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Chichan H, Maus M, Heindl LM. Subthreshold Nanosecond Laser, from Trials to Real-Life Clinical Practice: A Cohort Study. Clin Ophthalmol 2021; 15:1887-1895. [PMID: 33986589 PMCID: PMC8110265 DOI: 10.2147/opth.s307671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Age-related macular degeneration (AMD), a degenerative disorder, is a major cause of irreversible severe visual deterioration in the older Western population. Thus, treatments that resolve drusen may prove helpful in limiting the progression of AMD. The study aimed to evaluate the clinical outcome of sub-threshold nanosecond laser therapy (SNL) using a double-frequency nanosecond-pulsed laser with discontinuous energy beam distribution in the early stages of age-related macular degeneration (AMD). Methods In a single-center cohort study, 64 eyes with early or intermediate AMD were treated using SNL and then compared to 77 untreated, control eyes. The primary outcome measures included the area and amount of drusen, and the secondary outcome measures included change in visual acuity and rate of drusen progression within 6 months of follow-up. Results A total of 64 patients’ eyes following SNL treatment showed a significant reduction in the area and amount of drusen after 6 months in comparison to the corresponding values in the control group (p<0.001, respectively). There was no significant difference in visual acuity change after 6 months in both groups (p\documentclass[12pt]{minimal}
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\end{document}0.59, respectively). Within the 6-month follow-up, the rate of progression in drusen size and number was significantly lower in the SNL group (26%) than in the control group (69%; p<0.001). Discussion SNL therapy is a novel, promising approach for improving the macular morphology in patients with early and intermediate AMD. Further studies are necessary to reveal the potential to reduce the risk of transformation into advanced or wet AMD and to retain vision.
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Affiliation(s)
- Hasan Chichan
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, 50923, Germany.,Sehkraft Eye Center, Cologne, 50667, Germany
| | | | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, 50923, Germany.,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, 50937, Germany
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Statement and supplementary statement from the BVA, the DOG, and the RG on laser treatment of drusen in age-related macular degeneration (AMD) : August 2017, update October 2018. Ophthalmologe 2020; 117:1-10. [PMID: 30997527 DOI: 10.1007/s00347-019-0889-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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Abstract
Introduction Laser photocoagulation has been a valuable tool in the ophthalmologist's armamentarium for decades. Conventional laser photocoagulation relies on visible retinal burns as a treatment endpoint, which is thought to result in photocoagulative necrosis of retinal tissue. Recent studies have suggested that using subthreshold (ST) laser, which does not cause detectable damage to the retina may also have therapeutic effects in a variety of retinal diseases. Areas covered: We review the proposed biological mechanisms mediating the therapeutic effects of subthreshold laser on the retina, followed by the evidence for ST laser efficacy in retinal diseases such as diabetic macular edema, central serous chorioretinopathy, age-related macular degeneration, and retinal vein occlusion. Expert Commentary Multiple clinical studies demonstrate that subthreshold laser does not cause structural damage to the retina based on multimodal imaging. Evidence suggests that there is a therapeutic effect on decreasing diabetic macular edema and subretinal fluid in chronic central serous retinopathy; however, the effect may be relatively modest and is not as efficacious as first line treatments for these diseases. Given the repeatability and lack of damage to the retina by this treatment, subthreshold laser deserves further study to determine its place in the retina specialist's armamentarium.
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Affiliation(s)
- Spencer M Moore
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Daniel L Chao
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, CA, USA
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Findlay Q, Jobling AI, Vessey KA, Greferath U, Phipps JA, Guymer RH, Fletcher EL. Prophylactic laser in age-related macular degeneration: the past, the present and the future. Eye (Lond) 2018; 32:972-980. [PMID: 29520049 PMCID: PMC5944648 DOI: 10.1038/s41433-018-0035-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/14/2018] [Indexed: 11/09/2022] Open
Abstract
The presence of drusen in the posterior eye is a hallmark feature of the early stages of age-related macular degeneration and their size is an indicator of risk of progression to vision-threatening forms of the disease. Since the initial observations that laser treatment can resolve drusen, there has been great interest in whether laser treatment can be used to reduce the progression of age-related macular degeneration. In this article, we review the development of lasers for the treatment of those with age-related macular degeneration. We provide an overview of the clinical trial results that demonstrated drusen resolution but that had mixed effects on progression of disease. In addition, we provide a summary of the recent developments in pulsed lasers that are designed to reduce the energy applied to the posterior eye to provide the therapeutic effects of conventional continuous wave lasers while reducing the secondary tissue effects.
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Affiliation(s)
- Quan Findlay
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, 3010, VIC, Australia
| | - Andrew I Jobling
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, 3010, VIC, Australia
| | - Kirstan A Vessey
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, 3010, VIC, Australia
| | - Ursula Greferath
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, 3010, VIC, Australia
| | - Joanna A Phipps
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, 3010, VIC, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Parkville, VIC, Australia.
| | - Erica L Fletcher
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, 3010, VIC, Australia
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[Statement from the BVA, the DOG and the RG on laser treatment of drusen in age-related macular degeneration (AMD) : August 2017]. Ophthalmologe 2017; 114:1008-1014. [PMID: 28980062 DOI: 10.1007/s00347-017-0574-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kurokawa K, Makita S, Yasuno Y. Investigation of Thermal Effects of Photocoagulation on Retinal Tissue Using Fine-Motion-Sensitive Dynamic Optical Coherence Tomography. PLoS One 2016; 11:e0156761. [PMID: 27271952 PMCID: PMC4894600 DOI: 10.1371/journal.pone.0156761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/19/2016] [Indexed: 11/26/2022] Open
Abstract
To enable an objective evaluation of photocoagulation, we characterize thermal tissue changes induced by laser irradiation with different laser parameters using optical coherence tomography (OCT). Spectral-domain OCT with a newly developed image processing method was used to monitor the thermal changes of ex vivo porcine retina. A sequence of OCT B-scans was obtained at the same retinal position simultaneously with the photocoagulation. Cross-sectional tissue displacement maps with respect to an OCT image taken before laser irradiation were computed for images taken before, during, and after laser irradiation, by using a correlation-based custom algorithm. Cross-sectional correlation maps (OCT correlation maps) were also computed from an OCT image taken before laser irradiation as a base-line to visualize alterations of tissue microstructure induced by laser irradiation. By systematically controlling laser power and exposure times, tissue displacements and structural changes of 200 retinal regions of 10 porcine eyes were characterized. Thermal tissue changes were characterized by B-scan images, OCT correlation maps, and tissue displacement maps. Larger tissue deformation was induced with higher laser power and shorter exposure time, while the same total laser energy (10 mJ) was applied. The measured tissue displacements revealed the complicated dynamics of tissue displacements. Three types of dynamics were observed; lateral expansion, lateral constriction, and a type showing more complicated dynamics. The results demonstrated the ability of this OCT-based method to evaluate retinal changes induced by laser irradiation. This evaluation could lead to further understanding of thermal effects, and increasing reproducibility of photocoagulation therapy.
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Affiliation(s)
- Kazuhiro Kurokawa
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Computational Optics and Ophthalmology Group, Tsukuba, Ibaraki, Japan
| | - Shuichi Makita
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Computational Optics and Ophthalmology Group, Tsukuba, Ibaraki, Japan
| | - Yoshiaki Yasuno
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Computational Optics and Ophthalmology Group, Tsukuba, Ibaraki, Japan
- * E-mail:
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Jobling AI, Guymer RH, Vessey KA, Greferath U, Mills SA, Brassington KH, Luu CD, Aung KZ, Trogrlic L, Plunkett M, Fletcher EL. Nanosecond laser therapy reverses pathologic and molecular changes in age‐related macular degeneration without retinal damage. FASEB J 2014; 29:696-710. [DOI: 10.1096/fj.14-262444] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- A. I. Jobling
- Department of Anatomy and NeuroscienceThe University of MelbourneVictoriaAustralia
| | - R. H. Guymer
- Centre for Eye Research AustraliaUniversity of MelbourneRoyal Victorian Eye and Ear HospitalVictoriaAustralia
| | - K. A. Vessey
- Department of Anatomy and NeuroscienceThe University of MelbourneVictoriaAustralia
| | - U. Greferath
- Department of Anatomy and NeuroscienceThe University of MelbourneVictoriaAustralia
| | - S. A. Mills
- Department of Anatomy and NeuroscienceThe University of MelbourneVictoriaAustralia
| | - K. H. Brassington
- Centre for Eye Research AustraliaUniversity of MelbourneRoyal Victorian Eye and Ear HospitalVictoriaAustralia
| | - C. D. Luu
- Centre for Eye Research AustraliaUniversity of MelbourneRoyal Victorian Eye and Ear HospitalVictoriaAustralia
| | - K. Z. Aung
- Centre for Eye Research AustraliaUniversity of MelbourneRoyal Victorian Eye and Ear HospitalVictoriaAustralia
| | - L. Trogrlic
- Department of Anatomy and NeuroscienceThe University of MelbourneVictoriaAustralia
| | | | - E. L. Fletcher
- Department of Anatomy and NeuroscienceThe University of MelbourneVictoriaAustralia
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Comprehensive detection, grading, and growth behavior evaluation of subthreshold and low intensity photocoagulation lesions by optical coherence tomographic and infrared image analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:492679. [PMID: 24900968 PMCID: PMC4037579 DOI: 10.1155/2014/492679] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/11/2014] [Indexed: 11/18/2022]
Abstract
Purpose. To correlate the long-term clinical effect of photocoagulation lesions after 6 months, as measured by their retinal damage size, to exposure parameters. We used optical coherence tomographic (OCT)-based lesion classes in order to detect and assess clinically invisible and mild lesions. Methods. In this prospective study, 488 photocoagulation lesions were imaged in 20 patients. We varied irradiation diameters (100/300 µm), exposure-times (20–200 ms), and power. Intensities were classified in OCT images after one hour, and we evaluated OCT and infrared (IR) images over six months after exposure. Results. For six consecutive OCT-based lesion classes, the following parameters increased with the class: ophthalmoscopic, OCT and IR visibility rate, fundus and OCT diameter, and IR area, but not irradiation power. OCT diameters correlated with exposure-time, irradiation diameter, and OCT class. OCT classes discriminated the largest bandwidth of OCT diameters. Conclusion. OCT classes represent objective and valid endpoints of photocoagulation intensity even for “subthreshold” intensities. They are suitable to calculate the treated retinal area. As the area is critical for treatment efficacy, OCT classes are useful to define treatment intensity, calculate necessary lesion numbers, and universally categorize lesions in clinical studies.
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Hartmann KI, Gomez ML, Bartsch DUG, Schuster AK, Freeman WR. Effect of change in drusen evolution on photoreceptor inner segment/outer segment junction. Retina 2012; 32:1492-9. [PMID: 22481478 DOI: 10.1097/iae.0b013e318242b949] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the integrity of photoreceptor inner segment/outer segment (IS/OS) junction after change of drusen size in age-related macular degeneration using spectral-domain optical coherence tomography. METHODS Drusen volume raster scans were performed with the Spectralis spectral-domain optical coherence tomography (Heidelberg Engineering) through 2,624 drusen in 14 eyes with clinically dry age-related macular degeneration, which had been longitudinally followed-up between 23 and 28 months without intervention (mean, 26.3 months). All eyes had Early Treatment Diabetic Retinopathy Study visual acuity. A total of 416 of 2,624 drusen were analyzed. RESULTS Of 416 drusen, 83 (20%) were found to have regressed spontaneously (Group A), 212 (51%) showed no change in size (Group B), and 121 (29%) progressed (Group C). Mean drusen size of all drusen was 63.7 ± 25.7 μm. Cross-sectional analysis of drusen morphology showed a correlation between drusen size and disrupted IS/OS junction/photoreceptor integrity (r = -0.48, P < 0.001). Of the drusen that regressed over time, there was intact IS/OS junction integrity. Even drusen that caused a major disruption showed IS/OS restoration in 74% of the drusen (P < 0.001). CONCLUSION Progression of drusen shows structural disruption of the IS/OS junction. After drusen regression, the IS/OS junction is either able to restore as drusen regress or was artifactitiously compressed and not initially visible because of the initial drusen compression of the IS/OS junctional line. Therefore, drusen evolution may play an important role in affecting the photoreceptor IS/OS junction integrity.
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Affiliation(s)
- Kathrin I Hartmann
- Department of Ophthalmology, University of California, San Diego, La Jolla, California 92037, USA.
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Koinzer S, Schlott K, Portz L, Ptaszynski L, Baade A, Bever M, Saeger M, Caliebe A, Denner R, Birngruber R, Brinkmann R, Roider J. Correlation of temperature rise and optical coherence tomography characteristics in patient retinal photocoagulation. JOURNAL OF BIOPHOTONICS 2012; 5:889-902. [PMID: 22899667 DOI: 10.1002/jbio.201200091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/03/2012] [Accepted: 07/08/2012] [Indexed: 06/01/2023]
Abstract
We conducted a study to correlate the retinal temperature rise during photocoagulation to the afterward detected tissue effect in optical coherence tomography (OCT). 504 photocoagulation lesions were examined in 20 patients. The retinal temperature increase was determined in real-time during treatment based on thermoelastic tissue expansion which was probed by repetitively applied ns laser pulses. The tissue effect was examined on fundus images and OCT images of individualized lesions. We discerned seven characteristic morphological OCT lesion classes. Their validity was confirmed by increasing visibility and diameters. Mean peak temperatures at the end of irradiation ranged from approx. 60 °C to beyond 100 °C, depending on burn intensity.
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Affiliation(s)
- Stefan Koinzer
- Department of Ophthalmology, University of Kiel, Kiel, Germany.
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Treumer F, Klettner A, Baltz J, Hussain A, Miura Y, Brinkmann R, Roider J, Hillenkamp J. Vectorial release of matrix metalloproteinases (MMPs) from porcine RPE-choroid explants following selective retina therapy (SRT): Towards slowing the macular ageing process. Exp Eye Res 2012; 97:63-72. [DOI: 10.1016/j.exer.2012.02.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/31/2012] [Accepted: 02/16/2012] [Indexed: 11/15/2022]
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