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UnlabelledBACKGROUND AND OBJECTIVE To examine the biophysical effects of photothermal heating on herniated intervertebral discs during laser decompression surgery.Study design/materials and methodsEx vivo bovine nucleus pulposus specimens were irradiated with a Nd: YAG laser (lambda = 1.32 microm, 100 seconds exposure time, 9-31 W/cm(2), 4.8 mm spot diameter), whereas changes in tissue thermal, mechanical, and optical properties were monitored by using, respectively, infrared radiometry, tissue tension measurements, and diffuse reflectance from a HeNe probe laser. Morphologic changes and mass reduction were monitored by recording shape changes on video and weighing specimens before and after laser exposure.ResultsAt power densities below 20 W/cm(2), evaporation of water and specimen volume reduction (shrinking) were consistently observed on video during irradiation. In contrast, above 20 W/cm(2), vapor bubbles formed within the specimen matrix and subsequently ruptured (releasing heated vapors). When radiometric surface temperature approaches approximately 60 to 70 degrees C (denaturation threshold for tissue), tissue tension begins to increase, which is consistent with observations of specimen length reduction. The onset of this change in tissue tension is also reflected in characteristic alterations in diffuse reflectance. With cessation of laser irradiation, a sustained increase in tissue tension is observed, which is consistent with changes in specimen length and volume. Higher laser power results in a faster heating rate and subsequently an accelerated tension change. Specimen mass reduction increased with irradiance from 19 to 72% of the initial mass for 9--31 W/cm(2), respectively. Irradiated specimens did not return to their original shape after immersion in saline (48 hours) in contrast to air-dried specimens (24 hours), which returned to their original shape and size.ConclusionThese observations suggest that photothermal heating results in irreversible matrix alteration causing shape change and volume reduction (observed on video and evidenced by the increase in tissue tension) taking place at approximately 65 degrees C. Inasmuch as high laser power results in vapor bubble formation and specimen tearing, the heating process must be controlled. Diffuse reflectance measurements provide a noncontact, highly sensitive means to monitor dynamically changes in tension of nucleus purposus.

The laser irradiation of cartilage results in a plastic deformation of the tissue allowing for the creation of new stable shapes. During photothermal stimulation, mechanically deformed cartilage undergoes a temperature dependent phase transition, which results in accelerated stress relaxation of the tissue matrix. Cartilage specimens thus reshaped can be used to recreate the underlying framework of structures in the head and neck. Optimization of this process has required an understanding of the biophysical processes accompanying reshaping and also determination of the laser dosimetry parameters, which maintain graft viability. Extensive in vitro, ex-vivo, and in vivo animal investigations, as well as human trials, have been conducted. This technology is now in use to correct septal deviations in an office-based setting. While the emphasis of clinical investigation has focused on septoplasty procedures, laser mediated cartilage reshaping may have application in surgical procedures involving the trachea, laryngeal framework, external ear, and nasal tip. Future directions for research and device design are discussed.

Laser radiation can be used to reshape cartilage tissue into new morphologic configurations. When a critical temperature is attained, mechanically deformed cartilage becomes malleable and may be reshaped into new geometric configurations that harden as the tissue cools. This temperature-dependent process results in mechanical stress relaxation and is characteristic of a phase transformation. The principal advantages of using laser radiation for the generation of thermal energy in tissue are precise control of both the space-time temperature distribution and time-dependent thermal denaturation kinetics. In this study, we illustrate the utility of laser mediated cartilage reshaping in ex vivo porcine model of reconstructive nasal and laryngeal surgery, and attempt to determine the temperature range in which accelerated stress relaxation occurs during laser mediated cartilage reshaping. Optimization of the reshaping process requires identification of the temperature dependence of this phase transformation and its relationship to observed changes in cartilage optical (diffuse scattering), mechanical (internal stress), and thermodynamic properties (heat capacity). Light scattering, infrared radiometry, and modulated differential scanning calorimetry were used to measure temperature-dependent changes in the biophysical properties of cartilage tissue during fast (laser mediated) and show heating (conventional calorimetric heating). Our studies using MDSC and laser probe techniques have identified changes in tissue thermodynamic and optical properties suggestive of a phase transformation occurring near 60°C. Clinically, reshaped cartilage tissue can be used to recreate the underlying cartilagious framework of structures in the head and neck such as the ear, larynx, trachea, and nose.

Laser-assisted cartilage reshaping is mediated by thermally induced stress relaxation, and may be used to alter cartilage morphology for reconstructive surgical procedures in the upper airway and face without carving, morselizing, or suturing. Internal stress σ(t), integrated backscattered light intensity I(t) from a He-Ne probe laser (λ=632.8 nm), and radiometric surface temperature Sc(t) were measured during the reshaping of porcine nasal septal cartilage using a pulsed Nd:YAG laser (λ=1.32 μm). Internal stress and integrated backscattered light intensity were observed to increase, plateau, and then decrease in similar ways during laser irradiation. The plateau region occurred when the cartilage front surface temperature approached 65 °C. I(t) was utilized in a feedback control procedure to reshape cartilage specimens from a flat to a curved geometry. Immediately following laser irradiation, the tissues were rehydrated in normal saline for 15 min while wrapped around a small dowel. A stable shape change was retained for 21 days while the specimens were stored in normal saline at 5 °C. The backscattered light intensity signal mirrors underlying changes in internal stress, and further rate of change or slope of I(t) is nearly zero when the surface temperature reaches about 65 °C. Measurements of I(t) (or, equivalently, the fractional change in integrated backscattered light intensity ΔI(t)/I0) may be used to control the process of laser-assisted cartilage reshaping and minimize nonspecific thermal injury due to uncontrolled heating. © 1998 Society of Photo-Optical Instrumentation Engineers.

Cartilage undergoes characteristic deformation following laser irradiation below the ablation threshold. Measurements of surface temperature and integrated scattered light intensity were performed during laser irradiation. Porcine auricular cartilage (1 - 2 mm thickness) was irradiated with an Nd:YAG laser (lambda equals 1.32 micrometer) with varying dose (J/cm2). Surface temperature was monitored using a single element HgCdTe infrared detector, responsive between 10 - 14 micrometer. A HeNe laser beam (lambda equals 632.8 nm) was incident on the back surface of the cartilage specimen and fractional integrated back scattered light intensity was measured using an integrating sphere and a silicon photodiode. Laser irradiation (2 W, 5.83 W/cm2, 50 Hz PRR) was allowed to proceed until surface temperature reached 70 degrees Celsius. Cartilage deformation was observed in each instance. Integrated scattered light intensity reached a plateau before the peak temperature (70 degrees) was reached. At increased laser power (10 W, 39.45 W/cm2, 50 Hz PRR), a feedback controlled cryogen spray was used to maintain surface temperature below 50 degrees Celsius. A similar plateau response was also noted in integrated scattered light intensity. This signal may be used to optimize the process of stress relaxation in laser cartilage reshaping. Several clinical applications are discussed. ©2005 Copyright SPIE - The International Society for Optical Engineering.

In this study, we attempted to determine the critical temperature [Tc] at which accelerated stress relaxation occurred during laser mediated cartilage reshaping. During laser irradiation, mechanically deformed cartilage tissue undergoes a temperature dependent phase transformation which results in accelerated stress relaxation. When a critical temperature is attained, cartilage becomes malleable and may be molded into complex new shapes that harden as the tissue cools. Clinically, reshaped cartilage tissue can be used to recreate the underlying cartilaginous framework of structures such as the ear, larynx, trachea, and nose. The principal advantages of using laser radiation for the generation of thermal energy in tissue are precise control of both the space-time temperature distribution and time-dependent thermal denaturation kinetics. Optimization of the reshaping process requires identification of the temperature dependence of this phase transformation and its relationship to observed changes in cartilage optical, mechanical, and thermodynamic properties. Light scattering, infrared radiometry, and modulated differential scanning calorimetry (MDSC) were used to measure temperature dependent changes in the biophysical properties of cartilage tissue during fast (laser mediated) and slow (conventional calorimetric) heating. Our studies using MDSC and laser probe techniques have identified changes in cartilage thermodynamic and optical properties suggestive of a phase transformation occurring near 60°C.

Nowadays glaucoma is one of the leading causes of irreversible blindness worldwide. The main goal in preservation of vision in glaucoma patients is reducing intraocular pressure (IOP), which is considered the main controlled risk factor for progression of glaucomatous optic neuropathy. The article discusses the effectiveness and safety of various transscleral laser technologies in the treatment of glaucoma. Modern transscleral laser technologies that affect the uveoscleral drainage and scleral hydro-permeability are less traumatic and more gentle making them promising in the treatment of patients with early stages of glaucoma, and not only in terminal glaucoma with pain syndrome resistant to conventional treatment ("last resort surgery").

Moderate heating of collagenous tissues such as cartilage and cornea by infrared laser irradiation can produce biologically nondestructive structural rearrangements and relaxation of internal stresses resulting in the tissue reshaping. The reshaping results and eventual changes in optical and biological properties of the tissue strongly depend on the laser-irradiation regime. Here, a speckle-contrast technique based on monochromatic illumination of the tissue in combination with strain mapping by means of optical coherence elastography (OCE) is applied to reveal the interplay between the temperature and thermal stress fields producing tissue modifications. The speckle-based technique ensured en face visualization of cross correlation and contrast of speckle images, with evolving proportions between contributions of temperature increase and thermal-stresses determined by temperature gradients. The speckle-technique findings are corroborated by quantitative OCE-based depth-resolved imaging of irradiation-induced strain-evolution. The revealed relationships can be used for real-time control of the reshaping procedures (e.g., for laser shaping of cartilaginous implants in otolaryngology and maxillofacial surgery) and optimization of the laser-irradiation regimes to ensure the desired reshaping using lower and biologically safer temperatures. The figure of waterfall OCE-image demonstrates how the strain-rate maximum arising in the heating-beam center gradually splits and drifts towards the zones of maximal thermal stresses located at the temperature-profile slopes., (© 2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Moderate heating of such collagenous tissues as cornea and cartilages by infra-red laser (IR laser) irradiation is an emerging technology for nondestructive modification of the tissue shape and microstructure for a variety of applications in ophthalmology, otolaryngology and so on. Postirradiation high-resolution microscopic examination indicates the appearance of microscopic either spheroidal or crack-like narrow pores depending on the tissue type and irradiation regime. Such examinations usually require special tissue preparation (eg, staining, drying that affect microstructure themselves) and are mostly suitable for studying individual pores, whereas evaluation of their averaged parameters, especially in situ, is challenging. Here, we demonstrate the ability of optical coherence tomography (OCT) to visualize areas of pore initiation and evaluate their averaged properties by combining visualization of residual irradiation-induced tissue dilatation and evaluation of the accompanying Young-modulus reduction by OCT-based compressional elastography. We show that the averaged OCT-based data obtained in situ fairly well agree with the microscopic examination results. The results obtained develop the basis for effective and safe applications of novel nondestructive laser technologies of tissue modification in clinical practice. PICTURE: Elastographic OCT-based images of an excised rabbit eye cornea subjected to thermomechanical laser-assisted reshaping. Central panel shows resultant cumulative dilatation in cornea after moderate (~45-50°C) pulse-periodic heating by an IR laser together with distribution of the inverse Young modulus 1/E before (left) and after (right) IR irradiation. Significant modulus decrease in the center of irradiated region is caused by initiated micropores. Their parameters can be extracted by analyzing the elastographic images., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Infrared (IR) laser impact has no analogues for rapid and safe cartilage reshaping. For better penetration of radiation optical clearing agents (OCAs) can be applied. In present work, the effect of low-osmolality agent iohexol on costal cartilage is studied. Specifically, it is shown that ½ of total increase of optical transparency occurs in 20 minutes of immersion. Maximally, cartilage transparency on 1560 nm can be increased in 1.5 times. Injection of iohexol results in increased tissue hygroscopicity, lower drying rate and higher percentage of bound water. Effective diffusion coefficients of water liberation at 21°C are (5.3 ± 0.4) × 10 -7 and (3.3 ± 0.1) × 10 -7 cm 2 /s for untreated and iohexol-modified tissue, respectively. Raman spectroscopy of irradiated iohexol solution reveals its photo and thermo-stability under clinically used IR laser energies up to 350 W/cm 2 for exposure times of several seconds. At energies higher than 500 W/cm 2 [Correction added on 5 September 2018, after first online publication: This unit has been changed] decomposition of iohexol occurs rapidly through formation of molecular iodine and fluorescent residue., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The article describes a newly developed and tested diffractive optical element (DOE) that converts non-uniform radiation of the laser output into a homogeneous ring. The Gerchberg-Saxton algorithm is shown to be well suited for achieving annular intensity distribution. Testing this ring transducer on threshold-plasticity cornea demonstrated the reversibility of axisymmetric changes in the cornea. Atomic-Force microscopy of the area of maximum stresses in the corneal periphery showed no significant changes in the structure of the cornea when irradiated in the selected mode. Measurement of Young's modulus of the corneal surface areas after their irradiation also revealed no changes in the elastic properties, while examination of the corneal structure demonstrated the absence of significant structural changes in irradiated samples compared with intact ones.

We describe the use of elastographic processing in phase-sensitive optical coherence tomography (OCT) for visualizing dynamics of strain and tissue-shape changes during laser-induced photothermal corneal reshaping, for applications in the emerging field of non-destructive and non-ablative (non-LASIK) laser vision correction. The proposed phase-processing approach based on fairly sparse data acquisition enabled rapid data processing and near-real-time visualization of dynamic strains. The approach avoids conventional phase unwrapping, yet allows for mapping strains even for significantly supra-wavelength inter-frame displacements of scatterers accompanied by multiple phase-wrapping. These developments bode well for real-time feedback systems for controlling the dynamics of corneal deformation with 10-100 ms temporal resolution, and for suitably long-term monitoring of resultant reshaping of the cornea. In ex-vivo experiments with excised rabbit eyes, we demonstrate temporal plastification of cornea that allows shape changes relevant for vision-correction applications without affecting its transparency. We demonstrate OCT's ability to detect achieving of threshold temperatures required for tissue plastification and simultaneously characterize transient and cumulative strain distributions, surface displacements, and scattering tissue properties. Comparison with previously used methods for studying laser-induced reshaping of cartilaginous tissues and numerical simulations is performed., (© 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The review covers different aspects of the impact of femtosecond laser-assisted cataract surgery on the state of the macular zone of the retina. Literature search has revealed inconsistency of the published data and indicated the need for a more detailed study of this problem.

Background and Objective: Laser reshaping of cartilage is a prospective technique which can be applied for manufacturing the natural implants for otolaryngology and reconstructive surgery. Optical properties and optimal laser settings for laser reshaping of costal cartilage depend on its thickness, water content, and structural anisotropy of the tissue, in particular, the distinct orientation of collagen packing. The aim of the work is to study the effect of different collagen orientation, thickness, and drying of costal cartilage on its interaction with laser radiation., Materials and Methods: Costal cartilage was cut along and crosswise the distinct collagen orientation. The dried and normal cartilage was used for the comparative analysis. The collagen package was studied using atomic force microscopy. The dried tissue was analyzed with thermogravimetry-differential scanning calorimetry (TG-DSC) analysis to reveal the residual water content. The optical transmittance was measured for two wavelengths λ: 1,560 and 532 nm. The reshaping of cartilage of 1-3 mm in thickness was performed with infrared laser with λ = 1560 nm while, the radiation with λ = 532 nm was used to determine the location of the IR beam., Results: The transmittance of 532 nm radiation does not depend on collagen orientation and tissue drying. The IR radiation transmits better along the distinct collagen direction in dried cartilage while in normal cartilage the intensity of transmitted IR radiation increases intermittently passing crosswise and does not change dramatically with time along the collagen orientation., Conclusions: The effect of structural anisotropy of costal cartilage reveals itself in the increasing scattering of IR radiation with λ = 1,560 nm passing crosswise the collagen orientation when tissue water content is decreased. The radiation with λ = 1,560 nm is effective to perform the reshaping for cartilage of 1-3 mm in thickness; however, for 3 mm, the residual mechanical stress should be taken into account. Lasers Surg. Med. 48:887-892, 2016. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background and Objective: Magnetic nanoparticles with the ability to absorb laser radiation are the perspective agents for the early diagnostics and laser therapy of degenerative cartilage. The effect of starch stabilized magnetite nanoparticles (SSNPs) on the cartilage structure components has never been studied before. The aim of the work is to establish the Erbium:glass laser effect on costal and articular cartilage impregnated with SSNPs., Materials and Methods: Porcine articular and costal cartilage disks (2.0 mm in diameter and 1.5-2 mm in thickness) were impregnated with SSNPs and irradiated using a 1.56 μm laser in therapeutic laser setting. The one sample group underwent the second irradiation after the SSNPs impregnation. The samples were analyzed by the means of histology, histochemistry and transmission electron microscopy (TEM) to reveal the alterations of cells, glycosaminoglycans and collagen network., Results: The irradiated cartilage demonstrates the higher content of cell alterations than the intact one due to the heat and mechanical affection in the course of laser irradiation. However the alterations are localized at the areas near the irradiated surfaces and not dramatic. The impregnation of SSNPs does not cause any additional cell alterations. For both costal and articular cartilage the matrix alterations of irradiated samples are not critical: there is the slight decrease in acid proteoglycan content at the irradiated areas while the collagen network is not altered. Distribution and localization of impregnated SSNPs is described: agglomerates of 150-230 nm are observed located at the borders between matrix and cell lacunas of articular cartilage; SSNPs of 15-45 nm are found in the collagen network of costal cartilage., Conclusions: It was shown that SSNPs do not appreciably affect the structural components of both articular and costal cartilage and can be safely used for the laser diagnostics and therapy. The area of structural alterations is diffuse and local as the result of the mechanical and heat effect of laser impact. SSNPs reveal the areas of the structural alterations of cartilage matrix and give information about the size of the pores and defects., (© 2015 Wiley Periodicals, Inc.)

Background and Objectives: Pores in the sclera are a candidate pathway for aqueous transport and therefore can be utilized to decrease the intraocular pressure (IOP) in glaucomatous eyes. Since pore formation is a well-known mechanism for stress relaxation in solids, laser-induced creation of pores in cartilage increases hydraulic permeability and promotes tissue regeneration. The aim of this paper is to demonstrate the thermo-mechanical effect of non-destructive laser irradiation on microstructural changes in sclera, in particular pore formation, resulting in substantial increase of water permeability of eye tissues that can be a novel approach to normalize the IOP., Materials and Methods: Experiments were performed ex vivo on eight eyes of four mini-pigs and in vivo on eight eyes of four rabbits using pulse repetitive laser radiation of 1.56 µm in wavelength. Twenty laser spots of 0.6 mm in diameter with laser settings (power 0.9 W, pulse duration of 200 milliseconds, pulse repetition rate of 2 Hz) resulting in substantial increase of sclera hydraulic permeability were applied on the sclera at 1-2 mm from the eye limb. Sclera and underlying structures (choroid and ciliary body) of the rabbits' eyes were examined histologically in 1 and 45 days after laser irradiation, atomic force microscope (AFM) was applied before and after laser irradiation., Results: Histological and AFM examinations have clearly recognized laser-assisted stable structural alterations: rarefication of the collagen structure in the laser irradiated zone and formation of sub-micron pores. Laser-induced alterations in the structure of ciliary bodies were small in size and mainly reversible. We have proposed a possible mechanism of the arising pores stabilization due to formation of small stable gas bubbles in sclera tissue., Conclusions: It is shown, for the first time, that thermo-mechanical effect of pulse repetitive laser irradiation results in pores formation in sclera. That can be a basis of a novel, safe, and effective technique for IOP normalization due to enhancing of uveoscleral outflow under non-destructive laser irradiation of the sclera., (© 2013 Wiley Periodicals, Inc.)

Optical properties of cornea and sclera of the eye and their alterations under the effect of 1.56-μm laser radiation are studied. The laser settings corresponded to the laser treatment regimens used (1) to correct the shape of the cornea and change the refraction of the eye and (2) to improve the hydraulic permeability of the sclera in glaucoma cases. A fiber-optical system to investigate the dynamics of the reflected and transmitted scattered laser radiation and a setup with a double integrating sphere to determine the optical properties of the ocular tissues on the basis of the Monte-Carlo simulation of the propagation of light was used. When the radiation characteristics corresponded to the treatment regimens for correcting the shape of the cornea, no noticeable changes were detected in its optical properties. When irradiating the sclera in conditions corresponding to the treatment regimens for improving its hydraulic permeability, the optical characteristics of the tissue showed definite changes. The results obtained as to the dynamics of the optical signals during the course of laser irradiation of the cornea and sclera create prerequisites for designing test systems to be used with novel medical laser techniques for correcting visual abnormalities.

Background and Objective: Laser reshaping of cartilage is a new effective and safe technique for correction of nasal septum and ear deformities. Costal cartilage is a most suitable natural material for transplantation. The problem is to obtain stable proper shape of cartilage implants. The objective of this article is to study reshaping of porcine costal cartilage for larynx stenosis surgery using Erbium glass fiber laser., Materials and Methods: Porcine cartilage plates 3 mm in thickness were mechanically curved and irradiated (1) on one side (stretched or compressed) and (2) on both sides with different sequence. Irradiation was performed using a 1.56 µm laser with power varied from 1 to 2.5 W, exposure time from 5 to 20 seconds, spot diameter of 2.5 mm, pulse duration of 500 milliseconds, pulse repetition rate of 1.4 Hz. For each laser setting, stable curvature radius was measured during 24 hours after the experiment. Irradiated samples were analyzed by means of differential scanning calorimerty (DSC) to reveal the collagen denaturation degree., Results: The optimum laser setting for stable reshaping of costal cartilage without visual thermal damage of cartilage matrix was established: laser power of 2.2 W, exposure time of 6 seconds. Nonlinear thermomechanical behavior of cartilage in the course of its laser reshaping is experimentally revealed. The influence of irradiation sequence on the curvature radius of cartilage implant is found for the first time. It is shown that (1) it is possible to use laser reshaping technique for making stable proper shape of costal cartilage, and (2) primary irradiation of compressed side followed with an irradiation of stretched side is more effective than reverse sequence of laser treatment. DSC analysis showed that thermal effect of irradiated specimens (2.58-3.79 J/g) was slightly lower that that for intact cartilage specimens and considerably lower than that for denaturation of collagen (65 ± 5 J/g)., Conclusions: It is possible to use laser reshaping technique for preparation of stable cartilage implants. Nonlinear thermomechanical behavior of cartilage is experimentally revealed. The influence of irradiation sequence on curvature radius of cartilage grafts is established for the first time., (Copyright © 2011 Wiley-Liss, Inc.)

The purpose of this study was to characterize essential changes in the structure of annulus fibrosus (AF) after hydrothermal and infrared (IR) laser treatment and to correlate these results with alterations in tissue state. Polarization-sensitive optical coherence tomography imaging was used to measure collagen birefringence in AF. Differential scanning calorimetry was used as a complementary technique, providing detailed information on thermodynamic processes in the tissue. Birefringence, peak of the denaturation endotherm, and the enthalpy of denaturation (DeltaHm) were determined before and after hydrothermal heat treatment (85 degrees C for 15 min) and non-ablative Er:glass fiber laser exposures on AF in the whole disk (vertebrae-disk-vertebrae complex). Our data have demonstrated quantitative differences between results of laser and hydrothermal heating. Birefringence did not disappear and DeltaHm did not change after treatment in the water bath, but loss of birefringence and a decrease in the enthalpy did occur after laser exposure. These results could be explained by the photomechanical effect of laser irradiation. We suggest that thermo-mechanical stress played a dominant role in the disruption of the collagen network of AF under non-homogeneous laser heating.

Cartilaginous and connective tissues were exposed to a moderate-intensity IR laser treatment with IR radiometric temperature control. The isotherms of water sorption by dry preparations of intact and laser-treated tissues were obtained and calculated in terms of well known models. It was shown that the sorption capacity of a monolayer of tissues decreases with increasing temperature during laser treatment. Changes in the supramolecular structure of the extracellular matrix of tissues (loss of regularity) upon IR laser exposure are discussed.

Like pure water, the water incorporated into cartilage and cornea tissue shows a pronounced dependence of the absorption coefficient on temperature. Alteration of the temperature by radiation with an IR free-electron laser was studied by use of a pulsed photothermal radiometric technique. A computation algorithm was modified to take into account the real IR absorption spectra of the tissue and the spectral sensitivity of the IR detector used. The absorption coefficients for several wavelengths within the 2.9- and 6.1-microm water absorption bands have been determined for various laser pulse energies. It is shown that the absorption coefficient for cartilage decreases at temperatures higher than 50 degrees C owing to thermal alterations of water-water and water-biopolymer interactions.

Experimental-and-morphological as well as physical-and-chemical changes occurring in the eye fibrous coat tissues, i.e. the cornea and sclera, at non-ablation impact of fiber laser radiation (Er-glass) with a wavelength of 1.56 mcm were analyzed. Necrobiotic or necrotic changes occur in the tissues with regard for laser radiation capacity and impact duration; subsequently, the regenerative process involving a retraction of the sclera and a flattening of the cornea takes place in the end. When the cornea is heated by fiber laser radiation with a minimally possible intensity (up to 0.3 Wt), a temporary weakening is observed in the corneal rigidity. Should it be accompanied by a simultaneous occurrence of retraction forces coming from the sclera (at its coagulation), it can be used to change, in the clinical controllable mode, the corneal curvature radius.

Mechanically deformed morphologic cartilage grafts undergo temperature-dependent stress relaxation during sustained laser irradiation resulting in stable shape changes. In this study, porcine nasal septal cartilage specimens were evaluated for viability by measuring the incorporation of Na2(35)SO4 into proteoglycan (PTG) macromolecules in whole tissue culture following laser-mediated reshaping. Synthesis rates of PTG were determined by scintillation counting lyophilized specimens and normalizing these values by total protein content. Positive controls were established by inducing chondrocyte apoptosis using prolonged exposure to nitric oxide (NO). In chondrocytes, apoptosis induced using NO resulted in significantly lower PTG synthesis rates compared to untreated native specimens. Cartilage specimens were irradiated with light emitted from a Nd:YAG laser (25 W/cm2, lambda = 1.32 microns) while recording simultaneously radiometric surface temperature, internal stress and back-scattered light intensity from a probe laser. Each specimen received one, two or three sequential laser exposures. The duration of each exposure was determined from real-time measurements of characteristic changes in back-scattered light intensity that correlate with accelerated stress relaxation. A 5 min time interval between each laser exposures allowed the cartilage specimen to return to thermal equilibrium. Average PTG synthesis rates decreased with successive laser exposures, though these were always higher than baseline rates established for NO-treated tissues, suggesting that laser-mediated cartilage reshaping acutely does not eliminate the entire population of viable chondrocytes. The reduction in PTG synthesis is correlated with the time-temperature-dependent heating profile created during laser irradiation, supporting our hypothesis that careful monitoring of laser dosimetry is required to ensure chondrocyte viability.

To study mechanisms of cartilage modelling, estimation of optimal parameters and regimens of laser radiation, the authors made in vitro and human experiments on nasal septum cartilages and in vivo experiments on cartilages of the floor of the auricle in rabbits and pig. Ho-laser radiation is thought the most appropriate tool for cartilage shaping. A method of non-invasive correction of the nasal septum cartilage in its distortion has been designed. 2/3 of the patients recovered or improved nasal respiration. Laser operation has no age restrictions, is non-invasive, can be made outpatiently, is not followed by pharmacological treatment.

To study the mechanism of simulation of a cartilage, to define the optimum parameters and laser radiation regimens, the authors made a complex of in vitro experiments on the cartilages of the nasal septum in man and domestic animals and in vivo experiments on those of the concha in rabbits and pigs. Holmium laser radiation is shown to be the most suitable tool for formation of a cartilage. Evidence is provided for the possibility of irreversibly altering the shape of a cartilage during laser radiation. A procedure has been developed for non-invasive correction of the septum of the nose for its curvature. Restored or improved nasal respiration was observed in more than two thirds of the patients. Laser surgery is not of age-limited application, it is noninvasive, can be performed in the outpatient settings and requires no drug treatment in the postoperative treatment.

Objective: To demonstrate feedback-controlled laser-mediated cartilage reshaping using dynamic measurements of tissue optical properties and radiometric surface temperatures., Design: Flat cartilage specimens were reshaped into curved configurations using a feedback-controlled laser device., Materials: Fresh porcine nasal septum, stripped of perichondrium and cut into uniform strips (25 x 10 x 1.5-2.1 mm) with a custom guillotine microtome., Interventions: Cartilage specimens secured in a cylindrical reshaping jig (2.5 cm in diameter) and irradiated with an Nd:YAG laser (lambda = 1.32 microns, 25 W/cm2, 50-Hz pulse repetition rate). During laser irradiation, radiometric surface temperature was measured along with changes in forward-scattered light from a diode probe laser (lambda = 650 nm, 5 mW), using a lock-in detection technique. Sequential irradiation of the specimen outer surface was made (3 laser passes). Characteristic changes in tissue temperature and light-scattering signals were used to terminate laser irradiation., Results: Effective reshaping was accomplished for both thin (1.5-mm) and thick (2.1-mm) specimens. Following reshaping, specimens were stored in saline solution at 4 degrees C for 21 days. No return to the original flat configuration was noted during this period., Conclusions: The prototype device effectively reshapes flat native porcine cartilage into curve configurations. The use of optical and thermal signals provides effective feedback control for optimizing the reshaping process.

We have investigated the biocompatibility of calcium phosphate coatings deposited by pulsed laser ablation from hydroxyapatite (HA) targets onto polyethylene and Teflon substrates. It was found that the cell density, attachment, and morphology of primary rat calvaria osteoblasts were influenced by both the original polymer and by the nature of the apatite coatings. HA coatings on Teflon were found to have higher biocompatibility in terms of cell adhesion and spreading. In vivo studies of bone response to coatings deposited by KrF excimer and CO2 lasers on commercial Ti6A14V alloy implants show that both deposition techniques suppress fibrous tissue formation and promote osteogenesis. © 1998 Society of Photo-Optical Instrumentation Engineers.

Atomic force microscopy (AFM) has been used to study the surface morphology of apatite films deposited on metallic and polyethylene substrates by laser ablation using KrF and transversely excited atmospheric CO2 lasers. The films are found to consist of a smooth apatite coating with macroparticles scattered on the surface. A wide variety of macroparticles, differing in size, shape and roughness, were found and analysed employing the high spatial resolution of AFM (< 1 nm). We have investigated the correlation between the apatite film morphology and the deposition conditions. Of particular importance are laser fluence, gas pressure, the nature of the target and the substrate temperature. We have explained these dependencies on the basis of a theoretical model which includes evaporation and a cluster-type laser ablation mechanism.

The thermodynamic characteristics of the 'bound-to-free' phase transformation of water are studied by means of differential microcalorimetry and FTIR spectroscopy. This phase transition controls the stress relaxation and reshaping of cartilage which we have observed previously under moderate laser heating. It is shown that the FTIR spectrum of bound water in cartilage differs from that of free water in cartilage, and that both show differences to the FTIR spectrum of pure water. The proportion of bound water in cartilage is found to be of the order 4%. We have examined water liberation and absorption kinetics and found them to be controlled by diffusion through the tissue and also by the bound-to-free water transformation. The theoretical modelling and experimental data allowed calculation of diffusion coefficients and the activation energy for water transfer. The latter was found to be close to the heat of phase transformation of water. We have established that the drying and wetting processes in cartilage are reversible (fully or in a part, depending on the temperature of preliminary drying) and can be described by identical solutions of the diffusion problem, with coefficients of water diffusion being the same. The mechanism of water diffusion in cartilaginous tissue is also discussed.

A phenomenological model of an increase in ultraviolet absorption in bone tissue induced by ultraviolet radiation of excimer laser has been developed. It is assumed that the increase in absorption is related to photochemical reactions in collagen. The model accounts for changes in the intensity of laser radiation due to its absorption inside the specimen. From the comparison of experimental and calculated results the parameters of the photochemical model were estimated. The temperature fields in the specimen were calculated with regard to laser-induced changes in absorption coefficient. The limits of applicability of the model are discussed.

The experiments were made to study CO2-laser ability to promote spontaneous formation of nasal septum cartilage. Laser-induced changes in physical and histological characteristics of the cartilage tissue were followed up. Optimal regimens of radiation were selected which allowed to modify cartilage shape without impairment of its morphological and histological structure. In vivo tests were performed on rabbit auricular floor cartilage. The present shape of the cartilage remained stable. It is inferred that laser energy may be a promising tool in plastic ENT surgery.

Rat experiments were performed to study osteogenesis and osseointegration in implanting fragments of dental titanic implants into the spongy bone. The implant spray-coating with hydroxyapatite produced by excimer and CO2 lasers stimulates osteogenesis. Bone tissue integration with implant proceeds more actively in response to CO2 laser radiation. The weakest integration was registered between the metal and bone tissues.

Use of various lasers and regimens for spraying the coatings and for additional thermal processing makes it possible to purposefully alter the morphology, composition, and crystallinity of the coatings, and hence, the optimal coatings, as regards their biological activity, may be created. Replacement of eximer lasers with CO2 lasers makes the spraying process cheaper and comparable in efficacy with the plasma process, with the quality of coatings and reproducibility of their parameters appreciably improved. Experiments with coatings of three types, sprayed by CO2 lasers, demonstrated that they met the mechanical and physico-chemical requirements of biocompatibility.

Investigations of structural and mechanical properties of cartilage tissue exposed to laser radiation have shown the effect of laser relaxation of the tension existing in the cartilage and changes in the latter form to be due to phasic transition of water from bound into free state. Laser radiation does not induce macroscopic transformations of the matrix structure. New form of the cartilage proved stable this offering new prospects for wide application of this technique in otorhinolaryngology and plastic surgery.