Leg Vein Management: Sclerotherapy, Ambulatory Phlebectomy, and Laser Surgery

Ethanolamine Oleate Sclerotherapy Versus Simple Cyst Aspiration in the Management of Orbitopalpebral Cyst Associated With Congenital Microphthalmos

PURPOSE

To evaluate the efficacy of ethanolamine oleate (EO) sclerotherapy in the management of orbitopalpebral cysts associated with congenital microphthalmos, and compare it with simple cyst aspiration.

METHODS

Retrospective, interventional comparative case series of 12 orbitopalpebral cysts of 8 patients associated with congenital microphthalmos. Five cysts were treated with simple aspiration and 7 cysts with EO sclerotherapy. Cyst resolution was the main outcome measure.

RESULTS

Five cysts underwent aspiration alone at a median age of 12 weeks. One (20%; 95% CI, 0%-55.1%) of these 5 showed complete resolution. Seven cysts (6 patients) underwent aspiration combined with EO sclerotherapy at a median age of 30 weeks (3 had recurred following prior cyst aspiration). Postsclerotherapy, 6 eyes (85.7%; 95% CI, 59.8%-100%) showed complete cyst resolution (p = 0.072, Fisher exact test). The mean follow-up was 8.8 months (range, 3-23 months). In the EO group, 1 cyst (14.3%) required repeat sclerotherapy and another cyst showed partial resolution at 6 weeks. The number needed to treat with sclerotherapy to prevent 1 recurrence was 2 (1-5, 95% CI). No procedure-related complications were noted.

CONCLUSIONS

Simple aspiration of orbitopalpebral cyst is associated with a high recurrence rate and should be reserved for early prognostication of visual potential in the microphthalmic eye. Minimally invasive EO sclerotherapy provides a rapid, effective, and uncomplicated treatment modality for definitive therapy, and should be preferred in cases with no visual prognosis in the microphthalmic eye demonstrating adequate bony orbital expansion.

Systematic review of endovenous laser treatment for varicose veins

Background

The safety and effectiveness of endovenous laser treatment (EVLT) for varicose veins are not yet fully evaluated.

Methods

Medical bibliographic databases, the internet and reference lists were searched from January 1966 to September 2004. Only case series were available for inclusion in the review.

Results

Thirteen studies met the inclusion criteria. Self-limiting features, such as pain, ecchymosis, induration and phlebitis, were commonly encountered after treatment. Deep vein thrombosis and incorrect placement of the laser in vessels were uncommon adverse events. No study has yet assessed the effectiveness of laser therapy in comparison to saphenofemoral junction ligation with saphenous vein stripping. Occlusion of the saphenous vein and abolition of venous reflux occurred in 87·9–100 per cent of limbs, with low rates of re-treatment and recanalization.

Conclusion

From the low-level evidence available it seems that EVLT benefits most patients in the short term, but rates of recanalization, re-treatment, occlusion and reflux may alter with longer follow-up. The lack of such data, in addition to the small numbers of patients in the available studies, demonstrates the need for a randomized clinical trial of EVLT versus conventional surgery.

Laser treatment of leg veins: Physical mechanisms and theoretical considerations

BACKGROUND AND OBJECTIVES

A discussion of laser treatment of leg veins is based on a review of the literature, theoretical analysis, and the clinical experiences of the authors. Theoretical computations are discussed within the context of clinical observations.

STUDY DESIGN/MATERIALS AND METHODS

A Monte Carlo model is used to examine volumetric heat production, fluence rate, and temperature profiles in blood vessels at 1,064 and 532 nm wavelengths with various beam diameters, vessel diameters, and pulse durations.

RESULTS

Clinical observations, Monte Carlo results, and a review of the literature suggest that longer wavelengths and longer pulses durations favor vessel contraction over intraluminal thrombosis. Monte Carlo simulations show that longer wavelengths are more likely to uniformly heat the vessel compared to highly absorbing wavelengths. Methemoglobin production causes deeply penetrating wavelengths to generate more volumetric heat for the same input radiant exposure.

CONCLUSIONS

Clinical observations and models support the role of long wavelengths and long pulses in optimal clearance of most leg telangiectasias.

532-nm Nd:YAG and 595-nm Pulsed Dye Laser Treatment of Leg Telangiectasia Using Ultralong Pulse Duration

BACKGROUND

Telangiectatic leg veins have been treated using lasers with variable success.

OBJECTIVE

We aimed to examine the efficacy and tolerability of a 595-nm pulsed dye laser (PDL) and a 532-nm Nd:YAG laser using ultralong pulse duration to improve leg telangiectasias with a single treatment.

METHODS

Ten subjects with leg telangiectasias up to 1.0 mm in diameter participated in the study. The telangiectatic patch was divided into two approximately equal adjacent areas. The first area was treated with a 532-nm Nd:YAG laser at a fluence of 20 J/cm2 and a pulse duration of 50 ms using a contact cooling device. The second area was treated with a 595-nm PDL at a fluence of 25 J/cm2 and a pulse duration of 40 ms using cryogen spray precooling. Each area was treated once only. Photographic evaluation was used for an assessment of response.

RESULTS

Two of 10 subjects had less than 25%, 3 had 25% to 50%, 2 had 50% to 75%, and 3 had more than 75% improvement after single treatment with a 532-nm Nd:YAG laser. Similarly, 2 of 10 subjects had less than 25%, 2 had 25% to 50%, and 6 had 50% to 75% improvement with the 595-nm PDL. Hyperpigmentation occurred in one subject treated with the 532-nm Nd:YAG laser and two subjects treated with the 595-nm PDL. No blistering, crusting, hypopigmentation, or scarring were observed.

CONCLUSION

Both lasers using ultralong pulse width improved leg telangiectasias after a single treatment with minimal adverse reactions.