Laser Procedures Research Articles

Deep learning-based normative database of anterior chamber dimensions for angle closure assessment: the Singapore Chinese Eye Study.

The lack of context for anterior segment optical coherence tomography (ASOCT) measurements impedes its clinical utility. We established the normative distribution of anterior chamber depth (ACD), area (ACA) and width (ACW) and lens vault (LV), and applied percentile cut-offs to detect primary angle closure disease (PACD; ≥180° posterior trabecular meshwork occluded). We included subjects from the Singapore Chinese Eye Study with ASOCT scans. Eyes with ocular surgery or laser procedures, and ocular trauma were excluded. A deep-learning algorithm was used to obtain Visante ASOCT (Carl Zeiss Meditec, USA) measurements. Normative distribution was established using 80% of eyes with open angles. Multivariable logistic regression was performed on 80% open and 80% angle closure eyes. Diagnostic performance was evaluated using 20% open and 20% angle closure eyes. We included 2157 eyes (1853 open angles; 304 angle closure) for analysis. ACD, ACA and ACW decreased with age and were smaller in females, and vice versa for LV (all p<0.022). ACD 20th percentile and LV 85th percentile had a balanced accuracy of 84.4% and 84.2% in detecting PACD, respectively. When combined, ACD 20th and LV 85th percentile had 88.68% sensitivity and 88.85% specificity in detecting PACD as compared with a multivariable regression model (ACA, angle opening distance, LV, iris area) with 88.33% sensitivity and 83.75% specificity. Anterior chamber parameters varied with age and gender. The ACD 20th and LV 85th percentile values may be used in silos or in combination to detect PACD in the absence of more sophisticated classification algorithms.

Efficacy of new two-stage methods of surgical and laser treatment for primary open-angle glaucoma combined with cataract

Background. Lowering the intraocular pressure (IOP) is the only proven method to slow the progression of glaucomatous optic neuropathy. Successful conservative treatment or surgery do not guarantee the preservation of visual fields throughout life. Despite the current advances in conservative treatment of primary open-angle glaucoma, about 5.3 % of patients still require surgical or combined treatment. There is no consensus yet on approaches to the treatment of patients with glaucoma and cataract. The objective was to evaluate the effectiveness of new two-stage methods for surgical and laser treatment of patients with primary open-angle glaucoma associated with cataract. Materials and methods. Seventy patients (70 eyes) with primary open-angle glaucoma stages I–IV complicated by cataract were included in this study. There were two observation groups. All patients received a two-stage treatment — micropulse transscleral cyclophotocoagulation (MP-TSCPC) and phacoemulsification with a monofocal intraocular lens (IOL) implantation. The first group (n = 34) included participants who underwent phacoemulsification with IOL implantation (stage 1) one month prior to MP-TSCPC (stage 2). The second group (n = 36) consisted of patients who underwent MP-TSCPC (stage 1) and phacoemulsification with IOL implantation a month after (stage 2). These groups did not statistically differ in terms of age, gender, baseline IOP, and stage of primary open-angle glaucoma. The primary outcome measure was the normalization of IOP with or without the use of antiglaucoma medications and without a need for further laser and incisional procedures in 1, 3 and 6 months. The secondary outcome was stabilization or expansion of visual fields when evalua­ting 1, 3, and 6 months after stage 2. Results. The average IOP level with antihypertensive medications before the treatment in group 1 was 27.5 ± 1.3 mmHg, in group 2 — 27.0 ± 1.1 mmHg. One month after the treatment, patients of group 1 had normal IOP in 94.2 % of eyes and in 5.8 % of eyes with local antihypertensive medications; in group 2, IOP was normal in 100 % of eyes without antiglaucoma medications (p &lt; 0.05). In 3 and 6 months, better hypotensive results were in group 2, but outcomes were not statistically significant. The visual fields were preserved at the preoperative level or expan­ded in patients from groups 1 and 2 one month after the treatment in 91.2 and 97.2 % of the eyes, respectively, 3 months after — in 91.2 and 97.2 %, 6 months after — in 88.2 and 94.4 % of the eyes, respectively. In group 2, better functional results were obtained at all time points, but it was not statistically significant. Conclusions. The studies have established a high efficacy and safety of new two-stage methods for surgical and laser treatment of patients with primary open-angle glaucoma and cataract with a follow-up period of 6 months. There was a tendency to greater efficacy of the method, where MP-TSCPC as stage 1 was followed by phacoemulsification with IOL implantation as stage 2. The nature and frequency of surgical and postoperative complications in both groups did not differ.

National Trends in Laryngeal Laser Surgery: Comparison of Operative Versus Office-Based Procedures.

To analyze national trends in the prevalence of office-based laryngeal ablative procedures and compare those with traditional operative excisional procedures utilizing direct laryngoscopy. For years 2013-2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 31572 (flexible laryngoscopy with laser ablation of lesion), 31540 (operative direct laryngoscopy with excision of lesion), 31541 (operative direct microlaryngoscopy with excision of lesion), and 31545 (operative direct microlaryngoscopy with excision of lesion and local tissue flap reconstruction). For each CPT code, the total number of charges billed to the Medicare database in each calendar year was recorded and annual trends were analyzed. Biopsy procedures were not included. The annual number of office-based laser procedures (CPT 31572) remained relatively constant since the CPT code was introduced in 2017 (range: 18887-25241 procedures annually, trendline slope = +16, R2:0.02). Office-based laser procedures comprised a small portion of total laryngeal excisional procedures (range: 8.4%-12.1%). The total number of operative laryngeal excisions, billed by CPT 31540 and 31541, declined over the studied time frame (Trendline slope = -132, R2:0.93; Trendline slope = -950, R2: 0.93 respectively). Office-based laser procedures comprise a small fraction of procedures to remove laryngeal lesions. The number of office-based laser procedures has been relatively stable over the last 5 years. This finding contrasts with the prevailing health care trend toward office-based procedures. Further research is needed to understand the decrease in operative laryngeal lesion excision procedures observed over the last 10 years. 4 Laryngoscope, 2024.

Exploring wear, corrosion, and microstructure in PEO coatings via laser surface treatments on aluminum substrates

The inadequate resistance to corrosion and wear of Al-based alloys is a major hindrance to their extensive use. Plasma electrolytic oxidation (PEO), a common and efficient coating technique, creates an oxide coating similar to ceramic on the surface of Al-based alloys, thereby improving their ability to withstand corrosion and wear. Studies have shown that PEO treatment can significantly enhance the short-term corrosion and wear resistance of Al-based alloys. To improve the long-term corrosion resistance of PEO coatings, researchers are now exploring the combination of laser processes with the PEO process. Laser processing is a simple yet efficient technique known for its flexibility, precision, and control. Various laser procedures are recognized for their ability to improve the resistance to wear and corrosion of PEO coatings applied on Al substrates and their alloys. Laser melting procedures have the capability to standardize and modify the microstructure of aluminum-based alloys. This review focuses on enhancing the anti-corrosion and anti-wear properties of aluminum alloys through the integration of laser surface treatments with PEO technology.

Photorefractive Keratectomy: Technical Evolution, Refractive Outcomes, Corneal Wound Healing Response, and Complications.

Photorefractive keratectomy (PRK) was the first excimer laser procedure developed to treat refractive errors. The safety and efficacy of PRK established it as one of the most performed corneal refractive procedures worldwide. With the introduction of laser in situ keratomileusis (LASIK), and more recently keratorefractive lenticule extraction (KLEx) procedures, many corneal surgeons favor these newer corneal procedures as the first choice due to faster visual rehabilitation and less discomfort during the early postoperative period. Importantly, however, PRK remains a viable alternative for most corneal refractive candidates and there are many situations in which PRK remains the refractive procedure of choice. This review addresses the technical evolution of PRK-mechanical epithelial debridement versus alcohol-assisted epithelial removal versus excimer laser-assisted epithelial debridement (transepithelial) PRK-and reports the PRK refractive outcomes compared to other keratorefractive laser procedures. The corneal wound response associated with each PRK technique and the indications, limitations, and complications of PRK are reviewed to aid refractive surgeons to best position PRK in their overall practice. [J Refract Surg. 2024;40(10):e754-e767.].

Short pulse grid and subthreshold micropulse laser (the sandwich grid) plus intravitreal ranibizumab for the treatment of diabetic macular edema

ObjectiveTo investigate the effects of two laser treatment procedures combined, short pulse grid laser (SP) and subthreshold micropulse laser (MP) (the sandwich grid [SWG] technique), plus intravitreal ranibizumab (IVR) on central subfield thickness (CSFT), best-corrected visual acuity (BCVA) and macular sensitivity in patients with diabetic macular edema (DME).MethodsForty-five eyes (of 33 patients) with center-involving DME were treated with the SWG laser technique plus IVR and followed for 12 months. Laser treatment was performed at baseline: SP laser spots were placed in a grid pattern in the macular area (500 µm from the fovea) according to the extension of DME; subsequently, MP laser was delivered up to the edge of the fovea. MP laser re-treatment sessions could be performed every 3 months if DME was present and CSFT was ≥ 300 μm on SD-OCT. IVR injection was performed at baseline and repeated monthly if CSFT > 300µm. Preoperatively and monthly, ophthalmological examination was performed including measurements of BCVA, CSFT, and macular sensitivity.ResultsOne-year follow-up data is available for 37 eyes of 27 patients. Mean ± SE CSFT (µm) was 509.36 ± 25.14 and 325.76 ± 15.34 at baseline and 12 months, respectively. A significant reduction in mean CSFT was observed at all study visits compared to baseline (p < 0.001). Mean ± SE BCVA (logMAR) was 0.62 ± 0.04 and 0.45 ± 0.04 at baseline and 12 months, respectively. A significant improvement in mean BCVA was observed at all study visits compared to baseline (p < 0.001). Mean ± SE macular sensitivity (dB) was 17.85 ± 0.80 and improved to 19.05 ± 0.59 after one year of follow-up (p = 0.006). The mean number of IVR injections was 8.29 ± 0.63. The mean number of MP laser procedures including the initial SWG laser session was 3.67 ± 0.22. No ocular or systemic adverse effects were observed.ConclusionThe SWG laser technique plus IVR was associated with significant improvement in macular edema, BCVA, and macular sensitivity in patients with center-involving DME.Clinical Trial Number (CAAE)22969019.4.0000.5440.

REJUVENESCIMENTO FACIAL NA BIOMEDICINA ESTÉTICA FACIAL

The general objective of the theme was to investigate the impact of facial rejuvenation on aesthetic biomedicine, addressing aspects related to safety, effectiveness and patient satisfaction. Thus, he sought to discuss facial aging; evaluate the main facial rejuvenation procedures available in aesthetic biomedicine, including techniques, products and technologies used; analyze the clinical and scientific aspects involved in facial rejuvenation treatments, considering the benefits, risks and limitations of each approach. The methodology adopted consists of carrying out a literature review, through a bibliographic survey. Studies will be searched in the Virtual Health Library (VHL), PubMed and Google Scholar databases. To select articles, the following descriptors are used: biomedicine; aesthetics; aging. The inclusion criteria established were direct relevance to the topic; publication in Portuguese and/or English; publication period between 2010 and 2024; availability of the full article. Articles that fell outside the scope of the study, were published in languages other than Portuguese and English, published before 2010, available only as abstracts and duplicates in different databases were excluded from the analysis. With the results of the research, it was possible to conclude that facial rejuvenation in aesthetic biomedicine offers a variety of techniques, from chemical peelings to laser procedures and dermal fillers, adapted to the individual needs of each patient. The personalized approach ensures effective and safe results, driven by a comprehensive understanding of scientific principles and a multidisciplinary approach. These innovative treatments promote not only aesthetic improvements, but also patients' self-esteem and well-being.

Corticosteroid-induced Glaucoma: An avoidable blindness

Healthcare professionals frequently advise the use of topical steroid eye drops to manage and control postoperative inflammation following phacoemulsification. Although there are many benefits associated with steroid usage, it is imperative to recognize the potential negative repercussions that may arise. In individuals who respond to steroids, the use of topical steroid drops can lead to an increase in intraocular pressure (IOP). Increase in IOP resulting from the side effects of steroids typically manifests several weeks following the initiation of eye drop therapy. The first documentation of steroid induced glaucoma (SIG) can be traced back to the 1950s on the administration of systemic adrenocorticotropic hormones. The elevation of IOP is a complex issue influenced by various factors, but the primary factor is the increased resistance within the outflow mechanisms of the trabecular meshwork. Out of all the risk factors related to ocular hypertension caused by steroid use, a preexisting glaucoma diagnosis is the most frequently seen. The usage of different routes of steroids administration has been linked to the occurrence of ocular hypertension. The current management approach prioritizes the exploration of steroid-sparing treatment options, discontinuing steroid use, employing medications to lower intraocular pressure, and considering interventional laser and surgical procedures.

49940 Racial differences in wRVU compensation for pediatric dermatology visits may be driven by laser procedures

49940 Racial differences in wRVU compensation for pediatric dermatology visits may be driven by laser procedures

Laser Hemorrhoidoplasty and Lateral sphincterotomy Procedures vs Conservative Treatment for Hemorrhoids and Fissure in Ano: A Trial Comparing Laser and Conservative treatments

Objective: According to the ‘‘vascular’’ theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. Aim: Our aim was to compare the hemorrhoid laser procedure and laser aided lateral sphincterotomy vs conservative treatment of symptomatic hemorrhoids and fissure in ano. Material and Method: A comparison trial between hemorrhoid laser procedure, lateral sphincterotomy and conservative treatment for hemorrhoids and fissure in ano was made. This study was conducted at Vels Medical College and Hospital, Manjankaranai, Tamil Nadu. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 30 patients treated with the laser hemorrhoidoplasty, 30 patients–with laser aided lateral sphincterotomy and 40 patients treated with conservative methods. Operative time, postoperative pain, post-op healing time were evaluated. Results: A total number of 100 patients ( 65 men and 35 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty, laser sphincterotomy and conservative treatments were observed in operative time and early postoperative pain. The procedure time for LHP was 15.49 min laser aided lateral sphincterotomy was 10.19 min. Conclusion: The laser hemorrhoidoplasty and laser guided sphincterotomy procedures were more effective than conservative methods. Postoperative pain and healing time were drastically less in the early and late post op period.

The Impact of Femtosecond Laser on Intraocular Pressure with Cataract Surgery in Healthy Eyes.

Femtosecond laser-assisted cataract surgery leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP. To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) using the LDVZ8 laser on intraocular pressure (IOP) during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS). This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a six-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed. Mean IOP increase after docking was 2.3±4.1mmHg (P<0.0001); maximum increase 17.6mmHg, peak 38mmHg. Sixty-one (61) eyes (25.1%) demonstrated an increase of ≥5mmHg and 10 (3.7%) showed an increase of ≥10mmHg; pre-docking IOP was associated with an IOP increase of ≥5mmHg (P-0.029). IOP reduction over six months post-surgery was similar for FLACS and CPCS (P>0.05),-1.33±3.12mmHg for FLACS (P<0.001) and -1.4±2.87mmHg for CPCS (P<0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β -0.742, P<0.001) and CPCS (β -0.743, P<0.001). Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS, and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.

Long-term follow-up of pilonidal sinus disease treated by radial laser surgery

PurposeLaser ablation is one of the newest and most advanced minimally invasive techniques in treating pilonidal sinus disease (PSD). Most studies on the subject have small sample sizes and relatively short follow-up times, making evaluation of long-term healing rates and recurrences difficult. Furthermore, long-term results for laser surgery of PSD are still lacking. The aim of this study was to retrospectively report long-term follow-up results for PSD treatment by radial laser surgery.MethodsWe retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019. Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years.ResultsTwelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%). These recurrences appeared at a median 12.2 months after the laser procedure, range 4.2 to 51 months. A total of 23 patients (27.7%; 95% CI 19.0–38.0) underwent a reoperation, 11 patients due to postoperative infection or prolonged recovery and 12 patients due to PSD recurrence. Recurrent PSD and spillage of pus during operation were statistically significantly associated with the need for a second operation.ConclusionRadial laser surgery provides a minimally invasive treatment option with an acceptable recurrence rate in long-term follow-up.

The laser pilonidoplaty

Background: The aim of our study was to evaluate the safety, efficacy and clinical outcome of a laser procedure for the treatment of pilonidal sinus. Objectives were to investigate its effectiveness in terms of operation time, healing time, and the duration of hospitalization, resumption of normal activity, the degree of postoperative complications and rate of recurrence patient satisfaction. Methods: Patients suffering from pilonidal sinus were operated by laser pilonidoplasty at our institute. Laser pilonidoplasty done under spinal anesthesia or local + sedation after a small primary pit excision (0.5-1 cm incision), excision of secondary pits and careful cleaning of the sinus tracts with a curette. After curettage, the laser energy laser set at a wavelength of 1470 nm) was delivered in continuous mode 10 w/sec into the sinus tract f/b saline wash and dressing. Results: Mean duration of procedure was 35.5 min, mean duration of hospital stay was 1.3 days, mean resumption of normal activity within 8.4 days, mean duration for complete wound healing by secondary intention 29.33 days. Among complications, non-healing ulcer reported in 34% and pain noted in 26%. Recurrence rate was 14%. Success rate was 86% and overall patient’s satisfaction was 94%. Conclusions: Laser pilonidopasty proved to be a safe and effective procedure for treating patients suffering from pilonidal sinus with average success rate, less morbidity, fewer complications with better patient satisfaction rate.

A Study of the Prevalence of Diabetic Retinopathy in Patients With Ischemic Heart Disease and Diabetes Mellitus.

Background Diabetes mellitus is one of the most important and common chronic diseases worldwide and is expected to increase in prevalence. Diabetic retinopathy (DR) is one of the most prevalent microvascular sequelae of diabetes mellitus (DM), and ischemic heart disease is a macrovascular sequela. This study was conducted to find out the relation between the degree of DR and ischemic heart disease severity in Indian patients. Materials and methods This cross-sectional, descriptive, hospital-based study was conducted in the ophthalmology department at Dr. D. Y. Patil Medical Hospital, Pune, Maharashtra, India, from September 2022 to June 2024. A total of 200 eyes from 100 patients who were diagnosed with cases of ischemic heart disease and diabetes mellitus were included in the study. Patients with corneal pathology like endothelial dystrophies, corneal degenerations, corneal scars, or trauma preventing good visualization of the posterior segment were excluded from the study. Patients with active uveitis, patients with a history of undergoing any previous vitreoretinal surgery or laser procedures, non-compliant patients, patients not willing to undergo the procedure, or those not consenting to the study were also excluded. Written informed consent was obtained from each patient. Data was entered in Microsoft Exceland statistical analysis was done using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. As the continuous variables showed a skewed distribution, we used the Mann-Whitney test and the Kruskal-Wallis test to test the significance of the difference between continuous and categorical variables. A chi-square test was employed to check the association between categorical variables. Significance was assumed at an alpha error of 5%. Results The prevalence of diabetic retinopathy was found to be 95%. The mean age of patients with DR and patients with no diabetic retinopathy was 58.38 and 59.40 years, respectively, with the majority of the patients being in the age group of 60-69 years (46%). The majority of the patients were males (65%), while 35% were females. There was a significant association between the severity of diabetic retinopathy and the higher HbA1c levels, the use of insulin as a treatment modality, and the higher blood sugar levels in our study population. It was observed that the patients in our study with an ejection fraction of <40% had significantly higher severity of diabetic retinopathy in the form of PDR and high-risk PDR. The severity of the DR was directly correlated with the severity of IHD in our study, with most of the IHD patients with a 40-60% ejection fraction having moderate NPDR and patients with a >60% ejection fraction having mild or moderate NPDR. Conclusion The prevalence of diabetic retinopathy among the IHD patients with diabetes was 95% in our study, with moderate NPDR being the most common stage of DR seen among the patients. It was observed that more severe stages of diabetic retinopathy were seen in patients who were on treatment with insulin than in patients who were on treatment with OHA. Severe stages of diabetic retinopathy were associated with higher blood sugar levels (BSL) and higher glycated hemoglobin levels. In the present study, it was observed that a lower ejection fraction (<40%), which is a marker of reduced cardiac function, was associated with more severe stages of diabetic retinopathy.

Evaluation of hemorrhoid laser procedure with anal suture mucopexy and its effectiveness to treat second and third-degree hemorrhoids: A prospective study

Evaluation of hemorrhoid laser procedure with anal suture mucopexy and its effectiveness to treat second and third-degree hemorrhoids: A prospective study

A Study on the Effective Follow-up Care Method After Laser Treatment: Focusing on Skin Health Behavior

Recently, women in their 30s and 40s are paying attention to making their skin appear whiter and cleaner through pigmentation treatments such as laser toning. For the effectiveness of the procedure and rapid recovery, follow-up care after the laser procedure is also necessary. Through this study, we tried to find out the efficacy of skin health behavior according to the care method after the laser procedure. Skin health behavior (daily life habits, dietary habits, sleep habits, and the presence or absence of cosmetic health supplements) was compared and analyzed by dividing the study subjects receiving vitamin care, ultrasound care, and cryo care for women in their 30s and 40s into three groups. A total of 300 questionnaires were surveyed for a week from August 5 to August 11, 2022, using PCs and mobile phones, and a total of 300 copies were collected. As a result of the study, ultrasound and cryo care alternately dominated the post-care process evaluation and skin improvement satisfaction, while vitamin care was continuously at the bottom. On the other hand, in terms of skin health behavior, overall, ultrasound, cryo, and vitamin care groups scored high. Based on the results of this study, it is expected that it will become the cornerstone of clinical data to be used in the future by developing a skin whitening program through personalized skin counseling in the practice of hospitals and clinics.

Frenotomy for Ankyloglossia: Conventional technique under general anesthesia in pediatric patients

Introduction: Ankyloglossia, commonly known as tongue-tie, is a prevalent birth defect characterized by a shortened and taut lingual frenulum, resulting in various complications. It occurs more frequently in males and can lead to breastfeeding difficulties, poor weight gain, and challenges in oral hygiene. The purpose of this article is to discuss frenotomy as a surgical intervention for ankyloglossia, involving the removal of the lingual frenulum under general anesthesia. Case History: a 9-year-old male patient with class III ankyloglossia, experiencing difficulty in pronouncing words and maintaining oral hygiene due to a short lingual frenulum. Despite initial behavioral challenges, comprehensive dental treatment, including frenectomy under general anesthesia, was successfully performed. Discussion: Ankyloglossia, or tongue-tie, results from cellular degeneration of the lingual frenulum, often associated with a genetic mutation in the MTHFR gene, affecting folate processing. Tongue development involves the migration of muscles from pharyngeal arches, leading to attachment issues at the lingual frenulum, causing ankyloglossia. Untreated consequences include feeding difficulties, dental decay, and speech articulation challenges. Conventional frenotomy, a simple and efficient technique, offers rapid, cost-effective symptom relief, promoting smooth recovery and improved outcomes compared to laser procedures. Conclusion: frenotomy for ankyloglossia under general anesthesia effectively improves tongue mobility and alleviates associated symptoms. General anesthesia ensures patient comfort and facilitates precise execution of the procedure. The conventional frenotomy technique enhances tongue movements, highlighting the efficacy of surgical intervention for this condition.

Complications of dermatologic lasers in high Fitzpatrick phototypes and management: an updated narrative review.

This article explores the intricacies of laser surgery, acknowledging inherent risks and complications. Patients with higher Fitzpatrick phototypes, characterized by unique biological traits, face heightened vulnerability during laser treatments. Limited experience with darker skin tones necessitates a higher level of laser expertise and a conservative approach. The study aims to comprehensively review laser therapy's side effects and complications, with a specific focus on Fitzpatrick phototypes IV through VI. We searched the MEDLINE database from 1972 to 2023 to consolidate knowledge. Results illuminate nuanced challenges associated with laser surgery in higher phototypes. In conclusion, this research emphasizes the need for enhanced expertise and caution in laser procedures for individuals with darker skin, offering valuable insights to optimize patient safety and outcomes.

A prospective, randomized, single-blinded study evaluating the effect of frozen-section directed excision on positive surgical margins in high-grade vulvar dysplasia.

TPS5644 Background: Vulvar cancer accounts for 2-5% of gynecologic malignancies. As with many skin cancers, vulvar cancer is preceded by a dysplastic state. Currently, wide local excision (WLE) is the surgical treatment modality used to excise visually dysplastic tissue, with a 0.5 cm border. However, this methodology does not incorporate the risk of microinvasion and positive margins on the tissue sample. The significance in having positive margins is a 3-fold higher risk of recurrence when positive margins are present. Our study seeks to compare this current standard of care with a frozen section directed excision, which is similar to Mohs Surgery, a long-established surgical technique mainly used in dermatology. This technique allows for repeated pathologic evaluation to ensure negative margins are present before cessation of the surgery. The goal of this study is to show the superiority of Frozen-Section Directed Excision (FSDE) in conducting vulvectomies in reducing positive margin rates, thus potentially reducing recurrence rates. Methods: This is a prospective randomized, single-blinded study. The target population is adults ≥ 18 years of age with histological or cytological confirmation of VIN 2, VIN 3, VIN 2/3 or High-grade Dysplasia NOS with a planned excisional procedure, with high suspicion by the enrolling investigator that gross surgical margins of ≥ 3 mm can be achieved without laser or other destructive procedures. One group of subjects is assigned to the FSDE surgery arm and will undergo this procedure. The other group of subjects will be assigned to the WLE (standard of care) arm and will undergo that procedure. The randomization will be 1:1. This trial is designed as a group sequential study with two primary analysis timepoints. The interim analysis will occur after the surgical margin status is known for the first 56 evaluable subjects and the second after all (112 targeted) evaluable subjects. Information regarding the surgery procedure, the amount of time the surgery procedure takes, and total amount of pain medication required during surgery and while in the surgery recovery area will be collected. The study team will also look at recurrence rates in six months, if any other therapies are required, and subject satisfaction related to the surgery, recovery, and sexual function by using questionnaires before and after the procedure. Based on previously published cases and a review of cases of vulvar excision at our institution, it is anticipated that the rate of positive margins will exceed 50% with standard surgery. It is expected that FSDE will reduce the positive margin rate by at least 50%. Assuming 56% of standard surgeries result in positive margins and a two-tailed alpha of 0.05, 56 subjects per arm or a total of 112 evaluable subjects will provide 80% power to detect this difference. Clinical trial information: NCT05934851 .

Intraoral Applications of Lasers in the Prosthetic Rehabilitation with Fixed Partial Dentures-A Narrative Review.

Laser, an acronym for Light Amplification by Stimulated Emission of Radiation, is a powerful tool with diverse applications in modern dentistry. It emits monochromatic, coherent light resulting from photon-induced chain reactions. Available dental lasers include diode, argon, Er,Cr:YSGG, Er:YAG, Nd:YAG, and CO2. The unique property of these lasers, allowing them to be effectively used on both soft and hard tissues based on the operational parameters, positions them as particularly suited for a wide range of dental procedures. Compared to traditional methods, lasers offer advantages such as improved hemostasis and quicker wound healing. Such benefits stress the shift towards laser technology in dental treatment. In the realm of dental prosthodontics, which focuses on esthetics, functionality, and the physiological aspects of dental prostheses, lasers provide promising outcomes. Among the prosthetic options, fixed partial dentures stand out for their ability to mimic natural teeth, offering both esthetic and functional features, leading to satisfactory long-term outcomes if managed properly. This review paper delves into the specific application of laser technology in the context of prosthetic rehabilitation involving fixed partial dentures. By investigating intraoral laser procedures, it contributes to understanding laser's role in improving patients' satisfaction and clinical efficiency in this field.