Ophthalmological laser therapy system

Abstract

An ophthalmological laser therapy system having an appliance base and an appliance head, displaceable relative to one another by translational movement and having a laser device and to a corresponding method. A laser pivot arm is fastened to the appliance head pivotable about a horizontal first axis. The laser pivot arm is encompassed by a pivot arm housing, which is fastened in a separately pivotable manner on the appliance head in coaxial fashion relative to the laser pivot arm and/or by virtue of an examination pivot arm with an examination device, defining an examination volume, being fastened to the appliance head pivotable about a second axis, wherein both axes are arranged such that a work volume of a laser beam, when the laser pivot arm is in a work position, is a partial volume of the examination volume, when the examination pivot arm is in a work position.

Claims

1. An ophthalmological laser therapy system comprising: an appliance base; an appliance head; a laser device that includes a laser source, a first laser therapy optical unit and a laser pivot arm with a second laser therapy optical unit and a laser exit aperture; wherein the appliance head is displaceable on the appliance base in an xy-plane by a translational movement; the laser pivot arm is coupled to the appliance head in a manner pivotable about a first axis; and the laser pivot arm is encompassed by a pivot arm housing, which is coupled in a separately pivotable manner on the appliance head in coaxial fashion relative to the laser pivot arm.

2. The ophthalmological laser therapy system as claimed in claim 1, wherein the first axis is a horizontal first axis.

3. The ophthalmological laser therapy system as claimed in claim 1, further wherein the laser pivot arm is pivotable by a greater angle than the pivot arm housing.

4. The ophthalmological laser therapy system as claimed in claim 1, further wherein the laser pivot arm and the pivot arm housing each have a separate weight balancing apparatus.

5. The ophthalmological laser therapy system as claimed in claim 1, further wherein the appliance head is also displaceable in the z-direction on the appliance base.

6. The ophthalmological laser therapy system as claimed in claim 1, further comprising a pre-positioning device that pre-positions of the appliance head.

7. The ophthalmological laser therapy system as claimed in claim 6, wherein said pre-positioning device includes a camera.

8. The ophthalmological laser therapy system as claimed in claim 1, wherein the laser pivot arm, the pivot arm housing or both further comprise at least one detection device.

9. The ophthalmological laser therapy system as claimed in claim 8, wherein the at least one detection device further comprises a video microscope apparatus or an OCT apparatus.

10. The ophthalmological laser therapy system as claimed in claim 1, further comprising an input apparatus, an output apparatus or a therapy screen that is movably fastened to the pivot arm housing.

11. The ophthalmological laser therapy system as claimed in claim 10, wherein the input apparatus or the output apparatus is rotatable about an axis that is parallel to the first axis of the pivot arm housing.

12. The ophthalmological laser therapy system as claimed in claim 1, wherein the first laser therapy optical unit, the second laser therapy optical unit or both contains a scan system comprising at least two scanners, and the first axis of the laser pivot arm is arranged in the beam axis between the scanners.

13. The ophthalmological laser therapy system as claimed in claim 1, further comprising a position regulating apparatus that regulates the relative position between the laser pivot arm and/or the examination pivot arm in a work position and a patient's eye, said position regulating apparatus being configured to reposition the relative position of the appliance head according to position of a patient's eye.

14. The ophthalmological laser therapy system as claimed in claim 1, further comprising an examination pivot arm with an examination device, which defines an examination volume and is fastened to the appliance head to be pivotable about a second axis, and wherein both axes are arranged relative to one another in terms of their relative position such that a work volume of a laser beam, when the laser pivot arm is in a work position, is a partial volume of the examination volume of the examination device on the examination pivot arm, when the examination pivot arm is in a work position, while the laser pivot arm and the examination pivot arm are not arranged in the pivot region of the respective other pivot arm in their respective rest position.

15. An ophthalmological laser therapy system comprising: an appliance base; an appliance head; a laser device that includes a laser source, a first laser therapy optical unit and a laser pivot arm with a second laser therapy optical unit and a laser exit aperture; wherein the appliance head is displaceable on the appliance base in an xy-plane by a translational movement; the laser pivot arm is coupled to the appliance head in a manner pivotable about a first axis; the ophthalmological laser therapy system further comprising an examination pivot arm with an examination device, which defines an examination volume and is fastened to the appliance head to be pivotable about a second axis, and wherein both axes are arranged relative to one another in terms of their relative position such that a work volume of a laser beam, when the laser pivot arm is in a work position, is a partial volume of the examination volume of the examination device on the examination pivot arm, when the examination pivot arm is in a work position, while the laser pivot arm and the examination pivot arm are not arranged in the pivot region of the respective other pivot arm in their respective rest position; wherein the second axis of the examination pivot arm extends to be non-parallel relative to the first axis of the laser pivot arm.

16. The ophthalmological laser therapy system as claimed in claim 15, wherein the first axis is a horizontal first axis.

17. The ophthalmological laser therapy system as claimed in claim 15, wherein the examination device is a surgical microscope.

18. The ophthalmological laser therapy system as claimed in claim 15, further comprising an input apparatus, an output apparatus or a therapy screen that is movably fastened to the pivot arm housing; wherein the input apparatus or the output apparatus is rotatable about an axis that is parallel to the first axis of the pivot arm housing, the examination device is rotatable about an axis that is parallel to the second axis of the examination pivot arm, and both are coupled each by way of a coupling apparatus to the movement of the pivot arm housing or of the examination pivot arm or both of the foregoing.

19. The ophthalmological laser therapy system as claimed in claim 15, wherein the first laser therapy optical unit, the second laser therapy optical unit or both contains a scan system comprising at least two scanners, and the first axis of the laser pivot arm is arranged in the beam axis between the scanners.

20. The ophthalmological laser therapy system as claimed in claim 15, further comprising a position regulating apparatus that regulates the relative position between the laser pivot arm and/or the examination pivot arm in a work position and a patient's eye, said position regulating apparatus being configured to reposition the relative position of the appliance head according to position of a patient's eye.

21. An ophthalmological laser therapy method, comprising: placing a patient onto a patient support adjacent an ophthalmological laser therapy system comprising: an appliance base; an appliance head; a laser device that includes a laser source, a first laser therapy optical unit and a laser pivot arm with a second laser therapy optical unit and a laser exit aperture; wherein the appliance head is displaceable on the appliance base in an xy-plane by a translational movement and the laser pivot arm is coupled to the appliance head in a manner pivotable about a first axis, in a rest position, the method further comprising: pre-positioning the appliance head; pivoting the laser pivot arm into a work position; positioning the laser pivot arm over the patient's eye; performing the laser therapy step; and pivoting the laser pivot arm into the rest position.

22. The ophthalmological laser therapy method as claimed in claim 21, further comprising pre-positioning the appliance head by application of a pre-positioning device.

23. The ophthalmological laser therapy method as claimed in claim 21, further comprising raising the appliance head following performing the laser therapy.

24. The ophthalmological laser therapy method as claimed in claim 21, further comprising: synchronously pivoting a pivot arm housing and the laser pivot arm into a work position, further pivoting the laser pivot arm out of the pivot arm housing before the positioning over an eye of the patient; pivoting the laser pivot arm into the pivot arm housing after performing the laser therapy; and synchronized pivoting of the pivot arm housing and the laser pivot arm into the rest position.

Description

(1) The present invention will now be explained on the basis of exemplary embodiments. In the drawing:

(2) FIGS. 1a to 1d show an ophthalmological laser therapy system according to the invention, wherein FIG. 1a highlights various portions whose configurations lead to different embodiments of the ophthalmological laser therapy system according to the invention, and FIG. 1b illustrates a standby mode, FIG. 1c illustrates a laser therapy mode and FIG. 1d illustrates an examination mode using a surgical microscope of a first embodiment of a ophthalmological laser therapy system according to the invention.

(3) FIGS. 2a and 2b show the arm-in-arm principle of a laser pivot arm and pivot arm housing in a preferred embodiment of a ophthalmological laser therapy system according to the invention.

(4) FIGS. 3a and 3b show a schematic illustration of an apparatus for monitoring the function of the spring of a weight balancing apparatus.

(5) FIG. 4 shows the coupling mechanism of the therapy screen to the movement of the pivot arm housing.

(6) FIG. 5 shows the arrangement of individual elements of an ophthalmological laser therapy system according to the invention in a rest position with a retracted optical unit.

(7) FIG. 1a initially highlights various portions that contribute to solving the problem of this invention. Different configurations of these portions lead to various embodiments of the ophthalmological laser therapy system 100 according to the invention.

(8) Initially, it should be noted that the patient couch 500 is not part of the ophthalmological laser therapy system 100 according to the invention; instead, it is only illustrated in the figures to provide an improved understanding of the function and, in particular, the work area of ophthalmological laser therapy systems 100 according to the invention. However, from the function of these ophthalmological laser therapy systems, the advantage of being able to use a very simple embodiment of patient couches 500 at this position becomes comprehensible.

(9) Ophthalmological laser therapy systems 100 according to the invention are distinguished by a laser pivot arm 3 that is fastened to the appliance head 1 in a manner pivotable about a horizontal axis 4 and that can be pivoted back and forth between a rest position and a work position. Since this laser pivot arm 3 is pivoted over the patient for laser therapy on the patient's eye but can be returned into a rest position for steps in which the laser pivot arm 3 is not required in order to use the space above the work position differently, the laser pivot arm 3, firstly, is protected by virtue of the laser pivot arm 3 being enclosed by a pivot arm housing 6, which is fastened in a pivotable manner to the device head 1 in coaxial fashion in relation to the laser pivot arm 3. This is the “arm-in-arm” principle 200. In addition to mechanical protection for the laser pivot arm 3 itself, the “arm-in-arm” principle moreover offers the advantage of independent weight balancing apparatuses for the laser pivot arm 3 and the pivot arm housing 6 and also, in particular, the option of distributing the weights of superstructures. Details of this arm-in-arm principle 200 are shown in FIGS. 2a and 2b.

(10) If use is furthermore made of one or more further independent examination pivot arms 14 in addition to the laser pivot arm 3, said examination pivot arms are each arranged about an axis of pivotable arm systems in relation to one another such that all work steps of a laser therapy on the eye of a patient can be carried out in such a way that the point of action of all work steps aided by the laser pivot arm 3 or one or more examination pivot arms 6 always remains stationary; i.e., the position of the patient's eye need not be changed during the entire laser therapy. The position of the patient's eye in the first work step determines the position of all subsequent work steps and hence the point of action of the devices required in each case, which are on the various pivot arms 3, 14. This is facilitated by a special arrangement 300 of the pivot axes 4, 16 of the various pivot arms 3, 14 in relation to one another on the appliance head 1 of the ophthalmological laser therapy system 100.

(11) The pivotability of the various arms that can each have superstructures—such as a therapy screen 12 on the pivot arm housing 6 of the laser pivot arm 3 or an examination device 15 on the examination pivot arm 14—leads to a tilt of these superstructures in each case when pivoting the arms from a work position into a rest position, should said superstructures be fastened in an immobile manner. However, these superstructures should nevertheless be usable where applicable. By way of example, even in the rest position, the therapy screen 12 is a screen that is available to a surgeon in the vicinity of the work and should be used, for example, by the surgeon for the display of information or for inputs. Therefore, said screen should be in a non-tilted position, even in the rest position. A similar desire for a non-tilted position even in the rest position may exist for, e.g., a surgical microscope or another examination device, on an examination pivot arm 14, with parts that would be set into unwanted motion in the case of a tilt. This is realized by coupling such superstructures to the respective pivot arm 3, 14 by way of a coupling mechanism 400. FIG. 4 shows a configuration of such a coupling mechanism 400.

(12) These various solution areas, i.e., the “arm-in-arm” principle 200, the arrangement of the pivot axes 300 on the appliance head 1 of an ophthalmological laser therapy system 100 with a laser pivot arm 3 and at least one examination pivot arm 14, and a coupling mechanism 400 for superstructures that should always be present on pivot arms in a non-tilted position, independently of the position of the pivot arms, can be used both together and individually in order to solve the problem of the invention. However, the greatest use is obtained if these different solution areas are used simultaneously.

(13) FIGS. 1b to 1d now show an exemplary embodiment of an ophthalmological laser therapy system 100 according to the invention for which the “arm-in-arm” principle 200 is realized by a laser pivot arm 3 that is enclosed by a pivot arm housing 6, the ophthalmological laser therapy system 100 contains an additional examination pivot arm 14 with a surgical microscope 15, with the first axis 4 of the laser pivot arm 3 and the second axis 16 of the examination pivot arm 14 on the appliance head 1 having an appropriate arrangement 300 in relation to one another, and a therapy screen 12 movably fastened to the pivot arm housing 6 is coupled to the movement of the pivot arm housing 6 and also a surgical microscope 15 movably fastened to the examination pivot arm 14 is coupled to the movement of the examination pivot arm 14 in such a way that the therapy screen 12 and the surgical microscope 15 are always maintained in a non-tilted manner.

(14) An ophthalmological laser therapy system 100 as shown in this exemplary embodiment can be used very well for a SMILE method, for example, but also for other methods for correcting the visual acuity of an eye or for cataract operations.

(15) Here, FIG. 1b shows a standby mode of this ophthalmological laser therapy system 100, in which all pivot arms 3, 6, 14 are in a rest position, i.e., “parked” pivoted upward on the appliance head 1 in a space-saving manner, and in which, for example, a patient can be appropriately placed and positioned on the patient couch 500.

(16) By contrast, FIG. 1c illustrates a laser therapy mode, i.e., the mode in which the laser pivot arm 3 was brought into a work position. By contrast, the examination pivot arm 14 is still in a rest position.

(17) Finally, FIG. 1d shows an examination mode of the exemplary embodiment of the ophthalmological laser therapy system 100 using a surgical microscope 15. Here, the examination pivot arm 14 has been brought into a work position while the laser pivot arm 3 and its pivot arm housing 6 are in a rest position.

(18) The details should now be specified below.

(19) The exemplary embodiment of the ophthalmological laser therapy system 100 is composed of an appliance base 2 and an appliance head 1 that is adjustable on this appliance base 2 in terms of its height above the ground plane, i.e., the z-direction, and in terms of its position in the plane, i.e., in the x- and y-directions. The device head 1 contains a first part of the laser therapy optical unit required for performing the laser therapy. In the exemplary embodiment, the appliance head 1 also contains the laser source, in this case a femtosecond laser source, required to produce a corresponding pulsed laser beam.

(20) The second part of the laser therapy optical unit is rotatably mounted about a horizontal first axis 4 in a laser pivot arm 3. The laser pivot arm 3 can be pivoted about this first axis 4 from a rest position, in which it projects upward in approximately perpendicular fashion, into a work position, in which it is arranged approximately horizontally on the appliance head 1, i.e., approximately parallel to the ground plane, and back again.

(21) The laser pivot arm 3 with its second laser therapy optical unit and the laser exit aperture 8 is surrounded by a housing, the pivot arm housing 6, in such a way that the pivot arm housing 6 leaves an opening for the laser exit aperture 8. This pivot arm housing 6 is mounted separately to the laser pivot arm 3 in coaxial fashion.

(22) FIGS. 2a and 2b illustrate details of the “arm-in-arm” principle 200 of laser pivot arm 3 and pivot arm housing 6 in one exemplary embodiment of the ophthalmological laser therapy system according to the invention.

(23) Initially, the pivot arm housing 6 pivots by an angle of approximately 90° together with the laser pivot arm 3 between an approximately perpendicular rest position or standby position and a horizontal work position. The movement is restricted by stops.

(24) Overall, the laser pivot arm 3 can be moved by a greater angle than the pivot arm housing 6. Hence, the laser exit aperture 8, on which a contact glass or patient interface for coupling the laser pivot arm 3 to the eye of the patient to be treated can be affixed in a detachable manner, can be positioned protruding out of the pivot arm housing 6 to a greater or lesser extent, or else it can be retracted completely into the pivot arm housing 6.

(25) In the rest position of the laser pivot arm 3 and when pivoting the laser pivot arm 3 and its pivot arm housing 6 from a rest position into a work position and from the work position into a rest position, the laser exit aperture 8 is retracted into the pivot arm housing 6, as illustrated in FIG. 2a. Hence, the laser pivot arm 3 is in a slightly tilted position in comparison with its pivot arm housing 6.

(26) Once the pivot arm housing 6 has arrived in a work position, i.e., in the horizontal, the laser pivot arm 3 is released downward and slightly pivoted further such that it, too, reaches an approximately horizontal position and the laser exit aperture 8 emerges from the pivot arm housing 6. Here, as a consequence of its dedicated weight balancing apparatus 5, the laser pivot arm 3 itself can be moved effortlessly. In the approximately horizontal work position of both pivot arm housing 6 and laser pivot arm 3, as illustrated in FIG. 2b, i.e., with a protruding laser exit aperture 8, the ophthalmological laser therapy system 100 is in the laser therapy mode.

(27) A very low-friction weight balancing apparatus 5 of the laser pivot arm 3 facilitates the movement of the laser pivot arm 3 with a low force F, which is substantially less than 3 N for this exemplary embodiment, and hence a coupling with an eye of a patient to be treated that is secured against crushing: For this example, the force is 1.6+/−0.5 N.

(28) The pivot arm housing 6 is provided with a dedicated weight balancing apparatus 7. The separate coaxial bearing of laser pivot arm 3 and the pivot arm housing 6 surrounding the latter, with separate weight balancing apparatuses 5, 7 and a downwardly secured stop 21 for the pivot arm housing 6, avoids the decisive disadvantage of corresponding systems according to the prior art with pivotable arms, as described in U.S. Pat. No. 8,771,262 B2, for example. No provision is made there for the optical unit to be upwardly deflectable in the work position of the laser pivot arm with a force that is harmless to the eye and independently of external actions, which of course are prevented in the solution according to the invention by the pivot arm housing 6.

(29) The use of separate weight balancing apparatuses 5, 7 for the pivot arm housing 6 and the laser pivot arm 3 has a plurality of advantages:

(30) Motor driven movement or pivoting of the respective arm 3, 6 about the first axis 4 can make do with relatively low-power motors. These substantially only need to overcome the inertia of the system and therefore cannot build up dangerous forces on the pivot arm housing 6.

(31) Moreover, the laser pivot arm 3 and the pivot arm housing 6 can be moved—even together—by hand at all times. This facilitates freeing the patient in the case of a defect or a power outage without problems.

(32) Should the patient couch 500 be moved upward in an unwanted manner, the patient cannot be crushed as the laser pivot arm 3 in its pivot arm housing 6 can be pressed upward with a harmless force.

(33) The weight balancing apparatus 7 of the pivot arm housing 6 contains a gas spring 26. The use of a gas spring 26 has the following advantages: It allows a compact construction of the weight balancing apparatus 7 and can integrate a damping function. The latter protects against speeds that are too high and serves as a brake in the end positions of the pivot movement.

(34) A gas spring 26 has a high friction on account of the gas seals. This is unwanted in the case of the laser pivot arm 3 but wanted in the case of the pivot arm housing 6. It causes the pivot arm housing 6 to stop passively in each position. Thus, for example, the pivot arm housing 6 can also be brought in a motor driven fashion into a type of ready position, where it stops without current and from where it can be brought into the work position manually by the physician. This is advantageous when the physician wishes to exert manual control in relation to the approach of the arm to the patient.

(35) Thus, a gas spring 26 is only seldom used in the weight balancing apparatus 5 of a laser pivot arm 3, while it constitutes a very preferred solution for the weight balancing apparatus 7 of the pivot arm housing 6.

(36) FIGS. 3a and 3b show an apparatus for monitoring the function of the spring of such an example weight balancing apparatus 7, by which a failure of the gas spring 26 can be identified. Here, FIG. 3a illustrates a situation in which the spring force lies in the desired range, while FIG. 3b shows the situation in which the spring force is too low, for example because, as illustrated here, the gas spring 26 is broken. In the latter case—i.e., when there are problems with the gas spring 26—, it is ensured that the downward pivoting of the pivot arm housing 6 is prevented; i.e., the pivot mechanism is blocked.

(37) To this end, the preferred weight balance apparatus 7 contains a gas spring 26, the tension of which in its suspension 27 is monitored. This is effectuated by virtue of the suspension 27 of the gas spring 26 being slightly movable and detachably connected to a switching element 28, which is a pressure switch kept closed by an appropriate pressure in this case. The pivot mechanism of the pivot arm housing 6 is only released in this closed state of the pressure switch. An electromechanically detachable locking mechanism serves to this end.

(38) If the spring force of the gas spring 26 now is sufficiently high, then a sensor spring 25, which is likewise connected to the suspension 27, is extended up to a stop 29 in a guide 30 of the sensor spring 25. Then, the pressure switch 28 is kept closed by the suspension 27 or by an extension of the suspension 27, the locking mechanism is released and the pivot arm housing 6 is pivotable about its pivot axis, i.e., about the first axis 4.

(39) However, if the spring force of the gas spring 26 is too low, i.e., lower than the force of the sensor spring 25, then the sensor spring 25 moves back the suspension 27 of the gas spring 26 in the guide 30. The pressure switch 28 is opened in the process, the locking mechanism remains closed and the pivot mechanism is not released.

(40) FIG. 4 shows a further advantageous aspect of an exemplary embodiment of the ophthalmological laser therapy system 100 according to the invention: Here, the coupling mechanism of the therapy screen 12 to the movement of the pivot arm housing 6 is illustrated as an example of an apparatus 400 coupled to a pivot arm.

(41) The therapy screen 12 is movably fastened to the pivot arm housing 6. In this case, the therapy screen 12, at the same time, is also the screen of a video microscope 13, showing the view from the second laser therapy optical unit and the laser exit aperture 8 onto the eye to be treated. The video image of this video microscope 13, which is displayed on the therapy screen 12, is used by the surgeon, for example for the approach to, and the affixment of a contact glass or another patient interface on, the eye to be treated and for the observation of the laser cuts being carried out.

(42) Further information that is important for the laser therapy progress is likewise displayed on the therapy screen 12. In this exemplary embodiment, the therapy screen 12 is embodied as a touchscreen and consequently also facilitates the input of information or the navigation during the course of the treatment.

(43) The therapy screen 12 is movably fastened to the pivot arm housing 6 in such a way that it is rotatable about an axis 20 that is parallel to the horizontal pivot axis, i.e., the first axis 4, of the pivot arm housing 6. What is achieved by way of a coupling rod 19 is that the therapy screen 12 always remains in the same relative position when pivoting the laser pivot arm 3 together with the pivot arm housing 6. This facilitates the use of the therapy screen 12 both in the rest position and in the work position of the laser pivot arm 3.

(44) As shown further in FIGS. 1b to 1d, the image of a camera 9 serves to pre-position the appliance head 1. Said camera is fastened to the appliance head 1 and therefore has a fixed spatial relation to the position of the appliance head 1. The position is selected in such a way that a largely parallax-free view of the work volume of a therapy laser beam is effectuated, in particular of the possible position of its focus as a work point of a therapy objective in the second laser therapy optical unit.

(45) A graphics that is overlaid on the image of the camera 9 on the therapy screen 12 and/or else on the planning screen 31 already shows in the standby mode, i.e., in the rest position of the laser pivot arm 3, the expected position of the laser pivot arm 3 in its then pivoted-down work position. With the aid of this image, the surgeon can pre-position the appliance head 1 in such a way that the laser pivot arm 3 after pivoting-down into its work position, i.e., in the laser mode, is in an ideal position for the treatment start in respect of an approximate positioning, and only fine positioning in respect of structures of the eye is still necessary.

(46) Furthermore, a joystick 11 for controlling the coupling process to the patient is attached to the pivot arm housing 6. In the work position, the joystick 11, the laser exit aperture 8 of the laser therapy optical unit and the video image of the eye are aligned along a vertical line 23 in order to facilitate an equally ergonomic operation for right-handed and left-handed users.

(47) Moreover, this exemplary embodiment of the ophthalmological laser therapy system 100 according to the invention contains a force sensor which contributes to the automatic position regulation that is important from a safety point of view: To this end, the force sensor is arranged in such a way that the second laser therapy optical unit lies on the force sensor when the laser pivot arm is in the work position.

(48) Pressure of the patient's eye against the second laser therapy optical unit or the laser exit aperture unburdens the force sensor. This leads to an automatic movement of the position of the appliance head 1 in such a way that the laser pivot arm 3 moves away from the patient in the work position. A higher pressure on the force sensor arises by a pull of the patient: As a result of this, the appliance head 1 is then moved in the opposite direction.

(49) FIG. 5 now shows the work space gain as a consequence of the therapy screen 12 remaining non-tilted in the rest position: The space 22 can be used for components of the laser device 24 in the appliance head 1. If the therapy screen 12 were fixedly fastened to the pivot arm housing 6, as illustrated by reference sign 12a, the space 22 would be blocked for the therapy screen 12, pivoting thereto in the rest position, with an additional safety margin.

(50) Now, a typical course of treatment using an above-described ophthalmological laser therapy system 100, as can be used, for example, for a SMILE treatment or as part of a SMILE treatment, is described below:

(51) First, the treatment or therapy parameters are planned on a planning screen 31, which is likewise arranged directly in the ophthalmological laser therapy system 100 in this exemplary embodiment. However, alternatively, the planning screen 31 can also be spatially separated from the ophthalmological laser therapy system 100. When planning, the ophthalmological laser therapy system 100 is preferably in a standby position, i.e., the laser pivot arm 3 and optionally the examination pivot arm 14, too, are pivoted up vertically in the rest position on the system.

(52) The patient is placed on the patient couch 500. This is possible with some comfort on account of the pivoted-up laser pivot arm 3.

(53) Then, the surgeon positions the height of the appliance head 1 by use of a joystick 10 on this appliance head 1, by means of which the translational movement of the appliance head 1 over the appliance base 2 can be controlled. In the process, orientation is provided by the image supplied by the camera 9, said image, including an overlaid symbol of a pivoted-down laser pivot arm 3, being visible on the therapy screen 12 and/or on the planning screen 31. As an alternative to the joystick, the positioning can also be effectuated in other embodiments by inputs on one of the two screens 12, 31 or by way of push-buttons on the laser therapy system 100.

(54) The surgeon triggers the motor-driven pivoting-down of the laser pivot arm 3 in, and together with, its pivot arm housing 6; a corresponding push-button employed to this end is not illustrated in the figures. As a result of the pre-positioning and the still retracted laser exit aperture 8 of the laser pivot arm, a clear space remains between the laser exit aperture 8 and the patient's eye, said clear space expediently having a size of between 50 mm and 150 mm.

(55) Now, a contact glass is placed on the laser exit aperture 8, if this has not yet happened in the rest position of the laser pivot arm 3. The contact glass is held against the laser exit aperture 8 by negative pressure. Activation and deactivation of the hold by negative pressure is carried out in this case by virtue of pressing the contact glass against the laser exit aperture 8; in the process, the latter is still slightly moved in its retracted position and the switching process is triggered. This is advantageous over previously conventional laser therapy systems: There, the hold of the contact glass is switched separately. Consequently, the contact glass may fall down when it is detached. By contrast, in the solution described here, the surgeon or operator always holds sway over the contact glass during the switching process.

(56) Then, the surgeon initiates the release of the movement of the laser pivot arm 3 within the pivot arm housing 6 by use of a joystick rotation of the joystick 11 on the pivot arm housing 6, or alternatively by a separate push-button (not illustrated). An automatic trigger of the movement by way of the applied contact glass is also possible in other embodiments. In the process, the laser exit aperture 8 with the contact glass moves toward the eye with the force set by the weight balancing apparatus 5 of the laser pivot arm 3, which is less than 3 N at the contact glass or level with the laser exit aperture 8. Here, the travel is approximately 50 mm, a range for this travel that is very generally expedient for all ophthalmological laser therapy systems 100 according to the invention is from 30 mm to 100 mm. Hence, a safe distance from the eye, which is approximately 30 mm or, very generally, expediently assumes a value of between 10 mm and 100 mm, still remains.

(57) Finally there is the docking phase, i.e., the phase in which the contact glass is affixed: Here, the surgeon steers the contact glass toward the eye of the patient using the joystick 11 under observation by the video microscope 13. Fixating the eye by suctioning the eye to the contact glass is triggered by a button on the joystick 11 when the correct position is reached. In one configuration, it is possible to assist the correct positioning or centering of the contact glass or another patient interface on the eye by virtue of processing the video microscope image and using this to control the appliance head 1.

(58) Hence, it is now finally possible by use of a foot switch, which is not illustrated here, to start the actual laser therapy step by activating the laser beam, which is guided through the laser therapy optical units and the laser exit aperture and focused in the patient's eye.

(59) After completing this laser therapy step, the suctioning of the eye by application of negative pressure is released by virtue of the pressure being increased here again, the laser pivot arm 3, and hence also the laser exit aperture 8, are pivoted back into the pivot arm housing 6 again and the appliance head 1 is slightly raised by a displacement in the z-direction. Hence, a safe distance from the eye is present once again. If need be, docking could be carried out once again from this position.

(60) However, as a rule, this is not required. The contact glass or the patient interface can be removed from the laser exit aperture 8, with the release being effectuated by brief upward pressure.

(61) Now, the laser pivot arm 3 is pivoted up again together with its pivot arm housing 6; the clear space above the patient is re-established. Now, it is possible to perform further work steps or the patient can leave their position on the patient couch 500. The laser pivot arm 3 with its pivot arm housing 6 pivoting up is initiated electronically, by pushing a button in this case. Alternatively, the laser pivot arm 3 with its pivot arm housing 6 can be pushed manually until this is recognized by a position sensor on the pivot arm housing; following this, a motor takes over the movement.

(62) However, where both eyes of a patient are to be treated, the appliance head 1 can be moved by a translational movement in the x- and/or y-direction over the appliance base 2 prior to pivoting-up of the laser pivot arm 3 with its pivot arm housing 6 in its rest position such that the laser pivot arm 3 with its pivot arm housing 6 is positioned over the other eye. A treatment of the second eye can then be effectuated in the same way by virtue of a new contact glass or patient interface being secured on the laser exit aperture 8 by application of negative pressure, and all steps following this are carried out as described above.

(63) Furthermore, an examination pivot arm 14 containing an examination device, in this case a surgical microscope 15, is also fastened in a pivotable manner about a second axis 16 on the appliance head 1 in this exemplary embodiment of an ophthalmological laser therapy system 100 according to the invention. By way of example, such a surgical microscope is required, or at least suggested, for the second main work step of the “SMILE” treatment. In the present exemplary embodiment, the surgical microscope 15 contains a camera for recording the video and a slit projector for extended observation options in addition to the necessary illumination. However, camera and slit projector also may be lacking entirely at this point or used individually.

(64) The pivot axis of the examination pivot arm 14, i.e., the second axis 16, is positioned at a particularly expedient location in space. This allows bringing the surgical microscope 15 on the examination pivot arm 14 from its rest position in which the examination pivot arm 14 is likewise pivoted up—either in a likewise perpendicular position or in an oblique position—to its work position using only one pivot movement.

(65) This work position is also defined by a restriction of the rotational movement of the examination pivot arm 14 by a stop. Here, it has a special property of coinciding with the work position of the laser pivot arm 3 with its second laser therapy optical unit and its laser exit aperture 8 and hence, according to the invention, this avoids a change in position of the patient during the treatment.

(66) The rest position of the examination pivot arm 14 with its surgical microscope 15 is expediently selected in such a way that the surgical microscope 15 is then situated behind the therapy screen 12. Firstly, this releases the space for the access and exit of the patient and, secondly, facilitates a compact ophthalmological laser therapy system 100 in the standby mode.

(67) In the exemplary embodiment described here, the second axis 16, i.e., the pivot axis of the examination pivot arm 14, is arranged particularly advantageously in relation to the first axis 4, which is the pivot axis of the laser pivot arm 3 and its pivot arm housing 6, in order to be able to embody the ophthalmological laser therapy system 100 as compactly as possible:

(68) The second axis 16 of the examination pivot arm 14 forms an angle in relation to a perpendicular plane through the first axis 4 of the laser pivot arm 3 of 0° and an angle in relation to a horizontal plane through the first axis 4 of the laser pivot arm 3 of 30°.

(69) The second axis 16 extends through a point situated at a distance of 320 mm above the axis of rotation of the laser pivot arm 3, 320 mm behind the work position of the laser exit aperture 8 and 50 mm from the perpendicular plane through the axis of rotation of the laser pivot arm 3.

(70) The surgical microscope 15 has a similar mount on the examination pivot arm 14 as the therapy screen 12 has on the pivot arm housing 6: rotatable about an axis 18 that is parallel to the axis of rotation of the examination pivot arm 14, i.e., the second axis 16, and rotatably connected to the appliance head 1 by a coupling rod 19. Here, the coupling rod 19 has an axis of rotation on the appliance head 1 that is parallel to the first axis 4.

(71) Here, the angle of the first axis 4 in relation to the second axis 16 in space must be compensated in the holder of the surgical microscope 15, i.e., in the relative position of the axis 18, so that the surgical microscope 15 once again stands without tilt in space.

(72) Hence, the surgical microscope 15 remains in its work position in each position of the examination pivot arm 14. This has various advantages:

(73) Movable attachment parts on the surgical microscope 15, such as a slit projector, for example, do not slide out of place. Moreover, the aesthetic appearance is uniform.

(74) Similar to the pivot arm housing 6 of the laser pivot arm 3, the examination pivot arm 14 is also provided with a weight balancing apparatus 7 containing a gas spring 25. Here too, this again has the advantages already described above: The use of a weak motor for moving the examination pivot arm 14, rendered possible thereby, offers safety in relation to a risk of crushing the patient's head. The corresponding configuration of the drive can be kept relatively small and it is more cost-effective than a solution that has to balance the entire weight. Moreover, the examination pivot arm 14 is also movable by hand at all times.

(75) In the case of an examination pivot arm 14, which contains a surgical microscope 15 or else other superstructures which are not provided for contact with the eye, i.e., which do not contain any protruding optical units or the like, the risk of crushing a patient's head is decisive in this case, and it is possible to work with the maximum forces or smaller forces on the patient's head of less than 65 N—as described above. However, in other embodiments, in which an examination device 15 requires contact with the eye, it is once again necessary to apply the “arm-in-arm” principle and consequently it is necessary to avoid a risk of crushing the eye by the inner pivot arm in this case, said inner pivot arm containing the eye-contacting examination device 15, by virtue of working with substantially lower maximum forces of less than 3 N on the eye—as described above.

(76) If such an examination pivot arm 14 with a surgical microscope 15 is present, it is possible to perform the complete SMILE treatment using the ophthalmological laser therapy system 100 according to the invention. To this end, after pivoting up the laser pivot arm 3 with its pivot arm housing 6 into its rest position after completing the actual laser therapy step, as described here, the treatment is continued as follows:

(77) The surgeon initiates the motor-driven downward pivoting of the examination pivot arm 14 by pressing a button. The motor moves the examination pivot arm 14 into its work position, where it rests on a stop. The work position is determined by expedient selection of the relative position of the two pivot axes, i.e., the first axis 4 and the second axis 16, and the end position of the examination pivot arm 14 determined by the stop is determined in such a way that the eye to be treated further lies in the examination volume of the surgical microscope 15 directly after pivoting down the examination pivot arm 14.

(78) Minor corrections, to the extent that these are necessary, are possible by adjusting the position of the appliance head 1 in relation to the appliance base 2 by translational movements. Serving to this end is the joystick 10 present on the appliance base 2, a separate foot console or a joystick present on the surgical microscope 15.

(79) Once examination pivot arm 14 with the surgical microscope 15 has been positioned accordingly, the lenticule extraction is carried out by the surgeon.

(80) After completing the lenticule extraction, the examination pivot arm 14 with the surgical microscope 50 is pivoted up in a motor-driven manner and consequently pivoted back into its rest position. This can be initiated by pressing a button or else—as already described above for the pivot arm housing 6 and the laser pivot arm 3 by pushing. Hence, the clear space over the patient is re-established.

(81) In this case, the aforementioned features of the invention, which are explained in various exemplary embodiments, can be used not only in the combinations specified in an exemplary manner but also in other combinations or on their own, without departing from the scope of the present invention.

(82) A description related to device features is analogously applicable to the corresponding method with respect to these features, while method features correspondingly represent functional features of the device described.