WO2013057176A1 - Système de laser ophtalmologique et procédé de traitement chirurgical au laser de la cornée - Google Patents

Système de laser ophtalmologique et procédé de traitement chirurgical au laser de la cornée Download PDF

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Publication number
WO2013057176A1
WO2013057176A1 PCT/EP2012/070631 EP2012070631W WO2013057176A1 WO 2013057176 A1 WO2013057176 A1 WO 2013057176A1 EP 2012070631 W EP2012070631 W EP 2012070631W WO 2013057176 A1 WO2013057176 A1 WO 2013057176A1
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WO
WIPO (PCT)
Prior art keywords
cornea
laser
scattered light
unit
light intensities
Prior art date
Application number
PCT/EP2012/070631
Other languages
German (de)
English (en)
Inventor
Dieter Grebner
Matthias Reich
Original Assignee
Carl Zeiss Meditec Ag
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Carl Zeiss Meditec Ag filed Critical Carl Zeiss Meditec Ag
Publication of WO2013057176A1 publication Critical patent/WO2013057176A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
    • A61F9/00827—Refractive correction, e.g. lenticle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00878—Planning
    • A61F2009/00882—Planning based on topography

Definitions

  • the invention relates to an ophthalmic laser system with a
  • Treatment beam path which includes a pulse laser, and a
  • Detection beam path comprising an optoelectronic detector, and a method for laser surgical treatment of the cornea, in particular for the purpose of a refractive correction.
  • the cornea of the human eye has internal mechanical stresses. This tension structure can co-determine the shape of the cornea and thus cause, for example, defective vision.
  • the invention has for its object to provide an ophthalmic laser system of the type mentioned, which is a laser surgery treatment of Cornea with high accuracy allows, especially taking into account internal mechanical stresses of the cornea.
  • the object is achieved by an ophthalmic laser system having the features specified in claim 1, and by a method having the features specified in claim 12.
  • an ophthalmic laser system is provided with a detection beam path which comprises an optoelectronic detector for (depth-selective) detection of light of precisely a variably adjustable polarization state, a first variably adjustable beam deflection unit and a transfer optic, and a treatment beam path comprising an ultrashort laser second variably adjustable beam deflection unit and a focusing optics, as well as a control unit, a calculation unit and an evaluation unit, wherein
  • the evaluation unit is set up to carry out the following steps:
  • the calculation unit is set up to carry out the following steps:
  • the control unit for controlling the laser, the first deflecting unit and the focusing optics is set up based on the control data.
  • determined different directions of the cornea by the first deflection unit is set differently and for each position first and second
  • Scattered light intensities are determined with different polarization states. As a result, a three-dimensional model can be determined and adapted, which allows a higher accuracy.
  • an ultrashort pulse laser is a laser capable of emitting radiation pulses with a duration in the fs or ps range.
  • Mechanical stresses are preferably internal stresses in the corneal tissue.
  • a determination of scattered light intensities is highly selective in the sense of the invention if scattered light intensities from different depths of the cornea can be recorded with depth resolution either simultaneously or sequentially.
  • the invention allows the surgical treatment of the cornea with high
  • the evaluation unit, the calculation unit or the control unit can output the voltages determined on the basis of the model such that they can be visually perceived by an operator.
  • the unit in question may receive instructions from the operator to modify the model.
  • the mechanical model can be composed, for example, according to US 2009/0187386 A1 of finite elements, their position and mechanical
  • the direction from the cornea, from which the scattered light intensities are determined defines from which location in the cornea the detected scattered light is recorded.
  • at least one first scattered light intensity, which (exclusively) has the first polarization state, and at least one second scattered light intensity, which (exclusively) has the second polarization state is determined from a location.
  • first and second scattered light intensities can be determined from a plurality of different locations of the cornea.
  • Scattered light intensities are determined, for example, be adjusted by means of an adjustable beam deflection unit.
  • first and second scattered light intensities can then be recorded by the new location.
  • a three-dimensional model can be identified and adjusted which allows higher accuracy.
  • third and further scattered light intensities can be determined for additional polarization states and used in the adaptation.
  • the evaluation unit determines a topography of the cornea from which to adapt the model to the light intensities
  • the laser system comprises a
  • Topographiemessvortechnisch determined or predetermined topography data of the cornea adapt. Also in this way the accuracy of the model can be improved.
  • Illumination beam path to be coupled with a light source and the
  • Evaluation unit be set up to carry out the following steps before determining the first scattered light intensity:
  • Embodiments in which the detection beam path has optics which directs light of the light source which is directed onto the cornea by means of the first deflection unit are directed perpendicularly to the cornea independently of a position of the first deflection unit, in particular with the arrangement of FIGS Optics on a side of the transfer optics facing away from the laser.
  • Attachment optics may be, for example, a diffractive or refractive element and consist of a lens or a lens combination. Their focal length preferably corresponds to their distance from the cornea plus about 8 mm, so for example 20 mm. The vertical incidence of the illumination light and the vertical detection at each location of the cornea simplify the adaptation of the model, since the
  • Birefringence so only occurs along a minimum path length through the cornea.
  • control unit is expediently designed to carry out the following steps:
  • the fixing device Deactivate the fixing device after determining the scattered light intensities.
  • the stress states of the cornea can be measured in a defined deformed state of the cornea.
  • the deformation may be, for example, a applanation through a plane contact glass.
  • Measurement of light intensities with different polarization states without external deformation and before or after a corresponding measurement with external deformation are performed and the light intensities from both measurements are used in the adaptation of the model.
  • the same defined deformation can be simulated in the model.
  • the strength of the cornea can be determined with higher accuracy.
  • the adaptation of the mathematical model to the determined scattered light intensities is carried out by the calculation unit or the control unit and / or
  • the detector is an optical coherence tomograph (OCT) or designed to confocal with the second focusing optic detection. These detectors allow depth discrimination with high axial resolution.
  • OCT optical coherence tomograph
  • WO 2010/07020 A2 be formed with other programming of the local control unit, the disclosure of which is incorporated herein in its entirety.
  • Scattered light intensities determine a length of the eye and a thickness of the lens. Based on these data, a cataract operation can be performed in the same treatment, for example in the form of an anterior or posterior capsulorhexis by means of the ultra-short pulse laser, the destruction of the biological lens or irradiation of the epithelial cells arranged equatorially in the capsular bag.
  • the evaluation unit, the calculation unit and the control unit are the same unit and / or
  • the first and second deflection units are the same deflection unit and / or
  • the invention also includes an OCT that detects a topography of the cornea, either by means of an integrated topography measuring device
  • the invention comprises an ophthalmological measuring device for receiving scattered light from a cornea, having an illumination beam path which comprises a light source, and a detection beam path coupled to the illumination beam path, which has an optoelectronic detector for (depth-selective) detection of light of precisely one variably adjustable light
  • Polarization state a variably adjustable beam deflecting unit and a transfer optics, wherein the common behind the coupling point beam path is characterized by an optic, which light of the light source, which is directed by means of the deflection on the cornea, regardless of a position of the
  • Deflection unit perpendicular to the cornea directs, in particular with arrangement of the optics between the coupling point and a closing element to the outside, for example, a cover glass.
  • the invention can be used in particular in the following applications:
  • cataract operation for limbal relaxation incisions or transparent corneal incisions.
  • ReLEx refractive lenticle
  • refractive treatments such as femtosecond LASIK or cataract surgery (for limbal relaxation incisions, transparent corneal incisions and / or to reduce corneal astigmatism).
  • ICR implantation to select the ICR and / or optimize the ICR position.
  • Fig. 1 shows a first laser system consisting of a measuring device, a
  • Fig. 2 shows a second laser system in which the three devices are combined in one and
  • FIG. 3 shows a flowchart of a method for the laser surgical treatment of the cornea.
  • Fig. 1 shows a schematic representation of an ophthalmic laser system 1, the separate devices, namely a measuring device 1 .1, a
  • the patient's eye 2 is first placed in the examination area in front of the measuring device 1 .1 for measuring the cornea 3, and later in the treatment area in front of the irradiation device 1 .3 for irradiation.
  • the measuring device 1 .1 comprises a detector 12, for example a
  • Spectral space OCT (engl., "Spectral-domain OCT"), in conjunction with a polarization beam splitter 5 and a defined for example motor defined about the optical axis of the system 1 rotatable ⁇ / 2 plate 15 adjustable
  • a scanning optics 6 is polarization-discriminating, a scanning optics 6, an x-y deflection unit 7 ("scanner unit"), an example z-focusable transfer optics 8 and a
  • Beam splitter 5 a lighting beam C coupled, in which a
  • Light source 10 is arranged, which emits unpolarized IR light. Between the laser system 1 and the eye 2, an optical attachment 13 is arranged all on the Cornea 3 focused rays regardless of their angle of incidence perpendicular to the cornea 3 directs.
  • the detector 12 accordingly receives in the reverse direction scattered light from the cornea 3 and converts its intensity into a digital quantity, which is output to the evaluation unit 1 1 .1.
  • the evaluation unit 1 1 .1 set the direction from which light is picked up by the cornea 3. It may also be the light source 10 with respect to the emitted intensity and the wave plate 15 with respect to the single polarization state transmitted to the detector 12 (here: the
  • the evaluation unit 1 1 .1 switches on the light source 10 and sets the detector 12 to a first one
  • Polarization state by correspondingly rotates the wave plate 15 and sets by the deflection unit 7, a first direction of incidence of light from the cornea 3. Then, it simultaneously detects first intensities of illuminating light backscattered at different depths in the cornea from the first direction.
  • the determination can be carried out sequentially from different depths, and then places the deflection unit 7 back in a different direction of incidence from that of the cornea 3 Then, it simultaneously detects further first intensities of illumination light backscattered at different depths in the cornea from the second direction.
  • This scanning operation is repeated for a plurality of directions of incidence.For the retina, no stray light is scattered into the detection beam path D because it is outside of the retina Coherence range of the OCT
  • Embodiments (not shown) with confocal detection the retina is outside the confocal area.
  • the evaluation unit 1 1 .1 sets the detector 12 to a second one
  • Polarization state which is different from the first polarization state, by rotating the wave plate 15 in another position, for example by 90 °, and sets the deflection unit 7, for example, in the first (incidence) direction. It then simultaneously detects second intensities of illumination light backscattered at different depths in the cornea from the first direction of the cornea. Subsequently, it adjusts the deflection unit 7, for example, to the second direction of incidence of the cornea 3. Then it simultaneously detects further second intensities of backscattered at different depths in the cornea
  • Evaluation unit 1 1 .1 a mathematical (standard) model of a cornea 3, which describes a topography and mechanical stresses,
  • the computing unit 1 1 .2. It adjusts the model to the detected scattered light intensities using different light propagation velocities for the two polarization states. For this purpose, for example, it can simulate the birefringence of light under the measured incident directions by means of ray tracing (English, "ray tracing") and carry out a compensation calculation with ray tracing parameters.
  • ray tracing English, "ray tracing”
  • the calculation device 1 .2 is, for example, a commercial computer with a central processing unit, a calculation unit 1 1 .2
  • Main memory and a display which is connected via two interfaces on the one hand to the evaluation unit 1 1 .1 and on the other hand to the control unit 1 1 .3.
  • the calculation unit 1 1 .2 can for example provide the evaluation unit 1 1 .1 with data for adapting the patient-customized model of the cornea 3, for example an intraocular pressure and general mechanical properties of the cornea 3. This data can be provided by the calculation unit 1 1 Receive treatment via an input device or read from a database.
  • a cut geometry to be generated in the cornea for example by receiving it from the practitioner or a database, and iteratively adapts it based on this model by predicting a deformation of the cornea on the basis of the customized model of the cornea 3 to a predetermined target criterion, for example one predetermined refractive effect or a given Topography, is reached. Subsequently, the calculation unit 1 determines 1 .2
  • Control data for a laser cut on the basis of the previously adapted cutting geometry and outputs this to the control unit 1 1 .3.
  • the irradiation device 1 .3 comprises in addition to the control unit 1 1 .3 a
  • Ultrashort pulse laser 4 for example a Yb fiber laser, a scanning optics 6, a second xy deflection unit 7 '("scanner unit"), a z-focusing optics 8' and a cover glass 9, which together form a treatment beam path B, which belongs to
  • a fixing device 14 with a contact lens for the eye 2 is arranged between the laser system 1 and the eye 2.
  • the contact lens can be spherical, plane, eye-curved or one
  • there is a spherical curvature in which the cornea 3 is fixed in the fixed (eg.
  • the control unit 1 1 .3 receives the control data from the calculation unit 1 1 .2, fixed on a signal of the practitioner out the eye 2 in the
  • Focusing optics 8 ' based on this control data so that the adapted laser cut is generated in the cornea 3. Finally, it releases the fixing device 14. Finally, the practitioner removes the tissue separated by means of the radiation pulses.
  • any other adjustable polarization-selective element may be used in place of the polarization beam splitter 5 and waveplate 15 combination. So it is possible, for example, the first scattered light intensities in a linear
  • the detection beam path can be designed fiber-optically.
  • the setting of the respectively to be detected polarization state can then be done for example via variable fiber optic elements.
  • the optical attachment 13 can be arranged within the measuring device 1 .1, for example between the
  • FIG. 2 an alternative laser system 1 is shown schematically, in which all three devices are combined in one. However, the operation corresponds to that described for Fig. 1 as far as nothing else is described below.
  • the detection beam D is by means of the polarization beam splitter 5 in the
  • Treatment beam path B coupled, the same time as
  • Illumination beam C is used by a beam attenuator 17 in the
  • Treatment beam B can be pivoted.
  • the laser 4 can serve as a light source 10, in the swung-out state it is used to process the cornea 3.
  • the control unit 1 1 is simultaneously evaluation,
  • Calculation unit This can for example be realized by appropriate software modules that interact with each other via interfaces.
  • Fig. 3 shows the sequence of a method according to the invention in the form of a
  • the first and second scattered light intensities are determined for different polarization states and by means of the deflection unit 7 from different directions from the cornea, that is, from different locations of the cornea.
  • the deflection unit 7 from different directions from the cornea, that is, from different locations of the cornea.
  • Topographiemessvortechnisch for example, is coupled into the detection beam path, the topography of the cornea measured and in the form of
  • Topographies be provided.
  • topographical data can be determined, for example, from the scattered light intensities determined by means of the detector 12.
  • a thickness of the cornea 3 is determined in this way.
  • a given mechanical model of a general cornea is determined according to the thickness of the cornea and topographical data from the topography data and adjusted based on the determined scattered light intensities due to birefringence to the mechanical stresses patient-specific, for example by means of a finite element method (FEM) and a simulation of
  • FEM finite element method
  • Adaptation of the model for example, a given intraocular pressure and predetermined general mechanical properties are used.
  • the FEM model comprising the topography and the mechanical stresses is then used to iteratively optimize a given cutting geometry by means of a compensation calculation: for this purpose, the cut is made in the
  • Deviation of the model from a given target criterion determined. If the deviation is greater than a predetermined one
  • control data which include spatial control data for a deflection unit 7 'and a focusing unit 8' in order, for example, to generate gas bubble fields as cut surfaces by means of optical breakthroughs.
  • the patient then has to place his eye 2 in the treatment area.
  • Deflection unit 7 'and the focusing unit 8' are radiation pulses in
  • Target volumes V registered, which cause the precalculated optical breakthroughs in the target volumes V. LIST OF REFERENCES

Abstract

2.1. Les systèmes de lasers ophtalmologiques (1) connus, comprenant un trajet de faisceau de détection (D) qui contient un détecteur optoélectronique (12) pour détecter la lumière et un trajet de faisceau de traitement (B) qui contient un laser à impulsions ultracourtes (4), n'offrent qu'une précision limitée pour le traitement de la cornée. 2.2. Cette précision peut être augmentée en utilisant un détecteur (12) pour détecter de la lumière qui possède exactement un état de polarisation réglable de manière variable et un module déviateur de faisceau réglable (7/7') dans chacun des deux trajets de faisceaux, en relevant avant de traiter la cornée des intensités de lumière diffusée ayant des états de polarisation différents, provenant de la même direction, et en y adaptant un modèle de cornée afin de déterminer une géométrie de coupe à générer et de l'adapter à une déformation prédite au moyen du modèle. Ceci permet un traitement chirurgical très précis de la cornée car l'état biomécanique de la cornée est pris en compte, y compris ses contraintes mécaniques internes lors de l'incision. 2.3. Correction de l'amétropie.
PCT/EP2012/070631 2011-10-20 2012-10-18 Système de laser ophtalmologique et procédé de traitement chirurgical au laser de la cornée WO2013057176A1 (fr)

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Application Number Priority Date Filing Date Title
DE102011116760A DE102011116760A1 (de) 2011-10-20 2011-10-20 Ophthalmologisches Lasersystem und Verfahren zur laserchirurgischen Behandlung der Cornea
DE102011116760.2 2011-10-20

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Cited By (1)

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Publication number Priority date Publication date Assignee Title
DE102022122164A1 (de) 2022-09-01 2024-03-07 Heidelberg Engineering Gmbh Vorrichtung zur Ermittlung der Länge eines Objekts, insbesondere der Länge eines Auges

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DE102021130664A1 (de) 2021-11-23 2023-05-25 Schwind Eye-Tech-Solutions Gmbh Verfahren zum Bereitstellen von Steuerdaten für einen Laser einer Behandlungsvorrichtung

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DE102006016968A1 (de) 2006-04-11 2007-10-18 Gehm, Ulrich, Dr. Reflexionspolariskop zur Sichtbarmachung der Spannungsstrukturen in der menschlichen Cornea
DE102006036800A1 (de) * 2006-08-07 2008-02-14 Carl Zeiss Meditec Ag Vorrichtung zur individuellen Therapieplanung und positionsgenauen Modifikation eines optischen Elements
WO2009033111A2 (fr) 2007-09-06 2009-03-12 Lensx Lasers, Inc. Ciblage précis d'une photodisruption chirurgicale
US20090187386A1 (en) 2008-01-18 2009-07-23 Bille Josef F Finite element modeling of the cornea
WO2009127921A2 (fr) 2008-04-16 2009-10-22 20/10 Perfect Vision Operations Gmbh Système et procédé pour altérer des distributions de contraintes internes pour refaçonner un matériau
WO2010007020A1 (fr) 2008-07-14 2010-01-21 Philip Morris Products S.A. Languette de canal de formation pour un appareil de fabrication de filtres
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WO2011116306A2 (fr) * 2010-03-19 2011-09-22 Avedro, Inc. Systèmes et méthodes d'application et de surveillance de thérapie oculaire

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DE102006016968A1 (de) 2006-04-11 2007-10-18 Gehm, Ulrich, Dr. Reflexionspolariskop zur Sichtbarmachung der Spannungsstrukturen in der menschlichen Cornea
DE102006036800A1 (de) * 2006-08-07 2008-02-14 Carl Zeiss Meditec Ag Vorrichtung zur individuellen Therapieplanung und positionsgenauen Modifikation eines optischen Elements
WO2009033111A2 (fr) 2007-09-06 2009-03-12 Lensx Lasers, Inc. Ciblage précis d'une photodisruption chirurgicale
US20090187386A1 (en) 2008-01-18 2009-07-23 Bille Josef F Finite element modeling of the cornea
WO2009127921A2 (fr) 2008-04-16 2009-10-22 20/10 Perfect Vision Operations Gmbh Système et procédé pour altérer des distributions de contraintes internes pour refaçonner un matériau
WO2010007020A1 (fr) 2008-07-14 2010-01-21 Philip Morris Products S.A. Languette de canal de formation pour un appareil de fabrication de filtres
DE102008062658A1 (de) * 2008-12-17 2010-06-24 Carl Zeiss Meditec Ag Ophthalmologisches Lasersystem und Betriebsverfahren
WO2011116306A2 (fr) * 2010-03-19 2011-09-22 Avedro, Inc. Systèmes et méthodes d'application et de surveillance de thérapie oculaire

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102022122164A1 (de) 2022-09-01 2024-03-07 Heidelberg Engineering Gmbh Vorrichtung zur Ermittlung der Länge eines Objekts, insbesondere der Länge eines Auges

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