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A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration

BACKGROUND: Vascular endothelial growth factor (VEGF) is a significant modulator of ocular angiogenesis, including that of neovascular age-related macular degeneration (nAMD). Intravitreal injection of anti-VEGF is the benchmark treatment for most retinal vascular diseases, including nAMD, diabetic...

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Autores principales: Mansour, Ahmad M, Tripathy, Koushik, Parodi, Maurizio Battaglia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Virtual Ophthalmic Research Center 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445313/
https://www.ncbi.nlm.nih.gov/pubmed/37641639
http://dx.doi.org/10.51329/mehdiophthal1457
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author Mansour, Ahmad M
Tripathy, Koushik
Parodi, Maurizio Battaglia
author_facet Mansour, Ahmad M
Tripathy, Koushik
Parodi, Maurizio Battaglia
author_sort Mansour, Ahmad M
collection PubMed
description BACKGROUND: Vascular endothelial growth factor (VEGF) is a significant modulator of ocular angiogenesis, including that of neovascular age-related macular degeneration (nAMD). Intravitreal injection of anti-VEGF is the benchmark treatment for most retinal vascular diseases, including nAMD, diabetic maculopathy, and macular edema secondary to retinal venous occlusion. Anti-VEGF treatment is a high-frequency, time-consuming, non-cost-effective therapy, especially in countries and regions with limited resources. This treatment is easily restricted, and in practice, maintaining long-term periodic care is challenging for patients. HYPOTHESIS: Light peripheral panretinal photocoagulation (PPRP) is applied in a mild form (barely visible mild light gray mark) anterior to the equator so as not to jeopardize the visual field. PPRP lessens the ischemia that causes neovascularization and decreases the metabolic demand in the peripheral retina. PPRP reduces serum angiopoietin-2 and VEGF levels in patients with type 2 diabetes mellitus with proliferative diabetic retinopathy. We propose using light PPRP to suppress VEGF secretion, aiming to attenuate the VEGF drive and halt choroidal neovascular growth in eyes with nAMD. Our regimen is based on two concepts: first, nAMD is a diffuse or generalized disease that affects the posterior segment; and second, PPRP is very effective in regressing diabetic retinopathy. PPRP has reportedly been successful in cases of macular edema (diabetic or following venous occlusion) resistant to VEGF antagonists. Light PPRP may be used as prophylaxis, adjunctive treatment, or monotherapy in nAMD when intravitreal injections of VEGF antagonists are not feasible. CONCLUSIONS: The established light PPRP therapy could be promising as a one-time, cost-effective therapy or prophylaxis in patients with nAMD or at high risk. This proposed modality could be suitable for patients who have injection phobia or prefer a one-time affordable therapy to the long-term monthly visits to retinologists. Future trials are necessary to verify the safety and efficacy of this proposed treatment modality in selected patients with nAMD.
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spelling pubmed-104453132023-08-28 A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration Mansour, Ahmad M Tripathy, Koushik Parodi, Maurizio Battaglia Med Hypothesis Discov Innov Ophthalmol Hypothesis BACKGROUND: Vascular endothelial growth factor (VEGF) is a significant modulator of ocular angiogenesis, including that of neovascular age-related macular degeneration (nAMD). Intravitreal injection of anti-VEGF is the benchmark treatment for most retinal vascular diseases, including nAMD, diabetic maculopathy, and macular edema secondary to retinal venous occlusion. Anti-VEGF treatment is a high-frequency, time-consuming, non-cost-effective therapy, especially in countries and regions with limited resources. This treatment is easily restricted, and in practice, maintaining long-term periodic care is challenging for patients. HYPOTHESIS: Light peripheral panretinal photocoagulation (PPRP) is applied in a mild form (barely visible mild light gray mark) anterior to the equator so as not to jeopardize the visual field. PPRP lessens the ischemia that causes neovascularization and decreases the metabolic demand in the peripheral retina. PPRP reduces serum angiopoietin-2 and VEGF levels in patients with type 2 diabetes mellitus with proliferative diabetic retinopathy. We propose using light PPRP to suppress VEGF secretion, aiming to attenuate the VEGF drive and halt choroidal neovascular growth in eyes with nAMD. Our regimen is based on two concepts: first, nAMD is a diffuse or generalized disease that affects the posterior segment; and second, PPRP is very effective in regressing diabetic retinopathy. PPRP has reportedly been successful in cases of macular edema (diabetic or following venous occlusion) resistant to VEGF antagonists. Light PPRP may be used as prophylaxis, adjunctive treatment, or monotherapy in nAMD when intravitreal injections of VEGF antagonists are not feasible. CONCLUSIONS: The established light PPRP therapy could be promising as a one-time, cost-effective therapy or prophylaxis in patients with nAMD or at high risk. This proposed modality could be suitable for patients who have injection phobia or prefer a one-time affordable therapy to the long-term monthly visits to retinologists. Future trials are necessary to verify the safety and efficacy of this proposed treatment modality in selected patients with nAMD. International Virtual Ophthalmic Research Center 2022-12-03 /pmc/articles/PMC10445313/ /pubmed/37641639 http://dx.doi.org/10.51329/mehdiophthal1457 Text en © Author(s). https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
spellingShingle Hypothesis
Mansour, Ahmad M
Tripathy, Koushik
Parodi, Maurizio Battaglia
A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration
title A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration
title_full A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration
title_fullStr A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration
title_full_unstemmed A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration
title_short A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration
title_sort hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration
topic Hypothesis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445313/
https://www.ncbi.nlm.nih.gov/pubmed/37641639
http://dx.doi.org/10.51329/mehdiophthal1457
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