Efficacy of Pattern Scan Laser photocoagulation for superficial conjunctival nevi ablation

Treatment Outcome of Conjunctival Cyst Ablation by Pattern Scan Laser

PURPOSE

To evaluate the effectiveness of conjunctival cyst ablation using pattern scan laser photoablation.

METHODS

Ninety-four cases of symptomatic conjunctival cysts were included. After staining the surface of a conjunctival cyst with a dark-purple marker pen, an incision was made into the conjunctival cyst using a 26-gauge needle. Low-energy photoablation using 3 × 3 grids of spots was then applied around the incision site for a mean of 50 times. The laser spots were 400 μm in size, the power delivered ranged from 400 to 450 mW, and the duration of each laser pulse was 80 ms.

RESULTS

During a mean follow-up period of 6.5 months (range 6-16 months), 84 cases of conjunctival cysts (89.4%) were successfully corrected by conducting either 1 or 2 laser sessions. The cyst was completely resolved after a single laser session in 74 cases (78.7%). There were 20 cases of recurrence, which involved fixed, thick, and large cysts. The conjunctival cyst recurred again after the second laser session in 2 of the 12 eyes in which the procedure was repeated. The remaining 8 cases were observed without additional treatment. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed.

CONCLUSIONS

Pattern scan laser photoablation of a conjunctival cyst with the adjunctive use of cyst surface staining to increase the amount of thermal laser energy absorption is a simple and effective method for treating conjunctival cysts in an outpatient clinic.

Sublimation of Benign Conjunctival Nevi Using Plasma-Assisted Noninvasive Surgery: A Clinical Case Series

Background

Conjunctival nevi (CN) are common benign ocular tumors. Given their low risk of malignancy, surgical removal of nevi is primarily requested by patients. Herein, we introduce Atmospheric Low-temperature Plasma (ALTP) as a novel noninvasive method for the removal of CN.

Methods

A clinical case series was conducted from 2020 to 2021 at the Vision Health Ophthalmic Center in Tehran, Iran. CN in one of the eyes of seven patients was treated. In all patients, the benignity of CN was confirmed by ocular oncologists. The white handpiece of the Plexr device, which generates plasma with the lowest output, was used to apply plasma spots on the nevi. In addition, the Ocular Surface Disease Index (OSDI) questionnaire was completed by all patients before and six months after the treatment.

Results

In all patients, the nevi outside the limbus area completely disappeared. The mean size of pre- and post-operative nevi was 3.89×11.7 and 0.54×1.69 mm, respectively. Results of the OSDI questionnaire showed significantly lower scores after the surgery in all patients.

Conclusion

The ALTP method is a simple, cost-effective, and office-based surgery to remove CN safely and effectively.

A Novel Approach to Treatment of Conjunctival Cyst Ablation Using Atmospheric Low-Temperature Plasma

Purpose

Introducing a new technique to remove the conjunctival cyst using atmospheric low-temperature plasma (ALTP) and assessing its effectiveness.

Patients and Methods

Five eyes with conjunctival cysts were included in this study. The procedure was started by applying a plasma spot on the highest point of the cyst, and then other spots were spirally applied to the base of the cyst to debulk it. The conjunctival cysts were removed using the white handpiece of the plasma generator device (Plexr, GMV s.r.l Grottaferrata, Italy). Refraction, visual acuity, intraocular pressure (IOP), contrast sensitivity (CS), aberrometry, dry eye tests, and ocular surface disease index (OSDI) questionnaire were measured before, one and six months after treatment.

Results

The mean size of the cysts was 3.6 mm (range 2.1 to 4.8 mm). No intraoperative and postoperative complications were observed. Postoperative examinations showed that the patients’ cysts were completely healed and recurrence did not occur. Significant changes in visual parameters, IOP, CS, aberrometry and dry eye tests were not observed in the follow-up periods after treatment compared to before. OSDI score decreased after cyst removal.

Conclusion

Our recommended technique using ALTP can be used as a new approach to treating conjunctival cysts. This technique is a simple, office-based, minimally invasive, effective and inexpensive way to remove a cyst.

Novel treatment of papillomatous conjunctival lesions using pattern scanning laser photocoagulation: 1-Year results

PURPOSE

To evaluate the safety and 1-year effect of pattern scanning laser photocoagulation treatment for pedunculated papillomatous and sessile conjunctival lesions in a low-resource setting with extremely limited operating room access.

METHODS

Adult patients with clinical diagnosis of conjunctival papilloma underwent complete ophthalmologic exam including anterior segment photography. After topical anesthesia and toluidine blue 1% instillation, the lesion was treated by pattern scanning photocoagulation using a duration time that varied from 20 to 100 ms and power from 600 to 1800 mW, treating the entire lesion surface with a 2 mm margin. Patients were examined weekly for a month then monthly and underwent retreatment as necessary.

RESULTS

Six patients and seven eyes that had clinically significant non-malignant pedunculated or sessile papillomatous lesions were treated. All lesions responded to treatment, with complete resolution after an average of 2.3 sessions. Procedures were well tolerated with only minor mild discomfort persisting up to two days post-treatment. Patients were followed for a mean follow-up time of 13 months with no recurrences reported.

CONCLUSION

Short-term results of the pattern scanning laser photocoagulation approach, with toluidine blue for papillomatous conjunctival lesions are favorable with a 100% success rate in this cohort. This rate is comparable to surgical excision. This novel strategy proved to be a less resource intensive alternative that not only could demonstrate its usefulness in settings with chronic operating room shortages, but also in recurrent cases. Longer follow-ups with a larger sample size and cost-analysis are necessary to confirm our findings.

Conjunctival cystectomy assisted by pattern scan laser photocoagulation

BACKGROUND

To introduce a new technique of laser-assisted conjunctival cystectomy using pattern scan laser (PASCAL) photocoagulation.

CASE PRESENTATION

A 50-years-old Asian woman presented with a conjunctival cyst in the left eye. Slit-lamp examination revealed a 5 mm × 2 mm sized freely movable conjunctival cyst. After a 1 mm × 1 mm sized conjunctival opening was made using PASCAL photocoagulation, the cyst was extracted using a non-toothed forceps without rupture. Two weeks later, complete re-epithelialization of the conjunctiva was observed without any complications. No evidence of recurrence was noted over the 6-month follow-up period.

CONCLUSION

Conjunctival cystectomy with the adjunctive use of PASCAL photocoagulation can be an effective and safe treatment method.