Er:YAG laser ablation of epiretinal membranes in perfluorocarbon fluid-filled eyeballs: a preliminary report

Abstract

Purpose: The Er:YAG laser emitting radiation at a wavelength of 2.94 micrometer has been shown to produce precise tissue ablation because of the high water absorption at this wavelength. These studies evaluated the effects of the Er:YAG laser on pig retina utilizing a perfluoro-carbon/retina interphase with the goal to precisely ablate epiretinal membranes. Method: Various laser pulse energies were applied to the surface of pig retinas in perfluorocarbon filled enucleated eyes using a specially designed rotating sample holder. Free running ((tau) equals 250 microseconds) Er:YAG laser pulses were transmitted through a zirconium fluoride (ZrF 4 ) fiber guarded by a low OH-quartz fiber at its distal tip. The tip diameters measured 400 micrometers and 1 mm. The fiber probe was elevated 1 mm above the retinal surface. The laser energy was applied in a systematic fashion while alternating energy settings and probe diameters. Radiant exposures were set to 1 J/cm 2 , 3 J/cm 2 , 5 J/cm 2 , and 10 J/cm 2 . Results: Eight of ten eyes were treated with concentric circles of 3.5 mm, 6.5 mm, and 9.5 mm radius. The remaining two eyes were treated with a hand held probe. Tissue ablation increased with radiant exposure in a linear fashion. At a radiant exposure of 1 J/cm 2 , tissue ablation was minimal with a maximum tissue ablation depth of 10 micrometers and minimal thermal damage to adjacent tissue. A radiant exposure of 10 J/cm 2 produced an ablation depth of 30 - 50 micrometers. As the ablation was performed under perfluorcarbon fluid, used as transmitting medium, no laser- induced pressure transients have been measured. Conclusion: The Er:YAG laser in combination with perfluorocarbon fluid produced precise and homogeneous tissue ablation of the pig retina. Such precise tissue ablation needs to be achieved in order to safely ablate epiretinal membranes in close proximity to the retina surface. Further in-vivo experiments will be done to examine the functionality of the retina after laser treatment.