Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

BACKGROUND: Diabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR).

OBJECTIVES: The primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP?

ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) for efficacy but other designs also used.

REVIEW METHODS: Systematic review and economic modelling.

RESULTS: The Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO.

LIMITATION: The current evidence is insufficient to recommend PRP for severe NPDR.

CONCLUSIONS: There is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005408.

FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Picosecond metrology of laser-driven proton bursts

Tracking primary radiation-induced processes in matter requires ultrafast sources and high precision timing. While compact laser-driven ion accelerators are seeding the development of novel high instantaneous flux applications, combining the ultrashort ion and laser pulse durations with their inherent synchronicity to trace the real-time evolution of initial damage events has yet to be realized. Here we report on the absolute measurement of proton bursts as short as 3.5±0.7 ps from laser solid target interactions for this purpose. Our results verify that laser-driven ion acceleration can deliver interaction times over a factor of hundred shorter than those of state-of-the-art accelerators optimized for high instantaneous flux. Furthermore, these observations draw ion interaction physics into the field of ultrafast science, opening the opportunity for quantitative comparison with both numerical modelling and the adjacent fields of ultrafast electron and photon interactions in matter.

Guided post-acceleration of laser-driven ions by a miniature modular structure

All-optical approaches to particle acceleration are currently attracting a significant research effort internationally. Although characterized by exceptional transverse and longitudinal emittance, laser-driven ion beams currently have limitations in terms of peak ion energy, bandwidth of the energy spectrum and beam divergence. Here we introduce the concept of a versatile, miniature linear accelerating module, which, by employing laser-excited electromagnetic pulses directed along a helical path surrounding the laser-accelerated ion beams, addresses these shortcomings simultaneously. In a proof-of-principle experiment on a university-scale system, we demonstrate post-acceleration of laser-driven protons from a flat foil at a rate of 0.5 GeVm^-1, already beyond what can be sustained by conventional accelerator technologies, with dynamic beam collimation and energy selection. These results open up new opportunities for the development of extremely compact and cost-effective ion accelerators for both established and innovative applications.

Corrosion Fatigue Behaviour of Laser-welded Shape Memory NiTi Wires in a Simulated Body Fluid

Corrosion fatigue is a fracture process as a consequence of synergistic interactions between the material structure, corrosive environment and cyclic loads/strains. It is difficult to be detected and can cause unexpected failure of engineering components in use. This study reveals a comparison of corrosion fatigue behaviour of laser-welded and bare NiTi wires using bending rotation fatigue (BRF) test coupled with a specifically-designed corrosion cell. The testing medium was Hanks’ solution (simulated body fluid) at 37.5 oC. Electrochemical impedance spectroscopic (EIS) measurement was carried out to monitor the change of corrosion resistance of sample during the BRF test at different periods of time. Experiments indicate that the laser-welded NiTi wire would be more susceptible to the corrosion fatigue attack than the bare NiTi wire. This study can serve as a benchmark for the product designers and engineers to understand the corrosion fatigue behaviour of the NiTi laser weld joint and determine the fatigue life safety factor for NiTi medical devices/implants involving laser welding in the fabrication process.

Space and time characterization of laser-induced plasmas for applications in chemical analysis and thin film deposition

Après des décennies de développement, l'ablation laser est devenue une technique importante pour un grand nombre d'applications telles que le dépôt de couches minces, la synthèse de nanoparticules, le micro-usinage, l’analyse chimique, etc. Des études expérimentales ainsi que théoriques ont été menées pour comprendre les mécanismes physiques fondamentaux mis en jeu pendant l'ablation et pour déterminer l’effet de la longueur d'onde, de la durée d'impulsion, de la nature de gaz ambiant et du matériau de la cible. La présente thèse décrit et examine l'importance relative des mécanismes physiques qui influencent les caractéristiques des plasmas d’aluminium induits par laser. Le cadre général de cette recherche forme une étude approfondie de l'interaction entre la dynamique de la plume-plasma et l’atmosphère gazeuse dans laquelle elle se développe. Ceci a été réalisé par imagerie résolue temporellement et spatialement de la plume du plasma en termes d'intensité spectrale, de densité électronique et de température d'excitation dans différentes atmosphères de gaz inertes tel que l’Ar et l’He et réactifs tel que le N2 et ce à des pressions s’étendant de 10‾7 Torr (vide) jusqu’à 760 Torr (pression atmosphérique). Nos résultats montrent que l'intensité d'émission de plasma dépend généralement de la nature de gaz et qu’elle est fortement affectée par sa pression. En outre, pour un délai temporel donné par rapport à l'impulsion laser, la densité électronique ainsi que la température augmentent avec la pression de gaz, ce qui peut être attribué au confinement inertiel du plasma. De plus, on observe que la densité électronique est maximale à proximité de la surface de la cible où le laser est focalisé et qu’elle diminue en s’éloignant (axialement et radialement) de cette position. Malgré la variation axiale importante de la température le long du plasma, on trouve que sa variation radiale est négligeable. La densité électronique et la température ont été trouvées maximales lorsque le gaz est de l’argon et minimales pour l’hélium, tandis que les valeurs sont intermédiaires dans le cas de l’azote. Ceci tient surtout aux propriétés physiques et chimiques du gaz telles que la masse des espèces, leur énergie d'excitation et d'ionisation, la conductivité thermique et la réactivité chimique. L'expansion de la plume du plasma a été étudiée par imagerie résolue spatio-temporellement. Les résultats montrent que la nature de gaz n’affecte pas la dynamique de la plume pour des pressions inférieures à 20 Torr et pour un délai temporel inférieur à 200 ns. Cependant, pour des pressions supérieures à 20 Torr, l'effet de la nature du gaz devient important et la plume la plus courte est obtenue lorsque la masse des espèces du gaz est élevée et lorsque sa conductivité thermique est relativement faible. Ces résultats sont confirmés par la mesure de temps de vol de l’ion Al+ émettant à 281,6 nm. D’autre part, on trouve que la vitesse de propagation des ions d’aluminium est bien définie juste après l’ablation et près de la surface de la cible. Toutefois, pour un délai temporel important, les ions, en traversant la plume, se thermalisent grâce aux collisions avec les espèces du plasma et du gaz.

Photosensitivity of Laser Dye Mixtures in Polymer Matrix – A Photoacoustic Study

Laser induced photoacoustic (PA) technique is used in the study of photostability of polymethyl methacrylate (PMMA) films doped with Rhodamine 6G -Rhodamine B dye system. Energy transfer from a donor molecule to an acceptor molecule in a dye mixture affects the output of the dye system. Details of investigations on the role of laser power, modulation frequency and the irradiation wavelength on the photosensitivity of the dye mixture doped PMMA films are presented.

Optical Emission Diagnostics Of Laser Produced Plasma From Graphite And Yba2cu3o7

This thesis is entitled “OPTICAL EMISSION DIAGNOSTICS OF LASER PRODUCED PLASMA FROM GRAPHITE AND YBa2Cu3O7. The work presented in this thesis covers the experimental results on the plasma produced with moderately high power laser with irradiance range in between 10 GW cm 2 to 100 GW cm -2. The characterization of laser produced plasma from solid targets viz. graphite and high temperature superconducting material like YBa2Cu3O7 have been carried out. The fundamental frequency from a Q - switched Nd: YAG laser with 9 ns pulse duration is used for the present studies. Various optical emission emission diagnostic techniques were employed for the the characterization of the LPP which include emission spectroscopy, time resolved studies, line broadening method etc. In order to understand the physical nature of the LPP like recombination, collisional excitation and the laser interaction with plasma, the time resolved studies offer the most logical approach

Spectral Characterization of Laser Induced Plasma from Titanium Dioxide

Optical emission from TiO2 plasma, generated by a nanosecond laser is spectroscopically analysed. The main chemical species are identified and the spatio-temporal distribution of the plasma parameters such as electron temperature and density are characterized based on the study of spectral distribution of the line intensities and their broadening characteristics. The parameters of laser induced plasma vary quickly owing to its expansion at low background pressure and the possible deviations from local thermodynamic equilibrium conditions are tested to show its validity.

Spectral Characterization of Laser Induced Plasma from Titanium Dioxide

Optical emission from TiO2 plasma, generated by a nanosecond laser is spectroscopically analysed. The main chemical species are identified and the spatio-temporal distribution of the plasma parameters such as electron temperature and density are characterized based on the study of spectral distribution of the line intensities and their broadening characteristics. The parameters of laser induced plasma vary quickly owing to its expansion at low background pressure and the possible deviations from local thermodynamic equilibrium conditions are tested to show its validity.

Spectral Characterization of Laser Induced Plasma from Titanium Dioxide

Optical emission from TiO2 plasma, generated by a nanosecond laser is spectroscopically analysed. The main chemical species are identified and the spatio-temporal distribution of the plasma parameters such as electron temperature and density are characterized based on the study of spectral distribution of the line intensities and their broadening characteristics. The parameters of laser induced plasma vary quickly owing to its expansion at low background pressure and the possible deviations from local thermodynamic equilibrium conditions are tested to show its validity

Spectral Characterization of Laser Induced Plasma from Titanium Dioxide

Optical emission from TiO2 plasma, generated by a nanosecond laser is spectroscopically analysed. The main chemical species are identified and the spatio-temporal distribution of the plasma parameters such as electron temperature and density are characterized based on the study of spectral distribution of the line intensities and their broadening characteristics. The parameters of laser induced plasma vary quickly owing to its expansion at low background pressure and the possible deviations from local thermodynamic equilibrium conditions are tested to show its validity.

Characterization and Imaging Diagnostics of Laser Induced Plasma from Solid Targets

Laser induced plasma (LIP) emissions from some metal oxide targets were studied with corresponding metal targets of pure quality as a reference. Atomic emissions in the visible region were used in the spectroscopic procedures of LIP characterization. The studies were meant to throw light into LIP dynamics and they provided many experimental results which improved the general awareness of plasma state.When target materials were photo-ablated with an energetically suitable laser pulse, they developed electric charges in them.An electrical signal which was delivered from the target served as an alternative probe signal for the diagnostics of LIP and to track different charged states in the plasma. The signal showed a double peak distribution with positive polarity and a modified time of flight with various voltage levels of a given polarity.The expansion dynamics of LIP in magnetic field were also investigated by monitoring the voltage transients generated at the target.