Benefits of contact and noncontact YAG laser for periorbital hemangiomas

The use of propranolol in the management of periocular capillary haemangioma--a systematic review

Capillary haemangioma or infantile haemangioma (IH) is the most common congenital vascular tumour in the periocular region. Several treatment modalities have been documented, with variable degree of success. Propranolol has recently been reported to be an effective and safe alternative. The aim of this systematic review is to examine the evidence base for the use of propranolol administered orally in the management of periocular capillary haemangioma, and use this information to guide future research. A systematic review of literature was carried out by two independent reviewers using the search strategies highlighted below. A total of 100 cases of oral propranolol use in periorbital or orbital capillary haemangiomas have been documented in the literature. Of the 85 cases that had details of previous treatment, it was used as first-line treatment in 50 (58.8%). The commonest dose used was 2 mg/kg/day. Adverse events were documented in one-third of cases; in most cases these were minor. Improvement or complete resolution of the lesions occurred in 96% of cases. Recurrence was noted in one-fifth of cases. Propranolol has shown a lot of promise in the therapy of IH and further research in the form of properly designed randomized trials is certainly warranted. Treatment guidelines based on literature available to date is included in this review.

Long term follow-up of intralesional laser photocoagulation (ILP) for hemangioma patients

BACKGROUND AND OBJECTIVES

Hemangiomas remain a challenge for patients and plastic surgeons. Promising results have been reported using intralesional photocoagulation (ILP) for treatment. The objective of our study is to review the long term results of a large series of hemangiomas in patients treated by ILP. Materials (Subjects) and Methods: A retrospective review of 684 hemangiomas in patients were treated by ILP with an Nd:YAG (neodymium-yttrium-aluminium-garnet) (1064 nm) laser over a period of 10 years (January 1996-January 2005). Patients' ages ranged from one month to 11 years 5 months (mean, 1 year 10 months). The patient group consisted of 474 females and 210 males.

RESULTS

Patients were treated with an Nd:YAG laser delivered through a 600 m optical fiber. Laser power was set at 7 to 15 watts (W) and delivered with pulse duration of 7 to 15 seconds (s). The results showed 603 (88.6%) patients had more than 50% reduction of the volume in hemangiomas at 3 months after one treatment; and 663 (96.9%) patients had more than 50% reduction of the volume at 3 months after two treatments. Patients who had continuous ILP achieved excellent results.

CONCLUSIONS

Postoperative complications have been related to photocoagulation that has been delivered too extensively or superficially, with resultant ulceration, infection, bleeding, and scarring. These complications can be avoided if this potential for harm is kept in mind.

Treatment of Facial Venous Malformations with Combined Radiofrequency Current and 900 nm Diode Laser

BACKGROUND

Laser treatment of venous malformations is a major challenge because of the large variations in skin pigmentation, anatomic location, and vessel size and depth.

OBJECTIVE

To determine the safety and effectiveness of electro-optical synergy, a new technology that combines the 900 nm diode laser with radiofrequency current for the treatment of facial venous malformation.

METHODS

Fourteen patients with Fitzpatrick skin types II to IV were treated for facial venous malformations with simultaneous radiofrequency energy (60-80 J/cm3) and optical diode laser energy (fluence 80-100 J/cm2) in one to three sessions. All lesions measured less than 100 cm2. Lesion clearance was evaluated by three specialists on the basis of digital photographs taken before the first treatment and 1 and 2 months after the last treatment.

RESULTS

Thirteen patients showed a complete response and one patient a partial response. The results were rated excellent in the 13 patients and good in one patient. Transient swelling, erythema, and pain were present in all patients, with permanent scarring in only one patient.

CONCLUSION

The combination of laser light and radiofrequency energy is effective and safe for the treatment of facial venous malformations. It provides additional heating of the vessels without increasing laser intensity. The side effects are minimal.

Periocular hemangiomas: what every physician should know

Hemangiomas are the most common benign tumor of infancy. Most hemangiomas remain asymptomatic and can be managed by close observation; however, immediate treatment is indicated for hemangiomas that may cause significant complications. Periocular hemangiomas warrant close evaluation and early, active treatment of those with the potential to threaten or permanently compromise vision. Herein we review the clinical features of periocular hemangiomas, differential diagnosis, possible ophthalmologic complications and sequelae, and therapeutic modalities.

Use of laser photocoagulation for treatment of cutaneous angiomatosis in one dog and two cats

One dog and 2 cats were evaluated because of multiple progressively enlarging cutaneous vascular plaques. Biopsies were performed and revealed small well-circumscribed dermal nodules of dilated fully enclosed blood-filled spaces lined by single layers of endothelial cells aligned on thin fibrous walls, with minimal mitotic activity. A diagnosis of cutaneous angiomatosis was made in all 3 animals. Cutaneous angiomatosis is a progressive proliferative lesion of vascular tissue involving the dermis and subcutaneous tissues of dogs and cats. Lasers of selected wavelengths have been used to induce photothermal coagulation of hemoglobin-containing cutaneous lesions in humans; argon-pumped dye and neodymium:yttrium-aluminum-garnet lasers were used to treat the cutaneous lesions in the animals of this report. Laser treatment may provide an alternative to wide surgical resection or limb amputation for management of this condition in veterinary patients.

Cryogen spray cooling and pulsed dye laser treatment of cutaneous hemangiomas

When a cryogen spurt is applied to the skin surface for tens of milliseconds, cooling remains localized in the epidermis, leaving the temperature of deeper hemangioma vessels unchanged. The objective of this study was to compare the efficacy and safety of noncooled laser treatment (NC-LT) vs. cryogen spray cooling plus laser treatment (CSC-LT) for cutaneous hemangiomas in a large series of patients. A retrospective review was conducted of 164 patients treated with the pulsed dye laser (lambda = 585 nm; taurho = 450 microsec) over an 8-year period. Eighty-two patients received NC-LT using light doses of 5.5 to 8 J per square centimeter. Subsequently, 82 patients received CSC-LT using light doses of 9 to 10 J per square centimeter. The primary efficacy measure was quantitative assessment of improvements in lesional volume, texture, and color. Safety was evaluated for each treatment group by monitoring for adverse effects. Based on chi-squared analysis, there were clinical and significant differences in the number of treatments (p = 0.001), and improvement in volume (p = 0.008) and texture (p = 0.001) of the CSC-LT group compared with the NC-LT group. Permanent adverse effects were not observed in either group. In conclusion, CSC permitted the use of higher incident light doses for treatment of cutaneous hemangiomas, resulting in fewer treatments required and better improvement in lesional volume and texture.

Treatment of venous malformations with an intense pulsed light source (IPLS) technology: A retrospective study

BACKGROUND AND OBJECTIVE

The intense pulsed light source (IPLS) technology provides an innovative concept in the treatment of vascular lesions. We investigated the effectiveness of IPLS in the treatment of venous malformations.

STUDY DESIGN/MATERIALS AND METHODS

A retrospective study of 11 patients with venous malformations (VMA) treated with IPLS was initiated. Clinical VMA characteristics recorded were size and location. Data collected included treatment parameters (filters, pulse duration, fluence, and pulse sequencing), % clearance, and side effects (e.g., swelling, blisters, crusting, pain, altered pigmentation, and scarring).

RESULTS

Good and very good (70-100%) clearance was achieved in 8 malformations smaller than 100 cm(2). Especially small lesions needed only 2-3 treatments. Three VMA larger than 100 cm(2) could be cleared well in an average of 18 sessions. The most frequently used parameters were the 590 nm filter in long pulse mode, triple pulses, and fluences at an average of 80.4 J/cm(2). Side effects included prolonged erythema in 23.6, swelling in 17.9%, crusting in 4.7%. Bleeding, hypo-, hyperpigmentation, and scarring were rare (0.9% respectively).

CONCLUSION

IPLS presents an effective method for treating VMA, especially small malformations, with a justifiable rate of side effects when optimal parameters are chosen.

YAG laser meloplasty and blepharoplasty

Twenty-eight patients have undergone facelift and blepharoplasty in which the YAG laser scalpel was used. The laser is able to produce an incision with excellent hemostasis. The patients in this series demonstrated markedly diminished blood loss during surgery and reduced bruising, swelling, pain, and discomfort postoperatively. Contralateral procedures done with the laser on one side and conventional surgery on the other side demonstrated greater benefit on the laser side.

Lasers in ophthalmology

This article reviews the principle uses of ophthalmic lasers, providing historical background with an emphasis on new applications and areas of investigation. Ophthalmic photocoagulation was the first medical laser application and has restored or maintained vision in millions of people. More recently, photodisruption and, increasingly, ablation have gained prominence for treating a wide range of ocular pathology. The unique properties of lasers have also been harnessed for diagnostic purposes, with optical coherence tomography representing a significant improvement over existing imaging methods. Many ophthalmic applications of lasers have been developed, but the field is a dynamic one which continues to evolve along with laser technology itself.

Surgical excision of periorbital capillary hemangiomas

BACKGROUND

Periorbital capillary hemangiomas of childhood can produce ptosis, strabismus, and anisometropia, resulting in amblyopia. Traditional therapy with either systemic or local corticosteroids occasionally yields incomplete resolution of these lesions and may be associated with numerous adverse complications. The authors report their experience performing surgical resection of periorbital capillary hemangiomas.

METHODS

Twelve children with periorbital capillary hemangiomas were treated surgically. Six of these children had previously failed to adequately respond to steroid injections and six were primarily treated with surgical resection. All lesions were believed to be localized and did not appear to be infiltrative on preoperative computed tomographic scans.

RESULTS

All lesions were completely resected, except for two in which there was a small area of residual hemangioma surrounding the lacrimal drainage system that was left intact. Controlled intraoperative hemorrhage in two patients required intraoperative directed-donor blood transfusion. Perioperatively, in one patient a wound dehiscence developed, which required minor repair. This same patient elected to have surgical scar revision postoperatively. The patients have been followed up to 5 years. All did well with improved cosmesis, and they have good lid function. No recurrences have been noted.

CONCLUSION

Surgical resection of pediatric capillary hemangiomas should be considered a treatment option in those that fail to respond to corticosteroids and/or are isolated and noninfiltrative in nature.

Capillary hemangioma (infantile periocular hemangioma)

Capillary hemangiomas are the most common orbital tumors in children. They typically arise early in life, grow rapidly during a proliferative phase and then slowly regress in an involutional phase. The tumors may present as small isolated lesions of minimal clinical significance or as large disfiguring masses that can cause visual impairment and systemic symptomatology. Capillary hemangiomas are managed effectively by establishing a secure diagnosis, outlining the extent of the tumor, and understanding the natural history of the lesion, as well as its response to therapy. The ophthalmic and systemic manifestations of capillary hemangiomas are discussed in detail, as are the histopathology, radiologic findings, differential diagnosis, and therapeutic alternatives.

Feasibility of skin deepithelialization using the contact neodymium-yttrium-aluminum-garnet laser

In a manner similar to laserbrasion, the carbon dioxide (CO2) laser has a proven role for expediting skin deepithelialization, which is an essential component of many reconstructive procedures. However, the contact Neodymium-Yttrium-Aluminum-Garnet (Nd:YAG) laser has many additional attributes such as tactile feedback and less plume that theoretically offer an advantage over the CO2 laser for this adjunctive maneuver. In rat experimental models and clinical applications, removal of the epidermis necessary for skin deepithelialization may indeed be achieved using a rounded probe for vaporization with the contact Nd:YAG laser. Unfortunately, the length of time necessary for skin deepithelialization with the Nd:YAG laser exceeded even conventional methods, such that this role with the present technology, although possible, is inefficient and impractical.