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Nagel I, Mueller A, Freeman WR, Kozak I. Laser-Based Therapy Approaches in the Retina: A Review of Micropulse Laser Therapy for Diabetic Retinopathy. Klin Monbl Augenheilkd 2024; 241:1201-1206. [PMID: 39389554 DOI: 10.1055/a-2418-5173] [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: 10/12/2024]
Abstract
PURPOSE This review aims to elucidate the mechanisms and clinical utility of subthreshold micropulse laser (SML) therapy in the context of retinal care. Subthreshold or "nondestructive" laser therapy encompasses treatment modalities that induce minimal or no harm to retinal or choroidal tissue and leave no visible sings post-application, while achieving clinical efficacy. METHODS A comprehensive review of literature sourced from databases including PubMed, Medline, Embase, Cochrane, and Web of Science was conducted, focusing on articles published before February 2024, and discussing the contemporary use of SML therapy in treating diabetic retinopathy (DR). RESULTS The review presents evidence from scientific literature supporting SML therapy as a viable therapeutic approach for management of DR. Across numerous studies, SML therapy has demonstrated safety and additional therapeutic efficacy without causing damage to underlying retinal tissue. CONCLUSION Subthreshold laser treatment emerges as a safe strategy for addressing DR. Numerous studies have shown its additional efficacy to anti-VEGF pharmacotherapy, which is the currently approved monotherapy for complications of DR. Ongoing research and clinical investigations aim to further elucidate the mechanisms and optimize the therapeutic advantages of this technology.
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Affiliation(s)
- Ines Nagel
- Jacobs Retina Center, University of California San Diego, La Jolla, California, United States
| | | | - William R Freeman
- Jacobs Retina Center, University of California San Diego, La Jolla, California, United States
| | - Igor Kozak
- Ophthalmology, Moorfields Eye Hospital Dubai, Abu Dhabi, United Arab Emirates
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Ashrafkhorasani M, Habibi A, Nittala MG, Corradetti G, Emamverdi M, Sadda SR. Peripheral retinal lesions in diabetic retinopathy on ultra-widefield imaging. Saudi J Ophthalmol 2024; 38:123-131. [PMID: 38988777 PMCID: PMC11232752 DOI: 10.4103/sjopt.sjopt_151_23] [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: 07/07/2023] [Accepted: 10/03/2023] [Indexed: 07/12/2024] Open
Abstract
Peripheral retinal imaging plays a crucial role in the diagnosis, management, and prognosis of diabetic retinopathy (DR). Traditional fundus imaging techniques have limited coverage of the retina, resulting in missed peripheral lesions. The advent of ultra-widefield (UWF) imaging has revolutionized the assessment of the peripheral retina. UWF imaging modalities provide comprehensive visualization of the retina, enabling the detection of peripheral lesions without the need for mydriasis. Integration of UWF imaging with other modalities, including fluorescein angiography (FA), indocyanine green angiography, pseudocolor imaging, and fundus autofluorescence, further enhances our understanding of peripheral retinal lesions. UWF imaging has demonstrated improved detection of DR lesions and presumably more accurate management of DR compared to traditional fundus photography and dilated fundus examination. UWF-FA and UWF-optical coherence tomography angiography have emerged as valuable tools for assessing retinal and choroidal vascular abnormalities, nonperfusion areas, neovascularization, and microvascular abnormalities. The presence and increasing extent of predominantly peripheral lesions detected using UWF FA are associated with a higher risk of DR progression and proliferative DR. UWF imaging provides a comprehensive evaluation of DR severity, aiding in more accurate risk stratification and treatment decision-making. Overall, UWF imaging modalities have significantly advanced our understanding of peripheral retinal lesions in DR, facilitating early detection and targeted management for better visual outcomes.
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Affiliation(s)
- Maryam Ashrafkhorasani
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Abbas Habibi
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Muneeswar G. Nittala
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
| | - Giulia Corradetti
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mehdi Emamverdi
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Srinivas R. Sadda
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Lin Z, Deng A, Hou N, Gao L, Zhi X. Advances in targeted retinal photocoagulation in the treatment of diabetic retinopathy. Front Endocrinol (Lausanne) 2023; 14:1108394. [PMID: 36936172 PMCID: PMC10018161 DOI: 10.3389/fendo.2023.1108394] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
AIM Targeted retinal photocoagulation (TRP) is an emerging laser technology for retinal targeted therapy. TRP can specifically act on unperfused retinal capillaries and retinal intermediate ischemic areas, reduce damage to tissue perfusion areas and panretinal photocoagulation (PRP) complications or adverse events. In this regard, this review discusses the treatment options, efficacy, and latest progress of TRP for diabetic retinopathy (DR) based on randomized controlled trial (RCT), meta-analysis, case review, and other existing studies. METHODS In-depth research was conducted on articles about the proposal and development of TRP, its simple application in DR, and combined therapy. In order to review the new progress, application methods, effects, and prospects of TRP in the treatment of DR, the articles related to TRP in the databases of PubMed and Web Of Science since this century were comprehensively analyzed. RESULTS TRP is effective in treating DR and may become a substitute for PRP in the future. In addition, the treatment regimen of TRP combined with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs can also be used as a new therapeutic approach to expand the treatment regimen for the treatment of DR, and this combination therapy also has effects on other retinal vascular diseases. CONCLUSIONS With the advancement of technology, TRP has been continuously applied in clinical practice, and its potential benefits have opened up broad prospects for the treatment of DR. The combination therapy of TRP and anti-VEGF is expected to become a new option for patients with DR an retinal diseases.
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Toto L, D'Aloisio R, De Nicola C, Evangelista F, Ruggeri ML, Cerino L, Simonelli MB, Aharrh-Gnama A, Di Nicola M, Porreca A, Mastropasqua R. Short-term comparison between navigated subthreshold microsecond pulse laser and oral eplerenone for chronic central serous chorioretinopathy. Sci Rep 2022; 12:4727. [PMID: 35304566 PMCID: PMC8933552 DOI: 10.1038/s41598-022-08764-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
To compare the anatomical/functional changes after navigated subthreshold pulse laser (SML) and oral eplerenone therapy for chronic central serous chorioretinopathy (cCSC). A total of 36 eyes of 36 patients suffering from cCSC treated with navigated SML (Navilas® 577s; OD-OS GmbH, near Berlin, Germany) (18 eyes, SML group) and oral eplerenone (18 eyes, eplerenone group) were enrolled in this retrospective study. Main outcome measures during a 3-month follow up period included changes of best corrected visual acuity (BCVA), central macular thickness (CMT), foveal subretinal fluid thickness (FSRFT), and subfoveal choroidal thickness (SFCT). At baseline average duration of symptoms was 6.8 ± 0.6 months in SML group and 6.4 ± 0.9 months in eplerenone group (p = 0.127). Mean BCVA, CMT and FSRFT changed significantly over time (p < 0.001). From baseline to 90 days the BCVA improved from 0.3 ± 0.1 to 0.1 ± 0.1 logMAR in SML group and from 0.3 ± 0. to 0.2 ± 0.1 logMAR in eplerenone group, CMT reduced from 357.1 ± 104.3 to 210.6 ± 46.7 μm and from 428.7 ± 107.7 to 332.5 ± 27.5 μm in SML group and eplerenone group respectively, FSRFT reduced from 144.4 ± 108.2 to 22.6 ± 37.2 μm and from 217.1 ± 105.9 to 54.4 ± 86.2 μm in SML group and eplerenone group. 55.6% of patients in SML group and 66.7% in eplerenone group showed a complete resolution of FSRFT during follow up. The interaction between group and time was statistically significant with greater absolute variation for CMT and FSRFT in SML group compared to eplerenone group (p < 0.001 and p = 0.043). SFCT did not change significantly during follow up (p = 0.083) for both groups. Both navigated SML and oral eplerenone were effective treatments showing recovery of retinal morphology and related visual acuity improvement in cCSC.
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Affiliation(s)
- Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Rossella D'Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Chiara De Nicola
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Maria Ludovica Ruggeri
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Luca Cerino
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Maria Beatrice Simonelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Agbéanda Aharrh-Gnama
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Annamaria Porreca
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
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Mounirou BAM, Adam ND, Yakoura AKH, Aminou MSM, Liu YT, Tan LY. Diabetic Retinopathy: An Overview of Treatments. Indian J Endocrinol Metab 2022; 26:111-118. [PMID: 35873941 PMCID: PMC9302419 DOI: 10.4103/ijem.ijem_480_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Diabetic retinopathy (DR), substantially impacts the quality of life of diabetic patients, it remains, in developed countries, the leading cause of vision loss in working-age adults (20-65 years). Currently, about 90 million diabetics suffer from DR. DR is a silent complication that in its early stages is asymptomatic. However, over time, chronic hyperglycemia can lead to sensitive retinal damage, leading to fluid accumulation and retinal haemorrhage (HM), resulting in cloudy or blurred vision. It can, therefore, lead to severe visual impairment or even blindness if left untreated. It can be classified into nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR is featured with intraretinal microvasculature changes and can be further divided into mild, moderate, and severe stages that may associate with diabetic macular oedema (DME). PDR involves the formation and growth of new blood vessels (retinal neovascularisation) under low oxygen conditions. Early identification and treatment are key priorities for reducing the morbidity of diabetic eye disease. In the early stages of DR, a tight control of glycemia, blood pressure, plasma lipids, and regular monitoring can help prevent its progression to more advanced stages. In advanced stages, the main treatments of DR include intraocular injections of anti-vascular endothelial growth factor (VEGF) antibodies, laser treatments, and vitrectomy. The aim of this review is to provide a comprehensive overview of the published literature pertaining to the latest progress in the treatment of DR.
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Affiliation(s)
- Bassirou A. M. Mounirou
- Department of Endocrinology and Metabolic Diseases, First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Nouhou D. Adam
- Department of Ophthalmology, Lamorde National Hospital, Niamey, Niger
| | | | - Mahamane S. M. Aminou
- Department of Endocrinology and Metabolic Diseases, General Reference Hospital of Niamey, Niger
| | - Yu T. Liu
- Department of Ophthalmology, Lamorde National Hospital, Niamey, Niger
| | - Li Y. Tan
- Department of Endocrinology and Metabolic Diseases, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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Statement of the German Ophthalmological Society, the German Retina Society, and the Professional Association of Ophthalmologists in Germany on treatment of diabetic macular edema : Dated August 2019. Ophthalmologe 2021; 118:40-67. [PMID: 33033871 DOI: 10.1007/s00347-020-01244-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Amoroso F, Souied EH, Cohen SY, Pedinielli A, Astroz P, Blanco Garavito R, Capuano V, Querques G, Miere A. OCTA-guided navigated laser therapy for advanced macula neovascularization secondary to age related macular degeneration. Eur J Ophthalmol 2020; 31:3182-3189. [PMID: 33353405 DOI: 10.1177/1120672120983191] [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: 11/15/2022]
Abstract
INTRODUCTION To evaluate the effects of the Navilas system guided by optical coherence tomography angiography for advanced macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). METHODS Prospective case-series including nine eyes presenting with advanced MNV with persistence of exudative signs, no longer responding to anti-VEGF therapy, best-corrected visual acuity at least of 1.3 logMar. All patients were treated with Navilas guided by overlaid optical coherence tomography angiography (OCTA) images at the site of branching large neovascular trunks. RESULTS Occlusion of large neovascular trunks successfully occurred in all nine included patients. OCTA analysis revealed, at 1 month follow up, MNV total area decreasing from 6.2 ± 3.1 to 2.6 ± 3.4 mm2. At 6 months follow up, mean MNV area was 3.3 ± 3.4 mm2 (p = 0.008). CONCLUSION This preliminary study showed that Navilas treatment guided by OCTA may represent an attractive therapeutic option in advanced neovascular lesions secondary to AMD.
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Affiliation(s)
- Francesca Amoroso
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Eric H Souied
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Salomon Yves Cohen
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France.,Ophthalmic Center for Imaging and Laser, Paris, France
| | - Alexandre Pedinielli
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Polina Astroz
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Rocio Blanco Garavito
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Vittorio Capuano
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Giuseppe Querques
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France.,Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
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Yoshida S, Murakami T, Nozaki M, Suzuma K, Baba T, Hirano T, Sawada O, Sugimoto M, Takamura Y, Tsuiki E. Review of clinical studies and recommendation for a therapeutic flow chart for diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 2020; 259:815-836. [PMID: 32997288 DOI: 10.1007/s00417-020-04936-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/25/2022] Open
Abstract
Diabetic macular edema (DME), characterized by exudative fluid accumulation in the macula, is the most common form of sight-threatening retinopathy in patients with diabetes. The management of DME has changed considerably in recent years, especially following the development of intravitreal anti-vascular endothelial growth factor therapy which has emerged as a first-line therapy for center-involved DME. Laser treatment, intravitreal steroid therapy, and vitrectomy are also important treatment options for DME. We believe that it is important to choose the most appropriate treatment option for DME based on the clinical evidences, in addition to the careful consideration of individual patients' general or ocular condition, DME characteristics, patients' motivation, and compliance to the treatment in real-world clinical practice. In this review, we have summarized important clinical evidences for the main treatments for DME, presented an expert review for these evidences, and proposed a recommended therapeutic flow chart for DME. We hope that our review of the clinical evidences and the recommended therapeutic flow chart for DME will contribute to better treatment outcome for DME.
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Affiliation(s)
- Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan.
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Miho Nozaki
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya-Shi, Aichi, 467-8601, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kagawa, Kita-gun, 761-0793, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan
| | - Osamu Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu-shi, Shiga, 520-2192, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu-shi, Mie, 514-8507, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Eiko Tsuiki
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki-shi, Nagasaki, 852-8523, Japan
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Mecê P, Gofas-Salas E, Paques M, Grieve K, Meimon S. Optical Incoherence Tomography: a method to generate tomographic retinal cross-sections with non-interferometric adaptive optics ophthalmoscopes. BIOMEDICAL OPTICS EXPRESS 2020; 11:4069-4084. [PMID: 32923029 PMCID: PMC7449754 DOI: 10.1364/boe.396937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 05/05/2023]
Abstract
We present Optical Incoherence Tomography (OIT): a completely digital method to generate tomographic retinal cross-sections from en-face through-focus image stacks acquired by non-interferometric imaging systems, such as en-face adaptive optics (AO)-ophthalmoscopes. We demonstrate that OIT can be applied to different imaging modalities using back-scattered light, including systems without inherent optical sectioning and, for the first time, multiply-scattered light, revealing a distinctive cross-sectional view of the retina. The axial dimension of OIT cross-sections is given in terms of focus position rather than optical path, as in OCT. We explore this property to guide focus position in cases where the user is "blind" focusing, allowing precise plane selection for en-face imaging of retinal pigment epithelium, the vascular plexuses and translucent retinal neurons, such as photoreceptor inner segments and retinal ganglion cells, using respectively autofluorescence, motion contrast and split detection techniques.
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Affiliation(s)
- Pedro Mecê
- Institut Langevin, ESPCI Paris, CNRS, PSL University, 1 rue Jussieu, 75005 Paris, France
| | - Elena Gofas-Salas
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
| | - Michel Paques
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, F-75012, Paris, France
| | - Kate Grieve
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, F-75012, Paris, France
| | - Serge Meimon
- DOTA, ONERA, Université Paris Saclay F-91123 Palaiseau, France
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10
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Blindbæk SL, Peto T, Grauslund J. Aflibercept and navigated versus conventional laser in diabetic macular oedema: a 12-month randomized clinical trial. Acta Ophthalmol 2020; 98:347-352. [PMID: 31602811 DOI: 10.1111/aos.14266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/14/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the efficacy of intravitreal aflibercept and navigated laser as compared to intravitreal aflibercept and conventional laser in diabetic macular oedema (DME) treatment. METHODS In 12-month randomized clinical trial, 48 eyes of 37 patients with centre-involved DME at Odense University Hospital were randomized 1:1 to receive three monthly injections of aflibercept followed by navigated (group A) or conventional (group B) focal/grid laser. From month four through twelve, patients were examined monthly, and additional injections were given pro re nata (PRN) (central retinal thickness [CRT]>20% from lowest measurement or loss in visual acuity [VA]>5 Early Treatment Diabetic Retinopathy Study [ETDRS] letters compared with baseline). Outcome measures; (1) percentage of eyes that needed additional injections after laser in group A and B, (2) mean number of injections in group A and B, and (3) mean change in VA and CRT in group A and B. RESULTS In the PRN phase, 60.5% of patients needed additional injections without differences between groups A and B (58.3 versus 63.2%, p > 0.99). The mean number of injections between baseline and month 12 was 4.4 (4.2 versus 4.6, p = 0.41). From baseline to month 12, VA improved by 8.4 ETDRS letters, and CRT was reduced by 97.4 μm (+9.4 versus +7.1 letters, p = 0.17, and -83.2 versus -115.4 μm, p = 0.21). CONCLUSION No difference in need for retreatment was detected between treatment arms of aflibercept and navigated versus conventional laser.
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Affiliation(s)
- Søren L. Blindbæk
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
- OPEN, Odense Patient Data Explorative Network Odense University Hospital Odense Denmark
| | - Tunde Peto
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Centre for Public Health Queen's University Belfast Belfast UK
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Steno Diabetes Center Odense Odense Denmark
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Amoroso F, Pedinielli A, Astroz P, Semoun O, Capuano V, Miere A, Souied EH. Comparison of pain experience and time required for pre-planned navigated peripheral laser versus conventional multispot laser in the treatment of diabetic retinopathy. Acta Diabetol 2020; 57:535-541. [PMID: 31749047 DOI: 10.1007/s00592-019-01455-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/06/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the pain and the duration of a panretinal photocoagulation (PRP) session using a conventional multispot laser (Quantel Medical) versus the Navilas® laser. METHODS Treatment-naïve patients requiring bilateral PRP for diabetic retinopathy were included. For each patient, PRP was carried out using a conventional multispot laser (Quantel Medical, 577 nm) in one eye and the other eye was treated with the Navilas laser (OD-OS, 577 nm). For both PRP treatments, similar parameters (same power, exposure time, number, size and spacing of the spots) were used. For each eye, the duration of the session and the pain, measured using respectively a chronometer and a visual analogic scale (VAS), were recorded. RESULTS Thirty-two eyes of sixteen patients (mean age 57 ± 13 SD, range 28-74), 11 men and 5 women, have been included. A mean of 1289 (1000-1500) spots with a mean power of 352 mW (300-450 mW) and an exposure time of 27 ms (20-30 ms) were delivered. The PRP session with the Navilas laser (mean time of 5.2 ± 0.8 min) was faster than with the conventional multispot laser (6.6 ± 1.1 min) (p = 0.02). Laser-induced pain was significantly reduced (VAS of 2.4 ± 1.6) using the Navilas laser compared to conventional laser (VAS: 7.1 ± 2) (p < 0.001). CONCLUSION The PRP sessions using the Navilas laser were significantly faster and less painful than with a conventional multispot laser in our series.
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Affiliation(s)
- Francesca Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, 40 Avenue de Verdun, 94000, Creteil, France.
| | - Alexandre Pedinielli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, 40 Avenue de Verdun, 94000, Creteil, France
| | - Polina Astroz
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, 40 Avenue de Verdun, 94000, Creteil, France
| | - Oudy Semoun
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, 40 Avenue de Verdun, 94000, Creteil, France
| | - Vittorio Capuano
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, 40 Avenue de Verdun, 94000, Creteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, 40 Avenue de Verdun, 94000, Creteil, France
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, 40 Avenue de Verdun, 94000, Creteil, France
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Efficacy of navigated focal laser photocoagulation in diabetic macular edema planned with en face optical coherence tomography versus fluorescein angiography. Int Ophthalmol 2020; 40:1913-1921. [PMID: 32285237 DOI: 10.1007/s10792-020-01363-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/01/2020] [Indexed: 11/27/2022]
Abstract
AIM To analyze the efficacy of navigated focal laser photocoagulation (FLP) of microaneurysms in diabetic macular edema (DME) planned using en face optical coherence tomography (OCT) as against fluorescein angiography (FA). METHODS Twenty-six eyes of 21 DME patients (12 males, 9 females, 69.5 ± 12.3 years) with mean BCVA of 0.52 ± 0.44 LogMAR were included. En face OCT images of deep capillary plexus slab and FA images were used to plan FLP targeting of leaky microaneurysms. The primary outcome measures were central retinal thickness (CRT) and macular volume. The secondary outcome measure was best-corrected visual acuity (BCVA). RESULTS The difference in the change of CRT and macular volume between en face OCT and FA-planned FLP after 1 month and at the end of follow-up was not statistically significant (p > 0.05), except for a higher CRT reduction in the en face OCT-planning group (p = 0.007) at the end of mean follow-up of 2.6 ± 0.9 months. There was no difference in BCVA change between the two planning options (p = 0.42). CONCLUSION En face OCT is a non-inferior alternative for FA in the planning of navigated FLP of microaneurysms in DME.
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Polat O, Inan S, Baysal Z, Yigit S, Inan UU. Comparison of navigated laser and conventional single-spot laser system for induced pain during panretinal photocoagulation. Lasers Med Sci 2020; 35:687-693. [PMID: 31741148 DOI: 10.1007/s10103-019-02886-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/23/2019] [Indexed: 01/10/2023]
Abstract
To compare the panretinal photocoagulation (PRP)-induced pain response between novel navigated laser (Navilas) and conventional single-spot laser. The eyes were randomly assigned to Navilas or conventional laser. Contralateral eyes underwent PRP with the other system with 30 min resting interval. Pulse duration was 100 ms in conventional laser and 30 ms or 100 ms in Navilas and power setting was enough to create gray-white light burn on both devices. Pain response was evaluated by verbal scale (VS) (0-4) and visual analog scale (VAS) (0-10) after each PRP application. The mean age of 70 patients (140 eyes) was 62.52 ± 9.49 years. Mean power and spot numbers for Navilas and conventional laser were 291.9 ± 85.3 mW vs 368.4 ± 72.0 mW, and 375.4 ± 108.4 vs 374.2 ± 105.0 (p < 0.001 and p = 0.53, respectively). Pain scores for Navilas and conventional laser were 1.19 ± 0.73 and 1.99 ± 0.84 for VS and 2.41 ± 1.65 and 4.74 ± 2.17 for VAS (p < 0.001 and p < 0.001). More comfortable PRP is achieved with Navilas system in comparison with conventional single-spot laser system. However, small number of patients treated with same pulse duration and different contact lenses used for two systems should be taken into consideration. Besides, we did not report comparative clinical efficiency of either laser system.
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Affiliation(s)
- Onur Polat
- Ophthalmology Clinic, Afyonkarahisar State Hospital, Orhangazi Mah. Nedim Helvacıoğlu Cd. No: 73, 03030, Afyonkarahisar, Turkey.
| | - Sibel Inan
- Faculty of Medicine, Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Zeki Baysal
- Ophthalmology Clinic, Batman State Hospital, Batman, Turkey
| | - Safiye Yigit
- Ophthalmology Clinic, Gerede State Hospital, Bolu, Turkey
| | - Umit Ubeyt Inan
- Ophthalmology Clinic, Park Hayat Hospital, Afyonkarahisar, Turkey
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Mansour SE, Browning DJ, Wong K, Flynn HW, Bhavsar AR. The Evolving Treatment of Diabetic Retinopathy. Clin Ophthalmol 2020; 14:653-678. [PMID: 32184554 PMCID: PMC7061411 DOI: 10.2147/opth.s236637] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy. Methods A review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance. Results Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion Pharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and treatment burden are more constrained. Results with subthreshold laser appear promising but will require more rigorous study to establish its role as adjunctive therapy. Evidence to support an optimal integration of the various treatment options is lacking. Central to the widespread adoption of any therapeutic regimen for DR and DME is substantiation of safety, efficacy, and cost-effectiveness by a body of sound clinical trials.
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Affiliation(s)
- Sam E Mansour
- George Washington University, Washington, DC, USA.,Virginia Retina Center, Warrenton, VA, 20186, USA
| | - David J Browning
- Charlotte Eye Ear Nose & Throat Associates, Charlotte, NC 28210, USA
| | - Keye Wong
- Retina Associates of Sarasota, Sarasota, FL 34233, USA
| | - Harry W Flynn
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL, USA
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Stellungnahme der DOG, der RG und des BVA zur Therapie des diabetischen Makulaödems. Ophthalmologe 2020; 117:218-247. [DOI: 10.1007/s00347-019-01015-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Blindbæk SL, Peto T, Grauslund J. How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular edema? Acta Ophthalmol 2019; 97:339-346. [PMID: 30575304 DOI: 10.1111/aos.13997] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/16/2018] [Indexed: 01/06/2023]
Abstract
Vascular endothelial growth factor inhibitors (anti-VEGF) have consistently demonstrated efficacy and safety and changed both the aim and perspectives of diabetic macular edema (DME) treatment. Hence, the present and future role of focal/grid laser photocoagulation in DME treatment has been subjected to some debate. However, extensive insight into technical advances in novel laser systems, treatment protocols of anti-VEGF trials and the functional impact of modern focal/grid photocoagulation is needed to evaluate the present and future role of photocoagulation in DME treatment. Across a wide range of clinical trials laser therapy was required as adjunctive/rescue treatment in approximately 20-50% of patients receiving anti-VEGF monotherapy for centre involving DME. Further, a lower retreatment rate and a more stable reduction in retinal thickness have been demonstrated in more studies. However, lacking information on the laser systems used, their technical specifications and protocols of application often complicates direct comparison of results in anti-VEGF trials. Hence, this paper aimed to provide an overview of the currently available data relevant to the potential role of focal/grid laser photocoagulation in DME treatment including a thorough overview of the current most commonly used laser systems. Results with subthreshold diode micropulse laser photocoagulation are intriguing and may offer a valuable option as adjunctive therapy to anti-VEGF treatment. However, more well-designed studies on combination therapy are warranted to determine the full potential of modern retinal photocoagulation systems. In conclusion, current data suggest that focal/grid laser therapy should still be an option for consideration as adjunctive therapy in many patients.
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Affiliation(s)
- Søren L. Blindbæk
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Tunde Peto
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Centre for Public Health Queen's University Belfast Belfast UK
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Steno Diabetes Center Odense Odense Denmark
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Gologorsky D, Rosen RB, Giovinazzo J, Jansen M, Landa G, Lee J. Navigated Retina Laser Therapy as a Novel Method for Laser Retinopexy of Retinal Tears. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e206-e209. [PMID: 30457657 DOI: 10.3928/23258160-20181101-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the use of a navigated laser system for the treatment of retinal tears. MATERIALS AND METHODS A planned pattern laser retinopexy was performed using a navigated laser photocoagulator incorporating rapid panretinal photocoagulation technology with an individualized target overlay to produce a 3 × 3 square pattern surrounding a horseshoe tear. Institutional review board approval was not applicable for this case. RESULTS Successful laser retinopexy 360° around the tear was achieved. CONCLUSION In select cases, a navigated laser system may be utilized for the treatment of retinal tears. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e206-e209.].
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Herold TR, Langer J, Vounotrypidis E, Kernt M, Liegl R, Priglinger SG. 3-year-data of combined navigated laser photocoagulation (Navilas) and intravitreal ranibizumab compared to ranibizumab monotherapy in DME patients. PLoS One 2018; 13:e0202483. [PMID: 30138384 PMCID: PMC6107183 DOI: 10.1371/journal.pone.0202483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/04/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The prospective, comparative evaluation of combined navigated laser photocoagulation and intravitreal ranibizumab in the treatment of diabetic macular edema has shown advantage of a combination therapy compared to ranibizumab monotherapy at year 1 with significantly reduced injections. The purpose of this retrospective study was to determine the long-term visual gains and need of injections in a 3 year-follow-up period. METHODS Retrospective analysis of patients of the original study in the long-term follow-up from month 12 to 36. BCVA measurements following the original 1 year study were taken using logMAR charts. Injections were provided with standard of care using PRN, based on change in BCVA and CRT using SD-OCT scans. Main outcome measures were change in BCVA and mean number of injections from 12 to 36 months. RESULTS BCVA was stable in both groups from 12 through 36 months, showing a change of 0.16 ± 0.1 log MAR. Following the initial reduction in required injections at month 12, combination therapy patients continued to require 1.3 times fewer injections over the next 24 months (2.91 ± 2.3 vs 3.85±3.7 injections for monotherapy). CONCLUSIONS Combination of navigated laser and ranibizumab achieved BCVA gains equivalent to anti-VEGF monotherapy. These results could be maintained through month 36. Required injections were 2.0 injections lower in year 1 and further 1.3 times fewer in year 2 and 3 in the combination group compared to monotherapy. Adding navigated laser photocoagulation to intravitreal anti-VEGF therapy may still represent a superior therapeutic approach to DME patients.
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Affiliation(s)
- Tina Rike Herold
- Department of Ophthalmology, University Hospital, LMU, Munich, Germany
- * E-mail:
| | - Julian Langer
- Department of Ophthalmology, University Hospital, LMU, Munich, Germany
| | | | | | - Raffael Liegl
- Department of Ophthalmology, University Hospital, LMU, Munich, Germany
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Maltsev DS, Kulikov AN, Uplanchiwar B, Lima LH, Chhablani J. Direct navigated laser photocoagulation as primary treatment for retinal arterial macroaneurysms. Int J Retina Vitreous 2018; 4:28. [PMID: 30151240 PMCID: PMC6104015 DOI: 10.1186/s40942-018-0133-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To compare the efficacy and safety of conventional and navigated laser photocoagulation as the primary treatment option for retinal arteriolar macroaneurysm (RAM). METHODS Eleven (9 male and 2 females, mean age 65.1 ± 12.1 years) and 17 (13 male and 4 females, mean age 66.2 ± 8.9 years) patients were included in conventional laser photocoagulation (CLP) and navigated laser photocoagulation (NLP) groups, respectively. The primary outcome measures were LogMAR best-corrected visual acuity (BCVA) and central retinal thickness at the end of the follow-up. The secondary outcome measure was total laser energy applied during the procedure. RESULTS At the end of the mean follow-up of 11.4 ± 4.0 months, baseline LogMAR BCVA increased significantly from 0.65 ± 0.14 to 0.26 ± 0.12 (p < 0.001) in CLP group and from 0.57 ± 0.33 to 0.29 ± 0.34 (p < 0.001) in NLP group. Central retinal thickness decreased significantly from 514.5 ± 53.2 µm to 295.3 ± 11.3 µm (p < 0.001) and from 494.0 ± 111.2 µm to 285.8 ± 51.4 µm (p < 0.001) in CLP and NLP group, respectively. Total laser energy and number of laser burns applied per procedure in NLP group was statistically significantly lower than in CLP group (0.28 ± 0.13 J vs 0.59 ± 0.06 J, p < 0.001 and 28.5 ± 14.2 burns vs 48.9 ± 5.1 burns, respectively, p < 0.001). No adverse events related to laser treatment was noted in study groups during the follow-up. CONCLUSION This study demonstrated superiority of navigated laser photocoagulation compared to conventional laser photocoagulation in primary treatment of RAM which results from similar efficacy and safety of both techniques with lower mean total laser energy and number of laser burns required for navigated laser photocoagulation.
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Affiliation(s)
- Dmitrii S. Maltsev
- Department of Ophthalmology, Military Medical Academy, 5 Klinicheskaya St, St. Petersburg, Russia 194044
| | - Alexei N. Kulikov
- Department of Ophthalmology, Military Medical Academy, 5 Klinicheskaya St, St. Petersburg, Russia 194044
| | - Bhushan Uplanchiwar
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, 500 034 India
| | - Luiz H. Lima
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, 500 034 India
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Chhablani J, Alshareef R, Kim DT, Narayanan R, Goud A, Mathai A. Comparison of different settings for yellow subthreshold laser treatment in diabetic macular edema. BMC Ophthalmol 2018; 18:168. [PMID: 29996798 PMCID: PMC6042372 DOI: 10.1186/s12886-018-0841-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the safety and efficacy of two subthreshold parameters (5 and 15% duty cycle (DC)) compared to standard ETDRS (early treatment of diabetic retinopathy study) continuous wave (CW) laser. METHODS In this prospective randomized study, 30 eyes from 20 patients with non-center involving macular edema were randomized into 3 different groups: 5% DC, 15% DC and CW navigated modified ETDRS laser treatment. Titration in subthreshold groups was performed with 30% of the threshold power, decided with microsecond pulses. CW laser was titrated to a barely visible burn. All patients underwent microperimetry, thickness measurements and visual acuity examinations at baseline, 6 weeks and 12 weeks post treatment. RESULTS At three months follow up, retinal sensitivity was significantly reduced in the CW group by - 2.2 dB whereas in both subthreshold groups, retinal sensitivity increased by 2.4 dB for 5% and 1.9 dB for 15% DC with no significant difference. Retinal volume (mm3) decreased in both subthreshold groups by 0.08 ± 0.3 and 0.12 ± 0.11 in 5 and 15% DC group respectively. Whereas the CW group showed volume increase of 0.55 ± 0.92 (p = 0.02 and 0.01 for 5 and 15% DC groups). Visual acuity remained stable in all 3 groups (- 0.7 letter in 5% DC; 2.11 letters in 15% DC and 0.88 in CW with no significant difference). CONCLUSION Subthreshold microsecond laser was shown to be safe and effective with both 5 and 15% DC as compared to conventional photocoagulation with ETDRS parameters. The 15% DC setting trended to achieve better anatomical, visual and functional outcomes. TRIAL REGISTRATION Retrospectively registered ( NCT03571659 , 06/26/2018).
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Affiliation(s)
- Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy Campus Banjara Hills, Hyderabad, 500034, India.
| | - Rayan Alshareef
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - David Ta Kim
- Department of Surgery, Division of Ophthalmology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Raja Narayanan
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy Campus Banjara Hills, Hyderabad, 500034, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy Campus Banjara Hills, Hyderabad, 500034, India
| | - Annie Mathai
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy Campus Banjara Hills, Hyderabad, 500034, India
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Evaluation of Navigated Laser Photocoagulation (Navilas 577+) for the Treatment of Refractory Diabetic Macular Edema. J Ophthalmol 2018; 2018:3978514. [PMID: 29854426 PMCID: PMC5954871 DOI: 10.1155/2018/3978514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/26/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose To evaluate navigated laser photocoagulation for the treatment of refractory diabetic macular edema (DME). Methods Retrospective study of 25 eyes (21 patients) treated with Navilas 577+ focal laser system. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (OCT) parameters were measured at baseline, 1, 3, and 6 months, and final visit. Results The mean follow-up period was 12.8 ± 2.4 (7–16 months). All subjects had history of previous treatment which was injection of triamcinolone acetonide or antivascular endothelial growth factor (VEGF) agents. The navigated laser photocoagulation was delivered to the microaneurysms on indocyanine green angiography (ICGA) in 21 of 25 eyes (84%), fluorescein angiography (FA) guided in 3 eyes, and OCT angiography guided in 1 eye. After initial navigated laser treatment, 16 of 25 eyes (64%) were needed additional navigated laser photocoagulation, injection of triamcinolone acetonide, and/or injection of VEGF agents. Although median BCVA remained stable, the central retinal thickness and macular volume were significantly decreased over 6 months (p < 0.05). All patients were treated without complications. Conclusions Focal photocoagulation using Navilas 577+ showed to be effective in treating DME with improvement in macular edema on OCT over 6 months. Navilas 577+ was beneficial to perform navigated laser photocoagulation based on three modalities (ICGA, FA, and OCT angiography).
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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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Combination of Navigated Macular Laser Photocoagulation and Anti-VEGF Therapy: Precise Treatment for Macular Edema under Dry Retinal Conditions. J Ophthalmol 2017; 2017:7656418. [PMID: 28316837 PMCID: PMC5338071 DOI: 10.1155/2017/7656418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/14/2016] [Accepted: 01/04/2017] [Indexed: 01/02/2023] Open
Abstract
Purpose. To compare the controllability of navigated macular laser photocoagulation (MLP) in dry versus edematous retina and validate that pretreatment diagnostic images can be used as basis for navigated MLP after the macular edema (ME) has been resolved. Materials and Methods. Group 1 was divided into subgroup 1 (dry retina MLP) and subgroup 2 (MLP in ME) for comparisons of laser-burn diameters. In group 2, the areas and locations of ME before an intravitreal injection of anti-VEGF (IVAV) were compared with those of recurrent ME. Results. The average actual diameter as percentage of planned diameter of laser burn in subgroup 1 (11 DME eyes, 6 BRVO eyes) versus subgroup 2 (5 DME eyes, 8 BRVO eyes) was 115.1 ± 9.1% versus 167.2 ± 13.8% (based on retro-mode scanning laser ophthalmoscopy), and 118.1 ± 14.8% versus 176.1 ± 11.6% (based on OCT) (p < 0.001). In group 2 (6 DME eyes, 6 BRVO eyes), difference in mean ME area before IVAV and that in recurrent edema was insignificant (p > 0.05). Conclusion. The controllability of navigated MLP in dry retina is improved compared to edematous retina. This study validates that pretreatment diagnostic images can be used as basis for navigated MLP after the edema has been resolved.
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Su D, Hubschman JP. A Review of Subthreshold Micropulse Laser and Recent Advances in Retinal Laser Technology. Ophthalmol Ther 2017; 6:1-6. [PMID: 28185205 PMCID: PMC5449296 DOI: 10.1007/s40123-017-0077-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Indexed: 11/29/2022] Open
Abstract
The role of retinal photocoagulation as a first line therapy for various retinal pathologies has decreased with the introduction of anti-vascular endothelial growth factor therapy. However, retinal laser therapy remains an important treatment modality, especially with the emergence of micropulse subthreshold treatment and the integration of newer technology such as augmented reality and semi-automated delivery. This review summarizes current evidence for micropulse laser as a treatment modality and discusses the role of new technology such as augmented reality in the future of laser therapy.
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Affiliation(s)
- Daniel Su
- Stein Eye Institute, University of California, Los Angeles, CA, USA
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Prokopetc K, Bartoli A. A comparative study of transformation models for the sequential mosaicing of long retinal sequences of slit-lamp images obtained in a closed-loop motion. Int J Comput Assist Radiol Surg 2016; 11:2163-2172. [PMID: 27325139 DOI: 10.1007/s11548-016-1439-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Navigated panretinal photocoagulation is a standard care for proliferative diabetic retinopathy. Slit-lamp-based systems used for this treatment provide a narrow view of the retina. Retinal mosaics are used for view expansion and treatment planning. Mosaicing slit-lamp images is a hard task due to the absence of a physical model of the imaging process, large textureless regions and imaging artifacts, mostly reflections. METHODS We present a comparative study of various geometric transformation models applied to retinal image mosaicing in computer-assisted slit-lamp imaging. We propose an efficient point correspondence-based framework for transformation model evaluation in a typical closed-loop motion scenario. We compare the performance of multiple linear and nonlinear models of different complexities and assess the effect of the number of points used for parameter estimation. We use a local fitting error (LFE) metric to estimate the models' performance in pairwise registration. Because LFE alone is not conclusive regarding the problem of accumulated drift, we propose a loop closure error (LCE) metric to quantify the effect of accumulated local registration errors. We also provide a new normalization procedure for the quadratic transformation model, widely used in retinal image registration. RESULTS In total, seven transformation models were evaluated on three datasets of long image sequences. LFE decreases with increasing complexity of the model, while LCE, in contrast, shows superior performance of simple models. Varying the number of point correspondences did not reveal a common trend for the LCE metric, showing an increase in the error for simple models and an unstable behavior of the complex models. CONCLUSION Our results show that simple models are less sensitive to drift and preferable for sequential mosaicing in slit-lamp imaging, while more complex models are the best choice for short-term registration.
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Affiliation(s)
- Kristina Prokopetc
- ALCoV-ISIT, UMR 6284 CNRS / Université d'Auvergne, 28 place Henri Dunant, 63001, Clermont-Ferrand, France.
- QuantelMedical, 11 Rue du Bois Joli, 63808, Cournon-d' Auvergne, France.
| | - Adrien Bartoli
- ALCoV-ISIT, UMR 6284 CNRS / Université d'Auvergne, 28 place Henri Dunant, 63001, Clermont-Ferrand, France
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Nanoengineering of therapeutics for retinal vascular disease. Eur J Pharm Biopharm 2015; 95:323-30. [PMID: 26022642 DOI: 10.1016/j.ejpb.2015.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 01/07/2023]
Abstract
Retinal vascular diseases, including diabetic retinopathy, neovascular age related macular degeneration, and retinal vein occlusion, are leading causes of blindness in the Western world. These diseases share several common disease mechanisms, including vascular endothelial growth factor (VEGF) signaling, hypoxia, and inflammation, which provide opportunities for common therapeutic strategies. Treatment of these diseases using laser therapy, anti-VEGF injections, and/or steroids has significantly improved clinical outcomes. However, these strategies do not address the underlying root causes of pathology, and may have deleterious side effects. Furthermore, many patients continue to progress toward legal blindness despite receiving regular therapy. Nanomedicine, the engineering of therapeutics at the 1-100 nm scale, is a promising approach for improving clinical management of retinal vascular diseases. Nanomedicine-based technologies have the potential to revolutionize the treatment of ophthalmology, through enabling sustained release of drugs over several months, reducing side effects due to specific targeting of dysfunctional cells, and interfacing with currently "undruggable" targets. We will discuss emerging nanomedicine-based applications for the treatment of complications associated with retinal vascular diseases, including angiogenesis and inflammation.
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Mastropasqua L, Di Antonio L, Toto L, Mastropasqua A, Di Iorio A, Carpineto P. Central serous chorioretinopathy treated with navigated retinal laser photocoagulation: visual acuity and retinal sensitivity. Ophthalmic Surg Lasers Imaging Retina 2015; 46:349-54. [PMID: 25856822 DOI: 10.3928/23258160-20150323-09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 10/23/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the effect of navigated retinal laser photocoagulation on visual acuity (VA) and retinal sensitivity in eyes with acute central serous chorioretinopathy (CSC). PATIENTS AND METHODS Prospective, noncomparative, interventional case series of 30 eyes of 29 patients with acute CSC were treated using navigated photocoagulation. Patients were monitored for 180 days. RESULTS Mean VA improved from 0.3 ± 0.1 to 0.1 ± 0.1 logMAR (P < .001). Mean retinal sensitivity within central 8° and 4° improved from 9.4 ± 4.7 dB to 14.9 ± 3.6 dB and from 9.0 ± 5.6 dB to 14.6 ± 4.2 dB respectively (P < .001). In all cases, a decrease in mean central retinal thickness of -50.6 ± 2.9 µm (P < .001) and in mean subretinal fluid thickness of -52.0 ± 3.3 µm (P < .001) was observed during follow-up. CONCLUSION Navigated retinal laser photocoagulation demonstrated safety and accuracy for the treatment of acute CSC. VA and retinal sensitivity evaluations showed a significant improvement associated with resolution of the subretinal fluid during follow-up.
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Liegl R, Langer J, Seidensticker F, Reznicek L, Haritoglou C, Ulbig MW, Neubauer AS, Kampik A, Kernt M. Comparative evaluation of combined navigated laser photocoagulation and intravitreal ranibizumab in the treatment of diabetic macular edema. PLoS One 2014; 9:e113981. [PMID: 25541960 PMCID: PMC4277267 DOI: 10.1371/journal.pone.0113981] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/02/2014] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate if a standardized combination therapy regimen, utilizing 3 monthly ranibizumab injections followed by navigated laser photocoagulation, reduces the number of total ranibizumab injections required for treatment of diabetic macular edema (DME). Research Design and Methods A 12-month, prospective comparison of 66 patients with center-involving DME: 34 patients with combination therapy were compared to 32 patients treated with ranibizumab monotherapy. All patients initially received 3 monthly ranibizumab injections (loading phase) and additional injections pro re nata (PRN). Combination therapy patients additionally received navigated laser photocoagulation after the loading phase. Main outcome measures were mean number of injections after the loading phase and change in BCVA from baseline to month 12. Results Navigated laser combination therapy and ranibizumab monotherapy similarly improved mean BCVA letter score (+8.41 vs. +6.31 letters, p = 0.258). In the combination group significantly less injections were required after the 3 injection loading phase (0.88±1.23 vs. 3.88±2.32, p< = 0.001). By month 12, 84% of patients in the monotherapy group had required additional ranibizumab injections as compared to 35% in the combination group (p< = 0.001). Conclusions Navigated laser combination therapy demonstrated significant visual gains in most patients. Retreatment rate and number of injections were significantly lower compared to ranibizumab monotherapy and compared to the results of conventional laser combination therapy previously reported in pivotal anti-VEGF studies.
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Affiliation(s)
- Raffael Liegl
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Julian Langer
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Lukas Reznicek
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Michael W. Ulbig
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Anselm Kampik
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Marcus Kernt
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
- * E-mail:
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Keren S, Loewenstein A, Coscas G. Pathogenesis, prevention, diagnosis and management of retinal vein occlusion. World J Ophthalmol 2014; 4:92-112. [DOI: 10.5318/wjo.v4.i4.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/26/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Retinal vein occlusion (RVO) is the second vascular retinal cause of visual loss and defined by the occlusion of a retinal vein. It is divided into branch retinal vein occlusion or central retinal vein occlusion, depending on the location of occlusion. RVO has severe medical, financial and social implications on the patients. The diagnosis of the disease is easier nowadays with the use of spectral domain optical coherence tomography and fluorescein angiography. The treatment options for RVO have changed dramatically over the past few years with the introduction of the intravitreal injections of dexamethasone (Ozurdex), bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (EYLEA), along with the panretinal laser photocoagulation, abandoning former treatment modalities and surgical solution. This manuscript is a review of current literature about RVO with emphasize on the pathophysiology, risk factors and prevention, diagnosis and sub-group categorization and treatments including medical and surgical. Since no official guidelines are available for the treatment of RVO patients, and considering the latest developments in the treatment options, and the variety of follow-up and treatment modalities, this manuscript aims to provide tools and knowledge to guide the physician in treating RVO patients, based on the latest publications from the literature and on several of the patients characteristics.
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Kozak I, Luttrull JK. Modern retinal laser therapy. Saudi J Ophthalmol 2014; 29:137-46. [PMID: 25892934 PMCID: PMC4398802 DOI: 10.1016/j.sjopt.2014.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/03/2014] [Accepted: 09/07/2014] [Indexed: 12/29/2022] Open
Abstract
Medicinal lasers are a standard source of light to produce retinal tissue photocoagulation to treat retinovascular disease. The Diabetic Retinopathy Study and the Early Treatment Diabetic Retinopathy Study were large randomized clinical trials that have shown beneficial effect of retinal laser photocoagulation in diabetic retinopathy and have dictated the standard of care for decades. However, current treatment protocols undergo modifications. Types of lasers used in treatment of retinal diseases include argon, diode, dye and multicolor lasers, micropulse lasers and lasers for photodynamic therapy. Delivery systems include contact lens slit-lamp laser delivery, indirect ophthalmocope based laser photocoagulation and camera based navigated retinal photocoagulation with retinal eye-tracking. Selective targeted photocoagulation could be a future alternative to panretinal photocoagulation.
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Affiliation(s)
- Igor Kozak
- King Khaled Eye Specialist Hospital, Vitreoretinal Division, Riyadh, Saudi Arabia
| | - Jeffrey K Luttrull
- Private Retina Practice, 3160 Telegraph Road, Suite 230, Ventura, CA, USA
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Hoeh AE, Pollithy S, Dithmar S. Factors affecting laser power in retinal Navilas laser treatment. Graefes Arch Clin Exp Ophthalmol 2014; 253:849-54. [PMID: 25161075 DOI: 10.1007/s00417-014-2774-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 07/30/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the effect of patient-associated factors on the minimum laser power needed for a mild visible burn in focal laser treatments using the 532 nm Navilas laser system. METHODS We conducted a monocentric prospective pilot study of 58 eyes of 40 patients with diabetic macular edema. The following parameters were analysed: axial length, refraction, iris pigmentation, lens status, lens grading and densitometry, retinal and choroidal thickness and focus setting during treatment. Laser power was adjusted to produce mild, barely visible burns. Retinal laser burn size was measured 30 min after treatment. RESULTS Focus setting is significantly correlated with retinal lesion size (r = 0.50, p = 0.001) and laser power (r = 0.44, p < 0.001). Axial length only correlated with laser power when the effect of focus was controlled. Phakic eyes needed more laser power than pseudophakic eyes (78.3 versus 67.2 mW, p = 0.051). No correlation of laser power with any other factor could be found. CONCLUSIONS Among the examined parameters, focus setting had the strongest effect on the laser power needed to produce a mild visible burn. The association of focus with laser power can be explained by the focus-dependent change of retinal spot size. Lens status (phakic versus pseudophakic patients) seems to influence laser light transmission in the examined age group.
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Affiliation(s)
- Alexandra E Hoeh
- Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany,
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Kim MS, Lee SW, Kim JS. Comparison of the Time Required for Panretinal Photocoagulation and Associated Pain between Navilas® and Conventional Laser Therapy in Diabetic Retinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.8.1150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Seong Woo Lee
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Suk Kim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Jung JJ, Gallego-Pinazo1 R, Lleó-Pérez A, Huz JI, Barbazetto IA. NAVILAS Laser System Focal Laser Treatment for Diabetic Macular Edema - One Year Results of a Case Series. Open Ophthalmol J 2013; 7:48-53. [PMID: 24082979 PMCID: PMC3785058 DOI: 10.2174/1874364101307010048] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 07/08/2013] [Accepted: 07/22/2013] [Indexed: 11/22/2022] Open
Abstract
Purpose: To report one year outcomes of focal Navigated Retina Laser Therapy (NAVILAS) for diabetic macular edema (DME). Methods: Retrospective cohort series of 7 diabetic patients treated with NAVILAS focal laser. Statistical analysis included descriptive and continuous variables (Best-corrected logMAR Visual Acuity and time-domain optical coherence tomography (OCT) parameters) which were compared using a non-parametric procedure, the Friedman tests for repeated measures. A p-value of less than 0.05 was considered to denote statistical significance. Results: diabetic patients (4 male; 3 female) with an average age of 60.8 years (range 48-85 years) were included. All treated eyes were phakic; patients had an average hemoglobin A1C of 9.1 (range 7.8-11.7) at baseline and 8.0 (range 7.4-8.4) at 12 months. Six of the 7 patients had intravitreal bevacizumab injections prior to focal laser treatment with 1 patient having had more than 1 prior injection (total 3). At 12 months, median logMAR improved from 0.695 (± interquartile range 0.574) to 0.477 (± 0.573, p <0.001). OCT median central foveal thickness decreased from 248 (± 112) to 220 µm (± 41, p <0.001); total macular volume decreased from 7.84 (± 0.8) to 7.44 mm3 (± 0.7, p = 0.117); and largest macular subfield thickness decreased from 354 (± 116) to 289 µm (± 42, p <0.001). All patients were treated without complications. Conclusions: Focal NAVILAS showed to be safe and effective in treating DME with improvement in visual acuity and macular edema on OCT over 12 months in this case series. In clinical practice, combined treatment with focal laser including NAVILAS and anti-vascular endothelial growth factor may provide long-term improvement in DME.
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Affiliation(s)
- Jesse J Jung
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA ; Vitreous Retina Macular Consultants of New York, New York, NY, USA ; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA ; Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Chhablani J, Kozak I, Barteselli G, El-Emam S. A novel navigated laser system brings new efficacy to the treatment of retinovascular disorders. Oman J Ophthalmol 2013; 6:18-22. [PMID: 23772120 PMCID: PMC3678191 DOI: 10.4103/0974-620x.111898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The laser photocoagulation is now treatment of choice for various retinovascular disorders. Conventional slit-lamp based laser delivery systems have many limitations including, questionable accuracy, need of contact lens with local anesthesia, and inadvertent damage to fovea. Navigated laser system, a fundus camera based laser delivery system with computer based laser planning and laser treatment without contact lens achieves improved patient compliance, improved accuracy, and treatment ease for the physician, efficient panretinal photocoagulation pattern laser, excellent documentation, and advanced laser training. This article compares navigated laser systems with available conventional and PASCAL laser systems based on the literature and personal experience of the authors.
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Affiliation(s)
- Jay Chhablani
- Vitreo-retina Services, L. V. Prasad Eye Institute, Hyderabad, India
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Bandello F, Lattanzio R, Zucchiatti I, Del Turco C. Pathophysiology and treatment of diabetic retinopathy. Acta Diabetol 2013; 50:1-20. [PMID: 23277338 DOI: 10.1007/s00592-012-0449-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/11/2012] [Indexed: 01/07/2023]
Abstract
In the past years, the management of diabetic retinopathy (DR) relied primarily on a good systemic control of diabetes mellitus, and as soon as the severity of the vascular lesions required further treatment, laser photocoagulation or vitreoretinal surgery was done to the patient. Currently, even if the intensive metabolic control is still mandatory, a variety of different clinical strategies could be offered to the patient. The recent advances in understanding the complex pathophysiology of DR allowed the physician to identify many cell types involved in the pathogenesis of DR and thus to develop new treatment approaches. Vasoactive and proinflammatory molecules, such as vascular endothelial growth factor (VEGF), play a key role in this multifactorial disease. Current properly designed trials, evaluating agents targeting VEGF or other mediators, showed benefits in the management of DR, especially when metabolic control is lacking. Other agents, directing to the processes of vasopermeability and angiogenesis, are under investigations, giving more hope in the future management of this still sight-threatening disease.
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Affiliation(s)
- Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy.
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