201010685 六、發明說明： 本發明係關於一種用於眼科手術的雷射裝置。201010685 VI. INSTRUCTIONS: The present invention relates to a laser device for ophthalmic surgery.
在人類眼科手術中，已知許多治療方法，在該等方法 中將雷射輻射引導至眼睛上以便由入射雷射輻射與眼睛之 相互作用而達成指定治療目的。例示性治療類型為雷射屈 光手術，該手術設法藉助於該雷射輻射來改變光學系統「眼 睛」之成像性質。由於人眼睛之成像性質主要由角膜決定， 因此在許多情況下雷射屈光眼科手術涉及角膜治療。在該 治療中，特定切口應用及/或特定物質移除造成角膜形狀改 變-雷射屈光手術之-突出實例A LASIK (雷射原位角膜 成型術）。 眼睛之其他雷射手術治療可涉及眼睛之晶狀體或其他 70件’且用以例如消除白内障或其他病理變化。In human ophthalmic surgery, a number of treatments are known in which laser radiation is directed to the eye to achieve a specified therapeutic purpose by the interaction of incident laser radiation with the eye. An exemplary type of treatment is laser refractive surgery, which seeks to alter the imaging properties of the "eyes" of the optical system by means of the laser radiation. Since the imaging properties of the human eye are primarily determined by the cornea, in many cases laser refractive ophthalmic surgery involves corneal treatment. In this treatment, specific incision application and/or specific substance removal results in corneal shape changes - laser refractive surgery - highlight example A LASIK (laser in situ keratoplasty). Other laser surgical treatments of the eye may involve the lens of the eye or other 70's and are used, for example, to eliminate cataracts or other pathological changes.
—通申，需要在雷射治療可開始之前對眼睛進行精確固 疋出於此目的，已知提供獨立固定光源之慣例，該獨立 固定光源發射弱固定光束且患者之視野固定於其上。奸 療開始之前’治療醫師檢查眼睛之正確中心、，亦即，醫師 檢查患者眼睛之視野是否如預枝引導至固U源上。若 滿足條件，則醫師啟動雷站& $ 勒雷射裝置，使得雷射治療可開始。 然而，迄今為止，醫師枘 可3b客觀度量並瞭解眼睛之正 確中心。醫師僅可依貪# 八 身對欲治療之眼睛的主觀觀 察。因此’可能容易發生以 卜滑况醫師未注意到，串、老 之視野未固定於固定光调μ 〜 疋九源上，而是固定於與其鄰近之另一 點上。 5 201010685 光源上 二::::===:== 為達成此目的，本發明提供一種用於眼科手術的雷射 裝置’其包含： "工作雷射器’其用於提供工作雷射輻射. •一固定光源； •一測試光束源，其用於在欲治療之眼睛的方向上發射 一測試光束； -偵測構件，其用於偵測自眼睛沿測試光束之光束方向 反射的測試光束之背反射； -一控制電腦，其耦接至測試光束源及偵測構件；及 -用於該電腦之控制程式，該控制程式含有執行定中心 測試之指令，以便在欲藉助於工作雷射輻射進行眼睛治療 之前檢驗該眼睛於該固定光源上之固定，該定中心測試包 含由測試光束源發射測試光束，隨後由偵測構件檢查該測 試光束之背反射是否可偵測，且最後依賴於測試結果由該 控制電腦產生控制信號。 測試光束在欲治療之眼睛上產生背反射，例如經由在 角膜之前表面上反射及/或在角膜與眼睛前房之間的界面上 反射。偵測構件較佳以僅偵測自眼睛與入射測試光束同轴 反射之背反射的方式排列及實現。由於人眼睛表面並非精 確的球表面，且通常眼睛之旋轉中心亦與眼睛表面曲率之 中點不同’因此測試光束之共線反射實質上僅在眼睛之單 201010685 位置中實現。^患者將眼睛自此—位置移開，例如藉由 將視野引導至不同點上，則此導致反射光束之角度相對於 測試光束之入射方向有較大或較小程度的傾斜。僅當測試 光束正交入射至欲治療之眼睛表面上時，其恰好在相同方 向上反射，且可由伯測構件谓測。若固定光源經定位使得 僅在患者視野適當固定至固定光束上時方實現測試光束之 同軸反射狀況，則確保在偵測到具有足夠強度之背反射 ❹ 時，患者之眼睛經適當定中心。從而醫師可獲得檢查眼睛 正確中心之客觀標準。 偵測構件較佳根據干涉量測原理來操作。詳言之，可 使測試光束源及積測構件作為根據光學短相丨反:量敎 原理操作之0LCR測厚計配置的一部分。測厚計一般用於 非接觸式地量測眼睛之角膜厚度。另外，可能實現相對於 雷射裝置之參考點的距離量測。用於眼科手術之現代雷射 系統通常已配備有OLCR測厚計（〇LCR :光學低相干反射 量測法）或另-相干光學干涉量測裝置，藉助於此，可在 雷射治療之前、期間或之後進行眼睛量測。然而迄今為 止，該測厚計尚未用於測定眼睛之正確中心。若〇LCR測 厚計所發射之量測光束用作測試光束，且測厚計之干涉計 與所連接之評估構件用作❹】構件，則本發明之無^ 另外的設備構件。因此，此構成本發明之特别具成本效益 之具體實例，其易於整合至現有雷射裝置中。 根據-具體實例’若伯測構件债測到無測試光束之背 反射或僅有低於預定最低強度之背反射，則電腦所產生之 201010685 控制信號可使得輸出麗-改b 行μ心 發出光及/或聲警m，醫師 了在>口療開始之前棋$1丨吐β ^ 伸到眼睛是否正確固定之資訊。 或者或另外，若指、日,磁从 mw 構件债測到無測試光束之背反射 或僅有低於預定最低強产 BP 8# ^ ^ ^ ^ 又之责反射，則控制信號可使得對 « ^ ^ ^ 另方面，右偵測構件偵測到具有 預疋最低強度之測諸虫去& &广α ye 束的皮反射，則控制信號可使治療 得以啟動。 根據有利發展，定令心測試可與眼睛之厚度或距離量 測直接相結合。出於此目的，控制程式可含有達成以下目 =之指^ .基於作為定“測試之—部分所發射之測試光 及測試光束之所偵測背反射來進行測厚計厚度量測或距 離量測®此，可同時，例如作為常規所需之角膜厚度量 測之一部分來檢驗眼睛中心。其亦可為相對於角膜頂端（頂 點）之距離量測。由於測厚法本質為極敏感之量測，因此 僅在艮睛、1良好定位且背反射自角膜表面行進至測厚計 時’方可從而得到量測值。一旦患者看向旁側，背反射即 變得較弱且例如不再可能進行厚度量測。就此而言，亦可 將控制信號理解為測厚法是否已成功進行之指標。 詳S之，來自角膜前側之背反射適用於背反射的偵 測此具有以下優點：傳播介質空氣與角膜之間的折射率 不連續性特別大，且由此產生之背反射具有特別高的強 度。然而’或者亦可债測來自角臈背側之背反射，亦即， 由角膜與眼睛前房之間的折射率不連續性來偵測。甚至可 設想偵測來自肖膜前側之背反射與來自肖膜背側之背反 201010685 射。此使得有可能特別敏感地偵測眼睛之角位置。 為特別充分地利用眼睛表面之非球面性且為增加固定 檢驗之敏感性，可使測試光束之光束直徑相對於眼睛表面 的範圍較小。在此條件下，最佳背反射所必需之測試光束 與眼睛表面之間的正交性經特別選擇，且產生易價測之中 心信號。 以下參考隨附圖式來進一步說明本發明。 圖1展示本發明之雷射裝置，其中來自眼睛角膜之背 ❹ 反射實質上係沿測試光束之光束方向反射回測厚計； 圖2展示本發明之雷射裝置，其中眼晴未經定中心且 測试光束在角膜上實現之背反射並未沿測試光束之光束方 向反射。 圖1及圖2中所示之用於眼科手術的雷射裝置包含： 工作雷射器11 0，作為例如適於角膜切除之雷射光束源，其 發射脈衝雷射輻射；眼睛追蹤器12〇，其用以在角膜治療期 間追蹤眼睛移動；測厚計13〇，其經設計以偵測眼睛頂端與 ❹ 測厚計之間的距離且例如藉助於OLCR (「光學低相干反射 量測法」/光學短相干反射量測法）量測角膜厚度；及固定 光140 ’在角膜治療之前及期間患者視野係固定於其上，以 便保持眼睛儘可能小地移動。所有提及組件ιι〇至14〇在共 同光軸X上㈣，其係經由各種適當光學組件（諸如鏡面’、 透鏡等）實現。在圖i及圖2中’此等光學組件僅示意性 地表示為鏡面16(^除本身已知的所提及組件以外本發明 之雷射裝置亦具有電腦150’其具有控制程式16〇。該控制 9 201010685 程式160經設計以藉助於適當控制信號來控制控制線丨7〇 上之組件110至140。 此外，圖1及圖2中示意性地說明人眼睛2〇〇。示意圖 展示玻璃體210，且展示鞏膜220，其與眼睛前區中之角膜 23〇鄰接。此外，呈現晶狀體240、眼睛前房250、虹膜260 及眼後房270。視神經之出口示意性表示為與晶狀體相反。 必須確保在準備對眼睛200進行雷射手術治療期間， 患者之視野正確固定於固定光14〇上。此確保在準備及後- The need to accurately fix the eye before the laser treatment can begin. For this purpose, it is known to provide the practice of providing a separate fixed source that emits a weak fixed beam and the patient's field of view is fixed thereto. Before the start of adultery, the therapist examines the correct center of the eye, that is, the physician checks whether the field of vision of the patient's eye is directed to the solid U source. If the condition is met, the physician activates the Thunder Station & $ Le laser device so that laser treatment can begin. However, to date, physicians have been able to objectively measure and understand the correct center of the eye. Physicians can only rely on the subjective observation of the eye to be treated. Therefore, it may be easy for the doctor to notice that the string and the old field of view are not fixed to the fixed light source μ to the nine source, but are fixed at another point adjacent thereto. 5 201010685 Light source above two::::===:== To achieve this, the present invention provides a laser device for ophthalmic surgery, which comprises: "working laser device, which is used to provide a working laser Radiation. • A fixed light source; • A test beam source for emitting a test beam in the direction of the eye to be treated; - a detection component for detecting a reflection from the eye along the beam direction of the test beam Back-reflection of the beam; - a control computer coupled to the test beam source and the detection component; and - a control program for the computer, the control program containing instructions for performing a centering test to facilitate the use of a working thunder The radiation is fixed to the fixed light source prior to the treatment of the eye. The centering test includes emitting a test beam from the test beam source, and then the detecting member checks whether the back reflection of the test beam is detectable, and finally relies on The control signal is generated by the control computer in the test result. The test beam produces a back reflection on the eye to be treated, for example via reflection on the anterior surface of the cornea and/or on the interface between the cornea and the anterior chamber of the eye. Preferably, the detecting member is arranged and implemented in such a manner as to detect only back reflections from the eye and the coaxial reflection of the incident test beam. Since the surface of the human eye is not a precise spherical surface, and usually the center of rotation of the eye is also different from the midpoint of the curvature of the surface of the eye, the collinear reflection of the test beam is essentially only achieved in the single 201010685 position of the eye. The patient removes the eye from this position, for example by directing the field of view to a different point, which causes the angle of the reflected beam to be tilted to a greater or lesser extent relative to the direction of incidence of the test beam. Only when the test beam is orthogonally incident on the surface of the eye to be treated, it is reflected in the same direction and can be pre-measured by the test member. If the fixed source is positioned such that the coaxial reflection of the test beam is achieved only when the patient's field of view is properly fixed to the fixed beam, then the patient's eye is properly centered when a back-reflection 具有 with sufficient intensity is detected. This allows the physician to obtain objective criteria for checking the correct center of the eye. The detecting member preferably operates in accordance with the principle of interference measurement. In particular, the test beam source and the integrated test component can be used as part of the 0LCR thickness gauge configuration operating on the principle of optical short phase :: 敎 。. Thickness gauges are typically used to measure the corneal thickness of the eye non-contact. In addition, it is possible to measure the distance from the reference point of the laser device. Modern laser systems for ophthalmic surgery are usually equipped with an OLCR thickness gauge (〇LCR: optical low-coherence reflectometry) or another-coherent optical interference measurement device, which allows for laser treatment, Eye measurements were taken during or after. However, to date, the thickness gauge has not been used to determine the correct center of the eye. If the measuring beam emitted by the LCR thickness gauge is used as a test beam, and the interferometer of the gage and the connected evaluation member are used as the member, there is no other device component of the present invention. Thus, this constitutes a particularly cost effective embodiment of the present invention that is easily integrated into existing laser devices. According to the specific example, if the test component of the test component measures the back reflection of the test beam or only the back reflection of less than the predetermined minimum intensity, the 201010685 control signal generated by the computer can cause the output to emit light. And/or the audible alarm, the doctor has the information that the chess is $1 丨 ββ ^ before the start of the oral treatment. Or, in addition, if the finger, day, and magnetic are measured from the mw component debt to the back reflection without the test beam or only below the predetermined minimum strong production BP 8# ^ ^ ^ ^, then the control signal can make the « ^ ^ ^ On the other hand, the right detection component detects the skin reflection of the worms with the lowest intensity of the pre-dip and the wide α ye beam, and the control signal can initiate the treatment. According to an advantageous development, the fixed heart test can be directly combined with the thickness or distance measurement of the eye. For this purpose, the control program may contain a reference to the following: a thickness gauge or distance measurement based on the detected back reflections of the test light and the test beam emitted as part of the test. This can be used to test the center of the eye at the same time, for example as part of a conventional corneal thickness measurement. It can also be measured relative to the tip of the cornea (vertex). The thickness of the method is extremely sensitive. Measured, therefore only in the eye, 1 good positioning and back reflection from the surface of the cornea to the thickness measurement time can be obtained to obtain the measured value. Once the patient looks to the side, the back reflection becomes weaker and for example is no longer possible In this case, the control signal can also be understood as an indicator of whether the thickness measurement method has been successfully performed. In detail, the back reflection from the front side of the cornea is suitable for the detection of back reflection. This has the following advantages: propagation medium The refractive index discontinuity between the air and the cornea is particularly large, and the resulting back reflection has a particularly high strength. However, it is also possible to measure the back reflection from the dorsal side of the horn, ie It is detected by the refractive index discontinuity between the cornea and the anterior chamber of the eye. It is even conceivable to detect the back reflection from the anterior side of the opaque membrane and the back of the back of the opaque membrane. This makes it possible to detect particularly sensitively. The angular position of the eye. In order to make full use of the asphericity of the surface of the eye and to increase the sensitivity of the fixation test, the beam diameter of the test beam can be made smaller relative to the surface of the eye. Under this condition, the optimal back reflection The orthogonality between the necessary test beam and the surface of the eye is specifically selected and produces a center signal of the price measurement. The invention is further described with reference to the accompanying drawings in which: Figure 1 shows a laser device of the invention, wherein The back reflection from the cornea of the eye is substantially reflected back to the thickness gauge along the beam direction of the test beam; Figure 2 shows the laser device of the present invention, wherein the eye is uncentered and the test beam is reflected back on the cornea Not reflected in the direction of the beam of the test beam. The laser device for ophthalmic surgery shown in Figures 1 and 2 comprises: a working laser 110, as suitable for example A laser beam source for keratotomy that emits pulsed laser radiation; an eye tracker 12〇 that tracks eye movement during corneal treatment; a thickness gauge 13〇 designed to detect the top of the eye and the thickness of the ❹ The distance between the gauges and the corneal thickness is measured, for example, by means of OLCR ("optical low coherence reflectometry" / optical short coherence reflectometry); and the fixed light 140' is fixed to the patient's field of view before and during corneal treatment On it, in order to keep the eyes moving as small as possible. All references to components ιι to 14 are on the common optical axis X (four), which is achieved via various suitable optical components (such as mirrors, lenses, etc.). In Figures i and 2, 'the optical components are only schematically represented as mirrors 16 (the laser device of the present invention also has a computer 150' having a control program 16" in addition to the mentioned components known per se. The control 9 201010685 program 160 is designed to control the components 110 to 140 on the control line 7 by means of appropriate control signals. Furthermore, the human eye 2 示意 is schematically illustrated in Figures 1 and 2. The schematic shows the glass body 210 And a sclera 220 is shown that is adjacent to the cornea 23〇 in the anterior region of the eye. Furthermore, the lens 240, the anterior chamber 250 of the eye, the iris 260, and the posterior chamber 270 are present. The exit of the optic nerve is schematically represented as the opposite of the lens. During the preparation of laser surgery for the eye 200, the patient's field of view is properly fixed to the fixed light 14〇. This ensures that after preparation and after
折（folding-back)角膜薄片（角膜瓣）（假設進行laSIK Q 治療）之後暴露之治療平面300實質上相對於光轴X正交 排列。為檢驗此所謂的中心，電腦丨5〇之控制程式〗6〇使 才于藉助於測厚計130將測試光束3 1 〇沿眼睛200之方向上 的光軸X引導，詳言之，引導至治療平面3 〇〇上。在該處， 測試光束310產生背反射32〇，其在所期望之治療平面3〇〇 與光軸X主交對準的情況下沿光轴X反射回測庠計130。 在圖中，為清楚起見，光束31〇與32〇表示為彼此緊靠， 但顧然其亦可直接處於彼此之上。僅當治療平面3〇〇與光 〇 軸X之間的角度之正交條件在小公差範圍内實現時，背反 射320方以測厚計i3〇可進行測厚之方式進入測厚計1 中。測厚可為例如測厚計13〇與眼睛2〇〇之間的距離量測， 其中（詳a之）使用來自角膜23〇之前側的背反射32〇。對 X更敏感之程序係由角膜23〇之厚度量測構成，其中測 厚十130將來自角膜23〇之前側與背側之背反射均考慮在 内〇 10 201010685 ’ 因此，若確保固定光140及測厚計130之量測光束或 測試光束310彼此同轴行進且患者視野固定於固定光源 之固定光上，則可假設在測厚計13〇成功進行距離量測或 厚度量測的情況下，治療平面3〇〇與光軸χ相對於彼此正 交對準，且眼睛經定中心。另一方面，若不可藉助於測厚 計130進行測厚，則必可假設患者看向不正確的固定點， 而非看向固定光源140之固定光束》 圖2中呈現此種狀況。在此情況下，患者所選之不正 ® 確固定點330導致背反射320與測試光束310具有約5度 之角度偏差。治療平面3〇〇相對於光軸χ傾斜相同角度。 然而，實務上，發現角度偏差甚至丨度至2度皆足以使測 厚計130不可能進行測厚。 因此’若控制程式160自測厚計13〇接收之數據或信 號表明並未成功進行測厚，則控制程式16〇不會經由其控 制線170啟動工作雷射器11〇。然而，在測厚計13〇成功進 行測厚之情況下’控制程式16〇啟動工作雷射器丨丨〇，且對 ® 眼睛200之雷射手術治療可開始。 除圖1及圖2中所呈現之使用測厚計130來確定治療 平面300與光轴χ之正交性的具體實例以外，亦可設想僅 發射測試光束3 1 〇且接收背反射32〇之簡化配置，亦即， 不使用干涉量測裝置。在此情況下，僅背反射32〇之強度 將用於4貞測正交性。The treatment planes 300 exposed after folding-back corneal flaps (assuming laSIK Q treatment) are substantially orthogonally aligned with respect to the optical axis X. In order to test this so-called center, the control program of the computer is guided by the thickness gauge 130 to guide the optical beam X of the test beam 3 1 〇 along the direction of the eye 200, in particular, to The treatment plane is 3 〇〇. There, the test beam 310 produces a back reflection 32〇 that is reflected back to the meter 130 along the optical axis X with the desired treatment plane 3〇〇 aligned with the optical axis X. In the figures, for the sake of clarity, the beams 31 〇 and 32 〇 are shown as being in close proximity to one another, but it is also possible to be directly above each other. Only when the orthogonal condition of the angle between the treatment plane 3〇〇 and the pupil axis X is realized within a small tolerance range, the back reflection 320 side enters the thickness gauge 1 by way of thickness measurement i3〇. . The thickness measurement can be, for example, a measure of the distance between the thickness gauge 13 〇 and the eye 2 ,, where (detailed a) the back reflection 32 来自 from the front side of the cornea 23 使用. The procedure more sensitive to X consists of the measurement of the thickness of the cornea 23〇, wherein the thickness measurement 130 will be taken from the front side and the back side of the cornea 23〇 in consideration of the internal 〇10 201010685 ' Therefore, if the fixed light 140 is ensured And if the measuring beam or the test beam 310 of the thickness gauge 130 travels coaxially with each other and the patient's field of view is fixed on the fixed light of the fixed light source, it can be assumed that in the case where the thickness gauge 13 〇 successfully performs distance measurement or thickness measurement The treatment plane 3〇〇 and the optical axis 正交 are orthogonally aligned with respect to each other, and the eye is centered. On the other hand, if thickness measurement is not possible by means of the thickness gauge 130, it must be assumed that the patient looks at the incorrect fixed point rather than the fixed beam of the fixed source 140. This situation is illustrated in Figure 2. In this case, the patient selected the misalignment ® indeed fixed point 330 causes the back reflection 320 to have an angular deviation of about 5 degrees from the test beam 310. The treatment plane 3〇〇 is inclined at the same angle with respect to the optical axis χ. However, in practice, it has been found that the angular deviation or even the twist to 2 degrees is sufficient to make the thickness gauge 130 impossible to measure thickness. Therefore, if the data or signal received by the control program 160 from the thickness gauge 13 indicates that the thickness measurement has not been successfully performed, the control program 16 does not activate the working laser 11 via its control line 170. However, in the case where the thickness gauge 13 is successfully thickness-measured, the control program 16 starts the working laser, and the laser surgery for the ® eye 200 can be started. In addition to the specific examples of using the thickness gauge 130 presented in Figures 1 and 2 to determine the orthogonality of the treatment plane 300 to the optical axis ,, it is also contemplated to only emit the test beam 3 1 〇 and receive the back reflection 32 〇 Simplified configuration, that is, no interferometric measuring device is used. In this case, only the intensity of the back reflection 32 将 will be used for 4 正交 orthogonality.