Effects of long-pulsed 1064-nm Nd:YAG laser on telangiectasias and reticular veins: a human in-vivo histological study.

BACKGROUND: Telangiectasias and reticular veins are associated with aesthetic disorders. Sclerotherapy is the gold standard treatment, but long-pulsed 1064-nm Nd:YAG laser (LP1064 laser) is also used. No data on the human histological effects of these lasers are reported. The objective was to test different LP1064 laser parameters and their histological effects on the dermis, collagen, telangiectasias, and reticular veins. METHODS: This was a single-center, prospective, single-arm, case-control, human study. During surgery (dermolipectomy), the abdominal section of 10 female patients was irradiated with 6 different transdermal LP1064 laser parameters after anesthesia. Ten pieces with areas of varying irradiation were evaluated according to the characteristics of the vessels identified by area. In each piece, two irradiation areas were performed per group, totaling 12 irradiation areas per piece, with 120 regions later analyzed at the end of the ten samples. After removing the surgical product, histological sections were extracted, and the dermis, telangiectasias, and reticular veins were analyzed. RESULTS: Histological analysis showed that exposition to six different parameters from LP1064 laser led to significant dermal layer separation and collagen alterations. The effects were inconsistent on the loss of endothelial cells, intravascular thrombus formation, and fusion of vascular walls for both telangiectasias and reticular veins. In reticular veins, effects on intravascular thrombus formation and vascular wall fusion were not observed. CONCLUSIONS: The LP1064 laser in monotherapy with fixed settings did not lead to a consistent vascular lesion to promote immediate occlusion in telangiectasias and reticular veins. This strategy may not work as monotherapy for small vein treatment, but the possible late response to the LP1064 laser cannot be ruled out and require further investigation.

How efficient is laser therapy for telangiectasias, spider veins, and cherry angiomas?-A study using dynamic optical coherence tomography.

OBJECTIVES: A clinical study to investigate the effectiveness of pulsed dye laser (PDL) versus Nd:YAG laser in the treatment of telangiectasias, spider veins and cherry angiomas. Dynamic optical coherence tomography (D-OCT) was introduced as an innovative follow-up tool for evaluation of blood flow within superficial vessels and to allow visualization of morphological changes of the vasculature in vivo. The final aim of this study was to demonstrate a possible treatment benefit comparing both laser types. MATERIALS AND METHODS: Vessel structures of 102 skin lesions were documented photographically and dermoscopically. Subsequently, lesions were imaged using optical coherence tomography before laser therapy (a), directly after the treatment (p) and after a follow-up 4-6 weeks after laser treatment. All lesions were treated using either a 595 nm PDL or a 1064 nm Nd:YAG laser. Two main vessel parameters, namely density and diameter, and their possible changes during follow-up were observed in 150/300/500 µm penetration depth using D-OCT and were subsequently compared between both treatment groups. Other analyzed vessel parameters were depth of the plexus, mean diameter, mean density, top edge of the vessel, columns, and spikes. RESULTS: Both laser types are suitable options for the treatment of vascular skin lesions, with the most significant effect on cherry angiomas. PDL shows better results treating smaller vessels in upper skin regions, in comparison to Nd:YAG laser, achieving better results on deeper vessels, like spider veins. Using the applied laser settings, there was no statistically significant effect on telangiectasias. CONCLUSION: D-OCT represents a new, noninvasive imaging method to evaluate blood flow and vessel morphology in the follow-up of telangiectasias, spider veins, and cherry angiomas, which underwent laser therapy.

Case report: Novel leg vein treatment CLaCS guided by augmented reality 11 years follow-up.

Telangiectasias is most prevalent on the lower limbs and has been estimated to manifest in 40%-90% of the population. Treatments for telangiectasias include sclerotherapy, laser therapy, intense pulsed light treatment, microphlebectomy, and thermocoagulation. Cryo-Laser & Cryo-Sclerotherapy (CLaCS) effectively combines thermal and injection sclerotherapy. In this treatment, unwanted veins are targeted by a transdermal laser and immediately receive injection sclerotherapy. During the whole procedure, an air-cooling device (Cryo) blows onto the surrounding skin and tissue to prevent skin burn. Here, we present a case report of a challenging telangiectasias treated with ClaCS.

Vascular uses of LP1064 applicator on the harmony XL pro device.

INTRODUCTION: Vascular lesions of the lower extremities and face, such as varicose veins and telangiectasias, are a common dilemma for the dermatologist. In recent years, laser therapy has emerged as a viable treatment option for these vascular anomalies. MATERIALS AND METHODS: Although there are several types of lasers, the 1064-nm Nd:YAG in particular is popularly selected for its safety profile and versatility. The longer 1064 nm wavelength penetrates deeper into the skin while also being less absorbed by hemoglobin and melanin, thus resulting in minimized damage to surrounding structures and less pigmentation changes. The new LP1064 applicator on the Harmony XL Pro Device is one such laser. RESULTS: Numerous publications have corroborated the efficacy of 1064 nm Nd:YAG lasers. These studies cite at least over 75% of patients experiencing significant improvement in common vascular lesions. Efficacy of this laser is also seen for other vascular lesions such as port wine stains, hemangiomas, venous lakes, poikiloderma of Civatte, and angiokeratomas. Overall, the reported studies also show a low incidence of adverse events. CONCLUSION: The 1064 nm Nd:YAG laser, such as the Harmony LP1064 applicator, is a safe and effective tool to treat vein anomalies of the face and leg. Although commonly used for vein ablation, it has demonstrated a robust response in other indications as well.

980 nm laser endo-perivenous treatment of lower limb reticular veins and telangiectasias. Technical notes.

INTRODUCTION: For several years, the venous aesthetic problem has been tackled mainly with sclerotherapy techniques. In recent years, laser techniques have been added, both surface (transdermal) and endo-perivenous, performed with small optical fibers (100-200 µm) and low intensities in terms of LEED and Watt. The endo-perivenous technique has extended the possibilities of laser treatment also to the nourishing veins, to telangiectasias resistant to therapies with sclerosing agents and/or transdermal lasers and to vessels with larger diameters (1-3 mm) and depths >1.3 mm. MATERIALS AND METHODS: We report a series of 20 patients affected by reticular veins and telangiectasias of the lower limbs (CEAP C1-2) treated with endo-perivenous technique. The most used setting was: 3 W (range: 2-4 W) with a mean fluence delivered of 11.25 J/cm (range: 6-18) in pulse mode with 980 nm laser, 200 µm fiber after a preventive skin cooling. Scheduled follow-up occurred 20 and 60 days after treatment. RESULTS: Total technical success, understood as complete obliteration of all treated vessels, was achieved in 70% of cases (14/20) after just one treatment. The most observed early local complications were erythema, vesicles, and small cutaneous eschars that regressed in 3 weeks. At 60-day follow-up, just one complication was observed: a small area of hyperpigmentation (5%). In this case, chemical peel procedures was performed with good clinical results. CONCLUSIONS: Endoperivenous laser treatment represents an effective and valid tool for the treatment of teleangectasias and reticular varicose veins.

Nd:Yag laser combined with injection sclerotherapy in the treatment of reticular veins and telangiectasias (CLaCS method): A triple-blind randomized clinical trial comparing two sclerosing agents associated with same laser patterns.

BACKGROUND: Cryo-Laser & Cryo-Sclerotherapy (CLaCS) is a technique which combines thermal sclerotherapy and injection sclerotherapy. Telangiectasias and small varicosities are targeted by a transdermal laser and right after receive injection sclerotherapy. A cooling device blows -20°C air onto the skin and needle in a pre-, parallel-, and post-fashion. OBJECTIVE: Our objective was to establish if there is a difference in result and complications by varying the sclerosing agent but keeping the same ND:Yag long pulse laser parameters in the treatment of small varicosities. METHODS: Fifty five patients were enrolled prospectively and randomized to two groups; in the group 1 dextrose 75% was the sclerosing agent used in combination with the ND:Yag long pulse laser and, in the group 2, the same laser technique was used but the sclerosing agent was polidocanol 0.3% and dextrose 67%. RESULTS: The results were evaluated 30 days after the treatment by the patients and for blinded evaluators using before and after standardized photos with and without augmented reality. In the patient's perspective and in the blinded evaluation of the regular photos, no differences between the groups were found. Both groups had low rates of hyperpigmentation and bruising with no statistical difference. Patients treated with polidocanol had less pain after the treatment and a better clearance rate in the photos with augmented reality. No major complications were found. CONCLUSION: The treatment of small varicosities with CLaCS using Dextrose 75% or polidocanol 0.3% and Dextrose 67.5% is a safe and effective procedure and both sclerosing agents can be used with similar results. Possibly, in the polidocanol group more nonvisible reticular veins were cleared, but the implication of this find is not clear.

Efficacy and Safety of Intense Pulsed Light and Nonablative Fractional 1440-nm Diode Laser to a Combination of the 2 Modalities for Facial Rejuvenation.

BACKGROUND: The aging process involves laxity, hyperpigmentation, and telangiectasias. It is important to target those elements of aging to be successful at achieving rejuvenation. OBJECTIVE: To determine the efficacy, safety, and patient satisfaction of a combination intense pulsed light (IPL) and 1440-nm diode laser versus either treatment alone. METHODS: Forty subjects were enrolled in this randomized split-face trial: 20 were randomized to Group A (received IPL on one side of the face and IPL followed by the 1440-nm diode laser on the other side) and 20 were randomized to Group B (received 1440-nm diode laser on one side of the face and IPL followed by the 1440-nm diode laser on the other side). RESULTS: Investigators reported a percent improvement of 40% to 50% in all 3 groups at day 120; blinded investigator Global Aesthetic Improvement Scores were better in the combination group-90% compared with 84% and 83% in the IPL and 1440-nm diode laser groups, respectively. Wrinkling scores was significantly improved in the 1440-nm diode and combination groups. Hyperpigmentation and telangiectasias were significantly improved in all 3 groups. Adverse events were self-limited. CONCLUSION: Combination treatment with IPL and 1440-nm diode laser was found to be safe and effective and resulted in higher subject satisfaction.

Dorsal arachnoid web: A rare cause of syringomyelia and myelopathy / Telaraña aracnoidea dorsal: una causa rara de siringomielia y mielopatía

Dorsal arachnoidal webs are condensations of arachnoidal tissue densely adherent to the pial surface of the posterior aspect of the dorsal spinal cord. Infrequently described in literature they disrupt the flow of CSF in the spinal subarachnoid space leading to syringomyelia and myelopathy. While there are several theories on their origin, the “scalpel sign” on magnetic resonance imaging is considered to be pathognomonic of this condition. An illustrative case of a 58 year old man with syringomyelia and dorsal cord indentation who presented with spastic paraparesis, gait instability, parasthesias and bilateral non radicular upper limb pain that resolved following excision of the web is described to highlight the importance of considering this diagnosis when cases of so called “idiopathic” syringomyelia are encountered (AU)

Las membranas aracnoideas dorsales son condensaciones de tejido aracnoideo densamente adherido a la superficie pial de la cara posterior de la médula espinal dorsal. Descritas con poca frecuencia en la literatura, interrumpen el flujo del líquido cefalorraquídeo (LCR) en el espacio subaracnoideo espinal y provocan siringomielia y mielopatía. Si bien existen varias teorías sobre su origen, el «signo del bisturí» en la resonancia magnética se considera patognomónico de esta afección. Se describe un caso ilustrativo de un varón de 58 años con siringomielia e indentación medular dorsal que presentó paraparesia espástica, inestabilidad de la marcha, parestesias y dolor bilateral no radicular en miembro superior que se resolvió tras la exéresis de la telaraña para resaltar la importancia de considerar este diagnóstico cuando se encuentran casos de la llamada siringomielia «idiopática» (AU)

Intraprocedural OCT monitoring of the immediate treatment response during indocyanine green angiography-guided laser therapy of teleangiectatic capillaries in diabetic macular edema.

In this retrospective study the morphological response of teleangiectatic capillaries (TCs) to focal laser treatment and the functional and morphological outcome after Indocyanine green angiography (ICGA)-guided laser therapy was evaluated. TCs in eyes with diabetic macular edema (DME) were treated with laser therapy. The immediate and subsequent reaction of the TCs lumina to direct photocoagulation was monitored with customized OCT single scans. Additionally, patients were treated with intravitreal anti-VEGF as needed. 12 eyes of 9 patients with treatment naive (6 eyes) and pretreated (6 eyes) DME were followed-up for a mean of 24 months (± 8.1SD). Best-corrected visual acuity improved from 0.25 logMar (± 0.2SD) to 0.12 (± 0.10SD; p = 0.06) at each patient's last visit. During laser treatment a darkening of the TCs lumina was achieved in 91.3% of lesions. All these lesions fully resolved, whereas TCs, which showed no darkening of their lumen in OCT persisted and required re-treatment with laser. Additional anti-VEGF injections were indicated in only one eye (8.3%). The darkening of the TCs lumina visible in OCT might provide an image-biomarker that indicates successful coagulation of aneurysmatic lesions. Consequently, a significant functional and morphological improvement with need for anti-VEGF treatment in only one eye, was achieved.Information concerning the registration of the trial: date of registration: 11th of december, 2019. Trial registration number: 107/2019.

A laser platform incorporating a novel 524 nm laser pumped by a commercial hair removal laser effectively treats facial redness and lower-extremity spider veins.

BACKGROUND AND OBJECTIVES: Treatment of vascular lesions is one of the main applications of cutaneous laser technology, while the other is laser hair removal. We present here a vascular laser pumped by a commercial hair removal laser. STUDY DESIGN/MATERIALS AND METHODS: A novel 524 nm vascular laser was designed using a 755 nm hair removal laser as a pumping source. This 524 nm vascular laser was used to treat facial redness and leg telangiectasias in 24 subjects. Four treatments were administered to the face at 4-6-week intervals and final photographs were taken 8 weeks following the final treatment, while two treatments were administered to lower-extremity spider veins at 2-month intervals with follow-up photographs 3 months following the final treatment. Blinded analysis of digital images was performed by two physicians not involved in the study. RESULTS: Blinded evaluation of digital photographs revealed an average improvement score of 3.3 ± 1.7 (mean ± SEM) on a 0-10 scale for removing facial redness (p < 0.001), representing a 33% improvement. Leg veins improved an average of 51% corresponding to a score of 5.1 ± 2.0 (p < 0.001). Side effects were mild and limited to erythema, purpura, edema, and one instance of mild hyperpigmentation. CONCLUSIONS: This novel 524 nm laser is safe and effective for treating vascularity on the face and legs, and proves the ability to create a laser platform incorporating a hair removal laser which then can be used as a pumping source for the attached vascular laser module.

Giant, symptomatic mixed vascular malformation containing a cavernoma, developmental venous anomaly, and capillary telangiectasia in a 19-month-old infant.

Intracranial mixed vascular malformations (MVMs) are defined as any combination of a developmental venous anomaly (DVA), cerebral cavernous malformation (CCM), capillary telangiectasia (CTG), or arteriovenous malformation (AVM) within a single, contiguous lesion. However, most MVMs described in the literature contain only 2 pathologically discrete malformations; juxtaposition of 3 or more abnormalities in a single lesion remains exceedingly rare. We present the case of a 19-month-old female with new onset focal seizures and a 4-cm right basal ganglia lesion initially believed to be an embryonal neoplasm. She subsequently underwent gross total resection (GTR) of the lesion via a transsylvian-transinsular approach. Intraoperatively, the lesion appeared to be heterogenous and highly vascular, with areas of purplish-gray friable tissue. Pathology confirmed the lesion to be a MVM containing a CCM, CTG, and a DVA. This appears to be the first reported case of such a lesion confirmed on pathology in the literature.

Infrared reflectance image-guided laser photocoagulation of telangiectatic capillaries in persistent diabetic macular edema.

This study aimed to assess detection rate of telangiectatic capillaries (TelCaps) with infrared reflectance (IR) and optical coherence tomography (OCT) images and to evaluate the clinical efficacy of IR image-guided focal laser photocoagulation of TelCaps in persistent diabetic macular edema (DME). This retrospective case series included 28 eyes of 28 patients with TelCap and persistent DME refractory to intravitreal anti-vascular endothelial growth factor or corticosteroids. The presence of TelCaps was confirmed using IR and OCT images. All patients were followed up for more than 12 months after direct focal laser photocoagulation of the TelCaps. The TelCap closure rate, changes in best-corrected visual acuity, and central subfield thickness were analyzed. On IR imaging, TelCap appeared as a characteristic hyperreflectivity within a hyporeflective spherical lesion in 85.7% of the eyes. After focal laser photocoagulation, the TelCap closure rate was 57.1% at 3 months and 71.4% at 12 months. A significant improvement in visual acuity and reduction in central subfield thickness were observed at three and 12 months after focal laser photocoagulation (all p < 0.05). The characteristic hyperreflectivity within hyporeflective lesions on the IR image in conjunction with OCT helps identify the TelCap. Our results suggest that IR imaging and OCT-guided focal laser photocoagulation of TelCaps can improve functional and anatomical outcomes in persistent DME.

EXACT LASER FLUENCE FOR SUCCESSFUL TREATMENT OF FACE AND LEG TELANGIECTASIA.

OBJECTIVE: The aim: Facial and leg telangiectasia are usual cosmetic concern for females who have different skin phototypes and ages. Until now, the various treatments for these problem have frequently failed or led to unwanted side-effects. Based on approved pre-calculated doses, the present study highlights the clinical effects and safety of treatment after using the exact laser parameters from 1064-nm Nd: YAG laser. PATIENTS AND METHODS: Materials and methods: Twenty people with facial and leg telangiectasia underwent a single laser treatment, based on pre-calculated laser parameters for each case. RESULTS: Results: All subjects showed visible improvement, with 95-100% clearance of face telangiectasia directly after the first treatment, and 50-100% clearance of the lower extremity vessels after one to three days; with minimal side-effects. CONCLUSION: Conclusions: Treatment of facial and leg telangiectasia by using true, exact, and mathematically pre-calculated parameters of long pulse 1064 nm Nd: YAG laser was an effective and safe procedure of clearing face and leg telangiectasia.

RETINAL TELANGIECTASIA ASSOCIATED WITH OPTIC DISK PIT MACULOPATHY.

PURPOSE: To report a case of optic pit maculopathy with retinoschisis-like edema with a rare finding of retinal telangiectasia. METHODS: Retrospective case report. RESULTS: A 22-year-old white man with a right optic pit presented with blurry vision and was found to have optic pit maculopathy with retinoschisis-like macular edema and retinal telangiectasia along the superior-temporal arcade. The patient underwent pars plana vitrectomy with separation of posterior vitreous and inner retinal fenestration. Upon follow-up, retinal telangiectasia was resolved and retinoschisis-like edema was mostly resolved 2 years after surgery. CONCLUSION: Retinal telangiectasia seen in optic disk maculopathy may be secondary to ischemia induced by the intense stretching of the superficial vascular plexus in the inner retina because of macular edema. In our patient, when traction was relieved following surgical intervention, there was remodeling of the superficial vascular plexus that allowed for resolution of the retinal telangiectasia.

The efficacy of a single-session pro-yellow laser in the treatment of facial telangiectasia.

Facial telangiectasia (FT) is a condition in which small dilated vessels visibly protrude on the surface of the skin. The aim of this study was to evaluate the efficacy and safety of a single-session pro-yellow laser in the treatment of FT and spider angioma (SA) to compare it with a limited number of studies conducted on this subject. In this pilot study, we reviewed 41 patients who admitted to our dermatology clinic with FT and SA and were treated by using pro-yellow laser. The efficacy of the treatment was evaluated using the recorded clinical information and digital camera images. The improvement was graded as complete (90-100%), very good (75-89%), good (50-74%), moderate (25-49%), and weak (< 25%). Of the 41 patients included in the study, 37 (90.2%) had FT and four (9.8%) had SA. Twenty-two patients were female and 19 were male. Pro-yellow laser therapy was generally well tolerated by patients, and minimal pain occurred during the application. In 1-month follow-up, good, very good, or complete recovery was achieved in 51.4% of the FT patients. The new pro-yellow laser only has a yellow light wavelength. Its unique wavelength at 577-nm yellow light is ideal for vascular lesions. In this study, 51.4% of the patients with FT achieved good, very good, or complete improvement after a single session of 577-nm pro-yellow laser, and complete improvement was achieved in all the four patients with SA.

Long-pulsed 1064-nm and 755-nm lasers for C1 leg veins on skin type IV patients: a side-by-side comparison.

Long-pulsed 1064-nm (LP1064) and 755-nm (LP755) lasers have been demonstrated as effective treatments for leg veins. However, few studies of these treatments on Asian skin type as well as direct comparison between two methods were reported. The aim of this study was to compare the clinical efficacy and safety of LP1064 with LP755 in the treatment of C1 leg veins on skin type IV patients. Patients with symmetric matched areas C1 leg veins were treated with single session of LP1064 for the right and LP755 for the left. Treated areas of every patient were divided into matrices of 2 × 2 cm squares. Vessels in the highest density squares were subjected to evaluation. Spot sizes were 5 mm fixed. Pulse durations and fluences were according to vessel diameters and endpoints, respectively. The clearances were evaluated at 1 and 3 months post treatment. Side effects were recorded immediately, 10 min, 24 h, and 1 and 3 months after treatment. Twenty-two patients were enrolled with total 96 vessels from 22 selected squares in the right and 106 vessels from 22 selected squares in the left. At 1-month follow-up, the clearances of LP1064 and LP755 were not significantly different (71.87% and 71.69%, respectively; p = 0.99). At 3-month follow-up, the efficacies were constant and no recurrence occurred. Pain levels of both methods were moderate and significantly lower in LP755. These findings suggest that LP1064 and LP755 laser treatments were comparatively effective and safe for C1 leg veins of skin type IV patients.

State of the art on cryo-laser cryo-sclerotherapy in lower limb venous aesthetic treatment.

Here we describe a combination of neodymium:yttrium-aluminium-garnet 1064-nm laser emission and injection of 75% dextrose solution to treat lower limb reticular veins. The strategy is known as cryo-laser cryo-sclerotherapy. Preliminary outcomes are reported, showing ecchymosis in up to 30% of cases and intravenous thrombus in 14%. A satisfactory vessel elimination is found in 86% of cases. No improvement or worsening was reported in 14% of patients. The paper provides technical details with the aim of promoting homogeneity in future data collection, so fostering publication of long-term effectiveness and related comparative evaluation with sclerotherapy and laser treatment alone.