Martinez M, Maguen E, Bardenstein D, Duffy M, Yoser S, Papaioannou T, Grundfest W
Ophthalmology Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Refract Corneal Surg. 1992 Sep-Oct;8(5):368-74.
Photoablation with excimer lasers has demonstrated precise tissue cutting and minimal thermal damage. Potential ophthalmic applications of these lasers include remodelling of the corneal surface, glaucoma treatment, and phacoablation. Ablation of human lens with a 308 nm XeCl excimer laser light delivered through a fiber has been demonstrated in preliminary experiments. Intraocular delivery of laser light must be done in a fluid medium to preserve the integrity of ocular structures. However, little information is available on the effect of the fluid media on the ablation process. Therefore, a series of experiments was conducted to determine whether the ablation of human lens nucleus at 308 nm via a fiber differs in air and saline media.
Ablation of human lens nuclei (n = 30) was conducted with a XeCI excimer laser (308 nm) coupled to a 600 microns core size fiber. Irradiation was performed at 2.8 mJ/cm2 energy density and 20 Hz. The fiberoptic was brought to contact with the lens nucleus and remained fixed for the duration of irradiation. Variables consisted of the medium (air or saline) and number of pulses delivered (100 to 10,000). Following establishment of the tissue shrinkage ratio, the depth of each crater and the tissue volume removed were measured histologically. The histological features of nucleus ablation in air and in saline were also examined with both light and scanning electron microscopy.
Light microscopy revealed that the average zone of thermal damage adjacent to the crater is thinner in the presence of saline (60 microns, SD = 6 microns) than it is in air (90 microns, SD = 12 microns). In both media, the thickness of the zone of thermal damage is greater at the surface than it is at its base. Following irradiation in air, deep sharpedged craters with smooth walls are formed. Craters formed by irradiation in saline are characterized by reduced depth and irregular walls. For the same number of pulses applied (500, 1000, and 2000), the mean depth of ablation per pulse in air (8.6 to 2.7 microns/pulse) was greater by approximately a factor of two than that in saline (4.10 to 1.30 microns/pulse) at P < .01. However, the mean ablated volume removed per pulse was greater in saline (0.00250 to 0.00150 mm3/pulse) than in air (0.00120 to 0.00080 mm3/pulse), for the same number of pulses (1000, 2000) at P < .01.
In comparing the data for the same number of pulses applied in air and in saline, it appears that the depth of crater formed by irradiation in air is deeper than that in fluid. The overall volume ablated is greater in fluid than it is in air at 1000 and 2000 pulses. Additionally, the zone of thermal damage is thinner in the presence of saline than it is in air. Smoother crater shapes were observed following irradiation in air than in saline. These results suggest that under this specific experimental setup, the ablation in saline is different from that in air.
准分子激光光消融已显示出精确的组织切割和最小的热损伤。这些激光在眼科的潜在应用包括角膜表面重塑、青光眼治疗和超声乳化。在初步实验中已证明通过光纤输送308nm XeCl准分子激光对人晶状体进行消融。眼内激光输送必须在流体介质中进行以保持眼结构的完整性。然而，关于流体介质对消融过程的影响，目前可用信息很少。因此，进行了一系列实验以确定通过光纤在308nm下对人晶状体核的消融在空气和盐溶液介质中是否存在差异。
用耦合到600微米芯径光纤的XeCI准分子激光（308nm）对人晶状体核（n = 30）进行消融。以2.8mJ/cm²的能量密度和20Hz进行照射。将光纤与晶状体核接触并在照射期间保持固定。变量包括介质（空气或盐溶液）和输送的脉冲数（100至10,000）。在确定组织收缩率后，通过组织学测量每个弹坑的深度和去除的组织体积。还通过光学显微镜和扫描电子显微镜检查了在空气和盐溶液中晶状体核消融的组织学特征。
光学显微镜显示，在盐溶液存在下，弹坑相邻的平均热损伤区（60微米，标准差 = 6微米）比在空气中（90微米，标准差 =
