US20010041885A1 - Excimer laser eye surgery system - Google Patents

Excimer laser eye surgery system Download PDF

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Publication number
US20010041885A1
US20010041885A1 US09/777,626 US77762601A US2001041885A1 US 20010041885 A1 US20010041885 A1 US 20010041885A1 US 77762601 A US77762601 A US 77762601A US 2001041885 A1 US2001041885 A1 US 2001041885A1
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Prior art keywords
laser
patient
bed
patient bed
laser head
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Abandoned
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US09/777,626
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English (en)
Inventor
Kristian Hohla
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Technolas GmbH
Original Assignee
Technolas GmbH
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Publication date
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Priority to US09/777,626 priority Critical patent/US20010041885A1/en
Publication of US20010041885A1 publication Critical patent/US20010041885A1/en
Priority to US10/424,337 priority patent/US7022119B2/en
Assigned to TECHNOLAS GMBH OPHTHALMOLOGISCHE SYSTEME reassignment TECHNOLAS GMBH OPHTHALMOLOGISCHE SYSTEME CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: CHIRON TECHNOLAS GMBH OPHTHALMOLOGISCHE SYSTEME
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00804—Refractive treatments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00694—Aspects not otherwise provided for with means correcting for movement of or for synchronisation with the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00844—Feedback systems
    • A61F2009/00846—Eyetracking
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/02—Adjustable operating tables; Controls therefor
    • A61G13/04—Adjustable operating tables; Controls therefor tiltable around transverse or longitudinal axis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/02—Adjustable operating tables; Controls therefor
    • A61G13/06—Adjustable operating tables; Controls therefor raising or lowering of the whole table surface
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205—Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/121—Head or neck

Definitions

  • the invention relates to laser systems for eye surgery, and more particularly to a compact excimer laser eye surgery system particularly suited for laser in situ keratomileusis.
  • the excimer laser especially an argon fluoride excimer laser operating at a 193 nanometers, removes tissue through a non-thermal process of “ablation” in which the molecular bonds of tissue are literally broken. This allows precise amounts of tissue to be removed without heating the surrounding tissue-heating that can bum that tissue leading to scarring.
  • This ablative process using the excimer laser has been employed in a number of ways to literally reprofile the surface of the eye. These techniques are described, for example, in Assignee's U.S. patent application Ser. Nos. 08/338,495, filed Nov. 16, 1994, and 08/324,782, filed Oct. 18, 1994, which are hereby incorporated by reference.
  • an excimer laser system is constructed in a highly compact form, in which a patient bed forms an enclosure in which is placed the gas bottle for the excimer laser system, typically holding argon fluoride gas, along with electronics for powering and controlling the excimer laser system. Further, the patient bed enclosure can preferably be rolled away to allow easy access to these components for maintenance and service.
  • the laser head is placed immediately adjacent to the bed, but below the height of the bed.
  • the bed includes a bearing, allowing the bed to rotate over the laser head and away from an excimer laser optical extension through which the laser beam is fired into the patient's eye. This allows the patient to sit up without striking his or her head. Further, the bed can be rotated 90°, allowing non-laser ophthalmic surgery to be performed using the same equipment in the same clean room.
  • an automated lamellar keratoplasty (ALK) system is integrated into the laser system, providing both computer and monitoring and connections for a microkeratome.
  • Two foot switches are provided, one for advancing and retracting the microkeratome, and the other for activating the vacuum to the microkeratome.
  • This integrated system allows an easily used and controlled system for performing laser in situ keratomileusis (LASIK).
  • FIG. 1 is a perspective view of the laser system according to the invention.
  • FIGS. 2 A-C are top, side, and front views of the laser system according to the invention.
  • FIGS. 3 A-D are top, front, back, and side views of the patient bed enclosure and rotatable patient bed according to the invention.
  • FIGS. 4 A-C are top, front, and side views of the equipment enclosed by the patient bed enclosure of FIGS. 3 A-D;
  • FIG. 5 is a front view of the internal components of the system of FIG. 1, further illustrating the incorporated automated lamellar keratoplasty (ALK) system for performing LASIK.
  • ALK automated lamellar keratoplasty
  • FIG. 1 shown is the laser system L according to the invention.
  • This laser system is preferably based on a 193 nm argon-fluoride excimer laser, but other lasers could be used.
  • a patient bed enclosure 100 includes a patient bed 102 disposed on top of it.
  • a physician workstation platform 104 is situated diagonally away from the patient bed 102 , and includes a keyboard 106 and control inputs 108 .
  • the keyboard 106 and control inputs 108 provide input to a computer system that in part controls the laser system L. That computer system provides data for a display 110 .
  • the control inputs 108 , the keyboard 106 , and the display 110 serve to control the laser system L, and to fire an excimer laser beam through an optics path that extends perpendicularly through the physician workstation enclosure 112 , and then horizontally through an optical extension 114 .
  • the source of the laser beam is an excimer laser head found in a laser head enclosure 118 .
  • the optical extension 114 directs the excimer laser to the patient's eye as the patient lies on the patient bed 102 , and also provides optics 116 for the physician to view the surgery before and while it takes place.
  • the optical extension 114 also includes an eye tracking system which partially uses the optical path extending through the physician workstation enclosure 112 .
  • the eye tracking system preferably employs a high speed video camera and dedicated electronics, and works in conjunction with the computer system to maintain the laser optics aligned with a desired point on the patient's eye.
  • the patient bed enclosure 100 also includes a foot rest 117 for the physician to use during surgery.
  • This foot rest 117 further includes two foot switches 119 and 121 , which control the vacuum and power to a microkeratome in an automated lamellar keratoplasty (ALK) system used in a LASIK procedure. This is further discussed below in conjunction with FIG. 5.
  • ALK automated lamellar keratoplasty
  • the eye tracking system also employs TransputerTM boards manufactured by INMOS Limited used in conjunction with a Transputer Frame GrabberTM manufactured by Parsytech, GmbH, installed in the computer system.
  • FIGS. 2 A-C shown are views of the system of FIG. 1.
  • a top view in FIG. 2A illustrates how the optical extension 114 extends substantially over a head portion 124 of the patient bed 102 .
  • the physician then uses the optics 116 to observe the surgery as it takes place.
  • the laser head housing 118 adjacent to the patient bed 102 is the laser head housing 118 .
  • This laser head in the laser head housing 118 fires the laser beam, preferably a 193 nanometer excimer laser. This beam is fired parallel to the floor and then is reflected vertically up through the physician workstation enclosure 112 , and then out through the optical extension 114 . The laser beam is then reflected down into the patient's eye at a center point 120 .
  • FIG. 2B another view of the workstation is shown. From this view, a final beam path 122 is shown firing down from the optical extension 114 towards a head portion 124 of the bed 102 . It is also seen that if a patient were to sit up, the patient could strike his or her head on the optical extension 114 . In FIG. 2B, it is seen that the laser head 118 does not extend above the patient bed 102 . This feature will be appreciated in conjunction with FIG. 3A discussed below.
  • FIG. 2C shown is an end view, again showing the beam path 122 at which the excimer laser will fire onto the head portion 124 of the bed 102 . Also, it is seen that the height of the workstation platform 104 is set so that the physician is provided easy access to both the keyboard 106 and to the patient's head, which is resting in the head portion 124 of the patient bed 102 .
  • FIG. 2C also shows a patient bed adjustment platform 125 , which is part of the patient bed enclosure 125 . This adjustment platform 125 provides motorized control of the patient bed 102 in the x, y, and z axes through the controls 108 .
  • FIG. 3A shown is the patient bed 102 in its rotated position.
  • the patient bed 102 rotates on a bearing 126 , which firmly connects the patient bed 102 to the patient bed enclosure 100 .
  • the patient bed 102 position is adjusted by motors and pulleys 140 , which provide x, y, and z axes control of the adjustment platform 125 .
  • the patient bed 102 rotates over the laser head 118 .
  • the patient bed rotates sufficient so that the head portion 124 of the patient bed 102 has rotated out from under the optical extension 114 . The patient can then sit up without striking his or her head on the optical extension 114 .
  • the patient bed 102 can preferably rotate up to 90°, so that a single clean room could be used for performing both laser and non-laser ophthalmic surgery.
  • the doctor would operate on the patient's head located within a head portion 124 of the patient bed 102 , but rotated 90° away from the physician workstation platform 104 .
  • an electric solenoid 127 electrically latches into a latching hole 128 on the patient bed 102 , holding the patient bed 102 in place during surgery.
  • the patient bed 102 can rotate over it.
  • FIGS. 3B, 3C, and 3 D Three more views of the patient bed 102 and the patient bed enclosure 100 are shown in FIGS. 3B, 3C, and 3 D.
  • FIG. 3B is an end view from the perspective of the head portion 124 end of the patient bed 102 , and shows that the patient bed 102 is mounted on rollers 129 and locked into place with stops 1130 .
  • the patient bed enclosure 100 forms a cover that encloses a gas bottle holding argon fluoride gas needed by the laser head, cooling components, and electronics needed by the entire system. This is further discussed below in conjunction with FIGS. 4 A-C.
  • the patient bed enclosure 100 is rolled over those components in a direction 131 and then locked into place with the stops 130 before the system is operated.
  • FIG. 3C illustrates a left (from a patient's perspective) side view of the patient bed enclosure 100 and the patient bed 102 .
  • FIG. 3D illustrates a bottom end view (from the patient's perspective) of the patient bed 102 and the patient bed enclosure 100 .
  • an additional recess 132 is formed to accommodate the laser head discussed below in conjunction with FIGS. 4 A-C.
  • FIGS. 3 A-D it will be appreciated that there is an open space formed underneath the patient bed enclosure 100 .
  • This open space is used to enclose the material necessary for the laser system L to operate.
  • the patient bed enclosure 100 as the cover for these components, the patient bed 102 and the patient bed enclosure 100 can be easily rolled away from these components to allow easy access and service.
  • using this enclosed space is an advantage in surgical systems because clean room operating space is a scarce resource. Therefore, a smaller and more compact system provides advantages because it reduces then size of the clean room necessary.
  • FIGS. 4 A-C shown are block diagrams illustrating the arrangement of the components underneath the patient bed enclosure 100 .
  • a gas bottle 200 shown is a gas bottle 200 , electronics 202 for both providing power and for providing the computer system for the laser system L, and an internal laser head 204 .
  • AC power components are provided in the open space 203 left of the electronics 202 .
  • the electronics 202 include the computer system, the bed power supplies, and other system electronics, such as transformers and interface circuits.
  • the internal laser head 204 is enclosed by the laser head enclosure 118 , and forms a laser beam, preferably a 193 nanometer excimer laser beam that fired a left to right in reference to the diagram of FIG. 4A
  • the laser head 204 preferably includes an integral 30K volt power supply. Further included are various cooling components 206 .
  • the gas bottle 200 is mounted on rollers 208 for easy replacement of the gas bottle 200 after the patient bed enclosure 100 is rolled out of the way.
  • the electronics 202 include a portion that surrounds the gas bottle 200 , thereby more efficiently using the space.
  • the laser head 204 is shown, with beam egress points 210 and 212 for providing the excimer laser beam which is then reflected transversely through the optical extension 114 , which forms the final beam directing portion. That final beam directing portion then redirects the laser beams into the patient's eye.
  • the final beam direction portion includes optics necessary to adjust the position that the excimer laser beam strikes the patient's eye.
  • an aiming laser is preferably provided in the optical extension 114 colinearly aligned with the excimer laser. This preferably includes two aiming mirrors, one for each axis.
  • FIG. 4C a side view from the perspective as FIG. 3C is illustrated of the internal components. Again, it is seen how the electronics 202 wrap around the gas bottle 200 .
  • an ALK, or automated lamellar keratoplasty system 300 is integrated into the laser system L.
  • Automated lamellar keratoplasty is a system used to assist in a LASIK procedure, or a laser in situ keratornileusis procedure. This procedure requires a microkeratome, which preferably includes a vacuum port for providing suction for attachment to the eye and a power port for providing a high speed oscillating movement of the blade.
  • the two foot switches 117 and 119 are provided for the ALK system 300 . These switches turn the vacuum on and off power the microkeratome.
  • the vacuum and power for the ALK are provided integrally through the laser system L through two ports 306 and 308 .
  • a nurse will be stationed adjacent to the doctor and attach the microkeratome when it is needed.
  • the ports 306 and 308 can of course be located elsewhere on the laser system L, but their integral nature assists in the operation.
  • the ALK system is coupled to the electronics 202 for monitoring. For example, if the vacuum fails, one would immediately wish to cease blade movement, because high speed blade movement is necessary to prevent binding with the lamellar flap as it is taken.
  • the ALK system can be further integrated and controlled through computer access via the computer system in the electronics 202 .
  • the computer system is preferably integrated to the electronics 202 and provides control for various systems, including the display 110 , the control inputs 108 , and the keyboard 106 .
  • the computer system preferably controls the eye tracking system, the aiming system, the laser head 204 and the firing of the laser head 204 .
  • the computer system preferably includes a remote disk drive slot 312 , for example for the insertion of a preprogrammed shot pattern, such as that described in assignee's co-pending U.S. patent application Ser. No. ______entitled “Distributed Laser Surgery System” and filed concurrently herewith.
  • the computer system can be further integrated with the automated lamellar keratoplasty system 300 .
  • the automated lamellar keratoplasty system 300 typically provides a vacuum pressure output signal, microkeratome voltage and current output signals, as well as control inputs.
  • the computer system can both display the microkeratome voltage and current and vacuum pressure, and generate warning messages or disable both the power source within the automated lamellar keratoplasty system and the vacuum source within the automated lamellar keratoplasty system should there be a failure.
  • the computer system can be disposed between the automated lamellar keratoplasty system 300 and the foot switches 119 and 121 , so that the computer system itself controls the automated lamellar keratoplasty system 300 responsive to the foot switches 119 and 121 .
  • the user in such a situation could set the power level of the power source in the automated lamellar keratoplasty system 300 and the vacuum pressure of the vacuum source within the automated lamellar keratoplasty system 300 using feedback on the display 110 on a routine executing in the computer system of the electronics 202 .
  • the system provides a compact excimer laser surgery system with a rotatable bed for patient convenience and for non-excimer laser operation. Further, an integrated ALK system provides for the convenient performance of laser in situ keratomileusis.

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  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Optics & Photonics (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Laser Surgery Devices (AREA)
  • Radiation-Therapy Devices (AREA)
US09/777,626 1996-05-30 2001-02-06 Excimer laser eye surgery system Abandoned US20010041885A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
US09/777,626 US20010041885A1 (en) 1996-05-30 2001-02-06 Excimer laser eye surgery system
US10/424,337 US7022119B2 (en) 1996-05-30 2003-04-25 Excimer laser eye surgery system

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US65685696A 1996-05-30 1996-05-30
US28873299A 1999-04-09 1999-04-09
US09/777,626 US20010041885A1 (en) 1996-05-30 2001-02-06 Excimer laser eye surgery system

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US28873299A Division 1996-05-30 1999-04-09

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US10/424,337 Continuation US7022119B2 (en) 1996-05-30 2003-04-25 Excimer laser eye surgery system

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US20010041885A1 true US20010041885A1 (en) 2001-11-15

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US09/777,626 Abandoned US20010041885A1 (en) 1996-05-30 2001-02-06 Excimer laser eye surgery system
US10/424,337 Expired - Fee Related US7022119B2 (en) 1996-05-30 2003-04-25 Excimer laser eye surgery system

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US (2) US20010041885A1 (xx)
EP (1) EP0906073B1 (xx)
JP (1) JP2000511794A (xx)
CN (1) CN1198546C (xx)
AT (1) ATE259628T1 (xx)
AU (1) AU727933B2 (xx)
BR (1) BR9709472A (xx)
CA (1) CA2254714C (xx)
DE (1) DE69727675T2 (xx)
ES (1) ES2215229T3 (xx)
HK (1) HK1020856A1 (xx)
WO (1) WO1997046184A2 (xx)

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US9380976B2 (en) 2013-03-11 2016-07-05 Sync-Think, Inc. Optical neuroinformatics
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CN101626682B (zh) 2006-10-27 2014-04-16 爱德华兹生命科学公司 用于外科植入的生物组织
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US7022119B2 (en) 2006-04-04
EP0906073B1 (en) 2004-02-18
JP2000511794A (ja) 2000-09-12
DE69727675T2 (de) 2004-12-02
CA2254714C (en) 2008-04-22
ATE259628T1 (de) 2004-03-15
WO1997046184A2 (en) 1997-12-11
DE69727675D1 (de) 2004-03-25
CA2254714A1 (en) 1997-12-11
ES2215229T3 (es) 2004-10-01
AU3168097A (en) 1998-01-05
US20030225400A1 (en) 2003-12-04
CN1198546C (zh) 2005-04-27
AU727933B2 (en) 2001-01-04
BR9709472A (pt) 2000-01-11
EP0906073A2 (en) 1999-04-07

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