Panretinal Laser Photocoagulation Research Articles

Effect of pattern scanning laser on macular thickness in diabetic retinopathy.

Purpose:This study investigates the effect of pattern scanning laser (PASCAL) panretinal photocoagulation (PRP) on central macular thickness (CMT) and visual acuity (VA) in patients with proliferative diabetic retinopathy (PDR).Methods:This retrospective non-randomized comparative case series included 262 eyes (163 with macular edema) of 177 patients with PDR. Treatment was PRP alone (137), PRP + anti-vascular endothelial growth factor (VEGF) (69), PRP + focal laser (28), or all three (89). CMT and central macular volume 3 and 6 mm from fovea were analyzed before and 1, 3, and 6 months after PRP. Spot number was plotted against CMT, and linear regression analysis was performed.Results:For each treatment group and time point, there was a non-significant relationship between spot number and CMT. In eyes receiving all three treatment modalities, a significant negative relationship was found between spot number and 3-mm volume at 6 months (p = 0.04) and 6-mm volume at 1 month (p = 0.002) and 6 months (p = 0.011). There was no significant change in VA in any treatment group at the 6-month time point.Conclusion:PASCAL PRP ± focal laser or anti-VEGF was not associated with increased development of macular edema or change in VA. PASCAL PRP with focal laser and anti-VEGF may result in a decrease in macular edema.

Low Dose 125I Brachytherapy And Transpupillary Thermal Therapy (TTT) For Small To Medium Size Choroidal Melanoma

To evaluate our institutional outcomes after treatment of small to medium size choroidal melanoma with low dose COMS brachytherapy. Single center, retrospective review of small to medium size choroidal melanoma < 5 mm in apical height managed from 2005-2019 with 125I brachytherapy at prescribed dose < 80 Gy, using a homogeneous dose calculation methodology. Ocular outcomes included visual acuity, presence of ocular radiation side effects, and local tumor recurrence. The Kaplan-Meier method was used to estimate overall survival, and metastasis rates were reported using cumulative incidence with death as a competing risk. Univariable associations were analyzed using Cox proportional hazards regression. Radiation statistics were calculated using Monte Carlo dosimetry. There were 146 patients included. Patient demographics and presenting tumor features are described in Table 1. Patients were treated with 125I plaque radiotherapy at median dose 65 Gy (IQR: 65-65 Gy) to depth of 5 mm, with additional transpupillary thermotherapy (TTT) at the time of plaque removal in 140 (95.9%) cases. Median follow-up was 6.7 years (IQR: 2.7-9.3 years). At final follow-up, median logMAR visual acuity was 1.1 (IQR: 0.4-2.0) with Snellen acuity 20/15-20/40 (20%), 20/50-20/160 (26%), and 20/200 or worse (54%). Radiation complications were as follows: cystoid macular edema in 54 (38%), radiation maculopathy in 71 (50%), non-proliferative radiation retinopathy in 53 (38%), proliferative radiation retinopathy in 20 (14%), and radiation papillopathy in 53 (38%). There were 11 patients who required subsequent pan-retinal laser photocoagulation (8%). Radiation dose did not appear to impact radiation maculopathy or retinopathy, but radiation papillopathy was significantly associated with point dose, maximum dose, and mean dose to the optic disc (p < 0.05). Local tumor control was achieved in 145 (99.3%) patients with recurrence in 1 (0.7%) patient 6.5 years after plaque. The 5-year cumulative incidence of distant metastasis was 7.2% with 5-year overall survival of 96.2%. Low dose 125I plaque radiotherapy with TTT provided high rates of local tumor control. Radiation maculopathy, retinopathy, and papillopathy were still observed even with reduced radiation apex dose. Future studies are warranted to determine rates of tumor control and ocular toxicity in low dose brachytherapy without TTT.Abstract 3687; TablePatient CharacteristicsMedian age61 years (IQR: 51-68 years)SexFemale 58%ComorbiditiesAtherosclerotic disease 44%Diabetes 18%Hyperlipidemia 45%Hypertension 49%Tumor CharacteristicsMedian logMAR visual acuity0.18 (IQR: 0.0-0.4)Snellen acuity20/15-20/40 68%20/50-20/160 29%20/200 or worse 3%Tumor dimensionsLargest basal diameter (IQR) 8.0 mm (IQR: 6.7-10.0 mm)Thickness (IQR) 2.0 mm (IQR: 2.0-2.0 mm)Secondary retinal detachment18%Subfoveal/subretinal fluid88% Open table in a new tab

Longitudinal analysis of subfoveal choroidal thickness after panretinal laser photocoagulation in diabetic retinopathy using swept-source optical coherence tomography

Purpose: To describe the central three-dimensional (3D) thickness profile of the macula (CMT) and the subfoveal choroidal region (SFCT) in diabetic retinopathy (DR) following panretinal laser photocoagulation (PRP) using swept-source optical coherence tomography (SS-OCT). Methods: A prospective observational study including 17 eyes with proliferative DR (PDR) and 27 eyes with severe nonproliferative DR (sNPDR)] for whom PRP was done. All subjects received SS-OCT imaging before and 3 months after PRP (POM#3). SFCT and CMT changes were analysed at both visits. Intraclass Correlation Coefficients (ICC) and Coefficients of Variation (COV) were used to test the accuracy of thickness data. Results: SFCT has thinned from 233 ± 54 µm before PRP treatment to 216 ± 51 µm 3 months later (p < 0.001). Likewise, CMT declined at POM#3 as compared to pre-PRP status (p<0.001). SFCT was thinner in PDR before and at POM#3 (p<0.05) than sNPDR; whereas, no significant difference was observed in CMT between both groups in the two visits. No significant changes were found between groups in SFCT and CMT at POM#3. Regarding reliability, ICCSFCT=0.98 and ICCCMT=0.99. The COVs for CMT and SFCT were 5.03% and 5.91%, respectively. Conclusion: The mean SFCT and CMT decreased 3 months after PRP. We also reported reliability of SFCT measurements in DR using SS-OCT. Abbreviations: SS = Swept-Source, TD = time domain, SD = spectral domain, FD = Fourier-domain, 3D = three-dimensional, 2D = two-dimensional.

Optical coherence tomography angiography assessment of 577 nm laser effect on severe non-proliferative diabetic retinopathy with diabetic macular edema.

To quantitatively evaluate the effect of the combined use of 577-nm subthreshold micropulse macular laser (SML) and multi-point mode pan retinal laser photocoagulation (PRP) on severe non-proliferative diabetic retinopathy (NPDR) with central-involved diabetic macular edema (CIDME) using optical coherence tomography angiography (OCTA). In this observational clinical study, 86 eyes of 86 NPDR patients with CIDME who underwent SML and PRP treatment were included. Images were obtained 1d before laser and post-laser (1d, 1wk, 1, 3, and 6mo) using AngioVue software 2.0. Best corrected visual acuity (BCVA, LogMAR), foveal avascular zone area (FAZ), choriocapillary flow area (ChF), parafoveal vessel density (PVD), capillary density inside disc (CDD), peripapillary capillary density (PCD), macular ganglion cell complex thickness (mGCCT), central macular thickness (CMT), and subfoveal choroidal thickness (ChT) were compared between pre- and post-laser treatment. BCVA remained stable during 6mo post-laser therapy (pre-laser vs 6mo post-laser: 0.53±0.21 vs 0.5±0.15, P>0.05). PVD, ChF, ChT, CMT, and mGCCT significantly increased 1d post-laser therapy [pre-laser vs 1d post-laser: superficial PVD (%), 40.51±3.42 vs 42.43±4.68; deep PVD (%), 42.66±3.67 vs 44.78±4.52; ChF, 1.72±0.21 vs 1.9±0.12 mm2; ChT, 302.45±69.74 vs 319.38±70.93 µm; CMT, 301.65±110.78 vs 320.86±105.62 µm; mGCCT, 105.71±10.72 vs 115.46±9.64 µm; P<0.05]. However, PVD, ChF and ChT decreased to less than baseline level at 6mo post-laser therapy (pre-laser vs 6mo post-laser: superficial PVD (%), 40.51±3.42 vs 36.32±4.19; deep PVD (%), 42.66±3.67 vs 38.76±3.74; ChF, 1.72±0.21 vs 1.62±0.09 mm2; ChT, 302.45±69.74 vs 289.61±67.55 µm; P<0.05), whereas CMT and mGCCT decreased to baseline level at 6mo post-laser therapy (CMT, 301.65±110.78 vs 297.77±90.23 µm; mGCCT, 105.71±10.72 vs 107.05±11.81 µm; P>0.05). Moreover, FAZ continuously increased while CDD and PCD continuously decreased in 6mo after laser therapy. CMT and ChT had a significant positive correlation with ChF and PVD in most post-laser stages. During a 6-month follow-up period after combined use of SML and PRP therapy, BCVA remained stable and there was a decreased trend in macular edema. Blood flow increased at 1d post-laser therapy and reduced at 6mo post-laser therapy.

A child with a rare presentation of ocular bartonellosis

A 6-year-old boy was referred from the optometrist for bilateral painless blurred vision of 2 weeks duration during routine screening. Upon examination, best-corrected visual acuity was 20/200 (right eye) and 20/120 (left eye). Anterior segment examination was normal for both eyes. Funduscopy showed bilateral optic disc swelling with peripapillary exudates and diffuse retinochoroiditis involving the posterior pole. Optical coherence tomography revealed diffuse retinal thickening with intraretinal fluids and cystoid changes of central fovea. Fluorescein angiography showed bilateral hot discs with vasculitis in all quadrants and large areas of nonperfusion at peripheral retina. The patient was initially treated as presumed ocular tuberculosis (TB) based on clinical presentation and history of contact with family member having pulmonary TB. Antituberculous therapy was started and both eyes received panretinal laser photocoagulation. After 3 weeks of anti-TB treatment, serology for Bartonella turned out to be positive. Treatment was changed to intravenous ceftriaxone for 10 days followed by oral cotrimoxazole for 6 weeks and combined treatment with oral prednisolone. Gradual clinical improvement was seen with corresponding visual gain due to the reduction of macular edema, but residual thickening remained due to its chronicity.

OUTCOMES OF NONCONFLUENT DIODE LASER PANRETINAL PHOTOCOAGULATION FOR AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY AFTER INTRAVITREAL BEVACIZUMAB.

To assess the safety and efficacy of less dense panretinal photocoagulation after intravitreal bevacizumab in aggressive posterior retinopathy of prematurity infants. Retrospective consecutive case series of premature infants diagnosed with aggressive posterior retinopathy of prematurity between August 2012 and November 2015 who received intravitreal bevacizumab with subsequent modified indirect diode laser panretinal photocoagulation for reactivation or incomplete vascularization. Main outcome measures included postprocedural reactivation, retinal detachments, or anterior segment ischemia. Sixty-one eyes of 31 premature infants were identified. The average gestational age was 24 ± 2.2 weeks (range 22-27), and the average birth weight was 661.5 ± 167.1 g (range 340.0-930.5 g). The average follow-up was 3.9 ± 1.3 years (range 1.3-5.4 years). At the last follow-up, no patient had experienced postlaser reactivation, retinal detachments, anterior segment ischemia, or other laser complications. This study suggests that nonconfluent panretinal photocoagulation for aggressive posterior retinopathy of prematurity infants who have received intravitreal bevacizumab may be safe and effective. This study's strengths include a sizeable sample size, long-term follow-up of nearly 4 years, and consistency in treatment among patients by a single, experienced retinopathy of prematurity specialist.

Current Management of Combined Traction/Rhegmatogenous Retinal Detachments

Due to proliferative diabetic retinopathy (PDR) and related complications, 25% of diabetic patients experience significant visual impairment. Panretinal argon laser photocoagulation (PRP) and the use of vascular endothelial growth factors (VEGF) in recent years have reduced the frequency of visual loss and tractional retinal detachment (TRD) and combined tractional/rhegmatogenous retinal detachment (CTRD). TRD and CTRD are the primary indications for vitreoretinal surgery related to PDR. TRD and CTRD which elevate macula less than 6 months, rapidly progressive and threatening macula are the other important indications to vitreoretinal surgery in diabetic retinopathy. CTRD, which was almost inoperable in previous years, now it takes place in the indications to vitreoretinal surgery by the development of new surgical equipment (vertical and horizontal scissors, light systems, diamond knives, trocar systems, etc.) and new surgical techniques (segmentation, visco-dissection, en-block dissection). Small calibered (23, 25, 27 Gauge) vitrectomy probes shortened the duration of vitreoretinal surgery in TRD and CTRD cases. Preoperative anti-VEGF treatment inhibits the fibrovascular tissue activation in this way facilitates and enables safe surgery. As long as the vitreoretinal surgery equipment and techniques improved, the functional and anatomical success in CTRD and TRD will increase.

Diabetes und Augenerkrankungen

AbstractThe frequency of diabetic retinopathy increases and is a leading cause of blindness in the working population. Recommended exams are testing of the visual acuity, ophthalmoscopy with dilated pupils, fundus fluorescein angiography and optical coherence tomography (OCT). By OCT the diagnosis and monitoring of diabetic macular edema has vastly improved. By intravitreal medications such as intravitreal anti-VEGF or intravitreal steroids macular edema can be treated successfully. Panretinal laser photocoagulation is the gold-standard in the therapy of proliferative diabetic retinopathy. Patients benefit from good co-working of general practitioner and ophthalmologist concerning screening and treatment.

COMPARATIVE EVALUATION OF ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY, ULTRASOUND BIOMICROSCOPY, AND INTRAOCULAR PRESSURE CHANGES AFTER PANRETINAL PHOTOCOAGULATION BY PASCAL AND CONVENTIONAL LASER.

To compare intraocular pressure, anterior segment optical coherence tomography, and ultrasound biomicroscopy parameters over 3 months after panretinal photocoagulation (PRP) for proliferative diabetic retinopathy after 1 of 2 sittings by conventional laser (half PRP) and a single sitting of Pattern Scan Laser (PASCAL) PRP. This was a prospective, randomized, interventional study. All tests were performed at baseline, and at 1, 6, and 24 hours, and 1, 4, 8, and 12 weeks after PRP. The intraocular pressure at 1 hour and 6 hours after PRP was significantly raised in both groups. Mean intraocular pressure was 21.17 ± 4.01 mmHg after PASCAL and 17.48 ± 3 mmHg after conventional laser at 1 hour, P < 0.001. On anterior segment optical coherence tomography, conventional laser PRP caused a more significant narrowing of angle-opening distance (AOD750) and trabecular-iris space area (TISA 500), P = 0.03 and 0.04, respectively, on Day 1. Ultrasound biomicroscopy showed a significantly narrow angle in both groups on Day 1. A significant increase in ciliary body thickness was observed in both groups, with 57.1% of PASCAL and 100% of conventionally treated eyes showing ciliary effusion on Day 1 that decreased but persisted for the next 3 months. Performing PRP in sittings, prescribing previous glaucoma medications in patients at risk, and recording intraocular pressure an hour after the PRP could decrease complications.

Intravitreal injection of conbercept after operation in the treatment of proliferatived diabetic retinophathy complicated with vitreous hemorrhage

Objective To observe the efficacy and safety of intravitreal injection of conbercept in the treatment of proliferatived diabetic retinophathy (PDR) complicated with vitreous hemorrhage by minimally invasive vitreoretinal surgery. Methods Prospective clinical study. A total of 50 patients with PDR complicated with vitreous hemorrhage clinically diagnosed in Tianjin Medical University Eye Hospital who needed vitrectomy were recruited in this study. According to the principle of informed consent, the patients were divided into two groups: postoperative injection group and the control group. Twenty-five eyes of 25 patients in each group were examined before operation. No significant proliferative changes in the posterior pole and traction retinal detachment were observed. There was significant difference of age between two groups (t=-24.697, P=0.030), but no significant difference of sex (χ2=0.330, P=0.564), duration of diabetes (t=-1.144, P=0.258), logMAR BCVA (t=-0.148, P=0.883), lens state (χ2=0.397, P=0.529), panretinal laser photocoagulation (χ2=1.333, P=0.248). The postoperative injection group was treated with intravitreous injection of 0.05 ml conbercept (10 mg/ml) immediately after 27G minimally invasive vitrectomy. The other treatment and follow-up were the same as those in the postoperative injection group except for conbercept injection. All patients underwent routine slit-lamp examination, indirect ophthalmoscope and B-ultrasound examination before operation. The main outcome measure included the time of operation, the incidence rate of iatrogenic retinal holes and silicone oil filling. The recurrence of vitreous hemorrhage, BCVA, intraocular pressure, central retinal thickness (CRT), postoperative complications and progression were recorded 1 week, 1 month, 3 months and 6 months after operation. Results At 1 week and 1, 3, 6 months after operation, there was significant difference of logMAR BCVA between the two groups (t=-4.980, -4.840, -4.892, -5.439; P<0.001). At 3 and 6 months after operation, the recurrence of vitreous hemorrhage in the postoperative injection group was lower than that in the control group, but there was no statistical difference between two groups (χ2=3.030, 4.153; P=0.192, 0.103). At 1 week and 1, 3, 6 months after operation, the CRT in the postoperative injection group was lower than that in the control group, the difference was significant (t=-2.622, -2.638, -3.613, -3.037; P=0.012, 0.010, 0.001, 0.004, 0.005). There was no complications such as choroid detachment, proliferative vitreoretinopathy, retinal detachment, iris redness and neovascular glaucoma in all the eyes after operation. Conclusions Intravitreal injection of conbercept in the treatment of PDR after operation is safe and effective. It can reduce the recurrence of vitreous hemorrhage after vitrectomy, improve the BCVA. Key words: Diabetic retinopathy/complications; Vitreous hemorrhage; Angiogenesis inhibitors/therapeutic use; Vitrectomy

Study of Efficacy and Safety of Brolucizumab Versus Panretinal Photocoagulation Laser in Patients With Proliferative Diabetic Retinopathy

Study of Efficacy and Safety of Brolucizumab Versus Panretinal Photocoagulation Laser in Patients With Proliferative Diabetic Retinopathy

Long-term effects of pattern scan laser pan-retinal photocoagulation on diabetic retinopathy in Chinese patients: a retrospective study.

To evaluate the long-term effects of pattern scan laser (PASCAL) pan-retinal photocoagulation (PRP) on diabetic retinopathy (DR) in Chinese patients. In this retrospective study, we evaluated clinical data of 29 patients (53 eyes) with severe non-proliferative DR (SNPDR) or proliferative DR (PDR) who received PRP and follow-up at our hospital from 2008 to 2013. Sixteen patients (29 eyes) received PASCAL PRP and 13 patients (24 eyes) received 100-ms conventional laser PRP. After long-term follow-up (mean, min-max days: 719.8, 290-1666 for PASCAL PRP vs 743.5, 240-1348 for conventional PRP, P=0.569), patients receiving PASCAL PRP required fewer photocoagulation sessions than the conventional PRP group (2.6±1.0 vs 3.9±0.9, P<0.01). Best corrected visual acuity (BCVA) was reduced slightly in PASCAL PRP group while reduced significantly in conventional PRP group. At last visit, 24 eyes in the PASCAL group (88.9%) and 21 eyes in the conventional group (91.7%) were improved or stable. Two eyes in PASCAL PRP group (7.4%) and 3 eyes in the conventional PRP group (12.5%) developed vitreous hemorrhage or vitreous fibrovascular proliferation. PASCAL PRP is as effective and may be more conducive to maintaining visual acuity with less treatment sessions for DR treatment compared to conventional laser PRP.

Efficacy and Side Effects of Individualized Panretinal Photocoagulation

Abstract This was a pilot study, where we demonstrated comparable efficacy and side effects of less extensive versus standard panretinal photocoagulation in patients with treatment-naive proliferative diabetic retinopathy. Panretinal laser photocoagulation (PRP) is considered the standard treatment of PDR 1 , but given the invasive nature of the treatment, side-effects like loss of visual fields (VF) 2 and night vision 3 as well as diabetic macular edema (DME) 4 can be expected.

Selective panretinal laser photocoagulation in ischemic central retinal vein occlusion

To compare the effectiveness and safety of panretinal laser photocoagulation targeting far-periphery (sPRP) versus conventional panretinal laser photocoagulation (cPRP) in patients with ischemic central retinal vein occlusion (iCRVO) in terms of the degree of macular edema. The study included eight (5 males and 3 females, mean age 59.4±17.2 years) and seven (6 males and 1 female, mean age 75.7±9.1 years) patients in sPRP and cPRP groups, respectively. iCRVO was defined as a CRVO case with baseline best corrected visual acuity (BCVA) of <0.2, central retinal thickness (CRT) of >500 µm and severe intraretinal hemorrhages. sPRP included dense photocoagulation of far-periphery over 360˚ and standard photocoagulation of the mid-periphery. Primary outcome measures were CRT and macular volume at the end of the follow-up. BCVA served as the secondary outcome measure. The median of the follow-up period was 9.5 months (ranged from 1.5 to 19 months). In the sPRP group, at the end of the follow-up both CRT and macular volume significantly decreased from 892.0±149.4 µm to 391.8±131.2 µm (p<0.001) and from 16.6±4.1 mm3 to 9.7±1.4 mm3, respectively (p=0.008). In the cPRP group, at the end of the follow-up CRT and macular volume changes were statistically insignificant: from 761.0±162.1 µm to 705.0±181.8 µm (p=0.46) and from 13.6± 3.2 mm3 to 11.8±1.7 mm3, respectively (p=0.38). At the end of the follow-up, cPRP group did not have changes in BCVA, while in the sPRP group BCVA increased statistically significantly from 1.45±0.6 LogMAR (≈0.06) to 1.1±0.6 LogMAR (≈0.14) (p=0.03). There were no adverse events or complications associated with laser treatment in any of the study patients. This study demonstrates the superiority of sPRP compared with cPRP for treatment of patients with iCRVO, showing that selective laser treatment of the far-periphery results in significant reduction of macular edema associated with severe retinal ischemia.

PASCAL Laser Produces Less Pain Responses Compared to Conventional Laser System During the Panretinal Photocoagulation

Background: Majority of patients experience pain during complete the panretinal photocoagulation (PRP). Laser photocoagulation delivery progressed with the introduction of pattern-scanning laser systems (PASCAL). Shorter pulse duration and choroidal penetration are believed to reduce pain during laser treatment. Objective: The purpose of this study was to assess pain response in patients with proliferative diabetic retinopathy (PDR) who underwent either PASCAL or conventional laser. Subjects and Methods: Eighty eyes with newly diagnosed proliferative diabetic retinopathy were randomly divided in to two groups each composed of 40 eyes: group (A) in which patients were received standard argon laser panretinal photocoagulation and group (B) in which patients were received pattern scan multispot panretinal photocoagulation. Results: Mean pain scores were 0.515 ±0. 834 in the PASCAL laser and 0.128 ±...1 in the conventional laser group. Numerical pain score was statistically significant higher in conventional group than in PASCAL group (p<0.001). Conclusion: It could be concluded that pattern scan multispot laser PRP was associated with more patient comfort compared to conventional PRP.

PASCAL Laser Produces Less Pain Responses Compared to Conventional Laser System During the Panretinal Photocoagulation

Background: Majority of patients experience pain during complete the panretinal photocoagulation (PRP). Laser photocoagulation delivery progressed with the introduction of pattern-scanning laser systems (PASCAL). Shorter pulse duration and choroidal penetration are believed to reduce pain during laser treatment. Objective: The purpose of this study was to assess pain response in patients with proliferative diabetic retinopathy (PDR) who underwent either PASCAL or conventional laser. Subjects and Methods: Eighty eyes with newly diagnosed proliferative diabetic retinopathy were randomly divided in to two groups each composed of 40 eyes: group (A) in which patients were received standard argon laser panretinal photocoagulation and group (B) in which patients were received pattern scan multispot panretinal photocoagulation. Results: Mean pain scores were 0.515 ±0. 834 in the PASCAL laser and 0.128 ±...1 in the conventional laser group. Numerical pain score was statistically significant higher in conventional group than in PASCAL group (p<0.001). Conclusion: It could be concluded that pattern scan multispot laser PRP was associated with more patient comfort compared to conventional PRP.

Effect of Diabetes Duration on Proliferative Disease Regression after Panretinal Photocoagulation Using a Conventional Laser Versus Pattern Scan Multispot Laser

Background: Panretinal photocoagulation (PRP) is considered the gold standard for first line therapy in proliferative diabetic retinopathy (PDR). The aim of PRP is to prevent visual loss following vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma, by leading to regression of neovascularization. Objective: The purpose of this study was to compare the effect of diabetes duration on proliferative disease regression after pan-retinal photocoagulation using a conventional green laser versus a multispot pattern scan laser. Subjects and Methods: Eighty eyes with newly diagnosed proliferative diabetic retinopathy were randomly divided in to two groups each composed of 40 eyes: group (A) in which patients were received standard argon laser panretinal photocoagulation and group (B) in which patients were received pattern scan multispot panretinal photocoagulation. Changes in central macular thickness and BCVA at 1st, 4th, 12th week and 6th month follow-up were compared to baseline measurements. Fundus fluorescein angiography was performed at 4 weeks, 12 weeks and 6 months to assess regression of PDR. Results: by the end of the study, complete regression occurred in 37 (92.5%) of patients in conventional laser group and 36 (90%) patients in PASCAL group, while persistence of the disease occurred in 3 (7.5%) patients in each group and recurrence occurred 1 (2.5%) in PASCAL group. There was no statistically significant correlation in each study group between clinical outcome and age or duration of DM. Conclusion: There was no statistically significant correlation in each study group between duration of DM and proliferative disease regression.

Efficacy and safety of ranibizumab with or without panretinal laser photocoagulation versus laser photocoagulation alone in proliferative diabetic retinopathy - the PRIDE study.

Panretinal photocoagulation (PRP) is the current standard of care in proliferative diabetic retinopathy (PDR). However, treatment with anti-vascular endothelial growth factor agents might offer better patient outcomes with fewer side-effects. The PRIDE study aimed to assess the efficacy and safety of ranibizumab with or without PRP compared with PRP alone in patients with PDR. A total of 106 PDR patients without diabetic macular oedema were randomized to receive ranibizumab 0.5mg monotherapy (n=35), PRP (n=35) or combined ranibizumab 0.5mg/PRP (n=36). The primary objective of this 12-month, multicentre, phase II study was to investigate the change in area of retinal neovascularization (NV). Complete regression of leakage and best-corrected visual acuity (BCVA) were key secondary end-points. At Month 12, there was a statistically significant difference of -2.83mm² in the least square mean change in NV area between the ranibizumab monotherapy and PRP group, favouring ranibizumab (95% CI [-5.45; -0.21], p=0.0344). At Month 3, 67%/0%/67% of the patients in the ranibizumab/PRP/combination groups, respectively, showed complete regression of leakage from NVs, while at Month 12, 28%/8%/18% showed complete regression of leakage from NVs. BCVA change was greater in the ranibizumab group compared with the PRP monotherapy group at Month 12 (+1.6 letters; 95% CI [-2.3; 5.5] versus -3.9 letters; 95% CI [-7.8; -0.1], p=0.0495). Ranibizumab monotherapy is an alternative treatment option to laser treatment in patients with PDR. Ranibizumab showed stronger effects on NV leakage and area reduction while offering better visual acuity results than PRP alone.

Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study

BACKGROUND The aim of this study was to determine the levels of vascular endothelial growth factor (VEGF) in the aqueous humor and the effect of intravitreal anti-VEGF injection combined with panretinal photocoagulation (PRP) on the management in diabetes mellitus (DM) patients with neovascular glaucoma (NVG). &#x0D; METHODS This study was a prospective, interventional study in DM patients with NVG. Paracentesis followed by intravitreal bevacizumab (IVB) injection was performed in all eyes. The concentration of VEGF obtained from paracentesis was measured. In week-1, the intraocular pressure (IOP), sectorial iris neovascularization (NVI), and visual acuity were documented, and management was continued with PRP laser over a period of 1 week. All parameters and additional interventions performed after PRP were also recorded. &#x0D; RESULTS A total of 18 eyes from 17 patients were studied. The mean (SD) level of VEGF in the aqueous humor was 3,864 (1,468) pg/ml, and the mean (SD) of initial IOP was 39 (10.2) mmHg. There was a significant reduction in IOP in week-1 after the first intervention to 24.4 (8.0) mmHg (p = 0.001); however, at 2 weeks the IOP increased to 30.4 (6.7) mmHg. NVI showed significant regression in week-1 after IVB combined with PRP laser (p &lt; 0.05). All eyes required additional glaucoma implants (14 eyes) and cyclocryotheraphy (4 eyes). &#x0D; CONCLUSIONS In the eyes of diabetes patients with NVG, VEGF levels were high. With the use of IVB, the IOP was reduced, and NVI regressed; however, due to the severe stages of disease, all eyes required glaucoma surgery.

Laser Pan-Retinal Photocoagulation to Treat Central Retinal Vein Occlusion

Introduction. Retinal Vein Occlusion (RVO) is the second most common retinal blood vessel disease after diabetic retinopathy. CRVO is an acute blockage of the central retinal vein that causes abnormalities in the retina, characterized by sudden decreased vision. Based on the potential for vision loss from this retinal disease, proper diagnosis and management is needed to prevent further complications.&#x0D; Case Presentation. A man, age 50 years old, a civil servant, came to the eye clinic of Mohammad Hosein Hospital on February 2017. The main complaint was vision of right eye suddenly blurred since 5 months before. Based on the above examination found decreased vision in one eye, with visual acuity better than 6/60 and no RAPD. The funduscopic examination above shows the presence of dilatation and tortousity in the central retinal vein, dot / blot bleeding and flame shaped hemorrhages in all quadrants, exudates, neovascularization of the retina and optic disk, and the presence of edema in the optic disc and macula.&#x0D; Conclusion. Management performed on these patients is by performing a Pan-Retinal Photocoagulation (PRP) laser and Grid-Pattern Photocoagulation. The selection of this therapy is based on the consideration that the patient has been suffering from CRVO for more than 3 months.