INTERACCIÓN DE TEJIDOS BIOLÓGICOS MÍNIMAS PINCELADAS DE LÁSER. Por el material láser: de gas, de líquidos, de estado sólido y de semiconductor.

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1 ALGUNAS APLICACIONES DEL LÁSER: COMUNICACIONES Y MEDICINA (2) 1 2 INTERACCIÓN DE RADIACIÓN LÁSER CON TEJIDOS BIOLÓGICOS MÍNIMAS PINCELADAS DE LÁSER 3 4 CLASIFICACIÓN DE LOS LÁSERES Por el material láser: de gas, de líquidos, de estado sólido y de semiconductor. Por la forma de trabajo: de onda continua (CW) y con pulsos. Por la longitud de onda: IR, visible, uv y de rayos x 5 6

2 Láseres más empleados MECANISMOS DE INTERACCIÓN 11 12

3 Electromechanical. Causes dielectric breakdown in tissue caused by shock wave plasma expansion resulting in localized mechanical rupture. Photoablative. Causes photodissociation or breaking of the molecular bonds in tissue. Photothermal. Converts light energy into heat energy. This causes the tissue to heat up and vaporize. Photochemical. Causes target cells to start light-induced chemical reactions

4 As seen through an ophthalmoscope, part of the retina (arrow) has become detached from the underlying supporting tissue. A normal view of the retina is shown at right

5 (a) Placement of coagulation spots in the case of retinal holes or moderate detachments (b) Placement of coagulation spots during panretinal coagulation (a) Panretinal cogulation in a diabetes patient performed with an argon ion laser (power: 200 mw) A view of the back of the eye of a patient with a cataract A dense cataract seen through a dilated pupil A posterior subcapsular cataract A dense cataract seen through a dilated pupil A dense cataract seen through a normal pupil A snowflake cataract 27 A cataract with obvious clefts 28 the capsule behind the lens implant (arrow) A side view of an eye showing a cataract scattering light. Light passes through the clear lens implant 29 The thickened capsule scatters light 30

6 Laser makes a small hole in the capsule. Light can then pass directly onto the retina, without being scattered. Usually the laser is applied in a ring CAPSULOTOMIA POSTERIOR (Cirugía con láser tras una operación de cataratas) Capsulotomía Posterior es una forma de cirugía que suele ser necesaria, tras una operación de cataratas, para obtener una visión nítida y clara. En la operación de cataratas, la lente interna del ojo se extrae, cuando ha perdido transparencia, y es reemplazada por otra artificial Iris before and after laser treatment Fragmentation of a human lens using a picosecond Nd:YLF laser (pulse duration: 30 ps, pulse energy: 1 mj) 35 36

7 the normal eye long sighted short sighted astigmatic (a) Scanning slit for correction of myopia and anterior view of cornea (b) Scanning slit for correction of hyperopia (c) Rotating disk mask for correction of myopia Stair-like ablations of corneal tissue after performance of keratomileusis with an ArF laser

8 Limbal relaxing incisions (LRI) High-magnification photograph of LASIK treatment performed with a Nd:Glass laser (pulse duration: 50 ps, pulse energy: 3 µj) 43 Limbal relaxing incisions (LRI) are truly a modification of astigmatic keratotomy (AK), which is a procedure to treat astigmatism. Astigmatism is present when the cornea is not spherical, i.e., it is steeper in one meridian than the opposite meridian 180 degrees away. The cornea with astigmatism may be thought of as being more football shaped rather than basketball shaped. LRI s are incisions that are placed on the far peripheral aspect of the cornea (the limbus) resulting in a cornea that is more round. The astigmatism is thus reduced and uncorrected vision is improved 44 LASIK LASER EYE SURGERY LASIK stands for laser-assisted intrastromal in-situ keratomileusis, a vision correction procedure in which a flap of microns depth is cut in the front of the cornea, the flap is folded back to expose the stroma of the cornea, an excimer laser ablates (reshapes) the exposed stroma, and the flap is folded back down. The anterior layers of the cornea (epithelium, Bowman s Layer) are preserved (unlike in PRK, in which Bowman s Layer is burned away by the laser and does not grow back). The surgery corrects myopia, hyperopia, and astigmatism, but cannot fix presbyopia LASIK was invented in Colombia by Drs. Virgilio Galvis and Luis Ruiz, who followed the earlier work in keratomileusis of Dr. Jose Barraquer, who is considered to be the father of modern refractive surgery. Galvis s clinic claims to be able to treat myopia as bad as -25 diopters (D), hyperopia as bad as +17D, and astigmatism as bad as 9D (note that higher myopes may not get 20/20 vision, but they will be improved dramatically After applying anesthetizing drops, the surgeon marks the eye to indicate where the flap will be cut and then replaced The microkeratome slices a tiny flap in the cornea A suction ring holds the eye still and pressurizes it so it is firm enough to cut The flap is moved out of the way, but it is still attached The laser removes tissue to reshape the cornea. The flap is replaced on the eye 47 48

9 On the right, we show an illustration of a normal eye before any type of refractive procedure. The dark purple layer on the outer part of the cornea is called the epithelium. This protective outer layer is left intact with LASIK but is always removed when performing PRK. A speculum will be placed on your eye to hold your eyelid open. This will prevent you from blinking, and this is considered the most uncomfortable part of the LASIK procedure A device is used to make reference marks which the doctor uses for correctly aligning the flap after the LASIK laser procedure has been performed. This is a cross section view of the procedure performed by the microkeratome. The result is a uniform flap with a hinge, that the doctor lifts to expose the inner layers of the cornea. The device on the right is a suction plate which h will provide a base for the microkeratome. When the suction is applied, your eye is held stationary and you will feel some pressure which results in a temporary black out of vision in the eye The doctor then lifts the flap back to expose the inner layer of the cornea. With the eye held firmly in place, the second part of the device first flattens the cornea. This enables the special microkeratome blade to create a flap of uniform thickness. With the flap folded back, the refractive correction is made on the inner layer of the cornea

10 At this point the doctor will ensure that your eye is perfectly aligned and focused. The LASIK procedure in these photos was performed on a MEL 70. This laser uses a metal tracking ring which works in conjunction with an infrared tracking device. This is used for tracking any slight movement of the eye and ensures that the laser remains positioned on the area intended for treatment. In the photo to the left, the tracking ring has been placed on the eye and the small red light in the middle of the pupil indicates that the tracking device is locked in position. Therefore, the laser will follow any slight movement of the eye. The two outer red lights are used to gauge the correct focus for the laser. A sponge is placed over top of the flap. This ensures that the inner surface of the flap is unaffected by the laser and that laser treatment is confined to the intended area. The laser then contours the exposed layer of cornea according to the correction and widest possible optical zone. When the LASIK treatment is complete, the doctor removes the tracker ring The doctors washes the treated surface of the eye to ensure that any debris is flushed. The doctor will wash under the flap to remove any bubbles bbl or remaining i bits of debris. The flap is then floated back into it's original position Care must be taken by the doctor to ensure an excellent fit when repositioning the flap. The eye has a natural suction facility that keeps the flap firmly in place. The flap is returned to its original smooth position and the LASIK vision correction is complete. Because very little of the epithelium has been disturbed, most patients report only a few hours of discomfort after having LASIK vision correction

11 PRK (Photorefractive Keratectomy) Photorefractive Keratectomy (PRK) Intacs (Intracorneal rings) Intacs is a recent corneal ring prescription insert that is entirely reversible. Thus, patients who elect to have Intacs are not locked in to the procedure forever, as are patients who undergo other refractive procedures such as LASIK and PRK

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13 73 74 (a) Tejido del cerebro después de la exposición a un laser de Er:YAG (duración del pulso: 90 µs, energía del pulso: 60 mj). Se observa un deterioro mecánico evidente. (b) Ablación de tejido cerebral con el mismo láser

14 79 80 Balloon Angioplasty

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16 - Litotripsía de cálculos renales y uretrales - Vaporización de neoplasias y tumores - Incisión de estructuras de la uretra y uréter - Incisión del cuello vesical - Ablación de la próstata (HoLAP) - Enucleación de la próstata (HoLEP) - Termoterapia intersticial por inducción láser de BPH (LITT) - Coagulación / ablación de condilomas Especificaciones técnicas (Salvo modificaciones técnicas) Clase de láser: Tipo de láser: Longitud de onda: Potencia (máx.): Energía (máx.): Duración del impulso: Tasa de repetición: Transmisión del rayo: Refrigeración: Conexión a la red: Dimensiones: Peso: 4 Holmium:YAG 2,1 µm 30 W 3 J µs hasta 20 Hz Fibras low OH Quartz: 230 ìm / 365 ìm / 600 ìm / Side Fire / Aplicador LITT Refrigeración por aire 230 V, 16 A, 50/ 60 Hz 102 x 35 x 84 cm (L x W x H) aprox. 71 kg 91 Normas: IEC 601/ IEC 825 EG 92 Scientific Auriculo Medicine and Controlled Acupuncture Laser therapy Power injection for easy and fast therapy Enjoy relaxing therapy, because the modern ergonomic design means comfortable work. Precision in its finest form. The handylaser sprint offers high power and easy handling. It has short treatment durations and deep penetration. Select with one Finger continuous beam 10 Hz-Alpha frequency acoustic signal (timer) Sports medicine Physiotherapy Odontology Home visits handylaser sprint for power injection Laser Acupuncture David Rindge, DOM, AP, RN Integrating Low-Level Laser Therapy and Oriental Medicine, Part One Over 2,500 studies have already been performed using LLLT, and it is used throughout Europe and Asia to treat a wide variety of conditions. Therapeutic applications of LLLT which have shown promising results include: acne arthritis back pain carpal tunnel syndrome cerebral palsy dental applications fibromyalgia! headaches hearing disorders herpes maxillofacial disorders musculoskeletal disorders myofascial pain lymphedema migraines nerve regeneration neuralgia neuropathy Peyronie's disease prostatitis sinusitis scars skin disorders Sjoegren's syndrome sports injuries tendonitis wound healing Center for Aesthetic Surgery at Baylor College of Medicine Physicians C. Bob Basu, M.D., M.P.H.Mimi Leong, MDMorgan E. Norris, III, MDEser Yuksel, MD Procedures Blepharoplasty Free Flap Reconstruction Lip Suspension 6624 Fannin, Suite 2260 Houston, Tx Appointments: (713) The Center for Aesthetic Surgery at Baylor College of Medicine is a state-of- the-art facility dedicated to excellence in aesthetic surgery, skin care and laser therapy.we offer a range of services ranging from non-invasive aesthetic enhancement to complete facial rejuvenation, body contouring, and breast enhancement. Visible Red Probe Proven in extensive research to be the best wavelength for fast effective treatment of wounds, including diabetic, varicose, venous, neuropathic, infected non-healing ulcers and pressure sores. Also superb treatment for acne, psoriasis, herpes simplex and other dermatological conditions. Technical Specification Wavelength: 675nm 660nm Coherence: Laser Power: 30 mw50 mw Power Density:0.24 W/cm20.40 W/cm2 Aesthetic surgery and laser therapy help to create a more rejuvenated, youthful look and can potentially have a very positive impact on an individual's self esteem

17 Dr. Ralph J. Luciani, D.O., M.S., PhD., M.D.(H) Southwest Aesthetic & Integrative Medicine Laser Hair Removal: Face, Back, Arms, Neck, Legs, Bikini, Full Body An easy, safe treatment to remove unwanted body hair from any area with more permanent reduction results. Can be effectively used with any skin color and you can resume a normal lifestyle within minutes of treatment. Laser Vein Removal: Legs & Face A noninvasive treatment to treat a wide variety of vascular lesions including spider veins, facial veins, larger leg veins. Treatments are safe and fast, requiring no anesthesia. Laser Anti-Aging: Fine Lines, Dilated Capillaries, Rosacea, Pigmentation Laser Genesis is an advanced method that can reduce visible facial vessels as well as diffuse redness by gently warming the upper dermis, stimulating collagen, and improving the appearance of your skin. The result is a healthy, vibrant looking appearance TERMOTERAPIA INTERSTICIAL INDUCIDA POR LÁSER (LITT)

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