Laser system with balanced suspension for laser irradiation device and method of using the laser system

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 further includes a laser delivery device, the laser delivery device including optics for causing a treatment laser beam to exit the laser delivery device in a direction toward a patient's eye, and a support arm. The support arm is connected to the laser delivery device at a first end thereof and to a base at a second end thereof. The support arm is configured to position the laser delivery device in three dimensions relative to the base. The laser system further includes a motorized three-axis positioning system operatively coupled to a controller for positioning the laser delivery device 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 involve making incisions in the cornea or natural lens of the eye. The present invention also relates to a system for ablating a superficial portion of the cornea, such as photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) treatments. [Background technology]

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

[0003] The main steps of cataract surgery consist of making a corneal incision to gain access to the anterior chamber of the eye and an incision to correct astigmatism (limbal relaxing incision (LRI) or astigmatic keratotomy (AK)), cutting open the lens capsule to gain access to the lens (capsulotomy), fracturing the lens, removing the fractured lens through phacoemulsification, irrigation, and aspiration, and often placing an artificial intraocular lens in the eye.

[0004] Therefore, femtosecond laser-assisted cataract surgery is a multi-step process that includes femtosecond laser surgery (LRI, AK, corneal incision, capsulotomy, and lens fragmentation), phacoemulsification process (lens emulsification, liquefaction, and aspiration), and manual surgical procedure (implantation of intraocular lens).

[0005] However, when using conventional femtosecond laser systems, this typically requires the patient to be transferred from a standard patient table to a separate, stationary patient support that is part of the femtosecond laser system and specifically adapted for performing the laser surgery steps, but such patient transfer procedures complicate clinical workflow and are uncomfortable for the patient.

[0006] Furthermore, to reduce footprint and cost, it is desirable for a femtosecond laser system configured for cataract surgery to also be used to create the corneal flap for laser in situ keratomileusis (LASIK). However, the femtosecond laser for creating the LASIK flap should be located near the excimer laser system to allow for easy patient transfer from one system to the other. On the other hand, the femtosecond laser 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 enables efficient clinical workflow. Summary of the Invention

[0008]

[0003] An embodiment of the present invention relates to an ophthalmic laser system for performing laser treatment on an eye. The laser system includes a base housing at least a portion of a laser source of the laser system, the laser source configured to generate a therapeutic laser beam for performing the laser treatment. The laser system further includes a laser delivery device, the laser delivery device including optics for directing the therapeutic laser beam toward a patient's eye. The laser system further includes a support arm and a controller. The support arm is connected to the laser delivery device at a first end thereof. A second end of the support arm may be connected to a base, and additionally or alternatively, the support arm includes an interface at the second end thereof for connecting the support arm to an additional component. The support arm may be configured to allow the laser delivery device to be three-dimensionally positionable relative to the base. The laser delivery device may be positionable while maintaining a vertical orientation of the laser delivery device. The laser system may further include a motorized three-axis positioning system operatively coupled to the controller to position the laser delivery device relative to at least a portion of the support arm or the entire support arm. The positioning system may be configured to allow the laser delivery device to be three-dimensionally positionable.

[0009] The laser system may include an articulating beam conduit, at least a portion of which may extend between a first location where the therapeutic laser beam exits the base or support arm and a second location where the therapeutic laser beam enters the support arm or laser delivery device, and the laser system may include a coupling device for coupling the articulating beam conduit to the support arm at one or more locations along the beam conduit between the first and second locations.

[0010] The support arm may be connected to the laser irradiation device at a first end. The second end of the support arm may be connected to the base and / or may be connectable 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 base, or a wall, ceiling, or floor of a building.

[0011] The base of the laser system may be configured as a movable base that can move along a floor surface. The movable base may include multiple wheels, such as four wheels, for moving the base along a floor surface. The movable base may be configured so that the entire laser surgery system can be moved along the floor by a single person. The support arm and the laser irradiation device may be supported solely 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, greater than 10 nanojoules, or greater than 50 nanojoules. The pulse energy may be less than 20 microjoules, less than 15 microjoules, or less than 10 microjoules. The pulse duration of the pulsed laser beam may be less than 800 femtoseconds, less than 500 femtoseconds, less than 300 femtoseconds, 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 50 kHz or greater than 80 kHz. The repetition rate of the pulsed laser beam may be less than 10 MHz or less than 1 MHz. The central wavelength of the pulsed laser beam incident on the eye may be in the range between 800 nanometers and 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 may be configured such that the laser pulse has a pulse energy such that the laser beam causes photodisruption in the corneal tissue or natural lens of the patient's eye. The photodisruption may be caused by laser-induced optical breakdown. Alternatively, the pulse energy of the laser pulse may be below the threshold for causing laser-induced optical breakdown. For example, multiple pulses having pulse energies below the threshold for causing laser-induced optical breakdown may be superimposed to cause tissue separation within the cornea.

[0014] The infrared laser source may include a precompensator for at least partially precompensating for changes in group delay dispersion (GDD) of the laser pulse induced by components of the laser optics in the beam path of the laser beam downstream from the laser source. When a laser pulse has a positive GDD, longer wavelengths of the laser pulse propagate faster than shorter wavelengths. Therefore, because red wavelengths experience a lower refractive index than blue wavelengths, positive group delay dispersion corresponds to material dispersion that is typical in transparent media. The precompensator may be configured to reduce group delay dispersion. For example, the reduced group delay dispersion produced by the precompensator may have less positive or more negative group delay dispersion.

[0015] The lateral diameter of the focal point of the treatment laser beam of the infrared laser source within the cornea or lens may be less than 10 micrometers, or less than 6 micrometers. The diameter may be greater than 3 micrometers. The lateral diameter may be measured perpendicular to the optical axis of the laser optics. The lateral diameter may be measured as the diameter of the 80% circle of energy.

[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 focuses on the front surface of the eye. The wavelength of the treatment 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 treatment laser beam generated by the excimer laser source may be less than 100 ns or less 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 that stores instructions processable 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 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 scan path of the pulsed laser beam to scan a laser focal point on or in the cornea or natural lens of the patient's eye. The controller may be configured to determine the scan path based on patient-specific data.

[0019] The controller may be configured to generate the scan pattern such that the laser pulses overlap or do not overlap. The lateral displacement between adjacent laser pulses may be less than 30 micrometers, or less than 20 micrometers, or less than 10 micrometers. The displacement may be greater than 0.5 micrometers, or greater than 1 micrometer.

[0020] The laser source may include an oscillator laser configured to generate a train of low-energy ultrashort pulses. The pulse energy of the low-energy ultrashort pulses may be less than 100 nJ, 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, the oscillator laser may be located within the base, and an amplifier for the laser source and / or a pre-compensator configured to reduce group delay dispersion of the treatment laser beam may be located within the laser delivery device. Alternatively, the base may house the entire laser source, including the oscillator laser, amplifier, and pre-compensator.

[0022] The base may include one or more housings, each housing housing 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, particularly a regenerative amplifier or a fiber amplifier.

[0023] The support arm may include one or more arm sections. The support arm may include multiple arm sections connected in series. Adjacent arm sections of the support arm may be connected via one or more joints. An arm section may be defined as a single member of the support arm that provides a non-articulating connection between a first end of the arm section and a second end of the arm section. An arm section may provide a rigid or extendable connection between the first end of the arm section and the second end of the arm section. At one or both ends of the arm section, the arm sections may be attached to a joint or integrally connected. The term "integrally connected" means that a first element / feature extends or transitions continuously from a second element / feature and is not two separate and distinct elements.

[0024] The support arm may include at least one arm section forming part of a multi-bar linkage of the support arm. The multi-bar linkage may be configured such that an orientation of a first end of the multi-bar linkage relative to a second end of the multi-bar linkage is maintained during movement of the first end relative to the second end. The multi-bar linkage may be a parallel linkage and / or a four-bar linkage. The multi-bar linkage may be counterbalanced to provide at least partial gravity balance for the laser delivery device.

[0025] The arm sections may be connected in series via rotary joints. Each rotary joint may be configured to allow the orientation of adjacent arm sections relative to one another to be adjustable. Each rotary joint may have one or two rotation axes. The support arm may include at least one multi-axis joint having two or more rotation axes. The rotation axes may be substantially perpendicular or oriented perpendicular to one another. One of the two rotation axes may be substantially oriented along a vertical direction or oriented along a vertical direction.

[0026] The support arm may be configured such that the distance measured along a horizontal line between the laser emitter and the point where the support arm connects to the base is adjustable. The maximum horizontal distance between the base and the tip of the emitter may be greater than 50 centimeters, or greater than 10 centimeters. The distance may be less than 5 meters, or less than 3 meters.

[0027] The support arm may further be configured to allow the laser application device to move along an arc-shaped or substantially arc-shaped path of travel. The arc may lie in a horizontal plane or substantially in a horizontal plane. The radius of the arc may be greater than 10 centimeters or greater than 50 centimeters. The radius may be less than 5 meters or less than 3 meters. The radius may be defined by the longitudinal extent of one arm section of the support arm, the support arm being configured to allow the arm section to rotate about a horizontal axis of rotation and / or a vertical axis of rotation. Alternatively, the support arm may be configured to allow the arm section to rotate about a substantially horizontal axis of rotation and / or a substantially vertical axis of rotation. The arm section may be part of a multi-bar linkage, particularly a four-bar linkage or a parallel linkage. Additionally or alternatively, the arm section may be counterbalanced to provide at least partial gravity balance for the laser application device.

[0028] The positioning system may include guides, particularly linear guides, for each of the three axes. The axes of the positioning system may be perpendicular to one another. The positioning system may be configured as an XYZ positioning system, with the Z axis being the vertical or substantially vertical axis. Each guide may be configured as a sliding guide and / or a roller guide. Each guide may include two mating guide members. The first guide member may be configured as a rail, may form a guide track, and / or may define a guide path. The second guide member may be configured as a carriage and / or may be configured to be movable along the guide path and / or the guide track. The carriage may be a sliding carriage and / or a roller carriage.

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

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

[0031] For one or more or each of the axes, the positioning rate may be user adjustable, either continuously or in steps. The laser system may be configured to receive user input to adjust the positioning rate of one or more or each of the axes of the positioning system.

[0032] The positioning system may be located between the support arm and the laser irradiation device, but it is also conceivable that the positioning system is part of the support arm.

[0033] According to one embodiment, the laser delivery device includes a manually operable control operatively coupled to the controller for positioning the laser delivery device relative to at least a portion of the support arm based on user input received via the control element. The manually operable control may be configured for directional control, particularly three-dimensional directional control. By way of example, the manually operable control may include a joystick and / or one or more buttons. Each button may correspond to a direction of movement.

[0034] According to a further embodiment, the laser application device comprises 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 application device 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 front image is in focus. Additionally or alternatively, the image processing algorithm may be configured to determine one or more parameters dependent on or indicative of the level of focus of at least a portion of the image. The image processing algorithm may include a segmentation algorithm for segmenting the front image. The image processing algorithm may determine one or more parameters dependent on or indicative of the level of focus of one or more image regions of the segmented image regions.

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

[0037] According to a further embodiment, the laser application device comprises a beam combiner for combining an imaging beam path of the imaging system and a beam path of the treatment laser beam.

[0038] The beam combiner may be configured to deflect the treatment laser beam toward or substantially toward the eye. The beam combiner may include a mirror 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 from the focusing optics, within the focusing optics, or upstream from the focusing optics.

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

[0040] According to one embodiment, the laser application device includes a display device for displaying a front image during at least a portion of positioning of the laser application device relative to the support arm. The display device may be mounted on or integrated into a housing of the laser application device. The display may be viewable by a user during operation of the manually operable control elements.

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

[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 irradiating device. The sensors may be distributed circumferentially at equal angles around the optical axis of the laser irradiating device. Additionally or alternatively, the sensors may be positioned at the same or substantially the same radial distance from the optical axis of the laser irradiating device.

[0043] The measured parameter of the mechanical interaction may depend on or be a force or a directional component of the force. The force may occur between the patient's eye and the laser irradiation device. Additionally or alternatively, the measured mechanical interaction may depend on or be a change in the force between the patient's eye and the laser irradiation device over time.

[0044] The interaction measuring unit may include a plurality of interaction measuring sensors, one or more of which may include a force sensor, a piezoelectric sensor and / or a strain gauge.

[0045] The interaction measurement unit may be configured to measure the magnitude of the projection of the force vector onto the optical axis of the laser irradiation device (i.e., the cross section of the optical axis at the point where the treatment laser beam exits the laser irradiation device towards the patient's eye) and / or the magnitude of the projection of the force vector onto a plane perpendicular to the optical axis.

[0046] The strain gauge may be configured to measure strain in a sensing material caused by a force. The strain may be compressive or tensile. The strain gauge may be configured as a foil gauge, a semiconductor gauge (utilizing the piezoresistive effect), or a capacitive strain gauge. The piezoelectric sensor may utilize 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 contemplated that the force sensor may include an interferometric strain sensor or measure forces acting on a birefringent material. It is also contemplated that the force sensor may be a fiber optic force sensor.

[0047] The force sensor may be positioned in the force path between the patient's eye and the optics that focus the treatment laser beam into the patient's eye.

[0048] According to a further embodiment, the laser irradiating device includes a display device. The controller may be configured to generate data representing graphical and / or textual information using the output signal generated by the interaction measurement unit. Additionally or alternatively, the controller may be configured to display the graphical and / or textual information on the display device during at least a portion of positioning of the laser irradiating device 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 irradiation device 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 one embodiment, the coupling device comprises a tension force transmission connection, which may comprise a tension spring for transmitting the tension force.

[0052] According to a further 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 the coupling member of the coupling device relative to the longitudinal axis of the arm section of the support arm. The coupling member may be rigidly attached or integrally connected to the articulating beam conduit.

[0053] The lateral guides may guide movement of the linking members in a direction parallel or substantially parallel to the longitudinal axis of the arm sections of the support arm. The guides may be configured to limit variation in the longitudinal orientation of a plane defined by successive arm sections of the articulating beam conduit during movement of the laser delivery device.

[0054] According to a further embodiment, the laser application device includes an optical coherence tomography (OCT) system configured to obtain a cross-sectional image of at least a portion of the eye.

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

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

[0058] According to one embodiment, the support arm includes an arm section that is rotatable about a horizontal or substantially horizontal axis. According to a further embodiment, the arm section is part of a multi-bar linkage, such as a parallel linkage, in particular a four-bar linkage. The multi-bar linkage may be configured such that the vertical orientation of the laser irradiation device is maintained during rotation of the arm section about the horizontal axis.

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

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

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

[0062] According to a further embodiment, the support arm comprises a counterbalance mechanism for providing at least partial gravitational counterbalance to the tip of the irradiation device.

[0063] According to a further embodiment, the balancing mechanism includes one or more springs, each of which may be configured as a gas spring or as a mechanical spring.

[0064] According to a further 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 include a lockable joint and / or a brake for braking movement of the parts of the joint relative to one another. The locking mechanism of the lockable joint may be based on positive locking of the members of the joint that are otherwise movable relative to one another.

[0065] According to a further embodiment, the laser application device includes a manually operable control for selectively activating and deactivating the braking and / or locking system based on user input received therethrough.

[0066] According to a further embodiment, the laser system includes an interaction measurement unit configured to generate an output signal dependent on a mechanical interaction between the patient's eye and the laser irradiation device. A controller may be operatively 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 conduit may include one or more joints, each joint connecting adjacent longitudinal pipe sections. Each pipe element may define a linear laser beam path extending along the longitudinal axis of the pipe section. For each pipe section, the respective pipe section may be rigid or may be extensible along the longitudinal axis of the respective pipe element.

[0068] Each joint of the articulating beam conduit may include a mirror system, which may include one or more mirrors, configured to deflect a treatment laser beam emitted from a first of adjacent pipe elements connected to the joint into a second of the adjacent pipe elements.

[0069] According to a further embodiment, the support arm or the laser application device has a rotary joint having a vertically extending axis of rotation for rotating the laser application device relative to at least a portion of the support arm about a vertical axis.

[0070] According to a further embodiment, the laser system comprises a locking system configured to lock a revolute joint having a vertically extending axis of rotation.

[0071] According to further embodiments, the laser irradiation device includes a focusing optical system for focusing the therapeutic laser beam into 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 through deflection of the laser beam.

[0072] A further embodiment of the present disclosure relates to a method for positioning a laser delivery device of an ophthalmic laser system relative to a patient's eye. The method includes positioning the laser delivery device relative to the patient's eye using a support arm. The support arm may be connected to the laser delivery device at a first end of the support arm. A second end of the support arm may (a) be connected to a base and / or (b) include an interface at the second end of the support arm for connecting the support arm to an additional component. The laser system may be configured to generate a therapeutic laser beam for performing laser treatment. The support arm may be configured such that the laser delivery device is positionable relative to the base while maintaining a vertical orientation of the laser delivery device. The method may further include positioning the laser delivery device relative to the support arm using a motorized three-axis positioning system.

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

[0074] According to a further embodiment, during said part of the positioning, the distance of the focal plane from the laser irradiation device substantially corresponds to a predetermined distance of the laser irradiation device from the patient's eye, in particular from the cornea of ​​the patient's eye.

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

[0076] The time interval during which the front image is displayed and the time interval during which the textual information and / or iconographic information based on the output signal of the interaction unit may be identical, overlap, or may not overlap.

[0077] According to a further embodiment, the method includes an interaction measurement unit generating an output signal dependent on a mechanical interaction between the patient's eye and the laser delivery device, and may also include using a controller of the laser system to determine, based on the output signal, whether to deactivate a brake on the support arm that prevents movement of the second end of the support arm relative to the first end of the support arm. [Brief explanation of the drawings]

[0078] [Figure 1] FIG. 1 is a perspective view of a laser system according to an exemplary embodiment. [Figure 2] 2 is a second perspective view of the laser system according to the exemplary embodiment shown in FIG. 1 with the support arm in a rest position. [Figure 3] 2 is a schematic diagram of the laser system of the exemplary embodiment shown in FIG. 1, showing the extent of the lateral movement range of the laser irradiation device of the laser system of the exemplary embodiment shown in FIG. 1. FIG. [Figure 4] 2 is a further schematic top view of the laser system according to the exemplary embodiment shown in FIG. 1. [Figure 5] 2 is a schematic side view of a support arm and a laser irradiation device of the laser system according to the exemplary embodiment shown in FIG. 1. [Figure 6] 2 is a schematic diagram of information displayed on a display device of a laser irradiation device of the laser system according to the exemplary embodiment shown in FIG. 1. [Figure 7] 2 is a schematic diagram of an imaging system, an OCT system, and a beam combiner disposed within a laser irradiation unit of the laser system according to the exemplary embodiment shown in FIG. 1. FIG. [Figure 8-1] 8A is a schematic diagram of an interaction measurement unit of a laser irradiation device of the laser system according to the exemplary embodiment shown in FIG. 1. FIG. [Figure 8-2] 8B is a schematic diagram of an interaction measurement unit of the laser irradiation device of the laser system according to the exemplary embodiment shown in FIG. 1. FIG. [Figure 9] 2 is a schematic diagram of information displayed on a display device of a laser irradiation device of the laser system according to the exemplary embodiment shown in FIG. 1. [Figure 10] 2 is a schematic diagram of a parallel linkage and balancing mechanism of the support arm of the laser system according to the exemplary embodiment shown in FIG. 1. FIG. [Figure 11] 11A-11C are side views of a support arm and an articulating beam conduit of a laser system, and a coupling device for coupling the articulating beam conduit to the support arm of a laser system according to an example embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0079] 1 is a schematic diagram of an exemplary embodiment of an ophthalmic laser system 1 for performing laser treatments of the eye, which may include, but are not limited to, creating flaps for laser in situ keratomileusis (LASIK) treatments, creating corneal incisions and limbal relaxing incisions (LRI, AK), performing capsulotomy (particularly anterior capsulotomy), and lens fragmentation.

[0080] Laser system 1 includes a laser source configured to generate a therapeutic laser beam for performing laser therapy. At least a portion of the laser source is mounted within housing 2 of base 3. An additional portion of the laser source may be located within laser delivery device 6, which is supported by and / or within articulated support arm 4 that supports laser delivery device 6. It is also contemplated that base 3 may include two or more housings, each housing housing a portion of the laser source. For example, a first housing of base 3 houses an oscillator laser of the laser source, and a second housing of the base houses an amplifier and / or pre-compensator of the laser source.

[0081] The laser system 1 includes laser optics configured to direct a laser beam to a patient's eye positioned on a patient couch or support (not shown in FIG. 1 ). A laser source generates a treatment laser beam, which is guided by the laser optics through a portion of the support arm 4, an articulated beam conduit 5, and a laser delivery device 6. The articulated beam conduit 5 extends at least between a first location where the laser beam exits the support arm 4 and a second location where the laser beam enters the laser delivery device 6. However, the present disclosure is not limited to such a configuration for directing the treatment laser beam from the base 3 to the patient's eye. By way of example, the laser beam may be guided through the entire support arm. In particular, the laser system may be configured without a beam conduit. It is also contemplated that the articulated beam conduit 5 extends at least between a first location where the treatment laser beam exits the base 3 and a second location where the treatment laser beam enters the support arm 4 or the laser delivery device 6. Portions of the articulating beam conduit may be located in the base 3, in the support arm 4 and / or in the laser irradiation device 6.

[0082] In the exemplary embodiment shown in FIG. 1 , the laser source is configured to emit a pulsed laser beam having a pulse energy and pulse duration sufficient to cause laser-induced optical breakdown (LIOB) in the cornea or natural lens of the patient's eye. The laser-induced optical breakdown caused by the laser pulse leads to photodisruption, whereby a series of overlapping or closely spaced consecutive laser pulses create cuts in the corneal tissue or natural lens. Photodisruption is a non-thermal process. The laser optics includes a scanning system configured to scan the focal point of the pulsed laser beam into the eye to form a perforated cut or a continuous (i.e., non-perforated) cut. In the exemplary embodiment shown in FIG. 1 , the scanning system is disposed within the laser irradiation device 6. However, it is also contemplated that at least a portion of the scanning system may be disposed within the base 3 and / or the support arm 4.

[0083] It should be noted that the present disclosure is not limited to the above-described laser treatments and laser systems. Specifically, the laser system may be configured to controllably ablate corneal tissue without causing significant damage to adjacent and / or underlying ocular tissue. The laser system may emit light having a wavelength greater than 150 nm or greater than 190 nm. The wavelength may be less than 400 nm or less than 200 nm. By way of example, the laser source may be configured as an excimer laser source. The laser system may be an argon fluoride (ArF) excimer laser that generates pulses of laser light having a wavelength of substantially 193 nm. Laser ablation processes may be used to reshape the cornea. Such ablation treatments may include, but are not limited to, photorefractive keratectomy (PRK), laser assisted subepithelial keratomileusis (LASEK), laser in situ keratomileusis (LASIK), and phototherapeutic keratectomy (PTK). In each of these procedures, a laser beam can be used to remove a predetermined amount of corneal stroma and Bowman's membrane located beneath the corneal epithelium to form a reshaped surface portion.

[0084] 1, the laser source is located in the base. However, it is also conceivable that only a portion of the laser source is located in the base and a second portion of the laser source is located in the laser irradiation device 6 or in the support arm 4. By way of example, an oscillator laser of the laser source may be located in the base and a regenerative amplifier and / or pre-compensator of the laser source may be located in the laser irradiation device and / or the support arm.

[0085] Using the support arm 4, the laser irradiation device 6 can be positioned in three dimensions. The support arm 4 may be configured to allow manual positioning of the laser irradiation device 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. A three-axis motorized positioning system 9 is arranged between the support 4 and the laser irradiation device 6. The positioning system 9 may be configured so that the laser irradiation device 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 irradiation device and a portion of the support arm 4 are positionable relative to a further portion of the support arm 4. By way of example, the positioning system 9 may be arranged between two arm sections or may be part of an arm section of the support arm 4.

[0086] For example, as will be explained in more detail below, the positioning system 9 is used in a fine positioning procedure after the laser irradiation device 6 has been positioned using the support arm 4 in a coarse positioning procedure.

[0087] The positioning system 9 may be operatively coupled to a controller (not shown in FIG. 1 ). The controller may be located within the base 3. However, it is also contemplated that the controller may be located in a housing that is separate from the base 3 and separate from the laser irradiation device 6. The controller may be connected to components of the base 3, the positioning system 9, and / or the laser irradiation device 6 via wired or wireless connections.

[0088] The laser irradiation device 6 may further include a manually operable control unit 10, which is operatively coupled to a controller for positioning the laser irradiation device 6 relative to a portion of the support arm 4 or the entire support arm 4 using a 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 (as shown in FIG. 1 , for example). 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 representing a direction of movement of the laser irradiation device 6.

[0089] The configuration of the ophthalmic laser system according to the exemplary embodiment allows for the positioning of the laser delivery device relative to the patient so that the patient can remain on the normal patient couch on which the patient has received pre-operative treatment, thereby avoiding patient movement that would otherwise be required to transfer the patient from the normal patient couch to a separate, stationary patient support that is part of the laser system and is specifically provided for performing the laser surgical steps.

[0090] For this reason, the surgical laser system of the present disclosure not only improves the efficiency of clinical workflow, but also reduces the footprint required in the operating room because space is not required for a fixed patient support dedicated to performing laser surgery. Additionally, a mobile laser surgery system also facilitates cleaning and sterilization of the operating room.

[0091] Furthermore, to reduce footprint and cost, it is desirable for a femtosecond laser system configured for cataract surgery to also be used to create a corneal flap for laser in situ keratomileusis (LASIK). However, the femtosecond laser for creating the LASIK flap is preferably located near the excimer laser system so that the patient can easily move from one system to the other. Meanwhile, the femtosecond laser for cataract surgery is preferably located in a sterile operating room where the natural lens is emulsified using a phacoemulsification device and the intraocular lens is implanted. The laser system according to the exemplary embodiment is a mobile laser system that can be easily moved between various locations within a hospital. Furthermore, the articulating support arm allows surgeons to more flexibly position the laser system within a surgical operating room, where many other devices, such as a surgical microscope, a phacoemulsification system, and operating room trolleys, must be located and where there must be sufficient space for one or more surgeons or other medical personnel.

[0092] As shown in FIG. 1 , as well as the schematic top view of FIG. 4 and the schematic side view of FIG. 5 , the support arm 4 may be configured as an articulated support arm having two or more arm sections connected in series. The support arm 4 may include a first arm section 8 and a second arm section 11. The first arm section 8 may be rotatably supported by the base 3 such that the first arm section 8 is rotatable about a first vertical axis A1. The first vertical axis A1 may have a fixed position and orientation relative to the base 3. Additionally or alternatively, the base may be configured such that the position, particularly the height and / or orientation (rotation), of the first arm section 8 relative to the base 3 is adjustable. For example, the base 3 may be configured such that the first arm section is supported by the base using a rotational bearing assembly (not shown in FIG. 1 ) that rotatably supports the first arm section 8 about the first vertical axis A1. The base 3 may be configured so that the height of the rotary bearing assembly relative to the rest of the base 3 is adjustable, for example using a motorized height adjustment mechanism.

[0093] The first arm section 8 may be connected to the second arm section 11 via an intermediate joint 12. The intermediate joint 12 may be configured to allow the orientation of the second arm section 11 relative to the first arm section 8 to be adjustable in two dimensions. By way of example, the intermediate joint 12 may be configured to allow the second arm section 11 to rotate about a vertical axis A2 and a horizontal axis A3.

[0094] The support arm 4 is configured so that the laser irradiation device 6 has the same vertical orientation before and after rotation of the second arm section 11 about the horizontal axis A3. In the exemplary embodiment, rotation of the second arm section 11 about the horizontal axis A3 is coupled to the orientation of the laser irradiation device 6 relative to the second arm section. This coupling is a mechanical coupling achieved through a multi-bar linkage of the support arm 4, which may be configured as a parallel linkage. Two or more parallel bars of the parallel linkage may form the second arm section 11. However, it is also conceivable that the second arm section 11 and / or the laser irradiation device 6 may include a tilt sensor for measuring the tilt of the second arm section 11 and / or the laser irradiation device 6 relative to a horizontal plane. A controller may be provided that receives output signals from the one or more tilt sensors and controls adjustment of the vertical orientation of the laser irradiation device 6 based on the measured tilt. Adjustment of the vertical orientation may be performed using a motor driving a rotary joint. It is also conceivable that the connection between the second arm section 11 and the laser irradiation device 6 is configured so that the vertical orientation of the laser irradiation device 6 is maintained by gravity acting on the laser irradiation device 6.

[0095] The parallel linkage may be configured such that a distal end of the parallel linkage (i.e., distal to the base 3) maintains a vertical orientation regardless of the orientation of the second arm section 11 relative to the horizontal plane. An example of a parallel linkage is described below with reference to FIG. 10.

[0096] 1, 4, and 5, the laser irradiation device 6 can rotate relative to the support arm 4 about a vertical rotation axis A6. The vertical rotation axis A6 may extend through the laser irradiation device 6, particularly through the housing 22 of the laser irradiation device 6. However, it is also possible that the vertical rotation axis A6 does not extend through the laser irradiation device 6. Rotating the laser irradiation device about the vertical rotation axis A6 changes the orientation of the laser irradiation device 6 relative to the support arm 4.

[0097] Rotating the laser irradiator 6 relative to at least a portion of the support arm 4 allows the surgeon to adjust the orientation of the laser irradiator 6 relative to the patient's eye during a coarse positioning procedure so that the positioning of the laser irradiator 6 relative to the patient's eye is not hindered by spatial constraints dictated by the patient's anatomy. Additionally or alternatively, the laser system may be configured such that the laser irradiator 6 is rotatable relative to the support arm about a horizontal axis relative to at least a portion of the support arm (not shown in FIGS. 4 and 5 ). In addition to the laser irradiator 6 being rotatable about a horizontal axis, the laser system may be configured such that the laser irradiator 6 is rotatable about a roll axis that is stationary relative to the laser irradiator 6, i.e., is stationary relative to different rotational positions of the laser irradiator 6 obtained by rotation about a vertical and / or horizontal axis (not shown in FIGS. 4 and 5 ). This provides even greater flexibility for adjusting the orientation of the laser irradiator 6 relative to the patient.

[0098] The laser system according to the exemplary embodiment 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. Specifically, this allows a surgeon to perform a coarse positioning procedure by manually positioning the laser irradiation device 6 at a location near the patient's head. After the coarse positioning procedure, the surgeon activates the braking and / or locking system of the support arm so that the positioning system 9 can be used in the blocked state to perform a fine positioning procedure.

[0099] In the exemplary embodiment, the laser irradiation device 6 includes one or more manually operable control elements 18a, 18b that allow the surgeon to deactivate a braking and / or locking system so that the support arm 4 can be used to position the tip of the irradiation device at another location. In the exemplary embodiment, the laser irradiation device includes two handles 17a, 17b (shown in FIG. 4 ) that can be grasped with the surgeon's hands. Each handle is provided with a release button 18a, 18b. When the surgeon presses both release buttons simultaneously, the braking and / or locking system is deactivated, allowing the surgeon to position the laser irradiation device 6 in three dimensions. For simplicity of illustration, the handles 17a, 17b and the release buttons 18a and 18b are not shown in FIGS. 1 and 2 .

[0100] The laser system according to the exemplary embodiment is configured to allow the laser delivery device to be positioned relative to the patient's head by performing a coarse positioning procedure in which the laser delivery device 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 delivery device 6 is positioned in its final position relative to the patient's head where the laser treatment will be performed.

[0101] The coarse positioning procedure using the support arm 4 allows the surgeon to perform quick and efficient coarse positioning relative to the patient's head. Manual adjustability also provides improved patient safety, as the surgeon can quickly move the laser delivery device 6 away from the patient's head if necessary. However, it is contemplated that one or more joints of the support arm may be motorized so that coarse positioning is performed fully or partially using motors (i.e., using manual positioning).

[0102] As described in more detail below, the fine positioning procedure may be performed based on images from an imaging system that is part of the laser irradiation device 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 irradiation device 6.

[0103] FIG. 6 schematically illustrates the information displayed on the display device 19 of the laser irradiation device 6 during the coarse positioning procedure. As can be seen from FIG. 6, the surgeon views an image generated by an imaging system provided within the laser irradiation device 6 on the display device 19. The imaging system acquires a front image 20 of the patient's eye using a fixed object plane distance. The object plane distance is adjusted to correspond to the desired predetermined distance between the laser irradiation device and the patient's eye. Thus, using the front image of the eye, the surgeon can control the lateral position of the laser irradiation device using the three-axis positioning system so that the center of the crosshairs 24 is centered at the center of the eye's pupil. Furthermore, by adjusting the vertical position of the laser irradiation device 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 irradiation device so that the distance between the laser irradiation device 6 and the patient's eye matches the desired predetermined distance.

[0104] The above coarse positioning procedure may be performed with the suction ring and contact element (described below with reference to FIGS. 7 and 8A) attached to the eye. The laser delivery device 6 and contact element may be configured so that the iris and limbus are displayed in the front image 20. By way of example, the surgeon may determine whether the front image 20 is in focus based on some or all of these features.

[0105] The controller of the laser system may include an image processing algorithm configured to determine whether at least a portion of the frontal image 20 is in focus and / or to determine one or more parameters dependent on or indicative of a level of focus of at least a portion of the frontal image 20. As an example, the portion of the frontal image 20 may be an 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 dependent on or indicative of a level of focus of one or more image regions of the segmented image regions. As an example, the segmented image regions may represent the iris of the patient's eye.

[0106] The controller may be configured to display graphical and / or textual information on the display device 19 based on the determined parameters.

[0107] The placement of the imaging system within the laser delivery device 6 is described below with reference to Figure 7. The laser delivery device 6 includes a beam combiner 26. The beam combiner 26 is in the beam path of the treatment laser beam 27 between a scanning system (not shown in Figure 7) and a contact element 28 of the patient interface. The contact element 28 includes a concave contact surface that contacts the anterior surface of the cornea during treatment. It is noted that the concave shape of the contact element 28 shown in Figure 7 is only an example, and that the contact surface of the contact element 28 could be planar or convex toward the eye.

[0108] The beam combiner 26 may be located in the beam path of the treatment laser beam 27 between the two components 30a and 30b of the focusing optics 36, as shown in FIG. 7. The focusing optics 36 is also located within the laser delivery device 6. It is also conceivable that the laser delivery device includes at least a portion of a scanning system for three-dimensionally scanning the focal point of the treatment laser beam within the eye. The scanning system may include an axial scanning system for scanning the laser focal point along the axis of the laser beam and / or a beam deflection scanning system for scanning the laser beam through deflection of the laser beam.

[0109] Each of components 30a and 30b may include one or more optical elements, such as lenses, although the present disclosure is not limited to such configurations. It is also contemplated that beam combiner 26 may be in the beam path of treatment laser beam 27 either between the scanning system and the focusing optics or between the focusing optics and contact element 28.

[0110] 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. As shown schematically in FIG. 7 , the beam combiner 26 may be configured to combine the beam path of the laser beam 27 on the one hand with the measurement beam path 31 of an optical coherence tomography (OCT) system 32 and the imaging beam path 33 of an imaging system 34 on the other hand. The imaging system may have a two-dimensional photosensitive imaging sensor. The photosensitive image sensor may have a two-dimensional array of photosensitive pixels. The optical interference imaging system may be configured to acquire cross-sectional images of the cornea and / or natural lens of the eye. The imaging system having an imaging sensor may be configured to acquire two-dimensional frontal images of the eye.

[0111] In the eye treatment system according to the exemplary embodiment, the measurement beam path 31 of the optical interferometry system 32 and the imaging beam path 33 of the imaging system 34 are combined using a second beam combiner 35 that 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.

[0112] The cross-sectional images of the OCT system 32 can be used to observe whether the anterior surface of the cornea comes into contact with the contact element 28 during the fine positioning procedure.

[0113] As described below with reference to FIG. 8, during the fine positioning procedure, the position of the laser irradiation device relative to the patient's eye is monitored based on signals from the interaction measurement unit, which generates an output signal dependent on the mechanical interaction between the patient's eye and the laser irradiation device.

[0114] FIG. 8A schematically illustrates, in an enlarged view, the contact element 28 and other components used to couple the contact element 28 to the laser optics on the one hand and to the patient's eye 29 on the other hand. The laser system includes a coupling portion 37, which may be rigidly connected to the laser optics or may be supported so as to be displaceable in a direction parallel to the optical axis of the laser optics. The contact element 28 and coupling portion 37 are configured such that the contact element 28 is removably coupleable with the coupling portion 37. In the coupled state, the contact element 28 may be at a substantially predetermined position relative to the laser optics or may have a predetermined inclination relative to the optical axis OA of the laser optics. Alternatively, in embodiments in which the contact element 28 is supported so as to be displaceable in a direction parallel to the optical axis OA of the laser optics, in the coupled state, the contact element 28 is at a predetermined radial position relative to the optical axis and has a predetermined inclination relative to the optical axis. The contact element 28 is attached to the coupling portion 37 using a suction mechanism including a suction source 38.

[0115] The laser system further includes a suction ring 39 that can be secured to the eye 29 and to which the contact element 28 can be firmly attached. The suction ring 39 includes a skirt that forms a groove, which defines a suction channel between the skirt and the anterior surface of the eye 29. Thus, a vacuum source 40 is used to create a vacuum in the vacuum passage, thereby fixedly attaching the suction ring 39 to the anterior surface of the eye 29.

[0116] The suction ring 39 is rigidly attached to the clamping mechanism 41 or is formed with the clamping mechanism 41 as a single piece. The clamping mechanism 41 is used to secure the contact element 28 to the suction ring 39. An example of such a clamping mechanism 41 is disclosed in U.S. Patent Application Publication No. 2007 / 0093795, the contents of which are incorporated herein by reference for all purposes. However, the present invention is not limited to configurations in which the contact element 28 is secured to the suction ring 39 using a clamping mechanism. Specifically, it is contemplated that the contact element 28 and the suction ring 39 may be integrally formed, such as formed as a single piece or integrated into a unitary assembly.

[0117] As can be seen from Figure 8A and from Figure 8B, which is a top view of connecting portion 37 and eye 29, connecting portion 37 includes a connecting ring 42 for connecting connecting portion 37 to the remainder of the laser delivery device. Additionally, connecting portion 37 includes a plurality of extension arms 43a, 43b, 43c, 43d, each connecting connecting ring 42 to a lower portion 44 of connecting portion 37.

[0118] When the connecting portion 37 is attached to the rest of the laser application device, the connecting portion 37 contacts a plurality of force sensors 45a, 45b, 45c, and 45d. The force sensors 45a, 45b, 45c, and 45d are arranged in a plane perpendicular to the optical axis OA of the laser application device and thus parallel to the plane of the mounting ring 42. As can be seen in FIG. 8B , the force sensors are circumferentially distributed at equal distances and angles from the optical axis OA of the laser application device. By way of example, each force sensor 45a, 45b, 45c, and 45d includes a piezoelectric force sensor that measures tensile and / or compressive forces acting on the piezoelectric force sensor. Additionally or alternatively, strain gauges may be disposed on one or more of the extension arms.

[0119] As can be seen from the cross-sectional view of Figure 8A, each of force sensors 45a, 45b, 45c, and 45d is positioned in the force path between the patient's eye 29 and focusing optics 36 (shown in Figure 7), which focuses the therapeutic laser beam into the patient's eye 29 and is part of the laser delivery device. Thus, the magnitude of the force measured by each force sensor, as well as the difference in the magnitude of the force measured by the different force sensors, can be used to determine the magnitude and direction of the force between the laser delivery device and the eye.

[0120] Thus, by monitoring the output signals of force sensors 45a, 45b, 45c, and 45d, it is possible to dock the laser system to the eye with a circumferentially uniform force that 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-breaking procedures where "soft docking" techniques are used.

[0121] To perform the "soft docking" technique, a contact element 28 (shown in FIG. 8A) is used, which has a concave contact surface for contacting the anterior surface of the cornea. The force between the patient's eye and the laser delivery device 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 eye's cornea.

[0122] Using the force sensor output signal to perform the "soft docking" technique ensures that the vertical force component does not exceed a predetermined level, so that only minimal corneal deformation occurs and posterior corneal folds are avoided. Posterior corneal folds can deflect the treatment laser beam, resulting in "postage stamp" incisions. Additionally, ensuring that the horizontal force component does not exceed a predetermined level ensures that the eye does not tilt, thereby improving the accuracy of the laser treatment.

[0123] 9 is a schematic diagram of the 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 also shows an image 47 generated based on the output signals of the force sensors 45a, 45b, 45c, and 45d (shown in FIGS. 8A and 8B). The OCT image may be a real-time OCT image.

[0124] In the exemplary embodiment, FIG. 47 has three concentric rings, each with eight markers, with a central marker. After the controller processes the output signal of the interaction measurement sensor, one of the markers, such as marker 48 in FIG. 9, is highlighted. The ring on which the highlighted marker is located indicates the magnitude of the measured force, with larger ring diameters indicating higher magnitudes of force measured by the force sensor. Specifically, the inner two rings indicate acceptable force levels, while the outer ring indicates unacceptable force levels. If the force level is unacceptable, the surgeon uses the controllable positioning system 9 (shown in FIG. 1) with the controller 10 to lift the laser irradiation device and move it away from the patient. Adjusting the laser irradiation device so that the longitudinal force level is below a predetermined level ensures that corneal creases are avoided.

[0125] The circumferential position of the highlighted mark indicates the direction of the lateral component of the force measured using the force sensor. In Figure 9, the highlighted mark is located on the right side, indicating to the surgeon that the laser irradiation device should be moved in the negative x-direction to minimize the lateral force. When the lateral force is minimized, this prevents the eye from tilting relative to the optical axis of the laser irradiation device.

[0126] Additionally or alternatively, the controller may be configured to determine a parameter indicative of or dependent on the magnitude of at least one component of force between the laser delivery device and the patient's eye. The controller may be configured to display the parameter on a display device. The force component may be a component along an optical axis of the laser delivery device or a component in a plane oriented perpendicular to the optical axis of the laser delivery device.

[0127] Thus, the use of force sensors and a three-axis positioning system allows the surgeon to perform a docking procedure that ensures a high quality of the surgical procedure.

[0128] In an exemplary embodiment, the laser system uses the output signal of the interaction measurement unit to determine whether to deactivate the braking and / or locking system based on the output signal of the interaction measurement unit, thereby preventing damage to the patient's eye in the event that the patient moves their head during laser treatment. For example, if the projection of the force vector onto the optical axis of the laser irradiation device exceeds a predetermined threshold, the laser source and the braking and / or locking system are deactivated.

[0129] Figure 10 is a cross-sectional view of a parallel linkage including second arm section 11 in the laser system according to the exemplary embodiment shown in Figure 1. Second arm section 11 comprises two bars 52 and 53 of a four-bar linkage configured as a parallel linkage with bars 52 and 53 of the second arm section oriented parallel to each other and four joints 53a, 53b, 53c, and 53d, each having a horizontal axis of rotation.

[0130] The parallel link mechanism also includes a balancing mechanism that provides a balance that at least partially offsets gravity G acting on the laser irradiation device (not shown in FIG. 10 ). In the exemplary embodiment, the balancing mechanism includes a compression spring 54 disposed in the first bar 53 and exerting a pulling force on a toothed belt 55, which extends into the second bar 52 via two toothed belt loops 56, 57. One end of the toothed belt 55 is fastened to the second bar 52 using a fastening member 58.

[0131] 1, the laser system according to an exemplary embodiment includes a coupling mechanism for connecting the articulating beam conduit 5 to the second arm section 11 of the support arm 4. This coupling mechanism 16 is depicted in detail in the side views of Figures 11A-11C.

[0132] 11A-11C, the coupling mechanism 16 includes a first coupling member 58 that is rigidly attached or integrally connected to the articulating beam conduit 5. Furthermore, the coupling mechanism includes a second coupling member 59, which is a corresponding coupling member to the first coupling member 58 and is attached or integrally connected to the second arm section 11. In the exemplary embodiment, the first and second coupling members 58, 59 are configured as lateral guides that limit lateral movement of the first coupling member 59 relative to a direction parallel to the longitudinal axis of the second arm section 11. In the exemplary embodiment, the coupling mechanism 16 has the effect that, for various positions of the laser irradiation device 6 assumed through movement of the first and second arm sections 8 and 11 of the support arm 4, the plane defined by adjacent tube sections 13 and 14 of the articulating beam conduit 5 has a substantially vertical orientation. This ensures that the articulating beam conduit 5 does not collide with the support arm 4 during operation of the laser system 1. Such a collision may damage the articulating beam conduit 5 and / or the support arm 4 or may interfere with the positioning of the laser irradiation device 6 using the support arm 4.

[0133] 11A-11C show a schematic diagram of how the first and second connecting members 58, 59 are positioned relative to each other for each of three different configurations of the support arm 4. For various inclinations of the second arm section 11, the articulating beam conduit 5's joint between the first arm section 13 and the second arm section 14 remains connected to the second arm section 11 of the support arm 1. Furthermore, because the articulating beam conduit 5 extends between the laser irradiation device 6 and the point where the treatment laser beam exits the first arm section 8 of the support arm 4, the articulating beam conduit 5 can remain engaged with the linear guide even when the second arm section rotates about the vertical axis A2. However, it should be noted that, if there is sufficient play in the lateral guide, the articulating beam conduit 5 can also be connected to the second arm section 11 even when the articulating beam conduit extends from the point where the treatment laser beam exits the base 3.

[0134] Additionally or alternatively, it is contemplated that the coupling device may include a tension transmission connection.

[0135] The above-described embodiments are merely examples and are not intended to limit the technical approaches of the present invention. Although the present invention has been described in detail with reference to preferred embodiments, those skilled in the art will understand that the technical approaches of the present invention may be modified or equivalently replaced 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" or "an" does not exclude a plurality. Reference signs in the claims should not be construed as limiting the scope.

[0136] Before presenting the claims, the following section first describes some prominent features of certain embodiments of the disclosure. Item 1: An ophthalmic laser system for performing laser treatment of an eye, comprising: a base that houses at least a portion of a laser source of the laser system, the laser source being configured to generate a therapeutic laser beam for performing the laser treatment; a laser irradiation device comprising optics such that the therapeutic laser beam exits the laser irradiation device in a direction toward a patient's eye; a support arm; and a controller, wherein the support arm is connected to the laser irradiation device at a first end thereof, and a second end of the support arm is (a) connected to the base and / or (b) comprises an interface at the second end thereof for connecting the support arm to a further component, wherein the support arm is configured such that the laser irradiation device is positionable in three dimensions relative to the base while maintaining a vertical orientation of the laser irradiation device, and the laser system further comprises a motorized three-axis positioning system operatively coupled to the controller for positioning the laser irradiation device in three dimensions relative to at least a portion of the support arm. Item 2: The laser system of item 1, wherein the laser irradiation device comprises a manually operable control operatively coupled to the controller for positioning the laser irradiation device relative to the support arm based on user input received via the control element. Item 3: The laser system of item 1 or 2, wherein the laser irradiation device 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 positioning of the laser irradiation device relative to the support arm. Item 4: The laser system of item 3, wherein the laser irradiation device includes a display device for displaying a front image during at least a portion of positioning of the laser irradiation device relative to the support arm. Item 5: A laser system according to any one of items 1 to 4, wherein the laser irradiation device comprises an interaction measuring unit for generating an output signal that depends on a parameter of the mechanical interaction between the patient's eye and the laser irradiation device. Item 6: The laser system of item 5, wherein the output signal depends on the force between the patient's eye and the laser irradiation device, and / or the interaction part includes a force sensor, a strain gauge sensor, and / or a piezoelectric element. Item 7: A laser system according to item 5 or 6, wherein the laser irradiation device is provided with a display device, and the controller is configured to generate data representing graphical information and / or textual information using the output signal generated by the interaction measurement unit, and to display the graphical information and / or textual information on the display device during at least a portion of the positioning of the laser irradiation device relative to the support arm. Item 8: An ophthalmic laser system for performing laser treatment of an eye, comprising: a base housing at least a portion of a laser source of the laser system, the laser source being configured to generate a therapeutic laser beam for performing the laser treatment; a laser illumination device comprising optics by which the therapeutic laser beam exits the laser illumination device toward a patient's eye; a support arm connected to the laser illumination device at a first end of the support arm, the support arm being (a) connected to the base and / or (b) comprising an interface at a second end of the support arm for connecting the support arm to a further component; and an articulated beam conduit, at least a portion of which extends between a first location where the therapeutic laser beam exits the base or support arm and a second location where the therapeutic laser beam enters the support arm or laser illumination device, the laser system including a coupling device for coupling the articulated beam conduit to the support arm at one or more locations along the beam conduit between the first location and the second location. Item 9: The laser system of item 8, wherein the coupling device comprises a tensile force transmission connection. Item 10: The laser system of item 9, wherein the tension force transmission connection comprises a tension spring for transmitting the tension force. Item 11: The laser system according to any one of items 8 to 10, wherein the coupling device comprises a guide, in particular a lateral guide. Item 12: The laser system of item 11, wherein the guide is configured to limit variations in the vertical orientation of a plane defined by successive arm sections of the articulating beam conduit during movement of the laser irradiation device. Item 13: The laser system of any one of items 8 to 12, wherein the laser irradiation device comprises an optical coherence tomography (OCT) system configured to acquire a cross-sectional image of at least a portion of the eye. Item 14: The laser system of item 13, wherein the laser irradiation device comprises a beam combiner for combining the beam path of the measurement arm of the OCT system with the beam path of the treatment laser beam. Item 15: The laser system of any one of items 8 to 14, wherein the support arm comprises an arm section rotatable about a horizontal axis or a substantially horizontal axis. Item 16: In the laser system of item 15, the arm section includes a parallel link mechanism. Item 17: The laser system of any one of items 8 to 16, wherein the support arm comprises a first arm section and a second arm section connected in series to each other via an intermediate joint, the first arm section being rotatable about a vertical axis or a substantially vertical axis, and the second arm section being rotatable about a horizontal axis or a substantially horizontal axis. Item 18: The laser system of item 17, wherein the intermediate joint is configured to allow the second arm section to rotate about a horizontal axis or a substantially horizontal axis and about a vertical axis or a substantially vertical axis. Item 19: The laser system of item 17 or 18, wherein the second arm section includes a parallel link mechanism. Item 20: The laser system of any one of items 8 to 19, wherein the support arm includes a counterbalance mechanism for providing gravitational balance to the tip of the irradiation device. Item 21: The laser system of item 20, wherein the support arm comprises one or more springs, and wherein the support arm is configured to provide at least a portion of gravity counterbalance using the one or more springs. Item 22: The laser system of any one of items 8 to 21, wherein the support arm is provided with 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. Item 23: The laser system of item 22, wherein the laser irradiation device comprises a manually operable control for selectively activating and deactivating the braking and / or locking system based on user input received therethrough. Item 24: A laser system according to item 22 or 23, wherein the laser system comprises an interaction measurement unit configured to generate an output signal dependent on a mechanical interaction between the patient's eye and the laser irradiation device, and wherein the controller is operatively connected to the interaction measurement unit and the brake, and the controller is configured to receive the output signal generated by the interaction measurement unit and determine whether to deactivate the brake and / or locking system based on the received output signal. Clause 25: A laser system according to any one of claims 8 to 24, further comprising an articulated beam conduit, at least a portion of the articulated beam conduit extending between a first location on or in the arm section of the base or support arm and a second location on or in the laser irradiation device. Item 26: A laser system according to any one of claims 8 to 25, wherein the support arm has a rotary joint, the rotary joint having a vertically extending rotation axis for rotating the laser irradiation device about an axis extending through the laser irradiation device. Item 27: The laser system of item 25 or 26, wherein the laser system includes a locking system configured to lock a rotary joint having a rotation axis extending through the laser irradiation device. Item 28: A laser system according to any one of items 8 to 27, wherein the laser irradiation device comprises an objective lens for focusing the treatment laser beam in the eye, and / or an axial scanning system for scanning the focus of the laser along the axis of the laser beam, and / or a beam deflection scanning system for scanning the laser beam through deflection of the laser beam. Item 29: A method for positioning a laser irradiation device of an ophthalmic laser system relative to a patient's eye, comprising: positioning the laser irradiation device 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, the support arm is connected to the base and / or is connectable to a stationary component at a second end of the support arm, the base houses at least a portion of a laser source of the laser system, the laser source being configured to generate a treatment laser beam for performing laser treatment, the support arm being configured such that the laser irradiation device is positionable relative to the base while maintaining a vertical orientation of the laser irradiation device, the method further comprising positioning the laser irradiation device relative to at least a portion of the support arm using a motorized three-axis positioning system. Item 30: The method of item 29, further comprising the steps of acquiring a front image of the eye using an imaging system of the laser irradiation device, and displaying the front image on a display device of the laser system during at least a portion of the positioning of the laser irradiation device relative to the support arm. Clause 31: The method of clause 30, wherein during at least a portion of the positioning, a distance of the focal plane from the laser irradiation device substantially corresponds to a predetermined distance of the laser irradiation device from the patient's eye. Item 32: Any one of the methods of items 29 to 31, further comprising the steps of: an interaction measuring unit generating an output signal dependent on the mechanical interaction between the patient's eye and the laser irradiation device; using a controller of the laser system to determine textual and / or graphical information based on the output signal; and displaying the textual and / or graphical information during at least a portion of the positioning of the laser irradiation device relative to the support arm. Item 33: Any one of the methods of items 29 to 32, further comprising a step in which an interaction measurement unit generates an output signal dependent on a mechanical interaction between the patient's eye and the laser irradiation device, and a step in which, using a controller of the laser system, based on the output signal, determines whether to deactivate a brake of the support arm that prevents movement of the second end of the support arm relative to the first end of the support arm. Item 34: Any one of the methods of items 29 to 33, wherein the output signal depends on the force between the patient's eye and the laser irradiation device, and / or the interaction part includes a force sensor and / or a strain gauge sensor. Clause 35: The laser system of any one of clauses 1 to 7, further comprising an articulated beam conduit, at least a portion of the articulated beam conduit extending between a first location where the treatment laser beam exits the base or support arm and a second location where the treatment laser beam enters the support arm or laser irradiation device, and the laser system including a coupling device for coupling the articulated beam conduit to the support arm at one or more locations along the beam conduit between the first location and the second location. Item 36: The laser system of item 35, wherein the coupling device comprises a tensile force transmission connection. Item 37: The laser system of item 36, wherein the tension force transmission connection comprises a tension spring for transmitting the tension force. Item 38: The laser system of any one of items 35 to 37, wherein the coupling device comprises a guide, in particular a lateral guide. Item 39: The laser system of item 38, wherein the guide is configured to limit variations in the vertical orientation of a plane defined by successive arm sections of the articulated beam conduit during movement of the laser irradiation device. [Explanation of symbols]

[0137] 1. Ophthalmic laser system 2, 22 enclosure 3 base 4 support arms 5 Beam Conduit 6. Laser irradiation device 9 Positioning System 10 Control Unit Arm sections 8 and 11 12 Intermediate joint Sections 13 and 14 16 Connection mechanism 17a, 17b handle 18a, 18b Control elements 19 Display device 20, 46 images 24 Crosshairs 26, 35 Beam combiner 27 Laser Beam 28 Contact Elements 29 eyes 30a, 30b components 31, 33 Beam path 32 OCT System 34 Imaging System 36 Focusing optical system 37 Connecting part 38 Suction source 39 Suction Ring 40 Vacuum source 41 Clamping mechanism 42 Connecting Ring 43a, 43b, 43c, 43d Extension arms 44 Lower 45a, 45b, 45c, 45d Force sensors 47 Figures 48 signs 52, 53 bars 53a, 53b, 53c, 53d joints 54 Compression spring 55 Toothed belt 56, 57 Toothed belt ring 58, 59 Connecting members

Claims

1. 1. An ophthalmic laser system for performing laser treatment of an eye, comprising: a base housing at least a portion of a laser source of the laser system, the laser source configured to generate a treatment laser beam for performing the laser treatment; a laser delivery device comprising an optical system for causing the treatment laser beam to exit the laser delivery device in a direction toward the patient's eye; A support arm; Controller and Equipped with The support arm is connected to the laser irradiation device at a first end of the support arm, and a second end of the support arm is (a) connected to the base; and / or (b) an interface at the second end of the support arm for connecting the support arm to a further component; the support arm is configured to enable the laser irradiation device to be three-dimensionally positioned relative to the base while maintaining a vertical orientation of the laser irradiation device; The ophthalmic laser system further comprises a motorized three-axis positioning system operatively coupled to the controller for positioning the laser irradiation device in three dimensions relative to at least a portion of the support arm.

2. 10. The laser system of claim 1, wherein the laser delivery device comprises a manually operable control operatively coupled to the controller for positioning the laser delivery device relative to the support arm based on user input received via a control element.

3. 3. The laser system of claim 1, wherein the laser irradiation device comprises 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 irradiation device relative to the support arm.

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

5. 5. The laser system of claim 1, wherein the laser irradiation device comprises an interaction measuring unit for generating an output signal dependent on a parameter of a mechanical interaction between the patient's eye and the laser irradiation device.

6. 6. The laser system of claim 5, wherein the output signal depends on a force between the patient's eye and the laser irradiation device, and / or the interaction part includes a force sensor, a strain gauge sensor, and / or a piezoelectric element.

7. 7. The laser system of claim 5 or 6, wherein the laser irradiation device is provided with a display device, and the controller is configured to generate data representing icon information and / or text information using the output signal generated by the interaction measurement unit, and to display the icon information and / or text information on the display device during at least a portion of the positioning of the laser irradiation device relative to the support arm.

8. 1. An ophthalmic laser system for performing laser treatment of an eye, comprising: a base housing at least a portion of a laser source of the laser system, the laser source configured to generate a treatment laser beam for performing the laser treatment; a laser delivery device comprising an optical system through which the therapeutic laser beam exits the laser delivery device toward the patient's eye; a support arm, the support arm being connected to the laser irradiation device at a first end of the support arm, the support arm comprising: (a) connected to the base; and / or (b) a support arm comprising an interface at a second end of the support arm for connecting the support arm to a further component; Articulated beam conduit and Equipped with at least a portion of the articulated beam conduit extends between a first location where the treatment laser beam exits the base or the support arm and a second location where the treatment laser beam enters the support arm or the laser delivery device; 1. An ophthalmic laser system, wherein the laser system includes a coupling device for coupling the articulating beam conduit to the support arm at one or more locations along the beam conduit between the first location and the second location.

9. 10. The laser system of claim 8, wherein the coupling device comprises a tension transfer connection.

10. 10. The laser system of claim 9, wherein the tension force transmission connection comprises a tension spring for transmitting tension forces.

11. 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. 12. The laser system of claim 11, wherein the guide is configured to limit variations in vertical orientation of a plane defined by successive arm sections of the articulating beam conduit during movement of the laser delivery device.

13. 13. The laser system of claim 8, wherein the laser irradiation device comprises an optical coherence tomography (OCT) system configured to obtain cross-sectional images of at least a portion of the eye.

14. 14. The laser system of claim 13, wherein the laser irradiation device comprises a beam combiner for combining a beam path of a measurement arm of the OCT system with a beam path of the treatment laser beam.

15. 15. The laser system of claim 8, wherein the support arm comprises an arm section rotatable about a horizontal or substantially horizontal axis.

16. 16. The laser system of claim 15, wherein the arm section comprises a parallel linkage.

17. 17. The laser system of claim 8, wherein the support arm comprises a first arm section and a second arm section connected in series to each other via an intermediate joint, the first arm section being rotatable about a vertical or substantially vertical axis, and the second arm section being rotatable about a horizontal or substantially horizontal axis.

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

19. 19. The laser system of claim 17 or 18, wherein the second arm section comprises a parallel linkage.

20. 20. The laser system of claim 8, wherein the support arm comprises a counterbalance mechanism for providing gravitational counterbalance to the tip of the irradiation device.

21. 21. The laser system of claim 20, wherein said support arm comprises one or more springs, said support arm being configured to provide at least a portion of said gravity counterbalance using said one or more springs.

22. 22. The laser system of any one of claims 8 to 21, 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. 23. The laser system of claim 22, wherein the laser delivery device comprises a manually operable control for selectively activating and deactivating the braking and / or locking system based on user input received therethrough.

24. 24. The laser system of claim 22 or 23, wherein the laser system comprises an interaction measurement unit configured to generate an output signal dependent on a mechanical interaction between the patient's eye and the laser irradiation device, and the controller is operatively connected to the interaction measurement unit and the braking and / or locking system, and 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. 25. The laser system of claim 8, further comprising an articulated beam conduit, at least a portion of the articulated beam conduit extending between a first location on or in the base or an arm section of the support arm and a second location on or in the laser irradiation device.

26. 26. The laser system of claim 8, wherein the support arm has a rotary joint having a vertically extending axis of rotation for rotating the laser irradiation device about an axis extending through the laser irradiation device.

27. 27. The laser system of claim 25 or 26, wherein the laser system comprises a locking system configured to lock the rotary joint having the rotation axis extending through the laser application device.

28. 28. The laser system of claim 8, wherein the laser irradiation device comprises an objective lens for focusing the treatment laser beam in the eye, and / or an axial scanning system for scanning the focal point of the laser along the axis of the laser beam, and / or a beam deflection scanning system for scanning the laser beam through deflection of the laser beam.

29. 1. A method for positioning a laser delivery device of an ophthalmic laser system relative to a patient's eye, comprising: positioning a laser delivery device relative to the patient's eye using a support arm; Including, the support arm is connected at a first end of the support arm to a base of the ophthalmic laser system; the support arm is connected to the base and / or is connectable at a second end of the support arm to a stationary component; the base houses at least a portion of a laser source of the laser system; the laser source is configured to generate a treatment laser beam for performing laser treatment, and the support arm is configured to allow the laser irradiation device to be positioned relative to the base while maintaining a vertical orientation of the laser irradiation device; positioning the laser delivery device relative to at least a portion of the support arm using a motorized three-axis positioning system; A method comprising:

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

31. 31. The method of claim 30, wherein during at least a portion of the positioning, a distance of a focal plane from the laser delivery device substantially corresponds to a predetermined distance of the laser delivery device from the patient's eye.

32. 32. The method of claim 29, further comprising: an interaction measurement unit generating an output signal dependent on the mechanical interaction between the patient's eye and the laser irradiation device; using a controller of the laser system to determine textual and / or graphical information based on the output signal; and displaying the textual and / or graphical information during at least a portion of the positioning of the laser irradiation device relative to the support arm.

33. 33. The method of any one of claims 29 to 32, further comprising: an interaction measurement unit generating an output signal dependent on a mechanical interaction between the patient's eye and the laser irradiation device; and using a controller of the laser system to determine, based on the output signal, whether to deactivate a brake on the support arm that prevents movement of the second end of the support arm relative to the first end of the support arm.

34. 34. The method of any one of claims 29 to 33, wherein the output signal depends on the force between the patient's eye and the laser irradiation device, and / or the interaction part includes a force sensor and / or a strain gauge sensor.

35. 8. The laser system of claim 1, further comprising an articulated beam conduit, at least a portion of the articulated beam conduit extending between a first location where the treatment laser beam exits the base or the support arm and a second location where the treatment laser beam enters the support arm or the laser delivery device, the laser system including a coupling device for coupling the articulated beam conduit to the support arm at one or more locations along the beam conduit between the first location and the second location.

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

37. 37. The laser system of claim 36, wherein the tension force transmission connection comprises a tension spring for transmitting tension force.

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

39. 40. The laser system of claim 38, wherein the guide is configured to limit variations in vertical orientation of a plane defined by successive arm sections of the articulating beam conduit during movement of the laser delivery device.

Images