WO1989011260A1 - Piece a main et appareil pour chirurgie et dentisterie au laser - Google Patents

Piece a main et appareil pour chirurgie et dentisterie au laser Download PDF

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Publication number
WO1989011260A1
WO1989011260A1 PCT/US1989/002094 US8902094W WO8911260A1 WO 1989011260 A1 WO1989011260 A1 WO 1989011260A1 US 8902094 W US8902094 W US 8902094W WO 8911260 A1 WO8911260 A1 WO 8911260A1
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WO
WIPO (PCT)
Prior art keywords
handpiece
variable focus
focus lens
lens
image
Prior art date
Application number
PCT/US1989/002094
Other languages
English (en)
Inventor
John Taboada
Robert H. Poirier
Original Assignee
Refractive Laser Research & Development Program, L
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Refractive Laser Research & Development Program, L filed Critical Refractive Laser Research & Development Program, L
Publication of WO1989011260A1 publication Critical patent/WO1989011260A1/fr

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Classifications

    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B23—MACHINE TOOLS; METAL-WORKING NOT OTHERWISE PROVIDED FOR
    • B23K—SOLDERING OR UNSOLDERING; WELDING; CLADDING OR PLATING BY SOLDERING OR WELDING; CUTTING BY APPLYING HEAT LOCALLY, e.g. FLAME CUTTING; WORKING BY LASER BEAM
    • B23K26/00—Working by laser beam, e.g. welding, cutting or boring
    • B23K26/0096—Portable laser equipment, e.g. hand-held laser apparatus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/0046—Dental lasers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00821—Methods or devices for eye surgery using laser for coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B23—MACHINE TOOLS; METAL-WORKING NOT OTHERWISE PROVIDED FOR
    • B23K—SOLDERING OR UNSOLDERING; WELDING; CLADDING OR PLATING BY SOLDERING OR WELDING; CUTTING BY APPLYING HEAT LOCALLY, e.g. FLAME CUTTING; WORKING BY LASER BEAM
    • B23K26/00—Working by laser beam, e.g. welding, cutting or boring
    • B23K26/02—Positioning or observing the workpiece, e.g. with respect to the point of impact; Aligning, aiming or focusing the laser beam
    • B23K26/03—Observing, e.g. monitoring, the workpiece
    • B23K26/032—Observing, e.g. monitoring, the workpiece using optical means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B2018/2255—Optical elements at the distal end of probe tips
    • A61B2018/2272—Optical elements at the distal end of probe tips with reflective or refractive surfaces for deflecting the beam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00853—Laser thermal keratoplasty or radial keratotomy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/009—Auxiliary devices making contact with the eyeball and coupling in laser light, e.g. goniolenses

Definitions

  • the present invention relates to a handpiece and related apparatus for performing surgery and dentistry with a laser.
  • condition (a) functions through non-linear optical processes such as dielectric breakdown, which creates a finely localized absorption site because the resulting plasma is usually opaque to the laser beam.
  • Patent 4,326,529 attempts to achieve the correction of corneal irregularities by keratoplasty technique, in which the central stroma is heated with a radio frequency electrode probe, to break collagen crosslinks, to contract the collagen which is a part of the clear corneal medium.
  • the method disclosed in Doss et al has the disadvantage that the heat deposition is not easily localized in the three-dimensional space of the cornea.
  • Roussell et al U.S. Patent 4,409,979 provides apparatus for treating the human eye with laser radiation, and for viewing the site.
  • Reflectors and prisms are provided to conduct light from a light source to the site, passing eccentric to the optical path; an image is conducted from the site to a viewing instrument, such as a microscope, centrally of the optical path.
  • a beam from a laser is caused to strike the central part of a mirror which is movable between an operative position and a retracted position. In the operative position, the mirror directs the laser radiation to the site, generally along the optical path. In the retracted position, the mirror is removed from the optical path, permitting passage of the aforementioned light beam and observing beam.
  • a weak laser is also provided, whose beam passes in a path eccentric to the optical path.
  • a manually adjustable focussing lens is provided in the light paths to focus the light from the light source and the laser radiation.
  • the arrangement presents a problem which requires the provision of a rotatable tube for housing beam splitters and reflectors which are part of the optical path of the light source beam, the observing beam, and the weak laser beam.
  • manipulation of the rotatable tube and manual adjustment of the focussing lens are required to achieve the desired viewing and focussing, prior to the energization of the power laser and the moving of the mirror into operative position to direct the power laser beam to the site.
  • the method of Roussell et al has the disadvantage that it cannot be moved with the freedom of a handpiece with six degrees of freedom. In addition, the method requires the intervention of an operator to establish the focal site of the laser energy delivery.
  • Muckerhide U.S. Patent 4,316,467 discloses the use of a laser for treating birthmarks or lesions on the skin, in which control of the power or energy level of a laser is effected by receiving radiation reflected from the lesion by a fiberoptic bundle: a control circuit senses the intensity corresponding to the color intensity of the region to which the laser beam is directed and varies the energy of the laser.
  • Goldenberg U.S. Patent 4,641,912 discloses an excimer laser system used for angioplasty, and includes a pair of optical fibers, one for obtaining an image of the atherosclerotic plaque to be ablated by the laser energy, a second optical fiber being provided for lasing the plaque.
  • a video camera and monitor are utilized to acquire and display an image of the plaque.
  • Karlin et al U.S. Patent 4,583,539 discloses a system for performing surgery on the eye using a CO2 laser source and an articulated arm structure, the laser energy being delivered through a probe which is connected to the articulated arm structure and which is insertable into an eye.
  • Kimura U.S. Patent 4,266,549 discloses a laser scalpel including a probe through which light may be directed to illuminate the optical site: where a tumor is to be subjected to lasing, a picture or graphic representation may be obtained.
  • An adaptor is provided at the tip of the probe to engage the tissue at or adjacent the tumor, to establish the distance of the focussing lens of the probe to the tumor to be laser.
  • Remy et al U.S. Patent 4,289,378 discloses an apparatus for adjusting the focal point of a working laser beam onto a microscopic target region of a transparent biological object. Use is made of an auxiliary laser beam having a wavelength within the visible range, and through joint manual focussing of the laser beams, the location of focussing of the working beam at a particular locus at a desired depth within the transparent biological specimen is achieved.
  • the handpiece includes a centrally located optical fiber through which the laser beam is passed to the tooth.
  • the handpiece is provided at its distal end with a distance spacer to engage the tooth and provide a fixed spacing between the tooth and the end of the optical fiber to regulate the amount and strength of irradiation of laser beams from the laser source.
  • Patent 4,521,194 discloses a method of removing incipient carious lesions and/or stains from teeth by the application of a laser beam from a source such as a yttrium-aluminum-garnet laser.
  • a source such as a yttrium-aluminum-garnet laser.
  • These aforementioned apparatus also lack provision for the delivery of high peak power TEM(oo) laser mode radiation, as this radiation would normally destroy the fiber-optic delivery devices. For example, five millijoules Q- switched YAG laser pulses would destroy the single mode fiber-optic ends.
  • An apparatus and method for performing laser surgery in which a focussed laser beam is directed by a handpiece to an operational site, and is automatically focussed, so that the tissue modifying (ablation, cutting, melting, etc.) effect of the laser beam is located at a desired locus along the axis of the beam in the subject body.
  • the handpiece which is provided is supported by a novel articulated arm system which permits the handpiece to have six degrees of freedom.
  • the novel arrangement which uses prisms permits the delivery of high peak power laser radiation ranging from the ultraviolet to the infrared.
  • a dichroic reflector which receives laser radiation passed through the articulating arm system from a laser source, the laser radiation (including a concentric alignment beam) entering the handpiece along an optical path at right angles to the optical path which is substantially coincident with the axis of the handpiece.
  • a system of focussing lenses is provided in the handpiece.
  • a light source is optically connected to the handpiece through a fiberoptic bundle, which is connected to the proximal end of the handpiece, light passing axially along the handpiece axis and through the dichroic reflector and the variable focus lens to the site, the observation light from the site passing through the focussing lens and the dichroic reflector into the fiberoptic bundle and to a control system which causes automatic focussing of the adjustable lens, to focus the laser radiation at a preselected depth in the subject body related to a reference or benchmark in the body, which may be, for example, the endothelial cell layer of a cornea.
  • the control system may take the form of an image scanner which delivers a signal to an error signal generator having a reference signal source therein, and generating an error signal to an electromagnetic impulser which controls a fluid cylinder.
  • the fluid cylinder has a piston in it moved by the electromagnetic impulser, and is connected by a flexible conduit to a variable volume chamber of the variable focus lens.
  • the handpiece lower member may be rotated about the handpiece axis, and the handpiece is rotatable about the above mentioned lateral axis.
  • the fiberoptic bundle and the fluid conduit are both flexible, permitting unrestrained movement of the handpiece.
  • Another object is the provision of such method and apparatus including a handpiece in which the depthwise positioning of the focus spot of a focussed laser beam is automatically controlled relative to a reference feature.
  • Another object of the present invention is to provide an apparatus which includes a handpiece for delivery of laser energy and for permitting observation of the site along the axis of the handpiece.
  • Another object of the present invention is to provide an apparatus and method which include a plano ⁇ convex sapphire lens with the piano side to the tissue to be treated.
  • a further object is to provide a thin hand contact lens to cover the cornea to serve as a guide surface.
  • Still another object of the present invention is the provision of an apparatus which provides to a surgeon simultaneous, superimposed images of an operating site, derived from direct observation through a viewing instrument, and from a superimposed video image acquired through a handpiece at the operational site.
  • a further object of the present invention is to provide an apparatus which delivers laser radiation to an operational site through a handpiece while providing the handpiece with six degrees of freedom of motion for orientation of the handpiece relative to the operational site.
  • Yet a further object of the present invention is the provision of an apparatus which delivers laser radiation to an operational handpiece with a minimum of encumbrance, minimum friction and inertia, and optimum counterbalancing using a single boom and a novel air bearing beam conduit.
  • FIG. 1 is a schematic view of an apparatus in accordance with the present invention.
  • Fig. 1A is a detailed view of a part of the apparatus of Fig. 1, and a contact lens on a cornea.
  • Fig. 2 is a schematic view showing portions of the apparatus of Fig. 1, in greater detail.
  • Fig. 3 is a view, partly in section, of- a dental handpiece in accordance with the present invention. DESCRIPTION OF THE PREFERRED EMBODIMENT
  • FIG. 1 an apparatus 10 for performing laser surgery on an eye E.
  • the transparent cornea C having within it the endothelial layer EL, and with a contact lens 60 on the cornea; the lens 60 is optional.
  • the herein disclosed apparatus utilizes the depth • of the endothelium as a reference or landmark for achieving the delivery of laser radiation at a concentrated focus spot within the cornea at a desired depth relative to the endothelium, regardless of the contour of the outer surface. Because the contact lens 60 has the novel arrangement of having the piano side to the cornea, the focussing is extremely accurate and localized.
  • the endothelial layer is utilized as a reference for a focussing system and a variable focus lens, described below.
  • the herein disclosed method and apparatus are particularly applicable to treating the cornea with laser energy, the method and apparatus herein disclosed are not necessarily limited to that application.
  • the apparatus 10 includes a handpiece 12 adapted to be held in the hand of a surgeon. Handpiece 12 is supported by an articulating arm system 14, which receives energy from an ablative laser 16. There may also be provided a relatively weak, aligning laser 18.
  • the laser 16 may be, for example, a high repetition rate, Q-switched YAG TEMoo mode system having an energy per pulse of about three millijoules and a rep rate of the order of 2,000 pulses per second.
  • the laser 16 is coaxially traversed by the beam from the aligning laser 18, which is preferable a visible, low powered CW laser, and is used for achieving beam component alignment, or optionally as a source of illumination for the reference endothelial cell layer.
  • the laser 18 is a three milliwatt helium neon laser.
  • the laser beam in the Gaussian TEMoo mode can be diffraction limited focussed to a minimum spot size on the order of about 10 microns.
  • the novel prism arrangement of the articulating system of the present invention permits any number of high power very ablative lasers to be used, such as an excimer laser for wavelengths in the far UV range, or an f-center laser for wavelengths in the near IR region.
  • a movable platform or carriage (not shown) supports the lasers 16 and 18 and the articulating arm system 14.
  • a flexible coherent fiberoptic bundle 20 and a flexible conduit 22 Connected to the handpiece 12 is a flexible coherent fiberoptic bundle 20 and a flexible conduit 22, which are in turn connected to a monitoring and control system 24.
  • a viewing instrument 26 such as a microscope, is provided, containing a beam splitter 28, and having adjacent to it a TV monitor 30. A surgeon S views through this instrument as shown.
  • the articulating arm system 14 is shown in schematic form, and provides for six degrees of movement of the handpiece 12.
  • an outer tube 41a which is fixed, and in practice extends upwardly from prism 42.
  • An inner tube 41b is axially rotatable relative to the outer tube 41a. This permits the remainder of articulating arm system 14 to rotate in a horizontal plane.
  • the outer tube 41a is suitably anchored and supported, as mentioned above.
  • Fixedly connected at right angles to the inner tube 41b is an outer tube 43a, - having within it a prism or other reflector 44.
  • Axially rotatable in the outer tube 43a is an inner tube 43b.
  • a tube 45a is connected at right angles to the inner tube 43b, and in it is a reflector 46.
  • a counter-weight 47 is connected to the tube 45a by an arm 47a.
  • Tube 45a has an enlarged end 45c in which is mounted a tube 45d, and within the tube 45d there is a perforated tube 45e of smaller diameter, providing a chamber 45f between them.
  • Air or gas is supplied to the chamber 45f through a conduit 48 supplied with air from an air or gas source 49 through a pressure regulator 49a.
  • An inner tube 45g is located within the perforated tube 45e, and is rotatably and axially movable, being supported on an almost frictionless air cushion between the inner tube 47b and the perforated tube 45e.
  • the inner tube 45g has at its outer end a reflector 50, and is secured at right angles to an inner tube 51a, there being an outer tube 51b which is axially rotatable with respect to it.
  • the outer tube 51b forms part of a T-shaped housing 52 which includes a tube 53 transverse to the tube 51b.
  • a lower tubular member 54 is axially rotatable relative to the tube 53.
  • a dichroic reflector 56 Within the housing 53 are a dichroic reflector 56, and adjacent the proximal end of handpiece 12 and within housing 53 is a relay lens 57.
  • a variable focus lens generally designated 58 Within the tubular member 54 is a variable focus lens generally designated 58 and at its distal end is a plano-convex coupling lens 59, in engagement with the piano side to the outer surface of cornea C.
  • the piano side of lens 50 is in engagement with the surface of a hard contact lens 60 through which the radiation passes and which serves as a guide surface.
  • Fig. 2 there is shown the handpiece 12, including the dichroic reflector 56, which is located at the juncture of an optical path through the tubes 51a and 51b, and an optical path along the axis of tubes 53 and 54.
  • the variable focus lens 58 includes for example a negative lens 61 movable axially on guides 62, and a positive lens 63 fixed in position by a locking ring 64.
  • a flexible bellows 66 is hermetically attached to the lenses 61 and 63: flexible conduit 22 extends from the flexible bellows 66, and is in fluid communication with the chamber formed by the lenses 61 and 63 and the flexible bellows 66.
  • the monitoring and control system 24 includes a lens 72 in alignment with an end of the fiberoptic bundle 20, and dichroic reflectors 73 and 74.
  • a light source 76 is in alignment with dichroic reflector 73, and provides light to the operating site, through the lens 72, and fiberoptic bundle 20, and thence into the handpiece 12, passing through relay lens 57, dichroic reflector 56, the variable focus lens 58, and coupling lens 59.
  • the illumination provided by the alignment laser 18 (Fig. 1) can serve to provide the image of the endothelial cells, in which case optical element 75a, 75b, which are bandpass filters passing only the wavelength of the alignment laser, are utilized.
  • a television camera 77 is in alignment with the partial reflector 74, to receive images of the site, TV camera 77 being connected to the TV monitor 30 (Fig. 1).
  • an image scanner 78 which receives an image from the endothelial layer EL.
  • the image scanner by means of out-of-focus sensings, measures the departure of the optical system comprised of the variable focus lens 58, and lenses 59 and 57 from focus on the reference layer EL, i.e., it measures the focus condition.
  • the scanner 78 delivers a signal representative thereof to an error signal generator 79.
  • Error signal generator 79 includes an internal reference standard, such as a pre-set voltage, and generates an error signal in proportion to the difference between the reference voltage and the voltage supplied from image scanner 78.
  • the generated error signal is supplied to an electromagnetic impulser 81 which, in response to the signal received, moves a piston rod 82 into or out of a fluid cylinder 83.
  • the fluid cylinder 83 is fluid connected with the variable volume chamber of variable focus lens 58 by the flexible conduit 22.
  • the focus of the variable lens is changed in accordance with the variation of the thickness of the cornea C.
  • the automatic adjustment of the variable lens with thickness variations of the cornea C assures that the laser beam focal point lies at a predetermined fraction of the corneal thickness since the focus condition of the variable lens system affects the surgical laser beam.
  • the handpiece 12 is maneuvered into position so that the coupling lens 59 at the distal end thereof is in engagement with the outer surface of the cornea C of the eye E under observation and treatment, as shown in Fig. 1.
  • the engagement surface may be a contact lens 60 positioned to cover the cornea and to provide a transparent guide surface.
  • the positioning of handpiece 12 is facilitated by the articulating arm system 14, which permits six degrees of freedom of movement of handpiece 12.
  • the handpiece 12 may be moved or translated, along three mutually perpendicular axes, and may be rotated about three mutually perpendicular axes.
  • variable focus lens 58 there will be no change made to the variable focus lens 58, and when the laser 16 is fired, there will be produced a very high energy density, highly localized spot, at a precise and automatically determined distance in relation to the endothelial layer EL.
  • the laser is not fired when the foregoing condition is not obtained.
  • the handpiece 12 will be caused by the surgeon to move over the outer surface of the cornea C, for example in a radial path as in radial keratotomy, and assuming that it engages a thickness change, it will be apparent that the piano end surface of coupling lens 59 will be moved away from the reference or benchmark endothelial layer EL.
  • the image received by the image scanner 78 will be out of focus, and the image scanner 78 will therefore send a signal to the error signal generator 79 which will be different from the internal reference voltage of error signal generator 79.
  • the error signal generator 79 When a comparison is made, a difference between the two voltage signals occurs, and an error signal will be generated and sent to the electromagnetic impulser 81, resulting in movement of the piston rod 82, and a change in the focal length of the variable focus lens 58.
  • the correction is accomplished in an extremely short period of time, so that the firing of the laser 16, which may, as is typical, be under the control of the surgeon, be accomplished without delay.
  • the laser beam will be focussed so as to place the high energy, small diameter focus spot in the corneal layer at a desired, predetermined distance relative to the location of the endothelial layer E .
  • the surgeon utilizing both the handpiece 12 and the viewing instrument 26, will be able to -obtain an image of the site which may be substantially the same as if he were looking into the distal end of the handpiece 12.
  • the image of the site will pass from the site through the coupling lens 59, variable lens 58, dichroic reflector 56, and relay lens 57 into the fiberoptic bundle 20, and thence through lens 72 to the beam splitter 74.
  • the image will then pass to the TV camera 77, and be transmitted to the TV monitor 30, the image appearing via the beam splitter 28 occupies a small position of the viewing field in the viewing instrument 26. It will be appreciated that the viewing instrument 26 and the handpiece 12 may be maneuvered so as to be closely adjacent to each other, for viewing the same portion of the cornea C.
  • a handpiece 120 for dental applications, handpiece 120 being shown in conjunction with teeth T upon which dental work is to be performed.
  • the handpiece 120 comprises T-shaped housing 52 formed by outer tube 51b and tube 53 transverse to it.
  • Lower tubular member 54 is shown, rotatable with respect to tube 53, and having within it the variable focus lens 58.
  • the dichroic reflector 56 and relay lens 57 are also shown, extending to the variable focus lens 58.
  • a reflector 121 which may take the form of a diverting prism.
  • the diverting prism 121 will divert the light from the light source 76 to the target area on one of the teeth T, and the image thereof will be delivered to the image scanner 78, with the optical distance from lens 58 and the straight line distance of the diverting prism 121 to the dental target determined by image scanner 78, and the focus of the light and laser beams varied in accordance therewith by the error signal generator 79, the electromagnetic impulser 81, cylinder 83, and conduit 22.
  • the dental operator may be able to effect removal of material on the dental target even though the distance between the diverting prism 121 and the dental target will change due to either or both of the following conditions.
  • One condition is that the dental handpiece 120 may be moved so as to cause the beam to traverse a surface or region of the dental target which is curved, and the operator of the handpiece 120 will not be able to maintain the diverting prism 121 at a precise distance from the dental target as the beam is moved over the curving surface thereof.
  • the other condition which is also overcome by the present invention, is the inability of a dental operator to maintain the dental handpiece and particularly the diverting prism 121 at a precise distance, even from a plane surface, should such be encountered in or on the teeth T.
  • the physical distance from the diverting prism 121 to the dental target site will vary, but such variation will be sensed, and there will be caused the automatic focussing of the localized energy focus spot of the laser beam on the surface of the dental target site through the above described exemplary focussing apparatus.

Abstract

Procédé et appareil permettant d'effectuer une chrirurgie médicale ou dentaire. Le corps du sujet sur lequel l'opération doit être effectuée possède une référence, telle qu'une couche dans la cornée ou une surface d'une dent. Une pièce à main ou porte-outil (12) possède un premier chemin optique longitudinal et un second chemin optique transversal, un reflecteur dichroïque (56) étant placé à la jonction des chemins. La pièce à main contient une lentille à foyer variable (58) et un faisceau de fibres optiques (20) est connecté axialement à l'extrémité distale de la pièce à main. De la lumière passant par le faisceau de fibres optiques arrive dans la pièce à main pour éclairer le site d'opération. L'image du site passe par la lentille à foyer variable, dans le faisceau de fibres optiques puis arrive à un appareil de commande (24) pour régler la lentille à foyer variable de manière à focaliser le rayon laser de traitement à une distance prédéterminée par rapport à la référence. On fait arriver un rayon laser dans la pièce à main par le second chemin optique, puis au travers de la lentille à foyer variable qui focalise le rayon en un point localisé qui se trouve à une distance prédéterminée par rapport à la référence: la distance peut être égale à zéro et, par exemple dans ce cas la référence est la surface d'une dent à extraire. La pièce à main est supportée par un système à bras articulé qui présente six degrés de liberté de mouvement. Un procédé permettant d'effectuer l'opération consiste à déterminer à l'aide d'un équipement de mesure de l'état du foyer la distance d'une référence dans le corps d'un sujet, à ajuster une lentille à foyer variable par des signaux de commande proportionnels à l'état du foyer mesuré, et à faire passer un rayon laser au travers de la lentille à foyer variable dans la position réglée.
PCT/US1989/002094 1988-05-19 1989-05-18 Piece a main et appareil pour chirurgie et dentisterie au laser WO1989011260A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US19584388A 1988-05-19 1988-05-19
US195,843 1988-05-19

Publications (1)

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WO1989011260A1 true WO1989011260A1 (fr) 1989-11-30

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EP (1) EP0414791A1 (fr)
JP (1) JPH04501963A (fr)
CA (1) CA1325250C (fr)
IL (1) IL90318A (fr)
WO (1) WO1989011260A1 (fr)

Cited By (15)

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FR2659039A1 (fr) * 1990-03-05 1991-09-06 Gen Electric Procede et appareil de surveillance optique du traitement des materiaux par laser.
DE4015066A1 (de) * 1990-05-10 1991-11-14 Hans Wilhelm Bergmann Vorrichtung und verfahren zur automatischen kontrolle von zahnbehandlungen und chirurgischen eingriffen mit hilfe gepulster laser
FR2670106A1 (fr) * 1990-12-05 1992-06-12 Kaltenbach & Voigt Piece a main dentaire permettant le traitement des dents au moyen de rayons laser.
DE4211234A1 (de) * 1992-04-03 1993-10-07 Kaltenbach & Voigt Zahnärztliches Laser-Behandlungsgerät
DE4233744A1 (de) * 1992-10-07 1994-04-14 Hager & Meisinger Gmbh Werkzeug zum Behandeln durch Laserstrahlen
EP0608052A2 (fr) * 1993-01-22 1994-07-27 Intelligent Surgical Lasers, Inc. Stabilisateur pour l'oeil en chirurgie opthalmique à laser
WO1995011059A1 (fr) * 1993-10-18 1995-04-27 Dusa Pharmaceuticals, Inc. Source lumineuse et procede de therapie photodynamique
FR2737311A1 (fr) * 1995-07-25 1997-01-31 Bm Ind Dispositif de gestion de faisceau
WO1997012559A2 (fr) * 1995-09-11 1997-04-10 Laser- Und Medizin-Technologie Gmbh, Berlin Dispositif d'enlevement de matiere d'une piece par rayonnement laser
WO2000029166A1 (fr) * 1998-11-12 2000-05-25 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Procede et dispositif pour l'usinage de pieces a l'aide d'un rayonnement a haute energie
WO2004014486A1 (fr) * 2002-08-09 2004-02-19 Dobkine Vadim G Procede et dispositif laser utilises dans le traitement d'infections
WO2004014487A1 (fr) * 2002-08-09 2004-02-19 Genestho Inc. Procede et dispositif a laser de traitement d'infections endocavitaires
EP1607064A3 (fr) * 2004-06-17 2006-01-11 Cadent Ltd. Procédé et appareil d'imagerie en couleurs d'une structure tridimensionnelle
WO2007007335A1 (fr) * 2005-07-14 2007-01-18 Light Instruments Ltd. Dispositif d’émission d’énergie laser avec une pièce à main à pivot
EP1941843A3 (fr) * 2004-06-17 2008-07-23 Cadent Ltd. Procédé et appareil d'imagerie couleur d'une structure tridimensionnelle

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DE102009005194B4 (de) * 2009-01-20 2016-09-08 Anton Kasenbacher Laserbearbeitungsgerät zur Bearbeitung eines Materials
DE102010026288A1 (de) * 2010-07-06 2012-01-12 Yong-min Jo System zur Materialabtragung im Mundraum

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Cited By (36)

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Publication number Priority date Publication date Assignee Title
FR2659039A1 (fr) * 1990-03-05 1991-09-06 Gen Electric Procede et appareil de surveillance optique du traitement des materiaux par laser.
DE4015066A1 (de) * 1990-05-10 1991-11-14 Hans Wilhelm Bergmann Vorrichtung und verfahren zur automatischen kontrolle von zahnbehandlungen und chirurgischen eingriffen mit hilfe gepulster laser
FR2670106A1 (fr) * 1990-12-05 1992-06-12 Kaltenbach & Voigt Piece a main dentaire permettant le traitement des dents au moyen de rayons laser.
DE4211234A1 (de) * 1992-04-03 1993-10-07 Kaltenbach & Voigt Zahnärztliches Laser-Behandlungsgerät
DE4233744A1 (de) * 1992-10-07 1994-04-14 Hager & Meisinger Gmbh Werkzeug zum Behandeln durch Laserstrahlen
EP0608052A2 (fr) * 1993-01-22 1994-07-27 Intelligent Surgical Lasers, Inc. Stabilisateur pour l'oeil en chirurgie opthalmique à laser
EP0608052A3 (fr) * 1993-01-22 1994-10-26 Intelligent Surgical Lasers Stabilisateur pour l'oeil en chirurgie opthalmique à laser.
US5441531A (en) * 1993-10-18 1995-08-15 Dusa Pharmaceuticals Inc. Illuminator and methods for photodynamic therapy
US5782895A (en) * 1993-10-18 1998-07-21 Dusa Pharmaceuticals, Inc. Illuminator for photodynamic therapy
WO1995011059A1 (fr) * 1993-10-18 1995-04-27 Dusa Pharmaceuticals, Inc. Source lumineuse et procede de therapie photodynamique
FR2737311A1 (fr) * 1995-07-25 1997-01-31 Bm Ind Dispositif de gestion de faisceau
WO1997012559A2 (fr) * 1995-09-11 1997-04-10 Laser- Und Medizin-Technologie Gmbh, Berlin Dispositif d'enlevement de matiere d'une piece par rayonnement laser
WO1997012559A3 (fr) * 1995-09-11 1997-05-09 Laser & Med Tech Gmbh Dispositif d'enlevement de matiere d'une piece par rayonnement laser
US6086366A (en) * 1995-09-11 2000-07-11 Clinicon Corporation Device for removing material from a workpiece by laser radiation
WO2000029166A1 (fr) * 1998-11-12 2000-05-25 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Procede et dispositif pour l'usinage de pieces a l'aide d'un rayonnement a haute energie
US6791057B1 (en) 1998-11-12 2004-09-14 Fraunhofer-Gesellschaft Zur Forderung Der Angewandten Forschung E.V. Method and device for machining workpieces using high-energy radiation
US7409954B2 (en) 2002-08-09 2008-08-12 Genestho Inc. Method for treatment of infections with ultraviolet laser light
WO2004014486A1 (fr) * 2002-08-09 2004-02-19 Dobkine Vadim G Procede et dispositif laser utilises dans le traitement d'infections
WO2004014487A1 (fr) * 2002-08-09 2004-02-19 Genestho Inc. Procede et dispositif a laser de traitement d'infections endocavitaires
EP1607064A3 (fr) * 2004-06-17 2006-01-11 Cadent Ltd. Procédé et appareil d'imagerie en couleurs d'une structure tridimensionnelle
US20160295191A1 (en) 2004-06-17 2016-10-06 Align Technology, Inc. Method and apparatus for colour imaging a three-dimensional structure
EP1941843A3 (fr) * 2004-06-17 2008-07-23 Cadent Ltd. Procédé et appareil d'imagerie couleur d'une structure tridimensionnelle
US10944953B2 (en) 2004-06-17 2021-03-09 Align Technology, Inc. Method and apparatus for colour imaging a three-dimensional structure
US7511829B2 (en) 2004-06-17 2009-03-31 Cadent Ltd. Method and apparatus for colour imaging a three-dimensional structure
US7724378B2 (en) 2004-06-17 2010-05-25 Cadent Ltd. Method and apparatus for colour imaging a three-dimensional structure
US8102538B2 (en) 2004-06-17 2012-01-24 Cadent Ltd. Method and apparatus for colour imaging a three-dimensional structure
US8363228B2 (en) 2004-06-17 2013-01-29 Cadent Ltd. Method and apparatus for colour imaging a three-dimensional structure
US9404740B2 (en) 2004-06-17 2016-08-02 Align Technology, Inc. Method and apparatus for colour imaging a three-dimensional structure
US7319529B2 (en) 2004-06-17 2008-01-15 Cadent Ltd Method and apparatus for colour imaging a three-dimensional structure
US10728519B2 (en) 2004-06-17 2020-07-28 Align Technology, Inc. Method and apparatus for colour imaging a three-dimensional structure
US10750151B2 (en) 2004-06-17 2020-08-18 Align Technology, Inc. Method and apparatus for colour imaging a three-dimensional structure
US10750152B2 (en) 2004-06-17 2020-08-18 Align Technology, Inc. Method and apparatus for structure imaging a three-dimensional structure
US10764557B2 (en) 2004-06-17 2020-09-01 Align Technology, Inc. Method and apparatus for imaging a three-dimensional structure
US10812773B2 (en) 2004-06-17 2020-10-20 Align Technology, Inc. Method and apparatus for colour imaging a three-dimensional structure
US10924720B2 (en) 2004-06-17 2021-02-16 Align Technology, Inc. Systems and methods for determining surface topology and associated color of an intraoral structure
WO2007007335A1 (fr) * 2005-07-14 2007-01-18 Light Instruments Ltd. Dispositif d’émission d’énergie laser avec une pièce à main à pivot

Also Published As

Publication number Publication date
EP0414791A1 (fr) 1991-03-06
IL90318A0 (en) 1989-12-15
IL90318A (en) 1994-05-30
JPH04501963A (ja) 1992-04-09
CA1325250C (fr) 1993-12-14

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