Noncontact laser photothermal keratoplasty. I: Biophysical principles and laser beam delivery system.

BACKGROUND Thermal shrinkage of stromal collagen is known to produce changes in the corneal curvature. We designed a novel, noncontact laser beam delivery system to perform laser photothermal keratoplasty. MATERIALS AND METHODS The instrument consisted of a pulsed holmium:YAG laser (2.10-micrometer wavelength, 250-microsecond pulse width, 5-hertz repetition rate) coupled via a monofilament fiber to a common slit-lamp microscope equipped with a polyprism, an adjustable mask, and a projection lens. The system projected an 8-spot annular pattern of infrared laser energy on the cornea to achieve a thermal profile within the stroma and to attain controlled, predictable collagen shrinkage. The system produced treatment patterns of 8 to 32 spots of 150 to 600 microns diameter in concentric rings, continuously adjustable between 3 and 7 mm. The versatility of the system in creating different treatment patterns was tested on thermal paper and human cadaver eyes. RESULTS A uniform beam profile and different treatment patterns for myopia, hyperopia, and astigmatism were obtained. Myopic correction of 6.00 diopters was demonstrated on cadaver eyes. Corneal topography documented corneal flattening (> 6.00 D) with the following treatment parameters: each spot size on the cornea = 300 microns, radiant exposure of each spot = 18.0 J/cm2, number of pulses = 1, diameter of the treatment ring = 3 mm. CONCLUSIONS Noncontact slit-lamp microscope laser delivery system for laser photothermal keratoplasty provides flexible and precise selection of laser treatment parameters. It may improve the efficacy of the procedure.