Effectiveness of a 308-nm excimer laser in treatment of vitiligo: a review

Vitiligo is a relatively common acquired disorder, characterized by progressive loss of melanocytes from the epidermis and the epidermal appendages. The disease is associated with considerable morbidity because of a major impact on the quality of life. The treatment for vitiligo is generally unsatisfactory and challenging. There are a variety of therapeutic possibilities including topical corticosteroids, topical calcineurin inhibitors, as well as phototherapy with Psoralen plus UVA (PUVA), narrow-band UVB, and a 308-nm excimer laser and/or lamps. Furthermore, surgical methods encompass grafting and transplantation while depigmentation treatments and psychological support may also be considered. The objective is to assess the effect of the 380-nm excimer laser in the treatment of vitiligo based on the available studies and case series. We searched the relevant literature about vitiligo and excimer laser published between 1990 and 2012 using the MEDLINE database. We reviewed all relevant articles about 308-nm excimer laser and light sources assessing their efficacy in the management of vitiligo as well as their side effects. The value of combination treatment methods was also analyzed. The available studies provide strong evidence that the excimer laser represents the most effective approach to treat vitiligo compared to ordinary phototherapy. Excimer laser is relatively safe and effective for localized disease. UV-sensitive areas respond best as well as a short duration of the disease. More frequent treatments achieve better results. Compared to other treatment modalities, the excimer laser most likely constitutes the treatment of choice for localized vitiligo. Its efficacy can be further improved in combination with other therapies such as corticosteroids, pimecrolimus, or tacrolimus.

Expanded polytetrafluoroethylene graft for bypass surgery using the excimer laser-assisted nonocclusive anastomosis technique

OBJECT: Patients with complex craniocerebral pathophysiologies such as giant cerebral aneurysms, skull base tumors, and/or carotid artery occlusive disease are candidates for a revascularization procedure to augment or preserve cerebral blood flow. However, the brain is susceptible to ischemia, and therefore the excimer laser-assisted nonocclusive anastomosis (ELANA) technique has been developed to overcome temporary occlusion. Harvesting autologous vessels of reasonable quality, which is necessary for this technique, may at times be problematic or impossible due to the underlying systemic vascular disease. The use of artificial vessels is therefore an alternative graft for revascularization. Note, however, that it is unknown to what degree these grafts are subject to occlusion using the ELANA anastomosis technique. Therefore, the authors studied the ELANA technique in combination with an expanded polytetrafluoroethylene (ePTFE) graft. METHODS: The experimental surgeries involved bypassing the abdominal aorta in the rabbit. Ten rabbits were subjected to operations representing 20 ePTFE graft-ELANA end-to-side anastomoses. Intraoperative blood flow, followup angiograms, and long-term histological characteristics were assessed 75, 125, and 180 days postoperatively. Angiography results proved long-term patency of ePTFE grafts in all animals at all time points studied. Data from the histological analysis showed minimal intimal reaction at the anastomosis site up to 180 days postoperatively. Endothelialization of the ePTFE graft was progressive over time. CONCLUSIONS: The ELANA technique in combination with the ePTFE graft seems to have favorable attributes for end-to-side anastomoses and may be suitable for bypass procedures.

New-Generation Hybrid Contact Lens for the Management of Extreme Irregularity in a Thin Cornea After Unsuccessful Excimer Laser Refractive Surgery

Purpose: To report a very successful outcome obtained with the fitting of a new-generation hybrid contact lens of reverse geometry in a thin cornea with extreme irregularity due to the presence of a central island after unsuccessful myopic excimer laser refractive surgery. Methods: A 32-year-old man attended to our clinic complaining of very poor vision in his right eye after bilateral laser in situ keratomileusis (treatment or surgery) for myopia correction and some additional retreatments afterward. After a comprehensive ocular evaluation, contact lens fitting with a reverse geometry hybrid contact lens (SynergEyes PS, SynergEyes, Carlsbad, CA) was proposed as a solution for this case. Visual, refractive, and ocular aberrometric outcomes with the contact lens were evaluated. Results: Distance visual acuity improved from a prefitting uncorrected value of 20/200 to a postfitting corrected value of 20/16. Prefitting manifest refraction was +6.00 sphere and −3.00 cylinder at 70°, with a corrected distance visual acuity of 20/40. Higher order root mean square for a 5-mm pupil changed from a prefitting value of 1.45 to 0.34 µm with the contact lens. The contact lens wearing was reported as comfortable, and the patient was very satisfied with this solution. Conclusions: The SynergEyes PS contact lens seems to be an excellent option for the visual rehabilitation of corneas with extreme irregularity after myopic excimer laser surgery, minimizing the level of higher order aberrations and providing an excellent visual outcome.

Surface roughness after excimer laser ablation using a PMMA model:profilometry and effects on vision

PURPOSE: To show that the limited quality of surfaces produced by one model of excimer laser systems can degrade visual performance with a polymethylmethacrylate (PMMA) model. METHODS: A range of lenses of different powers was ablated in PMMA sheets using five DOS-based Nidek EC-5000 laser systems (Nidek Technologies, Gamagori, Japan) from different clinics. Surface quality was objectively assessed using profilometry. Contrast sensitivity and visual acuity were measured through the lenses when their powers were neutralized with suitable spectacle trial lenses. RESULTS: Average surface roughness was found to increase with lens power, roughness values being higher for negative lenses than for positive lenses. Losses in visual contrast sensitivity and acuity measured in two subjects were found to follow a similar pattern. Findings are similar to those previously published with other excimer laser systems. CONCLUSIONS: Levels of surface roughness produced by some laser systems may be sufficient to degrade visual performance under some circumstances.

Poly(methyl methacrylate) model study of optical surface quality after excimer laser photorefractive keratectomy

Purpose: To evaluate lenses produced by excimer laser ablation of poly(methyl methacrylate) (PMMA) plates. Setting: University research laboratory. Methods: Two Nidek EC-5000 scanning-slit excimer laser systems were used to ablate plane-parallel plates of PMMA. The ablated lenses were examined by focimetry, interferometry, and mechanical surface profiling. Results: The spherical optical powers of the lenses matched the expected values, but the cylindrical powers were generally lower than intended. Interferometry revealed marked irregularity in the surface of negative corrections, which often had a positive “island” at their center. Positive corrections were generally smoother. These findings were supported by the results of mechanical profiling. Contrast sensitivity measurements carried out when observing through ablated lenses whose power had been neutralized with a suitable spectacle lens of opposite sign confirmed that the surface irregularities of the ablated lenses markedly reduced contrast sensitivity over a range of spatial frequencies. Conclusion: Improvements in beam delivery systems seem desirable.

Excimer laser surface ablation - a review

Corneal surface laser ablation procedures for the correction of refractive error have enjoyed a resurgence of interest, especially in patients with a possible increased risk of complications after lamellar surgery. Improvements in the understanding of corneal biomechanical changes, the modulation of wound healing, laser technology including ablation profiles and different methods for epithelial removal have widened the scope for surface ablation. This article discusses photorefractive keratectomy, trans-epithelial photorefractive keratectomy, laser-assisted sub-epithelial keratomileusis and epithelial-laser-assisted in situ keratomileusis. © 2010 The Authors. Journal compilation © 2010 Royal Australian and New Zealand College of Ophthalmologists.

Ion beam processing of oriented CuO films deposited on (100) YSZ by laser ablation

A systematic study of Ar ion implantation in cupric oxide films has been reported. Oriented CuO films were deposited by pulsed excimer laser ablation technique on (1 0 0) YSZ substrates. X-ray diffraction (XRD) spectra showed the highly oriented nature of the deposited CuO films. The films were subjected to ion bombardment for studies of damage formation, Implantations were carried out using 100 keV Arf over a dose range between 5 x 10(12) and 5 x 10(15) ions/cm(2). The as-deposited and ion beam processed samples were characterized by XRD technique and resistance versus temperature (R-T) measurements. The activation energies for electrical conduction were found from In [R] versus 1/T curves. Defects play an important role in the conduction mechanism in the implanted samples. The conductivity of the film increases, and the corresponding activation energy decreases with respect to the dose value.

Dielectric Studies of laser ablated Ca doped BaTiO3 thin films

Recently, there has been growing interest in Ca modified BaTiO3 structures due to their larger electro-optic coefficients for their use in optical storage of information over conventional BaTiO3 crystals. Barium Calcium Titanate (BCT) shows promising applications in advanced laser systems, optical interconnects and optical storage devices. BaTiO3 thin films of varied Ca (3 at. % - 15 at. %) doping were deposited using pulsed laser ablation (KrF excimer laser) technique over Pt/Si substrates. The stoichiometric and the compositional analysis were carried out using EDAX and SIMS. The dielectric studies were done at the frequency regime of 40 Hz to 100 kHz at different ambient temperatures from 200 K to 600 K. The BCT thin films exhibited diffuse phase transition, which was of a typical non lead relaxor behavior and had high dielectric constant and low dielectric loss. The phase transition for the different compositions of BCT thin films was near the room temperature, showing a marked departure from the bulk phase transition. The C - V and the hysteresis behavior confirmed the ferroelectric nature below the phase transition and paraelectric at the room temperature.

Interface states of laser ablated BaTiO3 and Ba0.9Ca0.1TiO3 thin films in MFS structure determined by DLTS and C – V technique

BaTiO3 and Ba0.9Ca0.1TiO3 thin films were deposited on the p – type Si substrate by pulsed excimer laser ablation technique. The Capacitance – Voltage (C-V) measurement measured at 1 MHz exhibited a clockwise rotating hysteresis loop with a wide memory window for the Metal – Ferroelectric – Semiconductor (MFS) capacitor confirming the ferroelectric nature. The low frequency C – V measurements exhibited the response of the minority carriers in the inversion region while at 1 MHz the C – V is of a high frequency type with minimum capacitance in the inversion region. The interface states of both the MFS structures were calculated from the Castagne – Vaipaille method (High – low frequency C – V curve). Deep Level Transient Spectroscopy (DLTS) was used to analyze the interface traps and capture cross section present in the MFS capacitor. There were distinct peaks present in the DLTS spectrum and these peaks were attributed to the presence of the discrete interface states present at the semiconductor – ferroelectric interface. The distribution of calculated interface states were mapped with the silicon energy band gap for both the undoped and Ca doped BaTiO3 thin films using both the C – V and DLTS method. The interface states of the Ca doped BaTiO3 thin films were found to be higher than the pure BaTiO3 thin films.

Field-induced dielectric properties of laser ablated antiferroelectric (Pb0.99Nb0.02)(Zr0.57Sn0.38Ti0.05)0.98O3 thin films

Niobium-modified lead zirconate stannate titanate antiferroelectric thin films with the chemical composition of (Pb0.99Nb0.02)(Zr0.57Sn0.38Ti0.05)0.98O3 were deposited by pulsed excimer laser ablation technique on Pt-coated Si substrates. Field-induced phase transition from antiferroelectric to ferroelectric properties was studied at different fields as a function of temperature. The field forced ferroelectric phase transition was elucidated by the presence of double-polarization hysteresis and double-butterfly characteristics from polarization versus applied electric field and capacitance and voltage measurements, respectively. The measured forward and reverse switching fields were 25 kV/cm and 77 kV/cm, respectively. The measured dielectric constant and dissipation factor were 540 and 0.001 at 100 kHz, respectively, at room temperature.

Optical transfer of periodic microstructures by interfering femtosecond laser beams

We report on an optical interference method for transferring periodic microstructures of metal film from a supporting substrate to a receiving substrate by means of five-beam interference of femtosecond laser pulses. Scanning electron microscopy and optical microscopy revealed microstructures with micrometer-order were transferred to the receiving substrate. In the meanwhile, a negative copy of the transferred structures was induced in the metal film on the supporting substrate. The diffraction characteristics of the transferred structures were also evaluated. The present technique allows one-step realization of functional optoelectronic devices. (C) 2005 Optical Society of America.

Crystallization of amorphous Si films by pulsed laser annealing and their structural characteristics

Nanocrystalline silicon (nc-Si) films were prepared by pulsed laser annealed crystallization of amorphous silicon (alpha-Si) films on SiO2-coated quartz or glass substrates. The effect of laser energy density on structural characteristics of nc-Si films was investigated. The Ni-induced crystallization of the a-Si films was also discussed. The surface morphology and microstructure of these films were characterized by scanning electron microscopy, high-resolution electron microscopy, atomic force microscopy and Raman scattering spectroscopy. The results show that not only can the alpha-Si films be crystallized by the laser annealing technique, but also the size of Si nanocrystallites can be controlled by varying the laser energy density. Their average size is about 4-6 nm. We present a surface tension and interface strain model used for describing the laser annealed crystallization of the alpha-Si films. The doping of Ni atoms may effectively reduce the threshold value of laser energy density to crystallize the alpha-Si films, and the flocculent-like Si nanostructures could be formed by Ni-induced crystallization of the alpha-Si films.

Laser annealing of sputtered silicon for wafer-bonding applications

Sputtered silicon is investigated as a bonding layer for transfer of pre-processed silicon layers to various insulating substrates. Although the material appears suitable for low temperature processing, previous work has shown that gas trapped in the pores of the sputtered material is released at temperatures above 350 degrees C and further increases of temperature lead to destruction of any bonded interface. Pre-annealing at 1000 degrees C before bonding drives out gas and/or seals the surface, but for device applications where processing temperatures must be kept below about 300 degrees C, this technique cannot be used. In the current work, we have investigated the effect of excimer laser-annealing to heat the sputtered silicon surface to high temperature whilst minimising heating of the underlying substrate. Temperature profile simulations are presented and the results of RBS, TEM and AFM used to characterise the annealed layers. The results verify that gases are present in the sub-surface layers and suggest that while sealing of the surface is important for suppression of the out-diffusion of gases, immediate surface gas removal may also play a role. The laser-annealing technique appears to be an effective method of treating sputtered silicon, yielding a low roughness surface suitable for wafer bonding, thermal splitting and layer transfer.

Study of ground-state titanium ion velocity distributions in laser-produced plasma plumes

The velocity distribution of ground-state titanium ions within a low-temperature plasma resulting from the laser ablation of a titanium target has been investigated. A KrF excimer laser was focused onto the target at moderate fluences (