Functionally Guided Retinal Protective Therapy for Dry Age-Related Macular and Inherited Retinal Degenerations: A Pilot Study

Luttrull, Jeffrey K.; Margolis, Benjamin W. L.

doi:10.1167/iovs.15-18163

Cited by 45 publications

(98 citation statements)

References 32 publications

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“…Hence, SMPL is less harmful than continuous wave lasers because, since the pulses are very short, heat can be dissipated within tissue. For the low-intensity/ high-density 810 diode laser treatment employed in the current study, prior clinical studies have shown the absence of retinal damage (Luttrull et al 2005(Luttrull et al , 2012Luttrull & Sinclair 2014;Luttrull 2016a;Luttrull & Margolis 2016b), and improvement of visual function and electrophysiology (Luttrull 2016a(Luttrull , 2018aLuttrull et al 2018b). The socalled high-density treatment (by delivering continuous spots on the retina) has been demonstrated to be more effective than the treatment with space among spots, thus with lower number (Lavinsky et al 2011).…”

Section: Discussionmentioning

confidence: 68%

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The subthreshold micropulse laser treatment of the retina restores the oxidant/antioxidant balance and counteracts programmed forms of cell death in the mice eyes

Cillà

Vezzola

Farruggio

et al. 2018

Acta Ophthalmologica

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Purpose Subthreshold micropulse laser (SMPL) has been increasingly used for the treatment of different retinal and choroidal macular disorders. However, the exact mechanisms of action have not yet been clearly defined. Therefore, we aimed to examine the role of SMPL treatment in the modulation of oxidant/antioxidant systems, apoptosis and autophagy in the mice eyes. Methods A specific laser contact lens for retina was positioned on the cornea of 40 mice (20 young and 20 old) in order to focus the laser on the eye fundus for SMPL treatment. Within 6 months, 20 animals received one treatment only, whereas the others were treated three times. Eye specimens underwent histological analysis and were used for thiobarbituric acid reactive substances (TBARS) and glutathione (GSH) quantification, as well as for the superoxide dismutase 1 (SOD1) and the selenoprotein thioredoxin reductase 1 (TrxR1) expression evaluation. Western blot was performed for nitric oxide synthase (NOS) subtypes detection and to examine changes in apoptotic/autophagy proteins expression. Results SMPL treatment reduced TBARS and increased GSH and SOD1 in the mice eyes. It also reduced cytochrome c, caspase 3 expression and activity and cleaved caspase 9, and increased Beclin 1, p62 and LC3β. The effects were more relevant in the elderly animals. Conclusion Our results showed that SMPL therapy restored the oxidant/antioxidant balance within retinal layers and modulated programmed forms of cell death. Further studies may confirm these data and could evaluate their relevance in clinical practice.

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Section: Discussionmentioning

confidence: 68%

“…For the low‐intensity/high‐density 810 diode laser treatment employed in the current study, prior clinical studies have shown the absence of retinal damage (Luttrull et al. , ; Luttrull & Sinclair ; Luttrull ; Luttrull & Margolis ), and improvement of visual function and electrophysiology (Luttrull , ; Luttrull et al. ).…”

Section: Discussionmentioning

confidence: 75%

The subthreshold micropulse laser treatment of the retina restores the oxidant/antioxidant balance and counteracts programmed forms of cell death in the mice eyes

Cillà

Vezzola

Farruggio

et al. 2018

Acta Ophthalmologica

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“…We also calculated Arrhenius values for 810-nm treatments, where no titration is done, and tabulated the results in Table 5. Assuming the patient's optical characteristics match model parameters in Table 2, treatment using laser settings from Luttrull et al 7 yields X within the expected range for nondamaging treatment, but two other settings 44,45 produce Arrhenius values below X HSP ¼ 0.3. In addition, without titration, variations in pigmentation and transparency could produce widely varying results in different patients.…”

Section: Comparison Of the Model To Clinical Settingsmentioning

confidence: 98%

Comparison of Continuous-Wave and Micropulse Modulation in Retinal Laser Therapy

Wang

Quan

Dalal

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…Most recently, subthreshold micropulse diode has been considered as an invisible retinal therapy that has no discernible morphological effect on either the RPE or the sensory retina. However, it has been shown to induce heat shock protein and to provide some electrophysiological enhancement of retinal ganglion cell function in individuals with dry age‐related macular degeneration (ARMD) …”

Section: Review Of Clinical‐based Studiesmentioning

confidence: 99%

Short‐pulse duration retinal lasers: a review

Chidlow

Wood

Casson

2016

Clinical Exper Ophthalmology

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The development of lasers for biological use was an important medical advance in the 20th century with numerous evidence-based therapeutic applications to retinal disease, including capillary leakage at the macula. Although the role of photocoagulative laser in the treatment of macular oedema has diminished, there is evidence for a modified role in clinical management, particularly for extrafoveal leakage. Additionally, it may reduce the frequency of required intravitreal injections and assist in visual stabilization when used as an adjunct. The tissue destructive effect of photocoagulative lasers has motivated the development of safer macular lasers and the search for novel therapeutic applications, including treatment of drusen and regeneration of dysfunctional retinal pigment epithelium.Key words: laser, nanosecond, photocoagulation, retina, subthreshold diode micropulse. BRIEF HISTORY OF RETINAL LASERIn 1947, Meyer-Schwickerath developed the first retinal photocoagulator. He was inspired by noting a medical student's macular injury caused by unprotected viewing of the 1945 northern latitudes solar eclipse, and his photocoagulator created retinal burns by focussing sunlight on the retina. Originally, this was achieved by bringing the patient to the roof of the hospital and focussing the early morning sun with a series of mirrors and lenses. A few years later, he trialled a carbon arc photocoagulator on human subjects. In 1956, with assistance from Zeiss (Oberkochen, Germany), the first xenon-arc lamp photocoagulator was assembled to treat anterior and posterior tumours as well as retinal vascular diseases. The development of lasers was a landmark technological breakthrough and was soon utilized to treat the retina. The original ruby laser was later followed by the introduction of argon and krypton lasers and the development of continuous wave 488-nm/515-nm (blue-green) lasers. Since the Diabetic Retinopathy Study 2 and the Early Treatment of Diabetic Retinopathy Study (ETDRS), 3,4 retinal photocoagulation has been a routine clinical tool for the treatment of diabetic neovascularization and macula oedema. It has been the principle tool to inhibit neovascularization associated with other ischemic retinopathies 5,6 and to treat macular oedema associated with branch retinal vein occlusion.6 However, the advent of anti-vascular endothelial growth factor (anti-VEGF) therapy was a game changer, and the role of laser in clinical practice, particularly its therapeutic role in macular oedema, has undergone significant changes. RETINAL LASER IN THE ANTI-VEGF ERAThe clinically beneficial effects of laser principally pertain to reduction of macular oedema, inhibition of angiogenesis and creation of a chorioretinal scar. Explanations for the efficacy of laser in the treatment of retinal angiogenesis (which generally involves pan-retinal photocoagulation with higher energy settings than macular laser) include simple destruction of retinal tissue leading to reduced VEGF 'load' and reduced retinal oxygen demands and t...

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Functionally Guided Retinal Protective Therapy for Dry Age-Related Macular and Inherited Retinal Degenerations: A Pilot Study

Abstract: Our findings suggest a role for SDM as retinal protective therapy in chronic progressive retinal diseases. Pattern electroretinography enables (early, preventive) functionally guided, rather than (late, therapeutic) image-guided, disease management.

Cited by 45 publications

References 32 publications

The subthreshold micropulse laser treatment of the retina restores the oxidant/antioxidant balance and counteracts programmed forms of cell death in the mice eyes

The subthreshold micropulse laser treatment of the retina restores the oxidant/antioxidant balance and counteracts programmed forms of cell death in the mice eyes

Comparison of Continuous-Wave and Micropulse Modulation in Retinal Laser Therapy

Short‐pulse duration retinal lasers: a review

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