R 774Use of an Er:YAG-laser in vitreous and retina
Introduction: Use of (electro)mechanical instruments for vitrectomy is not without problems. An increase of the cutting rate compared to today´s instruments is preferable because this would lead to a more thorough vitrectomy in the periphery of the eye. As the removal of epiretinal membranes is not always possible using microforceps the non-contact ablation of such membranes would be an important step forward.
State of the Art: An Er:YAG-laser seems promising for reaching the aforementioned goales. Its wavelength of 2.94 µm matches the absorption peak of water so that the Er:YAG emitted laser light travels some few micrometers into tissue. There are two interesting developments concering Er:YAG laser applications in the vitreous and retina. On the one hand, the use of the Er:YAG-laser for cutting vitreous is examined. The advantage of the laser is its high cutting rate so that by tuning the suction of the handpiece a very thorough vitrectomy at the vitreous base is possible without the risk of creating retinal tears. Another line of research focuses on ablation of epiretinal membranes (or the internal limiting membrane). The removal of epiretinal membranes in eyes with proliferative vitreoretinopathy remains a challenge and is often impossible with conventional microforceps. First animal experiments show that a non-contact removal of epiretinal membranes will probably be possible.
Outlook: If both lines of research are successful the Er:YAG-laser would be a universal instrument for surgery of both the vitreous and the retina which would be superior to today´s techniques. Especially the combination of cutting the vitreous and membrane removal is exciting. The Er:YAG-laser might even be more universally applicable: it is conceivable for cataract removal, glaucoma surgery and even trephination of the cornea.
Augenklinik der Albert-Ludwigs-Universität, Freiburg