ERBIUM:YAG LASER APPLICATIONS IN VITREORETINAL SURGERY

Abstract

Segmentation and removal of fibrocellular and fibrovascular membranes from the vitreous cavity and from the surface of the retina is an important step in vitreoretinal surgery for pathologies including diabetic traction retinal detachment, proliferative vitreoretinopathy, retinopathy of prematurity, penetrating trauma, and macular pucker. Although the vitreoretinal instrumentation has substantially developed, surgical approaches are limited to mechanical methods, such as use of microscisjsors or of the vitreous cutter for transection, and peeling with forceps or picks. In most cases, mechanical methods are successful; however, complications including hemorrhages and retinal breaks may be induced by excessive traction or difficulties of tissue engagement. In addition, in extreme cases with epiretinal membranes firmly adhered to the retina, the available mechanical methods are insufficient for the necessary removal of this tissue. The investigation of lasers as instruments for surgical maneuvers within the vitreous cavity or close to the surface of the retina is attractive because laser technology may offer advantages, such as sharper, tractionless cutting and ablation, finer control, and greater ease of surgical approach compared with conventional instruments. Infrared lasers, through the laser/tissue interaction of photothermal ablation, 29 and excimer lasers through the ablative photodecomposition, 27 are currently the best candidates for the incision and ablation of biological tissues within the eye.