Functional deficits resulting from laser-induced damage in the rat retina

MURIN: Multimodal Retinal Imaging and Navigated-laser-delivery for dynamic and longitudinal tracking of photodamage in murine models

Laser-induced photodamage is a robust method for investigating retinal pathologies in small animals. However, aiming of the photocoagulation laser is often limited by manual alignment and lacks real-time feedback on lesion location and severity. Here, we demonstrate a multimodality OCT and SLO ophthalmic imaging system with an image-guided scanning laser lesioning module optimized for the murine retina. The proposed system enables targeting of focal and extended area lesions under OCT guidance to benefit visualization of photodamage response and the precision and repeatability of laser lesion models of retinal injury.

Co-grafts of Human Embryonic Stem Cell Derived Retina Organoids and Retinal Pigment Epithelium for Retinal Reconstruction in Immunodeficient Retinal Degenerate Royal College of Surgeons Rats

End-stage age-related macular degeneration (AMD) and retinitis pigmentosa (RP) are two major retinal degenerative (RD) conditions that result in irreversible vision loss. Permanent eye damage can also occur in battlefields or due to accidents. This suggests there is an unmet need for developing effective strategies for treating permanent retinal damages. In previous studies, co-grafted sheets of fetal retina with its retinal pigment epithelium (RPE) have demonstrated vision improvement in rat retinal disease models and in patients, but this has not yet been attempted with stem-cell derived tissue. Here we demonstrate a cellular therapy for irreversible retinal eye injuries using a "total retina patch" consisting of retinal photoreceptor progenitor sheets and healthy RPE cells on an artificial Bruch's membrane (BM). For this, retina organoids (ROs) (cultured in suspension) and polarized RPE sheets (cultured on an ultrathin parylene substrate) were made into a co-graft using bio-adhesives [gelatin, growth factor-reduced matrigel, and medium viscosity (MVG) alginate]. In vivo transplantation experiments were conducted in immunodeficient Royal College of Surgeons (RCS) rats at advanced stages of retinal degeneration. Structural reconstruction of the severely damaged retina was observed based on histological assessments and optical coherence tomography (OCT) imaging. Visual functional assessments were conducted by optokinetic behavioral testing and superior colliculus electrophysiology. Long-term survival of the co-graft in the rat subretinal space and improvement in visual function were observed. Immunohistochemistry showed that co-grafts grew, generated new photoreceptors and developed neuronal processes that were integrated into the host retina. This novel approach can be considered as a new therapy for complete replacement of a degenerated retina.

Transient Increase and Delay of Multifocal Electroretinograms Following Laser Photocoagulations for Diabetic Macular Edema

Background: The acute physiological changes induced by focal retinal photocoagulation (PC) have been largely unexplored. Methods: This was a case-series study. We recorded multifocal electroretinograms (mfERGs) just before PC, and mfERGs were also recorded 5′, 15′, one hour, 24 h, and one week after the PCs. Transient changes of mfERGs were analyzed in eyes which underwent PCs to treat diabetic macular edema. The mfERGs recorded from the predominantly irradiated area and that from non-irradiated areas were analyzed separately. Results: Fifteen eyes of 15 patients were included in this study. The mfERGs elicited from non-irradiated areas did not change after PC, but the mfERGs elicited from the irradiated area changed with time; the amplitude was larger at 60′ than that before (p < 0.05) and at 5′ after PC (p < 0.01) and significantly smaller at 24 h and 1 week than that before and at 60′ after the PC (p < 0.01). The implicit time was significantly prolonged after PC. mfERG on irradiated area with the severe diabetic change was less altered after PCs. Conclusions: The transient increase in the amplitude at 60′ likely resulted from a biological amplification of partially damaged cells adjacent to the PC spots. The mfERGs manifested the dynamic alterations of the retinal function following PCs.

Effect of Intravitreal Bevacizumab Injection before Panretinal Photocoagulation on the Prevention of Macular Edema Aggravation in Proliferative Diabetic Retinopathy

Objective: To investigate the effects of intravitreal bevacizumab (IVB) injection before PRP on the prevention of macular edema (ME) in patients with PDR. Methods: This retrospective observational study included patients diagnosed with PDR treated by PRP with (combination group) or without (PRP alone group) preoperative IVB injection (1.25 mg/0.05 mL). The primary outcome measure was the change in the central macular thickness (CMT), while the secondary outcome measure was the change in visual acuity. Measurements were made before and at one, two, and three months after treatment. Results: In the PRP alone group, the mean baseline CMT of 277.8 μm increased to 290.4 μm at one month (p = 0.201) and 308.8 μm at two months (p = 0.002), followed by a decrease to 271.2 μm at three months (p = 0.437). In the combination group, the values at baseline and one, two, and three months after PRP were 322.9 μm, 295.4 μm (p = 0.002), 330.1 μm (p = 0.906), and 274.5 μm (p = 0.030), respectively. Visual acuity changes were comparable between the two groups at all time points. Conclusion: IVB injection before PRP leads to decreased CMT in comparison to CMT in patients with PRP alone.

Electroretinogram evaluation for the treatment of proliferative diabetic retinopathy by short-pulse pattern scanning laser panretinal photocoagulation

Panretinal photocoagulation (PRP) is a standard method for proliferative diabetic retinopathy (PDR) treatment. However, conventional PRP usually significantly damages the retinal structure and vision. Retinal pattern scanning laser (PASCAL) photocoagulation has emerged as a new technique with fewer complications for the treatment of retinal disorders. This study compares the therapeutic effects of short-pulse PASCAL to conventional single-spot PRP for PDR. Fifty-two PDR patients (104 eyes) were randomly assigned into a short-pulse PASCAL-PRP treatment (SP) group and a conventional PRP treatment (TP) group. The best corrected visual acuity (BCVA) and full-field flash electroretinogram (ERG) data were evaluated before and after the two treatments. The BCVA data between before and after the PRP treatments did not show any significant difference. After the PRP treatment, the b-wave amplitude (b-A) in the dark-adapted 3.0 ERG (p = 0.0005) and the amplitude in the light-adapted 3.0 flicker ERG (p = 0.009) were significantly higher in the SP group compared with that of the TP group. In addition, after the PRP treatment, the a-wave implicit time (a-T) of light-adapted 3.0 ERG prolonged significantly in the TP group compared to the SP group. Compared with the parameters before the treatments, the a-A and b-A under dark-adapted 3.0 ERG and the b-A under the light-adapted 3.0 ERG in both TP and SP groups after the treatments decreased significantly (p < 0.05). Short-pulse PASCAL-PRP significantly attenuated partial vision damage compared to conventional PRP, although it still caused limited retinal injury and mild reduction in retinal function. These findings suggest that short-pulse PASCAL-PRP is a promising technique for PDR treatment.

Exosomes derived from MSCs ameliorate retinal laser injury partially by inhibition of MCP-1

Although accumulated evidence supports the notion that mesenchymal stem cells (MSCs) act in a paracrine manner, the mechanisms are still not fully understood. Recently, MSC-derived exosomes (MSC-Exos), a type of microvesicle released from MSCs, were thought to carry functional proteins and RNAs to recipient cells and play therapeutic roles. In the present study, we intravitreally injected MSCs derived from either mouse adipose tissue or human umbilical cord, and their exosomes to observe and compare their functions in a mouse model of laser-induced retinal injury. We found that both MSCs and their exosomes reduced damage, inhibited apoptosis, and suppressed inflammatory responses to obtain better visual function to nearly the same extent in vivo. Obvious down-regulation of monocyte chemotactic protein (MCP)-1 in the retina was found after MSC-Exos injection. In vitro, MSC-Exos also down-regulated MCP-1 mRNA expression in primarily cultured retinal cells after thermal injury. It was further demonstrated that intravitreal injection of an MCP-1-neutralizing antibody promoted the recovery of retinal laser injury, whereas the therapeutic effect of exosomes was abolished when MSC-Exos and MCP-1 were administrated simultaneously. Collectively, these results suggest that MSC-Exos ameliorate laser-induced retinal injury partially through down-regulation of MCP-1.

Peripapillary nerve fiber layer thickness changes after macular photocoagulation for clinically significant diabetic macular edema

PURPOSE

To evaluate the effect of macular photocoagulation (MPC) on peripapillary nerve fiber layer (PNFL) thickness measurement in patients with clinically significant diabetic macular edema (CSME).

METHODS

This study was a prospective interventional case series. Patients with CSME underwent MPC. Optical coherence tomography (OCT) was used to measure the PNFL and central macular thicknesses before and 3 months after MPC.

RESULTS

Thirty-three eyes of 25 patients with a mean age of 59.4 ± 7.2 years were included. There was no statistically significant difference between pre- and post-MPC mean best corrected visual acuity (0.35 ± 0.29 and 0.40 ± 0.23 LogMAR, respectively, P = 0.2). Mean baseline and 3 months central macular subfield thickness was 305.9 ± 90.7 and 317.5 ± 112.4 microns, respectively (P = 0.1). Peripapillary nerve fiber layer thickness was 105.7 ± 10.0 before and 106.1 ± 9.9 three months after MPC (P = 0.7). No significant differences were found between pre and post MPC measurements in temporal, nasal, inferior and superior nerve fiber layer thickness in each quadrant around optic nerve head (P > 0.05).

CONCLUSIONS

Macular photocoagulation has no statistically significant effect on PNFL thickness measurements in patients with CSME.

Electroretinogram evaluation of equine eyes with extensive 'bullet-hole' fundic lesions

OBJECTIVE

To evaluate the impact of extensive bullet-hole nontapetal fundic lesions in horses on retinal function as measured by full-field electroretinography (ERG).

MATERIALS AND METHODS

Full-field ERG was performed on two horses with numerous bullet-hole lesions in the nontapetal fundus of both eyes. The ERG was first recorded from the eye with the more extensive lesions in response to a low-intensity light stimulus (0.03 cd s/m(2) ) that was given at times (T) T = 5, 10, 15, 20 min of dark adaptation. Consecutively, combined rod-cone response was evaluated bilaterally in response to high-intensity light stimulus (3 cd s/m(2) ), followed by cone function evaluation by flicker stimulus (3 cd s/m(2) at 30 Hz). Off-line analysis of the ERG recordings was then performed.

RESULTS

Despite extensive bullet-hole lesions in the nontapetal fundus bilaterally in both horses, retinal function as measured by ERG did not show any observable deficits. The b-wave amplitude of the full-field ERG increased continuously from 5 to 20 min of dark adaptation peaking at 446 μv and 377 μv for horse number 1 and 2, respectively. The b-wave amplitudes of the combined rod-cone response were OS- 459 μv and OD- 392 μv for horse number 1 and OS- 491 μv and OD- 608 μv for horse number 2. The amplitude of the flicker ERG for horse number 1 was OS- 86 μv and OD- 110 μv and for horse number 2, OS- 80 μv and OD- 74 μv.

CONCLUSIONS

Extensive bullet-hole chorioretinal lesions do not appear to compromise outer retinal function in these horses.

Nerve fiber layer thickness in eyes treated with red versus green laser in proliferative diabetic retinopathy: short-term results

PURPOSE

To evaluate changes of retinal nerve fiber layer (RNFL) thickness after panretinal photocoagulation (PRP) in red versus green laser-treated eyes.

PROCEDURE

This is a prospective, randomized, fellow-eye controlled clinical trial conducted on 60 eyes of 30 patients (mean age 52.3 ± 7.8 years; 57% male) with early- to high-risk proliferative diabetic retinopathy type II diabetes who received standard red or green laser treatment. Scanning laser polarimetry (GDx) was performed to evaluate RNFL thickness at baseline and at week 6.

RESULTS

Only 22 patients (44 eyes) could perform reliable GDx tests. At week 6 after PRP, the RNFL thickness increased by an average of 3.35 ± 9.18 µm (p = 0.02) and 2.08 ± 4.75 µm (p = 0.04) in the red and green laser groups, respectively. There was no significant correlation between changes in RNFL thickness and the number of laser burns, age, HbA1c or blood pressure. The difference in the change of the RNFL thickness between the red and green laser groups was not significant (p = 0.8).

CONCLUSION

Though RNFL thickness was increased significantly 6 weeks after PRP with red and green laser in comparison to baseline, there was no significant difference in RNFL thickness between red and green laser groups.

Intravitreal saline injection ameliorates laser-induced retinal damage in rats

PURPOSE

Injury to the central nervous system has been shown to trigger a physiologic response in the form of some degree of natural self-repair. This beneficial reaction may be boosted by appropriate preconditioning via a reversible injury to the retina. Here we report the ameliorative effect of intravitreal saline injection on laser-induced retinal damage.

METHODS

Standard argon laser lesions (514 and 544 nm, 200 μm, 0.1 W, 0.05 seconds) were induced in the eyes of 36 Dark Agouti pigmented rats and immediately followed by injection of saline either intravitreally (5 μL) or intravenously (0.5 mL). Lesions were evaluated histologically and morphometrically after 3, 20, and 60 days.

RESULTS

At all 3 time points, the eyes of rats injected intravitreally showed less laser-induced retinal cell loss (P < 0.05) and smaller lesion diameters (P < 0.05) than those of intravenously injected rats.

CONCLUSION

Intravitreal saline injection evidently has a neuroprotective effect on the rat retina. The mechanism of action of this effect should be further elucidated and its clinical applicability tested.

The potential neuroprotective effects of weekly treatment with glatiramer acetate in diabetic patients after panretinal photocoagulation

Purpose

Evaluation of the neuroprotective effect of weekly glatiramer acetate (GA) on retinal structure and function in diabetic patients who underwent panretinal photocoagulation (PRP).

Patients and methods

Patients with severe nonproliferative or early proliferative diabetic retinopathy and no previous laser treatment were randomly divided into two groups: (1) those who received four GA treatments and (2) those who received placebo treatment. The subcutaneous injections were administered 1 week prior to laser and weekly in the subsequent three sessions of PRP in both groups. All patients underwent a full ophthalmic examination (best-corrected logMAR visual acuity, slit lamp examination, applanation tonometry, fundus biomicroscopy and indirect fundus examination); functional examination (standard automated perimetry, electroretinography and frequency-doubling technology C-20 visual field) and anatomic examination (color photography, optical coherence tomography (OCT) and Heidelberg retinal tomography). The examinations were performed before the photocoagulation and repeated 1,3,6, and 12 months after treatment (in a double-masked manner). To compare the two groups, generalized estimating equation models were performed to account for the dependence between eyes of the same patient.

Results

Thirteen patients (23 eyes) were included in the study group and 13 patients (24 eyes) were included in the control group. OCT showed a statistically significant difference in retinal nerve fiber layer (RNFL) thickness in the inferior peripapillary region and average thickness with thinner measurements in the control group at 1-year post-PRP. Functional analysis demonstrated a difference between groups, but it did not reach statistical significance.

Conclusion

The results of this study suggest that weekly GA treatment has a potential neuro-protective effect on the RNFL following photocoagulation for diabetic retinopathy.

Development and recovery of laser-induced retinal lesion in rats

PURPOSE

Laser-induced retinal lesions undergo primary and secondary degeneration followed by a partial reduction of the lesion size. To evaluate treatment effects, detailed data regarding the changes of the lesion over time are essential. The purpose of the study is to describe the histologic changes in an argon laser-induced retinal lesion over a period of 60 days.

METHODS

Argon laser lesions were produced in retinas of pigmented rats. The lesions were examined by light microscopy 1 hour and 1, 2, 3, 20, and 60 days after the exposure.

RESULTS

The diameter of the lesion increased 24 hours after photocoagulation and then decreased by day 20. Most pyknotic nuclei seen in the outer nuclear layer 1 hour after lasering disappeared 3 days later. Remodeling began 3 days after lasering. By day 60, partial filling in of the empty area with sliding of adjacent nuclei was observed. Recovery was also seen in the other retinal layers.

CONCLUSION

The course of a laser-induced retinal lesion is gradual: the photoreceptors are damaged first and the damage then spreads to other layers and to the adjacent retina. By day 3, the damage spreading stops, and adjacent cells begin to fill in and remodel the area of the lesion.

High-resolution imaging of the human retina in vivo after scatter photocoagulation treatment using a semiautomated laser system

PURPOSE

To image the ultrastructural morphology of retinal laser effects and their healing response in vivo using spectral domain optical coherence tomography (SD-OCT).

DESIGN

Prospective, interventional study.

PARTICIPANTS

Ten patients undergoing panretinal photocoagulation for proliferative diabetic retinopathy.

METHODS

Panretinal photocoagulation (PRP) was performed using a semiautomated patterned scanning laser system providing a raster of effects with homogenous intensity. Retinal morphology and localization of effects owing to laser-tissue interaction were imaged at 1 day, 1 week, and at monthly intervals for 6 months. The characteristic, specific structural changes during the healing process were followed over time using an SD-OCT device (Spectralis OCT) allowing for high-resolution raster scanning of the entire lesion pattern with identification of identical retinal sites (tracking modality).

MAIN OUTCOME MEASURES

Retinal morphology and localization of effects of photocoagulation on SD-OCT images.

RESULTS

At day 1 after PRP, the photocoagulation effects were sharply delineated from the surrounding unaffected retina and all spots seemed to be identical in size and location. The area of tissue destruction was confined to the outer retinal layers, extending from the outer nuclear layer (ONL) to the retinal pigment epithelium (RPE). At 1 week, images showed a progressive loss of the affected outer retinal layers, namely, the ONL and the outer plexiform layer. Concomitant distortion of the inner nuclear and plexiform layers generated a pattern of "archways" between adjacent laser spots. The photoreceptor layers (PRL) seemed to be eliminated in the photocoagulated area, particularly at the borders of each lesion. The lesion center contained a condensed RPE and PRL segment. The ONL recovered partially, but the PRL inner and outer segments remained absent. During the long-term follow-up, RPE cells migrated to the center of the lesion, forming a hyperplastic scar.

CONCLUSIONS

The characteristic morphology of retinal photocoagulation effects in vivo and over time was identified for the first time in human eyes using SD-OCT. The OCT imaging demonstrated a well-defined reproducible area of destruction confined to the outer retinal layers. Healing proceeded as the condensation of the RPE and PRL in the lesion center.

Ameliorative effect of PN-277 on laser-induced retinal damage

BACKGROUND

The retinal damage induced by laser photocoagulation increases considerably by the secondary degeneration process whereby tissues adjacent to the primary lesion are destroyed. As the neuroprotective effect of immunization by PN-277 was previously demonstrated in models of retina, optic nerve, brain, and spinal cord lesions, it may be used also for reducing retinal damage induced by laser. The aim of this study was to evaluate the neuroprotective effect of immunization with PN-277 in reducing the spread of laser-induced retinal damage.

METHODS

Standard argon laser lesions were created in 36 DA pigmented rats. Seven days before exposure to laser, the rats were divided into a test group (n = 18) that was pre-immunized with intraperitoneal injection of PN-277 and control group (n = 18) treated with saline. Histological and morphometrical evaluations of the retinal lesions were preformed 3, 20, and 60 days after the injury.

RESULTS

Significant ameliorative effect was demonstrated in the retinas of the pre-immunized animals 60 days after exposure to laser. The diameter of the lesion was 356 microm as compared with 406 microm (P < 0.01), the cell density of the photoreceptor cell bodies measured in the whole lesion was 72.4% of normal as compared with 64.5% (P = 0.01), and at the center of the lesion it was 57.3% of normal as compared with 38.2% (P < 0.01) (treated and control groups, respectively).

CONCLUSIONS

Immunization with PN-277 has an ameliorative effect in neural tissue such as the retina. This type of immunization may be of clinical significance in reducing laser-induced retinal injuries in humans.

The spatial resolution of the porcine multifocal electroretinogram for detection of laser-induced retinal lesions

PURPOSE

This study aimed to investigate the spatial resolution of a porcine multifocal electroretinogram (mfERG) protocol by testing its ability to detect laser-induced retinal lesions. Furthermore, we wanted to describe time-dependent changes in implicit time and amplitude of the different mfERG peaks after laser-induced retinal damage.

METHODS

Three pigs underwent a three-port pars plana vitrectomy, followed by laser photocoagulation of different lesion sizes within the visual streak. In an additional six non-vitrectomized pigs, we studied changes in mfERG signals with time after a uniform laser photocoagulation within the visual streak. The animals were evaluated with mfERG 1 and 6 weeks after treatment. After the last mfERG examination, selected eyes were processed for histological examination.

RESULTS

The size of the smallest lesion detected was approximately 1/4 of the longest diameter of the optic disc (LDOD) measured in pixels. When analysing the uniform lesions we found that signals deriving from the centre of the laser lesions were characterized by a significant reduction in the amplitude of all three peaks after 1 week of observation. After 6 weeks, the amplitudes of P1 and N2 were still significantly reduced. The implicit times were unaffected by laser treatment in the acute phase. After 6 weeks only P1 was significantly delayed.

CONCLUSION

We have determined the spatial resolution of the mfERG in the porcine retina to be smaller than or equal to the area of two adjacent hexagons, corresponding to a width of approximately 288 pixels or 1.2 mm. Laser lesions of uniform size resulted in a significant reduction of the amplitudes 1 and 6 weeks after treatment.

Retina remodeling following diode laser

BACKGROUND

The purpose of this study was to characterize the sequential development of focal and surround retinal injury and repair following transscleral diode laser to rat retina.

METHODS

Transscleral laser photocoagulation of the retina was induced with a diode laser (DioPexy Probe, 810 nm, 200 mW, 2 seconds) in adult Long-Evans rats. The right eye of rats with survival times of 0 days (n = 4), 5 days (n = 6), 2 weeks (n = 4), 6 weeks (n = 6), and 12 weeks (n = 4) was studied. Using serial sections, detailed pathological changes in laser-treated and surrounding retinal and choroidal areas were compared with the control fellow eye.

RESULTS

Photocoagulation damage was limited to the retina, sparing Bruch's membrane, with minimal choroidal involvement in almost all cases (23/24 eyes). Following damage to the neural retina, the sequence of major remodeling processes was consistent and included inflammatory response, reparative changes, and formation of glial-vascular scar with neovascularization.

INTERPRETATION

This new laser model caused reproducible injury, inflammation, and scarring confined to the retina, and may be a tool to help test the effects of candidate neuroprotective/regenerative agents on retinal degeneration to prevent vision loss.

Microarray-based gene expression analysis during retinal maturation of albino rats

BACKGROUND

In recent years, the rat has become a commonly-used animal model for the study of retinal diseases. Similar to other tissues, the retina undergoes significant functional changes during maturation. Aiming to gain knowledge on additional aspects of retinal maturation, we performed gene expression and histological analyses of the rat retina during maturation.

METHODS

Rat retinas were dissected at three time points. Histological examination of the samples was performed, and the expression levels of retinal genes were evaluated using the rat whole-genome microarray system. Quantitative real-time PCR analysis was used to validate selected expression patterns. Various statistical and bioinformatic tools were used to identify differentially expressed genes.

RESULTS

The microarray analysis revealed a relatively high number of highly expressed non-annotated genes. We identified 603 differentially expressed genes, which were grouped into six clusters based on changes in expression levels during the first 20 weeks of life. A bioinformatic analysis of these clusters revealed sets of genes encoding proteins with functions that are likely to be relevant to retinal maturation (potassium, sodium, calcium, and chloride channels, synaptic vesicle transport, and axonogenesis). The histological analysis revealed a significant reduction of outer nuclear layer thickness and retinal ganglion cell number during maturation.

CONCLUSIONS

These data, taken together with our previously reported electrophysiological data, contribute to our understanding of the retinal maturation processes of this widely-used animal model.