Presidential Greeting - American Society for Laser Medicine and ...

#46
CUTANEOUS LASER
SURGERY
INVESTIGATION INTO SAFE AND EFFECTIVE
TREATMENT INTERVALS OF PORT WINE STAINS
USING THE PULSED DYE LASER
Robert Anolik Tracey Newlove, Elliot T. Weiss,
Anne Chapas, Leonard Bernstein,
Roy G. Geronemus
Laser and Skin Surgery Center of New York, New York, NY
Background: Pulsed dye laser (PDL) therapy is a proven
therapeutic option in the management of port wine stains (PWSs).
Although several studies demonstrate greater efficacy when
treatment is initiated as soon as possible, optimal treatment
intervals are not yet defined. We suggest more frequent treatment
intervals may capitalize on the therapeutic advantage of
delivering additional therapy at more responsive younger ages. In
addition, more frequent sessions might expedite overall treatment
period. The purpose of this study is to assess the relative safety
and efficacy of PDL treatments at 2-, 3-, and 4-week intervals
among patients with PWSs.
Study: This is a retrospective chart review of infants with PWSs
who received at least five PDL treatments in a private
dermatology center. Twenty-four patients were randomly selected
by including the first eight PWS patients found to have been
treated every 2 weeks, every 3 weeks, and every 4 weeks on review
of charts in reverse chronological order. Charts were screened for
adverse events and efficacy was assessed by comparison of
photographs before and after five treatment sessions by blinded,
non-treating dermatologists.
Results: Adverse events were equivalent in all interval groups
and only included expected side effects of erythema, swelling, and
bruising. These findings resolved before subsequent treatment
sessions in all groups. No group showed any long-term adverse
event. In addition, all interval groups showed a diminished
appearance of their PWSs. Notably, more frequent treatment
interval groups demonstrated more rapid and effective resolution
of their PWSs relative to less frequent groups, taking into account
anatomic location.
Conclusion: PDL treatments at 2-, 3-, and 4-week intervals
permit safe and effective management of PWSs. Shorter
treatment intervals, however, allowed for relatively more rapid
and effective treatment. Practitioners treating PWSs should
consider these findings when establishing their own treatment
protocols.
#47
American Society for Laser Medicine and Surgery Abstracts 15
REAL-TIME LASER SPECKLE IMAGING AS AN
INTRAOPERATIVE DIAGNOSTIC TOOL DURING
TREATMENT OR PORT WINE STAIN
BIRTHMARKS
Bruce Yang, Owen Yang, Kristen Kelly,
J. Stuart Nelson, Bernard Choi
Beckman Laser Institute and Medical Clinic,
University of California, Irvine, CA
Background: Laser speckle imaging (LSI) is a technique in
which imaging of coherent light remitted from an object results in
a speckle pattern. The spatio-temporal statistics of this pattern is
related to the movement of optical scatterers, such as red blood
cells, and image processing algorithms are applied to produce
speckle flow index (SFI) maps, which are representative of tissue
blood flow. If performed in real time, LSI can play an important
role in image-guided surgery. Previous publications reported use
of LSI as a tool in assessing photocoagulation during laser
treatment of port wine stain (PWS) birthmarks; however, the time
necessary to acquire and process images rarely allowed for
immediate feedback during laser treatment. Therefore, we
integrated graphics-processing-unit (GPU)-based processing into
our clinical LSI instrument.
Study: With real-time LSI, we have imaged 22 patients ranging
from 2 to 64 years of age. Imaging at eight frames per second, we
continuously calculate SFI values for both the treated PWS
regions as well as the surrounding normal tissue. We look to see if
treated regions show a uniform reduction in flow exhibited by
decreased SFI values, similar to that of surrounding normal
tissue. If the treated region appears to have high or non-uniform
SFI values, that area will undergo retreatment.
Results: In general, SFI values within treated regions showed a
progressive decrease with each treatment pass, as well as a border
of hyperemia surrounding the treated region. With real-time
feedback, the physician was in most cases able to achieve uniform
vascular shutdown in the region of interest.
Conclusion: Access to real-time blood-flow maps enables direct
visualization of the degree of photocoagulation achieved with
pulsed-dye laser therapy. In several cases, we have retreated
regions with persistent perfusion, to achieve complete vascular
shutdown, which is the hallmark of a successful PWS treatment
session.
#48
THE USE OF LONG PULSED LASER ND:YAG
LASER IN THE TREATMENT OF PEDIATRIC
VENOUS MALFORMATION
Stratos Sofos, Se Hwang Liew
Liverpool, United Kingdom
Background: Venous malformation in the pediatric population
can present with pain, bleeding or debilitating deformity, which
can be difficult to manage. Sclerotherapy, surgery and more
recently the long pulsed Nd:YAG laser have been used with
variable success rates. We aim to investigate the use of the long
pulsed Nd:YAG laser in treating symptomatic venous
malformation, and to identify the specific group of patients most
likely to benefit from such treatment.
Study: A prospective clinical trial was carried out on 59
consecutive patients. Treatment criteria include large facial
deformity, painful or bleeding lesions. One to three treatments
were given at 6–8 weekly intervals. Results were evaluated both
subjectively and objectively.
Results: A total of 59 patients were treated. The average followup
was 24 months. Subjective and objective assessment of efficacy
correlated well, and all patients achieved good to excellent results
in pain and bleeding control and in reducing size of lesions in lip
and oral mucosa. It is, however, not effective in reducing the size
of large, relatively high flow lesions in the limbs. Complications
from treatment include skin blistering (n ¼ 4), ulceration (n ¼ 4)
and subsequent hypertrophic scarring (n ¼ 3). Three patients had
partial.