Non-contact direct selective laser trabeculoplasty: light propagation analysis.

Selective laser trabeculoplasty (SLT), used to treat glaucoma and ocular hypertension, requires the use of a gonioscope placed on the cornea to visualize and irradiate the trabecular meshwork (TM). Alternatively, non-contact direct SLT (DSLT) irradiates the TM through the overlying tissues. Here we analyze this innovative procedure using analytical modeling and Monte Carlo simulations to quantify the laser energy reaching the TM through the overlying tissues. Compared with energy launched from the laser, DSLT energy transmission to the TM is 2.8 times less than SLT, which verifies the efficacy of non-contact DSLT given the lowest reported effective SLT energies.

Subsurface photodisruption in human sclera: wavelength dependence.

BACKGROUND AND OBJECTIVE: Approximately 105 million people worldwide have glaucoma, and approximately 5 million are blind from its complications. Current surgical techniques often fail because of scarring of the conjunctival tissue, Tenon's tissue, or both. Femtosecond lasers can create highly precise incisions beneath the surface of a tissue, as previously demonstrated in the transparent cornea. Because the sclera is a highly scattering subsurface, photodisruption has not been previously possible. MATERIALS AND METHODS: To overcome scattering, a laser operating at 1,700 nm was used to make subsurface cuts in human sclera in vitro via photodisruption. RESULTS: Sub-10-microm width incisions were created beneath the surface without collateral tissue effects, something not possible with shorter wavelengths used to date in corneal applications with the femtosecond laser. CONCLUSION: Completely subsurface photodisruptions can be accomplished in human sclera in vitro. In vivo studies are required to evaluate the potential use of this technology for scleral applications.

High precision subsurface photodisruption in human sclera.

BACKGROUND AND OBJECTIVES: Femtosecond pulses can generate high precision subsurface photodisruption in transparent tissues, such as the cornea. We used femtosecond laser technology to demonstrate early proof of concept for high precision subsurface photodisruption in the translucent sclera. This technique may ultimately enable novel surgical procedures for the treatment of glaucoma and/or presbyopia. STUDY DESIGN/METHODS AND MATERIALS: Microjoule femtosecond pulses from two different sources, 1060 and 775 nm, were used to make subsurface incisions in human sclera in vitro. Scleral tissue was dehydrated to improve translucency at these wavelengths. The beam was focused to a 1.5 (775 nm) or 5 microm spot size (1060 nm) and scanned below the tissue surface at various depths to produce four incision patterns. RESULTS: Photodisruption on the backsurface of the sclera was achieved without damage to overlying tissue. Several types of intrascleral incisions were made, including transcleral channels and grooves for scleral implants. CONCLUSIONS: High precision, subsurface scleral photodisruption can be achieved in vitro for a variety of intrascleral incisions. Further studies are required to determine if this technique is applicable in vivo for actual surgical applications.