Dynamic Oct Signal Loss For Determining Rpe Radiant Exposure Damage Thresholds In Microsecond Laser Microsurgery

Featured Application Real-time dosimetry of selective retina therapy (SRT) using spectral-domain optical coherence tomography. SRT is a gentle laser treatment method for various diseases of the fundus (i.e., central serous chorioretinopathy and diabetic macular edema) associated with reduced retinal pigment epithelium function. Optical microsurgery of the retinal pigment epithelium (RPE) requires reliable real-time dosimetry to prevent unwanted overexposure of the neuroretina. The system used in this experiment implements optical coherence tomography (OCT) to detect the intentional elimination of RPE cells. We evaluated the performance of OCT dosimetry in terms of its ability to detect RPE cell damage caused by microsecond laser pulses of varying duration. Therefore, ex-vivo porcine RPE choroid sclera explants were embedded in an artificial eye and exposed to single laser pulses of 2-20 mu s duration (wavelength: 532 nm, exposure area: 120 x 120 mu m(2), intensity modulation factor: 1.3). Simultaneously, time-resolved OCT M-scans were recorded (central wavelength: 870 nm, scan rate: 33 kHz). Post-irradiation, RPE cell damage was quantified using a calcein-AM viability assay and compared with an OCT-dosimetry algorithm. The results of our experiments show that the OCT-based analysis successfully predicts RPE cell damage. At its optimal operating point, the algorithm achieved a sensitivity of 89% and specificity of 94% for pulses of 6 mu s duration and demonstrated the ability to precisely control radiant exposure of a wide range of pulse durations towards selective real-time laser microsurgery.