OBJECTIVES:To systematically evaluate submissions to the CAPER database by analyzing procedural context, characteristics of reported adverse events (AEs), and provider involvement in order to identify patterns with potential implications for patient safety. METHODS:A retrospective review of all reports submitted to the CAPER database from March 2021 to August 2025 was conducted, categorizing cases by procedure type, reported AE, and provider involved. RESULTS:In total, 199 reports describing 298 AEs across 35 various cutaneous procedures were submitted to the CAPER registry from March 2021 to August 2025. Dermatologists performed 62% of reported procedures, while non-dermatologist physicians, non-physicians, and unknown providers accounted for 38%. Filler injections, ablative laser resurfacing, and non-ablative laser treatments were the most frequently reported procedures. Although dermatologists performed most procedures represented in the registry, 51% of reported AEs were associated with procedures performed by non-dermatology providers. Erythema and scarring were among the most frequently reported AEs, while rare but serious events, including vascular compromise and necrosis, were reported following injectable and energy-based procedures performed by a variety of provider types, including non-physicians. CONCLUSIONS:The CAPER registry provides valuable insight into AEs associated with cutaneous procedures and may help identify emerging safety concerns related to new devices or techniques. Broader engagement with AE reporting systems may inform best practices and improve patient safety, particularly as cutaneous procedures increasingly occur outside traditional clinical settings.
BACKGROUND:Prolonged postoperative air leak (PAL) after thoracic surgery remains a major cause of morbidity, extended hospital stays, and bronchopleural fistula. Existing intraoperative aerostasis assessment methods, including water submersion testing, iodine indicator instillation, and ventilator flowmetry, are subjective, anatomically restricted, or provide limited information about the precise location and magnitude of individual leaks. This experimental study evaluates a quantitative intraoperative aerostasis monitoring approach employing a laser photoacoustic leak detector with sulfur hexafluoride SF6 as a biologically inert trace gas marker, configured in a rabbit thoracotomy model. METHODS:Validation proceeded in two sequential phases. Bench-top experiments used a latex-balloon respiratory analogue ventilated under positive end-expiratory pressure conditions (PEEP 490-1500 Pa), with controlled microdefects introduced using a 26 G needle. Acute in vivo studies were conducted in a New Zealand White rabbit (3.2 kg) anesthetized with isoflurane and undergoing left-sided lateral thoracotomy with controlled visceral pleural and bronchial stump defects. SF6 was introduced into the ventilator circuit at 0.02 vol.% (1:5000 v/v). The laser photoacoustic leak detector probe (3 mm inner diameter) was hand-scanned across the operative field while photoacoustic signals were recorded continuously at 10 Hz. A mass-balance model tailored to rabbit ventilatory parameters was derived and experimentally validated to relate measured SF6 concentration to defect efflux rate. RESULTS:All 12 controlled defects (10 visceral pleural and 2 bronchial stump) were detected. During systematic scanning of the exposed lung surface, peak signal-to-background ratios ranged from 155:1 to 540:1 at 3-10 mm probe stand-off distance, with a median localization error of 2 mm (0-4 mm range) relative to the known defect sites. Calculated SF6 efflux rates agreed with theoretical predictions within 14%. Continuous ambient monitoring showed operative-field SF6 concentrations of 0.012-0.058 ppm, more than 13,000-fold below the occupational exposure limit. Introduction of 0.02 vol.% SF6 into the ventilator circuit produced no detectable changes in end-tidal carbon dioxide or ventilatory mechanics compared with baseline. CONCLUSIONS:In this rabbit thoracotomy model, laser photoacoustic SF6 leak detection is feasible, safe, and quantitatively reliable for intraoperative aerostasis assessment. The method offers high sensitivity and millimeter-scale spatial resolution when the operative field is systematically scanned, thereby complementing conventional aerostasis tests that rely on visual detection of air bubbles. These findings should be interpreted as proof-of-concept in an experimental setting. Further work is required to refine the human-machine interface, to assess performance in more complex operative fields and minimally invasive procedures, and to compare this approach with existing acoustic and gas-analysis techniques. The validated mass-balance framework provides a basis for scaling efflux-rate estimation to human ventilatory parameters and for future clinical studies linking intraoperative leak characteristics with PAL.
OBJECTIVE:To elucidate the relationship between immediate whitening (IW), vacuole formation, and melanosome disruption in in vivo human skin following picosecond laser irradiation and to establish a mechanistic basis for clinical endpoint selection in pigmented lesions. METHODS:A 755-nm picosecond laser was applied to in vivo normal human skin under varying irradiation conditions. IW responses were graded clinically. Histological analysis quantified vacuole number density and area, and electron microscopy assessed melanosome morphology. A melanosome disruption threshold fluence model was used to estimate fluence at the dermoepidermal junction (DEJ) and to validate the experimental irradiation conditions. Comparisons with a 755-nm nanosecond laser were performed under endpoint-matched and DEJ fluence-matched conditions. RESULTS:Vacuole area increased with the IW degree. Under slight IW, some vacuoles exceeded the cellular scale (defined by basal cell area), whereas under no IW, vacuoles remained below the cellular scale despite melanosome disruption. These findings indicate that the spatial scale of laser-induced immediate responses shifts from subcellular (no IW) to cellular levels (slight IW). Theoretical analysis confirmed that most irradiation settings exceeded the threshold for melanosome disruption. Compared with nanosecond lasers, picosecond lasers produced more spatially confined vacuole formation at matched IW levels, but larger vacuoles under DEJ fluence-matched conditions. CONCLUSION:IW reflects the spatial scale of picosecond laser-induced immediate responses and serves as a mechanistic indicator for disease-specific clinical endpoint selection. These findings provide a framework for optimizing and standardizing picosecond laser treatment parameters.
OBJECTIVES:Selective photothermolysis with Q-switched ruby laser (QsRL) is used for treatments of dermal melanocytosis. Acute widespread cutaneous manifestations associated with transient systemic effects have rarely been reported. MATERIALS AND METHODS:Patients who developed generalized erythema during QsRL treatment under general anesthesia were retrospectively identified and evaluated. RESULTS:During QsRL treatment, two infants with nevus of Ota and one infant with ectopic Mongolian spots developed generalized erythema. The erythema developed after the initiation of laser treatment rather than after induction of anesthesia. It occurred in non-laser-irradiated areas, including distant regions completely shielded from the laser. The erythema progressed rapidly, resembling an allergic reaction. However, the erythema subsided promptly after QsRL treatment. The borders were distinct without wheals, and reproducibility was observed. In some sessions, transient hypotension followed the erythema. Serum tryptase levels, measured in two infants, were below the cutoff values for anaphylaxis. CONCLUSION:Generalized erythema during QsRL treatment under general anesthesia appears to be transient but may be underrecognized. Laser therapy can induce inflammatory responses, and inflammation-mediated mechanism may contribute to the development of erythema; however, the underlying factors remain unclear.
OBJECTIVES:To systematically evaluate wavefront shaping (WFS) as a strategy for deep-tissue phototherapy, assessing progress and translational readiness across four clinically relevant dimensions. METHODS:Narrative review of three mainstream WFS strategies-feedback iterative optimization, transmission matrix (TM) measurement, and optical phase conjugation (OPC)-evaluated against the core requirements of phototherapy: penetration depth, energy deposition accuracy, dynamic stability, and clinical translation. RESULTS:Time-reversal of ultrasound-encoded (TRUE)-based WFS has achieved TRUE-based WFS has demonstrated focusing through approximately 2 mm of living brain tissue, substantially exceeding the approximately 1 mm limit of conventional optics. Peak-to-background ratios (PBR) exceeding 400 have been demonstrated with natural gradient optimization algorithms, and millisecond-scale system response times have been achieved with digital optical phase conjugation. However, no study has simultaneously demonstrated millisecond-scale correction and sustained, therapeutically effective, and safe light-dose delivery in a living model, and only one study has established a quantitative relationship between WFS optical optimization and a biophysical therapeutic endpoint. CONCLUSIONS:WFS demonstrates compelling optical capabilities that directly address the physical barriers limiting conventional phototherapy. Clinical translation requires a shift from optical demonstration to therapeutic validation, incorporating standardized preclinical protocols, absolute light-dose measurement at the target, and multidimensional biological endpoint assessment.
OBJECTIVES:This manuscript reviews studies on the use of pulsed dye laser (PDL) and intense pulsed light (IPL) for the treatment of cutaneous rosacea, with a focus on their emerging role in managing ocular rosacea. METHODS:A literature search was conducted using the PubMed database with the terms "rosacea and intense pulsed light", "ocular rosacea and intense pulsed light", "rosacea and pulsed dye laser", and "ocular rosacea and pulsed dye laser." Of the 81 initially identified articles, studies not in English and those published before 1999 were excluded to ensure relevance to modern laser technologies. Additionally, review articles and case reports with three or fewer patients were excluded due to limited generalizability and statistical robustness. RESULTS:After applying exclusion criteria, 20 articles remained. Studies consistently demonstrated significant improvement in erythema and telangiectasia following multiple sessions of PDL or IPL, with minimal differences between the two modalities. However, one study reported that IPL treatment was faster to administer. While IPL has been widely studied in ophthalmology for treating dry eye syndrome and meibomian gland dysfunction, it has also been shown to effectively alleviate ocular rosacea symptoms, reducing lid margin telangiectasia and improving meibum expressibility. CONCLUSIONS:PDL and IPL have demonstrated efficacy and safety in managing cutaneous rosacea, and IPL has also proven beneficial for ocular rosacea. These findings support the expanding role of laser and light-based therapies as effective treatment options for patients suffering from rosacea-related symptoms.
ABSTRACT Objectives To evaluate the visual outcomes of Nd:YAG laser posterior capsulotomy performed in the supine position under general anesthesia in children with visual axis opacification after cataract surgery. Materials and Methods A retrospective clinical case series of 13 eyes of 9 children with visual axis opacification following congenital, uveitic, or juvenile cataract surgery was conducted. All patients underwent Nd:YAG laser posterior capsulotomy in the supine position under general anesthesia at the Eye Clinic, University Medical Centre Ljubljana, between September 2019 and November 2025. Results Posterior capsulotomy was successfully performed in all 13 eyes. The median age at treatment was 9.1 years (range: 0.9–14 years) and the median follow‐up was 23.8 months (range: 2–60 months). Mean best corrected visual acuity (BCVA) improved from 0.85 ± 0.60 logMAR preoperatively to 0.64 ± 0.73 logMAR postoperatively ( p = 0.002). Three eyes (23%) required a secondary Nd:YAG capsulotomy due to recurrent VAO. Transient intraocular pressure elevation occurred in two eyes (15%) and resolved with topical treatment. No other complications were observed. Conclusions This study demonstrates the feasibility of performing Nd:YAG laser posterior capsulotomy under general anesthesia to manage VAO in children who are unable to undergo the procedure in the standard seated position.
OBJECTIVES:Paronychia is a common and often painful cutaneous adverse event of epidermal growth factor receptor inhibitor therapy that can impair function and quality of life. We report the first known case of amivantamab-associated paronychia successfully treated with 532-nm potassium-titanyl-phosphate laser. MATERIALS AND METHODS:A 67-year-old man with metastatic non-small cell lung cancer receiving amivantamab developed painful periungual inflammation with pyogenic granuloma-like changes involving multiple fingers and both great toes after failing multiple topical therapies. A representative lesion on the left fourth digit was selected for treatment and underwent two sessions of 532-nm KTP laser therapy. Treated and untreated digits were compared for clinical response. RESULTS:Following two treatment sessions, the treated digit demonstrated marked improvement in erythema, pain, and friability. Untreated digits remained inflamed and symptomatic, serving as a within-patient comparator. No adverse events were observed. CONCLUSION:Given its superficial vascular targeting mechanism and broad clinical availability, the 532-nm KTP laser may represent a practical and effective therapeutic option for refractory EGFRI-associated paronychia. To our knowledge, this is the first reported case of successful treatment of amivantamab-associated paronychia with a 532-nm KTP laser.
OBJECTIVES:Laser lithotripsy carries an inevitable risk of collateral tissue injury. This study compared the safety profiles of pulsed Holmium:YAG and Thulium:YAG lasers by examining their effects on soft tissue under laser settings relevant to lithotripsy, using ex vivo porcine kidney models. METHODS:Direct laser impacts were applied to porcine renal parenchyma and pelvis at constant fiber movements and clinical laser settings (0.2-3.5 J, 10-40 Hz, 2-40 W), with high-power extensions for the Thulium:YAG laser up to 80 W/200 Hz. From 560 histological sections, coagulation and cutting depths were measured and clustered. RESULTS:At equivalent power, the Thulium:YAG laser operated with longer pulses than Holmium:YAG, reducing pulse energy per time (pulse power ≤ 3362 vs. ≤ 7777 W). Holmium:YAG laser produced deeper lacerations up to 9.3 mm in renal parenchyma, compared to 5.0 mm with the Thulium:YAG laser. In renal pelvis, maximal cut depth was 3.6 mm with Holmium:YAG-twice as that observed with the Thulium:YAG. While pulse power was a primary determinant for soft tissue damage, high frequencies (100-200 Hz) did not elevate it. Cluster analysis identified laser-specific damage profiles: Thulium:YAG favored coagulative damage at limited depths, whereas Holmium:YAG induced deep lacerations with limited coagulation and tissue detachment. CONCLUSION:Soft tissue safety and complication risk depend on laser parameters and choice of technology. Reduced pulse powers maximize safety, instead pulse frequency seems safe to elevate for improved efficiency. At power levels beyond 20 W, Thulium:YAG benefited from longer pulses showing safer profiles, with shallower penetration and more reliable coagulation compared to Holmium:YAG.
OBJECTIVES:A novel open-angle glaucoma treatment procedure, femtosecond laser image-guided high-precision trabeculotomy (FLIGHT), non-invasively creates aqueous humor (AH) drainage channels from the anterior chamber (AC) to Schlemm's canal (SC) through the trabecular meshwork (TM). The channels decrease AH outflow resistance, thus decreasing intraocular pressure (IOP). The effect of the procedure greatly depends on the condition of the SC segment where the drainage channel ends. The purpose of this study was to develop a 3D finite element model (FEM) of the FLIGHT procedure in the case of resistive flow of the AH in the SC, including cases of segmental flow resulting from blocked or collapsed segments of the SC. METHODS:We adopted the 3D FEM of the intact glaucomatous eye, including drainage system parameters, from our previous paper to simulate the FLIGHT treatment in eyes with resistive and segmental flow in the SC. The TM, SC and collector channels (CCs) were modeled as porous materials, with assigned permeability, to approximate the outflow resistance found in these tissues in-vivo. The permeability of segments of the SC was varied to model resistive and segmental flow within the SC. The FLIGHT treatment was simulated by removing block-like pieces of the TM to create channels that connected the AC to the SC. The size and locations of collapsed segments of SC in the FEM were varied to investigate their impact on IOP reduction following simulated FLIGHT. RESULTS:The FEM simulation results showed that the IOP reduction was maximized when FLIGHT drainage channels were in "free flow" segments of SC. Conversely, channels connecting the AC to blocked or collapsed regions of SC had a significantly diminished effect on IOP reduction. However, this was mitigated by replacing a single drainage channel with multiple channels that bypass the TM in different locations, including "free flow" segments. CONCLUSIONS:The condition of SC distal to the FLIGHT drainage channels has a significant influence on IOP reduction. The importance of multiple drainage channels targeting more segments of the SC is highlighted to mitigate the effect of collapsed segments of the SC.
BACKGROUND:Staphylococcus aureus (S. aureus) is a major cause of skin, wound, and device-related infections. Blue light (405-470 nm), shows promise for treating this organism. However, the translatability, dosing parameters, safety, and effectiveness remain unclear, and no systematic review currently exists. OBJECTIVES:To evaluate the antimicrobial efficacy and safety of blue light therapy against S. aureus across experimental models. METHODS:All relevant in vitro, in vivo, and clinical studies were identified through systematic searches of PubMed, Embase, Web of Science, Cochrane Library, Scopus, and ClinicalTrials. gov. Studies evaluating blue light without exogenous photosensitizers reporting bacterial or clinical outcomes were included. Risk of bias was assessed using SYRCLE. This study was registered with PROSPERO (ID: CRD420251089518). RESULTS:A total of 33 articles met inclusion criteria: 20 planktonic models, 6 biofilm models, and 17 methicillin-resistant S. aureus (MRSA) specific outcomes. The predominant wavelength tested was 405 nm (87.9%). Blue light reduced bacterial burden across models, though results varied by dose and experimental conditions. Additionally, 57.6% of studies did not report statistical significance. CONCLUSIONS:Blue light demonstrates antimicrobial activity against S. aureus, including MRSA, but heterogeneity in study design and limited in vivo data restrict clinical translation. We propose a standardized set of 8 reported parameters for future blue light studies.
OBJECTIVES:To report the first case of Koebner phenomenon induced by picosecond laser treatment in a patient with psoriasis. We analyzed the clinical and histopathological features and discussed the possible mechanism by which the laser's photomechanical effect triggered the reaction. METHODS:A 58-year-old woman with well-controlled plaque psoriasis underwent 755-nm picosecond alexandrite laser treatment (pulse duration: 750 ps; fluence: 3.77 J/cm2; spot size: 3 mm) for seborrheic keratoses on the back and lower waist. Clinical, dermoscopic, and histopathological assessments were performed. RESULTS:One month after treatment, erythematous, scaly plaques emerged at the laser-irradiated sites. Clinical and dermoscopic findings were consistent with psoriasis. Histology confirmed psoriasiform changes, and immunohistochemistry demonstrated a T-cell-predominant infiltrate (CD3+) with dermal CD4+ predominance and epidermal CD8+ enrichment. Notably, no Koebner phenomenon was seen in coexisting melanocytic nevi. Lesions resolved after 4 weeks of topical corticosteroids, with no recurrence up to 4 months. CONCLUSIONS:To our knowledge, this is the first report of the Koebner phenomenon induced by picosecond laser therapy in a patient with psoriasis. Although picosecond lasers are known for minimal thermal damage, their photomechanical effects may activate immune responses and trigger new psoriatic lesions. Therefore, caution and careful monitoring are advised when using picosecond lasers in patients with psoriasis.
OBJECTIVE:To evaluate the effects of antimicrobial photodynamic therapy (aPDT), systemic pharmacological therapy, and their combination on irradiated mandibular post-extraction bone repair relevant to osteoradionecrosis (ORN) development in a rat model. METHODS:Twenty-six male Wistar rats were initially randomized into five experimental groups: non-irradiated extraction control, irradiated extraction plus systemic pharmacological therapy, irradiated extraction plus combined systemic pharmacological therapy and aPDT, irradiated extraction plus aPDT alone, and irradiated extraction without post-extraction treatment. The model included a single 20 Gy focal irradiation dose to the left mandible, followed by the first mandibular molar extraction 10 days later. During the experiment, some animals were lost due to procedural causes unrelated to treatment, resulting in final group sizes of 5, 5, 3, 4, and 6, respectively. The results were evaluated by micro-computed tomography (p = 0.02), radiographic examinations, histopathological analysis, and assessment of hepatic steatosis. RESULTS:Irradiated untreated animals showed the most pronounced structural and histopathological alterations. All treatment protocols improved bone repair compared with the irradiated untreated group. However, the combined protocol consistently showed the most favorable structural, radiographic, and histological findings, with better preservation of bone architecture and more organized osteogenesis. CONCLUSIONS:aPDT combined with systemic pharmacological therapy may represent a promising multimodal strategy for irradiated mandibular bone injury relevant to ORN development.
BACKGROUND:Clinicians frequently use diode laser-assisted oral frenectomy to correct anatomical restrictions in the oral cavity as a minimally invasive alternative. However, evidence for its effect on wound healing and on reducing common postoperative complications remains unclear. This systematic review and meta-analysis aimed to evaluate the clinical efficacy of diode laser-assisted frenectomy compared with the conventional scalpel technique. METHODS:This review adheres to the PRISMA statement, and the protocol is registered in PROSPERO (CRD420251050170). A comprehensive electronic and manual search identified comparative studies of diode laser vs. scalpel frenectomy from January 2015 to December 2025. The analysis pooled the primary outcomes (postoperative discomfort, intraoperative hemorrhage, and wound healing) with 95% confidence intervals (CI) using a random-effects model. Heterogeneity assessment used the I2 statistic. Visual inspection of funnel-plot symmetry assessed publication bias. RESULTS:Fourteen studies met the inclusion criteria. The meta-analysis showed that the diode laser reduced postoperative pain on day 1 (SMD = -1.73; 95% CI: -2.70 to -0.77) and day 7 (SMD = -1.84; 95% CI: -2.78 to -0.90), compared with the scalpel. The diode laser also reduced intraoperative hemorrhage (SMD = -1.97; 95% CI: -2.89 to -1.05). Wound healing on day 7 did not differ significantly between groups. CONCLUSIONS:This meta-analysis indicates that diode laser-assisted frenectomy reduces postoperative pain, significantly. In addition, the laser group experienced less intraoperative hemorrhage and better wound healing at 7 day. Future clinical trials should standardize wound-healing indices, define uniform follow-up intervals, and incorporate cost-effectiveness analyses.
OBJECTIVES:This study aimed to evaluate the efficacy of photobiomodulation therapy (PBMT), therapeutic ultrasound (TUS), boric acid (BA), and their combinations in preventing experimentally induced intra-abdominal adhesions in rats. MATERIALS AND METHODS:Ninety-six male Wistar rats (14 weeks old) were randomly assigned to eight groups (Control, Laparotomy, Physiological Saline, BA, PBMT, TUS, BA + PBMT, and BA + TUS; n = 12/group). Adhesions were surgically induced. Treatments were applied once daily for 7 consecutive days as follows: BA (8 mg/kg, intraperitoneal), PBMT (904 nm, 3 J/cm2 applied to the incision site), and TUS (1 MHz, 0.5 W/cm2 applied to the incision site). On Day 8, rats were euthanized, and peritoneal fluid and adhesion tissue samples were collected for macroscopic scoring, histopathology, biochemical assays, and gene expression analyses. RESULTS:PBMT alone significantly reduced adhesion scores compared with the control (p < 0.05) and showed the most pronounced antifibrotic effect, while BA and TUS, alone or in combination, had limited impact. BA treatment increased malondialdehyde (MDA) levels (p < 0.05), indicating higher oxidative stress, whereas PBMT enhanced antioxidant enzyme activities, including superoxide dismutase (SOD) and catalase (CAT) (p < 0.05). Gene expression analysis revealed that PBMT modulated cytokines linked to inflammation, particularly tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1). CONCLUSION:PBMT demonstrated significant potential in reducing intra-abdominal adhesions by alleviating inflammation, controlling oxidative stress, and promoting tissue repair. BA and TUS showed limited efficacy under the present experimental conditions, and BA in particular was associated with increased oxidative stress and inflammatory responses. Further research with optimized dosing, extended treatment durations, and combination strategies is warranted.
