Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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).
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References
Aron-Rosa D, Aron J, Griesemann J, Thyzel R (1980) Use of the neodymium:YAG laser to open the posterior capsule after lens implant surgery. J Am Intra-Ocular Implant Soc 6:352–354
Behrens A, Seitz B, Langenbucher A, Kus MM, Rummelt C, Küchle M (1999) Evaluation of corneal flap dimensions and cut quality using a manually guided microkeratome. J Refract Surg 15:118–123
Gimbel HV, Iskander NG, Peters T, Penno EA (2000) Prevention and management of microkeratome-related laser in situ keratomileusis complications. J Refract Surg 16 [Suppl]:226–229
Heisterkamp A, Ripken T, Lubatschowski H, Drommer W, Lütkefels E, Mamom T, Welling H, Ertmer W (2001) Optimisation of the parameter for intrastromal refractive surgery with ultrashort laser pulses. Proc SPIE 4245:246–255
Heisterkamp A, Mamom T, Kermani O, Drommer W, Welling H, Ertmer W, Lubatschowski H (2002) Intrastromal refractive surgery with ultrashort laser pulses in living animals. Proc SPIE 4611:136–143
Heisterkamp A, Ripken T, Mamom T, Drommer W, Welling H, Ertmer W, Lubatschowski H (2002) Nonlinear side effects of fs pulses inside corneal tissue during photodisruption. Appl Phys B 74:1–7
Juhasz T, Loesel FH, Horvath C, Kurtz RM, Mourou G (1998) Femtosecond laser for ultra-accurate surgery: application to corneal surgery. Ultrafast Phenomena IX:687–691
Kurtz RM, Horvath C, Liu H, Krueger RR, Juhasz T (1998) Lamellar refractive surgery with scanned intrastromal picosecond and femtosecond laser pulses in animal eyes. J Refract Surg 14:541–548
Lubatschowski H, Maatz G, Heisterkamp A, Hetzel U, Drommer W, Welling H, Ertmer W (2000) Application of ultrashort laser pulses for intrastromal refractive surgery. Graefes Arch Clin Exp Ophthalmol 238:33–39
Lubatschowski H, Heisterkamp A, Drommer W, Kermani O, Welling H, Ertmer W (2001) Application of ultrashort laser pulses for refractive surgery of the eye. LaserOpto 6:40–46
Maatz G, Heisterkamp A, Lubatschowski H, Barcikowski S, Fallnich C, Welling H, Ertmer W (2000) chemical and physical side effects at application of ultrashort laser pulses for intrastromal refractive surgery. J Opt A Pure Appl Opt 2:59–64
Niemz MH, Klancnik EG, Bille JF (1991) Plasma-mediated ablation of corneal tissue at 1053 nm using a Nd:YLF oscilllator/regenerative amplifier laser. Lasers Surgery Med 11:426–31
Noack J, Vogel A (1999) Laser-induced plasma formation in water at nanosecond to femtosecond time scales: calculation of thresholds, absorption coefficients, and energy density. IEEE J Quant Elec 35 (8):1156–1167
Stern D, Schoenlein R, Puliafito C, Dobi E, Birngruber R, Fujimoto J (1989) Corneal ablation by nanosecond, picosecond, and femtosecond lasers at 532 nm and 625 nm. Arch Ophthalmol 107
Vongthongsri A, Srivannaboon S, Horatanaruang O, Nariptaphan P (2000) Laser in situ keratomileusis corneal flap creation with the Nidek MK-2000 and the Carriazo Barraquer microkeratomes. J Refract Surg 16:272–275
Wachtlin J, Langenbeck K, Schründer S, Zhang EP, Hoffmann F (1999) Immunohistology of corneal wound healing after photorefractive keratectomy and laser in situ keratomileusis. J Refract Surg 15:451–458
Acknowledgements
This work was supported by the German Ministry of Education and Research (BMBF), project-nr. 13N7793, and the German Science Foundation, project-nr. Lu498/1.
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Heisterkamp, A., Mamom, T., Kermani, O. et al. Intrastromal refractive surgery with ultrashort laser pulses: in vivo study on the rabbit eye. Graefe's Arch Clin Exp Ophthalmol 241, 511–517 (2003). https://doi.org/10.1007/s00417-003-0683-z
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DOI: https://doi.org/10.1007/s00417-003-0683-z