Optos-guided pattern scan laser (Pascal)-targeted retinal photocoagulation in proliferative diabetic retinopathy.

Abstract

PURPOSE:

To investigate the clinical effects and safety of targeted pattern scan laser (Pascal) retinal photocoagulation (TRP) in proliferative diabetic retinopathy (PDR).

METHODS:

Prospective and non-randomized study of 28 eyes with treatment-naive proliferative diabetic retinopathy (PDR). Single-session 20-ms-Pascal TRP strategy applied 1500 burns to zones of retinal capillary non-perfusion and intermediate retinal ischaemia guided by wide-field fluorescein angiography (Optos). Main outcome measures at 12 and 24 weeks included; PDR grade (assessed by two masked retina specialists); central retinal thickness (CRT); mean deviation (MD) using 24-2 Swedish interactive threshold algorithm (SITA)-standard visual fields (VF); and ETDRS visual acuity (VA).

RESULTS:

Following primary TRP, there was PDR regression in 76% of patients at 12 weeks (κ = 0.70; p < 0.001). No laser re-treatment was required at 4 weeks, and 10 eyes underwent repeat TRP at 12 weeks. Wide-field Optos angiography at 24 weeks showed complete disease regression in 37% and partial regression in 33%. Additional panretinal laser photocoagulation (PRP) was planned for active PDR in 30%. There were significant reductions in CRT over time (10.4 μm at 12-weeks, p = 0.007; 12.1 μm at 24-weeks, p = 0.0003). The MD on VFs improved after 12 weeks (+1.25 dB; p = 0.015) and 24 weeks (+1.26 dB, p = 0.01). The VA increased by +3 letters at 24 weeks (95% CI, 1.74-5.01; p < 0.0001).

CONCLUSIONS:

This pilot study reports that Optos-guided Pascal 20-ms TRP using 1500 burns for treatment-naive PDR is a promising procedure with favourable safety profile.

• 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: Acta ophthalmologica (Acta Ophthalmol) Vol. 91 Issue 3 Pg. 251-8 (May 2013) ISSN: 1755-3768 [Electronic] England
• PMID: 22176513 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• hemoglobin A1c protein, human

Topics

• Adult
• Algorithms
• Blood Glucose (metabolism)
• Diabetes Mellitus, Type 1 (complications)
• Diabetes Mellitus, Type 2 (complications)
• Diabetic Retinopathy (physiopathology, surgery)
• Female
• Fluorescein Angiography
• Fourier Analysis
• Glycated Hemoglobin (metabolism)
• Humans
• Laser Coagulation (methods)
• Lasers, Solid-State (therapeutic use)
• Male
• Middle Aged
• Prospective Studies
• Retinal Neovascularization (physiopathology, surgery)
• Tomography, Optical Coherence
• Treatment Outcome
• Visual Acuity (physiology)
• Visual Fields (physiology)