Tolerance of Laser Panretinal Photocoagulation Treatment Under Topical Anaesthesia Using Slit Lamp Delivery vs Indirect Ophthalmoscope Laser Panretinal Photocoagulation Under Peribulbar Anaesthesia

Abstract

Background and Objective: To compare the pain perceived by patients undergoing argon laser panretinal photocoagulation treatment for proliferative diabetic retinopathy under slit lamp delivery after topical anaesthesia and indirect ophthalmoscope laser delivery after peribulbar anaesthesia. Study design/ Patient and Methods: Prospective, multicentre non-randomised, study. Forty-six eyes of 46 patients with proliferative diabetic retinopathy were treated either by slit lamp delivery using topical anaesthesia (Group A) or indirect ophthalmoscope laser panretinal photocoagulation after peribulbar anaesthesia (Group B). Patients in both the categories were divided into two subgroups, one receiving pan retinal photocoagulation for the first time (A1 & B1) and the second group receiving laser treatment for the second or subsequent time (A2 & B2). The primary outcome measure was eye pain perceived during the laser treatment and pain within 48 hours following laser treatment. Patients graded the pain from (0-10) on a visual analogue scale. Secondary outcome measure included the need for oral analgesia within 48 hours following the laser procedure. Results: Overall panretinal photocoagulation treatment under peribulbar anaesthesia is more comfortable than topical anaesthesia (p<0.001), but pain within 48 hours following the laser procedure was similar in the two groups (p=0.118). Panretinal photocoagulation for the first time with peribulbar injection was more comfortable than topical anaesthesia (p=0.001), but both the groups perceived similar pain 48 hours following the laser procedure (p=0.571). Subsequent laser treatment is again more comfortable under peribulbar anaesthesia (p<0.001) and is also more comfortable than topical anaesthesia causing less pain 48 hours following laser treatment (p=0.004). Conclusion: Peribulbar anaesthesia does not abolish pain completely, but definitely made argon laser panretinal photocoagulation treatment more comfortable for patients. Panretinal photocoagulation under topical anaesthesia is painful and this pain may persist for up to 48 hours. Peribulbar anaesthesia is not entirely effective in controlling pain during the first 48 hours following laser treatment in those patients undergoing laser application for the first time. Patients need to be counselled regarding pain following panretinal photocoagulation treatment and the need for oral analgesia.