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PubMedDate not supplied

[Preventive laser coagulation of the retina in children with uveitis].

Presented are cases of proliferative uveitis in which a laser coagulation of the retina has been performed in order to separate the fibrous changes. The authoresses discuss 2 groups: treated without coagulation and with the use of an argon laser coagulation. They see better anatomical and functional results in group in which prophylactical coagulation has been performed. They draw on this basis the conclusion that it should be used earlier, before the complications which hinder this operation come forth.

Adolescent↗

PubMed2004

Endoscopic laser coagulation of the ciliary processes in patients with severe chronic glaucoma.

BACKGROUND: To investigate the effect of endoscopic laser coagulation on the ciliary processes in order to control intraocular pressure (IOP) in patients with severe chronic glaucoma. PATIENTS AND METHODS: 6 eyes (5 pseudophakic, 1 phakic) of 5 patients (mean age 60 years, range 46 - 70) were treated. Glaucoma was related to previous detachment surgery (patients 1), panuveitis (patient 2), iris dystrophy (patient 3), or neovascularization (patient 4: central venous occlusion; patient 5: proliferative diabetic retinopathy). Preoperatively, all patients had not responded to intensive glaucomatous topical and systemic treatment (mean 4.2 drugs, range 3 - 5). Trabeculectomy has been unsuccessfully performed in patients 2 and 3. After pars plana vitrectomy, the ciliary processes were coagulated under endoscopic view over 180 - 270 degrees using endolaser (argon green with spots of 300 - 500 mW for 0.4 - 0.5 s). Patient 5 was treated in both eyes. RESULTS: The mean preoperative IOP was 39 mm Hg (range 32 - 47). The mean postoperative follow-up was 339 days (range 125 - 485). The postoperative IOP was over 1 year under 21 mm Hg in patient 1 with one topical drug, and in patients 2 and 3 without any further treatment. Patient 4 needed trabeculectomy and one topical drug to control IOP. The IOP was not controlled in patient 5 with the shortest follow-up despite additional topical treatment. No serious treatment-related complication was noted. CONCLUSIONS: Endoscopic laser coagulation allows a precise destruction of the ciliary processes, and permits a better control of IOP in certain cases of severe chronic glaucoma. Further investigations are necessary to better evaluate this therapy.

Aged↗

PubMed1994

Interstitial Nd:YAG laser coagulation with a cylindrical diffusing fiber tip in experimental liver metastases.

Interstitial laser coagulation as a means of destructing hepatic metastases was investigated. Colon carcinoma CC531 was implanted in the liver of 42 Wag/Rij rats; 20 days later, tumors (5.5 +/- 0.2 mm) were exposed to 1,064 nm Nd:YAG laser light at 4 W/cm and either 600, 1,200, 2,400, 3,400, or 4,800 J/cm from a 0.5 cm Helioseal coated cylindrical diffuser. Temperature and fluence rate were measured at the tumor boundary. Lesions were studied on day 2 and 36 posttreatment by light microscopy. Tumor proliferative activity was assessed by bromodeoxyuridine incorporation. Liver damage and function were determined by serum liver enzymes and antipyrine clearance. Fluence rate increased during laser treatment up to 170%; mean temperature increased logarithmically up to 69.7 degrees C. Short-term light microscopy showed coagulation necrosis of 7-11 mm without charring. Lesion size and liver enzymes increased logarithmically with laser energy applied. No deterioration in liver function was found. At 4,800 J/cm complete tumor remission occurred in three of four animals. This study shows the ability of interstitial laser coagulation to produce selective destruction of colonic tumor within the liver.

Adenocarcinoma↗

PubMed2003

[Long-term follow-up of interstitial laser coagulation in the treatment of benign prostatic hyperplasia].

INTRODUCTION: Besides standard open or transurethreal adenoma resection, less morbid interstitial laser coagulation (ILC) is an alternative therapeutical option that could reduce lower urinary tract symptoms, especially in high-risk patients. Although short-term results indicate effectiveness, reliable long-term statistics are still lacking. Therefore, to assess long-term satisfaction and overall success rate, we re-evaluated patients with a mean follow-up of 7 years after laser treatment. METHODS: A total of 72 patients had been included in our ILC programme between 1993 and 1995. Mean age was 74 years. About 45 % of the patients had since died of other causes. In all, 23 patients were evaluated by telephone questionnaire, International Prostate Symptom Score (IPSS), Quality of Life (QoL), second surgical interventions or medical therapy. Our patient group was treated with interstitial Nd:YAG laser coagulation (mediLas fibertom). A perineal (34 %), transurethral (23 %) or combined (43 %) approach was chosen, depending on the preoperative volume of the prostate (range 40 - 100 ml; mean 59.3 ml). RESULTS: 68.4 % of the patients were satisfied with their current urological situation. Mean IPSS was 8.8 vs. 18.8 preoperatively mean QoL 1.5 vs. 3.3. 15.8 % had undergone conventional transurethral prostatic resection in the interim; one patient uses a urine catheter. 15.8 % receive medical treatment for lower urinary tract symptoms. CONCLUSIONS: Although the results of standard TUR or open surgery imply higher success, the long-term results of ILC demonstrate effectiveness. Further follow-up studies on a larger number of patients are advisable. The low morbidity of ILC makes this procedure an interesting alternative option in the treatment of high risk patients.

Aged↗

PubMed1980

[Fluorescein fundus angiography and laser coagulation in central serous chorioretinitis].

100 cases of central serous chorioretinitis with fluorescein leakage treatment with and without argon laser coagulation was compared. Final visual acuity was significantly better, and the duration of disease shorter, in the 61 patients who underwent coagulation than in the 39 who did not. Laser coagulation was especially effective in the cases with leakage in the upper macular region.

Adolescent↗

PubMed1998

Endoscopic laser coagulation in the management of severe twin-to-twin transfusion syndrome.

OBJECTIVE: To assess the clinical effectiveness of endoscopic laser coagulation of placental vessels in the treatment of severe transfusion syndrome. DESIGN: Prospective study. SETTING: Three referral centres for the management of twin-to-twin transfusion syndrome. POPULATION: One hundred and thirty-two pregnancies complicated by severe twin-to-twin transfusion syndrome, reflected by polyhydramnios and enlarged bladder of one twin and oligoanhydramnios and collapsed bladder of the other twin, presenting before 28 weeks of gestation. METHODS: Prospective collection of data on pre-procedure assessment, the procedure and the follow up were collected prospectively. Laser coagulation of placental vessels crossing the intertwin membrane on the chorionic surface under sono-endoscopic guidance, followed by amniodrainage. MAIN OUTCOME MEASURES: Maternal and pregnancy complications, perinatal death and morbidity were assessed over the last five years with follow up of survivors. RESULTS: Endoscopic laser was carried out at a median gestation of 21 weeks. The total number of surviving infants was 144 (55%) and there was at least one survivor in 97 cases (73%). At a minimum age of one year neurological handicap was suspected in six survivors (4.2%). CONCLUSIONS: The results of this multicentre study are similar to those in our original report on the first 45 cases. In comparison with serial amniodrainage, the survival rate may be similar, but the handicap rate in survivors appears much lower. This study stresses the need for a prospective study comparing these two techniques.

Endoscopy↗

PubMed2002

Postoperative laser coagulation as retinopexy in patients with rhegmatogenous retinal detachment treated with scleral buckling surgery: a prospective clinical study.

PURPOSE: To evaluate postoperative laser photocoagulation as retinopexy mode in patients with rhegmatogenous retinal detachment treated with scleral buckling surgery. METHODS: The authors conducted a prospective feasibility study of consecutive patients with rhegmatogenous retinal detachment treated with scleral buckling surgery and postoperative laser during an 18-month period with a minimal follow-up of 6 months. Outcome measures were total retinal reattachment and the occurrence of proliferative vitreoretinopathy (PVR). RESULTS: A total of 123 patients (124 eyes) were included in this study. Seventy-six percent were phakic and 24% were pseudophakic. Fifty percent presented with one horseshoe tear, 15% with multiple tears, 30% with round breaks, and 5% with no identifiable break. Ten percent presented with a vitreous hemorrhage and 25% with three or four quadrants of detached retina. Six patients had PVR C1. Twelve patients required a postoperative gas injection, five patients received an additional buckle, and five patients underwent a vitrectomy, in four because of PVR. In all patients the retina was fully reattached at the end of follow-up. Planned postoperative laser coagulation took place 1 day to 10 weeks (median 3(1/2) weeks) after buckling surgery. Buckling material was removed in three patients without redetachment. CONCLUSION: Postoperative laser coagulation is a feasible alternative retinopexy mode in scleral buckling surgery, with encouraging anatomical results and a low incidence of PVR.

Cryosurgery↗

PubMed2001

[Transscleral and transpupillary laser coagulation in proliferative sickle-cell retinopathy].

BACKGROUND: Transscleral diode laser photocoagulation is a new method for treating proliferative sickle-cell retinopathy (PSR). Other treatments include transpupillary laser photocoagulation and transscleral cryocoagulation CASE REPORT: We report two patients with sickle-cell disease and PSR, one treated by transpupillary argon laser coagulation and the other by transscleral diode laser scatter photocoagulation. CONCLUSION: Transpupillary and transscleral laser photocoagulation are effective and safe in the treatment of PSR. Transscleral photocoagulation is an alternative treatment method in eyes with PSR and cloudy optical media or with poor mydriasis in which transpupillary coagulation cannot be performed.

Adolescent↗

PubMed1983

Transpupillary CW YAG laser coagulation. A comparison with argon green and krypton red lasers.

The authors have developed a CW YAG laser for transpupillary coagulation. The effects of CW YAG coagulation on the retina, retinal vessels, and fovea were compared with those produced by the krypton red and argon green lasers. To produce threshold coagulative lesions in monkeys and rabbits, we needed five to ten times more energy with the CW YAG than with the krypton red or argon green lasers. Nerve fiber damage was observed only when coagulating retinal vessels with the argon green laser. At the parameters used, none of the lasers damaged the sensory retina of the fovea. The CW YAG may be used as a new mode of laser coagulation in the treatment of retinal diseases.

Animals↗

PubMed1996

Neodymium:YAG laser coagulation prostatectomy: 3 years of experience with 227 patients.

PURPOSE: For 3 years we prospectively followed a cumulative cohort of men who underwent neodymium:YAG laser coagulation prostatectomy to relieve bladder outlet obstruction to determine the safety, efficacy and durability of this procedure. MATERIALS AND METHODS: A total of 227 men with symptomatic bladder outlet obstruction was treated with the Urolase side-firing laser fiber between October 15, 1991 and October 15, 1994. Voiding outcomes, including peak urinary flow rates, residual urine volumes and American Urological Association symptom scores, were measured with time, and immediate and long-term complications were assessed. RESULTS: Median patient followup was 26 months (maximum 42). Significant improvement occurred in all measured voiding parameters, including 133% in peak flow rates and 61% in symptom scores 1 year postoperatively. Overall 87% of patients noticed improved quality of life as a result of surgery. Minimum postoperative followup was 6 months in all cases. Complications included prostatitis in 2.6% of patients, urethral stricture in 1.8%, bladder neck contracture in 4.4% and reoperation for residual prostate tissue in 5.3%. CONCLUSIONS: Neodymium:YAG laser coagulation of the prostate represents an efficacious surgical intervention for symptomatic bladder outlet obstruction with minimal associated morbidity. Voiding outcomes are durable through 3 years.

Aged↗

PubMed2003

[Chemotherapy in combination with laser coagulation or interstitial hyperthermia--effective combined therapy for disseminated skin melanoma].

Thirty-eight patients with disseminated skin melanoma received chemotherapy in conjunction with laser coagulation or interstitial hyperthermia of intra- or subcutaneous metastases. Use of combination therapy was followed by a rise to 37% in total response and 16%--complete regression, respectively. Most effectiveness was attained when the dacarbazine + cisplatin + BCNU + tamoxifen regime was employed. In this group of 16 patients (46%), total response was 56% and, what is most significant, 31% in complete regression. In all cases of apparent response, polychemotherapy was administered both before and after laser coagulation or interstitial hyperthermia.

Adult↗

PubMed2004

Interstitial laser coagulation for management of benign prostatic hyperplasia: long-term follow-up.

AIM: We evaluated the long-term results of transurethral interstitial laser coagulation in the treatment of benign prostatic hyperplasia (BPH) with up to 9 years of follow up at the Kurashiki Central Hospital and determined the patient characteristics that predict a favorable outcome. METHODS: From December 1993 to May 1997, a total of 82 patients were enrolled in the present study. Subjective and objective voiding parameters were collected from medical records and a self-administered questionnaire was sent to the patients. Kaplan-Meier plots were constructed to assess the risk of retreatment. RESULTS: The mean follow-up period was 48.4 months (range, 3-108 months). A total of 59 patients (72%) did not need any additional treatment at 12 months and 30 patients (37%) did not require additional treatment during the entire follow-up period. A total of 29 patients (35%) were retreated during follow-up. Transurethral prostate resection (TURP) was performed in 18 patients (22%). The remaining 11 patients (13%) were offered additional pharmacotherapy. The minimum and median retreatment-free durations were 3 and 14 months, respectively. Seven patients died and 17 were lost to follow-up. Men aged 71 years or older had greater likelihood of requiring retreatment than those younger than 71 years (P = 0.0397). No significant differences were noted in the other baseline characteristics. Among postoperative parameters, a rate of decrease of the International Prostate Symptom Score of the patient of lower than 60% and a rate of decrease in patient quality of life of lower than 50% at 3 months were associated with greater likelihood of retreatment (P = 0.0083 and P = 0.0006, respectively). CONCLUSIONS: Interstitial laser coagulation is effective for the treatment of BPH. Good long-term results and an acceptably low retreatment rate render this modality an effective alternative to TURP, especially for younger patients. Short-term improvement of subjective symptoms was predictive of favorable long-term outcome.

Age Factors↗

PubMed2001

Metabolic activity and DNA integrity in human hepatic metastases after interstitial laser coagulation (ILC).

BACKGROUND AND OBJECTIVE: For investigations into interstitial laser coagulation (ILC) of solid tumors, tissue whitening is used as a parameter for the extent of coagulation. This obvious demarcation is associated with global thermal denaturation, but it is not clear whether this finding is a good indicator of the exact outer boundary of the lethal tissue effect. STUDY DESIGN/MATERIALS AND METHODS: ILC with portal inflow occlusion was performed in human hepatic metastases of colorectal carcinoma directly after surgical resection (n = 5) or before surgical resection (n = 5) with laser parameters adapted to tumor diameter. Mitochondrial NADH-diaphorase activity and DNA integrity were assessed by histoenzymatic staining. RESULTS: In 7 of 10 tumors (mean diameter, 3.7 cm), an area of macroscopic coagulation (mean diameter, 4.2 cm) encircled the tumor in all three axes. Macroscopic coagulation corresponded to absent metabolism and disintegrated DNA. Furthermore, the macroscopic volumes of coagulation produced in tumor were comparable to the dimensions in normal porcine liver with the same laser parameters. CONCLUSION: ILC with portal inflow occlusion results in areas with complete cell avitality in the zone of tissue whitening in human hepatic liver metastases.

Colorectal Neoplasms↗

PubMedDate not supplied

[Choice of YAG-Nd mode for conduction of interstitial laser coagulation in benign prostatic hyperplasia].

Basing on the results of fundamental and experimental investigations, we have selected the YAG-Nd laser mode for interstitial laser coagulation (ILC) of the prostate using laser unit LAMIN-1 made in Russia. The experiments were performed on cadaver prostates (3 macropreparations of human prostate 50-80 cm3 in volume). The samples were exposed to laser radiation after their immersion into 5% glucose solution. Laser worked with impulse frequency 30 Hz, power 30-50 W, time of exposure 20-50 s. In exposure 30-40 or 20 s recommended power is 30 or 40-50 W, respectively. The resultant coagulation necrosis covers 2.8-2.9 cm3, carbonized layer is absent. The above mode was used in 10 operations in 65-85-year-olds. The duration of the intervention was 10-15 min maximum. The sites were 3-5 in the lateral lobe and 2 in the middle lobe of the prostatic gland. The outcomes were followed up for 12 months. The comparison of the mean control values with those before the procedure provided the following picture after 12 months: preoperative IPSS 21.9 vs 9.3 scores postoperatively; residual urine 140 vs 30 cm3; maximum urination rate 6.7 ml/s vs 13.5 ml/s, respectively. For interstitial laser coagulation we think it valid to use high laser power and short exposure because short duration of the operation, complete hemostasis, minor lesion of the urothelium, unnecessary long-term drainage of the urinary bladder minimize the risk of intra- and postoperative complications.

Age Factors↗

PubMed1999

Interstitial laser coagulation for hepatic tumours.

BACKGROUND: The potential role of interstitial laser coagulation (ILC) for patients with irresectable hepatic tumours is currently being investigated. Since its introduction in 1983 it has evolved into an innovative minimally invasive technique. METHODS: On the basis of a Medline literature search and the authors' experience, the principles, current state and prospects of ILC for hepatic tumours are reviewed. RESULTS: Animal studies and early clinical studies have shown the safety and feasibility of ILC. The site of interest can be approached at laparoscopy or percutaneously and treatment is easily repeatable. Recent advances include the use of fibres with a cylindrical diffusing light-emitting tip, the length of which is adaptable to tumour diameter, water-cooled fibre systems, simultaneous multiple fibre application, and hepatic inflow occlusion during laser treatment. ILC allows complete destruction of tumours up to 5 cm in diameter. Currently a limitation is the lack of reliable real-time monitoring of laser-induced effects but progress in magnetic resonance imaging techniques should allow accurate temperature measurements to be obtained rapidly during treatment. However, the actual benefit of ILC in terms of patient survival remains to be investigated. CONCLUSION: In terms of tools and experience, ILC has now been developed sufficiently to study its effect on survival of patients with irresectable hepatic tumours.

Humans↗

PubMed2005

Cervical length as a prognostic factor for preterm delivery in twin-to-twin transfusion syndrome treated by fetoscopic laser coagulation of chorionic plate anastomoses.

OBJECTIVE: To evaluate the risk of spontaneous preterm delivery in relation to cervical length in severe cases of twin-to-twin transfusion syndrome (TTTS) diagnosed before 26 weeks of gestation and treated by laser coagulation of the intertwin placental anastomoses. METHODS: This was an observational study of cases of severe TTTS diagnosed before 26 weeks of gestation and treated by fetoscopic laser coagulation between January 2002 and December 2003 in three centers. Laser was the first-line treatment in all cases. Elective preterm deliveries before 34 weeks' for maternal or fetal indications, including intrauterine death of both fetuses, were excluded. Transvaginal sonographic measurement of cervical length prior to laser treatment and other risk factors of preterm delivery were evaluated by univariate and logistic regression analysis. RESULTS: Among the 137 women included, the mean cervical length was 32 and 38 mm in women delivering before and at or after 34 weeks, respectively (P < 0.001). For a cervical length of < 30 mm, the risk of delivery before 34 weeks was 74%. Severity of the disease, deepest vertical pool of amniotic fluid and amniotic fluid volume drained after the procedure were not associated with preterm delivery. Logistic regression analysis identified three independent factors to predict preterm delivery: short cervical length (increased risk), parity (increased risk) and intrauterine death of one twin (decreased risk). CONCLUSION: In TTTS treated by laser, without indications for elective preterm birth, cervical length before treatment is significantly associated with gestational age at delivery, and this is independent of parity, intrauterine death of one fetus and other risk factors.

Adult↗

PubMed1996

[Diode laser coagulation of stage 3+ retinopathy of prematurity].

BACKGROUND: Laser photocoagulation in retinopathy of prematurity (ROP) appears to have fewer adverse effects and to be at least as effective as cryotherapy. METHODS: To evaluate the efficacy and safety of diode laser photocoagulation we examined 50 eyes affected by stage 3+ ROP in 30 very low birth weight infants (gestational age 24-29 weeks, mean +/- SD 26.5 +/- 1.4 weeks; birth weight 480-1400 g, 898 +/- 208 g) in a prospective (uncontrolled) clinical study. Photocoagulation treatment was performed using a diode laser (810 nm) with a laser indirect ophthalmoscope delivery system. Follow-up ranged from 3 to 23 months (10.5 +/- 6.4 months). RESULTS: In 46 (92%) of the 50 eyes ROP regressed after a single laser treatment and the outcome was a flat, attached retina. Two eyes (4%) had a second laser session and one other eye (2%) had additional retinal detachment surgery, resulting in the regression of ROP and a flat, attached retina. Thus, the success rate was 98% (49 out of 50 eyes). In 1 (2%) of the 50 eyes treatment failed and ROP progressed to stage 5, although additional retinal detachment surgery was performed. No adverse side effects of diode laser treatment were noted, except for a small amount of retinal/preretinal bleeding in the ridge in 8 eyes (16%) and slight postoperative anterior chamber bleeding in 1 eye (2%) with dense tunica vasculosa lentis. There were neither lenticular opacities nor cataract formation. CONCLUSION: Diode laser photo coagulation using the laser indirect ophthalmoscope for stage 3+ ROP was easy to administer. Laser treatment had only minor side effects and was at least as effective as cryotherapy.

Female↗

PubMed1999

Minimally invasive treatment of BPH with interstitial diode laser coagulation.

The Authors report their preliminary experience on the use of interstitial laser coagulation (ILC) for the treatment of benign prostatic hyperplasia (BPH). Twenty-three patients underwent interstitial laser treatment of BPH with the Indigo 830 laser system, from April 1996 to September 1997. Inclusion criteria were: maximum flow rate < 12 ml/sec, postvoiding residual volume < 300 ml, AUA symptom score > 13. All patients were catheterized for 10 days postreatment. Average follow up was 10.9 months. Marked improvement was shown at one, three and six months in terms of AUA score, maximum urinary flow rates, QL index, postvoiding residual volume, voiding bladder pressure values and prostatic weight reduction. No major complication were reported. The Authors believe that ILC is an easy and effective treatment for elder and compromised patients with lower urinary tract symptoms due to BPH.

Aged↗