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EP2117488A1 - Système de coagulation - Google Patents

Système de coagulation

Info

Publication number
EP2117488A1
EP2117488A1 EP08707515A EP08707515A EP2117488A1 EP 2117488 A1 EP2117488 A1 EP 2117488A1 EP 08707515 A EP08707515 A EP 08707515A EP 08707515 A EP08707515 A EP 08707515A EP 2117488 A1 EP2117488 A1 EP 2117488A1
Authority
EP
European Patent Office
Prior art keywords
laser
coagulation system
coagulation
detector
signal
Prior art date
Legal status (The legal status 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 status listed.)
Withdrawn
Application number
EP08707515A
Other languages
German (de)
English (en)
Inventor
Diego Zimare
Manfred Dick
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Carl Zeiss Meditec AG
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 EP2117488A1 publication Critical patent/EP2117488A1/fr
Withdrawn legal-status Critical Current

Links

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
    • 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
    • A61F9/00821—Methods or devices for eye surgery using laser for coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00844—Feedback systems
    • A61F2009/00851—Optical coherence topography [OCT]
    • 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
    • A61F2009/00863—Retina
    • 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
    • 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
    • A61F2009/00897—Scanning mechanisms or algorithms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00817—Beam shaping with masks

Definitions

  • the invention relates to a coagulation system for the coagulation of organic tissues.
  • Light coagulation was first used in the late 1940s by the focused light of an axial high pressure lamp to treat various diseases of the retina, such as diabetic retinopathy.
  • various diseases of the retina such as diabetic retinopathy.
  • absorption of the laser beam in particular in the pigment epithelium, a lying in the retina, a dark dye, in particular melanin-bearing layer, the retina is heated and coagulated. This focuses the metabolism on the still healthy areas of the retina.
  • biochemical cofactors are stimulated. The course of the disease is significantly slowed down or stopped.
  • DE 30 24 169 describes a method for operating a photocoagulator for biological tissue.
  • DE 39 36 716 a device for the thermal modification of biological tissue is described.
  • a disadvantage of the devices described in the two publications, however, is that when they are used, tissue worth preserving, in particular the photoreceptor layer located in the beam direction in front of the retinal pigment epithelium, is destroyed.
  • the object of the present invention is therefore to provide a coagulation system for the coagulation of organic tissue which minimizes the destruction of tissue worthy of preservation.
  • a coagulation system for coagulating organic tissues comprising a laser, a detector, a control device and a breaker, wherein the laser is arranged to emit a working beam, the detector a Dimension meter and is arranged to detect a signal and forward the detection of a signal to the control device, the control device is configured to activate an interrupter, the interruption is arranged to emit the radiation of at least one wavelength of the working beam of the laser interrupt, and the signal corresponds to a degree of coagulation or degree of change of the tissue.
  • the control device is preferably set up to switch the interrupter when the detector signals exceed predetermined limit values.
  • Argon lasers, diode lasers, diode-pumped solid-state lasers, diode-pumped semiconductor lasers, frequency doubled Nd: YAG lasers, etc. are preferably used.
  • the lasers can be pulsed or used as CW lasers.
  • other light sources are also conceivable, such as, for example, focused light of a xenon lamp, of light-emitting diodes (LEDs), superluminescent diodes (SLDs), etc.
  • Laser systems, particularly preferably multi-length systems, which are set up, are preferably used Green, yellow, red and infrared wavelength to emit.
  • Wavelengths used in particular for coagulation lie in the green wavelength range (514 nm, 532 nm) where the comparatively highest absorption of the photopigment melanin is present or in the yellow spectral range (561-580 nm), where the absorption of the blood pigment hemoglobin is maximal.
  • red wavelengths 630-690 nm
  • infrared wavelengths e.g. 810 nm.
  • any device that can detect the presence of radiation is suitable.
  • the detector is preferably suitable for determining the radiation density and / or radiation direction and / or a wavelength of the radiation.
  • the detector is a smart sensor having a microprocessor.
  • the detector is a photocell, a photodiode or a photomultiplier, particularly
  • a semiconductor detector preferably of silicon or germanium, such as a charge-coupled device, particularly preferably a bolometer or pyrometer used.
  • the detectors are preferably arranged in a detection system.
  • the detection system is an interferometer.
  • any device is suitable, which can control a device depending on an input variable.
  • the controller preferably has both at least one input interface and at least one output interface.
  • the controller is programmable.
  • a connection-programmed control particularly preferably a stored-program control, is used.
  • the controller has a processor architecture.
  • any device is suitable which is adapted to interrupt the working beam of a laser in whole or in part.
  • a device which switches off the laser is used as a breaker.
  • a diaphragm which is suitable for limiting or interrupting the working beam of a laser.
  • the aperture is preferably positioned in an area through which the laser beam passes.
  • a filter is used. To interrupt the filter is preferably feasible in the working beam.
  • the filter interrupts only a part of the working jet, preferably the filter interrupts only waves of the working jet which have a certain length, more preferably the filter completely interrupts the working jet.
  • the interrupter is preferably set up to interrupt the emission of individual waves with specific wavelengths of a laser or laser system, which preferably emits waves with wavelengths in the visible range, particularly preferably waves with wavelengths in the infrared range. chen.
  • waves with wavelengths in the visible range, particularly preferably waves with wavelengths in the infrared range are interrupted.
  • the interrupter is also set up to interrupt waves independently of a detected coagulation. Thus, patient-specific pre-selected coagulation times can also be switched in series using the interrupter.
  • the intensity of waves with specific wavelengths with which the organic tissue is irradiated is preferably changed during the irradiation. More preferably, the emission of waves having a certain wavelength, or one of several specific wavelengths, is interrupted over the entire irradiation period. This makes it possible to stop the irradiation in response to the detection signal. In addition, it is possible to change the irradiation time-dependent. As a result, in particular the penetration depth of the radiation is controlled. In this way, it is possible to selectively irradiate the tissue over the irradiation period with the wavelengths which are most suitable for inducing coagulation and preventing damage to the surrounding tissue.
  • the emission of radiation having wavelengths in the infrared region is interrupted to limit penetration into the depth of the tissue. Infrared radiation has wavelengths of 780 nm to 1 mm.
  • the working beam is preferably parallel, more preferably bundled.
  • the working beam is preferably unpolarized, particularly preferably polarized.
  • a polarized working beam is elliptical, preferably circular, more preferably linear.
  • the working beam has a wavelength, preferably several different wavelengths. These wavelengths are preferably in the visible and / or infrared range.
  • the dimension meter is set up to evaluate the effect of the applied radiation.
  • a measuring microscope particularly preferably an interferometic device, a confocal device or an optical coherence tomography device or OCT device is used.
  • the OCT device preferably operates according to the "time domain principle", particularly preferably according to the "spectral domain (Fourier) principle".
  • An interferometric device is any device by which an interference pattern can be generated.
  • the interferometric device used is a Twyman-Green interferometer, preferably a Mach-Zehnder interferometer, particularly preferably a Fabry-Perot interferometer or a Michelson interferometer.
  • a confocal device a device is preferably used which has an objective for focusing light into the sample.
  • the confocal device has a light source, a beam splitter and two pinhole diaphragms.
  • light from the light source is passed through the pinhole, the beam splitter and the lens in the sample, and passed from there through the lens back to the beam splitter and the pinhole.
  • a device is preferably used which has a light source, a beam splitter, a measuring arm, a reference arm with mirror and a detector.
  • beams of the light source are directed to the mirror, the measuring arm and the detector by the beam splitter.
  • the transit time of the light on the reference arm and the measuring arm is preferably compared.
  • the interference of the individual spectral components is detected.
  • Light sources which provide a short coherence length are preferably used as the light source or radiation source.
  • An OCT signal is preferably based on scattering, particularly preferably on absorption.
  • the signal is in particular reflected and / or scattered, preferably fluorescently and particularly preferably generated thermally or acoustically.
  • the signal is preferably produced by exceeding a limit for certain properties of the radiation reflected by the organic tissue.
  • the signal is preferably the exceeding of a specific brightness value or a value for the scattering, particularly preferably the exceeding of a specific temperature value, an acoustic pressure gradient or a wavelength.
  • Waves are here spreading vibrations. Preferably, they are shock waves, more preferably periodic waves.
  • the wavelength here is the smallest distance between two points of the same phase of a wave.
  • the two points of the same phase have the same deflection and the same direction of movement over time.
  • the degree of change of the fabric preferably corresponds to a change in the spectral properties (color change) or a change in the mechanical properties such as hardness or elasticity, particularly preferably a temperature change of the fabric or its acoustic effects.
  • the laser has a clock for clocking the working beam for a period of between 10 ms and 10,000 ms.
  • clocks or fast switches for emission durations in the range of
  • the electric circuit of the pump energy is used for clocking or fast switching of the laser emission as a clock.
  • Electro-mechanical, acousto-optic (Bragg cells) or electro-optical switches (Pockels cells) are particularly preferably used for interrupting the intracavity or external resonator beam path. Pulsed power here means that a certain power is delivered in recurring equal time intervals. In this case, preferably, the period in which the power is delivered in each case the same.
  • pre-set irradiation times are preferably used in the time range of preferably 10 ms to 10 000 ms, particularly preferably about 100 ms.
  • the pulse is preferably triggered in single shot operation by the doctor for emission when he has found with the help of the aiming beam the position on the fundus.
  • the gentler selective retinal therapy preferably pulse lengths in the range from 0.1 ⁇ s to about 10 ms, more preferably 1-5 ⁇ s, are used.
  • the irradiation times are also fixed.
  • the pulse is triggered in the single-shot operation by the doctor to the emission, if he has also found with the help of the aiming beam, the position on the fundus.
  • the laser preferably has a pulse generator for pulsing the working beam with a pulse duration between 2 and 10 .mu.s, preferably between 3 and 7 .mu.s, particularly preferably 5 .mu.s.
  • a damper is preferably used in the optical resonator. It is particularly preferred to use an acousto-optic modulator or a saturable absorber as the pulse transmitter.
  • the damper which is inserted into the resonator, when switched on, prevents reflected light from being emitted. As a result, no radiation is emitted.
  • a switch is preferably used, which can switch very fast ( ⁇ 10 ns) between blocking and transmission.
  • an optical grating is produced in a transparent solid, on which the light beam is diffracted.
  • the sound waves responsible for this are generated electrically via the piezoelectric effect.
  • the saturable absorber a material having a transition whose normal state is normally occupied for the desired wavelength is preferably employed. When incorporated in the laser, this material preferably absorbs some of the laser radiation. If the absorber saturates, ie if many states are excited, the absorption preferably drops, the quality of the resonator exceeds the laser threshold and laser activity occurs for a short time.
  • the pulse duration is the period during which radiation is emitted. Preferably, this period begins with the onset of a radiation increase and ends when no radiation is emitted.
  • the pulse duration is 10 to 10000 ms, preferably 1 to 10 ⁇ s, particularly preferably lms.
  • the laser has a property control for emitting radiation in the wavelength range of 500-1064 nm.
  • a resonator is preferably used, particularly preferably in combination with a temperature control device or an electric current.
  • the temperature and / or the current sets an optical wavelength of the resonator which determines the wavelength of the wave.
  • the signal can be generated by the working beam. This is a simple way to generate a signal.
  • the signal is generated directly by the beam, which also causes the coagulation.
  • the signal is hereby preferably conducted to the detector by reflection from the organic tissue and / or scattering of the working beam.
  • the manner of reflection and / or scattering particularly preferably at least one property of the reflected and / or scattered beam, is preferably changed.
  • the signal can be generated by an auxiliary beam.
  • the signal is preferably generated independently of the working beam.
  • the characteristics of the signal can be determined by the properties of the auxiliary beam.
  • no limitation on the properties of the working beam is required. Other wavelengths and / or amplitudes and / or frequencies may be used.
  • An auxiliary beam is a beam, which is preferably used exclusively for generating the signal.
  • the auxiliary beam can be generated by a source other than the working beam.
  • the properties of the auxiliary beam can be determined in a particularly targeted manner. Thus, both the direction of the auxiliary beam and its wavelength or a composition of waves of different wavelengths, amplitude and frequency can be set independently.
  • the source can be any object that emits waves or particles.
  • light sources such as lamps, more preferably lasers are used.
  • the signal is preferably a signal that can be generated by scattering and / or reflection and / or fluorescence excitation and / or thermal excitation. This allows the signal to be generated easily.
  • the signal is generated directly by the changes in the organic tissue.
  • Scattering is the deflection of the beam through interaction with other objects. It is produced here in particular by the lens, the vitreous and / or the retina. A change in one of these objects preferably produces a change in the spread. Preferably, a change in the scattering by a change in the retina, in particular in the target area of the therapeutic laser radiation is used as a signal.
  • Reflection is the reflection of a wave from a surface. Also at the boundary layer of two media with strongly different characteristic resistances reflections occur.
  • the reflection is here preferably diffuse, particularly preferably directed. If the unevenness of the surface or boundary layer is small relative to the wavelength, directional reflection is achieved, otherwise the reflection is diffuse.
  • the signal is generated here by reflection at the retina. A change in the retina or its surface preferably alters the properties of the reflected one
  • Beam By changing the roughness and / or geometry of the surface of the retina becomes the direction of reflection affected.
  • properties of the reflected beam such as the wavelength or amplitude, are changed.
  • fluorescence excitation objects are irradiated with rays of specific wavelengths. This leads to the irradiated objects being excited to fluorescence radiation.
  • fluorescence radiation By changing the retina during coagulation, its fluorescence radiation is preferably also changed. From the change in fluorescence radiation, the degree of coagulation can be determined.
  • the signal is preferably generated by exceeding an intensity or characteristic of the fluorescence radiation.
  • thermal excitation light is preferably emitted.
  • bodies emit light.
  • solids already show additional light emissions at lower temperatures. This additional radiation occurs only on initial heating.
  • tissue is changed by thermal influence. These changes are preferably visually recognizable, particularly preferably determined by acoustic effects.
  • the signal is generated in each case by exceeding a limit value for a specific property.
  • the working beam and / or auxiliary beam preferably has waves with a wavelength in the VIS spectral range and / or IR spectral range.
  • the working beam particularly preferably has waves with a wavelength both in the VIS spectral range and in the IR spectral range.
  • the auxiliary beam particularly preferably has waves with a wavelength in the VIS range. Spectral range and not in the IR spectral range. This prevents the auxiliary beam from penetrating into the retina and unnecessarily heating the retina by waves with wavelengths in the IR spectral range.
  • the VIS spectral range has waves with wavelengths from 380 to 750 nm.
  • the IR spectral range includes waves with wavelengths from 780 nm to 1 mm.
  • the dimension meter is preferably a laterally and / or depth direction defined treatment zone scannable. Thereby, the state of the tissue in each area of the treatment zone can be determined.
  • the treatment zone is scanned without contact, preferably measured values are recorded and, with particular preference, stored.
  • the dimension meter has an OCT detector.
  • a detector is preferably used in which short-coherent light is used with the aid of an interferometer, preferably a Michelson interferometer for distance measurement.
  • the Michelson interferometer preferably has a beam splitter or semitransparent mirror in which radiation is split and reunited.
  • a photodetector more preferably a line sensor is used.
  • a time or a spectral domain or frequency domain method is used in the distance measurement.
  • the dimension meter preferably has a confocal detector.
  • a confocal detector is preferably a detector with a light source, two pinhole, a beam splitter and a lens used.
  • the excitation light is focussed into the sample through one of the pinhole apertures, the beam splitter and the objective. This excitation light is preferably reflected by the sample and imaged on a pinhole. Behind the pinhole is preferably an evaluation. Preferably, the light passing through the pinhole is evaluated. Preferably, the sample is scanned and an image composed of the results.
  • the confocal detector is set up in the coagulation system according to the invention to be aligned with a treatment area of the retinal tissue.
  • a detection signal which is registered by a single photodetector and of the scattering or absorption in it
  • Point directly depends on the invention can be used to assess the coagulation progress online.
  • a change of the detection signal can thus be assigned directly to the coagulation progress. If the change in the detection signal corresponds to a predetermined value that corresponds to the desired degree of coagulation, the laser exposure of the retinal tissue can be stopped online.
  • the dimension meter has a confocal OCT detector. It is preferably provided to use a confocal detector and an OCT detector combined in order to increase the significance of the signal, ie to improve the signal-to-noise ratio. In this confocal OCT arrangement, the change in the detection signal can also be evaluated and used for online shutdown of the laser exposure of the retinal tissue.
  • the dimension meter has a laser vibrometer.
  • a laser vibrometer With the help of a laser vibrometer, acoustic effects, which reflect the degree of change of the tissue, for example, during a laser therapy on the fundus of the eye, are detected.
  • Laser vibrometers work on the principle of Doppler frequency shift. The laser light backscattered by a vibrating object provides all information for the determination of object velocity and absolute oscillation amplitudes.
  • a scanning vibrometer detects the movement of several measuring points simultaneously.
  • a single-point vibrometer captures the movement of a single point of measurement.
  • a 3D laser vibrometer simultaneously acquires all three directions of acceleration at one measuring point.
  • laser vibrometry uses the acoustic signal of a damped oscillation or, in a pulsed multi-pulse irradiation, the induced tissue oscillations occurring thereby for analysis.
  • the pilot beam of the therapeutic laser system which is inevitably positioned at the site of the therapy on the ocular fundus, used in addition to its target function at the same time for laser vibrometry.
  • the described one-point vibrometer is sufficient.
  • a part of the reflected therapy laser light is used for laser vibrometry.
  • Particular preference is given to using a further independent laser wavelength for laser vibrometry.
  • this detection technique in the non-contact method is particularly advantageous.
  • it is used in a fundus camera with ophthalmoscope lens as a carrier system of the therapy laser. It is particularly preferably used in a slit lamp with contact glass.
  • the dimension meter has a laser vibrometer in an optically confocal arrangement to the treatment area on.
  • interference signals that are caused by areas not located in the focus area of the therapy spot of the laser are suppressed and the signal-to-noise ratio is improved.
  • the coagulation system preferably has a localization system for locating the treatment zone (s) and / or assigning the treatment zone (s) to a fundus image. This can be used to determine where an organic tissue has been treated. This is helpful for a subsequent coagulation treatment of organic tissues after initial treatment.
  • a coordinate system is preferably used, on which the treatment zones are marked.
  • the coordinate system is preferably a Cartesian coordinate system, particularly preferably a polar coordinate system.
  • the fundus image used is preferably the inclusion of a retina. Particularly preferred is a recording of the retina of the treated patient is used.
  • the localization system preferably uses position data of the scanner system which aligns the therapeutic laser beam and the associated confocal and / or OCT detector with the respective treatment point on the fundus of the eye.
  • the reference of these position data to the individual eye fundus of the patient is preferably produced by establishing the reference to a retinal coordinate system at the beginning of the treatment in such a way that significant points such as the fovea and the optic disc are centrally positioned with the aiming beam containing the corresponding position data Scanner unit registered.
  • associated system parameters preferably the contact glass used and / or the magnification and / or the image angle are coregistered. Accordingly, the treatment data record is also available for later interventions and can perform a targeted treatment or safely assess the success of therapy.
  • the localization system preferably offers the possibility of treating areas which have already been treated intraoperatively during a follow-up examination and / or aftertreatment, e.g. with a correspondingly scanned pilot or aiming beam to mark and / or border.
  • a scaling for different image acquisition modalities is provided in the localization system.
  • a registration is provided on the basis of significant features, preferably of the nerve fiber head and / or the macula, particularly preferably of the blood vessels on the eye fundus, for the purpose of accurate image overlay.
  • a calibration of the position data of the laser scanner unit is provided on the respective target image to finally ensure a clear assignment of all data.
  • the localization system preferably has a memory for the subsequent localization of the treatment zones.
  • semiconductor memories such as flash memories, magnetic memories such as hard disks, or optical memories such as CDs may be used as memories.
  • Fig. 1 is a schematic view of a coagulation system according to the invention.
  • Fig. 2 is a schematic view of a second embodiment of a coagulation system according to the invention.
  • FIG. 1 an inventive coagulation system 1 is shown.
  • the coagulation system 1 has a laser 10 with an acousto-optical modulator 13 and a resonator 14, at whose output end a breaker 40 is arranged. Both the laser 10 and the breaker 40 are connected to a controller 30.
  • the control device 30 is in turn connected to a detector 20.
  • the laser 10 emits a working beam 15.
  • the working beam 15 is directed to the treatment zone 60 of a retina 50 of a human eye. From the retina 50, the working beam is reflected as a spherical wave 17. A part of the spherical wave 17 is redirected to the detector 20.
  • the indirectly backscattered laser light or fluorescent light is detected with a ring diaphragm.
  • the laser 10 selectively emits radiation at one wavelength or at up to four different wavelengths.
  • the acousto-optic modulator 13 switches very quickly between blocking and transmitting, so that the waves are pulsed.
  • Resonator 14 has a modular design and can optionally emit four different wavelengths (e.g., yellow, green, red, infrared).
  • This laser radiation causes a coagulation effect on the retina.
  • blood vessels of the retina are closed here, among other things.
  • the retina is divided into different areas that are assigned to different therapy zones. Different irradiation profiles, ie sequences of irradiation with waves which have specific wavelengths in the VIS and / or IR range, are used in the different therapy zones.
  • the output of the source is for Performing selective retinal therapy (SRT) pulsed.
  • SRT selective retinal therapy
  • the pulse duration in which power is delivered is 5 ⁇ s.
  • This short pulse radiation of 5 ⁇ s can be applied with a repetition frequency of 100 Hz (10-10000Hz).
  • RPE retinal pigment epithelium
  • an individually adapted pulse train length is generated in this operating regime with the aid of the detector 20.
  • a predetermined change of the detection signal to a limit value of, for example, 100 Hz / 5 ⁇ s quasi-continuous pulse train with the aid of the interrupter 40 or the acousto-optical modulator 13 is interrupted.
  • the light energy is absorbed by the tissue of the retina, converted into heat and thereby leads to denaturation or coagulation of the tissue. Complete coagulation destains the retina. The area of the retina, in which there is complete coagulation, no longer supports vision.
  • the reflected spherical wave 17 changes. This changed spherical wave 17 is deflected to a detector 20.
  • the detector 20 has an OCT detector 23, which radiates its measuring radiation coaxially to the treatment laser 10 onto the treatment zone 60 and at the same time superimposes the backscattered signal with an internal reference signal with respect to the treatment zone with exact position.
  • the detector 20 sends this information to the controller 30. Thereafter, the controller 30 shuts off the laser 10.
  • the laser 10 is switched off online even at first tissue changes in order to avoid collateral tissue damage, in particular the photoreceptor layer.
  • the coagulation equipped to interrupt different treatment wavelengths in the visual and infrared range independently. The effect on the tissue can therefore be controlled both temporally and spectrally.
  • waves with wavelengths in the infrared range are interrupted when sufficient coagulation has taken place in deeper tissue layers of the retina.
  • Fig. 2 shows a second embodiment of a coagulation system according to the invention.
  • the signal is generated by an auxiliary beam 16.
  • the auxiliary beam 16 here has a wavelength in the visual spectral range. It is directed to the retina 50, reflected from there as a spherical wave and directed to a detector 20.
  • the detector 20 has a confocal detector 24, by which the wavelength of the beam can be determined.
  • the detector 20 can check the condition of the retina in various areas.
  • the measuring point of this OCT detector 23 is aligned with the "coagulation" spot of the laser or therapy laser 10.
  • a detection signal which is registered by a single photodetector or a line sensor and by the scattering or absorption in this point directly The change in the detection signal can thus be directly associated with the coagulation progress If the change in the detection signal corresponds to a predetermined value that corresponds to the desired degree of coagulation, the laser exposure of the retinal tissue is stopped online.
  • the control device 30 is connected to a recording system 31. This recording system records the location and intensity of the treatment. It is set up to display the treatment locations on a previously recorded fundus image. This allows subsequent localization of the treatment zones. This is helpful for follow-up treatments.

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  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Optics & Photonics (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Laser Surgery Devices (AREA)
  • Investigating Or Analysing Materials By Optical Means (AREA)
  • Radiation-Therapy Devices (AREA)

Abstract

L'invention concerne un système de coagulation (1) destiné à la coagulation des tissus organiques, en particulier de la rétine (50), présentant un laser (10), un détecteur (20), un dispositif de contrôle (30) et un interrupteur (40), le laser (10) étant réglé pour émettre un faisceau de travail (15), le détecteur présentant un mesureur dimensionnel (22) et étant réglé pour détecter un signal correspondant à un degré de coagulation du tissu et rediriger la détection du signal vers le dispositif de contrôle (30) , le dispositif de contrôle (30) étant réglé pour activer un interrupteur (40), et l'interrupteur (40) étant réglé pour interrompre l'émission de rayonnement pour au moins une longueur d'onde du faisceau de travail (15) du laser (10).
EP08707515A 2007-02-05 2008-02-01 Système de coagulation Withdrawn EP2117488A1 (fr)

Applications Claiming Priority (2)

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DE102007005699A DE102007005699A1 (de) 2007-02-05 2007-02-05 Koagulationssystem
PCT/EP2008/000834 WO2008095659A1 (fr) 2007-02-05 2008-02-01 Système de coagulation

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DE102007005699A1 (de) 2008-08-07
WO2008095659A1 (fr) 2008-08-14

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