Laser Therapy For Retinopathy Research Articles

Laser therapy for retinopathy in sickle cell disease.

Laser therapy for retinopathy in sickle cell disease.

Comparison of Intravitreal Anti-VEGF Agents With Laser Photocoagulation for Retinopathy of Prematurity of 1,627 Eyes in China.

PurposeTo compare the efficacies and treatment outcomes of intravitreal anti-VEGF agents and laser therapy in retinopathy of prematurity (ROP).MethodsA retrospective, non-randomized, comparative study of patients diagnosed with type 1 ROP or aggressive posterior ROP (A-ROP) treated with intravitreal anti-VEGF agents or laser therapy as primary treatment at the People's Hospital of Peking University.ResultsA total of 1,627 eyes of 862 patients were included. In Group 1, 399 eyes of 204 patients were diagnosed with A-ROP or zone I type 1 ROP. The initial regression of the anti-VEGF subgroup was better than that of the laser subgroup, and the reactivation rate and rate of progression to retinal detachment were lower than those of the laser subgroup. In Group 2, 1,228 eyes of 658 patients were diagnosed with zone II type 1 ROP. The reactivation rate of the laser subgroup was lower than that of the anti-VEGF subgroup. No significant differences were found in the initial regression and the probability of developing retinal detachment. Among the anti-VEGF agents, the reactivation rate in eyes treated with conbercept was much lower than that in eyes treated with ranibizumab. The spherical power and spherical equivalents of eyes treated with laser were significantly higher than those of eyes treated with anti-VEGF agents 1 year after initial treatment.ConclusionsIn contrast to laser therapy, anti-VEGF agents as primary treatments have potential advantages for eyes with zone I type 1 ROP and A-ROP. For eyes with zone II type 1 ROP, laser photocoagulation and anti-VEGF agents therapy showed similar efficacy; however, the rate of reactivation with laser therapy was significantly lower than that with anti-VEGF agents. Among the anti-VEGF agents, the reactivation rate was much lower in eyes treated with conbercept than in eyes treated with ranibizumab. Compared to anti-VEGF agents, laser treated eyes had greater trend to myopia.

Comparative Analysis of Intravitreal Ranibizumab versus Laser Therapy for Retinopathy of Prematurity

Comparative Analysis of Intravitreal Ranibizumab versus Laser Therapy for Retinopathy of Prematurity

Characteristics of "Older Old" Patients with Sickle Cell Anemia Who Survived for More Than 80 Years

Survival of patients with sickle cell anemia (SS) has increased progressively since the 1990's. Newborn screening, prophylactic antibiotics, newer vaccines, safer blood transfusion, chelation therapy and hydroxyurea are some reasons for this change in longevity. Patients with SS in their sixth or seventh decade have been described previously. This report describes two of our patients with SS who survived beyond the age of 80 years.The first patient is an 81 year old African American woman with SS that was first diagnosed at the age of 8 years. She used to have frequent vaso-occlusive crises (VOC) during childhood and young adulthood. Crises became less frequent with age and she had one VOC only during the last 15 years. Past medical history was significant for status post (S/P) cholecystectomy & appendectomy, congestive heart failure, avascular necrosis of the right hip, S/P right hip replacement, S/P laser therapy for retinopathy, cataract, glaucoma, history of leg ulcers, history of tuberculosis, hypertension, pneumonia, respiratory failure, pacemaker implantation secondary to complete heart block and iron overload due frequent blood transfusions over the years. At the age of 79 years she had mild Parkinson's disease. On physical exam her vital signs were within normal. Pertinent findings included Grade II/VI systolic heart murmur and scars of previous surgeries and of leg ulcers. Medications included folic acid, antihistamines, furosemide, verapamil, laxatives, multivitamins, baby aspirin, proton pump inhibitor; eye drops for glaucoma, acetaminophen with codeine for pain and Ropinirol for Parkinson's. Iron chelation with desferasirox was not successful due to increase in serum creatinine and was replaced with deferiprone. Her usual hemoglobin (Hb) was 7.0-8.5 g/dl, hematocrit (Hct) 22-25.5%, platelet and white blood cell counts (WBC) within normal and Hb F that varied between 3.1 and 14% over the years.The second patient was a Caucasian woman of Italian ancestry known to have SS that was first diagnosed at the age of 19 when she presented with VOC. Since then she experienced frequent VOCs that were treated mostly at home or in the Emergency Department and occasionally required hospital admissions. Complications of her disease included generalized avascular necrosis which was most severe in her hips and knees and less severe in her shoulders and wrists. She was S/P bilateral hip replacement, right knee replacement and S/P total right hip revision done about 10 years after the previous hip replacement. Other complications over the years included bilateral sickle retinopathy managed with laser therapy, bilateral cataracts treated surgically, mitral valve prolapse, papillary necrosis, urinary tract infections, irritable bowel syndrome, osteoporosis, and anxiety disorder. In her seventies she had paroxysmal atrial fibrillation treated initially with Coumadin and later prophylactically with amiodarone, mild myocardial infarction and a small ankle ulcer that healed after standard therapy. Physical exam was remarkable for grade II/VI apical murmur and scars of previous surgeries. Medications included a broad spectrum of medications that included folic acid, calcium, vitamin D, opioid and nonopioid analgesics, proton pump inhibitors, antibiotics and anxiolytics. Blood transfusions were given sporadically when needed. Her Hb was 7.5-8.5 g/dL and Hct was 23-27% most of the time, WBC and platelet counts were within normal when in the steady state but the WBC count increased to 14-16,000 /uL during VOCs. Fetal Hb varied from 7 to 12 % over the years. She died recently from cardiac complications at the age of 86 years.Both patients had excellent family support, were compliant with their medications and kept regular follow-up clinic visits over the year. Their WBC counts were within normal most of the time. These factors may have contributed significantly to their longevity. DisclosuresPulte:Selexys: Research Funding; EBSCO: Consultancy; ApoPharma: Research Funding.

Laser therapy for retinopathy in sickle cell disease.

Sickle cell disease includes a group of inherited haemoglobinopathies affecting multiple organs including the eyes. Some people with the disease develop ocular manifestations due to vaso-occlusion. Vision-threatening complications of sickle cell disease are mainly due to proliferative sickle retinopathy which is characterized by proliferation of new blood vessels. Laser photocoagulation is widely applicable in proliferative retinopathies such as proliferative sickle retinopathy and proliferative diabetic retinopathy. It is important to evaluate the efficacy and safety of laser photocoagulation in the treatment of proliferative sickle retinopathy to prevent sight-threatening complications. To evaluate the effectiveness of various techniques of laser photocoagulation therapy in sickle cell disease-related retinopathy. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 21 September 2015.We also searched the following resources (24 March 2015): Latin American and Carribean Health Science Literature Database (LILACS); WHO International Clinical Trials Registry Platforms (ICTRP); and ClinicalTrials.gov. Randomised controlled trials comparing laser photocoagulation to no treatment in children and adults. Two authors independently assessed trial eligibility, the risk of bias of the included trials and extracted and analysed data. We contacted the trial authors for additional information. Two trials (341 eyes of 238 children and adults) were included comparing efficacy and safety of laser photocoagulation to no therapy in people with proliferative sickle retinopathy. There were 121 males and 117 females with an age range from 13 to 67 years. The laser photocoagulation technique used was different in the two trials; one single-centre trial employed sectoral scatter laser photocoagulation using an argon laser; and the second, two-centre trial, employed feeder vessel coagulation using argon laser in one centre and xenon arc in the second centre. The follow-up period ranged from a mean of 21 to 32 months in one trial and 42 to 47 months in the second. Both trials were at risk of selection bias (random sequence generation) because of the randomisation method employed for participants with bilateral disease. One study was considered to be at risk of reporting bias.Using sectoral scatter laser photocoagulation, one trial (174 eyes) reported that complete regression of proliferative sickle retinopathy was seen in 30.2% in the laser group and 22.4% in the control group (no difference between groups). The same trial reported the development of new proliferative sickle retinopathy in 34.3% of laser-treated eyes and in 41.3% of eyes given no treatment; again, there was no difference between treatment groups. The second trial, using feeder vessel coagulation, did not present full data for either treatment group for these outcomes.There was evidence from both trials (341 eyes) that laser photocoagulation using scatter laser or feeder vessel coagulation may prevent the loss of vision in eyes with proliferative sickle retinopathy (at median follow up of 21 to 47 months). Data from both trials indicated that laser treatment prevented the occurrence of vitreous haemorrhage with both argon and xenon laser; with the protective effect being greater with feeder vessel laser treatment compared to scatter photocoagulation.Regarding adverse effects, the incidence of retinal tear was minimal, with only one event reported. Combined data from both trials were available for 341 eyes; there was no difference between the laser and control arms for retinal detachment. In relation to choroidal neovascularization, treatment with xenon arc was found to be associated with a significantly higher risk, but visual loss related to this complication is uncommon with long-term follow up of three years or more.Data regarding quality of life and other adverse effects were not reported in the included trials. Our conclusions are based on the data from two trials conducted over 20 years ago. In the absence of further evidence, laser treatment for sickle cell disease-related retinopathy should be considered as a one of therapeutic options for preventing visual loss and vitreous haemorrhage. However, it does not appear to have a significant different effect on other clinical outcomes such as regression of proliferative sickle retinopathy and development of new ones. No evidence is available assessing efficacy in relation to patient-important outcomes (such as quality of life or the loss of a driving licence). There is limited evidence on safety, overall, scatter argon laser photocoagulation is superior in terms of adverse effects, although feeder vessel coagulation has a better effect in preventing vitreous haemorrhage. Further research is needed to examine the safety of laser treatment compared to other interventions such as intravitreal injection of anti-vascular endothelial growth factors. In addition, patient-important outcomes as well as cost-effectiveness should be addressed.

Changes in serum levels of stress factors before and after laser therapy for retinopathy of prematurity

Objective To investigate the alterations of dopamine, norepinephrine, cortisol, C-reactive protein(CRP), heart rate(HR), respiratory rate(RR) and mean artery pressure(MAP) before and after the laser photocoagulation for retinopathy of prematurity(ROP) with topical anesthesia and to provide the guideline for improving its routine management and interventions. Methods Thirty children with ROP who received ROP laser photocoagulation in Guang zhou Women and Children's Medical Center from May to Dec.2012 were selected.The blood of the 30 cases of infants were collected at 4 time points: before laser therapy, the end of laser therapy, 1 hour and 24 hours after laser therapy.The concentrations of dopamine, norepinephrine, cortisol and CRP in plasma were measured at each time point with radio immunoassay, and the values of HR, RR and MAP of infants were recorded as well. Results The levels of dopamine, norepinephrine and cortisol at the end and 1 hour after therapy were higher than those in the quiet state before therapy, and the differences were statistically significant(t=6.39, 2.55; t=7.74, 2.91; t=8.87, 2.15; all P 0.05); the levels of HR and RR at the end of therapy, 1 hour and 24 hours after therapy had statistical difference in comparison with those in the quiet state before therapy(t=4.33, 3.84, 3.38; t=6.81, 4.42, 2.96; all P<0.05). The level of MAP at the end of therapy had statistical difference in comparison with that in the quiet state before therapy(t=6.10, P<0.001). Conclusions Infants who experienced ROP laser photocoagulation had stress response.Clinicians should pay more attention to monitoring HR and RR of preterm infants receiving retinal laser photocoagulation under topical anesthesia and take active interventions in order to relieve the stress response. Key words: Topical anesthesia; Retinopathy of prematurity; Laser photocoagulation; Stress factor

Continuous intravenous infusion of fentanyl suggests improved safety over morphine in preterm infants undergoing laser therapy in retinopathy of prematurity

Introduction: Currently, there is no consensus regarding the optimal mode of anesthesia for retinopathy of prematurity (ROP) laser treatment. Studies have established that general anesthesia with intubation confers significant risk in preterm neonates, and that opioid analgesia with benzodiazepine sedation is ideal when the NICU is equipped for such surgical procedures. While small retrospective studies have looked at the safety and efficacy of morphine (n = 130), ketamine (n = 11), and remifentanil (n = 6), no studies have looked at fentanyl for ROP laser surgery.

Genetic markers in diabetes mellitus: the need and promise for specific drug therapies in defined subtypes of diabetes patients

frequency or severity of hypoglycemia. Further benefit is often attained from additional treatment directed to normalizing blood pressure and circulating lipids, as well as specific interventions for diabetes complications, such as laser therapy for retinopathy. This article will focus on current approaches to blood glucose control. The management of glycemia in diabetes typically includes attention to diet and exercise combined with pharmacologic agents selected from a palette of injectable and oral drugs. Advances in available forms of insulin and other drugs over the past two to three decades, plus home glucose meters and, for some patients, devices such as insulin pumps and continuous glucose monitoring systems, has substantially increased the capacity of diabetes patients to control their blood glucose levels and to decrease the associated long-term risks. However, current therapeutic strategies still often fail to bring patients to glycemic targets. In the USA, data from the National Health and Nutrition Examination Survey (NHANES) indicates that only approximately 50% of diabetes patients are at or below the conservative hemoglobin A1c goal of 7% [2]. In considering strategies for improving glycemic therapy, there is increasing interest in approaches that better link treatment to specific diabetes subtypes in individual patients. It has long been known that diabetes is a heterogeneous disorder. Recognition of different forms of the disease corresponding to today’s Type 1 and 2 diabetes is evident in medical writing dating back 2000 years [3]. Standard treatment approaches to these two forms of diabetes differ, with early initiation of insulin in patients recognized to have Type 1 diabetes and often long periods of management with oral hypoglycemic agents in patients with Type 2 diabetes. More refined examination of individual phenotypes, biochemical markers, and inheritance patterns over the past several decades has progressively identified additional diabetes subtypes, such as maturity onset diabetes of the young (MODY), An estimated 24 million people in the USA (>8% of the population) and approximately 250 million people worldwide have diabetes [101]. When it is poorly controlled, diabetes has acute medical consequences resulting from osmotic diuresis, disturbed fluid and electrolyte balance, compromised immune function and, in extremely insulin-deficient patients, ketoacidosis. Of equal or greater importance, the diagnosis of diabetes brings with it a markedly increased risk of longterm complications. Diabetes-associated macrovascular disease contributes to an increased occurrence of myocardial infarction, congestive heart failure, stroke and peripheral vascular disease, and microvascular complications of diabetes often lead to loss of vision, renal insufficiency and disabling symptomatic neuropathies. In the USA, diabetes is the seventh leading cause of death, largely from the impact of its long-term complications, with financial costs that exceed US$150 billion per year [101]. The development of diabetes in most individuals results from an unfavorable confluence of environmental and genetic factors. In Type 1 diabetes, it is thought that yet unidentified environ mental insults (toxic, infectious or other), acting in a susceptible genetic background, lead to initiation and progression of autoimmune b-cell destruction. In Type 2 diabetes, lifestyle factors (excess calorie intake, decreased exercise and possibly specific dietary components), again acting in a susceptible genetic background, typically result in both insulin resistance and compromised insulin secretion. The common defining biomarker for diabetes is hyperglycemia and, irrespective of the underlying cause, compelling data indicate that improved control of blood glucose in diabetes relieves acute symptoms, reduces long-term complications, and decreases associated morbidity and mortality. Although there is ongoing debate on the preferred target level for glycemia [1], the accepted fundamental principle is one of bringing blood glucose as close as possible to normal without inducing an unacceptable

Efficacy and safety of continuous intravenous infusion of remifentanil in preterm infants undergoing laser therapy in retinopathy of prematurity: clinical experience.

Preterm infants often require surgery. As experimental evidence suggests that premature infants may experience pain and this could even result in fatal complications, the anaesthesiologist must face problems related to lowbirth weight, high risk of hypothermia, concomitant pulmonary disease and metabolic and receptor immaturity. Recently remifentanil has been considered an optimal analgesic drug in a preterm infant undergoing mechanical ventilation and frequent surgical manoeuvres, but no clinical studies have been reported in the literature. The aim of our study was to evaluate the efficacy of a continuous intravenous infusion of remifentanil in premature infants undergoing laser therapy for retinopathy of prematurity (ROP). Six premature infants with ROP were scheduled for laser therapy. The procedure was performed in the neonatal intensive care unit. Transcutaneous carbon dioxide, pulse oximetry, respiratory rate, ECG and noninvasive blood pressure were continuously monitored. Infusion of remifentanil started with a dose of 0.75-1 microg x kg-1x min-1, 1 h before surgery. A midazolam bolus dose (0.20 mg x kg-1) was administered and the remifentanil infusion was increased to 3-5 microg x kg-1x min-1 taking into account haemodynamic and respiratory changes or spontaneous movements. Increased dosage was necessary only for 10 min during the procedure. No changes in temperature and ventilatory settings were observed and after 2 h from the surgical procedure the preterm infants were back to their preoperative status. A continuous infusion of remifentanil allowed optimal control of surgical stress and a return to preoperative status and ventilatory settings without side-effects.