We used optical coherence tomography (OCT) for non-invasive imaging of the anterior segment of the eye for
investigating partial-thickness scleral channels created with a femtosecond laser. Glaucoma is associated with elevated
intraocular pressure (IOP) due to reduced outflow facility in the eye. A partial-thickness aqueous humor (AH) drainage
channel in the sclera was created with 1.7-&mgr;m wavelength femtosecond laser pulses to reduce IOP by increasing the
outflow facility, as a solution to retard the progression of glaucoma. It is hypothesized that the precise dimensions and
predetermined location of the channel would provide a controlled increase of the outflow rate resulting in IOP reduction.
Therefore, it is significant to create the channel at the exact location with predefined dimensions. The aim of this
research has two aspects. First, as the drainage channel is subsurface, it is a challenging task to determine its precise
location, shape and dimensions, and it becomes very important to investigate the channel attributes after the laser
treatment without disturbing the internal anterior structures. Second, to provide a non-invasive, image-based verification
that extremely accurate and non-scarring AH drainage channel can be created with femtosecond laser. Partial-thickness
scleral channels created in five human cadaver eyes were investigated non-invasively with a 1310-nm time-domain OCT
imaging system. Three-dimensional (3D) OCT image stacks of the triangular cornea-sclera junction, also known as
anterior chamber angle, were acquired for image-based analysis and visualization. The volumetric cutting-plane
approach allowed reconstruction of images at any cross-sectional position in the entire 3D volume of tissue, making it a
valuable tool for exploring and evaluating the location, shape and dimension of the channel from all directions. As a
two-dimensional image-based methodology, an image-processing pipeline was implemented to enhance the channel
features to augment the analysis. In conclusion, we successfully demonstrate that our image-based visualization tool is
appropriate for effective investigation and evaluation of femtosecond laser-created, partial-thickness aqueous humor
drainage channels in the sclera.
Photodisruption of femtosecond laser at 1700nm wavelength has been demonstrated
as a potential subsurface surgical method that can be used in trabeculectomy for
glaucoma treatment without causing failure due to scarring at the level of conjunctiva
and underlying tissue [1, 2]. In this study, Fourier domain optical coherence
tomography (FD-OCT) technology is used to demonstrate high speed non-invasive
imaging of high precision photodisruption in human sclera. Photodisruption cavities
of different size in human sclera can reveal itself in its 3D FDOCT image. Transclera
channel cut from back to surface and partial transclera channel are easily identified in
3D OCT image. The whole 3D data set acquired with high speed frequency domain
OCT system permits further quantitative analysis of subsurface phtodisruption
incisions. The preliminary results indicate that high speed frequency domain OCT
system is a good candidate for imaging subsurface photodisruption with femtosecond
laser and its 3D image may provide good guidance during surgical procedures when it
is integrated with laser ablation system.
The reduced outflow rate caused by the increased resistance through trabecular meshwork (TM) has been thought to be the main reason for elevated intraocular pressure (IOP). It has been demonstrated that femtosecond laser pulses tuned to 1.7 μm wavelength can create the partial thickness channel in the sclera in ex vivo human eyes [1] and aqueous outflow can be increased by these channels in porcine eyes [2]. It was also shown that the outflow rate is reduced over time in ex vivo human eyes [3]. Therefore, the control experiment without laser treatment at the same condition was conducted and showed that outflow was reduced by 1.5 ± 0.8 μl/min at 15mmHg and 1.8 ± 1.0 μl/min at 25mmHg. However, the outflow rate increased by 0.26 μl/min at 15mmHg and 0.15 μl/min at 25mmHg after the partial thickness channel was created, meaning the amount of increased outflow rate might be more than measured considering the outflow reduction in control experiment. We suggest that the femtosecond laser created partial thickness channel can increase the outflow rate and delay the progression of glaucoma.
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