【 文献重点摘要 】

Objective

The picosecond 755 nm alexandrite laser using a diffractive lens array has demonstrated consistent clinical efficacy for improving the appearance of acne scarring and wrinkles amongst other benefits. This small pilot study is to assess the difference, if any, in clinical benefit if a higher than the standard protocol for number of pulses delivered to a tissue area is used compared to the standard protocol guidelines.

Method

Seven subjects received treatment to one side of the face with a standard protocol number of laser pulses with the other side of the face receiving higher than standard number of pulses from the same 755 nm picosecond laser using an additional diffractive lens array. Photographs at final follow up were compared to baseline by two blinded Board Certified Dermatologists and assessed for improvements to acne scarring using a 6-point grading score, for wrinkles using the Fitzpatrick Wrinkle & Elastosis 3-point grading scale and a Global Aesthetic Improvement Scale assessment. Subjects also completed a satisfaction questionnaire.

Results

For the acne scarring subjects, the average improvement from baseline to final follow up was 4.0+/-1.0 for the standard treated side and 4.5+/-0.5 for the high pulse side. There was no statistically significant difference between the two treated sides (P>0.05, n=3 paired t-test). For the wrinkle subjects, the average grading of the standard pulse side improved from 2.0+/-0.82 to 1.75+/-1.0 from baseline to final follow-up. The high pulse side improved from 1.5+/-1.0 to 1.125+/-0.25 from baseline to final follow-up. There was no statistically significant difference between the improvement of the standard and high pulse treatment sides (P>0.05, n=4 paired t-test). The comparison of baseline to final follow-up images of each subject found both sides to be Much or Very Much improved with no statistically significant difference between the standard and high pulse sides (P>0.05, n=7 paired t-test). Six of the seven subjects did not note any difference between the effect on different sides of the face and four of the seven rated their overall improvement after treatment as Good, three subjects as Reasonable and one subject with Slight Improvement. All subjects found the treatment comfortable and easy to tolerate and there was no increased incidence of side effects other than the mild occurrences typically observed for this type of treatment.

Conclusion

This is a small pilot study with limited subject numbers and further data is needed to be able to make firm conclusions of observed trends, which suggest that the use of higher than standard suggested protocol number of pulses with the diffractive lens array and the 755nm picosecond laser does not appear to offer any additional benefit over that that can already be achieved with the standard number of pulses, but also does not increase risk of detrimental post treatment effects either.

Keywords

Picosecond; non-ablative; facial rejuvenation; wrinkle; acne scarring; laser

目的

使用衍射透镜阵列的皮秒755 nm紫翠宝石激光在改善痤疮、疤痕和皱纹等方面显示出一致的临床疗效。这项小型先导性研究旨在评估与标准方案指南相比，如果使用比标准方案更高的传送到组织区域的脉冲数量的标准方案，在临床益处方面的差异(如果有的话)。

方法

7例受试者一侧接受标准方案数目的激光脉冲治疗，另一侧使用附加衍射透镜阵列接收高于标准数目的755 nm皮秒激光的脉冲。最后随访时的照片由两名盲人委员会认证皮肤科医生与基线进行比较，并使用6分分级评分评估痤疮疤痕的改善情况，使用Fitzpatrick皱纹和弹性增殖症3分分级量表和全球美学改善评分评估皱纹的改善情况。受试者还完成了一份满意度问卷。

结果

对于痤疮瘢痕形成的受试者，从基线到最终随访的平均改善，标准治疗侧为4.0+/-1.0，高脉冲侧为4.5+/-0.5。两治疗侧比较差异无统计学意义(P>0.05，n=3配对t检验)。对于有皱纹的受试者，从基线到最终随访，标准脉侧的平均评分从2.0+/-0.82提高到1.75+/-1.0。从基线到末次随访，高脉冲侧由1.5±-1.0改善到1.125+/-0.2 5。标准脉冲治疗侧与高脉冲治疗侧的改善差异无统计学意义(P>0.05，n=4配对t检验)。基线与最终随访图像比较，双侧均有明显或非常显著的改善，标准侧与高脉冲侧比较差异无统计学意义(P>0.05，n=7配对t检验)。七名受试者中有六名没有注意到对面部不同侧面的影响有任何差异，七名受试者中有四名将治疗后的总体改善评为良好，三名受试者为合理，一名受试者略有改善。所有受试者都发现这种治疗舒适且容易耐受，除了这种治疗通常观察到的轻微副作用外，并没有增加副作用的发生率。

结论

这是一项试验性的小型研究，受试者数量有限，还需要进一步的数据才能对观察到的趋势做出确切的结论，这表明使用高于标准建议脉冲数的衍射透镜阵列和755 nm皮秒激光似乎没有提供比使用标准脉冲数所能达到的任何额外好处，也不会增加有害的治疗后效应的风险。结果表明，对于衍射透镜阵列和755 nm皮秒激光，使用高于标准建议脉冲数的脉冲似乎没有提供任何额外的好处，也不会增加治疗后有害效果的风险。

关键词

皮秒；非消融；面部年轻化；皱纹；痤疮疤痕；激光