LASER RESENSITIZATION OF MEDICALLY UNRESPONSIVE NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Efficacy and Implications.

PURPOSE: Drug tolerance is the most common cause of treatment failure in neovascular age-related macular degeneration. "Low-intensity/high-density" subthreshold diode micropulse laser (SDM) has been reported effective for a number of retinal disorders without adverse effects. It has been proposed that SDM normalizes retinal pigment epithelial function. On this basis, it has been postulated that SDM treatment might restore responsiveness to anti-vascular endothelial growth factor drugs in drug-tolerant eyes. METHODS: Subthreshold diode micropulse laser treatment was performed in consecutive eyes unresponsive to all anti-vascular endothelial growth factor drugs, including at least three consecutive ineffective aflibercept injections. Monthly aflibercept was resumed 1 month after SDM treatment. RESULTS: Thirteen eyes of 12 patients, aged 73 to 97 years (average, 84 years), receiving 16 to 67 (average, 34) anti-vascular endothelial growth factor injections before SDM treatment were included and followed for 3 months to 7 months (average, 5 months) after SDM treatment. After SDM treatment and resumption of aflibercept, 92% (12 of 13) of eyes improved, with complete resolution of macular exudation in 69% (9 of 13). Visual acuity remained unchanged. Central and maximum macular thicknesses significantly improved. CONCLUSION: Subthreshold diode micropulse laser treatment restored drug response in drug-tolerant eyes with neovascular age-related macular degeneration. Based on these findings, a theory of SDM action is proposed, suggesting a wider role for SDM as retinal reparative/protective therapy.

Associative return electron transfer. A bond-coupled electron transfer in the photoreactions of cyclopropylamines.

The dynamics of the geminate radical-ion pairs formed by electron transfer to the excited states of cyanoanthracenes from 2-phenylcyclopropylamines are dominated by exothermic bond cleavage of the amine radical cations. Quantitative studies of product formation as a function of the energetics of the photochemical and corresponding thermal reactions provide support for a novel mechanism in which return electron transfer in the geminate pair occurs in concert with bond formation from the ring-opened radical cations. This bond-coupled electron transfer process is referred to as an associative return electron transfer reaction. The important features of the associative electron transfer process that explain the experimental observations are described in terms of potential energy surfaces and competition between adiabatic and non-adiabatic deactivation paths.