NIDEK. GREEN LASER PHOTOCOAGULATOR Model GYC-1000 COMBINATION DELIVERY UNIT [ATTACHABLE TO NIDEK YC-1300/1400, YC-1600] OPERATOR S MANUAL

Transcription

1 NIDEK GREEN LASER PHOTOCOAGULATOR Model GYC-1000 COMBINATION DELIVERY UNIT [ATTACHABLE TO NIDEK YC-1300/1400, YC-1600] OPERATOR S MANUAL (SUPPLEMENT TO THE GYC-1000 OPERATOR S MANUAL)

2 * Specifications are subject to change without notice for improvement. NIDEK CO., LTD. : 34-14, Maehama, Hiroishi-cho, Gamagori, Aichi , Japan (Manufacturer) Telephone: (0533) Facsimile: (0533) NIDEK CO., LTD : 6th Floor, Takahashi Bldg., No.2, 3-chome, Kanda-jinboucho (Tokyo Office) Chiyoda-ku, Tokyo , Japan Telephone: (03) Facsimile: (03) Telex: NIDEK J NIDEK INCORPORATED : Westinghouse Drive Fremont, California 94539, U. S. A. (United States Agent) Telephone: (510) Facsimile: (510) NIDEK SOCIETE ANONYME : Europarc 13, rue Auguste Perret, CRETEIL, France (Authorized Representative) Telephone: (01) Facsimile: (01) P9A2A Printed in JAPAN

3 BEFORE USE OR MAINTENANCE OF THE COMBINATION SYSTEM, READ THIS MANUAL AND OPERATOR S MANUAL OF THE MAIN BODY. THIS OPERATOR S MANUAL CONTAINS ONLY INFORMATION TO UNDERSTAND THE OPERATING PROCEDURE AND MAINTENANCE OF THE COMBINATION DELIVERY UNIT (ATTACHABLE TO NIDEK OPHTHALMIC YAG LASER SYSTEM YC-1300/1400, YC-1600). This manual contains information to understand the system which allows selection between the green laser beam and the YAG laser beam as a result of attaching the delivery unit to the slit lamp of the YAG laser system. This manual provides general descriptions of the delivery unit, cautions for safety, specifications, accessories, operating procedures, and maintenance. As for the detailed operating procedures of the YAG laser system or other optional delivery units, refer to the particular operator s manual. IEC is applied to the contents described in this manual. To understand the correct use of the photocoagulation system, this manual and operator s manual of the GYC main body are needed. Especially, cautions for safety and operating procedures should be understood thoroughly before using the laser system. Be sure to store this manual with the system and refer to it when necessary. Use of the combination system is limited to the treatment of eye disease by qualified physicians only. The physicians are responsible for the application of the combination system and the technical selection of the treatment of various eye diseases. If you find any problems during, or have questions about operation, please contact NIDEK or your authorized distributor. [NOTE] This delivery unit is attachable to 3 types of YAG laser systems, YC-1300/1400, YC Figures used in the manual to describe the YAG laser system are mainly for the YC In this manual, 2 laser systems are abbreviated as follows: GYC...Green Laser Photocoagulator Model GYC-1000 YC...Ophthalmic YAG Laser System Model YC-1300/1400, or YC-1600 [Note on display of the exposure time and the interval time (in the repeat mode)] When the exposure time or the interval time (in the repeat mode) on the display of the control box of the GYC-1000 is less than 1.00 or 1.0, 0 before the decimal point is displayed small. (Example: if the setting is 0.30, the display shows.)

4 Table of Contents 1 INTRODUCTION Outline of the Combination Delivery Unit Classifications of the Combination Delivery Unit Symbol Information SAFETY Storage, Transport, and Installation Precautions Wiring and Connection Precautions Usage Precautions After Use Precaution, Maintenance, and Checks Disposal Safety Devices Nominal Ocular Hazard Distance (NOHD) Labels SYSTEM DESCRIPTION INSTALLATION Attaching the Combination Delivery Unit Preparation Attaching to the YC slit lamp Installing Connection to the YAG Laser System Connection to the YC-1300/ Connection to the YC-1300/1400 (Old type) Connection to the YC-1300/1400 (New type) Connection to the YC Detachment of the Combination Delivery Adjustment of the Green Laser Spot OPERATING PROCEDURES Starting the Delivery System Preparation Laser Emission (Green Laser Beam) End of Operatoin Use of the YAG Laser Beam Indicaitons for Misoperation Emergency Stop Storing in the Carrying Case Page

5 6 MAINTENANCE Cleaning Cleaning the exterior Cleaning the optical parts SPECIFICATIONS ACCESSORIES Standard Configurations Options Words in This Manual...End of this manual

6 1 INTRODUCTION 1.1 Outline of the Combination Delivery Unit This unit is needed to comprise the combination system which enables you to emit the green laser beam or YAG laser beam while performing the observation with the slit lamp of the YAG laser system. This delivery unit is mounted on the slit lamp of the YAG laser system and connected to the NIDEK GREEN LASER PHOTOCOAGULATOR, Model GYC-1000 using the connecting cable and fiber-optic cable. With the combination system, selection can be made between photocoagulation by the green laser beam (wavelength: 532 nm, frequency-doubled, solid state) and photodisruption by the Nd:YAG laser beam. In addition, this selection can be easily made by changing the optical path of the laser beam with the laser select lever, and various kinds of safety devices are integrated into the system to emit the selected laser beam only. The combination delivery unit is attachable to the following 3 YAG laser systems: NIDEK OPHTHALMIC YAG LASER SYSTEM YC-1300/1400 NIDEK OPHTHALMIC YAG LASER SYSTEM YC-1600 Fiber-optic cable Combination delivery unit Protective filter unit Operator Laser emission Patient YC-1300/1400, main body YC-1600 main body GYC-1000 main body Motorized table Foot switch CAUTION United States Federal law restricts this device to sale by or on the order of a physician.

7 1.2 Classifications of the Combination Delivery Unit 1-2 [Classification under the provision of 93/42/EEC (MDD)] Class IIb As long as this delivery unit is connected to the main body, this delivery unit is classified as a Class IIb unit. [Class of the laser system] Class 4 As long as this delivery unit is connected to the main body, this unit is classified into Class 4 system. A Class 4 laser is capable of producing an injury to eyes by direct laser exposure or diffuse reflections (0.5 W or more). [Protection method against electric shock] Class I As long as this delivery unit is connected to the main body, this delivery unit is classified as a Class I system. A Class I system is a system in which the protection against electric shock does not rely on basic insulation only, but which includes an additional safety precaution in such a way that means are provided for the connection of accessible conductive parts to the protective (earth) conductor in the fixed wiring of the installation in such a way that accessible conductive parts cannot become live in the event of a failure of the basic insulation. [Degree of protection against electric shock] Type B applied part As long as this delivery unit is connected to the main body, this delivery unit is classified as a system with a Type B applied part. A system with a Type B applied part provides an adequate degree of protection against electric shock particularly regarding; - allowable leakage currents - reliability of the protective earth connection (if present) [Degree of protection by the enclosure] This delivery unit is classified as an IP20. An IP20 system is protected against an ingress of solid foreign objects, such as a finger having a diameter of 12.5 mm or greater, however, it is an ordinary system without protection against an ingress of liquids. Be careful not to exposure water to this delivery unit. [Sterilization methods recommended by the manufacturer] This delivery unit does not have any part to be sterilized or disinfected. [Degree of safety in the presence of flammable anesthetics and/or flammable cleaning agents] This delivery unit should be used in an environment where no flammable anesthetics and/or flammable cleaning agents are present.

8 1-3 [Mode of operation] As long as this delivery unit is connected to the main body, this unit is an continuous operating system. [Classification by transportability] This delivery unit is classified as a transportable system. 1.3 Symbol Information This symbol means that the system is classified as a system with a type B applied part. This symbol indicates that important descriptions related to operation or maintenance are contained in the operator s manual and that an operator must refer to the operator s manual prior to operation and maintenance.

9 2 SAFETY In this manual, signal words are used to designate the degree or level of safety alerting. The definitions are as follows. WARNING: CAUTION: Indicates a potentially hazardous situation which, if not avoided, could result in death or serious injury. Indicates a potentially hazardous situation which, if not avoided, may result in minor or moderate injury or in a property damage accident. Even situations indicated by WARNING and CAUTION may result in serious injury under certain conditions. Safety precautions must be strictly followed at all times. 2.1 Storage, Transport, and Installation Precautions CAUTION In storage, transport, and installation, verify that the following conditions are met: - Not exposed to direct sunlight or ultraviolet rays - Not exposed to rain or water - No chemicals or organic solvents are present - No poisonous gas, sulfur, salt, or large amount of dust is contained in the air - Level and stable without vibration and shock - The following are the specified environmental conditions for storage and transport (packed condition), and installation (unpacked condition) For storage and transport: Temperature: 14 to 122 ºF (- 10 to 50 ºC) / Humidity: 10 to 95 % (non-condensing) For installation: Temperature: 50 to 86 ºF (10 to 30 ºC) / Humidity: 30 to 85 % (non-condensing) In transport of the combination system, observe the following instructions: - To avoid injury or malfunction, remove the delivery unit from the main body and store them in the carrying case or shipping carton (keep the shipping carton used for delivery) - To maintain the performance of laser emission, put the protective cover on over the dichroic mirror and the protective cap on the fiber connector before storing them in the carrying case. - To avoid shift of the optical axis, do not subject the main body or the delivery unit of the combination system to physical shock even if they are packed in the carrying case or shipping carton. - To avoid condensation, keep the change in temperature as little as possible.

10 2-2 CAUTION In installation of the combination system, observe the following instructions: - To avoid troubles from condensation, let the combination system sit until the condensation has dissipated before installation. - To avoid malfunction from change in temperature and condensation, do not install the combination system where it is exposed to the direct flow of air conditioning. - To avoid adverse effect on the lens or mirror, do not install the combination system in a high temperature, high humidity, or dusty environment. - To let the combination system dissipate heat properly, install it so that the air vent on the rear panel and the wall or the foreign object are more than 10 cm apart. Attach or remove the delivery unit to the main body with the key switch off ( ). If the delivery unit is attached ore removed with the key switch on ( ), an error may occur. 2.2 Wiring and Connection Precautions CAUTION In handling the power cord and cables, observe the following instructions: - To avoid short circuit or fire from broken wire, perform the connection and disconnection holding the plug, and do not coil the power cord and connecting cables forcefully in a short curvature, or crush or pinch them with heavy objects. - To avoid short circuit or fire, replace the broken wire with a new one. - Never pull the power cord or a connecting cable to transport the system. In handling the power cord, observe the following instructions: - To avoid malfunction or electric shock, use a grounded power outlet which meets the power requirements specified in the label on the main body. - To avoid malfunction or fire, do not overload the electrical outlet. In handling the connecting cable of the combination system, observe the following instructions: - To avoid malfunction or failure of the system, connect the cable plug to the DELIVERY connector on the front panel of the main body. In handling the fiber-optic cable, observe the following instructions: - To avoid damage or deterioration in laser delivery performance, do not let any part of the fiber-optic cable bend with a radius of 10 cm (4.5 in) or more. - Connect the cable plug to the FIBER connector on the front panel of the main body. When the GYC or YC is used with other equipment simultaneously, observe the following instruction: - To avoid electric shock caused by potential difference between equipments, connect each ones potential equalizing conenctor with a special cable.

11 Usage Precautions WARNING Use of controls or adjustments, or performance of procedures other than those specified herein may result in hazardous radiation exposure. In handling of the delivery unit, observe the following instructions: - Only service technicians properly trained by Nidek may install and configure the combination system. Only qualified physicians may perform emission of the green laser for treatment. - To avoid hazardous radiation exposure, do not perform operation which is not described or different from the procedure specified in the operator s manual. - To avoid electric shock, do not modify nor touch the internal structure. - To maintain the performance of laser emission, never soil or scratch the lens or mirror. - To obtain appropriate result of laser emission, do not adjust the laser focus adjustment ring or the illumination focus adjustment ring except for installation and service. Before starting the combination system, observe the following instructions: - To avoid ignition or explosion from the laser emission, verify that there is no flammable anesthetic gas in the operating room. - To protect the eyes of personnel in the operating room, instruct them to wear recommended safety goggles (or the equivalent) before the operation and not to look at the laser beam directly during the operation. Recommended goggles... Model YL-300 for frequency doubled Nd: YAG: D L8 YL DIN (Produced by YAMAMOTO KOGAKU CO., LTD. Japan) - To prevent accidents, perform the check following 5.3 Checks Before Use and 5.4 Function Checks (p. 5-3) in the operator s manual of the main body and record each result in the list (p. 5-5) when starting operation of the combination system. During operation of the combination system, observe the following instructions: - To avoid unintended exposure to the laser beam, do not gaze at the aiming beam that is emitted from the laser aperture or direct it toward personnel. Always pay attention to the direction in which it is emitted. - To avoid accident caused by unauthorized personnel, do not leave the combination system unattended while it is operational. If the operator has to be away from the system, turn the key switch to the off position, remove the key, and store it in the customary place. During operation of the photocoagulation system, observe the following instructions: - Do not use the photocoagulation system simultaneously with other electronic equipment to avoid electromagnetic interference with the action of the system - Do not use the photocoagulation system simultaneously in the same room with other equipment such as a life-support equipment that has serious effects on the life of patient and the treatment, or other measurement or treatment equipment that involves small signal. - Do not use cables and accessories that are not specified for the photocoagulation system because that may deteriorate the electromagnetic compatibility. - Do not use the photocoagulation system simultaneously with portable radio frequency communication systems because it may have an adverse effect on the system.

12 2-4 CAUTION In use of the YC slit lamp, observe the following instructions: - To avoid damage to the retina of the patient, only trained physician may perform observation using the YC slit lamp. Do not emit unnecessarily intense laser beam. - To avoid the blue hazard, set the illumination for observation to the minimum level initially, and then increase it until the desired intensity can be obtained. After the observation, lower the illumination intensity to the minimum level again. - Wipe the forehead rest, the chinrest, and the grips of the YC slit lamp every time before observing a patient to keep them clean. For laser emission, observe the following instructions: - When the green laser beam (wavelength: 532 nm) of the GYC-1000 is emitted into tissue, following symptoms may occur. Pay attention to the direction of the aiming beam to avoid emitting the laser beam into the eye or onto skin inadvertently. - Skin symptoms... Damage to the cornea, etc. or blindness - Eye symptoms... Pain or burn - To avoid exposure to the reflected laser beam, verify that there is no reflective object in the optical path before laser emission. - To avoid excessive reaction, set the laser to a low output power initially, and then increase it until the desired effect can be obtained. Always set the output power to the minimum after the laser emission. - To avaoid damage to the cornea or the crystalline lens, if the indirect lens is used for laser emission, take the magnification into consideration and take care not to make the spot size larger than approximately 200 µm. - To avoid exposure to the accidentally emitted laser beam, always place the combination system in the condition in which the laser cannot be emitted (standby mode) except when emitting the laser. - Confirm that the combination system is in a proper condition for laser emission by the following procedures: (if any abnormality is found in step 2, ask Nidek for check and adjustment. 1. Project the aiming spot on a non-reflective, even surface. 2. Verify that the intensity of the illumination spot is even around the center as shown in the figure on the right and that lowering of the intensity or vignetting does not occur. When the green laser beam is emitted in photocoagulation using the YC slit lamp, the color of the green laser beam can be seen slightly in the view field occasionally. This occurs when the beam that is reflected from the contact lens enters the optical system for observation. The symptom differs according to the type of contact lens, and condition in which the green laser beam enters the contact lens. The light intensity is attenuated to a safe level by the protective filter that is incorporated in the slit lamp. If an intense light is seen, stop the use of the system immediately, and ask NIDEK for checking of the system.

13 2.4 After Use Precaution, Maintenance, and Checks CAUTION 2-5 After use of the combination system, observe the following instructions: - To avoid the tracking phenomenon, if the system will not be used for a long period of time, disconnect the power cord from the grounded power outlet. - To avoid dust and scratches, if the combination system will not be used for a long period of time, disconnect the delivery unit from the main body and the YC slit lamp and store them in the carrying case. - To maintain the performance of laser emission, when the combination system is not being used, turn off the power and put dust cover over it. For maintenance of the combination system, observe the following instructions: - To avoid accidents caused by improper repair of the system, only service technicians properly trained by NIDEK may repair the system. - To maintain the performance of laser emission, take care not to scratch or accumulate dust on the optical parts such as lens and mirror. - To protect the exterior or maintain the operability of the system, do not use organic or abrasive solvents for cleaning. For check of the combination system, observe the following instructions: - To maintain the performance of laser emission, ask NIDEK or your authorized distributor for calibration of output power and exposure time of the laser beam, and for measurement of the earth resistance and leakage current once a year. - To avoid infection, wipe the surface of the delivery unit (especially the inside parts of the headband and overband) with a clean cloth dampened with alcohol before returning it to NIDEK for repair or maintenance.

14 Disposal CAUTION When disposing of the delivery unit, follow the local governing ordinances and recycling plans. (For details, ask NIDEK or your authorized distributor.) When disposing of packing materials, sort them by material and follow local governing ordinances and recycling plans. When disposing of the GYC main body and the YC main body, see the operator s manual for each. 2.6 Safety Devices [Protective filter] To protect the operator s eye from the reflected light of the green laser beam, the protective filter can be attached to the YC slit lamp. If the filter is not set in the observation optical path, the green laser beam cannot be emitted though the foot switch is pressed. [LASER EMISSION indicator] During the combination system operation (while the key switch is in the ON ( indicator on the delivery unit lights up to call the operator s attention. ) position), the [Manual reset function] After the combination system is stopped due to the stop signal from the remote connector, the power being cut, an unintended cause, etc., the system does not restart automatically even though all problem have been solved and the system is ready to be restarted. It is on the operator s decision whether to restart the system or not. To restart the system, turn the key switch to the OFF ( ) position (manual reset), and then to the ON ( ) position again. 2.7 Nominal Ocular Hazard Distance (NOHD) The nominal ocular hazard distance (NOHD) of the green laser beam of the combination system is as follows: NOHD = 14.6 m

15 Labels In order to call the operator s attention, the appropriate warning labels are attached to the specified locations on the delivery unit. [Combination delivery unit] [Protective filter unit]

16 2-8 [Carrying case] (option)

17 3 SYSTEM DESCRIPTION [Combination delivery unit] Fiber-optic cable LASER EMISSION indicator Filter connector Screw Micromanipulator lever Spot size control knob Laser focus ring Laser select lever Dichroic mirror YC connector GYC connector

18 3-2 Fiber-optic cable Delivers the laser beam from the GYC to the combination delivery unit. Its connector is connected to the FIBER connector on the connector panel of the GYC. LASER EMISSION indicator Lights when the key switch of the GYC is turned to the ON ( ) position. Filter connector The filter connector of the protective filter unit is connected here. Screw Fixes the delivery unit to the YC slit lamp. Micromanipulator lever Used to finely adjust the spot positions of the aiming beam and green laser beam of the GYC. Spot size control knob Used to adjust the spot size of the aiming beam and green laser beam of the GYC in the range between 50 and 500 µm. The spot size is indicated on the control box of the GYC. Laser focus ring Used to align the focal points of the aiming beam and green laser beam of the GYC with those of the YC. Laser select lever Used to select the laser beam to be used between the green laser beam and YAG laser beam. Dichroic mirror Aligns the green laser beam with the illumination light and delivers them to the affected area. YC connector Connected to the PRINTER connector on the rear side of the power supply unit of the YC- 1300/1400 or to the Remote connector on the switch box of the YC GYC connector Connected to the DELIVERY connector on the connector panel of the GYC.

19 3-3 [Protective filter unit] Connecting cable Knob Filter IN position Filter lever Filter OUT position Connecting cable Connected to the filter connector of the delivery unit. Knob Fixes the binocular tube of the YC slit lamp to the protective filter unit. Filter lever Used to control the protective filter manually. By sliding the lever clockwise viewed from the operator s side, the filter is inserted into the observation optical path, and the filter is removed by sliding it counterclockwise.

20 4 INSTALLATION 4.1 Attaching the Combination Delivery Unit Preparation 1. Remove the tonometer holder from the top of the YC microscope. Tonometer holder Remove the 2 screws. 2. Attach the mounting block to where the tonometer holder was. Mounting block Use the 2 screws to fix the mounting block. 3. Attach the absorption plate to the top of the prism head of the illumination tower. Absorption plate Use double-sided tape to fix the absorption plate.

21 Attaching to the YC slit lamp CAUTION When attaching the combination delivery unit, set the laser select lever to the YAG position so that the dichroic mirror is contained inside the delivery unit. If the delivery unit is attached while the dichroic mirror is lowered, the mirror may be damaged. 1. Loosen the screw and remove the protective cover. 2. Fit the combination delivery unit onto the mounting block. The pin of the mounting block shall fit into the hole on the delivery unit. Screw Pin Hole 3. Tighten the screw to fix the combination delivery unit. 4. Loosen the screw on the YC binocular tube and remove the binocular tube. Binocular tube Protective filter unit Knob Screw 5. Fit the protective filter unit to the mount of the YC binocular tube and fix it with the screw. 6. Fit the YC binocular tube to the mount of the protective filter unit and fix it with the knob.

22 Connect the connecting cable connector of the protective filter unit to the filter connector of the combination delivery unit. Filter connector

23 Installing 1. Place the GYC main body and the delivery unit is attached on a convenient position. 1) Prepare a wagon or the extension table (option) and install the main body. CAUTION Verify that the surface on which the wagon or the equivalent is installed is level and stable. Otherwise, the main body may fall during use of the combination system. Leave a clearance of 10 cm or more for the rear surface of the GYC main body. Otherwise, air infusion for cooling down of the laser cannot be properly performed through the slits on the rear and side surfaces of the main body, and this may have and adverse effect. When installing the GYC main body, never pull the cables or crush them with the casters. Physical shock to cables may cause a malfunction of the combination system. [A: When using a wagon] Prepare a wagon which has enough space for the GYC main body (approximately W: 30cm D: 40cm). [B: When using a extension table (option)] Prepare the extension table. Loosen the 3 screws so that the YC optical table can be bound in the fixing part of the extension table. Securely fit the fixing part onto the YC optical table until it comes in full contact with the end of the motorized optical table. Then, tighten the 3 screws. Lightly weigh upon the extension table with hands to verify that the main body can be placed on it with no problem. YC optical table Screws Extension table 2) When the installed position is decided, lock the caster as necessary.

24 Verify the power supply. 1) Verify that the power cord is not connected anywhere. 2) Verify that the wall-outlet meets the power requirements labeled on the GYC main body. CAUTION If the wall-outlet does not meet the power requirements, the combination system may be damaged, or it may not perform properly. 2. Connect the plugs and cable plugs to the GYC main body. CAUTION Securely connect each plug to the specified connector, etc. If the plug is connected to a wrong connector or connected improperly, there is a fear of a system malfunction or the system may be damaged. Attach or remove the delivery unit to the main body with the key switch off ( ). If the delivery unit is attached ore removed with the key switch on ( ), an error may occur. Fiber-optic cable plug Slit lamp delivery unit cable plug Power cord Foot switch Short plug 1) Connect the female plug of the power cord to the inlet of the GYC main body. 2) Connect the cable plug of the foot switch to the FOOT SW connector. 3) Connect the short plug to the REMOTE connector. 4) Connect the connecting cable plug of the combination delivery unit to the DELIVERY connector.

25 4-6 6) Remove the rubber cap from the plug of the fiber-optic cable, and connect the plug to the FIBER connector. * When using the wagon (option), pass the fiber-optic cable through the antenna of the wagon if necessary. Rubber cap CAUTION Pay attention to the handling of the fiberoptic cable so that it is not coiled with a radius of under 10 cm. The transmittancy of the laser beam may be reduced or the optical fiber way be damaged. 10 cm or more 4. Attach the connector cover to the GYC main body in the reverse order of step Connect the YC connecting cable to the YAG laser system. The connecting method of the YC connecting cable differs according to the model, YC-1300/ 1400, or YC Refer to 4.2 Connection to the YAG Laser System (p. 4-8). 6. Connect the power cords of the GYC main body and the YC power supply unit (for the YC- 1600, AC adopter) to the wall-outlet verified in step Verify that the laser select lever is set to the GREEN (green laser beam) position. Laser select lever

26 Start operation of the combination system. 1) If necessary, turn ON the master switch on the YC motorized table. 2) Insert the key into the YC key switch and turn it to the ON ( ) position. 3) Turn ON ( ) the master switch of the GYC main body. Master switch 4) Insert the key into the GYC main body and turn it to the ON ( ) position. The GYC goes into the STANDBY state after approximately 10 seconds. STANDBY Key switch 9. Perform the check of the combination system. Perform the check referring to 5.4 Function Check (p. 5-3) and record each result in the 5.5 Function check list (p. 5-5) in the Operator s Manual for the main body. (To adjust the laser spot, go to step 4 of 4.4 Adjustment of the Green Laser Spot (p. 4-11).) 10. Stop operation of the combination system. Turn the key switch of the GYC main body to the OFF ( ) position, and turn OFF ( ) the master switch. Turn the key switch of the YC to the OFF ( ) position, and, if necessary, turn OFF ( ) the master switch on the YC motorized table. 11. Put the dust covers over the GYC main body and the YC to which the delivery unit is attached. 12. Remove the keys from the GYC main body and YC and store them in a customary place.

27 Connection to the YAG Laser System As the connection method of the YC connecting cable varies according to the model, YC-1300/1400, or YC-1600, make sure of the model of YC to be connected Connection to the YC-1300/1400 The type of power supply unit and connector layout of the YC-1300/1400 varies according to the serial number. Here, connection methods of both old and new types are described respectively. Old type YC-1300: S/N or earlier, YC-1400: S/N or earlier New type YC-1300: S/N or later, YC-1400: S/N or later Connection to the YC-1300/1400 (Old type) 1. Fix the YC connecting cable coming from the delivery unit with clamps along the surface of the YC microscope arm. Attachment position of clamps 2. Remove the connector cover on the rear side of the power supply unit of the YC-1300/ screws Remove the 2 screws. 3. Connect the YC connecting cable connector of the delivery unit to the PRINTER connector on the rear side of the power supply unit of the YC-1300/1400. Lift the springs on both right and left sides to lock the connector. PRINTER connector Connector cover

28 Put the connector cover back on. Use the 2 screws to fix the connector cover Connection to the YC-1300/1400 (New type) 1. Fix the YC connecting cable coming from the delivery unit with clamps along the surface of the YC microscope arm. Attachment position of clamps 2. Connect the YC connecting cable connector of the delivery unit to the PRINTER DC COMBO connector on the right side of the power supply unit of the YC-1300/1400. Lift the springs on both right and left sides to lock the connector. NOTE PRINTER DC COMBO connector If the PRINTER DC COMBO connector on the right side of the power supply unit is covered with a plate, a modification for the connector attachment is necessary. Ask NIDEK or your authorized distributor.

29 Connection to the YC-1600 * When the YC-1600 has the lower-fixation-type illumination tower, replace it with the tiltable illumination tower. Ask NIDEK or your authorized distributor. 1. Fix the YC connecting cable of the delivery unit with clamps along the surface of the YC microscope arm. Attachment position of clamps 2. Remove the remote connector on the switch box of the YC Connect the YC connecting cable connector of the delivery unit to the Remote connector on the switch box of the YC Remote connector Lift the springs on both right and left sides to lock the connector. 4.3 Detachment of the Combination Delivery There is no problem in using the system as the YAG laser system while the combination delivery unit is attached, however, to detach the combination delivery unit, refer to the following and perform the procedures in the reverse order Attaching to the YC slit lamp (p. 4-2) 4.2 Connection to the YAG Laser System (p. 4-8)

30 Adjustment of the Green Laser Spot At the first time of installation or when the focal point or position of the green laser beam seems to have shifted due to an inertial force, follow the procedures below to check and adjust the green laser spot. 1. If the combination system is in operation, go to step Select GREEN (green laser beam) with the laser select lever of the delivery unit. Laser select lever 3. Start operation of the combination system. 1) If necessary, turn ON the master switch on the YC motorized table. 2) Insert the key into the YC key switch and turn it to the ON ( ) position. 3) Turn ON ( ) the master switch of the GYC main body. 4) Insert the key into the GYC main body and turn it to the ON ( ) position. The GYC goes into the STANDBY state after approximately 10 seconds. 5) Keep pressing the AIMING switch on the control box of the GYC to turn OFF ( ) the aiming beam. 4. Adjust the eyepiece power and pupillary distance (PD). 1) Remove the plug from the mounting hole for the focusing rod on the YC. 2) Insert the focusing rod into the mounting hole so that its flat surface faces the microscope. Focusing rod Plug

31 3) Project the slit image of the proper length, width and intensity onto the focusing rod. 4) Fully turn the eyepiece dioptric adjustment control to the + side and look into the microscope. 5) While looking at the slit image with one eye, slowly turn the eyepiece dioptric adjustment control to the - side until the slit image is focused sharply WARNING Be sure to adjust the eyepiece power for each eye and do not turn the eyepiece dioptric adjustment control from the - side to the + side. Otherwise, the eyepiece power cannot be properly adjusted, and an adverse effect on laser emission may result. 6) Perform the eyepiece power adjustment to the other eye in the same manner as step 5). 7) Adjust the pupillary distance (PD) by moving the binocular tube so that the slit images observed with both eyes become one. 6. Check the coincidence of the illumination spot and the aiming beam. 1) Fix the YC slit lamp with the stopper so that it does not move in the front, back, right, and left directions. 2) Set the aperture diameter of the illumination spot to the minimum (φ 0.2 mm). 3) Adjust the intensity of the aiming beam with the AIMING switches on the control box. Spot size display 4) Set the spot size of the aiming beam to 50 µm with the spot size control knob. CAUTION Verify that the illumination tower is in its uppermost position. AIMING switch

32 4-13 5) Set the magnification of the YC slit lamp to the maximum. Then observe the spots of the illumination and the aiming beam that are projected on the focusing rod. Laser focus ring 6) If the spots are in the same position, proceed to step 7. 7) If the spots are shifted, adjust the aiming beam to the illumination spot by moving the micromanipulator. 7. Adjust the focal point of the laser beam with the illumination light. Micromanipulator lever Turn the laser focus ring until the aiming spot on the target becomes the minimum and can be seen sharply and clearly. 8. Remove the focusing rod and put the plug into the mounting hole. Keep the removed focusing rod in a table drawer. Focusing rod Plug 9. Stop operation of the combination system. Turn the key switch of the GYC main body to the OFF ( ) position, and turn OFF ( ) the master switch. Turn the key switch of the YC to the OFF ( ) position, and, if necessary, turn OFF ( ) the master switch on the YC motorized table. 10. Put the dust covers over the GYC main body and the YC to which the delivery unit is attached. 11. Remove the keys from the GYC main body and YC and store them in a customary place.

33 5 OPERATING PROCEDURES 5.1 Starting the Delivery System 1. Remove the dust covers from the GYC main body and the YC. CAUTION Pay attention not to apply load to the connecting cable and fiber-optic cable when removing the dust cover. Otherwise, a malfunction of the delivery system may result. 2. Instruct all personnel present in the operating room except the operator and patient to wear the safety goggles for the green laser beam. WARNING The safety goggles vary according to the laser type and its use. Be sure to use the recommended goggles. Furthermore, never gaze at the laser beam directly even when wearing the safety goggles. Recommended goggles For green laser beam...model YL-300 for frequency doubled Nd: YAG: D L8 YL DIN (Produced by YAMAMOTO KOGAKU CO., LTD. Japan) For YAG laser beam...model YL-110 for Nd: YAG: IR L6 YL DIN (Produced by YAMAMOTO KOGAKU CO., LTD. Japan) Using any goggles other than recommended may cause damage to eye. 3. Verify that the laser select lever is set to the GREEN (green laser beam) position. Laser select lever 4. Start operation of the combination system. 1) If necessary, turn ON the master switch on the YC motorized table. 2) Insert the key into the YC key switch and turn it to the ON ( ) position.

34 5-2 3) Turn ON ( ) the master switch of the GYC main body. Master switch 4) Insert the key into the GYC main body and turn it to the ON ( ) position. At this time, perform the operation check referring to 5.4 Function Checks (p. 5-3) in the Operator s Manual for the main body and record each result in the 5.5 Function check list (p. 5-5) in the Operator s Manual for the main body. The GYC goes into the STANDBY mode after approximately 10 seconds after indicating and on the control box. Key switch 5) Keep pressing the AIMING switch on the control box to turn OFF ( ) the aiming beam. on the side of the AIMING level indicator lights up. AIMING switch

35 5.2 Preparation Adjust the heights of the YC motorized table and chair for ease of observation. 2. Adjust the eyepiece power and pupillary distance (PD). 1) Remove the plug from the mounting hole for the focusing rod. 2) Insert the focusing rod into the mounting hole so that its flat surface faces the microscope. 3) Project the slit image of the proper length, width and intensity onto the focusing rod. 4) Fully turn the eyepiece power control to the + side and look into the microscope. * For eyeglass wearers, fold back the eye cups. 5) While looking at the slit image with one eye, slowly turn the eyepiece dioptric adjustment control to the - side until the slit image is focused sharply. WARNING Be sure to adjust the eyepiece power for each eye and do not turn the eyepiece dioptric adjustment control from the - side to the + side. Otherwise, the eyepiece power cannot be properly adjusted, and an adverse effect on laser emission may result. 6) Perform the eyepiece power adjustment to the other eye in the same manner as step 5). 7) Adjust the pupillary distance (PD) by moving the binocular tube so that the slit images observed with both eyes become one. 8) Remove the focusing rod and put the plug into the mounting hole. Keep the removed focusing rod in a table drawer.

36 Verify that the aiming beam is turned OFF. If not, keep pressing the AIMING switch on the control box to turn OFF ( ) the aiming beam. 4. Clean the parts where a patient s skin contacts. Wipe the forehead rest, chin rest, and grip with clean gauze dampened with rubbing alcohol. * When using the chin rest paper, remove a piece of paper. * When using the chinrest paper, use a new a piece of paper for every patient. 5. Have the patient sit in front of the slit lamp. 1) Have the patient s chin rest on the chin rest and touch his or her forehead to the forehead rest. 2) Have the patient hold the grips to stabilize the patient s position. 6. Adjust the heights of the chin rest and chair so that the surgery can be performed comfortably for both operator and patient. Turn the chin rest elevation control to align the patient s eyes with the eye level marker. 7. Fix the patient s head with the head belt. 8. Fix the patient s visual axis with the fixation lamp. Head belt Eye level marker Chinrest elevation control

37 [Cautions in use of the slit lamp] Be sure to set the light intensity to the minimum level (not turning off) at the beginning, and raise it as necessary. Make a habit of returning the light intensity to the minimum level after every examination. The patient may suffer from the excessive brightness at the beginning of the examination, and a high-intensity light may cause thermal and photochemical damage (blue light hazard) to the patient s retina. Pay attention to the following when handling the slit lamp. - Reduce the light intensity as much as possible. - Reduce the size of the illuminated area as much as possible (slit width and diaphragm). - Set the angle between the illumination and visual axis to the maximum. - Use the color filter, and in special cases, diffuser. Especially pay attention to the projection of the illumination light when examining infants, aphakic patients and patients with eye disease Manipulate the joystick to bring the slit image onto the patient s eye. 10. Turn the illumination control on the YC slit lamp to adjust the light intensity of the slit image. 11. Roughly focus the slit image on the patient s cornea by manipulating the joystick. 12. Put a contact lens on the patient s eye or place an aspheric lens in front of the patient s eye. When using the contact lens, apply the surface anesthesia to the patient s eye. If necessary, use the corneal protection agent. 13. Manipulate the joystick while looking into the microscope to examine the patient s eye. As necessary, change the microscope magnification, slit width, slit diaphragm, inclination of slit, and filter type using the YC slit lamp.

38 Laser Emission (Green Laser Beam) 1. Set each laser emission condition. Settings of all the laser emission conditions except the spot size setting are performed on the control box, and the spot size is set with the spot size control knob on the delivery unit. All the laser emission conditions are shown on the control box. Aiming level indicator INTERVAL display COUNTER display POWER display Emergency stop switch SPOT SIZE display Spot size control knob AIMING switches TIME switches TIME display Reset switch POWER switches INTERVAL switch [a. Output power (aperture of delivery)] The output power of the green laser beam is set with the POWER control. The output power can be set between 50 and 500 mw in 10mW increments and between 500 and 1700 mw in 50 mw increments. [b. Exposure time] The exposure time of the green laser beam is set with the TIME switches. The exposure time can be set in the range between 0.01 and 0.10 seconds in 0.01 second increments, 0.10 and 0.50 seconds in 0.05 second increments, 0.50 and 1.00 seconds in 0.10 second increments, and 1.00 and 3.00 seconds in 1.00 second increments. [c. Single/Repetition mode] The single or repetition mode is selected by pressing the INTERVAL switch as necessary. In the repetition mode, the repetition time (between 1.0 and 0.1 seconds in 0.1 second increments) is indicated on the INTERVAL display on the control box. (In the single mode, no indication.) [d. Aiming level] The intensity of the aiming beam is set with the AIMING switches. The intensity of the aiming beam is increased with the switch, and it is decreased with the switch.

39 5-7 [e. Counter reset] The indication on the counter is reset to 0 by pressing the reset switch as necessary. [f. Spot size] The spot size is adjusted by turning the spot size control knob on the delivery unit. The spot size can be set in the range between 50 and 500 µm in 10 µm increments. 2. Slide the filter lever to the IN position to insert the protective filter into the observation optical path. CAUTION If the indirect lens is used for laser emission, take the magnification into consideration and take care not to make the spot size larger than approximately 200 µm. If the spot size is excessively large, the energy density becomes high on the cornea and the crystalline lens and they may be damaged. 3. Place the combination system in the READY mode. Press the STATUS switch to change the system state to the READY mode. When the combination system is placed in the READY mode, the indication lights up on the control box. * Change from the STANBY mode to the READY mode takes approximately 2 seconds. * When the aiming beam is off ( ), the system cannot enter the READY mode. CAUTION STATUS switch Always place the combination system in the STANDBY mode by pressing the STATUS switch whenever the laser beam is not emitted. This prevents an accidental emission of the laser beam even if the foot switch is pressed inadvertently. 4. Emit the green laser beam by pressing the foot switch. 1) Adjust the positions of the joystick and contact lens. 2) When the emission position is determined, press the foot switch. The green laser beam is emitted, and the number of green laser emissions is indicated on the COUNTER display. While the green laser is being emitted, a series of beep sounds is heard. COUNTER display

40 5-8 CAUTION If a series of the beep sounds is produced and the green laser beam is not emitted even though the foot switch is pressed, check whether the system is placed in the READY mode and the aiming beam is emitted. The system is designed not to emit the green laser beam if all the conditions mentioned above are not met. If a series of beep sounds is not produced and the green laser beam is not emitted even though the foot switch is pressed, check whether the foot switch is connected to the GYC main body. The green laser beam cannot be emitted if the foot switch is not connected to the main body. When the green laser beam is emitted in photocoagulation using the YC slit lamp, the color of the green laser beam can be seen slightly in the view field occasionally. This occurs when the beam that is reflected from the contact lens enters the optical system for observation. The symptom differs according to the type of contact lens, and condition in which the green laser beam enters the contact lens. The light intensity is attenuated to a safe level by the protective filter that is incorporated in the slit lamp. If an intense light is seen, stop the use of the system immediately, and ask NIDEK for checking of the system. 5. When the laser emission is completed, place the combination system in the STANDBY mode. 1) Press the STATUS switch to place the system in the STANDBY mode. indication lights up on the control box. STATUS switch 2) Keep pressing the AIMING switch to turn OFF the aiming beam. The indication lights up on the control box. AIMING switch 6. Decrease the light intensity of the slit lamp. Set the light intensity to the minimum level (not turning off) with the brightness control on the slit lamp.

41 5.4 End of operation Release the patient from the YC slit lamp. Release the head belt and let the patient remove his or her chin from the chin rest. 2. When performing the laser emission on the next patient, go back to step 4 of 5.2 Preparation (p. 5-3) while the combination system is in the STANDBY mode. 3. Stop operation of the combination system. 1) Turn the key switch of the GYC main body to the OFF ( ) position. Then, remove the key and store it in a customary place. 2) Turn OFF ( ) the master switch of the GYC main body. Key switch Master switch 3) Turn the key switch of the YC slit lamp to the OFF ( ) position. Then, remove the key and store it in a customary place. 4) If necessary, turn OFF ( ) the master switch on the YC motorized table. 4. Instruct all personnel present to take off the safety goggles. 5. Put the dust cover over the combination system. Put the dust covers over the GYC main body and the YC slit lamp. NOTE If the system will not be used for a long period of time, or if the delivery unit will be used at other facilities, remove the delivery unit from the YC slit lamp and store it in the carrying case. (Refer to 5.8 Storing in the Carrying Case (p. 5-13).)

42 Use of the YAG Laser Beam After 5.2 Preparation, use the YAG laser beam following the procedure below. 1. Verify that the key switch of the GYC main body is in the OFF ( ) position and the system is in the STANDBY mode. 2. Slide the laser select lever on the combination delivery unit to the YAG position. Laser select lever Indications on the GYC control box go off except the the indication. 3. Instruct all personnel present in the operating room except the operator and patient to wear the safety goggles for the YAG laser beam. WARNING The safety goggles vary according to the laser type and its use. Be sure to use the recommended goggles. Recommended goggles For YAG laser beam...model YL-110 for Nd: YAG: IR L6 YL DIN (Produced by YAMAMOTO KOGAKU CO., LTD. Japan) Using any goggles other than the recommended ones may result in damage to eyes. 4. Operate the YC according to its operator s manual. CAUTION To emit the YAG laser beam, use the foot switch or the trigger switch (on the top of the joystick) which are connected to the YC. Only the switches connected to the YC allow emission of the YAG laser beam. 5. When surgery with the YAG laser beam is finished, place the system in the state in which the laser beam cannot be emitted. a) For the YC-1300/1400, press the READY switch to place the system in the OFF state. b) For the YC-1600, press the switch to place the system in the STANDBY mode.