title: A Computational Model of Peripheral Photocoagulation for the Prevention of Progressive Diabetic Capillary Occlusion.
abstract: We developed a computational model of the propagation of retinal ischemia in diabetic retinopathy and analyzed the consequences of various patterns and sizes of burns in peripheral retinal photocoagulation. The model addresses retinal ischemia as a phenomenon of adverse local feedback in which once a capillary is occluded there is an elevated probability of occlusion of adjacent capillaries resulting in enlarging areas of retinal ischemia as is commonly seen clinically. Retinal burns of different sizes and patterns, treated as local oxygen sources, are predicted to have different effects on the propagation of retinal ischemia. The patterns of retinal burns are optimized with regard to minimization of the sum of the photocoagulated retina and computer predicted ischemic retina. Our simulations show that certain patterns of retinal burns are effective at preventing the spatial spread of ischemia by creating oxygenated boundaries across which the ischemia does not propagate. This model makes no statement about current PRP treatment of avascular peripheral retina and notes that the usual spot sizes used in PRP will not prevent ischemic propagation in still vascularized retinal areas. The model seems to show that a properly patterned laser treatment of still vascularized peripheral retina may be able to prevent or at least constrain the propagation of diabetic retinal ischemia in those retinal areas with intact capillaries.
authors.affiliation: School of Optometry, Indiana University, Bloomington, IN 47405, USA.
authors.forename: Thomas J
authors.identifier: 0000-0002-3843-2322
authors.initials: TJ
authors.lastname: Gast
authors.affiliation: The Biocomplexity Institute, Indiana University, Bloomington, IN 47405, USA; Physics Department, Indiana University, Bloomington, IN 47405, USA.
authors.forename: Xiao
authors.identifier: 0000-0002-8611-891X
authors.initials: X
authors.lastname: Fu
authors.affiliation: The Biocomplexity Institute, Indiana University, Bloomington, IN 47405, USA; Physics Department, Indiana University, Bloomington, IN 47405, USA.
authors.forename: John Scott
authors.identifier: 0000-0002-2342-0484
authors.initials: JS
authors.lastname: Gens
authors.affiliation: The Biocomplexity Institute, Indiana University, Bloomington, IN 47405, USA; Physics Department, Indiana University, Bloomington, IN 47405, USA; School of Informatics and Computing, Indiana University, Bloomington, IN 47408, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Glazier
mesh_terms: D002196:Capillaries / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D003198:Computer Simulation; D003930:Diabetic Retinopathy / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D018450:Disease Progression; D006801:Humans; D007511:Ischemia / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D008028:Light Coagulation / Q000379:methods*; D012160:Retina / Q000378:metabolism / Q000601:surgery*; D012171:Retinal Vessels / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D042461:Vascular Endothelial Growth Factor A