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Laser-Induced Ocular Lesions with Thulium Fiber Laser in Endourology: An Ex Vivo Study - Beyond the Abstract

The Thulium Fiber Laser (Tm-F) is currently evaluated clinically as a safe alternative to the Holmium: yttrium–aluminum–garnet (Ho:YAG) laser in endourology.1 If Tm-F has shown in vitro higher efficiency in stone dusting, its safety profile has also been demonstrated, based on the lower risk of laser fiber fracture and lower power degradation at the fiber tip, compared to Ho:YAG.2-4 Drawing a parallel, the in vivo safety aspects of a laser source must include the occurrence of adverse events. Doizi et al recently reviewed the ocular risk of a laser exposure during an endourological procedure.5


The authors reported laser-induced eye injuries in 37.9% of all kinds of adverse events. These eye injuries were associated with the use of Neodymium-Doped:YAG (Nd:YAG) (69%) in the majority of cases, diode lasers (20.1%), and KTP (11%) with improper eye protection. Consequently, Villa et al studied firstly the ex vivo risk of eye laser-injury with Ho:YAG.6 They reported exclusively lesions of the anterior segment of the ocular globe, but only when there was no eye protection and when the energy was high (2 J) and viewed from a short distance (0–5 cm). Therefore, our study intended to evaluate similarly the risk of eye laser-injury with Tm-F.7

We reported similar results, compared to the previous publication with the Ho:YAG laser, with corneal lesions up to 5cm fiber-eye distance, without proper eye protection. Some specific aspects of the methodology have to be highlighted. Learning from the previous study of Villa et al and applying the ALARA (as low as reasonably achievable) principle, the experimental protocol decided to analyze only the anterior segment of the eye samples. We consecutively decreased the total amount of required samples and only analyzed the corneal lesions, using a fluorescein serum. Therefore, we avoided a pathological analysis and were able to reuse the samples when there was no injury after a laser experiment.

Despite these experimental and ethical aspects, our study confirmed the similar ocular risk of Tm-F, compared to Ho:YAG. Thus, as the guidelines of the European Association of Urology on lasers and technologies recommend, all intraoperative personnel should wear proper protection eyeglasses, such as laser safety eyeglasses or at least standard eyeglasses, in order to prevent corneal or retinal damage caused by unintentional laser exposure.8

Written by: Frederic Panthier1 & Olivier Traxer2

  1. Sorbonne Universite, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
  2. Tenon Hospital, Assitance Publique-Hopitaux De Paris. Pierre Et Marie Curie University, Paris, France

References:

  1. Traxer O, Corrales M. Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results-A Systematic Review. J Clin Med. 30 juill 2021;10(15):3390.
  2. Panthier F, Doizi S, Lapouge P, Chaussain C, Kogane N, Berthe L, et al. Comparison of the ablation rates, fissures and fragments produced with 150 µm and 272 µm laser fibers with superpulsed thulium fiber laser: an in vitro study. World J Urol. 6 avr 2020;
  3. Uzan A, Chiron P, Panthier F, Haddad M, Berthe L, Traxer O, et al. Comparison of Holmium:YAG and Thulium Fiber Lasers on the Risk of Laser Fiber Fracture. J Clin Med. 30 juin 2021;10(13):2960.
  4. Germain T, Berthe L, Panthier F, Gorny C, Traxer O, Doizi S. Assessment of Factors Involved in Laser Fiber Degradation with Thulium Fiber Laser. J Endourol. 29 déc 2021;
  5. Doizi S, Audouin M, Villa L, Rodríguez-Monsalve Herrero M, De Coninck V, Keller EX, et al. The eye of the endourologist: what are the risks? A review of the literature. World J Urol. déc 2019;37(12):2639‑47.
  6. Villa L, Cloutier J, Compérat E, Kronemberg P, Charlotte F, Berthe L, et al. Do We Really Need to Wear Proper Eye Protection When Using Holmium:YAG Laser During Endourologic Procedures? Results from an Ex Vivo Animal Model on Pig Eyes. J Endourol. mars 2016;30(3):332‑7.
  7. Panthier F, Chiron P, Gorny C, Berthe L, Doizi S, Corrales M, et al. LASER-INDUCED OCULAR LESIONS WITH THULIUM FIBER LASER IN ENDOUROLOGY : AN EX VIVO STUDY. J Endourol. 4 mars 2022
  8. Professionals S-O. EAU Guidelines: Urolithiasis [Internet]. Uroweb. [cité 21 sept 2020]. Disponible sur: https://uroweb.org/guideline/urolithiasis/

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