Among the 35 included studies, 1 reported that the affected nails were filed to a thickness of 0.03 to 0.05 mm prior to laser treatment. In one study, subsequent hemorrhage occurred after treatment and subsided after 2 weeks.[14] After reducing the laser energy density, there was no evidence of bleeding.[14] Laser treatment with CO2 resulted in a larger wound on the nail deck and nail bed and the formation brown eschar, which can readily hemorrhage.[15] The majority of patients in the included studies reported experiencing a mild to moderate burning sensation during laser treatment, which was tolerable. There were no serious adverse reactions.
The meta-analysis performed in this study was conducted on data extracted from 35 articles, including 5 RCT studies, 1723 patients and 4278 diseased nails. The included studies did not show evidence of publication bias and the risk of selective reporting was determined as being low. The majority of the included studies were scored as being of medium quality or above. In general, the analysis revealed that the efficacy of laser treatment of onychomycosis was approximately 63%. In comparison, the mycological efficacy of itraconazole pulse therapy and continuous terbinafine therapy for the treatment of onychomycosis were 79.6% and 84.8%, respectively.[16] Thus, the overall efficacy of laser treatment was moderately lower than that of conventional oral drug treatments, but it produced less reported side effects, such as damage to the liver and kidney or gastrointestinal reactions.[17] Further, the data suggested that laser treatment appeared to be more suitable for certain population subgroups, such as children, the elderly and pregnant women.
The results of the present study have certain limitations: The methods employed in the included studies were heterogeneous. The subjects included in the studies also differed in basic characteristics such as age, duration of disease and duration of follow-up. Because of these differences, despite the present analysis more randomized controlled trials are needed to verify the findings regarding the efficacy of laser treatment for onychomycosis.
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