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In-vitro- und In-vivo-Untersuchungen zur Presbyopiebehandlung mit Femtosekundenlasern

In vitro and in vivo investigations on the treatment of presbyopia using femtosecond lasers

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Zusammenfassung

Hintergrund

Ultrakurze (Femtosekunden) Laserpulse können feinste Schnitte in menschlichem Gewebe produzieren, ohne dieses zu eröffnen. Die Anwendbarkeit der Femtosekunden- (fs-)Lasertechnik an der Augenlinse im Hinblick auf eine mögliche Presbyopietherapie sollte evaluiert werden.

Material und Methoden

Insgesamt wurde an 150 Schweinelinsen in vitro eine fs-Lentotomie vorgenommen. Schnittkonfiguration und Laserparameter wurden optimiert, um möglichst glatte Schnitte mit möglichst geringer Gasblasenbildung zu erhalten. Dann wurden 4 Albinokaninchen in vivo behandelt, 3 Monate lang beobachtet und schließlich die gelaserten Linsen entnommen und beurteilt.

Ergebnisse

Bei geeigneter Parameterwahl am fs-Laser kann Lichtstreuung durch persistierende und konfluierende Gasblasen in der Schweinelinse fast komplett vermieden werden. Eine Pulsenergie von weniger als 1,2 µJ und eine Schnittgeometrie mit Spotabständen von ≥5 µm sind dabei entscheidend. In vivo blieben die Kaninchenlinsen über 3 Monate makroskopisch klar. Lediglich die direkt um die Plasmazündung gruppierten Zellstrukturen waren zertrennt, bereits ca. 5–10 µm entfernte Strukturen schienen unverletzt. Katarakte traten in keiner der Kaninchenlinsen auf.

Schlussfolgerung

Die fs-Laser-Lentotomie könnte sich prinzipiell zur Therapie des Presbyopie eignen.

Abstract

Background

Ultrashort (femtosecond) laser pulses can generate precise cuts in biological tissue without damaging the surface. The application of femtosecond laser technology at the lens was evaluated with respect to a possible treatment of presbyopia.

Materials and methods

Femtosecond laser lentotomy was performed on 150 pig lenses in vitro. Cutting geometry and laser settings were optimized to generate smooth cuts with a minimum of produced gas bubbles. Four rabbit lenses were treated afterwards in vivo and were controlled for 3 months post-treatment. The lenses were then extracted and evaluated.

Results

With suitable laser settings, light scattering due to residual gas bubbles could be almost completely avoided in pig lenses. A pulse energy of less than 1.2 µJ and a cutting geometry with spot separations of more than 5 µm are important. The rabbit lenses stayed macroscopically clear for 3 months in vivo. Only the cell structures directly adjacent to the laser focus were cut; structures 5–10 µm away appeared to be intact. No cataract formation occurred during this time.

Conclusion

Femtosecond laser application allows precise and smooth cuts inside pig and rabbit lenses without damage to adjacent tissue.

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Danksagung

Die Arbeiten werden gefördert durch das Bundesministerium für Bildung und Forschung BMBF (Förderkennzeichen: 13N8709).

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Authors and Affiliations

  1. Laser Zentrum Hannover e.V.

    T. Ripken, P. Breitenfeld & H. Lubatschowski

  2. Cole Eye Center, Cleveland Clinic Foundation, Cleveland, USA

    R. R. Krueger

  3. Laserforum Köln e.V., Augenklinik am Neumarkt, Schildergasse 107, 109, 50667, Köln

    G. Gerten, O. Kermani & U. Oberheide

Authors
  1. G. Gerten
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  2. T. Ripken
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  3. P. Breitenfeld
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  4. R. R. Krueger
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  5. O. Kermani
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  6. H. Lubatschowski
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  7. U. Oberheide
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Correspondence to G. Gerten.

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Vorgetragen auf der DOG 2004

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Gerten, G., Ripken, T., Breitenfeld, P. et al. In-vitro- und In-vivo-Untersuchungen zur Presbyopiebehandlung mit Femtosekundenlasern. Ophthalmologe 104, 40–46 (2007). https://doi.org/10.1007/s00347-006-1400-1

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  • DOI: https://doi.org/10.1007/s00347-006-1400-1

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