Comparison of the Time Required for Panretinal Photocoagulation and Associated Pain between Navilas® and Conventional Laser Therapy in Diabetic Retinopathy

Comparison of Pain Scores Among Patients Undergoing Conventional and Novel Panretinal Photocoagulation for Diabetic Retinopathy: A Systematic Review

“…The computed mean difference of pain scores is equivalent to 1 to 2 VAS points favoring long-pulse NNL over conventional SSL. The CCT of Kim et al 22 also showed a significantly higher mean VAS score among patients undergoing conventional SSL versus short-pulse NNL (6.9 ± 1.1 versus 3.3 ± 1.2). Although the study design has a serious risk of bias, the reviewers believe that this bias effectively lowers VAS scores in the conventional SSL group given that a smaller area is treated with this laser, further supporting that NNL is less painful compared to conventional SSL.…”

“…The reviewers did not find significant concerns in the selection of participants (Domain 2), classification of interventions (Domain 3), deviations from intended interventions (Domain 4), missing data (Domain 5), measurement of outcomes (Domain 6), and selection of the reported result (Domain 7). Overall, three CCTs appeared to have low risk of bias, and only the study of Kim et al 22 was assessed to have serious risk of bias.

Figure 3 Risk of bias assessment of included CCTs.

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“… See above. Polat 2019 36 PDR, Type 1 or 2 DM, > 18 years old History of vitrectomy or ocular trauma, active or history of intraocular inflammation, media opacities obscuring fundus details or affecting power parameters, mental or visual deficiency and inability to express pain on pain scales Kim 2014 22 PDR Previous retinal photocoagulation, corneal opacity, cataract, vitreous hemorrhage, media opacity Abbreviations: PDR, proliferative diabetic retinopathy; DM, diabetes mellitus; VA, visual acuity; CRT, central retinal thickness; μm, micrometers; OCT, optical coherence tomography; BP, blood pressure; DME, diabetic macular edema; NPDR, non-proliferative diabetic retinopathy; BCVA, best-corrected visual acuity; PRP, panretinal photocoagulation; VEGF, vascular endothelial growth factor; HR, high risk; NVI, neovascularization of the iris; NVG, neovascular glaucoma; RD, retinal detachment.

Figure 1 Search yield.

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“…Figure 3 shows the assessment of the risk of bias of the included RCTs. In the evaluation of bias due to confounding (Domain 1), the reviewers found serious concerns in the methodology of Kim et al 22 where both interventions were performed on the same eye. NNL was used for the superior, nasal, and inferior quadrants during the first session, then conventional SSL was done in the temporal retina a week later.…”

“…15,[19][20][21] In addition, pain may increase the patient's risk for complications during the procedure if it stimulates sudden movement of the eye. 22 Ophthalmologists should employ methods to minimize the amount of pain experienced by their patients during ocular procedures. The use of retrobulbar, peribulbar, and sub-Tenon's block have been suggested, but these methods pose the patient toadditional risk for complications.…”