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doi: 10.18282/jsd. 3.i1.143
EDITORIAL
Lase su ge y o eyelid ma gin umo s
Adam Kemeny-Beke
Depa men o Oph halmology, Facul y o Medicine, Uni e si y o Deb ecen, Deb ecen, Hunga y
Eyelid ma gin is one o he mos challenging ana omic
egions in he human body, and eyelid ma gin umo s
aise special di icul ies in he ield o pe iocula
su ge y based on ana omical, his ological and aes he ic
poin s o iew. Al hough manually pe o med su gical
excision is he i s line choice o emo e eyelid ma gin
umo s, p e iously, o la e, lase s ha e gained popula i y
wi h ega ds o eyelid umo s and especially eyelid ma gin
umo ex ac ion. The e is sca ce da a wi h espec o his
opic, and mos o hem a e case epo s.
Di e en ypes o lase appa a us emi ing di e en
ligh beams a e a ailable o pe io bi al lase su ge y, i.e.
a gon lase (A , 488–514 nm), e bium:y ium-aluminium-
ga ne lase (E :YAG, 2790–2940 nm), e bium:y ium-
scandium-gallium-ga ne lase (E :YSGG, 2790 nm), and
ca bon dioxide lase wi h an in a ed sou ce (CO2, 10,600
nm). Due o he in oduc ion o new-gene a ion echnical
inno a ions such as pencil-shaped hand pieces o new
wo king modes, nowadays lase he apy is one o he mos
widesp ead o ms o pe iocula su ge y.
The e a e h ee basic ypes o in e ac ion be ween
lase beam and issue: pho ocoagula ion, pho odis up ion,
and pho oabla ion[1]; he clinically mos u ilized o hese
is he las one. In he cou se o lase su ge y, a zone o
coagula i e nec osis called la e al he mal damage (LTD)
abu s he ea ed a ea. Gi en he ac ha he ex ension o
LTD plays an ou s anding ole in he aes he ic esul , he
p esence o possible side e ec s should diminish. In o de
o achie e a mo e p ecise abla ion zone, he lase pulse
du a ion should be dec eased o a pe iod sho e han he
he mal elaxa ion ime o so issues.
Al hough newly imp o ed lase se s ha e se e al
ad an ages o e classic app oaches, pe iocula lase
su ge y, especially lid ma gin lase su ge y, is no ee o
complica ions. Some special ea u es should be aken in o
conside a ion, p edominan ly ana omical and his ological
issues, umo localiza ion, and he p oximi y o he
nasolac imal d ainage sys em.
The main issue conce ning e e y ype o su ge y is he
ac ha p eope a i e diagnosis is he key poin , and in
cases whe e his is inco ec , addi ional ea men will be
necessa y.
Pe io bi al lase su ge y is high- anked in oph halmology
as i combines he ad an ages o lase su ge y achie ed in
de ma ology and aes he ic su ge y.[2-4] The e a e se e al
bene i s o lase s. adi ional excision including less
bleeding, issue des uc ion, minimal occu ence o
dysch omia, e c. Fu he mo e, he e is no pos ope a i e
edema and/o ecchymosis, and he e a e smalle amoun s
o g anula ion issue and, less equen ly, ewe unaes he ic
sca o ma ions. The lase sha pens excision, e apo a ion,
and ulgu a ion o issues, all while main aining hemos asis.
One o he bes ad an ages o lase su ge y o eyelid
ma gin umo s is i s ana omical aspec ; since he lase beam
keeps he ma gins in hei ana omical posi ion, en opion o
ec opion a e no o be eckoned wi h.
Al hough a mo e ex ensi e collagen sh inkage can
occu due o in ense hea compa ed o manually pe o med
su gical excision, i can be a oided by using app op ia e
ene gy luence[5]. T ea men should be s a ed wi h low
ene gy and hen inc eased, in o de o a oid he mal
damage.
Se e al ac o s may ha e an impac on he esul o
eyelid ma gin lase su ge y and some o hem may esul in
side e ec s.
Among he mos se e e ad e se e en s e e ed o
in he li e a u e conce ning pe iocula lase su ge y a e
se e e bu ns, co neal inju ies, o e en ocula pe o a ion.
A 0.3 % a e o co neal auma a e lowe eyelid lase
blepha oplas y was epo ed by he ASAPS/ASPRS Lase
Task Fo ce Su ey Summa y[6]. To a oid any co neal
damage, s ainless s eel, o me allic non- e lec i e in e nal
ocula shields a e highly ecommended in he pe io bi al
a eas; by using hese ma e ials, no de ec able al e a ions
in sli -lamp, pupilla y, o unduscopic e alua ions a e
pe io bi al lase i adia ion can be iden i ied. The ques ion
o in ec ion could be aised du ing pe iocula su ge y
as, o en, an unco e ed su ace is c ea ed du ing hese
p ocedu es. Di e en ypes o po en ial in ec ions, i.e.,
bac e ial, i al o ungal can occu in he pos ope a i e
pe iod a e pe iocula o eyelid lase su ge y. Besides
E :YAG lase s, CO2 lase s ha e become he cu en ool o
esu acing and hy idec omy. Since he a o emen ioned
p ocedu es ha e been ela ed o inc eased eco e y ime
mainly in pa ien s wi h da ke skin ypes, o minimize
hese impe ec ions o abla i e lase , an abla i e ac ional
pho o he molysis lase has been designed, which is able o
main ain he a o able clinical e icacy o he non-abla i e
CO2 lase .
Hype ophic o keloid sca o ma ion, e y hema, and
Lase su ge y o eyelid ma gin umo s
2 doi:10.18282/jsd. 3.i1.143
clinical mani es a ion o asodila ion ha e also been
epo ed in he li e a u e as some o he mos equen
side e ec s o pe iocula lase su ge y. Pigmen a ion
diso de s can also occu ollowing eyelid lase su ge y.
Hypopigmen a ion is mo e equen han pos -in lamma o y
hype pigmen a ion (PIH) a e lase ea men , as deep
he mal damage e adica es melanocy e popula ion and may
unmask a p e-exis ing i iligo. This symp om is called he
Koebne phenomenon. Some lase su geons ecommend
he use o 5- luo ou acil o ad ancing wound eco e y,
bu his ea men may inc ease he isk o pos -lase
hypopigmen a ion[7]. To educe hype - o hypopigmen a ion
e ec s, he su geon has o minimize he lase ene gy ou pu .
The e is a con o e sy abou wea ing occlusi e d essing
in he pos ope a i e pe iod; some au ho s ecommend i s
applica ion[2], howe e , o he s no e ha his is a isk ac o
o pos -lase su ge y’s bac e ial and ungal in ec ion[8].
To summa ize he cogni ion abou eyelid lase su ge y,
i has o be emphasized ha many pa ien s, who a e a aid
o adi ional su gical in e en ions, a e less sca ed o lase
su ge y, which is sa e, simple, as , and e icien . Lase
su ge y is a e y use ul skill no only in pe iocula su ge y
bu also in eyelid ma gin su ge y. In o de o minimize hei
unc ional and aes he ic complica ions, ho ough pa ien
selec ion, ca e ul and me iculous checkup, and adequa e
su geon aining a e absolu ely indispensable.
Re e ences
1. Thall EH. P inciples o lase s. In: Yano M, Duke JS (edi o s).
Oph halmology. London: Mosby; 1999. p. 2.5.1–2.5.6.
2. Ya es B, Que SK, D’Souza L, Suchecki J, Finch JJ. Lase
ea men o pe iocula skin condi ions. Clin De ma ol.
2015;33(2):197-206.
3. T elles MA, B ych a P, S anek J, Allones I, Al a ez J,
Koegle G, Luna R, Buil C. Lase echniques associa ed wi h
acial aes he ic and epa a i e su ge y. Facial Plas Su g.
2005;21(2):83-98.
4. Blanco G, Cla e o A, Sopa ka CN, Pa inely JR. Pe iocula
lase complica ions. Semin Plas Su g. 2007;21(1):74-9. doi:
10.1055/s-2007-967752.
5. Ful on JE J . Complica ions o lase esu acing: Me hods o
p e en ion and managemen . De ma ol Su g 1998; 24(1): 91–
99. doi: 10.1111/j.1524-4725.1998. b04059.x.
6. Ap elbe g DB. Summa y o he 1997 ASAPS/ASPRS
Lase Task Fo ce Su ey on lase esu acing and lase
blepha oplas y. Plas Recons Su g 1998; 101(2): 511–518.
doi.o g/10.1097/00006534-199802000-00043.
7. Pa k KY, Oh IY, Moon NJ, Seo SJ. T ea men o in ao bi al
da k ci cles in a opic de ma i is wi h a 2790-nm e bium:
y ium scandium gallium ga ne lase : A pilo s udy. J Cosme
Lase The 2013; 15(2): 102–106. doi.o g/10.3109/14764172.
2012.759236.
8. Nanni CA, Als e TS. Complica ions o ca bon dioxide
lase esu acing. An e alua ion o 500 pa ien s. De ma ol
Su g 1998; 24(3): 315–320. doi: 10.1111/j.1524-4725.1998.
b04161.x.
Keywo ds: Pe iocula lase su ge y; eyelid, ma gin; complica ion
Ci a ion: Kemeny-Beke A. Lase su ge y o eyelid ma gin umo s. J Su g De ma ol 2018; 3(1): 143. h p://dx.doi.o g/jsd.
3.i1.143.
Recei ed: 4 h Oc obe 2017; Published Online: 21s No embe 2017
*Co espondence o: Adam Kemeny–Beke, Depa men o Oph halmology, Facul y o Medicine, Uni e si y o Deb ecen,
Nagye dei k . 98, H-4032, Deb ecen, Hunga y; [email p o ec ed]