INITIAL CLINICAL-EXPERIENCE WITH THE PICOSECOND ND-YLF LASER FOR INTRAOCULAR THERAPEUTIC APPLICATIONS

Aims/background-Compared with nanosecond (ns) pulses of conventional N d-YAG lasers, picosecond tps) laser pulses allow intraocular surgery a t considerably lower pulse energy. The authors report initial clinical experiences using a Nd:YLF ps laser for the treatment of various indi cations for photodisruption. Methods-A Nd:YLF laser system (ISL 2001, wavelength 1053 nm) was used to apply pulse series of 100-400 mu J sin gle pulse energy at a repetition rate of 0.12-1.0 kHz, Computer contro lled patterns were used to perform iridectomies (n=53),capsulotomies ( n=9), synechiolysis (n=3), and pupilloplasties (n=2). Other procedures were vitreoretinal strand incision (n=2) and peripheral retinotomy (n =1). For comparison, 10 capsulotomies and 20 iridotomies were performe d with a Nd:YAG ns laser. The ps laser cut of an anterior capsule was assessed by scanning electron microscopy (SEM). Results-Open, well def ined iridectomies (mean total energy 4028 mJ, mean diameter 724 mu m) were achieved at first attempt in 92% of the cases. In 64% an iris ble eding and in 21% an IOP increase of >10 mm Hg occurred. All capsulotom ies were performed successfully (mean energy 690 mJ/mm cutting length) but with a high incidence of intraocular lens damage. The attempted v itreoretinal applications remained unsuccessful as a result of optical aberrations of the eye and contact lens. Although ps laser capsulotom ies and iridectomies required much higher total energy than ns procedu res, the resulting tissue effects of the ps pulses were more clearly d efined. SEM examination of a ps incision of the anterior lens capsule demonstrated, nevertheless, that the cut was more irregular than the e dge of a continuous curvilinear capsulorhexis. Conclusion-Series of ps pulses applied in computer controlled patterns can be used effectivel y for laser surgery in the anterior segment and are considerably less disruptive than ns pulses. The ps laser is well suited for laser iride ctomies while the ns laser is preferable for posterior capsulotomies. As vitreoretinal applications remained unsuccessful, the range of indi cations for intraocular photodisruption could not be extended by the p s laser.