Laser surgery for eyelid margin tumors

Copy igh © 2018 Kemeny-Beke A. This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion-NonComme cial 4.0 In e na ional License (h p://c ea i ecommons.o g/licenses/by-nc/4.0/), pe mi ing all non-comme cial use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. 1 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]