JP6422627B2 - Ophthalmic surgery microscope - Google Patents

Description

  The present invention relates to an ophthalmic surgical microscope used for ophthalmic surgery.

  As a method for treating cataract, ultrasonic lens emulsification aspiration surgery is known. In such an operation, the nucleus of the lens of the patient's eye that has become cloudy with a perfusion suction device) is emulsified (crushed) with ultrasound and removed by suction. The artificial intraocular lens is then placed in the lens capsule. An ophthalmic surgical microscope disclosed in Patent Document 1 is used for such ophthalmic surgery. The apparatus of Patent Document 1 includes an illumination unit that irradiates the fundus with illumination light and illuminates the crystalline lens from the back with the light from the fundus. Such an illumination unit is configured to suitably obtain a red background illumination (red reflection) of the crystalline lens.

JP-A-2005-118561

  However, the illumination unit described in Patent Document 1 does not take into consideration the difference in refractive power for each patient's eye, the change in irradiation state of illumination light to the eye after the lens is removed during the operation, and the like. It is difficult to ensure a favorable illumination state for each eye or during surgery.

  In view of the above problems, it is an object of the present invention to provide an ophthalmic surgical microscope that can ensure a favorable illumination state in a patient's eye and during surgery.

In order to solve the above problems, the present invention is characterized by having the following configuration.
(1)
An illumination optical system that forms an illumination light emitted from an illumination light source on the fundus of the patient's eye and an anterior ocular segment image including the patient's eye lens illuminated from the back by the illumination light imaged on the patient's fundus An ophthalmic surgical microscope comprising an observation optical system,
The illumination optical system changes the imaging position of the illumination light with respect to the patient's eye fundus along the illumination optical axis of the illumination optical system when observing the anterior segment image by the observation optical system. With
Furthermore, it is characterized by further comprising control means for controlling the changing means based on the refractive power of the patient's eye acquired by the refractive power acquiring means for acquiring the refractive power of the patient's eye.

  ADVANTAGE OF THE INVENTION According to this invention, a favorable illumination state can be ensured in a patient's eye and an operation.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a schematic diagram illustrating a surgical microscope according to the present embodiment. In the present embodiment, the axial direction of the patient's eye (eye E) is described as the Z direction, and the horizontal direction is described as the X and Y directions.

  The surgical microscope 100 includes an observation unit 10, an illumination unit 30, an operation unit 80, a control unit 70, and the like. The observation unit 10 and the illumination unit 30 are built in a housing (not shown). The observation unit 10 is used as an observation optical system for observing the eye E during surgery. The illumination unit 30 is used as an illumination optical system for illuminating the eye E during surgery.

The observation unit 10 includes an optical path from the patient's eye E to the surgeon's eye. In addition, although the operation microscope of this embodiment has taken as an example the binocular type which has a part of observation optical path respectively independent with respect to the operator's left and right eyes, in FIG. Only the optical path on the left eye side of the surgeon is illustrated. The microscope may be a monocular type.
The observation unit 10 includes an objective lens 11 disposed in a common optical path between the left and right observation optical paths. Furthermore, an aperture 12, a lens 13, a lens 14, a lens 15, an aperture 16, a tube lens 17, and an eyepiece 18 are arranged on the observation optical path (on the optical axis L1). The lens 13, the lens 14, and the lens 15 (at least one of them) are respectively moved in the optical axis direction by the drive unit 21 to form a zoom system (magnification unit) 22. The tube lens (lens barrel lens) 17 has a role of forming an image plane on the upstream side (operator eye side) of the diaphragm 16.

A beam combiner 19 that is an optical coupling element is disposed between the objective lens 11 and the zoom system 22 (aperture 12) (upstream of the objective lens 11). The beam combiner 19 has a role of making the optical axis L2 of the illumination unit 30 (illumination optical system) coincide (coaxial) with the optical axis L1 of the observation unit 10 (observation optical system). The beam combiner 19 of the present embodiment is a half mirror that transmits and reflects at a predetermined ratio of visible light (observation light and illumination light), for example. As the beam combiner 19, a prism, a partial reflection mirror, or the like can be used. The half mirror of this embodiment preferably has a high transmittance. Here, the beam combiner 19 is sized to cover the observation optical path of the left and right eyes. The beam combiner 19 is preferably arranged downstream of the lens 13 (on the patient's eye) and upstream of the objective lens 11 so that the magnification of the illumination light beam does not change by the zoom system 22. Here, the beam combiner 19 is also arranged downstream of the diaphragm 12 so as not to interfere with the diaphragm 12. The beam combiner 19 may be configured to cover the optical paths of the left and right eyes, in other words, a configuration separated for the optical paths of the left and right eyes.
The illumination unit 30 is an illumination device for obtaining red reflection in cataract surgery. The illumination unit 30 has a role of illuminating the anterior segment of the eye E, mainly the crystalline lens. The illumination unit 30 includes a light source 31 and optical elements (a lens 32, a field stop 33, an aperture stop 34, and a lens 35). The illumination unit 30 shares the beam combiner 19 and the objective lens 11 with the observation unit 10. In the illumination unit 30, the optical elements are arranged on the illumination optical axis L2 from the light source 31 toward the objective lens 11 (downstream). The illumination light emitted from the light source 31 is irradiated toward the fundus of the eye E through each member.

  The illumination unit 30 has optical paths corresponding to the left and right observation optical paths. That is, the illumination unit 30 includes a right-eye illumination optical path that matches the observation light path (optical axis) for the operator's right eye, and a left-eye illumination optical path that matches the observation light path for the operator's left eye. It has. In FIG. 1, only one optical element arranged in the illumination light path for the left eye of the surgeon is shown to explain one illumination light path of the illumination unit 30. When the illumination unit 30 includes optical elements for the left and right eyes, for example, two light sources 31 are provided for the left and right eyes. The aperture stop 34 includes two openings (aperture portions) for the left and right eyes, respectively. The lenses (groups) 32 and 35 are lenses of a size that covers the optical paths for the left and right eyes. In addition, each optical element may be prepared separately for the optical paths of the left and right eyes, or may be configured to share a part.

  The light source 31 emits visible illumination light. As the light source 31, for example, a halogen lamp, a xenon lamp, a white LED (light emitting diode), or the like is used. The light source 31 may be configured to emit illumination light. For example, the output end face of the fiber for guiding the illumination light emitted from the light source to a predetermined optical path may be used as the light source. That is, illumination light such as a halogen lamp arranged in another unit may be guided by a fiber, and the emission end face of the fiber may be used as a light source. Moreover, it is good also as a structure which uses what becomes a secondary light source with respect to the light source 31 as a 2nd light source of illumination light. For example, illumination light emitted from a halogen lamp or the like can be transmitted through a diffusion plate, and the diffusion plate can be used as a light source.

The lens 32 has a positive refractive power and collects the luminous flux of the illumination light from the light source 31. The field stop 33 has an opening on the illumination optical axis L2. The field stop 33 has a role of limiting the luminous flux of the illumination light emitted from the light source 31 and determining the illumination range of the observation surface defined by the objective lens when the illumination light is irradiated onto the eye E. The aperture stop 34 has an opening on the illumination optical axis L2. The aperture stop 34 has a role of determining the size of the light source 31 imaged on the fundus. The lens 35 has a positive refractive power (optical power). The lens 35 guides the illumination light that has passed through the aperture stop 34 to the beam combiner 19 and the objective lens 11.
The lens (relay lens) 32 has a positive refractive power, forms an image of the light source 31 at the position of the aperture of the aperture stop 34 via the field stop 33, and forms an intermediate image of the light source 31. The aperture stop 34 has a positional relationship conjugate with the fundus of the eye E, and has a role of determining a spot size (illumination range) when an intermediate image of the light source 31 is formed on the fundus. The illumination light beam that has passed through the aperture stop 34 passes through a lens (relay lens) 35, is made coaxial with the optical axis L1 by a beam combiner 19, and then forms an image on the fundus of the eye E through the objective lens 11. Is done. At this time, the illumination light beam emitted from the objective lens 11 is parallel light. The illumination light that has become parallel light is applied to the eye E. At this time, if the eye E is a normal eye (0D (diopter)), the illumination light beam is condensed on the fundus of the eye E, and a light source is imaged on the fundus. Therefore, the light source 31, the aperture stop 34, and the fundus are conjugate. The light source image formed on the fundus serves as an illumination light source that illuminates the crystalline lens of the eye E from the back (transillumination). The light that has passed through the eye E (reflected light at the fundus) enters the observation unit 10 as parallel light. The observation unit 10 can obtain a microscope image of the eye E that is illuminated by illumination.
The illumination unit (illumination optical system) 30 includes a moving mechanism 41 as a changing unit for changing the imaging state of the illumination light irradiated toward the fundus of the eye E. Specifically, the changing means (the moving mechanism 41) changes the imaging position of the light source in the eye E along the illumination optical axis by changing the imaging state of the illumination light beam emitted from the objective lens. The illumination light beam can be imaged on the fundus even in various states such as non-stereoscopic eyes for each patient, and aphakic eyes after removing the crystalline lens.
In this embodiment, the changing means includes at least two stages, for example, when the light source forms an image on the fundus when the eye E is a normal eye (0D), and when the lens is removed by ultrasonic lens emulsification and suction surgery. In this case, the imaging state of the illumination light is changed so as to include the case where the light source forms an image on the fundus, but it is preferable that the adjustment state can be freely adjusted in two steps or more, and the adjustment range is wider. . Further, in this embodiment, the moving mechanism 41 that moves the light source 31 and the aperture stop 34 along the optical axis L2 of the illumination optical system so that the imaging state of the light source can be changed in at least two stages. Is provided. The moving mechanism 41 of the present embodiment is a cam mechanism that houses the light source 31 and the aperture stop 34. The moving mechanism 41 has a configuration (zoom mechanism) in which the positions of the light source 31 and the aperture stop 34 are slid and changed. In the moving mechanism 41, the position of the intermediate image and the position of the aperture stop 34 are made to coincide with each other and the state is maintained. In the moving mechanism 41, the light source 31 and the aperture stop 34 are moved correspondingly.

The illumination unit 30 includes a drive unit 42. The drive unit 42 drives the moving mechanism 41. An actuator and a stepping motor are used for the drive unit 42. The drive unit 42 drives the moving mechanism 41 based on a command signal from the control unit 70 and changes the positions of the light source 31 and the aperture stop 34. The moving mechanism 41 may be driven manually.
Although not shown, the surgical microscope 100 is provided with a second illumination unit. The second illumination unit has a visible light source, emits illumination light toward the eye E, and illuminates, for example, the anterior eye segment. The second illumination unit has an illumination optical path different from that of the illumination unit 30 and, for example, shares the objective lens 11.
It is supported by the observation unit 10, the illumination unit 30, and an arm (not shown). The arm is held by the moving unit 60. The moving unit 60 is an alignment unit that allows the observation unit 10 and the illumination unit 30 to move together in the XYZ directions. The moving unit 60 includes a driving unit such as a motor. The moving unit 60 moves the observation unit 10 and the like three-dimensionally based on a command signal from the control unit 70. The moving unit 60 adjusts the focal position and the observation position of the objective lens 11. For example, the anterior segment is adjusted so that it can be easily observed.
The operation unit 80 is an operating device (controller) for operating each drive unit. The operation unit 80 includes an alignment operation unit 81 for performing an alignment operation of the observation unit 10 and the like, a magnification operation unit 82 for performing an observation magnification changing operation, and a state for changing the imaging state of illumination light by the illumination unit 30. An illumination operation unit 83 is provided. The operation unit 80 is, for example, a foot switch operated by a foot so that the operator can easily operate during the operation. When each operation unit is operated, an operation signal is sent to the control unit 70. The alignment operation unit 81 is configured to be able to input operation signals in positive and negative directions in the X direction, Y direction, and Z direction, respectively. The magnification operation unit 82 is configured to input an operation signal for enlarging or reducing the magnification. The illumination operation unit 83 is configured to be able to input an operation signal for changing the imaging state of the illumination light in the positive and negative directions along the optical axis L2 (Z direction). Specifically, an operation signal for changing the imaging state of the illumination light beam in the positive and negative directions along the optical axis L2 at the imaging position of the light source 31 and the like is input by operating the illumination operation unit 83. In the present embodiment, the imaging state of the illumination light can be handled in the range of the eye diopter 30D to -20D. The operation unit 80 can input an operation signal corresponding to the above range in a predetermined step (for example, 1D). The above range considers the case where the lens is removed with a hyperopic eye.
The control unit 70 is a unit (control means) that controls and controls the surgical microscope 100. The control unit 70 of the present embodiment is a CPU (Central Processing Unit). The control unit 70 is connected to the drive unit 21, the light source 31, the drive unit 42, the moving unit 60, the operation unit 80, and the like. The control unit 70 sends a command signal (control signal) to the drive unit 21, the drive unit 42, and the moving unit 60 based on the operation signal from the operation unit 80. The controller 70 turns on the light source 31 and adjusts the amount of light based on an input signal from a switch (not shown).

  Next, a change in the imaging state of illumination light will be described. Here, a method of changing the imaging position of the light source 31 along the optical axis in the eye E will be described.

  2 to 4 are optical diagrams of the illumination unit 30. FIG. Here, the illustration of the drive unit and the like is omitted. FIG. 2 shows a case where the eye E1 is normal (0D), and FIGS. 3 and 4 show a case where the eye E2 is hyperopic (for example, + 10D).

As shown in FIG. 2, the illumination light beam emitted from the light source 31 is condensed (imaged) by the lens 32 onto the opening of the aperture stop 34. At this time, the illumination light beam is limited by the light beam diameter by the field stop 33. The illumination light beam is relayed to the lens 35, reflected by the beam combiner 19, and coaxial with the observation optical axis L1. The illumination light beam reflected by the beam combiner 19 passes through the objective lens 11, becomes parallel light, and is irradiated toward the fundus of the eye E1. Here, since the eye E1 is a normal eye, the illumination light beam is condensed on the fundus and the light source 31 is imaged (a light source image is formed on the fundus). The image of the light source 31 formed on the fundus acts as a light source for illuminating the crystalline lens from the back as red reflection. The light beam from the fundus passes through the eye E1, passes through the objective lens 11 and the beam combiner 19, and is expanded in diameter by the lenses 13, 14, and 15 (enlargement of the image by the zoom system 22). The light beams that pass through the lenses 13 to 5 are collected by the tube lens 17 shown in FIG. 1, and an anterior segment image of the eye E <b> 1 is formed upstream of the tube lens 17. At this time, the luminous flux is limited by the diaphragms 12 and 16. The surgeon (observer) visually recognizes the anterior segment image magnified through the eyepiece 18.
In this embodiment, since the effective optical diameter of each optical element of the observation unit 10 is designed so that all the parallel light beams directed from the eye E1 toward the objective lens 11 can be condensed by the tube lens 17, the operator The eye can see an anterior segment image that includes a (bright) lens with a suitably illuminated lens.

  Next, a case where the far-sighted eye E2 is illuminated under the same illumination conditions as described above will be described. As shown in FIG. 3, the illumination light beam is not condensed on the fundus of the eye E. The illumination light flux that is parallel light emitted from the objective lens 11 receives the refractive power of the eye E2, but is not sufficiently refracted and forms an image on the back side of the fundus. Actually, a spot having a large diameter is projected onto the fundus (a state where a defocused spot is projected). The spot of illumination light formed on the fundus can be regarded as a light source placed on the fundus. A light beam (reflected light beam) from the fundus enters the observation unit 10 through the anterior eye portion of the eye E2. At this time, the light flux receives the refractive power of the eye E, but the light flux from the eye E2 toward the objective lens 11 becomes diffused light, and some of the light flux may not be incident on the objective lens 11. In such a case, the amount of the reflected light beam incident on the observation unit 10 is smaller than that in the case of FIG. The appearance changes compared to.

  Here, a hyperopic eye is taken as an example, but the same applies to an eye from which the lens nucleus has been removed by suction (even if only the sac is used).

  Next, a case where the imaging position of the light source 31 is changed and the light source 31 is imaged on the fundus of the hyperopic eye will be described. FIG. 4 is a diagram illustrating a configuration of an illumination unit that forms an image of the light source 31 on the fundus of the hyperopic eye E2. The position of the optical element in the illumination unit 30 is changed so that the illumination light beam emitted from the objective lens 11 toward the eye E2 becomes convergent light and a light source image is formed on the fundus of the eye E2.

In order to use the illumination light beam emitted from the objective lens 11 as convergent light, the light source 31 is moved away from the lens 32 (upstream side). Here, the light source 31 is moved upstream from the original position by the movement amount M1. As a result, the intermediate image formation position of the light source 31 approaches the lens 32.
Further, the aperture stop 34 is moved so that the aperture stop 34 does not cause the intermediate image to be vignetted. The movement of the aperture stop 34 is made to correspond to the movement of the intermediate imaging position. Here, the aperture stop 34 is moved upstream from the original position by the movement amount M2. The moving mechanism 41 is a cam structure in which the light source 31 and the aperture stop 34 are conjugated, and the movement amount M1 of the light source 31 and the movement amount M2 of the aperture stop 34 are associated with each other.

As the intermediate imaging position of the light source 31 moves upstream, the light passing through the lens 35 and the objective lens 11 becomes convergent light. The illumination light flux that has become convergent light reaches the eye E2, receives the refractive power of the eye E2, and is condensed on the fundus. As a result, the light source 31 forms an image on the fundus of the eye E2 which is a hyperopic eye. The illuminated anterior segment image is visually recognized by the operator as in the case of FIG.
In this embodiment, by moving the light source 31 and the aperture stop 34 in this manner, the light source 31 can be imaged on the fundus even in the case of a hyperopic eye. At this time, the distance (height) between the objective lens 11 and the eye E is constant. Therefore, the imaging state of the illumination light (imaging position on the illumination optical axis of the light source 31) can be changed in a constant alignment state in the Z direction.
In the moving mechanism 41 described above, the movement amount M1 and the movement amount M2 are associated with the far-sighted eye (+ 10D) having a predetermined refractive power (diopter). The amount of movement M1 and the amount of movement M2 corresponding to the hyperopic eye) can be prepared. For example, the light source 31 and the like can be continuously changed at a plurality of positions, and the diffusion state (including diffusion, convergence, and parallelism) of the illumination light beam emitted from the objective lens 11 is changed stepwise or continuously. It is good also as a structure.
Here, although the moving mechanism of the light source 31 and the aperture stop 34 is a cam mechanism, it is not limited to this. A configuration in which the movement amount and direction of the light source 31 and the aperture stop 34 are associated with each other (for example, a conjugate relationship is maintained) may be used, and the light source 31 and the aperture stop 34 are fixed to individual drive units and the drive unit is controlled. It is good. In this case, the control amount of each drive unit is configured to correspond in advance.

The operation of the surgical microscope having the above configuration will be described.
The surgeon performs cataract surgery (ultrasonic emulsification and intraocular lens replacement). The surgeon turns on the illumination light with a switch (not shown). The operator operates the alignment operation unit 81, positions the observation unit 10 and the illumination unit 30 in the XYZ directions, operates the magnification operation unit 82, and determines the observation magnification.
Next, the surgeon confirms the illumination state of the crystalline lens of the eye E. The surgeon operates the illumination operation unit 83 to change the illumination state of the crystalline lens by the illumination unit 30 to change the imaging state of the illumination light beam to be a condition suitable for the surgeon. At this time, even if the eye E is a normal eye, a farsighted eye, or a myopic eye, the lens can be illuminated under the condition that a red reflection suitable for the operator is obtained. Note that it is not always necessary to form a light source (intermediate imaging, secondary light source) on the fundus of the patient's eye, and most of the reflected light of the illumination light spot formed on the fundus is incident on the optical element of the observation optical system. It is sufficient that such an imaging state is obtained.
Then, the surgeon starts sucking and removing the lens nucleus. The operator can appropriately change the illumination state of the lens when removing the lens nucleus. The surgeon operates the illumination operation unit 83 to proceed with the surgery so that the lens is illuminated under conditions suitable for the surgeon. All of the lens nucleus is removed, the intraocular lens is placed in the sac, and the series of operations is completed.

  As described above, the surgical microscope 100 according to the present embodiment can perform surgery by suitably illuminating the crystalline lens while ensuring illumination conditions (example: red reflection). Specifically, even in the case of an aphakic eye as described above, the crystalline lens can be favorably illuminated even when the diopter of the patient's eye is not 0D (far-sighted eye, near-sighted eye). Moreover, even if the state of the lens changes during the operation, the lens can be suitably illuminated.

  In the above description, the light source 31 and the like are moved in multiple stages (continuously). However, the present invention is not limited to this. Any configuration that can change the imaging position of the light source 31 (imaging state of the illumination light) in at least two stages may be used. Such a doubling and moving mechanism may be a slide mechanism (slider) or the like.

In the above description, the light source 31 and the aperture stop are moved. However, the present invention is not limited to this. Any configuration that can change the divergence state (convergence state) of the light beam toward the objective lens 11 may be used. For example, when no aperture stop is used, only the light source 31 can be moved in the optical axis direction, or the light source 31 can be fixed and only the aperture stop can be moved. Further, the divergent state (convergence state) of the light beam directed toward the objective lens 11 using another lens system (a lens system including one or more lenses) placed in the optical path of the illumination unit without moving the light source or the aperture stop. It can also be changed. Such a lens system can be moved along the optical axis, or can be inserted into and removed from the illumination optical path. A power variable lens can also be used. In the case of a variable power lens, it is arranged on the optical axis L2 upstream of the beam combiner 19 so that the power is changed.
In the above description, the configuration in which the optical element (light source 31 and the like) of the illumination unit 30 is moved (controlled) by the drive unit 42 (electric drive) is not limited to this. It is sufficient that the optical element can be moved, and a configuration in which the optical element is manually moved may be used. For example, an operation knob may be provided in the moving mechanism, and the operator may change the image formation position of the light source 31 by moving the optical element by operating the operation knob during the operation.

  In the present embodiment, a visible light source is used, but an illumination light source that emits infrared light may be used. In this case, a photographing optical system including a light receiving element for imaging infrared light that illuminates the anterior segment is prepared, and the signal obtained by the light receiving element is displayed on the monitor via the control unit. You can also.

  In the above description, the surgeon moves the light source 31 and the like as appropriate. However, the present invention is not limited to this. Any structure may be used as long as the lens is illuminated under conditions suitable for the operator by changing the imaging state of the light source on the fundus. For example, the refractive power of the eye E may be measured, and the control unit 70 may move the light source 31 or the like based on the obtained measurement value.

  FIG. 5 is a block diagram showing the control system. An eye refractive power (refractive power) acquisition unit 90 is connected to the control unit 70. Here, illustration of other members is omitted. The eye refractive power acquisition unit 90 is, for example, a data processing unit that acquires an eye refractive power value (measurement value) of the eye E acquired by another device, or an eye refractive power measurement unit provided in the surgical microscope 100. is there. Examples of the data processing unit include an electronic medical record system that manages measurement values, and an input unit that inputs data from an external storage device. The eye refractive power measurement unit projects the measurement light of the eye E through a beam combiner (dichroic mirror) disposed on the optical axis L1, receives the reflected light of the measurement light, and increases the refractive power of the eye E. It is a unit to measure.

  The control unit 70 controls the drive unit 42 based on the measurement value (refractive power) acquired by the eye refractive power acquisition unit 90 so that the light source 31 forms an image on the fundus. When the eye refractive power acquisition unit 90 is a measurement unit, the measurement is performed during the operation, and the drive unit 42 is controlled so that the light source 31 is imaged on the fundus in real time. Thus, during surgery (or during surgery), the light source 31 is automatically imaged on the fundus, and the lens is illuminated under conditions suitable for the surgeon so that surgery can be performed. Moreover, it is good also as a structure which notifies an operator of the measured value which the eye refractive power acquisition unit 90 obtained by alerting means, such as a buzzer with which the control part 70 is provided. As a notification means, it is good also as a structure which copies in an operator's observation visual field by a head-up display etc. FIG. The surgeon operates the lighting with reference to the notification result.

In the above description, the example in which the light source 31 forms an image on the fundus is given as an example in which the crystalline lens is illuminated under conditions suitable for the operator, but is not limited thereto.
From the viewpoint of retinal light damage, it is desirable to avoid imaging the illumination light beam on the fundus as much as possible. Therefore, the image is formed only when it is really necessary, and in other cases, the risk of retinal light damage is reduced by intentionally shifting the image formation position, so that the skill level of the operator and the condition of the eye of the patient's eye are reduced. Depending on the minimum required red reflex, surgery may be performed.
It is conceivable that suitable conditions vary depending on the content of surgery, the surgical site of interest, and the like. For example, it is good also as a suitable condition that the light quantity of the reflected light beam which injects into the observation part 10 from the eye E is as much as possible. Alternatively, it is preferable that the light source 31 does not form an image on the fundus and a large spot is formed on the fundus. Even when the cornea is operated with the lens illuminated from the back, it is conceivable that the preferred conditions are different. The spot here includes a spot when an image of the light source is formed on the fundus and a spot in a state where the image of the light source is not formed on the fundus (defocused).

  In the above description, the illumination light beam spot formed on the fundus is achieved by changing the imaging state of the illumination light. However, the present invention is not limited to this. The spot size on the fundus may be changed while maintaining the imaging mode of the illumination light. Moreover, it is good also as a structure which adjusts the optical element of an observation optical system (for example, change of a position). For example, in order to guide red reflection to the observation optical path, the spot size of illumination on the fundus and the cross section area of the observation optical path are related. For this reason, it is preferable that the spot size of the illumination imaged on the fundus and / or the observation optical path cross-sectional area can be adjusted according to the state of the eye. Specifically, the aperture size of the aperture stop is changed. For example, a configuration in which the aperture stop is replaced with a variable aperture stop can be given. In addition, the position of the stop on the observation optical axis is changed along the axial direction. For example, it is preferable to move the aperture so that the aperture position of the aperture is conjugate with the fundus.

  In the above description, the configuration of the coaxial illumination is set such that the illumination optical axis coincides with the observation optical axis, but the configuration is not limited to this. Any structure may be used as long as the illumination light is irradiated toward the fundus. The illumination optical axis may be shifted by several degrees with respect to the observation optical axis.

  In the above description, the illumination light is emitted toward the fundus and the lens is illuminated from the back, but the present invention is not limited to this. In ophthalmic surgery, any configuration that illuminates a patient's eye, tissue around the patient's eye, or the like may be used, and any configuration that can change the imaging state of the illumination light at that time.

It is the schematic explaining the surgical microscope which concerns on this embodiment. It is an optical diagram of an illumination optical system. FIG. 3 is an optical diagram of an illumination optical system when a far-sighted eye is illuminated in the state of FIG. 2. It is an optical diagram of the illumination optical system when the far-sighted eye is suitably illuminated. It is a block diagram of the example of a change.

DESCRIPTION OF SYMBOLS 10 Observation part 11 Objective lens 19 Beam combiner 30 Illumination part 31 Light source 34 Aperture stop 41 Movement mechanism 42 Drive part 60 Movement unit 70 Control part 80 Operation unit 100 Surgical microscope

Claims (1)

An illumination optical system that forms an illumination light emitted from an illumination light source on the fundus of the patient's eye and an anterior ocular segment image including the patient's eye lens illuminated from the back by the illumination light imaged on the patient's fundus An ophthalmic surgical microscope comprising an observation optical system,
The illumination optical system changes the imaging position of the illumination light with respect to the patient's eye fundus along the illumination optical axis of the illumination optical system when observing the anterior segment image by the observation optical system. With
The ophthalmic surgical microscope further comprises control means for controlling the changing means based on the refractive power of the patient's eye acquired by the refractive power acquiring means for acquiring the refractive power of the patient's eye.

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