Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial

OBJECTIVES

To report 5-year follow-up results of a randomised clinical trial comparing holmium laser enucleation of the prostate (HoLEP) with open prostatectomy (OP).

METHODS

One hundred twenty patients with prostates greater than 100g in weight according to transrectal ultrasound were randomised to either the HoLEP or the OP group (ie, 60 patients to each group). Preoperative and postoperative assessments included American Urological Association Symptom Score (AUA-SS), maximum urinary flow rates (Qmax), and postvoid residual urine (PVRU) volumes. Measurements were performed at 1, 3, 6, 12, 18, 24, 36, 48, and 60 mo. Postoperative outcome data were compared. All complications were recorded.

RESULTS

Five years postoperatively, a total of 46 patients (38.3%) were lost to follow-up or had to be excluded from the study. All the remaining 74 patients (42 HoLEP vs. 32 OP patients, p=0.11) had undergone the 5-yr follow-up assessments. Mean AUA-SS was 3.0 in both groups (p=0.98), mean Qmax was 24.4 ml/s in both groups (p=0.97) and PVRU volume was 11 ml in the HoLEP and 5 ml in the OP group (p=0.25). Late complications consisted of urethral strictures and bladder-neck contractures; reoperation rates were 5% in the HoLEP and 6.7% in the OP group (p=1.0). No patient developed benign prostatic hyperplasia recurrence.

CONCLUSIONS

Five years after the operation, the improvements in micturition obtained with HoLEP and OP were equally good, and reoperation rates similarly low. HoLEP seems to be a true endourological alternative to OP.

Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium:YAG laser

PURPOSE

To compare the operating modes of the Holmium:YAG laser and Thulium fiber laser. Additionally, currently available literature on Thulium fiber laser lithotripsy is reviewed.

MATERIALS AND METHODS

Medline, Scopus, Embase, and Web of Science databases were searched for articles relating to the operating modes of Holmium:YAG and Thulium fiber lasers, including systematic review of articles on Thulium fiber laser lithotripsy.

RESULTS

The laser beam emerging from the Holmium:YAG laser involves fundamental architectural design constraints compared to the Thulium fiber laser. These differences translate into multiple potential advantages in favor of the Thulium fiber laser: four-fold higher absorption coefficient in water, smaller operating laser fibers (50-150 µm core diameter), lower energy per pulse (as low as 0.025 J), and higher maximal pulse repetition rate (up to 2000 Hz). Multiple comparative in vitro studies suggest a 1.5-4 times faster stone ablation rate in favor of the Thulium fiber laser.

CONCLUSIONS

The Thulium fiber laser overcomes the main limitations reported with the Holmium:YAG laser relating to lithotripsy, based on preliminary in vitro studies. This innovative laser technology seems particularly advantageous for ureteroscopy and may become an important milestone for kidney stone treatment.

Advances in Lasers for the Treatment of Stones-a Systematic Review

PURPOSE OF REVIEW

Laser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year.

RECENT FINDINGS

Variable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and "cleaving only" fiber tip preparation can be beneficial for the lithotripsy procedure. Different laser settings and the surgical technique employed can have significant impact on the success of laser lithotripsy. When safely done, complications of laser lithotripsy are rare and concern the endoscopic nature of procedure, not the technology itself, making laser lithotripsy one of the safest tools in urology. Laser lithotripsy has had several new developments and more insight has been gained in recent years with many more advances expected in the future.

Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause

Aim To evaluate the effects of the vaginal erbium laser (VEL) in the treatment of postmenopausal women suffering from genitourinary syndrome of menopause (GSM). Method GSM was assessed in postmenopausal women before and after VEL (one treatment every 30 days, for 3 months; n = 45); the results were compared with the effects of a standard treatment for GSM (1 g of vaginal gel containing 50 μg of estriol, twice weekly for 3 months; n = 25). GSM was evaluated with subjective (visual analog scale, VAS) and objective (Vaginal Health Index Score, VHIS) measures. In addition, in 19 of these postmenopausal women suffering from stress urinary incontinence (SUI), the degree of incontinence was evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after VEL treatments. Results VEL treatment induced a significant decrease of VAS of both vaginal dryness and dyspareunia (p < 0.01), with a significant (p < 0.01) increase of VHIS. In postmenopausal women suffering from mild to moderate SUI, VEL treatment was associated with a significant (p < 0.01) improvement of ICIQ-SF scores. The effects were rapid and long lasting, up to the 24th week of the observation period. VEL was well tolerated with less than 3% of patients discontinuing treatment due to adverse events. Conclusion This pilot study demonstrates that VEL induces a significant improvement of GSM, including vaginal dryness, dyspareunia and mild to moderate SUI. Further studies are needed to explore the role of laser treatments in the management of GSM.

Femtosecond lasers for LASIK flap creation: a report by the American Academy of Ophthalmology

OBJECTIVE

To review the published literature to assess the safety, efficacy, and predictability of femtosecond lasers for the creation of corneal flaps for LASIK; to assess the reported outcomes of LASIK when femtosecond lasers are used to create corneal flaps; and to compare the differences in outcomes between femtosecond lasers and mechanical microkeratomes.

METHODS

Literature searches of the PubMed and Cochrane Library databases were last conducted on October 12, 2011, without language or date limitations. The searches retrieved a total of 636 references. Of these, panel members selected 58 articles that they considered to be of high or medium clinical relevance, and the panel methodologist rated each article according to the strength of evidence. Four studies were rated as level I evidence, 14 studies were rated as level II evidence, and the remaining studies were rated as level III evidence.

RESULTS

The majority of published studies evaluated a single laser platform. Flap reproducibility varied by device and the generation of the device. Standard deviations in flap thicknesses ranged from 4 to 18.4 μm. Visual acuities and complications reported with LASIK flaps created using femtosecond lasers are within Food and Drug Administration safety and efficacy limits. Of all complications, diffuse lamellar keratitis is the most common after surgery but is generally mild and self-limited. Corneal sensation was reported to normalize by 1 year after surgery. Unique complications of femtosecond lasers included transient light-sensitivity syndrome, rainbow glare, opaque bubble layer, epithelial breakthrough of gas bubbles, and gas bubbles within the anterior chamber.

CONCLUSIONS

Available evidence (levels I and II) indicates that femtosecond lasers are efficacious devices for creating LASIK flaps, with accompanying good visual results. Overall, femtosecond lasers were found to be as good as or better than mechanical microkeratomes for creating LASIK flaps. There are unique complications that can occur with femtosecond lasers, and long-term follow-up is needed to evaluate the technology fully.

Laser therapy for the restoration of vaginal function

Laser therapy has a therapeutic role in various medical conditions and most recently has gained interest as a non-hormonal treatment for genitourinary syndrome of menopause (GSM) and as a non-invasive option for stress urinary incontinence (SUI). Several therapies are available to alleviate GSM symptoms, including hormonal and non-hormonal products. Both microablative fractional CO₂ laser and the non-ablative vaginal Er:YAG laser (VEL) induce morphological changes in the vaginal tissues, and data from non-randomized clinical trials suggest that laser therapy can alleviate vaginal dryness and dyspareunia. VEL has been reported to improve SUI as well as vaginal prolapse. Although large randomized trials have not been reported, the evidence suggests that VEL can be offered as a safe and efficacious alternative to hormone replacement therapy (HRT) for GSM, as well as a first-line treatment for mild to moderate SUI, before surgical procedures are resorted to. Randomized studies are needed to compare laser treatments with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications. Research is presently evaluating both an automated robotic probe for VEL treatments and an intraurethral probe for the treatment of severe and type III SUI.

Novel minimally invasive laser treatment of urinary incontinence in women

BACKGROUND AND OBJECTIVE

Urinary incontinence (UI) is a common disorder that affects women of various ages and impacts all aspects of life. Our aim was to evaluate the non-invasive erbium:yttrium-aluminum-garnet (Er:YAG) laser that exploits its thermal effect and has been used in reconstructive and rejuvenation surgery as a potential treatment strategy for stress UI (SUI) and mixed UI (MUI).

STUDY DESIGN/MATERIALS AND METHODS

We included 175 women (aged 49.7 ± 10 years) with newly diagnosed SUI (66% of women) and MUI (34%), respectively. Patients were clinically examined and classified by incontinence types (SUI and MUI) and grades (mild, moderate, severe, and very severe) using International Consultation on Incontinence Modular Questionnaire (ICIQ) and assessing Incontinence Severity Index (ISI). Using Er:YAG laser, we performed on average 2.5 ± 0.5 procedures in each woman separated by a 2 month period. At each session, clinical examination was performed, ICIQ and ISI assessed and treatment discomfort measured with visual analog system (VAS) pain scale, and adverse effects and patients' satisfaction were followed. Follow-ups were performed at 2, 6, and 12 months after the treatment.

RESULTS

After the treatment, ISI decreased for 2.6 ± 1.0 points in patients diagnosed with mild UI before the treatment, for 3.6 ± 1.4 points in those with moderate UI, for 5.7 ± 1.8 points in those with severe UI and for 8.4 ± 2.6 in those with very severe UI (P < 0.001, paired samples t-test). Altogether, in 77% patients diagnosed with SUI, a significant improvement was found after treatment, while only 34% of women with MUI exhibited no UI at one year follow-up. Age did not affect the outcome. No major adverse effects were noticed in either group.

CONCLUSION

The results of our study, have shown that new non-invasive Er:YAG laser could be regarded as a promising additional treatment strategy for SUI with at least one year lasting positive effects. On the other hand, it does not seem appropriate for treating MUI.

Impact of Stone Size, Location, Composition, Impaction, and Hydronephrosis on the Efficacy of Holmium:YAG-Laser Ureterolithotripsy

OBJECTIVES

The impact and outcome of holmium:YAG-laser (Ho:YAG) ureterolithotripsy in treating proximal and distal ureteral stones was investigated.

METHODS

A total of 543 patients harbouring proximal (n=194) or distal (n=349) ureteral stones underwent semirigid Ho:YAG ureterolithotripsy. The degree of hydronephrosis; stone size, location, impaction, and composition; and complication and stone-free rates were recorded.

RESULTS

Mean stone size for proximal and distal stones was 7.1+/-3.6 mm and 6.2+/-2.5 mm, respectively. The stone-free rate on the first postoperative day was 79.4% for proximal and 96.8% for distal stones (p<0.0001). For proximal stones <10mm and > or =10mm, respectively, the stone-free rate was 80.5% and 74.3% (p=0.4) and for distal stones 97.3% and 94.3% (p=0.2). Stone-free rates for radio-opaque versus radiolucent stones in proximal stones were 79.6% versus 77.9% (p=0.8) and 97.6% versus 96.2% in distal stones (p=0.5). Impaction correlated significantly with stone-free rates (p<0.0001). Stone-free rates for nonimpacted versus impacted proximal stones were 85.8% versus 67.2% (p=0.003) and for distal stones 99.2% versus 91.4% (p<0.003), respectively. The presence or degree of hydronephrosis did not correlate with treatment success (p=0.4, p=0.8). The presence of intraoperative complications correlated significantly with proximal compared to distal ureteral stone location (p=0.004). Auxiliary measures in proximal versus distal stones were performed in 20.6% versus 2.9% (p<0.0001).

CONCLUSIONS

In this series, stone-free rates in Ho:YAG ureterolithotripsy were significantly higher in distal and nonimpacted stones but were independent of stone size and composition and the degree of hydronephrosis. Ureterolithotripsy in proximal stones was associated with higher intraoperative complication and retreatment rates compared to distal stones.

Er:YAG laser therapy for peri-implant infection: a histological study

The purpose of this study was to evaluate the effects of Er:YAG laser on degranulation and implant surface debridement in peri-implant infection. The peri-implant infection was experimentally induced in dogs, and the treatment was performed using an Er:YAG laser or a plastic curet. Animals were sacrificed after 24 weeks, and undecalcified histological sections were prepared and analyzed. Degranulation and implant surface debridement were obtained effectively and safely by Er:YAG laser. Histologically, a favorable formation of new bone was observed on the laser-treated implant surface, and the laser group showed a tendency to produce greater bone-to-implant contact than the curet group. These results indicate that the Er:YAG laser therapy has promise in the treatment of peri-implantitis.

Fractional photothermolysis for the treatment of striae distensae in Asian skin

BACKGROUND

Striae distensae (SD) are dermal scars characterized by linear atrophic depressions. Fractional photothermolysis (FP) is an effective modality for the treatment of cutaneous scars.

OBJECTIVE

To evaluate the safety and efficacy of FP for the treatment of SD in Asian skin.

METHODS

Six female volunteers aged between 20 and 35 years with chronic striae albae phase SD on both buttocks were enrolled. SD lesions on the right buttock were irradiated with a 1550-nm FP laser and patients were followed every 4 weeks for a total of 8 weeks. Outcome assessments included serial photographs, erythema index and melanin index tracking, skin elasticity, histologic examination, and the patients' subjective satisfaction scores.

RESULTS

FP treatment was associated with a substantial improvement in the appearance of SD at 8 weeks post-treatment. The erythema index and melanin index of the treated SD lesions tended to converge with those of the control skin at 4-week follow-up. Skin elasticity was found to be partially normalized after FP. In addition, there was a significant increase in epidermal thickness, collagen, and elastic fiber deposition after FP as demonstrated by histologic examination. Adverse effects of FP included mild and transient pain and hyperpigmentation.

CONCLUSION

FP can reduce SD by stimulating new collagen and elastic fiber synthesis. In addition, repetitive treatments might constitute an effective approach to improving the treatment of SD.

Deep anterior lamellar keratoplasty with femtosecond-laser zigzag incisions

We describe a technique that uses IntraLase-created zigzag incisions for deep anterior lamellar keratoplasty. In this technique, the laser creates a precise incision that extends to within 70 microm of the recipient Descemet membrane. The deep incision minimizes air escape into the peripheral cornea during big-bubble formation. In cases that require hand dissection, the deep incision provides a reference for gauging the dissection depth. The angled incision edge facilitates final stromal excision with scissors. Compared with standard vertical incisions, the zigzag incision provides an interlocking wound configuration and facilitates matching the donor and recipient anterior surfaces.

Panretinal photocoagulation for proliferative diabetic retinopathy: pattern scan laser versus argon laser

PURPOSE

To evaluate the efficacy of the pattern scan laser (PASCAL) in treating newly diagnosed high-risk proliferative diabetic retinopathy (PDR).

DESIGN

Retrospective comparative case series.

METHODS

SETTING

Institutional.

STUDY POPULATION

Eighty-two consecutive eyes of the same number of patients with newly diagnosed high-risk PDR treated with panretinal photocoagulation (PRP) using either argon green laser (41 eyes treated before February 2007) or PASCAL (41 eyes treated February 2007 or thereafter), then followed for at least 6 months.

PROCEDURE

Retrospective chart review with attention to main outcome measures, age, sex, race, follow-up interval, insulin dependence, hemoglobin A1c, and total number of lasers spots.

MAIN OUTCOME MEASURES

Persistence or recurrence of neovascularization, incidence of vitreous hemorrhage (VH), neovascularization of the iris (NVI), neovascular glaucoma (NVG), and need for vitrectomy.

RESULTS

Patients treated with the PASCAL and argon laser received a similar number of spots (1438 vs 1386; P = .59). Patients treated with the PASCAL were more likely to experience persistence or recurrence of neovascularization within 6 months of initial treatment (73% vs 34%; P < .0008). The study was not adequately powered to detect a significant difference in incidence of vitreous hemorrhage, NVI, NVG, or need for vitrectomy.

CONCLUSIONS

When using traditional laser settings, PRP performed with the PASCAL is less effective than that performed with traditional argon laser in effecting lasting regression of retinal neovascularization in the setting of previously untreated high-risk PDR. Physicians may need to change treatment parameters when using PASCAL pattern laser therapy for high-risk PDR.

Assessing the Learning Curve of Holmium Laser Enucleation of Prostate (HoLEP). A Systematic Review

We systematically assessed the learning curve of Holmium laser enucleation of the prostate using the available literature to identify, as our primary outcome, the average number of cases required to reach competency. A computerized search of PubMed and Scopus for articles published from inception through to January 2018 was performed including 24 studies with a total of 5173 patients. Even though different outcome measures require varying case-loads to reach a plateau, Holmium laser enucleation of prostate has an acceptable learning curve with a proposed figure approximating 25-50 cases, with a structured mentorship programme aiding for faster progress.

Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects

The holmium:YAG (Ho:YAG) laser lithotriptor is capable of operating at high pulse energies, but efficient operation is limited to low pulse rates (∼10 Hz) during lithotripsy. On the contrary, the thulium fiber laser (TFL) is limited to low pulse energies, but can operate efficiently at high pulse rates (up to 1000 Hz). This study compares stone ablation threshold, ablation rate, and retropulsion for the two different Ho:YAG and TFL operation modes. The TFL (λ = 1908 nm) was operated with pulse energies of 5 to 35 mJ, 500-μs pulse duration, and pulse rates of 10 to 400 Hz. The Ho:YAG laser (λ = 2120 nm) was operated with pulse energies of 30 to 550 mJ, 350-μs pulse duration, and a pulse rate of 10 Hz. Laser energy was delivered through 200- and 270-μm-core optical fibers in contact mode with human calcium oxalate monohydrate (COM) stones for ablation studies and plaster-of-Paris stone phantoms for retropulsion studies. The COM stone ablation threshold for Ho:YAG and TFL measured 82.6 and 20.8 J∕cm(2), respectively. Stone retropulsion with the Ho:YAG laser linearly increased with pulse energy. Retropulsion with TFL was minimal at pulse rates less than 150 Hz, then rapidly increased at higher pulse rates. For minimal stone retropulsion, Ho:YAG operation at pulse energies less than 175 mJ at 10 Hz and TFL operation at 35 mJ at 100 Hz is recommended, with both lasers producing comparable ablation rates. Further development of a TFL operating with both high pulse energies of 100 to 200 mJ and high pulse rates of 100 to 150 Hz may also provide an alternative to the Ho:YAG laser for higher ablation rates, when retropulsion is not a primary concern.

The most reliable preoperative assessment of renal stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: a single-center experience

OBJECTIVE

To examine which parameters should be measured to preoperatively determine the stone burden as predictors of stone-free (SF) status after a single flexible ureteroscopy (URS). Although several stone parameters reportedly influence the outcome of treatment for urinary stones, the most reliable indicators of stone burden remain unclear.

METHODS

Patients with renal stones treated by flexible URS with holmium laser lithotripsy between October 2009 and December 2011 at a single institute were retrospectively evaluated. The SF status was determined by kidney-ureter-bladder (KUB) films at postoperative day 1. Correlations of possible predictors with the SF status were analyzed using a logistic regression model.

RESULTS

According to the univariate analysis, the following variables were significantly associated with failed treatment: number of stones (P = .001), cumulative stone diameter (CSD) (P < .001), stone surface area (SA) (P < .001), stone volume (P < .001), and presence of lower pole calculi (P = .008). According to the multivariate analysis, the stone volume (P < .001) and the CSD (P = .015) were found to be independent predictors of SF status. The SA (P = .598) had no significant independent influence on the SF status.

CONCLUSION

Among the several parameters regarding the renal stone burden, the stone volume determined by noncontrast computed tomography and the CSD of the KUB were significantly and independently inversely related to the success rate of URS. Among the 3 parameters of stone burden, the SA was found to have a lower clinical utility and priority as a predictor of a SF status after URS.

Lasers and the treatment of chronic periodontitis

For many intraoral soft-tissue surgical procedures the laser has become a desirable and dependable alternative to traditional scalpel surgery. However, the use of dental lasers in periodontal therapy is controversial. This article presents the current peer-reviewed evidence on the use of dental lasers for the treatment of chronic periodontitis.

Optos-guided pattern scan laser (Pascal)-targeted retinal photocoagulation in proliferative diabetic retinopathy

PURPOSE

To investigate the clinical effects and safety of targeted pattern scan laser (Pascal) retinal photocoagulation (TRP) in proliferative diabetic retinopathy (PDR).

METHODS

Prospective and non-randomized study of 28 eyes with treatment-naive proliferative diabetic retinopathy (PDR). Single-session 20-ms-Pascal TRP strategy applied 1500 burns to zones of retinal capillary non-perfusion and intermediate retinal ischaemia guided by wide-field fluorescein angiography (Optos). Main outcome measures at 12 and 24 weeks included; PDR grade (assessed by two masked retina specialists); central retinal thickness (CRT); mean deviation (MD) using 24-2 Swedish interactive threshold algorithm (SITA)-standard visual fields (VF); and ETDRS visual acuity (VA).

RESULTS

Following primary TRP, there was PDR regression in 76% of patients at 12 weeks (κ = 0.70; p < 0.001). No laser re-treatment was required at 4 weeks, and 10 eyes underwent repeat TRP at 12 weeks. Wide-field Optos angiography at 24 weeks showed complete disease regression in 37% and partial regression in 33%. Additional panretinal laser photocoagulation (PRP) was planned for active PDR in 30%. There were significant reductions in CRT over time (10.4 μm at 12-weeks, p = 0.007; 12.1 μm at 24-weeks, p = 0.0003). The MD on VFs improved after 12 weeks (+1.25 dB; p = 0.015) and 24 weeks (+1.26 dB, p = 0.01). The VA increased by +3 letters at 24 weeks (95% CI, 1.74-5.01; p < 0.0001).

CONCLUSIONS

This pilot study reports that Optos-guided Pascal 20-ms TRP using 1500 burns for treatment-naive PDR is a promising procedure with favourable safety profile.

SEM evaluation of the interaction pattern between dentin and resin after cavity preparation using ER:YAG laser

OBJECTIVE

The aim of this study was to describe the interaction pattern formed between dentin and resin on cavities prepared with an erbium laser (Er:YAG). The morphological aspect of the irradiated dentin after acid etching was also observed.

METHODS

Ten dentin disks were obtained from fresh extracted third molars. Each disk received two cavities, one prepared with a conventional high-speed drill, while the other cavity was obtained by the use of an Er:YAG laser (KaVo KEY Laser, KaVo Co.). The laser treatment was performed with 250 mJ/pulse, 4Hz, non contact mode, focused beam, and a fine water mist was used. Five disks were prepared for morphological analysis of the acid etched dentin. The other five disks had their cavities restored with Single Bond (3M) followed by Z100 resin (3M). The specimens were observed under scanning electron microscopy after dentin-resin interface demineralization and deproteinization.

RESULTS AND CONCLUSIONS

It was observed that the morphological characteristics of the acid-etched irradiated dentin were not favorable to the diffusion of monomers through the collagen network. The dentin-resin interfacial aspect of irradiated dentin, after acid etching, showed thin tags and scarce hybridization zones, which agreed with the morphology of the irradiated and acid-etched dentin substrate observed.

IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity

This committee opinion reviews the laser-based vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The United States Food and Drug Administration has issued a warning for unsubstantiated advertising and use of energy-based devices. Well-designed case-control studies are required to further investigate the potential benefits, harm, and efficacy of laser therapy in the treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The therapeutic advantages of nonsurgical laser-based devices in urogynecology can only be recommended after robust clinical trials have demonstrated their long-term complication profile, safety, and efficacy.

Longterm follow-up of pars plana vitrectomy for vitreous floaters: complications, outcomes and patient satisfaction

PURPOSE

Floaters caused by degenerative or postoperative changes in the vitreous can interfere with all aspects of visual functioning. The aim of this study is to report the longterm outcome of pars plana vitrectomy (PPV) for persistent vitreous opacities.

METHODS

In a retrospective, non-randomized, interventional case study we reviewed all cases of vitreous floaters that were vitrectomized at our department between 1997 and 2006. Patient complaints and satisfaction were assessed by a questionnaire administered at the end of follow-up.

RESULTS

Seventy-three consecutive cases were included (61 patients). Mean Snellen best corrected visual acuity (BCVA) before surgery was 0.81. Overall, 85% of patients complained of severe or very severe difficulty caused by floaters. A total of 42% of eyes were pseudophakic, four of which were operated with combined PPV and phacoemulsification. Mean follow-up time was 37 months. Of the phakic eyes, 60% were operated for cataract during follow-up. One retinal detachment (RD) occurred immediately postoperatively (1.3%) and another four eyes developed RD during longterm follow-up 24-44 months after PPV (5.5% of cases). Postoperative BCVA remained mostly unchanged. Overall, 88% of patients were satisfied with the results of the operation.

CONCLUSIONS

Some patients make considerable complaints as a result of vitreous opacities and their distress does not correlate with visual acuity. Vitrectomy is a safe and effective procedure with which to help these patients. Patients should be informed about the risk of cataract progression, unexpected inflammatory reaction and an increased risk for RD several years after PPV (5.5%).

Two-year follow-up of posterior capsule opacification after implantation of a hydrophilic or hydrophobic acrylic intraocular lens

PURPOSE

To evaluate posterior capsule opacification (PCO) 2 years after cataract surgery following implantation of a hydrophilic or a hydrophobic single-piece acrylic intraocular lens (IOL) with a sharp edge.

METHODS

Phacoemulsification cataract surgery was performed in one eye of 120 patients with senile cataract in this prospective study. They were randomized to implantation of either a hydrophilic acrylic IOL (BL27; Bausch & Lomb, Rochester, NY, USA) or a hydrophobic acrylic IOL (AcrySof) SA60AT; Alcon Laboratories, Fort Worth, TX, USA). Two years after surgery, retroillumination images were obtained and PCO area and severity were evaluated using pocoman software. Best corrected visual acuity (VA) (both high-contrast [100%] and low-contrast [2.5%]), glare, laser flare and intraocular pressure were measured. Capsulotomy rates were recorded.

RESULTS

Patients implanted with the hydrophilic IOL had a greater percentage area and severity of PCO compared with patients with the hydrophobic IOL (p < 0.001). There was no difference in PCO between men and women in the hydrophilic group. However, in the hydrophobic group, women had significantly more PCO than men (p < 0.05). Patients with the hydrophobic acrylic IOL had better high- and low-contrast visual activity (VA) (p < 0.01) and less glare (p < 0.001) than those with a hydrophilic acrylic IOL. Of the patients with the hydrophilic IOL, 42% underwent capsulotomy, compared with 10% in the hydrophobic group (p < 0.001).

CONCLUSIONS

Two years after surgery, patients with the SA60AT hydrophobic acrylic IOL had less PCO and better high- and low-contrast VA than patients with the BL27 hydrophilic acrylic IOL.

Nd:YAG laser goniopuncture after deep sclerectomy: outcomes

PURPOSE

This study aimed to investigate the safety and efficacy of Nd:YAG laser goniopuncture (LGP) in lowering intraocular pressure (IOP) after deep sclerectomy (DS).

METHODS

We reviewed the outcomes in 258 eyes of 258 consecutive patients who underwent DS or combined phacoemulsification and DS between August 2001 and December 2003. Mitomycin C was used during surgery in 192 eyes (74.4%).

RESULTS

Mean follow-up was 40 +/- 11 months after DS and 31 +/- 12 months after LGP. Laser goniopuncture was performed in 173 eyes (67.0%). The mean interval between LGP and DS was 10.3 +/- 8.7 months. The probability of LGP being performed was 63.1% (95% confidence interval [CI] 57.3-69.4) at 36 months after surgery. At 2 years after LGP, the probability of maintaining IOP < 15 mmHg with a 20% decrease from the pre-laser IOP and no further glaucoma procedure or medication was 49.7% (95% CI 41.9-57.1). Iris covering the trabeculo-Descemet's membrane was the only factor significantly associated with the failure of LGP (hazard ratio 3.0, p < 0.001). Complications observed after LGP included peripheral anterior synechiae in 23 (13.2%), hypotony in seven (4.0%), late acute IOP rise in three (1.7%), delayed bleb leak in one and blebitis in two eyes. Argon laser iridoplasty was performed in 45 (26.0%) and needle revision in 41 (23.7%) eyes.

CONCLUSIONS

ND:YAG laser goniopuncture is an effective procedure to further lower IOP after DS. An IOP of < 15 mmHg is achieved and maintained for > or = 2 years in about 50% of cases after a single LGP procedure. There are potentially serious complications associated with the procedure. Regular gonioscopy is recommended following LGP to detect any occlusion of the goniopuncture by the iris.

Current evidence for transurethral laser therapy of non-muscle invasive bladder cancer

INTRODUCTION

Bladder cancer is the second most common malignancy of urologic tumors. Back in 1976, lasers were added to the endourological armetarium for bladder tumor treatment. Despite nowadays' standard procedure for staging and treating non-muscle invasive bladder tumor by transurethral resection of bladder tumors (TURB) via a wire loop, laser resection techniques for bladder tumor came back in focus with the introduction of Ho:YAG and not to mention recently Tm:YAG lasers. This review aims to display the current evidence for these techniques.

MATERIALS AND METHODS

Throughout April 2010, MEDLINE and the Cochrane central register of controlled trials were searched previously for the following terms: "Laser, resection, ablation, coagulation, Nd:YAG Neodym, HoYAG: Holmium, Tm:YAG Thulium and transitional carcinoma, bladder, intravesical."

RESULTS

Eleven articles on Ho:YAG and 7 on Tm:YAG were identified. Searches by Cochrane online library resulted in no available manuscripts.

CONCLUSION

Today, Nd:YAG does not play any role in treatment of lower urinary tract transitional cell carcinoma. Ho:YAG and Tm:YAG seem to offer alternatives in the treatment of bladder cancer, but still to prove their potential in larger prospective randomized controlled studies with long-term follow-up. Future expectations will show whether en bloc resection of tumors are preferable to the traditional "incise and scatter" resection technique, in which is contrary to all oncological surgical principles. For the primary targets, here are within first-time clearance of disease, in addition to low in-fields and out-of-fields recurrence rates.