Author(s): Vogel, Alfred; Venugopalan, Vasan | Abstract: The mechanisms of pulsed laser ablation of biological tissues were studied. The transiently empty space created between the fiber tip and the tissue surface improved the optical transmission to the target and thus increased the ablation efficiency. It was found that the structure and morphology also affect the energy transport among tissue constituents.

/pdf/mechanisms-of-pulsed-laser-ablation-of-biological-tissues-58cltfa63z.pdf

Mechanisms of pulsed laser ablation of biological tissues.

Laser myopic keratomileusis (photorefractive keratectomy) was performed on 29 rhesus monkey corneas with an argon fluoride (193-nm) excimer laser and a computer-controlled, moving slit delivery system. The 4-mm-diameter central ablation zone ranged in depth from 11 microns (-2 diopters effect) to 46 microns (-8 diopters effect). Corneas were studied for the 9 months postoperatively by clinical slit-lamp microscopy, and periodically with light and transmission electron microscopy. By 6 weeks, mild to moderate subepithelial haze was apparent in 93% of the corneas, with considerable variability in density. Progressive clearing occurred so that by 6 to 9 months 12 of 13 surviving corneas (92%) were either completely clear (4 corneas) or trace hazy (8 corneas). The epithelium was thickened at 21 days after ablation and returned to normal thickness by 3 months. At 3 weeks, subepithelial fibroblasts were three times the density of normal keratocytes and returned to nearly normal numbers by 9 months. We concluded that the anterior monkey cornea demonstrated a mild, typical wound healing response after excimer laser keratomileusis.

Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys.

Laser-tissue interactions

A method and system is described that greatly improves the safety and efficacy of ophthalmic laser surgery. The method and system are applicable to precise operations on a target subject to movement during the procedure. The system may comprise the following elements: (1) a user interface, (2) an imaging system, which may include a surgical microscope, (3) an automated tracking system that can follow the movements of an eye, (4) a laser, (5) a diagnostic system, and (6) a fast reliable safety means, for automatically interrupting the laser firing.

Automated laser workstation for high precision surgical and industrial interventions

Low energy, ultra-short (femptosecond) pulsed laser radiation is applied to the patient's eye in one of a number of patterns such that the exposed ocular tissue is ablated or excised through the process of optical breakdown or photodisruption in a very controlled fashion. The process can be gentle enough that the invention makes possible the performance of a number of surgical procedures that in the past could not have been performed at all, such as capsulorhexis, or were performed in a fashion that provided less than an ideal result or excessive trauma to the ocular tissue. Such latter applications include the making of incisions for corneal transplantation, radial and arcuate keratotomy, and intrastromal cavitation. Using the laser inside the eye allows the surgeon to perform glaucoma operations such as trabeculoplasty and iridotomy, cataract techniques such as capsulectomy, capsulorhexis and phacoablation, and vitreoretinal surgery, such as membrane resection. The various procedures are accomplished by controlling energy flux or irradiance, geometric deposition of beam exposure and exposure time.

Ophthalmic surgical laser and method

In the context of ultraviolet-laser sculpting of the cornea to achieve optical correction through a newly shaped anterior surface, the invention subjects the laser beam to certain shaping and homogenizing operations prior to any attempt to specially characterize the beam for a particular sculpturing procedure. In a preferred embodiment, the shaping and homogenizing operations present a tolerably homogeneous beam of enlarged dimension, so that specialty-characterizing may proceed on a dimensional scale that is greater than the corresponding dimension of ultimate surgical delivery to the eye, thereby enabling greater control of the quality of specialty-characterizing. Provision is made for selectively monitoring the quality of the homogeneity and/or of the specially-characterized beam, with further provision for automated cutoff of laser beam delivery to an eye in the event that quality is not within predetermined limits of tolerance. And preferably, all beam shaping, homogenizing and characterizing operations proceed in a controlled environment which precludes ozone development and thus minimizes the beam-degrading effect of ozone and particulates or other contaminants.

Sculpture apparatus for correcting curvature of the cornea

A surgical technique for removing corneal tissue with scanned infrared radiation is disclosed which utilizes short mid-infrared laser pulses to provide a tissue removal mechanism based on photospallation. Photospallation is a photomechanical ablation mechanism which results from the absorption of incident radiation by the corneal tissue. Since photospallation is a mechanical ablation process, very little heat is generated in the unablated adjacent tissue. The disclosed surgical system includes a scanning beam delivery system which allows uniform irradiation of the treatment region and utilizes low energy outputs to achieve controlled tissue removal. A real-time servo-controlled dynamic eye tracker, based on a multiple-detector arrangement, is also disclosed which senses the motion of the eye and provides signals that are proportional to the errors in the lateral alignment of the eye relative to the axis of the laser beam. Temporal and frequency discrimination are preferably utilized to distinguish the tracking illumination from the ambient illumination and the surgical laser beam.

Method and apparatus for removing corneal tissue with infrared laser radiation

• The design and development of the instrumentation utilized during the clinical and histopathologic evaluations of the first human eyes treated by argon fluoride excimer laser radiation are described. The laser, optical, alignment, measurement, and control subsystems required for this research were constructed to create a laser beam that has an axially symmetric energy distribution, can be calibrated and measured, can be aligned with the target tissue, and can be manipulated to excise surface tissue. The use of this excimer laser system has demonstrated that a nonuniform superficial lamellar keratectomy can be produced to excise areas of opacified, scarred, or abnormal cornea or to create a new anterior corneal curvature in attempts to correct refractive errors.

Excimer laser instrumentation and technique for human corneal surgery.

An eye restraining device includes a ring-shaped element (18) which contacts the sclera (14) of an eye (16) so that the cornea (20) projects above the ring-shaped element. A second embodiment includes a head restraint including a plurality of adjustable engaging components for accommodating different sized heads.

Eye restraining device

A surgical technique for removing corneal tissue with scanned infrared radiation is disclosed which utilizes short mid-infrared laser pulses to provide a tissue removal mechanism based on photospallation. Photospallation is a photomechanical ablation mechanism which results from the absorption of incident radiation by the corneal tissue. Since photospallation is a mechanical ablation process, very little heat is generated in the unablated adjacent tissue. The disclosed surgical system includes a scanning beam delivery system which allows uniform irradiation of the treatment region and utilizes low energy outputs to achieve controlled tissue removal. A real-time servo-controlled dynamic eye tracker, based on a multiple-detector arrangement, is also disclosed which senses the motion of the eye and provides signals that are proportional to the errors in the lateral alignment of the eye relative to the axis of the laser beam. Temporal and frequency discrimination are preferably utilized to distinguish the tracking illumination from the ambient illumination and the surgical laser beam. A laser parametric generator for surgical applications is disclosed which utilizes short-pulse, mid-infrared radiation. The mid-infrared radiation may be produced by a pump laser source, such as a neodymium-doped laser, which is parametrically down converted in a suitable nonlinear crystal to the desired mid-infrared range. The short pulses reduce unwanted thermal effects and changes in adjacent tissue to potentially submicron-levels. The parametrically converted radiation source preferably produces pulse durations shorter than 25 ns at or near 3.0 microns but preferably close to the water absorption maximum associated with the tissue. The down-conversion to the desired mid-infrared wavelength is preferably produced by a nonlinear crystal such as KTP or its isomorphs. In one embodiment, a non-critically phased-matched crystal is utilized to shift the wavelength from a near-infrared laser source emitting at or around 880 to 900 nm to the desired 2.9-3.0 microns wavelength range. A fiber, fiber bundle or another waveguide means utilized to separate the pump laser from the optical parametric oscillation (OPO) cavity is also included as part of the invention.

Method and apparatus for removing corneal tissue with infrared laser radiation and short pulse mid-infrared parametric generator for surgery

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