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Carmen A Puliafito - One of the best experts on this subject based on the ideXlab platform.
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Transpupillary Thermotherapy ttt of occult choroidal neovascularization a retrospective noncomparative case series of fifty seven eyes
Seminars in Ophthalmology, 2001Co-Authors: Carl H Park, Martin A. Mainster, Jay S Duker, Carmen A Puliafito, Elias ReichelAbstract:Purpose. To evaluate the efficacy of Transpupillary Thermotherapy (TTT) for the treatment of occult choroidal neovascularization. Methods. A retrospective, noncomparative case series of 57 eyes of 52 patients who presented with occult subfoveal CNV and were treated with TTT. Results. 83% of eyes were either stable (+/− one line) or showed improvement in visual acuity. 83% of eyes showed stabilization of their exudative process after one TTT treatment as evidenced by resorption of subretinal and/or intraretinal exudate or hemorrhage. Nine percent of eyes developed classic CNV during the mean follow-up time of ten months. Conclusions. TTT appears to stabilize the exudative process in eyes with occult CNV. A prospective, sham-controlled, randomized study (TTT4CNV Clinical Trial) is currently underway to directly compare TTT to the natural history of occult CNV
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Transpupillary Thermotherapy of occult subfoveal choroidal neovascularization in patients with age related macular degeneration
Ophthalmology, 1999Co-Authors: Elias Reichel, Audina M Berrocal, Arnold J Kroll, Vinay Desai, Jay S Duker, Carmen A PuliafitoAbstract:Abstract Objective To evaluate the efficacy of Transpupillary Thermotherapy for the treatment of occult subfoveal choroidal neovascularization (CNV) in patients with age-related macular degeneration. Design A retrospective, noncomparative case series. Participants Sixteen eyes of 15 consecutive patients who presented with occult subfoveal choroidal neovascularization secondary to age-related macular degeneration. Intervention After informed consent was obtained, 16 eyes of 15 patients were treated with Transpupillary Thermotherapy. All patients underwent pretreatment fluorescein angiography and were deemed untreatable by the Macular Photocoagulation Study standard. Transpupillary Thermotherapy was delivered using a diode laser at 810 nm. A variable spot size of 1.2 mm, 2.0 mm, or 3.0 mm was used depending on the size of CNV. The diode laser was delivered through a contact lens, and treatment was initiated in one spot for 60 seconds' duration at a power range between 360 and 1000 mW. The end point was an area of no visible color change to a light-gray appearance. Main outcome measures In all eyes, outcome was assessed by Snellen chart visual acuity and clinical examination. In 10 of 16 eyes, preoperative and postoperative fluorescein angiography and optical coherence tomography were available. In the remaining 6 of 16 eyes, exudation was measured by postoperative clinical examination alone. Results Three eyes (19%) showed a two-or-more-line improvement in visual acuity over a period of 6 to 25 months. Mean follow-up was 13 months. Visual acuity remained stable (no change or one-line improvement) in nine treated eyes (56%). The remaining four eyes (25%) showed a decline (equal to one-line worsening or greater) in visual acuity. Fifteen eyes (94%) demonstrated decreased exudation on fluorescein angiography, optical coherence tomography, and/or clinical examination. Conclusions Transpupillary Thermotherapy shows no deleterious side effects in treating occult subfoveal choroidal neovascularization. A randomized, prospective study is necessary to evaluate treatment efficacy.
Sung Chul Lee - One of the best experts on this subject based on the ideXlab platform.
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treatment of serous macular detachment associated with circumscribed choroidal hemangioma
American Journal of Ophthalmology, 2012Co-Authors: Hee Jung Kwon, Min Kim, Christopher Seungkyu Lee, Sung Chul LeeAbstract:Purpose To evaluate the effects of Transpupillary Thermotherapy and intravitreal bevacizumab injection on serous macular detachment and cystoid macular edema (CME) associated with circumscribed choroidal hemangioma. Design Retrospective, interventional case series. Methods We reviewed the records of 12 patients with circumscribed choroidal hemangioma treated with Transpupillary Thermotherapy and/or intravitreal injection of bevacizumab. We assessed changes in best-corrected visual acuity (BCVA), central foveal thickness by optical coherence tomography, and resolution of serous macular detachment and CME. Results Six of 8 patients treated with Transpupillary Thermotherapy showed complete resolution of serous macular detachment and CME and the median minimal angle of resolution (logMAR) BCVA improved from 0.85 to 0.35 ( P = .026). Among these 6 patients, 1 had no recurrence for 86 months and 5 had sustained resolution of serous macular detachment for a mean duration of 32.8 months before recurrence. Among the 9 patients treated with bevacizumab (including 5 patients who had Transpupillary Thermotherapy as a primary treatment), 5 showed resolution of serous macular detachment and the median logMAR BCVA improved from 0.7 to 0.5 ( P = .042). Among these 5 patients, 3 had sustained resolution for a mean duration of 5.7 months and 2 showed recurrent serous macular detachment after 3 and 12 months. Conclusion Transpupillary Thermotherapy and intravitreal bevacizumab appear effective in the management of symptomatic circumscribed choroidal hemangioma, although recurrence of serous macular detachment and CME developed after long-term follow-up of Transpupillary Thermotherapy, and the duration of treatment effectiveness appears to be short with bevacizumab.
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gamma knife radiosurgery for choroidal haemangiomas with extensive exudative retinal detachment
British Journal of Ophthalmology, 2009Co-Authors: Won Kyung Song, Suk Ho Byeon, Sung Soo Kim, Oh Woong Kwon, Sung Chul LeeAbstract:Choroidal haemangioma (CH) is a benign vascular tumour. CH that produces visual symptoms due to subretinal fluid has been treated with cryotherapy, diathermy, photocoagulation, photodynamic therapy (PDT), Transpupillary Thermotherapy (TTT) and various radiation therapies. However, extensive exudative retinal detachment is challenging to treat. Previous reports utilising gamma knife radiosurgery (GKR) in CHs are scarce.1 2 We present our results of GKR on CH with extensive exudative retinal detachment (RD). The medical records of three consecutive CH patients with decreased visual acuity due to extensive exudative RD involving more than two quadrants, treated with GKR, were retrospectively reviewed. GKR was performed as a secondary treatment after the aggravation of exudative RD following a single session of Transpupillary Thermotherapy (TTT). Table 1 lists the basic characteristics of the patients. The mean age of the patients was 38.3 years …
Elias Reichel - One of the best experts on this subject based on the ideXlab platform.
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Transpupillary Thermotherapy ttt of occult choroidal neovascularization a retrospective noncomparative case series of fifty seven eyes
Seminars in Ophthalmology, 2001Co-Authors: Carl H Park, Martin A. Mainster, Jay S Duker, Carmen A Puliafito, Elias ReichelAbstract:Purpose. To evaluate the efficacy of Transpupillary Thermotherapy (TTT) for the treatment of occult choroidal neovascularization. Methods. A retrospective, noncomparative case series of 57 eyes of 52 patients who presented with occult subfoveal CNV and were treated with TTT. Results. 83% of eyes were either stable (+/− one line) or showed improvement in visual acuity. 83% of eyes showed stabilization of their exudative process after one TTT treatment as evidenced by resorption of subretinal and/or intraretinal exudate or hemorrhage. Nine percent of eyes developed classic CNV during the mean follow-up time of ten months. Conclusions. TTT appears to stabilize the exudative process in eyes with occult CNV. A prospective, sham-controlled, randomized study (TTT4CNV Clinical Trial) is currently underway to directly compare TTT to the natural history of occult CNV
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Transpupillary Thermotherapy for age related macular degeneration long pulse photocoagulation apoptosis and heat shock proteins
Ophthalmic Surgery and Lasers, 2000Co-Authors: Martin A. Mainster, Elias ReichelAbstract:Objective To provide a biophysical foundation for using Transpupillary Thermotherapy (TTT) to manage choroidal neovascularization in age-related macular degeneration (ARMD). Methods Retinal temperature rise in laser therapy is proportional to retinal irradiance (laser power/area) for a particular spot size, exposure duration, and wavelength. TTT is a low irradiance, large spot size, prolonged exposure (long-pulse), infrared laser photocoagulation protocol. Results from an experimentally confirmed, finite element model of retinal light absorption and heat conduction are used to analyze laser parameter selection and its consequences. Results from apoptosis, heat shock protein and hyperthermia research are used to examine how chorioretinal damage from clinical procedures might be reduced. Results Chorioretinal thermal equilibration occurs during long-pulse TTT photocoagulation. Retinal temperature increases are similar in the RPE where laser radiation absorption is significant and in the adjacent neural retina where there is negligible radiation absorption. For parameters used to treat occult choroidal neovascularization in lightly-pigmented fundi (800-mW, 810-nm, 3-mm retinal spot diameter, 60-sec exposure duration), the maximum chorioretinal temperature elevation is calculated to be roughly 10 degrees C, significantly lower than the 20 degrees C temperature elevations measured in threshold, conventional short-pulse retinal photocoagulation. Conclusions To achieve a preselected temperature rise, TTT laser power must be increased or decreased in proportion to the diameter rather than the area of the laser spot. Clinical power settings should be adjusted for fundus pigmentation and media clarity because both of these factors affect absorbed retinal irradiance and thus retinal temperature rise. Noninvasive thermal dosimetry currently is unavailable for clinical retinal photocoagulation, but potential thermometric techniques include MRI, liposomal-encapsulated dyes, multispectral imaging or reflectometry, and subretinal or episcleral thermometry. TTT may be useful not only as independent therapy, but also as an adjunct to PDT, antiangiogenic drugs and ionizing radiation therapy in the management of neovascular ARMD. Low temperature, long-pulse photocoagulation is a potential strategy for decreasing neural retinal damage in subsequent TTT or short-pulse photocoagulation and perhaps even for treating glaucoma or retinal degenerations.
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Transpupillary Thermotherapy of occult subfoveal choroidal neovascularization in patients with age related macular degeneration
Ophthalmology, 1999Co-Authors: Elias Reichel, Audina M Berrocal, Arnold J Kroll, Vinay Desai, Jay S Duker, Carmen A PuliafitoAbstract:Abstract Objective To evaluate the efficacy of Transpupillary Thermotherapy for the treatment of occult subfoveal choroidal neovascularization (CNV) in patients with age-related macular degeneration. Design A retrospective, noncomparative case series. Participants Sixteen eyes of 15 consecutive patients who presented with occult subfoveal choroidal neovascularization secondary to age-related macular degeneration. Intervention After informed consent was obtained, 16 eyes of 15 patients were treated with Transpupillary Thermotherapy. All patients underwent pretreatment fluorescein angiography and were deemed untreatable by the Macular Photocoagulation Study standard. Transpupillary Thermotherapy was delivered using a diode laser at 810 nm. A variable spot size of 1.2 mm, 2.0 mm, or 3.0 mm was used depending on the size of CNV. The diode laser was delivered through a contact lens, and treatment was initiated in one spot for 60 seconds' duration at a power range between 360 and 1000 mW. The end point was an area of no visible color change to a light-gray appearance. Main outcome measures In all eyes, outcome was assessed by Snellen chart visual acuity and clinical examination. In 10 of 16 eyes, preoperative and postoperative fluorescein angiography and optical coherence tomography were available. In the remaining 6 of 16 eyes, exudation was measured by postoperative clinical examination alone. Results Three eyes (19%) showed a two-or-more-line improvement in visual acuity over a period of 6 to 25 months. Mean follow-up was 13 months. Visual acuity remained stable (no change or one-line improvement) in nine treated eyes (56%). The remaining four eyes (25%) showed a decline (equal to one-line worsening or greater) in visual acuity. Fifteen eyes (94%) demonstrated decreased exudation on fluorescein angiography, optical coherence tomography, and/or clinical examination. Conclusions Transpupillary Thermotherapy shows no deleterious side effects in treating occult subfoveal choroidal neovascularization. A randomized, prospective study is necessary to evaluate treatment efficacy.
Carol L. Shields - One of the best experts on this subject based on the ideXlab platform.
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Submillimeter retinoblastoma monitoring following Transpupillary Thermotherapy using hand-held optical coherence tomography
International Journal of Retina and Vitreous, 2018Co-Authors: Mark Mcgarrey, Thamolwan Surakiatchanukul, Carol L. ShieldsAbstract:Background Precise, submillimeter visualization of retinal microstructures is useful for treatment monitoring of retinoblastoma. Herein, we report the use of hand-held optical coherence tomography (HH-OCT) to document a nearly-invisible retinoblastoma and monitor tumor response to Transpupillary Thermotherapy (TTT). Case presentation A 3-week-old boy was diagnosed with unilateral familial retinoblastoma in the left eye, classified as group B, and treated with intravenous chemoreduction. At 13-month follow-up, the tumor in the left eye was regressed, and evaluation of the right eye revealed a microscopic, nearly invisible tumor measuring 372 µm in thickness and 1.51 mm in basal dimension. The tumor was confirmed on HH-OCT and the diagnosis was changed to bilateral familial retinoblastoma. The new tumor was subsequently treated with TTT and after 1 month, the tumor regressed to an optically dense scar 166 µm in thickness by HH-OCT. Five months after TTT, the scar was clinically flat and measured 73 µm. Conclusions HH-OCT has assumed a significant role in the monitoring of retinoblastoma in children. In this case, imaging with HH-OCT allowed precise localization of the tumor and submillimeter monitoring of treatment response following TTT.
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Small choroidal melanoma with monosomy 3.
Middle East African Journal of Ophthalmology, 2010Co-Authors: Fariba Ghassemi, Miguel A Materin, Carol L. Shields, Jerry A. ShieldsAbstract:PURPOSE: To report a patient with small juxtapapillary choroidal melanoma with chromosome 3 monosomy treated with I(125) plaque and Transpupillary Thermotherapy (TTT). A 64-year-old Caucasian male presented with painless blurred vision of the left eye. Ocular examination disclosed a small juxtapapillary choroidal melanocytic tumor with overlying subretinal fluid and orange pigment. Ultrasound showed an elevated choroidal mass of 2 mm thickness with low reflectivity on A-scan and hollowness on B scan, consistent with a small choroidal melanoma. The patient was treated with plaque I(125) radiotherapy combined with one session of TTT. Genetic testing of the tumor cells obtained by fine needle aspiration biopsy showed chromosome 3 monosomy. At 1 year after treatment, the tumor was regressed with resolution of subretinal fluid and 20/40 visual acuity. A small choroidal melanoma can manifest monosomy of chromosome 3, a known predictive factor for the development of systemic metastasis.
Serge Mordon - One of the best experts on this subject based on the ideXlab platform.
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Heat shock protein hyperexpression on chorioretinal layers after Transpupillary Thermotherapy. Invest Ophthalmol Vis Sci. 2001;42(12):2976–2980. Clinical Ophthalmology Publish your work in this journal Clinical Ophthalmology is an international, peer-revi
2015Co-Authors: Thomas Desmettre, Claude-alain Maurage, Serge MordonAbstract:PURPOSE. To assess a biological effect induced by temperature elevation during Transpupillary Thermotherapy (TTT). METHODS. Six pigmented rabbits were anesthetized, and TTT was performed on the right eye using an 810-nm diode laser installed on a slit lamp (spot size, 1.3 mm; duration, 60 sec-onds; power, 92–150 mW). A series of laser pulses were aimed at the posterior pole of the retina. The left eyes were used as the control. Twenty-four hours after laser irradiation, a histo-logic study was performed on the chorioretinal layers. Tissue samples were fixed in formalin and embedded in paraffin. A monoclonal antibody was used to detect heat shock protein (Hsp)70 immunoreactivity, followed by a biotinylated goat anti-mouse antibody, revealed by the avidin-biotin complex and the 3-amino-9-ethyl-carbazole (AEC) chromogen. Retinal structures were further identified by hematoxylin erythrosi
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comparison of laser beam intensity profiles produced by photodynamic therapy pdt and Transpupillary Thermotherapy ttt lasers
Lasers in Surgery and Medicine, 2005Co-Authors: T Desmettre, Serge MordonAbstract:Background and Objectives: For photodynamic therapy (PDT) or Transpupillary Thermotherapy (TTT) lasers, long irradiation time (typically 1 minute or longer) is used and a large area of retina is treated. Consequently, the power stability but also the light distribution within the laser beam plays a major role. This study aimed to evaluate beam intensity profiles produced by several PDT and TTT lasers. Study Design/Materials and Methods: A beam profile analyzer (Cohu 4812 camera connected to a LPA-300PC, Spiricon, Logan, UT) was used to compare the beam profiles of PDT lasers: OPAL™ (Lumenis, USA); ACTIVIS™ (Quantel Medical, France), VISULAS™ (Zeiss, Germany). Spots of 2, 3, 4, and 5 mm were tested with each laser. Similarly, TTT lasers: OCULIGHT SLx™ (Iridex, CA) and IRIDIS ™ (Quantel Medical, France) were evaluated with 2 and 3 mm spot diameter and power ranging from 200 to 1,000 mW. Results: PDT lasers: OPAL had a “top hat” and homogeneous profile whatever the spot size. Numerous micro-spikes and micro-nadirs of power were observed with the ACTIVIS and the VISULAS. TTT lasers: for the IRIDIS the beam shape was rather gaussian, but the homogeneity was reduced by micro-spikes of power. With the OCULIGHT Slx the beam shape was rather top hat and only few micro-spikes or micro-nadirs of power could be disclosed. Discussion: The literature tends to prove that the shape and homogeneity of the beam profile could play a role on the efficacy of the treatment. Conclusion: Since PDT and TTT lasers display different beam profiles, this parameter should be carefully evaluated when performing clinical evaluations of PDT or TTT treatments. © 2005 Wiley-Liss, Inc.
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Transpupillary Thermotherapy ttt with short duration laser exposures induce heat shock protein hsp hyperexpression on choroidoretinal layers
Lasers in Surgery and Medicine, 2003Co-Authors: Thomas Desmettre, Claude-alain Maurage, Serge MordonAbstract:Background and Objectives To assess a choroidal heat shock protein hyperexpression after Transpupillary Thermotherapy (TTT) performed with exposures shorter than 60 seconds. Study Design/Materials and Methods Nine male pigmented rabbits were anesthetized and TTT was performed on their right eye with a 810 nm diode laser (Iridis, Quantel-Medical (France)) (spot size: 1.3 mm). Three exposure durations (60, 30, or 15 seconds) were used with three ranges of power for each duration (“high,” “mild,” or “low”). A series of laser impacts was delivered to the posterior pole of the retina. Left eyes were used as controls. Twenty-four hours after laser irradiation, the animals were killed and histological study was performed on chorioretinal layers. Tissue samples were fixed in formalin and embedded in paraffin. A monoclonal antibody was used to detect Hsp70 immunoreactivity (mouse IgGl, SPA-810, Stress Gen, Victoria, BC, Canada), followed by a biotinylated goat anti-mouse antibody (Dako, Glostrup, Denmark), revealed by the avidin–biotin complex (Vectastain kit, Vector Laboratries, Burlingame, CA, USA) and the AEC chromogen. Retinal structures were further identified by HES coloration. Results During the experiments, the laser spots were not visible except for the strongest “high” powers for each exposure duration, where a whitening was discernable at the end of the laser exposures. A strong HSP70 immunoreactivity was detected in choroidal, non-pigmented cells for laser exposures lasting 60, 30, or 15 seconds with “mild” laser powers. On the contrary, rare HSP hyperexpression was detected with “high” or “low” laser powers lasting 60, 30, or 15 seconds. No HSP-70 immunoreactivity was detected on control eyes nor outside of the irradiated zones of treated eyes. Conclusions Transpupillary laser irradiation lasting 15, 30, or 60 seconds induces an hyperexpression of HSP on choroidal layers. This could be a basis for the use of TTT with “short” laser exposures. Lasers Surg. Med. 33:102–107, 2003. © 2003 Wiley-Liss, Inc.
