Optos‐guided pattern scan laser (Pascal)‐targeted retinal photocoagulation in proliferative diabetic retinopathy

Abstract

. Purpose: To investigate the clinical effects and safety of targeted pattern scan laser (Pascal) retinal photocoagulation (TRP) in proliferative diabetic retinopathy (PDR). Methods: Prospective and non‐randomized study of 28 eyes with treatment‐naive proliferative diabetic retinopathy (PDR). Single‐session 20‐ms‐Pascal TRP strategy applied 1500 burns to zones of retinal capillary non‐perfusion and intermediate retinal ischaemia guided by wide‐field fluorescein angiography (Optos). Main outcome measures at 12 and 24 weeks included; PDR grade (assessed by two masked retina specialists); central retinal thickness (CRT); mean deviation (MD) using 24‐2 Swedish interactive threshold algorithm (SITA)‐standard visual fields (VF); and ETDRS visual acuity (VA). Results: Following primary TRP, there was PDR regression in 76% of patients at 12 weeks (κ = 0.70; p < 0.001). No laser re‐treatment was required at 4 weeks, and 10 eyes underwent repeat TRP at 12 weeks. Wide‐field Optos angiography at 24 weeks showed complete disease regression in 37% and partial regression in 33%. Additional panretinal laser photocoagulation (PRP) was planned for active PDR in 30%. There were significant reductions in CRT over time (10.4 μm at 12‐weeks, p = 0.007; 12.1 μm at 24‐weeks, p = 0.0003). The MD on VFs improved after 12 weeks (+1.25 dB; p = 0.015) and 24 weeks (+1.26 dB, p = 0.01). The VA increased by +3 letters at 24 weeks (95% CI, 1.74–5.01; p < 0.0001). Conclusions: This pilot study reports that Optos‐guided Pascal 20‐ms TRP using 1500 burns for treatment‐naive PDR is a promising procedure with favourable safety profile.

Ultra-wide Field Retinal Imaging in Detection, Classification, and Management of Diabetic Retinopathy

“…PDR regression with reduced NV leakage was seen in 76% of eyes at 12 weeks. 48 Repeat TRP was needed in 10 eyes (37%) by 12 weeks. At 6 months, complete PDR regression was seen in 10 eyes (37%) and partial regression in an additional 9 eyes (33%).…”

Emerging Issues for Ultra-Wide Field Angiography

“…Reddy et al [23] were the first to explore this field, and they reported NV regression in 2 eyes treated by means of TRP with no PRP-related side effect. Subsequently, Muqit et al [24,25] prospectively confirmed on a larger sample that TRP and PRP have the same efficacy on NV regression, but the former causes higher reduction in CMT. Figure 4 shows the DR downgrade after TRP.…”

Ultra-Widefield Retina Imaging: Principles of Technology and Clinical Applications

“…Other studies have demonstrated the association between peripheral retinal nonperfusion and the occurrence of neovascularization, macular ischemia, and diabetic mac-http://dx.doi.org/10.21561/jor.2016.1.1.1 ular edema (DME) [20,[31][32][33]. Another study suggested that UWF FA will be used to guide the management of DR [34]. UWF-guided targeted retinal photocoagulation to areas of nonperfusion with successful regression of retinal neovascularization.…”