JPWO2018181976A1 - Ophthalmic laser treatment device - Google Patents

Abstract

An ophthalmic laser treatment device that irradiates a patient's eye with a therapeutic laser beam is a laser irradiation optical system that irradiates the patient's eye with the therapeutic laser beam, and a two-dimensional scan of the spot of the therapeutic laser beam on the tissue of the patient's eye. Scanning means, a pattern irradiation means for forming a spot of a predetermined pattern, a mode selection means for selecting a normal output mode or a low output mode, and a control means. In the low output mode, the operator can operate the pattern selection unit, the setting unit for setting the reference irradiation energy, and the correction unit for reducing the reference irradiation energy. When the low output mode is set, the control unit does not accept the pattern selection until the correction of the reference irradiation energy is performed by the correction unit, and can accept the pattern selection after the correction.

Description

  The present disclosure relates to an ophthalmic laser treatment device that irradiates a patient's eye with treatment laser light.

  Patent Literature 1 discloses an ophthalmic laser treatment apparatus that scans a treatment laser beam on a tissue of a patient's eye and irradiates a pattern to a treatment site. In the ophthalmic laser treatment apparatus of Patent Literature 1, the spot of the irradiation pattern is divided into a plurality of groups, and a series of treatment laser lights are irradiated while moving the irradiation area of the treatment laser light.

JP 2014-68909 A

  By the way, when performing pattern irradiation as in Patent Literature 1, if the irradiation energy of the treatment laser light is incorrectly set, there is a possibility that unintended energy may be irradiated to a plurality of portions of the eye tissue. Further, when the pattern irradiation region is divided into a plurality of regions as in Patent Literature 1, there is a possibility that a treatment laser beam may be irradiated to a region different from the initially planned region. For example, the patient's eye may move during a series of pattern irradiations. In addition, for example, when the irradiation energy of the treatment laser light is small and it is difficult to observe the irradiation mark, it may be difficult to aim the eye tissue.

  An object of the present disclosure is to provide an ophthalmic laser treatment apparatus that solves at least one of the disadvantages of the related art.

In order to solve the above problems, the present invention is characterized by having the following configuration.
(1) An ophthalmic laser treatment apparatus for irradiating a treatment laser beam to a patient's eye includes a laser irradiation optical system for irradiating a treatment laser beam emitted from a treatment laser light source to the patient's eye, and the laser irradiation optical system. Scanning means for scanning the spot of the treatment laser light two-dimensionally on the tissue of the patient's eye, pattern irradiation means for forming a spot of a predetermined pattern using the laser irradiation optical system and the scanning means, A normal output mode for modifying the tissue of the patient's eye by irradiating the treatment laser light, and the treatment laser in the normal output mode for optically stimulating the tissue of the patient's eye without modifying the tissue of the patient's eye A mode selection unit for selecting a low output mode to output relatively lower than the light output, and a control unit for controlling an ophthalmic laser treatment apparatus, the low output mode Is a pattern selecting means for selecting the predetermined pattern from a plurality of patterns, setting means for setting the irradiation energy of the treatment laser light as a reference, and a patient eye without denaturing the tissue of the patient eye In order to optically stimulate the tissue, the correction means for performing a correction to reduce the output by a predetermined amount with respect to the irradiation energy that is the reference set by the setting means, and the operator can operate, When the low output mode is set, the control unit does not accept the pattern selection by the pattern selection unit until the irradiation energy serving as the reference set by the setting unit is corrected by the correction unit. After the correction by (1), the pattern selection by the pattern selecting means can be accepted.
(2) An ophthalmic laser treatment apparatus for irradiating a treatment laser beam to a patient's eye shows a laser irradiation optical system for irradiating the treatment laser beam to a tissue of the patient's eye, and a region to be irradiated with the treatment laser beam. A first pattern, a shape different from the first pattern, a second pattern for aligning the first pattern with a treatment target site, and storage means for storing the first pattern and the second pattern. An aiming optical system for scanning aiming light on the tissue of the patient's eye to form a first spot based on the first pattern and a second spot based on the second pattern on the tissue of the patient's eye And characterized in that:

It is the external appearance perspective view which looked at the laser treatment apparatus for ophthalmology from the diagonally right upper side. FIG. 2 is a schematic configuration diagram of an optical system and a control system of the ophthalmic laser treatment apparatus in FIG. 1. It is a perspective view of a scanning part. It is an example of an observation image. It is a figure showing an example of a pattern. It is a figure showing an irradiation condition screen (normal output mode). It is a figure showing an irradiation condition screen (low output mode). It is a figure showing a pattern selection screen. It is an example of a pattern. It is an example of a pattern. It is an example of a pattern. This pattern is displayed only in the normal output mode. This pattern is displayed only in the normal output mode. This pattern is displayed only in the normal output mode. This pattern is displayed only in the low output mode. This pattern is displayed only in the low output mode. This pattern is displayed only in the low output mode. It is a figure which shows the 1st pattern for therapeutic laser beam irradiation. It is a figure which shows the 2nd pattern for therapeutic laser beam irradiation. It is a figure showing the 3rd pattern for treatment laser beam irradiation. It is a figure showing a pattern for position checks. FIG. 15 is a diagram showing an observation image irradiated with the pattern of FIG. 14. FIG. 16 is a diagram showing an observation image irradiated with the pattern of FIG. 15. It is a figure showing an output ratio selection screen. 6 is a flowchart illustrating a flow of an operation in a low output mode. 5 is a flowchart relating to control executed by a control unit in a low output mode. 5 is a flowchart relating to control executed by a control unit in an LPM test. 6 is a flowchart relating to control of aiming light executed by a control unit in a low output mode.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. The ophthalmic laser treatment apparatus 1 of the present embodiment can perform treatment of the patient's eye E by irradiating the patient's eye E with treatment laser light.

  This will be described with reference to FIGS. The ophthalmic laser treatment apparatus 1 of the present embodiment includes a delivery unit 2, a laser light source unit 10, and an optical fiber 20. The delivery section 2 includes a laser irradiation optical system 40 (see FIG. 2). The laser light source unit 10 includes a treatment laser light source 11. In the present embodiment, the delivery unit 2 and the laser irradiation optical system 40 are connected by the optical fiber 20 or the like. The control unit 70 is housed in the housing of the laser light source unit 10. An operation unit 80, a foot switch 81, and the like are connected to the laser light source unit 10.

  The ophthalmic laser treatment apparatus 1 of the present embodiment further includes a slit lamp microscope unit 3 (slit lamp) and a table unit 4. The slit lamp microscope unit 3 includes an observation optical system 30 and an illumination optical system 60 (see FIG. 2). The delivery unit 2 is connected (combined) with a main unit 5 provided in the slit lamp microscope unit 3. The table section 4 places the main body section 5 to which the delivery section 2 is connected. Note that the aspect of the ophthalmic laser treatment apparatus 1 is not limited to the present disclosure. For example, the delivery unit 2 and the laser light source unit 10 may be integrated. Further, for example, the delivery unit 2 and the slit lamp microscope unit 3 may be integrated.

  The slit lamp microscope section 3 of the present embodiment includes a main body section 5 and a headrest section 22. The main body unit 5 includes a microscope unit 7, an illumination unit 6, a joystick unit 9, and a displacement mechanism 8. The microscope section 7 houses an observation optical system 30 (see FIG. 2). The illumination unit 6 accommodates an illumination optical system 60 (see FIG. 2). The displacement mechanism 8 serving as a displacement means moves the main body 5 (laser irradiation optical system 40 and the like) placed on the table 4 in the vertical direction (Y direction in FIG. 1) and the horizontal direction (X direction in FIG. 1). Or in the front-back direction (Z direction in FIG. 1). Further, the displacement mechanism 8 can rotate the observation optical system 30 in the horizontal direction about the axis extending in the vertical direction as the rotation center. The surgeon can operate the joystick 9 to move the main body 5 in the up-down direction, the left-right direction, or the front-back direction.

<Laser light source unit>
The laser light source unit 10 of the present embodiment includes a treatment laser light source 11 that emits treatment laser light, an aiming light source 12 that emits visible aiming laser light (aiming light), and a beam splitter 13 that combines the treatment laser light and the aiming light. (Combiner), and a condenser lens 14. The treatment laser light source 11 can emit laser light having a wavelength corresponding to the purpose of treatment. The treatment laser light source 11 of the present embodiment emits a laser beam having a wavelength in a visible range, for example, 532 nm (green), 577 nm (yellow), 647 nm (yellow), so that the fundus Er absorbs the energy of the laser beam. it can. In the present embodiment, by controlling the treatment laser light source 11 by the control unit 70, any of three types (green / yellow / red) of treatment laser light can be selectively emitted from the treatment laser light source 11.

  The aiming light source 12 emits aiming light for allowing the operator to recognize the irradiation position of the treatment laser light. In the present embodiment, the wavelength of the aiming light is in the visible range so that the operator can visually recognize the aiming light with the naked eye. A different wavelength from the treatment laser light may be used as the aiming light. For example, a wavelength of 670 nm (red) may be used as the wavelength of the aiming light. Accordingly, even when the operator protection filter for attenuating the treatment laser light is provided in the observation optical system 30, the operator can easily confirm the irradiation position of the treatment laser light. As the aiming light source 12, for example, a laser diode (LD) that emits red laser light may be used.

  The beam splitter 13 reflects most of the treatment laser light and transmits part of the aiming light. The laser light multiplexed by the beam splitter 13 is condensed by the condenser lens 14 and is incident on the incident end face of the optical fiber 20. Between the treatment laser light source 11 and the beam splitter 13, a shutter 15 for blocking treatment laser light is provided. A shutter 16 is provided in an optical path through which the aiming light or the treatment laser light is guided. The shutter 16 of the present embodiment is a safety shutter that is closed when an abnormality occurs.

<Laser irradiation optical system>
Next, the laser irradiation optical system 40 will be described. The laser irradiation optical system 40 (irradiation means) of the present embodiment is used for irradiating the treatment eye with the treatment laser light emitted from the treatment laser light source 11. In this embodiment, the laser irradiation optical system 40 is shared by the treatment laser light and the aiming light. Note that the laser irradiation optical system 40 of the present embodiment can also be said to be an aiming optical system for forming a spot of aiming light based on a predetermined pattern on the tissue of the patient's eye E. Hereinafter, the treatment laser light will be described, but the same applies to the aiming light. The treatment laser light emitted from the emission end face of the optical fiber 20 passes through the lens 41, the zoom lens 42, and the mirror 43 in this order, and then passes through the scanning unit 50 (scanning means), the objective lens 46, the reflection mirror 49, and the contact lens CL. Then, the light is irradiated to the fundus Er (treatment site). The zoom lens 42 for changing the spot size of the laser light is movable in the optical axis direction. The operator holds the contact lens CL.

  The scanning unit 50 of the present embodiment is provided in the laser irradiation optical system 40. The scanning unit 50 is used for two-dimensionally scanning the spot (irradiation position) of the treatment laser beam on the fundus Er of the patient's eye E. In addition, the position on the fundus Er of the patient's eye E is on the tissue of the patient's eye E or on the eye tissue. The scanning unit 50 of the present embodiment is a scanning optical system that two-dimensionally moves the irradiation position (irradiation direction) of the laser light. The scanning unit 50 of the present embodiment includes a scanner mirror. The scanning unit 50 of the present embodiment includes a galvanometer mirror 51 (first galvanometer mirror) and a galvanometer mirror 55 (second galvanometer mirror). The galvanometer mirror may be referred to as a galvanometer scanner. The galvanometer mirror 51 of the present embodiment includes a mirror 52 (first mirror) that reflects a laser beam and an actuator 53. The actuator 53 is a driving unit that drives (rotates) the mirror 52. The galvanometer mirror 55 includes a mirror 56 (second mirror) and an actuator 57.

  In the present embodiment, the treatment laser light that has passed through each optical element of the laser irradiation optical system 40 is reflected by the reflection mirror 49, and then is irradiated to the fundus Er as the target surface via the contact lens CL. The zoom lens 42 is held by a lens cam (not shown). When the lens cam rotates, each zoom lens 42 moves in the optical axis direction. The position of the zoom lens 42 can be detected by an encoder 42a attached to the lens cam. The control unit 70 of the present embodiment can receive the position information (detection signal) of each lens from the encoder 42a and acquire the spot size of the treatment laser beam. Although details will be described later, the scanning unit 50 is controlled based on a command signal from the control unit 70 so that the spot of the treatment laser beam is formed as a two-dimensional pattern on the target surface. Although not shown, the reflection mirror 49 of the present embodiment includes a mechanism for inclining the optical axis L1 of the laser beam two-dimensionally by the operation of the operator.

  The configuration of the scanning unit 50 of the present embodiment will be described with reference to FIG. FIG. 3 is a perspective view of the scanning unit 50 of the present embodiment. The mirror 52 is attached to the actuator 53 so that the reflection surface can swing in the X direction. On the other hand, the mirror 56 is attached to the actuator 57 so that the reflection surface can swing in the Y direction. In the present embodiment, the rotation axis of the mirror 52 is parallel to the Y axis, and the rotation axis of the mirror 56 is parallel to the X axis. The actuator 53 and the actuator 57 are connected to the control unit 70 and are individually driven. The actuator 53 and the actuator 57 incorporate a motor and a potentiometer (both are not shown), and each of the mirror 52 and the mirror 56 is independently rotated (oscillated) based on a command signal from the control unit 70. You. At this time, position information indicating how much the mirror 52 or the mirror 56 has rotated is sent to the control unit 70 by the potentiometers of the actuator 53 and the actuator 57, and the control unit 70 turns the mirror 52 or the mirror 56 in response to the command signal. Movement position can be grasped. That is, the control unit 70 of the present embodiment determines the position of each spot using the output signal of the potentiometer.

  The control unit 70 according to the present embodiment includes: starting driving of the scanning unit 50, stopping driving of the scanning unit 50, starting irradiation of the treatment laser light from the treatment laser light source 11, and stopping irradiation of the treatment laser light from the treatment laser light source 11. By repeating the order, spots S of a predetermined pattern (see FIG. 5 as an example) can be formed on the fundus Er. That is, the control unit 70 of the present embodiment can control the driving of the scanning unit 50 and the irradiation of the treatment laser light to perform pattern irradiation of the treatment laser light. In other words, the ophthalmic laser treatment apparatus 1 of the present embodiment has a pattern irradiation unit that forms a spot of a predetermined pattern using the laser irradiation optical system 40 and the scanning unit 50. In this embodiment, each spot constituting the spot S is separated. However, the spots may be connected to each other. As described above, the pattern irradiation unit of the present embodiment can form the spot S having a predetermined pattern even with respect to the aiming light. Using the observation optical system 30 and the aiming light, the surgeon can grasp the part to be irradiated with the treatment laser light.

<Observation optical system>
The observation optical system 30 of the present embodiment is used to observe the patient's eye E. That is, the observation optical system 30 of the present embodiment is an observation unit for observing the patient's eye E. The observation optical system 30 of the present embodiment includes an objective lens, a variable power optical system, a protection filter, an erecting prism group, a field stop, an eyepiece, and the like. The surgeon looks into the eyepiece of the observation optical system 30 and looks at the fundus Er, the spot of the aiming light (in other words, the reflected light in which the aiming light is reflected by the fundus Er), and the site of the fundus Er irradiated with the treatment laser light ( (Irradiated spot) can be confirmed. The observation image (fundus image visually recognized by the operator) illustrated in FIG. 4 includes the fundus Er of the patient's eye E, the macula M of the patient's eye E, the optic disc D of the patient's eye E, and the blood vessel V of the patient's eye E. ing. Note that a light receiving element may be arranged in the observation optical system 30 to electronically acquire an observation image of the patient's eye E.

<Illumination optical system>
The illumination optical system 60 of the present embodiment is used to project illumination light onto the patient's eye E. The illumination optical system 60 of the present embodiment has a light source 61, a condenser lens 62, a slit 63, a projection lens 64, and the like. The illumination optical system 60 can project slit light to the patient's eye E. The surgeon can observe the fundus Er illuminated by the illumination optical system 60 using the observation optical system 30.

<Control unit>
Return to FIG. The control unit 70 of the present embodiment includes a CPU 71 (processor), a ROM 72, a RAM 73, a nonvolatile memory 74, and the like. The CPU 71 controls each unit in the ophthalmic laser treatment apparatus 1. The ROM 72 stores various programs, various patterns (pattern PS1, pattern PP, etc.), initial values, and the like. The RAM 73 can temporarily store various information. The non-volatile memory 74 is a non-transitory storage medium capable of retaining stored contents even when power supply is cut off. For example, a USB memory, a flash ROM, or the like removably attached to the control unit 70 may be used as the nonvolatile memory 74. The control unit 70 of the present embodiment is a control unit that controls the ophthalmic laser treatment apparatus 1.

  The treatment laser light source 11, the aiming light source 12, the encoder 42a, the actuator 53, the actuator 57, the operation unit 80, and the foot switch 81 are connected to the control unit 70 of the present embodiment. The foot switch 81 of the present embodiment is a trigger input unit for irradiating a laser beam. The operation unit 80 according to the present embodiment has a function as a display unit for displaying various parameters related to the irradiation condition of the treatment laser light, and a setting unit for setting various parameters related to the irradiation condition of the treatment laser light. Function. The operation unit 80 of the present embodiment includes a monitor 82 of a touch panel type. By operating (touching) the touch panel, various parameters relating to the irradiation condition of the treatment laser beam can be set. Note that the control unit 70 of the present embodiment has a function as a display control unit that controls the display content of the monitor 82.

  In the present embodiment, when the foot switch 81 is depressed by the operator, the control unit 70 sets the treatment laser light pattern (one or a plurality of spots) on the target surface based on the setting of various parameters. Is irradiated. That is, the control unit 70 of the present embodiment is an irradiation control unit that controls irradiation of the treatment laser beam to the patient's eye E. The control unit 70 of the present embodiment controls the treatment laser light source 11 and also controls the scanning unit 50 based on the set pattern to form a pattern of the treatment laser light on the fundus Er which is the target surface. Before the foot switch 81 is depressed, the control unit 70 of the present embodiment forms a pattern (one or a plurality of spots) of aiming light on the target surface using a pattern for therapeutic laser light.

  FIG. 5 is a diagram illustrating an example of a pattern of a spot position. In the pattern shown in FIG. 5, the spots S (in FIG. 5, an aggregate of nine spots) are arranged in a 3 × 3 square matrix. Here, the spot S indicates both the aiming light and the treatment laser light. Based on such a pattern, the treatment laser light and the aiming light are scanned by the scanning unit 50, and a pattern is formed on the target surface. The irradiation of the spot S is started from the spot position SP1 which is the start position, and the spot S is two-dimensionally scanned toward the spot position SP9 which is the end position. That is, scanning is performed in the order of the spot position SP1, the spot position SP2,..., The spot position SP8, and the spot position SP9. In the present embodiment, as indicated by the arrow (S-shaped) in the figure, the spots S are sequentially scanned to adjacent spots S so as to move between the spots S as efficiently as possible.

<How to use>
A method of using the ophthalmic laser treatment apparatus 1 according to the present embodiment will be described. Note that the ophthalmic laser treatment apparatus 1 of the present embodiment has a normal output mode and a low output mode. The normal output mode of the present embodiment is used to degenerate the tissue of the patient's eye E. In other words, the normal output mode of the present embodiment is used, for example, to denature the protein of the patient's eye E. The low-power mode of the present embodiment is used to optically stimulate the tissue of the patient's eye E without denaturing the tissue of the patient's eye E. That is, the low output mode of the present embodiment is suitable for treating the treatment site of the patient's eye E with a small irradiation energy (treatment laser beam). The low output mode according to the present embodiment is suitable for treatment of, for example, the macula or around the macula. The surgeon turns on the power of the ophthalmic laser treatment apparatus 1. When the power is turned on, the ophthalmic laser treatment apparatus 1 is initialized, and the ophthalmic laser treatment apparatus 1 is in a standby state in the normal output mode.

  The surgeon fixes the patient's head to the headrest 22. The operator operates the joystick unit 9 while observing the observation image by looking through the eyepiece of the microscope unit 7, and aligns the laser irradiation optical system 40 with respect to the patient's eye E. When the laser irradiation optical system 40 is positioned with respect to the patient's eye E, aiming light is also used. The surgeon determines the distance between the patient's eye E and the laser irradiation optical system 40 based on the focus state of the observation image. The following description is based on the assumption that the positioning of the laser irradiation optical system 40 with respect to the patient's eye E has been completed, and the operator can observe the fundus Er of the patient's eye E.

<Normal output mode>
In the normal output mode of the present embodiment, the irradiation condition screen 100 (see FIG. 6) is displayed on the monitor 82. The irradiation condition screen 100 according to the present embodiment includes a spot size display unit 140, a laser selection unit 110, an output setting unit 120, an irradiation time setting unit 130, a pattern setting unit 150 (first pattern selection unit), a test unit 170, A low output mode selection unit 180 is provided. The operator can change the irradiation condition of the treatment laser light and the like by touching each item (the above-described output setting unit 120 and the like) on the monitor 82.

  In the present embodiment, the spot size display section 140 displays the spot diameter using the output signal of the encoder 42a. The laser selection unit 110 is used by an operator to select the type (green / yellow / red) of the treatment laser light. The output setting unit 120 is used by an operator to set the output value (unit: watt) of the treatment laser light. In the present embodiment, the output value of the treatment laser light (green) is in the range of 50 mW to 1500 mW, the output value of the treatment laser light (yellow) is in the range of 50 mW to 1500 mW, and the output value of the treatment laser light (red). Can be set within a range of 50 mW to 800 mW.

  The irradiation time setting unit 130 is used to set the irradiation time of the treatment laser light. In the present embodiment, the irradiation time of the treatment laser beam can be set to any one of 2.00 seconds and 3.00 seconds within the range of 0.01 to 1.00 seconds. The pattern setting unit 150 is used to set a pattern of the treatment laser light. In the present embodiment, a predetermined pattern can be selected from 25 types of patterns stored in the ROM 72 in advance. The test unit 170 is used when performing test irradiation with the treatment laser light. When the test unit 170 is touched, the irradiation mode of the ophthalmic laser treatment apparatus 1 switches between the normal irradiation mode and the test irradiation mode. In the test irradiation mode, the operation of the pattern setting section 150 is invalidated, and the pattern Pa (see FIG. 9A) as a single spot is automatically set. In the normal irradiation mode, the operation of the pattern setting unit 150 becomes valid. In this embodiment, an arbitrary pattern can be selected from 25 types of patterns.

  The low output mode selection unit 180 (mode selection means) of the present embodiment is used for switching from the normal output mode to the low output mode. In other words, the ophthalmic laser treatment apparatus 1 of the present embodiment has a normal output mode for modifying the tissue of the patient's eye by irradiating the treatment laser light, and optically transforms the tissue of the patient's eye without modifying the tissue of the patient's eye. There is provided mode selection means for selecting a low output mode in which the output of the treatment laser beam is relatively lower than the output of the treatment laser beam in the normal output mode for stimulation. When the low output mode selection unit 180 is touched, the display on the monitor 82 switches to the irradiation condition screen 200 (see FIG. 7). In conjunction with the switching from the irradiation condition screen 100 to the irradiation condition screen 200, the operation mode of the ophthalmic laser treatment apparatus 1 switches from the normal output mode to the low output mode. In this embodiment, the color tone of the entire screen is different between the irradiation condition screen 100 and the irradiation condition screen 200. Specifically, the background color (base color) of the irradiation condition screen 100 is an achromatic color, whereas the background color of the irradiation condition screen 200 is a chromatic color. This makes it easier for the surgeon to understand the operation mode of the ophthalmic laser treatment apparatus 1 (in this embodiment, either the normal output mode or the low output mode). In the present embodiment, the background color of the irradiation condition screen 100 is gray, and the background color of the irradiation condition screen 200 is yellow. The background color of the irradiation condition screen 200 corresponds to the treatment laser beam (yellow) fixedly set in the low output mode.

<Low output mode>
As described above, in the low output mode of the present embodiment, the irradiation condition screen 200 (see FIG. 7) is displayed on the monitor 82. The irradiation condition screen 200 according to the present embodiment includes a spot size display section 240, a laser selection section 210, an output setting section 220 (output value setting means), an irradiation time setting section 230, and a pattern setting section 250 (second pattern selection means). , An output ratio setting unit 260 (correction unit), a test unit 270, a transition unit 280, and a position check unit 290 (aim selection unit). The position check unit 290 of the present embodiment is displayed when a pattern (for example, FIGS. 11A to 11C) in which the irradiation area moves during a series of pattern irradiations is set. The transition unit 280 is a mode selection unit for selecting between the normal output mode and the low output mode, similarly to the low output mode selection unit 180. Each of the output setting unit 220 and the irradiation time setting unit 230 is a setting unit for setting the irradiation energy of the treatment laser beam as a reference. In addition, the output ratio setting unit 260 serves as a reference set by the setting unit (the output setting unit 220 or the irradiation time setting unit 230) to optically stimulate the patient's eye tissue without denaturing the patient's eye tissue. This is correction means for correcting the irradiation energy to reduce the output by a predetermined amount. In the low output mode, at least the operator can operate the pattern selecting means, the setting means, and the correcting means.

  The spot diameter using the output signal of the encoder 42a is displayed on the spot size display section 240 of the present embodiment. The laser selector 210 is used to present the type (yellow) of the set treatment laser light to the operator. In the present embodiment, the type of treatment laser light that can be irradiated in the low output mode is fixedly set to yellow, and selection of treatment laser light using the laser selection unit 210 is prohibited. However, the green treatment laser light or the red treatment laser light may be selectable in the low output mode. The output setting unit 220 is used by an operator to set the output value (unit: watt) of the treatment laser light. In the present embodiment, the output value of the treatment laser beam (yellow) can be set within a range of 60 mW to 1500 mW. The irradiation time setting unit 230 is used by an operator to set the irradiation time of the treatment laser light. In the present embodiment, the irradiation time of the treatment laser beam can be set in a range of 0.01 to 0.03 seconds. However, the time that can be set by the irradiation time setting unit 230 may be set to any one of 2.00 seconds and 3.00 seconds within the range of 0.01 to 1.00 seconds.

  The pattern setting section 250 is used by an operator to set the pattern of the treatment laser light. In this embodiment, the operator can select an arbitrary pattern from 25 types of patterns stored in the ROM 72 in advance. The test unit 270 is used when the operator performs test irradiation with the treatment laser light. When the test unit 270 is touched, the irradiation mode of the ophthalmic laser treatment apparatus 1 switches between the normal irradiation mode and the test irradiation mode. In the following description, the test irradiation mode may be called an LPM test mode. In the test irradiation mode, the operation of the pattern setting unit 250 is invalid, and the pattern Pa (see FIG. 9A) as a single spot is automatically set. In the normal irradiation mode, the operation of the pattern setting unit 250 becomes valid. In this embodiment, an arbitrary pattern can be selected from 25 types of patterns.

  The output ratio setting section 260 is used to correct the output value set by the output setting section 220. Specifically, the output ratio setting unit 260 of the present embodiment is used to attenuate the output value (before correction) set by the output setting unit 220 to a predetermined ratio (ratio). That is, since the output ratio setting unit 260 of the present embodiment optically stimulates the tissue of the patient's eye E without denaturing the tissue of the patient's eye E, the output value at which the tissue of the patient's eye E barely denatures (before correction) At a predetermined rate (ratio). In this embodiment, as the setting of the output ratio setting unit 260, the output ratio can be selected within the range of 10 to 90%. Note that the lower limit value of the output ratio selectable by the output ratio setting unit 260 changes according to the output value (before correction) set by the output setting unit 220. As an example, when 60 mW is set by the output setting unit 220, the output ratio value selectable by the output ratio setting unit 260 is 90%. The control unit 70 of the present embodiment can be selected by the output ratio setting unit 260 so that the output value corrected by the setting of the output ratio setting unit 260 (in other words, the corrected output value) does not fall below 50 mW. An output ratio value or an output ratio value selectable on an output ratio selection screen 350 (see FIG. 18) is controlled. The position check unit 290 is used by the operator to align the laser irradiation optical system 40 with the patient's eye E. Specifically, the position check unit 290 of the present embodiment is used by the operator to position the irradiation target region of the treatment laser light to the treatment target site of the patient's eye E. In other words, the position check unit 290 of the present embodiment is used for the operator to switch the pattern of the aiming light.

<Operation flow>
An example of an operation flow of the ophthalmic laser treatment apparatus 1 in the low output mode will be described with reference to FIG. In the present embodiment, at the time of transition from the normal output mode to the low output mode, some of the operation parameters of the ophthalmic laser treatment apparatus 1 are initialized (automatically set) for the low output mode. In the present embodiment, the type of the treatment laser light is automatically set to yellow as an initial setting. In this embodiment, as an initial setting, a pattern shared by the aiming light and the treatment laser light is automatically set to a single spot (see FIG. 9A), and the output ratio (output setting unit 220) is automatically set to 100%. In the initial setting of this embodiment, a predetermined initial value is also automatically set for the output value (POWER) and the irradiation time (TIME) of the treatment laser beam.

  The low output mode of the present embodiment has a normal operation mode and an LPM test mode as operation states. The initial state of the low output mode is the LPM test mode. In the LPM test mode, the operation of the pattern setting unit 250 is invalidated. That is, in the LPM test mode of the present embodiment, the operator is prohibited from changing the pattern. The control unit 70 of the present embodiment stores the mode flag in the RAM 73 and manages the normal operation mode or the LPM test mode.

  It returns to FIG. In step S101, the operator sets output values (before correction). Specifically, the operator operates the output setting unit 220 to set the output value (before correction) of the treatment laser light. In step S101, the irradiation time may be set (polarized), or both the output value (before correction) and the irradiation time may be set (changed). In other words, the irradiation energy for irradiating the patient's eye E may be set in the setting of step S101. Next, in step S102, the operator operates the foot switch 81 to perform test irradiation of the treatment laser beam. Since step S102 is under the condition of the LPM test mode, the pattern used at the time of the test irradiation is a single spot (see FIG. 9A). Next, in step S103, the surgeon observes the site of the patient's eye E to which the therapeutic laser light has been test-irradiated. Specifically, the surgeon checks the presence or absence of the spot trace or the degree (degree) of the spot trace. Next, in step S104, the operator determines whether the output value (before correction) set in step S101 is appropriate based on the observation result in step S103. In the present embodiment, the surgeon determines whether or not the output value (before correction) of the treatment laser beam that barely degenerates the tissue of the patient's eye E has been set. The bare degeneration of the tissue of the patient's eye E is determined based on, for example, whether or not a barely visible coagulation spot (spot mark) has been generated based on the irradiation of the treatment laser beam. If the output value (before correction) is appropriate, the process proceeds to step S105. If the output value (before correction) is not appropriate, the process returns to step S101. For example, when the spot trace cannot be confirmed in step S103, or when the spot trace is confirmed in step S103 but the spot trace is too clear, the process returns to step S101. That is, the surgeon repeats the test irradiation and the observation of the spot trace during the LPM test mode to determine the output value (before correction). The output value (before correction) is, in other words, the reference output value. In the present embodiment, the output value that barely denatures the tissue of the patient's eye E is used as the reference output value.

  In step S105, the operator changes (sets) the output ratio. The output ratio setting unit 260 is operated by the operator to change the output ratio. In the present embodiment, the output ratio can be changed within a range of 10% to 90%. The lower limit value of the selectable output ratio changes according to the output value (before correction) set by the output setting unit 220. As an example, when 60 mW is set by the output setting unit 220, the output ratio selectable by the output ratio setting unit 260 is 90%. Although details will be described later, in the present embodiment, the operation of the operator is regulated so that the output value (after correction) corrected by the output ratio does not fall below a predetermined value (50 mW) provided in advance. As an example, the surgeon changes the output ratio in consideration of a treatment laser light irradiation site (macular M, peripheral area), a disease state, and the like. That is, in step S105, the irradiation energy set in step S101 may be corrected (attenuated in this embodiment).

  In the present embodiment, when the output ratio is changed, the operation mode switches to the normal operation mode. In other words, when the output ratio is set to a value less than 100%, the LPM test mode is automatically canceled. That is, in the present embodiment, when the operator operates to irradiate the patient's eye with an output value (before correction) smaller than the output value that barely denatures the tissue of the patient's eye E, the LPM test mode is automatically canceled. When the LPM test state is released, the pattern can be changed. Next, in step S106, the operator operates the pattern setting unit 250 to select an arbitrary pattern. Next, in step S107, the surgeon operates the foot switch 81 to irradiate the treatment laser beam (main irradiation). That is, irradiation of the treatment laser beam using the selected pattern is performed with an output value smaller than the output value (before correction). The treatment in the low output mode is performed as described above. In other words, the irradiation of the treatment laser beam using the selected pattern is performed with irradiation energy smaller than the irradiation energy before correction. In other words, the irradiation of the treatment laser beam using an arbitrary pattern is performed with an output value smaller than the output value (before correction) that barely degenerates the tissue of the patient's eye E. Thus, for example, pattern irradiation (other than a single spot) with an output value that denatures the tissue of the patient's eye E is suppressed, and optical stimulation of the tissue of the patient's eye E that does not degenerate the tissue of the patient's eye E is suppressed. The operator can select an arbitrary pattern and perform it efficiently.

  To summarize the flow of steps S101 to S107, the operator first sets reference conditions (see steps S101 to S104). For example, an output value is set as the reference condition. Next, the operator optimizes the irradiation conditions (see steps S105 and S106). As the optimization of the irradiation condition, for example, the output value set under the reference condition is attenuated (corrected). Next, the operator performs treatment on the treatment site under the optimized irradiation conditions (see step S107). That is, in steps S101 to S104, the operator determines the output value (before correction) at which the tissue of the patient's eye E barely changes while repeating the operation of the output setting unit 220 and the irradiation of the laser beam. Next, in steps S105 and S106, the operator operates the output ratio setting unit 260 to output an output value for optically stimulating the tissue of the patient's eye E without denaturing the tissue of the patient's eye E (after correction). To determine. Next, in step S107, the operator irradiates a treatment laser beam to the treatment site with an output value (after correction) that optically stimulates the tissue of the patient's eye E without denaturing the tissue of the patient's eye E. When the low output mode is set, the control unit of the present embodiment does not accept the pattern selection by the pattern selection unit until the correction unit corrects the reference irradiation energy set by the setting unit. After the correction by, pattern selection by the pattern selection means can be accepted. Thus, the operator can determine the irradiation conditions (irradiation energy) step by step. This facilitates the irradiation of the treatment laser light in consideration of, for example, the part to be irradiated with the treatment laser light (macular M, peripheral portion), a disease state, and the like.

  In this embodiment, the LPM test mode is automatically canceled in conjunction with the change of the output ratio (in other words, the change from the output ratio of 100%). However, the method of releasing the LPM test mode is not limited to this. For example, a time correction unit for correcting the irradiation time set by the irradiation time setting unit 230 may be provided, and the LPM test mode may be automatically canceled in conjunction with the change of the irradiation time using the time correction unit. That is, the LPM test mode may be automatically canceled when the set irradiation energy is corrected (changed). In the LPM test mode of the present embodiment, pattern irradiation of the treatment laser beam to a plurality of parts of the patient's eye E is suppressed. In other words, in the normal mode of the present embodiment, it is possible to irradiate a pattern of the treatment laser beam to a plurality of portions of the patient's eye E. As described above, in the present embodiment, by using the LPM test mode, it is possible to suppress unintended irradiation of energy to a wide area of the eye tissue. Note that the number of spots during pattern irradiation may be reduced in the LPM test mode as compared to the normal mode.

<Control in low output mode>
The control executed by the control unit 70 in the low output mode of the present embodiment will be described with reference to FIG. In step S201, the control unit 70 determines whether or not the current mode is the LPM test mode. In the case of the LPM test mode, the process proceeds to step S202, and in the case of the normal mode, the process proceeds to step S203. In the present embodiment, the initial setting of the low output mode is the LPM test mode, and the output ratio is 100%. When the output ratio is changed, the LPM test mode is automatically canceled (changed to the normal mode). In step S202, an LPM test process (see FIG. 21) is performed. The details of the LPM test process will be described later.

  In step S203, control unit 70 detects the presence or absence of a pattern selection operation. Specifically, the control unit 70 determines whether or not a pattern selection operation has been performed on the pattern selection screen 400. If a pattern selection operation has been performed, the process proceeds to step S204. In step S204, the setting is changed to the selected pattern. When the setting change of the pattern is completed, the process proceeds to step S205. In step S205, the control unit 70 detects the presence or absence of an irradiation operation. Specifically, when the operation of the foot switch 81 is detected, the process proceeds to step S206, and when the operation of the foot switch 81 is not detected, the process proceeds to step S207. In step S206, the control unit 70 controls the treatment laser light source 11 to irradiate the treatment laser light of the type set by the laser selection unit 210 to the patient's eye E based on the set irradiation conditions. In step S207, control unit 70 detects the presence or absence of a mode end operation. Specifically, when detecting the operation of the transition unit 280, the control unit 70 ends the low output mode, and transitions to the normal output mode. On the other hand, when the control unit 70 does not detect the operation of the transition unit 280, the process returns to step S201 to maintain the low output mode. In the low output mode of the present embodiment, the pattern irradiation of the aiming light to the patient's eye E is continuously performed in the pattern used for the pattern irradiation of the treatment laser light.

<LPM test processing>
The control executed by the control unit 70 in the LPM test process (step S202 in FIG. 20) of the present embodiment will be described with reference to FIG. In step S301, the control unit 70 detects the presence or absence of a change operation of the output value (before correction). Specifically, the control unit 70 proceeds to step S302 when detecting the operation of the output setting unit 220, and proceeds to step S304 when not detecting the operation of the output setting unit 220. In step S302, control unit 70 determines whether or not the output value after change (before correction) is less than 60 mW. If it is less than 60 mW, the process returns to step S301 without changing the output value. On the other hand, if it is 60 mW or more, the process proceeds to step S303 to change the output value (before correction), and then proceeds to step S304.

  In step S304, control unit 70 detects the presence or absence of an operation for changing the irradiation time. Specifically, the control unit 70 proceeds to step S305 when detecting an operation of the irradiation time setting unit 230, and proceeds to step S306 when detecting no operation of the irradiation time setting unit 230. In step S305, the control unit 70 changes the setting to the irradiation time based on the operation of the irradiation time setting unit 230, and then proceeds to step S306. In step S306, control unit 70 detects the presence or absence of a change operation of the output ratio. Specifically, the control unit 70 proceeds to step S310 when detecting the operation of the output ratio setting unit 260, and proceeds to step S307 when not detecting the operation of the output ratio setting unit 260.

  In step S307, control unit 70 detects whether or not test unit 270 has been operated. When detecting the operation of the test unit 270, the control unit 70 proceeds to step S308, and when not detecting the operation of the test unit 270, proceeds to step S301 (return). In step S308, control unit 70 displays output ratio selection screen 350 (see FIG. 18). An output ratio button is arranged on the output ratio selection screen 350 of the present embodiment. On the output ratio selection screen 350, buttons corresponding to output ratios that can be changed are arranged. Specifically, on the output ratio selection screen 350, a button having an output ratio at which the output value (after correction) becomes 50 mW or more even when selected is arranged. The output ratio selection screen 350 illustrated in FIG. 18 is a screen when the output value (before correction) that can be set by the output setting unit 220 is set to 500 mW or more.

  In step S309, control unit 70 detects the presence or absence of an output ratio selection operation. When the control unit 70 detects the operation of selecting the output ratio, the process proceeds to step S310. When the control unit 70 does not detect the operation of selecting the output ratio, the process remains at step S309. In step S310, control unit 70 changes the output ratio. Specifically, the control unit 70 changes the output ratio based on the change operation detected in step S306 or the selection operation detected in step S309. The output value (after correction) changed by the output ratio is 50 mW or more. Next, in step S311, the control unit 70 releases the LPM test mode. That is, the mode is changed from the LPM test mode to the normal mode. As described above, the control unit 70 performs the LPM test process. In the low output mode of the present embodiment, the control unit 70 controls the output value of the treatment laser beam applied to the patient's eye E so as not to fall below a predetermined lower limit. Thereby, the irradiation of the unstable treatment laser light to the patient's eye E due to the low output is suppressed. The unstable treatment laser light is, for example, an event in which the output value varies between irradiations when the treatment laser light is repeatedly irradiated. In the present embodiment, it is easy to set the output ratio with respect to the set output value (before correction).

<Selectable patterns>
A pattern that can be selected in the normal output mode and a pattern that can be selected in the low output mode will be described with reference to FIGS. 8, 9A to 9C, 10A to 10C, and 11A to 11C. First, patterns that can be selected in the normal output mode will be described with reference to FIGS. 8, 9A to 9C, and 10A to 10C. When the pattern setting unit 150 is touched on the irradiation condition screen 100 (see FIG. 6) in the normal mode, a pattern selection screen 300 (see FIG. 8) is displayed on the monitor 82. The pattern selection screen 300 according to the present embodiment includes a selection unit 310 and a transition unit 320. In the selection unit 310, 25 types of patterns (patterns Pa to Py1) are arranged in 5 rows and 5 columns. Each pattern has a different shape. As an example, FIG. 9A shows a pattern Pa, FIG. 9B shows a pattern Pl, and FIG. 9C shows a pattern Pp. FIG. 10A shows the pattern Pw1, FIG. 10B shows the pattern Px1, and FIG. 10C shows the pattern Py1. When any one of the patterns in the selection unit 310 is selected, the display on the monitor 82 is switched to the irradiation condition screen 100 (see FIG. 6), and the selected pattern is displayed in the pattern display area 111. When the transition unit 320 is touched on the pattern selection screen 300, the screen returns to the irradiation condition screen 100 without changing the pattern.

  The details of the patterns Pw1, Px1, and Py1 of the present embodiment will be described. 10A to 10C are spots S formed on the eye tissue. White circles and black circles indicate the order of pattern irradiation, and the white circles and black circles have the same irradiation energy. In the present embodiment, the pattern Px1 is a ring-shaped pattern, the pattern Pw1 is a substantially ring-shaped pattern lacking the right side, and the pattern Py1 is a substantially ring-shaped pattern lacking the left side. The pattern Pw1 and the pattern Py1 are patterns suitable for, for example, irradiating a treatment laser beam while avoiding a nerve bundle from the optic disc D. The pattern Px1 is a pattern suitable for, for example, irradiating a treatment laser beam around the periphery of the macula.

  In each pattern of FIGS. 10A to 10C, a plurality of spots constituting each pattern are divided into a plurality of groups (for example, a first group to a third group). 10A to 10C, the first group is indicated by a black circle. First, aiming light spots are formed at the positions of the spots (black circles) in the first group. When the foot switch 81 is operated in this state, the treatment laser light is applied to the spot position of the aiming light. When irradiation of the treatment laser beam to the first group is completed, spots of aiming light are formed at the positions of the spots of the second group. When the foot switch 81 is operated in this state, the treatment laser light is applied to the spot position of the aiming light. When the irradiation of the treatment laser beam to the second group is completed, a spot of the aiming light is formed at the position of each spot of the third group. When the foot switch 81 is operated in this state, the treatment laser light is applied to the spot position of the aiming light. By dividing a plurality of spots into a plurality of groups, the time spent for pattern irradiation can be divided. Thus, for example, even if the patient's eye E moves during pattern irradiation, it is easy to suppress unintended irradiation of the treatment laser beam to the eye tissue.

  Next, a pattern that can be set in the low output mode will be described with reference to FIGS. 8, 9A to 9C, and 11A to 11C. When the pattern setting section 250 is touched on the irradiation condition screen 200 (see FIG. 7), a pattern selection screen 400 (see FIG. 8) is displayed on the monitor 82. The pattern selection screen 400 according to the present embodiment includes a selection unit 410 and a transition unit 320. In the selection unit 410, 25 types of patterns (patterns Pa to Py2) are arranged in 5 rows and 5 columns. Each pattern has a different shape. In the present embodiment, the same pattern as in the normal output mode is arranged in each of the patterns Pa to Pv. Further, patterns different from those in the normal output mode are arranged in the pattern Pw2, the pattern Px2, and the pattern Py2.

  FIG. 11A shows a pattern Pw2, FIG. 11B shows a pattern Px2, and FIG. 11C shows a pattern Py2. In the present embodiment, the pattern Pw2, the pattern Px2, and the pattern Py2 are all ring-shaped patterns. The pattern Pw2 and the pattern Px2 differ in the number of spots included in each group when a plurality of spots are divided into a plurality of groups. The pattern Py2 has a different pattern irradiation range from the pattern Pw2 and the pattern Px2. The patterns Pw2, Px2, and the pattern Py2 are, for example, patterns suitable for irradiating the macula M with therapeutic laser light.

  Note that white circles and black circles in FIGS. 11A to 11C have the same meanings as in FIGS. When any of the patterns in the selection section 410 is selected, the display on the monitor 82 is switched to the irradiation condition screen 200, and the selected pattern is displayed in the pattern display area 211 (see FIG. 7). When the transition unit 320 is touched on the pattern selection screen 400, the screen returns to the irradiation condition screen 200 without changing the pattern.

  As described above, the ophthalmic laser treatment apparatus 1 of the present embodiment is independent of the shared pattern (patterns Pa to Pv) shared between the normal output mode and the low output mode, and independent of the normal output mode and the low output mode. And selectable individual patterns (patterns Pw1, Pw2, Px1, Px2, Py1, Py2). In this embodiment, the number of selectable patterns is the same between the normal output mode and the low output mode, but the types (shapes) of the selectable patterns are different. Thus, for example, in each of the normal output mode and the low output mode, only the frequently used patterns are presented to the operator, and the operator's selection operation is simplified. In addition, erroneous pattern selection is also suppressed.

  In the present embodiment, the normal output mode and the low output mode are different from each other in three of the presented patterns, but the present invention is not limited to this. It is sufficient that the ophthalmic laser treatment apparatus 1 has a plurality of operation modes and at least one of the plurality of presented patterns changes according to the selected operation mode. Further, even in the same operation mode, at least one of the plurality of patterns presented may be changed according to the setting of the irradiation condition and the like. Note that “change” includes an increase or decrease in the number of patterns to be presented.

<Position check means>
Next, the position checking means of the ophthalmic laser treatment apparatus 1 of the present embodiment will be described. Hereinafter, the description will be made on the assumption that the pattern Px2 (see FIG. 11B) is selected on the pattern selection screen 400 in the low output mode. When the pattern Px2 is selected, the aiming light corresponding to the pattern Px2 is applied to the patient's eye E. The aiming light is being scanned, and a spot AS1 of aiming light shown in FIG. In the pattern Px2 of the present embodiment, a plurality of spots forming the pattern Px2 are divided into a plurality of groups (first group G1 to eighth group G8). In the present embodiment, when the foot switch 81 is operated eight times, a series of irradiation of the treatment laser light corresponding to the pattern Px2 is completed.

  The patterns PS1 to PS3 used in the following description are a part of the pattern obtained by dividing the pattern Px2. Further, as an example, the spot corresponding to the pattern PS1 is the spot AS1. When the foot switch 81 is operated while the pattern PS1 is set and the aiming light spot AS1 (first group G1) is presented, the position of each spot constituting the spot AS1 is irradiated with the treatment laser light. When the irradiation of the treatment laser light is completed, the pattern PS2 is automatically set, and the irradiation area of the aiming light moves. A spot AS2 (second group G2) of aiming light shown in FIG. 13 is formed on the patient's eye E. When the foot switch 81 is operated during the presentation of the spot AS2, the position of each spot of the spot AS2 is irradiated with the therapeutic laser beam. When the irradiation of the treatment laser light is completed, the pattern PS3 is automatically set, and the irradiation area of the aiming light moves again. A spot AS3 (third group G3) of aiming light shown in FIG. Thus, the irradiation area of the aiming light and the treatment laser light moves in the circumferential direction with respect to the reference position U.

  The ophthalmic laser treatment apparatus 1 of the present embodiment has a position check unit. In the present embodiment, when the position check unit 290 is touched during the low output mode, a pattern (for aiming light) having a shape different from the pattern of the treatment laser light is applied to the patient's eye E. FIG. 15 shows a spot AP of the aiming light formed on the patient's eye E in which the pattern PP is set. FIG. 22 shows the control executed by the control unit 70 during the low output mode.

  Referring to FIG. In step S401, control unit 70 detects whether or not operation of position check unit 290 has been performed. When the operation of the position check unit 290 is detected, the process proceeds to step S402, and when the operation of the position check unit 290 is not detected, the process proceeds to step S404. In step S402, the control unit 70 sets the pattern PP, irradiates the patient's eye E with aiming light for forming the spot AP, and then proceeds to step S403. In step S403, the control unit 70 determines whether the irradiation of the aiming light using the pattern PP has been continued for 5 seconds or more. If it has continued for 5 seconds or more, the process proceeds to step S404. That is, when the position check unit 290 is operated, a spot AP (sighting light) is formed on the tissue of the patient's eye E for 5 seconds. In step S404, the control unit 70 changes the pattern (for example, the pattern AP2) used for pattern irradiation of the treatment laser beam, and irradiates the pattern with the aiming light. Steps S401 to S404 are repeatedly executed during the low output mode.

  The relationship between the observation image and the spot of the aiming light will be described with reference to FIGS. FIG. 16 shows a pattern irradiation process using the pattern Px2 (FIG. 11B), and shows a state where a spot AS3 (third group G3) of aiming light is formed on the patient's eye E. That is, FIG. 16 shows a process of performing annular irradiation on the macula M using the pattern Px2. In the present embodiment, when the pattern Px2 is selected, each time the foot switch 81 is operated, the formation position of the aiming light spot and the formation position of the treatment laser light spot move. The spot of the aiming light (spot AS3 in FIG. 16) is a part of a plurality of spots forming the pattern Px2.

  FIG. 17 is an observation image observed by the operator when the operator touches the position check unit 290 in the state of FIG. By operating the position check unit 290, the pattern used for pattern irradiation is changed from the pattern PS3 to the pattern PP. With the change of the pattern used for pattern irradiation, the spot of the aiming light switches from the spot AS3 to the spot AP. Although not shown in FIGS. 16 and 17, the reference position U (see FIGS. 14 and 15) is the same position on the eye tissue in FIGS. 16 and 17. That is, in FIGS. 16 and 17, the positional relationship between the patient's eye E (the retina part) and the laser irradiation optical system 40 is maintained. The spot AP according to the present embodiment is a spot for irradiating a treatment scheduled site with a treatment laser beam. The spot AP of the present embodiment has a different shape from the spot AS (spots AS1, AS2, AS3, etc.) for forming the irradiation position (irradiation area) of the treatment laser beam. In the present embodiment, for example, the treatment laser light is irradiated with low energy, and even though it is difficult to observe the spot mark of the treatment laser light, the treatment laser light is easily irradiated to the originally intended eye part.

  As described above with reference to FIG. 22, in the present embodiment, when the position check unit 290 is operated, the spot of the aiming light formed on the eye tissue switches from the spot AS3 to the spot AP. Then, after the spot AP is presented for a predetermined time (predetermined 5 seconds), the spot AP is automatically returned to the spot AS3. The operator need only interrupt the state of looking through the eyepiece of the microscope unit 7 only when switching from the spot AS3 to the spot AP. Since the spot is automatically switched from the spot AP to the spot AS3, for example, the operator is free from the trouble of interrupting the state of looking through the eyepiece of the microscope unit 7 to return the spot. Note that the switching from the spot AS3 to the spot AP may be automatically performed based on a predetermined condition. Further, the spot AP may be normally presented, and the spot AS may be temporarily formed when the position check unit 290 is operated. The operator may irradiate the treatment laser beam while the spot AS is being formed (temporarily). The presentation of the spot AS3 and the presentation of the spot AP may be alternately repeated.

  The pattern PP of the present embodiment has an annular shape. Specifically, in the pattern PP of the present embodiment, a plurality of spots forming the pattern PP are arranged in an annular shape with the reference position U as a center. On the other hand, the pattern PS of the present embodiment is a spot that is moved in the circumferential direction around the reference position U. The spot AP is formed on the patient's eye E, so that the operator can maintain the positional relationship between the patient's eye E and the laser irradiation optical system 40 (in other words, even if the pattern irradiation area moves in the circumferential direction during a series of pattern irradiations). Then, it can be easily determined whether or not the treatment laser beam can be irradiated to the initially planned eye tissue region. That is, the ophthalmic laser treatment apparatus 1 of the present embodiment includes a change unit (for example, the patterns PS1 to PS3) for changing the positional relationship between the spot AP and the spot AS.

  Note that the pattern irradiation area (the position where the spot AS is formed) in the present embodiment moves in the circumferential direction, but the movement of the pattern irradiation area is not limited to movement in the circumferential direction (that is, rotation). For example, the pattern irradiation area may be moved in the up / down direction / left / right direction (for example, see JP-A-2014-68909). By performing pattern irradiation of aiming light using the pattern PP, the laser irradiation optical system 40 is aligned with an ocular tissue portion which is a reference for the series of pattern irradiation during a series of pattern irradiation that divides a plurality of spots into a plurality of groups. If possible. In the present embodiment, the spot AS and the spot AP are switched, but the spot AS and the spot AP may be simultaneously formed (presented).

  Note that some of the plurality of spots forming the pattern PP are shared with some of the plurality of spots forming the pattern PS. Describing with reference to FIGS. 14 and 15, the spot in the frame G of the pattern PS3 coincides with the spot in the frame H of the pattern PP. That is, the diameter of the pattern PP of the present embodiment matches the inner diameter of the pattern Px2 (ring-shaped pattern). Therefore, in the irradiation of the treatment laser light using the pattern Px2, the treatment laser light is not irradiated inside the spots forming the pattern PP. By observing the fundus Er image and the aiming light spot AP, the surgeon can easily grasp the irradiation range of the treatment laser light in a series of pattern irradiation using the pattern Px2. In addition, the pattern PP of this embodiment can suppress irradiation of aiming light to a fovea, for example. Thereby, the glare of the patient irradiated with the aiming light is reduced. However, the shape of the pattern PP is not limited to this. For example, the pattern PP may be a square, a cross, or a solid circle with the reference position U at the center of gravity. Further, for example, the pattern PP may be a single spot (the spot is arranged at the reference position U). It suffices if the laser irradiation optical system 40 can be positioned with respect to the ocular tissue part which is a reference for a series of pattern irradiation. Although the spot AP of the present embodiment is suitable for alignment with the macula M, the target of the spot AP is not limited to the macula M. For example, aiming at the optic disc D, blood vessel V, and the like may be performed using the spot AP. The laser treatment apparatus for ophthalmology 1 may include a plurality of spots AP having different shapes, and may be able to select the spot AP. This selection may be made by the operator, or may be automatically selected according to the operation mode of the ophthalmic laser treatment apparatus 1.

<Summary>
As described above, the ophthalmic laser treatment apparatus according to the present embodiment is provided in the laser irradiation optical system for irradiating the patient's eye with the treatment laser light emitted from the treatment laser light source, and the treatment laser light Scanning means for scanning the spot two-dimensionally on the tissue of the patient's eye, and pattern irradiation means for forming a spot of a predetermined pattern using a laser irradiation optical system and a scanning means. Also, a normal output mode for denaturing the tissue of the patient's eye by irradiating the treatment laser light, and a treatment laser beam in the normal output mode for optically stimulating the tissue of the patient's eye without denaturing the tissue of the patient's eye And a control means for controlling the ophthalmic laser treatment apparatus. In the low output mode, a pattern selecting means for selecting a predetermined pattern from a plurality of patterns, a setting means for setting irradiation energy of a reference treatment laser beam, and a patient eye without denaturing the tissue of the patient eye In order to optically stimulate the tissue, the operator can operate correction means for performing a correction to reduce the output by a predetermined amount with respect to the reference irradiation energy set by the setting means. When the low output mode is set, the control unit does not accept the pattern selection by the pattern selection unit until the irradiation energy serving as the reference set by the setting unit is corrected by the correction unit. Pattern selection by the selection means can be accepted. Thereby, for example, pattern irradiation of the treatment laser beam with unintended irradiation energy is suppressed.

  In the ophthalmic laser treatment apparatus 1 of the present embodiment, the setting means includes an output value setting means for setting an output value of the treatment laser light, and the correction means includes an output set by the output value setting means. Decrease the value. Thus, for example, an event in which the treatment laser light is irradiated to the patient's eye E with an unintended output value (treatment laser light) is suppressed. Further, in the ophthalmic laser treatment apparatus 1 of the present embodiment, the correction means regulates the setting range that can be set by the output value setting means so that the corrected output value does not fall below a predetermined lower limit. Thereby, for example, an event that the unstable treatment laser light is irradiated on the patient's eye E can be suppressed.

  Further, the ophthalmic laser treatment apparatus 1 of the present embodiment includes irradiation control means for controlling irradiation of the treatment laser light to the patient's eye E, and the control means is configured to prohibit pattern selection by the pattern selection means. Forms a single spot as a predetermined pattern. Thereby, for example, the burden on the patient's eye E when determining the reference condition is reduced.

  Further, the ophthalmic laser treatment apparatus 1 of the present embodiment includes a laser irradiation optical system 40 for irradiating the tissue of the patient's eye E with the treatment laser light, and a first pattern (for example, pattern PS3) and a shape different from the first pattern, a second pattern (for example, pattern PP) for aligning the first pattern with the treatment target site, and a storage unit (1) for storing the first pattern and the second pattern. ROM 72) and aiming optics for scanning aiming light on the tissue of the patient's eye E to form a first spot based on the first pattern and a second spot based on the second pattern on the tissue of the patient's eye E System (laser irradiation optical system 40). Thereby, for example, irradiation of a treatment laser beam to an unintended part can be suppressed.

  Further, the ophthalmic laser treatment apparatus 1 of the present embodiment includes an aim selecting means (position check unit 290) for selectively forming any one of the first spot and the second spot on the tissue of the patient's eye E. Have. Thereby, for example, the first spot and the second spot can be easily switched by a simple operation.

  Further, the ophthalmic laser treatment apparatus 1 of the present embodiment includes a change unit for changing the positional relationship between the first spot and the second spot. Thereby, for example, even if the pattern irradiation area is moved, it is easy to align the aiming light with the irradiation scheduled area. In addition, the ophthalmic laser treatment apparatus 1 of the present embodiment includes irradiation control means for controlling irradiation of the treatment laser light to the patient's eye E, and the change means changes the first spot when irradiation of the treatment laser light is performed. The second spot is moved in the circumferential direction with respect to the first spot as a rotation center. Thereby, for example, it is easy to perform pattern irradiation on the macula M. Further, the ophthalmic laser treatment apparatus 1 of the present embodiment uses an annular shape as the first pattern. Thereby, for example, it is easy to perform pattern irradiation on the macula M.

  The ophthalmic laser treatment apparatus 1 of the present embodiment can irradiate the patient's eye E with a plurality of treatment laser lights having different wavelengths. However, the technology of the present disclosure may be applied to an ophthalmic laser treatment apparatus that can irradiate only the treatment laser light (for example, yellow) of a specific wavelength to the patient's eye E. Further, the ophthalmic laser treatment apparatus 1 of the present embodiment forms a pattern composed of separated spots by intermittently irradiating a laser beam. However, a pattern of continuous spots may be formed by continuous irradiation with laser light.

  The embodiment disclosed this time is an example in all respects, and should be considered as non-limiting. The scope of the present invention is defined by the terms of the claims, rather than the description above, and is intended to include the claims, any equivalents, and all modifications within the scope.

E: patient's eye 40: laser irradiation optical system 50: operation unit 260: output ratio setting unit 350: output ratio selection screen 410: pattern selection screen

Claims (4)

A laser irradiation optical system that irradiates the patient's eye with treatment laser light emitted from the treatment laser light source,
Scanning means provided in the laser irradiation optical system, for two-dimensionally scanning the spot of the treatment laser light on the tissue of the patient's eye;
Using the laser irradiation optical system and the scanning means, pattern irradiation means for forming a spot of a predetermined pattern,
A normal output mode for modifying the tissue of the patient's eye by irradiating the treatment laser light, and the treatment laser in the normal output mode for optically stimulating the tissue of the patient's eye without modifying the tissue of the patient's eye Mode selection means for selecting a low output mode to be relatively low output than the light output,
Control means for controlling the ophthalmic laser treatment device,
With
In the low power mode,
Pattern selection means for selecting the predetermined pattern from a plurality of patterns,
Setting means for setting the irradiation energy of the treatment laser light as a reference,
Correction means for performing a correction to reduce the output by a predetermined amount with respect to the reference irradiation energy set by the setting means in order to optically stimulate the tissue of the patient's eye without denaturing the tissue of the patient's eye When,
Is operable by the surgeon,
When the low output mode is set, the control unit does not accept the pattern selection by the pattern selection unit until the correction unit corrects the reference irradiation energy set by the setting unit. After the correction by the means, it is possible to accept the pattern selection by the pattern selection means,
An ophthalmic laser treatment apparatus characterized by the above-mentioned. The ophthalmic laser treatment apparatus according to claim 1,
The setting means includes an output value setting means for setting an output value of the treatment laser light,
The correction means reduces the output value set by the output value setting means,
An ophthalmic laser treatment apparatus characterized by the above-mentioned. The ophthalmic laser treatment apparatus according to claim 2,
The correction means regulates a setting range that can be set by the output value setting means so that the output value after correction does not fall below a predetermined lower limit value,
An ophthalmic laser treatment apparatus characterized by the above-mentioned. The ophthalmic laser treatment apparatus according to any one of claims 1 to 3,
An irradiation control unit that controls irradiation of the treatment laser light to the patient's eye,
The control means forms a single spot as the predetermined pattern when pattern selection by the pattern selection means is prohibited,
An ophthalmic laser treatment apparatus characterized by the above-mentioned.

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