Photodisruption

Form of minimally invasive surgery used in ophthalmology

Photodisruption
Specialty	ophthalmology
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Photodisruption is a form of minimally invasive surgery used in ophthalmology, utilizing infrared Nd:YAG lasers to form plasma ("lightning bolt"), which then causes acoustic shock waves ("thunderclap") which then in turn affects tissue.^[1]^[2]^[3] The tissue ruptures as a result of the vapor bubble produced by the laser; the temperature required to produce this effect is between 100 and 305 °C.^[4]

Because the infrared laser is invisible to the surgeon's eye, typically a companion HeNe laser is used in conjunction. However, the eye lens acts as a prism, so the infrared light bends at a shallower angle than the red light, causing chromatic aberration. This means the area highlighted by the HeNe laser is not precisely the area being affected Nd:YAG laser, and therefore some surgical lasers have an added adjustment to compensate.^[2]

The first successful use of photodisruption was in 1972, on a case of trabecular meshwork.^[1] Photodisruption came to wide use in the early 1980s for the treatment of extracapsular cataract extraction.^[1] The technique is most commonly used for lithotripsy of urinary calculi and the treatment of posterior capsulotomy of the lens.^[3] When used in corneal surgery, picosecond and nanosecond disruptors are used on the lamellae of the corneal stroma, and the method may be preferable as it leaves the epithelium and Bowman's layer unharmed. This modifies the outer corneal curvature, which affects the refractive property of the eye.^[5]

References

^ ^a ^b ^c Fankhauser, Franz; Kwasniewska, Sylwia (2003). Lasers in Ophthalmology: Basic, Diagnostic, and Surgical Aspects : a Review. Kugler Publications. p. 304. ISBN 9789062991891.
^ ^a ^b Yanoff, Myron; Duker, Jay S.; Augsburger, James J. (2009). Ophthalmology. Elsevier Health Sciences. pp. 44–45. ISBN 9780323043328.
^ ^a ^b Niemz, Markolf H. (2007). Laser-Tissue Interactions: Fundamentals and Applications. Springer Science & Business Media. p. 126. ISBN 9783540721918.
^ Palanker, Daniel; Blumenkranz, Mark; Weiter, John (2006). "Retinal Laser Therapy: Biophysical Basis and Applications". Retina (4 ed.). Elsevier Mosby. p. 549.
^ Waynant, Ronald W. (2001). Lasers in Medicine. CRC Press. p. 233. ISBN 9781420040746.

Tests and procedures involving the eyes

Anesthesia for eye surgery
Eye surgery
- Oculoplastics
Eye examination

Adnexa

Eyelids	Blepharoplasty East Asian blepharoplasty Epicanthoplasty Eyelid revision Hughes procedure Tarsorrhaphy
Lacrimal system	Dacryocystorhinostomy Punctoplasty

Globe

Refractive surgery	Alpins method Automated lamellar keratoplasty Conductive keratoplasty Corneal inlay Epikeratophakia Epi-LASIK Intrastromal corneal ring segment Keratomileusis Laser blended vision Laser eye surgery Laser thermal keratoplasty LASIK Contoura Vision Limbal relaxing incisions Phakic intraocular lens implantation Photorefractive keratectomy Radial keratotomy SMILE
Cataract surgery	Capsulorhexis Capsulotomy Glued intraocular lens Hydrodelineation Hydrodissection Intraocular lens scaffold Manual small incision cataract surgery Phacoemulsification Prechop
Retinal surgery	Ignipuncture Laser photocoagulation Scleral buckle
Glaucoma surgery	Cyclodestruction Excimer laser trabeculostomy Minimally invasive glaucoma surgery Trabeculectomy Trabeculoplasty
Transplantation	Whole eye transplantation Corneal transplantation Corneal button Descemet membrane endothelial keratoplasty Pre-Descemet's endothelial keratoplasty
Other	Anterior chamber paracentesis Boston keratoprosthesis Corneal collagen cross-linking Enucleation Conformer Evisceration Gundersen flap Intravitreal injection Iridectomy Peritomy Photodisruption Phototherapeutic keratectomy Pterygium Sclerotomy Vitrectomy