Lasers in Ophthalmology

Laser in
Ophthalmology
Mohammed Bader Al –Jaryan
CABOpht, FICMS(Ophth), FICO
MRCS Glas.(Ophth),MRCS Ed (Ophth)
Objectives
At the end of the lecture, students should be

able to:
• Properties of laser
• Classification of laser
• Effects of laser on living tissues
• Uses of laser in ophthalmology
LASER
• Laser: Light Amplification by Stimulated
Emission of Radiation.
• Properties of laser
– Monochromatic: single wavelength and eliminates
chromatic aberration.
– Coherent beam in phase and wave form with each
other
– Collimated: parallel rays with limited divergence.
Classifications of Laser
• According to the emitted wavelength:
– Visible LASER: lying in visible portion of
spectrum, e.g. double frequency YAG laser with a
wavelength 488-514nm
– Invisible LASER: lying either in ultraviolet portion

of the spectrum (e.g. Excimer laser with a wave
length 193nm) or in the infrared portion (e.g.
Carbon dioxide LASER with a wave length 10600
nm and YAG LASER with a wavelength 1064 mm)
• According to the state of the active medium of
LASER
– Solid state LASER: as YAG LASER

– Liquid state LASER: as dye laser
– Gas state LASER: as excimer , CO₂ LASER and
Argon LASER .
The Basic Components of LASER System
• Power source: generate energy.

• Active medium: with special properties to
emit photons ( solid, liquid or gas)
• Chamber: which stores active medium, with
mirrors at opposite end to reflect energy back
and forth( optical feedback) and one of these
mirrors partially transmit energy
Effects of LASER Energy on Tissue
• Photocoagulation ( thermal effect) : Temperature
is raised to 65-80 C°, resulting in coagulation of
proteins, the clinical effect is burn tissues.(e.g.
Argon LASER)
• Photo-disruption: Temperature is raised to 100-
350 C°, resulting in destruction of interatomic
forces ( electrons stripped from atoms) , clinical
effect is cutting of tissues.(e.g. ND:YAG laser)
• Photochemical :
– Photoablation: no release of heat , long-chain
tissue polymers into smaller volatile fragments;
clinical effect is tissue removal. (e.g. excimer
LASER).
– Photoradiation: involves intravenous
administration of photosensitizing agent, which is
taken up by the target tissue, causes sensitization
of the target tissue. Exposure of this sensitized
tissue to laser light induces the formation of
cytotoxic free radicals (PDT).
Uses of Laser in Ophthalmology
• Lid disorders: (by thermal effect)
– For wart or papilloma removal: CO₂ laser
– For skin rejuvenation : CO ₂ or erbium:YAG laser
– For trichiasis or distichiasis: double frequency ND:YAG
laser
• Refractive errors:
– By using excimer laser photoablation to change the
diopteric power of cornea throught alteration of the
curvature of cornea.
– Procedures include PRK, LASIK and SMILE
– In myopia, refractive surgery decrease the corneal
refractive power while in hyperopia the opposite is true.
– PRK( photorefractive keratoectomy ) :
• The epithelium is removed and discarded reshaping.
• Reshaping of the underlying corneal tissue with
excimer laser.
• The epithelium regenerates within a few days after
surgery.
– Lasik (laser-assisted in situ keratomileusis):
• a thin flap is created on the cornea with a
microkeratome or a femtosecond laser.
• This flap is lifted to expose the underlying corneal
tissue
• Reshaping of the underlying corneal tissue with
excimer laser.
• Replacement of corneal flap.
– SMILE ( Small Incision Lenticule Extraction) :
• The most recent refractive surgery
• Utilizes an ultra fast bursts of laser energy in the
order of femtosecond duration (10-15 of the second)
• Precisely targets and breaks tissue at molecular
level
• In this procedure, the laser produces a series of
tiny bubbles at the base of the lenticule then at the
top of it
• A small keyhole incision is created at the periphery
of the cornea to allow for removal of lenticule.
• For lenticular disorders:
– Femtosecond laser assisted cataract surgery:
Femtosecond laser is used to create a more
precis corneal incision, capsulotomy and
nuclear fragmentation.
– ND:YAG laser
• may be used for posterior capsular opacification
that may develop following cataract surgery
• Used to do posterior capsulotomy to clear the
central visual axis.
• Glaucoma:
– Peripheral iridotomy: (photo-disruption)
• In pupillary block mechanism of angle closure glaucoma,
the aqueous is trapped in the posterior chamber
• Peripheral iridotomy is an opening in the peripheral part
of the iris to allow for passage of aqueous from posterior
chamber to anterior chamber
• This can be done by ND:YAG laser
– Laser trabeculoplasty (photocoagualtion)
• to enhance the drainage of trabecluar mesh work in open
angle glaucoma
• Uses Argon laser (ALT) or selective laser (SLT)
– Cyclophotocoagulation
• Aims to decrease aqueous production from ciliary body
• Can be either trans-scleral or endoscopic
• Laser tissue absorption in the retina
– Melanin : in the RPE, absorbs longer wave length
– Xanthophyll: in the outer and inner nuclear layers,
absorbs short wave length
– Hemoglobin: variable absorption but absorbs RED
light poorly.
• Retinal disorders:
– Panretinal photocoagulation
• For proliferative retinopathy (neovascularization)
• Aims for burning of peripheral retina to decrease
retinal demand of oxygen and decrease the release of
angiogenic factors.
– Focal laser:
• Targets leaking microaneurysms
• Smaller spot and less energy are needed
– Grid laser: for macular edema
– Micropulse laser : laser is delivered in short pulses to
decrese thermal damage.
– Laser retinopexy: for closure of retinal tears
– Photodynamic therapy: by photoradiation effect leading
to closure of neovacularisation without damage to
Thank You for Attendance

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Laser in

At the end of the lecture, students should be

– Invisible LASER: lying either in ultraviolet portion

– Solid state LASER: as YAG LASER

• Power source: generate energy.

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