Panretinal Photocoagulation Group Research Articles

Retinal vein changes in patients with high-risk proliferative diabetic retinopathy treated with conbercept and panretinal photocoagulation co-therapy: a cohort study.

This study aimed to observe and compare retinal vein diameter changes and other essential indicators in patients with high-risk proliferative diabetic retinopathy (PDR) treated with intravitreal injection of conbercept (IVC) combined with panretinal photocoagulation (PRP) versus PRP monotherapy. A retrospective analysis was conducted on data from patients with high-risk PDR who received specific treatment and were followed up for 24 months. Among 82 patients with high-risk PDR, 50 eyes received PRP combined with IVC, whereas 32 eyes received PRP alone. During the 24-month follow-up period, changes in best-corrected visual acuity (BCVA), central foveal thickness (CFT), retinal vein diameter, number of microaneurysms (MA), neovascularization (NV) area, hard exudate (HE) area, size of the foveal avascular zone (FAZ), superficial capillary plexus (SCP) blood flow density, and adverse effects were recorded and compared between the two groups at baseline and at 6, 12, 18, and 24 months after treatment. The relationship between each observation index and vein diameter was also analyzed. During the 24-month follow up, significant improvements in the BCVA, CFT, retinal vein diameter, number of MAs, NV area, HE area, FAZ, and SCP were observed in the IVC+PRP group after treatment. The PRP group only showed significant reductions in NV and HE areas. The IVC+PRP group showed significant superiority over the PRP group in improving the vein diameter, number of MA, and HE area. However, no statistically significant difference in NV area reduction was found between the groups. In the treatment of high-risk PDR, IVC+PRP therapy has a significant advantage over PRP monotherapy. IVC+PRP therapy may reverse diabetes-induced retinal vein changes, restoring morphology and function.

Long-Term Real-World Outcomes of Corneal Changes in Proliferative Diabetic Retinopathy: Panretinal Photocoagulation vs. Intravitreal Conbercept

PurposeTo compare long-term real-world outcomes of corneal thickness (CT) alterations in proliferative diabetic retinopathy (PDR) patients treated with panretinal photocoagulation (PRP) and intravitreal conbercept (IVC). MethodsThis retrospective study included 69 eyes of 69 patients with PDR (42 PRP and 27 IVC). Full corneal thickness (FCT), corneal epithelial thickness (CET) and corneal stromal thickness (CST) measured by anterior segment optical coherence tomography at baseline were compared between groups. These CT changes at last follow-up from baseline were also compared between groups and within each group. ResultsDuring a mean follow-up of more than two years, the IVC group demonstrated a significantly increased corneal thickness from baseline compared to the PRP group in some areas (PRP vs. IVC: FCT 0-2 mm: -0.59 ± 9.31 vs. 5.59 ± 9.23 μm, p = 0.009; CST 0-2 mm: -2.05 ± 8.79 vs. 3.48 ± 7.52 μm, p = 0.015; CST 2-5 mm: -1.78 ± 13.27 vs. 5.68 ± 14.53 μm, p = 0.046). In within-group comparisons, a significantly increased FCT from baseline was found in the 0-2 mm area in the IVC group (p = 0.004), but no significant change was observed in the PRP group (p = 0.691). For CET changes, a significantly increased CT was observed in the 0-2 mm, 2-5 mm and 5-7 mm areas in both groups respectively (all p < 0.05). Regarding CST, an increased CT was found in the 0-2 mm area in the IVC group (p = 0.037), while a decreased trend was observed in 0-2 mm and 2-5 mm areas in the PRP group (all p > 0.05). ConclusionWhen using PRP or IVC in the long-term management of PDR, CT changes should be considered. This may provide evidence for corneal protection during PDR treatment.

Long-term real-world outcomes of retinal microvasculature changes in proliferative diabetic retinopathy treated with panretinal photocoagulation vs. intravitreal conbercept

PurposeTo compare long-term real-world outcomes of retinal microvasculature changes in proliferative diabetic retinopathy (PDR) treated with panretinal photocoagulation (PRP) vs. intravitreal conbercept (IVC) and to explore the potential factors affecting these changes. MethodsThis study retrospectively included 96 treatment-naïve PDR eyes of 96 type 2 diabetes mellitus patients [59 PRP and 37 IVC]. Baseline characteristics and treatment details were collected. Optical coherence tomography angiography (OCTA) data of macular vessel density (VD) and optic disc capillary density (CD) at baseline and at the last follow-up were compared between groups. The differences between the baseline and the last follow-up OCTA data in each group were also tested for significance. The correlation between the change in each OCTA parameter from baseline and each baseline characteristic/treatment parameter was investigated in each group. ResultsDuring a mean follow-up of two years, greater superficial (SCP) (p = 0.004) and deep capillary plexus (DCP) VD (p < 0.001) were observed in the foveal area in the PRP than in the IVC. Compared to the baseline, SCP VD in the foveal area increased in the PRP (p = 0.012), while an increased SCP VD in some sectors in the parafoveal and perifoveal areas (p < 0.05), rather than the foveal area (p = 0.908), was seen in the IVC. For both groups, eyes with a higher VD/CD at baseline tended to develop capillary dropout more intensively (all p < 0.05). In the IVC group, foveal avascular zone (FAZ) area change showed a negative correlation with baseline FAZ area (p = 0.020), and complementary PRP exerted a negative influence on FAZ area change (p = 0.002). In the PRP group, SCP VD change was positively correlated with follow-up frequency, and was negatively correlated with diastolic blood pressure (all p < 0.05); DCP VD change showed a positive correlation with PRP shot number (p = 0.019). ConclusionThe aforementioned microvasculature changes should be considered when PRP or IVC is adopted in PDR long-term management.

Retinal and Choroidal Alterations in Diabetic Retinopathy Treatment using Subthreshold Panretinal Photocoagulation with Endpoint Management Algorithm: A Secondary Analysis of a Randomized Clinical Trial.

The aim of this study was to compare retinal and choroidal alterations in eyes with severe nonproliferative diabetic retinopathy (NPDR) after panretinal photocoagulation (PRP), using conventional pattern scan laser (PASCAL) and PASCAL with endpoint management (EPM). This was a post hoc analysis of a paired randomized clinical trial. Bilateral treatment-naïve eyes of an individual with symmetric severe NPDR were randomly allocated into the threshold PRP group and subthreshold EPM PRP group. Patients had follow-up visits at 1, 3, 6, 9, and 12months post-treatment. The retinal thickness (RT), choroidal thickness (CT), choroidal area, and choroidal vascularity index (CVI) were compared between the two groups and among different time points within the same group. Seventy eyes of 35 patients with diabetes mellitus (DM) were finally included for analysis at the 6- and 12-month visits, respectively. At 3 and 6months post-treatment, the RT in the subthreshold EPM PRP group was significantly thinner than that in the threshold PRP group. CT, stromal area, and luminal area were reduced earlier in the threshold PRP group than in the subthreshold EPM PRP group. CVI was not significantly different within the same group or between groups at most time points. At 12months post-treatment, retinal thickening and choroidal disturbance may be slightly less severe and more delayed in eyes receiving PRP using PASCAL with EPM than in those receiving PRP using conventional PASCAL. The EPM algorithm may be a good alternative in PRP when treating severe NPDR. ClinicalTrials.gov identifier, NCT01759121.

Comparison of targeted retinal photocoagulation versus pan-retinal photocoagulation in the treatment of proliferative diabetic retinopathy

The aim of this study was to compare the efficacy of targeted retinal photocoagulation (TRP) with pan retinal photocoagulation (PRP) in the treatment of proliferative diabetic retinopathy (PDR). A total of 100 patients with PDR were enrolled in the study. The patients were divided into the TRP group (n=50) and the PRP group (n=50). The primary outcome measure was the proportion of patients who achieved a complete regression of PDR. Secondary outcome measures included the effect of TRP or PRP on visual acuity, visual fields and the need for further treatments. The results showed that the TRP is an effective treatment modality in proliferative retinopathy regression (86%) like PRP group (72%). The TRP group also showed a visual acuity improvement (0.19 logMAR) compared to the PRP group (mean improvement of 0.13 logMAR) with good preservation of visual fields. There were no significant differences in the need for further treatments between the two groups. These results suggest that TRP is safe treatment option for PDR. Material and Methods: This study was conducted in the Department of ophthalmology Khyber Teaching Hospital Peshawar from January 2020 to July 2021. A total of 100 patients with proliferative diabetic retinopathy were included in the study.

Anti-vascular endothelial growth factor for proliferative diabetic retinopathy.

Proliferative diabetic retinopathy (PDR) is an advanced complication of diabetic retinopathy that can cause blindness. It consists of the presence of new vessels in the retina and vitreous haemorrhage. Although panretinal photocoagulation (PRP) is the treatment of choice for PDR, it has secondary effects that can affect vision. Anti-vascular endothelial growth factor (anti-VEGF), which produces an inhibition of vascular proliferation, could improve the vision of people with PDR. To assess the effectiveness and safety of anti-VEGFs for PDR and summarise any relevant economic evaluations of their use. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov, and the WHO ICTRP. We did not use any date or language restrictions. We last searched the electronic databases on 1 June 2022. We included randomised controlled trials (RCTs) comparing anti-VEGFs to another active treatment, sham treatment, or no treatment for people with PDR. We also included studies that assessed the combination of anti-VEGFs with other treatments. We excluded studies that used anti-VEGFs in people undergoing vitrectomy. Two review authors independently selected studies for inclusion, extracted data, and assessed the risk of bias (RoB) for all included trials. We calculated the risk ratio (RR) or the mean difference (MD), and 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence. We included 15 new studies in this update, bringing the total to 23 RCTs with 1755 participants (2334 eyes). Forty-five per cent of participants were women and 55% were men, with a mean age of 56 years (range 48 to 77 years). The mean glycosylated haemoglobin (Hb1Ac) was 8.45% for the PRP group and 8.25% for people receiving anti-VEGFs alone or in combination. Twelve studies included people with PDR, and participants in 11 studies had high-risk PDR (HRPDR). Twelve studies were of bevacizumab, seven of ranibizumab, one of conbercept, two of pegaptanib, and one of aflibercept. The mean number of participants per RCT was 76 (ranging from 15 to 305). Most studies had an unclear or high RoB, mainly in the blinding of interventions and outcome assessors. A few studies had selective reporting and attrition bias. No study reported loss or gain of 3 or more lines of visual acuity (VA) at 12 months. Anti-VEGFs ± PRP probably increase VA compared with PRP alone (mean difference (MD) -0.08 logMAR, 95% CI -0.12 to -0.04; I2 = 28%; 10 RCTS, 1172 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may increase regression of new vessels (MD -4.14 mm2, 95% CI -6.84 to -1.43; I2 = 75%; 4 RCTS, 189 eyes; low-certainty evidence) and probably increase a complete regression of new vessels (RR 1.63, 95% CI 1.19 to 2.24; I2 = 46%; 5 RCTS, 405 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP probably reduce vitreous haemorrhage (RR 0.72, 95% CI 0.57 to 0.90; I2 = 0%; 6 RCTS, 1008 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may reduce the need for vitrectomy compared with eyes that received PRP alone (RR 0.67, 95% CI 0.49 to 0.93; I2 = 43%; 8 RCTs, 1248 eyes; low-certainty evidence). Anti-VEGFs ± PRP may result in little to no difference in the quality of life compared with PRP alone (MD 0.62, 95% CI -3.99 to 5.23; I2 = 0%; 2 RCTs, 382 participants; low-certainty evidence). We do not know if anti-VEGFs ± PRP compared with PRP alone had an impact on adverse events (very low-certainty evidence). We did not find differences in visual acuity in subgroup analyses comparing the type of anti-VEGFs, the severity of the disease (PDR versus HRPDR), time to follow-up (< 12 months versus 12 or more months), and treatment with anti-VEGFs + PRP versus anti-VEGFs alone. The main reasons for downgrading the certainty of evidence included a high RoB, imprecision, and inconsistency of effect estimates. Anti-VEGFs ± PRP compared with PRP alone probably increase visual acuity, but the degree of improvement is not clinically meaningful. Regarding secondary outcomes, anti-VEGFs ± PRP produce a regression of new vessels, reduce vitreous haemorrhage, and may reduce the need for vitrectomy compared with eyes that received PRP alone. We do not know if anti-VEGFs ± PRP have an impact on the incidence of adverse events and they may have little or no effect on patients' quality of life. Carefully designed and conducted clinical trials are required, assessing the optimal schedule of anti-VEGFs alone compared with PRP, and with a longer follow-up.

Optic nerve head perfusion changes in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab or photocoagulation: a randomized controlled trial.

Proliferative diabetic retinopathy (PDR) is a serious sight-threatening disease, and half of the patients with high-risk PDR can develop legal blindness within 5 years, if left untreated. This study was aimed at comparing panretinal photocoagulation (PRP) and intravitreal ranibizumab injections in terms of radial peripapillary capillary (RPC) density on optical coherence tomography angiography (OCTA) in patients with treatment-naive PDR. This open-label, prospective, randomized clinical trial included 50 patients with treatment-naive PDR with optic disc neovascularization and randomized them into two groups: group 1, with patients undergoing two sessions of PRP 2 weeks apart, and group 2, with patients received three intravitreal ranibizumab injections (0.5 mg) 1 month apart for 3 consecutive months. Patients underwent a full ophthalmological examination, including best-corrected distance visual acuity (BCDVA) measurement in the logarithm of minimal angle of resolution (logMAR) notation and OCTA before intervention and monthly after the last laser session or the first intravitreal ranibizumab injection for 3 months of follow-up. Visual field (VF) was tested at the beginning and end of 3 months. Forty-two (84%) eyes completed the 3-month follow-up, including 22 eyes in the PRP group (88%) and 20 (80%) eyes in the ranibizumab group. The two groups were comparable in terms of demographic characteristics, diabetes duration, baseline BCDVA, glycated hemoglobin level, OCTA parameters, VF indices, and intraocular pressure (all P > 0.05). The RPC density change from baseline to the 3-month follow-up was significantly lower in the PRP group than in the ranibizumab group (mean difference in RPC density change: - 3.61%; 95% confidence interval: - 5.57% to - 1.60%; P = 0.001). The median (interquartile range) logMAR change from baseline to the 3-month follow-up (0.0 [0.2]) was significantly higher in the PRP group than in the ranibizumab group (- 0.15 [0.3]; P < 0.05). The median changes in central foveal thickness from baseline to the 3-month follow-up differed significantly between the two groups (P = 0.001). In eyes with PDR and neovascularization of the disc RPC density on OCTA increased in the ranibizumab group and decreased in the PRP group. Visual acuity gain was higher in the ranibizumab group than in the PRP group. Future multicenter trials addressing our limitations are required to verify the findings of this study.

Efficacy of intravitreal conbercept combined with panretinal photocoagulation for severe nonproliferative diabetic retinopathy without macular edema

To assess efficacy of intravitreal conbercept (IVC) injection in combination with panretinal photocoagulation (PRP) vs PRP alone in patients with severe nonproliferative diabetic retinopathy (SNPDR) without macular edema (ME). Forty-eight patients with SNPDR without ME (56 eyes) were divided into the PRP group and IVC+PRP group (the pulse group) in this retrospective clinical study. Conbercept was intravitreally administered to patients in the pulse group 1wk before treatment with PRP and followed up for 1, 3, and 6mo. The best-corrected visual acuity (BCVA, logMAR), center foveal thickness (CFT), visual acuity (VA) improvement, and adverse reactions were compared between groups. In the PRP group, the BCVA reduced at 1 and 3mo before improving at 6mo. In the pulse group, baseline BCVA decreased continuously at 1mo, increased at 3 and 6mo. BCVA in the pulse group was better than that in the PRP group at 1, 3, and 6mo. There was an increase in CFT in the PRP group during follow-up compared with baseline. In the pulse group, CFT was increased at 1mo relative to baseline, steadily decreased to the baseline level at 3 and 6mo. There was a more significant reduction in CFT in the pulse group during follow-up compared with the PRP group. The effective rates of VA in the PRP and the pulse groups were 81.48% and 100%, respectively. As PRP pretreatment, a single dose of IVC administration has beneficial effects for preventing PRP-induced foveal thickening and increasing VA in patients with SNPDR without ME.

Comparison of retinal layer thickness and microvasculature changes in patients with diabetic retinopathy treated with intravitreous bevacizumab vs panretinal photocoagulation

To compare changes in retinal layers and microvasculature in diabetic retinopathy (DR) patients after bevacizumab therapy and panretinal photocoagulation (PRP). This prospective study divided patients into two groups: patients treated with bevacizumab and those treated with PRP. Patients visited our retinal clinic at 1, 3, and 6 months after treatment. Retinal layer thickness and vessel density (VD) using optical coherence tomography angiography were analyzed. 37 eyes in the bevacizumab group and 36 eyes in the PRP group were enrolled. In the bevacizumab group, the parafoveal RNFL, GCL, and IPL thicknesses significantly decreased (P < 0.001, P = 0.013, and P = 0.017, respectively), whereas the thicknesses in the PRP group showed an increasing tendency over time (P = 0.087, P = 0.005, and P = 0.003, respectively). The VD of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the bevacizumab group did not show significant changes, whereas the VD in the PRP group significantly increased over time (both P < 0.001). Additionally, RNFL (P = 0.001) and GCL thicknesses (P = 0.035) were significant factors affecting changes in BCVA, whereas the VDs of SCP and DCP did not. Patients who received bevacizumab therapy did not show a significant change in macular VD, whereas the VD of patients after PRP significantly increased after treatment. The increased macular VD in patients after PRP would be associated with the increased inner retinal layer thickness after treatment, which was significantly related to the impairment in visual acuity.

A clinical study of contrast sensitivity and visual acuity in patients following retinal photocoagulation for diabetic retinopathy

This study is aimed to assess the effect of retinal photocoagulation on contrast sensitivity and visual acuity.In this prospective observational study,patients with diabetic retinopathy in either one or both eyes requiring retinal photocoagulation were included in the study. Eyes which were subjected to treatment for diabetic retinopathy were divided into 3 groups. Group 1 included eye which were subjected to pan retinal photocoagulation (PRP) alone, Group 2 included eyes which were subjected to PRP and macular laser (ML) and Group 3 included eyes which were subjected to ML alone. Assessment of visual acuity and contrast sensitivity were done before and three months post retinal photocoagulation.Descriptive statistics were used and where required. paired t test, One- way, ANOVA, Post HOC tests, Tukey HSD tests were used. The sample size was calculated to be 64 eyes. Total of 64 eyes of 37 patients, underwent retinal photocoagulation for diabetic retinopathy. Out of the 37 patients, only 16 patients (29 eyes) came for follow up at the end of 3 months of laser photocoagulation. Number of eyes requiring PRP was more when compared to PRP with ML and ML alone. Pre-laser and post-laser visual acuity following PRP, remained unchanged. Improvement in visual acuity was seen in eyes that underwent ML alone. There was worsening of visual acuity in eyes that underwent combination of PRP and ML. However, p value was not significant. Pre-laser and post-laser contrast sensitivity, improved in eyes that underwent only PRP and macular laser alone. There was a reduction in CS when both forms of treatment were combined, though p value was not significant Eyes which underwent PRP alone, showed improvement in contrast sensitivity without any change in visual acuity. While reduction in visual acuity and contrast sensitivity was observed in eyes which underwent combination treatment (PRP and ML), there was improvement in visual acuity and contrast sensitivity in eyes which underwent macular laser alone. Contrast sensitivity is necessary component of visual function. Abnormal contrast sensitivity can affect day to day activities. Hence it is important to counsel patients about the possibility of contrast sensitivity being affected to some extent following laser treatment for diabetic retinopathy.

Comparison of the Effect of Pan-Retinal Photocoagulation and Intravitreal Conbercept Treatment on the Change of Retinal Vessel Density Monitored by Optical Coherence Tomography Angiography in Patients with Proliferative Diabetic Retinopathy.

Background: This study compares the changes in retinal vessel density (VD) after pan-retinal photocoagulation (PRP) and intravitreal conbercept (IVC) treatment in proliferative diabetic retinopathy (PDR) eyes by optical coherence tomography angiography (OCTA). Methods: A total of 55 treatment-naïve PDR eyes were included in this retrospective study. Of these, 29 eyes were divided into a PRP group, and 26 eyes were divided into an IVC group based on the treatment they received. OCTA was performed to measure macular and papillary VD at each follow-up in both groups. Results: The macular VD for superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC) and papillary VD for radial peripapillary capillary (RPC) between the two groups demonstrated no significant difference at baseline and month 12 (p > 0.05). The paired t-test results showed that the macular VD for SCP, DCP, CC and papillary VD for the RPC at month 12 did not differ to the baseline in each group (p > 0.05). Conclusions: During the 12-month follow-up, there was no significant change of macular and papillary VD between the PRP and IVC treatment in PDR eyes. Additionally, compared to the baseline, there were no significant changes of macular and papillary VD after either the PRP or IVC treatment. Considering the decrease in VD as DR progress, both treatment modalities can potentially prevent macular and papillary VD loss in PDR.

Intravitreal injection of ranibizumab (Lucentis) versus pan-retinal photocoagulation as a preoperative adjuvant before vitrectomy in management of proliferative diabetic retinopathy

BackgroundDiabetic retinopathy is a microvascular complication of diabetes mellitus, and it is the most common ophthalmic complication. Pan-retinal photocoagulation (PRP) has been the standard treatment for proliferative diabetic retinopathy (PDR) and can be used as an adjuvant before vitrectomy but has adverse effects. The use of intravitreal ranibizumab has been suggested as an alternative treatment or an alternative adjuvant before vitrectomy.AimThis study was conducted to study the effect of intravitreal injection of ranibizumab 10 mg/ml (Lucentis) versus PRP as an adjuvant before vitrectomy in the management of PDR.Patients and methodsThis study was performed on 40 eligible eyes, which were allocated into two groups: group A included 20 eyes that were injected by ranibizumab 10 mg/ml (Lucentis) intravitreally 4–7 days before vitrectomy and group B included 20 eyes that received argon laser photocoagulation (PRP) 1 month before vitrectomy.ResultsThe study revealed highly statistically significant difference between both groups regarding the incidence of intraoperative bleeding, with patients in the PRP group showing less intraoperative bleeding, a lower need for intraoperative use of diathermy, a lower need for intraoperative use of both blunt and sharp dissection, as well as a need for a lower number of endolaser shots when compared with patients in the intravitreal injection of ranibizumab group. It can be concluded that treatment with ranibizumab was not associated with a higher incidence of postoperative bleeding or complications than PRP at 6 months postoperatively among eyes with PDR and that ranibizumab may be an appropriate alternative adjuvant for patients with PDR. However, more studies with longer-term follow-up are recommended to complement the current study results and demonstrate real clinical differences between the two adjuvant treatments.ConclusionUsing both adjuvants before vitrectomy enhances vitrectomy outcome when best indicated rather than without using. The shorter time of surgery and less endodiathermy or endolaser use is with the PRP group, although postoperative best-corrected visual acuity gaining is not significant. So, real clinical differences between the two adjuvants need more research studies.

Subthreshold Pan-Retinal Photocoagulation Using Endpoint Management Algorithm for Severe Nonproliferative Diabetic Retinopathy: A Paired Controlled Pilot Prospective Study

Purpose: The aim of this study was to report the efficacy and safety profile of subthreshold pan-retinal photocoagulation (PRP) using endpoint management (EPM) algorithm compared with conventional threshold PASCAL PRP for the treatment of severe nonproliferative diabetic retinopathy (NPDR). Methods: This was a prospective, single-center, paired randomized controlled trial of 56 eyes of 28 participants with bilateral symmetric severe NPDR. One eye of the participant was randomly assigned to receive the subthreshold EPM PRP, while the other eye of the same participant received the threshold PASCAL PRP. The primary outcome measures included the difference in the 1-year risk of progression to PDR between 2 groups, and mean changes of the logarithm of the minimal angle of resolution (logMAR) visual acuity (VA). The second outcome measures included central foveal thickness (CFT), 1-year risk of progression to PDR, and visual field (VF) parameters. Results: The subthreshold EPM PRP group and the threshold PASCAL PRP group had similar 1-year risk of progression to PDR during the 12-month follow-up visits (17.86 vs. 14.29%, p > 0.05). Slightly decreased VA was found in both groups (0.08 vs. 0.09 logMAR VA); however, no statistical difference was found for neither group (p > 0.05). Similar results were found for thickened CFT for both groups (23.59 vs. 28.34 μm, p > 0.05). Specifically, although substantial loss of VF was found in the threshold PASCAL PRP group (p < 0.05), no obvious damage to VF was seen in the subthreshold EPM PRP group (p > 0.05). Conclusion: The subthreshold EPM PRP is noninferior to the conventional threshold PASCAL PRP in the treatment of severe NPDR during 12-month follow-up and could be an alternative treatment option for patients with severe NPDR.

Efficacy of conbercept combined with panretinal photocoagulation in the treatment of proliferative diabetic retinopathy

This prospective clinical study was to compare the effect of panretinal photocoagulation (PRP) associated with intravitreal conbercept injections versus PRP alone in the treatment of proliferative diabetic retinopathy (PDR). For each of 15 patients included, one eye was randomly assigned to receive treatment with PRP, and the other eye received conbercept combined PRP. Ophthalmic examinations, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) were performed at baseline and at each monthly visit until 6 months. Fluorescein angiography (FA) was acquired at baseline, 3 months and 6 months. Between group and within group analysis was done by using generalized estimating equations (GEE). The combination group had a significant decrease of neovascularization (NV) leakage area than the PRP group at month 3 and month 6 after treatment, and a better best-corrected visual acuity (BCVA) during the first three months. Within-group analysis indicated a significant decrease in NV leakage at month 3 and month 6 in both groups, and a significant increase in BCVA at 1 month in the combination group. In summary, the combination of intravitreal injection of conbercept and PRP can significantly reduce the NV of PDR patients and achieve better BCVA during the drug’s lifespan compared with PRP alone.

Effects of intravitreal conbercept before panretinal photocoagulation on lipid exudates in diabetic macular documented by optical coherence tomography.

To evaluate the effects of intravitreal conbercept (IVC) as adjunctive treatments before panretinal photocoagulation (PRP) to decrease hyperreflective dots (HRDs) in Chinese proliferative diabetic retinopathy (PDR) patients. Fifty-nine enrolled patients were categorized into 2 groups: single dose IVC (0.5 mg/0.05 mL) 1wk before PRP (Plus group) or PRP only (PRP group). Six months later, we measured the best corrected visual acuity (BCVA), central macula thickness (CMT) by optical coherence tomography and counted the number of HRDs in different retina layers. The average CMT significantly decreased in Plus group but increased in PRP group. The average BCVA in the Plus group was also significantly better than that in the PRP group. Total HRDs decreased in the Plus group but increased in PRP group significantly. IVC pre-treatment has beneficial effects on reducing HRDs forming in the inner retina layer while the PRP alone increased the HRDs in the outer retina layer. IVC is a promising adjunctive treatment to PRP in the treatment of PDR. Single dose IVC one week before PRP is suggested to improve retina blood-retina barrier, decrease lipid exudate and inhibit HRDs development in PDR.

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.

Visual Field Changes Over 5 Years in Patients Treated With Panretinal Photocoagulation or Ranibizumab for Proliferative Diabetic Retinopathy

Preservation of peripheral visual field (VF) is considered an advantage for anti-vascular endothelial growth factor agents compared with panretinal photocoagulation (PRP) for treatment of proliferative diabetic retinopathy. Long-term data on VF are important when considering either treatment approach. To further evaluate changes in VF throughout 5 years among eyes enrolled in the Protocol S clinical trial, conducted by the DRCR Retina Network. Post hoc analyses of an ancillary study within a multicenter (55 US sites) randomized clinical trial. Individuals with eyes with proliferative diabetic retinopathy enrolled in Protocol S were included. Data were collected from February 2012 to February 2018. Analysis began in June 2018. Panretinal photocoagulation or intravitreous injections of 0.5-mg ranibizumab. Diabetic macular edema, whenever present, was treated with ranibizumab in both groups. Panretinal photocoagulation could be administered to eyes in the ranibizumab group when failure or futility criteria were met. Mean change in total point score on VF testing with the Humphrey Field Analyzer 30-2 and 60-4 test patterns. Of 394 eyes enrolled in Protocol S, 234 (59.4%) were targeted for this ancillary study. Of these, 167 (71.4%) had VF meeting acceptable quality criteria at baseline (median [interquartile range] age, 50 [43-58] years; 90 men [53.9%]). At 5 years, 79 (33.8%) had results available. The mean (SD) change in total point score in the PRP and ranibizumab groups was -305 (521) dB and -36 (486) dB at 1 year, respectively, increasing to -527 (635) dB and -330 (645) dB at 5 years, respectively (P = .04). After censoring VF results after PRP treatments in the ranibizumab group, the 5-year mean change in total point score was -201 (442) dB. In a longitudinal regression analysis of change in total point score including both treatment groups, laser treatment was associated with a mean point decrease of 208 (95% CI, 112-304) dB for the initial PRP session, 77 (95% CI, 21-132) dB for additional PRP sessions, and 325 (95% CI, 211-439) dB for endolaser. No association was found between change in point score and the number of ranibizumab injections during the previous year (-9 per injection [95% CI, -22 to 3]). The limited data available from Protocol S suggest that there are factors besides PRP associated with VF loss in eyes treated for proliferative diabetic retinopathy. Further clinical research is warranted to clarify the finding. ClinicalTrials.gov identifier: NCT01489189.

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.

Longitudinal neovascular changes on optical coherence tomography angiography in proliferative diabetic retinopathy treated with panretinal photocoagulation alone versus with intravitreal conbercept plus panretinal photocoagulation: a pilot study

PurposeTo investigate the longitudinal changes in neovascularization of the retinal elsewhere (NVE) size on optical coherence tomography angiography (OCTA) in proliferative diabetic retinopathy (PDR) treated by panretinal photocoagulation (PRP) alone or by single intravitreal conbercept injection plus PRP.MethodsA prospective pilot study. Forty-four PDR eyes with NVE confirmed by fundus fluorescein angiography (FFA) and OCTA were included. They were assigned to receive PRP alone (PRP group) or intravitreal conbercept injection plus PRP (combination group). Ophthalmic examinations, including BCVA and OCTA to measure the NVE size, were performed at baseline before each PRP session, and at 1, 3, and 6 months.ResultsTwenty-nine eyes were included in the PRP group, and 15 eyes were included in the combination group. There was no significant difference between the two groups with respect to age, BCVA, and NVE area at baseline. In both groups, there was a significant (P < 0.05) NVE size reduction during the majority of study visits, with the reduction observed in the combination group significantly larger than that in the PRP group. No significant BCVA changes were observed in either groups, except that in the PRP group, the BCVA at 3 months was significantly improved (P < 0.05). No deaths or unexpected adverse events (AEs) were reported.ConclusionsIntravitreal conbercept plus PRP was more effective than PRP monotherapy in NVE regression. Precise quantification of the NVE area by OCTA makes it a useful tool for monitoring the response of retinal neovascular lesions to the therapy.

Optical Coherence Tomography Evaluation of Retinal Nerve Fiber Layer and Ganglion Cell Layer Thickness before and after Argon Laser in Treatment of Diabetic Retinopathy

Background: Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes with the potential to cause severe vision loss and blindness and a devastating effect on quality of life. Objective: Discuss the macular ganglion cell and retinal nerve fiber layer (RNFL) changes after laser treatment as a management of diabetic retinopathy. Patients and Methods: This study was carried out on 55 eyes of 35 patients designed as a prospective, interventional case series at Sohag Ophthalmic Diagnostic Laser Unit between January 2016 and March 2017. A complete ophthalmologic examination was performed, including best-corrected visual acuity (BCVA) using the ETDRS charts, intraocular pressure (IOP) measurement, slit-lamp biomicroscopic examination, fundus examination, fluorescein angiography, and 3D optical coherence tomography (OCT) 2000. Results: The value of RNFL (superior and total) in the GRID group is more than in the pan-retinal photocoagulation (PRP) group which increased at 1 month post laser (not significant) then significantly decreased at 6 month follow up. The value of RNFL (inferior) in the GRID group is more than in the PRP group which significantly increased at 1 month post laser then decreased at 6 month follow up table 4. Conclusion: Significant ganglion cell (GC) and RNLF decrease at the sixth month of follow-up can be attributed to axonal loss secondary to direct or indirect effects of PRP treatment. SD OCT is a very valuable tool to document the RNFL thickness changes following the argon laser photocoagulation.