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Phaco-Ersatz is a surgical procedure for restoring accommodation in which the presbyopic crystalline lens is replaced by a flexible polymer gel in the lens capsule. We assessed the feasibility of simultaneously correcting ametropia while restoring accommodation using Phaco-Ersatz by utilizing polymer gel of the appropriate refractive index. Computation results using paraxial equations and ray tracing on two model eyes indicate that although this approach might be feasible for the hypermetrope, its usefulness for correcting myopia is limited, principally due to significant reductions in the resultant amplitude of accommodation.

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BACKGROUND AND OBJECTIVE: The size (0.5-1.0 cm) of early nonpalpable breast tumors currently detected by mammography and confirmed by stereotactic core biopsy is of the order of the penetration depth of near infrared photons in breast tissue. In principle, stereotactically biopsied tumors, therefore, could be safely and efficiently treated with laser thermotherapy. The aim of the current study is to confirm the controlled heating produced by clinically relevant power levels delivered with an interstitial laser fiber optic probe adapted for use with stereotactic mammography and biopsy procedures. STUDY DESIGN/MATERIALS AND METHODS: Temperature increases and the resultant thermal field produced by the irradiation of ex vivo (porcine and human) and in vivo (porcine) tissue models appropriate to the treatment of human breast tissue by using cw Nd:YAG laser radiation delivered with a interstitial fiber optic probe with a quartz diffusing tip, were recorded with an array of fifteen 23-gauge needle thermocouple probes connected to a laboratory computer-based data acquisition system. RESULTS: By using a stepwise decreasing power cycle to avoid tissue charring, acceptably symmetric thermal fields of repeatable volumetric dimensions were obtained. Reproducible thermal gradients and predictable tissue necrosis without carbonization could be induced in a 3-cm-diameter region around the fiber probe during a single treatment lasting only 3 minutes. The time-dependences of the temperature rise of the thermocouples surrounding the LITT probe were quantitatively modeled with simple linear functions during the applied laser heating cycles. CONCLUSION: Analysis of our experimental results show that reproducible, symmetric and predictable volumetric temperature increases in time can be reliably produced by interstitial laser thermotherapy.

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BACKGROUND AND OBJECTIVE: The purpose of this work was to quantify the magnitude of an artifact induced by stainless steel thermocouple probes in temperature measurements made in situ during experimental laser interstitial thermo-therapy (LITT). A procedure for correction of this observational error is outlined. STUDY DESIGN/MATERIALS AND METHODS: A CW Nd:YAG laser system emitting 20W for 25-30 s delivered through a fiber-optic probe was used to create localized heating. The temperature field around the fiber-optic probe during laser irradiation was measured every 0.3 s in air, water, 0.4% intralipid solution, and fatty cadaver pig tissue, with a field of up to fifteen needle thermocouple probes. RESULTS: Direct absorption of Nd:YAG laser radiation by the thermocouple probes induced an overestimation of the temperature, ranging from 1.8 degrees C to 118.6 degrees C in air, 2.2 degrees C to 9.9 degrees C in water, 0.7 C to 4.7 C in intralipid and 0.3 C to 17.9 C in porcine tissue after irradiation at 20W for 30 s and depending on the thermocouple location. The artifact in porcine tissue was removed by applying exponential and linear fits to the measured temperature curves. CONCLUSION: Light absorption by thermocouple probes can induce a significant artifact in the measurement of laser-induced temperature increases. When the time constant of the thermocouple effect is much smaller than the thermal relaxation time of the surrounding tissue, the artifact can be accurately quantified. During LITT experiments where temperature differences of a few degrees are significant, the thermocouple artifact must be removed in order to be able accurately to predict the treatment outcome.

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BACKGROUND AND OBJECTIVE: To quantify and compare holmium:YAG (2.1 microns) and thulium:YAG (2.0 microns) laser-induced scleral shrinkage for retinal buckling procedures. MATERIALS AND METHODS: Two overlapping spots of either laser radiation were applied at the equatorial sclera of 50 human cadaver eyes. Scleral shrinkage was expressed as a relative change of length between two reference points on the scleral surface, and quantified as a function of energy per pulse, total energy, scleral thickness, and intraocular pressure (IOP). Tissue effects were studied histopathologically. RESULTS: Shrinkage was most dependent on total fluence and attained a maximum of 27% to 30% with an IOP of 4 mm Hg, regardless of scleral thickness or laser parameters, but decreased with increasing IOP. The thulium:YAG laser produced more efficient scleral shrinkage and less collagen damage than the holmium:YAG laser. CONCLUSION: The recommended parameters for laser-induced scleral shrinkage are the thulium:YAG laser, with 2.4 J/cm2 per pulse and 12.0 to 14.4 J/cm2 total fluence (5 to 6 pulses). IOP control (< or = 4 mm Hg) is crucial during laser scleral buckling.

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BACKGROUND: This investigation describes the preclinical development of a laser fiberoptic interstitial delivery system for the thermal destruction of small breast cancers. We propose adaptation of this technology to stereotactic mammographic instrumentation currently employed for diagnostic core biopsy to thermally ablate a site of disease with maximal treatment efficacy, minimal observable superficial change, reduced patient trauma, and lowered overall treatment costs. STUDY DESIGN: Laser hyperthermia is a clinical modality that seeks to achieve tumor destruction through controlled tissue heating. The advantage of laser-induced hyperthermia over traditionally used heat sources such as ultrasound, microwave, or radiowave radiation lies in the ability to focus heat localization to the specific tumor tissue site. Neodymium:yttrium aluminum garnet (Nd:YAG) laser light transmitted through a fiberoptic cable to a diffusing quartz tip can induce such temperature increases leading to localized tissue destruction. Because breast cancer occurs with greatest frequency in the mature woman whose breast tissue has undergone glandular involution with fatty replacement, this study concentrates on determining the resultant laser energy heat distribution within fat and fibrofatty tissue. This investigation studied the time-temperature responses of ex vivo human breast and porcine fibrofatty tissue, which led to an in vivo subcutaneous porcine model for the practical demonstration of a laser hyperthermia treatment of small volumes of porcine mammary chain tissue. RESULTS: Spatial recordings of the resultant temperature fields through time exhibited similar, reproducible thermal profiles in both ex vivo human breast and subcutaneous porcine fat. In vivo laser-produced temperature fields in porcine subcutaneous fat were comparable to those in the ex vivo analyses, and showed a histologically, sharply defined, and controllable volume of necrosis with no injury to adjacent tissues or to overlying skin. CONCLUSIONS: Interstitially placed, fiberoptically delivered Nd:YAG laser energy is capable of controlled tissue denaturation to a defined volume for the treatment of small breast cancers. It is hoped that this minimally invasive approach, with further investigation and refinement, may lead to the effective treatment of small, well-defined breast cancers that are commonly diagnosed through stereographic mammography and stereotactic core biopsy. The juxtaposition of such a localized treatment modality with these increasingly used diagnostic tools is of considerable promise.

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BACKGROUND AND OBJECTIVE: 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. STUDY DESIGN/MATERIALS AND METHODS: The output of a frequency-quintupled Nd:YAG laser (213 nm) was transformed into a quasi-Gaussian beam. PMMA and corneal lenticules maintained under controlled hydration were ablated until perforation was detected. RESULTS: The ablation rate of PMMA and cornea at 213 nm were similar to that at 193 nm when radiant exposure was below 200 mJ/cm2 and increased gradually between one and two times faster than that at 193 nm when radiant exposure was > 200 mJ/ cm2. CONCLUSIONS: PMMA and cornea ablation at 213 nm are similar to that at 193 nm and are different from that at 248 nm. The difference between PMMA and cornea ablation rates should be considered when using PMMA to test ablated diopter and smoothness for photorefractive surgery.

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Light of a Nd:YAG laser presented through a fiberoptic cable to a diffusing tip can be adapted to mammographic stereotactic instruments now used for core biopsy in the hyperthermic endoablation of breast cancer. This approach to cancer destruction extends breast preservation to the point of no observable surface skin change. The initial analysis characterizes the effects of laser endohyperthermia in a physical model as well as in tissue, both ex vivo and in vivo, to create a reliable technique that will lead to human trials. A fiberoptic cable with a diffusing quartz tip placed deep within soft tissue can pass light of a neodymium laser and consequent thermal energy for the destruction of surrounding soft tissues. Because breast cancer occurs with greatest frequency in the involuted breasts of women more than 50 years of age and because this tissue is predominantly fibro-fatty in nature, our work has concentrated on model development and the determination of heat distribution and destruction of fat and fibro-fatty tissue. Following the development of a physical model, time-temperature courses were found to be similar in ex vivo human breast tissue and subcutaneous porcine fat. This led to in vivo porcine studies that confirmed similar time-temperature courses. For tissues brought to a range of 60 degrees C to 80 degrees C and sustained for the better part of 20 minutes, gross and histological analyses reveal complete destruction over a 1 1/2 cm radial region around the laser tip. This approach offers great promise for the treatment of stereotactically biopsied small T1 breast carcinomas.

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A prototype frequency-quintupled Nd:YAG laser was used with a scanning system to create, on poly(methylmethacrylate) (PMMA) blocks, ablations corresponding to a correction of 6 diopters of myopia by photorefractive keratectomy. The topography of the ablated samples was measured with an optical profilometer to evaluate the smoothness and accuracy of the ablations. The ablation depth was larger than expected. With a 50% to 70% spot overlap, large valleylike variations with a maximum peak-to-peak amplitude of 20 µm were observed. With an 80% spot overlap, the rms surface roughness was 1.3 µm, and the central flattening was 7 diopters. This study shows that optical profilometry can be used to determine precisely the ablation per pulse and the smoothness and accuracy of surface ablations. Knowing the exact ablation per pulse is necessary to produce a smooth and accurate corneal surface by scanning photorefractive keratectomy.

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The corneal-ablation rate, the beam-intensity distribution, and the initial and the desired corneal topographies are used to calculate a spatial distribution map of laser pulses. The optimal values of the parameters are determined with a computer model, for a system that produces 213-nm radiation with a Gaussian beam-intensity distribution and a peak radiant exposure of 400 mJ/cm(2). The model shows that with a beam diameter of 0.5 mm, an overlap of 80%, and a 5-mm treatment zone, the roughness is less than 6% of the central ablation depth, the refractive error after correction is less than 0.1 D for corrections of myopia of 1, 3, and 6 D and less than 0.4 D for a correction of myopia of 10 D, and the number of pulses per diopter of correction is 2500 when the beam-intensity distribution is Gaussian and 580 when it is flat.

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