飞秒激光晶状体切割机制与光量效关系研究

The scientific treating methods for both cataract and presbyopia are paid close attention by medicine as the aggravation of the global ageing problem. Femtosecond laser-assisted crystalline lens softening surgery for treating presbyopia etiologically is still under development at lab. Under the guidance of “Vision 2020” project issued by WHO, femtosecond laser-assisted lentotomy surgery for cataract, in which femtosecond laser takes the place of the traditional ultrasound technique as a novel tool, has recently been applied in clinic and enhanced cataract treatment into the age of refraction surgery. . While confined by the wavelength and pulse duration of the available commercial femtosecond laser, the optimized parameters and customized plan of such femtosecond laser-assisted lentotomy have not been studied thoroughly or established, which limit either the clinical application of femtosecond laser-assisted presbyopia surgery or the enhancement of safety and efficiency of femtosecond laser-assisted cataract surgery, or the creative and broad application of ultrafast laser to medicine. Given the differences on physical and chemical structure between crystalline lens and cornea, we hypothesize that there may be difference theoretically on the primary process between femtosecond laser-crystalline lens interaction and femtosecond laser-cornea interaction, then there may be gradient of laser doses inside crystalline lens due to the gradient of elasticity among the crystalline lens collagen fibers. . To prove such hypotheses, our research team has firstly proposed the related studies in such femtosecond laser-assisted lentotomy surgeries on the basis of the homemade femtosecond laser with adjustable wavelength and pulse duration developed by Institute of Physics, CAS, since 2010 and obtained preliminary positive results. This project aims at explaining the scientific question on the mechanism of femtosecond laser-crystalline lens interaction from a new angle of view, discussing the dosimetric relationship and scientific rule between the interaction, making the clinical criterion of safety and customization on femtosecond laser assisted lentotomy surgery for the yellow, and filling the medical gap in dynamic etiological treatment for presbyopia..

伴随全球人口老龄化，老视与白内障的科学治疗受到医学关注。利用飞秒激光软化晶状体对因治疗老视的研究尚在实验室阶段；在WHO“Vision2020”目标指导下利用飞秒激光作为新型工具切割晶状体的方法使得白内障的治疗近期进入屈光手术时代。然而受到现有商业飞秒激光器激光参数的限制，飞秒激光晶状体切割手术的优化、个性化手术方案尚未得到充分研究与阐述，限制了飞秒激光老视手术的临床化进程与飞秒激光白内障手术安全性、有效性的提升。考虑到角膜与晶状体理化结构的不同，其与飞秒激光相互作用的原初过程理论上存在不同，且源于晶状体内部胶原纤维硬度梯度，晶状体内部可能存在激光切割剂量梯度。为证实如上假说本团队自2010年首次提出利用自主搭建的参数可调的新型飞秒激光器开展该领域的实验研究并取得初步结果。本项目将从新的视角阐明飞秒激光晶状体相互作用机制，探讨其光量效关系与科学规律，制定黄种人飞秒激光晶状体手术的临床标准。