CN103169568B - 用于创建切口以提高人工晶状体设置的装置 - Google Patents
用于创建切口以提高人工晶状体设置的装置 Download PDFInfo
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Abstract
本发明涉及一种用于将人工晶状体插入患者的眼睛的系统和方法,包括用于产生光束的光源、用于以包括配准特征的封闭的治疗图案的形式偏转光束的扫描仪、以及被配置以将封闭的治疗图案的传送至患者的眼睛内的靶组织以在其中形成具有配准特征的封闭切口的传送系统。将人工晶状体安置在封闭切口中,其中人工晶状体具有配准特征,其与封闭切口的配准特征接合。作为选择地,扫描仪可以形成用于支柱的独立的配准切口,所述支柱经由支撑物部件连接至人工晶状体。
Description
本申请是发明名称为“用于创建切口以提高人工晶状体设置的装置”、申请日为2008年3月13日、申请号为200880007890.1的中国专利申请的分案申请。
相关申请
本申请要求享有2007年3月13日提交的美国临时申请No.60/906944的权益,其通过引用包含于此。
技术领域
本发明涉及眼科手术过程和系统。
背景技术
白内障摘除是世界上最常进行的手术过程之一,在美国每年约进行二百五十万的案例,全球于2000年进行了九百一十万的案例。预期在2006年全球估算约增加至一千三百三十万个案例。这一市场由各种部分组成,包括用于植入的人工晶状体,有助于手术操作的粘弹性聚合物,包括超声乳化晶状体尖端、管以及各种刀和钳子的一次性器械。通常使用术语称为晶状体乳化法的技术执行现代的白内障手术,其中使用具有用于冷却目的的相关水流的超声尖端,以在术语称为晶状体前囊切开术或者更新近的撕囊术中在晶状体前囊中进行开口之后,对晶状体的相对硬核进行雕刻。在这些步骤以及移通过抽吸方法而不断裂以移除其余软晶状体皮层之后,将合成可折叠人工晶状体(IOL)通过小切口插入眼睛。
过程中最早和最关键的步骤之一是执行撕囊术。该步骤从称为开罐式晶状体囊切开术的较早技术发展而来,其中使用锋利的针以环形方式在晶状体囊前部上穿孔,其后移除通常直径5-8mm范围中的晶状体囊的环形碎片。这有助于由超声乳化术而进行下一步骤的核雕刻。由于与初始开罐式技术相关的各种并发症,尝试通过引导本领域专家开更好的技术,用于在乳化步骤之前移除晶状体囊前部。撕囊术的概念是提供光滑的连续的圆形开口,通过其不仅可以安全和容易地执行核的超声乳化术,还用于容易地插入人工晶状体。其提供了用于插入的畅通的中心通路,用于由患者将图像透射至视网膜的永久孔,以及IOL在其余囊内部的支撑,其将限制错位的可能性。
使用开罐式晶状体囊切开术的较早技术,或者甚至使用持续的撕囊术,可能会发生问题,该问题涉及外科医生由于缺乏红反射不能充分地观察晶状体囊以足够安全地将其抓住,在不具有径向裂口和延伸的情况下撕开合适尺寸的光滑圆形开口,或者涉及初始开口之后维持前房深度、小尺寸瞳孔或由于透镜不透明性而不存在红反射的技术困难。通过使用诸如亚甲兰或靛青绿的染料,已经最小化了与可视化相关的一些问题。在具有弱小带(通常年长患者)的患者和非常幼小的儿童中,产生其它并发症,这些患者具有非常柔软和弹性的晶状体囊,这非常难以机械地撕裂。
许多白内障患者有散光。当角膜在一个方向上具有不同于其他方向的曲率时,可以发生散光。IOL用于校正闪光,但要求精确的安置、定向和稳定性。使用IOL进行完全的且长时间的校正是困难的。而且,即使许多患者具有更严重的像差,但当前不使用IOL矫正超过5D的散光。对其矫正通常还包括使得角膜形状更球形,或者至少更径向对称。具有大量的方法,包括角膜移植术、散光角膜切除术(AK)、角膜松弛切口(CRI)以及角膜缘松弛切口(LRI)。使用手动、机械切割进行上述方法。当前,不容易或可预测地完全矫正散光。进行手术以矫正不均匀性的患者中的约三分之一发现,他们的眼睛退回到相当大的度数,并且仅注意到小改善。另三分之一的患者发现,散光度显著地减少了,但是并未得以完全矫正。其余三分之一患者具有最鼓舞人心的结果,实现了大部分或所有的所需矫正。
需要一种眼科手术方法、技术和装置,以提高护理散光白内障患者的标准。
发明内容
本发明提供了通过使用短脉冲激光器以创建尺寸和形状与IOL自身互补的晶状体囊切口而将IOL精确和准确地植入患者眼睛的晶状体囊中的方法和装置。这通过将不对称特征添加至切口和晶状体或其部分上而实现。
用于治疗靶组织上损伤的设备包括用于产生光束的光源、用于以包括配准特征的封闭治疗图案的形式偏转光束的扫描仪,以及配置以将封闭的治疗图案传送至靶组织以在其中形成具有配准特征的封闭切口的一个或多个光学元件的传送系统。
用于插入患者眼睛的人工晶状体包括成形用于使光穿过其聚焦的透镜部分,以及从透镜部分延伸的用于向透镜部分提供弹性力的至少两个触片。透镜部分包括形成配准特征的外围边缘。
用于插入患者眼睛的人工晶状体包括成形用于光穿过其聚焦的透镜部分,从透镜部分延伸的用于向透镜部分提供弹性力的至少两个触片,以及与透镜部分分离并且通过至少一个支撑件而连接至透镜部分的支柱。
在阅读说明书、权利要求书和随附附图之后,本发明的其他目的和特征将变得明显。
附图说明
图1是光束扫描系统的示意图。
图2是示出替代束结合方案的光学图。
图3是具有备选OCT结构的光束扫描系统的示意图。
图4是具有另一备选OCT组合方案的光束扫描系统的示意图。
图5是旋转非对称撕囊术切口的顶视图。
图6是互补旋转非对称IOL的顶视图。
图7是位于图5的晶状体囊中的图6的IOL的顶视图。
图8和9是图6的旋转非对称IOL的侧视图。
图10是旋转非对称撕囊术切口的顶视图。
图11是互补旋转非对称IOL的顶视图。
图12是位于图10的晶状体囊中的图11的IOL的顶视图。
图13是旋转非对称撕囊术切口的顶视图。
图14是示出互补旋转非对称IOL的图的顶视图。
图15是旋转非对称撕囊术切口的顶视图。
图16是互补旋转非对称IOL的顶视图。
图17是图16的旋转非对称IOL的透视图。
图18是图16的旋转非对称IOL的侧视图。
图19是旋转非对称IOL的顶视图。
图20是旋转非对称IOL的顶视图。
具体实施方式
与当前标准的护理相比,本文公开的技术和系统提供了许多优点。具体地,使用三维图案化的激光切割,使得能够在晶状体囊中快速和精确地形成开口,以有助于人工晶状体的安置和稳定性。
本文所述的技术所允许的另一手术过程提供了在晶状体囊前部和/或后部中受控地形成切口。常规的过程需要完整的圆形或几乎完整的圆形切口。使用常规、手动撕囊术技术形成的开口主要依赖于晶状体囊组织的机械剪切属性以及晶状体囊的不可控的撕裂,以形成开口。这些常规技术受限制于中央晶状体部分或者使用机械切割器械可到达的区域,并且在形成裂口期间使用精确的解剖测量来改变有限度数。相反的,可以使用本文所述的可控的图案化的激光技术,以在事实上晶状体囊前部和/或后部中任意位置并且事实上以任意形状创建切口。在“Bag-in-the-lens”外科手术中,必须在前和后囊中进行匹配切口以将IOL安装在合适的位置。本发明特别适于执行这种匹配切口。
而且,这些囊切口可以被修改或调整以容纳非对称IOL,其需要精确地定位其位置和旋转方向。而且,本文所述的可控的、图案化的激光技术还具有有效和/或利用精确的晶状体囊尺寸、测量和其他尺寸信息,其允许形成切口或开口,同时最小化对周围组织的影响。
本发明可以由这样的系统实施,所述系统投射或扫描光束进入患者眼睛68,诸如图1中所示的系统2,包括超快(UF)光源4(例如,毫微微秒激光器)。使用该系统,可以在患者的眼睛中以三个维度扫描光束:X,Y,Z。在该实施例中,UF波长可以在1010nm至1100nm之间改变,并且脉冲宽度可以从100fs至10000fs之间变化。脉冲重复频率也可以从10kHZ至250kHz之间变化。关于对非靶组织的无意损伤的安全限制受在关于重复率和脉冲能量的上限限制;同时,完成手术过程的阈值能量、时间、和稳定性受脉冲能量和重复率的下限限制。在眼睛68中并且尤其在晶状体69和眼睛的前囊中的聚焦点的峰值功率足够产生光学击穿,并且开始等离子体介导消融处理。优选采用近红外波长,因为在光谱范围中减小了生物组织中的线性光吸收和散射。作为一个实例,激光器4可以是重复脉冲的1035nm的设备,其以100kHz的重复率产生500fs脉冲,并且在10微焦范围中产生独立脉冲能量。
激光器4经由输入和输出设备302而受控于控制电子装置300,以产生光束6。控制电子装置300可以是计算机、微控制器等。在该实例中,整个系统受控于控制器300和移动通过输入/输出设备IO302的数据。可以使用图形用户界面GUI304,以设置系统操作参数,处理在GUI304上的用户输入(UI)306,以及显示收集到的诸如眼睛结构的图像的信息。
所产生的UF光束6朝向患者眼睛68行进,通过半波片8和线性偏光器10。光束的偏光态可以被调整,从而使得所期望量的光通过半波片8和线性偏光器10,其一起用作为UF光束6的可变衰减器。另外,线性偏光器10的方向确定入射在光束组合器34上的入射光偏光态,由此最优化光束组合器的通量。
UF光束行进通过遮光器12、光圈14和拾取设备16。出于过程和安全的原因,系统受控的遮光器12确保打开/关闭对激光器的控制。光圈设置了对激光束有用的外径,而拾取设备监控有用光束的输出。拾取设备16包括部分反射镜20和检测器18。可以使用检测器18测量脉冲能量、平均功率或其组合。可以使用该信息以反馈至用于衰减的半波片8,并且核实遮光器12是否打开或关闭。此外,遮光器12可以具有位置传感器,以提供冗余状态检测。
光束通过光束调节级22,其中可以修改诸如光束直径、发散度、圆形度和散光的光束参数。在该所示的实例中,光束调节级22包括2元件光束扩展望远镜,其包括球面光学器件24和26,以便于实现所需的光束尺寸和准直。虽然本文中未示出,但是可以使用变形或其它光学系统以实现所期望的光束参数。用于确定这些光束参数的因素包括激光的输出光束参数、系统的整体放大倍率以及在治疗位置处的所期望的数值孔径(NA)。此外,可以使用光学系统22以使光圈14成像至所期望的位置(例如,下文所述的2-轴的扫描设备50之间的中心位置)。这样,确保通过光圈14的光量能够通过扫描系统。随后,拾取设备16进行对可用光的可靠测量。
从调节级22出射之后,光束6反射离开折叠镜28、30和32。出于对准目的,这些镜可以调节。随后,光束6入射在光束组合器34上。光束组合器34反射UF光束6(并且发射下文描述的OCT光束114和瞄准光束202)。为了使光束组合器有效操作,入射角优选保持在45度以下,并且固定光束可能处的偏光。对于UF光束6,线性偏光器10的方向提供了固定的偏光。
在光束组合器34之后,光束6继续行进在z-调整或Z扫描设备40上。在该说明性实例中,z-调整包括具有两个透镜组42和44的伽利略望远镜(每个透镜组包括一个或多个透镜)。透镜组42沿着z-轴围绕望远镜的准直位置移动。这样,患者的眼睛68中光斑的聚焦位置沿着z轴移动,如图所示。一般地,在透镜42的运动和焦点的运动之间存在固定的线性关系。在该情况下,z-调整望远镜具有近似2×光束扩展率,以及透镜42的移动与焦点的移动的1:1关系。作为选择地,透镜组44可以沿着z-轴移动以促使z-调整和扫描。z-调整是用于在眼睛68中进行治疗的z-扫描设备。其可以受到系统的自动和动态控制,并且被选择为独立的或与下文所述的X-Y扫描设备相互影响。可以使用镜36和38,用于将光轴对准z-调整设备40的轴。
在通过z-调整设备40之后,由镜46和48将光束6引导至x-y扫描设备。镜46和48能够被调整以用于对准目的。优选在控制电子装置300的控制下使用两个镜52和54,通过扫描设备50实现X-Y扫描,其使用电动机、检流计或任何其他公知的光学移动设备在垂直方向上旋转。镜52和54位于靠近下述的物镜58和接触透镜66组合的焦阑位置,如下所述。倾斜这些镜52/54,使得它们偏转光束6,引起在位于患者的眼睛68中的UF焦点的平面中侧向位移。物镜58可以是复杂的多元件透镜元件,如图所示,并且由透镜60、62和64指示。透镜58的复杂性将由扫描区域尺寸、聚焦焦点尺寸、物镜58的近侧和远侧上可获得的工作距离以及像差控制量所规定。一个实例是在10mm的区域上产生10μm的光斑尺寸、焦距60mm的f-theta透镜58,其具有15mm直径的输入光束尺寸。作为选择地,由扫描仪50进行的X-Y扫描可以通过使用一个或多个可移动光学元件(例如,透镜,光栅)来实现,所述可移动光学元件经由输入和输出设备302而被控制电子装置300控制。
扫描仪50在控制器300的控制下,可以自动产生瞄准和治疗扫描图案。这种图案可以包括单点光、多点光,连续图案的光、多个连续图案的光、和/或其任意组合。此外,瞄准图案(使用下述的瞄准光束202)不必与治疗图案(使用光束6)相同,但是优选的,至少限定其边界以便于出于患者安全性考虑而确保仅在所期望的靶区域中传送治疗光。例如,这可以通过使得瞄准图案提供预期治疗图案的轮廓而实现。这样,可以使得用户即使不知道各个焦点自己的准确位置,也可以知晓治疗图案的空间范围,并且因而最优化扫描的速度、效率和精确性。还可以使瞄准图案作为闪烁被感知,以便于进一步增强其对用户的可视性。
可以使用光学接触透镜66以帮助进一步将光束6聚焦到患者的眼睛68中,同时帮助稳定眼睛位置,所述光学接触透镜66可以是任何合适的眼用透镜。光束6的定位和特性和/或光束6形成在眼睛68上的扫描图案可以进一步通过使用诸如操纵杆的输入设备或其他任何适合的用户输入设备(例如,GUI304)而被控制,以定位患者和/或光学系统。
可以设置UF激光器4和控制器300以瞄准眼睛68中靶结构的表面,并且确保光束6将聚焦在合适的位置,并且不会意外地损伤非靶组织。可以使用本文中所述的成像形式和技术,诸如举例而言,光学相干断层成像术(OCT)、浦肯雅成像、Scheimpflug成像、或超声,以确定位置,并且测量晶状体和晶状体囊的厚度以向激光聚焦方法提供更好的精确性,包括形成2D和3D构图。使用包括下列的一种或多种方法,还可以实现激光聚焦,所述方法包括直接观察瞄准光束、光学相干断层成像术(OCT)、浦肯雅成像、Scheimpflug成像、超声或其他已知的眼科或医学成像形式和/或其组合。虽然其他形式在本发明的范围中,在图1的实施例中,描述了一种OCT设备100。眼睛的OCT扫描将提供关于晶状体囊前部和后部的轴位置、白内障核的边界以及前房的深度的信息。随后,将该信息装载入控制电子装置300,并且用于编程和控制随后的激光协助的外科手术过程。还可以使用信息以确定涉及手术过程的大量参数,诸如举例而言,用于切割晶状体囊以及分割晶状体皮层和核的焦点平面的上轴限和下轴限、以及晶状体囊的厚度等。
图1中的OCT设备100包括宽带或扫频光源102,其由光纤耦合器104分成参考臂106和采样臂110。参考臂106包括模块108,其包含参考反射以及合适的分散和路径长度补偿。OCT设备100的采样臂110具有输出连接器112,其作为至UF激光系统的其余部分的接口。随后,由耦合器104将从参考臂106和采样臂110返回的信号导向检测设备128,其采用时域、频率或单点检测技术。在图1中,使用频域技术,具有920nm的OCT波长和100nm的带宽。
从连接器112出射之后,使用透镜116准直OCT光束114。由透镜116的焦距确定已准直的光束114的尺寸。由眼睛中的焦点处的所期望的NA以及导向眼睛68的光束串的放大倍率来确定光束114的尺寸。一般地,在焦平面中,OCT光束114不需要具有与UF光束6相同高的NA,因而在光束组合器34的位置,OCT光束114的直径小于UF光束6。在准直透镜116之后是光圈118,其进一步修改眼睛处的OCT光束114的最终的NA。选择光圈118的直径以最优化入射在靶组织上的OCT光以及返回信号的强度。使用可以是主动或动态的偏光控制元件120以补偿例如可能由角膜双折射中的各个差别引起的偏光态改变。随后使用镜122和124以将OCT光束114导向光束组合器126和34。出于对准目的,并且尤其用于将OCT光束114覆盖在光束组合器34之后的UF光束6之上,可以调整镜122和124。相似地,使用光束组合器126以将OCT光束114与下述的瞄准光束202组合在一起。
一旦与在光束组合器34之后的UF光束6组合,OCT光束114沿着与UF光束6相同的路径,通过系统的其余部分。这样,OCT光束114指示了UF光束6的位置。OCT光束114穿过z-扫描40和x-y扫描50的设备,随后穿过物镜58、接触透镜66并且进入眼睛68。从眼睛内部的结构出来的反射和散射提供了返回光束,其折回通过光学系统、进入连接器112,通过耦合器104,并且至OCT检测器128。这些返回的反射提供了OCT信号,它们接着由系统解释为UF光束6的焦点的X、Y、Z中的位置。
OCT设备100的工作原理是,测量其参考臂和采样臂之间的光路长度中的差别。因而,将OCT通过z-调整40,并未延伸OCT系统100的z-范围,这是因为光路长度不作为42的移动的函数进行改变。OCT系统100具有固有的与检测方案相关的z-范围,并且在频域检测的情况下,其尤其与分光计和参考臂106的位置相关。在图1中使用的OCT系统100的情况下,在水相环境中,z-范围近似为1-2mm。将该范围延伸至至少4mm,涉及了OCT系统100中参考臂的路径长度的调整。在采样臂中将OCT光束114穿过z-调整40的z-扫描,允许最优化OCT信号强度。通过将OCT光束114聚焦在靶结构上,同时通过匹配地增加OCT系统100的参考臂106中的路径而调节已延伸的光路长度,而实现上述操作。
因为由于诸如沉浸指数、折射率以及彩色和单色的像差而在OCT测量中关于UF聚焦设备的基本差值,必须考虑用UF光束焦点位置来分析OCT信号。应当进行作为X、Y、Z的函数的校准或配准程序,以便于将OCT信号信息匹配至UF焦点位置以及涉及绝对尺寸量。
还可以使用对瞄准光束的观察以协助用户指导UF激光聚焦。此外,假设瞄准光束精确地表示了红外光束参数,那么代替红外OCT和UF光束,肉眼可见的瞄准光束可能有助于对准。在图1所示的结构中采用了瞄准子系统200。由瞄准光束光源201产生瞄准光束202,诸如运行在633nm波长的氦-氖激光器。作为选择地,可以使用630-650nm范围中的激光二极管。使用氦氖633nm的光束的优点是其长的相干长度,其将允许使用瞄准路径作为激光不相等路径干涉仪(LUPI),以例如测量光束串的光学质量。
一旦瞄准光束光源产生瞄准光束202,使用透镜204来准直瞄准光束202。由透镜204的焦距确定已准直的光束的大小。由眼睛中的焦点处所期望的NA以及导向眼睛68的光束串的放大倍率,决定瞄准光束202的大小。一般地,瞄准光束202应当在焦平面中具有与UF光束6接近相同的NA,并且因而,瞄准光束202具有与在光束组合器34的位置处的UF光束类似的直径。由于在系统对准眼睛的靶组织期间,瞄准光束意于代替UF光束6,大部分瞄准路径模仿如前所述的UF路径。瞄准光束202进行通过半波片206和线性偏光器208。可以调整瞄准光束202的偏光态,从而所期望量的光通过偏光器208。因而,元件206和208用作为用于瞄准光束202的可变衰减器。另外,偏光器208的方向确定入射在光束组合器126和34上的入射偏光态,由此固定偏光态,并且允许最优化光束组合器的通过量。当然,如果使用半导体激光器作为瞄准光束光源200,可以改变驱动电流以调整光学功率。
瞄准光束202继续通过遮光器210和光圈212。系统受控的遮光器210提供了瞄准光束202的开/关控制。光圈212设置瞄准光束202的外部有效直径,并且可以被适当地调整。可以使用测量眼睛中的瞄准光束202的输出的校准程序,以经由偏光器206的控制而设置瞄准光束202的衰减。
其次,瞄准光束202通过光束调节设备214。可以使用一种或多种公知的光束调节光学元件来修改诸如光束直径、发散性、圆形度和散光的光束参数。在从光纤中出现瞄准光束202的情况下,光束调节设备214可以简单地包括具有两个光学元件216和218的光束扩张望远镜,以便实现预期的光束大小和准直。根据在眼睛68的位置匹配UF光束6和瞄准光束202所需要的内容来决定用于确定诸如准直度的瞄准光束参数的最终因素。通过适当地调整光束调节设备214,可以考虑色差。此外,使用光学系统214将光圈212成像至所期望的位置,诸如光圈14的共轭位置。
接着,瞄准光束202反射离开折叠镜222和220,它们优选可调整用于精密对准在光束组合器34之后的UF光束6。随后,瞄准光束202入射在光束组合器126上,在其中瞄准光束202与OCT光束114组合。光束组合器126反射瞄准光束202,并且发射OCT光束114,这允许在两个波长范围更有效地运作光束组合功能。作为选择,光束组合器126的发射和反射功能可以颠倒并且结构可以反转。在光束组合器126之后,由光束组合器34将瞄准光束202和OCT光束114一同与UF光束6组合。
图1中示意性地示出用于成像在眼睛68上或内的靶组织的设备,示为成像系统71。成像系统包括照相机74和照明光源86,用于在靶组织上创建图像。成像系统71收集图像,图像可以由系统控制器300使用以提供中心围绕或位于预定结构中的图案。用于观察的照明光源86通常是宽带和不相干的。例如,光源86可以包括多个LED,如图所示。观察光源86的波长优选在700nm至750nm的范围中,但是可以是光束组合器56所接受的任何波长,所述光束组合器56将观察光与用于UF光束6和瞄准光束202的光束路径组合(光束组合器56反射观察波长,同时发射OCT波长和UF波长)。光束组合器56可以部分地发射瞄准波长,从而瞄准光束202对于观察照相机74是可见的。在光源86前面的可选的偏光元件84可以是线性偏光器、四分之一波片、半波片或任何组合,并且用于优化信号。如近红外波长产生的假彩色图像是可接受的。
使用与UF光束6和瞄准光束202相同的物镜58和接触透镜66,将来自光源86的照明光引导向下朝向眼睛。反射和散射离开眼睛68中的各种结构的光由相同的透镜58和66收集,并且引导返回朝向光束组合器56。其中,经由光束组合器和镜82将返回的光引导返回进入观察路径,并且引导至照相机74上。照相机74可以是例如但不局限于具有合适尺寸形式的任何基于硅的检测器阵列。视频透镜76将图像形成在照相机的检测器阵列上,同时光学元件80和78分别提供偏光控制和波长过滤。光圈或虹膜81提供了对成像NA的控制,并且因而提供了对聚焦深度和景深的控制。小光圈提供的优点是大的景深,其有助于患者对接过程。作为选择,可以切换照明和照相路径。而且,可以使得瞄准光源200在红外范围内发射,其将不能直接可见但是可以使用成像系统71对其捕获和显示。
通常需要粗调配准,从而当接触透镜66接触角膜时,靶组织处于系统的X、Y扫描的捕获范围中。因而,对接过程是优选的,其优选在系统靠近接触状况(即,患者的眼睛68和接触透镜66之间的接触)时考虑患者的运动。观察系统71被配置成使得聚焦深度足够大,以至于在接触透镜66接触眼睛68之前可以看见患者的眼睛68和其他显著特征。
优选地,将运动控制系统70集成在总控制系统2中,并且可以移动患者、系统2或其元件、或此两者,以实现接触透镜66和眼睛68之间精确和可靠的接触。而且,可以将真空抽吸子系统和凸缘包含在系统2中,并且用于稳定眼睛68。可以在监视成像系统71的输出的同时完成经由接触透镜66将眼睛68对准系统2,并且可以手动执行,或通过借助于控制电子装置300经由IO以分析成像系统71电子产生的图像而自动执行。还可以使用力和/或压力传感器的反馈以识别接触以及启动真空子系统。
在图2的可选实施例中示出可选的光束组合结构。例如,图1中的被动光束组合器34可以被替换为图2中的主动光束组合器140。主动光束组合器34可以是移动或动态受控元件,诸如检流计扫描镜,如图所示。主动组合器140改变其角度方向,以便于每次一个地将UF光束6或已组合的瞄准光束202和OCT光束114引导朝向扫描仪50并且最终将其引导朝向眼睛68。主动组合技术的优点在于其避免了使用被动光束组合器将光束与相似波长范围或偏光状态组合的困难。该能力折衷了及时地同时具有光束的能力以及由于主动光束组合器140的位置公差引起可能的较差准确性和精确性。
图3中示出了另一可选实施例,其类似于图1的实施例,但是使用了用于OCT100的可选方法。图3中,除了参考臂106已经被参考臂132代替之外,OCT101与图1中的OCT100相同。通过在透镜116之后包括分光器130而实现该自由空间OCT的参考臂132。随后,参考光束132行进通过偏光控制元件134,并且随后进行至参考返回模块136上。参考返回模块136包含合适的分散和路径长度调整和补偿元件,并且产生合适的参考信号,用于与采样信号干涉。现在OCT101的采样臂出现在分光器130之后。该自由空间结构的潜在优点包括单独的偏光控制和参考和采样臂的维护。OCT101的基于光纤的分光器104还可以由基于光纤的循环器代替。作为选择地,与参考臂136相反,OCT检测器128和分光器130可以一起移动。
图4示出了用于组合OCT光束114和UF光束6的另一可选实施例。在图4中,OCT156(其可以包括OCT100或101的结构中的任一个)被配置成使得使用光束组合器152在z-扫描40之后OCT156的OCT光束154耦合至UF光束6。这样,OCT光束154避免了使用z-调整。这允许OCT156可能更容易地折叠进入光束,并且缩短了路径长度,用于更稳定的操作。如关于图1所讨论的,该OCT结构耗费了已优化的信号返回强度。存在许多可能的OCT干涉计的结构,包括时域和频域方法、单光束和双光束方法、扫频源等,如美国专利No.5748898、5748352、5459570、6111645和6053613中所述(所述文献通过参考被包含于此)。
图5至图9示出了本发明一个实施例的不同方面,其可以使用上述的扫描系统2来实施。如图5中所示,撕囊术切口400(其可以使用系统2被创建)被改变用于散光矫正人工晶状体(IOL)。这种散光矫正IOL需要设置成不仅位于眼睛68的晶状体囊402中正确的位置处,还被定向在正确的旋转/计时角度。因而,它们具有固有的旋转非对称性,与球形IOL不同。该实例中所示的切口400是椭圆形的,然而其他形状也是有用的。可以连续或分段地形成切口400,以便从很大程度上维持患者的眼睛68的晶状体囊装置的结构整体性。可能认为这种不完整的切口400作为穿孔切口,并且使得它们将逐渐移除以便于使它们的非故意地延伸撕囊术的可能性最小化。无论怎样,切口400是封闭的切口,出于本公开的目的,这意味着其在同一位置开始和结束,并且在其中包围特定量的组织。封闭切口的最简单实例是圆形切口,其中由切口包围圆形片段的组织。因而接下来封闭的治疗图案(即,由系统2产生的用于形成封闭切口的治疗图案)是也在同一位置开始和结束并且由此限定环绕空间的治疗图案。
封闭切口400的一个关键特征是其包括配准特征以定向将被安置在其内的IOL。对于所示的椭圆形切口400,其椭圆形形状是其配准特征,这允许借助于其固有的旋转非对称性而精确安置IOL,这与手动CCC的所期望的圆形结果不同。示出了切口400的椭圆长轴404和短轴406。长轴404和短轴406不相等。可以相对于患者的眼睛68以任何旋转角形成切口400,尽管其在本实例中示出为在虹膜的平面中,其长轴404沿着水平方向。切口400趋于与IOL上的一个或多个互补配准特征匹配。可以使用系统2的测距子系统(例如OCT100的子系统)以精确地定义将切开的晶状体囊402的表面。这可以用于将激光脉冲额定地与靶晶状体囊402自身的附近隔离,因而最小化所需的能量和治疗时间,并且与之相应地增加患者安全性和总效率。
如图6中所示,IOL408包括用于聚焦光的光学部分410和用于定位IOL408的触片(haptic)416。光学部分410是(关于其光轴)旋转非对称透镜,其包括椭圆形的外周侧壁或边缘412,与椭圆形切口400匹配的互补配准特征。在该实例中,椭圆形边缘412包括长轴418和短轴420。长轴418和短轴420不相等。人工晶状体IOL408还包括表面414,用于保持触片元件416,并且提供用于晶状体囊402的支撑平台,以将人工晶状体408的光学器件410固定在患者的眼睛68的晶状体囊402中合适的方向和位置。示出表面414是椭圆形的,但是并非必须是椭圆形的。触片416提供了稳定性,并且可以用于通过向晶状体囊402的前部施加保持力而将人工晶状体408的边缘412设置在切口400中。触片416可以在任意方向上部署。可以使得人工晶状体408的光学器件410的圆柱形矫正的方向符合其长轴418或其短轴420。这样,人工晶状体IOL408和光学器件410可以以标准方式制造,并且可以使得切口400的旋转方向和光学器件410的球形和圆柱形的光强度改变以符合患者的眼睛68的个体光学规定。
图7示出了一旦将人工晶状体408安装在晶状体囊402中、匹配所接合的配准特征边缘412和切口400并且位于表面414上,合适地立即配置人工晶状体408。长轴404和长轴418长度不等。短轴406和短轴420长度也不等。这样设置是为了适应在撕囊术切口之后晶状体囊402可能稍微缩短的事实。这些轴的长度之间的差趋于允许晶状体囊402缩短,并且仍然经由切口400较好地将人工晶状体408置于晶状体囊402中。这些差应当被限制于允许合理的缩短,但是不能多至允许人工晶状体408显著的旋转。例如,这些长度差的典型值的范围可以从100μm至500μm。
图8示出了图6和7中所示的同一人工晶状体408的侧视图。在该示意性示图中,示出边缘412位于光学器件410的与人工晶状体408的表面424相同的侧上。人工晶状体408上的表面422用于维持边缘412和切口400之间匹配的整体性。在图6和7中所示的可选视图中可见边缘412作为表面422的突出部分。示出了镜片410的光轴411。该示图中,触片416位于视线上。
图9是图8的透镜结构的侧视图,但是旋转90度以示出显示表面426在两个方向上不弯曲(即,成形为圆柱形透镜)。光学器件410的该圆柱形或环面光学系统提供了对患者的散光的圆柱形矫正。该示图中,触片416定位垂直于视线。
图10示出了类似于图6的实例的非对称的可选实施例,不同之处在于切口400包括形成为从别的圆形切口400延伸的槽的配准特征428。配准特征428用于提供将匹配配准特征(即,突出部分)定位在人工晶状体410上的装置。图11中示出包括光学器件410的IOL408的互补配准特征428。仅出于示意性目的,示出配准特征428的形状为半圆形。作为选择,用于边缘412和切口400的诸如图15中所示的水珠形不太可能包含锋利的边缘,因而不太可能无意地延伸撕囊术。许多相似的互补形状是可能的,并且落入本发明的范围中。图1中所示的短脉冲激光系统的优点在于,其可以经由等离子体介导消融处理而提供不太可能延伸的光滑切口400。
图11中,配准特征430趋于与切口400的配准特征428匹配。这用于正确地定位光学器件410,并且维持其旋转整体性。在此,边缘412和表面414还提供了用于确保机械稳定性和关于患者眼睛68的晶状体囊402的正确定向的特征。与图6相似的对非对称长轴404和418的描述,配准特征430可以设置在任意旋转方向,以适于各个处方。如前述,触片416可以在任意方向上部署。
图12示出了一旦经由切口400将人工晶状体408安装在晶状体囊402中、其中接合了匹配特征边缘412的人工晶状体408的正确直接布置,与图7中所示相似。
图13示出了类似于图6和10的可选实施例,增加了配准切口432(由系统2产生的治疗光束的配准图案形成),其与撕囊术切口400分离并且不同。如前所述,配准切口432用于提供在人工晶状体408上定位匹配配准特征的装置。
图14示出了类似于图11的可选实施例,具有位于配准切口432中的支柱434,以及远离人工晶状体408上的光学器件410的顶部支撑物436。支柱434和支撑物436示为远离触片416之间的法线倾斜,但是并非必须如此。许多相似的互补结构是可能的,并且落入本发明的范围中。
IOL408还可以借助于环形凸缘与撕囊术切口匹配。可以使得撕囊术切口400的形状定向IOL408,以实现圆柱形矫正,如图15中示意性所示。图15的非对称切口400类似于图5、10和13中所示,其中其趋于与人工晶状体408上的凸缘而不是边缘412和表面414相匹配。
图16示出了利用凸缘438与切口400匹配的人工晶状体408。如图所示,人工晶状体408包括光学器件410和凸缘438。该凸缘438可以是圆周形的,如图所示,但不是必须如此。其可以简单地位于光学器件410的顶部并且用于将人工晶状体408匹配和保持在晶状体囊402中的相同目的。凸缘438包含凹槽440,以将晶状体囊402安置在切口400中。旋转非对称凹槽440用于将人工晶状体408精确地定位和维持在切口400中,处于用于个人散光处方的正确旋转方向。使用光学器件410实现该光学矫正。作为选择地,当凸缘438位于人工晶状体408的顶部时,可以在凸缘438和光学器件410之间(而不是在凸缘438中,如图所示)创建凹槽440。可以在“bag-in-the-lens”手术中使用这种人工晶状体408。
图17和18示出了如图16所示的相同结构,但是从不同的观察角度以更好地示出凹槽440。可以使得凹槽440连续地接合切口400,如图所示,或者通过提供切割进入凸缘438的槽口而不连续地接合。这种槽口可以用于更容易地开始使凸缘438经由接口400与晶状体囊402接合。作为选择,可以形成凸缘438以使得其边缘和凹槽440之间的深度沿着其外周改变。这样,可以使用浅深度的区域作为起始点,用于更容易地使人工晶状体408经由切口400与晶状体囊402接合。
图19示出了类似于图16的可选实施例,但是其中可以使得光学器件410在凸缘438中旋转。为了对准光学器件410的旋转,在凸缘438上显示成角度对准的标记444,并且在光学器件410上显示互补的对准标记446。这样,可以以标准方式制造人工晶状体408和光学器件410,并且可以相对于其周围凸缘438来旋转光学器件410,以提供散光矫正以适应个人的处方。以22.5°的间隔示出对准标记444,但是也可以是其它方式。可以将对准标记444和446蚀刻在其主元件的材料中,或者作为选择地印刷在其上。
图20示出了类似于图14和19所示的一个其他可选实施例,其中使得光学器件410在环448中旋转。在该所示的实例中,支柱434和支撑物436与光学器件410集成,并且包含对准标记444。如前所述,环448包含触片416和表面414,但是现在还具有对准标记444。光学器件410的支撑物436上的对准标记446有助于散光矫正光学器件410的旋转方向。这样,经由切口400将人工晶状体408最终定向在患者的眼睛的晶状体囊402中,所述切口可以形成在任意方向上。许多这种类似的互补结构是可能的,并且落入本发明的范围中。
应当理解,本发明不局限于上述和本文中所示的实施例,而是包括落入附属权利要求书的范围中的任何和所有改变。例如,本文中本发明的参考文献并不意于限制任何权利要求书的范围或权利要求项的范围,但是作为代替地,仅参考一个或多个权利要求所覆盖的一个或多个特征。图1、3和4中所示的扫描仪50下游的所有光学元件形成光学元件的传送系统,用于将光束6、114和202传送至靶组织。可以想到,根据系统的所期望特征,在传送系统中可以省略一些或甚至大部分所示的光学元件,这仍然可靠地向靶组织传送已扫描的光束。突出配准特征可以替换为凹口(即,槽口),并且反之亦然。
Claims (17)
1.一种用于在患者的眼睛中创建切口的设备,包括:
a.用于产生激光束的源;
b.扫描仪,被配置为将所述激光束的焦点引导至患者的眼睛的晶状体囊的各个部位;
c.控制器,可操作地耦合到所述扫描仪,所述控制器被配置为操作所述扫描仪以:
1)利用所述激光束创建撕囊术切口;以及
2)利用所述激光束创建配准特征,所述配准特征被配置为使人工晶状体在患者的眼睛的晶状体囊中定向;以及
d.具有一个或多个光学元件的传送系统,被配置为将所述激光束传送至患者的眼睛的晶状体囊。
2.根据权利要求1所述的设备,其中所述撕囊术切口是连续的。
3.根据权利要求1所述的设备,其中所述撕囊术切口是局部的。
4.根据权利要求3所述的设备,其中所述撕囊术切口是穿孔的。
5.根据权利要求1所述的设备,其中所述配准特征是所述撕囊术切口的形状,且所述形状是非旋转对称的。
6.根据权利要求5所述的设备,其中所述形状为椭圆形。
7.根据权利要求5所述的设备,其中所述形状为具有形成于其中的非对称特征的圆形。
8.根据权利要求7所述的设备,其中所述非对称特征为凹槽。
9.根据权利要求1所述的设备,其中所述配准特征是与所述撕囊术切口相分离的切口。
10.一种用于在患者的眼睛中创建切口的设备,包括:
a.用于产生激光束的源;
b.扫描仪,被配置为将所述激光束的焦点引导至患者的眼睛的晶状体囊的各个部位;
c.控制器,可操作地耦合到所述扫描仪,所述控制器被配置为操作所述扫描仪以利用所述激光束创建封闭的切口,所述封闭的切口包括所述激光束创建的配准特征,所述配准特征被配置为使人工晶状体在患者的眼睛的晶状体囊中定向;以及
d.具有一个或多个光学元件的传送系统,被配置为将所述激光束传送至患者的眼睛的晶状体囊。
11.根据权利要求10所述的设备,其中所述封闭的切口是连续的。
12.根据权利要求10所述的设备,其中所述封闭的切口是局部的。
13.根据权利要求12所述的设备,其中所述封闭的切口是穿孔的。
14.根据权利要求10所述的设备,其中所述配准特征是所述封闭的切口的形状,且所述形状是非旋转对称的。
15.根据权利要求14所述的设备,其中所述形状为椭圆形。
16.根据权利要求14所述的设备,其中所述形状为具有形成于其中的非对称特征的圆形。
17.根据权利要求16所述的设备,其中所述非对称特征为凹槽。
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