Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session

274 Pages·2009·13.69 MB·English

Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
183 - A283 184 - A284
Subthreshold Laser Treatment for Symptomatic Retinal Arterial Cystoid Macular Edema and Nd-yag Capsulotomy: Prospective Study of 30
Macroaneurysms Cases
M.B. Parodi, P. Iacono, M. Cascavilla, F. Bandello. Department of Ophthalmology, A. Giocanti, J. Tilleul, C. Rohart, F. Fajnkuchen, M. Touati, S. Buffet, T. Grenet, M.
University of Udine, Udine, Italy. Lussato, G. Chaine. Ophthamology, Avicenne hospital, Bobigny, France.
Purpose: To describe the effectiveness of subthreshold laser treatment (SLT) with Purpose: To measure macular thickness with the Optical Coherence Tomography
infrared micropulse diode laser for the treatment of retinal arterial macroaneurysms after Nd-YAG laser posterior capsulotomy in 30 eyes who had undergone previous
(RAM) associated with macular exudation. cataract surgery.
Methods: Interventional case series including 8 cases of RAM who underwent Methods: Ophthalmology department, Hospital Avicenne, Bobigny, France. Thirty
treatment with SLT. Complete ophthalmic examinations, including Early Treatment eyes of 30 patients were included in this prospective single-centre study. Consecutive
of Diabetic Retinopathy Study visual acuity (ETDRS-VA), OCT and fluorescein Nd-YAG laser posterior capsulotomies were performed between january and november
angiography, were performed at the moment of the study entry and at 3-month 2008. All patients received the same drug protocol after Nd-YAG capsulotomy
intervals, with a planned follow-up of 12 months. Main outcome measures were the (acetazolamide, aproclonidine, rimexolone). All patients had a slit-lamp biomicroscopic
decrease in mean foveal thickness (MFT) on OCT, and the changes in ETDRS-VA. examination at each visit. Demographic parameters (age, sex and medical history),
Results: The change in MFT from the initial values was statistically significant visual acuity, intraocular pressure, macular thickness, and complications following
(p<0.001) with resolution of exudation. At the 12-month evaluation, all the patients Nd-YAG laser capsulotomy were analysed. Parameters were studied before Nd-YAG
gained at least 10 letters (two lines) in ETDRS-VA. No laser scar was detectable after laser capsulotomy, at one week post-capsulotomy, at one month and at 3 months
SLT. post capsulotomy. The primary outcome measurement was central foveal thickness
Conclusions: SLT is a promising approach for the treatment of symptomatic RAM. measured by OCT (Stratus OCT 3, Zeiss). The number of pulses, energy delivered and
CR: M.B. Parodi, None; P. Iacono, None; M. Cascavilla, None; F. Bandello, None. the interval between cataract surgery and capsulotomy were noted for each patient.
Support: None A student test was used for statistic data.
Results: The mean age of patient was 72,2+/-11,9 years. The mean visual acuity before
laser was 0,6+/-0,3 LogMar. The mean visual acuity were 0,2+/-0,3 , 0,1+/-0,3, 0,1+/-0,3
LogMar at one week, one month, 3 months after Nd-YAG capsulotomy, respectively.
The mean macular thickness of the central area were 203,9+/-21,6 µm before Nd-YAG
laser and 210,3+/-20,2, 202,1+/-18,9, 207,1+/-15,3 µm at one week, one month and three
months after capsulotomy, respectively. There was no statistically increase of macular
thickness at each time (p>0,05). There were no complications in our study after Nd-
YAG capsulotomy, and no correlation between number of pulses, energy delivered,
interval between cataract surgery and macular thickness.
Conclusions: Macular cystoid edema is a classic complication after Nd-YAG
capsulotomy. However, there was no significant increase of macular thickness in
short-term after Nd-YAG capsulotomy in our study.
CR: A. Giocanti, None; J. Tilleul, None; C. Rohart, None; F. Fajnkuchen, None; M.
Touati, None; S. Buffet, None; T. Grenet, None; M. Lussato, None; G. Chaine,
None.
Support: None
185 - A285 186 - A286
Treatment Comparison of Intravitreal Bevacizumab (Avastin®), Focal-grid Sequential Therapy With Laser Photocoagulation and Intravitreal Bevacizumab
Laser and Combination Therapy for Diabetic Macular Edema in a Diverse for Extrafoveal Choroidal Neovascularization
Clinic Population
F. Gelisken, F. Ziemssen, M. Völker, K.U. Bartz-Schmidt. Ophthalmology, Univ
C.C. Zatezalo1,2, K.E. Burleigh1,2, R.M. Lieberman1,2, R.M. Fischer1,2. 1Ophthalmology, Tubingen, Tubingen, Germany.
Mount Sinai Medical Center, New York, NY; 2Ophthalmology, Elmhurst Hospital
Purpose: To evaluate the efficacy and safety of sequential intravitreal bevacizumab
Center, Queens, NY.
and laser photocoagulation for extrafoveal choroidal neovascularisation (CNV).
Purpose: To examine the efficacy and long-term outcomes in patients receiving either Methods: In this retrospective interventional pilot study, 9 eyes of 9 consecutive
a single injection of intravitreal bevacizumab (Avastin®) (IVA), focal-grid laser (FGL) patients were treated with intravitreal bevacizumab (1.25 mg) one week after the
or combination therapy (CT) (IVA followed by FGL) for diabetic macular edema in a laser photocoagulation of the extrafoveal well-defined CNV lesions. Intravitreal
diverse clinic population. bevacizumab was repeated three times at 6-week intervals and thereafter if leakage was
Methods: A retrospective chart review of consecutive 119 patients (142 eyes) receiving seen on the fluorescein angiography.Best corrected visual acuity (BVCA), fluorescein
IVA(1.25mg/0.05ml), FGL or CT was conducted. Data, including best corrected visual angiography and optical coherence tomography was performed at baseline and at
acuity (BCVA), central retinal thickness (CRT) via optical coherence topography, 3 months follow-up visits. Primary outcomes were the BCVA and central retinal
demographics, A1c, was collected at the time of treatment and at 1, 3, 6, and 12 months thickness (CRT)
(mo). The main outcome measures included BCVA and CRT. BCVA at each visit was Results: Median age of the patients (6 female, 3 male) was 74.7 years. In all patients
calculated and expressed in logMar and patient years. Within each cohort, patients a follow-up period of 12 months was available. CNV was secondary to age-related
were subgrouped by initial BCVA 20/20-20-40 (A), 20/50-20/150 (B), >20/200 (C). macular degeneration in all eyes. Average number of bevacizumab injections was
Results: 119 patients (142 eyes); 62 Hispanics, 51 Asians, and 6 Blacks. Initial and final 4.1 (range 3 to 8). Mean logMAR BCVA was 0.34 at baseline and 0.29 at the 12-months
BCVA ranged from 20/20 to 20/400. examination, respectively (P=0.559). Mean CRT decreased significantly from 223µm
-In the 79 eyes receiving FGL, the mean initial BCVA was 20/47.19; it was 20/41.7 at (baseline) to 179µm to (12 month, P=0.024). The anatomic response was independent of
1 mo, 20/47.71 at 3 mo, 20/40.57 at 6 mo and 20/41.89 at 12 mo. Initial mean CRT was baseline visual acuity Pearson coefficient: 0.329, P=0.387). In 4 eyes further bevacizumab
244.58um. treatment was needed because of the leakage due to the persistent and/or recurrent
-Forty-one eyes were treated with IVA. Mean BCVA was 20/122 at time of treatment, CNV. Only in one eye subfoveal recurrent CNV developed. No systemic side effects
20/82.24 at 1 mo, 20/80.26 at 3 mo, 20/76.92 at 6 mo and 20/75.89 at12 mo. There is were observed. In one eye recurrent vitreous haemorrhage developed that resolved
statistically significant improvement in BCVA at 3 mo. (p=0.03) and 6 mo. (p=0.032). spontaneously.
Initial mean CRT was 395um. Conclusions: One year results indicate that intravitreal bevacizumab in combination
-In the CT group (n=22), the mean initial BCVA was 20/83, 20/81.34 at 1 mo, 20/76.9 at with laser photocoagulation is well tolerated and associated with improvement or
3 mo, 20/75.89 at 6 mo and 20/93.85 at 12 mo. Initial mean CRT was 340um. stabilisation in BCVA and reduced angiographic leakage in most eyes with extrafoveal
-The percent improvement of BCVA from presentation at 1 mo for FGT, IVA, CT was well-defined CNV secondary to AMD. Larger controlled case series are needed for
14.4%, 21.8%, and 1.42% respectively; at 3 mo 1.3%, 21.8%, and 5.4%; at 6 mo 17.7%, identify the role of sequential laser photocoagulation and intravitreal bevacizumab
25.5% and 6.3%; and at 12 mo 14.2%, 26.2% and -8.5%. A1c ranged from 5.4%-14.1%: injection for the treatment of extrafoveal CNV.
initial mean for each group was 8.3%, 7.6% and 7.85%. CR: F. Gelisken, None; F. Ziemssen, None; M. Völker, None; K.U. Bartz-Schmidt,
Conclusions: Patients receiving FGL demonstrated stabilization of BCVA throughout None.
all data points, even with the highest mean A1c. Although IVA showed statistically Support: None
significant improvement in BCVA at 3 and 6 mo, the addition of laser (CT) did not
appear to improve outcome. This underscores the need for timely treatment in all
patient populations.
CR: C.C. Zatezalo, None; K.E. Burleigh, None; R.M. Lieberman, None; R.M. Fischer,
None.
Support: None
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
183-186
Monday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 1382 - 1406 / B121 - B145
219. Functional Retinal Imaging Organizing Section: MOI
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
187 - A287 188 - A288
Macular Drusen After Peripheral Laser Treatment Pegaptanib Sodium versus Macular Laser Photocoagulation for Diabetic
S. Kesting1, D.H. Kauffmann Jokl2,3, R.T. Smith2, J. van Meurs1, M. Busuioc2. Macular Edema
1Vitreoretinal Surgery, Rotterdam Eye Hospital, Rotterdam, The Netherlands; A.V. Bux1, G. Querques1, A.R. Fusco2, C. Iaculli1, N. Delle Noci1. 1Ophthalmology,
2Ophthalmology, Columbia University, New York, NY; 3Ophthalmology, New York University of Foggia, Foggia, Italy; 2Hygiene, University of Bari, Bari, Italy.
Medical College, Valhalla, NY.
Purpose: To report the short-term anatomic and functional outcomes after primary
Purpose: To report the 2 year findings of the effect upon central macular drusen in intravitreal pegaptanib sodium in patients with diabetic macular edema (DME).
eyes treated with peripheral laser photocoagulation. Methods: We conduced a retrospective outcome analysis, by optical coherence
Methods: 14 patients with bilateral central macular drusen and normal acuity had tomography and best-corrected visual acuity (BCVA), of eyes with DME treated with
one eye treated with 200 argon laser spots (500 micron diameter) in the anterior- primary intravitreal pegaptanib sodium (Macugen) (intravitreal pegaptanib group).
superior retinal quadrant. Pre and post-operative drusen area were determined by These results were compared with the ones of eyes treated with primary macular
an established digital protocol, and the findings were verified by double masked laser photocoagulation (macular laser photocoagulation group).
observers. The untreated eye was the control. Results: A total of 56 eyes of 56 patients with a minimum of 6 months’ follow-up
Results: The central drusen area for the treated eyes showed in 4 eyes minimal change were included for analysis. For the intravitreal pegaptanib group (26 eyes) we found
(less than 10%), in 8 eyes a significant decrease and in 2 eyes a significant increase significant changes in mean BCVA and reductions in mean central macular thickness
(significant = 20% or more). The control eyes showed in 3 eyes minimal change, in 5 (CMT) compared with baseline at the last follow-up visit (p < .05). For the macular
eyes a significant decrease and in 6 eyes a significant increase. The net effect for each laser photocoagulation group (30 eyes), we found no statistically significant changes
patient upon the summed central drusen area (OD plus OS) showed 3 patients to be in mean BCVA and CMT compared with baseline at the last follow-up visit.
minimally changed, 5 patients to show a slight increase (10 to 20%), and 6 patients Conclusions: The short-term outcomes suggest that primary intravitreal pegaptanib
to show a slight decrease. No CNV was noted and visual acuity remained unaltered treatment may be superior to macular laser photocoagulation in patients affected
in treated and control eyes. with DME.
Conclusions: Peripheral laser treatment may affect the course of central macular CR: A.V. Bux, None; G. Querques, None; A.R. Fusco, None; C. Iaculli, None; N.
drusen in both the treated and the untreated eye. Further prospective investigation Delle Noci, None.
of these effects is warranted. Support: None
CR: S. Kesting, None; D.H. Kauffmann Jokl, None; R.T. Smith, None; J. van Meurs,
None; M. Busuioc, None.
Support: None CT: www.ISRCTN.org, 96759546
189 - A289 190 - A290
Concentric Contraction of Retinal Grid Laser Lesions Following a Pattern Scan Treatment of Diabetic Macular Edema With Intravitreal Triamcinolone, Focal-
Laser Treatment Using the Pascal© Laser System grid Laser or Combination Therapy in a Diverse Clinic Population
M. Bolz, G.G. Deak, S.G. Prager, G. Mylonas, J. Lammer, K. Kriechbaum, C. Scholda, K.E. Burleigh1,2, C.C. Zatezalo1,2, R.M. Lieberman1,2, R.M. Fischer1,2. 1Ophthalmology,
C. Prünte, U. Schmidt-Erfurth, Diabetic Retinopathy Research Group Vienna. Dept of Mount Sinai Hospital, New York, NY; 2Ophthalmology, Elmhurst Hospital Center,
Ophthalmology, Medical University of Vienna, Vienna, Austria. Queens, NY.
Purpose: To examine intra-retinal morphologic in vivo changes secondary to a focal Purpose: To examine the efficacy and long-term outcomes in patients of a single
or grid macular Pascal© laser treatment in the human retina. intravitreal injection of 4mg/0.1mL of preservative free triamcinolone acetonide,
Methods: Fifteen patients with untreated diabetic macular edema (DME) received focal-grid laser (FGL) and combination therapy (CT) for diabetic macular edema
a focal (group 1) or grid pattern (group 2) photocoagulation treatment using a semi- (DME) in a diverse clinic population.
automated patterned scanning laser system (PASCAL©, Optimedica). All patients were Methods: A retrospective chart review of 109 consecutive patients (127 eyes) receiving
examined at baseline, day 1, week 1 and monthly until month 3 using spectral domain FGL, IVK, or CT was conducted. Data collected include HA1c, demographics, best
optical coherence tomography (SD OCT; Spectralis OCT©, Heidelberg Engineering) corrected visual acuity (BCVA), and central retina thickness (CRT) as measured by
and infrared (IR) and color photo (CF) fundus imaging. optical coherence topography (OCT). Main outcome measures included BCVA and
Results: At day 1, in both groups there were distinct intra-retinal laser lesions only CRT, both assessed initially and at 1, 3, 6, and 12 BCVA was converted to logMar.
in the outer layers, i.e. the photo receptor layer (PRL), the outer nuclear layer (ONL) All interventions were subdivided with respect to initial BCVA (20/20-20/40, 20/50-
and the outer plexiform layer (OPL). Single focal lesions (group 1) were detectable as 20/100, <20/200).
delineated alterations of theses layers showing a rather perpendicular intra-retinal Results: Of the109 patients (127 eyes) included, there were 66 Hispanics, 39 Asians,
course with distinct borders surrounded by edematous tissue. Laser lesions of a grid 5 Blacks, and 2 Caucasians. Initial visual acuity ranged from 20/20-20/400. A1cs
pattern photocoagulation (group 2) showed alterations of the same layers. However, ranged from 5.4%-14.1%, with an initial mean of 8.3%, 8.2% and 7.8% for FGL, IVK
the outer retinal layers, i.e. the retinal pigment epithelium, the PRL and ONL, seemed and CT respectively. The FGL (n=79) mean BCVA at time of treatment was 20/24,
to be dislocated into the direction of the center of the grid pattern. This resulted in 20/41.73 at 1 mo, 20/47.7 at 3 mo, 20/41 at 6 mo, and 20/42 at 12 mo. The mean CRT
lesions showing a rather diagonal intra-retinal course. Furthermore, in all patients was 244.58um at presentation. Initial mean BCVA for IVK (n=18) was 20/138, 20/88
of group 2, there was a clear decrease in central retinal thickness already at day at 1 mo, 20/106 at 3 mo, 20/107 at 6 mo and 20/65 at 12 mo. There was statistically
1, further proceeding until month 3. Apart from that, the closure of intra-retinal significant improvement in BCVA at12 mo (p= 0.1294). Initial mean CRT was 404 um.
microaneurysms and a continuing scarring reaction of the laser lesions at the level The CT (n=28) mean BCVA was 20/86 at time of treatment, 20/61 at 1 mo, 20/47 at 3
of the PRL could be demonstrated until month 3. mo, 20/58 at 6 mo and 20/59 at 12 mo, demonstrating statistically significant change
Conclusion: The application of a grid laser pattern in the human retina seems to at 3 mo and 6 mo (p= 0.01017 and p= 0.0661). The mean initial CRT was 379um. Percent
cause an immediate concentric contraction of the outer retinal layers which could be improvement from initial BCVA to data points at 1,3,6 and 12 mo was calculated at
interpreted as an immediate scarring reaction due to therapy. Focal laser treatment 14%, 0%, 17%, and 14% for FGL, and 23%, 14.3%, 13%, and 40%; 28%, 28.5%, 30%, and
did not show this characteristic outer layer shifting, yet revealed equivalent scarring 17% for IVK and CT, respectively.
changes in the PRL over time. Conclusions: We found CT to show a statistically significant improvement in BCVA
CR: M. Bolz, None; G.G. Deak, None; S.G. Prager, None; G. Mylonas, None; J. at 3 months and 6 months, which was not sustained. Despite elevated A1c levels, all
Lammer, None; K. Kriechbaum, None; C. Scholda, None; C. Prünte, None; U. groups did maintain their initial level of BCVA. It is therefore important to identify
Schmidt-Erfurth, None. and to appropriately treat DME in a diverse population.
Support: None CT: www.clinicaltrials.gov, NCT00682240 CR: K.E. Burleigh, None; C.C. Zatezalo, None; R.M. Lieberman, None; R.M. Fischer,
None.
Support: None
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
187-190
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
191 - A291 192 - A292
OCT and Visual Acuity in PDR Treated With Laser-Triamcinolone Pulsatile Ocular Blood Flow Following Laser Photocoagulation for Diabetic
O.O. Maia, Jr.1,2A, B.S. Takahashi2A, M.L. Monteiro2B, W.Y. Takahashi2A. 1Cli nica Retinopathy
Especializada em Retina e Vitreo, Sao Rafael Hospital - Monte Tabor Foudation, R. Sandhu1,2, T. Adewoyin2, S. Sivaprasad2, V. Chong3. 1Ophthalmology, Southend
Salvador, Brazil; ARetina and Vitreous Service, BNeuro-ophthalmology Service, University Hospital, Southend, Essex, United Kingdom; 2Retinal Research Unit,
2University of Sao Paulo Medical School, Sao Paulo, Brazil. King’s College Hospital, London, United Kingdom; 3Ophthalmology, Oxford Eye
Hospital, Oxford, United Kingdom.
Purpose: To evaluate the correlation between ETDRS best-corrected visual acuity
(BCVA) and central macular thickness (CMT) in eyes with moderate proliferative diabetic Purpose: Previous cross-sectional studies have shown decreased ocular blood flow
retinopathy (PDR) treated with laser (pan-retinal and macular) photocoagulation and in eyes treated with laser photocoagulation for proliferative diabetic retinopathy
intravitreal triamcinolone acetonide (IVTA) injection. (PDR) compared to non-diabetic controls. The aim of this prospective interventional
Methods: Prospective, interventional case-series. Twenty-eight eyes from 28 patients study was to evaluate changes in pulsatile ocular blood flow (POBF) over 9 months
with treatment-naive moderate PDR were submitted to pan-retinal and macular laser following pan-retinal photocoagulation (PRP) and macular laser for PDR and clinically
photocoagulation according to the EDTRS guidelines. After completion of pan-retinal significant macular edema (CSME) respectively.
photocoagulation treatment at week 3, all eyes were assigned to receive a single 4 Methods: Subjects with PDR (37 eyes) and CSME (27 eyes) received PRP and macular
mg IVTA injection (Kenalog®40; triamcinolone acetonide injectable suspension, USP, laser respectively according to Diabetic Retinopathy Study (DRS) and Early Treatment
Bristol-Myers Squibb Company). BCVA, digital color fundus photography, CMT of Diabetic Retinopathy Study (ETDRS) criteria. The Blood Flow Analyser (Dicon
measured using optical coherence tomography (Stratus® Tomographer, Model 3000, Diagnostics; Paradigm, USA) was used to measure POBF at baseline, 1, 3 and 9 months
Carl Zeiss Meditec, Dublin, California, USA) was performed in all patients at baseline following laser photocoagulation.
and at months 1, 3, and 6 after treatment. BCVA and CMT measurements before and Results: The POBF was significantly reduced following PRP and the effect was
after treatment were compared. Spearman’s rank correlation coefficients were used maintained at 9 months following PRP (p=0.005). There was a trend to decrease in
to evaluate the relationship between BCVA and CMT measurements. POBF with an increase in the number of burns (p= 0.07). However, POBF did not alter
Results: At baseline, average CMT was 326.0 ± 101.1 µm (mean ± standard deviation), significantly after macular laser (p=0.29).
and BCVA was 0.37±0.20. After treatment, CMT decreased significantly to 242.2±35.1 Conclusions: This is the first prospective study to evaluate POBF at successive intervals
(P< 0.001), 231.4±31.2 (P< 0.001), and 231.4±33.2 µm (P< 0.001) at 1, 3, and 6 months, following laser photocoagulation for diabetic retinopathy. A significant change in
respectively, as compared to baseline measurements (Wilcoxon signed ranks test). POBF following PRP and not macular laser suggests that PRP causes global changes
BCVA improved to 0.20±0.13 (P< 0.001), 0.15±0.09 (P< 0.001), and 0.14±0.08 (P< 0.001) in choroidal blood flow.
at 1, 3, and 6 months after treatment, respectively (Wilcoxon signed ranks test). CR: R. Sandhu, None; T. Adewoyin, None; S. Sivaprasad, None; V. Chong, None.
Improvement in BCVA was followed by a significant reduction in CMT at 1, 3 and 6 Support: None
months follow up when compared to baseline measurements (P < 0.001, ANOVA).
There was a strong correlation between BCVA improvement and reduction of CMT
(ρ = 0.527, P= 0.004) (ρ = 0.423, P= 0.025) (ρ = 0.564, P= 0.002), at 1, 3, and 6 months,
respectively (Spearman’s correlation coefficient).
Conclusions: A single injection of IVTA as an adjuvant to laser treatment was
effective in reducing CMT and improving BCVA in eyes with moderate PDR. A strong
correlation between CMT reduction and improvement in BCVA in these patients with
no previous treatment of the diabetic retinopathy was observed. A larger sample with
longer follow-up is warranted to confirm our findings.
CR: O.O. Maia, Jr., None; B.S. Takahashi, None; M.L. Monteiro, None; W.Y.
Takahashi, None.
Support: ARVO International Travel Grants CT: www.clinicaltrials.
gov, NCT00443521
193 - A293 194 - A294
Morphologic Changes in the Human Retina After Laser Treatment Using Supra Efficacy and Safety of Pascal Photocoagulator in the Treatment of Proliferative
and Sub Threshold Laser Energies Imaged by SD-OCT Diabetic Retinopathy
G.G. Deak1,2, M. Bolz1, S.G. Prager1, K. Kriechbaum1, M. Ritter1, C. Scholda1, U. Schmidt- I. Zucchiatti, D. Veritti, P. Lanzetta, F. Bandello. Department of Ophthalmology,
Erfurth1, Diabetic Retinopathy Research Group (DRRG) Vienna. 1Department of University of Udine, Udine, Italy.
Ophthalmology, Medical University of Vienna, Vienna, Austria; 2Department of
Purpose: To evaluate the safety and efficacy of the Pascal photocoagulator system in
Ophthalmology, Semmelweis University, Budapest, Hungary.
the treatment of proliferative diabetic retinopathy (PDR) and to report laser parameters
Purpose: To evaluate the morphologic changes in retinal structure after laser used.
photocoagulation using supra- and subthreshold energies. Methods: A retrospective review of twenty-six eyes of twenty-one patients with naïve
Methods: Ten patients with proliferative diabetic retinopathy (PDR) or central retinal severe non-proliferative diabetic retinopathy (NPDR) or PDR who underwent full
vein occlusion (CRVO) received scatter laser photocoagulation using a semi-automated PASCAL PRP between December 2006 and May 2008 was performed. Eyes included
patterned scanning laser system (PASCAL, Optimedica). Adjacent to the upper or in the study received no other therapies during the follow-up period. Data were
lower vessel arcades a study area was created. In this area 2x2 pattern laser spots collected reviewing patient’s charts and fluorescein angiograms. Seven eyes (27%)
were applied with halving the flux of the laser energies in a stepwise manner starting had severe NPDR, sixteen eyes (62%) had early PDR, three eyes (11%) had high risk
from an individually selected energy producing the typical grayish lesions. The study PDR. Panretinal photocoagulation (PRP) was performed using the PASCAL system.
areas were than imaged at day one, three and seven, than at month one, two and three No efforts were done to complete PRP in a single session. The treatment was deemed
using color fundus photography, autofluorescence (AF), infra read (IR) imaging and successful for early and high risk PDR, at the latest follow up visit, if neovascularization
spectral domain OCT (SD OCT; Spectralis OCT, Heidelberg Engineering). had regressed and no further treatment was planned. For severe NPDR the procedure
Results: The starting suprathreshold energy lesions were well visible in all patients was effective if no new vessels devoloped.
immediately after laser application and throughout the follow up period with both, Results: The average follow up of the study group was 11.5 months (range: 6 - 19
color fundus photography, IR and AF and showed characteristic changes on OCT. months, C.I. 95% ±0.28). The total number of procedures was 103. On average, 3.9
The halved flux laser burns (first step) were funduscopically undetectable during the sessions (C.I. 95% ±0.15) were required for a complete PRP. Parameters: mean power
laser session, but during the follow up were often detectable on IR and AF images and was 822 mW (C.I. 95% ±19.8) with an exposure time of 20 msec. The spot size used
sometimes on fundus photography as well. On OCT they showed similar changes was 200-400 µm. In 21 eyes the 5x5 pattern was used (81%), whereas the 3x3 pattern
as the supra threshold laser scars, but were much smaller in diameter. The 3rd and was applied in 5 eyes (19%). On average 880 spots (C.I. 95% ±33.5) were delivered
4th steps of the flux halving showed no changes during the laser treatment or at the in each session. Nineteen eyes (73%) showed a complete regression of the new
follow ups on any of the imaging modalities. vessels; neovascularization resolved partially in seven eyes and required additional
Conclusions: Subthreshold laser burns with halved energy flux produce similar photocoagulation. No major side effects were registered in most eyes. One eye only
morphologic changes in the retina as suprathreshold energies but with a lesser extent. developed a choroidal detachment after receiving 2600 spots at higher power a single
Energies below this range show no signs of morphologic changes detectable with OCT, session, which resolved spontaneously in one week.
autofluorescence, infrared or color fundus photographic imaging. Conclusions: The Pascal photocoagulator is safe and effective in the management of
CR: G.G. Deak, None; M. Bolz, None; S.G. Prager, None; K. Kriechbaum, None; M. the PDR. Shortening exposure time necessitates the use of higher power to achieve
Ritter, None; C. Scholda, None; U. Schmidt-Erfurth, None. the desired therapeutic endpoint. Retinal photocoagulation using PASCAL system has
Support: None CT: www.clinicaltrials.gov, NCT00682240 comparable efficacy to published results with conventional photocoagulation.
CR: I. Zucchiatti, None; D. Veritti, None; P. Lanzetta, Neovista Inc, C; Novartis
Pharma AG, C; Iridex Co, P; Allergan, R; Novartis Pharma AG, R; QLT Inc, R;
Optimedica Co, R; F. Bandello, None.
Support: None
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
191-194
Monday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 1382 - 1406 / B121 - B145
219. Functional Retinal Imaging Organizing Section: MOI
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
195 - A295 196 - A296
Reduced Fluence Decreases Pain Caused by Panretinal Photocoagulation for Manchester Study of Pattern Scanning Laser (Pascal®) Panretinal
Diabetic Retinopathy Photocoagulation (PRP) in Proliferative Diabetic Retinopathy [MAPASS]: 1500
burns pattern single session vs. single-spot multiple session PRP
G. Garcia-Aguirre, O. Alvarez-Verduzco, M. Lopez, S. Vera-Rodriguez, M. Martinez-
Castellanos, O. Burgos-Vejar, J. Guerrero-Naranjo, J. Fromow-Guerra, V. Morales-Canton. P.E. Stanga1A, M.M.K. Muqit1A, D.B. Henson1B, J.C.B. Gray1A, L.B. Young1A, S.J. Charles1A,
Retina, Asoc Para Evitar la Ceguera, Mexico City, Mexico. G.S. Turner1A, G.R. Marcellino2. AVitreoretinal Unit, BAcademic Unit, 1Manchester
Royal Eye Hospital, Manchester, United Kingdom; 2Optimedica Corporation, Santa
Purpose: To measure pain perceived by diabetic patients receiving panretinal
Barbara, CA.
photocoagulation using reduced fluence parameters (RFP), compared to traditional
parameters (TP). Aim: To investigate the effects of single session Pattern Scanning Laser (SS; Pascal
Methods: Diabetic patients scheduled for panretinal photocoagulation who accepted panretinal photocoagulation, PRP) versus single-spot multiple session (MS;
to participate in the study were included. All eyes received at least 500 burns, using conventional PRP) on foveal thickness and visual field (VF) in proliferative diabetic
a 532 nm laser. The right eye was treated with RFP (time 20-50 msec, power 400-700 retinopathy (PDR).
mW), while the left eye was treated with TP (time 100-200 msec, power 200-400 mW). Methods: Prospective, randomised clinical trial. PDR was treated with 1,500 burns
Parameters were adjusted in both cases to obtain a gray-whitish burn. The eye to be between two groups (SS-PRP Pascal 20 ms, single session; MS-PRP single-spot 100
treated first was assigned in an alternate fashion. After each eye received treatment, ms, twice-weekly over 3 sessions). ETDRS visual acuity (VA), central retinal thickness
patients were questioned about the perceived pain using the NRS-11 scale (0 = no (CRT, Topcon, 3D OCT-1000), and 24-2 SITA-Std Humphrey/Estermann VFs were
pain; 10 = most painful experience). recorded at baseline, 1 and 3 months post-laser. Laser powers and treatment times
Results: Twenty-five patients were included. Fluence per burn using RFP was 16.7 were recorded. Paired t-test analysis was performed.
± 10.5 J/cm2, and using TP was 35 ± 15.1 J/cm2 (p=0.000001). Pain score was 5 ± 2.19 Results: Results reported for 24 eyes (12-SS, 12-MS). Average power used for Pascal
for RFP and 7.7 ± 1.5 for TP (p=0.000058). There was a positive correlation (R2=0.4) SS-PRP was significantly higher than conventional MS-PRP (277mW-SS; 140mW-
between fluence per burn and pain perceived. No complications were observed MS; p<0.0001). However, at one month, mean CRT increased significantly following
secondary to treatment. MS-PRP, in comparison to SS-PRP (254.4-MS; 225.7-SS, p=0.02). In the SS-PRP group
Conclusions: Using RFP seems to reduce pain secondary to photocoagulation alone, CRT measured at baseline (232.6 µm) did not alter significantly after 1 month
compared to TP. (233.6 µm, p=0.78) and 3 months (239.3 µm, p=0.95). Mean threshold VF values did not
CR: G. Garcia-Aguirre, None; O. Alvarez-Verduzco, None; M. Lopez, None; S. change significantly at 1 month (SS, -0.727dB, SD 2.493, n=520; MS, -0.428dB SD 4.333,
Vera-Rodriguez, None; M. Martinez-Castellanos, None; O. Burgos-Vejar, None; J. n=416), or 3 months (SS, -1.381dB, SD 4.801, n=312; MS, -0.585dB, SD 2.548, n=260). No
Guerrero-Naranjo, None; J. Fromow-Guerra, None; V. Morales-Canton, None. eyes were below DVLA UK driving VF standards after PRP. Mean total duration of
Support: None CT: www.clinicaltrials.gov, NCT00802269 Pascal SS-PRP was <10% of conventional single-spot MS-PRP (p<0.0001).
Conclusions: We report a favourable safety profile for Pascal SS-PRP compared to
conventional MS-PRP. A significant increase in CRT after single-spot MS-PRP was
observed at one month compared to Pascal SS-PRP, suggesting that multiple treatments
may induce a prolonged inflammatory response as there may be insufficient time for
the tissue to recover between each session. There were no significant changes in VF
following PRP at all time points. Pascal PRP may be safely and rapidly performed
with 1,500 burns in a SS.
CR: P.E. Stanga, Optimedica Corp., F; Optimedica Corp., R; M.M.K. Muqit, None; D.B.
Henson, None; J.C.B. Gray, None; L.B. Young, None; S.J. Charles, None; G.S. Turner,
None; G.R. Marcellino, Employed by Optimedica, E.
Support: Optimedica Corporation CT: If Other, enter the registry site and
corresponding number
197 - A297 198 - A298
Visual Acuity and Macular Thickness in Patients Treated With Short-Duration Experimental Retinectomy With a Raman-Shifted Q-Switched Alexandrite
Photocoagulation for Diabetic Retinopathy Laser System
K. Yoneda, K. Kojima, H. Koizumi, T. Yasuhara, S. Kinoshita. Ophthalmology, Kyoto K.M. Joos1A, R. Prasad1A, J. Kozub1B, A. Agarwal1A, J. Shen1A. AVanderbilt Eye Institute,
Prefectural Univ of Med, Kamigyo-ku, Japan. BFree Electron Laser Center, 1Vanderbilt University, Nashville, TN.
Purpose: To report visual acuity (VA) and central macular thickness changes in a series Purpose: Several groups have identified a wavelength at 6.1 µm produced by an
of patients with diabetic retinopathy treated with short-duration photocoagulation experimental Free Electron Laser as capable of ablating tissue, including retina,
(SDPC) versus those treated with normal-duration photocoagulation (NDPC). with a minimal amount of collateral damage. It is hypothesized that 6.1 µm
Methods: Eighteen eyes of 9 patients with pre-proliferative or proliferative diabetic produced by a portable laser, likewise, would be useful for incising layers such as
retinopathy who had not been previously treated were treated with pan-retinal performing a retinectomy in detached retina with extensive anterior proliferative
photocoagulation (PC). This study was approved by the Institutional Review Board vitreoretinopathy.
(IRB), and previous written informed consent was obtained from all subjects. Multi- Methods: An alexandrite laser system, which provides a high-intensity Q-switched
color PC was used for the pan-retinal PC, and the common PC setting (yellow color, pulse (780 nm, 50-100 ns duration, 10 pulses per second), is wavelength-shifted
450-µm diameter, 300 shots per day, every 2 weeks, 4 times) was used for both groups. by a two-stage stimulated Raman conversion process into the 6-7 µm range (Light
The right eye of each patient was treated with SDPC (0.05 seconds, 350 mW) and the Age, Inc.). Fifteen fresh cadaver porcine retinas were detached with subretinal fluid
left eye was treated with NDPC (0.2 seconds, 200 mW). Macular thickness obtained or left intact. They were lased with 6.1 µm with a 100 µm diameter spot at 0.6 mJ
by optical coherence tomography (OCT) and VA were measured at the time of each after removal of the vitreous. Specimens were examined grossly and prepared for
procedure and at each subsequent follow-up. histological examination.
Results: The mean age of the patients was 64 years (range: 54-78 years). Disease Results: The Raman-shifted alexandrite laser produced a smooth Gaussian profile. A
etiology was pre-proliferative diabetic retinopathy in 12 cases (67%) and proliferative narrow spectrum was produced at 6.1 µm making it well-suited for efficient coupling
retinopathy in 6 cases (33%). The mean follow-up period was 21 weeks (range: 10-36 into a hollow-glass waveguide beam delivery system. A full-thickness retinal incision
weeks). Pre-treatment macular thickness in the SDPC and NDPC groups was 212 ± with minimal thermal damage was obtained at a low energy level of 0.6 mJ in detached
26.9µm and 213 ± 28.3µm (p = 0.93), respectively. Post-treatment macular thickness of retinas. However, the depth of the incision did vary from an incomplete incision to a
the NDPC group (252 ± 37.2 µm) was significantly thicker than that of SDPC group (194 full-thickness incision involving the underlying choroidal layer in attached retinas.
± 32.8µm) (p = 0.003). Pre- and post-treatment logMAR VA for the SDPC group was Conclusions: The 6.1 µm mid-infrared energy produced by a portable laser is capable
maintained (pre: 0.14 ± 0.27, post: 0.14 ± 0.23, p = 0.50). Whereas pre- and post-treatment of incising detached retinas with minimal thermal damage. However, the safety
logMAR VA for the NDPC group was significantly decreased (pre: 0.05 ± 0.15, post: and precision of this laser may be enhanced with imaging capability to detect when
0.13 ± 0.13, p = 0.03). All patients experienced less pain with SDPC than with NDPC. the desired incision depth has been achieved in real-time if underlying layers are
Conclusions: The use of SDPC results in a significantly lower incidence of macular present.
edema and VA decrease than traditional PC. Pan-retinal PC using SDPC has few CR: K.M. Joos, None; R. Prasad, None; J. Kozub, None; A. Agarwal, None; J. Shen,
side-effects, such as macular edema, visual dysfunction, and pain. None.
CR: K. Yoneda, None; K. Kojima, None; H. Koizumi, None; T. Yasuhara, None; S. Support: AFSOR – DOD FA9550-04-1-0045, NEI Core Grant EY08126-18, Unrestricted
Kinoshita, None. Departmental Grant from Research to Prevent Blindness, Inc., NY; Joseph Ellis Family
Support: None Research Fund.
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
195-198
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
199 - A299 200 - A300
Selective Retinal Therapy With Microsecond Exposures Using a Continuous Fundus Autofluorescence and Fourier-Domain Optical Coherence Tomography
Line Scanning Laser of Medium-Pulse Pascal versus Conventional Long-Pulse Photocoagulation:
Y.M. Paulus1, H. Nomoto1, A. Jain1, C. Sramek2, R.F. Gariano1, G. Schuele3, D. Palanker1. Study of Burn Morphology and Healing Responses
1Department of Ophthalmology, Stanford School of Medicine, Palo Alto, CA; M.M. Muqit1, J.C.B. Gray1, G.R. Marcellino2, D.B. Henson1, L.B. Young1, S.J. Charles1,
2Department of Applied Physics, Stanford University, Palo Alto, CA; 3OptiMedica G.S. Turner1, A.D. Dick3, P.E. Stanga1. 1Retinal Unit, Manchester Royal Eye Hospital,
Inc, Santa Clara, CA. Manchester, United Kingdom; 2Optimedica Corporation, Santa Clara, CA; 3Bristol
Eye Hospital, Bristol, United Kingdom.
Purpose: Retinal laser therapy with microsecond exposures enables selective targeting of
retinal pigmented epithelium (RPE) and photoreceptors. Using a continuous line scanning Purpose: To investigate the evolution of medium-pulse duration Pattern scanning
laser, we evaluate the effects of scanning rate and power on spatial confinement, safety, laser (Pascal: 10 ms, 20 ms) burns in comparison to long-pulse conventional (100
and healing of the retinal lesions. ms) photocoagulation using fundus autofluorescence (AF). To evaluate the AF
Methods: A 532 nm frequency-doubled Nd:YAG laser (PASCAL ®) with retinal beam characteristics using Fourier-Domain optical coherence tomography (FD-OCT) of
diameters of 40 and 66 µm was applied to 48 eyes of 24 Dutch-Belted rabbits in vivo. the outer retina (OR).
The duration of retinal exposure (dwell time), defined as the diameter of the beam Methods: Pilot study of consecutive patients with diabetic macular oedema and
divided by the scanning velocity, varied from 15 to 60 µs. Lesions were assessed acutely proliferative diabetic retinopathy that underwent macular and panretinal laser
ophthalmoscopically and with fluorescein angiography (FA), and flatmounts of the RPE, photocoagulation. Fundus photography (FP), FD-OCT (Topcon, 3D OCT-1000), and
choroid, and sclera were stained with live-dead fluorescent assay (LD). Histological fundus camera-based AF (Topcon TRC-50DX, type IA) were performed in 20 eyes of
analysis was performed at 1 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 2 months 12 patients at 1 hour, 1 week, 2 weeks, 1 month, and one-year following laser.
after laser application. Results: Threshold laser burns were incompletely visible with colour and red-free FP
Results: Histological analysis demonstrated that ophthalmoscopic visibility (OV) of the one hour after laser. AF enabled visualization of complete Pascal arrays at one hour,
lesions corresponded to photoreceptor damage. In sub-visible lesions, the FA and LD with localized lack of AF at sites of burns. By observing laser tissue interactions via
staining yielded similar thresholds of RPE damage, which was also visible histologically. FD-OCT and AF, all Pascal burns are initially square-edged and displayed equivalent
The ratio of the thresholds of rupture and OV to FA visibility (measures of safety and autofluorescence, localised to junction of inner and outer segments of photoreceptors
selectivity) increased with decreasing duration and beam size. For 15 µs exposures and and apical retinal pigment epithelium. With increasing duration of laser pulse, burn
a beam diameter of 66 µm, these ratios were 7 (SD 1.23) and 2.8 (SD 0.72), respectively. size increases with time with a contemporaneous diffuse increase in AF. Over time,
For 40 µm beam diameter, they increased to 10.5 (SD 0.82) and 4 (SD 1.99), respectively. Pascal burns reduced in size (100 µm 10 ms: 15% mean reduction; 400 µm 20 ms: 45%
Above the threshold of OV, histology at one day showed RPE damage and drop-out of mean reduction) in comparison to conventional 100 ms pulse duration burns.
photoreceptors without effects in the inner retina. By one week, RPE proliferation and Conclusions: We report in vivo spatial localization and clinical correlations of
photoreceptor migration from adjacent unaffected areas into the damaged zone restored medium-pulse Pascal and 100 ms burns using AF and FD-OCT. Ophthalmoscopically-
continuity of the photoreceptor and RPE layers. By 1 month, photoreceptors appeared invisible and threshold Pascal laser produces highly localized, well-circumscribed
normal without scarring. Some hypertrophy and hyperpigmentation of the renewed burns within OR. Longer-pulse durations produce more diffuse burns due to thermal
RPE persisted at 2 months. blooming and greater collateral damage. AF may be used as a monitoring tool after
Conclusions: Retinal therapy with a fast scanning continuous laser achieves selective laser photocoagulation, either to confirm successful placement of burns, to plan re-
targeting of the RPE and, at higher power, of the photoreceptors. The safety window and treatments, or when using subthreshold burns.
RPE selectivity increases with decreasing exposure time. Continuous scanning laser can CR: M.M. Muqit, None; J.C.B. Gray, None; G.R. Marcellino, Employee of Optimedica,
treat large retinal areas within the eye fixation time. For example, 100 mm2 can be treated E; D.B. Henson, None; L.B. Young, None; S.J. Charles, None; G.S. Turner, None; A.D.
within 350 ms using a 66 µm beam and a scanning velocity of 4.4 m/s. Dick, None; P.E. Stanga, Optimedica Corp., F; Optimedica Corp., R.
CR: Y.M. Paulus, None; H. Nomoto, None; A. Jain, None; C. Sramek, None; R.F. Gariano, Support: Sponsorship from Optimedica Corporation
None; G. Schuele, OptiMedica, E; D. Palanker, OptiMedica, C; OptiMedica, P.
Support: Alcon Research Institute grant, the Horngren and Miller Family Foundations,
OptiMedica Corp., the Angelos and Penelope Dellaporta Research Fund
201 - A301 202 - A302
Laser Power-Dependent Expression of Vascular Endothelial Growth Factor Pascal Laser Photocoagulation Induces Less Vegf Expression in Murine Retina
(VEGF) by Porcine RPE After Photocoagulation Than Conventional Laser Treatment
Y. Miura1, F. Treumer1, A. Klettner1, J. Hillenkamp1, R. Brinkmann2, R. Birngruber2, J. Y. Hirano, A. Ito, M. Nozaki, Y. Ogura. Ophthalmology and Visual Science, Nagoya
Roider1. 1Eye Clinic, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, City University Medical Sciences, Nagoya, Japan.
Germany; 2Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.
Purpose: We reported that retinal scatter laser photocoagulation induced upregulation
Purpose: In order to investigate the effect of laser photocoagulation on the secretion of vascular endothelial growth factor (VEGF) in the sensory retina and the retinal
of vascular endothelial growth factor (VEGF) from RPE cells with different laser pigmented epithelial (RPE)-choroid at an early period (Itaya M, et al. 2007). Recently,
irradiation ranging from sublethal to superlethal powers. a new semi-automated photocoagulator, patterned scanning laser photocoagulator
Methods: RPE-choroid porcine tissue explants were irritated with a frequency-doubled (PASCAL®) was developed (Blumenkranz MS, et al. 2006). The purpose of this study
Nd:YAG laser (wavelength 532 nm, exposure time 100ms, spot diameter 300µm) with is to compare the expression pattern of VEGF in murine retina between PASCAL®
laser powers of 0, 20, 40, 60, 80, and 100 mW. After laser irradiation, the tissues were and conventional laser treatment.
maintained in perfusion culture system. Threshold power for cell viability was Methods: Retinal scatter laser photocoagulation was performed on C57BL/6J mice
determined by Calcein-AM cell viability test. Following laser irradiation, media using PASCAL® laser (group P) or a conventional laser (group C). The eyes were
samples were obtained after 24 hours for quantification of vascular endothelial growth enucleated 3, 7 days after laser treatment. The level of VEGF in the sensory retina
factor (VEGF) by enzyme-linked immunosorbent assay (ELISA). and the RPE-choroid was quantified by ELISA. The expression pattern of VEGF in the
Results: According to the calcein-AM viability test, the threshold power was sensory retina and the RPE-choroid was also evaluated by immunohistochemistry.
determined around 50 mW for the 300 µm spot diameter. Following laser irradiation, Results: Three days after laser treatment, the VEGF levels in the sensory retina and the
VEGF concentration in the medium increased linear with laser power: exposure to 0-, RPE-choroid significantly increased in both the group P and the group C (vs control;
20-, 40-, 60-, 80, and 100 mW resulted in VEGF-concentrations of 275, 321, 352, 381,421 P<0.01). However, the VEGF exression in the group P was significantly less than that
and 507 pg/ml, respectively (n=3 samples for each power). in group C (P<0.05) in the sensory retina. There was no significant difference in the
Conclusions: Expression of VEGF was increased after laser irradiation in a power- level of VEGF between the group P and the group C in the RPE-choroid. Histological
dependent manner. Interestingly, significant concentrations were also found far below observations revealed that the inner retina in the group P was less affected compared
the threshold laser power for immediate cell death. The expression of VEGF following to the group C.
sublethal laser irradiation may be caused by intracellular temperature increase. Conclusions: We have shown that PASCAL® laser induced less VEGF induction in
CR: Y. Miura, None; F. Treumer, None; A. Klettner, None; J. Hillenkamp, None; R. the sensory retina compared to conventional laser treatment. PASCAL® laser may
Brinkmann, None; R. Birngruber, None; J. Roider, None. prevent macular edema after panretinal photocoagulation.
Support: German ministry of education and research (BMBF) Grant 01 EZ 0734 CR: Y. Hirano, None; A. Ito, None; M. Nozaki, None; Y. Ogura, None.
Support: None
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
199-202
Monday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 1382 - 1406 / B121 - B145
219. Functional Retinal Imaging Organizing Section: MOI
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
203 - A303 204 - A304
Pattern Scan Laser Photocoagulation: Safety and Complications, Experience Retinal Damage Profiles and Cellular Responses to Laser Treatment:
After 1301 Consecutive Cases Comparison Between a Novel, Non-Thermal Laser and a Conventional
E. Romo-Garcia1, R. Velez-Montoya1, J. Guerrero-Naranjo1, J. Jimenez-Sierra1, J. Fromow- Photocoagulator
Guerra1, H. Quiroz-Mercado2, V. Morales-Cantón1. 1Retina, APEC, Mexico, Mexico; G. Chidlow1, J.P.M. Wood1, R.J. Casson1, M. Plunkett2. 1Ophthalmic Research
2Ophthalmology, Denver Health Medical Center, Denver, CO. Laboratories, Royal Adelaide Hospital, Adelaide, Australia; 2Ellex R&D Pty Ltd,
Adelaide, Australia.
Purpose: To report the safety and incidence of adverse effects, during and after a
successful photocoagulation for different pathologies using a Pattern Scan Laser Purpose: Thermal lasers remain the gold standard for treatment of diabetic retinopathy;
(PASCAL) system and its modified settings. however, there are many associated clinical side-effects such as the inability to treat within
Methods: We reviewed the clinical records of 1301 consecutive cases who were treated the foveal region due to collateral retinal damage. Ongoing clinical trials indicate that a
with laser; using PASCAL since November 2007 to July 2008. In case of any complication novel nanosecond pulse laser (2RT) reduces diabetic macular edema. In the current study
during the treatment or in the following two weeks; the type of complication, the eye we compared retinal damage and cellular responses resulting from laser treatment of rats
involved, the affected retina quadrant, treatment and if it resolved in a satisfactory with a conventional thermal photocoagulator laser and the 2RT laser at clinically relevant
energy levels.
manner or presented long-term disabilities were recorded.
Methods: Pigmented Dark Agouti rats were treated with approximately 100 shots of either
Results: Bleeding (presumably from Bruch´s membrane ruptures) in 1.30% (17 cases)
a conventional photocoagulator laser (532nm, CW laser, Ellex Integre with 0.1sec pulse
of the patients, being the supero-temporal cuadrant the most common location;
duration) or a nanosecond pulse laser (532nm, Q-switched Retinal Regeneration Therapy
Choroidal detachments were seen in 2 cases (0.15%). All complications resolved within laser prototype, Ellex 2RT with 3 nanosecond pulse duration). Laser settings were at visible
two weeks without treatment. lesion threshold for the CW laser and at visible lesion threshold and below for the 2RT laser.
Conclusions: The PASCAL system demonstrated to be safe in treating retinal Rats were killed at various time points following the procedure. Samples were processed for
conditions requiring laser photocoagulation. The complications were few and with histology, immunohistochemistry, in situ biochemical assays, real-time and conventional
no long term consequences. RT-PCR and Western blotting using standard methodologies.
CR: E. Romo-Garcia, None; R. Velez-Montoya, None; J. Guerrero-Naranjo, None; J. Results: The photocoagulator laser caused retinal lesions that were principally evident
Jimenez-Sierra, None; J. Fromow-Guerra, None; H. Quiroz-Mercado, None; V. within the outer retina. These were associated with photoreceptor cell death, astrocyte
Morales-Cantón, None. and Müller cell activation, and infiltration of macrophages and neutrophils. In addition,
Support: None upregulations of inflammatory cytokines, heat shock proteins, endogenous trophic factors,
and matrix metalloproteinases were induced. In comparison, all of these changes were
drastically attenuated when the 2RT laser was used, particularly at the sub-visual power
setting, although RPE cell loss was still evident.
Conclusions: The photocoagulator laser produced marked retinal damage and cellular
responses consistent with an inflammatory response to thermal injury. In contrast, the
2RT laser produced negligible retinal damage and cellular responses at clinically relevant
energy levels, and only marginally greater effects at elevated energy levels. These results
show that nanosecond pulses of the 2RT laser produce an isolated insult at the level of
the RPE without causing collateral damage to the neuroretina, which is a normal clinical
consequence of thermal photocoagulator laser procedures. These results may have important
implications for the treatment of diabetic macular edema, proliferative diabetic retinopathy
and early AMD.
CR: G. Chidlow, Ellex R&D Pty Ltd, F; J.P.M. Wood, Ellex R&D Pty Ltd, F; R.J. Casson,
None; M. Plunkett, Ellex R&D Pty Ltd, E; Ellex R&D Pty Ltd, P.
Support: Research supported in part by Ellex R&D Pty Ltd and the Australian Government
Department of Industry Tourism and Resources, AusIndustry.
205 - A305 206 - A306
Pascal® (Pattern Scan Laser) Photocoagulator - An Analysis of 313 Cases Detection of Retinal Proteins in Saliva and Serum Following Retinal
C.A. Sanghvi1, M. Muqit1, R. McLauchlan1, C. Waterman1, L. Young1, S. Charles1, Photocoagulation in Rabbits
G. Marcellino2, P. Stanga1. 1Ophthalmology, Manchester Royal Eye Hospital, J. Dunmire, R. Bouhenni, M. Hart, J. Sapitro, A. Chomyk, H. Nakamura, D.P. Edward.
Manchester, United Kingdom; 2Optimedica, Santa Clara, CA. Department of Ophthalmology, Summa Health System, Akron, OH.
Purpose: To analyse laser parameters and outcomes with the Pascal® photocoagulator Purpose: Retinal injuries affecting the photoreceptors and/or the retinal pigment
which delivers a pattern array of multiple sequential burns while reducing the pulse epithelium (RPE) may result in leakage of subcellular fragments of retinal-specific
duration to 10 ms for macular photocoagulation and 20 ms for PRP. proteins into the systemic circulation through the underlying choroid. These molecules
Methods: Retrospective case note review of 313 patients divided into - group A - may be detected in body fluids following the injury. To test this hypothesis, we used
patients undergoing PRP for PDR, group B - patients undergoing focal treatment for Liquid chromatography/Mass spectrometry (LC/MS/MS) to detect retinal proteins
CSME, group C - patients undergoing grids for diffuse diabetic macular oedema, in body fluids of Dutch Belted rabbits following retinal photocoagulation
group D - patients undergoing sector PRP for ischaemic BRVO, group E - patients Methods: Rabbits were treated using an Nd:YAG laser (532 nm) to create retinal
undergoing PRP for ischaemic CRVO, group F - patients undergoing treatment for photocoagulation. Saliva and serum samples were collected from 15 and 9 rabbits
macular oedema secondary to BRVO, group G - patients with rubeosis iridis and respectively both pre and post laser treatment. Unpaired control samples were also
neovascular glaucoma secondary to BRVO, CRVO or PDR who underwent PRP, and obtained from non-treated animals. Presence or absence of retinal-specific proteins
group H - patients undergoing retinopexy for retinal breaks. was confirmed by LC/MS/MS analysis.
Results: Mean Logmar visual acuity for all procedures improved after laser but was Results: Retinal-specific proteins were detected in 46.7% of saliva (n=15) and 100% of
not statistically significant (p=0.065). 72% of procedures were successful and 28% pooled serum (n=3) from samples taken 24 hours after laser injury. Proteins identified
were unsuccessful at a mean follow-up of 5 months. No laser related complications from saliva included Retinal Guanylyl Cyclase (n=2), Guanine Nucleotide Binding
were observed. Topical anaesthesia was sufficient in all patients. Significantly higher Proteins (n=3) and Guanylyl Cyclase Activating Protein (n=2). Proteins identified from
powers were required with Pascal® than with conventional laser (p=0.001). Single serum included Rhodopsin (n=1), Guanine Nucleotide Binding protein β 5 (n=1), and
session PRP was performed in 15 group A patients using a mean of 1952 burns, 10 of Regulator of G protein Signaling 9 (n=1). None of these proteins were detected in any
which were successful, but 5 needed further laser. paired or unpaired samples from non-treated control rabbits.
Conclusions: This method offers significant benefits while remaining consistent with Conclusion: Retinal-specific proteins were detected in the saliva and serum of rabbits
standard protocols. Outcomes are comparable with conventional laser. The shorter subjected to laser treatment. Although these proteins were detected at low levels
pulse duration necessitates the use of higher power but this is not associated with in a small number of samples, and given that they are retinal-specific proteins not
any adverse effects. normally expressed in other tissues, any observation in body fluid may be a significant
indication of injury to the retina-RPE complex. Also, it is known that low abundance
proteins analyzed by LC/MS may not be observed in every sample. We suggest that
LC/MS/MS may be a suitable method to preliminarily screen for candidate retinal
proteins released into body fluids following retinal injury.
CR: J. Dunmire, None; R. Bouhenni, None; M. Hart, None; J. Sapitro, None; A.
Chomyk, None; H. Nakamura, None; D.P. Edward, None.
Support: USAMRA contract #W81XWH-05-2-0093 and AFDW contract #FA7014-
07-C-0047.

CR: C.A. Sanghvi, None; M. Muqit, None; R. McLauchlan, None; C. Waterman,
None; L. Young, None; S. Charles, None; G. Marcellino, Optimedica, I; P. Stanga,
None.
Support: None
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
203-206
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
207 - A307 208 - A308
Structural Changes of the Retina After Conventional Laser Photocoagulation Laser Protection and Sensitization of an in vitro Retinal Model Depends Upon
and Selective Retina Treatment (SRT) in Spectral Domain OCT the Order of Artificial Pigmentation and Hyperthermia Pretreatment
R. Regler1, A. Walter1, P. Prahs1, D. Theisen-Kunde2, C. Alt3, R. Brinkmann2, C. Framme1. M.L. Denton1, G.D. Noojin1, M.S. Foltz1, L.E. Estlack2, R.J. Thomas3, B.A. Rockwell3.
1University Eye Hospital, Regensburg, Germany; 2Medical Laser Center, Luebeck, 1Northrop Grumman, Brooks City-Base, TX; 2Conceptual MindWorks, Inc, San
Germany; 3Wellman Center for Photomedicine, Massachusetts General Hospital, Antonio, TX; 3AFRL, 711 HPW/RHDO, Brooks City-Base, TX.
Harvard Medical School, Boston, MA.
Purpose: To study the effects of mild hyperthermia preconditioning on the
Purpose: High resolution optical coherence tomography (OCT) in patients can be achieved susceptibility of retinal pigment epithelial (RPE) cells to laser damage at 514 nm.
using spectral domain OCT. This may allow a first-time evaluation of the extent of Methods: An existing artificially pigmented in vitro retinal model (Denton et al.,
damage to the retinal pigment epithelium (RPE) and the neurosensory retinal layer after 2008, J. Biomed. Opt., 13(5):054014) was used to identify protection or enhancement of
conventional laser photocoagulation and selective retina treatment (SRT), which only laser-induced damage 18 hr after mild hyperthermia preconditioning (PC) treatment.
targets the RPE while sparing the photoreceptors. Control and experimental RPE cells were exposed (16 replicates of the same irradiance)
Methods: In a retrospective observation spectral domain OCT was used to evaluate the to a 0.93-mm diameter laser beam (514-nm line from an argon laser) for 0.25 s. Area
appearance of 175 conventional retinal laser lesions (CRL) lasting 1 hour up to 4 years after of damage was assessed using a live-dead fluorescence indicator method 1-hr post
treatment in ten patients with diabetic maculopathy and 91 SRT lesions in 9 patients with exposure. The hyperthermia pretreatment consisted of a 20-min ramp up from 37 ºC
central serous retinopathy, geographic atrophy and diabetic maculopathy lasting 1 hour to 42 ºC, an additional 20 min at 42 ºC, followed by a quick ramp down to 37 ºC. In
up to 2 years. CRL lesions were applied with an ophthalmoscopically slightly whitish- addition to the PC of RPE cells after artificial pigmentation, RPE cells and melanosome
gray appearance (Nd:YAG laser at 532nm wavelength; power: 100-200mW; retinal spot particles (MPs) were PC separately and added together 1 hr later. Finally, PC cells
diameter: 100µm; pulse duration: 100ms), while the only angiographically visible SRT without pigment were pigmented with normal MPs. For each exposure, corresponding
lesions were applied with a Nd:YLF (527nm; pulse duration: 200ns [30 pulses at 100Hz]; fluorescence and IR images (high-speed high-magnification) were spatially overlaid
energy : 100-200µJ/pulse; retinal spot diameter: 200µm). with each other to identify thermal history of cells at the boundary of death.
Results: All CRL lesions revealed high reflectivity throughout the full-thickness Results: Combining the results of all 16 replicates, area of laser damage was summed
neurosensory tissue one hour after irradiation suggesting complete neurosensory and compared to control exposures. Cells that were PC after pigmentation had a 5.25
coagulation. In contrast, the neural retina appeared unaffected immediately after SRT. fold increase in damaged area. Cells PC before addition of adding normal MPs had
For both lesion types the RPE appeared to be thinner immediately after treatment. no difference in laser-induced damage area. When cells and MPs were PC separately,
Within a period of four weeks both lesion types showed a thickening of the RPE layer but added later, they had markedly less damaged area after laser exposure. In all 4
indicating RPE proliferation. While neurosensory retina appeared unaffected in SRT sample types, the average temperature the cells at the boundary of death experienced
lesions during the follow-up period, within seven days a full-thickness strong contraction was the same, indicating the integrated temperature-time product for cell death was
and an increased reflectivity of the neurosensory layers was observed for CRL lesions. unaltered.
CRL lesions of about one year and older revealed RPE atrophy combined with significant Conclusions: The location of MPs during hyperthermia determines whether pigmented
changes in the neurosensory tissue whereas SRT lesions one year and older presented RPE cells were resistant or sensitized to subsequent laser damage at 514 nm. The PC
unaffected neurosensory structures and a firm RPE layer. appears to alter the photochemistry and/or the absorption properties of the MPs.
Conclusions: Spectral domain OCT can clinically be used to exactly follow the extent CR: M.L. Denton, None; G.D. Noojin, None; M.S. Foltz, None; L.E. Estlack, None; R.J.
of laser induced lesions over time. For both, CRL and SRT laser lesions a postoperative Thomas, None; B.A. Rockwell, None.
RPE proliferation process was observed with subsequent appearance of atrophy only in Support: AFOSR Grant 92HE04COR
CRL lesions whereas the neurosensory retina appeared unaffected following SRT. This
underlines the selective effect of SRT also in humans.
CR: R. Regler, None; A. Walter, None; P. Prahs, None; D. Theisen-Kunde, None; C.
Alt, None; R. Brinkmann, None; C. Framme, None.
Support: Dr. Werner Jackstaedt foundation, Wuppertal, Germany CT: www.clinicaltrials.
gov, nct00403884
209 - A309 210 - A310
Cytokines in Vitreous of Rabbits After Photocoagulation Using Conventional Krypton Yellow Laser Photocoagulation for Retinal Arterial Macroaneurysm
and Short Pulse Pattern Scanning Laser L.D. Brown1, R.N. Sjaarda2. 1Ophthalmology, Friedenwald Eye Institute, Baltimore,
S. Lee1A, M. Shin1B, B. Oum1B, J. Lee1B. ADep. of ophthalmology, BDep. of MD; 2Ophthalmology, Greater Baltimore Medical Center, Baltimore, MD.
Ophthalmology, 1Pusan National University Hospital, Busan, Republic of Korea.
Purpose: To review the results of krypton laser photocoagulation for retinal arterial
Purpose: To compare the effect of photocoagulation using between conventional laser macroaneurysms in symptomatic eyes.
and short pulse pattern scanning laser. Methods: A retrospective analysis was performed on 24 eyes in 24 patients undergoing
Methods: Laser photocoagulation was performed using conventional in the right eye laser photocoagulation with yellow wavelength (568 nm) krypton laser for symptomatic
and pattern scanning laser in left eye of eight pigmented rabbit. The spot diameter retinal arterial macroaneurysms involving the macula from 1998-2008.
was 400 µm and the exposure time was 0.1 and 0.02 seconds respectively. The power These patients had direct treatment to the macroaneurysm by a single retinal
was adjusted for mild to moderate burns which were similar visually. A hundred surgeon. All patients presented with worsening visual acuity secondary to the
burns were made for each eye. Vitreous humor was aspirated before, at 1, 3 and 7 days macroaneurysm involving the macula evidenced by biomicroscopy, color fundus
after the photocoagulation. IL-1, IL-6, IL-8 and TNF-α were measured in five rabbits. photos, and angiography. Eyes with macroaneurysms not contributing to visual loss
Specimens for histological examinations were obtained at 1, 3 and 7 days. or threatening the macula were not in included in the study. Visual acuities were
Results: Ophthalmoscopic findings were similar in both lasers. The ranges of power recorded at the initial visit, at treatment, and at time ranges of 3, 6, and 9 month
were 175-225 mW in conventional laser and 400-500 mW in pattern scanning laser. intervals following treatment, and at the final exam. Snellen acuities were converted
IL-6, IL-8 and TNF-α has increased significantly in both groups at 1, 3 and 7 days to logMAR scale for comparison. Complications and comorbid ocular diseases were
(p<0.05), while there was no significant difference between two groups. Histological also noted along with subsequent interventions following treatment.
findings were similar in the both eyes. Results: Twenty four eyes in 24 patients were included in this review. There were 19
Conclusion: In the case of achieving similar intensity of photocoagulation burn, there females and 5 males. The average age at onset was 80 years old. At the initial visit,
was no difference between short pulse pattern scanning and conventional laser in mean visual acuity was 1.00 (~20/200) (range: 0.3 to 2) compared to the final visit
levels of IL-1, IL-6, IL-8 and TNF-α as well as histological findings. visual acuity of 0.71 (~20/102) (range: 0.18 to 1.3) resulting in the mean visual angle
CR: S. Lee, None; M. Shin, None; B. Oum, None; J. Lee, None. being approximately halved. The mean final follow-up visit was 96 weeks (range: 13
Support: Medical Research Institute, Pusan National University Hospital to 364). Of the 24 eyes, 5 eyes experienced subsequent comorbid ocular conditions
which limited their outcome. Of the remaining 19 eyes, the mean initial visual acuity
was 1.11 (~20/258) (range: 0.3 to 2) and the final visual acuity at a mean follow-up
of 57 weeks (range: 13 to 135) was 0.64 (~20/87) (range: 0.18 to 1.3). There were no
complications related to the treatment.
Conclusions: In our series, krypton laser photocoagulation was found to be safe
and provides a benefit in eyes with symptomatic retinal arterial macroaneurysms.
Improvements in visual acuity were greater in eyes without other comorbid ocular
conditions.
CR: L.D. Brown, None; R.N. Sjaarda, None.
Support: None
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
207-210
Monday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 1382 - 1406 / B121 - B145
219. Functional Retinal Imaging Organizing Section: MOI
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
211 - A311 212 - A312
Comparison of Retinal Morphologic Changes Using Conventional and Pascal© Acute Retinal Morphologic Changes Following Panretinal Laser Coagulation in
Laser System the Human Retina
S.G. Prager1, M. Bolz1, G.G. Deak1,2, K. Kriechbaum1, G. Mylonas1, C. Scholda1, U. C. Treu1, M. Bolz1, G.G. Deak1,2, S.G. Prager1, G. Mylonas1, C. Scholda1, U. Schmidt-
Schmidt-Erfurth1, DRRG Vienna. 1Department of Ophthalmology, Medical Erfurth1, Diabetic Retinopathy Research Group (DRRG) Vienna. 1Department
University Vienna, Vienna, Austria; 2Department of Ophthalmology, Semmelweis of Ophthalmology, University of Vienna, Vienna, Austria, Vienna, Austria;
University, Budapest, Hungary. 2Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
Purpose: To compare the morphologic changes of laser lesions in the human retina Purpose: To determine the acute morphological in vivo changes in the human retina
in vivo performed by 2 different retinal laser systems. after panretinal photocoagulation in patients suffering from proliferative diabetic
Methods: In this prospective interventional study, 20 patients in need of panretinal retinopathy (PDR).
photocoagulation were randomized into two groups: one group was treated with a Methods: Ten patients with previously untreated proliferative diabetic retinopathy
conventional laser system (Novus Omni(c), Coherent) and the other group with a were evaluated in this prospective study. All patients underwent a photocoagulation
semi automated patterned scanning laser system (PASCAL(R), Optimedica). Laser therapy using a semi-automated patterned scanning laser system (PASCAL©) or with
lesions were imaged at day 1, week 1, and thereafter in monthly intervals up to six a conventional laser system (Novus Omni©, Coherent). Measurements were obtained
months using a spectral domain OCT (SD OCT) device (Spectralis(R), Heidelberg with the Spectral Domain OCT (Spectralis OCT © Heidelberg Engineering), infrared
Engineering), infrared (IR) and color photo (CF) imaging. (IR) and autofluorescence (AF) imaging at day 1, 2, 4 and 7 after treatment. The laser
Results: Laser lesions from both systems were well visible in OCT already at day 1 lesions were evaluated for changes in their retinal structure, diameter, and center
as focal sharply delineated tissue destruction from the outer plexiform to the photo point thickness.
receptor layer. At week 1, laser lesions by the Pascal laser system showed a symmetric Results: On the first two days following treatment, the intra-retinal lesions were
pattern with a roundish spot shape, equal spot size and spot distance clearly detectable confined to the outer retinal layers i.e. the photo receptor layer (PRL), the outer nuclear
in IR, CF and SD OCT images. Laser lesions performed with the conventional system layer (ONL) and in part the outer plexiform layer (OPL), and showed clear borders to
were shaped round to oval and in some cases confluent. Apart from that, there were the surrounding tissue in SD OCT. The loss of the marginal sharpness as well as the
no differences in the intra-retinal changes with time between both groups. decrease in diameter and thickness could be observed within each lesion between
Conclusions: Intra-retinal lesions following photocoagulation treatment with a semi day 3 and 7. These changes were caused by a strong scarring reaction in the PRL and
automated laser system show high uniformity in size, shape and progression. A ONL causing traction forces on the inner retinal layers lying above. The onset and
conventional single spot laser treatment causes the same intra-retinal lesions, however, extent of this tissue reaction to therapy depended on the administered Laser energy.
showing a high diversity in the individual spot size and shape. By day seven coagulates had already lost their initial shape and reflectivity and
CR: S.G. Prager, None; M. Bolz, None; G.G. Deak, None; K. Kriechbaum, None; G. showed a clear attachment of the OPL to the laser coagulate which was than visible
Mylonas, None; C. Scholda, None; U. Schmidt-Erfurth, None. as a hyper-reflective area at the level of the PRL.
Support: None CT: www.clinicaltrials.gov, NCT00682240 Conclusions: Panretinal laser therapy causes significant acute structural intra-retinal
morphologic changes observable in the first seven days that can clearly be analyzed
in SD OCT. Traction forces on the inner layers lying above the lesions emerged
between day 3 and 7 indicating a characteristic scarification process depending on
the laser energy used.
CR: C. Treu, None; M. Bolz, None; G.G. Deak, None; S.G. Prager, None; G. Mylonas,
None; C. Scholda, None; U. Schmidt-Erfurth, None.
Support: None
213 - A313 214 - A314
PASCAL Retinal Photocoagulation: Review of Parameters Applied in 1,241 Focal Juxtafoveal and Grid Pattern Selective Micro-Pulsed Laser
Treatments Photocoagulation for Treatment of Chronic Central Serous Chorioretinopathy
P. Lanzetta1A, D. Veritti1A, I. Zucchiatti1A, C. Savorgnani1A, D. Drigo1B, F. Bandello1A. A.R. Dare1, D. Lavinsky2, F. Magalhães2, L. Roisman2, F. Tognin3, C.E. Moreira1, J.A.
ADept of Ophthalmology, BIstitute of Hygiene and Epidemiology, DPMSC, Cardillo1. 1Ophthalmology, CBEO, Araraquara, Brazil; 2Ophthalmology, Federal
1University of Udine, Udine, Italy. University of São Paulo, São Paulo, Brazil; 3Ophthalmology, Hospital de Olhos,
Purpose: To report laser parameters used for the PASCAL® photocoagulation system with Araraquara, Brazil.
short pulse duration (20 msec) in patients treated at our institution for different retinal Purpose: To report the functional and anatomic outcomes of selective 810-nm
conditions. Perioperative complications type and incidence are also reported. micro-pulsed laser photocoagulation (SMLP) for chronic idiopathic central serous
Methods: We conducted a retrospective chart review of 752 eyes who underwent chorioretinopathy (ICSC) with juxtafoveal leakage.
laser treatment using the PASCAL® photocoagulation system from December 2006 to Methods: Ten eyes in 9 patients with persistent ICSC and juxtafoveal leakage longer
November 2008. A total of 1,241 interventions applied with a wide field (Quadraspheric) than 6 months’ duration and leakage pinpoint inside of the foveal avascular zone were
or three mirror lens were divided into three groups - group A, focal or modified grid treated. Following an individual power adjustment for chorioretinal pigmentation
macular laser for diabetic macular edema; group B, panretinal photocoagulation for and media transparency, a high density focal and grid (pulse of 2200 µs set at a duty
proliferative diabetic retinopathy; group C, retinopexy for retinal tears and holes. Retinal cycle of 10% for 300 milliseconds) was delivered to the pinpoint angiographic leakage
whitening was the desired endpoint during irradiation. Descriptive statystical analysis a well as to a adjacent area of normal retina. For main outcome measures changes in
was performed for laser settings including power, exposure time, spot size, number of ETDRS best correct visual acuity and central macular thickness obtained using optical
spots, number of treatments/eye. The gaussianity of each distribution was tested with coherence tomography were series-measured over a 6-months follow-up. Pre and post-
Shapiro-Wilk test. treatment fluorescein angiography (FA) and microperimetry were assessed.
Results: Results are synthetized in Table 1. Most frequently used patterns were single Results: No visible clinical signs of treatment could be detected either on fundus
spot (89% of cases) in group A, 5x5 box with 0.5 spot spacing (72%) in group B, and 2x2 examination and FA. In parallel, mycroperimetry examination disclosed no induced
box with 0.5 spot spacing (78%) in group C. Distributions of all variables analysed are laser-related focal damage to the treatment area. Improvement of 2 or more lines
non-normal and asymmetrical. No complications was encountered in group A and C. on the ETDRS chart was achieved in all patients. At the end of follow-up, the
In group B, three cases of retinal haemorrhage secondary to a micro-explosion and two average preoperative foveal thickness was reduced by more than half of its original
cases of choroidal detachment were reported. thickness.
Conclusions: Retinal photocoagulation with short duration is clinically feasible without Conclusions: The beneficial and selective clinical response even of foveal applied
significant complications. Powers used are higher than usually applied with longer pulses SMLP substantiates a novel and more comprehensive therapeutic strategy for the
(100-200 msec) as previously reported. treatment of ICSC patients, and raises the possibility of improving upon the costly
photodynamic therapy if these findings could be validated in sufficiently powered
clinical trials.
CR: A.R. Dare, None; D. Lavinsky, None; F. Magalhães, None; L. Roisman, None; F.
Tognin, None; C.E. Moreira, None; J.A. Cardillo, None.
Support: None
CR: P. Lanzetta, Iridex Co, P; Neovista Inc, C; Novartis Pharma AG, C; Allergan, R;
Novartis Pharma AG, R; QLT Inc, R; Optimedica Co, R; D. Veritti, None; I. Zucchiatti,
None; C. Savorgnani, None; D. Drigo, None; F. Bandello, None.
Support: None
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
211-214
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
215 - A315 216 - A316
The Effect of Triamcinolone Acetonide on the Healing of Retinal In Human Functional Analysis of Different Clinical Grades of Retinal
Photocoagulation Lesions Coagulation Lesions
H. Nomoto, Y.M. Paulus, R. Dalal, R.F. Gariano, D. Palanker, M.S. Blumenkranz. R. Peroni1, J.A. Cardillo1,2, A. Daré1, D. Lavinsky3, C.E. Moreira1. 1CBEO, Araraquara,
Department of Ophthalmology, Stanford University School of Medicine, Stanford, Brazil; 2Hospital de Olhos de Araraquara, Araraquara, SP, Brazil; 3Universidade
CA. Federal de São Paulo UNIFESP/EPM, São Paulo, Brazil.
Purpose: Intravitreal triamcinolone acetonide (TA) is commonly used in patients Purpose: To assess the microperimetry changes on normal human retina of retinal
undergoing retinal photocoagulation to treat retinal vascular disorders. However, the photocoagulation lesions of various clinical grades.
effect of triamcinolone on the healing of retinal laser burns has not been studied. We Methods: A 532-nm diode laser was used to irradiate the temporal retina of 20 patients
evaluate the effect of intravitreal TA on healing of the retinal photocoagulation lesions undergoing photocoagulation for proliferative diabetic retinopathy and the resulting
using drug and laser dosing regimens typically employed in clinical practice. lesions immediately graded according to its clinical appearance from an invisible
Methods: A 532nm Nd:YAG laser (PASCALTM) with a retinal beam diameter of 267 µm or mild gray to a moderate to severe white. Microperimetry was performed at the
was applied to 40 eyes of 20 Dutch-Belted rabbits in vivo. Lesions of varying clinical targeted area prior and at 1 and 4-week post laser irradiation.
intensities were produced in each eye with pulses from 5 to 100 ms at a constant Results: Showing a parallel pattern of response for all patients involved in this
power of 175 mW. Each eye received either 2mg TA/50uL, or the same volume of investigation, invisible and light to light-moderated burns caused no detectable
balanced salt solution (BSS). An intravitreal injection was administered either one changes on the microperimetry assessment. On the contrary, moderate to intense
week prior to or immediately following laser treatment. Lesions were assessed acutely lesions caused a sustained significant decrease in retina sensitivity.
ophthalmoscopically and then histologically at 1 day, 3 days, 1 week, 1 month, and Conclusion: Optimal therapeutic benefit of macular photocoagulation can be achieved
2 months after laser application. more selectively using light to barely visible lesions and not only with clinically
Results: Immediately after photocoagulation followed by the intravitreal injection, invisible lesions. In complementation to animal histological assessment, these data may
intense lesions in the TA and BSS groups were ophthalmoscopically indistinguishable. facilitate studies to determine those aspects of laser treatment necessary for beneficial
However, histological analysis revealed that the lesions in the TA injected eyes were clinical response and those that result in extraneous retina damage.
wider and exhibited slightly more coagulative necrosis at 1 day. In intense lesions the CR: R. Peroni, None; J.A. Cardillo, None; A. Daré, None; D. Lavinsky, None; C.E.
diameter of RPE-photoreceptor defect at 1 day was 23% larger with TA (336 ± 6.8 µm) Moreira, None.
than with BSS (272 ± 13 µm). At 3 days, lesions were 133% larger (436 ± 63 µm) with Support: None
TA than with BSS (197 ± 7.0 µm), and at 1 week the TA lesions were 80% larger (310
± 14 µm vs. 172 ± 17 µm). At 1 month the TA lesions were still larger by 57%, and at 2
months the difference decreased to 41% (172 ± 35 µm vs. 122 ± 6.8 µm). Similarly, the
diameter of histologically evident damage in the outer nuclear layer was 60% larger
in TA-injected eyes at 7 days and 43% larger at 2 months.
Conclusions: Intravitreal TA injection immediately following intense laser
photocoagulation significantly alters healing of the laser lesions; in particular,
lesion size is significantly enlarged. This effect is most pronounced within the first
week, but persists to a lesser degree for up to 2 months. The impact of intravitreal
triamcinolone on the retinal wound healing when administered one week prior to
treatment or following mild to moderate burns is currently under investigation and
will also be presented.
CR: H. Nomoto, None; Y.M. Paulus, None; R. Dalal, None; R.F. Gariano, None; D.
Palanker, OptiMedica, C; OptiMedica, P; M.S. Blumenkranz, OptiMedica, P.
Support: Alcon Research Institute grant, the Horngren and Miller Family Foundations,
the Angelos and Penelope Dellaporta Research Fund
217 - A317 218 - A318
Optimal Endpoint and Lesion Character for Subtreshold Micropulse Indocyanine Green Angiography-Guided Laser Photocoagulation for Idiopathic
Photocoagulation Protocols Targeting Diabetic Macular Edema Macular Telangiectasia
J.A. Cardillo1,2, A. Daré2, R. Peroni2, D. Lavinsky3, R.A. Costa1, C.E. Moreira2. 1Hospital Y. Usui, Y. Hirano, M. Nozaki, T. Yasukawa, Y. Ogura. Ophthalmology and Visual
de Olhos de Araraquara, Araraquara, Brazil; 2Centro Brasileiro de Especialidades Science, Nagoya City University Medical Sciences, Nagoya, Japan.
Oftalmológicas, Araraquara, SP, Brazil; 3Universidade de São Paulo UNIFESP/EPM,
Purpose: As reported previously, while laser photocoagulation was effective for
São Paulo, SP, Brazil.
type I (aneurysmal) telangiectasia, type II (perifoveal) telangiectasia was refractory
Purpose: To clinically compare the characteristics of the retinal lesions of successfully to laser photocoagulation. The reason was because focal targets such as aneurysms
and non-successfully treated patients that underwent subthreshold 810nm-diode were not detectable by fluorescein angiography (FA) in eyes with type II telangiectasia.
micropulse (SDMP) photocoagulation for diabetic macular edema. We evaluated the efficacy of indocyanine green angiography (IA)-guided laser
Methods: A retrospective clinical and angiographic analysis of the resulting macular photocoagulation combined with subtenon injection of triamcinolone acetonide
coagulation lesions of 200 eyes that underwent SDMP was performed. Lesions (STTA) for idiopathic macular telangietasia.
were classified as (1) angiographic-visible lesion, (2) barely visible lesion (red-free Methods: Seven eyes of 7 patients were enrolled in this study. Two patients were
photography), (3) invisible lesion and respectively correlated to the functional (ETDRS male: 5 patients female. The mean age was 72 years, ranging 50-82 years. Two were
best correct visual acuity) and anatomical (OCT-central macular thickness) outcome classified into type I, and 5 eyes type II. Mean follow-up period was 8.0 (ranged
one-year pos-treatment. 4-16) months. FA and IA were performed with Heidelberg Retina Angiogram 2.
Results: In 93% of 70 eyes that improved 15 or more letters, the lesions were classified Laser photocoagulation targeted leaky vessels detected by IA, carried out with the
as type 1 (n=35) and type 2 (n=30) lesions. On the contrary, in 80 % of 10 eyes loosing following settings: wavelength of 577 nm, power of 100-200 mW, spot size of 100-200
15 or more letters a type 3 lesion was detected. A parallel anatomical correlation was µm, and duration of 0.2 sec. Immediately after photocoagulation, STTA (20 mg) was
observed, and 87% of 128 eyes that experienced a complete regression of the macular performed. Central macular thickness was periodically measured by optical coherence
edema presented a type 1 (n=50) or type 2 lesion (n=62). tomography. Logarithm of the minimum angle of resolution (LogMAR) visual acuity
Conclusion: For optimized SDMP treatment protocols and guidelines, in the effort was also measured.
to minimize the side effects while maintaining the efficacy retinal photocoagulation Results: At the final visit, the mean central macular thickness and the mean visual
lesions should be titrated to a barely clinically visible or to an angiographic-visible acuity were improved significantly from baseline (p<0.05). Visual acuity was improved
endpoint. with 0.3 or more of LogMAR units in 2 eyes (29 %), stabilized in 5 eyes (71 %), and
CR: J.A. Cardillo, None; A. Daré, None; R. Peroni, None; D. Lavinsky, None; R.A. deteriorated in no eyes (0%). No adverse effects were reported throughout the
Costa, None; C.E. Moreira, None. observation period.
Support: None Conclusions: IA was helpful to detect microangiopathy even in eyes with type II
telangiectasia. ICG-guided laser photocoagulation combined with STTA might be
effective to treat not only type I but also type II idiopathic macular telangiectasia.
CR: Y. Usui, None; Y. Hirano, None; M. Nozaki, None; T. Yasukawa, None; Y.
Ogura, None.
Support: None
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
215-218
Monday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 1382 - 1406 / B121 - B145
219. Functional Retinal Imaging Organizing Section: MOI
Sunday, May 3, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 183 - 227 / A283 - A327
109. Laser: Technology and Treatments Organizing Section: RE
219 - A319 220 - A320
Comparison of the Effects of Bevacizumab Before vs After Pattern Panretinal Laser Demarcation Photocoagulation for Rhegmatogenous Retinal Detachments
Photocoagulation J.L. Heffez1A, Z. Al-Mohtaseb1, P.E. Carvounis1A,2, A.J. Barkmeier1A, E.R. Holz1A.
F. Hernández-Miranda1, M. Lopez Miranda1, C. Claudia2, C. Cortes Alcocer2, V. Morales AVitreoretinal Surgery, 1Baylor College of Medicine, Houston, TX; 2Vitreoretinal
Canton1. 1RETINA, Asociacion Para Evitar la Ceguera en Mex, Mexico city, Mexico; surgery, Veterans Affairs Medical Center, Houston, TX.
2RETINA, Asociacion Para Evitar la Ceguera en Mex, Puebla, Puebla, Mexico.
Purpose: To evaluate demarcation laser photocoagulation (DLP) for macula-sparing
Purpose: To compare the effect of an intravitreal injection of bevacizumab before rhegmatogenous retinal detachments (RRD) with and without symptoms of posterior
vs. after panretinal pattern-laser photocoagulation (PRLP) with PASCAL and to vitreous separation or progressive visual field defect.
prevent and reduce diabetic macular edema (DME) in patients with proliferative Methods: Retrospective, interventional, single surgeon case series of consecutive
diabetic retinopathy (PDR). patients with RRD treated with demarcation laser photocoagulation between March
Methods: Fifteen patients with clinical diagnosis of PDR were randomized into two 1999 and February 2008 at an academic center. The null hypothesis was that there
groups: 9 patients were treated with intravitreal injection of bevacizumab prior to exists no difference in the rate of progression for retinal detachment irrespective of
PRP (group A); 6 patients were treated with intravitreal injection of bevacizumab after the presence (‘symptomatic’) or absence (‘asymptomatic’) of symptoms of posterior
PRP (group B). The initial exam included the best corrected visual acuity (BCVA) by vitreous separation or visual field defect at presentation.
ETDRS protocol, contrast sensitivity and color exams, electroretinogram (ERG), optic Results: 27 eyes of 26 patients were included in the study. Twenty-two of the 27 eyes
coherence tomography (OCT), fluorescein angiography (FA), and an indirect fundus (81.4%) did not require additional treatment and remained attached during mean
examination. Follow-up examinations were done at days 10, 52, 85. follow-up of 38.4 months. None of the 14 asymptomatic patients required surgery (0%)
Results: The visual acuity registered in group A at 10 days improved a mean of 4 letters, while five of the 13 patients (38.5%) who were symptomatic at presentation required
3.6 letters at 52 days, and 5.6 letters at day 85 (p>0.05). The visual acuity in group B intervention (p=0.016): 1 patient required additional laser only and 4 patients required
decreased at 10 day follow-up visit by a mean of -1 letter, and the VA improved at 52 surgery. Pre- and post- DLP logMAR visual acuity was 0.15 and 0.14, respectively.
days follow-up by a mean of 9 letters. 100% of the patients in group A, that started Conclusion: DLP is an effective alternative to scleral buckling or vitrectomy for treating
with abnormal ishihara test maintained abnormal results throughout, on the other asymptomatic RRDs. It has a high failure rate among eyes with symptomatic RRD.
hand, in group B 100% of the patients that started with abnormal exams finished with CR: J.L. Heffez, None; Z. Al-Mohtaseb, None; P.E. Carvounis, None; A.J. Barkmeier,
normal exams. In the farnsworth Munsen examination group A, 60% of the patients None; E.R. Holz, None.
started with a tritanomaly and finished with a tritanomaly, 40% maintained normal Support: None
studies. In group B, 50% presented changes from normal to tritanomaly and 50% with
protanomaly, this was maintained until the end of the study. The contrast sensitivity
in group A was improved by 0.35 in 40% of the patient population, 40% showed a
decreased of 0.25. In group B, 100% of the patients showed a decreased of 0.5 to -1.25.
In both groups the “a” and “b” wave decreased in 100% of the ERGs, and increased
in the implicit time. Optical coherence tomography in group A macular thickness
and volume decreased a mean of 153µm, and 2.0mm3, in group B macular thickness
and volume decreased a mean of 109µm, and 1.18 mm3.
Conclusions: It is better to use an intravitreal injection of bevacizumab after PRP
where the visual acuity improvement was demonstrated to be p<0.05. In other studies
there was no statistical difference shown.
CR: F. Hernández-Miranda, None; M. Lopez Miranda, None; C. Claudia, None; C.
Cortes Alcocer, None; V. Morales Canton, None.
Support: None
221 - A321 222 - A322
Management of Vasoproliferative Tumors of the Retina by Laser Computational Model of Retinal Photocoagulation
Photocoagulation D.V. Palanker1A, C. Sramek1B, H. Nomoto1A, Y.M. Paulus1A, J. Brown1B, P. Huie1A.
V. Krivosic1, N. Benhamou2, L. Desjardins3,2, P. Le Hoang4, R. Tadayoni1, P. Massin1, A. AOphthalmology, BApplied Physics, 1Stanford University, Stanford, CA.
Gaudric1. 1Ophthalmology, Lariboisiere Hospital, Paris, France; 2Centre d’imagerie,
Purpose: Despite the extensive use of retinal photocoagulation in clinical practice,
Nice, France; 3Curie Institut, Paris, France; 4Ophthalmology, Pitie Salpetriere
the dependence of the lesion size and retinal rupture on laser parameters (beam size
Hospital, Paris, France.
and shape, pulse duration, and power) are poorly understood and characterized. We
Purpose: To report the efficacy of laser photocoagulation in treating vasoproliferative developed a computational model that can predict the width and depth of retinal lesions
tumors of the retina (VPTR). for many laser parameters, as well as the corresponding safe therapeutic range. This
Methods: Retrospective non-comparative interventional case series. 27 patients model can provide guidance for retinal therapy determining the extent of thermal
(18 women and 9 men) with VPTR. Main outcome measures were best-corrected damage in tissue, and the number of lesions required to coagulate certain fraction of
visual acuity (BCVA), the presence of intra or subretinal lipidic exudates, retinal the retinal surface area.
detachment (RD), cystoid macular edema (CME) and epiretinal membrane (ERM). Methods: Absorption of 532 nm radiation was measured in the pigmented retinal layers
Laser photocoagulation was performed either on slit-lamp or during a pars plana in freshly enucleated rabbit eyes, including variability in RPE cell size and pigmentation,
vitrectomy on all the peripheral vascular telangiectasis visible at the surface of the as well as beam shape and power transmission. Retinal coagulation and rupture
VPTR. (vaporization) thresholds were measured in-vivo and in-vitro with pulse durations
Results: Twelve patients were treated by slit-lamp laser photocoagulation. Mean varying from 1 to 200 ms. RPE damage thresholds were assessed using a fluorescent
follow up was 3 years (6 months to 10 years). Mean BCVA increased from 20/40 (CF viability assay. This data was used to construct and validate an Arrhenius model of retinal
to 20/20) before treatment to 20/32 (CF to 20/20) at the end of the follow up. No loss photocoagulation using the finite-element computational package COMSOL 3.4.
of vision was observed. Peripheral retinal lipidic exudation regressed completely in Results: The peak temperature at rupture threshold was in the range of 180 - 190 ºC
8/12 cases. Fifteen patients underwent vitrectomy due to the presence of an ERM (9 for pulse durations from 1 to 200 ms. An Arrhenius damage integral with activation
cases), a large exudative RD (1 case), a reghmatogenous and exudative RD (3 cases), or energy of 340 kJ/mol (3.5 eV) properly described the measured RPE damage thresholds.
a vitreous hemorrhage (2 cases). Mean follow up was 15 months (6 months to 7 years). The predicted lesion width showed good quantitative agreement with histological data
Mean BCVA increased from 20/125 (CF to 20/50) before treatment to 20/50 (CF to 20/20) over a wide range of pulse parameters, corresponding to clinical grades of retinal lesions
at the end of the follow up. No loss of vision was observed. The retina reattached in ranging from barely visible to intense. The use of a ring-shaped beam profile eliminates
all cases. Retinal and subretinal exudates resorbed completely in 12/15 cases and the central hot spot characteristic of top-hat and Gaussian beams, and is expected to
significantly in the remaining 3. Post operative complications were reghmatogenous double the safe therapeutic range for short (from 1 to 10 ms) pulse durations.
RD in 2 cases successfully reattached after additional surgery. Conclusions: A computational model of retinal photocoagulation can be used to determine
Conclusions: Selective laser photocoagulation of the peripheral retinal telangiectasis the required number of laser exposures needed to treat a given retinal area with arbitrary
associated with VPTR induced in all our cases the regression of retinal exudation. laser parameters. This allows for the proper comparison of the clinical efficacy of various
Slit lamp laser photocoagulation have been sufficient in about half of the cases. In laser treatments, while assuring that the same retinal area is coagulated at all settings.
more severe conditions, large exudative retinal detachment, vitreous hemorrhage, An optimized ring-shaped beam profile can allow for safe photocoagulation with pulse
or epiretinal membrane, vitrectomy was combined efficiently with direct durations in the range of a few milliseconds, which can help to further reduce pain and
endophotocoagulation of the telangiectasis. improve spatial confinement of the thermal effects in the retina.
CR: V. Krivosic, None; N. Benhamou, None; L. Desjardins, None; P. Le Hoang, CR: D.V. Palanker, OptiMedica Inc., F; OptiMedica Inc., C; OptiMedica Inc., P; C. Sramek,
None; R. Tadayoni, None; P. Massin, None; A. Gaudric, None. None; H. Nomoto, None; Y.M. Paulus, None; J. Brown, None; P. Huie, None.
Support: None Support: AirForce Office of Scientific Research, Stanford Photonics Research Center,
Alcon Research Institute, the Horngren and Miller Family Foundations, the Dellaporta
Research Fund
Copyright 2009 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
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