Tissue response of selective retina therapy by means of a feedback‐controlled energy ramping mode

Park, Young-Gun; Seifert, Eric; Roh, Yong Kyun; Theisen-Kunde, Dirk; Kang, Seungbum; Brinkmann, Ralf

doi:10.1111/ceo.12342

Cited by 33 publications

(35 citation statements)

References 40 publications

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“…These results support the safety of SRT for the neural retina and selectivity for the RPE, and are consistent with the outcomes from previous studies on the safety of SRT. 12,14,18,31 Several studies have confirmed the safety of SRT. Park et al 18 showed that the structures of photoreceptors were preserved and that RPE was disrupted in rabbit eyes after SRT using optical coherence tomography (OCT).…”

Section: Discussionmentioning

confidence: 95%

“…12,14,18,31 Several studies have confirmed the safety of SRT. Park et al 18 showed that the structures of photoreceptors were preserved and that RPE was disrupted in rabbit eyes after SRT using optical coherence tomography (OCT). Framme et al 31 also used OCT to show the selectivity of SRT for RPE in humans.…”

Section: Discussionmentioning

confidence: 95%

“…If the reflectometry detected microbubbles and the value exceeded a certain threshold, the laser pulse train was ended automatically by a feedback system. 17,18 The laser energy at a certain threshold could be considered the energy that induces selective RPE damage. 11,12,18 Continuous-wave laser PC was performed with the slit-lamp delivery system of a PASCAL Streamline system (Topcon Medical Laser Systems, Inc., Santa Clara, CA, USA), a frequency-doubled Nd:YAG laser with a wavelength of 532 nm.…”

Section: Laser Irradiationmentioning

confidence: 99%

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Retinal Pigment Epithelium Responses to Selective Retina Therapy in Mouse Eyes

Kim

Jang

Lee

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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Citation: Kim HD, Jang SY, Lee SH, et al. Retinal pigment epithelium responses to selective retina therapy in mouse eyes. Invest Ophthalmol Vis Sci. 2016;57:3486-3495. DOI:10.1167/iovs.16-19508 PURPOSE. To investigate the characteristics of retinal pigment epithelium (RPE) and retinal damage induced by selective retina therapy (SRT) in mice, and to elucidate longitudinal changes in RPE cells.METHODS. C57BL/6J mice received SRT and continuous-wave laser photocoagulation (cwPC). The cell death pattern was evaluated using TUNEL assay, and proliferative potential of the RPE cells was evaluated using 5-ethynyl-2 0 -dexoyuridine (EdU) assay. To investigate the cell-cell integrity of RPE cells, b-catenin staining was performed. The number and hexagonality of RPE cells in the SRT-treated area were estimated using a Voronoi diagram with time periods of 3 hours to 14 days. Antibodies to microphthalmia-associated transcription factor (MiTF) and orthodenticle homeobox 2 (Otx2) were used to confirm the specific characteristics of RPE cells in the SRT-treated area.RESULTS. The number of TUNEL-positive cells located in the neural retina was significantly lower in lesions treated with SRT compared to those treated with cwPC. EdU-positive RPE cells were first detected 3 to 12 hours after SRT, and increased until 3 to 7 days after SRT. bcatenin staining showed that hexagonality was compromised and subsequently, RPE cells expanded in size within the targeted location. The number of RPE cells in SRT lesions decreased gradually until 12 hours after SRT and recovered by 14 days. Upregulated expression of MiTF and Otx2 was observed for 2 weeks in the SRT lesions.CONCLUSIONS. Selective retina therapy seems to induce selective RPE damage without collateral thermal injury in the neural retina. Furthermore, SRT-treated lesions recovered by proliferation of RPE cells that were present in the treated lesions and by expansion of adjacent RPE cells.Keywords: microphthalmia-associated transcription factor (MiTF), orthodenticle homeobox 2 (Otx2), retinal pigment epithelium, selective retina therapy L aser photocoagulation is a mainstay for the treatment of several retinal conditions associated with retinal pigment epithelium (RPE) dysfunction. 1-4 Continuous-wave laser photocoagulation (cwPC) has been used in the treatment of various macular diseases, such as diabetic macular edema (DME), agerelated macular degeneration, and central serous chorioretinopathy (CSC), over several decades.2-4 Light energy from cwPC is converted into heat in the melanosomes of RPE cells. By heat diffusion, this thermal energy not only damages the RPE but also results in collateral damage of surrounding components, particularly overlying photoreceptors, Bruch's membrane, and choriocapillaries. [5][6][7][8] This is a desired effect because it induces scar formation, which prevents further retinal detachment in retinal holes, and damages photoreceptors during panretinal photocoagulation, which is thought to preserve the central macula in diabetic retinopathy. Howev...

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Section: Laser Irradiationmentioning

confidence: 99%

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Retinal Pigment Epithelium Responses to Selective Retina Therapy in Mouse Eyes

Kim

Jang

Lee

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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“…Compared with CW laser therapy, RPE-targeting lasers such as SDM, retinal rejuvenation therapy (2RT), and selective retina therapy (SRT) can cause less damage to the neural retina in DME using a short pulse duration like a microsecond or even a nanosecond [51–56]. Although the mechanism of SDM remains unknown, the laser may induce changes of cytokines in RPE and activate heat shock protein expression [13, 57].…”

Section: Current Preventive Trends In Treating Progression Of Drmentioning

confidence: 99%

New Diagnostic and Therapeutic Approaches for Preventing the Progression of Diabetic Retinopathy

Park

Roh

2016

Journal of Diabetes Research

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Diabetic retinopathy (DR) is a severe sight-threatening complication of diabetes mellitus. Retinal laser photocoagulation, antivascular endothelial growth factors, steroid therapy, and pars plana vitrectomy are now used extensively to treat advanced stages of diabetic retinopathy. Currently, diagnostic devices like ultrawide field fundus fluorescein angiography and the improvement of optical coherence tomography have provided quicker and more precise diagnosis of early diabetic retinopathy. Thus, treatment protocols have been modified accordingly. Various types of lasers, including the subthreshold micropulse laser and RPE-targeting laser, and selective targeted photocoagulation may be future alternatives to conventional retinal photocoagulation, with fewer complications. The new developed intravitreal medications and implants have provided more therapeutic options, with promising results.

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“…Recently, an alternative SRT approach has been developed based on a rapidly scanning continuous wave laser, such that RPE cells are exposed to a scanning laser light to achieve dwell times of a few microseconds [40,41] . This technique has been further refined using an automatic, energy ramping, non-contact, reflectometric dosimetry technique [42] . Several small clinical studies have demonstrated the efficacy of SRT in diabetic retinopathy, diabetic macular edema, central serous chorioretinopathy, and subfoveal fluid after a rhegmatogenous retinal detachment [43][44][45][46] .…”

Section: Paulus Ym Retinal Lasersmentioning

confidence: 99%