Comparison of 755-nm picosecond alexandrite laser versus 1064-nm Q-switched Nd:YAG laser for melasma: A randomized, split-face controlled, 2-year follow-up study.

OBJECTIVES: Pulsed laser treatment of melasma has shown some promising results. To compare the effectiveness and safety of 755-nm picosecond alexandrite laser (PSAL) fitted with diffractive lens array (DLA) versus 1064-nm Q-switched neodynimum:yttrium aluminum garnet laser (QSNYL) for the treatment of melasma. METHODS: We conducted a randomized, split face controlled, 2-year follow-up study. Each face was divided into two parts, each side receiving three treatments with either PSAL or QSNYL at 1 month intervals. Modified Melasma Area Severity Index scores (mMASI), pain scores, patient satisfaction and adverse events were recorded. In vivo reflectance confocal microscopy (RCM) images were acquired. RESULTS: Twenty subjects were enrolled and three dropped out. At 6 months, mMASI scores were significantly lower than baseline for QSNYL sides (p = 0.022), with no statistically significant difference between PSAL sides before and after treatment, PSAL sides versus QSNYL sides, or patient satisfaction scores. QSNYL treatment was associated with less pain (p = 0.014). No serious adverse events were reported. In the PSAL sides RCM showed a large number of dendritic melanocytes infiltrated in the dermis at 2 weeks and 4 weeks after treatment. Ten patients (58.82%) reported recurrence or exacerbation at 2-year follow-up with no statistically significant difference between the two lasers. CONCLUSIONS: QSNYL demonstrated short term clinical efficacy for melasma, but did not provide any additional benefit compared to PSAL with DLA. QSNYL was associated with less pain. There was a high recurrence rate at 2-year follow-up. RCM allowed the detection of cellular changes in melasma lesions.

A novel treatment for Riehl's melanosis targeting both dermal melanin and vessels.

BACKGROUND/PURPOSE: Riehl's melanosis is a difficult-to-treat condition characterized by persisting dermal hyperpigmentation. This study aimed to evaluate the efficacy of a histology-specific targeted therapy for Riehl's melanosis. METHODS: Skin biopsy samples of Riehl's melanosis were assessed to identify histology-specific targets for treatment. Subsequently, the efficacy of a combination involving a fractional picosecond laser and a pulsed dye laser (PDL) targeting the dermal melanin and vessels, respectively, was evaluated. Clinical improvement was assessed using the dermal pigmentation area and severity index (DPASI). The treatment outcomes were compared to those of a control, in this case a single laser treatment solely targeting pigmentation. RESULTS: Histological and immunohistochemical analyses identified dermal melanin pigment and dilated vessels as treatment targets for Riehl's melanosis. The combined treatment of the fractional picosecond laser and PDL showed a significant reduction of the DPASI scores, which was significantly better than the control group. Patients who underwent the combined laser treatment indicated high levels of satisfaction with no adverse events except of transient erythema and oedema. CONCLUSION: The combined treatment of a fractional picosecond laser and a PDL was more effective for Riehl's melanosis compared to single laser treatment. The treatment targets both dermal pigmentation and dilated vessels, offering promising results for those working to manage Riehl's melanosis.

A Prospective, Split-Face, Randomized Study Comparing a 755-nm Picosecond Laser With and Without Diffractive Lens Array in the Treatment of Melasma in Asians.

BACKGROUND AND OBJECTIVES: Treatment of melasma with lasers remains a challenge due to its limited clinical efficacy in addition to high rates of recurrence and side effects. Recently, picosecond lasers have shown favorable results in treatment of benign pigmented lesions. To compare the efficacy and safety of using a 755-nm picosecond laser for the treatment of melasma in a split-face manner, having one side treated with a fractionated beam (diffractive lens array [DLA] coupling) and with a full-beam (flat optics) on the other side. STUDY DESIGN/MATERIALS AND METHODS: Eighteen subjects presenting with mixed-type melasma were enrolled. Each patient was randomly treated with a 755-nm picosecond laser coupled with DLA on one side of the face and without DLA (flat optics) on the other side. The laser was delivered through an 8-mm spot size with an average fluence of 0.4 J/cm2 at 2.5 Hz for a total of two passes without pulse overlapping. All subjects received five monthly treatments. Subjective (clinical evaluation) and objective (color readings) assessments on the degree of pigment clearance and adverse effects were obtained at 1-, 3-, and 6-month after the final treatment. RESULTS: At 6 months after the last treatment, physician-rating scores were 1.50 ± 0.76 and 1.50 ± 0.65 of the DLA and flat-optics sides, respectively. Pigment clearance significantly improved from 1 to 6 months after the treatment on each side (P = 0.019 on DLA and P = 0.023 on flat-optics sides). No statistically significant differences in physician-rating scores between the two treatment techniques were observed at all follow-up visits. Objective assessments of melasma clearance corresponded to the clinical evaluation. However, the full-beam (flat optics) provided lower incidence of pos-tinflammatory hyperpigmentation than the fractioned one. CONCLUSIONS: A 755-nm picosecond laser is safe and effective for the treatment of melasma in dark-skinned individuals. The use of DLA does not provide additional benefit over the flat optics in clearing pigmentation. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Three-Year Results of Facial Photoaging in Asian Patients After Alexandrite 755 nm Picosecond Laser With Diffractive Lens Array: A Split-Face, Single-Blinded, Randomized Controlled Comparison.

BACKGROUND AND OBJECTIVE: The long-term efficacy of a picosecond alexandrite laser (PSAL) with a diffractive lens array (DLA) for the treatment of photoaging is absent. To observe the long-term efficacy of PSAL for the treatment of photoaging. STUDY DESIGN/MATERIALS AND METHODS: Each patient (n = 10) received 10 treatments at 2-week intervals. One side of the face was randomly selected for treatment. At 1, 3, 6, and 36 months after the final treatment, two blinded physicians evaluated photographs with four clinical indicators of photoaging (dyschromia, skin texture, skin laxity, and rhytids). A quartile scale was used. RESULTS: At baseline, there were no significant differences in dyschromia, skin texture, facial laxity, or rhytids between the treated and control sides (P > 0.05). Picosecond laser-treated side showed 0.85 and 1.05 (both P < 0.05) better for dyschromia at 3- and 6-month follow-up, and 0.6 (P < 0.05) better for skin texture at 6-month follow-up. At 36-month follow-up, the degree of photoaging is intensified on the control side while the rejuvenation efficacy maintained on the treated side, with 1.4, 0.75, and 0.8 (all P < 0.05) better for dyschromia, skin texture, and rhytids relative to the control side measures. CONCLUSION: Our results demonstrate the long-term efficacy and safety of PSAL with DLA for the treatment of facial photoaging. LIMITATION: Small sample size and the lack of objective evaluation. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

A comparative study with a 755 nm picosecond Alexandrite laser with a diffractive lens array and a 532 nm/1064 nm Nd:YAG with a holographic optic.

BACKGROUND AND OBJECTIVES: This study was performed to better understand the cutaneous effects of using a fractional picosecond laser at 755 nm with a diffractive lens array and a picosecond Nd:YAG laser at 532 mn and 1064 nm with a holographic optic. We characterized the injuries created by these devices on skin clinically and histologically over 24 hours. With this information we modeled the effects of these devices on a cutaneous target. METHODS: Eight patients, representing Fitzpatrick skin types I-VI, were treated on their backs with a picosecond Alexandrite laser with a diffractive lens array, as well as a picosecond Nd:YAG laser at 532 nm and 1064 nm with a holographic optic. Photographs were taken 15 minutes and 24 hours after treatments. Punch biopsies were obtained at 24 hours and examined histologically. RESULTS: Treatment with the picosecond Nd:YAG laser at both 532 nm and 1064 nm with the holographic optic revealed erythema and small scatted areas of petechial hemorrhage areas immediately and in many cases at 24 hours after treatment. The 755 nm picosecond Alexandrite laser with diffractive lens array produced erythema immediately after treatment, which largely dissipated 24 hours later. Histologies revealed intra-epidermal vacuoles with all three wavelengths. Fractional picosecond Nd:YAG laser at 532 nm and 1064 nm with the holographic optic showed focal areas of dermal and intra-epidermal hemorrhage with areas of vascular damage in some patients. CONCLUSIONS: This study demonstrates that both fractional picosecond devices produce vacuoles in the skin, which are most likely due to areas of laser induced optical breakdown (LIOB). In the patients (skin type II-IV) we observed scatter areas of hemorrhage in the skin, due to vascular damage with the 532 nm and 1064 nm, but not with 755 nm wavelengths. Lasers Surg. Med. 50:37-44, 2018. © 2017 Wiley Periodicals, Inc.

Delivery of light to the skin through ablated conduits.

BACKGROUND AND OBJECTIVES: Non-invasive laser skin treatment modalities are generally designed to protect the epidermis by cooling and limiting the laser energy deposition in accordance with skin type. We explore a treatment modality that uses a 2,940 nm Er:YAG laser with high tissue absorption to ablate an array of channels through the epidermis and upper dermis, and then deliver laser energy from a 1,320 nm Nd:YAG laser with lower tissue absorption through the ablated channels. Treatment through ablated conduits offers a unique capability to deliver laser radiation to a deeper level in the dermis or beyond the dermis and the delivered energy to be deposited in a nearly uniform distribution. The ablated channels represent a relatively small surface and volume fraction of the epidermis and upper dermis, and heal very fast. A pilot study was performed to explore the benefits of treatments through ablated conduits for skin tightening, cellulite, and acne scarring. MATERIALS AND METHODS: A custom-built laser from Cynosure Inc. was designed to deliver to the epidermis up to 3 J/cm2 at 2,940 nm from an Er:YAG laser followed in less than 10 ms by up to 20 J/cm2 at 1,320 nm from a Nd:YAG laser. Both laser sources were delivered to the skin through a diffractive lens array. The spatial intensity modulation created by the diffractive lens array on the skin surface consisted of a low energy density background that did not damage the epidermis and a superimposed array of much higher energy density regions where the Er:YAG laser ablated the channels, and most of the 1,320 nm laser energy was delivered through the channels. Various fluence combinations of the ablative and non-ablative lasers were tested on ex vivo human skin samples to evaluate tissue effects and parameters for a clinical test. A limited clinical study was performed to evaluate tissue response and healing effects. RESULTS: Histology confirmed the presence of ablative channels through the epidermis and upper dermis as well as the absence of epidermal damage apart from the channels. Three days posttreatment there was complete skin healing with no evidence of channel ablation or coagulation in the skin biopsies. Limited clinical testing for facial treatments showed mild improvement for acne scarring and skin laxity. CONCLUSIONS: Laser skin treatment through ablated conduits can be performed safely with fast subsequent healing of the channels ablated through the skin. Further refinement of the treatment parameters and variation of the wavelength of the non-ablative laser source may bring improved treatment efficacy. Lasers Surg. Med. 49:69-77, 2017. © 2016 Wiley Periodicals, Inc.

Safety and efficacy of a novel diffractive lens array using a picosecond 755 nm alexandrite laser for treatment of wrinkles.

INTRODUCTION: Picosecond lasers have been reported to be effective for removal of tattoo pigment. This prospective study evaluated the efficacy and safety of the treatment of peri-oral and -ocular wrinkles using a novel diffractive lens array coupled with a picosecond 755 nm alexandrite laser. METHODS: Forty female subjects presenting with wrinkles from photodamage were enrolled in an IRB approved study. Subjects received four picosecond diffractive lens array treatments to the full face at 1 month intervals. Six subjects were biopsied (two subjects at 1 month, two subjects at 3 months, and two subjects at 6 months). Digital photographic images were taken at 1, 3, and 6 months post-final treatment visits. Images were graded by blinded physicians for fine lines/wrinkles, erythema, dyschromia, and global improvement. Data on discomfort level, satisfaction, and side effects were recorded. RESULTS: Overall blinded physician rated global improvement ranged from improved to much improved at 1-, 3-, and 6-month time points. At baseline the average Fitzpatrick wrinkle score was 5.48. At the 6-month follow-up the average score was 3.47. The overall average change in score from pre-treatment to post-treatment was 1.97. Subject self-assessment at 6 months indicated that 90% of subjects were extremely or satisfied with their results. Unanticipated adverse events were absent with anticipated post-treatment erythema lasting for just several hours. CONCLUSIONS: A novel diffractive lens array used with a picosecond 755 nm alexandrite laser for treatment of wrinkles is highly effective and safe for wrinkles and other signs of photoaging. Lasers Surg. Med. 49:40-44, 2017. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: A retrospective review.

BACKGROUND: Laser therapy in patients with skin of color is associated with an increased rate of complications. The 755-nm picosecond laser with the diffractive lens array (DLA) has been used for the treatment of scars, striae, and rejuvenation. By delivering high energy to focused areas, the DLA minimizes complications. OBJECTIVE: This study explores the adverse events associated with treatment with the 755-nm picosecond laser with DLA in individuals with Fitzpatrick skin type IV to VI. METHOD: A retrospective chart review of patients treated with the 755-nm picosecond laser with DLA with a standardized spot size of 6 mm, fluence of 0.71 J/cm(2), and pulse width of 750 to 850 picoseconds was performed. Standard clinical photographs were obtained before treatment and at follow-up. Treatment sites were assessed for dyspigmentation, erythema, edema, and herpetic lesions. RESULTS: A total of 56 patients with Fitzpatrick skin type IV to VI, atrophic and hypertrophic scars, and pigmented lesions or striae were included. Ten patients (17.9%) were lost to follow-up. Transient adverse events, most commonly erythema and hyperpigmentation, were reported after therapy; these resolved in all cases. LIMITATIONS: Retrospective design is a limitation. CONCLUSION: The 755-nm picosecond laser with the DLA device may be a safe therapeutic alternative for unwanted scars, pigmented lesions, and striae in patients with skin of color.

The histology of skin treated with a picosecond alexandrite laser and a fractional lens array.

BACKGROUND AND OBJECTIVES: The treatment of acne scars and wrinkles with a picosecond Alexandrite laser was recently FDA cleared. In 2014 we presented our initial histologic findings with this device on in vivo and ex vivo skin. This current study expands on the 2014 pilot study with an investigation of different energy settings using histology and the confocal microscope to describe the changes observed in the skin. MATERIALS AND METHODS: We used a 755 nm picosecond Alexandrite laser with a fractional optic with three different energy settings to treat in vivo. After treatment, the patients and skin samples were also evaluated with a confocal microscope followed by biopsies which were evaluated histologically. RESULTS: Histology revealed unique intra-epidermal cavities. The number, density, and the size of these cavities were dependent on the melanin index and delivered energy when evaluated with histopathology and the confocal microscope. These localized zones of injury appear to form microscopic epidermal injury zones which are exfoliated over a 3-week period. CONCLUSIONS: These intra-epidermal cavities result from areas of laser-induced optical breakdown (LIOB). This injury is most consistent with a localized plasma formation in the epidermis initiated by the melanin absorption of the high energy picosecond light. It appears that treatments with this device and optic result in improvements in dyspigmentation and acne scars with new collagen, elastic tissue, and mucin. The production of this LIOB could directly stimulate an epidermal repair mechanism that results in these clinical findings. Lasers Surg. Med. 48:646-652, 2016. © 2016 Wiley Periodicals, Inc.

Clinical Outcomes After Bilateral Implantation of a Diffractive Trifocal Intraocular Lens: A Worldwide Pooled Analysis of Prospective Clinical Investigations.

Purpose: To investigate visual and safety outcomes of AcrySof® IQ PanOptix® (model TFNT00), a trifocal, presbyopia-correcting intraocular lens (IOL), in patients of different ethnicities across multiple countries, based on a pooled analysis of six prospective multicenter studies. Patients and Methods: This pooled analysis included adult patients from six prospective clinical studies performed across 56 centers worldwide. After cataract removal by phacoemulsification, all patients were implanted with TFNT00; follow-up duration varied from 3 to 12 months according to the studies' design. Binocular defocus curve; absolute manifest refraction spherical equivalent (MRSE); and binocular photopic uncorrected and corrected visual acuities at distance (UCDVA, BCDVA; 4-5 m), intermediate (UCIVA, DCIVA; 60-66 cm), and near (UCNVA, DCNVA; 40 cm) were measured. Results: The study included 557 patients, 547 of whom were implanted bilaterally with the TFNT00 IOL (n = 1094 eyes). Binocular visual data at 1 month and 3-6 months after implantation were available for up to 546 and 542 bilaterally implanted patients, respectively. A continuous range of 0.1 logarithm of the minimum angle of resolution (logMAR) or better vision from distance (0.00 diopter [D], 4-5 m) to near (-3.00 D; optically equivalent to 33 cm) was observed 3-6 months after TFNT00 implantation. At 3-6 months, 88.2% of first eyes achieved an MRSE ≤0.50 D and 88.7% of second eyes achieved an MRSE ≤0.50 D. Overall, 99.3%, 92.3%, and 94.6% of patients bilaterally implanted with TFNT00 achieved binocular photopic BCDVA, DCIVA, and DCNVA of 0.14 logMAR or better, respectively. Ocular adverse device effects and secondary surgical interventions (SSIs) were infrequent. Conclusion: This global pooled analysis showed that TFNT00 provided a continuous range of 0.1 logMAR (~20/25 Snellen) or better vision from distance to 33 cm, with a low incidence of ocular adverse device effects and SSIs.

Clinical outcome of diffractive multifocal lens versus monofocal lens in post-laser in situ keratomileusis patients: A retrospective, comparative study.

Purpose: To compare the clinical outcomes of diffractive multifocal and monofocal lenses in post-laser in situ keratomileusis (LASIK) patients who underwent cataract surgery. Methods: This was a retrospective, comparative study of clinical outcomes that was conducted at a referral medical center. Post-LASIK patients who underwent uncomplicated cataract surgery and received either diffractive multifocal or monofocal lens were studied. Visual acuities were compared at baseline and postoperatively. The intraocular lens (IOL) power was calculated with Barrett True-K Formula only. Results: At baseline, both groups had comparable age, gender, and an equal distribution hyperopic and myopic LASIK. A significantly higher percentage of patients receiving diffractive lenses achieved uncorrected distance visual acuity (UCDVA) of 20/25 or better (80 of 93 eyes, 86% vs. 36 of 82 eyes, 43.9%, P = 1.0 x 105) and uncorrected near vision of J1 or better (63% vs. 0) compared to the monofocal group. The residual refractive error had no significant difference (0.37 ± 0.39 vs. 0.44 ± 0.39, respectively, P = 0.16) in these two groups. However, more eyes in the diffractive group achieved UCDVA of 20/25 or better with residual refractive error of 0.25-0.5 D (36 of 42 eyes, 86% vs. 15 of 24 eyes, 63%, P = 0.032) or 0.75-1.5 D (15 of 21 eyes, 23% vs. 0 of 22 eyes, P = 1.0 x 10-5) compared to the monofocal group. Conclusion: This pilot study shows that patients with a history of LASIK who undergo cataract surgery with a diffractive multifocal lens are not inferior to those who receive monofocal lens. Post-LASIK patients with diffractive lens are more likely to achieve not only excellent near vision, but also potentially better UCDVA, regardless of the residual refractive error.

Diffractive Achromat with Freeform Slope for Broadband Imaging over a Long Focal Depth.

We propose a method for designing a long-focal-depth diffractive achromat (LFDA). By applying rotational symmetric parameterization, an LFDA with a diameter of 10.89 mm is designed over three wavelengths at six focal planes. The smoothly changed slope designed by the binary variable slope search (BVSS) algorithm greatly reduces the discontinuity in depth, thus it is a fabrication-friendly process for grayscale laser direct writing lithography, involving less fabrication error and cost. The deviation between the designed and fabricated profiles amounts to 9.68%. The LFDA operates at multiple wavelengths (654 nm, 545 nm, and 467 nm) with a DOF of 500 mm~7.65λ × 105 (λ = 654 nm). The simulated and measured full-width at half-maximum (FWHM) of the focused beam is close to the diffraction limit. Experimental studies suggest that the LFDA possesses a superior capability to form high-quality chromatic images in a wide range of depths of field. The LFDA opens a new avenue to achieve compact achromatic systems for imaging, sensing, and 3D display.

Spatio-chromatic vision with multifocal diffractive intraocular lens.

BACKGROUND: This study aims to detect alterations in the spatio-chromatic pseudophakic vision produced by multifocal diffractive intraocular lenses (IOLs) and provides a physical interpretation. METHODS: In vitro characterization of the imaging performance of two diffractive IOLs: AT LISA Tri (Zeiss) and FineVision (PhysIOL) in on-bench model eye illuminated with red (R, 625 nm), green (G, 530 nm) and blue (B, 455 nm) lights. We used the metrics: energy efficiency (EE), area under the modulation transfer function, longitudinal chromatic aberration (LCA), and halo intensity. Through-focus (TF) analysis and calculation of the expected defocus curve under white (W) daylight were included. In vivo visual acuity (VA) of 50 pseudophakics (60 eyes) was assessed under W, R, G, B lights at far and near. Two clinical experiments evaluated LCA and R, G, B TF-EE effects on pseudophakic vision and their relative importance. RESULTS: Clinical mean VA values under W light agreed with the predicted values at far and near for both IOLs. LCA measurements and R, G, B TF-EE curves were consistent with their lens design based on the 0th and 1st diffraction orders operative for far and near vision, respectively. LCA effects were compensated at near but noticed at far (- 0.75 D under B light). We detected strong asymmetry in visual resolution depending on the object distance and the illuminating wavelength-red predominance at far, blue predominance at near-in consistency with the TF-EE measurements. CONCLUSIONS: Diffractive multifocal IOL designs produce asymmetries in the spatio-chromatic vision of pseudophakics beyond the alterations strictly due to LCA. VA asymmetry for far/near object distance under R and B illumination is clinically detectable in subjects implanted with IOLs with 0th and 1st diffraction orders for far and near vision, respectively. Such VA asymmetry cannot be explained solely from the influence of defocus, as would be derived from a chromatic difference of power, but mainly from the wavelength dependence of the EE.

Pitfalls of Using NIR-Based Clinical Instruments to Test Eyes Implanted with Diffractive Intraocular Lenses.

The strong wavelength dependency of diffractive elements casts reasonable doubts on the reliability of near-infrared- (NIR)-based clinical instruments, such as aberrometers and double-pass systems, for assessing, post-surgery, the visual quality of eyes implanted with diffractive multifocal intraocular lenses (DMIOLs). The results obtained for such patients when using NIR light can be misleading. Ordinary compensation for the refractive error bound to chromatic aberration is not enough because it only considers the best focus shift but does not take into account the distribution of light energy among the foci which strongly depends on the wavelength-dependent energy efficiency of the diffractive orders used in the DMIOL design. In this paper, we consider three commercial DMIOL designs with the far focus falling within the range of (-1, 0, +1)-diffractive orders. We prove theoretically the differences existing in the physical performance of the studied lenses when using either the design wavelength in the visible spectrum or a NIR wavelength (780 to 850 nm). Based on numerical simulation and on-bench experimental results, we show that such differences cannot be neglected and may affect all the foci of a DMIOL, including the far focus.

Outcomes of 1064-nm picosecond laser alone and in combination with fractional 1064-nm picosecond laser in tattoo removal.

BACKGROUND: Removal of the unwanted tattoo was initially focused treatment of picosecond laser in the setting of the unfractionated beam, whereas the fractionated 1064-nm picosecond lasers (Fr-Pico) has been successfully utilized in various skin conditions, including scar and benign pigmented lesions. However, no studies compared the combination of Fr-Pico and unfractional 1064-nm picosecond laser (UFr-Pico) and UFr-Pico alone in tattoo removal. OBJECTIVE: This study aims to compare the efficacy and safety of the combination of Fr-Pico and UFr-Pico and the UFr-Pico and in tattoo removal. MATERIALS AND METHODS: Nineteen black tattoos in 11 patients were treated with UFr-Pico on one half and in combination with Fr-Pico on another half over three sessions with 4-week intervals and 4-week follow-up after the last session. Treatment efficacy was assessed using digital photographs, skin imaging analysis, and patient satisfaction. RESULTS: After three treatments, tattoo clearance scores revealed that greater than 50% clearance was achieved in 11 (84.6%) tattoos treated with combination side and 9 (69.2%) tattoos with UFr-Pico alone. Significant differences were observed between the groups at 8 and 12 weeks. Skin textural changes also demonstrated significant improvements in the combination side at Week 12. Adverse events, such as blistering and textural changes, were fewer in the combination side. CONCLUSION: The combination of 1064 nm Fr-Pico and UFr-Pico may be more effective and safer in tattoo removal than UFr-Pico alone.

Premium Monovision versus Bilateral Myopic Monovision, Hybrid Monovision and Bilateral Trifocal Implantation: A Comparative Study.

Purpose: Contemporary monovision techniques use premium intraocular lenses (IOLs), either in both eyes or at least in the non-dominant one. Primary objective of this study was to compare the efficacy of premium monovision (implantation of the trifocal diffractive Panoptix IOL in the non-dominant eye and the bifocal hybrid refractive-diffractive Restor IOL in the dominant eye), against bilateral myopic monovision (implantation of the monofocal SN60WF IOL targeting -0.50 D in the dominant eye and -1.25 D myopia in the non-dominant one), hybrid monovision (implantation of Panoptix in the non-dominant eye and SN60WF in the dominant eye) and bilateral trifocal implantation (with bilateral Panoptix implantation). Methods: This is a prospective, comparative, clinic-based trial. Cataract patients populated four study groups: Monovision Group (MoG), Multifocal Lens Group (MfG), Hybrid Monovision Group (HmG) and Premium Monovision Group (PmG). Binocular Uncorrected Distance Visual Acuity (UDVA), Uncorrected Reading Acuity and Critical Print Size at 60cm (UIRA, UICPS) and at 40cm (UNRA, UNCPS), contrast sensitivity, vision-related functional impairment, dysphotopsia symptoms and spectacle dependence were evaluated 6 months following the operation of the second eye. A mathematical model was constructed, which calculated the relative efficacy of each surgical intervention. Results: A total of 120 participants were recruited and populated equally the study groups. Significant improvement of preoperative UDVA was observed in all study groups. No significant differences could be detected in postoperative UDVA and UIRA (p = 0.24) among study groups, while significant differences were noticed in UICPS (p = 0.04), UNRA (p = 0.02) and UNCPS (p = 0.01). Dysphotopic phenomena (glare and shadows) were significantly more in the MfG arm followed by the PmG group (p = 0.04 and p = 0.02, respectively), while perceived difficulty and spectacle independence rates were significantly better in PmG group. PmG presented the best overall relative efficacy. Conclusion: All surgical techniques present satisfactory outcomes. Premium monovision seems to demonstrate the best outcomes. Trial Registration: ClinicalTrials.gov, NCT04618380. Registered 05 November 2020, https://clinicaltrials.gov/ct2/show/NCT04618380.

Efficacy and Safety Evaluation of Picosecond Alexandrite Laser with a Diffractive Lens Array for Treatment of Melasma in Asian Patients by VISIA Imaging System.

Objective: To evaluate the efficacy and safety of picosecond (ps) 755-nm alexandrite laser with a diffractive lens array (DLA) generating laser-induced optical breakdown, which may be beneficial for melasma treatment. Background: Melasma is notorious for difficult to treat with any modality setting. Recently, picosecond alexandrite laser with DLA seems promising for dealing with it without intolerable complications. Methods: Twenty (N = 20) Asian female melasma patients with Fitzpatrick skin type IV were recruited for 3 treatment sessions of picosecond 755-nm alexandrite laser with DLA at a 4- to 6-week interval. The pulse duration was 750 ps. An 8-mm spot size and the fluence of 0.4 J/cm2 was used over the target area with 2 passes per treatment area and around 2000-2500 passes in total. The repetition rate was 10 Hz. Melasma Area and Severity Index (MASI) score and VISIA® imaging system analysis were utilized for evaluation before treatment and 4 weeks after the completion of the third treatment session. The clinical improvement and adverse events were assessed by the physicians and patients, respectively. Results: The median age of the patients was 45 years (from 27 to 55 years). In the physicians' evaluation, 40% (n = 8) of patients showed good improvement and 40% (n = 8) of patients showed moderate improvement. The mean MASI score before and after laser therapy showed significant improvement from 9.0 ± 4.8 to 6.5 ± 3.7 (p < 0.001). VISIA analysis of the forehead presented significant improvement in spots (p = 0.007) and porphyrins (p = 0.032). Some patients experienced erythema (25%), pruritus (20%), and scaling (20%) but subsided within few days of using emollients and sunscreen. Only 5% (n = 1) of patients developed mild postinflammatory hyperpigmentation, which also subsided in 3 weeks. Conclusions: Three sessions of picosecond 755-nm alexandrite laser with a DLA were effective for melasma treatment in Asian patients with minimal side effects.