Non-Invasive Femtosecond Laser Glaucoma Surgery Guided by Micron-Resolution OCT

微米分辨率OCT引导的无创飞秒激光青光眼手术

• 批准号: 10222703
• 负责人: TIBOR JUHASZ
• 金额: $ 44.5万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222703
• 关键词: 3-Dimensional; Algorithms; Aqueous Humor; Area; Argon; Cadaver; Cataract Extraction; Clinical; Contact Lenses; Cornea; Coupled; Couples; Development; Devices; Dimensions; Drainage procedure; Ensure; Eye; Fiber; Future; Geometry; Glaucoma; Human; Image; Imaging Techniques; Inflammation; Laboratories; Laser In Situ Keratomileusis; Lasers; Light; Location; Longevity; Methods; Operative Surgical Procedures; Optics; Outpatients; Patients; Perfusion; Phase; Physiologic Intraocular Pressure; Physiologic pulse; Procedures; Property; Protocols documentation; Resolution; Sclera; Structure of sinus venosus of sclera; Surface; Surgical Flaps; Surgical incisions; System; Techniques; Technology; Testing; Three-Dimensional Imaging; Tissues; Trabecular meshwork structure; Trabeculectomy; Treatment Protocols; anterior chamber; aqueous; base; conjunctiva; conventional therapy; glaucoma surgery; image guided; improved; lens; novel; portability; prototype; response; standard of care; technology development; treatment optimization; wound; wound healing

Project Summary / Abstract The major objective of this proposal is to test the hypothesis that high-precision aqueous humor (AH) drainage channels, which connect the anterior chamber (AC) to Schlemm's canal (SC), created non- invasively and ab-interno with micron-resolution OCT (µ-OCT) image guided femtosecond laser trabeculectomy (IGFLT) will increase AH outflow and lower intraocular pressure (IOP) and therefore may be used as a non-invasive long lasting surgical treatment for glaucoma. Femtosecond (FS) laser pulses can be delivered through transparent and translucent tissue to perform high-precision, sub-surface surgical procedures with no collateral damage to adjacent or superficial tissue. These unique properties of FS laser- tissue interactions provide a marked advantage over traditional laser procedures for high-precision, sub-surface treatments. Based on these findings we believe that treatment of the trabecular meshwork (TM) area with FS laser pulses will provide improvements over traditional laser treatments such as argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). We propose that using FS laser pulses to create high- precision drainage channels (ab-interno) through the TM and juxtacanicular tissue (JCT) will restore the normal AH outflow facility of the eye and therefore lower IOP. To reliably create such drainage channels the exact determination of the location of the TM and SC is required. We propose to develop and use a laboratory prototype of a µ-OCT image guided FS laser system to ensure the accurate placement of the drainage channels. Major benefits of IGFLT are: 1) ab-interno, non-invasive procedure without any incisions or wound to the surface, 2) exact placement of the channels with micron accuracy, 3) accurate control of the AH outflow increase by creating the required channel cross section, 4) potential longevity due to minimized collateral tissue damage, 5) surgery can be performed as a quick outpatient procedure, 6) potential repeatability due to small treatment zone with no damage to adjacent tissue. To test our hypotheses we propose the following Specific Aims: 1) Develop an optical delivery system which couples a surgical femtosecond laser beam with a near infrared µ-OCT beam, allowing µ-OCT image guided delivery of FS laser pulses for the creation of high-precision aqueous humor drainage channels from the anterior chamber to Schlemm's canal. 2) Demonstrate µ-OCT image guided femtosecond laser trabeculectomy using ab-interno delivery of a near infrared FS laser beam through a gonioscopic contact lens by creating outflow channels of predetermined geometry which connect the AC to SC in human cadaver eyes. Evaluate the quality and dimensions of the channels with various imaging techniques. Create technical requirements for clinical technology development. 3) Evaluate the effect of µ-OCT image guided FS laser created channels on AH outflow facility in human cadaver eyes using standard perfusion methods. Optimize treatment protocols for predetermined IOP reduction. Confirm final technology requirements for a portable clinical prototype planned to be developed and tested in a subsequent future project.

项目摘要 /摘要 该提议的主要目的是检验高精度水性幽默的假设 （AH）将前室（AC）连接到Schlemm的运河（SC）的排水通道，造成了非 - 与微分辨率OCT（µ-OCT）图像引导的飞秒激光 小梁切除术（IGFLT）将增加出口和降低眼内压（IOP），因此可能 用作青光眼的非侵入性持久手术治疗。飞秒（FS）激光脉冲 可以通过透明和半透明的组织传递以进行高精度，次外科 对邻近或表面组织没有附带损害的程序。 FS激光的这些独特特性 组织相互作用提供了比传统激光程序的明显优势 治疗。基于这些发现，我们认为与FS的小梁网站（TM）区域的处理 激光脉冲将对传统激光治疗（例如氩激光小梁成形术）提供改进 （ALT）和选择性激光小梁成形术（SLT）。我们建议使用FS激光脉冲创建高 精密排水通道（AB-Interno）通过TM和叶核组织（JCT）将恢复 正常的AH出口设施，因此降低IOP。可靠地创建这样的排水通道 需要确切确定TM和SC的位置。我们建议开发和使用实验室 µ-OCT图像引导的FS激光系统的原型，以确保排水的精度放置 频道。 IGFLT的主要好处是：1）Ab-Interno，无侵入性程序，没有任何切口或伤口 表面，2）以微米精度精确放置通道，3）精确控制AH出口 通过创建所需的通道横截面来增加，4）由于最小的侧支组织而导致潜在的寿命 损坏，5）手术可以作为快速门诊手术进行，6）由于较小而导致潜在的重复性 治疗区没有对相邻组织的损害。为了检验我们的假设，我们提出以下特定 目的：1）开发一种光学输送系统，该系统将手术飞秒激光束与接近 红外µ-OCT光束，允许µ-OCT图像引导FS激光脉冲的传递以创建高精度 从前室到Schlemm运河的水性幽默引流通道。 2）演示µ-OCT图像 使用Ab-Interno递送近红外FS激光束的引导飞秒激光小梁切除术 通过创建预定几何形状的流出通道，将AC连接到SC， 在人类的尸体眼中。通过各种成像技术评估通道的质量和尺寸。 为临床技术开发创建技术要求。 3）评估指导µ-OCT图像的效果 FS激光使用标准灌注方法在人尸体眼中的AH出口设施上创建了通道。 优化预定IOP减少的治疗方案。确认最终技术要求 计划在随后的未来项目中开发和测试便携式临床原型。