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

Higaki, Masahiko; Nozaki, Miho; Yoshida, Munenori; Ogura, Yuichiro

doi:10.1155/2018/9371895

Cited by 12 publications

(13 citation statements)

References 28 publications

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“…Eventually, the lateral expansion of scars after argon laser treatment considerably exceeds the expansion of those applied with the PASCAL system. 27 Extended elimination of hypoxic tissue might contribute to better neovascularization regression. 28 However, laser energy not only spreads laterally but also vertically.…”

Section: Discussionmentioning

confidence: 99%

Retinal and Choroidal Perfusion Status in the Area of Laser Scars Assessed With Swept-Source Optical Coherence Tomography Angiography

Karst

Beiglboeck

Scharinger

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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Citation: Karst SG, Beiglboeck H, Scharinger R, et al. Retinal and choroidal perfusion status in the area of laser scars assessed with swept-source optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2019;60:4865-4871. https://doi.org/ 10.1167/iovs.19-27977PURPOSE. To evaluate the perfusion status of the retina and choriocapillaris in the area of laser scars on swept-source optical coherence tomography angiography (OCTA) images of eyes previously treated with panretinal photocoagulation (PRP). METHODS.Cross-sectional exploratory analysis of swept-source OCTA images, which were retrospectively reviewed for laser scars. The appearance of the capillary networks in the area of previous laser were evaluated following a three-step grading system (normal/sparse/ missing capillary network). The superficial and deep capillary plexus of the retina and the choriocapillaris were graded separately. RESULTS.A total of 3140 laser scars in 54 eyes of 31 patients (13 female, mean age 57 6 12 years) were included in this analysis. In the retina, 6.8% of the superficial and deep capillary network in the area evaluated appeared normal, 58% and 56% sparse, and 35% and 37% missing. Capillary dropout in the retina was not restricted to the area of prior laser treatment. The choriocapillaris decorrelation signal was either sparse (61%) or completely missing (38%) within the laser scar area. The perfusion of the choriocapillaris appeared normal in the area adjacent to laser scars.CONCLUSIONS. Capillary non-perfusion in the choriocapillaris was found within the laser scar area. Laser treatment seems to cause sustained non-perfusion of choriocapillaris in the area treated.

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Section: Discussionmentioning

confidence: 99%

Retinal and Choroidal Perfusion Status in the Area of Laser Scars Assessed With Swept-Source Optical Coherence Tomography Angiography

Karst

Beiglboeck

Scharinger

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…Higaki et al reported that the expansion rates of the laser lesion in short-pulse laser were significantly lower than those after conventional laser. [8] Our results showed a restoration of the choriocapillaris at 2 weeks, and the recovery continued with time and was almost normal appearing at 1 year in some lasered spots with our laser settings using OCTA. On the contrary, the outer retina and RPE were also disrupted in the lasered spots 1 year after the laser photocoagulation.…”

Section: Discussionmentioning

confidence: 52%

Changes in choriocapillaris and retinal morphology after laser photocoagulation by OCT angiography

Iwase

Ueno²,

Ra³

et al. 2018

Medicine

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Rationale:Earlier studies have shown that laser photocoagulation treatments are associated with good long-term visual acuity in most patients with severe nonproliferative diabetic retinopathy (S-NPDR). Histopathologic studies of autopsied eyes have demonstrated defects in the choriocapillaris beneath the retinal laser lesions secondary to photocoagulation for S-NPDR. These lesions have been observed to expand centrifugally over time especially in the posterior pole, and the atrophy of the retinal pigment epithelium (RPE) can be significantly enlarged. There are, however, limited studies detailing the in vivo changes that occur in the RPE and choriocapillaris following laser photocoagulation.Patient concerns:A 46-year-old woman presented with visual disturbances in both eyes.Diagnoses:Fundus examinations showed many retinal hemorrhages and soft exudates in the four quadrants due to S-NPDR.Interventions:Laser photocoagulations with a 532-nm wavelength argon laser with power of 170 to 230 mW and spot size of 200 μm were performed to treat the S-NPDR. The changes in the choriocapillaris and retinal vasculature were followed by optical coherence tomography (OCT) angiography.Outcomes:The choriocapillaris beneath the laser spots was disrupted from 1 hour following the photocoagulation but it was restored at week 2. The choriocapillaris appeared almost normal at some laser spots, but they were still some spots that were altered at 1 year. The outer retina and RPE were disrupted beneath the laser spots at 1 year. On the contrary, there were no visible retinal vascular changes in the superficial and deep plexuses of retinal vasculature determined by OCT angiography with manual and automated segmentation.Lessons:The choriocapillaris in human eyes can recover after laser photocoagulation although the outer retina and RPE remain disrupted and do not recover.

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“…For these reasons, RS was reduced after laser therapy using the conventional focal/grid laser. In contrast, the advantages of short-pulse laser include reduced RPE/outer retina damage and smaller lesion size due to the reduced spread of heat [ 16 , 18 , 34 , 35 ]. Decreased lesion size may also be attributed to the stable RS after laser treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, the patterned scanning laser has become popular as a less invasive laser therapy [ 11 ]. In addition, because tissue invasion depends on the time of laser exposure, the short-pulse laser method causes less thermal diffusion [ 16 , 17 ] as well as lowers the risk of damage to the outer retina and the lesion size [ 18 – 20 ]. Therefore, MAPC using short-pulse duration has several advantages for the treatment of the delicate macular area.…”

Section: Introductionmentioning

confidence: 99%

Microperimetric analysis of diabetic macular edema after navigated direct photocoagulation with short-pulse laser for microaneurysms

et al. 2023

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

Cited by 12 publications

References 28 publications

Retinal and Choroidal Perfusion Status in the Area of Laser Scars Assessed With Swept-Source Optical Coherence Tomography Angiography

Retinal and Choroidal Perfusion Status in the Area of Laser Scars Assessed With Swept-Source Optical Coherence Tomography Angiography

Changes in choriocapillaris and retinal morphology after laser photocoagulation by OCT angiography

Microperimetric analysis of diabetic macular edema after navigated direct photocoagulation with short-pulse laser for microaneurysms

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