Panretinal Photocoagulation Using Short-Pulse Laser Induces Less Inflammation and Macular Thickening in Patients with Diabetic Retinopathy

Takamura, Yoshihiro; Arimura, Shogo; Miyake, Seiji; Matsumura, Takeshi; Gozawa, Makoto; Iwasaki, Kentaro; Inatani, Masaru

doi:10.1155/2017/8530261

Cited by 16 publications

(14 citation statements)

References 32 publications

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“…The degree of pain for the patient and the expansion of the coagulation zone were also reduced compared to those in the conventional laser. In addition, it has been reported that the amount of inflammatory cytokines induced following its treatment was lower than that of the conventional methods [77]. Finally, the operation time could be shortened, a significant point during the surgery [78,79].…”

Section: Treatment For Drmentioning

confidence: 99%

Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy

Tomita

Lee

Ohta³

et al. 2021

JCM

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Diabetic retinopathy (DR) is a complication of diabetes and one of the leading causes of vision loss worldwide. Despite extensive efforts to reduce visual impairment, the prevalence of DR is still increasing. The initial pathophysiology of DR includes damage to vascular endothelial cells and loss of pericytes. Ensuing hypoxic responses trigger the expression of vascular endothelial growth factor (VEGF) and other pro-angiogenic factors. At present, the most effective treatment for DR and diabetic macular edema (DME) is the control of blood glucose levels. More advanced cases require laser, anti-VEGF therapy, steroid, and vitrectomy. Pan-retinal photocoagulation for non-proliferative diabetic retinopathy (NPDR) is well established and has demonstrated promising outcomes for preventing the progressive stage of DR. Furthermore, the efficacy of laser therapies such as grid and subthreshold diode laser micropulse photocoagulation (SDM) for DME has been reported. Vitrectomy has been performed for vitreous hemorrhage and tractional retinal detachment for patients with PDR. In addition, anti-VEGF treatment has been widely used for DME, and recently its potential to prevent the progression of PDR has been remarked. Even with these treatments, many patients with DR lose their vision and suffer from potential side effects. Thus, we need alternative treatments to address these limitations. In recent years, the relationship between DR, lipid metabolism, and inflammation has been featured. Research in diabetic animal models points to peroxisome proliferator-activated receptor alpha (PPARα) activation in cellular metabolism and inflammation by oral fenofibrate and/or pemafibrate as a promising target for DR. In this paper, we review the status of existing therapies, summarize PPARα activation therapies for DR, and discuss their potentials as promising DR treatments.

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Section: Treatment For Drmentioning

confidence: 99%

Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy

Tomita

Lee

Ohta³

et al. 2021

JCM

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“…Recently, short-pulse pattern scan laser system (PASCAL® Streamline, Topcon Medical Laser systems, Santa Clara, CA, USA) has been developed [ 6 , 7 ], and it is known that short-pulse laser treatment is quicker, generates less heat, and is less painful to eyes than the conventional laser treatment [ 6 ]. Moreover, some reports indicate that short-pulse laser treatment induces less inflammation, fewer inflammatory cytokines in the sensory retina, and less macular thickening in patients with diabetic retinopathy than the conventional pulse duration [ 2 – 4 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Less Expansion of Short-Pulse Laser Scars in Panretinal Photocoagulation for Diabetic Retinopathy

Higaki

Nozaki

Yoshida

et al. 2018

Journal of Ophthalmology

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Purpose To compare the expansion rates of laser photocoagulation scars between the conventional laser and short-pulse laser using fundus autofluorescence (FAF). Methods Retrospective chart review. Conventional laser was performed on 6 eyes of 6 patients, and short-pulse laser was performed on 11 eyes of 8 patients with diabetic retinopathy. FAF images were obtained by Optos® 200Tx (Optos, Dunfermline, Scotland, UK) at 1, 3, 6, and 12 months after treatment. The average area of 20 photocoagulation scars was measured by using ImageJ software. The expansion rates were calculated from the proportion of the averaged area against the optic disc area. Regression of retinopathy and central macular thickness were also evaluated. Results The expansion rates of the conventional laser scars compared with the size at 1 month after treatment were 1.12 ± 0.08 (3 M), 1.27 ± 0.12 (6 M), and 1.39 ± 0.11 (12 M). The expansion rates of the short-pulse laser scars were 1.04 ± 0.05 (3 M), 1.09 ± 0.04 (6 M), and 1.13 ± 0.05 (12 M). The expansion rates of the short-pulse laser were significantly lower than those of the conventional laser (p < 0.01). Conclusion FAF images were useful to evaluate the changes in the photocoagulation scar sizes. The scars with the short-pulse laser showed lower expansion rates than those of the conventional laser.

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“…However, laser photocoagulation may be an important factor in the postoperative anterior inflammation. 11 18 19 Actually, our data showed that there was a positive correlation between the number of laser shots and AFI in the VIT group. In contrast, this significant relationship was not observed in the IVTA+VIT group, which indicated that IVTA potentially could inhibit inflammation after surgery even if the number of laser spots was relatively greater.…”

Section: Discussionmentioning

confidence: 56%

Effect of intravitreal triamcinolone acetonide injection at the end of vitrectomy for vitreous haemorrhage related to proliferative diabetic retinopathy

et al. 2018

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Background/AimsTo investigate whether intravitreal injection of triamcinolone acetonide (IVTA) combined with vitrectomy prevents postoperative inflammation in patients with vitreous haemorrhage (VH) due to proliferative diabetic retinopathy (PDR).MethodsThis prospective, multicentre, randomised study conducted at seven sites in Japan enrolled patients diagnosed as having VH following PDR. Patients underwent vitrectomy with (IVTA+VIT group) or without (VIT group) IVTA at the end of the surgery. Anterior flare intensity (AFI), central retinal thickness (CRT), best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured before and at 3 days, 1 week, 1, 3 and 6 months after surgery and compared.ResultsNumber of patients who completed 6 months of follow-up was 40 and 41 in VIT group and IVTA+VIT group, respectively. AFI was significantly higher in the VIT group than in the IVTA+VIT group at 3 days (P=0.033), 1 week (P=0.019) and 1 month (P=0.037). There were no significant differences in CRT, BCVA and IOP between the groups through the observational periods. In the cases with macular oedema >350 µm of CRT at 3 days, CRT was significantly lower in the IVTA+VIT group than in the VIT group at 1 month (P=0.041).ConclusionsIVTA combined with vitrectomy and cataract surgery contributed to inhibit the postoperative inflammation in patients with VH due to PDR. The effect of IVTA in the reduction of diabetic macular oedema may be limited to the early stage after surgery.Trial registration numberUMIN000020376, Post-results.

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Panretinal Photocoagulation Using Short-Pulse Laser Induces Less Inflammation and Macular Thickening in Patients with Diabetic Retinopathy

Cited by 16 publications

References 32 publications

Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy

Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy

Less Expansion of Short-Pulse Laser Scars in Panretinal Photocoagulation for Diabetic Retinopathy

Effect of intravitreal triamcinolone acetonide injection at the end of vitrectomy for vitreous haemorrhage related to proliferative diabetic retinopathy

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