ORLANDO - The fractional eCO2 laser appears to be an effective and safe tool for eyelid resurfacing, with quick re-epithelialization and resolution of erythema, according to a chart review of 28 patients.
Eyelid resurfacing with the Lutronic eCO2 laser holds several advantages over traditional CO2 laser resurfacing, said Dr. Woodward of Duke University Medical Center, Durham, N.C.
"Fractional eCO2 allows laser energy to heat tissue deep in the reticular dermis via microablative columns without removing all of the surface epithelium as traditional CO2 lasers did," she said in an interview. "The healing time is significantly reduced with fractional eCO2 in comparison to traditional resurfacing, which is an advantage for patients who want to return to work."
All of the 28 patients underwent eyelid resurfacing with the eCO2 laser. The study included patients with Fitzpatrick skin types I-IV, with the majority being II and III. Patients were randomly assigned to the 120-mcm spot size (17) or the 300-mcm spot size (11).
Twenty of the patients underwent a concurrent bilateral lower-lid transconjunctival blepharoplasty. They were instructed to use vinegar and Aquaphor for the first two postop days, followed by vinegar and a sunscreen with zinc until epithelialization.
Two physicians who were blinded to the clinic visits evaluated patient response by rating more than 260 photos, which were presented in random order from preoperative to 6 months postoperative. They rated erythema, rhytids, telangiectasias, and dyschromia. The study also included patient reports of overall satisfaction and dry eye.
Erythema was similar in both groups, peaking at 1 week (level of 2 on 4-point scale) and then decreasing sharply to 0.5 by 1 month and 0 by 6 months.
Patients in the 120-mcm group experienced epithelization in an average of 5.6 days; the 300-mcm group took 6.4 days.
Rhytids, rated on a 3-point scale, decreased from an average of 2.5 to 1 by 1 week, with no significant between-group difference. By 6 months, rhytids were an average of 1.7, with no difference between the groups.
Telangiectasias were low at baseline (0.25 on a 5-point scale) and remained unchanged by 6 months, with no between-group difference. There also was no difference in the occurrence of dry eye. Dyschromias improved from 1 to 0.5. Patient satisfaction was high in both groups, rising from 0 to 2.5 on a scale of 0-4 at 1 month and 3.5 at 6 months. Patient satisfaction for the eight patients who did not have blepharoplasty was very similar.
There was no ectropion, infection, herpetic outbreaks, or hypopigmentation. Two patients developed postinflammatory hyperpigmentation, which resolved with hydroquinone 4%.
"This is an exciting new treatment with high patient satisfaction that can be done in a single treatment under local anesthesia. Traditional CO2 resurfacing may tighten the skin and reduce more rhytids than fractional resurfacing, but with the eCO2 laser, a physician can use the 1-mm spot size to do a traditional resurfacing if indicated," Dr. Woodward said.
The laser used in the study is on loan from the manufacturer, Lutronic Inc. Neither Dr. Woodward nor any of her coinvestigators accept remuneration from the company.