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1.
Lasers Med Sci ; 39(1): 121, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38722564

RESUMO

To develop and validate a 3D simulation model to calculate laser ablation (LA) zone size and estimate the volume of treated tissue for thyroid applications, a model was developed, taking into account dynamic optical and thermal properties of tissue change. For validation, ten Yorkshire swines were equally divided into two cohorts and underwent thyroid LA at 3 W/1,400 J and 3 W/1,800 J respectively with a 1064-nm multi-source laser (Echolaser X4 with Orblaze™ technology; ElEn SpA, Calenzano, Italy). The dataset was analyzed employing key statistical measures such as mean and standard deviation (SD). Model simulation data were compared with animal gross histology. Experimental data for longitudinal length, width (transverse length), ablation volume and sphericity were 11.0 mm, 10.0 mm, 0.6 mL and 0.91, respectively at 1,400 J and 14.6 mm, 12.4 mm, 1.12 mL and 0.83, respectively at 1,800 J. Gross histology data showed excellent reproducibility of the ablation zone among same laser settings; for both 1,400 J and 1,800 J, the SD of the in vivo parameters was ≤ 0.7 mm, except for width at 1,800 J, for which the SD was 1.1 mm. Simulated data for longitudinal length, width, ablation volume and sphericity were 11.6 mm, 10.0 mm, 0.62 mL and 0.88, respectively at 1,400 J and 14.2 mm, 12.0 mm, 1.06 mL and 0.84, respectively at 1,800 J. Experimental data for ablation volume, sphericity coefficient, and longitudinal and transverse lengths of thermal damaged area showed good agreement with the simulation data. Simulation datasets were successfully incorporated into proprietary planning software (Echolaser Smart Interface, Elesta SpA, Calenzano, Italy) to provide guidance for LA of papillary thyroid microcarcinomas. Our mathematical model showed good predictability of coagulative necrosis when compared with data from in vivo animal experiments.


Assuntos
Terapia a Laser , Glândula Tireoide , Animais , Terapia a Laser/métodos , Terapia a Laser/instrumentação , Glândula Tireoide/cirurgia , Glândula Tireoide/patologia , Suínos , Simulação por Computador , Modelos Teóricos , Reprodutibilidade dos Testes
2.
Swiss Dent J ; 134(3)2024 May 17.
Artigo em Alemão | MEDLINE | ID: mdl-38757921

RESUMO

A pyogenic granuloma is an acquired, benign tissue formation of the skin and/or oral mucosa. Surgical excision is the most common treatment for these lesions. In this case report a case of a 60-year-old woman with a pyogenic granuloma in region 21 is presented. An excisional biopsy was performed with a CO2 laser under local anesthesia and the specimen was examined by a pathologist. No recurrency were observed in this case.


Assuntos
Granuloma Piogênico , Humanos , Feminino , Pessoa de Meia-Idade , Granuloma Piogênico/cirurgia , Granuloma Piogênico/patologia , Granuloma Piogênico/diagnóstico , Lasers de Gás/uso terapêutico , Biópsia , Terapia a Laser/métodos , Diagnóstico Diferencial
3.
Harefuah ; 163(5): 298-304, 2024 May.
Artigo em Hebraico | MEDLINE | ID: mdl-38734943

RESUMO

INTRODUCTION: Glaucoma is a progressive optic neuropathy and is the leading cause of preventable irreversible blindness worldwide. Glaucoma causes progressive visual field loss and can have significant implications on the patient's quality of life. Lowering intraocular pressure (IOP) is the only treatment proven to prevent vision loss from glaucoma. It is achieved using medication, laser treatment and surgery. The treatment paradigm of glaucoma has been one whereby surgical intervention has been left for advanced cases due to a variety of reasons, mainly concerning safety and long term success. The past two decades have seen a paradigm shift towards earlier IOP lowering interventions using a wide array of different technologies in the laser and surgical spaces. This review aims to understand the background to this paradigm shift, its necessity, and its potential impact on the vision and life of glaucoma patients.


Assuntos
Glaucoma , Pressão Intraocular , Terapia a Laser , Qualidade de Vida , Humanos , Glaucoma/terapia , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Terapia a Laser/métodos , Cegueira/etiologia , Cegueira/prevenção & controle , Campos Visuais/fisiologia , Progressão da Doença , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/terapia
4.
Card Electrophysiol Clin ; 16(2): 117-124, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38749629

RESUMO

Transvenous laser lead extraction poses a risk of major complications (0.19%-1.8%), notably injury to the superior vena cava (SVC) in 0.19% to 0.96% of cases. Various factors contribute to SVC injury, which can be categorized as patient-related (such as female gender, low body mass index, diabetes, renal problems, anemia, and reduced ejection fraction), device-related (including the number, dwell time, and type of leads), or procedural-related (such as reason for extraction, venous obstructions, and bilateral lead placements).


Assuntos
Remoção de Dispositivo , Terapia a Laser , Veia Cava Superior , Humanos , Veia Cava Superior/lesões , Veia Cava Superior/cirurgia , Feminino , Remoção de Dispositivo/efeitos adversos , Masculino , Terapia a Laser/efeitos adversos , Pessoa de Meia-Idade , Idoso , Desfibriladores Implantáveis/efeitos adversos , Marca-Passo Artificial/efeitos adversos
5.
Vestn Oftalmol ; 140(2): 54-62, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38742499

RESUMO

PURPOSE: This study analyzes the influence of various factors on the hypotensive effect of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: A retrospective study of the SLT effect was performed in 582 patients (756 eyes; mean age - 71.9±9.5 years) with POAG stages I-III. The level of intraocular pressure (IOP) decrease was assessed at 1 day, 1, 3, 6, and 12 months after SLT. The relationship between the hypotensive effect and age, gender, glaucoma stage, initial IOP level, number and type of instilled drugs, presence of intraocular lenses, and the surgeon performing the intervention were analyzed. RESULTS: In the entire sample, the hypotensive effect of SLT after 1 day was 4.1±3.4 mm Hg, after 1, 3, 6, and 12 months - 3.7±4.8; 3.5±3.8; 3.1±3.4 and 2.3±3.8 mm Hg, respectively. The hypotensive effect of SLT was most dependent on the preoperative IOP level (R>0.64, p<0.05). No significant correlation was found between the hypotensive effect and the stage of POAG, gender, age, number of hypotensive drugs, phakia/aphakia, and the surgeon. A weaker hypotensive effect of SLT was found in eyes receiving monotherapy with α2-adrenoceptor agonists (p<0.03) and a combination of four drugs (p<0.02). CONCLUSION: SLT is an effective method of additional IOP reduction in POAG at any stage and with any hypotensive regimen. At the same time, the results of its use in real clinical practice indicate the need for more careful IOP control after the procedure, especially in eyes with POAG stage III, as well as in eyes without hypotensive therapy and on the maximum drop regimen.


Assuntos
Glaucoma de Ângulo Aberto , Pressão Intraocular , Terapia a Laser , Trabeculectomia , Humanos , Glaucoma de Ângulo Aberto/cirurgia , Glaucoma de Ângulo Aberto/fisiopatologia , Trabeculectomia/métodos , Feminino , Masculino , Idoso , Pressão Intraocular/fisiologia , Estudos Retrospectivos , Terapia a Laser/métodos , Resultado do Tratamento , Pessoa de Meia-Idade , Anti-Hipertensivos/uso terapêutico
6.
Minerva Urol Nephrol ; 76(2): 210-220, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38742554

RESUMO

BACKGROUND: Transient urinary incontinence (UI) is distressing event following holmium laser enucleation of the prostate (HoLEP). Novel technique namely, veil sparing HoLEP (VS-HoLEP), was proposed to improve early continence outcome. In this trial (NCT03494049), VS-HoLEP was compared to standard HoLEP (St-HoLEP). METHODS: VS-HoLEP entails early apical separation with sparing of ventral apical mucosal veil proximal to the verumontanum. Eligible symptomatic BPH patients were randomly allocated to St-HoLEP (91) and VS-HoLEP (89). The primary outcome was UI as depicted by one-hour pad test at one month postoperatively. Other outcome measures include all perioperative parameters, complications, and urinary outcome measures at different follow-up points. RESULTS: Median preoperative prostate size was 138 (50:282) and 128 (50:228) mL in St-HoLEP and VS-HoLEP groups respectively. At one month the number of patients with positive one-hour pad test was 21 (23.1%) and 10 (11.4%) in St-HoLEP and VS-HoLEP groups respectively (P 0.047). The difference was significantly in favor of VS-HoLEP considering the number of patients reporting UI, the number of patients with positive one-hour pad test as well as the grade of UI reported at one and 4 months. The difference was not statistically significant at 12 months. The median time to patients' reported continence was 8 (1-52) and 1.5 (1-52) weeks in St-HoLEP and VS-HoLEP groups respectively (P≤0.005). The technique independently predicted positive one-hour pad test at one and four months respectively. At twelve months presence of DM (diabetes mellitus) and more percent PSA reduction independently predicted positive one-hour pad test. CONCLUSIONS: Veil sparing HoLEP enhances significantly early postoperative urine continence both subjectively and objectively. Optimization of the surgical technique could cut short the number of leaking patients and reduce the degree as well as the duration of transient postoperative urine leak.


Assuntos
Lasers de Estado Sólido , Complicações Pós-Operatórias , Hiperplasia Prostática , Incontinência Urinária , Humanos , Masculino , Lasers de Estado Sólido/uso terapêutico , Lasers de Estado Sólido/efeitos adversos , Idoso , Hiperplasia Prostática/cirurgia , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Terapia a Laser/métodos , Terapia a Laser/efeitos adversos , Resultado do Tratamento
7.
Stomatologiia (Mosk) ; 103(2): 86-90, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38741541

RESUMO

The paper presents an overview of modern scientific data on the study of the effect of laser radiation on biological tissues of the mouth in the therapeutic treatment of dental diseases. The use of lasers in the treatment of dental caries and its complications, non-carious lesions of hard dental tissues, as well as the use of lasers in the treatment of periodontal diseases and aesthetic restoration of teeth is considered.


Assuntos
Terapia a Laser , Humanos , Terapia a Laser/métodos , Cárie Dentária/terapia , Doenças Periodontais/terapia , Terapia com Luz de Baixa Intensidade/métodos , Lasers
8.
Minerva Urol Nephrol ; 76(2): 157-165, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38742551

RESUMO

INTRODUCTION: One recent addition to different lasers used for endoscopic enucleation of the prostate is the thulium fiber laser (TFL). The purpose of this systematic review is to present the feasibility, safety and efficacy of TFL Enucleation of the Prostate (ThuFLEP). EVIDENCE ACQUISITION: PubMed®, Scopus® and Cochrane® primary databases were systematically screened. The search strategy used the PICO (Patients, Intervention, Comparison, Outcome) criteria. Patients should be adults with benign prostatic obstruction (BPO) undergoing ThuFLEP. While comparative studies reporting comparison of ThuFLEP to other BPO treatments were included, cohort studies with no comparison group were also accepted. Outcomes including enucleation time and complication rates were reported. EVIDENCE SYNTHESIS: Twelve studies met all the predefined criteria and were included in the final qualitative synthesis. Mean operative time and enucleation time ranged from 46.6±10.2 to 104.5±33.6 and from 38.8±17.9 to 66.0±24.9 minutes, respectively. Most of the complications were Grade I or Grade II ones. Although TFL was found to present some advantages over older BPO treatments, its outcomes were comparable with other endoscopic enucleation approaches. CONCLUSIONS: ThuFLEP seems to be a feasible, safe and efficient approach for BPO symptoms management. Limited evidence showed that although ThuFLEP was associated with a reduced total operative time, it was also associated with worse IPSS improvement at 1-year follow-up, when compared with MOSESTM Holmium Laser Enucleation of the Prostate (HoLEP). These findings confirm the well-established opinion that the enucleation technique itself is more important than the technology which is used.


Assuntos
Terapia a Laser , Hiperplasia Prostática , Túlio , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Túlio/uso terapêutico , Terapia a Laser/métodos , Terapia a Laser/instrumentação , Terapia a Laser/efeitos adversos , Resultado do Tratamento , Prostatectomia/métodos , Prostatectomia/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Duração da Cirurgia
10.
Otol Neurotol ; 45(5): 552-555, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38728557

RESUMO

OBJECTIVE: The retrospective cohort study aimed to determine the safety and efficacy of TruBlue laser application in cholesteatoma surgeries. METHODS: All cholesteatoma surgeries conducted from January 2018 to January 2022 in two tertiary referral hospitals in Hong Kong, with and without use of TruBlue laser, were included. Pure tone audiogram was done pre- and post-operatively to assess hearing. Disease extent was graded with ChOLE score and ChOLE staging. Residual disease was determined clinically, radiologically, or surgically with second look operation. RESULTS: One hundred twenty cholesteatoma cases were identified. There are 39.2% (n = 47) of the cholesteatoma surgeries that utilized TruBlue laser, while 60.8% (n = 73) did not. Overall follow-up duration was 21 ± 12.4 months, ranging from 2 to 47 months. Both groups were similar in demographics, pre-operative hearing and ChOLE staging. The length of stay was comparable in both groups (2 ± 2 days in nonlaser, 1 ± 1 day in laser, p = 0.31). There was no facial nerve injury related to surgery in both groups, and overall complication rates were similar (4.1% in nonlaser, 4.3% in laser, p = 0.97). The postoperative hearing was comparable with good hearing preservation in both groups. Residual cholesteatoma occurred in 17.8% (n = 13) in nonlaser group, and 21.3% (n = 10) in laser group, which was not statistically significant (p = 0.64). Seventy percent of the cholesteatoma residual in laser group occurred at area that TruBlue LASER cannot be applied. CONCLUSION: TruBlue LASER was safe in cholesteatoma surgeries, though no added benefits were shown in reducing cholesteatoma residual rate. A larger controlled study is warranted to discern the true effect of TruBlue LASER. LEVEL OF EVIDENCE: Level 3.


Assuntos
Colesteatoma da Orelha Média , Humanos , Masculino , Feminino , Colesteatoma da Orelha Média/cirurgia , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Terapia a Laser/métodos , Resultado do Tratamento , Procedimentos Cirúrgicos Otológicos/métodos , Adolescente , Adulto Jovem , Audiometria de Tons Puros , Idoso
12.
Lasers Med Sci ; 39(1): 124, 2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38709332

RESUMO

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).


Assuntos
Cervicalgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Cervicalgia/radioterapia , Cervicalgia/terapia , Terapia a Laser/métodos , Resultado do Tratamento , Amplitude de Movimento Articular , Medição da Dor
13.
J Drugs Dermatol ; 23(5): 353-359, 2024 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-38709701

RESUMO

BACKGROUND: Medical aesthetic procedures for facial antiaging with laser and energy-based devices (EBDs) are rapidly increasing, but standards integrating skincare before, during, and after these treatments are lacking. The algorithm for integrated skin care for facial antiaging treatment with EBDs aims to stimulate healing, reduce downtime, and improve comfort and treatment outcomes. METHODS: A panel of 8 global physicians employed a modified Delphi method and reached a consensus on the algorithm integrating skincare based on the best available evidence, the panel's clinical experience, and opinions. RESULTS: The algorithm has a pretreatment (starts 2 - 4 weeks before the procedure) and treatment (day of treatment) section, followed by care after the procedure (0 - 7 days) and follow-up care (1 - 4 weeks after the procedure or ongoing). Applying a broad-spectrum sunscreen with an SPF 50 or higher, combined with protective measures such as wearing a wide-brimmed hat and sunglasses, is recommended to protect the face from sun exposure. Dyschromia is a significant concern for those with skin of color (SOC). Clinicians may recommend skincare using a gentle cleanser and moisturizer containing vitamins C and E, retinoid, or other ingredients such as niacinamide, kojic acid, licorice root extract, azelaic acid, and tranexamic acid, depending on the patient's facial skin condition. CONCLUSION: Medical aesthetic procedures for facial antiaging with EBDs integrating skincare or topical treatments may improve outcomes and patient satisfaction. Topical antioxidants and free radical quenchers can combat photodamage and may offer a safe alternative to topical hydroquinone.  J Drugs Dermatol. 2024;23(5):353-359.     doi:10.36849/JDD.8092.


Assuntos
Algoritmos , Satisfação do Paciente , Envelhecimento da Pele , Higiene da Pele , Humanos , Envelhecimento da Pele/efeitos dos fármacos , Higiene da Pele/métodos , Técnica Delphi , Resultado do Tratamento , Face , Terapia a Laser/métodos , Protetores Solares/administração & dosagem
14.
Lasers Med Sci ; 39(1): 126, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38714553

RESUMO

Thulium laser enucleation of the prostate (ThuLEP) is a highly effective approach to the treatment of benign prostatic hyperplasia. We present here a description of the "ARTh Technique" and the benefits it offers in terms of improved visualization, short operation times, and easy recognition of the dissection plane, describing specifically the anterior release (AR) technique using ThuLEP(Th). Included in this retrospective study were 32 consecutive patients operated on between January 2022-November 2022. Parameters were measured before and after the procedure: the International Prostate Symptom Score(IPSS), maximum flow rate(Qmax), post-void residual urine(PVR) prostate-specific antigen(PSA), prostate volume, operation-time, morcellation-time, catheterization-time and presence of transient urinary incontinence, and compared. The median age of patients undergoing enucleation of the prostate using the ARTh technique was 64 years (range: 44-83). The median prostate volume of the patients was 83.5 ml(50-128 ml), preoperative-IPSS was 24.8(15-33), postoperative-IPSS was 7(5-11), preoperative-Qmax was 8.1 ml/Sects. (5-11.5 ml/sec), postoperative-Qmax was 26.9 ml/Sect. (20.8-34 ml/sec), preoperative-PVR was 145 ml(75-258 ml), postoperative-PVR was 36.2 ml(0-66 ml), total operation time was 51.4 min(28-82 min), enucleation time was 36.9 min(19-51 min) and morcellation time was 15.3 min(8-27 min). The ARTh technique is a safe procedure that allows the surgeon to easily recognize and adhere to the defined dissection plane, thus decreasing operation times, significantly reducing the rate of postoperative transient urinary incontinence (TUI).


Assuntos
Lasers de Estado Sólido , Hiperplasia Prostática , Túlio , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Lasers de Estado Sólido/uso terapêutico , Adulto , Terapia a Laser/métodos , Terapia a Laser/instrumentação , Próstata/cirurgia , Prostatectomia/métodos , Duração da Cirurgia , Resultado do Tratamento
15.
Sci Rep ; 14(1): 11457, 2024 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769365

RESUMO

To compare two different wavelengths of the surgical contact diode laser (CDL) for producing a posterior laryngofissure in in-vivo pigs. Anesthetized pigs underwent a tracheostomy and an anterior laryngofissure through a cervicotomy. They were randomly selected for the CDL wavelength and Power, according to the peak of Power set at device (980nm wavelength: Ppeak power of 10 W, 15 W, and 20 W, or 1470 nm wavelength: Ppeak 3 W, 5 W, 7 W, 10 W). At the end of the experiment, the laryngotracheal specimen was extracted and sent for histology and morphometry measurements (incision size, depth, area, and lateral thermal damage). Hemodynamic data and arterial blood gases were recorded during the incisions. Statistical analysis of the comparisons between the parameters and groups had a level of significance of p < 0.05. Twenty-six pigs were divided into CDL 980 nm (n = 11) and 1470 nm (n = 15). There was a greater incision area at the thyroid level in the 980 nm CDL and a wider incision at the trachea level, with a larger distance between mucosa borders. There were no significant differences in the area of lateral thermal damage between the two groups and neither difference among the power levels tested. Both wavelengths tested showed similar results in the various combinations of power levels without significant differences in the lateral thermal damage. The posterior laryngofissure incision can be performed by either of the wavelengths at low and medium power levels without great difference on lateral thermal damage.


Assuntos
Laringe , Lasers Semicondutores , Animais , Suínos , Laringe/cirurgia , Terapia a Laser/métodos , Traqueia/cirurgia
16.
Photobiomodul Photomed Laser Surg ; 42(5): 375-382, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38776547

RESUMO

Objective: This study aimed to collate all published studies on laser therapy for pilonidal disease and demonstrate the safety and effectiveness of minimally invasive techniques. Methods: A comprehensive literature search, with no language limitations, was performed using PubMed, Embase, and Web of Science from inception to April 23, 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and evaluated the bias risk of included studies. Meta-analysis was performed using RevMan software (version 5.4). (PROSPERO Registration ID Number CRD42023420803). Results: The analysis included 1214 patients from 13 studies, who fulfilled the pre-defined inclusion criteria. With a median follow-up of 12 (range, 7.8-25) months, 1000 (84.4%) patients achieved healing after primary laser treatment. The mean complication and recurrence rates were 12.7% and 7.6%, respectively. Conclusions: Laser ablation for pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low postoperative recovery, and shorter recovery periods following employment.


Assuntos
Terapia a Laser , Seio Pilonidal , Seio Pilonidal/cirurgia , Seio Pilonidal/radioterapia , Humanos , Terapia com Luz de Baixa Intensidade
17.
Vestn Oftalmol ; 140(2. Vyp. 2): 129-135, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739142

RESUMO

The influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy and hydrodynamic parameters of phacoemulsification remains insufficiently studied. PURPOSE: This study evaluates the influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy, hydrodynamic parameters of phacoemulsification, and the degree of corneal endothelial cell loss. MATERIAL AND METHODS: Hybrid phacoemulsification was performed in 336 patients (336 eyes) with grade IV immature cataract according to the Buratto classification in three age-matched groups. Group 1 included 103 patients (103 eyes) who underwent hybrid phacoemulsification with preliminary femtosecond laser-assisted fragmentation of the nucleus with a «pizza¼ pattern (division of the nucleus with 10 radial cuts). Group 2 included 112 patients (112 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «cylinders¼ pattern (division of the nucleus with 8 radial cuts in combination with 5 circular cuts). Group 3 included 121 patients (121 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «grid¼ pattern (division of the nucleus with 8 radial cuts in combination with multiple mutually perpendicular cuts in the central zone in the form of a grid with a 0.5 mm cell). Effective ultrasound time and the volume of irrigation solution for emulsification of the lens nucleus fragments were determined during the operation. The loss of corneal endothelial cells was assessed 3 months after surgery. RESULTS: The minimum effective ultrasound time was noted after using the "grid" pattern - 4.05 (2.88; 4.74) s, which was significantly less than with the "cylinders" pattern - 4.97 (3.78; 5.88) s and the "pizza" pattern - 6.15 (4.52; 7.75) s (p<0.05). The effective ultrasound time when using the "cylinders" pattern was significantly less than with the "pizza" pattern (p<0.05). The volume of irrigation solution used for emulsification of the lens nucleus fragments was significantly less in the "grid" pattern - 41.5 (33.5; 49.5) ml compared to the "cylinders" patterns 58.5 (51.0; 66.0), p<0.05 and "pizza" pattern 75.0 (66.0; 83.5), p<0.01. The volume of irrigation solution when using the "cylinders" pattern was significantly less than when using the "pizza" pattern (p<0.05). The loss of corneal endothelial cells after using the "grid" pattern was 8.82 (7.59; 9.87)%, which was significantly less than after the "cylinders" patterns - 9.97 (8.81; 10.83)%, p<0.05 and "pizza" - 11.70 (10.62; 12.97)%, p<0.05. At the same time, the loss of endothelial cells after using the "cylinders" pattern was significantly less than after the "pizza" pattern (p<0.05). CONCLUSIONS: The choice of the optimal pattern of preliminary femtosecond laser-assisted fragmentation of the lens nucleus provides a significant decrease in the energy and hydrodynamic parameters of phacoemulsification and, accordingly, the loss of corneal endothelial cells.


Assuntos
Catarata , Hidrodinâmica , Terapia a Laser , Núcleo do Cristalino , Facoemulsificação , Humanos , Facoemulsificação/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Núcleo do Cristalino/cirurgia , Catarata/diagnóstico , Terapia a Laser/métodos , Resultado do Tratamento , Idoso , Acuidade Visual
18.
Vestn Oftalmol ; 140(2. Vyp. 2): 109-115, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38739139

RESUMO

Fragmentation and aspiration of soft cataracts require different surgical techniques and approaches compared to the removal of dense nuclei, including when using a femtosecond laser. PURPOSE: This study was conducted to develop a non-ultrasound technique for aspiration of a soft lens nucleus after its preliminary femtosecond laser-assisted fragmentation. MATERIAL AND METHODS: The study included 63 patients (63 eyes) aged 23 to 40 years who underwent surgery. In 27 cases, early or immature cataract was observed, and in 36 cases, cataract removal was performed for refractive purposes in high myopia and complex myopic astigmatism. The VICTUS femtosecond laser surgical system (Technolas Perfect Vision GmbH, Germany) was used for preliminary fragmentation of the lens nucleus. Surgeries were performed using the Centurion Vision System phacoemulsifier (Alcon Laboratories, Inc., USA). The volume of the required irrigation solution was evaluated during the surgery. Intraoperative and postoperative complications were assessed. RESULTS: The surgery was performed without complications in all cases. Capsulorhexis edge was completely preserved along its entire circumference. The study showed the fundamental possibility of aspirating a cataract with a nucleus of grade I-II density without low-frequency ultrasound after preliminary femtosecond laser-assisted fragmentation of the nucleus with a "grid" pattern, which ensures minimal fragment size in the central zone of the nucleus. The volume of irrigation solution required for aspiration of the nucleus was 36.0 (27.0; 44.0) ml, which does not significantly differ from the volume of solution during ultrasound phacoemulsification of a nucleus of such density. CONCLUSIONS: Femtosecond laser-assisted fragmentation of the lens nucleus with a "grid" pattern and phacoemulsifier systems with a high vacuum level allow effective aspiration of a soft lens without using low-frequency ultrasound.


Assuntos
Facoemulsificação , Humanos , Adulto , Masculino , Feminino , Facoemulsificação/métodos , Terapia a Laser/métodos , Catarata , Resultado do Tratamento , Núcleo do Cristalino/cirurgia , Sucção/métodos , Acuidade Visual
19.
Invest Ophthalmol Vis Sci ; 65(5): 13, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38713484

RESUMO

Purpose: The purpose of this study was to measure intraocular pressure (IOP) elevation while applying standard gonioscopy, selective laser trabeculoplasty (SLT), and laser iridotomy procedural lenses. Methods: Twelve cadaver eyes were mounted to a custom apparatus and cannulated with a pressure transducer which measured IOP. The apparatus was mounted to a load cell which measured the force on the eye. Six ophthalmologists performed simulated gonioscopy (Sussman 4 mirror lens), SLT (Latina lens), and laser iridotomy (Abraham lens) while a computer recorded IOP (mm Hg) and force (grams). The main outcome measures were IOP and force applied to the eye globe during ophthalmic diagnostics and procedures. Results: The average IOP's during gonioscopy, SLT, and laser iridotomy were 43.2 ± 16.9 mm Hg, 39.8 ± 9.9 mm Hg, and 42.7 ± 12.6 mm Hg, respectively. The mean force on the eye for the Sussman, Latina, and Abraham lens was 40.3 ± 26.4 grams, 66.7 ± 29.8 grams, and 65.5 ± 35.9 grams, respectively. The average force applied to the eye by the Sussman lens was significantly lower than both the Latina lens (P = 0.0008) and the Abraham lens (P = 0.001). During gonioscopy indentation, IOP elevated on average to 80.5 ± 22.6 mm Hg. During simulated laser iridotomy tamponade, IOP elevated on average to 82.3 ± 27.2 mm Hg. Conclusions: In cadaver eyes, the use of standard ophthalmic procedural lenses elevated IOP by approximately 20 mm Hg above baseline.


Assuntos
Cadáver , Gonioscopia , Pressão Intraocular , Iris , Terapia a Laser , Trabeculectomia , Humanos , Pressão Intraocular/fisiologia , Terapia a Laser/métodos , Iris/cirurgia , Trabeculectomia/métodos , Tonometria Ocular , Idoso , Iridectomia/métodos , Feminino , Masculino , Idoso de 80 Anos ou mais
20.
World J Urol ; 42(1): 306, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38722445

RESUMO

PURPOSE: The question of best surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) remains controversial. We compared the outcomes of aquablation and holmium laser enucleation of the prostate ("HoLEP") in a prospective cohort. METHODS: Patients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume ("PV"), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo ("CD") classification. RESULTS: We included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients' larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation's results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01). CONCLUSIONS: While aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.


Assuntos
Técnicas de Ablação , Lasers de Estado Sólido , Hiperplasia Prostática , Humanos , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/complicações , Masculino , Idoso , Estudos Prospectivos , Lasers de Estado Sólido/uso terapêutico , Pessoa de Meia-Idade , Técnicas de Ablação/métodos , Terapia a Laser/métodos , Prostatectomia/métodos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Água , Resultado do Tratamento
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