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1.
Medicine (Baltimore) ; 100(2): e24013, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466143

RESUMO

RATIONALE: The femtosecond laser LDV Z 8 is unique, and the only femtosecond laser used in ophthalmic microsurgery, which is characterized by low-energy near-infrared (1030 nm) femtosecond single pulses in the nano-Joule range and a very high repetition rate in the MHz range. To the best of our knowledge, this is the first description of unintentional partial corneal incision in the anterior part of a stroma by the femtosecond laser. PATIENT CONCERNS: A 79-year-old patient was referred to our clinic for cataract surgery. On admission, we diagnosed mature cataract of the left eye and pseudophakic of the right eye. The patient was qualified for the Femtosecond Laser-Assisted Cataract Surgery (FLACS). Unexpectedly during FLACS procedure after lens fragmentation the surgeon observed unexpected paracentral incision in the cornea. DIAGNOSIS: The corneal incision line between 4 to 8 o'clock was observed. In vivo confocal microscopy was performed to assess the morphology and depth of the corneal wound. The corneal incision covered the epithelium, Bowman's membrane and stroma of the cornea reached a depth of 336 um. INTERVENTIONS: The patient was under increased ophthalmologic controls; follow up with typical ophthalmic examinations and confocal microscopy was performed. OUTCOMES: In 2-year follow-up period, this complication had no effect on postoperative visual function, the patient had no visual problems and obtained the final BCVA 5/5. There is no dislocation of the lens in 2 years follow-up. LESSONS: Low pulse energy and high pulse frequency in the LDV Z8 causes a low traumatization of tissues. In a 2-year follow-up, the corneal incision line could be observed on the slit lamp examination without long-term visual consequences of this complication. In our opinion, the most likely cause of this complication was human error and lack of communication between medical personnel. The operation team should be alert and great caution must be exercised during the procedure and check the laser settings parameters carefully each time.


Assuntos
Extração de Catarata/efeitos adversos , Extração de Catarata/métodos , Lesões da Córnea/etiologia , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Idoso , Córnea/patologia , Feminino , Humanos , Microscopia Confocal , Acuidade Visual
2.
Medicine (Baltimore) ; 99(51): e23337, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371065

RESUMO

ABSTRACT: Recently, trans-sacral epiduroscopic laser decompression (SELD) using flexible epiduroscopy and laser system is 1 of the options for minimally invasive surgery in herniated lumbar disc. However, outcomes after SELD in patients with disc herniation of lumbar spine are not proven worldwide. The authors reported clinical, surgical, and radiological outcome after SELD in patients with mild to moderate disc herniation.Between 2015 and 2018, eighty-two patients who underwent SELD for single level disc herniation with a minimum follow-up of 6.0 months were investigated retrospectively. Clinical outcomes were assessed using the visual analog scale for low back and leg pain and Odom's criteria for patient satisfaction. Also, surgical outcomes, including complications, recurrences, and revision surgeries, and radiological outcomes using regular simple radiograph were analyzed.The mean visual analog scale score of low back pain and leg pain improved from 5.43 ±â€Š1.73 and 6.10 ±â€Š1.67 to 2.80 ±â€Š1.43 and 3.58 ±â€Š2.08 at the final follow-up (p < 0.001). On the other hand, according to Odom's criteria, the success rate (excellent or good results at 6 months after surgery) was 58.5%. Surgical complications occurred in 7 patients (8.5%), including dura puncture during the procedure, transient headache or nuchal pain, and transient mild paralysis. The rate of additional procedures after SELD was 17.1% (6 patients of revision surgery and 8 patients of an additional nerve block).Our findings demonstrated that SELD for lumbar disc herniation achieved less favorable patient satisfaction compared with previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.


Assuntos
Descompressão Cirúrgica/métodos , Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Fatores Etários , Índice de Massa Corporal , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Terapia a Laser/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Duração da Cirurgia , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Retorno ao Trabalho/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais
3.
Medicine (Baltimore) ; 99(50): e23282, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327253

RESUMO

BACKGROUND: Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants. Although a variety of managements are available for ROP, the efficacy is still unsatisfied. Studies have suggested that laser therapy (LT) may benefit ROP. However, no systematic review has addressed this topic. Thus, this systematic review aims to evaluate the efficacy and safety of LT for ROP. METHODS: A comprehensive literature search will be performed from electronic databases (PubMed, EMBASE, AMED, Cochrane Library, WorldSciNet, Science online, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure) and other sources. The time is from the database construction to the present. Two investigators will independently carry out literature selection, data extraction and quality assessment. We will utilize RevMan 5.3 software for statistical analysis. Data synthesis will be conducted either as a narrative summary or meta-analysis. Statistical heterogeneity will be appraised using I test. If heterogeneity is low, pooled estimates will be calculated using a fixed-effects model. Otherwise, we will utilize a random-effects model to pool the data. RESULTS: This study will provide up-to-date evidence on the efficacy and safety of LT for ROP, which may help to assess whether LT is effective and safe for ROP. CONCLUSION: This study will provide helpful evidence to determine whether or not LT is effective and safe for ROP, which may benefit both patients and clinicians. STUDY REGISTRATION: osf.io/3tmnf.


Assuntos
Terapia a Laser , Retinopatia da Prematuridade/cirurgia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
Arch. Soc. Esp. Oftalmol ; 95(11): 528-537, nov. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197743

RESUMO

INTRODUCCIÓN: La cirugía de la catarata asistida con el láser femtosegundo (FLACS) se ha considerado un avance tecnológico en la cirugía moderna de la catarata. Tras los años de experiencia, se ha observado que los resultados clínicos presentan más complicaciones de las esperadas al inicio. Con este estudio queremos comparar los beneficios e inconvenientes de la técnica FLACS con la cirugía de catarata convencional. MÉTODO: Utilizamos las plataformas PubMed y Web of Science para la búsqueda de la literatura científica. RESULTADOS: Actualmente, el FLACS ha mejorado la técnica quirúrgica en cuanto al menor tiempo de ultrasonidos empleado y a la menor pérdida de células endoteliales. Asimismo, el centrado de la capsulotomía y la corrección del astigmatismo con las incisiones arqueadas han mejorado. Como inconvenientes destacan el alto coste del láser, las complicaciones intraoperatorias sobre la cápsula, la inducción de miosis intraoperatoria y la curva de aprendizaje de la técnica. CONCLUSIONES: Consideramos la técnica FLACS beneficiosa para casos concretos como pacientes con cirugía premium programada o con bajo recuento de células endoteliales. No obstante, creemos que, dado el coste tecnológico, no es una técnica rentable para la mayoría de los casos de nuestra práctica clínica diaria, que son casos estándares


INTRODUCTION: Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD: The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS: The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS: The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice


Assuntos
Humanos , Extração de Catarata/métodos , Terapia a Laser/métodos , Terapia a Laser/efeitos adversos , Extração de Catarata/efeitos adversos , Resultado do Tratamento , Capsulotomia Posterior/métodos , Cirurgia da Córnea a Laser/métodos , Análise Custo-Benefício
5.
Medicine (Baltimore) ; 99(41): e22520, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031293

RESUMO

BACKGROUND: There is no consensus in existing literature on the pulse power, application time, frequency and the dose of energy of laser therapy for the patients. Therefore, we conducted this research for the assessment of safety and efficiency of ultrasound and high-intensity laser therapy (HILT) in the lumbar disc herniation (LDH) patients. METHODS: Our present research was approved by the institutional review board in the West China-Guangan Hospital. All the participants would acquire the written informed consent. From December 2020 to December 2021, we will conduct a prospective evaluation via a senior surgeon for 1 hundred LDH patients who plan to undergo the conservative treatment at our hospital. In this research, the inclusion criteria contained: the patients with lumbar disc herniation diagnosed by lumbar MRI; the patients with no history of trauma or congenital abnormalities; and the patients with sufficient psychological ability to understand and then answer the questions raised in assessment scale. The participants were randomly divided into the control group or HILT group after performing the examination of baseline. The main outcome was the pain score of visual analog scale. The other results contained the adverse effects, back range of motion as well as functional scores. CONCLUSIONS: We assumed that the HILT is as effective as the ultrasound therapy in treating pain for LDH. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5975).


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Terapia a Laser/efeitos adversos , Dor Lombar/etiologia , Vértebras Lombares , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Terapia por Ultrassom/efeitos adversos
6.
Surgery ; 168(5): 909-914, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32792099

RESUMO

BACKGROUND: This study investigates the clinical outcomes of endovenous microwave ablation and endovenous laser ablation for varicose veins. METHODS: A total of 139 patients who underwent endovenous microwave ablation and 145 patients who underwent endovenous laser ablation were included in this multicenter study. The clinical outcomes and complications were assessed at 1, 6, and 12 months after the procedure. The effect on quality of life was assessed by the Aberdeen Varicose Vein Questionnaire and the EuroQol Group 5-Dimension Self-Report Questionnaire. RESULTS: The endovenous microwave ablation group had a shorter procedure time than the endovenous laser ablation group (42.58 ± 15.62 minutes vs 65.46 ± 24.38 minutes, P < .01), and no significant differences were observed in the other procedure parameters. The incidences of induration (20.26% vs 31.06%) and ecchymosis (13.07% vs 22.98%, P < .05) were lower in the endovenous microwave ablation group. The rates of temporary paresthesia (9.80% vs 18.01%) and residual varicosities (8.61% vs 16.77%, P < .05) were lower in the endovenous microwave ablation group at 1 month. There were no significant differences in paresthesia or saphenous vein closure rates between the groups at 6 and 12 months. Both groups had significant improvements in their Aberdeen Varicose Vein Questionnaire and EuroQol Group 5-Dimension Self-Report Questionnaire scores post-procedure, and no significant differences in Aberdeen Varicose Vein Questionnaire and EuroQol Group 5-Dimension Self-Report Questionnaire scores were confirmed. However, local recurrence below the knee was lower in the endovenous microwave ablation group (2.34% vs 8.46%, P < .05) after 12 months. CONCLUSION: Our results confirmed that the endovenous microwave ablation procedure demonstrated a shorter procedure time, lower complication, and local recurrence than the endovenous laser ablation procedure.


Assuntos
Técnicas de Ablação/métodos , Terapia a Laser/métodos , Micro-Ondas/uso terapêutico , Varizes/cirurgia , Técnicas de Ablação/efeitos adversos , Adulto , Feminino , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Varizes/psicologia
7.
Tech Vasc Interv Radiol ; 23(2): 100672, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591188

RESUMO

Image-guided percutaneous thermal ablation is a widely acceptable local therapy for patients with colorectal liver metastases who are noneligible for surgery or present with recurrence after hepatectomy. The increasing knowledge of factors that affect oncologic outcomes has allowed selected patients with resectable small volume colorectal liver metastases to be treated by thermal ablation with curative intent. The continuous technological evolutions in imaging and image-guidance and the wide implementation of microwave ablation that overcomes most of the limitations of radiofrequency ablation have contributed to this paradigm shift. The importance of patient selection, ablation margin evaluation, and confirmation of complete tumor ablation (A0) are discussed in this article.


Assuntos
Neoplasias Colorretais/patologia , Criocirurgia , Terapia a Laser , Neoplasias Hepáticas/cirurgia , Metastasectomia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência , Cirurgia Assistida por Computador , Biópsia , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Fluordesoxiglucose F18/administração & dosagem , Humanos , Terapia a Laser/efeitos adversos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Margens de Excisão , Metastasectomia/efeitos adversos , Micro-Ondas/efeitos adversos , Seleção de Pacientes , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Ablação por Radiofrequência/efeitos adversos , Compostos Radiofarmacêuticos/administração & dosagem , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento , Carga Tumoral
8.
Semin Vasc Surg ; 32(3-4): 89-93, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32553124

RESUMO

Lower limb varicose veins are a common vascular disorder producing pain and disability when truncal vein reflux is present. Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is a safe and effective method for treating this condition. An unintended complication of this procedure is endothermal heat-induced thrombosis (EHIT) of common femoral vein. A retrospective outcomes analysis of patients who underwent EVLA of the GSV at King Khalid University Hospital from June 2006 to November 2018 was conducted to identify the risks factors and incidence of EHIT. Patients were assessed by clinical examination and duplex ultrasound imaging after the EVLA, and patient demographic characteristics and procedural factors predictive of EHIT were determined. Following EVLA, 11,070 duplex ultrasound examinations were performed for 1,230 limbs, and EHIT was detected in 65 (5.3%) limbs in 60 (6.8%) patients. Essentially all EHIT cases were detected in the first week (n = 63; 96.9%) and clot regression occurred over a period of 1-4 weeks. There were no significant differences in patient demographic characteristics or procedural factors between the EHIT and non-EHIT groups, except for the percentage of women (86% v 73%; P = .02), maximum GSV diameter (6.7 ± 2.7 mm v 6.0 ± 2.1 mm; P = .04), and percentage of patients with a competent saphenofemoral junction (41% v 37%; P < .001). EVLA is a safe treatment for great saphenous vein reflux, but EHIT can occur and was associated with female sex, large maximum GSV diameter, and competent saphenofemoral junction. Venous duplex imaging after EVLA is recommended because EHIT is asymptomatic in most patients.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Terapia a Laser/efeitos adversos , Veia Safena/cirurgia , Varizes/cirurgia , Trombose Venosa/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Arábia Saudita/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/epidemiologia , Trombose Venosa/diagnóstico por imagem
10.
Am J Ophthalmol ; 217: 232-239, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32437671

RESUMO

PURPOSE: To investigate the long-term stability of corneal astigmatism after combined femtosecond (fs)-assisted phacoemulsification and arcuate keratotomy. DESIGN: Retrospective, interventional case series. METHODS: Surgery was performed using a Victus (Bausch & Lomb) platform. A single, 450-µm-deep arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism measurements obtained preoperatively and at 2 and 5 years postoperatively were analyzed using vector analysis. RESULTS: A total of 44 eyes of 44 patients (mean age 66.0 ± 10.1 years) were included. The mean preoperative corneal astigmatism was 1.40 ± 0.66 diopters (D). This was reduced to 0.74 ± 0.54 D at 2 years and 0.70 ± 0.50 at 5 years postoperatively (P < .001). There were no statistically significant differences between postoperative corneal astigmatism at 2 years and at 5 years (P = .609). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .805). At the end of 5 years, 65% of the eyes were within 15 degrees of the preoperative astigmatic meridian. Comparative analysis showed significantly higher surgically induced astigmatism, lower differences in vector and absolute angles of error for the eyes with preoperative with-the-rule (WTR) astigmatism than eyes with against-the-rule (ATR) astigmatism at 5 years (P < .004). CONCLUSIONS: Our study showed the stability of femtosecond (fs)-assisted arcuate keratotomy was well-maintained over 5 years. There was a tendency of increasing overcorrection of preoperative WTR astigmatism and undercorrection of ATR astigmatism over time.


Assuntos
Astigmatismo/etiologia , Córnea/cirurgia , Ceratoplastia Penetrante/efeitos adversos , Terapia a Laser/efeitos adversos , Facoemulsificação/efeitos adversos , Refração Ocular , Idoso , Astigmatismo/diagnóstico , Astigmatismo/fisiopatologia , Córnea/diagnóstico por imagem , Doenças da Córnea/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Facoemulsificação/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual
11.
J Med Vasc ; 45(3): 130-146, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32402427

RESUMO

Venous insufficiency is a very common disease affecting about 25% of the French population (if we combine all stages of its progression). It is a complex disease and its aetiology has not yet been fully elucidated. Some of its causes are well known, such as valvular dysfunction, vein wall defect, and the suctioning effect common to all varicose veins. These factors are generally associated and together lead to dysfunction of one or more of the saphenous veins. Saphenous vein dysfunction is revealed by ultrasound scan, a reflux lasting more than 0.5 seconds indicating venous incompetence. The potential consequences of saphenous vein dysfunction over time include: symptoms (heaviness, swellings, restlessness, cramps, itching of the lower limbs), acute complications (superficial venous thrombosis, varicose bleeding), chronic complications (changes in skin texture and colour, stasis dermatitis, eczema, vein atresia, leg ulcer), and appearance of unaesthetic varicose veins. It is not possible to repair an incompetent saphenous vein. The only therapeutic options at present are ultrasound-guided foam sclerotherapy, physical removal of the vein (saphenous stripping), or its thermal ablation (by laser or radiofrequency treatment), the latter strategy having now become the gold standard as recommended by international guidelines. Recommendations concerning thermal ablation of saphenous veins were published in 2014 by the Société française de médecine vasculaire. Our society has now decided to update these recommendations, taking this opportunity to discuss unresolved issues and issues not addressed in the original guidelines. Thermal ablation of an incompetent saphenous vein consists in destroying this by means of a heating element introduced via ultrasound-guided venous puncture. The heating element comprises either a laser fibre or a radiofrequency catheter. The practitioner must provide the patient with full information about the procedure and obtain his/her consent prior to its implementation. The checklist concerning the interventional procedure issued by the HAS should be validated for each patient (see the appended document).


Assuntos
Terapia a Laser/normas , Ablação por Radiofrequência/normas , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Lista de Checagem/normas , Tomada de Decisão Clínica , Consenso , Humanos , Terapia a Laser/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Índice de Gravidade de Doença , Resultado do Tratamento , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem
12.
J Vis Exp ; (159)2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32449714

RESUMO

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid's arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.


Assuntos
Terapia a Laser/instrumentação , Lasers Semicondutores , Hiperplasia Prostática/cirurgia , Humanos , Complicações Intraoperatórias/etiologia , Terapia a Laser/efeitos adversos , Tempo de Internação , Masculino , Qualidade de Vida , Resultado do Tratamento
13.
Am J Ophthalmol ; 217: 224-231, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32335056

RESUMO

PURPOSE: To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years. DESIGN: Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS: Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. PATIENT POPULATION: Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye. OBSERVATION PROCEDURES: Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA). MAIN OUTCOME MEASURE: PCO score (scale, 0-10). RESULTS: The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P = .23). CONCLUSION: The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development.


Assuntos
Resinas Acrílicas/efeitos adversos , Opacificação da Cápsula/etiologia , Cápsula do Cristalino/patologia , Lentes Intraoculares/efeitos adversos , Facoemulsificação/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Áustria/epidemiologia , Opacificação da Cápsula/diagnóstico , Opacificação da Cápsula/epidemiologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Incidência , Terapia a Laser/efeitos adversos , Cápsula do Cristalino/cirurgia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Fatores de Tempo
14.
Khirurgiia (Mosk) ; (3): 89-96, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271744

RESUMO

OBJECTIVE: To analyze efficacy and safety of submucosal laser ablation of internal hemorrhoids (SLT). MATERIAL AND METHODS: Systematic review included 10 articles published in electronic databases PubMed, Cochrane Library, Elibrary until January 2019. There were only full-text publications from prospective clinical trials devoted to submucosal laser ablation in the treatment of hemorrhoids. Isolated SLT was used in 4 trials, combination with other minimally invasive procedures was reported in 6 reports. RESULTS: SLT was predominantly used in the treatment of hemorrhoids grade 2-3. Efficacy of procedure was 91.1-100% after 6 months and 87.5-100% after 12 months. Intra- and postoperative complications included intraoperative bleeding (8.4%), perianal and external piles edema (8.2%), postoperative bleeding (2.7%), urinary retention (1.2%), anal fistula (0.6%), perianal abscess (0.14%). CONCLUSION: Submucosal laser ablation is quite effective and safe option for treatment of hemorrhoids grade 2-3. However, further researches are required considering the absence of clear recommendations on laser beam parameters, indications for procedure and data on long-term outcomes.


Assuntos
Hemorroidectomia/métodos , Hemorroidas/cirurgia , Terapia a Laser , Hemorroidectomia/efeitos adversos , Humanos , Mucosa Intestinal/cirurgia , Terapia a Laser/efeitos adversos
15.
PLoS One ; 15(4): e0223229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271751

RESUMO

To explore the shape characteristics of ablation lesions created via laser ablation (LA), radiofrequency ablation (RFA) and microwave ablation (MWA) in canine prostates and the clinical significance of these characteristics, six adult male beagles were randomly assigned to the LA, RFA, and MWA groups. These ablations were performed with common parameters applied in clinical practice (LA, 3 W/1200 J; RFA and MWA, 30 W/120 s). One ablation lesion was created in each lobe of the prostate via the ablation technique, resulting in a total of twelve ablation lesions. Transrectal ultrasound (TRUS) was used as guidance during puncture and to monitor changes in the ablation lesions. Finally, the ablation efficacy was assessed using transrectal contrast-enhanced ultrasonography (CEUS), and the transverse diameter (TRD), anteroposterior diameter (APD) and longitudinal diameter (LD) of each ablation lesion were measured. The volume (V) and the ratio (R) value were calculated. R reflects the shape characteristic of the ablation lesion (the R value close to 1.0 indicates a more spherical shape). The R values of the ablation lesions were 0.89 ± 0.02, 0.72 ± 0.01, and 0.65 ± 0.03 for RFA, MWA and LA, respectively, and they were significantly different (P = 0.027). The volumes of the ablation lesions were 2.17 ± 0.10 ml, 1.51 ± 0.20 ml, and 0.79 ± 0.07 ml for MWA, LA and RFA, respectively, and they were also significantly different (P = 0.001). The three abovementioned thermal ablation techniques with common parameters in clinical practice can be used for ablation in the prostate. The shapes and volumes of the ablation lesions of the three techniques were varied: The RFA-created lesions had the lowest volumes and were more spherical in shape, demonstrating that RFA could be used for the treatment of relatively small lesions or tumours adjacent to vital organs. The MWA lesions had the largest size with a spherical shape, which could be advantageous for the ablation of tumours with relatively large sizes. The sizes of the ablation lesions created via LA were between those of RFA and MWA but presented more oval in shape, suggesting that this method is highly appropriate for the ablation of benign prostatic hyperplasia (BPH).


Assuntos
Terapia a Laser/veterinária , Complicações Pós-Operatórias/veterinária , Hiperplasia Prostática/veterinária , Ultrassom Focalizado Transretal de Alta Intensidade/veterinária , Animais , Cães , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Masculino , Micro-Ondas/uso terapêutico , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Hiperplasia Prostática/cirurgia , Ultrassom Focalizado Transretal de Alta Intensidade/efeitos adversos , Ultrassom Focalizado Transretal de Alta Intensidade/métodos
16.
J Glaucoma ; 29(6): e50-e52, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32287149

RESUMO

PURPOSE: To describe vision-threatening complications after micropulse diode transscleral cyclophotocoagulation (MP-TSCPC). METHODS: Retrospective case series. Medical charts of patients who underwent MP-TSCPC and developed visually significant inflammation and hyphema after the procedure were reviewed. Patients were seen at the Upstate Medical University Ophthalmology clinic between 2017 and 2019. RESULTS: Out of 64 patients who underwent MP-TSCPC in the defined time period, 2 patients with postprocedure severe inflammation and hyphema were identified. One patient had severe-stage primary open-angle glaucoma (POAG). After MP-TSCPC, the patient was noted to have a large visually significant anterior chamber reaction and hyphema that occupied 80% of the anterior chamber on postprocedure day 1. The patient was treated with topical and oral corticosteroids, and topical atropine. The second patient had uncontrolled severe-stage POAG. The patient underwent MP-TSCPC. After the procedure, the patient was noted to have significant inflammation with fibrin and hyphema that filled 80% of the anterior chamber. The patient was treated with topical steroids. CONCLUSIONS: As with any intervention, complications are inevitable. Recognition of complications and its possible associations allow for better and more individualized risk versus benefit analysis of an intervention. In this case series, exuberant anterior segment inflammation and hyphema occurred in 2 patients who underwent MP-TSCPC. The authors' goal is to raise awareness of severe anterior chamber inflammation and hyphema as complications occurring after laser treatment with a reputation of minimal or no side-effect profile and to better understand this relatively new laser advancement in the treatment of glaucoma.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Hifema/etiologia , Inflamação/etiologia , Terapia a Laser/efeitos adversos , Idoso de 80 Anos ou mais , Humanos , Hifema/diagnóstico , Hifema/patologia , Inflamação/diagnóstico , Inflamação/patologia , Terapia a Laser/métodos , Lasers Semicondutores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Esclera/cirurgia , Índice de Gravidade de Doença
17.
World Neurosurg ; 139: e88-e97, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32251808

RESUMO

BACKGROUND: Laser interstitial thermal therapy (LITT) is a stereotactic-guided technique, which is increasingly being performed for brain lesions. The aim of our study was to report the national trends and factors predicting the clinical outcomes following LITT using the Nationwide Inpatient Sample. METHODS: We extracted data from 2011-2016 using ICD-9/10 codes. Patients with a primary procedure of LITT were included. Patient demographics, complications, length of hospital stay, discharge disposition, and index-hospitalization charges were analyzed. RESULTS: A cohort of 1768 patients was identified from the database. Mean length of hospital stay was 3.2 days, 82% of patients were discharged to home, and in-hospitalization cost was $124,225. Complications and mortality were noted in 12.9% and 2.5% of patients following LITT, respectively. Non-Caucasian patients (estimate ratio [ER] 4.26), those with other insurance (compared with commercial, ER: 5.35), 3 and 4+ comorbidity indexes, patients with higher quartile median household income (second, third, and fourth quartile compared with first quartile), and those who underwent nonelective procedures were likely to have higher complications and less likely to be discharged home. Patients with 4+ comorbidity indexes were likely to have longer length of hospital stay (ER 1.39) and higher complications (ER: 7.95) and were less likely to be discharged home (ER: 0.17) and have higher in-hospitalization cost (ER: 1.21). CONCLUSIONS: LITT is increasingly being performed with low complication rates. Non-Caucasian race, higher comorbidity index, noncommercial insurance, and nonelective procedures were predictors of higher complications and being less likely to be discharged home. In-hospitalization charges were higher in patients with higher comorbidity index and those with noncommercial insurance.


Assuntos
Encefalopatias/terapia , Terapia a Laser/métodos , Técnicas Estereotáxicas , Resultado do Tratamento , Estudos de Coortes , Feminino , Humanos , Pacientes Internados , Terapia a Laser/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Técnicas Estereotáxicas/efeitos adversos
18.
J Vasc Surg ; 72(1): 356-366.e5, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32093910

RESUMO

OBJECTIVE: Our study aimed to perform a meta-analysis based on current evidence to investigate the efficacy of different debulking devices in the treatment of femoropopliteal in-stent restenosis (FP-ISR). METHODS: We systematically searched for articles reporting treatment of FP-ISR patients in the MEDLINE, Embase, and Cochrane databases. Randomized controlled trials, cohort studies, and retrospective studies were included, and clinical characteristic outcomes were extracted and pooled. The efficacy end points included primary patency and freedom from target lesion revascularization (TLR) at 1 year. Pooled estimates were calculated using the random effects model. For each point, effect size and 95% confidence intervals (CIs) were calculated. RESULTS: We identified 12 studies with 743 patients that could be included in this meta-analysis. The overall primary patency at 1 year was 58.3% (95% CI, 44.7%-71.9%), and freedom from TLR at 1 year was 67.0% (95% CI, 60.5%-74.6%). Subgroup analysis showed that the laser debulking + percutaneous transluminal angioplasty (PTA) group was associated with a similar primary patency and freedom from TLR compared with the mechanical debulking + PTA group (53.8% vs 52.8; 65.4% vs 62.1%). Subgroup analysis demonstrated that the long lesion and short lesion groups and the occlusive and stenosis groups shared similar results of primary patency and freedom from TLR. Laser + drug-coated balloon was associated with higher primary patency and freedom from TLR compared with laser + PTA (78.5% vs 58.3%; 76.7% vs 66.4%). CONCLUSIONS: Debulking devices show promising and favorable results for FP-ISR patients with complex lesions. Debulking devices combined with a drug-coated balloon might be an efficacious way to treat FP-ISR complex lesions in the future.


Assuntos
Angioplastia/instrumentação , Aterectomia/instrumentação , Artéria Femoral , Terapia a Laser/instrumentação , Doença Arterial Periférica/terapia , Artéria Poplítea , Trombectomia/instrumentação , Angioplastia/efeitos adversos , Aterectomia/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Recidiva , Fatores de Risco , Trombectomia/efeitos adversos , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
Exp Eye Res ; 193: 107976, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32081669

RESUMO

Neuropathic dry eye is one of the most frequently seen complications after corneal refractive surgery, however, its incidence decreases in a significant manner along the first six months postoperative, reaching between 10 and 45% incidence. However, little is known on the inflammatory status of the ocular surface during this recovery process. We aim to analyze the clinical and tear molecule concentration changes along six months after advanced surface ablation for myopia correction, in a prospective study including 18 eyes of 18 subjects who bilaterally underwent advanced surface ablation corneal refractive surgery. Clinical variables (uncorrected distance visual acuity, symptoms, conjunctival hyperemia, tear osmolarity, tear stability, corneal fluorescein staining, conjunctival lissamine staining, Schirmer test, and corneal esthesiometry) and a panel of 23 pro and anti-inflammatory cytokines/chemokines concentration in tears preoperatively and at 1, 3 and 6 months postoperatively were evaluated. We found that uncorrected distance visual acuity improved significantly from baseline at 1-month visit, symptoms improved and tear osmolarity decreased significantly from baseline at 3-month visit and there was a decrease in mechanical corneal threshold between 1-month and 3- and 6-month visits. Regarding tear molecules, IL-4, IL-5, IL-6, IL-13, IL-17A, and IFN-γ tear levels were significantly increased at all the three visits, compared to preoperative levels at V0; IL-2 and VEGF were also significantly increased at 1-month and 6-month visits, but not at 3-month visit, whereas IL-9 IL-10 and IL-12 were only significantly increased at 6-month visit. Although we found that there is a recovery in clinical variables at 6 months postoperatively (i.e. neuropathic dry eye was not developed in the sample), ocular surface homeostasis is not completely restored, as it can be seen by the changes in concentration of some pro and anti-inflammatory molecules measured in tears.


Assuntos
Citocinas/metabolismo , Síndromes do Olho Seco/metabolismo , Terapia a Laser/efeitos adversos , Procedimentos Cirúrgicos Refrativos/efeitos adversos , Lágrimas/metabolismo , Adulto , Biomarcadores/metabolismo , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Estudos Prospectivos , Fatores de Tempo , Acuidade Visual
20.
J Glaucoma ; 29(4): 280-286, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32053556

RESUMO

PRéCIS:: Adjuvant diclofenac and apraclonidine eye drop given in conjunction with selective laser trabeculoplasty (SLT) do not significantly impact medium-term intraocular pressure (IOP) reduction compared with placebo, but apraclonidine can be used to blunt immediate postlaser pressure spikes. PURPOSE: There is limited high-grade evidence guiding the choice of eye drops given before and after SLT. The authors chose to measure IOP during the first 24 hours, at 1 week, 6 weeks, and 6 months after SLT, and compare the effect of apraclonidine before SLT and diclofenac after SLT, with placebo. MATERIALS AND METHODS: In this double-blind, randomized, placebo-controlled trial, patients with open-angle glaucoma or ocular hypertension referred for SLT were recruited between 2016 and 2018. Patients were randomized to receive either apraclonidine pre-SLT with placebo post-SLT, placebo pre-SLT with diclofenac post-SLT, or placebo before and after SLT. RESULTS: Sixty eyes from 35 patients were treated with 360-degree SLT. Twenty-four-hour IOP measurements with patient self-monitoring after SLT demonstrated a moderate IOP spike at 1 hour and 2 hours post-SLT in the placebo and diclofenac study arms (mean=+4.05±0.58 mm Hg and +4.47±0.73, respectively, P<0.001 vs. pre-SLT IOP), which was prevented by apraclonidine (mean=-2.41±0.88 mm Hg, P<0.0001 vs. other study arms post-SLT). There were no significant differences between the 3 arms of the study on the long-term IOP reduction achieved by SLT (6 wk: P=0.51, 6 mo: P=0.42). CONCLUSIONS: Neither the use of apraclonidine before SLT nor diclofenac after SLT significantly influenced the IOP reduction induced by SLT. Except for a slight and transient reduction in intraocular inflammation, there was no beneficial effect of diclofenac on early IOP changes or the degree of patient discomfort relative to placebo.


Assuntos
Clonidina/análogos & derivados , Diclofenaco/uso terapêutico , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/cirurgia , Trabeculectomia , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Clonidina/uso terapêutico , Método Duplo-Cego , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Lasers Semicondutores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologia , Soluções Oftálmicas/uso terapêutico , Tonometria Ocular
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