Free-Electron Laser (FEL) Ablation of Ocular Tissues

Efficacy and predictability of soft tissue ablation using a prototype Raman-shifted alexandrite laser

Previous research showed that mid-infrared free-electron lasers could reproducibly ablate soft tissue with little collateral damage. The potential for surgical applications motivated searches for alternative tabletop lasers providing thermally confined pulses in the 6- to-7-µm wavelength range with sufficient pulse energy, stability, and reliability. Here, we evaluate a prototype Raman-shifted alexandrite laser. We measure ablation thresholds, etch rates, and collateral damage in gelatin and cornea as a function of laser wavelength (6.09, 6.27, or 6.43 µm), pulse energy (up to 3 mJ/pulse), and spot diameter (100 to 600 µm). We find modest wavelength dependence for ablation thresholds and collateral damage, with the lowest thresholds and least damage for 6.09 µm. We find a strong spot-size dependence for all metrics. When the beam is tightly focused (~100-µm diameter), ablation requires more energy, is highly variable and less efficient, and can yield large zones of mechanical damage (for pulse energies>1 mJ). When the beam is softly focused (~300-µm diameter), ablation proceeded at surgically relevant etch rates, with reasonable reproducibility (5% to 12% within a single sample), and little collateral damage. With improvements in pulse-energy stability, this prototype laser may have significant potential for soft-tissue surgical applications.

Raman-shifted alexandrite laser for soft tissue ablation in the 6- to 7-µm wavelength range

Prior work with free-electron lasers (FELs) showed that wavelengths in the 6- to 7-µm range could ablate soft tissues efficiently with little collateral damage; however, FELs proved too costly and too complex for widespread surgical use. Several alternative 6- to 7-µm laser systems have demonstrated the ability to cut soft tissues cleanly, but at rates that were much too low for surgical applications. Here, we present initial results with a Raman-shifted, pulsed alexandrite laser that is tunable from 6 to 7 µm and cuts soft tissues cleanly-approximately 15 µm of thermal damage surrounding ablation craters in cornea-and does so with volumetric ablation rates of 2-5 × 10(-3) mm(3)/s. These rates are comparable to those attained in prior successful surgical trials using the FEL for optic nerve sheath fenestration.

Interplay of wavelength, fluence and spot-size in free-electron laser ablation of cornea

Infrared free-electron lasers ablate tissue with high efficiency and low collateral damage when tuned to the 6-microm range. This wavelength-dependence has been hypothesized to arise from a multi-step process following differential absorption by tissue water and proteins. Here, we test this hypothesis at wavelengths for which cornea has matching overall absorption, but drastically different differential absorption. We measure etch depth, collateral damage and plume images and find that the hypothesis is not confirmed. We do find larger etch depths for larger spot sizes--an effect that can lead to an apparent wavelength dependence. Plume imaging at several wavelengths and spot sizes suggests that this effect is due to increased post-pulse ablation at larger spots.

Mid infrared optical parametric oscillator (OPO) as a viable alternative to tissue ablation with the free electron laser (FEL)

BACKGROUND AND OBJECTIVES

Investigations with a Mark-III free electron laser, tuned to 6.45 microm in wavelength have demonstrated minimal collateral damage and high ablation yield in ocular and neural tissues. While the use of mid-IR light produced by the free electron laser (FEL) has shown much promise for surgical applications, further advances are limited due the high costs of its use. Further investigation and widespread clinical use of six-micron radiation requires the development of an alternative laser source. In this research, we compared a Mark-III FEL and an Er:YAG pumped ZGP-OPO with respect to the effect of pulse duration on ablation efficiency and thermal damage on porcine cornea.

STUDY DESIGN/MATERIALS AND METHODS

A five by seven grid of craters was made about the center of each cornea. Craters were made with a 60-microm spotsize with a 500-microm spacing. Ablation craters were made using 50 pulses per crater at approximately three times the ablation threshold (for water). Histological analysis was used to determine crater depth and thermal damage.

RESULTS

The average zone of thermal damage at 6.1 microm was found to be 4.1 microm for the optical parametric oscillator (OPO) and 5.4 microm for the FEL. At 6.45 microm, the damaged zone was 7.2 microm for the OPO and 7.2 microm for the FEL. At 6.73 microm, the damaged zone was 6.3 microm for the OPO and 7.6 microm+/-0.3 microm for the FEL.

CONCLUSIONS

The OPO caused similar or significantly less thermal damage in porcine cornea when compared with the FEL while generating significantly deeper craters. We determined that the ZGP-OPO has much promise as a bench-top replacement for the FEL for soft tissue ablation.

The effect of free-electron laser pulse structure on mid-infrared soft-tissue ablation: biological effects

Previous studies have shown that changing the pulse structure of the free electron laser (FEL) from 1 to 200 ps and thus reducing the peak irradiance of the micropulse by 200 times had little or no effect on both the ablation threshold radiant exposure and the ablated crater depth for a defined radiant exposure. This study focuses on the ablation mechanism at 6.1 and 6.45 microm with an emphasis on the role of the FEL pulse structure. Three different experiments were performed to gain insight into this mechanism. The first was an analysis of the ablation plume dynamics observed for a 1 ps micropulse compared with a 200 ps micropulse as seen through bright-field analysis. Negligible differences are seen in the size, but not the dynamics of ablation, as a result of this imaging. The second experiment was a histological analysis of corneal and dermal tissue to determine whether there is less thermal damage associated with one micropulse duration versus another. No significant difference was seen in the extent of thermal damage on either canine cornea or mouse dermis for the micropulse durations studied at either wavelength. The final set of experiments involved the use of mass spectrometry to determine whether amide bond breakage could occur in the proteins present in tissue as a result of direct absorptions of mid-infrared light into the amide I and amide II absorption bands. This analysis showed that there was no amide bond breakage due to irradiation at 6.45 microm on protein.

In-vivo response to free electron laser incision of the rabbit cornea

BACKGROUND AND OBJECTIVE

We analyzed the in vivo ocular response to corneal incisions made by Medical Free Electron Laser (MFEL) as a function of scan rate and incision depth. Additionally, we compared biomicroscopy, optical coherence tomography (OCT), and light microscopy as ocular response diagnostic tools.

STUDY DESIGN/MATERIALS AND METHODS

Rabbit corneas were incised with pulsed MFEL radiation at 2.94 microm wavelength, scalpel incisions or focal cautery treatment were used as controls. The MFEL beam scan rate ranged from 0.2 to 1.0 mm/second. Ocular effects were monitored for 2 hours postoperatively using OCT and slit lamp examination. Ocular tissue was fixed for light microscopic examination.

RESULTS

Anterior chamber fibrin formation correlated with MFEL incision depth. Slower scan rates resulted in deeper incisions and greater fibrin formation. OCT was better than slit lamp biomicroscopy at identifying fibrin attachments. OCT and light microscopy proved to be excellent companion technologies.

CONCLUSIONS

Deep corneal incisions in the rabbit produced by the MFEL resulted in fibrin formation in the anterior chamber.