Thermal Collateral Damage in Porcine Corneas After Photoablation With Free Electron Laser

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.

A comparison of mass removal, thermal injury, and crater morphology of cortical bone ablation using wavelengths 2.79, 2.9, 6.1, and 6.45 µm

BACKGROUND AND OBJECTIVE

Previous investigations have reported evidence of wavelength dependence on cortical bone ablation. This study used mid-infrared laser wavelengths generated by a free electron laser (FEL) and mass removal measurements to further examine the ablation efficiency of a wavelength (2.79 microm) not previously reported and three wavelengths (2.9, 6.1, and 6.45 microm) previously demonstrated by crater morphology alone to be efficient for cortical bone removal.

STUDY DESIGN/MATERIALS AND METHODS

The wavelengths examined were provided by an FEL emitting 4 microseconds macropulses consisting of 1-2 picoseconds duration micropulses delivered at 350 picoseconds intervals. The mass removal measurements were conducted by a microbalance, and the collateral thermal injury and crater morphology of cortical bone were examined by light microscopy following standard histologic processing.

RESULTS

The study demonstrated that the highest mass removal was achieved at lambda = 6.1 microm followed by, in order, lambda = 2.9, 6.45, and 2.79 microm. The zones of thermal injury and crater morphology created in cortical bone at the selected wavelengths were examined at the radiant exposure of 28.3 J/cm2. Ablation using lambda = 6.1 microm provided the largest crater size and the least collateral thermal injury. The greatest amount of collateral thermal injury was produced by lambda = 2.79 microm at both the sides and base of the ablation crater.

CONCLUSIONS

The mass removal of cortical bone produced by FEL ablation at selected mid-IR wavelengths was measured as a function of incident radiant exposure. The ablation efficiency was found to be dependent upon wavelength. The lambda = 2.79 microm did not offer any improvement over the other wavelengths evaluated, suggesting that a potential shift in the dynamic optical properties of water during tissue irradiance with the FEL does not present an advantage to the cutting of cortical bone. The lambda = 6.1 microm provided the highest ablation efficiency with deepest crater and the least amount of collateral thermal injury.

Mid-IR laser ablation of articular and fibro-cartilage: a wavelength dependence study of thermal injury and crater morphology

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate areas of collateral thermal injury and crater morphology for evidence of wavelength-dependent effects on the ablation of articular cartilage and fibro-cartilage (meniscus) using selected mid-IR wavelengths produced by a free electron laser.

STUDY DESIGN/MATERIALS AND METHODS

Two types of cartilage, articular cartilage and fibro-cartilage were used in the study. The wavelengths (lambda) evaluated were 2.79, 2.9, 6.1, and 6.45 microm generated by a free electron laser (FEL) using a 4 microseconds macropulse configuration. The zone of thermal injury and crater morphology produced by laser ablation were examined by light microscopy following standard histologic processing.

RESULTS

The zone of thermal injury and crater morphology created in cartilage by the FEL at selected mid-IR wavelengths were examined as a function of incident radiant exposure. Ablation using lambda = 6.1 microm provided the largest crater size for both articular and fibro-cartilage at all radiant exposures. For the zones of collateral thermal injury in articular cartilage, lambda = 6.1 microm produced the least thermal injury at the radiant exposure of 7.6 J/cm2. When the radiant exposure is increased to 20.4 J/cm2, both lambda = 6.1 and 6.45 microm produced less thermal injury than the ablation using lambda = 2.79 and 2.9 microm. The greatest amount of collateral thermal injury was produced by lambda = 2.79 microm for both tissue types.

CONCLUSIONS

The results demonstrate that crater depth and collateral thermal injury produced in articular cartilage and fibro-cartilage are wavelength-dependent with 6.1 microm providing the largest craters at all radiant exposures. The least amount of thermal injury was created in articular cartilage using lambda = 6.1 microm at the radiant exposure of 7.6 J/cm2. Both 6.1 and 6.45 microm wavelengths demonstrated similar amount of thermal injury at 20 J/cm2 that was less than lambda = 2.79 and 2.9 microm at similar fluences. These observations are explained based on the absorption by water and protein in the tissue types studied. It is further observed that the use of crater dimensions may not provide a reliable estimate for the amount of tissue removal provided by an ablation procedure.

Free electron laser ablation of articular and fibro-cartilage at 2.79, 2.9, 6.1, and 6.45 ?m: Mass removal studies

BACKGROUND AND OBJECTIVE

The wavelength and tissue-composition dependence of cartilage ablation was examined using selected mid-infrared laser wavelengths.

STUDY DESIGN/MATERIALS AND METHODS

The mass removal produced by pulsed laser ablation of articular and fibro-cartilage (meniscus) were measured. The wavelengths examined were 2.79, 2.9, 6.1, and 6.45 microm and provided by a free electron laser (FEL) emitting 4 microsecond macropulses consisting of 1-2 picoseconds duration micropulses delivered at 350 picosecond intervals. The measurement of tissue mass removal was conducted using a microbalance during laser ablation.

RESULTS

These studies demonstrated that for articular cartilage the highest mass removal was achieved at lambda = 6.1 microm followed by, in order, lambda = 2.79, 2.9, and 6.45 microm. In comparison, the maximum mass removal for fibro-cartilage was achieved using lambda = 6.1 microm radiation with no statistically significant differences in mass removal provided by the other wavelengths. In evaluation of the comparative influence of each wavelength on tissue type, there was no difference in ablation efficiency between articular and fibro-cartilage at lambda = 6.1 microm. However, the ablation efficiency of articular cartilage was higher than that of fibro-cartilage at both lambda = 2.79 and 2.9 microm. By contrast, lambda = 6.45 microm radiation ablated fibro-cartilage more efficiently than articular cartilage at radiant exposures greater than 12 J/cm2.

CONCLUSIONS

The mass removal of articular and fibro-cartilage produced by FEL ablation at selected mid-IR wavelengths was measured as a function of incident radiant exposure. The ablation efficiency was found to depend on both wavelength and tissue type. The 6.1 microm wavelength was found to provide the highest ablation efficiency for both articular and fibro-cartilage.

Development of an orbital endoscope for use with the free electron laser

PURPOSE

To explore the feasibility of designing, constructing, and testing an orbital endoscope for use with the free electron laser (FEL).

METHODS

An experimental study with an author-designed laser delivery system through an endoscope was conducted. Two adult pig cadavers and 6 fresh human cadavers had orbital endoscopy performed to develop a method of optic nerve sheath fenestration (ONSF) with the FEL. Twelve orbits were used to develop the surgical procedure by comparing visualization media and surgical technique. In the first 7 trials, a different variable was changed; the procedure was then refined in the human cadaver experiments. An ONSF was performed with the FEL (6.45 microm, 30 Hz, 2 to 3 mJ, 250-microm spot size) through a glass hollow wave guide introduced through an endoscope in 4 human cadaver orbits.

RESULTS

Visualization of the orbital structures was clearest with carbon dioxide; sodium hyaluronate did not displace the fat, and saline hydrated the orbital fat. Biopsy forceps alone did not produce a dural window in the four trials that used the forceps. A dural window was made by using the FEL through a glass hollow wave guide adapted to the Olympus HYF-XP endoscope in the second, third, fifth, and sixth human trials with the FEL. Histologic evidence of the ONSF was produced.

CONCLUSIONS

A hollow wave guide capable of transmitting the FEL through an endoscope was successfully constructed. ONSF with the FEL applied through an endoscope is technically feasible. Additional studies are currently examining techniques to improve intraorbital endoscopy.

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.