Erbiumlaserphakoemulsil ikation - Eine klinische Pilotstudie

Abstract

Erbium laser phacoemulsification is a surgical method that makes the emulsification of softer nuclei under clinical conditions possible with a low rate of complications also in the beginning of the learning curve. For higher nucleus hardnesses, technical and surgical parameters have to be optimised. Advantages of erbium laser phacoemulsification compared to ultrasonic phacoemulsification are less energy transmission into the eye, no heating of anterior chamber, impossibility of corneal burns and easier access in eyes that are deep into the orbit. Especially advantageous is the high protection of endothelium by erbium laser phacoemulsification. A prospective controlled comparative study to ultrasonic emulsification is desirable.

Erbium: yttrium–aluminum–garnet laser induced vapor bubbles as a function of the quartz fiber tip geometry

“…Some reports [5][6][7][8]24,25 investigated the use of pulsed erbium:YAG lasers as an alternative in phacoemulsification to liquefy the cataract lens of the eye. Basically, there are concerns over potential effects of ultrasonic energy delivery by the phacoemulsification probe on such nontarget ocular structures as the corneal endothelium and the lens capsule.…”

“…In particular, this mid-infrared laser is useful for various applications in ophthalmology such as sclerostomy and trabecolectomy in glaucoma treatment, phacoemulsification in cataract surgery as well as in posterior segment surgery for removal of vitreous structures. [2][3][4][5][6][7][8][9][10][11][12][13] Beside the precise tissue ablation, due to the high absorption in water containing tissue, microsurgical applications of pulsed erbium: YAG lasers require flexible ͑such as low OH Ϫ quartz fibers͒ and high transparent optical waveguides ͑such as ZrF 4 fibers͒ for efficient light transmission that do not hinder surgeons. While standard low OH Ϫ quartz fibers are not sufficiently transparent ͑attenuation 100 dB/m͒ to guide 2.94 m radiation, the ZrF 4 fibers with an attenuation of less than 0.1 dB/m seem to be most applicable.…”

Spiegelmikroskopische Verlaufskontrollen bei Endophthalmitis nach Kataraktoperation12

“…Viele wissenschaftliche Studien zur Spiegelmikroskopie in der Kataraktchirurgie waren vergleichende Studien an Augen ohne Komplikationen oder relevante Begleiterkrankungen (Lit. in [9,13,19]). Gröûere spiegelmikroskopische Untersuchungen nach Endophthalmitis fehlen bislang.…”

“…Während bei heutigen Operationstechniken die Reduzierung der Endothelzellzahl unter 1 % liegen kann [9], lag die kurzfristige Endothelschädigung in den 80er Jahren bei unkomplizierten Verläufen meist zwischen 10 % und 20 %, langfristig noch darüber [13,17,19]. Mögliche Schäden des Hornhautendothels durch eine Endophthalmitis wurden bislang überwiegend kasuistisch beschrieben [2, 6,12].…”

Why Use Ultrashort Pulses in Ophthalmology and Which Factors Affect Cut Quality

“…The Er:YAG laser still had to show superiority over conventional phacoemulsification in cataract surgery. In a pilot study, three capsule ruptures occurred in 40 cataract surgeries [ 13 , 14 ]. These happened due to dynamics of the laser–tissue interaction process of the Er:YAG laser and the learning curve of the surgeon.…”