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Sonntag SR, Hamann M, Seifert E, Grisanti S, Brinkmann R, Miura Y. Detection sensitivity of fluorescence lifetime imaging ophthalmoscopy for laser-induced selective damage of retinal pigment epithelium. Graefes Arch Clin Exp Ophthalmol 2024; 262:2885-2895. [PMID: 38587656 DOI: 10.1007/s00417-024-06449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
PURPOSE To investigate the sensitivity of fluorescence lifetime imaging ophthalmoscopy (FLIO) to detect retinal laser spots by comparative analysis with other imaging modalities. METHODS A diode laser with a wavelength of 514 nm was applied with pulse durations of 5.2, 12, 20, and 50 µs. The laser pulse energy was increased so that the visibility of the laser spot by slit-lamp fundus examination (SL) under the irradiator's observation covers from the subvisible to visible range immediately after irradiation. The irradiated areas were then examined by fundus color photography (FC), optical coherence tomography (OCT), fundus autofluorescence (AF), FLIO, and fluorescein angiography (FA). The visibility of a total of over 2200 laser spots was evaluated by two independent researchers, and effective dose (ED) 50 laser pulse energy values were calculated for each imaging modality and compared. RESULTS Among examined modalities, FA showed the lowest mean of ED50 energy value and SL the highest, that is, they had the highest and lowest sensitivity to detect retinal pigment epithalium (RPE)-selective laser spots, respectively. FLIO also detected spots significantly more sensitively than SL at most laser pulse durations and was not significantly inferior to FA. AF was also often more sensitive than SL, but the difference was slightly less significant than FLIO. CONCLUSION Considering its high sensitivity in detecting laser spots and previously reported potential of indicating local wound healing and metabolic changes around laser spots, FLIO may be useful as a non-invasive monitoring tool during and after minimally invasive retinal laser treatment.
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Affiliation(s)
- Svenja Rebecca Sonntag
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Maximilian Hamann
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | | | - Salvatore Grisanti
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Yoko Miura
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
- Medical Laser Center Lübeck, Lübeck, Germany.
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.
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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Wijesinghe RE, Kahatapitiya NS, Lee C, Han S, Kim S, Saleah SA, Seong D, Silva BN, Wijenayake U, Ravichandran NK, Jeon M, Kim J. Growing Trend to Adopt Speckle Variance Optical Coherence Tomography for Biological Tissue Assessments in Pre-Clinical Applications. MICROMACHINES 2024; 15:564. [PMID: 38793137 PMCID: PMC11122893 DOI: 10.3390/mi15050564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
Speckle patterns are a generic feature in coherent imaging techniques like optical coherence tomography (OCT). Although speckles are granular like noise texture, which degrades the image, they carry information that can be benefited by processing and thereby furnishing crucial information of sample structures, which can serve to provide significant important structural details of samples in in vivo longitudinal pre-clinical monitoring and assessments. Since the motions of tissue molecules are indicated through speckle patterns, speckle variance OCT (SV-OCT) can be well-utilized for quantitative assessments of speckle variance (SV) in biological tissues. SV-OCT has been acknowledged as a promising method for mapping microvasculature in transverse-directional blood vessels with high resolution in micrometers in both the transverse and depth directions. The fundamental scope of this article reviews the state-of-the-art and clinical benefits of SV-OCT to assess biological tissues for pre-clinical applications. In particular, focus on precise quantifications of in vivo vascular response, therapy assessments, and real-time temporal vascular effects of SV-OCT are primarily emphasized. Finally, SV-OCT-incorporating pre-clinical techniques with high potential are presented for future biomedical applications.
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Affiliation(s)
- Ruchire Eranga Wijesinghe
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Sri Lanka Institute of Information Technology, Malabe 10115, Sri Lanka;
- Center for Excellence in Intelligent Informatics, Electronics & Transmission (CIET), Sri Lanka Institute of Information Technology, Malabe 10115, Sri Lanka
| | - Nipun Shantha Kahatapitiya
- Department of Computer Engineering, Faculty of Engineering, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (N.S.K.); (U.W.)
| | - Changho Lee
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju 61186, Republic of Korea
- Department of Nuclear Medicine, Chonnam National University Medical School & Hwasun Hospital, 264, Seoyang-ro, Hwasun 58128, Republic of Korea
| | - Sangyeob Han
- ICT Convergence Research Center, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea
| | - Shinheon Kim
- ICT Convergence Research Center, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea
| | - Sm Abu Saleah
- ICT Convergence Research Center, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea
| | - Daewoon Seong
- School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea
| | - Bhagya Nathali Silva
- Center for Excellence in Intelligent Informatics, Electronics & Transmission (CIET), Sri Lanka Institute of Information Technology, Malabe 10115, Sri Lanka
- Faculty of Computing, Sri Lanka Institute of Information Technology, Malabe 10115, Sri Lanka
| | - Udaya Wijenayake
- Department of Computer Engineering, Faculty of Engineering, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (N.S.K.); (U.W.)
| | - Naresh Kumar Ravichandran
- Center for Scientific Instrumentation, Korea Basic Science Institute, 169-148, Gwahak-ro, Yuseong-gu, Daejeon 34133, Republic of Korea
| | - Mansik Jeon
- School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea
| | - Jeehyun Kim
- School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea
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Yoon CK, Yu HG. Selective retina therapy with real-time feedback-controlled technology in central serous chorioretinopathy: a 24-month follow-up real-world prospective study. BMJ Open Ophthalmol 2024; 9:e001517. [PMID: 38253572 PMCID: PMC10806644 DOI: 10.1136/bmjophth-2023-001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Although central serous chorioretinopathy (CSC) treatment using selective retinal therapy (SRT) has presented favourable outcomes, no long-term studies with a real-world clinical practice regimen have been conducted. METHODS AND ANALYSIS We performed a long-term assessment of CSC treatment using SRT with real-time feedback (RTF) technology. 50 patients (53 eyes) with CSC and more than a 1-month symptom duration were recruited and treated with SRT using a 1.7 µs pulse width, 527 nm neodymium-doped yttrium lithium fluoride (Nd:YLF) laser equipped with an RTF system. RESULTS After 6 months of treatment, complete subretinal fluid resolution was achieved in 62% of the eyes. The mean best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution, mean±SD) improved slightly from 0.15±0.18 at baseline to 0.12±0.21 at 6 months (p=0.062). The central retinal thickness (CRT; mean±SD) was reduced significantly from 350.6±100.1 µm at baseline to 268.2±70.6 µm at 6 months (p<0.001). Long-term follow-up revealed significant improvements in BCVA, from 9 months until 24 months, and in CRT, from 1 month until 24 months. No treatment-related adverse events were observed during the 24-month follow-up period. CONCLUSION Our results suggest that SRT with RTF technology is a long-term safe treatment with anatomical improvement for patients with CSC.
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Affiliation(s)
- Chang Ki Yoon
- Department of Ophthalmology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Retina Center, The Sky Eye Institute, Seoul, Korea (the Republic of)
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5
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Burri C, Salzmann S, Wandel J, Hoffmann L, Považay B, Meier C, Frenz M. Real-time OCT feedback-controlled RPE photodisruption in ex vivo porcine eyes using 8 microsecond laser pulses. BIOMEDICAL OPTICS EXPRESS 2023; 14:6328-6349. [PMID: 38420306 PMCID: PMC10898567 DOI: 10.1364/boe.503941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 03/02/2024]
Abstract
Selective retinal pigment epithelium (RPE) photodisruption requires reliable real-time feedback dosimetry (RFD) to prevent unwanted overexposure. In this study, optical coherence tomography (OCT) based RFD was investigated in ex vivo porcine eyes exposed to laser pulses of 8 µs duration (wavelength: 532 nm, exposure area: 90 × 90 µm2, radiant exposure: 247 to 1975 mJ/µm2). For RFD, fringe washouts in time-resolved OCT M-scans (central wavelength: 870 nm, scan rate: 85 kHz) were compared to an RPE cell viability assay. Statistical analysis revealed a moderate correlation between RPE lesion size and applied treatment energy, suggesting RFD adaptation to inter- and intraindividual RPE pigmentation and ocular transmission.
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Affiliation(s)
- Christian Burri
- optoLab, Institute for Human Centered Engineering, Bern University of Applied Sciences, Biel, Switzerland
- Biomedical Photonics Group, Institute of Applied Physics, University of Bern, Bern, Switzerland
| | - Simon Salzmann
- optoLab, Institute for Human Centered Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Jasmin Wandel
- Institute for Optimisation and Data Analysis, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - Leonie Hoffmann
- optoLab, Institute for Human Centered Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Boris Považay
- optoLab, Institute for Human Centered Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Christoph Meier
- optoLab, Institute for Human Centered Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Martin Frenz
- Biomedical Photonics Group, Institute of Applied Physics, University of Bern, Bern, Switzerland
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6
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Burri C, Salzmann S, Amstutz M, Hoffmann L, Považay B, Meier C, Frenz M. Investigation of the Influence of Pulse Duration and Application Mode on Microsecond Laser Microsurgery of the Retinal Pigment Epithelium. Life (Basel) 2023; 13:1314. [PMID: 37374097 DOI: 10.3390/life13061314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Optical microsurgery confined to the retinal pigment epithelium (RPE) requires locally optimized laser parameters and reliable real-time feedback dosimetry (RFD) to prevent unwanted neuroretinal overexposure. This study aimed to compare pulses of different durations and application modes (single, ramp, burst). Moreover, optical coherence tomography (OCT)-based RFD was investigated in an ex vivo experiment, utilizing nine porcine eyes that were exposed to laser pulses of 8, 12, 16 and 20 µs duration (wavelength: 532 nm, exposure area: 90 × 90 µm2, radiant exposure: 247 to 1975 mJ/µm2). Simultaneously, time-resolved OCT M-scans were recorded (central wavelength: 870 nm, scan rate: 85 kHz) for RFD. Post irradiation, retinal changes were assessed with color fundus photography (CFP) and cross-sectional OCT B-scans. RPE cell damage was quantified via fluorescence-based cell viability assay and compared to the OCT dosimetry feedback. Our experiments indicate cumulative RPE damage for pulse bursts of 16 µs and 20 µs, whereas no cumulative effects were found for pulse durations of 8 µs and 12 µs applied in ramp mode. According to statistical analysis, OCT-RFD correctly detected RPE cell damage with 96% sensitivity and 97% specificity using pulses of 8 µs duration in ramp mode.
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Affiliation(s)
- Christian Burri
- Biomedical Photonics Group, University of Bern, Sidlerstrasse 5, 3012 Bern, Switzerland
- Institute for Human Centered Engineering (HuCE)-OptoLab, Bern University of Applied Sciences, Quellgasse 21, 2501 Biel, Switzerland
| | - Simon Salzmann
- Institute for Human Centered Engineering (HuCE)-OptoLab, Bern University of Applied Sciences, Quellgasse 21, 2501 Biel, Switzerland
| | - Mylène Amstutz
- Institute for Human Centered Engineering (HuCE)-OptoLab, Bern University of Applied Sciences, Quellgasse 21, 2501 Biel, Switzerland
| | - Leonie Hoffmann
- Institute for Human Centered Engineering (HuCE)-OptoLab, Bern University of Applied Sciences, Quellgasse 21, 2501 Biel, Switzerland
| | - Boris Považay
- Institute for Human Centered Engineering (HuCE)-OptoLab, Bern University of Applied Sciences, Quellgasse 21, 2501 Biel, Switzerland
| | - Christoph Meier
- Institute for Human Centered Engineering (HuCE)-OptoLab, Bern University of Applied Sciences, Quellgasse 21, 2501 Biel, Switzerland
| | - Martin Frenz
- Biomedical Photonics Group, University of Bern, Sidlerstrasse 5, 3012 Bern, Switzerland
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Yamamoto M, Miura Y, Hirayama K, Kyo A, Kohno T, Theisen-Kunde D, Brinkmann R, Honda S. Comparative Treatment Study on Macular Edema Secondary to Branch Retinal Vein Occlusion by Intravitreal Ranibizumab with and without Selective Retina Therapy. Life (Basel) 2023; 13:life13030769. [PMID: 36983925 PMCID: PMC10058026 DOI: 10.3390/life13030769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
The purpose of this study was to compare the safety and efficacy of selective retina therapy (SRT) combined with the intravitreal injection of ranibizumab (IVR) in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). This trial was a 12-month single-center, randomized, single-masked prospective study. Eligible patients were randomized (1:1) to IVR and SRT (IVR + SRT group), or IVR and sham SRT (IVR + sham group). After the initial IVR, all participants received ME resolution criteria-driven pro re nata treatment. SRT or sham SRT was always applied one day after IVR. The primary outcome measure of this study was the mean change in central macular thickness (CMT) from baseline, and the secondary outcome measures were the mean change in visual acuity from baseline and the number of IVR treatments at a 52-week follow-up. Thirteen patients were in the IVR + SRT group, and 11 were in the IVR + sham group. Compared to the baseline, mean CMT and BCVA improved significantly after 52 weeks in both groups, with no significant difference between the two groups. The mean number of IVR was 2.85 ± 1.52 in the IVR + SRT group and 4.73 ± 2.33 in the IVR + sham group at the 52-week follow-up, with a significant difference between the two groups (p < 0.05). IVR combined with SRT may significantly decrease the number of IVR treatments while maintaining the visual and anatomical improvement effect of IVR monotherapy.
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Affiliation(s)
- Manabu Yamamoto
- Department of Ophthalmology and Visual Science, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
- Correspondence: ; Tel.: +81-6-6645-3867
| | - Yoko Miura
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany
- Department of Ophthalmology, University of Lübeck, 23562 Lübeck, Germany
- Medical Laser Center Lübeck, 23562 Lübeck, Germany
| | - Kumiko Hirayama
- Department of Ophthalmology and Visual Science, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Akika Kyo
- Department of Ophthalmology and Visual Science, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Takeya Kohno
- Department of Ophthalmology and Visual Science, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | | | - Ralf Brinkmann
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany
- Medical Laser Center Lübeck, 23562 Lübeck, Germany
| | - Shigeru Honda
- Department of Ophthalmology and Visual Science, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
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8
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Practical treatment options for persistent central serous chorioretinopathy and early visual and anatomical outcomes. Jpn J Ophthalmol 2023; 67:295-300. [PMID: 36867256 DOI: 10.1007/s10384-023-00978-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/18/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Persistent central serous chorioretinopathy (pCSC) may be treated by laser photocoagulation (PC), selective retina therapy (SRT), or photodynamic therapy (PDT). We conducted retrospective analyses regarding the choice of therapy for pCSC in the best clinical practice and the outcomes of these modalities. STUDY DESIGN A retrospective interventional study. METHODS The records of 71 eyes of 68 treatment naïve pCSC cases who underwent PC, SRT, or PDT were reviewed. First, the baseline clinical parameters were evaluated to find significant factors associated with the choice of treatment option. Second, the 3 months' visual and anatomical outcomes of each modality were assessed. RESULTS The PC, SRT, and PDT groups included 7, 22, and 42 eyes, respectively. The leakage pattern in fluorescein angiography (FA) was significantly associated with the choice of treatment (p<0.005). The dry macula ratio at 3 months post-treatment was 29%, 59%, and 81% in the PC, SRT, and PDT groups, respectively, which significantly differed among the groups (p<0.01). The best-corrected visual acuities tended to be improved after the treatments in all groups. Central choroidal thickness (CCT) was significantly decreased in all groups (p<0.05, p<0.01, and p<0.00001, in PC, SRT, and PDT groups, respectively). Logistic regression analysis for dry macula revealed that SRT (p<0.05), PDT (p<0.05), and the changes in CCT (p<0.01)were the significant association factors. CONCLUSION The leakage pattern in FA was associated with the choice of treatment option for pCSC. PDT achieved a significantly higher dry macula ratio than PC, 3 months after the treatment.
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Ivanova EV, Volodin PL. Development of the selective micropulse individual retinal therapy depends on age and type on the Fitzpatrick scale. Graefes Arch Clin Exp Ophthalmol 2023; 261:381-390. [PMID: 36006485 DOI: 10.1007/s00417-022-05800-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To develop a selective micropulse individual retinal therapy (SMIRT) based on the age and appearance type of the patient, to derive a formula for calculating power, and evaluate clinical efficacy for the treatment of central serous chorioretinopathy (CSCR). METHODS 73 patients (aged 30-65 years) with acute CSCR and types 1-4 on the Fitzpatrick scale were divided into 2 groups. In the first group (33 patients), the testing of the micropulse mode (50 µs, 2.4%, 10 ms, 100 µm, 0.4-1.9 W) on the Navilas 577 s laser system defined as selective by computer modeling was performed. A logistic regression function based on probability damage detection (PDD) of the 1584 laser spots from power, age, and type on the Fitzpatrick scale was constructed. PDD is the probability of detecting the laser spots using the autofluorescence method. The second group was divided into 4 subgroups of 10 eyes each. Groups 2.1, 2.2, and 2.3 were treated without preliminary testing. The power for Groups 2.1, 2.2, and 2.3 was obtained with the inverse PDD function, so that PDD was 50%, 70%, and 90%, respectively. Control group 2.4 went without treatment. RESULTS The transmission and absorption coefficients of laser radiation of the eye depend on the age and the Fitzpatrick scale type. In Groups 2.1-2.3, complete resorption of subretinal fluid was observed 3 months after CSCR treatment in 5 (P < 0.35), 8 (P < 0.023), and 10 eyes (P < 0.0008) out of 10, respectively. CONCLUSION The developed SMIRT is effective for CSCR treatment with PDD 90%.
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Affiliation(s)
- Elena V Ivanova
- Laser Retinal Surgery Department, The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia.
| | - Pavel L Volodin
- Laser Retinal Surgery Department, The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
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Factors Predicting Response to Selective Retina Therapy in Patients with Chronic Central Serous Chorioretinopathy. J Clin Med 2022; 11:jcm11020323. [PMID: 35054017 PMCID: PMC8778271 DOI: 10.3390/jcm11020323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/05/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
This retrospective study aimed to assess the safety and efficacy of selective retina therapy (SRT) with real-time feedback-controlled dosimetry (RFD) for chronic central serous chorioretinopathy (CSC) and to evaluate factors predictive of treatment response. We included 137 eyes of 135 patients with chronic CSC. SRT was performed to cover each of the leakage areas on fundus fluorescein angiography. Changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were evaluated at baseline and at 3 and 6 months after treatment. Complete SRF resolution was observed in 52.6% (72/137 eyes) and 90.5% (124/137 eyes) at 3 and 6 months, respectively. Mean BCVA (logMAR) significantly improved from 0.41 ± 0.31 at baseline to 0.33 ± 0.31 at month 6 (p < 0.001). Mean CMT significantly decreased from 347.67 ± 97.38 μm at baseline to 173.42 ± 30.95 μm at month 6 (p < 0.001). Mean SRF height significantly decreased from 187.85 ± 97.56 µm at baseline to 8.60 ± 31.29 µm after 6 months (p < 0.001). Baseline SRF height was a significant predictive factor for retreatment requirement (p = 0.008). In conclusion, SRT showed favorable anatomical outcomes in patients with chronic CSC. A higher baseline SRF height was a risk factor for retreatment.
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Jeon SH, Kim M, Lee J, Roh YJ. The Effect of Selective Retina Therapy for Bevacizumab-Resistant Chronic Central Serous Chorioretinopathy. Ophthalmologica 2021; 245:91-100. [PMID: 34649253 DOI: 10.1159/000520187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of selective retina therapy (SRT), used in conjunction with real-time feedback dosimetry (RFD), in the treatment of bevacizumab-resistant chronic central serous chorioretinopathy (CSC). PATIENTS AND METHODS In this retrospective cohort study, 22 eyes of 22 patients with bevacizumab-resistant chronic CSC, showing focal or diffuse foveal leakages on fundus fluorescein angiography (FFA), were included. After evaluation of the test spots at temporal arcades, SRT (wavelength, 527 nm; pulse repetition rate, 100 Hz; ramping over maximal 15 micropulses; and spot diameter, 200 μm) using RFD was applied to the leakage sites observed on FFA. Changes in the mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were evaluated at baseline and at 1, 3, 6, 9, and 12 months following treatment. RESULTS SRF completely resolved in 81.8% (18/22 eyes) cases at 12 months post-treatment. The mean BCVA (logarithm of the minimum angle of resolution [logMAR]) improved from 0.49 ± 0.29 at baseline to 0.43 ± 0.36 at 12 months (p = 0.067). The mean BCVA gain was 0.06 logMAR, equivalent to 3 ETDRS letters. The CMT significantly decreased from 323 ± 85.6 μm at baseline to 221.5 ± 60.4 μm at 12 months (p < 0.001). The mean SRF height also significantly decreased from 174.6 ± 86.4 μm at baseline to 35.1 ± 75.4 μm at 12 months (p < 0.001). CONCLUSION SRT showed favorable visual and anatomical outcomes in patients with bevacizumab-resistant chronic CSC.
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Affiliation(s)
- Seung Hee Jeon
- Department of Ophthalmology and Visual Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Minhee Kim
- Department of Ophthalmology and Visual Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Jiyoung Lee
- Department of Ophthalmology and Visual Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Jung Roh
- Department of Ophthalmology and Visual Science, Catholic University of Korea, Seoul, Republic of Korea
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12
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Volodin PL, Ivanova EV. Clinical Evaluation of Individualized and Navigated Microsecond Pulsing Laser for Acute Central Serous Chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2021; 51:512-520. [PMID: 32955591 DOI: 10.3928/23258160-20200831-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/01/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVE A computational model has predicted parameters for using a navigated microsecond pulsing laser system to treat central serous chorioretinopathy (CSC). PATIENTS AND METHODS A prospective, single-center, interventional case series was conducted for patients with acute CSC who were enrolled following screening and informed consent. Treatment involved laser pulse duration of 50 μs, 2.4% Duty Cycle, 100 μm spot size, and 10 ms pulse duration. RESULTS Average best-corrected visual acuity (decimal) of 12 patients improved from 0.86 ± 0.03 at baseline to 0.97 ± 0.01 at 3 months. Baseline central retinal thickness decreased from 452.58 μm ± 24.53 μm at baseline to 249.25 μm ± 2.92 μm at 3 months. Retinal sensitivity improved from 24.1 dB ± 1.09 dB at baseline to 28.98 dB ± 0.23 dB at 3 months. In all cases, subretinal fluid was resorbed. CONCLUSION The parameter sets derived from the computer model can be applied safely and effectively for CSC treatment using the navigated microsecond pulsing laser system. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:512-520.].
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13
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Sonntag SR, Seifert E, Hamann M, Lewke B, Theisen-Kunde D, Grisanti S, Brinkmann R, Miura Y. Fluorescence Lifetime Changes Induced by Laser Irradiation: A Preclinical Study towards the Evaluation of Retinal Metabolic States. Life (Basel) 2021; 11:life11060555. [PMID: 34199212 PMCID: PMC8231852 DOI: 10.3390/life11060555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 12/17/2022] Open
Abstract
Fluorescence Lifetime (FLT) of intrinsic fluorophores may alter under the change in metabolic state. In this study, the FLT of rabbit retina was investigated in vivo after laser irradiation using fluorescence lifetime imaging ophthalmoscopy (FLIO). The retina of the Chinchilla bastard rabbits was irradiated with a 514 nm diode laser. FLIO, fundus photography, and optical coherence tomography (OCT) were conducted 30 min and 1 to 3 weeks after treatment. After strong coagulation, the FLT at laser spots was significantly elongated immediately after irradiation, conversely shortened after more than a week. Histological examination showed eosinophilic substance and melanin clumping in subretinal space at the coagulation spots older than one week. The FLT was also elongated right around the coagulation spots, which corresponded to the discontinuous ellipsoid zone (EZ) on OCT. This EZ change was recovered after one week, and the FLT became the same level as the surroundings. In addition, there was a region around the laser spot where the FLT was temporarily shorter than the surrounding area. When weak pulse energy was applied to selectively destroy only the RPE, a shortening of the FLT was observed immediately around the laser spot within one week after irradiation. FLIO could serve as a tool to evaluate the structural and metabolic response of the retina to laser treatments.
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Affiliation(s)
- Svenja Rebecca Sonntag
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (S.R.S.); (S.G.)
| | - Eric Seifert
- Medical Laser Center Lübeck, 23562 Lübeck, Germany; (E.S.); (D.T.-K.); (R.B.)
| | - Maximilian Hamann
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany; (M.H.); (B.L.)
| | - Britta Lewke
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany; (M.H.); (B.L.)
| | - Dirk Theisen-Kunde
- Medical Laser Center Lübeck, 23562 Lübeck, Germany; (E.S.); (D.T.-K.); (R.B.)
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (S.R.S.); (S.G.)
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, 23562 Lübeck, Germany; (E.S.); (D.T.-K.); (R.B.)
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany; (M.H.); (B.L.)
| | - Yoko Miura
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (S.R.S.); (S.G.)
- Medical Laser Center Lübeck, 23562 Lübeck, Germany; (E.S.); (D.T.-K.); (R.B.)
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany; (M.H.); (B.L.)
- Correspondence:
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Büttner M, Luger B, Abou Moulig W, Junker B, Framme C, Jacobsen C, Knoll K, Pielen A. Selective retina therapy (SRT) in patients with therapy refractory persistent acute central serous chorioretinopathy (CSC): 3 months functional and morphological results. Graefes Arch Clin Exp Ophthalmol 2021; 259:1401-1410. [PMID: 33205239 PMCID: PMC8166675 DOI: 10.1007/s00417-020-04999-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/15/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Central serous chorioretinopathy (CSC) is a disease presenting with detachment of the neurosensory retina and characteristic focal leakage on fluorescein angiography. The spontaneous remission rate is 84% within 6 months. In this study, the efficacy of selective retina therapy (SRT) was examined in patients with therapy refractory persistent acute CSC defined by symptoms for at least 6 months and persistent subretinal fluid (SRF) despite eplerenone therapy. MATERIAL AND METHODS This is a prospective, monocentric observational study in 17 eyes (16 patients, mean age 42 years, 2 female). SRT was performed with the approved R:GEN laser (Lutronic, South Korea), a micropulsed 527-nm Nd:YLF laser device, with a train of 30 pulses of 1.7 μs at 100-Hz repetition rate at the point of focal leakage determined by fluorescein angiography (FA) at baseline (BSL). Visits on BSL, week 4 (wk4), and week 12 (wk12) included best corrected visual acuity (BCVA, logMar), central retinal thickness (CRT) on spectral domain optical coherence tomography (SD-OCT), and FA. Statistical analysis was performed by pair-by-pair comparisons of multiple observations in each case with Bonferroni correction for multiple testing. (IBM SPSS Statistics 25®). RESULTS Mean CRT at BSL was 387.69 ± 110.4 μm. CRT significantly decreased by 106.31 μm in wk4 (95%-KI: 21.42-191.2; p = 0.01), by 133.63 μm in wk12 (95%-KI: 50.22-217.03; p = 0.001) and by 133.81 μm (95%-KI: 48.88-218.75; p = 0.001) compared to BSL. Treatment success defined as complete resolution of SRF occurred at wk4 in 7/17 eyes (35.3%) and at wk12 in 10/17 eyes (58.8%). Re-SRT was performed in 7/17 eyes (41.2%) after an average of 107.14 ± 96.59 days. Treatment success after Re-SRT was observed in 4/6 eyes (66.6%, 12 weeks after Re-SRT). Mean BCVA did not change significantly from BSL to any later timepoint after adjusting for multiple testing. Notably, eyes with treatment success showed better BCVA at all timepoints and gained more letters compared to failures. CONCLUSION Single or repetitive SRT may be an effective and safe treatment in 2 of 3 patients suffering from acute persistent CSC after 6 months of symptoms or more. We observed complete resolution of SRF in around 60% of eyes 12 weeks after first SRT treatment and also 12 weeks after Re-SRT treatment in eyes with persistent or recurrent SRF. Results on the long-term course after SRT are still pending.
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Affiliation(s)
- Maximilian Büttner
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Benjamin Luger
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Wasim Abou Moulig
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Bernd Junker
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Carsten Framme
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Christina Jacobsen
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Katharina Knoll
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Amelie Pielen
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany
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15
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Kyo A, Yamamoto M, Hirayama K, Kohno T, Theisen-Kunde D, Brinkmann R, Miura Y, Honda S. Factors affecting resolution of subretinal fluid after selective retina therapy for central serous chorioretinopathy. Sci Rep 2021; 11:8973. [PMID: 33903643 PMCID: PMC8076253 DOI: 10.1038/s41598-021-88372-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to investigate the factors of clinical outcome of selective retina therapy (SRT) for central serous chorioretinopathy (CSC). This retrospective study included 77 eyes of 77 patients, who were treated with SRT for CSC and observed at least 6 months after the treatment. SRT laser (527 nm, 1.7 µs, 100 Hz) was used for treatment. The mean best-corrected visual acuity (logMAR), central macular thickness (CMT) and central choroidal thickness were changed from baseline to at 6-months follow-up with significant difference. The multivariate analyses found that the rate of change (reduction) in CMT was associated with focal leakage type on fluorescein angiography (FA) (p = 0.03, coefficient 15.26, 95% confidence interval 1.72–28.79) and larger baseline CMT (p < 0.01, coefficient − 0.13, 95% confidence interval − 0.13 to − 0.05). Complete resolution of subretinal fluid was associated with nonsmoking history (p = 0.03, odds ratio 0.276, 95% confidence interval 0.086–0.887) and focal leakage type on FA (p < 0.01, odds ratio 0.136, 95% confidence interval 0.042–0.437). These results may be useful for predicting the therapeutic effectiveness of SRT.
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Affiliation(s)
- Akika Kyo
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Manabu Yamamoto
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan.
| | - Kumiko Hirayama
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Takeya Kohno
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | | | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Yoko Miura
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.,Department of Ophthalmology, University of Lübeck, Lübeck, Germany
| | - Shigeru Honda
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
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Pauleikhoff L, Agostini H, Lange C. [Central serous chorioretinopathy]. Ophthalmologe 2021; 118:967-980. [PMID: 33861376 DOI: 10.1007/s00347-021-01376-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
Central serous chorioretinopathy (CSC) is the fourth most common disease of the macula after age-related macular degeneration, diabetic retinopathy and retinal vein occlusion and a cause of irreversible visual loss. This article gives an overview of the epidemiology, risk factors, pathophysiology, clinical presentation, multimodal imaging and discusses current therapeutic options for CSC.
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Affiliation(s)
- Laurenz Pauleikhoff
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - Hansjürgen Agostini
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - Clemens Lange
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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17
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Oh J, Yoon CK, Kim BH, Yu HG. Evaluation of the Safety and Efficacy of Selective Retina Therapy Laser Treatment in Patients with Central Serous Chorioretinopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 35:51-63. [PMID: 33307626 PMCID: PMC7904406 DOI: 10.3341/kjo.2020.0112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/30/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose To assess the safety and efficacy of selective retina therapy (SRT) using a Q-switched neodymium-doped yttrium lithium fluoride laser with feedback systems in patients with idiopathic central serous chorioretinopathy (CSC). Methods This randomized clinical trial enrolled patients having at least 3-month symptom of CSC. From month 3 visit, all subjects in both groups were eligible for SRT retreatment if they showed persistent or recurrent subretinal fluid (SRF). The primary outcome was complete resolution of SRF by optical coherence tomography at 3 months after treatment. The secondary outcomes were changes in SRF, central macular thickness (CMT) and best-corrected visual acuity at the 1-, 3-, and 6-month examinations. Results Sixty-eight CSC patients were included (SRT, 31; control, 37). After 1 and 3 months, complete resolution of SRF was achieved in 25.8% and 54.8% of SRT group and 17.6% and 35.1% of controls. The differences were not statistically significant (p = 0.424 and p = 0.142, respectively). However, mixed model for repeated measures analyses showed that the reduction of SRF and CMT were observed earlier in SRT group than in the sham group (least squares mean difference, −59.7 μm; 95% confidence interval, −98.2 to −21.2; p = 0.0029; least squares mean difference −67.0 μm; 95% confidence interval, −104.8 to −29.2; p = 0.0007, respectively). Significant reduction of SRF (≥50% reduction from baseline) was more frequently observed in SRT group (80.6%) than the sham group (44.1%) at month 1 (p = 0.007). Early reduction of SRF and CMT was more abundant in SRT group with symptom duration less than 6 months. Treatment related serious adverse events were not observed. Conclusions SRT using a Q-switched neodymium-doped yttrium lithium fluoride laser with feedback system was safe in this trial and effective for early resolution of SRF in the CSC patients. Early intervention with SRT can be a safe alternative for patients with acute symptomatic CSC.
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Affiliation(s)
- Jaeryung Oh
- Department of Ophthalmology, Korea University Anam Hospital, Seoul, Korea
| | - Chang Ki Yoon
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Bo Hee Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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18
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Battaglia Parodi M, Arrigo A, Iacono P, Falcomatà B, Bandello F. Central Serous Chorioretinopathy: Treatment with Laser. Pharmaceuticals (Basel) 2020; 13:ph13110359. [PMID: 33147718 PMCID: PMC7692124 DOI: 10.3390/ph13110359] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023] Open
Abstract
Currently, no general consensus exists regarding the management of central serous chorioretinopathy (CSC). Laser treatments include three different therapeutic approaches: conventional laser, subthreshold laser and photodynamic therapy. Conventional focal laser, addressed to seal the leaking points, as evidenced on fluorescein angiography, was largely used in the past, but now, it is almost completely abandoned, owing to the potential complications. Several studies confirmed the positive effects achieved by subthreshold laser treatment in CSC, even though its improper application in the PLACE trial has questioned the effectiveness.
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Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
- TSRetina, 34123 Trieste, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
| | - Pierluigi Iacono
- IRCCS-Fondazione Bietti, Via Livenza 3, 00198 Rome, Italy
- Correspondence: ; Tel.: +39-06-77052834; Fax: +39-06-77052833
| | - Bruno Falcomatà
- Department of Ophthalmology, Ospedale Bianchi-Malacrino-Gabrielli, 89100 Reggio Calabria, Italy;
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
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Kaymak H, Funk S, Fricke A, Fulga R, Klabe K, Seitz B, Langenbucher A, Schwahn H. Efficacy of nanosecond laser treatment in central serous chorioretinopathy with and without atrophy of retinal pigment epithelium. Int J Retina Vitreous 2020; 6:11. [PMID: 32518690 PMCID: PMC7271527 DOI: 10.1186/s40942-020-00214-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the outcomes of subthreshold nanosecond laser treatment of chronic central serous chorioretinopathy (CSC) as a function of the severity of concomitant of retinal pigment epithelium (RPE) defects. Methods This retrospective study compares data from 23 CSC diagnosed eyes with only mild RPE defects (group 1), 16 CSC eyes with moderate RPE defects (group 2), and 17 CSC eyes having severe RPE defects (group 3). After subthreshold treatment with the standard Ellex 2RT™ nanosecond laser (Ellex Medical Lasers Ltd, Australia), changes in macular structure and levels of subretinal fluid (SRF) were assessed by OCT-SD, OCT-A, functional integrity of the retina was assessed by corrected distance visual acuity (CDVA) and microperimetry, each at baseline and 1, 3, 6, and 12 months after initial treatment; re-treatment took place in cases of persistent SRF pro re nata. Results During the 12 months observation period, group 1 and 2 mostly required on initial and one re-treatment (1.9 ± 1.0 treatments; 1.9 ± 1.3 treatments). In contrast, group 3 was subject to three to four treatments (3.7 ± 1.5 treatments). 6 to 12 months after treatment, subretinal fluid (SRF) disappeared in 100% of the eyes of group 1 and in 76.9%, and 42.9% of the eyes of group 2 and group 3, respectively. Retinal sensitivity and CDVA improved in group 1 and 2, but did not change significantly in group 3 during the 12 months period. Conclusions Subthreshold nanosecond laser treatment is an effective and safe method for the restoration of macular anatomy and sensitivity in acute and chronic CSC cases with only mild or moderate RPE defects. However, this laser treatment has very limited outcome in CSC eyes with more severe RPE defects.
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Affiliation(s)
- Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie, Theo-Champion-Str. 1, 40549 Duesseldorf, Germany.,Institute of Experimental Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100/22, 66424 Homburg, Germany
| | - Saskia Funk
- Internationale Innovative Ophthalmochirurgie, Theo-Champion-Str. 1, 40549 Duesseldorf, Germany
| | - Andreas Fricke
- Internationale Innovative Ophthalmochirurgie, Theo-Champion-Str. 1, 40549 Duesseldorf, Germany
| | - Roxana Fulga
- Internationale Innovative Ophthalmochirurgie, Theo-Champion-Str. 1, 40549 Duesseldorf, Germany
| | - Karsten Klabe
- Internationale Innovative Ophthalmochirurgie, Theo-Champion-Str. 1, 40549 Duesseldorf, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100/22, 66424 Homburg, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100/22, 66424 Homburg, Germany
| | - Hartmut Schwahn
- Internationale Innovative Ophthalmochirurgie, Theo-Champion-Str. 1, 40549 Duesseldorf, Germany
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20
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Lee S, Wei S, Guo S, Kim J, Kim B, Kim G, Kang JU. Selective retina therapy monitoring by speckle variance optical coherence tomography for dosimetry control. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-9. [PMID: 32061065 PMCID: PMC7019183 DOI: 10.1117/1.jbo.25.2.026001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 01/29/2020] [Indexed: 05/29/2023]
Abstract
SIGNIFICANCE Selective retina therapy (SRT) selectively targets the retinal pigment epithelium (RPE) and reduces negative side effects by avoiding thermal damages of the adjacent photoreceptors, the neural retina, and the choroid. However, the selection of proper laser energy for the SRT is challenging because of ophthalmoscopically invisible lesions in the RPE and different melanin concentrations among patients or even regions within an eye. AIM We propose and demonstrate SRT monitoring based on speckle variance optical coherence tomography (svOCT) for dosimetry control. APPROACH M-scans, time-resolved sequence of A-scans, of ex vivo bovine retina irradiated by 1.7-μs duration laser pulses were obtained by a swept-source OCT. SvOCT images were calculated as interframe intensity variance of the sequence. Spatial and temporal temperature distributions in the retina were numerically calculated in a 2-D retinal model using COMSOL Multiphysics. Microscopic images of treated spots were obtained before and after removing the upper neural retinal layer to assess the damage in both RPE and neural layers. RESULTS SvOCT images show abrupt speckle variance changes when the retina is irradiated by laser pulses. The svOCT intensities averaged in RPE and photoreceptor layers along the axial direction show sharp peaks corresponding to each laser pulse, and the peak values were proportional to the laser pulse energy. The calculated temperatures in the neural retina layer and RPE were linearly fitted to the svOCT peak values, and the temperature of each lesion was estimated based on the fitting. The estimated temperatures matched well with previously reported results. CONCLUSION We found a reliable correlation between the svOCT peak values and the degree of retinal lesion formation, which can be used for selecting proper laser energy during SRT.
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Affiliation(s)
- Soohyun Lee
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
| | - Shuwen Wei
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
| | - Shoujing Guo
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
| | | | | | - Gihoon Kim
- Lutronic Center, Goyang, Republic of Korea
| | - Jin U. Kang
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
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Predictive factors of outcome of selective retina therapy for diabetic macular edema. Int Ophthalmol 2020; 40:1221-1232. [PMID: 31950333 DOI: 10.1007/s10792-020-01288-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/06/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To investigate the predictive factors of clinical outcome of selective retina therapy (SRT) for diabetic macular edema (DME). METHODS This retrospective study included 22 eyes of 22 patients (15 males and 7 females), who were treated with SRT for DME at the Department of Ophthalmology of Osaka City University Hospital and observed at least 6 months after the treatment. The mean age was 64 years (range 40-81). Thirteen of the 22 eyes (59%) had a treatment history other than SRT before. SRT laser (527 nm, 1.7 µs, 100 Hz) was used for treatment. Changes in the best-corrected visual acuity (BCVA) (logMAR) and central macular thickness (CMT) in optical coherence tomography were examined at baseline, 3-month follow-up, and 6-month follow-up. Factors associated with the rate of change in CMT at 3 and 6 months after SRT were examined. RESULTS The mean BCVA (logMAR) was 0.26 ± 0.31, 0.22 ± 0.27 and 0.23 ± 0.29 at baseline, 3 months and 6 months, respectively (p = 0.15 at 3 months, 0.40 at 6 months; compared to baseline). The mean CMT was 502 ± 163, 493 ± 204, and 416 ± 185 μm at baseline, 3 months, and 6 months, respectively (p = 0.69 at 3 months, 0.01 at 6 months; compared to baseline). The multivariate analysis found a significant negative association with previous macular photocoagulation (p = 0.03) at 3 months and a positive association with a history of insulin use (p = 0.02) and previous panretinal photocoagulation (p = 0.03) at 6 months after SRT. CONCLUSION The CMT was significantly decreased at 6 months after SRT in DME. The history of insulin use and panretinal photocoagulation may positively and the history of macular photocoagulation may negatively affect the outcome of SRT, which must be considered when determining the therapeutic indications for SRT.
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Tode J, Richert E, Koinzer S, Klettner A, von der Burchard C, Brinkmann R, Lucius R, Roider J. Selective Retina Therapy Reduces Bruch's Membrane Thickness and Retinal Pigment Epithelium Pathology in Age-Related Macular Degeneration Mouse Models. Transl Vis Sci Technol 2019; 8:11. [PMID: 31737435 PMCID: PMC6855371 DOI: 10.1167/tvst.8.6.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/03/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose To investigate the effect of selective retina therapy (SRT) on age-related macular degeneration (AMD)-like alterations of retinal pigment epithelium (RPE) and Bruch's membrane (BrM) in AMD mouse models as therapeutic approach for the treatment of dry AMD. Methods In B6.129P2-Apoetm1Unc/J (ApoE−/−) and B6.129X1-Nfe2I2tm1Ywk/J (NRF2−/−), one randomized eye of each mouse in groups of 15 mice was treated by SRT (532 nm, 300 ms, ∼1.4-μs pulse, 100 Hz, 50-μm spot), the fellow eye and healthy C57BL/6J mice served as controls. Clinical examinations were obtained at treatment day and 1 month later, followed by enucleation to analyze BrM thickness and ultrastructural RPE morphology. Results Nearly all ApoE−/− and NRF2−/− mice showed AMD-like retinal alterations. BrM thickness was increased in both mouse models, RPE had vacuoles within the cell body and shortened apical microvilli. SRT neither affected neuroretinal anatomy nor function. BrM thickness as well as AMD-like ultrastructural alterations of the RPE were significantly reduced in laser-treated eyes compared with fellow control and untreated control eyes. Conclusions SRT reduces BrM thickness and AMD-like RPE alterations in AMD mouse models without damage to structural or functional properties of neuroretina. It may be a prophylactic or therapeutic option for dry AMD. Translational Relevance SRT shows therapeutic effectivity in murine AMD models and might therefore become an option for the treatment of dry AMD.
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Affiliation(s)
- Jan Tode
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Elisabeth Richert
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Stefan Koinzer
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Alexa Klettner
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Claus von der Burchard
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Ralf Brinkmann
- Institute for Biomedical Optics, University of Lübeck and Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, Lübeck, Germany
| | - Ralph Lucius
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Olshausenstr. 40, Kiel, Germany
| | - Johann Roider
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
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Funk S, Fulga R, Klabe K, Breyer D, Seitz B, Langenbucher A, Kaymak H. [Nanosecond Laser Treatment in Chorioretinopathia Centralis Serosa without RPE Defects: A Retrospective Case Series]. Klin Monbl Augenheilkd 2019; 238:60-66. [PMID: 31600817 DOI: 10.1055/a-0999-5542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chorioretinopathia centralis serosa (CCS) is a uni- or bilateral disease of the macula which is characterized by detachment of the neuro-sensory retina. The spontaneous resolution rate is 68% after four months and 84% after six months. PURPOSE To investigate the efficacy of subthreshold nanopulse laser treatment for central serous chorioretinopathy (CCS) in the absence of any atrophy in the retinal pigment epithelium (RPE). METHODS This retrospective study comprised 23 eyes of 23 patients without previous treatment. Patients were followed up to 12 months. Laser treatment was performed with the 2RT® nanolaser using a grid stimulation. Changes in corrected visual acuity (VA), microperimetry and subretinal fluid height in optical coherence tomographic images were measured. Saliences in autofluorescence images and angiographic images were observed. All results were documented 1, 3, 6 and 12 months after the first treatment. Patients did not receive any supplementary treatment. RESULTS Two months after the first treatment, 74% of the patients showed complete SRF resolution and 91% of the patients within 6 months had complete resorption of the SRF. Central visual acuity and macula sensitivity significantly improved from 0.18 ± 0.16 logMAR to 0.09 ± 0.17 logMAR and 24.19 ± 3.96 dB to 27.59 ± 2.89 dB. The SRF decreased within one month significantly. No CNV was documented during the observation time. The baseline subretinal fluid height is a predictive factor of faster resolution. CONCLUSION The evaluation of our treatment results shows that the therapy is a safe and promising method. Patients with a CCS without existing RPE defects benefit from the treatment with the 2RT® nanolaser, which is associated with an improvement of the macula function.
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Affiliation(s)
- Saskia Funk
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
| | - Roxana Fulga
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
| | - Karsten Klabe
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
| | - Detlev Breyer
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar
| | - Hakan Kaymak
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
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Hutfilz A, Sonntag SR, Lewke B, Theisen-Kunde D, Grisanti S, Brinkmann R, Miura Y. Fluorescence Lifetime Imaging Ophthalmoscopy of the Retinal Pigment Epithelium During Wound Healing After Laser Irradiation. Transl Vis Sci Technol 2019; 8:12. [PMID: 31588376 PMCID: PMC6748347 DOI: 10.1167/tvst.8.5.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/19/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose To investigate the change in fluorescence lifetime of retinal pigment epithelium (RPE) after laser irradiation by using an organ culture model. Methods Porcine RPE-choroid-sclera explants were irradiated with selective retina treatment laser (wavelength: 527 nm, beam diameter: 200 μm, energy: 80–150 μJ). At 24 and 72 hours after irradiation, the mean fluorescence lifetime (τm) was measured with fluorescence lifetime imaging ophthalmoscopy (FLIO) (excitation wavelength: 473 nm, emission: short spectral channel: 498-560 nm, long spectral channel: 560–720 nm). For every laser spot, central damaged zone (zone 1: 120 × 120 μm), area including wound rim (280 × 280 μm except zone 1), and environmental zone (440 × 440 μm except zone 1 and 2) were analyzed. Peripheral zone at a distance from laser spots longer than 2000 μm was examined for comparison. Cell viability was evaluated with calcein-acetoxymethyl ester and morphology with fluorescence microscopy for filamentous-actin. Results The RPE defect after selective retina treatment was mostly closed within 72 hours. FLIO clearly demarcated the irradiated region, with prolonged τm at the center of the defect decreasing with eccentricity. In short spectral channel, but not in long spectral channel, τm in the environmental zone after 72 hours was still significantly longer than in the peripheral zone. Conclusions FLIO may clearly demarcate the RPE defect, demonstrate its closure, and, moreover, indicate the induced metabolic changes of surrounding cells during wound healing. Translational Relevance This ex vivo study showed that FLIO may be used to evaluate the extent and quality of restoration of the damaged RPE and to detect its metabolic change in human fundus noninvasively.
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Affiliation(s)
- Alessa Hutfilz
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.,Medical Laser Center Lübeck, Lübeck, Germany
| | - Svenja Rebecca Sonntag
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Britta Lewke
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.,Medical Laser Center Lübeck, Lübeck, Germany
| | | | - Salvatore Grisanti
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ralf Brinkmann
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.,Medical Laser Center Lübeck, Lübeck, Germany
| | - Yoko Miura
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.,Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.,Medical Laser Center Lübeck, Lübeck, Germany
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Statement of the Professional Association of German Ophthalmologists (BVA), the German Society of Ophthalmology (DOG) and the German Retina Society (RG) on central serous chorioretinopathy. Ophthalmologe 2018; 116:10-20. [DOI: 10.1007/s00347-018-0809-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Chhablani J, Roh YJ, Jobling AI, Fletcher EL, Lek JJ, Bansal P, Guymer R, Luttrull JK. Restorative retinal laser therapy: Present state and future directions. Surv Ophthalmol 2018; 63:307-328. [DOI: 10.1016/j.survophthal.2017.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/13/2017] [Accepted: 09/22/2017] [Indexed: 01/30/2023]
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Tode J, Richert E, Koinzer S, Klettner A, von der Burchard C, Brinkmann R, Lucius R, Roider J. Thermal Stimulation of the Retina Reduces Bruch's Membrane Thickness in Age Related Macular Degeneration Mouse Models. Transl Vis Sci Technol 2018; 7:2. [PMID: 29736323 PMCID: PMC5931258 DOI: 10.1167/tvst.7.3.2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 03/16/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose To investigate the effect of thermal stimulation of the retina (TS-R) on Bruch's membrane (BrM) thickness in age-related macular degeneration (AMD) mouse models as a novel concept for the prophylaxis and treatment of dry AMD. Methods Two knockout AMD mouse models, B6.129P2-Apoetm1Unc/J (ApoE−/−) and B6.129X1-Nfe2I2tm1Ywk/J (NRF2−/−), were chosen. One randomized eye of each mouse in four different groups (two of different age, two of different genotype) of five mice was treated by TS-R (532 nm, 10-ms duration, 50-μm spot size), the fellow eye served as control. Laser power was titrated to barely visible laser burns, then reduced by 70% to guarantee for thermal elevation without damage to the neuroretina, then applied uniformly to the murine retina. Fundus, optical coherence tomography (OCT), and fluorescein angiography (FLA) images were obtained at the day of treatment and 1 month after treatment. Eyes were enucleated thereafter to analyze BrM thickness by transmission electron microscopy (TEM) in a standardized blinded manner. Results Fundus images revealed that all ApoE−/− and NRF2−/− mice had AMD associated retinal alterations. BrM thickness was increased in untreated controls of both mouse models. Subvisible TS-R laser spots were not detectable by fundus imaging, OCT, or FLA 2 hours or 1 month after laser treatment. TEM revealed a significant reduction of BrM thickness in laser-treated eyes of all four groups compared to their fellow control eyes. Conclusions TS-R reduces BrM thickness in AMD mouse models ApoE−/− and NRF2−/− without damage to the neuroretina. It may become a prophylactic or even therapeutic treatment option for dry AMD. Translational Relevance TS-R may become a prophylactic or even therapeutic treatment option for dry AMD.
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Affiliation(s)
- Jan Tode
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Elisabeth Richert
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Stefan Koinzer
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Alexa Klettner
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Claus von der Burchard
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Ralf Brinkmann
- Institute for Biomedical Optics, University of Lübeck, and Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | - Ralph Lucius
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Kiel, Germany
| | - Johann Roider
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
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Stellungnahme des Berufsverbandes der Augenärzte Deutschlands, der Deutschen Ophthalmologischen Gesellschaft und der Retinologischen Gesellschaft zur Chorioretinopathia centralis serosa (CCS). Ophthalmologe 2018; 115:388-399. [DOI: 10.1007/s00347-018-0680-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kim YJ, Lee YG, Lee DW, Kim JH. Selective Retina Therapy with Real-Time Feedback-Controlled Dosimetry for Treating Acute Idiopathic Central Serous Chorioretinopathy in Korean Patients. J Ophthalmol 2018; 2018:6027871. [PMID: 29545953 PMCID: PMC5818953 DOI: 10.1155/2018/6027871] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/24/2017] [Accepted: 01/16/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate short-term treatment outcomes following selective retina therapy (SRT) with real-time feedback-controlled dosimetry in Korean patients with acute idiopathic central serous chorioretinopathy (CSC). METHODS Sixteen eyes (16 patients) with acute idiopathic CSC (symptom duration < 3 months) were included in this retrospective study. All patients underwent a single session of SRT with real-time feedback-controlled dosimetry. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) before and 3 months after treatment were examined and compared. RESULTS The logarithm of minimal angle of resolution BCVA was significantly better 3 months after treatment (0.16 ± 0.18) than at the time of diagnosis (0.27 ± 0.18, P = 0.002). Additionally, subretinal fluid had resolved in all 16 eyes 3 months after treatment and CFT was significantly lower 3 months after treatment (215.6 ± 17.9 μm) than at baseline (441.4 ± 124.8 μm, P < 0.001). No notable SRT-related complications were observed during the study period. CONCLUSION The results of the present study suggest that SRT is a useful therapeutic option for patients with acute idiopathic CSC. Further studies are required to better understand the long-term efficacy of this treatment. This trial is registered with clinical trial registration number NCT03339856.
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Affiliation(s)
- Ye Ji Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
| | - Youn Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
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Abstract
Ophthalmology was the first medical specialty to adopt lasers right after their invention more than 50 years ago, and they gradually revolutionized ocular imaging, diagnostics, therapy, and surgery. Challenging precision, safety, and selectivity requirements for ocular therapeutic and surgical procedures keep advancing the laser technologies, which in turn continue enabling novel applications for the preservation and restoration of sight. Modern lasers can provide single-cell-layer selectivity in therapy, submicrometer precision in three-dimensional image-guided surgery, and nondamaging retinal therapy under optoacoustic temperature control. This article reviews the evolution of laser technologies; progress in understanding of the laser-tissue interactions; and concepts, misconceptions, and accidental discoveries that led to modern therapeutic and surgical applications of lasers in ophthalmology. It begins with a brief historical overview, followed by a description of the laser-tissue interactions and corresponding ophthalmic applications.
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Affiliation(s)
- Daniel Palanker
- Department of Ophthalmology and Hansen Experimental Physics Laboratory, Stanford University, Stanford, California 94305;
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Han JW, Choi J, Kim YS, Kim J, Brinkmann R, Lyu J, Park TK. Comparison of the neuroinflammatory responses to selective retina therapy and continuous-wave laser photocoagulation in mouse eyes. Graefes Arch Clin Exp Ophthalmol 2018; 256:341-353. [PMID: 29322247 DOI: 10.1007/s00417-017-3883-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/02/2017] [Accepted: 12/20/2017] [Indexed: 01/12/2023] Open
Abstract
PURPOSE This study investigated microglia and inflammatory cell responses after selective retina therapy (SRT) with microsecond-pulsed laser in comparison to continuous-wave laser photocoagulation (cwPC). METHODS Healthy C57BL/6 J mice were treated with either a train of short pulses (SRT; 527-nm, Q-switched, 1.7-μs pulse) or a conventional thermal continuous-wave (532-nm, 100-ms pulse duration) laser. The mice were sacrificed and their eyes were enucleated 1, 3, 7, and 14 days after both laser treatments. Pattern of cell death on retinal section was evaluated by TUNEL assay, and the distribution of activated inflammatory cells and glial cells were observed under immunohistochemistry. Consecutive changes for the expression of cytokines such as IL-1β, TNF-α, and TGF-β were also examined using immunohistochemistry, and compared among each period after quantification by Western blotting. RESULTS The numbers of TUNEL-positive cells in the retinal pigment epithelium (RPE) layer did not differ in SRT and cwPC lesions, but TUNEL-positive cells in neural retinas were significantly less on SRT. Vague glial cell activation was observed in SRT-treated lesions. The population of inflammatory cells was also significantly decreased after SRT, and the cells were located in the RPE layer and subretinal space. Proinflammatory cytokines, including IL-1β and TNF-α, showed significantly lower levels after SRT; conversely, the level of TGF-β was similar to the cwPC-treated lesion. CONCLUSIONS SRT resulted in selective RPE damage without collateral thermal injury to the neural retina, and apparently produced negligible glial activation. In addition, SRT showed a markedly less inflammatory response than cwPC, which may have important therapeutic implications for several macular diseases.
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Affiliation(s)
- Jung Woo Han
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Bucheon, South Korea
| | - Juhye Choi
- Department of Medical Science, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 320-832, Republic of Korea
| | - Young Shin Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Bucheon, South Korea
| | - Jina Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Bucheon, South Korea
| | - Ralf Brinkmann
- Institute of Biomedical Optics, University of Lübeck and Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Germany
| | - Jungmook Lyu
- Department of Medical Science, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 320-832, Republic of Korea.
| | - Tae Kwann Park
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Bucheon, South Korea. .,Laboratory for Translational Research on Retinal Macular Degeneration, College of Medicine, Soonchunhyang University, Bucheon, South Korea. .,Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, #170 Jomaruro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, South Korea.
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Kim JM, Kim JY. Selective Retina Therapy in Patients with Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.10.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Min Kim
- Myung-Gok Eye Resarch Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Joo Yeon Kim
- Myung-Gok Eye Resarch Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Gawęcki M, Jaszczuk-Maciejewska A, Jurska-Jaśko A, Grzybowski A. Functional and morphological outcome in patients with chronic central serous chorioretinopathy treated by subthreshold micropulse laser. Graefes Arch Clin Exp Ophthalmol 2017; 255:2299-2306. [PMID: 28831603 PMCID: PMC5696495 DOI: 10.1007/s00417-017-3783-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/04/2017] [Accepted: 08/14/2017] [Indexed: 01/04/2023] Open
Abstract
Background Chronic central serous chorioretinopathy is a serious therapeutic problem as it may lead to significant visual impairment. The aim of this retrospective study is to evaluate functional and morphological effects, as well as factors influencing visual outcome in patients treated by subthreshold micropulse laser. Methods Fifty-one eyes with chronic central serous chorioretinopathy lasting longer than 4 months (18 months on average) underwent up to two sessions of subtreshold micropulse laser treatment. Change in best corrected visual acuity, central retinal thickness, central retinal volume, average central retinal thickness and maximum subretinal fluid height were measured. Relation between the effects of the treatment and the initial retinal morphological and functional parameters was then analyzed. Results The total resorption of subretinal fluid was achieved in 36 cases (70.6%). There was, however, only a minor improvement in best corrected visual acuity of approximately one line on the Snellen chart. No correlation was observed between the effects of the treatment and the duration of the symptoms, retinal morphology and initial visual acuity. Younger patients responded better to the therapy. Conclusion Subthreshold micropulse laser treatment in chronic serous chorioretinopathy provides good morphological results, however significant improvement of visual acuity is not to be expected.
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Affiliation(s)
- Maciej Gawęcki
- Dobry Wzrok Ophthalmological Clinic, Kliniczna 1B/2, 80-402, Gdańsk, Poland
| | | | - Anna Jurska-Jaśko
- Dobry Wzrok Ophthalmological Clinic, Kliniczna 1B/2, 80-402, Gdańsk, Poland
| | - Andrzej Grzybowski
- Chair of Ophthalmology, University of Warmia and Mazury, Warszawska 30, 10-082, Olsztyn, Poland. .,Department of Ophthalmology, Poznan City Hospital, Poznan, Poland.
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Selective retina therapy with automatic real-time feedback-controlled dosimetry for chronic central serous chorioretinopathy in Korean patients. Graefes Arch Clin Exp Ophthalmol 2017; 255:1375-1383. [DOI: 10.1007/s00417-017-3672-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 01/19/2023] Open
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Yasui A, Yamamoto M, Hirayama K, Shiraki K, Theisen-Kunde D, Brinkmann R, Miura Y, Kohno T. Retinal sensitivity after selective retina therapy (SRT) on patients with central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2016; 255:243-254. [DOI: 10.1007/s00417-016-3441-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/26/2016] [Accepted: 07/07/2016] [Indexed: 11/24/2022] Open
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Morphologic changes in the retina after selective retina therapy. Graefes Arch Clin Exp Ophthalmol 2016; 254:1099-109. [DOI: 10.1007/s00417-016-3331-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 02/09/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022] Open
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Breukink MB, Mohr JK, Ossewaarde-van Norel A, den Hollander AI, Keunen JE, Hoyng CB, Boon CJ. Half-dose photodynamic therapy followed by diode micropulse laser therapy as treatment for chronic central serous chorioretinopathy: evaluation of a prospective treatment protocol. Acta Ophthalmol 2016; 94:187-97. [PMID: 26670630 DOI: 10.1111/aos.12938] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/17/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the outcome of a prospective protocol for the treatment of chronic central serous chorioretinopathy (CSC). METHODS Interventional prospective case series in 59 eyes (59 patients) with active chronic CSC. All patients were first treated with indocyanine green angiography (ICGA)-guided half-dose photodynamic therapy (PDT). In case of persistent serous subretinal fluid (SRF) after a follow-up period of at least 6 weeks, ICGA-guided PDT was repeated. If the SRF persisted after two PDT treatments, additional ICGA-guided high-density subthreshold diode micropulse laser (HSML) therapy was performed. Clinical evaluation included best-corrected visual acuity (BCVA), fundoscopy, OCT, fundus autofluorescence, fluorescein angiography and ICGA. RESULTS After a single PDT treatment, complete resolution of SRF was seen in 37 of 59 eyes. Of the 22 eyes with no complete resolution of SRF, 19 eyes received a second PDT treatment, after which seven eyes of the 19 eyes showed a complete resolution of SRF. Ten eyes underwent HSML, of which one eye had complete resolution of SRF within 7 weeks. At final follow-up a complete resolution of SRF was present in 80% of all eyes. The mean BCVA improved from 0.28 logMAR at baseline to 0.16 logMAR at final follow-up. Improvement of BCVA was highest after the first treatment (-0.12 logMAR, p < 0.001). CONCLUSIONS The proposed treatment strategy using half-dose PDT and HSML in active chronic CSC resulted in an anatomical success rate of 80%. The first half-dose PDT treatment has the highest likelihood of a favourable treatment response on OCT and BCVA increase.
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Affiliation(s)
- Myrte B. Breukink
- Department of Ophthalmology; Radboud University Medical Center; Nijmegen the Netherlands
| | - Jacqueline K. Mohr
- Department of Ophthalmology; Radboud University Medical Center; Nijmegen the Netherlands
| | | | - Anneke I. den Hollander
- Department of Ophthalmology; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Human Genetics; Radboud University Medical Center; Nijmegen the Netherlands
| | - Jan E.E. Keunen
- Department of Ophthalmology; Radboud University Medical Center; Nijmegen the Netherlands
| | - Carel B. Hoyng
- Department of Ophthalmology; Radboud University Medical Center; Nijmegen the Netherlands
| | - Camiel J.F. Boon
- Department of Ophthalmology; Leiden University Medical Center; Leiden the Netherlands
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Stur M, Ansari-Shahrezaei S, Haas A, Tittl M. Leitlinien für die Betreuung und Behandlung von Patienten mit Chorioretinopathia centralis serosa. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-015-0276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park YG, Kim JR, Kang S, Seifert E, Theisen-Kunde D, Brinkmann R, Roh YJ. Safety and efficacy of selective retina therapy (SRT) for the treatment of diabetic macular edema in Korean patients. Graefes Arch Clin Exp Ophthalmol 2016; 254:1703-13. [DOI: 10.1007/s00417-015-3262-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/21/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022] Open
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Kang S, Park YG, Kim JR, Seifert E, Theisen-Kunde D, Brinkmann R, Roh YJ. Selective Retina Therapy in Patients With Chronic Central Serous Chorioretinopathy: A Pilot Study. Medicine (Baltimore) 2016; 95:e2524. [PMID: 26817895 PMCID: PMC4998269 DOI: 10.1097/md.0000000000002524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We evaluated visual outcomes, changes of maximum macular thickness (MMT) and subretinal fluid (SRF), and safety in patients with chronic central serous chorioretinopathy (CSC) after treatment with selective retina therapy (SRT). Retrospective cohort study of patients with chronic CSC presenting to a university-based hospital from January 2014 through January 2015 was conducted. A total of 12 eyes of 12 patients with chronic CSC lasting for at least 3 months was recruited. The follow-up period ranged from 3 to 12 months. Following evaluation of test spots at temporal arcades, SRT (Q-switched neodymium-doped yttrium lithium fluoride [Nd:YLF] laser; wavelength, 527 nm, pulse duration, 1.7 microsececond) was applied to the surrounding areas of leakage observed on fluorescein angiogram and/or pigment epithelial detachment (PED). Changes in best-correct visual acuity (BCVA), MMT, and SRF and macular sensitivity (MS) by microperimetry (MP) were evaluated. Eyes received treatment in a mean of 3.83 spots at the pulse energy of 65 to 90 μJ. Mean BCVA (logMAR) improved from 0.23 ± 0.12 at baseline to 0.14 ± 0.13 at 3 months. MMT decreased from 341.4 ± 85.5 μm at baseline to 236.0 ± 57.9 μm at 3 months. SRF completely resolved in 75% (9 eyes) at 3 months. Large PEDs (2 eyes) were flattened at 3 months. Retreatment was performed in 4 eyes. MP showed no evidence of scotoma around SRT-treated lesions. SRT treatment targeting the surrounding area of leakage point showed favorable visual and structural outcomes in chronic CSC patients without the risk of scotoma.
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Affiliation(s)
- Seungbum Kang
- From the Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (SK, YGP, JRK, YJR); Clinical Research Institute, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea (SK); and Medical Laser Center Lübeck GmbH, Lübeck, Germany (ES, DT-K, RB)
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A Comparative Study of Retinal Function in Rabbits after Panretinal Selective Retina Therapy versus Conventional Panretinal Photocoagulation. J Ophthalmol 2015; 2015:247259. [PMID: 26525905 PMCID: PMC4615217 DOI: 10.1155/2015/247259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 01/21/2023] Open
Abstract
Purpose. This study evaluates functional changes in electroretinographic findings after selective retina therapy (SRT) compared to panretinal photocoagulation (PRP) in rabbits. Methods. The right eyes of 12 Chinchilla rabbits received 200 laser treatment spots. The right eyes of six rabbits received SRT (SRT group), whereas the other six animals were treated using PRP on the right eye (PRP group). The eyes were investigated using full-field ERG 1 hour and 3 weeks after treatment. Histologic exam to assess the tissue response of lasers was performed on 3 weeks. Results. No significant changes in the mean ROD or CR b-wave amplitudes of the SRT lesions were evident, compared to baseline, 1 h after laser treatment (p = 0.372 and 0.278, resp.). In addition, the OPs and 30 Hz flickers of the SRT lesions were not significantly altered (p = 0.17 and 0.243, resp.). At 3 weeks, similar results were found. Comparing the two groups, the ROD b-wave amplitude was reduced in the PRP and SRT groups to 60.04 ± 4.2% and 92.32 ± 6.43% of baseline (p < 0.001). Histologically, there was no visible photoreceptor alterations on week 3. Conclusions. SRT in rabbit eyes induced less functional loss than PRP in both rod-mediated retinal function and cone-mediated retinal function. In addition, SRT irradiated eyes had no functional loss compared to its control.
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Framme C, Walter A, Berger L, Prahs P, Alt C, Theisen-Kunde D, Kowal J, Brinkmann R. Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy. Ophthalmologica 2015; 234:177-88. [PMID: 26368551 DOI: 10.1159/000439188] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/30/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Selective retina therapy (SRT), the confined laser heating and destruction of retinal pigment epithelial cells, has been shown to treat acute types of central serous chorioretinopathy (CSC) successfully without damaging the photoreceptors and thus avoiding laser-induced scotoma. However, a benefit of laser treatment for chronic forms of CSC is questionable. In this study, the efficacy of SRT by means of the previously used 1.7-µs and shorter 300-ns pulse duration was evaluated for both types of CSC, also considering re-treatment for nonresponders. MATERIAL AND METHODS In a two-center trial, 26 patients were treated with SRT for acute (n = 10) and chronic-recurrent CSC (n = 16). All patients presented with subretinal fluid (SRF) in OCT and leakage in fluorescein angiography (FA). SRT was performed using a prototype SRT laser system (frequency-doubled Q-switched Nd:YLF-laser, wavelength 527 nm) with adjustable pulse duration. The following irradiation settings were used: a train of 30 laser pulses with a repetition rate of 100 Hz and pulse durations of 300 ns and 1.7 µs, pulse energy 120-200 µJ, retinal spot size 200 µm. Because SRT lesions are invisible, FA was always performed 1 h after treatment to demonstrate laser outcome (5-8 single spots in the area of leakage). In cases where energy was too low, as indicated by missing FA leakage, energy was adjusted and the patient re-treated immediately. Observation intervals were after 4 weeks and 3 months. In case of nonimprovement of the disease after 3 months, re-treatment was considered. RESULTS Of 10 patients with active CSC that presents focal leakage in FA, 5 had completely resolved fluid after 4 weeks and all 10 after 3 months. Mean visual acuity increased from 76.6 ETDRS letters to 85.0 ETDRS letters 3 months after SRT. Chronic-recurrent CSC was characterized by less severe SRF at baseline in OCT and weaker leakage in FA than in acute types. Visual acuity changed from baseline 71.6 to 72.8 ETDRS letters after 3 months. At this time, SRF was absent in 3 out of 16 patients (19%), FA leakage had come to a complete stop in 6 out of 16 patients (38%). In 6 of the remaining chronic CSC patients, repeated SRT with higher pulse energy was considered because of persistent leakage activity. After the re-treatment, SRF resolved completely in 5 patients (83.3%) after only 25 days. CONCLUSION SRT showed promising results in treating acute CSC, but was less effective in chronic cases. Interestingly, re-treatment resulted in enhanced fluid resolution and dry conditions after a considerably shorter time in most patients. Therefore, SRT including re-treatment if necessary might be a valuable CSC treatment alternative even in chronic-recurrent cases.
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Affiliation(s)
- Carsten Framme
- University Eye Hospital, Medical School Hannover, Hannover, Germany
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Laser-based strategies to treat diabetic macular edema: history and new promising therapies. J Ophthalmol 2014; 2014:769213. [PMID: 25332833 PMCID: PMC4190043 DOI: 10.1155/2014/769213] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/30/2014] [Accepted: 09/04/2014] [Indexed: 02/08/2023] Open
Abstract
Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. The management of DME is complex and often various treatment approaches are needed. At the present time, despite the enthusiasm for evaluating several new treatments for DME, including the intravitreal pharmacologic therapies (e.g., corticosteroids and anti-VEGF drugs), laser photocoagulation still remains the current standard in DME. The purpose of this review is to update our knowledge on laser photocoagulation for DME and describe the developments in laser systems. And we will also discuss the new laser techniques and review the latest results including benefits of combined therapy. In this paper, we briefly summarize the major laser therapeutics for the treatment of diabetic macular edema and allude to some future promising laser therapies.
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Chhablani J, Rani PK, Mathai A, Jalali S, Kozak I. Navigated focal laser photocoagulation for central serous chorioretinopathy. Clin Ophthalmol 2014; 8:1543-7. [PMID: 25170248 PMCID: PMC4144935 DOI: 10.2147/opth.s67025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background and objective To assess the efficacy of navigated laser (Navilas®) treatment for central serous chorioretinopathy. Materials and methods Prospective study included 16 eyes of 15 subjects with nonresolving central serous chorioretinopathy. Fluorescein-angiography guided Navilas® treatment was performed. Pre- and posttreatment best-corrected visual acuity, pre- and posttreatment central macular thickness, number of leaks on fluorescein angiography, and various treatment parameters were analyzed. Pain experience was evaluated using the visual analog pain scale. Results Sixteen eyes from 15 subjects (mean age 42.2±9.9 years) were analyzed. Mean duration of symptoms was 11.45±6.6 months. Average number of leaks per eye was 2.8 and one laser spot per leak was performed. There was complete resolution of subretinal fluid in 15 out of 16 eyes at 2 months. Average visual analog pain scale score was 0.63±1.41. Conclusion Navilas® without a contact lens achieved resolution of subretinal fluid with a single laser spot for each single leak and minimum iatrogenic damage.
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Affiliation(s)
- Jay Chhablani
- Srimati Kanuri Santhamma Vitreo-Retina Service, L V Prasad Eye Institute, Hyderabad, India
| | - Padmaja Kumari Rani
- Srimati Kanuri Santhamma Vitreo-Retina Service, L V Prasad Eye Institute, Hyderabad, India
| | - Annie Mathai
- Srimati Kanuri Santhamma Vitreo-Retina Service, L V Prasad Eye Institute, Hyderabad, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Vitreo-Retina Service, L V Prasad Eye Institute, Hyderabad, India
| | - Igor Kozak
- Division of Vitreoretinal Diseases and Surgery, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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Park YG, Seifert E, Roh YJ, Theisen-Kunde D, Kang S, Brinkmann R. Tissue response of selective retina therapy by means of a feedback-controlled energy ramping mode. Clin Exp Ophthalmol 2014; 42:846-55. [PMID: 24698550 DOI: 10.1111/ceo.12342] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/27/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate the safety and selectivity of the retinal pigment epithelium lesions by using automatic energy ramping and dosimetry technique for selective retina therapy and to investigate the healing response. METHODS Ten eyes of Chinchilla Bastard rabbits were treated with an automatic dosage controlled selective retina therapy laser (frequency doubled Q-switched Nd:YLF, wavelength: 527 nm, pulse duration: 1.7 μs, repetition rate: 100 Hz, pulse energy: linear increasing from pulse to pulse up to shut down - maximal 110 μJ, max. number of pulses in a burst: 30, retinal spot diameter: 133 μm). After treatment, fundus photography, optical coherence tomography and fluorescein angiography were performed at three time points from 1 h to 3 weeks. Histological analysis was performed. RESULTS A total of 381 selective retina therapy laser spots were tested (range 13-104 μJ).Typical fundus photographs obtained at 1 h after irradiation showed that 379 out of 381 lesions produced by selective retina therapy were not visible ophthalmoscopically and the lesions could be detected by angiography only. Optical coherence tomography images revealed that the structure of photoreceptors was preserved, but a disrupted retinal pigment epithelium layer was observed as was expected. By 3 weeks, histology showed selective retinal pigment epithelium damage without any effect on the inner retina and focal proliferation of the retinal pigment epithelium layer. CONCLUSIONS Automatically controlled selective retina therapy is a significant improvement in this innovative treatment. It could be demonstrated that the non-contact, reflectometric technique with a controlled pulse energy ramp is safe and selective.
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Affiliation(s)
- Young-Gun Park
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Liegl R, Ulbig MW. Central Serous Chorioretinopathy. Ophthalmologica 2014; 232:65-76. [DOI: 10.1159/000360014] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/18/2014] [Indexed: 11/19/2022]
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Maier M, Stumpfe S, Feucht N, Strobl P, Rath V, Lohmann C. Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa. Ophthalmologe 2014; 111:173-80. [DOI: 10.1007/s00347-013-3001-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Beger I, Koss MJ, Koch F. [Treatment of central serous chorioretinopathy: MicroPulse photocoagulation versus bevacizumab]. Ophthalmologe 2013; 109:1224-32. [PMID: 23053340 DOI: 10.1007/s00347-012-2688-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to evaluate the treatment of central serous chorioretinopathy (CSC) with either subthreshold diode-laser MicroPulse (MP) or intravitreal bevacizumab (BCZ) using the Pro Re Nata (PRN) scheme. METHODS This comparative, controlled, prospective study over 10 months examined 52 eyes of 52 patients with either (a) treatment with MP at the active leakage site guided by fluorescein angiography (FA) (n=16 eyes), (b) intravitreal injection of 1.25 mg BCZ (n=10 eyes) or (c) passive observation (n=26 eyes). Outcome measures included changes in retinal pigment epithelium (RPE) leakage at FA, central macular thickness (CMT), best corrected visual acuity (BCVA) and 10° macular perimetry. RESULTS At the end of the study there was a 12.5 % persistent leakage in the MP group compared to 60 % in the BCZ group and 92 % in the control group. Mean CMT decreased by 94 µm in the MP, 38 µm in the BCZ and did not change in the control group. Mean BCVA improved by six ETDRS letters in the MP, decreased by one letter in the BCZ and by 2 letters in the control group. In the MP group mean perimetric deficit improved by 1.5 decibels and corrected lost variance by 2.6. In the BCZ it improved by 0.6 and by 0.5 in the control group. Retreatment was required in 7 out of 16 eyes of the SDM (43.75 %), and in 5 out of 10 eyes of the BCZ group (50 %). CONCLUSIONS MP photocoagulation was superior to intravitreal injections of 1.25 mg BCZ in the treatment of CSC which resulted in enhanced visual acuity and macular perimetry.
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Affiliation(s)
- I Beger
- Studienzentrum Retina, Klinik für Glaskörper und Netzhautchirurgie, Zentrum der Augenheilkunde, Klinikum der Johann Wolfgang Goethe-Universität, Theodor Stern Kai 7 (Haus 7c), 60590, Frankfurt am Main, Deutschland.
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Long-term safety, high-resolution imaging, and tissue temperature modeling of subvisible diode micropulse photocoagulation for retinovascular macular edema. Retina 2012; 32:375-86. [PMID: 21971077 DOI: 10.1097/iae.0b013e3182206f6c] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine the long-term safety of high-density subvisible diode micropulse photocoagulation (810 nm), compare the clinical findings with computational modeling of tissue hyperthermia and to report results for a subset of eyes treated for diabetic macular edema (ME) documented pre- and postoperatively by spectral-domain optical coherence tomography. METHOD All eyes treated for ME from diabetic retinopathy (diabetic ME) and branch retinal vein occlusion between April 2000 and January 2010 were reviewed for subvisible diode micropulse laser-induced retinal damage. Therapeutic outcomes were reviewed for a subgroup treated for diabetic ME with pre- and postoperative spectral-domain optical coherence tomography. Laser-induced retinal thermal effects were modeled computationally using Arrhenius formalism. RESULTS A total of 252 eyes (212 diabetic ME, 40 branch retinal vein occlusion) of 181 patients qualified. None of the 168 eyes treated at irradiance <350 W/cm2 and 7 of 84 eyes at ≥ 590 W/cm2 had retinal damage (P = 0.0001) (follow-up 3-120 months, median, 47). Sixty-two eyes of 48 patients treated for diabetic ME with pre- and postoperative spectral-domain optical coherence tomography with median 12 months follow-up had no retinal injury by infrared, red-free, or fundus autofluorescence photos; fluorescein angiography or indocyanine green angiography; or spectral-domain optical coherence tomography. Central foveal thickness (P = 0.04) and maximum macular thickness decreased (P < 0.0001). Modeling of retinal hyperthermia demonstrates that the sublethal clinical regimen corresponds to Arrhenius integral >0.05, while damage is likely to occur if it exceeds 1. CONCLUSION Subvisible diode micropulse can effectively treat retinovascular ME without laser-induced retinal damage, consistent with Arrhenius modeling of pulsed hyperthermia.
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