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Vujosevic S, Limoli C, Piccoli G, Costanzo E, Marenzi E, Torti E, Giannini D, Polito MS, Luzi L, Nucci P, Parravano M. A gender-based analysis of retinal microvascular alterations in patients with diabetes mellitus using OCT angiography. J Diabetes Complications 2024; 38:108852. [PMID: 39213716 DOI: 10.1016/j.jdiacomp.2024.108852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To assess the difference in microvascular changes between males and females with diabetes mellitus (DM) without diabetic retinopathy (NoDR) and with mild-to-moderate non-proliferative diabetic retinopathy (NPDR) using Optical Coherence Tomography Angiography (OCT-A). DESIGN Retrospective cross-sectional study. METHODS 267 DM patients, 133 females (49.81 %), 111 with NoDR (41.57 %) and 156 NPDR (58.43 %) were included. Foveal-centered 3 × 3 mm OCT-A images corresponding to the superficial (SCP), intermediate (ICP) and deep capillary plexus (DCP), and full retinal (RET) slab were used for analysis. For each slab, FAZ area, perimeter, and circularity index (CI) were determined, following manual delineation of the FAZ; perfusion (PD) and vessel density (VD), fractal dimension (FD), vessel length density (VLD), geometric perfusion deficits (GPD) were also computed. Flow voids (FV) were determined in the choriocapillaris plexus; and perfused capillary density (PCD) in the RET slab. RESULTS Females showed larger FAZ CI in SCP and greater FAZ area and perimeter than males in NPDR group. Males had higher central macular thickness than females in NPDR group. All density metrics at the level of ICP and DCP were affected in the NPDR group with no gender differences. Of note, the same significant findings were found in type 1 DM patients, and not in type 2 DM patients. CONCLUSIONS Our OCT-A findings suggest significant microvascular changes in females with NPDR compared to males, but no such differences in patients without DR. Therefore, gender-related vascular alterations might be present in early stages of DR with potential role.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy.
| | | | | | | | - Elisa Marenzi
- Laboratory of Custom Computing and Programmable Systems, Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Emanuele Torti
- Laboratory of Custom Computing and Programmable Systems, Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | | | | | - Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Grzybowski A, Sulaviková Z, Gawęcki M, Kozak I. Subthreshold laser treatment in retinal diseases: a mini review. Graefes Arch Clin Exp Ophthalmol 2024; 262:2337-2344. [PMID: 38280029 DOI: 10.1007/s00417-024-06382-4] [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: 09/05/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 01/29/2024] Open
Abstract
PURPOSE To summarize the mechanism and the clinical applications of subthreshold laser (STL) in retinal practice. Subthreshold or "non-destructive" laser includes all types of laser treatments that produce minimal or no damage to the tissues and no visible signs after application. METHODS A descriptive review of articles from literature databases (PubMed, Medline, Embase, Cochrane, Web of Science) published before August 2023, which discuss current STL treatments of retinal diseases. RESULTS This review provides evidence for STL as a treatment option for central serous chorioretinopathy, diabetic retinopathy, age-related macular degeneration, macular edema due to retinal vein occlusion, and other maculopathies. In most published reports, STL has shown a therapeutic effect without damage to the underlying tissue. CONCLUSION Subthreshold laser treatment has shown safety and efficacy in the management of some retinal and macular diseases. Stimulation of the retinal pigment epithelium without destroying adjacent neuroretina has been shown to be sufficient in inducing retinal repair in many clinical cases. Recent research and clinical studies continue to explore the mechanisms and improving therapeutic benefits of this technology as well as extend the range of retinal disorders treatable by this modality.
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Affiliation(s)
- Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznań, Poland
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
| | - Zuzana Sulaviková
- Department of Ophthalmology, Faculty Hospital in Trencin, Trencin, Slovak Republic
| | | | - Igor Kozak
- Moorfields Eye Hospitals UAE, 62807, Abu Dhabi, United Arab Emirates.
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Cano-Cano F, Martín-Loro F, Gallardo-Orihuela A, González-Montelongo MDC, Ortuño-Miquel S, Hervás-Corpión I, de la Villa P, Ramón-Marco L, Navarro-Calvo J, Gómez-Jaramillo L, Arroba AI, Valor LM. Retinal dysfunction in Huntington's disease mouse models concurs with local gliosis and microglia activation. Sci Rep 2024; 14:4176. [PMID: 38378796 PMCID: PMC10879138 DOI: 10.1038/s41598-024-54347-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
Huntington's disease (HD) is caused by an aberrant expansion of CAG repeats in the HTT gene that mainly affects basal ganglia. Although striatal dysfunction has been widely studied in HD mouse models, other brain areas can also be relevant to the pathology. In this sense, we have special interest on the retina as this is the most exposed part of the central nervous system that enable health monitoring of patients using noninvasive techniques. To establish the retina as an appropriate tissue for HD studies, we need to correlate the retinal alterations with those in the inner brain, i.e., striatum. We confirmed the malfunction of the transgenic R6/1 retinas, which underwent a rearrangement of their transcriptome as extensive as in the striatum. Although tissue-enriched genes were downregulated in both areas, a neuroinflammation signature was only clearly induced in the R6/1 retina in which the observed glial activation was reminiscent of the situation in HD patient's brains. The retinal neuroinflammation was confirmed in the slow progressive knock-in zQ175 strain. Overall, these results demonstrated the suitability of the mouse retina as a research model for HD and its associated glial activation.
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Affiliation(s)
- Fátima Cano-Cano
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Francisco Martín-Loro
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Andrea Gallardo-Orihuela
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - María Del Carmen González-Montelongo
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Samanta Ortuño-Miquel
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Unidad de Bioinformática, Hospital General Universitario Dr. Balmis, 03010, Alicante, Spain
| | - Irati Hervás-Corpión
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
- Programa de Tumores Sólidos, Centro de Investigación Médica Aplicada (CIMA), Departamento de Pediatría, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008, Pamplona, Spain
| | - Pedro de la Villa
- Departamento de Biología de Sistemas, Universidad de Alcalá de Henares, 28871, Alcalá de Henares, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034, Madrid, Spain
| | - Lucía Ramón-Marco
- Laboratorio de Investigación, Diagnostics Building, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis, Av. Pintor Baeza 12, 03010, Alicante, Spain
| | - Jorge Navarro-Calvo
- Laboratorio de Investigación, Diagnostics Building, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis, Av. Pintor Baeza 12, 03010, Alicante, Spain
| | - Laura Gómez-Jaramillo
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Ana I Arroba
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain.
| | - Luis M Valor
- Laboratorio de Investigación, Diagnostics Building, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis, Av. Pintor Baeza 12, 03010, Alicante, Spain.
- Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), 03202, Elche, Spain.
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Karasu B, Akbas YB, Aykut A, Çelebi ARC. Subthreshold Photocoagulation, Laser Endpoint Management Based on Optical Coherence Tomography Angiography in Cases of Diabetic Macular Edema Refractory to Anti-VEGF. Klin Monbl Augenheilkd 2024; 241:197-208. [PMID: 35453154 DOI: 10.1055/a-1792-3009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to determine the changes that occur in the vasculature, as based on optical coherence tomography angiography (OCTA) after non-damaging endpoint management (EpM), using a continuous wave yellow laser. The study was on eyes with diabetic macular edema (DME) that were resistant to anti-vascular endothelial growth factors (anti-VEGFs). MATERIALS AND METHODS This was a retrospective analysis of OCTA images of 44 eyes in 44 patients with DME refractory to anti-VEGF. The eyes were treated with a PASCAL Streamline yellow laser (577 nm wavelength, 200 mm spot size). Treatment was administered to the DME area and utilized 10% continuous wave laser energy and 0.50 µm beam diameter spot spacing. Best-corrected visual acuity (BCVA) and enhanced in-depth imaging with optical coherence tomography (EDI-OCT) and fundus autofluorescence (FAF) images were recorded at baseline, and 3 and 6 months posttreatment. Total choroidal area (TCA), luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI) were calculated using Image J software. The macula was divided into five quadrants in accordance with the mapping system in the Early Treatment Diabetic Retinopathy Study (ETDRS). RESULTS All patients (mean age: 58.90 ± 9.55 years) were diagnosed with diabetes mellitus type 2. Mean BCVA at baseline was 0.30 ± 0.11 logarithm of the minimum angle of resolution (logMAR) versus 0.23 ± 0.10 logMAR at 3 months (p = 0.032) and 0.17 ± 0.10 logMAR at 6 months (p = 0.013). The foveal avascular zone area (FAZ) decreased in the deep capillary plexus (DCP) from baseline to 6 months (p = 0.028). Vessel densities (VDs) of the superficial capillary plexus (SCP), DCP, and choriocapillaris decreased significantly in the fovea at 3 and 6 months compared to baseline (p < 0.05 for both follow-up time points). There were significant decreases in SCP and DCP in the superior quadrant at the end of month 6 (p = 0.001 and p = 0.038, respectively). There was a significant decrease in the nasal quadrant of the DCP and choriocapillaris at the end of month 6 (p = 0.024 and p = 0.049, respectively). Although there was a significant decrease in central macular thickness (CMT) (p < 0.001), subfoveal choroidal thickness (SFCT) (p < 0.001), and LA (p = 0.034) at months 3 and 6, there was no significant change in the CVI (p = 0.19). According to the DME recovery rate, 36 eyes (81%) were irradiated once, whereas 8 eyes (19%) were irradiated twice. CONCLUSIONS Non-damaging EpM therapy using a continuous wave yellow laser in eyes with DME that are resistant to anti-VEGFs induces significant changes in the SCP, choriocapillaris, and, most commonly, the DCP, which caused a significant decrease in VDs during 6 months of follow-up.
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Affiliation(s)
- Bugra Karasu
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Içmeler Mahallesi, Piri Reis Caddesi, Tuzla State Hospital, Tuzla, Turkey
| | - Yusuf Berk Akbas
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Bereketzade, Beyoglu, Turkey
| | - Aslan Aykut
- Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
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Singuri S, Luo S, Hatipoglu D, Nowacki AS, Patel R, Schachat AP, Ehlers JP, Singh RP, Anand-Apte B, Yuan A. Clinical Utility of Spectral-Domain Optical Coherence Tomography Marker Disorganization of Retinal Inner Layers in Diabetic Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2023; 54:692-700. [PMID: 38113360 DOI: 10.3928/23258160-20231031-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Disorganization of retinal inner layers (DRIL) is a potential spectral-domain optical coherence tomography (SD-OCT) imaging biomarker with clinical utility in diabetic retinopathy (DR). PATIENTS AND METHODS A cross-sectional study was conducted at a large academic center. The cohort was composed of 1,175 patients with type 2 diabetes with and without retinopathy on initial examination between September 2009 and January 2019 (n = 2,083 eyes). DR risk and progression factors were obtained from the medical record. Trained graders masked to patients' clinical histories evaluated SD-OCT scans for DRIL. RESULTS Of 2,083 eyes, 28.1% (n = 585) demonstrated presence of DRIL with high interrater reliability (K = 0.88, 95% CI 0.86-0.90). DRIL was associated with worse visual acuity (VA) (P < 0.001) and DR severity (P < 0.0001). Insulin users had more severe DR (P < 0.0001). DR-related factors, race (Black, White) and sex (male) were significantly associated with DRIL (P < 0.05). CONCLUSIONS DRIL was strongly associated with DR severity and worse VA, supporting its utility as an unfavorable prognostic indicator. [Ophthalmic Surg Lasers Imaging Retina 2023;54:692-700.].
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Bodea F, Bungau SG, Bogdan MA, Vesa CM, Radu A, Tarce AG, Purza AL, Tit DM, Bustea C, Radu AF. Micropulse Laser Therapy as an Integral Part of Eye Disease Management. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1388. [PMID: 37629677 PMCID: PMC10456532 DOI: 10.3390/medicina59081388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
Ocular diseases can significantly impact vision and quality of life through pathophysiological alterations to the structure of the eye. The management of these conditions often involves a combination of pharmaceutical interventions, surgical procedures, and laser therapy. Laser technology has revolutionized many medical fields, including ophthalmology, offering precise and targeted treatment options that solve some of the unmet needs of other therapeutic strategies. Conventional laser techniques, while effective, can generate excessive thermal energy, leading to collateral tissue damage and potential side effects. Compared to conventional laser techniques, micropulse laser therapy delivers laser energy in a pulsed manner, minimizing collateral damage while effectively treating target tissues. The present paper highlights the advantages of micropulse laser therapy over conventional laser treatments, presents the implications of applying these strategies to some of the most prevalent ocular diseases, and highlights several types and mechanisms of micropulse lasers. Although micropulse laser therapy shows great potential in the management of ocular diseases, further research is needed to optimize treatment protocols, evaluate long-term efficacy, and explore its role in combination therapies.
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Affiliation(s)
- Flaviu Bodea
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.B.); (C.M.V.); (D.M.T.); (A.-F.R.)
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.B.); (C.M.V.); (D.M.T.); (A.-F.R.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Mihaela Alexandra Bogdan
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Cosmin Mihai Vesa
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.B.); (C.M.V.); (D.M.T.); (A.-F.R.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Ada Radu
- Ducfarm Pharmacy, 410514 Oradea, Romania;
| | - Alexandra Georgiana Tarce
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Anamaria Lavinia Purza
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.B.); (C.M.V.); (D.M.T.); (A.-F.R.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Cristian Bustea
- Department of Surgery, Oradea County Emergency Clinical Hospital, 410169 Oradea, Romania;
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.B.); (C.M.V.); (D.M.T.); (A.-F.R.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
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Li G, Ho M, Li S, Chen L, Iu L, Cheung CY, Brelen M, Young AL. COMPARING FUNCTIONAL AND VASCULAR LAYER OUTCOMES OF LASER PHOTOCOAGULATION VERSUS SUBTHRESHOLD MICROPULSE LASER FOR DIABETIC MACULAR EDEMA: An OCT-Angiography Study. Retina 2023; 43:823-831. [PMID: 36728901 DOI: 10.1097/iae.0000000000003711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/01/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare the efficacy of conventional laser and subthreshold micropulse laser (SML) in treating diabetic macular edema in terms of functional outcomes and changes in quantitative metrics for the retinal capillary and choriocapillary vascular layers. METHODS Fifty-two eyes from 52 patients with treatment-naive, clinically significant macular edema were randomly assigned to the conventional laser group or SML group in a 1:1 ratio. Best-corrected visual acuity, central macular thickness (CMT), and optical coherence tomography angiography scans were measured at baseline, 1, 3, and 6 months after treatment. RESULTS The SML group showed rapid visual recovery, improving from baseline of 0.320 ± 0.31 logarithm of the minimum angle of resolution (20/42 Snellen) to 0.270 ± 0.22 logarithm of the minimum angle of resolution (20/37 Snellen) at 1 month ( P = 0.038) and had significant improvements in CMT at 6-month post-treatment (353.88-301.00 µ m, P = 0.005). Statistically significant changes were detected across all optical coherence tomography angiography metrics, including vessel density, vessel length density, vessel diameter index, and fractal dimension, at 6 months for both groups in the deep capillary plexus and choriocapillary plexus. CONCLUSION Subthreshold micropulse laser resulted in early visual recovery and sustained macular thickness improvement in the treatment of diabetic macular edema. Microvascular perfusion parameters, including vessel density, vessel length density, and fractal dimension, improved in the deep capillary plexus and choriocapillary plexus for both treatment groups at 6 months post-treatment.
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Affiliation(s)
- Gabriel Li
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; and
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; and
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sophia Li
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; and
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lijia Chen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; and
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; and
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marten Brelen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; and
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; and
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
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Iovino C, Iodice CM, Pisani D, Rosolia A, Testa F, Giannaccare G, Chhablani J, Simonelli F. Yellow Subthreshold Micropulse Laser in Retinal Diseases: An In-Depth Analysis and Review of the Literature. Ophthalmol Ther 2023; 12:1479-1500. [PMID: 36933125 PMCID: PMC10164197 DOI: 10.1007/s40123-023-00698-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Yellow subthreshold micropulse laser (YSML) is a retinal laser capable of inducing a biologic response without causing thermal damage to the targeted tissue. The 577-nm YSML is delivered to the retina abiding by different protocols in which wavelength, power, duration, spot size and number of spots can be properly set to achieve the most effective and safe treatment response in various chorioretinal disorders. The ultrashort trains of power modulate the activation of the retinal pigment epithelium cells and intraretinal cells, such as Müller cells, causing no visible retinal scars. Subthreshold energy delivered by YSML stimulates the production of the heat-shock proteins, highly conserved molecules that protect cells against any sort of stress by blocking apoptotic and inflammatory pathways that cause cell damage. YSML treatment allows resorption of the subretinal fluid in central serous chorioretinopathy and intraretinal fluid in various conditions including diabetic macular edema, postoperative cystoid macular edema and other miscellaneous conditions. YSML also seems to modulate the development and progression of reticular pseudodrusen in dry age-related macular degeneration. The aim of this review is to discuss and summarize the safety and efficacy of YSML treatment in retinal diseases.
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Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Clemente Maria Iodice
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Danila Pisani
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Rosolia
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Zavorkova M, Nekolova J, Prochazkova L, Cermakova E, Jiraskova N. Diabetic macular edema treatment with subthreshold micropulse laser - five-year long monitoring. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:74-79. [PMID: 36622063 DOI: 10.5507/bp.2022.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/19/2022] [Indexed: 01/10/2023] Open
Abstract
AIM The objective of this study was to evaluate the efficacy of diabetic macular edema (DME) therapy using subthreshold micropulse laser (SMPL) with a wavelength of 577 nm during a long-term monitoring period of 5 years. METHODS The cohort included the total number of 52 eyes of 34 patients with DME. All underwent the standard laser treatment for the diabetic retinopathy outside the macula and DME treatment with SMPL. Subsequent check-ups were followed every 3 months in the first year of treatment, and every 4 to 6 months in the following years. The treatment was combined neither with focal macular laser nor with anti-VEGF therapy. RESULTS The mean central retinal thickness (CRT) was 345.9 µm SD 122.6 µm at the beginning of the monitoring. At the end of the follow-up period five years after treatment it was 256.4 µm SD 98.4 µm. The mean CRT decreased by 89.5 µm SD 153.6 µm during 5 years. At the beginning of the monitoring, before treatment with SMPL, the best corrected visual acuity (BCVA) was 70.0, SD 10.1 ETDRS letters. One year after therapy, BCVA was 72, SD 10.0 letters, two years later it was 71.4, SD 10.4 letters and decreased to 66.9, SD 12.1 letters after 5 years. The mean BCVA decreased by merely 3.1, SD 10.9 letters during 5 years. CONCLUSION Based on our long-term observations, the DME treatment with SMPL appears to be an effective method for reducing DME and protecting BCVA against rapid worsening.
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Affiliation(s)
- Martina Zavorkova
- Department of Ophthalmology, Faculty of Health Studies, Jan Evangelista Purkyne University and Department of Ophthalmology, Masaryk Hospital, Usti nad Labem, Krajska zdravotni a.s., Usti nad Labem, Czech Republic.,Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University and Department of Ophthalmology, University Hospital Hradec Kralove, Czech Republic
| | - Jana Nekolova
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University and Department of Ophthalmology, University Hospital Hradec Kralove, Czech Republic
| | - Lidmila Prochazkova
- Department of Ophthalmology, Faculty of Health Studies, Jan Evangelista Purkyne University and Department of Ophthalmology, Masaryk Hospital, Usti nad Labem, Krajska zdravotni a.s., Usti nad Labem, Czech Republic
| | - Eva Cermakova
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Nada Jiraskova
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University and Department of Ophthalmology, University Hospital Hradec Kralove, Czech Republic
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10
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Subthreshold Micropulse Laser for Diabetic Macular Edema: A Review. J Clin Med 2022; 12:jcm12010274. [PMID: 36615074 PMCID: PMC9821545 DOI: 10.3390/jcm12010274] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/18/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Diabetic macular edema (DME) is one of the main causes of visual impairment in patients of working age. DME occurs in 4% of patients at all stages of diabetic retinopathy. Using a subthreshold micropulse laser is an alternative or adjuvant treatment of DME. Micropulse technology demonstrates a high safety profile by selectively targeting the retinal pigment epithelium. There are no standardized protocols for micropulse treatment, however, a 577 nm laser application over the entire macula using a 200 μm retinal spot, 200 ms pulse duration, 400 mW power, and 5% duty cycle is a cost-effective, noninvasive, and safe therapy in mild and moderate macular edemas with retinal thickness below 400 μm. Micropulse lasers, as an addition to the current gold-standard treatment for DME, i.e., anti-vascular endothelial growth factor (anti-VEGF), stabilize the anatomic and functional retinal parameters 3 months after the procedure and reduce the number of required injections per year. This paper discusses the published literature on the safety and application of subthreshold micropulse lasers in DME and compares them with intravitreal anti-VEGF or steroid therapies and conventional grid laser photocoagulation. Only English peer-reviewed articles reporting research within the years 2010-2022 were included.
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11
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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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12
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Grzybowski A, Markeviciute A, Zemaitiene R. Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update. J Clin Med 2021; 10:5300. [PMID: 34830582 PMCID: PMC8619917 DOI: 10.3390/jcm10225300] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023] Open
Abstract
Macular edema (ME) is associated with various conditions; however, the main causes of ME are retinal vein occlusion (RVO) and diabetes. Laser photocoagulation, formerly the gold standard for the treatment of ME, has been replaced by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. Despite its efficiency, this treatment requires frequent injections to preserve the outcomes of anti-VEGF therapy, and as many patients do not sufficiently respond to the treatment, ME is typically a chronic condition that can lead to permanent visual impairment. Generalized recommendations for the treatment of ME are lacking, which highlights the importance of reviewing treatment approaches, including recent anti-VEGFs, intravitreal steroid implants, and subthreshold micropulse lasers. We reviewed relevant studies, emphasizing the articles published between 2019 and 2021 and using the following keywords: macular edema, diabetic macular edema, retinal vein occlusion, laser photocoagulation, anti-VEGF, and intravitreal injections. Our results revealed that a combination of different treatment methods may be beneficial in resistant cases. Additionally, artificial intelligence (AI) is likely to help select the best treatment option for patients in the near future.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, 10-561 Olsztyn, Poland;
- Institute for Research in Ophthalmology, 60-836 Poznan, Poland
| | - Agne Markeviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania;
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania;
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13
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Işık MU, Değirmenci MFK, Sağlık A. Factors affecting the response to subthreshold micropulse laser therapy used in center-involved diabetic macular edema. Lasers Med Sci 2021; 37:1865-1871. [PMID: 34657215 DOI: 10.1007/s10103-021-03441-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to investigate the effect of the status of retinal pigment epithelium (RPE) and HbA1c levels on the efficacy of the subthreshold micropulse laser (SMPL) in the treatment of center-involving diabetic macular edema (DME). A total of 20 eyes of 20 patients (mean age 57.9 ± 9.7 years) who were diagnosed with center-involving DME and treated with SMPL for refusing intravitreal injection and 20 eyes of 20 age- and sex-matched healthy participants were enrolled. All patients were followed up in the 1st and 3rd months after SMPL. For measurement of RPE area central 1000 microns, macular EDI-OCT scans were binarized by using the public domain software ImageJ, with a semi-automated technique. There was a significant increase in BCVA values and a significant decrease in CMT values during follow-up. The area of RPE before SMPL was significantly thinner in the patient group (p: 0.004). When the areas of RPE before and 3 months after SMPL were compared, no significant change was observed (p: 0.437). When the relationship between pre-treatment area of RPE and HbA1c was examined, an inverse correlation was observed (p: 0.018). The patients were evaluated by dividing them into 2 groups as 2nd session SMPL required and not required, and the area of RPE was smaller in the group requiring 2nd session SMPL (p: 0.030). The status of central RPE may be a determining factor on the response to treatment. Additionally, HbA1c levels may have an impact on treatment efficacy.
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Affiliation(s)
- Mehmed Uğur Işık
- Retina Department, Department of Ophthalmology, Kastamonu University Faculty of Medicine, 37100, Kastamonu, Turkey.
| | | | - Ayhan Sağlık
- Cornea Department, Department of Ophthalmology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
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14
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Subthreshold Micropulse Laser Modulates Retinal Neuroinflammatory Biomarkers in Diabetic Macular Edema. J Clin Med 2021; 10:jcm10143134. [PMID: 34300297 PMCID: PMC8304624 DOI: 10.3390/jcm10143134] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 01/03/2023] Open
Abstract
Subthreshold micropulse laser treatment has become a recognized option in the therapeutic approach to diabetic macular edema. However, some yet undefined elements pertaining to its mechanism of action and most effective treatment method still limit its clinical diffusion. We reviewed the current literature on subthreshold micropulse laser treatment, particularly focusing on its effects on the modulation of retinal neuroinflammation. Subthreshold micropulse laser treatment seems to determine a long-term normalization of specific retinal neuroinflammatory metabolic pathways, contributing to the restoration of retinal homeostasis and the curtailing of local inflammatory processes. Optimized and standardized parameters ensure effective and safe treatment.
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15
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Frizziero L, Calciati A, Torresin T, Midena G, Parrozzani R, Pilotto E, Midena E. Diabetic Macular Edema Treated with 577-nm Subthreshold Micropulse Laser: A Real-Life, Long-Term Study. J Pers Med 2021; 11:jpm11050405. [PMID: 34067994 PMCID: PMC8152245 DOI: 10.3390/jpm11050405] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to evaluate the long-term efficacy and safety of 577-nm subthreshold micropulse laser (SMPL) treatment in a large population of patients affected by mild diabetic macular edema (DME) in a real-life setting. We retrospectively evaluated 134 eyes affected by previously untreated center-involving mild DME, and treated with 577-nm SMPL, using fixed parameters. Retreatment was performed at 3 months, in case of persistent retinal thickening. Optical coherence tomography (OCT), along with short and near-infrared fundus autofluorescence, were used to confirm long-term safety. At the end of at least one year follow-up, a significant improvement in visual acuity was documented, compared to baseline (77.3 ± 4.5 and 79.4 ± 4.4 ETDRS score at baseline and at final follow-up, respectively), as well as a reduction in the mean retinal thickness of the thickest ETDRS macular sector at baseline. A reduction in the central retinal thickness and the mean thickness of the nine ETDRS sectors was also found, without reaching statistical significance. No patients required intravitreal injections. No adverse effects were detected. This study suggests that 577-nm SMPL is a safe and repeatable treatment for mild DME that may be applied to real-life clinical settings using fixed parameters and protocols.
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Affiliation(s)
- Luisa Frizziero
- Department of Neuroscience—Ophthalmology, University of Padova, 35128 Padova, Italy; (L.F.); (A.C.); (T.T.); (R.P.); (E.P.)
| | - Andrea Calciati
- Department of Neuroscience—Ophthalmology, University of Padova, 35128 Padova, Italy; (L.F.); (A.C.); (T.T.); (R.P.); (E.P.)
| | - Tommaso Torresin
- Department of Neuroscience—Ophthalmology, University of Padova, 35128 Padova, Italy; (L.F.); (A.C.); (T.T.); (R.P.); (E.P.)
| | | | - Raffaele Parrozzani
- Department of Neuroscience—Ophthalmology, University of Padova, 35128 Padova, Italy; (L.F.); (A.C.); (T.T.); (R.P.); (E.P.)
| | - Elisabetta Pilotto
- Department of Neuroscience—Ophthalmology, University of Padova, 35128 Padova, Italy; (L.F.); (A.C.); (T.T.); (R.P.); (E.P.)
| | - Edoardo Midena
- Department of Neuroscience—Ophthalmology, University of Padova, 35128 Padova, Italy; (L.F.); (A.C.); (T.T.); (R.P.); (E.P.)
- IRCCS—Fondazione Bietti, 00120 Rome, Italy;
- Correspondence: ; Tel.: +39-049-821-2110
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