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Comparison of Photochemical Crosslinking Versus Sutures for Bonding Conjunctival Grafts

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives To explore whether Rose Bengal-induced photochemical crosslinking (RB-PCL) can be a replacement for sutures in conjunctival autograft bonding, we compared the safety, operating time, postoperative ocular signs, and inflammatory responses of RB-PCL versus nylon suturing for sealing conjunctival autografts in rabbits. Study Design/Materials and Methods Thirty-six New Zealand White rabbits underwent limbal conjunctival autografting using either sutures or RB-PCL to attach conjunctival autografts to the bare sclera. Animals were randomized to one of two groups (18 per group): the suture group or RB-PCL group. Photochemical crosslinking with a wavelength of 532 nm green light with an illumination intensity of 0.6 W/cm(2) for 250 seconds (150 J/cm(2)) or suturing was performed followed by light examination at 3, 7, 28 days after surgery to evaluate the healing condition. Rabbits in each group were euthanized on day 3 (n = 6), 7 (n = 6), or 28 (n = 6) postoperatively, and the graft tissues from the surgical site were processed to evaluate inflammatory response by assessing protein levels of tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6) as well as histological examination. Cell viability was evaluated by counting both total and dead cells on hematoxylin and eosin (H&E) stained tissue samples from both groups at 3 and 7 days after surgery. The surgery procedure time was recorded and the graft surface temperatures were measured before and after illumination. Results Photochemical crosslinking effectively secured the limbal conjunctival autograft over an ocular conjunctival defect with no significant difference from the suture group. The time required for this light activated bonding method was similar to 550 seconds in comparison with the suture method of half hour. The differences of measured temperature on the graft surface before and after RB-PCL treatment were 2.98 +/- 0.11 degrees C. The induction of IL-6 and TNF-alpha protein was remarkably reduced in the RB-PCL group compared with the suture group at 3 and 7 days after surgery. Histology revealed less infiltrated neutrophils were observed in the RB-PCL group than in the suture group at 3 and 7 days postoperatively. Furthermore, the RB-PCL group showed a better healing process with less eye discharge and mild conjunctival congestion. No significant difference in percent dead cells was observed between RB-PCL and suture groups at 3 and 7 days after surgery. Conclusions RB-PCL is a promising alternative for bonding the conjunctival autograft with shorter operation time, less inflammation and better healing outcomes compared to conventional suture. Thermal damage and phototoxicity were not observed using the RB-PCL method in bonding conjunctival grafts. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Multi-Factors Associated With Efficacy and Adverse Events of Fractional Erbium:YAG Laser-Assisted Delivery of Topical Betamethasone for Stable Vitiligo: A Retrospective Analysis

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives Although topical corticosteroids are still the first-line option for vitiligo, its efficacy is still unsatisfactory for stable vitiligo. A few studies have focused on laser-assisted drug delivery (LADD) but were limited by their sample deficiency and analyses of the influencing factors. To determine the efficacy, adverse events, and their influencing factors of fractional erbium: yttrium-aluminum-garnet (Er:YAG) laser-assisted topical delivery of corticosteroids in stable vitiligo. Study Design/Materials and Methods We retrospectively reviewed 1,026 lesions in 684 patients with stable vitiligo who underwent treatment with fractional Er:YAG laser-assisted delivery of topical compound betamethasone solution between January 2014 and December 2017. Multi-factors associated with different outcomes were analyzed by logistic regression in this study. Results A total of 413 of 1,026 lesions (40.3%) were effective 12 months after the first treatment. Age (<14 years old), disease duration (<1 year), lesion location (on face and neck), hairy lesions, and drug concentration were independent factors associated with effective repigmentation. A common adverse event was hyperpigmentation (14.4%), which was highly correlated with 22% density. Conclusions Fractional Er:YAG laser-assisted delivery of topical compound betamethasone is a good option for the management of vitiligo. The treatment may be suggested in these situations: younger patients, shorter disease duration, and lesions on the face and neck with hair. The appearance of white hair in the lesion area does not affect our confidence in vitiligo treatment. Density >22% may cause hyperpigmentation, but it does not significantly contribute to the efficacy. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Evaluation of the Safety and Efficacy of a Picosecond Alexandrite Laser With DLA for Acne Scars in Chinese Patients

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives Recently, picosecond laser treatment has been used as an effective treatment for acne scars. To evaluate the efficacy and safety of a picosecond alexandrite laser with a diffractive lens array in the treatment of acne scars in Chinese patients. Study Design/Materials and Methods Patients with facial acne scars were treated with a picosecond alexandrite laser in three sessions at 4- to 6-week intervals and followed up for 2 months. Primary outcomes were measured by physicians' blinded evaluation of the acne scar using the ECCA (echelle d'eva physicians'luation clinique des cicatrices d'acne) grading scale. The secondary outcomes included the investigator global assessment (IGA) on the improvement of post-inflammatory erythema (PIE), patients' assessment of improvement on a 4-point scale and of satisfaction on a 5-point scale. Pain scores and adverse effects were also evaluated. Result Twenty patients with Fitzpatrick skin types III and IV were enrolled in the study and completed all treatment and follow-up visits. The mean ECCA scores fell from 197.75 +/- 35.26 to 142.00 +/- 35.92 (a 28% improvement), and the change was significant (P = 0.000). The mean IGA score of PIE improvement was 3.03 +/- 0.75 (0 = no improvement and 4 = 76-100% improvement). On the basis of the patients' self-assessment, the average improvement scores were 2.30 +/- 0.98 (0 indicating 0-25% improvement and 3 indicating >75% improvement). In total, 50% and 30% of the patients were "satisfied" and "very satisfied," respectively, with the treatment. The mean pain score was 3.20 +/- 0.50 (0 = no pain, 10 = maximum pain) with topical anesthesia. The adverse effects included transient and mild erythema, edema, and scabbing. Conclusions Treatment with a picosecond alexandrite laser with a diffractive lens array is effective and safe for acne scars in Chinese patients. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Efficacy of a New Therapeutic Option for Vulvar Intraepithelial Neoplasia: Superficial Shaving Combined With Photodynamic Therapy

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objective Vulvar intraepithelial neoplasia (VIN), a precancerous lesion, is difficult to treat by excision or ablation due to high recurrence rates. Photodynamic therapy (PDT) is a minimally invasive therapeutic procedure and is now widely used to treat non-melanoma skin diseases. However, the clinical response rates of VIN to single PDT are unstable. The reason may be the limited light penetration into deep tissues. Objective: To retrospectively evaluate the clinical response and recurrence of VIN after combined treatment with superficial shaving and PDT. Study Design/Materials and Methods Seventeen patients with VIN were enrolled. All patients had multifocal high-grade VIN that had failed to respond to various therapies. Superficial shaving was performed only once and prior to the first 5-aminolaevulinic acid (5-ALA)-PDT cycle. Generally, the procedure of 5-ALA PDT for each patient was performed in three sessions. Clinical response, recurrence, cosmetic outcomes, adverse events, patient satisfaction, quality of life, and mental health were assessed. The expression of p16 and Ki-67 in pre- and post-treatment tissue was detected. Results A clinical response of 94% was observed in 17 patients, who were administered combination therapy, over an observation period of 12 months. Approximately, 71% of patients had excellent cosmetic outcomes. All patients had satisfactory therapeutic effects and significant improvements in quality of life and mental health. Downregulation of p16 and Ki-67 may have been correlated with recurrence after 5-ALA-PDT. Conclusion Combined treatment with superficial shaving and 5-ALA-PDT is a safe and effective option for VIN. In particular, combination therapy is recommended for patients with large, multifocal, high-grade lesions; repeated recurrence; and strong willingness to maintain vulvar configuration and function. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Corneal Damage Effects Induced by a 770-2,500 nm Supercontinuum Light Source

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives Widespread applications of supercontinuum (SC) source lead to the possibility of ocular damages. However, the corneal damage effects induced by SC have not been explored before. The objectives of this study are to determine the rabbit corneal injury threshold for SC radiation and to examine whether the existing safety guidelines and standards are suitable for the hazard evaluation of this new kind of light source. Study Design/Materials and Methods A series of experiments was conducted in the New Zealand white rabbit model to determine the corneal damage thresholds induced by a 770-2,500 nm SC source, with a corneal 1/e beam diameter of 0.37 mm. Through slit-lamp biomicroscope, optical coherence tomography (OCT), and histopathology the corneal damage characteristics at the threshold level were revealed. By employing the action spectra determined through the analysis of safety guidelines and standards, the damage thresholds for SC source could be compared with the corresponding exposure limits. Results The determined damage thresholds given in terms of the peak radiant exposure for exposure durations of 2.0 and 10.0 seconds were 2.1 x 10(3) and 7.4 x 10(3) J/cm(2), respectively. At threshold level, corneal damages involved the epithelium and the shallower stroma, and no obvious changes could be found in the deep stroma, Descemet's membrane, and endothelium. Conclusions The exposure limits for the anterior parts of the eye in the wavelength range of 700-1,200 nm are overly conservative. The obtained results contribute to the knowledge base for the hazard evaluation of SC source. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Percutaneous Interstitial Nd:YAG Laser Therapy for Axillary Osmidrosis

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives To investigate the effects of percutaneous interstitial Nd:YAG laser irradiation on the apocrine glands and molecules involved in odor production (apolipoprotein [ApoD], androgen receptor [AR]) in the subcutaneous tissue of a pig. Study Design/Materials and Methods Skin on the back of healthy adult miniature pigs was exposed to pulsed Nd:YAG laser irradiation at 5 or 10 W, or continuous Nd:YAG laser irradiation at 10 W. Samples were taken 1 hour, 1 week, and 1 month after treatment for histology, western blot, and real-time quantitative polymerase chain reaction (qRT-PCR) analysis. Results One week and 1 month after irradiation, the apocrine glands in pigskin became rounded, glandular cells were shorter, and the glandular cavities were larger compared with controls, but there were no obvious changes in fat cell distribution of collagen around the apocrine glands. One month after irradiation at 10 W in continuous mode, there was a significant decrease in ApoD expression in apocrine cells and ApoD and AR protein and expression levels in pigskin compared with controls. There were also significant differences in ApoD and AR protein and expression levels between treatments. Conclusions Percutaneous interstitial Nd:YAG laser irradiation has potential as a safe and efficacious treatment for axillary osmidrosis as it may decrease the production of volatile unsaturated fatty acids, steroids, and associated unpleasant odors in the axilla. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Improvement of Surgical Scars by Early Intervention With Carbon Dioxide Fractional Laser

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives Laser therapy during the early stage of wound healing can reduce surgical scar formation. Previous clinical trials showed that ablative fractional laser (AFL) therapy might have achieved the best outcomes; however, there was no consensus on the laser therapy protocol. The current study investigated the efficacy of early intervention with carbon dioxide FL (CO2 FL) in reducing the surgical scars in patients of all age groups to understand the effects of specific intervention timing, light dose, number of treatments, treatment interval on the therapeutic outcome, and side effects. Study Design/Materials and Methods Within 1 week after suture removal, 18 patients received low-energy CO2 FL therapy on their incisional wounds from facial or neck surgery. The treatments were performed once every 3 months for 1-3 sessions. After the surgical treatment, we applied a topical gel that contained recombinant human epidermal growth factor (EGF) on the incisional wounds to facilitate wound healing. The outcomes were evaluated by the Vancouver Scar Scale (VSS) and a satisfaction survey (the quartile grading scale) before and 3 months after completing the therapy was conducted. During the same period, 15 patients who had not received any treatment for about one year after face and neck surgery were randomly selected as the untreated control group. Results In the treatment group, 18 patients had no obvious scar marks after the laser therapy. The satisfaction survey showed excellent outcomes in 16 (88.9%) patients and good outcomes in two (11.1%). After treatment, the average VSS scale and satisfaction score of the treatment group were 1.11 and 3.89, respectively; while the average VSS scale of the control group was 3.07 and the satisfaction score was 1.93. There were significant differences in VSS scale and satisfaction score between the treatment group and the control group (P < 0.01). No adverse effects were observed. Conclusions Early intervention with CO2 FL on surgical wounds achieved satisfactory outcomes in improving the surgical scars. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Percutaneous Laser Ablation of Hepatic Tumors Located in the Portacaval Space: Preliminary Results

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives Limited data have been used to evaluate the feasibility and effectiveness of percutaneous laser ablation (PLA) (a modality that has been proven to be a safe method for tumors in high-risk locations) for hepatic tumors in the space between the portal vein and inferior vena cava (IVC). The goal of this study was to investigate the characteristics and therapeutic effectiveness of ultrasound-guided PLA of hepatic tumors in the portacaval space. Study Design/Materials and Methods Ten patients, who had hepatic tumors in the portacaval space (defined as tumors located in the space formed by the hepatic portal vein and IVC less than 5 mm from the margins of both vessels), receiving ultrasound-guided PLA between January 2016 and June 2017 were analyzed. Tumors in the type I portacaval space were enclosed on three sides of major vessels, and tumors in the type II portacaval space were enclosed on two sides of major vessels. The technical success, treatment response, complete tumor ablation (CTA), local tumor progression (LTP), and distant tumor recurrence (DTR) were assessed and recorded at the follow-up. Results The mean tumor diameter was 1.8 +/- 0.4 cm. Technical success and initial CTA were achieved in all 10 patients without major complications. The 6-month and 12-month LTP rates were 0% and 10%, respectively. The DTR rate was 20% at both the 6- and 12-month follow-ups. Conclusions The preliminary results showed that ultrasound-guided PLA was feasible and safe for tumors in the portacaval space, and further studies on larger populations with a longer follow-up are needed to delineate the use of PLA and evaluate its therapeutic efficacy. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Characterization of Laser-Resistant Port Wine Stain Blood Vessels Using In Vivo Reflectance Confocal Microscopy

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives Port wine stain (PWS) is a congenital vascular malformation of the human skin. Laser is the treatment of choice for PWS. Laser-resistant PWS is one crucial factor accounting for inadequate treatment outcome, which needs to be fully characterized. This study aims to quantitatively characterize the morphology of laser-resistant PWS blood vessels in the upper papillary dermis using in vivo reflectance confocal microscopy (RCM). Study Design/Materials and Methods A total of 42 PWS subjects receiving laser treatment from August 2016 through July 2018 were enrolled into this study. Thirty-three subjects had facial PWS; nine had extremity PWS. All subject's PWS received multiplex 585/1,064 nm laser treatment. RCM images were taken before and after treatment. The density, diameter, blood flow, and depth of PWS blood vessels were analyzed. Results We found 44.4% PWS on the extremities (four out of nine subjects) were laser-resistant, which was significantly higher (P < 0.001) when compared with those PWS on the face (15.2%, 5 out of 33 subjects). The laser-resistant facial PWS blood vessels had significantly higher blood flow (1.35 +/- 0.26 U vs. 0.89 +/- 0.22 U, P < 0.001), larger blood vessel diameters (109.60 +/- 18.24 mu m vs. 84.36 +/- 24.04 mu m, P = 0.033) and were located deeper in the skin (106.01 +/- 13.87 mu m vs. 87.82 +/- 12.57 mu m, P < 0.001) in the skin when compared with laser-responsive PWS on the face. The average PWS blood vessel density (17.01 +/- 4.63/mm(2) vs. 16.61 +/- 4.44/mm(2), P = 0.857) was not correlated to the laser resistance. Conclusions Laser-resistant PWS blood vessels had significantly higher blood flow, larger diameters, and were located deeper in the skin. RCM can be a valuable tool for a prognostic evaluation on laser-resistant lesions before treatment, thereby providing guidance for tailored laser treatment protocols, which may improve the therapeutic outcome. The limitations for this study include relative small sample size and acquisitions of different blood vessels before and after 2 months of treatment. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Single-Fiber Laser Ablation in Treating Selected Metastatic Lymph Nodes of Papillary Thyroid Carcinoma and Benign Cold Thyroid Nodules-Preliminary Results

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives To evaluate the feasibility and efficacy of single-fiber laser ablation (LA) under ultrasound guidance and appropriate ablation modes in the treatment of selected metastatic lymph nodes of papillary thyroid carcinoma (PTC) and benign cold thyroid nodules Study Design/Materials and Methods A total of 18 patients (consisting of 8 patients with 18 metastatic lymph nodes of PTC and 10 patients with 10 benign cold thyroid nodules) each underwent one session of single-fiber LA under ultrasound guidance. On the basis of the sizes of the nodules, the ablation modes were chosen accordingly. The single-dot ablation mode was used in the nodules with three orthogonal diameters measuring no greater than 10 mm in diameter, with a dot, a level and an insertion. The double-dots overlapping ablation mode was used in the nodules with the largest diameters measuring greater than 10 mm (in which the nodules measured no more than 15 mm in diameter and with the other two perpendicular diameters measuring no greater than 10 mm in diameter) with two dots, a level and two insertions. The multiple levels and dots overlapping ablation mode was used in the nodules with the three orthogonal diameters all measuring larger than 10 mm, with multiple dots, levels and insertions. Results After 12 months of follow-up in the treated nodules of the metastatic lymph nodes of PTC and benign cold thyroid nodules, the mean baseline volumes decreased from 0.29 +/- 0.12 to 0.03 +/- 0.03 ml and 3.85 +/- 0.64 to 1.1 +/- 0.37 ml, respectively, and the mean volume reduction ratios (VRRs), which was calculated as {[(initial volume-final volume) x 100%]/initial volume}, were 90.3 +/- 7.6% and 72 +/- 5.8%, respectively. There were six ablative zones that completely disappeared, whereas the ablative zones that still existed presented as scar-like areas or small hyperechoic areas that were compatible with scar tissue among the 18 malignant nodules at the last follow-up. Conclusions Single-fiber LA under ultrasound guidance, with the appropriate ablation modes, is feasible and effective for the treatment of selected metastatic lymph nodes of PTC and benign cold thyroid nodules. This study suggests that single-fiber LA may be applied to selected cases with appropriate ablation modes. Lasers Surg. Med. 2019 (c) 2019 Wiley Periodicals, Inc.

Prevention of Local Tumor Recurrence After Surgery by Thermosensitive Gel-Based Chemophotothermal Therapy in Mice

期刊: LASERS IN SURGERY AND MEDICINE, 0; ()

Background and Objectives Local recurrence of cancer after surgery has long been a tough problem. In the present study, thermosensitive gel-based chemophotothermal therapy was applied to prevent the recurrence of liver cancer after surgery. Study Design/Materials and Methods Mesoporous silica nanoparticles (MSNs) were used as first-level carrier to co-load doxorubicin (DOX) and ICG. Then, the drug-loaded MSNs (D-I@MSN) were incorporated into poloxamer gel. A mimic model of liver cancer recurrence after surgery was prepared by subcutaneously injecting H22 cells into the armpit of mice. Then the two-level composite gel (D-I@MSN/gel) was also subcutaneously injected at the same site before the formation of tumor, followed by 808 nm laser irradiation. Results The loading efficiency and entrapment efficiency of DOX were as high as 8.85% and 96.9%, and that of ICG were 9.24% and 99.3%, respectively. The results of in vitro cytotoxicity showed that cell viability in D-I@MSN+Laser group was only 5.8% after being irradiated by 808 nm laser for 5 minutes (0.5 W/cm(2)). In animal studies, tumor formation (tumor recurrence) was greatly inhibited in D-I@MSN+Laser group. Conclusions The thermosensitive gel-based chemophotothermal therapy showed excellent safety and efficacy when applied in the prevention of mimic local tumor replase after surgery in mice, presenting its great potential clinically. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

Effects of Different 980-nm Diode Laser Parameters in Hepatectomy

期刊: LASERS IN SURGERY AND MEDICINE, 2019; 51 (8)

Background and Objective Despite the successful application of laser in animal experiments and clinics, the adjustment of laser parameters during surgery is still unclear. This study aimed to investigate the effect of different 980-nm diode laser parameters in hepatectomy. This could provide a clear protocol for using 980-nm diode laser in hepatectomy. Study Design/Materials and Methods In total, 48 Sprague-Dawley rats were used to explore the effects of different 980-nm diode laser parameters in hepatectomy, by setting different parameter combinations. The rats were randomly divided into eight groups, including the continuous wave group and quasi-continuous wave group. The effects were assessed in terms of liver resection speed, extent of intraoperative bleeding, and thermal damage. Results In the quasi-continuous wave group, there was a significant difference in resection speed at the different laser parameters (P < 0.001); however, there was no significant difference in intraoperative bleeding and thermal damage. In the continuous wave group, there was a significant difference in resection speed, intraoperative bleeding, and thermal damage at different parameters. Conclusion The study showed that the average power determined hemostasis efficiency and thermal damage, and peak power determined the liver resection speed, whereas the pulse width and repetition frequency are not independent factors. When using 980-nm diode laser in hepatectomy, the average power should be decreased to prove hemostasis efficiency in delicate operations, and the peak power should be decreased to accelerate the procedure without worsening thermal damage. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

JIF:3.26

The Value of Confocal Laser Endoscopy in Assessing the Quality of Duodenal Ulcer Healing

期刊: LASERS IN SURGERY AND MEDICINE, 2019; 51 (8)

Background and Objective Confocal laser endomicroscopy (CLE) is a novel endoscopic technique that can image cells and subcellular layers of the gastric mucosa in vivo. We aimed to investigate the value of CLE in assessing the quality of ulcer healing (QOUH) and preliminarily establish evaluation criteria. Materials and Methods Patients with duodenal ulcers were enrolled. After duodenal ulcer healing, we compared the value of CLE and white light endoscopy (WLE) in assessing the QOUH by using the histopathological diagnosis as the gold standard. At the same time, immunohistochemistry was performed to examine the expressions of transforming growth factor beta 1 (TGF-beta 1) and fibroblast growth factor 2 (FGF-2) in normal and scar tissues. Results In assessing the QOUH classified as poor, good, and excellent by the pathological classification, the sensitivity of WLE was 57.14%, 50%, and 47.06%, the specificity was 87.80%, 52.38%, and 81.58%, and the accuracy was 80.00%, 50.91%, and 70.91%, respectively. Meanwhile, the sensitivity of CLE was 73.33%, 85.19%, and 92.31%, the specificity was 95%, 85.71%, and 92.86%, and the accuracy was 89.09%, 85.45%, and 92.73%, respectively. The kappa value for the correlation with pathological diagnosis grade was 0.38 for WLE vs. 0.74 for CLE. The assessment of the QOUH in the CLE image classification showed great improvement compared with that in the WLE image classification. The image classification of CLE was not associated with the immunohistochemical expression of TGF-beta 1 or FGF-2 according the Spearman rank correlation (P > 0.05). Conclusion Compared with WLE, CLE has a higher value in assessing the QOUH. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

JIF:3.26

Treatment of Cafe-Au-Lait Spots Using Q-Switched Alexandrite Laser: Analysis of Clinical Characteristics of 471 Children in Mainland China

期刊: LASERS IN SURGERY AND MEDICINE, 2019; 51 (8)

Background and Objectives Cafe-au-lait spots, also known as cafe-au-lait macules (CALMs), are a common pigmentary disorder. Although various laser modalities have been used to treat CALMs, the efficacy of laser treatment in children differs from that in adults. We investigated the efficacy, safety, and clinical factors of the treatment of CALMs using Q-switched alexandrite laser (755 nm) therapy in children. Methods In total, 471 children with CALMs underwent Q-switched alexandrite laser therapy at a treatment interval of 3-12 months. The safety and efficacy of the laser treatment were evaluated by reviewing clinical records and photographs before and after treatments. Results Of the 471 patients, 140 (29.72%) were cured completely, 124 (26.33%) showed substantial improvement, 110 (23.35%) showed improvement, and 97 (20.60%) showed no improvement after one to nine treatments. The overall treatment success rate was 79.41%, and the treatment efficacy was positively correlated with the number of laser treatments (rs = 0.26, P < 0.0001). Sex and the interval of laser treatments were also associated with significant differences in treatment outcomes (P < 0.05). No obvious adverse effects were observed. Multivariate logistic regression analysis showed that the number of treatments influenced the treatment efficacy (odds ratio, 2.130; 95% confidence interval, 1.561-2.908). Conclusions Q-switched alexandrite laser (755 nm) therapy is safe and highly effective for CALMs in children, and the number of treatments affects the treatment efficacy. Lasers Surg. Med. (c) 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

JIF:3.26

A Prospective Study in the Treatment of Lentigines in Asian Skin Using 532 nm Picosecond Nd:YAG Laser

期刊: LASERS IN SURGERY AND MEDICINE, 2019; 51 (9)

Background and Objective To evaluate safety and efficacy of treatment with the picosecond Nd:YAG 532 nm for lentigines in Asian skin. Study Design/Materials and Methods This was a prospective, open-label cohort study, using a novel picosecond 532-nm laser for the treatment of facial lentigines. Subjects received up to three laser treatments every 4-6 weeks and were assessed at 4 and 12 weeks after final treatment. Primary endpoint was degree of improvement in lentigines at 12 weeks after the final treatment, assessed by treating investigator based on Physicians Global Assessment. Secondary end-points included degree of improvement in lentigines at 12 weeks after final treatment, assessed by subject (Subject's Global Assessment), and change in mean relative Melanin index (MI) value at 3 months after final treatment as compared to baseline as assessed by mexameter measurement. Results A total of 20 patients (3 male, and 17 female) of Asian-descent with Fitzpatrick skin type III and IV, with lentigines on the face were included in this study. A total of 89 lesions were treated with the laser setting of 532-nm, 750 picoseconds, fluence of 0.2-0.5 J/cm(2), and spot size of 4 mm. One hundred and thirty-seven treatment sessions were given in total. Eighteen patients (90%) achieved a moderate to significant improvement at 12-week follow-up based on a 5-grade physician global assessment scale. The improvement rate of relative MI (MI in the lesion minus normal skin) was 33.30 +/- 18.71 and 37.63 +/- 19.25% at 4- and 12-week follow-up. Post-inflammatory hyperpigmentation (PIH) occurred in 14 of 137 sessions (10.2%), and hypopigmentation occurred in one patient with five lesions (3.6%). Conclusion This study demonstrates that using picosecond Nd:YAG laser 532 nm for removal of solar lentigines in darker skin type appears to be safe and effective. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc. Limitations Small study group.

JIF:3.26

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