Panretinal Photocoagulation Treatment Research Articles

Analysis of the quality of life and the influencing factors in patients with diabetic retinopathy before and after receiving pan-retinal photocoagulation

Objective: Quality of life and the influencing factors in patients with diabetic retinopathy before and after receiving treatment of pan-retinal photocoagulation (PRP) were studied. Methods: Prospective study. A total of 55 diabetic retinopathy patients were collected at Beijing Friendship Hospital, Capital Medical University from November 2016 to August 2017 and were surveyed using Vision Function Questionaire (VFQ-25) to evaluate their quality of life before and 3 months after treatment with PRP. According to diagnostic criteria, the patients were divided into two groups: severe nonproliferative diabetic retinopathy(NPDR) and proliferative diabetic retinopathy group(PDR). SPSS was used for statistical analysis. Results: The score of VFO-25 general health before PRP treatment was 62.73±14.20, obviously lower the other sub scale scores of VFO-25. The results of variance analysis there was significant statistical difference between the composite score and the different educational levels (F=2.94, P<0.05), but there was no statistical difference for diabetes duration (F=3.01, P<0.05). The composite score was significantly significance between the severe NPDR and PDR group(t=8.95, P<0.05). The patients with hyperlipidemia (t=-3.21, P<0.05), hypertension(t=-2.32, P<0.05) and renal insufficiency(t=-2.05, P=0.045) has lower composite score. There was high relationship for age among the factors of worse logMAR vision, better logMAR vision and age (r=-0.47, P<0.05; r=-0.38, P<0.05; r=-0.26, P<0.05). The scores of VFQ-25 subscale of social function (t=-2.07, P<0.05) , role limitations (t=-2.38, P<0.05) , dependency (t=-2.99, P<0.05) and mental health (t=-2.26, P<0.05) was significantly increased after treatment of PRP. The score of ocular pain was obviously decreased (t=4.19, P<0.001) ; there were no significance in other sub scale scores. Conclusions: This study showed that the degree of visual acuity, the severity of DR and age were an important factor affecting the quality of life in DR patients. PRP therapy could improve the mental health and social field of DR patients, but failed to improve the scores of other visual functions in the patients. (Chin J Ophthalmol, 2018, 54:611-616).

Combined treatment of Conbercept and panretinal photocoagulation for neovascular glaucoma after central retinal vein occlusion

Combined treatment of Conbercept and panretinal photocoagulation for neovascular glaucoma after central retinal vein occlusion

Cost Evaluation of Early Vitrectomy versus Panretinal Photocoagulation and Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy

To evaluate costs and cost-utility of early vitrectomy (pars plana vitrectomy [PPV]) compared with panretinal photocoagulation (PRP) and intravitreal ranibizumab (IVR) for proliferative diabetic retinopathy (PDR) without diabetic macular edema. A decision analysis model of cost-utility. There were no participants. A decision analysis was based on results from the Diabetic Retinopathy Clinical Research Network Protocol S comparing treatment of PRP with IVR (0.3 mg) in PDR without incident macular edema to model the total 2-year costs and outcomes for each treatment scenario. These values were compared with the 2-year hypothetical costs of early PPV for PDR. Centers for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility-based and nonfacility setting. Cost-utility was calculated on the basis of the preserved visual utility and estimated life years remaining. In addition, costs for lifetime treatment were modeled for all scenarios and used to calculate lifetime quality-adjusted life years (QALY) costs for each scenario. Sensitivity analyses were performed to evaluate the impact of the model's assumptions. Cost of treatment, utility, and cost per QALY. The modeled cost per QALY of treatment for PDR for 2 years of utility in the facility (nonfacility) setting was $163 988 ($102 559) in the PRP group, $436 992 ($326 424) in the IVR group, and $181 144 ($107 965) in the PPV group. Sensitivity analysis showed that both IVR and PPV groups would have equivalent costs per QALY over the first 2 years if 78% (facility) and 80% (nonfacility) of patients in the PPV group required additional treatment with IVR (at the dose of 10.1 injections as in Protocol S). Beyond 2 years, the cost per QALY in the facility (nonfacility) setting was calculated as $61 695 ($21 752) in the PRP group, $338 348 ($239 741) in the IVR group, and $63 942 ($22 261) in the PPV group. Early PPV as a strategy for treatment of PDR without macular edema demonstrates cost-utility similar to management with PRP and more favorable cost-utility compared with IVR in the short term. This advantage over IVR continues when lifetime costs are factored.

Optical coherence tomography characteristics of active and regressed retinal neovessels secondary to proliferative diabetic retinopathy before and after panretinal photocoagulation

Aim: To describe the changes in the appearance of diabetic neovascularization and vitreoretinal interface before and after panretinal photocoagulation (PRP) using high-resolution spectral-domain optical coherence tomography (SD-OCT). Design: A prospective noncomparative observational case series study was performed on 15 eyes with proliferative diabetic retinopathy (PDR). Patients and Methods: Patients with PDR were scanned using SD-OCT scans directly over the region of the neovessels before and after PRP treatment. Results: The study included 15 treatment-naive eyes with PDR of 11 patients, 8 females and 3 males with a mean age of 54.18 ± 10.9 years (range 29–65 years). The mean best-corrected logarithm of the minimum angle of resolution visual acuity was 0.68 ± 0.19 (range 0.4–1). One (9.1%) case had insulin-dependent diabetes mellitus (type 1) and 10 (9.1%) cases had noninsulin-dependent diabetes (type 2). Posterior hyaloid was detached and identifiable in pretreatment SD-OCT scans in 11 (73.33% of studied eyes) eyes and not identifiable in 4 (36.67%) eyes. Changes in SD-OCT scan appearance after PRP included progression of posterior hyaloid separation with possible progressive retinal traction and retinoschisis, consolidation of the neovessels, regression of neovessels, or occurrence of preretinal hemorrhage. One case showed no visible change at the vitreoretinal interface. Conclusion: There are changes in the appearance of the diabetic neovessels and the vitreoretinal interface after PRP treatment that could be detected by SD-OCT.

Panretinal Photocoagulation: A Review of Complications

ABSTRACT Panretinal photocoagulation (PRP) is a mainstay of therapy for retinal ischemic disease. The procedure involves creating thermal burns in the peripheral retina leading to tissue coagulation, the overall consequence of which is improved retinal oxygenation. While highly effective, there have been concerns historically regarding the anatomic effects and visual complications following PRP, the most common of which include choroidal effusions, exudative retinal detachments, macular edema, visual field deficits, and night vision defects. The occurrence of these complications is closely tied to laser parameters such as increased duration and power and intensive treatment in a single sitting, all of which cause increased dispersion of thermal energy within the retina and choroid. The advent of newer laser delivery systems, such as the multispot pattern laser, has greatly mitigated but not eliminated these issues. The following article reviews the most common complications following PRP treatment, including reported occurrences, inciting factors, and underlying pathophysiology.

Analysis of reasons for noncompliance with laser treatment in patients of diabetic retinopathy

To identify the underlying reasons for noncompliance among Chinese patients undergoing laser photocoagulation treatment for diabetic retinopathy (DR). Prospective cohort study. A total of 262 patients with DR with indications for panretinal photocoagulation and focal laser treatment were recruited. Those who did not complete the prescribed laser treatment were categorized into 2 types of defaulters: Type 1 defaulters were those who did not initiate laser treatment as scheduled; type 2 defaulters were those who did not complete the entire laser sessions, including terminating midterm or defaulting prompt supplement of laser treatment. A standardized questionnaire was given to the 2 types of defaulters to collect information about the reasons for noncompliance. Data were analyzed and subjected to χ2 test or Fisher exact statistical tests. The noncompliance rate was 45.5%, which is significantly greater than some developed countries. Unawareness of the necessity for treatment and unawareness of the importance to complete treatment were 2 main reasons leading to noncompliance, representing 28.8% and 36.0%, respectively. Unawareness of the necessity for treatment and fear of laser treatment were more important for type 1 defaulters (29 vs 6 and 11 vs 0, respectively), whereas unawareness of completeness of laser treatment was overweighed in type 2 defaulters (27 vs 13 patients; all P<0.01). These results were likely related to the lack of knowledge about the potential consequences of DR, the underlying principle of laser treatment, and panretinal photocoagulation procedures. Developing appropriate education programs targeting specific reasons will help to improve the compliance in patients with DR.

Evaluation of retinal blood flow before and after panretinal photocoagulation using pattern scan laser for diabetic retinopathy

ABSTRACTPurpose: Laser speckle flowgraphy (LSFG) can measure blood flow in the ocular fundus. We analyzed the relationship between retinal blood flow and panretinal photocoagulation (PRP) in diabetic retinopathy.Methods: This retrospective observational study examined the eyes of 35 patients with proliferative diabetic retinopathy (PDR) or non-PDR (NPDR). PRP was performed using a pattern scan laser. Using LSFG, blood flow was evaluated as the mean blur rate (MBR) or the relative flow volume (RFV). We also evaluated MBR in the vessels of the optic nerve head (MBR-V), RFV at the first retinal artery (RFV-A), and RFV at the first retinal vein (RFV-V) before bifurcation. Blood flows were measured prior to treatment initiation, during each PRP session, and after PRP.Results: The total number of laser spots created was 4258 ± 461. Regression of neovascular activity at 6 months after PRP occurred in 29 (82.85%) eyes. MBR-V significantly decreased to 83.9 ± 16% (p = .0039), 79.3 ± 21% (p = .0001), and 73.5 ± 26% (p = .0001) after the first, second, and third PRP treatment sessions. MBR-V was also reduced to 75.0 ± 25% (p = .0001), 75.0 ± 25% (p = .0001), and 80.3 ± 22% (p = .0001) at 1, 3, and 6 months following PRP. During and at 6 months after the PRP treatments, RFV-A and RFV-V were also significantly reduced (p< .01).Conclusions: During and after PRP treatments using pattern scan laser, retinal blood flow was reduced. Retinal blood flow may be an auxiliary measurement for effectively evaluating PRP or PDR.

Retinal Findings of a Unique RTEL1 Mutation in Dyskeratosis Congenita

We describe the retinal manifestations of a patient with a unique mutation of the Regulator of telomere length 1 ( RTEL1) gene resulting in dyskeratosis congenita (DC), a rare, fatal, inherited disease. A 4-year-old boy with DC was referred for ophthalmology consult by his attending hematologist and underwent a complete ophthalmic examination, including wide-field fundus imaging and fluorescein angiography. The patient was found to have bilateral retinal vasculopathy and extensive microvascular abnormalities in addition to avascular regions in the temporal peripheral retina. He received multiple pan-retinal photocoagulation treatments in both eyes. Our case highlights the importance of ophthalmic screening and fluorescein angiography and the potential need for timely laser photocoagulation for sight-threatening retinopathy in patients with DC.

Management of neovascular glaucoma with intravitreal ranibizumab, panretinal photocoagulation, and subsequent 5-fluorouracil augmented trabeculectomy: A case report.

Rationale:Neovascular glaucoma (NVG) is one of the most refractory types of glaucoma caused by high ischemic retinal disorders, resulting in severe visual loss. Intravitreal injections of ranibizumab have been reported to have anatomical and functional success in treating NVG.Patient concerns-Diagnoses-Interventions:We report a case with neovascular glaucoma due to central retinal vein occlusion who received combination therapy with intravitreal ranibizumab (IVR) injection, panretinal photocoagulation (PRP) and subsequent 5-fluorouracil (5-FU) augmented trabeculectomy.Outcomes:One week after IVR injection, the intraocular pressure (IOP) had partially decreased to 33 mmHg, and there was a complete regression of neovascularization of the iris (NVI) and the angle (NVA). PRP was feasible after IVR due to improvement of corneal edema which made an adequate view of the posterior pole of fundus. The surgery of trabeculectomy with 5-FU was performed 2 weeks after IVR to control the IOP. The intraoperative and postoperative courses were uneventful without any adverse complication. Post trabeculectomy, his vision remained stable and the IOP was in the range of 4-15 mmHg without topical antiglaucoma medications. A functioning bleb was maintained and there was no recurrence of NVI and NVA during the complete follow-up period of 6 months.Lessons:Combined treatment of IVR, PRP, and subsequent 5-FU augmented trabeculectomy is demonstrated to be a possible new paradigm for the management of advanced NVG with angle closure and intractable elevation of IOP.

Long-term Effect of Panretinal Photocoagulation on Spectral Domain Optical Coherence Tomography Measurements in Diabetic Retinopathy

ABSTRACTPurpose: To evaluate the effects of panretinal photocoagulation on spectral domain optical coherence tomography measurements in diabetic retinopathy by comparing the thicknesses of the central macula, retinal nerve fiber layer, and ganglion cell layer, we used a Cirrus HD OCT® (Carl Zeiss Meditec, Dublin, CA, USA) in normal and diabetic retinopathy cohorts.Methods: We analyzed patients who visited our retinal clinic between May 2013 and July 2014. The patients were classified into four groups: normal (Group A), diabetes without diabetic retinopathy (Group B), severe nonproliferative or proliferative diabetic retinopathy (Group C), and at least 3 years after panretinal photocoagulation treatment (Group D). The mean thicknesses of the macula, retinal nerve fiber layer, and ganglion cell layer in each group were compared by measuring a macular cube 512 × 128 scan and an optic disc cube 200 × 200 scan twice.Results: In total, 154 patients were enrolled. The mean thickness of the central macula in groups A to D was 257.2, 256.8, 257.4, and 255.6 µm, respectively, and did not differ significantly. The mean thickness of the RNFL in group A to D was 96.8, 96.5, 97.2, and 92.8 µm, respectively, and was significantly lower in group D (decreased in the inferior, superior, and nasal sectors, but increased in the temporal). The mean thickness of the ganglion cell layer was also significantly lower in group D (A, 84.5 µm; B, 84.4 µm; C, 82.5 µm; D, 78.5 µm).Conclusions: The mean thicknesses of the retinal nerve fiber and ganglion cell layers were decreased significantly in eyes with diabetic eye disease treated with panretinal photocoagulation compared to normal or eyes with diabetic eye disease that had not been laser-treated. Laser treatment might have altered the thickness of the inner layer of the retina, and such changes should be considered in diabetic retinopathy patients after panretinal photocoagulation treatment.

Trends in Vitreoretinal Procedures for Medicare Beneficiaries, 2000 to 2014

The purpose of this study was to identify changes in use for vitreoretinal procedures by measuring the number of allowed services using data from the US Medicare Part B Fee-for-Service (FFS) beneficiaries and their providers. To analyze vitreoretinal procedural trends, which may indicate standard of care and importance of developing methods of treatments. Medicare Part B National Summary Data Files for calendar years 2000 to 2014 were used to identify the number of allowed services for vitreoretinal procedures and commonly used pharmacologic agents. Linear regression analysis was performed to identify trends in use. To analyze vitreoretinal procedural trends, which may indicate standard of care and importance of developing methods of treatments. Vitreoretinal procedures grew 6-fold from 2000 to 2014. Intravitreal injections were the primary driver of growth. A total of 2922 injections were performed in 2000, compared with 2 619 950 injections in 2014 (P< 0.01). Scleral buckling declined from 6502 procedures in 2000 to 1260 procedures in 2014 (P < 0.01), whereas vitrectomy use for retinal detachment increased from 13 814 surgeries in 2008 to 19 288 surgeries in 2014 (P < 0.01). Focal laser treatments declined from 188 351 procedures in 2002 to 83 379 procedures in 2014 (P < 0.01). Panretinal photocoagulation treatments declined from 109 840 procedures in 2004 to 81 005 procedures in 2014 (P < 0.01). Vitreoretinal practice patterns changed significantly from 2000 to 2014. Intravitreal injections increased by 89 563%. Intravitreal injections accounted for 0.55% of all vitreoretinal procedures in 2000 and increased to 87% in 2014. Scleral buckling sharply declined, and preference for retinal detachment repair shifted further toward vitrectomy with a distribution of 83% vitrectomy, 5% scleral buckling, and 12% pneumatic retinopexy in 2014. Use of laser photocoagulation significantly declined for treatment of macular edema and proliferative retinopathy. Cryotherapy procedures declined across all indications.

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

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 &amp; B1) and the second group receiving laser treatment for the second or subsequent time (A2 &amp; 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&lt;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&lt;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.

Changes in choroidal thickness in patients with diabetic retinopathy

PurposeTo investigate the changes in choroidal thickness (ChT) following panretinal photocoagulation (PRP) for diabetic retinopathy (DR) and compare ChT in relation to DR severity.MethodsThirty-two eyes [19 eyes with proliferative DR (PDR) and 13 eyes with severe nonproliferative DR (NPDR)] for which PRP was necessary were analyzed. ChT was measured before PRP and at 1, 3, and 6 months after PRP using the swept-source optical coherence tomography. ChT of the 61 eyes matched with the PDR patients for the mean age and axial length was also measured and statistically compared in relation to severity.ResultsThe central field ChT before PRP treatment was 268.6 ± 104.5 µm (mean ± standard deviation) and was significantly decreased at 1, 3, and 6 months after PRP (254.5 ± 105.3, 254.2 ± 108.2, and 248.1 ± 101.8 µm, respectively, P < 0.0001). The central field ChT of severe NPDR (323.2 ± 61.3 µm) was significantly thicker than that of normal (248.3 ± 70.7 µm) and mild to moderate NPDR (230.0 ± 70.3 µm, P = 0.0455 and 0.0099, respectively). Moreover, the central field ChT of PDR (307.3 ± 84.1 µm) was significantly thicker than of mild to moderate NPDR (P = 0.0169).ConclusionChT significantly decreased after PRP, which continued for at least 6 months after treatment. ChT of severe NPDR and PDR was significantly thicker than that of mild to moderate NPDR. ChT of patients with DR was changed according to the treatment and severity of DR.

Pattern scan laser versus single spot laser in panretinal photocoagulation treatment for proliferative diabetic retinopathy

Pattern scan laser versus single spot laser in panretinal photocoagulation treatment for proliferative diabetic retinopathy

Effects of panretinal laser photocoagulation on the corneal nerve plexus and retinal nerve fiber layer in retinal vein occlusion.

To determine the effects of panretinal photocoagulation (PRP) on corneal sub-basal nerve plexus (SBNP) and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with unilateral central retinal vein occlusion (CRVO) who had previously undergone PRP treatment. Sixty-four eyes of 32 patients (19 male, 13 female) with unilateral ischemic type CRVO who had undergone PRP treatment at least 6 months previously were included in this cross-sectional study. The laser scanning in vivo corneal confocal microscope was used to determine corneal SBNP parameters. The peripapillary RNFL thickness was assessed with spectral-domain optical coherence tomography. Data obtained from the PRP-treated eyes were compared with those of the fellow unaffected eyes. The mean age of patients was 63.5 ± 10.7 years (range 45-85 years). The mean nerve fiber density (NFD), nerve branch density, and nerve fiber length (NFL) were significantly lower in PRP-treated eyes compared with fellow eyes (p<0.001 for all). Average peripapillary RNFL thickness was significantly lower in PRP-treated eyes than in fellow eyes (p = 0.007). The NFD and NFL showed a modest but significant positive correlation with average peripapillary RNFL thickness (r = 0.310, p = 0.013 and r = 0.272, p = 0.030, respectively). Significant reductions in corneal SBNP parameters and average peripapillary RNFL thickness were observed in the eyes of patients receiving PRP for the treatment of ischemic CRVO.

The influence on ocular surface produced by panretinal photocoagulation in patients with diabetic retinopathy

Objective To observe the influence on ocular surface of the panretinal photocoagulation in patients with diabetic retinopathy(DR). Methods In the study , 48 eyes of 48 cases with severe nonproliferative DR were enrolled. The patients were divided into two groups randomly, with 25 eyes in the trial group and the other 23 eyes in the control group. The trial group received the treatment of panretinal photocoagulation implemented by four steps at 7 days intervals. The control group was not treated. The breakup time test (BUT), Schirmer I test, fluorescein corneal staining were carried out before the first time treatment and 3days, 7days (before the second time treatment), 14 days (before the third time treatment), 21days (before the forth time treatment), 28days, 60days as well as 90 days after the first treatment. Results The trial group after laser photocoagulation had significantly lower mean BUT and higher mean fluorescein staining scores at all examination points compared with those before laser photocoagulation(P 0.05). Conclusion Panretinal photocoagulation can affect ocular surface in patients with DR. Clinicians should pay much attention to those changes. Key words: Panretinal photocoagulation; Breakup time, tear membrane; Corneal staining; Schirmer I test

Matrix Metalloproteinase-1 and Matrix Metalloproteinase-9 in the Aqueous Humor of Diabetic Macular Edema Patients.

PurposeTo assess the concentrations of matrix metalloproteinase (MMP)-1 and MMP-9 in the aqueous humor of diabetic macular edema (DME) patients.MethodThe concentrations of MMP-1 and MMP-9 in the aqueous humors of 15 cataract patients and 25 DME patients were compared. DME patients were analyzed according to the diabetic retinopathy (DR) stage, diabetes mellitus (DM) duration, pan-retinal photocoagulation (PRP) treatment, recurrence within 3 months, HbA1C (glycated hemoglobin) level, and axial length.ResultsThe concentrations of MMP-1 and MMP-9 of the DME groups were higher than those of the control group (p = 0.005 and p = 0.002, respectively). There was a significant difference in MMP-1 concentration between the mild non-proliferative diabetic retinopathy (NPDR) group and the proliferative diabetic retinopathy (PDR) group (p = 0.012). MMP-1 concentrations were elevated in PRP-treated patients (p = 0.005). There was a significant difference in MMP-9 concentrations between the mild NPDR group and the PDR group (p < 0.001), and between the moderate and severe NPDR group and the PDR group (p < 0.001). The MMP-9 concentrations in PRP treated patients, DM patients with diabetes ≥ 10 years and recurrent DME within 3months were elevated (p = 0.023, p = 0.011, and p = 0.027, respectively). In correlation analyses, the MMP-1 level showed a significant correlation with age (r = -0.48, p = 0.01,), and the MMP-9 level showed significant correlations with axial length (r = -0.59, p < 0.01) and DM duration (r = 049, p = 0.01).ConclusionsConcentrations of MMP-1 and MMP-9 were higher in the DME groups than in the control group. MMP-9 concentrations also differed depending on DR staging, DM duration, PRP treatment, and degree of axial myopia. MMP-9 may be more important than MMP-1 in the induction of DM complications in eyes.

Cost Evaluation of Panretinal Photocoagulation versus Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy

To evaluate costs of panretinal photocoagulation (PRP) vs. intravitreal ranibizumab (IVR) for proliferative diabetic retinopathy (PDR). A Markov-style model of cost-effectiveness and cost utility. There were no participants. Based on results from Diabetic Retinopathy Clinical Research (DRCR) Network Protocol S, we performed a Markov-style analysis to generate the total 2-year costs for each treatment arm. The cost per line-year saved and cost utility were calculated based on the estimated life years remaining. Both treatment arms were assumed to result in 9 lines of vision saved in 20% of patients. Medicare reimbursement data were acquired to determine costs, which were then separately calculated for practice settings of a hospital-based facility as the highest end of the cost range and a nonfacility in the same geographic area as the lowest end. Cost parameters for a prototypical patient's life expectancy also were modeled and calculated. Inputed cost of therapy, cost per line saved, cost per line-year saved, and cost per quality-adjusted life years (QALY). When PRP was the primary treatment, the 2-year cost in the facility setting was $13 053, with cost per line saved $7252, cost per line-year $240, and cost per QALY $7988. In the nonfacility setting costs were approximately 21% lower. When IVR was the primary treatment, the 2-year cost in the facility setting was $30 328, cost per line saved was $16 849, cost per line-year $575, and cost per QALY $19 150. In the nonfacility setting costs were approximately 15% lower. Extrapolation to lifetime therapy yielded the cost per QALY with PRP treatment of $14 219 to $24 005 and with IVR of $138 852 to $164 360. Cost utility for PRP would be 85% lower than IVR in the facility setting and 90% lower than IVR in the nonfacility setting. PRP compared with IVR as primary treatment for PDR is less expensive over 2 years, but both fall well below the accepted cost per QALY upper limit. However, over an average lifetime, the cost differential between PRP and IVR increases, and IVR therapy may exceed the typical accepted limit of cost per QALY.

Diabetic Papillopathy After Panretinal Photocoagulation Treatment With İntravitreal Ranibizumab: A Case Report

Diabetic Papillopathy After Panretinal Photocoagulation Treatment With İntravitreal Ranibizumab: A Case Report

Safety and efficacy of panretinal photocoagulation in patients with high-risk proliferative diabetic retinopathy using pattern scan laser versus conventional YAG laser

The purpose of the study was to compare the results of panretinal photocoagulation (PRP) using the pattern scan laser (PASCAL) in a single setting versus multiple sessions of standard YAG laser in patients with proliferative diabetic retinopathy. Charts of 35 eyes that were treated with the PASCAL and an equal number of eyes that were treated with conventional laser were retrospectively reviewed. The whole PRP treatment was performed in one session in the PASCAL group, whereas all the patients in the conventional-laser group completed the entire PRP treatment in two or three sessions. Persistence and/or recurrence of neovascularization, complications encountered, total number of laser spots, and mean power used were compared. Patients treated with the PASCAL received significantly higher number of laser spots than those treated with conventional laser (2885 vs. 1642, p < 0.001). The PASCAL and conventional-laser systems required an average power of 650 mW and 330 mW, respectively (p < 0.001). Patients treated with the PASCAL showed similar rates of treatment failure within 12 months of follow-up compared with patients treated with conventional laser (14% vs. 11%, p > 0.05). In the PASCAL group, vitreous hemorrhage, neovascular glaucoma, retinal hemorrhage, and choroidal detachment were reported in two, two, one, and two patients, respectively, whereas only one each vitreous hemorrhage and neovascular glaucoma were encountered in the conventional-laser group. Our study reports that single-session PRP with the PASCAL has similar efficacy compared with conventional laser, and has a favorable side-effect profile.