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Treatment outcomes of modified argon laser photocoagulation for conjunctivochalasis.

ABSTRACT: To determine the effectiveness of conjunctivoplasty using a modified argon laser photocoagulation method on patients with conjunctivochalasis (CCh). This study included 25 cases of symptomatic inferior CCh. After staining the surface of a redundant conjunctiva using a dark-purple marker, low-energy argon laser photocoagulation (500 μm spot size for 0.5 seconds at power 300 mW) was applied under topical anesthesia for a mean of 80 times. The patients were aged 67.6 ± 7.1 years (mean ± standard deviation). During a mean follow-up period of 7.8 months (range of 6-12 months), the CCh grades of 21 eyes (84%) decreased after laser conjunctivoplasty. Calculated reduction rates of grades 1, 2, and 3 were 90%, 75%, and 67%, respectively. Patient subjective symptoms were improved in 80% of cases. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed. Our modified argon laser photocoagulation method employs staining the conjunctival surface to increase the thermal laser energy absorbed by the target. This novel technique is simple and effective for treating mild-to-moderate-grade CCh in outpatient clinics.

SUBMITTER: Han J

PROVIDER: S-EPMC9839297 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Treatment outcomes of modified argon laser photocoagulation for conjunctivochalasis.

Han Jisang J Lee Shin-Hyo SH Choi Chul Young CY Shin Hyun Jin HJ

Medicine 20230101 2

To determine the effectiveness of conjunctivoplasty using a modified argon laser photocoagulation method on patients with conjunctivochalasis (CCh). This study included 25 cases of symptomatic inferior CCh. After staining the surface of a redundant conjunctiva using a dark-purple marker, low-energy argon laser photocoagulation (500 μm spot size for 0.5 seconds at power 300 mW) was applied under topical anesthesia for a mean of 80 times. The patients were aged 67.6 ± 7.1 years (mean ± standard de ...[more]

PMID: 36637938

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Project description:ObjectiveTo compare 2 laser photocoagulation techniques for treatment of diabetic macular edema: the modified Early Treatment Diabetic Retinopathy Study (ETDRS) direct/grid photocoagulation technique and a potentially milder (but potentially more extensive) mild macular grid (MMG) laser technique in which microaneurysms are not treated directly and small mild burns are placed throughout the macula, whether or not edema is present.MethodsTwo hundred sixty-three subjects (mean age, 59 years) with previously untreated diabetic macular edema were randomly assigned to receive laser photocoagulation by either the modified ETDRS (162 eyes) or MMG (161 eyes) technique. Visual acuity, fundus photographs, and optical coherence tomography measurements were obtained at baseline and at 3.5, 8, and 12 months. Treatment was repeated if diabetic macular edema persisted.Main outcome measureChange in optical coherence tomography measurements at 12-month follow-up.ResultsAmong eyes with a baseline central subfield thickness of 250 microm or greater, central subfield thickening decreased by an average of 88 microm in the modified ETDRS group and by 49 microm in the MMG group at 12-month follow-up (adjusted mean difference, 33 microm; 95% confidence interval, 5-61 microm; P = .02). Weighted inner zone thickening by optical coherence tomography decreased by 42 microm in the modified ETDRS group and by 28 microm in the MMG group (adjusted mean difference, 14 microm; 95% confidence interval, 1-27 microm; P = .04); maximum retinal thickening (maximum thickening of the central and 4 inner subfields) decreased by 66 and 39 microm, respectively (adjusted mean difference, 27 microm; 95% confidence interval, 6-47 microm; P = .01), and retinal volume decreased by 0.8 and 0.4 mm3, respectively (adjusted mean difference, 0.3 mm3; 95% confidence interval, 0.02-0.53 mm3; P = .03). At 12 months, the mean change in visual acuity was 0 letters in the modified ETDRS group and 2 letters worse in the MMG group (adjusted mean difference, 2 letters; 95% confidence interval, -0.5 to 5 letters; P = .10).ConclusionsAt 12 months after treatment, the MMG technique was less effective at reducing optical coherence tomography-measured retinal thickening than the more extensively evaluated current modified ETDRS laser photocoagulation approach. However, the visual acuity outcome with both approaches is not substantially different. Given these findings, a larger long-term trial of the MMG technique is not justified.Application to clinical practiceModified ETDRS focal photocoagulation should continue to be a standard approach for treating diabetic macular edema.Trial registrationclinicaltrials.gov Identifier: NCT00071773.

Project description:Purpose: The aim of this study was to evaluate the effect of gestational age (GA) at the time of fetoscopic laser photocoagulation (FLP) for severe twin–twin transfusion syndrome (TTTS) on perinatal outcomes in a single center in Taiwan. Materials and methods: Severe TTTS was defined as a diagnosis of TTTS before a GA of 26 weeks. Consecutive cases of severe TTTS treated at our hospital with FLP between October 2005 and September 2022 were included. The evaluated perinatal outcomes were preterm premature rupture of membranes (PPROM) within 21 days of FLP, survival 28 days after delivery, GA at delivery, and neonatal brain sonographic imaging findings within 1 month of delivery. Results: We included 197 severe TTTS cases; the mean GA at the time of FLP was 20.6 weeks. After the cases were divided into cases of FLP at early (below 20 weeks) and late GAs (more than 20 weeks), the early-GA group was discovered to be associated with a deeper maximum vertical pocket in the recipient twin, a higher rate of PPROM development within 21 days of FLP, and lower rates of survival of one or both twins. In the cases of stage I TTTS, the rate of PPROM within 21 days of FLP was higher in the group that underwent FLP at an early GA than in the group that underwent FLP at a late GA (50% (3/6) vs. 0% (0/24), respectively, p = 0.005). Logistic regression analysis revealed that the GA at the time of FLP and the cervical length before FLP is implemented are significantly associated with the survival of one twin and the incidence of PPROM development within 21 days of FLP. The GA at the time of FLP, the cervical length before FLP, and TTTS being stage III TTTS were associated with the survival of both twins after FLP. Neonatal brain image anomalies were associated with GA at delivery. Conclusions: FLP being performed at an earlier GA is a risk factor for lower fetal survival and PPROM development within 21 days of FLP in cases of severe TTTS. Delaying FLP for cases involving stage I TTTS diagnosed at an early GA without risk factors, such as maternal symptoms, cardiac overload in the recipient twin, or a short cervical length, may be considered, but whether delaying FLP would improve surgical outcomes and, if so, how long the delay should be may need further trials to answer.

Project description:ImportanceInterest in teleophthalmology has been growing, especially during the COVID-19 pandemic. The advent of fifth-generation (5G) wireless systems has the potential to revolutionize teleophthalmology, but these systems have not previously been leveraged to conduct therapeutic telemedicine in the ophthalmology field.ObjectiveTo assess the feasibility of 5G real-time laser photocoagulation as a telemedicine-based treatment for diabetic retinopathy (DR).Design, setting, and participantsThis was a prospective study involving a retinal specialist from the Peking Union Medical College Hospital in Beijing, China, who performed online 5G real-time navigated retinal laser photocoagulation to treat participants with proliferative or severe nonproliferative DR who had been recruited in the Huzhou First People's Hospital in Zhejiang Province, China, located 1200 km from Beijing from October 2019 to July 2020.InterventionsThese teleretinal DR and laser management procedures were conducted using a teleophthalmology platform that used the videoconference platform for teleconsultation, after which telelaser planning and intervention were conducted with a laser system and a platform for remote computer control, which were connected via 5G networks.Main outcomes and measuresDiabetic eye prognosis and the real-time laser therapy transmission speed were evaluated.ResultsA total of 6 participants (9 eyes) were included. Six eyes were treated via panretinal photocoagulation alone, while 1 eye underwent focal/grid photocoagulation and 2 eyes underwent both panretinal photocoagulation and focal/grid photocoagulation. The mean (SD) age was 53.7 (13.6) years (range, 32-67 years). The mean (SD) duration of diabetes was 14.3 (6.4) years (range, 3-20 years). The mean (SD) logMAR at baseline was 0.32 (0.20) (20/30 Snellen equivalent). Retinal telephotocoagulation operations were performed on all eyes without any noticeable delay during treatment. The mean (SD) number of panretinal photocoagulation laser spots per eye in 1 session was 913 (243).Conclusions and relevanceThis study introduces a novel teleophthalmology paradigm to treat DR at a distance. Applying novel technologies may continue to ensure that remote patients with DR and other conditions have access to essential health care. Further studies will be needed to compare this approach with the current standard of care to determine whether visual acuity or safety outcomes differ.

Dataset Information

Treatment outcomes of modified argon laser photocoagulation for conjunctivochalasis.

Publications

Treatment outcomes of modified argon laser photocoagulation for conjunctivochalasis.

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