Rejuvenable lenticule incision with rejuvenable options using a femtosecond laser eye system

Abstract

A corneal microlentisection removal procedure provides convenient retreatment options in the event of treatment interruption. The procedure is executed by an ophthalmic laser system according to a programmed treatment plan that defines an incision, an optional annular incision, a basal microlentisection with an optical zone, and a flat topbed incision. If interruption occurs during the incision, the treatment plan is realigned with the partially formed incision and continues, or realigned with a new incision placed at a different angular location. If interruption occurs during the annular incision, the treatment plan is modified to define a larger annular incision concentric with the partially formed annular incision. If interruption occurs during the basal or top incision, the depth of the partially formed basal or top incision is measured, and the treatment plan is modified to create a deeper basal incision or a shallower top incision, respectively.

Description

[0001] Cross-references to related applications

[0002] This application claims the benefit of U.S. Provisional Patent Application No. 63 / 085985, filed September 30, 2020, pursuant to 35 U.S.SC §119(e), the entire contents of which are incorporated herein by reference. Technical Field

[0003] The present invention relates generally to laser-assisted ophthalmic procedures, and more specifically to systems and methods for corneal lenticule removal procedures with re-treatable corneal lenticule incisions. Background Technology

[0004] Vision impairments, such as myopia, hyperopia, and astigmatism, can be corrected using eyeglasses or contact lenses. Alternatively, the cornea of ​​the eye can be surgically reshaped to provide the desired optical correction. Eye surgery has become very common; some patients consider it an optional procedure to avoid using contact lenses or eyeglasses to correct refractive problems, while others undergo it to correct adverse conditions such as cataracts. Furthermore, with the recent development of laser technology, laser surgery is gradually becoming the preferred technique in ophthalmological procedures.

[0005] Different laser eye surgery systems use different types of laser beams for various procedures and indications. These include, for example, ultraviolet lasers, infrared lasers, and near-infrared ultrashort pulse lasers. Ultrashort pulse lasers emit radiation with pulse durations ranging from as short as 10 femtoseconds to as long as 3 nanoseconds and wavelengths between 300 nm and 3000 nm.

[0006] Previous surgical methods for reshaping the cornea include laser-assisted in situ keratomileusis (LASIK), refractive keratomileusis (PRK), and corneal microlens removal.

[0007] In the LASIK procedure, an ultrashort pulse laser is used to cut a corneal flap, exposing the corneal stroma for photoablation with an ultraviolet beam from an excimer laser. The photoablation of the corneal stroma reshapes the cornea and corrects refractive conditions such as myopia, hyperopia, and astigmatism. In the PRK procedure, which does not create a flap, the epithelium is first removed, followed by the removal of some stromal material using an excimer laser. The epithelium will grow back within a few days after the procedure.

[0008] In corneal lenticule removal procedures, instead of using an excimer laser to ablate corneal tissue after creating a corneal flap, the technique involves tissue resection through two intersecting femtosecond laser incisions to form a lenticule for removal. The removal of the lenticule alters the shape and power of the cornea to correct vision. Lens removal can be performed with or without a corneal flap. Using a flapless procedure, a refractive lenticule is created within an intact portion of the anterior cornea and removed through a small incision.

[0009] In a standard corneal microlens removal procedure, the microlens incision process comprises three parts in the following order: First, forming a bottom microlens incision, which includes a bottom optical zone and a bottom transition zone; second, forming a top microlens incision, which includes a top optical zone and a top transition zone; and third, forming an inlet cut. The top and bottom optical zones are located at the center of their respective microlens incisions and have surface shapes determined by the power correction achieved through the microlens removal procedure. The top and bottom transition zones are located outside their respective optical zones and have shapes not determined by the power correction to be achieved but influenced by other considerations, such as the mechanical properties of the formed microlens that affect ease of removal. The bottom and top microlens surfaces typically have the same diameter (e.g., 6mm-8mm). The top and bottom incisions intersect each other (and extend beyond the intersecting line) to isolate the microlens volume. The inlet cut is formed near the periphery of the microlens to provide an entry port for removing the microlens from the cornea.

[0010] During the lenticule extraction procedure, treatment interruptions may occasionally occur due to various system and procedural malfunctions, such as aspiration in the patient interface device (the device that mechanically couples the patient's eye to the ophthalmic laser system). Such interruptions prevent the completion of full lenticule formation and may force the surgeon to switch to a PRK or LASIK procedure as a retreatment option. Because PRK and LASIK involve different laser systems (excimer laser vs. femtosecond laser) than lenticule extraction, this retreatment option is inconvenient for the patient. Summary of the Invention

[0011] Therefore, the present invention relates to a method and related apparatus for forming corneal microlenses, which substantially avoids one or more problems caused by the limitations and disadvantages of related technologies.

[0012] One object of the present invention is to provide a re-treatment corneal microlens formation process and to provide a re-treatment option that can be performed using the same femtosecond laser system.

[0013] Additional features and advantages of the invention will be set forth in the description which follows, and will be apparent in part from that description, or may be learned by practice of the invention. The objects and other advantages of the invention will be realized and obtained by means of the structures particularly pointed out in the written description, its claims, and the accompanying drawings.

[0014] To achieve the above objectives, the present invention provides a method for forming a corneal microlens in the cornea of ​​a patient's eye, implemented in an ophthalmic laser system, comprising: (a) generating a laser beam; (b) scanning a laser beam focal spot in the cornea by executing a treatment plan, the treatment plan including defining a bottom portion of a basal microlens incision and a top portion of a superior bed incision, wherein the basal microlens incision includes an optical region having a shape determined by a defined optical power of the microlens, the superior bed incision having a flat shape, and the superior bed incision being located above the basal microlens incision and having a diameter smaller than that of the basal microlens incision; (c) responding to... (d) In response to an interruption during the execution of the bottom portion of the treatment plan after the bottom microlens incision has been partially formed, the treatment plan is modified to define a new bottom microlens incision located below the partially formed bottom microlens incision, and the laser beam focal spot is scanned to form the new bottom microlens incision by executing the modified treatment plan; and (d) In response to an interruption during the execution of the top portion of the treatment plan after the top bed incision has been partially formed, the treatment plan is modified to define a new top bed incision located above the partially formed top bed incision, and the laser beam focal spot is scanned to form the new top bed incision by executing the modified treatment plan.

[0015] On the other hand, the present invention provides a method for forming a corneal microlens in the cornea of ​​a patient's eye, implemented in an ophthalmic laser system, comprising: (a) generating a laser beam; (b) scanning a laser beam focal spot in the cornea by executing a treatment plan, the treatment plan sequentially including an entrance portion defining an entrance cut, a bottom portion defining a bottom microlens incision, and a top portion defining a top bed incision, wherein the bottom microlens incision includes an optical region having a shape determined by a defined optical power of the microlens, the top bed incision has a flat shape, the top bed incision is located above the bottom microlens incision and has a diameter smaller than the diameter of the bottom microlens incision, the top bed incision and the bottom microlens incision intersect each other near their respective peripheries to define isolated microlens volumes, and the entrance cut has a strip shape and extends upward from the outer edge of the bottom microlens incision; (c) modifying the treatment plan to define alignment with the partially formed entrance cut in response to an interruption in executing the entrance portion of the treatment plan after the entrance cut has been partially formed. (d) In response to an interruption in the execution of the bottom portion of the treatment plan after the inlet cut has been formed and the bottom microlens incision has been partially formed, the treatment plan is modified to define a new bottom microlens incision below the partially formed bottom microlens incision and a new top bed incision above the partially formed bottom microlens incision, and the laser beam focal spot is scanned in the execution of the modified treatment plan to form the new bottom microlens incision and the new top bed incision; and (e) In response to an interruption in the execution of the top portion of the treatment plan after the inlet cut has been formed and the bottom microlens incision has been partially formed, the treatment plan is modified to define a new top bed incision above the partially formed top bed incision, and the laser beam focal spot is scanned in the execution of the modified treatment plan to form the new top bed incision.

[0016] On the other hand, the present invention provides a method for forming a corneal microlens in the cornea of ​​a patient's eye, implemented in an ophthalmic laser system, comprising: (a) generating a laser beam; and (b) scanning a laser beam focal spot in the cornea by executing a treatment plan, the treatment plan sequentially including an inlet portion defining an inlet cut, an annular portion defining an annular cut, a bottom portion defining a bottom microlens incision, and a top portion defining a top bed incision, wherein the bottom microlens incision includes an optical region having a shape determined by a defined optical power of the microlens, and the top bed incision has a flat shape and is located at the bottom of the cornea. Above the microlens incision and having a diameter smaller than that of the bottom microlens incision, the annular cut has an annular shape and extends between the top bed incision and the bottom microlens incision, both of which intersect the annular cut near their respective peripheries to define isolated microlens volumes, and the inlet cut has a strip shape and extends upward from the outer edge of the bottom microlens incision; (c) in response to an interruption when the inlet portion of the treatment plan is performed after the inlet cut has been partially formed, the treatment plan is modified to define a new inlet aligned with the partially formed inlet cut. The treatment involves: (a) an incision, a new annular incision, a new bottom microlens incision, and a new top bed incision; and (b) scanning a laser beam to complete the incision and form the new annular incision, the new bottom microlens incision, and the new top bed incision by executing a modified treatment plan; (c) in response to an interruption during the execution of the annular portion of the treatment plan after the incision has been formed and the annular incision has been partially formed, modifying the treatment plan to define a new annular incision, a new bottom microlens incision, and a new top bed incision having radii larger than the partially formed annular incision and concentrically aligned with the partially formed annular incision. (e) Scanning the laser beam to form the new ring, the new bottom microlens incision, and the new top bed incision by executing a modified treatment plan; (e) In response to an interruption during the execution of the bottom portion of the treatment plan after the inlet cut and ring cut have been formed and the bottom microlens incision has been partially formed, modifying the treatment plan to define a new bottom microlens incision below the partially formed bottom microlens incision and a new top bed incision above the new bottom microlens incision, and scanning the laser beam focal spot to form the new bottom microlens incision and the new top bed incision by executing a modified treatment plan;And (f) in response to an interruption during the execution of the top portion of the treatment plan after the inlet incision, circumferential incision, and bottom microlens incision have been formed and the top bed incision has been partially formed, modifying the treatment plan to define a new top bed incision located above the partially formed top bed incision, and scanning the laser beam focal spot to form the new top bed incision by executing the modified treatment plan.

[0017] In some implementations, the radius of the new annular cut is 20-100 micrometers larger than the radius of the partially formed annular cut, the apex of the new bottom microlens cut is located 5-20 micrometers below the apex of the partially formed bottom microlens cut, and the new top bed cut is located 5-10 micrometers above the partially formed top bed cut.

[0018] It should be understood that the foregoing general description and the following detailed description are merely exemplary and illustrative, and are intended to provide further explanation of the claimed invention. Attached Figure Description

[0019] Figure 1 A corneal microlens formed according to a first embodiment of the present invention is illustrated schematically.

[0020] Figure 1A and Figure 1B A corneal microlens formed by a re-treatment step according to the first embodiment is illustrated schematically.

[0021] Figure 2 The process of forming a corneal microlens with retreatment options according to the first embodiment is illustrated schematically.

[0022] Figure 3 A corneal microlens formed according to a second embodiment of the present invention is illustrated schematically.

[0023] Figure 3A A corneal microlens formed by a re-treatment step according to the second embodiment is illustrated schematically.

[0024] Figure 4 The process of forming a corneal microlens with retreatment options according to the second embodiment is illustrated schematically.

[0025] Figure 5A and Figure 5B Two exemplary ophthalmic laser systems are schematically illustrated and can be used to implement embodiments of the present invention.

[0026] Figure 6 It shows Figure 5A and Figure 5B An exemplary fast scanning low-speed sweep scheme in an ophthalmic laser system.

[0027] Figure 7 and Figure 8 It shows the use of Figure 5A and Figure 5B An exemplary microlens surface notching method for a fast scanning low-speed sweeping scheme in an ophthalmic laser system. Detailed Implementation

[0028] Embodiments of the present invention provide an improved method for corneal microlentiform incision formation implemented in a femtosecond ophthalmic laser system, which provides a retreatment option after interruption during the procedure. The retreatment option is performed using the same femtosecond laser system without requiring a change to a PRK or LASIK procedure.

[0029] In the corneal microlens removal procedure according to the first embodiment of the present invention, the microlens cutting process includes the following three parts in the order in which they are performed (see...). Figure 1 (Side view): Inlet cut 101, bottom microlens incision 102, and flat top bed incision 103. Note that "incision" and "cut" are used interchangeably in this disclosure. The bottom microlens incision preferably has a larger diameter (e.g., 8 mm) than the top bed incision (e.g., 6 mm), and the top and bottom incisions intersect each other near their peripheries to form the isolation microlens volume 100 to be removed. The inlet cut is a strip-shaped incision positioned along the outer edge of the bottom microlens incision, extending upward and optionally outward to reach the anterior corneal surface, thereby providing an inlet port for removing the microlens from the cornea.

[0030] The bottom microlens cutout 102 includes a bottom optical region 102A located in the central region, and a bottom transition region 102B optionally surrounding the bottom optical region. The shape of the bottom optical region 102A is determined by the power correction to be achieved by the microlens removal procedure. Since the top bed cutout is flat, the optical region of the bottom cutout provides all the power of the microlens. The shape of the transition region 102B is not determined by the power correction to be achieved, but is influenced by other considerations, such as the mechanical properties of the formed microlens, which affect the ease of removal.

[0031] If treatment is interrupted during the microlenticule incision procedure, for example due to aspiration loss in the patient interface device, different sets of retreatment steps are performed depending on the stage of the treatment interruption. (See reference...) Figure 2 A corneal microlens removal procedure with a re-treatment option is described according to a first embodiment of the present invention.

[0032] After the patient's eye is coupled to the laser system via a patient interface device (commonly referred to as docking) (step S201), the planned microlentidenectomy procedure begins (step S202). As previously described, the planned microlentidenectomy procedure includes forming an inlet incision, then forming a bottom microlentidenectomy, and then forming a flat top bed incision. Parameters of the incisions are used to program the treatment plan, which includes defining the various portions of each incision. The microlentidenectomy procedure is executed by the ophthalmic laser system under the control of a system controller (e.g., a computer) that executes the treatment plan. If a malfunction occurs, the computer automatically interrupts the execution of the treatment plan. The surgeon then takes the necessary actions and instructs the computer to perform the retreatment steps as described below.

[0033] If the process is interrupted during the formation of the incision (i.e., interruption occurs during the execution of the incision portion of the treatment plan) ("Yes" in step S203), the surgeon re-aligns the eye with the laser system via the patient interface if necessary (step S204). The original treatment plan is then modified by aligning the incision of the original treatment plan with the partially formed incision (step S205), and the planned microlenticule incision procedure is continued with the modified (aligned) treatment plan to form the incomplete portion of the incision (i.e., skipping the formed portion of the incision), the top bed incision, and the bottom microlenticule incision (step S206). After successful retreatment, the microlentus is removed from the cornea (step S207).

[0034] The alignment step (step S205) can be performed by the surgeon with the assistance of a user interface display of the ophthalmic laser system. The user interface display shows an image of the patient's eye, in which the partially formed incision is visible, and overlaid a representation of the incision (at least the incision) drawn according to the treatment plan. Using the user interface display, the surgeon can move the representation of the incision to align with the partially formed incision in the eye image, and the computer modifies the treatment plan accordingly. The alignment step is necessary because it re-aligns the potential displacement and rotation of the eye relative to its position before interruption. Except for any displacement and rotation, the modified treatment plan is otherwise identical to the original treatment plan. Step S206 is performed in response to the surgeon's instructions.

[0035] Because the entry cut is only used by the microlens removal tool to approach and remove the microlens, the shape of the entry cut does not affect the optical power of the microlens. Therefore, the alignment accuracy requirements for partially formed entry cuts and continuous entry cuts are relatively low.

[0036] In an alternative implementation, in step S205, the partially formed inlet cut is ignored, and the original treatment plan is modified by moving the inlet cut position to a new angular position that avoids the partially formed inlet cut, and the modified treatment plan is executed to form a new inlet cut, a bottom microlens incision, and a top bed incision.

[0037] If the procedure is interrupted during the formation of the lenticule incision ("Yes" in step S208), then, if necessary, the surgeon reconnects the eye to the laser system via the patient interface (step S209) and uses the depth measurement subsystem of the ophthalmic laser system to measure the depth of the apex (lowest point) of the partially formed lenticule incision (step S210). The treatment plan is then modified by shifting the bottom and top incisions downwards so that the apex of the new lenticule incision is located at a predetermined distance below the apex of the partially formed lenticule incision, as measured in step S210 (step S211). The predetermined distance can be, for example, 5 micrometers to 20 micrometers, or more preferably about 10 micrometers. The new lenticule incision and the top bed incision also have the same parameters as in the original treatment plan, including the distance between the bottom and top incisions. The new lenticule incision does not need to be precisely vertically aligned with the partially formed lenticule incision. The modified treatment plan may also include extending the existing incision downwards to reach the now deeper basal lenticule incision (this would require aligning the modified treatment plan with the existing incision using the techniques described earlier), or alternatively include new incisions at different angular locations. The modified treatment plan is executed to form a new basal lenticule incision and a top bed incision (step S212). After successful retreatment, the lenticule is removed from the cornea (step S207). Steps S210-S212 are performed in response to the surgeon's instructions.

[0038] Figure 1A The partially formed bottom microlens incision 102', the new bottom microlens incision 102, the top bed incision 103, and the inlet cut 101 (new or extended) are schematically shown. The microlens volume 100 is isolated by the new bottom microlens incision 102 and the top bed incision 103. Because the original bottom microlens incision 102' is incomplete, for example, it does not extend the entire 360-degree angular range in the top view, it will not form an isolated volume with the top bed incision 103 or the new bottom microlens incision 102. Therefore, the microlens volume can be removed with minimal complications.

[0039] In a preferred embodiment, the bottom microlens notch is formed by placing short laser scan lines in a direction tangent to a line parallel to the latitude of the bottom microlens notch and scanning these short laser scan lines along the meridian of the longitude of the bottom microlens surface to form multiple sweeps (described in more detail later). Since each sweep passes through the apex of the microlens, the apex is formed after the first scan. Therefore, in most cases, the apex is at least partially formed when an interruption occurs during the formation of the bottom surface, and its depth can be measured in step S210.

[0040] The depth of a vertex can be measured using a non-confocal detector of an ophthalmic laser system that detects the reflected laser beam, which is reflected by a partially formed bottom notch and collected by the objective lens of the laser system. Details of such a depth measurement subsystem are described in co-owned U.S. Patent Application Publication 2020 / 0064622, entitled “Detection of Optical Surface of Patient Interface for Ophthalmic Laser Applications Using a Non-Cofocal Configuration,” the disclosure of which is incorporated herein by reference. The depth of a vertex can also be measured using an optical coherence tomography (OCT) subsystem of an ophthalmic laser system.

[0041] In this retreatment option, care should be taken to avoid the adverse effects of air bubbles when creating a new lenticule incision at a deeper depth. Air bubbles typically form at the incision site when using a femtosecond pulsed laser to cut corneal tissue. These air bubbles can interfere with the formation of subsequent incisions at deeper depths. Therefore, if air bubbles generated during the initial planned lenticule incision 102' remain, they can be eliminated through an incision cut, or a new lenticule incision can be formed after sufficient time has been allowed for the air bubbles to dissipate.

[0042] If the procedure is interrupted during the formation of the apical incision ("Yes" in step S213), the surgeon re-connects the eye to the laser system via the patient interface if necessary (step S214) and measures the depth of the partially formed apical incision using the depth measurement subsystem of the ophthalmic laser system (step S215). A modified treatment plan is then generated and executed to form a new apical incision at a predetermined depth shallower than the partially formed apical incision (step S216). This predetermined distance can be, for example, 5-10 micrometers. Because the basal lenticule incision is sufficiently larger than the originally planned apical incision, the new, shallower apical incision will still intersect the basal lenticule incision around the entire periphery to form an isolated lenticule volume. After successful retreatment, the lenticule is removed from the cornea (step S207). Steps S215-S216 are performed in response to the surgeon's instructions.

[0043] Figure 1B The inlet cut 101, the bottom microlens incision 102, the partially formed top bed incision 103', and the new top bed incision 103 are schematically shown. The new top bed incision 103 and the bottom microlens incision 102 form an isolated microlens volume 100. Because the initial top bed incision 103' is incomplete, it will not form an isolated volume with either the top bed incision 103 or the bottom microlens incision 102. Therefore, the microlens volume can be removed with minimal complications.

[0044] Because the top bed cut is flat, it is not necessary to vertically align the top bed cut with the already formed bottom microlens cut. If the top cut were microlens-shaped, the apex of the top microlens would have to be precisely aligned with the apex of the bottom microlens cut.

[0045] In an alternative implementation, the inlet incision is formed after the bottom microlental incision and the top bed incision in the initial treatment plan. If the procedure is interrupted during the formation of the inlet incision, similar to step S205, the modified plan for the inlet incision is aligned with the partially formed inlet incision, and the inlet incision continues using the modified plan. The retreatment steps for the interrupted bottom and top incisions remain the same as described above.

[0046] In another alternative implementation, in the initial treatment plan, a top bed incision is formed prior to the bottom microlenticular incision. If the procedure is interrupted while the top bed incision is being formed, the depth of the partially formed top bed incision is measured, and a new top bed incision and bottom microlenticular incision are formed by executing a modified treatment plan, wherein the top and bottom incisions are shifted upwards such that the new top bed incision is located at a predetermined distance above the partially formed top bed microlenticular incision. The result is similar to... Figure 1BThe results are shown. In this alternative embodiment, if the procedure is interrupted while the bottom microlenticular incision is being formed, the depth of the apex of the partially formed bottom microlenticular incision is measured, and a new bottom microlenticular incision is formed by executing a modified treatment plan, wherein the new bottom microlenticular incision is located at a predetermined distance deeper than the partially formed bottom microlenticular incision. The results are similar to... Figure 1A The results are shown below.

[0047] In another alternative embodiment, the inlet incision and the basal incision are combined into one part; that is, when the basal incision is formed, some scans of the laser scanning line extend upward to reach the anterior corneal surface to form the inlet incision. In this embodiment, if the procedure is interrupted while the basal lenticule incision is being formed, the treatment plan is modified to place the basal lenticule incision below the partially formed basal lenticule incision as described above, and the position of the inlet port is further rotated to form a new basal lenticule incision with the inlet incision.

[0048] Figure 3 , Figure 3A and Figure 4 The corneal microlenticule removal procedure according to a second embodiment of the present invention is illustrated schematically. The corneal microlenticule incision in this embodiment comprises the following four parts in sequence of execution (see...). Figure 3 (Side view): Inlet cut 301, annular cut 302, bottom microlens cut 303, and flat top bed cut 304. The annular cut has an annular shape and extends in a substantially vertical direction between the top and bottom cuts, with or without an inclination angle. The top and bottom cuts do not intersect each other, but both intersect the annular cut near their peripheries to form the isolated microlens volume 300 to be removed. The inlet cut is a strip-shaped cut positioned along the outer edge of the bottom microlens cut, the outer edge of the top bed cut, or the annular cut. The microlens formed by the annular cut has a greater... Figure 1 The thicker edge of the microlens in the first embodiment makes it easier to remove. Other aspects of the corneal microlens incision are similar. Figure 1 Those aspects of the first implementation plan.

[0049] In the second implementation scheme, such as Figure 4 As shown, after the patient's eye is connected to the laser system via the patient interface device (step S401), the planned microlens incision procedure begins (step S402).

[0050] If the procedure is interrupted during the formation of the incision ("Yes" in step S403), a retreatment procedure similar to those steps in the first embodiment (steps S204 to S206) is performed (step S404). After successful retreatment, the microlens is removed from the cornea (step S405).

[0051] If the procedure is interrupted during the formation of the annular incision ("Yes" in step S406), the surgeon re-aligns the eye with the laser system via the patient interface if necessary (step S407) and modifies the initial treatment plan to define an annular incision with a slightly larger radius (e.g., 20-100 micrometers) than the initial annular incision (step S408). The modified treatment plan may also include a new incision, but the parameters of the basal lenticule incision and the superior bed incision preferably remain unchanged. The modified treatment plan is aligned with the partially formed annular incision so that the new annular incision is concentric with the partially formed annular incision (step S409). Similar to step S205, alignment can be performed with the assistance of the ophthalmic laser system's user interface display. The modified treatment plan is executed to form a new annular incision, a basal lenticule incision, and a superior bed incision (step S410). After successful retreatment, the lenticule is removed from the cornea (step S405). Steps S408-S410 are performed in response to the surgeon's instructions.

[0052] Figure 3A The partially formed annular cut 302', the new (wider) annular cut 302, the bottom microlens incision 303, the top bed incision 304, and the inlet cut 301 are schematically shown. Because the initial annular cut 302' is incomplete, it will not form an isolated volume with the top and bottom incisions 303 and 304 or with the new annular cut 302. Therefore, the microlens volume can be removed with minimal complications.

[0053] If the procedure is interrupted while the bottom lenticule incision is being formed ("Yes" in step S411), a retreatment step similar to those steps in the first embodiment (steps S209 to S212) is performed (step S412). In other words, the bottom and top incisions are displaced downward relative to the partially formed bottom lenticule incision. If the procedure is interrupted while the top bed incision is being formed ("Yes" in step S413), a retreatment step similar to those steps in the first embodiment (steps S214 to S216) is performed (step S414). In other words, the top bed incision is displaced upward relative to the partially formed top bed incision. After successful retreatment, the lenticule is removed from the cornea (step S405).

[0054] In all the above embodiments, the new incisions (circumferential incision, bottom microlenticule incision, top bed incision) of the modified treatment plan are located outside the corresponding partially formed incisions. More specifically, the new bottom microlenticule incision is located below the partially formed bottom microlenticule incision, the new top bed incision is located below the partially formed top bed incision, and the new circumferential incision is located outside the partially formed circumferential incision.

[0055] Now for reference Figure 5A and Figure 5B A more detailed description of the ophthalmic laser system that can be used to perform the above-described microlens removal procedure is provided.

[0056] Figure 5A An ophthalmic surgical laser system 1 suitable for making incisions in target materials, such as the cornea of ​​the eye, is shown. A laser 2 (such as a femtosecond laser) provides a pulsed laser beam 2A, which can be used for optical procedures to treat the eye. System 1 also includes, but is not limited to: a high-frequency scanner (such as a resonant scanner) 3 for scanning the pulsed laser beam to generate a scan line 12, a scan line rotator 4 for rotating the scan line 12, a beam expander 5, an objective lens 6 for focusing the laser beam, an XY scanning device 7 for deflecting or guiding the laser beam onto or within a target, a rapid Z scanning device 8, a patient interface 9, an automated Z device 10, a controller 13, and a communication module 15.

[0057] The resonant scanner 3 scans the pulsed laser beam at a high resonant frequency (e.g., several kiloHz) to produce a scan line extending in a lateral orientation (i.e., perpendicular to the laser beam propagation direction Z) and having a desired length (e.g., between 1 mm and 2 mm). The length of the scan line can be adjustable. The scan line rotator 4 can be implemented by a Dove prism, a Pechan prism, a set of mirrors, etc., mounted on a rotating stage. By rotating the scan line rotator 4 about the Z-axis, the lateral orientation of the scan line 12 is rotated, allowing the scan line to be placed at any desired orientation in the XY plane (i.e., a lateral plane perpendicular to the laser beam propagation direction Z). The XY scanning device 7 can be a movable XY scanning stage on which a focusing objective lens 6 is mounted; the XY scanning device 7 carries the objective lens 6 and moves it relative to the patient interface device 9 so that the center of the scan line 12 moves relative to the patient's eye in the XY direction. The rapid Z-scanning device 8 changes the depth of the laser focal spot position in the eye (i.e., along the Z direction). Therefore, when the movable XY scanning stage 7 and the fast Z scanning device 8 move the center of the scan line in the X, Y, and Z directions, the scan line rotator 4 modifies the lateral orientation of the scan line 12. Because the scanning speed of the resonant scanner is generally much faster than that of the XY scanning stage and the fast Z scanning device, the scan line 12 can be referred to as a fast scan line, and the movement of the fast scan line in the X, Y, and Z directions can be referred to as a slow sweep.

[0058] The XY scanning stage 7 can be a motorized stage with two motors that drive its movement in the X and Y directions. Preferably, the XY scanning stage is a recoil-free stage configured to reduce or eliminate mechanical vibration. The fast Z-scan device 8 may include a voice coil actuator that drives a lens in the Z direction. The movement of the lens causes a change in the depth of focus. The fast Z-scan frequency can be between 50 Hz and 15,000 Hz.

[0059] The patient interface device 9 couples the patient's eye to the ophthalmic surgical laser system 1. The patient interface 9 may include a visualization beamsplitter to reflect light from the eye along optical path 11 toward a video microscope or ophthalmic microscope 14, allowing the eye to be imaged by the microscope's image detector. The visualization beamsplitter, optical path 11, and microscope 14 are optional.

[0060] The automatic Z module 10 may include a confocal detector or a non-confocal detector and may be used to measure the depth of a target surface, as described in more detail in the aforementioned U.S. Patent Application Publication 2020 / 0064622.

[0061] Controller 13 (which may be implemented by a processor executing suitable machine-readable program code and data stored in non-volatile memory) is operatively coupled to various components of system 1, including laser 2, fast Z-scan device 8, resonant scanner 3, scan line rotator 4, XY stage 7, detector 14, and communication module 15. Controller 13 is configured to guide these components of the system to output a focal spot of a pulsed laser beam in the eye in a desired pattern for eye modification. Communication module 15 provides information at the system and / or remotely to the operator of laser system 1 via a wired or wireless data connection, and may include a display, user input devices such as a keyboard, mouse, joystick, etc. The ophthalmic surgical laser system may additionally include an OCT (Optical Coherence Tomography) device (…). Figure 5A (Not shown in the image), which can be used to measure the structure of a target (e.g., eye tissue).

[0062] Figure 5BAn ophthalmic surgical laser system 20 suitable for making incisions in target materials, such as the cornea of ​​the eye, is shown. System 20 includes, but is not limited to: a laser source (not shown) for generating an input pulsed laser beam 21; a fast Z-scanning device 22; a resonant scanner 23 for generating scan lines 12B of the pulsed laser beam 21; a scan line rotator 24 for rotating the lateral orientation of the scan lines 12B; a beam expander 25; an objective lens (low-speed Z-scanner) 26 with an adjustable focusing mechanism; an XY scanning stage 27 for deflecting or guiding the pulsed laser beam 21 onto or within a target; a patient interface 28 optionally including a beam splitter; a controller 13B; an optional image detector 29 disposed on an optical path 29A defined by the beam splitter of the patient interface; and a communication module 15B. The low-speed Z-scanner 26 can be used to set the laser focal spot at a desired depth of focus, which sets the Z-baseline of the scan pattern.

[0063] Figure 5B The system and Figure 5A One difference between the systems is that, Figure 5A The XY scanning stage 7 carries both the objective lens 6 and other components, including the rapid Z-scanning device 8, the resonant scanner 3, the scan line rotator 4, and the beam expander 5. Figure 5B The XY scanning stage 27 carries the objective lens 26 but does not carry the other components mentioned above. It should be noted that... Figure 5A In the system, objective lens 6 may also be equipped with a low-speed Z scanner (also indicated by reference numeral 6 in the attached figure).

[0064] The following jointly owned U.S. patent application numbers describe having Figure 5A and Figure 5B Further details of the ophthalmic surgical laser system configured as shown are found in: 14 / 970898, filed December 16, 2015, entitled “Compact Ultra-Short Pulsed Laser Eye Surgery Workstation”; and 14 / 865396, filed September 25, 2015, entitled “Systems and Methods for Lenticular Laser Incision,” the entire contents of which are incorporated herein by reference.

[0065] In the above ophthalmic laser systems, beam scanning can be achieved using a "fast scanning low-speed sweep" scanning scheme, which is also referred to as the fast scan line scheme in this paper. Figure 6An example scan is shown, using an 8 kHz (e.g., between 7 kHz and 9 kHz) resonant scanner to produce a fast scan line 410 of approximately 1 mm (e.g., between 0.9 mm and 1.1 mm) and a scan speed of approximately 25 m / s, as well as X, Y, and Z scanning mechanisms with scan speeds (sweep speeds) less than approximately 0.1 m / s. The fast scan line 410 can be perpendicular to the beam propagation direction, i.e., it is always parallel to the XY plane. The trajectory of the low-speed sweep 420 can be any three-dimensional curve drawn by X, Y, and Z scanning devices (e.g., an XY scanner and a fast Z scanner). The advantage of the "fast scan, low-speed sweep" scanning scheme is that it uses only small field-of-view optics (e.g., a field-of-view diameter of 1.5 mm) capable of achieving high focusing quality at a relatively low cost. Larger surgical fields of view (e.g., a field-of-view diameter of 10 mm or greater) are achieved using an XY scanner, which can be unrestricted.

[0066] exist Figure 7 (Perspective) and Figure 8 In the example shown (top view), the laser system uses a "fast scan, low-speed sweep" scanning scheme to create a smooth, lenticular cut. First, in the three-dimensional microlens cutting, the fast scan line is preferably positioned tangent to a latitudinal parallel line 510 on the surface of the microlens. The latitudinal parallel line is the intersection of this surface with a plane perpendicular to the Z-axis (which is the axis parallel to the depth direction of the eye), i.e., a circle on the lens surface perpendicular to the Z-axis and having a defined distance to a vertex (the intersection of the surface and the Z-axis, also the highest or lowest point in the Z direction). This can be achieved, for example, by adjusting the scan line rotator to the corresponding orientation via software (e.g., via a controller). Second, the low-speed sweep trajectory preferably moves along a longitude meridian 520 on the surface of the microlens. The longitude meridian is the intersection of this surface with a plane passing through the Z-axis, i.e., a curve passing through a vertex and having a defined angular direction relative to the Z-axis. This can be accomplished, for example, by coordinating the XY scanner and the fast Z scanner via software (e.g., via a controller). The procedure begins with a scan line parallel to the latitude parallel and sweeps along the curvature with the largest diameter across the apex of the lens. Multiple sweeps are performed in a continuous angular direction relative to the Z-axis (e.g., by rotating the scan line rotator between consecutive sweeps) to form the entire microlens. With this preferred procedure, there are no vertical “steps” in the dissection. The deviation between the laser focus position and the desired spherical surface dissection is also minimized.

[0067] Figure 8 A top view 950 of the microlens notch 915 is shown, illustrating three exemplary sweeps (1A to 1B), (2A to 2B), and (3A to 3B), where each sweep passes through (i.e., across) the microlens notch vertex 955. The notch has a diameter 957 (D). 切割Top view 980 shows a top view of an exemplary sweep.

[0068] It should be noted that Figure 7 The example in the text is an upwardly curved microlens surface, but the same explanation applies to downwardly curved microlens surfaces, such as bottom microlens surfaces 102 and 303.

[0069] In the above embodiments, the "fast scan-low sweep" scanning scheme can also be used to form other incisions for corneal microlentiforms. To form a flat bed incision 103 or 304, the fast scan line is kept in the same XY orientation and scanned by XY and Z scanners in a raster scan mode, i.e., sweeping along parallel lines or a serpentine path. To form a ring incision 302, the fast scan line is placed tangentially to the ring and scanned in the Z direction, wherein the scan line rotates between scans. To form an inlet incision 101 or 301, the laser scan line is placed at the desired position and orientation of the inlet incision and scanned in the Z direction with or without rotation between scans.

[0070] Based on the above references Figure 2 and Figure 4 In the described corneal microlentifold incision method, controller 13 or 13B controls the laser source and scanner of the laser system to scan the focal spot of the laser beam in the eye tissue to form various incisions according to the treatment plan. Depth measurement steps (e.g., steps S210, S215) can be implemented using the automated Z-module 10. The user interface device used in steps S205 and S409 can be implemented by communication device 15 or 15B.

[0071] It will be apparent to those skilled in the art that various modifications and variations can be made to the corneal microlenticule incision method and related apparatus of the present invention without departing from the spirit or scope of the invention. Therefore, the present invention is intended to cover various modifications and variations falling within the scope of the appended claims and their equivalents.

Claims

1. An ophthalmic laser system for forming microlenses in the cornea of ​​a patient's eye, the ophthalmic laser system comprising a controller, wherein, The controller is configured to control the ophthalmic laser system: (a) Generate a laser beam; (b) Scanning a laser beam focal spot in the cornea by executing a treatment plan, the treatment plan including defining a bottom portion of a bottom microlens incision and a top portion of a top bed incision, wherein the bottom microlens incision includes an optical region having a shape defined by a defined power of the microlens, the top bed incision has a flat shape, and the top bed incision is located above the bottom microlens incision; and Alternatively: (c) In response to an interruption during the execution of the bottom portion of the treatment plan after the bottom microlens incision has been partially formed, the treatment plan is modified to define a new bottom microlens incision having the same shape as the bottom microlens incision and located below the partially formed bottom microlens incision without coinciding with or intersecting the partially formed bottom microlens incision, and the laser beam focal spot is scanned to form the new bottom microlens incision by executing the modified treatment plan; Alternatively: (d) In response to an interruption during the execution of the top portion of the treatment plan after the top bed incision has been partially formed, the treatment plan is modified to define a new top bed incision having the same shape as the top bed incision and located above the partially formed top bed incision without coinciding with or intersecting the partially formed top bed incision, and the laser beam focal spot is scanned to form the new top bed incision by executing the modified treatment plan.

2. The ophthalmic laser system according to claim 1, wherein, Step (c) also includes measuring the depth of the apex of the partially formed bottom microlens incision before modifying the treatment plan.

3. The ophthalmic laser system according to claim 2, wherein, The apex of the new bottom microlens cut is located 5-20 micrometers below the apex of the partially formed bottom microlens cut.

4. The ophthalmic laser system according to claim 1, wherein, Step (d) also includes measuring the depth of the partially formed top bed incision before modifying the treatment plan.

5. The ophthalmic laser system according to claim 4, wherein, The new topbed incision is located 5-10 micrometers above the partially formed topbed incision.

6. The ophthalmic laser system according to claim 1, wherein, In the treatment plan, the bottom section is performed before the top section.

7. The ophthalmic laser system according to claim 1, wherein, In the treatment plan, the top section is performed before the bottom section.

8. The ophthalmic laser system according to claim 1, wherein, The treatment plan also includes an inlet portion defining an inlet cut having a strip shape and extending upward from the outer edge of the bottom microlentiolar incision to reach the anterior surface of the cornea, and wherein the controller is also configured to control the ophthalmic laser system: (e) In response to an interruption during the execution of the entry portion of the treatment plan after the entry cut has been partially formed, the treatment plan is modified to define a new entry cut aligned with the partially formed entry cut, and the laser beam focal spot is scanned by executing the modified treatment plan.

9. The ophthalmic laser system according to claim 8, wherein, In the treatment plan, the inlet section is performed before the bottom section and the top section.

10. The ophthalmic laser system according to claim 1, wherein, The bottom microlens cut and the top bed cut intersect each other near their respective peripheries to define isolated microlens volumes.

11. The ophthalmic laser system according to claim 1, wherein, The treatment plan also includes a ring-shaped portion defining an annular incision having an annular shape and extending between the basal microlenticular incision and the superior bed incision, wherein both the basal microlenticular incision and the superior bed incision intersect the annular incision near their respective peripheries to define isolated microlenticular volumes, and wherein the controller is further configured to control the ophthalmic laser system. (e) In response to an interruption during the execution of the annular portion of the treatment plan after the annular cut has been partially formed, the treatment plan is modified to define a new annular cut having a radius larger than that of the partially formed annular cut, the new annular cut being concentrically aligned with the partially formed annular cut, and the laser beam focal spot is scanned by executing the modified treatment plan.

12. The ophthalmic laser system according to claim 11, wherein, The radius of the new annular cut is 20-100 micrometers larger than the radius of the partially formed annular cut.

13. The ophthalmic laser system according to claim 11, wherein, Step (b) includes: The laser beam is scanned by a resonance scanner to form a laser scan line, the scan line being a straight line of predetermined length parallel to the XY plane; and Multiple sweeps are formed by using an XY scanner and a Z scanner to collectively form the bottom microlens cutout. Forming these multiple sweeps includes, for each sweep: placing the scan line tangentially to a line parallel to the latitude of the bottom microlens cutout, and scanning the laser scan line along a meridian of longitude of the bottom microlens cutout, wherein the parallel line of latitude is a circle on the bottom microlens cutout, the circle being perpendicular to the Z-axis and having a defined distance to the vertex of the bottom microlens cutout, and the meridian of longitude is a curve passing through the vertex and having a defined angular position around the Z-axis.

14. The ophthalmic laser system according to claim 11, wherein, Step (b) includes: The laser beam is scanned by a resonance scanner to form a laser scan line, the scan line being a straight line of predetermined length parallel to the XY plane; and Multiple parallel sweeps are formed by using an XY scanner to create the scan lines, and these multiple parallel sweeps together form the top bed cut.

15. The ophthalmic laser system according to claim 1, wherein, The treatment plan also includes a defined incision portion for an incision that extends upward from the outer edge of the bottom microlentiolar incision to reach the anterior surface of the cornea, and the controller is further configured to control the ophthalmic laser system. (e) In response to an interruption during the execution of the treatment plan after the inlet cut has been partially formed, the treatment plan is modified to define a new inlet cut located at a different angular position from the partially formed inlet cut, without coinciding with or intersecting with the partially formed inlet cut, and the laser beam focal spot is scanned by executing the modified treatment plan.

16. An ophthalmic laser system for forming microlenses in the cornea of ​​a patient's eye, the ophthalmic laser system comprising a controller, wherein, The controller is configured to control the ophthalmic laser system: (a) Generate a laser beam; (b) Scanning a laser beam focal spot in the cornea by executing a treatment plan that sequentially includes an entry portion defining an inlet cut, a bottom portion defining a bottom microlens incision, and a top portion defining a top bed incision, wherein the bottom microlens incision includes an optical region having a shape determined by a defined power of the microlens, the top bed incision has a flat shape, the top bed incision is located above the bottom microlens incision, the top bed incision and the bottom microlens incision intersect each other near their respective peripheries to define isolated microlens volumes, and the inlet cut extends upward from the outer edge of the bottom microlens incision; Alternatively: (c) In response to an interruption during the execution of the entry portion of the treatment plan after the entry cut has been partially formed, the treatment plan is modified to define a new entry cut, a new bottom microlens incision, and a new top bed incision, the new entry cut being located at a different angular position from the partially formed entry cut, without coinciding with or intersecting the partially formed entry cut, and the laser beam is scanned by executing the modified treatment plan to complete the entry cut and form the new bottom microlens incision and the new top bed incision; Alternatively: (d) In response to an interruption during the execution of the bottom portion of the treatment plan after the inlet incision has been formed and the bottom microlens incision has been partially formed, the treatment plan is modified to define a new bottom microlens incision and a new top bed incision having the same shape as the bottom microlens incision and located below the partially formed bottom microlens incision without coinciding with or intersecting the partially formed bottom microlens incision, the new top bed incision being located above the new bottom microlens incision, and the laser beam focal spot is scanned by executing the modified treatment plan to form the new bottom microlens incision and the new top bed incision; Alternatively: (e) in response to an interruption during the execution of the top portion of the treatment plan after the inlet incision and the bottom microlens incision have been formed and the top bed incision has been partially formed, the treatment plan is modified to define a new top bed incision having the same shape as the top bed incision and located above the partially formed top bed incision, and the laser beam focal spot is scanned to form the new top bed incision by executing the modified treatment plan.

17. The ophthalmic laser system according to claim 16, wherein, Step (d) further includes measuring the depth of the apex of the partially formed bottom microlens incision before modifying the treatment plan, wherein the apex of the new bottom microlens incision is located 5 to 20 micrometers below the apex of the partially formed bottom microlens incision.

18. The ophthalmic laser system according to claim 16, wherein, Step (e) further includes measuring the depth of the partially formed topbed incision before modifying the treatment plan, wherein the new topbed incision is located 5 to 10 micrometers above the partially formed topbed incision.

19. An ophthalmic laser system for forming microlenses in the cornea of ​​a patient's eye, the ophthalmic laser system comprising a controller, wherein, The controller is configured to control the ophthalmic laser system: (a) Generate a laser beam; (b) Scanning a laser beam focal spot in the cornea by executing a treatment plan, the treatment plan sequentially including an inlet portion defining an inlet cut, an annular portion defining an annular cut, a bottom portion defining a posterior lenticule incision, and a top portion defining a superior bed incision, wherein the posterior lenticule incision includes an optical region having a shape determined by a defined power of the microlens, the superior bed incision has a flat shape and is located above the posterior lenticule incision, the annular cut has an annular shape and extends between the superior bed incision and the posterior lenticule incision, both the superior bed incision and the posterior lenticule incision intersect the annular cut near their respective peripheries to define isolated microlens volumes, and the inlet cut extends upward from the outer edge of the posterior lenticule incision; and Alternatively: (c) In response to an interruption during the execution of the entry portion of the treatment plan after the entry cut has been partially formed, the treatment plan is modified to define a new entry cut located at a different angular position than the partially formed entry cut, and not coinciding with or intersecting with the partially formed entry cut, the new annular cut, the new bottom microlens incision, and the new top bed incision, and the laser beam is scanned by executing the modified treatment plan to complete the entry cut and form the new annular cut, the new bottom microlens incision, and the new top bed incision; Alternatively: (d) In response to an interruption during the execution of the annular portion of the treatment plan after the inlet cut has been formed and the annular cut has been partially formed, the treatment plan is modified to define a new annular cut, a new bottom microlens incision, and a new top bed incision, the new annular cut having a radius larger than that of the partially formed annular cut and being concentrically aligned with the partially formed annular cut without coinciding with or intersecting the partially formed annular cut, and the laser beam is scanned by executing the modified treatment plan to form the new ring, the new bottom microlens incision, and the new top bed incision; Alternatively: (e) in response to an interruption during the execution of the bottom portion of the treatment plan after the inlet cut and the annular cut have been formed and the bottom microlens incision has been partially formed, the treatment plan is modified to define a new bottom microlens incision and a new top bed incision, the new bottom microlens incision having the same shape as the bottom microlens incision and located below the partially formed bottom microlens incision, the new top bed incision being located above the new bottom microlens incision without coinciding with or intersecting the partially formed bottom microlens incision, and the laser beam focal spot is scanned by executing the modified treatment plan to form the new bottom microlens incision and the new top bed incision; Alternatively: (f) In response to an interruption during the execution of the top portion of the treatment plan after the inlet cut, the annular cut, and the bottom microlens incision have been formed and the top bed incision has been partially formed, the treatment plan is modified to define a new top bed incision having the same shape as the top bed incision and located above the partially formed top bed incision without coinciding with or intersecting the partially formed top bed incision, and the laser beam focal spot is scanned to form the new top bed incision by executing the modified treatment plan.

20. The ophthalmic laser system according to claim 19, wherein, The radius of the new annular cut is 20-100 micrometers larger than the radius of the partially formed annular cut.

21. The ophthalmic laser system according to claim 19, in, Step (e) further includes measuring the depth of the apex of the partially formed bottom microlenticular incision before modifying the treatment plan, wherein the apex of the new bottom microlenticular incision is located 5-20 micrometers below the apex of the partially formed bottom microlenticular incision; and Step (f) further includes measuring the depth of the partially formed topbed incision before modifying the treatment plan, wherein the new topbed incision is located 5-10 micrometers above the partially formed topbed incision.

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