Photodisruption

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Photodisruption
Specialty ophthalmology

Photodisruption is a form of minimally invasive surgery used in ophthalmology, utilizing infrared Nd:YAG lasers to form plasma ("lightning bolt"), which then causes acoustic shock waves ("thunderclap") which then in turn affects tissue. [1] [2] [3] The tissue ruptures as a result of the vapor bubble produced by the laser; the temperature required to produce this effect is between 100 and 305 °C. [4]

Because the infrared laser is invisible to the surgeon's eye, typically a companion HeNe laser is used in conjunction. However, the eye lens acts as a prism, so the infrared light bends at a shallower angle than the red light, causing chromatic aberration. This means the area highlighted by the HeNe laser is not precisely the area being affected Nd:YAG laser, and therefore some surgical lasers have an added adjustment to compensate. [2]

The first successful use of photodisruption was in 1972, on a case of trabecular meshwork. [1] Photodisruption came to wide use in the early 1980s for the treatment of extracapsular cataract extraction. [1] The technique is most commonly used for lithotripsy of urinary calculi and the treatment of posterior capsulotomy of the lens. [3] When used in corneal surgery, picosecond and nanosecond disruptors are used on the lamellae of the corneal stroma, and the method may be preferable as it leaves the epithelium and Bowman's layer unharmed. This modifies the outer corneal curvature, which affects the refractive property of the eye. [5]

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<span class="mw-page-title-main">Cataract</span> Clouding of the lens inside the eye causing poor vision

A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or double vision, halos around light, trouble with bright lights, and difficulty seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts cause 51% of all cases of blindness and 33% of visual impairment worldwide.

<span class="mw-page-title-main">Floater</span> Deposits within the eyes vitreous humour

Floaters or eye floaters are sometimes visible deposits within the eye's vitreous humour, which is normally transparent, or between the vitreous and retina. They can become particularly noticeable when looking at a blank surface or an open monochromatic space, such as blue sky. Each floater can be measured by its size, shape, consistency, refractive index, and motility. They are also called muscae volitantes, or mouches volantes. The vitreous usually starts out transparent, but imperfections may gradually develop as one ages. The common type of floater, present in most people's eyes, is due to these degenerative changes of the vitreous. The perception of floaters, which may be annoying or problematic to some people, is known as myodesopsia, or, less commonly, as myodaeopsia, myiodeopsia, or myiodesopsia. It is not often treated, except in severe cases, where vitrectomy (surgery), laser vitreolysis, and medication may be effective.

<span class="mw-page-title-main">Keratoconus</span> Medical condition involving the eye

Keratoconus (KC) is a disorder of the eye that results in progressive thinning of the cornea. This may result in blurry vision, double vision, nearsightedness, irregular astigmatism, and light sensitivity leading to poor quality-of-life. Usually both eyes are affected. In more severe cases a scarring or a circle may be seen within the cornea.

<span class="mw-page-title-main">Pterygium (eye)</span> Pinkish, triangular tissue growth on the cornea of the eye

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<span class="mw-page-title-main">LASIK</span> Corrective ophthalmological surgery

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<span class="mw-page-title-main">Refractive surgery</span> Surgery to treat common vision disorders

Refractive eye surgery is optional eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea (keratomileusis), lens implantation or lens replacement. The most common methods today use excimer lasers to reshape the curvature of the cornea. Refractive eye surgeries are used to treat common vision disorders such as myopia, hyperopia, presbyopia and astigmatism.

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A phakic intraocular lens (PIOL) is a special kind of intraocular lens that is implanted surgically into the eye to correct myopia (nearsightedness). It is called "phakic" because the eye's natural lens is left untouched. Intraocular lenses that are implanted into eyes after the eye's natural lens has been removed during cataract surgery are known as pseudophakic.

<span class="mw-page-title-main">Corneal endothelium</span>

The corneal endothelium is a single layer of endothelial cells on the inner surface of the cornea. It faces the chamber formed between the cornea and the iris.

<span class="mw-page-title-main">Cataract surgery</span> Removal of opacified lens from the eye

Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye that has developed an opacification, which is referred to as a cataract, and usually its replacement with an artificial intraocular lens.

Laser surgery is a type of surgery that uses a laser to cut tissue.

<span class="mw-page-title-main">Pinguecula</span> Medical condition

A pinguecula is a common type of conjunctival stromal degeneration in the eye. It appears as an elevated yellow-white plaque in the bulbar conjunctiva near the limbus. Calcification may also seen occasionally.

<span class="mw-page-title-main">Corneal neovascularization</span> Medical condition

Corneal neovascularization (CNV) is the in-growth of new blood vessels from the pericorneal plexus into avascular corneal tissue as a result of oxygen deprivation. Maintaining avascularity of the corneal stroma is an important aspect of corneal pathophysiology as it is required for corneal transparency and optimal vision. A decrease in corneal transparency causes visual acuity deterioration. Corneal tissue is avascular in nature and the presence of vascularization, which can be deep or superficial, is always pathologically related.

<span class="mw-page-title-main">Pellucid marginal degeneration</span> Degenerative corneal condition

Pellucid marginal degeneration (PMD) is a degenerative corneal condition, often confused with keratoconus. It typically presents with painless vision loss affecting both eyes. Rarely, it may cause acute vision loss with severe pain due to perforation of the cornea. It is typically characterized by a clear, bilateral thinning (ectasia) in the inferior and peripheral region of the cornea, although some cases affect only one eye. The cause of the disease remains unclear.

<span class="mw-page-title-main">Gholam A. Peyman</span> Iranian-American ophthalmologist and retina surgeon known for inventing LASIK eye surgery

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The eye, like any other optical system, suffers from a number of specific optical aberrations. The optical quality of the eye is limited by optical aberrations, diffraction and scatter. Correction of spherocylindrical refractive errors has been possible for nearly two centuries following Airy's development of methods to measure and correct ocular astigmatism. It has only recently become possible to measure the aberrations of the eye and with the advent of refractive surgery it might be possible to correct certain types of irregular astigmatism.

<span class="mw-page-title-main">Corneal opacity</span> Medical condition

The human cornea is a transparent membrane which allows light to pass through it. The word corneal opacification literally means loss of normal transparency of cornea. The term corneal opacity is used particularly for the loss of transparency of cornea due to scarring. Transparency of the cornea is dependent on the uniform diameter and the regular spacing and arrangement of the collagen fibrils within the stroma. Alterations in the spacing of collagen fibrils in a variety of conditions including corneal edema, scars, and macular corneal dystrophy is clinically manifested as corneal opacity. The term corneal blindness is commonly used to describe blindness due to corneal opacity.

Exposure keratopathy is medical condition affecting the cornea of eyes. It can lead to corneal ulceration and permanent loss of vision due to corneal opacity.

References

  1. 1 2 3 Fankhauser, Franz; Kwasniewska, Sylwia (2003). Lasers in Ophthalmology: Basic, Diagnostic, and Surgical Aspects : a Review. Kugler Publications. p. 304. ISBN   9789062991891.
  2. 1 2 Yanoff, Myron; Duker, Jay S.; Augsburger, James J. (2009). Ophthalmology. Elsevier Health Sciences. pp. 44–45. ISBN   9780323043328.
  3. 1 2 Niemz, Markolf H. (2007). Laser-Tissue Interactions: Fundamentals and Applications. Springer Science & Business Media. p. 126. ISBN   9783540721918.
  4. Palanker, Daniel; Blumenkranz, Mark; Weiter, John (2006). "Retinal Laser Therapy: Biophysical Basis and Applications". Retina (4 ed.). Elsevier Mosby. p. 549.
  5. Waynant, Ronald W. (2001). Lasers in Medicine. CRC Press. p. 233. ISBN   9781420040746.