Anterior stromal puncture with the Nd:YAG laser.

A simple and consistent puncture of the anterior stroma was created with the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in a rabbit model. Varying energy levels were tested, and settings at 2.0 mJ produced well-formed anterior stromal breaks. The laser shock wave disrupted Descemet's membrane in only 1 of 50 animals. The wound healed normally in vivo over a 3-month period. Compared to needle puncture, the laser puncture created less stromal scarring. Initial human studies also showed that energy levels from 1.5-2.5 mJ were sufficient to create local breaks in Bowman's layer. Further human studies will be needed to determine if Nd:YAG laser puncture offers any advantages over current techniques for stromal puncture in the treatment of traumatic recurrent corneal erosions.