Laser treatment of retinal angiomatosis

Dermatologic Therapy, 2017

Angiokeratomas can present therapeutic challenges, especially in cases of extensive lesions, where traditional surgical methods carry high risks of scarring and hemorrhage. Argon, pulsed dye (PDL), neodymium-doped yttrium aluminum garnet (Nd:YAG), copper vapor, potassium titanyl phosphate, carbon dioxide, and erbium-doped yttrium aluminum garnet (Er:YAG) lasers have emerged as alternative options. To review the use and efficacy of lasers in treating angiokeratomas. A PubMed search identified randomized clinical trials, cohort studies, case series, and case reports involving laser treatment of cutaneous angiokeratomas. Twenty-five studies were included. Quality ratings were assigned using the Oxford Centre for Evidence-Based Medicine scheme. Several laser modalities are effective in treating multiple variants of angiokeratomas. Vascular lasers like PDL, Nd:YAG, and argon are the most studied and of these, PDL offers the safest side effect profile. Nd:YAG may be more effective for hyperkeratotic angiokeratomas. Combination treatment with multiple laser modalities has also demonstrated some success. Lasers are a promising treatment option for angiokeratomas, but current use is limited by the lack of treatment guidelines. There are limited high quality studies comparing laser treatments to each other and to non-laser options. Additional studies are needed to establish guidelines and to optimize laser parameters.

Saudi Journal of Ophthalmology, 2014

Background: Retinal arterial macroaneurysms (RAM) is a pathological dilatation of retinal arterial vessel. Argon laser photocoagulation has been for a long time the gold standard of many vascular diseases of the retina such as macroaneurysm. From this work emerges how the introduction of intravitreal anti-VEGF therapies have enhanced the 'effectiveness of the combination of argon laser photocoagulation in cases of persistent retinal edema, we present the case of a retinal macroaneurysm with macular hemorrhage focus and oedema in a patient with a history of systemic arterial hypertension. Methods: A 77 year-old woman patient reported sudden decline in visual acuity in the left eye; the best corrected visual acuity (BCVA)was 1/10 in left eye. Fluorescein angiography (FAG) resulted in diagnosis of Macroaneurysm at the posterior pole with macular hemorrhage focus and oedema. The patient was treated with laser treatment in the left eye; after 30 days, the visual acuity was 1/50 and at optical coherence tomography (OCT) the retinal profile was significantly altered. After 30 days, a single intravitreal ranibizumab injection was performed and, after 7 days, visual acuity was 1/10. After 24 months from ranibizumab-based therapy the final visual acuity was 10/10 and OCT examination revealed a normal retinal profile. Conclusion: In this case report the association of argon laser photocoagulation with intravitreal anti-VEGF injection has been proven to be effective and safe in case of persistent retinal oedema.

British Journal of Dermatology, 2004

Optometry and Vision Science, 2006

Purpose. The purpose of this study is to describe a patient with retinal angiomatous proliferation (RAP) treated successfully by photodynamic therapy. Methods. A 74-year-old white woman was referred to our clinic for evaluation as a result of progressive decrease of vision in the right eye. Visual acuity was 20/100 in the affected right eye. The findings of fluorescein and indocyanine green angiography were consistent with a diagnosis of RAP, and cystoid macular edema was also revealed by optical coherence tomography (OCT). Photodynamic therapy (PDT) was carried out because of visual deterioration and localization of the RAP. Results. The RAP was treated with PDT, and an improvement in visual acuity to 20/60 was noted 4 months after treatment and 20/40 after 6 months. The resolution of the lesion was confirmed by fluorescein angiography, indocyanine green angiography, and OCT. Conclusions. Photodynamic therapy can be effective for the treatment of RAP when it is associated with visual acuity decrease and is located near the fovea.

Clinical and Experimental Optometry, 2011

Since its discovery in the 1940s, retinal photocoagulation has evolved immensely. Although the first photocoagulators used incandescent light, it was the invention of the laser that instigated the widespread use of photocoagulation for treatment of retinal diseases. Laser permits selection of electromagnetic wavelength, energy levels, spot size and pulse duration. These variables are crucial for accurate targeting of retinal tissue and prevention of detrimental side-effects such as central blind spots. There is ongoing clinical research dedicated to optimising such parameters and many innovative modes of laser delivery are now being offered. Laser photocoagulation is the mainstay of treatment for various retinal and macular diseases. Considering the escalating prevalence of such conditions and widespread use of photocoagulation, it is important for optometrists to grasp the basic principles and be aware of new developments in retinal laser therapy.

2006

Tufted angioma is a rare, benign, cutaneous angiomatous proliferation. It is more common in children and is clinically characterized by red-purple painfull plaques, more common in trunk. When spontaneous regression does not occur, proposed treatments (conventional surgery, steroid therapy, interferon and laser) achieve little success. We describe a case of a 11-year-old girl with a tufted angioma located in the trunk treated with pulsed-dye laser, showing important relief of local pain, and small reduction in lesion size. We have been motivated to describe this case due to the small number of such reports in Brazil and by the attempt to treat it with pulsed-dye laser.

The Journal of Dermatologic Surgery and Oncology, 1994

BACKGROUND. Tuberous sclerosis is a complex disorder of hamartoma formation in many organs, particularly the skin, brain, eye, kidney, and heart. The characteristic skin lesions are angiofibromas (AF), the shagreeri patch, periungual fibromas, and "ash-leaf" white macu1t.s. Treatment for AF has previously included electrocoagulation, electrodesiccatiori and curettage, dermabrasion, excision, cryosurgery, and oral 13-cis retinoic acid. Both argon and CO, lasers have been used in isolated cases to treat AF. OBJECTIVE. The purpose uf this work is the study of the applicatiori of three different lasers in the treatment of facial AF. METHODS. Ten patients with facial AF were treated with COz, argoti, arid pulsed dye lasers. Patients' AF were graded with regard to the size arid color of the lesions. A 2-3-cmz test was assayed 011 the face of all patients with each laser before per-formirig a cowiplete treatment and in order to choose the best laser. RESULTS. Results were considered excellent in seven patients and good in three patients, with decrease of erythema and flattening of the AF. Minimal scarring was noted in t w o patients. Transient erythema was observed in patients treated with the CO, laser. All patients or their parents considered the treatment cosmetically satisfactory. CONCLUSION. W e found the CO, laser to be a better therapeutic tool than the argon laser to treat AF, especially in those patients with multiple and protuberant AF. The argon laser would be more useful in those patients with very red AF and light complexion, and the pulsed dye laser in those with very red and flat AF.

OphthaTherapy, 2020

Retinal diseases account for the vast majority of ophthalmologic disorders. Over the past years, laser-based approach has been successfully used. Despite introduction of other potentially innovative, beneficial and successful therapeutic methods, lasers are still considered the gold standard. In this review, we discuss the spectrum of currently prevailing laser methods and new insights into novel perspectives and techniques regarding laser management of retinal disorders. This paper is divided into three sections. Two parts, already published in previous issues, have presented methodology with the spectrum of laser-based techniques and literature review investigating the existing knowledge in laser management of diabetic retinopathy, diabetic macular edema and vascular retinal disorders. Finally, the current one, consists of the principles guiding laser treatment of retinal tears, retinal degeneration, retinopathy of prematurity, age-related macular degeneration and other retinal diseases.

Expert Review of Ophthalmology, 2018

Introduction: Laser therapy is a cornerstone for control of intraocular retinoblastoma, after chemotherapy has brought the disease under initial control. Since first described over 6 decades ago, laser technologies and approaches have evolved to improve tumor control. Despite its important role, few publications describe techniques, types of lasers, and modes of delivery for retinoblastoma. Areas covered: The physical and optical properties of lasers, mechanisms of action, delivery systems and complications are described. Hand-held optical coherence tomography (OCT) detects microscopic retinoblastoma tumors and guides treatment, achieving precision primary therapy and elimination of recurrences. Expert commentary: In all the excitement of new therapies to cure intraocular retinoblastoma, laser treatment always compliments but is rarely mentioned. Hand-held OCT now adds precision to put laser in the forefront in achieving cure of retinoblastoma.

Photomedicine and Laser Surgery, 2011

Objective: Hemangioma is a mesenchymal benign tumor formed by blood vessels. Anomalies affect up to 10% of children and they are more common in females than in males. The aim of this study was to evaluate hemangioma treatment using four different types of lasers, namely, alexandrite, Er:YAG, CO 2 , and pulsed dye laser (PDL). Background data: The argon laser was the first to be used for dermatological patients, namely, with port wine stains (PWS) in the late 1960s and early 1970s. A variety of different lasers and light sources were useful in the treatment of vascular lesions, e.g., KTP, Nd:YAG, CO 2 , PDL, and Er:YAG. Methods: A group of 869 consecutive patients with hemangioma was retrospectively reviewed. The patients including in our study were divided into four groups according to the type of laser used: Alexandrite laser (n = 85, 58 women and 20 men), CO 2 laser (n = 78, 58 women and 20 men), Er:YAG laser (n = 105, 87 women and 18 men), and PDL laser (n = 601, 453 women and 148 men). All patients were treated in one session without anesthesia application. The ablative systems vaporized the tissues until the hemangioma was removed. The non-ablative systems used one shot, which destroyed the hemangioma blood vessels. Results: For the treatment efficacy analysis, the following factors were evaluated: therapeutic effect (yes vs. no), loss of pigment (yes vs. no), and appearance of scar (yes vs. no). From results it was evident that the therapeutic effect of all the lasers except alexandrite was very high; almost 100%. In the CO 2 and the Er:YAG laser groups a high percentage of side effects was also observed. Exposure to these lasers caused loss of pigment and scar formation in many cases. The best therapeutic effect, with only minor side effects, has been achieved with the PDL laser. Conclusion: It was confirmed that PDL (595 nm, 1.5 ms, 7 mm, 9-11 J/cm 2) had optimal effect without scars. Er:YAG or CO 2 laser radiation with specific characteristics was also useful for small superficial lesions.

American Journal of Ophthalmology, 2011

Ophthalmology, 2007

To determine tumor control rates, complication rates, and visual acuity (VA) for patients with macular retinoblastoma undergoing systemic chemotherapy and foveal diode laser ablation. Design: Noncomparative retrospective case series. Participants: All patients with retinoblastoma in the macula at the Bascom Palmer Eye Institute between 1991 and 2004 were evaluated. Patients included in the study were managed by the same clinician with a planned therapeutic strategy. Methods: Patients with Reese-Ellsworth groups I to IV disease underwent 4 to 9 cycles of systemic chemotherapy with vincristine, etoposide, and carboplatin, and patients with group V disease underwent 6 to 10 cycles with or without cyclosporine. All tumors underwent repetitive diode laser ablation (2-24 sessions) applied to the foveal and extrafoveal portions of tumors at each visit until tumors were deemed inactive for at least 6 months. Main Outcome Measures: Recurrence requiring external beam radiation therapy or enucleation; VA; and complications including iris atrophy, peripheral focal lens opacity, peripheral anterior synechiae, and foveal neovascular membrane. Results: Forty-four eyes of 33 patients were treated. Eyes were classified as Reese-Ellsworth group I (1 [2%]), II (6 [12%]), III (3 [7%]), IV (5 [9%]), or V (29 [67%]). Thirty-eight eyes (86%) had successful tumor control and avoided enucleation at a median follow-up of 36 months. At 3 years, tumor control rates were 100% for Reese-Ellsworth groups I to IV and 83% for group V. All eyes requiring enucleation were in Reese-Ellsworth group V. No eyes required external beam radiation. The most common complications were iris atrophy (61%) and focal lens opacity (14%). Strabismus was noted in 16% of eyes. Snellen VA measured 20/40 or better in 36% of eyes, 20/80 or better in 57%, and 20/400 or better in 86%. An increasing number of laser applications and chemotherapy cycles was not associated with decreased VA, strabismus, or development of an afferent pupillary defect but was associated with development of local complications. Conclusions: A unique approach to the application of diode laser therapy characterized by repetitive foveal treatments and aggressive chemotherapy resulted in tumor control rates that exceed those previously published. Furthermore, despite laser application directly to the fovea, 57% of patients retained 20/80 or better vision.

Retina (Philadelphia, Pa.), 2004

To examine the influence of photodynamic therapy (PDT) with verteporfin on the indication and frequency of conventional thermal krypton laser photocoagulation in choroidal neovascularization. A retrospective chart review was performed comparing laser indication and frequency 1 year before and 2 years after PDT started to be used routinely following the guidelines of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study Group and the Verteporfin in Photodynamic Therapy Study Group. Similar frequencies of laser treatment were seen in the year before and during the first year after PDT was commenced (301 [7.1% of all patients] to 281 [6.9%]). In the year thereafter, however, there was a marked decrease in laser treatments (174 [3.9%]). Interestingly, there was a steady increase in the relative frequency of laser treatments of extrafoveal and parapapillary lesions in the years after PDT was commenced (29.2%, year 1; 30.6%, year 2; and 39.6%, year 3). PDT has ...

Ophthalmic Surgery, Lasers, and Imaging, 2012