Surgery with fs-laser in the posterior part of the eye could be useful for separation of tractional epiretinal membrane and vitreous floaters treatment. However, focus degradation occurs near the retina due to induced aberrations by cornea and lens. To overcome this issue, adaptive optics with wavefront sensor and wavefront modulator can be utilized. We demonstrate an alternative concept for image guided femto second laser (fs-laser) surgery in the posterior eye with wavefront sensorless adaptive optics (WFSLAO). Our laboratory setup consists of an 800 nm fs-laser and a superluminescent diode (SLD) with 897.2 nm central wavelength. The SLD is used for optical coherence tomography (OCT) whereby the light for the OCT sample arm and the fs-laser share the same optical path which contains a deformable mirror, scanner and focusing optics. Energy calibrated photodiodes are used to measure the threshold energy for a laser induced optical breakdown inside a water filled chamber that acts as simple eye model. OCT image based metrics were used to determine a set of Zernike polynomials that describe a near optimal deformable mirror state. Such a mirror state improved OCT resolution and at the same time lowered the required fs-laser energy for a laser induced optical breakdown inside the eye model substantially.
While fs-lasers are clinically established for surgery in the anterior eye, their use in the posterior eye is impeded by aberrations and focus position errors. We implemented a laboratory system to investigate whether fs-laser surgery in the posterior eye is made more feasible by aberration correction and tomographic image guidance. Aberration correction is obtained by adaptive optics (AO) and the image guidance is accomplished by optical coherence tomography (OCT). System characteristic measurements and cutting experiments were performed inside an eye model. By aberration correction, wavefront errors were reduced from 270 nm root-mean-square (rms) to 64 nm rms, ignoring Zernike terms for tilts and focus. The Strehl ratio of the assigned point spread function is improved from 0.11 to 0.78. The threshold pulse energy of laser-induced optical breakdown in water is lowered from about 3.0 to about 1.3 μJ measured at the eye model entrance. After laser cutting of a synthetic foil placed 300 μm in front of porcine retinal tissue with the corrected system, postoperative three-dimensional OCT imaging showed no lesions in the tissue. Our results corroborate that AO and OCT will be two essential assistive components for possible clinical systems for fs-laser–based surgery in the posterior eye.
The interaction effect of photodisruption, which is used for dissection of biological tissue with fs-laser pulses, has been intensively studied inside water as prevalent sample medium. In this case, the single effect is highly reproducible and, hence, the method of time-resolved photography is sufficiently applicable. In contrast, the reproducibility significantly decreases analyzing more solid and anisotropic media like biological tissue. Therefore, a high-speed photographic approach is necessary in this case. The presented study introduces a novel technique for high-speed photography based on the principle of chromatic encoding. For illumination of the region of interest within the sample medium, the light paths of up to 12 LEDs with various emission wavelengths are overlaid via optical filters. Here, MOSFET-electronics provide a LED flash with a duration <100 ns; the diodes are externally triggered with a distinct delay for every LED. Furthermore, the different illumination wavelengths are chromatically separated again for detection via camera chip. Thus, the experimental setup enables the generation of a time-sequence of ≤ 12 images of a single cavitation bubble dynamics. In comparison to conventional time-resolved photography, images in sample media like water and HEMA show the significant advantages of this novel illumination technique. In conclusion, the results of this study are of great importance for the fundamental evaluation of the laser-tissue interaction inside anisotropic biological tissue and for the optimization of the surgical process with high-repetition rate fs-lasers. Additionally, this application is also suitable for the investigation of other microscopic, ultra-fast events in transparent inhomogeneous materials.
Fs-lasers are well established in ophthalmic surgery as high precision tools for corneal flap cutting during laser in situ keratomileusis (LASIK) and increasingly utilized for cutting the crystalline lens, e.g. in assisting cataract surgery. For addressing eye structures beyond the cornea, an intraoperative depth resolved imaging is crucial to the safety and success of the surgical procedure due to interindividual anatomical disparities. Extending the field of application even deeper to the posterior eye segment, individual eye aberrations cannot be neglected anymore and surgery with fs-laser is impaired by focus degradation. Our demonstrated concept for image-guided vitreo-retinal fs-laser surgery combines adaptive optics (AO) for spatial beam shaping and optical coherence tomography (OCT) for focus positioning guidance. The laboratory setup comprises an adaptive optics assisted 800 nm fs-laser system and is extended by a Fourier domain optical coherence tomography system. Phantom structures are targeted, which mimic tractional epiretinal membranes in front of excised porcine retina within an eye model. AO and OCT are set up to share the same scanning and focusing optics. A Hartmann-Shack sensor is employed for aberration measurement and a deformable mirror for aberration correction. By means of adaptive optics the threshold energy for laser induced optical breakdown is lowered and cutting precision is increased. 3D OCT imaging of typical ocular tissue structures is achieved with sufficient resolution and the images can be used for orientation of the fs-laser beam. We present targeted dissection of the phantom structures and its evaluation regarding retinal damage.
Although fs-laser surgery is clinically established in the field of corneal flap cutting for laser in situ keratomileusis, surgery with fs-laser in the posterior part of the eye is impaired by focus degradation due to aberrations. Precise targeting and keeping of safety distance to the retina also relies on an intraoperative depth resolved imaging. We demonstrate a concept for image guided fs-laser surgery in the vitreous body combining adaptive optics (AO) for focus reshaping and optical coherence tomography (OCT) for focus position guidance. The setup of the laboratory system consist of an 800 nm fs-laser which is focused into a simple eye model via a closed loop adaptive optics system with Hartmann-Shack sensor and a deformable mirror to correct for wavefront aberrations. A spectral domain optical coherence tomography system is used to target phantom structures in the eye model. Both systems are set up to share the same scanner and focusing optics. The use of adaptive optics results in a lowered threshold energy for laser induced breakdown and an increased cutting precision. 3D OCT imaging of porcine retinal tissue prior and immediately after fs-laser cutting is also demonstrated. In the near future OCT and AO will be two essential assistive components in possible clinical systems for fs-laser based eye surgery beyond the cornea.
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