Laser system having a balanced suspension for a laser applicator and method of using the same

Abstract

The present disclosure relates to an ophthalmic laser system for performing laser treatment of an eye. The laser system includes a base housing a laser source of the laser system. The system also includes a laser applicator including an optical system through which the therapeutic laser beam exits the laser applicator in a direction toward the eye of the patient and a support arm. A support arm is connected to the laser applicator at a first end of the support arm and a second end of the support arm is connected to the base. The support arm is configured such that the laser applicator is positionable in three dimensions relative to the base. The laser system also includes an electric three-axis positioning system operably coupled to the controller for positioning the laser applicator in three dimensions relative to at least a portion of the support arm.

Description

Technical Field

[0001] The present invention relates to a system for performing laser treatments, such as treatments that form incisions in the cornea or natural lens of an eye. The present invention also relates to systems for ablating portions of the corneal surface, such as laser photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) treatments. Background Art

[0002] Cataract surgery is one of the most common ophthalmic surgical procedures. The primary goal of cataract surgery is to remove the aged lens and replace it with an artificial or intraocular lens (IOL) that restores some of the optical properties of the aged lens.

[0003] The major steps of cataract surgery include making a corneal incision to allow access to the anterior chamber of the eye and an incision to correct astigmatism (limbal relaxing incision, abbreviated LRI or astigmatic keratotomy, abbreviated AK), cutting and opening the lens capsule to access the lens (capsulotomy), lens fragmentation and removal of the fragmented lens by phacoemulsification, irrigation and aspiration, and in most cases placement of an artificial intraocular lens in the eye.

[0004] Therefore, femtosecond laser-assisted cataract surgery is a multistage process that includes femtosecond laser surgery (LRI, AK, keratotomy, capsulotomy, and lens fragmentation), phacoemulsification process (emulsification, liquefaction, and aspiration of the lens), and manual surgery (implantation of an intraocular lens).

[0005] However, with conventional femtosecond laser systems, this typically requires moving the patient from their regular hospital bed to a separate fixed patient stand that is part of the femtosecond laser system and specifically adapted to perform the laser procedure. However, such patient transfer procedures complicate clinical workflow and are uncomfortable for the patient.

[0006] Furthermore, to reduce floor space and cost, it is desirable to configure a femtosecond laser system for cataract surgery to also be used to form the corneal flap for laser in situ keratomileusis (LASIK). However, the femtosecond laser used to form the LASIK flap should be located near the excimer laser system to allow for easy patient movement from one system to another. On the other hand, the femtosecond laser used for cataract surgery should be located in the sterile operating room where phacoemulsification and IOL implantation are performed.

[0007] In view of the above, there is a need to provide a laser system that allows for an efficient clinical workflow. Summary of the invention

[0008] Embodiments of the present invention relate to an ophthalmic laser system for performing laser treatment of an eye. The laser system includes a base that houses at least a portion of a laser source of the laser system, wherein the laser source is configured to generate a therapeutic laser beam for performing the laser treatment. The laser system also includes a laser applicator, the laser applicator including an optical system, and the therapeutic laser beam exits the laser applicator in a direction toward the patient's eye through the optical system. The laser system also includes a support arm and a controller. The support arm is connected to the laser applicator at a first end of the support arm. The second end of the support arm can be connected to the base, and, additionally or alternatively, the support arm includes an interface for connecting the support arm to another component at the second end of the support arm. The support arm can be configured so that the laser applicator can be positioned in three dimensions relative to the base. The laser applicator can be positionable while maintaining a vertical orientation of the laser applicator. The laser system can also include an electric three-axis positioning system, which is operably coupled to the controller for positioning the laser applicator relative to at least a portion of the support arm or relative to the entire support arm. The positioning system can be configured so that the laser applicator can be positioned in three dimensions.

[0009] The laser system may include an articulated beam guide tube. At least a portion of the articulated beam guide tube may extend between a first position, in which the therapeutic laser beam exits from the base or from the support arm, and a second position, in which the therapeutic laser beam enters the support arm or enters the laser applicator. The laser system may include a coupling device for coupling the articulated beam guide tube to the support arm at one or more positions along the beam guide tube between the first position and the second position.

[0010] The support arm may be connected to the laser applicator at a first end. The second end of the support arm may be connected to the base and / or may be connected to an additional component at the second end of the support arm. The additional component may be external to the ophthalmic laser system. For example, the additional component may be a second substrate or may be a wall, ceiling, or floor of a building.

[0011] The base of the laser system can be configured as a movable base that can be moved on a floor surface. The mobile base can include a plurality of wheels, such as four wheels for moving the base on the floor surface. The mobile base can be configured so that the entire laser surgical system can be moved on the floor by one person. The support arm and the laser applicator can be supported only by the base.

[0012] The laser source may be an infrared laser source. The infrared laser source may be configured as a femtosecond laser source. The pulse energy of the laser pulse may be greater than 1 nanojoule, or greater than 10 nanojoules, or greater than 50 nanojoules. The pulse energy may be less than 20 microjoules, or less than 15 microjoules, or less than 10 microjoules. The pulse duration of the pulsed laser beam may be less than 800 femtoseconds, or less than 500 femtoseconds, or less than 300 femtoseconds, or less than 150 femtoseconds, or less than 100 femtoseconds. The pulse duration may be greater than 10 femtoseconds or greater than 50 femtoseconds. The repetition rate of the pulsed laser beam may be greater than 50kHz or greater than 80kHz. The repetition rate of the pulsed laser beam may be less than 10MHz or less than 1MHz. The central wavelength of the pulsed laser beam incident on the eye may be in the range of 800 nanometers to 1400 nanometers, or between 900 nanometers and 1400 nanometers, or between 1000 nanometers and 1100 nanometers, or between 1010 nanometers and 1050 nanometers.

[0013] The infrared laser source can be configured such that the laser pulses have a pulse energy such that the laser beam produces photodetachment within the corneal tissue or within the natural lens of the patient's eye. The photodetachment can be caused by laser-induced optical breakdown. Alternatively, the pulse energy of the laser pulses can be below a threshold for producing laser-induced optical breakdown. For example, multiple pulses having pulse energies below a threshold for producing laser-induced optical breakdown can overlap in a manner that produces tissue separation within the cornea.

[0014] The infrared laser source may include a precompensator for at least partially precompensating for changes in the group delay dispersion (GDD) of the laser pulses, the group delay dispersion being caused by components of the laser optical system in the beam path of the laser beam downstream of the laser source. If the laser pulses have a positive GDD, laser pulses of longer wavelengths propagate faster than laser pulses of shorter wavelengths. Positive group delay dispersion thus corresponds to material dispersion typical in transparent media, since red wavelengths experience a lower refractive index than blue wavelengths. The precompensator may be configured to reduce the group delay dispersion. For example, the reduced group delay dispersion produced by the precompensator may have a lower positive or more negative group delay dispersion.

[0015] The transverse diameter of the focus of the therapeutic laser beam of the infrared laser source in the cornea or lens can be less than 10 microns, or less than 6 microns. The diameter can be greater than 3 microns. The transverse diameter can be measured in a direction perpendicular to the optical axis of the laser optical system. The lateral diameter can be measured as the energy diameter of 80% of the surround.

[0016] Alternatively, the laser source may be configured as an excimer laser source. The laser system may be configured to generate a laser beam that is focused on the front surface of the eye. The wavelength of the therapeutic laser beam generated by the excimer laser source may be greater than 150 nm or greater than 190 nm. The wavelength may be less than 400 nm or less than 200 nm. The pulse duration of the therapeutic laser beam generated by the excimer laser source may be shorter than 100 ns or shorter than 50 ns. The pulse duration may be greater than 1 ns or greater than 3 ns.

[0017] The controller may include a data processing system. The data processing system may include a computer system having a processor and a memory for storing instructions that can be processed by the processor. The processor may execute an operating system. The data analysis system may further include a user interface configured to allow a user to receive data from the data processing system and / or provide data to the data processing system. The user interface may include a graphical user interface.

[0018] The controller may be configured to determine a scanning path of the pulsed laser beam for scanning the laser focus on or within the cornea or natural lens of the patient's eye. The controller may be configured to determine the scanning path based on patient-specific data.

[0019] The controller may be configured to generate the scanning pattern so that the laser pulses overlap or do not overlap. The lateral displacement of adjacent laser pulses may be less than 30 microns, or less than 20 microns, or less than 10 microns. The displacement may be greater than 0.5 microns or greater than 1 micron.

[0020] The laser source may include an oscillator laser configured to generate a sequence of low energy ultrashort pulses. The pulse energy of the low energy ultrashort pulses may be less than 100 nJ or less than 20 nJ, or less than 10 nJ. The pulse energy may be greater than 1 pJ or greater than 100 pJ. The laser source may also include an amplifier, such as a regenerative amplifier or a fiber amplifier, for amplifying at least a portion of the low energy ultrashort pulses.

[0021] The base of the laser system may house a portion of the laser source. For example, an oscillator laser may be disposed in the base, and an amplifier and / or precompensator of the laser source may be disposed in the laser applicator, the amplifier and / or precompensator being configured to reduce the group delay dispersion of the therapeutic laser beam. Alternatively, the base may house the entire laser source, such as an oscillator laser, an amplifier, and a precompensator.

[0022] The base may include one or more housings. Each housing may house a portion of the laser source. For example, a first housing of the base may house a seed laser of the laser source, and a second housing of the base may house an amplifier of the laser source, in particular a regenerative amplifier or a fiber amplifier.

[0023] The support arm may include one or more arm segments. The support arm may include multiple arm segments, which are connected in series. Adjacent arm segments of the support arm may be connected via one or more joints. An arm segment may be defined as a component of the support arm, which provides a non-articulated connection between a first end of the arm segment and a second end of the arm segment. The arm segment may provide a rigid or telescopic connection between the first end of the arm segment and the second end of the arm segment. At one or both ends of the arm segment, the arm segment may be attached or integrally connected to the joint. The term "integrally connected" means that a first element / feature extends or transitions from a second element / feature in a continuous manner, rather than as two separate and distinguishable elements.

[0024] The support arm may include at least one arm segment, the arm segment forming part of a multi-bar linkage of the support arm. The multi-bar linkage may be configured so that the orientation of the first end of the multi-bar linkage relative to the second end of the multi-bar linkage is maintained while the first end is moved relative to the second end of the multi-bar linkage. The multi-bar linkage may be a parallel linkage and / or a four-bar linkage. The multi-bar linkage may be balanced so as to provide at least partial gravity balance for the laser applicator.

[0025] The arm segments may be connected in series via a swivel joint. Each of the swivel joints may be configured so that the orientation of adjacent arm segments relative to each other is adjustable. Each swivel joint may have one or two axes of rotation. The support arm may include at least one multi-axis joint having two or more axes of rotation. Each axis of rotation may be oriented orthogonally or substantially orthogonally relative to each other. One of the two axes of rotation may be oriented or substantially oriented in a vertical direction.

[0026] The support arm may be configured so that the distance measured in the horizontal direction between the laser applicator and the location where the support arm is connected to the base is adjustable. The maximum horizontal distance between the base and the applicator head may be greater than 50 cm or greater than 10 cm. The distance may be less than 5 meters or less than 3 meters.

[0027] The support arm may also be configured so that the laser applicator can move in a circular or substantially arc-shaped path of travel. The arc may be in a horizontal or substantially horizontal plane. The radius of the arc may be greater than 10 cm or greater than 50 cm. The radius may be less than 5 meters or less than 3 meters. The radius may be defined by the longitudinal extent of an arm segment of the support arm, wherein the support arm is configured so that the arm segment can rotate around a horizontal axis of rotation and / or around a vertical axis of rotation. Alternatively, the support arm may be configured so that the arm segment can rotate around a substantially horizontal axis of rotation and / or around a substantially vertical axis of rotation. The arm segment may be part of a multi-bar linkage, in particular a four-bar or parallel linkage. Additionally or alternatively, the arm segment may be balanced to provide at least partial gravity balance for the laser applicator.

[0028] For each of the three axes, the positioning system may include a guide, in particular a linear guide. The axes of the positioning system may be perpendicular to each other. The positioning system may be configured as an XYZ positioning system, wherein the Z axis is a vertical or substantially vertical axis. For each of the guides, the corresponding guide may be configured as a sliding guide and / or a roller guide. Each of the guides may include two mating guide members. The first guide member may be configured as a track, may form a guide track and / or may define a guide path. The second guide member may be configured as a slide and / or may be configured to be able to move along a guide path and / or a guide track. The slide may be a sliding slide and / or a roller slide.

[0029] For each of the three axes of the positioning system, the range of motion may be less than 500 mm or less than 150 mm. The range of motion may be at least 1 mm or at least 3 mm.

[0030] For each of the three axes of the positioning mechanism, the positioning accuracy may be worse than 1 micron or worse than 10 microns. The positioning accuracy may be better than 500 microns or better than 100 microns.

[0031] For one or more or each of the axes, the positioning speed may be user adjustable in a continuous or stepwise manner.The laser system may be configured to receive user input for adjusting the positioning speed of one or more or each axis of the positioning system.

[0032] The positioning system may be arranged between the support arm and the laser applicator. However, it is also conceivable that the positioning system is part of the support arm.

[0033] According to one embodiment, the laser applicator comprises a manually operable control unit operably coupled to the controller for performing positioning of the laser applicator relative to at least a portion of the support arm based on user input received via the control element. The manually operable control unit may be configured for directional control, in particular for three-dimensional directional control. For example, the manually operable control unit may comprise a joystick and / or comprise one or more buttons. Each button may correspond to a direction of travel.

[0034] According to a further embodiment, the laser applicator comprises an imaging system for acquiring a frontal image of at least a portion of the patient's eye at least during positioning of the laser applicator relative to at least a portion of the support arm.

[0035] The controller of the laser system may include an image processing algorithm for determining whether at least a portion of the frontal image is in focus. Additionally or alternatively, the image processing algorithm may be configured to determine one or more parameters that depend on or indicate a focus level of at least a portion of the image. The image processing algorithm may include a segmentation algorithm for segmenting the frontal image. The image processing algorithm may determine one or more parameters that depend on or indicate a focus level of one or more segmented image regions.

[0036] The imaging system may include an image sensor. The image sensor may include a two-dimensional ordered or unordered array of pixels. The image sensor may be sensitive to one or more wavelengths in the range between 380 nanometers and 950 nanometers or in the range between 380 nanometers and 1400 nanometers. The imaging system may include an imaging optical system for imaging a tissue portion arranged in an object plane of the imaging optical system onto the image sensor. At least a portion of the imaging optical system may be provided by a portion of a focusing optical system for focusing the therapeutic laser beam into the patient's eye.

[0037] According to a further embodiment, the laser applicator comprises a beam combiner for combining an imaging beam path of the imaging system with a beam path of the therapeutic laser beam.

[0038] The beam combiner may be configured to deflect the therapeutic laser beam in a direction towards or substantially towards the eye. The beam combiner may include a reflector and / or a prism. The beam combiner may be configured as a dichroic beam combiner. The beam combiner may be in the beam path of the laser beam downstream of the focusing optical system, within the focusing optical system, or upstream of the focusing optical system.

[0039] The distance of the object plane of the imaging system from the laser applicator may be configured, or may be adjustable, so that the distance substantially corresponds to the distance of the laser applicator from the cornea of ​​the patient's eye during laser treatment.

[0040] According to an embodiment, the laser applicator comprises a display device for displaying the frontal image at least during part of the positioning of the laser applicator relative to the support arm. The display device may be mounted on the housing of the laser applicator or may be integrated in the housing of the laser applicator. The display may be visible to the user during operation of the manually operable control element.

[0041] According to another embodiment, the laser applicator comprises an interaction measurement unit for generating an output signal which depends at least on a parameter of the mechanical interaction between the patient's eye and the laser applicator.

[0042] The interaction measurement unit may include a plurality of interaction measurement sensors. The sensors may be distributed circumferentially around the optical axis of the laser applicator. The sensors may be distributed circumferentially around the optical axis of the laser applicator at equal angles. Additionally or alternatively, the sensors may be arranged at the same or substantially the same radial distance from the optical axis of the laser applicator.

[0043] The measured parameter of the mechanical interaction may depend on the force or the directional component of the force, or may be the force or the directional component of the force. The force may occur between the patient's eye and the laser applicator. Additionally or alternatively, the measured mechanical interaction may depend on the temporal variation of the force or the temporal variation of the force between the patient's eye and the laser applicator.

[0044] The interaction measurement unit may include a plurality of interaction measurement sensors. One or more of the interaction measurement sensors may include a force sensor, a piezoelectric sensor and / or a strain gauge.

[0045] The interaction measurement unit can be configured to measure the size of the projection of the force vector on the optical axis of the laser applicator (i.e., a cross-section of the optical axis at the location where the therapeutic laser beam emerges from the laser applicator toward the patient's eye) and / or the size of the projection of the force vector on a plane perpendicular to the optical axis.

[0046] The strain gauge may be configured to measure the strain in the sensing material caused by the force. The strain may be compressive or tensile. The strain gauge may be configured as a foil gauge, a semiconductor gauge (which uses the effect of piezoresistivity), or a capacitive strain gauge. A piezoelectric sensor may use the piezoelectric effect in a piezoelectric material such as quartz. The piezoelectric sensor may measure compressive, tensile, and / or shear forces acting on the piezoelectric sensor. It is also conceivable that the force sensor comprises an interferometric strain sensor or measures forces acting on a birefringent material. It is also conceivable that the force sensor is a fiber optic force sensor.

[0047] The force sensor may be arranged in a force path between the patient's eye and an optical system that focuses the therapeutic laser beam into the patient's eye.

[0048] According to another embodiment, the laser applicator includes a display device. The controller can be configured to use the output signal generated by the interactive measurement unit to generate data representing graphical and / or textual information. Additionally or alternatively, the controller can be configured to display graphical and / or textual information on the display device at least during a portion of the positioning of the laser applicator relative to at least a portion of the support arm.

[0049] The graphical and / or textual information generated using the output signal of the interaction measurement unit may depend on the magnitude and direction of the force between the laser applicator and the eye, which may be determined using the interaction measurement unit.

[0050] Additionally or alternatively, the graphical and / or textual information may depend on the rate at which the magnitude and / or direction of the measured force changes.

[0051] According to an embodiment, the coupling device comprises a tension transmitting connection.The tension transmitting connection may comprise a tension spring for transmitting tension.

[0052] According to another embodiment, the coupling device comprises a guide. The guide may be configured as a lateral guide. The lateral guide may be configured to limit lateral movement of a coupling member of the coupling device relative to the longitudinal axis of the arm segment of the support arm. The coupling member may be rigidly attached or integrally connected to the articulated beam guiding tube.

[0053] The lateral guides may guide movement of the coupling member in a direction parallel or substantially parallel to the longitudinal axis of the arm segments of the support arm. The guides may be configured to limit changes in the vertical orientation of a plane defined by successive arm segments of the articulated beam directing tube during movement of the laser applicator.

[0054] According to another embodiment, the laser applicator includes an optical coherence tomography (OCT) system configured to acquire cross-sectional images of at least a portion of the eye.

[0055] The central wavelength of the OCT measurement arm can be in the range between 750 and 1400 nanometers. The optical coherence tomography system can be configured to acquire cross-sectional images of the cornea and / or at least a portion of the natural lens of the eye. The OCT system can include a scanner. The scanner of the OCT system can be separate from the scanner of the optical system for scanning the therapeutic laser beam.

[0056] According to a further embodiment, the laser applicator comprises a beam combiner for combining the beam path of the measuring arm of the OCT system with the beam path of the treatment laser beam.

[0057] The beam combiner for combining the beam path of the therapeutic laser beam with the beam path of the measuring arm of the OCT system may be configured as a dichroic beam combiner. At least a portion of the beam combiner for combining the beam path of the measuring arm of the OCT system with the therapeutic laser beam may be provided by at least a portion of the beam combiner for combining the imaging beam path of the imaging system with the beam path of the therapeutic laser beam.

[0058] According to one embodiment, the support arm comprises an arm segment rotatable about a horizontal or substantially horizontal axis. According to another embodiment, the arm segment is part of a multi-bar linkage, in particular a four-bar linkage, such as a parallelogram linkage. The multi-bar linkage may be configured such that during rotation of the arm segment about the horizontal axis, the vertical orientation of the laser applicator is maintained.

[0059] According to another embodiment, the support arm comprises a first arm segment and a second arm segment connected to each other in series via an intermediate joint. The first arm segment is rotatable about a vertical or substantially vertical axis, and the second arm segment is rotatable about a horizontal or substantially horizontal axis.

[0060] According to another embodiment, the intermediate joint system is configured to allow the second arm segment to (a) rotate about a horizontal or substantially horizontal axis, and (b) rotate about a vertical or substantially vertical axis. The intermediate joint system may include two joints that are rigidly attached to or integrally connected to each other. The first joint of the two joints has an axis of rotation that is oriented vertically or substantially vertically, and the second joint of the two joints has an axis of rotation that is oriented horizontally or substantially horizontally. The first joint may be attached to or integrally connected to the first arm segment, and the second joint may be attached to or integrally connected to the second arm segment.

[0061] According to a further embodiment, the second arm segment is part of a multi-bar linkage, in particular a four-bar linkage such as a parallel linkage.

[0062] According to another embodiment, the support arm includes a counterbalancing mechanism for providing at least partial gravity counterbalancing for the applicator head.

[0063] According to another embodiment, the balancing mechanism comprises one or more springs. Each of the springs may be configured as a gas spring or a mechanical spring.

[0064] According to another embodiment, the support arm comprises a braking and / or locking system for preventing movement of the second end of the support arm relative to the first end of the support arm. The braking and / or locking system may comprise one or more lockable joints and / or brakes for braking movement of parts of the joint relative to each other. The locking mechanism of the lockable joint may be based on positive locking of components of the joint that are otherwise movable relative to each other.

[0065] According to another embodiment, the laser applicator comprises a manually operable control unit for selectively activating and deactivating the braking and / or locking system based on user input received via the control unit.

[0066] According to another embodiment, the laser system includes an interaction measurement unit configured to generate an output signal that depends on the mechanical interaction between the patient's eye and the laser applicator. The controller is operably connected to the interaction measurement unit and the braking and / or locking system. The controller is configured to receive the output signal generated by the interaction measurement unit and determine whether to deactivate the braking and / or locking system based on the received output signal.

[0067] The articulated beam guiding tube may include one or more joints, each joint connecting adjacent longitudinal tube segments. Each of the tube elements may define a linear laser beam path, the linear laser beam path extending along the longitudinal axis of the tube segment. For each tube segment, the corresponding tube segment may be rigid or may extend along the longitudinal axis of the corresponding tube element.

[0068] Each joint of the articulated beam guiding tube may include a reflector system. The reflector system may include one or more mirrors. The reflector system may be configured to deflect a therapeutic laser beam emitted from a first tube element of adjacent tube elements connected to the joint into a second tube element of the adjacent tube elements.

[0069] According to another embodiment, the support arm or the laser applicator has a swivel joint with a vertically extending swivel axis for swivelling the laser applicator about a vertical axis and relative to at least a portion of the support arm.

[0070] According to another embodiment, a laser system includes a locking system configured for locking a rotary joint having a vertically extending axis of rotation.

[0071] According to further embodiments, the laser applicator comprises a focusing optical system for focusing the therapeutic laser beam within the eye and / or an axial scanning system for scanning the laser focus along the axis of the laser beam; and / or a beam deflection scanning system for scanning the laser beam by deflecting the laser beam.

[0072] Further embodiments of the present disclosure relate to a method for positioning a laser applicator of an ophthalmic laser system relative to an eye of a patient. The method includes positioning the laser applicator relative to the eye of the patient using a support arm. The support arm can be connected to the laser applicator at a first end of the support arm. The second end of the support arm (a) can be connected to a base and / or (b) can include an interface for connecting the support arm to another component at the second end of the support arm. The laser system can be configured to generate a therapeutic laser beam for performing laser therapy. The support arm can be configured so that the laser applicator can be positioned relative to the base of the base while maintaining a vertical orientation of the laser applicator. The method can also include positioning the laser applicator relative to the support arm using an electric three-axis positioning system.

[0073] According to further embodiments, the method includes acquiring a frontal image of the eye using an imaging system of the laser applicator. The method may also include displaying the frontal image on a display device of the laser system during at least a portion of the positioning of the laser applicator relative to the support arm. The displayed frontal image may be a real-time image.

[0074] According to a further embodiment, during the positioning portion, the focal plane is at a distance from the laser applicator that substantially corresponds to a predetermined distance of the laser applicator from the patient's eye, in particular from a cornea of ​​the patient's eye.

[0075] According to another embodiment, the method further comprises generating an output signal by the interaction measurement unit, the output signal being dependent on the mechanical interaction between the patient's eye and the laser applicator. The method may further comprise determining, using a controller of the laser system, textual and / or graphical information based on the output signal. The method may further comprise displaying textual and / or graphical information at least during a portion of the positioning of the laser applicator.

[0076] The time span for displaying the front image and the time span for the text and / or graphic information based on the output signal of the interaction unit may be the same, overlapping or non-overlapping.

[0077] According to another embodiment, the method includes generating an output signal by the interaction measurement unit, the output signal being dependent on the mechanical interaction between the patient's eye and the laser applicator. The method may also include using a controller of the laser system and determining based on the output signal whether to deactivate a brake of the support arm, the brake preventing movement of the second end of the support arm relative to the first end of the support arm. BRIEF DESCRIPTION OF THE DRAWINGS

[0078] Figure 1 is a perspective view of a laser system according to an exemplary embodiment.

[0079] Figure 2is a second perspective view of a laser system according to an exemplary embodiment. Figure 1 , with the support arm in a rest position.

[0080] Figure 3 yes Figure 1 A schematic diagram of a laser system of an exemplary embodiment is shown in FIG. Figure 1 The extent of the lateral movement range of the laser applicator of the laser system of the exemplary embodiment shown in ;

[0081] Figure 4 is Figure 1 A further schematic top view of a laser system according to an exemplary embodiment is shown in;

[0082] Figure 5 is Figure 1 A schematic side view of a support arm and a laser applicator of a laser system according to an exemplary embodiment is shown in FIG.

[0083] Figure 6 It is based on Figure 1 A schematic diagram of information shown on a display device of a laser applicator of a laser system of an exemplary embodiment shown in FIG.

[0084] Figure 7 It is arranged according to Figure 1 Schematic diagram of an imaging system, an OCT system, and a beam combiner in a laser applicator of a laser system of an exemplary embodiment shown in FIG.

[0085] Fig. 8A and 8B Schematically shows the Figure 1 An interactive measurement unit of a laser applicator of a laser system of the exemplary embodiment shown in FIG.

[0086] Fig. 9 is based on Figure 1 A schematic diagram of information shown on a display device of a laser applicator of a laser system of an exemplary embodiment shown in FIG.

[0087] Fig.10 is based on Figure 1 A schematic diagram of a parallel linkage and a balancing mechanism of a support arm of a laser system of an exemplary embodiment shown in FIG.

[0088] Figures 11A to 11C is a side view of a support arm and an articulated beam directing tube of a laser system and a coupling device for coupling the articulated beam directing tube to the support arm according to an exemplary embodiment. DETAILED DESCRIPTION

[0089] Figure 1is a schematic diagram of an ophthalmic laser system 1 according to an exemplary embodiment for performing laser treatments of the eye. The treatments may include, but are not limited to, forming a flap for laser in situ keratomileusis (LASIK) treatments, forming corneal incisions and limbal relaxing incisions (LRI, AK), performing capsulotomies (particularly anterior capsulotomies), and lens fragmentation.

[0090] The laser system 1 comprises a laser source configured to generate a therapeutic laser beam for performing laser therapy. At least a portion of the laser source is mounted in a housing 2 of a base 3. Another portion of the laser source may be arranged in a laser applicator 6 supported by an articulated support arm 4 and / or in a support arm 4 supporting the laser applicator 6. It is also conceivable that the base 3 comprises more than one housing, wherein each of them houses a portion of the laser source. For example, a first housing of the base 3 houses an oscillator laser of the laser source and a second housing of the base houses an amplifier and / or a precompensator of the laser source.

[0091] The laser system 1 includes a laser optical system configured to direct a laser beam toward a Figure 1 4 , and a laser system 300 for guiding a therapeutic laser beam from the base 3 to the patient's eye on a bed or support not shown in the figure. The laser source generates a therapeutic laser beam, which is guided by the laser optical system through a portion of the support arm 4, an articulated beam guide tube 5 and a laser applicator 6. The articulated beam guide tube 5 extends at least between a first position where the laser beam leaves the support arm 4 and a second position where the laser beam enters the laser applicator 6. However, the present disclosure is not limited to such a configuration for guiding the therapeutic laser beam from the base 3 to the patient's eye. For example, the laser beam can be guided through the entire support arm. In particular, the laser system can be configured so that it does not include a beam guide tube. It is also conceivable that the articulated beam guide tube 5 extends at least between a first position and a second position, in which the therapeutic laser beam is emitted from the base 3 and in which the therapeutic laser beam enters the support arm 4 or enters the laser applicator 6. A portion of the articulated beam guide tube can be arranged in the base 3, in the support arm 4 and / or in the laser applicator 6.

[0092] exist Figure 1 In the exemplary embodiment shown, the laser source is configured to emit a pulsed laser beam having a pulse energy and a pulse duration sufficient to produce laser-induced optical breakdown (LIOB) in the cornea or natural lens of an eye of a patient. The laser-induced optical breakdown produced by the laser pulses results in photoablation, such that a series of consecutive overlapping or closely positioned laser pulses produce cuts in the corneal tissue or natural lens. Photoablation is a non-thermal process. The laser optical system includes a scanning system configured to scan the focus of the pulsed laser beam within the eye to form a perforated incision or a continuous (i.e., non-perforating) incision. In Figure 1In the exemplary embodiment shown, the scanning system is arranged in the laser applicator 6. However, it is also conceivable that at least a part of the scanning system is arranged in the base 3 and / or in the support arm 4.

[0093] It should be noted that the present disclosure is not limited to the above-mentioned laser treatments and laser systems. Specifically, the laser system can be configured to controllably ablate corneal tissue without causing significant damage to adjacent and / or underlying tissues of the eye. The laser system can emit light having a wavelength greater than 150nm or greater than 190nm. The wavelength can be less than 400nm or less than 200nm. As an example, the laser source can be configured as an excimer laser source. The laser system can be an argon fluoride (ArF) excimer laser that produces laser pulses having a wavelength of substantially 193nm. The laser ablation process can be used to reshape the cornea. Such ablation treatments may include, but are not limited to, excimer laser keratectomy (PRK), excimer laser subepithelial keratomileusis (LASEK), excimer laser in situ keratomileusis (LASIK), and excimer laser therapeutic keratectomy (PTK). In each of these surgeries, a laser beam can be used to remove a predetermined amount of corneal stroma, which is located below the corneal epithelium and Bowman's membrane to form a reshaped surface portion.

[0094] exist Figure 1 In the exemplary embodiment shown, the laser source is arranged in the base. However, it is also conceivable that only a part of the laser source is arranged in the base and a second part of the source is arranged in the laser applicator 6 or in the support arm 4. For example, the oscillator laser of the laser source can be arranged in the base and the regenerative amplifier and / or the precompensator of the laser source can be arranged in the laser applicator and / or the support arm.

[0095] Using the support arm 4, the laser applicator 6 is positionable in three dimensions. The support arm 4 can be configured to allow manual positioning of the laser applicator 6 in three dimensions. However, it is also conceivable that the support arm may include one or more motors so that at least a portion of the movements that can be performed using the support arm 4 are motorized. Between the support 4 and the laser applicator 6, an electric three-axis positioning system 9 is provided. The positioning system 9 can be configured so that the laser applicator 6 is positionable relative to the support arm 4. It is also conceivable that the positioning system 9 is part of the support arm 4, so that the laser applicator and a portion of the support arm 4 are positionable relative to another portion of the support arm 4. For example, the positioning system 9 can be arranged between two arm segments or can be part of an arm segment of the support arm 4.

[0096] For example, as described in more detail below, after the laser illuminator 6 is positioned in a coarse positioning procedure using the support arm 4, the positioning system 9 is used in a fine positioning procedure.

[0097] The positioning system 9 may be operably coupled to the controller ( Figure 1 ). The controller may be arranged in the base 3. However, it is also conceivable that the controller is arranged in a housing which is separate from the base 3 and also separate from the laser applicator 6. The controller may be connected to the base 3, the positioning system 9 and / or components of the laser applicator 6 via a wired or wireless connection.

[0098] The laser applicator 6 may further include a manually operable control unit 10, which is operably coupled to the controller for performing positioning of the laser applicator 6 relative to the portion or relative to the entire support arm 4 using the positioning system 9. The manually operable control unit 10 may be configured for directional control. By way of example, the control unit 10 may be configured as a joystick (such as Figure 1 ). However, the present disclosure is not limited to such control elements. It is also conceivable that the control element includes one or more buttons, each button indicating the direction of travel of the laser applicator 6.

[0099] The configuration of the ophthalmic laser system according to an exemplary embodiment allows positioning of the laser applicator according to the patient so that the patient can remain in the conventional hospital bed in which the patient has received preoperative treatment. Thus, patient transfers can be avoided, which would otherwise require moving the patient from his conventional hospital bed to a separate fixed patient support that is part of the laser system and is specifically provided for performing the laser surgical procedure.

[0100] To this end, the surgical laser system according to the present disclosure not only increases the effectiveness of clinical workflow, but also reduces the floor space required in the surgical operating room, because there is no space required for a fixedly mounted patient support, which is only provided for performing laser surgery. In addition, the movable laser surgery system facilitates cleaning and disinfection of the surgical operating room.

[0101] In addition, in order to reduce floor space and cost, it is desirable that the femtosecond laser system configured for cataract surgery is also used to form the corneal flap of excimer laser in situ keratomileusis (LASIK). However, the femtosecond laser used to form the LASIK flap should be located near the excimer laser system so that the patient can easily move from one system to another. On the other hand, the femtosecond laser used for cataract surgery should be located in a sterile operating room, where the natural lens is emulsified using a phacoemulsification device and an intraocular lens is implanted. The laser system according to an exemplary embodiment is a mobile laser system that can be easily moved between different locations in a hospital. Moreover, the articulated support arm allows the surgeon to more flexibly arrange the laser system in a surgical operating room, in which many other devices such as surgical microscopes, phacoemulsification systems, and operating room trolleys are positioned, and in which there must be enough space for one or more surgeons and other medical staff.

[0102] As in Figure 1 In and also Figure 4 Schematic top view and Figure 5 As illustrated in the schematic side view of , the support arm 4 can be constructed as an articulated support arm having one or more arm segments, which are connected in series. The support arm 4 may include a first arm segment 8 and a second arm segment 11. The first arm segment 8 can be rotatably supported by the base 3 so that the first arm segment 8 can rotate around a first vertical axis A1. The first vertical axis A1 can have a fixed position and orientation relative to the base 3. Additionally or alternatively, the base can be constructed so that the position, in particular the height and / or orientation (rotation) of the first arm segment 8 relative to the base 3 is adjustable. As an example, the base 3 can be configured so that the first arm segment is supported by the base using a rotating bearing assembly ( Figure 1 The swivel bearing assembly is used to rotatably support the first arm section 8 about the first vertical axis A1. The base 3 can be configured so that the height of the swivel bearing assembly relative to the rest of the base 3 is adjustable, for example using an electric height adjustment mechanism.

[0103] The first arm segment 8 may be connected to the second arm segment 11 via an intermediate joint 12. The intermediate joint 12 may be configured such that the orientation of the second arm segment 11 relative to the first arm segment 8 is adjustable in two dimensions. As an example, the intermediate joint 12 may be configured such that the second arm segment can rotate about a vertical axis A2 and also about a horizontal axis A3.

[0104] The support arm 4 is configured so that the laser applicator 6 has the same vertical orientation before and after the rotation of the second arm segment 11 around the horizontal axis A3. In an exemplary embodiment, the rotation of the second arm segment 11 around the horizontal axis A3 is coupled to the orientation of the laser applicator 6 relative to the second arm segment. The coupling is a mechanical coupling obtained by a multi-bar linkage mechanism of the support arm 4, which can be configured as a parallel linkage mechanism. Two or more parallel bars of the parallel linkage can form the second arm segment 11. However, it is also conceivable that the second arm segment 11 and / or the laser applicator 6 include a tilt sensor for measuring the inclination of the second arm segment 11 and / or the laser applicator 6 relative to the horizontal plane. A controller can be provided that receives output signals from one or more tilt sensors and controls the adjustment of the vertical orientation of the laser applicator 6 based on the measured inclination. The adjustment of the vertical orientation can be performed using a motor that drives a rotary joint. It is also conceivable that the connection between the second arm segment 11 and the laser applicator 6 is configured so that the vertical orientation of the laser applicator 6 is maintained by the gravity acting on the laser applicator 6.

[0105] The parallel link can be configured such that the distal end of the parallel link (ie, the distal end relative to the base 3) maintains its vertical orientation regardless of the orientation of the second arm segment 11 relative to the horizontal plane. Fig.10 Describe an example for a parallel linkage.

[0106] from Figure 1 , Figure 4 and Figure 5 It can be seen in FIG that the laser applicator 6 can be rotated about a vertical rotation axis A6 relative to the support arm 4. The vertical rotation axis A6 can extend through the laser applicator 6, in particular through the housing 22 of the laser applicator 6. However, it is also conceivable that the vertical rotation axis A6 does not extend through the laser applicator 6. Rotating the laser applicator about the vertical rotation axis A6 changes the orientation of the laser applicator 6 relative to the support arm 4.

[0107] Rotating the laser applicator 6 relative to at least a portion of the support arm 4 allows the surgeon to adjust the orientation of the laser applicator 6 during the rough positioning procedure so that the positioning of the laser applicator 6 relative to the patient's eye is not hindered by the spatial limitations defined by the patient's anatomy. Additionally or alternatively, the laser system can be configured such that the laser applicator 6 can be rotated relative to the support arm about a horizontal axis relative to at least a portion of the support arm (not shown). Figure 4 and Figure 5In addition to the laser applicator 6 being rotatable about a horizontal axis, the laser system can also be configured so that the laser applicator 6 is rotatable about a rolling axis, which is fixed relative to the laser applicator 6, i.e. fixed for the different rotational positions of the laser applicator 6 obtained by rotation about a vertical and / or horizontal axis ( Figure 4 and 5 This provides even greater flexibility in adjusting the orientation of the laser applicator 6 relative to the patient.

[0108] The laser system according to this exemplary embodiment includes a brake and / or locking system for preventing the movement of the second end of the support arm relative to the first end of the support arm. In particular, this allows the surgeon to perform a rough positioning procedure by manually positioning the laser applicator 6 close to the patient's head. After the rough positioning procedure, the surgeon activates the brake and / or locking system of the support arm so that in the stopped state, the surgeon can perform a fine positioning procedure using the positioning system 9.

[0109] In an exemplary embodiment, the laser applicator 6 includes one or more manually operable control elements 18a, 18b that allow the surgeon to deactivate the brake and / or locking system so that the applicator head can be positioned to a different position using the support arm 4. In an exemplary embodiment, the laser applicator includes two handles 17a, 17b (eg, Figure 4 ), which can be grasped by the surgeon's two hands. A release button 18a, 18b is provided at each handle. If the surgeon presses both release buttons simultaneously, the braking and / or locking system is deactivated and the surgeon can position the laser applicator 6 in three dimensions. Figure 1 and Figure 2 In FIG. 1 , the handles 17a, 17b and the release buttons 18a and 18b are not shown.

[0110] The laser system according to an exemplary embodiment is configured to allow positioning of the laser applicator relative to the patient's head by performing a coarse positioning procedure in which the laser applicator 6 is adjusted relative to the patient's head using the support arm 4. Then, in a subsequent fine positioning procedure using the three-axis positioning system 9, the laser applicator 6 is positioned to its final position relative to the patient's head undergoing laser treatment.

[0111] The rough positioning procedure using the support arm 4 allows the surgeon to perform a quick and effective rough positioning relative to the patient's head. The manual adjustability also provides increased safety for the patient, since the surgeon can quickly move the laser applicator 6 to a position away from the patient's head if necessary. However, it is conceivable that one or more joints of the support arm are motorized so that the rough positioning is performed completely or partially (i.e., using manual positioning) using a motor.

[0112] As further explained in more detail below, the fine positioning procedure can be performed based on images from an imaging system that is part of the laser applicator 6 and / or based on measurements from an interaction measurement unit that measures mechanical interactions, such as forces, between the patient's eye and the laser applicator 6.

[0113] Figure 6 The information displayed on the display device 19 of the laser applicator 6 during the rough positioning process is schematically shown. Figure 6 It can be seen that the surgeon sees an image on the display device 19, which image is generated by an imaging system, which is disposed within the laser applicator 6. The imaging system acquires a frontal image 20 of the patient's eye using a constant object plane distance. The object plane distance is adjusted so that it corresponds to a desired predefined distance between the laser applicator and the patient's eye. Thus, using the frontal image of the eye, the surgeon can control the lateral position of the laser applicator using the three-axis positioning system so that the center of the crosshairs 24 is located at the center of the pupil of the eye. In addition, by adjusting the vertical position of the laser applicator 6 using the positioning system 9 until a focused image appears on the display device 19, the surgeon can adjust the height of the laser applicator so that the distance between the laser applicator 6 and the patient's eye corresponds to the desired predefined distance.

[0114] The above rough positioning process can be carried out on the suction ring and the contact element (see below). Figure 7 and 8A The laser applicator 6 and the contact element can be configured so that the iris and limbus are displayed in the frontal image 20. As an example, the surgeon determines whether the frontal image 20 is in focus based on some or all of these features.

[0115] The controller of the laser system may include an image processing algorithm for determining whether at least a portion of the frontal image 20 is in focus and / or is configured to determine one or more parameters that depend on or are indicative of a focus level of at least a portion of the frontal image 20. As an example, the portion of the frontal image 20 may be the iris of an eye. The image processing algorithm may include a segmentation algorithm for segmenting the frontal image. The image processing algorithm may determine one or more parameters that depend on or are indicative of a focus level of one or more segmented image regions. As an example, the segmented image regions may represent the iris of an eye of a patient.

[0116] The controller may be configured to display graphical and / or textual information on the display device 19 based on the determined parameters.

[0117] Refer to below Figure 7The arrangement of the imaging system in the laser applicator 6 is described. The laser applicator 6 includes a beam combiner 26. The beam combiner 26 is in the scanning system ( Figure 7 The contact element 28 includes a concave contact surface that contacts the front surface of the cornea during treatment. It should be noted that Figure 7 The concave shape of the contact element 28 shown in FIG. 2 is merely an example, and it is conceivable that the contact surface of the contact element 28 is planar or convex toward the eye.

[0118] like Figure 7 As shown, the beam combiner 26 can be located in the beam path of the treatment laser beam 27 between the two parts 30a and 30b of the focusing optical system 36. The focusing optical system 36 is also arranged in the laser applicator 6. It is also conceivable that the laser applicator includes at least a part of a scanning system for three-dimensionally scanning the focus of the treatment laser beam in the eye. The scanning system can include an axial scanning system for scanning the laser focus along the axis of the laser beam and / or a beam deflection scanning system for scanning the laser beam by deflection of the laser beam.

[0119] Each of components 30a and 30b may include one or more optical elements, such as lenses. However, the present disclosure is not limited to such a configuration. It is also conceivable that the beam combiner 26 is either in the beam path of the treatment laser beam 27 between the scanning system and the focusing optical system, or in the beam path of the treatment laser beam 27 between the focusing optical system and the contact element 28.

[0120] The beam combiner 26 may include a semi-transparent mirror and / or a prism. The semi-transparent mirror may be a dichroic mirror and / or the prism may be a dichroic prism. Figure 7 , the beam combiner 26 can be configured to combine the beam path of the laser beam 27 with a measuring beam path 31 of an optical coherence tomography (OCT) system 32 on the one hand and with an imaging beam path 33 of an imaging system 34 on the other hand. The imaging system can have a two-dimensional light-sensitive imaging sensor. The light-sensitive image sensor can have a two-dimensional array of light-sensitive pixels. The optical coherence imaging system can be configured to acquire cross-sectional images of the cornea and / or the natural lens of the eye. The imaging system with the imaging sensor can be configured to acquire a two-dimensional frontal image of the eye.

[0121] In an eye treatment system according to an exemplary embodiment, the measurement beam path 31 of the optical coherence system 32 and the imaging beam path 33 of the imaging system 34 are combined using a second beam combiner 35, which is outside the beam path of the treatment laser beam 27. The second beam combiner 35 may include a mirror and / or a prism. The mirror may be a dichroic mirror and / or the prism may be a dichroic prism.

[0122] The cross-sectional images of the OCT system 32 may be used to observe during the fine positioning procedure whether the anterior surface of the cornea has contacted the contact element 28 or not.

[0123] As discussed below with reference to FIG. 8 , during the fine positioning procedure, the position of the laser applicator relative to the patient's eye is monitored based on a signal from an interaction measurement unit that generates an output signal that is dependent on the mechanical interaction between the patient's eye and the laser applicator.

[0124] Fig. 8A The contact element 28 and further components for coupling the contact element 28 relative to the laser optical system on the one hand and to the patient's eye 29 on the other hand are schematically shown in the exploded view. The laser system comprises a coupling portion 37, which can be rigidly connected to the laser optical system or can be movably supported in a direction parallel to the optical axis of the laser optical system. The contact element 28 and the coupling portion 37 are configured such that the contact element 28 is detachably coupled to the coupling portion 37. In the coupled state, the contact element 28 can be in a substantially predefined position relative to the laser optical system and can have a predefined inclination relative to the optical axis OA of the laser optical system. Alternatively, in an embodiment in which the contact element 28 is movably supported in a direction parallel to the optical axis of the laser optical system, in the coupled state, the contact element 28 is in a predefined radial position relative to the optical axis and has a predefined inclination relative to the optical axis. The contact element 28 is attached to the coupling portion 37 using a suction mechanism, which comprises a suction source 38.

[0125] The laser system further comprises a suction ring 39 which can be fixed to the eye 29 and to which the contact element 28 can be rigidly attached. The suction ring 39 comprises a skirt forming a groove which defines a suction channel between the skirt and the front surface of the eye 29. Thus, the suction ring 39 is fixedly attached to the front surface of the eye 29 by creating a vacuum in the vacuum channel using a vacuum source 40.

[0126] The suction ring 39 is rigidly attached to the clamping mechanism 41 or is formed as an integral piece with the clamping mechanism 41. The clamping mechanism 41 is used to fix the contact element 28 to the suction ring 39. An example of such a clamping mechanism 41 is disclosed in document US 2007 / 0093795A1, the content of which is incorporated herein by reference for all purposes. However, the present invention is not limited to the configuration in which the contact element 28 is fixed to the suction ring 39 using a clamping mechanism. In particular, it is conceivable that the contact element 28 and the suction ring 39 are formed integrally, for example, formed as a single piece or integrated as a single-piece component.

[0127] As from Fig. 8A And also from the top view of the coupling part 37 and the eye 29 Figure 8B It can be seen that the coupling portion 37 includes a coupling ring 42 for coupling the coupling portion 37 to the rest of the laser applicator. Further, the coupling portion 37 includes a plurality of extension arms 43a, 43b, 43c, 43d, each extending arm connecting the coupling ring 42 to the lower portion 44 of the coupling portion 37.

[0128] When the coupling portion 37 is mounted to the rest of the laser applicator, the coupling portion 37 contacts a plurality of force sensors 45a, 45b, 45c, 45d. The force sensors 45a, 45b, 45c, 45d are arranged in a plane perpendicular to the optical axis OA of the laser applicator and therefore parallel to the plane of the mounting ring 42. Figure 8B It can be seen that the force sensors are circumferentially distributed around the optical axis OA of the laser applicator at equal angles and are also at the same distance from the optical axis OA. As an example, each of the force sensors 45a, 45b, 45c and 45d includes a piezoelectric force sensor that measures the tensile force and / or compressive force acting on the piezoelectric force sensor. Additionally or alternatively, strain gauges are arranged on one or more of the extension arms.

[0129] from Fig. 8A As can be seen from the cross-sectional view, each of the force sensors 45a, 45b, 45c and 45d is arranged between the patient's eye 29 and the focusing optical system 36 (such as Figure 7 The focusing optical system focuses the treatment laser beam at the patient's eye 29 and is part of the laser applicator. Therefore, the force magnitude measured by each of the corresponding force sensors and the difference between the force magnitudes measured by different force sensors can be used to determine the magnitude and direction of the force between the laser applicator and the eye.

[0130] Thus, monitoring the output signals of force sensors 45a, 45b, 45c and 45d allows the laser system to be docked to the eye with circumferentially uniform force, which ensures that the eye does not tilt during laser treatment. The uniform force measured by the force sensors is particularly important in capsulotomy and lens fragmentation procedures using a "soft docking" technique.

[0131] To perform the "soft docking" technique, a contact element 28 (such as Fig. 8A The force between the patient's eye and the laser applicator is kept at a low level so that in the docked state, a thin layer of saline solution exists between the contact surface of the contact element and the anterior surface of the cornea of ​​the eye.

[0132] Using the output signal of the force sensor to perform the "soft docking" technique ensures that the vertical force component does not exceed a predetermined level, so that there is only minimal corneal deformation and posterior corneal wrinkles are avoided. Posterior corneal wrinkles can deflect the treatment laser beam, which can result in a "postage stamp" incision. In addition, by ensuring that the lateral component of the force does not exceed a predetermined level, it is ensured that the eye is not tilted, which increases the accuracy of the laser treatment.

[0133] Fig. 9 4 is a schematic diagram of information displayed on the display device 19 during the fine positioning procedure. The display device shows an OCT image 46 acquired during the docking procedure, and a force sensor 45a, 45b, 45c and 45d ( Fig. 8A and 8B 47 of the output signal generation of FIG. 47. The OCT image may be a real-time OCT image.

[0134] In the exemplary embodiment, the diagram 47 has three concentric rings, wherein the indicators are arranged in the center, and each of the rings has eight indicators. After the output signal of the interactive measurement sensor is processed by the controller, one of the indicators is highlighted, for example Fig. 9 The ring on which the highlighted indicator is located indicates the magnitude of the measured force, wherein a larger diameter of the ring indicates a higher magnitude of force measured by the force sensor. Specifically, the inner two rings indicate acceptable force levels, wherein the outer rings indicate unacceptable force levels. If the force level is unacceptable, the surgeon uses a positioning system 9 (eg, which can be controlled by the control unit 10) to adjust the force level. Figure 1 ) to move the laser applicator in a direction away from the patient by raising the laser applicator. Adjusting the laser applicator so that the vertical force level is below a predetermined level ensures that corneal wrinkles are avoided.

[0135] The circumferential position of the highlighted indicator indicates the direction of the lateral component of the force measured using the force sensor. Fig. 9, the highlighted indicator is on the right, which indicates to the surgeon that the laser applicator should be moved in the negative x-direction in order to minimize lateral forces. If lateral forces are minimized, this avoids tilting of the eye relative to the optical axis of the laser applicator.

[0136] Additionally or alternatively, the controller may be configured to determine a parameter indicative of or dependent upon the magnitude of at least one component of a force between the laser applicator and the patient's eye. The controller may be configured to display the parameter on the display device. The component of the force may be a component along the optical axis of the laser applicator, or a component in a plane oriented perpendicular to the optical axis of the laser applicator.

[0137] Thus, the use of force sensors and a three-axis positioning system allows the surgeon to perform a docking procedure that ensures high-quality surgery.

[0138] In a laser system according to an exemplary embodiment, the output signal of the interaction measurement unit is used to determine whether to deactivate the braking and / or locking system based on the output signal of the interaction measurement unit. Thereby, it is possible to prevent damage to the patient's eyes in the event that the patient moves his head during laser treatment. For example, if the projection of the force vector on the optical axis of the laser applicator exceeds a predetermined threshold, the laser source and the braking and / or locking system are deactivated.

[0139] Fig.10 is a cross-sectional view of a parallel connecting rod, which includes a second arm segment 11 in a laser system according to an exemplary embodiment. Figure 1 The second arm segment 11 comprises two rods 52 and 53 of a four-bar linkage, which is configured as a parallel linkage having the rods 52 and 53 of the second arm segment oriented parallel to each other and four joints 53a, 53b, 53c and 53d, each of which has a horizontal axis of rotation.

[0140] The parallel linkage mechanism also includes a balancing mechanism for providing a balance that at least partially offsets the effects of the laser applicator ( Fig.10 In the exemplary embodiment, the balancing mechanism comprises a compression spring 54 which is arranged in the first rod 53 and exerts tension on a toothed belt 55 which extends into the second rod 52 via two toothed pulleys 56, 57. In the second rod 52, one end of the toothed belt 55 is fastened with a fastening member 58.

[0141] Back to Figure 1 The laser system according to an exemplary embodiment includes a coupling mechanism for coupling the articulated beam guiding tube 5 to the second arm segment 11 of the support arm 4. Figures 11A to 11C The coupling mechanism 16 is illustrated in more detail in the side view of FIG.

[0142] As from Figures 11A to 11C As can be seen, the coupling mechanism 16 comprises a first coupling member 58, which is rigidly attached or integrally connected to the articulated beam guiding tube 5. Furthermore, the coupling mechanism comprises a second coupling element 59, which is a coupling element corresponding to the first coupling element 58 and is attached or integrally connected to the second arm segment 11. In an exemplary embodiment, the first and second coupling elements 58, 59 are configured as lateral guides, which limit the lateral movement of the first coupling element 59 relative to a direction parallel to the longitudinal axis of the second arm segment 11. In an exemplary embodiment, the coupling mechanism 16 has the effect that for different positions of the laser applicator 6 presented by the movement of the first arm segment 8 and the second arm segment 11 of the support arm 4, the plane defined by the adjacent tube segments 13 and 14 of the articulated beam guiding tube 5 has a substantially vertical orientation. This ensures that during operation of the laser system 1, the articulated beam guiding tube 5 does not collide with the support arm 4. Such a collision could damage the articulated beam guiding tube 5 and / or the support arm 4, or could prevent positioning of the laser applicator 6 using the support arm 4.

[0143] Specifically, FIG. 11A to FIG. 11C How the first and second coupling members 58, 59 are positioned relative to each other is schematically shown for each of the three different configurations of the support arm 4. The joint between the first and second arm segments 13 and 14 of the articulated beam guiding tube 5 remains coupled to the second arm segment 11 of the support arm 1 for different inclinations of the second arm segment 11. Furthermore, since the articulated beam guiding tube extends between the laser applicator 6 and the location where the therapeutic laser beam is emitted from the first arm segment 8 of the support arm 4, the articulated beam guiding tube 5 can remain engaged with the linear guide even if the second arm segment is rotated about the vertical axis A2. However, it is to be noted that if the lateral guides have sufficient play, the articulated beam guiding tube 5 can be coupled to the second arm segment 11 even if the articulated beam guiding tube extends from the location where the therapeutic laser beam is emitted from the base 3.

[0144] Additionally or alternatively, it is also conceivable that the coupling device comprises a tension-transmitting connection.

[0145] The embodiments described above are merely illustrative and not limiting of the technical approach of the present invention. Although the present invention is described in detail with reference to the preferred embodiments, it will be understood by those skilled in the art that the technical approach of the present invention may be modified or replaced by equivalents without departing from the scope of protection of the claims of the present invention. In the claims, the word "comprising" does not exclude other elements or steps, and the indefinite article "a" does not exclude a plurality. Any reference numerals in the claims should not be interpreted as limiting the scope.

[0146] Before we proceed with reciting the claims, we first set forth the following items describing some salient features of certain embodiments of the present disclosure.

[0147] Item 1: An ophthalmic laser system for performing laser treatment of an eye, the laser system comprising: a base housing at least a portion of a laser source of the laser system, wherein the laser source is configured to generate a therapeutic laser beam for performing the laser treatment; a laser applicator, the laser applicator comprising an optical system through which the therapeutic laser beam exits the laser applicator in a direction toward the patient's eye; a support arm; and a controller; wherein the support arm is connected to the laser applicator at a first end of the support arm, and wherein the second end of the support arm (a) is connected to the base and / or (b) includes an interface for connecting the support arm to another component at the second end of the support arm; wherein the support arm is configured so that the laser applicator is positionable in three dimensions relative to the base while maintaining a vertical orientation of the laser applicator; and wherein the laser system also includes an electric three-axis positioning system, which is operably coupled to the controller for positioning the laser applicator in three dimensions relative to at least a portion of the support arm.

[0148] Item 2: A laser system according to item 1, wherein the laser applicator includes a manually operable control unit, which is operably coupled to the controller for performing positioning of the laser applicator relative to the support arm based on user input received via the control element.

[0149] Item 3: A laser system according to Item 1 or 2, wherein the laser applicator includes an imaging system for acquiring a frontal image of at least a portion of the patient's eye during at least a portion of the positioning of the laser applicator relative to the support arm.

[0150] Item 4: The laser system of Item 3, wherein the laser applicator includes a display device for displaying a frontal image at least during a portion of the positioning of the laser applicator relative to the support arm.

[0151] Item 5: A laser system according to any of the preceding items, wherein the laser applicator comprises an interaction measurement unit for generating an output signal, the output signal being dependent on a parameter of the mechanical interaction between the patient's eye and the laser applicator.

[0152] Item 6: A laser system according to Item 5, wherein the output signal depends on the force between the patient's eye and the laser applicator; and / or the interaction determination unit includes a force sensor, a strain sensor and / or a piezoelectric element.

[0153] Item 7: A laser system according to Item 5 or 6, wherein the laser applicator includes a display device, wherein the controller is configured to generate data representing graphic and / or text information using the output signal generated by the interactive measurement unit; and display the graphic and / or text information on the display device at least during a portion of the positioning of the laser applicator relative to the support arm.

[0154] Item 8: An ophthalmic laser system for performing laser treatment of an eye, the laser system comprising: a base, the base housing at least a portion of a laser source of the laser system, wherein the laser source is configured to generate a therapeutic laser beam for performing the laser treatment; a laser applicator, the laser applicator comprising an optical system, the therapeutic laser beam exiting the laser applicator toward a patient's eye through the optical system; a support arm, the support arm connected to the laser applicator at a first end of the support arm, and wherein the support arm (a) is connected to the base and / or (b) includes an interface for connecting the support arm to another component at a second end of the support arm; an articulated beam guide tube, wherein at least a portion of the articulated beam guide tube extends between a first position and a second position, in which the therapeutic laser beam exits the base or the support arm, and in which the therapeutic laser beam enters the support arm or the laser applicator; wherein the laser system comprises a coupling device for coupling the articulated beam guide tube to the support arm at one or more positions along the beam guide tube between the first position and the second position.

[0155] Item 9: The laser system of Item 8, wherein the coupling device comprises a tension transmitting connection.

[0156] Item 10: The laser system of Item 9, wherein the tension transmitting connection comprises a tension spring for transmitting the tension.

[0157] Item 11: Laser system according to any of items 8 to 10, wherein the coupling device comprises a guide, in particular a lateral guide.

[0158] Item 12: The laser system of Item 11, wherein the guide is configured to limit changes in the vertical orientation of a plane defined by successive arm segments of the articulated beam guide tube during movement of the laser applicator.

[0159] Item 13: A laser system according to any of the preceding claims, wherein the laser applicator includes an optical coherence tomography (OCT) system configured to acquire cross-sectional images of at least a portion of the eye.

[0160] Item 14: The laser system of Item 13, wherein the laser applicator comprises a beam combiner for combining a beam path of a measurement arm of the OCT system with a beam path of the therapeutic laser beam.

[0161] Item 15: The laser system of any of the preceding items, wherein the support arm comprises arm segments that are capable of rotating about a horizontal or substantially horizontal axis.

[0162] Item 16. The laser system of Item 15, wherein the arm segment comprises a parallel linkage.

[0163] Item 17: A laser system according to any of the preceding items, wherein the support arm includes a first arm segment and a second arm segment connected in series to each other via an intermediate joint; wherein the first arm segment is rotatable about a vertical or substantially vertical axis, and the second arm segment is rotatable about a horizontal or substantially horizontal axis.

[0164] Item 18: The laser system of Item 17, wherein the intermediate joint is configured to allow the second arm segment to rotate about the horizontal or substantially horizontal axis and about a vertical or substantially vertical axis.

[0165] Item 19: The laser system of Item 17 or 18, wherein the second arm section comprises a parallel linkage.

[0166] Item 20: The laser system of any of the preceding items, wherein the support arm includes a counterbalancing mechanism for providing gravity balance for the applicator head.

[0167] Item 21. The laser system of Item 20, wherein the support arm comprises one or more springs, wherein the support arm is configured to provide at least a portion of the gravity balance using the one or more springs.

[0168] Item 22: The laser system of any of the preceding items, wherein the support arm includes a braking and / or locking system for preventing movement of the second end of the support arm relative to the first end of the support arm.

[0169] Item 23: The laser system of Item 22, wherein the laser applicator comprises a manually operable control unit for selectively activating and deactivating the braking and / or locking system based on user input received via the control unit.

[0170] Item 24: A laser system according to Item 22 or 23, wherein the laser system includes an interaction measurement unit, which is configured to generate an output signal depending on the mechanical interaction between the patient's eye and the laser applicator; wherein the controller is operably connected to the interaction measurement unit and the brake; wherein the controller is configured to receive the output signal generated by the interaction measurement unit and determine whether to deactivate the braking and / or locking system based on the received output signal.

[0171] Item 25: The laser system of any of the preceding claims, further comprising an articulated beam guide tube, wherein at least a portion of the articulated beam guide tube extends between a first position on or within the base or an arm segment of the support arm and a second position on or within the laser applicator.

[0172] Item 26: The laser system of any of the preceding claims, wherein the support arm has a swivel joint having a vertically extending axis of rotation for rotating the laser applicator about an axis extending through the laser applicator.

[0173] Item 27: The laser system of Item 25 or 26, wherein the laser system comprises a locking system configured to lock the rotary joint having the rotation axis, the rotation axis extending through the laser applicator.

[0174] Item 28: A laser system according to any of the preceding items, wherein the laser applicator comprises: an objective lens for focusing the therapeutic laser beam within the eye and / or an axial scanning system for scanning the laser focus along the axis of the laser beam; and / or a beam deflection scanning system for scanning the laser beam by deflecting the laser beam.

[0175] Item 29: A method for positioning a laser applicator of an ophthalmic laser system relative to an eye of a patient, the method comprising: positioning the laser applicator relative to the patient's eye using a support arm, wherein the support arm is connected to a base of the ophthalmic laser system at a first end of the support arm; and wherein the support arm is connected to the base and / or is connectable to a fixed component at a second end of the support arm; wherein the base houses at least a portion of a laser source of the laser system, wherein the laser source is configured to generate a therapeutic laser beam for performing the laser therapy; wherein the support arm is configured such that the laser applicator is positionable relative to the base of the base while maintaining a vertical orientation of the laser applicator; and positioning the laser applicator relative to at least a portion of the support arm using an electrically powered three-axis positioning system.

[0176] Item 30: The method according to Item 29 further includes: acquiring a frontal image of the eye using an imaging system of the laser applicator; and displaying the frontal image on a display device of the laser system during at least a portion of the positioning of the laser applicator relative to the support arm.

[0177] Item 31: A method according to Item 30, wherein, during at least a portion of the positioning, the distance of the focal plane from the laser applicator substantially corresponds to a predetermined distance of the laser applicator from the patient's eye.

[0178] Item 32: The method according to any one of Items 29 to 31 further includes: generating an output signal by an interaction measurement unit, the output signal being dependent on the mechanical interaction between the patient's eye and the laser applicator; determining text and / or graphic information based on the output signal using a controller of the laser system; and displaying the text and / or graphic information at least during a portion of the time when the laser applicator is positioned relative to the support arm.

[0179] Item 33: The method according to any one of items 29 to 32 also includes: generating an output signal by an interaction measurement unit, wherein the output signal depends on the mechanical interaction between the patient's eye and the laser applicator; using a controller of the laser system and determining based on the output signal whether to deactivate a brake of the support arm, wherein the brake prevents movement of the second end of the support arm relative to the first end of the support arm.

[0180] Item 34: A method according to any one of items 29 to 33, wherein the output signal depends on the force between the patient's eye and the laser applicator; and / or the interaction determination unit includes a force sensor and / or a strain sensor.

[0181] Item 35: The laser system of any one of Items 1 to 7 further comprises an articulated beam guide tube, wherein at least a portion of the articulated beam guide tube extends between a first position and a second position, wherein in the first position the therapeutic laser beam exits from the base or the support arm, and in the second position the therapeutic laser beam enters the support arm or the laser applicator; wherein the laser system comprises a coupling device for coupling the articulated beam guide tube to the support arm at one or more positions along the beam guide tube between the first position and the second position.

[0182] Item 36. The laser system of Item 35, wherein the coupling device comprises a tension transfer connection.

[0183] Item 37. The laser system of Item 36, wherein the tension transmitting connection comprises a tension spring for transmitting the tension.

[0184] Item 38: Laser system according to any one of items 35 to 37, wherein the coupling device comprises a guide, in particular a lateral guide.

[0185] Item 39. The laser system of Item 38, wherein the guide is configured to limit changes in the vertical orientation of a plane defined by successive arm segments of the articulated beam guide tube during movement of the laser applicator.

Claims

1. An ophthalmic laser system for performing laser treatment of an eye, the laser system comprising: a base housing at least a portion of a laser source of the laser system, wherein the laser source is configured to generate a therapeutic laser beam for performing the laser therapy; a laser applicator including an optical system through which the therapeutic laser beam exits the laser applicator in a direction toward the patient's eye; a support arm; and a controller; wherein the support arm is connected to the laser applicator at a first end of the support arm, and wherein a second end of the support arm: (a) connected to the base and / or (b) comprising an interface for connecting the support arm to another component at the second end of the support arm; wherein the support arm is configured to enable the laser applicator to be positionable in three dimensions relative to the base while maintaining a vertical orientation of the laser applicator; and Wherein, the laser system further comprises an electric three-axis positioning system, which is operably coupled to the controller and is used to position the laser applicator in three dimensions relative to at least a portion of the support arm.

2. The laser system according to claim 1, wherein: The laser applicator includes a manually operable control unit operably coupled to the controller for performing positioning of the laser applicator relative to the support arm based on user input received via the control element.

3. The laser system according to claim 1 or 2, wherein: The laser applicator includes an imaging system for acquiring a frontal image of at least a portion of the patient's eye during at least a portion of the positioning of the laser applicator relative to the support arm.

4. The laser system according to claim 3, wherein: The laser applicator comprises a display device for displaying the frontal image at least during a portion of the positioning of the laser applicator relative to the support arm.

5. The laser system according to any one of the preceding claims, wherein: The laser applicator comprises an interaction measurement unit for generating an output signal depending on a parameter of a mechanical interaction between the patient's eye and the laser applicator.

6. The laser system according to claim 5, wherein: The output signal depends on the force between the patient's eye and the laser applicator; and / or the interaction determination unit comprises a force sensor, a strain sensor and / or a piezoelectric element.

7. The laser system according to claim 5 or 6, wherein: The laser applicator includes a display device, wherein the controller is configured to generate data representing graphic and / or text information using the output signal generated by the interactive measurement unit; and to display the graphic and / or text information on the display device at least during a portion of the positioning of the laser applicator relative to the support arm.

8. An ophthalmic laser system for performing laser treatment of an eye, the laser system comprising: a base housing at least a portion of a laser source of the laser system, wherein the laser source is configured to generate a therapeutic laser beam for performing the laser therapy; A laser applicator comprising an optical system through which the therapeutic laser beam exits the laser applicator toward an eye of a patient; a support arm connected to the laser applicator at a first end of the support arm, and wherein the support arm: (a) connected to the base and / or (b) comprising an interface for connecting the support arm to another component at the second end of the support arm; Articulated beam guide tube, wherein at least a portion of the articulated beam guide tube extends between a first position, in which the therapeutic laser beam exits the base or the support arm, and a second position, in which the therapeutic laser beam enters the support arm or the laser applicator; Wherein, the laser system comprises a coupling device for coupling the articulated beam guiding tube to the support arm at one or more positions along the beam guiding tube between the first position and the second position.

9. The laser system of claim 8, wherein: The coupling device comprises a tension transmitting connection.

10. The laser system of claim 9, wherein: The tension transmitting connection includes a tension spring for transmitting the tension.

11. The laser system according to any one of claims 8 to 10, wherein: The coupling device comprises a guide, in particular a lateral guide.

12. The laser system of claim 11, wherein: The guide is configured to limit changes in the vertical orientation of a plane defined by successive arm segments of the articulated beam directing tube during movement of the laser applicator.

13. The laser system according to any one of the preceding claims, wherein: The laser applicator includes an optical coherence tomography (OCT) system configured to acquire cross-sectional images of at least a portion of an eye.

14. The laser system of claim 13, wherein: The laser applicator comprises a beam combiner for combining the beam path of the measuring arm of the OCT system with the beam path of the therapeutic laser beam.

15. The laser system according to any one of the preceding claims, wherein: The support arm comprises arm segments which are rotatable about a horizontal or substantially horizontal axis.

16. The laser system of claim 15, wherein: The arm segment includes a parallel linkage mechanism.

17. A laser system according to any one of the preceding claims, wherein: The support arm comprises a first arm segment and a second arm segment connected to each other in series via an intermediate joint; wherein the first arm segment is rotatable about a vertical or substantially vertical axis and the second arm segment is rotatable about a horizontal or substantially horizontal axis.

18. The laser system of claim 17, wherein: The intermediate joint is configured to allow the second arm segment to rotate about the horizontal or substantially horizontal axis and about a vertical or substantially vertical axis.

19. The laser system according to claim 17 or 18, wherein: The second arm section includes a parallel link.

20. The laser system according to any one of the preceding claims, wherein: The support arm includes a counterbalancing mechanism for providing gravitational balance to the applicator head.

21. The laser system of claim 20, wherein: The support arm includes one or more springs, wherein the support arm is configured to provide at least a portion of the weight balance using the one or more springs.

22. The laser system according to any one of the preceding claims, wherein: The support arm comprises a braking and / or locking system for preventing movement of the second end of the support arm relative to the first end of the support arm.

23. The laser system of claim 22, wherein: The laser applicator comprises a manually operable control unit for selectively activating and deactivating the braking and / or locking system based on user input received via the control unit.

24. The laser system of claim 22 or 23, wherein: The laser system comprises: an interaction measurement unit configured to generate an output signal depending on the mechanical interaction between the patient's eye and the laser applicator; wherein the controller is operably connected to the interaction measurement unit and the braking and / or locking system; wherein the controller is configured to receive the output signal generated by the interaction measurement unit and determine whether to deactivate the braking and / or locking system based on the received output signal.

25. The laser system of any preceding claim, further comprising an articulated beam guide tube, wherein: At least a portion of the articulated beam directing tube extends between a first location on or in the base or arm segment of the support arm and a second location on or in the laser applicator.

26. A laser system according to any one of the preceding claims, wherein: The support arm has a swivel joint with a vertically extending axis of rotation for rotating the laser applicator about an axis extending through the laser applicator.

27. The laser system of claim 25 or 26, wherein: The laser system includes a locking system configured to lock the rotary joint having an axis of rotation extending through the laser applicator.

28. A laser system according to any one of the preceding claims, wherein: The laser applicator comprises: an objective lens for focusing the therapeutic laser beam within the eye and / or an axial scanning system for scanning the laser focus along the axis of the laser beam; and / or a beam deflection scanning system for scanning the laser beam by deflecting the laser beam.

29. A method of positioning a laser applicator of an ophthalmic laser system relative to an eye of a patient, the method comprising: positioning a laser applicator relative to the patient's eye using a support arm, wherein the support arm is connected to a base of the ophthalmic laser system at a first end of the support arm; and wherein the support arm is connected to the base and / or connectable to a fixing component at a second end of the support arm; wherein the base accommodates at least a portion of a laser source of the laser system; wherein the laser source is configured to generate a therapeutic laser beam for performing the laser therapy; wherein the support arm is configured to enable the laser applicator to be positionable relative to the base of the pedestal while maintaining a vertical orientation of the laser applicator; and wherein the laser applicator is positioned relative to at least a portion of the support arm using a motorized three-axis positioning system.

30. The method of claim 29, further comprising: acquiring a frontal image of the eye using an imaging system of the laser applicator; and displaying the frontal image on a display device of the laser system during at least a portion of the positioning of the laser applicator relative to the support arm.

31. The method according to claim 30, wherein: During said at least a portion of said positioning, the focal plane is at a distance from said laser applicator that substantially corresponds to a predetermined distance of said laser applicator from said patient's eye.

32. The method according to any one of claims 29 to 31, further comprising: generating, by an interaction measurement unit, an output signal that depends on a mechanical interaction between the patient's eye and the laser applicator; determining textual and / or graphical information based on the output signal using a controller of the laser system; and displaying the textual and / or graphical information during at least a portion of the positioning of the laser applicator relative to the support arm.

33. The method according to any one of claims 29 to 32, further comprising: An output signal is generated by the interaction measurement unit, the output signal being dependent on the mechanical interaction between the patient's eye and the laser applicator; a controller of the laser system is used to determine, based on the output signal, whether to deactivate a brake of the support arm, the brake preventing movement of the second end of the support arm relative to the first end of the support arm.

34. A method according to any one of claims 29 to 33, wherein: The output signal depends on the force between the patient's eye and the laser applicator; and / or the interaction determination unit comprises a force sensor and / or a strain sensor.

35. The laser system of any one of claims 1 to 7, further comprising an articulated beam guide tube, wherein: At least a portion of the articulated beam guide tube extends between a first position where the therapeutic laser beam is emitted from the base or the support arm and a second position where the therapeutic laser beam enters the support arm or the laser applicator; wherein the laser system includes a coupling device for coupling the articulated beam guide tube to the support arm at one or more positions along the beam guide tube between the first position and the second position.

36. The laser system of claim 35, wherein: The coupling device comprises a tension transmitting connection.

37. The laser system of claim 36, wherein: The tension transmitting connection includes a tension spring for transmitting the tension.

38. A laser system according to any one of claims 35 to 37, wherein: The coupling device comprises a guide, in particular a lateral guide.

39. The laser system of claim 38, wherein: The guide is configured to limit changes in the vertical orientation of a plane defined by successive arm segments of the articulated beam directing tube during movement of the laser applicator.

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