Photocoagulation Research Articles

Contemporary methods of treating venous lake lesions on the oral mucosa: A literature review.

A venous lake (VL) is a vascular lesion arising from dilated venous vessels surrounded by thick fibrous tissue, located in the upper layers of the dermis. It can also appear in the oral cavity, especially on the lips, buccal mucosa and tongue. Recurrent bleeding or aesthetic complaints are the most common reasons for the treatment of these lesions. This review aims to present the current state of knowledge regarding the treatment of VL lesions in the oral cavity. PRISMA guidelines were followed. Articles were searched in the following databases: Pubmed, Medline and Scopus. The authors of this study analyzed scientific works concerning VL treatment. Keywords searched included "venous lake", "venous lake treatment", "sclerotherapy", "laser", "laser photocoagulation", "infrared coagulation", and "diathermocoagulation". Two articles described electrocoagulation, 10 articles focused on photocoagulation using laser devices, 2 articles studied photocoagulation with infrared, and 4 articles described sclerotherapy for the treatment of VL lesions. The most effective therapeutic options were electrocoagulation, 808 nm diode laser photocoagulation and 1064 nm Nd:YAG.

Modern view on predicting outcomes after fetoscopic laser coagulation of placental anastomoses in polyuria-oliguria syndrome (review)

The purpose of this literature review is to analyze the results of fetoscopic laser photocoagulation of placental anastomoses, obtained in various studies published in foreign and domestic medical publications in recent years.Materials and methods. The review included published data over the last 10 years. The literature search was conducted in Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley and Cochrane Library databases.Result. As a result of the analysis, the main ultrasound and fetoscopic markers influencing the outcome of the surgical treatment were determined: the location of the placenta on the anterior and posterior walls, the location of the umbilical cord attachment, the number of placental anastomoses; abnormal graphs of blood flow rates in the umbilical cord arteries; the distance between the attachment points of the umbilical cord; dissociated growth of the fetuses; the duration of gestation and the stage of severity of twin-to-twin transfusion syndrome, as measured with the R. Quintero staging system, at the time of the operation; the experience of the operating surgeons; and the duration of the operation.Conclusion. Analysis of the literature data has shown that these markers are extremely unreliable in predicting the chances of survival for one or both fetuses. Further study of ultra-sound and fetoscopy predictors of adverse outcome of laser photocoagulation of placental anastomoses will allow for a more balanced approach to the choice of surgical tactics and personalized consultations with patients.

Innovative study of the fetal heart in monochorionic multiple births

Introduction. Fetal echocardiography is currently one of the main methods of prenatal diagnosis. However, in recent years, attention has shifted towards the use of ultrasound to assess fetal myocardial function.The aim of this study is compare global longitudinal deformation of the myocardium of the left (LV) and right ventricles (RV) of the heart in fetuses with uncomplicated singleton pregnancy, in fetuses from monochorionic twins with transfusion syndrome, selective growth retardation and in uncomplicated monochorionic multiple pregnancy.Material and methods. A prospective cohort study was conducted which included 60 pregnant patients: Group I — patients with an uncomplicated singleton pregnancy (n=25); Group II — 35 patients with monochorionic diamniotic twins, whose pregnancy in 10 cases was complicated by feto-fetal transfusion syndrome (stages I-III according to Quintero R.A.), in 10 cases — selective growth retardation of the second fetus and in 15 cases monochorionic twins without complications. The following parameters were determined: global longitudinal deformation (GLD) of the myocardium of the ventricles of fetal hearts using the speckle tracking method of ejection fraction (EF), end-diastolic and end-systolic volumes of the ventricles of the heart.Results. Significant differences were established in GLD of RV and LV between singleton and monochorionic multiple pregnancies (LV: -21.2 ± 2.03 versus -23.41 ± 0 .25, p = 0.003); RV: — 20.3 ± 2.5 versus -23.3 ± 2.5, p = 0.013). Significant differences were revealed in GLD of the LV and RV in recipient fetuses before and after laser coagulation of placental anastomoses (LPCA) [LV in recipients before LCPA (- 20.4 ± 2.98) versus LV recipient after LCPA (-24.2 ± 3.3), p = 0.018], [RV in recipients before LKPA (- 20.4 ± 2.8) vs. RV in recipients after laser coagulation of placental anastomoses (-23.7 ± 3.4, p = 0.012].Conclusion. Assessment of the cardiac function of fetuses from monochorionic twins using the echocardiographic speckle tracking technique makes it possible to identify early changes in fetal myocardial function in twins from monochorionic diamniotic twins, as well as to carry out reliable testing monitoring changes in cardiac function over time.

Laser Photocoagulation Treatment for Candida Chorioretinitis.

The purpose of this article is to describe the novel surgical technique utilizing laser photocoagulation for the management of Candida chorioretinal lesions that are refractory to medical therapy. This report presents the use of laser photocoagulation applied to a Candida chorioretinal lesion that was refractory to extensive systemic and intravitreal antifungal medications. The presenting lesion was in an immunosuppressed patient. Argon laser photocoagulation was applied onto and surrounding the Candida chorioretinal lesion. Following laser photocoagulation, the Candida chorioretinal lesion has remained resolved for over one year with no further reactivation, extensions, or satellites. Candida chorioretinitis can be extremely therapeutically resistant. Current treatment involves systemic and intravitreal antifungals. There are currently limited options for chorioretinal lesions refractory to standard medical therapy. The authors report the novel application of laser photocoagulation as a potential treatment option in refractory cases of Candida chorioretinitis.

Bim Expression Influences Choroidal Endothelial Cell Characteristics and Their Response to Therapeutic Intervention.

In the aging population, choroidal vessels grow through the Bruch's membrane, resulting in a loss of central vision due to choroidal neovascularization (CNV). During active neovascularization, CNV is associated with inappropriate levels of apoptosis in multiple cell types, including choroidal endothelial cells (ChECs). Bim is a pro-apoptotic member of the Bcl-2 family. It is essential for cell apoptosis due to exposure to drugs such as dexamethasone or decreased pro-survival factors, including vascular endothelial growth factor (VEGF). To better elucidate the cell autonomous contribution of Bim expression in the integrity and neovascularization of the choroidal vasculature, we isolated ChECs from wild-type and Bim-deficient (Bim-/-) mice. ChECs lacking Bim expression demonstrated increased expression of VEGF, osteopontin, and the inflammatory cytokines Rantes/Ccl5 and IL6. Bim-/- ChECs were more proliferative and demonstrated an increased capacity to undergo capillary morphogenesis. Anti-VEGF had a diminished capacity to disrupt capillary morphogenesis in Bim-/- ChECs. In vivo, utilizing the mouse laser photocoagulation model, anti-VEGF treatment mitigated CNV in wild-type but not Bim-/- mice. We also tested other modalities that are thought to not require the intrinsic death pathway for their function and showed that propranolol, anti-CTGF, and the TSP1-mimetic peptide ABT898 mitigated CNV in mice lacking Bim expression to varying degrees. Thus, in ChECs, Bim expression could impact the effectiveness of treatment modalities that require the intrinsic death pathway to mitigate CNV.

Inflammasome activation aggravates choroidal neovascularization.

Inflammasome activation is implicated in diseases of aberrant angiogenesis such as age-related macular degeneration (AMD), though its precise role in choroidal neovascularization (CNV), a characteristic pathology of advanced AMD, is ill-defined. Reports on inhibition of inflammasome constituents on CNV are variable and the precise role of inflammasome in mediating pathological angiogenesis is unclear. Historically, subretinal injection of inflammasome agonists alone has been used to investigate retinal pigmented epithelium (RPE) degeneration, while the laser photocoagulation model has been used to study pathological angiogenesis in a model of CNV. Here, we report that the simultaneous introduction of any of several disease-relevant inflammasome agonists (Alu or B2 RNA, Alu cDNA, or oligomerized amyloid β (1-40)) exacerbates laser-induced CNV. These activities were diminished or abrogated by genetic or pharmacological targeting of inflammasome signaling constituents including P2rx7, Nlrp3, caspase-1, caspase-11, and Myd88, as well as in myeloid-specific caspase-1 knockout mice. Alu RNA treatment induced inflammasome activation in macrophages within the CNV lesion, and increased accumulation of macrophages in an inflammasome-dependent manner. Finally, IL-1β neutralization prevented inflammasome agonist-induced chemotaxis, macrophage trafficking, and angiogenesis. Collectively, these observations support a model wherein inflammasome stimulation promotes and exacerbates CNV and may be a therapeutic target for diseases of angiogenesis such as neovascular AMD.

Exploring the Protective Effects of Xueshuantong Injection on Central Retinal Vein Occlusion

Abstract Objective: This study aimed to assess the therapeutic effects of Xueshuantong (XST), a traditional Chinese medicine that has been studied for its protective effects on the cardiovascular system and anti-inflammatory properties, on central retinal vein occlusion (CRVO) in rabbits and rats. Materials and Methods: CRVO was induced in rabbits and rats by laser photocoagulation. The animals were then treated with different doses of XST or lyophilized XST (L). Color fundus photography, fundus fluorescein angiography, histological examination, TUNEL assay, and immunofluorescence staining were conducted to evaluate the therapeutic effects. Results: The study revealed that both XST and lyophilized XST injections exhibited therapeutic effects against CRVO in rabbits and rats. The drugs improved retinal lesions and structure and mitigated apoptosis of retinal cells to varying degrees. Additionally, downregulation of tumor necrosis factor-α and interleukin-6 within the retina was observed in both drug groups. Conclusions: The results indicate that XST injection exhibited significant protective effects against experimental CRVO by regulating angiogenesis and inflammation, suggesting its potential as an effective therapeutic strategy for treating CRVO.

A rare case report of endobronchial neurofibroma treated with transbronchial endoscopic resection and literature review.

Endobronchial neurofibroma is an extremely rare neoplastic disease. The majority of endobronchial neurofibroma are symptomatic, but nonspecific. The treatment of endobronchial neurofibroma is controversial that surgery is previously considered to be the main option. With the development of bronchoscopic intervention, most endobronchial neurofibroma can be treated with transbronchial endoscopic resection with few complications. Here we reported a case of diagnosed endobronchial neurofibroma that was successfully resected with transbronchial electrical snaring and laser coagulation. Moreover, the relevant literature was reviewed to raise awareness of this disease. A 57-year-old man presented to our hospital with cough, sputum, and shortness of breath for 2 days. Physical examination was normal. Laboratory tests revealed moderately increased C-reactive protein. Chest computed tomography showed a 10 × 8 mm round, polypoid-shaped nodule located in the left main bronchus, which was heterogeneous after contrast enhancement. It demonstrated a smooth, round, hypervascularized neoplasma obstructing most of the lumen of the upper left main bronchus under bronchoscopy. The tumor was removed with electrical snaring and laser coagulation completely instead of surgical resection, without any complications. Pathologically, it was confirmed of endobronchial neurofibroma. Repeated bronchoscopy showed no recurrence of the tumor, and the procedure site healed with a little of fibrotic scar formation. Endobronchial neurofibroma is rare. Although the standard treatment for endobronchial neurofibroma is surgery, transbronchial endoscopic resection (electrical snaring and laser coagulation) is an applicable option, especially for those lesions strictly in the lumen.

Treatment Options and Referral Pattern among Patients with Retinal Diseases Attending an Eye Clinic in a Tertiary institution, North Central Nigeria.

Objectives: The aim of the study was to determine the treatment modalities and pattern of referral of patients with retinal diseases in the eye clinic. Methods: All consenting new patients attending the eye clinic were recruited for the study and interviewed by the author. The treatment offered to the participants diagnosed with retinal disease (medical, surgical, LASER, optical or a combination) was recorded. Information on the patient’s referral for vitreoretinal consultation (this could be ‘yes’ or ‘no’) and reasons for the referral were also documented and analyzed. Results: treatment options for the 278 study participants were: medical for 100 (36%), optical for 94 (33.8%) optical correction, surgical for 24 (8.6%), LASER photocoagulation for 6 (2.2%) and a combination of LASER photocoagulation and intravitreal avastin injection for 20 (7.2%) patients. Counselling and watchful expectancy accounted for treatment of 34 (12.2%) patients. Seventy-four patients of the 278 included in the study had retinal diseases. Of these 74 with retinal diseases, 46 (62.2%) were referred to vitreoretinal units out of which 39 (84.8%) patients were referred to the vitreoretinal unit in JUTH and 7 (15.2%) were referred to vitreoretinal units elsewhere. The referrals were largely on account of unavailability of requisite equipment in 3 (42.8%) patients, surgical expertise in 2 (28.6%) patients and patient request in 2 (28.6%) cases. Conclusion: The need for establishment of standard vitreoretinal services strategically in each geo-political zone of Nigeria to cater more efficiently to the needs of patients with retinal diseases and appropriate referral cannot be overemphasized

Predictive Factors for Functional and Anatomical Outcomes After Anti-VEGF Treatment for Macular Edema in Patients with Branch Retinal Vein Occlusion.

This study aimed to identify predictive factors for the improvement of best-corrected visual acuity (BCVA) and reduction of central macular thickness (CMT) after treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) in a real-world setting. This retrospective study included patients with ME secondary to BRVO who were treated with intravitreal injection of bevacizumab as the first-line therapy and were followed up for 12 months. Demographic and clinical data, in addition to baseline spectral domain optical coherence tomography (SD-OCT) features, were considered as possible biomarkers of final BCVA and CMT. We also collected the data concerning the need for additional treatment including sectorial laser photocoagulation, change to another anti-VEGF agent, or intravitreal corticosteroid injection. A total of 161 eyes were analyzed. BCVA significantly improved from baseline to 12-month follow-up (0.6 and 0.4 logMAR, respectively; P 0.01). CMT decreased significantly during the follow-up period (from 498.0 to 325.0 m; P 0.01). Final BCVA correlated positively with baseline BCVA (P 0.01, r = 0.57). Older age at diagnosis and baseline SD-OCT findings including CMT, disruption of the retinal inner layers, retinal pigment epithelium (RPE) damage, and impairment of the ellipsoid zone and external limiting membrane negatively affected final BCVA (P 0.01). Multiple regression analysis identified age and BCVA at baseline as the only independent predictors of final BCVA (P = 0.001 and P 0.01, respectively). No association was found between clinical data, SD-OCT parameters, and final CMT. Various clinical and SD-OCT parameters are prognostically relevant for visual improvement in ME secondary to BRVO. Age at diagnosis and baseline BCVA were found to be independent predictors of visual outcome.

Laser Treatment for Diabetic Retinopathy: History, Mechanism, and Novel Technologies.

Background: Diabetic retinopathy (DR), as a complication of diabetes mellitus (DM), remains a significant contributor to preventable vision impairment in the working-age population. Laser photocoagulation is essential in treating DR in conjunction with anti-vascular endothelial growth factor (VEGF) injection, steroids, and vitrectomy. This review summarizes the history of laser photocoagulation and highlights its current role and long-term effectiveness in real-world conditions. Methods: The National Clinical Trial (NCT), PubMed, Google Scholar, and China National Knowledge Infrastructure (CNKI) databases were searched utilizing combined or individual keywords, and a total of 121 articles were reviewed by the authors. Results: Several novel laser photocoagulation technologies, such as patterned scanning laser, subthreshold micropulse laser, navigated laser, multimodal imaging-guided laser, and retina rejuvenation therapy, substantially decrease the adverse effects and improve the accuracy and security of laser therapy. Numerous studies have demonstrated the outstanding clinical efficacy of combination therapies with pharmacologic treatments like anti-VEGF in treating DR and diabetic macular edema (DME). A 20-year follow-up retrospective study in our center preliminarily demonstrated the long-term effectiveness of conventional laser photocoagulation. Conclusions: More clinical trials are required to confirm the clinical effectiveness of novel laser technologies. Better treatment protocols for the combination therapy may be detailed. Anti-VEGF treatment has better effects, especially for DME and in a short period. But in real-world conditions, given the long-term effectiveness and economic advantages of conventional laser treatment, it should be prioritized over anti-VEGF injection in certain situations.

A drug delivery system of HIF-1α siRNA nanoparticles loaded by mesenchymal stem cells on choroidal neovascularization.

Aim: To assess mesenchymal stem cells (MSCs) as carriers for HIF-1αsiRNA-loaded nanoparticles (NPs) for targeted therapy of experimental choroidal neovascularization (CNV).Materials & methods: A poly (lactic-co-glycolic acid) (PLGA)-core/lipid-shell hybrid NP was designed. The transfection efficacy of MSCs with the hybrid NPs was assessed. Mice were intravenously injected with MSCs after laser photocoagulation and CNV was assessed at 7days post-injection.Results & conclusion: The transfection efficiency of hybrid NPs into MSCs was 72.7%. HIF-1α mRNA expression in 661w cells co-cultured with MSC-hybrid-siRNA NPs was significantly lower. Intravenous delivery of MSC-hybrid-siRNA NPs greatly reduced CNV area and length. Intravenous injection of MSC-hybrid-siRNA NPs achieved therapeutic efficacy in reducing CNV area. The MSC-mediated homing enabled targeted inhibition of ocular angiogenesis.

Management of retinal diseases, therapeutic association between ophthalmology and endocrinology in the treatment of diabetic retinopathy

Introduction: Effective management of retinal diseases, especially diabetic retinopathy, is crucial for preventing severe visual complications. Collaboration between ophthalmologists and endocrinologists plays a fundamental role in the effective treatment of this condition, aiming to preserve vision and improve patients' quality of life. Methods: A bibliographic review was conducted to understand the management of retinal diseases and the therapeutic association between ophthalmology and endocrinology in the treatment of diabetic retinopathy. We used databases such as MEDLINE, PubMed, and Scielo to identify relevant articles published in the last 20 years. Inclusion and exclusion criteria were defined to ensure the selection of pertinent studies. Results: After the search and selection of articles, patterns and trends in the management of diabetic retinopathy were identified. A variety of treatment options were located, including laser photocoagulation, intravitreal injections of medications, and vitreoretinal surgery. The importance of metabolic control of diabetes to prevent retinal damage was noted. The analysis of the studies also highlighted that the interaction between these specialties ensures better clinical outcomes. Conclusion: The importance of collaboration between ophthalmologists and endocrinologists in the management of diabetic retinopathy is reinforced. An integrated approach that considers both ophthalmological and endocrinological aspects of the disease is essential to provide effective care to patients. This cooperation can result in better visual outcomes and quality of life for those affected by diabetic retinopathy.

Telomere Biology Disorders: Report on Clinical and Angiographic Findings

PurposeTo evaluate the retinal vasculature in pediatric patients with telomere biology disorders (TBD). DesignRetrospective consecutive case series. SubjectsPediatric patients with a diagnosis of TBD who underwent widefield fluorescein angiography (FA). MethodsElectronic medical records of pediatric patients with TBD at a tertiary referral eye center were reviewed from January 2019 to July 2023. Vascular phenotype was assessed by reviewing FA images. Main outcomes measuresIncomplete peripheral vascularization, aneurysmal dilatation, terminal arborization, anastomotic loops, capillary dropout, neovascularization, tortuosity, leakage from tractional membranes, and blockage from hemorrhage. ResultsFourteen eyes from 7 patients were included. All patients were genetically confirmed for TBD. The most common genetic variants were in CTC1 (5 patients; 71.4%), ACD (1 patient; 14.3%), and RTEL1 (1 patient; 14.3%). On FA, the most common findings were incomplete peripheral vascularization (14 eyes, 100%), aneurysmal dilatation (12 eyes, 85.7%), terminal arborization (12 eyes, 85.7%), anastomotic loops (12 eyes, 85.7%), capillary dropout (10 eyes, 71.4%), and neovascularization (9 eyes, 64.3%). Regarding treatment, laser photocoagulation (14 eyes, 100%), intravitreal bevacizumab injection (13 eyes, 92.6%), and sub-tenon’s Kenalog (11 eyes, 78.6%) were utilized. All patients managed with laser photocoagulation and/or bevacizumab required multiple treatments. ConclusionOur study describes a spectrum of vascular changes evidenced by widefield FA in pediatric patients with genetically confirmed TBD. Although further research is warranted to fully understand the etiology of these subtle vascular anomalies, widefield FA should be conducted in patients with genetically confirmed or suspected TBD.

Laser Hemorrhoidoplasty and Lateral sphincterotomy Procedures vs Conservative Treatment for Hemorrhoids and Fissure in Ano: A Trial Comparing Laser and Conservative treatments

Objective: According to the ‘‘vascular’’ theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. Aim: Our aim was to compare the hemorrhoid laser procedure and laser aided lateral sphincterotomy vs conservative treatment of symptomatic hemorrhoids and fissure in ano. Material and Method: A comparison trial between hemorrhoid laser procedure, lateral sphincterotomy and conservative treatment for hemorrhoids and fissure in ano was made. This study was conducted at Vels Medical College and Hospital, Manjankaranai, Tamil Nadu. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 30 patients treated with the laser hemorrhoidoplasty, 30 patients–with laser aided lateral sphincterotomy and 40 patients treated with conservative methods. Operative time, postoperative pain, post-op healing time were evaluated. Results: A total number of 100 patients ( 65 men and 35 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty, laser sphincterotomy and conservative treatments were observed in operative time and early postoperative pain. The procedure time for LHP was 15.49 min laser aided lateral sphincterotomy was 10.19 min. Conclusion: The laser hemorrhoidoplasty and laser guided sphincterotomy procedures were more effective than conservative methods. Postoperative pain and healing time were drastically less in the early and late post op period.

Real-time placental vessel segmentation in fetoscopic laser surgery for Twin-to-Twin Transfusion Syndrome

Twin-to-Twin Transfusion Syndrome (TTTS) is a rare condition that affects about 15% of monochorionic pregnancies, in which identical twins share a single placenta. Fetoscopic laser photocoagulation (FLP) is the standard treatment for TTTS, which significantly improves the survival of fetuses. The aim of FLP is to identify abnormal connections between blood vessels and to laser ablate them in order to equalize blood supply to both fetuses. However, performing fetoscopic surgery is challenging due to limited visibility, a narrow field of view, and significant variability among patients and domains. In order to enhance the visualization of placental vessels during surgery, we propose TTTSNet, a network architecture designed for real-time and accurate placental vessel segmentation. Our network architecture incorporates a novel channel attention module and multi-scale feature fusion module to precisely segment tiny placental vessels. To address the challenges posed by FLP-specific fiberscope and amniotic sac-based artifacts, we employed novel data augmentation techniques. These techniques simulate various artifacts, including laser pointer, amniotic sac particles, and structural and optical fiber artifacts. By incorporating these simulated artifacts during training, our network architecture demonstrated robust generalizability. We trained TTTSNet on a publicly available dataset of 2060 video frames from 18 independent fetoscopic procedures and evaluated it on a multi-center external dataset of 24 in-vivo procedures with a total of 2348 video frames. Our method achieved significant performance improvements compared to state-of-the-art methods, with a mean Intersection over Union of 78.26% for all placental vessels and 73.35% for a subset of tiny placental vessels. Moreover, our method achieved 172 and 152 frames per second on an A100 GPU, and Clara AGX, respectively. This potentially opens the door to real-time application during surgical procedures. The code is publicly available at https://github.com/SanoScience/TTTSNet.

Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa.

Vasa previa is a condition where unprotected fetal vessels cross the cervix within the membranes, posing a considerable risk of fetal death or severe morbidity if the membranes rupture before or during delivery. There has not been a definitive in utero treatment for this condition. Patients are typically closely monitored and hospitalized in the early third trimester and scheduled for cesarean delivery before term. This approach poses considerable physical, social, psychological, and financial challenges for pregnant patients and their families. Furthermore, fetal vessel rupture may lead to severe hypoxic-ischemic injury and consequent neurodevelopmental impairment. Finally, babies delivered early due to vasa previa may face both the short- and long-term consequences of prematurity. Recently, fetoscopic laser photocoagulation using a single-port fetoscope has emerged as a potential therapeutic option for patients with types II and III vasa previa. This innovative approach aims to reduce hospital stays, increases the chance of successful vaginal delivery, and potentially allows pregnancies to reach full term, providing lifelong benefits for the infant. Preliminary clinical studies on human subjects have demonstrated promising results concerning the feasibility, safety, and efficacy of this intervention for a subset of patients with types II and III vasa previa. After reviewing the current state of the art, we argued that offering fetoscopic laser photocoagulation in specialized centers under IRB supervision meets the ethical obligations of beneficence and non-maleficence for both pregnant and fetal patients, as well as the autonomy-based obligations for pregnant patients.

Pre-term Familial Exudative Vitreoretinopathy: A Novel Nonsense LRP5 Mutation.

This case report details the diagnosis and management of a pre-term infant with aggressive bilateral retinal pathology. A 4-week-old preterm baby girl, born at 28 weeks and 6 days to consanguineous parents, was referred for suspected aggressive posterior retinopathy of prematurity (ROP). She had a family history of bilateral retinal detachments and intellectual disability in an older sister. Clinical assessment included retinal examination, fluorescein angiography, optical coherence tomography, dual-energy X-ray absorptiometry (DEXA), and genetic testing. The genetic testing involved sequence analysis and copy number variation analysis of 25 genes related to vitreoretinopathy. Retinal examination and fluorescein angiography revealed extensive non-perfusion and telangiectatic vessels in both eyes, and a macula-involving tractional retinal detachment in the left eye. Despite treatment with intravitreal bevacizumab and laser photocoagulation, they progressed to total retinal detachment and no light perception in both eyes. Genetic testing revealed a pathogenic homozygous nonsense mutation in the LRP5 gene (c.3259C>T, p.(Gln1087*)), a mutation not previously reported in association with familial exudative vitreoretinopathy (FEVR). At 10 months of age, DEXA demonstrated normal bone density, diverging from the typical presentation of osteoporosis pseudoglioma syndrome associated with LRP5 mutations. This case describes a novel mutation in a complex retinal disease and underscores the necessity of considering pre-term FEVR in the differential diagnosis of atypical or aggressive ROP in preterm infants. The overlap in clinical features between ROP and FEVR highlights the complexity of diagnosis and management and the importance of genetic testing in preterm infants with retinal vascular abnormalities.

Selective nanosecond laser removal of retinal pigment epithelium for cell therapy

Retinal pigment epithelial (RPE) cells play a crucial role in the health of the retina, and their dysfunction is associated with various ocular diseases. The transplantation of RPE cells has been proposed as a potential treatment for numerous degenerative diseases, including geographic atrophy from macular degeneration. However, current models to induce RPE damage in animal models prior to transplantation involve mechanical scraping, chemical administration, or laser photocoagulation techniques, which can damage the overlying neurosensory retina. This study aims to investigate the feasibility and efficacy of nanosecond duration laser treatment to safely remove large areas of RPE cells without causing damage to the adjacent tissue or affecting the retinal architecture. Twelve pigmented rabbits were treated with a nanosecond laser on each eye at a laser energy ranging from 200 to 800 nJ with a treated area of 5 × 5 mm2. Human induced pluripotent stem cells-differentiated to RPE (hiPSC-RPE) cells labeled with indocyanine green (ICG), an FDA approved dye, were transplanted subretinally into the damaged RPE areas at day 14 post-laser treatment. The RPE atrophy and hiPSC-RPE cell survival was evaluated and monitored over a period of 14 days using color photography, fluorescein angiography (FA), photoacoustic microscopy (PAM), and optical coherence tomography (OCT) imaging. All treated eyes demonstrated focal RPE loss with a success rate of 100%. The injured RPE layers and the transplanted hiPSC-RPE cells were visualized in three dimensions using PAM and OCT. By performing PAM at an optical wavelength of 700 nm, the location of hiPSC-RPE cells were identified and distinguished from the surrounding RPE cells, and the induced PA signal increased up to 18 times. Immunohistochemistry results confirmed the grafted hiPSC-RPE replaced regions of RPE damage. This novel technique has the potential to serve as an animal model of RPE degeneration, to improve models of RPE transplantation, and may help accelerate translation of this therapeutic strategy for clinical use.

Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease.

To describe the multimodal imaging features, treatment, and outcomes of patients diagnosed with adult-onset Coats disease. This retrospective study included patients first diagnosed with Coats disease at ≥18 years of age between September 2017 and September 2021. Some patients received anti-vascular endothelial growth factor (VEGF) therapy (conbercept, 0.5 mg) as the initial treatment, which was combined with laser photocoagulation as needed. All the patients underwent best corrected visual acuity (BCVA) and intraocular pressure examinations, fundus color photography, spontaneous fluorescence tests, fundus fluorescein angiography, optical coherence tomography (OCT), OCT angiography, and other examinations. BCVA alterations and multimodal image findings in the affected eyes following treatment were compared and the prognostic factors were analyzed. The study included 15 patients who were aged 24-72 (57.33±12.61)y at presentation. Systemic hypertension was the most common associated systemic condition, occurring in 13 (86.7%) patients. Baseline BCVA ranged from 2.0 to 5.0 (4.0±1.1), which showed improvement following treatment (4.2±1.0). Multimodal imaging revealed retinal telangiectasis in 13 patients (86.7%), patchy hemorrhage in 5 patients (33.3%), and stage 2B disease (Shield's staging criteria) in 11 patients (73.3%). OCT revealed that the baseline central macular thickness (CMT) ranged from 129 to 964 µm (473.0±230.1 µm), with 13 patients (86.7%) exhibiting a baseline CMT exceeding 250 µm. Furthermore, 8 patients (53.3%) presented with an epiretinal membrane at baseline or during follow-up. Hyper-reflective scars were observed on OCT in five patients (33.3%) with poor visual prognosis. Vision deteriorated in one patient who did not receive treatment. Final vision was stable in three patients who received laser treatment, whereas improvement was observed in one of two patients who received anti-VEGF therapy alone. In addition, 8 of 9 patients (88.9%) who received laser treatment and conbercept exhibited stable or improved BCVA. Multimodal imaging can help diagnose adult-onset Coats disease. Anti-VEGF treatment combined with laser therapy can be an option for improving or maintaining BCVA and resolving macular edema. The final visual outcome depends on macular involvement and the disease stage.