CN102325490B - 使用角膜中心的眼内透镜对准 - Google Patents

使用角膜中心的眼内透镜对准 Download PDF

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CN102325490B
CN102325490B CN201080008314.6A CN201080008314A CN102325490B CN 102325490 B CN102325490 B CN 102325490B CN 201080008314 A CN201080008314 A CN 201080008314A CN 102325490 B CN102325490 B CN 102325490B
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pupil center
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I·李维斯
J·H·塔拉默
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Alcon Research Co ltd
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Abstract

一种用于生成针对眼的辐射状对准向导的方法包括收集术前角膜地形图数据。所述数据包括未扩大眼的角膜顶点位置和瞳孔中心位置。所述方法随后包括在眼被扩大之后定位该眼的已扩大瞳孔中心。所述方法还包括确定角膜顶点和已扩大瞳孔中心之间的经调节的偏移并且基于所述经调节的偏移将对准数据显示在该眼的图像上。

Description

使用角膜中心的眼内透镜对准
相关申请
本申请要求于2009年2月19日提交的、序列号为61/153,709的临时申请和于2009年2月26日提交的、序列号为61/155,562的临时申请的优先权。
背景技术
眼内透镜(IOL)的旋转定向对于现代白内障手术而言正变得越来越重要。尽管已开发出了涉及自动眼跟踪的复杂算法用以在激光视力校正手术期间监测瞳孔中心和角膜缘，但是这些算法中的每一个都需要眼主动地注视目标的能力。该方法可能无法用于诸如白内障手术的程序中，在所述程序中典型地使用麻醉剂，例如眼周麻醉剂注射，导致眼不能自主地聚焦或注视目标。即使当使用局部麻醉时，患者也会因为在IOL被***并且旋转就位时瞳孔必须保持扩大而难以保持注视并且无法使用生理瞳孔。
激光视力校正治疗可以被定位为居中于生理瞳孔上。然而对于居中于晶状体(其已被去除)囊袋或睫状沟的内部的眼内透镜，IOL的中心点与角膜顶点比与瞳孔中心更紧密地相关，这是因为囊袋和睫状沟的解剖结构更紧密地对应于角膜顶点。如果IOL的旋转轴基于瞳孔中心，则对准必须参考扩大瞳孔进行确定，这是因为在正常眼中相对于光或调节刺激的收缩或扩大，未扩大瞳孔的中心(瞳孔形心)将变化多达1mm。与之相比，扩大瞳孔的中心保持更为恒定。
发明内容
在本发明的某些实施例中，一种用于生成针对眼的辐射状对准向导的方法包括收集术前角膜地形图数据。所述数据包括未扩大眼的角膜顶点位置和瞳孔中心位置。所述方法随后包括在眼被扩大之后定位该眼的已扩大瞳孔中心。所述方法还包括确定角膜顶点和已扩大瞳孔中心之间的经调节的偏移并且基于所述经调节的偏移将对准数据显示在眼的图像上。在特定实施例中，具体化为计算机可读介质的软件可由处理器执行以实现这类方法的各步骤。
在其他实施例中，一种用于生成针对眼的辐射状对准向导的***包括存储器、处理器和显示器。所述存储器可操作以存储术前角膜地形图数据，所述数据包括未扩大眼的角膜顶点位置和瞳孔中心位置。所述处理器可操作以在眼被扩大之后定位该眼的已扩大瞳孔中心并且确定角膜顶点和已扩大瞳孔中心之间的经调节的偏移。所述显示器可操作以基于所述经调节的偏移将对准数据显示在该眼的图像上。
附图说明
可以参考以下附图理解本发明，在附图中：
图1示出了具有辐射状网格覆盖的眼的图像。
图2示出了根据本发明特定实施例的外科手术***的框图。
图3示出了根据本发明特定实施例的生成外科显示的示例性方法。
具体实施方式
在本文中公开了用于在仰卧位置确定眼的角膜顶点的定位和眼球旋转位置的技术，因为其与在未麻醉眼在垂直坐位注视目标期间确定的眼位置相关。一旦角膜顶点的位置被确定，随后可以连同该角膜顶点使用虹膜、巩膜或眼球的结膜或巩膜外组织上的解剖学标志来创建两个或以上参考点，因此允许眼表面上的特定子午线的角(以度计)的可再现定位，这又可以准确确定眼内透镜在眼内部的旋转位置，从而校正散光或其他不对称光学像差。
如上所述，眼内透镜(IOL)在囊袋或睫状沟中的解剖学放置更接近地对准角膜顶点。而且，IOL经常被设计为校正主要由角膜形状产生的折射误差，例如像差。角膜形状又例如在患者注视的情况下使用角膜地形图测量器相对于角膜顶点被确定。对于多数患者，视轴将与角膜顶点对准，使得由此得到的测量值将关于角膜顶点测量角膜地形图，包括角膜的任何折射像差。即使在视轴相对于角膜顶点成角(通常标记有被称为“kappa”的角)使得患者注视产生测量值和角膜顶点之间的微小未对准的情况下，对准仍然将大体相对接近。因此，角膜顶点是为成功折射校正确定IOL的正确对准(例如为了校正散光而确定正确旋转对准)的更合适的参考点。本发明的各种实施例通过使用角膜顶点作为参考而有利地允许IOL的更精确定位。
现在将更详细地论述本发明的特定实施例的各种方面。根据本发明特定实施例的一个方法示例可以作为一系列步骤被描述。在第一步骤中，可以使用局部用药实现瞳孔的完全药物性扩大。
在第二步骤中，受试者可以垂直坐位，头和下巴位于裂隙灯显微镜或类似装置中。在该位置，可以拍摄眼前段的角膜地形图像和照片并且使用软件进行分析。在一实施例中，照片可以具有足以允许识别作为眼解剖结构的一部分或者由外科医生或其他卫生保健提供者放置的结膜、巩膜外或巩膜标志的品质和清晰度。
在第三步骤中，可以使用商业上可获得的地形图测量器软件来分析角膜地形图像，并且可以确定角膜顶点相对于已扩大瞳孔的中心的位置。适当的x，y偏移然后可以被应用于成像软件，以便使用角膜顶点作为网格的中心点在眼或它的图像上创建辐射状网格覆盖(例如，360度)。
在第四步骤中，当在外科手术期间眼被扩大并且患者处于仰卧位置时可以例如通过手术显微镜从解剖学标志和重叠在眼视图上的网格的位置确定眼内透镜旋转放置的适当轴。
在特定实施例中，可以在每个步骤(或若干步骤，或步骤之间，或以某些其他重复方式)测量瞳孔直径以保证它在整个程序期间保持相对恒定，因此始终提供更精确的测量值。
通常，当瞳孔被扩大时利用地形图测量器或类似软件获得的眼地形图和瞳孔中心之间的关系可能变化。因此，例如在一患者体内当瞳孔未扩大时在瞳孔和角膜中心之间可能有0.55mm的水平距离和0.11mm的垂直距离。在一类似患者体内，当眼扩大时在瞳孔和角膜中心之间可能有大约0.57mm的水平距离的偏移，但是几乎没有垂直偏移。因此，即使使用瞳孔定心，也可能必须使测得的地形图再对准瞳孔以便将地形图精确地映射到瞳孔的中心。
通常，分析几何学基本原理表明如果我们希望将极坐标系的极点从(0，0)移动到(r0，θ0)，并且保持新极轴平行于旧极轴，则我们得到使新坐标(r′，θ′)与旧坐标相关的以下方程：
r′＝sqrt(r2+r0 2+2rr0cos(θ-θ0)，
θ′＝arctan([rsin(θ)+r0sin(θ0)]/[rcos(θ)+r0cos(θ0)])，
x＝rcos(θ)，
y＝rsin(θ)，
r＝±sqrt(x2+y2)，
θ＝arctan(y/x)。
在该情况下，我们可以假设(r，θ)是根据原点在瞳孔中心的极坐标系的患者眼上的标志点的坐标。可以使用各种图像分析技术对瞳孔中心进行定位，包括但不限于在Gray等人的美国专利No.5,740,803中所述的技术，上述专利通过引用被合并于本文中。有序对(r0，θ0)是由地形图测量器计算的角膜中心相对于瞳孔中心的坐标并且(r′，θ′)是根据原点在角膜中心上的坐标系的标志点的新坐标。
在一个例子中，当与角膜中心相对参考瞳孔中心测量标志点时误差计算表征为角度值误差。具体地，瞳孔中心和角膜中心之间大约0.5mm的水平距离导致标志点的角度值的大约9°误差。考虑到在校正下每1°的误差引起3％的散光，校正散光或光学像差的IOL与不对称光学器件的旋转对准的该量值的误差对IOL植入物的校正效果是有害的。
图1示出了具有辐射状网格覆盖的眼图像。覆盖可以居中于例如瞳孔或角膜顶点。上述过程可以用于一种***，所述***自动定位瞳孔的中心以根据地形图测量器读数再分配新的坐标系原点并且然后使用角膜顶点(如上所述)作为网格的定心点将360度网格覆盖在眼图像上。换句话说，可以使用本文中所述的技术捕捉从瞳孔中心到角膜顶点的偏移来改善自动瞳孔定心***，这可以被应用于基于位于眼的图像内的瞳孔中心将辐射状网格覆盖居中于角膜顶点上。该***例如可以有用地用于提供复曲面眼内透镜或其他定向敏感光学植入物的外科手术向导或放置和/或定向。本领域普通技术人员将容易领会使这样的***合适地适应从瞳孔中心到角膜顶点的偏移，并且所有这样的变型或修改应当属于本公开的范围内。
上述方法或过程及其步骤可以在适合于特定应用的硬件、软件或它们的任何组合中实现。硬件可以包括通用计算机和/或专用计算机设备。图2是根据本发明特定实施例的用于生成外科显示的***100的框图。***100包括具有处理器104的控制台102。处理器104可以是一个或多个微处理器、微控制器、嵌入式微控制器、可编程数字信号处理器或其他可编程器件，连同有内部和/或外部存储器106。处理器104也可以或替代地具体化为专用集成电路、可编程门阵列、可编程阵列逻辑或可以被配置为处理电子信号的任何其他器件或器件的组合。存储器106可以是任何合适形式的数据存储装置，包括易失性的或非易失性的电子、磁或光存储器，所述存储器包括代码108，所述代码包括由处理器104执行的指令。还将领会可以使用可以被存储、编译或解释以在以上器件以及处理器、处理器体系结构的异构组合或不同硬件和软件的组合中的一个上运行的结构化编程语言(例如C)、面向对象编程语言(例如C++)或任何其他高级或低级编程语言(包括汇编语言、硬件描述语言和数据库编程语言和技术)来创建计算机可执行代码108。
在图2所示的实施例中，***100还包括用于在外科手术期间观察眼的显示器108和显微镜110。显示器108可以包括用于生成针对眼的对准向导的任何合适的输出设备，包括打印机、视频显示器或光投影仪。在特定实施例中，显示器108可被耦接到显微镜110使得图像被投影到显微镜的视野中。显微镜110可以是用于视觉地检查眼的任何合适的工具，其可以包括电子和/或光学视图。
图3是例示了用于生成针对眼的辐射状对准向导的示例性方法的流程图200。在步骤202，收集术前角膜地形图数据，所述数据包括未扩大眼的角膜顶点位置和瞳孔中心位置。在步骤204，在眼已扩大之后定位眼的已扩大瞳孔中心。在步骤206，确定角膜顶点和已扩大瞳孔中心之间的经调节的偏移。在步骤208，基于所述经调节的偏移将对准数据显示在该眼的图像上。
因此，在一个方面，上述每一种方法及其组合可以具体化为计算机可执行代码，当在一个或多个计算机设备上执行时，所述计算机可执行代码实现所述方法的各步骤。在另一个方面，所述方法可以具体化为实现其各步骤的***，并且可以以许多方式发布在设备上，或者所有功能性可以被整合到专用、独立设备或其他硬件中。在另一个方面，用于执行与上述过程相关的步骤的手段可以包括上述的硬件和/或软件中的任何一个。所有这样的排列和组合应当属于本公开的范围内。
尽管已结合详细显示和描述的优选实施例公开了本发明，但是本领域的技术人员将显见对其进行的各种修改和改进。

Claims (12)

1.一种用于生成对准向导以相对于眼精确定位眼内透镜的***，包括：
存储器，其可操作以存储包括未扩大眼的角膜顶点位置和瞳孔中心位置的术前角膜地形图数据、角膜顶点位置和瞳孔中心位置之间的偏移和基于偏移创建的眼内透镜的术前对准数据；
处理器，其可操作以在该眼被扩大之后定位眼的图像的已扩大瞳孔中心并且确定角膜顶点和已扩大瞳孔中心之间的经调节的偏移，以及基于经调节的偏移创建眼内透镜的经调节的对准数据；以及
显示器，其可操作以将经调节的对准数据显示在该眼的图像上。
2.根据权利要求1所述的***，其中经调节的对准数据的显示包括辐射状网格。
3.根据权利要求1所述的***，其中经调节的对准数据的显示包括相对于该眼的至少一个子午线的显示。
4.根据权利要求1所述的***，还包括手动可移动以向所述处理器指示瞳孔的中心的定点设备。
5.根据权利要求1所述的***，其中所述处理器可操作以使用图像分析软件定位瞳孔中心。
6.根据权利要求1所述的***，其中经调节的对准数据的显示包括显示复曲面眼内透镜的圆柱轴。
7.一种用于生成对准向导以相对于眼精确定位眼内透镜的设备，包括：
收集术前角膜地形图数据的装置，所述术前角膜地形图数据包括未扩大眼的角膜顶点位置和瞳孔中心位置；
确定角膜顶点位置和瞳孔中心位置之间的偏移的装置；
基于偏移创建眼内透镜的对准数据的装置；
使用图像分析软件在该眼被扩大之后定位眼的图像的已扩大瞳孔中心的装置；
确定角膜顶点和已扩大瞳孔中心之间的经调节的偏移的装置；
基于经调节的偏移创建眼内透镜的经调节的对准数据的装置；以及
将经调节的对准数据显示在该眼的图像上的装置。
8.根据权利要求7所述的设备，其中显示经调节的对准数据的装置包括显示辐射状网格的装置。
9.根据权利要求7所述的设备，其中显示经调节的对准数据的装置包括相对于该眼显示至少一个子午线的装置。
10.根据权利要求7所述的设备，其中定位瞳孔中心的装置包括手动移动定点设备以指示瞳孔的中心的装置。
11.根据权利要求7所述的设备，其中定位瞳孔中心的装置包括使用图像分析软件自动定位瞳孔中心的装置。
12.根据权利要求7所述的设备，其中显示经调节的对准数据的装置包括显示复曲面眼内透镜的圆柱轴的装置。
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