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Ikegami Y, Shiraya T, Araki F, Ueta T, Toyama T, Yanagita T, Numaga J, Shoji N, Kato S. Microperimetric analysis of diabetic macular edema after navigated direct photocoagulation with short-pulse laser for microaneurysms. Int J Retina Vitreous 2023; 9:12. [PMID: 36864536 PMCID: PMC9979500 DOI: 10.1186/s40942-023-00447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Focal laser photocoagulation is an important treatment option for diabetic macular edema (DME). This study aimed to examine the retinal sensitivity (RS) and morphological changes at the coagulated site after direct photocoagulation of microaneurysms (MAs) in patients with DME using a navigated laser photocoagulator with a short-pulse duration of 30 ms. METHODS Images of early-phase fluorescein angiography were merged with images from the optical coherence tomography (OCT) map with 9 Early Treatment Diabetic Retinopathy Study grid circles, and MAs inside the edema area were selected for direct photocoagulation. The best-corrected visual acuity (BCVA), parameters of the OCT map including central retinal thickness and retinal thickness in edema range, central RS, and RS in the edema area were assessed at 1 and 3 months after the laser treatment. The RS points that overlapped with the laser spots were identified by merging the Navilas' digital treatment reports and the microperimetry images. RESULTS Seventeen eyes from 14 patients were studied. The mean retinal thickness in the edema range decreased at 3 months compared with pretreatment (P = 0.042), but the BCVA, central retinal thickness, central RS, and RS in the edema area remained unchanged. Overall, 32 of 400 sensitivity points overlapped with the laser-coagulated spots. The mean RS at these spots were 22.4 ± 5.3 dB at 1 month and 22.5 ± 4.8 dB at 3 months, with no significant change from the baseline of 22.7 ± 3.5 dB. CONCLUSIONS Retinal thickness improved in the coagulated edema area without a decrease in RS after direct photocoagulation of MAs with a short 30-ms pulse using Navilas. This promising therapeutic strategy for DME is effective and minimally invasive.
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Affiliation(s)
- Yasuko Ikegami
- Department of Ophthalmology, University of Kitasato School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan. .,Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. .,Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
| | - Tomoyasu Shiraya
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Fumiyuki Araki
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takashi Ueta
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Taku Toyama
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomohiko Yanagita
- grid.410786.c0000 0000 9206 2938Department of Ophthalmology, University of Kitasato School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa Japan
| | - Jiro Numaga
- grid.417092.9Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Nobuyuki Shoji
- grid.410786.c0000 0000 9206 2938Department of Ophthalmology, University of Kitasato School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa Japan
| | - Satoshi Kato
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Sangal K, Prasad M, Siegel NH, Chen X, Ness S, Subramanian ML. Focal Laser Photocoagulation for Central Serous Chorioretinopathy in Under-Represented Populations: A Retrospective Case Series. Case Rep Ophthalmol 2022; 13:991-998. [PMID: 36605045 PMCID: PMC9808303 DOI: 10.1159/000527439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
This case series examines visual and anatomic outcomes of focal laser photocoagulation in the treatment of central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) in under-represented populations. We reviewed records of 25 eyes with CSCR and SRF that underwent focal laser photocoagulation. Visual acuity (VA) and central macular thickness (CMT) were recorded prior to laser, after laser treatment, and at final follow-up and were all compared using Wilcox signed-rank tests after using Shapiro-Wilk tests to determine normality. The racial and ethnic breakdown of our cohort (n = 25) includes 64% Hispanic (n = 16), 20% black (n = 5), 12% Asian (n = 3), 4% other (n = 1). Patients were followed for a median of 15.5 months (range: 5.75-87 months) after treatment. The VA prior to laser compared to best-available VA significantly improved (p = 0.0003). Pre-laser CMT to post-laser CMT (p < 0.0001) and pre-laser CMT to final CMT (p < 0.0001) significantly improved. Excluding the one eye that developed a choroidal neovascular membrane, the pre-laser VA to final VA improved significantly (p = 0.0047) as well as the pre-laser CMT to final CMT (p < 0.0001). Of the 25 eyes, 4 had persistent SRF following laser, and of the 21 eyes with complete resolution of SRF, 2 developed recurrent SRF. Focal laser photocoagulation can significantly improve VA and CMT in CSCR with active SRF in patients who have been under-represented in prior clinical studies.
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Affiliation(s)
- Kajal Sangal
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Minali Prasad
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Nicole H Siegel
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Xuejing Chen
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Steven Ness
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Manju L Subramanian
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW This review highlights indications and evidence on laser therapy in the management of diabetic retinopathy and diabetic macular edema. Particular focus is placed upon the benefits and limitations of conventional laser photocoagulation versus more modern laser photocoagulation techniques, as well as the role of laser photocoagulation in treatment of diabetic retinopathy and diabetic macular edema with the frequent utilization of pharmacologic, including anti-vascular endothelial growth factor (VEGF), therapy. RECENT FINDINGS Laser photocoagulation remains the gold-standard therapy for the effective, definitive treatment of PDR, and also is highly effective in the management of DME. However, numerous recent studies have demonstrated the clinical efficacy and improved functional and anatomic outcomes of combination therapy with pharmacologic treatment. Continuing innovations in laser technology and improved understanding of laser-retinal interactions and pathophysiology demonstrate that laser therapy will continue to play a critical role in the treatment of diabetic retinopathy and diabetic macular edema for many years to come.
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Affiliation(s)
- Lesley A. Everett
- grid.214458.e0000000086837370Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - Yannis M. Paulus
- grid.214458.e0000000086837370Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105 USA
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Maltsev DS, Kulikov AN, Burnasheva MA, Kazak AA, Chhablani J. Efficacy of navigated focal laser photocoagulation in diabetic macular edema planned with en face optical coherence tomography versus fluorescein angiography. Int Ophthalmol 2020; 40:1913-21. [PMID: 32285237 DOI: 10.1007/s10792-020-01363-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Shin YI, Kim KM, Lee MW, Kim JY, Jo YJ. Long-term results of focal laser photocoagulation and photodynamic therapy for the treatment of central serous chorioretinopathy. Jpn J Ophthalmol 2019; 64:28-36. [PMID: 31863228 DOI: 10.1007/s10384-019-00697-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the long-term results of focal laser photocoagulation and photodynamic therapy (PDT) for treatment of central serous chorioretinopathy (CSC). STUDY DESIGN Retrospective chart review. METHODS Sixty-two patients with CSC, thirty-three of whom were treated with focal laser photocoagulation, and 29 with PDT and who were followed up for > 6 months, were enrolled. The focal laser was performed at sites of focal leakage (but not subfoveal leaks) shown in fluorescein angiography. PDT was performed at sites of subfoveal or juxtafoveal focal leakage or not definite focal leakages. Best corrected visual acuity (BCVA), central macular thickness (CMT), resolution of subretinal fluid (SRF) and recurrence were analyzed. RESULTS The follow-up duration of the focal laser group was 35.2 ± 22.6 and of the PDT group, 46.4 ± 21.5 months. Time to resolution of SRF was 1.8 ± 1.5 months for the focal laser group and 1.2 ± 0.5 months for the PDT group. SRF was rapidly absorbed in the PDT group. In both groups, the CMT was decreased 1 month after treatment. The BCVA improved significantly 1 month after treatment in the focal laser group and 3 months after treatment in the PDT group. However, there was no significant difference in CMT reduction and BCVA improvement between the two groups. It subsequently remained similar for up to 3 years. Ten patients (30.3%) in the focal laser group and three patients (10%) in the PDT group recurred during the follow-up period. CONCLUSIONS PDT showed early resolution of the SRF compared to focal laser. In CSC patients, both the CMT and BCVA remained stable for 3 years after treatment. After 3 or more years of follow-up, PDT showed a lower recurrence rate than focal laser.
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Affiliation(s)
- Yong-Il Shin
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Kyeung-Min Kim
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Young-Joon Jo
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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Demir G, Artunay Ö, Sucu ME, Demircan A, Yaşa D, Alagöz C, Öcal MC. Treatment of intravitreal bevacizumab combined with focal laser photocoagulation in the case of macular telangiectasia type 2 with retinal arterial macroaneurysm. Lasers Med Sci 2018; 34:427-430. [PMID: 30027424 DOI: 10.1007/s10103-018-2587-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 08/08/2017] [Indexed: 11/24/2022]
Abstract
Macular telangiectasia type 2 (Mac Tel 2) is a bilateral disease of unknown cause with characteristic changes of the retinal vasculature. To the best of our knowledge, we could not find any reported cases of Mac Tel 2 with retinal arterial macroaneurysm (RAM). Our aim is to report a case of Mac Tel 2 with RAM.
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Affiliation(s)
- Gökhan Demir
- Beyoglu Eye Training and Research Hospital, The University of Health Sciences, İstanbul, Turkey.
| | - Özgür Artunay
- Beyoglu Eye Training and Research Hospital, The University of Health Sciences, İstanbul, Turkey
| | - Mehmet Emin Sucu
- Beyoglu Eye Training and Research Hospital, The University of Health Sciences, İstanbul, Turkey
| | - Ali Demircan
- Beyoglu Eye Training and Research Hospital, The University of Health Sciences, İstanbul, Turkey
| | - Dilek Yaşa
- Beyoglu Eye Training and Research Hospital, The University of Health Sciences, İstanbul, Turkey
| | - Cengiz Alagöz
- Beyoglu Eye Training and Research Hospital, The University of Health Sciences, İstanbul, Turkey
| | - Mevlüt Celal Öcal
- Beyoglu Eye Training and Research Hospital, The University of Health Sciences, İstanbul, Turkey
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Demir G, Artunay Ö, Sucu ME, Demircan A, Yaşa D, Alagöz C, Öcal MC. Treatment of intravitreal bevacizumab combined with focal laser photocoagulation in the case of macular telangiectasia type 2 with retinal arterial macroaneurysm. Lasers Med Sci 2019; 34:235-8. [PMID: 29804166 DOI: 10.1007/s10103-018-2548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/21/2018] [Indexed: 10/16/2022]
Abstract
Macular telangiectasia type 2 (Mac Tel 2) is a bilateral disease of unknown cause with characteristic changes of the retinal vasculature. To the best of our knowledge, we could not find any reported cases of Mac Tel 2 with retinal arterial macroaneurysm (RAM). Our aim is to report a case of Mac Tel 2 with RAM.
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Eriş E, Perente İ, Vural E, Yaşa D, Ozkaya A. Assessment of focal laser photocoagulations' early effect on polypoidal choroidal vasculopathy with optical coherence tomography angiography. Lasers Med Sci 2018; 33:1833-1835. [PMID: 29497888 DOI: 10.1007/s10103-018-2463-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/01/2018] [Indexed: 11/29/2022]
Abstract
Polypoidal choroidal vasculopathy (PCV) is seen with polypoidal lesions and branching vascular networks (BVNs) (Spaide et al. in Retina 15(2):100-110, 1995; Yannuzzi et al. in Retina 10(1):1-8, 1990). There are reports about laser photocoagulation for PCV (Yuzawa et al. in Japan J Ophthalmol 47(4):379-384, 2003; Lee et al. in Eye 23(1):145-148, 2009); however, all these reports are about final vision and frequent relapses. Therefore, this treatment merits rigorous scrutiny using optical coherence tomography angiography (OCTA).
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Affiliation(s)
- Erdem Eriş
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. .,, Istanbul, Turkey.
| | - İrfan Perente
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Esra Vural
- Mardin Governement Hospital, Mardin, Turkey
| | - Dilek Yaşa
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Ozkaya
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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