LAUSR

Naevus of Ota is a blue-gray pigmentation of the sclera and adjacent skin caused by dermal melanocytes; it is common among Asian people. The use of laser therapy for treating cutaneous lesions of naevus of Ota has been established. However, therapy options for ocular lesions are limited. We have previously reported the potential efficacy and safety of laser treatments for pigmented ocular lesions such as naevus of Ota. This study aimed to validate the efficacy and safety of Q-switched Nd: YAG laser therapy for ocular lesions of naevus of Ota. Fifteen eyes from 13 patients were treated with Q-switched Nd: YAG laser, Tango (Ellex, Tokyo) in the selective laser trabeculoplasty mode (wavelength: 532 nm, diameter: 400 lm, laser irradiation time: 3 ns). Informed consent was obtained from all patients or their parents (for minors). We selected cases in which the patient received more than three treatments and underwent re-evaluation at least three times, because it was after three treatments that patients began to perceive definite improvement. Three male and 10 female patients (ages: 18–52 years; average: 32.8 years) were enrolled in the study. All cases involved cutaneous and ocular (scleral) lesions. The irradiation output was 0.8–1.5 mJ, and each treatment included 10–867 shots of irradiation. Improvements were evaluated objectively by an ophthalmologist by comparing before and after photographs; and subjectively by the patients at each treatment. Subjective and objective improvements were noted after a maximum of three treatments in all patients. Complete disappearance of the lesion was confirmed with slit-lamp examination in 12 eyes, and a substantial improvement was observed in the remaining three eyes. Conjunctival oedema and mild subconjunctival haemorrhage occurred in all cases. The oedema subsided in a few days, and the haemorrhage disappeared in 2 weeks. No uveitis was observed during the therapy, and steroid use was not needed in any patient. No patient complained of alteration in visual acuity. The patients were followed up for 0.9– 6.0 years (average: 3.1 years). All the patients were examined with slit-lamp microscopy, fundoscopy, and intraocular pressure measurement at every visit during the followup period; no patient showed any abnormality. No recurrence or serious complications were noted in the observation and follow-up period up to 3 years. Superficial lesions seemed to resolve, but deep lesions did not respond as well to the treatment and tended to leave persisting pale blue pigmentation. An 18-year-old Japanese woman presented with blue pigmentation on the sclera of the left eye (Fig. 1a); the cutaneous lesion had been previously treated. A clinical diagnosis of naevus of Ota was determined, and informed consent for laser therapy was obtained. She received 10 treatments at intervals of 3 months over 3 years (Fig. 1b). Each treatment involved an irradiation output of 1.3–1.5 mJ and included 252–867 shots. The patient had been worried about the possibility of pain and serious ocular complications from laser therapy.