Retinal Photocoagulation Research Articles

Effectiveness of intraoperative optical coherence tomography on vitrectomy for proliferative diabetic retinopathy.

We sought to verify the effect of intraoperative optical coherence tomography (iOCT) on vitrectomy for the treatment of proliferative diabetic retinopathy (PDR). Retrospective study. We reviewed 178 eyes with PDR treated with 25-gauge vitrectomy by a single surgeon between April 2013 and December 2017. In total, 98 eyes of 77 patients with PDR (mean age, 52.5 ± 11.7 years) treated with vitrectomy using iOCT (iOCT group) and 80 eyes of 60 patients with PDR (mean age, 53.1 ± 10.9 years) treated without iOCT (non-iOCT group) were included in the study. To determine the effects of combining vitrectomy with iOCT, a comparison was made of patients treated with this combination and patients treated with vitrectomy without iOCT. The effects of these treatments were assessed on the basis of intraoperative complications, reoperation ratios, postoperative complications, operation times, and postoperative visual acuity. The operation time was significantly reduced for the iOCT group (72.9 ± 23.9min) when compared with the non-iOCT group (91.3 ± 31.2min) (P = .001). The incidences of intraoperative complications, reoperation, and postoperative complications did not differ significantly between the 2 groups (P = .542, 0.258, and 0.860 respectively). Six months after surgery, the postoperative visual acuity did not differ significantly between the 2 groups (P = .508). Multiple linear regression analysis revealed that the operation time was significantly correlated with iOCT (beta [standard partial regression coefficient] = - 0.28, P < .001), the fibrovascular proliferative membrane (beta = 0.17, P = .009), cataract surgery (beta = 0.22, P = .016), preoperative retinal photocoagulation (beta = - 0.14, P = .021), intraoperative complications (beta = 0.16, P = .023), and posterior vitreous detachment (beta = - 0.14, P = .04). Use of iOCT reduced the operation time without affecting the incidence rates of intraoperative and postoperative complications, reoperation ratios, or postoperative visual acuities in patients who underwent vitreous surgery for PDR.

INTRAOPERATIVE THREE-DIMENSIONAL FLUORESCEIN ANGIOGRAPHY-GUIDED PARS PLANA VITRECTOMY FOR BRANCH RETINAL VEIN OCCLUSION.

To show surgical results of the intraoperative 3D fluorescein angiography-guided pars plana vitrectomy for branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere. The NGENUITY 3D visualization system was used for the digital-assisted vitrectomy. Three-dimensional fluorescein angiography-guided pars plana vitrectomy was performed in three patients with branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere. In all eyes, the scatter retinal photocoagulations for a nonperfusion area, depicted as hypofluorescein, and the segmentation and delamination of the perivascular fibrovascular proliferative membrane, depicted as hyperfluorescein, could be safely performed on the same screen while implementing intraoperative 3D fluorescein angiography. Three-dimensional fluorescein angiography-guided pars plana vitrectomy, a novel approach that fully uses the advantages of digital-assisted vitrectomy, can be one of the useful techniques for the treatment of branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere.

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia.

To observe the clinical effect of pars plana vitrectomy (PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma (PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment (MHRD) with PS. This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS (62 eyes) were enrolled in the study. Patients were divided into 23G PPV combined with PS marginal retina intraoperative photocoagulation group (combined group) and conventional surgery group (conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane (ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity (BCVA) and average number of operations were observed and compared between the two groups. The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7% (29/31) and 67.7% (21/31), respectively (χ2 =6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2% (23/31) and 67.7% (21/31), respectively (χ2 =0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group (t=-41.962, P≤0.001). Postoperative logMAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the logMAR BCVA before surgery, each group was improved (t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the logMAR BCVA between the eyes of the two groups (t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average (t=-2.705, P=0.009). Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.

Diabetic Retinopathy and Typical Retinitis Pigmentosa

A 39-year-old woman with typical retinitis pigmentosa (RP) for 9 years and a positive family history of night blindnesswas diagnosed with diabetes mellitus (DM). She developed proliferative diabetic retinopathy (PDR) during the courseof disease. She was promptly managed with pan retinal photocoagulation (PRP). PDR developing in a case of typicalRP is extremely rare and has not been reported in the literature to date. Recognition of this rare, vision threateningcomplication, points out a definite need to further look deep into the pathogenesis of diabetic retinopathy.

Laser Treatment Modalities for Diabetic Retinopathy

Diabetes is a chronic progressive metabolic disorder that is caused by the body's inability to regulate blood glucose levels. If uncontrolled, it can lead to various complications. Among its various complications, long-term diabetes leads to diabetic retinopathy (DR). It is a disease involving blood vessels and the destruction of retinal nerves. It is usually classified into two types: proliferativediabetic retinopathy (PDR) and nonproliferative diabetic retinopathy (NPDR). It progresses and causes loss of vision. The leading cause of loss of vision is diabetic macular edema (DME). The argon laser is used as a modality in the management of PDR. There are various types of laser photocoagulation, such as peripheral retinal laser photocoagulation,focal macular laser photocoagulation, and grid photocoagulation. DR results in various adverse consequences such as vitreous hemorrhage, fibrosis, traction, detachment of the retina, and glaucoma. To assess DR, a detailedfundus examination with a slit lamp biomicroscopeneeds to be done. Seven-standard field stereoscopic-color fundus photography needs to be done for documentation and follow-up. Patients with diabetesmellitus (DM) type 1 have a greater risk of suffering fromDR. Another major complication of the condition is DME, which is characterized by an increase in the permeability of vessels and the thickening of the central part of the retina along with the accumulation of hard exudates on the macula. This article discussesvarious laser therapy modalities for the treatment of DR, their types, mechanisms, and aims. Clinical features of DR include abnormal dilatation of capillaries, and outpouchings in the form of microaneurysm from the capillary wallareone of the earliest and most dangerous changes; later, non-perfusion of the retina occurs, which is associated with cotton wool spots and blot hemorrhages. In patients suffering from PDR and maculopathy, peripheral retinal laser photocoagulation is used as a mode of intervention.

Optical Coherence Tomography Following Panretinal Photocoagulation Demonstrating Choroidal Detachment

Retinal laser therapy such as panretinal photocoagulation can be associated with complications, including rare cases of choroidal detachment. This report describes high-resolution optical coherence tomography (OCT) imaging after retinal laser panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR) demonstrating choroidal detachment. A series of three sequential patients with high-risk proliferative diabetic retinopathy who were PRP laser naïve were examined with spectral-domain OCT immediately after green solid-state laser or PASCAL® PRP treatment. All three patients demonstrated a significant choroidal detachment immediately after PRP treatment. By one month after PRP, the choroidal detachment resolved spontaneously in all patients. OCT examinations were performed to detect and evaluate the severity and the change of choroidal detachment and thickness measurements were quantified and demonstrated a mean decrease in choroidal thickness of 122 µm (p &lt; 0.05 in all patients). Conventional green solid-state laser and PASCAL® laser both have the risk of developing complications such as choroidal detachment. While the rate of choroidal detachment has been reported to be quite low, this could be due to subclinical, self-limited, choroidal detachments. The risk could be larger than previously reported using modern high-resolution clinical optical imaging such as OCT.

Application of Artificial Intelligence in Ophthalmology for the Diagnosis and Treatment of Eye Diseases

In this paper, we present the main aspects of artificial intelligence application in ophthalmology for the diagnosis and treatment of eye diseases on the example of developing a computer system for personalizing retinal laser photocoagulation. Approaches to the automation of eye disease prediction and treatment based on fundus images are described. Four problems of applying the neural network approach are highlighted. Decision support information technology for personalizing laser treatment of diabetic macular edema and identifying prognostic factors of surgical outcome using methods of intellectual analysis of large unstructured data is described. The system allows the doctor to form a plan of optimal coagulation arrangement for retinal laser coagulation for each case, to predict the quality of laser coagulation depending on the initial data on the localization and severity of edema and to improve his skills by comparing the result of coagulation performed and the coagulation plan proposed by the system.

Retinal Laser Photocoagulation

Background: Panretinal photocoagulation (PRP) is the standard gold therapy to prevent vision loss in severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).Contents: Photocoagulation is a therapeutic technique using a solid light source to coagulate tissue. This light energy is absorbed by the retinal tissue and converted into thermal energy. This energy then causes the abnormal blood vessels in the retina to shrink and disappear. It takes approximately 6-8 weeks for complete shrinkage of blood vessels.Conclusion: Laser retinal photocoagulation is the standard therapy in diabetic retinopathy patients. By causing thermal lesions of the pathological retinal vessels, the expected outcome can be achieved in 2-3 months of therapy.

Chorioretinal venous anastomosis for non-ischemic retinal vein occlusion.

Retinal vein occlusion (RVO) refers to the occlusion of the central retinal vein or primary and secondary branches caused by multiple factors. Clinical treatments for it include intravitreal or systemic vasodilator application, local usage of steroids and NSAID (non-steroidal anti-inflammatory drugs), thrombolysis, hemodilution, retinal laser photocoagulation, vitrectomy with vascular sheath incision, chorioretinal venous anastomosis (CRVA), and so on. At present, most treatments are aimed at RVO complications, while chorioretinal vein anastomosis can fundamentally reflux retinal vein blood through the choroid by venous vascular remodeling. Reports on the treatment of retinal vein occlusion by chorioretinal anastomosis are numerous in various countries. As a treatment means, CRVA can drain the venous blood, skipping the thrombosis spot, thus partially relieving anatomical vascular occlusion to achieve a therapeutic purpose. In this study, CRVA is evaluated from the aspects of indications, implementation process, postoperative effect evaluation, complications, and combination with anti-VEGF treatment. Based on the development of laser technology and vitrectomy, we hope to further review this treatment and provide a new reference for the clinical treatment of RVO.

A Review of Central Serous Chorioretinopathy: Clinical Presentation and Management.

Central serous chorioretinopathy (CSC) may be understood as a disease of the chorioretina with the serous detachment of the neurosensory retina, which is secondary to single or multiple localized defects in retinal pigment epithelium (RPE). CSC is one of the common forms of loss of vision, usually seen in people who do belong to the working-age group. The most common symptoms are blurring of vision, usually unilateral and which is perceived as a scotoma in the center of the field of vision with associated metamorphopsia and micropsia. The risk factor associated with CSC is psychosocial stress, type A personality, pregnancy, and hypercortisolism. Normal vision is often restored within a span of a few months. After around three months, if the resolution of acute CSC did not change or, let us say, in the case of CSC that is chronic, one should consider treatment. In acute CSC, to resolve symptoms, especially in individuals who work in a field where eyesight is of utmost importance, for example, pilots, focal photocoagulation of leaking RPE lesions can be performed. CSC is a prototype cause of serous neuroretinal detachment, which involves the fovea. CSC symptoms reflect the separation between the RPE and the photoreceptors and the bullous distension of the foveal retina. The effect of therapy as such on the long-term outcome of vision visual is not sufficiently documented. The management would largely be dependent on the appropriate diagnosis made based on clinical presentations, and thus it becomes very much necessary to have knowledge about the same and counsel the patient regarding the association between stress and disease pathology. In acute CSC, retinal photocoagulation is successful to a good extent in eliminating or reducing the leakage of RPE and hence it induces resolution of the serous detachment. This review article is made to make sure the reader is updated about the various clinical and management aspects of CSC by providing a comprehensive idea that is obtained from various well-acknowledged databases across the globe on CSC.

Long-term clinical prognosis of 335 infant single-gene positive FEVR cases

PurposeTo describe and analyze the clinical prognosis of infants diagnosed of familial exudative vitreoretinopathy (FEVR) with single gene mutation in long-term follow-up.MethodsA retrospective case study was conducted on 355 FEVR infants with single positive gene.ResultOf the 335 single-gene positive infant FEVR cases (under 3 years old), 20% (n = 67) was diagnosed of strabismus at first visit. Staging of various genotypes was different (P < 0.001). Patients with NDP mutations presented the most severe clinical phenotypes and patients with ZNF408 mutations presented the mildest clinical phenotypes. Most infants underwent surgery under 1 year old (5th stage 75 of 108 [69.44%]). The axial length of different genotypes showed no significant difference (P = 0.2891). The 1st to 3rd stage cases were given intravitreal injection and/or retina photocoagulation with the last follow-up vision above 20/67. The 4th to 5th stage cases received the transcorneal vitrectomy with lensectomy or lens sparing vitrectomy (LSV), whose lens maintained transparent after LSV (11/14[78.58%]). After 2 to 10 years of follow-up, 37.96% (41/108) of post-surgery cases showed retinal funnel-like unfold and posterior pole unfold, 69.57% (16/ 23) of which received second surgery for closure of pupil with good prognosis. At the last follow-up, 20% (60/300) were with vision above 20/200.ConclusionLRP5 gene mutation was the most common mutation in FEVR patients. The severity of the clinical phenotype varied with different gene mutations. The main surgical methods for cases at Stage 4–5 were transcorneal vitrectomy with lensectomy or LSV. The earlier FEVR occurred, the worse prognosis would be. Active surgical intervention and lens sparing were necessary for cases at Stage 4–5.

The association between different hypoglycemic regimens and postoperative diabetic macular edema after vitrectomy in the Japanese patients with proliferative diabetic retinopathy.

PurposeTo study the association between different hypoglycemic regimens and postoperative diabetic macular edema (DME).MethodsA secondary analysis based on a retrospective cohort study.ResultsIn this secondary analysis, 124 eyes from patients with proliferative diabetic retinopathy (PDR) who underwent pars plana vitrectomy (PPV) between January 2008 and September 2012 were included. We found that compared with oral hypoglycemic medication, oral hypoglycemic medication plus insulin treatment revealed an insignificant relationship with postoperative DME (odds ratio [OR]=0.8, 95% confidence interval [CI]: 0.12-5.21, P=0.8167), only insulin treatment revealed a significant association with postoperative DME (OR=0.10, 95% CI: 0.01-0.84, P=0.0337) after adjusted age, sex. After adjusted age, sex, diabetes mellitus (DM) duration, glycosylated hemoglobin (HbA1c), the results did not have obvious changes (OR=0.61, 95% CI: 0.09-4.26, P=0.6187; OR=0.07, 95% CI: 0.01-0.65, P=0.0197). Furthermore, after adjusted age, sex, DM duration, HbA1c, hypertension, intraoperative retinal photocoagulation, vitreous hemorrhage, macular detachment, fibrovascular membrane, intraocular lens implantation and microincision vitrectomy surgery, the results were consistent (OR=0.66, 95% CI: 0.05-9.49, P=0.7621; OR=0.06, 95% CI: 0.00-0.81, P=0.0342). The same trend was observed in these adjusted models as well (p for trend was 0.0254, 0.0141, and 0.0311, respectively).ConclusionIn conclusion, our results of the secondary analysis should be interpreted as a significant association between insulin treatment and reduced risks of postoperative DME in Japanese PDR patients with PPV surgery, compared with oral medications. Well glycemic control with longstanding insulin therapy may be beneficial to reduce the risks of postoperative DME in PDR patients. Our investigation calls for large-scale and long-term prospective clinical studies for a full evaluation of the exact role of insulin in the progression of postoperative DME.

Deep Learning Models for Segmenting Non-perfusion Area of Color Fundus Photographs in Patients With Branch Retinal Vein Occlusion.

PurposeTo develop artificial intelligence (AI)-based deep learning (DL) models for automatically detecting the ischemia type and the non-perfusion area (NPA) from color fundus photographs (CFPs) of patients with branch retinal vein occlusion (BRVO).MethodsThis was a retrospective analysis of 274 CFPs from patients diagnosed with BRVO. All DL models were trained using a deep convolutional neural network (CNN) based on 45 degree CFPs covering the fovea and the optic disk. We first trained a DL algorithm to identify BRVO patients with or without the necessity of retinal photocoagulation from 219 CFPs and validated the algorithm on 55 CFPs. Next, we trained another DL algorithm to segment NPA from 104 CFPs and validated it on 29 CFPs, in which the NPA was manually delineated by 3 experienced ophthalmologists according to fundus fluorescein angiography. Both DL models have been cross-validated 5-fold. The recall, precision, accuracy, and area under the curve (AUC) were used to evaluate the DL models in comparison with three types of independent ophthalmologists of different seniority.ResultsIn the first DL model, the recall, precision, accuracy, and area under the curve (AUC) were 0.75 ± 0.08, 0.80 ± 0.07, 0.79 ± 0.02, and 0.82 ± 0.03, respectively, for predicting the necessity of laser photocoagulation for BRVO CFPs. The second DL model was able to segment NPA in CFPs of BRVO with an AUC of 0.96 ± 0.02. The recall, precision, and accuracy for segmenting NPA was 0.74 ± 0.05, 0.87 ± 0.02, and 0.89 ± 0.02, respectively. The performance of the second DL model was nearly comparable with the senior doctors and significantly better than the residents.ConclusionThese results indicate that the DL models can directly identify and segment retinal NPA from the CFPs of patients with BRVO, which can further guide laser photocoagulation. Further research is needed to identify NPA of the peripheral retina in BRVO, or other diseases, such as diabetic retinopathy.

Change in Central Macular Thickness on OCT after Pan Retinal Photocoagulation

Background: Proliferative diabetic retinopathy is the proliferation of retinal neo vessels due to uncontrolled diabetes mellitus and long duration of this disease that leads to advance diabetic eye disease . proliferative diabetic retinopathy is treated by pan retinal photocoagulation which reduces retinal oxygen demand by retinal photocoagulation. Retinal photocoagulation leads to the laser tissue interaction called thermal damage leading to coagulative necrosis of the retinal pigment epithelial cells as these cells contain melanin a dark pigment that has the ability to absorb light energy in argon laser spectrum. Objective: To determine the mean change in central macular thickness after pan retinal photocoagulation on optical coherence tomography of the macula in patients with proliferative diabetic retinopathy . Material &amp; Methods: Our study was a Quasi experimental study conducted at Department of Ophthalmology, Services Hospital Lahore for duration of six months from April 2021 to September 2021. In this study 40 eyes from 40 patients with proliferative diabetic retinopathy were selected who underwent pan retinal photocoagulation in one sessions with 1500 burn marks. Patients in the age group of 15 to 70 years, male and female, with proliferative diabetic retinopathy in at least one eye with no history of ocular surgery or ocular trauma in last one year were included in this study . Optical coherence tomography of macula was performed before and four weeks after the session of pan retinal photocoagulation. CMT (central macular thickness) was measured for mean change in central macular thickness. Results: In this study , the mean age of patients was 48.68±1.52 years, and gender ratio of female to male patients was 1:0.77,The mean CMT before start of treatment that was considered as baseline was 230.55±5.0 and the mean CMT value after four weeks of pan retinal photocoagulation was 238.50±6.43. (p-value=0.001) Conclusion: No significant change in CMT was found from baseline CMT to four weeks after pan retinal photocoagulation. Keywords: Optical coherence tomography, pan retinal photocoagulation, Central Macular Thickness, proliferative diabetic retinopathy

Efficacy evaluation of intravitreal ranibizumab therapy for three types of retinopathy of prematurity

To evaluate efficacy of intravitreal ranibizumab (IVR) therapy for aggressive posterior retinopathy of prematurity (ROP), threshold ROP disease and type 1 pre-threshold ROP. A retrospective analysis was performed on 40 patients (76 eyes) who had IVR as the primary treatment for ROP from April 2017 to January 2018. According to disease pathogenic features, the 76 eyes were divided into three groups: aggressive posterior ROP (AP-ROP) group (16 eyes), threshold ROP group (28 eyes) and type 1 pre-threshold ROP group (32 eyes). The characteristics of patients and lesions situation before the first intravitreal injection, and posttreatment fundus outcomes determined by wide-angle RetCam fundus imaging were recorded. The birth weight and postmenstrual age of first IVR treatment in AP-ROP, threshold ROP, and type 1 pre-threshold ROP groups were significant difference (1087.50±246.78, 1103.75±168.30, 1257.03±210.82 g, P=0.005; 34.50±1.46, 36.89±2.97, 36.50±2.36wk, P=0.008), while the gestational age was not difference (28.00±2.00, 28.54±1.90, 28.59±1.43wk, P=0.510). The retina hemorrhage ratio (with/without: 14/2, 8/20, 5/27), iris neovascularization or vascular engorgement ratio (with/without: 12/4, 11/17, 6/26), and the zone I (inside/outside: 16/0, 2/26, 5/27) in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group were difference significantly (all P<0.05). The regression rates were 37.5%, 92.86%, and 100%, and the recurrence rates were 62.5%, 7.14%, and 0 in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group, respectively (both P<0.05). The recurrence eyes were cured by secondary IVR or retinal laser photocoagulation. IVR is an effective treatment for all types of ROP. The regression of AP-ROP is significantly lower than type 1 pre-threshold and threshold disease. Birth weight, retinal hemorrhage, iris neovascularization or vascular engorgement and lesions located in zone I may be associated with AP-ROP recurrence and retreatment, which should be noted in follow-up.

Long use of continuous positive airway pressure protects against the development of treatment-requiring retinopathy of prematurity

Although preterm infant mortality is low, the proportion of patients with treatment-requiring retinopathy of prematurity (TR-ROP) is high in Japan. Various multicenter studies have reported the risk factors for TR-ROP; however, no large-scale studies have been conducted in Japan. We retrospectively analyzed 13,645 infants born at < 28 weeks’ gestation (January 1, 2009–December 31, 2018), and registered in the Neonatal Research Network of Japan database. TR-ROP was defined as ROP requiring retinal laser photocoagulation and/or intravitreal anti-vasoendothelial growth factor drugs. Multivariable logistic regression analysis was performed to identify factors associated with TR-ROP development. The median gestational age of enrolled infants was 26 weeks (interquartile range [IQR], 24–27 weeks), median birth weight was 760 g (IQR, 620–918 g). Proportion of patients with TR-ROP was 30.3%. TR-ROP was significantly associated with birth at < 26 weeks’ gestational age (adjusted odds ratio [aOR] 1.54), blood transfusion (aOR 1.49), invasive ventilation ≥ 28 days (aOR 1.41), sepsis (aOR 1.29), birth weight < 750 g (aOR 1.28), intraventricular hemorrhage (aOR 1.33), delayed achievement of full enteral feeding > 14 days (aOR 1.28), and continuous positive airway pressure (CPAP) therapy ≥ 28 days (aOR 0.79). Supplemental oxygen ≥ 28 days was not associated with TR-ROP development. Lower gestational age at birth and birth weight, blood transfusion, prolonged invasive ventilation, sepsis, intraventricular hemorrhage, and delayed achievement of full enteral feeding were risk factors for TR-ROP, whereas CPAP use was protective against TR-ROP.

Comparison of serum and vitreous TGF-β1 levels in proliferative diabetic retinopathy with and without panretinal photocoagulation laser therapy

Introduction: A long-term diabetic retinopathy will cause an increase in several growth factors expression like Transforming Growth Factor β (TGF-β). This multipotent cytokine is involved in the process of endothelial cell proliferation. Therefore, this study aims to observe the relationship between TGF-β1 levels in serum and vitreous fluid of Proliferative Diabetic Retinopathy (PDR) patients given Pan Retinal Photocoagulation (PRP) laser therapy. Method: This was a cross-sectional study involving 14 patients with PDR. TGF-β1 levels of vitreous and peripheral blood were measured using Enzyme-linked Immunosorbent Assay (ELISA) method. The data were statistically analyzed using SPSS software for Windows ver. 23.0 for Mann-Whitney and the Spearman correlation test. Results: Our subjects consisted of 57.1% males with a mean age of 51.8 years, where dyslipidemia was the most common comorbid disease. Mean serum TGF-β1 level was 12,821.43 ± 5,253.16 pg/ml, while the mean value in vitreous was 3,692.86 ± 333.89 pg/ml. Meanwhile, there was no significant difference in serum and vitreous TGF-β1 levels between subjects with and without PRP laser therapy (p&gt;0.05). Conclusion: There was no significant correlation between TGF-β1 levels in proliferative diabetic retinopathy patients with and without panretinal photocoagulation laser therapy. However, there was a decreasing trend in TGF-β1 levels in the vitreous fluid, indicating that PRP laser therapy has a positive effect on preventing the formation of neovascularization in the eye.

Efficacy and safety of a combination of shuangdan mingmu capsules and laser therapy for diabetic retinopathy, and its effect on blood glucose indices and quality of life of patients

Purpose: To investigate the efficacy and safety of a combination of Shuangdan Mingmu capsules andlaser therapy in diabetic retinopathy (DR), as well as on blood glucose index and quality of life.Methods: One hundred and twenty DR patients admitted to Zhenba County Peoples Hospital, Shaanxi were assigned equally to 2 groups: A and B. Retinal laser photocoagulation was performed for group B patients, while Shuangdan Mingmu capsules were given to group A, in addition to laser treatment. Ophthalmic parameters, blood glucose indices, ultrasonic indices, platelet parameters, quality of life, and incidence of adverse drug reactions (ADR) were determined and compared between groups A andB.Results: Following treatment, group A had significantly better ophthalmic parameters, blood glucose indices and platelet parameters (p &lt; 0.05); better ultrasonic indices and quality of life (p &lt; 0.001), and lower ADRs (p &lt; 0.05) than group B.Conclusion: The combination of Shuangdan Mingmu capsules and laser therapy effectively cures ocular lesions, controls blood glucose, and lowers ADR in DR patients. Therefore, the combined therapy should be further investigated for the management of diabetic retinopathy.

Анализ геморрагических осложнений в хирургии пролиферативной диабетической ретинопатии

Purpose. Determination of factors associated with the incidence of hemophthalmos in the early and late postoperative period in patients with proliferative diabetic retinopathy (PDR). Material and мethods. Retrospective analysis of postoperative complications was performed in 124 patients (133 eyes) with PDR, who received treatment at the Research institute of Eye Diseases from 2018 to 2021. The study included patients with PDR with indications for surgical treatment (hemophthalmos, traction retinal detachment (TRD), traction diabetic macular edema). All patients underwent minimally invasive vitrectomy using additional chandelier-type illuminators with bimanual dissection and delamination of the proliferative tissue and careful removal of the vitreous base with sclerocompression. In all cases, the operation was completed without the use of any tamponade. Peripheral retinal photocoagulation (RP) was performed in 98 cases (73.7 %), phacoemulsification with intraocular lens implantation in 66 cases (49.6 %), angiogenesis inhibitors were used perioperatively in 47 cases (35.3 %). Results. Of 133 operated eyes, early postoperative intravitreal hemorrhage (EPH) was observed in 17 cases (12.8 %), of which 6 resorbed spontaneously and 11 required repeated surgical intervention. The development of EPH was significantly associated with the absence of intraoperative RP (p &lt; 0.01), and the frequency of revision of the vitreal cavity to eliminate EPH correlated with the unstable course of arterial hypertension (AH) (p= 0.048) and with the absence of panretinal photocoagulation (PRP) before surgery (p= 0.012). It was found that EPH developed more often in patients operated on for TRD (p= 0.007) and in cases accompanied by severe intraoperative bleeding (p= 0.001) and unintentional intraoperative damage to the retinal vessels of the 2nd-3rd order (p&lt; 0.01). Late postoperative intravitreal hemorrhage (LPH) was observed in 20 cases (19.8 %), of which 11 resorbed spontaneously and 9 required surgical treatment. The development of LPH is significantly associated with the absence of intraoperative RP (p&lt; 0.01 for self-resorbed LPH and p= 0.041 for LPH requiring revision of the vitreal cavity). The frequency of revision of the vitreal cavity for the treatment of LPH is significantly associated with the unstable course of hypertension (p= 0.007) and the presence of EPH requiring surgical intervention (p= 0.003). The use of anti-angiogenic drugs before and during surgery did not show a significant correlation with the occurrence of EPH and LPH. Conclusions. Analysis of complications showed that EPH and LPH occurred in 12.8 % and 19.8 % of cases, respectively. Factors associated with the development of EPH were identified: the absence of PRP before surgery, the absence of intraoperative RP, TRD, intraoperative damage to the retinal vessels of the 2nd-3rd order. Factors associated with the development of LPH were identified: failure to perform RP intraoperatively, unstable course of hypertension, and the presence of EPH that required surgical intervention. Keywords: diabetic retinopathy, vitrectomy, bianual vitrectomy, postoperative hemorrhage, panretinal photocoagulation, peripheral retinal photocoagulation, arterial hypertension.

Лазерные методы лечения активной ретинопатии недоношенных: от режима одиночного импульса до навигации

Purposе. Тo present the stages of development of laser technologies for the treatment of active retinopathy of prematurity at the S. Fyodorov Eye Microsurgery Federal State Institution, the Kaluga Branch. Material and methods. Transpupillary laser photocoagulation of the retina was performed in 1546 children (2523 eyes) with active ROP from 2004 to 2021. Laser coagulation of the retina was carried out on various stationary laser ophthalmocoagulators acting in green and yellow spectra with a wavelength of 532 nm, 561 nm and 577 nm. Indications for laser treatment were the 2 nd and the 3 rd stage of the disease with an unfavorable course, the stage of early clinical manifestations, and the stage of manifestation of aggressive posterior ROP. Results. As the technology of retinal laser photocoagulation improved in patients with active ROP, the efficiency naturally increased and the duration of laser treatment decreased. Currently, the effectiveness of transpupillary laser coagulation of the retina using a hexagonal pattern has made it possible to achieve regression of the disease at the 2 nd stage with an unfavorable course in 100 % of cases, at the 3 rd stage with an unfavorable course type – in 97 %. The time for laser coagulation of the retina for the 2 nd stage was 6 ± 2 minutes, for the 3 rd stage it was 8 ± 3 minutes. Navigation assisted laser coagulation of the retina is the latest trend in laser treatment of active ROP. Conclusion. Permanent improvement of laser ophthalmocoagulators and the introduction of new methods of laser coagulation into clinical practice determine their continuous progress in achieving the maximum percentage of regression of active ROP with a minimum duration of the treatment session. Keywords: retinal laser photocoagulation, retinopathy of prematurity, ophthalmocoagulator.