Laser Procedures Research Articles

Posterior to the ridge laser in zone 2 stage 3 retinopathy of prematurity with plus disease: Efficacy and safety.

This study aimed to ascertain the efficacy and safety of an additional posterior to the ridge laser for treatable zone 2 stage 3 retinopathy of prematurity (ROP). This study was a retrospective chart review of infants undergoing laser treatment for ROP at a single center from March 2014 to March 2022. The chart review specifically searched for infants treated for zone 2 stage 3 ROP with plus disease, where additional posterior to the ridge laser was performed. Seventy-eight eyes of 45 infants met the inclusion criterion. The mean birth weight and gestational age were 1166.09 ± 329.66 gm and 29 ± 2 weeks, respectively. Group 1 comprised 52 eyes treated for high-risk prethreshold stage 3 ROP, while group 2 comprised 26 eyes treated for threshold ROP. 532-nm frequency-doubled Nd:YAG laser (Nidek, Japan) was used in all eyes. Apart from the standard laser to the avascular retina, an additional three rows of laser were applied posterior to the ridge in all eyes during the primary laser sitting (except in two eyes where it was performed as a rescue treatment 2 weeks after the first sitting). No complications were observed during or immediately after the laser procedure. A favorable outcome was achieved in 98.07% of eyes with prethreshold ROP and 76.92% of eyes with threshold ROP. Overall, a favorable outcome was achieved in 71 (91.02%) of the 78 eyes. Posterior to the ridge laser performed in the primary sitting along with the standard laser for treatable stage 3 ROP in zone 2 is safe and effective. Further prospective studies are needed to study this underutilized approach.

Safety of esthetic procedures in rheumatic patients: single-center survey of patients

The popularity of esthetic medicine is growing every year, also among patients with autoimmune inflammatory rheumatic diseases (AIRD). The objective of this study was to evaluate the safety of esthetic medicine (AM) procedures in patients with AIRD. A semi-structured, anonymous questionnaire regarding rheumatic and concomitant diseases and AM procedures was distributed among adult patients hospitalized in the rheumatology department or attending outpatient clinic in the National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw. The main outcome was the occurrence of an adverse event. A number of 512 patients took part in the survey and 15 were excluded (AM procedure preceded the diagnosis of AIRD). The study group consisted of 497 patients, of whom 47 had undergone AM procedures. The procedures performed included: tattooing (22 patients), piercing (16 patients), hyaluronic acid (7 patients), botulinum toxin (5 patients) injections, laser procedures (6 patients), plastic surgery (4 patients), mesotherapy (3 patients) and others. The vast majority of patients had these performed during remission or low disease activity. 70.2% of patients received treatment with disease-modifying antirheumatic drugs (DMARDs) during the AM procedure, with TNF-alfa inhibitors being the most common (63.6%). Adverse events occurred in 15% of patients. All were mild and transient site reactions. Most patients would like to repeat the AM procedure in the future. The use of esthetic medicine procedures in patients with AIRD, including those treated with biologic DMARDs, was associated with a risk of mild site reactions. Most of the patients expressed satisfaction with the results of the AM procedure.

Advancement in Understanding Glaucoma: A Comprehensive Review.

Glaucoma, a silent thief of sight, remains a significant cause of irreversible blindness due to a substantial number of undiagnosed and untreated cases. To combat this insidious disease effectively, a multifaceted approach is imperative. Early detection is paramount in the battle against glaucoma. Patient history, including family history, plays a pivotal role in identifying those at risk. A comprehensive understanding of a patient's genetic predisposition can significantly enhance the accuracy of diagnosis and detection of suspicious cases. Treatment options include prescription eye drops, oral medicines, laser treatment, surgery, or a combination of approaches. Trabeculectomy involves the surgical creation of an aqueous humor drainage channel, while laser trabeculoplasty enhances aqueous outflow by modifying the trabecular meshwork. However, these procedures pose certain risks and complications. Exploration of alternative treatments with lower risks is underway. These innovative approaches hold promise in reducing the burdens associated with conventional treatments such as trabeculectomy. However, the effectiveness of these alternatives in the long term remains a subject of ongoing research. Neuroprotective drugs have also been in development to halt the progression of glaucoma. However, their success remains uncertain due to challenges, such as a lack of understanding of the underlying mechanisms, scarcity of suitable drugs, and regulatory hurdles in gaining approval. In essence, the overarching goal of glaucoma therapy is to reduce intraocular pressure through various means - medications, laser procedures, or innovative methods. The aim is to slow down the disease's progression, thereby preserving vision and improving the patient's quality of life. In conclusion, addressing the challenge of glaucoma requires a comprehensive approach encompassing early detection, innovative treatments, and ongoing research into potential cures. Only through concerted efforts can we hope to reduce the impact of this sight-stealing disease on individuals and society as a whole.

Which Laser System is Optimal for Cystolithotripsy of Large Bladder Calculi?

A variety of laser sources are available to treat bladder stones. The aim of this study was to compare time and cost efficiency of the thulium fiber laser (TFL) to four holmium lasers (HLs) with different powers or technologies, including MOSES™ during simulated cystolithotripsy. In a benchtop simulation of laser cystolithotripsy, 25 identical 4-cm BegoStones (calcium oxalate monohydrate consistency) were placed on a grid within a 3D-printed bladder model. Lasers were operated at maximal energy, using a 550 µm fiber. Lasers compared were: 60W TFL, 120W HL with MOSES™, conventional 120W, 100W, and 30W HLs. Five trials were performed for each laser with endpoints of laser time, total time, number of fiber strippings, and total energy. Cost effectiveness was modelled using laser purchase price, fiber, and OR time cost. ANOVA with Tukey's B post hoc was performed to compare outcomes. Spearman's test was used to assess correlation between laser power and procedure time. The laser and total operating times were significantly different between the five systems (p<0.001). The 120W HL with MOSES™ was the fastest with 60.9 min laser and 68.3 min procedure times, while the 30W HL was the slowest with 281.2 min laser and 297.5 min procedure times. The 60W TFL was faster than the 30W HL, but slower than the higher power HLs. Higher laser power was associated with shorter procedure time (Rs=-0.98; p=0.002). When estimating cost per procedure, the MOSES™ HL was the cheapest, but had the highest purchase cost. The TFL was not cost-effective for large bladder stones compared to the 100W HL. When treating large bladder stones, total laser power was highly correlated with laser and procedure times and the TFL was limited by its total power. The most cost-effective laser for use will depend on the case volume.

Evaluation of the Erbium-doped Yttrium Aluminum Garnet Laser and the Conventional Method on Pain Perception and Anxiety Level in Children during Caries Removal: A Randomized Split-mouth Study.

To assess and compare children's anxiety level and pain perception during cavity preparation using an erbium-doped yttrium aluminum garnet (Er:YAG) laser vs traditional rotational treatment. A randomized, controlled, split-mouth clinical trial was carried out in 35 healthy children with 70 carious primary molars. Teeth were divided equally into two groups according to the method of treatment. A bur was used to prepare the cavity in one quadrant, while an Er:YAG laser was used to prepare the cavity in the other quadrant. Anxiety was assessed using Venham's dental anxiety scale and a fingertip pulse oximeter. The pain was assessed using the Wong-Baker Face Pain Rating Scale, and the number of local anesthesia (LA) needed during both procedures was also considered. The mean age was 9.4 ± 1.29. Males accounted for 51.4% of the participants. There were no statistically significant variations in pulse rate at the baseline between Er:YAG laser and the conventional treatments. The mean pulse rate was higher during the conventional intervention than during the laser intervention; this difference was statistically significant vs the baseline pulse rate. The mean pulse rate with the conventional method was significantly higher during and after cavity formation than with the laser method. The Er:YAG laser and the conventional groups showed statistically significant differences in the Venham's and Wong-Baker scores. The scores of both scales were much higher in the conventional group. The number of participants who requested LA during the conventional technique was significantly higher than during the laser procedure. Using Er:YAG lasers to remove caries produces minimal pain and anxiety and reduces the requirement for LA. During cavity preparation, the Er:YAG laser helps children stay calm. Abdrabuh RE, El Meligy OAES, Felemban OM, et al. Evaluation of the Erbium-doped Yttrium Aluminum Garnet Laser and the Conventional Method on Pain Perception and Anxiety Level in Children during Caries Removal: A Randomized Split-mouth Study. Int J Clin Pediatr Dent 2023;16(S-1):S39-S44.

Efficacy of autologous adipose-derived stem cells and fractional carbon dioxide laser in the treatment of atrophic linear scars

Background Atrophic linear scars are scars that exhibit indentation or depression in the skin below the level of the surrounding tissues. Hyperpigmentation or hypopigmentation may be present. They are often caused by surgery, burns, and trauma. Objective To evaluate the efficacy of autologous adipose-derived stem cells (ADSCs) combined with fractional carbon dioxide (CO2) laser in the treatment of atrophic linear scars. Patients and methods This randomized, controlled preliminary study included 20 patients aged 20–45 years of both sexes with facial atrophic linear scars. The patients were randomized systematically into two groups: group A (combined ADSCs and fractional CO2 laser procedure) and group B (fractional CO2 laser only) of 10 patients each. The scar was evaluated using the Vancouver scar scale, along with a subjective satisfaction questionnaire, and ultrasound skin analysis at baseline and 1 month after the third treatment session. Results All participants completed the study. The mean Vancouver scar scale score improved significantly from 3.60±0.69 to 1.20±0.79 and from 2.20±1.03 to 1.60±0.52 with fractional CO2 laser plus ADSCs and CO2 laser procedure, respectively (P&lt;0.001). However, CO2 laser plus ADSCs was significantly superior. Ultrasound skin examination showed a statistically significant increase in dermal collagen density (thickness) in both groups. Conclusion Our study shows that treatment with CO2 laser exposure plus ADSCs is safe and more effective for atrophic linear scar management than CO2 laser exposure alone.

CHRONIC INFLAMMATORY DERMATOSIS: ROSACEA, OVERVIEW, DESCRIPTION, PRESENTATION, EPIDEMIOLOGY, PATHOPHYSIOLOGY, TYPES, DIFFERENTIAL DIAGNOSIS, TREATMENT OF THE DISEASE AND ITS ROLE IN PREGNANCY

Introduction: Rosacea is a chronic inflammatory dermatosis involving especially the cheeks, nose, chin and forehead, characterized by repetitive episodes of transient flushing or erythema, persistent erythema, in addition to phymatous changes, papules, pustules and telangiectasias. Objective: to detail the current information related to rosacea, description, presentation, epidemiology, pathophysiology, types, differential diagnosis, treatment of the disease and its role in pregnancy. Methodology: a total of 50 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 39 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: rosacea, treatment, chronic inflammatory dermatosis. Results: Phymatous changes are not frequent, however they occur primarily in the nose (rhinophyma) and more commonly in men. Rosacea usually begins between 30 and 50 years of age, however it can occur at any age. The approximate population prevalence is between less than 1 to 22%. The neurocutaneous mechanisms in rosacea, reflecting reactivity to temperature change, alcohol, sports, UV rays and spicy foods, may be mediated by the ankyrin and vanilloid subfamilies of the transient receptor potential (TRP). Increased rosacea can occur in pregnancy and multiple cases linked to rosacea fulminans (RF) are reported in the literature. Conclusions: Rosacea is characterized by repetitive episodes of redness, persistent erythema, inflammatory papules-pustules and telangiectasias. Previously rosacea was divided into ocular, phymatous, fulminant and granulomatous types, however there is now a new classification of rosacea. In the treatment the first thing is to identify the trigger, then make some general recommendations on the skin such as the use of sunscreen and finally give treatment that can be both topical and systemic or even to use laser or other procedures. The differential diagnosis of rosacea is broad and should be carefully analyzed. Treatment in pregnant women is a huge challenge, because several of the treatments for rosacea are contraindicated or have limited evidence of probable side effects to the fetus. KEYWORDS: rosacea,treatment,dermatosis,inflammatory.

Training ambidexterity - A survey-based analysis on the dexterity of ophthalmologists in performing standard ophthalmic procedures.

Our study was designed to determine ophthalmologists' dexterity in performing standard ophthalmic procedures at various levels of expertise via a structured questionnaire. A structured questionnaire was administered via the Google platform from August 20 to September 19, 2022, to assess the perspectives and preferences of ophthalmologists concerning their proficiency in using their right hand, left hand, or both hands to perform routine tasks required in the practice of ophthalmic medicine and surgery. Two hundred and three participants took part in the survey. A majority (n = 162, 79.8%) of the clinicians considered themselves right-handed, nine (4.4%) considered themselves left-handed, and 32 (15.7%) considered themselves ambidextrous. Also, 86% (n = 174) of the participants considered ambidexterity an essential trait in the practice of ophthalmic medicine and surgery. The number of cataract surgeries performed had an impact on the comfort of using both hands for performing anterior vitrectomy (P < 0.001), injection of viscoelastic (P < 0.001), and toric marking (P < 0.05), but not on the performance of capsulorhexis and switching of foot pedals. The number of procedures carried out had an impact on the comfort of using both hands in gonioscopy (P < 0.001), 90 D evaluation (P < 0.001), and 20 D evaluation (P < 0.05). More years of experience had an impact on skills involving the use of both hands for slit lamp joystick usage (P < 0.05) and laser procedures (P < 0.001). Irrespective of a person's handedness, trained ambidexterity in the required fields is achievable and has a significant impact on one's ability to perform the required skill optimally and appropriately.

Local anesthesia with blue-dyed lidocaine for a better patient's tolerance during office-based laryngology procedures: how I do it.

In-office laryngological procedures became common alternatives to general anesthesia for biopsies, injection laryngoplasties, and laser procedures. The limiting step remains the laryngeal anesthesia whose quality can influence patients' and operators' comfort. We propose to dye the lidocaine with methylene blue and do an instillation through a catheter introduced in the video-endoscope's operating channel, which permits a progressive anesthesia focused on the larynx, avoiding an unwanted pharyngeal anesthesia and any tracheal irritation. Using blue-dyed lidocaine can help reduce the volume of anesthesia required for an office-based laryngology intervention, improving patients' and surgeon's comfort and reducing anesthesia's side effects.

Glaucoma Treatment Patterns in Sub-Saharan Africa.

Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma. Laser therapy was underutilized where they were available. Physicians were more likely to recommend surgery in severe glaucoma, laser therapy in mild glaucoma, while recommendation of medical therapy did not depend on glaucoma severity. To characterize treatment patterns for newly diagnosed glaucoma in sub-Saharan Africa (SSA). This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0. Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, the laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%. Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first-line approach in this setting.

Evaluating Access to Laser Eye Surgery by Driving Times Using Medicare Data and Geographical Mapping

Recently, several states have granted optometrists privileges to perform select laser procedures (laser peripheral iridotomy, selective laser trabeculoplasty, and YAG laser capsulotomy) with the aim of increasing access. However, whether these changes are associated with increased access to these procedures among each state's Medicare population has not been evaluated. To compare patient access to laser surgery eye care by estimated travel time and 30-minute proximity to an optometrist or ophthalmologist. This retrospective cohort database study used Medicare Part B claims data from 2016 through 2020 for patients accessing new patient or laser eye care (laser peripheral iridotomy, selective laser trabeculoplasty, YAG) from optometrists or ophthalmologists in Oklahoma, Kentucky, Louisiana, Arkansas, and Missouri. Analysis took place between December 2021 and March 2023. Percentage of each state's Medicare population within a 30-minute travel time (isochrone) of an optometrist or ophthalmologist based on US census block group population and estimated travel time from patient to health care professional. The analytic cohort consisted of 1 564 307 individual claims. Isochrones show that optometrists performing laser eye surgery cover a geographic area similar to that covered by ophthalmologists. Less than 5% of the population had only optometrists (no ophthalmologists) within a 30-minute drive in every state except for Oklahoma for YAG (301 470 [7.6%]) and selective laser trabeculoplasty (371 097 [9.4%]). Patients had a longer travel time to receive all laser procedures from optometrists than ophthalmologists in Kentucky: the shortest median (IQR) drive time for an optometrist-performed procedure was 49.0 (18.4-71.7) minutes for YAG, and the the longest median (IQR) drive time for an ophthalmologist-performed procedure was 22.8 (12.1-41.4) minutes, also for YAG. The median (IQR) driving time for YAG in Oklahoma was 26.6 (12.2-56.9) for optometrists vs 22.0 (11.2-40.8) minutes for ophthalmologists, and in Arkansas it was 90.0 (16.2-93.2) for optometrists vs 26.5 (11.8-51.6) minutes for ophthalmologists. In Louisiana, the longest median (IQR) travel time to receive laser procedures from optometrists was for YAG at 18.5 (7.6-32.6) minutes and the shortest drive to receive procedures from ophthalmologists was for YAG at 20.5 (11.7-39.7) minutes. Although this study did not assess impact on quality of care, expansion of laser eye surgery privileges to optometrists was not found to lead to shorter travel times to receive care or to a meaningful increase in the percentage of the population with nearby health care professionals.

Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists.

The change in glaucoma surgical volumes due to the coronavirus disease 2019 pandemic was not uniform across procedure types and was unequal between rural and urban practice locations. To quantify the impact of the coronavirus disease 2019 pandemic on surgical volumes performed by fellowship-trained glaucoma subspecialists. This retrospective cohort analysis of the Centers for Medicare and Medicaid Services Medicare Public Use File extracted all glaucoma surgeries, including microinvasive glaucoma surgeries (MIGSs), trabeculectomy, goniotomy, lasers, and cataract surgery, performed by fellowship-trained glaucoma surgeons in rural and urban areas between 2016 and 2020. Predicted estimates of 2020 surgical volumes were created utilizing linear squares regression. Percentage change between predicted and observed 2020 surgical volume estimates was analyzed. Statistical significance was achieved at P <0.05. In 2020, fellowship-trained glaucoma surgeons operated mostly in urban areas (N = 810, 95%). A 29% and 31% decrease in predicted cataract surgery volumes in urban and rural areas, respectively, was observed. Glaucoma surgeries experienced a 36% decrease from predicted estimates (N = 56,781). MIGS experienced an 86% and 75% decrease in rural and urban areas, respectively. Trabeculectomy in rural areas experienced a 16% increase relative to predicted estimates while urban areas experienced a decrease of 3% ( P > 0.05). The number of goniotomies decreased by 10% more in rural areas than in urban areas (-22% and -12%, respectively). Laser procedures decreased by 8% more in urban areas than in rural areas (-18% and -10%, respectively). Among glaucoma-trained surgeons, glaucoma surgeries experienced a greater volume loss than cataract surgeries. In urban US areas, relative reductions in MIGS and goniotomy volumes in urban areas may have been compensated by greater laser and trabeculectomy volumes. Trabeculectomies in rural areas were the only group exceeding predicted estimates. Glaucoma subspecialists may utilize these findings when planning for future events and in overcoming any remaining unmet need in terms of glaucoma care.

The role of matrix metalloproteinases and their tissue inhibitors in the formation of hypertrophic skin scars with the use of a pulsed dye laser and Fermencol phonophoresis

BACKGROUND: An imbalance between matrix metalloproteinases (MMPs) expression and tissue inhibitors of MMP is considered as a possible mechanism for impaired collagen synthesis and degradation, which leads to the development of hypertrophic scars. The use of a vascular laser, in particular a pulsed dye laser, leads to coagulation of the vascular locus that feeds the hypertrophic skin scar, resulting in a decrease in extracellular matrix synthesis. The use of collagenase phonophoresis increases the effectiveness of laser therapy due to the destruction of the extracellular matrix.&#x0D; AIM: To study the role of matrix metalloproteinases and their tissue inhibitors in the pathogenesis of immature hypertrophic skin scars and to evaluate the dynamics of enzymes during the combined use of a pulsed dye laser and Fermenkol phonophoresis.&#x0D; MATERIAL AND METHODS: The study was performed with the participation of 125 patients aged 22 to 55 years with immature (up to 6 months) hypertrophic skin scars. All patients were divided into 4 groups according to the simple fixed randomization procedure. The first group (control, n=32) received course local compression therapy using silicone plates for 2 months. The second group (main group I, n=31) underwent two courses of Fermencol phonophoresis (5 daily procedures lasting 10 minutes each with a break of 34 weeks). The third group (main group II, n=31) underwent two pulsed dye laser procedures with an interval of 4 weeks. The fourth group (main III, n=31) received complex treatment, which included a combination of two pulsed dye laser procedures and two cycles of Fermenkol phonophoresis. The study of the clinical condition of patients was carried out according to the modified Vancouver scar scale (VSS). The content of MMP and tissue inhibitor of metalloproteinase-1 in blood serum was determined by enzyme immunoassay. Patients were examined twice: before the start and 2 weeks after the end of the course of treatment. To form a sample of reference values of MMPs and tissue inhibitors of metalloproteinases (TIMPs), a group of 20 somatically healthy individuals was used.&#x0D; RESULTS: Initially reduced levels of MMP-1 and MMP-9 were found in the blood serum of patients with immature hypertrophic skin scars, with high values of TIMP-1, which allows us to consider reduced expression as an important link in the pathogenesis of the fibroproliferative process in the skin, which causes excessive deposition of extracellular matrix components. The use of pulsed dye laser in combination with Fermencol phonophoresis was accompanied by an increase in the content of MMP in the blood serum of patients with immature hypertrophic skin scars, which positively correlated with the severity of the clinical result of treatment, assessed by VSS.&#x0D; CONCLUSION: A conclusion was made about the clinical and pathogenetic significance of MMPs and TIMPs in the development of fibroplastic processes, which allows us to consider these biochemical parameters as informative criteria for the effectiveness of the therapy.

Effect of Virtual Reality Distraction on Satisfaction and Tolerability in Patients Undergoing In-Office KTP Laser Procedure

To study the effect of virtual reality (VR) on satisfaction, discomfort, stress, and cooperation in patients undergoing in-office potassium titanyl phosphate (KTP) laser procedure. Prospective study. Thirty-seven patients were enrolled in this prospective study. The State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory was used to measure the level of state anxiety. Satisfaction, discomfort, pain, stress, acceptance of VR, relaxation with VR, and willingness to wear VR were evaluated using a 100-mm visual analog scale (VAS). A 5-point Likert-like scale was used to rate the patient cooperation. All procedures were completed successfully with cooperation of patients. Satisfaction score in VR group was 88.3±9.0, and in control group was 81.6±9.7 (P=0.040). There were significant differences in both nasal cavity and laryngopharynx discomfort between two groups (P=0.030 and P=0.016, respectively). The pain score of control group was higher than that of VR group but it was not statistically significant (P=0.140). The stress of control group during procedure was more obvious than that of VR group (30.5±24.0 versus 17.0±9.2, P=0.021). The mean VAS scores of acceptance of VR were all more than 75. The results of regression analysis showed that VR had significant effects on satisfaction with the procedure (P=0.004), discomfort of nasal cavity (P=0.030) and laryngopharynx (P=0.016), and feeling of stress (P=0.021) during the procedure. Distraction of VR can enhance satisfaction in both procedure and stress management for patients undergoing in-office KTP laser procedure. Acceptance of VR in VR group was relatively good.

Effect of Nd:YAG laser capsulotomy on graft endothelium after penetrating keratoplasty

BackgroundTo investigate the safety of Nd:YAG laser capsulotomy in eyes with Penetrating Keratoplasty (PK) and its impact on corneal endothelium as well as graft survival. MethodsThirty patients who underwent Nd: YAG laser capsulotomy after PK and 30 pseudophakic control eyes were included in this prospective study. Endothelial cell density (ECD), hexagonality (HEX), coefficient of variation (CV), central corneal thickness (CCT), and the change of these values during follow-up measured at the 1st hour, first week, and first month after the laser and the data were compared between groups. ResultsThe mean time passed between the PK procedure and the subsequent YAG laser procedure was i.e. of YAG laser after PK was 30.5 ± 15.2 months (range 6 to 57 months). Baseline ECD was 1648.2 ± 669.77 cells/mm² in the PK group and 2008.27 ± 347.42 cells/mm² in the control group. In the first month, ECD was 1545.2 ± 639.35 cells/mm² in the PK group and 1979 ± 350.95 in the control group. The loss was significantly higher in PK group (-103 ± 153.67 cells/mm²) (6.25%) compare to the control group (-28.73 ± 82.31 cells/mm²) (1.44%) (p = 0.024). A significant increase in CV was observed in the PK group, and not in the control group (p = 0.008, p = 0.255, respectively). There were no significant changes in HEX and CCT values in either group. ConclusionNd:YAG laser provides a significant increase in visual acuity in first month in patients with PK with no significant harmful effect on graft transparency. Endothelial cell density measurements during follow-up will be beneficial.

Modeling the biomechanics of laser corneal refractive surgery

We present a finite element model of the human cornea used to simulate corneal refractive surgery according to the three most diffused laser procedures, i. e., photo-refractive keratectomy (PRK), laser in-situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE). The geometry used for the model is patient-specific in terms of anterior and posterior surfaces of the cornea and intrastromal surfaces originated by the planned intervention. The customization of the solid model prior to finite element discretization avoids the struggling difficulties associated with the geometrical modification induced by cutting, incision and thinning. Important features of the model include the identification of the stress-free geometry and an adaptive compliant limbus to account for the surrounding tissues. By the way of simplification, we adopt a Hooke material model extended to the finite kinematics, and consider only the preoperative and short-term postoperative conditions, disregarding the remodeling and material evolution aspects typical of biological tissues. Albeit simple and incomplete, the approach demonstrates that the post-operative biomechanical state of the cornea, after the creation of a flap or the removal of a small lenticule, is strongly modified with respect to the preoperative state and characterized by displacement irregularities and stress localizations.

Practice patterns and costs of glaucoma treatment in Japan.

Understanding the practice patterns and costs of glaucoma care in real-world clinical settings is important for optimizing medical expenses. However, glaucoma treatment trends and associated costs in Japan are unknown. We aimed to unveil glaucoma treatment trends and costs using a large administrative claims database in Japan. Retrospective cohort study. We included patients diagnosed with glaucoma between April 2014 and March 2021 using the DeSC database. We calculated the frequencies and costs of antiglaucoma eyedrops, incisional or laser procedures, and ophthalmic examinations stratified by fiscal year and age. In the year-by-year analyses, the age distribution was standardized based on the 2020 distribution. A total of 841,747 patient-years (429,051 patients) were included. The number of prescribed eyedrops significantly increased and the fixed-combination eyedrops proportion decreased with age. Trabeculectomy frequency decreased, and that of laser trabeculoplasty increased during the observation period. The frequencies of both incisional and laser procedures peaked in the 75-79 age group. In 2020, 16.1 bottles of eyedrops per patient-year were prescribed, and 15.9 incisional surgeries and 11.3 laser therapies were performed per 1000 patient-years. Intraocular pressure measurement and visual field testing were performed 6.5 times and 2.0 times per patient-year, respectively. The total direct cost of glaucoma treatment was 55,139 yen (US $399.5) per patient-year, of which medications accounted for 44.2%, ophthalmic examinations for 47.4%, and incisional or laser procedures for 8.4%. These results may be useful for understanding glaucoma treatment trends and costs in Japan.

Light in Orthodontics: Applications of High-Intensity Lasers, Photobiomodulation, and Antimicrobial Photodymanic Therapies in Daily Practice

Orthodontics is constantly seeking innovation towards mechanical efficiency and better oral-related quality of life during treatment. This narrative review aims to discuss novel scientific reports about light therapies and how they can optimize different stages of orthodontic intervention: before, during, and after treatment. Recurrent conditions that can be treated with laser devices are the removal of carious tissue, dentin hypersensitivity, and temporomandibular disorders. Evidence reveals that laser procedures accelerate health recovery, enabling individuals to initiate orthodontic treatment. Along orthodontic procedure, photobiomodulation therapy, is indicated for analgesia after appliance activations, repair of traumatic ulcers, and acceleration of tooth movement. Moreover, antimicrobial photodynamic therapy is well-indicated for effective decontamination of oral infections such as herpetic lesions and peri-implantitis. Finally, high-intensity lasers are good allies in removing brackets and reconditioning red esthetics. There are many benefits to the use of light sources in the orthodontic routine: simplicity of technique, ease of handling devices, minimal invasiveness, and patient comfort during procedures. It is essential that professionals develop a critical overview of technological advances, offering safe and evidence-based therapies. Recent advances indicate that laser therapies improve patient experiences during orthodontic treatment and minimize the side effects of clinical interventions.

A PROFILE OF DIABETIC RETINOPATY PATIENTS RECEIVING GREEN LASER FROM 2015 TO 2019 IN D.I.KHAN DIVISION, PAKISTAN

ABSTRACT: Background: Diabetic retinopathy (DR) is one of the leading cause of blindness worldwide and laser therapy has a basic role in the control of diabetic retinopathy. Green laser therapies are performed both for proliferative diabetic retinopathy and diabetic macular edema. The aim of our study was to determine the frequencies of different stages of diabetic retinopathy in patients undergoing laser in our setup. Materials &amp; Methods: This descriptive study was conducted at the department of Ophthalmology, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2019.The sample consisted of all the diabetic patients undergoing green laser procedures during this period at Eye Unit, DHQ Teaching Hospital D.I.Khan Pakistan. Results: Out of a total of 1,893 green laser procedures performed for diabetic patients from January 2015 to December 2019, 1,011 were male and 882 were female. 969 (51.1%) patients were having relatively early stages of DR, 676 (35.7) patients had advanced DR and 248 (13.1%) had diabetic macular edema (DME). Conclusion: Laser therapy is frequently needed for the control of diabetic eye disease so keeping in mind the disease burden the laser facilities should be expanded in our setup.

The effect of Nd:YAG Laser applied in the posterior capsule opacification on retinal and choroidal structures

PurposeTo assess the effect of neodymium:yttrium–aluminum–garnet (Nd-YAG) laser procedure on the choroid and retina in patients who developed posterior capsular opacification (PCO) after cataract surgery. MethodsIn this study, 32 eyes of 30 patients who underwent Nd:YAG laser treatment for PCO were evaluated. Visual acuity (VA), intraocular pressure (IOP), central macular thickness (CMT) with optical coherence tomography device (OCT), ganglion cell layer (GCL), inner plexiform layer (IPL), retinal nerve fiber layer (RNFL) and subfoveal choroidal thickness (SCT) were measured. Choroidal vascular index (CVI) was calculated from HD line images obtained by spectral domain OCT with the software Image J. ResultsThe mean age of the patients participating in the study was 60.1 ± 8.9 years. There was no significant difference in IOP, CMT, RNFL, GCL, IPL and SCT values ​​in all comparisons before and after laser (p>0.05 for all values). While Nd:YAG laser pretreatment CVI was 63.2 ± 3.2%, it was 66.8 ± 2.9% at 1 week and 67.1 ± 2.6% at 1 month after laser treatment. A significant difference was detected in the comparison of pre-laser CVI and post-laser 1 week and 1 month CVI (p<0.05 for all values). DiscussionCVI was found to be significantly higher in the post-laser period in patients who underwent Nd:YAG laser. As far as the author knows, this study is the first research in the literature to evaluate this relationship. CVI can be used to evaluate choroidal vascular changes after Nd:YAG laser.