Abstract:Introduction
Diabetic retinopathy (DR) is microangiopathy causing ischemia leading to proliferative diabetic retinopathy and macular edema. Panretinal photocoagulation (PRP) reverses the ischemia leading to regression of neovessels. Most previous studies showed the large vessel effects of PRP, while optical coherence tomography angiography (OCTA) allowed noninvasive quantification of microvascular retinal changes.
Aim
To study the effect of PRP on … Show more
“…Foveal avascular zone area also improved from baseline to 6 months of follow-up (0.56 ± 0.27 vs 0.46 ± 0.21). 32 Additionally, macular thickness also increased significantly (p<0.05) after PRP therapy at 6 months of follow-up. 33 A decrease in amplitude and increase in latency of pattern-reversal visual evoked potentials was observed in patients with PDR post completion of PRP session.…”
Section: Management Of Pdrmentioning
confidence: 87%
“… 61 PRP on the other hand has been noted to have significant improvement in vessel density of superficial and deep capillary plexuses for fovea and para foveal retina and constriction of FAZ on OCTA. 32 PDR with single NVE is presented in Figure 1A . Figure 1 ( A ) PDR with single NVE, ( B ) PDR with no traction, ( C ) PDR with traction, ( D ) PDR with CI-DME, ( E ) PDR with non-centre involving DME, ( F ) Active PDR after pan-retinal photocoagulation.…”
Section: A Few Clinical Scenarios For Pdr Managementmentioning
confidence: 99%
“…61 PRP on the other hand has been noted to have significant improvement in vessel density of superficial and deep capillary plexuses for fovea and para foveal retina and constriction of FAZ on OCTA. 32 PDR with single NVE is presented in Figure 1A. These patients can be initiated on anti-VEGF treatment and observed for regression of NV.…”
Section: Selecting a Patient With Pdr For Anti-vegf Therapymentioning
Diabetic retinopathy (DR) is considered one of the leading causes of vision loss globally. It principally causes upregulation of pro-angiogenic, proinflammatory, and vascular permeability factors such as vascular endothelial growth factor (VEGF), leading to neovascularisation. The advanced stage of DR or proliferative diabetic retinopathy (PDR) is of more concern, as it leads to vitreous haemorrhage and traction retinal detachment. Various risk factors associated with PDR include hyperglycemia, hypertension, neuropathy, dyslipidemia, anaemia, nephropathy, and retinal complications of drugs used for diabetes. Current management approaches for PDR have been stratified and involve pan-retinal photocoagulation, vitrectomy, and anti-VEGF agents. Given the emerging role of anti-VEGF agents as a favourable adjunct or alternative therapy, they have a critical role in the management of PDR. The review emphasises current management approaches for PDR focusing on anti-VEGF therapy. The review also highlights the risk/benefit evaluation of the various approaches employed for PDR management in various clinical scenarios.
“…Foveal avascular zone area also improved from baseline to 6 months of follow-up (0.56 ± 0.27 vs 0.46 ± 0.21). 32 Additionally, macular thickness also increased significantly (p<0.05) after PRP therapy at 6 months of follow-up. 33 A decrease in amplitude and increase in latency of pattern-reversal visual evoked potentials was observed in patients with PDR post completion of PRP session.…”
Section: Management Of Pdrmentioning
confidence: 87%
“… 61 PRP on the other hand has been noted to have significant improvement in vessel density of superficial and deep capillary plexuses for fovea and para foveal retina and constriction of FAZ on OCTA. 32 PDR with single NVE is presented in Figure 1A . Figure 1 ( A ) PDR with single NVE, ( B ) PDR with no traction, ( C ) PDR with traction, ( D ) PDR with CI-DME, ( E ) PDR with non-centre involving DME, ( F ) Active PDR after pan-retinal photocoagulation.…”
Section: A Few Clinical Scenarios For Pdr Managementmentioning
confidence: 99%
“…61 PRP on the other hand has been noted to have significant improvement in vessel density of superficial and deep capillary plexuses for fovea and para foveal retina and constriction of FAZ on OCTA. 32 PDR with single NVE is presented in Figure 1A. These patients can be initiated on anti-VEGF treatment and observed for regression of NV.…”
Section: Selecting a Patient With Pdr For Anti-vegf Therapymentioning
Diabetic retinopathy (DR) is considered one of the leading causes of vision loss globally. It principally causes upregulation of pro-angiogenic, proinflammatory, and vascular permeability factors such as vascular endothelial growth factor (VEGF), leading to neovascularisation. The advanced stage of DR or proliferative diabetic retinopathy (PDR) is of more concern, as it leads to vitreous haemorrhage and traction retinal detachment. Various risk factors associated with PDR include hyperglycemia, hypertension, neuropathy, dyslipidemia, anaemia, nephropathy, and retinal complications of drugs used for diabetes. Current management approaches for PDR have been stratified and involve pan-retinal photocoagulation, vitrectomy, and anti-VEGF agents. Given the emerging role of anti-VEGF agents as a favourable adjunct or alternative therapy, they have a critical role in the management of PDR. The review emphasises current management approaches for PDR focusing on anti-VEGF therapy. The review also highlights the risk/benefit evaluation of the various approaches employed for PDR management in various clinical scenarios.
“…The total number of shots reached approximately 2000 – 3000 laser burns, with a 1-burn width apart, outside the vascular arcades nasal to the disc at 2- and 3-disc diameters temporal to the macula in two sessions: lower and nasal followed by upper and temporal. The goal was to produce gray burns and avoid dense white burns, and all settings were adjusted to achieve the desired effect [ 2 , 22 ].…”
Background: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
“…Pan-retinal photocoagulation (PRP) can effectively reverse retinal DR-caused ischemia while maintaining the integrity of macular microvascular structure. The treatment effect can be effectively evaluated by quantifying the retinal VD and FAZ areas after PRP in patients with DR ( Abdelhalim et al, 2022 ; Sariyildiz et al, 2023 ).…”
Section: Clinical Research and Applications In Ocular Disordersmentioning
Retinal blood vessels are the only directly observed blood vessels in the body; changes in them can help effective assess the occurrence and development of ocular and systemic diseases. The specificity and efficiency of retinal vessel quantification technology has improved with the advancement of retinal imaging technologies and artificial intelligence (AI) algorithms; it has garnered attention in clinical research and applications for the diagnosis and treatment of common eye and related systemic diseases. A few articles have reviewed this topic; however, a summary of recent research progress in the field is still needed. This article aimed to provide a comprehensive review of the research and applications of retinal vessel quantification technology in ocular and systemic diseases, which could update clinicians and researchers on the recent progress in this field.
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