DOCSLIB.ORG

Laser Technologies in Ophthalmic Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Laser Technologies in Ophthalmic Surgery IOP Laser Physics Astro Ltd Laser Physics Laser Phys. Laser Phys. 26 (2016) 084010 (20pp) doi:10.1088/1054-660X/26/8/084010 26 Laser technologies in ophthalmic surgery 2016 V V Atezhev1, B V Barchunov1, S K Vartapetov1, A S Zav’yalov2, K E Lapshin1, V G Movshev2 and I A Shcherbakov3 © 2016 Astro Ltd 1 Physics Instrumentation Center, A.M. Prokhorov General Physics Institute, LAPHEJ Russian Academy of Sciences, Moscow, Russia 2 “Optosistemy”, LLC, Moscow, Russia 3 A.M. Prokhorov General Physics Institute, Russian Academy of Sciences, Moscow, Russia 084010 E-mail: [email protected] V V Atezhev et al Accepted for publication 16 June 2016 Published 27 July 2016 Abstract Excimer and femtosecond lasers are widely used in ophthalmology to correct refraction. Laser systems for vision correction are based on versatile technical solutions and include multiple Printed in the UK hard- and software components. Laser characteristics, properties of laser beam delivery system, algorithms for cornea treatment, and methods of pre-surgical diagnostics determine LP the surgical outcome. Here we describe the scientific and technological basis for laser systems for refractive surgery developed at the Physics Instrumentation Center (PIC) at the Prokhorov General Physics Institute (GPI), Russian Academy of Sciences. 10.1088/1054-660X/26/8/084010 Keywords: laser technology, ophthalmic surgery, femtosecond lasers Paper (Some figures may appear in colour only in the online journal) 1054-660X 1. Introduction an excimer ArF laser with the wavelength 193 nm is optimal for corneal ablation according to the criteria of the ablation 8 One of the first branches of medical science, where lasers quantitative precision, the absence of any effect upon neigh- were used, was ophthalmology. The eye, with its transpar- boring tissues, and the smoothness of the postsurgical surface. ent refractive media, was a perfectly convenient anatomical The first commercial excimer ophthalmosurgical setups oper- structure with the deep parts accessible for treatment by laser ated with high-energy pulsed lasers and beams with character- radiation and further monitoring of the results. istic dimensions equal to the diameter of the treatment field of One of the first of such operations was laser coagulation by the corneal optical zone (OZ) (⩽9 mm). The intensity profile an argon laser, which provided an opportunity, for example, at the cornea was formed by profiled rotating or changeable to fix retinal detachment to eye tunics. Another application apertures. The first Russian commercial device [2] used an of lasers was for glaucoma treatment, a disease caused by the original optical scheme utilizing the Gaussian beam homoge- stoppage of eye fluid outflow. In this case, the laser plays the nizer. This formation technique provided an absolutely smooth role of ‘a light needle’ forming an artificial channel for this postsurgical surface of the cornea. However, the application of outflow. wide-aperture beams did not provide an opportunity for sta- These operations demonstrated the advantages of laser eye ble correction of hyperopia and astigmatism. It was later pro- microsurgery such as posed [3] that a small-diameter laser beam (0.7–1.2 mm) can be used to scan the corneal surface to form an arbitrary post- - non-contact surgical surface. This technique is known as a flying spot . - being aseptic ‘ ’ Each pulse of an ArF laser ablates a small (smaller than 1 µm) - precise localization of the impact and minimal effect corneal layer that provides an opportunity to form a calculated upon the neighboring tissues postsurgical surface with high precision. - opportunity of surgery without violating the integrity of The most modern type of laser ophthalmologic surgery is the eye s anatomic structures. ’ custom vision correction. The difference from the earlier tech- In ophthalmology, lasers found the broadest application for niques is that in the case of custom vision correction not only the correction of refractive errors. It was established in [1] that spheroastigmatic deviations get corrected, but also a patient’s 1054-660X/16/084010+20$33.00 1 © 2016 Astro Ltd Printed in the UK Laser Phys. 26 (2016) 084010 V V Atezhev et al Figure 1. (а) OZ is the optical zone, TZ is the transition zone, and UC is the intact (not ablated) cornea. (b) Composing parts of the OZ: OZ0 is namely the optical zone and OZS is the suboptical zone. unique nonregular refractive defects that cannot be corrected A presbyopic patient has (using any kind of spectacles) only a by spectacles. Custom correction is performed on the basis very narrow range of distance, where he can see sharply. of keratometry (measurement of corneal shape) and aber- Surgery for the treatment of regular refraction pathology is rometry (aberration measurement for the whole eye’s optical considered to be successful if the uncorrected distance visual tract) data. Since in the case of custom surgery it is necessary acuity (UDVA) is no worse or better than the presurgery best to create smaller profile elements at the cornea, this surgery corrected distance visual acuity (CDVA). In other words, if demands a new level of precision and stability for the laser a patient has the visual acuity with spectacles equal to 1.0 correction of the corneal shape. In particular, the necessary before surgery, his visual acuity without spectacles after sur- element is an eye-tracking system for monitoring the surgi- gery must be 1.0 or better. cal process that introduces corresponding corrections during surgery. The key parameter of the eye-tracking system is its 2.1.2. Basic techniques for diagnostics and postsurgical latent period, i.e. the time from the moment of eye displace- monitoring ment to the moment of registration of this movement during A. Determination of subjective refraction (manual selection the surgery. of spectacles). It provides an opportunity to determine the A human eye is a dynamic structure, where a multiplicity correction parameters for regular refractive distortions. of processes with various time and space scales takes place. B. Keratotopography (keratometry). The basic output data For example, eye movements during surgery must be consid- are in the form (height map) of the outer surface of an ered with the time scale of milliseconds, while postsurgical eye cornea. Various types of curvature at each point of adaptation processes may take several months. Each of these the cornea are calculated on its basis. Thus, the refrac- processes may affect decisively the quality of postsurgi- tive properties of deep eye portions are not registrated by cal vision and, therefore, must be taken into account while keratometry in any way. designing equipment for ophthalmologic surgery. C. Aberrometry provides information on the aberrations In this paper, we describe scientific and technological solu- caused by not only defects of the cornea, but the whole tions implemented in commercial laser ophthalmosurgical optical tract of an eye. To measure these aberrations systems MicroScan Visum (an excimer laser) and Femto ‘ ’ ‘ at the crossing point of the eye s optical axis and the Visum (a femtosecond (FS) laser) developed in PIC GPI, and ’ ’ retina, a small-sized infrared light source is formed that also the results of the clinical use of these systems. is obtained by directing a narrow beam along the eye’s optical axis. In this case, the wavefront Wx(), y leaving 2. Excimer lasers the pupil (in the form of an expansion over the Zernike polynomials [4]) represents the output data of an aber- 2.1. General issues of excimer-laser refractive correction rometer. If a plane wavefront goes out of an eye focused at an infinitely distant object, in this ideal case the eye 2.1.1. Pathologies as objects for treatment. In this paper, the does not need surgical correction. refractive pathologies of vision are divided into regular (sphe- roastigmatic) and nonregular ones. It is assumed in both cases Thus, aberrometry provides not only geometrical, but optical that the optical media of an eye stay completely transparent. data characterizing not only the cornea, but the whole optical Regular pathologies can be corrected by selecting standard tract. However, the definition domain of its data does not go spectacles that is equivalent to placing a spherical and cylin- beyond the pupil at the measurement moment, while the kera- drical lens combination in front of an eye. All other refrac- tometry data are not restricted in this way. tive pathologies will be referred to as nonregular. A special place among the latter belongs to presbyopia, which is the 2.1.3. Surgery classification in performance technique. A 50 µm loss of crystalline lens motility causing the impossibility of layer of epithelium exists over the corneal surface layer. It accommodation, i.e. control of an eye-focusing distance. must be removed before starting the laser treatment of the 2 Laser Phys. 26 (2016) 084010 V V Atezhev et al cornea. Refractive surgery is divided into the following types examination (selection of spectacles using Snellen-like tables). according to the way it is performed. Calculation is based on the principles of geometrical optics. Let us give some necessary definitions of the ophthalmo- A. Photorefractive keratectomy (PRK). The epithelium is metric terms. removed mechanically. A weak axis is the direction Oαflat in the Oxy plane. It is B. Transepithelium PRK. The epithelium is removed by the the section of the presurgical cornea with a plane including the same excimer laser that performs the major stage of the Oz axis and the Oαflat beam (crossing the coordinate origin surgery. and constituting the angle αflat with the Ox axis) that has the C. LASIK (laser-assisted in situ keratomileusis). The epithelium minimum curvature (at the coordinate origin) among all direc- is removed temporarily together with the corneal surface tions Oα in the plane Oxy. layer of 100–160 µm with the help of a mechanical instru- A strong axis is the direction Oαsteep in the plane Oxy that ment (microkeratom).
Load more

Recommended publications
  • CONDUCTIVE KERATOPLASTY: a RADIOFREQUENCY-BASED TECHNIQUE for the CORRECTION of HYPEROPIA by Marguerite B
    CONDUCTIVE KERATOPLASTY: A RADIOFREQUENCY-BASED TECHNIQUE FOR THE CORRECTION OF HYPEROPIA BY Marguerite B. McDonald MD ABSTRACT Purpose: To evaluate the data on the safety, effectiveness, and stability of conductive keratoplasty (CK), a thermal, radiofrequency- based technique for treating 0.75 to 3.00 diopters (D) of spherical hyperopia. Methods: A prospective, consecutive series, multicenter clinical trial involving 400 hyperopic eyes was conducted by 19 surgeons at 12 centers. The treatment goal was emmetropia. Cohort follow-up was up to 2 years. Results: At 12 months postoperatively, data were available for 97.5% (354/363) of eyes for efficacy variables and 98% (391/400) of eyes for safety variables. A total of 54% of the CK eyes showed 20/20 or better uncorrected visual acuity, and 92% showed 20/40 or better at 12 months. The mean postoperative manifest refractive spherical equivalent was within 0.50 D in 61% and within 1.00 D in 88%. After CK, eyes were approximately 0.50 D myopic at month 1 and effectively emmetropic at 6 months. At 24 months, there was a 20% loss of initial effect. Safety results showed a 2-line loss of best-corrected visual acuity in 2% of the CK-treated eyes. The incidence of induced cylinder of 2.00 D or greater was below 1%. Conclusion: The CK technique corrects low to moderate hyperopia effectively and safely and with acceptable stability. It spares the visual axis, does not require the creation of a large flap, and is not associated with postoperative dry eye. CK has value as an alternative to hyperopic LASIK for patients with hyperopia.
    [Show full text]
  • Soft Tissue Laser Dentistry and Oral Surgery Peter Vitruk, Phd
    Soft Tissue Laser Dentistry and Oral Surgery Peter Vitruk, PhD Introduction The “sound scientific basis and proven efficacy in order to ensure public safety” is one of the main eligibility requirements of the ADA CERP Recognition Standards and Procedures [1]. The outdated Laser Dentistry Curriculum Guidelines [2] from early 1990s is in need of an upgrade with respect to several important laser-tissue interaction concepts such as Absorption Spectra and Hot Glass Tip. This position statement of The American Board of Laser Surgery (ABLS) on soft tissue dentistry and oral surgery is written and approved by the ABLS’s Board of Directors. It focuses on soft tissue ablation and coagulation science as it relates to both (1) photo-thermal laser-tissue interaction, and (2) thermo-mechanical interaction of the hot glass tip with the tissue. Laser Wavelengths and Soft Tissue Chromophores Currently, the lasers that are practically available to clinical dentistry operate in three regions of the electromagnetic spectrum: near-infrared (near-IR) around 1,000 nm, i.e. diode lasers at 808, 810, 940, 970, 980, and 1,064 nm and Nd:YAG laser at 1,064 nm; mid-infrared (mid-IR) around 3,000 nm, i.e. erbium lasers at 2,780 nm and 2,940 nm; and infrared (IR) around 10,000 nm, i.e. CO2 lasers at 9,300 and 10,600 nm. The primary chromophores for ablation and coagulation of oral soft tissue are hemoglobin, oxyhemoglobin, melanin, and water [3]. These four chromophores are also distributed spatially within oral tissue. Water and melanin, for example, reside in the 100-300 µm-thick epithelium [4], while water, hemoglobin, and oxyhemoglobin reside in sub-epithelium (lamina propria and submucosa) [5], as illustrated in Figure 1.
    [Show full text]
  • Fakultät Für Physik Und Astronomie
    Fakult¨atf¨urPhysik und Astronomie Ruprecht-Karls-Universit¨atHeidelberg Diplomarbeit im Studiengang Physik vorgelegt von Felix Frank aus Lahr 2007 Comparison of Two Femtosecond Laser Systems For Two-Photon Imaging of RPE Cells Die Diplomarbeit wurde von Felix Frank ausgef¨uhrtam Kirchhoff Institut f¨urPhysik unter der Betreuung von Herrn Prof. Dr. J. Bille Abstract Age-related macular degeneration (AMD) is a retinal disease that affects the retinal pigment epithelium (RPE) cells in the macular region. It is the lead- ing cause for blindness in the Western world. In the RPE, enlarged lipofuscin granules show autofluorescence that is monitored through confocal scanning laser ophthalmoscope (cSLO) in clinical practice today. This work focuses on a new approach. The lipofuscin is imaged by means of a two-photon excited fluorescence (TPEF) ophthalmoscope. This offers intrinsic three dimensional resolution and a larger sensing depth. A conven- tional cSLO (HRT, Heidelberg Engineering, Germany) has been modified for TPEF imaging at video rate speed (20 Hz). Two different femtosecond (fs) lasers have been used for the setup. A mode- locked Ti:Sa laser (Mira 900, Coherent, USA) and a compact, all diode- pumped, solid-state Nd:glass fsd oscillator (femtoTRAINTM Nd-Glas V1.0, High Q Laser, Austria). The first images of the high-speed TPEF ophthalmoscope on retinas from donor eyes are presented. The results show the potential for in vivo TPEF imaging of the human eye in everyday clinical use. Zusammenfassung Altersbedingte makul¨areDegeneration (AMD) ist eine Netzhauterkrankung, welche die Pigmentepithelzellen (RPE) in der Makula beeintr¨achtigt. In den RPE Zellen zeigen vergr¨oßerte Lipofuscin K¨ornchen Autofluoreszenz, die heutzutage in den Kliniken mit einem konfokalen Scanning Laser Oph- thalmoskop (cSLO) kontrolliert wird.
    [Show full text]
  • Surgical and Minimally Invasive Treatments for Benign Prostatic Hypertrophy/Hyperplasia (BPH) Effective Date: 8/17/2020
    Medica Coverage Policy Policy Name: Surgical and Minimally Invasive Treatments for Benign Prostatic Hypertrophy/Hyperplasia (BPH) Effective Date: 8/17/2020 Important Information – Please Read Before Using This Policy These services may or may not be covered by all Medica plans. Please refer to the member’s plan document for specific coverage information. If there is a difference between this general information and the member’s plan document, the member’s plan document will be used to determine coverage. With respect to Medicare and Minnesota Health Care Programs, this policy will apply unless those programs require different coverage. Members may contact Medica Customer Service at the phone number listed on their member identification card to discuss their benefits more specifically. Providers with questions about this Medica coverage policy may call the Medica Provider Service Center toll-free at 1-800-458-5512. Medica coverage policies are not medical advice. Members should consult with appropriate health care providers to obtain needed medical advice, care and treatment. Coverage Policy The following surgical and minimally invasive approaches to the treatment of benign prostatic hypertrophy/ hyperplasia (BPH) are COVERED for patients with documented urinary outflow obstruction secondary to BPH. 1. Transurethral resection of the prostate (TURP) 2. Transurethral incision of the prostate (TUIP) 3. Transurethral laser coagulation therapies, including non-contact visual laser ablation of the prostate (VLAP) and interstitial laser coagulation of the prostate (ILCP, Indigo Laser) 4. Transurethral vaporization therapies, including contact laser vaporization, electrovaporization, and photoselective vaporization (aka Green Light Laser PVP) 5. Transurethral needle ablation of the prostate (TUNA, radiofrequency thermotherapy) 6.
    [Show full text]
  • UC Irvine UC Irvine Previously Published Works
    UC Irvine UC Irvine Previously Published Works Title Laser brain cancer surgery in a xenograft model guided by optical coherence tomography. Permalink https://escholarship.org/uc/item/9hn478d1 Journal Theranostics, 9(12) ISSN 1838-7640 Authors Katta, Nitesh Estrada, Arnold D McElroy, Austin B et al. Publication Date 2019 DOI 10.7150/thno.31811 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Theranostics 2019, Vol. 9, Issue 12 3555 Ivyspring International Publisher Theranostics 2019; 9(12): 3555-3564. doi: 10.7150/thno.31811 Research Paper Laser brain cancer surgery in a xenograft model guided by optical coherence tomography Nitesh Katta1, Arnold D Estrada1, Austin B McElroy1, Aleksandra Gruslova2, Meagan Oglesby2, Andrew G Cabe2, Marc D Feldman2, RY Declan Fleming1, Andrew J Brenner2, and Thomas E Milner1 1. University of Texas at Austin 2. University of Texas Health Science Center at San Antonio Corresponding author: [email protected]. © Ivyspring International Publisher. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions. Received: 2018.11.26; Accepted: 2019.04.24; Published: 2019.05.26 Abstract Higher precision surgical devices are needed for tumor resections near critical brain structures. The goal of this study is to demonstrate feasibility of a system capable of precise and bloodless tumor ablation. An image-guided laser surgical system is presented for excision of brain tumors in vivo in a murine xenograft model. The system combines optical coherence tomography (OCT) guidance with surgical lasers for high-precision tumor ablation (Er:YAG) and microcirculation coagulation (Thulium (Tm) fiber laser).
    [Show full text]
  • Guidelines on Lasers and Technologies T.R
    Guidelines on Lasers and Technologies T.R. Herrmann, E.N. Liatsikos, U. Nagele, O. Traxer, A.S. Merseburger (chair) © European Association of Urology 2014 TABLE OF CONTENTS PAGE 1. INTRODUCTION 5 1.1 Safety 5 1.2 Methodology 5 1.2.1 Data identification 5 1.2.2 Publication history 6 1.2.3 Quality assessment of the evidence 6 1.3 References 6 2. LASER-BASED TREATMENTS FOR BLADDER OUTLET OBSTRUCTION (BOO) AND BENIGN PROSTATIC ENLARGEMENT (BPE) 7 2.1 Introduction 7 2.2 Physical principles of laser action 7 2.2.1 Reflection 7 2.2.2 Scattering 7 2.2.3 Absorption 7 2.2.4 Extinction length 7 2.3 Historical use of lasers 8 2.3.1 Nd:YAG laser 8 2.3.2 Nd:YAG laser-based techniques 8 2.4 References 8 3. CONTEMPORARY LASER SYSTEMS 9 3.1 Introduction 9 3.2 KTP (kalium titanyl phosphate, KTP:Nd:YAG [SHG] and LBO (lithium borat, LBO:Nd:YAG [SHG]) lasers 9 3.2.1 Physical properties 10 3.2.1.1 Ablation capacity 10 3.2.1.2 Bleeding rate 10 3.2.1.3 Coagulation zone 10 3.2.2 Surgical technique of KTP/LBO lasers 11 3.2.3 Urodynamic results and symptom reduction 11 3.2.4 Risk and complications, durability of results 12 3.2.4.1 Intra-operative complications 12 3.2.4.2 Early post-operative complications 12 3.2.4.3 Late complications and durability of results 13 3.2.5 Conclusions and recommendations for the use of KTP and LBO lasers 14 3.2.6 References 14 3.3 Diode lasers 16 3.3.1 General aspects 16 3.3.2 Physical properties 17 3.3.2.1 Ablation capacity 17 3.3.2.2 Bleeding rate 17 3.3.2.3 Coagulation zone 17 3.3.3 Diode laser techniques 18 3.3.4 Clinical results
    [Show full text]
  • Modernity, Experience, Security
    Ophthalmology Clinical Centre SPEKTRUM in Wroclaw, POLAND was established in 2001 by a team of ophthalmologists, headed by prof. M.H.Niżankowska. Team consisted of specialists with many years of clinical experience, improved in continuous studies in Ophthalmological Departmants across Europe, the US and in other leading ophthalmic centers in the world. Modernity, Experience, Security Performed medical services Diagnostics The modern diagnostic equipment allows us to perform a wide range of ophthalmic examinations at the highest level: Pentacam, OCT, OCT Visante, HRT III, fluorescein angiography, digital photograph of the eye (anterior and posterior), ultrasound of the eye and orbit, pachymetry, tonometry, perimetry, corneal topography, endothelial microscopy, measuring of the power of artificial intraocular lens preformed by IOL master Surgery Surgical Ophthalmology Ward, equipped with the latest generation of ophthalmic devices, two air- conditioned operating theaters with digital recording of each procedure. Enables to perform microsurgical ophthalmic operations in the "one-day surgery." Range of services - full spectrum of vitreoretinal surgery in indications such as intravitreal haemorrhage, epiretinal membrane or macular holes - cataract surgery We provide • accurate and reliable power selection implanted lens (IOL) non-contact optical biometry IOL MASTER or ultrasound biometry • highest quality IOL implants (including lenses AcrySof ReSTOR multifocal, toric lenses AcrySof Toric multifocal toric lens AcrySof ReSTORToric) •we minimize
    [Show full text]
  • Basics of Laser in Surgery from Incision Time to Restoration
    *IN THE NAME OF GOD* summary Basics of laser in surgery from Incision time to Restoration Dr.Alborz Mirzadeh Th e development of non-invasive, non-toxic, and non-pollutant methods for the treatment of diff erent illnesses represents a constant concern of scientists from the medical fi eld worldwide. In this category fi t the methods based on the use of laser systems, which are successfully applied both in human and veterinary medicine due to the special properties of laser radiation: monocromaticity, coherence, intensity, and directionality. Th e aim of this paper is to present the laser systems used in several domains of veterinary medicine and some experimental results obtained by diff erent authors. Fields of laser use in veterinary medicine Protecting life and human and animal health is a constant concern of both doctors and specialists in various fi elds (biochemistry, biophysics, biology, etc.). Th eir joint eff orts have led to the development of new methods of treatment based on new discoveries and technology including laser. The first use of lasers in veterinary medicine was in larynx surgery in dogs (1) and horses (2). Th e results obtained in these early studies paved the way for the current use of the laser in general surgery, small animal targeting liver lobe resection, partial excision of the kidneys, and tumor excision or resection (intra-abdominal, intra-thoracic, breast, brain). At the same time, experiments on the use of laser for photodynamic therapy of tumors in animals and laser phototherapy have begun. What’s in
    [Show full text]
  • Laser Brain Cancer Surgery Guided by Optical Coherence Tomography
    Supplementary Material: Laser Brain Cancer Surgery Guided by Optical Coherence Tomography 250µm B 500µm 500µm A C D 500µm E 500µm Figure S1. Angiography images computed using described methodology (Section 2). Panel A, B, C, D and E correspond to mice #1, #2, #3, #4 and #5, respectively. D A 250µm B 250µm C D Figure S2. A, B) Angiography image contrast improvement (mouse #2). A-scan interleaving improves vasculature contrast (Panel B compared to Panel A) without loss in spatial resolution. C, D) Histograms of angiography images in A, B respectively. Gaussian distributions of signal (thin solid line) and background (asterisk line) levels. See text for description. A B C 250µm 1.10 mm Figure S3. A) Raw intensity image (-30dB to 25dB grayscale). B) Calculated attenuation1.10 mm coefficient image (inverted grayscale to highlight regions of low attenuation corresponding to tumor regions as well as shadows from large blood vessels. C) Overlay of intensity and masked, thresholded attenuation image. A B C D Figure S4. Rendered tumor volumes (yellow, attenuation coefficient less than 5.7mm-1) overlaid on OCT intensity (blue). Panels A, B, C and D correspond to mice #1, #2, #3, #5. For Panel C, the volume stack was reduced from 3.5 3.5 3mm3 (Panels A, B and D) to 3.5 1.75 3mm3 for better tumor visualization. In all mice imaged, tumors occupied a characteristic columnar region along the needle track and a wider region along the corpus callosum/hippocampus (for mouse #4 refer to Figure 4 Panel B). B 500 µm C 250 µm A 250µm 300 µm 500 µm Figure S5.
    [Show full text]
  • The Retinal Effects of Copper Vapor Laser Exposure Shimon Gabay.T Israel Kremer,* Isaac Ben-Sira,* Dan Sagie,T Dov Weinberger,* and Gideon Erezf
    Investigative Ophthalmology & Visual Science, Vol. 29, No. 4, April 1988 Copyright © Association for Research in Vision and Ophthalmology The Retinal Effects of Copper Vapor Laser Exposure Shimon Gabay.t Israel Kremer,* Isaac Ben-Sira,* Dan Sagie,t Dov Weinberger,* and Gideon Erezf The copper vapor laser is a pulsed gas laser which emits energy in two wavelengths simultaneously: 510.6 nm (green) and 578.2 nm (yellow). Each pulse has a duration of 15 nsec, maximal energy of 3 mJ and a peak power of more than 100 kW. It is a variably high repetition rate laser, in the range between 1 kHz and more than 20 kHz. We studied its interaction with the rabbit retina, while using two different repetition rates, 4 kHz and 18 kHz. The histological analysis of the lesion produced by 4 kHz repetition rate showed undesired retinal effects, similar to those caused by other pulsed lasers. On the other hand, the histological examination of the lesion produced by the 18 kHz repetition rate showed a desired coagulation effect, limited to the outer retinal layers, and comparable to a lesion produced by a continuous wave (CW) laser. Invest Ophthalmol Vis Sci 29:528-533, 1988 Lasers in ophthalmology are used mainly for reti- above 20 kHz, delivering two wavelengths: 510.6 nm nal coagulation, iridectomy and lens capsulotomy. and 578.2 nm.10 The pulse peak power can be in- Argon laser is now widely in use as a retinal photo- creased by decreasing the repetition rate, while the coagulator,12 as it is well-transmitted by the ocular average power has an optimal level at intermediate media3 and well-absorbed by the retinal pigment epi- repetition rate.
    [Show full text]
  • Subthreshold Nano-Second Laser Treatment and Age-Related Macular Degeneration
    Journal of Clinical Medicine Review Subthreshold Nano-Second Laser Treatment and Age-Related Macular Degeneration Amy C. Cohn 1,* , Zhichao Wu 1,2 , Andrew I. Jobling 3 , Erica L. Fletcher 3 and Robyn H. Guymer 1,2 1 Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, Melbourne 3002, Australia; [email protected] (Z.W.); [email protected] (R.H.G.) 2 Department of Ophthalmology, Department of Surgery, The University of Melbourne, Parkville 3052, Australia 3 Department of Anatomy and Neuroscience, The University of Melbourne, Parkville 3052, Australia; [email protected] (A.I.J.); e.fl[email protected] (E.L.F.) * Correspondence: [email protected] Abstract: The presence of drusen is an important hallmark of age-related macular degeneration (AMD). Laser-induced regression of drusen, first observed over four decades ago, has led to much interest in the potential role of lasers in slowing the progression of the disease. In this article, we summarise the key insights from pre-clinical studies into the possible mechanisms of action of various laser interventions that result in beneficial changes in the retinal pigment epithelium/Bruch’s membrane/choriocapillaris interface. Key learnings from clinical trials of laser treatment in AMD are also summarised, concentrating on the evolution of laser technology towards short pulse, non- thermal delivery such as the nanosecond laser. The evolution in our understanding of AMD, through advances in multimodal imaging and functional testing, as well as ongoing investigation of key pathological mechanisms, have all helped to set the scene for further well-conducted randomised trials to further explore potential utility of the nanosecond and other subthreshold short pulse lasers Citation: Cohn, A.C; Wu, Z.; Jobling, in AMD.
    [Show full text]
  • Retinal Laser Photocoagulation
    001519 NV-27-CME:3-PRIMARY.qxd 4/12/10 2:02 PM Page 88 CONTINUING MEDICAL EDUCATION Retinal Laser Photocoagulation J H Lock, MBBS, K C S Fong, FRCOphth University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, University of Malaya, Kuala Lumpur 50603, Malaysia SUMMARY Other retinal conditions treatable with laser Since its discovery in the 1940s, retinal photocoagulation has photocoagulation include diabetic macular oedema (DMO), evolved immensely. Although the first photocoagulators retinal vein occlusions, leaking arterial macroaneurysms, age- utilised incandescent light, it was the invention of laser that related macular degeneration (AMD), retinopathy of instigated the widespread use of photocoagulation for prematurity (ROP) and retinal tears. For each condition, laser treatment of retinal diseases. Laser permits choice of is targeted at different tissue types in distinct areas of the electromagnetic wavelength in addition to temporal delivery retina (Table I). Therefore, the appropriate choice of methods such as continuous and micropulse modes. These wavelength is imperative. As technology has matured, not variables are crucial for accurate targeting of retinal tissue only are different wavelengths becoming more accessible, and prevention of detrimental side effects such as central there is a wider variety of laser delivery methods that promise blind spots. Laser photocoagulation is the mainstay of to enhance precision of laser burns or simplify the application treatment for proliferative diabetic retinopathy amongst of retinal laser. many other retinal conditions. Considering the escalating prevalence of diabetes mellitus, it is important for physicians In this article we will outline the history of retinal laser to grasp the basic principles and be aware of new photocoagulation, discuss the nature and application of developments in retinal laser therapy.
    [Show full text]