Photocoagulation Up to Ora Serrata in Diabetic Vitrectomy to Prevent Recurrent Vitreous Hemorrhage.

PURPOSE: To evaluate the role of performing photocoagulation up to ora serrata during vitrectomy in preventing recurrent vitreous hemorrhage (VH) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: This retrospective, nonrandomized study included 60 eyes from 60 patients who had undergone PPV for VH due to PDR. These patients were divided into two groups: group 1, those who underwent photocoagulation up to ora serrata using the scleral indentation technique during surgery; and group 2, those who did not undergo scleral indentation when photocoagulation and underwent photocoagulation up to vortex veins. Their hospital records were analyzed to investigate the recurrence rate of VH, the time until recurrence of VH after surgery, logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) measured before surgery and at 1, 2, and 3 years after surgery, and the occurrence of complications such as neovascular glaucoma (NVG) during follow-up. RESULTS: Group 1 exhibited lower recurrence rate of VH (2 of 30 [6.7%] vs. 10 of 30 [33.3%], p = 0.01) and lower occurrence of postoperative NVG (2 of 30 [6.7%] vs. 8 of 30 [26.7%], p = 0.038) compared with group 2. There were no statistically significant differences in logMAR BCVA measured at 1, 2, and 3 years between the two groups (at 1 year: 0.54 ± 0.43 vs. 0.54 ± 0.44, p = 0.954; at 2 years: 0.48 ± 0.47 vs. 0.55 ± 0.64, p = 0.235; at 3 years: 0.51 ± 0.50 vs. 0.61 ± 0.77, p = 0.200). Logistic regression analysis showed that among several factors that could affect recurrence rate of VH, only range of photocoagulation performed was a statistically significant factor (odds ratio, 0.119; 95% confidence interval, 0.022-0.659; p = 0.015). CONCLUSIONS: Photocoagulation treatment over a wider range with scleral indentation could be a beneficial adjunct procedure for preventing postoperative recurrent VH following diabetic vitrectomy.

Photocoagulation with GREENLIGHT© laser in radiation-induced haemorrhagic cystitis: Results of a single-center series.

INTRODUCTION: Radiation-induced haemorrhagic cystitis (RIHC) is one complication of the pelvic radiotherapy. The GREENLIGHT© laser (GL) has been barely studied in the treatment of radiation cystitis. The primary objective was to evaluate the efficacy of GL in refractory RIHC patients (RRC) in a single-centre series. MATERIALS AND METHODS: Twenty-nine patients were treated by GL bladder photocoagulation (GLBP). These patients showed signs of refractory haematuria in the context of RIHC. The primary endpoint was the absence of haematuria that would require a subsequent surgical intervention. Secondary endpoints were postoperative hospitalization length of stay, the occurrence of complications according to the Clavien-Dindo classification, the occurrence of functional urinary disorders and the number of cystectomies. RESULTS: After a median follow-up of 30 months, 24 (82.7%) patients had no recurrence of haematuria. No postoperative complications were reported. A disabling overactive bladder secondary to the procedure occurred in 9 patients (31.0%). Two patients needed a cystectomy at 1 and 11 months. CONCLUSION: GLBP may constitute an efficient line of treatment for RIHC. Despite overactive bladder it allowed to avoid or delay cystectomy.

Therapeutic Efficacy of Intravitreal Conbercept Injections with or without Focal Macular Photocoagulation for Diabetic Macular Edema.

Objective: This study aimed to investigate the effectiveness and safety of intravitreal conbercept injections with or without focal macular photocoagulation in the treatment of diabetic macular edema (DME). Methods: This retrospective study included 60 DME patients (60 eyes) divided into two treatment groups. The conbercept group received monthly intravitreal injections for 5 consecutive sessions, while the combination therapy group received intravitreal injections and focal macular photocoagulation. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were observed before and at months 1, 3, 6, 9, and 12 after treatment in both groups, along with the number of intravitreal conbercept injections administered. Results: At 1, 3, 6, 9, and 12 months after treatment, both the conbercept and combined treatment groups showed improvement in best-corrected visual acuity (BCVA) and decrease in central macular thickness (CMT) compared to before treatment, with statistical significant differences (P < .05). However, the differences in BCVA and CMT between the two groups at each time point after treatment were not significant (P > .05). During the 1-year follow-up period, the mean number of injections in the combined treatment group was 6.3±0.8, which was less than that in the conbercept treatment group (7.6 ± 0.9), with a significant difference (t = 5.556, P < .001). The incidence of subconjunctival hemorrhage was 10.9% and 10.5% in the two groups, respectively, with no significant inter-group difference (χ² = 0.013, P = .908). None of the patients exhibited serious treatment-related ocular and systemic complications during the treatment period. Conclusions: Treatment of DME with intravitreal conbercept injections, whether with or without focal macular photocoagulation, is safe and effective in improving the patients' visual acuity and retinal anatomy. However, patients who receive combined treatment require fewer intravitreal injections than those who receive conbercept treatment alone.

Rituximab, Intravitreal Bevacizumab and Laser Photocoagulation for Treatment of Macrophage Activation Syndrome and Retinal Vasculitis in Lupus: A Case Report.

Systemic lupus erythematosus (SLE) most commonly manifests as mild to moderate disease with severe manifestations such as diffuse alveolar hemorrhage, central nervous system vasculitis, macrophage activation syndrome (MAS) or retinal vasculitis (RV) with visual disturbances occurring in a significantly smaller proportion of patients, most of whom have a poor outcome. Macrophage activation syndrome and RV are insufficiently early and rarely recognized presentations of lupus-consequently there are still no treatment recommendations. Here we present the course of diagnosis and treatment of a patient with an SLE flare that resulted in both life-threatening disease (MAS) and vision-threatening disease (RV). The patient was successfully treated with systemic immunosuppressives, a high dose of glucocorticoids and rituximab (RTX), in parallel with intraocular therapy, intravitreal bevacizumab (BEV) and laser photocoagulation.

Comparison of Pregnancy Outcomes of Previable and Periviable Rupture of Membranes After Laser Photocoagulation for Twin-Twin Transfusion Syndrome.

OBJECTIVE: To describe the pregnancy outcomes of patients who experienced previable and periviable prelabor rupture of membranes (PROM) after the treatment of twin-twin transfusion syndrome. METHODS: We conducted a retrospective cohort study of patients whose pregnancies were complicated by twin-twin transfusion syndrome who were treated with fetoscopic laser photocoagulation at a single fetal center and subsequently experienced PROM from April 2010 to June 2019. Outcomes were infant survival and latency from PROM to delivery. Patients were grouped by gestational age at PROM (before 26 weeks of gestation and 26 weeks or later). The group with PROM before 26 weeks of gestation was stratified by gestational age at PROM for further description of outcomes. RESULTS: Two-hundred fifty of 653 patients (38%) developed PROM, 81 before 26 weeks of gestation and 169 after 26 weeks of gestation. In the setting of PROM before 26 weeks of gestation, the rate of survival of both twins to neonatal intensive care unit (NICU) discharge was 46.3%, compared with 76.9% in the setting of PROM at 26 weeks of gestation or later ( P <.001); the survival rate of at least one twin was 61.2% and 98.5%, respectively ( P <.001). Fourteen, 22, and 45 patients experienced PROM at 16-19 6/7, 20-22 6/7, and 23-25 6/7 weeks of gestation, respectively. Survival of both twins and at least one twin to NICU discharge was 25.0%, 47.4%, 52.8% (for two) and 33.3%, 47.4%, and 77.8% (for at least one), respectively, among those groups. Fifty-seven of the 81 patients with PROM before 26 weeks of gestation experienced a latency longer than 48 hours. In the setting of PROM before 26 weeks of gestation, when latency lasted longer than 48 hours, overall survival was improved (69.6% vs 53.7%, respectively, P =.017). With latency longer than 48 hours and PROM at 16-19 6/7, 20-22 6/7, and 23-25 6/7 weeks of gestation, survival of both twins to NICU discharge was 60.0%, 61.5%, and 60.7%, respectively, and survival of at least one twin was 80.0%, 61.5%, and 85.7%, respectively. CONCLUSION: Earlier gestational age at PROM after laser photocoagulation is associated with longer latency but lower rates of survival. When PROM occurs before 26 weeks of gestation and latency exceeds 48 hours, rates of neonatal survival are significantly improved.

Risk factors associated with progression of diabetic retinopathy in eyes treated with panretinal photocoagulation.

Uncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). We retrospectively reviewed DR patients who had completed PRP in at least one eye with a 3-year follow-up. A total of 243 eyes of 243 subjects (mean age 52.6 ± 11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P = 0.019); lower baseline visual acuity (P < 0.001); and higher platelet count (P = 0.048), hemoglobin (P = 0.044), and hematocrit, (P = 0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P < 0.001) and platelet count (HR: 1.215, P = 0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

Application of 5G Technology to Conduct Real-Time Teleretinal Laser Photocoagulation for the Treatment of Diabetic Retinopathy.

Importance: Interest in teleophthalmology has been growing, especially during the COVID-19 pandemic. The advent of fifth-generation (5G) wireless systems has the potential to revolutionize teleophthalmology, but these systems have not previously been leveraged to conduct therapeutic telemedicine in the ophthalmology field. Objective: To assess the feasibility of 5G real-time laser photocoagulation as a telemedicine-based treatment for diabetic retinopathy (DR). Design, Setting, and Participants: This was a prospective study involving a retinal specialist from the Peking Union Medical College Hospital in Beijing, China, who performed online 5G real-time navigated retinal laser photocoagulation to treat participants with proliferative or severe nonproliferative DR who had been recruited in the Huzhou First People's Hospital in Zhejiang Province, China, located 1200 km from Beijing from October 2019 to July 2020. Interventions: These teleretinal DR and laser management procedures were conducted using a teleophthalmology platform that used the videoconference platform for teleconsultation, after which telelaser planning and intervention were conducted with a laser system and a platform for remote computer control, which were connected via 5G networks. Main Outcomes and Measures: Diabetic eye prognosis and the real-time laser therapy transmission speed were evaluated. Results: A total of 6 participants (9 eyes) were included. Six eyes were treated via panretinal photocoagulation alone, while 1 eye underwent focal/grid photocoagulation and 2 eyes underwent both panretinal photocoagulation and focal/grid photocoagulation. The mean (SD) age was 53.7 (13.6) years (range, 32-67 years). The mean (SD) duration of diabetes was 14.3 (6.4) years (range, 3-20 years). The mean (SD) logMAR at baseline was 0.32 (0.20) (20/30 Snellen equivalent). Retinal telephotocoagulation operations were performed on all eyes without any noticeable delay during treatment. The mean (SD) number of panretinal photocoagulation laser spots per eye in 1 session was 913 (243). Conclusions and Relevance: This study introduces a novel teleophthalmology paradigm to treat DR at a distance. Applying novel technologies may continue to ensure that remote patients with DR and other conditions have access to essential health care. Further studies will be needed to compare this approach with the current standard of care to determine whether visual acuity or safety outcomes differ.

Clinical efficacy of intravitreal aflibercept injection versus vitrectomy with panretinal photocoagulation for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis.

BACKGROUND: In the current literature, it is still controversial whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) patients. Given that there is no high-quality meta-analysis or review to incorporate existing evidence, the purpose of this study is to systematically review the level I evidence in the literature to ascertain whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with PRP for PDR patients. METHODS: The systematic literature review is structured to adhere to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), which include requirements deemed essential for the transparent reporting of results. A systematic search will be performed in Web of Science, Embase, Scopus, Science Direct, Cochrane Library up to and inclusive of March 19, 2021. The method of data extraction will follow the approach outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome is change in best-corrected visual acuity. The secondary outcomes are change in area of neovascularization and change in area of retinal nonperfusion. Where disagreement occurs, this will be resolved through discussion. All outcomes are pooled on random-effect model. A P value of < .05 is considered to be statistically significant. RESULTS: The results of our review will be reported strictly following the PRISMA criteria. CONCLUSIONS: The hypothesis of the study was that visual acuity recovery would be faster with vitrectomy because the blood is mechanically cleared during surgery. REGISTRATION NUMBER: 10.17605/OSF.IO/NCAXW.

Visual Field Changes Over 5 Years in Patients Treated With Panretinal Photocoagulation or Ranibizumab for Proliferative Diabetic Retinopathy.

Importance: Preservation of peripheral visual field (VF) is considered an advantage for anti-vascular endothelial growth factor agents compared with panretinal photocoagulation (PRP) for treatment of proliferative diabetic retinopathy. Long-term data on VF are important when considering either treatment approach. Objective: To further evaluate changes in VF throughout 5 years among eyes enrolled in the Protocol S clinical trial, conducted by the DRCR Retina Network. Design, Setting, and Participants: Post hoc analyses of an ancillary study within a multicenter (55 US sites) randomized clinical trial. Individuals with eyes with proliferative diabetic retinopathy enrolled in Protocol S were included. Data were collected from February 2012 to February 2018. Analysis began in June 2018. Interventions: Panretinal photocoagulation or intravitreous injections of 0.5-mg ranibizumab. Diabetic macular edema, whenever present, was treated with ranibizumab in both groups. Panretinal photocoagulation could be administered to eyes in the ranibizumab group when failure or futility criteria were met. Main Outcomes and Measures: Mean change in total point score on VF testing with the Humphrey Field Analyzer 30-2 and 60-4 test patterns. Results: Of 394 eyes enrolled in Protocol S, 234 (59.4%) were targeted for this ancillary study. Of these, 167 (71.4%) had VF meeting acceptable quality criteria at baseline (median [interquartile range] age, 50 [43-58] years; 90 men [53.9%]). At 5 years, 79 (33.8%) had results available. The mean (SD) change in total point score in the PRP and ranibizumab groups was -305 (521) dB and -36 (486) dB at 1 year, respectively, increasing to -527 (635) dB and -330 (645) dB at 5 years, respectively (P = .04). After censoring VF results after PRP treatments in the ranibizumab group, the 5-year mean change in total point score was -201 (442) dB. In a longitudinal regression analysis of change in total point score including both treatment groups, laser treatment was associated with a mean point decrease of 208 (95% CI, 112-304) dB for the initial PRP session, 77 (95% CI, 21-132) dB for additional PRP sessions, and 325 (95% CI, 211-439) dB for endolaser. No association was found between change in point score and the number of ranibizumab injections during the previous year (-9 per injection [95% CI, -22 to 3]). Conclusions and Relevance: The limited data available from Protocol S suggest that there are factors besides PRP associated with VF loss in eyes treated for proliferative diabetic retinopathy. Further clinical research is warranted to clarify the finding. Trial Registration: ClinicalTrials.gov identifier: NCT01489189.

Efficacy of Ahmed Glaucoma Valve Implantation on Neovascular Glaucoma.

To evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation in treating neovascular glaucoma (NVG) and analyze the factors influencing the surgical success rate, a retrospective investigation of 59 NVG patients (66 eyes) who underwent AGV implantation was conducted at Jiangsu Province Hospital, China, from January 2014 to June 2018. Intraocular pressure (IOP), visual acuity, surgical success rates, medications, and complications were monitored at post-operative 1 day, 1 week, 1, 3, 6 and 12 months. Surgical success criteria were defined as 6 mm Hg < IOP < 21 mmHg with or without additional medications. Results showed average IOP was statistically significant between pre-operative visit and each follow-up visit (all P<0.05). At 12 months, the success rate was 66.7%. Multiple stepwise regression analysis suggested that age, panretinal photocoagulation (PRP), complications and hyphema were significant factors influencing the surgical success rate (all P<0.05). Thus, we conclude that AGV implantation is effective and safe for treatment of NVG. Surgical success is dependent on age, PRP, complications, and hyphema.

Epiretinal Membrane Formation after Treatment of Retinal Breaks: Cryoretinopexy versus Laser Retinopexy.

PURPOSE: The purpose of the study was to study the prevalence of macular epiretinal membrane (ERM) formation for retinal tears treated with laser retinopexy and cryoretinopexy. The study sought to identify whether there is a difference in ERM formation prevalence between these 2 treatments. DESIGN: Retrospective, single-center, chart review study. PARTICIPANTS: Patients seeking treatment at a private practice institution (The Retina Institute, St. Louis, Missouri) over a 10-year period between 2006 and 2016 for the evaluation and treatment of a retinal tear. METHODS: A chart review was conducted comprising all patients undergoing procedures for Current Procedural Terminology codes 67141 (prophylaxis of retinal detachment, cryotherapy) and 67145 (prophylaxis of retinal detachment, photocoagulation) and patients with an International Classification of Diseases, Ninth Edition, Clinical Modification, diagnosis code of 362.56 (macular puckering), who underwent procedures identified with Current Procedural Terminology codes 67141 and 67145. MAIN OUTCOME MEASURES: Epiretinal membrane development, time between treatment and ERM development, and surgical intervention for ERM progression. RESULTS: A total of 2257 eyes underwent treatment for retinal breaks with 1655 eyes treated by laser retinopexy and 602 eyes treated by cryoretinopexy. The mean age of the cryoretinopexy group was 59.4±1.5 years and in the laser retinopexy group was 61.4±0.8 years. A total of 74 patients (3.2%) demonstrated an ERM after treatment for a retinal tear during an 11-year period (2006-2016). A total of 26 cryoretinopexy eyes (4.32%) and 48 laser retinopexy eyes (2.90%) demonstrated an ERM after treatment of retinal breaks (P = 0.094). The average time to ERM development was 11.5 months for the cryoretinopexy group and 12 months in the laser retinopexy group (P = 0.878). Seven ERMs progressed to requiring surgical intervention: 2 in the cryoretinopexy group and 5 in the laser retinopexy group. There was no statistically significant difference between the groups with regard to ERM progression resulting in surgical intervention (P = 0.707). CONCLUSIONS: Treatment of retinal breaks with either cryoretinopexy or laser retinopexy showed no statistically significant difference in the incidence, timing, or severity of ERM formation between these treatment methods.

Congenital Laser-Induced Burns: A Potential Complication after Laser Photocoagulation in Monochorionic Twin Pregnancy.

Background: Fetoscopic laser photocoagulation can directly injure fetal skin and may at birth resemble aplasia cutis congenita (ACC). Case report: A twin monochorionic pregnancy was complicated by twin-to-twin transfusion syndrome requiring in utero laser photocoagulation, resulting in the death of one twin. After birth, the viable baby presented skin lesions in both legs that were congruent with laser-induced burns. Conclusions: Laser-induced burns present as asymmetric superficial non-necrotic or ulcerated lesions, with a geographic outline, which turn into scars with no retraction or contractures and no changes in pain perception or motor limitations over time. ACC lesions are bilateral and symmetric, with a regular outline, an ulcerated or necrotic appearance, a higher degree of skin involvement affecting all skin layers and, over time, they turn into scars with retraction and contractures. These differential features may help clinicians in a challenging approach to the diagnosis of congenital skin defects.

Risk Factors and Outcomes of Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy.

We identified clinical characteristics and risk factors of choroidal neovascularization (CNV) in eyes with prior episode of central serous chorioretinopathy (CSC). This retrospective case-control study included those initially diagnosed with CSC and developed CNV secondarily (Group 1, n = 16), those diagnosed with CNV in eyes of previous putative CSC (Group 2, n = 14), and those initially diagnosed with CSC, and did not develop CNV secondarily, as a control group for Group 1 (Group 3, n = 250). Clinical characteristics including treatment outcomes were assessed. Demographics and multimodal imaging at the time of CSC diagnosis of secondary CNV were compared between the groups to identify risk factors. Duration from diagnosis of CSC to development of CNV in Group 1 was 40.2 ± 42.0 months. Classic CNV was noted in 23 (76.7%) eyes. After treatment with intravitreal antiangiogenics with average of 4.9 times, visual acuity improved in Group 1 and Group 2 (p = 0.002). Multivariate analysis revealed that systemic hypertension, pigmentary changes, and double layer sign were associated with development of CNV secondary to CSC (p < 0.05). Hypertension, pigmentary changes, and double layer sign were independent risk factors for CNV secondary to CSC. The CNV's responded well to treatment, resulting in improved vision.

Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options.

The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.

Comparison of the safety and efficacy of triple sequential therapy and transscleral cyclophotocoagulation for neovascular glaucoma in the angle-closure stage.

To compare the efficacy and safety of triple therapy combining intravitreal injection of anti-vascular endothelial growth factor, trabeculectomy, and pan-retinal photocoagulation via binocular indirect ophthalmoscopy, with that of transscleral cyclophotocoagulation (TCP) to treat neovascular glaucoma in the angle-closure stage. Eighteen triple therapy patients and 25 TCP patients between May 2014 and May 2016 were retrospectively analysed. Anterior chamber puncture and anti-VEGF intravitreal injection were performed on the first day of sequential therapy. Trabeculectomy was performed 3-5 d after injection; pan-retinal laser photocoagulation via binocular indirect ophthalmoscopy was initiated 5-7 d later. The IOP of the triple therapy group was lower than that of the TCP group (15.2 ± 2.2 vs. 20.0 ± 8.5 mmHg) and fewer anti-glaucoma drugs were used (0.5 ± 1.0 vs. 0.6 ± 1.0) after treatment. The success rates of the two groups were 89% and 60% respectively (P = 0.032). The visual function of 94% of triple therapy patients was preserved or improved compared to 64% of TCP patients with statistical significance (P = 0.028). No patient in the triple therapy group showed hypotony or eyeball atrophy. Compared to TCP, triple therapy shows higher success rate, fewer complications, and attributes to visual function preservation.

Novel treatment of papillomatous conjunctival lesions using pattern scanning laser photocoagulation: 1-Year results.

PURPOSE: To evaluate the safety and 1-year effect of pattern scanning laser photocoagulation treatment for pedunculated papillomatous and sessile conjunctival lesions in a low-resource setting with extremely limited operating room access. METHODS: Adult patients with clinical diagnosis of conjunctival papilloma underwent complete ophthalmologic exam including anterior segment photography. After topical anesthesia and toluidine blue 1% instillation, the lesion was treated by pattern scanning photocoagulation using a duration time that varied from 20 to 100 ms and power from 600 to 1800 mW, treating the entire lesion surface with a 2 mm margin. Patients were examined weekly for a month then monthly and underwent retreatment as necessary. RESULTS: Six patients and seven eyes that had clinically significant non-malignant pedunculated or sessile papillomatous lesions were treated. All lesions responded to treatment, with complete resolution after an average of 2.3 sessions. Procedures were well tolerated with only minor mild discomfort persisting up to two days post-treatment. Patients were followed for a mean follow-up time of 13 months with no recurrences reported. CONCLUSION: Short-term results of the pattern scanning laser photocoagulation approach, with toluidine blue for papillomatous conjunctival lesions are favorable with a 100% success rate in this cohort. This rate is comparable to surgical excision. This novel strategy proved to be a less resource intensive alternative that not only could demonstrate its usefulness in settings with chronic operating room shortages, but also in recurrent cases. Longer follow-ups with a larger sample size and cost-analysis are necessary to confirm our findings.

Inhibition of YAP ameliorates choroidal neovascularization via inhibiting endothelial cell proliferation.

Purpose: Age-related macular degeneration (AMD) is the leading cause of central visual loss among patients over the age of 55 years worldwide. Neovascular-type AMD (nAMD) accounts for approximately 10% of patients with AMD and is characterized by choroidal neovascularization (CNV). The proliferation of choroidal endothelial cells (CECs) is one important step in the formation of new vessels. Transcriptional coactivator Yes-associated protein (YAP) can promote the proliferation of multiple cancer cells, corneal endothelial cells, and vascular smooth muscle cells, which participate in angiogenesis. This study intends to reveal the expression and functions of YAP during the CNV process. Methods: In the study, a mouse CNV model was generated by laser photocoagulation. YAP expression was detected with western blotting and immunohistochemistry. YAP siRNA and ranibizumab, a VEGF monoclonal antibody, were injected intravitreally in CNV mice. The YAP and VEGF expression levels after injection were detected with western blotting. The incidence and leakage area of CNV were measured with fundus fluorescein angiography, choroidal flat mounting, and hematoxylin and eosin (HE) staining. Immunofluorescent double staining was used to detect YAP cellular localization with CD31 (an endothelial cell marker) antibody. Proliferating cell nuclear antigen (PCNA) expression in CNV mice without or with YAP siRNA intravitreal injection and the colocalization of PCNA and CD31 were measured with western blotting and immunofluorescent double staining, respectively. Results: YAP expression increased following laser exposure, in accordance with vascular endothelial growth factor (VEGF) expression. YAP siRNA and ranibizumab decreased VEGF expression and the incidence and leakage area of CNV. YAP was localized in the vascular endothelium within the CNV site. Additionally, after laser exposure, YAP siRNA inhibited the increased expression of PCNA, which was colocalized with endothelial cells. Conclusions: This study showed that YAP upregulation promoted CNV formation by upregulating the proliferation of endothelial cells, providing evidence for the molecular mechanisms of CNV and suggesting a novel molecular target for nAMD treatment.

Panretinal Photocoagulation: A Review of Complications.

Panretinal photocoagulation (PRP) is a mainstay of therapy for retinal ischemic disease. The procedure involves creating thermal burns in the peripheral retina leading to tissue coagulation, the overall consequence of which is improved retinal oxygenation. While highly effective, there have been concerns historically regarding the anatomic effects and visual complications following PRP, the most common of which include choroidal effusions, exudative retinal detachments, macular edema, visual field deficits, and night vision defects. The occurrence of these complications is closely tied to laser parameters such as increased duration and power and intensive treatment in a single sitting, all of which cause increased dispersion of thermal energy within the retina and choroid. The advent of newer laser delivery systems, such as the multispot pattern laser, has greatly mitigated but not eliminated these issues. The following article reviews the most common complications following PRP treatment, including reported occurrences, inciting factors, and underlying pathophysiology.

PASCAL laser platform produces less pain responses compared to conventional laser system during the panretinal photocoagulation: a randomized clinical trial.

BACKGROUND: Most of patients experience pain during the panretinal photocoagulation(PRP). Laser photocoagulation delivery has advanced with the introduction of pattern-scanning laser systems (PASCAL). Shorter pulse duration and less choroidal penetration believed to reduce pain during the laser treatment. OBJECTIVES: To compare the severity of expressed pain scores in patients with PDR who underwent PRP either with PASCAL laser or conventional laser. METHODS: A total of 28 patients with a diagnosis of PDR who were scheduled for bilateral PRP therapy were enrolled into the prospective study. Both eyes were treated within the same session and while one eye was treated with PASCAL the other was treated with conventional laser randomly. Pulse duration was adjusted to 100-ms in conventional laser and 30 ms in PASCAL. The severity of pain was graded using a verbal scale and a visual analog scale (VAS). RESULTS: Mean age was 61.36±9.10 years. Mean verbal and VAS scores were 1.32±0.47 and 2.86±1.21 in the PASCAL laser and 2.39±0.49 and 5.75±1.35 in the conventional laser group, respectively. Differences between expressed pain scores obtained by both two scales were statistically significant (p<0.001). CONCLUSION: PASCAL laser significantly alleviates pain levels possibly due to the shorter laser pulse duration and lower intensity.