Intrastromal Refractive Surgery Research Articles

Corneal Ectasia After Intrastromal Presbyopic Surgery

To report histopathologic findings in a case of bilateral corneal ectasia following intrastromal femtosecond laser presbyopia surgery. Case report. A 56-year-old patient was referred for bilateral corneal ectasia. He was treated for hyperopia using LASIK twice in both eyes. A bilateral femtosecond laser intrastromal presbyopia correction was secondarily performed. The patient complained of progressive loss of distance visual acuity shortly after. Corneal topography showed a bilateral central corneal protrusion. Rigid contact lenses were successfully fitted on the right eye and, because the patient still complained, a deep anterior lamellar keratoplasty was performed in the left eye. Light and electronic microscopy of the corneal button revealed that the inner intrastromal incision crossed the LASIK interface and led to stromal bed dehiscence. This case illustrates that intrastromal refractive surgery should not be recommended in eyes previously treated by lamellar refractive surgery.

Experimental femtosecond laser photodisruption of rabbit sclera for minimally invasive laser sclerostomy: An in vitro study

Femtosecond laser technology, used as a minimally invasive tool in intrastromal refractive surgery, may also have potential as a useful instrument for glaucoma filtration surgery. The purpose of the present study was to evaluate the feasibility of minimally invasive laser sclerostomy by femtosecond laser photodisruption and seek the appropriate patterns of laser ablation and relevant laser parameters. A femtosecond laser (800 nm/50 fs/1 kHz), focused by a 0.1 numerical aperture (NA) objective lens, with different pulse energies and exposure times was applied to ablate hydrated rabbit sclera in vitro . The irradiated samples were examined by scanning electron microscopy (SEM). By moving a three-dimensional, computer-controlled translation stage to which the sample was attached, the femtosecond laser could produce three types of ablation patterns, including linear ablation, cylindrical aperture and rectangular cavity. With pulse energies ranging from 37.5 to 150 μJ, the linear lesions were consistently observed at the inner surface of sclera, whereas it failed to make any photodisruption if pulse energy was below the threshold value of 31.25 μJ, with the corresponding threshold intensity of 4.06×10 14 W/cm 2 . The depths of the linear lesions increased linearly with both pulse energy (37.5–150 μJ) and exposure time (0.1–0.4 s). Histological examination showed the incisions produced by femtosecond laser photodisruption had precise geometry and the edges were sharp and smooth, with no evidence of collateral damage to the surrounding tissue. Our results predict the potential application of femtosecond laser pulses in minimally invasive laser sclerostomy for glaucoma treatment.

Mini-invasive corneal surgery and imaging with femtosecond lasers

Based on the transparency of corneal tissue and on laser plasma mediated non-thermal tissue ablation, near infrared femtosecond lasers are promising tools for minimally invasive intrastromal refractive surgery. Femtosecond lasers also enable novel nonlinear optical imaging methods like second harmonic corneal imaging. The microscopic effects of femtosecond laser intrastromal surgery were successfully visualized by using second harmonic corneal imaging with diffraction limited resolution, strong imaging contrast and large sensing depth, without requiring tissue fixation or sectioning. The performance of femtosecond laser intrastromal surgery proved to be precise, repeatable and predictable. It might be possible to integrate both surgical and probing functions into a single femtosecond laser system.

Intrastromal refractive surgery with ultrashort laser pulses: in vivo study on the rabbit eye.

Femtosecond (fs) laser pulses may offer new possibilities in the field of refractive surgery, especially when using the laser as a microkeratome. By induction of nonlinear absorption processes the laser can be used to perform intrastromal cuts. The conventional microkeratome, associated with numerous potential side effects, can possibly be replaced. Furthermore, refractive lenticules can be prepared within the stroma and removed in a single-step operation. In 10 rabbits, cuts were made to create both a lamellar flap and an intrastromal refractive lenticule. The flap was lifted, the lenticule was extracted and, finally, the flap was repositioned (intrastromal laser keratomileusis, ILK). The corneal samples were collected up to 120 days after treatment and processed for histopathological analysis. All flaps could be opened and prepared lenticules could be extracted in one piece by the surgeon. The treated corneas developed a mild wound healing reaction, comparable to that known from excimer laser in situ keratomileusis (LASIK) studies. The wound healing was restricted to the flap-stroma interface, most pronounced at the periphery of the flaps. The use of the fs-laser offers new possibilities in preparation of corneal flaps, possibly providing advantages over conventional microkeratomes. Furthermore, the fs-laser has the potential to create intrastromal refractive lenticules for complete refractive procedures (ILK).

Intrastromal Refractive Surgery Using Ultrashort Laser Pulses

Summary By generating micro-plasma inside the corneal stroma of the eye with fs pulses, it is possible to achieve an extremely precise cutting effect. With a titanium sapphire fs laser system, the cutting effect on corneal tissue was investigated in vitro and in vivo with pulse energies, ranging from 800 nJ to 4 μJ. The irradiated samples were examined by light and electron microscopy. The range of thermal and mechanical damage of the adjacent tissue generated by fs-photodisruption is comparable with the tissue alterations seen with ArF excimer laser ablation. As a result, fs photodisruption has the potential to become an attractive tool for intrastromal refractive surgery.

Chemical and physical side effects at application of ultrashort laser pulses for intrastromal refractive surgery

Focusing femtosecond (fs) laser pulses into transparent media, such as corneal tissue, leads to optical breakdown, generation of a micro-plasma and, thus, a cutting effect inside the tissue - provided the intensity at the focus exceeds a threshold which depends on the pulse duration. For fs pulses, the corresponding threshold pulse energy is reduced by some orders of magnitude compared with ns or ps pulses. At a low pulse energy, thermal and mechanical damage to surrounding tissue is minimized, enabling a highly precise cutting effect inside the tissue while leaving anterior layers unaltered. In the following, investigations concerning aspects of the interaction of ultrashort laser pulses with aqueous media are presented: in particular, detection of pressure transients and bubble formation. For the first time - to our knowledge - the content of the resulting gas bubbles was analysed by gas chromatography, giving evidence of molecular hydrogen. Secondly, the potential of three-dimensional cutting effects within the corneal stroma for refractive surgery applications was evaluated in vitro on freshly enucleated porcine eyeglobes. Laser pulses with a duration of 200-300 fs and energies of 1.5-600 µJ were provided by a mode-locked Ti:sapphire laser with subsequent chirped pulse amplification.

An In Vivo Model of Femtosecond Laser Intrastromal Refractive Surgery

To develop an animal model for evaluation of femtosecond laser intrastromal refractive surgery. Intrastromal photodisruption was performed in New Zealand Albino rabbits using a femtosecond laser system. This surgical pattern consisted of a 100 microm-tick pyramid of laser pulses starting 180 microm below the corneal surface. Animals underwent serial slit lamp examinations and corneal thickness measurements at 1,3,7,14, and 28 days, then monthly up to 1 year. Approximately 70 microm of central corneal thinning were seen at 1 week, remaining stable up to 7 months. Intrastromal photodisruption with femtosecond lasers produced consistent changes in corneal thickness without loss of corneal transparency. These changes were more stable than those produced with excimer laser procedures in a similar animal model.