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Nano Laser Photofragmentation

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Abstract

The use of lasers for the fragmentation of the lens in cataract surgery is an interesting alternative to traditional ultrasonic phacoemulsification. Since the beginning of phacoemulsification it has been a constant ambition to reduce the operative trauma and collateral damage of intraocular tissue during phacoemulsification. Parameters to be changed are operating time, total intraocular energy used, incision size, tissue heating, corneal endothelial cell loss and induced corneal astigmatism. During the last years different laser systems have been developed to minimize thermal and mechanical damage of the intraocular tissue [1–3].

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... В связи с этим появляется возможность полного отказа от ультразвуковой энергии в рамках рефракционной хирургии хрусталика. Учитывая то, что основной контингент пациентов является представителями молодого (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) и среднего возраста (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), переход с ультразвуковой энергии на более безопасную лазерную остается приоритетным направлением в современной офтальмохирургии. ...
... Преимущества этой методики связаны с отсутствием нагрева роговицы и безопасностью лазерного излучения для интраокулярных структур [30]. Была предложена универсальная рукоятка с интегрированным ИАГ-лазерным излучателем, который может быть присоединен к системе ирригации-аспирации факоэмульсификаторов [31]. К преимуществам методики можно отнести отсутствие нагрева и низкое повреждающее действие на эндотелий. ...
Article
Introduction . This review presents the current knowledge about the methods of lens surgery for the correction of refractive errors in patients with presbyopia and other refractive errors. And also about possible methods of minimization of ultrasound load during the surgery. Purpose. To present current relevant literature scientific knowledge on refractive lens surgery, possible ways of minimization of ultrasound load and new IOL models. Material and methods . To perform the review the literature references were searched through the abstract databases PubMed and Scopus for the period up to and including 2023 using the keywords “zero phaco”, “refractive lens exchange”, “presbyopia”, “femtosecond laser”, “U/S phaco”, “premium IOL”, “refractive error surgery”, “endothelial dystrophy”. A total of 76 articles related to the review topic were selected. Results . Multiple studies confirmed efficacy, safety and fast visual rehabilitation after lens surgery with maximal ultrasound load reduction, in particular in patients with metabolic disorders and predisposition to corneal dystrophies. Conclusion . The literature review suggests that with increasing patient expectations and the use of premium IOLs in the era of refractive lens surgery, predictability and accuracy have become essential. Thus, the technology of safe lens femtosurgery has greatly improved surgical techniques and has revolutionized ophthalmic surgery in recent decades.
... Основой его является использование ИАГ-лазера, обеспечивающего фрагментацию хрусталика. Наряду с отсутствием нагрева лазерное излучение с длиной волны 1,4-1,8 мкм имеет высокий коэффициент поглощения в средах с высоким содержанием воды и является безопасным для интраокулярных структур [35]. ...
... Преимуществом является отсутствие нагрева и низкое травмирующее действие на эндотелий. Однако разработчики отмечают высокий расход ирригационной жидкости и удлинение времени операции, что следует отнести к недостаткам этой технологии [35][36]. ...
Article
Full-text available
The balance between the efficiency of lens’ destruction and the safety of this process for intraocular structures is the most important aspect in the search for alternative energy approaches in cataract surgery. The article provides a literature review summarizing modern medical and technical solutions aimed at developing new and effective methods of cataract phacoemulsification. One of the main components of cataract surgery is the balance between the effectiveness of ultrasound destruction of the lens and the safety of this process for intraocular structures. Most of the available technical solutions designed to replace ultrasound do not yet allow this to be fully implemented, since they have insufficient destructive power or are technologically complex and expensive, which makes it difficult for their mass introduction into widespread practice. In this regard, it is urgent to search for alternative energy approaches aimed at increasing the efficiency of destruction without increasing the negative effects associated with an increase in ultrasound dose.
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To evaluate the safety and efficacy of a Q-switched neodymium:YAG (Nd:YAG) laser for removal of the human cataract. A multicenter, prospective, noncomparative study. A total of 100 consecutive eyes undergoing cataract extraction with the Dodick Photolysis, Q-switched Nd:YAG laser. Corneal endothelial cell loss, visual acuity improvement, intraocular pressure change, total intraocular energy used, and intraoperative and postoperative complications. The mean values were postoperative visual acuity improvement from 20/46.5 (0.43) to 20/26.6 (0.75), decrease in endothelial cell count of 177 cells/mm2 (7.55%), and intraocular energy used of 6.7 J. Minor complications were encountered in three cases. These data suggest that Dodick Photolysis may be a safe and effective new technology for cataract removal in human eyes. It appears to offer low intraocular energy and heat release, a clear-cornea incision less than 1.5 mm in size, and safe operation within the capsular bag.