EFFECT OF INTRAVITREAL TRIAMCINOLONE ACETONIDE ON HEALING OF RETINAL PHOTOCOAGULATION LESIONS

A clinically viable approach to restoring visual function using optogenetic gene therapy

Optogenetic gene therapies offer a promising strategy for restoring vision to patients with retinal degenerative diseases, such as retinitis pigmentosa (RP). Several clinical trials have begun in this area using different vectors and optogenetic proteins (Clinical Identifiers: NCT02556736, NCT03326336, NCT04945772, and NCT04278131). Here we present preclinical efficacy and safety data for the NCT04278131 trial, which uses an AAV2 vector and Chronos as the optogenetic protein. Efficacy was assessed in mice in a dose-dependent manner using electroretinograms (ERGs). Safety was assessed in rats, nonhuman primates, and mice, using several tests, including immunohistochemical analyses and cell counts (rats), electroretinograms (nonhuman primates), and ocular toxicology assays (mice). The results showed that Chronos-expressing vectors were efficacious over a broad range of vector doses and stimulating light intensities, and were well tolerated: no test article-related findings were observed in the anatomical and electrophysiological assays performed.

Comparison of the actual diameter of capsulotomy and predicted diameter of capsulotomy after femtosecond laser-assisted capsulotomy

PURPOSE

To compare the consistency between the actual diameter of capsulotomy (ADC) and the predicted diameter of capsulotomy (PDC) in femtosecond laser-assisted cataract surgery (FLACS) and analyze the factors that influence the deviation of the diameter of capsulotomy (DDC) between the actual and predicted.

SETTING

Aier Eye Hospital of Wuhan University, China.

DESIGN

Retrospective observational case series.

METHODS

Patients who underwent FLACS from March 2020 to March 2021 were reviewed. The ADC in FLACS was measured and compared with the PDC. The effects of age, sex, and biometrics on DDC were analyzed.

RESULTS

412 eyes of 336 patients were included. The mean age was 53.0 ± 0.91 years (range 3 to 91 years). When the PDC was set to 4.50 mm, the results showed that the ADC was 5.21 ± 0.21 mm with a significant difference between them ( P < .05). However, when the PDC was set to 5.2 mm, the ADC was 5.10 ± 0.38 mm without a significant difference between them ( P > .05). No correlation ( P > .05) was found between the DDC and the axial length, the DDC and the anterior chamber depth (ACD), and the DDC and the mean keratometry (Km), but a negative correlation was found between the DDC and the lens thickness (LT) ( r = -0.21; P < .05) and the DDC with age ( r = -0.70; P < .05). Using curvilinear regression analysis, a development of an age-depending correction formula was predicted: ADC = PDC + 1.23 - 0.30 ln (x) (x = age ≥3) ( R2 = 0.65; F = 752.39; P = .00).

CONCLUSIONS

The consistency of the ADC and PDC was influenced by age and LT. For patients aged 40 years or younger, the younger the patient, the wider the DDC; for patients older than 40 years, the DDC was small. The thicker the LT, the smaller the DDC.

Laser Therapy in the Treatment of Diabetic Retinopathy and Diabetic Macular Edema

PURPOSE OF REVIEW

This review highlights indications and evidence on laser therapy in the management of diabetic retinopathy and diabetic macular edema. Particular focus is placed upon the benefits and limitations of conventional laser photocoagulation versus more modern laser photocoagulation techniques, as well as the role of laser photocoagulation in treatment of diabetic retinopathy and diabetic macular edema with the frequent utilization of pharmacologic, including anti-vascular endothelial growth factor (VEGF), therapy.

RECENT FINDINGS

Laser photocoagulation remains the gold-standard therapy for the effective, definitive treatment of PDR, and also is highly effective in the management of DME. However, numerous recent studies have demonstrated the clinical efficacy and improved functional and anatomic outcomes of combination therapy with pharmacologic treatment. Continuing innovations in laser technology and improved understanding of laser-retinal interactions and pathophysiology demonstrate that laser therapy will continue to play a critical role in the treatment of diabetic retinopathy and diabetic macular edema for many years to come.

Combination of vascular endothelial growth factor inhibitors and laser therapy for diabetic macular oedema: a review

This review provides a perspective on published and ongoing clinical trials of vascular endothelial growth factor inhibitors (anti-VEGF agents) combined with laser therapy for diabetic macular oedema (DMO). Although there was little short-term benefit in combining prompt macular laser with anti-VEGF therapy for centre-involving DMO in the Diabetic Retinopathy Clinical Research Network (DRCRnet) Protocol I study, deferred macular laser was still required in over 40% of study eyes in DRCRnet Protocol T. Macular laser was applied in more than 30% of eyes with centre-involving DMO receiving ranibizumab in the RISE and RIDE studies. For non centre-involving DMO the evidence-base still supports use of focal macular laser alone, although clinicians should be cautious about applying laser too close to the foveal avascular zone with the availability of pharmacotherapy. Ongoing clinical trials are assessing whether selectively targeting areas of peripheral retinal ischaemia with laser reduces the number of anti-VEGF injections to stabilise DMO and whether combining macular micropulse laser with anti-VEGF therapy is beneficial in DMO.

The evolution of laser therapy in ophthalmology: a perspective on the interactions between photons, patients, physicians, and physicists: the LXX Edward Jackson Memorial Lecture

PURPOSE

To present the evolution of laser therapy in modern ophthalmic practice.

DESIGN

Review of published experimental and clinical studies.

METHODS

A review was undertaken of the work of multiple investigators leading to the invention of the laser, its biophysical effects on ocular tissues from which it derives its name (light-amplified stimulation of emitted radiation), and the development of various laser-based devices and methods to treat common ophthalmologic disorders, with particular emphasis on new and emerging retinal and anterior segment applications.

RESULTS

Because the eye is optimized for the transmission of light and its transduction into neural signals, lasers are particularly well suited for ophthalmic therapy. This fact and the high demands for precision in therapy have inspired the development of highly sophisticated laser systems that have impacted the treatment of common diseases. These include diabetic retinopathy, age-related macular degeneration, retinal venous occlusive disease, retinopathy of prematurity, and optical aberrations including ametropia, cataract, and glaucoma, among others. Recent developments in scanning laser systems, including image-guided systems with eye tracking, real-time feedback, and ultra-short pulse durations, have enabled increased selectivity, precision, and safety in ocular therapy. However, improved outcomes have been associated with increased cost of medical care, and attention to and optimization of their cost effectiveness will continue to be required in the future.

CONCLUSIONS

The invention and evolution of modern ophthalmic lasers have enhanced therapeutic options and can serve as a heuristic model for better understanding the process of innovation, including the societal benefits and also unintended consequences, including increased costs.