Jan 11, 2012 ... VERFAHREN. SYSTEME D'ENREGISTREMENT DE MESURES OCULAIRES
POUR CHIRURGIE REFRACTIVE. ET PROCEDES ASSOCIES.
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EUROPEAN PATENT SPECIFICATION
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(45) Date of publication and mention
(51) Int Cl.:
A61F 9/01 (2006.01)
of the grant of the patent: 11.01.2012 Bulletin 2012/02
(86) International application number: PCT/US2005/042952
(21) Application number: 05825678.5
(87) International publication number:
(22) Date of filing: 29.11.2005
WO 2006/060323 (08.06.2006 Gazette 2006/23)
(54) EYE REGISTRATION SYSTEM FOR REFRACTIVE SURGERY AND ASSOCIATED METHODS AUGENREGISTRIERSYSTEM FÜR DIE REFRAKTIVE CHIRURGIE UND RELEVANTE VERFAHREN SYSTEME D’ENREGISTREMENT DE MESURES OCULAIRES POUR CHIRURGIE REFRACTIVE ET PROCEDES ASSOCIES (72) Inventors:
(84) Designated Contracting States: AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IS IT LI LT LU LV MC NL PL PT RO SE SI SK TR
• GRAY, Gary, P. Orlando, Florida 32836 (US) • CAMPIN, John, A. Orlando, Florida 32828 (US)
(30) Priority: 30.11.2004 US 999268 (74) Representative: Hanna, Peter William Derek et al (43) Date of publication of application:
Hanna Moore & Curley 13 Lower Lad Lane Dublin 2 (IE)
24.10.2007 Bulletin 2007/43
(73) Proprietor: Alcon RefractiveHorizons, Inc. Fort Worth, Texas 76134 (US)
(56) References cited:
EP 1 845 918 B1
WO-A-01/28476 WO-A-02/087442
WO-A-01/78584 WO-A-03/053228
Note: Within nine months of the publication of the mention of the grant of the European patent in the European Patent Bulletin, any person may give notice to the European Patent Office of opposition to that patent, in accordance with the Implementing Regulations. Notice of opposition shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention). Printed by Jouve, 75001 PARIS (FR)
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Description TECHNICAL FIELD OF THE INVENTION [0001] The present invention relates to systems for improving objective measurements preceding corrective eye surgery, and, more particularly, to such systems for improving results of corrective laser surgery on the eye.
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BACKGROLTND OF THE INVENTION
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[0002] Laser-in-situ-keratomileusis (LASIK) is a common type of laser vision correction method. It has proven to be an extremely effective outpatient procedure for a wide range of vision correction prescriptions. The use of an excimer laser allows for a high degree of precision and predictability in shaping the cornea of the eye. Prior to the LASIK procedure, measurements of the eye are made to determine the amount of corneal material to be removed from various locations on the corneal surface so that the excimer laser can be calibrated and guided for providing the corrective prescription previously determined by the measurements. Refractive laser surgery for the correction of astigmatism typically requires that a cylindrical or quasicylindrical ablation profile be applied to the eye. The long axis of this profile must be properly oriented on the eye in order to accurately correct the visual aberration. [0003] An objective measurement of a patient’s eye is typically made with the patient sitting in an upright position while focusing on a target image. A wavefront analyzer then objectively determines an appropriate wavefront correction for reshaping the cornea for the orientation of the eye being examined. The LASIK or PRK procedure is then performed with the patient in a prone position with the eye looking upward. [0004] It is well known that the eye undergoes movement within the socket comprising translation and rotation ("cyclotortion") as the patient is moved from the upright measuring position to the prone surgery position. Techniques known in the art for accommodating this movement have included marking the eye by cauterizing reference points on the eye using a cautery instrument (U.S. Pat. No. 4,476,862) or caustic substance, a very uncomfortable procedure for the patient. It is also known to mark a cornea using a plurality of blades (U.S. Pat. No. 4,739,761). The application on the scleral surface or the injection of a dye or ink is also used to mark the reference locations to identify the orientation of the eye during measurement, permitting a positioning of the corrective profile to the same orientation prior to surgery. However, the time delay from measurement to surgery often causes the ink to run, affecting the accuracy of an alignment. Making an impression on the eye (U.S. Pat. No. 4,705,035) avoids the caustic effects of cauterizing and the running effect of the ink. However, the impression can lose its definition quickly relative to the time period between the measurement and surgery.
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[0005] For correction of astigmatism, it is known to mark the cornea preparatory to making the surgical incisions (U.S. Pat. No. 5,531,753). [0006] Tracker systems used during the surgical procedure or simply for following eye movement, while the patient is in a defined position, are known to receive eye movement data from a mark on a cornea made using a laser beam prior to surgery (U.S. Pat. No. 4,848,340) or from illuminating and capturing data on a feature in or on the eye, such as a retina or limbus, for example (U.S. 5,029,220; 5,098,426; 5,196,873; 5,345,281; 5,485,404; 5,568,208; 5,620,436; 5,638,176; 5,645,550; 5,865,832; 5,892,569; 5,923,399; 5,943,1 l7; 5,966,197; 6,000,799; 6,027,216). [0007] Commonly owned US 6,702,806, 2004/0143245, and 2004/0143244 address the problem of registering a pre-surgery image with a live eye image with the use of image mapping and manipulation, and also with software for calculating and imposing a graphical reticle onto a live eye image. [0008] WO 01/28476 (Tecnolas GMBH Ophthalmologische Systeme) and WO 03/053228 (Sensomotoric Instruments GMBH) are representative of the state of the art, and both describe a system that generally includes features of the pre-characterizing part of claim 1 which follows. [0009] WO 01/78584 (Alcon Universal Ltd) describes a system that uses an ink mark as a reference feature, and that does not rely solely on using an extracorneal eye feature such as a blood vessel as a reference feature. BRIEF SUMMARY OF THE INVENTION
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[0010] The present invention is directed to an orientation system for corrective eye surgery that aligns (registers) pairs of eye images taken at different times, in accordance with claims which follow. An exemplary embodiment of the method comprises the step of retrieving a reference data set comprising stored digital image data on an eye of a patient. The stored image data will have been collected with the patient in a pre-surgical position. These data include image data on an extracorneal eye feature. [0011] A real-time data set is collected that comprises digital image data on the patient eye in a surgical position different from the pre-surgical position. These realtime image data include image data on the extracorneal eye feature. [0012] A combined image is then displayed that comprises a superposition of the reference and the real-time data sets, and a determination is made as to whether the combined image indicates an adequate registration between the reference and the realtime data sets. Such a determination is made based upon the extracorneal eye feature data in the reference and the real-time data sets. If the registration is not adequate, one of the reference and the real-time data sets is manipulated, i.e., translated and/or rotated, until an adequate registration is achieved.
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[0013] A system of the present invention is directed to apparatus and software for orienting a corrective program for eye surgery, including computer software for achieving the superposition of the reference and the realtime data sets. [0014] Thus an aspect of the present invention provides a system and method for achieving a precise registration of the eye by making sure that an eye feature is positioned in substantially the same location on the superimposed images. As a result, a prescription measurement for reshaping a cornea, for example, will account for the rotation and translation of the eye occurring between measurements made with the patient in a sitting position and laser surgery with the patient in a supine position. [0015] The features that characterize the invention, both as to organization and method of operation, together with further objects and advantages thereof, will be better understood from the following description used in conjunction with the accompanying drawing. It is to be expressly understood that the drawing is for the purpose of illustration and description and is not intended as a definition of the limits of the invention. These and other objects attained, and advantages offered, by the present invention will become more fully apparent as the description that now follows is read in conjunction with the accompanying drawing. BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
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[0016] FIG. 1 is a schematic diagram of the system of the first embodiment of the present invention.
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FIGs. 2A, 2B is a block diagram of the data flow. FIG. 3 illustrates the reference data set image. 40
FIG. 4 illustrates the reference data set image of FIG. 3, but with data from a central area including the area inside the limbus removed. FIG. 5 illustrates a portion of the sampled reference data set image at a higher magnification. FIG. 6 illustrates the sampled reference data set image of FIG. 5 interdigitated with a sampled real-time data set image.
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DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS [0017] A description of the preferred embodiments of the present invention will now be presented with reference to FIGs. 1-6. [0018] A schematic diagram of the system 10 of an
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embodiment of the invention is shown in FIG. 1, data flow of an exemplary embodiment of the method 100 in FIGs. 2A,2B, and displayed images in FIGs. 3-6. In an exemplary embodiment of the system 10, a patient’s eye 11 is imaged in a substantially upright position by capturing a first video image 12 using a camera such as a chargecoupled-device (CCD) camera 13 (block 101). Such an image 12 is illustrated in FIG. 3. The first image, comprising a reference data set, is stored in a database 14 in electronic communication with a processor 15. [0019] Next an objective measurement is made on the eye 11 to determine a desired correction profile, using a measurement system 16 such as that disclosed in copending application 09/566,668, although this is not intended as a limitation (block 102). [0020] Once the correction profile is determined, the patient is made ready for surgery, and placed in the second position, which is typically prone. Alternatively, the first scan to determine the correction profile may be made in a different location and at a time prior to the surgical procedure, the time interval being, for example, several weeks. [0021] Real-time image data are collected prior to and during surgery using a second camera 18, in communication with a second system 38 for performing surgery, and these data are also stored in the database 14. In a preferred embodiment both the first 13 and the second 18 cameras are adapted to collect color images, and these images are converted using software resident on the processor 15 to pixel data. It is useful to collect color images for viewing by the physician, since preselected identifiable images such as a blood vessel 21 (FIG. 3) are more readily seen within the sclera 23, since the red color of the vessel 21 is clearly identifiable. [0022] Next the surgeon identifies a plurality of features in the eye 11 using a graphical user interface (GUI) while viewing the still image of the eye (FIG. 3). Such features may include a preferred center 40 of the cornea 41 in the reference set (block 103), the location of the limbus 42 (block 105), and the location of an extracorneal feature such as a blood vessel 21 (block 107). The system then generates indicia for display superimposed on the reference data, including a reticle 43 comprising crossed, perpendicular lines 44 with cross-hatching 45 and a central circle 46 centered about the corneal center 40 and smaller than the limbal ring 42, with the crossing point of the lines 44 corresponding to the cornea center 40 (block 104). The indicia also include a ring 47 positioned atop the limbus 42 (block 106). [0023] The reference data set is then manipulated by removing pixel data from all pixels circumscribed by the limbus 42 (block 108; FIG. 4), and typically by removing pixel data from an area 48 beyond the limbus 42, to yield a first reduced reference data set. [0024] Prior to and during surgery, a real-time data set comprising real-time digital image data on the patient eye 11 in a surgical position different from the pre-surgical position is collected (block 109). The real-time image da-
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ta include image data on the blood vessel 21. Next one of the reference and the real-time data sets is scaled to the other of the reference and the real-time data sets (block 110). This scaling is performed in order to equalize a display size of the reference and the real-time data sets for subsequent display in a superimposed image. [0025] The pixels of the first reduced reference data set are then sampled to result in a second reduced reference data set (block 111; FIG. 5). This sampling preferably takes the form of removing data from a predetermined pattern of pixels, leaving a data set having data in all the pixels except those in the predetermined pattern. An exemplary predetermined pattern comprises alternate pixels. It can be seen that the blood vessel 21 is clearly visible in FIG. 5, thereby indicating that the sampling does not cause a sufficient loss of resolution to interfere with identification of the vessel 21. [0026] The pixels in the real-time data set are then sampled by removing pixel data from a set of pixels in the real-time data set disjoint from those of the second reduced reference data set (block 112) to yield a reduced real-time data set. [0027] Next the second reduced reference data set and the reduced real-time data set are summed (block 113), so that each pixel of the summed set contains data from a unitary one of the second reduced reference and reduced real-time data sets. A superimposed image comprising the sum is displayed (block 114; FIG. 6). [0028] Examination of FIG. 6 indicates that the blood vessel 21 images from the second reduced reference and reduced real-time data sets are clearly visible, and that they are not in registry (block 115). In such a case, either an automatic or manual manipulation of one of the data sets is performed (block 116) until adequate registration is achieved (block 115), and the data processing beginning at block 111 is carried out again. [0029] Once registry is considered adequate, the surgical process can begin (block 117), with monitoring continued during surgery. Thus the treatment pattern, typically a laser shot pattern calculated to achieve a desired corneal profile using, for example, an excimer laser, can be modified to account for eye rotation resulting from the patient’s movement from upright to prone position. [0030] In the foregoing description, certain terms have been used for brevity, clarity, and understanding, but no unnecessary limitations are to be implied therefrom beyond the requirements of the prior art, because such words are used for description purposes herein and are intended to be broadly construed. Moreover, the embodiments of the apparatus illustrated and described herein are by way of example, and the scope of the invention is not limited to the exact details of construction. [0031] Having now described the invention, the construction, the operation and use of preferred embodiment thereof, and the advantageous new and useful results obtained thereby, the new and useful constructions, and reasonable mechanical, equivalents thereof obvious to those skilled in the art, are set forth in the appended
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claims.
Claims 5
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A system (10) for orienting a corrective program for eye surgery comprising: a database (14) housing a reference data set comprising digital image pixel data on an eye (11) of a patient, the image data (12) having been collected with the patient in a pre-surgical position and including image data on an eye feature (21), wherein the eye feature is an extracorneal eye feature comprising a blood vessel (21) in a sclera of the eye (11); a processor (15) and a display device in signal communication therewith; a camera (18) for collecting (109) a real-time data set comprising real-time digital image pixel data on the patient eye in a surgical position different from the pre-surgical position, the realtime image data including image data on an extracorneal eye feature; and computer software resident on the processor having code segments adapted to: retrieve (101) the reference data set from the database; determine (105) a location of a limbus (42) of the eye in the reference data set, determine a location of (107) the extracorneal eye feature in the reference data set; remove (108) data from all pixels circumscribed by the limbus, receive a determination (115) as to whether there is an adequate registration between the reference and the real-time data sets based upon the extracorneal eye feature data in the reference and the real-time data sets; and if the registration is not adequate, manipulate (116) one of the reference and the realtime data sets until an adequate registration is achieved, characterized in that
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the computer software resident on the processor has code segments further adapted to: sample the pixels of the reference data set to result in a reduced reference data set (111); sample the pixels of the real-time data set to result in a reduced real-time data set so as to remove (112) pixel data from a set of
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pixels in the real-time data set disjoint from those of the reduced reference data set containing data; sum (113) the reduced reference data set and the reduced real-time data set to obtain a superimposed image wherein each pixel contains data from only one of the reduced reference data set and the reduced realtime data set to form the combined image; and display (114) the said summed and combined image comprising a superposition of the reference and the real-time data sets, from which said determination (115) may be made of adequacy of registration between the reference and the real-time data sets based upon the alignment of the extracorneal eye feature data in the reference and the real-time data sets.
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The system recited in Claim 8, wherein the reticle (43) comprises a pair of substantially perpendicular lines (44) intersecting at the determined preferred cornea center (40).
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10. The system recited in Claim 9, wherein the reticle (43) further comprises a plurality of substantially perpendicular hatch marks (45) disposed substantially equidistantly along the lines (44). 10
11. The system recited in Claim 9, wherein the reticle (43) further comprises a circle (46) substantially smaller than the cornea having a center at the determined preferred cornea center (40). 15
12. The system recited in Claim 7, wherein the software further has a code segment for determining (105) a location of a limbus (42) of the eye (11) in the reference data set. 20
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The system recited in Claim 1, wherein the determination-receiving step (115) comprises receiving input from an operator based upon operator visualization of the displayed combined image. 25
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The system recited in Claim 2, wherein the software further has a code segment for receiving operator input for performing the data set manipulation (116).
13. The system recited in Claim 12, wherein the software further has a code segment for displaying (108) the reference data set with a second indicium superimposed thereon comprising a circle (46) centered on the determined preferred cornea center (40) and positioned along the determined limbus (42) location. 14. The system of claim 1, wherein the reference data set pixel-sampling code segment is adapted to remove (111) pixel data from a predetermined pattern of pixels in the reference data set.
The system recited in Claim 1, wherein the software further has a code segment for automatically determining (115) whether the combined image has an adequate registration.
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The system recited in Claim 4, wherein the software further has a code segment for calculating the data set manipulation based upon the determining step (1 I S).
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15. The system recited in Claim 14, wherein the reference data set pixel-sampling code segment is adapted to remove (I 11) pixel data from alternate pixels.
The system recited in Claim 1, wherein the software further has a code segment for scaling (110) one of the reference and the real-time data sets to the other of the reference and the real-time data sets in order to equalize a display size of the reference and the real-time data sets displayed in the superimposed image.
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16. The system recited in Claim 15, wherein the reference data set pixel-sampling code segment is adapted to remove pixel data from alternate pixels outside the limbus (42).
The system recited in Claim 1, wherein the software further has a code segment for determining (103) a preferred center of a cornea of the eye (11) in the reference data set.
17. The system recited in Claim 1, further comprising means (38) for, if the registration is adequate, performing (117) the eye surgery. 45
18. The system recited in Claim 17, wherein the eye surgery performing (117) means (38) comprises an excimer laser and control apparatus adapted to achieve a desired corneal profile. 50
Patentansprüche 8.
The system recited in Claim 7, wherein the software further has a code segment for displaying (104,106) an image of the reference data set with an indicium superimposed thereon comprising a reticle (43) centered on the determined preferred cornea center (40).
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System (10) zum Ausrichten eines Korrekturprogramms für die Augenchirurgie, mit: einer Datenbank (14), die einen Referenzdatensatz enthält, der digitale Bildpunktdaten eines
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Auges (11) eines Patienten aufweist, wobei die Bilddaten (12) vom Patienten in einer prächoperativen Position erfasst worden sind und Bilddaten eines Augenmerkmals (21) enthalten, wobei das Augenmerkmal ein außerhalb der Cornea (Hornhaut) befindliches Merkmal mit einem Blutgefäß in der Sclera (Lederhaut) des Auges (11) ist; einem Prozessor (15) und einem in Signalkommunikation mit diesem stehenden Anzeigegerät; einer Kamera (18) zum Erfassen (109) eines Echtzeit-Datensatzes, der digitale Echtzeit-Bildpunktdaten des Patientenauges in einer operativen Position aufweist, die von der präoperativen Position verschieden ist, wobei die EchtzeitBilddaten Daten eines extracornealen Augenmerkmals enthalten; und einer auf dem Prozessor residenten ComputerSoftware mit Codesegmenten, die eingerichtet sind zum: Abrufen (101) des Referenzdatensatzes aus der Datenbank; Bestimmen (105) der Lage des Limbus (42) des Auges im Referenzdatensatz; Bestimmen der Lage (107) des extracornealen Augenmerkmals im Referenzdatensatz; Entfernen (108) von Daten aus allen Bildpunkten, die vom Limbus umschrieben sind; Empfangen einer Bestimmung (115), ob eine hinreichende Übereinstimmung zwischen dem Referenzdatensatz und dem Echtzeit-Datensatz auf Basis der extracornealen Augenmerkmalsdaten im Referenzdatensatz und dem Echtzeit-Datensatz gegeben ist; und bei nicht hinreichender Übereinstimmung Manipulieren (116) des Referenzdatensatzes und des Echtzeit-Datensatzes, bis eine hinreichende Übereinstimmung erzielt wird, dadurch gekennzeichnet, dass die prozessorresidente Computer-Software Codesegmente hat, die ferner eingerichtet sind zum Abtasten der Bildpunkte des Referenzdatensatzes, so dass ein reduzierter Referenzdatensatz resultiert (111); Abtasten der Bildpunkte des Echtzeit-Datensatzes, so dass ein reduzierter EchtzeitDatensatz resultiert, indem Bildpunktdaten aus einem Bildpunktsatz im Echtzeit-Datensatz entfernt (112) werden, die nicht mit denen des Daten enthaltenden reduzierten Referenzdatensatzes zusammenhängen; Summieren (113) des reduzierten Refe-
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System nach Anspruch 1, bei dem der Bestimmungsschritt (115) das Empfangen einer bedienerseitigen Eingabe auf Basis der Visualisierung des angezeigten kombinierten Bildes durch den Bediener aufweist.
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System nach Anspruch 2, bei dem die Software ferner ein Codesegment zum Empfangen der bedienerseitigen Eingabe hat, um die Datensatzmanipulation auszuführen (116).
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System nach Anspruch 1, bei dem die Software ferner ein Codesegment zur automatischen Bestimmung (115) hat, ob das kombinierte Bild eine hinreichende Passgenauigkeit hat.
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System nach Anspruch 4, bei dem die Software ferner ein Codesegment zum Berechnen der Datensatzmanipulation auf Basis des Bestimmungsschrittes (115) hat.
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System nach Anspruch 1, bei dem die Software ferner ein Codesegment zum Skalieren (110) eines des Referenzdatensatzes oder des Echtzeit-Datensatzes auf den anderen des Referenzdatensatzes oder des Echtzeit-Datensatzes hat, um die Anzeigegröße des Referenzdatensatzes und des Echtzeit-Datensatzes im überlagerten Bild anzugleichen.
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System nach Anspruch 1, bei dem die Software ferner ein Codesegment zum Bestimmen (103) eines bevorzugten Mittelpunktes der Cornea des Auges (11) im Referenzdatensatz hat.
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System nach Anspruch 7, bei dem die Software ferner ein Codesegment zum Anzeigen (104, 106) eines Bildes des Referenzdatensatzes mit einer überlagerten Anzeigeeinrichtung, die ein Retikel (43) aufweist, das auf den bestimmten bevorzugten Mittelpunkt der Cornea (40) zentriert ist.
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Revendications
System nach Anspruch 8, bei dem das Retikel (43) ein Paar im Wesentlichen senkrechte Linien (44) hat, die sich im bestimmten bevorzugten Mittelpunkt der Cornea (40) schneiden.
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Système (10) pour orienter un programme de correction pour une chirurgie de l’oeil, comprenant :
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10. System nach Anspruch 9, bei dem das Retikel (43) ferner eine Mehrzahl im Wesentlichen senkrechte Schraffurmarken (45) aufweist, die im Wesentlichen abstandsgleich entlang den Linen (44) angeordnet sind. 11. System nach Anspruch 9, bei dem das Retikel (43) ferner einen Kreis (46) aufweist, der im Wesentlichen kleiner als die Cornea ist und dessen Mittelpunkt im bestimmten bevorzugten Mittelpunkt der Cornea (40) liegt. 12. System nach Anspruch 7, bei dem die Software ferner ein Codesegment zum Bestimmen (105) der Lage des Limbus (42) des Auges (11) im Referenzdatensatz hat. 13. System nach Anspruch 12, bei dem die Software ferner ein Codesegment zum Anzeigen (108) des Referenzdatensatzes mit einer zweiten überlagerten Anzeigeeinrichtung hat, die einen Kreis (46) aufweist, der im bevorzugten Mittelpunkt der Cornea (40) zentriert und entlang der bestimmten Lage des Limbus (42) positioniert ist
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une base de données (14) recevant un ensemble de données de référence comprenant des données de pixel d’image numérique d’un oeil (11) d’un patient, les données d’image (12) ayant été recueillies le patient étant dans une position pré-chirurgicale et comprenant des données d’image d’une caractéristique de l’oeil (21), la caractéristique d’oeil étant une caractéristique d’oeil extra cornéenne comprenant un vaisseau sanguin (21) dans une sclère de l’oeil (11) ; un processeur (15) et un dispositif d’affichage en communication de signal avec celui-ci ; une caméra (18) pour recueillir (109) un ensemble de données en temps réel comprenant des données de pixel d’image numérique en temps réel de l’ oeil du patient dans une position chirurgicale différente de la position pré-chirurgicale, les données d’image en temps réel comprenant des données d’image d’une caractéristique d’oeil extra cornéenne ; et un logiciel d’ordinateur résidant sur le processeur ayant des segments de code adaptés pour :
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14. System nach Anspruch 1, bei dem das Codesegment zum Bildpunktabtasten des Referenzdatensatzes eingerichtet ist, um Bildpunktdaten (111) aus einem vorgegebenen Bildpunktmuster im Referenzdatensatz zu entfernen.
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15. System nach Anspruch 14, bei dem das Codesegment zum Bildpunktabtasten des Referenzdatensatzes eingerichtet ist, um Bildpunktdaten (111) aus wechselnden Bildpunkten zu entfernen.
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16. System nach Anspruch 15, bei dem das Codesegment zum Bildpunktabtasten des Referenzdatensatzes zum Entfernen von Bildpunktdaten aus wechselnden Bildpunkten außerhalb des Limbus (42) eingerichtet ist. 17. System nach Anspruch 1, das ferner ein Mittel (38) zum Ausführen der Augenoperation aufweist, wenn eine hinreichende Übereinstimmung gegeben ist. 18. System nach Anspruch 17, bei dem das Mittel zum Ausführen (117) der Augenoperation einen ExcimerLaser und ein Steuergerät aufweist, das zum Erzielen eines gewünschten Cornea-Profils eingerichtet ist.
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récupérer (101) l’ensemble de données de référence à partir de la base de données ; déterminer (105) un emplacement d’un limbe (42) de l’oeil dans l’ensemble de données de référence, déterminer un emplacement (107) de la caractéristique d’oeil extra cornéenne dans l’ensemble de données de référence ; supprimer (108) des données à partir de tous les pixels circonscrits par le limbe, recevoir une détermination (115) indiquant s’il y a un calage adéquat entre les ensembles de données de référence et de temps réel sur la base des données de caractéristique d’oeil extra cornéenne dans les ensembles de données de référence et de temps réel ; et le calage n’est pas adéquat, manipuler (116) l’un des ensembles de données de référence et de temps réel jusqu’à ce qu’un calage adéquat soit obtenu, caractérisé en ce que
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le logiciel d’ordinateur résidant sur le processeur a des segments de code supplémentaires adaptés pour : échantillonner les pixels de l’ensemble de don-
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nées de référence pour obtenir un ensemble de données de référence réduit (111) ; échantillonner les pixels de l’ensemble de données en temps réel pour obtenir un ensemble de données en temps réel réduit de manière à supprimer (112) des données de pixels depuis un ensemble de pixels dans l’ensemble de données en temps réel disjointes de celles constituées des données contenant un ensemble de données de référence réduit ; ajouter (113) l’ensemble de données de référence réduit et l’ensemble de données en temps réel réduit pour obtenir une image superposée dans laquelle chaque pixel contient des données provenant d’un seul parmi l’ensemble de données de référence réduit et l’ensemble de données en temps réel réduit pour former l’image combinée ; et afficher (114) l’image sommée et combinée comprenant une superposition des ensembles de données de référence et en temps réel, à partir de laquelle la détermination (115) peut être constituée d’une adéquation de calage entre les ensembles de données de référence et en temps réel sur la base de l’alignement des données de caractéristique d’oeil extra cornéenne dans les ensembles de données de référence et en temps réel. 2.
Système selon la revendication 1, caractérisé en ce que l’étape de réception de détermination (115) comprend la réception d’une entrée provenant d’un opérateur sur la base de la visualisation par l’opérateur de l’image combinée affichée.
chage des ensembles de données de référence et en temps réel affichés dans l’image superposée.
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Système selon la revendication 1, caractérisé en ce que le logiciel comprend en outre un segment de codes pour déterminer automatiquement (115) si l’image combinée a un calage adéquat.
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Système selon la revendication 1, caractérisé en ce que le logiciel comprend de plus un segment de codes pour mettre à l’échelle (110) l’un des ensembles de données de référence et en temps réel sur l’autre des ensembles de données de référence et en temps réel afin d’égaliser une dimension d’affi-
Système selon la revendication 1, caractérisé en ce que le logiciel comprend de plus un segment de codes pour déterminer (103) un centre préféré d’une cornée de l’oeil (11) dans l’ensemble de données de référence.
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Système selon la revendication 7, caractérisé en ce que le logiciel comprend de plus un segment de codes pour afficher (104,106) une image de l’ensemble de données de référence avec un indice superposé sur celle-ci comprenant un réticule (43) centré sur le centre de cornée préféré déterminé (40).
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Système selon la revendication 8, caractérisé en ce que le réticule (43) comprend une paire de lignes sensiblement perpendiculaires (44) se recoupant au niveau du centre de cornée préféré déterminé (40).
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Système selon la revendication 2, caractérisé en ce que le logiciel comprend de plus un segment de codes pour recevoir une entrée d’opérateur pour effectuer la manipulation d’ensemble de données (116).
Système selon la revendication 4, caractérisé en ce que le logiciel comprend de plus un segment de codes pour calculer la manipulation d’ensemble de données sur la base de l’étape de détermination (115).
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10. Système selon la revendication 9, caractérisé en ce que le réticule (43) comprend de plus une pluralité de marques de hachures sensiblement perpendiculaires (45) disposées sensiblement de manière équidistante le long des lignes (44). 11. Système selon la revendication 9, caractérisé en outre en ce que le réticule (43) comprend de plus un cercle (46) sensiblement plus petit que la cornée ayant un centre au niveau du centre de cornée préféré déterminé (40). 12. Système selon la revendication 7, caractérisé en ce que le logiciel comprend de plus un segment de codes pour déterminer (105) un emplacement d’un limbe (42) de l’oeil (11) dans l’ensemble de données de référence. 13. Système selon la revendication 12, caractérisé en ce que le logiciel comprend de plus un segment de codes pour afficher (108) l’ensemble de données de référence avec un second indice superposé sur celui-ci comprenant un cercle (46) centré sur le centre de cornée préféré déterminé (40) et positionné le long de l’emplacement du limbe déterminé (42). 14. Système selon la revendication 1, caractérisé en ce que le segment de codes d’échantillonnage de pixels d’ensemble de données de référence est adapté pour supprimer (111) des données de pixel provenant d’un motif de pixels prédéterminé de l’ensemble de données de référence. 15. Système selon la revendication 14, caractérisé en ce que le segment de codes d’échantillonnage de pixels d’ensemble de données de référence est adapté pour supprimer (111) les données de pixels
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à partir de pixels alternés. 16. Système selon la revendication 5, caractérisé en ce que le segment de codes d’échantillonnage de pixels d’ensemble de données de référence est adapté pour supprimer des données de pixels à partir de pixels alternés à l’extérieur du limbe (42). 17. Système selon la revendication 1, caractérisé en ce qu’il comprend de plus des moyens (38) pour, si le calage est adéquat, effectuer (117) la chirurgie de l’oeil. 18. Système selon la revendication 17, caractérisé en ce que les moyens (38) pour effectuer une chirurgie de l’oeil (117) comprennent un laser à exiler et un appareil de commande adaptée pour obtenir un profil cornéen voulu.
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EP 1 845 918 B1 REFERENCES CITED IN THE DESCRIPTION
This list of references cited by the applicant is for the reader’s convenience only. It does not form part of the European patent document. Even though great care has been taken in compiling the references, errors or omissions cannot be excluded and the EPO disclaims all liability in this regard.
Patent documents cited in the description • • • • • • • • • • • • • •
US 4476862 A [0004] US 4739761 A [0004] US 4705035 A [0004] US 5531753 A [0005] US 4848340 A [0006] US 5029220 A [0006] US 5098426 A [0006] US 5196873 A [0006] US 5345281 A [0006] US 5485404 A [0006] US 5568208 A [0006] US 5620436 A [0006] US 5638176 A [0006] US 5645550 A [0006]
• • • • • • • • • • • • • •
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US 5865832 A [0006] US 5892569 A [0006] US 5923399 A [0006] US 59431L7 A [0006] US 5966197 A [0006] US 6000799 A [0006] US 6027216 A [0006] US 6702806 B [0007] US 20040143245 A [0007] US 20040143244 A [0007] WO 0128476 A [0008] WO 03053228 A [0008] WO 0178584 A [0009] US 09566668 B [0019]
