Single-session vs multiple-session pattern scanning laser panretinal photocoagulation in proliferative diabetic retinopathy: The Manchester Pascal Study.

Abstract

OBJECTIVE:

To investigate the effects of pattern scanning laser (Pascal; OptiMedica, Santa Clara, California) multispot panretinal photocoagulation given in a single-session (SS-PRP) vs single-spot multiple-session PRP (MS-PRP) on proliferative diabetic retinopathy (PDR).

METHODS:

Single-center, randomized clinical trial of 40 eyes. Proliferative diabetic retinopathy was treated with a 400-mum spot size in 1500 burns given either as Pascal in 20-millisecond SS-PRP or in 3 sessions (100-millisecond MS-PRP) during a 4-week period. Visual acuity, central subfield retinal thickness (CRT), and 24-2 Swedish interactive thresholding algorithm visual fields were recorded at baseline and 4 and 12 weeks.

MAIN OUTCOME MEASURES:

Central subfield retinal thickness, mean deviation, and PDR grade at 12 weeks.

RESULTS:

There was a significant increase in mean CRT with MS-PRP (22 mum at 4 weeks, 95% CI, -32.25 to -10.75; 20 mum at 12 weeks, 95% CI, -28.75 to -10.82; P < .001) and no significant increase in the SS-PRP group. The mean deviation increased significantly in the SS-PRP group after 4 weeks (0.73 dB, P = .048), with no significant changes in either group at other points. A positive effect on PDR was observed in 74% of eyes in the SS-PRP group vs 53% in the MS-PRP group (P = .31). Mean treatment time for SS-PRP was 5.04 minutes (SD, 1.5 minutes) compared with 59.3 (SD, 12.7 minutes) in the MS-PRP group (P < .001).

CONCLUSIONS:

There were no adverse outcomes (CRT, visual acuity, or visual field) from using multispot SS-PRP vs single-spot MS-PRP at 12 weeks postlaser, and treatment times were significantly shorter for multispot SS-PRP. Pascal SS-PRP was as effective as MS-PRP in the treatment of PDR.

APPLICATION TO CLINICAL PRACTICE:

Twenty-millisecond Pascal SS-PRP may be safely and rapidly performed in 1500 burns with a similar efficacy to conventional MS-PRP. TRIAL IDENTIFIER: Research and Development Office PIN R00037, Central Manchester University Hospitals Foundation Trust.

• Authors: Mahiul M K Muqit, George R Marcellino, David B Henson, Lorna B Young, Niall Patton, Stephen J Charles, George S Turner, Paulo E Stanga
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 128 Issue 5 Pg. 525-33 (May 2010) ISSN: 1538-3601 [Electronic] United States
• PMID: 20457972 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Algorithms
• Diabetic Retinopathy (diagnosis, physiopathology, surgery)
• Female
• Fluorescein Angiography
• Humans
• Laser Coagulation
• Lasers, Solid-State (therapeutic use)
• Male
• Middle Aged
• Postoperative Complications
• Prospective Studies
• Retina (pathology, surgery)
• Retinal Neovascularization (diagnosis, physiopathology, surgery)
• Retreatment
• Treatment Outcome
• Visual Acuity (physiology)
• Visual Fields