WO2018181976A1 - Ophthalmic laser treatment device - Google Patents

Abstract

An ophthalmic laser treatment device for radiating a laser beam for treatment to a patient's eye includes: a laser irradiation optical system for radiating a treatment laser beam to the patient's eye; a scanning means for two-dimensionally scanning a spot of the treatment laser beam on the tissue of the patient's eye; a pattern irradiating means for forming a spot of a predetermined pattern; a mode selecting means for selecting between a normal output mode and a low output mode; and a control means. In the low output mode, the operator can operate a pattern selecting means, a setting means for setting reference irradiation energy, and a correction means for lowering the reference irradiation energy. When the low output mode is set, the control means does not accept the pattern selection until the reference irradiation energy is corrected by the correction means, and can accept the pattern selection after the correction.

Description

Ophthalmic laser treatment device

The present disclosure relates to an ophthalmic laser treatment apparatus that irradiates a patient's eye with a therapeutic laser beam.

Patent Document 1 discloses an ophthalmic laser treatment apparatus that scans a treatment laser beam on a tissue of a patient's eye and irradiates the treatment site with a pattern. In the ophthalmic laser treatment apparatus of Patent Document 1, a spot of an irradiation pattern is divided into a plurality of groups, and a series of treatment laser beams are irradiated while moving an irradiation region of the treatment laser beam.

JP 2014-68909 A

By the way, when performing pattern irradiation like patent document 1, if the irradiation energy of the treatment laser beam was set incorrectly, there existed a possibility of irradiating unintended energy to several places of eye tissue. Further, when the pattern irradiation region is divided into a plurality of regions as in Patent Document 1, there is a possibility that the region different from the originally planned region may be irradiated with the treatment laser beam. For example, the patient's eyes may move during a series of pattern irradiations. Further, for example, when the irradiation energy of the treatment laser light is small and it is difficult to observe the irradiation trace, there is a fear that it is difficult to aim the eye tissue.

This disclosure aims to provide an ophthalmic laser treatment apparatus that solves at least one of the above-mentioned drawbacks of the prior art.

In order to solve the above problems, the present invention is characterized by having the following configuration.
(1) An ophthalmic laser treatment apparatus that irradiates a patient's eye with a therapeutic laser beam is provided in a laser irradiation optical system that irradiates a patient's eye with a treatment laser beam emitted from a treatment laser light source, and the laser irradiation optical system. Scanning means for two-dimensionally scanning the spot of the treatment laser light on a tissue of a patient's eye, pattern irradiation means for forming a predetermined pattern spot using the laser irradiation optical system and the scanning means, The treatment laser in the normal output mode for modifying the tissue of the patient's eye by irradiating the treatment laser light, and in the normal output mode for optically stimulating the tissue of the patient's eye without modifying the tissue of the patient's eye A mode selection means for selecting a low output mode that is relatively lower than the light output; and a control means for controlling the ophthalmic laser treatment apparatus, the low output mode Includes a pattern selection unit for selecting the predetermined pattern from a plurality of patterns, a setting unit for setting the irradiation energy of the treatment laser light serving as a reference, and the patient's eye without degenerating the tissue of the patient's eye In order to stimulate the tissue optically, the operator can operate the correction means for correcting the output to be reduced by a predetermined amount with respect to the reference irradiation energy set by the setting means, When the low output mode is set, the control means does not accept the pattern selection by the pattern selection means until the reference irradiation energy set by the setting means is corrected by the correction means, and the correction means It is possible to accept the pattern selection by the pattern selection means after the correction by.
(2) An ophthalmic laser treatment apparatus that irradiates a patient's eye with a therapeutic laser beam indicates a laser irradiation optical system for irradiating the tissue of the patient's eye with a treatment laser beam, and an irradiation scheduled area of the treatment laser beam A first pattern and a shape different from the first pattern, a second pattern for aligning the first pattern with a treatment target site, and storage means for storing the first pattern and the second pattern; , An aiming optical system for scanning aiming light on the tissue of the patient's eye to form a first spot based on the first pattern and a second spot based on the second pattern on the tissue of the patient's eye And.

It is the external appearance perspective view which looked at the ophthalmic laser treatment apparatus from diagonally right above. It is a schematic block diagram of the optical system and control system of the ophthalmic laser treatment apparatus of FIG. It is a perspective view of a scanning part. It is an example of an observation image. It is a figure which shows an example of a pattern. It is a figure which shows an irradiation condition screen (normal output mode). It is a figure which shows an irradiation condition screen (low output mode). It is a figure which shows a pattern selection screen. It is an example of a pattern. It is an example of a pattern. It is an example of a pattern. This pattern is displayed only in the normal output mode. This pattern is displayed only in the normal output mode. This pattern is displayed only in the normal output mode. This pattern is displayed only in the low output mode. This pattern is displayed only in the low output mode. This pattern is displayed only in the low output mode. It is a figure which shows the 1st pattern for treatment laser beam irradiation. It is a figure which shows the 2nd pattern for treatment laser beam irradiation. It is a figure which shows the 3rd pattern for treatment laser beam irradiation. It is a figure which shows the pattern for a position check. It is a figure which shows the observation image irradiated with the pattern of FIG. It is a figure which shows the observation image irradiated with the pattern of FIG. It is a figure which shows an output ratio selection screen. It is a flowchart explaining the flow of operation in low output mode. It is a flowchart regarding the control which a control part performs in a low output mode. It is a flowchart regarding the control which a control part performs by a LPM test. It is a flowchart regarding control of aiming light which a control part performs in a low output mode.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. The ophthalmic laser treatment apparatus 1 according to the present embodiment can treat the patient's eye E by irradiating the patient's eye E with a treatment laser beam.

This will be described with reference to FIG. 1 and FIG. The ophthalmic laser treatment apparatus 1 of this embodiment includes a delivery unit 2, a laser light source unit 10, and an optical fiber 20. The delivery unit 2 includes a laser irradiation optical system 40 (see FIG. 2). The laser light source unit 10 includes a treatment laser light source 11. In the present embodiment, the delivery unit 2 and the laser irradiation optical system 40 are connected by the optical fiber 20 or the like. A control unit 70 is accommodated in the housing of the laser light source unit 10. An operation unit 80, a foot switch 81, and the like are connected to the laser light source unit 10.

The ophthalmic laser treatment apparatus 1 of this embodiment further includes a slit lamp microscope unit 3 (slit lamp) and a table unit 4. The slit lamp microscope unit 3 includes an observation optical system 30 and an illumination optical system 60 (see FIG. 2). The delivery unit 2 is connected (combined) to a main body unit 5 provided in the slit lamp microscope unit 3. The table part 4 mounts the main body part 5 to which the delivery part 2 is connected. The aspect of the ophthalmic laser treatment apparatus 1 is not limited to the present disclosure. For example, the delivery unit 2 and the laser light source unit 10 may be integrated. For example, the delivery part 2 and the slit lamp microscope part 3 may be integrated.

The slit lamp microscope unit 3 of the present embodiment includes a main body unit 5 and a headrest unit 22. The main body unit 5 includes a microscope unit 7, an illumination unit 6, a joystick unit 9, and a displacement mechanism 8. The microscope unit 7 accommodates an observation optical system 30 (see FIG. 2). The illumination unit 6 accommodates an illumination optical system 60 (see FIG. 2). The displacement mechanism 8 serving as a displacement means moves the main body 5 (laser irradiation optical system 40 and the like) placed on the table unit 4 in the vertical direction (Y direction in FIG. 1) and the horizontal direction (X direction in FIG. 1). Or in the front-rear direction (Z direction in FIG. 1). Further, the displacement mechanism 8 can rotate the observation optical system 30 in the horizontal direction with an axis extending in the vertical direction as a rotation center. The operator can operate the joystick portion 9 to move the main body portion 5 in the up-down direction, the left-right direction, or the front-rear direction.

<Laser light source unit>
The laser light source unit 10 of the present embodiment includes a treatment laser light source 11 that emits treatment laser light, an aiming light source 12 that emits visible aiming laser light (aiming light), and a beam splitter 13 that combines the treatment laser light and the aiming light. (Combiner) and a condenser lens 14. The treatment laser light source 11 can emit laser light having a wavelength according to the purpose of treatment. The treatment laser light source 11 of the present embodiment emits laser light having a visible wavelength, for example, 532 nm (green), 577 nm (yellow), and 647 nm (yellow) so that the fundus Er absorbs the energy of the laser light. it can. In the present embodiment, the control unit 70 controls the treatment laser light source 11 so that any one of three types (green / yellow / red) of treatment laser light can be selectively emitted from the treatment laser light source 11.

The aiming light source 12 emits aiming light for causing the operator to recognize the planned irradiation position of the treatment laser light. In the present embodiment, the wavelength of the aiming light is in the visible range so that the operator can visually recognize the aiming light with the naked eye. A wavelength different from the treatment laser light may be used as the aiming light. For example, a wavelength of 670 nm (red) may be used as the wavelength of the aiming light. Thereby, even if an operator protection filter for attenuating the treatment laser beam is provided in the observation optical system 30, it is easy for the operator to confirm the planned irradiation position of the treatment laser beam. As the aiming light source 12, for example, a laser diode (LD) that emits red laser light may be used.

The beam splitter 13 reflects most of the treatment laser light and transmits part of the aiming light. The laser light combined by the beam splitter 13 is condensed by the condenser lens 14 and enters the incident end face of the optical fiber 20. Between the treatment laser light source 11 and the beam splitter 13, a shutter 15 for blocking the treatment laser light is provided. A shutter 16 is provided in the optical path through which the aiming light or the treatment laser light is guided. The shutter 16 of the present embodiment is a safety shutter that is closed when an abnormality occurs.

<Laser irradiation optical system>
Next, the laser irradiation optical system 40 will be described. The laser irradiation optical system 40 (irradiation means) of this embodiment is used to irradiate the patient's eye E with the treatment laser light emitted from the treatment laser light source 11. In this embodiment, the laser irradiation optical system 40 is shared by the treatment laser light and the aiming light. The laser irradiation optical system 40 of this embodiment can also be said to be an aiming optical system for forming a spot of aiming light based on a predetermined pattern on the tissue of the patient's eye E. Hereinafter, the treatment laser light will be described, but the sighting light is the same. The treatment laser light emitted from the emission end face of the optical fiber 20 passes through the lens 41, the zoom lens 42, and the mirror 43 in this order, and then passes through the scanning unit 50 (scanning means), the objective lens 46, the reflection mirror 49, and the contact lens CL. Then, the fundus Er (treatment site) is irradiated. The zoom lens 42 for changing the spot size of the laser light is movable in the optical axis direction. The operator holds the contact lens CL.

The scanning unit 50 of the present embodiment is provided in the laser irradiation optical system 40. The scanning unit 50 is used for two-dimensionally scanning the spot (irradiation position) of the treatment laser light on the fundus Er of the patient's eye E. In addition, on the fundus Er of the patient's eye E, in other words, on the tissue of the patient's eye E or on the eye tissue. The scanning unit 50 of the present embodiment is a scanning optical system that moves the irradiation position (irradiation direction) of laser light two-dimensionally. The scanning unit 50 of this embodiment includes a scanner mirror. The scanning unit 50 of the present embodiment includes a galvano mirror 51 (first galvano mirror) and a galvano mirror 55 (second galvano mirror). In other words, the galvanometer mirror may be referred to as a galvanometer scanner. The galvanometer mirror 51 of this embodiment includes a mirror 52 (first mirror) that reflects laser light and an actuator 53. The actuator 53 is a drive unit that drives (rotates) the mirror 52. The galvanometer mirror 55 includes a mirror 56 (second mirror) and an actuator 57.

In the present embodiment, the treatment laser light that has passed through each optical element of the laser irradiation optical system 40 is reflected by the reflection mirror 49 and then irradiated to the fundus Er, which is the target surface, via the contact lens CL. The zoom lens 42 is held by a lens cam (not shown). When the lens cam rotates, each zoom lens 42 moves in the optical axis direction. The position of the zoom lens 42 can be detected by an encoder 42a attached to the lens cam. The control unit 70 of the present embodiment can receive the position information (detection signal) of each lens from the encoder 42a and acquire the spot size of the treatment laser light. Although details will be described later, the scanning unit 50 is controlled based on a command signal from the control unit 70 so that the spot of the treatment laser beam is formed as a two-dimensional pattern on the target surface. Although illustration is omitted, the reflection mirror 49 of the present embodiment includes a mechanism for two-dimensionally tilting the optical axis L1 of the laser light by an operator's operation.

The configuration of the scanning unit 50 of this embodiment will be described with reference to FIG. FIG. 3 is a perspective view of the scanning unit 50 of the present embodiment. The mirror 52 is attached to the actuator 53 so that the reflecting surface can be swung in the X direction. On the other hand, the mirror 56 is attached to the actuator 57 so that the reflecting surface can be swung in the Y direction. In this embodiment, the rotation axis of the mirror 52 is parallel to the Y axis, and the rotation axis of the mirror 56 is parallel to the X axis. The actuator 53 and the actuator 57 are connected to the control unit 70 and are driven individually. The actuator 53 and the actuator 57 include a motor and a potentiometer (both not shown), and each of the mirror 52 and the mirror 56 is independently rotated (swinged) based on a command signal from the control unit 70. The At this time, the position information of how much the mirror 52 or the mirror 56 has been rotated is sent to the control unit 70 by the potentiometers of the actuator 53 and the actuator 57, and the control unit 70 rotates the mirror 52 or the mirror 56 with respect to the command signal. The moving position can be grasped. That is, the control unit 70 of the present embodiment positions each spot using the output signal of the potentiometer.

The control unit 70 of the present embodiment starts driving the scanning unit 50, stops driving the scanning unit 50, starts irradiating treatment laser light from the treatment laser light source 11, and stops irradiating treatment laser light from the treatment laser light source 11. By repeating the order, a predetermined pattern of spots S (see FIG. 5 as an example) can be formed on the fundus Er. That is, the control unit 70 of the present embodiment can perform the pattern irradiation of the treatment laser light by controlling the driving of the scanning unit 50 and the irradiation of the treatment laser light. In other words, the ophthalmic laser treatment apparatus 1 of the present embodiment has a pattern irradiation unit that forms a predetermined pattern of spots using the laser irradiation optical system 40 and the scanning unit 50. In this embodiment, each spot constituting the spot S is separated. However, each spot may be connected. As described above, the pattern irradiating unit of the present embodiment can form the spot S having a predetermined pattern even for the aiming light. The surgeon can grasp the site to be irradiated with the treatment laser light by using the observation optical system 30 and the aiming light.

<Observation optics>
The observation optical system 30 of this embodiment is used for observing the patient's eye E. That is, the observation optical system 30 of the present embodiment is an observation unit for observing the patient's eye E. The observation optical system 30 of the present embodiment includes an objective lens, a variable magnification optical system, a protective filter, an erecting prism group, a field stop, an eyepiece lens, and the like. The surgeon looks into the eyepiece lens of the observation optical system 30 and sees the fundus Er, the spot of the aiming light (in other words, the reflected light reflected by the fundus Er), and the region of the fundus Er irradiated with the treatment laser beam ( (Irradiated spot) can be confirmed. 4 includes a fundus Er of the patient eye E, a macular M of the patient eye E, an optic disc D of the patient eye E, and a blood vessel V of the patient eye E. ing. Note that an observation image of the patient's eye E may be acquired electronically by arranging a light receiving element in the observation optical system 30.

<Illumination optics>
The illumination optical system 60 of the present embodiment is used for projecting illumination light onto the patient's eye E. The illumination optical system 60 of this embodiment includes a light source 61, a condenser lens 62, a slit 63, a projection lens 64, and the like. The illumination optical system 60 can project slit light on the patient's eye E. The surgeon can observe the fundus Er illuminated by the illumination optical system 60 using the observation optical system 30.

<Control unit>
Returning to FIG. The control unit 70 of this embodiment includes a CPU 71 (processor), a ROM 72, a RAM 73, a nonvolatile memory 74, and the like. The CPU 71 controls each part in the ophthalmic laser treatment apparatus 1. The ROM 72 stores various programs, various patterns (pattern PS1, pattern PP, etc.), initial values, and the like. The RAM 73 can temporarily store various information. The non-volatile memory 74 is a non-transitory storage medium that can retain stored contents even when power supply is interrupted. For example, a USB memory, a flash ROM, or the like that is detachably attached to the control unit 70 may be used as the nonvolatile memory 74. The control unit 70 of this embodiment is a control unit that controls the ophthalmic laser treatment apparatus 1.

The treatment laser light source 11, the aiming light source 12, the encoder 42a, the actuator 53, the actuator 57, the operation unit 80, and the foot switch 81 are connected to the control unit 70 of the present embodiment. The foot switch 81 of this embodiment is a trigger input unit for irradiating laser light. The operation unit 80 of the present embodiment functions as a display unit for displaying various parameters related to the treatment laser light irradiation conditions, and as a setting unit for setting various parameters related to the treatment laser light irradiation conditions. With functionality. The operation unit 80 of this embodiment includes a touch panel monitor 82. By operating (touching) the touch panel, it is possible to set various parameters related to the irradiation condition of the treatment laser beam. Note that the control unit 70 of the present embodiment has a function as display control means for controlling the display content of the monitor 82.

In this embodiment, when the foot switch 81 is stepped on by the operator, the control unit 70 treats the treatment laser light so as to form a treatment laser light pattern (one or a plurality of spots) on the target surface based on the setting of various parameters. Irradiate. That is, the control unit 70 of the present embodiment is an irradiation control unit that controls irradiation of the treatment laser light to the patient's eye E. The control unit 70 of the present embodiment controls the treatment laser light source 11 and also controls the scanning unit 50 based on the set pattern to form a treatment laser light pattern on the fundus Er that is the target surface. In addition, before the foot switch 81 is stepped on, the control unit 70 of the present embodiment forms a pattern (one or a plurality of spots) of aiming light on the target surface using the pattern for the treatment laser light.

FIG. 5 is a diagram illustrating an example of a spot position pattern. In the pattern shown in FIG. 5, the spots S (a set of nine spots in FIG. 5) are arranged in a 3 × 3 square matrix. Here, the spot S refers to both aiming light and treatment laser light. Based on such a pattern, the treatment laser light and the aiming light are scanned by the scanning unit 50, and a pattern is formed on the target surface. Irradiation of the spot S is started from the spot position SP1 that is the start position, and the spot S is scanned two-dimensionally toward the spot position SP9 that is the end position. That is, scanning is performed in the order of spot position SP1, spot position SP2,... Spot position SP8, spot position SP9. In the present embodiment, as indicated by an arrow (S-shape) in the figure, the spots S are sequentially scanned into adjacent spots S so as to move between the spots S as efficiently as possible.

<How to use>
The usage method of the ophthalmic laser treatment apparatus 1 of this embodiment is demonstrated. Note that the ophthalmic laser treatment apparatus 1 of the present embodiment includes a normal output mode and a low output mode. The normal output mode of this embodiment is used to denature the tissue of the patient's eye E. In other words, the normal output mode of the present embodiment is used to denature the protein of the patient eye E, for example. The low output mode of the present embodiment is used for optically stimulating the tissue of the patient eye E without degenerating the tissue of the patient eye E. That is, the low output mode of this embodiment is suitable for treating the treatment site of the patient's eye E with a small amount of irradiation energy (treatment laser light). The low output mode of the present embodiment is suitable for, for example, treatment of the macula or the macular region. The surgeon turns on the power of the ophthalmic laser treatment apparatus 1. When the power is turned on, the ophthalmic laser treatment apparatus 1 is initialized, and the ophthalmic laser treatment apparatus 1 enters a standby state in the normal output mode.

The surgeon fixes the patient's head to the headrest portion 22. The operator looks at the eyepiece of the microscope unit 7 and observes the observation image, and operates the joystick unit 9 to align the laser irradiation optical system 40 with the patient's eye E. In addition, when aligning the laser irradiation optical system 40 with the patient's eye E, aiming light is used together. The surgeon determines the distance between the patient's eye E and the laser irradiation optical system 40 based on the focus state of the observation image. In the following description, it is assumed that the alignment of the laser irradiation optical system 40 with respect to the patient's eye E is completed and the operator can observe the fundus Er of the patient's eye E.

<Normal output mode>
In the normal output mode of the present embodiment, the irradiation condition screen 100 (see FIG. 6) is displayed on the monitor 82. The irradiation condition screen 100 of the present embodiment includes a spot size display unit 140, a laser selection unit 110, an output setting unit 120, an irradiation time setting unit 130, a pattern setting unit 150 (first pattern selection unit), a test unit 170, and A low output mode selection unit 180 is provided. The surgeon can touch the items (such as the output setting unit 120 described above) on the monitor 82 to change the irradiation condition of the treatment laser beam.

In the present embodiment, the spot size display unit 140 displays the spot diameter using the output signal of the encoder 42a. The laser selection unit 110 is used by an operator to select the type (green / yellow / red) of treatment laser light. The output setting unit 120 is used by the operator to set the output value (unit: watts) of the treatment laser beam. In this embodiment, the output value of the treatment laser beam (green) is in the range of 50 mW to 1500 mW, the output value of the treatment laser beam (yellow) is in the range of 50 mW to 1500 mW, and the output value of the treatment laser beam (red) Can be set within a range of 50 mW to 800 mW.

The irradiation time setting unit 130 is used for setting the irradiation time of the treatment laser beam. In the present embodiment, the irradiation time of the treatment laser beam can be set to any one of 2.00 seconds and 3.00 seconds within a range of 0.01 to 1.00 seconds. The pattern setting unit 150 is used to set a pattern of treatment laser light. In the present embodiment, a predetermined pattern can be selected from 25 types of patterns stored in advance in the ROM 72. The test unit 170 is used when performing test irradiation with a treatment laser beam. When the test unit 170 is touched, the irradiation mode of the ophthalmic laser treatment apparatus 1 is switched between the normal irradiation mode and the test irradiation mode. In the test irradiation mode, the operation of the pattern setting unit 150 is invalid, and a pattern Pa (see FIG. 9A) that is a single spot is automatically set. In the normal irradiation mode, the operation of the pattern setting unit 150 is effective. In the present embodiment, an arbitrary pattern can be selected from 25 types of patterns.

The low output mode selection unit 180 (mode selection means) of the present embodiment is used for switching from the normal output mode to the low output mode. That is, the ophthalmic laser treatment apparatus 1 according to this embodiment includes a normal output mode for modifying the tissue of the patient's eye by irradiation with the treatment laser light, and optically transforming the tissue of the patient's eye without modifying the tissue of the patient's eye. In order to stimulate, a mode selection means for selecting a low output mode that is relatively lower than the output of the treatment laser beam in the normal output mode is provided. When the low output mode selection unit 180 is touched, the display on the monitor 82 is switched to the irradiation condition screen 200 (see FIG. 7). In conjunction with the switching from the irradiation condition screen 100 to the irradiation condition screen 200, the operation mode of the ophthalmic laser treatment apparatus 1 is switched from the normal output mode to the low output mode. In the present embodiment, the color tone of the entire screen is different between the irradiation condition screen 100 and the irradiation condition screen 200. Specifically, the background color (base color) of the irradiation condition screen 100 is an achromatic color, while the background color of the irradiation condition screen 200 is a chromatic color. Thereby, the surgeon can easily grasp the operation mode of the ophthalmic laser treatment apparatus 1 (in this embodiment, one of the normal output mode and the low output mode). In the present embodiment, the background color of the irradiation condition screen 100 is gray, and the background color of the irradiation condition screen 200 is yellow. The background color of the irradiation condition screen 200 corresponds to the treatment laser beam (yellow) fixedly set in the low output mode.

<Low output mode>
As described above, the irradiation condition screen 200 (see FIG. 7) is displayed on the monitor 82 in the low output mode of the present embodiment. The irradiation condition screen 200 of this embodiment includes a spot size display unit 240, a laser selection unit 210, an output setting unit 220 (output value setting unit), an irradiation time setting unit 230, and a pattern setting unit 250 (second pattern selection unit). , An output ratio setting unit 260 (correction unit), a test unit 270, a transition unit 280, and a position check unit 290 (aim selection unit) are provided. The position check unit 290 of the present embodiment is displayed when a pattern (for example, FIGS. 11A to 11C) in which the irradiation area moves during a series of pattern irradiation is set. Similar to the low output mode selection unit 180, the transition unit 280 is a mode selection unit for selecting the normal output mode and the low output mode. Both the output setting unit 220 and the irradiation time setting unit 230 are setting means for setting the irradiation energy of the reference treatment laser beam. Further, the output ratio setting unit 260 optically stimulates the patient's eye tissue without degenerating the patient's eye tissue, and thus becomes a reference set by the setting means (the output setting unit 220 or the irradiation time setting unit 230). This is a correction means for correcting the irradiation energy to reduce the output by a predetermined amount. In the low output mode, the operator can operate at least the pattern selection means, the setting means, and the correction means.

In the spot size display unit 240 of this embodiment, the spot diameter using the output signal of the encoder 42a is displayed. The laser selection unit 210 is used to present the set type (yellow) of treatment laser light to the operator. In this embodiment, the type of treatment laser light that can be irradiated in the low output mode is fixed to yellow, and selection of the treatment laser light using the laser selection unit 210 is prohibited. However, it may be possible to select the green treatment laser light or the red treatment laser light in the low output mode. The output setting unit 220 is used by the operator to set the output value (unit: watts) of the treatment laser beam. In the present embodiment, the output value of the treatment laser beam (yellow) can be set within a range of 60 mW to 1500 mW. The irradiation time setting unit 230 is used by the operator to set the irradiation time of the treatment laser light. In the present embodiment, the treatment laser light irradiation time can be set within a range of 0.01 to 0.03 seconds. However, the time that can be set by the irradiation time setting unit 230 may be set to any of 2.00 seconds and 3.00 seconds within the range of 0.01 to 1.00 seconds.

The pattern setting unit 250 is used by an operator to set a pattern of treatment laser light. In this embodiment, the surgeon can select an arbitrary pattern from 25 types of patterns stored in advance in the ROM 72. The test unit 270 is used when the surgeon performs test irradiation with a treatment laser beam. When the test unit 270 is touched, the irradiation mode of the ophthalmic laser treatment apparatus 1 is switched between the normal irradiation mode and the test irradiation mode. In the following description, the test irradiation mode may be referred to as an LPM test mode. In the test irradiation mode, the operation of the pattern setting unit 250 is invalid, and a pattern Pa (see FIG. 9A) that is a single spot is automatically set. In the normal irradiation mode, the operation of the pattern setting unit 250 is effective. In the present embodiment, an arbitrary pattern can be selected from 25 types of patterns.

The output ratio setting unit 260 is used to correct the output value set by the output setting unit 220. Specifically, the output ratio setting unit 260 of the present embodiment is used to attenuate the output value (before correction) set by the output setting unit 220 to a predetermined ratio (ratio). That is, the output ratio setting unit 260 of the present embodiment optically stimulates the tissue of the patient's eye E without degenerating the tissue of the patient's eye E. Therefore, the output value (before correction) that the tissue of the patient's eye E barely degenerates. Is attenuated at a predetermined rate. In this embodiment, as the setting of the output ratio setting unit 260, the output ratio can be selected within a range of 10 to 90%. Note that the lower limit value of the output ratio that can be selected by the output ratio setting unit 260 varies depending on the output value (before correction) set by the output setting unit 220. As an example, when 60 mW is set in the output setting unit 220, the output ratio value that can be selected by the output ratio setting unit 260 is 90%. The control unit 70 of this embodiment can be selected by the output ratio setting unit 260 so that the output value corrected by the setting of the output ratio setting unit 260 (in other words, the corrected output value) does not fall below 50 mW. The output ratio value or the output ratio value that can be selected on the output ratio selection screen 350 (see FIG. 18) is controlled. The position check unit 290 is used by the operator to align the laser irradiation optical system 40 with the patient's eye E. Specifically, the position check unit 290 of the present embodiment is used by the operator to align the treatment laser light irradiation scheduled region with the treatment target site of the patient's eye E. In other words, the position check unit 290 of the present embodiment is used by the operator to switch the aiming light pattern.

<Operation flow>
An example of the operation flow of the ophthalmic laser treatment apparatus 1 in the low output mode will be described with reference to FIG. In the present embodiment, at the time of transition from the normal output mode to the low output mode, some of the operation parameters of the ophthalmic laser treatment apparatus 1 are initially set (automatically set) for the low output mode. In this embodiment, as an initial setting, the type of treatment laser light is automatically set to yellow. In this embodiment, as an initial setting, a pattern shared by the aiming light and the treatment laser light is automatically set to a single spot (see FIG. 9A), and the output ratio (output setting unit 220) is automatically set to 100%. In the initial setting of this embodiment, predetermined initial values are automatically set for the output value (POWER) and the irradiation time (TIME) of the treatment laser beam.

The low output mode of this embodiment has a normal operation mode and an LPM test mode as operation states. The initial state of the low output mode is the LPM test mode. In the LPM test mode, the operation of the pattern setting unit 250 is invalidated. That is, in the LPM test mode of this embodiment, the pattern change by the operator is prohibited. Note that the control unit 70 of the present embodiment manages whether the normal operation mode or the LPM test mode is stored in the RAM 73.

Return to FIG. In step S101, the surgeon sets an output value (before correction). Specifically, the surgeon operates the output setting unit 220 to set the output value (before correction) of the treatment laser beam. In step S101, the irradiation time may be set (polarized light), or both the output value (before correction) and the irradiation time may be set (changed). In other words, the irradiation energy irradiated to the patient's eye E may be set by setting in step S101. Next, in step S102, the operator operates the foot switch 81 to perform test irradiation of the treatment laser light. Since step S102 is under the condition of the LPM test mode, the pattern used for the test irradiation is a single spot (see FIG. 9A). Next, in step S103, the surgeon observes the region of the patient's eye E that has been irradiated with the treatment laser light for test. Specifically, the surgeon confirms the presence or absence of the spot trace or the degree (degree) of the spot trace. Next, in step S104, the surgeon determines whether or not the output value (before correction) set in step S101 is appropriate based on the observation result in step S103. In this embodiment, the surgeon determines whether or not the output value (before correction) of the treatment laser beam that barely denatures the tissue of the patient's eye E can be set. The slight degeneration of the tissue of the patient's eye E is determined by, for example, whether or not a coagulation spot (spot mark) that can be barely seen has been generated based on the irradiation of the treatment laser light. If the output value (before correction) is valid, the process proceeds to step S105, and if the output value (before correction) is not valid, the process returns to step S101. For example, if the spot trace cannot be confirmed in step S103, or if the spot trace is too clear in step S103, the process returns to step S101. That is, the surgeon repeats test irradiation and spot mark observation during the LPM test mode to determine an output value (before correction). Note that the output value (before correction) is a reference output value in other words. In the present embodiment, an output value that barely denatures the tissue of the patient's eye E is used as a reference output value.

In step S105, the surgeon changes (sets) the output ratio. The operator operates the output ratio setting unit 260 to change the output ratio. In this embodiment, the output ratio can be changed within a range of 10% to 90%. Note that the lower limit value of the selectable output ratio varies depending on the output value (before correction) set in the output setting unit 220. As an example, when 60 mW is set in the output setting unit 220, the output ratio that can be selected by the output ratio setting unit 260 is 90%. Although details will be described later, in the present embodiment, the operator's operation is restricted so that the output value corrected after the output ratio (after correction) does not fall below a predetermined value (50 mW). As an example, the surgeon changes the output ratio in consideration of a treatment laser beam irradiation planned site (macular M, peripheral portion), a disease state, and the like. That is, in step S105, the irradiation energy set in step S101 may be corrected (attenuated in this embodiment).

In this embodiment, when the output ratio is changed, the operation mode is switched to the normal operation mode. In other words, when the output ratio is set to a value less than 100%, the LPM test mode is automatically canceled. That is, in the present embodiment, when the operator operates to irradiate the patient eye with an output value smaller than the output value (before correction) that barely denatures the tissue of the patient eye E, the LPM test mode is automatically canceled. When the LPM test state is canceled, the pattern can be changed. Next, in step S106, the operator operates the pattern setting unit 250 to select an arbitrary pattern. Next, in step S107, the operator operates the foot switch 81 to perform treatment laser light irradiation (main irradiation). That is, treatment laser light irradiation using the selected pattern is performed with an output value smaller than the output value (before correction). As described above, treatment in the low output mode is performed. In other words, treatment laser light irradiation using the selected pattern is performed with irradiation energy smaller than the irradiation energy before correction. In other words, treatment laser light irradiation using an arbitrary pattern is performed with an output value smaller than an output value (before correction) that barely denatures the tissue of the patient's eye E. Thereby, for example, pattern irradiation (other than a single spot) with an output value that denatures the tissue of the patient's eye E is suppressed, and optical stimulation to the tissue of the patient's eye E that does not denature the tissue of the patient's eye E The surgeon can select any pattern efficiently.

Summarizing the flow of steps S101 to S107, the operator first sets a reference condition (see steps S101 to S104). For example, an output value is set as the reference condition. Next, the operator optimizes the irradiation conditions (see steps S105 and S106). As optimization of irradiation conditions, for example, attenuation (correction) of output values set under reference conditions is performed. Next, the surgeon performs treatment on the treatment site under the optimized irradiation condition (see step S107). That is, in steps S101 to S104, the operator determines an output value (before correction) that barely degenerates the tissue of the patient's eye E while repeating the operation of the output setting unit 220 and the irradiation of the laser beam. Next, in steps S105 and S106, the surgeon operates the output ratio setting unit 260 to output the output value for optically stimulating the tissue of the patient eye E without modifying the tissue of the patient eye E (after correction). To decide. Next, in step S107, the surgeon irradiates the treatment site with the treatment laser beam with an output value (after correction) that optically stimulates the tissue of the patient's eye E without modifying the tissue of the patient's eye E. When the low output mode is set, the control unit of the present embodiment does not accept pattern selection by the pattern selection unit until the reference irradiation energy set by the setting unit is corrected by the correction unit. It is possible to accept the pattern selection by the pattern selection means after the correction. Thus, the surgeon can determine irradiation conditions (irradiation energy) step by step. Thereby, for example, irradiation of the treatment laser beam in consideration of a treatment laser beam irradiation planned site (macular M, peripheral portion), a disease state, and the like becomes easy.

In this embodiment, the LPM test mode is automatically canceled in conjunction with a change in the output ratio (in other words, a change from the output ratio of 100%). However, the method for canceling the LPM test mode is not limited to this. For example, a time correction unit for correcting the irradiation time set by the irradiation time setting unit 230 may be provided, and the LPM test mode may be automatically canceled in conjunction with the change of the irradiation time using the time correction unit. That is, when the irradiation energy once set is corrected (changed), the LPM test mode may be automatically canceled. Note that, in the LPM test mode of the present embodiment, the pattern irradiation of the treatment laser beam to a plurality of parts of the patient's eye E is suppressed. In other words, in the normal mode of the present embodiment, it is possible to irradiate a plurality of parts of the patient's eye E with a treatment laser beam pattern. As described above, in this embodiment, by using the LPM test mode, it is possible to suppress unintended energy irradiation to a wide region of the eye tissue. Note that the number of spots at the time of pattern irradiation may be reduced in the LPM test mode than in the normal mode.

<Control in low output mode>
Control performed by the control unit 70 in the low output mode of the present embodiment will be described with reference to FIG. In step S201, the control unit 70 determines whether or not the LPM test mode is set. If the mode is the LPM test mode, the process proceeds to step S202. If the mode is the normal mode, the process proceeds to step S203. In the present embodiment, the initial setting of the low output mode is the LPM test mode, and the output ratio is 100%. When the output ratio is changed, the LPM test mode is automatically canceled (changed to the normal mode). In step S202, an LPM test process (see FIG. 21) is performed. Details of the LPM test process will be described later.

In step S203, the control unit 70 detects the presence / absence of a pattern selection operation. Specifically, the control unit 70 determines whether or not a pattern selection operation has been performed on the pattern selection screen 400. If a pattern selection operation has been performed, the process proceeds to step S204. In step S204, the setting is changed to the selected pattern. When the pattern setting change is completed, the process proceeds to step S205. In step S205, the control unit 70 detects the presence or absence of an irradiation operation. Specifically, if an operation of the foot switch 81 is detected, the process proceeds to step S206, and if an operation of the foot switch 81 is not detected, the process proceeds to step S207. In step S206, the control unit 70 controls the treatment laser light source 11 to irradiate the patient's eye E with the type of treatment laser light set by the laser selection unit 210 based on the set irradiation conditions. In step S207, the control unit 70 detects the presence / absence of a mode end operation. Specifically, when detecting the operation of the transition unit 280, the control unit 70 ends the low output mode and transitions to the normal output mode. On the other hand, when the operation of the transition unit 280 is not detected, the control unit 70 returns to step S201 and maintains the low output mode. In the low output mode of the present embodiment, pattern irradiation of the aiming light to the patient's eye E is continuously performed with the pattern used for pattern irradiation of the treatment laser light.

<LPM test processing>
The control executed by the control unit 70 in the LPM test process (step S202 in FIG. 20) of the present embodiment will be described with reference to FIG. In step S301, the control unit 70 detects the presence or absence of an operation for changing the output value (before correction). Specifically, when the operation of the output setting unit 220 is detected, the control unit 70 proceeds to step S302, and when the operation of the output setting unit 220 is not detected, the control unit 70 proceeds to step S304. In step S302, the control unit 70 determines whether or not the changed output value (before correction) is less than 60 mW. If it is less than 60 mW, the process returns to step S301 without changing the output value. On the other hand, if it is 60 mW or more, the process proceeds to step S303 to change the output value (before correction), and then proceeds to step S304.

In step S304, the control unit 70 detects the presence / absence of an irradiation time changing operation. Specifically, when the operation of the irradiation time setting unit 230 is detected, the control unit 70 proceeds to step S305, and when the operation of the irradiation time setting unit 230 is not detected, the control unit 70 proceeds to step S306. In step S305, the control unit 70 changes the setting to the irradiation time based on the operation of the irradiation time setting unit 230, and then proceeds to step S306. In step S306, the control unit 70 detects the presence / absence of an output ratio changing operation. Specifically, when the operation of the output ratio setting unit 260 is detected, the control unit 70 proceeds to step S310, and when the operation of the output ratio setting unit 260 is not detected, the control unit 70 proceeds to step S307.

In step S307, the control unit 70 detects whether or not the test unit 270 is operated. If the operation of the test unit 270 is detected, the control unit 70 proceeds to step S308. If the operation of the test unit 270 is not detected, the control unit 70 proceeds (returns) to step S301. In step S308, the control unit 70 displays an output ratio selection screen 350 (see FIG. 18). On the output ratio selection screen 350 of this embodiment, output ratio buttons are arranged. On the output ratio selection screen 350, buttons corresponding to output ratios that can be changed are arranged. Specifically, the output ratio selection screen 350 is provided with an output ratio button that has an output value (after correction) of 50 mW or more even when selected. The output ratio selection screen 350 illustrated in FIG. 18 is a screen when the output value (before correction) that can be set by the output setting unit 220 is set to 500 mW or more.

In step S309, the control unit 70 detects the presence / absence of an output ratio selection operation. When detecting the output ratio selection operation, the control unit 70 proceeds to step S310. When the output ratio selection operation is not detected, the control unit 70 remains in step S309. In step S310, the control unit 70 changes the output ratio. Specifically, the control unit 70 changes the output ratio based on the change operation detected in step S306 or the selection operation detected in step S309. The output value changed after the output ratio (after correction) is 50 mW or more. Next, in step S311, the control unit 70 cancels the LPM test mode. That is, the mode is changed from the LPM test mode to the normal mode. As described above, the LPM test process by the control unit 70 is performed. In the low output mode of this embodiment, the output value of the treatment laser light irradiated to the patient's eye E is controlled by the control unit 70 so as not to fall below a predetermined lower limit value. Thereby, irradiation of the unstable treatment laser beam to the patient's eye E due to the low output is suppressed. An unstable treatment laser beam is an event in which the output value varies between each irradiation when the treatment laser beam is repeatedly irradiated, for example. In this embodiment, it is easy to set the output ratio with respect to the set output value (before correction).

<Selectable patterns>
The patterns selectable in the normal output mode and the patterns selectable in the low output mode will be described with reference to FIGS. 8, 9A to 9C, 10A to 10C, and 11A to 11C. First, patterns that can be selected in the normal output mode will be described with reference to FIGS. 8, 9A to 9C, and 10A to 10C. When the pattern setting unit 150 is touched on the irradiation condition screen 100 in the normal mode (see FIG. 6), the pattern selection screen 300 (see FIG. 8) is displayed on the monitor 82. The pattern selection screen 300 of this embodiment is provided with a selection unit 310 and a transition unit 320. In the selection unit 310, 25 types of patterns (pattern Pa to pattern Py1) are arranged in 5 rows and 5 columns. Each pattern has a different shape. As an example, FIG. 9A is a pattern Pa, FIG. 9B is a pattern Pl, and FIG. 9C is a pattern Pp. 10A shows the pattern Pw1, FIG. 10B shows the pattern Px1, and FIG. 10C shows the pattern Py1. When any pattern of the selection unit 310 is selected, the display on the monitor 82 is switched to the irradiation condition screen 100 (see FIG. 6), and the selected pattern is displayed in the pattern display area 111. When the transition unit 320 is touched on the pattern selection screen 300, the irradiation condition screen 100 is returned without changing the pattern.

Details of the patterns Pw1, Px1, and Py1 of this embodiment will be described. The white circles and black circles in FIGS. 10A to 10C are spots S formed on the eye tissue. White circles and black circles indicate the order of pattern irradiation, and the irradiation energy is the same between white circles and black circles. In the present embodiment, the pattern Px1 is a ring-shaped pattern, the pattern Pw1 is a substantially ring-shaped pattern with the right side missing, and the pattern Py1 is a substantially ring-shaped pattern with the left side missing. The pattern Pw1 and the pattern Py1 are suitable patterns when, for example, the treatment laser beam is irradiated while avoiding the nerve bundle from the optic nerve head D. The pattern Px1 is a pattern suitable when, for example, a treatment laser beam is irradiated around the circumference of the macula.

10A to 10C, a plurality of spots constituting each pattern are divided into a plurality of groups (for example, a first group to a third group). In FIGS. 10A to 10C, the first group is indicated by a black circle. First, a spot of aiming light is formed at the position of each spot (black circle) in the first group. When the foot switch 81 is operated in this state, the treatment laser light is irradiated to the spot position of the aiming light. When irradiation of the treatment laser beam to the first group is completed, a spot of aiming light is formed at the position of each spot of the second group. When the foot switch 81 is operated in this state, the treatment laser light is irradiated to the spot position of the aiming light. When irradiation of the treatment laser beam to the second group is completed, a spot of aiming light is formed at the position of each spot of the third group. When the foot switch 81 is operated in this state, the treatment laser light is irradiated to the spot position of the aiming light. By dividing a plurality of spots into a plurality of groups, the time spent for pattern irradiation can be divided. Thereby, for example, even if the patient's eye E moves during pattern irradiation, it is easy to suppress unintended irradiation of the treatment laser light to the eye tissue.

Next, patterns that can be set in the low output mode will be described with reference to FIGS. 8, 9A to 9C, and 11A to 11C. When the pattern setting unit 250 is touched on the irradiation condition screen 200 (see FIG. 7), the pattern selection screen 400 (see FIG. 8) is displayed on the monitor 82. In the pattern selection screen 400 of this embodiment, a selection unit 410 and a transition unit 320 are provided. In the selection unit 410, 25 types of patterns (pattern Pa to pattern Py2) are arranged in 5 rows and 5 columns. Each pattern has a different shape. In the present embodiment, the same pattern as in the normal output mode is arranged in each of the patterns Pa to Pv. Further, patterns different from the normal output mode are arranged in the pattern Pw2, the pattern Px2, and the pattern Py2.

FIG. 11A shows the pattern Pw2, FIG. 11B shows the pattern Px2, and FIG. 11C shows the pattern Py2. In the present embodiment, the pattern Pw2, the pattern Px2, and the pattern Py2 are all ring-shaped patterns. The pattern Pw2 and the pattern Px2 differ in the number of spots included in each group when the plurality of spots are divided into a plurality of groups. The pattern irradiation range of the pattern Py2 is different from the pattern Pw2 and the pattern Px2. The patterns Pw2, Px2, and the pattern Py2 are suitable patterns when, for example, the macular M is irradiated with the treatment laser light.

Note that white circles and black circles in FIGS. 11A to 11C have the same meanings as in FIGS. 10A to 10C, and thus description thereof is omitted. When any pattern in the selection unit 410 is selected, the display on the monitor 82 is switched to the irradiation condition screen 200, and the selected pattern is displayed in the pattern display area 211 (see FIG. 7). When the transition unit 320 is touched on the pattern selection screen 400, the irradiation condition screen 200 is returned without changing the pattern.

As described above, the ophthalmic laser treatment apparatus 1 of the present embodiment is independent of the common patterns (patterns Pa to Pv) shared between the normal output mode and the low output mode, and the normal output mode and the low output mode. And selectable individual patterns (patterns Pw1, Pw2, Px1, Px2, Py1, Py2). In this embodiment, the number of patterns that can be selected is the same between the normal output mode and the low output mode, but the types (shapes) of the selectable patterns are different. Thereby, for example, in each of the normal output mode and the low output mode, only the frequently used pattern is presented to the operator, and the operator's selection operation is simplified. In addition, erroneous pattern selection is also suppressed.

In the present embodiment, the normal output mode and the low output mode are different from each other in three patterns to be presented, but the present invention is not limited to this. The ophthalmic laser treatment apparatus 1 has a plurality of operation modes, and at least one of the patterns to be presented may be changed according to the selected operation mode. In addition, even in the same operation mode, at least one of a plurality of presented patterns may be changed according to the setting of the irradiation condition and the like. Note that “change” includes an increase or decrease in the number of patterns to be presented.

<Position check method>
Next, position check means included in the ophthalmic laser treatment apparatus 1 of this embodiment will be described. In the following description, it is assumed that the pattern Px2 (see FIG. 11B) is selected on the pattern selection screen 400 in the low output mode. When the pattern Px2 is selected, the patient's eye E is irradiated with aiming light corresponding to the pattern Px2. The aiming light is scanned, and the aiming light spot AS1 shown in FIG. In the pattern Px2 of this embodiment, a plurality of spots constituting the pattern Px2 are divided into a plurality of groups (first group G1 to eighth group G8). In the present embodiment, when the foot switch 81 is operated eight times, a series of treatment laser light irradiation corresponding to the pattern Px2 is completed.

The patterns PS1 to PS3 used in the following description are a part of patterns obtained by dividing the pattern Px2. As an example, the spot corresponding to the pattern PS1 is the spot AS1. When the pattern PS1 is set and the foot switch 81 is operated while the aiming light spot AS1 (first group G1) is presented, the treatment laser light is irradiated to the positions of the spots constituting the spot AS1. When the irradiation of the treatment laser light is completed, the pattern PS2 is automatically set, and the irradiation area of the aiming light moves. On the patient's eye E, an aiming light spot AS2 (second group G2) shown in FIG. 13 is formed. When the foot switch 81 is operated during the presentation of the spot AS2, the treatment laser light is irradiated to the position of each spot of the spot AS2. When the irradiation of the treatment laser beam is completed, the pattern PS3 is automatically set, and the irradiation region of the aiming light moves again. On the patient's eye E, an aiming light spot AS3 (third group G3) shown in FIG. 14 is formed. In this way, the irradiation area of the aiming light and the treatment laser light moves in the circumferential direction with respect to the reference position U.

The ophthalmic laser treatment apparatus 1 of the present embodiment has position check means. In the present embodiment, when the position check unit 290 is touched during the low output mode, the patient eye E is irradiated with a pattern (for aiming light) having a shape different from the pattern of the treatment laser light. FIG. 15 shows a spot AP of aiming light formed on the patient's eye E with the pattern PP set. FIG. 22 shows control executed by the control unit 70 during the low output mode.

FIG. 22 will be described. In step S401, the control unit 70 detects whether or not the position check unit 290 is operated. If the operation of the position check unit 290 is detected, the process proceeds to step S402. If the operation of the position check unit 290 is not detected, the process proceeds to step S404. In step S402, the control unit 70 sets the pattern PP, irradiates the patient's eye E with the aiming light for forming the spot AP, and then proceeds to step S403. In step S403, the control unit 70 determines whether or not the irradiation of the aiming light using the pattern PP is continued for 5 seconds or more. If it continues for 5 seconds or more, the process proceeds to step S404, and if it is less than 5 seconds, the process proceeds to step S402. That is, when the position check unit 290 is operated, a spot AP (aiming light) is formed on the tissue of the patient's eye E for 5 seconds. In step S404, the control unit 70 changes to a pattern (for example, pattern AP2) used for pattern irradiation of the treatment laser light, and performs pattern irradiation with aiming light. Steps S401 to S404 are repeatedly executed during the low output mode.

The relationship between the observed image and the spot of the aiming light will be described with reference to FIGS. FIG. 16 shows a pattern irradiation process using the pattern Px2 (FIG. 11B), and shows a state where a spot AS3 (third group G3) of aiming light is formed on the patient's eye E. FIG. That is, FIG. 16 shows a process of performing annular irradiation on the macula M using the pattern Px2. In the present embodiment, when the pattern Px2 is selected, each time the foot switch 81 is operated, the spot formation position of the aiming light and the spot formation position of the treatment laser light move. The spot of the aiming light (spot AS3 in FIG. 16) is a part of a plurality of spots constituting the pattern Px2.

FIG. 17 is an observation image observed by the operator when the operator touches the position check unit 290 in the state of FIG. By operating the position check unit 290, the pattern used for pattern irradiation is changed from the pattern PS3 to the pattern PP. With the change of the pattern used for pattern irradiation, the spot of the aiming light is switched from the spot AS3 to the spot AP. Although not shown in FIGS. 16 and 17, the reference position U (see FIGS. 14 and 15) is the same position on the eye tissue in FIGS. 16 and 17. That is, in FIG. 16 and FIG. 17, the positional relationship between the patient's eye E (retinal region) and the laser irradiation optical system 40 is maintained. The spot AP of the present embodiment is a spot for irradiating a treatment laser beam to a treatment planned site. The spot AP of the present embodiment has a different shape from the spot AS (spots AS1, AS2, AS3, etc.) for forming the treatment laser light irradiation position (irradiation region). In the present embodiment, for example, even if it is difficult to observe the spot mark of the treatment laser light with the treatment laser light being irradiated with low energy, it is easy to irradiate the originally planned eye part with the treatment laser light.

As described above with reference to FIG. 22, in the present embodiment, when the position check unit 290 is operated, the spot of the aiming light formed on the eye tissue is switched from the spot AS3 to the spot AP. Then, after the spot AP is presented for a predetermined time (predetermined 5 seconds), the spot AP is automatically returned from the spot AP to the spot AS3. The operator only has to interrupt the state of looking into the eyepiece lens of the microscope unit 7 only when switching from the spot AS3 to the spot AP. Since the spot AP is automatically switched to the spot AS3, for example, the operator is freed from the trouble of interrupting the state of looking into the eyepiece lens of the microscope unit 7 to return the spot. Note that switching from the spot AS3 to the spot AP may be automatically performed based on a predetermined condition. Alternatively, the spot AP may be normally presented and the spot AS may be temporarily formed when the position check unit 290 is operated. The surgeon may irradiate the treatment laser beam while the spot AS is being formed (temporarily). In addition, the presentation of the spot AS3 and the presentation of the spot AP may be alternately repeated.

The pattern PP of the present embodiment has an annular shape. Specifically, in the pattern PP of the present embodiment, a plurality of spots constituting the pattern PP are arranged in an annular shape around the reference position U. On the other hand, the pattern PS of the present embodiment is a spot that is moved in the circumferential direction around the reference position U. By forming the spot AP on the patient's eye E, the operator can determine the positional relationship between the patient's eye E and the laser irradiation optical system 40 (in other words, even if the pattern irradiation area moves in the circumferential direction during a series of pattern irradiations). In this case, it is possible to easily determine whether or not the initially planned ocular tissue region can be irradiated with the treatment laser beam. That is, the ophthalmic laser treatment apparatus 1 according to the present embodiment includes changing means (patterns PS1 to 3 as an example) for changing the positional relationship between the spot AP and the spot AS.

In addition, although the pattern irradiation area | region (formation position of spot AS) of this embodiment moves to the circumferential direction, the movement of a pattern irradiation area | region is not restricted to the movement (that is, rotation) to the circumferential direction. For example, the pattern irradiation region may be moved in the up / down direction / left / right direction (see, for example, JP-A-2014-68909). The laser irradiation optical system 40 is aligned with the ocular tissue site used as a reference for a series of pattern irradiations during a series of pattern irradiations in which a plurality of spots are divided into a plurality of groups by performing pattern irradiation of aiming light using the pattern PP. I can do it. In the present embodiment, the spot AS and the spot AP are switched, but the spot AS and the spot AP may be formed (presented) at the same time.

It should be noted that some of the plurality of spots constituting the pattern PP are shared with some of the plurality of spots constituting the pattern PS. Referring to FIGS. 14 and 15, the spot in the frame G of the pattern PS3 matches the spot in the frame H of the pattern PP. That is, the diameter of the pattern PP of the present embodiment matches the inner diameter of the pattern Px2 (ring-shaped pattern). Therefore, in the treatment laser light irradiation using the pattern Px2, the treatment laser light is not irradiated inside the spots constituting the pattern PP. By observing the fundus Er image and the sighting light spot AP, the surgeon can easily grasp the irradiation range of the treatment laser light during a series of pattern irradiations using the pattern Px2. In addition, the pattern PP of this embodiment can suppress irradiation of the aiming light to the fovea, for example. Thereby, the glare of the patient irradiated with the aiming light is reduced. However, the shape of the pattern PP is not limited to this. For example, the pattern PP may be a quadrangle, a cross, or a solid circle with the reference position U as the center of gravity. Further, for example, the pattern PP may be a single spot (the spot is arranged at the reference position U). It is only necessary that the laser irradiation optical system 40 can be aligned with an eye tissue site as a reference for a series of pattern irradiations. The spot AP of the present embodiment is suitable for alignment with the macular M, but the target of the spot AP is not limited to the macular M. For example, aiming at the optic nerve head D, blood vessel V, or the like may be performed using the spot AP. The ophthalmic laser treatment apparatus 1 may include a plurality of spot APs having different shapes, and may select the spot AP. This selection may be selected by the operator or may be automatically selected according to the operation mode of the ophthalmic laser treatment apparatus 1.

<Summary>
As described above, the ophthalmic laser treatment apparatus of the present embodiment is provided in the laser irradiation optical system that irradiates the patient's eye with the treatment laser light emitted from the treatment laser light source, and the treatment laser light. Scanning means for two-dimensionally scanning the spot on the tissue of the patient's eye, and pattern irradiation means for forming spots of a predetermined pattern using a laser irradiation optical system and scanning means. In addition, a normal output mode for modifying the patient's eye tissue by irradiation with the treatment laser light and a treatment laser beam in the normal output mode for optically stimulating the patient's eye tissue without modifying the patient's eye tissue. Mode selection means for selecting a low output mode that is relatively lower than the above output, and control means for controlling the ophthalmic laser treatment apparatus. In the low output mode, a pattern selection means for selecting a predetermined pattern from a plurality of patterns, a setting means for setting the irradiation energy of the reference treatment laser light, and the patient's eye without modifying the tissue of the patient's eye In order to optically stimulate the tissue, the operator can operate correction means for correcting the output to be reduced by a predetermined amount with respect to the reference irradiation energy set by the setting means. When the low output mode is set, the control means does not accept the pattern selection by the pattern selection means until the reference irradiation energy set by the setting means is corrected by the correction means, and the pattern after correction by the correction means is not accepted. The pattern selection by the selection means can be accepted. Thereby, for example, pattern irradiation of the treatment laser light with unintended irradiation energy is suppressed.

In the ophthalmic laser treatment apparatus 1 of the present embodiment, the setting means includes an output value setting means for setting the output value of the treatment laser beam, and the correction means is an output set by the output value setting means. Decrease the value. Thereby, for example, the event of irradiating the patient's eye E with the unintended output value (treatment laser light) of the treatment laser light is suppressed. Further, in the ophthalmic laser treatment apparatus 1 according to the present embodiment, the correction unit regulates a setting range that can be set by the output value setting unit so that the corrected output value does not fall below a predetermined lower limit value. Thereby, the event which irradiates the patient eye E with the unstable treatment laser beam can be suppressed, for example.

In addition, the ophthalmic laser treatment apparatus 1 according to the present embodiment includes an irradiation control unit that controls irradiation of the treatment laser light to the patient's eye E, and the control unit prohibits pattern selection by the pattern selection unit. Forms a single spot as a predetermined pattern. Thereby, for example, the burden on the patient's eye E when determining the reference condition is reduced.

In addition, the ophthalmic laser treatment apparatus 1 according to the present embodiment includes a laser irradiation optical system 40 for irradiating the tissue of the patient's eye E with the treatment laser light, and a first pattern (for example, a pattern) indicating the irradiation target region of the treatment laser light. PS3) has a shape different from that of the first pattern, a second pattern (for example, pattern PP) for aligning the first pattern with the treatment target site, and storage means for storing the first pattern and the second pattern ( ROM 72) and sighting optics for scanning aiming light on the tissue of patient eye E to form a first spot based on the first pattern and a second spot based on the second pattern on the tissue of patient eye E A system (laser irradiation optical system 40) is provided. Thereby, for example, irradiation of the treatment laser beam to an unintended site can be suppressed.

Further, the ophthalmic laser treatment apparatus 1 according to the present embodiment includes aiming selection means (position check unit 290) for selectively forming either the first spot or the second spot on the tissue of the patient's eye E. I have. Thereby, for example, the first spot and the second spot can be easily switched by a simple operation.

Moreover, the ophthalmic laser treatment apparatus 1 of the present embodiment includes a changing unit for changing the positional relationship between the first spot and the second spot. Thereby, for example, even if the pattern irradiation area is moved, the aiming light can be easily aligned with the irradiation scheduled area. Moreover, the ophthalmic laser treatment apparatus 1 of this embodiment includes an irradiation control unit that controls irradiation of the treatment laser light to the patient eye E, and the changing unit displays the first spot when the treatment laser light is irradiated. As a rotation center, the second spot is moved in the circumferential direction with respect to the first spot. Thereby, for example, it is easy to perform pattern irradiation on the macular M. Moreover, the ophthalmic laser treatment apparatus 1 of the present embodiment uses an annular shape as the first pattern. Thereby, for example, it is easy to perform pattern irradiation on the macular M.

In addition, the ophthalmic laser treatment apparatus 1 of this embodiment can irradiate the patient's eye E with a plurality of treatment laser beams having different wavelengths. However, the technology of the present disclosure may be applied to an ophthalmic laser treatment apparatus that can irradiate the patient's eye E with only a specific wavelength of treatment laser light (for example, yellow). Moreover, the ophthalmic laser treatment apparatus 1 according to the present embodiment intermittently emits laser light to form a pattern composed of separated spots. However, the laser beam may be continuously irradiated to form a pattern with continuous spots.

It should be considered that the embodiment disclosed this time is illustrative in all respects and not restrictive. The scope of the present invention is defined by the terms of the claims, rather than the description above, and is intended to include any modifications within the scope and meaning equivalent to the terms of the claims.

E: Patient eye 40: Laser irradiation optical system 50: Operation unit 260: Output ratio setting unit 350: Output ratio selection screen 410: Pattern selection screen

Claims (4)

A laser irradiation optical system for irradiating a patient's eye with a treatment laser beam emitted from a treatment laser light source;
A scanning means provided in the laser irradiation optical system for two-dimensionally scanning a spot of the treatment laser light on a tissue of a patient's eye;
Pattern irradiation means for forming spots of a predetermined pattern using the laser irradiation optical system and the scanning means;
The treatment laser in the normal output mode for modifying the tissue of the patient's eye by irradiating the treatment laser light, and in the normal output mode for optically stimulating the tissue of the patient's eye without modifying the tissue of the patient's eye Mode selection means for selecting a low output mode that is relatively lower in output than the light output;
Control means for controlling the ophthalmic laser treatment device;
With
In the low power mode,
Pattern selecting means for selecting the predetermined pattern from a plurality of patterns;
Setting means for setting the irradiation energy of the treatment laser beam as a reference;
Correction means for correcting to reduce the output by a predetermined amount with respect to the reference irradiation energy set by the setting means in order to optically stimulate the patient eye tissue without degenerating the patient eye tissue When,
The surgeon can operate,
When the low output mode is set, the control means does not accept the pattern selection by the pattern selection means until the reference irradiation energy set by the setting means is corrected by the correction means. Enabling pattern selection by the pattern selection means after correction by means;
An ophthalmic laser treatment apparatus characterized by the above. The ophthalmic laser treatment apparatus according to claim 1,
The setting means includes an output value setting means for setting an output value of the treatment laser light,
The correction means reduces the output value set by the output value setting means;
An ophthalmic laser treatment apparatus characterized by the above. The ophthalmic laser treatment apparatus according to claim 2,
The correction means regulates a setting range that can be set by the output value setting means so that the corrected output value does not fall below a predetermined lower limit value.
An ophthalmic laser treatment apparatus characterized by the above. The ophthalmic laser treatment apparatus according to any one of claims 1 to 3,
Irradiation control means for controlling irradiation of the treatment laser light to the patient's eye,
The control unit forms a single spot as the predetermined pattern when pattern selection by the pattern selection unit is prohibited.
An ophthalmic laser treatment apparatus characterized by the above.

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