly, between the hole positions C → c is exposed, and between the hole positions c → D is tunnel 43c (upper case → lower case: exposure, lower case → upper case: tunnel), c → D → d → E → e → F → f → G → g → H → h → I → i → J → j → K → k → L → l → M → m → N → n → O → o → P → p → A zigzag through the needle in this order Suture. Between the hole position p → A, one end of the suture thread 52 is connected to the other end. Of course, the sewing start position is not limited to the hole position a. Accordingly, even a person who is good at sewing in a clockwise direction can easily and continuously zigzag the recipient's cornea 41b and the donor's cornea 41a with good regularity.

Thus, according to the control method of the corneal transplantation support device 100 and the suture hole creation device as the embodiment, the control unit 35 that controls the output of the medical laser device 20 is provided. Based on the settings of the hole positions AP for needle insertion and extraction based on the settings and the tunnels 42a to 42p connecting the corresponding hole positions a to p and the tunnels 43a to 43p, the output of the medical laser device 20 is controlled, and the donor The tunnels 42 and 43 (cavities) having arc-shaped cross sections are formed in the tissues of the cornea 41a and the recipient cornea 41b.

  With this configuration, the suture needle 51 can be smoothly inserted into the tunnel 42a formed in the donor's cornea 41a, the tunnel 42a formed in the recipient's cornea 41b, and the like, regardless of the skill level of the practitioner. It becomes like this. In the case of end-to-end suture, the practitioner only has to pass the suture needle 51 through the created tunnels 42a to 42p, and the donor's cornea 41a and the recipient's cornea 41b can be sutured with good reproducibility.

With this control method, a suture needle 51 (a blunt tip blunt needle) with a rounded tip can be used, so that not only threading out of the tunnel can be prevented, but also tissue damage can be greatly reduced. Become. During sewing, the hole position of the sutured object and the hole position of the sutured object can be accurately aligned, so that the suture needle can be smoothly inserted into the sutured article and the sutured object without depending on the skill level of the operator. As a result, the suture and the suture can be sewn with good reproducibility without the suture being biased in one direction with respect to the suture. Accordingly, it is possible to provide the corneal transplantation support device 100 and the corneal suturing operation method capable of supporting the practitioner's suturing operation at the time of corneal suturing that affects the result of corneal transplantation.

  In this example, during continuous stitching, the hole positions A ′ and I ′ for end-to-end stitching are set at positions slightly shifted from the radial line (1), and the hole positions are shifted slightly from the radial line (5). Although the case where E ′ and M ′ are set has been described, the present invention is not limited to this. If there is a concern about weakening of the surrounding tissue due to the denseness of the hole positions A and A ′, the hole positions E and E ′, the hole positions I and I ′, and the hole positions M and M ′, the respective radial lines (1), From (5), on the side where the tunnels 43a, 43e, 43i, and 43m are not formed, the hole positions A ′, E ′, I ′, and M ′ are set so as to be shifted clockwise or counterclockwise by about 5 ° in angle. May be.

  It is possible to prevent adverse effects caused by the hole positions A and A 'and the hole positions I and I' being arranged in a row on the radial line (1). Similarly, it is possible to prevent adverse effects caused by the hole positions E and E 'and the hole positions M and M' being arranged in a row on the radial line (5). Thus, using the end-to-end suture tunnels 43a ′, 43e ′, 43i ′, 43m ′ formed in the tissue away from the position where the tunnels 43a, 43e, 43i, 43m are not formed, prior to continuous stitching. End-to-end stitching can be performed. The corresponding hole positions A ', E', I ', M' can be separated from the hole positions A, E, I, M, and weakening of the surrounding tissue can be prevented.

  In the embodiment described above, the case where the transplant opening 41x and the tunnels 42a to 42p, 43a to 43p, and the like are formed by spiral scanning has been described. However, the present invention is not limited to this. The transplant opening 41x and the tunnels 42a to 42p, 43a to 43p, and the like may be formed by raster scanning. Moreover, the case where these are combined may be sufficient. For example, the transplant cut opening 41x may be formed by spiral scanning, and the tunnels 42a to 42p, 43a to 43p, etc. may be formed by raster scanning.

  INDUSTRIAL APPLICABILITY The present invention is extremely suitable when applied to a corneal transplantation assisting device and a corneal suturing surgical method for assisting a practitioner in suturing at the time of corneal suturing that affects the result of corneal transplantation.

DESCRIPTION OF SYMBOLS 11 Imaging device 12 Input tool 20 Medical laser apparatus (hole formation part)
DESCRIPTION OF SYMBOLS 21 Light source part 22 Optical system 23 Lens drive mechanism 24 Stage drive mechanism 25,35 Control part 26 Detection part 30 Personal computer 31 Mouse 32 Keyboard 33 Input / output port 34 Display apparatus 36 Memory part 100 Corneal transplantation support apparatus (stitching hole creation apparatus)

Claims (10)

A suture hole creating device for creating a hole for needle guidance when stitching a suture to a suture,
An input unit for inputting a suture condition including a shape of the sutured object and a sutured object, the number of sutures, a hole position for needle insertion / extraction , and a suture procedure ;
A hole forming part for forming the hole part for connecting the hole position of the sutured object and the hole position of the sutured object;
On the basis of the sewing condition setting a plurality of holes located in the object to be sewn product with a plurality of holes located in the suture material, based the the hole position of the suture material after setting to the hole position of the suture material A completed suture image relating to the suture between the suture and the object to be sutured is created, and the position coordinate data of the hole arrangement pattern of the suture and the object to be suture included in the completed suture image is referred to the suture boundary line. The position coordinate data of the hole arrangement pattern of the suture object and the position coordinate data of the hole arrangement pattern of the suture object are decomposed into two groups, and the hole position of the suture object is determined by the position coordinate data of one of the groups. A plurality of hole portions are formed in the tissue connecting the hole position of the suture and the suture boundary line , and the hole position is set in the sutured object by the position coordinate data of the other group. , The covered Compound suture holes creating device and a control unit for controlling the output of the hole forming element to form the hole and hole position on the tissue connecting the said stitching border. Either one of clockwise and counterclockwise can be set with respect to the suturing procedure,
The controller is
The suture hole creation device according to claim 1, wherein a hole arrangement pattern corresponding to the clockwise direction and the counterclockwise direction is set for the hole forming portion. The controller is
The suture hole creation device according to claim 1, wherein an output of the hole forming part is controlled so that at least an opening serving as a transplant target part is formed in the sutured object together with the hole part. The controller is
At least the hole position of the sutured object and the hole position of the sutured object to be stitched separately, or the hole position of the sutured object and the hole position of the sutured object are continuously stitched. The suture hole creating apparatus according to claim 1, wherein the hole forming portion is controlled so as to form a hole portion for continuous stitching. The controller is
A first hole position of a predetermined number of stitches is set at the peripheral edge of the suture and a second hole position of the same number of sutures is set at the peripheral edge of the opening of the suture;
The needle guide hole from the peripheral edge of the suture to the first hole position, and the needle guide hole from the peripheral edge of the suture to the second hole. The suture hole creating apparatus according to claim 4 , wherein the hole forming unit is controlled to form. When the sutured object having the shape to be sutured is combined with the sutured object opened in a substantially circular shape, or the sutured object having the shape to be sutured is combined with the sutured object opened in a substantially elliptical shape. In the case of stitching, the position where the control unit stitches the sutured object and the sutured object is the number of stitches η, and the hole part connecting the hole position of the sutured object and the hole position of the sutured object The set pitch angle θ is set to 360 ° / η with reference to the suture center position where the set pitch angle is θ and the center position when the sutured object and the sutured object are sutured is the suture center position. The suture hole creating device according to claim 5 , wherein The controller is
When the radial line passing through the suture center position is a radial line,
Η / 2 of the diameter lines in which the second hole position of the sutured object is set are rotated by an angle θ / 2 with respect to the suture center position,
The controller is
The needle connecting the first hole position of the suture set on the radial line rotated by an angle θ / 2 and the second hole position of the suture target set on the radial line before rotation The suture hole creating apparatus according to claim 6 , wherein the hole forming unit is controlled so as to form a guide hole. In the hole forming portion,
A medical laser device is used that forms a cavity by causing a plasma explosion in a short time within the tissue of the sutured object and the sutured object,
The suture hole creation device according to claim 7 , wherein the control unit controls the medical laser device so as to connect the cavity at a hole portion connecting the first and second hole positions. A method for controlling a suture hole creating apparatus for creating a hole for needle guidance when a suture is sutured to an object to be sutured,
The suture hole creating device has a control part and a hole forming part,
The controller is
Inputting the shape of the suture material and the suture material, suture number, hole position of needle insertion, the suture conditions including suturing procedure,
Setting a plurality of hole positions in the sutured object and a plurality of hole positions in the sutured object based on the inputted sewing conditions ;
Creating a completed suture image relating to the stitching between the suture and the sutured object based on the set hole position of the sutured object and the hole position of the sutured object;
The position coordinate data of the hole arrangement pattern of the suture and to-be-sewn objects included in the completed suture image that has been created, the position coordinate data of the hole arrangement pattern of the suture and the sutured object with reference to the suture boundary line, Disassembling into two groups of position coordinate data of the hole arrangement pattern of the object;
The hole forming portion is set so as to form a hole in the tissue connecting the hole position of the suture and the suture boundary line by setting a hole position in the suture by the position coordinate data of one group after disassembly. Controlling step ;
By setting the hole position on the object to be sutured object by the position coordinate data of the other group after the decomposition, the hole forming said to form a hole in the tissue connecting the said suture boundary line with the hole position of the suture material the method of suture holes creating apparatus for executing and controlling the parts. For the suture, the cornea of the cornea donor is handled,
The method for controlling a suture hole creating apparatus according to claim 9 , wherein a cornea of a corneal transplant patient is handled with respect to the sutured object.

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