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Perspektiven der laserassistierten Keratoplastik

Eine aktuelle Übersicht und erste experimentelle Erfahrungen mit dem Pikosekundeninfrarotlaser (λ = 3 µm)

Perspectives of laser-assisted keratoplasty

Current overview and first preliminary results with the picosecond infrared laser (λ = 3 µm)

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Zusammenfassung

Hintergrund

Die vorliegende Arbeit gibt eine Übersicht über den aktuellen Stand der laserassistierten Keratoplastik und beschreibt eine Machbarkeitsstudie zur Anwendung eines neuen Pikosekundenlasers für die applanationsfreie Hornhauttrepanation.

Methoden

Das Verfahren basiert auf einem speziell angepassten Lasersystem (PIRL-HP2-1064 OPA-3000, Attodyne Inc., Kanada), das bei einer Wellenlänge von 3000 ± 90 nm mit einer Pulsdauer von 300 ps und einer Repetitionsrate von 1 kHz arbeitet. Der Pikosekundeninfrarotlaser (PIRL) wird mithilfe eines selbst entwickelten Optiksystems über eine Scannereinheit zur Probe geführt. Die Korneoskleralscheiben wurden vor der Trepanation auf einer künstlichen vorderen Augenkammer fixiert und anschließend unter kontrollierten und stabilen Augeninnendruckverhältnissen mit dem PIRL behandelt.

Ergebnisse

Ein definiertes Ablationsschema, z. B. kreisförmig, linear, rechteckig oder scheibenförmig, kann gewählt und die spezifischen Abmessungen können durch den Benutzer festgelegt werden. Innerhalb dieser Studie wurden kreisförmige und gerade Inzisionen der Hornhaut analysiert. Makroskopische, histologische, konfokal mikroskopische und „Environmental scanning electron microscopy“ (ESEM)-Untersuchungen wurden zur Charakterisierung der Schnittqualität durchgeführt. Mithilfe des PIRL konnten reproduzierbar und stabil Inzisionen in der humanen und porcinen Hornhaut bei minimaler Schädigung des umliegenden Gewebes ausgeführt werden.

Schlussfolgerungen

Die Laserstrahlung des PIRL, die im mittleren infraroten Spektralbereich (λ = 3 µm) exakt auf eine Vibrationsanregungsbande des Wassermoleküls abgestimmt ist, dient als effektives Hilfsmittel zur applanationsfreien Trepanation der Hornhaut und erweitert damit das Instrumentarium der Hornhauttransplantationschirurgie.

Abstract

Background

This article provides a review of the current state of laser-assisted keratoplasty and describes a first proof of concept study to test the feasibility of a new mid-infrared (MIR) picosecond laser to perform applanation-free corneal trephination.

Methods

The procedure is based on a specially adapted laser system (PIRL-HP2-1064 OPA-3000, Attodyne, Canada) which works with a wavelength of 3,000 ± 90 nm, a pulse duration of 300 ps and a repetition rate of 1 kHz. The picosecond infrared laser (PIRL) beam is delivered to the sample by a custom-made optics system with an implemented scanning mechanism. Corneal specimens were mounted on an artificial anterior chamber and subsequent trephination was performed with the PIRL under stable intraocular pressure conditions.

Results

A defined corneal ablation pattern, e.g. circular, linear, rectangular or disc-shaped, can be selected and its specific dimensions are defined by the user. Circular and linear ablation patterns were employed for the incisions in this study. Linear and circular penetrating PIRL incisions were examined by macroscopic inspection, histology, confocal microscopy and environmental scanning electron microscopy (ESEM) for characterization of the incisional quality. Using PIRL reproducible and stable incisions could be made in human and porcine corneal samples with minimal damage to the surrounding tissue.

Conclusion

The PIRL laser radiation in the mid-infrared spectrum with a wavelength of 3 µm is exactly tuned to one of the dominant vibrational excitation bands of the water molecule, serves as an effective tool for applanation-free corneal incision and might broaden the armamentarium of corneal transplant surgery.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S.J. Linke, L. Ren, A. Frings, J. Steinberg, W. Wöllmer, T. Katz, R. Reimer, N.O. Hansen, N. Jowett, G. Richard und R.J. Dwayne Miller geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland

    S.J. Linke, A. Frings, J. Steinberg, T. Katz & G. Richard

  2. CareVision/Clinica Baviera Deutschland, Hamburg, Deutschland

    S.J. Linke & T. Katz

  3. Max Planck Institut für strukturelle Dynamik der Materie, Hamburg, Deutschland

    L. Ren, N.O. Hansen, N. Jowett & R.J. Dwayne Miller

  4. Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland

    W. Wöllmer & N. Jowett

  5. Leibniz Institut für experimentelle Virologie, Heinrich-Pette Institut, Universität Hamburg, Hamburg, Deutschland

    R. Reimer

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  1. S.J. Linke
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  2. L. Ren
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  3. A. Frings
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  4. J. Steinberg
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  6. T. Katz
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  9. N. Jowett
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  10. G. Richard
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  11. R.J. Dwayne Miller
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Correspondence to S.J. Linke.

Additional information

__ ____

Diese Studie wurde durch einen European Research Council Advanced Investigator Grant „Miller: ERC-adG-2011-291630: SUREPIRL, Picosecond Infrared Laser for Scarfree Surgery with Preservation of Tissue Structure and Recognition of Tissue Type and Boundaries“ gefördert.

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Linke, S., Ren, L., Frings, A. et al. Perspektiven der laserassistierten Keratoplastik. Ophthalmologe 111, 523–530 (2014). https://doi.org/10.1007/s00347-013-2995-7

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