Intrastromal Corneal Reshaping Using a High-Intensity Femtosecond Laser: A Novel Method of Vision Correction

Abstract

A new technology to perform a minimally invasive cornea reshaping procedure has been developed. This can eliminate the incidence of the flap-related complications of the conventional eye refractive procedures by multiphoton processes using a very high-intensity (I ≥ 10^13 W/cm^2), but low energy (Ep ∼ 100 – 200 μJ) femtosecond laser pulses. Due to much lower energy than that of the nanosecond laser pulses for the thermal photoablation, the multiphoton processes cause almost no collateral damage by heat and shock wave generation.

In this method, a series of femtosecond laser pulses is used to create very narrow (< 30 μm) and sufficiently long (≥ 2.5 mm) micro-channels in the cornea. The micro- channels are oriented almost perpendicular to the eye’s optical axis. Once the micro-channel reaches a desired length, another series of femtosecond pulses with higher intensity is efficiently delivered through the micro-channel to the endpoint where a certain amount of the stromal tissue is disintegrated by the multiphoton processes. The disintegrated fragments are ejected out of the cornea via the same micro-channel, allowing the corneal surface to collapse, and changing its refractive power. This new corneal reshaping method obviates any process of damaging the corneal surface layer, while retaining the advantages of the conventional refractive procedures such as Laser in situ keratomileusis (LASIK) and Photorefractive keratectomy (PRK).

In order to demonstrate the flapless cornea reshaping procedure, we have conducted ex-vivo experiments on fresh porcine eyes. The reshaped corneas were evaluated by using optical coherence tomography (OCT). The test results have shown that this flapless intrastromal procedure can reshape the cornea as intended with almost no surface damage.

We have also performed a series of experiments to demonstrate the multipho- ton processes in the corneal tissue by very high-intensity femtosecond laser pulses. Through the optical emission spectroscopy, we investigated the spectral lines of calcium atom and ions from the femtosecond laser-induced plasma from the porcine corneal tissue. The experimental results have shown the intensity-dependence of ablation rate, which qualitatively verifies the characteristics of the multiphoton processes.