This extensive proliferation remained until month 3, when it decreased in height back down to the level of the IS/OS line. Some laser lesions (30/379 lesions, 7.9%) could not be assigned to one
of the aforementioned healing types. In these cases, different morphologies were found: flattening of the RPE but without restoration of the IS/OS line (22/379, 5.8% BTK signaling inhibitors lesions); subtle and discontinuous RPE fragments (“RPE satellites”) reaching the outer parts of the ONL (5/379, 1.3% lesions); and large RPE columns at month 1 regressing to RPE atrophy until month 3 (3/379, 0.8% lesions). Each patient developed at least 2 different healing types, and only 2 patients did not present any type III lesions at all. The present study evaluated morphologic changes of the retinal pigment epithelium after focal or grid photocoagulation in DME patients over time using polarization-sensitive OCT technology. This novel imaging technique revealed that laser-induced effects on the RPE caused significant retinal remodeling throughout the observation period. Although there was local RPE thinning at day 1, it was followed by a significant increase in the extent of polarization-scrambling tissue by week 1, suggesting RPE proliferation. At month 1, 3 different types of morphologic
alteration could be identified VX-770 chemical structure and described in detail over the course of the study. Recent advances in pharmacologic treatment with intravitreal steroids and/or vascular endothelial growth factor inhibitors offer new approaches for the management Idoxuridine of diabetic retinopathy;
however, in some cases grid, focal, and panretinal photocoagulation remain essential therapeutic options for diabetic patients with vision-threatening retinopathy.7 Retinal laser photocoagulation is an inherently destructive therapy, but the beneficial effect and its ability to reduce the risk of vision loss have been demonstrated in the ETDRS trial.6 However, a clear characterization of the therapeutic mechanism remains elusive.8, 9, 10, 11, 12 and 13 Over the last decades very few histologic studies have been conducted on the topic of retinal healing after photocoagulation, both in general and using the micro-pulsed PASCAL system, because of limited availability of human tissue.22, 23, 24 and 25 Paulus and associates presented a detailed study on rodent eyes after retinal photocoagulation with a PASCAL laser at different intensities of applied energy. In light lesions with a 15-ms pulse duration, initial RPE damage was described, followed by restoration of the lesion with a gliotic scar of hypopigmented RPE cells by week 1 after treatment. Over the course of 3 months the lesions were recolonized by more continuous pigmented RPE cells, accompanied by a reduction of lesion size.