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[Clinical aspects of retinopathy of prematurity. Results following diode laser coagulation].

Retinopathy of prematurity (ROP) represents a disease of the immature retina of preterm infants due to irregular vascularisation. The present article gives information about different parameters of the newborns (gestational age, birth weight, need of oxygen, stage of ROP) and shows the results concerning anatomical and functional aspects following diode laser treatment in 61 prematurely born babies, diagnosed and treated in a period of 5S years in the Hospital of the Ludwig Maximilians University. The mean +/- SD gestational age was 24.9 (+/- 1.59) weeks, the mean +/- SD birth weight was 683 (+/- 174) grams. Diode laser treatment was performed at a mean +/- SD age of 36.14 (+/- 2.04) weeks. Stage 3 retinopathy with "plus disease" was diagnosed in 95.5 % of the infants. In comparison to term born babies or preterm infants without ROP, the diode laser-treated newborns showed a higher incidence of myopia (59 %). An unfavourable outcome in term of the anatomic situation was seen in 9.8 % of these babies.

Child, Preschool↗

[KTP laser coagulation for xanthelasma palpebrarum].

BACKGROUND: Xanthelasma palpebrarum is a benign skin disorder of unknown etiology appearing as one or multiple yellowish plaques around the eyelids. Hyperlipidemia, thyroid dysfunction, and diabetes mellitus are possible pathogenetic triggers. Removal of xanthelasma is desired for aesthetic reasons. While there are many treatment options, search continue for newer methods with less scarring and post-inflammatory hyperpigmentation. PATIENTS AND METHODS: We employed for the first time KTP laser (532 nm) for the treatment of 14 patients with xanthelasma palpebrarum on 33 eyelids. RESULTS: More than 70% of the patients tolerated KTP laser irradiation without any analgesia. 85.7% showed respectable reduction of xanthelasma palpebrarum after one to three treatment sessions without side effects. CONCLUSIONS: KTP laser irradiation represents a minimally invasive, safe and effective treatment option for the reduction of xanthelasma palpebrarum without undesired side effects.

Adult↗

Long-term outcome of kidney function after twin-twin transfusion syndrome treated by intrauterine laser coagulation.

Twin-twin transfusion syndrome (TTTS) is caused by unbalanced shunting of blood between monochorionic twins. It is well known that chronic hypotension and hypovolemia may cause renal insufficiency in the donor twin. The long-term outcome of kidney function after TTTS has not previously been delineated in the literature, however. The aim of this study was to evaluate the long-term outcome of kidney function in children after intrauterine laser treatment for severe TTTS. Eighteen surviving twin pairs after intrauterine laser treatment for TTTS were involved in the study. Their gestational age at birth was 29-39 weeks, their median birth weight was 2050 g, and their median age at evaluation was 3 years 1 month, range 1 year 9 months to 4 years 5 months. Serum creatinine, cystatin C, and beta 2-microglobulin, sodium, potassium, and phosphate excretion, and urine albumin and alpha-1-microglobulin were measured. Creatinine clearance was calculated by use of the Schwartz formula. The laboratory findings for all 36 children were within normal limits. There were no significant differences between donors and recipients. Despite severe alteration of renal function before the laser treatment (anuria-polyuria) no long-term impairment of renal function could be detected in any of the 18 twin pairs.

Child Development↗

[Results of perifoveal argon laser coagulation of subfoveal choroid neovascularization in age related macular degeneration].

BACKGROUND: The treatment of patients with subfoveal choroidal neovascular membrane in age-related macular degeneration is unsatisfactory because only a limited number of patients are eligible. The aim of this study was to prospectively evaluate a new perifoveal treatment technique in patients with subfoveal choroidal neovascular membrane. METHODS: Between April 1992 and January 1994, 385 patients underwent clinical examination and fluorescein angiography. Eligibility criteria were met by 21 (5.5%) patients (22 eyes): well or poorly defined subfoveal choroidal neovascular membrane (< or = 3.5 disc diameters), without fibrosis, with visual acuity < or = 0.25. Visual acuity, morphological findings and complications were studied. The follow-up period was 12-32 months. RESULTS: The visual acuity before laser treatment ranged from counting fingers up to 0.25 (median 0.06). At the end of the follow-up (median 18 months) 28% (6/21) of patients showed a better visual acuity, whereas 44% (9/21) were unchanged and 28% (6/21) had deteriorated compared to visual acuity before treatment. In 71% (15/21) of eyes, resolution of the choroidal neovascular membrane was achieved with development of an atrophic laser scar. CONCLUSION: The visual outcome and the morphological findings after perifoveal laser treatment of subfoveal choroidal neovascular membrane in age-related macular degeneration show it to be an alternative method of treatment with favourable results. Due to inclusion criteria it is suitable only for a limited number of patients.

Aged↗

Water-jet-cooled Nd:YAG laser coagulation: selective destruction of rat liver metastases.

The photocoagulating properties of the water-jet-cooled Nd:YAG laser (1,064 nm) have been studied in a rat tumor model. A colon carcinoma CC531 was implanted in the liver; 20 days after inoculation, laser therapy was performed with 600 J, 850 J, 1,200 J, 1,700 J, or 2,400 J at a power setting of either 10 or 20 W. Liver damage was determined in tissue specimen on day 1 after treatment and by serum levels of alanine aminotransferase and aspartate aminotransferase on day 1 and 2. Tissue specimen of day 36 were used to evaluate tumor remission. Liver function was assessed by antipyrine clearance on day 2. Light microscopic examination on day 1 showed coagulative necrosis up to 10 mm in diameter at 1,700 J and 20 W. At 20 W, liver damage was 22% larger than at 10 W (P = 0.0001). A significant relationship was found between laser energy and liver damage with complete tumor destruction in all animals at 2,400 J. No deterioration in liver function was found. The results of this study show the ability of the water-jet-cooled Nd:YAG laser to produce tumor coagulation necrosis with minor liver damage.

Adenocarcinoma↗

Colorectal adenomas: inflammatory changes that simulate malignancy after laser coagulation--evaluation with transrectal US.

To evaluate the assumption that inflammatory changes in the rectal wall after treatment of colorectal adenoma with photocoagulation may simulate malignant infiltration, the findings were reviewed in 23 follow-up examinations performed with transrectal ultrasound (TRUS) in 17 patients with benign adenoma. Special attention was given to the appearance of the wall layers underneath the adenoma. After partial coagulation, changes in the colorectal wall were usually seen on TRUS scans obtained early in follow-up; sometimes the thickened muscle layer had an irregular outer margin. In three of the 13 early examinations, lesions mimicked malignancy. To correlate these findings with histologic proof, an experimental study was performed: Colorectal specimens from pigs were examined with ultrasound (US) and microscopy. The abnormal sonographic appearance of specimens on US scans was caused by an inflammatory reaction in the deep wall layers; concomitant serositis appeared to be responsible for the malignancy-mimicking irregular outer margin. In screening for malignancy in colorectal adenoma, TRUS may cause overstaging during the first 6 weeks after polypectomy or after a session of laser treatment and should be avoided.

Adenoma↗

[Substance analytic studies of the effectiveness of laser coagulation in diabetic retinopathy].

An order to optimize photocoagulation in diabetic retinopathy, it is necessary to have objective criteria concerning substance-specific fundus changes like blood, melanin, xanthophyl, cytochrome aa3, and light scattering. By means of fundus reflectometry macular reflectance spectra can be measured and are different in normals and in diabetics before or after treatment. If logarithmic difference spectra are used only pathological alterations or changes caused by the coagulation are demonstrable. These difference spectra can be approximated by a linear model function containing the extinction spectra of the substances mentioned above and a term for light scattering. Spectra deconvolution delivers coefficients, describing differences in the substance concentrations between diabetics before and after treatment and age-matched normals. When we examined these coefficients, we found that neither their behavior in diabetic retinopathy nor their reaction to photocoagulation is unique. Thus, it might be possible to obtain references to patient-specific adapted coagulation by deconvolution of the macular reflectance spectra measured before treatment. Classification of the patients in specific types of reaction, according to the shape of the logarithmic difference spectra or the results of the spectra deconvolution, could be a step in deciding on the success of the therapy on a case-to-case basis.

Adult↗

Treatment of glaucoma simplex with argon laser coagulation of the scleral spur (L.S.S.C.).

Wise and Witter published in 1979 the results of argon laser treatment of glaucoma simplex. They coagulated in and just behind the trabeculum using as little energy as possible (+/- 100 coagulations, 50 mu, 1/10 sec, 80-1500 mWatt, spaced over 360 degrees). As we consider that coagulation of the trabeculum is not entirely without risk, we modified the technique by placing the lesions in the scleral spur. Up to the end of 1981, 84 eyes had been treated in 69 patients. Of 28 eyes in which treatment had taken place at least 1 year ago, the results in twenty-five were able to be analysed. The average decrease in pressure one year after treatment was 6.5-8.5 mm Hg (+/- 30% of the original value). The coefficient of outflow was measured in 10 eyes before and after treatment. This rose from an average of 0.11 (+/- 0.03) to an average of 0.18 (+/- 0.02).

Aged↗

Interstitial laser coagulation technique. Executive summary.

In March 1999, it was again my privilege to moderate a meeting of distinguished colleagues organized by Indigo Medical, Inc. as their BPH Advisory Panel. This executive summary highlights the most important conclusions of our day-long session. Details can be found in the subsequent sections of the publication. Our discussion of ILC technique is based on several exciting new concepts in prostatic anatomy. These concepts are derived from anatomical studies using fresh cadavers that have revealed the structures of the prostate in greater detail than ever before. Such findings are important because the great majority of descriptions of this anatomy are incomplete or inaccurate. An overview of the current clinical anatomy is found in Section VI.

Clinical Trials as Topic↗

[Laser coagulation of senile, moist macular degeneration].

Age-related macular degeneration (AMD) is a common disease in ophthalmology. The current status of knowledge in subretinal neovascularisations concerning epidemiology and treatment based on the findings of the macular photocoagulation study is shown. Most important parameters in treatment of subretinal neovascularisations in AMD are exact localization of the membrane in fluorescein angiography, its size and the visual acuity. The treatment of extra-foveal, well demarcated membranes can be recommended. Moreover recent results in the treatment of subfoveal, well demarcated membranes show some benefit for the patient as long as the size of the membrane is lower than 2 discs areas and the actual visual acuity is taken into account. Indocyanin-Green-(ICG)-angiography is recommended in occult subretinal membranes. Guidelines for the treatment are given.

Aged↗