WO1987000036A1 - Dispositif de chirurgie au laser, en particulier pour la keratotomie de la cornee (i) - Google Patents

Dispositif de chirurgie au laser, en particulier pour la keratotomie de la cornee (i) Download PDF

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Publication number
WO1987000036A1
WO1987000036A1 PCT/DE1986/000265 DE8600265W WO8700036A1 WO 1987000036 A1 WO1987000036 A1 WO 1987000036A1 DE 8600265 W DE8600265 W DE 8600265W WO 8700036 A1 WO8700036 A1 WO 8700036A1
Authority
WO
WIPO (PCT)
Prior art keywords
slit lamp
laser
operated
gap
eye
Prior art date
Application number
PCT/DE1986/000265
Other languages
German (de)
English (en)
Inventor
Reinhardt Thyzel
Original Assignee
Thyzel Reinhardt Meditec
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Thyzel Reinhardt Meditec filed Critical Thyzel Reinhardt Meditec
Publication of WO1987000036A1 publication Critical patent/WO1987000036A1/fr

Links

Classifications

    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B23—MACHINE TOOLS; METAL-WORKING NOT OTHERWISE PROVIDED FOR
    • B23K—SOLDERING OR UNSOLDERING; WELDING; CLADDING OR PLATING BY SOLDERING OR WELDING; CUTTING BY APPLYING HEAT LOCALLY, e.g. FLAME CUTTING; WORKING BY LASER BEAM
    • B23K26/00—Working by laser beam, e.g. welding, cutting or boring
    • B23K26/02—Positioning or observing the workpiece, e.g. with respect to the point of impact; Aligning, aiming or focusing the laser beam
    • 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
    • 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
    • A61F9/00817—Beam shaping with masks
    • 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
    • A61F2009/00853—Laser thermal keratoplasty or radial keratotomy
    • 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

Definitions

  • the invention relates to a device for laser surgery and in particular for keratotomy of the cornea with a laser according to the preamble of patent claim 1.
  • a mask is used whose UV-light-permeable areas have the shape of the desired "cutting pattern" to have. This mask becomes tight arranged in front of the eye to be operated on and irradiated with UV laser light.
  • a specially made mask is required for each desired pattern. Since the individual eyes to be operated differ with regard to their shape, their curvature, etc., even with a "topologically" identical pattern, it is practically necessary to make a mask for each operation.
  • the arrangement of the mask directly in front of the eye to be operated on hinders control of the success of the treatment during the operation.
  • the invention is based on the basic idea of integrating a device for laser surgery and in particular for keratotomy of the cornea into a slit lamp device in such a way that the normal slit provided in the slit lamp can be used as an aperture for the laser beam.
  • the laser beam is either through the slit lamp housing - but without using the slit of the slit lamp to limit the beam - or through the arm that carries the slit lamp microscope.
  • the laser light is first deflected coaxially to the axis of rotation of the slit lamp or the slit lamp microscope passing through the eye to be operated on, then mirrored out of the axis of rotation into the support arm of the slit lamp or slit lamp microscope and then reversed parallel to the axis of rotation ⁇ steers, so that it goes through the slit lamp or the vertical part of the support arm of the slit lamp microscope. Only after a new reflection is the light directed into the eye to be operated on in a horizontal plane.
  • the object of the invention is therefore to specify a device for laser surgery and in particular the keratomy of the cornea with a laser and in particular with a UV laser, in which the slit of a slit lamp can be used as a diaphragm - something which has not yet been considered has been drawn - and where the number of Reflections of the UV laser beam is as low as possible.
  • the invention is based on the principle of separating the movement of the slit lamp from the movement of the slit lamp microscope, which can be pivoted in a known manner about a vertical axis which, for example, can pass through the eye to be operated in the basic position of the device.
  • the slit lamp itself cannot be pivoted about this vertical axis, but can only be displaced in the horizontal direction perpendicular to the axis of the eye to be operated. It is thus possible to introduce the laser beam directly into the beam path thereof by means of a deflection device, for example a prism, which is firmly connected to the base of the slit lamp, without the laser beam first having to be guided over the pivot axis.
  • the deflection device which reflects the laser beam initially guided in the direction of the displacement of the slit lamp into the beam path of the slit lamp, and the deflection device is required directs the laser beam emerging from the slit lamp onto the eye to be operated.
  • the chin rest for the patient's head can be displaced in the direction of the axis of the eye to be operated on, so that the distance between the slit lamp which can be displaced in the lateral direction and the to be operated on can be kept constant.
  • chin support is understood to mean any device that is suitable for fixing the patient's head.
  • the chin rest can therefore also have, for example, an additional forehead rest at any time.
  • the terms horizontally and vertically likewise relate to a device which is designed for the operation of a seated patient.
  • the terms horizontal and vertical are to be defined accordingly, ie refer to a "body coordinate system".
  • the horizontal plane is therefore understood to mean any plane which contains the straight line connecting the patient's two eyes and the axis of the eyes in the normal position.
  • the slit lamp is attached to a telescopic arm. This not only allows the slit lamp to be attached and moved comparatively easily, but also completely encapsulates the laser beam before entering the slit lamp.
  • the movement of the headrest or chinrest can be coupled in any way with the movement of the slit lamp and, if appropriate, the rotation of the mirror element, which directs the illumination and the operating light beam onto the eye to be operated on.
  • a mechanical coupling can be used for this.
  • a particularly simple design is obtained according to claim 3, however, if the slit lamp can be moved by hand or by motor in a manner known per se by the operator, while the chin rest, i.e. the fixing element for the patient's head is moved by a motor.
  • the coordination between the individual displacements and, if necessary, the rotation of the deflecting element for the illuminating and operating light beam is carried out by an electronic control which ensures that the length of the light path between the eye to be operated and the slit lamp remains constant regardless of the lateral deflection of the slit lamp .
  • the slit of the slit lamp is arranged between two collecting optical elements which form a telecentric arrangement.
  • the slit lamp image illuminated with visible and coherent light still shows the known shallow depth of field of an incoherent image.
  • a further laser for example a helium-neon laser, which operates in the visible range and serves exclusively as a target beam.
  • the mechanical slit of the slit lamp can of course be rotated mechanically in a manner known per se in order, for example, to carry out radial keratotomy cuts.
  • the gap since the gap then has to be areally illuminated with UV laser light, the gap cuts out only a small part of the available laser light.
  • the design according to the invention permits a further advantageous variant in which the gap image on the cornea is optically, for example, by means of a Dove prism, an Oxley prism or, for example, a further developed Oxley prism, as described in the simultaneously filed application "Device for laser surgery and in particular for keratotomy of the cornea (III)" are rotated.
  • This optical rotation of the slit image as claimed in claim 5 has the advantage that the beam cross section of excimer lasers, which is elongated from the outset, does not have to be expanded square, but can be left elongated and only has to be fully concentrated on the slit. This can be done by a simple telecentric beam expansion and, if necessary, by a Beam expansion with cylindrical lenses.
  • FIG. 1a shows a schematic cross section through a device according to the invention
  • FIG. 1b shows a schematic longitudinal section through a device according to the invention
  • FIG. 2 shows a cross section through a further embodiment of the invention.
  • FIG. 1a and 1b show a cross section and a longitudinal section through a device according to the invention.
  • the device shown only schematically, has an excimer laser 1, a slit lamp 2, a slit lamp microscope 3 and a chin rest 4 for the patient's head.
  • the slit lamp 2 is held on a telescopic arm 5 in the direction of an arrow labeled x.
  • the chin rest 4 can be moved by a motor in the direction of an arrow labeled y.
  • the slit lamp microscope 3 can be pivoted in a manner known per se about a vertical axis 6 which, in the basic position of the chin rest 4, passes through the eye to be operated on.
  • the beam 7 of the excimer laser 1 is widened and expanded by a widening optics 8, which is only shown schematically passed through the telescopic arm 5, on which the slit lamp 2 is guided and attached.
  • a prism 9 deflects the beam 7 by 90 °, so that the laser beam 7 runs in the beam path of the slit lamp 2.
  • the optics and the gap of the slit lamp 2 is only shown schematically and is designated by the reference numeral 10.
  • the laser beam 7, which is limited by the gap of the slit lamp 2, is then directed by the prism 11 onto the eye to be operated on.
  • Fig. 2 shows a cross section through a slit lamp 2 designed according to the invention, which is held on the telescopic arm 5 in the direction of arrow x slidably.
  • the laser beam 7 of the laser 1 (not shown in FIG. 2) strikes a mirror 9 and is deflected by it by 90 °, i.e. deflected in the direction of arrow z. Then the laser beam 7 passes through a lens 13 with a positive effect, the slit 14 of the slit lamp 2 and a further lens 15 with a positive effect.
  • a rotating prism 12 for example a Dove-r prism or an Oxle prism, is arranged after the lens 15. The prism 12 is able to rotate the image of the gap 14 on the cornea to be operated, so that radial and "tangential" cuts as well as all cuts lying between these two layers can be carried out.
  • the prism 11 has the task of directing the beam of the slit lamp 2 onto the eye to be operated on.
  • a lighting device 16 known per se is provided in the slit lamp 2, which illuminates the slit 14 with a visible one Illuminated light.
  • the lighting device which is constructed in a known manner and has a lamp, a condenser, etc., is generally referred to by reference numeral 16.
  • the mirror 9 is a quartz glass plate provided with a coating, which is partially transparent, so that both the laser beam 7 and the light from the lighting device 16 are introduced into the beam path of the slit lamp.
  • the lenses 13, 15 are UV achroates, which can consist, for example, of CaF 2 and Si0 2 and which form a telecentric arrangement, ie the “distance” between the two lenses 13 and 15 is equal to the sum of their focal lengths.
  • the focal length of the lens 13 is approximately 200 mm
  • the focal length of the lens 14 is between 50 and 100 mm, preferably approximately 60 mm.
  • the focal length values of the lenses 13 and 14 forming a tele-centric arrangement depend on the respective conditions; the only decisive factor is that the two lenses or lens groups form a telecentric arrangement.
  • the exemplary embodiment shown in FIG. 2 has a number of advantages:
  • an optical rotating device 12 By using an optical rotating device 12, it is possible to change the gap only in its length and width without rotating it in the splitting plane.
  • the slit image on the cornea is rotated exclusively by means of the optical rotating device (12).
  • the gap can thus be illuminated in such a way that virtually all of the UV laser light can be used for surgical purposes.
  • the UV slit image i.e. the image of the gap on the cornea, which is caused by UV laser light, has a much greater depth of field than the visible gap image.
  • the depth of field of the UV slit image is several millimeters, so that a high contour sharpness of the slit image is maintained despite the inclination of the cornea.
  • the high depth of field is a consequence of illuminating the gap with coherent laser light.
  • the illumination with incoherent visible light by means of the illumination device 16 results in the normal slit image with a shallow depth of field and, accordingly, a lower contour sharpness on the cornea.
  • all the mirror elements used can be quartz glass prisms, which have the advantage of a higher degree of reflection than mirror layers. It is also possible, in order to achieve a high contour sharpness of the slit image even in the visible region, to additionally use a target beam laser, for example a helium-neon laser.
  • the device that a motorized adjustment of the chin rest and possibly a rotation of the prism 11 according to the lateral deflection of the slit lamp 2, i.e. the displacement of the slit lamp 2 in the direction of arrow x can be an electronic control or a mechanical coupling. However, electronic control is preferred, since electronic control makes it easy to adjust the chin rest by motor.
  • another laser for example an HF laser with a wavelength in the infrared range, can also be used.

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  • Health & Medical Sciences (AREA)
  • Optics & Photonics (AREA)
  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • Ophthalmology & Optometry (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgery (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Plasma & Fusion (AREA)
  • Mechanical Engineering (AREA)
  • Laser Surgery Devices (AREA)
  • Eye Examination Apparatus (AREA)

Abstract

Dans un dispositif de chirurgie au laser, utilisé en particulier pour effectuer la kératotomie de la cornée, la fente (14) d'une lampe à fente sert d'obturateur pour le faisceau chirurgical de lumière. Afin de réduire autant que possible le nombre de surfaces réfléchissantes (9, 10) servant à réfléchir le faisceau chirurgical de lumière dans la lampe à fente, la lampe à fente n'est pas pivotable autour d'un axe, mais simplement coulissable en ligne droite. Le faisceau du laser excimer (1) est dirigé dans le sens de déplacement linéaire de la lampe à fente par un élément réfléchissant fixé à la base de la lampe à fente, est introduit dans celle-ci et appliqué par le système de guidage du faisceau de la lampe à fente sur le tissu à opérer. Afin de maintenir constante la distance entre la lampe à fente et le tissu à opérer, l'appuie-tête (4) du patient est réglable. Grâce à cet agencement, et à l'entraînement vertical normal de la lampe à fente, on peut déplacer avec une plus grande liberté l'image de la fente sur le tissu à opérer.
PCT/DE1986/000265 1985-06-29 1986-06-30 Dispositif de chirurgie au laser, en particulier pour la keratotomie de la cornee (i) WO1987000036A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE19853523342 DE3523342A1 (de) 1985-06-29 1985-06-29 Vorrichtung zur laserchirurgie und insbesondere zur keratomie der cornea (i)
DEP3523342.7 1985-06-29

Publications (1)

Publication Number Publication Date
WO1987000036A1 true WO1987000036A1 (fr) 1987-01-15

Family

ID=6274559

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/DE1986/000265 WO1987000036A1 (fr) 1985-06-29 1986-06-30 Dispositif de chirurgie au laser, en particulier pour la keratotomie de la cornee (i)

Country Status (4)

Country Link
EP (1) EP0229789A1 (fr)
JP (1) JPS63500495A (fr)
DE (1) DE3523342A1 (fr)
WO (1) WO1987000036A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5290571A (en) * 1988-04-29 1994-03-01 Immunotec Research Corporation, Ltd. Biologically active whey protein concentrate

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE10056897C1 (de) * 2000-11-14 2002-09-26 Georg Hillrichs UV-Laserskalpell und Verwendung dieses Skalpells zum Abtrag von festen Werkstückoberflächen
US8419713B1 (en) 2012-08-01 2013-04-16 The University Of Utah Research Foundation Carrier assembly with caps for medical connectors
US8328767B2 (en) 2007-01-16 2012-12-11 Catheter Connections, Inc. Disinfecting caps for medical male luer connectors
US11628288B1 (en) 2014-07-14 2023-04-18 Merit Medical Systems, Inc. Disinfecting cap for needleless injection sites
EP3573699B1 (fr) 2017-01-27 2022-08-10 Merit Medical Systems, Inc. Capuchon luer désinfectant et méthode d'utilisation

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB1076560A (en) * 1964-10-16 1967-07-19 American Optical Corp Improvements in or relating to photocoagulation apparatus
US3569993A (en) * 1967-06-26 1971-03-09 Euratom Apparatus for irradiating a specimen with a laser beam
WO1984001110A1 (fr) * 1982-09-13 1984-03-29 American Hospital Supply Corp Instrument de chirurgie ophtalmique au laser
DE3414986A1 (de) * 1983-04-21 1984-10-25 Cilco Inc., Huntington, W.Va. Lasersystem fuer chirurgische zwecke

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3720213A (en) * 1971-02-05 1973-03-13 Coherent Radiation Laser photocoagulator
FI762582A (fi) * 1976-09-08 1978-03-09 Lasertek Oy Korneamikroskop
FR2524298A1 (fr) * 1982-04-01 1983-10-07 Essilor Int Appareil de chirurgie ophtalmologique a laser
DE3331586A1 (de) * 1983-09-01 1985-03-28 Fa. Carl Zeiss, 7920 Heidenheim Ophthalmologisches kombinationsgeraet fuer diagnose und therapie

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB1076560A (en) * 1964-10-16 1967-07-19 American Optical Corp Improvements in or relating to photocoagulation apparatus
US3569993A (en) * 1967-06-26 1971-03-09 Euratom Apparatus for irradiating a specimen with a laser beam
WO1984001110A1 (fr) * 1982-09-13 1984-03-29 American Hospital Supply Corp Instrument de chirurgie ophtalmique au laser
DE3414986A1 (de) * 1983-04-21 1984-10-25 Cilco Inc., Huntington, W.Va. Lasersystem fuer chirurgische zwecke

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5290571A (en) * 1988-04-29 1994-03-01 Immunotec Research Corporation, Ltd. Biologically active whey protein concentrate

Also Published As

Publication number Publication date
JPS63500495A (ja) 1988-02-25
EP0229789A1 (fr) 1987-07-29
DE3523342A1 (de) 1987-01-02

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