Treatment of vascular lesions with combined dynamic precooling, postcooling thermal quenching, and ND:YAG 1,064-nm laser.

The purpose of this study is to evaluate the effectiveness and safety of the newly developed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064-nm laser system for nonablative laser treatment of vascular lesions in Asians. Five patients with vascular lesions in the periorbital area received serial treatments. The fluences were set between 80 and 90 J/cm(2). The patients were followed for 6 months. Improvements were noted in all patients. Transient erythema and swelling were noted in all patients during the postoperative period. Transient purpura occurred in one patient. The Nd:YAG 1,064-nm laser system, when coupled with dynamic precooling and postcooling thermal quenching, is effective and safe in treating periorbital vascular lesions even when multiple treatments are performed. No significant adverse effects were noted in this study.

Nonablative laser resurfacing.

The CoolTouch (Roseville, CA) laser combines Nd:YAG 1320 nm wavelength beam and thermal sensing cryogenic spray. A review and presentation of data on the efficacy and safety of this laser are covered in this article. Clinical results showed that the laser is effective with few complications if thermal control is achieved.

Lateral canthal tendon suspension using the carbon dioxide laser. A modified technique.

BACKGROUND: The "tarsal strip" procedure was developed to correct lower eyelid ectropion caused by lateral canthal tendon laxity. OBJECTIVE: The "tarsal strip" procedure is improved by using the carbon dioxide (CO2) laser. METHODS: The CO2 laser was used to perform lateral canthotomy. Patients were evaluated postoperatively for subjective improvement in preoperative symptoms. Complications such as epithelial inclusion cysts were actively sought. RESULTS: Thirty-one patients (60 lids) were followed for an average of 12 months. Preoperative symptoms resolved in 86% (N = 27), improved in 7% (N = 2), and did not change in 7% (N = 2). Two patients required additional surgery. Complications were not observed in this study. CONCLUSION: The modified "tarsal strip" procedure using the CO2 laser provides many advantages compared with the original procedure. A clean dissection improves visibility and allows easy identification of the lateral tarsal plate. The lateral canthal angle is preserved and epithelial inclusions are prevented because the conjunctival mucosa is not violated.

Congenital synkinetic movements associated with elevation of the upper eyelid.

Congenital synkinetic movement of the upper eyelid is rare. In this case report, we present a 4-year-old patient with a left upper eyelid ptosis that improved on abduction and became worse on adduction. The patient also had congenital esotropia and superior rectus palsy. Strabismus surgery was performed, and excellent surgical results were achieved. A 17-mm left levator aponeurectomy and myectomy was later performed with satisfactory results. Pathology studies of the levator muscle and aponeurosis showed no evidence of inflammation, degeneration, or atrophy. Electron microscopy showed no skeletal muscle abnormality. We postulate that this congenital synkinetic movement reflects an incomplete nerve cell dying process that occurs during the embryonic phase of development.

Chlamydial infection of subcutaneous conjunctival transplants in guinea pigs.

The development and testing of candidate vaccines for trachoma are constrained because only humans and nonhuman primates are susceptible to conjunctival infection with Chlamydia trachomatis. Guinea pig inclusion conjunctivitis (GPIC), an analogous disease of guinea pigs, provides a useful, less expensive model to study ocular chlamydial infections. GPIC is caused by a Chlamydia psittaci strain whose external constituents are very similar to those of C. trachomatis. To develop a better model for studying GPIC immunity, conjunctival pockets were established under the abdominal skin of guinea pigs by subcutaneous implantation. Up to six implants could be produced in each animal. The success rate of implantation was 79.0% (n = 148). These pockets were then infected with GPIC. The organism was recovered from the autografts indicating local replication, and tests for serum antibody by microimmunofluorescence showed production of GPIC-specific antibody of IgG and IgM classes after infection. There was minimal antibody response after moderate inoculating doses to the implants, and the titers increased more slowly than after eye infection with GPIC; with higher concentration of the inoculum, however, the antibody response increased to the same levels as with the ocular challenge but more slowly. Inoculation of pockets with GPIC also produced acute inflammatory changes in infected autografts (n = 101). Histologic examination of infected grafts showed chlamydial inclusions in epithelial cells and significant infiltration with lymphocytes and polymorphonuclear cells. Subcutaneous autografts may provide a useful model for chronologic studies of chlamydial infection. The delayed immunologic response, however, suggests that these pockets of implanted epithelium do not have full access to the immune system.