WO2010149300A1 - Appareil laser et procédé, en particulier procédé permettant de faire fonctionner un appareil laser pour la production de données de commande du rayonnement pour un laser pulsé - Google Patents

Appareil laser et procédé, en particulier procédé permettant de faire fonctionner un appareil laser pour la production de données de commande du rayonnement pour un laser pulsé Download PDF

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Publication number
WO2010149300A1
WO2010149300A1 PCT/EP2010/003605 EP2010003605W WO2010149300A1 WO 2010149300 A1 WO2010149300 A1 WO 2010149300A1 EP 2010003605 W EP2010003605 W EP 2010003605W WO 2010149300 A1 WO2010149300 A1 WO 2010149300A1
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laser
control data
ablation
vertex
irradiation control
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PCT/EP2010/003605
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German (de)
English (en)
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WO2010149300A8 (fr
Inventor
Georg Sluyterman Van Langeweyde
Michael Bergst
Gregor Stobrawa
Mark Bischoff
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Carl Zeiss Meditec Ag
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Publication of WO2010149300A1 publication Critical patent/WO2010149300A1/fr
Publication of WO2010149300A8 publication Critical patent/WO2010149300A8/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
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00804—Refractive treatments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00804—Refractive treatments
    • A61F9/00806—Correction of higher orders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00878—Planning
    • A61F2009/0088—Planning based on wavefront

Definitions

  • Laser apparatus and method in particular operating method for a laser apparatus, for generating irradiation control data for a pulsed laser
  • the invention relates to a method for generating irradiation control data for the ablation of material from a curved surface (be it aspherical or spherical), in particular a cornea, according to a predetermined SoII ablation profile by means of a pulsed laser, a method for ablating material from a curved one Surface (aspheric or spherical), in particular a cornea, according to a predetermined target ablation profile and a laser device for carrying out these methods with a laser for a pulsed operation.
  • the ablation that is, the removal of material from a surface of a body, by means of a pulsed laser beam is basically known.
  • a laser beam is directed onto the surface to be ablated, where material of the body absorbs at least a portion of the laser radiation. With sufficient energy input material is removed from the surface.
  • This laser ablation can therefore be used to form a body without contact with high accuracy, in particular even at low ablation depths.
  • a "flying spot” method material is removed from the surface by passing a pulsed laser beam across the surface in accordance with predetermined radiation control data by means of a scanning unit ("scanner").
  • the irradiation control data comprise a sequence of positions of target locations on the surface, to which at least one pulse of the laser beam is to be directed in.
  • the irradiation control data may additionally contain at least one indication, for the irradiation, a beam or pulse property, in particular the energy of one or more pulses or the fluence, that is to say the energy of one or more pulses with respect to the irradiated area, is determined on a plane orthogonal to the direction of the laser beam on the surface of the body , pretends n for the energy / fluence, must be between two consecutive Pulses are changed. If the laser operates at a constant pulse energy or fluence during ablation, no radiation control data need be given in terms of pulse energy or fluence.
  • the irradiation control data are determined on the basis of a predetermined SoII ablation profile. This is a lot of desired material removal depending on the location on the surface. Typically, the material depth to be ablated is predefined for several locations (referred to below as destination).
  • the desired ablation profile can be displayed in any desired manner. For example, points on a given dot matrix in a reference plane and the points respectively associated with ablation depths may be present. However, it is also possible to specify the desired ablation profile by at least one function parameterized by at least one function parameter and a value of the function parameter, wherein the function and the value of the function parameter are chosen such that the function depends on the value of the function parameter and on Place in the reference plane indicates the Ablationstiefe.
  • polynomials such as Zernike polynomials or splines can be used, for example.
  • each pulse removes a single-pulse ablation volume, which is given by the cross-section of the laser beam at the surface assumed to be orthogonal to the beam direction for this purpose and by the ablation depth. If several pulses arrive at the same target location, the ablation depths accumulate so that overall a greater depth is achieved.
  • the irradiation control data are now determined so that the ablation volumes achieved by the entry of the pulses at the destinations specified by the irradiation control data coincide as well as possible with the desired target ablation profile. It should be noted that the ablation actually achieved at a target site depends on the effective energy input, which generally differs from the pulse energy delivered by the laser and in turn depends on the surface characteristics at the respective target location.
  • the fluence at a particular destination depends on the surface slope of the target treating body at this point, because the angle of incidence of the laser beam on the one hand determines the effective irradiated area and on the other hand, the degree of (absorption-reducing) reflection. For this reason, the irradiation control data must be corrected in a location-dependent manner in order to be able to generate a predefined SoII ablation profile as precisely as possible.
  • US 2003/0105457 A1 describes the correction of the energy of the laser pulses for the refractive surgical treatment of the cornea as a function of the angle of incidence of the laser beam, taking into account the above-mentioned effects of the angle of incidence on the fluence at the destination.
  • An improved correction of irradiation control data for the cornea is described in US 2008/058781 A1, the disclosure of which is fully incorporated herein by reference.
  • ablation program the shape of the beam profile and the surface inclination of the cornea are taken into account.
  • provisional irradiation control data are determined on the basis of the desired ablation profile and iteratively approximates the desired ablation profile by simulation of the irradiation on the basis of the surface inclination to be determined.
  • US 2004/0019346 A1 also describes the correction of the irradiation control data as a function of the local surface inclination.
  • the target ablation profile is centered around the pupil whose position is determined for this purpose.
  • the problem is that the human eye can move during a laser surgery treatment, in particular can perform so-called saccadic movements at a speed up to about 800 ° per second, so that in extreme cases drastic deviations of the current irradiation position can occur within a short time. It is therefore necessary to determine movements of the eye and to take into account the current position of the eye when determining the radiation control data. This is also called tracking the laser beam. Such measures are known, for example, from US 2005/0278004 A1, in which rotational and translational movements of the eye are tracked. According to the method described in EP 1 923 027 A1, the instantaneous position of the eye is determined by identifying the center of the pupil. In addition, a deviation of the determined Corrected pupil center from the corresponding site on the corneal surface.
  • the invention has for its object to further improve the aforementioned method and a laser device of the type mentioned, so that the actually generated shape better matches the target ablation.
  • the object is achieved by a method having the features specified in claim 1, and by a laser device having the features specified in claim 12.
  • a method for generating irradiation control data that a position of a (momentary) vertex of the surface to be ablated relative to an optical axis of the laser is determined and used in the preparation of the irradiation control data.
  • a device for determining a position of the (instantaneous) vertex of the curved surface to be irradiated with respect to an optical axis of the laser and a control unit for carrying out the method according to the invention is provided for a laser device, wherein the device comprises a light source and a spatially resolving light receiver for receiving having reflected light on the surface and is connected to the control unit for data transmission.
  • the position is determined in the coordinate system of the laser (typically Cartesian coordinates x / y / z with z in the direction of the optical axis of the laser).
  • the determination of the position of the instantaneous vertex with respect to the optical axis of the laser but takes place in particularly advantageous embodiments, regardless of a fixation on a predetermined line of sight (for general surfaces: regardless of the current orientation of the surface).
  • the vertex with respect to the optical axis of the laser is that point of the surface to be ablated, which lies closest to the laser along this optical axis (ie in the zero position of the laser beam).
  • the optical axis of the laser while the optical axis of those optics is to be considered that the Laser device terminates towards the surface to be ablated.
  • the vertex with respect to the optical axis of the laser is the point of the surface whose orthogonal projection on the optical axis has the smallest distance to the laser device.
  • it can be defined as a peak (highest point) in the direction of the optical axis of the laser or as a local maximum or extremum with respect to the optical axis of the laser.
  • this point In the case of the cornea, this point, referred to as a vertex with respect to the optical axis of the laser, generally deviates from the puncture point of the visual axis (also referred to as the visual axis) through the cornea surface, from the center of the comea surface (ie, the puncture point of the optical axis of the eye) and from the highest point of the cornea at fixation (which is approximately identical to the puncture point of the visual axis). However, depending on the individual shape of the cornea, placement of the eye and line of vision, it may coincide coincidentally with one of these points.
  • the instantaneous vertex with respect to the optical axis of the laser is not surface-stable, it generally moves (in both spherical and aspherical surfaces) with surface roughness in a surface-fixed reference frame relative to surface-solid dots (such as the puncture point of the visual axis through the comea surface, the puncture point of the axis of symmetry of the eye through the corneal surface).
  • the instantaneous vertex has a constant position in the reference frame of the laser, but moves in a surface-fixed reference frame.
  • an aspheric surface it also moves in the reference frame of the laser.
  • translation movements it moves (regardless of the surface shape) in the reference frame of the laser, but not in the surface-fixed reference frame.
  • combined translational and rolling movements it moves in both frames.
  • Ablation of curved surfaces typically has radially varying ablation efficiencies that result in distortion of the resulting ablation profile.
  • ablation efficiency can have different causes and become refer to different reference points.
  • the reference center (the reference point) for projection losses (reduced effective energy input) due to the surface tilt is just the vertex with respect to the optical axis of the laser, since these losses depend exclusively on the angle of incidence.
  • the reference point here the point of penetration of the axis of symmetry of the ablation efficiency model through the surface to be ablated, is the instantaneous vertex with respect to the optical axis of the laser.
  • the so-called apex which is in the case of a rotationally symmetric surface such as the cornea of the piercing point of its axis of symmetry through the surface, a fixed relative position with respect to the surface to be ablated.
  • the apex may be referred to as the ocular reference point.
  • the accuracy of a surface ablation, in particular a laser surgical treatment of the cornea can be improved if this vertex and an ocular reference point such as the puncture point of the visual axis through the corneal surface is not coincide.
  • an ocular reference point such as the puncture point of the visual axis through the corneal surface is not coincide.
  • the target to be fixed in the case of non-optimal fixation of the eye (due to the deviation from the optical axis of the laser and the visual axis, the target to be fixed must lie away from the optical axis of the laser).
  • Embodiments in which the position of the instantaneous vertex during an irradiation (in particular repeatedly) is determined and the laser is tracked with respect to the instantaneous vertex are particularly preferred, for example by compensating ablation efficiency variations of at least one submodel relative to the instantaneous vertex as the reference point.
  • the position of an eye-fixed feature such as the apex, the pupil (center, centroid) or the limbus is additionally determined in a conventional manner, tracked and used to track the laser. If the laser energy to be used is predetermined, not only can the point of incidence of the laser be tracked, but additionally the desired ablation profile can be adapted.
  • the desired ablation profile is to be decomposed into the profile of the desired correction times an efficiency compensation function.
  • the center of the profile of the desired correction may be, for example, the pupil center, which is the efficiency compensation function of the current vertex.
  • the irradiation control data are expediently recalculated for tracking the laser as a function of the position of the instantaneous vertex. This includes the consideration of ablation efficiency variations as a function of the instantaneous vertex with respect to the optical axis of the laser (and, where determined, other reference points).
  • movements of the surface to be ablated for example in the case of the cornea, arbitrary or involuntary eye movements, are automatically taken into account in the generation of the irradiation control data.
  • an iterative approach of the actual ablation profile to the desired ablation profile succeeds in this way with little effort and high accuracy.
  • a model of an ablation efficiency distribution can be used which is dynamically determined for tracking the laser as a function of the position of the instantaneous vertex with respect to the optical axis of the laser.
  • At least two submodels of a respective ablation efficiency distribution, in particular accumulated, are used to correct the irradiation control data when the irradiation control data is generated, wherein the first submodel refers to an eye-fixed point, in particular an apex or a vertex with respect to an optical axis of an eye or the pupil or the limbus, is referred to as a reference point and the second sub-model is based on the particular momentary vertex with respect to the optical axis of the laser as a reference point.
  • This embodiment is based on the recognition that causes of variations of the ablation efficiency are possible leading to other reference centers (reference points) than the vertex with respect to the optical axis of the laser.
  • variation may occur due to biomechanical circumstances, for example, in response to the current or previous (laser) surgical treatment.
  • the reference point here is the symmetry axis of the desired ablation profile (the current or earlier treatment), ie an eye-tight point.
  • stationary structural changes of the comeal tissue typically have as reference point the apex of the cornea.
  • each of the different effects leads to a separate ablation efficiency distribution, which, while considered individually, can generally be described approximately radially symmetrically, but may each have different reference centers (more generally for non-radially symmetric variations: reference points).
  • reference points more generally for non-radially symmetric variations: reference points.
  • the conventional ablation efficiency model is decomposed into a plurality of radially symmetric sub-efficiency functions (submodels). This, in conjunction with the determination of the location of the vertex of the cornea with respect to the optical axis of the laser, allows for multiple compensation of local ablation efficiency variations and thus improves the accuracy of laser surgical treatment.
  • the first submodel and the second submodel are each radially symmetric with respect to the respective reference point. This allows the preparation of the irradiation control data with little effort and thus done in a short time. The duration of irradiation (duration of treatment) is minimized.
  • the target ablation profile is corrected for ablation efficiency using the first partial model with the eye-fixed reference point before the radiation control data is generated. This reduces the effort for the preparation of the irradiation data and thus the required irradiation time, since the compensation needs to be performed only once based on the first partial model.
  • irradiation control data of the laser pulses actually emitted are recorded during the irradiation and taken into account in particular in the case of an iterative generation of irradiation control data.
  • a change in the position of the vertex with respect to the optical axis of the laser by means of a device for measuring a movement of the surface, in particular for measuring an eye movement are determined.
  • a laser device which achieves this advantage has, for determining the position of the instantaneous vertex, a device for measuring a movement of the surface, in particular for measuring an eye movement. For example, rotational movements are measured around two or three axes and optionally translational movements along two or three axes.
  • wavefront information of the surface in particular of an ocular wavefront
  • the wavefront information and the vertex are preferably determined by means of the same device.
  • the determination of the wavefront information can be done by measuring or accepting a corresponding data set.
  • the vertex with respect to the optical axis in the state of fixing the eye to a fixation target along the optical axis of the wavefront measuring device used can be detected and used as a reference point for registering an ablation efficiency model for wavefront portions of a laser surgery operation.
  • the instantaneous vertex for tracking the laser can be determined and used.
  • an original position of a vertex of the cornea with respect to the optical axis of the laser can be determined preferably in a fixed state of the eye in question, as in correct fixation coincides with the ophthalmic puncture point of the visual axis through the corneal surface.
  • the laser device having a device for identifying a fixation of an eye.
  • the determination of the position of the instantaneous vertex succeeds, for example, by accumulation of the individual changes to the starting position of the vertex with respect to the optical axis of the laser.
  • a higher accuracy of this determination is achieved by intermediately referencing (for example at regular intervals) by measuring the absolute position of the vertex with respect to the optical axis of the laser. For example, can Intermediate referencing a fixing light can be switched flashing, so that the patient is stopped for fixation.
  • the generation of irradiation control data according to the invention is expediently carried out before or during an ablation of material from a surface, in particular a cornea, by means of a pulsed laser according to a predetermined desired ablation profile, whereby pulses of the laser are generated on the surface in accordance with the generated irradiation control data to produce an actual ablation profile be delivered.
  • the invention also includes control units and computer programs that are set up to carry out a method according to the invention.
  • FIG. 1 schematically shows a first laser device and an eye with reference points for ablation efficiency variations
  • Fig. 2 shows a second laser device with external Fixierlichtario
  • FIG. 3 is a flowchart of a method for generating radiation control data and for ablating material from a surface.
  • the method described in DE 10 2005 006 897 A1 and the arrangement described therein can be used in expanded form according to the invention for generating irradiation control data and for ablating material from a surface, for example in principle.
  • the use of other methods and the use of other arrangement are possible.
  • 1 shows a schematic representation of a laser device 1 for the ablation of material from a curved surface 2, in this case a cornea of an eye 3, with a pulsed laser 4, for example an excimer laser.
  • the laser is controlled by a control unit 5.
  • an xy-scanning unit 6, a z-scanning unit 7, a first illumination light source 8 and a second illumination light source 9 are controlled by the control unit 5.
  • a spatially resolving detector 10 for example a CCD video camera or a CMOS detector, is coupled via a color-neutral beam splitter 11 into the illumination beam path of the illumination light sources 8, 9. Both the laser 4 and the illumination light sources 8, 9 are imaged by a focusing optics 12, which at the same time terminates the laser device 1 towards the surface 2.
  • the visual axis VAA of the eye 3 pierces the surface of the cornea 2 at the piercing point A. Shown is also the optical axis OA L of the laser 4 and an orthogonal O to this, which marks the highest point V of the cornea 2 in the direction of the optical axis OAL , This point V of the cornea 2, which is closest to the laser device 1 (here only coincidentally located on the optical axis OA L of the laser 4), is the vertex V with respect to the optical axis OA L of the laser 4. Since the eye 3 is not on the laser device 1 is aligned (no fixation of the fixation light not shown here), the two optical axes OA A and OAL do not coincide, but are oriented at an angle to each other. Even with the correct fixation, the axes do not necessarily coincide, for example due to a lateral displacement of the eye 3. Due to a superposition of different causes, there is a non-radially symmetrical variation of the ablation efficiency on the cornea 2.
  • the illumination beam path of the illumination light sources 8, 9 is coupled via a further beam splitter 11 to the illumination beam path of the laser 4 such that the laser 4 and the first illumination light source 8 have coaxial optical axes.
  • the second illumination light source 9 is arranged away from the optical axis so that it is suitable for the reflection-free recording of an image of the cornea and, for example, the pupil 13 behind it by means of the detector 10. This is to detect and track the position of the apex A or pupil 13 (its center or center of gravity) or limbus (not shown).
  • the second illumination light source 9 can also be used to identify a fixation by the eye 3, for example by evaluation of the images of the detector 10 by means of image processing.
  • the first illumination light source 8 In contrast to the second illumination light source 9 causes the first illumination light source 8, whose light is expanded by the optics 12, 14 so that the entire eye 3 is illuminated, in an image recording by means of the detector 10 due to their coaxial, coinciding with the zero position of the laser 4 Placement of a mirror reflex on the surface 2 of the cornea or the sclera 15.
  • the location of this reflection in the recorded image in the simplest conceivable case of a smooth surface 2, the position of the vertex V of the cornea with respect to the optical axis OA L of the laser 4 in laser coordinates and serves to identify and track this situation.
  • a focus can be formed on the disturbed mirror image of the first illumination light source 8 on the rough surface 2 by image processing.
  • a plurality of illumination light sources 9, which are noncoaxial with the observation beam path of the detector 10 and whose mirror images lie outside the area of the surface 2 to be ablated or outside a region of a corneal flap, but which are sharply imaged, are used
  • the location of the vertex V is determined from the mirror images of the coaxial first illumination light source 8 relative to the mirror images of the non-coaxial second illumination sources 9.
  • the mirror images of the non-coaxial second illumination light sources become the current vertex This is done assuming an approximately spherical geometry of the cornea.
  • a complete topography of the eye 3 is first determined (means are not shown for the sake of simplicity), for example in a known manner by imaging Placido - Wrestling and derivation of surface slopes and hence determination of the height of the cornea.
  • a follow - up of the eye orientation and the lateral movement takes place and from this calculation of the momentarily highest point (Vertex V).
  • the tracking is achieved, for example, by one or more video cameras 10, which record the limbus of the eye, wherein the lateral offset and from its ellipticity the orientation of the eye 3 is determined from the center of the limbus.
  • a multi-point sensor which analyzes the direction of movement and speed of the eye 3 at several points of the eye 3 and which works on the principle of an optical mouse, for example by evaluating laser speckles different speeds and directions can track the movement and orientation change of the eye 3.
  • the points of the sensor are optimally located on the sclera 15 or on the iris 13, since they are non-transparent.
  • FIG. 2 shows an alternative arrangement in which the second illumination light source 9 is arranged outside the laser device 1.
  • the (instantaneous) vertex V which in turn is marked as the highest point V of the cornea by an orthogonal O to the optical axis OA L of the laser 4, lies neither on the optical axis OA L of the laser 4 nor on the visual axis VAA of the laser Eye 3.
  • Fig. 3 the implementation of the method according to the invention is illustrated by a flow chart.
  • a corresponding computer program is executed, for example, by the control unit 5.
  • the irradiation control data of the respectively treated destination are referred to as current irradiation control data, the destinations being treated sequentially.
  • the control unit 5 is to specify a target ablation profile on the basis of which, for example, it generates a set of irradiation control data comprising a multiplicity of corresponding destinations.
  • a target ablation profile on the basis of which, for example, it generates a set of irradiation control data comprising a multiplicity of corresponding destinations.
  • the algorithms used concretely for the generation of the irradiation control data reference is made to DE 10 2005 006 897 A1.
  • the correction of the irradiation control data by compensation of ablation efficiency variations likewise takes place with the algorithm according to DE 10 2005 006 897 A1, but several times each with a different submodel which relates to a respective reference point A or V respectively.
  • a partial model according to FIG DE 10 2005 013 252 A1 can be used for a compensation (correction) of an ablation efficiency variation of biological origin.
  • Other partial models with other reference points can be considered in alternative embodiments (not shown).
  • the tracking and control of the laser 4 and the determination of the position of the instantaneous vertex V and the eye-fixed reference point can be carried out as described above or in another way.
  • the ocular point A for example, a center of gravity of the pupil or the limbus (or the apex) may be used.
  • the eye-fixed profile components, which are corrected in the tracking of the shooting position based on a change in position of the eye-fixed reference point, are for example a basic correction and a partial model of the ablation efficiency distribution. The order of the steps is not set to the order shown.
  • the determination of the position of the instantaneous vertex V and the associated compensation of the ablation efficiency can be carried out before the determination of the position of the ocular point A (apex or pupil or limbus) and the associated compensation of the ablation efficiency. It is also conceivable first to determine the position of both reference points A, V and only then to correct the irradiation control data for compensation of the ablation efficiency variations. Instead of radially symmetrical submodels centered around the reference points A, V, one or both of the two submodels may not be radially symmetrical.
  • the control of the ablation takes place, for example, according to the instantaneous distance of the instantaneous vertex V by variation of the number of shots per destination of the SoII ablation profile, ie per irradiation point on the surface 2, or by varying the energy of the individual single shot assigned to the respective destination.
  • varying the number of shots per destination by logging during the procedure, a log of how many shots have already been fired at each destination is recorded, for each shot the position (distance) relative to the current location of the current vertex V.
  • the irradiation control data associated with this destination such as energy, spot size, and shape, are also logged, and the actual vertex spacing, which is particularly dependent on interim eye movements, and the irradiation control data are used for Determining a successful effective ablation volume of the single shot that models the ablation efficiency. These individual volumes are added to a current ablation map that represents the effective ablation. On the basis of the ablation card, the decision is made before each subsequent single shot whether it is still applied or whether enough ablation has already been achieved in order to fulfill the desired ablation profile. In the latter case, the shot is not made, but continued with the next destination. The iterative repetition including remeasurement of the location of the current vertex V can be done either after each shot or after completion of a destination.
  • control unit 5 can create a list of randomly distributed destinations that cover the area of the ablation sufficiently densely. It can successively process this list several times and calculate a single shot for each target location and decide on the delivery as described above, for example until the target ablation profile has been achieved with a deviation of less than a single, smallest possible ablation volume.
  • Another alternative is the so-called onion peel ablation.
  • 1/10 of the total ablation to be achieved per target location and shot is generated in the manner of an onion dish and the test for adequate fulfillment of the desired ablation profile is carried out after each dish, not after each shot ,
  • VA A visual axis of the eye

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

Abstract

1. L’invention concerne un appareil laser et un procédé, en particulier un procédé permettant de faire fonctionner un appareil laser pour la production de données de commande du rayonnement pour un laser pulsé. 2.1 Dans le cas de l’ablation au laser, pour le traitement de la cornée par chirurgie réfractive, on sait corriger en fonction de l’angle d’incidence du faisceau laser les données de commande du rayonnement définies à partir d’un profil d’ablation théorique en ce qui concerne l’énergie de l’impulsion laser. La forme du profil du faisceau et l’inclinaison de surface de la cornée peuvent ainsi être prises en compte. L’invention a pour objet de permettre une concordance encore meilleure de la forme effectivement produite et du profil d’ablation théorique. 2.2 A cette fin, une position d’un vertex (momentané) de la surface à enlever par rapport à un axe optique du laser est définie et utilisée pour la production des données de commande du rayonnement. On a constaté selon l’invention que la prise en compte de la position effective du vertex par rapport à l’axe optique du laser permet d’améliorer la précision d’une ablation de surface, en particulier d’un traitement de la cornée par chirurgie laser, lorsque ce vertex et un point de référence fixe de l’œil, comme le point de passage de l’axe visuel par la surface de la cornée, ne coïncident pas. 2.3 Ophtalmologie
PCT/EP2010/003605 2009-06-23 2010-06-16 Appareil laser et procédé, en particulier procédé permettant de faire fonctionner un appareil laser pour la production de données de commande du rayonnement pour un laser pulsé WO2010149300A1 (fr)

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DE102009030464.9A DE102009030464B4 (de) 2009-06-23 2009-06-23 Lasergerät und Verfahren, insbesondere Betriebsverfahren für ein Lasergerät, zur Erstellung von Bestrahlungssteuerdaten für einen gepulsten Laser
DE102009030464.9 2009-06-23

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US20230181365A1 (en) * 2020-05-24 2023-06-15 Carl Zeiss Meditec Ag Uv-laser-based system for correcting impaired vision, and method for centering same

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WO2010149300A8 (fr) 2011-03-10
DE102009030464A1 (de) 2010-12-30

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