Panretinal Laser Photocoagulation Research Articles

Efficacy comparison of multipoint and single point scanning panretinal laser photocoagulation in non-proliferative diabetic retinopathy treatment.

Non-proliferative diabetic retinopathy (NPDR) poses a significant challenge in diabetes management due to its microvascular changes in the retina. Laser photocoagulation, a conventional therapy, aims to mitigate the risk of progressing to proliferative diabetic retinopathy (PDR). To compare the efficacy and safety of multi-spot vs single-spot scanning panretinal laser photocoagulation in NPDR patients. Forty-nine NPDR patients (86 eyes) treated between September 2020 and July 2022 were included. They were randomly allocated into single-spot (n = 23, 40 eyes) and multi-spot (n = 26, 46 eyes) groups. Treatment outcomes, including best-corrected visual acuity (BCVA), central macular thickness (CMT), and mean threshold sensitivity, were assessed at predetermined intervals over 12 months. Adverse reactions were also recorded. Energy levels did not significantly differ between groups (P > 0.05), but the multi-spot group exhibited lower energy density (P < 0.05). BCVA and CMT improvements were noted in the multi-spot group at one-month post-treatment (P < 0.05). Adverse reaction incidence was similar between groups (P > 0.05). While energy intensity and safety were comparable between modalities, multi-spot scanning demonstrated lower energy density and showed superior short-term improvements in BCVA and CMT for NPDR patients, with reduced laser-induced damage.

Intravitreal Lucentis (Ranibizumab) as A Treatment for Diffuse Diabetic Macular Edema

Introduction: Humanized anti-VEGF (Vascular endothelial growth factor) antibody fragment Lucentis (Ranibizumab) is prescribed to treat neovascular (wet) age-related macular degeneration, diabetic macular edema, diabetic retinopathy, and myopic choroidal neovascularization. It is also used to treat macular edema following retinal vein occlusion. Objective: This study was carried out to evaluate the anatomic effect and visual acuity response following intravitreal Lucentis (Ranibizumab). Methodology: In this investigation, diffuse diabetic macular edema was present in 30 eyes belonging to 30 patients with stable diabetes mellitus. Every eye had undergone argon laser photocoagulation, either Focal, Grid, or pan-retinal photocoagulation (PRP), for a minimum of three months. The patients with a mean age was 58.13±5.17 years were treated with two intravitreal injections of 0.5 mg of ranibizumab in 0.05 ml spaced four weeks apart. A skilled ophthalmologist assessed each patient's best-corrected visual acuity (BCVA), also assessed their central macular thickness (CMT) using optical coherence tomography, and assessed their diabetic retinopathy at both the baseline and follow-up sessions. The results: The results showed that the means of BCVA were significantly (P&lt;0.01) decreased from baseline (1.189±0.077 logMAR) to 1 month (0.162±0.058 logMAR) and 3 months (1.109±0.049 logMAR) after injection. Also the results revealed that the mean of CMT were significantly (P&lt;0.01) declined from the baseline (477.47±151.32 µm) to 1 month (438.27±115.68 µm) and 3 month (396.80±115.26 µm) after treatment. Conclusions: The study concluded that after three months of the second injection of Lucentis (ranibizumab) significantly reduced central macular thickness and improved visual acuity, then diffuse diabetic macular edema is significantly improved and treated using Lucentis (ranibizumab).

Cataract surgery outcomes in children and adolescents with type 1 diabetes mellitus

PurposeTo report the outcomes of cataract surgery in children and adolescents with type 1diabetes mellitus. MethodsThe medical records of all pediatric patients (<18 years of age) with a diagnosis of type 1 diabetes mellitus who had undergone surgery for cataract between January 2000 and December 2019 at a tertiary care center were reviewed retrospectively. ResultsA total of 27 eyes of 15 patients who met the inclusion criteria were included. Median age at cataract surgery was 13 (IQR, 9.5-16) years, and median follow-up was 3.8 (IQR, 1.25-7.2) years, with 11 eyes followed for more than 5 years. Visual acuity improved from a median preoperative value of 0.8 (IQR, 0.55-1.3) logMAR to 0.15 (IQR, 0-0.45) logMAR at final follow-up. Posterior capsular visual axis opacification in 40.7% and diabetic retinopathy in 14.8% were the common complications requiring additional intervention, including laser capsulotomy and panretinal photocoagulation, respectively. ConclusionsCataract surgery in children and adolescents with type 1 diabetes leads to improvement in visual acuity. Proliferative diabetic retinopathy can lead to poor visual outcomes in these children. Visual axis opacification occurs at similar rates with or without primary posterior capsulorhexis.

Autonomous screening for laser photocoagulation in fundus images using deep learning

BackgroundDiabetic retinopathy (DR) is a leading cause of blindness in adults worldwide. Artificial intelligence (AI) with autonomous deep learning algorithms has been increasingly used in retinal image analysis, particularly for...

Spontaneous peeling of an epiretinal membrane in an eye with treated proliferative diabetic retinopathy

An epiretinal membrane (ERM) usually occurs in eyes that have had a posterior vitreous detachment (PVD). Primary causes are typically unknown, but several secondary causes are known, such as retinal vascular disease. The presence of an ERM can exert traction on the neurosensory retina and can also contribute to the development of cystoid macular edema (CME). Rare ERM cases have shown spontaneous separation from the inner retinal surface, often leading to improved visual symptoms. We present a diabetic patient with proliferative diabetic retinopathy treated with panretinal laser photocoagulation who developed a marked ERM. Over a 5 year period, there was liquefaction and separation of the posterior hyaloid along with progressive and spontaneous release of the ERM, leading to improved foveal contour. This case demonstrates the self-peeling of a secondary ERM following PVD formation in an eye with treated proliferative diabetic retinopathy.

Acute Retinal Necrosis Complicated by Serous Retinal Detachment Associated with Varicella-Zoster Virus Infection in an Immunocompetent Young Adult

Acute retinal necrosis syndrome (ARN syndrome) is a rare, rapidly progressive viral retinitis with a grim functional prognosis. We present a case of a 43-year-old immunocompetent woman who experienced unilateral acute retinal necrosis, with Varicella-Zoster Virus (VZV) infection as the etiology. A unilateral vesicular facial rash accompanied by rapidly declining visual acuity over 7 days prompted consultation. Intravenous antiviral treatment and panretinal photocoagulation laser (PPR) were initiated, followed by antiviral prophylaxis. The patient developed ophthalmic zona lesions, peripheral retinal ischemia, and unilateral macular serous retinal detachment (SRD). Treatment included valacyclovir, corticotherapy and PPR laser. Knowledge of this condition, diagnosed clinically, is crucial due to its rapid progression and severe complications. Early intervention appears to be a significant prognostic factor, emphasizing its therapeutic urgency.

Comparative efficacy and safety of different anti-VEGF agents combined with different delivery methods for neovascular glaucoma: a systematic review and Bayesian network meta-analysis

ObjectiveTo compare the efficacy and safety of different anti-vascular endothelial growth factor (VEGF) agents combined with different delivery methods for neovascular glaucoma (NVG).DesignSystematic review and Bayesian network meta-analysis (NMA).Data sourcesPubMed,...

Treatment of Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy in Cipto Mangunkusumo Hospital During Pandemic Era (March 2020 - March 2022)

Introduction &amp; ObjectivesProliferative diabetic retinopathy (PDR) is the most common etiology for vitreous hemorrhage (VH)and can be sight-threatening. Current treatment modalities for VH in PDR included anti-VEGFinjection, panretinal photocoagulation (PRP) laser, and vitrectomy. We conducted study to evaluatetreatment modalities and outcomes of VH in PDR during the pandemic era.&#x0D; MethodsA retrospective study of VH in PDR was conducted at Cipto Mangunkusumo Hospital, Indonesia,from March 2020 to March 2022. Primary treatment was the therapy planned at the initial visit,while secondary treatment was subsequent treatment after follow-ups. Good anatomical outcomewas defined as vitreous clearing at last follow-up, while functional outcome was visual acuity (VA)improvement in LogMAR.&#x0D; ResultsThis study included 83 patients (97 eyes), which is smaller than the previous study in our centerbefore the pandemic. Mean age was 54,28±8,57 years, with almost equal males and females. InitialVA was LogMAR 2,48 (0,15 – 2,80). The most frequent treatment for VH in PDR was vitrectomy(53,5%), followed by anti-VEGF injection, PRP laser, and observation. Glaucoma after vitrectomy wasthe most common complication (5,2%). Vitreous clearing was achieved in 85,5% of cases, which wassignificantly associated with vitrectomy surgery (p=0,013) and initial treatment time (p=0,023). TheVA improvement was LogMAR -0,48(-2,48–2,40) which was related to initial VA (p&lt;0.05), yet therewas no significant association with treatment modality.&#x0D; ConclusionVitrectomy is essential to achieve vitreous clearing in VH caused by PDR. Initial visual acuity, notthe type of treatment modality, is a significant factor in vision improvement.

Predictors of visual outcome after pars plana vitrectomy secondary to proliferative diabetic retinopathy.

Objective: Advanced proliferative diabetic retinopathy can lead to serious ophthalmological complications, including blindness. This research aimed to determine visual outcomes after pars plana vitrectomy secondary to proliferative diabetic retinopathy, as well as to identify its predictors. Methods: This prospective clinical study was performed in the Ophthalmology Clinic of the Clinical Centre University of Sarajevo. 60 subjects (eyes) with performed pars plana vitrectomy secondary to proliferative diabetic retinopathy were included in the study. Results: After univariate linear regression analysis, glucose, HbA1c, vascular endothelial growth factor, previous pan-retinal laser photocoagulation, baseline best corrected visual acuity, gas injection, vitreous haemorrhage, iris rubeosis, and glaucoma were found to be statistically significant parameters associated with postoperative visual outcome (p<0.05). Multivariate linear regression analysis was performed to evaluate the association between factors and postoperative best corrected visual acuity. Only intravitreal vascular endothelial growth factor concentration, previous pan-retinal photocoagulation, and gas injection remained statistically significant associated with postoperative best corrected visual acuity (p<0.05). Conclusion: Vitrectomy is an effective treatment for advanced proliferative diabetic retinopathy. Factors correlated with the better visual outcome are good systemic control, previous pan-retinal photocoagulation, low intravitreal vascular endothelial growth factor concentration, younger age, intraoperative internal gas tamponade, combined phacoemulsification and pars plana vitrectomy surgery, and the absence of postoperative complications. Abbreviations: PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, TDR = tractional retinal detachment, BCVA = best corrected visual acuity, DR = diabetic retinopathy, RDD = rhegmatogenous retinal detachment, NVG = neovascular glaucoma, BRVO = branch retinal vein occlusion, CBC = complete blood count, DBT = differential blood count, ESR = erythrocyte sedimentation rate, HbA1c = glycosylated hemoglobin, PHACO = phacoemulsification, ILM = internal limiting membrane, PPV = pars plana vitrectomy, IOP = intraocular pressure, PRP = pan-retinal photocoagulation, ETDRS = Early treatment diabetic retinopathy study.

Long-term longitudinal retinal changes after conventional and pattern scan laser panretinal photocoagulation in diabetic retinopathy

PurposeComparison the effect of conventional and pattern scan laser (PASCAL) panretinal photocoagulation (PRP) on macula and optic disk in diabetic retinopathy (DR). MethodsThis retrospective study included 57 patients. In the conventional laser group, PRP was completed using the LightMed LightLas 532 laser device in accordance with the ETDRS protocol. In the pattern laser group, it was completed in a single session using PASCAL device with 20 ms pulse duration and multispot pattern. Central macular thickness (CMT) and retinal nerve fiber layer (RNFL) thickness were evaluated before laser treatment and at 1, 6 and 12 months after treatment. ResultsThere were 30 eyes in the conventional laser group and 27 eyes in the PASCAL group. There was no significant difference between the groups in terms of age (p = 0.560), sex (p = 0.866), duration (p = 0.498) and stage (p = 0.503) of diabetes, visual acuity (p = 0.104) and intraocular pressure (p = 0.963).In both groups, CMT increased significantly (p ˂0.001), while RNFL thickness decreased significantly (p ˂0.001) at 12 months. While CMT and mean RNFL thickness increased in the first month in both groups, it decreased progressively until the 12th month. ConclusionConventional and pattern laser systems used in the treatment of DR................ cause an increase in CMT and thinning of RNFL thickness in the long term. This change is more in the conventional laser group compared to the pattern laser.

Efficacy Of Intravitreal Bevacizumab in the Treatment of Vitreous Hemorrhage Secondary to Proliferative Diabetic Retinopathy

Objective: To determine the efficacy of intravitreal bevacizumab in the treatment of vitreous hemorrhage secondary to proliferative diabetic retinopathy. Study Design: Quasi-experimental study. Place and Duration of Study: The study was conducted at PNS Shifa Hospital, Karachi Pakistan, from Sep 2018 to Feb 2019. Methodology: The study included 131 patients with proliferative diabetic retinopathy who presented with vitreous hemorrhage. Vitreous hemorrhage was graded into mild-moderate or severe. Patients were randomized into two groups: the bevacizumab group was treated with three intravitreal injections of bevacizumab given on monthly intervals and the control group which was observed. Vitrectomy was performed if the patient had non resolving hemorrhage by four months or developed tractional retinal detachment during study period. Results: Mean age of patients was 51.8±7.4 and 52.6±6.7 in treatment and control group respectively. Percentage of patients with vision of less than 6/60 in treatment group reduced from (58.7%) at baseline to (33%) at 4 months. Patients with mild to moderate VH who were subjected to intravitreal bevacizumab had significantly less chance of undergoing PPV at 4 months (4.76%) as compared with control group (20%). Improvement in visual acuity was also statistically significant at 4 months (p&lt;0.05). Conclusion: Intravitreal bevacizumab can be effective in diabetic retinopathy related mild to moderate vitreous hemorrhage in terms of improving the vision, reducing the rate of requirement for vitrectomy and completing panretinal laser photocoagulation

Outcomes of Pars Plana Vitrectomy with Panretinal Photocoagulation for Treatment of Proliferative Diabetic Retinopathy Without Retinal Detachment: A Seven-Year Retrospective Study.

To review clinical outcomes of patients with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) who underwent pars plana vitrectomy (PPV) with endolaser panretinal photocoagulation (PRP) without retinal detachment (RD) repair. Retrospective chart review of the rate of postoperative clinical findings and visual acuity in patients with PDR from May 2014 to August 2021. Pars plana vitrectomy with endolaser PRP was performed in 81 eyes of 81 patients (mean age of 62.1 ± 10.5 years). At a median follow-up of 18 months, mean Snellen best-corrected visual acuity (BCVA) significantly improved from 20/774 preoperatively to 20/53 at last follow-up (P < 0.001). Postoperative complications and clinical findings included VH (12.3%), diabetic macular edema (DME) (12.3%), ocular hypertension (8.6%), RD (4.9%), and need for additional PPV (6.2%). Eyes with PRP performed within 6 months before surgery had a lower frequency of developing postoperative VH (5.3%) compared to eyes that received PRP more than 6 months before surgery (27.3%, P = 0.04). Eyes that received preoperative anti-vascular endothelial growth factor (VEGF) treatment (2.0%) had a lower frequency of postoperative VH compared to eyes that did not receive anti-VEGF treatment (14.3%, P = 0.04). Eyes that received intraoperative sub-tenon triamcinolone acetonide developed postoperative DME (4.0%) less frequently than eyes that did not receive sub-tenon triamcinolone acetonide (26.7%, P = 0.04). In patients with PDR and VH, PPV with PRP yielded significant improvements in visual acuity and resulted in overall low rates of recurrent postoperative VH. Preoperative anti-VEGF and PRP laser treatment were associated with lower rates of postoperative VH. Furthermore, intraoperative use of sub-tenon triamcinolone acetonide was associated with a lower rate of postoperative DME. Pars plana vitrectomy with endolaser PRP in conjunction with the aforementioned pre- and intraoperative therapies is an effective treatment for patients with PDR and VH.

Vancomycin-Associated Hemorrhagic Occlusive Retinal Vasculitis: A Case Series and Systematic Review.

This study describes three unilateral cases of hemorrhagic occlusive retinal vasculitis (HORV) after cataract surgery and a review of the literature until February 2022, including 21 articles reporting HORV cases. Altogether, 61 eyes (41 patients) were included. Twenty patients had bilateral and 21 patients had unilateral HORV. Prophylactic vancomycin was given to all patients. Additional vancomycin use was associated with the worst outcome. The mean time to HORV was 9 days post-cataract surgery. In bilateral cases, the median time between surgeries was 7 days. Visual acuity was < 20/400 in 48%, with no light perception in 20%. Neovascular glaucoma developed in 43%. Central macular thickening or hyperreflectivity of the inner retinal layers on optical coherence tomography was associated with worse outcomes. Corticosteroid treatment, early panretinal laser photocoagulation, or anti-vascular endothelial growth factor therapy, and prophylaxis alternative to vancomycin is recommended. [Ophthalmic Surg Lasers Imaging Retina 2022;53:702-712.].

Ischemia and laser photocoagulation in retinal vein occlusion

Retinal vein occlusions (RVO) are associated with retinal ischemia to ahighly variable extent. An ischemic retina may lead to the development of neovascularization and further to secondary complications such as neovascular glaucoma, vitreous hemorrhage or tractional retinal detachment. Numerous factors such as vascular endothelial growth factor (VEGF) and other cytokines are produced in the ischemic area, which cause macular edema. Before the introduction of intravitreal drug injections (IVI), retinal laser photocoagulation was the leading form of treatment. Macular laser photocoagulation was applied in the form of focal laser or grid laser in patients with branch retinal vein occlusion (BRVO) to treat macular edema. In patients with ischemic RVO, panretinal laser photocoagulation (PRP) was recommended for treatment of secondary neovascular complications. The value of laser treatment in the management of patients with RVO changed after the introduction of IVI treatment. This article presents a review of the current study results and the recommendations for performing laser photocoagulation of the central and peripheral retina in patients with RVO. Conventional focal or grid laser photocoagulation has been replaced by IVI treatment in the management of macular edema secondary to BRVO; however, macular laser treatment can still be considered in patients with BRVO if the macular edema persists despite the use of available IVI drugs. The use of central laser photocoagulation in these cases is based on the findings of fluorescein angiography. Disseminated panretinal laser photocoagulation is still indicated in RVO patients who have large areas of nonperfusion, have developed neovascularization and/or late complications. Targeted laser photocoagulation of the peripheral areas of nonperfusion has recently been recommended by several authors and is expected to improve not only the visual outcome of IVI treatment, but more importantly to also reduce the duration of treatment and the number of re-injections needed. Clear evidence for targeted laser treatment is not yet available and is afocus of currently ongoing prospective randomized studies.

Branch Retinal Vein Occlusion: A Case Report

To report a case of a major branch retinal vein occlusion (BRVO) in the superotemporal region with superior macular involvement and a review of its natural history. This is a retrospective case presentation of a 49-year-old African Caribbean female patient presented to Accident and Emergency with unilateral persistent acute history of reduced central vision of left eye for 10 days with no other associated symptoms. Treatment options included using scatter (pan-retinal) laser photocoagulation followed by intravitreal injections as the area of non-perfusion is &gt;5-disc area. It is warranted to understand the risk factors associated with BRVO and to develop appropriate treatment and follow-up plans.

Optical Coherence Tomography Following Panretinal Photocoagulation Demonstrating Choroidal Detachment

Retinal laser therapy such as panretinal photocoagulation can be associated with complications, including rare cases of choroidal detachment. This report describes high-resolution optical coherence tomography (OCT) imaging after retinal laser panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR) demonstrating choroidal detachment. A series of three sequential patients with high-risk proliferative diabetic retinopathy who were PRP laser naïve were examined with spectral-domain OCT immediately after green solid-state laser or PASCAL® PRP treatment. All three patients demonstrated a significant choroidal detachment immediately after PRP treatment. By one month after PRP, the choroidal detachment resolved spontaneously in all patients. OCT examinations were performed to detect and evaluate the severity and the change of choroidal detachment and thickness measurements were quantified and demonstrated a mean decrease in choroidal thickness of 122 µm (p &lt; 0.05 in all patients). Conventional green solid-state laser and PASCAL® laser both have the risk of developing complications such as choroidal detachment. While the rate of choroidal detachment has been reported to be quite low, this could be due to subclinical, self-limited, choroidal detachments. The risk could be larger than previously reported using modern high-resolution clinical optical imaging such as OCT.

Effect of pan-retinal laser photocoagulation on intravitreal vascular endothelial growth factor concentration in proliferative diabetic retinopathy.

Objective: This study aimed to determine the intravitreal concentration of VEGF in eyes with PDR and to evaluate the effects of previous PRP on its level. Methods: It was a cross-sectional study performed at the Clinical Centre University. It included 90 eyes surgically treated with PPV, divided into three groups, group A - patients with PDR with previous PRP, group B - patients with PDR without previous PRP, and group C - PPV performed due to the indication unrelated to diabetes. A vitreous sample was obtained during PPV, and the VEGF concentration was determined using an Enzyme-linked immunosorbent assay test (ELISA). Shapiro-Wilk, nonparametric tests Kruskal-Wallis, Mann-Whithney U test, ANOVA and Spearman's correlation test were used. Results: The highest vitreous VEGF concentration was in group B - 972.96 (743.33-1149.13) and was higher than in group A - 69.22 (37.33-225.15) and in group C - 19.93 (1.15-32.17) (p<0.001). There was a positive correlation between VEGF vitreous concentration and glucose level in group A patients (Rho=0.410; p=0.027). Conclusion: As a treatment before PPV surgery, PRP showed to be effective in the reduction of VEGF levels, which also highlighted a decrease in complications during and postoperatively. Abbreviations: DRS = Diabetic Retinopathy Study, PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, PRP = pan-retinal photocoagulation, PPV = pars plana vitrectomy, HbA1c = glycosylated hemoglobin, ETDRS = Early treatment diabetic retinopathy study, ESR = erythrocyte sedimentation rate, BCVA = best corrected visual acuity, OCT = optical coherent tomography, ILM = internal limiting membrane, PHACO = phacoemulsification, IOL = intraocular lens, ELISA = Enzyme-linked immunosorbent assay test, AUC = area under the curve, DME = diabetic macular oedema, TDR = tractional retinal detachment, VMT = vitreomacular traction.

Conventional and Pattern Scanning Pan-Retinal Photocoagulation Laser in Diabetic Patients' Visual Field.

Introduction: In this study, we aimed to compare visual field defects in two different laser methods, namely conventional pan-retinal photocoagulation (PRP) and pattern scanning PRP, in patients with either proliferative diabetic or very severe non-proliferative diabetic retinopathy. Methods: This study was a randomized, single-blind, prospective clinical trial. Twenty patients with either proliferative or very severe non-proliferative diabetic retinopathy were enrolled in this study. Notably, only those patients with the same severity scores in both eyes were included. One eye underwent the conventional PRP laser and another eye underwent the pattern scanning PRP laser simultaneously. Swedish interactive threshold algorithms (SITA) standard perimetry was performed at baseline and one month after the treatment, and visual field defects were evaluated. Results: The pattern standard deviation (PSD) significantly increased in both the pattern and conventional PRP laser groups after one month. The change of the PSD at baseline and after the treatment was not significant between the groups. The mean deviation (MD) level significantly decreased in the conventional group after one month. The change in the MD level at baseline and after the treatment was not significant between the pattern and conventional groups. The change in the mean best corrected visual acuity (BCVA) between the groups was not significant. Conclusion: Changes in visual acuity and visual fields of the patients between the pattern and conventional PRP laser methods showed no significant difference; however, the pattern PRP method caused a smaller reduction in overall sensitivity in the patient's visual field.

Travel burden in treatment of retinopathy of prematurity

Approximately 10% of infants screened for ROP require treatment. Current treatment options include Panretinal Laser Photocoagulation or Intravitreal antiVEGF. Our institution provides treatment of ROP for a very large geographic region, making the travel burden for some patients a large barrier to care access. Our aim is to compare the follow-up and travel burden between patients with ROP treated with laser and those treated with intravitreal antiVEGF at our institution.

Diabetic retinopathy with extensively large area of capillary non-perfusion: characteristics and treatment outcomes

BackgroundCapillary non-perfusion is an important characteristic for diabetic retinopathy (DR) indicating microvascular damage and ischemia. Data on the description and treatment outcomes of DR with large area of non-perfusion are lacking to date. We aim to describe the characteristics and treatment outcomes in a series of patients with DR who presented extensively large area of capillary non-perfusion (LACNP).MethodsFundus fluorescein angiograms from medical charts in patients diagnosed with DR between Jan 2017 and Dec 2019 were retrospectively reviewed. Clinical data in eyes with LACNP including imaging and laboratory findings at the first presentation were analyzed. The LACNP was defined as over 70% area of capillary non-perfusion throughout the whole image retina. The mean follow-up duration was 12.4 ± 16.7 months. Follow-up data including extensive pan-retinal photocoagulation and surgical intervention and treatment outcomes were evaluated.ResultsA total of 43 eyes in 24 patients with LACNP were included, accounting for 3.3% of DR populations in the same period. The overall percentage of non-perfusion area was 79.1 ± 8.1%. All patients received proper control of diabetes and hypertension, and extensive pan-retinal laser photocoagulation. During the follow-up periods, 20 eyes (46.5%) developed severe neovascular complications, of which 15 eyes (34.9%) underwent vitrectomy and/or anti-glaucoma surgeries. Conservative therapies including glycemic control and supplemental laser photocoagulation were conducted in 23 eyes (53.5%) without neovascular complications. In the final follow-up, best corrected visual acuity improved or maintained stable in 19 eyes (44.2%) while deteriorated in 24 eyes (55.8%).ConclusionsThe presence of LACNP is the hallmark of advanced DR and often indicates a poor visual outcome, although aggressive treatments may slow DR progression and maintain central vision for some time.