Clinical Papers & Articles

Ophthalmology
Dental
Dermatology


GLAUCOMA

Comparison of the effects of 180° and 360° applications of selective laser trabeculoplasty on intraocular pressure and cornea
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.

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

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.

ConclusionSubthreshold 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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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.
 
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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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VITREOLYSIS

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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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
 
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DENTAL

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
 
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DERMATOLOGY

The Aesthetic Guide
Author: Jeffrey Frentzen
May/June 2017
 
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The Aesthetic Guide
Author: Kevin A. Wilson
September/October 2015
 
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