LASER PHOTOCOAGULATION FOR PROLIFERATIVE DIABETIC RETINOPATHY, SINGLE SPOT 532-nm vs MULTISPOT 577-nm: VERY SHORT TERM CLINICAL EFFICACY

ABSTRACT This study aimed to compare clinical efficacy of retinal laser photocoagulation using a 577-nm multi-spot laser with pulses of 20 ms versus conventional 532-nm single-spot laser treatment with pulses of 100 ms, on the same patient with proliferative diabetic retinopathy (PDR) during 6-weeks follow-up. We included 46 eyes of patients treated at the retina service of the Mexican Institute of Ophthalmology, Queretaro, Mexico. Pan-retinal photocoagulation (PRP) was performed on one eye (Group 1) using multi-spot PRP with the EasyRet® 577 diode laser (Quantel Medical, Cournon d’Auvergne, France). On the other eye (Group 2), laser treatment was performed by the conventional single spot method using the Oculight SL® 532 diode laser (IRIDEX Corporation, Mountain View, CA, The USA). The primary endpoint was absence of signs in which the disease was considered active at 6 weeks and the secondary outcomes included laser parameters, best-corrected visual acuity (BCVA), central macular thickness (CMT) at baseline, and 6 weeks and results of subjective pain analysis. There was no significant difference between both treatment groups regarding age, gender, BCVA or CMT at baseline. At 6 weeks, PDR activity was similar between the groups (47.8 % versus 56.5%; p =0.55). No significant difference in CMT and BCVA was observed between the groups throughout the study period. Patient-reported pain scores were similar between the groups (5.0 versus 5.8; p = 0.30). However, total time of procedure was significantly shorter in group 1 (12.9 minutes [min] versus 22.3 min; p < 0.001). No major adverse events were identified We concluded that laser photocoagulation of the retina with the use of the multi-spot technology in patients with PDR has similar short-term efficacy to that of conventional single spot retinal photocoagulation. The multi-spot laser required less time to complete the procedure with more spots delivered to compensate its lower fluency, showing similar patient tolerance.

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Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

Health Technology Assessment ◽

10.3310/hta19510 ◽

2015 ◽

Vol 19 (51) ◽

pp. 1-248 ◽

Cited By ~ 18

Author(s):

Pamela Royle ◽

Hema Mistry ◽

Peter Auguste ◽

Deepson Shyangdan ◽

Karoline Freeman ◽

...

Keyword(s):

Systematic Review ◽

Diabetic Retinopathy ◽

Cost Effectiveness ◽

Laser Treatment ◽

Laser Photocoagulation ◽

Visual Loss ◽

Argon Laser ◽

Economic Modelling ◽

Pan Retinal Photocoagulation ◽

Retinal Photocoagulation

BackgroundDiabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR).ObjectivesThe primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP?Eligibility criteriaRandomised controlled trials (RCTs) for efficacy but other designs also used.Data sourcesMEDLINE and EMBASE to February 2014, Web of Science.Review methodsSystematic review and economic modelling.ResultsThe Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO.LimitationThe current evidence is insufficient to recommend PRP for severe NPDR.ConclusionsThere is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs.Study registrationThis study is registered as PROSPERO CRD42013005408.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Efficacy of Intravitreal Triamcinolone after or Concomitant with Laser Photocoagulation in Nonproliferative Diabetic Retinopathy with Macular Edema

European Journal of Ophthalmology ◽

10.1177/112067210901900418 ◽

2009 ◽

Vol 19 (4) ◽

pp. 630-637 ◽

Cited By ~ 2

Author(s):

Erdinc Aydin ◽

Helin Deniz Demir ◽

Huseyin Yardim ◽

Unal Erkorkmaz

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Laser Photocoagulation ◽

Control Group ◽

Clinical Effects ◽

Intravitreal Triamcinolone ◽

Nonproliferative Diabetic Retinopathy ◽

Significant Difference ◽

Group 3 ◽

The Mean

Purpose To investigate the clinical effects and outcomes of intravitreal injection of 4 mg of triamcinolone acetonide (IVTA) after or concomitant with macular laser photocoagulation (MP) for clinically significant macular edema (CSME). Methods Forty-nine eyes of 49 patients with nonproliferative diabetic retinopathy and CSME were randomized into three groups. The eyes in the laser group (n=17), group 1, were subjected to MP 3 weeks after IVTA; the eyes in the IVTA group (n=13), group 2, were subjected to MP, concomitant with IVTA; the eyes in the control group (n=19), group 3, underwent only IVTA application. Visual acuity (VA), fundus fluorescein angiography, and photography were performed in each group. Results In the first group, the mean VA improved from 0.17±0.09 at baseline to 0.28±0.15 (p=0.114) and in the second group, deteriorated from 0.19±0.08 at baseline to 0.14±0.08 at the sixth month (p=0.141), respectively. In Group 3, the mean VA improved from 0.16±0.08 at baseline to 0.28±0.18 (p=0.118) at the end of the follow-up. When VA was compared between the control and study groups, significant difference was detected at the sixth month (p=0.038). Conclusions MP after IVTA improved VA, rather than MP concomitant with IVTA, and only IVTA application for CSME. MP after IVTA may reduce the recurrence of CSME and needs further investigations in a longer period.

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Diabetic Retinopathy Treated with Laser Photocoagulation and the Indirect Effect on Glycaemic Control

Journal of Diabetes Research ◽

10.1155/2014/158251 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Anna Praidou ◽

Sofia Androudi ◽

Periklis Brazitikos ◽

George Karakiulakis ◽

Eleni Papakonstantinou ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Glycaemic Control ◽

Laser Treatment ◽

Laser Photocoagulation ◽

Argon Laser ◽

Previous Treatment ◽

Blood Levels ◽

Patients With Diabetes ◽

Group A ◽

Group B

Purpose. To identify any possible relation between glycaemic control and previous laser photocoagulation for diabetic retinopathy.Methods. Seventy-two patients with diabetes were included in the study and were separated into 2 groups according to previous treatment (group A) or not (group B) with argon laser photocoagulation. Glycaemic control was estimated by measuring blood levels of HbA1c in four consecutive measurements.Results. Blood levels of HbA1c in group A were significantly lower 3, 6, and 12 months after laser treatment as compared to blood levels of HbA1c before laser treatment (7.1±0.4% versus7.6±0.9%,7.2±0.2% versus7.6±0.9%, and7.1±0.2% versus7.6±0.9%, resp., allP<0.05). Blood levels of HbA1c in group B did not differ significantly in four consecutive measurements.Conclusion. Our results suggest that we should anticipate a better glycaemic control in cases of patients with diabetes previously treated with laser photocoagulation.

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Bevacizumab-Augmented Retinal Laser Photocoagulation in Proliferative Diabetic Retinopathy: A Randomized Double-Masked Clinical Trial

European Journal of Ophthalmology ◽

10.1177/112067210801800215 ◽

2008 ◽

Vol 18 (2) ◽

pp. 263-269 ◽

Cited By ~ 76

Author(s):

A. Mirshahi ◽

R. Roohipoor ◽

A. Lashay ◽

S.-F. Mohammadi ◽

A. Abdoallahi ◽

...

Keyword(s):

Clinical Trial ◽

Diabetic Retinopathy ◽

High Risk ◽

Laser Treatment ◽

Proliferative Diabetic Retinopathy ◽

Laser Photocoagulation ◽

Intravitreal Bevacizumab ◽

Complete Regression ◽

Standard Laser ◽

Risk Characteristic

Purpose To evaluate the additional therapeutic effect of single intravitreal bevacizumab injection on standard laser treatment in the management of proliferative diabetic retinopathy. Methods A prospective, fellow-eye sham controlled clinical trial was conducted on 80 eyes of 40 high-risk characteristic proliferative diabetic retinopathy type II diabetics. All cases received standard laser treatment according to Early Treatment Diabetic Retinopathy Study protocol. Avastin-assigned eyes received 1.25 mg intravitreal bevacizumab (Genentech Inc., San Francisco, CA) on the first session of their laser treatments. Fluorescein angiography was performed at baseline and at weeks 6 and 16, and proliferative diabetic retinopathy regression was evaluated in a masked fashion. Results The median age was 52 years (range: 39–68) and 30% of the participants were male. All patients were followed for 16 weeks. A total of 87.5% of Avastin-injected eyes and 25% of sham group showed complete regression at week 6 of follow-up (pp<0.005). However, at week 16, PDR recurred in a sizable number of the Avastin-treated eyes, and the complete regression rate in the two groups became identical (25%; p=1.000); partial regression rates were 70% vs 65%. In the subgroup of Avastin-treated eyes, multivariate analysis identified hemoglobin A1c as the strongest predictor of proliferative diabetic retinopathy recurrence (p=0.033). Conclusions Intravitreal bevacizumab remarkably augmented the short-term response to scatter panretinal laser photocoagulation in high-risk characteristic proliferative diabetic retinopathy but the effect was short-lived, as many of the eyes showed rapid recurrence. Alternative dosing (multiple and/or periodic intravitreal Avastin injections) is recommended for further evaluation.

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Subthreshold 577 nm laser photocoagulation vesus conventional 532 nm laser photocoagulation for diabetic macular oedema

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v3i3.226 ◽

2021 ◽

Vol 3 (3) ◽

pp. 123-140

Author(s):

Linda Sui-Lin Ong ◽

Tajunisah Mohd Iqbal ◽

Kenneth Choong-Sian Fong

Keyword(s):

Diode Laser ◽

Macular Oedema ◽

Laser Photocoagulation ◽

Retinal Thickness ◽

Diabetic Macular Oedema ◽

Macular Thickness ◽

Clinically Significant ◽

Clinically Significant Macular Oedema ◽

532 Nm

Purpose: To evaluate the visual and anatomic outcomes of the subthreshold micropulse 577 nm yellow diode laser (MYL) and to compare its efficacy with the conventional green 532 nm diode laser (CGL) in Asian eyes with diabetic macular oedema (DME).Study design: Prospective randomized controlled clinical trialMethods: Sixty-seven eyes of 43 patients with clinically significant macular oedema (CSME) were randomized to receive either MYL (n = 37) or CGL (n = 30) at baseline and were followed up for 12 months. Titration in the MYL group was performed with 15% duty cycle, 300 ms duration, and double the threshold power, while the modified Early Treatment of Diabetic Retinopathy Study (mETDRS) protocol was used for the CGL arm with the power titrated to a barely visible burn. Parameters noted included best-corrected visual acuity (BCVA) (logMAR), central subfoveal thickness (CST), macular volume (MV), and average macular thickness (AMT) using optical coherence tomography, and presence of visible laser scars on colour fundus photographs and fundus autofluorescence, at baseline and at 12 months.Results: At 12 months follow-up, BCVA improved by 4.7 and 8.8 letters, respectively, for the MYL and CGL treatment arms (p < 0.05). There was a significant reduction in all retinal thickness parameters (CST, MV, and AMT) when compared to baseline in both laser treatment arms at 12 months. There was no significant difference in either BCVA or retinal thickness parameters between the two treatment arms at 1, 3, 6, 9, or 12-month follow-up. Laser scars were observed in 26.7% of patients in the MYL group compared to 75% of patients in the CGL group (p = 0.029).Conclusions: MYL is an effective, safe, and patient-friendly treatment option for clinically significant macular oedema, with improvement in BCVA, reduction in macular thickness, and less scarring after treatment at 12 months.

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A Clinical Study of Diabetic Retinopathy

Journal of Nepal Medical Association ◽

10.31729/jnma.638 ◽

2003 ◽

Vol 42 (148) ◽

Author(s):

KJD Karki

Keyword(s):

Diabetic Retinopathy ◽

Clinical Study ◽

High Risk ◽

Key Words ◽

Laser Treatment ◽

Proliferative Diabetic Retinopathy ◽

Laser Photocoagulation ◽

Visual Loss ◽

Diabetic Patients ◽

Vitrectomy Surgery

A clinical study of diabetic retinopathy was conducted from March- May 2002 to diagnose a patient’sdiabetic retinopathy level and identify eyes of proliferative diabetic retinopathy and maculopathy so thatthese patients could get appropriate and timely laser photocoagulation surgery and other surgical modalitiesto reduce the risk of visual loss. This study shows that out of 248 diabetic patients examined, 45.9% patientshad retinal changes. The potential candidates for panretinal and focal laser treatment were the patientswith very severe non-proliferative diabetic retinopathy (NPDR) (3.5%), early proliferative diabeticretinopathy (PDR) or high-risk PDR (3.5%), and maculopathy (8.8%).Key Words: Diabetic retinopathy, Laser photocoagulation surgery and vitrectomy Surgery.

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Bullous Exudative Retinal Detachment after Retinal Pattern Scan Laser Photocoagulation in Diabetic Retinopathy

Case Reports in Ophthalmology ◽

10.1159/000480723 ◽

2017 ◽

Vol 8 (3) ◽

pp. 475-481 ◽

Cited By ~ 1

Author(s):

Shohei Nishikawa ◽

Hiroshi Kunikata ◽

Naoko Aizawa ◽

Toru Nakazawa

Keyword(s):

Diabetic Retinopathy ◽

Retinal Detachment ◽

Laser Photocoagulation ◽

Standard Treatment ◽

Case Series ◽

Exudative Retinal Detachment ◽

Moderate Number ◽

Key Points ◽

Pattern Scan Laser ◽

Retinal Photocoagulation

Laser retinal photocoagulation is the gold standard treatment for diabetic retinopathy. We describe 3 cases in which bullous exudative retinal detachment (ERD) developed after pattern scan laser photocoagulation (PASCAL) in diabetic retinopathy. ERD spontaneously resolved in all 3 cases with various visual courses. This case series highlights 2 key points: first, ERD can occur regardless of gender, age, glycemic control, or vitreous status and despite a moderate number of laser shots, even with PASCAL; second, ERD in nonvitrectomized eyes may cause irreversible visual loss, even if the ERD resolves within 1 month.

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Association of Fenofibrate and Diabetic Retinopathy in Type 2 Diabetic Patients: A Population-Based Retrospective Cohort Study in Taiwan

Medicina ◽

10.3390/medicina56080385 ◽

2020 ◽

Vol 56 (8) ◽

pp. 385

Author(s):

Ying-Chieh Lin ◽

Yu-Ching Chen ◽

Jorng-Tzong Horng ◽

Jui-Ming Chen

Keyword(s):

Diabetic Retinopathy ◽

Cohort Study ◽

Laser Treatment ◽

Population Based ◽

Hypoglycemic Agents ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Significant Difference ◽

Type 2 Diabetic

Background and Objectives: Fenofibrate, a PPAR-α agonist, has been demonstrated to reduce the progression of diabetic retinopathy (DR) and the need for laser treatment in a FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study. However, in the subgroup of patients without pre-existing DR, there was no significant difference in the progression of DR between the fenofibrate group and the placebo group. In this study, we aim to investigate whether fenofibrate can decrease the risk of incident DR in a population-based cohort study of type 2 diabetic patients in Taiwan. Materials and Methods: A total of 32,253 type 2 diabetic patients without previous retinopathy were retrieved from 892,419 patients in 2001–2002. They were then divided into two groups based on whether they were exposed to fenofibrate or not. The patients were followed until a diagnosis of diabetic retinopathy was made or until the year 2008. Results: With a follow-up period of 6.8 ± 1.5 years and 5.4 ± 2.6 years for 2500 fenofibrate users and 29,753 non-users, respectively, the Cox proportional hazard regression analysis revealed that the hazard ratio (HR) of new onset retinopathy was 0.57 (95% CI 0.57–0.62, p < 0.001). After adjusting for hypertension; the Charlson comorbidity index (CCI); and medications such as angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), anticoagulants, gemfibrozil, statins, and hypoglycemic agents, the adjusted HR was 0.75 (95% CI 0.68–0.82, p < 0.001). The need for laser treatment has an HR and adjusted HR of 0.59 (95% CI 0.49–0.71, p < 0.001) and 0.67 (95% CI 0.56–0.81, p < 0.001), respectively. Conclusion: Our study showed that the long-term and regular use of fenofibrate may decrease the risk of incident retinopathy and the need for laser treatment in type 2 diabetic patients. Since there are limitations associated with our study, further investigations are necessary to confirm such an association.

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Ocular Pulse Amplitude after Panretinal Photocoagulation in Normotensive Eyes with Proliferative Diabetic Retinopathy

European Journal of Ophthalmology ◽

10.5301/ejo.5000913 ◽

2016 ◽

Vol 27 (4) ◽

pp. 481-484

Author(s):

Marija M. Bozic ◽

Jelena B. Karadzic ◽

Igor M. Kovacevic ◽

Ivan S. Marjanovic

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Laser Photocoagulation ◽

Argon Laser ◽

Pulse Amplitude ◽

Panretinal Photocoagulation ◽

Ocular Pulse Amplitude ◽

Diabetes Mellitus Type Ii ◽

Significant Difference ◽

Ocular Pulse

Purpose To assess the effect of panretinal laser photocoagulation on ocular pulse amplitude (OPA) in normotensive eyes with proliferative diabetic retinopathy. Methods Prospectively, we performed unilateral argon laser panretinal photocoagulation (PRP) in 30 patients with diabetes mellitus type II and previously untreated bilateral proliferative diabetic retinopathy. Before and 7 and 30 days after the treatment, OPA was measured using dynamic contour tonometer. Results Compared with the untreated contralateral eyes, laser photocoagulation led to a reduction of OPA. Ocular pulse amplitude did not significantly differ in photocoagulated eyes 7 days after the treatment, but there was a significant difference in OPA 30 days after the treatment. The decrease in OPA values was 15% 7 days after PRP and 40% 30 days after PRP. Conclusions Ocular pulse amplitude reduction after PRP indirectly informs us about choriocapillary closure, already reported in previous studies.

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Influences of 27-Gauge Vitrectomy on Corneal Topographic Conditions

Journal of Ophthalmology ◽

10.1155/2017/8320909 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Takafumi Hirashima ◽

Takao Utsumi ◽

Miou Hirose ◽

Hideyasu Oh

Keyword(s):

Diabetic Retinopathy ◽

Epiretinal Membrane ◽

Spherical Aberration ◽

The Other ◽

Significant Difference ◽

The Difference ◽

Group 2 ◽

Higher Order Aberration ◽

Topographic Parameters ◽

Group 1

Purpose. To evaluate the influences of 27-gauge vitrectomy on corneal topographic conditions. Method. Fifty-six eyes of 56 patients undergoing 27-gauge vitrectomy were retrospectively studied. Twenty-three eyes with epiretinal membrane (ERM), 23 eyes with macular hole (MH), and 10 eyes with proliferative diabetic retinopathy (PDR) were included. Forty-five of the 56 eyes underwent 27-gauge phacovitrectomy (group 1), and the remaining 11 eyes underwent 27-gauge vitrectomy alone (group 2). Corneal topography was obtained with a wave-front analyzer preoperatively and at 1 and 3 months postoperatively. The corneal topographic parameters evaluated were the average corneal power, regular astigmatism, spherical aberration, and higher-order aberration (HOA). Results. In between-group analyses of groups 1 and 2, no significant differences were observed regarding the changes of the 4 parameters from the baseline to 1 and 3 months postoperatively. No significant differences in the changes of all parameters from the baseline to 1 and 3 months postoperatively were also observed between MH group and the other two groups. A significant difference in the change of HOA from the baseline to 1 month postoperatively was observed between ERM and PDR group however, the difference disappeared at 3 months. Conclusion. 27-gauge vitrectomy did not induce substantial changes in the corneal topographic conditions.

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