Using the CO2 laser in oculoplastic surgery

Over the past five years, we have successfully performed oculoplastic surgery on several hundred patients at the Belgian Ocular Laser Center (BOLC; http://www.BOLC.org/) in Ghent, Belgium and, during this time, I have found the CO₂ laser to provide an excellent alternative to the scalpel for treating the eyelids. Finally, we can offer bloodless surgery and improved outcomes.

The major indications for this laser include blepharoplasty, entropion, ectropion, ptosis of the upper eyelid and xanthelasmata. We do not, however, use this type of laser for skin resurfacing because we strongly believe that the Erbium:YAG laser is a better and safer option for superficial skin tissue ablation.

Understanding the physics

Laser energy is a single wavelength and the CO₂ laser, which is at a wavelength of 10,600 nm, is strongly absorbed by water (a chromophore). The CO₂ laser is an infrared laser and, as such, can only be delivered through an articulated arm. It is important to note, however, that if the aiming beam is coaxial in nature, one must ensure that this beam and the infrared beam are exactly aligned, by testing the laser on a tongue blade prior to surgery.

What do you need to get started?

We currently use the Coherent UltraPulse CO₂ laser (Lumenis), the ultrapulse mode of which is characterized by pulses of high peak power, delivered in rapid sequence, which are sustained over the entire duration of the pulse. This modality is used to make the skin incision. The constant wave modality, on the other hand, produces continuously applied light with no variation over time, to incise conjunctiva and to dissect tissue.

Certain safety issues must be taken into consideration when performing this procedure and it is imperative that a notice, advising that laser surgery is in progress, is posted outside of the surgical suite in order to eliminate the chance of being disturbed.

surgical field.