Jin H. Shen

Optic nerve sheath fenestration with a novel wavelength produced by the free electron laser (FEL).

To determine whether 6.45‐μm free electron laser (FEL) energy can successfully perform optic nerve sheath fenestration and to compare the acute and chronic cellular responses with this surgery.

Endoscopic goniotomy with the free electron laser in congenital glaucoma rabbits.

Purpose: Goniotomy is a surgical treatment of choice to treat primary infantile glaucoma. Goniotomy has been studied in vitro in animal and human cadaver eyes with several lasers. The objective of this study was to investigate the functional and morphologic effectiveness of goniotomy with the free electron laser in comparison with conventional needle goniotomy in early congenital glaucoma rabbits. Materials and Methods: Ten rabbits with early congenital glaucoma underwent goniotomy over 100 to 120° with a needle or the free electron laser. The wavelength was 6.45 μm, and the energy level ranged from 2.2 to 3.5 mJ at 30 Hz. Because most corneas were edematous in these rabbits, an Olympus 0.8‐mm diameter endoscope was coupled to the laser waveguide or the needle and inserted into the anterior chamber filled with a viscoelastic material to perform the goniotomy. Intraocular pressures were followed up to 3 weeks before an acute goniotomy was performed in the contralateral eye. All eye specimens were processed for light microscopic evaluation. Results: Incision of the pectinate ligaments and underlying trabecular meshwork was visualized through the endoscope on a video monitor during the surgeries. The mean intraocular pressure decreased after free electron laser goniotomy and after needle goniotomy, and the edematous corneas became clear in some cases. Histologic study showed successful lysing of the pectinate ligaments by the free electron laser with no obvious collateral thermal damage. However, some areas of peripheral anterior synechiae occurred. Similar results were observed in needle goniotomy cases. Conclusions: The free electron laser is capable of performing goniotomy in rabbit eyes with lower intraocular pressures in treated eyes 3 weeks after surgery. The histologic results of free electron laser goniotomy are comparable to those of conventional goniotomy. The endoscope provides beneficial visualization to perform the goniotomy in eyes with edematous corneas. The rabbit with early congenital glaucoma is also a useful infantile glaucoma surgical model.

Hollow-glass waveguide delivery of an infrared free-electron laser for microsurgical applications

The purpose of this research is to deliver free-electron-laser (FEL) pulses for intraocular microsurgery. The FEL at Vanderbilt University is tunable from 1.8 to 10.8 microm. To deliver the FEL beam we used a metallic-coated hollow-glass waveguide of 530-mum inner diameter. A 20-gauge cannula with a miniature CaF2 window shielded the waveguide from water. Open-sky retinotomy was performed on cadaver eyes. The system delivered as much as 6 x 10(5) W of FEL peak power to the intraocular tissues without damage to the waveguide or to the surgical probe.

Ablation rate of PMMA and human cornea with a frequency-quintupled Nd: YAG laser (213 nm)

As an alternative to the standard excimer laser used for PRK, we investigated the ablation rate at 213 nm of PMMA, and human corneas under controlled hydration.

Miniature forward‐imaging B‐scan optical coherence tomography probe to guide real‐time laser ablation

Investigations have shown that pulsed lasers tuned to 6.1 µm in wavelength are capable of ablating ocular and neural tissue with minimal collateral damage. This study investigated whether a miniature B‐scan forward‐imaging optical coherence tomography (OCT) probe can be combined with the laser to provide real‐time visual feedback during laser incisions.

Experimental Retinectomy with a 6.1 μm Q-switched Raman-shifted Alexandrite Laser

Purpose: It is hypothesized that 6.1 μm produced by a portable laser would be useful for incising tissue layers such as performing a retinectomy in detached retina with extensive anterior proliferative vitreoretinopathy. Methods: An alexandrite laser system, which provides a high-intensity Q-switched pulse (780 nm, 50-100 ns duration, 10 Hz), is wavelength-shifted by a two-stage stimulated Raman conversion process into the 6-7 μm range (Light Age, Inc.). Fresh cadaver porcine retinas were lased with 6.1 μm using a 200 μm diameter spot at 0.6 mJ after removal of the vitreous. Specimens were examined grossly and prepared for histological examination. Results: The Raman-shifted alexandrite laser produced a smooth Gaussian profile. A narrow spectrum was produced at 6.1 μm. A full-thickness retinal incision with minimal thermal damage was obtained at a low energy level of 0.6 mJ in the retinas. However, the depth of the incision did vary from an incomplete incision to a full-thickness incision involving the underlying choroidal layer in attached retinas. Conclusions: The 6.1 μm mid-infrared energy produced by a portable laser is capable of incising detached retinas with minimal thermal damage.

Optic nerve sheath fenestration using a Raman‐shifted alexandrite laser

Optic nerve sheath fenestration is an established procedure for relief of potentially damaging overpressure on the optic nerve resulting from idiopathic intracranial hypertension. Prior work showed that a mid‐IR free‐electron laser could be delivered endoscopically and used to produce an effective fenestration. This study evaluates the efficacy of fenestration using a table‐top mid‐IR source based on a Raman‐shifted alexandrite (RSA) laser.

Design and evaluation of an intraocular B-scan OCT-guided 36-gauge needle

Optical coherence tomography imaging is widely used in ophthalmology and optometry clinics for diagnosing retinal disorders. External microscope-mounted OCT operating room systems have imaged retinal changes immediately following surgical manipulations. However, the goal is to image critical surgical maneuvers in real time. External microscope-mounted OCT systems have some limitations with problems tracking constantly moving intraocular surgical instruments, and formation of absolute shadows by the metallic surgical instruments upon the underlying tissues of interest. An intraocular OCT-imaging probe was developed to resolve these problems. A disposable 25-gauge probe tip extended beyond the handpiece, with a 36-gauge needle welded to a disposable tip with its end extending an additional 3.5 mm. A sealed 0.35 mm diameter GRIN lens protected the fiber scanner and focused the scanning beam at a 3 to 4 mm distance. The OCT engine was a very high-resolution spectral-domain optical coherence tomography (SDOCT) system (870 nm, Bioptigen, Inc. Durham, NC) which produced 2000 A-scan lines per B-scan image at a frequency of 5 Hz with the fiber optic oscillations matched to this frequency. Real-time imaging of the needle tip as it touched infrared paper was performed. The B-scan OCT-needle was capable of real-time performance and imaging of the phantom material. In the future, the B-scan OCT-guided needle will be used to perform sub-retinal injections.