JP6593043B2 - Laser therapy device - Google Patents

Description

  The present disclosure relates to a laser treatment apparatus that performs treatment by irradiating a diseased part with a treatment laser beam while allowing an operator to observe the affected part.

  2. Description of the Related Art Conventionally, a laser treatment apparatus is known that performs treatment by irradiating an affected area with a treatment laser beam while allowing an operator to observe the affected area (see, for example, Patent Document 1). The laser treatment apparatus of Patent Document 1 has a binocular microscope unit for an operator to observe a patient's eye including an affected part. The surgeon aligns the illumination part of the slit delivery with the patient's eye using the microscope, and uses the micromanipulator to aim the sighting light at the affected area and then irradiates the affected laser beam for treatment. .

JP 2002-136539 A

  However, in order to observe the patient's eye using the microscope unit, for example, it is necessary to adjust the diopter of the eyepiece in advance according to the diopter of the operator. If the diopter adjustment of the eyepiece is not performed properly, even if the affected area can be observed in focus, the irradiated laser beam forms an image at a position deviating from the affected area in the direction along the optical axis (that is, The laser beam may be irradiated to the affected area in a blurred state).

  An object of the present disclosure is to provide a laser treatment apparatus that irradiates a laser beam at a suitable position.

In order to solve the above problems, the present disclosure is characterized by having the following configuration.
(1) A laser treatment apparatus that performs treatment by condensing laser light on an affected area, and an irradiation optical system that irradiates the affected area with a laser beam emitted from an emission end of an optical fiber; Alignment adjusting means for manually adjusting alignment of the condensing position of the laser light with respect to the affected part in at least the direction along the optical axis of the irradiation optical system, and a collection of the laser light adjusted by the alignment adjusting means Alignment detecting means for detecting an alignment state between a light position and the affected part, and an optical axis of the irradiation optical system between the affected part and the condensing position of the laser light where the outline of the laser light is most clear An eyepiece having an alignment detection means for detecting an alignment state in a direction along the diopter, and a diopter adjustment means, wherein the surgeon observes the affected part. An observation unit having an eye part, and a notification unit provided in the observation unit, wherein detection of the alignment detection unit is performed in a field of view of an operator looking into the eyepiece unit using a detection result of the alignment detection unit. An informing means for presenting the result .

  According to the present disclosure, it is possible to provide a laser treatment apparatus that irradiates a suitable position with laser light.

1 is a schematic external view of a laser treatment apparatus. It is a side view of the optical system of the delivery unit. It is an upper view of the optical system of a delivery unit. It is explanatory drawing of the control system of a laser treatment apparatus. It is explanatory drawing explaining diopter adjustment. It is explanatory drawing which observes an affected part and irradiates a laser beam. It is explanatory drawing explaining a conjugate relationship. It is explanatory drawing explaining a conjugate relationship. It is explanatory drawing explaining the case where diopter adjustment is not performed suitably.

  Exemplary embodiments of the present disclosure will be described below with reference to the drawings. 1-4 is a figure for demonstrating the laser treatment apparatus 1 of a present Example. 1 to 3, the left-right direction of the patient will be described as the X-axis direction, the up-down direction of the patient as the Y-axis direction, and the front-back direction of the patient as the Z-axis direction.

  The laser treatment apparatus 1 of the present embodiment is an apparatus that treats a patient's eye Ep by irradiating treatment laser light. For example, the laser treatment apparatus 1 mainly includes an observation optical system 30 and an irradiation optical system 40. For example, the observation optical system 30 causes the operator to observe the patient's eye Ep. For example, the irradiation optical system 40 irradiates the patient's eye Ep with a treatment laser beam.

  First, the external appearance of the laser treatment apparatus 1 is demonstrated based on FIG. The laser treatment apparatus 1 may include, for example, a main body unit 2, a control unit 3, a delivery unit 4, and the like. The main body 2 may accommodate, for example, a therapeutic laser light source 2a, an aiming light source 2b, a control unit 70, and the like. As the treatment laser light, for example, an argon laser, a krypton laser, a die laser, a solid-state laser, a semiconductor laser, or the like may be used. The control unit 3 may be able to set laser irradiation conditions such as laser output and irradiation time, for example. The delivery unit 4 may include, for example, an illumination optical system 10, an alignment detection optical system 20, an observation optical system 30, an irradiation optical system 40, a display optical system 50 (see FIGS. 2 and 3), which will be described later.

  For example, treatment laser light and aiming light oscillated in the main body 2 are guided to the irradiation optical system 40 of the delivery unit 4 via the optical fiber cable 5.

  The laser treatment apparatus 1 may include a foot switch 6, a gantry 7, a manipulator 8, a drive unit 9, and the like. For example, the foot switch 6 may transmit a trigger signal for laser irradiation. For example, the gantry 7 may move the delivery unit 4 up and down. The manipulator 8 may drive, for example, a movable mirror 44 (see FIGS. 2 and 3) described later. For example, the drive unit 9 may drive the delivery unit 4 in the XYZ axial directions to align the delivery unit 4 with the patient's eye Ep. The drive unit 9 may include, for example, a joystick 9a and a drive unit 9b. For example, the drive unit 9 may drive the delivery unit 4 by driving the drive unit 9b based on the operation of the joystick 9a by the operator.

<Illumination optics>
The illumination optical system 10 will be described with reference to FIG. For example, the illumination optical system 10 illuminates the fundus Er of the patient's eye Ep. The illumination optical system 10 is used as an example of an illumination unit for illuminating an affected area of a patient using light from a light source. The illumination optical system 10 has an optical axis L2. The illumination optical system 10 includes, for example, an illumination light source 11, a condenser lens 12, a variable circular aperture 13, a variable slit plate 14, a filter 15, projection lenses 16a and 16b, a correction lens 17, and division mirrors 18a and 18b. Good. For example, the illumination light source 11 may emit visible light. As the illumination light source 11, for example, a halogen lamp or the like may be used. The variable circular aperture 13 may be capable of changing the opening diameter, for example. The variable slit plate 14 may be capable of changing the slit width, for example.

  For example, the visible light beam emitted from the illumination light source 11 passes through the condenser lens 12, and then the height of illumination light (length in the Y direction) illuminated on the patient's eye Ep is determined by the variable circular aperture 13. The visible light beam is further determined in width (length in the X direction) by the variable slit plate 14 and formed into a slit-shaped light beam. Thereafter, the light beam on the side of the operator's eye Eo with respect to the optical axis L2 is directed to the split mirror 18a via the filter 15 and the projection lenses 16a and 16b. The light beam on the patient's eye Ep side with respect to the optical axis L2 is further corrected in optical path length by the correction lens 17 and travels toward the split mirror 18b. The slit light flux reflected by the split mirrors 18 a and 18 b illuminates the fundus Er of the patient eye Ep through the contact lens 19.

<Observation optics>
Next, the observation optical system 30 will be described with reference to FIGS. The observation optical system 30 is used, for example, to observe the fundus oculi Er of the patient's eye Ep. The observation optical system 30 is used as an example of observation means for an operator to observe an affected area of a patient. The observation optical system 30 has an optical axis L3 (optical axes L3L, L3R). As shown in FIG. 3, the observation optical system 30 includes, for example, an objective lens 31, a pair of left and right variable magnification lenses 32L and 32R, imaging lenses 33L and 33R, erecting prisms 34L and 34R, field stops 35L and 35R, an eyepiece, and the like. Lenses 36L, 36R and the like may be provided. The operator may observe the intermediate images formed on the field stops 35L and 35R with the eyepieces 36L and 36R.

  The eyepieces 36L and 36R are part of the eyepiece 37 for the operator to observe the affected area. In the laser treatment apparatus 1 of the present embodiment, the eyepieces 36L and 36R can be moved in the optical axis direction of the observation optical system 30. The eyepieces 36L and 36R are used as an example of diopter adjusting means that adjusts according to the diopter of the examiner so that the position of the treatment spot by the laser beam and the fundus of the surgeon have a conjugate relationship. That is, the eyepiece unit 37 is used as an example of diopter adjustment means. 2 and 3, the optical axis L3 observed with the operator's right eye is denoted as the optical axis L3R, and the optical axis L3 observed with the operator's left eye is denoted as the optical axis L3L. The observation optical system 30 of the present embodiment has an optical path that is symmetric with respect to the optical axis L1 when viewed from above (above the paper surface in FIG. 3).

  In the laser treatment apparatus 1 of the present embodiment, a beam splitter 21L (21R) is arranged between the variable power lens 32L (32R) and the imaging lens 33L (33R) of the observation optical system 30. A beam splitter 52L (same as 52R) is disposed between the beam splitter 21L (same as 21R) and the imaging lens 33L (same as 33R). The beam splitters 21L and 21R are used as an example of an optical path branching unit, and branch the optical path of the alignment detection optical system 20 from the optical path of the observation optical system 30. The beam splitters 52 </ b> L and 52 </ b> R are used as an example of an optical path combining unit, and combine the optical path of the display optical system 50 with the optical path of the observation optical system 30. Detailed description of the alignment detection optical system 20 and the display optical system 50 will be described later.

  For example, a dichroic mirror or a half mirror may be used instead of the beam splitters 21L and 21R or the beam splitters 52L and 52R. In the laser treatment apparatus 1 of the present embodiment, the beam splitters 21L and 21R or the beam splitters 52L and 52R, which are optical path synthesis members (optical path branching members), are plate-like optical members. For example, optical path synthesis means (optical path branching members) ) May be a prism.

  The beam splitters 21L and 21R of the laser treatment apparatus 1 of the present embodiment transmit (straight) 75% of the light that travels from the objective lens 31 toward the eyepieces 36L and 36R along the optical axis L3, and 25% Is reflected in a direction perpendicular to the optical axis L3. The light reflected by the beam splitter 21L is received by the light receiving element (imaging element 23) of the alignment detection optical system 20. The beam splitters 52L and 52R of the laser treatment apparatus 1 of the present embodiment transmit 75% of the light traveling from the objective lens 31 toward the eyepieces 36L and 36R along the optical axis L3, and beams from the LCDs 53L and 53R. 25% of the light traveling in the direction of the splitters 52L and 52R is reflected in the direction along the optical axis L3. The transmittance and reflectance of the beam splitters 21L and 21R or the beam splitters 52L and 52R are not limited to this, and may be determined as appropriate including spectral transmission characteristics (spectral reflection characteristics).

<Control unit>
Next, the control unit 70 will be described with reference to FIG. The control unit 70 controls various operations of the laser treatment apparatus 1. The control unit 70 is used as an example of a control unit that inputs various signals of the laser treatment apparatus 1 and controls various members. For example, the control unit 70 includes a therapeutic laser light source 2a, an aiming light source 2b, a control unit 3, a foot switch 6, a manipulator 8, an illumination light source 11, an image sensor 23, an LCD 53, a movable mirror 44, a joystick 9a, and a drive unit 9b. The buzzer 90 may be connected.

  A monitor may be connected to the control unit 70, and an observation image (or a captured image) of the affected area may be displayed as a moving image (or a still image) using the output signal of the image sensor 23 input to the control unit 70. . That is, the monitor may be used as an example of observation means for observing the affected area of the patient. In this case, the control unit 70 is used as an example of an observation image display control unit for displaying an observation image on a monitor. Further, a sound may be generated using a buzzer 90 serving as a sound generation means. In this case, the control unit 70 is used as an example of a sound generation control unit for generating sound by the sound generation unit. Further, the control unit 70 notifies the operator of the alignment state detected by the alignment detection means by displaying on the LCD 53 serving as a display means. As a display, it is good also as a character or a pattern which shows an alignment state, for example. In this case, the control unit 70 is used as an example of a display control unit. That is, the laser treatment apparatus 1 according to the present embodiment includes a notification unit that notifies the operator of the alignment state, and the control unit 70 serves as a notification control unit that controls the notification unit.

<Irradiation optics>
Next, the irradiation optical system 40 will be described. The irradiation optical system 40 irradiates the patient's eye Ep with the treatment laser light. The irradiation optical system 40 is used as an example of irradiation means for condensing a laser beam on an affected part of a patient. The irradiation optical system 40 has an optical axis L1. The irradiation optical system 40 may include, for example, a collimator lens 41, a variable power lens 42, an objective lens 43, a movable mirror 44, and the like. The variable power lens 42 may change the spot size of the treatment laser light by moving in the optical axis direction of the optical axis L1 of the irradiation optical system 40, for example. The movable mirror 44 may be driven by, for example, an operator operating the manipulator 8.

  The treatment laser light oscillated in the main body 2 enters the irradiation optical system 40 from the emission end 5a of the optical fiber cable 5 via the optical fiber cable 5. The laser beam incident on the irradiation optical system 40 passes through the collimator lens 41, the variable power lens 42, and the objective lens 43, and is then reflected by the movable mirror 44 and guided to the patient's eye Ep.

  The treatment laser light is condensed by the irradiation optical system 40 so as to have a beam profile suitable for treatment at a predetermined position along the optical axis L1. That is, the treatment laser light forms treatment spot light at a predetermined position along the optical axis L1. Note that the position on the optical axis L1 where the treatment spot is formed may not coincide with the position on the optical axis L1 at which the spot size is minimized.

  As shown in FIG. 3, the observation optical system 30 of the present embodiment is a binocular observation system, so that the movable mirror 44 is arranged without interfering with the two left and right eye observation optical axes. Further, a dichroic mirror having characteristics that reflect the treatment laser light and aiming light and transmit the observation illumination light may be used instead of the movable mirror 44.

  The irradiation optical system 40 may irradiate the patient eye Ep with aiming light. The aiming light is emitted, for example, for the operator to confirm the spot position of the treatment laser light. For example, the aiming light may form an aiming index image S at the spot position of the treatment laser light (see FIG. 6). When the treatment laser beam and the aiming beam are irradiated to the patient's eye Ep through a common optical path, the irradiation position, spot size, etc. of the treatment laser beam and the aiming beam match. In addition, also when irradiated with a treatment laser beam, it is irradiated with the shape similar to the aiming index image S of FIG.

  As described above, the irradiation optical system 40 may not irradiate the treatment laser beam and the aiming beam with a common optical path. For example, the laser treatment apparatus 1 may irradiate the patient's eye Ep from an optical path different from the irradiation optical system 40 or may not include the aiming light source 2b. For example, instead of aiming light, treatment laser light may be dimmed and irradiated with a low light amount.

<Alignment detection optical system>
Next, the alignment detection optical system 20 will be described with reference to FIG. The alignment detection optical system 20 is used, for example, to detect the alignment state of the treatment laser light focused on the affected part in the direction along the optical axis L1 of the irradiation optical system 40. That is, the laser treatment apparatus 1 uses the alignment detection optical system 20 as an example of an alignment detection unit. The alignment detection optical system 20 includes, for example, the optical path from the objective lens 31 to the beam splitter 21 shared by the observation optical system 30 and the alignment detection optical system 20, and also includes an imaging lens 22, an image sensor 23, and the like. Good. The laser treatment apparatus 1 according to the present embodiment uses an image sensor 23 as a light receiving element. For example, a CCD image sensor or a CMOS image sensor may be used for the image sensor 23. The image sensor 23 may be sensitive to visible light and infrared light. The wavelength received by the image sensor 23 is not limited to visible light. The alignment detection optical system 20 may be provided with a visible cut characteristic, and the imaging element 23 may receive only infrared light. Moreover, although the alignment detection optical system 20 of the laser treatment apparatus 1 of this embodiment branches from the optical axis L3 (optical axis L3L, L3R) of the observation optical system 30, it is not restricted to this. You may detect alignment by the optical path which does not overlap with the observation optical system 30. FIG.

  The aiming light and the treatment laser light emitted from the irradiation optical system 40 are condensed toward the affected part and become spot light. For example, the patient's eye is positioned at the position on the optical axis L1 where the spot light of the aiming light and the treatment laser light is formed (the position where the treatment spot is formed, that is, the position where the outline of the spot light is most clear in the present embodiment). When the fundus oculi Er of the Ep is positioned, the light emitted from the fundus oculi Er of the patient's eye Ep passes through the objective lens 31, a pair of left and right zoom lenses 32 </ b> L and 32 </ b> R, the beam splitter 21, and the imaging lens 22. 23 is imaged. That is, the position where the spot light is formed and the image sensor 23 are in a conjugate relationship. In the present embodiment, the fundus image formed on the image sensor 23 is an image with high contrast (sharpness) in the alignment state where the contour of the spot light is most clear on the fundus Er. On the other hand, in an alignment state in which the contour of the spot light is blurred on the fundus Er, the fundus image formed on the image sensor 23 is a blurred image with low contrast (sharpness).

  An output signal of the image sensor 23 is input to the control unit 70. The control unit 70 of the laser treatment apparatus 1 according to the present embodiment analyzes the fundus image captured by the image sensor 23 using a known contrast detection method, thereby aligning the laser light irradiated from the irradiation optical system 40. Is detected. If the image of the affected area captured by the image sensor 23 is within a predetermined contrast value range (or greater than or equal to a threshold value), the control unit 70 detects that the alignment has been achieved (focused state). On the other hand, if the image of the affected part imaged by the image sensor 23 does not reach the range of the predetermined contrast value, the image is detected as being out of alignment (in-focus state). That is, the control unit 70 of the laser treatment apparatus 1 according to the present embodiment detects whether or not the delivery unit 4 is aligned at a predetermined position by analyzing the contrast degree of the image of the affected part imaged by the imaging element 23. To do. An allowable width may be provided for the in-focus state or the out-of-focus state. By providing the allowable width, it is conceivable that the alignment state can be suitably notified to the operator even if the patient's eye Ep slightly moves during alignment.

  Note that the predetermined position is, for example, a position where the outline of the focused treatment laser light becomes clearest when the treatment laser light is irradiated to the affected area. The control unit 70 notifies the operator of the display corresponding to the above-described in-focus state and out-of-focus state using the display unit (the display unit will be described later). That is, the laser treatment apparatus 1 of this embodiment includes an alignment detection unit for detecting the alignment state of the treatment laser light in the direction along the optical axis L1 of the irradiation optical system 40. Moreover, the alignment detection optical system 20 and the control part 70 are provided as an example of an alignment detection means.

  Note that the alignment detection method is not limited to the above-described contrast detection method. Other known techniques may be used. As an example, a phase difference detection method using a separator lens and a line sensor, or an image plane phase difference AF method using an image sensor incorporating a phase difference AF instead of the image sensor 23 may be used. Alternatively, the index may be projected onto the patient, and the alignment detection may be performed using the reflected light of the projected index. As a phase difference detection method, it is conceivable to use a separator lens and a line sensor instead of the image sensor 23 in FIG. In this case, it is conceivable that the separator lens and the line sensor are arranged at a position on the optical axis L4 that is farther from the imaging lens 22 than the position at which the imaging element 23 is arranged. With respect to the image plane phase difference AF method, it is conceivable that an image sensor incorporating the phase difference AF is disposed at the position of the image sensor 23. The notification of the alignment state is not limited to the expression of the in-focus state and the out-of-focus state. It is good also as a display mode which an operator can grasp | ascertain an alignment degree according to the alignment degree (space | interval amount from a focusing position) which an alignment detection means detects. For example, it is good also as an indicator as a display mode which shows the degree of alignment.

<Display optical system>
Next, the display optical system 50 will be described with reference to FIG. The display optical system 50 is used as an example of a notification unit that notifies the alignment state. The display optical system 50 is also an example of display means for performing diopter adjustment of the operator using diopter adjustment means (eyepieces 36L and 36R). For example, the display optical system 50 may present the focus index M (Ma, Mb, Mc) and the reticle RT (RTa, RTb) shown in FIG. 6 within the visual field of the operator looking through the eyepiece 37. Good. The display optical system 50 may include, for example, beam splitters 52L and 52R, projection lenses 51L and 51R, LCDs 53L and 53R, and the like. In the delivery unit 4 of the laser treatment apparatus 1 of the present embodiment, the observation optical system 30 and the display optical system 50 share the optical path from the beam splitter 21L (21R) to the eyepiece lens 36L (36R). The light emitted from the LCD 53 forms an aerial image larger than the aperture diameters of the field stops 35L and 35R at the positions of the field stops 35L and 35R, and then is projected onto the fundus Eor of the operator. The size of the aerial image of the LCD 53 formed at the position of the field stops 35L and 35R may be smaller than the diameter of the stop of the field stops 35L and 35R. It is only necessary that the operator who looks into the eyepiece 37 can check the focus index M (Ma, Mb, Mc) or the reticle RT (RTa, RTb).

  The surgeon can visually recognize the display contents of the display optical system 50 combined with the observation image of the affected part obtained by the observation optical system 30. In the LCD 53 of the laser treatment apparatus 1 of the present embodiment, the light emitting elements are arranged in a lattice shape, and each element can emit visible light. Instead of the LCD 53, for example, an organic EL display may be used. Further, without using the projection lenses 51L and 51R and the LCDs 53L and 53R, the transmittance can be varied in an arbitrary shape at a position (for example, the position of the field stops 35L and 35R) conjugate with the position where the treatment spot is formed on the optical axis L1. A liquid crystal shutter capable of performing the above may be arranged. A display means is not restricted to this, The display which the control part 70 alert | reports to an operator should just be contained in the visual field of the operator who operates the laser treatment apparatus 1. FIG. In the present embodiment, the projection lens 51 and the LCD 53 are provided for the right eye and the left eye, respectively. However, for example, a single projection lens 51 and the LCD 53 may be used.

<Operation method>
Next, the operation of photocoagulation in the apparatus having the above configuration will be described. First, the surgeon rotates the eyepiece 37 by hand to move the eyepiece lenses 36L and 36R to the movable end on the far side (the side away from the erecting prisms 34L and 34R). The surgeon looks into the eyepiece 37 with one eye (for example, the right eye) and observes the reticles RTa and RTb superimposed on the observation image (see FIG. 5). As shown by the dotted lines in FIG. 5A, when the outlines of the reticles RTa and RTb appear to be blurred, the surgeon rotates the eyepiece 37 corresponding to the peeped eye by hand, and the eyepiece 36R (or 36L) is moved to the near side (the side closer to the erecting prism 34). As shown by solid lines in FIG. 5B, when the contours of the reticles RTa and RTb are clearly visible, the operator stops the rotation of the eyepiece 37. The surgeon also adjusts the diopter of the other eye (left eye) in the same manner. The reason for starting the adjustment from the far side is to prevent the operator's eye adjustment function from working. The inconvenience when the operator's eye adjustment function works will be described later.

  Next, the surgeon operates the control unit 3 to set solidification conditions such as laser output and irradiation time. When the laser irradiation preparation on the main body 2 side of the laser treatment apparatus 1 is ready, after turning on each light source including the illumination optical system 10, the joystick 9a is operated to move the delivery unit 4, and the fundus of the patient's eye Ep Il is illuminated and observed. The surgeon moves the joystick so that the focus index M (Ma to Mc) superimposed on the observation image has the shape of the focus index Ma shown in FIG. The position in the Z direction of the delivery unit 4 with respect to the patient's eye Ep is adjusted by operating 9a. In a state where the delivery unit 4 is aligned at a predetermined position with respect to the patient's eye Ep, the focus index Ma is displayed. In the state where the focus index Ma is displayed, the surgeon looks at the observation image of the fundus oculi Er as well. On the other hand, in a state where the delivery unit 4 is not aligned at a predetermined position, as shown in FIG. 6B, the focus index Mb having a shape different from the focus index Ma (display mode for notifying alignment) is not obtained. , Mc are displayed. In this case, the operator sees the observation image of the fundus Er in an out-of-focus state (indicated by a dotted line in FIG. 6B). The surgeon adjusts the position of the delivery unit 4 in the Z direction with respect to the patient's eye Ep so that the focus index Ma is displayed.

  After confirming the treatment site, the surgeon operates the manipulator 8 to adjust the aiming of the aiming light by the irradiation optical system 40 to the treatment site (for example, parafoveal neovascularization) and adjust the spot size and the like. The surgeon may use a fixation lamp or the like in order to guide the treatment site. Also, for example, instead of manipulating the manipulator 8 and aiming the aiming light at the affected area, the surgeon operates the joystick 9a and moves the delivery unit 4 in the XY directions to treat the aiming of the aiming light. It may be adjusted to the affected area. When aiming is completed, the operator steps on the foot switch 6 to start photocoagulation.

  A trigger signal from the foot switch 6 is transmitted to the control unit 70. The control unit 70 oscillates the treatment laser light emitted from the treatment laser light source 2 a based on the setting conditions input in advance to the control unit 3. The treatment laser light is irradiated to the affected part along the same optical path as the aiming light, and photocoagulation treatment is performed.

  Next, the relationship between the focus feeling of the image of the affected area observed by the surgeon and the focused state of the treatment laser beam will be described with reference to the optical path diagrams of FIGS. First, the case where the alignment detection means, notification means, and reticle presenting means of this embodiment are not used will be described with reference to FIG. 7 and 8 are optical path diagrams in which the observation optical system 30 of the present embodiment is mainly simplified. The lens U1 is a simplified lens of the objective lens 31 and the variable power lenses 32L and 32R. The lens U2 corresponds to the imaging lens 33. The lens U3 is a simplified lens of the eyepieces 36L and 36R. The lens Uo is a lens in which the refraction of the cornea and the crystalline lens of the operator's eye Eo is simplified. Since the operator (operator eye Eo) in FIGS. 7A and 7B and the operator (operator eye Eo ′) in FIG. 7C have different diopters, FIG. The lens Uo ′ is a lens in which the refraction of the cornea and the crystalline lens of the operator's eye Eo ′ is simplified. The point T is a point where the treatment laser beam is condensed on the optical axis L3. A portion indicated by a circle is a point on the optical axis L3 having a conjugate relationship with the fundus oculi Eor of the operator's eye Eo. Point A is a point observed by the operator on the optical axis L3. A portion indicated by a cross is a point on the optical axis L3 that is conjugate with a point (point T) where the treatment laser beam is condensed.

  In FIGS. 7 and 8, T ′, T ″, and A ′ are positions where an intermediate image (aerial image) between the point T and the point A is formed. The distance DWD is a distance between the point T and the lens U1. The distance DWD is a predetermined distance that is a working distance of the optical system of the laser treatment apparatus 1. The distance DAP is the distance between the point T ′ (the first aerial image position at the point T) and the lens U3. Since the lens U3 can move on the optical axis L3 for diopter adjustment, the distance DAP is indicated. 7 and 8, the refraction by the patient's eye Ep and the contact lens 19 is omitted for the sake of simplicity. The same reference numerals in FIGS. 7 and 8 have the same meaning. 7 and 8, the field stop 35 is positioned at the point T '.

  FIG. 7A will be described. The operator places the calibration surface of the calibration rod B for diopter adjustment at a position separated from the lens U1 by a distance DWD before alignment to the affected area (see FIG. 7A). A hole for inserting the calibration rod B is provided in the housing of the delivery unit 4 in advance. When the calibration rod B is inserted into the hole, the calibration surface is arranged at a predetermined position on the optical axis L3, and the positional relationship between the calibration surface of the calibration rod B and the optical system of the delivery unit 4 is fixed. The operator looks through the eyepieces 36L and 36R (lens U3) and moves the lens U3 as diopter adjustment means to a position where the calibration surface of the calibration rod B can be clearly seen (with good contrast). In FIG. 7A, the position of the lens U3 that is the distance DAP is the position where the operator's eye Eo can most clearly see the calibration surface. The position of the lens U3 may be adjusted by projecting slit light from the illumination optical system 10 and observing the outline of the slit. When the position of the lens U3 is adjusted (that is, the diopter is adjusted), a point (point T) where the treatment laser light is collected, a calibration surface (point A) on the optical axis L3, and the operator's eye The fundus Eor of Eo has a conjugate relationship (see FIG. 7A). Each of the eyepieces 36L and 36R is adjusted for each eye.

  Subsequently, the surgeon removes the calibration rod B from the housing of the delivery unit 4 and aligns the delivery unit 4 with the affected part (see FIG. 7B). The surgeon performs alignment of the delivery unit 4 in the Z direction to a position where the focus feeling (contrast feeling) of the observation image is most suitable. Since the lens U3 is adjusted to a suitable position (the above-mentioned distance DAP) using the calibration rod B described above, a point (point T) where the treatment laser beam is focused on the optical axis L3 and an affected part (point) A) and the fundus oculi Eor of the operator's eye Eo have a conjugate relationship (see FIG. 7B). Therefore, if the treatment laser beam is irradiated in this state, the treatment laser beam is suitably focused on the affected area. That is, the affected part is preferably irradiated with spot light. Here, a case where the lens U3 is not adjusted appropriately will be described. As a case where the lens U3 is not properly adjusted, for example, a case where the surgeon forgets to adjust the lens U3 can be considered. In addition, there may be a case where a plurality of surgeons share the laser treatment device 1 and an operator different from the surgeon who has adjusted the lens U3 uses the laser treatment device 1 of the lens U3.

  FIG. 7C is different from the operator (referred to as operator P1) operated in FIGS. 7A and 7B while maintaining the position (distance DAP) of the lens U3 adjusted in FIG. 7A. This is a case where a diopter operator (referred to as operator P2) uses the laser treatment apparatus 1. Since the operator eye Eo of the operator P1 and the operator eye Eo 'of the operator P2 have different diopters, FIG. 7B and FIG. 7C have different imaging relationships. In FIG. 7C, the adjusting power of the surgeon's eye Eo '(the refractive adjusting power of the crystalline lens) is working. Since the adjusting force is working, the operator's eye Eo 'can observe the point A, which should be originally blurred, with good contrast as shown in FIG. 9A. However, since the adjusting force is working, there is a separation between a point where the observation can be suitably performed (point A) and a point where the treatment laser beam is collected (point T). In FIG.7 (c), the point (point A) which can observe an affected part suitably before distance DWD is located. Accordingly, when the delivery unit 4 is positioned at a position where the affected area is observed with good contrast and irradiated with the treatment laser light, the treatment laser light reaches the affected area before the irradiated treatment laser light is suitably condensed. there is a possibility.

  Next, the case of using the alignment detection means, the notification means, and the reticle presenting means of the present embodiment will be described with reference to FIGS. 8 and 9A. The positional relationship of the optical members of the delivery unit 4 is the same as that in FIG. A portion indicated by 53 ′ in FIG. 8 is an intermediate image (aerial image) of the LCD 53 formed through the projection lens 51. Similarly to FIG. 7C, the operator's eye Eo 'observes the point A in a state where the lens U3 is not suitably adjusted. The image sensor 23 is disposed at a position on the optical axis L4 of the alignment detection optical system 20 that is conjugate with the point T that is the distance DWD. Therefore, the light emitted from the point A is not suitably imaged on the image sensor 23, and the control unit 70 is configured so that the delivery unit 4 is aligned at a position different from the position where the treatment laser light is collected. Is detected. The control unit 70 notifies the operator of the alignment detection result by displaying the focus indexes Ma, Mb, Mc (see FIG. 9B). The surgeon can determine whether or not the delivery unit 4 is properly aligned with the affected part, regardless of the contrast of the image of the affected part observed with the naked eye. In addition, by displaying the reticles RTa and RTb, the surgeon can confirm the contrast of the contours of the reticles RTa and RTb when the focus index Ma is displayed even though there is no contrast in the affected area image. Thus, it is possible to immediately grasp whether or not the diopter adjusting means is suitably adjusted.

  In addition, although the control part 70 of the laser treatment apparatus 1 of this embodiment notifies an operator of an alignment state by changing the display content of LCD53, it is not restricted to this. For example, as the notification means, the sound of the buzzer 90 may be changed according to the alignment state. That is, the sound generation means may be used as the notification means. As an example, the buzzer 90 may be intermittently sounded when the alignment is not correct and may be continuously sounded when the alignment is correct. The surgeon can grasp the alignment state without moving the line of sight from the affected area. Note that both display means and sound generation means may be used as the notification means. Note that the laser treatment apparatus 1 may only include the buzzer control means.

  Note that the observation means of the laser treatment apparatus 1 of the present embodiment includes reticle presenting means for displaying the reticle RT (RTa, RTb) at a position conjugate with the affected area of the patient. The shape of the reticle presented by the reticle presenting means is not limited to the shapes of the reticles RTa and RTb shown in FIG. It is only necessary for the operator to adjust the diopter adjustment means. Further, different reticle shapes may be presented in the right-eye LCD 53R and the left-eye LCD 53L. As an example, only the reticle RTa is displayed on the LCD 53R for the right eye. Only the reticle RTb may be displayed on the LCD 53L for the left eye. By presenting different reticles RT for the right eye and for the left eye, the operator observes the sharpness of the contours of the reticle RTa and the reticle RTb that are visually recognized to the left and right after adjustment of the diopter adjustment means. Thus, it can be easily determined whether or not the diopter adjusting means has been suitably adjusted. For example, if the sharpness of the contour differs greatly between the reticle RTa and the reticle RTb, the operator may perform diopter adjustment again.

  The ophthalmologic apparatus of the present embodiment includes both the alignment detection unit and the reticle presentation unit, but may include only one unit. For example, only the reticle presenting means may be provided. Further, when the treatment laser light is irradiated while the alignment detection means detects that it is displaced, the display mode of the reticle RT may be changed (for example, blinking for a predetermined time). By performing such control, even when the operator intentionally shifts the alignment and irradiates the treatment laser light, the treatment laser light irradiation is not hindered and the diopter adjustment state is set to the operator. It can make you conscious.

  Further, as a modification example using the observation optical system 30, a light projecting unit that projects index light onto the fundus Eor of the operator's eye Eo, and a light receiving element that receives the index light reflected by the fundus Eor of the operator's eye Eo with a light receiving element. And an adjustment determination unit that determines whether or not the diopter adjustment unit is preferably adjusted using a light reception signal of the light receiving element. If such a configuration is used, the laser treatment apparatus 1 can determine whether or not the operator appropriately adjusts the diopter adjusting means. The diopter adjustment state may be notified to the operator using the determination result of the adjustment determination means. The laser treatment apparatus 1 may include a driving unit that drives the eyepiece lens 36, and the eyepiece lens 36 may be moved to a suitable position using the determination result of the adjustment determination unit.

  The laser treatment apparatus 1 of the present embodiment notifies the operator of the alignment state using the detection result of the alignment detection means, but performs the alignment drive of the delivery unit 4 using the detection result of the alignment detection means. May be. For example, the delivery unit 4 may be driven in the XYZ axial directions by the drive unit 9b using the detection result of the alignment detection means.

  In addition, although the laser treatment apparatus 1 of this embodiment has the eyepiece part 37 as an observation means to observe an affected part, it is good also considering the alignment detection optical system 20 as an observation means. As an example, the members from the imaging lenses 33L and 33R to the eyepieces 36L and 36R may be eliminated, and the observation image of the patient may be displayed on a monitor connected to the control unit 70 using the output signal of the image sensor 23. . With such a configuration, it is possible to provide the laser treatment apparatus 1 including the observation unit and the alignment detection unit even with a simple configuration. The laser treatment apparatus 1 may include only an observation image display control unit for causing the monitor to display an observation image. Although the alignment in the Z direction is performed by moving the delivery unit 4 in the Z direction, the alignment in the Z direction may be performed by moving an internal optical member (for example, a lens) in the optical axis direction.

<Action and effect>
The laser treatment apparatus 1 of the present embodiment is a laser treatment apparatus 1 that performs treatment by condensing laser light on an affected area, an irradiation optical system 40 that irradiates the affected area with laser light emitted from a laser light source, and an affected area. Alignment detection means for detecting the alignment state of the laser beam in the direction along the optical axis L1 of the irradiation optical system 40, notification means for notifying the operator of the alignment state using the detection result of the alignment detection means, and visual An eyepiece unit 37 having degree adjusting means, and an observation unit having an eyepiece unit 37 for an operator to observe the affected part. According to such an embodiment, for example, the affected part can be appropriately irradiated with laser light without depending on the adjustment state of the diopter adjusting means of the eyepiece 37. The laser therapy apparatus 1 can be easily handled without requiring skill in operating the apparatus.

  Moreover, the alignment detection means of the laser treatment apparatus 1 of this embodiment has the alignment detection optical system 20 with the light receiving element which receives the light from an affected part, and detects an alignment state using the output signal of a light receiving element. To do. With this aspect, the alignment state can be detected without depending on the characteristics of the irradiation optical system 40. As an example, the irradiation optical system 40 can be prevented from having a complicated configuration in order to detect the alignment state.

  In addition, the light receiving element of the laser treatment apparatus 1 of the present embodiment is the image pickup element 23, and as an example, alignment is performed with a simple configuration by such an aspect in which the image pickup element 23 is placed at a position conjugate with the position of the treatment spot by the laser light. The state can be detected. Moreover, the output signal of the image sensor 23 can also be used as an observation means, and an inexpensive laser treatment apparatus 1 can be provided.

  Further, the notification means of the laser treatment apparatus 1 of the present embodiment includes a sound generation means for notifying the operator, and changes sound generation control according to the detection result of the alignment detection means. With this mode, the operator can determine the alignment state without moving the line of sight. Therefore, for example, it is possible to quickly irradiate the affected part with the treatment laser beam.

  Moreover, the notification means of the laser treatment apparatus 1 of the present embodiment includes display means for notifying the surgeon, and changes display control according to the detection result of the alignment detection means. With this mode, the surgeon can determine the alignment state without greatly moving the line of sight. Therefore, for example, it is possible to quickly irradiate the affected part with the treatment laser beam.

  Further, the observation means of the laser treatment apparatus 1 of the present embodiment includes reticle presenting means for presenting the reticle RT at a position conjugate with the fundus Eor of the surgeon. According to this aspect, the operator's diopter can be easily adjusted, and the affected part can be suitably irradiated with the treatment laser beam. Further, the same member can be used for the display means for notifying the alignment state and the reticle presenting means, and the display means and the reticle presenting means can be provided even with a simple configuration.

  Further, the notifying means of the laser treatment apparatus 1 of the present embodiment changes the shape of the reticle RT according to the detection result of the alignment detecting means. According to such an embodiment, the operator can easily determine the adjustment state of the diopter adjustment means. The laser therapy apparatus 1 can be easily handled without requiring skill in operating the apparatus.

  The laser treatment apparatus 1 of the present embodiment is a laser treatment apparatus 1 that performs treatment by condensing laser light on an affected area, and an irradiation optical system 40 that irradiates the affected area with laser light emitted from a laser light source. The eyepiece 37 having a diopter adjusting means, which presents the reticle RT at a position conjugate with the position of the treatment spot by the laser beam and the observation means having the eyepiece 37 for the operator to observe the affected area. Reticle presenting means is provided. According to this aspect, the diopter adjustment performed by the operator is facilitated, and the treatment laser beam can be suitably applied to the affected area.

  Although the delivery unit 4 has been described as an example, it can be used for various microscopes such as a surgical microscope. It can also be used in combination with a fundus camera.

  In the present embodiment, the sharpness of the contour of the spot light (aiming light or treatment laser light) is analyzed, and the alignment state of the treatment laser light focused on the affected part in the direction along the optical axis L1 of the irradiation optical system 40 An example of detecting the error is illustrated. However, the alignment detection method (the direction along the optical axis L1) is not limited to the sharpness of the contour of the spot light. For example, the alignment state may be detected by analyzing the size of the spot light. As an example, the control unit 70 acquires the spot size (value) of the aiming light from the output signal of the image sensor 23 arranged at the focal position of the observation optical system. Then, the control unit 70 compares a predetermined value stored in advance in a storage unit (not shown) with the acquired spot size (value). The controller 70 detects the alignment state (direction along the optical axis L1) based on the comparison result (magnitude relationship).

  Here, the spot size formed in the affected area may be changeable (can be set) by the operator operating the control unit 3. In such a case, the control unit 70 may call the predetermined value corresponding to the spot size set by the control unit 3 from the storage unit and perform the above-described comparison. That is, the control unit 70 may consider the setting of the irradiation condition of the laser beam irradiated to the affected part when detecting the alignment state (the direction along the optical axis L1). Thereby, for example, even if the spot size formed in the affected area changes with a change in the laser beam irradiation condition setting, the control unit 70 can suitably detect the alignment state (direction along the optical axis L1).

  Further, when the control unit 70 compares the acquired spot size with a predetermined value, parameters of the patient's eye (diopter, axial length, etc.) may be taken into consideration. That is, the control unit 70 may consider the eye characteristics of the patient's eye when detecting the alignment state (direction along the optical axis L1). For example, the controller 70 may acquire the parameters of the eye to be examined by operating the control unit 3 and inputting the parameters of the patient's eyes. Thereby, for example, even if the spot size detected using the imaging device 23 changes due to the eye characteristics of the patient's eyes (optical characteristics related to spot formation), the control unit 70 is in the alignment state (along the optical axis L1). Direction) can be detected suitably.

  Further, when the control unit 70 compares the acquired spot size with a predetermined value, the optical characteristics of the contact lens 19 used when performing the treatment may be considered. That is, the control unit 70 may consider information on the optical characteristics of the contact lens when detecting the alignment state (direction along the optical axis L1). For example, the operator may operate the control unit 3 and input the type information of the contact lens 19, so that the control unit 70 may acquire information regarding the optical characteristics of the contact lens 19. Thereby, for example, even if the spot size detected using the image sensor 23 changes depending on the type of contact lens used, the control unit 70 can suitably detect the alignment state (direction along the optical axis L1). .

  Note that the control unit 70 may control the buzzer 90 to issue a warning when it detects a shift in the focal position (for example, the outline of the spot of the aiming light is blurred). Thereby, for example, the surgeon can recognize that the spot of the aiming light and the affected part are displaced in the direction along the optical axis L1 of the irradiation optical system 40. Therefore, the surgeon can perform suitable alignment with respect to the affected part.

  As an example, consider a case where diopter adjustment by the operator is insufficient, or a case where the operator neglects diopter adjustment. In this case, even if the affected area is focused, the spot of the aiming light in the affected area is in a state where the outline is blurred. At this time, the control unit 70 detects a blur of the contour of the spot acquired by the image sensor 23 and emits a warning sound. Thereby, the event which a treatment laser beam is irradiated in the unintended alignment state is suppressed.

  In addition, even when the laser treatment apparatus 1 breaks down, it is possible to suppress the irradiation of the treatment laser light in an unintended alignment state using the output signal of the image sensor 23. Specifically, the focus state of the affected part (image) imaged by the image sensor 23 is compared with the focus state of the spot (image) of the aiming light. For example, in a failure state of the laser treatment apparatus 1, there may occur a state where the affected part is in focus but the spot is not in focus. In such a case, the control unit 70 can detect that the laser treatment apparatus 1 is in a failure state by comparing the focus state of the affected part with the focus state of the spot. When the control unit 70 detects that the laser treatment apparatus 1 is in a failure state, the control unit 70 emits a warning sound. In this way, it is possible to suppress irradiation of treatment laser light in an unintended alignment state.

  It should be thought that embodiment disclosed this time is an illustration and restrictive at no points. The scope of the present invention is defined by the terms of the claims, rather than the description above, and is intended to include any modifications within the scope and meaning equivalent to the terms of the claims.

DESCRIPTION OF SYMBOLS 1 Laser treatment apparatus 2 Main-body part 3 Control part 4 Delivery unit 10 Illumination optical system 20 Alignment detection optical system 30 Observation optical system 40 Irradiation optical system 50 Display optical system 70 Control part

Claims (3)

A laser treatment apparatus that performs treatment by condensing laser light on an affected area,
An irradiation optical system for irradiating the affected area via a lens with the laser light emitted from the exit end of the optical fiber;
Alignment adjustment means for manually adjusting the alignment of the condensing position of the laser beam with respect to the affected part in the direction along the optical axis of at least the irradiation optical system;
Alignment detecting means for detecting an alignment state between the condensing position of the laser light adjusted by the alignment adjusting means and the affected part, wherein the concentration of the laser light that makes the contour of the affected part and the laser light clearest Alignment detection means for detecting an alignment state in a direction along the optical axis of the irradiation optical system with respect to a light position;
An eyepiece unit having a diopter adjustment unit, the observation unit having the eyepiece unit for an operator to observe the affected part; and
Informing means provided in the observing means, the informing means for presenting the detection result of the alignment detecting means in the visual field of the operator looking into the eyepiece using the detection result of the alignment detecting means When,
A laser treatment apparatus comprising: The laser treatment apparatus according to claim 1,
The laser treatment apparatus, wherein the alignment detection means includes an alignment detection optical system having a light receiving element that receives light from the affected area, and detects the alignment state using an output signal of the light receiving element. The laser treatment apparatus according to claim 1 or 2,
The laser treatment apparatus, wherein the observation means includes a reticle presenting means for presenting a reticle at a position conjugate with an affected area of a patient, and presenting the reticle within a visual field of an operator looking through the eyepiece. .