Surgical intervention with the laser is nothing unusual today. Ever since the cutting and welding tool from the plastics processing industry found its way into medicine in the eighties, its range of applications has steadily expanded. The laser is most frequently used in ophthalmology. But also in skin diseases or in urology is worked with laser.
Laser treatment - light and heat
In laser treatment, physicians and physicians use the conversion of light into heat in the tissue. The energy particles of light, the photons, are accelerated by the decay of an added noble gas. Depending on which gas is used, the wavelength of the generated light is very different and different types of tissue can be treated.
The gas argon, for example, is used in the argon laser to soil vessels, because it emits its energy particularly well to the red blood pigment hemoglobin. When treated with the CO2 laser tissue absorbs a lot of energy, so this laser can be cut very well and tissue removed.
The laser works particularly well in the field of eye diseases. Short-, long- or astigmatism can be treated well with a laser surgery, if the conventional corrections are not sufficient. The two most important procedures are Lasik ("laser in situ keratomileusis") and LasEK ("laser epithelial keratomileusis").
During treatment with the laser, the laser beam partially "grinds" the cornea, altering the refractive power. Although there is a higher risk of scarring, the LasIK method has high and sustained success rates of 70-80% at values down to -10 dioptres.
During the procedure, the cornea is marked and the eyeball is sucked in with a ring so that the eye sees nothing for a few seconds.
Then a very thin layer (lamella) is cut off with a fine planer and a small fabric web is left standing. The cut layer is folded down and the actual removal of the tissue inside the cornea with the excimer laser can begin.
Then the surfaces are rinsed well and sucked back the folded lamella of the cornea. Then follow eye drops, bandage or dressing lens. The procedure is described as almost painless and performed on an outpatient basis. The surgery lasts less than 15 minutes and is already checked 1-2 hours after the procedure.
In the first few days after, the eye should not be rubbed to avoid shifting the lamella. If you work in a very dusty environment, you have to do without it for 2 weeks after the operation. Basically, the new visual acuity must first stabilize; therefore you should do without driving for some time in the dark after the procedure.
The LasEK treatment is a little gentler than the LasIK method. Here, the outer, extremely thin layer of the cornea is replaced with alcohol and rolled aside, before being treated with the excimer laser as in LasIK. LasEK is mainly used in patients with thinner corneas. The complication rate of treatment is 1-4%. Only a few cases of laser eye perforation have become known worldwide.
The treatments are usually not paid by the health insurance. Retinal detachments can be successfully rewelded with the laser, new vessel growths in diabetic eye patients can be obliterated with the argon laser. In chronic progressive corneal diseases or systemic immune diseases, the laser is not used.
Psoriasis and venous problems
While laser treatment in ophthalmology is well established, an interesting new treatment option has been developed for patients with psoriasis using an excimer laser. The laser light is applied to the plaques of the affected skin; while the dosage is determined exactly. Since the light is selectively and selectively applied, the spread can be stopped immediately, a small area after a few treatments - usually less than 10 irradiations - be made to disappear.
Due to the laser's "aiming accuracy", unaffected parts of the body are spared. At the next visit - depending on the result - the doses are increased or reduced and thus adapted to the given healing. As a rule, one treatment per week is sufficient. In the initial period, up to two treatments per week are possible.
The treatment costs are between 100 and 200 euros per session, but are based on the size of the affected skin area and the dose of light to be applied. They are usually only taken over by private health insurance companies.
Aftercare is foresight
With the excimer laser technology, the aftercare of psoriasis is also possible. After the appropriate healing of psoriasis, the patient presents again at more or less regular intervals. Psoriasis does not occur at the beginning of a large area, but initially on small area. This means that flocks the size of a penny will appear in either healed areas or new locations.
If these foci are treated in a timely manner with a light UVB laser, the single irradiation is sufficient until the complete disappearance.
This makes it possible to perform a follow-up care by psoriasis accurate laser. Aftercare is provided in this case, so that long-term intervals are possible. Compared to the costs of initial treatment, the follow-up costs for aftercare are rather low at around 30 euros. An ineffective ointment therapy can be omitted, cortisone-containing preparations are not used.
Removal of spider veins - a still young process
Even spider veins, the very thin and finely branched superficial vein extensions, can be treated with laser beams. However, there are still not completely satisfactory results, so that in many cases must be treated several times. As lasers for the treatment of spider veins have not been used for very long, there is still a lack of experience.
Well established in angiology
In contrast, the use of lasers in angiology, so the vascular healing, quite common. Just by the gentle method to dissolve clots, they can be used well. In this case, in the context of angiography, the thin examination tube is extended with a laser head. The laser can then work precisely on site without damaging the surrounding tissue. Interventions with the Skapell are not necessary for this.
Use in urology
Also in urology, laser treatments are performed endoscopically. Smaller prostate enlargements can be treated by introducing a so-called "resectoscope" into the urethra. Even trapped ureteral stones or bladder stones are directly removed by the laser: The high-energy light pulses lead to a shock wave, which smashes the stones.
In addition, benign growths on the penis in the area of the glans can be removed with a CO2 laser. However, the treatment of prostate cancer is not possible. The application possibilities of modern lasers increase more and more, the devices are constantly improved and extended. The combination of modern imaging techniques, medical data processing and information technology leads to new procedures for laser treatments.
Whether and to what extent a laser treatment in individual diseases is possible and useful should be clarified with the attending physician.