Original Article

Palmoplantar Psoriasis: Treatment with Calcipotriol and Local UVA Radiation Compared with Local PUVA

Nikolai Tsankov, Simin Meymandi, Ivan Grozdev, Hamidreza Shafiei

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 1-5

INTRODUCTION: Palmoplantar psoriasis could hardly be differentiated from chronic tylotic eczema both clinically and histologically. The most commonly used therapeutic options for palmoplantar psoriasis are long-term therapy with topical corticosteroids and local PUVA. Frequently, it is a recalcitrant disease. We investigated the efficacy  and tolerability of the combination of topical calcipotriol with local UVA radiation in comparison with local PUVA therapy.

METHODS: In a total of 43 patients with palmoplantar psoriasis, 33 were given 15 sessions of local UVA radiation and topical calcipotriol and the remainder received 15 sessions of local PUVA (psoralen + UVA radiation).

RESULTS: The statistical analyses of the results showed that the effect and tolerability of both therapeutic modalities are comparable.

CONCLUSION: Combination of topical calcipotriol and local UVA radiation is an optional corticosteroid-free therapeutic modality for palmoplantar psoriasis. It has a comparable effectiveness and tolerability with local PUVA.

Low Level Laser Therapy in Management of Chemotherapy-Induced Oral Mucositis: Prophylaxis or Treatment?

Gholamreza Esmaeeli Djavid, Amirhossein Emami, Leila Ataie-Fashtami, Seyed reza Safaeinodehi, Farzad Merikh-Baiat, Mohsen Fateh, Nasrin Zand

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 12-17

INTRODUCTION: Chemotherapy-induced oral mucositis (COM) is a common, debilitating complication of cancer therapy. The aims of this study were to evaluate the effect of low level laser therapy (LLLT) on prevention of COM in patients with hematologic malignancies.

METHODS: Fifty-five patients hospitalized to undergo chemotherapy in Imam Hospital were included into the study. These patients were divided into two groups. The oral cavity of the patients were illuminated by continues laser beam using a GaAlAs laser device with wavelength of 630 nm, power output 30 mW, and dose of 5 J/cm2 for six days (LLLT group). The patients in the second group underwent placebo irradiation (power output equal to zero) with the similar protocol. The severity of the COM was clinically evaluated based on WHO grading scale. The patientys’quality of life was assessed before and after the intervention according to EORTC QLQ-C30 questionnaire.

RESULTS: The incidence of COM in LLLT group (31%) was less than the placebo group (41%). Mean duration of COM healing was 4.8 and 12 days in LLLT and placebo groups, respectively (p=0.03). Xereostomia was significantly less severe in LLLT group in comparison with the placebo group (p=0.007).

CONCLUSION: Our findings showed that LLLT significantly reduced the incidence of oral mucositis of WHO grade 3 and 4 as the most debilitating form of oral mucositis,in which oral alimentation is impossible. Also, LLLT could reduce duration of oral mucositis, decreased the risk of secondary infection, and accelerated return to normal nutrition. 

Evaluating the Effect of the Different Diabetic Control’s Methods Including Tight Control on the Healing Response of Diabetic Foot Ulcer Treated with Low Level Laser Therapy (LLLT)

Soheila Mokmeli, Zahra Ayatollahzadeh Shirazi, Mahrokh Daemi, Fatemah Ayatollahzadehshirazi, Alireza Soosanabadi, Mitra Hajizadeh

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 18-25

INTRODUCTION: Low-level laser therapy (LLLT) is shown effective in healing diabetic foot ulcer when combined with conventional therapy. Since; Diabetes mellitus is a leading cause of impaired wound healing. The aim of this study is to determine the effect of different diabetic control’s methods on the healing response of diabetic foot ulcer in those patients treated with Low level laser therapy (LLLT), added to conventional therapy.

METHODS: This study contains 74 diabetic foot-ulcers which most of them prone to resistance to conventional therapy. Different stages of diabetic foot ulcers and ways of controlling blood glucose level are included in this study. There were 3 response groups; Group 1-Insulin receiving patients, most of them had a very tight blood glyceamic level profile controlling. Group 2- Non-insulin receiving or drug dependent patients, had a periodical blood glyceamic level profile with flatuance. Group 3- Mixed methods. Most of the patients in this group had tight blood glyceamic level profile controlling. The way to control blood glucose level should be according to the internist`s consult. The wounds irradiation are performed by the combination of infra-red and red, (860 nm and 650 nm) laser, with the total energy density of 3.6 J/cm² in addition of intravenous laser therapy (IVL) with 2.5 MW, 650 nm (red) laser used for 30 minutes. All wounds have been photographed from equal distance, before and after treatments, and all the wounds were staged by a surgeon who was neutral about the effects of the laser therapy. The surgeon’s judgment was established only by the visual assessments of the wounds. All the mathematical and statistical analysis is based on the descriptive statistics using the software package SPSS16.

CONCLUSION: LLLT promote the tissue repair process of diabetic foot ulcer. Healing response of the patients was not dependent on methods of controlling blood glucose level. Previously it was reported that tight control of diabetes containing continuous subcutaneous insulin infusion and others on split mixed doses promotes healing of diabetic foot lesions. In this study; we found interruption of LLLT in the treatment of diabetic wound; can give a very acceptable result even in the absence of tight controlling of glucose level. When the quantity presentations value of the mean blood glucose level distribution was on the range of 144- 275 mg/dl. In this multi-disciplinary method we achieved a remarkably shorter mean healing time of two months, compared with other reported studies with healing time of three to six months. 

Does Pimecrolimus Cream Enhance the Effect of Excimer Laser on Eyelid Vitiligo?

Behrooz Barikbin, Golsan Kardan, Maryam Yousefi, Hamideh Moravvej

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 26-29

INTRODUCTION: Vitiligo is a cutaneous disorder of pigmentation, for which, there are some proven modalities of treatment. In this study, we evaluated the efficacy of the addition of topical pimecrolimus to 308nm Excimer laser in reducing treatment duration and improving the response rate of eyelid vitiligo, compared with 308nm Excimer laser monotherapy.

METHODS: Fifty two symmetrically localized lesions of eyelid vitiligo in 26 patients were observed. Each of vitiliginous patches was treated with 308nm Excimer laser twice a week for a total of 30 sessions. Topical pimecrolimus 1% cream was applied to the patches of right eyelid(group A lesions) and eucerine cream as a placebo to the left side patches(group B lesions)twice daily, throughout the study. Photographs were taken at baseline, 6 and 15 weeks after starting the treatment.

RESULTS: Twenty two patients (44 lesions) completed the study. Repigmentation was appeared in all (100%) of groups A and B lesions. A 75% or more repigmentation was achieved in 17(78%) of group A versus 14 (64%) of group B lesions. The average number of sessions needed for the appearance of repigmentation was 8 for group A lesions and 12 for group. The repigmentaion of 50% or more in patients with disease duration of 2 years or less and those with more than 2 years duration ere 100% and 59.2%, respectively.

CONCLUSION: Repigmentation rate obtained by the combination therapy of eyelid vitiligo with 308nm Excimer laser and topical Pimecrolimus 1%cream is significantly higher, and obtained in fewer sessions in comparison with 308nm Excimer laser and placebo combination therapy. 

Review Article

Femtosecond Laser Versus Mechanical Microkeratome in Thin-Flap Laser in Situ Keratomileusis (Lasik) for Correction of Refractive Errors an Evidence-Based Effectiveness and Cost Analysis

Ali Mostafaie, Alireza Mahboub Ahari, Fatemeh Sadeghi Ghyassi, Sakineh Hajebrahimi, Mahmoud Yousefi

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 6-11

INTRODUCTION: To compare the efficacy and cost-effectiveness of Femtosecond laser versus mechanical Microkeratome corneal flap creation in correction of refractive errors.

METHODS: I this review, a comprehensive search of Medline, SCOPUS, Cochrane, TRIP database, supplemented by HTA and economic databases was performed. We searched for randomized controlled trials (RCTs) of Femtosecond laser which included mechanical Microkeratome in other arm. The quality of the retrieved studies was appraised by two independent reviewers and appropriate articles were finalized.

RESULTS: A total of 1142 articles were identified, of which, 1059 were excluded after review of the titles and abstracts and 83 articles remained. Systematic reviews and RCTs were evaluated through CASP international worksheet. Eventually, 61 titles were excluded, leaving 22 articles to be reviewed.

Safety: There was no individual evidence to cover all safety components about Femtosecond laser, but in summary, this modality seems a safe method for corneal flap creation.

Effectiveness: No statistically significant difference was shown in visual acuity and refractive errors. The important secondary end point of this review was diffuse Lamellar keratitis in 17% of the femtosecond group versus 5% in mechanical Microkeratome. Inflammation was low-grade and improved during the first 3 months of follow-up period with a low dose medication without corneal scarring. The two groups was comparable in all clinical outcomes including Unorrected Visual Acuity (UCVA), Best Special Corrected Visual Acuity (BSCVA), manifest refraction, wave front aberrometry, Schirmer test, and Tear Break up time (TBUT).

Cost Analysis: Results showed that marginal cost incurred due to Femtosecond technology adoption may vary from 27 to 117 € (resulted from sensitivity analysis). It is clear that additional cost may be a small proportion of LASIK procedure total cost.

CONCLUSION: Although Femtosecond flap creation is a modern method with a good quality of corneal flap, but, there is no high-quality evidence to show superiority of Femtosecond laser in clinical outcomes. Although the efficacy and cost of the systems is almost equal, traditional method still remains as the standard approach.


Nonablative Fractional Laser Resurfacing

Hamideh Moravvej, Behrooz Barikbin, Seyed Alireza Ghavam, Soheil Karimi

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 30-35

The desire to achieve cosmetic rejuvenation and reduce effects of aging and photodamage urged scientists to develop effectual techniques which have minimal side effects and impressive long-term efficacy. Traditional ablative resurfacing laser therapy has been used for several years;however, it has harmful side effects on the patient’s skin such as dyspigmentation, persistent erythema, infections, acneiform eruptions and scarring. It also prolongs downtime, so it puts a significant burden on society. Nonablative resurfacing laser therapy declines side effects of traditional therapies, although it has lower effectiveness in comparison with ablative one.Nonablative fractional resurfacing laser therapy commenced a modern technique which diminished side effects, while maintains the efficacy of traditional methods. The aim of of this current review is to sum up nonablative fractional laser therapies used for skin photorejuvenation at the past and present time and to evaluate the indications,advantages and classification of it and non-fractional resurfacing laser therapy

Holmium Laser Prostate Enucleation (HOLEP) Versus Trans-Urethral Resection of Prostate (TURP) in Treatment of Symptomatic Prostatic Enlargement;A Health Technology Assessment

Sakineh Hajebrahimi, Alireza Mahboub Ahari, Fatemeh Sadeghi Ghyassi, Ali Mostafaie, Mahmoud Yousefi

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 36-42

INTRODUCTION: Our aim was to compare the cost effectiveness of holmium laser prostate enucleation (HOLEP) versus trans-urethral resection of prostate.

METHODS: We searched all available databases for any controlled trials comparing HOLEP and TURP from January 2000 to February 2009. Two independent reviewers studied and appraised the selected evidences. Then, effectiveness and cost effectiveness of HOLEP was evaluated.

RESULTS: We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality of evidence with limited sample sizes. Overall success rate of HOLEP was comparable with TURP; but, some secondary outcomes such as pick flow rate twelve months after the surgery was better in HOLEP. A comparison between the original costs and those obtained from sensitivity analysis showed that the cost parameters were sensitive to the number of the patients treated. Increasing the number of the patients from 200 to 300 changed the study’s results in favor of the new techniques.

CONCLUSION: Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation.Thus, utilization of these equipments will divide the costs between two groups of the services. In economic terms, these properties lower overhead costs and justify the purchasing of these equipments.

Case Report

Immediate Relief of TMJ Clicking Following Low Level Laser Therapy after Orthodontic Treatment A Case Report

Massoud Seifi, Elahe Vahid-Dastjerdi

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 43-45

INTRODUCTION:To determine efficacy of low level laser therapy for clicking temporomandibular joint (TMJ) with a diode laser following orthodontic treatment.

METHODS: Performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in a case of an orthodontic patient following the termination of treatment. Patient had a history of severe clicking before initiation of treatment protocol. Low level diode laser (wave length 808 nm, power 0.7 watt, Time 60 seconds), applied for the purpose of relieving the signs.

RESULTS:During the process of intervention and establishing the proper dental occlusion sign of temporomandibular joint dysfunction i.e. clicking reduced significantly (p<0.05) but remained at the lowest level from the perspective of frequency and severity index. Patient had no sign and symptom at the end of treatment. Clicking was reemerged in the retention period, i.e. after six months. Clinical signs disappeared immediately after the application of laser once (p<0.05) with no recurrence after four months follow up.

CONCLUSION:Low level laser therapy serves as an adjuvant to orthodontic treatment while establishing the proper occlusion of stomatognathic system has pivotal role in function and stability of outcome.

Retrograde Holmium- YAG Laser Endopyelotomy

Mohammad Reza Razzaghi, Abdolah Razi, Hooman Mokhtarpour, Mohammad Mohsen Mazloomfard, Behzad Lotfi

Journal of Lasers in Medical Sciences, Vol. 2 No. 1 (2011), 26 April 2011, Page 46-48

Endourologic pyeloplasty is being a substitute of open pyeloplasty in management of ureteropelvic junction obstruction. This procedure can be done in different manners like balloon dilation, cold knife and electrosurgical endoureterotomy, accucise and lasers.A 47 year old woman referred with history of previous open pyeloplasty. Hydronephrosis of right kidney with unremarkable T ½ was found in DTPA scan. A full-thickness lateral incision was done with holmium:YAG laser just below the right UPJ and carried through the stenotic segment until the renal pelvis was reached. Half-time of radioisotope excretion was 13 min for the right kidney in diuretic renogram 3 months following operation