JP3717964B2 - Laser treatment device - Google Patents

Description

[0001]
[Industrial application fields]
The present invention relates to a laser treatment apparatus that performs treatment by irradiating an affected area with therapeutic laser light.
[0002]
[Prior art]
Laser treatment apparatuses such as an argon laser are widely used particularly in the ophthalmic field. Ophthalmic laser treatment is mainly used for photocoagulation of the fundus and the like using the thermal action and incision (destruction) of the iris and the like using the impact action.
In photocoagulation treatment for fundus lesions, heat generated by light absorption by an absorber (mainly pigment epithelial melanin) is transferred to surrounding tissues to cause protein coagulation. For example, in the treatment of retinal detachment, this protein coagulation causes adhesion between the retina and the choroid and strengthens the bond. In this case, the destruction of the tissue is not the purpose, but rather it is required to be solidified without being destroyed. Therefore, the laser light has a low output and the irradiation time is lengthened.
[0003]
In the treatment of angle-closure glaucoma, the impact of the laser is used to perforate the iris and form a passage between all posterior chambers non-invasively. In this case, since the purpose is mechanical incision (destruction) of the tissue, the laser light is increased in output to increase the peak output value and shorten the irradiation time.
Both of these treatments are performed by preparing two types of lasers with different output characteristics and using them properly according to the output characteristics of the laser light, or by changing the output and irradiation time of one laser. It was.
[0004]
[Problems to be solved by the invention]
However, in the latter apparatus for adjusting the output and irradiation time, even if the laser light is output at a low output for photocoagulation and the irradiation time is lengthened, the influence of the impact action is inevitable. Further, even if the laser is output at a high power for incision and the irradiation time is shortened, the thermal action is accompanied.
The present invention has been devised in view of the above circumstances, and a laser capable of effectively performing coagulation and incision (destruction) with a single laser, and further reducing undesirable incidental effects. It is a technical problem to provide a treatment apparatus.
[0005]
[Means for Solving the Problems]
In order to solve the above problems, the present invention is characterized by having the following configuration.
(1) A laser light source that emits therapeutic laser light, a power source that supplies energy to cause the laser light source to oscillate laser light, light guide means that guides the laser light to the diseased part of the patient's eye, and irradiation of the diseased part In a laser treatment apparatus comprising: setting means for changing the output and irradiation time of the laser light to be performed, and capable of performing different treatments of coagulation and incision (destruction) by adjusting the output and irradiation time of the laser light , Rise time setting means that can selectively set the rise time of the laser output, the amount of current that the power source supplies to the laser light source based on the output, rise time, and irradiation time of the laser beam, and the current until the set output Control the supply time and the supply time of the current after the set output is reached, respectively, or limit the amount of current and the laser beam that the power supply supplies to the laser light source. And a control means for controlling the opening / closing speed and opening time of the shutter to set the output, rise time, and irradiation time of the set laser beam .
[0009]
[Example 1]
Hereinafter, an embodiment of the present invention will be described with reference to the drawings. FIG. 1 is a diagram showing a schematic configuration of a laser treatment apparatus using a slit lamp delivery optical system, and the configuration will be described separately for an optical system and a control system.
(Optical system)
Reference numeral 1 denotes a laser light source that emits a therapeutic laser beam. As the therapeutic laser, an argon laser, a krypton laser, a dilaser (dye laser), a semiconductor laser, Nd : A laser having a main wavelength of 532 nm, which is the second harmonic of the YAG laser, can be used. Reference numeral 2 denotes a beam splitter, and a part of the laser light from the laser light source 1 reflected by the beam splitter 2 is received by the photodetector 4 through the attenuator 3 to detect the light. The unit 4 monitors the output of the laser beam based on the amount of received light. A safety shutter 5 is inserted into the optical path in a predetermined case to block the laser light. Reference numeral 6 denotes a dichroic mirror. The emitted light beam (main wavelength 633 nm) of the visible semiconductor laser 7 for aiming is corrected into a circular shape and then made coaxial with the treatment laser light by the dichroic mirror 6. A condensing lens 8 condenses laser light and makes it incident on the optical fiber 9.
[0010]
The optical fiber 9 guides the laser light to the laser light irradiation unit 10 of the slit lamp delivery. The laser light emitted from the optical fiber 9 is applied to the patient's eye E via the collimating lens 11, the focusing lens 12, the mirror 13, and the contact lens 14. Reference numeral 15 denotes a binocular microscope unit in which the operator's eye observes the patient's eye E.
[0011]
(Control system)
Reference numeral 20 denotes an irradiation switch for transmitting a trigger signal for laser irradiation, which is arranged on the operator side. Reference numeral 21 denotes a panel operation unit for operating the apparatus. The panel operation unit 21 is provided with various operation switches and a display unit. Reference numeral 30 denotes a key control switch for starting the apparatus main body. Reference numeral 31 denotes an irradiation time knob for setting the laser irradiation time, and reference numeral 32 denotes a display unit thereof. Reference numeral 33 denotes an output adjustment knob for setting the output of the laser light to be irradiated, and 34 is a display section thereof. Reference numeral 35 denotes a setting switch for setting the rise time of the laser output. For the rise time of the laser output, for example, five stages of 10 μm second, 100 μm second, 1 m second, 10 m second, and 100 m second can be selected. When one of the switches 35 is pressed, the lamp behind the switch is turned on, and the surgeon can know the set rise time of the laser output.
[0012]
In addition to these switches and the display unit, the panel operation unit 21 switches the counter display unit 36 for displaying the number of laser beams irradiated, the single mode and the repeat mode, and the repeat mode. A switch for setting a pause time and its display unit 37, a knob 38 for adjusting the brightness of aiming light, a spot size display unit 39 for displaying a laser irradiation range, and the like, and the safety shutter 5 when the irradiation switch 20 is operated. A switch 40 or the like that is driven to enable laser irradiation is provided.
[0013]
The irradiation switch 20 and the panel operation unit 21 are connected to the control unit 22 and transmit various input signals to the control unit 22. The control unit 22 operates the power supply circuit 23 according to the input signal and controls the laser oscillation of the laser light source 1. The output, irradiation time, and rise time of the laser oscillated from the laser light source 1 are respectively the amount of current supplied to the laser light source 1, the current supply time, and the current supply time until the set output is obtained. It is done by adjusting.
[0014]
Reference numeral 25 denotes a detection circuit that performs predetermined processing on the signal from the photodetector 4 to detect and process the laser output signal. The control unit 22 controls the laser output signal processed by the detection circuit 25 and the output adjustment knob. From the laser output setting signal set at 33, an output adjustment signal is input to the power supply circuit 23 so that the output of the laser light from the laser light source 1 matches the set value and is stabilized.
26 is a solenoid for inserting / removing the safety shutter 2 into / from the optical path, and 27 is a drive circuit thereof. Reference numeral 28 denotes a drive circuit for the visible semiconductor laser 4.
[0015]
Next, the operation of the apparatus as described above will be described.
The operator turns the key control switch 30 to activate the apparatus, and then operates the switch of the panel operation unit 21 to output the laser, irradiation time, rise time, etc. according to the purpose of treatment. Set the laser irradiation conditions. When the apparatus is activated, the safety shutter 5 is inserted into the optical path, and the laser light from the laser light source 1 is in a blocked state.
Next, while observing the patient's eyes using the microscope unit 15, the surgeon adjusts the spot size and the like by matching the Aimig light from the visible semiconductor laser 7 with the affected part. When the adjustment is completed, the switch 40 is pressed so that the trigger signal from the irradiation switch 20 can be activated. When the irradiation switch 20 is pressed, the control unit 23 drives the solenoid 26 to open the safety shutter 5 and activates the power supply circuit 23 based on the laser output, the irradiation time and the rise time setting signals, Laser light is emitted from the light source 1. The emitted laser light is irradiated to the affected part of the patient's eye E through the above-described optical system.
[0016]
Next, the difference in the output state of the laser light irradiated to the patient's eye due to the difference in the irradiation condition setting of the laser output, irradiation time, and rise time will be described. 2 and 3 are diagrams showing the relationship between the output of the laser beam irradiated to the patient's eye and the time due to the difference in the irradiation condition setting.
In FIG. 2, A is an output example when the laser output is set to a low output and the laser irradiation time is set long, and B is a laser output set to a high output and the laser irradiation time is set short. This is an output example when The rise time of the laser output is set to the same set value (for example, 1 msec).
[0017]
A ′ in FIG. 3 is an output example in which the rise time of the laser output is set long (for example, 10 ms or 100 ms) with respect to A in FIG. 2, and B ′ is a laser with respect to B in FIG. This is an output example in which the output rise time is shortened (for example, 100 μm seconds or 10 μm seconds). Comparing A ′ and A ′ shown in FIG. 2 and FIG. 3, in the case of solidification, the rise time of the laser output can be set to a long side, so that the rise can be made gentle. The mechanical destruction action by can be more relaxed. On the other hand, when B and B 'are compared, in the case of anterior eye destruction treatment, the rise time can be sharpened by setting the rise time to a shorter side, so that the mechanical destruction action by the impact force is further improved. Can be made.
[0018]
In this way, in addition to setting the laser light output and irradiation time conditions, the laser output rise time can be variably set according to the purpose of treatment, thereby making it possible to perform laser irradiation more suited to the purpose. .
[0019]
[Example 2]
In the first embodiment, the power supply circuit 24 is operated so that the rise time and irradiation time of the laser output are variable, and the current supply time and the total supply time until the output from the laser light source 1 reaches the set output are adjusted. In the second embodiment, the control is performed by controlling the opening / closing speed and the opening time of the shutter for limiting the laser light emitted from the laser light source 1.
FIG. 4 is a diagram illustrating the configuration of the apparatus according to the second embodiment, and the components common to those in FIG. 1 are not illustrated and described. Reference numeral 5 'denotes a shutter, and the shutter 5' serves as a safety shutter for blocking laser light in a predetermined case, and the rise time and irradiation time of the irradiation laser output to the patient's eye can be changed by opening and closing the shutter 5 '. Acts as a mechanism. A pulse motor 26 ′ opens and closes the shutter 5 ′, a drive circuit 27 ′ is a drive circuit for the pulse motor 26 ′, and the drive circuit 27 ′ is connected to the control unit 22.
[0020]
When the irradiation switch 20 is pressed, the control unit 22 activates the power supply circuit 23 based on the laser output and irradiation time setting signal to emit laser light from the laser light source 1. Further, the control unit 22 rotates the pulse motor 26 'via the drive circuit 27' based on the laser output, rise time and irradiation time setting signals, and determines the opening speed and release time of the shutter 5 '. Control.
[0021]
FIG. 5 is a diagram for explaining the laser output state from the laser light source 1 and the output state of the laser passing through the shutter 5 ′. (A) of FIG. 5 is an output state in which the rise time is set to a long side for low output and long-time irradiation, and (b) is an output state in which the rise time is set to a short side for high output and short-time irradiation. . C and D in the figure indicate laser output states from the laser light source 1, and C 'and D' in shaded portions indicate output states of laser light irradiated to the patient's eyes when the shutter 5 'is opened. Indicates. The rise time of the laser output irradiated to the patient's eyes changes in relation to the opening speed of the shutter 5 '. In other words, by variably controlling the opening speed of the shutter 5 'by the pulse motor 26', the laser output can be made to rise gently or sharply, and laser irradiation suitable for the purpose can be performed. It becomes.
[0022]
Although the present invention has been described with reference to the first and second embodiments, various modifications can be made to such embodiments. For example, in the first embodiment, the control of the rise time of the laser output is performed by the control of the power supply circuit, and in the second embodiment, the control is performed by the shutter drive control. However, both may be combined. That is, the earliest rising output is set in advance by a power source and a laser having an early rising output, and in the case of the earliest rising, the shutter is released at the timing before the laser emission, and then the laser is emitted. The laser is emitted to realize laser irradiation with a fast rise. In the case of a slow rise time, the laser is emitted before the shutter is released, and then the shutter is driven to release with the set rise time, thereby realizing laser irradiation with a variable rise time.
As described above, the present invention is not limited to the embodiments and can be variously modified and included in the present invention as long as the technical idea of the present invention is the same.
[0023]
【The invention's effect】
As described above, according to the present invention, the rise time of the laser output can be variably set according to the purpose of treatment with one device, so that a device capable of laser irradiation suitable for the purpose can be provided. Realized. Therefore, tissue destruction due to impact action can be reduced in coagulation treatment, and impact action can be improved in destruction treatment.
[Brief description of the drawings]
FIG. 1 is a diagram illustrating a schematic configuration of an apparatus according to a first embodiment.
FIG. 2 is a diagram illustrating the relationship between the output of laser light emitted to a patient's eye and time due to the difference in irradiation condition setting in the apparatus according to the first embodiment.
FIG. 3 is a diagram showing the relationship between the output of laser light emitted to a patient's eye and the time according to the difference in irradiation condition setting in the apparatus of Example 1.
4 is a diagram illustrating a configuration of an apparatus according to a second embodiment. FIG.
FIG. 5 is a diagram for explaining a laser output state from a laser light source and an output state of a laser passing through a shutter.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Laser light source 10 Laser light irradiation part 21 Panel operation part 22 Control part 23 Power supply circuit 31 Irradiation time knob 33 Output adjustment knob 35 Setting switch

Claims (1)

Laser light source for emitting therapeutic laser light, power supply for supplying energy for oscillating laser light to the laser light source, light guide means for guiding the laser light to the diseased part of the patient's eye, and laser irradiated to the diseased part And a setting means for changing the output of the light and the irradiation time. In a laser treatment apparatus capable of treating different actions of coagulation and incision (destruction) by adjusting the output of the laser light and the irradiation time , Rise time setting means that can selectively set the rise time, the amount of current that the power supply supplies to the laser light source based on the output of the laser beam, the rise time and the irradiation time, the current supply time until the set output is set, And the current supply time after the set output is reached, respectively, or the amount of current supplied by the power source to the laser light source and the laser light limiting shutter. Closing speed of, by controlling the opening time, the laser treatment apparatus, characterized in that it comprises an output of the set laser beam, and control means for the rise time and the irradiation time, the.

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