WO1989007921A1 - Procede et appareil commandant la profondeur d'incision d'un inciseur a laser - Google Patents

Procede et appareil commandant la profondeur d'incision d'un inciseur a laser Download PDF

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Publication number
WO1989007921A1
WO1989007921A1 PCT/US1989/000542 US8900542W WO8907921A1 WO 1989007921 A1 WO1989007921 A1 WO 1989007921A1 US 8900542 W US8900542 W US 8900542W WO 8907921 A1 WO8907921 A1 WO 8907921A1
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WO
WIPO (PCT)
Prior art keywords
laser
cut
depth
firing
optical
Prior art date
Application number
PCT/US1989/000542
Other languages
English (en)
Inventor
John Taboada
Robert H. Poirier
Original Assignee
Refractive Laser Research & Development Program, L
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 Refractive Laser Research & Development Program, L filed Critical Refractive Laser Research & Development Program, L
Publication of WO1989007921A1 publication Critical patent/WO1989007921A1/fr

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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
    • B23K26/03—Observing, e.g. monitoring, the workpiece
    • B23K26/032—Observing, e.g. monitoring, the workpiece using optical means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves 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
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • 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 present invention relates to a method and apparatus for making cuts by a laser in, particularly, human tissue such as a cornea.
  • Patent 4,641,912 discloses an excimer laser system used for angioplasty, and includes a pair of optical fibers, one for obtaining an image of the atherosclerotic plaque to be ablated by the laser energy, a second optical fiber being provided for lasing the plaque. A video camera and monitor are utilized to display an image of the plaque.
  • Karlin et al U.S. Patent 4,583,539 discloses a system for performing surgery on the eye using a C0 2 laser source and an articulated arm structure, the laser energy being delivered through a probe which is connected to the articulated arm structure and which is insertable into an eye.
  • Kimura U.S. Patent 4,266,549 discloses a laser scalpel including a probe through which light may be directed to illuminate the optical site: where a tumor is to be subjected to lasing, a picture or graphic representation may be obtained.
  • An adaptor is provided at the tip of the probe to engage the tissue at or adjacent the tumor, to establish the distance of the focussing lens of the probe to the tumor to be lased.
  • Remy et al U.S. Patent 4,289,378 discloses an apparatus for adjusting the focal point of a working laser beam onto a microscopic target region of a transparent biological object. Use is made of an auxiliary laser beam having a wavelength within the visible range, and through joint focussing of the laser beams, the location of focussing of the working beam at a particular locus at a desired depth within the transparent biological specimen is achieved.
  • a laser knife method and apparatus are provided in which an ablative laser source is provided with a fire pulse controller.
  • a probe receives and directs a laser beam to transparent tissue, such as a cornea, to make a cut which extends only a part way through the cornea.
  • the probe has apparatus to generate an optical transverse representation of the cornea and the cut in it, including a light source for delivering light to the tissue, a reflector for the image, and a lens for delivering the optical representation of the tissue and cut to an optical fiber bundle.
  • the optical representation has a relatively high degree of illumination in that part of the image corresponding to the uncut portion of the cornea, while the cut portion of the cornea has a relatively lower level, or no, illumination.
  • the optical image representation is delivered to an electronic scanner which emits pulses having voltages proportional to the intensity of the light at incremental locations along the optical image.
  • the emitted pulses are delivered to an amplitude threshold detector which emits pulses when the received pulses are at a suitably high voltage. indicative of the uncut portion of the cornea.
  • a clock drives the scanner and a down counting manually settable counter, and signals from the clock are delivered sequentially to a first gate and a second gate.
  • the first gate receives an end-of-count signal from the counter, so as to enable the gate to pass the clock pulses when the depth of cut has not exceeded the set depth.
  • the signals from the amplitude threshold detector are delivered to the second gate, so as to enable the second gate to pass the clock signals to the laser fire pulse controller only when the laser beam, upon firing, will strike an uncut portion of the tissue.
  • pulses pass to the laser fire pulse controller through a manually operable switch.
  • An object of the present invention is to provide an ablative laser knife apparatus and method for controlling the depth of cut of transparent tissue.
  • Another object of the invention is to provide an apparatus and method for cutting into transparent tissue without exceeding a predetermined depth of cut.
  • Still another object of the present invention is the provision of an apparatus and method for controlling the depth to which a cut in transparent tissue may be made, and for adjusting the maximum depth of cut.
  • Yet another object is the provision of a laser knife method and apparatus and control circuitry for preventing the firing of the laser unless the laser beam will strike only tissue which was not previously cut.
  • FIG. 1 is a schematic view of a laser knife depth of cut apparatus in accordance with the present invention.
  • Fig. 2 is an elevational view, partly in section, of a portion of a probe forming a part of the apparatus of Fig. 1.
  • Fig. 3 is a view taken on the line 3-3 of Fig. 2.
  • Fig. 4 is a schematic view of an optical scanner and related elements forming a part of the apparatus of Fig. 1.
  • Fig. 5 is a chart illustrating an optical image obtained of an uncut cornea by the probe of Fig. 2 and a corresponding voltage output.
  • Fig. 6 is a view similar to Fig. 5, and showing an optical image of a cut cornea.
  • Fig. 7 is a diagram of a circuit forming a part of the apparatus of Fig. 1, and related elements.
  • FIG. 1 an apparatus generally designated 10 for cutting transparent material, such as tissue, and more particularly cornea, by a laser, and for limiting the depth of cut, ensuring that the laser. is operative only to strike tissue when fired.
  • an ablative laser 12 such as an excimer type, controlled by a laser fire pulse controller 13.
  • the beam of laser 12 is delivered to an articulated arm system 14, comprising jointed, hollow arms and reflectors or refractors.
  • a probe 15 receives the laser beam from the articulated arm system 14 and directs it to the transparent tissue to be cut.
  • the probe 15 includes an annular optical element 16 which forms a part of the probe 15, and receives light from light source 17 through an optical fiber 18.
  • An optical image is acquired by a fiberoptic bundle 19 and is delivered to a signal converting and emitting apparatus 20.
  • Emitted signals are carried by a conductor 21, when manually operated switch 22 is closed, to the laser fire pulse controller 13 to fire the laser 12.
  • Fig. 2 there is shown the probe 15 in cross- section, probe 15 comprising a thin hollow tube 25 having at or near the upper end a focussing lens 26 sealed to it by a wall 27.
  • Lens 26 receives and focuses the laser beam 28 from the laser 12.
  • a conduit 29 is fluid connected to the tube 25, to introduce a body of liquid, such as normal saline solution, into the tube 25, through which the laser beam 28 passes.
  • tube 25 At its lower end, tube 25 has attached to it the annular transparent optical element 16 which comprises an annular flange 31 that receives the end of tube 25 and is securely attached to it.
  • the annular configuration of transparent optical element 16 provides a passage 32 which forms an extension of the fluid passage provided by the interior diameter of tube 25.
  • the annular optical element 16 also comprises an upwardly facing horizontal surface 33 and an inclined reflecting surface 34. As shown in Fig. 3, the bottom surface 36 of optical element 16 is provided with a plurality of radial grooves 37 to permit the efflux of normal saline solution which has passed downwardly through the tube 25 from conduit 29, thus washing out debris.
  • the bottom contact surface 36 and the cylindrical and conical surfaces of optical element 16 are polished optically clear.
  • the single fiber light conductor 18 is shown and the fiberoptic bundle 19, each extending, for convenience, at least partly along the length of the tube 25.
  • the bottom surface 36 of the optical element 16 is in engagement with the upper surface of a cornea C, which is a transparent organic tissue.
  • the laser beam 28 passes through the body of liquid which extends to the treatment site, i.e., the cornea C, and is focussed at a point P, and thereby has made a cut into the cornea C to the depth indicated by point P.
  • Light passing through the single optical fiber 18 will strike the upper surface 33 of optical element 16 and pass into it, the light being emitted from the bottom surface 36 and illuminating the cornea C.
  • Light will pass through cornea C where it has not been cut, that is, below the point P. Above the point P, where there has been a cut, the light will not pass, or will pass to a greatly diminished extent.
  • Coupling lens 39 may be a narrow graded index rod lens such as a Selfoc lens produced by N.G.S. America, Inc.
  • Fig. 4 is a diagrammatic illustration of a part of the signal converting and emitting apparatus 20. There is shown in Fig. 4 the end of the fiberoptic bundle 19 which projects the image formed by the ray 38 through a projection lens 41 and to a half-reflecting mirror 42, or the equivalent, where the image being projected onto a photodiode array scanner 45.
  • the image of the cornea may also be acquired by a video camera 43, and pass to a display monitor (not shown) for viewing.
  • the photodiode array scanner 45 may be a solid state line scanner, such as the EG&G Reticon G-Series solid state line scanner, which includes photodiode elements which emit signals proportional to the intensity of the light striking them, and which are serially scanned by a photodiode array scan controller 46, the latter including a start gate 47 for receiving a start signal, a clock gate 48 for receiving a clock signal, an output gate 49 for emitting an output or video signal, and a gate 51 for emitting an end of scan signal.
  • a photodiode array scan controller 46 the latter including a start gate 47 for receiving a start signal, a clock gate 48 for receiving a clock signal, an output gate 49 for emitting an output or video signal, and a gate 51 for emitting an end of scan signal.
  • the image of the cornea C is shown by line 52, which represents the inner edge or surface of the cornea, and by the line 53, which represents the outer edge or surface of the cornea C.
  • the line 54 is the demarcation line between the cut and uncut portions of the cornea C, so that the distance between the lines 53 and 54 represents the depth of cut, shown in Fig. 4 as being approximately three-fourths through the thickness of the cornea C, that is, three-fourths of the way between the outer edge or surface represented by line 53 and the inner edge or surface represented by line 54.
  • Fig. 5 is a representation of an image obtained by the probe and related apparatus of Fig.
  • the output of the photodiode array 45 is indicated along the ordinate, and light intensity along the abscissa. Within the curved line, therefore, it will be seen that for a substantial depth, there is a relatively high light intensity.
  • the ordinate will represent time, proportional to distance, due to the action of a clock, and the abscissa will represent voltage, due to the nature of the output of the photodiodes of the photodiode array 45, as above explained.
  • Fig. 6 illustrates the same relationships, after the cornea C has been cut partially through its depth or thickness; the dash lines represent the original corneal outer edge or surface, and the solid lines represent the corneal depth after the cornea has been partially cut through by the laser knife, as indicated by the solid line.
  • the upper generally horizontal part of the solid line represents the upper edge of the cornea with a cut therein, and, simultaneously, the bottom edge of the cut in the cornea.
  • a clock 60 emits pulses to a photodiode array controller 46, to manually settable, down-counting counter 61, to gate A and to gate C.
  • Preset counter 61 includes a manual set apparatus 61a.
  • Photodiode array controller 46 emits a video signal V as the photodiode array 45 is caused to scan the image of the cornea C.
  • Signal V as above indicated, comprises a series of high voltage pulses in response to illumination through the uncut portion of the cornea, and lower voltage pulses in response to illumination received from the cut portion of the cornea.
  • This signal V drives an amplitude threshold detector 62, which emits a threshold exceed signal during the time that it receives the higher voltage pulses from the photodiode array controller 46. These threshold exceed signals are provided to gate B and gate C.
  • the photodiode array controller 46 also emits an end-of-scan signal which enters the start gate 47 to recycle the photodiode array controller 46, and which resets the counter 61. Consequently, since the clock 60 drives the photodiode array controller 46 at a constant rate and since the photodiode array controller 46 is continuously recycled by the end-of-scan signal so that it successively scans the received image of the cornea, the effect is that the time elapsed is representative of a length, in this case, the thickness of the cornea.
  • the preset counter 61 When the preset counter 61 emits its end-of-count signal, it opens or enables gate A, thereby ensuring that the clock pulses are not passed to gate B unless the actual depth of cut is less than the preset depth of cut. That is, the end-of-count signal from the manually set, down-counting counter 61 determines the maximum depth of cut of the cornea and will not permit the firing of the laser to cut the cornea to a greater depth than the preset depth.
  • Gate B is enabled by threshold exceed signals TE from the amplitude threshold detector 62, so as to pass clock pulses received from gate A to the laser fire pulse controller 13 through the manually operated switch 22. Thus, gate B is enabled only when pulses from the laser 12 (Fig. 1) will strike an uncut portion of the cornea C.
  • Gate C which receives pulses from clock 60 and threshold exceed signals TE from the amplitude threshold detector 62, will be enabled by threshold exceed signals TE, and permit clock pulses to pass to a display counter 63, which also receives reset signals, which are the end-of-scan signals from the photodiode array controller 46.
  • This display counter 63 enables the operator to determine the thickness of the cornea C at the point of contact by the probe 15 prior to the beginning of a cut in the cornea C.
  • the display counter 63 counts clock pulses that are received when the gate C is enabled.

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

Abstract

On a mis au point un appareil et un procédé permettant de sectionner des tissus, tels que la cornée, à une profondeur déterminée au moyen d'un laser d'ablation. Une sonde amène de l'énergie au laser d'ablation par des fluides d'irrigation coaxiaux afin d'inciser le tissu, puis on acquiert une image optique du site balayé électroniquement afin de produire un signal analogique de tension. On commande l'impulsion de tir du laser à l'aide d'un circuit comprenant une première porte commandée par un compteur réglable sur une profondeur d'incision maximum, ainsi qu'une seconde porte commandée par des signaux représentant la partie non incisée du tissu.
PCT/US1989/000542 1988-02-24 1989-02-15 Procede et appareil commandant la profondeur d'incision d'un inciseur a laser WO1989007921A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US16000788A 1988-02-24 1988-02-24
US160,007 1988-02-24

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WO1989007921A1 true WO1989007921A1 (fr) 1989-09-08

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PCT/US1989/000542 WO1989007921A1 (fr) 1988-02-24 1989-02-15 Procede et appareil commandant la profondeur d'incision d'un inciseur a laser

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EP (1) EP0426669A1 (fr)
JP (1) JPH03502765A (fr)
IL (1) IL89358A0 (fr)
WO (1) WO1989007921A1 (fr)

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19635998C1 (de) * 1996-09-05 1998-04-23 Zeiss Carl Jena Gmbh Anordnung zur Laserkoagulation von unterhalb der Fundusoberfläche liegenden Retinaschichten und Verfahren zur Ermittlung von Veränderungen in tiefen Gewebeschichten der Retina
EP0871099A2 (fr) * 1997-03-13 1998-10-14 Sei S.p.A. Dispositif électronique de commande utilisable dans machines de coupe et de fraisage pour obtenir une distance constante de coupe
US7300436B2 (en) 2000-02-22 2007-11-27 Rhytec Limited Tissue resurfacing
US7335199B2 (en) 2000-02-22 2008-02-26 Rhytec Limited Tissue resurfacing
US7785322B2 (en) 2000-02-22 2010-08-31 Plasmogen Inc. Tissue treatment system
US7862564B2 (en) 2000-02-22 2011-01-04 Plasmogen Inc. Method of remodelling stretch marks
CN108526719A (zh) * 2018-04-25 2018-09-14 王天牧 一种复合材料的切割设备及切割方法

Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3245846A1 (de) * 1981-12-28 1983-07-14 Mitsubishi Denki K.K., Tokyo Einrichtung zur vermeidung fehlerhafter bestrahlung mit einem chirurgischen laserstrahl
EP0123548A1 (fr) * 1983-04-26 1984-10-31 Wayne A. Provost Appareil et méthode pour détecter les cavités
US4555179A (en) * 1982-11-08 1985-11-26 John Langerholc Detection and imaging of objects in scattering media by light irradiation
US4588885A (en) * 1984-02-07 1986-05-13 International Technical Associates Method of and apparatus for the removal of paint and the like from a substrate
JPS61108484A (ja) * 1984-10-29 1986-05-27 Mitsubishi Electric Corp レ−ザ加工機
WO1987001272A1 (fr) * 1985-08-29 1987-03-12 Coopervision, Inc. Couteau de keratotomie radiale et systeme d'utilisation de celui-ci
EP0222537A2 (fr) * 1985-10-22 1987-05-20 Kenneth K. York Système pour produire une surface arrondie par photoablation
US4705037A (en) * 1985-02-08 1987-11-10 Peyman Gholam A Topographical mapping, depth measurement, and cutting systems for performing radial keratotomy and the like
EP0255581A1 (fr) * 1986-05-27 1988-02-10 Bmb Patent Holding Corporation Procédé in-vitro et appareil pour modifier les propriétés de réfraction de la cornée

Patent Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3245846A1 (de) * 1981-12-28 1983-07-14 Mitsubishi Denki K.K., Tokyo Einrichtung zur vermeidung fehlerhafter bestrahlung mit einem chirurgischen laserstrahl
US4555179A (en) * 1982-11-08 1985-11-26 John Langerholc Detection and imaging of objects in scattering media by light irradiation
EP0123548A1 (fr) * 1983-04-26 1984-10-31 Wayne A. Provost Appareil et méthode pour détecter les cavités
US4588885A (en) * 1984-02-07 1986-05-13 International Technical Associates Method of and apparatus for the removal of paint and the like from a substrate
JPS61108484A (ja) * 1984-10-29 1986-05-27 Mitsubishi Electric Corp レ−ザ加工機
US4705037A (en) * 1985-02-08 1987-11-10 Peyman Gholam A Topographical mapping, depth measurement, and cutting systems for performing radial keratotomy and the like
WO1987001272A1 (fr) * 1985-08-29 1987-03-12 Coopervision, Inc. Couteau de keratotomie radiale et systeme d'utilisation de celui-ci
EP0222537A2 (fr) * 1985-10-22 1987-05-20 Kenneth K. York Système pour produire une surface arrondie par photoablation
EP0255581A1 (fr) * 1986-05-27 1988-02-10 Bmb Patent Holding Corporation Procédé in-vitro et appareil pour modifier les propriétés de réfraction de la cornée

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
Patent Abstracts of Japan, vol. 10, no. 295 (M-523)(2351), 7 October 1986; & JP-A-61108484 (MITSUBISHI ELECTRIC CORP.) 27 May 1986 *

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19635998C1 (de) * 1996-09-05 1998-04-23 Zeiss Carl Jena Gmbh Anordnung zur Laserkoagulation von unterhalb der Fundusoberfläche liegenden Retinaschichten und Verfahren zur Ermittlung von Veränderungen in tiefen Gewebeschichten der Retina
EP0871099A2 (fr) * 1997-03-13 1998-10-14 Sei S.p.A. Dispositif électronique de commande utilisable dans machines de coupe et de fraisage pour obtenir une distance constante de coupe
EP0871099A3 (fr) * 1997-03-13 1999-05-06 Sei S.p.A. Dispositif électronique de commande, utilisable dans des machines de coupe et de fraisage pour obtenir une distance constante de coupe
US7300436B2 (en) 2000-02-22 2007-11-27 Rhytec Limited Tissue resurfacing
US7335199B2 (en) 2000-02-22 2008-02-26 Rhytec Limited Tissue resurfacing
US7785322B2 (en) 2000-02-22 2010-08-31 Plasmogen Inc. Tissue treatment system
US7862564B2 (en) 2000-02-22 2011-01-04 Plasmogen Inc. Method of remodelling stretch marks
CN108526719A (zh) * 2018-04-25 2018-09-14 王天牧 一种复合材料的切割设备及切割方法

Also Published As

Publication number Publication date
IL89358A0 (en) 1989-09-10
EP0426669A1 (fr) 1991-05-15
JPH03502765A (ja) 1991-06-27

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