Abstract:BackgroundThe aim of this study was to evaluate the color-changing effect and adverse effects after Nd: YAG laser application on the iris surface of rabbit eyes.Material/MethodsThe study was performed on right eyes of 12 pigmented rabbits. A laser device that produces frequency doubled 532 nm wavelength Nd: YAG laser with 900 μm spot diameter was used. The laser was applied in 3 sessions at 2-week intervals, at energy levels of 0.8 mJ in Group A and 1.5 mJ in Group B. Slit-lamp examinations and measurements of… Show more
“…The Crystal Q-switched Nd: Yag laser (532 nm) with 3–4 ns pulses is shown to achieve a perfect depigmentation of the anterior iris, as was suggested in other studies. However, these two previous publications refer to an experimental work in rabbits [ 21 ], and a single clinical case of heterochromia [ 22 ]. Therefore, our study is the first in the world to establish all the scientifically proven bases, in a large series of patients and with a long follow-up time of 9 years, the first 5 years to compare four different types of laser and the last 4 years performed only with 532 nm/3–4 ns Nd: Yag Laser.…”
Section: Discussionmentioning
confidence: 99%
“…Furthermore, in 2017, Yildirim et al published: “Evaluation of color-changing effect and complications after Nd: YAG laser application on iris surface”. An experimental study in rabbits, that confirmed good cosmetic results and safety [ 21 ], and also, in 2018, 1 year later, Basoglu et al [ 22 ] published: “The effect of SLT laser application on iris to treat sectorial heterochromia: A promising technique”. Fig.…”
Purpose
To evaluate photoablative cosmetic iridoplasty (PCI), and its efficacy, safety, predictability, and satisfaction with the 532 nm Crystal Q-switched Nd: Yag laser, with 3–4 ns pulses, for depigmentation of the anterior epithelium of the iris in cases of heterochromia, nevus, or cosmetic indications (eye color change).
Design
Prospective clinical study on efficacy, safety, predictability, and satisfaction.
Method
The selection of patients was carried out in healthy individuals, over 18 years of age, with iris heterochromia (congenital-7% or acquired, secondary to topical medication-1%, trauma-0.5% or surgery-0.25%), nevus-0.25% and cosmetic cases-91%. Data were collected independently by assistant optometrists and classified in database. Excel statistical program was used to perform a general descriptive study, calculation of correlation factors, and statistical significance analysis between quantitative variables (Student T Test). PCI was performed in 1176 eyes of 588 patients. The procedures were planned in 2–3 phases of 4 consecutive sessions spaced 4–6 months apart. The IRÎZ® (Eyecos®) scanner was used to evaluate the cases, with photography, optical coherence tomography, and pneumotonography modules, along with the following software programs: Predictor®, Simulator® 3D, Analyzer® and Planner® (Eyecos®).
Results
This study began in 2012, so far 9 years of follow-up, to compare and choose the most suitable among 4 types of lasers to perform cosmetic iridoplasty. Finally, after 5 years, the Crystal Q-switched Nd: Yag at double frequency (532 nm) with 3–4 ns pulses demonstrated the highest efficacy, safety and predictability, so since early 2017 only this equipment has been used. Significant differences were found after 5-year follow-up between 1064, 532, 577 and 532/3–4 ns p = 0.09172, 0.06377 and 0.10183. From 9 January 2017 to 28 February 2020, 1176 eyes have been treated in 588 patients, with a mean age of 33.7 years (SD = 9.68 years, range = 18–70 years). 46.2% were male, and 53.7% were female. The efficacy, as quantified with the Analyzer® comparison software, was nearly 87–95%. There were no significant differences in corrected vision (9 years total follow-up p = 0.78235; last 4 years FU p = 0.99999) and ocular pressure (9 years total FU p = 0.68251; last 4 years FU p = 0.63204) before and after the procedure. The only notable complications (25%) were delayed and brief iritis, which were self-limited with routine topical treatment. The predictability was 80–90%. In the lightest-colored eyes, turquoise blue colors were obtained as a rule, in varying brightness; and in the darkest ones, gray blue tones of varying lightness. The patients’ subjective satisfaction at the end of treatment was 95%.
Conclusion
After 9 years of uninterrupted follow-up, PCI has demonstrated a high effectiveness to selectively depigment superficial melanin of iris, with a high predictability and patient satisfaction, without remarkable long-term complications. Only for a week, appropriate pre- and postoperative medication was necessary to guarantee the absence of discomfort, thus confirming security. PCI is effective, safe, and predictable for the treatment of pigmentary disorders in the iris and for the elective cosmetic indications in eye color change.
“…The Crystal Q-switched Nd: Yag laser (532 nm) with 3–4 ns pulses is shown to achieve a perfect depigmentation of the anterior iris, as was suggested in other studies. However, these two previous publications refer to an experimental work in rabbits [ 21 ], and a single clinical case of heterochromia [ 22 ]. Therefore, our study is the first in the world to establish all the scientifically proven bases, in a large series of patients and with a long follow-up time of 9 years, the first 5 years to compare four different types of laser and the last 4 years performed only with 532 nm/3–4 ns Nd: Yag Laser.…”
Section: Discussionmentioning
confidence: 99%
“…Furthermore, in 2017, Yildirim et al published: “Evaluation of color-changing effect and complications after Nd: YAG laser application on iris surface”. An experimental study in rabbits, that confirmed good cosmetic results and safety [ 21 ], and also, in 2018, 1 year later, Basoglu et al [ 22 ] published: “The effect of SLT laser application on iris to treat sectorial heterochromia: A promising technique”. Fig.…”
Purpose
To evaluate photoablative cosmetic iridoplasty (PCI), and its efficacy, safety, predictability, and satisfaction with the 532 nm Crystal Q-switched Nd: Yag laser, with 3–4 ns pulses, for depigmentation of the anterior epithelium of the iris in cases of heterochromia, nevus, or cosmetic indications (eye color change).
Design
Prospective clinical study on efficacy, safety, predictability, and satisfaction.
Method
The selection of patients was carried out in healthy individuals, over 18 years of age, with iris heterochromia (congenital-7% or acquired, secondary to topical medication-1%, trauma-0.5% or surgery-0.25%), nevus-0.25% and cosmetic cases-91%. Data were collected independently by assistant optometrists and classified in database. Excel statistical program was used to perform a general descriptive study, calculation of correlation factors, and statistical significance analysis between quantitative variables (Student T Test). PCI was performed in 1176 eyes of 588 patients. The procedures were planned in 2–3 phases of 4 consecutive sessions spaced 4–6 months apart. The IRÎZ® (Eyecos®) scanner was used to evaluate the cases, with photography, optical coherence tomography, and pneumotonography modules, along with the following software programs: Predictor®, Simulator® 3D, Analyzer® and Planner® (Eyecos®).
Results
This study began in 2012, so far 9 years of follow-up, to compare and choose the most suitable among 4 types of lasers to perform cosmetic iridoplasty. Finally, after 5 years, the Crystal Q-switched Nd: Yag at double frequency (532 nm) with 3–4 ns pulses demonstrated the highest efficacy, safety and predictability, so since early 2017 only this equipment has been used. Significant differences were found after 5-year follow-up between 1064, 532, 577 and 532/3–4 ns p = 0.09172, 0.06377 and 0.10183. From 9 January 2017 to 28 February 2020, 1176 eyes have been treated in 588 patients, with a mean age of 33.7 years (SD = 9.68 years, range = 18–70 years). 46.2% were male, and 53.7% were female. The efficacy, as quantified with the Analyzer® comparison software, was nearly 87–95%. There were no significant differences in corrected vision (9 years total follow-up p = 0.78235; last 4 years FU p = 0.99999) and ocular pressure (9 years total FU p = 0.68251; last 4 years FU p = 0.63204) before and after the procedure. The only notable complications (25%) were delayed and brief iritis, which were self-limited with routine topical treatment. The predictability was 80–90%. In the lightest-colored eyes, turquoise blue colors were obtained as a rule, in varying brightness; and in the darkest ones, gray blue tones of varying lightness. The patients’ subjective satisfaction at the end of treatment was 95%.
Conclusion
After 9 years of uninterrupted follow-up, PCI has demonstrated a high effectiveness to selectively depigment superficial melanin of iris, with a high predictability and patient satisfaction, without remarkable long-term complications. Only for a week, appropriate pre- and postoperative medication was necessary to guarantee the absence of discomfort, thus confirming security. PCI is effective, safe, and predictable for the treatment of pigmentary disorders in the iris and for the elective cosmetic indications in eye color change.
“…The procedure uses a device mounted onto a slit-lamp biomicroscope that produces a frequency-doubled 532-nm wavelength neodymium: yttrium-aluminum-garnet (Nd:YAG) laser with different spot diameters. Yildrim et al [4] conducted an animal study using a 900-lm spot size: they applied 200 laser shots (A.R.C. Laser, Germany) in two groups of rabbits divided according to the energy levels (group A, 0.8 mJ; group B, 1.2 mJ) with a laser application time of 3 ns.…”
Section: Surgical Techniquesmentioning
confidence: 99%
“…The authors also observed ciliary injection and mild anterior chamber reaction in all groups on the first day, which became more prominent in group B and eventually disappeared after the first week. Nevertheless, they did not administer antiinflammatory treatment, and there was no hypopyon or prolonged anterior chamber reaction [4].…”
Section: Clinical Application Outcomes and Complicationsmentioning
confidence: 99%
“…Various surgical techniques have been proposed for the treatment of patients seeking an elective and permanent change of eye color. Keratopigmentation (KTP) [1][2][3] was comprehensively investigated before being introduced into clinical practice, but other techniques such as laser iris depigmentation, even if noting interesting results , have been used clinically even before there are relevant data in the literature [4][5][6]. Finally, cosmetic iris implants have been surrounded by growing malpractice controversy: even if not approved, they continue to be used in some countries, leading to tremendous complications [7][8][9][10].…”
An increasing number of people are seeking elective cosmetic change of eye color. We review the surgical techniques, outcomes and complications arising from the various existing surgical alternatives, including cosmetic iris implants-which based on the available evidence should be considered malpractice-as well as laser iris depigmentation and cosmetic keratopigmentation. Laser iris depigmentation has been used clinically for aesthetic purposes without receiving official approval or licensing. The technique can be performed in an outpatient clinic thanks to the use of neodymium: yttrium-aluminum-garnet (Nd:YAG) lasers, but scientific literature data about this treatment is very limited. Cosmetic iris implants are neither CE-marked nor Food and Drug Administration (FDA)-approved, and lead to severe complications arising from their placement including uveitis, hyphema, glaucoma, cataract, corneal endothelial damage and severe vision loss. Management of complications resulting from iris implants might require several surgical procedures, and the follow-up is difficult among these poorly informed patients. Keratopigmentation is the most extensively studied technique and had long been investigated before being introduced into clinical practice: already introduced centuries ago, it was recently developed, reporting adequate levels of safety and efficacy. The medium-and long-term cosmetic outcomes of keratopigmentation and patient satisfaction have been the subject of recent reports. The available level of evidence suggests that cosmetic keratopigmentation is the best evidencesupported surgical choice for patients seeking a permanent cosmetic eye color change. Still, additional investigation is needed to optimize the outcomes, minimize postoperative complications and further develop this and other new surgical alternatives such as laser procedures.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
