Method for operating a controller for an ophthalmic laser system - Patent Application 20070122997

Abstract

Corneal lenticule extraction procedures offer a convenient retreatment option when a treatment interruption occurs. The procedure is performed by an ophthalmic laser system according to a programmed treatment plan, which defines an entrance incision, an optional ring incision, a lower lenticule incision with an optical zone, and a flat upper floor incision. If an interruption occurs during an entrance incision, the treatment plan is realigned with the partially formed entrance incision and continued, or realigned with a new entrance incision positioned at a different angular position. If an interruption occurs during a ring incision, the treatment plan is modified to define a larger ring incision concentric with the partially formed ring incision. If an interruption occurs during a lower or upper incision, the depth of the partially formed lower or upper incision is measured, and the treatment plan is modified to create a deeper lower incision or a shallower upper incision, respectively.

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application No. 63 / 085985, filed September 30, 2020, which is incorporated herein by reference in its entirety.

[0002] FIELD OF THE INVENTION The present invention relates generally to laser-assisted ophthalmic procedures, and more particularly to systems and methods for corneal lenticule extraction procedures with re-treatable corneal lenticule incisions. [Background technology]

[0003] Vision defects such as myopia, hyperopia, and astigmatism can be corrected using eyeglasses or contact lenses. Alternatively, the cornea of ​​the eye can be surgically reshaped to provide the necessary optical correction. Eye surgery is becoming more common with some patients pursuing it as an elective procedure to avoid using contact lenses or eyeglasses to correct refractive problems, and others pursuing it to correct adverse conditions such as cataracts. And with recent developments in laser technology, laser surgery is becoming the technique of choice for ophthalmic procedures.

[0004] Different laser eye surgery systems use different types of laser beams for various procedures and indications. These include, for example, ultraviolet lasers, infrared lasers, and near-infrared, ultrashort pulse lasers. Ultrashort pulse lasers emit radiation with pulse durations as short as 10 femtoseconds and as long as 3 nanoseconds, and wavelengths between 300 nm and 3000 nm.

[0005] Conventional surgical approaches to reshape the cornea include laser-assisted in situ keratomileusis (hereinafter "LASIK"), photorefractive keratectomy (hereinafter "PRK"), and lenticule extraction.

[0006] In a LASIK procedure, an ultrashort-pulse laser is used to cut a corneal flap, exposing the corneal stroma for photoablation by an ultraviolet beam from an excimer laser. Photoablation of the corneal stroma reshapes the cornea and corrects refractive conditions such as myopia, hyperopia, and astigmatism. In a PRK procedure, where no flap is created, the epithelial layer is removed first, and then some stromal material is removed by the excimer laser. The epithelial layer grows back within a few days after the procedure.

[0007] In corneal lenticule extraction, instead of ablating corneal tissue with an excimer laser after the creation of a corneal flap, this technique involves tissue removal through two intersecting femtosecond laser incisions to create a lenticule for extraction. Lenticule extraction changes the shape of the cornea and its refractive power to achieve vision correction. Lenticule extraction can be performed either with or without the creation of a corneal flap. In flapless procedures, a refractive lenticule is created in the intact portion of the anterior cornea and removed through a small incision.

[0008] In a conventional corneal lenticule extraction procedure, the lenticule incision process involves three segments, performed in order: first, the formation of the lower lenticule incision, which includes the lower optical zone and the lower transition zone; second, the formation of the upper lenticule incision, which includes the upper optical zone and the upper transition zone; and third, the formation of the entrance incision. The upper and lower optical zones are located at the center of the respective lenticule incisions and have a surface shape determined by the refractive correction to be achieved by the lenticule extraction procedure, while the upper and lower transition zones are located outside the respective optical zones and have a shape that is not determined by the refractive correction to be achieved but is influenced by other considerations, such as the mechanical properties of the formed lenticule, which affect ease of extraction. The lower and upper lenticule surfaces typically have the same diameter (e.g., 6-8 mm). The upper and lower incisions intersect each other (extending beyond the intersection line) to separate the lenticule volume. The entrance incision is formed near the periphery of the lenticule to provide an entrance port for the lenticule to be extracted from the cornea.

[0009] During the lenticule extraction process, treatment interruptions can occur occasionally due to various system and process failures, such as suction loss within the patient interface device (the device that mechanically couples the patient's eye to the ophthalmic laser system). Such interruptions can prevent the full lenticule from being completed and force the surgeon to switch to a PRK or LASIK procedure as a retreatment option. Because PRK and LASIK involve different laser systems (excimer laser vs. femtosecond laser) than corneal lenticule extraction, this retreatment option is inconvenient for the patient. Summary of the Invention [Means for solving the problem]

[0010] SUMMARY OF THE INVENTION Accordingly, the present invention is directed to a method and related apparatus for forming a corneal lenticule that substantially obviates one or more of the problems due to limitations and drawbacks of the related art.

[0011] It is an object of the present invention to provide a re-treatable corneal lenticule formation process and provide a re-treatment option that can be performed using the same femtosecond laser system.

[0012] Additional features and advantages of the disclosed embodiments will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the disclosure. The objectives and other advantages of the invention will be realized and attained by the structure particularly pointed out in the detailed description and claims hereof, as well as the appended drawings.

[0013] In order to achieve the above object, the present invention provides a method for forming a corneal lenticule, which is implemented in an ophthalmic laser system for forming a lenticule in the cornea of ​​a patient's eye, comprising: (a) generating a laser beam; (b) scanning a laser beam focus within the cornea by executing a treatment plan, the treatment plan including a lower segment defining a lower lenticule incision and an upper segment defining an upper floor incision, the lower lenticule incision including an optical zone having a shape determined by the defined refractive power of the lenticule, the upper floor incision having a flat shape, the upper floor incision being located above the lower lenticule incision and having a diameter smaller than that of the lower lenticule incision; and (c) the lower lenticule incision being a partial incision. and (d) in response to an interruption while executing a lower segment of the treatment plan after the upper floor incision has been partially formed, modifying the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision and scanning the laser beam focus by executing the modified treatment plan to form the new lower lenticule incision; and (d) in response to an interruption while executing an upper segment of the treatment plan after the upper floor incision has been partially formed, modifying the treatment plan to define a new upper floor incision located above the partially formed upper floor incision and scanning the laser beam focus by executing the modified treatment plan to form the new upper floor incision.

[0014] In another aspect, the present invention provides a corneal lenticule formation method implemented in an ophthalmic laser system for forming a lenticule in the cornea of ​​a patient's eye, comprising: (a) scanning a laser beam focal point within the cornea by executing a treatment plan, the treatment plan including, in order, an entrance segment defining an entrance cut, a lower segment defining a lower lenticule incision, and an upper segment defining an upper floor incision, the lower lenticule incision including an optical zone having a shape determined by the defined optical power of the lenticule, the upper floor incision having a flat shape, and an upper floor incision having a flat shape. a floor incision located above the lower lenticule incision and having a diameter smaller than that of the lower lenticule incision, the upper and lower floor incisions intersecting each other near their respective peripheries to define a separated lenticule volume, the entrance incision having a band shape and extending upward from the outer edge of the lower lenticule incision; and (c) in response to an interruption during execution of the entrance segment of the treatment plan after the entrance incision has been partially formed, a new entrance incision, a new lower lenticule incision, and a new upper floor incision aligned with the partially formed entrance incision. (d) in response to an interruption while executing the lower segment of the treatment plan after the entrance incision and the lower lenticule incision have been formed and the lower lenticule incision has been partially formed, modifying the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision and a new upper floor incision located above the new lower lenticule incision, and scanning the laser beam focus by executing the modified treatment plan to form the new lower lenticule incision and the new upper floor incision; and (e) in response to an interruption while executing the upper segment of the treatment plan after the entrance incision and the lower lenticule incision have been formed and the upper floor incision has been partially formed, modifying the treatment plan to define a new upper floor incision located above the partially formed upper floor incision, and scanning the laser beam focus by executing the modified treatment plan to form the new upper floor incision.

[0015] In another aspect, the present invention provides a method of forming a corneal lenticule implemented in an ophthalmic laser system for forming a lenticule in the cornea of ​​a patient's eye, the method comprising: (a) generating a laser beam; and (b) scanning a laser beam focal point within the cornea by executing a treatment plan, the treatment plan including, in order, an entrance segment defining an entrance cut, a ring segment defining a ring cut, a lower segment defining a lower lenticule incision, and an upper segment defining an upper floor incision, the lower lenticule incision being aligned with a defined optical power of the lenticule. (c) the entrance incision has a band shape and extends upward from an outer edge of the lower lenticule incision; (d) the entrance incision is partially formed and then heals; (e) the entrance incision has a flat shape, the upper floor incision is located above the lower lenticule incision and has a diameter smaller than a diameter of the lower lenticule incision; the ring incision has a ring shape and extends between the upper floor incision and the lower lenticule incision, both of which intersect the ring incision near their respective peripheries to define a separated lenticule volume; and (f) the entrance incision is partially formed and then heals. (d) in response to an interruption while executing the ring segment of the treatment plan after the entrance incision has been formed and the ring incision has been partially formed, modifying the treatment plan to define a new ring incision, a new lower lenticule incision, and a new upper floor incision aligned with the partially formed entrance incision, and scanning the laser beam by executing the modified treatment plan to complete the entrance incision and form the new ring incision, the new lower lenticule incision, and the new upper floor incision; (e) in response to an interruption while executing the lower segment of the treatment plan after the entrance incision and the ring incision have been formed and the lower lenticule incision has been partially formed, modifying the treatment plan to define a new ring incision, a new lower lenticule incision, and a new upper floor incision having a radius larger than that of the partially formed ring incision and aligned concentrically with the partially formed ring incision, and scanning the laser beam by executing the modified treatment plan to form the new ring, the new lower lenticule incision, and the new upper floor incision;(f) modifying the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision and a new upper floor incision located above the new lower lenticule incision, and scanning the laser beam focal point by executing the modified treatment plan to form the new lower lenticule incision and the new upper floor incision; and (f) in response to an interruption during execution of the upper segment of the treatment plan after the entrance cut, ring cut, and lower lenticule incision have been formed and the upper floor incision has been partially formed, modifying the treatment plan to define a new upper floor incision located above the partially formed upper floor incision and scanning the laser beam focal point by executing the modified treatment plan to form the new upper floor incision.

[0016] In some embodiments, the radius of the new ring incision is 20-100 microns larger than the radius of the partially formed ring incision, the apex of the new lower lenticule incision is located 5-20 microns below the apex of the partially formed lower lenticule incision, and the new upper floor incision is located 5-10 microns above the partially formed upper floor incision.

[0017] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the invention as claimed. [Brief explanation of the drawings]

[0018] [Figure 1] 1 shows a schematic representation of a corneal lenticule formed in accordance with a first embodiment of the present invention. [Figure 1A] 10A and 10B are schematic diagrams illustrating a corneal lenticule formed by a retreatment step according to a first embodiment. [Figure 1B] 10A and 10B are schematic diagrams illustrating a corneal lenticule formed by a retreatment step according to a first embodiment. [Figure 2] 10A and 10B show a schematic diagram of a process for forming a corneal lenticule with a retreatment option according to a first embodiment; [Figure 3] 3A and 3B illustrate schematically a corneal lenticule formed in accordance with a second embodiment of the present invention. [Figure 3A] 10A and 10B are schematic diagrams illustrating a corneal lenticule formed by a retreatment step according to a second embodiment. [Figure 4] 10A and 10B show a schematic diagram of a process for forming a corneal lenticule with a retreatment option according to a second embodiment. [Figure 5A] 1A and 1B illustrate schematic diagrams of two exemplary ophthalmic laser systems that may be used to implement embodiments of the present invention. [Figure 5B] 1A and 1B illustrate schematic diagrams of two exemplary ophthalmic laser systems that may be used to implement embodiments of the present invention. [Figure 6] 5C illustrates an exemplary fast scan slow sweep scheme for the ophthalmic laser system of FIGS. 5A and 5B. [Figure 7] 5C illustrates an exemplary lenticule surface incision method using the fast scan slow sweep method of the ophthalmic laser system of FIGS. 5A and 5B. [Figure 8] 5C illustrates an exemplary lenticule surface incision method using the fast scan slow sweep method of the ophthalmic laser system of FIGS. 5A and 5B. DETAILED DESCRIPTION OF THE INVENTION

[0019] Embodiments of the present invention provide an improved method for forming corneal lenticule incisions implemented in a femtosecond ophthalmic laser system that provides a retreatment option after a break in treatment, which is accomplished using the same femtosecond laser system without the need to change to a PRK or LASIK procedure.

[0020] In a corneal lenticule extraction procedure according to a first embodiment of the present invention, the lenticule incision process includes the following three segments in the order in which they are performed (see the side view in FIG. 1 ): an entrance incision 101, a lower lenticule incision 102, and a flat upper floor incision 103. Note that the terms “incision” and “incision” are used interchangeably in this disclosure. The lower lenticule incision preferably has a diameter (e.g., 8 mm) larger than that of the upper floor incision (e.g., 6 mm), and the upper and lower incisions intersect near their peripheries to form a separate lenticule volume 100 to be extracted. The entrance incision is a band-shaped incision located along the outer edge of the lower lenticule incision, extending upward and optionally outward to reach the anterior corneal surface to provide an entrance port for extracting the lenticule from the cornea.

[0021] The lower lenticule incision 102 includes a lower optical zone 102A located in the central region and an optional lower transition zone 102B surrounding the lower optical zone. The shape of the lower optical zone 102A is determined by the refractive power correction to be achieved by the lenticule extraction procedure. Because the upper incision is flat, the optical zone of the lower incision provides all of the refractive power of the lenticule. The shape of the transition zone 102B is not determined by the refractive power correction to be achieved, but is influenced by other considerations, such as the mechanical properties of the formed lenticule, which affect the ease of extraction.

[0022] If treatment is interrupted during the lenticule incision process, for example due to suction loss in the patient interface device, a different set of retreatment steps will be performed depending on the stage at which treatment is interrupted. Referring to Figure 2, a corneal lens extraction procedure with a retreatment option according to a first embodiment of the present invention will be described.

[0023] After the patient's eye is coupled to the laser system via a patient interface device (commonly referred to as docking) (step S201), the planned lenticule incision procedure begins (step S202). As previously described, the planned lenticule incision procedure includes forming an entrance incision, followed by a lower lenticule incision, and then a flat upper floor incision. The incision parameters are used to program a treatment plan including various segments that define the various incisions. The lenticule incision procedure is performed by the ophthalmic laser system under the control of a system controller (e.g., a computer) that executes the treatment plan. If a failure event occurs, the computer automatically interrupts the execution of the treatment plan. The surgeon then takes the necessary actions and instructs the computer to perform retreatment steps as described below.

[0024] If the procedure is interrupted while forming the entrance incision (i.e., an interruption occurs while performing the entrance incision segment of the treatment plan) ("Yes" in step S203), the surgeon redocks the eye to the laser system via the patient interface as needed (step S204). The original treatment plan is then modified by aligning its entrance incision with the partially formed entrance incision (step S205), and the planned lenticule incision procedure continues with the modified (aligned) treatment plan to form the unfinished portion of the entrance incision (i.e., skipping the already formed portion of the entrance incision), the upper floor incision, and the lower lenticule incision (step S206). After the retreatment is successfully completed, the lenticule is extracted from the cornea (step S207).

[0025] The alignment step (step S205) may be performed by the surgeon with the aid of the ophthalmic laser system's user interface display. The user interface display displays an image of the patient's eye in which the partially formed entrance incision is visible, overlaying a representation of the incision (at least the entrance incision) drawn according to the treatment plan. Using the user interface display, the surgeon may move the representation of the incision to align with the partially formed entrance incision in the eye image, and the computer modifies the treatment plan accordingly. The alignment step is required due to potential shifts and rotations of the redocked eye relative to its position before the interruption. Except for any shifts and rotations, the modified treatment plan is otherwise identical to the original treatment plan. Step S206 is performed in response to the surgeon's instructions.

[0026] Because the entrance cut is only used by the lenslet removal tool to access and remove the lenslets, the shape of the entrance cut does not affect the refractive power of the lenslets, and therefore the alignment accuracy between the partially formed entrance cut and the successive entrance cut has a relatively low accuracy requirement.

[0027] In an alternative embodiment, in step S205, the partially formed entrance cut is ignored, the original treatment plan is modified by moving the entrance cut position to a new angular position that avoids the partially formed entrance cut, and the modified treatment plan is executed to form a new entrance cut, an inferior lenticule incision, and an upper floor incision.

[0028] If the procedure is interrupted while forming the lower lenticule incision ("Yes" in step S208), the surgeon redocks the eye to the laser system via the patient interface if necessary (step S209), and the depth of the apex (lowest point) of the partially formed lower lenticule incision is measured using the depth measurement subsystem of the ophthalmic laser system (step S210). The treatment plan is then modified by shifting the lower and upper incisions downward so that the apex of the new lower lenticule incision is located a predetermined distance below the apex of the partially formed lower lenticule incision measured in step S210 (step S211). The predetermined distance may be, for example, 5 to 20 microns, or more preferably, approximately 10 microns. Otherwise, the new lower lenticule incision and upper floor incision have the same parameters as the original treatment plan, including the distance between the lower and upper incisions. The new lower lenticule incision does not need to be precisely aligned vertically with the partially formed lower lenticule incision. The revised treatment plan may also include extending the already-formed entrance incision downward to reach the now deeper inferior lenticule incision (which requires aligning the revised treatment plan with the already-formed entrance incision using the techniques described above), or may include a new entrance incision at a different angular position. The revised treatment plan is executed to form new inferior lenticule incisions and superior floor incisions (step S212). After successful completion of the retreatment, the lenticule is extracted from the cornea (step S207). Steps S210-S212 are performed according to the surgeon's instructions.

[0029] 1A schematically illustrates a partially formed lower lenticule incision 102′, a new lower lenticule incision 102, an upper floor incision 103, and an entry cut 101 (new or extended). A lenticule volume 100 is separated by the new lower lenticule incision 102 and the upper floor incision 103. Because the original lower lenticule incision 102′ is incomplete, e.g., does not extend over a full 360° angular range in plan view, it does not form a volume separated from the upper floor incision 103 or the new lower lenticule incision 102. Thus, the lenticule volume can be removed with minimal complications.

[0030] In a preferred embodiment, the lower lenticule incision is formed by placing short laser scan lines tangential to the latitude parallel of the lower lenticule incision and scanning the laser scan lines along the longitude meridians of the lower lenticule surface to form multiple sweeps (described in more detail below). Each sweep passes through the apex of the lenticule, so that the apex is formed after the first scan. Thus, in many cases, the apex is at least partially formed when an interruption occurs in the formation of the lower surface, so that its depth can be measured in step S210.

[0031] The apex depth may be measured using a non-confocal detector in the ophthalmic laser system, which detects a reflected laser beam that is reflected by the partially formed lower incision and focused by the objective lens of the laser system. Details of such a depth measurement subsystem are described in commonly owned U.S. Patent Application Publication No. 2020 / 0064622, entitled "Detection of Optical Surface of Patient Interface for Ophthalmic Laser Applications Using a Non-Confocal Configuration," the disclosure of which is incorporated herein by reference. The apex depth may also be measured using an optical coherence tomography (OCT) subsystem in the ophthalmic laser system.

[0032] In this retreatment option, care should be taken to avoid the adverse effects of air bubbles when forming a new lower lenticule incision at a deeper depth. When a femtosecond pulsed laser is used to incise corneal tissue, air bubbles often form at the incision site. Such bubbles can interfere with the formation of subsequent incisions at a deeper depth. Therefore, if any air bubbles generated when making the originally planned lower lenticule incision 102' still remain, they may be removed through an entry cut, or a new lower lenticule incision may be formed after sufficient time has passed for the air bubbles to dissipate.

[0033] If the procedure is interrupted while forming the upper floor incision ("Yes" in step S213), the surgeon redocks the eye to the laser system via the patient interface if necessary (step S214), and the depth of the partially formed upper floor incision is measured using the depth measurement subsystem of the ophthalmic laser system (step S215). A revised treatment plan is then generated and executed (step S216) to form a new upper floor incision at a depth shallower than the partially formed upper floor incision by a predetermined distance. The predetermined distance may be, for example, 5 to 10 microns. Because the lower lenticule incision is larger than the originally planned upper floor incision by a sufficient amount, the new shallower upper floor incision still intersects with the lower lenticule incision around the entire periphery to form a separated lenticule volume. After the retreatment is successfully completed, the lenticule is extracted from the cornea (step S207). Steps S215 to S216 are performed according to the surgeon's instructions.

[0034] 1B schematically shows the entry incision 101, the lower lenticule incision 102, the partially formed upper floor incision 103', and the new upper floor incision 103. The new upper floor incision 103 and the lower lenticule incision 102 form a separated lenticule volume 100. The original upper floor incision 103' is incomplete and therefore does not form a separated volume with either the upper floor incision 103 or the lower lenticule incision 102. Thus, the lenticule volume can be removed with minimal complications.

[0035] Because the upper floor incision is flat, it is not necessary to align the upper floor incision perpendicular to the already formed lower lenticule incision. If the upper incision is lenticule-shaped, the apex of the upper lenticule must be precisely aligned with the apex of the lower lenticule incision.

[0036] In an alternative embodiment, in the original treatment plan, the entrance incision is made after the inferior lenticule incision and the superior floor incision. If the procedure is interrupted while making the entrance incision, a revised plan for the entrance incision is aligned with the partially made entrance incision, similar to step S205, and the entrance incision is continued using the revised plan. The retreatment steps for the interrupted inferior and superior incisions remain the same as above.

[0037] In another alternative embodiment, in the original treatment plan, the upper floor incision is formed before the lower lenticule incision. If the procedure is interrupted while forming the upper floor incision, the depth of the partially formed upper floor incision is measured, and a revised treatment plan is executed to form new upper and lower floor incisions, with the upper and lower incisions shifted upward so that the new upper floor incision is located a predetermined distance above the partially formed upper floor lenticule incision. The result is similar to that shown in FIG. 1B. In this alternative embodiment, if the procedure is interrupted while forming the lower lenticule incision, the depth of the apex of the partially formed lower lenticule incision is measured, and a revised treatment plan is executed to form a new lower lenticule incision, with the new lower lenticule incision located a predetermined distance deeper than the partially formed lower lenticule incision. The result is similar to that shown in FIG. 1A.

[0038] In another alternative embodiment, the entrance incision is merged with the lower incision into one segment. That is, when forming the lower incision, a portion of the scan of the laser scan line is extended upward to reach the anterior corneal surface to form the entrance incision. In this embodiment, if the procedure is interrupted while forming the lower lenticule incision, the treatment plan is modified to position the lower lenticule incision below the partially formed lower lenticule incision as described above, and also to rotate the position of the entrance port to form a new lower lenticule incision with the entrance incision.

[0039] Figures 3, 3A, and 4 schematically illustrate a corneal lenticule extraction procedure according to a second embodiment of the present invention. The corneal lenticule incision in this embodiment includes four segments in the order in which they are performed (see the side view in Figure 3): an entrance incision 301, a ring incision 302, a lower lenticule incision 303, and a flat upper floor incision 304. The ring incision has a ring shape and extends substantially perpendicularly between the upper and lower incisions, with or without an inclination angle. The upper and lower incisions do not intersect each other, but both intersect with the ring incision near their peripheries to form a separate lenticule volume 300 to be extracted. The entrance incision is a band-shaped incision located along the outer edge of the lower lenticule incision, the outer edge of the upper floor incision, or the ring incision. The lenticule formed by the ring incision has a thicker edge than the lenticule in the first embodiment of Figure 1, making it easier to extract. Other aspects of the corneal lenticule incision are similar to those of the first embodiment of Figure 1.

[0040] In a second embodiment, as shown in FIG. 4, after the patient's eye is docked to the laser system via the patient interface device (step S401), the planned lenticule incision procedure begins (step S402).

[0041] If the procedure is interrupted during the formation of the entrance incision ("Yes" in step S403), the same retreatment steps (steps S204-S206) as in the first embodiment are performed (step S404). After the retreatment is successfully completed, the lenticule is extracted from the cornea (step S405).

[0042] If the procedure is interrupted while forming the ring cut ("Yes" in step S406), the surgeon redocks the eye to the laser system via the patient interface if necessary (step S407), and the original treatment plan is modified to define a ring cut with a slightly larger radius (e.g., 20-100 microns) than the original ring cut (step S408). The modified treatment plan may also include a new entrance cut, but the parameters of the lower lenticule incision and upper floor incision preferably remain unchanged. The modified treatment plan is aligned with the partially formed ring cut so that the new ring cut is concentric with the partially formed ring cut (step S409). Alignment may be performed using the user interface display of the ophthalmic laser system, as in step S205. The modified treatment plan is executed to form the new ring cut, lower lenticule incision, and upper floor incision (step S410). After successful completion of the retreatment, the lenticule is extracted from the cornea (step S405). Steps S408 to S410 are performed according to the surgeon's instructions.

[0043] 3A shows schematically the partially formed ring cut 302′, the new (wider) ring cut 302, the lower lenticule incision 303, the upper floor incision 304, and the entry cut 301. Because the original ring cut 302′ is incomplete, it does not form a separate volume with the upper and lower incisions 303 and 304 or with the new ring cut 302. Thus, the lenticule volume can be removed with minimal complexity.

[0044] If the procedure is interrupted during the formation of the lower lenticule incision ("Yes" in step S411), the same retreatment steps (steps S209 to S212) as in the first embodiment are performed (step S412). In other words, the lower and upper incisions are shifted downward relative to the partially formed lower lenticule incision. If the procedure is interrupted during the formation of the upper floor incision ("Yes" in step S413), the same retreatment steps (steps S214 to S216) as in the first embodiment are performed (step S414). In other words, the upper floor incision is shifted upward relative to the partially formed upper floor incision. After the retreatment is successfully completed, the lenticule is extracted from the cornea (step S405).

[0045] In all of the above-described embodiments, the new incisions (ring incision, lower lenticule incision, upper floor incision) in the modified treatment plan are positioned outside the corresponding partially formed incisions. More specifically, the new lower lenticule incision is positioned below the partially formed lower lenticule incision, the new upper floor incision is positioned below the partially formed upper floor incision, and the new ring incision is positioned outside the partially formed ring incision.

[0046] 5A and 5B, an ophthalmic laser system that may be used to perform the lenticule extraction procedure described above will now be described in more detail.

[0047] 5A shows an ophthalmic surgical laser system 1 suitable for making incisions in a target material, such as the cornea of ​​an eye. A laser 2, such as a femtosecond laser, provides a pulsed laser beam 2A that can be used in optical procedures to treat the eye. System 1 further includes, but is not limited to, a high-frequency scanner (such as a resonant scanner) 3 for scanning the pulsed laser beam to generate a scan line 12 of the pulsed laser beam, a scan line rotator 4 for rotating the scan line 12, a beam expander 5, an objective lens 6 for focusing the laser beam, an XY scanning device 7 for deflecting or directing the laser beam on or within the target, a high-speed Z scanning device 8, a patient interface 9, an auto-Z device 10, a controller 13, and a communication module 15.

[0048] The resonant scanner 3 scans a pulsed laser beam at a high resonant frequency (e.g., several thousand Hz) to generate a scan line extending in the lateral direction (i.e., perpendicular to the laser beam propagation direction Z) and having a desired length, e.g., 1 mm to 2 mm. The length of the scan line may be adjustable. The scan line rotator 4 may be implemented by a Dove prism, a Pechan prism, a set of mirrors, or the like mounted on a rotation stage. By rotating the scan line rotator 4 around the Z axis, the lateral orientation of the scan line 12 is rotated, so that the scan line may be positioned at any desired orientation in the XY plane (i.e., the lateral plane perpendicular to the laser beam propagation direction Z). The XY scanning device 7 may be a movable XY scanning stage to which a focusing objective lens 6 is attached. The XY scanning device 7 carries the objective lens 6 and moves it relative to the patient interface device 9 to move the center of the scan line 12 in the XY directions relative to the patient's eye. The high-speed Z scanning device 8 changes the depth (i.e., along the Z direction) of the laser focal position in the eye. Thus, the scan line rotator 4 changes the lateral orientation of the scan line 12, while the movable XY scanning stage 7 and fast Z scanning device 8 move the center of the scan line in the X, Y, and Z directions. Because the scanning speed of the resonant scanner is typically much faster than the speed of the XY scanning stage and fast Z scanning device, the scan line 12 is sometimes referred to as the fast scan line, and the movement of the fast scan line in the X, Y, and Z directions is sometimes referred to as the slow sweep.

[0049] The XY scanning stage 7 may be a motorized stage with two motors to drive movement in the X and Y directions. Preferably, the XY scanning stage is a reactionless stage configured to reduce or eliminate mechanical vibrations. The high-speed Z scanning device 8 may include a voice coil actuator that drives a lens in the Z direction. Movement of the lens results in a change in focal depth. The high-speed Z scanning frequency may be 50 Hz to 15,000 Hz.

[0050] A patient interface device 9 couples the patient's eye to the ophthalmic surgical laser system 1. The patient interface 9 may include a visualization beam splitter that reflects light from the eye along an optical path 11 toward a video microscope or ophthalmic microscope 14, allowing the eye to be imaged by an image detector on the microscope. The visualization beam splitter, optical path 11, and microscope 14 are optional.

[0051] The auto-Z module 10 may include either a confocal or non-confocal detector and may be used to measure the depth of a target surface, as described in more detail in the aforementioned U.S. Patent Application Publication No. 2020 / 0064622.

[0052] A controller 13, which may be implemented by a processor executing appropriate machine-readable program code and data stored in non-volatile memory, is operably coupled to various components of system 1, including laser 2, high-speed Z-scanning device 8, resonant scanner 3, scan line rotator 4, XY scanning stage 7, detector 14, and communication module 15. Controller 13 is configured to direct these components of the system to focus a pulsed laser beam into the eye in a desired pattern to modify the eye. Communication module 15 provides information to an operator of laser system 1 at the system and / or remotely via a wired or wireless data connection and may include user input devices such as a display, keyboard, mouse, joystick, etc. The ophthalmic surgical laser system may further include an OCT (optical coherence tomography) device (not shown in FIG. 5A ), which can be used to measure the structure of a target (e.g., ocular tissue).

[0053] FIG. 5B illustrates an ophthalmic surgical laser system 20 suitable for making incisions in a target material, such as the cornea of ​​an eye. The system 20 includes, but is not limited to, a laser source (not shown) generating an input pulsed laser beam 21, a high-speed Z scanning device 22, a resonant scanner 23 for generating a scan line 12B of the pulsed laser beam 21, a scan line rotator 24 for rotating the lateral orientation of the scan line 12B, a beam expander 25, an objective lens (slow Z scanner) 26 with an adjustable focusing mechanism, an XY scanning stage 27 for deflecting or steering the pulsed laser beam 21 onto or within the target, a patient interface 28 that may optionally include a beam splitter, a controller 13B, an optional image detector 29 positioned on an optical path 29A defined by the patient interface beam splitter, and a communications module 15B. The slow Z scanner 26 may be used to set the laser focus to a desired focal depth, which may establish a Z baseline for the scan pattern.

[0054] One difference between the system of Figure 5B and the system of Figure 5A is that the XY scanning stage 7 of Figure 5A carries both the objective lens 6 and other components including the fast Z scanning device 8, the resonant scanner 3, the scan line rotator 4, and the beam expander 5, whereas the XY scanning stage 27 of Figure 5B carries the objective lens 26 but does not carry the other components mentioned above. Note that in the system of Figure 5A, the objective lens 6 may comprise a slow Z scanner (also represented by reference numeral 6).

[0055] Further details of ophthalmic surgical laser systems having the configurations shown in Figures 5A and 5B are described in commonly owned U.S. patent application Ser. No. 14 / 970,898, filed December 16, 2015, entitled "Compact Ultra-Short Pulsed Laser Eye Surgery Workstation," and commonly owned U.S. patent application Ser. No. 14 / 865,396, filed September 25, 2015, entitled "Systems and Methods for Lenticular Laser Incision," both of which are incorporated herein by reference in their entireties.

[0056] In the above-described ophthalmic laser system, beam scanning can be achieved using a "fast scan-slow sweep" scanning scheme, also referred to herein as a fast scan line scheme. Figure 6 shows an example of scanning using an 8 kHz (e.g., 7 kHz to 9 kHz) resonant scanner to generate a fast scan line 410 of approximately 1 mm (e.g., 0.9 mm to 1.1 mm) and a scan speed of approximately 25 m / s, and an X, Y, and Z scanning mechanism with a scan speed (sweep rate) of less than approximately 0.1 m / s. The fast scan line 410 may be perpendicular to the optical beam propagation direction, i.e., it is always parallel to the XY plane. The trajectory of the slow sweep 420 can be any three-dimensional curve traced by the X, Y, and Z scanning devices (e.g., an XY scanner and a fast Z scanner). The advantage of the "fast scan-slow sweep" scanning scheme is that it uses only small field optics (e.g., a field diameter of 1.5 mm), which can achieve high focus quality at a relatively low cost. Large surgical fields (e.g., field of view diameter of 10 mm or more) are achieved using an XY scanner, which may be unlimited.

[0057] In the embodiment shown in Figures 7 (perspective view) and 8 (top view), the laser system uses a "fast scan-slow sweep" scanning method to form a smooth lenticule cut. First, in three-dimensional lenticule cuts, the fast scan line is preferably positioned tangent to the latitude line 510 on the surface of the lenticule. The latitude line is a circle (or other closed line) on the surface of the lenticule that is perpendicular to the Z axis and has a defined distance to the apex (the intersection of the surface with the Z axis, which is also the highest or lowest point in the Z direction). For example, this can be achieved by adjusting the scan line rotator to a corresponding orientation via software, e.g., a controller. Second, the slow sweep trajectory preferably moves along the longitude line 520 on the surface of the lenticule. The meridian is a curve that passes through the intersection of the surface with a plane passing through the Z axis, i.e., the apex, and has a defined angular direction relative to the Z axis. For example, this can be done via software, e.g., a controller, by adjusting an XY scanner and a high-speed Z scanner. The procedure starts with a scan line parallel to the latitude line and sweeps the apex of the lens according to the curvature with the largest diameter. Multiple sweeps are performed at successive angular orientations relative to the Z axis to form the entire lenticule, as achieved, for example, by rotating a scan line rotator between successive sweeps. This preferred procedure eliminates vertical "steps" in the incision. Deviations between the laser focus position and the intended spherical incision are also minimized.

[0058] 8 shows a plan view 950 of a lenticule incision 915 illustrating three exemplary sweeps (1A to 1B), (2A to 2B), and (3A to 3B), each sweep passing through (i.e., beyond) a lenticule incision apex 955. The incisions have a diameter 957 (D CUT ) Plan view 980 shows a plan view of one example sweep.

[0059] It should be noted that although the example of FIG. 7 is an upwardly curved lenticular surface, the discussion applies equally to downwardly curved lenticular surfaces such as lower lenticular surfaces 102 and 303.

[0060] The "fast scan-slow sweep" scanning method may also be used to form other incisions in the corneal lenticule in the above-described embodiments. To form the flatbed incision 103 or 304, the fast scan line is kept in the same XY orientation and scanned by the XY and Z scanners in a raster scan pattern, i.e., forming sweeps along parallel lines or serpentine paths. To form the ring cut 302, the fast scan line is placed tangential to the ring and scanned in the Z direction, with scan line rotation between scans. To form the entrance cut 101 or 301, the laser scan line is placed at the desired location and orientation of the entrance cut and scanned in the Z direction, with or without rotation between scans.

[0061] In the corneal lenticule incision method described above with reference to Figures 2 and 4, the controller 13 or 13B controls the laser source and scanner of the laser system to scan the focus of the laser beam within the eye tissue and form various incisions according to the treatment plan. The depth measurement steps (e.g., steps S210, S215) may be implemented using the auto-Z module 10. The user interface device used in steps S205 and S409 may be implemented by the communication device 15 or 15B.

[0062] It will be apparent to those skilled in the art that various modifications and variations can be made in the corneal lenticule incision method and related apparatus of the present invention without departing from the spirit or scope of the invention. Thus, it is intended that the present invention cover such modifications and variations as come within the scope of the appended claims and their equivalents.

[0063] [Embodiment] (1) A method of forming a corneal lenticule, carried out in an ophthalmic laser system for forming a lenticule in the cornea of ​​a patient's eye, comprising: (a) generating a laser beam; (b) scanning a laser beam focus within the cornea by executing a treatment plan, the treatment plan including a lower segment defining a lower lenticule incision and an upper segment defining an upper floor incision, the lower lenticule incision including an optical zone having a shape determined by the defined refractive power of the lenticule, the upper floor incision having a flat shape, the upper floor incision being located above the lower lenticule incision and having a diameter smaller than the diameter of the lower lenticule incision; (c) in response to an interruption during execution of the lower segment of the treatment plan after a lower lenticule incision has been partially formed, modifying the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision, and scanning the laser beam focal point by executing the modified treatment plan to form the new lower lenticule incision; (d) in response to an interruption while executing the upper segment of the treatment plan after the upper floor incision has been partially formed, modifying the treatment plan to define a new upper floor incision located above the partially formed upper floor incision, and scanning the laser beam focus by executing the modified treatment plan to form the new upper floor incision. (2) A corneal lenticule formation method as described in embodiment 1, wherein step (c) further comprises measuring the apex depth of the partially formed lower lenticule incision before modifying the treatment plan. (3) A method for forming a corneal lenticule as described in embodiment 2, wherein the apex of the new lower lenticule incision is located 5 to 20 μm (5 to 20 microns) below the apex of the partially formed lower lenticule incision. (4) A corneal lenticule formation method as described in embodiment 1, wherein step (d) further comprises measuring the depth of the partially formed upper floor incision before modifying the treatment plan. (5) A method for forming a corneal lenticule as described in embodiment 4, wherein the new upper floor incision is located 5 to 10 μm (5 to 10 microns) above the partially formed upper floor incision.

[0064] (6) A corneal lenticule formation method according to embodiment 1, wherein in the treatment plan, the lower segment is performed before the upper segment. (7) A corneal lenticule formation method according to embodiment 1, wherein in the treatment plan, the upper segment is performed before the lower segment. (8) The treatment plan further includes an entrance segment defining an entrance incision, the entrance incision having a band shape and extending upward from an outer edge of the lower lenticule incision to reach the anterior surface of the cornea, and the method further comprises: (e) In response to an interruption while executing the entrance segment of the treatment plan after the entrance cut has been partially formed, the method of forming a corneal lenticule as described in embodiment 1 further comprises modifying the treatment plan to define a new entrance cut aligned with the partially formed entrance cut, and scanning the laser beam focus by executing the modified treatment plan. (9) A corneal lenticule formation method according to embodiment 8, wherein in the treatment plan, the entrance segment is performed before the lower segment and the upper segment. (10) A method for forming a corneal lenticule as described in embodiment 1, wherein the lower lenticule incision and the upper floor incision intersect each other near their respective peripheries to define a separate lenticule volume.

[0065] (11) The treatment plan further includes a ring segment defining a ring incision, the ring incision having a ring shape and extending between the lower lenticule incision and the upper floor incision, the lower lenticule incision and the upper floor incision both intersecting the ring incision near their respective peripheries to define an isolated lenticule volume, and the method further comprises: (e) In response to an interruption while executing the ring segment of the treatment plan after the ring cut has been partially formed, the method of forming a corneal lenticule described in embodiment 1 further comprises modifying the treatment plan to define a new ring cut having a radius larger than that of the partially formed ring cut and concentrically aligned with the partially formed ring cut, and scanning the laser beam focus by executing the modified treatment plan. (12) A method for forming a corneal lenticule according to embodiment 11, wherein the radius of the new ring cut is 20 to 100 μm (20 to 100 microns) larger than the radius of the partially formed ring cut. (13) The step (b) Scanning the laser beam by a resonant scanner to form a laser scan line, the scan line having a predetermined length and being a straight line parallel to an XY plane; A corneal lenticule formation method as described in embodiment 11, comprising: using an XY scanner and a Z scanner to form multiple sweeps of the scan lines that collectively form the lower lenticule incision, and for each sweep, positioning the scan line tangentially to the latitude parallel of the lower lenticule incision; and scanning the laser scan line along the longitude meridians of the lower lenticule incision, wherein the latitude parallels are circles on the lower lenticule incision that are perpendicular to the Z axis and have a defined distance to the apex of the lower lenticule incision, and the longitude meridians are curves that pass through the apex and have a defined angular position around the Z axis. (14) The step (b) Scanning the laser beam by a resonant scanner to form a laser scan line, the scan line having a predetermined length and being a straight line parallel to an XY plane; A corneal lenticule formation method as described in embodiment 11, comprising: forming, by an XY scanner, multiple parallel sweeps of the scanning lines that collectively form the upper floor incision. (15) A method of forming a corneal lenticule, carried out in an ophthalmic laser system for forming a lenticule in the cornea of ​​a patient's eye, comprising: (a) generating a laser beam; (b) scanning a laser beam focus within the cornea by executing a treatment plan, the treatment plan including, in order, an entrance segment defining an entrance incision, a lower segment defining a lower lenticule incision, and an upper segment defining an upper floor incision, the lower lenticule incision including an optical zone having a shape determined by the defined refractive power of the lenticule, the upper floor incision having a flat shape, the upper floor incision being located above the lower lenticule incision and having a diameter smaller than that of the lower lenticule incision, the upper floor incision and the lower lenticule incision intersecting each other near their respective peripheries to define a separated lenticule volume, and the entrance incision having a band shape and extending upward from the outer edge of the lower lenticule incision; (c) in response to an interruption during execution of the entrance segment of the treatment plan after an entrance incision has been partially formed, modifying the treatment plan to define a new entrance incision aligned with the partially formed entrance incision, a new lower lenticule incision, and a new upper floor incision, and scanning the laser beam by executing the modified treatment plan to complete the entrance incision and form the new lower lenticule incision and the new upper floor incision; (d) in response to an interruption during execution of the lower segment of the treatment plan after the entrance incision has been formed and the lower lenticule incision has been partially formed, modifying the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision and a new upper floor incision located above the new lower lenticule incision, and scanning the laser beam focus by executing the modified treatment plan to form the new lower lenticule incision and the new upper floor incision; (e) in response to an interruption while executing the upper segment of the treatment plan after an entrance incision and a lower lenticule incision have been formed and an upper floor incision has been partially formed, modifying the treatment plan to define a new upper floor incision located above the partially formed upper floor incision, and scanning the laser beam focus by executing the modified treatment plan to form the new upper floor incision.

[0066] (16) A method for forming a corneal lenticule as described in embodiment 15, wherein step (d) further comprises measuring the depth of the apex of the partially formed lower lenticule incision before modifying the treatment plan, and the apex of the new lower lenticule incision is located 5 to 20 μm (5 to 20 microns) below the apex of the partially formed lower lenticule incision. (17) A method for forming a corneal lenticule as described in embodiment 15, wherein step (e) further includes measuring the depth of the partially formed upper floor incision before modifying the treatment plan, and the new upper floor incision is located 5 to 10 μm (5 to 10 microns) above the partially formed upper floor incision. (18) A corneal lenticule formation method implemented in an ophthalmic laser system for forming a lenticule in the cornea of ​​a patient's eye, comprising: (a) generating a laser beam; (b) scanning a laser beam focus within the cornea by executing a treatment plan, the treatment plan including, in order, an entrance segment defining an entrance incision, a ring segment defining a ring incision, a lower segment defining a lower lenticule incision, and an upper segment defining an upper floor incision, the lower lenticule incision including an optical zone having a shape determined by the defined optical power of the lenticule, the upper floor incision having a flat shape, the upper floor incision being located above the lower lenticule incision and having a diameter smaller than that of the lower lenticule incision, the ring incision having a ring shape and extending between the upper floor incision and the lower lenticule incision, both the upper floor incision and the lower lenticule incision intersecting the ring incision near their respective peripheries to define a separated lenticule volume, and the entrance incision having a band shape and extending upward from an outer edge of the lower lenticule incision; (c) in response to an interruption during execution of the entrance segment of the treatment plan after an entrance incision has been partially formed, modifying the treatment plan to define a new entrance incision, a new ring incision, a new lower lenticule incision, and a new upper floor incision aligned with the partially formed entrance incision, and scanning the laser beam by executing the modified treatment plan to complete the entrance incision and form the new ring incision, the new lower lenticule incision, and the new upper floor incision; (d) in response to an interruption while executing the ring segment of the treatment plan after an entrance incision has been formed and a ring incision has been partially formed, modifying the treatment plan to define a new ring incision, a new lower lenticule incision, and a new upper floor incision having a radius greater than a radius of the partially formed ring incision and concentrically aligned with the partially formed ring incision, and scanning the laser beam by executing the modified treatment plan to form the new ring, the new lower lenticule incision, and the new upper floor incision; (e) in response to an interruption during execution of the lower segment of the treatment plan after the entrance incision and the ring incision have been formed and the lower lenticule incision has been partially formed, modifying the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision and a new upper floor incision located above the new lower lenticule incision, and scanning the laser beam focus by executing the modified treatment plan to form the new lower lenticule incision and the new upper floor incision; (f) in response to an interruption while executing the upper segment of the treatment plan after an entrance incision, a ring incision, and a lower lenticule incision have been formed and an upper floor incision has been partially formed, modifying the treatment plan to define a new upper floor incision located above the partially formed upper floor incision, and scanning the laser beam focus by executing the modified treatment plan to form the new upper floor incision. (19) A method for forming a corneal lenticule according to embodiment 18, wherein the radius of the new ring cut is 20 to 100 μm (20 to 100 microns) larger than the radius of the partially formed ring cut. (20) Step (e) further comprises measuring the depth of the apex of the partially formed lower lenticule incision before modifying the treatment plan, and the apex of the new lower lenticule incision is located 5-20 microns below the apex of the partially formed lower lenticule incision; A corneal lenticule formation method as described in embodiment 18, wherein step (f) further includes measuring the depth of the partially formed upper floor incision before modifying the treatment plan, and the new upper floor incision is located 5 to 10 μm (5 to 10 microns) above the partially formed upper floor incision.

Claims

1. 1. A method of operating a controller of an ophthalmic laser system that may be used to form a lenticule in a cornea of ​​a patient's eye, comprising: (a) the controller controlling a laser to generate a laser beam; (b) the controller controls a resonant scanner, a scan line rotator, an XY scanning device, and a high-speed Z scanning device to scan a laser beam focus within the cornea based on a treatment plan, the treatment plan including a lower segment defining a lower lenticule incision and an upper segment defining an upper floor incision, the lower lenticule incision including an optical zone having a shape determined by the defined refractive power of the lenticule, the upper floor incision having a flat shape, the upper floor incision being located above the lower lenticule incision and having a diameter smaller than a diameter of the lower lenticule incision; (c) the controller detecting an interruption during execution of the lower segment of the treatment plan after a lower lenticule incision has been partially formed, and in response to the interruption, the controller modifying the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision, and controlling the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam focal point based on the modified treatment plan to form the new lower lenticule incision; (d) a method of operating a controller of an ophthalmic laser system, comprising: the controller detecting an interruption while executing the upper segment of the treatment plan after an upper floor incision has been partially formed; and in response to the interruption, the controller modifying the treatment plan to define a new upper floor incision located above the partially formed upper floor incision; and controlling the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam focus by executing the modified treatment plan to form the new upper floor incision.

2. 2. The method of claim 1, wherein in (c), the controller further comprises controlling the detector to measure the depth of the apex of the partially formed lower lenticule incision before modifying the treatment plan.

3. A method for operating a controller of an ophthalmic laser system as described in claim 2, wherein when the controller modifies the treatment plan, the treatment plan is set so that the apex of the new lower lenticule incision is located 5 to 20 μm (5 to 20 microns) below the apex of the partially formed lower lenticule incision.

4. A method for operating a controller of an ophthalmic laser system as described in claim 1, further comprising the controller setting the treatment plan to measure the depth of the partially formed upper floor incision prior to (d).

5. A method for operating a controller of an ophthalmic laser system as described in claim 4, wherein when the controller modifies the treatment plan, the treatment plan is set so that the new upper floor incision is positioned 5 to 10 μm (5 to 10 microns) above the partially formed upper floor incision.

6. A method for operating a controller of an ophthalmic laser system as described in claim 1, wherein the controller sets the treatment plan so that the lower segment is executed before the upper segment.

7. A method of operating a controller of an ophthalmic laser system as described in claim 1, wherein the controller sets the treatment plan so that the upper segment is executed before the lower segment.

8. The method according to claim 7, wherein the controller configures the treatment plan so that the treatment plan further includes an entrance segment defining an entrance incision, the entrance incision having a band shape and extending upward from an outer edge of the lower lenticule incision to reach the anterior surface of the cornea, the method comprising:

2. The method of claim 1, further comprising: (e) detecting an interruption while executing the entrance segment of the treatment plan after an entrance cut is partially formed, and in response to the interruption, modifying the treatment plan to define a new entrance cut aligned with the partially formed entrance cut, and controlling the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam focus by executing the modified treatment plan.

9. A method of operating a controller of an ophthalmic laser system as described in claim 8, wherein the controller sets the treatment plan so that the entrance segment is executed before the lower segment and the upper segment.

10. A method of operating a controller of an ophthalmic laser system as described in claim 1, wherein the controller sets the treatment plan so that the lower lenticule incision and the upper floor incision intersect each other near their respective peripheries to define a separate lenticule volume.

11. and wherein the controller controls the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device so that the treatment plan further includes a ring segment defining a ring incision, the ring incision having a ring shape and extending between the lower lenticule incision and the upper floor incision, the lower lenticule incision and the upper floor incision both intersecting the ring incision near their respective peripheries to define an isolated lenticule volume; and the method further comprises:

2. The method of claim 1, further comprising: (e) detecting an interruption while executing the ring segment of the treatment plan after a ring cut has been partially formed, and in response to the interruption, modifying the treatment plan to define a new ring cut having a radius larger than that of the partially formed ring cut and concentrically aligned with the partially formed ring cut; and controlling the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam focus by executing the modified treatment plan.

12. A method for operating a controller of an ophthalmic laser system as described in claim 11, wherein when the controller modifies the treatment plan, the treatment plan is set so that the radius of the new ring cut is 20 to 100 μm (20 to 100 microns) larger than the radius of the partially formed ring cut.

13. In the above (b), the controller controls a resonant scanner to scan the laser beam to form a laser scan line, the scan line having a predetermined length and being a straight line parallel to an XY plane; 12. The method of claim 11, further comprising: controlling an XY scanner and a Z scanner to form multiple sweeps of the scan line that collectively form the lower lenticule incision; wherein, for each sweep, the controller controls a resonant scanner, a scan line rotator, an XY scanning device, and a high-speed Z scanning device to position the scan line tangentially to a latitude parallel of the lower lenticule incision and scan the laser scan line along a longitude meridian of the lower lenticule incision; wherein the latitude parallel is a circle on the lower lenticule incision that is perpendicular to the Z axis and has a defined distance to an apex of the lower lenticule incision, and the longitude meridian is a curve that passes through the apex and has a defined angular position around the Z axis.

14. In the above (b), the controller controls a resonant scanner to scan the laser beam to form a laser scan line, the scan line having a predetermined length and being a straight line parallel to an XY plane; 12. The method of operating a controller of an ophthalmic laser system of claim 11, further comprising: the controller controlling an XY scanner to form multiple parallel sweeps of the scan lines that collectively form the upper floor incision.

15. 1. A method of operating a controller of an ophthalmic laser system that may be used to form a lenticule in a cornea of ​​a patient's eye, comprising: (a) the controller controlling a laser to generate a laser beam; (b) the controller controls a resonant scanner, a scan line rotator, an XY scanning device, and a high-speed Z scanning device to scan a laser beam focal point within the cornea based on a treatment plan, the treatment plan including, in order, an entrance segment defining an entrance incision, a lower segment defining a lower lenticule incision, and an upper segment defining an upper floor incision, the lower lenticule incision including an optical zone having a shape determined by the defined refractive power of the lenticule, the upper floor incision having a flat shape, the upper floor incision being located above the lower lenticule incision and having a diameter smaller than that of the lower lenticule incision, the upper floor incision and the lower lenticule incision intersecting each other near their respective peripheries to define a separated lenticule volume, and the entrance incision having a band shape and extending upward from the outer edge of the lower lenticule incision; (c) the controller detecting an interruption during execution of the entrance segment of the treatment plan after an entrance incision is partially formed, and in response to the interruption, the controller modifying the treatment plan to define a new entrance incision, a new lower lenticule incision, and a new upper floor incision aligned with the partially formed entrance incision, and controlling the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam based on the modified treatment plan to complete the entrance incision and form the new lower lenticule incision and the new upper floor incision; (d) the controller detecting an interruption during execution of the lower segment of the treatment plan after an entrance incision has been made and a lower lenticule incision has been partially formed, and in response to the interruption, the controller modifying the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision and a new upper floor incision located above the new lower lenticule incision, and scanning the laser beam focal point by executing the modified treatment plan to form the new lower lenticule incision and the new upper floor incision; (e) in response to an interruption during execution of the upper segment of the treatment plan after an entrance incision and a lower lenticule incision have been formed and an upper floor incision has been partially formed, the controller modifies the treatment plan to define a new upper floor incision located above the partially formed upper floor incision, and controls the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam focus by executing the modified treatment plan to form the new upper floor incision.

16. 16. The method of operating a controller of an ophthalmic laser system of claim 15, wherein in (d), the controller further includes controlling a detector to measure the depth of the apex of the partially formed lower lenticule incision before modifying the treatment plan, and the controller sets the treatment plan so that the apex of the new lower lenticule incision is located 5 to 20 μm (5 to 20 microns) below the apex of the partially formed lower lenticule incision.

17. 16. The method of operating a controller of an ophthalmic laser system of claim 15, wherein in (e), the controller further includes controlling a detector to measure the depth of the partially formed upper floor incision before modifying the treatment plan, and the controller sets the treatment plan so that the new upper floor incision is located 5 to 10 μm (5 to 10 microns) above the partially formed upper floor incision.

18. 1. A method of operating a controller of an ophthalmic laser system implemented in an ophthalmic laser system for forming a lenticule in a cornea of ​​a patient's eye, comprising: (a) a controller of the ophthalmic laser system controlling a laser to generate a laser beam; (b) the controller controls a resonant scanner, a scan line rotator, an XY scanning device, and a high-speed Z scanning device to scan a laser beam focal point within the cornea based on a treatment plan, the treatment plan including, in order, an entrance segment defining an entrance incision, a ring segment defining a ring incision, a lower segment defining a lower lenticule incision, and an upper segment defining an upper floor incision, the lower lenticule incision defining an optical zone having a shape determined by the defined optical power of the lenticule; the upper floor incision has a flat shape, the upper floor incision is located above the lower lenticule incision and has a diameter smaller than that of the lower lenticule incision, the ring incision has a ring shape and extends between the upper floor incision and the lower lenticule incision, both the upper floor incision and the lower lenticule incision intersect the ring incision near their respective peripheries to define a separated lenticule volume, and the entrance incision has a band shape and extends upward from an outer edge of the lower lenticule incision; (c) the controller detecting an interruption during execution of the entrance segment of the treatment plan after an entrance incision is partially formed, and in response to the interruption, the controller modifying the treatment plan to define a new entrance incision, a new ring incision, a new lower lenticule incision, and a new upper floor incision aligned with the partially formed entrance incision, and controlling the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam based on the modified treatment plan to complete the entrance incision and form the new ring incision, the new lower lenticule incision, and the new upper floor incision; (d) the controller detecting an interruption while executing the ring segment of the treatment plan after an entrance incision has been formed and a ring cut has been partially formed, and in response to the interruption, the controller modifying the treatment plan to define a new ring incision having a radius larger than a radius of the partially formed ring cut and concentrically aligned with the partially formed ring cut, a new lower lenticule incision, and a new upper floor incision, and controlling the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam by executing the modified treatment plan to form the new ring, the new lower lenticule incision, and the new upper floor incision; (e) the controller detects an interruption while executing the lower segment of the treatment plan after an entrance incision and a ring incision have been formed and a lower lenticule incision has been partially formed, and in response to the interruption, the controller modifies the treatment plan to define a new lower lenticule incision located below the partially formed lower lenticule incision and a new upper floor incision located above the new lower lenticule incision, and controls the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam focal point by executing the modified treatment plan to form the new lower lenticule incision and the new upper floor incision; (f) a method of operating a controller of an ophthalmic laser system, comprising: the controller detecting an interruption while executing the upper segment of the treatment plan after an entrance incision, a ring incision, and a lower lenticule incision have been formed and an upper floor incision has been partially formed; and in response to the interruption, the controller modifying the treatment plan to define a new upper floor incision located above the partially formed upper floor incision; and controlling the resonant scanner, the scan line rotator, the XY scanning device, and the high-speed Z scanning device to scan the laser beam focus by executing the modified treatment plan to form the new upper floor incision.

19. A method for operating a controller of an ophthalmic laser system as described in claim 18, wherein when the controller modifies the treatment plan, the treatment plan is set so that the radius of the new ring cut is 20 to 100 μm (20 to 100 microns) larger than the radius of the partially formed ring cut.

20. In step (e), the controller further includes controlling a detector to measure a depth of an apex of the partially formed lower lenticule incision before modifying the treatment plan, and setting the treatment plan so that the apex of the new lower lenticule incision is located 5-20 μm (5-20 microns) below the apex of the partially formed lower lenticule incision; 20. The method of claim 18, wherein in (f), the controller further includes controlling a detector to measure the depth of the partially formed upper floor incision before modifying the treatment plan, and setting the treatment plan so that the new upper floor incision is located 5 to 10 μm (5 to 10 microns) above the partially formed upper floor incision.

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