YAG Laser Photocoagulation Research Articles

The outcome of Photocoagulation Treatment of Retinal Vascular Diseases

Due to the significance of macular edema in retinal vascular diseases, this study aims to determine whether laser photocoagulation is effective in the treatment of macular edema and in the improvement of visual acuity. This is a prospective data study considering 80 patients with 52 eyes, with a follow-up of 6 weeks, 3 months, and six months with macular edema treated with double frequency yag laser photocoagulation in Aso Eye Hospital in Sulaymaniyah City, Kurdistan, Iraq, from February 2010 to October 2010. With six months of follow-up, visual acuity was improved in 36.4% of eyes, unchanged in 61.3%, and worsened in 2.3%. After this period the macular edema was improved in 78.85% and not improved in 21.15%. According to this study, baseline visual acuity and retinopathy severity were two important intervening factors in response to laser therapy. Comparing the current results with other studies, it has been found that, in assessing visual outcomes, laser photocoagulation is an effective modality in the treatment of macular edema, and it improves visual acuity in retinal vascular diseases.

Outcome of 532 nm Nd:YAG laser photocoagulation in retinopathy of prematurity from a referral center

ABSTRACT Clinical relevance: Retinopathy of prematurity is a preventable blinding disorder worldwide. Laser photocoagulation is said to be the gold standard care of treatment. However, various factors are known to affect the outcome. Background: The purpose of this study was to analyse the risk factors in patients with laser treatment requiring retinopathy of prematurity (ROP) and the outcome of 532 nm Nd:YAG laser photocoagulation (LP). Methods: Patients who underwent LP for ROP at a tertiary referral centre between January 2012 and January 2019 were enrolled. Those who were born and followed-up at the institution of the authors were in Group 1 and those who were born and followed-up elsewhere and referred to the authors for treatment were in Group 2. The clinical features, gestational ages, birth weights, and data regarding the treatment were retrospectively reviewed. The need for pars plana vitrectomy was taken as a poor outcome. Results: The mean gestational age and birth rate was 26.7 ± 1.9 weeks and 927.2 ± 263.5 grams, respectively, in Group 1 (57 infants, 111 eyes); and 28.5 ± 2.5 weeks and 1174.8 ± 385 grams, respectively, in Group 2 (66 infants, 131eyes) (p < 0.001 for both). The extent of the disease (p < 0.001), the zone of the disease (p = 0.002), and the timing of LP (p < 0.001) were significantly different between groups. In the whole cohort, the zone (p = 0.006) and stage (p < 0.001) of the disease, aggressive posterior disease (p = 0,009), and tunica vasculosa lentis were found to significantly interfere with the outcome. Conclusion: Eyes with more severe disease undergoing timely treatment and eyes with less severe disease undergoing delayed management had similar prognosis. A favourable outcome was obtained with 532 nm green laser in ROP.

Efficacy of Photocoagulation of Vascular Malformations in the Oral Mucosa Using Nd: YAG Laser.

The purpose of this study was to analyze the effectiveness of Nd: YAG laser photocoagulation in the treatment of vascular malformations in the oral and perioral area; 93 patients (104 lesions) were evaluated in an Ambulatory of Oral Medicine (2006-2013). The sample consisted of 57 women (61%) and 36 men (39%), aged 8 to 85 years. The lesion size was smaller than 3 cm in most patients. The lesions were located on the lips, jugal mucosa, tongue, palate, gingiva, and retromolar trigone. All patients were treated on an outpatient basis using local anesthesia and Nd: YAG laser (Power Laser C ) with a wavelength of 1064 nm and a fiber optic diameter of 400 μm. After treatment no patients had complications, however, in patients of deep lesions, 2 or more irradiations were required to treat the lesions. Finally, the authors conclude that the clinical and aesthetic satisfactory results of the 93 patients treated with Nd: YAG laser suggest that this type of laser is effective and safe in the treatment of oral and perioral vascular malformations.

Randomized controlled trial comparing Nd:YAG laser photocoagulation and bipolar electrocautery in the management of epistaxis.

The objective of this study is to evaluate the efficacy and degree of comfort of Nd:YAG laser photocoagulation compared to bipolar electrocautery in the management of epistaxis. Seventy-two consecutive patients with a history of epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either bipolar electrocautery (group 1) or Nd:YAG laser photocoagulation (group 2). The study was conducted in university-affiliated teaching hospital. Seventy-two consecutive patients who suffered from anterior epistaxis and presented to the Otolaryngology Department at the Eye, Ear, Nose and Throat Hospital, Fudan University, between June 2015 and August 2015. The following outcome measures were assessed: bleeding intensity, bleeding frequency 4 and 16weeks after treatment (0=no bleeding, 1=reduced bleeding, 2=the same, and 3=worse), participant perception of discomfort during treatment (grade 0-10, where 10 is the worst pain), and therapy duration and complications. At 16weeks, 91% of the laser patients versus 91% of the bipolar electrocautery patients had no reported bleeding. The outcome scores at 4 and 16weeks after treatment showed no significant difference between the two groups (P=0.5 and P=0.98, respectively; P>0.05). The median pain levels experienced during the office laser and bipolar electrocautery procedures were 3.0 and 4.0, respectively, and the median durations of the laser and electrocautery therapies were 3.0 and 4.0, respectively. Neither groups had complications. It can be concluded that Nd:YAG laser photocoagulation and bipolar electrocautery are both effective in the treatment of epistaxis. These two therapies are recommended. As a whole, these two therapies, performed in an office setting, are timely, efficacious, and well tolerated in the treatment of epistaxis.

Holmium YAG Photocoagulation: Safe and Economical Alternative to Transurethral Resection in Small Nonmuscle-Invasive Bladder Tumors.

To analyze our experience in the treatment of recurrences of bladder tumor using Holmium-YAG (Ho:YAG) laser, assessing recurrence rates, tumor progression, degree of safety, and patient satisfaction, as well as the economic repercussions of the technique. The study included 109 patients between February 2013 and 2016, who had a superficial recurrence of bladder tumor. Patients were treated by Ho:YAG laser photocoagulation on an outpatient basis and under local anesthetic. Cytology and previous biopsy were collected. The number of tumors, size, time of technique, and any complications were recorded. Subsequently, urine culturing was carried out and we recorded the visual analogue scale, a satisfaction questionnaire, and possible complications. The economic cost of the procedures was calculated. Data were analyzed using a chi-square test for continuous variables and Student's t for independent samples for dichotomous qualitative-quantitative variables. We carried out 139 procedures on 25 women (20%) and 114 men (80%) with a mean age of 67.85 ± 10.41 years and 246 tumors were treated. The consultation time was 21.5 minutes and the photocoagulation time was 7 minutes (1-35). As intraoperative complications, two patients presented monosymptomatic hematuria without requiring treatment and there were no postoperative complications. The total recurrence rate at 6 months was 20%. A value ≤4 on the EVA scale was reported for 94.7% of the patients. The saving per procedure compared with transurethral bladder resection was calculated at €2,007.09. The treatment of small recurrences of bladder tumor by photocoagulation with Ho:YAG laser is a well-tolerated technique that offers an acceptable level of cancer control and a lower cost compared with transurethral resection.

Role of Frequency Doubled Nd: Yag Laser in Treatment of Corneal Neovascularisation.

Cornea is the outermost transparent coat of eye along with sclera, for which its avascularity is essential for maintaining its transparency to have normal visual acuity. Corneal neovascularization is characterized by the invasion of new blood vessels into the cornea from the limbus interfering with corneal transparency, resulting in reduction in visual acuity. It also increases the risk of graft rejection. So their being a dire need to treat corneal neovascularisation, with laser photocoagulation being an effective means of treating it. To evaluate the efficacy and safety of frequency doubled Nd:Yag laser photocoagulation in treatment of corneal neovascularisation. A single centre prospective study was carried out on patients attending the outpatient department of ophthalmology in Maharani Laxmi Bai Medical College, Jhansi. Forty eyes of 40 patients having corneal neovascularisation with quiescent eyes satisfying the inclusion criteria were selected and treated with laser. The efficacy of the procedure was noted in terms of area of corneal neovascularisation, status of treated vessels, area of corneal opacity, visual acuity. The above parameters of selected patients were recorded before treatment and subsequent follow up visits at 1 week, 1 month, 2 month and 3 month after laser. Paired t-test was used to calculate the p-value. There was a statistically significant difference in the percentage mean area of corneal neovascularisation with a pre laser value of 31.93% to 17.62% after 3 months of laser treatment (p-value<0.0001). The percentage mean area of corneal opacity decreased from 30.75% to 23.74% (p<0.0001). Out of 185 corneal vessels, 99 (53.51%) vessels were completely occluded,17(9.18%) vessels were partially occluded and 69(37.29%) vessels were recanalised at the end of 3 months after laser treatment. Frequency doubled Nd:Yag laser is an effective and safe method for the treatment of corneal neovascularisation.

Nd:YAG laser photocoagulation of benign oral vascular lesions: a case series.

Vascular anomalies of the head and neck are common lesions usually associated with functional and/or aesthetic limitations. The aim of the present paper was to report a case series of oral vascular malformations treated with Nd:YAG laser photocoagulation, highlighting the clinical evolution and post-surgical complications. Fifteen patients diagnosed with oral vascular malformations were treated with Nd:YAG laser followed by three sessions of biostimulation. None of the patients presented post-surgical pain, but 6 of 15 patients (40%) experienced minimal post-surgical complications. All cases presented complete resolution of the lesions after laser treatment. More importantly, 12 out of 15 (80%) resolved after a single session. Low morbidity, minimal patient discomfort, and satisfactory aesthetic results point Nd:YAG laser photocoagulation as a promising option for the management of benign oral vascular lesions.

Long-term efficacy of Nd:YAG laser photocoagulation vs. liquid paraffin plus antiseptic cream in the treatment of recurrent epistaxis.

The objective of this study was to evaluate the long-term efficacy of Nd:YAG laser photocoagulation with that of liquid paraffin plus antiseptic cream in the management of recurrent epistaxis. Eighty consecutive patients who suffered from recurrent anterior epistaxis presented to the Otolaryngology Department at the Eye and ENT Hospital, Fudan University between February 2011 and June 2011. These patients with histories of recurrent epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either a combination of liquid paraffin plus antiseptic cream (Group 1) or Nd:YAG laser photocoagulation (Group 2). the following outcome measures were assessed: bleeding intensity; bleeding frequency 2 years after treatment (0 = no bleeding, 1 = reduced bleeding, 2 = the same, 3 = worse), participant's perception of discomfort during the management (grade 0-10, where 10 is the worst pain), and complications. Finally, 70 patients remain in our study. At 2 years, 86 % of laser patients versus 31 % of control patients had no reported bleeding. The outcome score at 2 years after treatment showed a significant difference between the two groups (P = 0.000, P < 0.01). The median and mean ± SD pain levels experienced were 5.0 and 5.2 ± 2.2. Both groups had no complications. It can be further concluded that Nd:YAG laser photocoagulation is a preferable therapy in the treatment of recurrent epistaxis in long-term efficacy. The level of pain associated with the procedure was well tolerated. It is a simple, easy, safe and rapid therapy, which can be performed in an office setting.

Organic Depression and Terson's Syndrome in Adult Polycystic Kidney Disease: Case Report and Review of Literature

Depressive symptoms are common in neurological diseases, at times posing dilemma in organic or functional origin. Cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes that resemble primary depressions both clinically and therapeutically in about half of the patients following acute stroke. Terson's syndrome is the direct occurrence of vitreous hemorrhage following subarachnoid/subdural hemorrhage, often overlooked in the acute setting. Autosomal dominant (adult) polycystic kidney disease may be associated with berry aneurysms and hypertension, and may lead to intracranial bleeds. We report an unusual case of organic depression and Terson's syndrome in a 50-year-old female with polycystic kidney disease and hypertension, following anterior communicating artery aneurysmal subarachnoid bleed with bilateral subdural extension. Management included anti-hypertensives, antiepileptics, neodymium: YAG laser photocoagulation, and aneurysmal clipping.

Staged endovascular and surgical treatment of slow-flow vulvar venous malformations

The objective of the study was to report our experience in a rare series of treated symptomatic slow-flow vulvar venous malformations (VVMs) using a staged, multidisciplinary approach. Consecutive patients with symptomatic lesions treated over a 7 year period (2005-2012) were followed up for technical success, resolution of symptoms, aesthetic outcomes, and complications. Direct endovenous sclerotherapy (DEVS) using sodium tetradecyl sulfate (STS) foam was performed in all patients under ultrasound and contrast-enhanced fluoroscopic guidance. Surgical excision and layered primary closure was performed within 24 hours after the last DEVS session. Eleven patients (mean age, 25 years; range, 4-43 years) were treated. Presenting symptoms included pain (n = 11), soft tissue swelling (n = 11), local heaviness (n = 11), dyspareunia (n = 2), and dysmenorrhea (n = 2). Most were isolated lesions (n = 8). There were 2 cases of Klippel-Trénaunay syndrome and 1 case of Maffucci syndrome. The latter required Nd:YAG laser photocoagulation prior to sclerotherapy. On average, approximately 3 DEVS sessions were required prior to surgical excision (range, 1-6). Mean estimated surgical blood loss was 130 mL (range, 20-400 mL). Mean follow-up was 23 months (range, 3-55 months). Elimination of pain and soft tissue redundancy was achieved in all patients with satisfactory aesthetic outcomes. All patients experienced minor pain and swelling after DEVS. Following surgical excision, there was 1 case of hematoma and wound dehiscence requiring surgical evacuation. No other reinterventions, endovascular or surgical, were required. VVMs require increased awareness and appropriate preoperative evaluation for proper identification and treatment. A multidisciplinary approach can provide improvement in clinical signs and symptoms with satisfactory cosmesis and minimal complications.

A prospective randomised controlled trial of Nd:YAG laser photocoagulation versus liquid paraffin plus antiseptic cream in the treatment of recurrent epistaxis

To evaluate the efficacy of Nd:YAG laser photocoagulation with that of liquid paraffin plus antiseptic cream in the management of recurrent epistaxis. Prospective clinical study. Eighty consecutive patients with histories of recurrent epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either a combination of liquid paraffin plus antiseptic cream (group 1) or Nd:YAG laser photocoagulation (group 2). University-affiliated teaching hospital. Eighty consecutive patients who suffered from recurrent anterior epistaxis presented to the Otolaryngology Department at the Eye and ENT Hospital, Fudan University between February 2011 and June 2011. The following outcome measures were assessed: bleeding intensity, bleeding frequency 4 and 12 weeks after treatment (0 = no bleeding, 1 = reduced bleeding, 2 = the same, 3 = worse), participant's perception of discomfort during the management (grade 0-10, where 10 is the worst pain) and complications. At 12 weeks, 85% of laser patients versus 40% of control patients had no reported bleeding. The outcome score at 4 weeks after treatment showed no significant difference between the two groups (P = 0.130, P > 0.05); however, the outcome score at 12 weeks after treatment showed a significant difference between the two groups (P = 0.000, P < 0.01). The median and mean ± sd pain levels experienced were 5.0 and 5.2 ± 2.2. Both groups had no complications. It can be concluded that Nd:YAG laser photocoagulation is a preferable therapy in the treatment of recurrent epistaxis, especially in terms of long-lasting efficacy. The level of pain associated with the procedure was tolerated. It is a simple, easy, safe and rapid therapy, which can be performed in an office setting.

Subthreshold Micropulse Diode Laser and Double Frequency Neodymium: YAG Laser in Treatment of Diabetic Macular Edema: A Prospective, Randomized Study Using Multifocal Electroretinography

The purpose of this study was to compare the efficacy of subthreshold micropulse diode (SDM) laser with double-frequency neodymium YAG (Nd:YAG) laser in treatment of clinically significant diabetic macular edema. Forty-six eyes of 33 patients with clinically significant macular edema (CSME) caused by diabetic retinopathy were randomized to either SDM (810?nm) laser or the conventional double-frequency Nd:YAG (532?nm) laser. Primary outcome measures were: change in the central macular thickness as measured by optical coherence tomography (OCT) and change in macular retinal sensitivity measured using multifocal electroretinography (MfERG). Secondary outcomes were: change in best corrected visual acuity (BCVA) and contrast sensitivity. The group was divided in half, with 23 eyes assigned to SDM laser and 23 eyes assigned to double-frequency Nd:YAG laser. Mean follow-up period was 6 months. No statistically significant difference was noted in either the primary or the secondary outcome measures between the two groups. Macular thickness decreased from the baseline measures of 298.5?49.3 and 312.9?45.8??m to 274.9?62.9 and 286.7?32.8??m in the SDM laser and Nd:YAG laser groups, respectively. On MfERG, P1 implicit wave time delay at baseline changed from 46.27?4.9 to 45.27?3.4?ms in the SDM group and from 46.55?4.9 to 45.27?4.1?ms in the Nd:YAG group. MfERG recordings of 18 of the 23 eyes treated with double-frequency Nd:YAG laser showed areas of signal void as compared to 4 eyes treated with the SDM laser. SDM laser photocoagulation showed an equally good effect on visual acuity, contrast sensitivity, and reduction of diabetic macular edema (DME) as compared to conventional Nd:YAG laser photocoagulation. MfERG recordings, however, suggest that SDM laser results in better preservation of electrophysiological indices.

Engineering the crystalline lens with a biodegradable or non-degradable scaffold

Both a biodegradable hyaluronic acid (HA) and a nondegradable polymeric gel were evaluated as scaffolds for tissue engineering the lens in Dutch Belt pigmented and New Zealand white rabbits. Following removal of the crystalline lens through a 2 mm capsulorhexis, a collagen patch or a silicone plug was placed in the capsule bag to seal the capsulotomy. In Part I, a cross-linked HA or cohesive solution of HA was injected into the capsule bag. In Part II, a synthetic polymer (SP) was injected into the capsular bag of one eye and HA followed by SP (HA/SP) was injected into the capsule bag of the opposite eye. At 3 months focal Nd:YAG laser photocoagulation was performed in an attempt to remove some retained HA gel in one eye. Overall the regenerated lenses of the HA gel groups were spherical with excellent cortical structure and clarity and a spherical nucleus of condensed HA gel. In the one eye treated with focal photocoagulation, partial clearing of the retained HA gel was noted. In the SP and HA/SP eyes, lens regrowth around the polymer was generally clear in the anterior and peripheral capsule bag and more opacified posterior to the polymeric scaffold. In summary, naturally regenerating lens tissue was directed to grow in a more normal, regular pattern by providing a biodegradable hyaluronic acid scaffold or a nondegradable polymeric optical scaffold.

Double frequency Nd:YAG laser for central serous chorioretinopathy.

目的 观察倍频Nd:YAG激光治疗中心性浆液性脉络膜视网膜病变(CSC)的临床效果及安全性.方法 回顾性分析CSC 112例(135眼).并分为两组,激光组:45例(52眼)中48眼接受了倍频Nd:YAG激光光凝治疗;药物组67例83眼接受了常规药物治疗.观察两组治疗后1个月的视力和视网膜神经上皮复位情况,以及激光治疗的并发症.结果 在治疗后1个月,激光组48眼中41眼的视力改善,43眼视网膜平复;药物治疗组83眼中,32眼视力改善,15眼神经上皮复位,两组差异有统计学意义(P＜0.01).没有激光并发症发生.结论 倍频Nd:YAG激光治疗CSC,能较快改善视力,缩短病程,且安全。

Miniature bending manipulator for fetoscopic intrauterine laser therapy to treat twin-to-twin transfusion syndrome

Recent typical therapy for twin-to-twin transfusion syndrome (TTTS) is selective laser photocoagulation of anastomotic communicating vessels on the placenta using the fetoscopic approach. The difficulty of a conventional laser device approach for this procedure depends significantly on the placental location, so a new robotized device is required to bend the direction of laser irradiation flexibly within the narrow uterus. The authors designed a miniature bending mechanism impelled by a wire-guided linkage driving method that provides a stable procedure for bending laser irradiation from -90 degrees to 90 degrees . Using this bending mechanism, the authors developed a bending manipulator with a diameter of 3.5 mm and a hollow central channel with a diameter of 0.8 mm for passing a glass fiber for neodymium:yttrium-aluminum-garnet (Nd:YAG) laser photocoagulation. The bending mechanism is motorized by an electrical actuator and controlled by a grip-type interface with a small joystick. The robotized tip's part and the actuator's part are easily separable for cleaning and sterilization. In performance evaluations of the manipulator, the bending characteristics with a glass fiber were examined. The bending range was -52.6 degrees to 80 degrees, with a very small hysteresis error, and the bending repeatability error was 0.5 degrees +/- 0.2 degrees, which corresponds with the high accuracy of 0.2 +/- 0.1-mm positioning error at the glass fiber's tip. In the evaluation of Nd:YAG laser photocoagulation, the study confirmed that the manipulator performed effective laser photocoagulation of the placental phantom surface (underwater chicken liver). The large bending range, reaching 80 degrees, enabled a flexible approach from various directions with a high irradiation efficiency of no less than 96.6%. The authors' original miniature bending manipulator can change the laser irradiating direction with highly repeatable positioning accuracy for speedy, safe, and effective vessel occlusion in clinical practice.

Nd:YAG Laser Treatment of a Vestibulovaginal Varicosity in a 15-Year-Old Pregnant Mare

A 15-year-old, pregnant Dutch Warmblood mare was exhibiting intermittent hemorrhage secondary to a large vestibulovaginal varicosity. The vessel was reduced with transendoscopic Nd:YAG laser photocoagulation. This technique is minimally invasive compared with traditional surgical ligation, and significantly decreases the risk of severe hemorrhage, especially with advancing pregnancy. One laser treatment resulted in complete reduction in vessel size and allowed the pregnancy to continue to term without incident or further vaginal hemorrhage.

Efficacy of neodymium:YAG laser therapy for gastric antral vascular ectasia (GAVE) following hematopoietic cell transplant

We determined the incidence of severe bleeding from gastric antral vascular ectasia (GAVE) after myeloablative hematopoietic cell transplant and the outcomes after treatment with endoscopic neodymium:YAG laser photocoagulation. From 1992 to 2005, the incidence of severe bleeding from GAVE was 6/4491 (0.13%). All patients had received oral busulfan and four had sinusoidal obstruction syndrome. Gastrointestinal bleeding began a median of 53 days after transplant (range 15-2952). After GAVE was diagnosed by endoscopic and histologic findings, a median of three (range 2-7) sessions of laser therapy were required to control the bleeding with a median of 2737 J (range 1117-6160 J) per session. A median of 16 units (range 4-44) had been transfused prior to laser therapy and a median of four additional units (range 0-113) were transfused until bleeding was controlled. All patients were followed for at least 70 days after the last laser therapy session, with no further episodes of bleeding. Complications were mild and included abdominal pain and asymptomatic ulceration; however, one patient required gastrectomy due to gastric necrosis following transarterial embolizations. In summary, severe bleeding from GAVE is rare following hematopoietic cell transplant. Treatment with endoscopic therapy using the Nd:YAG laser is safe and effective.

Neodymium‐YAG Laser for hemangiomas and vascular malformations – long term results

Hemangiomas and vascular malformations are the most common vascular lesions of infancy. Different lasers can be used for treatment. Nd:YAG laser photocoagulation is particularly effective because of its deep penetration into tissue. Thirty-one patients, aged from three months to 18 years, with voluminous hemangiomas and venous malformations were treated with a cw-neodymium:YAG laser. The quartz fibre was used in percutaneous and intralesional technique. Long-term follow-up data were acquired by clinical control or a patient questionnaire for a maximal period of eight years. Twenty patients could be evaluated. In the group with hemangiomas (n = 15), three cases showed nearly complete remission (> 90 %), ten cases had a partial reduction in size (50 - 90 %), in one case there was stable disease and in one case tumor growth. In the group with venous malformations (n = 5) two cases showed an excellent response (> 90 %), one case a moderate response (25 - 50 %) and in two cases there was no improvement. Adverse effects included scars (40 %), hyper- and hypopigmentation (23 %), mild atrophy (20 %) and a wrinkled texture (17 %). After maximal reduction in size, 30 % of the patients were not satisfied with the laser treatment outcome and elected surgical excision of the residual lesion. The neodymium:yttrium aluminium garnet (Nd:YAG) laser with percutaneous or intralesional application technique is a valuable tool for selected patients with hemangiomas and venous malformations.

Endoscopic therapy for upper-GI vascular ectasias

Background Upper-GI vascular ectasias, including angiodysplasia and gastric antral vascular ectasia may present with either acute or chronic bleeding. Endoscopic thermal modalities have been used to control acute bleeding and reduce transfusion requirements. Methods Endoscopic experience was reviewed for a 6-year period during which 32 patients requiring blood transfusions for upper-GI angiodysplasia or gastric antral vascular ectasia were evaluated. Patients seen during the first 5 years were treated with either Nd:YAG laser photocoagulation or multipolar electrocoagulation. During the most recent 12 months, all patients were treated by argon plasma coagulation. Response to therapy was assessed by change in mean Hb and transfusion requirements. Results Overall, 16 patients were treated by laser photoablation alone; 9, argon plasma coagulation with or without laser; and 7, multipolar electrocoagulation with or without laser. Mean follow-up for all patients was 19 months. After therapy, mean Hb concentration rose from 76 to 114 g/L for patients with gastric antral vascular ectasia and from 85 to 118 g/L for those with angiodysplasia. Endoscopic therapy abolished or reduced transfusion requirements in 93% of patients with gastric antral vascular ectasia and 76% with angiodysplasia. Patients with gastric antral vascular ectasia required a mean of 6 treatment sessions, while those with angiodysplasia required one to two sessions. Conclusions Endoscopic thermal ablation effectively controls acute bleeding and reduces transfusion requirements in most patients with upper-GI vascular ectasias. Patients with gastric antral vascular ectasia require significantly more treatment sessions to achieve this effect.

Advances in Imaging in Prenatal Diagnosis and Fetal Therapy

Technological advances in ultrasound have contributed to improvements in prenatal diagnosis. Transvaginal scanning and harmonic imaging have allowed better resolution and improved structural characterisation. Doppler techniques have further been improved, which allow accurate flow studies of vessels in the placenta and fetus. These have contributed much to the management of intrauterine growth restriction, fetal anaemia and twin-twin transfusion syndrome (TTTS). Three-dimensional sonography and magnetic resonance imaging ultrafast sequences are useful adjuncts to conventional 2-dimensional sonography, increasing the confidence and diagnostic accuracy of prenatal diagnosis. Fetal therapy has seen major advances in recent years as well, secondary to improvements in endoscopic instruments and surgical techniques. Selective Nd:YAG laser photocoagulation of communicating vessels and cord occlusion have been used to treat complications of monochorionic twins like TTTS and twin-reversed arterial perfusion sequence.