Non-Invasive Femtosecond Laser Glaucoma Surgery Guided by Micron-Resolution OCT

项目摘要/摘要 这项提议的主要目标是检验高精度房水的假设 (Ah)连接前房(AC)和Schlemm管(SC)的引流通道，创造了非 微米分辨率OCT(µ-OCT)图像制导飞秒激光的侵入性和非侵入性 小梁切除术(IGFLT)会增加AH流出，降低眼压，因此可能 可作为青光眼的一种无创、持久的外科治疗方法。飞秒(FS)激光脉冲 可以通过透明和半透明的组织进行高精度的亚表面外科手术 手术对邻近或浅表组织无附带损伤。FS激光器的这些独特特性-- 组织相互作用为高精度、亚表面的传统激光手术提供了显著的优势 治疗。基于这些发现，我们认为FS治疗小梁网(TM)区 激光脉冲将改善传统的激光治疗方法，如氩激光小梁成形术 ALT和选择性激光小梁成形术(SLT)。我们建议使用飞秒激光脉冲来产生高功率激光。 通过TM和关节周组织的精密引流通道(ab-interno)将恢复 眼部正常的AH流出设施，因此降低了眼压。为了可靠地建立这样的排水渠道， 需要准确确定TM和SC的位置。我们计划开发和使用一个实验室 一种用于确保引流准确放置的微光层析成像FS激光系统样机 频道。IGFLT的主要优点是：1)无创性，无任何伤口或伤口 表面，2)以微米级精度精确放置通道，3)精确控制AH流出 通过创建所需的通道横截面来增加，4)由于最小化侧支组织而潜在的寿命 损伤，5)手术可以作为快速门诊手术进行，6)由于小的原因，潜在的重复性 对邻近组织无损伤的治疗区。为了检验我们的假设，我们提出了以下具体建议 目标：1)开发一种将外科飞秒激光光束与近场激光耦合的光学传输系统 红外µ-OCT光束，允许µ-OCT图像引导传输FS激光脉冲，以创建高精度 房水引流通道从前房到Schlemm管。2)演示µ-OCT图像 导引飞秒激光小梁切除术使用近红外飞秒激光光束通过 通过创建将AC连接到SC的预定几何形状的流出通道来实现角度镜隐形眼镜 在人类身体的眼睛里。使用各种成像技术评估通道的质量和尺寸。 创建临床技术开发的技术要求。3)评价µ-OCT图像制导效果 FS激光使用标准灌流方法在人身体眼的AH流出设施上创建通道。 优化治疗方案以降低预定的眼压。确认最终的技术要求 便携式临床样机计划在后续的项目中开发和测试。

Project Summary / Abstract The major objective of this proposal is to test the hypothesis that high-precision aqueous humor (AH) drainage channels, which connect the anterior chamber (AC) to Schlemm's canal (SC), created non- invasively and ab-interno with micron-resolution OCT (µ-OCT) image guided femtosecond laser trabeculectomy (IGFLT) will increase AH outflow and lower intraocular pressure (IOP) and therefore may be used as a non-invasive long lasting surgical treatment for glaucoma. Femtosecond (FS) laser pulses can be delivered through transparent and translucent tissue to perform high-precision, sub-surface surgical procedures with no collateral damage to adjacent or superficial tissue. These unique properties of FS laser- tissue interactions provide a marked advantage over traditional laser procedures for high-precision, sub-surface treatments. Based on these findings we believe that treatment of the trabecular meshwork (TM) area with FS laser pulses will provide improvements over traditional laser treatments such as argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). We propose that using FS laser pulses to create high- precision drainage channels (ab-interno) through the TM and juxtacanicular tissue (JCT) will restore the normal AH outflow facility of the eye and therefore lower IOP. To reliably create such drainage channels the exact determination of the location of the TM and SC is required. We propose to develop and use a laboratory prototype of a µ-OCT image guided FS laser system to ensure the accurate placement of the drainage channels. Major benefits of IGFLT are: 1) ab-interno, non-invasive procedure without any incisions or wound to the surface, 2) exact placement of the channels with micron accuracy, 3) accurate control of the AH outflow increase by creating the required channel cross section, 4) potential longevity due to minimized collateral tissue damage, 5) surgery can be performed as a quick outpatient procedure, 6) potential repeatability due to small treatment zone with no damage to adjacent tissue. To test our hypotheses we propose the following Specific Aims: 1) Develop an optical delivery system which couples a surgical femtosecond laser beam with a near infrared µ-OCT beam, allowing µ-OCT image guided delivery of FS laser pulses for the creation of high-precision aqueous humor drainage channels from the anterior chamber to Schlemm's canal. 2) Demonstrate µ-OCT image guided femtosecond laser trabeculectomy using ab-interno delivery of a near infrared FS laser beam through a gonioscopic contact lens by creating outflow channels of predetermined geometry which connect the AC to SC in human cadaver eyes. Evaluate the quality and dimensions of the channels with various imaging techniques. Create technical requirements for clinical technology development. 3) Evaluate the effect of µ-OCT image guided FS laser created channels on AH outflow facility in human cadaver eyes using standard perfusion methods. Optimize treatment protocols for predetermined IOP reduction. Confirm final technology requirements for a portable clinical prototype planned to be developed and tested in a subsequent future project.