Cytotoxicity and mutagenicity of excimer laser radiation

Excimer laser tissue interactions in the cornea

Excimer lasers induces significant changes to corneal structure and corneal biomechanics. The aim of this paper is to describe all laser-tissue interactions which are relevant for clinical practice, particularly, we will focus on laser ablations profiles, causes of regression and haze and prevention of those. At last the manuscript will describe the impact on corneal biomechanics of different Laser Vision Corrections techniques.

Laser-assisted corneal transplantation surgery

Corneal transplant surgeries have a broad range of indications with outcomes largely dependent on surgeon experience. Traditional manual techniques have certain limitations pertaining to the preparation of donor tissue and the recipient bed that might affect the predictability of visual outcomes. Use of lasers for keratoplasty procedures not only improves the repeatability and consistency of the technique, but also enables the surgeon to control the thickness and shape of the transplant tissue tailored to the specific condition. Despite the advantages, cost-effectiveness and technical know-how remain the major challenges. We discuss the various techniques of laser-assisted keratoplasties with respect to their methods, precision, and efficacy in various corneal indications.

Repeated cryopreservation process impairs embryo implantation potential but does not affect neonatal outcomes

RESEARCH QUESTION

Does repeated cryopreservation process affect embryo implantation potential and neonatal outcomes of human embryos?

DESIGN

This retrospective cohort study was conducted in the Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. All assisted reproductive technology (ART) cycles were carried out between January 2014 and December 2018. Preferentially matched participants were divided into three groups according to the times of embryo cryopreservation: the fresh group (n = 249), the cryopreservation group (n = 244) and the re-cryopreservation group (n = 216). Embryo implantation rate, live birth rate, miscarriage rate and neonatal complication rate were compared among these three groups.

RESULTS

The embryo implantation rate, clinical pregnancy rate and live birth rate in the re-cryopreservation group were significantly lower, and the miscarriage rate also slightly increased. Logistic regression analysis indicated that embryos with repeated cryopreservation and lower trophectoderm scores were at higher risk of embryo implantation failure in single embryo transfer cycles (OR 1.79 and 1.56, respectively). No significant differences were observed in gender, gestational age, birthweight, neonatal abnormality and neonatal complications among the groups.

CONCLUSIONS

Our findings demonstrate the adverse effect of repeated cryopreservation on embryo implantation potential. The study offers embryologists and reproductive clinicians a warning of detrimental role of repeated cryopreservation. If unnecessary, it is strongly recommended to avoid repeated practice of vitrification and warming on embryos.

Corneal UV Protective Effects of a Topical Antioxidant Formulation: A Pilot Study on In Vivo Rabbits

This study aimed to evaluate the protective effect of a topical antioxidant and ultraviolet (UV) shielding action formulation containing riboflavin and D-α-tocopherol polyethylene glycol succinate (TPGS) vitamin E against corneal UV-induced damage in vivo rabbit eyes. In vivo experiments were performed using male albino rabbits, which were divided into four groups. The control group (CG) did not receive any UV irradiation; the first group (IG) was irradiated with a UV-B−UV-A lamp for 30 min; the second (G30) and third (G60) groups received UV irradiation for 30 and 60 min, respectively, and were topically treated with one drop of the antioxidant and shielding formulation every 15 min, starting one hour before irradiation, until the end of UV exposure. The cornea of the IG group showed irregular thickening, detachment of residual fragments of the Descemet membrane, stromal fluid swelling with consequent collagen fiber disorganization and disruption, and inflammation. The cornea of the G30 group showed edema, a mild thickening of the Descemet membrane without fibrillar collagen disruption and focal discoloration, or inflammation. In the G60 group, the cornea showed a more severe thickening, a more abundant fluid accumulation underneath the Descemet membrane with focal detachment, and no signs of severe tissue alterations, as were recorded in the IG group. Our results demonstrate that topical application of eye drops containing riboflavin and TPGS vitamin E counteracts UV corneal injury in exposed rabbits.

Effects of an antioxidant protective topical formulation on retinal tissue of UV-exposed rabbits

PURPOSE

The aim of this study has been to evaluate the protective effect of a topical antioxidant formulation containing riboflavin, d-α-tocopheryl polyethylene glycol (TPGS vitamin E), proline, glycine, lysine, and leucine against UV-B-induced damage in in vivo rabbit retina.

METHODS

Twenty male albino rabbits were used. Animals were divided into four groups of five animals each. Control group did not receive any UV irradiation. The first group (IG) was irradiated with a UV-A lamp for 30 min; the second (IG30) and the third (IG60) groups received UV irradiation for 30 and 60 min, respectively, and were topically treated with 1 drop (approximately 50 µl) of the antioxidant formulation, every 15 min, starting 1 h before irradiation, until the end of the UC exposure.

RESULTS

The retina of IG group showed extensive destruction of the retinal pigment epithelium (RPE) and of the cones and rods layer. The retina of G30 group showed a lesser destruction of both RPE and cones and rods layer. In the G60 group, retina showed an irregular thickening of the RPE, with massive edema of the inner and outer layer immediately adjacent together with a significant reduction of the photoreceptor number.

CONCLUSION

Our results demonstrate that a topical application of eye drops containing riboflavin, d-α-tocopheryl polyethylene glycol (TPGS vitamin E), proline, glycine, lysine, and leucine counteracts UV retinal injury in exposed retina rabbits.

Optoacoustic Tissue Differentiation Using a Mach-Zehnder Interferometer

Laser osteotomy offers a way to make precise and less traumatic cuts smaller than conventional mechanical bone surgery tools. To fully exploit the advantages of laser osteotomy over conventional osteotomy, real-time feedback to differentiate the hard bone from the surrounding soft tissues is desired. In this study, we differentiated various tissue types-hard and soft bone, fat, muscle, and skin tissues from five proximal and distal fresh porcine femurs-based on cutting sounds. For laser ablation, an Nd:YAG laser was used to create ten craters on the surface of each proximal and distal femurs. For sound recording, the probing beam of a Mach-Zehnder interferometer was placed 5 cm away from each ablation site. For offline tissue differentiation, we investigated the measurements by looking at the amplitude frequency band between 0.83 and 1.25 MHz, which provides the least average classification error. Then, we used principal component analysis to reduce the dimensionality and the 95% confidence ellipsoid (Mahalanobis distance) method to differentiate between tissues based on the acoustic shock wave. A set of 14 400 data points, measured from ten craters in four proximal and distal femurs, was used as "training data," while a set of 3600 data points from ten craters in the remaining proximal and distal femurs was considered as "testing data." As is seen in the confusion matrix, the experimental-based scores of hard and soft bones, fat, muscles, and skin yielded average classification errors (with leave-one-out cross validation) of 0.11%, 57.69%, 0.06%, 0.14%, and 2.92%, respectively. The results of this study demonstrate a promising technique for differentiating tissues during laser osteotomy.

Iatrogenic Damage of Eye Tissues: Current Problems and Possible Solutions

Visual system is at high risk of iatrogenic damage. Laser ocular surgery, the use of powerful illumination devices in diagnostics and surgical treatment of eye diseases, as well as long surgeries under general anesthesia provoke the development of chronic degenerative changes in eye tissues, primarily in the cornea and the retina. Despite the existence of approaches for prevention and treatment of these complications, the efficacy of these approaches is often limited. Here, we review the mechanisms of iatrogenic damage to eye tissues at the cellular and biochemical levels. It is well recognized that oxidative stress is one of the main factors hindering regeneration of eye tissues after injuries and, thereby, aggravating iatrogenic eye disorders. It is accompanied by the downregulation of low-molecular-weight antioxidants and antioxidant enzymes, as well as changes in the expression and redox status of proteins in the damaged tissue. In this regard, antioxidant therapy, in particular, the use of highly effective mitochondria-targeted antioxidants such as SkQ1, is considered as a promising approach to the prevention of iatrogenesis. Recent findings indicate that the most efficient protection of eye tissues from the iatrogenic injury is achieved by preventive use of these antioxidants. In addition to preventing corneal and retinal cell death induced by oxidative stress, SkQ1 contributes to the restoration of innate antioxidant defense of these tissues and suppresses local inflammatory response. Since the timing of routine medical manipulations is usually known in advance, iatrogenic damage to the ocular tissues can be successfully prevented using mitochondria-targeted therapy.

Excimer Lasers in Refractive Surgery

Introduction

In the field of ophthalmology, laser technology is used in many basic and clinical disciplines and specialities. It has played an important role in promoting the development of ophthalmology.

Aim

This article is designed to review the evolution of laser technology in refractive surgeries in ophthalmology, mainly focusing on the characteristics of the excimer laser applied in corneal refractive surgery.

Methods

This article was performed based on a literature review and Internet search through scientific databases such as PubMed, Scopus, Web of Science and Google Scholar.

Result

The literature on excimer laser technology addresses the technical and physical aspects of excimer lasers including types, characteristics and commercially available lasers on the market.

Conclusion

The conclusion on this forum aims to help understand the benefits of excimer laser use in ophthalmology, with focus on correction of refractive errors.

Mitochondria-targeted antioxidant SKQ1 protects cornea from oxidative damage induced by ultraviolet irradiation and mechanical injury

Background

Cornea protects the eye against natural and anthropogenic ultraviolet (UV) damage and mechanical injury. Corneal incisions produced by UV lasers in ophthalmic surgeries are often complicated by oxidative stress and inflammation, which delay wound healing and result in vision deterioration. This study trialed a novel approach to prevention and treatment of iatrogenic corneal injuries using SkQ1, a mitochondria-targeted antioxidant approved for therapy of polyethiological dry eye disease.

Methods

Rabbit models of UV-induced and mechanical corneal damage were employed. The animals were premedicated or treated with conjunctival instillations of 7.5 μM SkQ1. Corneal damage was assessed by fluorescein staining and histological analysis. Oxidative stress in cornea was monitored by measuring malondialdehyde (MDA) using thiobarbituric acid assay. Total antioxidant activity (AOA) was determined using hemoglobin/H₂O₂/luminol assay. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities were measured using colorimetric assays.

Results

In both models corneas exhibited fluorescein-stained lesions, histologically manifesting as basal membrane denudation, apoptosis of keratocytes, and stromal edema, which were accompanied by oxidative stress as indicated by increase in lipid peroxidation and decline in AOA. The UV-induced lesions were more severe and long healing as corneal endothelium was involved and GPx and SOD were downregulated. The treatment inhibited loss of keratocytes and other cells, facilitated re-epithelialization and stromal remodeling, and reduced inflammatory infiltrations and edema thereby accelerating corneal healing approximately 2-fold. Meanwhile the premedication almost completely prevented development of UV-induced lesions. Both therapies reduced oxidative stress, but only premedication inhibited downregulation of the innate antioxidant activity of the cornea.

Conclusions

SkQ1 efficiently prevents UV-induced corneal damage and enhances corneal wound healing after UV and mechanical impacts common to ocular surgery. Its therapeutic action can be attributed to suppression of mitochondrial oxidative stress, which in the first case embraces all corneal cells including epitheliocytes, while in the second case affects residual endothelial cells and stromal keratocytes actively working in wound healing. We suggest SkQ1 premedication to be used in ocular surgery for preventing iatrogenic complications in the cornea.

Effects of an antioxidant protective topical formulation on eye exposed to ultraviolet-irradiation: a study in rabbit animal model

Ultraviolet-radiation exerts a well-known role in the development of various ocular diseases and may contribute to the progress of age-related macular degeneration. Therefore, the use of compounds able to protect the eyes from UV-induced cellular damage is challenging. The aim of this study has been to test the protective effects of an antioxidant topical formulation against UV-induced damage in rabbit eyes. Twelve male rabbits were used. Animals were divided into 4 groups of 3 animals each. Control group (CG) did not receive any irradiation and/or eye drop. The other three experimental groups were treated as follows: the first group received only UVR irradiation for 30 min, without eye drop supplementation (Irradiation group, IG), the second (G30) and the third (G60) groups received UV irradiation for 30' and 60', respectively, and eye drop supplementation (riboflavin, d-alpha-tocopheryl polyethylene glycol, proline, glycine, lysine and leucine solution) every 15 min for three hours. In the IG group a significant increase of oxidized glutathione (GSSG) and hydrogen peroxide (H(2)O(2)) was recorded in the aqueous humor, whereas ascorbic acid levels were significantly lower when compared to control eyes. In the groups exposed to UVR rays for 30 min, and treated with the topical antioxidant formulation, the GSSG, H(2)O(2) and ascorbic acid levels were similar to those recorded in controls, whereas in the G60 group the three markers significantly differ from control group. In the lens, a significant decrease of alpha tocopherol and total antioxidant capacity (TAC) was recorded in IG-animals as compared to control group, whereas malondialdehyde (MDA) levels were significantly higher in UV-induced eye than in control eyes. In the G30 groups the alpha tocopherol, MDA and TAC levels do not significantly differ from those recorded in controls, whereas in the G60 group these three markers significantly differ from control group. Present findings demonstrate that topical treatment with the antioxidant formulation used herein protects ocular structures from oxidative stress induced by UV exposure in in vivo animal model.

Techniques and outcomes of minimally invasive trabecular ablation and bypass surgery

Minimally invasive glaucoma surgeries (MIGS) can improve the conventional, pressure-dependent outflow by bypassing or ablating the trabecular meshwork (TM), or creating alternative drainage routes into the suprachoroidal or subconjunctival space. They have a highly favourable risk profile compared to penetrating surgeries, and lower intraocular pressure with variable efficacy that may depend on the extent of outflow segments accessed. Since they are highly standardised procedures that use clear corneal incisions, they can elegantly be combined with cataract and refractive procedures to improve vision in the same session. There is a growing need for surgeons to become proficient in MIGS to address the increasing prevalence of glaucoma and cataracts in a well-informed, aging population. Techniques of visualisation and instrumentation in an anatomically highly confined space with semitransparent tissues are fundamentally different from other anterior segment surgeries, and present even experienced surgeons with a substantial learning curve. Here, we provide practical tips, and review techniques and outcomes of TM bypass and ablation MIGS.

Er:YAG laser osteotomy based on refined computer-assisted presurgical planning: first clinical experience in oral surgery

OBJECTIVE

This case report was aimed at primary clinical experience concerning surgical extraction of a displaced tooth with the help of the Er:YAG laser based on refined computer-assisted presurgical planning.

METHODS

The case refers to the extraction of a displaced maxillary canine in a female patient. For the osteotomy, a pulsed Er:YAG laser was applied with pulse energy of 500 mJ, pulse duration of 250 microsec and pulse frequency of 12 Hz. The fiber tip (1000 microm) was kept with a 1-2 mm distance to the bone surface. Refined presurgical computer-assisted planning was performed with regard to minimization of bone loss, especially for the sake of preservation of the alveolar ridge. Based on a detailed three-dimensional (3D) reconstruction of the patient's anatomy, dynamical simulations of a buccal and a palatinal variant of access osteotomy were provided. Additionally, a volumetric profile of bone tissue quality based on Hounsfield values was generated.

RESULTS

By means of the 3D reconstruction and the tissue quality profile, both bone thickness and quality was evaluated as superior in the palatinal rather than in the vestibular part. Therefore, a classical buccal access window was chosen. The laser osteotomy allowed an exact cut geometry without any thermal damage and merely minimal bone loss.

CONCLUSION

The enhanced possibilities by laser osteotomy allowed for full exploitation of presurgical planning. As regards the actual case, computer-assisted planning was of benefit for an appropriate choice of access osteotomy by enabling evaluation of the consistency of the bony structures.

Histological Changes and Unscheduled DNA Synthesis in the Rabbit Cornea Following 213-nm, 193-nm, and 266-nm Irradiation

PURPOSE

To examine the acute outcome of corneal irradiation in adult rabbits for 193-, 213-, and 266-nm laser wavelengths.

METHODS

Animals were randomly allocated to one of three groups and were treated with 213-nm quintupled Nd:YAG laser, a 193-nm excimer laser, or a 266-nm quadrupled Nd:YAG laser (n = 6 per group, two exposure durations). Thermal damage was assessed histologically and the extent of DNA damage estimated by measuring unscheduled DNA synthesis in corneal epithelial and stromal cells using 3H thymidine autoradiography.

RESULTS

For the 193- and 213-nm groups, irradiation did not induce thermal damage. Moreover, cells displaying unscheduled DNA synthesis represented < 4% of the total cell numbers with no difference between groups (P > .05). By contrast, the 266-nm laser led to stromal melting and vacuolation; unscheduled DNA synthesis levels were elevated over the other groups (P < .05).

CONCLUSIONS

Corneal laser ablation with the 213-nm Nd:YAG laser resulted in similarly low levels of thermal and DNA damage to those produced using the clinically accepted 193-nm excimer laser.

Scattered laser radiation and broadband actinic ultraviolet plasma emissions during LADARVision excimer refractive surgery

PURPOSE

To evaluate the potential occupational health hazards associated with scattered actinic ultraviolet (UV) laser radiation and broadband actinic UV plasma emissions during refractive surgery.

SETTING

Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, D.C., USA.

METHODS

Intraoperative radiometric measurements were made with the Ophir Power/Energy Meter (LaserStar Model with silicon detector, Model PD-10) and the International Light Radiometer/Photometer (Model IL 1400 with actinic ultraviolet detector, Model SEL240) with and without UV blocking filters (BLK 270 and Schott types WG-280 and WG-230). Measurements made during laser calibration as well as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) procedures were evaluated using a worst-case scenario and then compared with the American Conference of Governmental Industrial Hygeinists (ACGIH) Threshold Value Limits (TLV) to perform a risk/hazard analysis.

RESULTS

Most optical emissions were between 193 nm and 280 nm, and approximately 25% of the measurement result was due to broadband emissions greater than 270 nm for calibration targets. About 25% of optical emissions during LASIK were beyond 230 nm. No emissions beyond 230 nm were observed during PRK. Ultraviolet scattered radiation level was similar between PRK and LASIK. Maximum measured values of 80 nJ/pulse at 14 cm for PRK and 45 nJ/pulse at 38 cm for LASIK were used as the absolute worst-case analysis for exposure. Assuming the worst-case exposure conditions are equal to the maximum measured value during these studies at a workload of 20 patients per day, the cumulative occupational exposure at close range of actinic UV radiation did not exceed the 8-hour occupational exposure limit of 3 mJ/cm(2) for any 24-hour period.

CONCLUSIONS

Scattered UV laser radiation did not exceed occupational exposure limits at distances greater than 30 cm from either laser calibration targets or patient treatments over a workday. Laser eye protection is not necessary to protect operating room personnel since exposure levels are very low even under a worst-case scenario.

Possible applications of a non-contact 1.48 μm wavelength diode laser in assisted reproduction technologies

Recently, one laser system has been introduced in IVF fulfilling all safety requirements, while achieving a high standard of reproducibility in terms of ablation diameter. This 1.48 microm wavelength indium-gallium-arsenic-phosphorus (InGaAsP) semiconductor laser offers a variety of laser applications to the embryologist. On the one hand, zona pellucida of oocytes or embryos can be manipulated in order to facilitate ICSI or biopsy and assist hatching, and on the other, spermatozoa may be paralysed or immobilized prior to usage. To conclude, the 1.48 microm diode laser provides a promising tool for the microdissection of subcellular targets. The diode laser stands out due to the rapidity, the simplicity and the safety of the procedure which is supported by healthy offspring after laser application.

Er:YAG laser osteotomy directed by sensor controlled systems

BACKGROUND

Great efforts have been taken in the past to develop laser systems suitable for bone cutting. Laser systems emitting light in the infrared spectrum (2.9, 3.0 microm) have been found to be ideal for efficient bone ablation with very little carbonization.

AIM

To evaluate a new laser bone cutting system enabling the automatic detection of different tissue qualities by an integrated sensor to avoid damage to sensitive structures such as blood vessels or nerves.

MATERIAL

An Erbium:YAG laser containing an integrated closed-loop control system, was constructed and tested on dissected bone. Process emissions such as resonance changes caused by the interaction of laser light and various tissue structures can be used for a controlled system. Sensor signals from a photodiode and a piezo-electric accelerometer were received and processed to guide the laser osteotomy.

METHODS

Tests were performed on dissected bone specimens from rabbit femur (14) and minipig jaw (6). After laser application, the bone specimens were evaluated macroscopically and histologically.

RESULTS

The specimens were evaluated histomorphometrically for the depth of cortical bone ablation when the closed-loop control system switched off the laser. Mean courses of 97.45% (pig) and 97.83% (rabbit) showed that the systems work with precision.

CONCLUSION

After penetrating the cortical bone layer, the laser beam was promptly interrupted due to extreme changes of the signal character received by the sensor system. The in vitro tests of this new laser closed-loop control system were successful.

Ultraviolet-excited (308 nm) autofluorescence for bladder cancer detection

OBJECTIVES

To assess the ability of ultraviolet laser-induced autofluorescence for the diagnosis of transitional cell carcinoma of the bladder.

METHODS

We studied 43 patients undergoing transurethral resection with recurrent transitional cell carcinoma of the bladder. Guided through 5-aminolevulinic acid-induced fluorescence endoscopy, the autofluorescence of the red fluorescing areas and the adjacent tissue and inconspicuous-appearing mucosa were measured spectroscopically. The autofluorescence excitation was carried out with a xenon chloride excimer laser operating at 308 nm (AF308). For the evaluation of the autofluorescence spectra, an intensity ratio (335/430 nm) was calculated and correlated with the histologic results of the biopsies taken.

RESULTS

We analyzed the AF308 spectra of 114 biopsies (21 malignant, 93 benign). The autofluorescence intensity ratios for the benign lesions were a factor of 2 to 7 higher than carcinoma in situ and neoplastic tissue. Therefore, 20 of 21 neoplastic lesions were detected as true positive by AF308. A sensitivity and specificity for AF308 of 95% and 77%, respectively, could be calculated. The sensitivity and specificity for 5-aminolevulinic acid-induced fluorescence endoscopy was 90% and 61%, respectively. By combining the two methods, we calculated a sensitivity of 90% and a specificity of 84%.

CONCLUSIONS

The combination of a sensitive imaging technique such as 5-aminolevulinic acid-induced fluorescence endoscopy and a more specific spectral fluorescence probe technique with autofluorescence at 308 nm is a very efficient procedure in the detection of transitional cell carcinoma of the bladder.

Nanosecond, high-intensity pulsed laser ablation of myocardium tissue at the ultraviolet, visible, and near-infrared wavelengths: in-vitro study

BACKGROUND AND OBJECTIVE

A large number of clinical trials of transmyocardial laser revascularization (TMLR) have been conducted to treat severe ischemic heart diseases. A variety of laser sources have been used or tested for this treatment, however, no comprehensive study has been performed to reveal the mechanism and the optimum laser irradiation condition for the myocardium tissue ablation. There have been reported limited experimental data of the high-intensity pulsed laser ablation of myocardium tissues.

STUDY DESIGN/MATERIALS AND METHODS

A 1064-nm Q-switched Nd:YAG laser and its 2nd (532 nm), 3rd (355 nm), and 4th (266 nm) harmonics were used for ablation experiments. At each wavelength, 25 laser pulses irradiated the porcine myocardium tissue samples at a constant laser intensity (peak laser power divided by laser spot area) of approximately 2 GW/cm(2) and the ablation depths were measured. During ablation, laser-induced optical and acoustic emissions were measured to investigate the ablation mechanism at each laser wavelength. For the ablated tissues, histological observation was made with a polarization optical microscope.

RESULTS

It was shown that the ablation efficiency did not directly depend on the linear absorption coefficient of the tissue; the ablation depth was maximized at 355 and 1064 nm, and minimized at 532 nm. Strong laser-induced optical and acoustic emissions were observed for the 266- and 1064-nm laser irradiations. The histology showed that thermal denaturation of the tissue near the ablation walls decreased with decreasing wavelength for 266, 355, and 532 nm, but it was limited for 1064 nm.

CONCLUSION

At the laser intensity of approximately 2 GW/cm(2), ablation characteristics were drastically changed for the different laser wavelengths. The results indicated that for 266, 355, and 532 nm, the tissue removal was achieved mainly through a photothermal process, but for 266 nm the intense laser-induced plasma formation would result in a reduced laser energy coupling to the tissue. For 1064 nm, a photodisruption was most probable as a dominant tissue removal process. Because of the high ablation rate and limited thermal denaturation, the 355- and 1064-nm lasers could be potential laser sources for TMLR, although further investigation is needed to discuss the clinical issues.

193 nm photolysis of aromatic and aliphatic dipeptides in aqueous solution: dependence of decomposition quantum yield on the amino acid sequence

The values of molar absorption coefficient and quantum yields of photodecomposition and peptide bond scission were determined for a number of aromatic and aliphatic dipeptides under 193 nm laser irradiation in neutral argon-saturated aqueous solution. Under these conditions we could show that no dependence of the dipeptide decomposition quantum yield on the sequence of amino acid residues exists, neither for aromatic dipeptides nor for aliphatic ones.

Corneal Morphology in vitro After Superficial Keratectomy With Q-switched Er:YSGG and Free-running Er:YAG Lasers

PURPOSE

Examination of morphology in corneal ablation induced by a q-switched Er:YSGG (2.79 microm) laser and a free-running Er:YAG laser (2.94 microm).

METHODS

Defined ablation of 6-mm diameter and 15, 30, 55, 90, and 120-microm depth was performed on freshly enucleated swine eyes. Er:YSGG laser parameters: fluence 1.6 J/cm2, frequency 6 Hz, spot-size 465 microm FWHM, scanning-mode, pulse number 1520 to 6210. Er:YAG laser parameters: fluence 3 J/cm2, frequency 1.5 Hz, spotsize 6 mm, wide area ablation, pulse number 2 to 13. Corneal morphology was analyzed by gross photography, histology, scanning electron microscopy, and scanning nearfield acoustic microscopy.

RESULTS

Histology showed thermal damage of 5 to 15 microm in depth caused by the Er:YSGG laser in comparison with 10 to 20 microm by the Er:YAG laser. Average roughness of the ablated surface measured with scanning nearfield acoustic microscopy was 20 to 40 microm for the Er:YSGG laser and 5 to 15 microm for the Er:YAG laser. These data confirm the subjective impression of images created by scanning electron microscopy and gross photography.

CONCLUSIONS

Although the Er:YAG laser system appeared to demonstrate a smoother corneal surface than the q-switched Er:YSGG laser, the thermal damage in either case poses a potential limitation for clinical use in lamellar refractive surgery.

Mucosal exposure to light during routine endoscopy

BACKGROUND

The spectral irradiance delivered by a variety of gastrointestinal endoscopes was measured as a function of wavelength and used to estimate the amount of light delivered to the mucosal surface during routine endoscopic procedures.

METHODS

Spectral irradiances from seven different endoscopes were measured using a commercial spectroradiometer calibrated against a National Institute of Standards and Technology traceable source.

RESULTS

The largest maximum irradiance was 8.0 W/cm2 obtained from an endoscope used in transillumination mode. In the typical viewing mode, the largest maximum irradiance measured was 1.6 W/cm2. The majority of the light energy delivered by these gastrointestinal endoscopes was in the visible wavelength region (400 to 700 nm).

DISCUSSION

The measurements revealed surprisingly high light exposures in the visible wavelength range. In fact, the estimated tissue exposures can exceed by 40-fold the standards established for skin exposure to light set forth by the American National Standards Institute. Because gastrointestinal endoscopy is widely viewed to be safe, it is probable that the gastrointestinal tract has significant tolerance to light exposure.

Laser scissors and tweezers

In summary, we described the use of laser scissors and tweezers from three perspectives: (a) the historical background from which these two techniques evolved, (b) an understanding and lack of understanding of the mechanisms of interaction with the biological systems, and (c) the applications of the scissors and tweezers alone and in combination. As the technology improves and we gain a better understanding of how these two tools operate they will become even more useful in probing cell structure and function, as well as practically manipulating cells in genetics, oncology, and developmental biology.

Photorefractive keratectomy and cataract

Fifty male albino rabbits were studied. Ten animals served as controls. Forty animals were prepared to receive photorefractive keratectomy (PRK), including anesthesia, scraping of the corneal epithelial cells, etc. Twenty of these animals then received PRK with energy delivered by excimer laser (pulse rate = 20 Hz, fluence 250 mJ/cm2; number of pulses = 6032; cumulative UV dose = 1508J/cm2). The other 20 animals were exposed to the same operating microscope light as the PRK-treated animals, but they did not receive PRK. All three groups were divided into halves: the first half was immediately analyzed at 0 time, and the second half was observed 1 year later. Samples of aqueous humor and lens were analyzed. The levels of reduced and oxidized glutathione, hydrogen peroxide, ascorbic acid, and malondialdehyde were determined. Excimer laser-induced ultrastructural modifications of the lens, verified through scanning electron microscopy, were studied at the same intervals. Immediately after PRK, the biochemical parameters studied, both in aqueous humor and in lens of treated animals, showed significant differences. One year later, the observed biochemical variations in lens were still present, whereas aqueous humor values did not significantly differ from control values. Ultrastructural abnormalities of the lens appeared only 1 year after PRK In the animals that received only the preparation for PRK the biochemical and ultrastructural differences did not significantly vary as compared to the data obtained from control animals. These findings suggest that the biochemical and ultrastructural lens alterations induced by PRK may represent events relevant to cataractogenesis in the rabbit.

Fluence and mutagenic side effects of excimer laser radiation applied in ophthalmology in human lymphocytes in vitro

PURPOSE

To investigate the influence of different fluences in 193 and 248 nm excimer laser radiation on the yields of chromatid and chromosome aberrations induced in human lymphocytes in vitro.

METHOD

Heparinized human blood was exposed to 193 or 248 nm excimer laser radiation. The fluence was gradually increased from 21 to 400 mJ/cm2 in 193 nm (constant total energy of 250 J) and from 150 to 377 mJ/cm2 in 248 nm radiation (constant total energy of 500 J). Chromatid and chromosome aberrations were then analysed microscopically.

RESULTS

The yields of chromatid breaks and achromatic lesions depend on the fluence per pulse. This dependence contains a linear component, indicating a threshold of about 70 mJ/cm2 fluence in 193 nm and of about 250 mJ/cm2 fluence in 248 nm laser radiation. An increase of the yield of dicentric chromosomes could only be observed at the highest fluence tested (377 mJ/cm2) in the 248 nm series. Over 126 mJ/cm2 in 193 nm radiation no lymphocytes could be cultured and therefore no aberrations could be found.

CONCLUSIONS

Our findings show that the fluence of 193 nm and of 248 nm excimer laser radiation has an effect on the yields of chromatid breaks and achromatic lesions in human lymphocytes under in vitro conditions.

Corneal-tissue absorption coefficients for 193- and 213-nm ultraviolet radiation

The small-signal absorption coefficients of 193- and 213-nm nanosecond laser pulses in bovine corneal tissue have been studied. The absolute reflectance of a planar quartz-cornea interface was measured at various angles of incidence for low-intensity laser irradiation (i.e., pulse fluences 3 orders of magnitude below the ablation threshold). The reflectance-versus-angle data were analyzed by the use of Fresnel theory to estimate the effective complex index of refraction of the tissue. This analysis indicated corneal absorption coefficients of 39,900 ± 9800 cm(-1) at 193 nm and 21,400 ± 4900 cm(-1) at 213 nm.

Arf 193nm excimer laser corneal surgery and photo-oxidation stress in aqueous humor and lens of rabbit: one-month follow-up

Twenty male albino rabbits were studied. Four animals served as controls; the remaining 16 animals represented the treated group. All the treated animals were exposed to the same amount of energy delivered by the excimer laser (pulse rate: 20 Hz, fluence 250mJ/cm2; number of pulses: 6032; cumulative UV dose 1508 J/cm2) and were divided into eight groups of 2 animals each (four eyes). Samples of aqueous humor and lens were obtained at the following intervals: 5, 10, 20 and 40 min and 1, 2, 3 and 4 weeks after photorefractive keratectomy (PRK). The levels of reduced and oxidized glutathione, hydrogen peroxide, ascorbic acid and malondialdehyde were determined. Aqueous humor analyses, twenty min after PRK, showed no significant differences with pre-treatment values, while the observed variations in lens were constantly present over the entire follow-up period (one month). These findings suggest that the biochemical lens alterations induced by PRK may represent the earliest events relevant to cataractogenesis in the rabbit.

Non-contact microdrilling of mouse zona pellucida with an objective-delivered 1.48-microns diode laser

BACKGROUND AND OBJECTIVE

A non-touch laser-induced microdrilling procedure is studied on mouse zona pellucida (ZP).

STUDY DESIGN/MATERIALS AND METHODS

A 1.48-microns diode laser beam is focused in a 8-microns spot through a 45x objective of an inverted microscope. Mouse zygotes, suspended in a culture medium, are microdrilled by exposing their ZP to a short laser irradiation and allowed to develop in vitro.

RESULTS

Various sharp-edged holes can be generated in the ZP with a single laser irradiation. Sizes can be varied by changing irradiation time (3-100 ms) or laser power (22-55 mW). Drilled zygotes present no signs of thermal damage under light and scanning electron microscopy and develop as expected in vitro, except for a distinct eight-shaped hatching behavior.

CONCLUSION

The microdrilling procedure can generate standardized holes in mouse ZP, without any visible side effects. The hole formation can be explained by a local photothermolysis of the protein matrix.

Keratocyte-Populated Collagen Gel as an In Vitro Model of Excimer Laser Keratectomy

BACKGROUND

To develop an in vitro model to study the effects of excimer laser keratectomy on corneal stromal cells, we evaluated two types of collagen gel populated with keratocytes.

METHODS

Keratocyte-populated collagen gels were prepared with type I collagen in 6-well plates or in culture plate inserts, the bottom of which consisted of a nitrocellulose membrane, contained within 6-well plates. The gels were ablated by the 193-nm excimer laser, set to ablate 50, 100, or 200 microns deep, and was observed under a phase-contrast microscope for 2 days.

RESULTS

Keratocytes cultured in collagen gel developed cytoplasmic processes and formed networks of interconnected cells. Cells within the ablated area in the 6-well plates began to lose their cytoplasmic processes and became round approximately 3 hours after excimer laser ablation. These cellular changes were more prominent in the gels ablated to a depth of 200 microns. Cells outside of the ablation zones in the 6-well plates and the culture plate inserts remained intact.

CONCLUSIONS

These results suggest the use of keratocyte-populated collagen gel as an in vitro model of cellular response to excimer laser keratectomy and also suggest that gel prepared in culture plate inserts is the preferred method.

Excimer laser photorefractive keratectomy

Excimer laser photorefractive keratectomy has been used for the correction of myopia, hyperopia and astigmatism. This laser removes tissue through a process termed photoablative decomposition, in which incident photon energy is sufficient to break molecular bonds. Selective removal of tissue across the anterior corneal surface results in a change in anterior corneal curvature. The surgical outcome may be influenced also by interindividual variability in wound healing and pharmacologic interventions. The nature of the excimer laser-tissue interaction, and clinical outcomes of predictability, stability and complications of surgery for myopia are discussed in detail.

Microdissection of mouse and human zona pellucida using a 1.48-microns diode laser beam: efficacy and safety of the procedure

OBJECTIVE

To investigate the efficacy and safety of a small and affordable 1.48-microns continuous wave diode laser for zona pellucida (ZP) microdissection.

DESIGN

Mouse and human oocytes and zygotes were submitted to ZP drilling. The hole characteristics and possible laser-induced structural alterations of the neighboring cytoplasm were investigated with scanning and transmission electron microscopy. The safety of the procedure was checked on control and drilled zygotes by determining their ability to develop in vitro and in vivo.

SETTING

Collaborative study between three Swiss academic centers.

INTERVENTIONS

The collimated diode laser beam was delivered through a 45x objective of an inverted microscope and focused through the culture dish and culture medium in 1- to 3-microns spots.

MAIN OUTCOME MEASURE

Safety assessment of the laser drilling procedure.

RESULTS

The 1.48-microns radiation achieves a rapid, precise, and easily controlled lysis of the ZP without any micromanipulative handling of the eggs. Different shapes of holes can be produced by varying the laser beam intersection site on the ZP, laser power, and irradiation time. The energy needed to drill holes of a given diameter is greater for zygotes than for oocytes. Safety of the drilling procedure is confirmed by the lack of damage at the ultrastructural and biologic levels.

CONCLUSIONS

The low-cost 1.48-microns diode laser allows an easy, objective-driven, nontouch microdissection of the ZP. The procedure is safe, as drilled embryos give rise to normal and fertile offspring.

[Morphologic, biomechanical and experimental in vivo studies of laser-assisted meniscus resection]

Arthroscopic meniscectomy is associated with an irregularly shaped resection rim leading to further degeneration and a considerable rate of iatrogenic lesions to the adjacent cartilage. In a controlled experimental trial the clinical value of laser-assisted meniscectomy was assessed with special reference to whether laser application can overcome these common shortcomings of conventional surgery. An XeCl excimer laser (lambda = 308 nm, pulsewidth: 20 ns, repetition rate: 10-70 Hz, radiant exposure: 10-50 mJ/mm2) and a continuous wave Nd:YAG laser (lambda = 1064 nm, energy density: 21-93 W/mm2) were used with 600 microns and 800 microns quartz fibers, respectively. The study comprised an analysis of morphological and biomechanical characteristics of the meniscus exposed to laser treatment and an evaluation of reparative and degenerative changes following laser meniscectomy in an animal model. Light microscopy and scanning electron microscopy showed that excimer laser irradiation leads to well delineated resection borders with a transitional zone measuring 20 microns. Specimens exposed to Nd:YAG laser irradiation present extensive vaporization zones with the surface covered by an amorphous structure. Menisci irradiated by excimer or Nd:YAG laser energy show increased stiffness; the maximum value of radial strain at flexion is reduced, with a mean value of 1.5 +/- 0.3% following Nd:YAG laser irradiation and a mean value of 2.4 +/- 0.3% following excimer laser irradiation, compared with 3.0 +/- 0.5% in nonirradiated menisci. In vivo experiments show that laser energy prevents fibrillation of the menisceal structure, which was common in the control group; menisceal regeneration was not observed in any of the experimental groups. The extent of cellular infiltration in the synovial membrane is significantly increased following laser meniscectomy, indicating reactive synovitis (P < 0.05). Radiographs show enhanced progression of degenerative changes following laser surgery compared with conventional menisectomy; measurements of the subchondral bone density in the tibial plateau reveal significantly increased density following Nd:YAG (P < 0.01) and excimer laser irradiation (P < 0.05), confirming these observations. The proteoglycan content in the femoral cartilage corresponding to the zone of meniscus resection is significantly lower in the laser group than in the group subjected to conventional meniscectomy (P < 0.01). These results have various implications for clinical practice.(ABSTRACT TRUNCATED AT 400 WORDS)

Lasers in ophthalmology

This article reviews the principle uses of ophthalmic lasers, providing historical background with an emphasis on new applications and areas of investigation. Ophthalmic photocoagulation was the first medical laser application and has restored or maintained vision in millions of people. More recently, photodisruption and, increasingly, ablation have gained prominence for treating a wide range of ocular pathology. The unique properties of lasers have also been harnessed for diagnostic purposes, with optical coherence tomography representing a significant improvement over existing imaging methods. Many ophthalmic applications of lasers have been developed, but the field is a dynamic one which continues to evolve along with laser technology itself.

Photochemistry of DNA and related biomolecules: quantum yields and consequences of photoionization

The reactions of nucleic acids and constituents, which can be induced by laser UV irradiation, are described. Emphasis is placed on the quantum yields of various stable photoproducts of DNA and model compounds upon irradiation at 193, 248, 254 or 266 nm. In particular, those quantum yields and processes are discussed which involve photoionization as the initial step and occur in aqueous solution under well defined conditions, e.g. type of atmosphere. The efficiencies of some photoproducts, with respect to photoionization using irradiation at 193 or 248 nm, are presented. Radical cations of nucleobases are important sources of damage of biological substrates since they can cause lesions other than dimers and adducts, e.g. strand breakage, abasic sites, crosslinks or inactivation of plasmid and chromosomal DNA. While competing photoreactions, such as hydration, dimerization or adduct formation, diminish the selectivity of the photoionization method, a combination with model studies on pyrimidine- and purine-containing constituents of DNA has brought about an enhanced insight into the reaction mechanisms. The knowledge concerning the lethal events in plasmid and cellular DNA has been greatly improved by correlation with the chemical effects obtained by gamma-radiolysis, vacuum-UV (< 190 nm) and low-intensity irradiation at 254 nm.

Cutting and skin-ablative properties of pulsed mid-infrared laser surgery

BACKGROUND

Pulsed mid-infrared lasers allow a precise removal of soft tissues with only minimal thermal damage.

OBJECTIVE

To study the potential dermatosurgical usefulness of currently available systems at different wavelengths (2010-nm Thulium:YAG laser, 2100-nm Holmium:YAG laser, 2790-nm Erbium:YSGG laser, and 2940-nm Erbium:YAG laser) in vivo on pig skin.

METHODS

Immediate effects and wound healing of superficial laser-abrasions and incisions were compared with those of identical control lesions produced by dermabrasion, scalpel incisions, or laser surgery performed by a 1060-nm Nd:YAG and a 1060-nm CO2 laser (continuous and superpulsed mode).

RESULTS

Best efficiency and least thermal injury was found for the pulsed Erbium:YAG laser, leading to ablative and incisional lesions comparable to those obtained by dermabrasion or superficial scalpel incisions, respectively.

CONCLUSION

In contrast to other mid-infrared lasers tested, the 2940-nm Erbium:YAG laser thus provides a potential instrument for future applications in skin surgery, especially when aiming at a careful ablative removal of delicate superficial lesions with maximum sparing of adjacent tissue structures. However, in the purely incisional application mode pulsed mid-infrared lasers, though of potential usefulness in microsurgical indications (eg, surgery of the cornea), do not offer a suggestive alternative to simple scalpel surgery of the skin.

ArF-excimer laser-induced secondary radiation in photoablation of biological tissue

Secondary radiation, emitted during and after the irradiation of corneal, dermal, and dental tissue by an ArF-excimer laser (193 nm), was qualitatively and quantitatively characterized. Emission of secondary radiation was found in the range of 200-800 nm. The intensity of secondary radiation in the range of 200-315 nm (UVC and UVB) is approximately 20% of the total intensity at high laser fluences (> 2 J/cm2), and approximately 50% at moderate laser fluences (< 500 mJ/cm2); 10 muJ/cm2 in the UVC and UVB were measured at the sample surface, at fluences (< 1J/cm2) which are of relevance for clinical procedures on soft tissues. In dental tissue processing, very high fluences (> 5 J/cm2) are required. As a consequence, laser-induced plasma formation can be observed. Secondary radiation can be used as a visible guide for selective removal of carious altered tissue. The data we have found might be of assistance in estimating potential hazards for future mutagenic studies in the field.

Rate-dependent, nonlinear photoablation of ocular tissue at 308 nm

To quantify the dependence on pulse repetition rate of 308 nm laser ablation in ocular tissue and elucidate the photoablation mechanisms involved, 85 full-thickness ab interno sclerostomies were created in six human donor eyes using an 800-microns-diameter quartz optical fiber. A laser pulse duration of 135 ns, fluence of 31 mJ/mm2, and a fixed repetition rate between 5 and 40 Hz were used for 38 sclerostomies; the remaining 47 sclerostomies were completed at various laser settings during initial experimentation. Surprisingly, the numbers of pulses required for complete penetration of the optical fiber through the fixed tissue thickness were not constant as expected but decreased nonlinearly with increasing repetition rate. This demonstrates that the 308 nm excimer laser cuts ocular tissue significantly more rapidly per pulse at higher repetition rates. To explain this nonlinearity, we propose a composite ablation mechanism composed of photochemical, thermal, mechanical, and optical effects in varying proportions.

Photolesions in DNA upon 193 nm excitation

Aqueous solutions of plasmid (pBR322 and pTZ18R) and calf thymus DNA were excited by 20 ns laser pulses at 193 nm. The quantum yields of single-and double-strand break formation, interstrand cross-links, locally denatured sites, (6-4)photoproducts and biological inactivation (phi ssb, phi dsb, phi icl, phi lds, phi 6-4 and phi ina, respectively) were measured. The quantum yields are virtually independent of intensity, demonstrating a one-quantum process. The obtained values in aerated neutral solution in the absence of additives are phi ssb approximately 1.5 x 10(-3), phi dsb approximately 0.06 x 10(-3) (dose: 10-200 J m-2), phi icl approximately phi lds approximately 0.1 x 10(-3) and phi 6-4 = 0.5 x 10(-3). Both phi ssb and phi dsb decrease strongly with increasing concentrations of TE buffer (0.01-10 mM). Biological inactivation of the pTZ18R plasmid was determined from the transformation efficiency of Escherichia coli bacteria strains AB1157, AB1886 uvr and AB2480 uvr rec; the phi ina values are 1.4 x 10(-3), 2.1 x 10(-3) and 3 x 10(-3), respectively. The monoexponential survival curves in all cases show that a single damage site leads to inactivation (one single hit). The biological consequences of different photoproducts are discussed.

Pulpal effects of argon: fluoride excimer laser irradiation and acid-etching of rat molar enamel

The reaction of enamel, dentine and pulpal tissues to exposure from a laser beam has been shown to depend on the type of laser medium used. The objective of this study was to examine the pulpal response in rat molars after external enamel surface treatment with either an Ar:F excimer laser or acid-gel application. Maxillary right molar occlusal surfaces in 22 animals were irradiated (energy density = 45.0 J/cm2). Maxillary left molar occlusal surfaces were treated with 37 per cent phosphoric acid for 30 s. Untreated mandibular right molars served as controls. At two postoperative time periods (1 and 6 weeks), molars were removed, sectioned, stained (H&E) and scored. Data analysis indicated no significant difference between Ar:F irradiation and controls at 1 week. Treatment with laser or acid-etching left a similar degree of pathosis at 1 and 6 weeks. Although the Ar:F excimer laser produced a more exaggerated pulp response than controls at 6 weeks, tissue vitality was maintained. The Ar:F excimer laser may be useful for ablating vital tooth structure since pulpal tissue in rat molars exhibited no damage in response to low-power irradiation.

Restenosis after excimer laser angioplasty of coronary stenoses and chronic total occlusions

In an open clinical study, a xenon-chloride excimer laser was used for angioplasty of coronary stenoses (n = 48) and chronic total occlusions (n = 56) in 104 patients. Multifiber catheters (4.0F to 5.5F) transmitted 37 to 120 mjoules/mm2 of fiber surface. Excimer laser angioplasty was successful in 43 patients with a stenosis (89%), followed by percutaneous transluminal coronary angioplasty in 21 patients (49%) to reduce the stenosis to less than 50% luminal narrowing. In 39 patients (70%) with a chronic occlusion (age 1 to 14 months), recanalization by means of excimer laser angioplasty was successful, with subsequent percutaneous transluminal coronary angioplasty performed in 23 patients. Major complications included one perforation, one acute occlusion, and two severe dissections. Six-month angiographic follow-up examinations after successful angioplasty were completed in 40 patients (98%) with stenoses and 34 (94%) with occlusions. Restenosis (greater than 20% decrease in luminal diameter) occurred in 13 patients (33%) with stenoses and in 16 patients (47%) after angioplasty of a chronic occlusion. These long-term results indicate that restenosis after excimer laser angioplasty of coronary stenoses and chronic total occlusions is similar to reported results of conventional balloon angioplasty.