Laser welding of biological tissue: experimental studies in ophthalmology

In this paper we present an original approach to laser welding of ocular media. Attention is focused on laser welding of the cornea and lens capsule. The process is based on the interaction of near infrared diode laser radiation (at 810 nm) with tissue that was previously stained with an Indocyanine Green solution in sterile water. The topical application of the chromophore makes possible a selective heating of the tissue, which results in a homogenous welding effect with low thermal damage to the surrounding tissue. Experimental tests were performed ex vivo on both capsule and cornea, and in vivo (rabbits) only on the cornea, in order to characterize the process as a whole. Spectrophotometric, biomechanical, and thermal measurements were carried out in order to study the laser-tissue interaction, while morphological, histological and auto-florescence microscopy analyses made during a follow-up study provided information on the healing process in welded rabbit corneas. The welding procedure was set up according to the type of tissue, with the staining procedure and irradiation conditions being optimized in each case. Our test indicated that: 1) laser welding of corneal wounds, which is a non contact technique performed at low continuous wave laser power (12 W/cm2), can be proposed as a support to or substitute for the standard suturing technique in cataract surgery and in penetrating keratoplasty (in corneal transplants); 2) laser welding of the lens capsule requires a "contact irradiating technique" in order to be efficiently performed, since the tissue is in underwater conditions, with single spot pulses of about 100 J/cm2 fluence and pulse duration around 100 ms. In the latter case, laser welding was proposed as a tool for assisting closure of the lens capsule after the lens refilling procedure (Phaco-ersatz), or for repairing capsular breaks induced by accidental traumas or produced intraoperatively.