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Wang J, Fan W, Liu B, Pu N, Wu H, Xue R, Li S, Song Z, Tao Y. Encapsulated cell technology: Delivering cytokines to treat posterior ocular diseases. Pharmacol Res 2024; 203:107159. [PMID: 38554790 DOI: 10.1016/j.phrs.2024.107159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Encapsulated cell technology (ECT) is a targeted delivery method that uses the genetically engineered cells in semipermeable polymer capsules to deliver cytokines. Thus far, ECT has been extensively utilized in pharmacologic research, and shows enormous potentials in the treatment of posterior segment diseases. Due to the biological barriers within the eyeball, it is difficult to attain effective therapeutic concentration in the posterior segment through topical administration of drug molecules. Encouragingly, therapeutic cytokines provided by ECT can cross these biological barriers and achieve sustained release at the desired location. The encapsulation system uses permeable materials that allow growth factors and cytokines to diffuse efficiently into retinal tissue. Moreover, the ECT based treatment can be terminated timely when we need to retrieve the implant, which makes the therapy reversible and provides a safer alternative for intraocular gene therapy. Meanwhile, we also place special emphasis on optimizing encapsulation materials and enhancing preservation techniques to achieve the stable release of growth factors and cytokines in the eyeball. This technology holds great promise for the treatment of patients with dry AMD, RP, glaucoma and MacTel. These findings would enrich our understandings of ECT and promote its future applications in treatment of degenerative retinopathy. This review comprises articles evaluating the exactness of artificial intelligence-based formulas published from 2000 to March 2024. The papers were identified by a literature search of various databases (PubMed/MEDLINE, Google Scholar, Cochrane Library and Web of Science).
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Affiliation(s)
- Jiale Wang
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Wenhui Fan
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Bo Liu
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Ning Pu
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Hao Wu
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Rongyue Xue
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Siyu Li
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Zongming Song
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; Eye Research institute, Henan Academy of Medical Sciences, China.
| | - Ye Tao
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China; College of Medicine, Zhengzhou University, Zhengzhou 450001, China; Eye Research institute, Henan Academy of Medical Sciences, China.
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Akkan Aydogmus FS, Kalayci D, Polat Gultekin B. Subthreshold laser treatment for non-center involved diabetic macular edema via non-damaging retinal laser therapy (NRT). Int Ophthalmol 2024; 44:129. [PMID: 38472440 DOI: 10.1007/s10792-024-03065-1] [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: 08/05/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To evaluate the efficacy of subthreshold laser treatment via non-damaging retinal laser therapy (NRT) in patients with non-center involved diabetic macular edema (non-CI DME). METHODS In this prospective controlled study, NRT with 577 nm wavelength was performed to the edematous inner subfields as needed at 3 monthly intervals, while the control group received no treatment. If CI-DME developed in either group, intravitreal anti-VEGF was performed and the eye was excluded from subsequent analysis. RESULTS A total of 75 eyes (36 study eyes, 39 controls) were evaluated. The change in superior, nasal and temporal inner subfield thicknesses over time and between groups was found significant (P = 0.004, P < 0.001, P = 0.04 respectively). Best corrected visual acuity (BCVA) change was not significant over time and between groups (P = 0.69). Rates of CI-DME development requiring intravitreal anti-VEGF treatment were not different during the first and second years (P = 0.171, 0.908). No laser scar was detected in any eye in fundus autofluorescence imaging. CONCLUSION NRT performed as needed at 3 monthly intervals is effective after 21 months of follow up in the treatment of non-CI DME and it was safe. With this method, it may be foreseen that BCVA will be better preserved in the long term by avoiding the possible side effects of conventional laser.
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Affiliation(s)
- Fatma Sema Akkan Aydogmus
- Department of Ophthalmology, Ankara Bilkent City Hospital, Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya, Ankara, Turkey.
| | - Defne Kalayci
- Department of Ophthalmology, Ankara Bilkent City Hospital, Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya, Ankara, Turkey
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Tai F, Nanji K, Garg A, Zeraatkar D, Phillips M, Steel DH, Garg SJ, Kaiser PK, Guymer RH, Wykoff CC, Sivaprasad S, Chaudhary V. Subthreshold Compared with Threshold Macular Photocoagulation for Diabetic Macular Edema: A Systematic Review and Meta-Analysis. Ophthalmol Retina 2024; 8:223-233. [PMID: 37805099 DOI: 10.1016/j.oret.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/01/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023]
Abstract
TOPIC To compare the efficacy and safety of subthreshold macular laser to conventional focal laser photocoagulation for the treatment of vision loss secondary to diabetic macular edema (DME). CLINICAL RELEVANCE Macular laser remains an important and cost effective treatment option for vision loss secondary to DME. Although anti-VEGF therapy is often first-line, macular laser is of utility in low-resource or remote settings, for patients at risk of loss to follow-up, and for DME not meeting country-specific reimbursement criteria for anti-VEGF therapy. Subthreshold laser is a modality that does not produce clinical or histologic evidence of thermal damage, thereby potentially limiting the common complications of conventional laser. METHODS Ovid MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials (RCTs) from inception to September 28, 2022. Meta-analyses were performed using random-effects modeling. Data were collected at 12 and 24 months for best-corrected visual acuity (BCVA), central retinal thickness, diabetic retinopathy severity scale, rate of adverse events, rate of enrolled patients not completing treatment, rate of patients receiving retreatment, and quality-of-life measures. The risk of bias and certainty of evidence were assessed using Cochrane's Risk-of-Bias version 2 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) frameworks, respectively. Subgroup analysis was performed between subthreshold laser modalities and evaluated with Instrument to assess the Credibility of Effect Modification Analyses tool. RESULTS Fourteen RCTs comprising 514 eyes receiving conventional laser and 574 eyes receiving subthreshold laser were included. Subthreshold laser likely results in no difference to BCVA (moderate GRADE certainty) compared with conventional laser. Conventional laser demonstrated a small, statistically significant improvement in central retinal thickness (low GRADE certainty); however, the magnitude of this improvement is unlikely to be clinically important. There may not be a difference in the rate of adverse events (low GRADE certainty) at 12 months when comparing subthreshold laser to conventional laser for DME. CONCLUSION Randomized controlled trial literature to date suggests subthreshold laser to be as effective as conventional laser in the treatment of DME. Increased follow-up duration is needed to observe any long-term safety benefit from reduced retinal damage. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Felicia Tai
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Keean Nanji
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anubhav Garg
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mark Phillips
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David H Steel
- Department of Eye and Visual Sciences, Sunderland Eye Infirmary, Sunderland, United Kingdom; Department of Eye and Visual Sciences, Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Sunir J Garg
- Department of Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Peter K Kaiser
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robyn H Guymer
- Department of Ophthalmology, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Department of Surgery (Ophthalmology), the University of Melbourne, Melbourne, Australia
| | - Charles C Wykoff
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Sobha Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Varun Chaudhary
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Karasu B, Akbas YB, Aykut A, Çelebi ARC. Subthreshold Photocoagulation, Laser Endpoint Management Based on Optical Coherence Tomography Angiography in Cases of Diabetic Macular Edema Refractory to Anti-VEGF. Klin Monbl Augenheilkd 2024; 241:197-208. [PMID: 35453154 DOI: 10.1055/a-1792-3009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to determine the changes that occur in the vasculature, as based on optical coherence tomography angiography (OCTA) after non-damaging endpoint management (EpM), using a continuous wave yellow laser. The study was on eyes with diabetic macular edema (DME) that were resistant to anti-vascular endothelial growth factors (anti-VEGFs). MATERIALS AND METHODS This was a retrospective analysis of OCTA images of 44 eyes in 44 patients with DME refractory to anti-VEGF. The eyes were treated with a PASCAL Streamline yellow laser (577 nm wavelength, 200 mm spot size). Treatment was administered to the DME area and utilized 10% continuous wave laser energy and 0.50 µm beam diameter spot spacing. Best-corrected visual acuity (BCVA) and enhanced in-depth imaging with optical coherence tomography (EDI-OCT) and fundus autofluorescence (FAF) images were recorded at baseline, and 3 and 6 months posttreatment. Total choroidal area (TCA), luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI) were calculated using Image J software. The macula was divided into five quadrants in accordance with the mapping system in the Early Treatment Diabetic Retinopathy Study (ETDRS). RESULTS All patients (mean age: 58.90 ± 9.55 years) were diagnosed with diabetes mellitus type 2. Mean BCVA at baseline was 0.30 ± 0.11 logarithm of the minimum angle of resolution (logMAR) versus 0.23 ± 0.10 logMAR at 3 months (p = 0.032) and 0.17 ± 0.10 logMAR at 6 months (p = 0.013). The foveal avascular zone area (FAZ) decreased in the deep capillary plexus (DCP) from baseline to 6 months (p = 0.028). Vessel densities (VDs) of the superficial capillary plexus (SCP), DCP, and choriocapillaris decreased significantly in the fovea at 3 and 6 months compared to baseline (p < 0.05 for both follow-up time points). There were significant decreases in SCP and DCP in the superior quadrant at the end of month 6 (p = 0.001 and p = 0.038, respectively). There was a significant decrease in the nasal quadrant of the DCP and choriocapillaris at the end of month 6 (p = 0.024 and p = 0.049, respectively). Although there was a significant decrease in central macular thickness (CMT) (p < 0.001), subfoveal choroidal thickness (SFCT) (p < 0.001), and LA (p = 0.034) at months 3 and 6, there was no significant change in the CVI (p = 0.19). According to the DME recovery rate, 36 eyes (81%) were irradiated once, whereas 8 eyes (19%) were irradiated twice. CONCLUSIONS Non-damaging EpM therapy using a continuous wave yellow laser in eyes with DME that are resistant to anti-VEGFs induces significant changes in the SCP, choriocapillaris, and, most commonly, the DCP, which caused a significant decrease in VDs during 6 months of follow-up.
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Affiliation(s)
- Bugra Karasu
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Içmeler Mahallesi, Piri Reis Caddesi, Tuzla State Hospital, Tuzla, Turkey
| | - Yusuf Berk Akbas
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Bereketzade, Beyoglu, Turkey
| | - Aslan Aykut
- Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
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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.
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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
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Chhablani J. Subthreshold laser therapy guidelines for retinal diseases. Eye (Lond) 2022; 36:2234-2235. [PMID: 35739241 PMCID: PMC9674644 DOI: 10.1038/s41433-022-02136-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/16/2022] [Accepted: 06/10/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jay Chhablani
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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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.
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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
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Cardillo JA, Rodrigues MW, Oliveira RC, Messias AMV, Jorge R. Pascal short-pulse plus subthreshold endpoint management laser therapy for diabetic macular edema: the "sandwich technique". Int J Retina Vitreous 2022; 8:32. [PMID: 35655248 PMCID: PMC9161489 DOI: 10.1186/s40942-022-00381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 05/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Diabetic macular edema (DME) is the main cause of visual loss in diabetic patients. Despite the use of anti-VEGF therapy as first-line treatment, there are many patients whose response to treatment is poor or transient at best. Sophisticated laser techniques have emerged aiming at low-intensity retinal damage, avoiding excessive heat that causes tissue necrosis and related collateral effects. Objective To evaluate the effect of combined sublethal laser modalities from short-pulse duration (SPD) with endpoint management (EpM) subthreshold laser [named the “sandwich technique” (SWiT)] on central subfield thickness (CST) and best-corrected visual acuity (BCVA) in patients with DME. Material and methods In this consecutive retrospective study, 37 patients (37 eyes) with center-involved (CI) DME were treated with SWiT laser therapy from April 2017 to June 2021. The technique consisted of a mean number of 200 (range number 50–400) SPD laser burns OCT-guided thickened area performed on the juxta- and perifoveal area 500 µm away from the foveal center, overlapping with a mean number of 1000 (range number 800–1200) EpM laser burns focused on 6 mm macular diameter area but saving 300 µm toward the foveal center. All patients underwent ophthalmological evaluations, including BCVA and CST measurement by spectral-domain optical coherence tomography (SD-OCT), before and after SWiT laser therapy. The mean follow-up time was 19.2 months (range 2–60 months). Results Thirty-five out of 37 cases showed an improvement in CST and BCVA following treatment. At baseline, mean CST (µm) ± standard error (SE) and mean BCVA (logMAR) ± SE was 456.95 ± 37.00 and 0.71 ± 0.29, respectively. After a mean follow-up of 19.2 months, mean CST (µm) ± SE and BCVA (logMAR) ± SE were 272.09 ± 9.10 (p < 0.0001) and 0.54 ± 0.26 (p = 0.003), respectively. A statistically significant reduction in CST and improvement in BCVA was noted after laser therapy application. The anti-VEGF injection frequency was reduced during the mean 19.2 months of the study period. Conclusions The novel “sandwich” laser therapy aid reduced CST and improved BCVA in this retrospective case series. Further prospective studies are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s40942-022-00381-5.
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Affiliation(s)
- J A Cardillo
- Department of Ophthalmology, CRESEP- Eye Hospital public service, Araraquara, SP, Brazil
| | - M W Rodrigues
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP, 14049-900, Brazil.
| | - R C Oliveira
- Department of Ophthalmology, CRESEP- Eye Hospital public service, Araraquara, SP, Brazil
| | - A M V Messias
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP, 14049-900, Brazil
| | - R Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP, 14049-900, Brazil.
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Gültekin BP. Treatment results of nondamaging retinal laser therapy in diabetic macular edema. Ther Adv Ophthalmol 2022; 14:25158414211063284. [PMID: 35071981 PMCID: PMC8772017 DOI: 10.1177/25158414211063284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subthreshold nondamaging retinal laser therapy (NRT) provides a greater safety profile than conventional laser methods, but more data is needed on the efficacy and safety of subthreshold NRT in diabetic macular edema. PURPOSE To evaluate the efficacy and safety of NRT for the treatment of clinically significant macular edema (CSME) that is partially responsive or resistant to intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment. METHODS This was a retrospective case series study. Fifty eyes of 38 diabetic patients with CSME previously treated with at least 6-monthly intravitreal bevacizumab injections with/without intravitreal Ozurdex therapy were evaluated. The patients received 577-nm yellow wavelength laser therapy with PASCAL laser system (Topcon Medical Laser Systems, Santa Clara, CA, USA). Best-corrected visual acuity (BCVA) and central subfield thickness (CST) were evaluated before and 1, 3, 6, 12 and 24 months after laser treatment. RESULTS Baseline mean CST was 368.06 ± 86.9 µm. The mean CST values at the 1-, 3-, 6-, 12-, and 24-month visits were 336.93 ± 79.8, 352.40 ± 113.5, 336.36 ± 109.3, 325.10 ± 104 µm, and 310.08 ± 84.7 µm, respectively. The mean CST decreased significantly at the first (p = 0.002) and second year visits (p < 0.001) when compared with pretreatment values. Although visual acuity was improved at the first year compared with baseline, this difference was not statistically significant (p = 0.03). There was no significant difference in visual acuities between pretreatment and posttreatment visits. During 24-month follow-up, while 37 eyes were treated with [mean: 5.7 ± 3.4 (1-14)] intravitreal anti-VEGF injections, 3 eyes were administered single-dose intravitreal steroids. Additional intravitreal injections were not required in 10 (20%) eyes. CONCLUSION NRT is effective by itself or in combination with anti-VEGF agents in diabetic macular edema that is partially responsive or resistant to previous intravitreal injections. T role in treating this disorder should be assessed in more detail with prospective controlled studies.
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Affiliation(s)
- Burcu P. Gültekin
- Department of Ophthalmology, Ministry of Health Ankara City Hospital, 06800 Ankara, Turkey
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Comparison of short-pulse subthreshold (532 nm) and infrared micropulse (810 nm) macular laser for diabetic macular edema. Sci Rep 2021; 11:14. [PMID: 33420100 PMCID: PMC7794500 DOI: 10.1038/s41598-020-79699-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022] Open
Abstract
The purpose of the study was to assess both anatomic and functional outcomes between short-pulse continuous wavelength and infrared micropulse lasers in the treatment of DME. This was a prospective interventional study from tertiary care eye hospital—King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). Patients with center-involving diabetic macular edema were treated with subthreshold laser therapy. Patients in the micropulse group were treated with the 810-nm diode micropulse scanning laser TxCell (IRIDEX Corporation, Mountain View, CA, USA) (subthreshold micropulse—STMP group). Laser was applied according to recommendations for MicroPulse (125 microns spot size, 300 ms pulse duration and power adjustment following barely visible testing burn) in a confluent mode (low intensity/high density) to the entire area of the macular edema. Patients in the short-pulse group were treated with grid pattern laser with 20 ms pulse PASCAL laser 532 nm (TopCon Medical Laser Systems, Tokyo, Japan) with EndPoint algorithm, which was either 30% or 50% of testing burn (EndPoint 30% and EndPoint 50% groups, respectively). Main outcome measures included best-corrected visual acuity (BCVA in logMAR) and foveal thickness at baseline and the last follow-up visit at 6 months. There were 44 eyes in the micropulse group, 54 eyes in the EndPoint 50% group and 18 eyes in the EndPoint 30% group. BCVA for the whole cohort (logMAR) was 0.451 (Snellen equivalent 20/56) at baseline, 0.495 (Snellen equivalent 20/62) (p = 0.053) at 3 months, and 0.494 (Snellen equivalent 20/62) at the last follow-up (p = 0.052). Foveal thickness for the whole cohort was 378.2 ± 51.7 microns at baseline, 347.2 ± 61.3 microns (p = 0.002) at 3 months, and 346.0 ± 24.6 microns at the final follow-up (p = 0.027). As such the short-pulse system yields more temporary reduction in edema. Comparison of BCVA between baseline and 6 months for EndPoint 30%, EndPoint 50% and STMP groups was p = 0.88, p = 0.76 and p = 0.003, respectively. Comparison of foveal thickness between baseline and 6 months for EndPoint 30%, EndPoint 50% and STMP groups was p = 0.38, p = 0.22 and p = 0.14, respectively. We conclude that the infrared micropulse system seems to improve functional outcomes. When applied according to previously published reports, short-pulse system may yield more temporary reduction in edema while infrared micropulse system may yield slightly better functional outcomes.
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Abdelrahman A, Massoud W, Elshafei AMK, Genidy M, Abdallah RMA. Anatomical and functional outcomes of subthreshold micropulse laser versus intravitreal ranibizumab injection in treatment of diabetic macular edema. Int J Retina Vitreous 2020; 6:63. [PMID: 33292788 PMCID: PMC7712611 DOI: 10.1186/s40942-020-00265-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background To compare the therapeutic effects of subthreshold micropulse laser (SML) versus intravitreal injection of ranibizumab in treatment of diabetic macular edema (DME) both anatomically using optical coherence tomography (OCT) and functionally using best corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG). Methods his study was an interventional prospective randomized comparative study. The study included 120 eyes classified into 3 groups: Group 1 included 40 eyes of 28 patients treated by SML laser, group 2 included 40 eyes of 32 patients treated by intravitreal injection of ranibizumab, and group 3 (control group for mfERG) included 40 eyes of 20 patients with diabetes mellitus (DM) of more than 10 year duration with no signs of diabetic retinopathy (DR). BCVA measurements, OCT and mfERG were done for the cases before and after interference and were followed up for 6 months Results By the end of the follow up period, BCVA significantly improved by 31% in group 1 vs 93% in group 2 with a statistically highly significant difference between the two groups (p value < 0.001). There was also a significant decrease in central subfield thickness in both groups with more reduction in group 2 compared with group 1 (p value < 0.001). There was a significant improvement in P1 amplitude of mf-ERG in group 2 (p value < 0.002) with no significant improvement in group 1. There was a significant decrease in P1 implicit time in group 2 (p value < 0.001) while there was no significant decrease in group1. Conclusions Intravitreal injection of ranibizumab is a superior treatment modality for DME compared with SML regarding both anatomical and functional outcomes. Trial registration: This study has been approved by the local ethical committee of faculty of medicine of Minia University and retrospectively registered at the clinical trial gov. with Identifier: NCT04332133.
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Eng VA, Wood EH, Boddu S, Karth PA, Leng T. Preventing Progression in Nonexudative Age-Related Macular Degeneration With Subthreshold Laser Therapy: A Systematic Review. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e61-e70. [PMID: 30893458 DOI: 10.3928/23258160-20190301-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among the elderly in developed countries. Subthreshold retinal laser therapy is a new technique that targets drusen - a marker of nonexudative AMD - without causing incidental retinal damage associated with conventional laser photocoagulation. This review summarizes published literature on subthreshold retinal laser therapy as prophylactic treatment of nonexudative AMD. PATIENTS AND METHODS A literature search of the PubMed, Medline, and Embase databases was conducted from January 1997 to April 2018. Studies were analyzed based upon study design, laser parameters, drusen reduction, changes in visual acuity (VA), and the development of choroidal neovascularization (CNV) and/or geographic atrophy (GA). RESULTS Twelve studies involving 2,481 eyes treated with subthreshold retinal laser therapy were included in this review. Treatment led to increased drusen reduction, and studies with significant VA improvement were associated with significant drusen reduction. There was no significant change in the risk of developing CNV or GA. CONCLUSIONS Subthreshold retinal laser therapy is effective for reducing drusen and potentially improving vision in patients with nonexudative AMD. This therapy does not show benefits in reducing development of CNV or GA. Thus, its long-term efficacy to prevent progression to advanced AMD cannot yet be recommended. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e61-e70.].
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Jorge EC, Jorge EN, Botelho M, Farat JG, Virgili G, El Dib R. Monotherapy laser photocoagulation for diabetic macular oedema. Cochrane Database Syst Rev 2018; 10:CD010859. [PMID: 30320466 PMCID: PMC6516994 DOI: 10.1002/14651858.cd010859.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diabetic macular oedema (DMO) is a complication of diabetic retinopathy and one of the most common causes of visual impairment in people with diabetes. Clinically significant macular oedema (CSMO) is the most severe form of DMO. Intravitreal antiangiogenic therapy is now the standard treatment for DMO involving the centre of the macula, but laser photocoagulation is still used in milder or non-central DMO. OBJECTIVES To access the efficacy and safety of laser photocoagulation as monotherapy in the treatment of diabetic macular oedema. SEARCH METHODS We searched CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; MEDLINE; Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 24 July 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any type of focal/grid macular laser photocoagulation versus another type or technique of laser treatment and no intervention. We did not compare laser versus other interventions as these are covered by other Cochrane Reviews. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were gain or loss of 3 lines (0.3 logMAR or 15 ETDRS letters) of best-corrected visual acuity (BCVA) at one year of follow-up (plus or minus six months) after treatment initiation. Secondary outcomes included final or mean change in BCVA, resolution of macular oedema, central retinal thickness, quality of life and adverse events, all at one year. We graded the certainty of the evidence for each outcome using the GRADE approach. MAIN RESULTS We identified 24 studies (4422 eyes). The trials were conducted in Europe (nine studies), USA (seven), Asia (four) and, Africa (one), Latin America (one), Europe-Asian (one) and Oceania (one). The methodological quality of the studies was difficult to assess as they were poorly reported, so the predominant classification of bias was unclear.At one year, people with DMO receiving laser were less likely to lose BCVA compared with no intervention (risk ratio (RR) 0.42, 95% confidence interval (CI) 0.20 to 0.90; 3703 eyes; 4 studies; I2 = 71%; moderate-certainty evidence). There were also favourable effects observed at two and three years. One study (350 eyes) reported on partial or complete resolution of clinically significant DMO and found moderate-certainty evidence of a benefit at three years with photocoagulation (RR 1.55, 95% CI 1.30 to 1.86). Data on visual improvement, final BCVA, central macular thickness and quality of life were not available. One study related minor adverse effects on the central visual field and another reported one case of iatrogenic premacular fibrosis.Nine studies compared subthreshold versus standard macular photocoagulation (517 eyes). Subthreshold treatment was achieved with different methods of photocoagulation: non-visible conventional (two studies), micropulse (four) or nanopulse (one).Only one small study (29 eyes) reported on improvement or worsening of BCVA and estimates were very imprecise (improvement: RR 0.31, 95% CI 0.01 to 7.09; worsening: RR 0.93, 95% CI 0.15 to 5.76; very low-certainty evidence). All studies reported on continuous BCVA at one year; there was low-certainty evidence of no important difference between subthreshold and standard photocoagulation (mean difference (MD) in logMAR BCVA -0.02, 95% CI -0.07 to 0.03; 385 eyes; 7 studies; I2 = 42%), and were possibly different for different techniques (P = 0.07 and I2 = 61.5% for subgroup heterogeneity), with better results achieved with micropulse photocoagulation (MD -0.08 logMAR, 95% CI -0.16 to 0.0) as compared to the results achieved with nanopulse (MD 0.0 logMAR, 95% CI -0.06 to 0.06) and non-visible conventional (MD 0.04 logMAR, 95% CI -0.03 to 0.11), all of them compared to the standard lasers. One study reported partial to complete resolution of macular oedema at one year. There was low-certainty evidence of some benefit with standard photocoagulation, but estimates of effect were imprecise (RR 0.47, 95% CI 0.21 to 1.03; 29 eyes; 1 study). Studies also reported on the change in central macular thickness at one year and found moderate-certainty evidence of no important difference between subthreshold and standard photocoagulation (MD -9.1 μm, 95% CI -26.2 to 8.0; 385 eyes; 7 studies; I2 = 0%). There were no important adverse effects recorded in the studies.Nine studies compared argon laser versus another type of laser (997 eyes). There was moderate-certainty evidence of a small reduction or no difference between the interventions, with respect to improvement (RR 0.87, 95% CI 0.62 to 1.22; 773 eyes; 6 studies) and worsening of BCVA (RR 0.83, 95% CI 0.57 to 1.21; 773 eyes; 6 studies). Three studies reported few cases of subretinal fibrosis and neovascularization with argon laser and one study found subretinal fibrosis in the krypton group.One study (323 eyes) compared the modified ETDRS (mETDRS) grid technique with the mild macular grid (MMG), which uses mild, widely spaced burns throughout the macula. There was low-certainty evidence of an increased chance of visual improvement with MMG, but the estimate was imprecisely measured and the CIs include an increased risk or decreased risk of visual improvement at one year (RR 1.43, 95% CI 0.56 to 3.65; visual worsening: RR 1.40, 95% CI 0.64 to 3.05; change of logMAR visual acuity: MD -0.04 logMAR, 95% CI -0.01 to 0.09). There was a more significant reduction of central macular thickness with the mETDRS compared to the MMG technique (MD -34.0 µm, -59.8 to -8.3) in the MMG group. The study did not record important adverse effects. AUTHORS' CONCLUSIONS Laser photocoagulation reduces the chances of visual loss and increases those of partial to complete resolution of DMO compared to no intervention at one to three years. Subthreshold photocoagulation, particularly the micropulse technique, may be as effective as standard photocoagulation and RCTs are ongoing to assess whether this minimally invasive technique is preferable to treat milder or non-central cases of DMO.
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Affiliation(s)
- Eliane C Jorge
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of Ophthalmology, Otorhinolaryngology and Head and Neck SurgeryDistrito de Rubião Júnior, s/nBotucatuSão PauloBrazil18618‐970
| | - Edson N Jorge
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of Ophthalmology, Otorhinolaryngology and Head and Neck SurgeryDistrito de Rubião Júnior, s/nBotucatuSão PauloBrazil18618‐970
| | - Mayra Botelho
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of Internal MedicineBotucatuBrazil
| | - Joyce G Farat
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaAvenida Universitária 2766Altos do ParaísoSão PauloBrazil
| | - Gianni Virgili
- University of FlorenceDepartment of Translational Surgery and Medicine, Eye ClinicLargo Brambilla, 3FlorenceItaly50134
| | - Regina El Dib
- Institute of Science and Technology, UNESP ‐ Univ Estadual PaulistaDepartment of Biosciences and Oral DiagnosisSão José dos CamposSPBrazil
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Chhablani J, Alshareef R, Kim DT, Narayanan R, Goud A, Mathai A. Comparison of different settings for yellow subthreshold laser treatment in diabetic macular edema. BMC Ophthalmol 2018; 18:168. [PMID: 29996798 PMCID: PMC6042372 DOI: 10.1186/s12886-018-0841-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the safety and efficacy of two subthreshold parameters (5 and 15% duty cycle (DC)) compared to standard ETDRS (early treatment of diabetic retinopathy study) continuous wave (CW) laser. METHODS In this prospective randomized study, 30 eyes from 20 patients with non-center involving macular edema were randomized into 3 different groups: 5% DC, 15% DC and CW navigated modified ETDRS laser treatment. Titration in subthreshold groups was performed with 30% of the threshold power, decided with microsecond pulses. CW laser was titrated to a barely visible burn. All patients underwent microperimetry, thickness measurements and visual acuity examinations at baseline, 6 weeks and 12 weeks post treatment. RESULTS At three months follow up, retinal sensitivity was significantly reduced in the CW group by - 2.2 dB whereas in both subthreshold groups, retinal sensitivity increased by 2.4 dB for 5% and 1.9 dB for 15% DC with no significant difference. Retinal volume (mm3) decreased in both subthreshold groups by 0.08 ± 0.3 and 0.12 ± 0.11 in 5 and 15% DC group respectively. Whereas the CW group showed volume increase of 0.55 ± 0.92 (p = 0.02 and 0.01 for 5 and 15% DC groups). Visual acuity remained stable in all 3 groups (- 0.7 letter in 5% DC; 2.11 letters in 15% DC and 0.88 in CW with no significant difference). CONCLUSION Subthreshold microsecond laser was shown to be safe and effective with both 5 and 15% DC as compared to conventional photocoagulation with ETDRS parameters. The 15% DC setting trended to achieve better anatomical, visual and functional outcomes. TRIAL REGISTRATION Retrospectively registered ( NCT03571659 , 06/26/2018).
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Affiliation(s)
- Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy Campus Banjara Hills, Hyderabad, 500034, India.
| | - Rayan Alshareef
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - David Ta Kim
- Department of Surgery, Division of Ophthalmology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Raja Narayanan
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy Campus Banjara Hills, Hyderabad, 500034, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy Campus Banjara Hills, Hyderabad, 500034, India
| | - Annie Mathai
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy Campus Banjara Hills, Hyderabad, 500034, India
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Hamada M, Ohkoshi K, Inagaki K, Ebihara N, Murakami A. Subthreshold Photocoagulation Using Endpoint Management in the PASCAL® System for Diffuse Diabetic Macular Edema. J Ophthalmol 2018; 2018:7465794. [PMID: 29651345 PMCID: PMC5831979 DOI: 10.1155/2018/7465794] [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: 10/05/2017] [Accepted: 12/11/2017] [Indexed: 01/02/2023] Open
Abstract
We evaluated subthreshold photocoagulation using endpoint management (EPM) for the treatment of diabetic macular edema (DME). The study enrolled 10 eyes from 10 patients (6 men and 4 women) with DME. The entry criteria included central macular thickness (CMT) ≥ 300 μm and decimal visual acuity (VA) ≤ 0.5. The primary endpoints were VA (logMAR) and CMT at 6 months follow-up. Secondary endpoints included fundus autofluorescence, macular volume (MV), and macular sensitivity (MS). We used the PASCAL Streamline Yellow® (wavelength, 577 nm) system to perform grid pattern laser photocoagulation at 50% of the threshold (size, 100 μm; duration, 0.015 s; spacing, 0.5; and energy, 4.5-7.8 mJ). At 6 months posttreatment, CMT was significantly decreased, while there were no significant changes in macular sensitivity, mean BCVA (logMAR), or macular volume. Autofluorescence imaging revealed no changes after treatment in 6 of 10 eyes. No eyes exhibited subjective symptoms of scotoma after photocoagulation. Optical coherence tomography showed the complete resolution of macular edema in 4 eyes (40%) after a single treatment; MS was increased in all 4 of these eyes at 6 months posttreatment. In conclusion, subthreshold photocoagulation using EPM is safe and effective for DME treatment and preserves MS. This trial is registered with UMIN000012401.
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Affiliation(s)
- Masafumi Hamada
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Ophthalmology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Kishiko Ohkoshi
- Department of Ophthalmology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Keiji Inagaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Ophthalmology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Ophthalmology, Juntendo University Urayasu Hospital, 1-1 Tomioka 2-chome, Urayasu-shi, Chiba 279-0021, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Chan JCW, Choy BNK, Chan OCC, Li KKW. Early intraocular pressure change after peripheral iridotomy with ultralow fluence pattern scanning laser and Nd:YAG laser in primary angle-closure suspect: Kowloon East Pattern Scanning Laser Study Report No. 3. Graefes Arch Clin Exp Ophthalmol 2017; 256:363-369. [PMID: 29218423 DOI: 10.1007/s00417-017-3860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/11/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Our purpose was to assess the early intraocular pressure (IOP) changes of ultralow fluence laser iridotomy using pattern scanning laser followed by neodymium:yttrium-aluminum-gamet (Nd:YAG) laser. METHODS This is a prospective interventional study. Thirty-three eyes of 33 adult Chinese primary angle-closure suspect subjects were recruited for prophylactic laser peripheral iridotomy. Sequential laser peripheral iridotomy was performed using pattern scanning laser followed by Nd:YAG laser. Visual acuity (VA) and IOP were measured before treatment, at 1 h, 1 day, 1 week, 1 month, 3 months and 6 months after laser. Laser energy used and complications were documented. Corneal endothelial cell count was examined at baseline and 6 months. Patency of the iridotomy was assessed at each follow-up visit. RESULTS All subjects achieved patent iridotomy in a single session. The mean energy used was 0.335+/-0.088 J for the pattern scanning laser, and 4.767+/-5.780 mJ for the Nd:YAG laser. The total mean energy was 0.339+/-0.089 J. None of the eyes developed a clinically significant IOP spike (≥ 8 mmHg) at 1 h and 1 day after laser use. Only four eyes developed higher IOP at 1 h and all were ≤3 mmHg compared to baseline. The mean IOP was 13.8+/-2.5 mmHg at 1 h and 11.5+/-2.2 mmHg at 1 day, both were significantly lower than baseline (15.8+/-2.1 mmHg) (P < 0.001). Mean VA (logMAR) was similar at 1 h post laser compared to baseline (0.23 vs 0.26). There was also no statistically significant difference in mean VA at other follow-up visits compared to baseline. Peripheral iridotomy closure was encountered in two (6.1%) eyes, one at 1 month and another at 6 months follow-up. There were no complications including hyphema, peripheral anterior synechia formation nor prolonged inflammation throughout the follow-up period. There was no significant loss in corneal endothelial cell counts at 6 months (2255+/-490) compared to baseline (2303+/-386) (P = 0.347). CONCLUSIONS Sequential LPI using an ultralow fluence pattern scanning laser, followed by a Nd:YAG laser, is safe and efficacious, and produces no IOP spike in dark irides of primary angle-closure suspects. Further studies to investigate its role in the treatment of other angle-closure conditions are warranted.
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Affiliation(s)
- Jeffrey Chi Wang Chan
- Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kowloon, Hong Kong
- Department of Ophthalmology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Orlando Chia Chieh Chan
- Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kowloon, Hong Kong
| | - Kenneth Kai Wang Li
- Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kowloon, Hong Kong.
- Department of Ophthalmology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong.
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
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Mao X, You Z. 25G compared with 20G vitrectomy under Resight non-contact wide-angle lenses for Terson syndrome. Exp Ther Med 2017; 14:1193-1197. [PMID: 28810578 DOI: 10.3892/etm.2017.4592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/04/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to compare the effectiveness of 25G vitrectomy to standard 20G vitrectomy for treatment of Terson syndrome under Resight non-contact wide-angle lenses. This was a case-control study of 20 patients with Terson syndrome (study group) that underwent 25G vitrectomy under Resight non-contact wide-angle lenses, with those of 20 matched patients that underwent 20G vitrectomy (control group). Medical records were reviewed from between July 2011 and October 2013. Data included results of the Early Treatment Diabetic Retinopathy Study examination, ophthalmology B-scan ultrasonography and fundus photography. The mean age, follow-up time, the preoperative visual acuity of LogMAR and the preoperative intraocular pressure (IOP) were all comparable in the two groups (all P>0.05). There were statistically significant differences in postoperative visual acuity of LogMAR compared with preoperative visual acuity (P<0.001) in both groups, but no difference between the groups (P=0.845). However, the operative times (13.5 min in study group vs. 42 min in control group) and post-operative IOP at day 1 (13.5 vs. 20 mmHg) were significantly reduced in the study group compared to the control group (P<0.001). Therefore, the present findings suggest that 25G Vitrectomy for Terson syndrome under Resight non-contact wide-angle lenses can achieve a significantly shorter operative time and lower post-operative IOP compared with 20G Vitrectomy.
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Affiliation(s)
- Xinbang Mao
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhipeng You
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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Elhamid AHA. Combined Intravitreal Dexamethasone Implant And Micropulse Yellow Laser For Treatment Of Anti-VEGF Resistant Diabetic Macular Edema. Open Ophthalmol J 2017; 11:164-172. [PMID: 28839510 PMCID: PMC5543696 DOI: 10.2174/1874364101711010164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/16/2017] [Accepted: 06/07/2017] [Indexed: 01/20/2023] Open
Abstract
Purpose: To report the efficacy and safety of combined intravitreal dexamethasone implant and micropulse laser for anti-VEGF resistant diabetic macular edema. Patients and Methods: Prospective, non-controlled study that was conducted for twenty eyes with center-involved diabetic macular edema not responding to anti-VEGF therapy. Ozurdex intravitreal implant was injected to all eyes with subsequent micropulse yellow laser one month after the injection. All eyes were followed up after one, three, four, six, nine and twelve months. The primary outcome measure is the change in best corrected visual acuity (BCVA) after one year and secondary outcome measures are central macular thickness (CMT) change and safety of both dexamethasone implant and micropulse laser. Reinjection was done for those eyes with recurrent edema. Results: The mean age was 58.8 ±7.94 years. The mean BCVA was 0.6± 0.14, 0.57 ±0.12, 0.51±0.15, 0.59±0.12, 0.6± 0.12 and 0.59±0.14 after one, three, four, six, nine and twelve months in comparison to 0.45± 0.14 as initial BCVA [SS,P<0.05]. The CMT was 302.5±30.01, 330.6±20.24, 357.6±32.15, 285.4±19.95, 292.9±25.07 and 285.2±14.99 after one ,three, four ,six , nine and twelve months µm in comparison to initial CMT of 420.7 ±38.74µm [HS, P<0.01]. Cataract occurred in 6 eyes from 14 phakic eyes (42.8%). Transient ocular hypertension occurred in 6 eyes (30%). Reinjection was done for eight eyes (40%). Conclusion: Intravitreal dexamethasone implant and micropulse laser are both effective and safe treatment options for anti-VEGF resistant diabetic macular edema.
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Tan GS, Cheung N, Simó R, Cheung GCM, Wong TY. Diabetic macular oedema. Lancet Diabetes Endocrinol 2017; 5:143-155. [PMID: 27496796 DOI: 10.1016/s2213-8587(16)30052-3] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 02/07/2023]
Abstract
Diabetic macular oedema, characterised by exudative fluid accumulation in the macula, is the most common form of sight-threatening retinopathy in people with diabetes. It affects one in 15 people with diabetes resulting in more than 20 million cases worldwide. Few epidemiological studies have been done to specifically investigate risk factors for diabetic macular oedema, although poor glycaemic and blood pressure control are associated with the presence and development of the disorder. The pathophysiological processes begin with chronic hyperglycaemia, and interplay between vascular endothelial growth factor (VEGF) and inflammatory mediators. Non-invasive imaging using optical coherence tomography has allowed clinicians to detect mild levels of diabetic macular oedema in order to monitor progress and guide treatment. Although focal or grid laser photocoagulation was the traditional mode of treatment, intraocular pharmacotherapy with anti-VEGF agents is now the standard of care. However, these therapies are expensive and resource intensive. Emerging therapeutic strategies include improving efficacy and duration of VEGF suppression, targeting alternative pathways such as inflammation, the kallikrein-kinin system, the angiopoietin-Tie2 system, and neurodegeneration, and using subthreshold and targeted laser therapy. Ongoing research should lead to improvements in screening, diagnosis, and management of diabetic macular oedema.
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Affiliation(s)
- Gavin S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid, Spain
| | - Gemmy C M Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
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Wood EH, Leng T, Schachar IH, Karth PA. Multi-Modal Longitudinal Evaluation of Subthreshold Laser Lesions in Human Retina, Including Scanning Laser Ophthalmoscope-Adaptive Optics Imaging. Ophthalmic Surg Lasers Imaging Retina 2016; 47:268-75. [PMID: 26985801 DOI: 10.3928/23258160-20160229-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Subthreshold retinal laser therapy is efficacious for a variety of retinovascular disorders. Currently, it is unknown which laser parameters can ensure no detectable damage to human retina tissue. MATERIALS AND METHODS One informed physician participant with a normal retina was treated with three levels (75%, 50%, and 25%) of subthreshold 577-nm laser (PASCAL; Topcon, Santa Clara, CA) at 20-millisecond (ms) duration and 100 µm spot size. Several high-resolution retinal imaging modalities, including spectral-domain optical coherence tomography (SD-OCT) and scanning laser ophthalmoscope-adaptive optics (SLO-AO), were used to longitudinally image retinal laser lesions during a 9-month period. RESULTS SLO-AO and SD-OCT imaging of subthreshold laser therapy in human retina showed no cone cell or RPE damage at all time points during a 9-month period using the 25% threshold power 577-nm laser in the human retina. CONCLUSION It is likely that subthreshold laser therapy with 577-nm laser at 20-ms duration in the human retina is safe at the 25% of threshold power level.
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