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Objective: To evaluate the efficacy and safety of holmium:YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium:YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% (88/93) in the upper ureter, 99% (134/135) in the mid ureter , and 99% (127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium:YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2weeks~17months (with an average of 6.8 month) follow up postoperatively revealed that the overall stone-free rate was 98% (343/349) and no ureteral stenosis was found. Conclusions: Holmium:YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid-lower levels of ureteral calculi.

We report 5 cases of pulmonary disease treated with Holmium:YAG laser through fibrous bronchoscope. 1 inflammatory granuloma was cured after three times of treatment. Compared with conventional methods such as electrocautery and microwave treatment, laser has the merit of good hemostasis effect and quick recovery of the operation area. The other 4 patients who were suffered late lung cancer received 3-7 times of palliative treatment. After the treatment, the tumor tissues become smaller variably, and tact were unobstructed, symptoms of tract- obstructed obviously alleviated. We think that laser treatment has some practical significance in alleviating tract blocking of pulmonary diseases of late stage, and therefore raise the life quality.

Holmium:YAG laser thermokeratoplasty corrects hyperopia (farsightedness) by producing small areas of corneal collagen shrinkage that cause the central cornea to bulge outward, increasing optical power. Collagen shrinkage is probably caused by laser-heated corneal water, but details of the shrinkage mechanism are not known. We investigated the shrinkage mechanism by measuring changes in corneal ultrastructure, surface shrinkage, water content, and strength following Ho:YAG laser exposures. Morphological changes in collagen were documented by measurements from electron micrographs. Corneal adhesive strength was determined by measuring tearing force in a plane parallel to the corneal surface. Laser-induced water loss was measured by weighing corneal samples before and after exposure. Corneal surface shrinkage was assessed by photographing the movement of particles on the cornea. Lasered collagen fibrils increased in diameter, lost their orderly arrangement, and appeared `frayed.' The corneal surface contracted toward lasered areas with a maximal shift of approximately 190 micrometers , more than could be explained by a model based on collagen fibril changes. Water loss plays a minor role in corneal shrinkage since corneal samples lost about only about 1.4% of their weight after massive laser exposure. Despite marked changes in collagen structure, corneal adhesive force was unchanged.

This in vitro study was undertaken to determine energy levels necessary to produce tubule closure and surface smoothing on dentinal surfaces of human teeth and their resultant temperature increases within the pulpal canals with the Holmium:YAG laser. An optimal working spot size and even absorption pattern were produced by defocusing the laser beam and evaluated by images produced on light exposed and developed photographic paper. The surface effects on dentin were examined by scanning electron microscopy. A thermocouple was positioned in the canals of fresh dissected dog jaws and attached to a recorder which produced a graph of the temperature changes. The in vitro research model for intrapulpal temperatures changes was verified by comparing premortem and postmortem temperature readings. The same protocol was used to evaluate temperature changes in fresh human extracted teeth. In vivo histological studies were conducted to evaluate the effects of HO:YAG laser energy on pulpal tissues. The results of these studies indicate the HO:YAG laser at a wavelength of 2.12 microns can be safely and effectively used for photoconditioning of the dentinal surfaces of teeth in clinical conditions.

We report effects of applying variable doses of Holmium:YAG laser energy to bovine articular cartilage in vitro. The response of the cartilage to the Holmium:YAG laser energy was determined by quantification of cell proliferation and extracellular matrix glycosaminoglycan synthesis. This study demonstrates that articular cartilage cell metabolism was maintained at a normal level following treatment of cartilage at a dose of 0.6 joules/pulse. The laser energy was applied at 10 Hz for 10 seconds at 1 mm distance from the cartilage. Under these conditions and at a dose of 0.6 joules/pulse, the total energy density was calculated to be 240 joules/cm2, assuming minimal loss of energy due to water absorption. Energy levels grater than 0.8 joules/pulse corresponding to calculated energy densities greater than 320 joules/cm2 proved harmful to cartilage. Our data demonstrate that low levels of Holmium:YAG laser energy can be applied to articular cartilage under conditions that maintain and/or stimulate cell metabolism.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The effects of Ho:YAG laser energy on articular cartilage and subchondral bone adjacent to traumatically created cartilage lesions in a continuous weight-bearing model were investigated. The 2.1 micrometers wavelength was delivered in hand-controlled contact and near-contact hard tissue arthroscopic surgery in a saline medium. Bilateral arthroscopy was performed on normal antebrachiocarpal and intercarpal joints of four adult horses. One-hundred twenty traumatic lesions were created on three weight-bearing articular surfaces with a knife, curette, or a motorized burr. Depths of the lesions were partial and full thickness. Configurations of the lesions were lacerations, scrapes, and craters. Left limbs were used as controls. Right limb lesions were treated with various intensities of laser energy. Animals were sacrificed at intervals of 1, 3, and 8 weeks. Gross microscopic anatomy was documented, and tissue sections were subjected to blind review by a pathologist. Mankin grading for cellularity and proteoglycan content was used to qualitatively evaluate cartilage response. Cartilage adjacent to all lesions exposed to laser energy had better cellularity and proteoglycan content than corresponding controls by Mankin grading.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

To date, 1201 symptomatic patients with significant coronary artery disease were treated with the mid IR holmium:YAG (2.1 micron) laser in a multicenter study. Updated results of this study, as presented herein, substantiate the important role of this laser in treatment of lesions not ideal for conventional balloon angioplasty. This device is a safe and effective means of coronary revascularization.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Pulsed Holmium:YAG (Ho:YAG) laser has been approved for some clinical applications and is under investigation for others. There is little published evidence on the durability or damage parameters for the fibers used in delivering energy from pulsed Ho:YAG laser. This study makes an initial attempt to investigate the damage threshold of different silica fibers under various conditions. Three types of fibers supplied by different manufacturers underwent laboratory testing. The overall finding of the study is that a new `perfect' fiber sustains no damage when fired without a target in air or in saline at energies up to 1.5 J/pulse and repetition rate up to 10 Hz. This study suggests that one may need to chose a fiber according to the clinical procedure to be performed: in cases where only soft tissue is to be manipulated - - any fiber may fare well, in cases where bone or calcified tissue is to be lased -- one may need fiber with aluminized or other hard coating. We also conclude that only professional refinishing with the removal of all exposed core-cladding material can insure trouble free performance.

We describe the results of a 30 patient Phase I clinical trial using the Laser Thermokeratoplasty (LTK) treatment for correction of hyperopic astigmatism. We report the results for 29 patients who have reached 2 months post-operative. The average pre-op cylinder was reduced from -3.06 Diopters (D) to -1.21 D. Average spherical equivalent (SE) refractive error was reduced from +2.28 to +1.34 D. Six patients have reached 4 months post-op; the average cylinder of these patients has been reduced from -1.92 to -0.79 D while the average SE has been reduced from +1.29 to +0.31 D. Although patients had varying degrees of astigmatism pre-op, all treatments were performed with identical parameters (intended to correct a small amount of astigmatism) to enable us to determine the effect of the procedure without the influence of other factors such as varying zone diameter or laser fluence. The predictability and stability of the LTK procedure are supported by a recent study of 20 patients treated in Germany by Seiler for low to moderate degrees (2 - 4 D) of hyperopia. After 6 months post-op, 16 of 20 patients are within +/- 1 D of the attempted correction. Longer-term follow-up will be necessary to determine the ultimate refractive stability of the LTK procedure.

Conventional balloon coronary angioplasty has limitations for application on particular lesions, such as lesions near the left main trunk (LMT), ostial location, and highly eccentric lesions. Hence, efficacy of newly developed Holmium YAG laser coronary angioplasty (HLCA) was assessed for 24 patients with angina. Adjunctive balloon angioplasty was performed for 21 of 24 lesions. Delivered energy ranged from 1.5 to 2.5 watts/pulse and the total exposure time ranged from 6 to 32 seconds. Laser success, defined as 20% reduction of stenotic ratio, was obtained in 16 of 24 (67%) and overall procedural success rate was 92%. Follow up coronary angiography after 3 months showed restenosis in 9 of 19 patients (47%). HLCA is an acutely effective treatment for lesions identified as not ideal for balloon angioplasty. However, angiographical restenosis rate is similar to the conventional balloon angioplasty and a highly calcified complex lesion may not be a candidate for the treatment of HLCA, because of a potential risk of coronary perforation.© (1993) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

We report on two clinical trials, one involving 10 patients in the United States and the other in Berlin, Germany with 15 patients, all treated for hyperopia with a new laser surgical procedure known as laser thermokeratoplasty (LTK). The procedure involves making a circular array of corneal coagulations using an Ho:YAG laser, fiber-optic handpiece, and contact focusing tip. The extent of steepening of central corneal curvature is controlled by the diameter of the treatment zone. The LTK procedure induces an immediate and significant reduction in hyperopic refractive error. Although the clinical investigations are at an early stage, results of the clinical trials indicate that the LTK procedure may prove to be a reliable means of effecting a permanent change in refraction in patients suffering from hyperopic refractive disorders.

We sought to compare the properties of cylindrical and ball tip fibers (in conjunction with a holmium:YAG laser) by examining both their beam characteristics and the characteristics of the channels formed when the fibers passed through myocardial tissue. We found that the cylindrical fiber tip was able to produce a wider, more uniform channel with less surrounding thermal damage than the ball tip fiber. We attribute these findings to the shorter focal length, smaller beam spot size, and greater beam divergence produced by the ball tip fiber.