WO2011030509A1 - Microscope for ophthalmic surgery - Google Patents

Abstract

A microscope for ophthalmic surgery, enabling a toric intraocular lens to be highly accurately disposed within a patient's eye according to the condition of the astigmatism of the eye. A microscope (1) for ophthalmic surgery forms projected images on a patient's eye (E) on the basis of the direction of the astigmatism axis of the patient's eye (E), the projected images indicating the direction of the principal meridian of the patient's eye (E) or the direction which corresponds to the principal meridian of the patient's eye (E) and along which the principal meridian direction of a toric intraocular lens (80) is disposed. The microscope (1) for ophthalmic surgery forms, as the projected images, substantially annularly arranged bright spot images (90-k). The microscope (1) for ophthalmic surgery indicates in a blinking manner bright spot images (90-i, 90-j) corresponding to the direction of the principal meridian of the patient's eye (E) or the direction which corresponds to the principal meridian of the patient's eye (E) and along which the principal meridian direction of a toric intraocular lens (80) is disposed, and the microscope (1) also indicates the remaining bright spot images (90-k) in such a manner that the remaining bright spot images (90-k) are continuously lit.

Description

Ophthalmic surgery microscope

This invention relates to a microscope for ophthalmic surgery used in ophthalmic surgery.

In cataract surgery, a clouded lens is removed and an intraocular lens (Intraocular Lens, IOL) is inserted instead. Some intraocular lenses can correct astigmatism (referred to as toric IOL). Examples of intraocular lenses for correcting astigmatism are disclosed in Patent Documents 1 and 2, for example.

As is well known, in astigmatism correction, not only the strength of astigmatism (astigmatism power) but also its direction (astigmatism axis direction) is important. When transplanting a toric IOL, attention must be paid to the direction of lens placement. That is, in order for the toric IOL to exert a correction effect, it is necessary to match the strong main meridian direction of the cornea of the patient's eye (referred to as the patient's eye) and the weak main meridian direction of the lens as much as possible. It is known that when both are shifted by 10 degrees, the correction effect is reduced to about 65%, and when they are shifted by 30 degrees, the correction effect is almost zero. Thus, when transplanting a toric IOL, the strong main meridian direction of the cornea (or the astigmatic axis direction of the patient's eye) and the direction of the toric IOL (particularly the weak main meridian direction) are grasped, It is necessary to adjust the direction with high accuracy.

In order to match the strong main meridian direction of the cornea with the weak main meridian direction of the lens, the following method has been conventionally used.
(1) As the preoperative examination, the astigmatic axis direction of the patient's eye is measured with a keratometer.
(2) Immediately before the operation, marking is performed using ink on the conjunctiva in a substantially horizontal direction while observing the patient's eyes with a slit lamp microscope (slit lamp).
(3) After washing the patient's eyes in the operating room, the surgical protractor was pressed against the patient's eye while observing with an ophthalmic surgical microscope, and the astigmatic axis measured in (1) while referring to the mark attached in (2) Mark the direction on the cornea.
(4) The lens is removed and the toric IOL is inserted into the eye, and the toric IOL is rotated so that the axial mark attached to the toric IOL matches the astigmatic axial mark attached in (3). .

This conventional method has the following problems. First, since the patient's head is not always in the same posture at the time of the examinations (1) and (2), the horizontal direction (direction serving as a reference for the astigmatic axis direction) in the measurement of (1) and (2) There is a risk of deviation from the horizontal direction in the measurement. As a result, the astigmatic axis direction cannot be accurately marked in (3).

In addition, the mark given in (2) may disappear during the cleaning in (3). In that case, the astigmatism axis direction is marked again with the patient lying on the bed in the operating room with reference to the direction that seems to be the horizontal direction, but this reduces the accuracy of the astigmatism axis direction. Furthermore, since the eye rotates about 5 degrees between the sitting position and the prone position, this also causes a decrease in accuracy in the astigmatic axis direction.

There is a technique described in Patent Document 3 as a technique for supporting the positioning operation of the IOL inserted into the patient's eye. In this technique, when positioning the IOL, an image of a patient's eye is simply printed, or an image is printed on a contact lens and placed on the patient's eye.

However, when positioning is performed while referring to the printed image, it is necessary to check the position by comparing the patient's eye with the image, which makes it difficult to grasp the appropriate orientation of the toric IOL. Furthermore, it is necessary to print out images.

On the other hand, when a contact lens is used, a special device for printing an image on the contact lens is required, and it takes time to print out. In addition, it is necessary to ensure the safety of a material (ink or the like) for printing an image. Furthermore, it seems useless to use contact lenses just for that application. It is assumed that an image is printed on a transparent sticker and attached to a contact lens, but it is not very practical in view of the labor of this fine work.

Although it is not for cataract surgery, there is also a technique that can measure the corneal shape during surgery (see, for example, Patent Document 4). In this technique, a placido ring illuminator is provided at the lower part of a microscope barrel, a concentric pattern is projected onto the cornea of a patient's eye, and a reflection image is taken to obtain a corneal shape. When this technique is applied to cataract surgery, the shape of the cornea can be obtained and displayed on the screen during the surgery, but the operator cannot be notified of which direction is the astigmatic axis direction in the actual patient's eye. Therefore, the surgeon cannot grasp the orientation in which the toric IOL should be arranged.

Patent Document 5 discloses a technique for projecting an angle scale on the cornea of a patient's eye. According to this, it is possible to roughly grasp the astigmatism axis direction by looking at the projection image of the angle scale, but the patient's astigmatism axis measurement is different from the instrument that projects the angle scale, so the tilt of the patient's head at the time of measurement, etc. May cause errors.

In addition, as a technique for correcting astigmatism without using an intraocular lens, a limbal incision method (Liberal Relaxing Induction, hereinafter referred to as “LRI”) may be used (see, for example, Patent Document 2).

LRI cuts the cornea on a circular arc in a direction perpendicular to the strong principal meridian direction of the cornea. This is a technique to correct astigmatism by loosening the refractive power by loosening the curvature of the cornea at the incision site.

JP-A-5-344990 JP 2006-136714 A JP 2009-45461 A JP-A-8-66369 Japanese Patent Laid-Open No. 3-185416

As described above, in the conventional technique, the arrangement direction of the toric IOL to be transplanted cannot be clearly grasped under the microscope observation. Therefore, it has been difficult to match the toric IOL arrangement direction with high accuracy according to the astigmatism state of the patient's eye.

Also, with the conventional technique, the direction of incising the cornea cannot be clearly grasped in the LRI procedure. Furthermore, in the LRI procedure, it is necessary to change the length of the incision according to the degree of astigmatism. However, it is difficult for an operator to mark with a marker or the like to determine how much incision should be made in which direction with respect to the strong main meridian, and to determine the incision range with high accuracy.

The present invention has been made to solve such a problem, and an object thereof is to provide an ophthalmic surgical microscope capable of correcting astigmatism of a patient's eye with high accuracy.

In order to achieve the above object, the invention according to claim 1 is directed to an illumination optical system that irradiates a patient's eye with illumination light, and an observation optical system and / or an imaging system that receives the reflected light of the illumination light from the patient's eye. And acquiring means for acquiring astigmatism information including the astigmatism axis direction of the patient's eye, and projecting a light flux to the patient's eye based on the astigmatism axis direction included in the acquired astigmatism information, thereby referring to astigmatism correction. Projection means for forming a projected image indicating the reference direction on the patient's eye, and when the observation optical system is provided, the observation optical system reflects the light beam reflected by the patient's eye When the imaging system is provided, the imaging system guides the reflected light of the luminous flux from the patient's eye to the imaging device.
The invention according to claim 2 is the microscope for ophthalmic surgery according to claim 1, wherein the projection means forms a plurality of bright spot images arranged in a substantially annular shape as the projection image. The light beam is projected onto the light source, and based on the astigmatic axis direction acquired by the acquisition means, a specifying means for specifying a bright spot image at a position corresponding to the reference direction from the plurality of bright spot images And the identified bright spot image is formed in a manner different from other bright spot images.
The invention according to claim 3 is the microscope for ophthalmic surgery according to claim 1, wherein the reference direction is a principal meridian direction of the patient's eye or an arrangement of principal meridians of an intraocular lens corresponding thereto. It is a direction.
The invention according to claim 4 is the ophthalmic surgical microscope according to claim 1, wherein the reference direction is a strong principal meridian direction of the cornea of the patient's eye.
The invention according to claim 5 is the ophthalmic surgical microscope according to claim 3, wherein the specifying means is based on the acquired astigmatism axis direction or a strong principal meridian direction of the patient's eye or A bright spot image located in the weak main meridian direction or the arrangement direction of the strong main meridian or weak main meridian of the intraocular lens, and a bright spot image at a position facing the bright spot image in the substantially annular array, It is specified from among the plurality of bright spot images.
The invention according to claim 6 is the ophthalmic surgical microscope according to claim 2, wherein the projection unit blinks the bright spot image specified by the specifying unit and the other bright spot. The image is continuously lit.
The invention according to claim 7 is the ophthalmic surgical microscope according to claim 2, wherein the specifying unit is configured to obtain two bright spot images having adjacent astigmatism axis directions acquired by the acquiring unit. The two bright spot images and the bright spot images at positions facing each of the two bright spot images in the substantially annular array are determined. In particular, the projecting means blinks the identified four bright spot images and continuously lights up the other bright spot images.
The invention according to claim 8 is the ophthalmic surgical microscope according to claim 2, wherein the projection means forms a plurality of bright spot images arranged in a substantially annular shape on the patient's eye. Sometimes, a bright spot image corresponding to at least one of azimuth angles of 0 degrees, 90 degrees, 180 degrees and 270 degrees with respect to a predetermined direction is formed in a color different from that of the other bright spot images. It is characterized by.
The invention according to claim 9 is the ophthalmic surgical microscope according to claim 2, wherein the illumination optical system and the observation optical system include a common objective lens, and the projection means includes the objective lens. And the patient's eye, and includes a plurality of light sources arranged in an annular shape, and projects the luminous flux output from each of the plurality of light sources onto the patient's eye to form the bright spot image It is characterized by that.
The invention according to claim 10 is the ophthalmic surgical microscope according to claim 9, wherein the specifying unit corresponds to the reference direction based on the astigmatic axis direction acquired by the acquiring unit. By specifying a light source at a position from among the plurality of light sources, a bright spot image at the position is specified from among the plurality of bright spot images.
An eleventh aspect of the present invention is the ophthalmic surgical microscope according to the ninth aspect, wherein the projection means holds the plurality of light sources so as to be movable along an optical axis direction of the objective lens. And holding means.
The invention according to claim 12 is the microscope for ophthalmic surgery according to claim 2, wherein the acquisition means is provided in the observation optical system and before the projection image is formed on the patient's eye. An imaging means for receiving the reflected light from the patient's eye of the light beam projected by the projection means and taking the plurality of bright spot images; and based on an arrangement state of the taken multiple bright spot images. Calculating means for obtaining an astigmatism axis direction of a patient's eye, wherein the projection means forms, as the projection image, a plurality of bright spot images indicating the reference direction corresponding to the calculated astigmatism axis direction. Features.
The invention according to claim 13 is the ophthalmic surgical microscope according to claim 1, wherein the projection means projects the light flux so as to form a substantially linear slit image as the projection image. And including specifying means for specifying the direction of the longitudinal direction of the slit image corresponding to the reference direction based on the astigmatic axis direction acquired by the acquiring means, and the slit image in the specified direction. Forming.
The invention according to claim 14 is the ophthalmic surgical microscope according to claim 13, wherein the illumination optical system and the observation optical system include a common objective lens, and the projection means includes a light source, A slit plate formed of a slit plate in which a part of the light beam output from the light source is passed, and a slit light that is arranged between the objective lens and the patient's eye and is a part of the light beam that has passed through the slit. A reflecting member that reflects the eye toward the patient's eye and the longitudinal direction of the slit arranged in a direction corresponding to the direction of the slit image specified by the specifying means And a drive mechanism for rotating the slit plate.
The invention according to claim 15 is the microscope for ophthalmic surgery according to claim 1, wherein the acquisition unit is projected by the projection unit before forming the projection image on the patient's eye. Astigmatism of the patient's eye based on an imaging state of receiving the reflected light of the luminous flux from the patient's eye and photographing the plurality of bright spot images a plurality of times, and an arrangement state of the plurality of bright spot images photographed a plurality of times Computing means for obtaining an axial direction, wherein the projection means forms a plurality of bright spot images indicating the reference direction corresponding to the obtained astigmatic axial direction as the projected image.
The invention described in claim 16 is the microscope for ophthalmic surgery according to claim 1, wherein the reliability calculation means calculates the reliability based on the astigmatism information, and the calculation result by the reliability calculation means. Threshold processing means for performing threshold processing, and the projection means forms the projection image on the patient's eye based on a processing result by the threshold processing means.
The invention according to claim 17 is the microscope for ophthalmic surgery according to claim 15, wherein the reliability calculation means calculates the reliability based on the bright spot image photographed a plurality of times by the photographing means. Threshold value processing means for performing threshold processing on the calculation result by the reliability calculation means, and the projection means forms the projection image on the patient's eye based on the processing result by the threshold value processing means.
The invention according to claim 18 is the ophthalmic surgical microscope according to claim 16, further comprising a notifying means for notifying the second photographing by the photographing means based on the processing result by the threshold processing means. It is characterized by.

The ophthalmic surgical microscope according to the present invention can form, on the patient's eye, a projection image indicating a reference direction referred to in astigmatism correction based on the acquired astigmatic axis direction of the patient's eye.

Therefore, the surgeon can correct astigmatism of the patient's eye with high accuracy.

In addition, the “reference direction” in the present specification is a direction referred to when correcting astigmatism. For example, in a toric IOL transplant operation, it means the main meridian direction of the patient's eye or the arrangement direction of the main meridian of the intraocular lens corresponding thereto. In the LRI procedure, it means the strong principal meridian direction of the cornea of the patient's eye.

It is the schematic showing an example of the external appearance structure of embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic showing an example of the structure of the projection image formation part in embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic showing an example of the structure of the projection image formation part in embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic showing an example of a structure of the optical system in embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic showing an example of a structure of the optical system in embodiment of the microscope for ophthalmic surgery concerning this invention. It is a schematic block diagram showing an example of the structure of the control system in embodiment of the microscope for ophthalmic surgery concerning this invention. It is table information showing an example of a structure of the control system in embodiment of the microscope for ophthalmic surgery concerning this invention. It is a flowchart showing an example of operation | movement of embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic for demonstrating an example of operation | movement of embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic for demonstrating an example of operation | movement of embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic showing an example of the structure of the projection image formation part in embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic showing an example of the structure of the projection image formation part in embodiment of the microscope for ophthalmic surgery concerning this invention. It is the schematic for demonstrating an example of operation | movement of embodiment of the microscope for ophthalmic surgery concerning this invention. It is a schematic block diagram showing an example of the structure of the control system in embodiment of the microscope for ophthalmic surgery concerning this invention. It is a flowchart showing an example of operation | movement of embodiment of the microscope for ophthalmic surgery concerning this invention. It is a schematic block diagram showing an example of the structure of the control system in embodiment of the microscope for ophthalmic surgery concerning this invention. It is a flowchart showing an example of operation | movement of embodiment of the microscope for ophthalmic surgery concerning this invention.

[First Embodiment]
An example of an embodiment of the microscope for ophthalmic surgery according to the present invention will be described in detail with reference to the drawings.

[Constitution]
[Appearance structure]
An appearance configuration of the microscope for ophthalmologic surgery 1 according to this embodiment will be described with reference to FIG. The microscope for ophthalmologic surgery 1 includes a support 2, a first arm 3, a second arm 4, a driving device 5, a microscope 6 and a foot switch 8 as in the conventional art.

The drive device 5 includes an actuator such as a motor. The driving device 5 moves the microscope 6 in the vertical direction and the horizontal direction in accordance with an operation using the foot switch 8 or the like. Thereby, the microscope 6 can be moved three-dimensionally.

The lens barrel 10 of the microscope 6 houses various optical systems and drive systems. An inverter unit 12 is provided on the upper portion of the lens barrel unit 10. When the observation image of the patient's eye E is obtained as an inverted image, the inverter unit 12 converts the observation image into an erect image. A pair of left and right eyepieces 11 </ b> L and 11 </ b> R are provided on the upper portion of the inverter unit 12. An observer (operator or the like) can view the patient's eye E binocularly by looking into the left and right eyepieces 11L and 11R.

The microscope for ophthalmic surgery includes a projection image forming unit 13 as a characteristic configuration. The projection image forming unit 13 projects a light beam onto the patient's eye E to form a predetermined projection image on the patient's eye E. The projection image forming unit 13 constitutes an example of the “projection unit” of the present invention together with a support member 17 and a control unit 60 described later.

A configuration example of the projection image forming unit 13 is shown in FIGS. Here, reference numeral 14 in FIG. 2 represents a photographing unit. The photographing unit 14 stores a TV camera 56 described later. FIG. 3 shows a configuration when the head portion 131 of the projection image forming unit 13 is viewed from below (that is, the patient's eye E side, in other words, the opposite side of the lens barrel unit 10).

As shown in FIGS. 2 and 3, the head 131 is a disk-shaped member. As shown in FIG. 3, a plurality of LEDs 131-i (i = 1 to N) are provided on the lower surface of the head portion 131. The LED group 131-i is arranged in an annular shape. In this embodiment, 36 LEDs 131-i are provided at equal intervals (N = 36). That is, the LED group 131-i is disposed at an angle of 10 degrees with respect to the center position of the LED group 131-i. In other words, considering the line segment connecting each LED 131-i and the center position, the line segments related to the two adjacent LEDs 131-i and 131- (i + 1) intersect at an angle of 10 degrees at the center position. .

The LED group 131-i corresponding to the horizontal direction and the vertical direction can be configured to output a color different from that corresponding to the other direction. That is, the LEDs (LEDs 131-1, 131-10, 131-19, 131-28 respectively) at positions corresponding to the astigmatic axis direction (astigmatic axis angle) corresponding to 0 degrees, 90 degrees, 180 degrees, and 270 degrees It can be configured to output a light flux of a different color from the LED 131-i (i ≠ 1, 10, 19, 28). For example, red LEDs can be used as the LEDs 131-1, 131-10, 131-19, 131-28, and green LEDs can be used as the other LEDs 131-i (i ≠ 1, 10, 19, 28). Thereby, it is possible to easily recognize the horizontal direction and the vertical direction of the astigmatic axis.

Further, only some of the LEDs 131-1, 131-10, 131-19, and 131-28 may output a light beam having a color different from that of the other LEDs. For example, only the LED 131i corresponding to an angle of 0 degrees can be configured to output a different color from other LEDs (i ≠ 1).

Also, it is not necessary to configure all of the LEDs 131-1, 131-10, 131-19, and 131-28 to output a light beam of the same color (red in the above example). For example, a red LED is used as each LED 131-1, 131-19, a white LED is used as each LED 131-10, 131-28, and a green LED is used as another LED 131-i (i ≠ 1, 10, 19, 28). Can be used. Thereby, it is possible to easily identify the horizontal direction and the vertical direction.

In addition, instead of making the horizontal direction and the vertical direction recognizable according to the output color of the light source as described above, the same effect can be achieved by other configurations. For example, the direction can be identified by changing the brightness of the output light.

The LED group 131-i is an example of the “plurality of light sources” of the present invention. Here, each light source does not need to be an LED, and any device capable of outputting a light beam can be used. Further, the plurality of light sources may not be arranged at equal intervals. Since FIG. 3 is a bottom view, the arrangement order of the LED groups 131-i is set in the opposite direction (reverse direction) to the general astigmatic axis setting direction. Thereby, the corneal reflection light (Purkinje image) of the light beam output from the LED group 131-i is observed or photographed as a general astigmatic axis setting direction.

In this embodiment, 36 light sources are provided, but the number of light sources to be installed is also arbitrary. However, as will be described later, in this embodiment, since the astigmatic axis direction of the patient's eye E is measured based on the Purkinje image of the light beam output from the LED group 131-i, the accuracy and accuracy of this measurement can be ensured. It is desirable that a number of light sources be provided. Conversely, when a configuration that does not perform measurement in the astigmatism axis direction is employed, there is no limitation regarding the number of light sources.

In addition, the number of light sources can be appropriately set according to the accuracy required when the operator visually recognizes the astigmatic axis direction, the arrangement direction of the main meridian of the toric IOL or the strong main meridian direction of the cornea. . For example, in this embodiment, since the light sources are arranged at intervals of 10 degrees, the astigmatic axis direction and the like can be presented in units of at least 10 degrees. In order to present the astigmatic axis direction and the like with higher accuracy, the number of light sources corresponding to the accuracy (for example, 72 in the case of 5 degree units) is provided. The same is true for lower accuracy.

In this embodiment, a plurality of light sources (LED groups 131-i) each individually configured are provided, but the present invention is not limited to this. For example, it is possible to obtain a similar function by providing a display device (for example, an LCD (liquid crystal display)) on the lower surface of the head portion 131 and displaying a plurality of bright spots with this display device. In this case, each bright spot corresponds to a “light source”.

An objective lens unit 16 is provided at the lower end of the lens barrel unit 10. The objective lens unit 16 stores the dictated objective lens 15. A support member 17 is provided in the vicinity of the objective lens unit 16. The support member 17 is formed from the objective lens portion 16 toward the side.

A through hole extending in the vertical direction is formed at the tip end portion 17 a of the support member 17. An arm 133 is inserted into the through hole. The arm 133 is slidable in the through hole. Thereby, the arm 133 can be moved in the vertical direction (the direction indicated by the double-sided arrow A in FIG. 2) with respect to the distal end portion 17a. Here, the microscope 6 side is the upward direction, and the patient's eye E side is the downward direction.

A fall prevention part 134 is provided at the upper end of the arm 133. The fall prevention part 134 is a plate-like member having a diameter larger than the diameter of the through hole. Thereby, the fall prevention unit 134 prevents the arm 133 from falling off the tip portion 17a.

A head connection portion 132 is provided at the lower end of the arm 133. The head connecting portion 132 connects the head portion 131 to the arm 133 so that the surface on which the LED 131-i is provided faces downward.

With such a configuration, the head part 131, the head connection part 132, the arm 133, and the fall prevention part 134 (that is, the projection image forming part 13) are movable in the vertical direction with respect to the tip part 17a. For example, the user moves the projection image forming unit 13 by holding the arm 133 or the like. It is also possible to configure the projection image forming unit 13 to be moved electrically by using a driving means such as a motor.

A connecting hook 18 is provided on the lower surface of the support member 17. The connecting hook 18 is configured to be engageable with an engaging portion (not shown) of the projection image forming portion 13. This engaging part is provided in the head connection part 132, for example. When the projection image forming unit 13 is moved upward, the engaging unit and the connecting hook 18 are engaged to prohibit the vertical movement of the projection image forming unit 13. This engagement relationship can be released by a predetermined operation (for example, pressing a predetermined button). The configuration of the connecting hook 18 and the engaging portion is arbitrary.

With the above configuration, the LED group 131-i is held so as to be movable along the optical axis direction of the objective lens 15. The support member 17, the head part 131, the head connection part 132, the arm 133, and the fall prevention part 134 are examples of the “holding means” of the present invention. The holding means is not limited to the above configuration. As long as a plurality of light sources are movably held along the optical axis direction of the objective lens, the specific structure of the holding means is arbitrary.

[Configuration of optical system]
Next, the optical system of the microscope for ophthalmologic surgery 1 will be described with reference to FIGS. 4 and 5. Here, FIG. 4 is a view of the optical system viewed from the left side as viewed from the operator. FIG. 5 is a view of the optical system viewed from the operator side. In addition to the configuration shown in FIGS. 4 and 5, an optical system may be provided for an assistant who assists the surgeon to observe the patient's eye E.

In this embodiment, directions such as up and down, left and right, and front and rear are directions seen from the operator side unless otherwise specified. In addition, about the up-down direction, let the direction which goes to the observation object (patient eye E) from the objective lens 15 be a downward direction, and let this opposite direction be an upper direction.

At the lower position of the objective lens 15 (position between the objective lens 15 and the patient's eye E), the aforementioned LED group 131-i is provided. 4 and 5, only the LEDs 131-i and 131-j (i, j = 1 to N, i ≠ j) located at both ends when viewed from the viewpoint direction are described.

The term “between the objective lens 15 and the patient's eye E” means between the position (height position) of the objective lens and the position (height position) of the patient eye E in the vertical direction (that is, The position in the front-rear direction is not considered). The LED group 131-i is arranged in an annular shape, but if the projection image (bright spot image) arranged in a substantially annular shape can be formed on the cornea of the patient's eye E, the diameter of the annular shape is arbitrary. Can be set.

The observation optical system 30 will be described. As shown in FIG. 5, the observation optical system 30 is provided in a pair of left and right. The left observation optical system 30L is called a left observation optical system, and the right observation optical system 30R is called a right observation optical system. Symbol OL indicates the optical axis (observation optical axis) of the left observation optical system 30L, and symbol OR indicates the optical axis (observation optical axis) of the right observation optical system 30R. The left and right observation optical systems 30L and 30R are disposed so as to sandwich the optical axis O of the objective lens 15.

As in the conventional case, the left and right observation optical systems 30L and 30R are respectively a zoom lens system 31, a beam splitter 32 (only the right observation optical system 30R), an imaging lens 33, an image erecting prism 34, and an eye width adjustment prism 35. A field stop 36 and an eyepiece 37.

The zoom lens system 31 includes a plurality of zoom lenses 31a, 31b, and 31c. Each of the zoom lenses 31a to 31c can be moved in a direction along the observation optical axis OL (or the observation optical axis OR) by a driving mechanism (not shown). Thereby, the magnification at the time of observing or photographing the patient's eye E is changed.

The beam splitter 32 of the right observation optical system 30R separates part of the observation light guided from the patient's eye E along the observation optical axis OR and guides it to the TV camera imaging system. The TV camera imaging system includes an imaging lens 54, a reflection mirror 55, and a TV camera 56. The television camera imaging system is stored in the imaging unit 14.

The TV camera 56 includes an image sensor 56a. The image sensor 56a is configured by, for example, a CCD (Charge Coupled Devices) image sensor, a CMOS (Complementary Metal Oxide Semiconductor) image sensor, or the like. As the image sensor 56a, an element having a two-dimensional light receiving surface (area sensor) is used.

When the ophthalmic surgical microscope 1 is used, the light receiving surface of the imaging device 56a is, for example, a position optically conjugate with the surface of the cornea of the patient's eye E, or a depth from the apex of the cornea by ½ of the corneal curvature radius. It is arranged at a position optically conjugate with a position away in the direction.

The image erecting prism 34 converts the inverted image into an erect image. The eye width adjustment prism 35 is an optical element for adjusting the distance between the left and right observation lights according to the eye width of the operator (the distance between the left eye and the right eye). The field stop 36 blocks the peripheral region in the cross section of the observation light and limits the operator's visual field.

Subsequently, the illumination optical system 20 will be described. As shown in FIG. 4, the illumination optical system 20 includes an illumination light source 21, an optical fiber 21a, an exit aperture stop 26, a condenser lens 22, an illumination field stop 23, a slit plate 24, a collimator lens 27, and an illumination prism 25. Is done.

The illumination field stop 23 is provided at a position optically conjugate with the front focal position of the objective lens 15. The slit hole 24a of the slit plate 24 is formed at a position optically conjugate with the front focal position.

The illumination light source 21 is provided outside the barrel 10 of the surgeon's microscope 6. One end of an optical fiber 21 a is connected to the illumination light source 21. The other end of the optical fiber 21 a is disposed at a position facing the condenser lens 22 in the lens barrel 10. The illumination light output from the illumination light source 21 is guided by the optical fiber 21 a and enters the condenser lens 22.

An exit aperture stop 26 is provided at a position facing the exit port (fiber end on the condenser lens 22 side) of the optical fiber 21a. The exit aperture stop 26 acts to shield a partial region of the exit port of the optical fiber 21a. When the shielding area by the exit aperture stop 26 is changed, the emission area of the illumination light is changed. Thereby, the irradiation angle by the illumination light, that is, the angle formed by the incident direction of the illumination light with respect to the patient's eye E and the optical axis O of the objective lens 15 can be changed.

The slit plate 24 is formed of a disk-shaped member having a light shielding property. The slit plate 24 is provided with a light-transmitting portion including a plurality of slit holes 24 a having a shape corresponding to the shape of the reflecting surface 25 a of the illumination prism 25. The slit plate 24 is moved in a direction perpendicular to the illumination optical axis O ′ (direction of a double-headed arrow B shown in FIG. 4) by a driving mechanism (not shown). As a result, the slit plate 24 is inserted into and removed from the illumination optical axis O ′.

The collimator lens 27 converts the illumination light that has passed through the slit hole 24a into a parallel light flux. The illumination light that has become a parallel light beam is reflected by the reflecting surface 25 a of the illumination prism 25, enters the objective lens 15, and is further projected onto the patient's eye E via the front lens 13. Illumination light (a part) projected onto the patient's eye E is reflected by the cornea. Reflected light (sometimes referred to as observation light) of illumination light by the patient's eye E enters the observation optical system 30 via the objective lens 15. With such a configuration, an operator can observe an enlarged image of the patient's eye E.

[Control system configuration]
Next, the control system of the microscope for ophthalmic surgery 1 will be described with reference to FIG. In FIG. 6, a part of the control system is omitted. Omitted parts include the drive device 5, the drive mechanism of the slit plate 24, the drive mechanism of the zoom lens system 31, and the like.

The control system of the microscope for ophthalmologic surgery 1 is mainly composed of a control unit 60. The control unit 60 is provided at any part of the microscope for ophthalmic surgery 1 shown in FIG. Further, a computer may be provided separately from the configuration shown in FIG. 1 and used as the control unit 60.

Control unit 60 controls each part of microscope 1 for ophthalmic surgery. In addition, the control unit 60 executes various arithmetic processes as will be described later. The control unit 10 includes a microprocessor and a storage device in the same manner as a normal computer. The control unit 60 includes an astigmatism information calculation unit 61 and a light source identification unit 62.

In this embodiment, a Purkinje image formed on the cornea of the patient's eye E is photographed with the light flux from the LED group 131-i, and the astigmatic axis direction of the patient's eye E is obtained based on this photographed image. Then, based on this astigmatic axis direction, direction information for supporting the operation of transplanting the toric IOL into the patient's eye E is presented to the operator. The direction information includes the main meridian direction (strong main meridian direction or weak main meridian direction) of the cornea of the patient's eye E and the arrangement direction of the main meridian of the toric IOL (strong main meridian or weak main meridian).

Also, in the LRI procedure, direction information for supporting the operation of incising the corneal ring portion of the patient's eye E based on the astigmatic axis direction can be presented to the operator. This direction information includes the strong meridian direction of the cornea of the patient's eye E.

The photographing of the Purkinje image is performed by photographing the patient's eye E with the TV camera 56 in a state where a plurality of bright spot images are formed on the cornea of the patient's eye E by turning on the LED group 131-i. The TV camera 56 sends an electrical signal of the captured image to the control unit 60 via a cable (not shown). The astigmatism information calculation unit 61 analyzes the captured image of the Purkinje image obtained in this way to obtain the astigmatic axis direction of the patient's eye E. This analysis process is executed in the same manner as in the prior art as follows.

The Purkinje image in the photographed image is composed of a plurality of bright spot images arranged in a substantially annular shape. The LED group 131-i is arranged in an annular shape, but the plurality of bright spot images are deformed from the annular shape according to the corneal shape of the patient's eye E. In particular, when the patient's eye E has astigmatism, the plurality of bright spot images are arranged in an elliptical shape.

The astigmatism information calculation unit 61 obtains an astigmatism axis direction (astigmatism axis angle) based on the ellipse principal axis directions of a plurality of bright spot images arranged in an elliptical shape, for example, as described in JP-A-11-225963. In addition to this, the astigmatism information calculation unit 61 can also obtain the astigmatism power from the ellipticity (ratio between the minor axis and the major axis) or the spherical power from the size of the ellipse. The astigmatism information calculation unit 61 is an example of the “calculation means” in the present invention. The TV camera 56 is an example of the “photographing means” of the present invention.

The “acquisition means” of the present invention is not limited to the configuration including such “imaging means” and “calculation means”. For example, since the astigmatism examination of the patient's eye E may have been performed in the past, the configuration can be used as an acquisition unit so as to input the examination result (astigmatism axis direction). Specific examples of this acquisition means include a communication device (such as a LAN card) that can acquire the inspection result through a network such as a LAN, a reading device (such as a drive device) that reads the inspection result from a recording medium, and for manually inputting the inspection result. User interface (combination of display device and operation device).

Note that “acquisition” of the acquisition means includes both positive acquisition such as obtaining astigmatism information using the imaging means and calculation means and passive acquisition such as accepting input of astigmatism information from the outside.

The light source specifying unit 62 specifies the LED 131-i at a position corresponding to the direction information based on the astigmatic axis direction obtained by the astigmatism information calculating unit 61. Since each LED 131-i forms each bright spot image, specifying the LED 131-i is synonymous with specifying the bright spot image. The light source identification unit 62 is an example of the “identification unit” of the present invention.

The light source specifying unit 62 specifies the target LED 131-i as follows, for example. First, the light source specifying unit 62 stores in advance light source / astigmatic axis direction information in which the correspondence between each LED 131-i and the astigmatic axis direction is recorded. The light source / astigmatic axis direction information is, for example, table information in which the astigmatic axis direction is associated with each LED 131-i.

An example of this table information is shown in FIG. The table information 63 includes a “light source ID” column and an “astigmatic axis direction” column. In the “light source ID” column, identification information (ID information) given in advance to each LED 131-i is listed. In the table information 63, the code “i” in each LED 131-i shown in FIG. 3 is used as identification information. In the “Astigmatism axis direction” column, values in the astigmatism axis direction corresponding to the respective LEDs 131-i are listed.

Upon receiving the astigmatism axis direction obtained by the astigmatism information calculation unit 61, the light source specifying unit 62 specifies the astigmatism axis direction in the “astigmatism axis direction” column of the table information 63, and further, the specified astigmatism axis direction. The identification information in the “light source ID” column corresponding to is specified.

Further, the light source specifying unit 62 adds 180 degrees in the astigmatic axis direction, and specifies identification information corresponding to this sum based on the table information 63. The addition process at this time is performed using 360 degrees as a modulo. That is, when the sum value obtained by the addition process exceeds 360 degrees, 360 is subtracted from the sum value to obtain a remainder, and identification information corresponding to the remainder value is obtained. In this way, the two LEDs 131-i arranged at positions facing each other (that is, positions shifted by 180 degrees) are specified.

As a specific example, when the obtained astigmatism axis direction is 90 degrees, the light source identifying unit 62 first identifies “10” as identification information corresponding to 90 degrees, and further, 90 degrees + 180 degrees = 270 degrees. “28” is specified as the corresponding identification information. Thereby, the pair of LEDs 131-10 and 131-28 arranged at positions facing each other are specified.

The above method is sufficient when the acquired astigmatism axis direction is in units of 10 degrees. However, there may be a case where a light source that directly corresponds to the astigmatic axis direction cannot be specified, such as when the acquired unit of the astigmatic axis direction is less than 10 degrees. For example, when the astigmatic axis direction is obtained in units of 5 degrees, the light source that directly corresponds to the astigmatic axis direction 45 degrees cannot be specified. In such a case, the light source specifying unit 62 can specify the light source by executing the following process, for example.

In any case, a value of 0 degree or more and less than 180 degrees (that is, 0 ≦ θ <180) may be considered as the astigmatic axis direction θ. Further, the entire range (0 ≦ θ <180) of the astigmatism axis direction θ is 18 values (reference values) in units of 10 degrees 0 degrees, 10 degrees, 20 degrees,..., 170 degrees, and every 10 degrees. Can be classified into the sub-range Rk ((k−1) × 10 <θ <k × 10) (k = 1 to 18) with little overlap. When the acquired astigmatism axis angle θ corresponds to the reference value, the corresponding light source can be directly specified as described above.

On the other hand, when the acquired astigmatism axis direction θ is not the reference value, the astigmatism axis angle θ is included in any one of the partial ranges Rk. The partial range Rk including the astigmatic axis direction θ can be easily specified by comparing the magnitudes of the astigmatic axis direction θ and the reference value.

When the partial range Rk including the astigmatic axis direction θ is specified, the light source specifying unit 62 determines the LED 131- (k−) corresponding to the values at both ends of the partial range Rk (that is, (k−1) × 10 and k × 10). 1) Specify 131-k as the target light source. That is, the light source specifying unit 62 specifies the two LEDs 131-i that are closest to the astigmatic axis direction θ.

Further, the light source specifying unit 62 specifies the LED 131-j at a position facing each of the two LEDs 131-i (that is, a position shifted by 180 degrees). As described above, a total of four light sources, that is, the two light sources closest to the astigmatism axis direction θ and the two light sources at positions facing them are specified.

Identifying means is not limited to the above configuration. For example, instead of the table information 63 of FIG. 7, table information in which the pair of LEDs 131-i (i = 1 to 18) and 131- (i + 18) facing each other as described above is associated with each astigmatic axis direction in advance. You can remember it. Thereby, the process which specifies the identification information of a light source can be completed at once.

When using the LRI technique, the specifying unit (the light source specifying unit 62) specifies the LED 131-i at a position corresponding to the strong principal meridian direction of the cornea based on the astigmatic axis direction obtained by the astigmatism information calculating unit 61. To do.

Further, as the table information 63, the light source ID, the astigmatic axis direction, and the strong principal meridian direction of the cornea are associated. Therefore, when a certain astigmatic axis direction is specified, the strong principal meridian direction and light source ID of the cornea corresponding to the astigmatic axis direction are specified.

The operation unit 70 is used by an operator or the like to operate the microscope 1 for ophthalmic surgery. The operation unit 70 includes various hardware keys (buttons, switches, etc.) provided on the housing of the microscope 6 and the foot switch 8. When a touch panel display is provided, the operation unit 70 includes various software keys displayed on the touch panel display.

[Operation]
The operation of the ophthalmic surgical microscope 1 will be described. The operation related to the transplant operation of the toric IOL will be described below. An example of the operation of the microscope for ophthalmologic surgery 1 is shown in FIG.

When the surgeon performs a predetermined operation, the control unit 60 turns on the LED group 131-i to form a plurality of bright spot images on the cornea of the patient's eye E (S1). At this time, the surgeon appropriately moves the LED group 131-i up and down to arrange a plurality of bright spot images in an appropriate size (diameter).

In this state, the control unit 60 controls the TV camera 56 to photograph the patient's eye E in a state where a plurality of bright spot images are formed (S2). Thereby, a captured image of the Purkinje image is obtained. At this stage, the LED group 131-i may be turned off, or the lighting state may be continued.

The astigmatism information calculation unit 61 analyzes the captured image obtained in step 2 to obtain the astigmatism axis direction of the patient's eye E (S3). The light source specifying unit 62 refers to the table information 63 and specifies the LEDs 131-i and 131- (i + 18) corresponding to the astigmatic axis direction (weak principal meridian direction) (S4).

The control unit 60 causes the identified LEDs 131-i and 131- (i + 18) to blink, and causes the other LEDs 131-j (j ≠ i, i + 18) to be continuously lit (S5). Here, blinking means that the LEDs 131-i and 131- (i + 18) are repeatedly turned on and off at predetermined time intervals (for example, at intervals of 1 second). Continuous lighting is to keep the LED 131-j lit until an instruction to turn it off is given.

The observation image in the state of step S5 will be described. In FIG. 9, each bright spot image 90-k is formed by a light beam from the LED 131-k (k = 1 to 36). The bright spot images 90-1, 90-10, 90-19, and 90-28 correspond to the astigmatic axis directions of 0 degrees, 90 degrees, 180 degrees, and 270 degrees, respectively. Each of the bright spot images 90-1, 90-10, 90-19, 90-28 is presented in red, for example, and the other bright spot images 90-k (k ≠ 1, 10, 19, 28) are in green, for example. Presented in

The lens portion 81 of the toric IOL 80 is a toric lens. The toric IOL 80 is provided with a pair of support portions 82a and 82b that support the lens portion 81 in the eye. Further, the toric IOL 80 is provided with marks 83a and 83b indicating the main meridian direction (for example, the strong main meridian direction) of the lens unit 81. Note that the symbol Ea represents the pupil contour of the patient's eye E. The above is a form that is always observed in the same manner in this embodiment.

In step 4, it is assumed that a pair of opposing LEDs 131-i and 131-j are identified. At this time, in step 5, the LEDs 131-i and 131-j are blinked, and the other LEDs 131-k (k ≠ i, j) are continuously lit. As a result, as shown in FIG. 9, a pair of bright spot images 90-i and 90-j at the opposite positions are presented in a blinking state, and other bright spot images 90-k (k ≠ i, j) Is presented in a continuously lit state.

Since the blinking bright spot images 90-i and 90-j indicate the astigmatic axis direction (weak principal meridian direction) of the patient's eye E, the astigmatic axis direction can be intuitively recognized. The surgeon rotates and moves the toric IOL 80 to align the marks 83a and 83b with the blinking bright spot images 90-i and 90-j. Thereby, the weak main meridian direction of the patient's eye E and the strong main meridian direction of the toric IOL 80 can be matched with high accuracy.

[Other operation examples]
In the above example, the bright spot image in the astigmatic axis direction (weak principal meridian direction) of the patient's eye E is blinked, but the bright spot image in the direction orthogonal to this (strong principal meridian direction) can also be blinked. is there. For this purpose, the light source identification unit 62 may identify the LEDs 131-i and 131-j located in a direction orthogonal to the acquired astigmatism axis direction (that is, a direction shifted by 90 degrees). This specifying process can be easily executed with reference to the table information 63 and the like. This example of operation is effective when the patient's eye E is normal astigmatism, that is, when the strong main meridian direction and the weak main meridian direction of the patient eye E are substantially orthogonal, or when an LRI technique is used. is there. Hereinafter, an operation in the LRI procedure will be described.

Even when the LRI procedure is performed, the steps from S1 to S3 in FIG. 8 perform the same operation as in the case of the toric IOL transplant operation.

When performing the LRI procedure, in S4, the light source identifying unit 62 identifies the LEDs 131-i and 131- (i + 18) corresponding to the strong principal meridian direction of the cornea by referring to the table information 63 based on the astigmatic axis direction information. To do.

Next, similarly to S5, the control unit 60 blinks the identified LEDs 131-i, 131- (i + 18) and continuously lights the other LEDs 131-j (j ≠ i, i + 18).

Thereby, the surgeon can easily recognize the strong principal meridian direction of the cornea of the patient's eye E.

Furthermore, in the LRI procedure, in general, the incision range (the length of the incision) differs depending on the astigmatism intensity of the patient's eye E. In this case, it is possible to turn on a plurality of LEDs corresponding to the incision range. Therefore, for example, the astigmatism intensity of the patient's eye E is acquired in advance, and the number of LEDs corresponding to the astigmatism intensity is stored as the table information 63. And the light source specific | specification part 62 specifies LED which should be blinked based on the said astigmatism intensity. As an example, when the LED 131 is arranged in increments of 5 ° and the incision is made by 15 ° in each of the clockwise and counterclockwise directions with respect to the strong principal meridian point direction, The LED 131-i ± 3 and the LED 131- (i + 18 ± 3) are specified. Here, the LED 131-i and the LED 131-i + 18 are LEDs positioned in the strong principal meridian direction of the cornea of the patient's eye.

Note that it is not necessary to blink all the LEDs 131 in the incision range as described above. For example, the LEDs only at both ends of the incision range may be blinked. Or you may blink LED131 in the predetermined angle (30 degrees, 60 degrees, etc.) used as a standard of incision.

Further, instead of presenting the main meridian direction of the patient's eye E as described above, the direction in which the main meridian of the toric IOL 80 should be arranged (sometimes simply referred to as the main meridian arrangement direction) may be presented. . The toric IOL 80 is arranged so that its strong principal meridian is aligned with the astigmatic axis direction (weak principal meridian direction) of the patient's eye E. In other words, the toric IOL 80 is arranged so that its weak principal meridian is aligned with a direction (strong principal meridian direction) orthogonal to the astigmatic axis direction of the patient's eye E. By using this relationship, the light source specifying unit 62 can easily determine the arrangement direction of the strong main meridian (or weak main meridian) of the toric IOL 80, and the LEDs 131-i and 131-j corresponding to the arrangement direction can be obtained. It can be easily identified.

Next, a case where the astigmatic axis direction of the patient's eye E is located between two adjacent bright spot images (that is, between two adjacent light sources) will be described. The light source specifying unit 62 determines whether or not the astigmatic axis direction of the patient's eye E is positioned between two adjacent bright spot images. This determination process can be executed, for example, by determining whether there is a light source ID corresponding to the astigmatic axis direction in the table information 63. In addition, two adjacent bright spot images can be easily obtained by obtaining a bright spot image (light source) having the azimuth angle closest to the value in the astigmatic axis direction and a bright spot image (light source) having the closest azimuth angle. Can be specified.

The case where the astigmatic axis direction of the patient's eye E is obtained in units of less than 10 degrees will be described. Here, the astigmatic axis direction is obtained in units of 5 degrees, and the actually obtained astigmatic axis direction of the patient's eye E is 45 degrees. In this case, as described above, the light source specifying unit 62 specifies the four LEDs 131-5, 131-6, 131-23, and 131-24 corresponding to the four angles of 40 degrees, 50 degrees, 220 degrees, and 230 degrees. Will do. The control unit 60 blinks these four LEDs 131-5, 131-6, 131-23, 131-24 and continuously lights the other LEDs 131-k (k ≠ 5, 6, 23, 24).

Then, as shown in FIG. 10, four bright spot images 90-5, 90-6, 90-23, 90-24 are presented in a blinking state, and other bright spot images 90-k (k ≠ 5 , 6, 23, 24) are presented in a continuously lit state.

The operator makes the mark 83a (or 83b) coincide with the intermediate position between the adjacent bright spot images 90-5 and 90-6, and at the intermediate position between the adjacent bright spot images 90-23 and 90-24. The toric IOL 80 is rotationally moved so that the marks 83b (or 83a) coincide with each other. Thereby, the weak main meridian direction (or strong main meridian direction) of the patient's eye E and the strong main meridian direction (or weak main meridian direction) of the toric IOL 80 can be matched with high accuracy.

The astigmatism state of the patient's eye E can be measured as follows. In this embodiment, LED groups 131-i arranged in an annular shape are provided. On the other hand, a concentric pattern may be projected onto the cornea in corneal shape measurement (see, for example, Patent Document 4 described above). In this embodiment, the same corneal shape measurement can be performed.

For this purpose, it is desirable to provide a drive mechanism for moving the LED group 131-i in the vertical direction. This drive mechanism moves the head unit 131 and the like in the vertical direction under the control of the control unit 60.

When the LED group 131-i is moved in the vertical direction, the array size of the bright spot image group projected on the cornea of the patient's eye E (the diameter of the substantially annular array) is changed. Specifically, when the LED group 131-i is moved downward (closer to the patient's eye E), the array size is increased. Conversely, when the LED group 131-i is moved upward, the array size is decreased. Using this fact, the cornea shape is measured as follows.

First, the head part 131 is disposed sufficiently below. The control unit 60 controls the drive mechanism and moves the head unit 131 and the like upward at a constant speed, for example. Although it can be moved from above to below, it is considered preferable to move from below to above in consideration of the mental burden of the patient.

When moving upward of the head unit 131, the control unit 60 controls the TV camera 56 to photograph the patient's eye E at a predetermined time interval. This time interval can be determined according to the moving speed of the head unit 131. That is, the time interval can be determined depending on how many concentric circles are included as concentric patterns used for corneal shape measurement. In consideration of the eye movement of the patient's eye E and the like, it is desirable to perform this imaging process quickly.

The plurality of captured images acquired in this manner include substantially annular patterns (consisting of a plurality of bright spot images) each having a different array size. For example, the control unit 60 extracts a substantially annular pattern from each captured image. This extraction process is obtained, for example, by acquiring a captured image when the pattern is projected and a captured image when the pattern is not projected and taking the difference between them. Further, an image region having a predetermined luminance or higher may be extracted.

と When these patterns are considered together, it becomes a concentric pattern. The controller 60 determines the corneal shape of the patient's eye E based on this concentric pattern, for example, as in Patent Document 4. At this time, the pattern from each captured image may be drawn in one frame and the concentric pattern may be analyzed, or each captured image may be analyzed separately to analyze the concentric pattern as a whole.

According to this operation example, the form of the cornea of the patient's eye E, particularly the state of corneal astigmatism can be measured. In particular, even irregular astigmatism can be measured.

[Action / Effect]
The operation and effect of the microscope for ophthalmologic surgery 1 will be described.

As described above, the microscope for ophthalmologic surgery 1 is used for observing the patient eye E to be transplanted with an intraocular lens (toric IOL80) for correcting astigmatism or the patient eye E to be applied with the LRI technique. The optical system of the microscope for ophthalmologic surgery 1 includes an illumination optical system 20 that irradiates the patient's eye E with illumination light, and an observation optical system 30 that guides the reflected light of the illumination light from the patient's eye E to the eyepiece 37.

The microscope for ophthalmologic surgery 1 acquires astigmatism information including the astigmatism axis direction of the patient's eye E. For example, there are the following two acquisition methods. In the first acquisition method, a plurality of approximately circular bright spot images are formed on the cornea of the patient's eye E and photographed, and the photographed image is analyzed to obtain astigmatism information. According to this acquisition method, the astigmatism information of the patient's eye E can be measured immediately before or during the operation. Therefore, it is necessary to perform a preoperative examination as in the past, marking with ink, marking using a protractor for surgery, and the like. Disappear. Further, since the measurement can be performed in a state where the patient is placed on the operating table, it is possible to reduce the deviation in the astigmatic axis direction due to the deviation of the posture of the patient.

The second acquisition method is applicable when astigmatism information of the patient's eye E has been measured in the past, and accepts and uses this past measurement result.

Further, the microscope for ophthalmic surgery 1 projects a light beam onto the patient's eye E based on the acquired astigmatic axis direction, and direction information for supporting the toric IOL 80 transplantation operation or a direction for supporting the LRI technique. Information is projected onto the cornea of patient eye E. This direction information may be a projection image showing the main meridian direction of the patient's eye E, or may be a projection image showing the arrangement direction of the main meridian of the toric IOL 80 according to the main meridian direction of the patient's eye E. .

The observation optical system 30 guides the reflected light of the luminous flux from the patient's eye E to the eyepiece lens 37. By looking into the eyepiece lens 37, the surgeon can visually recognize the direction information projected on the cornea together with the patient eye E and the toric IOL 80 inserted into the eye. Thereby, the surgeon can grasp the deviation between the marks 83a and 83b attached to the toric IOL 80 and the direction information.

Furthermore, the surgeon rotates the toric IOL 80 so that the marks 83a and 83b and the direction information are in a predetermined positional relationship (same direction or orthogonal direction). Thereby, the toric IOL 80 can be arranged in an appropriate direction.

Thus, according to the microscope for ophthalmic surgery 1, it is possible to arrange the toric IOL 80 in the patient eye E with high accuracy according to the astigmatism state of the patient eye E. In addition, the porting operation of the toric IOL 80 can be made smooth and efficient.

Furthermore, according to such an ophthalmic surgical microscope 1, it is possible to easily determine the incision range of the cornea of the patient eye E according to the astigmatism state of the patient eye E.

The microscope for ophthalmologic surgery 1 can present the four types of direction information described above (that is, the strong main meridian direction or weak main meridian direction of the patient's eye E, or the arrangement direction of the strong main meridian or weak main meridian of the toric IOL 80). is there. However, the ophthalmic surgical microscope according to the present invention may always present single direction information. On the other hand, when it is configured to selectively present two or more direction information, it is desirable to be able to present information indicating the type of the direction information currently being presented. The presentation method may be a visual method, an auditory method, or any other method.

Further, the microscope for ophthalmologic surgery 1 forms a plurality of bright spot images 90-k (k = 1 to 36) arranged in a substantially annular shape on the cornea of the patient's eye E. Further, the microscope for ophthalmologic surgery 1 specifies the bright spot images 90-i and 90-j at positions corresponding to the direction indicated by the direction information based on the astigmatic axis direction of the patient's eye E.

At this time, the bright spot image group 90-k does not have to be formed on the cornea yet. That is, as described above, since the bright spot image group 90-k is formed by projecting a light beam onto the patient's eye E, a specific process is performed on the side that outputs the light beam (LED group 131-k). For example, the bright spot images 90-i and 90-j are also specified.

The ophthalmic surgical microscope 1 forms the specified bright spot images 90-i and 90-j in a different manner from the other bright spot images 90-k (k ≠ i, j). Here, the different aspects mean that they can be identified by visual recognition. In this embodiment, the specified bright spot images 90-i and 90-j are blinked, and the other bright spot images 90-k are continuously lit.

Here, “flashing” and “continuous lighting” generally mean the operation of the light source, but since the luminescent spot image is also presented in the same state corresponding to the operation of the light source, the operation of the light source and the presentation of the luminescent spot image There is no particular need to distinguish between states.

The different presentation modes of the specified bright spot image and other bright spot images are not limited to blinking and continuous lighting. For example, it is possible to change the color, the brightness (brightness), or the size of the bright spot image. In any case, as long as it is an aspect that can be identified by visual recognition as described above, the specific aspect is not limited.

With this configuration, it is possible to present the bright spot image in the direction indicated by the direction information in a manner different from other bright spot images. Thereby, since the operator can clearly visually recognize the direction indicated by the direction information, the toric IOL 80 can be arranged in the patient's eye E with high accuracy. In addition, the porting operation of the toric IOL 80 can be made smooth and efficient. Furthermore, the incision range of the cornea of the patient's eye E can be easily determined.

Further, as shown in FIGS. 9 and 10, the ophthalmic surgical microscope 1 has azimuth angles of 0 degrees, 90 degrees, 180 degrees and a predetermined direction (in this embodiment, the right horizontal direction in the observation visual field) as a reference. Bright spot images 90-1, 90-10, 90-19, 90-28 corresponding to 270 degrees are formed in a color different from other bright spot images 90-k (k ≠ 1, 10, 19, 28) It is supposed to be. As a result, the above four directions, which are guides for the astigmatic axis direction and the arrangement direction of the toric IOL 80, can be clearly seen. Therefore, the toric IOL 80 can be placed in the patient's eye E with high accuracy, and the toric IOL 80 can be transplanted smoothly and efficiently.

In addition, you may make it show only the luminescent point image corresponding to arbitrary one or more azimuth | directions in a different color among 0 degree, 90 degree | times, 180 degree | times, and 270 degree | times. It is also possible to distinguish from other luminescent spot images by changing the brightness and size of the luminescent spot image corresponding to the azimuth angle as a guide.

Further, the microscope for ophthalmic surgery 1 is capable of moving the LED group 131-i along the optical axis direction of the objective lens 15 (the direction indicated by the double-sided arrow A in FIG. 2). Therefore, the size (diameter) of the substantial ring formed by the plurality of bright spot images 90-k can be changed as appropriate. As a result, the toric IOL 80 can be transplanted smoothly and efficiently, and the toric IOL 80 can be placed in the patient's eye E with high accuracy. Furthermore, it is possible to perform corneal shape measurement as described above.

It is possible to detect the position of the movable LED group 131-i in this way and perform the following control based on the detection result. This control is executed by the control unit 60. A position sensor such as a micro switch is used for detecting the position of the LED group 131-i. In addition, when the control unit 60 performs movement control of the LED group 131-i, it is possible to detect the current position of the LED group 131-i based on the history of this control operation. Here, if the position of the LED group 131-i can be detected, the specific configuration thereof is arbitrary. Further, it may be configured to detect whether the LED group 131-i is moved downward or upward.

As the first control, first, the control unit 60 determines whether the detected position of the LED group 131-i is below a predetermined position (set in advance). The position detection and determination at this time may be executed at predetermined time intervals (that is, the position may be monitored in real time). Instead of executing position detection and determination, a sensor for detecting that the LED group 131-i has been moved below a predetermined position may be provided.

If it is determined that the LED group 131-i is located below the predetermined position, the control unit 60 turns on the LED group 131-i. Conversely, when it is determined that the LED group 131-i is located above a predetermined position (which may be the same as or different from the predetermined position), the control unit 60 turns off the LED group 131-i. Further, the LED group 131-i may be turned off in response to the LED group 131-i being in the housed state. This stored state is a state in which, for example, the engaging portion of the projection image forming portion 13 and the connecting hook 18 are engaged.

According to the first control, the operation of projecting the direction information onto the patient's eye E and the operation of terminating the projection can be automated, so that the operation by the operator can be reduced. Thereby, the operator can concentrate on the operation, and can improve the safety of the operation and shorten the operation time.

As a second control, when it is determined that the LED group 131-i is positioned below a predetermined position, the illumination light source 21 is controlled to change (particularly decrease) the amount of illumination light. The amount of change in light quantity at this time can be set as appropriate. Thereby, the visibility of the projected image formed on the cornea is improved, and the efficiency and accuracy of the alignment operation of the toric IOL 80 can be improved.

Note that instead of using the position of the LED group 131-i as a trigger, the amount of illumination light may be changed using the LED group 131-i as a trigger.

Further, when the LED group 131-i is moved upward from a predetermined position or is in a storage state, or when the LED group 131-i is turned off, the amount of illumination light is changed (for example, to the original light amount). It is also possible to control to return.

As the third control, it is possible to change the observation magnification according to the detection result of the position of the LED group 131-i. For example, the observation magnification can be changed to a predetermined value in response to the LED group 131-i moving downward from a predetermined position. Further, the observation magnification can be returned to the original value in response to the LED group 131-i moving upward from the predetermined position. Note that the observation magnification is changed when the control unit 60 relatively moves the zoom lenses 31a, 31b, and 31c.

According to the third control, similarly to the first control, it is possible to improve the safety of the operation and shorten the operation time.

In the above description, the arrangement direction of the main meridian of the toric IOL 80 is obtained only from the astigmatic axis direction of the patient's eye E, but this arrangement direction may be obtained in consideration of other conditions. For example, as described in Patent Document 3 described above, a change in the astigmatic axis direction resulting from the incision of the cornea is obtained, and the arrangement direction of the main meridian of the toric IOL 80 is determined based on the astigmatic axis direction after the change. It is possible to ask. The same applies to the case where the astigmatic axis direction of the patient's eye E is presented.

[Second Embodiment]
Another embodiment of the microscope for ophthalmic surgery according to the present invention will be described with reference to FIGS. This ophthalmic surgical microscope includes projection means having a configuration different from that of the above embodiment. The projection unit is configured to include a projection image forming unit 100 shown in FIG. The configuration other than the projection unit may be the same as in the above embodiment. Hereinafter, the drawings of the above embodiments will be referred to as appropriate. In the following description, a toric IOL transplantation operation is described, but it can also be applied to a technique related to astigmatism correction such as LRI.

The projection image forming unit 100 includes a light source 101, a lens 102, a slit plate 103, a driving mechanism 104, a lens 105, and a reflecting member 106. The light beam output from the light source 101 is applied to the slit plate 103 via the lens 102.

The slit plate 103 is a disk-shaped member as shown in FIG. The portions other than the slit 103a of the slit plate 103 have light shielding properties. Therefore, a part of the light beam applied to the slit 103 is transmitted through the slit 103a to form slit light. The slit light is applied to the reflecting member 106 via the lens 105. The lens 105 acts to form a real image (a slit image 110 described later) of the slit 103a on the cornea of the patient's eye E.

The reflection member 106 is provided obliquely with respect to the slit light irradiation direction. The reflecting member 106 reflects the slit light toward the patient's eye E. Thereby, a substantially linear slit image 110 as shown in FIG. 13 (substantially rectangular when the width is taken into consideration) is projected onto the cornea of the patient's eye E. Here, the symbol Ea indicates the pupil contour.

The drive mechanism 104 rotates the slit plate 103 in the direction indicated by the double-sided arrow C in FIG. 12, that is, in the circumferential direction of the slit plate 103. The rotation center at this time is the center position of the slit 103a. Thereby, the direction of the slit 103a is changed, and the direction of the slit image 110 projected on the patient's eye E is changed. The drive mechanism 104 operates under the control of the control unit 60 shown in FIG. The configuration of the drive mechanism 104 is arbitrary as long as the slit plate 103 is rotated in the direction of the double-sided arrow C.

An example of operation of this microscope for ophthalmic surgery will be described. The microscope for ophthalmologic surgery acquires astigmatism information including the astigmatic axis direction of the patient's eye E in advance.

Based on the acquired astigmatism axis direction (weak main meridian direction), the slit direction specifying unit 64 of the control unit 60 determines the main meridian direction (strong main meridian direction or weak main meridian direction) of the patient's eye E or the main of the toric IOL 80. The direction of the slit image 110 corresponding to the direction in which the meridian (strong main meridian or weak main meridian) is to be arranged (simply called the arrangement direction) is specified. At this time, the astigmatism of the patient's eye E is assumed to be normal astigmatism. The direction of the slit image 110 is the longitudinal direction.

In addition, since the direction of the slit image 110 uniquely corresponds to the direction of the slit 103a, specifying the direction of the slit image 110 and specifying the direction of the slit 103a are synonymous. Therefore, the slit direction specifying unit 64 specifies the direction of the slit 103 a, that is, the position in the rotation direction of the slit plate 103.

The control unit 60 controls the drive mechanism 104 to rotate the slit plate 103 so that the slit 103a is arranged in the specified direction. When the driving mechanism 104 uses the starting force of the pulse motor, the control unit 60 transmits a signal including the number of pulses for rotating the slit plate 103 from the current position to the target position to the pulse motor.

Here, an example of a method for acquiring the current position of the slit plate 103 will be described. First, the current position can be acquired by referring to the control history so far. Further, when the slit plate 103 is returned to a predetermined reference position after the projection image forming unit 100 is used, this reference position is set as the current position. Further, a sensor for detecting the current position of the slit plate 103 may be provided.

Further, the difference in position (angle) between the target position and the current position is obtained, and the value of this difference is divided by the unit rotation angle of the pulse motor (rotation angle for each pulse), whereby the number of pulses is calculated. It is possible to ask.

When the slit plate 103 is rotated to the target position, the control unit 60 turns on the light source 101. Thereby, a slit image 110 as shown in FIG. 13 is projected onto the patient's eye E.

The surgeon grasps the deviation between the marks 83 a and 83 b of the toric IOL 80 and the slit image 110 and moves the toric IOL 80 so that the marks 83 a and 83 b are aligned with the slit image 110.

According to such an ophthalmic surgical microscope, the toric IOL 80 can be arranged in the patient eye E with high accuracy in accordance with the astigmatism state of the patient eye E. In addition, the porting operation of the toric IOL 80 can be made smooth and efficient. The slit direction specifying unit 64 is an example of the “specifying means” in the present invention.

[Third Embodiment]
Another embodiment of the microscope for ophthalmic surgery according to the present invention will be described with reference to FIG. In the present embodiment, the patient's eye E in a state where a plurality of bright spot images are formed is imaged a plurality of times, and the astigmatic axis direction is determined from the average value.

When the surgeon performs a predetermined operation, the control unit 60 turns on the LED group 131-i to form a plurality of bright spot images on the cornea of the patient's eye E (S10). At this time, the surgeon appropriately moves the LED group 131-i up and down to arrange a plurality of bright spot images in an appropriate size (diameter).

In this state, the control unit 60 controls the TV camera 56 to photograph the patient's eye E in a state where a plurality of bright spot images are formed a plurality of times (S11). Thereby, a plurality of captured images of Purkinje images are obtained. The shooting interval can be arbitrarily determined (for example, 0.5 seconds).

The astigmatism information calculation unit 61 analyzes each of the plurality of captured images obtained in step 11. And the astigmatism information calculation part 61 calculates | requires the astigmatic axis direction of the patient's eye E in each of several picked-up image (S12). The method for obtaining the astigmatic axis direction is the same as in the first embodiment.

Next, the astigmatism information calculation unit 61 performs an averaging process in a plurality of astigmatism axis directions obtained in step 12, and calculates an average value in the astigmatism axis direction (S13). For example, when shooting nine times in step 11, the astigmatism information calculation unit 61 excludes an astigmatic axis direction that is larger (or smaller) than a certain threshold with respect to the astigmatic axis direction of each captured image obtained by the nine shootings. Then the average value is calculated.

The light source identification unit 62 refers to the table information 63 and identifies the LEDs 131-i and 131- (i + 18) corresponding to the average value in the astigmatic axis direction calculated in Step 13 (S14).

The control unit 60 causes the specified LEDs 131-i and 131- (i + 18) to blink, and causes the other LEDs 131-j (j ≠ i, i + 18) to be continuously lit (S15).

As described above, the astigmatism information calculation unit 61 obtains an astigmatism axis direction from each of a plurality of captured images. The astigmatism information calculation unit 61 performs an averaging process in a plurality of astigmatic axis directions to calculate an average value in the astigmatic axis direction. Then, the light source identification unit 62 can blink the LED 131-i corresponding to the average value in the astigmatic axis direction to obtain an accurate astigmatic axis direction.

In step 12, instead of obtaining the astigmatic axis direction in each of the plurality of photographed images, the astigmatism information calculation unit 61 obtains the position of each LED 131-i in each of the plurality of photographed images, and each LED 131-i. Is averaged over multiple images. Based on the averaged position of each LED 131-i, the astigmatism information calculation unit 61 can determine the astigmatism axis direction.

In step 13, it is only necessary to calculate the statistical value in the astigmatic axis direction. That is, instead of calculating the average value, a median value or mode value of values in the astigmatic axis direction may be calculated. When calculating the median value, the astigmatism information calculation unit 61 calculates one value as the median value among the values in the astigmatic axis direction. When calculating the mode value, the astigmatism information calculation unit 61 calculates the most frequent astigmatic axis direction among the plurality of astigmatic axis directions. The light source specifying unit 62 can obtain an accurate astigmatic axis direction by blinking the LED 131-i corresponding to the astigmatic axis direction based on the median value or the mode value.

[Fourth Embodiment]
Another embodiment of the microscope for ophthalmic surgery according to the present invention will be described with reference to FIGS. In the present embodiment, the manner in which the LED 131-i blinks is changed based on the reliability in the astigmatic axis direction.

As shown in FIG. 16, in the present embodiment, the control unit 60 includes a reliability calculation unit 65 and a threshold processing unit 66. In FIG. 16, the description of the astigmatism information calculation unit 61 and the light source identification unit 62 is omitted.

The reliability calculation unit 65 has a function of calculating a value for evaluating the accuracy of a measurement value with respect to actual astigmatism information based on astigmatism information (astigmatism axis information) obtained from at least one photographed image. ing. When this value is obtained from one image, for example, it is calculated based on the shape of the bright spot in one image. When there are a plurality of photographed images, the value is calculated based on the variation in the position of the bright spot in each image. In the present embodiment, these values may be referred to as “reliability”.

The threshold processing unit 66 has a function of comparing and determining the reliability calculated by the reliability calculation unit 65 and the threshold. For example, the threshold processing unit 66 determines whether or not the reliability is greater than the threshold. Based on the processing result by the threshold processing unit 66, the control unit 60 causes the LED 131-i to blink. Note that the threshold value may be a default value or a value arbitrarily set by the examiner.

Next, the operation of this embodiment will be described with reference to FIG.

When the surgeon performs a predetermined operation, the control unit 60 turns on the LED group 131-i to form a plurality of bright spot images on the cornea of the patient's eye E (S20). At this time, the surgeon appropriately moves the LED group 131-i up and down to arrange a plurality of bright spot images in an appropriate size (diameter).

In this state, the control unit 60 controls the TV camera 56 to photograph the patient's eye E in a state where a plurality of bright spot images are formed (S21). Thereby, a captured image of the Purkinje image is obtained.

The astigmatism information calculation unit 61 analyzes the captured image obtained in step 21 to obtain the astigmatism axis direction of the patient's eye E (S22).

The light source identification unit 62 refers to the table information 63 and identifies the LEDs 131-i and 131- (i + 18) corresponding to the astigmatic axis direction (weak principal meridian direction) (S23).

The reliability calculation unit 65 calculates a value (reliability) for evaluating the accuracy of the actual astigmatism information in the astigmatic axis direction obtained in step 22 (S24).

The threshold processing unit 66 determines the relationship between the reliability obtained in step 24 and a preset threshold (S25). For example, when the relationship between the reliability and the threshold is determined as “threshold> reliability”, the threshold processing unit 66 performs control so that the LEDs 131-i and 131- (i + 18) blink at a frequency of 1 Hz and a DUTY ratio of 0.5. The unit 60 is instructed. On the other hand, when the relationship between the reliability and the threshold is determined as “threshold <reliability”, the threshold processing unit 66 blinks the LEDs 131-i and 131- (i + 18) at a frequency of 2 Hz and a DUTY ratio of 0.5. An instruction is given to the controller 60 (S25).

Based on the instruction from the threshold processing unit 66, for example, the control unit 60 blinks each LED 131-i, 131- (i + 18) and continuously lights other LEDs 131-j (j ≠ i, i + 18). (S26). The lighting / flashing of the LED group 131-i is not limited to this. For example, when the reliability is lower than the threshold and the difference between the reliability and the threshold is equal to or greater than a predetermined value, it is determined that the reliability is low, and the LEDs 131-( It is also possible to blink the LED 131- (i + 17) and 131- (i + 19) disposed on both sides of the i ± 1) and the LED 131- (i + 18). In this case, it is possible to inform the operator that the reliability in the astigmatic axis direction is low.

Further, when the threshold processing unit 66 determines that the reliability is lower than the threshold and the difference between the reliability and the threshold is equal to or greater than a predetermined value, instead of projecting the projection image of the LED 131-i on the eye E to be examined. In addition, it is also possible to make a notification that prompts another shooting. The notification means for performing notification may be any method that stimulates a human-recognizable sensation, such as a visual, auditory, or tactile method. Specifically, the control unit 60 performs control so as to emit a predetermined warning sound from a speaker (not shown) provided in the ophthalmic surgical microscope 1, thereby notifying the surgeon of re-imaging. Or when displaying a picked-up image on a monitor etc., it is also possible to display on the monitor screen so that another photographing may be promoted.

In the present embodiment, the description is based on astigmatic axis information obtained from one photographed image, but the present invention is not limited to this. For example, astigmatic axis information obtained from a plurality of photographed images as in the third embodiment can be used. In this case, the reliability calculation unit 65 obtains a variation in the astigmatism axis information based on each piece of astigmatism information (astigmatism axis information) obtained from a plurality of captured images, and performs a process of calculating the width of the variation as the reliability. .

Thus, by changing the blinking method of the LED group 131-i according to the relationship between the reliability and the threshold value, the operator can know the accuracy of the astigmatic axis information. Therefore, when the accuracy of the astigmatism axis information is low, accurate astigmatism axis information can be obtained by performing imaging again, etc., and appropriate surgery can be performed.

1 Ophthalmic Surgery Microscope 13 Projection Image Forming Unit 131 Head 131-i LED
132 Head connection unit 133 Arm 134 Fall prevention unit 15 Objective lens 20 Illumination optical system 30 Observation optical system 56 TV camera 60 Control unit 61 Astigmatism information calculation unit 62 Light source specification unit 63 Table information 64 Slit direction specification unit 65 Reliability calculation unit 66 Threshold processing unit 80 Toric IOL
83a, 83b Mark 90-k Bright point image 100 Projection image forming unit 101 Light source 103 Slit plate 103a Slit 104 Drive mechanism 106 Reflective member 110 Slit image E Patient's eye

Claims (18)

1. An illumination optical system for illuminating the patient's eye with illumination light;
   An observation optical system and / or an imaging system that receives the reflected light of the illumination light by the patient's eye;
   Acquisition means for acquiring astigmatism information including the astigmatism axis direction of the patient eye;
   Projecting means for forming a projected image on the patient's eye indicating a reference direction referred to in astigmatism correction by projecting a light beam onto the patient's eye based on the astigmatic axis direction included in the acquired astigmatism information;
   With
   When the observation optical system is provided, the observation optical system guides the reflected light of the luminous flux from the patient's eye to an eyepiece,
   When the imaging system is provided, the imaging system guides the reflected light of the luminous flux from the patient's eye to an imaging device.
   A microscope for ophthalmic surgery characterized by the above.
2. The projection unit projects the light flux so as to form a plurality of bright spot images arranged in a substantially annular shape as the projection image, and based on the astigmatic axis direction acquired by the acquisition unit, Including specifying means for specifying a bright spot image at a position corresponding to a reference direction from the plurality of bright spot images, and forming the specified bright spot image in a mode different from other bright spot images,
   The microscope for ophthalmologic surgery according to claim 1.
3. 2. The microscope for ophthalmic surgery according to claim 1, wherein the reference direction is a main meridian direction of the patient's eye or an arrangement direction of a main meridian of an intraocular lens corresponding to the patient eye.
4. 2. The microscope for ophthalmologic surgery according to claim 1, wherein the reference direction is a strong principal meridian direction of the cornea of the patient's eye.
5. Based on the acquired astigmatism axis direction, the specifying means is a bright spot located in the strong main meridian direction or weak main meridian direction of the patient's eye or the arrangement direction of the strong main meridian or weak main meridian of the intraocular lens An image and a bright spot image at a position facing the bright spot image in the substantially annular array are specified from the plurality of bright spot images.
   The microscope for ophthalmic surgery according to claim 3.
6. The projecting means blinks the bright spot image specified by the specifying means and continuously lights the other bright spot images;
   The microscope for ophthalmic surgery according to claim 2.
7. The specifying means determines whether or not the astigmatic axis direction acquired by the acquisition means is located between two adjacent bright spot images, and if it is determined to be located, the two bright spot images, Identify a bright spot image at a position facing each of the two bright spot images in the substantially annular arrangement,
   The projection means blinks the specified four bright spot images and continuously lights other bright spot images.
   The microscope for ophthalmic surgery according to claim 2.
8. When the projection unit forms a plurality of bright spot images arranged in a substantially annular shape on the patient's eye, the azimuth angle with respect to a predetermined direction is 0 degree, 90 degrees, 180 degrees, and 270 degrees. Forming a bright spot image corresponding to at least one of the above in a different color from the other bright spot images,
   The microscope for ophthalmic surgery according to claim 2.
9. The illumination optical system and the observation optical system include a common objective lens,
   The projection means includes a plurality of light sources provided between the objective lens and the patient's eye and arranged in an annular shape, and projects a light beam output from each of the plurality of light sources onto the patient's eye. To form the bright spot image,
   The microscope for ophthalmic surgery according to claim 2.
10. The specifying unit specifies a light source at a position corresponding to the reference direction from the plurality of light sources based on the astigmatic axis direction acquired by the acquiring unit, thereby obtaining the plurality of bright spot images at the position. Identify from the bright spot images of
    The ophthalmic surgical microscope according to claim 9.
11. The projection unit includes a holding unit that holds the plurality of light sources so that the projection unit can move along an optical axis direction of the objective lens.
    The ophthalmic surgical microscope according to claim 9.
12. The acquisition means includes
    Provided in the observation optical system, before the projection image is formed on the patient's eye, the reflected light from the patient's eye of the light beam projected by the projection means is received to photograph the plurality of bright spot images. Photographing means;
    A calculating means for obtaining an astigmatic axis direction of the patient's eye based on an arrangement state of the plurality of bright spot images taken;
    Including
    The projection unit forms a plurality of bright spot images indicating the reference direction corresponding to the calculated astigmatic axis direction as the projection image.
    The microscope for ophthalmic surgery according to claim 2.
13. The projection unit projects the light flux so as to form a substantially linear slit image as the projection image, and the projection unit corresponds to the reference direction based on the astigmatic axis direction acquired by the acquisition unit. Including specifying means for specifying the orientation of the slit image in the longitudinal direction, and forming the slit image in the specified orientation;
    The microscope for ophthalmologic surgery according to claim 1.
14. The illumination optical system and the observation optical system include a common objective lens,
    The projection means includes
    A light source;
    A slit plate formed with a slit through which a part of the light beam output from the light source passes;
    A reflecting member that is disposed between the objective lens and the patient's eye and reflects the slit light that is part of the light flux that has passed through the slit toward the patient's eye;
    A drive mechanism for rotating the slit plate around the center position of the slit so as to arrange the longitudinal direction of the slit in a direction corresponding to the direction of the slit image specified by the specifying means;
    Comprising
    The microscope for ophthalmic surgery according to claim 13.
15. The acquisition means includes
    Imaging means for receiving the reflected light from the patient's eye of the luminous flux projected by the projection means before forming the projection image on the patient's eye, and photographing the plurality of bright spot images a plurality of times;
    An arithmetic means for obtaining an astigmatic axis direction of the patient's eye based on an arrangement state of the plurality of bright spot images photographed multiple times;
    Including
    The projection unit forms a plurality of bright spot images indicating the reference direction corresponding to the determined astigmatism axis direction as the projection image;
    The microscope for ophthalmologic surgery according to claim 1.
16. Reliability calculation means for calculating reliability based on the astigmatism information;
    Threshold processing means for performing threshold processing on the calculation result by the reliability calculation means,
    The microscope for ophthalmologic surgery according to claim 1, wherein the projection unit forms the projection image on the patient's eye based on a processing result by the threshold processing unit.
17. Reliability calculation means for calculating reliability based on the bright spot image photographed a plurality of times by the photographing means;
    Threshold processing means for performing threshold processing on the calculation result by the reliability calculation means,
    The microscope for ophthalmic surgery according to claim 15, wherein the projection unit forms the projection image on the patient's eye based on a processing result by the threshold processing unit.
18. The microscope for ophthalmologic surgery according to claim 16, further comprising notification means for performing notification based on a processing result by the threshold processing means.

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