Evaluating the efficacy of Nd:YAG fourth harmonic (266 nm) in comparison with ArF excimer (193 nm) in laser corneal reshaping: ex vivo pilot study.

PURPOSE: Laser corneal reshaping is a common eye surgery utilized to overcome many vision disorders. Different UV laser wavelengths can be effective in the treatment. However, the ArF excimer laser (193 nm) is the most commonly used due to its high absorption in the cornea. In the current study, we investigate the efficacy of applying a solid-state laser (Nd:YAG fourth harmonic at 266 nm) for the corneal reshaping procedure. METHODS: The utilized laser is generated using an optical setup based on a BBO nonlinear crystal which converts the Q-switched laser (532 nm) to its fourth harmonic (266 nm). Different pulse energies were applied with the same number of the shoots on ex vivo rabbit corneas, and the histological effect is studied. Moreover, the possible thermal damage on the treated corneal tissues was inspected via electron microscope. Additionally, the DNA damage on the corneal cells due to the application of the proposed laser was examined and compared with the existing technology (ArF Excimer laser at 193 nm) using the comet assay. RESULTS: The histological examination revealed an appropriate ablation result with the minimum thermal effect at 1.5 mJ and 2.0 mJ. The overall results show that applying 50-shoots of the 1.5-mJ pulse energy using the proposed 266-nm solid-state laser produces the optimum ablation effect with the minimum thermal damage, and almost the same DNA damage occurred using the commercial 193-nm ArF excimer laser. CONCLUSION: Solid-state laser at 266 nm could be a good alternative to the common 193-nm excimer laser for corneal reshaping procedures.

Nd:YAG fourth harmonic (266-nm) generation for corneal reshaping procedure: An ex-vivo experimental study.

Corneal reshaping is a common medical procedure utilized for the correction of different vision disorders relying on the ablation effect of the UV pulsed lasers, especially excimer lasers (ArF) at 193 nm. This wavelength is preferred in such medical procedures since laser radiation at 193 nm exhibits an optimum absorption by corneal tissue. However, it is also significantly absorbed by the water content of the cornea resulting in an unpredictability in the clinical results, as well as the high service and operation cost of the commercial ArF excimer laser device. Consequently, other types of solid-state UV pulsed lasers have been introduced. The present work investigates the ablation effect of solid-state laser at 266 nm in order to be utilized in corneal reshaping procedures. Different number of pulses has been applied to Polymethyl Methacrylate (PMMA) and ex-vivo rabbit cornea to evaluate the ablation effect of the produced laser radiation. PMMA target experienced ellipse-like ablated areas with a conical shape in the depth. The results revealed an almost constant ablation area regardless the number of laser pulses, which indicates the stability of the produced laser beam, whereas the ablation depth increases only with increasing the number of laser pulses. Examination of the ex-vivo cornea showed a significant tissue undulation, minimal thermal damage, and relatively smooth ablation surfaces. Accordingly, the obtained 266-nm laser specifications provide promising alternative to the traditional 193-nm excimer laser in corneal reshaping procedure.

Assessing the local temperature of human cornea exposed to surface ablation by different laser refractive-surgery devices: a numerical comparative study.

To evaluate the local temperature at corneal tissue after applying single laser pulse from six commercial devices; Medilex™, Katana laser-soft, MEL90, Technolas-Teneo317, Alcon EX500, and PulzarTMZ1. The temperature distribution is simulated using finite element solution of the Penne's bio-heat transfer equation on a 3-D model of human cornea using the manufacturer's assigning parameters. The obtained results showed that the heating effect of Katana laser soft is 40% lower than MEL90 and Pulzar™ Z1, while the broad beam Medilex™ showed the minimum temperature rise especially at 248-nm laser radiation. The change in laser parameters selected for ablation has significant effect on the corneal local temperature. The broad beam-based device produces lower local corneal temperature than other flying spot types.

Dependence of the heating effect on tissue absorption coefficient during corneal reshaping using different UV lasers: A numerical study.

Corneal reshaping using laser ablation effect is a well-known ophthalmologic operation implemented to correct many vision disorders. UV pulsed lasers are utilized in this surgery due to their high absorption in corneal tissue without affecting the other parts of the eye. Ideally ablation may not be associated with heat transport, since high temperature is the enemy of soft tissues. However, the thermal effect of this procedure can cause tissue damage if the temperature rises above the safety level without appropriate handling. In the present study, we try to find the trade-off between efficient ablation and minimal temperature rise. So the thermal effect on the corneal tissue after applying five UV wavelengths; 193, 210, 213, 223 and 248 nm has been simulated and investigated by solving Penne's bio-heat transfer equation using the finite element method. A 3D model of the human cornea is constructed using COMSOL Multiphysics computer software and the temperature rise is determined at the end of the laser pulse. The same spot size and pulse duration are used for each wavelength. While the absorption coefficient of the corneal tissue is the only variable as it is a wavelength dependent. The proposed results show that, the heating effect is directly proportional to the absorption coefficient. The highest recorded temperature was 259 °C at 193 nm, while, the minimum value was (70.1 °C) recorded at 248 nm at which the cornea has the lowest absorption coefficient.