Scattered ultraviolet emissions during refractive surgery using a high-frequency, wavefront-optimized excimer laser platform.
OBJECTIVE
To evaluate occupational ultraviolet (UV) exposure during photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) with the Allegretto Wave Eye-Q 400 Hz excimer laser.


METHODS
Walter Reed Center for Refractive Surgery, Washington, DC, USA.


METHODS
Intraoperative UV measurements were performed during PRK with epithelial removal using an Amoils brush, PRK with epithelial removal using 20% ethanol, or femtosecond LASIK. A LaserStar power/energy meter with a silicone detector (model PD-10) was used for the measurements. The maximum pulse energy 25.4 cm from the corneal surface was recorded for each surgical procedure. Measurements were evaluated using a worst-case scenario for exposure of operating room personnel, and the results were compared with the occupational exposure limit set by the International Commission on Non-Ionizing Radiation Protection.


RESULTS
Measurements were taken during 15 cases of each procedure. The mean maximum exposure was 129.38 nJ/pulse +/- 79.48 (SD) during brush PRK, 69.72 +/- 68.80 nJ/pulse during ethanol PRK, and 29.17 +/- 13.82 nJ/pulse during LASIK. The mean maximum exposure per eye was 0.085 mJ/cm(2), 0.046 mJ/cm(2), and 0.01 mJ/cm(2), respectively. The worst-case cumulative exposure during a heavy workday of 20 patients (40 eyes) was calculated at 3.92 mJ/cm(2), 1.51 mJ/cm(2), and 0.79 mJ/cm(2) for brush PRK, ethanol PRK, and LASIK, respectively.


CONCLUSIONS
Results indicate that the excimer laser platform used in the study may yield greater UV exposure than previous systems; however, the levels did not exceed occupational exposure limits.


BACKGROUND
No author has a financial or proprietary interest in any material or method mentioned.
Bower
Kraig S
KS
Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. kraig.bower@amedd.army.mil
Edwards
Jayson D
JD
Ryan
Denise Sediq
DS
Coe
Charles D
CD
Hope
Robert J
RJ
Sliney
David H
DH
D006801:Humans; D007432:Intraoperative Period; D020731:Keratomileusis, Laser In Situ / Q000295:instrumentation*; D054018:Lasers, Excimer; D009784:Occupational Diseases / Q000517:prevention & control; D016273:Occupational Exposure / Q000032:analysis* / Q000592:standards; D018903:Photorefractive Keratectomy / Q000295:instrumentation*; D011832:Radiation Injuries / Q000517:prevention & control; D011834:Radiation Monitoring; D014466:Ultraviolet Rays