Burn wound assessment in porcine skin using indocyanine green fluorescence.

BACKGROUND: An accurate assessment of deep dermal burns within the first week after burn is still an unresolved clinical problem. Infrared-excited fluorescence of indocyanine green was examined as a method of early determination of burn depth. METHODS: Burns of varying depths were placed on the paraspinal region, flank, and abdomen of swine using a heated brass block. Fluorescence images of the burns were recorded 1, 24, 48, and 72 hours later. RESULTS: The ratio of fluorescence in 64 burn wounds relative to adjacent normal tissue identified wounds that healed and did not heal within 21 days with an accuracy of 100%, after accounting for the age of the burn. Higher fluorescence ratios were observed in newly placed burns relative to older burns having comparable depths. CONCLUSION: Deep partial-thickness burns were differentiated from deep dermal full-thickness burns in a porcine skin burn model independent of body location. Diagnosis was possible between 1 and 72 hours after injury.

Automated retinal robotic laser system.

Researchers at the University of Texas and the USAF Academy have worked toward the development of a retinal robotic laser system. The overall goal of this ongoing project is to precisely place and control the depth of laser lesions for the treatment of various retinal diseases such as diabetic retinopathy and retinal tears. Separate low speed prototype subsystems have been developed to control lesion depth using lesion reflectance feedback parameters and lesion placement using retinal vessels as tracking landmarks. Both subsystems have been successfully demonstrated in vivo on pigmented rabbits using an argon continuous wave laser. Recent efforts have concentrated on combining the two subsystems into a single prototype capable of simultaneously controlling both lesion depth and placement. We have designated this combined system CALOSOS for Computer Aided Laser Optics System for Ophthalmic Surgery. Following the dual-use concept, this system is being adapted for clinical use as a retinal treatment system as well as a research tool for military laser-tissue interaction studies.

Automated lesion placement in the rabbit eye.

BACKGROUND AND OBJECTIVE: The objective of this research was to build a prototype feedback control system to precisely place argon laser lesions on the retina for treatment of retinal disorders. STUDY DESIGN/MATERIALS, AND METHODS: The prototype feedback control system was tested by placing lesions at specific locations on the retina of pigmented rabbits to simulate the treatment of diabetic retinopathy, retinal breaks or tears, and a pre-programmed, two-dimensional array of lesions was placed at a specific site. RESULTS: Results of feedback-controlled lesion placement performed in vivo on pigmented rabbits are presented. The ability to place lesions with automated feedback control is demonstrated. CONCLUSION: Automated feedback control placement of argon laser lesions is possible at a reasonable cost and has numerous therapeutic and safety benefits over current ballistic delivery.

Preliminary results on reflectance feedback control of photocoagulation in vivo.

The size of therapeutic laser-induced retinal lesions is critical for effective treatment and minimal complications. Due to tissue variability, the size of a lesion that results from a given set of laser irradiation parameters cannot be predicted. Real time feedback control of lesion size is implemented based on two-dimensional reflectance images acquired during irradiation. Preliminary results of feedback controlled lesions formed in pigmented rabbits demonstrate an ability to produce uniform lesions despite variations in tissue absorption or changes in laser power.

Reflectance feedback control of photocoagulation in vivo.

OBJECTIVE: The objective of this research was to build a real-time feedback system that controlled lesion size. Two-dimensional reflectance images were acquired with a charge-coupled device camera during irradiation, and argon laser exposure was ended when parameters of the image reached prespecified values. METHODS: The real-time feedback control system was tested by creating lesions at different power levels in pigmented rabbits. Laser exposure time was controlled by monitoring the central reflectance. RESULTS: Results of feedback-controlled lesions formed in vivo in pigmented rabbits are presented. An ability to produce uniform lesions despite variation in tissue absorption or changes in laser power is demonstrated. CONCLUSIONS: Reflectance control of photocoagulation is possible; incorporation of feedback during photocoagulation has numerous therapeutic and safety benefits over current ballistic delivery.

Calibrated real-time control of lesion size based on reflectance images.

Lesion size induced by laser photocoagulation is controlled in real time based on a two-dimensional reflectance image recorded by a CCD array during lesion formation. A feedback system using components of the reflectance image achieves uniform lesions by compensating for light absorption variability in biological media. Lesions are formed in a phantom by an argon laser to simulate retinal photocoagulation. The tissue model consists of a thin absorptive layer covered by a clear albumin protein layer. Results show a low variance in the sizes of the lesions (diameter or depth) produced in different irradiation conditions and the ability to produce lesions of a predefined size in varying illumination conditions.

Dynamic optical property changes: implications for reflectance feedback control of photocoagulation.

During laser treatment, coagulation affects the optical properties of the tissue. In particular, the formation of a white lesion significantly increases the scattering coefficient. This change in the optical properties in turn affects the laser light distribution in the tissue. The white lesion formed during photocoagulation of the retina has a dynamic effect upon reflection and fluence rate. This problem has been simulated on a model medium consisting of a thin absorbing layer covered with a 1 cm thick layer of albumin. The albumin layer is subdivided into coagulated (white) and uncoagulated (clear) layers. The optical properties of each layer have been determined and these values have been used to model light distribution in the medium. One-dimensional adding-doubling and three-dimensional Monte Carlo methods have provided light distributions in the medium for varying thicknesses of the coagulated albumin. Computed fluence reaching the absorbing layer decreased in the presence of a 275 microns or thicker coagulated layer. The coagulated layer attenuates light because it is highly scattering; however, this scattering also leads to a sub-surface peak in fluence rate at a level higher than the incident fluence. The latter effect outweighed the former for coagulated layer thicknesses less than 275 microns. Computed reflectance of argon laser light from a semi-infinite coagulated region initially increased linearly as a function of thickness. As the coagulation thickness increased beyond 4-5 optical depths, the reflectance approached a constant value, R infinity, at 9 optical depths (2 mm). Experimentally measured total reflectance is shown to be an inadequate indicator of the thickness of a lesion (finite coagulated volume); however, central reflectance from a lesion measured with a CCD camera confirmed the computed trends. These results provide a theoretical foundation for control of lesion thickness using reflectance images.