Abstract
BackgroundWe conducted this study to report on the indications and types of retinal laser therapy (RLT) performed in Bhutan, knowing which is critical for proper planning and successful delivery of the services.MethodsWe reviewed the laser registers maintained in the laser rooms and vitreoretinal (VR) operating theatres (including paediatric cases managed under anaesthesia) over three years at the national and the two regional referral hospitals (RRHs). Intraoperative laser treatments (endolaser) were excluded. Patient demography, indications and types of RLT were recorded and quantified. Comparisons of the expected and observed frequencies used Chi-squared tests.ResultsA total of 685 patients, including 8 cases of bilateral retinopathy of prematurity (ROP) received RLT. The majority of patients (411 cases, 60.0%, p < 0.0001) were males. The mean age was 54.1 ± 14.1 years, median 56 years. The most common indications for RLT were diabetic retinopathy (DR) and diabetic macular oedema (DMO) (542 cases, 66.0%), followed by retinal vein occlusion (RVO) (91 cases, 13.3%). Pan-retinal photocoagulation was the most common type of RLT performed (337 cases, 49.2%), followed by modified grid laser (207 cases, 30.2%), sectoral laser (41 cases, 6.0%), and prophylactic laser photocoagulation (33 cases, 4.8%).ConclusionsThe majority of patients were within working-age. Common indications for RLT were preventable such as DR, DMO and RVO, indicating need to control systemic diseases such as diabetes, hypertension, and dyslipidaemia. Currently, regular RLT is provided only at the national referral hospital in Thimphu, and periodically in the eastern and central RRHs when the retinal specialist visits. There is need to extend the retinal services to the eastern and central RRHs to improve accessibility and patient coverage in these regions challenged with difficult terrain and poor public transport system.
Highlights
We conducted this study to report on the indications and types of retinal laser therapy (RLT) performed in Bhutan, knowing which is critical for proper planning and successful delivery of the services
It is reported that anti-Vascular endothelial growth factor (VEGF) have significantly superior efficacy to laser photocoagulation in diabetic macular oedema (DMO) [6, 7], retinal vein occlusion (RVO) [8], and retinopathy of prematurity (ROP) [9]
In Bhutan, RLT was still considered for retinal disorders such as DMO, diabetic retinopathy (DR), RVO, retinal breaks, ROP, and retinal vasculitis (RV) for economic reasons
Summary
We conducted this study to report on the indications and types of retinal laser therapy (RLT) performed in Bhutan, knowing which is critical for proper planning and successful delivery of the services. The therapeutic benefits of laser were first reported in 1954 [1]. This prompted the invention of xenon-arc laser in 1956 for prophylaxis of retinal detachment (RD), but it was limited by poor focus [2]. Rai et al BMC Ophthalmology (2020) 20:404 considered as a treatment option if anti-VEGF treatment is not available or limited for socio-economic reasons. It is reported that anti-VEGFs have significantly superior efficacy to laser photocoagulation in diabetic macular oedema (DMO) [6, 7], retinal vein occlusion (RVO) [8], and retinopathy of prematurity (ROP) [9]. In Bhutan, RLT was still considered for retinal disorders such as DMO, diabetic retinopathy (DR), RVO, retinal breaks, ROP, and retinal vasculitis (RV) for economic reasons. The different types of RLT are focal, grid, modified grid, sectoral, scatter, and pan-retinal photocoagulation (PRP)
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