In-stent restenosis. Acute and long-term outcomes after excimer laser coronary angioplasty

OBJETIVE: With the increased use of intracoronary stents, in-stent restenosis has become a clinically significant drawback in invasive cardiology. We retrospectively assessed the short- and long-term outcomes after excimer laser coronary angioplasty of in-stent restenosis. METHODS: Twenty-five patients with 33 incidents of in-stent restenosis treated with excimer laser coronary angioplasty (ELCA) were analyzed. Sixty-six percent were males, mean age of 73±11 years, and 83% were functional class III-IV (NYHA). ELCA was performed using 23 concentric and 10 eccentric catheters with a diameter of 1.6-2.2 mm, followed by balloon angioplasty (PTCA) and ultrasound monitoring. The procedure was performed in the following vessels: left anterior descending artery, 10; left circumflex artery, 8; right coronary artery, 6; left main coronary artery, 2; and venous bypass graft, 7. RESULTS: The ELCA was successful in 71% of the cases, and PTCA was 100% successful. The diameter of the treated vessels was 3.44±0.5mm; the minimal luminal diameter (MLD) increased from 0.30mm pre-ECLA to 1.97mm post-ELCA, and to 2.94mm post-PTCA (p<0.001). The percent stenosis was reduced from 91.4±9.5% before ECLA to 42.3±14.9% after ELCA and to 14.6 ± 9.3% after PTCA (p<0.001). Seventeen (68%) patients were asymptomatic at 6 months and 15 (60%) at 1 year. New restenosis rates were 8/33 (24.2%) at 6 months and 9 /33 (27.3%) at 12 months. CONCLUSION: ELCA is safe and effective for the treatment of in-stent restenosis. In the present sample, a slight increase in new restenotic lesions between 6 and 12 months was found.

Simulation and Design of a high speed Solid State Switch for Excimer Laser

Excimerlaser sind gepulste Gaslaser, die Laseremission in Form von Linienstrahlung – abhängig von der Gasmischung – im UV erzeugen. Der erste entladungsgepumpte Excimerlaser wurde 1977 von Ischenko demonstriert. Alle kommerziell verfügbaren Excimerlaser sind entladungsgepumpte Systeme. Um eine Inversion der Besetzungsdichte zu erhalten, die notwendig ist, um den Laser zum Anschwingen zu bekommen, muss aufgrund der kurzen Wellenlänge sehr stark gepumpt werden. Diese Pumpleistung muss von einem Impulsleistungsmodul erzeugt werden. Als Schaltelement gebräuchlich sind Thyratrons, Niederdruckschaltröhren, deren Lebensdauer jedoch sehr limitiert ist. Deshalb haben sich seit Mitte der 1990iger Jahre Halbleiterschalter mit Pulskompressionsstufen auch in dieser Anwendung mehr und mehr durchgesetzt. In dieser Arbeit wird versucht, die Pulskompression durch einen direkt schaltenden Halbleiterstapel zu ersetzen und dadurch die Verluste zu reduzieren sowie den Aufwand für diese Pulskompression einzusparen. Zudem kann auch die maximal mögliche Repetitionsrate erhöht werden. Um die Belastung der Bauelemente zu berechnen, wurden für alle Komponenten möglichst einfache, aber leistungsfähige Modelle entwickelt. Da die normalerweise verfügbaren Daten der Bauelemente sich aber auf andere Applikationen beziehen, mussten für alle Bauteile grundlegende Messungen im Zeitbereich der späteren Applikation gemacht werden. Für die nichtlinearen Induktivitäten wurde ein einfaches Testverfahren entwickelt um die Verluste bei sehr hohen Magnetisierungsgeschwindigkeiten zu bestimmen. Diese Messungen sind die Grundlagen für das Modell, das im Wesentlichen eine stromabhängige Induktivität beschreibt. Dieses Modell wurde für den „magnetic assist“ benützt, der die Einschaltverluste in den Halbleitern reduziert. Die Impulskondensatoren wurden ebenfalls mit einem in der Arbeit entwickelten Verfahren nahe den späteren Einsatzparametern vermessen. Dabei zeigte sich, dass die sehr gebräuchlichen Class II Keramikkondensatoren für diese Anwendung nicht geeignet sind. In der Arbeit wurden deshalb Class I Hochspannungs- Vielschicht- Kondensatoren als Speicherbank verwendet, die ein deutlich besseres Verhalten zeigen. Die eingesetzten Halbleiterelemente wurden ebenfalls in einem Testverfahren nahe den späteren Einsatzparametern vermessen. Dabei zeigte sich, dass nur moderne Leistungs-MOSFET´s für diesen Einsatz geeignet sind. Bei den Dioden ergab sich, dass nur Siliziumkarbid (SiC) Schottky Dioden für die Applikation einsetzbar sind. Für die Anwendung sind prinzipiell verschiedene Topologien möglich. Bei näherer Betrachtung zeigt sich jedoch, dass nur die C-C Transfer Anordnung die gewünschten Ergebnisse liefern kann. Diese Topologie wurde realisiert. Sie besteht im Wesentlichen aus einer Speicherbank, die vom Netzteil aufgeladen wird. Aus dieser wird dann die Energie in den Laserkopf über den Schalter transferiert. Aufgrund der hohen Spannungen und Ströme müssen 24 Schaltelemente in Serie und je 4 parallel geschaltet werden. Die Ansteuerung der Schalter wird über hochisolierende „Gate“-Transformatoren erreicht. Es zeigte sich, dass eine sorgfältig ausgelegte dynamische und statische Spannungsteilung für einen sicheren Betrieb notwendig ist. In der Arbeit konnte ein Betrieb mit realer Laserkammer als Last bis 6 kHz realisiert werden, der nur durch die maximal mögliche Repetitionsrate der Laserkammer begrenzt war.

Excimer Laser no tratamento do vitiligo em 123 pacientes: estudo retrospectivo

Introduction: Vitiligo is cosmetically disfiguring and can cause significant psychological morbidity. Most therapies require protracted treatments and can lead to disappointing results. More recently, 308 nm Excimer laser has proven to be effective in treating vitiligo. Objective: To analyze the effectiveness and patient satisfaction of 308 nm Excimer treatment for vitiligo patches in a variety of locations on the body. Methods: Patients with generalized or localized vitiligo (n = 123, 321 lesions), were studied. The patients were treated at a private practice between 2007 and 2010. Two independent examiners analyzed the response to the therapy by comparing clinical and photographic records before and after treatment. Results: More than half (n = 77) of the patients presented repigmentation greater than 60%, 26 presented 40-59%, and 20% had levels less than 39%. Facial lesions responded better to treatment than those in other body parts. Elbows, hands and feet were the less sensitive areas. In general, the patients were satisfied with the treatment. Conclusion: The use of Excimer laser for treating vitiligo was effective and safe, producing satisfactory cosmetic results and improving patients' self esteem.

Glue-enhanced excimer laser-assisted nonocclusive anastomosis: a laboratory investigation

The excimer laser-assisted nonocclusive anastomosis (ELANA) technique has been developed as a clinical effective technique to perform intracranial high-flow bypass without temporary occlusion of cerebral vessels in otherwise untreatable or high-risk cerebrovascular diseases. We experimentally tested the application of a nonabsorbable cyanoacrylate-based sealant with the ELANA technique.

Experience in using the excimer laser-assisted nonocclusive anastomosis nonocclusive bypass technique for high-flow revascularization: Mannheim-Helsinki series of 64 patients

The excimer laser-assisted nonocclusive anastomosis (ELANA) technique enables large-caliber bypass revascularization without temporary occlusion of the parent artery.

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.

Differences in the early biomechanical effects of hyperopic and myopic laser in situ keratomileusis

PURPOSE: To compare changes in corneal hysteresis (CH) and the corneal resistance factor (CRF) in myopic and hyperopic laser in situ keratomileusis (LASIK) and evaluate their relationship to the number of photoablative pulses delivered, a surrogate for ablation volume. SETTING: Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, USA. METHODS: Preoperative and 1-week postoperative Ocular Response Analyzer measurements in eyes that had femtosecond-assisted LASIK were studied retrospectively. Changes in CH and CRF were compared and tested for correlation with the number of excimer laser pulses. RESULTS: Thirteen myopic eyes and 11 hyperopic eyes were evaluated. Preoperative corneal thickness, CH, CRF, programmed correction magnitude, flap thickness, and total number of fixed spotsize photoablative pulses were similar in the 2 groups (P>.1). Decreases in CH and CRF were greater after myopic LASIK than after hyperopic LASIK (P<.005), and changes in CRF were correlated with the number of excimer laser pulses in the myopic group only (r = -0.63, P = .02). Regardless of ablation profile, changes in CH were more strongly correlated with preoperative CH values than with attempted ablation volume. CONCLUSIONS: With comparable flap thickness and attempted ablation volumes, myopic photoablation profiles were associated with greater decreases in CRF and CH than hyperopic profiles. Results indicate that preoperative corneal biomechanical status, ablation volume, and the spatial distribution of ablation are important factors that affect corneal resistance and viscous dissipative properties differently. Preferential tissue removal in the natively thicker paracentral cornea in hyperopia may partially account for the rarity of ectasia after hyperopic LASIK.

Photorefractive keratectomy and butterfly laser epithelial keratomileusis: A prospective, contralateral study

PURPOSE: To evaluate results of two surface excimer laser refractive surgery techniques-photorefractive keratectomy (PRK) and butterfly laser epithelial keratomileusis (butterfly LASEK). METHODS: A prospective, randomized, double-masked study of 51 patients (102 eyes) who underwent laser refractive surgery. One eye of each patient was randomized to be operated with PRK and the fellow eye with butterfly LASEK Patients were followed for 1 year. RESULTS: No significant difference between groups for distance uncorrected visual acuity (UCVA) (P=.559) was noted. At 1 year, 98% (50 eyes) in the PRK group and 96.1% (49 eyes) in the butterfly LASEK group reached UCVA of 20/20. Predictability, efficacy, safety, and stability were not statistically significant between groups. Safety index was 1.0 for PRK and 0.996 for butterfly LASEK, One eye in the butterfly LASEK group lost one line of best-spectacle corrected visual acuity. At 12 months, 94.1% (48 eyes) and 86.3% (44 eyes) in the PRK and butterfly LASEK groups (P=.188), respectively, had a spherical equivalent refraction of +/- 0.50 diopters. Slight haze was observed in both groups. A statistical difference in haze between the groups was observed only in the first postoperative month, with higher intensity in the butterfly LASEK group (0.18 +/- 0.39) compared to the PRK group (0.08 +/- 0.21) (P=.04). CONCLUSIONS: Butterfly LASEK had similar predictability, efficacy, safety, stability, and haze incidence to PRK for the treatment of low to moderate myopia. However, on the second postoperative day, PRK showed better UCVA than butterfly LASEK.

Wetting response of KrF laser ablated polyimide surfaces

The wettability of polyimide surfaces microstructured using KrF laser radiation at fluences above the material ablation threshold was studied by static contact angle measurements. The laser-treated surfaces present a morphology consisting of conical features whose dimensions and areal density depend on the fluence. The effect of these parameters on the surface apparent contact angle depends on the wetting regime. When wetting occurs in the homogeneous regime, the apparent contact angle of the treated surfaces increases with the radiation fluence because the cone dimensions increase. In contrast, when wetting occurs in the heterogeneous regime, the apparent contact angle increases with the radiation fluence because the average distance between cones increases. The apparent water contact angle of the laser-treated surfaces can reach values as high as 162 degrees, as compared to 75 degrees for virgin polyimide.