Noncontact laser microsurgical apparatus

Abstract: A noncontact laser microsurgical apparatus and method for marking a cornea of a patient's or donor's eye in transplanting surgery or keratoplasty, and in incising or excising the corneal tissue in keratotomy, and for tissue welding and for thermokeratoplasty. The noncontact laser microsurgical apparatus (10) comprises a laser source (11) and a projection optical system for converting laser beams emitted from the laser source into coaxially distributed beam spots (61) on the cornea (31). The apparatus further includes a multiple-facet prismatic axicon lens system (18) movably mounted for varying the distribution of the beam spots (61) on the cornea. In a further embodiment of the method of the present invention, an adjustable mask pattern (25-28) is inserted in the optical path of the laser source to selectively block certain portions of the laser beams to thereby impinge only selected areas of the cornea.

Description: Field of the invention The present invention relates to a microsurgical apparatus and, more particularly, a noncontact laser microsurgical apparatus adapted for use in thermokeratoplasty for curing or alleviating corneal refractive error and/or astigmatism of a cornea of a human eye. Description of the related art Noncontact microsurgery of the cornea would minimize distortion of the cornea tissue, as occurs in contact-type techniques, and would decrease the likelihood of producing postoperative astigmatism. The use of lasers provides the potential for such noncontact microsurgery. Excimer lasers have been investigated in the past to produce linear corneal incisions or excisions. The argon fluoride excimer laser emitting at 193 nm has been shown to produce sharp, smooth-walled corneal cuts. More recently, the hydrogen fluoride, Q-switched Er:YAG, and Raman-shifted Nd:YAG lasers emitting at about 2.9 µm (micro meters), which corresponds to the peak absorption wavelength of water, have been experimentally used to produce linear corneal incisions or excisions. Industrial laser cutting by focusing the beam into a ring has been proposed as a method for drilling large diameter holes. The axicon, a diverging prismatic lens, has been used for such industrial purposes. An axicon system has been used by Beckman & Associates to study corneal trephination with a carbon dioxide laser. This experimentation is described in an article entitled "Limbectomies, Keratectomies and Kerastomies Performed With a Rapide-Pulsed Carbon Dioxyde Laser," American Journal of Ophtalmology, Vol. 71, No. 6, (June 1971). In this article, Beckman et al. describe the use of an axicon lens in combination with a focusing lens to form an "optical trephine" and perform various corneal experiments with animal's. The diameter of the trephine was governed by the focal length of the focusing lens in these experiments. Therefore, to vary the diameter of the annular beam it was necessary to change the focusing lens which acted to change the width of the annular ring and, thus, varied the amount of tissue incised or excised by the laser. Moreover, changing the focusing lens requires a time consuming process for each patient or donor. In addition, the optical system proposed in the Beckman et al. article requires the use of multiple focusing lenses of different focal length. US Patent Application Serial Number 07/056,711 filed June 2, 1987 entitled "A Cornea Laser-Cutting Apparatus", assigned to the same assignee as the present application, discloses that trephination of either a donor cornea or a recipient cornea may be performed utilizing a laser cutting technique. Noncontact laser microsurgery is recently applied in cure or alleviation of a cornea refractive error and/or astigmatism. US Patent no. 4,648,400 discloses an ophthalmic surgery system for performing radial keratotomy to cure the corneal refractive error. This prior system comprises optical unit having an ultra-violet laser source and a mask means which is adapted to be mounted on the cornea separately from the optical unit. The mask means includes a plurality of slits disposed along radial directions for selectively transmitting therethrough the laser beams emitted from the laser source in order to impinge the selected laser beams onto the cornea. PCT Patent Application WO-A-87/07829 discloses a noncontact microsurgical apparatus which comprises an infra-red laser source for treatment or operations in the front sections of an eye, or for radial keratotomy, and an axicon optical means located between an imaging optic and the laser source. The axicon optical means includes multi-prismatic facets for deflecting laser beams out of an optical axis of the imaging optic and forming such laser beams into a plurality of paraxially distributed beams. The imaging optic is adapted for imaging onto the eye the distributed beams deflected by the axicon optical means. The apparatus disclosed in the PCT application has similar disadvantage to that of the Beckman et al, because the PCT application's disposition of the imaging optic and the axicon optical means is substantially same as the Backman et al's. Accordingly, it is an object of the present invention to provide a noncontact laser microsurgical apparatus which is capable of performing thermokeratoplasty for curing corneal refractive error and/or astigmatism of a patient's eye. Yet another object of the present invention to provide a noncontact laser microsurgical apparatus wherein selected areas of the cornea may be caused to shrink so as to change the curvature of the cornea thereby curing or alleviating corneal refractive error and/or asigmatism but not to incise or excise any portion of the cornea. Additional objects and advantages of the invention 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 invention. The objects and advantages of the invention may be realized and attained by means of the instrumentalities and combinations particularly pointed out in the appended claims. SUMMARY OF THE INVENTION The inventors herein have discovered that, when the temperature of the tissue of a cornea of a human eye is above 60°C to less than 100°C, the corneal tissue will begin to shrink. Thus, selected areas of the cornea are impinged with laser beams having sufficient energy and for a sufficient time to heat the corneal tissue up to such temperature to thereby cause shrinkage of the corneal tissue in those selected areas. In this manner the curvature of the cornea can be changed to alleviate or cure the astigmatism and/or corneal refractive error. To achieve the foregoing objects, and in accordance with the purposes of the invention as embodied and described herein, the noncontact laser microsurgical apparatus of the present invention comprises means for generating laser beams ; and means for projecting the laser beams onto a cornea. The projection means defines an optical axis and includes means for converging the laser beams. The projecting means further includes axicon optical means for forming the projected beams into a plurality of paraxially distributed spots on the cornea, and means for varying the radial position of the spots. Preferably, the converging means includes a focusing lens and the axicon optical means includes at least one multiple-facet prismatic ("MFP") axicon lens mounted for movement along the optical axis of the projecting means. The generating means may comprise an infrared pulse laser beam generator with a preferred wavelength of about 1.3 - 3.3 µm, pulse duration of greater than 200 ns and energy flux of about 250 mJ/cm² whereby the corneal tissue may be heated only sufficiently to cause shrinkage of the tissue in selected areas to alleviate astigmatism and/or corneal refractive error. The projecting means preferably includes beam expander means for enlarging the radius of the laser beam emerging from the generating means. The apparatus may also include aiming means for projecting visible laser beams onto the cornea substantially coincident with the positions at which the laser beams projected through the axicon means impinge the cornea. The optical axis of the aiming means preferably partially overlaps with the optical axis of the projecting means. Preferably, the aiming means includes a visible laser beam source, and a mirror obliquely interposed between the beam expander means and the converging means for reflecting the visible laser beams and allowing the laser beams from the generating means to pass therethrough. The apparatus of the present invention may also include mask means disposed in the optical axis for selectively blocking portions of the projected laser beams while transmitting the remaining portions of the projected laser beams therethrough. In this manner shrinkage in the corneal tissue may be made only in selected areas of the cornea corresponding to the transmitting portions of the mask means. BRIEF DESCRIPTION OF THE DRAWINGS The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate presently preferred embodiments of the invention and, together with the general description given above and the detailed description of the preferred embodiments given below, serve to explain the principles of the invention. In the drawings : Fig. 1 illustrates an optical system arrangement of a non-contact laser microsurgical apparatus incorporating the teachings of the present invention ; Fig. 2A is a plan view of a concave MFP axicon lens ; Fig. 2B is a cross-sectional view of the MFP axicon lens shown in Fig. 2A ; Fig. 3A is a plan view of a convex MFP axicon lens ; Fig. 3B is a side view of the MFP axicon lens shown in Fig. 3A ; Fig. 4 is a plan view of a cornea of an eye with laser beam spots impinged thereon ; Fig. 5 illustrates a cutaway side view of a portion of the cornea wherein portions of the stroma of the cornea have been treated by thermokeratoplasty ; Fig. 6 illustrates one embodiment of a mask means which may be used with the present invention ; Fig. 7 illustrates a front view of an eye which has been treated in selected areas utilizing the apparatus of the present invention with mask means ; Fig. 8 illustrates another embodiment of the mask means of the present invention and the fully open position thereof ; Fig. 9 illustrates the partially closed position of the mask means of Fig. 8 ; and Fig. 10 illustrates the fully closed position of the mask means of Fig. 8. DESCRIPTION OF THE PREFERRED EMBODIMENTS AND METHOD Reference will now be made in detail to the presently preferred embodiments of the invention as illustrated in the accompanying drawings in which like reference characters designate like or corresponding parts throughout the several drawings. An optical delivery system of a noncontact laser microsurgical apparatus incorporating the teachings of the present invention includes means for generating laser beams. Since the corneal tissue is comprised almost entirely of water, this means that under atmospheric pressure the temperature to which the corneal tissue is raised must be less than 100°C. The inventors herein have discovered that above 60°C, the corneal tissue will begin to shrink. Thus, in this present invention, selected areas of the cornea are impinged with laser beams having sufficient energy and for a sufficient time to heat the corneal tissue to less than about 100°C to thereby cause shrinkage of the corneal tissue in those selected areas. As illustrated in Fig. 1 and embodied herein, the generating means of apparatus 10 comprises a laser source 11 which generates pulsed laser beams that are capable of shrinking in thermokeratoplasty the tissue of a living organ, i. e. a cornea for curing corneal refractive errors, e. g., hyperopia, myopia and/or astigmatism. The laser source selected may be an C.W.HF, or Holmium, Nd/YLF or Nd:YAG laser emitting at a wavelength of 1.0 - 3.3 µm, a pulse duration of greater than 200 n sec, and an energy flux of about 250 mJ/cm². Laser source 11, in this embodiment, may comprise a Ho (Holmium) laser, for example, emitting at a wavelength of about 2.1 µm. Laser source 11 is connected to a radiation control switch 11a. When the control switch is moved to the "on" position laser source 11 generates infrared pulsed beams. Radiation control switch 11a is preferably capable of controlling the energy of the pulse beams by insertion of a neutral density filter (not shown) in a transmitting path thereof. In accordance with the present invention, the apparatus includes means for projecting the laser beams along an optical axis onto the cornea. As embodied herein, the projecting means includes a beam expander means, generally referred to as 13, for expanding the laser beam generated by laser source 11. Beam expander means 13 includes a concave lens 14 and a convex lens 15. Laser beams emerging from convex lens 15 are formed in parallel and are in turn projected along optical axis 0₁. The beam expander means may also comprise a variable diverging beam expander comprised of a conventional zooming optical system or a pair of movable convex-concave axicon lenses described in the above-mentioned US Patent Application Serial no. 056,711. In accordance with the present invention, the apparatus includes means for converging the projected laser beams onto the cornea. As embodied herein, the converging means includes a condensing and focusing lens 17 which functions to condense and focus light passing therethrough onto a focal plane. The position of the focal plane S is determined in accordance with the geometry of the lens as will be well understood by those skilled in the art. Beam expander 13 also acts to increase the laser beam diameter entering lens 17, thereby increasing the numerical aperture of the optical system. Consequently, the focal spot of the beam at the focal plane RS of lens 17 is reduced. In accordance with this embodiment of the present invention, the apparatus includes axicon optical means for forming the converged laser beams into a plurality of paraxially distributed beam spots on the cornea. As embodied herein the axicon optical means may comprise a multiple-facet prismatic ("MFP") lens 18. As shown in Figs. 2A and 2B, axicon lens 18 may be configured with concave multiple-facet prisms (eight-facet prisms, for example) whose outer edges (prism bases) 100 are larger in width t than the optical axis portion 102 (length t') thereof. Axicon lens 18 may also be configured with convex multiple-facet prismatic lenses as shown in Figs. 3A and 3B whose outer edges (prism bases) 100 are larger in width t than optical axis portions 102 (length t') thereof. With reference to Fig. 4, the multiple-facet prism function of axicon lens 18 causes the converging laser beams emerging from lens 18 to be formed into a plurality of paraxially distributed beam spots 61 on cornea 31 of eye 30. The spots 61 are radially spaced from the apex P of cornea 31 and from optical axis O₁. Preferably, the laser beams are converged onto cornea 31 of eye 30 (a patient's eye) after reflection by a dichroic mirror 19 as shown in Fig. 1. As a result, cornea 31 is shrinked by the laser beam energy at spots 61. It is necessary to vary the cornea shrinking diameters in thermokeratoplasty. To this end, the present invention may include means for moving the axicon optical means along the optical axis O₁. Furthermore, in order to increase the number of, or adjust the angular positions of the beam spots, means may be provided to rotate the axicon optical means about the optical axis. As embodied herein, movement of the axicon optical means comprised of MFP lens 18, and movement of the converging means comprised of focusing lens 17 along optical axis O₁, and rotation of MFP axicon lens 18 about optical axis O₁, may be carried out by a known electro-mechanical device (not shown) which may comprise a combination of stepping motors, for example, controlled by a microprocesseur or minicomputer (not shown). By way of example and not limitation, model no. SPH-35AB-006 stepping motors manufactured by Tokyo Electronic Co., Ltd. may be used to move MFP lens 18 and focusing lens 17. In accordance with the present invention, the microsurgical apparatus incorporating the teachings of the present invention may include aiming means for projecting visible light beams onto the cornea substantially coincident with the positions at which the laser beams are to impinge the cornea. As embodied herein, the aiming means comprises an aiming system 20 which includes a He-Ne laser source 21 for generating visible light beams, beam expander means 22, and dichrotic beam combiner 16. Beam expander means 22 may comprise a concave lens 23 and convex lens 24. Dichrotic beam combiner 16 is positioned in optical axis O₁ and is selected such that it functions to reflect incident He-Ne laser beams, while laser beams from source 11 pass therethrough. He-Ne laser beams from laser source 21 are enlarged in diameter by expander means 22, whose output laser beams, in turn, are projected onto condensing and focusing lens 17 after reflection by cold mirror 16. Thus, laser beams from source 21, which are reflected by mirror 16, are coincident with a portion of optical axis O₁. For observing the cornea and the He-Ne laser beams projected thereon, the noncontact laser microsurgical apparatus may also include viewing means comprised of an operation microscope 2, indicated by phantom lines in Fig. 1. The configuration and function of operation microscopes is well known in the ophthalmology field, therefore, its detailed description is omitted. By way of example and not limitation, a model no. OMS-600 microscope manufactured by TOPCON CORPORATION may be used. An optical axis O₂ of operation microscope 2 is disposed to be coincident with a portion of optical axis O₁ of the noncontact laser microsurgical apparatus 10. In this configuration, mirror 19 functions as a half mirror for the laser beams from source 21, but as a complete mirror for the laser beams from source 11. An operator can determine an optimum diameter size of the laser beams projected onto the cornea by observing the laser beams from source 21 through operation microscope 2. With reference to Fig. 5, in thermokeratoplasty for curing hyperopia, for example, after the focal points "S" have been set at points "e" with an optimum diamter D₀ and an optimum depth "Δ" in the stroma 72 by independently moving focusing and condensing lens 17 and MFP axicon lens 18 along optical axis O₁ as has been described above, the Ho laser source 11 generates and projects the pulse laser beams onto the point "e". Eight burns are formed instantly and simultaneously at the points "e" and cause shrinkage of the tissue of the stroma in the vicinity "f" around the points "e". The thermal effect of the laser causing shrinkage of the tissue about points "e" leads to a change of the shape of the cornea to alleviate hyperopia. When sixteen spots are required to be shrinked, axicon lens 18 may be rotated by a predetermined angle about optical axis O₁, for example 22.5°, to mark an additional 8 spots (denoted by "X") in Fig. 4. In another embodiment of the present invention, MFP axicon lens 18 may be composed of at least one MFP lens having more than two facets, eight facets for example, which is rotatable about the optical axis O₁. Furthermore, apparatus 10 may include mask means, disposed between focusing and condensing lens 17 and cold mirror 16, for selectively defining at least one open aperture in optical axis O₁. In the present preferred embodiment, the mask means includes mask 25 having three mask units 26, 27 and 28 as shown in Fig. 6. Mask units 26 and 27 each include a pair of transparent portions 26a, 27a configured as 120° fan-shaped aperture angles 110 for transmitting laser beams emerging from cold mirror 16 therethrough, and a pair of opaque portions 26b, 27b configured as 60° fan-shaped aperture angles 112 for blocking the laser beams emerging from cold mirror 16. In accordance with the present invention, means may be provided for rotating mas units 26 and 27 in opposite directions, designated by arrows "a" and "b" in Fig. 6, relative one another about optical axis O₁ to change aperture angles 110a(α) and 112a within a prescribed range, for example, between 60°-120° as illustrated in Fig. 7. As embodied herein the rotating means may comprise a stepping motor (not shown) controlled by a microprocessor (not shown). One skilled in the art will readily identify such motors and controllers, and, since the configuration of these motors and controllers do not themselves constitute any portion of the present invention, a detailed description is omitted. However, by way of example, a model no. SPH-35AB-006 type motor manufactured by Tokyo Electric Co., Ltd. may be used. Also, any suitable controller such as an IBM PC/AT may be used to control the motor. The mask means may also include a mask unit 28 having a pair of semicircular portions 28a, 28b. Semicircular portion 28a is transparent to transmit laser beams therethrough, and semicircular portion 28b is opaque to the laser beams. Means may be provided to insert and remove mask unit 28 within optical axis O₁ to selectively block a portion of the laser beams from source 11, the blocked portion corresponding to the position of opaque semi-circular portion 28b. The mask units 26, 27 and 28 are constructed to be able to rotate in unison about optical axis O₁ to selectively position the apertures defined by masks 25 and 26 in optical axis O₁. In this embodiment, after aperture angles 110a(α) and 112a have been selected by individual opposite rotation of masks 25 and 26, and after the inclination angle β illustrated in Fig. 7 has been selected by common rotation about axis O₁ of masks 25 and 26 as a unit, the MFP axicon lens 18 rotates continously in predetermined minute steps about optical axis O₁. With reference to Fig. 7, in thermokeratoplasty for alleviating astigmatism, mask unit 25 may be used to selectively define the angular position β and the angle α, and to set the number of spots 61 projected onto the points "e". The thermal effect of the laser and the resulting shrinkage of tissue in vicinity "f" lead to a change of the shape of the cornea to alleviate the astigmatism. In this manner the shape of the cornea can be modified to alleviate astigmatism and/or cornea] refractive error. Moreover, any of the embodiments of the apparatus of the present invention may be used in the practice for shrinking corneal tissue to thereby control and define the selected areas of the cornea in which shrinkage is desirable. Fig. 8 illustrates alternative embodiment of the mask means. Therein, masks 150 and 152 having wedge shaped portions 154 and 156, respectively, may be moved simultaneously or individually in opposite directions relative one another along arrows 158 and 160, respectively. In this manner, the aperture angle a (as shown in Fig. 9) defined by the edges of the wedge portions 154 and 156 may be selected in a predetermined manner. Furthermore, masks 150 and 152 may be rotated individually or in unison by any suitable motor or manual means about optical axis O₁ to selectively define the position angle b' (as shown in Fig. 9) of the beam spots 61 on the cornea of the eye. Utilizing the mask means illustrated in Fig. 8, masks 150 and 152 may be moved towards each other along directions 158 and 160, respectively, during impingement of the cornea with laser beams. In Fig. 8, masks 150 and 152 are in the fully open state such that no portion of the cornea is blocked by wedge portions 154 and 156. As masks 150 and 152 are moved closer together as illustrated in Fig. 9, wedge portions 154 and 156 selectively block larger portions of the cornea from the laser beams emitted by source 11. In Fig. 10, wedge portions 154 and 156 overlap each other to fully block the cornea from any laser beams emitted by source 11. In this manner, alleviation of corneal astigmatism may be carried out more delicately and subtly utilizing the teachings of the present invention to cure not only corneal astigmatism, but also corneal spherical power error. Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the invention in its broader aspects is not limited to the specific details, representative devices, and illustrative examples shown and described. Accordingly, departures may be made from such details without departing from the spirit or scope of the general inventive concept as defined by the appended claims and their equivalents.

Claims: A noncontact laser microsurgical apparatus, comprising : means (11) for generating infra-red laser beams ; means for projecting said laser beams toward a cornea (31), said projecting means defining an optical axis (O₁), and including : means (17) for converging the laser beams onto the cornea (31) ; and axicon optical means (18) for forming the laser beams into a plurality of paraxially distributed beam spots (61) on the cornea (31), characterized in that said laser generating means (11) generates infra-red pulsed laser beams having wavelengths of about 1.3 µm to about 3.3 µm, pulse durations of greater than 200 ns and energy flux of about 250 mJ/cm² for causing shrinkage of the tissue of the cornea (31) in the vicinity (f) around points (e) at which said beam spots (61) are projected by said projecting means, whereby, the shape of the cornea (31) is changed, and then refractive error and/or astigmatism of the cornea (31) can be alleviated. A noncontact laser microsurgical apparatus as in claim 1, wherein said laser generating means (11) includes a Holmium laser emitting at a wavelength of about 2.1 µm. A nonctact laser microsurgical apparatus as in claim 1 or 2, wherein said converging means includes condensing lens (17) and means for moving said condensing lens (17) along the optical axis (O₁) for focusing said laser beam spots (61) onto points (e) with optimum depth (Δ) in the cornea (31). A noncontact laser microsurgical apparatus as in any one of claims 1 through 3, wherein said axicon optical means includes an axicon lens (18) which has multiple prismatic facets, and which is located between said converging means (17) and the cornea (31). A noncontact laser microsurgical apparatus as in any one of claims 1 through 4, further comprises means for moving said axicon optical means (18) along the optical axis (O₁) for adjusting a radial position of said beam spots (61) relative to the apex (P) of the cornea (31). A noncontact laser microsurgical apparatus as in any one of claims 1 through 5, further comprises means for rotating said axicon optical means (18) about the optical axis (O₁) for adjusting angular position of said beam spots (61). A noncontact laser microsurgical apparatus as in any one of claims 1 through 6, further comprising mask means (25, 150, 152) having at least one mask (26, 27, 28, 150, 152) for selectively defining at least one light transmissive aperture (26a, 27a, 28a) and at least one opaque aperature (26b, 27b, 28b, 154, 156) along said optical axis (O₁) of said projecting means. A noncontact laser microsurgical apparatus as in claim 7, wherein said mask means (25) includes first and second masks (26, 27) spaced from one another and aligned on said optical axis (O₁), each said mask (26, 27) including at least two fan-shaped light transmissive portions (26a, 27a) which define selected open angles (110) therebetween, first rotating means for rotating said first and second masks (26, 27) in opposite directions (a, b) relative one another to selectively adjust said selected open angles (α) formed between said transparent portions (26a, 27a) of said masks (26, 27), and second rotating means for rotating said masks (26, 27) in unison for adjusting the inclination angle (β) of the transparent portions (26a, 27a) of said masks (26, 27). A noncontact laser microsurgical apparatus as in claim 7, wherein said mask means (150, 152) includes at least two mask plates (150, 152) each of which has a wedge portion (154, 156) being movable into and out of said optical axis (O₁) of said projecting means for selectively defining an aperture angle (a') thereof, and which is rotatable about said optical axis (O₁) for selectively defining a position angle (b') thereof. A noncontact laser microsurgical apparatus as in any one of claims 1 through 9, wherein said projecting means includes beam expander means (13) for enlarging a radius of said laser beams. A noncontact laser microsurgical apparatus as in any one of claims 1 through 10, further comprising aiming means (20) for projecting visible light beams onto the cornea (31) at positions substantially coincident with positions to be imposed by said laser beams, and an optical axis of said aiming means (20) partially overlapping with said optical axis (O₁) of said projecting means. A noncontact laser microsurgical apparatus as in claim 11, wherein said aiming means (20) includes a visible laser beam source (21), and mirror means (16), obliquely interposed between said generating means (11) and said converging means (17), for reflecting the visible laser means emitted by said laser source (21) and for transmitting the laser beams from said generating means (11) therethrough.

Inventors: KOBAYASHI KATSUHIKO, PAREL JEAN-MARIE, YOKOKURA TAKASHI, KOBAYASHI, KATSUHIKO, PAREL, JEAN-MARIE, YOKOKURA, TAKASHI
Applicants: UNIV MIAMI, UNIVERSITY OF MIAMI
Application year: 1990
Main classification: A61B17
IPC codes: A61F9, A61B19