Clinical Papers & Articles

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GLAUCOMA

Selective Laser Trabeculoplasty as a Substitute for Medications in Patients with Mild-to-moderate Glaucoma in the Brazilian Public Health System
Leopoldo Ernesto Oiticica Barbosa, MD, Wilma Lelis Barboza, PhD, Ricardo Paletta Guedes, PhD, Clarissa dos Reis Pereira, MD, Remo Susanna Jr, PhD, and Marcelo Hatanaka, PhD
J Glaucoma 2024;33:303–309

Précis: Selective laser trabeculoplasty can be used as a substitute for medications in patients with mild-to-moderate glaucoma, reducing the cost of eye drop distribution in the Brazilian public health system.

Purpose: To observe the effectiveness of selective laser trabeculoplasty (SLT) as a substitute for eye drops in patients with open angle glaucoma in the Brazilian Public Health System.

Materials and Methods: SLT was performed bilaterally after medication washout. This is a prospective interventional study comparing intraocular pressure (IOP) when using eye drops at baseline (post-washout), and at 12-month follow-up after SLT. Medication was added if the target IOP was not achieved, following the Brazilian Public Health System eye drops protocol, based on medication costs. Absolute (without eye drops) and qualified (with eye drops) success were measured with IOP ≤ 21, IOP ≤ 18, IOP ≤ 15 and IOP ≤ 12 mm Hg. Besides IOP evolution, the ability to reduce IOP (in %), and eye drops reduction were evaluated.

Results: Ninety-two eyes of 46 patients were included, 70 eyes with mild glaucoma and 22 with moderate glaucoma; the mean number of eye drops was 2.26±1.06 (82.6% were using a prostaglandin analogue), and post-washout IOP of 21.10 ± 5.24 mm Hg. There was relative success at IOP ≤ 18 mm Hg, where the mild group had greater success than the moderate group (88.1% vs. 71.4%, P = 0.824). The average IOP reductions were 23.04% and 25.74% at 6 and 12 months, respectively. The average number of eye drops was 1.02, with 1.1% using a prostaglandin analogue. Furthermore, 68.19% of the patients had a decrease in the quantity of eye drops used.

Conclusion: SLT is effective in reducing IOP and replacing eye drops in patients in the Brazilian Public Health System. Moreover, there was a significant reduction in the use of prostaglandin analogues.

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Evaluation of selective laser trabeculoplasty effectiveness in cases with pseudoexfoliation glaucoma and ocular hypertension
Hakan Ozturk, Bediz Ozen
Eur Eye Res 2024;4:51-56

Purpose: The aim of the study was to evaluate and compare the effectiveness of a single-session of 180° selective laser trabeculoplasty (SLT) as primary treatment in newly diagnosed cases with pseudoexfoliation glaucoma (PEG) and ocular hypertension (OHT).

Methods: Thirty-six eyes of 36 PEG cases (PEG-group) and 32 eyes of 32 OHT cases (OHT-group) were included in the study. Intraocular pressure (IOP), central corneal thickness (CCT), and endothelial cell count (ECC) were noted at baseline and post-SLT 3rd month. IOP reduction and success rates were detected. Inter and intragroup comparisons were made

Results: At baseline, age and gender distributions of groups were similar (P>0.05). Baseline IOP was 26.7±1.6 in PEG-group and 27.2±1.2 mmHg in OHT-group (P=0.648). In both groups, there was a significant decrease in IOP at 3rd month compared to baseline (P<0.001). IOP at 3rd month was 18.9±1.1 in PEG-group and 19.6±0.6 mmHg in OHT-group (P=0.507). IOP reduction rate (29.2% vs. 27.9%, P=0.807) and success rate (69.4% vs. 75%, P=0.846) were similar in PEG-group and OHT-group. Baseline CCT was 541.4±25.3 in PEG-group and 543.3±22.1 μm in OHT-group (P=0.581), while baseline ECC was 2496.5±231.8 and 2512.3±242.7 cells/mm2, respectively (P=0.324). In groups, no significant change was detected in CCT and ECC values at 3rd month compared to baseline (P>0.05). IOP, CCT, and ECC values of groups were similar at 3rd month (P>0.05).

Conclusion: We found that single-session of 180° SLT was similarly effective in reducing the IOP in newly diagnosed PEG and OHT cases. We also detected that it was safe for cornea and could be used as primary treatment in newly diagnosed cases.

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Comparison of the short-term results of nasal and temporal 180° selective laser trabeculoplasties for open-angle glaucoma
Jayter Silva Paula, Cassia Senger, Carlos Gustavo de Moraes
Arquivos Brasileiros de Oftalmologia 2023; 86 (3): 217-22
 
Purpose: The nasal sector of the anterior chamber angle may present a higher density of collector channels, which may influence the results of angle surgeries. Considering the anatomical differences in the anterior chamber angle, we compared the results of the nasal and temporal 180° selective laser trabeculoplasty approaches for open-angle glaucoma.
 
Methods: A retrospective chart review was conducted for patients with open-angle glaucoma (primary, pseudoexfoliation, and pigmentary) who underwent at least one 180° selective laser trabeculoplasty session between December 2016 and October 2018. The nasal (N1) or temporal (T1) sectors were chosen at the physician’s discretion. Patients who did not experience decreased intraocular pressure between 3 and 6 months again underwent 180° selective laser trabeculoplasty in the opposite angle sector (T2 and N2). The main outcome measured was decrease in intraocular pressure at 6-month follow-up, after the last selective laser trabeculoplasty. A multivariable regression analysis was used to evaluate factors associated with decreased intraocular pressure after treatment.

Results: The procedure was performed initially in 45 eyes (N1, 25; T1, 20 eyes) and repeated in the opposite anterior chamber angle sector in 19 eyes (N2, 11; T2, 8 eyes). Analysis of variance revealed that only the N1 approach presented a significant difference in the decrease in intraocular pressure as compared with the T1, N2, and T2 approaches (p=0.0014). The baseline intraocular pressure (p=0.021) and anterior chamber angle sector (N1; p=0.044) correlated with decreased intraocular pressure.

Conclusion: Compared with the temporal approach, 180° selective laser trabeculoplasty performed initially in the nasal sector was associated with a more significant decrease in intraocular pressure. Considering the sectorial differences in the anterior chamber angle, further prospective trials are warranted to confirm our findings and provide more-efficient selective laser trabeculoplasty protocols.
 
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Alina Bakunowicz-Lazarczyk, Beata Urban, Malgorzata Kretowska
Journal of Ophthalmology, Volume 2022, Article ID 4068026, 8 pages
 
Purpose: To evaluate the efficacy of laser peripheral iridotomy (LPI) in preventing deterioration in eyes with ocular hypertension (OHT) and concave configuration of the iris. 
 
Materials and Methods: This was a retrospective study, which was carried out within a period of 3–5 years. Twenty-four patients with OHT and concave irises were treated with LPI and followed up periodically. IOP, central corneal thickness (CCT), anterior chamber depth (ACD), scleral spur angle (SSA), global neuroretinal rim (NRR) thickness, and global retinal nerve fiber layer (RNFL) were examined before and after LPI. 
 
Results: The average age of the 24 patients was 14.21 ± 1.41 (13–17.5) years on admission. The initial IOP of the 48 eyes was 23.21 ± 1.56 mmHg in RE and 22.96 ± 2.1 mmHg in LE before LPI. All 48 eyes had concave irises in both eyes. All eyes treated with LPI have shown iris flattening, which has persisted during follow-up (mean 1.54 ± 0.9 years). At the last follow-up visit, the average IOP was 17.58 ± 2.63 (14–21) mmHg in RE and 17.58 ± 2.86 (14–21) mmHg in LE, which was statistically lower than that of the baseline (). There were significant changes in SSA in both eyes and global RNFL in RE after LPI. 
 
Conclusions: In the current study, LPI resulted in an IOP-lowering effect and iris flattening in adolescent eyes with a concave configuration of the peripheral iris.
 
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Bediz Özen, Hakan Öztürk & Berna Yüce
Int Ophthalmol. 2020 Jan 7.

Purpose: To compare the effects of 180° and 360° selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and cornea in patients with bilateral primary open-angle glaucoma.

Methods: Fifty-two eyes of 26 patients were included. On the same day, 180° SLT (Group 1) was applied to one eye of patients and 360° SLT (Group 2) to the other eye. IOP values were compared at pre-SLT and post-SLT 1 day, 1 week, 1, 3, and 6 months. Changes in central corneal thickness (CCT) and endothelial cell count (ECC) were examined.

Results: In groups, significant decreases were observed in IOP at 1 week (p < 0.05), 1, 3, and 6 months (p < 0.001). No significant difference was determined between group 1 and 2 in IOP-lowering effectiveness or success rates (p > 0.05). There was no significant difference in CCT at inter- or intragroup comparisons (p > 0.05). In group 1, no significant difference was determined in pre- and post-SLT ECC (p > 0.05). In group 2, significant decrease in ECC was observed at 1 week (p < 0.05). However, ECC returned to its initial levels at 1 month.

Conclusions: To the best of our knowledge, this is the first study in literature to compare different quadrant SLT applications performed on both eyes, on the same day, in the same patient group and to compare the effects of those applications on IOP and cornea. In reducing IOP, 180° and 360° SLT are similarly effective. These effects begin on the 1st week and persist for 6 months. Temporary corneal changes may be observed following 360° SLT.

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Selective Laser Trabeculoplasty vs Micropulse Laser Trabeculoplasty for the Treatment of Open Angle Glaucoma and Ocular Hypertension
Dr. Marcela Irene De Leon De Leon, Dr. Jose Francisco Ortega Santana, Dr. Alfonso Garcia Lopez
International Journal of Research in Medical and Health Sciences - February 2017, Vol 14, No 01-2017

Abstract: Controlled, prospective, longitudinal, clinical trial with the objective to compare the efficacy of the micropulse laser trabeculoplasty (MLT) and the selective laser trabeculoplasty (SLT) in patients with open angle glaucoma or ocular hypertension. Patients were divided into two groups depending on the laser procedure, the group 1 was treated with SLT and the group 2 was treated with MLT; then they were followed for 3 months. 67 eyes were included in the trial (SLT: 38 eyes of 24 patients and MLT: 29 eyes of 19 patients). The average of age of the patients treated with SLT was 68.4 ± 8.8 years and with MLT 77.7 ± 7.3 years. The previous IOP was similar in both groups (SLT: 19.53 ± 4.03 mmHg, MLT: 19.76 ± 4.23 mmHg), a week after treatment (SLT: 18.53 ± 4.08 mmHg, MLT: 17.14 ± 5.19 mmHg), at month (SLT: 14.79 ± 2.42 mmHg, MLT: 16.26 ± 3.39 mmHg) and at 3 months (SLT: 15.66 ± 2.48 mmHg, MLT: 15.83 ± 3.19 mmHg). The percentage of IOP reduction was 19.81% with SLT and 19.89% with MLT. There was no statistically significant difference between the average IOP of both groups over 3 months of follow up. There was no difference in the number of drugs previous and posterior to the procedures, and there was not observed complications at any of the groups. The IOP-lowering effect of SLT and MLT was similar over 3 months in this group of patients and both proved to be safe procedures. 

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RETINA

Subthreshold Laser Therapy for CSCR
Rami Madani, BS; Adam Ayoub, BS; Tarek Alasil, MD
Retina Today - November/December 2024 Issue

Conclusion: The 577 nm subthreshold laser therapy is a viable option for treating cases of CSCR recalcitrant to standard laser photocoagulation therapy. It can also be done in most outpatient retina clinics, which typically lack the resources and equipment to perform PDT. Large-scale studies should focus on expanding the use of the 577 nm subthreshold laser in the management of CSCR; specifically, there is a need for clinical trials to directly compare its safety and efficacy with that of laser photocoagulation to firmly establish its position within the spectrum of available treatments for CSCR.
 
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Wataru Kikushima, Yukiko Furuhata, Taiyo Shijo, Mizuki Matsumoto, Yoichi Sakurada, Daphne Viel Tsuru, Kenji Kashiwagi
Science Direct, Photodiagnosis and Photodynamic Therapy 51 (2025) 104430

Purpose: To evaluate the treatment outcomes of subthreshold micropulse laser (SMPL) with a wavelength of 670 nm (red) for treatment-naïve diabetic macular edema (DME).

Methods: A retrospective observational study which included 42 eyes in 34 patients diagnosed with treatment- naïve DME was conducted. Twenty-one eyes underwent red SMPL and the other 21 eyes underwent intravitreal injection of aflibercept (IVA) as initial treatment and were followed up for 12 months. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) on optical coherence tomography (OCT), vessel density (VD), and foveal avascular zone area on OCT angiography (OCTA) were measured and compared between the two groups.

Results: In the red SMPL group, the mean BCVA slightly improved from 0.29 ± 0.28 at baseline to 0.22 ± 0.29 at 12 months (p = 0.18), while the mean CRT significantly decreased from 472 ± 200 μm at baseline to 320 ± 136 μm at 12 months (p = 0.003). At 12 months from baseline, the mean change in BCVA and CRT were similar between the red SMPL and IVA groups (p = 0.79 and p = 0.31, respectively). No significant change was detected in OCTA parameters except for VD at the nasal section in the red SMPL group.
 
Conclusion: Red SMPL for treatment-naïve DME maintained BCVA and significantly reduced CRT at 12 months. These treatment outcomes were equivalent to IVA in real-world settings, which tend to be inferior to clinical trials.
 
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Ameen Marashi, Aya Zazo
Annals of Medicine and Surgery 80 (2022) 104222
 
Background: Diabetic patients suffer from reduction of vision that one of its main causes is clinically significant macular edema (CSME). The purpose of this study is to determine if hybrid threshold can reduce macular thickness in Diabetic Macular Edema.
 
Materials and Methods: This study is a retrospective analysis single center cohort study. 12 eyes in 10 patients diagnosed with diabetic macular edema using SD-OCT treated with Hybridthreshold laser as the leaking microaneurysms were treated with threshold laser on the 5% duty cycle settings. A complete fundus exam, including best-corrected visual acuity changes, and monthly measuring retinal thickness using SD-OCT for 24 weeks follow up.
 
Results: Reduction of retinal thickness from 336.58 ± 86.26 μm to 264.33 ± 61.41 μm (p = 0.02) at 24 weeks follow up without significant changes of best-corrected visual acuity from 0.16 LogMAR to 0.08 LogMAR (p = 0.2) with minimal scar formation in 24 weeks follow up.
 
Conclusion: 532 nm Hybridthreshold laser reduces macular thickness up to 20% and stabilizes diabetic macular edema for 24 weeks follow up.  
 
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Wataru Kikushima, Taiyo Shijo, Yukiko Furuhata, Yoichi Sakurada, Kenji Kashiwagi
Pharmaceuticals 2021, 14, 1100
 
Abstract: We investigated the efficacy and safety of red (670 nm) subthreshold micropulse laser (SMPL) treatment for diabetic macular edema (DME) and compared the 1-year treatment outcomes of red and yellow (577 nm) SMPL for DME. A medical chart review was performed in 43 consecutive eyes of 35 patients who underwent red or yellow SMPL treatment for DME and were followed up for 12 months. There were 26 and 17 eyes in the yellow and red SMPL groups, respectively. The mean best-corrected visual acuity (BCVA) was maintained throughout the follow-up period of 12 months in the yellow and red SMPL groups (p = 0.39, p = 0.70, respectively). The central retinal thickness (CRT) measured by spectral-domain optical coherence tomography (SD-OCT) was significantly decreased at 12 months from baseline in the yellow and red SMPL groups (p = 0.047, p = 0.03, respectively). Although the amount of CRT reduction in the red SMPL group was significantly greater than that in the yellow SMPL group at 8 months from baseline (p = 0.02), the significance disappeared at the final follow-up period (p = 0.44). The red SMPL maintained the BCVA in patients with center- involving DME. The mean CRT in the red SMPL group significantly decreased, and the amount of CRT reduction was equivalent to that in the yellow SMPL group.
 
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Dr. Tarek Alasil
Retina Today - May/June 2020 Issue
 
Conclusion: In addition to its application in pan retinal photocoagulation and laser retinopexy, the yellow wavelength is effective and safe in the treatment of macular edema. The SP-Mode® Microsecond Laser Technology has a better safety profile when treating the central macula. SP-Mode® is a viable treatment option in glaucoma patients with macular edema.
 
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Wataru Kikushima, Yasushi Tateno, Yukiko Furuhata, Taiyo Shijo
Yamanashi University, Poster Presentation at the 36th Annual Meeting of Japanese Society for Ocular Circulation, 2019
 
Introduction: First line of therapy on Diabetic Macular Edema(DME) is intravitreal injection(anti-VEGF). However, because of medical cost and repeat treatment, it is difficult to treat and other treatment still remains demands as alternative treatment. Subthreshold pulsed laser treatment is safety treatment which does not damage photoreceptor cells and it is treated on some retinal diseases including DME. Thought there are many publications of subthreshold pulsed laser treatment on DME, there are few publications which compares focal laser treatment.
 
Purpose: To evaluate the long-term functional anatomical effects and safety of yellow wavelength subthreshold pulsed laser treatment on DME.
 
Method: 47 eyes (male: 30, female: 17, mean = 64.3±9.9 years, Jan. 2010 - Apr. 2018). Visual acuity: less than 0.8, CRT: more than 350μm, center-involving DME, Patients who were treated on DME treatment past 4 months were excluded. Conflict of Interest (COI) of the Principal Presenter: No potential COI to disclose. Cases that received treatment for ME (STTA, anti-VEGF drugs, PC) in the last 4 months were excluded. Monthly follow-up was performed, and retreatment was performed if ME with a CRT of 350 μm or more remained. As primary endpoints, logMAR visual acuity at the first year of treatment and central retinal thickness (CRT) on optical coherence tomography (OCT) were compared with those pre-treatment.
 
Conclusion: Subthreshold Micro Pulsed Laser Treatment on DME is significant decrease on CRT after 1 year. Outcome on Visual acuity is limited.
 
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Comparison of Intravitreal Bevacizumab Alone Versus Combined Bevacizumab and Macular Photocoagulation in Diabetic Macular Edema
Çetin Akpolat, Ferhat Evliyaoğlu, Muhammed Mustafa Kurt, Burak Erden, Mustafa Nuri Elçioğlu
Turkey Clinical J Ophthalmol. 2018; 27 (3): 187-93 

Objective: To compare the efficacy of intravitreal bevacizumab with combined bevacizumab followed by sequential macular laser photocoagulation in the treatment of diabetic macular edema. 
 
Materials and Methods: Thirty-one eyes injected with intravitreal bevacizumab and 30 eyes with combined therapy of bevacizumab injection and macular laser photocoagulation were included in this retrospective study. The main outcome measures were visual acuity, central macular thickness and the number of injections.
 
Results: Each participant completed at least 6 months of follow-up. Baseline best-corrected visual acuity and central macular thickness values of the bevacizumab monotherapy group were similar to those of the combination group (P=0.64 and P=0.15, respectively). In bevacizumab monotherapy group, baseline best-corrected visual acuity (0.91 Β± 0.65 logMAR) improved to 0.73Β±0.55 logMAR at 3 months and to 0.68Β±0.53 logMAR at 6 months of follow-up (P=0.03). Baseline central macular thickness decreased from 431.65 Β± 108.19ΞΌm to 381.77 Β± 113.29ΞΌm at 3 months and to 366.82 Β± 105.13ΞΌm at 6 months (P=0.03). In the combination group, baseline best-corrected visual acuity improved from 0.84Β±0.63 logMAR to 0.55Β±0.48 logMAR at 3 months and to 0.41Β±0.46 logMAR at 6 months (P=0.01), while baseline central macular thickness decreased from 400.77 Β± 119.05ΞΌm to 287.10 Β± 67.99ΞΌm at 3 months and to 265.24 Β± 81.48ΞΌm at 6 months following the treatment (P=0.02).
 
Conclusion: Both treatment modalities were effective in improving visual acuity and reducing central macular thickness. Adding macular laser to intravitreal bevacizumab appeared to be superior to bevacizumab alone in eyes with diabetic macular edema.
 
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Anadi Khatri, Eli Pradhan, Sweta Singh, Roshija Rijal, Bal Kumar Khatri, Gyanendra Lamichhane, Muna Kharel
Clinical Ophthalmology - October 2018, Vol 2018:12, Pages 1963-1971

AIM: Subthreshold lasers have gained popularity in the treatment of chorioretinopathy central serous chorioretinopathy (CSCR) and yellow (577 nm) lasers have completely revolutionized the treatment. However, there is very little literature regarding the use of a more common and conventional – green (532 nm) subthreshold laser for the treatment of chronic CSCR. We report the use of green (532 nm) laser for the treatment of chronic CSCR and its outcome.

Methods: Eyes with nonresolving CSCR were treated with green subthreshold laser and evaluated at the end of 5 months. Visual acuity, central macular thickness (CMT), and macular volume (MV) at baseline and at 5 months following treatment were evaluated.


Results: Thirteen eyes with chronic CSCR were treated with green laser in SP-Mode™. The mean duration of CSCR was 7.64±3.77 months at the time of treatment. The median age of the patients was 41 (35–57) years. The baseline mean best-corrected visual acuity (BCVA) was 0.96 logMAR ± 0.17, with mean baseline CMT of 503.8 µm ± 181.9 and MV of 12.8 mm3 ± 3.81. The mean CMT at 5 months was 211 µm ± 31.7 and mean MV was 9.65 mm3 ± 0.60, correlating to a mean decrease of 292 µm ± 79 in CMT and mean decrease of 3.18 mm3 ± 1.87 in the MV from baseline (P<0.05). The mean BCVA after treatment was 0.18 logMAR±0.09 (P<0.05). Two cases of CSCR with pigment epithelial detachment (PED) also had complete resolution of both at 5 months.

Conclusion: Subthreshold green laser (532 nm) is a safe and effective modality for the treatment of chronic CSCR with very good and stable outcomes. It may also be beneficial in the treatment of PEDs.

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Jamshed Ahmed, Rommana Fasih
Journal of Pakistan Medical Association - May 2016, Vol 66, No 5

Objective: To determine the anatomical and functional improvement in eyes with diffuse macular oedema after modified mild macular grid laser.

Methods: The prospective study was conducted at the Department of Ophthalmology Unit II, Civil Hospital Karachi, and the Department of Ophthalmology, Dow International Medical College, Karachi, from June 2011 to May 2014. We used neodymium-doped yttrium aluminium garnet 532nm frequency-doubled green laser to treat all eligible patients. Treatment variables were a spot size of 50 microns, exposure duration of 0.1 seconds, and power sufficient to produce barely visible burns in a grid pattern. We treated the thickened retina and non-thickened area of the macula excluding central 500 micron. Microaneurysms within the macular areas were treated by focal application of laser shots sufficient to bleach them.

Results: The study comprised 86 eyes of 52 patients who were treated by applying 180 to 360 burns with a mean of 275±51. Mean macular thickness differed significantly between time points (Wilks' Lambda 0.139; F (2, 6) = 125.95; p = 0.00001). Mean visual acuity changed significantly between time points (Wilks' Lambda 0.535; F (4, 82) = 17.8; p = 0.00001). At the last follow-up, visual acuity improved at least one line in 32(37.2%) eyes, remained stable in 48(55.8%) eyes, and declined in 6(6.9%) eyes.

Conclusion: Modified mild macular grid is an effective and safe procedure for patients with diffuse diabetic macular oedema.

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Dr. Igor Remesnikov
Astana Vision, Astana City, Republic of Kazakhstan
 
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YAG & VITREOLYSIS

The benefits of Nd:YAG hyaloidotomy in the management of subhyaloid retinal hemorrhage
Gafar Folohunso Yusuf, Gbemisola Racheal Borisade, Ojoma Sopuruchi Onyeka
Niger J Ophthalmol 2024;0:0

Abstract: Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser hyaloidotomy is a noninvasive outpatient procedure in which the posterior hyaloid face is punctured and the opening enables the drainage of subhyaloid hemorrhage into the vitreous. The aim of the study was to advocate for timely intervention and quick visual restoration for patients with subhyaloid retinal hemorrhage, especially when patients present early. We report two cases of successful management of subhyaloid retinal hemorrhage using Nd:YAG laser hyaloidotomy, without any complications. The first patient was a primiparous woman who experienced spontaneous nasal bleeding during pregnancy, while the second patient had subhyaloid retinal hemorrhage secondary to ocular trauma. Nd:YAG laser hyaloidotomy is a relatively safe, office-based procedure that ensures faster visual recovery in patients with subhyaloid retinal hemorrhage. 

Conclusions: Nd:YAG laser hyaloidotomy is advocated for subhyaloid hemorrhage because it is a safe, noninvasive office-based procedure that restores vision faster than other modalities of management. 

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Renzo Cañote, Daniela Rodríguez, Luis Izquierdo Jr, Roger Moncada, Carmen Maldonado, Maria Alejandra Henriquez
The Pan-American Journal of Ophthalmology, January 23, 2020
 
Purpose: The purpose of the study was to evaluate the quality of life and visual results after yttrium aluminum garnet (YAG) vitreolysis in symptomatic vitreous floaters.

Methods: This was a prospective case series study including patients with symptomatic floaters attending the Oftalmosalud Institute of eyes and underwent YAG laser vitreolysis. All patients completed the National Eye Institute Visual Functioning Questionnaire 25 for the quality of life assessment and the presence of floaters as well as the measure of the visual acuity reported preprocedure and after 3‐month follow‐up. Statistical analysis was done using score 0–100 for each question, and a sign test for paired samples was used.

Results: Twenty eyes of 20 patients were evaluated. The comparisons for the questionnaire show an improvement in the general vision (P = 0.008), near vision (P = 0.001), and distance vision (P = 0.012). Furthermore, the dependency of glasses (P = 0.012), the score of mental health (P = 0.007), and the best visual acuity (P = 0.004) were improved. Patients who referred improvement in the quality of life were 75% pseudophakic patients and 25% phakic patients. The complications were high intraocular pressure and subcapsular cataract. 

Conclusions: Our study revealed a moderate improvement in floater symptoms and in quality of life and visual outcomes. 

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Carlos E. Souza, Luiz H. Lima, Heloísa Nascimento, Claudio Zett and Rubens Belfort Jr
International Journal of Retina and Vitreous, Volume 6, Article number: 1 (2020)
 
Background: To objectively evaluate YAG laser vitreolysis for symptomatic vitreous floaters using color photo imaging.
 
Methods: In this interventional and prospective study, 32 eyes of 32 patients with symptomatic vitreous floaters secondary to posterior vitreous detachment (PVD) were treated with a single session of yttrium aluminum garnet (YAG) laser. Primary outcomes were objective and subjective changes measured by masked grading of color fundus photographs and National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25), respectively. Secondary outcomes included Early Treatment Diabetic Retinopathy Study (ETDRS), best-corrected visual acuity (BCVA) and adverse events. Wilcoxon signed-rank test was used to analyze the results of the objective and subjective assessments at each time point. P < 0.05 was considered statistically significant.
 
Results: Thirty-two patients (32 eyes; 13 men and 19 women) with symptomatic vitreous oaters were enrolled in this study (mean age: 59.4 years). All study patients were followed up for 6 months. Following the laser vitreolysis, there was a statistically signi cant improvement in both the near visual function (z = − 2.97; p = 0.003; r = 0.633) and visual disturbance rate (z = − 3.97; p < 0.001; r = 0.84). Distance visual function did not show statistically significant difference after the laser procedure (p = 1.00). Color fundus photograph did reveal vitreous opacity improvement over time in 93.7% of study eyes (partial improvement in 37.5% and total improvement in 56.2% of study eyes). During the follow-up period, recurrence of vitreous oaters, BCVA deterioration and adverse events were not observed.
 
Conclusions: YAG laser vitreolysis decreased the amount of vitreous oaters opacities seen on color fundus imaging and improved related symptoms according to the NEI VFQ-25 responses.

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The Results of the Treatment of Floating Opacities of the Vitreous Body Using a YAG Laser System with a Coaxial Light Divider
B.M. Aznabaev, T.R. Mukhamadeev, A.A. Alexandrov, T.I. Dibaev, A.S. Vafiev, I.Kh. Shavaliev
Ophthalmology. 2018; 15 (4): 411-415
 
Purpose: To evaluate the removal efficiency of floating opacities of the vitreous body using the DIXION LPULSA SYL-9000 Nd: YAG laser system with a coaxial light divider.

Patients and methods: The study involved 24 patients (24 eyes) with floating opacities of the vitreous body according to the Weiss ring type. All patients underwent laser vitreolysis using the DIXION LPULSA SYL-9000 Nd: YAG laser system with a coaxial light divider at the OPTIMED Center for Laser Restoration. The age of patients ranged from 47 to 81 years (average 58.3 ± 8.9 years). Among patients, 15 (62.5%) women and 9 (37.5%) men. Before the operation, a comprehensive ophthalmological examination was carried out, which included visometry, autorefractometry, pneumotonometry, biomicroscopy, ophthalmoscopy, ultrasound echobiometry, ultrasound B-scanning. Statistical processing was performed in the application package Statistica v.10.0.0 (StatSoft®, Inc.) and Excel (Microsoft Office Professional 2016). Before surgery, patients were observed for three months. Control examination was performed one day after the operation.

Results: After a follow-up examination, all patients experienced a subjective improvement in visual quality. In 18 (75%) patients there was a complete disappearance of floating "flies". The remaining patients noted the disappearance of a large floating spot.

Conclusion: Laser vitreolysis using an Nd: YAG laser system with a coaxial light divider can improve quality and increase visual acuity in patients with floating opacities. The results obtained indicate the effectiveness of the use of this installation and allow us to recommend it for the treatment of symptomatic floating opacities in the destruction of the vitreous body.

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Laser Treatment for Eye Floaters Comes to St. George 

Dixie Ophthalmic Specialists at Zion Eye Institute 
Article courtesy of The Spectrum
Author: Nichole Osinski
April 2016
 
Products Featured: LIGHTLas SLT Deux + Vitreolysis 
C-H Peng, S-J Chen, C-C Tsai, F-L Lee, S-H Chiou, W-M Hsu
Eye 21, 433-435 (2007)

“We described two young patients with persistent fovea detachment after scleral buckling for long-term retinal detachment."

Treatment: LIGHTLas Nd:YAG (LIGHTMED, USA) subretinal membranotomy was performed with a wavelength of 1064 nm, a pulse width of 4 ns, and a focal plan of up to 250 mm anteriorly. After mounting the Golmann contact lens (Haag-Streit, UK), the laser was applied to the thinner part of a band far from the macula. The end point of treatment was disruption of a band with total six pulses of 5.0 mJ/pulse. Nd:YAG laser produces photodisruption, and it can be applied in disorders of posterior segment including subhyaloid haemorrhage, diabetic tractional retinal detachment, preretinal macular fibrosis, and vitreoretinal traction from horseshoe tears.

Conclusion: LIGHTMED's LIGHTLas YAG is a safe and effective procedure for sub retinal membranotomy. It can successfully disrupt a subretinal band to reattach the retina, and prevent the need for vitreoretinal surgery. For young patients with subretinal bands after a scleral buckle procedure, anatomic and visual outcomes of the subretinal membranotomy are encouraging.
 
Products Featured: LIGHTLas YAG

DENTAL

The “Er:YAG laser-assisted periimplantitis total therapy (Er:LPTT)”-a novel procedure to perform periimplantitis treatment with bone regeneration therapy 
Teichen Lin, Yoichi Taniguchi, Akira Aoki, Chun-Cheng Chen 
Journal of Dental Sciences Vol 16, Issue 4, October 2021, Pages 1302-1304

Background: Implant therapy improves masticatory performance and oral health-related quality of life and demonstrates a high success rate. However, plaque-induced periimplantitis is inevitable, and no standard protocol for periimplantitis treatment has been established yet. The Er:YAG laser is effective for implant surface debridement and has a bactericidal effect. It produces minimal thermal damage under a suitable energy output as the wavelength of the Er:YAG laser (2940 nm) is highly absorbed by water. In recent years, several studies have suggested favorable outcomes of treating periimplantitis with Er:YAG laser instead of using conventional plastic or titanium instruments, air-abrasion, or chemical methods. Conventionally, following implant surface debridement, a bone graft is placed in the bony defect and then occasionally covered with a non-resorbable or resorbable membrane for guided bone regeneration (GBR). Additionally, recent studies have demonstrated the Er:YAG laser-assisted bone regenerative therapy, in which Er:YAG laser irradiation on the blood and bone graft without water spray aids bone regeneration. Based on this technique, we described a novel procedure, the Er:YAG laser-assisted periimplantitis total therapy (Er:LPTT), which involved the total application of Er:YAG laser in various procedures of periimplantitis therapy, including from implant surface debridement, granulation tissue removal, and up to simultaneous regenerative therapy.

Products Featured: SAPPHIRE Dental Laser

Er:YAG laser-assisted flapless esthetic crown lengthening procedure: A case report
Min Yes Ng, Taichen Lin, Cheng-Chia Yu, Chun-Cheng Chen
Journal of Dental Sciences, October 2021
 
Background: Excessive gingival display (EGD) is a growing concern and is often considered to have a negative impact on the esthetics of a smile. Altered passive eruption is a common etiologic factor, in which the gingival margin is malpositioned incisally and does not approximate the cemento-enamel junction (CEJ), resulting in short clinical crowns and unfavorable appearance. In cases of EGD related to altered passive eruption, an esthetic crown lengthening procedure is required, which involves gingivectomy and/or osseous resection to re-establish an appropriate biological width of 3 mm. Conventionally, esthetic crown lengthening requires the gingiva to be contoured by scalpel and osseous surgery using a rotary instrument under a full-thickness flap; however, the procedure is time consuming, requires suturing, and sounds frightening, especially for anxious patients who are afraid of surgery. Recently, Er:YAG laser (ErL) has gained attention in several periodontal and peri-implantitis therapies1 because it can precisely ablate both soft and hard tissues with minimal thermal side effects. Additionally, ErL irradiation without water spray can coagulate blood well, which could be advantageous for bleeding control during surgery. Herein, we demonstrate a minimally invasive, flapless esthetic crown lengthening approach using ErL.


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Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Jung-Chang Kung, Chern-Hsiung Lai, Kun-Tsung Lee, Po-Sung Fu, Jeng-Hao Chen, I-Jui Chen, Dah-You Yan, Cheng-Chu Wang, You-Syun Jheng, Yi-Min Wu
 
Products Featured: SAPPHIRE Dental Laser
Hsien-Nan Kuo, Hsiang-I Mei, Tung-Kuan Liu, Tse-Ying Liu, Lun-Jou Lo, and Chun-Li Lin
Hindawi BioMed Research International, Volume 2017, Article ID 4732302, 7 pages
 
Abstract: This study constructs a standard in vitro laser treatment platform with dental implant thread surface on bacterial adhesion for peri-implantitis at different tooth positions. The standard clinical adult tooth jaw model was scanned to construct the digital model with 6 mm bone loss depth on behalf of serious peri-implantitis at the incisor, first premolar, and first molar. A cylindrical suite connected to the implant and each tooth root in the jaw model was designed as one experimental unit set to allow the suite to be replaced for individual bacterial adhesion. The digital peri-implantitis and suite models were exported to fulfill the physical model using ABS material in a 3D printer. A 3 mm diameter specimen implant on bacterial adhesion against Escherichia coli was performed for gram-negative bacteria. An Er:YAG laser, working with a chisel type glass tip, was moved from the buccal across the implant thread to the lingual for about 30 seconds per sample to verify the in vitro laser treatment platform. The result showed that the sterilization rate can reach 99.3% and the jaw model was not damaged after laser irradiation testing. This study concluded that using integrated image processing, reverse engineering, CAD system, and a 3D printer to construct a peri-implantitis model replacing the implant on bacterial adhesion and acceptable sterilization rate proved the feasibility of the proposed laser treatment platform.
 
Products Featured: SAPPHIRE Dental Laser
2019 International Congress on Adhesive Dentistry
Kaohsiung Medical University Hospital and Kaohsiung Medical University in Kaohsiung City, Taiwan
Kun-Tsung Denzel Lee, Jung-Chang Kung, Chern-Hsiung Lai, Po-Sung Fu, I-Hui Chen, Dah-You Yan, Cheng-Chu Wang, You-Syun Jheng, Yi-Min Wu
 
Products Featured: SAPPHIRE Dental Laser

DERMATOLOGY

Affordable DermaLight KTP Laser Delivers High Efficacy and Ease of Use
The Aesthetic Guide
Author: Jeffrey Frentzen
May/June 2017
 
Products Featured: DermaLight
The Aesthetic Guide
Author: Kevin A. Wilson
September/October 2015
 
Products Featured: DermaLight

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