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

项目总结/摘要 这项建议的主要目的是测试假设，高精度的房水 (AH)连接前房（AC）和Schlemm管（SC）的引流通道， 使用微米分辨率OCT（µ-OCT）图像引导飞秒激光进行有创和腹部手术 小梁切除术（IGFLT）将增加AH流出并降低眼内压（IOP），因此可能 可用作青光眼的非侵入性持久手术治疗。飞秒激光脉冲 可以通过透明和半透明组织输送，以进行高精度的皮下手术 手术不会对邻近或浅表组织造成附带损伤。FS激光器的这些独特特性- 与传统激光手术相比，组织相互作用提供了显著的优势， 治疗。基于这些发现，我们认为用FS治疗小梁网（TM）区域 激光脉冲将提供对传统激光治疗的改进， (ALT)和选择性激光小梁成形术（selective laser trabeculoplasty，LASIK）。我们建议使用飞秒激光脉冲来产生高- 通过TM和椎弓根组织（JCT）的精确引流通道（ab-interno）将恢复 正常的AH流出设施的眼睛，因此降低IOP。为了可靠地形成这种排水通道， 需要精确确定TM和SC的位置。我们建议开发和使用一个实验室 µ-OCT图像引导FS激光系统的原型，以确保引流的准确放置 渠道IGFLT的主要优点是：1）ab-interno，无创手术，无任何切口或伤口， 表面，2）微米精度的通道精确放置，3）AH流出的精确控制 通过创建所需的通道横截面来增加，4）由于最小化的侧支组织而具有潜在的寿命 损伤，5）手术可以作为快速门诊手术进行，6）由于小 治疗区，对邻近组织无损伤。为了验证我们的假设，我们提出了以下具体的 目的：1）开发一种光学传输系统，该系统将外科飞秒激光束与近距离激光束耦合， 红外µ-OCT光束，允许µ-OCT图像引导FS激光脉冲的传输， 从前房到Schlemm管的房水引流通道。2)演示µ-OCT图像 使用近红外FS激光束通过一个 前房角镜接触透镜，其通过产生将AC连接到SC的预定几何形状的流出通道 在人类尸体的眼中。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)评估µ-OCT图像引导的效果 FS激光使用标准灌注方法在人尸体眼中的AH流出设施上创建通道。 优化治疗方案，以实现预定的IOP降低。确认最终技术要求， 便携式临床原型计划在随后的未来项目中开发和测试。

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.