A Side-by-Side Comparative Study of 1064 nm Nd:YAG, 810 nm ...

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Dermatologic Surgery

Volume 28 Issue 3 Page 224 - March 2002

A Side-by-Side Comparative Study of 1064 nm Nd:YAG, 810 nm Diode and

755 nm andrite Lasers for Treatment of 0.3-3 mm Leg Veins

Sorin Eremia, MD* Cindy Li, DO, and Sanusi H. Umar, MD

background.Laser and intense pulsed light device treatments of leg

veins have generally yielded disappointing results. Use of longer

wavelengths, longer pulse widths, and better cooling devices have

recently sparked renewed interests in these methods.

objective.To prospectively compare, side by side, a 3-msec cryogen

spray-equipped 755 nm alexandrite, a sapphire window cooled super-

long-pulse 810 nm diode, and a variable pulse width, cryogen spray-

equipped 1064 nm Nd:YAG laser for the treatment of 0.3-3mm leg veins.

methods.Thirty female volunteers, skin types I-V, age 32-67 years

with comparable sets of leg veins were treated with the Nd:YAG laser

and either the diode laser, alexandrite laser, or both. In most

patients two to three sets of comparable sites were treated.

Treatment parameters varied with each laser and according to the size

of veins being treated. Patients were examined 1 week after each

treatment and at 1, 2, and 3 months after the last treatment. Pre-

and posttreatment 35mm photographs were taken. Improvement was judged

by two experienced physicians both visually on patients and by

comparison of pre- and posttreatment photographs. Results were graded

as percent resolution, in five groups, 0, 0-25, 25-50, 50-75, and 75-

100.

results.In the 22 patients completing the study, 36 leg vein sites

were treated with the Nd:YAG laser, 18 leg vein sites were treated

with the diode laser, and 12 leg vein sites were treated with the

alexandrite laser. Greater than 75 improvement was observed at 88 of

the Nd:YAG laser-treated sites, 29 of the diode laser-treated sites,

and 33 of the alexandrite laser-treated sites. Greater than 50

improvement was observed at 94 of the Nd:YAG laser-treated sites, 33

of the diode laser-treated sites, and 58 of the alexandrite laser-

treated sites. Less than 25 improvement was observed at 6 of the

Nd:YAG laser-treated sites, 39 of the diode laser-treated sites, and

33 of the alexandrite laser-treated sites. Pain during treatment was

variably perceived by patients, but occasionally sufficient for

patients to decline further treatment. Posttreatment purpura and

telangiectatic matting were a significant drawback for the

alexandrite laser. Transient hemosiderin pigmentation, as seen with

sclerotherapy, was common with larger vessels.

conclusion.The cryogen spray-equipped 1064 nm Nd:YAG laser was

remarkably effective and safe for the treatment of 0.3-3 mm leg

veins. The use of topical anesthesia may be needed for some patients.

The super-long-pulse 810 nm diode laser gave unpredictable results.

Additional refinements of fluence and pulse width could improve its

performance. The 3-msec, 755 nm alexandrite laser at fluences of 60-

70 J/cm2 and an 8 mm spot can be effective, but inflammatory

response, purpura, and matting limit its usefulness. Longer pulse

widths might decrease these problems. For leg vein treatment, the

1064 nm wavelength is very safe for type V skin, the 810 nm

wavelength at super-long pulse widths of 400-1000 msec is very safe

for type IV and marginal for type V skin, and the 755 nm wavelength

is limited to nontanned type I-III skin.