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WO2021239600A1 - Système basé sur le laser et les uv pour corriger des troubles de la vision - Google Patents

Système basé sur le laser et les uv pour corriger des troubles de la vision Download PDF

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Publication number
WO2021239600A1
WO2021239600A1 PCT/EP2021/063606 EP2021063606W WO2021239600A1 WO 2021239600 A1 WO2021239600 A1 WO 2021239600A1 EP 2021063606 W EP2021063606 W EP 2021063606W WO 2021239600 A1 WO2021239600 A1 WO 2021239600A1
Authority
WO
WIPO (PCT)
Prior art keywords
eye
support arm
therapy device
laser therapy
base station
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.)
Ceased
Application number
PCT/EP2021/063606
Other languages
German (de)
English (en)
Inventor
Hartmut Vogelsang
Wolfgang Kern
Christoph HÄCKER
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 WO2021239600A1 publication Critical patent/WO2021239600A1/fr
Anticipated expiration legal-status Critical
Ceased 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
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • 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
    • A61F9/009—Auxiliary devices making contact with the eyeball and coupling in laser light, e.g. goniolenses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A61B2090/506—Supports for surgical instruments, e.g. articulated arms using a parallelogram linkage, e.g. panthograph

Definitions

  • the present invention relates to ultra violet laser (UVL) based laser vision correction (LVC) systems, i.e. systems for ametropia correction by means of laser radiation, the corresponding treatment laser emitting in the ultraviolet range, such as excimer lasers or solid-state lasers with wavelengths between approx. 193 nm and 213nm. These systems are typically pulsed systems, i.e. systems that do not emit continuous waves.
  • UVL-LVC systems are used to process the cornea of a patient's eye starting from its surface by means of photoablation, or to process a volume starting from the exposed area under a folded-away surface of the cornea of the patient's eye.
  • the invention also relates to corresponding methods for UVL-LVC systems.
  • the invention can also be used in ophthalmic systems in which the eye or the cornea is irradiated with longer light pulses or continuous light.
  • UVL-LVC systems such as the MEL systems from Carl Zeiss Meditec AG, the Amaris systems from Schwind eye-tech Solutions GmbH or the Micron systems from Excelsius Medical GmbH, have long been successfully used systems for ametropia correction. Nevertheless, they have a number of inadequacies or disadvantages, for which solutions are to be shown here.
  • a rigid laser beam guidance system is provided in today's UVL-LVC systems. Although this facilitates safe laser beam guidance, it makes it necessary to move the patient on a patient bed by means of this patient bed below a fixed system aperture in x, y, z coordinates until the patient's eye intended for treatment is correctly positioned relative to the optical axis of the system.
  • An exception is the system described in US 2013/0226157 A1, in which the laser arm, which is rigid per se, is positioned as a whole over the patient, but in such a way that it is still necessary to position the patient over the patient bed.
  • the latter often requires the patient to lie down for safety reasons are electrically and / or mechanically connected to the basic laser unit, which in turn enforces system approval and requires a large space.
  • a flap is typically only 100 ⁇ m thick and after the LASIK incision is only attached to the cornea by a very narrow "hinge", the hinge. Maintaining the hydration of the flap is very important for pathological reasons, but also to maintain the shape of the flap, since dehydrated flaps shrink within seconds.
  • a shrunk flap no longer “fits” well into the stromal bed (which of course is also due to the change in shape of the stroma surface due to the ablation), which in turn can lead to post-operative complications (e.g. “epithelial ingrowth”). If possible, flaps should not be folded, pulled or otherwise stressed.
  • Pulse ablation shape corresponds to the fluence distribution of the irradiated ablation laser pulse on a plane perpendicular to the direction of incidence
  • the pulse ablation shape is deformed by the geometry of the radiation on the cornea to the "Pulse ablation footprint on cornea” and thus changes Fluence distribution compared to the irradiated "Pulse ablation shape”.
  • the Fresnel losses can be calculated with the help of the Fresnel equations with knowledge of the refractive indices of air and cornea (or stroma) and the angle of incidence.
  • the polarization of the light must also be taken into account. Due to the relatively large working distance of known UVL-LVC systems to the patient's eye, it is difficult or even impossible to use back reflections from the cornea of the patient's eye for analysis, and this also makes centering difficult. The influence of inaccurate centering is well known and has been widely discussed in the literature. The "common" argument that centering errors, i.e.
  • Aberrations couple with decentering. Due to the coupling of the sphere and cylinder to higher-order aberrations (coma, spherical aberration, higher-order astigmatisms), including those that occur in natural (aspherical) eyes, decentering in real eyes, but also with purely spherical-cylindrical corrections, is critical . Eg adds Coma Decentering on astigmatism and defocus or spherical aberration on coma, astigmatism and defocus. A few examples are to be given here which initially only show the effects for the primary aberrations (up to the 4th order).
  • transition zones have not yet been mentioned.
  • decentering also means that transition zones can extend into the optically active zone, especially in the case of hyperopia corrections. This then leads to disturbances ("night vision complaints post surgery", here is not meant night myopia) in mesopic to scotopic light conditions and thus to patient dissatisfaction.
  • Pupil centering (centering to the CSC, “Corneal Sighting Center”) can be achieved well and safely in refractive surgery using eye tracking systems (“eye trackers”) as integrated pupil recognition.
  • eye tracking systems eye tracking systems
  • this type of centering is not the preferred choice, as it is now undisputed among experts that centering to the ophthalmic pole (visual axis, coaxially sighted corneal light reflex, "CSCLR", condition, see below) would be correct.
  • CSCLR coaxially sighted corneal light reflex
  • Hyperopic eyes are typically characterized by a non-negligible angle between the pupillary axis and the visual axis ("angle kappa"). Corneal Sighting Center and Ophthalmie Pole are no longer close enough to one another, which leads to a difference between "angle lambda” and "angle kappa”. In addition, the pupil and the pupil center are not a fixed mark. Both fluctuates with the lighting conditions.
  • the user moves the treatment center manually based only on the visual comparison to a topography measurement. Or he enters displacement coordinates into the system, which are usually given in relation to the pupil center (CSC) and which are taken, for example, from a topography measurement.
  • CSC pupil center
  • the problem is that the pupil diameter during the topography measurement does not match the pupil diameter under the laser due to the differences in illumination.
  • the frequently occurring displacement of the pupil center with the pupil size then results in a non-optimal centering, since the corneal vertex is not correctly determined.
  • UVL-LVC systems do not offer a method of tomographic alignment of the anterior chamber and tomographic centering. This can become important, e.g. in the case of corneal irregularities (e.g. caused by trauma or brief swelling of the corneal surface due to bubbles after femtosecond laser flap generation), which lead to the corneal vertex and / or the Purkinje reflex not being found correctly or in other words, a position is identified as a vertex which does not correspond to the normal physiological vertex position. The pure “surface information” of the cornea is then not, or not sufficiently, suitable for determining the optimal centering.
  • corneal irregularities e.g. caused by trauma or brief swelling of the corneal surface due to bubbles after femtosecond laser flap generation
  • the pure “surface information” of the cornea is then not, or not sufficiently, suitable for determining the optimal centering.
  • the object of the present invention is therefore to describe devices and a method which address the above-mentioned problems of currently used UVL-LVC systems.
  • the positioning of the patient's eye with respect to the laser beam guidance should be simplified.
  • the UVL-LVC system comprises a base station with a light source for generating light pulses, a carrier arm that is attached to the base station, an application part that is attached to the carrier arm and can be placed on an eye, the application part means for projecting the Having light pulses on the eye tissue, an optical transmission system which is designed to transmit the light pulses from the base station through the carrier arm to the application part, the carrier arm being made in several parts and the individual parts of the carrier arm being oriented by swivel joints whose axes of rotation are essentially parallel to one another are connected to each other. It is particularly advantageous if the support arm consists of three parts which are connected to one another by two swivel joints.
  • the applied part is also advantageously connected to the distal end of the support arm via a further swivel joint, the axis of rotation of which runs essentially parallel to the axes of rotation of the aforementioned swivel joints.
  • the system according to the invention also advantageously has positioning means for a rotary movement of the parts of the support arm parallel to a positioning plane for positioning the application part above the eye.
  • the support arm is attached to the base station in a height-adjustable manner.
  • the base station can comprise a column to which the support arm is attached, and this column can be vertically movable for vertical positioning of the support arm.
  • the base station can be positioned vertically.
  • the base station has means for beam shaping and beam deflection of the light pulses.
  • light pulses are not restricted to a specific pulse length, so that they can also come from a continuous light source. Furthermore, light is not restricted to visible wavelengths, and ultra-violet or infrared radiation is also included.
  • Fig. 2 a schematic view of the UVL-LVC system
  • Fig. 3 an embodiment of a swivel joint
  • Fig. 4 the UVL-LVC system in a rest position
  • the UVL-LVC system 1 does not have a rigid laser beam guidance system, but instead a multi-part articulated support arm 2, as shown in FIG. 1, which is mounted on a mobile laser unit.
  • the articulated arm 2 itself is realized by three swivel joints (DG1, DG2, DG3), the axes of rotation of the joints running essentially parallel to one another and perpendicular to the x-y plane. By means of these joints, the articulated arm 2 can only be displaced and positioned in the x, y direction over the patient's eye 3.
  • the overall system 1 can be adjusted in the fleas or a column 4 can be moved vertically relative to the base unit 5.
  • the patient 6 can thus remain stationary on a bed 7.
  • a specially movable bed 7 is not required.
  • the UVL-LVC system 1 can be used as a mobile system. Due to the small footprint and the articulated arm 2, the system can be positioned very variably (e.g. in cramped conditions in the operating room) to bed 7 and other systems; that is, without a fixed scheme as in other systems of the prior art. The mobility also enables the necessary cleaning and disinfection in a particularly simple manner.
  • an application part 8 which is rotatably mounted via the swivel joint DG3 (angle of rotation to the eye 3 with the axis of rotation along the z-direction).
  • the placement of the contact interface 10 attached to the application part 8 onto the eye 3 can furthermore be supported, for example, by a horizontal stripe projection (for example by scanning a suitable laser).
  • the application part 8 with contact interface 10 can be aligned with the control of the projected strip by turning the application part 8 itself (swivel joint DG3) on the eye 3 - e.g. to the corner of the eyelid - in order to avoid a static cyclic rotation of the eye 3 to the system. Any turning of the patient's head during the treatment does not affect the quality of the treatment.
  • Registration data obtained during the diagnosis of the patient can preferably be used in order to enable an automatic cyclic rotation correction.
  • a reference image obtained after alignment of the contact interface 10 in the sucked-in state of the eye 3 is used, which is compared with the registration data of the diagnosis in order to calculate a transformation of the laser pulse coordinates to compensate for the cyclic rotation.
  • FIG. 2 shows a more schematic representation of the UVL-LVC system according to the invention.
  • the laser head 11 for the ablation laser, power supplies, and other components necessary for operating the laser are accommodated in the mobile base unit 5.
  • the treatment laser beam is transmitted via known beam shaping optics and beam deflecting optics (scanners), which are contained in the structural unit 12, various deflecting mirrors, among others, in the swivel joints DG1 to DG3 by means of suitable optics inside the column 4 and the multi-part support arm 2 guided over the application part 8 and contact interface 10 to the patient's eye 3 (not shown here).
  • the base unit 5 can furthermore camera systems for monitoring, detection systems for example for the quality of the laser beam or also an OCT (Optical Coherence Tomography) system for displaying the eye before or during the operation.
  • OCT Optical Coherence Tomography
  • the beam path from the beam exit at the laser head 11 to the application part 8 and the articulated arm 2 can preferably be evacuated before triggering the UV laser pulses in order to reduce laser losses or interactions of the UV radiation with gases in the beam path.
  • the possible formation of ozone could damage the optical components.
  • Possibilities for measuring the joint positions (i.e. angles) of the swivel joints DG1 to DG3 are also advantageously provided, which can be necessary for the conversion of the image in the optical system.
  • the swivel joints DG1 to DG3 are preferably designed as slide bearings. However, other embodiments are also possible. For example, the bearings could also be designed as pressure roller bearings.
  • the joints can be braked / locked using electro- or magneto-mechanical systems or similar.
  • Fig. 3 shows an example of a suitable swivel joint.
  • the swivel joint has a deflection mirror 13 with a finely adjustable holder 14 and the actual bearing 15.
  • the laser beam 16 is directed highly precisely inside the support arm 2 to the next following swivel joint or the application part 8 by the order of the steering mirror.
  • FIG. 4 shows the UVL-LVC system 1 according to the invention in a parked position of the articulated arm 2.
  • the articulated arm 2 In this position, the articulated arm 2 is in the “folded” position, for example for transport in the operating room or when the system is not in operation.
  • the parking position has a lock (not shown here) for this purpose.
  • the calibration of the system before use could also take place in this position, for example in that the pulse energy of the UV laser can be determined and regulated in this parking position. Since the deflections (90 ° deflection over 45 ° mirror) of the laser beam 16 in the support arm 2 in connection with small scanner deflections only require small deviations of the deflections of 90 °, only very small changes in the pulse energy occur depending on the arm positioning.
  • FIG. 5 shows a variant of the application part 8 at the distal end of the articulated arm 2 with a display 17 which, for example, via a touch control, operating units for height adjustment along the z-axis (column 4 or base unit 5), lighting, control elements for the contact interface 10 (e.g. suction ablation products, suction eye) can realize.
  • a display 17 which, for example, via a touch control, operating units for height adjustment along the z-axis (column 4 or base unit 5), lighting, control elements for the contact interface 10 (e.g. suction ablation products, suction eye) can realize.
  • the contact interface 10 itself is connected to the application part 8 by the user via an interface.
  • the application part can also contain a 2D or 3D camera system for visualization.
  • the operating situation can then be visualized via additional screens 18 on the mobile base unit 5; these can also be designed as 3D-capable screens.
  • the application part 8 optionally has an integrated display 17 for the 2D camera. The user then has a visual impression in the natural direction directly on the patient's eye 3.
  • a stereoscopic view can also be provided, as shown schematically in FIG. 6, which serves for the stereographic superimposition of the images from two cameras in a 3D arrangement.
  • the images 19 from these cameras can then be viewed by the user on a focusing screen 21, for example via a suitable double-sided mirror 20.
  • a focusing screen 21 for example via a suitable double-sided mirror 20.
  • Other embodiments are also conceivable.
  • the view advantageously takes place in the direction of the real patient's eye 3.
  • the application part optionally has an integrated continuous light source, the light of which cross-links the cornea and thus stabilizes it.
  • a description of a device based on method features applies analogously to the corresponding method with regard to these features, while method features correspondingly represent functional features of the device described.

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

Abstract

L'invention concerne un dispositif de thérapie au laser à usage ophtalmologique comportant un bras de support en plusieurs parties destiné à une partie d'application qui peut être orientée par rapport à un oeil, les parties individuelles du bras de support étant reliées l'une à l'autre par des articulations rotoïdes qui sont orientées sensiblement parallèlement l'une à l'autre.
PCT/EP2021/063606 2020-05-24 2021-05-21 Système basé sur le laser et les uv pour corriger des troubles de la vision Ceased WO2021239600A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102020206420.2 2020-05-24
DE102020206420.2A DE102020206420A1 (de) 2020-05-24 2020-05-24 UV-Laser basiertes System zur Fehlsichtigkeitskorrektur

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WO2021239600A1 true WO2021239600A1 (fr) 2021-12-02

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PCT/EP2021/063606 Ceased WO2021239600A1 (fr) 2020-05-24 2021-05-21 Système basé sur le laser et les uv pour corriger des troubles de la vision

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DE (1) DE102020206420A1 (fr)
WO (1) WO2021239600A1 (fr)

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5364390A (en) * 1988-05-19 1994-11-15 Refractive Laser Research And Development, Inc. Handpiece and related apparatus for laser surgery and dentistry
EP1731120A1 (fr) * 2005-06-09 2006-12-13 SIE AG, Surgical Instrument Engineering Dispositif ophthalmologique destiné à l'ablation de tissus des yeux.
US20130226157A1 (en) 2012-02-24 2013-08-29 Cheng-Hao Huang Laser beam ophthalmological surgery method and apparatus
US20140194957A1 (en) * 2010-09-30 2014-07-10 Cxl Ophthalmics, Llc Ophthalmic treatment device, system, and method of use
US9592156B2 (en) 2012-02-24 2017-03-14 Excelsius Medical Co. Ltd. Laser beam ophthalmological surgery method and apparatus
DE102016206535A1 (de) * 2016-04-19 2017-10-19 Carl Zeiss Meditec Ag Behandlungssystem für ophthalmologische Zwecke mit Überlastungsschutz

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3823836A1 (de) 1988-07-14 1990-01-18 Fraunhofer Ges Forschung Verfahren zum vermessen von der bestueckung von leiterplatten dienenden bauelementen und einrichtung zur durchfuehrung des verfahrens
CH708619A1 (de) 2013-09-26 2015-03-31 Ziemer Ophthalmic Systems Ag Patienteninterface für ophthalmologische, optische Therapie- und Diagnoseeinrichtung.
DE102016204032A1 (de) 2016-03-11 2017-09-14 Carl Zeiss Meditec Ag Ophthalmologisches Lasertherapiesystem

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5364390A (en) * 1988-05-19 1994-11-15 Refractive Laser Research And Development, Inc. Handpiece and related apparatus for laser surgery and dentistry
EP1731120A1 (fr) * 2005-06-09 2006-12-13 SIE AG, Surgical Instrument Engineering Dispositif ophthalmologique destiné à l'ablation de tissus des yeux.
US20140194957A1 (en) * 2010-09-30 2014-07-10 Cxl Ophthalmics, Llc Ophthalmic treatment device, system, and method of use
US20130226157A1 (en) 2012-02-24 2013-08-29 Cheng-Hao Huang Laser beam ophthalmological surgery method and apparatus
US9592156B2 (en) 2012-02-24 2017-03-14 Excelsius Medical Co. Ltd. Laser beam ophthalmological surgery method and apparatus
DE102016206535A1 (de) * 2016-04-19 2017-10-19 Carl Zeiss Meditec Ag Behandlungssystem für ophthalmologische Zwecke mit Überlastungsschutz

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