The ‘anvil’ profile in femtosecond laser-assisted penetrating keratoplasty

Menabuoni, Luca; Canovetti, Annalisa; Rossi, Francesca; Malandrini, Alex; Lenzetti, Ivo; Pini, Roberto

doi:10.1111/aos.12144

Cited by 12 publications

(6 citation statements)

References 5 publications

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“…The temperature enhancement induces reversible thermal denaturation in the stromal collagen, with an immediate closuring of the wound walls upon cooling. This laser welding effect was firstly demonstrated in cataract surgery 7,8 and penetrating keratoplasty 9,10 . An optimized approach that we are presenting in this paper has been studied for application in endothelial keratoplasty.…”

Section: Introductionmentioning

confidence: 94%

An “All-laser” Endothelial Transplant

Rossi

Canovetti

Malandrini

et al. 2015

JoVE

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The "all laser" assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an intended depth, and a near infrared diode laser to weld the corneal tissue. The proposed technique enables to reach the three main goals in endothelial keratoplasty: a precise control in the thickness of the donor tissue; its easy insertion in the recipient bed and a reduced risk of donor lenticule dislocation. The donor cornea thickness is measured in the surgery room with optical coherence tomography (OCT), in order to correctly design the donor tissue dimensions. A femtosecond laser is used to cut the donor cornea. The recipient eye is prepared by manual stripping of the descemetic membrane. The donor endothelium is inserted into a Busin-injector, the peripheral inner side is stained with a proper chromophore (a water solution of Indocyanine Green) and then it is pulled in the anterior chamber. The transplanted tissue is placed in the final and correct location and then diode laser welding is induced from outside the eyeball. The procedure has been performed on more than 15 patients evidencing an improvement in surgery performances, with a good recovery of visual acuity and a reduced donor lenticule dislocation event. Video LinkThe video component of this article can be found at

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Section: Introductionmentioning

confidence: 94%

An “All-laser” Endothelial Transplant

Rossi

Canovetti

Malandrini

et al. 2015

JoVE

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“…Laser treatments are successfully used in different medical fields, such as in dermatology or ocular surgery [ 1 , 2 , 3 , 4 , 5 , 6 ]. In all these fields, laser systems have brought significant improvements and advantages for both the physicians and the patients, such as increased cooperation and reduction of pain and discomfort.…”

Section: Introductionmentioning

confidence: 99%

Characterization and Ex Vivo Application of Indocyanine Green Chitosan Patches in Dura Mater Laser Bonding

et al. 2021

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Dura mater repair represents a final and crucial step in neurosurgery: an inadequate dural reconstruction determines dreadful consequences that significantly increase morbidity and mortality rates. Different dural substitutes have been used with suboptimal results. To overcome this issue, in previous studies, we proposed a laser-based approach to the bonding of porcine dura mater, evidencing the feasibility of the laser-assisted procedure. In this work, we present the optimization of this approach in ex vivo experiments performed on porcine dura mater. An 810-nm continuous-wave AlGaAs (Aluminium Gallium Arsenide) diode laser was used for welding Indocyanine Green-loaded patches (ICG patches) to the dura. The ICG-loaded patches were fabricated using chitosan, a resistant, pliable and stable in the physiological environment biopolymer; moreover, their absorption peak was very close to the laser emission wavelength. Histology, thermal imaging and leak pressure tests were used to evaluate the bonding effect. We demonstrated that the application of 3 watts (W), pulsed mode (Ton 30 ms, Toff 3.5 ms) laser light induces optimal welding of the ICG patch to the dura mater, ensuring an average fluid leakage pressure of 216 ± 105 mmHg, falling within the range of physiological parameters. This study demonstrated that the thermal effect is limited and spatially confined and that the laser bonding procedure can be used to close the dura mater. Our results showed the effectiveness of this approach and encourage further experiments in in vivo models.

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“…It has been widely demonstrated that in a laser welded wound there is no foreign body reaction, a better and faster healing phase, a reorganization of the treated tissue architecture, with no scar formation and an immediate watertight closure of the wound, thus reducing the risk of infections [1]- [4]. Despite a significant experimental achievement of the last years, some limitations still hinder a standardized clinical application of laser welding technology in microsurgery, mainly due to the lack of a high degree of reproducibility of results.…”

Section: Introductionmentioning

confidence: 99%

Laser bonding with ICG-infused chitosan patches: preliminary experiences in suine dura mater and vocal folds

Rossi

Matteini

Ratto

et al. 2014

Biophotonics: Photonic Solutions for Better Health Care IV

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Laser bonding is a promising minimally invasive approach, emerging as a valid alternative to conventional suturing techniques. It shows widely demonstrated advantages in wound treatment: immediate closuring effect, minimal inflammatory response and scar formation, reduced healing time. This laser based technique can overcome the difficulties in working through narrow surgical corridors (e.g. the modern "key-hole" surgery as well as the endoscopy setting) or in thin tissues that are impossible to treat with staples and/or stitches. We recently proposed the use of chitosan matrices, stained with conventional chromophores, to be used in laser bonding of vascular tissue. In this work we propose the same procedure to perform laser bonding of vocal folds and dura mater repair. Laser bonding of vocal folds is proposed to avoid the development of adhesions (synechiae), after conventional or CO 2 laser surgery. Laser bonding application in neurosurgery is proposed for the treatment of dural defects being the Cerebro Spinal Fluid leaks still a major issue. Vocal folds and dura mater were harvested from 9-months old porks and used in the experimental sessions within 4 hours after sacrifice. In vocal folds treatment, an IdocyanineGreen-infused chitosan patch was applied onto the anterior commissure, while the dura mater was previously incised and then bonded. A diode laser emitting at 810 nm, equipped with a 600 µm diameter optical fiber was used to weld the patch onto the tissue, by delivering single laser spots to induce local patch/tissue adhesion. The result is an immediate adhesion of the patch to the tissue. Standard histology was performed, in order to study the induced photothermal effect at the bonding sites. This preliminary experimental activity shows the advantages of the proposed technique in respect to standard surgery: simplification of the procedure; decreased foreign-body reaction; reduced inflammatory response; reduced operating times and better handling in depth. ; phone 0039 055-522 5337; fax 0039 055 522 5305

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The ‘anvil’ profile in femtosecond laser-assisted penetrating keratoplasty

Cited by 12 publications

References 5 publications

An “All-laser” Endothelial Transplant

An “All-laser” Endothelial Transplant

Characterization and Ex Vivo Application of Indocyanine Green Chitosan Patches in Dura Mater Laser Bonding

Laser bonding with ICG-infused chitosan patches: preliminary experiences in suine dura mater and vocal folds

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The ‘anvil’ profile in femtosecond laser-assisted penetrating keratoplasty

Cited by 12 publications

References 5 publications

An &#8220;All-laser&#8221; Endothelial Transplant

An &#8220;All-laser&#8221; Endothelial Transplant

Characterization and Ex Vivo Application of Indocyanine Green Chitosan Patches in Dura Mater Laser Bonding

Laser bonding with ICG-infused chitosan patches: preliminary experiences in suine dura mater and vocal folds

Contact Info

Product

Resources

About

An “All-laser” Endothelial Transplant

An “All-laser” Endothelial Transplant