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Toto L, Ares I, Quarta A, Viggiano P, Ruggeri M, Formenti F, Boscia G, Porreca A, Di Nicola M, Boscia F, Mastropasqua R. Visual and anatomical evaluation of navigated subthreshold micropulse laser versus photodynamic therapy in managing chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06666-9. [PMID: 39425791 DOI: 10.1007/s00417-024-06666-9] [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: 04/03/2024] [Revised: 09/16/2024] [Accepted: 10/12/2024] [Indexed: 10/21/2024] Open
Abstract
PURPOSE To compare the visual and anatomical results of navigated subthreshold micropulse laser (nSML) and photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSCR). METHODS Patients who underwent either half-dose PDT or nSML for the management of chronic CSCR were included in this study. Comprehensive ophthalmic examination, fundus autofluorescence, and spectral domain optical coherence tomography (SD-OCT) were performed at baseline and at 1-, 3-, and 6-month follow-up visits after nSML or PDT. Fluorescein angiography and indocyanine green angiography were performed only at baseline. Main outcome measures were best corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and choroidal vascularization index (CVI) that were collected at baseline and at each follow-up visit for up to 6 months. RESULTS Forty-two eyes of 42 patients (PDT group-20 eyes, nSML group-22 eyes) affected by chronic CSCR were enrolled. At 6-month follow-up, no significant differences were observed between the nSML group compared to the PDT group in BCVA (0.10 [0.00; 0.20]) and 0.10 [0.10; 0.10], respectively, p=0.69, and between some OCT parameters, namely CMT and CVI. SFCT was significantly reduced in the PDT group more than in the nSML group (p=0.01). Twelve eyes (60%) in the PDT group had complete resolution of the SRF at 6 months compared to 8 eyes (36.4%) in the nSML group, but the difference was not statistically significant (p=0.14). CONCLUSION Results from patients treated with PDT and nSML showed that, at 6 months, no significant differences except for choroidal thickness. nSML is less invasive than PDT and can be used as an effective alternative to PDT. KEY MESSAGES WHAT IS KNOWN : Treating chronic CSCR is a therapeutic conundrum for clinicians because of a lack of definitive consensus over remediation options, two of which are photodynamic therapy (PDT) and navigated subthreshold micropulse laser (nSML) therapy. THIS STUDY SHOWS Results from patients treated with PDT and nSML showed no significant differences except for choroidal thickness. Even though patients treated with PDT recovered more quickly, retreatment was necessary due to fluid recollection. Although patients treated with nSML also needed retreatment, nSML is less invasive than PDT and can be used as an effective alternative to PDT.
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Affiliation(s)
- Lisa Toto
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. D'Annunzio Chieti-Pescara, Viale Abruzzo, 322, 66100, Chieti, CH, Italy
| | - Ignacio Ares
- Department of Ophthalmological Research Science, Potsdamer Augenklinik im Albrecht-von-Graefe-Haus GmbH, Hans-Thoma-Straße 11/2, 14467, Potsdam, OG, Germany
| | - Alberto Quarta
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. D'Annunzio Chieti-Pescara, Viale Abruzzo, 322, 66100, Chieti, CH, Italy.
| | - Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Umberto I, 1, 70121, Bari, BA, Italy
| | - Marialudovica Ruggeri
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. D'Annunzio Chieti-Pescara, Viale Abruzzo, 322, 66100, Chieti, CH, Italy
| | - Federico Formenti
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. D'Annunzio Chieti-Pescara, Viale Abruzzo, 322, 66100, Chieti, CH, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Umberto I, 1, 70121, Bari, BA, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, CH, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, CH, Italy
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Piazza Umberto I, 1, 70121, Bari, BA, Italy
| | - Rodolfo Mastropasqua
- Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, CH, Italy
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Nagel I, Mueller A, Freeman WR, Kozak I. Laser-Based Therapy Approaches in the Retina: A Review of Micropulse Laser Therapy for Diabetic Retinopathy. Klin Monbl Augenheilkd 2024. [PMID: 39389554 DOI: 10.1055/a-2418-5173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
PURPOSE This review aims to elucidate the mechanisms and clinical utility of subthreshold micropulse laser (SML) therapy in the context of retinal care. Subthreshold or "nondestructive" laser therapy encompasses treatment modalities that induce minimal or no harm to retinal or choroidal tissue and leave no visible sings post-application, while achieving clinical efficacy. METHODS A comprehensive review of literature sourced from databases including PubMed, Medline, Embase, Cochrane, and Web of Science was conducted, focusing on articles published before February 2024, and discussing the contemporary use of SML therapy in treating diabetic retinopathy (DR). RESULTS The review presents evidence from scientific literature supporting SML therapy as a viable therapeutic approach for management of DR. Across numerous studies, SML therapy has demonstrated safety and additional therapeutic efficacy without causing damage to underlying retinal tissue. CONCLUSION Subthreshold laser treatment emerges as a safe strategy for addressing DR. Numerous studies have shown its additional efficacy to anti-VEGF pharmacotherapy, which is the currently approved monotherapy for complications of DR. Ongoing research and clinical investigations aim to further elucidate the mechanisms and optimize the therapeutic advantages of this technology.
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Affiliation(s)
- Ines Nagel
- Jacobs Retina Center, University of California San Diego, La Jolla, California, United States
| | | | - William R Freeman
- Jacobs Retina Center, University of California San Diego, La Jolla, California, United States
| | - Igor Kozak
- Ophthalmology, Moorfields Eye Hospital Dubai, Abu Dhabi, United Arab Emirates
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von der Burchard C, Miura Y, Stanzel B, Chhablani J, Roider J, Framme C, Brinkmann R, Tode J. Regenerative Retinal Laser and Light Therapies (RELITE): Proposal of a New Nomenclature, Categorization, and Trial Reporting Standard. Lasers Surg Med 2024; 56:693-708. [PMID: 39210705 DOI: 10.1002/lsm.23833] [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: 01/24/2024] [Revised: 05/25/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Numerous laser and light therapies have been developed to induce regenerative processes in the choroid/retinal pigment epithelium (RPE)/photoreceptor complex, leaving the neuroretina undamaged. These therapies are applied to the macula for the treatment of various diseases, most prominently diabetic maculopathy, retinal vein occlusion, central serous chorioretinopathy, and age-related macular degeneration. However, the abundance of technologies, treatment patterns, and dosimetry protocols has made understanding these therapies and comparing different approaches increasingly complex and challenging. To address this, we propose a new nomenclature system with a clear categorization that will allow for better understanding and comparability between different laser and light modalities. We propose this nomenclature system as an open standard that may be adapted in future toward new technical developments or medical advancements. METHODS A systematic literature review of reported macular laser and light therapies was conducted. A categorization into a standardized system was proposed and discussed among experts and professionals in the field. This paper does not aim to assess, compare, or evaluate the efficacy of different laser or dosimetry techniques or treatment patterns. RESULTS The literature search yielded 194 papers describing laser techniques, 50 studies describing dosimetry, 272 studies with relevant clinical trials, and 82 reviews. Following the common therapeutic aim, we propose "regenerative retinal laser and light therapies (RELITE)" as the general header. We subdivided RELITE into four main categories that refer to the intended physical and biochemical effects of temperature increase (photothermal therapy, PTT), RPE regeneration (photomicrodisruption therapy, PMT), photochemical processes (photochemical therapy, PCT), and photobiomodulation (photobiomodulation therapy, PBT). Further, we categorized the different dosimetry approaches and treatment regimens. We propose the following nomenclature system that integrates the most important parameters to enable understanding and comparability: Pattern-Dosimetry-Exposure Time/Frequency, Duty Cycle/Irradiation Diameter/Wavelength-Subcategory-Category. CONCLUSION Regenerative retinal laser and light therapies are widely used for different diseases and may become valuable in the future. A precise nomenclature system and strict reporting standards are needed to allow for a better understanding, reproduceable and comparable clinical trials, and overall acceptance. We defined categories for a systematic therapeutic goal-based nomenclature to facilitate future research in this field.
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Affiliation(s)
- Claus von der Burchard
- Department of Ophthalmology, University of Kiel, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Yoko Miura
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
- Department of Ophthalmology, University of Luebeck, University Medical Center of Schleswig-Holstein, Luebeck, Germany
| | - Boris Stanzel
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Carsten Framme
- Hannover Medical School, University Eye Clinic, Hannover, Germany
| | - Ralf Brinkmann
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
- Medical Laser Center Luebeck, Luebeck, Germany
| | - Jan Tode
- Hannover Medical School, University Eye Clinic, Hannover, Germany
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Luttrull JK, Tzekov R, Bhavan SV. Progressive Thickening of Retinal Nerve Fiber and Ganglion Cell Complex Layers Following SDM Laser Vision Protection Therapy in Open-Angle Glaucoma. Ophthalmol Ther 2024:10.1007/s40123-024-01029-3. [PMID: 39298093 DOI: 10.1007/s40123-024-01029-3] [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: 07/29/2024] [Accepted: 08/29/2024] [Indexed: 09/21/2024] Open
Abstract
INTRODUCTION This work aims to determine the effect on nerve fiber layer (NFL) and ganglion cell complex (GCC) thickness trends in eyes with open-angle glaucoma (OAG) treated with Vision Protection Therapy™ (VPT). METHODS A retrospective analysis of spectral-domain optical coherence tomography (OCT) measured NFL and GCC thickness trends was performed, excluding eyes with poor-quality scans and principal diagnoses other than OAG. This study compares eyes with OAG managed conventionally with IOP control alone (controls) to eyes managed with the addition of VPT (VPT eyes). The direction (+ or -) and magnitude (microns/year) of the OCT trends were the study endpoints. RESULTS Seventy-eight control eyes of 40 patients and 61 VPT-treated eyes of 39 patients were included in the study. Positive NFL trends were noted in 5% of control eyes vs. 71% of VPT eyes (p < 0.0001). Positive GCC trends were noted in 8% of control eyes vs. 43% of VPT eyes (p < 0.0001). Mean NFL trends (µm/year) were - 0.692 for controls vs. 0.347 for VPT (p < 0.0001). Mean GCC trends (µm/year) were - 0.554 for controls vs. - 0.148 for VPT (p = 0.0175). CONCLUSIONS The addition of VPT to the conventional management of OAG resulted in highly significant improvements in NFL and GCC trends, indicating a reversal of key indicators of glaucoma severity and progression.
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Affiliation(s)
- Jeffrey K Luttrull
- Ventura County Retina Vitreous Medical Group, 3160 Telegraph Rd, Suite 230, Ventura, CA, 93003, USA.
- Ventura County Retina Vitreous Medical Group, Ventura, California, USA.
| | - Radouil Tzekov
- Department of Ophthalmology, School of Medicine, University of South Florida, Tampa, FL, USA
| | - Sathy V Bhavan
- Ventura County Retina Vitreous Medical Group, Ventura, California, USA
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Modrzejewska M, Zdanowska O. The Role of Heat Shock Protein 70 (HSP70) in the Pathogenesis of Ocular Diseases-Current Literature Review. J Clin Med 2024; 13:3851. [PMID: 38999417 PMCID: PMC11242833 DOI: 10.3390/jcm13133851] [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: 06/05/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Heat shock proteins (HSPs) have been attracting the attention of researchers for many years. HSPs are a family of ubiquitous, well-characterised proteins that are generally regarded as protective multifunctional molecules that are expressed in response to different types of cell stress. Their activity in many organs has been reported, including the heart, brain, and retina. By acting as chaperone proteins, HSPs help to refold denatured proteins. Moreover, HSPs elicit inhibitory activity in apoptotic pathways and inflammation. Heat shock proteins were originally classified into several subfamilies, including the HSP70 family. The aim of this paper is to systematise information from the available literature about the presence of HSP70 in the human eye and its role in the pathogenesis of ocular diseases. HSP70 has been identified in the cornea, lens, and retina of a normal eye. The increased expression and synthesis of HSP70 induced by cell stress has also been demonstrated in eyes with pathologies such as glaucoma, eye cancers, cataracts, scarring of the cornea, ocular toxpoplasmosis, PEX, AMD, RPE, and diabetic retinopathy. Most of the studies cited in this paper confirm the protective role of HSP70. However, little is known about these molecules in the human eye and their role in the pathogenesis of eye diseases. Therefore, understanding the role of HSP70 in the pathophysiology of injuries to the cornea, lens, and retina is essential for the development of new therapies aimed at limiting and/or reversing the processes that cause damage to the eye.
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Affiliation(s)
- Monika Modrzejewska
- 2nd Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Oliwia Zdanowska
- K. Marcinkowski University Hospital, 65-046 Zielona Góra, Poland
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Kaderli ST, Karalezli A, Kaderli A, Taskin SC, Sul S. Evaluation of the choroidal vascularity index after subthreshold yellow laser treatment in the patients with chronic central serous chorioretinopathy. Eye (Lond) 2022; 36:1826-1831. [PMID: 35562549 PMCID: PMC9391343 DOI: 10.1038/s41433-022-02090-7] [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: 11/27/2021] [Revised: 04/02/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the choroidal vascularity index (CVI) after subthreshold laser treatment in patients with central serous chorioretinopathy (CSC). METHOD A total of 32 eyes with CSC were included in this study. In group 1, 14 eyes with persistent CSC were treated with the PASCAL (Endpoint Management Software) at 577-nm wavelength and in group 2, 18 eyes without treatment. The luminal area (LA), stromal area (SA), total area of choroid (TA), and CVI were measured by binarization (ImageJ) of optical coherence tomography images. Changes of choroidal structure parameters were evaluated over 3 months. RESULT A significant decrease was observed in LA, TA, and CVI at the third month after the laser treatment (p = 0.018, p = 0.024, p = 0.046). The best-corrected visual acuity (BCVA) and choriocapillaris plexus (CCP) flow area values were increased after treatment in group 1 (p < 0.001, p = 0.002). The final subfoveal fluid height, and CVI were lower in group 1 (p = 0.003, p = 0.011). The visual acuity and CCP flow area were higher in group 1 at the third month (p < 0.001, p = 0.003). A positive correlation between the final BCVA and CVI was observed (r = 0.539, p = 0.01). DISCUSSION Decreased CVI was observed in CSC eyes after subthreshold yellow laser treatment. The CVI may be a useful index to evaluate the response to treatment.
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Affiliation(s)
- Sema Tamer Kaderli
- Ophthalmology Department, Mugla Education and Training Hospital, Muğla, Turkey.
| | - Aylin Karalezli
- Ophthalmology Department, Mugla Sitki Kocman University, Mugla, Turkey
| | - Ahmet Kaderli
- Ophthalmology Department, Mugla Sitki Kocman University, Mugla, Turkey
| | - Simay Can Taskin
- Ophthalmology Department, Mugla Sitki Kocman University, Mugla, Turkey
| | - Sabahattin Sul
- Ophthalmology Department, Mugla Sitki Kocman University, Mugla, Turkey
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Differential gene expression analysis using RNA sequencing: retinal pigment epithelial cells after exposure to continuous-wave and subthreshold micropulse laser. Jpn J Ophthalmol 2022; 66:487-497. [PMID: 35639223 DOI: 10.1007/s10384-022-00925-0] [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: 11/05/2021] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Subthreshold micropulse laser (SMPL) is more clinically efficient for the treatment of diabetic macular edema (DME) than the conventional continuous-wave (CW) laser. We aimed to characterize transcriptome changes after the application of these lasers and to compare the transcripts. METHODS Human pluripotent stem cell-derived retinal pigment epithelial cells were exposed to laser irradiation. Differentially expressed genes (DEGs), distribution of heat shock protein (Hsp) family, gene expression profile, and gene ontology (GO) enrichment analysis based on RNA sequencing data were investigated at 3 h and 24 h after irradiation. RESULTS CW laser induced more DEGs than SMPL (1771 vs. 520 genes). The expression of the Hsp family was confirmed in both groups: however, the induction patterns was different for different genes. GO enrichment analysis revealed that CW laser upregulated the expression of DEGs involved in vasculature development (GO: 0001944), related to apoptosis and repair after cell injury whereas SMPL upregulated the expression of DEGs involved in photoreceptor cell maintenance (GO: 0045494), photoreceptor cell development (GO: 0042461), and sensory perception of light stimuli (GO: 0050953). CONCLUSIONS The results provide insights into the genetic responses and may contribute to the understanding of the molecular mechanisms of laser-induced thermal effects.
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Hormetic Heat Shock Enhances Autophagy through HSF1 in Retinal Pigment Epithelium Cells. Cells 2022; 11:cells11111778. [PMID: 35681472 PMCID: PMC9179435 DOI: 10.3390/cells11111778] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/18/2023] Open
Abstract
To maintain homeostasis, cells have evolved stress-response pathways to cope with exogenous and endogenous stress factors. Diverse stresses at high doses may be detrimental, albeit low doses of stress, known as hormesis, can be beneficial. Upon exposure to stress, such as temperature rise, the conventional heat shock response (HSR) regulated by the heat shock transcription factor 1 (HSF1) facilitates refolding of misfolded proteins with the help of heat shock proteins (HSPs). However, the role and molecular mechanisms underlying the beneficial effects of HSR with other clearance processes, such as autophagy, remain poorly understood. In this study, human ARPE-19 cells, an in vitro model of retinal pigment epithelium, were treated with hormetic heat shock (HHS) and the autophagy expression profile was examined using quantitative PCR (qPCR), immunoblotting, immunoprecipitation, and immunofluorescence. We demonstrate that HHS enhances the expression of fundamental autophagy-associated genes in ARPE-19 cells through the activation of HSF1. HHS transiently increases the level of SQSTM1 and LC3B-II and activates autophagy. These findings reveal a role for autophagic HSF1-regulated functions and demonstrate the contribution of autophagy to hormesis in the HSR by improving proteostasis.
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Richert E, Papenkort J, von der Burchard C, Klettner A, Arnold P, Lucius R, Brinkmann R, Framme C, Roider J, Tode J. Selective retina therapy and thermal stimulation of the retina: different regenerative properties - implications for AMD therapy. BMC Ophthalmol 2021; 21:412. [PMID: 34847865 PMCID: PMC8630886 DOI: 10.1186/s12886-021-02188-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Selective Retina Therapy (SRT), a photodisruptive micropulsed laser modality that selectively destroys RPE cells followed by regeneration, and Thermal Stimulation of the Retina (TSR), a stimulative photothermal continuous wave laser modality that leads to an instant sublethal temperature increase in RPE cells, have shown therapeutic effects on Age-related Macular Degeneration (AMD) in mice. We investigate the differences between both laser modalities concerning RPE regeneration. METHODS For PCR array, 6 eyes of murine AMD models, apolipoprotein E and nuclear factor erythroid-derived 2- like 2 knock out mice respectively, were treated by neuroretina-sparing TSR or SRT. Untreated litter mates were controls. Eyes were enucleated either 1 or 7 days after laser treatment. For morphological analysis, porcine RPE/choroid organ cultures underwent the same laser treatment and were examined by calcein vitality staining 1 h and 1, 3 or 5 days after irradiation. RESULTS TSR did not induce the expression of cell-mediators connected to cell death. SRT induced necrosis associated cytokines as well as inflammation 1 but not 7 days after treatment. Morphologically, 1 h after TSR, there was no cell damage. One and 3 days after TSR, dense chromatin and cell destruction of single cells was seen. Five days after TSR, there were signs of migration and proliferation. In contrast, 1 h after SRT a defined necrotic area within the laser spot was seen. This lesion was closed over days by migration and proliferation of adjacent cells. CONCLUSIONS SRT induces RPE cell death, followed by regeneration within a few days. It is accompanied by necrosis induced inflammation, RPE proliferation and migration. TSR does not induce immediate RPE cell death; however, migration and mitosis can be seen a few days after laser irradiation, not accompanied by necrosis-associated inflammation. Both might be a therapeutic option for the treatment of AMD.
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Affiliation(s)
- Elisabeth Richert
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Julia Papenkort
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Claus von der Burchard
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Alexa Klettner
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Philipp Arnold
- Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Germany
| | - Ralph Lucius
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Kiel, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute for Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Carsten Framme
- Department of Ophthalmology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany. .,Department of Ophthalmology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Kaikkonen O, Turunen TT, Meller A, Ahlgren J, Koskelainen A. Retinal temperature determination based on photopic porcine electroretinogram. IEEE Trans Biomed Eng 2021; 69:991-1002. [PMID: 34506274 DOI: 10.1109/tbme.2021.3111533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Subthreshold retinal laser therapy (SLT) is a treatment modality where the temperature of the retinal pigment epithelium (RPE) is briefly elevated to trigger the therapeutic benefits of sublethal heat shock. However, the temperature elevation induced by a laser exposure varies between patients due to individual differences in RPE pigmentation and choroidal perfusion. This study describes an electroretinography (ERG)-based method for controlling the temperature elevation during SLT. METHODS The temperature dependence of the photopic ERG response kinetics were investigated both ex vivo with isolated pig retinas and in vivo with anesthetized pigs by altering the temperature of the subject and recording ERG in different temperatures. A model was created for ERG-based temperature estimation and the feasibility of the model for controlling SLT was assessed through computational simulations. RESULTS The kinetics of the photopic in vivo flash ERG signaling accelerated between 3.6 and 4.7%/C, depending on the strength of the stimulus. The temperature dependence was 5.0%/C in the entire investigated range of 33 to 44C in ex vivo ERG. The simulations showed that the method is suitable for determining the steady-state temperature elevation in SLT treatments with a sufficiently long laser exposure and large spot size, e.g., during > 30 s laser exposures with > 3 mm stimulus spot diameter. CONCLUSIONS The described ERG-based temperature estimation model could be used to control SLT treatments such as transpupillary thermotherapy. SIGNIFICANCE The introduced ERG-based method for controlling SLT could improve the repeatability, safety, and efficacy of the treatment of various retinal disorders.
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Wang Z, Feng C, Yang R, Liu T, Chen Y, Chen A, Yan B, Yuan Y, Zhang J. Large-Area Photoreceptor Degeneration Model in Rabbits by Photocoagulation and Oxidative Stress in the Retina. Front Neurosci 2021; 15:617175. [PMID: 34177442 PMCID: PMC8222581 DOI: 10.3389/fnins.2021.617175] [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: 10/14/2020] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
Photocoagulation is used for the treatment of retinal ischemic disease. However, due to the invasive nature of photocoagulation and variety of melanin concentrations between individuals, it is challenging to avoid damaging the adjacent photoreceptors and inducing several side effects. Previous studies indicate the role of laser power, duration, and spot size on retinal lesions, but the effect of interspot distance of the laser pulses needs to be considered in panretinal photocoagulation. In this study, we examine different parameters of photocoagulation on lesions of the retina in rabbit, finding that the lesion level of the outer nuclear layer of the retina depended on the pulse duration and laser spot size, and decreasing interspot distance could completely abolish the photoreceptor layer. The degeneration of the photoreceptor by photocoagulation occurred in 24 h and was not restored afterward. We then conducted panretinal photocoagulation in rabbit and found that oxidative stress was decreased in the inner nuclear layer of the retina, and pupillary light reflex and ERG signals were impaired. Our study could provide a rabbit model to explore the mechanism of photoreceptor degeneration and therapies for the side effects after photocoagulation.
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Affiliation(s)
- Zhexuan Wang
- State Key Laboratory of Medical Neurobiology, Department of Ophthalmology, MOE Frontiers Center for Brain Science, Zhongshan Hospital, Institute for Brain Science, Fudan University, Shanghai, China.,Department of Ophthalmology, Eye and Ent Hospital of Fudan University, Shanghai, China
| | - Chenli Feng
- State Key Laboratory of Medical Neurobiology, Department of Ophthalmology, MOE Frontiers Center for Brain Science, Zhongshan Hospital, Institute for Brain Science, Fudan University, Shanghai, China.,Department of Ophthalmology, Eye and Ent Hospital of Fudan University, Shanghai, China
| | - Ruyi Yang
- State Key Laboratory of Medical Neurobiology, Department of Ophthalmology, MOE Frontiers Center for Brain Science, Zhongshan Hospital, Institute for Brain Science, Fudan University, Shanghai, China.,Department of Ophthalmology, Eye and Ent Hospital of Fudan University, Shanghai, China
| | - Tingting Liu
- Department of Ophthalmology, Eye and Ent Hospital of Fudan University, Shanghai, China
| | - Yin Chen
- Key Laboratory of Brain Functional Genomics, Primate Research Center, East China Normal University, Shanghai, China
| | - Aihua Chen
- Key Laboratory of Brain Functional Genomics, Primate Research Center, East China Normal University, Shanghai, China
| | - Biao Yan
- State Key Laboratory of Medical Neurobiology, Department of Ophthalmology, MOE Frontiers Center for Brain Science, Zhongshan Hospital, Institute for Brain Science, Fudan University, Shanghai, China
| | - Yuanzhi Yuan
- State Key Laboratory of Medical Neurobiology, Department of Ophthalmology, MOE Frontiers Center for Brain Science, Zhongshan Hospital, Institute for Brain Science, Fudan University, Shanghai, China
| | - Jiayi Zhang
- State Key Laboratory of Medical Neurobiology, Department of Ophthalmology, MOE Frontiers Center for Brain Science, Zhongshan Hospital, Institute for Brain Science, Fudan University, Shanghai, China
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Prasuhn M, Miura Y, Tura A, Rommel F, Kakkassery V, Sonntag S, Grisanti S, Ranjbar M. Influence of Retinal Microsecond Pulse Laser Treatment in Central Serous Chorioretinopathy: A Short-Term Optical Coherence Tomography Angiography Study. J Clin Med 2021; 10:jcm10112418. [PMID: 34072472 PMCID: PMC8198696 DOI: 10.3390/jcm10112418] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Central serous chorioretinopathy (CSC) is a common macular condition characterized by detachment of the neuroretina and is a frequent cause of central vision loss in adults. Among the various therapeutic strategies, subthreshold microsecond pulsed laser (SML) treatment has become a useful option. Despite the suggested involvement of choroidal circulatory disturbances in CSC, the effects of this treatment on macular microperfusion have not been fully evaluated yet. Herein, we report the impact of SML on retinal and choroidal microvascular flow using non-invasive optical coherence tomography (OCT) angiography (OCTA). Methods: In this study, CSC patients with persistent subretinal fluid (SRF) with or without secondary choroidal neovascularization (CNV) were included (referred to as the pachychoroid neovasculopathy (PNV) group and the CSC group, respectively). SML was conducted using a yellow (577 nm) laser with a duty cycle of 10%, spot size of 200 µm and duration of 200 ms. Best corrected visual acuity (BCVA) as well as OCT and OCTA images were evaluated at baseline and 4 weeks after SML. OCTA parameters of interest included full retinal perfusion (FRP), choriocapillaris perfusion (CCP), Sattler’s layer perfusion (SLP), and Haller’s layer perfusion (HLP), which were evaluated longitudinally and compared to unaffected fellow eyes. Results: 27 affected eyes and 17 fellow eyes from 27 patients were included. Before treatment, central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) of affected eyes were significantly larger than in fellow eyes. Four weeks after SML, CRT decreased significantly, whereas perfusion parameters did not change. In subgroup analyses, the CSC group showed a significant decrease in SFCT, whereas the PNV group did not despite the decrease in CRT. Conclusion: Our results suggest that the SML may affect the SFCT of the CSC, but not the PNV patients at least within four weeks following treatment. This effect seems to be independent of the change in choroidal perfusion measured with OCTA.
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Affiliation(s)
- Michelle Prasuhn
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (A.T.); (F.R.); (V.K.); (S.S.); (S.G.); (M.R.)
- Laboratory for Angiogenesis & Ocular Cell Transplantation, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Correspondence: (M.P.); (Y.M.); Tel.: +49-451-3101-3212 (Y.M.)
| | - Yoko Miura
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (A.T.); (F.R.); (V.K.); (S.S.); (S.G.); (M.R.)
- Institute of Biomedical Optics, University of Lübeck, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Correspondence: (M.P.); (Y.M.); Tel.: +49-451-3101-3212 (Y.M.)
| | - Aysegül Tura
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (A.T.); (F.R.); (V.K.); (S.S.); (S.G.); (M.R.)
| | - Felix Rommel
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (A.T.); (F.R.); (V.K.); (S.S.); (S.G.); (M.R.)
- Laboratory for Angiogenesis & Ocular Cell Transplantation, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (A.T.); (F.R.); (V.K.); (S.S.); (S.G.); (M.R.)
| | - Svenja Sonntag
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (A.T.); (F.R.); (V.K.); (S.S.); (S.G.); (M.R.)
| | - Salvatore Grisanti
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (A.T.); (F.R.); (V.K.); (S.S.); (S.G.); (M.R.)
| | - Mahdy Ranjbar
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (A.T.); (F.R.); (V.K.); (S.S.); (S.G.); (M.R.)
- Laboratory for Angiogenesis & Ocular Cell Transplantation, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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13
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Wood JPM, Tahmasebi M, Casson RJ, Plunkett M, Chidlow G. Physiological response of the retinal pigmented epithelium to 3-ns pulse laser application, in vitro and in vivo. Clin Exp Ophthalmol 2021; 49:454-469. [PMID: 33904222 DOI: 10.1111/ceo.13931] [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: 12/03/2020] [Revised: 03/30/2021] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To treat healthy retinal pigmented epithelium (RPE) with the 3-ns retinal rejuvenation therapy (2RT) laser and to investigate the subsequent wound-healing response of these cells. METHODS Primary rat RPE cells were treated with the 2RT laser at a range of energy settings. Treated cells were fixed up to 7 days post-irradiation and assessed for expression of proteins associated with wound-healing. For in vivo treatments, eyes of Dark Agouti rats were exposed to laser and tissues collected up to 7 days post-irradiation. Isolated wholemount RPE preparations were examined for structural and protein expression changes. RESULTS Cultured RPE cells were ablated by 2RT laser in an energy-dependent manner. In all cases, the RPE cell layer repopulated completely within 7 days. Replenishment of RPE cells was associated with expression of the heat shock protein, Hsp27, the intermediate filament proteins, vimentin and nestin, and the cell cycle-associated protein, cyclin D1. Cellular tight junctions were lost in lased regions but re-expressed when cell replenishment was complete. In vivo, 2RT treatment gave rise to both an energy-dependent localised denudation of the RPE and the subsequent repopulation of lesion sites. Cell replenishment was associated with the increased expression of cyclin D1, vimentin and the heat shock proteins Hsp27 and αB-crystallin. CONCLUSIONS The 2RT laser was able to target the RPE both in vitro and in vivo, causing debridement of the cells and the consequent stimulation of a wound-healing response leading to layer reformation.
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Affiliation(s)
- John P M Wood
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Marzieh Tahmasebi
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Casson
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Malcolm Plunkett
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Glyn Chidlow
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Takashina H, Watanabe A, Komatsu K, Nakano T. Factors Influencing Threshold Energy in Subthreshold Photocoagulation for Diabetic Macular Edema. Clin Ophthalmol 2021; 15:1827-1830. [PMID: 33976530 PMCID: PMC8106463 DOI: 10.2147/opth.s309828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Subthreshold photocoagulation is one of the treatments for diabetic macular edema. However, the range of adequate laser energy that can be used for subthreshold photocoagulation is very restricted. Therefore, determination of the titration settings for the threshold energy is an essential part of the subthreshold-photocoagulation procedure. This study examined factors influencing the threshold energy used in subthreshold photocoagulation for diabetic macular edema. Methods For 20 consecutive cases (29 eyes) who had received treatment using Endpoint Management (EpM) between April 2019 and June 2020 for persistent diabetic macular edema after completion of panretinal photocoagulation, multiple regression analysis was used to examine factors influencing threshold energy. Results Analysis evaluating all the surgical procedures (n=150) determined there was statistical significance for a history of vitrectomy and cataract surgery, central macular thickness, interval from completion of panretinal photocoagulation, superior 6 mm subfield, and nasal 6 mm subfield. Further analysis examined surgical procedures that had been done in patients with a history of vitrectomy and cataract surgery (n=116). This analysis showed that central macular thickness, axial length, interval from completion of panretinal photocoagulation, and HbA1c were all statistically significant factors. Conclusion Threshold energy for diabetic macular edema was significantly influenced by a history of vitrectomy and cataract surgery, central macular thickness, and interval between the completion of panretinal photocoagulation and initial EpM. Transparency of ocular media and intraocular inflammation were speculated to be associated with these results.
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Affiliation(s)
| | - Akira Watanabe
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koji Komatsu
- Department of Ophthalmology, Tokyo Rosai Hospital, Tokyo, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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15
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Transient Increase and Delay of Multifocal Electroretinograms Following Laser Photocoagulations for Diabetic Macular Edema. J Clin Med 2021; 10:jcm10020357. [PMID: 33477886 PMCID: PMC7833362 DOI: 10.3390/jcm10020357] [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: 11/25/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The acute physiological changes induced by focal retinal photocoagulation (PC) have been largely unexplored. Methods: This was a case-series study. We recorded multifocal electroretinograms (mfERGs) just before PC, and mfERGs were also recorded 5′, 15′, one hour, 24 h, and one week after the PCs. Transient changes of mfERGs were analyzed in eyes which underwent PCs to treat diabetic macular edema. The mfERGs recorded from the predominantly irradiated area and that from non-irradiated areas were analyzed separately. Results: Fifteen eyes of 15 patients were included in this study. The mfERGs elicited from non-irradiated areas did not change after PC, but the mfERGs elicited from the irradiated area changed with time; the amplitude was larger at 60′ than that before (p < 0.05) and at 5′ after PC (p < 0.01) and significantly smaller at 24 h and 1 week than that before and at 60′ after the PC (p < 0.01). The implicit time was significantly prolonged after PC. mfERG on irradiated area with the severe diabetic change was less altered after PCs. Conclusions: The transient increase in the amplitude at 60′ likely resulted from a biological amplification of partially damaged cells adjacent to the PC spots. The mfERGs manifested the dynamic alterations of the retinal function following PCs.
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16
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Gawęcki M. Laser treatment in retinitis pigmentosa-a review. Lasers Med Sci 2020; 35:1663-1670. [PMID: 32435907 DOI: 10.1007/s10103-020-03036-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
Retinitis pigmentosa (RP) is a common inherited retinal disease for which effective treatment is not yet known. This review sought to analyze the available medical literature covering the efficacy of different forms of laser treatment for RP in laboratory and clinical trials. The PubMed database was searched using the following phrases: "laser photocoagulation", "subthreshold laser", "nanolaser", "micropulse laser", "retinitis pigmentosa", "rod-cone dystrophy", and "retinal dystrophy". Results were stratified as clinical or experimental studies. Six studies involving animal models and three studies involving human subjects that examined laser treatment in RP were found. Laboratory studies on rodents favored classic laser photocoagulation as the most effective therapy for slowing the progression of proto-oncogene tyrosine-protein kinase MER-related RP. Two clinical studies on humans suggested transient but robust functional benefits of subthreshold micropulse laser treatment in RP. The available material is too scarce to define laser treatment as a standard procedure to treat RP in humans. Nondamaging retinal laser therapy should be tested more intensively in clinical trials as there is no proven negative side effect of that treatment and the theoretical background, especially the chaperone and reparative roles of heat shock proteins elicited during the procedure, supports this form of RP management.
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Chang DB, Luttrull JK. Comparison of Subthreshold 577 and 810 nm Micropulse Laser Effects on Heat-Shock Protein Activation Kinetics: Implications for Treatment Efficacy and Safety. Transl Vis Sci Technol 2020; 9:23. [PMID: 32821495 PMCID: PMC7401905 DOI: 10.1167/tvst.9.5.23] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/10/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To compare the safety and efficacy of 810 versus 577 nm laser wavelengths for micropulse subthreshold (sublethal) laser treatment by mathematical analysis. Methods Two different representative laser parameter sets for micropulsed subthreshold diode laser treatment, one employing 810 nm and the other 577 nm, are compared with regard to efficacy by analysis of the kinetics of laser-induced heat-shock protein (HSP) activation; and for safety, by scaling law analysis. Results Kinetics analysis of laser-induced HSP activation shows that the primary therapeutic effect of laser is thermal incitement of a long-term wavelength-independent increase in the rate of HSP-mediated protein repair specific to sick and dysfunctional cells, rather than from short-term increases in free intracellular HSP concentrations. Scaling law analysis of the same 810 and 577 nm laser parameters, however, finds treatment safety highly wavelength-sensitive, favoring 810 over 577 nm. Conclusions Mathematical analyses of the effects retinal laser-induced HSP activation provide important insights into the mechanism of action and the importance of wavelength selection in modern retinal laser therapy. Our analyses find 810 and 577 nm to be equally effective, but 810 nm having a significantly wider therapeutic range/safety margin, and thus less likely to cause inadvertent, and thus unpredictable, laser-induced retinal damage, than 577 nm. Translational Relevance Mathematical analysis of enzyme reaction kinetics provides important insights into the mechanism of action and clinical implications of wavelength selection in modern retinal laser therapy.
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18
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Induction of Heat Shock Protein 70 in Mouse RPE as an In Vivo Model of Transpupillary Thermal Stimulation. Int J Mol Sci 2020; 21:ijms21062063. [PMID: 32192227 PMCID: PMC7139698 DOI: 10.3390/ijms21062063] [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: 02/11/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/14/2022] Open
Abstract
The induction of heat shock response in the macula has been proposed as a useful therapeutic strategy for retinal neurodegenerative diseases by promoting proteostasis and enhancing protective chaperone mechanisms. We applied transpupillary 1064 nm long-duration laser heating to the mouse (C57Bl/6J) fundus to examine the heat shock response in vivo. The intensity and spatial distribution of heat shock protein (HSP) 70 expression along with the concomitant probability for damage were measured 24 h after laser irradiation in the mouse retinal pigment epithelium (RPE) as a function of laser power. Our results show that the range of heating powers for producing heat shock response while avoiding damage in the mouse RPE is narrow. At powers of 64 and 70 mW, HSP70 immunostaining indicates 90 and 100% probability for clearly elevated HSP expression while the corresponding probability for damage is 20 and 33%, respectively. Tunel staining identified the apoptotic regions, and the estimated 50% damaging threshold probability for the heating (ED50) was ~72 mW. The staining with Bestrophin1 (BEST1) demonstrated RPE cell atrophy with the most intense powers. Consequently, fundus heating with a long-duration laser provides an approachable method to develop heat shock-based therapies for the RPE of retinal disease model mice.
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Yang HJ, Hu R, Sun H, Bo Chen, Li X, Chen JB. 4-HNE induces proinflammatory cytokines of human retinal pigment epithelial cells by promoting extracellular efflux of HSP70. Exp Eye Res 2019; 188:107792. [PMID: 31499034 DOI: 10.1016/j.exer.2019.107792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/09/2019] [Accepted: 09/05/2019] [Indexed: 12/14/2022]
Abstract
Oxidative stress and subsequent chronic inflammation result in dysfunction of the retinal pigment epithelium (RPE) and represent therapeutic targets in the context of age-related macular degeneration (AMD). However, molecular mechanisms that linked oxidative stress and inflammation still unclear. As an important byproduct of oxidative stress, 4-hydroxynonenal (4-HNE) induces apoptosis and lysosome dysregulation of RPE cells. In the present study, we evaluated cytokines production of RPE cells induced by 4-HNE by using cytokine array and confirmed that 4-HNE induced IL-6, IL-1β and TNF-α production in a concentration dependent manner. Specifically, 4-HNE also induced IL-10 and TGF-β production in low concentration. Molecular analysis revealed that intracellular HSP70 inhibited 4-HNE-induced production of pro-inflammatory cytokines, and 4-HNE exerted proinflammatory effects in RPE cells by enhancing extracellular release of HSP70, as efflux inhibitor Methyl-β-cyclodextrin (MBC) treatment significantly blocked the release of HSP70 and decreased IL-6 production of RPE cells induced by 4-HNE. Meanwhile, HSP70 inducer arimoclomol increased intracellular HSP70 production, but showed no influence on its extracellular level, also performed anti-inflammatory effects in 4-HNE-stimulated RPE cells. Whereas the anti-inflammatory effects of paeoniflorin, an HSP70 inducer simultaneously promoted its extracellular efflux, was lower than arimoclomol. In addition, we further confirmed that MBC exhibited synergetic effect with both paeoniflorin and arimoclomol to inhibit the production of proinflammatory cytokines induced by 4-HNE. Taken together, these results indicate that HSP70 plays a vital role in regulating inflammation of RPE cells induced by oxidative stress and might be a potential novel target for clinical treatment of AMD.
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Affiliation(s)
- Hua-Jing Yang
- Department of Ophthalomology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rui Hu
- Department of Eugenic Genetics Laboratory, Wuhan Medical and Health Center for Women and Children, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Hong Sun
- Department of Eugenic Genetics Laboratory, Wuhan Medical and Health Center for Women and Children, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Bo Chen
- Department of Ophthalomology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xia Li
- Ophthalmic Center, The Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, Hubei, 445000, China.
| | - Jian-Bin Chen
- Department of Ophthalomology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China.
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De Cillà S, Vezzola D, Farruggio S, Vujosevic S, Clemente N, Raina G, Mary D, Casini G, Rossetti L, Avagliano L, Martinelli C, Bulfamante G, Grossini E. The subthreshold micropulse laser treatment of the retina restores the oxidant/antioxidant balance and counteracts programmed forms of cell death in the mice eyes. Acta Ophthalmol 2019; 97:e559-e567. [PMID: 30585429 DOI: 10.1111/aos.13995] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/16/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE Subthreshold micropulse laser (SMPL) has been increasingly used for the treatment of different retinal and choroidal macular disorders. However, the exact mechanisms of action have not yet been clearly defined. Therefore, we aimed to examine the role of SMPL treatment in the modulation of oxidant/antioxidant systems, apoptosis and autophagy in the mice eyes. METHODS A specific laser contact lens for retina was positioned on the cornea of 40 mice (20 young and 20 old) in order to focus the laser on the eye fundus for SMPL treatment. Within 6 months, 20 animals received one treatment only, whereas the others were treated three times. Eye specimens underwent histological analysis and were used for thiobarbituric acid reactive substances (TBARS) and glutathione (GSH) quantification, as well as for the superoxide dismutase 1 (SOD1) and the selenoprotein thioredoxin reductase 1 (TrxR1) expression evaluation. Western blot was performed for nitric oxide synthase (NOS) subtypes detection and to examine changes in apoptotic/autophagy proteins expression. RESULTS SMPL treatment reduced TBARS and increased GSH and SOD1 in the mice eyes. It also reduced cytochrome c, caspase 3 expression and activity and cleaved caspase 9, and increased Beclin 1, p62 and LC3β. The effects were more relevant in the elderly animals. CONCLUSION Our results showed that SMPL therapy restored the oxidant/antioxidant balance within retinal layers and modulated programmed forms of cell death. Further studies may confirm these data and could evaluate their relevance in clinical practice.
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Affiliation(s)
- Stefano De Cillà
- Ophthalmology Unit Department of Health Sciences Azienda Ospedaliera Universitaria Maggiore della Carità University of East Piedmont Novara Italy
| | - Diego Vezzola
- Lab. Physiology/Experimental Surgery Department of Translational Medicine University of East Piedmont Novara Italy
| | - Serena Farruggio
- Lab. Physiology/Experimental Surgery Department of Translational Medicine University of East Piedmont Novara Italy
- AGING Project Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Stela Vujosevic
- Ophthalmology Unit Department of Health Sciences Azienda Ospedaliera Universitaria Maggiore della Carità University of East Piedmont Novara Italy
| | - Nausicaa Clemente
- Lab. Immunology IRCAD Department of Health Sciences University East Piedmont Novara Italy
| | - Giulia Raina
- Lab. Physiology/Experimental Surgery Department of Translational Medicine University of East Piedmont Novara Italy
- AGING Project Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - David Mary
- Lab. Physiology/Experimental Surgery Department of Translational Medicine University of East Piedmont Novara Italy
- AGING Project Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Giamberto Casini
- Department of Surgical Medical, Molecular and Critical Area Pathology University of Pisa Pisa Italy
| | - Luca Rossetti
- Eye Clinic San Paolo Hospital University of Milan Milan Italy
| | - Laura Avagliano
- Pathological Anatomy Department of Health Sciences San Paolo Hospital University of Milan Milan Italy
| | - Carla Martinelli
- Pathological Anatomy Department of Health Sciences San Paolo Hospital University of Milan Milan Italy
| | - Gaetano Bulfamante
- Pathological Anatomy Department of Health Sciences San Paolo Hospital University of Milan Milan Italy
| | - Elena Grossini
- Lab. Physiology/Experimental Surgery Department of Translational Medicine University of East Piedmont Novara Italy
- AGING Project Department of Translational Medicine University of Eastern Piedmont Novara Italy
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Miura Y, Seifert E, Rehra J, Kern K, Theisen-Kunde D, Denton M, Brinkmann R. Real-time optoacoustic temperature determination on cell cultures during heat exposure: a feasibility study. Int J Hyperthermia 2019; 36:466-472. [PMID: 30922131 DOI: 10.1080/02656736.2019.1590653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective/Purpose: In order to study the effects of hyperthermia and other temperature-related effects on cells and tissues, determining the precise time/temperature course is crucial. Here we present a non-contact optoacoustic technique, which provides temperatures during heating of cultured cells with scalable temporal and spatial resolution. METHODS A thulium laser (1.94 µm) with a maximum power of 15 W quickly and efficiently heats cells in a culture dish because of low penetration depth (1/e penetration depths of 78 µm) of the radiation in water. A repetitively Q-switched holmium laser (2.1 µm) is used simultaneously to probe temperatures at different locations in the dish by using the photoacoustic effect. Due to thermoelastic expansion of water, pressure waves are emitted and measured with an ultrasonic hydrophone at the side of the dish. The amplitudes of the waves are temperature dependent and can be used to calculate the temperature/time course at any location of probing. RESULTS We measured temperatures of up to 55 °C with a heating power of 6 W after 10 s, and subsequent lateral temperature profiles over time. Within this profile, temperature fluctuations were found, likely owing to thermal convection and water circulation. By using cultured retinal pigment epithelial cells, it is shown that the probe laser pulses alone cause no biological damage, while immediate cell damage occurs when heating for 10 s at temperatures exceeding 45 °C. CONCLUSIONS This method shows great potential not only as a noninvasive, non-contact method to determine temperature/time responses of cells in culture, but also for complex tissue and other materials.
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Affiliation(s)
- Yoko Miura
- a Medical Laser Center Lübeck , Lübeck , Germany.,b Institute of Biomedical Optics , University of Lübeck , Lübeck , Germany.,c Department of Ophthalmology , University Hospital Schleswig-Holstein , Campus Lübeck, Lübeck , Germany
| | - Eric Seifert
- a Medical Laser Center Lübeck , Lübeck , Germany
| | - Josua Rehra
- a Medical Laser Center Lübeck , Lübeck , Germany
| | | | | | - Michael Denton
- d 711th Human Performance Wing, Airman Systems Directorate, Bioeffects Division, Optic Radiation Bioeffects Branch , JBSA , Fort Sam Houston , TX , USA
| | - Ralf Brinkmann
- a Medical Laser Center Lübeck , Lübeck , Germany.,b Institute of Biomedical Optics , University of Lübeck , Lübeck , Germany
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Luttrull JK, Sinclair SH, Elmann S, Glaser BM. Low incidence of choroidal neovascularization following subthreshold diode micropulse laser (SDM) in high-risk AMD. PLoS One 2018; 13:e0202097. [PMID: 30138455 PMCID: PMC6107149 DOI: 10.1371/journal.pone.0202097] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/02/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose To determine the incidence of new choroidal neovascularization (CNV) in eyes with dry age-related macular degeneration (AMD) following subthreshold diode micropulse laser (SDM). Method In an observational retrospective cohort study, the records of all patients active in the electronic medical records database were reviewed to identify eyes with dry AMD treated with SDM. Identified eyes were classified by simplified AREDS categories, and analyzed for the primary endpoint of new CNV after treatment. Results The EMR revealed SDM was offered to 373/392 (95%) patients with dry AMD and elected by 363/373 (97%) between 2008–2017. Follow up was available for 354/363 patients (547 eyes, 98%) (range 6–108 mos., avg. 22). CNV risk factors included age (median 84 years, 67% > 80); reticular pseudodrusen (214 eyes, 39%); AREDS category (78% category 3 and 4); and fellow eye CNV (128 eyes, 23%). New CNV developed in 9/547 eyes (1.6%, annualized rate 0.87%). Visual acuity was unchanged. There were no adverse treatment effects. Summary In a review of a large group of eyes with exceptionally high-risk AMD, SDM was followed by a very low incidence of new CNV. If confirmed by further study, SDM would offer a new and highly effective treatment to reduce the risk of vision loss from AMD.
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