Panretinal Photocoagulation along the Long Ciliary Nerve in Diabetic Retinopathy

Abstract

Abstract Patients with a history of pan retinal photocoagulation for proliferative diabetic retinopathy underwent ultra-widefield imaging with identification of the long ciliary nerve. This study found high prevalence of photocoagulation along the nerve despite current guidance. Proliferative diabetic retinopathy is a prevalent disease associated with significant morbidity, reduced quality of life, high costs, and significant visual loss. 1 Panretinal photocoagulation (PRP) is a widely-used technique to decrease neovascularization and bleeding and reduce severe vision loss in proliferative diabetic retinopathy (PDR). 2 , 3 Despite its uses, multiple cases have linked peripheral laser photocoagulation near the long ciliary nerve (LCN) to corneal ulceration, transient accommodative paresis and pupillary disturbances 4 , 5 , 6 . Current guidelines from the Basic and Clinical Science Course recommend that “the long ciliary nerves in the 3 o’clock and 9 o’clock meridians should be avoided” during PRP. 7 The development of ultra-widefield (UWF) fundus imaging offers a unique opportunity to visualize the long ciliary nerve. The aim of this study is to establish the frequency of inadvertent panretinal photocoagulation along the long ciliary nerve through confirmation of laser marks on widefield fundus imaging.