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von der Burchard C, Kren C, Fleger JE, Theisen-Kunde D, Danicke V, Abbas HS, Kleyman V, Roider J, Brinkmann R. Real-Time Temperature-Controlled Retinal Laser Irradiation in Rabbits. Transl Vis Sci Technol 2024; 13:26. [PMID: 38639930 PMCID: PMC11037498 DOI: 10.1167/tvst.13.4.26] [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: 12/01/2023] [Accepted: 02/19/2024] [Indexed: 04/20/2024] Open
Abstract
Purpose Subdamaging thermal retinal laser therapy has the potential to induce regenerative stimuli in retinal diseases, but validated dosimetry is missing. Real-time optoacoustic temperature determination and control could close this gap. This study investigates a first in vivo application. Methods Two iterations of a control module that were optically coupled in between a continuous-wave commercial laser source and a commercial slit lamp were evaluated on chinchilla rabbits. The module allows extraction of the temperature rise in real time and can control the power of the therapy laser such that a predefined temperature rise at the retina is quickly achieved and held constant. Irradiations with aim temperatures from 45°C to 69°C were performed on a diameter of 200 µm and a heating time of 100 ms. Results We analyzed 424 temperature-guided irradiations in nine eyes of five rabbits. The mean difference between the measured and aim temperature was -0.04°C ± 0.98°C. The following ED50 values for visibility thresholds could be determined: 58.6°C for funduscopic visibility, 57.7°C for fluorescein angiography, and 57.0°C for OCT. In all measurements, the correlation of tissue effect was higher to the temperature than to the average heating laser power used. Conclusions The system was able to reliably perform temperature-guided irradiations, which allowed for better tissue effect control than simple power control. This approach could enhance the accuracy, safety, and reproducibility of thermal stimulating laser therapy. Translational Relevance This study is a bridge between preclinical ex vivo experiments and a pilot clinical study.
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Affiliation(s)
| | | | - Jan-Erik Fleger
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | | | - Hossam S. Abbas
- Medical Laser Center Lübeck, Lübeck, Germany
- Institute for Electrical Engineering in Medicine, University of Lübeck, Lübeck, Germany
| | - Viktoria Kleyman
- Institute of Automatic Control, Leibniz University Hannover, Hannover, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
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2
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Veysset D, Zhuo Y, Hattori J, Buckhory M, Palanker D. Interferometric thermometry of ocular tissues for retinal laser therapy. BIOMEDICAL OPTICS EXPRESS 2023; 14:37-53. [PMID: 36698667 PMCID: PMC9842005 DOI: 10.1364/boe.475705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
Controlling the tissue temperature rise during retinal laser therapy is highly desirable for predictable and reproducible outcomes of the procedure, especially with non-damaging settings. In this work, we demonstrate a method for determining the optical absorption, the thermal conductivity, and the thermal expansion coefficients of RPE and choroid using phase-resolved optical coherence tomography (pOCT). These parameters are extracted from the measured changes in the optical path length (ΔOPL) using an axisymmetric thermo-mechanical model. This allows the calculation of the temperature rise during hyperthermia, which was further validated by imaging the temperature-sensitive fluorescence at the same location. We demonstrate that, with a temperature uncertainty of ±0.9°C and a peak heating of about 17°C following a laser pulse of 20 ms, this methodology is expected to be safe and sufficiently precise for calibration of the non-damaging retinal laser therapy. The method is directly translatable to in-vivo studies, where we expect a similar precision.
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Affiliation(s)
- David Veysset
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA
| | - Yueming Zhuo
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA 94305, USA
| | - Junya Hattori
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan
| | - Mohajeet Buckhory
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA
| | - Daniel Palanker
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA
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3
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Miura Y, Inagaki K, Hutfilz A, Seifert E, Schmarbeck B, Murakami A, Ohkoshi K, Brinkmann R. Temperature Increase and Damage Extent at Retinal Pigment Epithelium Compared between Continuous Wave and Micropulse Laser Application. Life (Basel) 2022; 12:life12091313. [PMID: 36143352 PMCID: PMC9504342 DOI: 10.3390/life12091313] [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: 07/20/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Continuous wave (CW) and microsecond pulse (MP) laser irradiations were compared regarding cell damage and laser-induced temperature rise at retinal pigment epithelium (RPE). The RPE of porcine RPE-choroid-sclera explants was irradiated with a 577 nm laser in CW or MP mode (5% or 15% duty cycle (DC)) for 20 ms or 200 ms at an average laser power of 20−90 mW. Cell viability was investigated with calcein-AM staining. Optoacoustic (OA) technique was employed for temperature measurement during irradiation. For 200 ms irradiation, the dead cell area (DCA) increased linearly (≈1600 µm2/mW) up to the average power of 40 mW for all modes without significant difference. From 50 mW, the increase of DCA of MP-5% significantly dropped to 610 µm2/mW (p < 0.05), likely due to the detected microbubble formation. OA temperature measurement showed a monotonic temperature increase in CW mode and a stepwise increase in MP mode, but no significant difference in the average temperature increase at the same average power, consistent with the temperature modeling. In conclusion, there is no difference in the average temperature rise between CW and MP modes at the same average power regardless of DC. At lower DC, however, more caution is required regarding mechanical damage due to microbubble formation.
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Affiliation(s)
- Yoko Miura
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany
- Medical Laser Center Lübeck, 23562 Lübeck, Germany
- Department of Ophthalmology, University of Lübeck, 23562 Lübeck, Germany
- Correspondence: ; Tel.: +49-451-3101-3212; Fax: +49-451-3101-3204
| | - Keiji Inagaki
- Inagaki Eye Clinic, Chiba 279-0011, Japan
- Department of Ophthalmology, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | | | - Eric Seifert
- Medical Laser Center Lübeck, 23562 Lübeck, Germany
| | | | - Akira Murakami
- Department of Ophthalmology, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Kishiko Ohkoshi
- Department of Ophthalmology, Hiroo Hanezawa Internal Medicine and Ophthalmology Clinic, Tokyo 150-0012, Japan
- Department of Ophthalmology, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Ralf Brinkmann
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany
- Medical Laser Center Lübeck, 23562 Lübeck, Germany
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4
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Veysset D, Ling T, Zhuo Y, Pandiyan VP, Sabesan R, Palanker D. Interferometric imaging of thermal expansion for temperature control in retinal laser therapy. BIOMEDICAL OPTICS EXPRESS 2022; 13:728-743. [PMID: 35284191 PMCID: PMC8884207 DOI: 10.1364/boe.448803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
Precise control of the temperature rise is a prerequisite for proper photothermal therapy. In retinal laser therapy, the heat deposition is primarily governed by the melanin concentration, which can significantly vary across the retina and from patient to patient. In this work, we present a method for determining the optical and thermal properties of layered materials, directly applicable to the retina, using low-energy laser heating and phase-resolved optical coherence tomography (pOCT). The method is demonstrated on a polymer-based tissue phantom heated with a laser pulse focused onto an absorbing layer buried below the phantom's surface. Using a line-scan spectral-domain pOCT, optical path length changes induced by the thermal expansion were extracted from sequential B-scans. The material properties were then determined by matching the optical path length changes to a thermo-mechanical model developed for fast computation. This method determined the absorption coefficient with a precision of 2.5% and the temperature rise with a precision of about 0.2°C from a single laser exposure, while the peak did not exceed 8°C during 1 ms pulse, which is well within the tissue safety range and significantly more precise than other methods.
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Affiliation(s)
- David Veysset
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA
| | - Tong Ling
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA
- Present address: School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637457, Singapore
| | - Yueming Zhuo
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA 94305, USA
| | | | - Ramkumar Sabesan
- Department of Ophthalmology, University of Washington, Seattle, WA 98109, USA
| | - Daniel Palanker
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA 94305, USA
- Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA
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5
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Truong LTD, Lesniewski PJ, Wedding AB. Heat transfer simulation in laser irradiated retinal tissues. Biomed Phys Eng Express 2021; 8. [PMID: 34874294 DOI: 10.1088/2057-1976/ac3f51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/02/2021] [Indexed: 11/12/2022]
Abstract
A realistic model of human retinal tissues to simulate thermal performance of optical laser photocoagulation therapy is presented. The key criteria to validate the treatment effectiveness is to ensure the photocoagulation temperature between 60 and 70 °C is reached in the treatment region of interest. The model presented consists of truncated volumes of the retinal pigment epithelium (RPE) and adjacent retinal tissues. Two cases of choroid pigmentation are modelled to signify extreme cases of human eye difference: albino and dark colour choroid pigmentation. Conditions for consistent heating over the irradiated treatment spot is modelled for laser beams with different intensity profiles: 'top-hat', Gaussian and 'donut' modes. The simulation considers both uniform heating within retinal tissue layers and spatial intensity decay due to absorption along the direction of laser propagation. For a 500μm spot, pulse length 100 ms and incident power to the cornea of 200 mW, realistic spatial variation in heating results in peak temperatures increasing within the RPE and shifting towards the choroid in the case of choroidal pigmentation. Finite element analysis methodology, where heat transfer theory governs the temperature evolution throughout tissues peripheral to the irradiated RPE is used to determine the zone of therapeutic benefit. While a TEM01donut mode beam produces lower peak temperatures in the RPE for a given incident laser power, it reduces the volume of retinal tissue reaching excessive temperatures and maximises the zone of therapeutic benefit. Described are simulation limitations, boundary conditions, grid size and mesh growth factor required for realistic simulation.
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Affiliation(s)
- Linh T D Truong
- Laser Physics & Photonic Devices Laboratories, UniSA STEM, University of South Australia, Mawson Lakes, SA, 5095, Australia
| | - Peter J Lesniewski
- Laser Physics & Photonic Devices Laboratories, UniSA STEM, University of South Australia, Mawson Lakes, SA, 5095, Australia
| | - A Bruce Wedding
- Laser Physics & Photonic Devices Laboratories, UniSA STEM, University of South Australia, Mawson Lakes, SA, 5095, Australia
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Richert E, Papenkort J, von der Burchard C, Klettner A, Arnold P, Lucius R, Brinkmann R, Framme C, Roider J, Tode J. Selective retina therapy and thermal stimulation of the retina: different regenerative properties - implications for AMD therapy. BMC Ophthalmol 2021; 21:412. [PMID: 34847865 PMCID: PMC8630886 DOI: 10.1186/s12886-021-02188-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Selective Retina Therapy (SRT), a photodisruptive micropulsed laser modality that selectively destroys RPE cells followed by regeneration, and Thermal Stimulation of the Retina (TSR), a stimulative photothermal continuous wave laser modality that leads to an instant sublethal temperature increase in RPE cells, have shown therapeutic effects on Age-related Macular Degeneration (AMD) in mice. We investigate the differences between both laser modalities concerning RPE regeneration. METHODS For PCR array, 6 eyes of murine AMD models, apolipoprotein E and nuclear factor erythroid-derived 2- like 2 knock out mice respectively, were treated by neuroretina-sparing TSR or SRT. Untreated litter mates were controls. Eyes were enucleated either 1 or 7 days after laser treatment. For morphological analysis, porcine RPE/choroid organ cultures underwent the same laser treatment and were examined by calcein vitality staining 1 h and 1, 3 or 5 days after irradiation. RESULTS TSR did not induce the expression of cell-mediators connected to cell death. SRT induced necrosis associated cytokines as well as inflammation 1 but not 7 days after treatment. Morphologically, 1 h after TSR, there was no cell damage. One and 3 days after TSR, dense chromatin and cell destruction of single cells was seen. Five days after TSR, there were signs of migration and proliferation. In contrast, 1 h after SRT a defined necrotic area within the laser spot was seen. This lesion was closed over days by migration and proliferation of adjacent cells. CONCLUSIONS SRT induces RPE cell death, followed by regeneration within a few days. It is accompanied by necrosis induced inflammation, RPE proliferation and migration. TSR does not induce immediate RPE cell death; however, migration and mitosis can be seen a few days after laser irradiation, not accompanied by necrosis-associated inflammation. Both might be a therapeutic option for the treatment of AMD.
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Affiliation(s)
- Elisabeth Richert
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Julia Papenkort
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Claus von der Burchard
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Alexa Klettner
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Philipp Arnold
- Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Germany
| | - Ralph Lucius
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Kiel, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute for Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Carsten Framme
- Department of Ophthalmology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany. .,Department of Ophthalmology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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7
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Seifert E, Sonntag SR, Kleingarn P, Theisen-Kunde D, Grisanti S, Birngruber R, Miura Y, Brinkmann R. Investigations on Retinal Pigment Epithelial Damage at Laser Irradiation in the Lower Microsecond Time Regime. Invest Ophthalmol Vis Sci 2021; 62:32. [PMID: 33755044 PMCID: PMC7991964 DOI: 10.1167/iovs.62.3.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose New lasers with a continuous wave power exceeding 15 W are currently investigated for retinal therapies, promising highly localized effects at and close to the Retinal Pigment Epithelium (RPE). The goal of this work is to evaluate mechanisms and thresholds for RPE cell damage by means of pulse durations up to 50 µs. Methods A diode laser with a wavelength of 514 nm, a power of 15 W, and adjustable pulse durations between 2 µs and 50 µs was used. Porcine RPE-choroidal explants (ex vivo) and chinchilla bastard rabbits (in vivo) were irradiated to determine threshold radiant exposures for RPE damage H¯Cell by calcein vitality staining and fluorescence angiography, respectively. Thresholds for microbubble formation (MBF) H¯MBF were evaluated by time-resolved optoacoustics. Exemplary histologies support the findings. Results H¯MBF
is significantly higher than H¯Cell at pulse durations ≥ 5 µs (P < 0.05) ex vivo, while at 2 µs, no statistically significant difference was found. The ratios between H¯MBF and H¯Cell increase with pulse duration from 1.07 to 1.48 ex vivo and 1.1 to 1.6 in vivo, for 5.2 and 50 µs. Conclusions Cellular damage with and without MBF related disintegration are both present and very likely to play a role for pulse durations ≥ 5 µs. With the lower µs pulses, selective RPE disruption might be possible, while higher values allow achieving spatially limited thermal effects without MBF. However, both modi require a very accurate real-time dosing control in order to avoid extended retinal disintegration in this power range.
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Affiliation(s)
| | | | | | | | | | - Reginald Birngruber
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Yoko Miura
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany.,Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
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8
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Hansen S, Askou AL, la Cour M, Corydon TJ, Bek T. Subretinal Saline Protects the Neuroretina From Thermic Damage During Laser Induction of Experimental Choroidal Neovascularization in Pigs. Transl Vis Sci Technol 2021; 10:29. [PMID: 34185056 PMCID: PMC8254010 DOI: 10.1167/tvst.10.7.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to develop a porcine model for photocoagulation induced choroidal neovascularization (CNV) with high success rate and minimal thermic damage to the neuroretina. Methods Experimental CNV was induced by laser photocoagulation in both eyes of 16 domestic pigs. In the left eyes, photocoagulation was preceded by subretinal injection of saline to protect the neuroretina from thermic damage, whereas the right eyes were treated with photocoagulation only. The development of the CNV after 3, 7, 14, 28, and 42 days was evaluated by optical coherence tomography (OCT) scanning, fluorescein angiography, and OCT angiography, and by histology after enucleation. Results From day 7 after the photocoagulation, OCT showed subretinal density in all lesions of 14 alive animals, and either fluorescein or OCT angiography confirmed CNV formation in 11 of 14 of the eyes that had received photocoagulation alone and those in which photocoagulation had been preceded by subretinal injection of saline. In all cases pretreated with subretinal saline, the neuroretina was protected from immediate thermic damage. The formation of CNVs were confirmed by histology. For both groups, the largest lesions were observed within 14 days after photocoagulation. Conclusions Injection of subretinal saline can protect the retina from thermic damage induced by retinal photocoagulation without reducing the success rate in producing experimental CNV. The effect of interventional studies aimed at reducing photocoagulation induced experimental CNV in pigs can be evaluated within 2 weeks after photocoagulation. Translational Relevance This model provides a fundament to develop and evaluate novel treatment methods for neovascular retinal diseases.
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Affiliation(s)
- Silja Hansen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Thomas J Corydon
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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9
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Regal S, Troughton J, Delattre R, Djenizian T, Ramuz M. Changes in temperature inside an optomechanical model of the human eye during emulated transscleral cyclophotocoagulation. BIOMEDICAL OPTICS EXPRESS 2020; 11:4548-4559. [PMID: 32923063 PMCID: PMC7449722 DOI: 10.1364/boe.385016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 06/11/2023]
Abstract
Currently, many diseases of the eye are treated by laser surgery. An understanding of light propagation and the heating of eye tissue during laser exposure is crucial to improving the outcome of these procedures. Here, we present the development of physical and computational models of the human eye by combining optical light propagation and thermal characteristics. For the physical model, all parts of the eye, including cornea, lens, ciliary body, sclera, aqueous and vitreous humors, and iris, were fabricated using a 3D printed holder and modified polydimethylsiloxane. We also present a computational model based on finite element analysis that allows for a direct comparison between the simulation and experimental measurements. These models provide an opportunity to directly assess the rise in temperature in all eye tissues. The simulated and physical models showed good agreement for the transmission of light at varying incident angles. The heating of optical components was investigated in the retina and the ciliary body during simulated laser surgery. Temperature increases of 45.3°C and 30.6°C in the retina and ciliary bodies, respectively, were found in the physical model after 1 minute of exposure to 186 mW of 850 nm laser radiation. This compared to 29.8°C and 33.9°C increases seen under the same conditions in the simulation model with human eye parameters and 48.1°C and 28.7°C for physical model parameters. These results and these models are very promising for further investigation of the impact of laser surgery.
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Affiliation(s)
- Simon Regal
- Mines Saint-Etienne, Center of Microelectronics in Provence, Department of Flexible Electronics, F-13541 Gardanne, France
| | - Joe Troughton
- Mines Saint-Etienne, Center of Microelectronics in Provence, Department of Flexible Electronics, F-13541 Gardanne, France
| | - Roger Delattre
- Mines Saint-Etienne, Center of Microelectronics in Provence, Department of Flexible Electronics, F-13541 Gardanne, France
| | - Thierry Djenizian
- Mines Saint-Etienne, Center of Microelectronics in Provence, Department of Flexible Electronics, F-13541 Gardanne, France
- Al-Farabi Kazakh National University, Center of Physical-Chemical Methods of Research and Analysis, Almaty, Tole bi str., 96A, Kazakhstan
| | - Marc Ramuz
- Mines Saint-Etienne, Center of Microelectronics in Provence, Department of Flexible Electronics, F-13541 Gardanne, France
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10
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Munier FL, Beck-Popovic M, Chantada GL, Cobrinik D, Kivelä TT, Lohmann D, Maeder P, Moll AC, Carcaboso AM, Moulin A, Schaiquevich P, Bergin C, Dyson PJ, Houghton S, Puccinelli F, Vial Y, Gaillard MC, Stathopoulos C. Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity". Prog Retin Eye Res 2019; 73:100764. [PMID: 31173880 DOI: 10.1016/j.preteyeres.2019.05.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.
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Affiliation(s)
- Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland.
| | - Maja Beck-Popovic
- Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Guillermo L Chantada
- Hemato-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - David Cobrinik
- The Vision Center and The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA; USC Roski Eye Institute, Department of Biochemistry & Molecular Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tero T Kivelä
- Department of Ophthalmology, Ocular Oncology and Pediatric Ophthalmology Services, Helsinki University Hospital, Helsinki, Finland
| | - Dietmar Lohmann
- Eye Oncogenetics Research Group, Institute of Human Genetics, University Hospital Essen, Essen, Germany
| | - Philippe Maeder
- Unit of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Annette C Moll
- UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Angel Montero Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Alexandre Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Ciara Bergin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paul J Dyson
- Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Susan Houghton
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal Medicine Unit, Woman-Mother-Child Department, University Hospital of Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
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Miura Y, Seifert E, Rehra J, Kern K, Theisen-Kunde D, Denton M, Brinkmann R. Real-time optoacoustic temperature determination on cell cultures during heat exposure: a feasibility study. Int J Hyperthermia 2019; 36:466-472. [PMID: 30922131 DOI: 10.1080/02656736.2019.1590653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective/Purpose: In order to study the effects of hyperthermia and other temperature-related effects on cells and tissues, determining the precise time/temperature course is crucial. Here we present a non-contact optoacoustic technique, which provides temperatures during heating of cultured cells with scalable temporal and spatial resolution. METHODS A thulium laser (1.94 µm) with a maximum power of 15 W quickly and efficiently heats cells in a culture dish because of low penetration depth (1/e penetration depths of 78 µm) of the radiation in water. A repetitively Q-switched holmium laser (2.1 µm) is used simultaneously to probe temperatures at different locations in the dish by using the photoacoustic effect. Due to thermoelastic expansion of water, pressure waves are emitted and measured with an ultrasonic hydrophone at the side of the dish. The amplitudes of the waves are temperature dependent and can be used to calculate the temperature/time course at any location of probing. RESULTS We measured temperatures of up to 55 °C with a heating power of 6 W after 10 s, and subsequent lateral temperature profiles over time. Within this profile, temperature fluctuations were found, likely owing to thermal convection and water circulation. By using cultured retinal pigment epithelial cells, it is shown that the probe laser pulses alone cause no biological damage, while immediate cell damage occurs when heating for 10 s at temperatures exceeding 45 °C. CONCLUSIONS This method shows great potential not only as a noninvasive, non-contact method to determine temperature/time responses of cells in culture, but also for complex tissue and other materials.
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Affiliation(s)
- Yoko Miura
- a Medical Laser Center Lübeck , Lübeck , Germany.,b Institute of Biomedical Optics , University of Lübeck , Lübeck , Germany.,c Department of Ophthalmology , University Hospital Schleswig-Holstein , Campus Lübeck, Lübeck , Germany
| | - Eric Seifert
- a Medical Laser Center Lübeck , Lübeck , Germany
| | - Josua Rehra
- a Medical Laser Center Lübeck , Lübeck , Germany
| | | | | | - Michael Denton
- d 711th Human Performance Wing, Airman Systems Directorate, Bioeffects Division, Optic Radiation Bioeffects Branch , JBSA , Fort Sam Houston , TX , USA
| | - Ralf Brinkmann
- a Medical Laser Center Lübeck , Lübeck , Germany.,b Institute of Biomedical Optics , University of Lübeck , Lübeck , Germany
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12
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ZHOU YUAN, LI MUCONG, LIU WEI, SANKIN GEORGY, LUO JIANWEN, ZHONG PEI, YAO JUNJIE. Thermal Memory Based Photoacoustic Imaging of Temperature. OPTICA 2019; 6:198-205. [PMID: 31286029 PMCID: PMC6613656 DOI: 10.1364/optica.6.000198] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/18/2019] [Indexed: 05/05/2023]
Abstract
Temperature mapping is essential in many biomedical studies and interventions to precisely control the tissue's thermal conditions for optimal treatment efficiency and minimal side effects. Based on the Grüneisen parameter's temperature dependence, photoacoustic (PA) imaging can provide relative temperature measurement, but it has been traditionally challenging to measure absolute temperatures without knowing the baseline temperature, especially in deep tissues with unknown optical and acoustic properties. Here, we report a new thermal-energy-memory-based photoacoustic thermometry (TEMPT). By illuminating the tissue with a burst of nanosecond laser pulses, TEMPT exploits the temperature dependence of the thermal energy lingering, which is probed by the corresponding PA signals acquired within the thermal confinement. A self-normalized ratiometric measurement cancels out temperature-irrelevant quantities and estimates the Grüneisen parameter. The temperature can then be evaluated, given the tissue's temperature-dependent Grüneisen parameter, mass density, and specific heat capacity. Unlike the conventional PA thermometry, TEMPT does not require the knowledge of tissue's baseline temperature, nor the optical properties. We have developed a mathematical model to describe the temperature dependence in TEMPT. We have demonstrated the feasibility of the temperature evaluation on tissue phantoms at 1.5 cm depth within a clinically relevant temperature range. Finally, as proof-of-concept, we applied TEMPT for temperature mapping during focused ultrasound treatment in mice in vivo at 2 mm depth. As a generic temperature mapping method, TEMPT is expected to find applications in thermotherapy of cancers on small animal models.
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Affiliation(s)
- YUAN ZHOU
- Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - MUCONG LI
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - WEI LIU
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - GEORGY SANKIN
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - JIANWEN LUO
- Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - PEI ZHONG
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - JUNJIE YAO
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
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13
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Abstract
Rapid, accurate, and nondestructive mapping of material properties is of great interest in many fields, with applications ranging from detection of defects or other subsurface features in semiconductors to estimating temperature rise in various tissue layers during laser therapy. We demonstrate the speed and precision of two interferometric techniques, quantitative phase imaging and phase-resolved optical coherence tomography, in recording optical phase changes induced by energy deposition in various materials. Such phase perturbations can be used to infer sample properties, ranging from absorption and temperature maps to distribution of electric field or resistivity. We derive the theoretical sensitivity limits of such techniques and demonstrate their applicability to the mapping of absorption coefficients, temperature, and electric fields in synthetic and biological samples. Optical phase changes induced by transient perturbations provide a sensitive measure of material properties. We demonstrate the high sensitivity and speed of such methods, using two interferometric techniques: quantitative phase imaging (QPI) in transmission and phase-resolved optical coherence tomography (OCT) in reflection. Shot-noise–limited QPI can resolve energy deposition of about 3.4 mJ/cm2 in a single pulse, which corresponds to 0.8 °C temperature rise in a single cell. OCT can detect deposition of 24 mJ/cm2 energy between two scattering interfaces producing signals with about 30-dB signal-to-noise ratio (SNR), and 4.7 mJ/cm2 when SNR is 45 dB. Both techniques can image thermal changes within the thermal confinement time, which enables accurate single-shot mapping of absorption coefficients even in highly scattering samples, as well as electrical conductivity and many other material properties in biological samples at cellular scale. Integration of the phase changes along the beam path helps increase sensitivity, and the signal relaxation time reveals the size of hidden objects. These methods may enable multiple applications, ranging from temperature-controlled retinal laser therapy or gene expression to mapping electric current density and characterization of semiconductor devices with rapid pump–probe measurements.
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14
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Kern K, Mertineit CL, Brinkmann R, Miura Y. Expression of heat shock protein 70 and cell death kinetics after different thermal impacts on cultured retinal pigment epithelial cells. Exp Eye Res 2018; 170:117-126. [PMID: 29454858 DOI: 10.1016/j.exer.2018.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/25/2018] [Accepted: 02/14/2018] [Indexed: 12/19/2022]
Abstract
Recent technologies are broadening the possibility to treat the retinal pigment epithelium (RPE) with different thermal impacts, from sublethal to lethal ranges. Thus temperature-dependent subcellular molecular responses need to be elucidated in more detail. In this study, RPE cell viability and expression of heat shock protein 70 (Hsp70) were investigated after thermal irradiation with different temperature increase using an in-vitro model. Primary porcine RPE cell cultures were irradiated with different laser power of a thulium laser (λ = 1940 nm, beam-diameter 30 mm) for 10 s, such that the maximal temperatures at the center of the culture dish (Tmax) reach 40, 44, 47, 51 or 59 °C after 10-s irradiation. The temperature distribution across the culture dish shows a Gaussian decay from central position to the periphery of the dish. At 3, 24 and 48 h after irradiation cell viability was assessed with fluorescence microscopy using cell viability-indicating fluorescence dyes, followed by the determination of the threshold temperature for apoptotic change and death of RPE cells. Intracellular localization and amount of Hsp70 were investigated with immunofluorescence and western blotting, respectively. The threshold temperature (at the 10th second of irradiation: T10s) for cellular apoptosis and complete cell death showed a decrease over time after irradiation, suggesting a long-term process of thermally induced cell death. For complete cell death the threshold T10s was 52.1 ± 0.6 °C, 50.1 ± 1.4 °C, and 50.1 ± 0.8 °C, for 3, 24 and 48 h, respectively, whereas for the apoptotic changes 48.6 ± 1.8 °C, 47.2 ± 1.3 °C, and 46.7 ± 0.9 °C, respectively. Quantitative analysis of Hsp70 with western blotting showed a significant increase in intracellular Hsp70 at lethal irradiation with Tmax ≥ 51 °C, up to 19.6 ± 2.3 fold after 48 h at 59 °C, whereas sub-lethal irradiations with Tmax ≤ 44 °C led to a slight tendency of time-dependent increases (up to 1.8 ± 1.1 fold) over 48 h. Immunostainings for Hsp70 showed a circle- or ring-pattern of the Hsp70 staining during 3-48 h after irradiation, and the range of the 1st and 3rd quartiles of T10s for heat-induced Hsp70 expression over this time period was between 44.8 °C and 48.2 °C. A very strong staining of Hsp70 was observed at the border to the damaged zone, where many cells show the strong staining in the whole cytoplasmic space, while some cells in the nucleus, or some cells show the signs of cell migration and proliferation. Moreover, among the cells showing high intensity of Hsp70 staining, there are small round cells like apoptotic cells. Results suggest that RPE cell death after thermal irradiation may take time, and mostly undergoes through apoptosis, unless cells are immediately killed. Thermal irradiation-induced Hsp70 expression is not only temperature-dependent, but also depends largely on the existence of neighboring cell death, suggesting the crucial role of Hsp70 in apoptosis and wound healing processes of RPE cells. The increase of Hsp70 over 24-48 h indicates its long-term roles in cell responses both after sublethal and lethal thermal laser irradiations.
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Affiliation(s)
- Katharina Kern
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany; Medical Laser Center Lübeck, Lübeck, Germany
| | | | - Ralf Brinkmann
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany; Medical Laser Center Lübeck, Lübeck, Germany
| | - Yoko Miura
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany; Medical Laser Center Lübeck, Lübeck, Germany; Department of Ophthalmology, University of Lübeck, Lübeck, Germany.
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15
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Zhou J, He H, Chen Z, Wang Y, Ma H. Modulus design multiwavelength polarization microscope for transmission Mueller matrix imaging. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-10. [PMID: 29313323 DOI: 10.1117/1.jbo.23.1.016014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/11/2018] [Indexed: 05/18/2023]
Abstract
We have developed a polarization microscope based on a commercial transmission microscope. We replace the halogen light source by a collimated LED light source module of six different colors. We use achromatic polarized optical elements that can cover the six different wavelength ranges in the polarization state generator (PSG) and polarization state analyzer (PSA) modules. The dual-rotating wave plate method is used to measure the Mueller matrix of samples, which requires the simultaneous rotation of the two quarter-wave plates in both PSG and PSA at certain angular steps. A scientific CCD detector is used as the image receiving module. A LabView-based software is developed to control the rotation angels of the wave plates and the exposure time of the detector to allow the system to run fully automatically in preprogrammed schedules. Standard samples, such as air, polarizers, and quarter-wave plates, are used to calibrate the intrinsic Mueller matrix of optical components, such as the objectives, using the eigenvalue calibration method. Errors due to the images walk-off in the PSA are studied. Errors in the Mueller matrices are below 0.01 using air and polarizer as standard samples. Data analysis based on Mueller matrix transformation and Mueller matrix polarization decomposition is used to demonstrate the potential application of this microscope in pathological diagnosis.
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Affiliation(s)
- Jialing Zhou
- Tsinghua University, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Institute of, China
- Tsinghua University, Department of Biomedical Engineering, Beijing, China
| | - Honghui He
- Tsinghua University, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Institute of, China
| | - Zhenhua Chen
- Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China
| | - Ye Wang
- Tsinghua University, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Institute of, China
- Tsinghua University, Department of Physics, Beijing, China
| | - Hui Ma
- Tsinghua University, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Institute of, China
- Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China
- Tsinghua University, Department of Physics, Beijing, China
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Abstract
Since the 1960s, laser therapies have played a critical role in the treatment of numerous retinal diseases. Significant advances have been made in laser technology and the molecular understanding of laser-tissue interactions over the past 55 years to maximize the therapeutic effect while minimizing side-effects. While pharmacologic therapies (e.g., anti-vascular endothelial growth factor or anti-VEGF) are playing a larger role, laser therapy remains an important treatment modality for proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), sickle cell retinopathy, retinal vein occlusions, central serous chorioretinopathy, tumors, polypoidal choroidal vasculopathy, and retinal tears. With the development new laser technologies such as selective retinal therapy, subthreshold micropulse laser, nanosecond laser, photomediated ultrasound therapy, and navigated laser, the risk of adverse events has been significantly reduced. This review summarizes the latest developments in retinal laser therapy.
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Affiliation(s)
- Jia Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yannis Mantas Paulus
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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17
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Zaitsev VY, Matveyev AL, Matveev LA, Gelikonov GV, Omelchenko AI, Baum OI, Avetisov SE, Bolshunov AV, Siplivy VI, Shabanov DV, Vitkin A, Sobol EN. Optical coherence elastography for strain dynamics measurements in laser correction of cornea shape. JOURNAL OF BIOPHOTONICS 2017; 10:1450-1463. [PMID: 28493426 DOI: 10.1002/jbio.201600291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/24/2017] [Accepted: 04/23/2017] [Indexed: 05/20/2023]
Abstract
We describe the use of elastographic processing in phase-sensitive optical coherence tomography (OCT) for visualizing dynamics of strain and tissue-shape changes during laser-induced photothermal corneal reshaping, for applications in the emerging field of non-destructive and non-ablative (non-LASIK) laser vision correction. The proposed phase-processing approach based on fairly sparse data acquisition enabled rapid data processing and near-real-time visualization of dynamic strains. The approach avoids conventional phase unwrapping, yet allows for mapping strains even for significantly supra-wavelength inter-frame displacements of scatterers accompanied by multiple phase-wrapping. These developments bode well for real-time feedback systems for controlling the dynamics of corneal deformation with 10-100 ms temporal resolution, and for suitably long-term monitoring of resultant reshaping of the cornea. In ex-vivo experiments with excised rabbit eyes, we demonstrate temporal plastification of cornea that allows shape changes relevant for vision-correction applications without affecting its transparency. We demonstrate OCT's ability to detect achieving of threshold temperatures required for tissue plastification and simultaneously characterize transient and cumulative strain distributions, surface displacements, and scattering tissue properties. Comparison with previously used methods for studying laser-induced reshaping of cartilaginous tissues and numerical simulations is performed.
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Affiliation(s)
- Vladimir Y Zaitsev
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Alexander L Matveyev
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Lev A Matveev
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Grigory V Gelikonov
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Alexander I Omelchenko
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
- Institute of Photonic Technologies, Centre "Crystallography and Photonics", Russian Academy of Sciences, Moscow, Russia
| | - Olga I Baum
- Institute of Photonic Technologies, Centre "Crystallography and Photonics", Russian Academy of Sciences, Moscow, Russia
| | | | | | | | - Dmitry V Shabanov
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Alex Vitkin
- University Health Network and University of Toronto, 101 College street, Toronto, Ontario, M5G 1 L7, Canada
| | - Emil N Sobol
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
- Institute of Photonic Technologies, Centre "Crystallography and Photonics", Russian Academy of Sciences, Moscow, Russia
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18
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Baade A, von der Burchard C, Lawin M, Koinzer S, Schmarbeck B, Schlott K, Miura Y, Roider J, Birngruber R, Brinkmann R. Power-controlled temperature guided retinal laser therapy. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-11. [PMID: 29164836 DOI: 10.1117/1.jbo.22.11.118001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
Laser photocoagulation has been a treatment method for retinal diseases for decades. Recently, studies have demonstrated therapeutic benefits for subvisible effects. A treatment mode based on an automatic feedback algorithm to reliably generate subvisible and visible irradiations within a constant irradiation time is introduced. The method uses a site-individual adaptation of the laser power by monitoring the retinal temperature rise during the treatment using optoacoustics. This provides feedback to adjust the therapy laser power during the irradiation. The technique was demonstrated on rabbits in vivo using a 532-nm continuous wave Nd:YAG laser. The temperature measurement was performed with 523-nm Q-switched Nd:YLF laser pulses with 75-ns pulse duration at 1-kHz repetition rate. The beam diameter on the fundus was 200 μm for both lasers, respectively. The aim temperatures ranged from 50°C to 75°C in 11 eyes of 7 rabbits. The results showed ophthalmoscopically invisible effects below 55°C with therapy laser powers over a wide range. The standard deviation for the measured temperatures ranged from 2.1°C for an aim temperature of 50°C to 4.7°C for 75°C. The ED50 temperature value for ophthalmoscopically visible lesions in rabbits was determined as 65.3°C. The introduced method can be used for retinal irradiations with adjustable temperature elevations.
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Affiliation(s)
| | - Claus von der Burchard
- University Medical Center of Schleswig-Holstein, Department of Ophthalmology, Kiel, Germany
| | - Meike Lawin
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Germany
| | - Stefan Koinzer
- University Medical Center of Schleswig-Holstein, Department of Ophthalmology, Kiel, Germany
| | | | | | - Yoko Miura
- University of Lübeck, Institute of Biomedical Optics, Lübeck, Germany
| | - Johann Roider
- University Medical Center of Schleswig-Holstein, Department of Ophthalmology, Kiel, Germany
| | - Reginald Birngruber
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Germany
- University of Lübeck, Institute of Biomedical Optics, Lübeck, Germany
| | - Ralf Brinkmann
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Germany
- University of Lübeck, Institute of Biomedical Optics, Lübeck, Germany
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Singh R, Rajaraman S, Balasubramanian M. A Novel Nanoparticle Mediated Selective Inner Retinal Photocoagulation for Diseases of the Inner Retina. IEEE Trans Nanobioscience 2017; 16:542-554. [PMID: 28829313 PMCID: PMC5926191 DOI: 10.1109/tnb.2017.2741490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A novel nanoparticle mediated methodology for laser photocoagulation of the inner retina to achieve tissue selective treatment is presented. METHODS Transport of 527, 577, and 810 nm laser, heat deposition, and eventual thermal damage in vitreous, retina, RPE, choroid, and sclera were modeled using Bouguer-Beer-Lambert law of absorption and solved numerically using the finite volume method. Nanoparticles were designed using Mie theory of scattering. Performance of the new photocoagulation strategy using gold nanospheres and gold-silica nanoshells was compared with that of conventional methods without nanoparticles. For experimental validation, vitreous cavity of ex vivo porcine eyes was infused with gold nanospheres. After ~6 h of nanoparticle diffusion, the porcine retina was irradiated with a green laser and imaged simultaneously using a spectral domain optical coherence tomography (Spectralis SD-OCT, Heidelberg Engineering). RESULTS Our computational model predicted a significant spatial shift in the peak temperature from RPE to the inner retinal region when infused with nanoparticles. Arrhenius thermal damage in the mid-retinal location was achieved in ~14 ms for 527 nm laser thereby reducing the irradiation duration by ~30 ms compared with the treatment without nanoparticles. In ex vivo porcine eyes infused with gold nanospheres, SD-OCT retinal images revealed a lower thermal damage and expansion at RPE due to laser photocoagulation. CONCLUSION Nanoparticle infused laser photocoagulation strategy provided a selective inner retinal thermal damage with significant decrease in laser power and laser exposure time. SIGNIFICANCE The proposed treatment strategy shows possibilities for an efficient and highly selective inner retinal laser treatment.
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Petrova E, Liopo A, Oraevsky AA, Ermilov SA. Temperature-dependent optoacoustic response and transient through zero Grüneisen parameter in optically contrasted media. PHOTOACOUSTICS 2017; 7:36-46. [PMID: 28725558 PMCID: PMC5501891 DOI: 10.1016/j.pacs.2017.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 06/11/2017] [Accepted: 06/21/2017] [Indexed: 05/10/2023]
Abstract
Non-invasive optoacoustic mapping of temperature in tissues with low blood content can be enabled by administering external contrast agents. Some important clinical applications of such approach include temperature mapping during thermal therapies in a prostate or a mammary gland. However, the technique would require a calibration that establishes functional relationship between the measured normalized optoacoustic response and local tissue temperature. In this work, we investigate how a key calibration parameter - the temperature of zero optoacoustic response (T0 ) - behaves in different environments simulating biological tissues augmented with either dissolved or particulate (nanoparticles) contrast agents. The observed behavior of T0 in ionic and molecular solutions suggests that in-vivo temperature mapping is feasible for contrast agents of this type, but requires knowledge of local concentrations. Oppositely, particulate contrast agents (plasmonic or carbon nanoparticles) demonstrated concentration-independent thermal behavior of optoacoustic response with T0 defined by the thermoelastic properties of the local environment.
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Key Words
- GNR, Gold nanorods
- MRI, Magnetic resonance imaging
- NIR, Near-infrared
- NP, Nanoparticles
- OA, Optoacoustic
- Optical contrast agents
- Optoacoustic imaging
- Photoacoustic
- ROI, Region of interest
- SNR, Signal-to-noise ratio
- SOS, Speed of sound
- Temperature monitoring
- ThOR, Thermal (temperature-dependent) optoacoustic response
- USI, Ultrasound imaging
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21
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Miura Y, Pruessner J, Mertineit CL, Kern K, Muenter M, Moltmann M, Danicke V, Brinkmann R. Continuous-wave Thulium Laser for Heating Cultured Cells to Investigate Cellular Thermal Effects. J Vis Exp 2017. [PMID: 28715366 DOI: 10.3791/54326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
An original method to heat cultured cells using a 1.94 µm continuous-wave thulium laser for biological assessment is introduced here. Thulium laser radiation is strongly absorbed by water, and the cells at the bottom of the culture dish are heated through thermal diffusion. A laser fiber with a diameter of 365 µm is set about 12 cm above the culture dish, without any optics, such that the laser beam diameter is almost equivalent to the inner diameter of the culture dish (30 mm). By keeping a consistent amount of culture medium in each experiment, it is possible to irradiate the cells with a highly reproducible temperature increase. To calibrate the temperature increase and its distribution in one cell culture dish for each power setting, the temperature was measured during 10 s of irradiation at different positions and at the cellular level. The temperature distribution was represented using a mathematical graphics software program, and its pattern across the culture dish was in Gaussian form. After laser irradiation, different biological experiments could be performed to assess temperature-dependent cell responses. In this manuscript, viability staining (i.e., distinguishing live, apoptotic, and dead cells) is introduced to help determine the threshold temperatures for cell apoptosis and death after different points in time. The advantages of this method are the preciseness of the temperature and the time of heating, as well as its high efficiency in heating cells in a whole cell culture dish. Furthermore, it allows for study with a wide variety of temperatures and time durations, which can be well-controlled by a computerized operating system.
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Affiliation(s)
- Yoko Miura
- Institute of Biomedical Optics, University of Luebeck; Medical Laser Center Luebeck GmbH, University of Leubeck; Department of Ophthalmology, University of Luebeck;
| | | | | | | | | | | | - Veit Danicke
- Medical Laser Center Luebeck GmbH, University of Leubeck
| | - Ralf Brinkmann
- Institute of Biomedical Optics, University of Luebeck; Medical Laser Center Luebeck GmbH, University of Leubeck
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22
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Schlott K, Koinzer S, Baade A, Birngruber R, Roider J, Brinkmann R. Lesion strength control by automatic temperature guided retinal photocoagulation. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:98001. [PMID: 27670670 DOI: 10.1117/1.jbo.21.9.098001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/26/2016] [Indexed: 06/06/2023]
Abstract
Laser photocoagulation is an established treatment for a variety of retinal diseases. However, when using the same irradiation parameter, the size and strength of the lesions are unpredictable due to unknown inter- and intraindividual optical properties of the fundus layers. The aim of this work is to investigate a feedback system to generate desired lesions of preselectable strengths by automatically controlling the irradiation time. Optoacoustics were used for retinal temperature monitoring. A 532-nm continuous wave Nd:YAG laser was used for photocoagulation. A 75-ns/523-nm Q-switched Nd:YLF laser simultaneously excited temperature-dependent pressure transients, which were detected at the cornea by an ultrasonic transducer embedded in a contact lens. The temperature data were analyzed during the irradiation by a LabVIEW routine. The treatment laser was switched off automatically when the required lesion strength was achieved. Five different feedback control algorithms for different lesion sizes were developed and tested on rabbits in vivo. With a laser spot diameter of 133???m, five different lesion types with ophthalmoscopically visible diameters ranging mostly between 100 and 200???m, and different appearances were achieved by automatic exposure time control. The automatically controlled lesions were widely independent of the treatment laser power and the retinal pigmentation.
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Affiliation(s)
- Kerstin Schlott
- University of Lübeck, Institute of Biomedical Optics, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Stefan Koinzer
- University of Kiel, Department of Ophthalmology, Arnold-Heller-Straße 3, House 25, 24105 Kiel, Germany
| | - Alexander Baade
- Medical Laser Center Lübeck, Lübeck, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Reginald Birngruber
- University of Lübeck, Institute of Biomedical Optics, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Johann Roider
- University of Kiel, Department of Ophthalmology, Arnold-Heller-Straße 3, House 25, 24105 Kiel, Germany
| | - Ralf Brinkmann
- University of Lübeck, Institute of Biomedical Optics, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
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Saeger M, Heckmann J, Purtskhvanidze K, Caliebe A, Roider J, Koinzer S. Variability of panretinal photocoagulation lesions across physicians and patients. Quantification of diameter and intensity variation. Graefes Arch Clin Exp Ophthalmol 2016; 255:49-59. [PMID: 27405976 DOI: 10.1007/s00417-016-3416-9] [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: 02/15/2016] [Revised: 06/12/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Photocoagulation lesion intensity relies on the judgement of retinal blanching. Lesions turn out variable due to observer-dependent judgement and time dependency of blanching. We investigated lesion variability per patient and per physician in clinical routine treatments. METHODS In this observational clinical trial, different physicians performed panretinal photocoagulation for diabetic retinopathy. Study eyes received 20-30 study lesions at 20 ms (three physicians, nine eyes) and 200 ms (four physicians, 12 eyes) irradiation time (532 nm continuous wave photocoagulator, 300 μm spot size). Lesions were imaged after 1 hour with photography and optical coherence tomography (OCT). We measured lesion diameters in fundus and OCT images, and graded intensities according to a previously published six-step classifier. RESULTS 200-ms lesions were larger and more severe (568, 474-625 μm [median, IQR], predominantly class 6) than 20-ms lesions (397, 347-459 μm, predominantly classes 3-4). The impact of laser power was small compared to other factors. Lesion intensities and diameters in fundus and OCT images varied significantly between patients and between physicians. Median photographic lesion diameters varied by up to a factor of 1.61 (20 ms) or 1.5 (200 ms) respectively. CONCLUSIONS In this study, the treated area of retina varied by up to a factor of 1.612 = 2.59 for a given spot number. As clinical efficacy depends on the treated area, which is a function of lesion number by area per lesion, our results implicate poor control of the overall treatment effect if treatments are administered according to lesion number or spacing alone. Better ways of laser effect control should be sought.
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Affiliation(s)
- Mark Saeger
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jan Heckmann
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, University Hospital of Schleswig-Holstein, Campus Kiel, House 31, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
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Lavinsky D, Wang J, Huie P, Dalal R, Lee SJ, Lee DY, Palanker D. Nondamaging Retinal Laser Therapy: Rationale and Applications to the Macula. Invest Ophthalmol Vis Sci 2016; 57:2488-500. [PMID: 27159441 PMCID: PMC5995023 DOI: 10.1167/iovs.15-18981] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/25/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Retinal photocoagulation and nondamaging laser therapy are used for treatment of macular disorders, without understanding of the response mechanism and with no rationale for dosimetry. To establish a proper titration algorithm, we measured the range of tissue response and damage threshold. We then evaluated safety and efficacy of nondamaging retinal therapy (NRT) based on this algorithm for chronic central serous chorioretinopathy (CSCR) and macular telangiectasia (MacTel). METHODS Retinal response to laser treatment below damage threshold was assessed in pigmented rabbits by expression of the heat shock protein HSP70 and glial fibrillary acidic protein (GFAP). Energy was adjusted relative to visible titration using the Endpoint Management (EpM) algorithm. In clinical studies, 21 eyes with CSCR and 10 eyes with MacTel were treated at 30% EpM energy with high spot density (0.25-diameter spacing). Visual acuity, retinal and choroidal thickness, and subretinal fluid were monitored for 1 year. RESULTS At 25% EpM energy and higher, HSP70 was expressed acutely in RPE, and GFAP upregulation in Müller cells was observed at 1 month. Damage appeared starting at 40% setting. Subretinal fluid resolved completely in 81% and partially in 19% of the CSCR patients, and visual acuity improved by 12 ± 3 letters. Lacunae in the majority of MacTel patients decreased while preserving the retinal thickness, and vision improved by 10 letters. CONCLUSIONS Heat shock protein expression in response to hyperthermia helps define the therapeutic window for NRT. Lack of tissue damage enables high-density treatment to boost clinical efficacy, therapy in the fovea, and retreatments to manage chronic diseases.
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Affiliation(s)
- Daniel Lavinsky
- Department of Ophthalmology, Federal University Rio Grande do Sul, Porto Alegre, Brazil
| | - Jenny Wang
- Department of Applied Physics, Stanford University, Stanford, California, United States
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, California, United States
| | - Philip Huie
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, California, United States
- Department of Ophthalmology, Stanford University, Stanford, California, United States
| | - Roopa Dalal
- Department of Ophthalmology, Stanford University, Stanford, California, United States
| | - Seung Jun Lee
- Department of Ophthalmology, Stanford University, Stanford, California, United States
- Department of Ophthalmology, Kangwon National University, Chuncheon, South Korea
| | - Dae Yeong Lee
- Department of Ophthalmology, Stanford University, Stanford, California, United States
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Daniel Palanker
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, California, United States
- Department of Ophthalmology, Stanford University, Stanford, California, United States
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Morphologic changes in the retina after selective retina therapy. Graefes Arch Clin Exp Ophthalmol 2016; 254:1099-109. [DOI: 10.1007/s00417-016-3331-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 02/09/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022] Open
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Koinzer S, Baade A, Schlott K, Hesse C, Caliebe A, Roider J, Brinkmann R. Temperature-Controlled Retinal Photocoagulation Reliably Generates Uniform Subvisible, Mild, or Moderate Lesions. Transl Vis Sci Technol 2015; 4:9. [PMID: 26473086 DOI: 10.1167/tvst.4.5.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/21/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Conventional retinal photocoagulation produces irregular lesions and does not allow reliable control of ophthalmoscopically invisible lesions. We applied automatically controlled retinal photocoagulation, which allows to apply uniform lesions without titration, and aimed at five different predictable lesion intensities in a study on rabbit eyes. METHODS A conventional 532-nm photocoagulation laser was used in combination with a pulsed probe laser. They facilitated real-time fundus temperature measurements and automatic exposure time control for different predefined time/temperature dependent characteristics (TTC). We applied 225 control lesions (exposure time 200 ms) and 794 TTC lesions (5 intensities, exposure times 7-800 ms) in six rabbit eyes with variable laser power (20-66.4 mW). Starting after 2 hours, we examined fundus color and optical coherence tomographic (OCT) images over 3 months and classified lesion morphologies according to a seven-stage OCT classifier. RESULTS Visibility rates in funduscopy (OCT) after 2 hours were 17% (68%) for TTC intensity group 1, 38% (90%) for TTC group 2 and greater than 94% (>98%) for all consecutive groups. TTC groups 1 through 4 correlated to increasing morphological lesion intensities and increasing median funduscopic and OCT diameters. Group 5 lesions were as large as, but more intense than group 4 lesions. CONCLUSIONS Automatic, temperature controlled photocoagulation allows to apply predictable subvisible, mild, or moderate lesions without manual power titration. TRANSLATIONAL RELEVANCE The technique will facilitate standardized, automatically controlled low and early treatment of diabetic retinopathy study (ETDRS) intensity photocoagulation independently of the treating physician, the treated eye and lesion location.
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Affiliation(s)
- Stefan Koinzer
- Department of Ophthalmology University hospital of Schleswig-Holstein, Kiel, Germany
| | | | | | - Carola Hesse
- Department of Ophthalmology University hospital of Schleswig-Holstein, Kiel, Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, University hospital of Schleswig-Holstein, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology University hospital of Schleswig-Holstein, Kiel, Germany
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Feng X, Gao F, Xu C, Gaoming L, Zheng Y. Self temperature regulation of photothermal therapy by laser-shared photoacoustic feedback. OPTICS LETTERS 2015; 40:4492-5. [PMID: 26421564 DOI: 10.1364/ol.40.004492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article describes a laser-shared photothermal system that achieves tight temperature regulation by frequency-domain photoacoustic (FD-PA) feedback. To this end, a continuous-wave laser system was designed with arbitrarily modulatable laser intensity. And, by fast alternating in the time domain between a constant laser intensity for photothermal heating and a modulated laser intensity for FD-PA temperature measurement, photothermal temperature variations are captured by FD-PA in real time. A proportional-integral-derivative (PID) controller monitors the feedback from FD-PA measurements and controls photothermal heating dose accordingly, thus stabilizing the temperature at preset values. The proposed system is demonstrated to achieve ultrafast temperature measurement at a 4 kHz rate, and with proper averaging, the measurement and regulation accuracy are 0.75 deg and 0.9 deg respectively.
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Quezada C, Pieramici DJ, Matsui R, Rabena M, Graue F. Demarcation laser photocoagulation induced retinal necrosis and rupture resulting in large retinal tear formation. Photodiagnosis Photodyn Ther 2015; 12:314-6. [PMID: 25770055 DOI: 10.1016/j.pdpdt.2015.02.006] [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: 12/03/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
Retinal tears after laser photocoagulation are a rare complication that occurs after intense laser. It is talked about among retina specialist occurring particularly at the end of a surgical case while applying endophotocoagulation; to the best our knowledge, there are no reports in the literature of a large retinal tear induced after attempted in-office demarcation laser photocoagulation (DLP) that simulated a giant retinal tear. DLP has been employed in the management of selected cases of macula sparring rhegmatogenous retinal detachment (RRD). Even though extension of the retinal detachment through the "laser barrier" is considered a failure of treatment, few complications have been described with the use of this less invasive retinal detachment repair technique. We describe a case of a high myopic woman who initially was treated with demarcation laser photocoagulation for an asymptomatic retinal detachment associated with a single horseshoe tear and a full thickness large retinal tear was created where the laser was placed. Intense laser photocoagulation resulted in abrupt laser induced retinal necrosis and rupture creating this large retinal break. Proper laser technique should reduce the risks associated with this procedure.
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Affiliation(s)
- Carlos Quezada
- California Retina Consultants and Research Foundation, Santa Barbara, CA, United States; Instituto de Oftalmología "Fundación Conde de Valenciana", Mexico City, Mexico.
| | - Dante J Pieramici
- California Retina Consultants and Research Foundation, Santa Barbara, CA, United States
| | - Rodrigo Matsui
- Instituto de Oftalmología "Fundación Conde de Valenciana", Mexico City, Mexico
| | - Melvin Rabena
- California Retina Consultants and Research Foundation, Santa Barbara, CA, United States
| | - Federico Graue
- Instituto de Oftalmología "Fundación Conde de Valenciana", Mexico City, Mexico
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Petrova EV, Oraevsky AA, Ermilov SA. Red blood cell as a universal optoacoustic sensor for non-invasive temperature monitoring. APPLIED PHYSICS LETTERS 2014; 105:094103. [PMID: 25316928 PMCID: PMC4162524 DOI: 10.1063/1.4894635] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/22/2014] [Indexed: 05/11/2023]
Abstract
Optoacoustic (photoacoustic) temperature imaging could provide improved spatial resolution and temperature sensitivity as compared to other techniques of non-invasive thermometry used during thermal therapies for safe and efficient treatment of lesions. However, accuracy of the reported optoacoustic methods is compromised by biological variability and heterogeneous composition of tissues. We report our findings on the universal character of the normalized temperature dependent optoacoustic response (ThOR) in blood, which is invariant with respect to hematocrit at the isosbestic point of hemoglobin. The phenomenon is caused by the unique homeostatic compartmentalization of blood hemoglobin exclusively inside erythrocytes. On the contrary, the normalized ThOR in aqueous solutions of hemoglobin showed linear variation with respect to its concentration and was identical to that of blood when extrapolated to the hemoglobin concentration inside erythrocytes. To substantiate the conclusions, we analyzed optoacoustic images acquired from the samples of whole and diluted blood as well as hemoglobin solutions during gradual cooling from +37 to -15 °C. Our experimental methodology allowed direct observation and accurate measurement of the temperature of zero optoacoustic response, manifested as the sample's image faded into background and then reappeared in the reversed (negative) contrast. These findings provide a framework necessary for accurate correlation of measured normalized optoacoustic image intensity and local temperature in vascularized tissues independent of tissue composition.
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Affiliation(s)
- Elena V Petrova
- TomoWave Laboratories, Inc. , 6550 Mapleridge St., Suite 124, Houston, Texas 77081-4629, USA
| | - Alexander A Oraevsky
- TomoWave Laboratories, Inc. , 6550 Mapleridge St., Suite 124, Houston, Texas 77081-4629, USA
| | - Sergey A Ermilov
- TomoWave Laboratories, Inc. , 6550 Mapleridge St., Suite 124, Houston, Texas 77081-4629, USA
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Blumenkranz MS. The evolution of laser therapy in ophthalmology: a perspective on the interactions between photons, patients, physicians, and physicists: the LXX Edward Jackson Memorial Lecture. Am J Ophthalmol 2014; 158:12-25.e1. [PMID: 24699157 DOI: 10.1016/j.ajo.2014.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/21/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
Abstract
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.
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Park YG, Seifert E, Roh YJ, Theisen-Kunde D, Kang S, Brinkmann R. Tissue response of selective retina therapy by means of a feedback-controlled energy ramping mode. Clin Exp Ophthalmol 2014; 42:846-55. [PMID: 24698550 DOI: 10.1111/ceo.12342] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/27/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate the safety and selectivity of the retinal pigment epithelium lesions by using automatic energy ramping and dosimetry technique for selective retina therapy and to investigate the healing response. METHODS Ten eyes of Chinchilla Bastard rabbits were treated with an automatic dosage controlled selective retina therapy laser (frequency doubled Q-switched Nd:YLF, wavelength: 527 nm, pulse duration: 1.7 μs, repetition rate: 100 Hz, pulse energy: linear increasing from pulse to pulse up to shut down - maximal 110 μJ, max. number of pulses in a burst: 30, retinal spot diameter: 133 μm). After treatment, fundus photography, optical coherence tomography and fluorescein angiography were performed at three time points from 1 h to 3 weeks. Histological analysis was performed. RESULTS A total of 381 selective retina therapy laser spots were tested (range 13-104 μJ).Typical fundus photographs obtained at 1 h after irradiation showed that 379 out of 381 lesions produced by selective retina therapy were not visible ophthalmoscopically and the lesions could be detected by angiography only. Optical coherence tomography images revealed that the structure of photoreceptors was preserved, but a disrupted retinal pigment epithelium layer was observed as was expected. By 3 weeks, histology showed selective retinal pigment epithelium damage without any effect on the inner retina and focal proliferation of the retinal pigment epithelium layer. CONCLUSIONS Automatically controlled selective retina therapy is a significant improvement in this innovative treatment. It could be demonstrated that the non-contact, reflectometric technique with a controlled pulse energy ramp is safe and selective.
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Affiliation(s)
- Young-Gun Park
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Protective effect of a laser-induced sub-lethal temperature rise on RPE cells from oxidative stress. Exp Eye Res 2014; 124:37-47. [PMID: 24800654 DOI: 10.1016/j.exer.2014.04.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/22/2014] [Accepted: 04/18/2014] [Indexed: 11/22/2022]
Abstract
Recently introduced new technologies that enable temperature-controlled laser irradiation on the RPE allowed us to investigate temperature-resolved RPE cell responses. In this study we aimed primarily to establish an experimental setup that can realize laser irradiation on RPE cell culture with the similar temperature distribution as in the clinical application, with a precise time/temperature history. With this setup, we conducted investigations to elucidate the temperature-dependent RPE cell biochemical responses and the effect of transient hyperthermia on the responses of RPE cells to the secondary-exposed oxidative stress. Porcine RPE cells cultivated in a culture dish (inner diameter = 30 mm) with culture medium were used, on which laser radiation (λ = 1940 nm, spot diameter = 30 mm) over 10 s was applied as a heat source. The irradiation provides a radially decreasing temperature profile which is close to a Gaussian shape with the highest temperature in the center. Power setting for irradiation was determined such that the peak temperature (Tmax) in the center of the laser spot at the cells reaches from 40 °C to 58 °C (40, 43, 46, 50, 58 °C). Cell viability was investigated with ethidium homodimer III staining at the time points of 3 and 24 h following laser irradiation. Twenty four hours after laser irradiation the cells were exposed to hydrogen peroxide (H2O2) for 5 h, followed by the measurement of intracellular glutathione, intracellular 4-hydroxynonenal (HNE) protein adducts, and secreted vascular endothelial growth factor (VEGF). The mean temperature threshold for RPE cell death after 3 h was found to be around 52 °C, and for 24 h around 50 °C with the current irradiation setting. A sub-lethal preconditioning on Tmax = 43 °C significantly induced the reduced glutathione (GSH)/oxidized glutathione (GSSG) ratio, and decreased H2O2-induced increase of intracellular 4-HNE protein adducts. Although sub-lethal hyperthermia (Tmax = 40 °C, 43 °C, and 46 °C) caused a slight increase of VEGF secretion in 6 h directly following irradiation, secondary exposed H2O2-induced VEGF secretion was significantly reduced in the sub-lethally preheated groups, where the largest effect was seen following the irradiation with Tmax = 43 °C. In summary, the current results suggest that sub-lethal thermal laser irradiation on the RPE at Tmax = 43 °C for 10 s enhances cell defense system against oxidative stress, with increasing the GSH/GSSG ratio. Together with the results that the decreased amount of H2O2-induced 4-HNE in sub-lethally preheated RPE cells was accompanied by the lower secretion of VEGF, it is also strongly suggested that the sub-lethal hyperthermia may modify RPE cell functionality to protect RPE cells from oxidative stress and associated functional decrease, which are considered to play a significant role in the pathogenesis of age-related macular degeneration and other chorioretinal degenerative diseases.
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Feltgen N, Walter P. Rhegmatogenous retinal detachment--an ophthalmologic emergency. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:12-21; quiz 22. [PMID: 24565273 PMCID: PMC3948016 DOI: 10.3238/arztebl.2014.0012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rhegmatogenous retinal detachment is the most common retinological emergency threatening vision, with an incidence of 1 in 10 000 persons per year, corresponding to about 8000 new cases in Germany annually. Without treatment, blindness in the affected eye may result. METHOD Selective review of the literature. RESULTS Rhegmatogenous retinal detachment typically presents with the perception of light flashes, floaters, or a "dark curtain." In most cases, the retinal tear is a consequence of degeneration of the vitreous body. Epidemiologic studies have identified myopia and prior cataract surgery as the main risk factors. Persons in the sixth and seventh decades of life are most commonly affected. Rhegmatogenous retinal detachment is an emergency, and all patients should be seen by an ophthalmologist on the same day that symptoms arise. The treatment consists of scleral buckle, removal of the vitreous body (vitrectomy), or a combination of the two. Anatomical success rates are in the range of 85% to 90%. Vitrectomy is followed by lens opacification in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so that visual acuity can be preserved. CONCLUSION Rhegmatogenous retinal detachment is among the main emergency indications in ophthalmology. In all such cases, an ophthalmologist must be consulted at once.
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Koinzer S, Hesse C, Caliebe A, Saeger M, Baade A, Schlott K, Brinkmann R, Roider J. Photocoagulation in rabbits: Optical coherence tomographic lesion classification, wound healing reaction, and retinal temperatures. Lasers Surg Med 2013; 45:427-36. [DOI: 10.1002/lsm.22163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Stefan Koinzer
- Department of Ophthalmology; University Hospital of Schleswig-Holstein; Campus Kiel; House 25 Arnold-Heller-Str. 3 24105 Kiel Germany
| | - Carola Hesse
- Department of Ophthalmology; University Hospital of Schleswig-Holstein; Campus Kiel; House 25 Arnold-Heller-Str. 3 24105 Kiel Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics; University Hospital of Schleswig-Holstein; Campus Kiel; House 31 Arnold-Heller-Str. 3 24105 Kiel Germany
| | - Mark Saeger
- Department of Ophthalmology; University Hospital of Schleswig-Holstein; Campus Kiel; House 25 Arnold-Heller-Str. 3 24105 Kiel Germany
| | - Alexander Baade
- Medical Laser Center Lübeck GmbH; Peter-Monnik-Weg 4 23562 Lübeck Germany
| | - Kerstin Schlott
- Medical Laser Center Lübeck GmbH; Peter-Monnik-Weg 4 23562 Lübeck Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck GmbH; Peter-Monnik-Weg 4 23562 Lübeck Germany
| | - Johann Roider
- Department of Ophthalmology; University Hospital of Schleswig-Holstein; Campus Kiel; House 25 Arnold-Heller-Str. 3 24105 Kiel Germany
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Gao L, Wang L, Li C, Liu Y, Ke H, Zhang C, Wang LV. Single-cell photoacoustic thermometry. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:26003. [PMID: 23377004 PMCID: PMC3556647 DOI: 10.1117/1.jbo.18.2.026003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A novel photoacoustic thermometric method is presented for simultaneously imaging cells and sensing their temperature. With three-seconds-per-frame imaging speed, a temperature resolution of 0.2°C was achieved in a photo-thermal cell heating experiment. Compared to other approaches, the photoacoustic thermometric method has the advantage of not requiring custom-developed temperature-sensitive biosensors. This feature should facilitate the conversion of single-cell thermometry into a routine lab tool and make it accessible to a much broader biological research community.
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Affiliation(s)
- Liang Gao
- Washington University in St. Louis, Department of Biomedical Engineering, One Brookings Drive, St. Louis, Missouri, 63130
| | - Lidai Wang
- Washington University in St. Louis, Department of Biomedical Engineering, One Brookings Drive, St. Louis, Missouri, 63130
| | - Chiye Li
- Washington University in St. Louis, Department of Biomedical Engineering, One Brookings Drive, St. Louis, Missouri, 63130
| | - Yan Liu
- Washington University in St. Louis, Department of Biomedical Engineering, One Brookings Drive, St. Louis, Missouri, 63130
| | - Haixin Ke
- Washington University in St. Louis, Department of Biomedical Engineering, One Brookings Drive, St. Louis, Missouri, 63130
| | - Chi Zhang
- Washington University in St. Louis, Department of Biomedical Engineering, One Brookings Drive, St. Louis, Missouri, 63130
| | - Lihong V. Wang
- Washington University in St. Louis, Department of Biomedical Engineering, One Brookings Drive, St. Louis, Missouri, 63130
- Address all correspondence to: Lihong V. Wang, Washington University in St. Louis, Department of Biomedical Engineering, One Brookings Dr., St. Louis, Missouri, 63130. Tel: 314 935 6152; Fax: 314 935 7448; E-mail:
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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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Schlott K, Koinzer S, Ptaszynski L, Bever M, Baade A, Roider J, Birngruber R, Brinkmann R. Automatic temperature controlled retinal photocoagulation. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:061223. [PMID: 22734753 DOI: 10.1117/1.jbo.17.6.061223] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Laser coagulation is a treatment method for many retinal diseases. Due to variations in fundus pigmentation and light scattering inside the eye globe, different lesion strengths are often achieved. The aim of this work is to realize an automatic feedback algorithm to generate desired lesion strengths by controlling the retinal temperature increase with the irradiation time. Optoacoustics afford non-invasive retinal temperature monitoring during laser treatment. A 75 ns/523 nm Q-switched Nd:YLF laser was used to excite the temperature-dependent pressure amplitudes, which were detected at the cornea by an ultrasonic transducer embedded in a contact lens. A 532 nm continuous wave Nd:YAG laser served for photocoagulation. The ED50 temperatures, for which the probability of ophthalmoscopically visible lesions after one hour in vivo in rabbits was 50%, varied from 63°C for 20 ms to 49°C for 400 ms. Arrhenius parameters were extracted as ΔE=273 J mol(-1) and A=3 x 10(44) s(-1). Control algorithms for mild and strong lesions were developed, which led to average lesion diameters of 162 ± 34 μm and 189 ± 34 μm, respectively. It could be demonstrated that the sizes of the automatically controlled lesions were widely independent of the treatment laser power and the retinal pigmentation.
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Affiliation(s)
- Kerstin Schlott
- University of Lübeck, Institute of Biomedical Optics, Peter-Monnik-Weg 4, D-23562, Lübeck, Germany.
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