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One of the most frequently impacted locations by psoriasis is the scalp. It is seen in about 80% of psoriasis cases worldwide, and its treatment is challenging. To compare the efficacy and safety of excimer light versus topical methotrexate (MTX) 1% hydrogel in treatment of scalp psoriasis. This randomized prospective intra-patient comparative study was carried out on 30 patients with scalp psoriasis. Lesions were divided randomly into two areas: Area A and Area B. Area A received biweekly sessions of 308-nm excimer light and Area B received topical MTX 1% hydrogel once daily for 3 consecutive months. Psoriatic Scalp Severity Index (PSSI), itching score, patient satisfaction and dermoscopic red dots and white scales were used for assessment at the baseline, at the end of treatment protocol and 1 month after the last treatment session. Both treatment modalities induced significant improvement in PSSI, itching score and dermoscopic red dots and white scales (p < 0.001 for each). The mean percentage of improvement of PSSI was 75.82 ± 33.72 in Area A and 74.19 ± 31.64 in Area B with non-significant difference between both areas (p = 0.763). Moreover, the mean percentage reduction of itching score was 77.40 ± 24.61 in Area A and 67.67 ± 34.94 in Area B with non-significant difference between both areas (p = 0.430). Additionally, a notable improvement in dermoscopic red dots and white scales was observed in 83.3% of patients in Area A and in 60% in Area B at the end of treatment protocol with non-significant difference between both areas (p = 0.518) (p = 0.436). Marked patient satisfaction was noticed in both areas with non-significant difference between both areas (p = 0.433). 308-nm excimer light and topical MTX 1% hydrogel are equally safe and effective treatment options for scalp psoriasis with minimal side effects.

Excimer light was reported to be effective in treating alopecia areata (AA), as it induces T-cell apoptosis, however its combination with topical steroids in the management of AA still needs to be investigated. The study objectives were to determine the efficacy and safety of combining 308 nm–Excimer light and topical steroid versus either Excimer light or topical steroid alone in treating AA. Thirty AA patients were included, each patient had at least three patches, patches in each patient were randomly classified in to 3 groups. Group I patch: was treated by topical steroid only. Group II patch: was treated by Excimer light only. Group III patch: was treated by topical steroid and Excimer light. The response for hair growth was assessed at the baseline, week 8, week 12 then at 3months after the last session using a hair regrowth scale and trichoscopy. Any encountered adverse effects were recorded. All treatment groups showed significant improvement at the end of the study compared to the baseline, although hair regrowth was significantly better in group III where 60% of patches showed > 50% hair regrowth. All treatment groups showed significant decrease in black dots (BD) (trichoscopic sign of activity), and increase in signs of improvement (upright growing and pigtail hairs). However, BD and exclamation mark hair (EMH) were significantly reduced in the mixed therapy group compared to the other two groups. We concluded that excimer light is an effective and safe treatment option for AA, particularly when combined with topical steroid.

Background Vitiligo is a commonly acquired autoimmune pigmentary disorder. Some patients resist conventional treatments, leading to the search for combination therapies. Aims This study aimed to compare the efficacy of 308‐nm excimer laser monotherapy versus combined treatment with topical bimatoprost 0.03% in patients with facial vitiligo. Patients and Methods A single‐blind randomized clinical trial was conducted at Razi Hospital, Tehran, on 38 patients with facial vitiligo who had at least one facial vitiligo patch and had not undergone treatment in the past 3 months. The patients were randomly allocated to either the intervention group (n = 18) or the control group (n = 20). Both groups received 308‐nm EL therapy twice weekly for 15 weeks, while the intervention group additionally applied 0.03% bimatoprost solution daily. The patients were visited at the end of every 5 weeks and after the 15th week. Efficacy was evaluated using the scale for improvement assessment (SAI), visual analog scale satisfaction (VASS), and visual analog scale improvement (VASI). Data analysis was performed using the Mann–Whitney and t‐tests, with a significance level set at p < 0.05. Results Of the total patients, 27 (71.05%) were female and 11 (28.95%) were male. The male‐to‐female ratio was 50% in the intervention group and 33.33% in the control group. The mean VASI score, as the primary outcome, showed a significant increase over time in the intervention group (p ≤ 0.001), increasing from 4.53 to 7.20 (an increase of 2.67 units). Additionally, the intervention had a significant effect on the VASI outcome compared to the control (p ≤ 0.001; mean difference: 2.55 [1.63 to 3.47]). As the secondary outcomes, the mean VASS and SAI scores significantly decreased over time in the intervention group (p ≤ 0.05). The intervention also significantly affected the VASS and SAI outcomes compared to the control (p ≤ 0.001). The side effects of the intervention group were hypertrichosis in three patients and erythema burning in one patient. Conclusions Adding bimatoprost 0.03% to the treatment regimen may improve the outcomes of patients with facial vitiligo who are resistant to conventional treatments.

Background Research on evaluating the efficacy of non‐cultured epidermal cell suspension (NCECS) combined with excimer lamps for the treatment of vitiligo is currently unavailable. This research aims to evaluate the efficacy of this combination in treating vitiligo. Methods A prospective, controlled study was conducted from November 2021 to January 2024. Patients with stable vitiligo were randomly assigned into groups 1 (NCECS combined with excimer lamps) or 2 (NCECS alone). All patients were followed up 18 months after the procedure. Treatment effectiveness and adverse events were recorded. Results Sixty patients were randomly assigned to groups 1 (30 patients) and 2 (30 patients). A total of 33.3% of patients in group 1 achieved 100% repigmentation, significantly higher than the 6.7% in group 2 (p‐value = 0.021). Meanwhile, 63.3% of patients in group 1 achieved ≥ 90% repigmentation, higher than the 50% in group 2 but not statistically significant (p‐value = 0.435). The mean time to initial repigmentation in group 1 (2.35 ± 0.575 weeks) was significantly shorter than in group 2 (2.72 ± 0.665 weeks) (p‐value = 0.003). Both groups demonstrated a similar rate of good color match, but group 1 exhibited a lower incidence of the halo phenomenon. A total of 23.3% of patients in group 1 experienced mild erythema, which spontaneously resolved in a few days. Conclusions The combination of NCECS and excimer lamps can substantially stimulate the onset of repigmentation and enhance 100% repigmentation compared to NCECS monotherapy. Excimer lamps may reduce the incidence of the halo phenomenon.

Excimer laser coronary angioplasty (ELCA) in percutaneous coronary intervention (PCI) is safe and effective. However, thrombotic complications after ELCA occasionally occur. This study aimed to evaluate the impact of lipid-rich plaque in both in-stent restenosis (ISR) and de novo lesions on thrombus formation and transient no-reflow after ELCA. We conducted a single-center, retrospective, observational study including 27 lesions in 26 patients who underwent PCI with ELCA. Optical coherence tomography (OCT) was performed on all lesions before and immediately after ELCA. We measured the lipid angle per millimeter and lipid length of plaques with signal attenuation. We also recorded ELCA-induced thrombus formation and transient no-reflow. Thrombus formation and transient no-reflow were observed in nine (33%) and four lesions (15%), respectively. The frequency of ISR was significantly higher in the no-thrombus group than in the thrombus group. ISR lesions had a significantly lower lipid index (median [interquartile range] 108° [0°–756°] vs. 2541° [1205°–4336°]; p = 0.004) than de novo lesions. Among ISR lesions, those with ELCA-induced thrombus formation had a significantly higher lipid index (1370° [756°–4992°] vs. 29° [0°–285°]; p = 0.01) and significantly longer lipid length (8 mm [7–24 mm] vs. 0.5 mm [0–2.5 mm]; p = 0.01). The findings suggest that thrombus formation was more frequently observed in de novo lesions than in ISR lesions. OCT-detected lipid-rich plaques in ISR lesions were strongly associated with thrombus formation following ELCA.

PURPOSE: To compare refractive outcomes, higher order aberrations (HOAs), and the changes in contrast sensitivity after wavefront-guided femtosecond laser–assisted in situ keratomileusis (WFG LASIK) and optimized small incision lenticule extraction (SMILE) for moderate-to-high astigmatism correction. METHODS: This prospective, randomized study included 87 eyes: 40 eyes in the WFG LASIK group and 47 eyes in the SMILE group. Manual cyclotorsion compensation by marking the horizontal axis before SMILE surgery was used for optimized SMILE. Refractive diopter, aberrations, and contrast sensitivity were assessed 3 months postoperatively. The Alpins vector analysis method was used to analyze the astigmatic changes after surgery. RESULTS: There were no significant differences in the corrected distance visual acuity and refraction between the two groups after surgery. The fitted curve of surgically induced astigmatism versus target induced astigmatism was described as y = 0.9905 x + 0.0009 in the WFG LASIK group and y = 0.9672 x + 0.0026 in the SMILE group. The percentage of corneal astigmatism axis change within 5 degrees was statistically significant (chi-square test: 10.632, P = .001). HOAs increased in both the WFG LASIK and SMILE groups after surgery (t = −3.655, P = .001, t = −3.784, P = .001, respectively). However, comparison of the changes of HOAs between both groups was not significant (t = −0.565, P = .575). The improvement in contrast sensitivity in the WFG LASIK group was significantly higher than that in the SMILE group. CONCLUSIONS: WFG LASIK and optimized SMILE can achieve similar outcomes for astigmatism correction. Optimized SMILE with marking could achieve good astigmatism correction, even without an eye tracking system. [J Refract Surg. 2021;37(3):166–173.]

PURPOSE: To compare small incision lenticule extraction (SMILE) and femtosecond laser–assisted in situ keratomileusis (FS-LASIK) in terms of the predictability of central stromal thickness reduction in eyes with high myopia. METHODS: In this prospective, randomized contralateral eye trial, 42 patients received SMILE in one eye and FS-LASIK (using the Amaris 750S excimer laser [SCHWIND eye-tech-solutions]) in the fellow eye for the correction of high myopia (manifest refraction spherical equivalent: < −6.00 diopters). Spectral-domain optical coherence tomography was used to measure the central corneal and epithelial thickness. Pre-operative and postoperative values were compared to determine the amount of central stromal reduction achieved. RESULTS: At the 6-month follow-up visit, the amount of central stromal reduction was overestimated by 20.05 ± 5.92 µm in the SMILE group (P < .0001) and underestimated by 8.21 ± 8.14 µm in the FS-LASIK group (P < .0001). The mean actual central stromal reduction achieved with SMILE was significantly less than that achieved with FS-LASIK (10.10 ± 18.01 µm, range: 1.90 to 18.29 µm, P < .001). The discrepancy between the planned and achieved central corneal stromal reduction was not associated with refractive overcorrection or undercorrection in either the SMILE group or the FS-LASIK group (P = .9743 vs P = .0777). CONCLUSIONS: In patients with high myopia, the laser software platform may underestimate and overestimate the amount of actual corneal reduction in eyes treated with FS-LASIK and SMILE, respectively. SMILE required less corneal stroma compared to FS-LASIK in the studied cohort using the Amaris 750S excimer laser when correcting a similar spherical equivalent refraction. [J Refract Surg. 2022;38(2):90–97.]

PURPOSE: To compare the visual and refractive outcomes of femtosecond laser-assisted LASIK with small-incision lenticule extraction (SMILE) in terms of visual acuity, contrast sensitivity, aberrations, and dry eye. METHODS: A single-center prospective randomized study in which patients diagnosed as having myopia presenting for refractive correction were allocated to either a LASIK or SMILE group. The primary outcome measures were refractive efficacy, predictability, and safety, postoperative contrast sensitivity, aberrations, and dry eye status. Patients were followed up at days 1 and 15 and 3 months; postoperative uncorrected visual acuity (UCVA), aberrations, dry eye, and contrast sensitivity were recorded and compared to preoperative data. Two postoperative subjective questionnaires were used to assess pain, pricking sensation, redness, glare, and overall patient satisfaction. RESULTS: At day 1 postoperatively, 48 (96%) of 50 eyes in the SMILE group achieved a UCVA of 20/20 compared with 46 (92%) of 50 eyes in the LASIK group. At day 15 postoperatively, contrast sensitivity was similar in the two groups (At day 1 postoperatively, 48 (96%) of 50 eyes in the SMILE group achieved a UCVA of 20/20 compared with 46 (92%) of 50 eyes in the LASIK group. At day 15 postoperatively, contrast sensitivity was similar in the two groups ( P = .15), but by 3 months, it was better in the SMILE group than the LASIK group at all spatial frequencies ( P < .0001). At 3 months postoperatively, 42 (84%) eyes in each group achieved a UCVA of 20/20, with 6 (12%) eyes in the SMILE group and 2 (4%) eyes in the LASIK group achieving 20/15. Higher-order aberrations at 3 months postoperatively were significantly higher in the LASIK group (0.437 ± 0.103 µm) than in the SMILE group (0.267 ± 0.07 µm; P < .001). Postoperative dry eye and glare were significantly more common following LASIK ( P < .001). CONCLUSIONS: Three-month results demonstrate that refractive accuracy, dry eye, contrast, and induced aberrations are better following SMILE rather than LASIK. [[ J Refract Surg. 2014;30(9):590–596.]

There are few studies on excimer laser (308 nm) atherectomy in the treatment of infrapopliteal artery disease. The purpose of this retrospective clinical study was to assess the efficacy and safety of excimer laser atherectomy (ELA) in combination with adjuvant drug-coated balloon angioplasty (DCB) compared to DCB for infrapopliteal arterial revascularization in patients with ischemic diabetic foot. From September 2018 to February 2019, a total of 79 patients with diabetic foot were treated for infrapopliteal arterial revascularization at Tianjin First Central Hospital (Tianjin, China). In this project, 35 patients were treated with ELA combined with DCB angioplasty, and 44 patients were treated with DCB angioplasty. The patients’ baseline characteristics were similar between the 2 groups. The primary efficacy endpoints through 24 months were clinically driven target lesion revascularization (CD-TLR), wound healing rate, major amputation rate, and target vessel patency rate. The primary safety endpoint through 24 months was all-cause mortality. The primary efficacy results at 24 months of ELA + DCB versus DCB were CD-TLR of 14.3% versus 34.1% (p = 0.044), wound healing rate of 88.6% versus 65.9% (p = 0.019), target vessel patency rate of 80.0% versus 52.3% (p = 0.010), and major amputations rate of 5.7% versus 22.7% (p = 0.036). The safety signal at 24 months of all-cause mortality rate was 2.9% for ELA + DCB group and 4.5% for DCB group (p = 0.957). ELA combined with DCB angioplasty is more effective than DCB in the treatment of infrapopliteal artery disease in patients with ischemic diabetic foot, which can improve the wound healing rate and target vessel patency rate. There was no statistical difference in the safety results between the two groups.

Purpose To compare the corneal epithelial remodeling in eyes with high astigmatism that had small incision lenticule extraction (SMILE) and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK). Methods Seventy-four patients with myopic astigmatism of greater than −2.00 diopters (D) and little binocular difference in spherical equivalent were included in this contralateral comparative study. All patients received SMILE in one eye and FS-LASIK in the other eye randomly. The corneal epithelial remodeling pattern was mapped using the latest RTVue spectral-domain optical coherence tomographer (Optovue) by region. Results Satisfactory refractive correction was achieved in all enrolled eyes with either SMILE or FS-LASIK. The corneal epithelium gradually thickened following surgical cylinder correction, distributing mainly along the flat medium. The corneal epithelium proliferation is milder centrally but more pronounced in the mid-peripheral area after SMILE, compared with FS-LASIK. The flat-steep difference in corneal epithelial thickness (CET) is evident in the mid-peripheral and peripheral areas, which is more obvious in SMILE. Residual cylinder was positively correlated with CET in eyes that had FS-LASIK, but not SMILE. More importantly, these epithelial changes were positively correlated with the ablation depth and higher order aberrations following surgical refractive correction. Conclusions The postoperative CET map varied between SMILE and FS-LASIK. In eyes with high astigmatism, SMILE surgery is followed by milder and more stable corneal epithelial thickening. Moreover, the corneal epithelium is sensitive to stromal ablation and corneal remodeling is crucial to the postoperative visual quality. This study rigorously distinguished the CET difference between SMILE and FS-LASIK in astigmatic eyes and shed light on subsequent research. [J Refract Surg. 2024;40(10);e728–e741.]