1
|
Ma CC, Chen PH, Hsieh YH. Optimizing Diabetic Macular Edema Treatment: A Meta-Analysis of Subthreshold Micropulse Laser and Anti-Vascular Endothelial Growth Factor Combination Therapy. J Clin Med 2024; 13:4782. [PMID: 39200924 PMCID: PMC11355810 DOI: 10.3390/jcm13164782] [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: 06/24/2024] [Revised: 07/31/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Diabetic macular edema (DME) is the primary cause of visual impairment in individuals with diabetes. Anti-vascular endothelial growth factor (VEGF) is the current first-line treatment for DME owing to its effectiveness. However, frequent anti-VEGF injections may be inconvenient for patients. Therefore, this study aimed to investigate whether the addition of subthreshold micropulse laser (SML) to anti-VEGF therapy could reduce the requirement for anti-VEGF injections while maintaining the treatment efficacy for DME. Methods: Clinical trials retrieved from the databases of PubMed, EMBASE, and the Cochrane Library were evaluated to determine the effectiveness of combination treatment with SML and anti-VEGF medication compared with that of anti-VEGF treatment alone. The primary outcome measures were the changes in CMT, best-corrected visual acuity (BCVA), and the total number of intravitreal injections (IVIs). Results: The IVI + SML group revealed a substantial increase in the logarithm of the minimum angle of the resolution BCVA and a reduction in CMT at the 12-month follow-up (BCVA: random-effects; mean difference [MD], -0.05; 95% confidence interval [CI]: -0.10 to -0.01; p-value = 0.28, and CMT: random-effects; MD, -18.27; 95% confidence interval, -27.36 to -9.18; p-value = 0.20). The number of required IVIs in the IVI + SML group was lower than that in the IVI only group (random-effects; MD, -2.22; 95% CI: -3.13 to -1.31; p-value < 0.01). Conclusions: Combining SML therapy with anti-VEGF injections may reduce the total number of injections required, improve VA, and reduce CMT at the 12-month follow-up. Although the included studies used different SML regimens and anti-VEGF agents, this review indicates that the application of additional SML therapy results in positive clinical outcomes.
Collapse
Affiliation(s)
- Ching-Chih Ma
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Yun-Hsiu Hsieh
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| |
Collapse
|
2
|
Jiang Y, Cai Y, Zhang X, Chen L, Zhou X, Chen Y. A Two-Decade Bibliometric Analysis of Laser in Ophthalmology: From Past to Present. Clin Ophthalmol 2024; 18:1313-1328. [PMID: 38765459 PMCID: PMC11100493 DOI: 10.2147/opth.s458840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024] Open
Abstract
Background Laser therapy has been proven as an effective technique for managing ophthalmological disorders. To guide future research, we conducted a bibliometric analysis of laser applications in eye diseases from 1990 to 2022, aiming to identify key themes and trends. Methods We retrieved 3027 publications from the Web of Science Core Collection (WoSCC). Bibliometrix was used for science mapping of the literature, while VOSviewer and CiteSpace were applied to visualize co-authorship, co-citation, co-occurrence, and bibliographic coupling networks. Results From a co-citation reference network, we identified 52 distinct clusters. Our analysis uncovered three main research trends. The first trend revolves around the potential evolution of corneal laser surgery techniques, shifting from the treatment of refractive errors to broader applications in biomedical optics. The second trend illustrates the advancement of laser applications in treating a range of disorders, from retinal and ocular surface diseases to glaucoma. The third trend focuses on the innovative uses of established technologies. Conclusion This study offers significant insights into the evolution of laser applications in ophthalmology over the past 30 years, which will undoubtedly assist scientists in directing further research in this promising field.
Collapse
Affiliation(s)
- Yaping Jiang
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Yuying Cai
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Xin Zhang
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Li Chen
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Institute for Medical and Engineering Innovation, Eye & ENT Hospital, Fudan University; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, People’s Republic of China
| | - Yihui Chen
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| |
Collapse
|
3
|
Tatsumi T. Current Treatments for Diabetic Macular Edema. Int J Mol Sci 2023; 24:ijms24119591. [PMID: 37298544 DOI: 10.3390/ijms24119591] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Diabetic retinopathy is a major retinal disorder and a leading cause of blindness. Diabetic macular edema (DME) is an ocular complication in patients with diabetes, and it can impair vision significantly. DME is a disorder of the neurovascular system, and it causes obstructions of the retinal capillaries, damage of the blood vessels, and hyperpermeability due to the expression and action of vascular endothelial growth factor (VEGF). These changes result in hemorrhages and leakages of the serous components of blood that result in failures of the neurovascular units (NVUs). Persistent edema of the retina around the macula causes damage to the neural cells that constitute the NVUs resulting in diabetic neuropathy of the retina and a reduction in vision quality. The macular edema and NVU disorders can be monitored by optical coherence tomography (OCT). Neuronal cell death and axonal degeneration are irreversible, and their development can result in permanent visual loss. Treating the edema before these changes are detected in the OCT images is necessary for neuroprotection and maintenance of good vision. This review describes the effective treatments for the macular edema that are therefore neuroprotective.
Collapse
Affiliation(s)
- Tomoaki Tatsumi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba 260-8670, Japan
| |
Collapse
|
4
|
Iovino C, Iodice CM, Pisani D, Rosolia A, Testa F, Giannaccare G, Chhablani J, Simonelli F. Yellow Subthreshold Micropulse Laser in Retinal Diseases: An In-Depth Analysis and Review of the Literature. Ophthalmol Ther 2023; 12:1479-1500. [PMID: 36933125 PMCID: PMC10164197 DOI: 10.1007/s40123-023-00698-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Yellow subthreshold micropulse laser (YSML) is a retinal laser capable of inducing a biologic response without causing thermal damage to the targeted tissue. The 577-nm YSML is delivered to the retina abiding by different protocols in which wavelength, power, duration, spot size and number of spots can be properly set to achieve the most effective and safe treatment response in various chorioretinal disorders. The ultrashort trains of power modulate the activation of the retinal pigment epithelium cells and intraretinal cells, such as Müller cells, causing no visible retinal scars. Subthreshold energy delivered by YSML stimulates the production of the heat-shock proteins, highly conserved molecules that protect cells against any sort of stress by blocking apoptotic and inflammatory pathways that cause cell damage. YSML treatment allows resorption of the subretinal fluid in central serous chorioretinopathy and intraretinal fluid in various conditions including diabetic macular edema, postoperative cystoid macular edema and other miscellaneous conditions. YSML also seems to modulate the development and progression of reticular pseudodrusen in dry age-related macular degeneration. The aim of this review is to discuss and summarize the safety and efficacy of YSML treatment in retinal diseases.
Collapse
Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Clemente Maria Iodice
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Danila Pisani
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Rosolia
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
5
|
TRPV4 channels promote vascular permeability in retinal vascular disease. Exp Eye Res 2023; 228:109405. [PMID: 36773739 DOI: 10.1016/j.exer.2023.109405] [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: 06/11/2022] [Revised: 01/06/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
This study aimed to determine the role of transient receptor potential vanilloid 4 (TRPV4), a calcium (Ca2+)-permeable cation channel, in the pathophysiology of retinal vascular disease. The retinal vein occlusion (RVO) murine model was created by irradiating retinal veins using lasers. TRPV4 expression and localization were evaluated in RVO mice retinas. In addition, we examined the effects of TRPV4 antagonists (RQ-00317310, HC-067047, GSK2193874, and GSK2798745) on retinal edema, blood flow, and ischemic areas in RVO mice. Furthermore, changes in the retinal expression of tumor necrosis factor (TNF)-α and aquaporin4 (AQP4) by RQ-00317310 were analyzed using Western blot. We also assessed the barrier integrity of epithelial cell monolayers using trans-endothelial electrical resistance (TEER) in Human Retinal Microvascular Endothelial Cells (HRMECs). The expression of TRPV4 was significantly increased and co-localized with glutamine synthetase (GS), a Müller glial marker, in the ganglion cell layer (GCL) of the RVO mice. Moreover, RQ-00317310 administration ameliorated the development of retinal edema and ischemia in RVO mice. In addition, the up regulation of TNF-α and down-regulation of AQP4 were lessened by the treatment with RQ-00317310. Treatment with GSK1016790A, a TRPV4 agonist, increased vascular permeability, while RQ-00317310 treatment decreased vascular endothelial growth factor (VEGF)- or TRPV4-induced retinal vascular hyperpermeability in HRMECs. These findings suggest that TRPV4 plays a role in the development of retinal edema and ischemia. Thus, TRPV4 could be a new therapeutic target against the pathological symptoms of retinal vascular diseases.
Collapse
|
6
|
Ambiya V, Kumar A, Seth S, Kumar P, Oli A. 532 nm versus 810 nm subthreshold micropulse laser in treatment of non-resolving central serous chorioretinopathy: A randomized controlled trial. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
7
|
Hassanpoor N, Ahoor M, Latifi A, Niyousha M. Conventional and Pattern Scanning Pan-Retinal Photocoagulation Laser in Diabetic Patients' Visual Field. J Lasers Med Sci 2022; 13:e40. [PMID: 36743140 PMCID: PMC9841376 DOI: 10.34172/jlms.2022.40] [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: 04/30/2021] [Accepted: 08/27/2022] [Indexed: 01/27/2023]
Abstract
Introduction: In this study, we aimed to compare visual field defects in two different laser methods, namely conventional pan-retinal photocoagulation (PRP) and pattern scanning PRP, in patients with either proliferative diabetic or very severe non-proliferative diabetic retinopathy. Methods: This study was a randomized, single-blind, prospective clinical trial. Twenty patients with either proliferative or very severe non-proliferative diabetic retinopathy were enrolled in this study. Notably, only those patients with the same severity scores in both eyes were included. One eye underwent the conventional PRP laser and another eye underwent the pattern scanning PRP laser simultaneously. Swedish interactive threshold algorithms (SITA) standard perimetry was performed at baseline and one month after the treatment, and visual field defects were evaluated. Results: The pattern standard deviation (PSD) significantly increased in both the pattern and conventional PRP laser groups after one month. The change of the PSD at baseline and after the treatment was not significant between the groups. The mean deviation (MD) level significantly decreased in the conventional group after one month. The change in the MD level at baseline and after the treatment was not significant between the pattern and conventional groups. The change in the mean best corrected visual acuity (BCVA) between the groups was not significant. Conclusion: Changes in visual acuity and visual fields of the patients between the pattern and conventional PRP laser methods showed no significant difference; however, the pattern PRP method caused a smaller reduction in overall sensitivity in the patient's visual field.
Collapse
Affiliation(s)
- Narges Hassanpoor
- Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamadhosein Ahoor
- Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atena Latifi
- Ophthalmologist, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamadreza Niyousha
- Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran,Correspondence to Mohamadreza Niyousha, MD; Eye Research Center, Nikookari Eye Hospital, Tabriz, Iran, Zip code: 5154645395, Tel: + 98-41-36577332,
| |
Collapse
|
8
|
Bıçak F, Kayıkçıoğlu ÖR, Altınışık M, Doğruya S, Kurt E. Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edema. Int Ophthalmol 2022; 42:3829-3836. [DOI: 10.1007/s10792-022-02403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/13/2022] [Indexed: 10/16/2022]
|
9
|
Tatsumi T, Takatsuna Y, Oshitari T, Kaiho T, Kawasaki Y, Shiko Y, Sugawara T, Baba T, Yamamoto S. Randomized clinical trial comparing intravitreal aflibercept combined with subthreshold laser to intravitreal aflibercept monotherapy for diabetic macular edema. Sci Rep 2022; 12:10672. [PMID: 35739147 PMCID: PMC9226173 DOI: 10.1038/s41598-022-14444-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022] Open
Abstract
To compare the efficacy and safety of intravitreal aflibercept with three loading doses + pro re nata regimen combined with subthreshold laser application to that of IVA monotherapy on eyes with diabetic macular edema. This was a phase 4 clinical trial with a prospective, randomized, and parallel investigator-driven protocol. Patients with DME were randomly assigned to the IVA monotherapy group (n = 25) or the IVA + SL combination therapy group (n = 26). The main outcome measures were the number of IVA injections and the changes in the best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) at the final evaluation at 96 weeks. The mean number of IVA injections in the monotherapy group was 5.86 ± 2.43 and it was 6.05 ± 2.73 in the IVA + SL group at 96 weeks, and this difference was not significant (P = 0.83). The differences in the mean changes of the CRT (P = 0.17) and the BCVA (P = 0.31) were also not significant between the two groups throughout the follow-up period. We conclude that adjunct of SL to anti-VEGF therapy does not reduce the number of necessary intravitreal injections.
Collapse
Affiliation(s)
- Tomoaki Tatsumi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Yoko Takatsuna
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan. .,Department of Ophthalmology, Chiba Rosai Hospital, 2-16, Tatsumidaihigashi, Ichihara, Chiba, 290-0003, Japan.
| | - Toshiyuki Oshitari
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.,Department of Ophthalmology, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Tomomi Kaiho
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Faculty of Nursing, Japanese Red Cross College of Nursing, 4-1-3, Hiroo, Shibuya-ku, Tokyo, 150-0012, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takeshi Sugawara
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.,Chiba University Hospital Translational Research and Development Center, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| |
Collapse
|
10
|
Szczepan M, Llorián-Salvador M, Chen M, Xu H. Immune Cells in Subretinal Wound Healing and Fibrosis. Front Cell Neurosci 2022; 16:916719. [PMID: 35755781 PMCID: PMC9226489 DOI: 10.3389/fncel.2022.916719] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
The subretinal space is devoid of any immune cells under normal conditions and is an immune privileged site. When photoreceptors and/or retinal pigment epithelial cells suffer from an injury, a wound healing process will be initiated. Retinal microglia and the complement system, as the first line of retinal defense, are activated to participate in the wound healing process. If the injury is severe or persists for a prolonged period, they may fail to heal the damage and circulating immune cells will be summoned leading to chronic inflammation and abnormal wound healing, i.e., subretinal or intraretinal fibrosis, a sight-threatening condition frequently observed in rhematogenous retinal detachment, age-related macular degeneration and recurrent uveoretinitis. Here, we discussed the principles of subretinal wound healing with a strong focus on the conditions whereby the damage is beyond the healing capacity of the retinal defense system and highlighted the roles of circulating immune cells in subretinal wound healing and fibrosis.
Collapse
Affiliation(s)
- Manon Szczepan
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - María Llorián-Salvador
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mei Chen
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Heping Xu
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom,Aier Institute of Optometry and Vision Science, Changsha, China,*Correspondence: Heping Xu,
| |
Collapse
|
11
|
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.
Collapse
|
12
|
Singh R, Yang X. A 3D finite element model to study the cavitation induced stresses on blood-vessel wall during the ultrasound-only phase of photo-mediated ultrasound therapy. AIP ADVANCES 2022; 12:045020. [PMID: 35465057 PMCID: PMC9020880 DOI: 10.1063/5.0082429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
Photo-mediated ultrasound therapy (PUT) is a novel technique utilizing synchronized ultrasound and laser to generate enhanced cavitation inside blood vessels. The enhanced cavitation inside blood vessels induces bio-effects, which can result in the removal of micro-vessels and the reduction in local blood perfusion. These bio-effects have the potential to treat neovascularization diseases in the eye, such as age-related macular degeneration and diabetic retinopathy. Currently, PUT is in the preclinical stage, and various PUT studies on in vivo rabbit eye models have shown successful removal of micro-vessels. PUT is completely non-invasive and particle-free as opposed to current clinical treatments such as anti-vascular endothelial growth factor therapy and photodynamic therapy, and it precisely removes micro-vessels without damaging the surrounding tissue, unlike laser photocoagulation therapy. The stresses produced by oscillating bubbles during PUT are responsible for the induced bio-effects in blood vessels. In our previous work, stresses induced during the first phase of PUT due to combined ultrasound and laser irradiation were studied using a 2D model. In this work, stresses induced during the third or last phase of PUT due to ultrasound alone were studied using a 3D finite element method-based numerical model. The results showed that the circumferential and shear stress increased as the bubble moves from the center of the vessel toward the vessel wall with more than a 16 times increase in shear stress from 1.848 to 31.060 kPa as compared to only a 4 times increase in circumferential stress from 211 to 906 kPa for a 2 µm bubble placed inside a 10 µm vessel on the application of 1 MHz ultrasound frequency and 130 kPa amplitude. In addition, the stresses decreased as the bubble was placed in smaller sized vessels with a larger decrease in circumferential stress. The changes in shear stress were found to be more dependent on the bubble-vessel wall distance, and the changes in circumferential stress were more dependent on the bubble oscillation amplitude. Moreover, the bubble shape changed to an ellipsoidal with a higher oscillation amplitude in the vessel's axial direction as it was moved closer to the vessel wall, and the bubble oscillation amplitude decreased drastically as it was placed in vessels of a smaller size.
Collapse
Affiliation(s)
| | - Xinmai Yang
- Author to whom correspondence should be addressed:
| |
Collapse
|
13
|
Clinical variations and therapeutic challenges in the management of symptomatic retinal artery macroaneurysm: a tertiary center experience. Int Ophthalmol 2021; 42:497-507. [PMID: 34628543 DOI: 10.1007/s10792-021-02066-8] [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: 06/06/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To find out clinical characteristics, therapeutic options, and visual outcome in symptomatic retinal artery macroaneurysm (RAMA) patients. METHOD Newly diagnosed cases of symptomatic RAMA from January 2015 to December 2019 were included. Fifteen eyes of 15 patients with mean age 62.46 years ± 14.89 (SD) fulfilled the inclusion criteria. RESULT Hypertension was present in 66.6% of the patients, and the commonest site was superotemporal (12 eyes, 80%). The most commonly employed treatment was Nd: Yag laser hyaloidotomy in 4 eyes (26.6%). Other treatments were intravitreal bevacizumab in 3 eyes (20%), focal laser with intravitreal bevacizumab in 3 eyes (20%), PPV with focal laser (13.3%) in 2, focal laser only in one (6.6%), PPV with focal and intravitreal bevacizumab in one (6.6%). The mean best-corrected visual acuity (BCVA) at baseline was 1.35 ± 0.84 LogMAR, which improved to 0.39 ± 0.53 LogMAR at the last follow-up. Presenting VA 0.77 (±0.40) improved to 0.20 (±0.17) p value (0.180) in intravitreal bevacizumab only group, 1.29 (±0.35) to 0.75 (±0.15) p value 0.66 in Nd: Yag laser group, 2.67 (±0.58) to 0.46 (±0.28) p value 0.019 in PPV group and did not improve in combined anti-VEGF and focal laser group due to dense hard exudates at the fovea in one and persistent cystoid macular edema in another case. CONCLUSION With regard to its presentation, which can vary tremendously, there are no approved guidelines for its treatment. The present study reinforces the need for a treatment guideline development. Customization of treatment should be considered depending on the clinical presentation of each case.
Collapse
|
14
|
El Matri L, Chebil A, El Matri K, Falfoul Y, Chebbi Z. Subthreshold micropulse laser adjuvant to bevacizumab versus bevacizumab monotherapy in treating diabetic macular edema: one- year- follow-up. Ther Adv Ophthalmol 2021; 13:25158414211040887. [PMID: 34497974 PMCID: PMC8419546 DOI: 10.1177/25158414211040887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/03/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose To compare the therapeutic impact of combining intravitreal injections of bevacizumab (IVB) with micropulse laser (MPL) in central diffuse diabetic macular edema (DME) versus IVB monotherapy during 12 months follow-up. Methods We conducted a retrospective comparative study of 98 treatment-naive eyes (63 patients) with central diffuse DME. The first group of patients (IVB + MPL group, n = 49) was treated with 3 monthly IVB followed by MPL within 1 week after the third injection. Patients were then followed and treated on a pro re nata (PRN) basis, with MPL retreatment if necessary. The changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), number of IVB injections and MPL sessions were evaluated at 4, 8, and 12 months. A control group of diabetic patients with treatment-naive DME was treated with standard protocol of 3 monthly IVB as monotherapy then followed on a PRN basis (IVB group, n = 49). Statistic comparaison of BCVA, CMT, and IVB number variation was interpreted at 12 months between both groups. Results In IVB + MPL group, baseline BCVA improvement was not significant at 4 and 8 months (p = 0.90, p = 0.08), and was statistically significant (p = 0.01) at 12 months. Mean CMT significantly decreased at 4, 8, and 12 months (p < 0.01) in IVB + MPL group. The difference in BCVA (p = 0.091) and CMT (p = 0.082) variation at 12 months between both groups was not significant but the number of injections was significantly lower in IVB + MPL group (4.1 ± 1.5 injections) compared to IVB group (7.2 ± 1.3 injections) (p < 0.005). Conclusion Combining intravitreal injections of bevacizumab and MPL in the treatment of DME is effective and safe. This protocol may decrease the number of IVB and its frequency. It offers the advantage of lasting therapeutic response with fewer recurrences.
Collapse
Affiliation(s)
- Leila El Matri
- Department B, Institut Hedi Rais d'ophtalmologie de Tunis, Tunis, Tunisia
| | - Ahmed Chebil
- Department B, Institut Hedi Rais d'ophtalmologie de Tunis, Tunis, Tunisia
| | - Khaled El Matri
- Department B, Institut Hedi Rais d'ophtalmologie de Tunis, Boulevard 9 avril 1938, 1006 Tunis, Tunisia
| | - Yousra Falfoul
- Department B, Institut Hedi Rais d'ophtalmologie de Tunis, Tunis, Tunisia
| | - Zouheir Chebbi
- Department B, Institut Hedi Rais d'ophtalmologie de Tunis, Tunis, Tunisia
| |
Collapse
|
15
|
Altınel MG, Acikalin B, Alis MG, Demir G, Mutibayraktaroglu KM, Totuk OMG, Ardagil A. Comparison of the efficacy and safety of anti-VEGF monotherapy versus anti-VEGF therapy combined with subthreshold micropulse laser therapy for diabetic macular edema. Lasers Med Sci 2021; 36:1545-1553. [PMID: 33813612 DOI: 10.1007/s10103-021-03306-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/28/2021] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to compare the efficacy and safety of 577-nm subthreshold micropulse laser (SML) and intravitreal bevacizumab injection (IVB) combined therapy with IVB monotherapy in the treatment of diabetic macular edema (DME). This retrospective study included 80 eyes of 80 patients; 40 eyes were treated with IVB monotherapy, and 40 eyes were treated with SML-IVB combined therapy. The mean number of required IVB injections and changes of best corrected visual acuity (BCVA) and central macular thickness (CMT) values were compared between the groups. The mean age of the patients was 60.19±7.43 years. The baseline characteristics of the patients were similar between the groups. In the SML-IVB combined group, the mean number of required SML sessions was 2.1±0.81. The mean number of required IVB injections was 4.38±0.81 in the SML-IVB combined group and 5.65±1.51 in the IVB monotherapy group (p<0.05). The increase of the BCVA was significant in the SML-IVB combined group at the 3rd, 6th, 9th, and 12th months; however, in the IVB monotherapy group, it was only significant at the 3rd month (p<0.05). The mean CMT values of the 3rd, 9th, and 12th months were similar between the groups (p>0.05); only at the 6th month was it significantly lower in the SML-IVB combined group (p<0.05). When compared with baseline, the decrease of the CMT was statistically significant in both groups at the 3rd, 6th, 9th, and 12th months (p<0.05). In this study, a significant benefit of adding SML to IVB therapy was found with less IVB need, although a very significant increase in BCVA could not be achieved. The use of SML-IVB combined treatment may be an effective and safe alternative for DME.
Collapse
Affiliation(s)
- Meltem Guzin Altınel
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey.
| | - Banu Acikalin
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey
| | - Meryem Guler Alis
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey
| | - Gokhan Demir
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey
| | - Kemal Mert Mutibayraktaroglu
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey
| | - Ozgun Melike Gedar Totuk
- Department of Ophthalmology, Faculty of Medicine, Bahcesehir University, 34734, Kadikoy, Istanbul, Turkey
| | - Aylin Ardagil
- Atakoy Dunyagoz Hospital, 34158 Bakirkoy, Istanbul, Turkey
| |
Collapse
|
16
|
Bougatsou P, Panagiotopoulou EK, Gkika M, Dardabounis D, Konstantinidis A, Sideroudi H, Perente I, Labiris G. Comparison of Subthreshold 532 nm Diode Micropulse Laser with Conventional Laser Photocoagulation in the Treatment of Non-Centre Involved Clinically Significant Diabetic Macular Edema. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 63:25-30. [PMID: 32422113 DOI: 10.14712/18059694.2020.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of the study was to investigate the effect of the 532 nm (green) diode subthreshold micropulse laser (SML) in the treatment of non-centre involved clinically significant macular edema (CSME) in comparison to the conventional laser photocoagulation (CLP). METHODS A total of 60 eyes of patients diagnosed with non-centre involved CSME were randomly divided into two groups. SML photocoagulation was performed in the first group (G1), while CLP in the second one (G2). Central macular thickness (CMT) and best corrected visual acuity (BCVA) were measured prior to treatment and at 3 and 6 months after intervention. RESULTS G1 participants had significantly better CMT at 6 months after laser application (p = 0.04) compared to G2. Additionally, CMT in both groups was significantly lower 6 months after laser application in comparison to baseline values (G1: p < 0.001, G2: p = 0.002). Moreover, significant improvement was detected 6 months after SML in G1 regarding BCVA compared to values before laser treatment (p = 0.001). CONCLUSION SML was more effective than CLP in reducing CMT and improving BCVA in patients with non-centre involved CSME. Therefore, it seems that SML can be a good substitute for CLP in DME treatment if confirmed in future studies.
Collapse
Affiliation(s)
- Panagiota Bougatsou
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | | | - Maria Gkika
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Doukas Dardabounis
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Aristeidis Konstantinidis
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Haris Sideroudi
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Irfan Perente
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| |
Collapse
|
17
|
AlQahtani AS, Hazzazi MA, Waheeb SA, Semidey VA, Semidey VA, Elgendy HK, Alkhars WI, Abouammoh MA, Al-Dhibi H. Saudi Arabia Guidelines for diabetic macular edema: A consensus of the Saudi Retina Group. Saudi Med J 2021; 42:131-145. [PMID: 33563731 PMCID: PMC7989293 DOI: 10.15537/smj.2021.2.25623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Diabetes mellitus (DM) and its complications are major public health burdens in Saudi Arabia. The prevalence of diabetic retinopathy (DR) is 19.7% and the prevalence of diabetic macular edema (DME) is 5.7% in Saudi Arabia. Diabetic macular edema is a vision-threatening complication of DR and a major cause of vision loss worldwide. Ocular treatments include retinal laser photocoagulation, anti-vascular endothelial growth factor (anti-VEGF) agents, intravitreal corticosteroids, and vitreoretinal surgery when necessary. The present consensus was developed as a part of the Saudi Retina Group's efforts to generate Saudi guidelines and consensus for the management of DME, including recommendations for its diagnosis, treatment, and best practice. The experts' panel stipulates that the treatment algorithm should be categorized according to the presence of central macula involvement. In patients with no central macular involvement, laser photocoagulation is recommended as the first-line option. Patients with central macular involvement and no recent history of cardiovascular (CVS) or cerebrovascular disorders can be offered anti-VEGF agents as the first-line option. In the case of non-responders (defined as an improvement of <20% in optical coherence tomography or a gain of fewer than 5 letters in vision), switching to another anti-VEGF agent or steroids should be considered after 3 injections. Within the class of steroids, dexamethasone implants are recommended as the first choice. In patients with a recent history of CVS events, the use of anti-VEGF agents is not recommended, regardless of their lens status. The experts' panel recommends that a future study be conducted to provide a cut-off point for early switching to steroid implants in pseudo-phakic eyes.
Collapse
Affiliation(s)
- Abdullah S. AlQahtani
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Mohammad A. Hazzazi
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Saad A. Waheeb
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Valmore A. Semidey
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Valmore A. Semidey
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Hussein K. Elgendy
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Wajeeha I. Alkhars
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Marwan A. Abouammoh
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| | - Hassan Al-Dhibi
- From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
| |
Collapse
|
18
|
[Retinal arterial macroaneurysm and anti-Vascular Endothelial Growth Factor (aflibercept) in Eales's disease: A case report]. J Fr Ophtalmol 2020; 44:e91-e95. [PMID: 33309178 DOI: 10.1016/j.jfo.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 11/20/2022]
|
19
|
Lai K, Zhao H, Zhou L, Huang C, Zhong X, Gong Y, Li L, Xu F, Li C, Lu L, Jin C. Subthreshold Pan-Retinal Photocoagulation Using Endpoint Management Algorithm for Severe Nonproliferative Diabetic Retinopathy: A Paired Controlled Pilot Prospective Study. Ophthalmic Res 2020; 64:648-655. [PMID: 33053561 DOI: 10.1159/000512296] [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: 06/09/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to report the efficacy and safety profile of subthreshold pan-retinal photocoagulation (PRP) using endpoint management (EPM) algorithm compared with conventional threshold PASCAL PRP for the treatment of severe nonproliferative diabetic retinopathy (NPDR). METHODS This was a prospective, single-center, paired randomized controlled trial of 56 eyes of 28 participants with bilateral symmetric severe NPDR. One eye of the participant was randomly assigned to receive the subthreshold EPM PRP, while the other eye of the same participant received the threshold PASCAL PRP. The primary outcome measures included the difference in the 1-year risk of progression to PDR between 2 groups, and mean changes of the logarithm of the minimal angle of resolution (logMAR) visual acuity (VA). The second outcome measures included central foveal thickness (CFT), 1-year risk of progression to PDR, and visual field (VF) parameters. RESULTS The subthreshold EPM PRP group and the threshold PASCAL PRP group had similar 1-year risk of progression to PDR during the 12-month follow-up visits (17.86 vs. 14.29%, p > 0.05). Slightly decreased VA was found in both groups (0.08 vs. 0.09 logMAR VA); however, no statistical difference was found for neither group (p > 0.05). Similar results were found for thickened CFT for both groups (23.59 vs. 28.34 μm, p > 0.05). Specifically, although substantial loss of VF was found in the threshold PASCAL PRP group (p < 0.05), no obvious damage to VF was seen in the subthreshold EPM PRP group (p > 0.05). CONCLUSION The subthreshold EPM PRP is noninferior to the conventional threshold PASCAL PRP in the treatment of severe NPDR during 12-month follow-up and could be an alternative treatment option for patients with severe NPDR.
Collapse
Affiliation(s)
- Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hongkun Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaojing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
20
|
COMBINATION THERAPY OF INTRAVITREAL RANIBIZUMAB AND SUBTHRESHOLD MICROPULSE PHOTOCOAGULATION FOR MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION: 6-MONTH RESULT. Retina 2020; 39:1377-1384. [PMID: 29689025 PMCID: PMC6613833 DOI: 10.1097/iae.0000000000002165] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study suggests that the combination therapy of intravitreal ranibizumab and 577-nm subthreshold micropulse photocoagulation can treat macular edema secondary to macular edema secondary to branch retinal vein occlusion effectively, by decreasing the frequency of intravitreal ranibizumab injections than intravitreal ranibizumab monotherapy while maintaining good visual acuity at 6 months. Purpose: To determine the efficacy of the combination therapy of intravitreal ranibizumab (IVR) and 577-nm yellow laser subthreshold micropulse laser photocoagulation (SMLP) for macular edema secondary to branch retinal vein occlusion cystoid macular edema. Methods: Retrospective, consecutive, case–control study. Forty-six eyes of 46 patients with treatment-naive branch retinal vein occlusion cystoid macular edema were enrolled. The IVR + SMLP group consisted of 22 patients who had undergone both SMLP and IVR. Intravitreal ranibizumab group consisted of 24 patients who had undergone IVR monotherapy. Intravitreal ranibizumab therapy was one initial injection and on a pro re nata in both groups, and SMLP was performed at 1 month after IVR in the IVR + SMLP group. Preoperatively and monthly, best-corrected visual acuity and central retinal thickness were evaluated using swept source optical coherence tomography. Results: Best-corrected visual acuity and central retinal thickness significantly improved at 6 months in IVR + SMLP and IVR groups. Best-corrected visual acuity and central retinal thickness were not significantly different between the two groups at any time points. The number of IVR injections during initial 6 months in IVR group (2.3 ± 0.9) was significantly greater (P = 0.034) than that in IVR + SMLP group (1.9 ± 0.8). Conclusion: The combination therapy of IVR and SMLP can treat branch retinal vein occlusion cystoid macular edema effectively, by decreasing the frequency of IVR injections while maintaining good visual acuity.
Collapse
|
21
|
Chen XD, Omari A, Hwang M, Kwark L, Dakki N, Farsiu S, Gardner TW. Treated PDR Reveals Age-Appropriate Vision Deterioration But Distorted Retinal Organization. Transl Vis Sci Technol 2020; 9:3. [PMID: 32704423 PMCID: PMC7347280 DOI: 10.1167/tvst.9.3.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose We determined the progression of visual function, macular structure, and quality of life in patients with regressed proliferative diabetic retinopathy (PDR) after panretinal photocoagulation (PRP). Methods In this prospective study, 22 patients who underwent PRP for PDR and 11 age-matched control participants underwent examinations at baseline and after 5 years. Visual acuity, contrast sensitivity, reading acuity, frequency doubling perimetry, Humphrey field analyzer, and dark adaptation were measured. The Low Luminance Questionnaire and National Eye Institute Vision Function Questionnaire-25 were administered. Macular spectral-domain optical coherence tomography was taken. Results After 5 years, patients who had previously undergone PRP for PDR (18.4 ± 7.9 years previously) showed significant deterioration in contrast sensitivity, reading acuity, frequency doubling perimetry 24-2 pattern standard deviation, and Humphrey field analyzer 10-2 foveal sensitivity, which were equivalent to age-related decreases in control participants. They revealed no further impairment in vision-related activities on questionnaires. In contrast with controls, their maculas showed pathologic disorganization of the retinal layers, especially the nerve fiber layer, which were thicker and constituted a greater proportion of the overall retinal thickness than the norm and associated with impaired vision. Conclusions Patients with treated PDR had age-related decreases in vision, but stable quality of life. Prior injuries from the diabetes and, possibly, laser treatment led to substantial disruption in the retinal structure, which may explain the loss of vision. Translational Relevance Despite PRP treatment, patients with regressed PDR had pathologic progression of the nerve fiber layer; further investigation may identify a new therapeutic target to reverse the visual deficits.
Collapse
Affiliation(s)
- Xing D Chen
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Amro Omari
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Min Hwang
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Leon Kwark
- Departments of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Natalie Dakki
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Sina Farsiu
- Departments of Ophthalmology, Duke University Medical Center, Durham, NC, USA.,Departments of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Thomas W Gardner
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
22
|
Abouhussein MA, Gomaa AR. Aflibercept plus micropulse laser versus aflibercept monotherapy for diabetic macular edema: 1-year results of a randomized clinical trial. Int Ophthalmol 2020; 40:1147-1154. [PMID: 31919773 DOI: 10.1007/s10792-019-01280-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/31/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the role of adjuvant micropulse laser with aflibercept injections in the management of treatment naive center involving DME, looking at decreased treatment burden and increased efficacy as outcomes after 1 year. METHODS This was a prospective, single center, randomized trial that included 40 eyes (40 patients) with previously untreated center involved DME. Patients were randomly assigned to receive either aflibercept plus micropulse laser (group A) or aflibercept monotherapy (group B). RESULTS Overall, 40 patients were included in the study; they were randomized into either group A (aflibercept + micropulse; 20 patients) or group B (aflibercept monotherapy; 20 patients). The mean number of injections after the loading dose was 4.5 ± 1.4 in group A and was 5.4 ± 1.7 in group B, and the difference between both groups was statistically significant (P = 0.029). CONCLUSION Adding 577-nm micropulse laser to aflibercept is effective for treatment naïve DME and is associated with decreased number of injections.
Collapse
Affiliation(s)
- Mahmoud Alaa Abouhussein
- Ophthalmology Department, Alexandria University, 8 Hassan Allam Street, Smouha, Alexandria, Egypt.
| | - Amir Ramadan Gomaa
- Ophthalmology Department, Alexandria University, 8 Hassan Allam Street, Smouha, Alexandria, Egypt
| |
Collapse
|
23
|
Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology 2019; 127:P66-P145. [PMID: 31757498 DOI: 10.1016/j.ophtha.2019.09.025] [Citation(s) in RCA: 314] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
24
|
Blindbæk SL, Peto T, Grauslund J. How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular edema? Acta Ophthalmol 2019; 97:339-346. [PMID: 30575304 DOI: 10.1111/aos.13997] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/16/2018] [Indexed: 01/06/2023]
Abstract
Vascular endothelial growth factor inhibitors (anti-VEGF) have consistently demonstrated efficacy and safety and changed both the aim and perspectives of diabetic macular edema (DME) treatment. Hence, the present and future role of focal/grid laser photocoagulation in DME treatment has been subjected to some debate. However, extensive insight into technical advances in novel laser systems, treatment protocols of anti-VEGF trials and the functional impact of modern focal/grid photocoagulation is needed to evaluate the present and future role of photocoagulation in DME treatment. Across a wide range of clinical trials laser therapy was required as adjunctive/rescue treatment in approximately 20-50% of patients receiving anti-VEGF monotherapy for centre involving DME. Further, a lower retreatment rate and a more stable reduction in retinal thickness have been demonstrated in more studies. However, lacking information on the laser systems used, their technical specifications and protocols of application often complicates direct comparison of results in anti-VEGF trials. Hence, this paper aimed to provide an overview of the currently available data relevant to the potential role of focal/grid laser photocoagulation in DME treatment including a thorough overview of the current most commonly used laser systems. Results with subthreshold diode micropulse laser photocoagulation are intriguing and may offer a valuable option as adjunctive therapy to anti-VEGF treatment. However, more well-designed studies on combination therapy are warranted to determine the full potential of modern retinal photocoagulation systems. In conclusion, current data suggest that focal/grid laser therapy should still be an option for consideration as adjunctive therapy in many patients.
Collapse
Affiliation(s)
- Søren L. Blindbæk
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Tunde Peto
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Centre for Public Health Queen's University Belfast Belfast UK
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Steno Diabetes Center Odense Odense Denmark
| |
Collapse
|
25
|
Minimally invasive laser treatment combined with intravitreal injection of anti-vascular endothelial growth factor for diabetic macular oedema. Sci Rep 2019; 9:7585. [PMID: 31110222 PMCID: PMC6527558 DOI: 10.1038/s41598-019-44130-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/10/2019] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to investigate the effect of the combination of minimally invasive laser treatment to the intravitreal injection of anti-vascular endothelial growth factor (VEGF) for diabetic macular oedema (DME). This study was retrospective longitudinal study of thirty-four eyes of 31 patients with DME. Either once or several times of intravitreal anti-VEGF injection was followed by the single minimally invasive laser within a month. The mean best corrected visual acuity (VA) and the central macular thickness (CMT) were measured before treatment, 1, 3, 6 and 12 months after the first anti-VEGF injection. The mean logMAR VA had improved from 0.52 ± 0.34 at baseline to 0.44 ± 0.32 (p = 0.003), 0.40 ± 0.34 (p = 0.006), 0.43 ± 0.33 (p = 0.063), and 0.41 ± 0.34 (p = 0.009), at 1, 3, 6, and 12 months after treatment, respectively. The mean CMT decreased significantly by 1 month and maintained over 12 months (491.1 ± 133.9 µm at baseline, 396.6 ± 116.8 µm (p = 0.001), 385.2 ± 156.2 µm (p = 0.002), 336.5 ± 86.3 µm (p = 0.000), and 354.8 ± 120.4 µm (p = 0.000) at 1, 3, 6, and 12 months, respectively). The average number of the anti-VEGF injection in 1 year was 3.6 ± 2.1 in all patients. The combined intravitreal anti-VEGF and minimally invasive laser therapy improves the VA, alleviates DME, and may decrease the required number of anti-VEGF injections.
Collapse
|
26
|
Abstract
Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetic retinopathy with an increasing prevalence tied to the global epidemic in type 2 diabetes mellitus. Its pathophysiology starts with decreased retinal oxygen tension that manifests as retinal capillary hyperpermeability and increased intravascular pressure mediated by vascular endothelial growth factor (VEGF) upregulation and retinal vascular autoregulation, respectively. Spectral domain optical coherence tomography (SD-OCT) is the cornerstone of clinical assessment of DME. The foundation of treatment is metabolic control of hyperglycemia and blood pressure. Specific ophthalmic treatments include intravitreal anti-VEGF drug injections, intravitreal corticosteroid injections, focal laser photocoagulation, and vitrectomy, but a substantial fraction of eyes respond incompletely to all of these modalities resulting in visual loss and disordered retinal structure and vasculature visible on SD-OCT and OCT angiography. Efforts to close the gap between the results of interventions within randomized clinical trials and in real-world contexts, and to reduce the cost of care increasingly occupy innovation in the social organization of ophthalmic care of DME. Pharmacologic research is exploring other biochemical pathways involved in retinal vascular homeostasis that may provide new points of intervention effective in those cases unresponsive to current treatments.
Collapse
Affiliation(s)
- David J Browning
- Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina, USA
| | - Michael W Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | - Chong Lee
- Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina, USA
| |
Collapse
|
27
|
Kansora MB, Goldhardt R. Decision Making in Proliferative Diabetic Retinopathy Treatment. CURRENT OPHTHALMOLOGY REPORTS 2019; 7:45-50. [PMID: 31595210 DOI: 10.1007/s40135-019-00198-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose of Review The goal of this paper is to provide a comprehensive review of the recent advances in the management options for proliferative diabetic retinopathy. Recent Findings For many years cases of proliferative diabetic retinopathy (PDR) have been managed by pan retinal photocoagulation (PRP). The advent of anti-vascular endothelial growth factor (anti-VEGF) agents has changed the future of PDR management and has provided an alternative to PRP. Summary Management of PDR requires the identification of high risk characteristics for PDR and the decision regarding the most appropriate treatment modality. The risk to benefit ratio for each treatment modality must be considered in determining the appropriate choice between surgical intervention (PRP) versus medical intervention with anti-VEGF.
Collapse
Affiliation(s)
- Mary B Kansora
- VA North Texas Health Care System, 4500 S. Lancaster Rd, Dallas, TX 75216
- The University of Texas Southwestern Medical Center, Department of Ophthalmology, 5323 Harry Hines Blvd., Dallas, TX 75390
| | - Raquel Goldhardt
- Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL 33125
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, 900 NW 17 Street, Suite 275, Miami, FL. 33136
| |
Collapse
|
28
|
Değirmenci MFK, Demirel S, Batıoğlu F, Özmert E. Short-term Efficacy of Micropulse Yellow Laser in Non-center-involving Diabetic Macular Edema: Preliminary Results. Turk J Ophthalmol 2018; 48:245-249. [PMID: 30405946 PMCID: PMC6216533 DOI: 10.4274/tjo.04657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/30/2018] [Indexed: 12/01/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the efficacy of micropulse yellow laser (MPL) on best corrected visual acuity (BCVA) and retinal thickness in patients with non-center-involving diabetic macular edema (DME). Materials and Methods: We retrospectively reviewed 9 eyes of 8 patients with non-center-involving DME who underwent MPL treatment between January 2015 and December 2016. BCVA (logMAR) and retinal thickness were evaluated before and 3 months after treatment. Maximum retinal thickness was determined manually from simultaneous spectral-domain optical coherence tomography images and recorded. The change in the measurements from before to after treatment was analyzed statistically. Results: Of the 8 patients, 3 were female and 5 were male. The mean age was 52.8 years. Two of the 9 eyes had received previous intravitreal anti-vascular endothelial growth factor injection(s). Median BCVA was improved 3 months after treatment, although the difference was not statistically significant (0.34 logMAR before and 0.29 logMAR after treatment). BCVA was improved in 4 eyes while it showed no change in the remaining 5 eyes. The mean retinal thickness was 470.6 μm at baseline and 416 μm at 3 months after MPL treatment (p=0.01). Retinal thickness decreased in all eyes after treatment. Conclusion: In this study, parafoveal retinal thickness showed significant decrease after MPL treatment in patients with DME. The limited increase in BCVA may be due to the inclusion of a low number of patients and only those with non-center-involving macular edema. MPL may be used as an alternative to conventional argon laser in non-center-involving DME.
Collapse
Affiliation(s)
| | - Sibel Demirel
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Figen Batıoğlu
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Emin Özmert
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| |
Collapse
|
29
|
Citirik M. The impact of central foveal thickness on the efficacy of subthreshold micropulse yellow laser photocoagulation in diabetic macular edema. Lasers Med Sci 2018; 34:907-912. [PMID: 30368640 DOI: 10.1007/s10103-018-2672-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
Abstract
To evaluate the efficacy of short-term subthreshold micropulse yellow laser photocoagulation (SMYLP) on eyes with diabetic macular edema (DME) with different central foveal thicknesses (CFT). Eighty eyes of 40 patients who had previously undergone ranibizumab treatment for DME and who subsequently had recurrent macular edema were included to the study. The study subjects were divided into four groups according to their initial CFT values (group 1, 250-300 μm; group 2, 301-400 μm; group 3, > 401 μm; group 4, 250-300 μm untreated control subjects). Patients were treated with SMYLP for one session and followed for 6 months. All patients underwent complete ophthalmologic evaluation. The alteration from baseline in CFT and the best corrected visual acuity (BCVA) were measured. Patients with a pretreatment CFT ≤ 300 μm experienced the statistically significant reduction in CFT and gain in BCVA at 2 months (p < 0.05), whereas patients with baseline CFT > 300 μm experienced no significant change (p > 0.05). Hyperautofluorescence lesions, that were not previously described, were detected in fundus autofluorescence imaging in the early period after SYMLP laser and these lesions were regressed with time. Our study indicates that the SYMLP provides a statistically significant improvement in BCVA and a reduction in CFT in the patients with a pretreatment CFT of 300 μm or less in DME and can be safe and effective in mild DME treatment.
Collapse
Affiliation(s)
- Mehmet Citirik
- Ankara Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ulucanlar Cad. No: 59, 06230, Altindag, Ankara, Turkey.
| |
Collapse
|
30
|
Zhang H, Xie X, Li J, Qin Y, Zhang W, Cheng Q, Yuan S, Liu Q, Paulus YM, Wang X, Yang X. Removal of choroidal vasculature using concurrently applied ultrasound bursts and nanosecond laser pulses. Sci Rep 2018; 8:12848. [PMID: 30150731 PMCID: PMC6110758 DOI: 10.1038/s41598-018-31045-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/02/2018] [Indexed: 11/09/2022] Open
Abstract
Pathologic microvasculature plays a crucial role in innumerable diseases causing death and major organ impairment. A major clinical challenge is the development of selective therapies to remove these diseased microvessels without damaging surrounding tissue. This report describes our development of novel photo-mediated ultrasound therapy (PUT) technology for precisely removing choroidal blood vessels in the eye. PUT selectively removes microvessels by concurrently applying nanosecond laser pulses with ultrasound bursts. In PUT experiments on rabbit eyes in vivo, we applied 55-75 mJ/cm2 of light fluence at the retinochoroidal surface at 532-nm and 0.5 MPa of ultrasound pressure at 0.5 MHz. PUT resulted in significantly reduced blood perfusion in the choroidal layer which persisted to four weeks without causing collateral tissue damage, demonstrating that PUT is capable of removing choroidal microvasculature safely and effectively. With its unique advantages, PUT holds potential for the clinical management of eye diseases associated with microvessels and neovascularization.
Collapse
Affiliation(s)
- Haonan Zhang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, China
| | - Xinyi Xie
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Jia Li
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Yu Qin
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, China
| | - Wei Zhang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Qian Cheng
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, China
| | - Songtao Yuan
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Qinghuai Liu
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Yannis M Paulus
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA. .,Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA. .,Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, China.
| | - Xinmai Yang
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, KS, USA.
| |
Collapse
|
31
|
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]
|
32
|
Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema. Eur J Ophthalmol 2018; 28:68-73. [PMID: 28731494 DOI: 10.5301/ejo.5001000] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of micropulse laser in the early treatment of diabetic macular edema (DME) and its associated burden of anti-vascular endothelial growth factor (VEGF) injections. METHODS This retrospective comparative study compared a group of 19 eyes with DME treated with micropulse laser to a matched control group of 19 eyes with DME treated with ranibizumab injections without micropulse laser. Recorded parameters included previous medical and ocular history, previous and subsequent ranibizumab injections administered for DME, visual acuity (VA), central macular thickness throughout the follow-up period, and the occurrence of any complications. RESULTS The improvement in VA was comparable in both groups, at 12 months and at the final follow-up. Patients treated with micropulse laser required significantly fewer ranibizumab injections than their controls, both at 12 months (1.7 ± 2.3 vs 5.6 ± 2.1) and by the end of the follow-up (2.6 ± 3.3 vs 9.3 ± 5.1) (p<0.001 for both). No complications related to the micropulse laser were encountered. CONCLUSIONS Micropulse laser is a safe and effective treatment for DME, which may achieve comparable improvement in VA along with a significant reduction in the burden of anti-VEGF injections. We suggest a treatment approach for its inclusion in the early stages of DME.
Collapse
|
33
|
Glacet-Bernard A, Mahdavi KN, Coscas G, Zourdani A, Fardeau C. Macular Grid Photocoagulation in Persistent Macular Edema Due to Central Retinal Vein Occlusion. Eur J Ophthalmol 2018; 4:166-74. [PMID: 7819732 DOI: 10.1177/112067219400400306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Macular edema is still the main cause of poor visual prognosis in central retinal vein occlusion (CRVO). This study was designed to establish whether grid photocoagulation is effective in the management of this disorder. METHODS The records of 16 patients who had undergone macular grid photocoagulation for persistent macular edema due to CRVO were reviewed retrospectively. Pre-treatment visual acuity ranged from 20/400 to 20/40, and laser treatment was done six months or more after the onset of the disease. RESULTS Biomicroscopy and fluorescein angiography showed the improvement or disappearance of macular edema in 14/16 patients (87.5%). Improved visual acuity was observed in eight (50%) and no improvement or reduced vision in the other eight (50%). A poorer prognosis was statistically correlated with older age (p < 0.03), macular ischemia (p < 0.001), foveal avascular zone larger than 1/2 disc diameter (p < 0.05) and pigmentary clumps in the foveal area (p < 0.05). Laser treatment was ineffective for most patients with systemic vascular risk factors and pre-treatment visual acuity below 20/200. CONCLUSION Macular grid photocoagulation may be effective for drying up, or at least reducing, macular edema due to CRVO and some improvement of vision can be expected in half the cases.
Collapse
|
34
|
Yanyali A, Horozoglu F, Celik E, Ercalik Y, Nohutcu AF. Pars Plana Vitrectomy and Removal of the Internal Limiting Membrane in Diabetic Macular Edema Unresponsive to Grid Laser Photocoagulation. Eur J Ophthalmol 2018; 16:573-81. [PMID: 16952097 DOI: 10.1177/112067210601600412] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of pars plana vitrectomy (PPV) with removal of the internal limiting membrane (ILM) in diabetic patients with macular edema unresponsive to grid laser photocoagulation. METHODS In this randomized controlled study, 20 eyes of 10 patients with diabetic macular edema unresponsive to grid laser photocoagulation were evaluated. PPV with ILM removal was performed randomly in one eye each of 10 patients and taken as the study group; the untreated fellow eyes were taken as the control group. Main outcome measures were foveal thickness changes measured with optical coherence tomography and preoperative and post-operative visual acuity. Mann-Whitney U, Wilcoxon, and chi-square tests were used in statistical analysis. RESULTS The mean age of the patients was 61.5+/-6 years (range 51 to 71). All patients were followed up for 12 months. In the study group, mean foveal thickness was 391.3+/-91.6 microm preoperatively and 225.5+/-49.4 microm postoperatively (p=0.009). In the control group, mean foveal thickness was 356.2+/-140 microm at baseline and 318.4+/-111.1 microm at 12-month follow-up (p=0.138). Mean decrease in foveal thickness was 165.8+/-114.8 microm in the study group and 37.8+/-71.2 microm in the control group (p=0.016). In the study group, best-corrected log-MAR visual acuity was 0.71+/-0.43 preoperatively and 0.54+/-0.45 postoperatively (p=0.125). In the control group, best-corrected logMAR visual acuity was 0.43+/-0.44 at baseline and 0.59+/-0.55 at 12-month follow-up (p=0.235). In the study group, visual acuity improved by two or more lines in 4 eyes (40%) and remained stable in 6 eyes (60%). In the control group, visual acuity improved by two or more lines in 1 eye (10%) and decreased by two or more lines in 3 eyes (30%). CONCLUSIONS PPV with ILM removal appears to be an effective procedure for reducing diabetic macular edema unresponsive to grid laser photocoagulation. A further study with a large number of patients is required to assess the effectiveness and safety of this procedure.
Collapse
Affiliation(s)
- A Yanyali
- Department of Ophthalmology, Haydarpasa Numune Education and Research Hospital, Caddebostan 81060, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
35
|
Abstract
Since the 1960s, laser therapies have played a critical role in the treatment of numerous retinal diseases. Significant advances have been made in laser technology and the molecular understanding of laser-tissue interactions over the past 55 years to maximize the therapeutic effect while minimizing side-effects. While pharmacologic therapies (e.g., anti-vascular endothelial growth factor or anti-VEGF) are playing a larger role, laser therapy remains an important treatment modality for proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), sickle cell retinopathy, retinal vein occlusions, central serous chorioretinopathy, tumors, polypoidal choroidal vasculopathy, and retinal tears. With the development new laser technologies such as selective retinal therapy, subthreshold micropulse laser, nanosecond laser, photomediated ultrasound therapy, and navigated laser, the risk of adverse events has been significantly reduced. This review summarizes the latest developments in retinal laser therapy.
Collapse
Affiliation(s)
- Jia Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yannis Mantas Paulus
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
36
|
Caballero S, Kent DL, Sengupta N, Li Calzi S, Shaw L, Beli E, Moldovan L, Dominguez JM, Moorthy RS, Grant MB. Bone Marrow-Derived Cell Recruitment to the Neurosensory Retina and Retinal Pigment Epithelial Cell Layer Following Subthreshold Retinal Phototherapy. Invest Ophthalmol Vis Sci 2017; 58:5164-5176. [PMID: 29049716 PMCID: PMC5636205 DOI: 10.1167/iovs.16-20736] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose We investigated whether subthreshold retinal phototherapy (SRPT) was associated with recruitment of bone marrow (BM)–derived cells to the neurosensory retina (NSR) and RPE layer. Methods GFP chimeric mice and wild-type (WT) mice were subjected to SRPT using a slit-lamp infrared laser. Duty cycles of 5%, 10%, 15%, and 20% (0.1 seconds, 250 mW, spot size 50 μm) with 30 applications were placed 50 to 100 μm from the optic disc. In adoptive transfer studies, GFP+ cells were given intravenously immediately after WT mice received SRPT. Immunohistochemistry was done for ionized calcium-binding adapter molecule-1 (IBA-1+), CD45, Griffonia simplicifolia lectin isolectin B4, GFP or cytokeratin). Expression of Ccl2, Il1b, Il6, Hspa1a, Hsp90aa1, Cryab, Hif1a, Cxcl12, and Cxcr4 mRNA and flow cytometry of the NSR and RPE-choroid were performed. Results Within 12 to 24 hours of SRPT, monocytes were detected in the NSR and RPE-choroid. Detection of reparative progenitors in the RPE occurred at 2 weeks using flow cytometry. Recruitment of GFP+ cells to the RPE layer occurred in a duty cycle–dependent manner in chimeric mice and in mice undergoing adoptive transfer. Hspa1a, Hsp90aa1, and Cryab mRNAs increased in the NSR at 2 hours post laser; Hif1a, Cxcl12, Hspa1a increased at 4 hours in the RPE-choroid; and Ccl2, Il1b, Ifng, and Il6 increased at 12 to 24 hours in the RPE-choroid. Conclusions SRPT induces monocyte recruitment to the RPE followed by hematopoietic progenitor cell homing at 2 weeks. Recruitment occurs in a duty cycle–dependent manner and potentially could contribute to the therapeutic efficacy of SRPT.
Collapse
Affiliation(s)
- Sergio Caballero
- Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, United States
| | | | - Nilanjana Sengupta
- Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, United States
| | - Sergio Li Calzi
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Lynn Shaw
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Eleni Beli
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Leni Moldovan
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - James M Dominguez
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Ramana S Moorthy
- AVRUC, Indiana University Medical Center, Indianapolis, Indiana, United States
| | - Maria B Grant
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States
| |
Collapse
|
37
|
Scholz P, Altay L, Fauser S. A Review of Subthreshold Micropulse Laser for Treatment of Macular Disorders. Adv Ther 2017; 34:1528-1555. [PMID: 28540655 PMCID: PMC5504253 DOI: 10.1007/s12325-017-0559-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Indexed: 01/31/2023]
Abstract
Micropulse laser treatment is an alternative to the conventional continuous-wave laser for the treatment of retinal or macular diseases. In contrast to the conventional laser, the therapeutic effect of the subthreshold micropulse laser is not accompanied by thermal retinal damage. This fact is of particular importance when a treatment near the fovea is required. Micropulse treatment is applied in indications such as central serous chorioretinopathy (CSC), diabetic macular edema (DME), or macular edema due to retinal vein occlusion (RVO). This review outlines and discusses the published literature of subthreshold micropulse laser treatment for CSC, DME, and macular edema after RVO.
Collapse
Affiliation(s)
- Paula Scholz
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
| | - Lebriz Altay
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
- F. Hoffmann-La Roche, Basel, Switzerland
| |
Collapse
|
38
|
SUBTHRESHOLD MICROPULSE DIODE LASER VERSUS CONVENTIONAL LASER PHOTOCOAGULATION FOR DIABETIC MACULAR EDEMA: A Meta-Analysis of Randomized Controlled Trials. Retina 2017; 36:2059-2065. [PMID: 27096529 DOI: 10.1097/iae.0000000000001053] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the relative efficacy of subthreshold micropulse diode laser versus conventional laser photocoagulation for the treatment of diabetic macular edema. METHODS A comprehensive literature search was conducted to find relevant randomized controlled trials (RCTs). Efficacy estimates were determined by comparing weighted mean differences of the mean change of best-corrected visual acuity and central macular thickness from baseline. RESULTS Six RCTs were selected for this meta-analysis, including 398 eyes (203 eyes in the subthreshold micropulse diode laser group and 195 eyes in the conventional laser group). Subthreshold micropulse diode laser was superior to conventional laser in terms of mean change of logMAR best-corrected visual acuity at 3, 9, and 12 months after treatment (P = 0.02; P = 0.04, and P = 0.03, respectively), and it showed a similar trend at 6 months (P = 0.05). Although, there was no significant difference in terms of mean change in central macular thickness from baseline to 3, 6, 9, or 12 months (P = 0.80; P = 0.20; P = 0.88, and P = 0.86, respectively). CONCLUSION Subthreshold micropulse diode laser treatment resulted in better visual acuity compared with conventional laser, although the differences before 12 months are likely to be too small to be of clinical relevance and may be dependent on baseline best-corrected visual acuity. The two types of treatment seem to have similar anatomical outcome.
Collapse
|
39
|
New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion. J Ophthalmol 2017; 2017:4936924. [PMID: 28386476 PMCID: PMC5366235 DOI: 10.1155/2017/4936924] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Abstract
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.
Collapse
|
40
|
Shah S, Hariprasad SM. Application of Micropulse Lasers in Treating Macular Diseases. Ophthalmic Surg Lasers Imaging Retina 2016; 47:985-990. [PMID: 27842192 DOI: 10.3928/23258160-20161031-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
41
|
Laser Therapy in the Management of Diabetic Retinopathy. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
42
|
Roy S, Amin S, Roy S. Retinal fibrosis in diabetic retinopathy. Exp Eye Res 2016; 142:71-5. [PMID: 26675403 DOI: 10.1016/j.exer.2015.04.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/20/2015] [Accepted: 04/08/2015] [Indexed: 01/10/2023]
Abstract
In response to injury, reparative processes are triggered to restore the damaged tissue; however, such processes are not always successful in rebuilding the original state. The formation of fibrous connective tissue is known as fibrosis, a hallmark of the reparative process. For fibrosis to be successful, delicately balanced cellular events involving cell proliferation, cell migration, and extracellular matrix (ECM) remodeling must occur in a highly orchestrated manner. While successful repair may result in a fibrous scar, this often restores structural stability and functionality to the injured tissue. However, depending on the functionality of the injured tissue, a fibrotic scar can have a devastating effect. For example, in the retina, fibrotic scarring may compromise vision and ultimately lead to blindness. In this review, we discuss some of the retinal fibrotic complications and highlight mechanisms underlying the development of retinal fibrosis in diabetic retinopathy.
Collapse
Affiliation(s)
- Sayon Roy
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, Boston, MA, United States.
| | - Shruti Amin
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, Boston, MA, United States
| | - Sumon Roy
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, Boston, MA, United States
| |
Collapse
|
43
|
Park YM, Lee JE, Lee JS. Efficacy of Pattern Scan Laser photocoagulation for superficial conjunctival nevi ablation. Lasers Med Sci 2016; 31:1037-9. [PMID: 26914686 DOI: 10.1007/s10103-016-1915-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
Abstract
This study reports the efficacy and safety of Pattern Scan Laser (PASCAL) photocoagulation in the removal of superficial conjunctival nevi. Superficial conjunctival nevi were removed from 10 eyes of 10 patients using PASCAL. The laser spots were 200 μm in size, and the power delivered ranged from 250 to 300 mW. The duration of the laser pulse was kept at the minimum needed for adequate lesion removal. The duration of the laser pulse administered to the patients varied from 100 to 200 ms. Complete removal of the conjunctival nevus was observed in all the patients after PASCAL photocoagulation. Six months after treatment, complete re-epithelialization of the overlying conjunctiva was noted. No signs of recurrence or scarring were found in any of the patients during the follow-up period. Pure thermal denaturation is the main mechanism of PASCAL photocoagulation for removal of superficial conjunctival nevi. PASCAL can be considered as an alternative to conventional argon laser treatment or surgery.
Collapse
Affiliation(s)
- Young Min Park
- Department of Ophthalmology, Pusan National University School of Medicine and Medical Research Institute, Yangsan Pusan National University Hospital, Yangsan, South Korea.,Department of Ophthalmology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, South Korea
| | - Ji-Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine and Medical Research Institute, Yangsan Pusan National University Hospital, Yangsan, South Korea
| | - Jong Soo Lee
- Department of Ophthalmology, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, 1-10, Amidong, Seo-gu, Pusan, 602-739, South Korea.
| |
Collapse
|
44
|
Sublethal Photothermal Stimulation with a Micropulse Laser Induces Heat Shock Protein Expression in ARPE-19 Cells. J Ophthalmol 2015; 2015:729792. [PMID: 26697211 PMCID: PMC4677213 DOI: 10.1155/2015/729792] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/09/2015] [Accepted: 11/15/2015] [Indexed: 01/04/2023] Open
Abstract
Purpose/Aim of the Study. Subthreshold micropulse diode laser photocoagulation is an effective treatment for macular edema. The molecular mechanisms underlying treatment success are poorly understood. Therefore, we investigated the effects of sublethal laser energy doses on a single layer of densely cultured ARPE-19 cells as a model of the human retinal pigment epithelium (RPE). Materials and Methods. A single layer of densely cultured human ARPE-19 cells was perpendicularly irradiated with a micropulse diode laser. Nonirradiated cells served as controls. Sublethal laser energy was applied to form a photocoagulation-like area in the cultured cell layers. Hsp70 expression was evaluated using quantitative polymerase chain reaction and immunocytochemistry. Results. Photocoagulation-like areas were successfully created in cultured ARPE-19 cell layers using sublethal laser energy with our laser irradiation system. Hsp70 mRNA expression in cell layers was induced within 30 min of laser irradiation, peaking at 3 h after irradiation. This increase was dependent on the number of laser pulses. Hsp70 upregulation was not observed in untreated cell layers. Immunostaining indicated that Hsp70 expression occurred concentrically around laser irradiation sites and persisted for 24 h following irradiation. Conclusion. Sublethal photothermal stimulation with a micropulse laser may facilitate Hsp70 expression in the RPE without inducing cellular damage.
Collapse
|
45
|
Microperimetric assessment of retinal sensitivity in eyes with diabetic macular edema from a phase 2 study of intravitreal aflibercept. Retina 2015; 35:687-94. [PMID: 25621943 DOI: 10.1097/iae.0000000000000430] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate retinal sensitivity in patients with diabetic macular edema who received intravitreal aflibercept injection (IAI) or laser. METHODS A substudy included 46 patients from DA VINCI (a randomized, double-masked Phase 2 study) receiving either laser, 0.5 mg IAI every 4 weeks, 2 mg IAI every 4 weeks, 2 mg IAI every 8 weeks after 3 monthly doses (2q8), or 2 mg IAI as-needed after 3 monthly doses for 52 weeks. Retinal sensitivity was measured in one (central), five (one central and four inner), and eight (four inner and four outer) optical coherence tomography subfields. RESULTS Mean best-corrected visual acuity improvement in the subgroup at Week 52 was 3.3 letters with laser and ranged from 5.4 to 16.3 letters in the IAI groups. Retinal sensitivity of laser patients at Week 52 was comparable with baseline in the central optical coherence tomography subfield but decreased in the five and eight optical coherence tomography subfields. Compared with laser, retinal sensitivity significantly increased with IAI in the 2q8 and pooled IAI groups in the 5 and 8 optical coherence tomography subfields at Week 52 (P < 0.05). CONCLUSION Intravitreal aflibercept injection improved best-corrected visual acuity and retinal sensitivity in this subgroup of patients. Laser may cause a deterioration of macular function that is not detectable with best-corrected visual acuity testing.
Collapse
|
46
|
Lee SH, Kim SY, Park HS. Short-Term Results of Dexamethasone Intravitreal Implant in Patients with Refractory Diabetic Macular Edema. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.8.1201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
47
|
Efficacy of subthreshold micropulse laser in the treatment of diabetic macular edema is influenced by pre-treatment central foveal thickness. Eye (Lond) 2014; 28:1418-24. [PMID: 25359290 DOI: 10.1038/eye.2014.264] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/13/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine if the severity of diabetic macular edema influences the effectiveness of subthreshold micropulse (STMP) laser treatment. METHODS A total of 63 eyes of 58 patients with diabetic macular edema were divided into two groups based on their initial central foveal thickness (CFT). Group 1 had CFT ≤400 μm, group 2 had CFT >400 μm. The change from baseline in CFT and visual acuity were compared at 3, 6 and 12 months follow-up. Patients were considered for retreatment with micropulse laser at 3 months if macular edema had not improved. Patients were considered for rescue anti-VEGF injections if there was clinically significant macular edema at 6 months follow-up. Number of laser retreatments, injections, and any adverse effects from STMP laser were recorded. RESULTS Group 1 (n=33) experienced an average of 55 μm reduction in CFT and 0.2 log MAR gain in visual acuity at 12 months (P<0.001). No patient required rescue anti-VEGF injections. Group 2 (n=30) experienced no significant change in CFT or visual acuity by 6 months despite retreatment with STMP in 19 eyes. From 6 to 12 months follow-up, all the patients in group 2 received rescue Bevacizumab injections that resulted in 307 μm reduction in CFT and 0.3 log MAR improvement in visual acuity (P<0.001). No adverse effects from STMP laser were recorded. CONCLUSION Severity of edema can influence the effects of STMP laser. STMP monotherapy is safe and effective in treating edema of mild to moderate severity.
Collapse
|
48
|
Inagaki K, Ohkoshi K, Ohde S, Deshpande GA, Ebihara N, Murakami A. Comparative efficacy of pure yellow (577-nm) and 810-nm subthreshold micropulse laser photocoagulation combined with yellow (561-577-nm) direct photocoagulation for diabetic macular edema. Jpn J Ophthalmol 2014; 59:21-8. [PMID: 25392274 DOI: 10.1007/s10384-014-0361-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 10/14/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the efficacy of 577- and 810-nm subthreshold micropulse laser photocoagulation (SMLP) combined with direct photocoagulation to microaneurysms in diabetic macular edema (DME). METHODS A prospective nonrandomized interventional case series. Forty-nine consecutive patients (53 eyes) with DME were recruited. In 20/24 (83.3%) eyes, 810-nm SMLP (810-nm MP) to achieve a confluent grid pattern was followed by direct photocoagulation to microaneurysms via a continuous 561-nm wavelength laser. In 21/29 (72.5%) eyes, 577-nm SMLP (577-nm MP) was combined with direct photocoagulation to microaneurysms via the same instrument. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were examined 1, 2, 3, 6 and 12 months after treatment. RESULTS The mean power required for SMLP was lower in the 577-nm than in the 810-nm MP group (204.1 vs. 954.1 mW) (p < 0.0001). Significant reductions in CMT persisted from 3 to 12 months after treatment in all patients (p < 0.01). There were no significant intergroup differences in CMT until 12 months. In both groups, mean BCVA remained stable until 12 months after treatment. Additional treatment for persistent macular edema was performed within 12 months in 4/24 eyes (16.7%) in the 810-nm MP group and 1/29 eyes (3.4%) in the 577-nm MP group. CONCLUSION Either 577-nm MP or 810-nm MP combined with direct photocoagulation for microaneurysm closure reduced DME, maintained visual acuity and reduced the additional treatment rate within 12 months. The 577-nm MP apparatus required less energy for SMLP than the 810-nm MP instrument and was suitable for direct photocoagulation of microaneurysms.
Collapse
Affiliation(s)
- Keiji Inagaki
- Department of Ophthalmology, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan,
| | | | | | | | | | | |
Collapse
|
49
|
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.
Collapse
|
50
|
Kwon YH, Lee DK, Kwon OW. The short-term efficacy of subthreshold Micropulse yellow (577-nm) laser photocoagulation for diabetic macular edema. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:379-85. [PMID: 25276079 PMCID: PMC4179114 DOI: 10.3341/kjo.2014.28.5.379] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/24/2014] [Indexed: 01/18/2023] Open
Abstract
Purpose This pilot study aimed to evaluate the efficacy and safety of subthreshold micropulse yellow (577-nm) laser photocoagulation (SMYLP) in the treatment of diabetic macular edema (DME). Methods We reviewed 14 eyes of 12 patients with DME who underwent SMYLP with a 15% duty cycle at an energy level immediately below that of the test burn. The laser exposure time was 20 ms and the spot diameter was 100 µm. Laser pulses were administered in a confluent, repetitive manner with a 3 × 3 pattern mode. Results The mean follow-up time was 7.9 ± 1.6 months. The baseline-corrected visual acuity was 0.51 ± 0.42 logarithm of the minimum angle of resolution (logMAR), which was improved to 0.40 ± 0.35 logMAR (p = 0.025) at the final follow-up. The central macular thickness at baseline was 385.0 ± 111.0 µm; this value changed to 327.0 ± 87.7 µm (p = 0.055) at the final follow-up. Conclusions SMYLP showed short-term efficacy in the treatment of DME and did not result in retinal damage. However, prospective, comparative studies are needed to better evaluate the efficacy and safety of this treatment.
Collapse
Affiliation(s)
- Yoon Hyung Kwon
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea. ; Retina Center, Nune Eye Hospital, Seoul, Korea
| | | | | |
Collapse
|