Laser Monotherapy Research Articles

Efficacy and safety of combined low-fluence Q-switched Nd:YAG 1,064-nm laser with intensed pulsed light versus low-fluence Q-switched Nd:YAG 1,064-nm laser monotherapy in the treatment of melasma

Efficacy and safety of combined low-fluence Q-switched Nd:YAG 1,064-nm laser with intensed pulsed light versus low-fluence Q-switched Nd:YAG 1,064-nm laser monotherapy in the treatment of melasma

Cost-Effectiveness of Treatment of Diabetic Macular Edema

Macular edema is the most common cause of vision loss among patients with diabetes. To determine the cost-effectiveness of different treatments of diabetic macular edema (DME). Markov model. Published literature and expert opinion. Patients with clinically significant DME. Lifetime. Societal. Laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both. Discounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). All treatments except laser monotherapy substantially reduced costs, and all treatments except triamcinolone monotherapy increased QALYs. Laser treatment plus a VEGF inhibitor achieved the greatest benefit, gaining 0.56 QALYs at a cost of $6975 for an ICER of $12 410 per QALY compared with laser treatment plus triamcinolone. Monotherapy with a VEGF inhibitor achieved similar outcomes to combination therapy with laser treatment plus a VEGF inhibitor. Laser monotherapy and triamcinolone monotherapy were less effective and more costly than combination therapy. VEGF inhibitor monotherapy was sometimes preferred over laser treatment plus a VEGF inhibitor, depending on the reduction in quality of life with loss of visual acuity. When the VEGF inhibitor bevacizumab was as effective as ranibizumab, it was preferable because of its lower cost. Long-term outcome data for treated and untreated diseases are limited. The most effective treatment of DME is VEGF inhibitor injections with or without laser treatment. This therapy compares favorably with cost-effective interventions for other conditions. Agency for Healthcare Research and Quality.

Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars.

Background:While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between.Aim:The aim of the present study is to assess the efficacy and safety of fractional CO2 laser resurfacing in atrophic facial acne scars.Materials and Methods:Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as ‘excellent’ if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and <25% improvement were labelled as ‘good’ and ‘poor’ response, respectively. The overall satisfaction of the patients and any adverse reactions to the treatment were also noted.Results:Most of the patients showed a combination of different morphological types of acne scars. At the time of final assessment 6 months after the last laser session, an excellent response was observed in 26 patients (43.3%) while 15 (25%) and 19 patients (31.7%) demonstrated a good and poor response respectively. Rolling and superficial boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks.Conclusions:Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar scars with minimal adverse effects.

Long-term effectiveness of ranibizumab for age-related macular degeneration and diabetic macular edema

Neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME) are major causes of visual impairment in the elderly population worldwide. With the aging population, the prevalence of neovascular AMD and DME has increased substantially over the recent years. Vascular endothelial growth factor (VEGF) has been implicated as playing an important role in the pathogenesis of both neovascular AMD and DME. Since its introduction in 2006, ranibizumab, a recombinant, humanized, monoclonal antibody fragment against all isoforms of VEGF-A, has revolutionized the treatment of neovascular AMD and DME. The efficacy and safety of ranibizumab in neovascular AMD has been demonstrated in the ANCHOR and MARINA trials. Further studies including the PIER, PrONTO, and SUSTAIN trials have also evaluated the optimal dosing regimen of ranibizumab in neovascular AMD. The CATT and IVAN trials compared the safety and efficacy of ranibizumab with off-label use of bevacizumab. Studies such as SUSTAIN and HORIZON have shown that ranibizumab has a good safety profile and is well tolerated for over 4 years with very few serious ocular and systemic adverse events. For DME, Phase II RESOLVE study and Phase III RISE and RIDE studies have demonstrated superiority of ranibizumab treatment in improving vision over placebo controls. Phase II READ and Phase III RESOLVE and REVEAL studies have shown that ranibizumab is more effective both as monotherapy and in combination with laser compared with laser monotherapy. The 3-year results from the DRCRnet protocol I study found that ranibizumab with deferred laser resulted in better long-term visual outcome compared with ranibizumab with prompt laser. This review summarizes various important clinical trials on the long-term efficacy and safety of ranibizumab in the treatment of neovascular AMD and DME. The pharmacological properties of ranibizumab, its cost effectiveness, and impact on quality of life will also be discussed.

The combination treatment using CO2 laser and photodynamic therapy for HIV seropositive men with intraanal warts

We evaluate the effectiveness of combination treatment using photodynamic therapy after carbon dioxide laser in preventing the recurrence of condylomata acuminata for intraanal warts in HIV positive homosexual men. A retrospective survey of 41 patients referred to the STD clinic of the Fourth People's Hospital of Shenzhen for the treatment of intraanal warts among HIV positive homosexual men between Janurary 2009 and September 2011. The patients who accepted CO₂ laser monotherapy for the same diagnosis were used as the comparison group. After the confirmation of the diagnosis of HIV infection and intraanal warts, the patients were treated with the combination treatment using PDT with 5-ALA thermal gel immediately after CO₂ laser ablation of the warts. PDT was performed with irradiation of 100 J/cm² at an irradiance of 100-150 mW/cm² with a semiconductor laser, wavelength 635 nm. PDT therapy was repeated twice with 2 weekly intervals. Follow up examinations including an anoscopy every 4 weeks after the latest PDT. After 3 cycles of PDT treatments, 39 cases of anoscopy examination showed no new or recurrent lesions. At the end of the sixth months, recurrence occurred in 12(29%) cases. HPV 11 was present in 6 (50%) of these recurrences. HPV 6/11 or 16/18 remains positive in 19 cases (46.3%) and HPV negative in 22 cases. The combination treatment with CO₂ laser and PDT is much more effective in reducing the treatment cycles and the time intervals of the whole treatment for intraanal warts in HIV infected people.

Effects of Erbium-Doped: Yttrium Aluminum Garnet (Er: YAG) Laser on Bacteremia due to Scaling and Root Planing

Background: The aims of the present study were: [1] to evaluate whether Erbium-Doped: Yttrium, Aluminum and Garnet (Er: YAG) laser could be a prophylactic methods against transient bacteremia during scaling and root planing (SRP) [2] to confirm the efficacies of SRP with Er: YAG laser by clinical and microbiologic evaluations. Methods: Twenty chronic periodontitis subjects were randomly treated for quadrant SRP with either conventional hand instrument (n=10) or Er: YAG laser (n=10) monotherapy. Peripheral blood samples were drawn at baseline and 6 minutes after initiation of SRP, and were cultured for the analysis of bacteremia. Clinical measurements of full mouth plaque control record (PCR), probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP) were made at baseline and 1 month after SRP. In addition, microbiologic analyses of subgingival samples were also performed at baseline and 1 month after SRP using the polymerase chain reaction Invader method. Results: The incidence of bacteremia during SRP was 0% (0/10) in the Er: YAG laser group and 80% (8/10) in the hand instrument group, which was significantly different (P = 0.0003). All isolates from blood were facultative or obligate anaerobes and more than half of the microorganisms were species of streptococci. Intragroup comparison revealed that the mean PPD and CAL significantly decreased compared to baseline in both groups (P < 0.05). However, the percentage of BOP positive significantly decreased only in Er: YAG laser group (P = 0.005). In addition, the reductions of the subgingival bacterial counts between baseline and 1 month after SRP were also comparable between the two groups. Conclusion: The present study demonstrated that SRP with Er: YAG laser could not only be an alternative treatment for improvement of clinical and microorganisms situations but also a

Clinical efficacy of flumetasone/salicylic acid ointment combined with 308‐nm excimer laser for treatment of psoriasis vulgaris

To compare the clinical efficacy and safety of combining flumetasone ointment with 308-nm excimer laser therapy vs. 308-nm excimer laser monotherapy for the treatment of psoriasis vulgaris. Forty patients with psoriasis vulgaris were recruited; 20 were treated with flumetasone ointment plus 308-nm excimer laser therapy, and the other 20 received only excimer laser monotherapy. The flumetasone ointment was applied topically twice a day, and laser treatments were scheduled twice weekly for a total of 10 treatments. Clinical efficacy was evaluated in a blinded manner by two independent physicians using photographs taken before and after treatment. Of the 40 patients who received and completed the entire course of therapy, the psoriasis area and severity index score was improved by 82.51 ± 11.24% and 72.01 ± 20.94% in the combination group and laser group, respectively (P > 0.05), and the average cumulative dose was 5.06 ± 2.20 j/cm(2) in the combination group and 7.75 ± 2.25 j/cm(2) in the laser-only group, respectively (P < 0.05). The clinical data suggest that combination treatment using flumetasone ointment and a 308-nm excimer laser is superior to laser monotherapy for treatment of psoriasis vulgaris. The combination therapy can increase effectiveness and decrease the total laser dose, thus potentially reducing side effects.

Cost-effectiveness of ranibizumab in treatment of diabetic macular oedema (DME) causing visual impairment: evidence from the RESTORE trial

Background/aimsTo evaluate the cost-effectiveness of ranibizumab as either monotherapy or combined with laser therapy, compared with laser monotherapy, in the treatment of diabetic macular oedema (DME) causing visual impairment from...

Ranibizumab

Ranibizumab, an intravitreally administered inhibitor of vascular endothelial growth factor (VEGF), is approved for the treatment of visual impairment associated with diabetic macular oedema (DME) in the EU. In four well designed, phase II or III trials (RESOLVE, RESTORE, RIDE and RISE), 1-2 years' treatment with ranibizumab was more effective than sham or focal/grid laser therapy in improving best corrected visual acuity (BCVA) and reducing central retinal thickness (CRT) in patients with visual impairment associated with DME. Additionally, in two well designed phase III trials (RESTORE and DRCR.net-1), 1 year of treatment with ranibizumab as an adjunct to laser therapy was more effective than laser monotherapy in improving BCVA and CRT in patients with visual impairment associated with DME. Improvements in BCVA with ranibizumab alone or as an adjunct to laser therapy were observed at the first follow-up visits in these studies (i.e. 1-4 weeks after the start of treatment), and were associated with gains in vision-related quality of life, as assessed using the National Eye Institute Visual Functioning Questionnaire-25. The ocular and non-ocular adverse event profile of ranibizumab in patients with DME is similar to that observed in patients with neovascular (wet) age-related macular degeneration or retinal vein occlusion. Based on tolerability data from clinical trials, there is no indication that ranibizumab alone or combined with laser is associated with an increased risk of cardiovascular or cerebrovascular events potentially related to systemic VEGF inhibition.

Prevalence, Demographics, and Treatment Characteristics of Visual Impairment due to Diabetic Macular Edema in a Representative Canadian Cohort

Diabetic macular edema (DME) is the leading cause of blindness in the diabetic population. However, there is limited understanding of the epidemiology of DME with visual impairment (VI) and treatment in patients with diabetes in Canada. This observational, retrospective study used records from the Southwestern Ontario database to observe the demographics, prevalence, and treatment characteristics of VI due to DME compared to a healthy population in a real-world Canadian setting. Data was compared between a cohort of 8,368 diabetic (type 1 or 2) patients, who were ≥18 years old and had a diagnosis of DME with VI (visual acuity <20/40 in Snellen equivalent), and 76,077 age- and gender-matched subjects representing a healthy population. Among diabetic patients, prevalence of DME was 15.7%, and prevalence of VI due to DME was 2.56%. Laser monotherapy was the most frequently used treatment. Public funding covered costs for 85% of persons with DME while 18% were paid for with private funds. This study provides insight into the demographics, prevalence, and treatment of VI due to DME in a representative Canadian cohort. This data can help to inform evaluation of current DME treatment patterns and of proposed new treatment on drug plan budgets in Canada.

Does Pimecrolimus Cream Enhance the Effect of Excimer Laser on Eyelid Vitiligo

INTRODUCTION: Vitiligo is a cutaneous disorder of pigmentation, for which, there are some proven modalities of treatment. In this study, we evaluated the efficacy of the addition of topical pimecrolimus to 308nm Excimer laser in reducing treatment duration and improving the response rate of eyelid vitiligo, compared with 308nm Excimer laser monotherapy. METHODS: Fifty two symmetrically localized lesions of eyelid vitiligo in 26 patients were observed. Each of vitiliginous patches was treated with 308nm Excimer laser twice a week for a total of 30 sessions. Topical pimecrolimus 1% cream was applied to the patches of right eyelid(group A lesions) and eucerine cream as a placebo to the left side patches(group B lesions)twice daily, throughout the study. Photographs were taken at baseline, 6 and 15 weeks after starting the treatment. RESULTS: Twenty two patients (44 lesions) completed the study. Repigmentation was appeared in all (100%) of groups A and B lesions. A 75% or more repigmentation was achieved in 17(78%) of group A versus 14 (64%) of group B lesions. The average number of sessions needed for the appearance of repigmentation was 8 for group A lesions and 12 for group. The repigmentaion of 50% or more in patients with disease duration of 2 years or less and those with more than 2 years duration ere 100% and 59.2%, respectively. CONCLUSION: Repigmentation rate obtained by the combination therapy of eyelid vitiligo with 308nm Excimer laser and topical Pimecrolimus 1%cream is significantly higher, and obtained in fewer sessions in comparison with 308nm Excimer laser and placebo combination therapy.

Efficacy and safety of combination therapy with dexamethasone intravitreal implant (DEX implant) plus laser photocoagulation versus monotherapy with laser for treatment of diffuse diabetic macular edema (DDME)

Efficacy and safety of combination therapy with dexamethasone intravitreal implant (DEX implant) plus laser photocoagulation versus monotherapy with laser for treatment of diffuse diabetic macular edema (DDME)

The RESTORE Study: Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema

To demonstrate superiority of ranibizumab 0.5 mg monotherapy or combined with laser over laser alone based on mean average change in best-corrected visual acuity (BCVA) over 12 months in diabetic macular edema (DME). A 12-month, randomized, double-masked, multicenter, laser-controlled phase III study. We included 345 patients aged ≥18 years, with type 1 or 2 diabetes mellitus and visual impairment due to DME. Patients were randomized to ranibizumab + sham laser (n = 116), ranibizumab + laser (n = 118), or sham injections + laser (n = 111). Ranibizumab/sham was given for 3 months then pro re nata (PRN); laser/sham laser was given at baseline then PRN (patients had scheduled monthly visits). Mean average change in BCVA from baseline to month 1 through 12 and safety. Ranibizumab alone and combined with laser were superior to laser monotherapy in improving mean average change in BCVA letter score from baseline to month 1 through 12 (+6.1 and +5.9 vs +0.8; both P<0.0001). At month 12, a significantly greater proportion of patients had a BCVA letter score ≥15 and BCVA letter score level >73 (20/40 Snellen equivalent) with ranibizumab (22.6% and 53%, respectively) and ranibizumab + laser (22.9% and 44.9%) versus laser (8.2% and 23.6%). The mean central retinal thickness was significantly reduced from baseline with ranibizumab (-118.7 μm) and ranibizumab + laser (-128.3 μm) versus laser (-61.3 μm; both P<0.001). Health-related quality of life, assessed through National Eye Institute Visual Function Questionnaire (NEI VFQ-25), improved significantly from baseline with ranibizumab alone and combined with laser (P<0.05 for composite score and vision-related subscales) versus laser. Patients received ∼7 (mean) ranibizumab/sham injections over 12 months. No endophthalmitis cases occurred. Increased intraocular pressure was reported for 1 patient each in the ranibizumab arms. Ranibizumab monotherapy or combined with laser was not associated with an increased risk of cardiovascular or cerebrovascular events in this study. Ranibizumab monotherapy and combined with laser provided superior visual acuity gain over standard laser in patients with visual impairment due to DME. Visual acuity gains were associated with significant gains in VFQ-25 scores. At 1 year, no differences were detected between the ranibizumab and ranibizumab + laser arms. Ranibizumab monotherapy and combined with laser had a safety profile in DME similar to that in age-related macular degeneration.

Treatment of peri-implantitis using an Er:YAG laser or an air-abrasive device: a randomized clinical trial

Non-surgical peri-implantitis therapies appear to be ineffective. Limited data suggest that ER:YAG laser therapy improves clinical conditions. The present study aimed at comparing the treatment effects between air-abrasive (AM) and Er:YAG laser (LM) mono-therapy in cases with severe peri-implantitis. Twenty-one subjects in each group were randomly assigned to one time intervention by an air-abrasive device or an Er:YAG laser. Clinical data were collected before treatment and at 6 months. Data analysis was performed using repeat univariate analysis of variance controlling for subject factors. No baseline subject characteristic differences were found. Bleeding on probing and suppuration decreased in both the groups (p<0.001). The mean probing depth (PPD) reductions in the AM and LM groups were 0.9 mm (SD 0.8) and 0.8 mm (SD ± 0.5), with mean bone-level changes (loss) of -0.1 mm (SD ± 0.8) and -0.3 mm (SD ± 0.9), respectively (NS). A positive treatment outcome, PPD reduction ≥0.5 mm and gain or no loss of bone were found in 47% and 44% in the AM and LM groups, respectively. The clinical treatment results were limited and similar between the two methods compared with those in cases with severe peri-implantitis.

O21 Low level laser (LLLT) monotherapy Photobiostimulation in the treatment of osteochondrosis (osteoarthritis) of joints. Double-blind crossover, placebo-controlled clinical study

O21 Low level laser (LLLT) monotherapy Photobiostimulation in the treatment of osteochondrosis (osteoarthritis) of joints. Double-blind crossover, placebo-controlled clinical study

Laser application in non‐surgical periodontal therapy: a systematic review

The primary aim was to address the following focused question: What is the clinical effect of laser application compared with mechanical debridement in non-surgical periodontal therapy in patients with chronic periodontitis? A secondary aim was to survey the relevant literature in relation to safety of laser applications. Electronic databases of the PubMed and the Cochrane Library were searched and completed by manual searches up to December 2007. Following screening, 12 publications (11 studies) were eligible for the review. A meta-analysis could not be performed due to the heterogeneity of the studies. The results from a narrative synthesis indicate that Er:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and the long term (up to 24 months), compared with mechanical debridement. There is insufficient evidence to support the clinical application of either CO(2), Nd:YAG, Nd:YAP, or different diode laser wavelengths. The Er:YAG laser seems to possess characteristics most suitable for the non-surgical treatment of chronic periodontitis. Research conducted so far has indicated that its safety and effects might be expected to be within the range reported for conventional mechanical debridement. However, the evidence from the evaluated studies is weak.

Connection of tacrolimus and 308nm excimer laser in treating vitiligo

Two recent studies suggested the efficacy of a 308nm excimer laser treatment of vitiligo1,2. With this indication good results were also achieved with topical applications of tacrolimus3. We hypothesized that these two new treatments could be synergistic. Therefore we compared the respective efficacy of the combined of tacrolimus/308nm excimer laser therapy versus 308nm excimer laser monotherapy in treating vitiligo.

Kombinationstherapie der Psoriasis vulgaris mit dem 308-nm-Excimer-Laser und Calcipotriol

Die Kombinationstherapie mit topischem Calcipotriol und Schmalspektrum UVB 311 nm gilt als eine der wirksamsten und nebenwirkungsärmsten Therapieformen der mittelschweren Psoriasis vulgaris. Die 308-nm-Excimer-Laser-Monotherapie erreicht nach bisherigen Beobachtungen innerhalb von 8 bis 12 Sitzungen eine etwa 90 %ige Rückbildung der psoriatischen Plaques. An einem Kollektiv von 8 Patienten haben wir die therapeutische Kombination von Calcipotriol mit der 308-nm-Excimer-Laser-Bestrahlung im Halbseitenversuch gegenüber der 308-nm-Excimer-Laser-Monotherapie bei der Psoriasis vulgaris untersucht und eine deutlich schnellere Remission der Psoriasis auf der Seite der Kombinationstherapie nach bereits 6 bis 9 Sitzungen beobachtet. Ein fotodokumentierter Therapieverlauf wird exemplarisch dargestellt.

Clinical Assessment of Laser Monotherapy for Squamous Cell Carcinoma of the Mobile Tongue

Laser monotherapy for squamous cell carcinoma of the mobile tongue treated with CO2 laser was carried out on 18 cases between 1979 and 1997. Three cases recurred after laser surgery. As a subsequent therapy, radiotherapy was performed on two of them and laser surgery was repeated on the remaining one. No recurrences were found in the two patients who died from other diseases after laser surgery. The cure rate of primary tumors was 83.3%. One patient had subsequent metastasis after laser surgery. The rate of recurrence and subsequent metastasis was compared between a group of patients treated with laser surgery and a group treated with radiotherapy (interstitial implant). No differences were found in the rate of recurrence between the two groups. While 22 of 52 patients had a subsequent metastasis in the group treated with interstitial implant, only one patient had it in the group treated with laser surgery. There was a statistical difference between these two groups (p < 0.01).

Laser Ureterolithotripsy with Combined Rigid and Flexible Ureterorenoscopy

Because the pulsed dye laser can be transmitted through a thin, flexible quartz fiber a small caliber ureteroscope and flexible ureterorenoscope are applicable. Therefore, the use of a rigid or flexible ureterorenoscope was combined with laser lithotripsy to treat upper urinary tract calculi. All 14 ureteral stones below the pelvic brim were removed successfully with a rigid 7.2F (outer diameter) ureteroscope and 14 of 16 stones above the pelvic brim were removed with a flexible ureterorenoscope. Laser monotherapy was effective in 24 cases and the complementary use of forceps or electrohydraulic lithotripsy was required in 4. Two stones were lost from the visual field during endoscopic manipulation. There was no complication requiring surgical correction. The combined use of these instruments is highly successful and safe for the treatment of upper urinary tract calculi. (J. Urol., 143: 273–274, 1990).