本文選題：飛秒激光 + 微加工�。� 參考：《華中科技大學(xué)》2016年博士論文

【摘要】：目的：本研究致力于評(píng)估高重復(fù)頻率納焦單脈沖能量飛秒激光(納焦飛秒激光)在抗青光眼手術(shù)鞏膜組織高精度加工中的應(yīng)用。衡量納焦飛秒激光是否能對(duì)鞏膜進(jìn)行切割及探索納焦飛秒激光對(duì)鞏膜的生物及物理改變。背景：青光眼是世界范圍不可逆性致盲的首要病因。常規(guī)抗青光眼手術(shù)遠(yuǎn)期效果不佳,手術(shù)切口纖維化是導(dǎo)致手術(shù)失敗主要原因。手術(shù)過程中對(duì)組織的微創(chuàng)操作有利于減少術(shù)后纖維化的形成。納焦飛秒激光組織切割因其切割精細(xì),對(duì)周圍組織損傷極小且形成切口內(nèi)壁光滑等特征,為預(yù)防抗青光眼術(shù)后纖維化提供了新契機(jī)。方法：用納焦飛秒激光對(duì)兔離體鞏膜進(jìn)行蝕除,計(jì)算機(jī)控制的三維平臺(tái)用于實(shí)現(xiàn)各種形式的掃描。掃描過程中組織表面實(shí)時(shí)觀察由電荷耦合裝置(cCD)完成,組織表面溫度分布由紅外熱像儀完成,組織樣本的形態(tài)學(xué)改變由掃描電鏡觀察(SEM),組織樣本熱效應(yīng)由組織切片HE染色及Masson染色觀察。結(jié)果：納焦飛秒激光作用于離體兔鞏膜可形成裂隙樣,矩形,表面下蝕除。單次線性掃描顯示,切口深度與曝光時(shí)間成正比,與聚焦深度成反比。激光對(duì)組織加工過程中,實(shí)時(shí)觀測(cè)可得：納焦飛秒激光對(duì)組織加工時(shí)可產(chǎn)生熱累積效應(yīng),且與單脈沖能量及曝光時(shí)間成正比。通過對(duì)切口橫截面掃描電鏡觀察得出,激光切口內(nèi)壁非常光滑(Ra=0.93±0.14μm)。通過HE及Masson染色觀察顯示：激光加工時(shí)組織可出現(xiàn)顏色加深,膠原蛋白皺縮等變化。比較納焦飛秒激光與低重復(fù)頻率微焦單脈沖能量飛秒激光(微焦激光)鞏膜組織蝕除結(jié)果示：微焦激光光柵掃描所得切口內(nèi)表面粗糙度明顯大于納焦飛秒激光所得切口內(nèi)表面粗糙度,差別具有統(tǒng)計(jì)學(xué)意義(P=0.0135)。結(jié)論：該研究闡述了納焦飛秒激光在抗青光眼手術(shù)微創(chuàng)激光鞏膜蝕除中的潛在應(yīng)用價(jià)值。據(jù)筆者所知,此乃納焦飛秒激光對(duì)抗青光眼手術(shù)鞏膜切除的世界范圍內(nèi)首次研究。應(yīng)用1040nm波長(zhǎng)飛秒激光實(shí)現(xiàn)了水和鞏膜表面下蝕除。且通過組織熱損傷研究證明了納焦飛秒激光對(duì)組織加工熱效應(yīng)較小。與微焦激光相比,納焦飛秒激光可加工形成極精細(xì)且光滑的鞏膜切口,有望應(yīng)用于抗青光眼濾過手術(shù)中。
[Abstract]:Objective: to evaluate the application of high repetition rate nanfocal single pulse femtosecond laser (NRF) in high-precision scleral tissue processing in glaucoma surgery. To evaluate whether nanoclock femtosecond laser can cut sclera and explore the biological and physical changes of nanoclock femtosecond laser on sclera. Background: glaucoma is the leading cause of irreversible blindness worldwide. The long-term effect of conventional anti-glaucoma surgery is not good. The main cause of surgical failure is surgical incision fibrosis. The minimally invasive operation of tissue during operation is helpful to reduce the formation of postoperative fibrosis. Nano-Femtosecond laser tissue cutting provides a new opportunity for preventing fibrosis after glaucoma surgery because of its fine cutting, minimal injury to surrounding tissues and smooth inner wall of incision. Methods: the rabbit sclera was etched by nanoco femtosecond laser. The three dimensional platform controlled by computer was used to realize scanning in various forms. The real-time observation of the tissue surface was accomplished by the charge coupled device (CDD), and the temperature distribution of the tissue surface was accomplished by the infrared thermal imager. The morphological changes of tissue samples were observed by scanning electron microscope (SEM), and the thermal effects of tissue samples were observed by HE staining and Masson staining. Results: Femtosecond laser could form fissure shape, rectangle and surface erosion in isolated rabbit sclera. Single linear scanning shows that the incision depth is directly proportional to the exposure time and inversely proportional to the focus depth. In the process of laser processing, it can be found that the femtosecond laser can produce thermal accumulative effect, which is proportional to the single pulse energy and exposure time. The results of scanning electron microscopy show that the inner wall of the laser incision is very smooth, which is 0.93 鹵0.14 渭 m 路m ~ (-1). The results of HE and Masson staining showed that the changes of color and collagen shrinkage were observed during laser processing. Comparing the results of scleral tissue erosion between nanfocal femtosecond laser and low-repetition frequency microfocal single-pulse femtosecond laser (micro-focal laser), the results show that the internal surface roughness of microfocal laser raster scanning is obviously greater than that of nanfocal femtosecond laser. The roughness of the inner surface of the notch, The difference was statistically significant (P = 0.0135). Conclusion: this study describes the potential application value of nanokinetic femtosecond laser in minimally invasive laser scleral ablation in anti-glaucoma surgery. To the best of my knowledge, this is the first worldwide study of nanokorph femtosecond laser antiglaucoma surgery sclera resection. Water and scleral surface etching was realized by 1040nm femtosecond laser. The results of tissue thermal damage show that the femtosecond laser has less thermal effect on tissue processing. Compared with microfocal laser, nanoco femtosecond laser can produce extremely fine and smooth scleral incision, which is expected to be used in glaucoma filtering surgery.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R779.6

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