Selective retina therapy (SRT) for clinically significant diabetic macular edema.

PURPOSE: To test selective retina therapy (SRT) as a treatment of clinically significant diabetic macular edema (DME). METHODS: Prospective two-center interventional uncontrolled phase II pilot study. Thirty-nine eyes of 39 patients with previously untreated non-ischemic DME were treated with focal laser treatment using a Q-switched frequency doubled Nd:YLF laser which selectively affects the retinal pigment epithelium while sparing the photoreceptor layer. Optoacoustic measurements, fundus fluorescein angiography (FFA), and funduscopy were used to determine the individual threshold of RPE damage of each patient. The pulse energy was adjusted to apply angiographically visible but funduscopically invisible effects. Optoacoustic measurements were correlated with funduscopy and FFA. Follow-up examinations at 3 and 6 months post-treatment included best-corrected ETDRS visual acuity (BCVA), FFA, fundus photography, and retinal thickness measured by optical coherence tomography. The primary outcome measure was change of BCVA. Other outcome measures were change of retinal thickness, presence of hard exudates, leakage in FFA, accuracy of optoacoustic measurements, and correlation of BCVA with change of anatomical and systemic parameters. RESULTS: Mean BCVA improved from 43.7 letters (standard deviation, SD=9.1) at baseline to 46.1 letters (SD=10.5) at the 6-month follow-up (p=0.02). BCVA improved (>5 letters) or remained stable (+/-5 letters) in 84% of eyes. Thirteen percent of eyes improved by > or =10 letters, while 16% of eyes lost more than 5 letters. There was no severe loss of vision (> or =15 letters). Overall, retinal thickness, hard exudates, and leakage in FFA did not change significantly (p> 0.05), while improvement of BCVA correlated with a reduction of hard exudates (p=0.01) and central retinal thickness (p=0.01). Specificity and sensitivity of detecting the angiographic visible threshold of RPE damage by optoacoustic measurements were 86% and 70% respectively. No adverse effects or pain were noted during or after treatment. Conclusions Functional and anatomical improvement or stabilization was observed in most patients. SRT appears to be safe. Optoacoustic measurements accurately detect the individual threshold of RPE damage. A randomized trial is required to further test efficacy and safety of SRT as a treatment of clinically significant diabetic macular edema (DME).

Selective retina therapy (SRT) of chronic subfoveal fluid after surgery of rhegmatogenous retinal detachment: three case reports.

BACKGROUND: Shallow subfoveal fluid accumulation after successful surgery for retinal detachment can be the reason for compromised visual acuity. To date, therapeutical options to tackle this problem have not been established. Selective retina therapy (SRT) is a new laser technology that uses a train of mus-laser pulses to selectively damage retinal pigment epithelial (RPE) cells while sparing retinal structures. METHODS: We treated three patients with chronic subfoveal fluid accumulation after retinal detachment surgery. The median period between retinal surgery and SRT treatment was 7 months. For SRT, we used a prototype frequency-doubled, Q-switched Nd:YLF laser (lambda = 527 nm). Each laser exposition contained 30 pulses (t = 1,7 micros, 100 Hz, E = 100-400 microJ). Two of the three patients were treated subfoveally. OCT III (optical coherence tomography) examinations were performed to evaluate changes in subretinal fluid accumulation. RESULTS: In all three patients, we observed complete resolution of subfoveal fluid within 1-5 months. Follow-up has been 16 months to 2 years. Visual acuity improved in all patients. In one patient, cystoid macular edema developed 3 months after treatment. Additional SRT treatments were not necessary. CONCLUSION: SRT is a safe treatment. Visual acuity improved after SRT, even in subfoveal irradiations. SRT is an option to support subretinal fluid reabsorption. In this situation where no other therapeutical options are established, SRT may be a beneficial treatment for chronic subfoveal fluid accumulation after retinal detachment surgery.

Autologous retinal pigment epithelium-choroid sheet transplantation in age related macular degeneration: morphological and functional results.

OBJECTIVE: To evaluate the outcome of autologous retinal pigment epithelium (RPE)-choroid sheet transplantation after removal of a subfoveal choroidal neovascularisation (CNV) in patients with age related macular degeneration (AMD). METHODS: RPE-choroid sheet transplantation was performed in 10 consecutive patients with exudative AMD (n = 9) or geographic atrophy (n = 1). After CNV extraction, an autologous RPE-choroid patch was translocated from the midperiphery under the macula. Follow-up was between 6 and 12 months. Visual acuity testing and microperimetry (Nidek-MP1) as well as autofluorescence, fluorescein and indocyanine green (ICG) angiography were performed and the data were analysed retrospectively. RESULTS: Visual acuity (logarithm of minimum angel of resolution) before operation ranged from 0.7 to 1.8 (mean 1.37) and after operation from 0.4 to 1.6 (mean 1.24). Visual acuity after operation improved in seven patients (by a mean of 0.26), remained stable in one patient and decreased in two patients. Microperimetry showed light sensitivity and fixation on the sheet in five cases. ICG angiography demonstrated perfusion through the RPE-choroid graft in nine patients. Postoperative complications included retinal detachment (n = 1) and epiretinal membrane formation (n = 2). The patient with geographic atrophy developed a CNV after surgery. CONCLUSIONS: Autologous RPE-choroid sheet transplantation is feasible and a comparatively safe procedure. Microperimetry showed fixation and light perception over the graft with a moderate increase in mean visual acuity.