WO2003092566A1 - Appareil de mesure de rendement d'elevation thermique, appareil thermatologique et procede pour commander un rayon laser therapeutique - Google Patents

Appareil de mesure de rendement d'elevation thermique, appareil thermatologique et procede pour commander un rayon laser therapeutique Download PDF

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Publication number
WO2003092566A1
WO2003092566A1 PCT/JP2003/005530 JP0305530W WO03092566A1 WO 2003092566 A1 WO2003092566 A1 WO 2003092566A1 JP 0305530 W JP0305530 W JP 0305530W WO 03092566 A1 WO03092566 A1 WO 03092566A1
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Prior art keywords
light
intensity
eye
irradiation
predetermined
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PCT/JP2003/005530
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English (en)
Japanese (ja)
Inventor
Yasuhiro Tamaki
Ryo Obata
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Yasuhiro Tamaki
Ryo Obata
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Application filed by Yasuhiro Tamaki, Ryo Obata filed Critical Yasuhiro Tamaki
Priority to JP2004500753A priority Critical patent/JP4101800B2/ja
Priority to AU2003234773A priority patent/AU2003234773A1/en
Publication of WO2003092566A1 publication Critical patent/WO2003092566A1/fr

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    • 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
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491—Surgical glue applicators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00969—Surgical instruments, devices or methods, e.g. tourniquets used for transplantation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy

Definitions

  • Temperature rise efficiency measuring device thermal treatment device, and control method of therapeutic laser beam
  • the present invention relates to an ophthalmic thermotherapy apparatus used for laser therapy such as transpupillary thermotherapy, a method for controlling a therapeutic laser beam, and an irradiation intensity setting apparatus used for these.
  • transpupillary thermotherapy using laser light for heating is known.
  • TTT transpupillary thermotherapy
  • laser light is introduced into the eye via the pupil, and the affected part is heated by irradiating the affected part in the eye with necrosis or neovascularization of choroidal neovascularization or tumors formed in the affected part. Induce evacuation.
  • CNV choroida neovascularization
  • AMD age-related macular degeneration
  • Transpupillary thermotherapy as described above is performed using conventional photocoagulation therapy (for example, Macular photocoagulation study group, Arch Ophthalmol 1991; 109: pp. 1242-1257, Pomerantzeff et al., Arch Ophthalmol 1983; 101: 949 -953, etc.), the amount of energy irradiation per unit area is small, and the temperature rise during irradiation is relatively small, so there is a possibility of damaging the normal retina at the irradiation site and surrounding normal tissues. Is low.
  • conventional photocoagulation therapy for example, Macular photocoagulation study group, Arch Ophthalmol 1991; 109: pp. 1242-1257, Pomerantzeff et al., Arch Ophthalmol 1983; 101: 949 -953, etc.
  • the energy irradiation per unit area is large and the temperature rise is also large; the normal retina at the irradiation site and the surrounding normal tissues are also invaded. Likely to occur.
  • the temperature of the affected area in the eyeball is sufficiently controlled in the treatment examples reported so far. It is hard to say that.
  • the adjustment of the irradiation power of the laser light emitted from the laser light source must be a treatment that depends on intuition for each case. If the energy of the laser beam absorbed by the affected part in the sphere is insufficient, the affected part is insufficiently heated, and a sufficient therapeutic effect cannot be obtained. Conversely, if the energy of the laser light absorbed by the affected area is too high, the affected area will be overheated, causing tissue destruction and death.
  • the present invention has been made in view of the above problems, and an object of the present invention is to provide an ophthalmic thermotherapy apparatus capable of precisely controlling a rise in temperature of an affected part in an eyeball. Another object of the present invention is to provide an ophthalmic thermotherapy apparatus capable of easily improving the effect of treatment by accurately feeding back the effect of treatment using laser light.
  • Another object of the present invention is to provide a method for controlling a therapeutic laser beam useful for the above-described hyperthermia treatment and the like.
  • a temperature rise efficiency measuring device for ophthalmic hyperthermia includes a temperature rise efficiency in a predetermined region in an eye by infrared processing light having a predetermined wavelength used for ophthalmic hyperthermia.
  • a probe light supply unit that supplies the probe light having predetermined characteristics capable of reflecting the individual difference regarding the reflection in the predetermined region to the predetermined region, and a state in which the probe light is incident on the predetermined region.
  • a reflection detection unit for detecting the intensity of the reflected light.
  • the reflection detection unit detects the intensity of the reflected light from the predetermined region in a state where the probe light having the predetermined characteristic capable of reflecting the individual difference is incident on the predetermined region.
  • An index for determining the intensity of the processing light to be emitted from the light source at the time of implementation can be obtained.
  • the intraocular treatment using infrared rays is efficiently corrected. Or it can be optimized.
  • the probe light supply unit may be configured such that at least one of the intensity level of the processing light and the irradiation time is set to a predetermined value or more.
  • the probe light is generated by operating under the reduced test conditions. In this case, test irradiation with less damage can be performed using a light source for treatment.
  • an image of a predetermined region where the processing light and the probe light used in the thermal treatment is incident is formed within the wavelength range of the processing light for the treatment.
  • the optical system further includes an observation optical system for performing the operation, and an imaging device for capturing an image formed by the observation optical system.
  • the incident position of the probe light or the treatment light for treatment can be accurately positioned, and the hyperthermia treatment can be made appropriate.
  • the detection output of the reflection detection unit is displayed using a scale that serves as a scale when the processing light used for thermal treatment is incident on a predetermined area.
  • the display device further includes a display device.
  • an ophthalmic thermotherapy apparatus in the measurement device, the display device performs a display corresponding to a deviation amount in which a detection output of the reflection detection unit deviates from a predetermined standard value.
  • an ophthalmic thermotherapy apparatus according to the present invention of the present invention comprises the above-described measuring apparatus, a light source for generating treatment light for treatment, and an irradiation optical system for causing the treatment light from the light source to enter a predetermined region.
  • another ophthalmic thermotherapy apparatus includes a light source that generates infrared processing light having a predetermined wavelength, and a processing light from the light source to a predetermined region in the eye.
  • An irradiation optical system to be incident a reflection detection unit that detects the intensity of the reflected light from a predetermined area, and a control device that determines the intensity of the processing light to be emitted from the light source based on the detection output of the reflection detection unit.
  • the light that enters the eye when detecting the intensity of the reflected light can be the initial processing light itself in the case of thermal treatment, but the weak processing light before adjusting the intensity for treatment, that is, Inspection light can also be used. Further, the processing light to be emitted from the light source is appropriately adjusted according to the purpose of treatment and the content of treatment, not only based on the intensity of the reflected light.
  • the control device controls the light based on the detection output of the reflection detection unit. Since the intensity of the processing light to be emitted from the source is determined, it is possible to estimate, with a certain degree of accuracy, the temperature rise in a predetermined area in the eye, that is, the affected area due to the incidence of the processing light, and to treat the eye using infrared rays Can be efficiently corrected or optimized.
  • the control device is configured to determine an applied irradiation condition to be applied to a predetermined region in another eye based on the reference irradiation condition applied to the predetermined region in the specific eye.
  • a condition calculating unit that calculates a predetermined item such that a heating effect of the predetermined area in the another eye is equal to a heating effect of the predetermined area in the specific eye.
  • the heating effect applied to the treatment in a specific eye under the reference irradiation condition and the heating effect applied to the treatment in another eye under the applied irradiation condition can be almost matched.
  • the effect of treatment on one patient can be reflected in the effect of treatment on another patient, and information on treatment can be shared and standardized.
  • control device may be configured to perform the reference irradiation based on the heating effect of the predetermined region in the eye under the reference irradiation condition including the detection output of the reflected light from the predetermined region in the eye. It has a conversion unit for estimating the heating effect of a predetermined region in the eye under the applied irradiation conditions to be implemented by changing the conditions. In this case, the temperature rise of the affected part of the eye can be estimated as a relative effect to the applied irradiation condition obtained by changing the already applied reference irradiation condition with respect to the applied reference irradiation condition.
  • the reference irradiation condition and the applied irradiation condition are supplied into the pupil from the irradiation optical system when detecting the detection output from the reflected light detection unit and the intensity of the reflected light.
  • At least one of the reflection intensity ratio obtained from the ratio with the detection output from the incident light detection unit that detects the intensity of the incident light, the size of the predetermined region, and the attenuation of the incident light due to the cornea, lens, and vitreous body Include one each as an item.
  • the temperature rise of the affected part in the eye can be accurately estimated in accordance with the settings of the above items. If the attenuation in the vitreous is negligible, the attenuation of the incident light by only the cornea and the crystalline lens can be one item in the reference irradiation conditions and the applied irradiation conditions.
  • control device further includes an incident light detection unit that detects the intensity of the incident light supplied into the pupil from the irradiation optical system when detecting the intensity of the reflected light.
  • the intensity of the processing light to be emitted from the light source is determined based on the reflection intensity ratio obtained from the ratio between the detection output from the reflected light detection unit and the detection output from the incident light detection unit.
  • the intensity of the incident light supplied to the eye is adjusted in consideration of absorption in a predetermined part of the eye. Therefore, the temperature rise of the affected area in the eye can be accurately estimated.
  • control device has an irradiation density correction unit that corrects the intensity of the processing light to be emitted from the light source according to the size of the predetermined region.
  • the intensity of the incident light supplied into the eye can be adjusted in consideration of the energy density supplied to the predetermined region, the temperature rise of the affected part in the eye can be more accurately estimated.
  • control device may include an attenuation correction unit that corrects the intensity of the processing light to be emitted from the light source so as to cancel the attenuation of the incident light due to the cornea, the crystalline lens, and the vitreous body. Having. In this case, the intensity of the incident light supplied into the eye can be adjusted in consideration of the dimming in the eye, so that the temperature rise of the affected part in the eye can be estimated more accurately.
  • the method for controlling therapeutic laser light includes: a step of generating infrared processing light having a predetermined wavelength from a light source; a step of causing processing light from the light source to enter a predetermined region in the eye; Detecting the intensity of the reflected light from the area; and determining the intensity of the processing light to be emitted from the light source based on the detection output of the reflected light from the predetermined area.
  • the intensity of the processing light to be emitted from the light source is determined based on the detection output of the reflected light from the predetermined area. Therefore, the temperature rise of the affected part in the eye is estimated with a certain accuracy. Thus, treatment using laser light can be efficiently corrected or optimized.
  • the reference irradiation condition is determined based on a heating effect of the predetermined region in the eye under the reference irradiation condition including the detection output of the reflected light from the predetermined region in the eye.
  • the method further includes a step of estimating a heating effect of a predetermined region in the eye under an applied irradiation condition to be performed by making a modification to the above.
  • a predetermined item of application irradiation conditions to be applied to a predetermined region in another eye is determined.
  • the method further includes a step of calculating the heating effect of the predetermined region in the another eye so as to be equal to the heating effect of the predetermined region in the specific eye.
  • the reference irradiation condition and the applied irradiation condition are supplied to the pupil from the irradiation optical system when detecting the output of the intensity of the reflected light from the predetermined area and detecting the reflected light.
  • the reflected intensity ratio obtained from the ratio of the intensity of the incident light And at least one of the following: attenuation of incident light by the cornea, lens, and vitreous.
  • the detection output of the intensity of the reflected light from the predetermined area and the detection output of the intensity of the incident light supplied into the pupil when detecting the intensity of the reflected light are provided.
  • the intensity of the processing light emitted from the light source is determined based on the reflection intensity ratio obtained from the ratio.
  • the irradiation intensity setting device includes an input for receiving a detection output obtained by causing infrared processing light of a predetermined wavelength to enter a predetermined region in the eye and detecting the intensity of light reflected from the predetermined region.
  • a control device that determines the intensity of the processing light to be emitted from the light source in order to bring a predetermined region in the eye into a predetermined heating state based on the detection output received by the input unit.
  • the above-described irradiation intensity setting device can also appropriately support treatment using laser light for an affected part in the eye.
  • control device may be configured such that, based on the reference irradiation condition applied to a predetermined region in a specific eye, a predetermined one of application irradiation conditions to be applied to a predetermined region in another eye is determined.
  • a condition calculating unit that calculates an item such that a heating effect of the predetermined region in the another eye is equal to a heating effect of the predetermined region in the specific eye;
  • control device may be configured to perform the reference irradiation based on the heating effect of the predetermined region in the eye under the reference irradiation condition including the detection output of the reflected light from the predetermined region in the eye. It has a conversion unit for estimating the heating effect of a predetermined region in the eye under the applied irradiation conditions to be implemented by changing the conditions.
  • thermotherapy apparatus the control method, and the irradiation intensity setting apparatus
  • the heating of a predetermined area in the eye under reference irradiation conditions including a detection output of reflected light from a predetermined area in the eye is performed. Based on the effect, the heating effect of a predetermined area in the eye under the applied irradiation condition to be performed by changing the reference irradiation condition is estimated. In this case, appropriate treatment can be performed for various patient eyes.
  • another irradiation intensity setting device includes a light source that generates infrared processing light having a predetermined wavelength, an irradiation optical system that causes the processing light from the light source to enter a predetermined region in the eye, and a predetermined region.
  • a reflection detection unit that detects the intensity of the reflected light from the region, and the intensity of the processing light to be emitted from the light source to bring the predetermined region in the eye into a predetermined heating state based on the detection output of the reflection detection unit.
  • FIG. 1 is a conceptual diagram illustrating the structure of the ophthalmic thermotherapy apparatus according to the first embodiment.
  • FIG. 2 is a block diagram conceptually illustrating the structure of a control device 80 which is a part of the device shown in FIG.
  • FIG. 3 shows the cross-sectional structure of the patient's eye PE, and explains the conditions for detecting reflected light from the fundus.
  • FIG. 4 is a graph showing a measurement result of a temperature rise of the fundus when infrared light for treatment is incident using the thermal treatment apparatus of FIG.
  • FIG. 5 is a graph showing the results of measuring the temperature rise in the fundus when the therapeutic infrared light having different intensities is incident on the fundus.
  • Fig. 6 is a graph illustrating the relationship between the irradiation intensity of therapeutic infrared light and the saturation temperature of the fundus.
  • FIG. 7 is a graph illustrating the calculation of the heating line.
  • FIG. 8 is an example in which the graph shown in FIG. 7 is modified for a human body.
  • FIG. 9 is a flowchart illustrating an operation example of the thermal treatment apparatus shown in FIGS. 1 and 2.
  • FIG. 10 is a flowchart illustrating another operation example of the thermal treatment apparatus shown in FIGS. 1 and 2.
  • FIG. 11 is a graph illustrating the relationship between age and transmittance of the cornea and the like.
  • FIG. 12 is a diagram illustrating a modified example of the power meter according to the third embodiment.
  • FIG. 1 is a diagram illustrating the structure of an ophthalmic thermotherapy apparatus according to a first embodiment of the present invention.
  • the ophthalmic thermotherapy device 100 includes a light source device 10 that generates infrared processing light, and an irradiation optical system 20 that causes the processing light from the light source device 10 to enter the fundus EF of the patient's eye PE. , An illumination optical system 30 that illuminates the fundus EF, a condensing optical system 40 that collects the reflected light from the fundus EF, and a reflection detection that detects the intensity of the reflected light collected by the condensing optical system 40 Unit 50, an observation unit 60 for observing the state of the fundus EF, and an image recorder for recording an image of the fundus EF. Recording device 70 and a control device 80. Which calculates information necessary for driving the light source device 20 based on the output of the reflection detecting section 50 and the like.
  • the light source device 10 includes a laser light source 12 that generates infrared light for treatment as processing light, an optical fiber light guide 14 that guides light from the laser light source 12 to the outside, and a light source.
  • An emission end 16 is provided at the tip of the toe guide 14 and emits irradiation laser light having an appropriate divergence angle.
  • the infrared light for treatment emitted from the laser light source 12 has a wavelength of 808 nm, and is adapted to soft heating of the fundus.
  • the power of the irradiation laser light emitted from the emission end 16 is appropriately adjusted based on manual operation by an operator treating the patient's eye PE or a control signal output from the control device 80 to the light source device 20. Is done.
  • the light source device 10 also emits red aiming light, so that the irradiation position of the therapeutic infrared light on the fundus EF can be visually confirmed.
  • the irradiation optical system 20 includes a condensing lens 22 for condensing the irradiation laser light from the above-described emission end 16, and a contact lens 91, that is, a patient by bending the optical path of the irradiation laser light passing through the condensing lens 22.
  • Mirror 24 that guides the eye to the fundus EF of the eye PE.
  • the condenser lens 22 is movable in the direction of the optical axis, and can adjust the beam spot of the irradiation laser light, ie, the processing light, to be incident on the treatment site of the fundus EF, to an appropriate size.
  • the contact lens 91 that comes into contact with the eyeball is for preventing the movement of the eyeball, and is a part of the irradiation optical system 20 but also constitutes a part of the condensing optical system 40 and the like. It is a shared part.
  • the illumination optical system 30 passed through a light source 32 for generating illumination light for observation, a condenser lens 34 for condensing illumination light from the light source to have an appropriate beam diameter, and a condenser lens 34.
  • a contact lens 91 that is, a mirror 36 that guides the illumination light to the fundus EF by bending the optical path of the illumination light is provided.
  • the mirror 36 is arranged three-dimensionally on the near side in the direction perpendicular to the plane of the drawing with respect to the mirror 24 of the irradiation optical system 20, so that the illumination light is not blocked by the mirror 24. ing.
  • the condensing optical system 40 includes a collimator lens 42 that converts the reflected light emitted from the patient's eye PE into a parallel light beam, and a variable power optical system 44 that adjusts the beam diameter of the light beam that has passed through the collimator lens 42.
  • the variable magnification optical systems 44 and 46 can be operated independently, and the observation magnification of the image by the observation unit 60 and the recording magnification of the image by the image recording device 70 are adjusted independently. be able to.
  • the collimator lens 42, variable power The academic systems 44, 46, etc. constitute the observation optical system.
  • the reflection detector 50 is configured to partially split the reflected light passing through the condensing optical system 40 in the orthogonal direction, and a beam splitter 52, and 808 nm of the reflected light split by the beam splitter 52.
  • Band-pass filter 54 that transmits only light of the same type, an infrared sensor 56 that detects the intensity of reflected light that has passed through the non-pass filter 54, and power that converts the detection output of the infrared sensor 56 into a single unit. 58 in total.
  • the pan-pass filter 54 extracts only the infrared reflected light corresponding to the therapeutic infrared light, and the observation illumination light and the aiming light enter the infrared sensor 56 and affect the detection output. To prevent them from doing so.
  • the observation unit 60 includes a filter 62 that transmits observation illumination light and aiming light and blocks infrared reflected light among the reflected light transmitted through the beam splitter 52 described above, and a prism and a prism for obtaining an erect image.
  • an observation optical system 64 including an eyepiece and the like. An operator who treats the patient's eye PE can observe the fundus EF while looking through the observation optical system 64, and can appropriately change the observation magnification by adjusting the variable magnification optical system 42. In addition, the surgeon can observe the aiming light via the observation optical system 64, and can confirm whether or not the therapeutic infrared light is properly incident on the affected area of the fundus EF. .
  • the image recording device 70 is an imaging device, and can photograph an image of the fundus EF with respect to observation illumination light, infrared reflected light, and aiming light by switching a built-in filter. An image captured by the image recording device 70 can be displayed on the display 92.
  • the control device 80 is composed of a computer, and can detect the intensity of infrared reflected light that is reflected by the fundus EF and emitted from the patient's eye PE based on the detection output of the reflection detection unit 50. Further, the control device 80 can determine the state such as the color of the fundus EF based on the image information from the image recording device 70. Further, the control device 80 sends a control signal to the light source device 10 to adjust the intensity of the therapeutic infrared light emitted from the laser light source 12, that is, the therapeutic infrared light supplied to the fundus EF. it can.
  • the control device 80 as an incident light detection unit, monitors the intensity of the therapeutic infrared light emitted from the laser light source 12 based on a control signal output by itself, a response signal from the light source device 10, and the like. You can also.
  • FIG. 2 is a flowchart conceptually illustrating the structure of a control device 80 which is a part of the device shown in FIG. It is a lock figure.
  • the illustrated control device 80 includes a CPU 81, an input unit 82, a display unit 83, a display drive unit 84, a storage device 85, and an interface unit 86, similar to a general computer. ing.
  • the CPU 81 can exchange data with the display drive unit 84, the storage device 85, and the interface unit 86 by the bus BL. Further, the CPU 81 reads out predetermined programs and data from the storage device 85 based on an instruction from the input unit 82, and executes various processes based on these programs and data. More specifically, in the therapeutic light conversion program, the CPU 81 performs comparison based on an instruction from the input unit 82 and information from the storage device 85, the interface unit 86, and the like. A series of processing such as converting the heating data of the patient into heating data of the patient's eyes is performed.
  • the CPU 81 determines the intensity of the therapeutic infrared light emitted from the laser light source 12 based on an instruction from the input unit 82 in the therapeutic light irradiation program, and performs the treatment by the operator. Supports light irradiation, ie transpupillary hyperthermia.
  • the input unit 82 is composed of a keyboard or the like, and a command signal that reflects the intention of the operator who operates the control device 80, that is, the thermal treatment device 100, by GUI operation or the like using the display unit 83. Is output to the CPU 81.
  • the display unit 83 includes a display device or the like, and performs necessary display based on a drive signal input from the display drive unit 84.
  • the display drive unit 84 controls the display unit 83 by generating a drive signal based on data input from the CPU 81.
  • the storage device 85 includes a ROM for storing a basic program for operating the control device 80 and the like, and a RAM for temporarily storing an application program, input instructions, input data, processing results, and the like. Further, the storage device 85 is provided with a drive for driving a recording medium capable of holding an application program and data for storage by a magnetic or optical method.
  • the storage device 85 can be fixedly provided or can be detachably mounted.
  • the application program includes a treatment light conversion program and a treatment light irradiation program
  • the storage data includes a treatment information database DB.
  • Fig. 3 shows the cross-sectional structure of the patient's eye PE.
  • the light incident on the patient's eye PE is cornea E 1 and ⁇ ⁇
  • the light enters the lens E 3 via the anterior chamber E 2.
  • Light focused by the lens E 3 is imaged on the retina E 5 via nitric Solid E 4.
  • the therapeutic infrared light incident on the patient's eye PE and the effect of heating with the therapeutic infrared light are examined.
  • IQ be the intensity of the therapeutic infrared light that enters the patient's eye PE via the iris ⁇ ⁇ .
  • the strength of the therapeutic infrared destination incident on the retina E 5 and I i is examined.
  • the intensity of the therapeutic infrared light reflected by the retina E 5 and I 2 the intensity of the therapeutic infrared light detected by the apparatus of FIG. 1 is emitted et al or the patient's eye PE and I 3.
  • LA is the absorption loss coefficient of therapeutic infrared light in the optical path excluding the fundus EF from entering the patient's eye PE to exiting from it
  • L is the reflection loss coefficient of therapeutic infrared light in the same optical path excluding the fundus EF.
  • R the coefficients L A and LR become 1 when completely transmitted, and become 0 when completely attenuated.
  • the absorption loss coefficient LA of the former is due to absorption by the cornea ⁇ , anterior chamber E 2 , lens E 3 , and vitreous E 4
  • the reflection loss coefficient LR of the latter is corneal anterior chamber E 2 , lens E 3 , and it will be caused by the reflection of the interface. in the vitreous E 4.
  • the refractive index difference between the cornea and the outside of the patient's eye PE can be excluded from the influence by adjusting the refractive index of the contact lens 91.
  • the cornea Ei, the anterior chamber E 2 , the lens E 3 , and the vitreous E 4 have a refractive index of about 1.4 and a difference of about 0.05, so that the loss due to reflection at each interface is obtained.
  • the therapeutic infrared light incident on the fundus EF is reflected by the reflection coefficient R, absorbed by the retina E 5 and the choroid E? With the absorption coefficient A, and transmitted through the retina E 5 and the choroid E? through the membrane E 8 emitted to the outside of the patient's eye PE.
  • the therapeutic infrared light reflected by the fundus is scattered is blocked by the iris E 6, further, since it is partially detected by the focusing optical system 4 0 etc.
  • Figure 1 the actual Is detected by the thermotherapy apparatus 100 in FIG. 1 with the detection efficiency ⁇ .
  • I 3 ⁇ ⁇ LA 2 ⁇ R ⁇ I o
  • thermotherapy apparatus 100 in FIG. 1 a therapeutic infrared ray using the thermotherapy apparatus 100 in FIG. 1 is used. Light shall be incident.
  • alpha, beta, epsilon, LA is does not change, if the irradiation intensity I o and the irradiation time t constant, the relationship between the reflection intensity of the fundus EF I 3 and the temperature rise T (xQ) is divided I will. That is, with an increase in reflected intensity I 3 that is detected, the temperature rise T of the sea urchin irradiation spot portion I is apparent from equation (7) decreases linearly. Therefore, if the relationship between the reflection intensity ratio I 3 / Ia standardized by the irradiation intensity I 0 and the temperature rise T is obtained in advance and graphed, the specific patient eye can be obtained by ⁇ ⁇ or outside ⁇ or the slope of the graph. The variation ⁇ T of the temperature rise T caused by the difference ⁇ I so of the reflection intensity ratio I 3 / I 0 obtained between PE and another patient eye PE having a different dye concentration can be obtained.
  • the reflection intensity ratio I 3 ZID of the patient's eye PE does not necessarily need to be determined by setting the irradiation intensity I 0 during treatment, and an inspection light that is weaker than the irradiation intensity IQ of therapeutic infrared light is input. It can also be determined by firing. That is, as is clear from equation (5), the same patient's eye PE, the force al the reflection intensity I 3 and the illumination intensity IQ is considered proportional to.
  • Fig. 4 shows the eye of the Great Egret.
  • Fig. 4 shows the result of measuring the temperature rise of the fundus EF when the therapeutic infrared light is incident on the fundus EF using the thermotherapy device 100 of Fig. 1. It is a graph to do.
  • the horizontal axis indicates the reflection intensity ratio I 3 / I 0, and the vertical axis indicates the temperature rise T.
  • the incidence condition of the therapeutic infrared light was the same for a plurality of egrets, and as these egrets, white egrets and colored egrets were used so that the reflection intensity ratio I 3 ZI 0 was varied.
  • a thermocouple temperature sensor was inserted into the fundus EF of each egret to monitor the temperature rise.
  • the irradiation intensity IQ for heating was set to 13 OmW (in terms of irradiation output of the light source device 10), the incident spot diameter was set to 3 mm, and the irradiation time was set to 60 sec.
  • the temperature rise T at the irradiation spot of the fundus EF should naturally increase by time integration, but it has been experimentally found that it saturates early in the treatment time, as described in detail below. .
  • FIG. 5 is a graph illustrating the result of measuring the temperature rise of the fundus EF when the therapeutic infrared light having different intensities is incident on the fundus EF for the eyes of the egret.
  • the horizontal axis indicates the irradiation time of the therapeutic infrared light
  • the vertical axis indicates the temperature of the fundus EF.
  • the incident spot diameter of the therapeutic infrared light was 3 mm.
  • the temperature rise saturates when the irradiation time exceeds about 2 sec.
  • FIG. 6 is a graph experimentally showing the relationship between the irradiation intensity I 0 of the therapeutic infrared light and the saturation temperature of the fundus EF.
  • the incident spot diameter of the therapeutic infrared light was 3 mm.
  • the horizontal axis is the irradiation intensity of therapeutic infrared light I.
  • the vertical axis indicates the saturation temperature (° C) of the fundus EF.
  • the saturation temperature of the temperature rise in the irradiation spot increases in proportion to the irradiation intensity I 0 of the therapeutic infrared light incident on the fundus EF.
  • the temperature rise T of the fundus EF in a patient eye PE is ⁇
  • the irradiation intensity IQ should be increased by y times when it is desired to double the irradiation intensity.
  • the slope of the temperature rise with respect to the laser output of therapeutic infrared light is different.
  • FIG. 7 shows the calculated heating line CL based on FIG.
  • the heating line CL is used to calculate, based on the reflection intensity ratio I 3 / I 0 of the specific fundus EF, the temperature rise of the fundus EF when the therapeutic infrared light of an arbitrary intensity is incident. This is a conversion formula or a conversion formula.
  • Each heating line CL is obtained by interpolating or extrapolating a pair of lines in the graph shown in FIG. 6, and is not limited to the discrete reflection intensity ratio I 3 / I 0 illustrated in FIG. , The reflection intensity ratio I 3 / I which takes any value. It can be calculated every time.
  • the absorption loss coefficient in the case of Usagi and L AR the absorption loss coefficient in the case of the human body as LAH
  • the value of the reflection intensity ratio 1 3 Io 0. 2 X 1 0 - 4, 0. 6 X 1 0- 4, ... , respectively (LAHZLAR) is a need.
  • the saturation temperature is considered to be proportional to ⁇ ⁇ ⁇ LA -I 0 according to the above equation (7), and the slope of each heating line CL is reduced or increased by L AH / L AR. .
  • FIG. 8 is an example in which each heating line CL shown in FIG. 7 is modified for a human body, and shows a heating line CL ′ after calibration. In this case, 0.75.
  • the reflection intensity ratio I 3 / I o decreases at the ratio of (LAHZLAR) 2 and the effect of temperature rise decreases at the ratio of LAHZLAR, as compared to the eyes of the egret.
  • the graph of FIG. line CL '(e.g. 1 3 / 1. 0.
  • the effects of the treatment can be substantially matched between different patients having different reflection intensity ratios from the fundus EF.
  • the estimation of the rise in the temperature of the fundus EF may deviate slightly from the rise in the temperature of the actual patient.
  • the treatment results obtained can be applied to the treatment of other patient groups.
  • the CPU 81 performs appropriate display on the display unit 83 via the display drive unit 84 while receiving instructions from the operator via the input unit 82, and thereby the light source via the interface unit 86.
  • a control signal is output to 32 to cause the therapeutic infrared light to enter the fundus EF of the patient's eye PE at a predetermined low level for a short time. For example, 5 OmW therapeutic infrared light is incident on the 1 mm diameter area of the fundus EF for about 2 seconds.
  • Such low-level or short-term therapeutic infrared light is referred to as probe light. That is, the CPU 81, the light source device 10, the irradiation optical system 20, and the like function as a probe light supply unit.
  • the CPU 81 receives an output signal from the power meter 58 via the interface unit 86 as an input unit, and stores the output signal in the storage device 85 as the intensity of the reflected light from the fundus EF. (Step Sl).
  • the CPU 81 calculates a reflection intensity ratio I 3 / IQ, which is a relative intensity with respect to the therapeutic infrared light, based on the intensity of the reflected light from the fundus EF, and stores this in the storage device 85. (Step S2).
  • the CPU 81 reads out data of a specific patient or patient group to be compared specified by the operator via the input unit 82 from the treatment information database stored in the storage device 85 (Ste S3).
  • This data includes not only information on the reflection intensity ratio I 3 / I 0 obtained for the fundus EF of other patients, but also reference irradiation such as the irradiation time, irradiation spot diameter, temperature rise, and treatment results of therapeutic infrared light. Contains information about the condition.
  • the CPU 81 reads the graph information corresponding to FIG. 8 and the like from the treatment information database stored in the storage device 85 as a supplementary means, and A pair of heating lines corresponding to the patient's eye PE whose reflected light was measured in step SI is calculated (step S4).
  • the calculation of the heating line is as described in FIGS. 6 to 8, and is performed for each of the reflection intensity ratio I 3 / I 0 of the comparison target and the reflection intensity ratio I 3 / IQ of the patient's eye PE.
  • the CPU 81 uses the pair of heating lines obtained in step S4 to make the temperature rise obtained in the comparison object equal to the temperature rise of the patient eye PE whose reflected light was measured this time.
  • the output of the light source 32 that is, the intensity of the therapeutic infrared light is calculated (step S5).
  • the intensity of the therapeutic infrared light obtained in this manner is displayed on the display unit 83 as applicable irradiation conditions, including the irradiation time of the therapeutic infrared light, the irradiation spot diameter, and the like, and is stored in the storage device 85. .
  • the CPU 81 accepts a change in the item content for the applied irradiation condition from the operator via the input unit 82 while displaying an appropriate display on the display unit 83 via the display drive unit 84 (step S 6).
  • the CPU 81 receives this change from the input unit 82 and takes such changes. Store in storage device 85.
  • the CPU 81 determines whether or not a change has been input for the applied irradiation condition (step S7). If the change has been input, the CPU 81 determines the temperature of the fundus EF under the new applied irradiation condition. Estimate the rise (step S8) and terminate the process if no changes have been entered.
  • step S8 the CPU 81 sets the irradiation spot of the reference irradiation condition. Calculate the ratio of the irradiation spot diameter of the applied irradiation condition to the diameter of the beam. Then, the CPU 81 corrects the temperature rise of the fundus EF under the applied irradiation condition as a conversion unit, for example, in inverse proportion to this ratio, and displays the temperature change of the correction on the display unit 83. It is displayed and stored in the storage device 85.
  • step S8 the CPU 81 As a conversion unit, the temperature rise line corresponding to the patient's eye PE obtained in step S4 is read out again. Then, the CPU 81 determines a temperature change corresponding to the increase or decrease in the intensity of the therapeutic infrared light based on the read temperature rise line, and causes the display unit 83 to display the temperature change and display the storage unit 8. Save to 5.
  • step S8 when the irradiation spot diameter is different between the reference irradiation condition and the applied irradiation condition, the ratio of the spot diameter of the applied irradiation condition to the spot diameter of the reference irradiation condition is calculated.
  • the intensity of the therapeutic infrared light calculated in step S5 can be changed so as to be inversely proportional. In this case, the temperature rise can be matched between the reference irradiation condition and the applied irradiation condition.
  • FIG. 10 is a flowchart illustrating a treatment light irradiation program executed by the control device 80.
  • steps S1 and S2 are the same as those in FIG. 9, and thus description thereof is omitted.
  • step S104 as complementary means, the graph information corresponding to FIG. 8 and the like is read from the treatment information database stored in the storage device 85, and the graph information corresponding to the patient eye PE whose reflected light is measured in step S1 is read. Calculate the heating line.
  • step S21 the CPU 81 receives an instruction from the operator via the input unit 82 while performing appropriate display on the display unit 83 via the display driving unit 84,
  • the instruction value of the set temperature when the hyperthermia is applied to the treatment site of the fundus EF of the patient's eye PE is stored in the storage device 85.
  • step S22 the CPU 81 receives an instruction from the operator via the input unit 82 while performing appropriate display on the display unit 83 via the display drive unit 84,
  • the indication value of the irradiation spot diameter when the hyperthermia is applied to the treatment site of the fundus EF of the patient's eye PE is stored in the storage device 85.
  • step S23 the CPU 81 receives an instruction from the operator via the input unit 82 while performing appropriate display on the display unit 83 via the display drive unit 84,
  • the instruction value of the irradiation time when the hyperthermia is applied to the treatment site of the fundus EF of the patient's eye PE is stored in the storage device 85.
  • the CPU 81 sets the light source 32 so that the temperature rise of the patient's eye PE whose reflected light is measured this time becomes the temperature rise input in step S21.
  • the output, that is, the intensity of the therapeutic infrared light is calculated and stored in the storage device 85 (step S24).
  • the CPU 81 corrects the intensity of the therapeutic infrared light according to the irradiation spot diameter to be projected on the fundus EF as an irradiation density correction unit. That is, the ratio of the irradiation spot diameter set in step S22 to the irradiation spot diameter corresponding to the heating line obtained in step S4 is calculated, and the treatment calculated in step S5 is, for example, inversely proportional to this ratio. Change the intensity of infrared light for use.
  • the CPU 81 outputs a control signal to the light source 32 via the interface unit 86, and enters therapeutic infrared light into the fundus EF of the patient's eye PE under the conditions obtained in steps S22 to S24.
  • Step S25 Specifically, based on the irradiation spot diameter input in step S22, the irradiation time input in step S23, the intensity of the therapeutic infrared light calculated in step S24, etc., the fundus EF of the patient's eye PE is calculated. Irradiate therapeutic infrared light in place.
  • the surgeon can adjust the position of the condensing optical system 40 and the exit end 16 to adjust the incident position and irradiation spot diameter of the therapeutic infrared light.
  • the CPU 81 receives the output of the observation unit 60 via the interface unit 86, and can display on the display unit 83 whether or not the irradiation spot diameter has reached the target value. Support the treatment of
  • the control device 80 determines the intensity IQ of the treatment infrared light based on the detection output of the reflection detection unit 50, so that the fundus due to the incidence of the treatment infrared light
  • the temperature rise of the EF can be estimated with a certain degree of accuracy, and transpupillary hyperthermia treatment using infrared light can be efficiently corrected or optimized while providing feedback on past data.
  • the hyperthermia apparatus 100 according to the second embodiment is a modification of the apparatus according to the first embodiment, and has the same basic device configuration.
  • the intensity of the therapeutic infrared light is determined by more strictly considering the attenuation of light in the cornea, lens, and the like. That is, it is said that the transmittance of the cornea, the lens, and the vitreous body decreases with age, and the intensity of the therapeutic infrared light is determined in consideration of such a decrease in transmittance.
  • FIG. 11 is a diagram illustrating the relationship between age and transmittance of the cornea and the like. In the first embodiment, the attenuation due to the cornea, the lens, and the vitreous is fixed, but the intensity of the therapeutic infrared light is determined in consideration of the decrease in the transmittance of the cornea and the lens due to age.
  • the temperature rise can be estimated with sufficient accuracy as long as the patient's eyes PE are close in age.
  • the transmittances of the cornea, the lens, and the vitreous are L AL , LA 2 , and LAS
  • the reflection intensity ratio from the fundus EF I 3 no I is not limited.
  • the heating line is calibrated by the same method as that for obtaining Fig. 8, by the amount of change in the absorption loss coefficient LA.
  • L A3 1 In the following, namely as LA L AL ⁇ L A2
  • the reflection intensity ratio I 3 ZIQ is (L A30 / LA6O) 2 Increase in proportion 1 Increase temperature effect increases in proportion to LA30Z LA60.
  • LA30 is the product of the transmittances of the 30-year-old patient's eye with respect to the cornea and lens, as described in the above-mentioned LA equation.
  • LA60 is obtained by integrating the transmittances of the cornea and lens of a 60- year-old patient's eye.
  • the above calibration is performed in step S4 in FIG. 9 and step S104 in FIG.
  • the slope of the heating line is increased by L A30 ZL A60 , the value of the reflection intensity ratio I 3, I 0 (L A3 oZL A60) to double.
  • the above description has been made for the case where the transmittance is reduced in the cornea, the crystalline lens, and the like.However, when light is scattered by the cornea or the crystalline lens, even if the reflection intensity ratio of the probe light is large, the The effect of raising the temperature of the eyes may not be sufficiently obtained. Therefore, it is desirable to eliminate such error factors for a patient's eye whose scattering is not negligible. Specifically, for example, by modifying the inclination of the heating line appropriately according to the scattering state of the patient's eye, the temperature in the case of thermal treatment of the patient's eye can be increased. Ascent can be secured.
  • the thermal treatment apparatus is a modification of the apparatus according to the first embodiment with respect to detection and display of reflected light of probe light.
  • an intensity scale of the reflected light with respect to the probe light is provided for a power meter 58 which is a display unit for displaying the power of the reflected light detected by the infrared sensor 56 in FIG. This makes it possible to display not only the measurement result of the probe light but also how much the measured value deviates from the standard reflected light intensity.
  • FIG. 12 shows an example in which the power meter 58 is provided with a reflection intensity scale.
  • the power meter 58 has an intensity scale 58b on the display 58a, and the hand 58c moves on the intensity scale 58b.
  • the standard reflected light intensity of the average fundus for the probe light under the standard conditions for example, wavelength of 80 nm, laser output of 50 mW, spot diameter of 3 mm
  • the intensity difference, that is, the deviation is shown in%.
  • Such indications can be refined by statistical treatment of treatment effects.
  • the range of average reflected light intensity is within the range of standard hyperthermia (e.g., wavelength of 800 nm, laser power of 800 mW, spot diameter). 3 mm, 60 seconds) is possible. If it exceeds this range, the treatment light may be too small or too large. Therefore, the intensity of the treatment light, that is, the processing light can be appropriately adjusted to be appropriate.
  • standard hyperthermia e.g., wavelength of 800 nm, laser power of 800 mW, spot diameter
  • step S1 of FIG. 9 the same measurement as in step S1 of FIG. 9 was performed on a patient with age-related macular degeneration (hereinafter referred to as AMD patient) to measure the intensity of reflected light from the fundus of an AMD patient.
  • AMD patient age-related macular degeneration
  • the laser irradiation site which is infrared treatment light
  • Test irradiation that is, irradiation of probe light was performed under the set conditions, and the intensity of the reflected light, that is, the reflected light output was measured.
  • TTT was performed, and the therapeutic effect of TTT and the presence or absence of complications were observed in accordance with the reflected light output from each patient's eye.
  • the wavelength of TTT treatment light was 810 nm and the laser irradiation time was 60 seconds.
  • the spot size of the treatment light on the fundus should be 1.2 mm, 2 mm, or 3 mm depending on the size of the lesion.
  • the one-side output was set to 160 mW when the spot size was 1.2 mm, 270 mW when the spot size was 2 mm, and 400 mW when the spot size was 3 mm.
  • the wavelength of the probe light was 81 O nm, the laser output was 50 mW, and the laser irradiation time was 2 seconds. At this time, the spot size of the probe light at the fundus was the same diameter as the spot size of the treatment light.
  • the reflected light output is shown as the average soil standard deviation.
  • the ratio to the total average represents the relative intensity ratio of the reflected light output of the group based on 1.8 ⁇ 0.8, which is the average value of the reflected light output for all patient eyes.
  • 13 eyes were classified as “low” croup, 18 eyes were classified as “proper” croup, and 6 eyes were classified as “excess” croup.
  • Table 2 below is intended to specifically explain the outline of the above-mentioned measurement and therapeutic effects. Note that only 29 eyes out of 37 eyes in Table 1 above are shown. (Table 2)
  • TTT effect classification means the therapeutic effect of the two previous items: (1) the effect on neovascularization and (2) judgment based on the findings of excessive coagulation.
  • Pre-operative visual acuity means ⁇ minority visual acuity just before the operation, and “post-operative visual acuity” means ⁇ minority visual acuity after the operation (about 3 months).
  • Fluorescein angiography fluorescein mainly by fluorescence ophthalmoscopy Whether the outflow is attenuated.
  • Fluorescein angiography (fluorescein and indocyanine green fluorescein angiography) atrophy RPE and choroidal capillaries, or a clear image of the choroidal middle vasculature with TTT therapeutic light irradiation spots. If the shape was very similar to that of a perfect circle, it was judged as excessive coagulation finding +.
  • the reflected light output value is related to the temperature rise during TTT.
  • the reflected light output value can be used to efficiently modify treatment with TTT .

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Abstract

Cette invention se rapporte à un appareil de thermatologie ophtalmique capable de commander avec précision l'élévation de température dans une zone affectée du globe oculaire. Une unité de commande (80) calcule une paire de courbes d'élévation de température, respectivement sur la base du rapport d'intensité de réflexion (I3/I0) obtenu par rapport à un objet comparatif désigné et du rapport d'intensité de réflexion (I3/I0) de l'oeil (PE) du patient. L'unité de commande (80) calcule en outre la sortie d'une source lumineuse (32), c'est-à-dire l'intensité d'un rayon infrarouge thérapeutique, pour que l'élévation de température obtenue par rapport à l'objet comparatif soit égale à l'élévation de température de l'oeil (PE) du patient qui a été mesurée par rapport à la lumière réfléchie au moment présent.
PCT/JP2003/005530 2002-04-30 2003-04-30 Appareil de mesure de rendement d'elevation thermique, appareil thermatologique et procede pour commander un rayon laser therapeutique WO2003092566A1 (fr)

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JP2008225984A (ja) * 2007-03-14 2008-09-25 Topcon Corp 診療支援システム及びプログラム
JP2013048864A (ja) * 2011-08-31 2013-03-14 Nidek Co Ltd 眼科用レーザ治療装置
JP2014014486A (ja) * 2012-07-09 2014-01-30 Sumitomo Electric Ind Ltd レーザ治療装置、レーザ治療装置の動作方法および治療方法
KR20140122728A (ko) * 2012-01-18 2014-10-20 웨이브라이트 게엠베하 광학 밀도에 따라서 레이저 에너지를 조정하는 방법
JP2017148659A (ja) * 2017-06-12 2017-08-31 バーフェリヒト ゲゼルシャフト ミット ベシュレンクテル ハフツング 光学濃度に従ったレーザーエネルギーの調整

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WO1993003793A1 (fr) * 1991-08-22 1993-03-04 Roberto Enzo Di Biaggio Appareil de phototherapie
JP2573618B2 (ja) * 1987-09-18 1997-01-22 興和株式会社 治療用レーザ装置
EP1101450A1 (fr) * 1999-11-17 2001-05-23 Pulsion Medical Systems AG Appareil et méthode de traitement des vaisseaux poussants, dilatés ou malformés
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JP2573618B2 (ja) * 1987-09-18 1997-01-22 興和株式会社 治療用レーザ装置
JPH02271859A (ja) * 1989-04-14 1990-11-06 Sony Corp 眼科用レーザー凝固装置
WO1993003793A1 (fr) * 1991-08-22 1993-03-04 Roberto Enzo Di Biaggio Appareil de phototherapie
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Publication number Priority date Publication date Assignee Title
JP2008225984A (ja) * 2007-03-14 2008-09-25 Topcon Corp 診療支援システム及びプログラム
JP2013048864A (ja) * 2011-08-31 2013-03-14 Nidek Co Ltd 眼科用レーザ治療装置
KR20140122728A (ko) * 2012-01-18 2014-10-20 웨이브라이트 게엠베하 광학 밀도에 따라서 레이저 에너지를 조정하는 방법
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JP2014014486A (ja) * 2012-07-09 2014-01-30 Sumitomo Electric Ind Ltd レーザ治療装置、レーザ治療装置の動作方法および治療方法
JP2017148659A (ja) * 2017-06-12 2017-08-31 バーフェリヒト ゲゼルシャフト ミット ベシュレンクテル ハフツング 光学濃度に従ったレーザーエネルギーの調整

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