KR101118146B1 - Apparatus for the Treatment of Ocular Diseases and Apparatus for the Diagnosis of Ocular Diseases - Google Patents

Abstract

The present invention relates to an apparatus for diagnosing ocular disease using a laser and an apparatus for diagnosing ocular disease using a laser. In detail, the apparatus for diagnosing ocular disease according to the present invention irradiates a femtosecond laser beam focused on a vitreous in the eye, thereby focusing a region. The pressure wave caused by laser induced ionization and laser-induced absorption in the vitreous is characterized in that the treatment of eye diseases, in detail the eye disease diagnosis apparatus according to the present invention is to focus the femtosecond laser beam focused to the vitreous in the eye By measuring the change in the intensity of the scattered light to be irradiated and scattered, there is a characteristic of diagnosing the presence of eye disease based on the change in the intensity of the scattered light.

Ultrafast Laser, Femtosecond, Pressure Wave, Retina, Vitreous, Desquamation, Bleeding

Description

Apparatus for the Treatment of Ocular Diseases and Apparatus for the Diagnosis of Ocular Diseases}

The present invention relates to an apparatus for diagnosing eye diseases using a laser and an apparatus for diagnosing eye diseases using a laser. In detail, the apparatus for diagnosing eye diseases according to the present invention generates pressure waves inside a vitreous body by irradiation of a femtosecond laser beam, thereby retinal detachment. The ocular disease diagnosis apparatus according to the present invention has a characteristic of diagnosing the presence or absence of eye disease by measuring the change in the intensity of the scattered light and the irradiation of the femtosecond laser beam.

Diseases related to the stratified tissues of the stratification occur in a wide variety of forms. In particular, the major part of the eye's retinal tissue consists of a layered structure.

When the intraocular tissues having such a layered structure are structurally deformed, it is very common to develop vision loss or worse vision loss.

Cases of blindness due to macular degeneration and related macular disease have emerged as the leading cause of blindness, surpassing the existing blindness rate by glaucoma or cataract. In particular, according to the National Health Insurance Corporation, the number of young macular degeneration patients in their 20s and 40s, which was 7631 in 2000, increased by nearly 1373 in 2004.

Macular degeneration does not show any symptoms, but the vision gradually worsens, leading to blindness.In the early stages, symptoms such as blurred vision or distorted short-range objects appear in the eyes, but only after the disease progresses considerably.

The major causes of macular degeneration are premature retinopathy in children, diabetic retinopathy in adults, and macular degeneration in adults. When considering their underlying diseases as a cause of development, there are some differences, but in general, useless blood vessels grow or bleed in the macula at the center of the retina due to secondary retinal vascular endothelial cell proliferation due to damage of the retinal blood barrier. It is known to cause severe vision damage. However, little is known about the detailed etiology and progression of the disease.

In particular, among the various types of diseases that are emerging along with the explosive increase of the elderly population, macular degeneration and blindness due to macular degeneration is estimated to be about 10% or more of people over 65 years old. It is expected to suffer from visual impairment due to degeneration.

This early form of senile macular degeneration is characterized by a sharp drop in vision due to the detachment of the layered retina from the choroid or the swelling of the retina.

If the stratified structure of these ocular tissues is separated or anomalous phenomenon develops the stratified structure, ultimately in the central part of the retina due to the proliferation of secondary retinal vascular endothelial cells due to damage of the retinal blood barrier Useless blood vessels in the macular are known to develop into severe vision loss as they grow or bleed.

Current treatments for macular degeneration include surgery and drug therapy. On the other hand, macular degeneration is the key to the treatment of inhibiting neovascularization of the choroid covering the outer retina, but the cure is not known yet.

Pharmacotherapy is effective in the case of some of the diseases caused by macular degeneration such as "bijudine", a photodynamic therapy marketed by multinational pharmaceutical company Novartis, and various neovascular inhibitors (Anti-EGGF, Anti-VEGF). It is known, but the most common case of dry patients, drug therapy is not known at all, and side effects are reported to be very serious when using the drug therapy.

Specifically, surgery includes laser photocoagulation and resection, and a part of the retina using gas lasers (Ar ion, Kr ion lasers) causes a kind of burn that causes scars to stop growing new blood vessels. However, this method is so large that the size of the coagulation area is not negligible compared to the size of the macula, it does not eliminate the severe vision disorders and the underlying etiology is a new treatment technology is necessary.

An object of the present invention for solving the above problems is to provide a device for preventing thermal or photochemical damage based on ultrafast laser and non-invasive treatment of disease caused by deformation of layered tissue, based on ultrafast laser It provides a device that prevents thermal or photochemical damage and determines the presence or absence of eye diseases with very high accuracy in a short time.

Hereinafter, the eye disease diagnosis apparatus and the eye disease diagnosis apparatus of the present invention will be described in detail. Hereinafter, the technical and scientific terms used herein will be understood by those skilled in the art without departing from the scope of the present invention. Descriptions of known functions and configurations that may be unnecessarily blurred are omitted.

The present invention is based on ultra-fast laser (femtosecond laser), the disease caused by separation or modification of intraocular stratified tissue while minimizing thermal or photochemical damage, for example, retinopathy of prematurity and diabetic retinopathy, senile macular degeneration in adults Apparatus for non-invasive treatment and diagnosis of macular degeneration, which is an intraocular retinal layer in the back of the eye, deterioration of vision due to separation from the choroid, degeneration of the retinal layer, or ocular stratified eye disease. .

Hereinafter, an eye disease diagnosis apparatus using a laser according to the present invention will be described in detail.

The apparatus for diagnosing ocular disease according to the present invention irradiates a femtosecond laser beam focused with a vitreous humor in the eye, and generates an acoustic pressure wave generated by laser induced ionization and laser induced absorption in the vitreous in the focal region. It is characteristic to treat eye disease by causing shock wave.

Characteristically, deformation of the intraocular layered tissue (including partial separation between layers) is treated by the treatment device of the present invention causing the pressure wave, and bleeding due to intraocular damage or disease is eliminated.

More specifically, the retina detached from the choroid (including partial separation) is attached by the treatment device of the present invention causing the pressure wave, and blood accumulated inside the eye is discharged to the outside of the eye.

The pressure wave generated in the eye by the ocular disease diagnosis apparatus according to the present invention does not damage normal tissue, and treats the deformed layered tissue by applying pressure to the deformed intraocular layered tissue very quickly and accurately, and thus, conventional photocoagulation Alternatively, side effects that can occur in treatment with drugs can be minimized. This is because when the ultrafast laser used in the present invention reaches the retina in the interaction with the intraocular vitreous body, the mechanism of generating pressure waves very effectively even if the energy per unit area is less than the critical threshold energy of the retina is dependent on the nonlinear optical phenomenon. Because. This is because, in the case of nanosecond or combustion wave lasers, unlike the above, the critical laser energy generating the pressure wave is so high that the laser beam energy reaching the retina is higher than that directly damaging the retina. Cannot be generated.

In detail, an apparatus for diagnosing eye diseases using a laser according to the present invention includes a laser light source for generating a femtosecond laser beam; A power control unit controlling power of the laser beam generated from the laser light source; Fixing part for fixing the position of the eye to be treated; An optical system that irradiates a laser beam generated by the laser light source to the eye fixed by the fixing unit; And a focus controller configured to focus the laser beam irradiated to the eye by the optical system and to adjust the focus of the focused laser beam, wherein the focus controller adjusts the focus of the focused laser beam by the following Equation 1. The pressure wave due to laser induced ionization and laser induced absorption of the intravitreal body is characterized.

(Equation 1)

L _1ens <L _focus <L _retina

(L _focus is the focal length of the focused laser beam relative to the electrode of the eye (polus anterior) fixed to the fixed part, the L _1ens is eye relative to the electrode of the eye (polus anterior) fixed to the fixed part. The distance to the interface between the lens and the vitreous body according to the construction, and the L _retina is the distance to the interface between the _retina and the vitreous body along the eye axis with respect to the electrode of the eyeball fixed to the fixed part.)

The focus controller provides a laser beam having a focus at a predetermined position of the vitreous body in the eye so that pressure waves are generated in the minimum region of the vitreous body, and the position and pressure at which the pressure wave is generated by controlling the focal position of the laser beam. Adjusts the force, or pressure, per area in the lesion tissue as the wave propagates.

The focus control unit preferably adjusts the focus of the focused laser beam by Equation 2 below, in order to effectively treat eye diseases by the generated pressure wave and to prevent local normal tissue damage.

(Equation 2)

0.25L _o ≤ L _focus ≤ 0.75L _o

(L ₀ is the distance to the posterior pole along the eye axis with respect to the pole of the eyeball fixed to the fixture, and L _focus is the pole of the eyeball fixed to the fixture. Is the focal length of the focused laser beam.)

The power of the laser beam controlled by the power control unit mainly affects the generation of the pressure wave and the magnitude of the generated pressure wave.

In order to prevent permanent damage and resection of normal tissue in the eye and to treat a disease by pressure waves, the power control unit is characterized by adjusting the power of the laser beam according to Equation 3 below.

(Equation 3)

P _cri ≤ P _laser ≤ P _dem

(P _laser is the power of the laser beam to be irradiated, P _cri is the critical laser beam power in which the pressure wave is generated in the vitreous body by irradiation of the laser beam, and P _dem is the permanent damage of the intraocular tissue by irradiation of the laser beam and Ablation does not occur laser beam power.)

In particular, the power control unit adjusts the power of the laser beam used in Equation 4 below.

(Equation 4)

3 mW ≤ P _laser ≤ 22 mW

The laser beam power of Equation 4 is a preferable range when the laser has a pulse width of 50 fs to 500 fs, a wavelength of 750 to 850 nm and a repetition rate of 1 KHz, and 3 mW of Equation 4 is generated in the glass body by irradiation of the laser beam. It is the critical laser beam power at which the pressure wave occurs, the area of the laser beam power capable of treating P _laser eye disease, especially retinal detachment or removal of blood due to intraocular hemorrhage, and 22 mW of Equation 4 is the irradiation of the laser beam. It is the maximum laser beam power that does not cause permanent damage and ablation of normal tissue in the eye by the generation and propagation of pressure waves occurring in the vitreous.

The pulse width of the femtosecond laser beam generated from the light source has a major influence on whether the pressure wave is generated, the magnitude of the generated pressure wave, whether the cavitation occurs, and the degree of the cavity. The pulse width of the laser beam is 50 fs to 500 fs to suppress (minimize) the occurrence of cavities, to prevent permanent damage and resection of normal tissue in the eye by pressure waves, and to treat diseases caused by pressure waves. It is characterized in that the pulse width of the laser beam is preferably 100 fs to 200 fs. In this case, the femtosecond laser beam is preferably irradiated to the eye for 30 seconds to 2 minutes in order to generate a plurality of pressure waves to effectively treat the eye disease.

The wavelength of the laser beam has a major influence on the degree of laser beam absorption of the intraocular tissue, and thus, the wavelength of the laser beam has a major influence on the occurrence of cavitation and the generation of cavities.

In order to suppress (minimize) the generation of cavities, the wavelength of the laser beam is preferably in the near infrared region, in particular direct retinal absorption (linear absorption) is minimized, and linear absorption of constituents of the vitreous body (mainly water) is minimized. It is preferable to irradiate a laser operating at a wavelength of 750 nm or more and 850 nm or less, which is the minimum.

An apparatus for diagnosing ocular disease according to the present invention includes an imaging light source and an imaging device for generating an imaging beam which is white light, and monitoring the optical tissue by optically using the imaging beam irradiated to the eye by the optical system. It is preferable to further include a portion, more preferably, the eye of the eye fixed to the fixed portion, in order to more stably control the focus of the focused laser beam by the focus control unit together with the imaging light source and the monitoring unit It further comprises a guide light source for generating a guide beam irradiated into the construction.

The imaging beam and the guide beam are irradiated to the eye fixed to the fixed part by the optical system, and the laser beam and the guide beam irradiated to generate the pressure wave are irradiated to have the same optical axis. In this case, the imaging beam and the guide beam preferably satisfy laser class 1 (class 1).

As described above, the ocular disease diagnosis apparatus according to the present invention preferably comprises: a light source for generating the femtosecond laser beam; An imaging light source for generating white light to optically observe eye tissue; A guide light source for generating a guide beam for more clearly controlling focus control of the femtosecond laser beam; An optical system for irradiating the laser beam, a beam of an imaging light source, and a beam of a guide light source with an eye fixed by a fixing unit; A focus control unit focusing a laser beam radiated to the eye and controlling a focus; A power control unit controlling power of the laser beam irradiated to the eye; A fixing part for physically fixing the eye to be treated at a predetermined position; And a monitoring unit that optically monitors eye tissue using the imaging beam.

The optical system is adopted to process and adjust a beam generated from a light source (a light source generating a femtosecond laser beam, an imaging light source and a guide light source), and may include all conventional laser beam optical systems. For example, Mirrors with dichroic mirrors or concave mirrors that selectively reflect light depending on wavelength, lenses with objective or opphtalmoscope, optical filters with notch filters, The optical system including attenuator, splitter, and iris can be used to control the path of the pure short wavelength laser beam, and the intensity of the laser beam can be controlled using the neutral density filter. In addition, the number of pulses of the laser beam to be irradiated can be controlled using a fast optical shutter.

The focus control unit includes a focusing lens including an objective lens or an ophtalmoscope for focusing a femtosecond laser beam and a positioning stage, wherein the positioning stage includes the focusing lens for focusing the light. It is employed to move its position at least in one axis direction (for example, x-axis) or at least one axis direction (for example, x-axis) to move the position of the fixing part in which the eyeball is fixed. Or any conventional means of movement used to move the location of the treatment subject or treatment equipment in the treatment device.

The power control unit is employed to control the power of the femtosecond laser beam generated from the light source by controlling the voltage or current applied to the light source generating the femtosecond laser beam, and is used to control the power of the laser beam. It can include both voltage or current control means. In this case, the power control unit may include a feedback loop receiving an output result of a measuring unit (for example, a light receiving device) for measuring the power of the beam generated from the light source. It may also include all conventional laser power regulators, which may be configured as external optical elements, such as polarizers and polarization control optical components or combinations thereof.

The fixing part for fixing the position of the eye to be treated is employed to physically fix the position of the eye, and includes all conventional fixing means used to fix the position of the eye to be treated in the operation or treatment device of the eye disease. For example, the laryngeal part is located and may be composed of a support for physically supporting the larynx and a detachable strip for fixing the position of the upper head of the support, further comprising an eyelid fixing means for suppressing the movement of the upper and lower eyelids. It may include.

A real-time imaging device may be used as a monitoring unit for monitoring eye tissue, and a charge coupled device (CCD) camera may be provided to detect a photoluminescence signal split by a beam splitter.

At this time, the focus control unit, the monitoring unit and the power control unit is preferably controlled in conjunction with a control program driven by a digital processor.

Hereinafter, an eye disease diagnosis apparatus according to the present invention will be described in detail. Since the power control unit, the fixing unit, the optical system, and the focus control unit are similar to the above-described eye disease diagnosis apparatus in the ocular disease diagnosis apparatus described later, a detailed description thereof will be omitted.

An apparatus for diagnosing eye diseases using a laser according to the present invention includes a laser light source for generating a femtosecond laser beam; A power control unit controlling power of the laser beam generated from the laser light source; Fixing part for fixing the position of the eye to be diagnosed; An optical system that irradiates a laser beam generated by the laser light source to the eye fixed by the fixing unit; A focus control unit focusing the laser beam irradiated to the eye by the optical system and adjusting a focus of the focused laser beam; A power meter for measuring the intensity of the scattered light, which is a backward scattered laser beam; And a determination unit configured to receive the scattered light intensity measured by the power meter, calculate a fluctuation of the scattered light intensity, and determine whether there is an eye disease based on the variation of the scattered light intensity.

The determination unit interlocks with the focus control unit and the power meter to receive intraocular focus position information of the laser beam irradiated to the eyeball controlled by the focus control unit, and receives scattered light intensity measured by the power meter. The presence or absence of eye disease is determined by calculating a variation in scattered light intensity according to the intraocular focus position of the laser beam irradiated to the eyeball and the power of the laser beam irradiated to the eyeball.

More specifically, the determination unit shows the present embodiment by using the RMS value of the intensity of the transmitted light which is the light scattered rearward during eye irradiation of the femtosecond laser beam to show the present embodiment, but the actual diagnosis is the front of the scattered light It may include both measuring and observing the intensity. This is not contrary to the construction of the device since it has the optically identical configuration. The RMS of the scattered light intensity is an eye disease index that changes most sensitively to the turbidity of the vitreous or physical / chemical / biochemical changes of the vitreous material by the ocular disease.

Among the eye diseases that cause deformation of intraocular stratified tissue and the ocular diseases that cause detachment of intraocular stratified tissue using the above-mentioned variation of scattered light intensity, premature retinopathy in children and diabetic retinopathy in adults are the main causes of blindness. Retinal ocular disease caused by senile macular degeneration and constituent changes in vitreous humor, and visual acuity due to turbidity caused by changes in constituents of vitreous humor are diagnosed. In this case , in order to improve the reliability of the calculated RMS value, the femtosecond laser beam is preferably irradiated to the eye for 10 seconds to 60 seconds.

Specifically, the determination unit for determining the presence or absence of the eye disease calculates the root mean square (RMS) value of the scattered light intensity according to the power of the laser beam, the eyeball focal position information of the laser beam irradiated to the eye; And a root mean square (RMS) value of the scattered light intensity according to the power of the laser beam irradiated to the eye.

Preferably, the determining unit is a computer that stores the normal RMS data which is the root mean square (RMS) value of the scattered light intensity according to the focal position of the laser beam irradiated to the eye of a normal person having no eye disease and the power of the laser beam irradiated It further comprises a readable recording medium, and compares the normal RMS data and the RMS value calculated by the determination unit (preferably RMS value according to the focal position in the eye) to determine the presence of eye disease.

In this case, it is apparent that the normal RMS data may be measured using a device and conditions similar to those of the ocular disease diagnosis apparatus according to the present invention, for a normal person who does not have a specific disease including an eye disease.

As described above, the ocular disease diagnosis apparatus according to the present invention is characterized by irradiating a femtosecond laser beam to the eye, measuring the intensity of scattered light, and determining the presence or absence of eye disease based on the RMS value of the scattered light intensity. The focus control unit may adjust the focus of the focused laser beam by Equation 5 below, measure a change in scattered light intensity by the vitreous body, and use it as an indicator for determining whether eye disease is present.

(Eq. 5)

L _1ens <L _foc <L _retina

(L _foc is the focal length of the focused laser beam relative to the eye of the eye (polus anterior) fixed to the fixed part, the L _1ens is based on the eye of the eye of the eye (polus anterior) fixed to the fixed part The distance to the interface between the lens and the vitreous body according to the construction, and the L _retina is the distance to the interface between the _retina and the vitreous body along the eye axis with respect to the electrode of the eyeball fixed to the fixed part.)

Furthermore, in order to improve the sensitivity and accuracy of discrimination between normal eyes and eyes with diseases, it is preferable that the focus control unit adjusts the focus of the focused laser beam by Equation 6 below.

(Equation 6)

0.5L _o ≤ L _foc <L _retina

(L _foc is the focal length of the focused laser beam relative to the electrode of the eye (polus anterior) fixed to the fixed part, and L ₀ is the eye relative to the electrode of the eye (polus anterior) fixed to the fixed part L _retina is the distance to the boundary between the retina and the vitreous along the eye axis with respect to the polus anterior fixed to the fixed part.)

As described above, the apparatus for diagnosing ocular disease according to the present invention is characterized by irradiating a femtosecond laser beam to the eye and an RMS value obtained from scattered light intensity scattered from the eye as a criterion for determining whether or not the eye disease is retained. The femtosecond laser beam is irradiated so that the inside of the vitreous body is in focus, and the RMS value obtained from the scattered light intensity including the physical, chemical, and biochemical information of the vitreous to which the femtosecond laser beam is irradiated is used as a criterion for determining the presence of eye disease. Becomes

The RMS value of the scattered light intensity may serve as a criterion for determining the presence or absence of disease only in a laser power in a specific region that shows a significant difference value between an eye having no disease and an eye having a disease.

The presence or absence of disease may be determined using the RMS value of the scattered light intensity, and further, the power control unit may adjust the power of the laser beam to 3 mW to 15 mW in order to improve the sensitivity and accuracy of the discrimination.

When the femtosecond laser beam (ultrafast laser beam) is irradiated to the eye, the presence or absence of eye disease can be diagnosed by the above-mentioned change of scattered light intensity, and to prevent damage to normal eye tissue and to improve the sensitivity and accuracy of the discrimination. The pulse width of the laser beam is preferably 50fs to 500fs.

In the present invention, the wavelength of the laser beam has a major influence on the degree of laser beam absorption of the intraocular tissue, and in order to prevent damage to normal eye tissue and improve the sensitivity and accuracy of the discrimination, the wavelength of the laser beam is a near infrared region. Preferably, the wavelength of the laser beam is 750 nm to 850 nm.

The apparatus for diagnosing ocular disease according to the present invention does not damage normal eye tissue, treats deformed or separated intraocular layered tissue (including the retina) by using a pressure wave using an ultrafast laser, and treats intraocular blood. Exhaust to the outside has the effect of treating vascular diseases.

The apparatus for diagnosing ocular disease according to the present invention does not damage normal ocular tissues, and determines whether or not a patient possesses ocular disease by irradiating an ultrafast laser to the eye with a change in scattered light intensity that includes information on physical, chemical and biochemical changes of the eye. In particular, the presence or absence of eye disease is determined by the change in the scattered light intensity, which is very sensitive to physical, chemical, and biochemical changes of the vitreous body.

An apparatus for diagnosing ocular disease according to the present invention is characterized by treating deformed or separated intraocular layered tissue (including the retina) by using a pressure wave using an ultrafast laser, and discharging intraocular blood to the outside of the eye. .

More specifically, a pressure wave is generated in the vitreous body using a light source and a focus control part of a femtosecond laser beam, and the intraocular layered tissue deformed or separated by the propagation of the generated pressure wave or the floating blood in the eye is moved out of the eye. Emissions are treated, light sources with specific laser beam wavelengths minimize laser absorption, generate pressure waves while suppressing cavitation, and control the power of the laser beam and the pulse width of the laser beam to damage normal eye tissue. The deformed or separated intraocular stratified tissue is not treated, or normal eye tissue is not damaged, and the suspended intraocular blood is discharged to the outside of the eye for treatment.

An apparatus for diagnosing ocular disease according to the present invention is characterized by determining whether or not an eye disease is possessed by a change in scattered light intensity including information on physical / chemical / biochemical changes of the eye by irradiating an ultrafast laser to the eye.

More specifically, the femtosecond laser beam is irradiated with a focus on the inside of the eye glass using a light source and a focus control unit of the femtosecond laser beam, and the eye is represented by the change of the scattered light intensity including information on physical / chemical / biochemical changes of the glass body. Determine if you have a disease.

More specifically, the apparatus for diagnosing ocular disease according to the present invention uses a light source, a power controller, a focus controller, and a discriminator of a femtosecond laser beam to irradiate a femtosecond laser beam having a specific area of power so that the vitreous of the eye is in focus. RMS (Root Mean Square) of scattered light intensity is used to determine the presence or absence of eye disease, furthermore, it minimizes the laser absorption by using a light source having the wavelength of a specific laser beam to increase the reliability of discrimination and suppress the cavitation The power of the beam and the pulse width of the laser beam are controlled to determine the presence of eye disease with high sensitivity, accuracy and reliability without damaging normal eye tissue.

In the present invention, the treatment of retinal detachment, removal of floating blood in the eye, and measurement of the change in intensity of the ultrafast laser that are transmitted by irradiating ultrafast laser to the pig's eye, which is known to be relatively similar to human eye, are performed. An embodiment of the device according to the core idea of the ocular disease diagnostic device and the ocular disease disease device according to the invention will be described, and experimentally demonstrate the superiority of the treatment and diagnostic device according to the invention.

The eye used at this time was the eye extracted immediately after the slaughter in Hannong (Cheongwon, Chungcheongbuk-do). On the other hand, the pig eye extracted from the slaughterhouse was stored and stored in an ice box cooled with ice water so that there was no change when moving from the slaughterhouse to the laboratory. At this time, the migration time was not to exceed 50 minutes, and after the migration, tissue growth and primary cell culture using the explant method were used to confirm the damage of the retina.

1 is a schematic diagram of an eye disease indicator apparatus using a laser-induced pressure wave based on an ultrafast laser. 1, "Fs-laser" is a light source for generating a femtosecond laser beam, "A" is an attenuator, "M" is a VIS-IR mirror, "I" is an Iris (Q) "Quartz flow cell", "BS" is Beam Splitter, "CM" is Concave Mirror, "DM" is: Dichroic Mirror, "OL" stands for Ophthalmoscope Lens, "TS" stands for Translation Stage, "Filters" stands for Yellow & Blue Filter, "P" stands for Beam Polarizer. , "L" means lens, "E" means eyeball, "G" means guide laser for generating guide beam, CCD means digitally coupled device, "shutter" Means optical shutter. In FIG. 2, the red color represents an optical path of a light source generating a femtosecond laser beam, the pink color represents an optical path of a light source emitted from a guide light source, and the purple color represents white light for imaging. At this time, only the red color is shown when the light paths overlap.

The femtosecond laser beam, a therapeutic laser beam, has an 800 nm wavelength, a 1 kHz frequency, and a pulse width of 120 fs. As shown in FIG. 2, this was split into two beams using a 50:50 beam splitter. One is to generate white light using the super-continuum generation method using a biconvex laser with a focal length of 50 mm in a 10 mm long quartz flow water cell. Generated and used as imaging light. The other split beam was also used as laser light (femtosecond laser beam) for direct treatment purposes. In addition, in order to make the femtosecond laser beam source clear the intraocular focus, another laser beam (guide beam) was matched using a dichroic mirror to have the same optical axis as the femtosecond laser beam source. The femtosecond laser beam and guide light were focused in a swine ocular extracted using an ophthalmoscope lens using another dichroic mirror. On the other hand, the imaging beam (polarizing beam splitter) using a polarizing beam splitter (polarizing beam splitter) has the same optical axis as the other two laser beams to be irradiated to the eye. At this time, the intensity of the imaging light and the guide light used was controlled using an optical filter so that the intensity of class 1 or less. The range of optical wavelengths of imaging light also allowed the image to be optimized using another optical filter.

FIG. 2 illustrates the configuration of a region in which a laser beam is irradiated to the eye in more detail. In order to minimize distortion caused by the lens of the eye when the laser beam is incident on the eye, the VFLATAS lens is mounted in front of the eye. In addition, by filling a ringer solution between the VFLATAS lens and the lens to minimize the distortion. In addition, "P1, P2 ..... P8, P9" shown in Fig. 2 shows the aspect that the focus of the femtosecond laser beam is changed in the eye.

At this time, the focus of the femtosecond laser beam was adjusted by moving the eye to the position control stage to adjust the distance between the eye and the ophthalmoscope lens.

On the other hand, "P1" is close to the retina and "P9" is close to the lens (crystal lens). The distance between Pn and Pn + 1 (n is a natural number between 1 and 8) is 2 mm and P1 is 1 mm from the surface of the retina. Given that the size of the eye is about 20 mm and the thickness of the tissue behind the retina is about 3.5 mm, P8 and P9 mean the inner surface of the lens of the eye or the lens itself.

On the other hand, the state of the vitreous humor of the eye is generally considered to be a gel, and the physical and chemical properties such as the viscosity of the gel and the amount and type of protein are known to be very different depending on the state of the eye.

Before the direct experiments that caused the generation of pressure waves by the laser in the eye, we attempted to measure the change in the transmission by the ultrafast laser of the vitreous in the eye.

FIG. 3 is a partial view of an apparatus for measuring the ocular transmittance of a femtosecond laser beam, with a laser power meter mounted on the back of an eye extracted in a device similar to FIG. 1 for transmission at each focal point Was measured.

The laser power meter used was calibrated with the cryo-ECPR and the margin of error is within about 1%. On the other hand, a collimating lens having a diameter of 50 mm was applied to minimize the scattering effect of the laser beam transmitted through the eye by the non-removable tissue behind the eye.

4 is a fundus photograph result of two different kinds of eyeballs extracted from a slaughterhouse. Due to retinal disease, the fundus photograph of FIG. 4 (A) shows a very clear black portion due to retinal detachment at 12 o'clock and 9 o'clock, and the overall red color is very distinct. On the other hand, the fundus photograph of FIG. 4 (B) shows a very homogeneous reflection property without any color change.

FIG. 5 illustrates the transmittances measured by varying the focal position of the femtosecond laser beam in the eye and the power of the femtosecond laser beam, in which a disease similar to that of FIG. 4 exists (FIG. 5A) and a normal eye (FIG. 5). It can be seen that the change in transmittance is very different according to B) of 5. In this case, the temporal change rate of the transmittance is expressed as an error bar (error-bar) in the transmittance measured at each point, and FIGS. 5 to 6 are results obtained from 16 or more disease-bearing eyes and normal eyes.

As can be seen in FIG. 5 (A), in case of a diseased eye, when the power of the femtosecond laser beam is small, the fluctuation of the transmitted laser light is small, but when the power of the femtosecond laser beam increases from 6.1 mW to 8.3 mW. It can be seen that the intensity of the laser light transmitted in the focal points P2 and P3 is changed very severely. It can be seen that the change in the power of the transmitted laser light increases as the power of the incident femtosecond laser beam increases, and it becomes larger as it gets closer to the lens of the eyeball. In other words, in the case of 20.8 mW, the transmittance of the laser changes very severely in almost all intraocular regions.

On the other hand, even in the case of normal eyes, even when the power of the femtosecond laser beam is 12.3 mW, it can be seen that the change is very small in almost all areas of the eye. However, when the femtosecond laser beam power is more than 16.2 mW, it can be seen that the temporal change of the transmittance is very severe even in the normal eye.

The change in transmitted laser intensity with or without eye disease becomes more apparent by calculating a normalized root mean square (RMS) value for the change in transmitted laser intensity measured as shown in FIG. 6.

As can be seen in FIG. 6, in the presence of diseased eye (FIG. 6A), a very high RMS value appears even at very low power, while in healthy eyes (B of FIG. 6), a femtosecond laser beam of 12.3 mW or more is shown. In the power case, the RMS could be observed.

It can be seen from FIG. 5 to FIG. 6 that the femtosecond laser beam of 3 mW to 15 mW is irradiated to the eye to determine whether or not the eye disease that causes the physical / chemical / biochemical change of the vitreous is retained. At power less than 3mW, the change in transmitted laser intensity is insignificant, and it is impossible to determine whether there is a disease. At power above 15mW, the difference in transmitted laser intensity between normal and diseased eyes is insignificant. it's difficult. That is, the 3mW to 15mW femtosecond laser beam is a range in which the change in the transmitted laser intensity can have the information of the vitreous, and the difference in the change in the laser intensity transmitted through the normal eye and the diseased eye.

The result of measuring the change in transmitted laser intensity can be explained qualitatively as follows.

In general, there are many reasons for eye disease, but it is known that physical characteristics including the viscosity of the vitreous body change as the disease of the retina progresses. In addition, the turbidity of the intraocular vitreous becomes very severe.

Accordingly, when a femtosecond laser beam having a peak output with a very high peak power is focused on a diseased intraocular vitreous as shown in FIGS. 5 to 6, the normal eye and the diseased eye have the same laser beam. Even in the case of power, cavitation or bubble formation will occur in a very different way. In fact, the intraocular video observed by irradiating the eye with the femtosecond laser beam shows that the bubble is very severe even at low femtosecond laser beam intensity in the diseased eye.

This phenomenon (bubble production) becomes even stronger, especially when the laser is focused close to the retina, which is very consistent with generally known facts.

In other words, the previously reported facts indicate that the physical and chemical properties of the vitreous close to the retina are very different from those of normal eyes when retinal detachment and macular degeneration occur. This is in good agreement with FIGS. 5 to 6 and the image observation results.

From the above results, the femtosecond laser light is irradiated to the eye, and the focal position, the intensity of the irradiated femtosecond laser light, and the intensity of the transmitted light can be seen that the presence or absence of eye disease can be determined.

Although the results of FIGS. 5 to 6 are scattered in the forward direction, the same applies to the optical observation in the backward direction. In other words, the presence of eye disease can be determined by measuring the change in the intensity of light scattered in the reverse direction (backward, the direction from the center of the eye to the cornea) after focusing in the intraocular vitreous body without directly irradiating an ultrafast laser to the retina. .

Meanwhile, cavitation or bubble formation, which occurs when the femtosecond laser beam is focused on the medium, is always accompanied by the generation of pressure waves in the medium.

7 is a schematic diagram showing the treatment of eye diseases using pressure waves. Absorption of the vitreous in a laser beam with a wavelength of near infrared is negligible. However, the situation occurs very differently when focusing a very high peak power femtosecond laser beam. In other words, when the femtosecond laser beam is focused at the center of the eye, laser induced ionization occurs due to instantaneous multiphoton absorption of the material at the focal point due to the laser focusing for a very short time. do. At this time, the generated electrons and ions have a very high absorbance for the following photons, so a new laser-induced absorption phenomenon may occur, resulting in a very high energy state in a very short moment.

In this state, the light converging portion and its surroundings do not have a physical equilibrium state, and a shock pressure in the form of a wave occurs similarly to the concentric circles shown in FIG. 7. The generated pressure waves propagate at a rate of 4 nm / ps, depending on the type of material. When the above value is applied to the eye, i.e., when the size of the eye is assumed to be 20 mm and the laser is focused at the center of the eye, the retina is reached about 2.5 microseconds after the laser focusing.

On the other hand, the pressure wave generated when focusing hundreds of microJ or more ultrafast lasers on solid materials is known to be several GPa.

Although the pressure wave generated by focusing the femtosecond laser beam on the intraocular vitreous as in the present invention is a pressure generated at a short instant of 100 fs, the separated retina is reattached to the choroid and the eyeball as shown in FIGS. 8 to 10. At the same time as the bleeding stopped, blood floating in the eye was discharged to the outside of the eye, and normal eye tissue was confirmed to be intact.

FIG. 8 shows a fundus photograph observed before irradiating a femtosecond laser beam having a power of 3 mW to 22 mW to a diseased eye (left column) and after 5 to 10 minutes (right column). As can be seen in FIG. 8, the black part generated by the detachment of the fundus retina is removed very effectively, and the color of the retina, which is shown in red by the blood vessels generated in the retina, changes very effectively. .

In order to observe the above results in more detail, we performed histological examination of intraocular retinal tissue after laser irradiation. FIG. 9 shows the fundus photographs and histological images of the femtosecond laser beam before irradiation (FIG. 9C), after irradiation (FIG. 9A) and normal eyeball (FIG. 9B). As can be seen in Figure 9C the space generated in the retinal tissue of the disease eye can be seen that effectively removed by laser irradiation as shown in Figure 9A, this tissue test results of Figure 9B as a control It can be seen that the results are almost identical to those of normal eyes. In particular, histological examination confirmed that the femtosecond laser beam did not cause any damage to the upper layer of the retina or other tissues inside.

This is a simple example demonstrating that the ocular disease diagnosis apparatus of the present invention is a novel therapeutic technique that effectively attaches the retina away from the choroid to the tissue of the retina without any visible damage.

8 to 9 confirmed that the blood that reddened the retinal color was also removed by the disease. The laser power of the femtosecond laser beam was increased and the femtosecond laser beam was irradiated to the eye for 3 minutes, and the back of the eye was observed in detail. As a result, as shown in FIG. 10, the blood leaked from the eyeball to the back of the eyeball under the irradiation of the femtosecond laser beam could be observed.

This resulted in the retinal layer detachment from the choroid due to the momentary pressure wave generated by focusing the femtosecond laser beam on the intraocular vitreous body, and at the same time the neovascularization, capillary or retina caused by the disease in the eye. It can be seen that blood is removed to the back of the eye by the pressure applied.

While the present invention has been particularly shown and described with reference to exemplary embodiments thereof, it is to be understood that the invention is not limited to the disclosed embodiments, but, on the contrary, Those skilled in the art will recognize that many modifications and variations are possible in light of the above teachings.

Therefore, the spirit of the present invention should not be limited to the described embodiments, and all of the equivalents or equivalents of the claims as well as the claims to be described later will belong to the scope of the present invention. .

1 is a schematic diagram of an eye disease indicator device using a laser-induced pressure wave based on an ultrafast laser,

FIG. 2 is a diagram illustrating in detail the configuration of a region in which a laser beam is irradiated to the eye in the schematic diagram of FIG. 1.

FIG. 3 is a detailed view of an apparatus for measuring ocular transmittance of a femtosecond laser beam based on the apparatus of FIG. 1;

4 is a result of fundus photography according to the disease-bearing (A) no (B) of the eyes extracted from the slaughterhouse,

5 is a result showing transmittance measured by changing the focal position of the femtosecond laser beam in the eye and the power of the femtosecond laser beam according to the disease of the eye (A) and (B),

FIG. 6 illustrates a normalized root mean square (RMS) value for a change in transmitted laser intensity according to the presence or absence of eye disease (A) based on the measurement result of FIG. 5.

7 is a schematic diagram showing the treatment of eye diseases using pressure waves,

FIG. 8 shows fundus photographs observed before irradiation of a femtosecond laser beam to a diseased eye (left column) and after 5-10 minutes of irradiation (right column).

FIG. 9 shows the fundus photographs and histological examination photographs before (C), after irradiation (A) and normal eye (B) of therapeutic laser light.

FIG. 10 shows the optical picture of increasing the laser power of the femtosecond laser beam and irradiating the femtosecond laser beam to the eye for three minutes and observing the back of the eye.

Claims (20)

In eye disease diagnosis device using laser, A laser light source for generating a femtosecond laser beam; A power control unit controlling power of the laser beam generated from the laser light source; Fixing part for fixing the position of the eye to be treated; An optical system that irradiates a laser beam generated by the laser light source to the eye fixed by the fixing unit; And A focus control unit focusing the laser beam irradiated to the eye by the optical system and adjusting a focus of the focused laser beam; Including; The focal controller controls the focal point of the focused laser beam by Equation 1 to generate a pressure wave according to laser induced ionization and laser induced absorption of the intraocular vitreous. (Equation 1) L _1ens <L _focus <L _retina (L _focus is the focal length of the focused laser beam relative to the electrode of the eye (polus anterior) fixed to the fixed part, the L _1ens is eye relative to the electrode of the eye (polus anterior) fixed to the fixed part. The distance to the interface between the lens and the vitreous body according to the construction, and the L _retina is the distance to the interface between the _retina and the vitreous body along the eye axis with respect to the electrode of the eyeball fixed to the fixed part.) The method of claim 1, The focus control unit may be configured to adjust the focus of the focused laser beam by using Equation 2 below. (Equation 2) 0.25L _o ≤ L _focus ≤ 0.75L _o (L ₀ is the distance to the posterior pole along the eye axis with respect to the pole of the eyeball fixed to the fixture, and L _focus is the pole of the eyeball fixed to the fixture. Is the focal length of the focused laser beam.) The method of claim 1, The power control unit is an eye disease diagnosis apparatus, characterized in that for adjusting the power of the laser beam in the following equation 3. (Equation 3) P _cri ≤ P _laser ≤ P _dem (P _laser is the power of the laser beam to be irradiated, P _cri is the laser beam power to generate pressure waves in the vitreous body by irradiation of the laser beam, and P _dem is the permanent damage and ablation of intraocular tissue by irradiation of the laser beam. Is the laser beam power that does not occur.) The method of claim 3, The power control unit is an eye disease diagnosis device, characterized in that for adjusting the power of the laser beam by the following equation (4). (Equation 4) 3mW ≤ P _laser ≤ 22mW The method of claim 1, Pulse width of the laser beam is 50fs to 500fs eye disease diagnostic device, characterized in that. The method of claim 1, The wavelength of the laser beam is an eye disease diagnostic apparatus, characterized in that the near infrared region. The method of claim 6, The wavelength of the laser beam is an eye disease diagnostic device, characterized in that 750nm to 850nm. The method of claim 1, The eye disease diagnosis device is An imaging light source for generating an imaging beam that is white light; And A monitoring unit configured to include an imaging device, and configured to optically monitor eye tissue using the imaging beam irradiated to the eye by the optical system; Eye disease diagnostic device further comprises. The compound according to any one of claims 1 to 8, wherein The ocular disease is a device for diagnosing ocular disease, characterized in that the retinal detachment. The compound according to any one of claims 1 to 8, wherein The eye disease is an eye disease diagnostic device, characterized in that the intraocular hemorrhage. In eye disease diagnosis device using laser, A laser light source for generating a femtosecond laser beam; A power control unit controlling power of the laser beam generated from the laser light source; Fixing part for fixing the position of the eye to be diagnosed; An optical system that irradiates a laser beam generated by the laser light source to the eye fixed by the fixing unit; A focus control unit focusing the laser beam irradiated to the eye by the optical system and adjusting a focus of the focused laser beam; A power meter for measuring the intensity of the scattered light, which is a backward scattered laser beam; A computer-readable recording medium storing normal RMS data which is a root mean square (RMS) value of scattered light intensity according to an intraocular focus position of a laser beam irradiated to an eye of a normal person without eye disease and power of the irradiated laser beam; And The RMS value calculated by calculating the root mean square (RMS) value of the scattered light intensity according to the intraocular focus position of the laser beam irradiated to the eye and the power of the laser beam by receiving the scattered light intensity measured by the power meter. A discriminating unit comparing the normal RMS data to determine the presence of eye disease; Eye disease diagnostic apparatus comprising a. delete delete The method of claim 11, The focus control unit may be configured to adjust the focus of the focused laser beam according to Equation 5 below. (Eq. 5) L _1ens <L _foc <L _retina (L _foc is the focal length of the focused laser beam relative to the eye of the eye (polus anterior) fixed to the fixed part, the L _1ens is based on the eye of the eye of the eye (polus anterior) fixed to the fixed part The distance to the interface between the lens and the vitreous body according to the construction, and the L _retina is the distance to the interface between the _retina and the vitreous body along the eye axis with respect to the electrode of the eyeball fixed to the fixed part.) 15. The method of claim 14, The focus control unit is an eye disease diagnosis device, characterized in that for adjusting the focus of the focused laser beam by the following equation (6). (Equation 6) 0.5L _o ≤ L _foc <L _retina (L _foc is the focal length of the focused laser beam relative to the electrode of the eye (polus anterior) fixed to the fixed part, and L ₀ is the eye relative to the electrode of the eye (polus anterior) fixed to the fixed part L _retina is the distance to the boundary between the retina and the vitreous along the eye axis with respect to the polus anterior fixed to the fixed part.) 15. The method of claim 14, The power control unit is eye disease diagnosis device, characterized in that for adjusting the power of the laser beam from 3mW to 15mW. The method of claim 16, Pulse width of the laser beam is 50fs to 500fs eye disease diagnostic device, characterized in that. The method of claim 17, The wavelength of the laser beam is an eye disease diagnostic device, characterized in that the near infrared region. The method of claim 18, The wavelength of the laser beam is an eye disease diagnostic device, characterized in that 750nm to 850nm. The method of claim 11, The determining unit compares the value of the normal RMS data with the calculated RMS value at the same intraocular focus position and the power of the laser beam, and determines that the eye disease is retained when the calculated RMS value is larger than the normal RMS data. Eye disease diagnosis device.

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