Taxa de oclusão em veias safenas pós-endolaser de 1.470 nm e efeitos colaterais no seguimento de 1 ano / Rate of saphenous vein occlusion and side effects at 1 year follow up after 1470 nm endolaser

Resumo Contexto O uso do endolaser para doença venosa crônica envolve a escolha do comprimento de onda, fibra óptica e energia dispensada. Sua eficácia é avaliada pela taxa de oclusão venosa e, a segurança, pelos efeitos colaterais. Objetivos Demonstrar a incidência de oclusões venosas totais de veias safenas pós-endolaser no seguimento de 1 ano. Descrever a incidência e os efeitos colaterais e a necessidade de reintervenção ou complemento da terapêutica no pós-operatório. Métodos Estudo observacional retrospectivo de uma coorte com abordagem quantitativa de pacientes com insuficiência das veias safenas tratados com laser ablação endovenosa de 1.470 nm. Dados cadastrados em planilha MS Excel 2019, com cálculos de médias e desvios padrão pelo suplemento Power Query do Software. Resultados Foram elegíveis para o estudo 38 pacientes e 104 segmentos venosos, dos quais 100% estavam ocluídos em 30 dias e 99,04% em 1 ano pós-procedimento. O Linear Endovenous Energy Density médio para safena interna foi de 2.040,52 W/cm/s com desvio padrão ± 1.510,06 W/cm/s e 1.168,4 W/cm/s com desvio padrão de ± 665,011 W/cm/s para safena externa. Dor no trajeto da safena foi o principal efeito colateral, com oito casos (21,05%), seguido de parestesia, com um caso (2,63%). Conclusões Taxa de oclusão total no seguimento de 1 ano sugerindo técnica promissora e com atual aplicabilidade na amostra. A incidência da dor e parestesia podem ser justificadas pela alta média de energia utilizada em alguns casos. Recomenda-se a realização de estudos multicêntricos, com amostras maiores e mais homogêneas em relação à classificação Clínica-Etiológica-Anatômica-Patológica.

Abstract Background Use of endolaser for chronic venous disease involves choosing the laser wavelength and optical fiber to use and the quantity of energy to be administered. Efficacy is assessed by the venous occlusion rate and safety is evaluated in terms of side effects. Objectives To determine the incidence of total post-endolaser saphenous vein occlusion at 1-year follow-up. To describe side effects and their incidence and rates of reintervention or supplementary treatment during the postoperative period. Methods A retrospective, observational cohort study with a quantitative approach, enrolling patients with saphenous vein incompetence treated with intravenous 1,470 nm laser ablation. Data were input to an MS Excel 2019 spreadsheet, calculating means and standard deviations with the software's Power Query supplement. Results 38 patients and 104 venous segments were eligible for the study. 100% were occluded at 30 days and 99.04% were still occluded at 1 year after the procedure. Mean Linear Endovenous Energy Density administered to the internal saphenous vein was 2,040.52 W/cm/s with standard deviation of ± 1,510.06 W/cm/s and 1,168.4 W/cm/s with standard deviation of ± 665.011 W/cm/s was administered to the external saphenous vein. Pain along the saphenous path was the most common side effect, with eight cases (21.05%), followed by one case of paresthesia (2.63%). Conclusions The total occlusion rate at 1-year follow-up suggests the technique is promising and is currently applicable in this sample. The incidence of pain and paresthesia may be caused by the high mean energy delivered in some cases. It is recommended that multicenter studies be conducted with larger and more uniform samples in terms of their Clinical-Etiological-Anatomical-Pathological classifications.

What do Cochrane systematic reviews say about congenital vascular anomalies and hemangiomas? A narrative review

ABSTRACT BACKGROUND: Congenital vascular anomalies and hemangiomas (CVAH) such as infantile hemangiomas, port-wine stains and brain arteriovenous malformations (AVMs) impair patients' lives and may require treatment if complications occur. However, a great variety of treatments for those conditions exist and the best interventions remain under discussion. OBJECTIVE: To summarize Cochrane systematic review (SR) evidence on treatments for CVAH. DESIGN AND SETTING: Review of SRs conducted in the Division of Vascular and Endovascular Surgery of Universidade Federal de São Paulo, Brazil. METHODS: A broad search was conducted on March 9, 2021, in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed treatments for CVAH. The key characteristics and results of all SRs included were summarized and discussed. RESULTS: A total of three SRs fulfilled the inclusion criteria and were presented as a qualitative synthesis. One SR reported a significant clinical reduction of skin redness by at least 20%, with more pain, among 103 participants with port-wine stains. One SR reported that propranolol improved the likelihood of clearance 13 to 16-fold among 312 children with hemangiomas. One SR reported that the relative risk of death or dependence was 2.53 times greater in the intervention arm than with conservative management, among 218 participants with brain AVMs. CONCLUSION: Cochrane reviews suggest that treatment of port-wine stains with pulsed-dye laser improves redness; propranolol remains the best option for infantile hemangiomas; and conservative management seems to be superior to surgical intervention for treating brain AVMs.

Ablação térmica total assistida: apresentação da técnica ATTA / Assisted total thermal ablation: presentation of the ATTA technique

Resumo O tratamento da doença venosa crônica dos membros inferiores evoluiu de forma exponencial nas últimas décadas. Tais avanços permitiram o desenvolvimento de uma proposta de execução técnica sistematizada para o tratamento de ablação endovenosa com laser, a ablação térmica total assistida (ATTA). A técnica propõe um método padronizado de abordagem das veias axiais ou tributárias, varicosas ou inestéticas, de membros inferiores ou outros territórios, em regime ambulatorial ou de hospital-dia. Foram descritos os processos de preparo pré-operatório, marcação detalhada, materiais necessários, acessos venosos, anestesia, cálculo de potência e energia, a técnica de ablação, seguimento e eventos adversos. A ATTA é proposta como uma ferramenta para o tratamento da doença venosa crônica e das veias inestéticas, sugerindo possíveis expansões para as aplicações do laser, além dos troncos venosos, para toda veia passível de ser puncionada.

Abstract Treatment of lower limb chronic venous disease has progressed exponentially over recent decades. The advances achieved have made it possible to develop a proposal for a systematized intravenous laser ablation technique — assisted total thermal ablation (ATTA). The technique constitutes a standardized method for management of axial or tributary veins that are varicosed or esthetically unappealing, whether in the lower limbs or other areas, that can be performed on an outpatient or day-hospital basis. This article describes the processes for preoperative preparation and detailed marking, the materials needed, venous access, anesthesia, calculation of power and energy, the ablation technique itself, follow-up, and adverse events. The ATTA technique is proposed as a tool for treatment of chronic venous disease and of esthetically unappealing veins, suggesting possible extension of the applications for lasers beyond trunk veins to any vein that can be punctured.

Morphological changes of macular soft drusen and drusenoid DPED after subthreshold micropulse laser treatment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the morphological changes of macular soft drusen and drusenoid pigmental epithulium detachment(DPED)after subthreshold micropulse laser treatment(SMLT).<p>METHODS: Fourteen patients(20 affected eyes)with soft drusen and DPED clinically confirmed from August 2016 to October 2018, were included in this study. 577 nm yellow laser of SMLT was applied for soft drusen and DPED. The changes of soft drusen and DPED in best corrected visual acuity(BCVA)(LogMAR)and height, diameter and cross-sessional area according to fundus autofluorescence and SD-OCT examinations were observed after SMLT.<p>RESULTS: BCVA was not significant difference after treatment of soft drusen(<i>P</i>=0.260), and the DPED(<i>P</i>=0.736)than that of the baseline. Compared with the baseline values, the height and cross-sessional area of soft drusen were reduced at the 6mo after treatment(<i>P</i>=0.008, <i>P</i>=0.034). Compared with the baseline values, the differences were not statistically significant in height, diameter and cross-sectional area of DPED after treatment.<p>CONCLUSION: BCVA was not reduced for drusen and DPED after SMLT, however, the height and cross-sessional area of soft drusen was reduced compared with those before treatment, and the differences were not statistically significant in height, diameter and cross-sectional area of DPED before and after treatment. The results indicated that SMLT was effective for soft drusen, but was not effective for short-term treatment of DPED. SMLT caused no damage to the visual acuity in treatment of soft drusen and DPED, but prospective, controlled, large sample and long-term follow-up studies should be required.

Morphological changes of macular soft drusen and drusenoid DPED after subthreshold micropulse laser treatment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the morphological changes of macular soft drusen and drusenoid pigmental epithulium detachment(DPED)after subthreshold micropulse laser treatment(SMLT).<p>METHODS: Fourteen patients(20 affected eyes)with soft drusen and DPED clinically confirmed from August 2016 to October 2018, were included in this study. 577 nm yellow laser of SMLT was applied for soft drusen and DPED. The changes of soft drusen and DPED in best corrected visual acuity(BCVA)(LogMAR)and height, diameter and cross-sessional area according to fundus autofluorescence and SD-OCT examinations were observed after SMLT.<p>RESULTS: BCVA was not significant difference after treatment of soft drusen(<i>P</i>=0.260), and the DPED(<i>P</i>=0.736)than that of the baseline. Compared with the baseline values, the height and cross-sessional area of soft drusen were reduced at the 6mo after treatment(<i>P</i>=0.008, <i>P</i>=0.034). Compared with the baseline values, the differences were not statistically significant in height, diameter and cross-sectional area of DPED after treatment.<p>CONCLUSION: BCVA was not reduced for drusen and DPED after SMLT, however, the height and cross-sessional area of soft drusen was reduced compared with those before treatment, and the differences were not statistically significant in height, diameter and cross-sectional area of DPED before and after treatment. The results indicated that SMLT was effective for soft drusen, but was not effective for short-term treatment of DPED. SMLT caused no damage to the visual acuity in treatment of soft drusen and DPED, but prospective, controlled, large sample and long-term follow-up studies should be required.

Research on Risk Control of Upgraded Design and Development Changes of Laser Treatment Equipment after Registration / 中国医疗器械杂志

This paper analyzes the causes and risks of common design and development changes of laser treatment equipment, studies the changes of key components and their corresponding control measures, forms the identification method of design changes of laser treatment equipment, and gives suggestions on how to deal with design and development changes, so as to provide references for inspectors during on-site inspection.

Morphological changes of macular soft drusen and drusenoid DPED after subthreshold micropulse laser treatment / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To analyze the morphological changes of macular soft drusen and drusenoid pigmental epithulium detachment ( DPED ) after subthreshold micropulse laser treatment ( SMLT) .?METHODS: Fourteen patients ( 20 affected eyes ) with soft drusen and DPED clinically confirmed from August 2016 to October 2018, were included in this study. 577 nm yellow laser of SMLT was applied for soft drusen and DPED. The changes of soft drusen and DPED in best corrected visual acuity ( BCVA ) ( LogMAR ) and height, diameter and cross-sessional area according to fundus autofluorescence and SD - OCT examinations were observed after SMLT.?RESULTS: BCVA was not significant difference after treatment of soft drusen (P=0.260), and the DPED (P=0. 736 ) than that of the baseline. Compared with the baseline values, the height and cross-sessional area of soft drusen were reduced at the 6mo after treatment ( P=0. 008, P=0.034) . Compared with the baseline values, the differences were not statistically significant in height, diameter and cross - sectional area of DPED after treatment.?CONCLUSION: BCVA was not reduced for drusen and DPED after SMLT, however, the height and cross -sessional area of soft drusen was reduced compared with those before treatment, and the differences were not statistically significant in height, diameter and cross -sectional area of DPED before and after treatment. The results indicated that SMLT was effective for soft drusen, but was not effective for short-term treatment of DPED. SMLT caused no damage to the visual acuity in treatment of soft drusen and DPED, but prospective, controlled, large sample and long-term follow-up studies should be required.

Avaliação econômica do glaucoma primário de ângulo aberto / Economic evaluation of primary open-angle glaucoma

Resumo Objetivo: Avaliar a relação custo-utilidade do tratamento inicial com laser ou medicamentos do glaucoma primário de ângulo aberto (GPAA) no Brasil, considerando de um lado os custos totais e de outro lado o impacto na qualidade de vida dos pacientes. Métodos: O estudo foi realizado com base em um modelo de Markov, onde uma coorte teórica de portadores de GPAA em estágio inicial foi gerada. Os parâmetros usados no modelo foram obtidos na literatura e incluíram: custos médicos diretos (consultas, exames, tratamento); custos não médicos diretos (gasto com hospedagem, transporte, alimentação, acompanhante); custos indiretos (relacionados à incapacidade para o trabalho); valores de utilidade (qualidade de vida medida em QALY - quality-adjusted life year); e probabilidade de transição entre os estágios de saúde. Três estratégias de tratamento foram testadas no modelo: (1) sem tratamento; (2) tratamento inicial com colírios; (3) tratamento inicial com trabeculoplastia a laser. A medida de desfecho foi a razão de custo-utilidade incremental (RCUI). A robustez do modelo foi testada através de análise de sensibilidade. Resultados: As estratégias (2) e (3) de tratamento inicial do GPAA geraram ganhos em qualidade de vida em relação à (1) no Brasil. Iniciar o tratamento com laser gerou ganho médio de 1 QALY, enquanto que com medicamentos propiciou um ganho de 2 QALYs em média. Dentre as três estratégias testadas, a estratégia (2) foi a custo-efetiva e foi dominante sobre as demais, pois foi ao mesmo tempo a mais barata e a mais efetiva. Conclusão: Tanto a trabeculoplastia a laser quanto os medicamentos como tratamentos primários do GPAA inicial geraram ganhos significativos de qualidade de vida. A estratégia de se iniciar o tratamento com medicações foi custo-efetiva, quando se considera os custos totais. A alternativa de tratamento inicial através de trabeculoplastia a laser não foi custo-efetiva.

Abstract Objective: To evaluate the cost-utility relation of the initial treatment with laser or primary open-angle glaucoma medications (PLA) in Brazil, considering on the one hand the total costs and on the other side the impact on patients' quality of life. Methods: The study was performed based on a Markov model, where a theoretical cohort of early-stage GPAA carriers was generated. The parameters used in the model were obtained in the literature and included: direct medical costs (consultations, examinations, treatment); direct non-medical costs (accommodation, transportation, meals, companions); indirect costs (related to incapacity for work); utility values (quality of life measured in QALY - quality-adjusted life year); and probability of transition between stages of health. Three treatment strategies were tested in the model: (1) without treatment; (2) initial treatment with eye drops; (3) initial treatment with laser trabeculoplasty. The measure of outcome was the incremental cost-utility ratio (RCUI). The robustness of the model was tested through sensitivity analysis. Results: The strategies (2) and (3) of the initial treatment of POAG generated gains in quality of life in relation to (1) in Brazil. Initiating the laser treatment generated an average gain of 1 QALY, whereas with medication it gave a gain of 2 QALYs on average. Among the three strategies tested, strategy (2) was cost-effective and was dominant over the other strategies, since it was at the same time the cheapest and the most effective strategy. Conclusion: Both laser trabeculoplasty and medications as primary treatments of early-stage POAG have generated significant gains in quality of life. The strategy of starting treatment with medications was cost-effective, whereas laser trabeculoplasty strategy was not cost-effective, when non-medical costs (direct and indirect) are included.

Posterior laser barrage in advancing retinopathy of prematurity: A prospective randomized study

Purpose: To compare the outcomes of conventional laser photocoagulation versus additional posterior barrage laser in advanced stage 3 retinopathy of prematurity (ROP). Methods: A total of 20 infants with bilateral symmetric zone 2 stage 3 advancing ROP were treated with conventional laser treatment followed by randomization of one eye to receive additional posterior retinal laser treatment. Disc–fovea and inter-arcade distance was measured. The patients were followed up prospectively for 3 months. Structural and functional outcomes and safety profile were analyzed. Results: 18/20 (90%) eyes in the study group and 19/20 (95%) eyes in the control group achieved regression of disease. Faster and complete regression was observed at 4 weeks after posterior laser compared to the control group (P = 0.024). Disc–fovea and inter-arcade distance was comparable in both groups. Conclusion: Additional posterior barrage laser is a safe technique that led to faster and more complete regression in eyes with advancing ROP. Final regression profile was comparable in both treatment modalities.

Research progress on the treatment of oral and maxillofacial hemangioma / 口腔疾病防治

@#Hemangioma is the most common vascular benign tumor in infants and young children, 60% of which occur in the oral maxillo-facial region. One characteristic of oral and maxillofacial hemangioma is spontaneous regression, which generally does not require treatment; however, a few hemangiomas can produce complications including ulceration, functional disorders and disfigurement, which require active treatments. Currently, the treatment of oral and maxillofacial hemangioma include drug treatment, laser treatment and surgical treatment. The drugs used to treat hemangioma mainly include beta blockers, glucocorticoids, alpha-interferon, imiquimod and antitumor drugs. Drug therapy is suitable for multiple, rapidly proliferating hemangiomas and hemangiomas that affect vital organ function or endanger life. Laser therapy can be applied to the early treatment of rapidly growing hemangiomas at exposed sites. Surgical treatment is suitable for proliferative hemangioma with serious complications, the reconstruction of any external deformity and the repair of a scar after an ulcer. Combined therapy and the development of new technologies provide new directions for the treatment of hemangioma but the efficacy remains to be proven by large sample prospective studies. Clinicians should appropriately evaluate the patients with hemangioma and develop individualized treatment programs for patients with treatment indications. This article reviews the efficacy, mechanism, clinical application and adverse reactions of different treatment methods and provides references for clinical treatment.

The complication and prevention of laser photocoagulation in diabetic retinopathy treatment / 国际眼科杂志(Guoji Yanke Zazhi)

@#Diabetic retinopathy(DR)is a common microvascular complication of diabetes caused by chronic hyperglycemia and ischemia, which can seriously impair the patient's vision or even cause blindness. The main causes of visual impairment include macular edema, vitreous hemorrhage and neovascular glaucoma. Retinal laser photocoagulation is one of the most important therapies for DR. The thermal effects of laser photocoagulation can denature proteins, coagulate and destruct tissue, and finally scars occur. The scar tissue which consumes very low oxygen replaces the cones and rod and reduces tissue oxygen consumption significantly, and relieves the retinal ischemia and hypoxia especially for the middle and peripheral part of retina. However, complications such as macular edema, vitreous hemorrhage, and visual field defects may occur easily following laser treatment. This article reviews recent literatures about the complications and preventions of laser photocoagulation in DR treatment.

Comparison of removal torques between laser-etched and modified sandblasted acid-etched Ti implant surfaces in rabbit tibias

PURPOSE: The purpose of this study was to analyze the effects of two different implant surface treatments on initial bone connection by comparing the Removal Torque Values (RTQs) at 7 and 10 days after chemically modified, sandblasted, large-grit and acid-etched (modSLA), and Laser-etched (LE) Ti implant placements. MATERIALS AND METHODS: Twenty modSLA and 20 LE implants were installed on the left and right tibias of 20 adult rabbits. RTQs were measured after 7 and 10 days in 10 rabbits each. Scanning electron microscope (SEM) photographs of the two implants were observed by using Quanta FEG 650 from the FEI company (Hillsboro, OR, USA). Analyses of surface elements and components were conducted using energy dispersive spectroscopy (EDS, Horiba, Kyoto, Japan). RESULTS: The mean RTQs were 12.29 ± 0.830 and 12.19 ± 0.713 Ncm after 7 days (P=.928) and 16.47 ± 1.324 and 16.17 ± 1.165 Ncm after 10 days (P=.867) for LE and modSLA, respectively, indicating no significant inter-group differences. Pore sizes in the LE were 40 µm and consisted of numerous small pores, whereas pore sizes in the modSLA were 5 µm. In the EDS analysis, Ti, O, and C were the only three elements found in the LE surfaces. Na, Ca, Cl, and K were also observed in modSLA, in addition to Ti, O, and C. CONCLUSION: The implants showed no significant difference in biomechanical bond strength to bone in early-stage osseointegration. LE implant can be considered an excellent surface treatment method in addition to the modSLA implant and can be applied to the early loading of the prosthesis clinically.

Characteristics of Basal Cell Carcinoma Incompletely Removed by Laser Treatment due to Misdiagnosis as Benign Tumor / 대한피부과학회지

No abstract available.

Association of anterior chamber angle open parameters with postoperative intraocular pressure following laser peripheral iridotomy / 中华实验眼科杂志

Objective To evaluate the relationship between anterior chamber angle and intraocular pressure (IOP) after laser peripheral iridotomy (LPI) treatment.Methods A retrospective cases control study was adopted.Fifty-eight patients (58 eyes) who were diagnosed as primary angle closure (PAC) were included in this study.Ultrasound biomicroscopy (UBM) parameters in angle opening distance (AOD),trabecular iris area (TISA) and angle recess area (ARA) examination were performed before LPI.The changes of intraocular pressure (IOP) were compared between different time-points (before and 1 hour,2 hours,8 hours,24 hours,2 weeks,6 months and 12 months after LPI).The patients were divided into IOP≤21 mmHg group (41 eyes) and IOP＞21 mmHg group (17 eyes) after LPI.Relationship between anterior chamber angle and IOP after LPI treatment was explored.This study was approved by Ethic Committee of the Henan Eye Institute and informed consent was obtained from each patient.Results The IOPs were increased in 1 hour,2 hours after LPI and lowered in 2 weeks,6 months,12 months after LPI compared with IOP before LPI,with significant differences between them (all at P＜0.01).Twelve patients suffered transient elevated IOP and recovered by self-healing or treatment.IOP of 4 patients were elevated after 6 months to 1 year follow-up.The IOPs in 2 weeks,6 months and 12 months after LPI were lowered compared with IOP before LPI,with significant differences between them (all at P＜0.01).The UBM parameters were significantly increased in 2 weeks,6 months,12 months after LPI in comparison with IOP before IPL (all at P＜0.01).IOP and UBM parameters values were significantly different between IOP＞21 mmHg group and ≤21 mmHg group after LPI.Regression analysis indicated that ARA750 (OR =0.75,P＜0.05) was correlated to the IOP after LPI rather than IOP before operation,AOD and TISA (P＞0.05).Conclusions ARA750 value is correlated with the IOP variations after LPI.UBM structured observation can improve the surgical successful rates and safty and prevent complications.

A comparison analysis of transilluminated powered phlebectomy and endovanous laser treatment combined with high ligation on treating varicose great saphenous vein / 临床外科杂志

Objective To investigate the efficacy of transilluminated powered phlebectomy (TIPP) and endovanous laser treatment(EVLT) combined with high ligation on treating varicose great saphenous vein.Methods A total of 238 cases with varicose great saphenous vein were divided into TIPP group (119 cases)and EVLT group (119 cases).The incidence of postoperative recovery and complications of the two groups were compared.Results There was no significant difference between the two groups on the surgery duration and postoperative recovery incident(P ＞ 0.05);the saphenous nerve injury incidence and skin impairment incidence of the TIPP group were significantly less than that of EVLT group (P ＜ 0.05);the amount of bleeding,subcutaneous hematoma incidence,and amount of surgical incision of TIPP group were significantly more than that of the EVLT group(P ＜ 0.05).Conclusions TIPP and EVLT combined with high ligation are two effective minimally invasive surgical approaches on treating varicose great saphenous vein.EVLT is with less surgical incision and less bleeding,and is more applicable for mild case;TIPP is with less operative trauma,and is more applicable for severe case.

Analysis of visual acuity and macular edema in patients with diabetic retinopathy after laser treatment / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To analyze curative effect of laser treatment for diabetic retinopathy (DR).METHODS:A total of 100 patients (136 eyes) with DR who were admitted to our hospital during January 2015 to December 2016 were enrolled in the study.All patients were given 532nm laser treatment.Changes of visual acuity and the incidence of complications were statistically analyzed after treatment, and the macula central fovea retinal thickness and hemodynamic changes of affected eyes were compared before and after treatment.The effects of laser treatment were compared among patients with different types of diabetes, patients in different DR stages and patients with different glycosylated hemoglobin (HbAlc) levels.RESULTS:After treatment, the macula central fovea retinal thickness, end diastolic velocity (EDV), pulsatility index (PI) and central retinal artery (CRA), mean flow velocity (Vm) significantly decreased (P<0.05).After treatment, there were 2 cases (2 eyes) of bleeding and 2 cases (2 eyes) of tractional retinal detachment.The effective improvement rate of visual acuity was 83.1%.There were significant differences in the improvement rate of visual acuity among patients with different types of diabetes [type 1 (60.0%) vs type 2 (84.9%)], patients in different DR stages [preproliferative diabetic retinopathy (NPDR) 92.3%, early proliferative stage (PDR) 85.1%, high-risk PDR 54.2%] and patients with different HbAlc levels (< 8% 91.8% vs ≥8% 73.0%) (P<0.05).CONCLUSION:The 532nm laser treatment is effective for DR.It can significantly improve the retinal hemodynamics and visual acuity and relieve macular edema.Types of diabetes mellitus, stages of DR and blood glucose control effect may affect the effects of laser treatment.

Survey on Perspectives and Treatment Status Regarding Skin Laser Treatment / 대한피부과학회지

BACKGROUND: Skin laser treatment has improved significantly and has become an effective treatment approach for many skin diseases while also having applications for beauty treatments. However, since skin laser transfers energy directly to the skin, the misuse of such treatment may result in permanent damage to skin tissues. OBJECTIVE: This survey of Korean adults, conducted to obtain their perspectives on and their treatment experience with skin laser treatment, will be used to determine the current status of skin laser treatment and to identify necessary changes to ensure proper and safe conduct of skin laser treatment. METHODS: From April 5th to April 12th, 2016, a survey was conducted to obtain information regarding the perspectives and the treatment experience of adults aged 20~59 years. RESULTS: Approximately 50% of the participants had experience with skin laser treatment, and among these, 24.7% had not received treatment at a dermatology clinic. Compared to treatment at a dermatology clinic, the danger of side effects was 1.7 times higher at a non-dermatology clinic, 2 times higher at a skin care shop, and 5.3 times higher at an Oriental medical clinic. Among patients who received skin laser treatment, 16.1% experienced side effects, and among these, 1 out of 4 patients visited a non-dermatologist for treatment of these side effects. CONCLUSION: The results of the survey showed that in order for the public to receive safe and effective skin laser treatment based on professional diagnosis, there is a definitive need to provide correct information to the public and to implement changes to ensure proper understanding of skin laser treatment among this population.

Mirror Syndrome after Fetoscopic Laser Treatment - A Case Report / Síndrome do espelho após tratamento laser por fetoscopia - caso clínico

Abstract Mirror syndrome is a rare disease with unknown pathophysiology that can be present in different diseases that can cause fetal hydrops. The prognosis is usually bad with a high perinatal mortality. We report an unusual form of mirror syndrome that manifested itself only after a successful treatment for fetal hydrops (caused by twin-twin transfusion syndrome, in Quinteros stage IV) was performed. This syndrome was controlled by medical treatment, and despite the usually bad prognosis seen in these cases, we could extend the pregnancy from the 23rd to the 34th week of gestation, resulting in the birth of 2 live infants.

Resumo A síndrome do espelho é uma doença rara, de fisiopatologia desconhecida, que se manifesta em situações obstétricas responsáveis pela presença de hidrópsia fetal. Habitualmente o prognóstico é reservado, uma vez que se associa a elevadas taxas de mortalidade perinatal. O presente caso clínico trata de uma situação de síndrome do espelho que se manifestou, atipicamente, após o tratamento eficaz para a hidrópsia fetal associada à síndrome de transfusão feto-fetal. Apesar do mau prognóstico associado a estas situações, conseguiu-se controlar a situação apenas com tratamento médico e, desta forma, prolongar a gravidez durante 12 semanas.

Estudo comparativo da termoablação da veia safena magna na coxa, com e sem tumescência / Comparative study of great saphenous vein ablation in the thigh, with and without tumescence

Resumo Contexto O tratamento com laser endovenoso das veias safenas oferece ao paciente um procedimento com baixos índices de complicações, proporcionando retorno precoce à atividade ocupacional. Objetivo Comparar a formação de hematoma, a presença de parestesia no trajeto da veia safena magna (VSM) e a sua taxa de obliteração em 30 dias após a termoablação ao nível da coxa, utilizando ou não a tumescência e dois tipos de fibras. Métodos Estudo prospectivo em que foram analisados três grupos de pacientes submetidos a termoablação da VSM em coxa, utilizando comprimento de onda 1470 nm. No grupo 1, utilizou-se fibra convencional e tumescência; no grupo 2, fibra convencional sem tumescência; e no grupo 3, fibra dupla radial sem tumescência. Foram comparados, no período de 30 dias, a taxa de obliteração ao eco-Doppler, a ocorrência de parestesias e hematomas. Resultados Ao se comparar 90 VSMs de coxa submetidas a termoablação, obteve-se taxas de obliterações similares entre os grupos, sem diferença estatística. Nos grupos sem tumescência, ocorreu maior número de parestesias no trajeto da VSM na coxa no sétimo dia do que no grupo com tumescência, mas somente com significância estatística na comparação com o grupo da fibra convencional. Ocorreram hematomas em todos os grupos, sendo mais frequentes no grupo 1 (73,33%). Conclusões A realização da tumescência mostrou-se útil na prevenção de lesões neurológicas menores, mas não influenciou a ocorrência de hematomas e a taxa de oclusão da VSM na coxa em até 30 dias de sua termoablação.

Abstract Background Endovenous laser treatment of saphenous veins offers patients a procedure with low rates of complications and an early return to occupational activities. Objective To compare rates of formation of bruising, of paresthesia along the path of the great saphenous vein (GSV), and of GSV obliteration 30 days after thermal ablation in the thigh, performed with or without tumescence and using two different types of fiber. Methods This was a prospective study, analyzing three groups of patients who underwent GSV thermal ablation in the thigh, using a wavelength of 1470 nm. Patients in group 1 were treated with a conventional fiber using tumescence; those in group 2 were treated with a conventional fiber without using tumescence; and patients in group 3 were treated with a double radial fiber without tumescence. After 30 days, the rates of obliteration shown by Doppler ultrasonography, of paresthesias, and of bruising were compared. Results Comparison of the results of thermal ablation of 90 GSVs in the thigh revealed similar rates of obliteration, with no statistical differences. The rate of paresthesia along the path of the GSV in the thigh was higher in the groups without tumescence than in the group with tumescence, but the difference only attained statistical significance for the comparison with the group that was treated with the conventional fiber. There was bruising in all groups, with greater frequency in group 1 (73.33%). Conclusions Tumescence proved useful for preventing minor neurological injuries, but didn’t have any influence on the rates of bruising occurrence or of occlusion of the GSV in the thigh up to 30 days after thermal ablation.

The Role of Dynamic Ultrasound Biomicroscopy in Defining Laser Treatment in Pigment Dispersion Syndrome/ Pigmentary Glaucoma. A Case Series

Background: To assess utility of Dynamic UBM (in light & dark room illuminations) in deciding laser Iridotomy in Pigment Dispersion Syndrome(PDS)/Pigmentary Glaucoma (PG) Method: Prospective interventional cohort study. Eyes with PDS/PG underwent UBM under light & dark by same operator. Presence of Iris Concavity(IC), Iridolenticular Contact(ILC), Iridozonular Contact(IZC) &  Irido-Ciliary Process Contact(ICC) were quantified & LASER Iridotomy was advised. Post-LASER, UBM was redone at 4-6 weeks & later. Results: UBM was done in 10 eyes of 6 pts with PDS/PG. 4 eyes (40%-group 1) had IC under light with ILC. In 6 eyes (60%; group2) UBM was redone under dark, picking up IC in 5 eyes (50%). In group 2,5 eyes had ILC (1 eye each with IZC & ICC also).8 of the advised 9 eyes underwent Nd-YAG PI. 6(75%) eyes showed reversal of reverse pupillary block at mean follow up of 11.33wks. Conclusion: UBM in different room illuminations can be useful in deciding LASER treatment in PDS/PG to restore normal iris configuration.