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Clinical
Research |
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CORNEA |
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The Center for Refractive
Surgery and Cornea Research is dedicated to developing and
improving techniques for cornea surgery. The Institute also houses The
Division of Applied Optics. Here, physicians
and scientists with diverse interests are brought together to study
the application of optical principles to clinical problems and to develop
low vision aids for patients with age-related macular degeneration.
The Cornea
and Laser Vision Institute is situated at Glenpointe and is run
jointly with Hackensack University Medical Center. Dr. Peter
Hersh directs these centers. |
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Water
Jets for Refractive Surgery |
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Eugene Gordon, PhD |
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Dr. Gordon—
adjunct professor of ophthalmology; distinguished research professor
at the New Jersey Institute of Technology (electrical engineering and
computer engineering); and inventor of the argon laser and the photocoagulator,
both used to treat diabetic retinopathy— has developed and patented
a novel device that makes use of water jet technology for refractive
surgery. Industrial water jets, which are high-precision, high-pressure
streams of water, are powerful enough to cut titanium and other metals,
and Dr. Gordon has made use of these features in his development of
a safe and efficient �m-sized water jet for cornea surgery (with an
additional version for treatment of pterygia). Water jet-based refractive
surgery, or hydrokeratectomy (HRK), is a technology with a number of
theoretical advantages over scalpel- and laser-based technologies. Dr.
Gordon and his research team have constructed a water jet with which
to perform corneal surgery, and their experiments have demonstrated
the efficacy and safety of the device. Dr. Gordon has shown that, in
a laboratory model, incisions in corneas heal without clinically significant
opacification. The first use of the device will be to prepare a corneal
stromal bed for excimer corneal surgery in a manner analogous to that
in which automated lamellar keratomileusis (ALK) is used to perform
LASIK. HRK has the following advantages over ALK: HRK can be performed
at normal (versus high) intraocular pressures and HRK produces a smoother
cut than does ALK (confirmed ultrastructurally). A technique using a
cast of the cut cornea and flap has been implemented. A high accuracy,
high-resolution profilometer was acquired. The flaps are uniform and
within ~4 microns of the intended value. This is about 10 times more
accurate than for blade microkeratomes. Surface roughness of the cut
stroma is ~10 microns, comparable to the natural roughness of the Bowman’s
layer with the epithelium resected. The roughness is associated with
the existence of keratocytes that remain in place. The stromal surface
is not naturally smooth. The cast technique together with the profilometer
has turned out to be extraordinarily useful for making precision measurements
on corneas, particularly for studying refractive correction. |
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Hydration
Effects in Photorefractive Keratectomy |
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Peter
S. Hersh, MD |
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Dr. Hersh, clinical
director of the Center, is studying hydration effects after laser photorefractive
keratectomy (PRK). Since corneal hydration may affect optical outcome
after PRK, Dr. Hersh is studying the histopathology of corneas treated
with several different excimer laser treatment modalities to ascertain
the effects of such treatments on corneal hydration, contour, and smoothness.
These studies relate to ongoing clinical investigations of corneal
topography following excimer laser procedures and their clinical
effects, since it is believed that excimer treatment affects surface
morphology and subsequent postoperative corneal contour. |
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