Photodynamic therapy for infected foot ulcers in people with diabetes mellitus: a systematic review

BACKGROUND

Ulceration of the feet in patients with diabetes is a frequent complication that increases morbidity, mortality, hospitalization, treatment costs, and non-traumatic amputations.

OBJECTIVE

To present a systematic review of the treatment of patients with diabetes mellitus and infected foot ulcers using photodynamic therapy.

DESIGN AND SETTING

A systematic review was performed in the postgraduate program in nursing at the Universidade da Integração Internacional da Lusofonia Afro-Brasileira, Ceará, Brazil.

METHODS

PubMed, CINAHL, Web of Science, EMBASE, Cochrane Library, Scopus, and LILACS databases were screened. The methodological quality, risk of bias, and quality of evidence of each study were assessed. Review Manager was used for the meta-analysis.

RESULTS

Four studies were included. They highlighted significantly better outcomes in patient groups treated with photodynamic therapy than those in the control groups that were treated with topical collagenase and chloramphenicol (P = 0.036), absorbent (P < 0.001), or dry covers (P = 0.002). Significant improvements were noted in terms of the microbial load in the ulcers and tissue repair, with a reported reduction in the need for amputation by up to 35 times. Photodynamic therapy resulted in significantly better outcomes between the experimental and control groups (P = 0.04).

CONCLUSION

Photodynamic therapy is significantly more effective in treating infected foot ulcers than standard therapies.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) - CRD42020214187, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214187.

Optic nerve head perfusion changes in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab or photocoagulation: a randomized controlled trial

Background

Proliferative diabetic retinopathy (PDR) is a serious sight-threatening disease, and half of the patients with high-risk PDR can develop legal blindness within 5 years, if left untreated. This study was aimed at comparing panretinal photocoagulation (PRP) and intravitreal ranibizumab injections in terms of radial peripapillary capillary (RPC) density on optical coherence tomography angiography (OCTA) in patients with treatment-naive PDR.

Methods

This open-label, prospective, randomized clinical trial included 50 patients with treatment-naive PDR with optic disc neovascularization and randomized them into two groups: group 1, with patients undergoing two sessions of PRP 2 weeks apart, and group 2, with patients received three intravitreal ranibizumab injections (0.5 mg) 1 month apart for 3 consecutive months. Patients underwent a full ophthalmological examination, including best-corrected distance visual acuity (BCDVA) measurement in the logarithm of minimal angle of resolution (logMAR) notation and OCTA before intervention and monthly after the last laser session or the first intravitreal ranibizumab injection for 3 months of follow-up. Visual field (VF) was tested at the beginning and end of 3 months.

Results

Forty-two (84%) eyes completed the 3-month follow-up, including 22 eyes in the PRP group (88%) and 20 (80%) eyes in the ranibizumab group. The two groups were comparable in terms of demographic characteristics, diabetes duration, baseline BCDVA, glycated hemoglobin level, OCTA parameters, VF indices, and intraocular pressure (all P > 0.05). The RPC density change from baseline to the 3-month follow-up was significantly lower in the PRP group than in the ranibizumab group (mean difference in RPC density change: - 3.61%; 95% confidence interval: - 5.57% to - 1.60%; P = 0.001). The median (interquartile range) logMAR change from baseline to the 3-month follow-up (0.0 [0.2]) was significantly higher in the PRP group than in the ranibizumab group (- 0.15 [0.3]; P < 0.05). The median changes in central foveal thickness from baseline to the 3-month follow-up differed significantly between the two groups (P = 0.001).

Conclusions

In eyes with PDR and neovascularization of the disc RPC density on OCTA increased in the ranibizumab group and decreased in the PRP group. Visual acuity gain was higher in the ranibizumab group than in the PRP group. Future multicenter trials addressing our limitations are required to verify the findings of this study.

A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration

Background

Vascular endothelial growth factor (VEGF) is a significant modulator of ocular angiogenesis, including that of neovascular age-related macular degeneration (nAMD). Intravitreal injection of anti-VEGF is the benchmark treatment for most retinal vascular diseases, including nAMD, diabetic maculopathy, and macular edema secondary to retinal venous occlusion. Anti-VEGF treatment is a high-frequency, time-consuming, non-cost-effective therapy, especially in countries and regions with limited resources. This treatment is easily restricted, and in practice, maintaining long-term periodic care is challenging for patients.

Hypothesis

Light peripheral panretinal photocoagulation (PPRP) is applied in a mild form (barely visible mild light gray mark) anterior to the equator so as not to jeopardize the visual field. PPRP lessens the ischemia that causes neovascularization and decreases the metabolic demand in the peripheral retina. PPRP reduces serum angiopoietin-2 and VEGF levels in patients with type 2 diabetes mellitus with proliferative diabetic retinopathy. We propose using light PPRP to suppress VEGF secretion, aiming to attenuate the VEGF drive and halt choroidal neovascular growth in eyes with nAMD. Our regimen is based on two concepts: first, nAMD is a diffuse or generalized disease that affects the posterior segment; and second, PPRP is very effective in regressing diabetic retinopathy. PPRP has reportedly been successful in cases of macular edema (diabetic or following venous occlusion) resistant to VEGF antagonists. Light PPRP may be used as prophylaxis, adjunctive treatment, or monotherapy in nAMD when intravitreal injections of VEGF antagonists are not feasible.

Conclusions

The established light PPRP therapy could be promising as a one-time, cost-effective therapy or prophylaxis in patients with nAMD or at high risk. This proposed modality could be suitable for patients who have injection phobia or prefer a one-time affordable therapy to the long-term monthly visits to retinologists. Future trials are necessary to verify the safety and efficacy of this proposed treatment modality in selected patients with nAMD.

Laser oromaxillofacial photobiomodulation therapy: molecular mechanisms, outcomes and considerations

Tweetable abstract Photobiomodulation therapy is largely characterized as a safe therapeutic model that can modulate the activity of inflammatory and immune biomarkers while facilitating a metabolic response that can regenerate damaged tissue.

[Laser Therapies for Onychomycosis in Japan]

Various treatment methods other than oral and topical antifungal medications have been employed to treat onychomycosis. Treatment methods include mechanical removal of the affected part of the nail plate by using a toenail cutter or grinder and chemical removal by using occlusive dressing therapy with salicylic acid plaster or urea cream. In recent years, laser therapies have received attention as modalities for treatment of onychomycosis. Favorable outcomes in patients with onychomycosis have been reported in Japan from treatment combining carbon dioxide laser and topical antifungal drug, treatment with photodynamic therapy, and treatment with Nd:YAG laser. However, irradiation conditions, number of irradiation sessions, and efficacy evaluation methods vary among institutions and studies; thus, there is no established evidence to support these outcomes. In addition, a study reported that a combination of Nd:YAG laser and external antifungal drugs was more effective than each of the treatments alone. Future studies are required to provide clinical evidence on the effectiveness of laser therapies, on the enhancement of effect from the combination of laser and external antifungal drugs, and on the possibility of shortening treatment duration using laser therapies in the management of patients with onychomycosis.

Tooth movement alterations by different low level laser protocols: a literature review

Low-Level Laser Therapy (LLLT) provides several benefits for patients receiving orthodontic treatment. According to some literatures, Orthodontic Tooth Movement (OTM) can be enhanced but some investigators have reported contradictory results. This article reviews the literature regarding the different aspects of the use of LLLT on OTM and its alterations. The general data regarding the study design, sample size, wavelength (nm), power (mW), and duration were extracted and recorded independently. Electronic databases of PubMed and ScienceDirect from January 2009 to August 2014 were searched. Also Google Scholar and grey literature was searched for relevant references. Some investigators found that the amount of tooth movement in the Low-Energy Laser Irradiation (LELI) group was significantly greater than in the nonirradiation group by the end of the experimental period. Low-level laser irradiation accelerates the bone remodeling process by stimulating osteoblastic and osteoclastic cell proliferation and function during orthodontic tooth movement. But some researchers have reported that no statistical differences in the mean rate of tooth movement were noted between low energy and high energy experimental sides and their controls. Some evidence shows that low-level laser irradiation accelerates the bone remodeling process and some evidence shows that LLLT has not effect on OTM. In some investigations no statistical differences in the mean rate of tooth movement can be seen between low energy and high energy experimental sides and their controls. It has been shown by authors that laser irradiation can reduce the amount of OTM and a clinical usage for the inhibitory role of low level laser irradiation is enforcing the anchorage unit.

Effectiveness of lasers in the treatment of dentin hypersensitivity

Dentin hypersensitivity (DH) is a relatively common painful condition among dental problems. Although many studies have been performed regarding the diagnosis and treatment of DH, dental practitioners are still confused about the definite diagnosis and treatment.The use of lasers as a treatment for dentin hypersensitivity was first introduced in 1985.Laser treatment in dentin hypersensitivity is an interesting and controversial issue and many investigations have been done on its mechanism of action, advantages, and unclear points.The present literature review tries to go over the definition, diagnosis, etiology , predisposing factors, various laser types in the treatment of DH alone or in combination with topical desensitizing agents. Since a certain treatment has not yet introduced for dentin hypersensitivity, a combination of laser therapy and topical desensitizing factors ,can increase the success of the treatment compared with either treatments alone.