Investigation of corneal ablation efficiency using ultraviolet 213-nm solid state laser pulses.

PURPOSE: To determine the threshold and efficiency of corneal ablation for various values of laser fluence at the ultraviolet wave length of 213 nm. METHODS: A commercial Q-switched Nd:YAG laser was used to produce the fifth harmonic wavelength of 213 nm. Ablation trials were carried out on porcine corneas. Slit ablations of dimensions 0.5 x 2.5 mm were performed using seven values of laser fluence to obtain the most efficient fluence for ablation. The morphology of each ablation was obtained using a computer-automated confocal profiling system. These profiles were then analyzed to determine the ablation depth for the range of fluence values used. RESULTS: A fluence in the region of 200 mJ/cm2 was found to be the most efficient for ablation. The efficiency in this region was approximately 0.35 mm3/J, and the ablation rate was found to be 0.6 microm/pulse. The ablation threshold was found to occur at a fluence of 50 mJ/cm2. In the region of highest efficiency, the peak varied slightly in the fluence range between 150 and 250 mJ/cm2. CONCLUSIONS: This study confirms that the corneal ablation properties at 213 nm are comparable with those at the 193-nm excimer laser wavelength. Increased pulse energy was obtained for the fifth harmonic of Nd:YAG lasers at 213 nm through the use of new nonlinear optical crystals to perform the frequency conversion. A solid state laser is feasible to replace the excimer gas laser for performing refractive surgery procedures. For the first time, the increased energy at 213 nm allows large-beam ablations to be performed at this wavelength.     

Preliminary in vitro study of the histological effects of low fluence 193-nm excimer laser irradiation of corneal tissue

PURPOSE: To determine if moderate numbers of low fluence, 193-nm excimer laser pulses modify or damage the corneal stroma. METHODS: The corneal epithelium of fresh bovine eyes was scraped off and the exposed stroma was irradiated with 200 low fluence laser pulses from an argon fluoride excimer laser. This process was performed on five eyes each at two laser fluences, 10 mJ/cm2 and 30 mJ/cm2. The ten irradiated and three control (unirradiated) corneas were sectioned and studied by electron microscopy. The maximum and minimum thickness of the anterior layer of randomly oriented collagen fibers was measured using electron microscopy. RESULTS: The mean maximum thickness of the anterior randomly oriented layer of collagen was 1.23 +/- 0.45 microm in the control corneas, 0.67 +/- 0.32 microm in the corneas irradiated at 10 mJ/cm2, and 0.10 +/- 0.12 microm in the corneas irradiated at 30 mJ/cm2. The mean thickness of corneal stroma removed was 0.7 microm at a fluence of 10 mJ/cm2 and 1.1 microm at a fluence of 30 mJ/cm2. A thin, electron-dense pseudomembrane was present at both fluences. CONCLUSION: We report removal of bovine corneal stroma at 10 mJ/cm2--below the previously reported ablation threshold of 20 mJ/cm2.     

Histological comparison of corneal ablation with Er:YAG laser, Nd:YAG optical parametric oscillator, and excimer laser

PURPOSE: To use histological techniques to assess and compare the ablation depth, local damage, and surface quality of corneal ablations by a Q-switched Er:YAG laser, an optical parametric oscillator laser at 2.94 microm, a long pulse Er:YAG laser, and a 193-nm excimer laser. METHODS: Human cadaver eyes and in vivo cat eyes were treated with a 6.0-mm diameter, 30-microm-deep phototherapeutic keratectomy ablation and a 6.0-mm diameter, -5.00-D photorefractive keratectomy ablation. Human cadaver eyes were also treated with a 5.0-mm diameter, -5.00-D laser in situ keratomileusis (LASIK) ablation. Fluences and pulse widths used were 200 mJ/cm2 and 70 ns for the Q-switched Er:YAG, 150 mJ/cm2 and 7 ns for the optical parametric oscillator laser (OPO), 500 mJ/cm2 and 50 microseconds for the long pulse Er:YAG, and 160 mj/cm2 and 20 ns for the excimer laser. In the ablation rate study, 12 porcine eyes were ablated by the OPO laser with a range of layers and at different fluences ranging from 60 to 150 mJ/cm2, all using a 1.5-mm spot on the eye. The ablation depth of these acute ablations was evaluated by light microscopy examination. RESULTS: In the acute damage study, light microscopy showed a thin surface layer in all samples with minimal thermal damage except on the long pulse Er:YAG corneas. Transmission electron microscopy revealed less than 0.3-microm surface damage for all specimens of both the optical parametric oscillator and the excimer laser samples with no evidence of collagen shrinkage. Transmission electron microscopy showed damage layers of 0.5 to 3 microm for Q-switched Er:YAG and 3 to 10 microm for long pulse Er:YAG. Scanning electron microscopy showed smooth surfaces in all eyes, although the excimer was the roughest. In the porcine eye study, ablations were produced in both PTK and PRK modes with the ablation rate per layer increasing with the fluence. At 120 mJ/cm2, the average ablation rate was 1.9 microm per layer. CONCLUSIONS: The histology from the short pulse mid-infrared optical parametric oscillator laser at 2.94 microm was comparable to the 193-nm excimer with a smooth, damage-free, ablation zone when performing PRK and LASIK.     

Roughness of excimer laser ablated corneas with and without smoothing measured with atomic force microscopy

PURPOSE: To analyze the surface roughness of porcine corneas after excimer laser ablation with and without the smoothing procedure by means of atomic force microscopy. METHODS: Excimer laser photorefractive keratectomy (PRK) was performed on eight porcine corneas. Immediately following the procedure, smoothing was performed on four corneas using a viscous solution of 0.25% sodium hyaluronate. The corneas were examined in balanced salt solution after fixation in 2.5% glutaraldehyde solution using atomic force microscopy. Quantitative analysis of the ablated stromal surface topography was performed using the section analysis module of the atomic force microscopy software. Repeated measurements were made over small areas (< or =50 microm2) near the center of each ablation, with a vertical resolution of <1 nm. RESULTS: Images of the ablated stromal surface showed undulations and granule-like features on the ablated surface of the specimens. The specimens on which the smoothing procedure was performed (root-mean-square [RMS] rough: 0.152 +/- 0.014 microm) were more regular (P < .001) than those on which PRK alone was performed (RMS rough: 0.229 +/- 0.018 microm). CONCLUSIONS: Atomic force microscopy analysis requires a simpler preparation of the specimens with respect to that necessary for scanning electron microscopy; for this reason, atomic force microscopy techniques are more reliable for the study of biological surfaces and prove to be a feasible method to establish the differences when comparing different laser techniques. Our investigations highlight that although the laser cut of scanning-spot excimer laser systems is precise in removing even the smallest amounts of tissue, the smoothing technique may still be useful to reduce post-ablation roughness.     

Atomic force microscopic study of the human cornea following excimer laser keratectomy

The aim of this study was to examine the corneal surface structures with a new investigative method, the atomic force microscope following 193 nm excimer laser photoablation. Fresh human corneas were irradiated in vitro with an increasing number of impulses emitted by a 193 nm ArF laboratory excimer laser in order to produce either smooth flat surfaces or stair-like formations within the cornea. The corneas were investigated in a Topometrix(R) atomic force microscope in their native state. For comparison, three corneas were fixed with glutaraldehyde and processed for scanning electron microscopy.Atomic force microscopy and scanning electron microscopy revealed the same surface characteristics of photoablated corneas, though the preparation for scanning electron microscopy induced considerable shrinkage of the tissues. The layers of the cornea could be distinguished from each other and deeper ablations of the stroma produced a rougher surface. On the lateral walls of ablated stairs small droplets of ejected material could be seen with scanning electron microscope.Atomic force microscope produces three-dimensional images of the scanned native corneal surfaces and it could be a valuable tool to investigate the corneal smoothness. Our investigations have provided similar results as those obtained with scanning electron microscopy showing that the laser-ablated corneal surface remains relatively smooth. We suggest that the formation of condense droplets of ejected materials is based on hydrodynamic motions induced by boiling water solutions.     

Excimer laser ablation of the cornea and lens. Experimental studies

The pulsed ultraviolet excimer laser has been used to produce tissue ablation with a high degree of precision and with minimal thermal damage to adjacent structures. In comparative studies of excimer laser ablation of the cornea and crystalline lens using 193 nm and 248 nm radiation, threshold fluence for corneal and lens ablation was higher at 248 nm than at 193 nm. Ablation of corneal stroma at 193 nm produced the most precise cuts. When examined by transmission electron microscopy, a narrow zone of damaged tissue (0.1 to 0.3 micron) was seen immediately adjacent to the tissue removed by the laser. Ablation with 248 nm radiation produced incisions with ragged edges and with a wider and more severe zone of damage in adjacent stroma. Ultraviolet spectral transmission studies of the corneal stroma showed that absorption is 10 times greater at 193 nm than at 248 nm. The excimer laser was effective in producing well controlled ablation of the crystalline lens in vitro, with effects parallel to those seen in the cornea.     

Smoothing of the ablated porcine anterior corneal surface using the Technolas Keracor 217C and Nidek EC-5000 excimer lasers

PURPOSE: To demonstrate efficacy of a smoothing technique to increase regularity of the anterior corneal surface after photorefractive keratectomy (PRK), using two different excimer lasers. METHODS: Spherical ablations of -10.00 D were performed on 11 fresh porcine corneas using either the Technolas Keracor 217C scanning-spot or the Nidek EC-5000 scanning-slit beam excimer laser. Following the procedure, we performed a phototherapeutic keratectomy treatment (smoothing technique) on half of the corneal surface. The smoothing technique was performed using a viscous solution of 0.25% sodium hyaluronate, which was spread on the cornea prior to the procedure. The ablation zone was 6 mm in diameter and the transition zone extended to 3 mm. The ablation depth was set at 10 microm. Corneas were then examined with scanning electron microscopy. RESULTS: Smoother treatment zones were apparent in porcine corneas in which smoothing was performed following PRK, with both laser systems. Results from the two lasers were not directly compared. CONCLUSIONS: The smoothing procedure performed following PRK using a viscous 0.25% sodium hyaluronate masking solution and a scanning laser system rendered the porcine corneal surface more regular.     

Experimental retinal ablation using a fourth-harmonic 266 nm laser coupled with an optical fiber probe

PURPOSE: To explore the ablation potential of 266 nm laser pulses, with an intact porcine retina preparation. METHODS: Segments of porcine eyes were used in an in vitro preparation in which localized areas of intact retina and choroid could be exposed to 266 nm laser irradiation. The segments of ocular tissue were bathed in fluid, to mimic the intraocular environment. Contact between the probe and the retinal surface was established before the first laser pulse. Single or multiple pulses (5-7 ns duration) at fluence levels of 0.4 to 1.2 J/cm2 were delivered via a tapered fiber optic probe with a tip size of approximately 110 microm. The retinal tissue was then fixed and sectioned for histologic examination. The ablation depth and extent of damage were measured and related to fluence level and the number of pulses applied. RESULTS: Ablation of the inner retina was achieved by single pulses at fluence levels of 0.6 J/cm2 and higher. The depth of retinal ablation was highly dependent on fluence for lesions generated with a single pulse but less so for multiple pulses (3-10), particularly at lower fluence levels. Higher numbers of pulses (50-100) did not increase ablation depth in a predictable manner. CONCLUSIONS: Pulsed laser (266 nm) irradiation at low pulse counts and high fluence levels is a possible alternative for localized retinal ablation with minimal collateral damage in a fluid environment.     

Tissular and mechanical effects observed with an experimental femtosecond laser microkeratome for corneal refractive surgery

PURPOSE: Despite progress in mechanical microkeratomes used in refractive surgery, mechanical complications during cutting of the cornea still occur. Cutting by laser could reduce these complications and to date, the femtosecond laser is the only potential candidate for this purpose. Our study reports preliminary results with a femtosecond microkeratome for cutting porcine corneas ex vivo. METHODS: We first examined the fundamental principles of the interaction between the femtosecond laser and the corneal stroma, including the volume of tissue lesions, the laser breakdown threshold of the stroma and the laser ablation selectivity. We then analyzed the quality of cutting corneal flaps with the laser, focusing on collateral tissue effects and the roughness of the interfaces observed both histologically and with scanning electron microscopy. RESULTS: The photoablative and photodisruptive effects were very similar with the femtosecond laser. This characteristic is specific to ultrashort impulsion photodisruptor lasers and allows for a very precise surgical procedure. The laser-induced breakdown threshold of porcine corneal stroma was found to be 0.55 J/cm2. Collateral tissue lesions were on the submicrometer level. The roughness of the stromal bed was optimal for postage stamp cutting, providing very many contiguous points of impact which were as spherical as possible. CONCLUSION: Corneal photodisruption with a femtosecond laser is reproducible and extremely accurate. The optomechanical parameters involved with this technique require great technological skill and should be placed in experienced hands.     

Corneal morphology in vitro after superficial keratectomy with q-switched Er:YSGG and free-running Er:YAG lasers

PURPOSE: Examination of morphology in corneal ablation induced by a q-switched Er:YSGG (2.79 microm) laser and a free-running Er:YAG laser (2.94 microm). METHODS: Defined ablation of 6-mm diameter and 15, 30, 55, 90, and 120-microm depth was performed on freshly enucleated swine eyes. Er:YSGG laser parameters: fluence 1.6 J/cm2, frequency 6 Hz, spot-size 465 microm FWHM, scanning-mode, pulse number 1520 to 6210. Er:YAG laser parameters: fluence 3 J/cm2, frequency 1.5 Hz, spotsize 6 mm, wide area ablation, pulse number 2 to 13. Corneal morphology was analyzed by gross photography, histology, scanning electron microscopy, and scanning nearfield acoustic microscopy. RESULTS: Histology showed thermal damage of 5 to 15 microm in depth caused by the Er:YSGG laser in comparison with 10 to 20 microm by the Er:YAG laser. Average roughness of the ablated surface measured with scanning nearfield acoustic microscopy was 20 to 40 microm for the Er:YSGG laser and 5 to 15 microm for the Er:YAG laser. These data confirm the subjective impression of images created by scanning electron microscopy and gross photography. CONCLUSIONS: Although the Er:YAG laser system appeared to demonstrate a smoother corneal surface than the q-switched Er:YSGG laser, the thermal damage in either case poses a potential limitation for clinical use in lamellar refractive surgery.     

Comparison of different excimer laser ablation frequencies (50, 200, and 500 Hz)

Purpose

The aim of this study was to compare the influence of different excimer laser (193 nm) ablation frequencies (50, 200, and 500 Hz) on porcine cornea.

Methods

For this study, fresh porcine cadaver eyes were obtained from the butcher. PRK and LASIK were performed using a WaveLight Concept System 500 excimer laser. Various repetition rates (50, 200, and 500 Hz) and intended corrections (between -3 and -9 D) were used. Corneal endothelium was investigated pre- and post-operatively with the endothelial cell microscope EM 1000 Tomey?. Post-operatively, the corneas were embedded for light microscopic (HE, Picrosirius Red) and electron microscopic evaluation.

Results

The mean pre-operative cell count was 2,953 (SD 149) and the mean post-operative cell count was 2,974 (SD 156). There was no difference between the pre- and post-operative cell count and the different ablation frequencies. The distribution of collagen fibers and keratocytes was comparable in all different ablation frequencies. Also, the ultrastructural evaluation of keratocytes and fibers, assessed with transmission electron microscopy, was equal in all three different ablation frequencies.

Conclusions

The endothelial cell density and structural and ultra structural evaluation of the different ablation frequencies (50, 200, 500 Hz) showed no specific side-effects that could be associated with higher repetition rates. The quality of the ablation was comparable in all three different laser ablation frequencies. The 500-Hz excimer laser can provide the same ablation quality as slower platforms, but can also offer the advantage of requiring less treatment time than other laser platforms with lower repetition rates.     

Limitations of erbium:YAG laser photorefractive keratectomy

PURPOSE: The erbium:YAG laser (lambda = 2.94 microm) has been considered promising as an alternative to the ArF excimer laser in photorefractive keratectomy (PRK). However, corneal application of this mid-infrared solid state laser is still plagued with various disadvantages compared to that of the ArF excimer laser (lambda = 193 nm). We discuss the limitations of PRK with the erbium:YAG laser. METHODS: Measurements of ablation threshold, ablation efficiency, and thermal damage were done to compare the process of erbium:YAG laser photoevaporization to the ArF excimer laser. PRK procedures were performed on fresh enucleated pig corneas to investigate the morphology and surface roughness of the cornea after scanning-spot and fundamental mode photoablation. Surface roughness was measured by using a tactile surface reprofiling system. RESULTS: The ablation threshold and the ablation efficiencies for the erbium:YAG laser are significantly higher compared to the ArF excimer laser. Collateral thermal damage decreases with a reduction of laser pulse duration to a minimum of approximately 5 microm. Scanning electron microscopy and surface roughness measurements of the corneal surface after erbium:YAG laser treatment demonstrated higher surface roughness compared to ArF excimer laser treatments. CONCLUSIONS: The erbium:YAG laser is not at present an alternative to the ArF excimer laser for photorefractive keratectomy.     

Phototherapeutic smoothing as an adjunct to photorefractive keratectomy in porcine corneas.

PURPOSE: To study the smoothing effect of phototherapeutic keratectomy (PTK) using masking fluids as an adjunct to standard photorefractive keratectomy ablations. METHODS: Six fresh porcine corneas underwent -6.00, -10.00, and -15.00 D sphere ablations using the VISX Star excimer laser. Multizone treatments to a maximum 6.5 mm radially symmetrical bed were used with a fluence of 160 mJ/cm2. Three of the treatments were supplemented with a thin layer of balanced salt solution and 6 microm of full beam PTK. The corneas were examined by electron microscopy. RESULTS: Smoother treatment zones were apparent in corneas undergoing PTK following PRK. The effect was more marked at higher dioptric ablations. CONCLUSION: PTK may improve surface smoothness after PRK, especially for higher dioptric ablations.     

Infrared laser surgery of the cornea. Studies with a Raman-shifted neodymium:YAG laser at 2.80 and 2.92 micron

Tissue absorption lengths for infrared radiation at 2.8 to 3.1 micron are very short due to strong absorption by water. Corneal ablation using pulsed lasers at these wavelengths can potentially produce incisions similar in quality to cuts produced by excimer lasers at 193 nm. The authors have used 8-ns pulses at 2.80 and 2.92 micron, generated by a Raman-shifted neodymium:YAG (Nd:YAG) laser, to make slit-like incisions in bovine and human corneas. At 2.8 micron, etch depth per pulse increases sigmoidally from 0.15 micron at 390 mJ/cm2 to 3.8 micron at 2200 mJ/cm2. No ablation occurs at fluences below 250 mJ/cm2. Light and transmission electron microscopy show smooth-walled incisions bordered by a thermally damaged region that varies in width from 1.5 micron at 600 mJ/cm2 to 10 micron at 2200 mJ/cm2. The small amount of tissue damage produced at low fluences suggests that infrared ablation may be useful in keratorefractive surgery.     

Photorefractive keratectomy using solid state laser 213 nm and excimer laser 193 nm: a randomized, contralateral, comparative, experimental study

PURPOSE: To compare histopathologic changes after photorefractive keratectomy (PRK) for myopia using either a solid state laser (SSL) at 213 nm or an excimer laser (EL) at 193 nm in an experimental model. METHODS: Forty pigmented rabbits (80 eyes) underwent myopic PRK for the correction of 6 D. Photoablation was randomly assigned, with a solid state laser used in one eye and an EL in the fellow eye. Rabbits were killed immediately after ablation (n = 10) or at 7 days (n = 10), 1 month (n = 8), 3 months (n = 6), or 12 months (n = 6) after surgery. Corneal tissue was preserved for light microscopy and transmission electron microscopy at all postoperative intervals. RESULTS: All eyes reepithelialized in 1 week with no early or late postoperative complication. Immediately after ablation, light, scanning, and transmission electron microscopy revealed relatively smooth ablation surfaces in both groups. Seven days after surgery, epithelium in the SSL specimens appeared thinner than in the EL specimens. Activated keratocytes were observed adjacent to the epithelium in both groups, whereas endothelial cells demonstrated normal morphology. At 1, 3, and 12 months after surgery, tissue appearance of all corneal layers was similar in both groups. CONCLUSIONS: PRK in rabbits using ultraviolet SSL and EL revealed similar histopathologic findings up to 1 year after surgery.     

Mass spectroscopic analysis of excimer laser ablated material from human corneal tissue

The clinical feasibility of photorefractive keratectomy depends on the surface structure of the ablated cornea. Two factors that influence the remodeled surface are the homogeneity of the energy distribution and the properties of the laser source (energy and wavelength). Currently, the homogeneity of the beam is difficult to control. The second factor, laser source properties, was the focus of this study. We investigated the effect of laser wavelength and energy by analyzing the reaction products of photoablation. We monitored the fragments produced by UV-laser ablation of human corneas using mass spectroscopy in the range of 0 to 100 atomic mass units. At 248 nm (KrF), average photon energy was 5 mJ/cm2, increased to 90 mJ/cm2 by intervals of 5 mJ/cm2. At 193 nm (ArF), photon energy was increased by the same interval from 5 mJ/cm2 to 80 mJ/cm2. Our experiments showed that there was a fluence threshold of approximately 40 mJ/cm2 at 193 nm (ArF) and 50 mJ/cm2 at 248 nm (KrF). Exceeding this threshold led to sudden increases in the number and relative intensity of fragment peaks in mass spectroscopy. This indicates the onset of multiple-photon processes and effective photochemical breakdown. There was a significant difference between both wavelengths in the distribution of mass peaks, indicating higher ionization power at 193 nm.     

Healing after photorefractive keratectomy in cat eyes with a scanning mid-infrared Nd:YAG pumped optical parametric oscillator laser

PURPOSE: To evaluate the healing characteristics of cat corneas treated with a new scanning mid-infrared laser system. METHODS: Six adult cats were treated with 6-mm diameter photorefractive keratectomy (PRK) corrections. One eye in each animal was untreated as a control and the other was treated with either a -3.00 or -6.00 diopter ablation. The laser was a new Nd:YAG pumped optical parametric oscillator laser at 2.94 microm with a new scanning delivery system. The pulse width was 7 nanoseconds, the repetition rate was 10 Hz, the size of the laser spot on the eye was 1.0 mm, and the fluence was 150 mJ/cm2. Healing of the cat corneas was followed for 4 months. Slit-lamp and corneal topography evaluations were done at each follow-up examination. Histology was performed at the end of the study. RESULTS: The corneal epithelium healed within 1 week. There was no stromal haze in any eye after the epithelium healed. After the first 2 weeks, slit-lamp examination could not identify which eye was treated. Corneal topography showed corneal flattening. Light microscopy at 4 months revealed normal epithelium and increased keratocyte density in the anterior third of the cornea. Electron microscopy showed discontinuities in the basement membrane and hemidesmosomes. The deep stroma and endothelium were normal. CONCLUSIONS: Cat corneas treated with the new optical parametric oscillator laser healed normally with no adverse effects. Increased keratocyte activity in the anterior stroma was the only noticeable response besides the flattening shown by topography.     

Ablation of the cornea by using a low-energy excimer laser

We describe a new multipurpose method for corneal refractive surgery by using a focused excimer laser beam, which allows the application of a small, compact low-energy excimer laser. It is possible to ablate any area desired in the cornea without masking by scanning the focused beam. The ablation depths in freshly enucleated swine eyes were measured in relation to the number of laser pulses (at fixed fluence) and the pulse fluence at wavelengths = 248 nm and =193 nm. The irradiation conditions were investigated to obtain smooth ablation of the corneal material over an area of about 1 cm². The experiments show that smooth ablation is obtained when the ratio of the excimer laser beam spot diameter on the corneal surface and the displacement for one scanning step is given by a whole number. A simple model based on rectangular beam profiles is presented to exemplify this.     

Excimer laser lamellar keratoplasty

Purpose: To evaluate a procedure using the excimer laser to perform lamellar keratoplasty to treat deep corneal scars in the central optical zone. To determine if excimer laser can safely prepare a smooth surface for the host bed and the donor button, assess the interface opacity and evaluate the effects of the ablation on the recipient's endothelial surface with the deeper ablation.
Methods: Nineteen rabbits underwent an excimer laser lamellar keratoplasty in one eye. The rabbits were followed for 9 to 12 weeks until they were sacrificed.
Results: Little opacity developed at the graft-host interface and scanning electron microscopy of the endothelial surface showed little difference between the treated and untreated areas or the endothelium of the untreated eyes.
Conclusions: Our results suggest that the use of the excimer laser to treat corneas with deep stromal scars and normal endothelium is feasible. However, we have not proved that this technique will give a better result than conventional lamellar dissection methods.     

Human corneal ablation threshold using the 193-nm ArF excimer laser

PURPOSE: To determine the human corneal threshold ablation energy density for the 193-nm ArF excimer laser, approximating clinical conditions. METHODS: The VISX Star (Santa Clara, CA) 193-nm argon fluoride excimer laser was used to ablate the cornea in human eye bank eyes under clinical conditions. Corneas were exposed to energy densities of 10, 20, 30, 35, 40, 45, and 140 to 160 mJ/cm2. Corneas were fixed for light and transmission electron microscopy immediately after laser exposure. RESULTS: Different ablation thresholds for various corneal structural elements were observed. The ablation threshold for the collagen in the corneal stroma was determined to be 30 mJ/cm2. Keratocytes had ablation thresholds of 40 mJ/cm2. These different ablation thresholds accounted for the production of stromal peaks and valleys, with the keratocytes atop the peaks. CONCLUSIONS: Different corneal structural elements have different ablation threshold energy densities.