Laser treatment of rosacea

Rosacea is a common condition often resulting in persistent erythema and telangiectasia as well as rhinophyma in a number of patients. Over the last two decades lasers have been increasingly used in the treatment of these permanent changes. The literature is reviewed in terms of the different laser systems, side-effects and comparison with other surgical techniques. Laser studies on rosacea-associated telangiectasia and erythema are limited. Copper-bromide, krypton and KTP lasers have been used with good to excellent results. However, the most commonly applied system is the flash lamp-pumped pulsed dye laser. Rhinophyma can be treated with a variety of different surgical methods, including laser resurfacing. CO(2) lasers are the most widely used lasers, others are the Er:YAG and Nd:YAG lasers. Cosmetic end results are comparable to partial excision with a scalpel or electrosurgery. There does not appear to be an increased risk of infection or scarring, but the conventional surgical methods are quicker to perform and more cost effective.     

Long-pulsed ruby laser-assisted hair removal in male-to-female transsexuals

Background Unwanted male‐pattern pilosity is a heavy psychological burden and can cause distress for male‐to‐female transsexuals. Orchidectomy and oestrogen supplementation combined with antiandrogens fail to make hair disappear. Aims To study the effect of long‐pulsed ruby laser treatment. Results Hair density was successfully abated on the beard and chest of three male‐to‐female transsexuals. A lingering effect over 6 months with a 50–90% hair density reduction was obtained. Conclusion Photothermolysis using the long‐pulsed ruby laser is a promising, well‐tolerated method of hair removal in male‐to‐female transsexuals under oestrogen supplementation and antiandrogens.     

Combined endoscopic laser and radiotherapy palliation of advanced rectal cancer

Background : In the palliative treatment of patients with advanced, inoperable rectal cancer, combined endoscopic laser and radiotherapy have been claimed to be more effective than laser therapy alone. The number of laser treatments, laser energy used, relapse rate, treatment of relapse, morbidity and survival in consecutive patients who were treated either by laser therapy alone or laser plus radiotherapy was compared. Methods : Prospective data were analysed with regard to number of treatments, laser energy used, relapse rate, morbidity and survival for 56 consecutive patients. Results : The crude relapse rate was significantly higher in the laser only group than in the laser plus radiotherapy group (58 and 15%, respectively; P = 0.002). There was no difference between the groups in the median total number of laser treatments or the mean total laser energy used. In patients experiencing a relapse, there was no difference in the median number of relapses, the number of laser treatments post‐relapse or the total energy used post‐relapse. Survival did not differ between the groups and there were no treatment‐related deaths. Conclusions : These findings demonstrate a clear reduction in relapse after using combined laser and radiotherapy to palliate patients with advanced rectal cancer with no appreciable additional morbidity and have encouraged continuing use of this treatment.     

鼻内镜下局限性鼻中隔偏曲的微创治疗

目的介绍切割吸引器和CO2激光辅助的鼻中隔成形术,在局限性鼻中隔偏曲治疗中的应用及其疗效。方法30例局限性鼻中隔偏曲患者施行鼻内镜下鼻中隔成形术,其中使用切割吸引器18例(切割吸引器组),CO2激光辅助者12例(CO2激光组)。所有患者术前和术后3月,分别进行视觉模拟评分表评分(VAS评分)和声反射鼻测量计(AR)检查狭窄侧鼻腔最小横截面积,以观察评定手术疗效。结果两组患者术前和术后3月的VAS评分和AR最小横截面积比较,均有显著差异(P<0.01),而两组间比较无显著差异(P>0.05)。平均随访3~6月,所有患者均无鼻中隔穿孔、血肿、感染等并发症发生。结论切割吸引器和CO2激光辅助的鼻中隔成形术治疗局限性鼻中隔偏曲,是微创、安全和有效的。     

接触式半导体激光经巩膜睫状体光凝术治疗难治性青光眼疗效观察

目的:探讨接触式半导体激光经巩膜睫状体光凝术(CTDC)治疗难治性青光眼的临床疗效。方法:对12例(13只眼)难治性青光眼施行半导体经巩膜睫状体光凝术,激光能量1050~2000mW,时间1000~2000ms,击射点数7~28点,光凝范围180~360°。结果:术前眼压25~82mmHg,平均(58.40±19.43)mmHg;术后1个月眼压15~35mmHg,平均(25.30±6.02)mmHg。术后短期内所有病例均有眼部胀痛感及球结膜充血,3例发生前房炎症反应,2例发生少量前房出血,无其它明显并发症发生。结论:CTDC是治疗难治性青光眼的相对安全、简便、副作用少的有效治疗手段。     

Nd:YAG激光后囊切开治疗后发性白内障不同术式的疗效分析

目的探讨Nd:YAG激光后囊膜切开术治疗人工晶体植入眼后发性白内障的术式选择和并发症的预防方法.方法对70例接受Nd:YAG激光后囊膜切开术治疗的后发性白内障患者的临床资料进行回顾性分析.70例患眼中包括35例外伤性白内障患者,35例老年性白内障患者.根据病情分级(1、2和3级)而选择不同术式治疗,观察并统计应用十字型后囊切开术及开罐式切开术治疗的70例患眼术后的各种并发症及发生几率.结果术后矫正视力均显著提高.主要并发症依次为玻璃体前界膜破裂(28.6%)、人工晶体损伤(15.7%)及眼压升高(5.7%).结论应用Nd:YAG激光后囊膜切开术是行之有效的治疗方法,恰当的选择术式及对术后并发症的充分了解、预防将是提高疗效的关键.     

不同物理因子对腹部感染性切口的愈合观察

目的观察不同的物理因子对腹部感染性切口的愈合作用。方法200例腹部术后感染性切口随机分为微波组,微波加直线偏光近红外线组(SL),微波加He-Ne激光组,对感染性切口进行治疗。结果微波对感染性切口具有良好的愈合作用,微波加直线偏光近红外线及微波加He-Ne激光则疗效更显著,后两组与微波组比较,P﹤0.05,后两组与微波组疗效比较具有显著性差异,但后两组之间疗效无显著差异P>0.05。结论微波加直线偏光近红外线及微波加He-Ne激光对促进创面愈合比单纯应用微波疗效好。     

准分子激光上皮下角膜磨镶术的并发症探讨

目的分析准分子激光上皮下角膜磨镶术(LASEK)治疗高度近视的并发症,探讨其发生原因及预防措施。方法106例205眼高度近视患者(-7.00D～12.00D)行LASEK后均随诊12m,观察及分析其并发症。结果术中角膜上皮瓣不完整28眼占13.7%;术后角膜上皮愈合延迟5眼占2.4%;丝状角膜炎5眼占2.4%;角膜感染1眼占0.5%;角膜雾状混浊(haze)142眼占69.3%,平均(0.81±0.48)级,其中2级以上者11眼占5.4%;术后激素性高眼压3眼占1.5%。术后12m屈光回退>-1.00D23眼占11.2%;散光度增加>1.00D15眼占7.3%;矫正视力较术前下降1行20眼占9.8%。结论LASEK治疗高度近视安全、有效,但存在一定的并发症,尤其是术后早期的角膜上皮愈合延迟和晚期的严重角膜雾状混浊必须引起重视。手术技巧的提高和术后随访的完善,合理的用药有助于减少手术并发症的发生和提高手术的预测性和准确性。     

氪激光周边虹膜成形术联合Nd:YAG激光虹膜切除术治疗早期闭角型青光眼的评价

目的观察联合激光(氪激光 Nd:YAG激光)的两种不同方法治疗早期闭角型青光眼在控制眼压、手术并发症及角膜内皮损伤的表现。方法共观察43人65眼,分为两组,A组采用局部氪激光虹膜成型 YAG激光虹膜周切术,B组采用180度虹膜成型 YAG激光虹膜周切术,观察术后1h、1周、4周及以上时间段的眼压、手术并发症和角膜内皮细胞的变化。结果两种手术方法在降低眼压方面均未见明显疗效,两组间亦未见统计学差异(P>0.05),B组的术后并发症明显小于A组(P<0.01),角膜内皮损伤B组在术后1h未见明显差异(P>0.01),两组在1周、4周及以上的时间观察到两组角膜内皮细胞数较术前明显减少,A组较B组更有显著减少(P<0.01)。结论联合激光手术在治疗早期闭角型青光眼虽然存在较单纯Nd:YAG手术较多的优越性,但并没有明显的降低眼压作用,较大范围的激光虹膜成型后产生的并发症和角膜内皮损伤明显减少,因此临床应用更应注重考虑远期角膜内皮细胞的受损情况。