Towards femtosecond laser surgery guidance in the posterior eye: utilization of optical coherence tomography and adaptive optics for focus positioning and shaping

Although fs-laser surgery is clinically established in the field of corneal flap cutting for laser in situ keratomileusis, surgery with fs-laser in the posterior part of the eye is impaired by focus degradation due to aberrations. Precise targeting and keeping of safety distance to the retina also relies on an intraoperative depth resolved imaging. We demonstrate a concept for image guided fs-laser surgery in the vitreous body combining adaptive optics (AO) for focus reshaping and optical coherence tomography (OCT) for focus position guidance. The setup of the laboratory system consist of an 800 nm fs-laser which is focused into a simple eye model via a closed loop adaptive optics system with Hartmann-Shack sensor and a deformable mirror to correct for wavefront aberrations. A spectral domain optical coherence tomography system is used to target phantom structures in the eye model. Both systems are set up to share the same scanner and focusing optics. The use of adaptive optics results in a lowered threshold energy for laser induced breakdown and an increased cutting precision. 3D OCT imaging of porcine retinal tissue prior and immediately after fs-laser cutting is also demonstrated. In the near future OCT and AO will be two essential assistive components in possible clinical systems for fs-laser based eye surgery beyond the cornea.