Development of a fiber-optic laser delivery system capable of delivering 213 and 266 nm pulsed Nd:YAG laser radiation for tissue ablation in a fluid environment.

Ultraviolet (UV) lasers have the capability to precisely remove tissue via ablation; however, due to strong absorption of the applicable portion the UV spectrum, their surgical use is currently limited to extraocular applications at the air/tissue boundary. Here we report the development and characterization of a fiber-optic laser delivery system capable of outputting high-fluence UV laser pulses to internal tissue surfaces. The system has been developed with a view to intraocular surgical applications and has been demonstrated to ablate ocular tissue at the fluid/tissue boundary. The fifth (213 nm) and fourth(266 nm) harmonics of a Nd:YAG laser were launched into optical fibers using a hollow glass taper to concentrate the beam. Standard and modified silica/silica optical fibers were used, all commercially available. The available energy and fluence as a function of optical fiber length was evaluated and maximized. The maximum fluence available to ablate tissue was affected by the wavelength dependence of the fiber transmission; this maximum fluence was greater for 266 nm pulses (8.4 J/cm2) than for 213 nm pulses (1.4 J/cm2). The type of silica/silica optical fiber used did not affect the transmission efficiency of 266 nm pulses, but transmission of 213 nm pulses was significantly greater through modified silica/silica optical fiber. The optical fiber transmission efficiency of 213 nm pulses decreased as a function of number of pulses transmitted, whereas the transmission efficiency of 266 nm radiation was unchanged. Single pulses have been used to ablate fresh porcine ocular tissue. In summary, we report a method for delivering the fifth (213 nm) and fourth (266 nm) harmonics of a Nd:YAG laser to the surface of immersed tissue, the reliability and stability of the system has been characterized, and proof of concept via tissue ablation of porcine ocular tissue demonstrates the potential for the intraocular surgical application of this technique.